Low FODMAP Chicken casserole plus low fat processed food and food intolerances, incongruous ideals?

At my usual supermarket shop this morning I was very pleased to find a low dairy, low lactose own brand cream cheese. Wow – I thought – will have to give this a try, but as I always do out of habit I had a look at the nutritional information on the side of the carton. The amount of fat and saturated fat in the product was staggering 26.6g/100g of fat, 23.0g/100g of saturated fats, from coconut oil. Why is it that food that is meant for individuals who have to modify their diet as a result of allergies, intolerances or as a result of autoimmune conditions are higher in fat and calorie dense? You could argue that cream cheese is usually high in fat and you would be correct at 24g/100g of fat and 16g/100g of saturated fat but the free from brand is higher. It’s often the additional specially manufactured foods in a ‘free from’ diet that can be higher in calories than the standard alternative version, that means if you need to follow a specific diet you may be exposed to more calories as a result. Yes I do see people who are underweight and would really benefit from the extra, but I also see those who have problems in maintaining a healthy weight. For example some gluten-free bread is quite high in fat. Adding fat improves the taste and texture of free from food and you don’t often find a low-fat variety, it’s technically challenging I suppose. Yes, foods higher in fats and sugar are a treat – see recipe for chocolate covered coconut ice cream for an example, but when staples such as wheat free bread can be higher in fat this becomes more difficult to manage, if you need to control your calorie intake. Try and include plenty of alternatives such as rice, potatoes, lean meats, fish, vegetables and fruit in your diet (when tolerated) – those foods that are not processed are lower in calories, and often cheaper. This doesn’t mean you can’t have manufactured alternatives, as they are important to incorporate, to feel you are not being excluded too much, increase variety and help you to follow your diet, but try to keep these foods to a minimum of you are able. For the staples, such as bread, which is important if you need to take packed lunches, check the food labels of free from items and choose the ones that are lower in fats, sugar and calories when you can.

Check the label for nutritional information as well as the allergen labelling. Look at the following links:

http://www.nhs.uk/Livewell/Goodfood/Pages/food-labelling.aspx

http://www.nhs.uk/Livewell/Goodfood/Pages/food-labelling-terms.aspx

The following recipe is a low FODMAP chicken casserole.

700g Chicken Thighs (skins removed, trim off any visible fat – use thigh meat as it imparts a stronger flavour to the dish.)

3 celery sticks including leaves.

200 mls dry white wine

5 g Fresh thyme

1 dessert spoon of garlic infused olive oil

1/2 teaspoon of asafoetida

Juice of 1/2 a lemon

freshly ground pepper and dash of salt

Measure out wine in a measuring jug and add chopped thyme, olive oil, lemon, asafoetida, pepper and salt mix well.

Cut celery sticks and place in a casserole dish with the chicken thighs.

Pour over the mix and leave to marinade for 2 hours.

Cook for 1 hour gas mark 6/200 C remove from oven and allow to relax for five minutes.

This dish was served with low-fat roast potatoes made by par boiling for five minutes, drain off water and replace pan lid. Shake the pan to roughen the edges of the potatoes and use spray olive oil to reduce the amount of fat used. Roast till golden.

If wished you can pour off the liquid when the chicken is cooked to make a sauce, drain off the fat and discard and using a small pan pour in liquid and add cornflour mixed with a little water, to thicken.

Serves 4-6 people (but not my husband, who ate considerably more! This dish prompted a five-minute face wash from my cat after having a taste – a rare occurrence.)

Book Review IBS Free at Last – Second edition Patsy Catsos

Book Review IBS Free at Last – Second edition Patsy Catsos

This recently published book is based on the FODMAPs diet for irritable bowel syndrome. It’s a guide for those wishing to trial a low FODMAPs diet to alleviate symptoms; as such it is comprehensive, explains the diet fully and includes information about who should use this diet. It is safe, explanations about possible other conditions such as coeliac disease, which may be masked by going on wheat free diets, for example, are discussed fully. Dietetic treatment is vital to help with following the exclusion and reintroduction phases to ensure the diet is nutritionally complete and to give advice about eating out and shopping, finding onion and garlic free processed foods can be problematic, for example. Patsy has included common questions that patients have and answers these very well, useful for those following the diet and those who treat them. For USA patients this book does give examples of food plans and recipes – for those outside the US information about converting cups to grams may be useful for following the recipes and some of the medications and supplements mentioned may not be available in all countries. It is important to include information for those who do not get resolution of symptoms using this diet and this is mentioned. The book does not clearly detail other factors for consideration such as stress, anxiety and other areas such as behaviour around mealtimes, as it was intentionally written as a book about diet. Although written for the United States, this book is certainly useful for those who wish to know more about this new treatment for IBS, and would be a good accompaniment to those who are treated with  by their dietitian.  Healthcare professionals wishing to know more will also find it useful and it is fully referenced, it is available on Kindle and hardcopy from good book suppliers.

This book in Kindle version was provided free of charge by the author

LOFFLEX recipes Third Edition

Ground rice pudding Annette Sharp RD

50g Ground rice

25g Sugar

600ml rice milk (plain or vanilla – try to get one with added calcium)

1 tsp vanilla extract (optional)

Flavouring tinned pears, pineapple juice honey/cinnamon/cardamom to taste

Method

Place ground rice, sugar and milk in a small non stick saucepan and whisk until smooth. Gently bring to the boil, stirring whilst cooking – the mixture should quickly thicken into a custard consistency.Continue to simmer over a very low heat for 5-6 minutes, stirring occasionally. Transfer to a bowl, cover and leave to cool of can be eaten whilst warm. Can blend cold pudding to achieve a very smooth consistency.

Rice Flour Pancakes

1/2 cup of rice flour

300mls of milk

2 tbsp caster sugar

oil for frying

Whisk ingredients together and fry small pancakes (approx 2 inch in diameter) in a small amount of oil until dark golden, serve with jam made from allowed fruit or honey.  Alternatively omit the sugar and add herbs and serve with meat or fish from allowed list.

Chicken Noodle Stir Fry My Le Lac RD

100g Chicken Breast

50g Courgette (skinned and sliced thinly)

50g Mushrooms (chopped)

Dried Rice Noodles

1 tbsp Vinegar

1 tsp sunflower oil/olive oil

Salt to taste

NB this counts as one portion of vegetables

Bring a pan of water to boil, place noodles in the pan

Cook the noodles till softened, drain and rinse in cold water to prevent them sticking together

In a non stick pan heat the oil, add the chicken

When the chicken has browned add the courgettes and mushrooms

When the vegetables have cooked add the noodles and stir fry, them add the vinegar, salt to taste and serve.

Moroccan Lamb Tangine Layla Brown RD

Serves 4

2 tsp black pepper

11/2 tsp paprika

11/2 tsp ground ginger

1 tbsp turmeric

2 tsp ground cinnamon

1x shoulder of lamb, trimmed and cut into 5cm/2 inch chunks

2 large carrots, peeled and grated

2 tbsp of garlic infused oil

3 peppers

115g canned apricots

55g stewed plums

1 tsp powdered saffron

brown rice miso

1 tbsp clear honey

2 tbsp coriander

2 tbsp flat leaf parsley

Place the black pepper, paprika, ginger, turmeric and cinnamon into a small bowl and mix to combine. Place the lamb in a large bowl and toss together with the spice mix. Cover and leave overnight in the fridge.

Preheat the oven to 150C/300F/gas 2

Cut the remaining food into small pieces/chunks and place in a slow cook oven or casserole dish along with the other ingredients and brown rice miso, water and cook for approx 21/2 hours till meat is very tender.

Place in a serving dish with fresh herbs.

Serve with boiled rice.

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.

Self care for your irritable bowel – worth a look?

This month The IBS Network launched is new interactive on-line self-care plan for IBS, you may be wondering what it’s all about, and possibly not being a member you wouldn’t have access to it to try it out. Well, this blog will give you some more information to allow you to make your mind up before taking the plunge. Some questions you may be thinking of:

Why should I take responsibility for my IBS – surely I pay my taxes or health insurance to pay doctors to sort this out for me? 

So, has this happened then? If your IBS has been helped you probably wouldn’t be looking for answers. IBS is a chronic condition that is poorly understood by the medical profession, and they freely accept this is the case. This condition is very similar to other misunderstood syndromes such as chronic fatigue and fibromyalgia, IBS is a problem of how the digestive system functions, or moves – looking at it using tests and instruments doesn’t lead to a diagnosis, as there is nothing yet that can be seen. This is either because it is caused by something that researchers haven’t yet found or it is purely a dysfunction in the way the gut moves (think of it as being similar to the different speeds your heart can beat.) It does not mean that it’s all in your head, or you do not feel pain or you do not suffer from difficult diarrhoea or constipation. The plan can give you information that will help you think of what else it could be, but sometimes accepting IBS for what it is will allow you to move on and try to help yourself. Everyone’s IBS symptoms are different, you are best placed to be able to help with your own IBS as you understand what makes your IBS flare up.

But I don’t understand what affects my IBS – it’s so complicated! 😦

This is where the self-care plan can help, you can use the symptom tracker for two to three weeks, it is a simple tool that helps you log areas that affect your IBS such as life events, diet, medication, disturbed sleep and exercise. We have kept it fairly simple so that you can focus on general areas initially making it easier to design your self-help package. You can then print a report that will show you when you feel better or worse and what happened to cause a change. This is also a very good report to take along to your healthcare provider, to help them to identify the best course of treatment for you.

For example – So my symptom checker has shown that every time I eat pasta I feel worse and every time I have a meeting with the MD at work I get diarrhoea. You can then use the information contained in the plan to check out how to change your diet to help you feel better and what can be done to relax before your meeting or what medications may help you.

This is fine to talk about but I find it really difficult to change my life!

The answer to this is we all find it difficult to change from time to time. Make one change at a time if you can, this will make it easier for you to use your symptom tracker to see if the change has helped – be SMART with your changes

Specific goals – makes them easier to manage. e.g. “I wish to reduce my levels of stress”, this is not specific enough, how are you going to reduce stress? By doing what?

Measurable – you need to be able to see the effect to feel really great about your achievement – use your symptom checker, or a food & mood diary.

Achievable – How are you going to make the change? Try to choose parts of your plan to change that you feel are much easier to achieve, this will give you lots more confidence to try the harder changes. For each change ask yourself the following question

‘on a scale of 1-10, 1 being very easy and 10 being very difficult – what would I score the ease of making this change?’ Try the ones that score lower initially.

Realistic –  Think about if you can really achieve what you have planned – if it’s just too difficult to do, you will be setting yourself up to fail. Sometimes we can’t change some aspects of our lives, it is fine to accept this and PUT IT TO ONE SIDE, don’t keep focussing on what you can’t achieve. Another question to ask would be, is it the right time for me to make this change?

Time focussed – how long is it going to take? It may take a minimum of three weeks to change some aspect of your life and thinking how long you will need will help you to keep focussed.

Changing our lives, what we eat or how much exercise we do is a challenge, we all behave in a way that makes it easier to live our lives, but think about your symptoms – if you always do the same thing you will always get the same result – ask yourself do you want this to continue? what are you gaining from your IBS? What will changing mean? The care plan will help you think about your IBS and it contains exercises to help you understand your condition. Changing can take time and lapses are to be expected, it is what you do about a lapse that’s important – don’t put yourself down and feel a total failure, put it behind you as something that has happened (and was probably likely to happen!) and try again – small steps! Think and plan what you would do if you have a lapse in your planned changes before they happen and this will help. Don’t allow a lapse to become a relapse. Also plan to reward yourself when you reach each goal this will positively reinforce the changes you have made.

I have heard that having a practitioner actually helps with IBS? How will helping myself work?

All the information contained in the care plan has clinical evidence or experts in health have come to a consensus through experience that the information will help – we don’t yet have evidence that the self-help plan works as a whole, as it has only just been developed – this is something we hope to prove when people are starting to use it. There is a study that on-line self-help for other chronic conditions such as chronic fatigue* works, and whilst this doesn’t directly relate to IBS, with 10 – 20% of the population diagnosed a new way of helping needs to be developed.

If you are interested in the plan follow the link on the right hand side of this page or copy and post the following link

http://www.theibsnetwork.org

*Nijhof, Bleijenberg, Uiterwaal, Kimpen, Putte (2012) Effectiveness of an internet based cognitive behavioural treatment for adolescents with chronic fatigue syndrome (FITNET): a randomised controlled trial The Lancet published on line March 1, 2012

Coeliac Disease – What you need to know, by Alex Gazzola.

This comprehensive guide was published in 2011, is available from most major outlets and from Coeliac UK’s website (www.coeliacuk.org. or click on the link below right) Don’t let it being a book put you off, as it’s written in a succinct style, with short chapters and bold headings, so it’s easy to quickly find what you need to know. Newly diagnosed coeliacs will find it an invaluable companion to learn more about the disease and its management, when they have lots of questions that need answers. It will also be a good resource for dietitians and health care professionals new into practice who may be wondering how to answer patients’ questions. New regulations are covered, with regard to food labelling, important for those who need a pertinent update on the recent changes in this area. Above all, I was impressed by the chapter on emotional well-being, particularly important for those who have followed the diet for some considerable time and finding it difficult not to be tempted by foods containing gluten, or those who are really struggling to come to terms with their diagnosis and the lifelong commitment to following a gluten-free diet. This book will likely need updating in years to come with changes in treatments and regulations, but it has been written with much thought and empathy and should prove a valuable tool for those with a need for knowledge on coeliac disease. This book has been shortlisted for the Guild of Health Writers Writing Awards 2012 – Best Health Book category. For further information copy and paste the following link: http://foodallergyandintolerance.blogspot.co.uk/p/coeliac-disease-what-you-need-to-know.html

This book was provided free of charge by the author.

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