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

DSCF0937mod

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.

DSCF0969mod

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

Self care for Irritable Bowel Syndrome

As of last weekend the Self Care Plan for people with irritable bowel syndrome (IBS) is free access for those people with the condition and for those who might feel their symptoms are down to IBS, but are unsure and wish to know what to do next. Check it out here:

http://www.theibsnetwork.org/the-self-care-plan/

As the UK charity for people with IBS we felt it was important to have this information for everyone to access. I know of no other site that has information on symptoms, medical treatments, dietary treatments and psychological symptoms such as anxiety and depression that often follows this diagnosis, in one area and including tools that can help

such as the bowel relaxation recording. It also has information on alternative treatments and how useful these are for symptoms. It has been checked by the IBS Network team of advisors including gastroenterologists, psychotherapists and dietitians to ensure the information is as comprehensive and evidenced based as it can be. We also requested members to comment as the best people to advise us are people who are living with this condition. The plan is still open to comment so do please get in touch if you wish to make any compliments, suggestions or constructive criticism, we do wish to continue to improve this tool.

http://www.theibsnetwork.org/contact-us/

The plan is also useful to health practitioners to aid patients in clinic, I use it when I am in clinic. We have 10-20% of the population in  the UK living with IBS at any one time so self-care is going to be vital to help people to manage, we hope the plan will be a tool that people are happy to use and perhaps more importantly happy to recommend to others to spread the word.

We still need membership to help us to continue as a charity – membership includes the self-care plan symptom checker, access to ask health professionals questions, the help line, can’t wait card and travel translation card.  Well worth joining, also to help us to continue to provide help and support for people with this condition.

Valentines Day approaches – love me, love my gut – even if it misbehaves sometimes.

Now, I’m not a counsellor or psychologist but I am able to give you some advice around dining out and reducing the anxiety this can cause around safe foods to eat. If you are going out with a new partner Dr Barbara Bolen has some really useful advice around dating and functional bowel problems (IBS.) She advises that you should be open about having digestion problems and it is OK to describe them as such, you don’t need—and probably

A little flippant perhaps – but also some truth, love me love my GUT!

wouldn’t wish to go into detail. She also provides some good examples of how to describe your GUT problems so check out her website. An explanation will also help to reduce your anxiety about needing to go to the loo frequently during a meal and this might help reduce the actual visits required. Dr Bolen also has some really good information on her website about how to tell someone about your IBS, relationships and how to enjoy a healthy sex life with functional bowel problems, check out her site here –

http://ibs.about.com/od/livingwithibs/tp/IBSandDating.htm

Dr Bolen has also posted a link about this post and she does also appreciate Valentines Day is not a day that everyone celebrates and it can be a time that can be difficult psychologically – see the link here:-

http://ibs.about.com/b/2013/02/14/ibs-and-valentines-day.htm

If you are going on a date you may want to go to an establishment that you know well and ask for a table to be reserved in a good position, making it easier should you need to visit the toilet. Making a suggestion about where to go on a date shouldn’t cause a problem, just be a little assertive and ensure that you explain about your IBS at some point—if someone wishes to go out with you this really shouldn’t be an issue. You could also a look at the menu before your visit and telephone the chef to ask if they can cook your food without ingredients that may cause problems if this helps. See if your partner also wishes to look at the menu before arriving, this will leave more time for conversation and getting to know each other. Looking at the menu is easier to do these days as most restaurants post menus on-line.

Eating out on the Low FODMAP diet can be challenging, as onion and garlic are widely used, don’t forget to ask about sauces and stock. Having dietary intolerances shouldn’t stop you going out – some ideas for choosing food are grilled chicken breast, fish fillets, steak—in other words plain meat or fish without sauce. Egg dishes are also a possibility, omelette or frittata, check the dishes are onion and garlic free, if they are a problem for you. Choices for the starchy component are plain rice, freshly cooked potato or you could ask for wheat or gluten-free dishes (depending on your intolerance,) but again check for other FODMAPs. Establishments are now better at labelling their menus, or providing separate gluten-free menus, since a recent change in regulations. Or you could try sushi, if you like it but again check any vegetables for FODMAPs. Always remember that it might not be the food you have just eaten that causes symptoms. If you are through the exclusion phase stick to your known low FODMAP foods for the day and possibly the evening before your date depending on your GUT motility (knowing the time it takes food to pass through your digestive system.)

If foods high in fat are a problem for your digestion then ask for the meat grilled or cooked on a griddle which will allow the majority of the fat to drain away. Vegan options are a little more challenging as they often contain foods high in fermentable carbohydrates, but a risotto based on Low FODMAP vegetables or rice stuffed peppers would be an option here, not forgetting to ask about use of onion and garlic in the dish, should you need too.

Wheat free pasta I presume?

Some people find alcohol is a problem, if you want to have alcohol and it does give you symptoms, limit the amount that you have. You could have a glass of wine, for example with your main meal, or ask for a spritzer to make a longer drink. Order a spritzer with your starter and allow it to go a little flat before drinking it, if you suffer from bloating. Using an implement such as a straw or cocktail stirrer to mix your drink will help to disperse the gas it contains, but don’t be tempted to drink from the straw.  You could try a little seduction and gaze into your partners eyes, whilst stirring your drink! Watch the amount of fruit cocktails you have, if you have fructose intolerance—one small glass (100 ml) of pure fruit juice containing low FODMAP fruits is usually the maximum advised. So ensure your cocktail has no more than this amount and drink it with the main dish or sweet.

Check out The IBS Network Self-Care Plan for medications that are helpful.

I would really encourage you to eat out this Valentines Day if you are invited, you may have some symptoms because it can be difficult to avoid all FODMAPs, but the most important factor is that you go out and enjoy the experience. You might find a life partner by going on the date, what more could you wish for? If you don’t have a partner, you could plan to do something special with friends or family for the day.

Most of the advice has been about functional gut problems (IBS) but if you have inflammatory bowel disease IBD, some of the advice posted may be useful but I would strongly advise you to go on-line and check out Crohns & Colitis website (link to the main site is found to the right) as they have some really useful advice on relationships and IBD, or the link for The Ileostomy and Internal Pouch Association for advice.

Check out the living with IBD leaflet here

http://www.nacc.org.uk/content/services/infoSheets.asp

Now for the bah humbug ;-),  this advice also applies to the rest of the year! Valentines Day is very commercialised, expensive and anticipation of events occasionally can prove to be disappointing if you spend lots of money on the day. You could always suggest going out at another time, if you wish and there are other ways of showing your affection than an expensive card and some petrol station bought carnations! If you know what your partner likes, try making your own gifts, some baking perhaps (and I do include you gentlemen readers here too)—invest some time and personalise your gift, this will be really appreciated as it shows your love and understanding.

Happy New Year! Clinical Alimentary blog awards 2012

https://i0.wp.com/wallpaper.goodfon.com/wallpaper/previews-middle/379111.jpg

Will you sing this tonight on the strike of midnight, to being in the new year?

Should auld acquaintance be forgot

And never brought to mind

Should auld acquaintance be forgot

For the sake of auld lang syne.

For auld lang syne my dear

For auld lang syne

We’ll take a cup of kindness dear

For the sake of auld lang syne – Robert Burns

So as not to forget times long past and new friendships found – with a special thanks to all my followers – in particular (in no order of preference)

Dr Gary Lum author of Yummy Lummy, who consistently likes my posts and has so far provided my only reblog http://garydavidlum.com/

John Thompson (not a relation!) author of Sybaritica, for comments http://sybaritica.me/

Alex Gazzola author of Food Allergy and Intolerance, for support and always making me think ‘out of the box’ http://foodallergyandintolerance.blogspot.co.uk/

Dr Barbara B. Bolen author of About IBS, http://ibs.about.com/ and Patsy Catsos author of IBS free http://ibsfree.net – for driving the most views to my site

Nina and all at IBS Impact http://www.ibsimpact.com/about_us.htm http://ibsimpact.wordpress.com/ for supporting the IBS community and driving some very interesting discussions.

I hope the New Year brings all of my followers good luck, new opportunities and most of all a calm gut.

My most popular posts of 2012

https://clinicalalimentary.wordpress.com/2012/04/18/surely-these-digestive-enzymes-ive-found-can-help-or-are-they-money-down-the-toilet/

https://clinicalalimentary.wordpress.com/2012/03/27/lofflex-recipes/

https://clinicalalimentary.wordpress.com/2012/09/30/low-fodmap-on-a-budget-how-to-make-the-diet-more-affordable/

The WordPress.com stats helper monkeys prepared a 2012 annual report for this blog.

Here’s an excerpt:

600 people reached the top of Mt. Everest in 2012. This blog got about 6,900 views in 2012. If every person who reached the top of Mt. Everest viewed this blog, it would have taken 12 years to get that many views.

Click here to see the complete report.

Sage and hazelnut stuffing wheat free and Low FODMAP

IMG_1624This is a little late for Christmas 2012 but there is always next year or you could try this with roast chicken or any other light meat.

Ingredients

150g of fibre based wheat free bread

200 g of chicken livers

30g hazelnuts

a good handful of fresh sage leaves

leaves from 4 stalks of thyme

1 tablespoon of garlic infused oil

100 mls vegetable stock (made from celery + carrot) or chicken/turkey stock – this is probably better home made as stock cubes often contain onion and garlic.

Salt + pepper

Method

Crumb the bread (it is better if it is a little stale)

Chop the herbs and hazelnuts

Trim the livers – removing any white and connective tissue

Add the oil to a frying pan and lightly fry the livers, chop them into small pieces (or lightly blend) They do not need to be cooked through as the stuffing will be going in the oven.

Mix with the breadcrumbs, herbs livers, hazelnuts, salt + pepper.

Place the ingredients in an oven proof dish and cook at gas mark 5, 190 degrees C, for 20-30 minutes.

Serves 5 don’t have a very large amount as hazelnuts do contain a small amount of FODMAPs.