Month: December 2023

Navigating the Festive Feast: Seasonal Challenges for Digestive Health

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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.

Battling Winter Wheezes: How Cold Weather Impacts Asthma and the Benefits of FeNO Monitoring

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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.