My husband tells me I have unpleasant breath odour. I rarely eat spicy or garlicky food and have excellent oral hygiene. But I do have a lot of wind and bloating. I wondered whether to have tests for food intolerances?

L. Keeble, by email.

Dr Martin Scurr replies: As you have good oral hygiene, it's likely that the bad breath – or halitosis – is linked to a gut-related problem (which might also explain your bloating and wind).

One possible explanation is that you suffer from acid reflux (when stomach acid flows upwards into the gullet), possibly without you realising it.

Acid reflux doesn't always cause heartburn – other symptoms include recurrent throat clearing, burping, a bitter taste in the mouth – and bad breath.

Another possibility is that the bad breath is due to food being regurgitated back up into your gullet because the peristaltic wave – the involuntary contractions that push food and drink through our digestive tract – is impaired in some way.

Again, this can be linked to impaired movement in the digestive tract. Halitosis can also be caused by a H. pylori infection (a common bacterial gut infection – other symptoms include bloating and acid indigestion).

Or small intestinal bacterial overgrowth (SIBO) – when bacteria normally found in the large bowel move into the small bowel, again often due to problems with gut movement.

SIBO produces bloating and excess wind – which may include gases such as hydrogen, methane and sulphurous compounds, and may cause halitosis.

Bad breath may also be linked to an imbalance of gut microbes.

Another possible cause is atrophic rhinitis, where the nasal lining becomes thinned and dry. As a result the mucus forms into a crust, which becomes colonised by bacteria, causing a foul-smelling odour – some patients may not notice this themselves.

But this is a rare cause of chronic bad breath and usually occurs in those who have had nasal surgery or prolonged excessive treatment with nasal steroids (such as for allergy).

As to your question about being tested for food intolerances, going down that route is unlikely to be the answer.

However, persistent halitosis does merit further investigation so don't be embarrassed to raise this with your GP.

The first step should be for your GP to order a H. pylori test (which involves a stool sample), and to check whether you are low in vitamin B12 – which can be linked to changes in the cells in the stomach lining, and is more common with age.

For a while my 78-year-old husband has suffered episodes of becoming extremely cold, shaking all over – and has to go to bed and put the electric blanket on to warm up. This can happen even on a hot day. It's worrying me but I can't persuade him to see his GP.

Name and address supplied.

Dr Martin Scurr replies: The episodes that your husband experiences are called rigors: as well as shivering, these are often accompanied by a rise in body temperature and excessive sweating.

These are symptoms of an infection as the bacteria overwhelm the body. I wonder if your husband has a silent urinary infection or prostatitis (infection of the prostate), both of which are common at his age.

'Silent' means you don't experience obvious symptoms of the infection – for this reason, it could also be endocarditis (infection involving a heart valve) or gallbladder-related, any of which can occur without causing other symptoms.

One step you could take is to check his temperature during such a bout – if raised that would confirm the theory (if not raised then measure again after 15 and then 30 minutes).

I'd also suggest speaking to the GP about a urine test.

If a urine test proves negative your husband should be examined clinically to check his heart for a murmur and his abdomen for any areas of tenderness.

Further investigations may involve blood tests for inflammatory markers and potentially scans. Your husband should be investigated further to find a cause, which might be remediable.

In my view... New pill prevents migraine misery

Some good news for migraine sufferers (including me).

In recent years there has been a small but real advance in migraine prevention, with drugs called calcitonin gene-related peptides (e.g. erenumab given by injections, and rimegepant, a pill) – which block the action of a protein released from the nerves that drive the headache.

The problem is that these drugs can only be prescribed by specialists after older preventive strategies have failed and the use of them is therefore rationed –mainly on the grounds of cost.

But a new study has found that candesartan, a well-known and well-tolerated blood pressure drug, is effective for migraine prevention. It's not a guarantee, but it may halve the number of migraine days – literally how many days someone suffers.

It is a significant advance that can be prescribed by GPs for patients having four or more episodes of migraine each month. And it's inexpensive.

A happy start for 2026!