Advice on Christmas Dinners

No, its full of food! Only a few people really have a stomach full of air … and these individuals with “aerophagia” often swallow air even when they are not eating. The rest of us swallow 5–10ml of air with every bite of food, but less than 200ml is retained in the stomach. When the stomach gets too full of air, it is released by belching.

Studies of people who feel very full or bloated after meals have shown that the amount of air in the stomach and intestines is roughly the same as that in other people who have no symptoms after eating the same meal. What is different is, first, that the stomach is very sensitive and does not relax properly on eating, such that tension builds up in the muscle wall … this is the cause of fullness, nausea and pain after meals. Second, because of the discomfort, many people tense their diaphragm and back muscles forcing abdominal contents forwards making it look like there is a lot of air in the stomach!

Effective treatment aims to, first, reduce the tension in and sensitivity of the stomach wall and, second, use physiotherapy/breathing therapy to retrain people how to relax their diaphragm, back and abdominal wall after meals
 

With belching, air that is swallowed with the food collects in the upper stomach. This triggers a spontaneous, reflex relaxation of the sphincter/valve at the lower end of the oesophagus. This allows air to escape/vent from the stomach. Unfortunately, especially after big meals, food and fluid and acid secretions in the stomach can also come up into the oesophagus. This is the commonest cause of reflux.

With farting/poops, most of the gas passed is not swallowed but rather produced by bacteria in the colon. This moves around the colon and collects in the rectum. When the volume is large enough this triggers a reflex relaxation of the anal sphincter/valve and gas is released/vented through the anal canal.

Belching is not dangerous! However a small number of people with aerophagia swallow too much air and this can lead to severe bloating. Other people with abdominal pain, bloating or other symptoms ‘self-induce’ belching by tensing up their abdominal muscles and forcing air out of the stomach. This is rumination syndrome and is basically an unconscious effort to release the pressure/discomfort in the stomach.

Both aerophagia and rumination syndrome are behavioural disorders that can lead not only to embarrassing belching, but also to muscle tension and pain in the tummy, chest and throat … not healthy for the patient … not nice for their family and friends.

Farts are also not dangerous … unless you try to set light to them with a match! However, we all know that it can be unpleasant. Too much gas can be produced when a lot of poorly digestible carbohydrates are eaten and enter the colon where bacteria digest these nutrients and produce gas. Foods that do this include apples and pears, dark green vegetables like cabbages, pulses like lentils and beans, onions and garlic, wheat products, and milk … but only in those with lactase deficiency. Together these foods are often termed FODMAPS, for fermentable oligo-, di-, mono-saccharides and polyols.

The kind of bacteria in the colon also makes a difference. A few people really do have bacteria in their intestines that produce too much gas leading to bloating. Other bacteria produce foul smelling gas like hydrogen sulfide.

But there is another reason farts may be dangerous, perhaps even responsible for global warming! Methane is a greenhouse gas 30 times more potent than carbon dioxide! Although it must be stated that cows produce a lot more than humans...

One can make some simple dietary changes to reduce bloating. First avoid fizzy drinks (no champagne!) and eat slowly (do not gulp your food). Second reduce ‘difficult to digest’ foods (FODPAPs) that are fermented by bacteria in the large intestine and choose easily digested foods instead. Third, never be tempted to set light to your farts … no matter how drunk you are. It almost never works but the flame will still burn your butt.

Sigmund Freud told us about the dangers of anal retention. It is possible to retain your farts, but this leads to discomfort and bloating and, psychoanalysts might claim, in the end neurosis. Release your farts … and your fears!

The sound of farts is due to vibrations in the anal canal and buttocks (pobacken) as the air rushes out! If you know that you are going to fart and you cannot leave the room then try leaning forward in your seat or secretly pulling one buttock to the side to free the passage and silence your fart!

Alcohol does relax the stomach wall. Also, it is analgesic so it reduces any discomfort caused by eating too much. As a result of these effects people that drink alcohol before or during the meal may feel less full and eat more than normal. However, alcohol also slows emptying of the stomach. This is why when you are drinking you can eat more than you normally would … but you wake up in the middle of the night feeling horribly full and bloated.

Alcohol taken after the meal will relax the stomach and may reduce discomfort. Certain herbs also have well-proven effects on the stomach that appear to help the digestion. For example, Iberogast is a herbal medication available over the counter that can relax the stomach, speed up emptying of the stomach and reduce discomfort after meals. It may be that certain Magen Bitters have the same effect … but controlled studies have not been done!

Coffee and cigarettes have a stimulant effect on the stomach and intestines. Both would be expected to increase contractions of the stomach and speed up emptying.

When we eat a large volume of acid secretion is produced by the stomach to help digest the meal. These secretions are fluid and tend to collect in a so-called acid pocket or layer on top of the meal. This acid pocket is right next to the lower oesophageal sphincter/valve that separates the oesophagus from the stomach.

After a meal spontaneous, reflex relaxations of the sphincter/valve occur to allow air swallowed with the meal to escape/vent from the stomach. Unfortunately, especially after big meals, not only the air but also the acid secretions and food can come up into the oesophagus. This is the most frequent cause of reflux. This occurs more often in patients with reflux disease because this group tends to have a weak sphincter and anatomical changes in this area that increases the chances of acid secretions entering the oesophagus during these relaxations.

To reduce acid regurgitation after a large meal avoid vigorous activity, but do not lie down … both can trigger reflux. If a problem does occur then take an antacid-alginate preparation like Gaviscon Advance. This not only neutralizes acid but also forms a protective layer/raft over gastric contents that suppresses reflux for up to 90 minutes after taking the medication.

After a big Christmas dinner rest for a while! Vigorous activity such as running around after or lifting up grandchildren could well trigger acid regurgitation. However, it is not recommended to lie down. Especially in patients with a hiatus hernia lying down after meals can lead to severe reflux. Falling asleep sitting on the sofa watching TV is probably ideal!

Yes! The stomach and intestine can be trained! If you are not used to eating a lot and you get abdominal pains after big meals then you can prepare yourself for eating far too much at Christmas by slowly building up meal volume and building rich foods into your diet ahead of the feast.

First, train your stomach! Build up meal size over advent ready for the feast! Second, take an alcoholic aperitif! This will relax your stomach and your inhibitions about eating too much! Third, avoid the soup! Food taken in liquid form has a larger effect on the sensation of fullness than the same food taken in solid form! Fourth, eat fast! This gives the intestines less time to digest the food and send signals to your brain and stomach telling you to stop! Fifth, induce vomiting! It worked for the Romans (see Asterix in Switzerland), it can work for you too!

The opposite of the above…

One other tip, fatty foods tend to make people feel more full, bloated and nauseous than other foods. If you want a dessert, choose something sweet but not creamy.

A lot of exercise is needed to burn the 3,000kcal of food and drink taken at a large Christmas dinner. For an average-sized man this would be at least 1 hour a day running … every day for a week! For an average-sized women … even longer.