The Perfect Watercress Soup – low FODMAP

Watercress soup is sublime and tradition in our household means that we have it as a starter every Christmas. I have considered the fact that we can’t use onion – the complete taste profile onion gives to the dish – including the slight amount of sweetness it provides and I have replaced the onion with alternatives in hope of retaining it’s benefits without its nasty gut side effects.

Watercress is a member of the brassica family of vegetables, therefore it is related to broccoli, cabbage, radish and rocket. Watercress has lot’s of peppery goodness, but although it is rich in some nutrients you would only gain benefit if you include it in your diet regularly – luckily it has lots of uses. It tastes excellent with salmon and watercress is great to use as the leaves for a salad, if you enjoy it’s slightly hot taste! It contains some vitamin A, vitamin K and folate, plus iron (plus is a reasonable source of vitamin C to help absorption of the iron – it is probably better eaten as a salad leaf to achieve this benefit.) As it is a source of iron it is therefore useful for vegans to include in their diet alongside other sources – but this recipe would have to be made with almond milk and dairy free margarine instead of butter to make in suitable. Perhaps I could try that next!

The soup does contain butter and uses full cream milk – but this is a soup for special occasions – so it is OK to have this amount of fat occasionally and you could change to semi skimmed milk and 20g fat, if needed, if you do find that rich foods result in symptoms. The garnish I have used is watercress leaves, radish sprouts and dried seaweed – radish sprouts and seaweed are not integral to the dish, however – and the conkers in the picture are not edible. I hope you enjoy it!

Ingredients

  • 1 bag of fresh watercress
  • 500ml of full fat lactose free milk
  • 1 sprinkle of asafoetida
  • 1/4 teaspoon of sugar
  • Salt to taste
  • 40g butter
  • 1 tablespoon of corn flour

Method

  • Melt the butter in a pan and add the cornflour whilst mixing and the sprinkle of asafoetida and the sugar. This will not form a traditional roux, but not to worry.
  • Slowly drizzle in the milk – note that it will start to thicken at this stage and a whisk might be a better tool to use to ensure that no lumps are formed.
  • When all the milk is added then bring to a slight boil to thicken.
  • Add the watercress and cook until wilted then blend the soup
  • Season to taste.
  • Serves 1-2

Carrot and nut cake – vegan and low fodmap

This cake is a real treat, it also has a good degree of fibre which should help people with BS-C – however do be aware of the fibre and introduce slowly if your bowel is not used to it. It is sweet, vegan, egg and wheat free and low fodmap.

Ingredients

50g ground flaxseed

100ml water

400g Gluten Free self-raising flour

125g chestnut flour

100ml water

1 teaspoon ginger

2 teaspoons cinnamon

½ teaspoon of ground cloves

100g chopped pecan nut

1 teaspoon vanilla essence

150g castor sugar

200g brown sugar

500g carrots

150ml hazelnut oil

1 ¼ teaspoons gluten free baking powder

Method

Prepare 2, 7 inch cake tins

Mix the flaxseed with water and leave in the fridge for 30 minutes.

Add the dry ingredients (flour, ginger, cinnamon, cloves and ginger) to a bowl

Grate the carrot using a food processor using the grating accessory and add to the flour – mix well.

Chop the pecan nuts and add to the flour, mix.

Add the flaxseed and water mix to the food processor using the usual blade and blend for 20 seconds.

Add to the processor the sugar and vanilla essence and blend for 20 seconds and then whilst the processor is mixing drizzle in the oil slowly.

Pour this mix into the flour, nuts and carrots and mix well. If too stiff add 100ml of water – the mix should look like a cake mix.

Add the mix to the two cake tins and bake at gas mark 3 (165 degrees C) until a skewer/cake tester comes out clean from the mix.

The cake will rise and may crack a little on the surface but trim off the and turn the cake upside down for decorating.

Vegan ‘chicken’ and pumpkin couscous – low fodmap

An autumn favourite is pumpkin and numerous varieties can be found. When I was young pumpkin in the UK was unheard of – in fact we used to make Halloween lanterns with a swede! That certainly was a recipe for injury – although the pumpkin isn’t always easy to carve.

I have also decided to venture into a vegan recipe using vegan ‘chicken’ low FODMAP suitable products are based on soya protein or alternatively you could use Quorn ‘chicken’ pieces.

This was a fairly easy recipe to make and was lightly spiced – if you want a heavier spice then you can add more Ras El Hanout. Do check your spice mix has no high fodmap ingredients such as onion or garlic. Enjoy!

Ingredients

  • 200g Pumpkin
  • 30g Pumpkin seeds
  • 30g Pine nuts
  • 20g Sunflower seeds
  • 30g Course peanut butter
  • 200ml Water
  • 1 teaspoon of Ras El Hanout Spice
  • 200g Soya protein based chicken pieces
  • 250g Corn couscous
  • Spray oil
  • 30g mint leaves
  • Seasoning (salt and pepper) to taste

Method

  • Chop the pumpkin and boil in water till soft.
  • Spray oil into a frying pan and add the Ras El Hanout and fry gently with minimal oil to release the flavours, add the chopped mint leaves.
  • Add the peanut butter, seeds and water to the frying pan and cook till thickened
  • Add the ‘chicken’ pieces and cooked pumpkin
  • Weight the couscous and pour over the same amount of boiling water (250 ml) and leave to cook – run a fork through the mix to give texture to the couscous
  • You can either serve the ‘chicken’ sauce and couscous separately or mix the ‘chicken’ sauce through the couscous, as I have done.
  • Serves 5-6 enjoy!

Autumn jacket potatoes

It’s Autumn, I love this time of year but as the dark nights role in thoughts of wholesome, warm filling meals arrive. What could be more sustaining than a jacket potato for people following the low fodmap diet? This is also married with carrot and celeriac, oregano and thyme and of course mixed with cheese – not so much – but enough to provide ample calcium.

However food means more than sustenance – it is family, experience, love – in fact food ripples throughout life and our lived experiences. Many of us have stories to tell about food – both negative and positive. There are two considerations for people who wish to follow a low fodmap diet, what benefits might there be? Much longed for reduction in symptoms? The benefits are often the driving consideration. But what about negatives – how is changing the way that I eat going to affect my quality of life? You might be somewhat surprised at this suggestion – negatives in quality of life? But this diet is supposed to improve my situation, surely?

Consider cooking for the family, going out for a meal with a treasured friend, traveling on holiday and having a suitable option for lunch at work. How much additional planning and work is it going to take to follow this diet – can I afford to have additional work when I already have a very busy schedule to follow? These are all considerations that should be taken into account when deciding to follow an elimination diet – these are considerations that the dietitian can help you with and are what your dietitian will be contemplating as part of the assessment process. This is also another reason that the reduction phase of the diet should be as short as possible. The re-introduction phase will provide some freedom and release from some of the restrictions the low fodmap diet instills.

There are options for people who may not wish to follow a complete exclusion and would find that following the low fodmap diet too much to plan – because planning is what you will need to do, to be successful. There is a shorter low FODMAP version that the dietitian may consider if the full diet is too challenging and a wheat free or lactose free diet if these food types are considered to be the main issue from a diet history.

It hasn’t gone unnoticed by me how people with IBS try hard with regards to treatments – sometimes unfortunately too hard and continue far too long when diet treatments are not working. People then should explore other treatments and often need help or a nudge to move onto other options. To some extent this hard effort is why I work in the area of digestive illness, because I know my patients will often try their upmost to make changes, more than in other areas of dietetics and when this works, it is satisfying – although, truly, it is their hard work that has produced dividends. Symptoms of IBS really are the great motivator, I would suggest that their may be no greater drive towards change than these symptoms provide – imagine what could be achieved with such an instigator, if it was a positive driver rather than a negative one?

But, enough of the musings and lets get back to the recipe…

Ingredients

  • 3 jacket potatoes
  • 3 carrots
  • 2cm of celeriac (tip here: keep some blanched celeriac ready cut in your freezer for any recipes that ask for celery)
  • 150g grated cheese
  • 1 teaspoon oil
  • 1/2 tablespoon of chopped fresh oregano or 1 teaspoon of dried
  • 3 sprigs if thyme or 1 teaspoon of dried
  • Seasoning

Method

  • Warm the oven to 200 degrees C and then wash and prick the three jacket potatoes, place them on a baking tray and add to the oven. Depending on the size cook for 1 hour to 1 hour 20 minutes.
  • Whilst the potatoes are cooking add the oil to a pan and add the herbs and cook for 2-3 minutes.
  • Slice the carrots and celeriac and boil in a pan of hot water till soft. Mash and add the herbs and seasoning.
  • Grate the cheese.
  • When the potatoes are cooked scrape out the potato leaving the skins intact. Mash the filling with the carrot mix and add 100g of the grated cheese and mix. Add back to the potato skin shells and top with the remaining cheese.
  • Grill till the cheese has melted and then serve (serves 3)

Oyster mushrooms – a umami low fodmap option for IBS

It is autumn and the evenings are becoming darker. It is the season for mushrooms and many people really miss mushrooms when following the low fodmap diet. But if you are following the Kings College Low FODMAP diet oyster mushrooms are suitable. They are not as available as a few years ago and are now usually found in the section labelled up as wild mushrooms – so perhaps suitable for a treat only.

Mushrooms have an umami flavour – an earthy, complex meaty flavour that is very important particularly if you are vegan and missing the deep, rich flavour that meat offers. Mushroom also offers a texture that is robust, filling and satisfying. This is the flavour provided by glutamate (the natural variant of mono-sodium glutamate – MSG, a food additive) a chemical that in the past has been implicated in Chinese or Asian food intolerance or ‘Chinese restaurant syndrome’. It might be the FODMAP content rather than the glutamate that lead to perhaps some gastrointestinal upset in some people and not specifically the glutamate content – we have no evidence that ‘Chinese restaurant syndrome’ exists from eating food where MSG has been added (see the Compound Interest info-graphic above.) Some foods containing glutamate listed above also contain histamine, which also is implicated in developing symptoms such as palpitations, chest pain, headaches, asthma, flushing and gastrointestinal upset. They are cheese, fermented foods such as miso and tomato. These foods are possibly the foods which might have lead to Chinese Restaurant syndrome, although this reaction is likely to occur infrequently. If you do suspect a histamine intolerance and have the symptoms above see a dietitian who will provide help for you to check if you have. Please avoid information from the internet on histamine intolerance, as it is usually far too restrictive and might lead to nutritional deficiencies. Although actually we have no evidence that most people with IBS have histamine intolerance – in my opinion we need much more research in histamine reactions.

Who wouldn’t want to have this fantastic flavouring naturally found in mushroom, parmesan and soy sauce? I have developed a recipe for you. You can replace the parmesan with a vegan alternative, if you wish, and it really doesn’t change the flavour. Risotto is such a tasty filling meal for autumn evenings this recipe contains lots of umami from white miso, oyster mushrooms and parmesan cheese. Do enjoy it!

Ingredients

  • 160g Oyster mushrooms
  • 1 tablespoon oil
  • 250g arborio (risotto) rice
  • 15g white miso diluted with 700ml boiling water
  • 20g vegan or standard parmesan
  • 50g toasted pine nuts
  • 3-4 sprigs of thyme
  • additional grated parmesan

Method

  • Now the only rule really in making risotto is that you shouldn’t leave it alone for a second! It takes time to prepare but it is worthwhile putting that additional work in – you get out what you put in.
  • Grate the parmesan and set aside.
  • Toast the pine nuts in a drizzle of oil until they are brown -watch them closely as they can easily burn. Set aside to cool and then add the thyme (chopped) and mix well.
  • Add the oil to the pan and gently fry the mushrooms for 5 minutes. Then add rice to the pan and cook to 2 minutes.
  • Start to incorporate the miso based stock slowly to the pan over 10-15 minutes and keep stirring – this will prevent the rice from sticking to the pan.
  • The rice is ready when it is al dente (slightly firm to bite)
  • You may need additional liquid – water is suitable – depending on the rice you use.
  • At this point stir in the grated parmesan and serve topped with toasted pine nuts and extra grated parmesan to taste (you shouldn’t need any seasoning as the flavours are deep but add some at this point after tasting the dish if you wish.)
  • Enjoy!

A nice cup of tea

There is nothing more quintessentially English than a nice cup of tea. We debate the nuances of how to make it properly – milk before the tea or after, warm the pot before adding the hot water and tea or not, or how much tea to add to the pot. Tea also has lots of reported health benefits but does it help people with IBS? If you are interested, please read on…

Tea is culture, it’s refreshing, herbal tea is reported to be calming, relaxing – we all could do with a little of that, surely? Well perhaps all is not as it first appears.

Standard tea (black, white, green, yellow and oolong) are the true teas

Tea contains caffeine, a stimulant, not as much as coffee but certainly enough to have a systemic effect if sufficient is consumed. It is worth changing to decaffeinated if you have IBS, caffeine can not only stimulate the gut causing diarrhoea type symptoms it also disrupts sleeping patterns and poor sleep can be a symptom of IBS for some people. Some individuals with IBS also have overactive bladders, symptoms which can be influenced negatively by caffeine intake. Tea has lower levels of caffeine than coffee and certainly less than energy drinks, but do consider reducing or slowly swapping to decaffeinated if you drink caffeinated versions.

Oolong tea is high fodmap so will need to be avoided for the low FODMAP diet and tested as part of a re-introduction protocol, if you wish to drink it.

One study reported hard stools for tea in people with IBS (Simren et al 2001) but this was a prospective self reported study and has not been tested directly by a true randomized controlled study. This probably should be investigated but there are fewer studies in people with IBS with constipation for all treatments, unfortunately.

Rooibos

Rooibos is not a true tea and as such does not contain any caffeine and lower levels of tannin’s than true teas. It does however contain some of the poly-phenol compounds found in true tea. For the Monash version of the low fodmap diet it is categorized as low in FODMAP.

Herbal teas

Peppermint

Peppermint has been widely investigated for IBS symptoms. It acts as a smooth muscle relaxant so it can reduce those lower digestive tract spasms. Many people use the tea for the same effect. A number of people with IBS will also experience reflux, or upper gastrointestinal symptoms. Peppermint may also relax the sphincter (a ring of muscle) that prevents stomach acid from traveling up the food pipe (oesophagus). If someone has reflux it is probably not a good idea to drink peppermint tea. However it is good to help with lower abdominal pain so feel free to try it for that. If you want to read more about peppermint and IBS see my other blog post here:

https://clinicalalimentary.blog/2018/01/21/peppermint-and-ibs/

Camomile

Camomile is often stated as a treatment for IBS and ‘helps’ abdominal pain and induces sleep. Camomile acts as a neuroendocrine modulator so it has been suggested as a possible treatment to help with anxiety, insomnia and stress. This does suggest that it could be helpful for IBS type symptoms however Camomile contains FODMAP sugars therefore for those people with fodmap intolerance it is probably best avoided. Camomile also interacts with some drugs – please discuss this with you doctor or pharmacist before trying camomile tea. Common interactions are suggested with sedatives, blood thinners, anti-platelet drugs, aspirin, NSAID painkillers like ibuprofen and naproxen, but also others too (source: WebMD)

Fennel

Fennel is another herbal tea that is suggested to be a good option for those people with IBS. It again, also contains FODMAPs so if you are following the diet, perhaps this is one to avoid.

Dandelion tea

This tea has lot’s of anecdotal suggestions that it helps digestive symptoms, from increasing appetite, soothing minor digestive ailments and relieving constipation. There is no evidence that any of these symptoms are improved. Dandelion tea is another tea that it high in FODMAP so this might be the reason for the anecdotal reports of improving constipation, as lots of FODMAP containing foods are prebiotic (food for gut bacteria) and can help increase bowel function. Dandelion tea has also implications for drug interactions so it is best avoided for people taking diuretic medications, lithium and ciprofloxacin (an antibiotic.) Discuss this with your doctor or pharmacist before considering dandelion tea.

Fruit teas

Many people love fruit teas – they are naturally low in caffeine, however for me, they always promise more than they give. The odour of them is very tempting and I always feel disappointed that they are not more highly flavoured when drunk. If you like them though fruit teas should be fine to use. Use flavours suitable for the low FODMAP diet, if you are following it.

Testing tolerance to teas

For people following the low fodmap diet if you want to test the tea’s above which are high in FODMAP, to see if you can tolerate them, you can. Everyone has an individual tolerance to teas high in fodmap. Once your symptoms are reduced to a good level you could re-introduce the teas above and see how you get on. Use a standard cup as a portion and increase to three over three days, monitoring your symptoms as you go.

Following a Low FODMAP diet and adding milk to tea?

If you are following the low FODMAP diet then lactose is a problem for some people and if you need to exclude lactose then you can use lactose free cows milk – this is suitable for the low fodmap diet and the calcium it contains is slightly better absorbed than from milk alternatives. If you have been tested for lactose intolerance and you are not intolerant, you can use standard milk. Lactose free cows milk also marries with tea very well and you will not notice a difference in taste. This also means that Chai tea (milky tea with spices also added) is not suitable for people following the Low FODMAP diet, as it will contain lactose. You could make your own Chai tea with lactose free milk, if you wish.

Needing a milk free diet and have milk in tea? Which is the best option?

Well, for tea without sugar the best option is cashew milk, and for those who have sugar in their tea then coconut or almond milk are the better choices, according to people who have to follow milk free diets. I can attest to the cashew milk being suitable for tea without sugar, I tried it and really couldn’t taste a difference. Please ensure that your milk alternative is fortified with calcium, as cow’s milk forms a very good source of calcium in the diet and changing to milk alternatives may reduce your calcium intake. You could choose ones that are also fortified with B12 if you are following a vegan diet.

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