Author: Jules_GastroRD

I am a state registered dietitian. My speciality is dietary treatment of gut disorders such as irritable bowel syndrome, crohns disease, ulcerative colitis, coeliac disease, lactose & fructose malabsorption and multiple food intolerances. I have had lots of experience in other areas of dietetics and I wished to start this blog to spread the word about evidence based dietary treatments and dispel much of the quackery that is common with these diseases. All information on this site is of a general nature and is based on UK based treatments and guidelines. Please see your healthcare practitioner should you need more country specific information.

April is International Irritable Bowel Syndrome (IBS) Awareness Month

April is the International Awareness Month for irritable bowel syndrome (IBS) – a whole month, I hear you say? Wow, does it need a WHOLE month for people to be aware? Well my humble opinion on this matter is it does. Their can be a misunderstanding of this condition as everyone can suffer from upsets to their bowels on occasion from stressful events and IBS is often viewed as trivial by society because, after all, if up to 10 – 20% of the population suffer then surely it can’t be that bad? Irritable bowel syndrome is often played down and yes it isn’t a life limiting disease, but for some people it can have a real detrimental effect on their ability to work and have a good quality of life. It’s often quality of life that matters to people’s mood and ability to enjoy life, so this is important to everyone.

Irritable Bowel Syndrome is a range of symptoms that affect the way the bowel functions, and common symptoms include diarrhoea and/or constipation, pain with or without bloating, but IBS can include symptoms that are not directly related to the digestive tract, such as exhaustion, headaches, dizziness and depression – in fact it perhaps isn’t surprising that people get depressed with having to tolerate a myriad of confusing symptoms that on occasion isn’t managed well. There is no cure, yes there are treatments, but what works is different for everyone. Everyone’s IBS is different, therefore it does need some understanding of ones own symptoms and triggers that is important. This is where the IBS Self Care Plan developed by the IBS Network can help, because it helps to identify people’s individual symptoms and provides explanations of the various treatments that may help.

But we also must increase the profile of this syndrome in society and the devastating symptoms it can produce, a month of promotion to increase people’s awareness of the actuality of living with IBS will help. It would be really cool for you to share your IBS story this month to increase people’s knowledge and improve the image of this syndrome with the general public!  So comments to this blog would be useful and should you wish to share your story with a wider audience then contact The IBS Network and spread the awareness!!

Join the IBS Network – the UK national charity for IBS – who provide a helpline, email responses by health professional, quarterly magazine, monthly newsletter, can’t wait card and coming later this month for members only, The IBS Self Care Plan and symptom tracker, your own personal resource for understanding and managing your IBS. Check out the link on this blog site for further information

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LOFFLEX recipes

These recipes were ‘donated’ at a recent recipe drive at the hospital. They are suitable for the LOFFLEX diet for people who have crohns disease and have been previously treated with liquid/elemental diet therapy at the advice of their Consultant. It stands for low fat, low fibre limited exclusion (diet!) The recipes are wheat free, gluten free, egg free, dairy free, so will be fine for lots of other folks too! Will post more later in the week.

Smoked Salmon Risotto – donated by Eimear Bradley SRD

Ingredients – serves 2

70g Smoked salmon

1 Finely chopped pepper

180g Arborio or risotto rice

Black pepper

Salt/Herbs/Water

1/2 Tablespoon of garlic infused or garlic flavoured oil (do not use Garlic!)

Method

1. Fry risotto rice in 1/2 tablespoon of garlic infused oil

2. Make stock with boiling water and seasoning/herbs/small amount of salt

3. Slowly add stock to risotto and stir consistently for 25-30 minutes.

4. Skin peppers (blacken skin over a flame the put warm pepper in a plastic bag, allow to cool and skin will be easy to remove) chop finely, add to risotto during cooking.

5. Flake smoked salmon over the top and serve hot.

Beef Stroganoff with butternut squash (serves 4) – donated by Rachel Sharp SRD

Ingredients

400g beef rump steak, trimmed of fat (and gristle)

1 tbsp dairy free margarine

1 tbsp olive oil

250g mushrooms (without stems)

250g Butternut squash – peeled & chopped

400g white rice

1 tbsp rice or potato starch flour

300 mls boiled water

6 drops of gravy browning (no wheat or additives)

3 tbsp Soya cream

1/4 pack flat leaf parsley

1. Freeze beef (will allow you to slice it thin) and slice thinly, then season

2. Peel, de-seed and chop butternut squash into cubes. Boil for 9 minutes until soft.

3. Boil rice (cover with water just above the level of rice in the pan and simmer till soft)

4. In a large non stick frying pan, melt half the butter with half the oil, increase the heat and sear the beef in batches until browned on both sides. Remove from the heat and set aside. Repeat this process with the mushrooms.

5. Add the remaining butter and oil to the pan and melt. Stir in the rice flour for 1 minute, then gradually stir in the stock (300mls water + gravy browning) cook till thickened, then stir in the soya cream, season to taste and add both the beef and butternut squash, add etra water, if needed.

6. Drain the rice & serve hot with the creamy stroganoff.

Please note: Everyone’s dietary tolerance of foods, with crohns disease, is individual. If you suspect you have problems with these ingredients please check with your dietitian if the ingredient is OK for you, before trying the recipe. The recipes are designed for stage 1 of the LOFFLEX diet, but occasionally people can have reactions to foods in stage 1, so it is very important to keep in touch with your dietitian, when following the treatment.

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Indecision, indigestion?

I have finally decided on the name of this site – this has taken some time and considerable procrastination! should it be Clinicalimentary, a shortened version of the web address to represent dietetic clinics  – or Clinicalalimentary to represent the clinical nature to the work that I do. Someone once said “indecision is a common cause for indigestion” how true, so here it is – Clinicalalimentary- and indigestion be gone!!! Let me know what you think by all means, but I may not change my mind 😉

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Probiotics – what are they and can they help my gut?

There is a plethora of information about probiotics and we are constantly bombarded with advertisements promoting their use, for gut health, so what should we believe? Probiotics are products or food that contain bacteria, in large enough amounts to alter the number and/or type of bacteria that live in the large intestine (see diagram at the bottom of the page.) Everyone has populations of bacteria in their gut and we know that changes to these natural populations can occur in food poisoning or with any illness that occurs within the digestive tract. This could be irritable bowel syndrome, crohns or ulcerative colitits for example, but other disorders can affect the populations of bacteria. We are only just beginning to understand how these bacteria affect our health; they produce substances called short chain fatty acids from starchy foods, which help feed the digestive tract, keeping it healthy, a real benefit. They also help to produce vitamin K, a vital nutrient that helps our blood to clot and our bones keep healthy. So the relationship with our bacteria is beneficial for both the bacteria and us. These ‘good bacteria‘ also help to prevent some of the more harmful bacteria from developing and causing illness. Our bowels contain huge numbers of bacteria; our bodies contain about ten times more bacteria cells than the cells that make up our body, a good proportion of these are in our gut, an astounding fact.

What are often called ‘good bacteria’ are various types of bacteria commonly found in our bowel, and it is felt that if this natural ecosystem is damaged by illness, then replacing those bacteria helps to reduce symptoms such as diarrhoea, bloating and pain, which often accompany some digestive diseases. The theory is that taking these bacteria in food or drink will replace the bacteria that are missing; however in reality the effects are variable.

These bacteria are produced from dairy foods, such as Lactobacillus, Bifidobacterium and Lactobacillus acidophilus – long names for such cool microorganisms. We have good evidence that taking bacteria at the start of a course of antibiotics can prevent the diarrhoea that can accompany these medicines – antibiotics can reduce the natural populations of good bacteria in our bowel, which slightly alters digestion of starchy foods, resulting in diarrhoea. The case for probiotic effectiveness in reducing episodes of ulcerative colitis is controversial, but probiotics can be effective in reducing occurrence of infections that occur in people who have had reconstructive small bowel surgery (called pouches,) and can prevent diarrhoea that occurs when travelling abroad. For illnesses such as food poisoning, they may reduce the amount of days you are ill and reduce the number of times you need to visit the loo -which is always a benefit!

The products that are available also have varying effects in people with irritable bowel syndrome (IBS,) and the evidence for their usefulness for preventing further attacks of crohns disease is still uncertain. As these products are generally not harmful in most individuals, if you have irritable bowel syndrome UK health professionals advise that you could try them and see if they work for you. If you have crohns disease or colitis, it is probably better to discuss this with your gastroenterologist before you try them out.  Try them for at least a month if you wish and follow the manufacturers instructions, you may need to continue taking them if you find them beneficial, as their effect can be temporary. It is also advisable to store these products as the manufacturer recommends and use them within the date advised, to ensure that the products are effective as they can be.

Some people may be better to avoid taking these bacteria, for example if you have a severe intolerance to lactose (a natural sugar found in dairy foods,) most of the manufacturers products are based on milk, therefore they may give symptoms, as they may contain varying amounts of lactose, depending on the product. However the bacteria will have reduced the amount of lactose naturally found in these foods, so caution is advisable if you wish to try them.  Also if your doctor has told you that you have a weak immune system then you should not take these products.

Again we do not have evidence that probiotics can be helpful in preventing allergies or stopping infections of the bladder in adults, so don’t waste your money! Although I was informed by blogger yesnobananas that there is some evidence for a strain of lactobacillus Ramnosus in protection from developing atopic eczema, which is hard to find, but see her blog for further information

http://yesnobananas.wordpress.com/2013/01/10/can-probiotics-prevent-food-allergy/

But where we know they are effective, or the products are recommended by your registered health professional, they are certainly worth considering. If you wish to try them and are not too sure about your situation, you could always discuss their use with your healthcare provider.

Health professionals can check the links below for evidence base references:

http://www.patient.co.uk/doctor/Probiotics-and-Prebiotics.htm

http://www.cochrane.org/search/site/probiotics

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