It is tricky to create a pun for the “blue skies” part, but a wind blowing from behind? That is a slam dunk for your faithful correspondent!
If you fly long enough, you will eventually discover that gas in your body behaves badly at altitude. It expands, migrates, and chooses the least convenient moments to make itself known. For pilots, “wind” is more than a meteorological issue—it’s a physiological one, and sometimes an aeromedical problem.
A word of the day that might appeal is Favonian, meaning favorable and pleasant, especially of the wind. “Ah! This Favonian breeze is so pleasing on a hot day!” It derives from Favonius, an ancient Roman personification of the West Wind, the same word root when we say something is “favorable.” Bodily wind like burping, hiccups, and intestinal gas are usually benign annoyances, but in aviation they can become painful, distracting, or incapacitating due to gas expansion at altitude. You will doubtless recall Boyle’s law (“when the temperature of a given mass of confined gas is constant, the product of its pressure and volume is also constant”); just as the atmosphere is less dense, expanding with altitude, so the gas in your bowels expands.
Our guts cannot sense many types of painful stimuli, but stretching the intestines, such as by expanding gas, can be excruciating. We will dig into some serious causes shortly, but a good rule of thumb is for 24 hours before flight avoid food or drink that makes or contains gas, such as carbonated beverages, beans, broccoli, onions, or artificial sweeteners. On many commercial flights I have responded to the call for any doctors on board to see a passenger in agony due to retained gas that has expanded in their gut. If you have forgotten the above rule, suffer abdominal pain in the climb, and cannot expel gas, turn around and land because pain from expanding gas can lead to syncope, a fancy word for passing out.
It is also not a good idea to try new foods the day before a flight for this reason and, of course, if you have GI symptoms after a meal, be cautious about what medications you take because some are sedating and do not mix well with aviation.
Burping, or the older term, belching, is the release of stomach gas through the mouth. Usually, a harmless if embarrassing annoyance from food or drink, it can also signal an underlying disease. Beyond consuming gas in beer or soda, swallowing air (aerophagia) can be caused by talking while eating, chewing gum, smoking, or anxiety. It can also signal gastroesophageal reflux disease (GERD) or hiatal hernia and a poorly fitting CPAP mask for those with sleep apnea. Certain drugs can interfere with stomach emptying leading to burping, such as the GLP-1 meds for obesity, many pain relievers, cardiac drugs, lithium for bipolar conditions, and many others. Less common but still important reasons are impaired esophagus or stomach emptying (gastroparesis) due to multiple sclerosis, diabetes, or many other diseases, or a blockage downstream from a cancer or narrowed gut.If burping persists, or is associated with other symptoms like nausea, vomiting, or weight loss, see a doctor promptly.
Headwinds slow us down in flight, but a wind from your head, another manifestation of gas exiting through the mouth, is hiccups, medically known as singultus or “synchronous diaphragmatic flutter.” They are involuntary movements of the diaphragm and muscles between ribs followed 35 microseconds later by closure of vocal cords, which causes the “hic.” They can be caused by the same stimuli as burps, but also by a wide range of problems including brain tumors, meningitis, heart attacks, lung problems, obstructed bowel, diabetes, kidney failure, many drugs, and anything irritating the diaphragm such as a swelling in the liver or inflamed gallbladder. If wind is not variable and hiccups persist beyond 48 hours, or recur repeatedly for a month, seek urgent medical advice to exclude serious or even life-threatening causes. Flying during an attack is not wise, so self-ground until the problem abates.
So now to tail(pipe)wind—flatus. Intestinal gas arises from swallowed air and bacterial fermentation of undigested carbohydrates in the colon. Foods that make this more likely are beans, lentils, onions, cabbage, whole grains, and, as mentioned, certain artificial sweeteners. If these foods give you problems, try taking over-the-counter (OTC) galactosidase enzyme supplements.
Those with true lactose intolerance also have gas; it is quite common, so if you are troubled with inclement winds, try cutting out dairy and see if that helps and if so, reintroduce foods and take an OTC lactase enzyme supplement to ensure calm winds.
Some “functional bowel disorders” can cause gas; these are conditions where there are no structural or visible changes, including irritable bowel syndrome (IBS), and are thought to potentially be stress related. More serious problems include Crohn’s disease, ulcerative colitis, colon cancer, diverticulosis, coeliac disease, small intestinal bacterial overgrowth syndrome (SIBO), and pancreatic enzyme insufficiency, which is quite rare.
If no trigger food is obvious, the change in gas production is recent or is associated with other symptoms like abdominal pain (wind shear!), changed bowel habit, blood or mucus in the stool, general malaise, or weight loss, don’t whistle in the wind and see a doctor promptly.
To restate, pilots should employ the following strategies:
Another aviation expression is pertinent to this topic: “The airplane takes off against the wind, not with it.” Beyond underscoring how we achieve flight, it suggests that challenges and adversity can help one rise. Know your triggers, respect Boyle’s law, and don’t ignore persistent or progressive symptoms. If your gut is trying to get your attention, it may be doing you a favor. As with most things in aviation medicine, predictability is safety. If you can’t predict how your body will behave at altitude, that’s your cue to stay on the ground until you can. And if you have gas problems, ask your medic to provide a METAR—Medical Evaluation To Assess Rumblings.
Fly Well!
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