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Good Health and Bad Medicine:
 Carsickness And Seasickness

 Constipation - Part 1

 Constipation - Part 2

 Spastic Constipation

 Colitis

 Piles

 'gas' And Bloating

 Alkalizers And Acidosis

 Indigestion

 Diet - Part 1

 Read More Articles About: Good Health and Bad Medicine

'Gas' And Bloating

( Originally Published 1940 )

THERE is a pocket of air called the stomach bubble in the upper part of the normal stomach cavity. During a meal the bubble, which can be seen with the X-ray screen, is compressed in the upper part of the stomach. A small amount of air—more or less, depending on the individual, is also swallowed with each bite. Dr. Walter B. Cannon showed that an additional quantity of air enters the stomach with certain foods, such as soufflés, light omelettes and bread.

After a meal, if too much air has entered, its pressure in the stomach may force open the entrance to the stomach; the air then rises through the esophagus or gullet, resulting in a belch. A considerable part of the stomach may have to be filled before the air bubble is thus displaced.

It is clear then, that the pleasure that many people get from belching is not due to evacuation of a noxious gas, but simply to the reduction of the pressure within the stomach, through the escape of air. The transformation of the air bubble into a belch depends to some extent upon the kind as well as the quantity of food eaten. Certain foods are notorious for their ability to cause belching and even nausea. It is believed, for example, that cucumbers, melons, onions and tomatoes probably contain a specific substance, as yet unidentified, that induces regurgitation of food and belching.

Gas in the stomach is not caused by fermentation of food. The stomach contains a good deal of acid juice, and no fermentation can take place in the presence of much acid. In fact, the germs that ferment food cannot live in the presence of acid juice. Besides, even if there were no acid present, the period of about twoe hours during which food remains in the stomach is r, long enough for it to be fermented.

Many people can belch almost at will, whether or not they have just eaten. What happens is that these people swallow a good deal of air and then let it go. Most air swallowers, however, are unconscious of the fact that they swallow air, and frequently come to a physician complaining of "gas." In such cases physical examination reveals no organic defect, but if the physician inquires about the patient's habits and mode of living he generally finds that the patient is of a rather nervous temperament, and if the doctor observes him carefully he may see him gulping frequently. The belching is simply a result of the nervous habit of swallowing air. Gum chewing is also accompanied by swallowing of air. When these are the causes, the patient can be reassured that the gas he complains of is simply a bubble of air that collects from repeated swallowing, and is not a symptom of organic disease.

Those who eat hurriedly or under nervous strain swallow a good deal of air with their food and often feel a slight sense of pressure in the pit of the stomach, which is relieved by belching. Bicarbonate of soda may give relief, since it causes the formation of carbon dioxide gas, thus increasing the gas pressure in the stomach and making it easier for a person to belch.

Infants swallow a good deal of air during their feeding. The baby is uncomfortable until the mother holds the child upright for a few moments so that the air can be evacuated. After the belch, both mother and child are happy.

Bloating (doctors call it "flatulence") and belching are also common symptoms of gall-bladder disease, and a doctor generally ascertains that there is no evidence of gall-bladder trouble before he says that attacks of gas are due to nervousness or to improper habits of eating.

The bloated feeling is more often caused by an excessive accumulation of gas in the colon than by distention of the stomach, particularly in people with spastic constipation. In this condition the colon does not work in a smooth, coordinated way, and there appears to be interference with the normal "mass" movements in the colon, thus permitting an abnormal accumulation of gas. When the collection of gas reaches a certain pressure, it may produce the desire to defecate. The desire may occur several times daily, and if social conditions do not forbid, the gas or "flatus" may be passed by rectum. Many people with irritable colons dread public gatherings because of the frequent impulse to pass flatus. They know that if the impulse is suppressed, the colon is likely to fill up with gas and cause acute distress.

Flatulence is very common after the taking of a purgative. The cause is the same as in spastic constipation—disorganization of the activity of the colon muscles by an irritant cathartic drug. The distention is, of course, much worse if a per-son with an irritable colon takes a cathartic. The evacuations are then very explosive, and a great deal of watery stool and gas is passed. To some people, mineral oil can act like a cathartic. Although the oil apparently does not irritate the intestines in the same way as do cathartic drugs, much gas may follow habitual dosing with oil.

Flatulence is sometimes present in ordinary constipation. A small plug of stool may block the rectum and prevent the gradual and inoffensive elimination of the gas that is normally present in small amounts in the colon. As soon as the plug is expelled, the distention disappears.

It is commonly believed that gaseous distention or an excessive passage of flatus is due to fermentation of starch in the colon. Although the subject of fermentation in the colon is not yet thoroughly understood, it is known that in the normal digestive tract, starchy foods are completely broken down, digested, and assimilated by the blood before they reach the colon. When a cathartic is taken, however, some starch may be hurried through the small intestine into the colon. Under such circumstances, true fermentation may take place there. Even this is doubtful, however, since a certain type of germ is essential for fermentation and the great majority of colons contain few such germs.

Rough, indigestible foods can also cause flatulence. The cellulose and lignin in rough foods are indigestible, and when they reach the colon they produce an effect somewhat similar to that of cathartics. The intestines are irritated, normal activity is disturbed, and gas accumulates. Bran and foods such as beans, cabbage, peppers, cucumbers, radishes and pickles are notorious for their ability to produce gas. They contain roughage and perhaps other materials which irritate the intestines. Certainly those who have spastic constipation should avoid them.

Soft, fresh bread may be another cause of flatulence. Smooth, doughy indigestible lumps of such bread, which irritate the bowel and cause cramps and gas, are sometimes formed. Fresh bread should be avoided by those with spastic constipation and by others troubled by flatulence. "Matzoth" bread is also notorious for its capacity to cause flatulence.

Many people with flabby abdomens are troubled by gas. Exercises that strengthen the abdominal muscles will also improve the tone of the intestinal muscles, and may thus pre-vent an accumulation of gas. Wearing an abdominal belt has helped many people with flabby, pendulous abdomens. The belt not only supports the abdomen but, mote important, it appears to improve the circulation of the blood through the abdominal cavity and the bowels, increasing the tone of the intestinal muscles and thus facilitating the removal of the gas by the blood stream.

Flatulence also occurs in other conditions, some of them serious, such as heart disease, liver trouble, and peritonitis. A doctor should be consulted whenever gas is a troublesome symptom, since it may be due to one of these diseases.

There are many drugs on the market claiming virtues in the relief of gas or distention. One variety, of which Alka-Seltzer is typical, depends for its effect on the presence of sodium bicarbonate and effervescent salts. Effervescence occurs when the tablet is dropped into water and carbon dioxide gas is released. The water is now, in effect, simply a solution of sodium bicarbonate and carbon dioxide. When it is swallowed, the stomach becomes distended with carbon dioxide gas. The belching that follows is due entirely to the release of carbon dioxide gas from the stomach, and not due to actual relief or cure of so-called "acid indigestion." The same effect may be obtained by drinking Vichy water to which a pinch of bicarbonate of soda is added. And if all the ingredients of Alka-Seltzer are desired, a tablet of aspirin may be added.

Another type of drug exploited for relief of flatulence is the cathartic pill, such as Carter's Little Liver Pills. As has been shown, cathartics produce gas, and do not prevent or cure flatulence.

A third variety of "flatulence cure" is the charcoal tablet. Charcoal does absorb gas—but only when it is dry. As soon as it enters the stomach, however, the tablet becomes moist, and by the time it reaches the colon where the gas is accumulated, it is thoroughly wet, and therefore useless for gas absorption.

Bell-Ans consists essentially of charcoal, baking soda, ginger and oil of wintergreen. Ginger and oil of wintergreen belong to a class of drugs known as "carminatives." These are aromatic and pungent drugs which have a mildly stimulating effect upon the digestive tract and thus promote the absorption of gas from the intestine and its expulsion from the colon. Mint, ginger, and capsicum are frequently incorporated in prescriptions for people troubled by flatulence. There is no harm in the occasional use of a carminative drug for an attack of gas. It is not necessary, however, to purchase a patent medicine and it is dangerous to rely on any patent medicine like Bell-Ans to relieve an attack of acute indigestion, for which it has been advertised.

Spirits of peppermint may be purchased at the drug store for a few cents. It is just as effective as, and much cheaper and safer than, any patent medicine. Ten to fifteen drops taken on a lump of sugar or in half a glass of water containing one-half teaspoonful of bicarbonate of soda is a satisfactory dose.

If an attack of gas is not relieved by a little baking soda and peppermint in water, it is likely that the gas is trapped in the colon. A small enema may help dislodge the pocket of gas. A hot-water bottle against the abdomen may also be helpful. If attacks of flatulence occur frequently, a doctor's care should be sought. It must be remembered that there is no magic formula in medicine. The cause for repeated at-tacks of gas can often be found only after a good deal of study by a physician.

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