DEAR MAYO CLINIC: My doctor recommended that I add more fruits and vegetables to my diet. I have slowly increased my intake over the past two months, but lately I have begun to experience increased gas and bloating. Are there certain foods to avoid to limit abdominal distress? How can I embrace a more healthful diet but banish the discomfort?

ANSWER: Congratulations on working to embrace a more nutritious diet.  Incorporating more fruits and vegetables, which provide valuable fiber, is a step in the right direction to help manage cholesterol, blood pressure, blood sugar and overall weight. However, if you are not used to consuming fiber-rich foods in your diet, you will want to do so slowly to avoid bloating and abdominal pain.

The amount of fiber each person needs is based on age. Generally, men aged 50 and younger should aim for 38 grams of fiber daily, whereas women of this age would target 25 grams daily. As we age, fiber intake recommendations decrease. Men aged 51 and older should aim for 30 grams of fiber daily; women should aim for 21 grams daily.

Also, be mindful that certain foods — and drinks — can trigger excess digestive discomfort. Consider avoiding some common offenders and you can continue on your path to a more nutritious lifestyle. 

Fruits with high fructose content

Many people avoid fruit because fruit has sugar, including fructose and sorbitol, which can cause inflammation and gas. But fruit contains fiber, which is important for a healthy diet, and beneficial vitamins and minerals. Avoid fruits that are high in fructose, such as apples, pears and watermelon. Instead, choose bananas, oranges, cantaloupe and darker-hued fruit — such as blackberries, blueberries and strawberries — which contain valuable antioxidants.

Beans and lentils

Though beans and lentils are excellent sources of protein and fiber, these foods also contain complex sugars called oligosaccharides, which cause bloating and gas as they pass through the digestive system. To reduce the amount of sugar, always rinse canned beans and ensure they are thoroughly cooked. Cooking beans until they are very soft helps to decrease gas production.

Alternative, easier-to-digest options that won't cause as much bloating include tofu, tempeh or quinoa.

Cruciferous vegetables

Broccoli, cauliflower, brussels sprouts and cabbage are among the most challenging to digest due to their complex fibers, which tend to ferment in the gut, causing gas and bloating. Alternative nutrient-rich foods that are easier on the gut include dark leafy greens like kale, spinach and Swiss chard.

Onions and garlic

Many allium family varieties, including red and yellow onions and garlic, can be difficult to digest. This is because they contain something called fructan, which can ferment in the gut and cause nausea, bloating, gas and diarrhea. To reduce sensitivity, cook the vegetables well or soak in water for at least 15 minutes if eating them raw. You may also consider using powdered versions — although some people may still have sensitivity. To enhance flavor in your dishes, look to alternatives such as celery, fennel, shallots or chives. You can also add other spices and herbs such as basil, ginger and oregano to add depth to your meals without the fear of digestive issues.

With some adjustments, you can ease the bloating and discomfort you currently experience. Additional tips include:

• Eat smaller meals, more frequently. Instead of eating large meals, eat smaller portions more frequently throughout the day. This approach can help your digestive system process food more efficiently, reducing the chances of bloating.
• Eat slowly. Taking time to chew your food thoroughly can help ensure that food is properly broken down in your mouth, which aids digestion and reduces the strain on your stomach. This also helps you to avoid overeating, which can put unnecessary pressure on your digestive system and cause more bloating.
• Stay hydrated. Ensure you drink enough water daily to support healthy digestion. Being properly hydrated helps move food smoothly through your digestive tract.
• Avoid carbonated beverages. Soda and other carbonated beverages introduce excess air into the digestive system, which leads to more bloating and gas. Instead, drink still or flat water or try peppermint, chamomile or ginger tea after meals, which can help promote digestion and soothe your gut.
• Keep a food journal. As you adjust your diet, consider tracking what you eat and how you feel afterward in a food journal. This practice can help you identify specific trigger foods and let you make further adjustments for your comfort.

Hopefully, by incorporating small changes, you can continue enjoying your new diet without unpleasant side effects. Fiber has many benefits, including improved gut health over time. However, if you find that you still experience bloating, gas or other abdominal discomfort, talk with your primary healthcare specialist. He or she can rule out food allergies or other conditions. — Dr. Christine Nguyen, Family Medicine, Mayo Clinic, Jacksonville, Florida

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Bloating, burping and passing gas are natural and are usually caused by swallowed air or the breakdown of food through digestion. You may experience gas and gas pains only occasionally or repeatedly in a single day. When gas and gas pains interfere with your daily activities, there may be something wrong. Find out how to reduce or avoid gas and gas pains, and when you may need to see your doctor.

Bloating: Gas buildup in your stomach and intestines

When gas doesn't pass through belching or flatulence, it can build up in the stomach and intestines and lead to bloating. With bloating, you may also have abdominal pain that can vary from mild and dull to sharp and intense. Passing gas or having a bowel movement may relieve the pain.

Bloating may be related to:

• Eating fatty foods, which can delay stomach emptying and make you feel uncomfortably full
• Drinking carbonated beverages or eating gassy foods
• Eating too quickly, drinking through a straw, chewing gum or sucking on candies, resulting in swallowing air
• Stress or anxiety
• Smoking
• A gastrointestinal infection, blockage or disease
• Irritable bowel syndrome, a condition characterized by abdominal pain or cramping and changes in bowel function
• Conditions such as celiac disease or lactose intolerance in which the intestines aren't able to digest and absorb certain components of food

To reduce bloating, it may help to avoid or reduce the amount of gas-producing foods you eat. Many carbohydrates cause gas, and the following items are common culprits:

• Beans
• Broccoli
• Brussels sprouts
• Cabbage
• Carbonated drinks
• Cauliflower
• Chewing gum
• Fruits, such as apples, peaches and pears
• Hard candy
• Lettuce
• Milk and milk products
• Onions
• Sugar alcohols found in sugar-free foods (sorbitol, mannitol and xylitol)
• Whole-grain foods

Belching: Getting rid of excess air

Belching or burping is your body's way of expelling excess air from your stomach. It's a normal reflex caused by swallowing air. You may swallow excess air if you eat or drink too fast, talk while you eat, chew gum or suck on hard candies, drink carbonated beverages, or smoke.

Acid reflux or gastroesophageal reflux disease (GERD) can have the same effect. If stomach acid backs up into your esophagus, you may swallow repeatedly to clear the material. This can lead to swallowing more air and further belching.

Some people swallow air as a nervous habit — even when they're not eating or drinking. In other cases, chronic belching may be related to inflammation of the stomach lining (gastritis) or to an infection with Helicobacter pylori, the bacteria responsible for some stomach ulcers.

You can reduce belching if you:

• Eat and drink slowly. Taking your time can help you swallow less air.
• Avoid carbonated drinks and beer. They release carbon dioxide gas.
• Skip the gum and hard candy. When you chew gum or suck on hard candy, you swallow more often than normal. Part of what you're swallowing is air.
• Don't smoke. When you inhale smoke, you also inhale and swallow air.
• Check your dentures. Poorly fitting dentures can cause you to swallow excess air when you eat and drink.
• Treat heartburn. For occasional, mild heartburn, over-the-counter antacids or other remedies may be helpful. GERD may require prescription-strength medication or other treatments.

Bloating, belching and intestinal gas: How to avoid them

Bloating, belching, gas and gas pains can be embarrassing and uncomfortable. Here's what causes these signs and symptoms — and how you can prevent them.

Making lifestyle changes may help reduce or relieve excess gas and gas pain:

• Try smaller portions. Many of the foods that can cause gas are part of a healthy diet. So, try eating smaller portions of problem foods to see if your body can handle a smaller portion without creating excess gas.
• Eat slowly, chew your food thoroughly and don't gulp. If you have a hard time slowing down, put down your fork between each bite.
• Avoid chewing gum, sucking on hard candies and drinking through a straw. These activities can cause you to swallow more air.
• Check your dentures. Poorly fitting dentures can cause you to swallow excess air when you eat and drink.
• Don't smoke. Cigarette smoking can increase the amount of air you swallow.
• Exercise. Physical activity may help move gas through the digestive tract.

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Highlights include:

Many causes, many treatments: The Special Report covers treatments for digestive problems including ulcers, celiac disease, pancreatitis, Crohn's disease, diverticular disease, gallstones and liver disease. Seeking medical care sooner, rather than later, can help manage or even cure these conditions. Early action also may prevent a serious condition from becoming life threatening.

Aging alone isn't the problem: People often blame aging for digestive problems. With aging, changes do occur. For example, the stomach loses elasticity and doesn't hold as much food. But, in general, changes due to aging have a mild impact on digestion.

Heartburn (or heart attack?): Emergency care is recommended when heartburn seems different or worse than usual, especially if it occurs during physical activity or is accompanied by shortness of breath, sweating, dizziness, nausea or pain radiating into the shoulder and arm.

The heart and esophagus are in close proximity and share similar nerve connections. They both can cause chest pain, ranging from mild to severe. And distinguishing heartburn from heart attack is not always easy.

Don't blame spicy food: Most ulcers develop because of a bacterial infection or as a side effect of medications, not because of last night's dinner. The most common ulcer symptom is gnawing pain in the upper abdomen between the navel and breastbone. Treatment usually involves antibiotics and medications to reduce the level of acid in the stomach and give it a chance to heal.

Being 'regular' doesn't mean every day: Constipation — one of the most common complaints among older adults — is generally defined as having fewer than three bowel movements a week with stools that are hard and painful. In contrast, easy bowel movements, even if they occur just every other day, would be considered normal.

Constipation may be caused by dehydration, overuse of laxatives, medication side effects, a pattern of delaying bowel movements or underlying medication conditions. Exercise and adequate fiber in the diet can help. A physician can recommend other treatments such as fiber supplements or a brief course of laxatives.

Mayo Clinic Health Letter is an eight-page monthly newsletter of reliable, accurate and practical information on today's health and medical news. To subscribe, please call 800-333-9037 (toll-free), extension 9771, or visit Mayo Clinic Health Letter Online.

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