motivation – Clinical Alimentary

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)

Happy New Year to our my readers and I hope you will have a year of gut calmness in 2013. January is a natural time for contemplating change and you might be wondering how successful New Year resolutions are, I am sure the majority of people have attempted to make changes in the New Year. I know I have joined gyms and weight loss groups in January, signed up for twelve months only to lapse and end up wasting my money. So what is the trick here? Can we be successful in what we choose to renew? Looking into the actual evidence one study that compared New Years resolvers with those who wanted to change later in the year, the authors found that 46% of those choosing to change in the New Year were successful compared with 4% of those choosing to change later on. The reasons for their success were that they were contemplating change, really thinking about how it can be achieved and feeling confident of being successful. It might have been possible that the study was biased, those choosing to take part were more likely to be successful because of being more proactive for example, but even if the figures are an overestimation this is still pretty impressive. Other surveys have suggested that New Year isn’t the time to plan changes; a very large survey by Richard Wiseman suggested that 88% of people fail but the details of this survey were difficult to access.

After the Christmas indulgence in rich foods it is perhaps natural to want to look after your body and wipe the slate clean, this is a time of year when detox diets or programmes are promoted to help you cleanse your body, in general but also for people with IBS. I know from personal experience I always crave fresh foods after Christmas, fruit for example never gets eaten at Christmas in our home – I often wonder about the reason, every year in fact! Detox is the process of removing toxins from the body and I’ll let you into a little secret, we have a fantastic organ in our body called the liver, it really is a wondrous organ, it is our bodies detox machine and it normally works very effectively in removing toxins from inside our body, helped by our kidneys. But there is a natural need to look after our body this time of year and there is no harm in pampering it by eating a more healthy diet, within the restrictions of your IBS symptoms, of course. For example higher fibre is not advisable for everyone; check out the IBS Network Self Care Plan for more advice on changes to help changing to a healthier lifestyle. Perhaps getting back to your normal pattern of eating after the Christmas splurge might be a good goal to begin with, then choosing one more change to a healthier lifestyle to keep things manageable. Personally and professionally the problem I have with detox diets and regimens is that they don’t do what they propose to do. Sometimes they can be very expensive and are, in the main, just a very restrictive diet – which will result in rapid weight loss initially, making you feel lighter, less bloated and fresher, but this feeling is unlikely to be maintained. So what do you do to fulfil the need for a fresh new you? Your body will thank you if you make changes to make your life generally healthier and you can feel really positive that you are helping in the long-term. Being a little more active can help your digestion and changing to eating perhaps a little more healthily for your IBS, check out the Self Care Plan for advice about how to eat and manage your IBS. Perhaps all that is needed is planning to include some ‘me time’ in your life, this will be helpful, if you find your life is very busy. A thought to changes to help your well-being is also a possibility – the overriding consideration is that whatever you decide to do it has to be your choice and shouldn’t harm you in any way.

Here are some tips to help make those changes more permanent.

1. Think carefully about what you wish to change, I mean REALLY think, not just a transient ‘light-bulb’ moment, put the kettle on, get a pen and paper or use your laptop, deliberate and plan what you are going to do.

2. On your paper write a heading of positive and negative or pros and cons. How is changing helpful? What positive benefits are there to what you are planning? The more you can think of here the better.

3. What are the negative aspects of your change? These are very important to consider as we all choose to live the way we do as it is somehow easier for us, what makes it easier? The content of this list is possibly what is going to stop you changing or result in a relapse. How are you going to manage this aspect? Write a plan of action for if you lapse, remember lapses are likely and if you plan for the possibility, it’s less likely to become a fully blown relapse.

4. How are you going to put your plan into action? What exactly are you going to do? You need to be specific here.

5. You might find that thinking about your change results in deciding that it really isn’t the best time to do it, this is acceptable, maybe keep the pros and cons list somewhere safe and come back to it sometime in the future. Ensure your choice is an easy goal for you to achieve; being successful will help you make other changes. Goals need to be realistic and achievable deciding that it is perhaps not the right time to change is a positive step. Changing one aspect of you life at a time is more manageable.

6. How will you know whether you have made a positive change? It is important to measure this aspect as this is your motivation to continue, write it down or draw a graph, use the symptom tracker or there are lots of apps available to help with this and never forget to congratulate yourself on your achievements.

7. How long is it going to take to see an achievement? Measuring daily might not be helpful, weekly might be better. It depends on what you choose to do, but if you measure too much you might not see a change and this can be disheartening.

8. What do you do when you lapse? Well look at your measurements – what you have already achieved, congratulate your self for all that effort, use that motivation to continue. Also review your list of positive reasons you wrote at the start to refresh yourself on why you decided to change that aspect of your life.

If we live our lives without considering changing then we will carry on having to manage the negative aspects of what we choose to do. New Year is a really good time for people to consider what it is about our lifestyles can be improved and as such it is a really useful time, also getting others involved can also help people to keep up with resolutions.

J. C. Norcross, M. S. Mrykalo, M. D. Blagys (2002) Auld Lang Syne : Success Predictors, Change Processes, and Self-Reported Outcomes of New Year’s Resolvers and Nonresolvers Wiley Periodicals, Inc. J Clin Psychol 58: 397–405, 2002.

http://richardwiseman.wordpress.com/2009/12/29/how-to-keep-your-new-years-resolution/