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

Vegan ‘chicken’ and pumpkin couscous – low fodmap

An autumn favourite is pumpkin and numerous varieties can be found. When I was young pumpkin in the UK was unheard of – in fact we used to make Halloween lanterns with a swede! That certainly was a recipe for injury – although the pumpkin isn’t always easy to carve.

I have also decided to venture into a vegan recipe using vegan ‘chicken’ low FODMAP suitable products are based on soya protein or alternatively you could use Quorn ‘chicken’ pieces.

This was a fairly easy recipe to make and was lightly spiced – if you want a heavier spice then you can add more Ras El Hanout. Do check your spice mix has no high fodmap ingredients such as onion or garlic. Enjoy!

Ingredients

  • 200g Pumpkin
  • 30g Pumpkin seeds
  • 30g Pine nuts
  • 20g Sunflower seeds
  • 30g Course peanut butter
  • 200ml Water
  • 1 teaspoon of Ras El Hanout Spice
  • 200g Soya protein based chicken pieces
  • 250g Corn couscous
  • Spray oil
  • 30g mint leaves
  • Seasoning (salt and pepper) to taste

Method

  • Chop the pumpkin and boil in water till soft.
  • Spray oil into a frying pan and add the Ras El Hanout and fry gently with minimal oil to release the flavours, add the chopped mint leaves.
  • Add the peanut butter, seeds and water to the frying pan and cook till thickened
  • Add the ‘chicken’ pieces and cooked pumpkin
  • Weight the couscous and pour over the same amount of boiling water (250 ml) and leave to cook – run a fork through the mix to give texture to the couscous
  • You can either serve the ‘chicken’ sauce and couscous separately or mix the ‘chicken’ sauce through the couscous, as I have done.
  • Serves 5-6 enjoy!

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)

Do you have a problem with lactose?

The-chemistry-of-milk

The following script is based on an article I wrote for the Allergy & Free From show magazine last year. With some updates!

What is lactose?

Lactose is a sugar, for this sugar to be used by us, the walls of our lower digestive system produce a digestive enzyme called lactase. This enzyme helps to break down the sugar so it can be made small enough to be taken into the body and used as energy. See the above infographic.

What causes lactose intolerance?

Congenital lactose intolerance occurs because of the gut not being able to produce any lactase enzyme from birth – this is very rare. Primary lactose intolerance is where the gut loses the ability to create the lactase enzyme over time. Secondary lactose intolerance can occur with a digestive disease, gastrointestinal infections and food poisoning, which may or may not be short term.

Some people’s ethnic background puts them more at risk of lactose intolerance because in South America, Africa and Asia, over half of the indigenous population have primary lactose intolerance and in some Asian countries almost everyone can have primary lactose intolerance.

What symptoms might I have?

The symptoms from lactose intolerance can be unpleasant and embarrassing and range from loose, watery poo, wind, bloating and a distended tummy. Some people get stomach cramps, loud digestive gurgling noises, feeling sick and occasionally are sick. These symptoms occur because undigested lactose in the bowel pulls fluid from the body as it moves through the lower digestive tract, causing diarrhoea. Then lactose is then used for energy by the bacteria usually found in the bowel – this causes bloating and wind.

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When do I need to see my doctor?

Usually, digestive symptoms because of food poisoning are often quick to resolve (lactose intolerance after a digestive system infection usually resolves after six weeks), if you still struggle with symptoms, see your doctor, don’t be tempted to self-diagnose. Don’t be shy in talking about your symptoms – doctors have heard them all before. You can always write down your symptoms before you go if you just find them too difficult to talk about.

The following symptoms are not expected with lactose intolerance if you have swelling of your lips, mouth or face; rashes or wheezing within minutes to a few hours of drinking milk. This might suggest an allergy – see your doctor. Or, alternatively, blood mixed in your poo with a temperature and feeling unwell. These are not symptoms generally associated with lactose intolerance and may be due to another medical problem.  Contact your GP and don’t make drastic changes to your diet.

All children should be seen by their doctor and lactose intolerance because of cow’s milk protein allergy should be considered. Because babies and young children are more vulnerable, any symptoms of blood or mucus in poo, green vomiting, a temperature and severe tummy pain in young children call NHS 111 for advice or discuss with your doctor urgently.

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What tests are available for lactose intolerance?

No blood tests can identify lactose intolerance. Sometimes your doctor might advise a test called a hydrogen breath test – but often they will recommend following a full lactose-free diet for one month and then introduce lactose to test that symptoms return, which is usually very useful in identifying this intolerance. Testing food is also essential to find your own level of lactose tolerance. Most people can have a small amount without having any symptoms at all, and this knowledge can make following a lactose-free diet a little bit easier. A registered dietitian can help you do this effectively and check you are getting the correct nutrition from your modified diet.

Might symptoms be caused by something else?

Occasionally, it’s possible to have lactose intolerance along with other digestive complaints, such as:

Coeliac disease (autoimmune gluten enteropathy) this is because gluten, a protein in wheat, barley and rye, damages the bowel surface so it cannot make the lactase enzyme very well. See your doctor, and your doctor will complete tests for coeliac disease if it is suspected. It is vital to continue to eat food containing gluten to make quite sure that the tests used can identify coeliac disease well. Lactose intolerance usually resolves with treatment for coeliac disease.

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A few people with inflammatory bowel disease (IBD – Crohn’s disease and ulcerative colitis), which causes the bowel wall to become swollen and ulcerated, can also occasionally have problems digesting lactose. Due to inflammation of the bowel wall sometimes it cannot make the lactase enzyme very well. This lactose intolerance can resolve with treatment for IBD.

People with irritable bowel syndrome (IBS) can have problems digesting lactose, this might occur because of the gut microbe fermentation of some foods (called FODMAPs.) Lactose is a FODMAP. FODMAPs are sugars found widely in the diet that are poorly digested and result in symptoms for people with IBS. If you wish to try a low fodmap diet ask your doctor for a referral to a registered dietitian to help you. Don’t be tempted to exclude all carbohydrates from your diet. Wholegrain starchy carbohydrates are essential for long-term gut health.

Where is lactose found?

In animal milk, some cheeses, some yoghurts, processed foods made from animal milk and some medications. Most medications contain tolerable amounts so don’t stop taking them. Discuss alternatives with your doctor or pharmacist if you are taking a few medicines containing lactose, as this might be enough to cause symptoms.

Lactose-containing ingredients can be recognised on the food package ingredients list by the following words – milk, lactoglobulin, milk solids, buttermilk, lactose, artificial cream, whey powder, cheese, condensed milk, curd, skimmed milk powder, cream cheese, modified milk, evaporated milk, margarine and butter. As milk is an allergen, it will be listed as bold, in italics or in a different font or colour on the ingredients list. But lactose is not an allergen as such, so it doesn’t need to be listed separately to milk. Lactose-free animal milk products will be explicitly stated on the packaging by the manufacturer.

Where can I find lactose free products?

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Much lactose-free milk and alternative milk products can be found at larger supermarkets and can also be sourced online. Some manufacturers are Lactofree (Arla), Candia, supermarket home brands, free from milk (Alpro, Oately, Rice Dream, Good Hemp, Koko and Provamil.) Please note rice milk should not be given to children under 4 ½ years of age.

Other products, due to the processing methods used, might be lower in lactose naturally and some people can eat them with no problem such as standard hard cheeses and some yoghurts. Many other foods are typically free of lactose.

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The new ‘alternative’ on the block:

Tiger nut milk is a new marketed product trend, and I really don’t see the point of having this milk, unless you are from Spain and have Horchata as a cultural drink. Tiger nuts are tubers, and you can buy tiger nut milk ready made – but often making your own is advocated by bloggers and companies alike. Marketed as paleo – with little other nutritional content in the milk except for carbohydrate this marketing ploy seems a bit odd. Neither has it been tested for fodmap content.

So, people who have food intolerances and IBS, or those with inflammatory bowel disease, who may have associated conditions that result in extreme lethargy are required to make their own milk? You have to be kidding, right? There is no advantage to having this product nutritionally over and above other milk, and it does not naturally contain reasonable levels of calcium. This is exploitative of vulnerable patients in my opinion and risks long-term low calcium intake.

Is animal milk bad for me?

poison milk

No, quite the opposite in fact – lactose-free animal milk contain good levels of calcium iodine and vitamin B12. Unless you have any religious, cultural or ethical reasons to avoid it, you could just swap to lactose-free animal milk products. These products contain the same level of nutrition found in regular animal milk and have the added advantage of tasting the same. We also know that the calcium found in animal milk is slightly more readily absorbed into the body than the calcium used to fortify plant-based milk.

The internet is full of alternative articles scaremongering around the consumption of cows milk. While I have no issues at all with people who decide to avoid animal products for ethical, cultural or religious reasons, scaremongering others to avoid cows milk due to spurious health risks and unevidenced harms is unacceptable.

You might have heard that animal milk leaches calcium from the bones, this is just untrue, and stories of milk being ‘too acidic’ for the body has no basis in science. Neither does milk cause excessive mucus production in the body or inflammatory bowel disease.

However, if you have changed to plant-based milk for religious, ethical, cultural or personal choice, do ensure these are fortified with calcium and ideally vitamin D (plus vitamin B12 if you are vegan.)

Another nutritional consideration for those avoiding animal milk is that milk and dairy products are the primary sources of iodine for most people. So, avoiding cows milk and/or fish can also risk low levels of iodine in the body. Adults need 150 micrograms per day, pregnant and nursing mothers slightly higher at 200 micrograms, most milk alternatives are rarely fortified, too much-added iodine can also be problematic so ask your dietitian if you feel you are not getting adequate amounts.

What about raw milk?

Raw milk contains lactose and is therefore unsuitable for people with lactose intolerance and can risk gastroenteritis (food poisoning) if it is not properly treated. I would not take the risk of drinking raw milk, particularly if you have any other digestive complaints.

Can I buy a supplement to help me digest lactose?

Yes, they are available online or from health food shops. However, the effectiveness of them varies. But they might be useful to have to hand when eating out and travelling when it might be a little more challenging to avoid lactose.

Does having lactose intolerance affect my future health?

Not generally, but not getting adequate calcium in your diet because you have stopped having all milk products long term can lead to weakened bones. Adults should ensure they have at least three portions of lactose-free dairy or calcium-fortified alternatives a day (a portion size is a glass of lactose-free milk, a small matchbox size of hard cheese, or a yoghurt.) People with bowel diseases and teenage boys need more than this, and other children less. Discuss with your doctor or dietitian. A useful calcium information sheet can be downloaded free from the British Dietetic Association website under ‘food facts’.

I do not have any affiliations with the dairy industry and have never been funded or paid by them.

 

 

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