While we’re on the topic…I tend to think, that as good as we are at asking a lot about a patient’s health, we can always do better. One of the classic pitfalls for practitioners is having to rely so much on patient self-reporting: Is your period heavy,moderate or light?; How would you rate your appetite?; Do you suffer from excess flatulence? When our patients answer these questions, who are they able to compare their own experiences with? Or do they only compare them with themselves at another time in their life, e.g. my periods are heavier/lighter than they were before? Either way, this may lead to unintentionally misleading information from our patients, producing erroneous conclusions for us as clinicians. Do you suffer from excess flatulence? Well do they?? How exactly would most of us know?! Unless we can define what ‘normal’ looks like…?
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(But as many as 22 times a day – that’s almost one on the hour)
That’s the average number of ‘pop offs’, ‘air biscuits’, ‘bench-warmers’, ‘fluffs’, or whatever you want to call them, healthy humans do per day as cited in this great evidence based & entertaining article. Funnily enough I had exactly the same lecturing experience as the author: performing a snap poll on my students, asking for averages…and can I just say almost everyone was clearly under-reporting!! But the point is clear. How can our patients accurately rate the magnitude, severity or normality V abnormality of their bowels, menses, appetite, pain threshold etc – unless we provide some goalposts? And are we, in fact being lead to believe there is a problem when perhaps there isn’t? That certainly has been the conclusion of several studies into the matter of self-reported excessive flatulence. Hippocrates himself put in a good word for bottom trumpeting, saying “passing gas is necessary to well-being” and as a recent article in the Harvard Health Letter reads, “A little bit of extra flatulence, could be an indication that you’re eating the way you should!” Here here!
But my favourite quote from this article has to be about the high tech solutions on offer – for those who do accurately fall into the excessive category:
“Such as carbon fiber odor-eating underwear (cost: $65), which were put to the test in an American Journal of Gastroenterology study that included such gems as “Utilising gas-tight Mylar pantaloons, the ability of a charcoal lined cushion to adsorb sulphur-containing gases instilled at the anus of eight subjects was assessed.” Assessed, that is, by a panel of fart-sniffing judges. And the name of the charcoal lined cushion? The “Toot Trapper.”
How different that scene in Bridge Jones’ Diary would have been had these been her undergarment of choice instead of the control briefs!
Of course, if there is associated pain or an odour (which the article discusses as well) that makes the family dog leave the room…well, that’s another matter…;)
Is Glutamine your go-to prescription for patients with gut problems? Do you look for good levels of it when you’re choosing your gut repair formulas? Most of us do this because we’ve heard that a deficiency negatively impacts the gut tight junctions , villi structure and immunity etc. but how long has it been since you’ve reviewed the latest human studies on the digestive effects of Glutamine supplementation? The time is now. This previous UU30 installment cuts to the chase on the big research findings that warrant our urgent attention and necessitate big adjustments in how we use glutamine for guts.