Wil Dubois

Happy Saturday! Welcome to Ask D'Mine, our weekly advice column hosted by veteran type 1, diabetes author and clinical diabetes educator Wil Dubois.

This week, Wil holds his nose while reflecting on... gas. Yep, those pungent bubbles that weave through your intestines and release with a surprising burst. Of course, Wil offers some insight on whether the whole diabetes card factors in.

Read on, Friends.... you may be surprised what you hear.

 

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

Martha, type 2 from Texas, writes: I almost died of embarrassment when my little daughter asked me, “Momma, is it your diabetes that makes you fart so much?” I have been having a lot of gas since I was diagnosed. Could this be caused by my diabetes?

Wil@Ask D’Mine answers: Gotta love kids. They really cut right to it, don’t they?

Luckily for you, when you enter Ask D’Mine you’re in an embarrassment-free zone where nothing is off-limits.

So let's talk about farts and farting.

What is a fart? Medically referred to as flatulence (the white coat crowd can’t maintain any sense of dignity using the vernacular) a fart is nothing more than a combination of digestive gasses and air swallowed while eating, that finds its way back out of the human body through the anus. Simple enough, except for the fact that the process is often anything but silent and is frequently accompanied by a smell, officially called feculent, that no normal person enjoys.

Speaking of normal people, according to the Mayo Clinic, normal people have wind, break wind, toot, have or pass gas, suffer the vapors, cut the cheese, or let it rip several times per day.

And you thought fartology would be a stinker of a class to take in college.

The extensive Wikipedia entry on the subject quotes research stating that morning farts are higher in volume than farts later in the day. We are told that sounds, odors, and gas volume are highly variable from person to person, as well as from fart to fart emanating from the same person.

The fart toot is apparently caused by the vibration of the anal sphincters, and/or how tightly the buttocks are closed, as the wind is expelled. What’s in the wind? It’s as variable as the sounds and odors, but hydrogen, carbon dioxide, and methane are the most common elements in fart gas. The nasty odor comes from trace sulfur compounds, skatole, and mercaptans (the same stuff added to natural gas so you can smell a leak before your house blows up). And yes, there really are people who are apparently paid to study fart gas.

One more reason to be happy with whatever crappy job you may have now.

The gas itself comes from the breakdown of undigested foods (fermentation), malabsorption of—or intolerances to—certain foods, and to a lesser degree, swallowed air. Gas can also be a side effect of some common meds.

Wait a sec. How does one swallow air? According to the British National Health Service: By chewing gum, smoking, having loose-fitting dentures, or sucking on pen tops. I gotta admit that I’m a pipe smoker and a pen sucker, but no one has accused me of being an old fart (yet), so I guess my air intake is OK.

Oh and the Brits also point to scarfing your food down too quickly as a cause of gas. OK, I paraphrased that to translate it into American English. The Brits also look down their noses at so-called “fizzy drinks” as a source of excess digestive carbon dioxide, but admit that this sort of gas input is more likely to pass back up and out of the top of the digestive system as a belch, rather than to pass down and out the bottom as a fart.

Why do some foods digest poorly? A whole slew of side dishes contain large proportions of un-absorbable carbohydrates. These include the notorious bean, broccoli, cabbage, cauliflower, artichokes, raisins, prunes, and—surprisingly—apples. Bran can be rough on the digestion, and as anyone who’s had diabetes for more than a few years knows, artificial sweeteners called sugar alcohols are epic windbreakers.

Common meds that may cause you to pass gas include the over-the-counter NSAID pain killers, statins, the anti-smoking med Chantix, some antifungals, and—of course—laxatives. We’ll talk about diabetes meds separately in a bit.

Abnormal farting is commonly treated by a change in diet—either increased fiber or a reduction (or elimination) of the “gassy” foods we talked about above. Other anti-fart approaches include antibiotics or probiotics, the digestive enzyme Beano, and antacids. On the technology front, I kid you not, it’s possible to buy underwear and pants with built-in activated-charcoal filters to mask the fart odor in the fart-prone. Check out the hard body hotties for both guys and gals (allegedly suffering from flatulence) at this website! It would almost be high-class porn if it weren’t for the whole farting thing. Oh, and be sure to check out their fart posture guide.

But enough farting around. What’s the connection between farting and diabetes?

Not too much, actually. This is one of those few times in which diabetes, in and of itself, doesn’t seem to make a difference. Of course the diabetes complication gastroparesis can be a major fart generator, as gastroparesis basically messes up the entire digestive system. And high BG levels can lead to increased farting in some people because the excess sugar can fuel an over-growth in normal gut bacteria.

But while our diabetes may give us a free ride fart-wise, the same cannot be said for our medicine cabinets. The diabetes meds Glyset and Precose tend to be serious fart generators, so much so that they really aren’t used much in clinical practice. And the universal type 2 diabetes starter drug metformin can be a real gas, at least during the start-up phase. In most cases, farting is only an issue with metformin for a short time, but some people have chronic issues with it and need to find other treatments. Often, the extended release version of this pill will work for folks who can’t tolerate the “regular” formulation. Met farts are best avoided by slowly increasing the med dosing from 500 mg to the full dose over the period of one month, to let the body get adjusted to it.

Of course, we shouldn’t blow off the possibility that farting is a symptom of a more serious digestive disorder such as lactose intolerance, celiac, GERD, irritable bowl syndrome, or a peptic ulcer. So check in with your doc if you think you are farting more than you should be. The folks at Mayo say it’s time to see the doctor if your farting is “persistent or severe,” and especially if it’s accompanied by vomiting, diarrhea or constipation, weight loss, blood in the stool, or heartburn.

And lastly, we can’t leave this subject without addressing the unasked but burning question: Are farts flammable? Yes. Both methane and hydrogen are flammable so experts tell us that flatus can be ignited, although they declined to specify why anyone would want to do that. I’ve even read that there are more YouTube videos of this kind of action than you can count, but I haven’t personally checked on this for you. Hey, it’s early in the morning and I haven’t started my Ernest Hemingway drinking yet. Italian roast coffee and flaming fart videos are just not a combo I can stomach.

But that’s symbolic of the fact that some people (and cultures) are greatly embarrassed by farts; while other people (and cultures) find them a great source of humor.

I guess we’re a bit mixed in our country: You wouldn’t discuss farting at the country club, but you might post it on YouTube, and the prank fart simulator the Whoopee Cushion has been a best seller since it was introduced in the 1920s.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.