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

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)

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.

Image by Pexels from Pixabay

Image by congerdesign from Pixabay

Orecchiette con Cima de rape – Low FODMAP

This recipe was in a newspaper supplement but wasn’t really Low FODMAP friendly so I decided to give it an update and make it suitable for those with food intolerances. It is a traditional Puglian recipe using broccoli tops (Cima de Rape), which is a winter vegetable in Italy but is a really refreshing recipe for spring in the UK using broccoli tops makes it a suitable low FODMAP version.

The other problem is that there is no suitable gluten free Orecchiette pasta that is available in the UK, so fresh gluten free pasta has to be made if you want an authentic dish. The other point to note is that only if you find cooking relaxing should you attempt to made home made gluten free pasta. An important factor is not making more work for yourself if you don’t find cooking relaxing and dried pasta is suitable for this dish.

I have decided to make a longer recipe today as it is Bank Holiday weekend and the forecast suggested that it was going to rain although it hasn’t done yet. I have also posted some bluebell images from this weekend – bluebells are everywhere at the moment and are quite a spectacle.

Ingredients

Pasta (wheat free)

250g Pure maize flour (wheat contamination free if you are coeliac)

50g Gluten free bread flour

2 Eggs

Salt

1/2 Teaspoon xanthan gum

Enough water to bring the dough together

Stock

1 Ladle of pasta cooking water – top up to 500ml with water

20g Carrot chopped

30g Celeriac

1 Bay leaf

Small amount of salt and 6 peppercorns

Sauce

1 Head of broccoli (250g) stalks removed

1 Anchovy

1 Lemon

20g Parsley

20 Bay leaves

20g Rocket

30g Parmesan

3 Tablespoons of garlic infused olive oil

25g Butter

100ml White wine

Salt to taste

Method

Pasta

Weigh the flours into a bowl and add salt and xanthan gum. Mix the dry ingredients well before adding any liquid to the mix. Add the eggs and start to mix the flour, then add water to bring the flour together into a dough. Add just enough to ensure a soft mix – it is not possible to give a volume as this will depend on the fineness the flour mix you use. Once the dough is formed work it well to incorporate it together and make a smooth mix. This will take time, don’t worry about over working – this is not the same as making standard pasta. Roll out logs of the dough to the thickness of you thumb and then slice finely. To make the orecchiette shape press your finger into the centre of the disc. Bring a pan of water to boil and add salt and the pasta. Cook till the pasta rises in the pan remove and drain.

Zest the lemon and juice.

Chop the broccoli tops, celeriac, carrot, anchovy finely and add to separate bowls.

Then chop the basil, rocket and parsley and add to a bowl with the rest of the lemon juice.

Make the stock adding the pasta cooking liquor, carrot, celeriac, bay leaves and pepper to a pan and cook for 10 minutes, drain and save the stock. You could add the carrot and celeriac to the main dish but remove the bay leaf and peppercorns.

Add the olive oil to a pan and add the broccoli, anchovy and the zest of 1/2 the lemon and cook for four minutes then add the stock, wine, 1/2 the parmesan and butter and simmer for 10 minutes until the broccoli is soft.

Add the herbs and the rest of the lemon zest to the pan and then gently mix in the pasta to warm through. Serve and finish with a tablespoon of the lemon juice and the rest of the parmesan.

Serves two

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/

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!