How to use the new AIRE device

There’s a very clever, elegant new consumer health testing device called AIRE made by a company called FoodMarble. The device (pictured above) measures hydrogen gas, H2, in the breath, the same as formal H2 testing used to diagnose small intestinal bacterial overgrowth, SIBO.

Formal H2 breath testing is a hassle. There’s a day-before prep, you drink a sugar solution (lactulose or glucose), then collect breath samples every 15 minutes for 3 hours, then mail the package to a lab. If obtained directly without a doctor, each single-use test kit (glucose only) costs $149. If obtained through a doctor, then additional charges are typically added, especially if the testing is done in a lab or office. Each test kit is useful for only one round of tests. If you want to verify, for instance, that SIBO has been eradicated after a course of antibiotics, then you have to purchase another test kit and go through the process again. The same is true when assessing for all-too-common recurrences: another $149 test kit, another round of testing.

The AIRE device is therefore a game-changer, as it is reusable over and over again. At $159 per device, it can save a lot money over time, as well as cut down considerably on the hassle. It is exceptionally easy to use: turn the device on by pushing a button, open the app on your smartphone. It takes about two minutes for the device to warm-up, then it tells you to blow into the device for about 5 seconds and yields a 0-10 H2 reading within a few seconds.

The real usefulness of this device, however, is to generate a time-course of H2 release. In other words, perform a test prior to eating, consume food containing prebiotic fiber, then test again every 15-30 minutes for 3 hours; stop if a positive reading is obtained. In other words, you are trying to assess whether prebiotic fibers are converted to H2 gas by bacteria high up in the stomach, duodenum, jejunum, or ileum. If you test positive, you have SIBO. The AIRE device is also useful for assessing response to a course of treatment and to assess down the line for recurrences.

As elegant as the device is, there a few downsides:

1. The information provided with the device describe this technology as useful only to identify intolerance to FODMAPs foods. In other words, if you eat an apple and 30 minutes later you test H2-positive, FoodMarble says stop eating apples. You can see the folly in this and with all FODMAP conversations: It does not address the cause, i.e., SIBO or severe dysbiosis. This is why I tell people that a low-FODMAPS diet is nothing more than a symptom reducing maneuver, but does not correct anything, restore a healthy microbiome, or remove a potent source of inflammation (SIBO). (I don’t know if the company neglected any mention of SIBO to avoid tangling with the FDA and FTC, who give companies a hard time if they claim to diagnose or treat any health conditions. But I suspect they may not fully appreciate the implications of their device.) Follow the directions provided on how to use the device, but ignore the advice on avoiding FODMAPs.
2. This device is for the personal use of one person—The mouthpiece is not disposable, but can be wiped off with a moist cloth or paper towel. The company urges you to not use alcohol because it can damage the mouthpiece. You can share the device, of course, with someone you are intimate with, but it’s probably a bad idea to share with, say, coworkers or neighbors. In effect, one device for each person who wants to engage in testing.
3. I asked the company if they would share their data correlating their 0-10 H2 scale with formal H2 testing in parts per million H2. As I expected, they said no, claiming that it is proprietary. (This happens virtually every time we ask a company to share validation or reproducibility data: no, it’s proprietary. So we either perform the correlative testing ourselves or take FoodMarble’s word for their semi-quantitative scale.

Nonetheless, the device is a major step forward for managing SIBO, just as fingerstick blood sugar testing enormously empowered people in managing, and now reversing, type 2 diabetes. It is especially helpful for those of us self-managing SIBO in a world in which physicians do not keep up with issues in health unless they yield rich revenue returns. We shall be discussing the use of the AIRE device in more detail and how to put it to use as part of your health-restoration program in our Undoctored Inner Circle.