FLATULENCE

WIND PRODUCTION IS A NORMAL part of digestion - and a frequent target of adolescent humour. When wind is odoriferous, excessive or noise-producing, it's uncomfortable as well as embarrassing. If it builds up, it can contribute to abdominal discomfort.

What causes wind? It's made by the intestinal bacteria that ferment food in the colon, or large intestine (bowel). Generally, the fermentation of most carbohydrate products is odourless, while the fermentation of some proteins has an odour caused by hydrogen sulphide. On the other hand, certain foods have reputations as wind­producers, including broccoli, potatoes, dairy products and beans.

Sometimes it's not what you eat or drink, but how fast: swallowing air while eating or drinking too quickly can set the stage for gaseous episodes. Carbonated beverages can cause problems as well.

If you are prone to flatulence, it is important not to overeat. Eat your meals slowly and enjoy your food. Adding yogurt or other fermented foods to your diet can also help by maintaining a healthful level of bacteria in the intestines. Finally, if there are certain foods that seem to give you wind - and you don't want to give them up - try eating just small amounts of them regularly to build up a tolerance.

Wind is not a new ailment. And people have used herbal remedies to cure it for centuries. Agents that prevent or relieve wind formation in the intestines, whether they are pharmaceuticals or herbs, are called carminatives (anti-flatulents). Conventional medicine has used herbal carminatives for years; doctors still sometimes tell their patients to take a few drops of peppermint oil in a glass of warm water to calm excess wind. Meanwhile, many non-herbal, over-the-counter drugs (and a few prescription ones) are sold to relieve wind - but their effectiveness is questionable.

DRUG TREATMENT

Antacids

Activated dimeticone (Asilone Antacid, Bisodol Extra Tablets, Maalox Plus, others). Function: combine small gas bubbles to form larger ones. In theory the wind is easier to expel; in practice that has not proven to be true. Side effects: allergic reactions, bloating, constipation, diarrhoea, wind, heartburn.

Prokinetic agents such as cisapride and metoclopramide (Maxolon). Function: help move the contents of the stomach and the intestines. Although these drugs rarely help wind, they are sometimes prescribed for this purpose. Cisapride side effects: dizziness, vomiting, sore throat, chest pain, fatigue, back pain, depression, dehydration, diarrhoea, abdominal pain, constipation, flatulence, runny nose. Metoclopramide side effects: fatigue, apathy, depression, rash.

Other Drugs

Activated charcoal. Function: binds to intestinal gases such as sulphur and methane. Although there is no evidence that wind volume is reduced, charcoal may minimise the odour. Side effects: upset stomach, vomiting, constipation, diarrhoea, black stools; also, charcoal should not be taken with other drugs as their absorption will be blocked.

HERBAL REMEDIES

Peppermint (Mentha x piperita)

Why do restaurants offer these little candies at the door? Because peppermint contains menthol, which stimulates the flow of bile into the intestines, promoting digestion. Peppermint also helps relax the oesphageal sphincter, allowing wind to be released from the stomach via burping. Moreover, mint can help relieve the nausea that may accompany excessive wind. If you don't want to eat sweets, a cup of hot peppermint tea is something to enjoy after dinner. Typical dosage: 6 to 12 drops of essential oil inwater three times per day; or up to 3 cups of tea per day (steep 1/2 teaspoon of dried herb in1/4 litre of hot water for 15 minutes); or 10 to 20 drops of tincture in water after meals. Caution: do not use peppermint if you have heartburn or oesphageal reflux.

Camomile (Matricaria recutita)

This tension-easing herb also helps dispel wind and can increase the flow of bile, which aids digestion. The flavonoids from camomile have been shown to relax the muscle of the intestines, decreasing spasms. Camomile is also an anti-inflammatory. It is best used as an after-dinner tea, perhaps mixed with peppermint. Typical dosage: 3 to 4 cups of tea per day (steep1/2 to 1 teaspoon of dried flowers in 1/4 litre of hot water for 10 minutes). Caution: people allergic to ragweed may also be allergic to camomile.

Ginger (Zingiber officinale)

This root's fame for its ability to quell nausea

often overshadows its usefulness for simple indigestion and wind. Ginger also increases bile secretion and tones the bowel. Try pouring boiling water over a teaspoon of fresh crushed root and adding maple syrup for a delicious dessert tea. Drink it after a meal that might upset the stomach. Typical dosage: up to eight 500- or

600-milligram capsules per day; or % to 1 teaspoon fresh ground root per day; or 10 to 20 drops of tincture in water per day.

Fennel (Foeniculum vulgare)

Mentioned in most European medical texts, fennel has a time­honoured history as a digestive herb. The wind-dispelling qualities of fennel seeds have been known for hundreds of years; additionally they ease bloating and digestive spasms. Typical dosage: up to three 400- or 500-milligram capsules per day; or 1 cup of tea per day (simmer 1 teaspoon of crushed seeds in '/ litre of water for 10 to 15 minutes); or 30 to 60 drops of tincture in water up to four times per day.

Aniseed (Pimpenilla anisum)

This aromatic little seed has been shown in human studies to dispel wind. Typical dosage: up to 3 cups of tea per day (steep % teaspoon of dried, crushed seeds in '/, litre of hot water for 5 to 10 minutes).