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You Are Here: IC
Network : Fresh Tastes
: September 2003
Help for Painful Gas
and Bloating
 The
unpleasant sensations of abdominal gas and bloating are a minor
but common human misery that everybody gets now and then. Just check
how many feet of shelf space at the drugstore are taken up with
"anti-gas" remedies. But for some people, intestinal gas
can be not only uncomfortable and embarrassing, it can be downright
excruciating. And what's worse for people with IC, intestinal trouble
may provoke our sensitive bladder.
Relieving the
trouble starts with figuring out what's at the root of the situation,
but of course like so many things relating to IC, that's easier
said than done. It's yet another situation where "each person
is a bit different" and one approach doesn't fit all. Happily
however, once we've identified the cause, relief is often surprisingly
easy to come by. Doctors
know that unlike pain in an arm or leg, visceral abdominal pain
is often hard for patients to pinpoint. It may seem to spread from
one area to another or be "all over" the whole pelvic
area. What's even more confusing for patients, pelvic pain can be
"referred" from one site to another. For instance, sometimes
IC patients feel bladder flare-ups as an ache in their lower back--
an excellent example of how pain is "referred" from one
area of the pelvis to another. Once we've had IC for awhile though,
we get to know our body well and can ace out when the culprit is
our bladder, and when it isn't.
IBS - A Common Complaint
of IC patients
 When
painful gas and bloating becomes more of a daily burden than an
occasional annoyance, it's time for a trip to the doctor to rule
out serious illness. The trouble can stem from a variety of causes.
Yet for most of us, the cause is not life-threatening. Perhaps one
third or more of all IC patients exhibit such gastrointestinal symptoms
as part of an IC-associated disorder called irritable bowel syndrome
(IBS). IBS is commonly diagnosed with a procedure known as a colonoscopy.
This is similar to a cystoscopy, used to diagnose IC. For a colonoscopy,
the doctor looks into the colon through a flexible tube and views
the lining, looking for signs of possible disease.
IBS is a functional
gastrointestinal disorder. That means the colon looks perfectly
normal but it functions abnormally. IBS is a disorder of increased
colon sensitivity, much as IC involves an increased sensitivity
of the bladder. And, like both allergies and IC, it involves a type
of cell known as a mast cell.
In IBS, the
colon is so unusually sensitive that it may over-react to even the
gentle stimulation of a little gas. The reaction may take the form
of painful violent spasms of the colon's smooth muscle. That's why
some doctors also refer to the condition as "spastic colon."
IBS is a disorder involving a variety of symptoms, and like IC,
not everyone has exactly the same severity or pattern of symptoms.
Along with abdominal cramping and pain, IBS can also include chronic
diarrhea, chronic constipation, or alternating bouts of each.
Once the doctor
has diagnosed IBS, he may recommend dietary changes and offer
medications to calm the bowel spasms. Some of the medications
that are useful for IC are also useful in controlling IBS. Antispasmodics
such as Levsin may be prescribed to calm the colon spasms. Tricyclic
antidepressants such as Elavil, Sinequan or Tofranil, may be prescribed
to relieve pain and reduce the colon's sensitivity.
IBS usually
responds well to dietary modification too. In general, there are
several
dietary guidelines that doctors recommend, some of which are already
familiar to people with IC:
- Avoid alcohol
and caffeine
- Avoid the
food additives fructose and sorbitol, particularly if they occur
together.
- Minimize
the intake of foods high in saturated fats (i.e., ham, bacon).
- Minimize
the intake of "hot" spices (i.e., chili pepper, paprika,
cloves).
Some people
with IBS suffer from chronic constipation too. And quite a few of
the
medications we take for IC merely add to that problem. Here are
some of the chief offenders:
- Smooth muscle
relaxants and antispasmodics (Ditropan, Levsin, Detrol)
- Antihistamines
and drugs with antihistamine properties (Atarax, Vistaril, Benedryl,
Allegra, Claritin, etc.).
- Some pain
killers (Vicodin, Ultram, Oxycontin, etc.)
- Large amounts
of calcium-containing antacids (Tums, Prelief, etc.)
Unfortunately,
some foods IC people can safely eat bladder-wise, are constipating
and definitely not helpful for constipation-predominant IBS. Rice
and pasta are two foods that fall into that category. On the flip
side, there is diarrhea-predominant IBS. The medications and foods
that make the constipation worse, may tend to help the diarrhea-predominant
type. But there are some bladder-friendly foods that people with
diarrhea-predominant IBS will have trouble with because they tend
to have a laxative effect: peas, lentils, beans, and large amounts
of high-fiber foods. (High fiber foods include pears, whole wheat
bread, and most vegetables). The starch in potatoes can also have
somewhat of a laxative effect.
While fighting
bladder flares with antacids, beware of using baking soda in water
if you have the diarrhea-predominant version of IBS. It may make
the diarrhea worse (though the strategy may be helpful to people
with constipation-predominant IBS).
Food allergies can trigger
gas
 Two
other common conditions besides IBS can also provoke intestinal
gas, pain, and bloating: food allergy and food intolerance.
A significant proportion of IC patients suffer from allergies and
intolerances, and allergic IC patients often find relief from bladder
symptoms when they avoid the foods they are allergic to. But while
the intestinal symptoms may be similar, a food allergy is not the
same as a food intolerance. A true allergy is mediated by a substance
in the body called IgE. In diagnosing an allergy, a doctor may look
for high levels of circulating IgE in your system. An intolerance
does not involve IgE. Another difference: allergies are usually
triggered by proteins in foods (and sometimes proteins in the additives
derived from those foods), whereas intolerances can develop in reaction
to sugars, gluten, and many other non-protein molecules.
Often, if a
food allergy is the culprit in abdominal symptoms, it may also manifest
itself as IC bladder symptoms. This may be because allergies typically
involve a release of the mast cell irritant, histamine. Mast cell
troubles figure prominently is such diverse conditions as interstitial
cystitis, migraines, IBS, and allergies. Do you also have any itchiness
that mysteriously comes and goes?... sneezing after dinner?... a
runny nose when you eat? These can be triggered by histamine and
may be clues that a food allergy is at work. And don't rule out
a "food packaging allergy." BHA and BHT are two widely
used preservatives that keep critters from eating their way through
both food and food containers. The preservative is often applied
to the packaging, not the food. But a small amount of these chemicals
do get into the food anyway and, according to allergists, may trigger
an allergic reaction. For food allergies, avoidance is the best
solution, but oral and topical antihistamines may help the symptoms.
Lactose intolerance
a common problem
 Most
people have heard of lactose intolerance, but it's quite possible
to have an intolerance to other food substances too. An intolerance
simply means your body can't handle the substance... for whatever
reason. Sometimes the body may lack a crucial enzyme or other
substance needed to process the food. Sometimes the ultimate cause
is genetic. Your doctor may be able to identify why your intolerance
occurs, or he may not. Millions of people in the U.S. have intolerances
to certain foods, and for many, the cause remains a mystery.
Over the years
I've spoken with dozens of IC patients who suffer from lactose intolerance.
Symptoms involve abdominal cramps, gas, (and possibly diarrhea)
experienced after eating dairy products. Lactose intolerance is
an inability to digest a sugar found in milk (lactose), because
the body fails to produce an enzyme (lactase), necessary to break
it down. If the lactose isn't broken down, the body can't utilize
it and the sugar continues through the intestines intact.
Eventually it arrives at the colon where bacteria have a feast on
the sugar, producing copious quantities of gas as a by-product.
An over-the-counter lactase enzyme product (Lactaid,
for example) can be helpful when taken with dairy products. It's
well known that people of Asian, Middle Eastern, or African heritage
are more likely to have a lactose intolerance, but that doesn't
mean it occurs exclusively in those groups.
Suzanne, a fair-skinned
blond of northern European heritage who was a life-long milk drinker,
was recently surprised to find dairy products now give her gas,
cramps, and painful bloating. As long as she avoids dairy or takes
Lactaid, she does fine. Now in her late twenties, her only previous
gastrointestinal problems were colic during her first few months
of life. She speculates that perhaps her body's ability to produce
lactase has varied throughout her life-- sometimes normal, and sometimes
not. A recent convert to vegetarianism, and also a busy mother of
two preschoolers, she also wonders if fluctuating lactase levels
are her body's response to dietary change, ongoing stress, and lack
of sleep.
Doctors now
suspect that an undiagnosed lactose intolerance may be at the root
of some people's IBS, or at least exacerbate it. But here's another
surprise: don't assume that, because you've been drinking milk all
your life with no problems, the IBS you've recently developed has
nothing to do with lactose intolerance. Gastroenterology specialist
Jarol Knowles, MD, of the University of North Carolina noted that
studies have confirmed lactose digestion problems in some IBS patients
who are unaware of any symptoms related to eating dairy products.
He noted in one article, "...hydrogen breath tests were
performed on patients who had been diagnosed with IBS but who had
no apparent symptoms related to the ingestion of milk. Lactose malabsorption
was diagnosed in 68% of these patients. Symptoms improved after
a lactose restricted diet was introduced." Lactose intolerance
can be diagnosed with a hydrogen breath test, a test he now recommends
for all of his IBS patients.[1]
Fructose malabsorption:
it's more than just a fruit problem
 In
the last few years another food-related intolerance has come to
light as a possible cause for many people's gas, bloating and abdominal
pain. Once thought of as severe, rare, and the result of a genetic
disorder, mild to moderate fructose intolerance is now suspected
to occur in a significant proportion of the healthy population as
well as play a part in some cases of IBS.
Fructose is
a sugar found in fruit. Sucrose (regular table sugar) is made up
of glucose and fructose. Sugars can be big complex molecules, or
small and simple ones. The simplest sugar is glucose, which is the
sugar our bodies use for energy. Before any kind of sugar we eat
is utilized it must be broken down into small, simple units. But
some of us apparently have trouble breaking down and utilizing fructose.
And, as with lactose intolerance, when fructose is allowed to pass
through the digestive tract to the colon, bacteria have a field
day producing gas.
In a study presented
in 2002 to the 67th Annual Scientific Meeting of the American College
of Gastroenterology, researchers at the University of Kansas indicated
that fructose may not be properly absorbed by a significant portion
of healthy adults. Subjects in their study were given levels of
fructose about equal to that in a typical can of soda. They were
then given a hydrogen breath test (excess hydrogen gas would be
present if the fructose the person couldn't digest was instead being
utilized by gut bacteria). The study showed nearly half the subjects
had abnormally high levels of hydrogen gas.
In another paper
presented in 2001 to the College of Gastroenterology's Annual Scientific
Meeting, Young Choi, MD, and colleagues at the University of Iowa
studied 219 people with unexplained abdominal pain, gas and bloating.
In 78 percent of subjects, breath tests revealed abnormal levels
of hydrogen or methane gas in response to ingesting fructose. The
fructose actually provoked symptoms in 58 percent.
And in an article
appearing in August 2000, sugar malabsorption was linked to cases
of irritable bowel syndrome (IBS). In that study of 239 patients
with IBS, only 7 percent had normal absorption of three sugars commonly
found in food (fructose, lactose and sorbitol).The patients showed
a 56 percent improvement in symptoms after restricting their intake
of the sugars for one month. [2]
Fructose in
the American diet is increasing, and not because we are eating more
fruit. Manufacturers are adding ever-increasing amounts of sugars
of all kinds to food. And high fructose corn syrup is substituting
for other sugars in processed foods because it is cheaper.
So what foods
have fructose? All fruits of course, and processed foods that state
fructose, high fructose corn syrup, or sucrose on the label are
the obvious culprits. But some other foods have varying amounts
of fructose and may or may not be bothersome, depending on your
level of sensitivity: ham, bacon, lunch meats, sweet potatoes, yams,
corn, carrots, peas, yellow squash, sugar-added boxed cereals, mayonnaise,
many salad dressings, honey, tomato and tomato juice, maple syrup,
carbonated sodas, jellies.
Indigestible sugars
the well-known culprits
Certain kinds
of sugars are simply not digestible by humans at all. Cellulose
for instance, (a constituent of wood) is a sugar that mammals can't
digest but termites can. Raffinose, stachyose, and verbascose are
three indigestible sugars found in abundance in beans, nuts, legumes
such as peanuts, lentils and soy, some grains, and cruciferous vegetables
such as cabbage and cauliflower. The embarrassing social effects
of eating beans can be attributed to the fact that we can't utilize
these sugars but alas, some of the bacteria in our colon can. To
avoid pain from a sensitive colon we can avoid these gas-producing
foods of course, but what IC patient wants to extend their already
long list of things to avoid?
Helpful products
 For
gas pains provoked by beans and such, there's another solution: Beano.
Beano is an enzyme product available at most drug stores and some
supermarkets. You take it when you eat the offending food. It supplies
your body with the enzyme needed to break indigestible sugars like
raffinose into their more digestible components: glucose, sucrose,
galactose and fructose. One word of warning though be sure to take
your Elmiron at least an hour before, or two hours after, a meal with
Beano. Beano, when taken close to a dose of Elmiron, does appear to
dampen its pain-reducing effect.
 Another
product that might be worth a try is
Algonot. I've had IBS for a number of years, and after I
took Gastrocrom ( a prescription medication) a few years ago, the
IBS calmed down and the symptoms eventually disappeared. But after
a stressful summer this year, the IBS symptoms returned with a vengeance--
cramping, gas, constipation. So, this time rather than doing the
Gastrocrom again, I tried adding Algonot to my regular pill regimen.
Algonot is a dietary supplement that contains the mast-cell stabilizer
and anti-inflammatory, quercetin. I have a sensitive stomach so
I started with only one capsule a day and worked up to the recommended
dosage. (The manufacturer also advises chilling the capsules in
the fridge or freezer to help with any initial stomach upset. That
worked like a charm!) My stomach upset disappeared in a few days
and I could then take one a day at room temperature. (This reaction
is also typical of Gastrocrom it may make things worse a bit before
making it better). The Algonot didn't initially reduce the intestinal
gas-- I still had a lot of "rumbling"; but apparently
my colon's sensitivity to the gas was reduced within about three
weeks. It could rumble away with no cramping! After two months on
Algonot, the gas issue has "passed" (excuse the pun!).
I now have little intestinal rumbling, no constipation, and best
of all no IBS pain. I feel like my IBS is now nicely under control
again.... and in about ten months less time than the Gastrocrom
took to give me the same level of relief.
Like so many
things with IC, everyone's different. It may or may not work for
you. To my knowledge, there has been no published, large-scale,
controlled, clinical trial of Algonot (or its specific ingredient
combination) for irritable bowel syndrome. It is pricey-- about
a hundred dollars for a ninety-day supply. The product also contains
chondroitin and glucosamine, substances the manufacturer says may
help IC symptoms, too. Medical journals in recent years have been
filled with generally hopeful articles on these two substances as
treatments for osteoarthritis and other auto- immune disorders.
And I understand there is a study of Algonot (for IC), in the works.
Your doctor
may prefer to prescribe Gastrocrom (cromolyn sodium), also
a mast cell stabilizer, for your IBS. There is some published evidence
in the literature for Gastrocrom's use for IBS, though it is mainly
used for another mast-cell related disorder, systemic mastocytosis.
It comes in vials that you squirt into a glass of water and drink
half-an- hour before meals. It has to be taken over a long period
of time to be truly effective, though. You or your doctor can get
more information on Gastrocrom at the manufacturer's web site: www.celltechgroup.com.
------------------------------------------------------------------------
References:
1. Jarol B. Knowles, M.D. Dietary factors in gastrointestinal diseases.
1998. Participate, Vol. 7, #3, pgs. 1-3., publ. by International
Foundation for Functional Gastrointestinal Disorders (IFFGD).
2. Goldstein R., et al. Carbohydrate malabsorption and the effect
of dietary restriction on symptoms of irritable bowel syndrome and
functional bowel complaints. 2000. Israeli Medical Association Journal,
Vol 2, #8; pgs 583-587.
The Interstitial Cystitis Network
http://www.ic-network.com
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