Italian meatballs with Fodmapped sauce – a review.

I have purchased some Fodmapped sauces and soups to try, so I thought I would give you the low down. I bought them through the IBS Network website so that they would benefit from the purchase – were you aware that if you buy a starter pack you get membership covered for 1 year? The sauce was really tasty and gave an added advantage to tomato pasta sauces as you could really pick out the flavour of the aubergine – one of my favourite vegetables. Shortlisted for the Free From Food Awards I would say they are a great contender and tremendous to see a low fodmap product being reviewed. Any drawbacks? Yes, the price – the sauces are expensive compared to other sauces but they are onion and garlic free, which most ready made sauces (except plain passata and some pure tomato based pasta sauces) are not. Sometimes following the low fodmap diet can mean dry food unless you make your own stocks and sauces, you could argue that this needs to be done, but not everyone has the time. You could make a very simple roasted vegetable sauce yourself, however if time pushed these products are certainly a consideration. Putting additional pressures on busy lifestyles by making everything from scratch is sometimes unhelpful to symptoms. The packet gave a serving for 2 people. I have made an Italian dish, a comforting winter recipe, and in the process increased the portion size to 4!

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Ingredients

500g lean minced beef

1 egg

100g gluten free breadcrumbs

10g of basil leaves

10g oregano

1 packet of Fodmap Easy roasted vegetable pasta sauce

200g of dry polenta

60g parmesan

Seasoning

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Method

Place the mince in a bowl and add chopped herbs, egg and breadcrumbs and some seasoning, mix well. Roll into even sized meatballs – I made about 14 from the full mix. Set them aside.

Fry the meatballs in a dry non stick frying pan till browned.

Add the meatballs to a casserole dish with the sauce mix and 300mls of water. Place in an oven at gas mark 5 or 190 degrees C. Cook for 1 hour.

Using the directions on the packet for 200g of polenta add water to a pan and bring to the boil and pour in the polenta whilst stirring. Add extra liquid if needed to form a thick sauce, add parmesan (retain a small amount for serving) and seasoning (not much salt needed here!) to taste.

Serve

Serves 4 for a main meal.

Peppermint and IBS

Peppermint has a history of being used as a treatment for IBS. It is even used as a medication in a capsule that ensures it reaches the digestive tract where it is most useful. Peppermint, or more precisely menthol, relaxes smooth muscle and as our bowel is composed of layers of muscle fibres, peppermint can help relax the spasms that are a common symptom of IBS. Menthol activates cold-sensitive TRPM8 receptors in the mucosal tissues of the digestive tract, it is the primary source of the cooling sensation that follows the topical application of peppermint oil, this sensation is what is proposed to have an antispasmodic effect in IBS (Camilleri & Ford 2017)

Peppermint as a herb and food ingredient

So what about peppermint tea? There is no good systematic reviews or studies for this use of peppermint in IBS, but as a natural product it is less likely to have evidence, but some people do report that it does help them and they find it a useful to have means of including peppermint in the diet.

Peppermint is a suitable herb to use for the low fodmap diet. It can be used in low fodmap suitable recipes, such as the one below. According to Niki Segnit’s flavour thesaurus mint marries well with low fodmap foods such as peanut (particularly peanut butter – I am not convinced about this – but I am intrigued enough to give it a try) potato, beef, ginger, goats cheese, lamb, lime, melon (honeydew and cantaloupe), mackerel (and other oily fish), raspberry and strawberry. Not forgetting the ubiquitous marrying of dark chocolate and mint see a recipe here https://clinicalalimentary.blog/2017/11/24/chocolate-coated-peppermint-snow-peaks-low-fodmap-christmas-recipes/.

Warm feta and mint salad

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Ingredients

100g feta cheese

2 tablespoons pine nuts

200g cooked rice

25g finely chopped mint

1 tablespoon of olive oil

1 pack of small courgettes (or 2 large courgettes -works just as well!)

Caper flowers and a tablespoon of pomegranate are used here to decorate

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Method

Add the oil to a frying pan then add the pine nuts, chopped mint and finely cut courgette

Fry till toasted then add the cooked rice and blend well

Add chopped feta at the end of cooking and mix to warm through

Note the lack of salt added – feta is quite a salty so it is more than enough seasoning for the dish.

Serve warm or cold – marries well with grilled meat or just as it is!

Peppermint in medications

I am a dietitian and any medications should really be discussed with your doctor but as peppermint is a common food ingredient I don’t necessarily see a problem in looking at the evidence of peppermints use as an antispasmodic agent.

Peppermint is more effective than placebo for treating IBS (number needed to treat 2.5 – Ford et al 2008) with small numbers of adverse events with this medication but not all the reviewed studies reported on these. (Khanna R, Macdonald JK & Levesque BG 2014) completed a more recent review of the use of peppermint in IBS and again a moderate level of evidence of effectiveness was the reviews result which included a combination of data from 726 patients with IBS. With more side effects in the peppermint group of patients reported by these reviewers, although no data was given in the abstract, the effects were reported to be transient and heartburn was reported as the most experienced side effect. A more recent review (Camilleri and Ford 2017) suggested effectiveness of peppermint as an antispasmodic, with moderate evidence but also gave safety concerns for peppermint of reflux, heartburn, dry mouth and belching – and peppermint taste – presumably through reflux? Plus smell (not sure how this would be adverse though – it is in fact quite a pleasant smell on the breath) (Camilleri and Ford 2017.)

Why am I not surprised that heartburn is a side effect for some people with IBS? It is quite common for people with IBS to experience some upper gastrointestinal symptoms. As such, reflux and heartburn are included as symptoms checked for when using the Kings College validated symptom checklist, which I use in clinic. Again peppermint is a smooth muscle relaxant – so would it not relax the ring of muscle at the bottom of the oesophagus, leading to reflux symptoms?

All studies reviewed the short term effectiveness and suggested that more studies in the long term use is needed. Should you try a peppermint based medication? Certainly do if your GP/gastroenterologist suggests it, and the evidence based from systematic reviews suggest it is effective. But if you do suffer from IBS and reflux, another antispasmodic option might be a better choice, discuss with your GP or pharmacist, who can advise on use of peppermint and suitable alternatives.

Does peppermint ever cause any problems with allergy/intolerances?

One case review reported on an anaphylaxis reaction due to an IgE mediated allergic reaction to peppermint (Bayat R, Borici-Mazi R 2014) – this is extremely rare. It is quite possible that other reactions may be causing symptoms for a very small number of people. Peppermint is a natural source of salicylate. Aspirin, as a form of salicylate, can occasionally cause allergic reactions, and people with aspirin allergy, asthma and nasal polyps can occasionally have a food hypersensitivity to foods naturally containing salicylate. This type of food reaction again is quite rare but symptoms could be mistaken for IBS. Do seek the help of a dietitian if you suspect this kind of food hypersensitivity, as often information about salicylate containing foods on the internet is often far too restrictive for any low salicylate diet to be implemented safely. Also it is often quite tricky to identify these reactions to foods so an experienced practitioner is important to seek advice from.

Chemistry-Salicylic-Acid
www.compoundchem.com

Alexander C Ford, Nicholas J Talley, Brennan M R Spiegel, Amy E Foxx-Orenstein, Lawrence Schiller, Eamonn M M Quigley, Paul Moayyedi, (2008) Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis BMJ. 2008; 337: a2313.

Khanna R, MacDonald JK, Levesque BG. (2014) Peppermint oil for the treatment of irritable bowel syndrome: a systematic review and meta-analysis. J Clin Gastroenterol. 2014 Jul;48(6):505-12.

Michael Camilleri and Alexander C. Ford (2017) Pharmacotherapy for Irritable Bowel Syndrome J. Clin. Med. 2017, 6(11), 101; doi:10.3390/jcm6110101

Bayat R, Borici-Mazi R. (2014) A case of anaphylaxis to peppermint. Allergy Asthma Clin Immunol. 2014 Jan 28;10(1):6. doi: 10.1186/1710-1492-10-6.

 

 

Turmeric – medical jack-of-all trades, or just a great curry ingredient?

Chemistry-of-Turmeric
http://www.compoundchem.com/

Turmeric is a wonderful ingredient to add to a curry – it has also been exalted as a wonder food with lots of great benefits for health. Some of the more pervasive anecdotes with regards to turmerics ‘heath benefits’ are antioxidant, anti-inflammatory and anti-cancer effects and benefits for digestive health and IBS.

I have always had a bit of a problem with the anti-oxidant hypothesis in health, as an ex-polymer chemist, I was very experienced in protecting polymer products such as paints and adhesives from the effects of oxidation and environmental free radical degradation. This was not always easy to achieve – even the in simplest of formulations.

These free radical reactions do occur in our bodies – at a base level we are a very complex mix of chemical reactions and our bodies contain polymers. Turmeric is a polyphenol, and polyphenols do show anti-oxidant properties. With anti-oxidant protection, as a chemical reaction, one factor needs to be fulfilled – the anti-oxidant has to be situated at the site where the free radical reactions occur to be able to mop them up. Therefore any research involving turmeric in Petri dishes to observe it’s anti-oxidant (and anti-inflammatory or anti-cancer effects), or by feeding animals unsustainably large amounts may be very interesting, but far from proving it to be an effective anti-oxidant in our body. There is a problem with turmeric – it is very poorly absorbed in the digestive tract, it has poor solubility – therefore it would be difficult to transport it to the site of reaction. If the anti-oxidant cannot physically be transported to the site of free radical reaction, then it is clearly not possible for it to react! Until this problem is solved it is perhaps an entirely useless medical treatment, and of course, it needs to be studied in humans as a treatment, with randomized controlled trials and ultimately a systematic review. These problems can possibly be solved – by utilizing chemistry.

But…but…turmeric is ‘natural’, is the response, so therefore it is surely better for us than all those ‘chemicals’ in medicines? If you are going to use the anti-oxidant theory for the promotion of ‘alternative’ natural care, then you are buying into chemistry by using this as your argument. Spoiler alert – curcumin, the active compound in turmeric, is a chemical – see the infographic above. If it was effective it would be called a medicine, which may be possible in the future with lot’s more health research – but certainly, we are a very long way from this now. One research paper proposed turmeric as a jack-of-all-trades, in other words ‘useful’ for numerous health areas, which concomitantly also means master of none, an insightful figure of speech here, perhaps.

For digestive complaints, turmeric has a long history of use in Ayurvedic medicine as a compound which can be useful for indigestion, but with little strong evidence for effective use in either IBS or indigestion – just tantalizing pre-clinical trials and uncontrolled studies.

Past history has taught us that medicines are often derived from naturally occurring pharmacological plants, so research of turmeric should certainly continue – but we really shouldn’t be tempted to jump the gun with promoting turmerics alleged health effects, this is disingenuous.

So does turmeric have any benefits at all? Of course! Turmeric is low fodmap as a spice and can be used to flavour low fodmap recipes for people who have irritable bowel syndrome and imparts these foods with a very vibrant colour. If you are wanting a January ‘health kick’ from turmeric, or use it to ‘cure’ your IBS, then think again, but enjoying a great, warming, vibrant low fodmap meal made from turmeric, either low fodmap curry, or the low fodmap soup recipe below, in the depth of winter, is surely a sublime use of this wonderful spice?

Carrot, ginger and turmeric soup

Ingredients

500g carrots

1 tablespoon of oil

1 teaspoon of Moroccan spice (Fodify)

1 teaspoon of ginger

2 teaspoons of turmeric

1500mls water

seasoning to taste

Method

Peel and chop the carrots

Fry the spices in oil to release the flavour

Add the water and carrots to the spices

Cook till the carrots are soft, then blend with a hand blender

Season

Serves 3-4

https://www.nhs.uk/news/cancer/curry-spice-kills-cancer-cells/

https://www.nhs.uk/news/food-and-diet/spice-for-mice/

https://www.nhs.uk/news/food-and-diet/could-curry-spice-boost-brain-cell-repair/

https://link.springer.com/article/10.1007%2Fs11894-016-0494-0

Celebration trifle – low fodmap

It’s New Years eve and if you want a celebration dessert that can help people following a low fodmap diet but is also tasty for all your New Years Day party guests, this is ideal – it is made with lactose free mascarpone and lactose free creme fraiche (you can buy these at Tesco) plus gluten free sponge. Whilst this trifle is low fodmap it is not low in fat – if you have issues with foods high in fat resulting in symptoms take care – a small portion only is probably best!

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Ingredients

Sponge

100g gluten free self raising flour

2 eggs

100g margarine

100g castor sugar

Rhubarb

250g rhubarb

2 tablespoons of maple syrup

1/2 teaspoon of orange oil

1 tablespoon of granulated sugar

100ml of water

Topping

50g chopped pecan nuts

Cream

200g lactose free mascarpone

100g of lactose free creme fraiche

1 tablespoon of icing sugar

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Method

Sponge

Make the sponge – this is better prepared the day before to allow it to stale a little

Add the margarine and castor sugar to a bowl and using a hand mixer mix until light and creamy

Add one egg and beat till incorporated into the mix – if it curdles or separates just add a little of the flour to the mix.

Repeat with the other egg.

Add the flour and mix it in slowly with a metal spoon.

Pour into a 7 inch lined cake tin and put in an oven to cook at gas mark 5 190 degrees C for 45 minutes – or until a metal skewer inserted into the cake comes out clean.

Cool and slice length ways into two circles

Rhubarb

Wash slice and cook the rhubarb with the water, maple syrup and sugar and orange oil until soft – cool and save the cooking liquor. I like my rhubarb quite sharp to counteract the sweetness – add sugar or syrup to your preference here.

Cream

Mix the mascarpone with the creme fraiche and icing sugar – keep in the fridge

and build….

Build the trifle, one layer of rhubarb, then sponge – add some of the rhubarb cooking liquor to the sponge, then mascarpone – repeat until all the mixes are used up ending with a layer of mascarpone. Add chopped nuts to the top of the cake to decorate.

Serves 8

🎇🎊 Wishing all my followers a Happy New Year!🎊🎇

 

 

 

 

 

 

 

 

Mini chocolate orange panettone – low fodmap

This is an ideal Christmas recipe for low fodmappers who want to have a festive bread without marzipan and probably one of the only bread recipes that I have managed to produce that has risen well! It is based on an enriched bead dough mix produced using a standard purchased bread flour.

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Recipe

250g gluten free bread flour

150g dark chocolate chips

2 teaspoons of orange oil

2 eggs

1 tablespoon of oil

1 teaspoon of vanilla

1 pack of fast acting yeast

1 pinch of salt

1 small pinch of cream of tartar

50g of castor sugar

1 teaspoon of cinnamon

1/4 teaspoon of cloves

1 teaspoon of ginger

1 teaspoon of mixed spice

400ml of warm water

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Method

Add the flour, spices salt and dark chocolate chips to a bowl, mix.

Separate the yolk from the white of the eggs.

To the white add a pinch of cream of tartar and whisk till peaks are formed, adding 25g of sugar half way through, then add the rest when soft peaks are formed.

To the yolks add the oil, vanilla and orange oil

Start adding the water to the dry ingredients and mix with a hand mixer. Then add the yolks.

Fold into the mix half the beaten egg whites quickly to slacken the mix. The gently fold in the rest of the egg white.

Add to bread tins and leave in a warm place for 30 minutes to rise. Cook in a warm oven (200˚C, Fan 180˚C, 400˚F, Gas 6) for 30 minutes until cooked.

Coffee, caffeine and the complexities of digestion.

Struggling with sleep? Constantly wired? Have to dash to the toilet immediately after drinking your morning brew?

It’s possible that coffee is causing these symptoms. The caffeine contained in coffee is a gastrointestinal stimulant, this means caffeine increases the contractions that move the contents through the bowel, risking diarrhoea and urgency. For those with slower bowels (constipation) caffeine containing food and drinks may help you to go to the toilet, but caffeine does have other effects that should be considered.  For those with alternating symptoms it is worth tracking you caffeine intake through the day – you may find that intake might be the cause of problems. Black coffee is not a fodmap containing drink – but it can cause symptoms of IBS – so it is an important dietary factor to consider.

Many people with an overly sensitive digestive tract will experience symptoms with food and drinks high in caffeine, due to these exaggerated reflexes that occur with IBS. Older research suggests that for some people coffee can stimulate bowel function within 4 minutes of drinking it. This cannot possibly be a direct affect of coffee traveling through the bowel – but suggests that a pharmacological (drug like) affect or perhaps due to hormone stimulation?

Production of the hormone gastrin by the stomach is stimulated by coffee, which results in increased movement of the digestive system by the gastrocolic reflex (an involuntary and nearly instantaneous movement in response to a stimulus.) This reflex in some people is caused by the act of drinking coffee (the stimulus) and results in the bowels emptying to ‘make room’ for the next meal. This reflex can often be exaggerated in people who have problems with their bowels.

Coffee has a low osmolality of 58 osmol/Kg – meaning that drinking it black with no sugar can affect how quickly fluids pass from the digestive tract into the body – low osmolality drinks can result in fluids being absorbed more quickly. Drinking coffee with a meal could reduce these effects and so can adding milk/sugar (but sugar is not great for health) – so, having a breakfast of a cup of black coffee or a strong shot of espresso to kick start the day might not be too helpful for those with IBS.

Caffeine also has systemic effects on the body it is a bio-active compound – in other words – it can result in other symptoms in the body that might have consequences for people with IBS. IBS is also systemic condition, symptoms are not just confined to the digestive tract – see here for a comprehensive list of other symptoms https://www.theibsnetwork.org/have-i-got-ibs/what-is-ibs/. Not everyone has the experience of the stimulation of the nervous system as a result of large intakes of caffeine. If you are affected however caffeine can exert the following effects – increases in perception of alertness and wakefulness, palpitations, high blood pressure, insomnia, headaches and sometimes anxiety depending on individual tolerance.

Is it just the caffeine that is responsible in coffee for causing symptoms? Coffee contains many different compounds and whilst caffeine is responsible for some systemic effects there is little evidence that de-caffeinated coffee has and affects on the bowel – but some anecdotal evidence suggests that it might.

Coffee and the bladder

Some people also have bladder problems with IBS – urinary urgency and frequency can be affected by caffeine containing drinks. This is because they can relax the muscles in the pelvic floor.

Coffee, caffeine and sleep.

Health advice for sleep hygiene suggests that drinks containing caffeine should be limited a few hours before bed to avoid insomnia https://www.nhs.uk/conditions/insomnia/self-help/ Poor sleep is also associated with IBS with up to 74% of people with IBS stating that sleep is a problem and insomnia can increase levels of pain and perception of pain the next day. It is worth trying to incorporate some aspects of sleep hygiene into your treatment, if this is a problem for you.

Where else is caffeine found?

It can be very easy to have a large amount of caffeine, as it is found in a number of different foods and drinks – here is a table taken from our book IBS -Dietary advice to calm your gut available here http://amzn.to/2yBk3u7:

Food Approximate caffeine content
Coffee expresso (small cup) 200 mg
Coffee filter (1 cup) 140 mg
Coffee instant (1 cup) 100 mg
Energy drinks (250ml) 80 mg
Tea (1 cup) 75 mg
Cola (330 ml can) 25 mg
Chocolate (dark 25g) 20 mg
Chocolate (milk 25g)* 10 mg

*Also contains lactose and fats, which can also induce symptoms.

Caffeine can also be found in medications – discuss with your doctor or pharmacist if you wish to cut down or change medications.

How do I reduce my intake?

Because coffee is a bioactive compound immediately stopping drinking it can cause symptoms in susceptible people. Symptoms of withdrawal start 12-24 hours after abstinence and can last for 2-9 days. Symptoms are headache, fatigue, depression, difficulty concentrating, irritability and ‘brain fog ‘.

So DO NOT be tempted to go cold turkey, if you are considering cutting down on your intake. Cutting down gradually is helpful for withdrawal effects, slow changes can also help with maintaining the changes you have made.

Try reducing your intake by half a cup a day over a seven day period. Ensure you have other fluids available to drink – water or squash for example, to keep hydrated. You could use decaf tea/coffee if you wish but this might be a problem for some people perhaps.

Don’t be tempted to use coffee weaning products – they are expensive and have no evidence that they work.