Lemon – Low FODMAP

http://www.compoundchem.com

The words of the song the Lemon Tree, the words are undeniable “Lemon tree very pretty, and the lemon flower is sweet, but the fruit of the poor lemon is impossible to eat.” Many people with gastro-oesophageal reflux (GORD) and IBS avoid all citrus fruit due to reporting of them making symptoms of reflux worse. Yet, citrus fruits are allowed on the low FODMAP diet. I actually love lemon, the flavour is sharp and strong but has to be handled carefully in recipes to prevent is tasting like a popular cold remedy.

One point to mention here is that the National Institute of Health and Clinical Excellence (NICE) guidance on reflux does not specify a reduction of citrus fruit consumption as part of lifestyle GORD treatment. The reduction of coffee, chocolate, alcohol and fatty foods are the main focus of dietary lifestyle factors. Although the date of the review of this lifestyle advice is 2004 – so somewhat old data, but this is fine if no new developments have come to light. It is also worth noting that the measure of acidity, pH, is very low for stomach acid (2-3), for lemon Juice, it is 2, so not much different than the pH of gastric juices anyway. But people do report problems, so we do treat everyone as an individual and they can be reduced to a tolerable level, when needed.

Reduction of acidic foods also can reduce the amount of vitamin C in the diet, as ascorbic acid is found in higher levels in citrus fruits. Vitamin C full deficiency is rare in the UK, although arguably becoming more common due to fad diets, such as complete carnivore diets. Our bodies cannot make it, unlike other animals. Not much data is available on low vitamin C intake and GORD, but the effects of deficiency include damage to skin and likely the GI tract, which has a fast turnover of cells, not that helpful for those who have sensitive guts. The requirement for vitamin C might be increased in people who have diarrhoea – although caution is advised as vitamin C supplements above 3g/day (three times the amount of a standard over the counter supplement) will increase symptoms of abdominal pain and diarrhoea. As ever, it is better to get your nutrition from food, so once your symptoms have reduced, re-introduce those low FODMAP foods you have stopped eating, try them again, you might find that you can eat them after all.

Lemon butter drops

These little biscuits are only a mouthful – just a bite – but are a divine melt in the mouth treat. Especially nice for this time of year, Spring and Easter, (when Easter does arrive in April).

Ingredients

100g butter

200g rice flour

1/2g zanthan gum

Grated rind of 2 unwaxed lemons

1 egg

50g of gluten free self-raising flour plus extra for rolling out.

Filling (lemon curd)

4 wax free lemons – juice and rind

350g castor sugar

200g butter

1 1/2 tablespoons of corn flour

4 eggs

Method

Add the butter and sugar and cream (mix) together well.

Then add the grated lemon rind and egg, mix well

Add the flour and bring together into a dough, if it doesn’t bind together add a little more flour till it does.

Roll thinly and cut out small rounds (I made 40 with the mix)

Cook for 10 minutes at gas mark 6.

cool

Make the curd

Whisk together 4 eggs

Juice and grate the lemons and weigh out the other ingredients

Warm the eggs whilst adding the other ingredients and cook till thickened

Cool and add to the jars

(This is based on a Delia Smith recipe but with additional cornflour to make the curd thick enough to sandwich between the biscuits.)

Recipe makes enough for 20 small sandwich biscuits and enough curd to add to a litre and a half volume – more than enough to add to sterilized jam jars and they will keep for a few weeks.It does go a long way so you don’t need to use much for a sweet and sharp lemon flavour.


Is ginger useful for treating IBS?

Chemistry-of-Ginger-1024x724
http://www.compoundchem.com/2014/11/27/ginger/

The next ingredient to be reviewed is ginger. Ginger has many studies into its use to treat vomiting in pregnancy and to treat nausea during treatments such as chemotherapy or reducing sickness after surgery. Ginger has a long history of being used as a natural treatment for nausea, so one might expect that it could be used to reduce some of the symptoms of IBS. It is one of the most common herbal treatments used by patients to attempt to ameliorate symptoms of IBS (1). The action of ginger on the digestive tract is suggested to be an increase in prokinetic action of the tract (increasing movement or contractions without disrupting the rhythm) and it has also been suggested to be useful in pain reduction. The active ingredients in ginger can be seen in the diagram above and a placebo-controlled RCT parallel study in IBS (2) used the pharmaceutical grade ginger containing 2.29 mg/g of gingerols and 6-shogaols.  Raw and cooked ginger contain different chemical compounds and may have different modes of action on the digestive tract.

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The study had a good choice of placebo (brown sugar) tolerated by most patients with IBS. Study numbers were small – a larger trial with at least 100 patients per group would give a chance of better results. Larger doses appeared to give poorer results from this study, but the numbers in each group were small. We are aware that IBS is a very heterogeneic condition (wide variation in symptoms between people) and studying those people reporting more upper GI symptoms of IBS such as nausea and reflux plus constipation might improve results if the mode of action is to increase stomach emptying and increase digestive tract motility. The study, unfortunately, did not show that ginger was effective compared with placebo so we have therefore no evidence that ginger is an effective treatment for IBS.

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Does it cause harm?

Side effects in the study chosen were greater in the placebo group, the relevance for this is unknown – IBS is a challenging condition to treat with relapsing-remitting symptoms – no significance can be seen in regard to side effects as no statistics were applied to check whether this was significant in the study reviewed. Ginger is thought to be a safe treatment – ginger is also suitable to be used for the Low fodmap diet.  So a great tasting low fodmap ingredient – but don’t expect it will stop your IBS symptoms.

Just the ticket for a recipe then!

 

This is a very easy recipe to prepare and these biscuits can be stored in an airtight tin. They may go soft if not stored correctly.

Ingredients

325g Gluten Free self-raising Mix (I used Doves Farm)

1 tsp. xanthan gum

a beaten egg

75g muscovado sugar

75g golden syrup

75g butter

2 tsp. ground ginger

Method

Melt the butter, sugar and golden syrup in a pan then cool till the mix is only just warm

Beat the egg

Add the dry ingredients to a bowl and ensure the xanthan gum is mixed into the flour.

Add the wet ingredients to the dry and mix well till the mixture forms a dough.

Work this well.

Roll out the pastry dough into a thin sheet on grease-proof paper or a Teflon sheet and cut out the biscuits.

Add the biscuits to a greased baking tray and cook till golden brown in a moderate temperature oven – gas mark 4 or 180 degrees C

Makes around 30 biscuits (depending on what size cutter is used.)

1.Van Tilburg MA, Palsson OS, Levy RL, et al. (2008) Complementary and alternative medicine use and cost in functional bowel disorders: a six month prospective study in a large HMO. BMC Complement Altern Med. 2008; 8:46.

2. VAN TILBURG MA, PALSSON O S, RINGEL Y and WHITEHEAD WE (2014) Is ginger effective for the treatment of Irritable Bowel Syndrome? A double blind randomized controlled pilot trial Complement Ther Med. 22(1): 17–20. doi:10.1016/j.ctim.2013.12.015

 

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.

Spaghetti Cabonara -low fodmap

Whilst reading the Guardian newspaper recipe booklet this weekend I decided to have a go at one of the recipes in the pasta special and reduce the parmesan and low fodmap modify it. OK – this recipe scared me, adding egg to freshly cooked pasta – surely a recipe for scrambled egg, right? This is a classic Italian dish and no cream in sight and is a rich dish that is suitable for a low fodmap diet. It is easier to make than I first anticipated and much to my surprise, no scrambled egg in sight. This is a really creamy dish without adding cream and a tasty supper for chilli winter evenings.

I used bacon rather than pancetta as it is slightly leaner and 2/3 of the parmesan. Sometimes pecorino cheese is used instead – it really doesn’t matter. Having bacon occasionally is fine – I can’t actually remember the last time I did eat bacon, but obviously not a choice that should be included in your diet regularly and certainly not every day. This recipe was so easy but it could be included in an Italian themed dinner party or a relaxed meal with friends – it doesn’t take much effort at all – so give it a try.

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Ingredients

4 egg yolks

6 rashers of lean bacon

60g parmesan

400g of gluten free spaghetti

2 tablespoons of olive oil

Freshly ground black pepper

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Method

Bring a pan of water to the boil and cook the spaghetti according to the instructions on the packet – make sure that you follow the instructions carefully as this is the key to cooking the perfect gluten free pasta.

Whilst the water is boiling separate 4 egg yolks from the white (you can use the egg white to make meringue later) and beat.

Grate the parmesan

Add the olive oil to a pan and fry the bacon.

Drain the water from the pasta sauce saving a cup full.

Add the pasta to the bacon, off the heat and ensure the pasta is coated with the oil.

Add the eggs and cheese to the pasta with some of the pasta water and stir well till combined. The heat of the pasta will cook the sauce.

Add some freshly ground black pepper before serving and serve on warmed plates.

That’s it – serves 4.

Lamb Kofta on gluten free flat bread – low fodmap

I am at the moment experimenting with Greek and Middle Eastern dishes and modifying them to suit a low fodmap diet. I was surprised how well these flat breads turned out – although they are better when served slightly warmed. Enjoy…..

Ingredients

Kofta

400g lamb mince

small sprig of rosemary

1 teaspoon of Lebanese seven spice

1 teaspoon of garlic infused oil

seasoning

Flatbread

250g white gluten free bread flour

seasoning

1/4 teaspoon xanthan gum

1 egg

3 tablespoons lactose free yoghurt

70 mls of water

Method

Kofta

Chop the rosemary finely

Add the mince to a bowl and add the rest of the ingredients and mix well

Weigh into 50g portion sizes and shape into sausages.

Fry in spray oil for 15 minutes (or until cooked through thinner sausages cook faster)

Makes eight

Flatbread

Add the flour to a bowl and weigh in the xanthan gum

Mix well and add seasoning

Add the liquid ingredients and bring the dough together

Weigh into 6 separate balls

Roll out and trim into a circle shape

Fry with spray oil

Serve with feta cheese, a drizzle of olive oil, thyme and a tablespoon of pomegranate seeds per serving – if you are following a fodmap modified diet and can tolerate GOS (galacto-oligosaccharides) you could a tablespoon of hummus to each flatbread. If not you can use my recipe for Tzatziki and turn this into a Greek dish here https://clinicalalimentary.blog/2017/08/08/tzatziki-low-fodmap/

Warm Potato Salad

This potato salad is great for a summer barbecue and really easy to make. I have used lactose free plain yoghurt with mayonnaise to keep the calories lower and chives to flavour the salad. If you serve it slightly warm the mayonnaise soaks into the potatoes and also it means that if you have a problem with resistant starches you can avoid these too. I used Jersey potatoes – the best, but any salad potato will be suitable to use. It really couldn’t be easier to make!

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Ingredients

450g small jersey potatoes or small salad potatoes

1 tablespoon of mayonnaise

1 tablespoon of lactose free plain yoghurt

Chopped chives

Salt and pepper to taste

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Method

Boil the potatoes in salted water till soft.

Drain well.

Add the yoghurt and mayonnaise to a dish, season and add finely chopped chives.

Mix with the warm potatoes.

I decorated with some thyme leaves and chopped chard stems.

I hope you enjoy it!