Because It's Never 'Just' IBS

Hi again Fodmappers

It seems that most weeks I find myself talking to someone who has been diagnosed with IBS but who is sure their doctor has got it wrong. They are genuinely suffering and feel sure something has been missed. They wonder whether they may have Coeliac disease or Crohns or worse.

And it seems to me that they are sure it can't be 'just' IBS because we've all been led to believe that IBS is a trivial illness.

IBS is the kind of thing that comedians like to poke fun at. Sean Lock is one comedian who jokes about IBS, but he also says ".. IBS isn’t that bad, is it? I’ve got a sister-in-law who has it." Some people have even had their doctors tell them it's 'just' IBS. For the record, I once saw a doctor who told me it would 'pass'. It seems doctors are comedians too. Just.

So let's get this straight. There is no 'just' about IBS.

IBS is a nasty illness which affects every part of your life. It's not 'just' the bloating and the way that, over a few hours, you can appear to have become several months pregnant. Neither is it 'just' the way your bowels develop a life of their own, apparently rebelling against you at every opportunity. It's certainly not 'just' the intense pain which the pain killers don't seem to touch. It's an awful lot more.

It's the way you begin to fear for your job as you are taking more and more time off work.

It's the way you're surviving on very little sleep as finding a comfortable position at night seems impossible.

It's the look on your friend's faces when you make another excuse not to go out for food.

It's the way you've had to give up on that yoga class as you can't trust your belly to stay silent for that long.

It's not being able to remember the last time you did anything spontaneously.

It's having to cancel that trip at the last minute.

It's being scared to eat.

It's the way you lack the energy to carry out the simplest tasks.

It's the way your whole life seems to revolve around knowing where the nearest loo is.

It's the way your friends and family don't quite understand.

It's the embarrassment of it all.

It's the way it knocks your confidence.

It's the way it drags you down. 

And yes, much of that is true for others who suffer with chronic conditions, but we wouldn't (I hope) trivialise those. Having said that, I have a lot of sympathy for people with M.E which, until fairly recently, was referred to as 'yuppie flu'. Talk about trivialising!

So this week I was pleased to discover a petition started by the IBS Network to 'recognise it's not 'just' IBS'. (You can find out more about the IBS Network here.) It strikes me that this is exactly what is needed. But because IBS is embarrassing I do wonder how much publicity this campaign will get.

So, if this is something you feel strongly about, please add your name to the petition and let's stop trivialising this awful condition. It's a small step but you never know, it might 'just' make a difference.

'Til next time Fodmappers - Stay Fabulous. x

Can A Gluten Free Diet Help IBS?

And how is that different from a low-fodmap diet?

Hi again Fodmappers

I've noticed that there seems to be a lot of confusion surrounding gluten and whether going gluten-free can help reduce the symptoms of IBS, so that's what I want to talk about today. I also want to look at why you need to avoid wheat, barley and rye as part of a low-fodmap diet, and, finally, why some gluten-free products are not suitable for a low-fodmap diet. But first lets look at the difference between gluten and FODMAPs.

Gluten vs FODMAPs

Gluten is a protein (or more accurately a combination of two proteins) found in grains, particularly so in wheat but also in rye and barley, and it is this which gives dough it's stretchy quality. If you have bought flour for baking bread you will probably have bought a 'strong flour' as this type contains more gluten than the flour you might use for cakes or biscuits as bread making needs the elasticity that gluten provides. It's gluten that is a factor in coeliac disease.

Approximately 1 in 100 people in the U.K have coeliac disease. 'Coeliac disease is not a food allergy or intolerance, it is an autoimmune disease. In coeliac disease, eating gluten causes the lining of the small intestine to become damaged.' (1) People who have coeliac disease need to avoid ingesting even the smallest amount of gluten as to do so can cause further damage to the lining of the gut.

Fodmaps, on the other hand, are a group of carbohydrates found, not only in grains, but also in fruit, vegetables, nuts, pulses and dairy produce. 'Current research strongly suggests that this group of carbohydrates contributes to IBS...' (2)

IBS is much more common than coeliac disease, affecting between 1 in 4 and 1 in 10 people at any given time. (3) Though it is a chronic condition, it is a functional disorder. That is to say, the problem is in the way the gut functions, rather than in any damage to the gut itself.

Though wheat, barley and rye contain gluten they are also high-fodmap, and this seems to be where the confusion arises.

If you have IBS you may have discovered that you feel better if you eat gluten free products rather than wheat-based breads, biscuits, cakes, pastas and cereals. However, this is likely to be because, by choosing gluten free, you are also removing high-fodmap grains (such as wheat, rye and barley) from your diet.

A Gluten Free Caution

But if you have IBS, you do not need to avoid gluten, you need to avoid fodmaps. In fact fodmappers need to be careful when choosing 'gluten-free' as these products are designed for people with coeliac disease not IBS. Just because they are gluten-free doesn't mean they are necessarily low-fodmap. Remember fodmaps are found in more than just grains, and gluten-free products may also contain soya flour, apple fibre or inulin (from chicory) all of which are high-fodmap.

So the short answer to the question, 'can a gluten free diet help IBS?', is yes. But it has nothing to do with gluten. I hope that's cleared things up a bit?

'Til next time Fodmappers - Stay Fabulous. x

1. https://www.coeliac.org.uk/coeliac-disease/myths-about-coeliac-disease/
2. http://www.med.monash.edu/cecs/gastro/fodmap/
3. http://www.aboutibs.org/site/what-is-ibs/facts/

Low FODMAP Rebellious Ratatouille

And a quick lesson in using garlic as part of a low-fodmap diet.

Hi again Fodmappers - Today I want to share another simple vegetarian and vegan recipe idea that's so yummy, you'd never know it was low-fodmap, or vegetarian. But first I want to talk to you a little about garlic, particularly as I know some of you have asked ...

Can I have garlic as part of a low-fodmap diet?

It dawned on me recently that I rarely talk much about the ingredients I use and why it's ok (or not ok) to include them. For me, getting myself well has been as much about what I've learned as what I've eaten because, as I've mentioned before, low-fodmap is not about cutting back on what we eat, it's about replacing high fodmaps with low ones. I'm sure that understanding what I can incorporate, and how, has been a vital part of my success. So I'd like to pass on something which I think you'll find helpful too.

I like my food to have plenty of flavour and unfortunately garlic is high-fodmap (don't run away Fodmappers, there is good news to follow) so it's not surprising that I discovered it to be one of my main triggers. But there is a way we can still enjoy a little garlic flavour in our food. I shan't baffle you with science, but if you just want to skip to the recipe, feel free.

(If you're new to fodmaps you might like to read this.)

In a nutshell, garlic (along with onions and pulses) is a type of oligosaccharide and is water soluble. This means that when you add garlic to soups, sauces, stock etc, the oligos (the O in fodmap) will leach into your food. It is the oligos, along with other fodmaps, that trigger symptoms of IBS.

However, they are not soluble in oil. (I remember this seemed like a revelation when I learned this). This means we can still enjoy a little garlic as garlic infused oil. You can buy garlic infused oil but it's easy enough to make. And by making garlic infused oil we can safely include what is a high-fodmap ingredient in a low-fodmap diet!

So here is my simple ratatouille recipe. I'm calling this Rebellious Ratatouille as that's how I feel when I add 'naughty' ingredients like garlic to my recipes. I think you'll see that I've just made a couple of tweaks to make it low-fodmap. So easy when you know how. I hope you like it.

Rebellious Ratatouille

Ingredients

Olive Oil
A few garlic cloves
1 red pepper
2 courgettes
1 small aubergine
4 or 5 spring onions
1 small carton of passata
Fresh basil
Black pepper

Method

1. Chop garlic into fairly large pieces to make them easier to remove.
2. Heat the oil in a pan and add the garlic. Cook over a medium heat for about 15 minutes allowing the garlic to infuse.
3. Remove the garlic from the oil. You' now have garlic infused oil. (Didn't I say it was easy?)
4. Cut the white parts from the spring onions and discard. (This part is high in oligosaccharides).
5. Roughly chop the spring onion greens (leaves) peppers, courgettes and aubergines and add to the oil. Cook until softened, stirring continuously.
6. Add the passata and heat through.
7. Add the pepper and basil and simmer.

Serve with wheat free pasta and a side salad alongside a little grilled halloumi (watch portion size) or tofu sprinkled with paprika for extra yumminess.

'Til next time Fodmappers - Stay Fabulous. x

Low-FODMAP Rhubarb and Ginger Crumble

You know how sometimes you promise yourself you'll just have a little dessert, and before you know it you're having seconds?

Hi again Fodmappers

I've been longing for rhubarb crumble for a while and finally remembered to buy in what I needed. After dinner this evening I finally got my wish. I love the simplicity and the sharpness of rhubarb. It's real comfort food. And it tastes even better than I remembered.

But I imagine you might be a little cautious about rhubarb. After all, doesn't it have a reputation for being a laxative? Well that's true, but it is also low-fodmap. Confused? Keep reading ...

Without getting too complicated, rhubarb is high in fibre and can be a gentle laxative. Some Fodmappers might find this beneficial as a low-fodmap diet can in fact be low in fibre. However, it can also reduce diarrhoea by adding bulk to stools. (This is not unlike the effect of some prescription laxatives.) But most importantly from our point of view, as it is low-fodmap, we know that it isn't likely to trigger symptoms of IBS. In fact Monash (who we have to thanks for developing the low-fodmap diet) states that up to a cup of chopped rhubarb 'should be tolerated by most individuals with IBS'. (1)

Up to a cup? That sounds like a generous portion of rhubarb to me! And I like rhubarb! So, with rhubarb given the green light, here's my recipe for a tasty crumble.

I used stem ginger instead of sugar to sweeten the rhubarb, partly because I love the combination of ginger and rhubarb, and partly because there is plenty of sugar in the crumble topping. If you don't like ginger, just leave it out and maybe add a little sugar or maple syrup instead.

I also added a little ground almond to the crumble. Up to 10 almonds are low-fodmap and though I haven't calculate how many almonds are equivalent to 1/4 cup of ground, I figure that as the recipe serves 4 this should still be within the 'safe' limit for most people. Of course, if you know you're sensitive to nuts, just leave them out.

One final word of caution - this is yummy! (Even though I say so myself). And as you'll be aware from the discussion above regarding the acceptable amount of rhubarb and almonds, portion size is vitally important when it comes to keeping your tummy happy. If you think you're going to find this crumble hard to resist you could cook it in little ramekins and limit yourself to just the one. And they'd look cute too.

Rhubarb and Ginger Crumble

Serves 4 - 6

For the filling

500g of frozen rhubarb (defrosted)
4 pieces of stem ginger
Approx 2 Tbsp of water

For the Crumble

1 cup of Doves Farm gluten free plain white flour
1 cup of sugar
1/2 cup of butter or vegetable margarine
1/3 cup of oats
1/4 cup of ground almond
1 tsp of cinnamon

1. Place the rhubarb in a pan with the water to prevent it burning.
2. Cut the stem ginger into small pieces and add to the pan.
3. Cover the pan and simmer until the rhubarb begins to soften. Remove from heat.
4. Add the flour and butter to a bowl and rub together until it forms large breadcrumbs.
5. Add the sugar, oats, ground almonds and cinnamon to the flour and stir through.
6. Put the rhubarb and ginger filling into a greased ovenproof dish.
7. Spoon the crumble filling on top.
8. Cook in the oven for approx. 30 minutes.

Enjoy with lactose free cream or yogurt.

'Til next time Fodmappers - Stay fabulous.

(1). From the Monash phone app.

Why Keeping A Food Diary Didn't Help My IBS ..

And How You Can Make It Work For You.

Hi Fodmappers - How are you?

I have a couple of questions for you. Do you keep a food diary? And how useful are you finding it?

When I was diagnosed with IBS (and this was pre-fodmap) my G.P suggested I keep a food diary as I felt sure that my symptoms were, at least, aggravated by certain foods. And as this made perfect sense, I did just that. I still have it as it doubles up as my recipe book but looking back it's scary to see what I was eating!

But as careful as I was in recording everything I ate, as well as keeping notes on the events of the day in case stress was a factor, I couldn't make head or tail of what was making me ill. I had already cut out coffee and orange juice at that point as I had noticed that those were definitely a trigger for me but I wasn't getting any further in pin-pointing which other foods were a problem for me. Does that sound familiar?

When I discovered FODMAPs I realised why this was. I was going about this the wrong way round!

Let me give you an example of a meal from just one of my old diary entries. It was one of our favourites - Vegetarian Spaghetti Bolognaise.

The ingredients we would use were onions, garlic, red peppers, soya mince, passata, herbs and, of course, spaghetti. Nothing complicated there really, just a typical vegetarian meal, but if i'd known then what i know now! OMG!

In case you are still new to the low-fodmap diet, let me take you through that list.

Onions = High Fodmap
Garlic = High Fodmap
Red Peppers = Low
Soya =  High Fodmap
Tomatoes = Low
Herbs = Low
Spaghetti (Wheat) = High Fodmap

Looking at that, it really is no surprise I was unwell!

One of the problems with a food diary is that you need to list all the ingredients of everything you eat separately. And that includes the ingredients of shop bought products. You soon learn this, if you haven't already, as even foods which appear to be fodmap friendly (such as gluten free breads) can contain high fodmap ingredients like soya flour. But without knowing about fodmaps, unravelling the ingredients and the symptoms is pretty near impossible. Or at least I found it so.

As soon as I learned about the low-fodmap diet it just made so much sense. Rather than looking for a needle in a haystack (which is what I felt I was doing) you cut out ALL likely trigger foods and reintroduce them a few weeks later, one at a time, to see which ones cause the problems. It's so simple and so logical! This is when keeping a food diary comes into it's own. You can do just what I was failing to do, you can pinpoint EXACTLY what is upsetting you. And you can see how much better you can feel.

One of my first low-fodmap entries read;

"Felt pretty good most of the day, though a little bloating (very little) after lunch and evening meal. Both times this was short lived (less than an hour) and no pain!"

I'd been in a lot of pain prior to starting my low-fodmap journey, and though I think I was reluctant to get my hopes up at that point, that entry showed me there might just be light at the end of the tunnel. The bloating lessened soon after.

As for the bolognaise - I'm sure I've mentioned before that cutting out high-fodmap foods isn't about depriving yourself, it's about replacing them with low-fodmap alternatives such as spring onion greens instead of onions, garlic infused oil instead of garlic and opting for wheat free pasta. We do just that and we use diced aubergine instead of soya mince for that bolognaise texture. (See how I've just sneaked in another yummy recipe for you?) I'm also really enjoying discovering new pastas. Who knew there were so many out there?!

So if a food diary isn't working for you, maybe consider going about it the other way around?

'Til next time Fodmappers - Stay Fabulous! x

Why Your Large Intestine is Big News

Hi Fodmappers - How are you doing? I just wondered if you spotted the articles on IBS in the news this last week?

The first was a piece in 'The Independent' which reported on a study into the role of prebiotics (note: not probiotics) in the treatment of anxiety and IBS. And the second was a feature on the low-FODMAP diet in the 'Daily Mail'.

If you've been following this blog a while, you'll know that I have written before about the issue of prebiotics and a low-FODMAP diet, but it's something which continues to interest me as prebiotics, often listed simply as FOS or GOS, are high FODMAP. (FOS is short for Fructo-oligosaccharide and GOS for Galacto-oligosaccharide and they are highly fermentable.)

This particular study compared FOS, GOS (specifically one referred to as B-GOS) and a placebo. The Independent reports that, volunteers in the B-GOS group "paid less attention to negative words, and more attention to positive ones, than those taking placebo." And that they "also had lower levels of the stress hormone cortisol in their saliva after three weeks on the prebiotic than they had at the beginning of the experiment." What's more "The effect of B-GOS on the attention task is similar to results found when healthy volunteers were given anti-anxiety or anti-depressant medication."

Impressive results, eh?

As many people with IBS also suffer with anxiety surely this raises the question of whether we should all be dashing out and stocking up on prebiotics despite the fact that they are high FODMAP.

Well before you do, I suggest you take a glance at the images on my earlier blog. There you'll see that the prebiotics added to the supplements you might find in your health store are FOS not GOS. And as the study discovered, "No effects were found after the administration of FOS."

So what does this mean?

Well it means that there's probably no benefit to be gained from the use of prebiotics - at least at the moment. (That's not to say that there's no benefit to be gained from taking a probiotic). And that the most effective means of managing the symptoms of IBS continues to be the low-FODMAP diet. Nevertheless I think this is going to be an interesting area to keep an eye on. I'll let you know if I spot anything further.

Which brings me to the article in the Daily Mail. This was, as you would expect, less academic and more celebrity focused, but it did include a couple of recipes and information on the Monash phone app, which is a really useful tool to have. I'm not sure it had anything new to tell us but it's always nice to see FODMAP getting a bit of coverage and it gets people talking. Thinking about it now, someone asked me a few questions last week about going low-FODMAP and I wonder if they might have seen this particular article. Having experienced the benefits myself, it's something I'm always happy to talk about, and as you know, I also love discovering new things to eat.

I'll be back soon with another yummy recipe for you. In the meantime please don't be shy about saying hello. I'd love to know how you're getting on with your low-FODMAP diet and the difference it's making to you.

A New Year's Resolution for IBS

Hi again Fodmappers - I hope you had a fantastic Christmas and managed to avoid the yummy temptations which cause us so much grief?

As we're now moving into the New Year, I thought now would be a good time to focus on what you really want from the year ahead. In particular, are you ready to commit to getting your IBS symptoms under control? How would that sound as your New Year's resolution? Is that something you'd like to achieve? Maybe you've 'dabbled' with the low-FODMAP diet and want to give it another go? Or maybe your resolution is to begin to discover new ways to improve your digestive health? Maybe you've simply had enough of your IBS and you're ready to do something about it? Then welcome to Fabulous Fodmaps - this blog is for you.

(If you're an already experienced Fodmapper, I hope you might still find something useful here. Maybe you'd even like to leave a word of encouragement for newcomers in the comments at the end of this post?)

5 Steps to Low-FODMAP Success

1. Learn.

I suggest that your first step is to learn something about the low-FODMAP diet and why high-FODMAP food causes problems for people with IBS. If this is all new to you you might like to read the overview here or if you're ready for something a bit more indepth then you might like to watch the video, 'Beating the Bloat,' here. You don't need to become an expert in FODMAPs but gaining a bit of knowledge will help make sense of it all and I firmly believe that you are more likely to stick to the process if you understand why some food is allowed and some is not.

2. Explore.

With a bit of knowledge under your belt you're ready to discover new recipes that are suitable for your low-FODMAP diet. I share some of mine here but there are many more on the internet so you won't be short of ideas. I strongly suggest bookmarking any that take your fancy or simply jotting them down in a note book as you're going to need a good selection. You're going to need to think about breakfasts, lunches, evening meals and snacks, as well as eating out. The exclusion stage is a minimum of 6 weeks and that's a lot of meals. I will give you a word of caution though, and that is simply to be careful out there. Not all the recipes you see labelled as low-FODMAP actually are low-FODMAP. If you're not sure which ingredients are safe you can check the list here.

3. Plan Ahead.

Time to shop and to stock up on foods you've possibly never even looked at before. You're going to be visiting the Gluten-Free sections of your supermarket for wheat free pastas, breads and breakfast cereals, and you may be pleasantly surprised to discover that they are not as bad as you may have thought. You'll be trying lactose-free milks and seeing which ones you you prefer.You'll also be reading a lot of labels. Start stocking the cupboards with 'safe' food and clear out anything that you need to avoid and you'll have a better chance of succeeding.

4. Make it Fun.

It may seem tough at first but discovering new food can be an enjoyable experience all of it's own. Treat your low-FODMAP diet as you would any new cuisine and you'll look forward to mealtimes. Even invite friends for meals if you enjoy cooking and let them try something different too. And make sure to award yourself some low-FODMAP treats. For example, a little chocolate is permitted. There's more on that here.

5. Come Back Soon.

I shall be adding more recipes, tips and inspiration throughout the year so please add this blog to your favourites so that you can find your way back here. And don't forget to comment to let me know how you're getting on.

Happy New Year - may this be your best year yet.

__________________________________________________________________________

Like this blog? Use the links below to share to Facebook, Twitter, Google+ and Pinterest.

The Low-FODMAP Christmas Party Guide - Part 1

 

Hi Fodmappers - ready for those Christmas parties? If you're like me, I'm guessing that your thoughts are going to be as much about what you can safely eat and drink as what you might wear? After all there are more embarrassing things that can happen to someone with IBS then turning up in the same outfit as your colleague! So here's my Fodmapper's guide to surviving the party season.

Part 1 - What Can I Eat?

The Set Menu

Do you dread that moment when the menu gets passed around the office with the set meal options? It's hard enough finding a tasty vegetarian option let alone one which is FODMAP friendly. Assuming you're already committed to a sit down meal, how can you make sure it's 'safe'? If it's a traditional Christmas meal there are several things to watch for.

First Course - There is often the choice of a vegetable soup for the first course but this may not be the best option for you. Even something innocent sounding like a carrot and coriander or parsnip soup may contain onions which are high-FODMAP. So my first tip is to opt for the melon.

Main Course - Goats Cheese tartlet sounds great, doesn't it? It's so very tempting for a Veggie Christmas meal but so wrong for us Fodmappers. Onions have a way of sneaking into these too but there's also the pastry to consider, and to avoid. You'll also want to avoid anything with mushrooms. If a nut roast is on the menu it could very easily contain wheat, onions and mushroom! But don't fear. My tip for the main course? Phone the restaurant beforehand and explain that you have special dietary needs - this is nothing unusual these days. Some restaurants pride themselves on being able to cater for special diets, as long as you give them enough notice. If they can't accommodate you, you could always offer to provide your own. That way you can eat in the confidence that it tastes great as well as the fact that it's not going to upset your tummy.

As for the vegetables - potatoes, parsnips, carrots and green beans are low-FODMAP, so enjoy. You should find you can tolerate a small portion of broccoli but remember to avoid the peas. As for Brussels sprouts, Monash University advises that a serving of two is tolerated by most people with IBS, though I'd choose whether to have those or the broccoli (rather than both) just to be extra careful. Also you'll be wise to avoid the stuffing and gravy - both are likely to contain wheat and onions.

Dessert - Christmas desserts are a challenge as wheat and dried fruit are high-FODMAP, and best avoided. But if you like something sweet you could take along some home-made low-FODMAP Ginger, Orange and Walnut Mince Pies to surprise your colleagues (having spoken to the restaurant first) or go for the savoury option and finish with the cheese selection. Cheese boards often come with grapes which are safe to eat, just remember to give the wheat crackers a miss.

The Buffet

The other scenario at this time of year is the festive buffet. This is a whole lot easier as far as a low-FODMAP diet is concerned, partly because a buffet tends to be a much more informal meal anyway and partly because you'll be in control of what goes on to your plate. If you're not sure yet what foods are safe to eat, take time to familiarise yourself with the 'Foods to Avoid' and 'Foods to Enjoy' lists. There are plenty of buffet classics such as plain crisps, plain corn tortillas, carrot and celery sticks, cheese and pineapple on sticks, olives, peanuts, grapes, cheddar or feta cheese and salad leaves which are low-FODMAP, so you won't go hungry.

You could even offer to help prepare the buffet, that way you can make sure there are plenty of low-FODMAP options available. Or take something with you, everyone loves someone who brings food to a party.

One final tip, especially if you know you are easily tempted by festive goodies, is simply to eat something before you go out. That way when the food is put in front of you it'll be easier to stick to those safe options.

In Part 2 I'll take you through some low-FODMAP drinks options complete with a tasty recipe of my own for a winter warmer which I think you'll enjoy.

'Til then - stay fabulous! :)
________________________________________________________________________________

(Like this blog? Use the links below to share to Facebook, Twitter, Pinterest, Google+ or to send as an email)

Low-FODMAP Mince-Pies

Well it wouldn't be Christmas without them, would it?

Hi again Fodmappers. This will be my first Christmas since going low-fodmap and I realised I'm going to have to get organised if I want to enjoy some festive treats. So for the last few weeks I've been thinking about the things that really make Christmas for me, and mince-pies have got to be top of my list.

But mince-pies are normally a bit of a fodmappers nightmare. First there's the wheat in the pastry, but even if you go wheat free there's still the apple and dried fruit in the mincemeat. If you're buying ready made there may very well be other ingredients to watch for too - did someone say fructose-glucose syrup? It was only when I decided to try and create some low-fodmap mincemeat of my own that I discovered there's even fructose-glucose syrup in tubs of candied peel!

Eventually I struck on an idea, after all there are other Christmas flavours to be had. So here's my own twist on a Christmas favourite. These are vegetarian, wheat-free, gluten-free, apple-free and don't even contain the dried fruit that is normally found in mince pies - but are still very tasty. If you're vegan you could try replacing the butter with coconut oil. I haven't tried that but I imagine it would be yummy.

The directions below are for 12 mince pies. I hope you enjoy them.

Ginger, Orange and Walnut Mince-Pies

Pastry Ingredients

200g Gluten Free Plain White Flour
100g Butter
75g Cold Water

Mincemeat ingredients

6 x 1" Pieces of Bottled Stem Ginger
Zest of 1 Orange
Juice of 1 Orange
Zest of 1 Lemon
1/2 Tsp of Ground Cinnamon
1/2 Cup of Chopped Walnuts

First prepare the pastry.

Put the flour into a large bowl and add the butter. Work together until it resembles fine bread crumbs.
Add the water and stir through quickly until it begins to form a dough. Shape the dough into a ball and pop into the fridge for at least 30 minutes.

While the pastry is resting, prepare the mincemeat.

Chop the ginger into fine pieces and put into a pan with the orange zest, lemon zest, orange juice and cinnamon. Cook over a medium heat, stirring frequently, until it begins to take on a mincemeat like texture. Remove from the heat and allow to cool a little. Stir the chopped walnuts into the mixture.

Roll out the pastry and cut out circles using a pastry cutter. Be careful handling the pastry as gluten free pastry has less stretch than ordinary pastry. Place into a greased mince-pie tin. Put a dessertspoon of the ginger mince-pie filling into each pie and top with a star cut from the remaining pastry.

Bake in a pre-heated oven at 180C/350F for 20 minutes being careful not to overcook. Eat warm or allow to cool and sprinkle with icing sugar for the perfect festive finish.

 

Protein in the Vegetarian Low-FODMAP diet

 

The question is - are you getting enough?

Hi again fodmappers. 

A couple of times lately I've been asked how I manage to get enough protein on a vegetarian low-fodmap diet. It's a good question because, as you probably know, many of the usual vegetarian protein sources (legumes and some nuts) are off limits. Though I felt intuitively that I do get enough, it never hurts to do a bit of research and check. So that's been my project this last week.

I soon realised that, before looking at whether I was getting enough, I had to find out how much protein I should be having. That seems obvious I know, but when you constantly see ads for protein shakes, bars and protein based weight-loss programmes, the suggestion seems to be that none of us are getting enough, let alone anyone on a restricted diet!

The first figures I came across were that a sedentary man needs 56g a day and a woman needs 46g. Those figures weren't working for me for a simple reason, and that is that our need for protein must differ according to our body size, age and health, as well as our activity levels. After a while I tracked down a suggested intake of 0.66g of protein per kg of body weight for both men and women. (1) For me that works out at 31.43g of protein per day - much less than the average guidelines.

My next task, of course, was to find out how much protein there is in the food I eat. (A summary of just one day is at the end of today's blog). It's surprising what contains what!

I've recently converted to using cups as a way of measuring dry and liquid ingredients, but if you don't have these handy little measuring devices you might like to know that 1 cup is the same as 250ml. Simply find something in your kitchen that holds 250ml and you're away.

Dairy and Milk Alternatives

• 1 large egg = 6g
• 1 cup of grated cheddar cheese = 28g
• 1 cubic inch of cheddar cheese = 4.2g
• 1 cup of crumbled feta cheese = 21g
• 1 cubic inch of feta = 2.4g
• 1 cup of lactose free milk = 9g
• 1 cup of almond milk = 1.25g
• 1 cup of oat milk = 2.5g
• 1 cup of oat milk = 0.25g

Nuts and Seeds

• 1 cup of walnuts = 18g
• 1 cup of brazil nuts = 19g
• 1 cup of hazelnuts = 20g
• 1 cup of sunflower seeds = 29g
• 1 cup of sesame seeds = 26g
• 1 cup of dried pumpkin seeds = 39g
• 1 tbsp of peanut butter = 4g
• 1 tbsp of almond butter = 3.35g
• 1 tbsp of tahini/sesame seed paste = 3g

Grains

• 1 cup of cooked buckwheat = 6g
• 1 cup of cooked quinoa = 8g
• 1 cup of cooked brown rice = 5g
• 1 cup of cooked white rice = 4.2g
• 1 cup dry oatmeal/porridge oats = 6g

Fruit and Vegetables

• 1 medium banana = 1.3g
• 1 medium kiwi fruit = 0.8g
• 1 cup of spinach = 0.9g
• 1 large potato (baked with skin) = 7g
• 1 red or yellow bell pepper = 1g
• 1 small courgette = 1.4g
• 1 cup of shredded lettuce = 0.5g
• 1 medium tomato = 1.1g
• 1 cup of cubed butternut squash = 1.4g

Bread and Crackers

• 1 slice of Genius triple seeded bread = 2.1g
• 1 slice of Genius brown bread = 1.2g
• 1 slice of Genius spicy fruit bread = 1.2g
• 1 Kallo Organic unsalted rice cake =  0.6g
• 1 Nairns oat cake = 0.8g

Pasta

• 100g Orgran buckwheat spirals = 11.2g
• 100g Orgran corn and vegetable spirals = 6.9g

Other

• 100g of Tofu = 8g
• 100g of canned chick peas = 4.3g

I could include much more ....

So, back to the question of whether I am getting enough protein. The only way this was going to be accurate was if I added it up as I went along. So one day last week I met a friend for a cuppa (Hi Jacqui) and kept notes.

My breakfast that day was 1 banana (1.3g) and a bowl of porridge made with half a cup of oats and 1 cup of lactose free milk (12g). Mid-morning I had a gluten free coconut and raspberry slice (4g). And lunch was a kiwi fuit (0.8g), a peanut butter sandwich on Genius fruit bread (6.4g) and a small savoury muffin (6g). The recipe for the muffin (and it's really easy) can be found here.

If you've been counting you'll know that comes to 30.05g of protein (remember I need to aim for 31.43g) and at that point I have to confess I stopped counting.

But this has been an interesting issue to explore. I had never realised what a difference there is in the protein content of the low-fodmap milks, for example, and how something as simple as a bowl of porridge can give a real protein boost to the start of your day. It's an exercise that's definitely worth doing.

And it's been reassuring. The low-FODMAP diet is complicated enough, especially for vegetarians and vegans, without worrying about protein too.

So a big thank you to those of you who have asked, you know who you are. It's been an eye-opener putting this list together, and an education. If there are any other topics you'd like me to explore, please let me know.

1. http://www.nal.usda.gov/fnic/DRI/DRI_Tables/recommended_intakes_individuals.pdf

Beating the Bloat

Hi Fodmappers

Just a quick visit as I thought you might find this interesting.

"Professor Peter Gibson is Head of Gastroenterology at Monash University and an internationally renowned expert in the field. On 30 October 2013, he presented on the problem of Irritable Bowel Syndrome (IBS) and gut symptoms in general and about the world-wide fascination with dietary cures. He describes the controversy surrounding wheat intolerance, the most current research and outlines the new dietary approach, the low FODMAP diet, that is changing the way doctors and dietitians help people with IBS to manage their problem."

Chocolate Gets the Green Light

I love to share good news and, if you like chocolate, I have some very good news indeed. Dark chocolate is low-FODMAP!! (Doing a little happy dance right now - feel free to join in).

When I wrote about Rainbow Drops I promised I'd seek out more fun foods for you, and I just love chocolate so it had to be next. Well it seems Monash University (who we have to thank for coming up with the low-FODMAP diet) have kindly delved into this topic for us and the results are as follows.

Marked according to their traffic light system, one 30g serving (approx 5 squares) of dark chocolate, gets a green light. This means that it's low FODMAP and safe to enjoy as part of your diet. Right now I'm imagining dark chocolate chips in yummy low-FODMAP muffins. Mmmmmm.

However, the same size serving of both milk and white chocolate are given an amber light. This indicates that these contain a moderate amount of FODMAPs due to the lactose content. Depending on how well you tolerate lactose will depend on whether you can enjoy these too.

But a word of caution is probably called for before you dash off to buy the very best (and darkest) chocolate you can find, and that is to say that it's vitally important to stick to the serving size. FODMAPs are cumulative - the more you eat the more you increase your FODMAP level, and the higher the FODMAP level the greater the risk of tummy upsets.

Also Monash advise sticking to small portions as "Chocolate is high in fat, and when consumed in excess can affect gut motility and may trigger symptoms." (1)

Having said that, I think this still counts as good news and I hope it's brought as big smile to your face as it has to mine. I've always been partial to a nice bit of dark chocolate and don't we all deserve a treat now and then?

I think FODMAP just got a little more fabulous!

1. http://www.med.monash.edu.au/cecs/gastro/fodmap/diet-updates/chocolate.html

'Easy Cheesey' Low-Fodmap Omelette

 

Hi again Fodmappers. I hope you're all doing well and enjoying the blog so far. Tonight I just want to post a little something to show you that low-fodmap cooking doesn't have to be complicated. Yes you do need to discover replacements for some of the things that have probably been part of your 'normal' diet for years - such as replacements for wheat! Actually I didn't realise how much wheat I was eating until I had to stop! Anyway, it's nice to sometimes recognise that some of those 'normal' foods are also low-fodmap. So, tonight's recipe is ... ta da .... an omelette.

I shan't write out a recipe on how to make an omelette as I'm sure you know the basics, but I think it's worth mentioning the ingredients. This is a vegetarian omelette (because I'm vegetarian) but you can adapt it to your preference of course. The main thing to remember is to stick to low-fodmap ingredients. Yes that might sound obvious but that means using the green part of spring onions instead of regular onions, sticking to red and yellow peppers rather than green ones, and using a hard cheese such as cheddar as the lactose in cheese reduces as it hardens. (1) You could also add tomatoes, spinach, chives or potatoes. (2)

So there you have it, a 'normal' and easy recipe idea that is also low-fodmap. You could even keep a slice for your lunch-box. ;)

1. http://cheese.about.com/od/cheesebasics/f/lactose_free.htm
2. http://fabulousfodmaps.blogspot.co.uk/p/yummy-low-fodmap-foods-to-enjoy.html

Fun with FODMAPs

Look what I spotted today! I haven't had these since I was a kid and guess what? The ingredients are mostly sugar, maize, rice and glucose syrup which makes them vegetarian and low-FODMAP. This has inspired me to hunt out little treats that us fodmappers can enjoy. I'm on the case.

National Gut Awareness Week

Was it just me or did anyone else miss out on the news that it was National Gut Awareness Week last week? Ah well, better late than never. ;) Sadly this article doesn't say much about FODMAPs but there's still some useful tips here. See what you think.

National Gut Week 2014: How To Reduce Irritable Bowel Syndrome

The Huffington Post UK

Posted: 14/08/2014 15:56 BST Updated: 18/08/2014 17:59 BST

It's National Gut Awareness Week and it seems many of us could do with a lesson or two in how to look after our insides.

Irritable Bowel Syndrome (IBS) is Britain’s most common digestive complaint, affecting nearly a fifth of the population.

Despite the growing prevalence, the condition is extremely poorly managed: a recent survey of IBS sufferers revealed that over two thirds of sufferers have received no helpful advice from their GP regarding symptom relief and those affected try an average of five new products to relieve their symptoms each month.

Despite this, over 50% are still left battling the embarrassing and debilitating symptoms long-term.
Registered Nutritional Therapist and Chair of BANT (British Association for Applied Nutrition and Nutritional Therapy) Miguel Toribio-Mateas shares his tops tips to help reduce IBS safely and effectively:

De-stress
It is thought that IBS sufferers experience increased sensitivity to stress and anxiety, making it important to try to reduce the amount of stress in your life.

Regular exercise not only helps you to de-stress but also helps gas pass through the digestive tract more quickly, so you feel better faster.

Mindfulness-based stress reduction techniques have also been found to reduce the severity of symptoms.

Watch what you drink
Caffeine and alcohol are gastric irritants and act as triggers in some individuals, so are best avoided. Carbonated drinks may also contribute to bloating or cramping.

In contrast, drinking plenty of clear fluids (such as water and herbal teas) can help to ease digestion.

Try a ‘live’ probiotic
Studies have indicated that IBS patients experience a reduction in beneficial bacteria and higher concentration of pathogenic bacteria in the gut.

Newly published research suggests that a unique ‘live’ liquid bacteria known as Symprove can help re-address the balance, with study results demonstrating that all major IBS symptoms either improve or disappear completely in 60% of participants following 12 weeks of treatment; even in those for whom other probiotics and IBS treatments have failed.

Chew well
Be mindful of thorough and calm chewing; eating on-the-run or bolting food at your desk can often lead to compromised digestion.

Try putting your knife and fork down between bites and chewing with your mouth closed. This forces you to breathe through your nose, which relaxes and slows you down.

Give your digestive system a break
Large meals can place stress on the digestive system and trigger spasms in the gut. Some find it helpful to break them down into smaller, more frequent meals, whereas other IBS sufferers do better by leaving longer gaps between meals, and experience a reduction in symptoms by giving their system a break.

However, regularity tends to help the digestive system to operate in a steady fashion, particularly when symptoms are severe.

Avoid trigger foods
Management plans for IBS are highly individual, but symptoms are often improved by alterations in food intake. Lactose (milk sugar), fructose (fruit sugar) and sorbitol (an artificial sweetener) are common triggers in IBS patients.

In addition wheat, dairy, yeast, coffee, eggs, potatoes and onions can often cause problems.

Original Article can be found at http://www.huffingtonpost.co.uk/2014/08/14/national-gut-week-irritable-bowel-syndrome-ibs-tips_n_5678367.html

Chachouka

 

Hi there Fodmappers - Well as promised here's another yummy vegetarian low-fodmap recipe for you. My lovely man made this for our supper last night - aren't I the lucky one? It's adapted from a recipe in Hugh Fearnley-Whittingstall's book 'River Cottage Veg Every Day' where it is described as a 'spicy North African pepper and tomato stew' which makes a 'lovely, lazy supper'. It would also make a rather tasty breakfast!

The instructions below are pretty much true to the original recipe except with a few low-fodmap changes. Of course you can adjust the spices according to your preference. Personally I like a bit of spice - it makes up for all the things us fodmappers go without.

3 tablespoons garlic infused olive oil

1 teaspoon cumin seeds

The green part of some spring onions

1 red and 1 yellow pepper (seeded, cored and sliced)

Half teaspoon hot smoked paprika

A pinch of Saffron

Half carton of Passata

4 eggs

Salt and pepper 

Heat the oil in a large pan over a medium heat. Add cumin seeds and spring onion greens and fry until soft. Add the peppers and continue to cook over a medium heat until these have softened. Add paprika, saffron, passata and salt and pepper. Simmer for approx 15 minutes, stirring as needed. Meanwhile heat the oven to 180C/gas mark 4. After 15 minutes, transfer the contents of your pan into an ovenproof dish. Make 4 little indentations in the top of the mixture and crack an egg into each. Bake for 10 to 15 minutes.

Serve with some salad or wheat-free bread. Enjoy.

Prebiotics, FOS and a Low-FODMAP Diet

I was speaking to someone recently who told me her doctor had suggested a low-FODMAP diet and a probiotic - with the emphasis on her taking a probiotic which included a pre-biotic. This struck me as a bit of a contradiction, and hesitant as I was to dismiss her doctor's advice, I explained what I knew about prebiotics. But maybe we need to say a little about probiotics first? (Feel free to skip this bit if it's something you already understand).

Probiotics

Probiotics are supplements you will have come across I'm sure. They are sold in various forms such as capsules, powders, liquids and added to foods such as yogurts and yogurt drinks. They are often described as 'friendly bacteria' and advertised as a remedy for bloating. The aim of taking a probiotic is to rebalance the bacteria of the gut after a course of anti-biotics, for example, or where an excess of 'bad bacteria' has resulted in IBS type symptoms.

There seems to be general (if cautious) acceptance for the benefit of probiotics in helping manage IBS symptoms, such as this from NHS Choices;

"Probiotics may help reduce abdominal bloating and flatulence in some people with IBS, and they may help relieve pain and provide general relief. [...] however, we don't yet know the extent of the benefits, nor the most effective probiotic species and strain." (1)

Prebiotics

Prebiotics (FOS) are often included in probiotic supplements to provide a food source for these good guys, which seems reasonable, but it's possible they also feed the bad bacteria. As I found out, most of the studies into the benefits of prebiotics for gut health have been carried out on healthy people, not people with IBS.  In fact, Kevin Whelan of King's College, London reports that "in Crohn's disease and irritable bowel syndrome there is evidence that some prebiotics in high doses worsen functional symptoms." (2)

Well, as you can see in the photos below, the amount of prebiotics in supplements varies drastically. In fact I was surprised by just how much they vary. The first picture is of a bottle of probiotic capsules containing 100mg of FOS per capsule, whereas the  second picture is of a psyllium husk (fibre) supplement which contains 1620mg per serving. Quite a difference yet you might notice that the probiotic content of each is pretty similar.

 

FODMAPs

And here's that contradiction - the prebiotic Fructo-Oligosaccharides (FOS) are high FODMAP. Surely if you are reducing your FODMAP intake by limiting your diet to 'safe' foods, it doesn't make sense to add them back via prebiotic supplements, especially at the higher doses? Chances are that you are already getting sufficient prebiotics through everyday (low-FODMAP) foods anyway.

"If you are following a strict low–FODMAP diet, you can obtain prebiotics from non–FODMAP foods such as bananas, kale, chard, brown rice and oatmeal." (3)

Having discovered that I am sensitive to Fructo-oligosaccharides (including wheat, onions, garlic and cashews) I'm inclined to steer clear of probiotics which have added FOS altogether. Of course, if you can tolerate FOS (something you will discover from your low-FODMAP diet) then prebiotics probably aren't going to cause you problems either.

1. http://www.nhs.uk/Conditions/probiotics/Pages/Introduction.aspx#IBS 

2.  http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8952695&fileId=S0029665113001262

3. http://www.totalhealthmagazine.com/articles/digestion/hidden-carbs-that-can-hurt-your-gut.html

Ripe or Not? IBS, Bananas and FODMAPs.

Anyone else confused about whether bananas should be ripe or unripe (or maybe inbetween) on a low-FODMAP diet? I must admit this has been fascinating me as I remember reading some years ago that bananas benefit some people with IBS while being problematic for others. Could this be why? But then when I started reading up on it I found the info out there was more than a little bit confusing! Well, I've done a bit of digging and I think I've got it. So here goes.

It seems to me (if I've understood it correctly) that the issue with bananas is not just limited to the fructose/glucose content but also to something called 'resistant starch'. As you may already know, the fructose/glucose content of a banana varies according to how ripe or unripe it is.

'At harvest, when bananas are green and unripe, the fruits are 20 percent starch and 1 percent sugar. As the bananas ripen over 21 to 28 days, the starch turns into several types of sugars. Sucrose forms first but remains at a constant amount as fructose and glucose content increases. A fully ripe banana, which is yellow with some brown spots, is 14 percent fructose, 20 percent glucose and 66 percent sucrose, note researchers from a study published in "Food Chemistry" in May 2005.' (1) So as the glucose content is higher than fructose a ripe banana is fine. As for the sucrose, Monash University explains 'Sucrose is a disaccharide (2 sugar units) made up of equal parts of glucose and fructose. Sucrose is broken down and absorbed efficiently in the small intestine.' (2) So Sucrose isn't an issue.

But as for the starch content ...

Unripe bananas are difficult to digest as they contain something called resistant starch. 'In many ways, resistant starch is similar to and behaves like fermentable fiber in the digestive tract.' (3) And as we know 'Fermentable' is not good. Resistant starches are categorised according to four groups. Unripe bananas are classified RS2 (resistant starch type 2). 'RS2 – Is intrinsically resistant to digestion before cooking. RS2 includes unripe bananas, uncooked potatoes, along with many other foods.' (ibid).

So there you have it - two reasons to opt for ripe bananas. Hope that clears things up a bit.

1. http://www.livestrong.com/article/520165-fructose-bananas/
2. http://www.med.monash.edu/cecs/gastro/fodmap/faq.html
3. http://digestivehealthinstitute.org/2013/05/10/resistant-starch-friend-or-foe/

Low-FODMAP Veggie Summer Salad

This salad has become a firm favourite in our house this summer. I don't think it needs a recipe as such as I'm sure you can see most of the ingredients (sweet peppers, cucumber, tomatoes, radishes, olives, salad leaves and feta) and it's fun to adapt it to your own tastes. The one thing you can't see from this pic is the Quinoa base.

Quinoa is still a bit of a recent discover for me. It's low-FODMAP (of course) and gluten free so it can be eaten by people with IBS and also those with Coeliac disease. It is a complete protein and high in magnesium and iron and contains both soluble and insoluble fibre for good digestion. It also contains calcium so is a great addition to a vegan diet. I'm vegetarian, rather than vegan, so I get to enjoy a bit of both the feta and the quinoa.

The salad is dressed with a splash of olive oil and a sprinkle of sea-salt - but a squeeze of lemon juice could work well instead.

Enjoy. 

Managing IBS - A Solution Focused Approach

After being reminded recently what a miserable experience IBS can be, I wanted to share with you something a little different which I am experimenting with. This is based on the Solution Focused (SF) approach which was something I had some training in a few years ago but, so far, I haven't seen applied to IBS. Rather than focusing on your symptoms and difficulties, this approach encourages you (us) to look instead at what is already working for you - even when it feels like nothing is!

Essentially, SF explores a problem through asking questions like the ones below. These are not particularly difficult questions but are aimed at helping you recognise your strengths and coping strategies. And yes, you are strong and you are coping!

I encourage you to have a go at answering some of the questions below, and maybe making notes as you go along to reflect on or to add to later. If you can't answer them all, that's fine, go with those that you can answer fairly easily and jot down any that you might like to come back to another time. (Don't forget to bookmark this page so you can find your way here). Also if you feel you want to re-word the questions so that they better apply to you, please do so.

Just one suggestion. When answering the questions try not to use statements such as 'I wouldn't feel bloated' and instead focus on what the positive aspect of that would be, for example 'my clothes would fit comfortably' or 'I'd be able to sleep comfortably' or whatever is true for you. 

I hope you find this helpful - let me know how you get on.

1. How do you cope with your IBS?
2. What are the most effective ways you've found of managing your symptoms?
3. List 5 different ways in which you already manage your IBS.
4. If your IBS was better controlled, how would things be different for you?
5. What would tell you that your IBS problems were becoming more manageable?
6. What would you notice about yourself?
7. What would you be doing differently?
8. What would others notice about you?
9. Bring to mind a time recently when your symptoms have been (even relatively) under control. What else was different about that time?
10. What were you doing that was different to other times?
11. What was it about your diet (if anything) that was different to other times?
12. What do you think made the biggest contribution to how you felt?
13. How will you manage your symptoms better in future?
14. If you knew of one small thing you could do that would make a difference for you, what would that be?
15. What encouragement could you give yourself?
16. What have you learned from thinking about this?