Coriander carrots

My love of the carrot is growing – it really is a very versatile vegetable and the colour it provides to dishes adds a bit of warmth during the winter. Carrots partner very well with coriander and I have decided to use my gnocchi recipe to see if it works with carrot in place of parsnips – it appears that it does, but one word of warning – ensure you cook the carrots well and puree them before you add the flour to ensure you can roll them and they have the correct texture.

Ingredients

400g Carrots

70g of gluten free flour

2g of coriander stalks chopped finely

Coriander seeds to garnish

salt + pepper

Method

Cook the carrots till very soft and puree

add the flour, coriander stalks, salt + pepper and mix well

Roll into a 1cm width sausage on a floured board and cut even 1 cm strips.

Roll into a ball and flatten with a fork.

Boil till they float in water.

Serve

I thought I would add a picture of this little chap with his orange (red) breast – he was very friendly!

DSCF2123

Gulp, Adventures on the Alimentary Canal – a review!

gulpGulp – Adventures on the Alimentary Canal, is the perfect book for my blog! This is a wonderful lighthearted trip down the digestive tract with lots of fun, facts and interesting comments. Mary writes genuinely funny chapters on diverse subjects such as designing pet food (your pet is not like you – really, you should read this), how to survive being swallowed alive to the exploits of surgeon William Beaumont who experimented on the hapless Alexis St Martin who was left with a fistula from his stomach to the surface of his skin after a shooting – facilitating many a gruesome experiment. Sounds a bit ghastly but Mary treats each subject in such a cheerful way you really wouldn’t know it.

Just the ticket if you have some spare Christmas cash left over – I read the book in less than a weekend, couldn’t put it down and couldn’t stop laughing. I will leave you with a taster 😉 from the back of her book

“How have physicists made crisps crispier? What do laundry detergent and saliva have in common? Was self-styled ‘nutritional economist’ Horace Fletcher right to persuade  millions of people that chewing a bite of shallot 700 times would yield double the vitamins? Did Elvis actually die of constipation?”

Now – tell me you are not even a little interested?

 

This book was provided as a birthday gift from a friend – couldn’t resist telling everyone about it.

Off to London again!

I am planning another trip to London tomorrow, this time to Imperial college London for a course on allergic gastrointestinal disease. I am looking forward to the lecture on eosinophilic oesophagitis and gastroesophageal reflux and other upper GI motility disorders.

IMG_1523modThis is the course, I was very lucky to have been sponsored by Allergy UK to attend the training.

http://www3.imperial.ac.uk/cpd/courses/subject/medical/allergy/gastro

I will blog about my trip and let you know how I get on.

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

Alcohol is the anaesthesia by which we endure the operation of life – George Bernard Shaw

I have been wrestling with this post for some considerable time, I am getting fed up with it being in my drafts – hanging over me every time I look at my list. I promised Alex Gazzola that I would write about this topic so I have decided to go ahead. It is nearly twelve months since I went out for lunch and asked for a small glass of wine…………

The picture on the right hand side is a portion of alcohol 125 ml – note the size of the glass, having asked for a small glass of wine I couldn’t help feeling rather disappointed at the arrival of what looks like a virtually empty glass. This is what the supersizing of alcohol has achieved, the old portion is now far from the norm and leaves you feeling slightly peeved when it is served. It is now no longer acceptable to have this size of glass offered as an option, so therefore, it rarely is.

We need to address this issue, increasing levels of alcohol use will no doubt increase the levels of alcoholic over consumption and the resulting health issues that result from it. We have rising levels of alcoholic liver disease in this country and this costs everyone. It is comparable with the obesity epidemic in some respects as the problem of alcohol is multifactorial and as a consequence extremely difficult problem to address. But make no mistake it does need to be addressed, I have treated patients with malnutrition associated with decompensated liver disease, and shockingly some of those patients have been under thirty years of age – it is tragic, at any age to be informed that you are to have palliative treatment and are unlikely to survive as a consequence of something you were unaware was causing damage, and very sad when this occurs at a young age. Neither do I wish to be a scaremonger, as liver cirrhosis won’t happen to everyone, however when it does it happens quickly, without warning and numbers are rising. Malnutrition occurs in a number of ways, poor absorption of nutrients due to the digestive tract being inflamed, poor storage capacity of glycogen and vitamins by a damaged liver, people choosing to drink rather than eat and poor processing of nutrients due to damage to liver cells. But how can we achieve change?

In 2005 the UK drank >12.5 litres per capita (who) with lower-income individuals consuming approx 75% more than higher income individuals. 4% of deaths worldwide are attributed to alcohol (who.) The problem of alcohol dependency has been around for considerable time – one of the first enduring images of this was Hogarth’s Beer Street and Gin Lane etching of the social effects of alcohol in support of the Gin Act in 1736. This act increased taxes, required a maximum amount of gin sold to individuals and a licence required, this was in response to the government encouraging distilling to increase trade and prop up grain prices. Increases in drinking alcohol were reported to have increased crime, increased levels of ill-health among children and produced an ungovernable people. So government encouraged the production and consumption of alcohol – seem familiar? Or is this the individuals responsibility? Shall we consider the issues?

Responsibility

This is obviously needed, you may feel – someone has to be held to account for the situation – but at whose door do you place this responsibility? Perhaps you may feel that it is the individuals responsibility to address their excessive alcohol consumption? This may be the  governments view, but is it just party rhetoric to blame the individual and allow the government to abdicate its responsibility in this regard? I would feel that some individual responsibility is required, here – however you also need to look at the overall picture and how easy is it for a person to change and accept this responsibility. It is easy to change when you are highly motivated to do so, but this is more difficult when you are affected by consuming alcohol – it impairs judgement, so this might be more of a challenge. The more you drink the less likely you are to be able to change – swings and roundabouts. The title of this post also suggests another reason people have issues in changing – life. When you are poor, have little to look forward to and your money doesn’t go very far, what do you spend your money on to treat yourself? What you can afford – food that lacks nutritional balance, cigarettes and alcohol. Now, cigarette smoking has become less socially acceptable and more difficult to actually do, are we seeing a shift in cigarette smoking to alcohol consumption I wonder? It is also very easy to get alcohol as this can be purchased very easily and very cheaply, but does making alcohol less available work in reducing the amount people consume?

Temperance movement, abolition and prohibition

Is this the answer to make alcohol less available or perhaps not available at all? During the nineteen twenties and early nineteen thirties in the USA alcohol was prohibited for thirteen years looking at what happened during this time we could make a judgement. Cirrhosis of the liver dropped by 2/3 during this time, but those people who were determined to get alcohol still did.

One unforseen consequence was that drinking became more normal in women in the speakeasies and this allowed a new untapped market to be accessed by the alcohol industry. We also have those who say why should the average majority be penalised because a few people cannot handle their alcohol.

Can ‘have it all’ generation and individualism

We could say that we have just lived through a period of rampant individualism, to some extent at the expense of society – perhaps you can’t have both. Margaret Thatcher famously said in a quote to Womens Own magazine – “there is no such thing as society.” We are now living through a period of austerity, now I don’t want to go into detail about the politics of individualism in this post but it is relevent to alcohol consumption, we have come to imagine we can have it all without consequences – this goes for both alcohol and the individual and society.

It is entwined, the more people drink to excess the more society suffers in the costs of alcoholism, this will no doubt be expected to change with austerity – but maybe the damage has been done. It perhaps is easy to imagine that people who have less money during a period of austerity will be able to afford less alcohol – I send you back to the paragraphs on responsibility and temperance. Those who want to drink to excess will find a way and as people can afford less they perhaps rely more on cheap fixes. Both increasing alcohol costs within a period of austerity is needed. The more I think about this subject the more complicated it becomes. Political rhetoric has changed however with David Cameron’s Big Society which is proposed to allow people more control to improve communities, but can a reduction in the excessive consumption of alcohol be achieved in an overtly commercial society?

http://healthculturesociety.wikispaces.com/A+Culture+of+Excess+-+How+Consumerism+and+Individualism+has+shaped+Generation+Y%E2%80%99s+health+behaviours

Industry, corporate responsibility and market demand.

Industry has in my view some responsibility for the society we live in. Is it ok to sell alcohol and then suggest that people drink responsibly whilst offering happy hours, having alcohol available for a longer time period and in more outlets than ever before? This is contradictory, companies should have some social responsibility and perhaps should alleviate some of the burden of the added costs to the NHS of the increase in alcohol and the health problems it creates. But this is not actually addressing the problem, prevention is better than cure. I also wonder why there is a large number of older individuals who drink alcohol, perhaps some intervention is needed here and a bit of thinking out of the box. Is it due to social isolation of the elderly perhaps? Would some funding to help with increasing social inclusion be effective in reducing numbers of elderly people who rely on alcohol?

If you look at the statistics they are truly shocking – if you are interested in knowing about the cost of alcohol in your local area check out the following website

http://www.alcoholconcern.org.uk/campaign/alcohol-harm-map

For Calderdale area there were 40,916 admissions and attendances in 2010/2011 including 4907 hospital admissions perhaps surprisingly only 307 of these were from 16-24 years of age and perhaps more shockingly 1027 people were over 75. The cost of this was 12.9 million pounds.

This topic is very complex – I can’t begin to consider what the solutions are, in problems such as this it does take lots of different initiatives to chip away at the problem. We do need people to think of different ways of solving these problems but at least writing this post has helped me to understand the issues. It will hopefully help people to understand that this perhaps is not a problem that should be thought of as the individuals responsibility, but the answer should be found for that person individually, with help from alcohol services as each person will have different reasons for needing help.

Simply Gluten Free and Dairy Free – Grace Cheetham

SimplyGluten_Nov12This book is a useful addition to the bookshelves of anyone who has a requirement to follow either a dairy free, lactose free and gluten-free diet or both. However despite the name of this book it contains some recipes for a number of different food allergies or intolerances identified by symbols at the side of each recipe, the symbol key is at the front of the book. The gluten-free symbol does include wheat free so the recipes are suitable for those people needing to follow a wheat free diet, although this is not clear from the title of the book. For those coeliacs amongst my readers the book has the endorsement of Coeliac UK, meaning that the recipes are guaranteed gluten-free (as long as you use the listed gluten-free ingredients of course!) Healthy eating recipes are included and the pictures certainly make you want to try some of the dishes as they look fresh and colourful and Grace injects some personality into the chapters by writing a small introduction to each and hints and tips are included throughout. Most of the recipes are not easily identifiable as ‘free from’ by anyone who wouldn’t be aware, making the recipes useful for the whole family. Treats are not forgotten, also very important to include occasionally in the diet for those people who have to exclude certain foods. It is perhaps better to wait till you have identified your intolerances if you are being treated with the Low FODMAP diet before you think about buying the book as the recipes do contain a number of high FODMAP foods, but these types of foods are generally healthy for those people who don’t have Irritable Bowel Syndrome or types of gut inflammation such as crohn’s or Colitis. For Low FODMAP followers you should only consider these recipes if you only have lactose intolerance and/or need to avoid gluten or wheat and you are fine with all other types of high FODMAP foods. The recipes I tried worked well and the book is nicely presented and not too expensive, so perhaps think about the book as a nice birthday or Christmas present for your friends or relatives with free from needs. Or buy it yourself and treat your friends to some baked goods – even better!”

The book was provided by the author for this review