Can You Silence a Growling Stomach? with Christine Lee, MD

Podcast Transcript

John Horton:

Hello, and welcome to another Health Essentials Podcast. I'm John Horton, your host. When it comes to communication skills and voicing displeasure, it's tough to top your stomach. Your tummy has a way of getting your attention when things aren't ideal. That grumble can be anything but subtle. So how does this usually silent organ suddenly get so loud? Can it be a sign of something beyond just being hungry? When we have questions like that, we turn to gastroenterologist, Christine Lee, a regular guest on the podcast. Dr. Lee is one of the many experts at Cleveland Clinic who join us weekly to offer insight into our health. So, let's find out what's behind hunger pangs and the best way to keep that noise down. Dr. Lee, welcome back to the podcast. It is always a great time when we have you on.

Dr. Christine Lee:

Thank you for having me.

John Horton:

So today, we're talking about stomach pangs and really just how incredibly loudly your stomach can get. I mean, I know sometimes, I've had that where it just goes off and I cannot believe how loud it can be.

Dr. Christine Lee:

Yeah, so those noises can come and go. It's kind of like if you ever hear water trickling down your gutters along the side of your house, those are noises that sometimes get amplified depending on the food, gas that's traveling through your intestines.

John Horton:

One of the reasons I love doing this podcast is learning new things. And in researching this, I learned that there's actually a formal name for the growls that your stomach makes - and make sure I get this right - borborygmi. So, what causes this sound and hunger pangs in general?

Dr. Christine Lee:

Yeah, so you've said it perfectly well. That is great annunciation for it.

John Horton:

I've been practicing.

Dr. Christine Lee:

It's a scientific word that just means intestinal rumbling sound that can be made caused by gas and food or digested material moving through the intestines.

John Horton:

I mean, it's hard to believe, though, that just your intestines, the kind of things moving around there can make that audible sound.

Dr. Christine Lee:

Yeah, so it's multifactorial, meaning how much fluid is hitting against how much semi-solid material that's in your intestines. Additionally, the intestines are lined by muscles, but it does act like plumbing. So sometimes, it's just more rigid and sometimes, it's more compliant, more relaxed. So, depending on the motility - meaning how the intestines move and brush up against each segment of the intestines and how much fluid versus semi-formed or semi-solid material it hits in waves determines the sound, the pitch and the amplitude or how loud it is.

John Horton:

And sometimes, I'm amazed at how loud it is. I think we've all been in that spot where you're sitting in a room and your stomach just makes that noise and everybody turns and you're just like, "I can't believe that."

Dr. Christine Lee:

Yeah, unfortunately, it's not something you can control because it just really does have to do with the environment at the time that it's occurring. Meaning, the ratio mixes of liquid versus solid versus the rigidity or of your intestines at that time and how much buffer you have - meaning, soundproof wall barrier. So, the less padding you have, the louder the sound's going to be.

John Horton:

Well, I definitely have some padding, but it's still getting out. So, I thought when I was reading through everything, too, I saw that there was something with an appetite hormone called ghrelin - did I say that right?

Dr. Christine Lee:

Correct. Correct. That's a hormone that generally is released and circulates in your body, and the intent is to kind of hit the satiety center in your brain, so it controls your appetite. So, in a normal, perfect state, when you haven't eaten and your body needs some energy, that hormone gets released. It causes a lot of motility motion. So, it's basically trying to wake you up - the stomach's moving, the small bowels churning. It's kind of like saying, "Hey, feed me, feed me," kind of thing. And once the hormone satiety center gets hit and satisfied, then things calm down and it's supposed to control or stimulate or lessen your appetite.

John Horton:

Now everyone does associate that kind of grumbling stomach sound with being hungry, but is that the only reason that you might get that?

Dr. Christine Lee:

No, in general, most people associate that you hear it more when you're hungry, but sometimes, it can actually - especially if the noise is being produced lower in your abdomen - it may be just the fact that the food that you've eaten is getting digested through the small and large intestines and making that noise. So, if it's coming from there, it's part of just passage of the liquid and food debris going through the intestines. If it's coming from more in that stomach, upper abdominal area, it's generally more associated with hunger and that the stomach is empty and it's growling for more food.

John Horton:

Now are there also times where it's just, I hate that your stomach's just not happy? I saw where it's linked to food allergies or intolerances or things like that.

Dr. Christine Lee:

So, a lot of things can make your stomach unhappy. So, we do try to categorize mid, upper, mid and lower abdomen. A lot of times, people just use the word "stomach," but a stomach area is a generalized geographical space. So, the upper part of your abdomen is more truly in line with your stomach per se. Mid-abdomen can encompass a really small bowel and large bowel, and then the lower abdomen is generally predominantly your colon. So those three segments, when unhappy - meaning pain in the upper abdomen - are a little bit different than the pain in the mid or lower abdomen as the mid and lower abdomen suggests more intestinal or colonic origin. And the upper still can be your colon - your transverse colon goes up way high - but it could be generally the stomach or the transverse colon.

John Horton:

Dr. Lee, as long as we're talking about where all this is at, let's get a little real estate figured out here. So upper abdomen, I guess let's use our belly button as a navigation point. So, I take it the upper abdomen would be up above that?

Dr. Christine Lee:

So, the upper abdomen is above the belly button. Mid-abdomen would be the level of the belly button and lower abdomen is below the belly button. And the reason that helps us kind of help the patient locate the source of the problem is when your stomach's upset, we tend to think more in line of gastritis, peptic ulcer disease, upset stomach sort of thing. Mid-abdomen is where, if you had celiac sprue or lactose intolerance, that's where most of those symptoms will occur. And then, the lower abdomen, below your belly button generally, is predominantly all colons. So, when your lower abdomen hurts, more commonly, we make sure you don't have diverticular disease, diverticulitis, ischemic colitis or inflammatory bowel disease - or even just constipation needs to be ruled out - not necessarily food allergies.

John Horton:

Yeah, yeah. And I saw in the one thing, too, where there's sometimes a concern that you get the noise that it could be an intestinal blockage. And I take it that's a rare case, but I'm assuming that would be a lower sort of issue, too.

Dr. Christine Lee:

Right. Intestinal blockages are pretty serious, and we do want to make sure that if that is what's happening, we diagnose it quickly as possible and treat it. It's more common to have lower abdominal problems because a lot of people suffer from constipation or what we call irritable bowel syndrome, and it seems to affect the general population pretty commonly. So, a lot of people suffer from constipation and sometimes, they don't even realize they're constipated. So, a lot of people associate the word "constipation" with not having a bowel movement, a hard bowel movement requiring a lot of straining and pain to defecate, but that's not the only part of constipation. Constipation also can encompass people who have regular bowel movements, but they're not getting everything out. So even though they had a bowel movement in the morning, they kept a lot inside the colon, and the remaining stool in the colon can cause a lot of abdominal pain and cramping in the lower abdomen.

John Horton:

So, when that starts making itself known audibly, when do you know when it's just like you're hungry versus a larger problem that maybe you should talk to your doctor about?

Dr. Christine Lee:

So, if it's just the sound itself but it's not causing any symptoms, and symptoms means pain, fever, changes in bowel habits - meaning fluctuation from constipation to diarrhea - if you don't have any of those symptoms, it's just sound alone, then that's generally very benign and it's just one of those things of life. That being said, if it's accompanied with quite a bit of pain or pain attacks and also with changes in bowel habits where it's constipation to diarrhea or even bloody diarrhea, then that warrants an evaluation.

John Horton:

I'm assuming that if you're getting those noises and it doesn't go away after you get a little food in, that might be a reason for some concern, too.

Dr. Christine Lee:

Sure, yeah. So, in general, if it's bothering you, then it's worth taking a look and getting evaluated and checked out. What's that saying? If in doubt, check it out.

John Horton:

Definitely. So now the one thing everyone would want to know is if there's a way to quiet that stomach down so it's not quite as "I'm here" as it can be.

Dr. Christine Lee:

So, if the sound does bother you, then the thing that you could do to lessen that noise is to keep your large intestine less full. And this really does happen to almost all people. As we get older, our metabolism slows down, and we all know that, but they don't realize when metabolism slows down, your gut motility, which is the movement of your intestines, also slows down with that slowing down of metabolism. And when that happens, the quality of bowel movement decreases with age.

So, it's not uncommon for older folks - and older folks, I mean over the age of 30 or 40 - our metabolism is slowing. So it's not infrequent that you have a bowel movement, but you have quite a bit still left in your colon, so the more you have left in the colon, the more noise opportunity arises as fluid and newly formed, semi-solid material passes through the solid that was left in your colon, more likely to have that bangs and pangs sounds that can be made. Now if your colon's empty, it's less likely to make those noises.

John Horton:

Are there certain foods that you might eat that might be more prone to making your stomach groan and grumble a little bit?

Dr. Christine Lee:

Yes. So certain foods are more notorious than others for exacerbating more gas and noise production. The first category would be the cruciferous vegetables like broccoli, Brussels sprouts, cabbages, beans - those in natural form produce a lot of natural gas. So that could exacerbate that scenario. The second class would be dairy, lactose or milk, ice cream, yogurt - anything that has lactose in it is notorious also for making excessive gas production. The third category will be anything that's bubbly in itself. A lot of carbonated beverages or foods that are high content in air bubbles can also exacerbate those scenarios.

John Horton:

The stuff that always makes you a little burpy anyway after you drink it or eat it.

Dr. Christine Lee:

Correct, correct - yeah, because of the high air content in itself can actually make these scenarios worse.

John Horton:

I thought I read somewhere, too, that sugar-free candy might kick some stuff off.

Dr. Christine Lee:

Yes, that's absolutely right. So, sugar substitutes, whether it's sucralose or fructose, any kind of sweetener or artificial sweetener tend to cause more motility or almost like a non-absorbing effect. So, it causes an osmotic reaction in the intestines. So, it's very common to cause not just gas and noise but also diarrhea.

John Horton:

So, Dr. Lee, is there anything that you can do even while eating that would maybe help keep those loud noises at bay?

Dr. Christine Lee:

Yeah, absolutely. The loud noise is mediated with gas accumulation, and it is hanging off the intestine. So, decreasing the amount of air in our system will lessen all that noise-making opportunity. So, one simple behavior would be to chew with your mouth closed, which I hope we are all doing, and chew thoroughly.

John Horton:

We've covered that a lot on this show. Mom is always right.

Dr. Christine Lee:

Mom is always right. That's absolutely correct. So, chew with your mouth closed chew thoroughly. Make sure you do as much, what we call mastication. Chew up your food as much as possible. That kind of helps your intestines out quite a bit since they have to do less of it. The more you chew up here, the less work they need to be done in the intestinal area. So, chew thoroughly, swallow carefully. The less air you swallow in, the less air accumulation and bloating is inside your intestines. The third thing is what you can do after eating is, just on a day-to-day basis, make sure you stay active, make sure you exercise regularly, just keep things in motion. When your body is in motion, your intestines are in motion. Anything to avoid long periods of stagnant state where things kind of accumulate and build up. So, you want to just make sure you're always moving and doing exercises and staying as active as possible.

John Horton:

And since we talked about how a lot of times your stomach makes all that noise when it's hungry, what should people do when they're dieting? A lot of times people will cut back a little bit and you kind of get those grumbles as part of it. Any tips as far as when you're in that spot?

Dr. Christine Lee:

Yes, so that's pretty common. It's interesting that you say that because right now the popular thing is all these diets, whether it's a ketone diet or Atkins diet or protein diets - we don't discourage you from doing those, but just like you said, if you are doing those high protein calorie diet or ketone diet or intermittent fasting, you want to make sure you're accommodating for that. Because when you do that, your brain knows what you're doing but your body, all it recognizes is the decrease in caloric intake. And when that happens, it does affect your metabolism and your motility. Your motility will start to accommodate whether it will do one or two things - A is that it'll speed up things in hopes to wake you up and say, "Hey, what are you doing? You're not taking in as many calories before, so take more calories in." So, it starts banging things around.

Or it can actually go the other direction in what we call energy conservation mode, almost like starvation mode. You haven't eaten for a while, so it tries to conserve energy and so it decreases motility. And in that scenario, a lot of gas builds up and then, a lot of that gas, when it finally starts to move, can make a lot of noises. In the first scenario when it starts moving around to wake you up, it's almost in protests and revolts, wants you to eat more. So, in either case, if you are doing these fad diets, make sure you're accommodating for it by taking, whether it's prune juice or oatmeal or bran or some sort of over-the-counter laxatives to help things keep moving, especially the large intestines so that you don't have a buildup of methane or hydrogen gas.

John Horton:

And I take it when your stomach does make those grumble noises, a lot of times, the easiest thing is just to get a good, whole sort of food in there, some fruit, some veggies, something to make it happy.

Dr. Christine Lee:

Yes, yes. So, you want to stick with healthy foods. And again, with the pain or the sound, it's important to kind of locate where it's coming from. If it's your upper abdomen, then it's probably your stomach. And so, you do want to put some food there where it's berries, fruits or oatmeal. Those kinds of wholesome foods will help in those scenarios. If the pain and the noise is coming from the lower abdomen, that's mostly your colon. So those are the ones where prunes, prune juice or sort kind of over-the-counter laxatives to help eliminate the waste, will make the sounds and pains go away.

John Horton:

What about stress? Because I know we've all been in that situation where things just get real tense, and you can feel your stomach tighten up and those noises just start building after that. Can stress kick off hunger pangs, too?

Dr. Christine Lee:

Absolutely, absolutely. Stress is really interesting. It affects people so differently. In category A, stress can make some people's intestines just go into spasms. So, they have diarrhea, they have noise, they have pain, they have cramping, they have all sorts of things. There's a second category of people where stress affects them where they just kind of shut down, so they get really constipated or what we call obstipated. Things don't move and things build up, particularly gas pains or methane gas. And then, when finally, the stress is gone and it's released, then everything becomes very explosive. So, stress affects people so differently. It's very interesting. It can have either two extremes, it can actually cause them to get hyperactive or it can cause them to become hypoactive and then you suffer the ramifications when it finally wakes up. But either way, it's not pleasant.

John Horton:

So, if you're having that stress reaction, if you just take a few minutes to do some controlled breathing or things like that, will that usually make those sounds go away and kind of settle your stomach down?

Dr. Christine Lee:

It can. It depends on what you are up against. So, if it was just the beginning of it and you can kind of calm yourself down, then you can avoid those scenarios. However, if you're too far, long gone - meaning you hadn't pooped for like three days and then the stress hit - then all bets are off. And I'm not sure that any kind of meditation at that point is going to save you. So, the key is prevention. You want to put yourself in the most optimal state. You don't want to give your colon ammunition - ammunition being waste products. So, you want to eliminate the waste as effectively as possible. So, it's really not good enough that you went to the bathroom. You want to make sure you go to the bathroom well, so that you don't have so much left in inside that it's causing organic disorders - meaning diverticular disease, diverticulitis, ischemic colitis, volvulus, all sorts of things can go wrong when you have too much of the waste product held within your colon.

John Horton:

And I know we've talked about that before. You've mentioned the importance of just keeping your body, everything functioning the way it's supposed to and making sure you're on a regular schedule.

Dr. Christine Lee:

Yes, yes. So, a lot of folks, because they were young and healthy at some point, want that to continue throughout their lifetime. But as you know, everybody, I mean this affects everybody - I don't care if you're an Olympic athlete - we all gradually age, and as we age, our metabolism always slows down with age. It never speeds up with age, it always slows down. And as that slows down, even if you had the best, "My system always worked. I don't know what's happening," is what I hear the most, well, we're getting older, so just because you did something well in the past doesn't mean you're going to continue to do that job well when you're 60, 70, 80.

And so, every year as we get older, the quality of our defecation or intestinal motility decreases. So, we just have to accommodate for that. To accommodate, we may have to eat better foods, meaning more fiber, more fruits and vegetables, more whole grain. And if that's not enough, then you may need to implement regular exercise to keep the muscle tone and decrease the muscle wasting process. And then, if that's not enough, then you add the third agent, which is over-the-counter fiber or laxatives, or prune juice even just to kind of help us eliminate more effectively.

John Horton:

Well, we have covered a lot of ground just on grumbling stomachs and all the reasons behind that. So, I guess, before we say goodbye, do you have anything else you'd like to add on it? And just let me say "borborygmi"; one more time. What else can you add to it?

Dr. Christine Lee:

I would just emphasize prevention is your best bet. Don't wait until you have diverticular disease. Don't wait until you have bowel obstruction or ischemia or prolapse or rectal seals. Don't wait for those problems to happen. Be proactive, tighten those muscles, exercise your core, strengthen your core as much as possible. Learn to eat healthier every day. Make sure you exercise. Exercise - if I could bottle that up in a pill and pass that out - that would be the best medication available. It single-handily improves circulation, improves your well-being, it helps decrease muscle loss quite a bit and it keeps things moving. So just eat right, sleep well, exercise regularly. And even if you feel that your intestines are in the best shape, we're all getting older. So, prevention is key.

John Horton:

Great advice as always, Dr. Lee. So, appreciate you taking some time with us today and look forward to talking with you again soon.

Dr. Christine Lee:

Thank you for having me.

John Horton:

Hunger pangs may sound unnatural when they get going, but [depending on where the sounds are coming from] they're typically just your body's normal response to being hungry. A healthy snack is usually all it takes to calm things down. But if those pangs don't go away after eating, it might be time to touch base with your doctor. Till next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.