Book Review The Complete Idiots Guide to Eating Well with IBS Kate Scarlata RD

This book is a comprehensive guide to eating with irritable bowel syndrome. It is very user-friendly, you can dip in for a quick read or take your time. I liked the summaries at the end of every chapter and the hints and tips are very useful. The book contains lots of recipes all with nutritional breakdown and a gut fact attached to each one! Covering the fact that healthy eating – with foods that are tolerated – is very important.  The foods that can be problematic are covered and Kate does explain, in user-friendly terms, the reasons why these foods can result in symptoms, but also adds that everyone’s symptoms are individual, so it’s advisable to use the advice accordingly. She also explains how to use a food and symptom diary to identify problematic foods, which is extremely useful for those people who are managing their IBS symptoms themselves.

The book is published for the American market, red flag symptoms are discussed, however one area that does differ in the UK is the identification of people with coeliac disease. Please note that everyone (children and adults,) who have IBS should be, or have been, screened by serological testing (blood tests – endomysial antibody (EMA) IgA and/or tissue transglutaminase antibody tTGA) for coeliac disease, in the UK. At the time of the writing of the book, the emphasis on testing IBS patients for coeliac disease was geared more toward those with IBS-D in the US, the author (in her private practice) however, recommends that all of her IBS clients be tested for coeliac prior to altering their diet. These are guidelines from the National Institute of Clinical Health & Excellence (NICE) available here:-

http://guidance.nice.org.uk/CG86

I have seen patients’ whose main symptom of coeliac disease is constipation, so everyone is at risk and should be tested. Ask your GP and eat wheat, barley and rye (bread, pasta, chappatis, some breakfast cereals) before your test, see above guidelines. Read what Coeliac UK have to say here:-

http://www.coeliac.org.uk/coeliac-disease/how-to-get-diagnosed

Other differences I noticed was histamine intolerance was mentioned in the book – this is not well recognised in the UK, but it can be identified by your dietitian by using elimination diets and is likely to be covered somewhat in an additives free diet (benzoate additives for example, but substances that promote a histamine response are also found naturally in some fermented foods.) It is also advised for people on certain antidepressants – the MAOI (Monoamine Oxidase Inhibitor) diet, to help people avoid dangerous rises in blood pressure, this diet is rarely seen now in general dietetic practice.

http://en.wikipedia.org/wiki/Monoamine_oxidase_inhibitor

Other food intolerances are also mentioned, it is important to see a state registered dietitian if you suspect you have histamine intolerance as identifying these rare intolerances can be challenging.

This book is certainly worth considering if you want to buy a book to help you manage your IBS symptoms, I particularly liked the chapter on travelling and eating out, often areas where it is difficult to acquire advice. The book also discussed lifestyle factors and other areas outside the area of Low FODMAP foods, which is also included, and as such it should contain advice that can help most people with IBS who feel that their diet, or eating in general is problematic.

This book was provided free of charge by the author.

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.

Six good reasons to increase your fibre intake?

Fibre (or roughage) is a term you may have heard of, but what is it, you may be wondering? Why am I asked to increase, or decrease the amount of fibre I am eating? This is the one area that I give advice about most often.

Fibre is the residue of carbohydrates (starchy foods) that are left in our bowel after we have digested the food that we eat. So it’s waste then? Well not really, it is food for the good bacteria in our bowel and it’s useful for our health to have a good intake of wholegrain starchy foods. Fibre is found in wholegrain and bran based cereals, oats and oat flour, pulses (peas & beans,) lentils, wholemeal, brown & seeded breads, wholemeal pasta, brown rice, nuts, seeds, dried and fresh fruit and vegetables for example.

Two different kinds of fibre are

Soluble fibre – found in oats, golden linseeds, pulses and certain fruit pulps, and vegetables such as Jerusalem artichokes, this fibre is soluble in water. Soluble fibre is food for our gut bacteria and helps lower cholesterol levels.

Insoluble fibre – this is found in wheat bran, rye and other grains and is also the tough outer coatings on fruits, nuts & seeds, this fibre is not soluble in water. Insoluble fibre reduces constipation and promotes gut health.

We are all aware that we need to have at least 5 portions of fruit and vegetables per day, but little is said about wholegrain foods (2-3 servings per day are advised) – to be healthy we should include these in our diet where we can. The UK Committee On the Medical Aspects of food (1999) say that adults should aim for at least 18g up to 24g of fibre per day, this is rather old advice, however we are still as a population not achieving these levels and we have no reason to change this advice. (Levels may be different in other countries and children also have different requirements.)

So, why is this advice so important? Well we all know that those people who have a low intake get constipated, but longer term, low intake of fibre can be more problematic. But rather than focus on negatives, lets discuss the positive aspects. Six good reasons to increase your fibre intake:

1. High fibre foods take longer to leave our stomach, therefore making us feel fuller for longer, good food then, if you are aiming to manage your weight. This idea may be more complex than just adding fibre to processed food or supplements for example; high fibre foods take longer to eat also, which also may have additional effects on satiety.

2. Foods that contain fibre take longer for the available component to pass into our bodies and this can help to achieve a lower blood sugar level after meals, compared with low fibre food, for people who have type 2 diabetes.

3. Some fibre also provides prebiotic action, giving homes and food for the bacteria that live in our large bowel. Helping increases in numbers of ‘friendly bacteria’ is beneficial, these bacteria produce vitamin K and also make short chain fatty acids, which feeds our gut and keeps it healthy. High numbers of good bacteria also reduce the levels of harmful bacteria in our bowel, the ones that result in illness.

4. Having a higher intake of fibre also protects against bowel cancer (which type of fibre is more protective is disputed – Parkin & Boyd 2011.)

5. Fibre also decreases the time it takes for food to pass through our digestive system, reducing constipation (along with a good fluid intake.)

6. Total and ‘bad’ cholesterol levels are reduced with higher fibre diets, by reducing the amount of cholesterol that is reabsorbed into your body, reducing your risk of heart attacks and stroke.

Therefore, as you can see – lots of good reasons to ensure you eat plenty of sources.

All good advice – so why is it I sometimes give advice to reduce the amount of fibre people eat, isn’t this going to be harmful in the future? People who have bowel conditions that may need to reduce fibre intake are often advised to go on a low fibre or low residue diets because fibre stretches the bowel wall, causing bloating and increased pain, also if the bowel is narrowed high fibre residues may cause a blockage. These may be people with crohn’s disease, colitis, cancer, stricturing (narrowing of the bowel) or adhesions from past surgery. Sometimes the type of fibre may be problematic, such as for people with irritable bowel syndrome and advice is provided to eat fibre that does not result in as much bloating, such as following the Low FODMAP diet for example. All these situations need changes to the amount or type of fibre in the diet, but this is usually a short-term measure, and people are advised to increase their fibre intake back to healthy levels post illness or after surgery. They then need to increase the amount slowly initially, starting with fruits without skins or pith & well cooked vegetables, increasing to foods higher in fibre such as wholegrain breads and pulses when tolerated.

So why not try some sources of fibre if you don’t eat it often? It is always advisable to increase the amount you eat slowly, particularly if you are not used to eating large amounts. Start by including one more portion of fruit (about a handful) or vegetables (2-3 tablespoons or a small salad) per day, till you are eating recommended levels or start with a bowl of wholegrain cereal (30g,) then include wholegrain breads, oats, wholegrain pasta/rice – increase by one item per day and see how tasty it is!

http://summaries.cochrane.org/CD002128/dietary-advice-for-reducing-cardiovascular-risk Free article

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3252068/?tool=pubmed Parkin DM, Boyd, L. (2011) Cancers attributable to dietary factors in the UK in 2010 111 – low consumption of fibre British Journal of Cancer 105 (S27-S30) Free article

http://scielo.isciii.es/pdf/nh/v25n3/revision1.pdf
N. Babio1,2, R. Balanza1,2, J. Basulto1, M. Bulló1,2 and J. Salas-Salvadó1,2 (2010) Dietary fibre: influence on body weight, glycemic control and plasma cholesterol profile Nutr Hosp. 2010;25(3):327-340 Free article

http://www.diabetes.org.uk/Documents/Reports/Nutritional_guidelines200911.pdf Evidence-based nutrition guidelines for the prevention and management of diabetes
May 2011 diabetes UK Free article

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

Probiotics – what are they and can they help my gut?

There is a plethora of information about probiotics and we are constantly bombarded with advertisements promoting their use, for gut health, so what should we believe? Probiotics are products or food that contain bacteria, in large enough amounts to alter the number and/or type of bacteria that live in the large intestine (see diagram at the bottom of the page.) Everyone has populations of bacteria in their gut and we know that changes to these natural populations can occur in food poisoning or with any illness that occurs within the digestive tract. This could be irritable bowel syndrome, crohns or ulcerative colitits for example, but other disorders can affect the populations of bacteria. We are only just beginning to understand how these bacteria affect our health; they produce substances called short chain fatty acids from starchy foods, which help feed the digestive tract, keeping it healthy, a real benefit. They also help to produce vitamin K, a vital nutrient that helps our blood to clot and our bones keep healthy. So the relationship with our bacteria is beneficial for both the bacteria and us. These ‘good bacteria‘ also help to prevent some of the more harmful bacteria from developing and causing illness. Our bowels contain huge numbers of bacteria; our bodies contain about ten times more bacteria cells than the cells that make up our body, a good proportion of these are in our gut, an astounding fact.

What are often called ‘good bacteria’ are various types of bacteria commonly found in our bowel, and it is felt that if this natural ecosystem is damaged by illness, then replacing those bacteria helps to reduce symptoms such as diarrhoea, bloating and pain, which often accompany some digestive diseases. The theory is that taking these bacteria in food or drink will replace the bacteria that are missing; however in reality the effects are variable.

These bacteria are produced from dairy foods, such as Lactobacillus, Bifidobacterium and Lactobacillus acidophilus – long names for such cool microorganisms. We have good evidence that taking bacteria at the start of a course of antibiotics can prevent the diarrhoea that can accompany these medicines – antibiotics can reduce the natural populations of good bacteria in our bowel, which slightly alters digestion of starchy foods, resulting in diarrhoea. The case for probiotic effectiveness in reducing episodes of ulcerative colitis is controversial, but probiotics can be effective in reducing occurrence of infections that occur in people who have had reconstructive small bowel surgery (called pouches,) and can prevent diarrhoea that occurs when travelling abroad. For illnesses such as food poisoning, they may reduce the amount of days you are ill and reduce the number of times you need to visit the loo -which is always a benefit!

The products that are available also have varying effects in people with irritable bowel syndrome (IBS,) and the evidence for their usefulness for preventing further attacks of crohns disease is still uncertain. As these products are generally not harmful in most individuals, if you have irritable bowel syndrome UK health professionals advise that you could try them and see if they work for you. If you have crohns disease or colitis, it is probably better to discuss this with your gastroenterologist before you try them out.  Try them for at least a month if you wish and follow the manufacturers instructions, you may need to continue taking them if you find them beneficial, as their effect can be temporary. It is also advisable to store these products as the manufacturer recommends and use them within the date advised, to ensure that the products are effective as they can be.

Some people may be better to avoid taking these bacteria, for example if you have a severe intolerance to lactose (a natural sugar found in dairy foods,) most of the manufacturers products are based on milk, therefore they may give symptoms, as they may contain varying amounts of lactose, depending on the product. However the bacteria will have reduced the amount of lactose naturally found in these foods, so caution is advisable if you wish to try them.  Also if your doctor has told you that you have a weak immune system then you should not take these products.

Again we do not have evidence that probiotics can be helpful in preventing allergies or stopping infections of the bladder in adults, so don’t waste your money! Although I was informed by blogger yesnobananas that there is some evidence for a strain of lactobacillus Ramnosus in protection from developing atopic eczema, which is hard to find, but see her blog for further information

http://yesnobananas.wordpress.com/2013/01/10/can-probiotics-prevent-food-allergy/

But where we know they are effective, or the products are recommended by your registered health professional, they are certainly worth considering. If you wish to try them and are not too sure about your situation, you could always discuss their use with your healthcare provider.

Health professionals can check the links below for evidence base references:

http://www.patient.co.uk/doctor/Probiotics-and-Prebiotics.htm

http://www.cochrane.org/search/site/probiotics