World Digestive Health Day occurs annually on the 29th May. Launched in 2004 to mark the 45th anniversary of the World Gastroenterology Organisation’s (WGO) incorporation in 1958 (founded in 1935). This year’s theme is “Your Digestive Health: Make it a Priority”, emphasising that prioritising digestive health is vital for promoting well-being and enhancing quality of life1.

We have all been exposed to common digestive complaints that can arise from food intolerances at one time or another; whether we have eaten something and felt a bit bloated or sluggish, or perhaps even experienced some changes in bowel pattern. This can be more frequent or associated with eating out, travelling, hormonal imbalance, or even because of lifestyle changes. For some, these symptoms can occur frequently or can be severe, which may result in many sufferers turning to the internet to look for fast, easy and convenient solutions. It is understandable why people get frustrated with their digestive health, especially with unpredictable episodes that affect the quality of life, and this can lead to the avoidance of social events, or cause anxiety around eating out.

Remember, it is important not to self-diagnose as a number of conditions can cause similar symptoms to irritable bowel syndrome (IBS) and food intolerances but will have different treatment and management. For this reason, it is important to visit your GP/Family Doctor who may recommend further evaluation.

Some of the common food intolerance symptoms experienced can arise from carbohydrate malabsorption such as from lactose malabsorption, fructose malabsorption and sucrose malabsorption.

The intestine can only absorb a limited amount of fructose; most people can absorb 25-50g of fructose per sitting. Fructose malabsorption is a dietary impairment of the small intestine, whereby there is a limitation in the fructose carrier system which transports this sugar across the cell membrane.

Fructose malabsorption is not a food allergy, meaning there is no production of IgE antibodies or release of histamine. There are generally no typical allergic symptoms such as itching or hives.

In the large intestine, the unabsorbed fructose is metabolised by normal colonic bacteria to short-chain fatty acids and the gasses hydrogen, carbon dioxide, and methane. The increase in hydrogen or methane gas is detected with the breath test.

Possible causes of fructose malabsorption include:

  • Inherited or acquired abnormality of fructose transporting protein GLUT-5 (other family members are often affected).
  • Overuse of High Fructose Corn Syrup, or fruit juices in children.
  • Small intestinal bacterial overgrowth (SIBO).
  • Coeliac disease.
  • Chemotherapy or radiation (damage of small intestinal mucosa).
  • Dumping syndrome (rapid gastric emptying)

It can be difficult to see a relationship between the foods eaten and the symptoms experienced; this is because most foods contain a mixture of glucose and fructose, and foods with a high glucose content can help to absorb fructose. One molecule of glucose enables the absorption of one molecule of fructose. An example of this is when fructose was given in the form of sucrose (sucrose = fructose + glucose), its absorption capacity was increased e.g., table sugar (50% fructose, 50% glucose). The greater the glucose-to-fructose ratio in the food, the easier the fructose will be absorbed.

Lactose is normally hydrolysed into glucose and galactose, which are readily absorbed in the jejunum. Lactose needs to be hydrolysed in the small intestine by a B-galactosidase lactase-phlorizin hydrolase, generally called lactase. Lactase is found most abundantly in the jejunum at the tip of the intestinal villi and therefore is more vulnerable to intestinal diseases that cause cell damage than other sugars, which are located deeper.

If the enzyme lactase is lacking (or if inadequate amounts are produced), the lactose will not be completely hydrolysed, and the resultant condition is lactose malabsorption (also referred to as lactase deficiency). It is the most common type of carbohydrate intolerance and is the most common genetic disorder affecting more than half the world’s population.

When poorly absorbed lactose reaches the colon, gases produced may cause distension, cramps, flatulence, and general discomfort, along with diarrhoea, which can range from mild to explosive discharge. These symptoms produce the condition lactose intolerance, which is lactose malabsorption with discomfort. Symptoms associated with lactose intolerance may be mild or severe depending on the degree of lactase deficiency and the amount of lactose consumed. Lactose malabsorption can be diagnosed with a hydrogen methane breath test (HMBT) that will measure the level of gases in exhaled breath samples.

The number of people with lactose malabsorption is surprisingly large. It is estimated that about 68% of the world’s population has lactose malabsorption. It is more common in certain areas of the world such as Asia and among African Americans, American Indians, and Hispanics.

There are different types or forms of lactose malabsorption:
Congenital Lactase Deficiency (CLD) is a rare genetic condition. In this type, there is a marked deficiency of lactase production, if any at all, in the small intestine from birth. It is caused when a baby inherits 2 ineffective genes from their parents (one from each).

Familial Lactase Deficiency is the result of a defective lactase enzyme protein. Unlike CLD, the level of lactase enzyme production is normal but since the genes are producing a defective enzyme, lactase is deemed dysfunctional and ineffective.

Primary lactase deficiency is a condition that develops over time. After about the age of 2, the body
begins to produce less lactase. It is the most common type of lactase deficiency.

Developmental Lactase Deficiency results from low lactase levels and is a consequence of prematurely born babies. Premature babies born 28-32 weeks of gestation will have reduced lactase activity.

Secondary lactase deficiency occurs when injury to the small intestine or certain digestive diseases reduce the amount of lactase a person produces e.g. coeliac disease, inflammatory bowel disease, and Crohn’s disease.When the epithelium heals, the activity of lactase returns.

Sucrose is a disaccharide composed of glucose and fructose. It is hydrolysed by the enzyme sucrase, an a-glucosidehydrolase, which is naturally occurring in the small intestine.

Some people with genetic sucrase-isomaltase deficiency (GSID) are often misdiagnosed with IBS. People with GSID cannot digest sucrose and maltose (sugar found in grains) and can have difficulty digesting starch. Symptoms range from mild to severe.

Importance of not self-diagnosing:
If you are suffering from food intolerances, this may mean that the enzymes in your gut responsible for breaking down the food particles are either deficient, defective, or there may be an issue with the mechanism that transports molecules through the small intestine.

This point is of great importance as some people want to take the reins on their health, and in some cases self-diagnose. In recent times, there has been a large increase in online devices available aimed at providing you with “diagnostic” results. This includes devices that encompass home testing apps with instant results.

While there are some home testing devices available that are overseen by appropriately qualified professionals, there are other heavily marketed devices aimed at those with common digestive symptoms that are not up to the same standard or have practitioner involvement.

In the absence of practitioner involvement, devices that are used to allow patients to self-test at home with instant results and self-interpretation could potentially lead to a misdiagnosis or inadvertently avoiding important food sources. You must remember that if a person is not properly adhering to the clinically recommended protocols for testing, residual food in the intestinal tract may be detected on home testing breath devices leading to inaccuracies.

This comes back to the point about experienced practitioner involvement, as you don’t want to see a
patient unnecessarily avoiding food groups like lactose just because they misinterpreted the report, did
not prepare for the test in accordance with recommended protocols, given misinformation/misinformed
how the device is intended to be used or did not conduct the test correctly.

When your digestive health is out of sync, foods are not agreeing with your gut, and you are feeling the
burden of your symptoms, before choosing a quick and self-guided approach it is important to talk with your medical practitioner. There are a lot of easy-to-use home tests available, but it is important they are sourced from a reputable health professional who is available to discuss the results with you and recommend appropriate follow-up

Hydrogen Methane Breath Testing (HMBT):

Utilising reliable diagnostic tools such as HMBT offers precise insights into the underlying causes of gastrointestinal symptoms, enabling healthcare professionals to formulate effective and tailored treatment plans. Bedfont® Scientific Limited manufactures the Gastrolyzer® range of non-invasive breath testing devices that help to detect gastrointestinal disorders, one breath at a time. The Gastrolyzer® range includes the Gastro+™ which measures H2 and the GastroCH4ECK device which measures H2, CH4, and O2. Both devices provide instant results, recorded in parts per million (ppm).

To learn more about how the Gastrolyzer® range can help support your patients with gastrointestinal
disorders, visit https://www.gastrolyzer.com/.

References:
1. World Digestive Health Day: WDHD 2024 [Internet]. WDHD. Cited 17th May 2024]. Available from: https://wdhd.worldgastroenterology.org/ongoing-wdhd-campaigns/wdhd-2024

Gastrointestinal disorders such as carbohydrate malabsorption and lactose intolerance can be diagnosed with the aid of hydrogen (H2) and methane (CH4) breath testing (HMBT). Bedfont® Scientific Limited manufacture the GastroCH4ECK® device which measures H2, CH4, and Oxygen (O2). Unlike other HMBT devices which measure carbon dioxide (CO2), the GastroCH4ECK® device measures O2 as it is a quality indicator for the breath sample1.

What is the role of O2 in HMBT:
When a patient comes in for a HMBT test, after recording their baseline results, the patient will digest a specific substrate which is metabolised by the bacteria in the small intestine which will start producing H2 and/or CH4 gas. H2, CH4, and O2 will then be monitored in intervals; the O2 measurement is important because it helps to ensure that the bacteria in the large intestine, rather than those in the mouth or stomach, are responsible for any gas production observed during the test.

The science behind O2 being measured:
The Earth’s atmosphere consists of around 78% nitrogen (N2), 20.9% O2, 0.93% argon (Ar), CO2 0.03%; with the rest being various gases2. When you breathe in, your body converts a percentage of O2 into CO2, which settles at the base of the lungs, known as an end-tidal sample. During HMBT, if the levels of O2 exceed 14%, it indicates that an end-tidal sample has not been achieved, likely due to dilution by dead space in the upper airway. In such cases, the GastroCH4ECK® device compensates for this discrepancy with a correction ratio which will be displayed onscreen.

The earliest use of recorded modern HMBT was in the 1970s, with the rationale that defined CO2 concentration of an end-tidal breath as 5% was published in the same decade3. Eventually, the O2 concentration measurement was adopted, and the O2 end-tidal breath was 14%. When completing a breath test with the GastroCH4ECK® device, an on-screen dial will help to guide the exhalation rate; keep the arrow pointing in the green section of this indicator throughout the test. The arrow will change colour as the O2 level in the breath sample reduces to the target 15%, at which point it will turn green and the test will automatically stop after 3 seconds. Once the test is completed, the final results will be shown onscreen H2 and CH4 measured in parts per million (ppm). The final results for the O2 percentage and correction factor have a visual indicator to help interpret results displayed as a traffic light system.

Quality of measuring O2:
The quality of measuring O2 in an HMBT is crucial for accurately assessing functions, especially related to gastrointestinal health. Standardised testing protocols help ensure uniformity across the different testing facilities. Consistent protocols for fasting duration, substrate administration, and sampling intervals will help enhance the reliability and comparability of test results. Regular calibration is necessary to maintain accuracy, ensuring that measurement devices function and provide results correctly.

In summary, the measurement of O2 for HMBT is crucial because it ensures the accuracy and reliability of the results. O2 levels can influence the production of H2 and CH4 in the gut, and impact the test results and treatment. Healthcare professionals can obtain more precise measurements, leading to better diagnosis and management of gastrointestinal conditions like small intestinal bacterial overgrowth (SIBO) and improving patient outcomes.

Testing:
Bedfont® manufactures the Gastrolyzer® range of non-invasive breath testing devices that help to detect gastrointestinal disorders, one breath at a time. The Gastrolyzer® range consists of the Gastro+™ which measures H2 and the GastroCH4ECK device which measures H2, CH4, and O2; both devices provide instant results recorded in ppm. To find out more about how you can support your patients with gastrointestinal disorders with the Gastrolyzer® range, visit https://www.gastrolyzer.com/.

References:
1. Lee SM, Falconer IH, Madden T, and Laidler PO. Characteristics of oxygen concentration and the role of correction factor in real-time GI breath test. BMJ Open Gastroenterology. 2021 Jun 1;8(1):e000640. DOI:10.1136/bmjgast-2021-000640.
2. The atmosphere [Internet]. National Oceanic and Atmospheric Administration. [Cited 19th April 2024]. Available from: https://www.noaa.gov/jetstream/atmosphere
3. Niu HC, Schoeller DA, Klein PD. Improved gas chromatographic quantitation of breath hydrogen by normalization to respiratory carbon dioxide. The Journal of laboratory and clinical medicine. 1979 Nov 1;94(5):755-63. PMID: 501202.
4. Wolfson MR, Shaffer TH. Cardiopulmonary physical therapy. Fourth Edition, 2004.

Did you ever have an exam or a competition and get that feeling of butterflies in your tummy?

Or did you receive bad news and felt sick, or may have even vomited?

Then you have experienced the communication pathway that happens between the gut and brain,
often referred to as the gut-brain axis.

Also known as our 2nd brain, scientists call this system the enteric nervous system (ENS) and it has around 100 million nerve cells lining your gastrointestinal tract. The nervous system also works closely with your endocrine and immune system.

Our second brain communicates back and forth with our big brain—

For many years, it was believed that anxiety and depression contributed to irritable bowel syndrome and other functional gut symptoms, but studies now show that it may also be the other way around.

When the gastrointestinal system is aggravated, it may send signals to the central nervous system that affect mood. There is a notable higher incidence of people with IBS and functional bowel problems that develop depression and anxiety.

The microbiome also plays an important role in the gut-brain connection. They produce many of the chemical neurotransmitters that transport messages between your gut and brain.

Irritable Bowel Syndrome, also known as IBS, is one of the most common and debilitating gastrointestinal disorders affecting around 10-15% of the population. It is a functional gastrointestinal condition that most often affects the lower digestive system.

No definite cause of IBS has been identified yet. However, gut inflammation, altered gut motility, gut hypersensitivity to certain foods, and disturbed gut microbiome are all considered to play a role in IBS.

A diagnosis of IBS can leave people feeling frustrated because of the lack of standard or quick solutions, but IBS affect people differently, and therefore a diagnosis of IBS does require support.

IBS is characterised by a group of symptoms which consistently occur together. The most common of these are stomach cramps, bloating, discomfort, diarrhoea, and constipation.

As a functional Gastrointestinal disorder, it comes in multiple forms:

  • IBS-C refers to IBS with constipation, and it is one of the more common types.
  • IBS-D is also called IBS with diarrhoea.
  • IBS-M includes mixed bowel habits, for example, alternating patterns of diarrhoea and constipation.
  • Post-infectious IBS occurs after a Gastrointestinal infection.

Mental stress, anxiety, certain foods, and hormonal changes are some known triggers for IBS symptoms. Other triggers may include alcohol, some medicines, infections, and sudden changes in routine such as travelling. The effects of IBS triggers vary from person to person, what may flare up IBS symptoms in one person may resolve IBS symptoms in others.

This again ties in the gut-brain connection, stress and anxiety affect your nerves and make your digestive system overactive. Patients with IBS often suffer the worst abdominal pain when they are stressed. Because of the interplay between our gut and our brain, IBS is not just about the physical symptoms but can be an emotional rollercoaster affecting every aspect of your daily life.

IBS affects more women than men, and the symptoms of IBS in women tend to be more severe than in men. One of the reasons is hormonal imbalances in the menstrual cycle. Many women with IBS see their IBS symptoms fluctuate with their menstrual cycle. That’s because the hormonal fluctuations that occur during different stages of the menstrual cycle impact gut functions, thereby altering IBS symptoms. However, IBS symptoms don’t always correlate with menstrual cycles in every woman and with other factors affecting IBS symptoms, the impact of hormonal fluctuations varies from person to person.

There is no permanent cure for IBS. Effective management strategies often involve a combination of dietary changes, stress reduction techniques, and sometimes medication to address both the physical and psychological aspects of these conditions. Please note that the effectiveness of these medicines and supplements may vary from person to person, and you’re recommended to consult your doctor before using them for IBS.

So, you think you may have IBS? We recommend consulting your doctor about your symptoms to make a diagnosis. Your doctor may recommend tests such as SIBO (small intestinal bacterial overgrowth), lactose intolerance test, or other diagnostic tests.

The relationship between IBS and SIBO:
To understand the relationship between SIBO and IBS, what we need to do is to first look at what SIBO means. SIBO stands for Small Intestinal Bacterial Overgrowth. It refers to the condition where there is an abnormal increase in the bacterial population of the small intestine resulting in a range of symptoms, for example, diarrhoea, abdominal bloating, and even may lead to malnutrition. So, the patients with SIBO suffer almost the same symptoms as the patients with IBS do. Some studies state that approximately 80% of the people clinically diagnosed as IBS have SIBO too.

Take home message:
IBS and SIBO can significantly impact mental health, often leading to anxiety and mood disturbances. Firstly, the production of excessive amounts of gases such as hydrogen and methane from the bacteria in the small intestine may contribute to bloating, discomfort, and abdominal pain, all of which can affect one’s mood, while the social implications of these conditions can exacerbate stress and anxiety.

Secondly, SIBO can disrupt the absorption of important nutrients like Vitamin B12 and serotonin precursors, which are crucial for mood regulation. Lastly, inflammation triggered by SIBO can influence the production of neurotransmitters like serotonin and dopamine, further exacerbating mood disturbances. Overall, addressing SIBO not only targets gastrointestinal symptoms but also holds the potential for improving mood and overall well-being.

BS Awareness Month and upcoming webinar:
Delve deeper into SIBO and IBS leading up to IBS Awareness Month in April with our upcoming webinar featuring Melissa Dooley. Join us for our upcoming webinar SIBO and IBS: How HMBT can aid in investigation and diagnosis on Tuesday 26th March 2024 at 19:00pm GMT. Learn about SIBO and IBS and explore how hydrogen and methane breath testing serves as a powerful tool in identifying and managing these gastrointestinal disorders while also contributing to awareness and discovering effective strategies for integrating them into clinical practice.

Local company Bedfont Scientific Ltd. unites forces with NewMed Ltd. as joint Headline Sponsors for Heart of Kent Hospice Bluebell Walk 2024/5

Kent med-tech manufacturer Bedfont is delighted to announce a strategic partnership with NewMed Ltd. as a joint headline sponsor for Heart of Kent Hospice.

Bedfont is proud to be known as a world leader in breath analysis, having specialised in designing and manufacturing breath analysis medical devices for over 47 years. Using innovative technology, Bedfont provides cutting-edge medical devices at affordable prices to improve accessibility and healthcare standards worldwide.

Jason Smith, Managing Director at Bedfont Scientific Ltd., comments, “As a business, Bedfont is always looking for ways to give back to the community through charity events and sponsorships. We are thrilled to be teaming up with NewMed as a PEMF supplier and Heart of Kent Hospice as a brilliant charity. Both NewMed and Heart of Kent Hospice align with our core values, and we believe that through this collaboration, we can make a lasting difference throughout Kent. This marks a new chapter in Bedfont’s ongoing commitment to corporate social responsibility, and we are eager to share the positive outcomes with the world.”

For over 33 years, Heart of Kent Hospice has been providing compassionate, end-of-life care to people with terminal illnesses and their loved ones in Maidstone, Aylesford, Tonbridge, Malling and the surrounding towns and villages.

David Dadswell, Corporate Partnerships Manager at Heart of Kent Hospice, explains, “Our vision is for everyone living with a terminal illness in our community to achieve the best quality of life. They are committed to achieving this by enabling those patients under our care to live comfortably, with independence and dignity to the end of their lives, and to support those closest to them. We are thrilled to have not one but two headline sponsors support us and our work. Bedfont and NewMed are impressive companies in our community whose focuses are improving healthcare and wellbeing – perfect matches for the Hospice.”

Andy Smith, Managing Director at NewMed Ltd.,adds, “Sponsoring Heart of Kent Hospice aligns with our mission of enriching lives through PEMF therapy. This dual collaboration demonstrates our dedication to fostering positive change in people’s well-being. We are looking forward to working closely with Bedfont and Heart of Kent Hospice to support our local community.”

Bedfont and NewMed’s first event as headline sponsors will be the annual Bluebell Walk, taking place this year on Sunday 5th May 2024. The annual event sees walkers of all ages enjoy a stroll through the Bluebells of the Kent Countryside. Both companies will be there to support Heart of Kent Hospice and take part in the walk themselves. To join them, register for the walk here: https://register.enthuse.com/ps/event/BluebellWalk2024

Wednesday 13th March 2024

National No Smoking Day, which has occurred annually since its integration with Ash Wednesday in 19841, has served as an annual reminder for individuals striving to quit smoking. In the United Kingdom, No Smoking Day holds significance with campaigns aimed at raising awareness about the health risks associated with smoking and encouraging smokers to quit. The goals of No Smoking Day include promoting smokefree environments, supporting smoking cessation services, and advocating for stricter tobacco control measures to protect public health. This article aims to explore the current challenges faced by those seeking to quit smoking in the UK and educate future generations about the evolving laws surrounding tobacco control policies and the sale and purchase of tobacco products.

In 2019, the UK government released a green paper, announcing that the 2020s will be the decade of proactive, predictive, and personalised prevention2, setting an objective for England to be
‘Smokefree’ by 2030 by reducing adult smoking to 5% or less3, and increasing the legal age to smoke for those born after 2008. Additionally, as of January 2024, the government has announced that by the end of 2025, disposable vapes will be banned to protect children’s health, due to how easily accessible they are. The government also plans to introduce plain packaging and restrict flavours as most vapes come in sweet flavours. 

With these new massive law-enforced restrictions that will soon be introduced in England, there are still challenges that we face with smoking  cessation including cultural, educational, social, and future challenges.

Current and Future Challenges

Cultural Challenges: 

In England, smoking rates among ethnic minorities are lower rates than Caucasian groups, but the rates within ethnic groups are often gendered with men generally higher than women4. In 2019 smoking habits had a large difference in sex in Asian (13.9% in men and 2.9% in women), Chinese (12.6% in men and 4.0% in women), and black (12.9% in men and 6.9% in women) groups5. Other forms of tobacco are more common in some ethnic groups, shisha (waterpipe) use in 2012-2013 was estimated to be frequently used by about 1% of the British population, with higher rates  in Asian (7%), mixed (5%), and Black (4%) groups6. The smoking cessation process can pose difficulty when people have recently immigrated to the UK from countries that had higher smoking rates where there are different legal and cultural frameworks taken to tobacco use4.

Educational Challenges:

To help with smoking cessation in the UK, healthcare professionals should be able to advise smokers on how to quit smoking; a short survey conducted by Hunter et al. (2019) aimed to identify the extent of smoking cessation teaching and examination in 21 UK pharmacy schools. The survey concluded that there was a lack of training on the management of pregnant smokers and mental health patients who smoke. It was documented that 11 (52%) schools taught about the management of pregnant smokers and 3 (14%) schools taught about the management of mental health patients  who smoke. Smoking during pregnancy is the most preventable cause of adverse pregnancy health outcomes, with half of the pharmacy schools teaching about this. There was also little attention given to mental health patients who smoke, pharmacists need to provide support to vulnerable populations7.

The limited education provided to pharmacists regarding the management of pregnant smokers and mental health patients who smoke may result in a lack of accessibility to smoking cessation support for future patients. The lack of understanding regarding the harms of smoking could lead to significant repercussions.

Social Challenges:

Smoking used to be considered as a social activity, however a 12-year follow-up study by Phillip et al. (2022) found that smokers were more likely to be lonely and socially isolated compared to non-smokers. With a sample size of over 8000, with a mean age of 67 years old, this observational study found that smokers were more likely to be lonely and socially isolated than non-smokers, having less frequent social interactions with friends and family, less frequent engagement with the community and cultural activities, and being more likely to live alone8.

The idea of smoking being a social activity may be a misconception, with insufficient social support can be a challenge when trying to quit smoking, as individuals not surrounded by friends and family may not find the motivation to stay smoke-free.

Future Challenges: 

As the next generation will not legally be able to buy tobacco products, this could create a gap in education and awareness. Without ongoing efforts to educate young people about the dangers of smoking and the benefits of being smoke-free, they may not fully understand the harm it can cause. While the accessibility to tobacco products is already restricted in shops, minors could still be exposed to environments where smoking is normalised, such as having a parent who legally smokes. Without continued education, the future generation might not understand why they legally cannot smoke. With tobacco prices already high and set to rise more to deter smokers, those who still wish to smoke tobacco or sell tobacco products without paying taxes can turn to the illegal importation of tobacco which is sold at cheaper rates on the black market. As of 2020-2021, it is estimated that 16% of cigarettes purchased in the UK were from the black market9. The number of children using vapes has tripled in the last three years with 69% of current vapers aged 11 to 17 years old10. With the upcoming ban on tobacco products and the upcoming ban on disposable vapes, there is still access to non-disposable and refillable vape kits being sold, as well as the existing black market of disposable vapes in corner shops that are illegally imported11

Those born after 2008 may encounter different challenges related to smoking compared to the previous generations so there needs to be continual regulations, education, and support to advance to smokefree UK.

Carbon Monoxide (CO) testing: 

Bedfont® Scientific Ltd. manufactures the Smokerlyzer® range, non-invasive breath testing devices measuring carbon monoxide (CO) to help people stop smoking, one breath at a time. The Smokerlyzer® range consists of the Micro+™, piCObaby™, piCO™, and the homecare CO device the iCOquit®. All devices provide instant results with a traffic light system making CO levels identifiable to patients, whilst acting as a motivational tool to help them quit smoking. In addition to behavioural support and nicotine replacement therapy (NRT), CO devices have been integrated into stop-smoking programmes for years, used as a bio-verification tool that can identify CO on the breath (produced by incomplete combustion burning of tobacco products) and therefore confirm abstinence from traditional tobacco smoking, in addition to being used as a motivational tool for smokers.

To find out more about how you can support families with smoking cessation, visit https://www.bedfont.com/smokerlyzer

References:

1. National No Smoking Day [Internet]. UK Parliament. 2023. [Cited Friday 23rd February 2024]. Available from: https://commonslibrary.parliament.uk/research-briefings/cdp-2023-0056/#:~:text=National%20no%20smoking%20day%20has,supported%20by%20Alzheimer’s%20Research%20UK

2. Advancing our health: prevention in the 2020s- consultation document [Internet]. GOV.UK. 2019. [Cited Wednesday 31st January 2024]. Available from: https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the- 2020s/advancing-our-health-prevention-in-the-2020s-consultation-document

3. The Smokefree 2030 ambition for England [Internet]. House of Commons Library. 2023. [Cited Wednesday 31st January 2024]. Available from: https://researchbriefings.files.parliament.uk/documents/CBP-9655/CBP-9655.pdf

4. Tobacco and Ethnic Minorities [Internet]. ASH. 2019. [Cited Friday 2nd February 2024]. Available from: https://ash.org.uk/uploads/ASH-Factsheet_Ethnic-Minorities-Final-Final.pdf?

5. Adult smoking habits in the UK: 2019 [Internet]. Office for National Statistics. 2020. [Cited Friday 2nd February 2024]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies…

6. Akl EA, Gunukula SK, Aleem S, Obeid R, Jaoude PA, Honeine R, Irani J. The prevalence of waterpipe tobacco smoking among the general and specific populations: a systematic review.
BMC public health. 2011 Dec;11(1):1-2. PMID: 21504559 PMCID: PMC3100253 DOI:10.1186/1471-2458-11-244.

7. Hunter A, Bobak A, Anderson C. A survey of smoking cessation training within UK pharmacy education. Currents in Pharmacy Teaching and Learning. 2019 Jul 1;11(7):696-701. PMID:
31227092 DOI: 10.1016/j.cptl.2019.03.007.

8. Philip KE, Bu F, Polkey MI, Brown J, Steptoe A, Hopkinson NS, and Fancourt D. Relationship of smoking with current and future social isolation and loneliness: 12-year follow-up of older
adults in England. The Lancet Regional Health–Europe. 2022 Mar 1;14. DOI:10.1016/j.lanepe.2021.100302.

9. Outputs for April 2021 to March 2022 [Internet]. GOV.UK. [Cited Tuesday 13th February 2024]. Available from: https://www.gov.uk/government/publications/annual-outputs-for-tacking-tobacco-smuggling/outputs-for-april-2021-to-march-2022#:~:text=The%20government%20has%20had%20a,cigarettes%20and%20hand%2Drolling%20tobacco.

10. Department of health and social care media centre [Internet]. GOV.UK. 2024. [Cited Friday 2nd February 2024]. Available from: https://healthmedia.blog.gov.uk/2024/01/30/creating-a-smokefree-generation-and-tackling-youth-vaping-what-you-need-to-know/

11. The UK disposable vape ban: Impacts and alternatives [Internet] Vape Superstore. 2024. [Cited Friday 2nd February 2024]. Available from: https://www.vapesuperstore.co.uk/blogs/news/are-disposable-vapes-being-banned-in-the-uk

A history of Fractional exhaled Nitric Oxide (FeNO) testing: where it all began

The story of FeNO began in the 1990s after it gained a lot of interest from researchers in the potential it posed as a non-invasive biomarker for airway inflammation. When airways are inflamed, Nitric Oxide (NO) is naturally produced by your body to help combat inflammation. This production of NO was observed by researchers to be significantly higher in patients with asthma. Researchers initially used a technology called ‘chemiluminescence’, to undertake research into FeNO and asthma. Over time, as FeNO testing evolved, so did available technologies on the market, and FeNO testing with electrochemical sensors was introduced as a more robust and cost-effective solution.

Chemiluminescence vs electrochemical FeNO technology: why electrochemical sensor technology is now considered ‘gold standard

Both chemiluminescence and electrochemical sensor technology is adopted as a means of measuring and quantifying levels of nitric oxide in exhaled breath. Although both technologies are incredibly accurate and reliable when measuring exhaled nitric oxide, they both have note-worthy differences9. Whilst considered a highly sensitive and specific method for testing exhaled nitric oxide, chemiluminescence technology has some significant drawbacks, including the costly nature of the technology, and the additional complexity of using chemiluminescence devices9.

Chemiluminescence technology often requires additional specialist training as well as extra requirements for regular maintenance and calibration, which can lead to significant hikes in operational costs. Additionally, the size and portability of chemiluminescence devices are often at a disadvantage, as devices tend to be very bulky and less portable in comparison to other FeNO technologies such as electrochemical FeNO technology9.

Because of the difficulties chemiluminescence technology presented for widespread adoption in clinical practice, electrochemical technology was considered an alternative technology for carrying out FeNO testing in secondary and primary care. A number of studies were carried out comparing chemiluminescence technology to electrochemical technology, which found that there was a good correlation between the two technologies. A revolutionary finding, due to the cost-effective, accurate and portable nature of electrochemical technology for FeNO testing.

Electrochemical Technology and NObreath®: Dawn of A New Era

The need for more cost-effective, portable, and accurate solutions for FeNO testing was found in electrochemical technology, and a flurry of innovation from med-tech industries ensued, the NObreath® was born.

The NObreath® was developed by Bedfont® Scientific Ltd. in 2008, reflecting on over 10 years of FeNO development. Taking into consideration any obstacles current FeNO technology highlighted on market, the aim for Bedfont® was to develop the ultimate FeNO test solution, creating an electrochemical FeNO device developed with health care providers and patients in mind.

NObreath® vs alternative electrochemical FeNO technologies on the market: are they just as accurate?

NObreath® has been developed with accuracy and repeatability in mind and has been subject to the stringent processes of CE, FDA, CFDA and PMDA clearance (to name but a few) as part of their respective product registration and have also been shown in clinical research to result in excellent repeatability, reproducibility and comparability.

Additionally, the NObreath® device’s electrochemical sensor has been validated against chemiluminescence technology and has shown a good correlation between both technologies7. The NObreath® has been subject to many clinical studies and case study write-ups proving its accuracy and repeatability.

Further to clinical studies, case studies, and scrutiny by a number of different regulatory bodies, NObreath® has been subject to a number of lab condition tests to ensure accuracy, repeatability and stability of the electrochemical sensor, for up to 29,000 tests*, giving patients and healthcare professionals continued and accurate use with the NObreath®.

Finally, in addition to FeNO testing being a widely adopted test for airway inflammation in asthma patients such as ATS and ERS FeNO guidelines1, the NObreath® is one of three FeNO devices recommended by NICE5, an independent international organisation responsible for driving improvement and excellence in the health and social care system.

NObreath®: Breaking barriers in innovation and accessibility for all

NObreath® breaks barriers with its innovative features, making NObreath® the device of choice for healthcare providers.

Instant results

Why wait? Save precious clinic time with the NObreath® by receiving an instant and accurate FeNO test result.

No nonsense’ pricing for a cost-effective solution

NObreath® prides itself on being the most cost-effective FeNO solution on the market, by providing competitive pricing for mouthpieces and NObreath® devices. This is in addition to a long shelf life for mouthpieces, making test per patient the most cost-effective solution for operational overheads, increasing accessibility to all.

Incentive flow rate

The NObreath® has a selection of incentive flow rates suitable for all ages, to ensure patients exhale to a flow rate of 50ml/s for optimal and accurate FeNO testing.

FeNO testing without limits

The NObreath® has been designed to ensure continued use, meaning your device can be used over and over again**, reducing cost to your clinic, and limiting wastage for better environmental sustainability. Furthermore, to ensure continued use of your NObreath®, our easy ‘plug and play’ components mean healthcare professionals can easily maintain the NObreath® on-site without having to delay or suspend clinics due to off-site servicing or delay in having to purchase a new FeNO device.

Integrated infection control

The NObreath® device has integrated antimicrobial technology, in addition to integrated bacterial and viral filters in the NObreath® mouthpieces for improved infection control. Simple exhalation-only technique.

Simple exhalation-only technique

The exhalation-only technique on the NObreath® makes FeNO testing easy for all. There is no need to inhale through the device, as our partitioning method ensures any ambient NO is removed from the breath sample. As the breath sample enters the NObreath®, the first few seconds are partitioned and vented through the monitor bypassing the sensor chamber. After the partition period has elapsed, the pump will begin to draw the remaining viable sample into the sensor chamber, where the breath sample will be analysed in real-time. As the sensor measures the sample in real-time, by the end of the test, the result is instantly shown onscreen. Removal of potential environmental NO is advised by ‘ATS/ERS recommendations 2005 for standardized procedures for the measurement of exhaled nitric oxide (FeNO) testing’1, so you can have peace of mind that your FeNO result is accurate and dependable. Learn more about our partitioning method here: https://www.nobreathfeno.com/measuring-feno-with-the-nobreath/

Electrochemical technology: The new ‘gold standard’ for FeNO testing

The evidence showing the comparison to the NObreath® electrochemical FeNO device is directly comparable to chemiluminescence technology and other available electrochemical FeNO technology on the market; you can be sure that you own the ultimate FeNO test solution, an easy-to-use exhalation-only device, providing health care professionals with accurate and reliable results, utilising ‘gold standard’ and cost-effective electrochemical technology, with added portability for clinic use, and much more.

Visit https://www.nobreathfeno.com to find out how you can support your patients with FeNO monitoring, with the NObreath® from Bedfont® Scientific Ltd.


*Subject to correct use, maintenance and servicing
** Subject to 29,000 tests


References:

1. American Thoracic Society and European Respiratory Society. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide. American Journal of Respiratory and Critical Care Medicine. 2005;171(8):912-930.

2. Inoue Y, Sato S, Manabe T, Makita E, Chiyotanda M, Takahashi K, Yamamoto H, Yanagida N, and Ebisawa M. Measurement of exhaled nitric oxide in children: A comparison between NObreath® and NIOX VERO® analyzers. Allergy, asthma and immunology research. 2018;10(5):478-489.

3. Harnan SE, Tappenden P, Essat M, Gomersall T, Minton J, Wong R, Pavord I, Everard M, and Lawson R. Measurement of exhaled nitric oxide concentration in asthma: A Systematic review and economic evaluation of NIOX MINO®, NIOX VERO®, and NObreath®. Health Technology Assessment. 2015;19(82):1-330.

4. Kang SY, Lee SM, and Lee SP. Measurement of fractional exhaled nitric oxide in adults: comparison of two different analysers (NIOX VERO® and NObreath®). Tuberculosis and Respiratory Diseases. 2021;84(3):182-187.

5. National Institute for Health and Care Excellence. Measuring fractional exhaled nitric oxide concentration in asthma: NIOX MINO®, NIOX VERO®, and NObreath®[DG12]. 2014. Available from: https://www.nice.org.uk/guidance/dg12/chapter/5-Outcomes

6. Pisi R, Aiello M, Tzani P, Marangio E, Olivieri D, and Chetta A. Measurement of fractional exhaled nitric oxide by a new portable device: comparison with the standard technique. Journal of Asthma. 2010;47(7):805-809.

7. Antus B, Horvath I, and Barta I. Assessment of exhaled nitric oxide by a new hand-held device. Respiratory Medicine. 2010;104(9):1377-1380.

8. Yune S, Lee JY, Choi DC, and Lee BY. Fractional exhaled nitric oxide: Comparison between portable devices and correlation with sputum eosinophils. Allergy, Asthma and Immunology Research. 2015;7(4);404-408.

9. Maniscalco M;Vitale C;Vatrella A;Molino A;Bianco A;Mazzarella G; M. Fractional exhaled nitric oxide-measuring devices: Technology updateMauro [Internet]. U.S. National Library of Medicine; 2016 [cited 2023 Nov 22]. Available from: https://pubmed.ncbi.nlm.nih.gov/27382340/

After the festive season, taking care of your gut health is vital. This time of year is one for feasting, socialising, and spending time with friends and family. However, it also means significant changes in regime and diet. For some, the festive season brings challenges in the form of dietary concerns and gastro symptoms. Thus, it is no surprise that studies show that about one-third of people experience digestive issues during this period.

Many people experience issues like abdominal pain, bloating, diarrhoea, and indigestion. There are multiple reasons for digestive problems during the festive season.

This time of year often results in overindulgence in food, significant dietary changes, consuming foods that a person does not regularly consume and mixing different foods.

This is not to suggest that one should not enjoy the time. However, if you are better prepared, you can likely manage most gastrointestinal issues using home remedies or over-the-counter medications. Moreover, taking timely action may help prevent more severe consequences and a visit to a doctor.

Hence, to manage gastro symptoms effectively, it is vital to understand its causes and what part of the gastrointestinal tract is affected. It could be the upper part, the middle part, or the lower part of the digestive system.

Issues of Upper Gastrointestinal Tract

One can consider the oesophagus (food pipe) and stomach as the upper parts of the gastrointestinal tract. Even though digestion begins in the mouth, most digestive processes start in the stomach, where several digestive enzymes and hydrochloric acid are secreted.

Overeating or eating certain kinds of foods, like those high in fats or consuming too much alcohol, may cause stomach pain, heartburn, and bloating.

One of the most common issues people experience during the festive season is Gastro-oesophageal reflux disease (GORD), which can result in upper gastric symptoms. Certain foods and alcohol may also damage the upper lining of the stomach.

GORD can cause burning chest pain (located in the middle of the chest and may radiate towards the back). Some may even confuse it with heart pain.

It mainly occurs due to the high production of acid in the stomach. Some of this acid makes its way to the lower part of the esophagus, causing pain or heartburn. Overeating or consuming certain foods may loosen the lower oesophageal sphincter (valve), which prevents the backflow of the stomach’s content towards the food pipe.

Most cases of GORD can be managed with great success. One can benefit significantly from over-the-counter medications such as antacids which neutralise the acid and provide almost immediate pain relief. Additionally, one may benefit from other natural remedies like chamomile, licorice and by drinking different teas. It’s important for individuals with GORD to practice moderation and choose lighter, less acidic options when possible.

Mid-Gastrointestinal Tract or Small Intestine Issues

Understanding that most digestive processes occur in a small intestine is vital. Absorption of most nutrients also happens in this part of the intestine.

If you experience bloating, gas, pain in the centre of the abdomen, discomfort, changes in appetite, or mild diarrhoea, then all these issues are likely to be associated with the small intestine. These problems may be due to malabsorption/food intolerance, local infection, or even due to local irritation.

The small intestinal issue often tends to be chronic and many people may benefit from commonly available remedies like digestive enzymes.

For individuals that have food allergies or intolerances, such as wheat, milk, fish, soy, sesame or nuts, this season can be particularly challenging, with hidden ingredients and cross-contamination becoming more prevalent in shared meals. Careful reading of labels and open communication with hosts can help those with food allergies enjoy their food safely.

For those with coeliac disease, there is a greater risk of gluten contamination during the holiday season with traditional foods like stuffing and sauces. Opting for gluten-free alternatives and educating loved ones about the importance of cross-contamination prevention.

One of the chronic issues affecting the small intestine is small intestine bacterial overgrowth or SIBO. This occurs due to an overgrowth of bacteria that are normally present in the small intestine. SIBO may be associated with irritable bowel syndrome, pancreatic issues, and intestinal motility issues. Studies suggest that a high prevalence of patients diagnosed with IBS have small intestinal bacterial overgrowth.

If someone continues to experience issues like frequent bloating and abdominal discomfort, it is advisable to consult with your doctor who may use some more specific tests to diagnose the condition. For example, a hydrogen methane breath test (HMBT) is an important diagnostic investigation for confirming SIBO, and to check if there is a malabsorption or food intolerance present. One such example is the ability of the HBMT to check for lactose malabsorption. This is one of the most common types of carbohydrate malabsorption in the world affecting more than half the world’s population. Symptoms may be mild or severe depending on the degree of lactase deficiency and the amount of lactose consumed.

Most of these intestinal issues are treated through dietary changes, certain medications, and using health supplements. Additionally, some may also benefit from a low FODMAP diet.

Lower-Gastrointestinal Tract or Large Intestine Issues

In this part of the intestine, absorption of water and some vitamins occurs. The final processing of foods happens in the large intestine before their elimination. The large intestine is also rich in microbiota, which has numerous roles in health.

Disturbances of the large intestine are most likely to cause chronic diarrhoea or even constipation. It may also cause pain if you are living with inflammatory bowel disease. One should keep in mind that dietary changes during the festive season may exacerbate inflammation.

There are a few ways to take care of your large intestine, like drinking ample water and being aware of your dietary fibre intake.

If you are living with inflammation, it is worth remembering that any dietary changes may cause worsening symptoms or flares. To prevent such issues, it is better to consult a doctor, as managing IBD is quite challenging.

The Bottom Line

Significant dietary changes and feasting during the festive season cause changes in gastrointestinal function in most individuals. Fortunately, most of these changes do not require medical attention and can be managed through home remedies or over-the-counter medications.

However, in some cases, issues like bloating, diarrhoea, abdominal pain, and discomfort become chronic. In such instances, it is a good idea to seek medical attention. Many of these issues occur due to food intolerance, IBS, SIBO, and other similar conditions. In many instances, hydrogen-methane breath testing is of significant help. Hydrogen and methane breath testing is also a valuable diagnostic tool that can support the management of gastrointestinal symptoms and dietary challenges during this period, allowing for better symptom control and informed decision-making.

Before attending a gathering, communicate with your host about your dietary restrictions, concerns, and allergies. This can help them to provide alternatives and prevent cross-contamination. Stay hydrated by drinking water throughout the day as hydration is crucial for good digestion and can help prevent constipation. Being mindful of portion sizes can help to prevent overindulging. Remember that enjoying your favourite treats is okay, but moderation is key.

By understanding the impact of seasonal foods on various gastrointestinal symptoms and conditions, people can make informed choices, communicate their dietary needs, and enjoy the festive season to the fullest.

The festive season, adorned with twinkling lights and joyous gatherings, graces our tables with an array of delightful treats. However, for those grappling with gastrointestinal conditions, this time of year feast brings forth unique challenges. In this seasonal article, we embark on a journey to explore the impact of food on gastro symptoms and discover the invaluable role of Hydrogen and Methane Breath Testing (HMBT) in managing these challenges.

The Yuletide Culinary Extravaganza: The festive season is synonymous with indulgence, featuring a tapestry of rich, decadent dishes that can trigger gastrointestinal symptoms. From creamy mashed potatoes to buttery desserts, the abundance of high-fat and high-sugar foods poses a challenge for those with sensitive digestive systems.

A Culinary Journey Across the UK of Traditional Delights: Let’s embark on exploring the traditional foods of each country in the United Kingdom, along with some insights into their unique traditions and how these might impact digestive health.

1. England:

  • Traditional Food: Roast Beef and Yorkshire Pudding, Fish and Chips, Full English Breakfast.
  • Tradition: Afternoon Tea, a quintessential English tradition featuring tea, sandwiches, and pastries.
  • Impact on Digestive Health: Some may find the richness of traditional English dishes, especially those high in fat, challenging for digestion.

2. Scotland:

  • Traditional Food: Haggis, Neeps, and Tatties (turnips and potatoes), Scotch Broth.
  • Tradition: Hogmanay, the Scottish New Year’s celebration, often involves festive meals and customs.
  • Impact on Digestive Health: Haggis, a savoury pudding, may contain various ingredients, and individual tolerance can vary.

3. Wales:

  • Traditional Food: Welsh Rarebit, Cawl (a traditional soup), Bara Brith (fruitcake).
  • Tradition: The Eisteddfod, a cultural festival celebrating Welsh arts and literature, includes traditional foods.
  • Impact on Digestive Health: Rich and hearty dishes like Welsh Rarebit may be heavy for some digestive systems.

4. Northern Ireland:

  • Traditional Food: Ulster Fry (similar to Full English Breakfast), Irish Stew, Wheaten Bread.
  • Tradition: The Twelfth, a Protestant celebration, often involves communal meals.
  • Impact on Digestive Health: Traditional Irish Stew with lamb and vegetables is generally well-tolerated.

Ranking in Terms of Impact on Digestive Health: Considering individual digestive tolerance, it’s challenging to provide a definitive ranking. However, generally speaking, traditional dishes in Wales and Northern Ireland might be perceived as somewhat lighter compared to the richer and heartier offerings in England and Scotland.

A Neurological Journey of Pleasure: The seasonal indulgence in festive foods is not merely a matter of tradition; it has a profound neurological impact that contributes to the joy and comfort associated with these culinary choices.

Take, for instance, the rich and hearty fare of Scotland. Traditional dishes like haggis, neeps, and tatties are more than just a feast for the taste buds; they evoke a sense of home and nostalgia. The brain, in response to familiar and comforting flavours, releases neurotransmitters like dopamine and serotonin, creating a pleasurable experience that goes beyond the immediate taste.

In Wales, the emphasis on ingredients like lamb and leeks in dishes such as cawl reflects a connection to the land and local agriculture. Consuming these foods during the festive season triggers a neurological response tied to cultural identity and a deep-rooted sense of community. The brain perceives these flavours as not just sustenance but as a reaffirmation of cultural belonging, fostering a positive emotional response.

Moving to Northern Ireland, the fondness for Ulster Fry during the festive season is a sensory experience that goes beyond the plate. The sizzle of bacon, the aroma of fresh soda bread, and the savoury taste of potato bread collectively stimulate the brain’s reward centres. The anticipation and enjoyment of these familiar flavours release endorphins, creating a sense of happiness.

In England, the Christmas pudding, with its blend of spices, dried fruits, and a generous splash of brandy, is a sensory delight. This traditional dessert engages the brain through olfactory and gustatory stimuli. The combination of festive aromas and complex flavours activates the limbic system, responsible for emotions and memory, contributing to a sensory-rich experience.

Gastro Grumbles – The Impact of Festive Foods:

1. Carbohydrate Overload: As we delve into the heart of traditional seasonal fare, laden with carbohydrates, we encounter a dual challenge for individuals with digestive conditions like lactose intolerance or fructose malabsorption. The digestive system contends with potential issues such as bloating, gas, and abdominal discomfort. Simultaneously, the influx of carbohydrates influences the gut microbiome, serving as a substrate for microbial fermentation. This intricate interaction extends beyond digestion, as the brain’s reward centres respond to indulgence in carb-laden delights, experiencing a temporary boost in mood. The release of neurotransmitters like serotonin contributes to both digestive and neurological experiences, highlighting the interconnectedness of our gut, brain, and microbiome.

2. Fatty Feasts: Roasts, velvety gravies, and decadent desserts take centre stage, not only delighting the palate but also affecting the gut microbiome. Individuals with gallbladder issues or difficulties in fat digestion may experience symptoms like nausea, bloating, and diarrhoea. Fats, acting as substrates for microbial metabolism in the gut, influence the composition of the microbiome. This microbial interplay extends to the brain, triggering the release of dopamine, the pleasure neurotransmitter. The holistic impact on the digestive system, brain, and microbiome underscores the complex web of connections affected by festive fatty feasts.

3. Sugar Rush: Sweet treats, a staple during this time of year, pose a challenge for those with conditions like irritable bowel syndrome (IBS). The surge in sugar intake exacerbates digestive symptoms, causing pain and discomfort while concurrently influencing the gut microbiome. Sugar serves as a substrate for microbial activity, affecting the diversity and balance of gut bacteria. At the neurological level, the brain responds to the sugar rush by releasing endorphins, creating a fleeting sense of happiness. This multifaceted impact on the digestive system, brain, and microbiome highlights the intricate relationship between festive indulgences and the comprehensive well-being of our gut health.

4. Chocolate Delights: Amidst the festive spread, the allure of chocolate takes centre stage, captivating taste buds and contributing to the symphony of seasonal delights. While this beloved treat is a source of joy for many, its impact on digestive health can vary. For individuals with conditions like irritable bowel syndrome (IBS), the richness of chocolate may pose challenges, potentially triggering discomfort and digestive distress. On a neurological level, however, the consumption of chocolate triggers the release of endorphins and serotonin, eliciting feelings of pleasure and contentment. The complex interplay between the digestive system and the brain during the indulgence in chocolate adds a nuanced layer to the festive experience, reminding us that even the smallest treat can have both delightful and varied effects on our well-being.

HMBT: A Gift for Gastrointestinal Health: Enter Hydrogen and Methane Breath Testing, a tool, not so much as part of festive activities or gifts, is used for diagnosing conditions like Small Intestinal Bacterial Overgrowth (SIBO) and carbohydrate malabsorption. During the holiday season, HMBT can offer insights into how our bodies respond to the festive feast.

1. Monitoring Carbohydrate Intolerance: HMBT emerges as a valuable ally in identifying carbohydrate intolerance. Individuals experiencing bloating or discomfort after meals can undergo HMBT to pinpoint specific carbohydrates causing distress, enabling them to make informed dietary choices.

2. Unravelling Fats and Gases: The excessive consumption of fatty foods during the festive season can lead to the production of gases in the gut. HMBT, with its ability to detect hydrogen and methane levels, can assist in understanding the impact of fat-rich meals on digestive processes.

3. Personalised Dietary Guidance: Armed with HMBT results, individuals can collaborate with healthcare professionals to create personalised dietary plans. This empowers them to enjoy the festive season without compromising digestive well-being.

Tips for a Digestive-Friendly Festive Season:

  1. Moderation is Key:

Enjoy the festive spread but in moderation. Limiting portion sizes can help prevent overwhelming the digestive system.

  1. Mindful Eating:

Slow down and savour each bite. Mindful eating not only enhances the dining experience but can also aid digestion.

  1. Choose Wisely:

Opt for dishes that align with your dietary needs. If you have identified specific triggers through HMBT, make conscious choices.

  1. Stay Hydrated:

Adequate water intake supports digestion. Ensure you stay hydrated, especially if your meal is rich in salt or sugar.

Conclusion:

As we gather around the festive table, let’s not forget the importance of digestive health. By understanding the potential impact of festive foods and incorporating tools like HMBT into our wellness strategies, we can make the festive season both joyful and comfortable.

Note: This article is intended for informational purposes only and should not be considered as medical advice. Individuals with specific dietary concerns or health conditions should consult healthcare professionals for personalised guidance.

As we enter the winter months and it becomes cold outside, the air we breathe is dry and the protected fluid in our lungs evaporates. This environmental change triggers the muscles within our lungs to spasm as they work to maintain open airways, resulting in increased tightness and difficulty breathing. While asthma symptoms persist throughout the year, they can escalate during winter, aggravating issues such as chest pain, coughing, shortness of breath, chest tightness, and wheezing1.

Asthma is recognised in part by the variability of symptoms. Indeed, this variability is a key consideration in making the diagnosis of asthma2. Once a diagnosis is confirmed, asthma symptoms can continue to demonstrate variability. This variability may be unpredictable and unexpected due to the natural disease process, or more predictable because of exposure to individual triggers.

Asthma guidelines state that if symptoms worsen, the clinician should check adherence with prescribed medication, check inhaler technique and remove triggers2. This may be overlooked when increasing doses of inhaled medication or prescribing additional medications. It is worth thinking about how this can be done in practice.

Medication adherence can be a tricky subject to bring into the consultation. It is a complex mix of patients’ health beliefs or misjudgement of their condition3,4 and can also be influenced by cultural beliefs5. It is a fascinating subject and worth looking into in more depth to get an understanding of why some people will not take prescribed medication whether it is an intentional decision or a non-intentional action. The attitude and experience of the prescribing clinician can also influence a patient’s decision to adhere to a prescribed medication regimen6.

One of the strategies we tend to use to assess adherence is to look at the prescribing history – has the patient been prescribed adequate treatment (inhaled steroid-containing inhaler) to be taking it regularly as prescribed? Has the patient ordered excessive amounts of rescue medication (Salbutamol or Terbutaline) indicating poor symptom control? The national review of asthma deaths7 found these measures were potential contributors to mortality. Salbutamol overuse is the focus of the global social movement Asthma Right Care8, in part because of the recognised link between the overuse of rescue medication and the increase in asthma mortality and morbidity.

Another approach that can help when assessing adherence with inhaled corticosteroids is to measure fractional exhaled nitric oxide (FeNO). This measures eosinophilic airway inflammation which is a key component of most asthma types. If inhaled corticosteroids are taken regularly using the correct inhaler technique, this inflammation should be controlled unless a dose increase or addition of add-on therapy is required. If the patient is not taking regular treatment or is taking it using a poor technique, the airways will demonstrate this inflammation. If the test is undertaken following a clear explanation of what asthma is, how inhalers work and what the test will measure, the discussion on inhaler use has a good basis to work from – many people with asthma do not understand the disease process and how inhalers work so do not take them regularly. For those who are adherent with medication who can demonstrate good inhaler technique, a raised FeNO level may be an indication of the need to increase or add in medication.

Suboptimal inhaler technique is a common cause of increasing asthma symptoms and poor asthma control, yet is very common9. According to the systematic review published in 2016, only 31% of patients can use an inhaler correctly, and the inhaler technique has not improved over the past 40 years10.

Guidelines emphasize the importance of correct inhaler technique before escalating treatment2, yet many healthcare practitioners are not confident or indeed competent in checking and coaching patients to optimise the use of inhalers. To address this, the UK Inhaler Group have produced a Standards and Competency document11 to guide and encourage appropriate teaching and coaching of inhaler technique.

Checking the correct inhaler technique and assessing adherence with prescribed medication are 2 of the basics to check if a person presents with increasing asthma symptoms (not sudden acute asthma) especially if the person is found with raised FeNO levels.

The third element is to discuss and, where possible, eliminate asthma triggers. Whilst asthma has a natural variability which can often be unexpected and unpredictable, there are more obvious triggers that may be specific to the individual and will be known to increase asthma symptoms. There are a wide range of triggers from seasonal elements – increasing pollens in the spring and through summer, dampness and moulds in autumn, and respiratory infections in the winter – through exposure to perfumes and smoke, pets and animals, and house dust mites and many others besides.

Whilst some of these can also be unpredictable there are elements, especially as we go into winter for example, where a person knows from past experience that a particular season will ‘set them off’. The population with long-term health conditions are offered protection against some respiratory infections with vaccinations but viral infections have been found to cause up to 70% of asthma exacerbations12. So, what can we do to protect our patients with asthma as we move into winter in addition to vaccine administration? During the COVID-19 pandemic where social distancing rules and mask-wearing were mandated, there was a reduction in admissions to hospitals from long-term respiratory conditions but this is not an acceptable strategy in the future.

What we can do is be sure that our patients have the appropriate medication in a device that they can and will use on a regular basis to optimise asthma control leading up to known predictable periods of likely exacerbation. The basis of this must be the patient’s understanding of what asthma is and an understanding of the expected effects of prescribed medication, supported with a personalised asthma action plan that will help patients to know their potential when asthma control is optimal, to recognise deterioration and know how to act and adjust medications safely, when to seek help and from whom.

There are various tools that will help in this patient journey such as placebo inhaler devices to practice and optimise inhaler technique, and diagrams and airway models to improve understanding of asthma. Measurement of lung function using a peak flow meter when a patient, as well as a comparator when a patient has increasing symptoms, is helpful. Measurement of FeNO is a valuable addition to the asthma toolbox to measure airway inflammation which will help the patient better understand what asthma is and how inhaled medication, in particular inhaled steroids, target inflammation. In symptomatic patients, it can open conversations around adherence and inhaler technique, guide step-up and step-down treatment decisions, and work as part of the toolkit to optimise asthma control.

Delve deeper into the impacts of winter and asthma care in our upcoming webinar with Carol Stonham; Battling Winter Wheezes: How Cold Weather Impacts Asthma and the Benefits of FeNO Monitoring, being held on Tuesday 9th January 2024 at 7pm. Learn how FeNO measurements play a pivotal role in monitoring and managing respiratory health during colder months.

References:

  1. Why asthma is worse in winter [Internet]. Temple Health. 2021. [Cited Monday 13th November 2023]. Available from: https://www.templehealth.org/about/blog/why-asthma-worse-in-winter
  2. British Thoracic Society, SIGN. BTS/SIGN Guideline for the management of asthma. Available from https://www.brit-thoracic.org.uk/quality-improvement/guidelines/asthma/ [Last accessed 24.10.2023]
  3. Brandstetter S, Finger T, Fischer W, et al. Differences in medication adherence are associated with beliefs about medicines in asthma and COPD. Clin Transl Allergy. 2017;7(1):1–7. doi: 10.1186/s13601-017-0175-6
  4. Ahmedani BK, Peterson EL, Wells KE, et al. Asthma medication adherence: the role of God and other health locus of control factors. Ann Allergy Asthma Immunol. 2013;110(2):75-79. e2. doi: 10.1016/j.anai.2012.11.006
  5. Kaplan A, Mitchell PD, Cave AJ, et al. Effective asthma management: is it time to let the AIR out of SABA? J Clin Med 9(4):921. doi: 10.3390/jcm904092
  6. van Boven JF, Ryan D, Eakin MN, et al. Enhancing respiratory medication adherence: the role of health care professionals and cost-effectiveness considerations. J Allergy Clin Immunol Pract 4(5):835–846. doi: 10.1016/j.jaip.2016.03.007
  7. National review of asthma deaths. Why asthma still kills (2014). Available from https://www.rcplondon.ac.uk/projects/outputs/why-asthma-still-kills [Last accessed 24.10.2023]
  8. Asthma Right Care (PCRS) available from https://www.pcrs-uk.org/campaign/asthma-right-care [Last accessed 24.10.23]
  9. van der Palen J, Thomas M, Chrystyn H, Sharma RK, van der Valk pd, Goosens M, Wilkinson T, Stonham C, Chauhan AJ, Imber V, Svedsater H, Barnes NC. A randomised open-label cross-over study of inhaler errors, preference and time to achieve correct inhaler use in patients with COPD or asthma: comparison of ELLIPTA with other inhaler devices npj Primary Care Respiratory Medicine volume 26, Article number: 16079 (2016) [last accessed 24.10.2023]
  10. Sanchis J, Gich I, Pedersen S, et al Systematic review of errors in inhaler use: has patient technique improved over time?Chest 2016;150:394-406. doi:10.1016/j.chest.2016.03.041pmid:http://www.ncbi.nlm.nih.gov/pubmed/270607 26
  11. UK Inhaler Group (2016, reviewed 2019) Inhaler Standards and Competency Document. Available from https://www.ukinhalergroup.co.uk/uploads/s4vjR3GZ/InhalerStandardsMASTER.docx 2019V10final.pdf [Last accessed 24.10.2023]
  12. Hammond C, Kurten M, Kennedy JL. Rhinovirus and asthma: A storied history of incompatibility. Curr Allergy Asthma Rep. 2015;15:502.

Bedfont® scoops the Innovation Award and Export Award at the Kent Invicta Chamber of Commerce Business Awards

Medical device manufacturer, Bedfont®, is elated to announce its recent success in winning two esteemed business awards at the Kent Invicta Chamber of Commerce Business Awards. The annual business awards, which took at Westenhanger Castle on Thursday 23rd of November, bring together the business community showcasing the amazing achievements of a range of businesses and talented individuals throughout Kent.

Bedfont® was delighted to have won Success in International Trade 2023, boasting over 82 distributors worldwide, with exports accounting for 80% of turnover for the past 9 years.

Bedfont® was over the moon to win Innovative Business of the Year 2023, making it the 3rd year in a row – a significant achievement and testament to the innovation that is at the heart of Bedfont®.

Jason Smith, Managing Director at Bedfont®, comments, “We are incredibly honoured to receive not just one, but two prestigious business awards. This achievement reflects the hard work and enthusiasm of the exceptional members of the Bedfont® Family and our dedicated network of Distributors. Each member has played a vital role in our success, and these awards celebrate the collective effort that defines our company culture and core values.”

Bedfont’s mission is to work with the Bedfont® Family and healthcare professionals worldwide to provide cutting-edge breath analysis medical products to the highest standard, through technical innovation and professional business practice. Bedfont’s vision is a world where everyone has access to instant, non-invasive, simple breath testing to aid in medical diagnosis.