Wind WindBloatingDiet for windFlatus Belching This is a common symptom. In one survey 17% of people stated that they had excess belching. This is not due to excess production of gas in the stomach but is due to swallowed air. There is a small amount of air swallowed with every mouthful of food or fluid or with every swallow that unrelated to eating. There are more swallows per day if there is discomfort in the mouth (such as ill-fitting dentures or chewing gum). Excess air swallowing can be a “nervous” or stress response - analogous to the “gulp” when startled. Excess air swallowing may relate to the conscious, or perhaps subconscious belief, that belching will relieve abdominal discomfort or bloating. Acid reflux is associated with belching. Acid reflux causes increased saliva production. The old-fashioned term is "waterbrash". The saliva needs to be swallowed - therefore more swallows per day. Treatment of reflux can often reduce the amount of belching by stopping this cycle of events. Other factors. Rapid eating, gulping food. Smoking. Fizzy drinks and beer cause belching by release of carbon dioxide in the stomach. The gas comes out of the drink with time. Belching may be associated with other symptoms of indigestion. Treatment can be difficult. Acid lowering treatment should be tried first. Stress needs to be addresses if possible. Less hurried meals. Some dietary changes. Less fibre and avoiding carbonated drinks. Some success can be achieved with anti-anxiety medication. I prefer Aropax which is an anti-depressant with activity against panic attacks and anxiety.Bloating is common !!Bloating can be very distressing!!Abdominal Bloating This seemingly simple symptom is actually quite complicated and not well understood.The obvious suggestion is that there is too much “gas” in the abdomen. This may be true but not to a great extent.There may be several factors that explain bloating and distension Abdominal protrusion (visible distension) is affected by posture and back shape - the degree of curvature or lordosis of the back. This can be illustrated by recognizing that women vary considerably in how visible a pregnancy is at a given stage.Weight gain particularly around the middle. This puts more pressure on posture and may weaken abdominal muscles allowing more protrusion. There may be some delay in passage of wind through the bowel particularly in the small bowel. This gives the sensation of “trapped wind” but the inability to pass anything because the delay is further upstream!Fatty foods cause delay in transit of food and wind through the bowel as well as simply over-eating - lets face it – that’s happens sometimes.Another feature of this symptoms is the characteristic variation over a day. Typically the abdomen is flat and comfortable on awakening then gradually becomes more distended over the day.There are some studies that show there is a daily cycle of variation in muscle tone in the abdominal walls and also in the wall of the bowel. As there is relaxation of the bowel wall, then the air is allowed to take up a bigger space.Another clue is the association of irritable bowel syndrome and abdominal bloating. Some of the bloating is an abnormal perception of a mild amount of distension.The key feature of irritable bowel is an abnormal sensitivity to distension.This can be proven in experimental studies with balloon distension of parts of the colon and small bowel.Some sensations in the abdomen are the result of internalisation of stress. Hence common terms such as “butterflies in the stomach”, “gut reaction”, a “knotted stomach”.Abdominal bloating is more common in people with panic attacks. This may relate in part to hyperventilation and excessive air swallowing.An excessive amount of rumbling may be caused by; Excess fermentation of food.BUT it is more likely to be due to an over-active gut stimulated by the sympathetic nervous system.This is the system that gives the “fright or fight reaction” - also makes your “hairs stand on their ends”.What can be done! Treatment is difficult. The underlying problem is not well understood therefore advice is limitedReducing wind-forming foods can help (see below).Probiotics may decrease wind formation by bacteria (limited evidence)Treatment of constipation is important.Treating acid reflux can help. However drugs like omperazole can sometimes improve bloating and at other times seem to increase bloatingUnderstanding the role of air swallowing may help.Improved posture, strengthening abdominal muscles, weight loss. Diet tips to reduce wind and bloating Fermentation of food causes about half of the wind in the gut therefore dietary changes can reduce bloating. The other half is swallowed air - as discussed above.Most gas is produced by fermentation of poorly absorbed carbohydrates. See additional information in links below.Some suggestions for dietary changes to reduce wind. Switch from bread and pasta to rice as much as possible. The diet for reduction of wind is similar to a gluten-free diet except that corn can cause increased wind but is OK as part of the gluten-free diet. There does not need to be strict exclusion of wheat - just a change in "emphasis" from bread to rice. Gluten-free breads may still cause problems because of the use of substitutes like cornflour. Use rice crackers for snacks.Reduce dairy products: see section on Lactose Intolerance. Yoghurt is OK. Small amount of hard cheese. Avoid milk drinks and ice-cream.Reduce some fresh fruits. See section on Fructose Intolerance. Reduction in fresh fruit and using mainly canned fruit or stewed fruit helps. Avoid citrus juices, apples. Bananas and berryfruit are OK.Lactose and fructose are used as "fillers" in commercial foods such as museli bars etc. Fructose is present in large amounts in carbonated drinks e.g Coke - avoid!!! Definitely avoid diet carbonated drinks.Avoid wind-forming vegetables. Cabbage family - incl. broccoli, cauliflower.Beans - "baked beans", lentils, chick peas.OK vegetables are sliced green beans, lettuce, spinach, root vegetables (carrot, pumpkin, beetroot).Avoid Sorbitol and xylitol. Present in sugar free chewing gum. Chewing gum also increases wind because of increased number of swallows in a day (more swallowed air). Present in "diet sweets" and some artificial sweeteners.Avoid excess amounts of seeds and nuts.Drug treatment: in general not very helpful. Simethicone (found in antacids such as Mylanta Plus) has limited efficacy.Reduction of stomach acid by Losec or Somac is worth a trial of treatment.Activated charcoal tablets may help.Digestive enzymes (from health food shops) are not likely to work.Beano is a product available in USA - it reduces gas from lentils, beans - but not gas from fibre or lactose - not available in NZ.Flatulence It is normal to pass wind! This is a wide variation of normal. Range from 400 to 2500 mls of flatus per day.Most people "break wind" on average 15-20 times per day. There is a wide range - up to 40 times per day is normal.Swallowed air, if not belched up, is rapidly has to pass all the way through to the anus. There is nowhere else to go!For example - a laparoscopic operation for reflux can dramatically increase flatus because of a reduction in belching. In this case all swallowed air has to come out via the bottom end! Smelly Wind Smelly wind may be the result of having bacteria that produce sulphur type compounds (hydrogen disulphide, indoles, skatoles). It is easy to be too self-conscious.You may actually have an incorrect perception that there is a problem.It is not your fault – it is an effect of the type of bacteria in your colon.There is little known about how to change the bacteria in the colon – it does seem to unique to an individual and relatively fixed. The balance is important – some bacteria can destroy the gas (hydrogen) that other bacteria produce.Antibiotics may temporarily alter the balance of bacteria and produce more bad-smelling wind. Perhaps metronidazole could be useful because of a more selective effect – but the effect will be temporary (an not recommended).Probiotics such as Lactobacillus or Bifidobacterium could be useful but there is limited scientific evidence.Constipation or incomplete emptying of the rectum can be a problem. It is important that treatment of constipation should not aggravate wind (avoid fibre and lactulose).Lactulose increases wind although there are some reports that odour is reduced.The longer the time that faeces are in the colon then this is more fermentation taking place.Dietary changes to reduce sulphur gases could include; Elimination of broccoli, beer and white wine ( also asparagus, eggs). Also avoid garlic, onions and herbs of the fennel family.Some of these foods can cause bad breath because of the absorption into the bloodstream of some substances like hydrogen disulphide.There is suggestion that some foods like yoghurt and cranberry juice can reduce odour.Other treatments. Charcoal may reduce wind but not odour.Bismuth compounds – in particular Pepto-Bismol – have been stated to help – these products are not available in NZ.