How do I ease gastric pain and bloatedness?

In traditional Chinese medicine (TCM), stomach bloating and pain are probably due to the deficiency in the stomach, spleen and liver.

Q. I am a 40-year-old man. I have been experiencing gastric pain and feeling bloated for many years. At times, I wake up in the morning with gastric pain.

Sometimes, my stomach has so much gas that my legs feel wobbly if I do not pass it out, but doing so can be embarrassing. Sometimes, a sip of milk or cold drink causes significant discomfort in the tummy.

I went for a scope and computed tomography (CT) scan. They showed that I have Helicobacter bacteria and I took strong antibiotics. I have also seen traditional Chinese medicine practitioners. But my condition has not improved.

I maintain a healthy diet and exercise regularly. I avoid milk, cold drinks and spicy food but I cannot go without caffeine drinks such as coffee and tea. Is there any way to reduce the pain and feeling of bloatedness?

In traditional Chinese medicine (TCM), stomach bloating and pain are probably due to the deficiency in the stomach, spleen and liver.

In TCM, a good flow of qi (energy) is needed for good health. When the stomach is weak (due to chronic illnesses), it will not be able to digest food. The qi in the stomach will fail to descend as it should and this will trigger upper abdominal fullness and pain, especially after meals, with poor appetite, loose stool and fatigue.

The spleen transforms nutrients from food into qi and blood. When the spleen is weak (due to smoking, alcohol consumption and poor diet, such as spicy, oily, roasted, barbecued and fried food), it will transform nutrients into "heat" and "dampness" instead.

This will trigger pain with a burning sensation in the upper abdomen, thirst without a desire to drink, a dry mouth with a bitter taste, yellow urine and poor bowel movements.

When the stomach and spleen are weak, "coldness" is generated within the body, triggering continuous bloating and pain in the stomach.

The pain will be more intense when the stomach is empty or when cold food and drinks are consumed.

It will be alleviated with warm food and drinks. Other symptoms include fatigue, poor appetite, diarrhoea and cold extremities.

The liver regulates qi circulation. When the liver is weak (due to intense emotions such as anxiety, anger or depression), qi in the liver will stagnate, and prevent qi in the stomach from descending.

This triggers distention and pain in the upper abdomen and the sides of the ribs. Chinese medicine, acupuncture, moxibustion and cupping can help ease your symptoms by strengthening your organs and dispelling disease-causing factors.

Moxibustion involves burning a small herb above acupuncture points to help healing. Cupping involves using fire and cups to create a vacuum on the skin to enhance blood and qi circulation.

Chinese medicine such as milkvetch root, liquorice root processed with honey, largehead atractylodes rhizome and large trifoliolious bugbane rhizome strengthen the stomach and spleen. Indian bread, pinellia tuber and officinal magnolia bark enhance qi circulation in the stomach and dispel "dampness".

Cuttlebone, golden thread, baical skullcap root and dandelion dispel "heat" and "dampness". Chinese thorowax root, white peony root, turmeric root-tuber and orange fruit strengthen the liver and enhance qi circulation there.

You should take easily digested food, such as porridge, and avoid spicy, cold and oily food. Take many small meals instead of heavy meals. Chew and swallow the food slowly.

Abstain from smoking and drinking alcohol, coffee and tea.

Get enough sleep and regular exercise to reduce stress and enhance qi and blood circulation.

Ms Lim Lay Beng
Traditional Chinese medicine practitioner at YS Healthcare TCM Clinic

Western medical opinion

Food could be causing gas

A gas production is contributing to your bloating.

I do not think that your pain is due to a gastric condition such as acid reflux or Helicobacter pylori infection. While it is an important risk factor for stomach ulcer and stomach cancer, Helicobacter pylori is not associated with stomach pain or discomfort in the majority of people who harbour it in their stomachs.

I would caution you against excessive use of medication that reduces stomach acid (such as proton pump inhibitors), as this could give rise to small intestinal bacterial overgrowth, which would further aggravate your gas problem.

A research team from Monash University in Australia has recently developed the concept that food containing FODMAPs (fermentable, oligo-, di- and mono-saccharides and polyols) is most likely to contribute to production of gas in the intestines.

Unfortunately, many of these types of food are what people believe are, and have also been promoted by health promotion bodies as, healthy food. Examples are bran cereals, high-fibre bread, fruit (such as watermelon and pears), vegetables (such as cabbage, brussel sprouts, beans and legumes), and dairy products (especially milk and soft cheese).

Other sources of gas-inducing chemicals are sweets, breath mints and drinks that contain sugar-free sweeteners.

You may be relieved to know that coffee does not contain FODMAPs. Just make sure that you drink coffee made purely from coffee beans (avoid chicory which is sometimes added to coffee powder or mixes).

Drink your coffee without milk, creamer or sweetener. When drinking tea, avoid adding honey, as it contains fructose which is one of the FODMAPs. Similarly, watch out for fructose and artificial sugar (normal table sugar does not cause gas) in sweetened drinks.

Not all spices are bad. Chili, pepper and salt do not give rise to gas production. Onions and garlic do.

I hope this information helps you enjoy the food and drinks that you like without suffering gas-related symptoms.

If you need more advice, you may want to consult a dietitian knowledgeable about FODMAPs.

Dr Gwee Kok Ann
Gastroenterologist at the Stomach, Liver & Bowel Centre at Gleneagles Hospital, and adjunct associate professor of medicine at National University of Singapore

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