Learn About Flatulence
What is Flatulence?
Key Symptoms
What Causes Flatulence?
Conventional Treatments
Medications
Tests and Procedures
Treatment and Prevention
How Supplements Can Help
Self-Care Remedies
Alternative Therapies
When to Call a Doctor
References
Evidence Based Rating Scale
What is Flatulence?
Flatulence is the presence of excessive gas in the gastrointestinal tract. When someone senses uncomfortable abdominal pressure, the natural response can be to release a belch or to pass intestinal gas--called flatus--through the anus. It's harmless and quite normal. The average person passes gas many times a day. Often, it happens unnoticed, because unless certain chemical culprits are at work, intestinal gas can be virtually odorless. But at other times, it can produce the smell and/or sounds that we know too well.
What causes the odor that makes a person glad to be alone in the elevator? Even though gastrointestinal gas is composed in part of carbon dioxide, hydrogen, methane, and sulfur dioxide (all byproducts of digestion), it's the sulfur-containing components that are responsible for the offensive smell that sometimes goes along with flatulence. Unfortunately, humans have an uncanny ability to sniff out the presence of these compounds. For those who suffer from excessive gas, making changes to the diet and using certain supplements can bring welcome relief--for them as well as the people around them.
Key Symptoms
What Causes Flatulence?
The large intestine contains helpful bacteria that work to digest food. Some foods contain complex carbohydrates, which are difficult to break down in the stomach and small intestine. When partially digested carbohydrates from these foods ferment in the large intestine, excess gas results. Most foods that contain carbohydrates can cause gas; by contrast, proteins and fats cause very little gas. The most frequent food offenders are beans, broccoli, Brussels sprouts, and other types of legumes and vegetables. The soluble fiber in foods such as peas, oat bran, and most fruits is not broken down until it reaches the large intestine, where digestion can cause gas.
Other causes of excessive gas include:
Swallowing air. Anyone who is under stress or who eats or drinks too quickly may gulp more air than usual. This swallowed air produces extra gas.
Lactose intolerance. People who have trouble digesting lactose, the sugar in milk, are often plagued by bouts of gas after consuming dairy products.
Celiac disease. People with this digestive disorder have a hard time metabolizing gluten, a protein found in many grains, including wheat, rye, barley, bulgur, and others. They may experience gas and bloating after eating foods that contain these ingredients.
Conventional Treatments
The most common ways to reduce flatulence are by changing the diet, taking medications, and reducing the amount of air swallowed. For some people, limiting the intake of high-fat foods may be helpful because their digestion can delay stomach emptying, which causes the sensation of bloating and discomfort. Additionally, carbohydrates such as sugar, starches, and fiber should be limited. The body does not digest and absorb these carbohydrates in the small intestine because of a shortage or absence of enzymes that aid digestion. This undigested food enters the large intestine where it is broken down by normal harmless bacteria; the process produces hydrogen, carbon dioxide, and, in one-third of people, methane. Eventually, the gases exit through the rectum. The amount of gas-producing food that can be tolerated varies from person to person and must be determined through trial and error.
Medications
Digestive enzymes are sold as over-the-counter supplements and may help digest carbohydrates allowing people to eat foods that would otherwise cause flatulence. For lactose-intolerant individuals, the enzyme lactase comes in both tablet and chewable forms without a prescription as well as pre-mixed into some dairy products. Lactase should be taken just before meals to help aid digestion of lactose containing foods, e.g., milk, cheese, ice cream, butter.
Beano® is an over-the-counter digestive aid that contains the sugar-digesting enzyme that is needed to digest the sugar in beans and some vegetables. It comes in liquid and tablet form. For flatulence-causing disorders such as irritable bowel syndrome (IBS), prescription medicines are available.
Tests and Procedures
Flatulence is not usually caused by a serious medical condition but it can be the result of a more worrisome condition such as IBS or Celiac disease. Bloating and increased flatulence are also symptoms of ovarian cancer, which can be difficult to diagnose before it is advanced. Tests must be done to rule out serious causes of flatulence.
If lactose intolerance or gluten is the suspected cause of flatulence, the doctor may ask the patient to eliminate foods containing these products from the diet. Patients may also be asked to keep a journal for a several weeks, recording both specific foods eaten and any apparent reaction to them. A physical examination and other diagnostic tests such as blood tests, stool analysis, and food sensitivity testing may be ordered. (1, 2)
Treatment and Prevention
Unless flatulence is extreme, it is not necessary to do anything about it. But if it is of new onset, a visit to your health care provider is advised in order to rule out a more serious condition. For bothersome chronic flatulence, the first step is to cut down on or eliminate the foods that cause gas. Anyone who is unsure which foods are causing gassiness should try an elimination diet. For example, people who normally drink milk or eat certain vegetables that are known to be gas-promoters should eliminate them for a week. If the problem is resolved, add the foods back one at a time, in order to detect the culprit. For more information see the WholeHealthMD article on Food Elimination Diet. If elimination doesn't work or is not an option, supplements may help to minimize gastrointestinal gas.
How Supplements Can Help
A variety of supplements can be very effective at reducing the gas build-up that causes flatulence. Digestive enzymes, probiotics, certain carbohydrates, or herbs may be useful. They work in different ways to support or enhance different aspects of the digestive process.
Just a reminder: If you have a serious medical condition or are taking medication, it is always a good idea to check with your doctor before beginning a supplement program.
Plant-based digestive enzymes that contain a mixture of amylase, lipase, lactase, and protease support the natural work of the pancreatic juices in processing food. These may be effective for patients who experience a lot of gas and feel bloated or overfull after eating. Digestive enzymes are particularly helpful if a specific food or eating too much seems to trigger flatulence. A one-month trial will often determine if the enzymes will be effective. In one small study, 40 patients with IBS were given no enzyme therapy while 50 patients were given Biointol®, a mixture of beta-glucan, inositol, and digestive enzymes. The patients who received Biointol® had significant improvements in bloating, abdominal pain, and flatulence. (3)
Acidophilus and bifidus, known as probiotics, are among the gut's so-called good bacteria. Among other things, they help keep gas-producing bacteria in the large intestine from multiplying too much. Increasing the level of good bacteria in the gut can relieve gas, bloating, and other digestive woes. Studies show bifidus alleviates the bloating and flatulence associated with lactose intolerance. (4) Both should be taken between meals. Look for a dairy-free strain if gas may be due to lactose intolerance. A 2011 review of studies showed that probiotics were effective in treating the abdominal bloating and distention associated with functional gastrointestinal disorders. (5) For more information see the WholeHealthMD article on Probiotics.
FOS (fructo-oligosaccharides) may be a good idea as well. These indigestible carbohydrates stimulate the growth of acidophilus and bifidus, boosting their effectiveness. In a small 2011 study, patients who were given a combination of FOS and probiotics reported significant improvements in gastrointestinal symptoms and bowel habits. (6) For more information, see the WholeHealthMD article on FOS.
Ginger is used to relieve many digestive complaints. This herb contains oils that soothe the digestive tract. Try taking ginger supplements or mixing freshly grated ginger root with diluted lime juice to remedy flatulence. A ginger infusion made with 2 teaspoons of powdered ginger or grated fresh ginger steeped in a cup of hot, but not boiling, water may also be effective. (7)
Activated charcoal may help to relieve flatulence when all else fails; however, there is no consistent evidence to support its use. Activated charcoal absorbs intestinal gas and helps to minimize the odor. There are no recent studies supporting the use of activated charcoal for flatulence; it is not recommended for self-care. (8)
The essential oils of coriander are also responsible for its ability to act as a carminative—a substance that prevents formation of gas and eases its passage. (12, 13) Used as a tea, coriander has long had a reputation for easing flatulence and relieving the painful cramps that can accompany it. (14) In a 2006 pilot study of 32 patients with irritable bowel syndrome (IBS), the severity and frequency of abdominal pain, discomfort and bloating was significantly lower in a group treated with the herbal medicine Carmint, which contains coriander, Melissa officinalis (lemon balm) and Mentha spicata (spearmint). (15) More research is needed.
Self-Care Remedies
- Steer clear of artificial sweeteners. Sorbitol and xylitol, found in many sugar-free gums and candies, have a reputation for causing flatulence.
- Slow down at the table. Gulping meals can lead to incomplete digestion and, consequently, gas. Be sure to chew food thoroughly before swallowing. This activates the enzymes in saliva that begin the digestive process. Eating smaller, more frequent meals instead of fewer large meals a day will also help.
- Prepare beans properly. Soak dry beans for a few hours before cooking to remove some of their gas-producing carbohydrates. Be sure to discard the soaking water and use fresh water to cook the beans.
- Avoid gas-producing foods and beverages. Foods that are high in complex carbohydrates (some vegetables and legumes as well as high-fiber foods like prunes) are the most likely to cause flatulence. Meat, fish, eggs, grapes, berries, and nuts are less likely to produce gas. Also try to consume fewer raw vegetables; cooked is better for reducing gas production.
- Avoid dairy products if lactose intolerant. Lactose is the natural sugar in milk, which requires an enzyme (lactase) to digest it. There are many good "dairy-free" or "lactose-free" products available. The LACTAID® company makes two types of products. LACTAID® Fast Act Dietary Supplements are simply lactase supplements that are taken just before eating dairy products. The lactase then "pre-digests" the dairy product. The company also offers a variety of lactose-free dairy products.
Alternative Therapies
If flatulence is due to constipation, biofeedback may be helpful. Studies show biofeedback combined with electrical stimulation of the rectum improves symptoms of constipation. This reduces the time feces stay in the intestines, thus reducing the likelihood of flatulence. (8, 9)
Homeopathy, a 200 year old system of medicine using highly diluted doses of medicines chosen to match an individual patient's complete set of symptoms, may be helpful for flatulence. A 1997 meta-analysis of studies compared homeopathic remedies to placebo for treating flatulence due to sluggish bowels after abdominal or gynecological surgery. The analyses found a significant difference in favor of homeopathy over placebo on the time to first flatus. (10) You may be able to find your personal remedy with a self-help guide. (11) Alternatively, several combination homeopathic medicines (Gasalia®, Hyland's Gas™) are available over the counter to help with routine flatulence; however there are no published studies regarding their efficacy.
When to Call a Doctor
- Severe bloating accompanied by stomach cramps that seem worse than typical gas pains; blood in stool; or diarrhea that lasts for a few days.
- Bloating and/or flatulence that is a new and persistent problem that you haven't experienced before.
- Rapid weight loss.
References
1. National Digestive Diseases Information Clearinghouse (NDDIC). Available at http://digestive.niddk.nih.gov/ddiseases/pubs/gas/. Accessed January 20, 2012.
2. PubMed Health-Ovarian Cancer. Available at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001891/. Accessed January 25, 2012.
3. Ciacci C, Franceschi F, Purchiaroni F, Capone P, Buccelletti F, Iacomini P, Ranaudo A, Andreozzi P, Tondi P, Gentiloni Silveri N, Gasbarrini A, Gasbarrini G. Effect of beta-glucan, inositol and digestive enzymes in GI symptoms of patients with IBS. Eur Rev Med Pharmacol Sci. 2011 Jun;15(6):637-43.
4. He T, Priebe MG, Zhong Y, Huang C, Harmsen HJ, Raangs GC, Antoine JM, Welling GW, Vonk RJ. Effects of yogurt and bifidobacteria supplementation on the colonic microbiota in lactose-intolerant subjects. J Appl Microbiol. 2008 Feb;104(2):595-604.
5. Schmulson M, Chang L. Review article: the treatment of functional abdominal bloating and distension. Aliment Pharmacol Ther. 2011 May;33(10):1071-86. doi: 10.1111/j.1365-2036.2011.04637.x.
6. Nova E, Viadel B, Wärnberg J, et al. Beneficial effects of a synbiotic supplement on self-perceived gastrointestinal well-being and immunoinflammatory status of healthy adults. J Med Food. 2011 Jan-Feb;14(1-2):79-85.
7. White B. Ginger: an overview. Am Fam Physician. 2007 Jun 1;75(11):1689-91.
8. Azpiroz F, Serra J. Treatment of Excessive Intestinal Gas. Curr Treat Options Gastroenterol. 2004 Aug;7(4):299-305.
9. Privitera AC, Oliveri CE, Randazzo G, Ohazuruike NL, Prumeri S, Politi A, Succi L. Biofeedback therapy for outlet dysfunction: our experience. Chir Ital. 2009 May-Jun;61(3):281-8.
10. Barnes J, Resch KL, Ernst E. Homeopathy for postoperative ileus? A meta-analysis. J Clin Gastroenterol. 1997 Dec;25(4):628-33.
11. Horvilleur A, The Family Guide to Homeopathy, Health and Homeopathy Publishing, Inc. Virginia2002.
12. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physician's Guide to Herbal Medicine. Terry C. Telger, transl. 3rd ed. Berlin, GER: Springer, 1998.
13. Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.
14. Blumenthal M, Goldberg A, Brinckmann J, editors. Herbal Medicine: Expanded Commission E Monographs. Austin, TX: American Botanical Council; Boston: Integrative Medicine Communications; 2000.
15. Vejdani R, Shalmani HR, Mir-Fattahi M, et al. The efficacy of an herbal medicine, Carmint, on the relief of abdominal pain and bloating in patients with irritable bowel syndrome: a pilot study. Dig Dis Sci. 2006 Aug;51(8):1501-7.
Evidence Based Rating Scale
The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies and what our clinical advisors have found to be efficacious in their personal practice into a visual and easy to interpret format. This tool is meant to simplify the information on supplements and therapies that demonstrate promise in the treatment of certain conditions.
Supplement/
Therapy
|
Rating
|
Explanation
|
Activated charcoal
|
 |
No recent studies supporting its efficacy; not recommended for self-care. (8)
|
Biofeedback |
 |
Small studies show biofeedback improves constipation which reduces the likelihood of flatulence. (8, 9)
|
Coriander seed |
 |
Several alternative sources and a history of traditional use indicate potential efficacy. A pilot study showed beneficial results in treating abdominal pain, discomfort and bloating in patients with IBS. More research is needed. (12, 13, 14, 15)
|
Digestive enzymes |
 |
Small study shows efficacy in relieving flatulence in IBS patients when combined with beta-glucan and inositol. (3)
|
|
Supplement Recommendations for Flatulence
From Joyce Frye, DO/MBA/MSCE at WholeHealthMD:
Before you take any supplements, first try stopping all dairy products for a week. If your excess gas and flatulence disappear, that's your clue that you may simply have developed lactose intolerance. And that's easily treated by using Lact-Aid or drinking lactose-free milk.
How to Take the Supplements
To start, determine which foods are causing your episodes of flatulence (try a food elimination diet to help identify the culprits), and then make some changes to your diet. At the same time, you can add some digestive enzymes and fix the "friendly bacteria" balance in your intestines with the probiotics, acidophilus and bifidus, and the FOS (fructo-oligosaccharides). Within a month or two, you'll know if this program is effective. At the end of this time, you can drop the probiotics and FOS, and simply continue using digestive enzymes with your meals.
The ginger or the activated charcoal will help relieve acute symptoms. So if you have episodes of uncomfortable flatulence now and then despite the enzymes and probiotics, start at once using either of these until you get relief.
The activated charcoal, which has been a popular gas-absorbing and deodorizing remedy for years, is available as a capsule or a powder. You can take it when you're feeling especially gassy, or once a day for prevention until other methods begin to take effect. To use the powder, place it in a large glass, fill slowly with water and stir. Drink with a straw to avoid staining your teeth.
Important:
We at WholeHealthMD strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All our supplement recommendations also assume you are eating a healthful diet.

Be aware that certain
cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you're taking medications. Key cautions are given in the listing below, but you need to see the
WholeHealthMD Reference Library for a comprehensive discussion of each supplement's cautions and drug/nutrient interactions.