Broccoli

Broccoli is a newer addition to the low fodmap family – although particular attention needs to be made concerning which parts are low fodmap. Growing conditions and plant storage of FODMAPs affects the fodmap content of foods. A good example here is the ability to use the green parts of leeks and spring onions and not the bulb (the storage part of the plant.) The same is true for broccoli, the leaves and a small amount of stalk (less than 50g) are low fodmap – the stems alone above 50g per portion are not suitable. Testing individual components of food gives us more information about its fodmap content, and we are continuing to learn more about the diet with the valuable testing of the fodmap content of foods. It is thanks to the continued work by Kings College Nutrition department that has led to more information. Increased testing increases available foods and this makes the diet more varied, which is nutritionally more sound, but can add to the complexity of the diet making access to up to date information more critical. The best sources of information are dietitians who are fodmap trained, which is why it is recommended not to complete this diet alone.

What are the benefits of broccoli?

Nutritionally broccoli is suggested to be a powerhouse vegetable, although so are most others in their own way! The infographic above indicates that it has some good cancer-preventing properties via the content of sulforaphane – content of this chemical is affected by cooking time, and its benefits are debatable, as much of the evidence comes from studies in mouse models and cells in Petri dishes, one or two small studies in humans have been done, but certainly more information is needed. Broccoli provides dietary fibre content, which is always important for people with IBS. It contains good levels of vitamin A (more in the tops than the stalks), Vitamin C (but this will depend on how long the broccoli is cooked) and vitamin K.

What are the effects on the colonic microbiome? Well, in a small study broccoli consumption altered the variety of Firmicutes (reduced) and Bacteroides (increased) although it is really too early to say if this is beneficial in IBS or for those following the low fodmap diet. Interestingly Firmicutes have been found to be increased in people with IBS and reduction in the numbers of Bacteroides – perhaps this just represents people with IBS reducing consumption of those foods that are suggested widely on social media to increase symptoms, such as cruciferous vegetables. It would be interesting to know if including broccoli amounts recommended in the low fodmap diet improves these bacteria numbers and whether this is clinically significant.

What broccoli is unlikely to do:

  1. Detox your body – your liver, kidneys and lungs are all you need for this.
  2. Reduce ‘inflammation’ we don’t have enough information that broccoli has any effect for this unspecific term.
  3. Reduce pain in fibromyalgia

I suggest cutting off the stem of the broccoli as close to the head as possible and discarding (or using for other members of the family or feeding to rabbits), then trimming the stalks contained within the base of the head – you can then weight the stems and calculate how much to add to the dish per portion.

What other cruciferous Brassicaceae vegetables are good to include in the low fodmap diet? Pak Choy, choy sum, kale, white cabbage and red cabbage – so do include these as well as other low fodmap vegetables – remember variety in the diet is best!

Now for the recipe:

Vegan broccoli and pine nut pasta – Low FODMAP

Ingredients

300g Gluten free pasta

40g Pine nuts

1 head of broccoli

2.5 cm square of Vegusto Prosociano

1 Tablespoon of garlic infused oil

A few basil leaves

Seasoning to taste

Method

Chop the broccoli close to the head and then into small ‘trees’

Cook the pasta in boiling water using the packet directions adding seasoning

Add 1 tablespoon of garlic infused oil to a pan and roast the pine nuts.

Add the basil, cooked pasta and broccoli to the pan with a tablespoon of water the pasta was cooked in.

Combine and serve with a sprinkling of the cheese for each portion

Serves 4

https://www.nhs.uk/news/cancer/broccoli-and-breast-cancer/

https://modalitypartnership.nhs.uk/self-help/livewell/topics/superfoods/is-broccoli-a-superfood ,

https://www.ncbi.nlm.nih.gov/pubmed/30317146 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4317767/

The Aubergine

Aubergines have to be my favourite vegetable. I love that they marry well with other vegetables such as tomato and potato. They have a velvety texture and a creamy taste and more than earn their title as the vegetarian steak.

Although in some quarters they are suggested to produce intolerance, as along with potato, peppers and tomato, the aubergine is a member of ‘the nightshade family’ or Solanaceae, a deadly associated name for a wonderful group of vegetables (and fruit, if you count the tomato, which is technically a fruit). We have little evidence for the problems of the ‘nightshade family’, concerning the above group of four as a whole, and why would you want to exclude these versatile vegetables from your diet? Some are however known as histamine producing – the aubergine and tomato – but histamine intolerance is a rare occurrence and can be identified by knowledgeable practitioners, plus aubergine is only classed as a moderate inducer. Another possible consideration for reactions to the Solanaceae group is the alkaloid solanine, which is found in green potatoes, so store your potatoes well, covered in the dark to avoid sprouting and this should not be a problem.

I have not had experience of the bitter flavour with aubergine so wouldn’t usually resort to salting them, but the above infographic is useful as once salted they will not absorb as much oil, so it might be worth taking the time to do it. Segnit’s flavour thesaurus matches the aubergine with walnut and tomato and a sprinkling of nutmeg. So, here is my recipe for you – please tell me how you like it!

Ingredients

1 aubergine

1 tablespoon of olive oil

100g carrots

1 tin of tomato

1 teaspoon of cinnamon

1 teaspoon of paprika

1/2 teaspoon of nutmeg

150g walnuts

150g of sharply flavoured cheese (if vegan you can use alternative vegan cheese here) but I used Manchego.

Method

Chop the vegetables and walnuts

Fry the spices in the oil to release their flavour.

Add the vegetables to a casserole dish with the tomatoes and mix in the spices and salt to taste

Cook for 1 hour at gas mark 6, 200 degrees C

Crumble the cheese, sprinkle on the top of the casserole and grill to melt

Serve with crusty bread (gluten free or otherwise for those following a low fodmap or gluten free diet.)

An alternative low fodmap Christmas cake

If you have fructose malabsorption and/or fructans malabsorption and you are really missing a Christmas celebration cake – look no further. Christmas cake is exceptional – like the Wedding cake, but in recent years the heavy fruit cake has gone out of favour somewhat. It is also not really suitable for the low fodmap diet despite only a small slice being recommended, being packed with dried fruit and made using wheat flour. This alternative has ingredients that provide a Christmas taste and is packed full of flavour.

This is a spiced whiskey ginger and chestnut cake

Ingredients

225g Dairy free margarine

340g Dark muscovado sugar

2 eggs (or 40g egg alternative if you have an egg allergy)

240g Self-raising gluten free flour

100g Chestnut flour

1/2 teaspoon of salt

1 1/2 Teaspoons of nutmeg

1 1/2 Teaspoons of ground cloves

2 Teaspoons of ground cinnamon

2 Teaspoons of ginger

100g of crystallised ginger pieces

Method

Weigh out the dry ingredients and sieve them well into a bowl.

Cream the butter and sugar in another bowl. Add the eggs to a measuring jug and beat them with a fork, then slowly add the egg to the wet mix while beating.

If the mix looks slightly curdled (grainy) than add a tablespoon of flour to the wet ingredients and continue to mix it well.

Add the dry ingredients to the wet mix and stir them in using a metal spoon and a cutting and folding action, to not lose the air you have already added.

Chop up the ginger pieces finely and add to the mix. 

Place the mix into a greased 18cm cake tin.

Cook in an oven for 2 hours at gas mark 4 or 180 degrees C or until a cake skewer comes out of the mix clean (the surface of the cake was dry, and this might give a false  reading with the skewer, ensure you pierce the surface with a wider hole to allow wet mix to come out.)

I soaked the cake with whiskey to give it an added depth of flavour!

Meat free Sausages – Low fodmap

This recipe was devised as a result of trying to find low fodmap meat-free sausages and failing to find a suitable option easily. They are very tasty – although they do not taste the same as standard sausages – perhaps they are better as a result, give them a try and see! Just in time for meat-free Monday.

Ingredients

100g walnuts

2 slices of vegan gluten free bread

90g celeriac

190g roasted peppers

1/4 teaspoon of asafoetida

1/4 teaspoon of paprika

salt & pepper to taste

Method

Add all the ingredients into a food processor and blitz till fine. This should be a thick paste texture, but it will depend on the size of the slice of bread, just add more bread if it is too thin. Dust gluten-free flour on your hands then roll handfuls of this mix into a sausage shape, or they can also be rolled into balls if preferred. Shallow fry in vegetable oil and serve. It couldn’t be easier really!

This recipe was made at the end of a day out at The Piece Hall at Halifax – as the pictures show below, we had a great day out, but it was freezing!

IBS digestive distress – is there a problem with bread?

Many people with IBS state that bread is a real issue in provoking symptoms. Is this true? What is it about bread that is the problem? This post aims to discuss the provocateurs of digestive distress in IBS (Irritable Bowel Syndrome).

Cited as sustenance – for example, the line ‘give us this day our daily bread’ in the Lord’s prayer – having access to bread was life for the poor in the past and bread is a staple food in the United Kingdom. The first piece of toast dripping in butter and a cup of tea after a period of fasting through having surgery is one time I recall, and bread was all the food I desired. How wonderful it tasted. The mouthfeel of gluten is undeniable and can be identified by those who do need to follow gluten, wheat or fructans free diet. I have identified it when I have infrequently made a mistake, as in ‘wow, this gluten-free bread tastes GREAT’ only to later realise my mistake at a cost and in fact it was the standard wheat based bread I had consumed!

The-Chemistry-of-Bread-MakingIn the past bread was made locally and bakers were part of the local community. When industrialisation arrived, bread, needed in large quantities as a staple food, soon was produced in factories, one of the possible reasons was because it was terrible work – bakers had to rise early and work hard to provide the daily loaf for their community. Is industrialisation the cause of bread symptoms? Many blame the Chorleywood bread making process and fast fermentation – but harking back to the bread of the past does not always leave a rosy glow. Adulterating food with cheap ingredients was commonplace in Victorian history, alum (aluminium salt) was added to the dough to improve it’s colour and was thought to be one cause of Rickets, by reducing the availability of phosphorus, leading to decreasing its absorption from the diet.

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So, let’s take a look at bread more closely. There are possibly a few protagonists for digestive discomfort after eating bread, and the reason may be different for individuals – we will now discuss some of those possible causes:

Resistant starch content

‘Resistant’ starch does what its name suggests – it resists digestion and is a component of fibre.  Produced by heating/cooling treatment, these resistant carbohydrates are based on wheat (and other) grains. Now for a little bit of chemistry, not too complicated, I promise. Starch is a crystalline polymer (think of a chain of a necklace containing many small beads, each small bead representing a sugar molecule, the necklace representing a polymer chain – a starch). Chains of the starch molecules closely line up on cooling, forming crystals within the bread matrix, links (imagine two or more necklace strings joined together) or bridges between the starch chains makes the structure a tightly packed area, where our digestive enzymes (amylases) can’t penetrate. The speed and repetition in cooling and heating will affect the amount of the resistance formed. Exposed to up to 20g of resistant starch per day from our diet some of the bacteria (amylolytic) in our large intestine may be able to ferment these crystalline resistant areas more successfully . IBS has alterations in the gut microbes, meaning that gut fermentation is a possible consequence and symptoms likely, in those people with IBS.

Research has shown that only certain types of bacteria are capable of digesting resistant starch of the form Bifidobacterium spp. and Clostridium butyricum but these types of study are limited. Consumption of these starches enriches the gut microbial populations with more of the microbes capable of breaking down the starch. We know that people with IBS have different populations of gut bacteria than the general public – a changing diet to improve symptoms is a possible cause of this difference.

Similar mechanism to the mechanism that causes issues from resistant starch – in other words poorly absorbed starch components causes these starches to be fermented in the large bowel resulting in symptoms when the colon is overly sensitive in IBS.

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Gluten

Gluten is a different component, and it is a protein, not a starch. Different mechanisms occur with proteins. During bread mixing initially, the gluten is softened by adding water to the flour, then kneading the bread with the salt that is added strengthens the gluten bonds gives a stretchy mixture, which traps air giving a better rise. Proteins tend to solidify when heated during baking, producing the tight structure or links between the protein molecules. Some research has found by blinding during trials that it does appear to be the fructans in wheat that result in the majority of problems for people with IBS. However is it still possible for individuals to have an issue with gluten? It does make you wonder, for those people who can tolerate all other fodmaps except wheat, whether this is, in fact, a non-coeliac gluten sensitivity. In my experience, most people following a low fodmap diet will go utterly gluten-free despite the fact that small amounts of wheat are tolerated well. Or perhaps the problem is a non-IgE wheat allergic reaction, or maybe natural toxins developed by the wheat is the problem…

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Wheat ATIs

Wheat amylase-trypsin inhibitors are proteins that are found naturally in wheat and are resistant to digestion and were developed by the plant to act as a defence against parasites and insects. They are activators of innate immunity and are suggested to lead to digestive symptoms by activating an immune reaction in the gut mucosa resulting in low levels of inflammation. Bioactivity of these proteins was found to be lower in spelt flour – often stated to be tolerated better for digestion. Is it possible that these ATI’s or gluten activate an immune response that then sensitises the colon leading to reactions to fodmaps?

The processing of wheat to produce bread, however, reduced ATI’s bioactivity up to 30-50%. But some people state bread is explicitly a problem so we should look at the manufacturing process specifically.

Chorleywood bread making process – the case for fructans?

All the above are commonly found in all wheat-based food, but bread is processed, what effects does this have? The Chorleywood process was developed in 1961 and improves production time reducing costs of bread production. This production method can also use a lower protein content flour, which was the type of flour available in the UK, to reduce costs of having to import flour with higher protein. The protein content in UK wheat has increased since this development, but this process is still used and widely disparaged as a cause of digestive distress.

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One fascinating study looked at the differences in symptoms between the general population and those with IBS and whether a longer fermentation would lead to lower gut fermentation and gas (1). Now, this study was tiny and was completed in vitro (it was not a controlled trial in human subjects, although human stool from volunteers was used) so, the conclusions would need further study. The Chorleywood process produced more gas more quickly, after simulated digestion. The more prolonged fermentation process also led to a higher level of bifidobacteria in the stool, the levels of these microbes are reduced in IBS. Bifidobacteria also produce less fermentation in the gut, suggesting increasing numbers compared with others may help reduce symptoms.

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So, the combination of less gas delivered more slowly and increasing commensal bacteria that produce less gas anyway, was suggested to equal better tolerance, which is perhaps a leap of faith to suggest that this reduction will reduce symptoms without it being tested in humans. Voila, testing in humans has been done (2)! A more extensive study in humans also looked at Chorleywood process compared with sourdough and showed that a more extended fermentation leads to the breakdown of ATI components and reduced fodmap levels BUT NO DIFFERENCE IN SYMPTOMS OF IBS. Both studies used constipated volunteers, so no difference there, the symptom production in the second study was reported to possibly be a nocebo effect – expecting symptoms due to previous experience. Which is possible, six slices per day is a considerable amount to consume for people who have an intolerance to wheat. Diet was excluded as a confounding factor but what is not clear is how the bread was eaten and whether this was different in the two groups – toasted, fresh, or frozen, perhaps taking us back to resistant starches? Also, about a third of people with constipation based IBS will have pelvic floor dyssynergia, which in theory could elicit symptoms that might not necessarily be helped by changes in the diet, if symptoms are severe. Both these studies were pilot studies and need further investigation on a broader population of people with IBS.

Yeast

For many people with IBS yeast is anecdotally reported to result in symptoms. We do not have any evidence that this is a problem and this has been dismissed by the medical establishment as a cause. No evidence means precisely that, we don’t know, so would it be an issue? Saccharomyces cerevisiae, a yeast, has been studied in improving IBS symptoms, so we have another situation of modulating the gut microbiota to improve symptoms. While we have absolutely no evidence that a low yeast diet is useful, in IBS treatment, it might lead to altering the microbiome and should not be advised, but this is an area indeed worthy of further study.

I think in conclusion, symptom inducement in IBS with bread is complicated and needs further study – with this detail of research required for one food item – is it any wonder that we have not got a cure for this medical condition?

  1. Adele Costabile, Sara Santarelli, Sandrine P. Claus, Jeremy Sanderson, Barry N. Hudspith, Jonathan Brostoff Alison Lovegrove, P R. Shewry, Hannah E. Jones, Andrew M. Whitley, Glenn R. Gibson (2014) Effect of Breadmaking Process on In Vitro Gut Microbiota Parameters in Irritable Bowel Syndrome PLOS one Volume 9 Issue 10 e111225
  2. Laatikainen R, Koskenpato J, Hongisto SM, Loponen J, Poussa T, Huang X, Sontag-Strohm T, Salmenkari H, Korpela R (2017) Pilot Study: Comparison of Sourdough Wheat Bread and Yeast-Fermented Wheat Bread in Individuals with Wheat Sensitivity and Irritable Bowel Syndrome. Nutrients. 2017 Nov 4;9(11). pii: E1215. doi: 10.3390/nu9111215.

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