Flatulence is not funny for those who suffer
Shall we chat about flatulence? Given the time spent on this topic in comedy routines, you’d think it was hilarious. But it’s not that funny for people who suffer from the embarrassment and discomfort of excessive gas.
A multinational survey, including nearly 6,000 people, recently showed that flatulence affects 81% of the adult population.[1] Many participants also suffered from stomach rumbling, belching, bloating, and trapped wind. Remarkably, only 11% of the respondents had no gas symptoms.
The lead author, Professor Olafur Palsson from the University of North Carolina, said: “I think the most remarkable and surprising finding in our study is that almost all adults in the general population experience some daily gas-related symptoms. This is important given the data also clearly reveals that these symptoms affect people’s general well being. Having a high amount of these common intestinal symptoms is associated with higher levels of depression, anxiety and stress, as well as impaired general quality of life.”[1]
A variety of conditions are associated with excessive gas: small intestinal bacterial overgrowth (SIBO), celiac disease, and pancreatitis, among others. Tests are available for these and other conditions, so if you have gastrointestinal issues of any kind, it’s worth consulting a health professional in order to rule out any underlying medical conditions.[2],[3]
Flatulence varies from person to person depending on many factors, including diet, the microbiome, and inherent digestive capacity.[4],[5],[6] In many cases, excessive flatulence may be caused by incomplete digestion, in which case supplemental digestive enzymes may help.
Insufficient digestion as a cause of excessive gas
Insufficient digestion is a very common cause of intestinal gas and bloating.
Insufficient digestion is a very common cause of intestinal gas and bloating.[7],[8],[9],[10] If carbohydrates and proteins are not completely digested in the stomach and small intestine, they end up in the bowel, where they are fermented by bacteria.[6],[11]
Bacterial fermentation of carbohydrates produces small molecules (some of which are beneficial, like short-chain fatty acids) and odorless gases, such as carbon dioxide and methane, which are released as flatulence.[12] The fermentation of proteins, however, produces hydrogen sulfide (H2S), which smells like rotten eggs (more about this below).
Inadequate digestion causes gastrointestinal problems when certain foods are consumed, leading to food intolerance.
Foods that often produce flatulence include milk and dairy products; legumes (beans, soy, lentils, and peas); vegetables (such as cabbage, Brussels sprouts, broccoli, cauliflower, asparagus, onions, and turnips); fruits (especially apples, pears, peaches, apricots and plums); and whole grains (including wheat, rye and barley).[13],[14],[15],[16]
Food intolerances are often addressed by changing one’s diet to remove the offending foods. However, eliminating fiber-containing foods can change the microbiome in an unhealthy way.
Supplemental digestive enzymes can support the breakdown, absorption, and utilization of hard-to-digest carbohydrates, proteins, and plant fibers for individuals with mild digestive abnormalities, food intolerances or excessive gas, as discussed below.
Milk intolerance
Oral lactase supplementation can help relieve symptoms of lactose intolerance.
Milk and other dairy products contain lactose, a disaccharide that makes up around 2–8% of milk by weight.[17] Lactose is normally cleaved in the small intestine by an enzyme called lactase (also known as β-galactosidase).[9],[18] The two components of lactose, glucose and galactose, are then absorbed and used for energy in the rest of the body.
Lactase activity is plentiful in infants and children, but its activity drops in adulthood.[19] When lactose is not completely digested it becomes available for fermentation in the colon, resulting in excessive flatulence and other symptoms.[18],[19],[20],[21] In a recent study, 54% of individuals diagnosed with irritable bowel syndrome (IBS) were actually found to have lactose intolerance.[22]
Lactose intolerance is determined by assessing abdominal symptoms (pain, bloating, gas and/or diarrhea) after lactose ingestion.[11],[21],[23],[24] Oral lactase supplementation can help relieve symptoms of lactose intolerance.[18],[25],[26]
Milk intolerance also occurs due to proteins known as caseins.[27],[28],[29] An enzyme that is normally produced in the intestines, DPP-IV, is necessary for the digestion of caseins and may improve milk tolerance.[30],[31],[32]
Non-celiac gluten sensitivity
Improved digestion of gluten has been achieved by combining DPP-IV with a proline-specific enzyme known as aspergillopepsin.
Dietary gluten causes problems for people with celiac disease, wheat allergy, and non-celiac gluten sensitivity (NCGS).[33] People with celiac disease need to avoid gluten entirely, as even a small amount can damage intestinal tissues. A simple blood test is used to diagnose celiac disease.
NCGS occurs when there is incomplete digestion of wheat and related cereals. NCGS is associated with gas, bloating, abdominal pain, and other symptoms triggered by those foods.[34],[35] The carbohydrates in grains can also trigger symptoms, so “non-celiac wheat sensitivity” may be a more accurate term.[36],[37]
Improved digestion of gluten has been achieved by combining DPP-IV with a proline-specific enzyme from Aspergillus niger, known as aspergillopepsin.[38] In humans, supplementation with these enzymes resulted in the complete breakdown of approximately one gram of gluten before it reached the small intestine.[38] The enzymes improved NCGS symptoms in otherwise healthy adults in placebo-controlled trials.[39],[40],[41]
Mild pancreatic enzyme insufficiency
Mild pancreatic insufficiency can contribute to food intolerances and excessive gas production.
Pancreatic enzymes (amylase, proteases, and lipase) are essential for the normal breakdown of carbohydrates, proteins and fats, respectively.[42],[43],[44] Pancreatic enzymes are secreted into the small intestine in response to a meal.
If pancreatic enzymes are inadequate, partially digested proteins pass into the colon where they are fermented by bacteria, producing smelly H2S, ammonia, and other byproducts.[6],[45],[46],[47],[48] Excessive H2S levels contribute to irritable bowel syndrome.[49]
Pancreatic enzymes decline with age, beginning at about age 30.[50],[51],[52] Mild pancreatic insufficiency can contribute to food intolerances, excessive gas production, and symptoms resembling IBS.[53],[54],[55] Supplemental enzymes may aid in normal digestion of fats and proteins and relieve symptoms.[56],[57],[58]
Principles of digestive enzyme supplementation
It is important to take digestive enzymes at the beginning of the meal so that they are available during the first hour of digestion.
It is important to take digestive enzymes at the beginning of the meal so that they are available during the first hour of digestion.[26],[59],[60] Here are some of the supplemental enzymes that have been used:
- Amylase: This enzyme, present in saliva and in pancreatic fluid, breaks down carbohydrates (starch) into sugars which are more easily absorbed by the body.[61]
- Lactase (beta-galactosidase): Lactase is responsible for digesting the lactose present in milk. Supplemental lactase is often helpful for people with lactose intolerance.[26],[59]
- Alpha-galactosidase: This enzyme breaks down galactooligosaccharides (GOS) and raffinose family oligosaccharides found in legumes (beans) and GOS-containing vegetables.[62],[63],[64],[65] Alpha-galactosidase taken with foods has been shown to relieve symptoms in GOS-sensitive individuals.[66]
- Peptidase (DPP-IV): This enzyme plays a significant role in the digestion of proline-containing peptides, including those found in milk and wheat.[30],[38]
- Aspergillopepsin: This protease breaks down the proline-rich peptides from gluten, and may alleviate non-celiac gluten sensitivity (NCGS), especially if taken in combination with DPP-IV.[38],[67],[68]
- Lipase: This pancreatic enzyme works with bile from the liver to break down fat molecules so they can be absorbed and used by the body. Lipase can aid in the digestion of high-fat meals.[16],[58]
Last but not least, the microbiome is a key player in the development of flatulence,[69] and probiotic supplementation has been suggested to improve food intolerances.[70],[71],[72] A combination of digestive enzymes with probiotics may be helpful for people who suffer from excessive flatulence but are otherwise healthy.
If you enjoyed this article, you may also be interested in the following posts:
Are Gluten-Free Diets Just a Fad? Understanding celiac disease, wheat allergy, non-celiac gluten sensitivity, & other gluten-related disorders.
Can Probiotics Soothe IBS? Evidence supports the use of probiotics for IBS and enhanced quality of life.
Constipation: Solutions to Make All Systems “Go”! Supporting the nervous system, microbiome, and nutritional status for healthy, easy elimination.
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