Borborygmi? What is Borborygmi?

Dr Irene, author of "The Nutrition Tidbits" Newsletter, discusses those growling noises your stomach makes when you're really hungry - though there may be another cause, as she explains.

Everyone has had borborygmi. I have it right now. But don't get alarmed. The word sounds scary but it just means you have a good case of stomach growling.

What is Borborygmi?

Borborygmus (plural borborygmi) is the rumbling sound made by gas and fluids moving through the intestines. The word was originally coined by the Ancient Greeks in an attempt to imitate the sounds their bellies made when they were hungry. (Making words that sound like what they describe is called onomatopoeia, and borborygmus is an example.)

What Causes Borborygmi?

When you have gone for a few hours without eating, your brain tells you it's time to eat. It sends messages which cause peristaltic or wavelike muscle contractions that sweep through the walls of the stomach. The contractions mix food in your stomach with digestive juices and move the mix down into the intestines. Especially when there is no food in the stomach, the fluid and mucus in the stomach combined with all that movement in the intestines make gurgling and growling sounds. That's borborygmi.

Borborygmi Treatment

The treatment for a simple case of borborygmi is to eat something. This usually quiets the stomach. Sometimes though, food can actually cause your stomach to make a lot of noise! For example, if drinking a lot of apple juice sends a person's stomach into spasms and creates a lot of gas and noise, they may not have a simple case of borborygmi. They may be having trouble digesting fructose, otherwise known as dietary fructose intolerance.

We used to think of dietary fructose intolerance (DFI) as a relatively rare disorder. An article in this month's Journal of the American Dietetic Association provides evidence that it's more common than we think.

Before I go any further, let me clarify that there is a relatively rare disorder called Hereditary Fructose Intolerance (HFI), but this article doesn't refer to that genetic problem. Those individuals are totally missing an enzyme. I am addressing dietary fructose intolerance, where an individual is not able to absorb fructose efficiently in the intestinal tract.

When fructose (or any carbohydrate/sugar) is not absorbed efficiently by the intestines, it travels further down the intestinal tract. Bacteria naturally found in the gut love carbohydrate and they break it down into short chain fatty acids, carbon dioxide and hydrogen. Sounds like a good case of gas to me! And it is. The primary symptoms of dietary fructose intolerance are bloating, gas, borborygmi and flatulence. Sometimes diarrhea also occurs.

The Role of Fructose

The culprit for many people may be fructose in the diet. Fructose's chemical name is levulose but it is more commonly known as fruit sugar. There are many sources of fructose in your diet but we usually associate fructose with fruit or fruit juice because of the similar name. However fructose is also found in high amounts in honey and table sugar. (Table sugar is half fructose. This is because a molecule of table sugar/sucrose is a molecule of glucose joined with a molecule of fructose.)

Fructose intake has increased considerably in the United States, not just because we like fruit and fruit juices but because of the addition of high fructose corn syrup to many processed foods. Fructose is used commercially because it is sweet and cheap. Fructose is almost twice as sweet as table sugar. If you ranked the sweetness of sugar as 1.0, Fructose is rated as 1.75.

An Interesting Study

The research article described below is entitled "Fructose intake at current levels in the United States may cause gastrointestinal distress in normal adults". The title accurately portrays the importance of the article. Fructose may be the culprit causing gas and discomfort in normal healthy individuals.

The study evaluated tolerance to fructose in 15 normal healthy volunteers. This is a relatively small sample and the study needs to be repeated but the findings are still notable. To evaluate tolerance, the researchers used hydrogen breath analysis. Hydrogen breath analysis is a valid test for many carbohydrate intolerances, including lactose. It is based on the principle that, if you are given a beverage containing the sugar in question (whether it be lactose or fructose), if you do not digest it properly, your breath will contain high amounts of hydrogen as bacteria break down the sugars.

In the study subjects were given 2 different hydrogen tests at least 3 days apart. First they received a 25 gram dose of fructose and then 50 grams. Both these amounts are within the dose many people consume in their typical diet. For example, a 16 oz. bottle of apple juice may contain more than 30 grams of fructose and a 22 oz. soda could contain 30-40 grams, depending on the percent of fructose in the corn syrup sweetener. The article documents a 1996 source which found that individuals who drink a lot of fructose-sweetened beverages may consume 60-100 grams of fructose daily. I couldn't find documentation of fructose intake in recent national nutrition surveys but the 1977-78 National Food Consumption survey reported average intakes ranging from 15 grams for infants to 54 grams for teenage males.

The individuals studied were asked to fast at least 8 hours before the test so that food intake did not influence measurements. Subjects inhaled into a collection bag designed specifically for gas collection to obtain a baseline measure, and then the 25 gram dose was consumed. Samples of breath were then obtained at 30 minute intervals for 3 hours. A breath hydrogen level of more than 20 PPM was used as the criterion for fructose malabsorption. Any symptoms of discomfort were also recorded.

Results documented that over half the subjects (8 of 15) had clinical evidence of fructose malabsorption with the lower dose (25 grams)!. And 73% (11 of 15) were above the malabsorption cutoff with the 50 gram dose! The 25 gram dose caused gas and/or rumbling in 6 of 15 subjects, with one person reporting abdominal pain. However 7 subjects experienced pain with the higher dose.

The article points out that the relationship between fructose and intestinal distress is not new. Nutrition professionals and gastrointestinal specialist usually warn individuals with GI problems such as inflammatory bowel disease to limit fructose. This is because studies on people with various GI disorders (dyspepsia, irritable bowel syndrome etc.) have shown a high occurrence of fructose malabsorption.

What is relatively new is the recognition that the amount of fructose in the diet has increased to the point that the normal healthy individual may also be having problems. This is not only because of the increase in fructose in our food supply but also our larger portions. Now for some cautions in interpreting this study. This research did not look at fructose in foods eaten in combination meals but rather drinking a known dose of fructose. We need more research looking at commonly consumed high fructose foods and incidence of fructose intolerance.

Practical Advice

You cannot assume just because you have gas that you have fructose intolerance. You can, however, make an appointment with your doctor and discuss if it's reasonable to look for dietary causes of your discomfort. It may be lactose, fructose or other sugars. Many of these can be diagnosed using the non-invasive hydrogen breath analysis and this test is available through most hospital labs.

If the results indicate you can't tolerate a specific sugar, whether it be lactose or fructose (or both) you can ask a registered dietitian about how to avoid the offending sugar while consuming a nutritionally adequate diet.

Source

• I Berman-Levine PhD, RD. "Dr Irene's Nutrition Tidbits" Newsletter published October 2005 by HealthandAge.com.

If you are concerned about Borborygmi, you might want to read the following articles:

  When to Eat?
  A Probiotic for IBS
  Serum Iron Levels are Linked to the Metabolic Syndrome