Category: Digestive Health

What not to say to people with IBS – a response – #supportallGUTfolks

2014 update

This post was written in 2012 and since this date the offending comment still exists in Health Magazine and unfortunately the comment facility has been closed. If you feel aggrieved at the comment I suggest you write to them – although both Nina’s comment (IBS Impact) and my requests have fallen on deaf ears, so how successful you would be is debatable.

I was reading an article for help for people diagnosed with inflammatory bowel disease (IBD,) in Health Magazine, really good useful tips actually, on how to be empathetic for those people with IBD. However I did start to see red when I read a comment of you should keep your symptoms of IBS to yourself, when empathizing with people who have IBD. Now, I do get angry really quickly when people make the suggestion that IBS is somewhat insignificant – is this because it is a ‘syndrome’ perhaps? I had a rant and a cup of tea (to gather my thoughts,) then I wrote a response to this article. Not an angry response – quite a nice balanced one, explaining that it is not helpful to people with irritable bowel syndrome (IBS) for the magazine to make this comment, with the reasons why. I also requested that they remove this particular comment from the site – to ensure that it was empathetic to all. My response was deleted from the site by the system administrators, this denies my freedom of speech as an advocate for the UK charity for IBS, and my professional ability to support all those people living with difficult GUT symptoms, despite the diagnosis. I was pleased that IBS Impact still have a well-balanced comment on the site, but they have not asked for it to be moderated – perhaps that was the difference. You can see the article here:-

http://www.health.com/health/gallery/0,,20533275,00.html

I am not in any way suggesting that crohns disease or ulcerative colitis, or any other GUT disorder is not significant, quite the contrary, but people should understand that for some people the symptoms of IBS can be very disabling. Neither am I using this article to promote IBS’s cause, I am just advocating promoting tolerance for all. So how do you empathise with someone with IBS? You can start by not saying the following:

IBS is all in your head.

This is not true, symptoms are very real. Is it the age-old view of society that IBS is ‘all in your head’ and therefore your symptoms cannot surely be real. Irritable bowel syndrome is a functional bowel condition, it is a condition where the digestive tract moves in a disordered way, producing symptoms, also the gut is hypersensitive to bloating causing pain. Yes, tests are negative, but most tests do not measure the speed the GUT moves. These symptoms are not a normal condition for the body, therefore it is difficult to understand how this disorder can be ‘imagined’. Now the gut does have a connection with the brain and the way someone is feeling can affect the way the digestive tract moves, but it certainly does not all start and end in their head. Read more about what Dr Bolen says about the brain GUT connection and five reasons why IBS is not all in someone’s head here:-

http://ibs.about.com/od/symptomsofib1/a/braingut.htm

http://ibs.about.com/od/symptomsofib1/a/notstress.htm

Oh – are you one of ‘those’ people that have a self diagnosed (thinking here – made up) food ‘intolerance’?

This is misguided, we are all aware of the popularity of alternative diets for celebrities, this does not help the cause of individuals who may have intolerance to certain foods. This can result in some level of disdain when a person with intolerances asks for a meal or product free from a certain ingredient. Please accept that not everyone has had access to professional help to identify what is causing symptoms and you should trust them, they know their bodies and what they can tolerate. You can ask them to help you to provide a meal or product that will not make them ill, most people respond very favourably to a request for help.

You are so fussy when it comes to food, you just need to get over it and eat your meal.

Comments like these are really suggesting there is nothing wrong with the person with IBS – therefore I don’t believe food affects you at all – so pull yourself together. Do you really want to tell your friend or family member that you don’t believe what real symptoms they have? This statement reinforces negative feelings and can result in mealtime arguments, really unhelpful for all involved, this will not help anyone’s digestion. Feelings do need to be discussed in a useful way, but choose a suitable time to do so and make it a positive experience by listening to each other to start.

You told me you couldn’t eat what? Oh sorry I forgot, I’ve made a vindaloo, its wheat free, will that do? You can have a large glass of milk to help reduce the heat, if you want.

The best way around this is to understand what your friend or relative is sensitive too and then perhaps you can hold some store cupboard items, that can be relied upon in an emergency. It is better to plan so that everyone can eat the same meal, but perhaps you can have an alternative in case of unannounced visits, or if you forget. Basic examples would be eggs (omelettes, poached) plain chicken or fish, boiled rice, fresh boiled warm potato, frozen carrots, salad leaves and you could also put a loaf of sliced wheat free bread in the freezer.

What do you mean you can’t come out?

Some people with IBS do not want to travel without preplanned toilet facilities and they may not wish to discuss their personal symptoms with you. Please try not to be offended. What is useful to say is that you are sorry that the person cannot come on the trip, and if you are a real friend you can offer help, if it is wanted – no questions asked, please! Wait for the person to discuss their symptoms, they will, if they feel happy and comfortable to do so. If they ask for help then the IBS Network makes a can’t wait card for trips out, it can be used in shops and stores. You could plan the trip together or wait to go till the persons symptoms are a little better controlled before you go. Arranging to visit the person in their own home is always an option, to make them feel less excluded, if the trip cannot be cancelled.

HA,HA,HA, lol,  those are Dave’s symptoms????? Really?? OMG! Just wait till I tell……..

If this person you are talking about is a friend or work colleague or even an acquaintance, then imagine how you would feel if someone were to say those things about you. Your ‘friend’ does not deserve this sort of treatment, behaviour like this causes stress and could be viewed as very hurtful – please think before you speak. Les Floyd who writes a cool blog wrote a blog about Socrates and the triple filter test, ask yourself these questions before you speak – 1. Have you made sure what you are going to tell is true? 2. Is what you are going to tell something good? 3. Is what you are going to tell something useful? If what you are going to say does not fulfil the truth, goodness or usefulness filter then simply don’t open your mouth – end of. The blog, which is really worth reading can be found here

http://lesism.blogspot.co.uk/2012_05_01_archive.html

We don’t have a special fussy eaters menu.

Remember the fact that the customer is king, the best retort you can give is to say that you may not have a good understanding of the persons requirements BUT YOU ARE WILLING TO LEARN (this is the most important part.) “What can we get for you to eat?” Then listen carefully and try to avoid contamination of their food – prepare it separately. This will make the person comfortable in what you are going to provide, it will also keep you a customer – and never forget, people with food intolerances always eat with others. If the person has had a good visit they are more likely to return and spread the good word with friends and family. Web sites that can help are

http://www.coeliac.org.uk/food-industry/caterers-and-restaurateurs

http://allergytraining.food.gov.uk/

(for ‘allergy’ also read intolerance, plenty of information about how to cater for food intolerances on the site.)

Everybody gets tired.

Tiredness is a symptom of IBS, it is not known what the cause is, but it is a symptom. Yes everyone does get tired at times but some people with IBS can have the added complication of tiredness to cope with as well as the hustle and bustle of life. The person with IBS will have some idea of how much they can cope with, please be empathetic and listen.

Some of the comments or questions discussed here are a little bit exaggerated, but I am sure that everyone has had similar comments made to them at some point. I was also a little disappointed with some of the comments on the Health Magazine site – but each to their own I suppose, all I ask is please be sensitive when speaking to someone with IBS. You know what, though? Some of the answers will also help others with GUT symptoms to eat well, so people with GUT conditions really do have very similar experiences and should be able to support each other.

Jules_GastroRD5 Comments

Spicy turkey burgers, Low FODMAP, milk free, Gluten free.

Went out for a 2 hour walk Saturday, the weather was sunny and hot, it doesn’t appear that way from the picture, but it is quite rare for us to have a cloudless sky.

Turkey Burgers

600g Turkey Mince

1 Egg

2 Small grated carrots

10g Chopped fresh coriander leaves

2 Teaspoons of powdered coriander

1 Teaspoon of chilli powder (omit if this causes symptoms.)

20g Grated ginger

1 Teaspoon of cumin

1/2 Flat teaspoon of asafoetida (if following a gluten-free diet ensure that asafoetida is wheat free)

Salt and pepper to taste

Served with brown rice and wild rocket.

Method

Place turkey mince into a mixing bowl and add other ingredients. Mix well (clean hands are best!)

The mix is rather wet, spoon a tablespoon of mix into a dry frying pan and cook for 1-2 minutes each side till the surface is brown, repeat till all mix is cooked. You can either then finish the cooking in the oven or grill till cooked through. Some of the water will leach out during cooking.

 

 

 

Jules_GastroRD1 Comment

Orange superfood, cheap and not too hard on the digestive tract ‘THE CARROT’ – yes, seriously!

Before I studied to be a dietitian I disdained the carrot, cheap nasty veggie filler, used too often in cheap food in my uninformed view. However as they say, knowledge is power, and I’ve had a bigger sheepish U-turn than David Cameron (they often use carrots in pasties too, you know, although this is less than traditional!) Carrots are full of fibre, and not too much of the gut fermentable stuff, so they are an excellent vegetable to choose. The main nutrient the carrot contains is beta carotene, the veggie Vitamin A, more available to the body if carrots are cooked, but they are also really nice grated raw, as crudities with low-fat dips. Carrots are also very good when cooked with cumin, thyme and coriander. Carrot juice also reduces the acidity of orange juice, making orange juice a less sharp drink, if you find its acidity a problem. Beta carotene is stored under the skin and converted to vitamin A (retinol) by the liver. Carrots are also suitable to have frozen as well as fresh, beta carotene is a fat soluble vitamin it is not easily leached during cooking or storage of the vegetable. Does eating carrots help you see in the dark? Well retinol is a required vitamin for vision, but most people do get adequate amounts, it helps you see better in the dark only if you are deficient in this vitamin, replenishing low stores will improve your vision. But it doesn’t improve it if you are eating enough, it is not exponential e.g. you do not get better and better vision if you eat more and more. Retinol is also needed for skin, teeth and to help your bones grow. Also a word of warning here – as with any food, variety is key to getting the range of nutrients your body needs – seriously overdosing on beta carotene – carrot juice or supplements, will turn you orange, carotenosis, although harmless and reversible on stopping consuming the offending item. 😉 Actually the lesson here is that there are no real ‘super’ foods eat a variety of foods to get what you need.

Related articles

Jules_GastroRD4 Comments

Bilberry and lemon fairy cakes – gluten free, low fodmap, dairy free, lactose free.

Went on the hunt for bilberry again – however a less successful foraging trip. Hiked for two and a half hours up hills, through bramble (will be back for bramble berries later next month!) and over bogs and moorland. I did find some, but less that last time and really only enough to add to cake, or breakfast, or yoghurt. I chose to bake some fairy cakes, as I will take some in to work on Friday and share them (keeps the family from eating them all – a good tip!) The weather was a little cloudy but I did see a little sun, I am glad that I decided to go in the morning as it is raining again now, but this is the reason we have such beautiful plants and wonderful countryside.

Ingredients

175g of wheat free gluten-free self raising flour*

125g dairy free margarine

175g of golden castor sugar

juice and grated peel of 1 lemon

A few bilberries (depends how many you can gather!)

1 cap full of vanilla extract.

2 eggs

Icing sugar and decorations (please ensure these are gluten-free if coeliac and following gluten-free diet, however a small amount of contamination from wheat should not cause a problem if you are following the Low FODMAP diet)

Method

Heat up your oven to gas mark 4.

Add margarine and castor sugar and vanilla essence to a mixing bowel and mix till pale with a hand mixer.

Add 1 egg and a tablespoon of the flour to the mix.

Mix till well incorporated. If the mix curdles slightly (starts to separate) you should add a little more flour.

Add the other egg and another tablespoon of flour and repeat the above process.

Grate the rind off the lemon and add to the bowl and mix well.

Add the flour and fold the mix using a metal spoon till all the flour is incorporated.

Cut the lemon in two and juice on half – add to the mixture and mix well.

Add bilberries and mix.

Spray silicone moulds with spray oil add some mixture to each, this makes about 15 buns.

Cook for 20 minutes or until golden and well risen.

Place on a cooling rack – do not remove the buns from the cases till fully cool, or you may find that they stick.

Juice the other half of the lemon and add to a bowl incorporate icing sugar into lemon juice till you have a runny consistency. Drizzle icing sugar over the buns and add decoration.

These are no higher in fats and sugar than normal buns – but they are high, so have one, don’t eat too many if you have IBS, as fat can cause symptoms if you eat too much. Share the rest with friends and see if they can tell that they have no wheat. *Please watch the flour if you are following a low fodmap diet as some gluten-free wheat free flour contains psyllium husk flour – to keep things moist, this can cause symptoms for some people.

Jules_GastroRDLeave a comment

Day 3 – getting complacent?

Just look at my scones, aren’t they just perfect? Guess what? I made them without the recommended 28g of oil – so slightly lower in fat too, so I’m not just thinking of gluten-free now, but healthy eating – multi tasking diva, lol! They were from a packet mix so I suppose I cheated a little but so what? Just a good food for a treat, they are a little better having been made for a day and they don’t have the ‘bicarbonate’ taste you sometimes can get after eating scones. So all good then?

Well, perhaps I speak too soon – all was not perfect with the pasta I made for my lunch. I followed the instructions on the packet. I always tell people to do this, since a previous experience of ending up with a lump of starch once when preparing gluten-free pasta. I was stirring the pan as advised as tasted the pasta which was a little too al-dente, then in a matter of seconds it went very mushy. I have still prepared my pasta salad for lunch so I will report back how this tastes later today.

I’m up early today, bright-eyed and bushy-tailed and ready for whatever the day may bring. Reflecting on things this morning and I do feel that it is really important as a dietitian not to impose your food likes/dislikes on others, I have always been somewhat aware of this when I recommend sip feed drinks to patients but also in clinic. I recommend those people who are newly diagnosed coeliac, it is really important to try as many different foods as possible as we all like different food. I may not like many of the gluten-free biscuits, for example, but others may – so I would advise to try again with foods if you are struggling with. So don’t let my feelings on gluten free biscuits cloud your judgement, they are worth trying for a treat. This is also good advice for people who have been coeliac for a number of years and who are stuck in a rut of eating the same food all the time – my experience over the past few days is that even in a short period of three years the choice of gluten-free food has improved significantly.

Jules_GastroRD4 Comments

Day 2 and Counting – no near misses today

Made it – day two, no near misses, up to now, at least! So I had the same breakfast as yesterday, which I am still enjoying – not like my foray into gluten-free in 2009 – I’m unsure what has changed perhaps it’s my improved knowledge of the diet.

My lunch is shown on the right, it consisted of

1 fillet of smoked mackerel

1 boiled egg

5 radishes

2 celery sticks

2 inch slice of cucumber

5 mushrooms

and 2 slices of my wonderful (?) gluten-free bread

Unfortunately I forgot to take some fruit with me today so I arrived home ready to devour ANYTHING,  I would have eaten a scabby donkey if one were available – they are gluten-free :-). The one problem with the gluten-free diet if you are not used to it planning is needed. What to have for my meal? Whilst preparing my meal I had 2 small gluten-free corn cakes and a banana.

My bread has gone stale now – so ready for toast, 2 slices of bread (or brick – which describes it a little better!) with Edam and some ham (packet ham – avoiding contamination.) I did really enjoy this and it has filled me up. The gluten-free carb foods do fill me up I wonder if that is because they can be higher in fat to improve the texture? I don’t think my bread will last another day so I have wasted that mix, about 1/3 of a loaf, I might try freezing some next time, but I don’t think I have enough mix left to make another loaf.

The good thing about following the diet is that I can’t have any biscuits – My one and only weakness!! 🙂 I am going to try to make some scones now – so watch out for another culinary disaster.

Jules_GastroRD2 Comments