FAQ #7 - Ideas for relieving bloating associated w/ abdominal radiation therapy?

I am presently undergoing radiation for endometrial cancer and I am encountering bloating after my meals. Do you have any suggestions to relieve this discomfort so that I still take a well balanced diet without fearing this bloating feeling?

I consulted with Suzanne Dixon, MS, MPH, RD former oncology nutrition specialist for the University of Michigan Comprehensive Cancer Center who has developed all the nutrition material for the excellent web site www.caring4cancer.com to help me answer your question. Here is her response along with some suggestions.

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Bloating is a very common side effect with the radiation for endometrial and ovarian cancer treatments. There isn't research in this area, but in my experience, diet changes help sometimes, and other times they don't make much of a difference. It's certainly worth a try to see if some of these changes might relieve some of the bloating.

Omitting 'gas producing' foods is one thing to try. It's the obvious stuff, which I'm sure you're familiar with: beans, peas, corn, cabbage, broccoli, cabbage, green leafies, etc. Unfortunately, it's a lot of the 'good stuff' people want to try to eat. But, temporarily omitting these foods may help. Also, avoiding carbonated drinks, talking when eating (which causes more air swallowing), and avoiding use of straws can help.

Glutamine sometimes helps, because the gut damage that is leading to the bloating can sometimes be improved/healed with glutamine and this alleviates gas. Starting dose of 3-4 grams 3x/day and going up to 10 grams 3x/day is worth trying. If there is no improvement within a week or so after reaching final dose, then it's probably not going to help and you could discontinue to avoid wasting money. Also, some patients complain glutamine actually causes bloating, so if you try it and get worsening of symptoms, I wouldn't even bother going up to the full dose.

Digestive enzymes may help. Something like pancrease or ultrase. These require a prescription, but you could ask your doctor.

Or, you could try supplemental, food-derived enzymes. Bromelain is a good one, and it may have anti-cancer activities too, so that's a bonus. Selecting bromelain is tricky, because there is both the 'dose' (mg) and the 'strength' (often referred to as GDU or gelatin digesting units). If the supplement is not sufficient 'strength' or GDU, then it won't do much. One with a GDU of at least 1500-2000 GDU per gram is good. Solgar Bromelain in 500 mg tablets is a good one. You could try 3-6 capsules per meal/snack. It's derived from pineapple so do not use if you possibly have a pineapple allergy.

Sometimes avoiding dairy, or using lactase or 'lactaid' products can help. Some people get temporary disruption in endogenous production of lactase (the enzyme that breaks down the milk sugar called lactose), so dairy can be a problem until lactase production returns to normal.

Adding in other 'digestive' aid type herbs may help, such as fennel, ginger, peppermint (if no gastro-esophageal reflux disorder). These are worth trying. All come in tea or capsule form. I think the teas are nice to try.

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I hope some of these ideas are helpful. Please be sure to ask for a consultation with the Registered Dietitian at your own cancer center for more individualized advice and follow-up.

Best wishes to you for health, healing, and hope!

Diana Dyer, MS, RD