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HEALTHY
EATING

Bloating & Food Choices

By Chirag Patel, MD

Belching, bloating and flatulence are some
of the most common reasons why patients
seek medical advice and dietary guidance. In
many cases, this may be completely normal,
but with increasing frequency and severity,
symptoms can be rather distressing.
Belching is a normal process that comes
from accumulated air in the stomach related
to swallowing. This can either come back up
as belching, or moved forward into the re-
mainder of the gastrointestinal tract, eventu-
ally passed as flatus. Flatulence results from a
combination of this swallowed air and gas
produced by colonic microbiota. Bloating is
a sensation of fullness or distension, mostly
at the upper abdomen. Food or gas in the
stomach, especially in abnormal amounts, small intestine and eventually the colonic terology consultation. Imaging, laboratory
can contribute to this sensation. The gut- bacteria can metabolize them to gases leading testing, breath testing for small intestinal bac-
brain axis can play as a large factor with this to excess flatulence. Other foods that can in- terial overgrowth and endoscopic evaluation
sensation as well. It is important to note that crease flatulence include onions, celery, car- can all play a further diagnostic role. The role
symptoms like melena, hematochezia or rots, raisins, bananas, apricots, prunes, of food allergy testing is unclear, and currently
weight loss should raise suspicion for more Brussels sprouts, alcohol and caffeine. When testing is not recommended for these symp-
aggressive or life-threatening etiologies. In similar symptoms occur consistently with in- toms in particular. As you can imagine, expan-
such cases, there should be a very low thresh- gestion of dairy, lactose intolerance should be sive workup can be quite costly and many may
old to refer to a gastroenterologist for further suspected early, especially given its high choose to seek further dietary modifications
evaluation. Otherwise, there can be a large prevalence. The key to all of these is to iden- via specialized diets like Low FODMAP (low
amount of overlap between these symptoms. tify the triggers and to use trial avoidance to in fermentable oligo-, di-, and monosaccha-
Similar lifestyle and dietary interventions can seek symptom relief. Multi-day, food diary rides and polyols), elimination diets or a low
lead to clinical improvement. logging timing of types of foods ingested, residue diet. These specific diets are best exe-
Everyone swallows air as a part of eating along with timing and types of symptoms ex- cuted by a consultation with a registered die-
and drinking. Excess air can be swallowed perienced, can be very helpful to identify po- titian and with supportive data to suggest
with carbonated beverages like beer or soda tential dietary triggers. superior clinical outcomes versus physician
and even with something as simple as chew- Constipation can sometimes contribute to consultation alone. Of these, a Low
ing gum. In large amounts, this can lead to these symptoms and can usually be detected FODMAP diet is one of the most popular
belching, bloating or flatulence. Eating large upon further symptom review. Treatment can recommended diets from a gastroenterolo-
meals or eating rapidly can result in these many times lead to resultant improvement in gist, especially when a case of Irritable Bowel
symptoms as well. Avoidance can be helpful bloating or flatulence symptoms as well. Syndrome (IBS) is suspected. Patients with
to mitigate some of these symptoms. Some Beyond these avoidances and constipation IBS have shown to be sensitive to even the
carbohydrates, like cauliflower, broccoli, management when necessary, ongoing symp- slightest increase in intestinal gas and some-
beans or cabbage can go undigested in the toms may indicate the need for a gastroen- times even a normal amount of gas. They may

24 SAN ANTONIO MEDICINE • May 2021