DEAR DR. MONA: I need help. I cannot stand and am so embarrassed about my problem. I cannot control passing gas and am now afraid to be around people because of it. Can you advise? — Betty

DEAR BETTY: Of course, your situation is not fatal but it can be really embarrassing so I understand your frustration and despair. Normally everyone passes gas about 10 to 12 times a day. Some individuals have excessive gas which they pass much more frequently, as in your case; others have difficulty passing gas and consequently complain of back and abdominal pain.

The gas you pass is usually made of oxygen, nitrogen, hydrogen, carbon dioxide and methane. Normally the majority of the gas in the intestine comes from fermenting carbohydrates that have not been digested by bacteria in the colon, as well as from swallowing air while speed eating, chewing gum, being nervous and drinking with a straw.

When you suffer from a large amount of gas it can be due to any number of causes — constipation, diverticulitis, or inflammatory bowel disease, such as ulcerative colitis or Crohn’s disease. Additionally certain medications, such as antibiotics and laxatives, increase gas production. Some individuals suffer from food intolerance most often containing dairy products (intolerance to sugar lactose), gluten (protein found in wheat and grains), and artificial sweeteners (sorbitol and mannitol used in sugar-free foods and drinks).

Healthy foods with high fiber contents such as whole grains, fruits, vegetables, legumes (beans and peas), supplements containing psyllium, such as Metamucil, may cause large amounts of gas production. Beverages containing carbonation such as soda and beer can cause gas.

If we understand the cause of your excessive gas production, then you can make some lifestyle changes to control this problem. You could try to eat smaller meals (low in dietary fats) slowly to decrease swallowing air, with adequate chewing. Try to determine whether anxiety causes you to have more flatulence. Avoid smoking and drinking carbonated beverages and start to implement an exercise program.

Consider dietary modifications an important part of managing this problem. You should keep a food diary to try to determine which food is causing the problem. Avoiding foods that cause increased gas, such as beans, onions, broccoli, brussels sprouts, cauliflower, artichokes, asparagus, pears, apples, peaches, prunes, sugar-free candies and chewing gum, whole-wheat bread, bran cereals or muffins, beer, sodas and other carbonated beverages, milk, cream, ice cream, and ice milk will help. Try eliminating them one by one and document whether you note any changes.

One solution could be to cut down on the fibers gradually and avoid dairy products to determine if milk intolerance is the causative factor. You could buy some Lactaid or Dairy Ease (lactase enzyme supplements which can be purchased over the counter) to use just before consuming dairy products.

If that doesn’t seem to ease your problem, you can try over-the-counter solutions such as Beano taken with the first bite of the food, Gas-X, Gelusil, Mylanta, Mylicon (simethicone), and CharcoCaps, Charcoal Plus (charcoal tablets). These products are inexpensive and can be purchased over the counter, so you can try them for a day or two and see if it makes a difference for you. Peppermint tea helps with gas but may lead to heart burn.

If your personal research into your problem fails, then you need to talk to your doctor or see a gastroenterologist. Be sure to document the products you have taken, the dietary changes you have made, and what kind of results you have experienced. An accurate food diary can be a great help-keeping track of everything you consume, as well as how much flatulence you experience.

So often, Betty, the solution is a simple one — avoiding the offending foods, if you only can determine what they are. You should not have to live with this, becoming a hermit in the process. And if you fail in your personal research, don’t hesitate to discuss this with your doctor. He or she should be able to offer some kind of treatment or advice for you.



Dr. Mona Alqulali is a board certified OB-GYN.