Helping Patients Overcome Obstacles to Healthy Eating


This article is brought to you by GlaxoSmithKline Consumer Healthcare

Consumers are becoming more aware of the health consequences associated with poor nutrition and sedentary lifestyles. Increasingly, Americans are incorporating various preventive health measures into their daily routines, such as establishing healthy eating habits. For those individuals who already suffer from serious medical conditions, dietary changes are often a required part of their treatment protocol.

In 2005, the Department of Health and Human Services released new dietary guidelines for Americans in an updated food pyramid (Figure). The new food pyramid provides individuals with advice and assistance on establishing healthy eating habits. Research has shown that a combination of eating healthier foods and exercising can reduce an individual's risk for cardiovascular disease, hypertension, certain cancers, osteoporosis, type 2 diabetes, and obesity. The new guidelines place an emphasis on the health benefits of consuming fiber-rich fruits, vegetables, and whole grains. The new dietary guidelines increase the daily recommendation to 9 servings of fruits and vegetables and 3 servings of whole grains.

Although many individuals are making healthier food choices, it is estimated that nearly 79 million Americans avoid certain healthy foods such as complex carbohydrates because the incomplete digestion of these foods can potentiate the occurrence of both uncomfortable and embarrassing digestive distress?commonly known as gas.1


Complex carbohydrates provide an excellent source of energy and contain an abundant supply of essential vitamins, minerals, and fiber. Many individuals, however, have difficulty fully digesting these types of foods due to a condition known as Complex Carbohydrate Intolerance (CCI). CCI affects millions of Americans and is caused by a lack of an intestinal enzyme called alpha-galactosidase, which results in the incomplete digestion of complex carbohydrates. The most common symptoms of CCI are flatulence, abdominal bloating, and abdominal cramping. These symptoms can affect patients' compliance with a healthy eating regimen.

Contributing Factors

Intestinal gas is typically caused by 2 factors: swallowed air (aerophagia) or normal breakdown of certain undigested foods by harmless bacteria typically present in the colon.2,3 The exact mechanism behind the production of intestinal gas is not completely understood. More than 99% of intestinal gas is a combination of the same odorless gases that are typically present in the environmental atmosphere.2 The primary components of intestinal gas include carbon dioxide, methane, nitrogen, oxygen, and hydrogen. Burping or belching is the typical means of eliminating most swallowed air. Other causes that can contribute include chewing gum, wearing loose-fitting dentures, and smoking.3

Gas in the lower-digestive tract can be caused by certain types of foods, such as carbohydrates. The body is unable to digest carbohydrates?such as sugars, starches, and fibers?in the small intestine, and these carbohydrates are then passed to the large intestine. Gas is produced by fermentation or metabolism of the ingested foods by bacteria normally found in the large intestine. Gas is eliminated via the rectum.3,4 Needless to say, gas resulting from incomplete digestion can be an embarrassment.

Precipitating Factors

Factors that may precipitate or aggravate intestinal gas include diet, medical conditions, and the use of some pharmacologic agents. According to the National Institute of Diabetes and Digestive and Kidney Diseases, foods that contain carbohydrates typically cause the most gas, whereas fats and proteins cause minimal gas. Foods that cause gas contain starches, fiber, and sugars, such as raffinose, lactose, fructose, and sorbitol.3 Because some pharmacologic agents can contribute to intestinal gas, pharmacists should always review a patient's medication profile to determine if any medications are responsible for symptoms of intestinal gas.4,5

Treatment Options

It is important to remind patients that, when they avoid eating healthy foods because of gas, they are missing the health benefits of these food groups. In addition, they should be told that treatment options are available that will enable them to make healthy eating choices without experiencing the discomfort and embarrassment of gas. For the many people who suffer from frequent episodes of gas, various nonprescription agents can both provide relief and reduce the incidence of gas. The primary classes of nonprescription agents available are antiflatulent agents (eg, simethicone) and digestive enzymes (eg, lactase replacement and alpha-galactosidase enzyme replacement agents).

Simethicone may provide relief of symptoms after intestinal gas has occurred. Lactose-replacement products may aid in treating intestinal gas and diarrhea in those individuals with lactose intolerance.

Beano (alpha-galactosidase) is the only nonprescription product of its kind currently on the market and is indicated for use in the management of flatulence. A natural dietary supplement, it is the only agent that prevents intestinal gas before it happens by treating the cause and not just the symptoms of intestinal gas. It is a natural enzyme product that is derived from Aspergillus niger mold and is effective in preventing gas when ingesting foods that contain oligosaccharides.4 Alpha-galactosidase exerts its therapeutic action of preventing intestinal gas by augmenting the breakdown of oligosaccharides before they reach the lower digestive tract. Beano is available as a solution and in tablet form and is recommended for individuals 12 years of age and older. The proper dose of Beano is approximately 5 to 10 drops or 2 to 3 tablets per half cup serving of foods that can cause gas. Consumers should be informed that the time of administration is essential to ensure efficacy of this product?Beano should be taken before eating the first bite of complex carbohydrate foods. Consumers should be reminded not to add Beano to food until after it is cooled because heat greater than 130?F can induce the degradation of the enzyme product.4 Patients with a history of mold allergies should not use this product, and those with galactosemia should consult their physician prior to using Beano because the enzymatic degradation of oligosaccharides produces galactose. Diabetics and pregnant and breast-feeding women should consult their physician prior to use.

The Role of the Pharmacist

Pharmacists should always ascertain if self-treatment is appropriate by assessing the person's medical history, symptoms, and drug profile, as well as his or her eating habits. Intestinal gas symptoms can also resemble other conditions, such as gallbladder or heart disease; such patients should be referred for further evaluation to their primary care providers.4

For more information on Beano, please visit the official Web site, or contact Glaxo-SmithKline Consumer Healthcare at 800-257-8650.

Ms. Terrie is a clinical pharmacy writer based in Haymarket,Va.

For a list of references, send a stamped, self-addressed envelope to: References Department, Attn. A. Stahl, Pharmacy Times, 241 Forsgate Drive, Jamesburg, NJ 08831; or send an e-mail request to:

Resource Information on Complex Carbohydrates


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