DRHOOK- Beans, beans: Flatulence can be more than embarrassing

the handsome doctor John Hong of Charlottesville

What a gas! How did that expression ever come about? Maybe it's because all of have flatulence every day (i.e. we fart). One reader told me his mother said, "Fart is a four-letter word. We ‘toot' instead."

Few people understand the terms flatulence or passing gas, and almost everyone knows fart. Does that make me a "fart tart" for saying it? 

 Anyway, "tooting" occurs 10-20 times a day in healthy people. If people didn't toot, they would explode by the time they are– let's say 20. People who complain about feeling bloated often wonder if they have too much gas.

 Is the gas you pass healthy?

 The intestines on average contain about 200ml of gas. Gas is absorbed by the intestines, burped up, or tooted out. About 500-1500cc of gas is tooted out each day. From the rear end, 99 percent of the gas consists of nitrogen, oxygen, carbon dioxide, hydrogen, and methane— none of which stinks. What smells bad are sulfur-containing compounds and short-chain fatty acids, ammonia, and skatoles (the last one, I believe, is how a slang term evolved for bowel excretions). 

 What causes gas in the intestines? Swallowed air is the biggest source of gas in the stomach, which then can pass down the river, so to speak. Carbonated drinks put CO2 in the intestines, but so does fiber ("Beans, beans, good for the heart..."). Undigested fats and proteins can be fermented by bacteria in the colon to cause CO2— sorta sounds like making beer.

 Hydrogen (H2) was in the Hindenburg blimp, and it can make you feel like a blimp too. Food ferments in the intestines of people with small intestine bacterial overgrowth (a slow GI system as seen in people with diabetes, hypothyroidism, scleroderma) and causes diarrhea and gas. Healthy folks who eat a lot of legumes or flour can pass these sugars to the colon for more H2 production.

 Methane is natural gas, and we all hear about people stupidly doing the Doors thing, "Light My Fire." Higher than normal methane levels, though, can be a sign of colorectal cancer, colon polyps, and ulcerative colitis.

 Malabsorption disorders can lead to excessive gas. One is pancreatic deficiency, which leads to fatty, floating, smelly stools. Lactose intolerance makes drinking milk as fun as pumping up your colon with an air pump. In Celiac sprue, consuming gluten is not a blast– well, with one exception. Parasites like Giardia can cause months of gas and loose bowel movements. Bad signs associated with increased tooting include: fever, waking up with abdominal pain, unintentional weight loss, blood in stool, vomiting, and new onset diarrhea. 

 The problem with folks who complain of abdominal bloating is that they tend to have the same amount of gas in their intestines as healthy people (according to studies– which must be a gas to do!). It appears people with IBS (Irritable Bowel Syndrome) have more discomfort than those without IBS, despite having the same amount of gas. 

 For people with annoying flatulence (meaning they end up alone at work or parties), there is actually GasMedic underwear or Underease Protective Underwear, to help reduce the smell! Sufferers can also sit on anti-smell charcoal-lined cushions so no one will have to say, "He who smelt it, dealt it."

 Overall, anti-gas pills like simethicone, bismuth, and activated charcoal haven't proven to be very effective. However, Beano can help reduce gas after eating beans, and Lactaid works for dairy disorders.

 A GI workup might be needed to make sure there isn't something bad causing the gas, especially with other associated symptoms. I have IBS, and I can relate to many of my patients. Actually, I have a friend whose nickname in college was "Geyser." You can figure out why.


Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice and a website, drjohnhong.com. Email him with your questions.