Category: Irritable Bowel Syndrome

The first noel – carol singing with warm Low FODMAP sweet pies

It’s the first of December today – and so the countdown begins. I hope you have had a nice surprise this morning when opening your advent calendar for the first time. The evenings are dark early and it is a really frenetic time of year. I wonder how many of you will have carol singers arriving at the door in two or three weeks time? Have you ever wondered if any of your visitors have food intolerances when handing them a warm mince-pie after their efforts? Is offering mince-pies too old-fashioned do you think? Would they rather have money? That would be a little sad and not really in keeping with the spirit of the season. I have decided to rewrite the Christmas favourite – mince-pie, to provide a different alternative for those people who want to avoid a bout of symptoms after their festive singing. The recipe is based on rice flour – the pies are baked blind so the filling really is up to you, if you want to avoid nuts or other ingredients, you can base the filling on something else. The pastry is a great base for jam, lemon curd tarts or custard tarts you can add any other filling you can imagine!

Ingredients

1) pastry recipe

240g Rice Flour

50g Dairy free margarine

50g Light muscovado sugar

2 Eggs

1/2 Teaspoon of xantham gum

pinch of salt

2) Filling

60g Light muscovado sugar

20g Treacle

45g Golden syrup

1/2 Cap of vanilla essence

50g Dairy free margarine

1/4 Teaspoon cinnamon

1/4 Teaspoon of mixed spice

1 1/2 eggs (use the other half for brushing the pastry)

50g Pecan nuts

50g Banana chips

DSCF1059modMethod

Add the rice flour, salt and xantham gum to a bowl and mix. Melt the margarine and sugar in a small pan and allow to cool a little. Add the eggs and sugar mix to the rice flour and knead thoroughly. Pastry without gluten needs working to give a good texture, if you need to add a little more egg then do. It really is different to cooking with standard pastry – you should not need to allow it to rest either. You can roll this out between cling film but I used a little rice flour and had no problem in rolling and cutting the pastry. Cut the pastry and add to a well greased pie baking sheet. Add baking beans to each tart case and cook for 10 minutes gas mark 5 or 190°C. Allow to cool, makes about 20-25 tarts depending on how thin you roll the pastry.

Melt the sugar, golden syrup, treacle, margarine, vanilla essence and spices in a pan under a low heat – allow to cool a little to ensure it doesn’t scramble the eggs. Add this mix to the eggs whilst beating. Save a pecan nut or banana chip as decoration for each tart and chop the rest separately. Split the sugar and egg mix into two – add chopped pecan to one and chopped banana chips to the other. Mix well then add a small amount to each tart and top with the decoration. Cook at the top of an oven at gas mark 5, 190°C for 15 minutes (do keep checking them to ensure they don’t burn.)

Be aware that these pies do contain fibre – so only eat a small amount! They are small pies just a morsel to tempt!

Updated 22.11.14

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Stir up Sunday – ‘free from’ fun! Low FODMAP, wheat free, gluten free, milk free

By this I certainly don’t mean devoid of pleasure! it is a tradition in our household to make Christmas puddings, but for this year I have decided to make a pudding that you can make just before Christmas and is made from ingredients that are cows milk protein, gluten, and wheat free plus Low FODMAP to ensure you have a symptom free Christmas. Everyone in the household would stir the pudding and a sixpence was often hidden inside, a nice surprise for someone on Christmas day. As long as you don’t choke on it that is!

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Ingredients

120g wheat/gluten-free self-raising flour*

1 tablespoon cocoa powder** (gluten free, dairy free – see link below)

1 teaspoon cinnamon

1 teaspoon mixed spice

1 teaspoon powdered ginger

1/4 freshly grated nutmeg

1 cap full of vanilla essence

100g dairy free margarine

2 eggs

1 tablespoon of treacle

grated rind of 1/2 lemon and 1/2 an orange

Juice of 1/2 an orange and 1/2 lemon

90g soft brown sugar.

2 tablespoons of dried blueberries

*this recipe does not work well with flour based on chickpea and chickpea flour is a source of FODMAPs.

Method

Weigh out and sieve the dry ingredients into a small bowl, add gluten substitute and mix well into the dry ingredients.

Generously grease a pint pudding basin

Weigh out margarine, treacle, soft brown sugar, lemon + orange rind, Lemon + orange juice, vanilla essence into a mixing bowl and using a hand mixer, mix well till the mixture is pale.

Add 1/3 of the egg and a tablespoon of the dry mix, mix well, if it looks like it is curdling add a little more flour. It will likely look like it is curdling so don’t be put off, just add some more flour. This recipe needs 2 eggs to stop it from crumbling, repeat till all the egg is used up.

Fold in the dry ingredients to the batter.

Then add the fruit and again mix into the batter. Get each of your family members to give

the pudding a stir – if you can drag them away from the tv. Add the batter to the pudding basin and cover the top with a grease proof paper lid tied with string, add a fold in the paper to allow room for the pudding to rise. Cover the whole dish with foil and steam for 1.5 hours. Serve!

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If you follow a gluten-free diet then ensure your spice ingredients are gluten-free – supermarkets usually ensure these ingredients are labelled appropriately.

DSCF0998modThe pudding has dried fruit – but not too much, so that a small portion should be suitable for those with fructose malabsorption. It is very light and a good choice for Christmas day pudding.

I found this really interesting blog on recipes from history with a plum pudding recipe – don’t try this at home it contains FODMAPs 😉

http://lostcookbook.wordpress.com/2013/11/24/plum-pudding/

DSCF1057**For milk free cocoa powder check out the following link

http://whatallergy.com/2013-07/can-you-buy-nut-and-dairy-free-cocoa-powder

Jules_GastroRD2 Comments

My annual toilet rant

I have to say I find the price of toilets rather expensive and unlike last year when I travelled to London, this year I am going to blog about the problem. My bladder is partly at fault here, because it does not feel the need to empty whilst I am on the train but as soon as I arrive at any railway station I have to go, and usually quickly.

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Toilets are a problem for many people with bowel disorders, or lack of them to be precise, many people feel anxious at going out because they need to know where the toilet is, as they can need to go with some urgency. This can increase feelings of anxiety increasing symptoms, making the problem worse. I have recently written an article on IBD and quality of life and the survey (The IMPACT study) I used for the article contests to this very fact in people with this condition. The UK part of the survey revealed that during a flare 97% of IBD sufferers needed to open their bowels urgently, this only dropped to 70% between flares – this therefore represents the majority of responders. Episodes of diarrhoea were 5-10 times per day for 38% during a flare, this level remained at 11% during remission, and this clearly has a major impact on an individual’s ability to travel, work and to function day-to-day. Perhaps not surprisingly this affected the unemployed to a greater extent. One of the primary reasons for work absence is frequency of needing the toilet (38%) and anxiety due to the risks of incontinence (33%).

posterimpact

The British Toilet Association says that the provision of public toilets is a vital service for those people with medical conditions. They campaign for ‘provision of clean, hygienic and safe publicly accessible toilets that are available where and when needed, for all types of users. They request an end to public toilet closures and authorities acceptance that access to safe, discrete toilet facilities are a basic human need. The IBD quality of life study also highlights the need for accessible facilities, unavailability of toilet facilities can increase a persons’ anxiety at going out, which can make symptoms worse. 26% of people with IBD have found they have had to be rude with staff in public areas, whom often do not appreciate the person with IBD’s needs, and have refused to allow people access to staff toilet facilities.

ots-british-toilet-association-southport-ots-onthespot-ots-otsnews.co_.uk_0

This can lead to an individual being housebound by their symptoms, reducing access to society, friends and family. 81% of people with IBD reported that they are anxious about toilet facilities when travelling somewhere new. Perhaps surprisingly, the Impact survey found that the level of concern about toilet access increased with increasing age, clearly these worries are a very personal and significant problem for people with IBD. I suspect that the same is likely true for people with IBS and other bowel conditions. I do feel that it is the responsibility of the station operators to keep these prices in proportion, particularly when we are having to experience price hikes in other areas and many people who rely on government aid to live, especially those with bowel conditions, whose anxiety at trying to make ends meet can have a direct impact on the symptoms they experience. So come on guys please consider your toilet prices – available toilet facilities are a basic human need, not an excuse for making money.

Can’t wait cards can be purchased from

www.theibsnetwork.org

www.nacc.org.uk

Radar key for disabled toilet facilities and guides are available from

www.radar-shop.org.uk/Detail.aspx?id=44

Read Peter’s blog on toilets and IBD here

http://www.crohnsupport.com/toilet-finder/

The impact study can be downloaded from

http://www.efcca-solutions.net/country.php

Related articles

Jules_GastroRD3 Comments

It’s a FODMAP free fishy friday

fish fridayDo you eat fish on Friday? Do you know where this tradition came from?

I think one of the most comforting foods during dank winter days is fish pie. It is warming, comforting and can be a really healthy option too. Great to come home too after work when you need something tasty and filling after a full week at work a great start to the weekend. Now our usual fare on Friday is pilchards on toast – but I will bring you this delight some other time.

Ingredients

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300g mixed fish, this can be purchased from supermarkets already prepared, use a white fish, a smoked fish and salmon.

2/3 pint of lactose free milk

1 tablespoon of cornflour

1 1/2 teaspoons of mustard

Small handful of flat leaved parsley

salt

2cm piece of freshly grated parmesan

1/3 small Butternut Squash, 1 tablespoon of garlic infused oil, 1/2 lemon

600g of potato

1 tablespoon of margarine

3 tablespoons of lactose free milk

Method

Chop the squash, drizzle with oil and lemon and roast in the oven till softDSCF0956mod

Boil the potato

Mash the squash and potato with margarine and 3 tablespoons of milk add a small amount of salt

Add milk to a pan with mustard, parsley and mix cornflour with a little milk and add this to the pan – cook till thickened.

Add fish to a dish and pour over sauce till the fish is covered, keep remaining sauce to serve with the dish later.

Spoon on the mash, level with a fork and then sprinkle on the cheese.

Place the dish in the centre of an oven at gas mark 6, 250ºC for 25 minutes.

Serve with the warmed sauce.

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Jules_GastroRD7 Comments

Stir fry beef low fodmap

gingergrind

This recipe is suitable for a Low FODMAP diet, lactose free, wheat free dairy free and some advice later will show you how you can modify this recipe suitable for Crohn’s and colitis too. Give it a go – also check out the following tool to help you monitor your symptoms of diarrhoea it is not a diagnostic programme so if you have a diagnosis and wish to know more read on…….

A new free online health programme and app called MyRhythm has just launched and is used to track your digestive health on the go discreetly and with ease. By inputting your food and mood, the app will draw up a monthly report, identifying certain triggers unique to the user for digestive upset.

Ingredients

1 tablespoon of Ginger, chopped

4 tablespoons of Tamari soy sauce

1 tablespoon of golden syrup

1 tablespoon of garlic infused oil (to ensure it is totally FODMAP free you need to purchase this)

1 pak choy

1 courgette

1 red pepper

1 spring onion, green part only

1/2 tin of bamboo shoots

250g of lean beef – cut into strips.

20131103_34modMethod

Chop ginger and add to a pestle with the golden syrup and garlic infused oil, grind to form a paste

Add this to the beef and chopped spring onion pour on the Tamari, mix well and leave to marinade for at least 30 minutes.

Chop the vegetables thinly and heat a wok – I use a non stick wok so I don’t need to add any further oil to this to cook the meat.

Add the meat first and cook, then add the vegetables and keep stirring till the vegetables are cooked.

Serve with boiled rice – ensure you use freshly boiled  rice and eat whilst hot to avoid resistant starches, if this is a problem for you.

20131103_53modIf you have colitis and don’t tolerate red meat you can use chicken or fish to make this recipe. If you are experiencing diarrhoea symptoms and have been advised to have a low fibre diet, you will need to reduce the amount of vegetables in this dish, 1/2 carrot and 1/2 a skinned red pepper cut finely and cooked well will be adequate (boil for 10 minutes – boil the pepper whole for 10 minutes and the skin will peel away, before you put the vegetables into a wok) and use powdered ginger instead of ginger root to make up the recipe. Discuss the iron content of your diet with your dietitian or IBD team – do not be tempted to try iron supplements without discussing this with your doctor or dietitian, they can make symptoms worse. Low FODMAP diet is suitable if you are in remission (your inflammatory markers or CRP are normal) with your colitis and are continuing to experience symptoms, your dietitian can advise you how to use the diet, to see which foods result in symptoms.

20131103_57modFor Crohn’s to make this diet suitable for LOFFLEX you can use the modifications which have been suggested for the low fibre diet.

Please note I do not endorse any medication companies but this app tool might be useful – only use medications on advice from your healthcare professional.

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Grains galore! Super? Or perhaps not……………

bread

It appears that we have some grains that are ‘super’ according to the blogosphere, now I am not necessarily a fan of super foods which are proposed to be better for you than standard foods, but it is great for people with food intolerances, allergies or autoimmune conditions to have more of a choice in grains. So an increase in the range of these foods might be a good idea. So what is the low down on these newly promoted grains compared with standard grains?

http://www.thehealthypress.blogspot.com

Freekeh (contains wheat, gluten and likely contains FODMAPs and resistant starches)

This grain is essentially toasted wheat using early harvested green grain. The grain is harvested early before it has fully ripened. This results in a higher protein content than wheat and the grain has a really nice texture and a nutty flavour it is based on durum wheat species. The grain has been produced in the middle east for some considerable time, it is an ancient grain! Therefore we are being sold a product, likely at a premium, that has been cultivated for many years. It is not the choice that anyone with a wheat allergy, wheat or gluten intolerance or people with coeliac disease should consider, therefore perhaps it isn’t as ‘super’ as you might first imagine! It is higher in protein therefore may be higher in gliadin (gluten type protein found in wheat.) It might also be higher in resistant starches, good for those people who want to have a high fibre product to improve gut transit, but certainly not a perfect choice for those with digestive problems.

Quinoa (gluten-free, wheat free and Low FODMAP)

Could this grain be the answer, a true  super grain? Actually quinoa is not a grain as such. It has all the essential amino acids (building blocks for protein) that are required for health, so it is an excellent choice for vegans to ensure that the proteins needed in the diet are consumed. It is also good for people who have coeliac disease and irritable bowel syndrome and those who have a wheat allergy (labels still need to be checked for contamination unfortunately) Getting more interested? I certainly am, however the only drawback is the expense of the flour  – a whopping £5.75 per kilo, wow. As a grain it can also be challenging to produce recipes using the product, but it does taste nice when done well. I have not yet tried cooking with the flour, I can’t get over how much it costs. If anyone can find a cheaper UK source I might be tempted to send for some and give it a try for you.

Buckwheat (gluten-free and wheat free)

Despite it’s very confusing name this grain is not a wheat grain, it is related to rhubarb. Again this grain has a similar level protein to wheat at 12% and contains 90% of the amino acids needed for health. This grain makes great pancakes but I have not had the experience of using it to cook other recipes. Buckwheat can cause allergies in its own right and single cases of anaphylaxis have been reported in literature, but it is likely a rare occurence, more prevalent in countries that use it as a staple food. It is a great choice for those with coeliac conditions and wheat allergy.

Spelt (contains wheat, contains gluten but Low FODMAP)

Again this is an ancient wheat grain containing a lower level of fermentable carbohydrate however spelt pasta is not lower in FODMAPs – just the flour. This needs to be 100% spelt and it is better to choose bread made from spelt that has been made using the sourdough process. I have cooked with spelt flour and dishes produced have a nice texture and I have not had any failures with this flour. It could be a choice for those who have problems with fermentable carbohydrates but those with wheat allergy, gluten intolerance or coeliac disease should avoid this grain. Unfortunately there is a lot of misinformation about this grain, in general by people who do not understand the requirements of the gluten-free diet. People can believe it is suitable for those with coeliac disease because it has a lower level of gluten, however it is NOT gluten-free. I am not aware of any published information on what level of gluten needs to be avoided for those with gluten intolerance, therefore this flour may need to be avoided by those people with non coeliac gluten intolerance also.

image from Wikimedia

Codex wheat (contains wheat, possibly FODMAPs but very very low gluten, therefore essentially gluten-free)

Codex wheat has been developed to replace wheat flour for people suffering from coeliac conditions, it is used in the UK by manufacturers of gluten free foods and generally for foods available on prescription, although its use in foods generally available to all is growing. The gluten content of wheat is processed by washing to remove the gluten and the wheat is then tested to ensure the content of gluten does not exceed guidelines. The benefit of codex wheat is that the texture of foods using the flour is a close approximation to those of normal wheat and therefore palatability is improved. It could contain fermentable carbohydrates, although what effect the washing process has on fermentable carbohydrates is not known for all available supply, the amount of fructans it contains depends on the type & processing of the bread, so it might not be a good choice for those with fructans intolerance. A recent research report by Whelan (2011) tested the fructans content of codex wheat and found variable amounts. It does contain wheat therefore it is not suitable for those who have wheat allergy.

Teff

Teff is an ancient Ethiopian grain that is gluten-free. It is widely used in gluten-free flour mixes and is a good choice, contains  13% protein and again an excellent amino acid profile, containing all the essential amino acids. The fructans and fodmap content of Teff is not known, but it is generally used in flour blends and gluten-free breads are generally tolerated by most people following the Low FODMAP diet although it has not be tested for FODMAP content.

Tricale

Tricale is a mixture or hybrid of wheat and rye grain. It is therefore not suitable for people with coeliac disease. The amount of fructans it contains is unknown, therefore it’s suitability for the low fodmap diet is unknown, however rye has high levels of fructans so it is probably best to avoid this grain. A Wiki article suggests the protein content is higher than wheat but the glutenin content is lower, but this does not mean it is suitable for use for those who have problems with wheat.

Kamut

Similar to Freekah, this is a middle eastern ancient grain, it’s true name is Khorasan, Kamut is a brand name. The grain manufacturers website suggests that this grain is high in selenium, this depends very much on the soil the grain is grown in. It contains wheat and gluten. It has a protein range of 12-18%. The companies nutritional analysis data can be found here:

Kamut nutritional information

Again fructans content is not available for this grain.

Updated 22.11.14

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