Tag: Irritable Bowel Syndrome

Ramen Eggs – low fodmap

These mini ramen eggs are great for a party as a snack food, they have a strong umami flavour and taste great! The eggs were free range, which is obviously really important to ensure the quail that laid them are able to forage and live as far as possible as they would in the wild. They are also just the right size to add to a Bento lunch box salad and are used in Japanese cuisine. I bought mine at a farmers market a few days ago. They are very simple to make and can also be made using hens eggs if you prefer to do that. Tamari is made without wheat and is therefore gluten free if you are also have coeliac disease, but do check the label before you purchase just in case.

Ingredients

  • 12 Quail eggs
  • 200ml Mirin (japanese sweet wine wine)
  • 100ml Tamari dark soy sauce
  • 2 star anise
  • Black and white sesame seeds – you only need a small amount to decorate the eggs when finished

Method

  • Add the mirin, soy sauce and star anise to a pan and heat till boiling and cook for five minutes to impart the star anise flavour.
  • Allow the marinade to cool
  • Add the quail eggs to a pan and warm to boil and cook for 2 minutes.
  • Add the eggs to a pan of cold water to stop the cooking.
  • Tap the base (the more rounded end) on a surface and peel the egg under a tap – take care as you should avoid damaging the egg surface if you can as this will be more obvious after the eggs are marinaded.
  • Marinade the eggs for 24 hours in the refrigerator.
  • Cut each egg in half and sprinkle with sesame seeds.
  • The marinade can be used again and makes an ideal marinade for salmon or tuna too!

Serves 3-4 as a party hors d’oeuvre to serve with drinks.

Jules_GastroRDLeave a comment

Two kiwi fruit a day keeps constipation away?

You have heard about prunes haven’t you? I even have a post about prunes here https://clinicalalimentary.blog/2015/09/13/prunes-natures-laxative/ and how they have been used to help with constipation due to their sorbitol content. Sorbitol is a polyol, a sugar that is not absorbed into the body and helps to keep fluid inside the bowel, helping with constipation, but it’s drawback is that it’s a FODMAP. So what if there was a fruit that acted in a similar way to prunes but was low FODMAP? How fantastic that would be – well, kiwi fruit might well be that option.

Some people with IBS with constipation do reduce the fibre that they consume because they have noticed that ‘fruit and vegetables’ can make symptoms worse. The challenge is that there is little data to suggest that the low FODMAP diet resolves constipation in IBS-C, but we should also recognise quality of life and pain and the importance of resolving these outcomes and if pain is reduced but constipation is not then this might be considered an improvement by the person following the diet. We clearly need more research in IBS-C for more treatments to be available in all areas. If the Low Fodmap diet is to be used in IBS-C, in this situation I would always consider patient wishes whilst stating that we know less about IBS-C, and state that the diet must be done for the least amount of time (3 weeks) and if symptoms get worse or do not improve they must stop the diet. Focus needs to be on increasing levels of fibre from foods that are well tolerated in those with IBS and constipation. This is why a dietitian who is knowledgeable about the GI tract can be really beneficial to see to get the balance right. Kiwi fruit would appear to be part of that solution.

For people with constipation in China a study did look at the effects on constipation and found that improvements were seen in transit time (shortened) although this was not a double blind study (the best kind of research study.) For IBS, another study4 gave reductions in transit time but again this was not blinded, which might be a problem, but how do you blind a kiwi fruit? This is always a difficult challenge in nutrition. The other problem is the high placebo effects for IBS studies and the decrease in transit time of approximately 20% could possibly be down to a placebo effect. So the science does need to be repeated with better quality studies. The mechanism of why kiwi reduced transit time has been studied5 in healthy adults by completing an MRI scan of the bowel and it was found that water content in the bowel was significantly increased and they also suspected that the kiwi showed some action in increasing movement of the bowel (prokinectic action). But we do know that kiwi is low fodmap therefore is less likely to provoke symptoms in people with IBS and there are other potential benefits such as increasing the fibre content of the diet is good for health – so why not give it a try?

Kiwi fruit has 3.0g fibre per 100g so that doesn’t seem a huge amount, for two 6.01g. Alternatively prunes have 3.1g per 100g so these figures are very similar. Does the type of fibre matter? It does for people with IBS and if people do respond to a low FODMAP diet then clearly if they have identified polyols as a problem kiwi fruit is an excellent alternative fruit to try to help increase fibre content of the diet. There is also another means of increasing the fibre content and that is to include the skin when you eat one. Yes, you have read this correctly – eat the skin! You might not be relishing that prospect but I do encourage you to give it a try. Wash the kiwi fruit, then trim off the ends and slice it into segments to eat. This is a better means if you are disinclined to give it a try by just eating it whole. Eating the skin will add an additional 1.5g2 per 100g therefore a total of 9.0g for two, just under of a third of the daily adult requirements per day!

Are there any people who perhaps should avoid kiwi? Perhaps if people have not tried it before and have been diagnosed with a latex allergy it is possible that kiwi fruit might provoke a reaction as they contain protein that has a very similar structure to latex and the bodies immune system can confuse kiwi for latex. Kiwi can also induce oral symptoms in those with oral allergy syndrome or pollen food syndrome for some people – again due to the protein in kiwi confusing the immune system. But if someone has no symptoms then they can include it in the diet.

  1. http://www.nutridata.self.com accessed 27.03.21

2. David P. Richardson · Juliet Ansell · Lynley N. Drummond (2018) The nutritional and health attributes of kiwifruit: a review European Journal of Nutrition (2018) 57:2659–2676

3. Annie On On Chan, Gigi Leung, Teresa Tong, Nina YH Wong (2007) Increasing dietary fiber intake in terms of kiwifruit improves
constipation in Chinese patients World J Gastroenterol 2007 September 21; 13(35): 4771-4775

4. Chang CC, Lin YT, Lu YT, Liu YS, Liu JF. Kiwifruit improves bowel function in patients with irritable bowel syndrome with constipation. Asia Pac J Clin Nutr. 2010;19(4):451-7. PMID: 21147704.

5. Wilkinson-Smith V, Dellschaft N, Ansell J, Hoad C, Marciani L, Gowland P, Spiller R. Mechanisms underlying effects of kiwifruit on intestinal function shown by MRI in healthy volunteers. Aliment Pharmacol Ther. 2019 Mar;49(6):759-768. doi: 10.1111/apt.15127. Epub 2019 Jan 31. PMID: 30706488; PMCID:

Kiwi fruit is yummy! Eat the skin too 😋

Jules_GastroRDLeave a comment

Pecan and maple syrup marzipan – low fodmap

Ok, so why do we need a marzipan based on pecans? Well, marzipan is based on almonds and these are limited on the low fodmap diet, it also contains honey – it would be very difficult to know how much FODMAP sugars are ingested with most Christmas marzipan containing dishes – so I thought I would see if I could make an option where amount consumed doesn’t matter (from a FODMAP content anyway!) Now, although Italians probably would balk at this statement but I think my version is actually better than the original. It is really tasty and a good treat for a Christmas winters evening whilst avoiding the winter weather. Or gift wrapped for friends or family – everyone likes a home made treat.

This dish is certainly not a healthy option – despite being high in nuts and containing a natural sugar – maple and ‘brown sugar’ – it is a sweet and should be treated as such. Too many people on Instagram post recipes for ‘energy balls’ and state they are healthy because they are based on natural ingredients – sugar is sugar – despite the source. Eat sparingly and Christmas is a good time to partake.

Ingredients

  • 200g finely ground pecans
  • 100g icing sugar
  • 100g soft brown sugar
  • 3 Medium egg yolks
  • 2 tsp liquid glucose
  • 1 tbsp maple syrup
  • 1 tsp glycerine
  • 1 tsp vanilla extract

Method

Grind the pecans in a food processor until smooth and place them in a bowl with the sieved icing sugar – then mix together.

In a saucepan, whisk together the brown sugar, egg yolks, glucose, maple syrup, glycerine and vanilla, then cook over a low heat whisking constantly until pale, light and boiling. Take care as this is HOT.

Pour the above liquid over the pecan mixture and stir well to make a smooth paste. Leave to cool, then wrap in cling film.

Makes 20 balls – I have coated them in gold and silver powder to make them great for a gift. They are just as nice eaten with a bit of hygge – curled up in front of a roaring fire with a good book . Enjoy.

Jules_GastroRDLeave a comment

Low FODMAP sausage rolls

Christmas party food is important for people who need to follow a free from diet. Here is a popular choice for most parties and the pastry worked out really well and was fairly easy to make.

Ingredients

  • 200g Plain flour
  • 150g butter
  • 1/2 teaspoon Xanthan gum
  • 1 teaspoon of baking powder
  • 50mls water
  • Flour to use to roll out the pastry
  • 500g low fat pork mince
  • 2 Sprigs parsley
  • 2 Sprigs thyme
  • 1 Sprig rosemary
  • 2 sprigs oregano
  • Egg
  • Salt to taste

Method

  • Sieve flour, Baking powder, xanthan gum and salt into a bowl, mix.
  • Weigh out the butter and divide into three.
  • Rub 1/3 of the butter into the flour and then add the water.
  • Bring the ingredients together and roll into a rectangle, mark out into three sections – to the bottom 2/3 and add blobs of butter to the dough.
  • Bring the bottom 1/3 of the pastry over the middle third and then fold over the top third. Rotate a quarter turn, roll and repeat the above at least three times.
  • Rest for 30 minutes before use.
  • Add the pork to a bowl and season.
  • Chop the herbs and add to a blender with the pork mince,
  • Remove the pastry from the fridge and roll out. Add a line of pork mince and fold over the pastry.
  • Cut the pastry and wash with egg wash before using.
  • Cook in an oven gas mark 6, 220 degrees C.
  • Better served warm.

Enjoy!

Jules_GastroRDLeave a comment

Oyster mushroom soup low FODMAP

Mushroom soup is really very tasty and oyster mushrooms are the only suitable mushrooms for the low FODMAP diet. I love mushrooms and I went on a foraging course to help identify them but I haven’t picked any as yet – to nervous about picking the wrong ones I suppose. I would love to come across an oyster mushroom in the wild and they may be sold as wild mushrooms but I suspect they rarely are – I found the ones I used in this recipe in an Tesco store and they weren’t too costly.

I have written about the umami flavour before here and I have just read a really interesting article in the Guardian newspaper online here. I was astonished to read that glutamate the flavour that is responsible for the meaty rich flavour is also found in human breast milk and our tongue has a specific receptor for it – no wonder we like it! So much for MSG and the reports of it being ‘toxic’ according to some who like to say all ‘chemicals’ are bad – spoiler alert – all food are based on chemicals!

Ingredients

  • 300g of oyster mushrooms.
  • 2 teaspoons white miso (check the label for other high fodmap ingredients).
  • 2 teaspoons of Tamari sauce.
  • 1 teaspoon of ginger.
  • 1 tablespoon of oil.
  • 2 tablespoons of lactose free cream.
  • 1 and a half pints of water.

Method

  • Chop mushrooms and add oil to a pan.
  • Fry the ginger and add the chopped mushrooms and cook for 10 minutes.
  • Add some hot water to the miso and dissolve then add the water, miso and Tamari sauce to the pan.
  • Cook for 10 minutes
  • Blend till smooth

Serve with cheese on toast floats for an additional umami flavour! It really couldn’t be easier.

Here is a picture of me and my mum on our foraging course in the Lake District – lots of mushrooms here but they were foraged by an expert!

Jules_GastroRDLeave a comment

Chestnut pies – an alternative to mince pies (low FODMAP)

Mince pies are quintessentially Christmas. Normally mince pies have a large amount of dried fruit which can cause problems for people with fructose malabsorption if enough are eaten, plus they are made from pastry, a source of fructans. This is the reason I decided to develop a nut based pie instead and chestnut was just the right choice (along side the fact I had 1/2 tin of chestnut puree left from the previous recipe!) I am probably going all out to trash the traditional mince pie – but needs must!

Again this is a Christmas recipe and not one necessarily for health – the addition of lard really should be part of a true shortcrust pastry, the recipe standard is 1/2 fat to flour and 1/2 lard to butter/margarine. The lard in the pastry is also traditional in mince pie but usually added as suet to the filling. This recipe is made a rich shortcrust with the addition of an egg and the sugar. A recipe for a treat occasionally and when else can you have a treat except Christmas?

Ingredients

  • Pie filling
  • 50g Candied Ginger
  • ½ Can chestnut puree
  • ¼ teaspoon Vanilla
  • 40g pecan nuts
  • ¼ teaspoon Cinnamon
  • 3 tablespoons maple syrup
  • Pastry
  • 200g gluten free plain flour
  • ½ teaspoon xanthan gum
  • 50g margarine
  • 50g Lard
  • 1 medium egg
  • 1 tablespoon sugar
  • 1 egg beaten for egg wash

Method

  • Sieve the flour into a bowl add the xanthan gum and mix well.
  • Add the sugar.
  • Cut the margarine and lard into small pieces and add to the flour.
  • Rub the fat into the flour until it forms a small crumb.
  • Add the egg and bring the crumb together into a pastry – you may need to add a small amount of water if it is too dry but be cautious – you can always add more but you can’t remove too much!
  • Chill the pastry whilst you make the filling.
  • Chop pecan nuts and add the filling ingredients into a pan and warm through till blended well, chill.
  • Roll out the pastry and cut out the pie bases and tops
  • To a well oiled pie tin add the pastry base, some filling (don’t overfill) and then add the top and glaze with beaten egg wash (it will not brown without this addition.
  • Cook at gas mark 6/200 degrees C for 15-20 minutes.
  • Serve with sprinkled icing sugar.

Jules_GastroRDLeave a comment