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clinical alimentary

Know your guts, love yourself.

Which path will you choose?

You might consider that this post is not relevant to IBS, but everyone has to make some changes, when diagnosed with a medical condition. Changes perhaps try a new diet, a new medication or treatment, these naturally will require some change to a persons usual lifestyle. I was lucky enough to train with an inspirational dietitian during my clinical placements and one experience I had during training was listening to my mentor explaining to a patient, using the metaphor of a path, for explaining the challenges of changing any behaviour that we need to, in life. She explained that choosing to change a behaviour is like choosing a path to walk and the path we all use as a default, as human beings, is often the easy, well trodden route. Or the path of least resistance. This is a human trait – it is certainly not being lazy, a comment I often hear from people – you are not lazy – you are human. Making changes is challenging, a difficult path to follow, often with steep slopes, an uneven, meandering, overgrown path – a formidable terrain. Initially both paths follow close to each other.

Often, when starting out on a demanding route, it is very easy to start to follow the more difficult path and step from the difficult route back to the easy one. This is very much to be expected – but when this happens, look behind you – how far have you come? You now have a decision to make – and this decision is solely yours, so take full ownership of it. You can continue to follow the well trodden route, consider what this will ultimately achieve – weigh up the costs and benefits of staying on your chosen path. If you choose to stay on the well trodden path then do not feel disappointed, don’t berate yourself for your choice. You have made a choice and there will be very good reasons for it. Maybe this is not the time for difficult challenges and believe it or not, it is perfectly acceptable to reach such a conclusion. Walk a little further and consider again whether you are ready to try the more difficult path, it will always be possible to step back onto it, from the easy route. People can hop from one path to the other a few times before they find that they are actually some way down the tough route and realise that the path actually does have very manageable sections. Now the easy path is some way in the distance and this tougher path has surprisingly become the new default. Think about the achievement you can make and the views you can expect to see, when following the challenging paths in life!

Easy like Sunday morning

Fancy a cooked breakfast occasionally and finding that your IBS symptoms are getting in the way? Then perhaps try this version, which is lower in fat than a ‘good old fry up’ and lower in fodmaps and therefore shouldn’t be too hard on your digestive system. Choose a wheat free bread that is <3g/100g of total fat, if you can. If you choose a bread that is lower in fat you can save calories, help your symptoms and the dish would come in at around 320 Kcal per portion – not too bad for a tasty breakfast! The added herbs gives the dish a nice flavour and added some vibrancy to the dish. If you choose a different aged ham or salami then check the label to ensure it doesn’t contain any fodmaps such as onion and garlic and is a lean meat. I found I didn’t need to add any salt to this dish as the ham provided plenty.

Ingredients

1 slice of wholegrain wheat free bread

1 slice of Serrano ham (trim any excess fat)

1 egg

Chives and thyme to serve.

Method

Add the bread to a plate and top with the Serrano ham, you can warm the bread and ham if you wish before you use it, but I didn’t bother.

Dry fry the egg or use a little 1 Kcal spray oil to the pan if you don’t have a non stick frying pan.

Cook the egg – then add on the top of the ham and sprinkle with chopped herbs. This works just as well with poached egg or scrambled – depending on your preference! Serves one.

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Pickled vegetables – Low Fodmap

I am a real fan of Ottolenghi’s work, his recipes are delicious, but unfortunately they do contain lots of ingredients high in Fodmaps, so not that great for people with IBS. This weekend however was a bit different – a recipe suitable for the Low Fodmap diet was published in the Guardian magazine. I have tweaked it a little, because I feel that if you are posting a recipe it needs to be referenced to the original source and modified – this is the only time I have, so far. The recipe was for pickled baby turnips – I have added baby turnips and radishes (for colour) and a little Worcestershire sauce into the pickle mix. This mix will last a few days in the fridge but no longer, as thorough sterilizing techniques have not been employed.

Ingredients

Pack of baby turnips (you can use standard turnip around 200g chopped)

5-6 Radishes

1/4 of a carrot spiraled and cut into short lengths

1 stick of fresh turmeric (you can use powdered but this will likely cloud the pickle liquor)

1 teaspoon Worcestershire sauce

2 teaspoons of granulated sugar

120ml White wine or rice vinegar

175ml Water

1 teaspoon of salt

Method

Chop the turnips and radish into quarters, wash thoroughly.

Pour the water, Worcestershire sauce and vinegar into the pan and add the sugar.

Warm and dissolve the sugar and heat to a rolling boil.

Take off the heat and cool. Add the vegetables, turmeric and salt.

Add to a jar and refrigerate.

These vegetables taste great with cold cuts of meat – don’t be too concerned that they contain a little sugar to counteract the sharpness of the vinegar. You will not be eating the pickling liquor, so it is really not a great amount of sugar that you will be adding into your diet.

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Chocolate, Courgette and Pecan Cake – Low Fodmap, gluten free

It’s Bank holiday weekend and as usual the weather is dismal, at least it’s not snowing like last week – time for some baking to lift the mood. How about a cake with some vegetables? Not something you fancy? It is worth trying this cake, the courgette adds some moisture to the gluten free cake and you really can’t taste it – so why not give it a try? Now as usual this cake is for a treat only, despite it containing a vegetable😉 – I am not suggesting you have cake every day – neither am I suggesting you be a total nutrition evangelist and avoid it for the rest of your life. It is not too sweet and very rich in flavour, so a small piece is all you will need to get a chocolate hit. It does contain a large amount of fat too, it would still be classed as high fat, if you have IBS, again a small piece is advisable. This gluten free option is certainly not going to lead to weight loss! It is a great option for a celebration, so you can share it with others and not be tempted to have more than one piece!

Ingredients

  • 250g of plain gluten free flour
  • 200g icing sugar
  • 65g of good quality cocoa powder
  • 2 teaspoons of bicarbonate of soda
  • 1 tablespoon of baking powder
  • 1/2 teaspoon of salt
  • 4 eggs
  • 350 ml of vegetable oil
  • 100g pecan nuts
  • 2 grated courgettes

Method

  • Warm the oven to gas mark 4, line a cake tin with parchment.
  • Grate the courgette.
  • Chop 50g of the pecan nuts and add to a bowl.
  • The other 50g of pecans, save for decorating, choose the best looking ones.
  • Weigh out the dry ingredients into the bowl containing the pecan nuts.
  • Crack the eggs into a bowl and add the oil, mix well.
  • Add the wet ingredients to the dry ingredients and mix using a hand blender.
  • Add the courgettes.
  • Mix well.
  • Add to a 7inch cake tin lined with parchment.
  • Cook in the oven for 90 minutes or until a skewer inserted in the cake comes out clean.
  • Trim the top of the cake flat and turn it over for decorating.
  • Add some sugar to a pan and cook till it caramelizes, dip in the pecans and cool.
  • Add the rest of the caramel to the top of the cake and cool.
  • Serves 10-12

If you are a coeliac check your cocoa powder, baking powder and and bicarbonate of soda is gluten free. The cake is low fodmap but occasionally people with IBS can have a problem with chocolate despite this fact. It is very difficult to provide an ‘IBS’ friendly recipe that will suit absolutely everyone. If anyone tells you different be suspicious, IBS can result in numerous food intolerances, remember only 70-80% are successful with the low fodmap diet, suggesting that other food might be problematic for some – or food isn’t actually the problem.

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Cod with caper and olive sauce

Flavourings such as capers can be included on the Low Fodmap diet and are especially important when onion and garlic are not available in the range of flavours that can be used to develop dishes. Capers are a delicate taste and one that I certainly did not appreciate when I was younger. I remember very well taking a jar of capers to a party when I was a teenager and not one person who attended the party liked them. But perhaps this was because I had stated to absolutely everyone in my eagerness – taste these, aren’t they really disgusting? Perhaps this preconditioned everyone else that of course capers are MEANT to taste dreadful, perhaps not too surprising that everyone else thought so. However when we are younger we have more taste buds therefore we taste more acutely and this is thought to be as a result of the higher energy needs of children enabling them to prefer and seek out energy dense foods. Bitter and sour notes in food are avoided – we only start to appreciate bitter notes in food when we are in our early twenties. As my taste has developed as I have aged I now really relish capers – they go rather well with fish and are better eaten warm and add a depth of flavour. I noted a very similar effect of olives, and do now love their saltiness and rich flavour. We also can develop aversions to foods and food aversion might be psychologically conditioned – a learned behaviour. If we experience sickness during a time when we are eating we can develop a strong aversion to that food, it is common that people undergoing chemotherapy can develop aversions to food. This can happen if strong negative emotions are developed during eating also, the food a ‘reminder’ of the episode therefore avoided.

Development of taste matures as we age, capers are an acquired taste, but one that will expand the range of dishes available to people following the Low Fodmap diet. Taste is a very complex sense – why not challenge yours and make this recipe?

Ingredients

2 pieces of white fish

1 egg

Gluten free flour for dusting

2 tablespoons of capers

1 Lemon (juice only)

1 tablespoon of oil

1 tablespoon of green olives

Salt and pepper to taste

(serve with steamed kale and new potatoes.)

Method

Mix the egg with a fork and add to a flat plate, add the flour to another flat plate with a small amount of salt and pepper.

Dip the fish fillets into the egg first, then the flour.

Fry in a small amount of oil till the flour is golden and then remove the fish fillets and cook for ten minutes in an oven till cooked through (timings will depend on how thick the fillets are.)

Add capers, olives and the juice of the lemon to the pan and warm through. You should not need to add salt to this sauce as the olives and capers add plenty of saltiness to the dish

Serve the fish and pour over the capers and olives, serve with green vegetables (I used kale) and boiled new potatoes in their skins for added fibre.

Enjoy!

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Rhubarb cordial

Rhubarb is one of my favourite vegetables – yes you heard right – it is a vegetable, a stalk, but with a glorious colour and taste. It marries very well with ginger. Rhubarb has an anecdotal use as a laxative in herbal and Chinese traditional medicine but paradoxically it is also suitable for a low fodmap diet. The leaves contain high levels of oxalic acid and are toxic so not to be consumed but the stalks are very popular around the Calder valley – perhaps because we are not too far from the rhubarb triangle.

What about the chemistry of rhubarb – well Andy Brunning of Compound Interest has produced the following excellent graphic.

The-Chemistry-of-Rhubarb

I can find no RCTs for the use of rhubarb as a laxative or its use to assist in ameliorating any symptoms in IBS so I can only assume that the anecdotes are just that but the information in the graphic is very interesting, non the less. But what about recipes – to make a rhubarb cordial and puree see the recipe below which makes around a pint of cordial.

400g of rhubarb

1 inch stick of ginger

Adequate water to cover the rhubarb in a pan

Sugar or sweeteners (not polyol based) to individual taste.

Wash and slice the rhubarb stalks, peel and chop the ginger and add to a small pan. Cover with water and cook till very soft. Add sugar (I used just enough to remove the tart taste.) Pass through a sieve or blend. then cool and add to a bottle – I used the one in the image it once contained rhubarb liqueur. The pureed rhubarb that remains in the sieve can be used to add to lactose free yoghurt as a breakfast fruit puree. Store the cordial in the fridge – you can either drink it cold or warm. Sweeteners will work just as well in the cordial and for those ‘nutrition evangelists’ that decry sweeteners as toxic- we have NO evidence that they are harmful and if they are used to reduce energy consumption for weight management or for diabetes management, then that surely has to be a benefit?

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Ginger, pumpkin and rice noodles Low Fodmap

This tasty recipe can be served with fish or chicken but it can be used as a lunch meal – hot or cold by itself, if you don’t eat meat. The noodles were ginger and pumpkin rice noodles – gluten and wheat free and suitable for a low fodmap diet, they are made by King Soba.

Ingredients

150g of noodles

1 teaspoon of cumin seeds

1 tablespoon of pumpkin seeds

1 tablespoon of pine nuts

2 carrots

Spray oil or 1/2 teaspoon of garlic infused oil

A few drops of soy sauce.

Method

Cook the noodles till soft in boiling water with a small amount of salt.

Peel then trim the carrot till the sides are straight and peel down the length of the carrot to produce strips, then cut them in half lengthwise. This makes thin strips that can cook quickly in a wok.

Add the oil to a wok and fry the cumin seeds for a few seconds to release the flavour.

Add the pine nuts and pumpkin seeds and a few drops of soy sauce (ensure gluten free if you have both IBS and coeliac disease.)

Then add the carrot and cook till softened.

Add the cooked noodles and mix well, then serve.

Serves 2.

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I use these noodles regularly and the dish was made from stock from my store cupboard.

Minted Boston runner beans

What on earth are Boston beans? I am, as many of you know, a down to earth Lancashire gal and labelling food with a new name to boost sales really doesn’t go down too well with me. Not impressed, however I am wrong, it seems – after a Google search – that Boston is a variety of bean which is a smaller variety and a plant which grows a good crop of French beans. A good crop – therefore these beans should not be expensive then, but they are a smaller bean, therefore exclusive? I also suspect that someone will label them a ‘super’ runner bean and a vegetable that you can’t possible live without. Anyhow, enough of me getting into a tizzy and being slightly cynical about the vagaries of available supermarket runner bean varieties. Some people might be very interested in the differences in crop variety, but it’s not for this blog, plus ordinary beans are just as super and will work just as well for this recipe. It’s mothering Sunday tomorrow and I will be cooking a chicken so this really simple runner bean recipe should go really well with it.

Ingredients

1 sprig of fresh mint

1 packet of runner beans

Juice of 1/2 lemon

1/2 lemon sliced

Salt

Spray oil

1 teaspoon of sesame seeds

Method

Spray the beans with oil and pour over lemon juice. Chop the mint and mix into the beans, then add a small amount of salt, roast for 15 minutes till soft. Spray lemon slices with oil and roast them at the same time as the beans. Garnish the beans with roasted lemon slices and sesame seeds. Serve – simple!

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How does the free from toad get in the hole?

It’s March and it is snowing today! I have been out and I did get soaked to the skin – urgh! It is not nice snow – more the sloppy sort that doesn’t stick around long enough to freeze properly. If you are thinking of cooking a really warming comforting meal you need go no further than the recipe for toad in the hole. But there is a catch if you are lactose and gluten or wheat free. How does the toad get in the free from hole? Make the following recipe and find out!

Ingredients

400 mls of lactose free milk

6 gluten free sausages

200g of gluten free self-raising flour

1 teaspoon of gluten free mustard powder

salt & pepper

3 eggs

1 tablespoon of olive oil

Method

weigh the flour into a bowl and add the mustard powder and mix well

break the three eggs into the bowl and add the lactose free milk

add salt & pepper and mix well

add the oil to a dish and heat in the oven

prick the sausages and add to the pan

pour around the batter and place in the top of an oven at gas mark 7 or 220 degrees C till the surface is nice and brown.

Serves four for a meal – if you have a problem with higher fat foods and your IBS then you might need to be cautious with your portion size. Also don’t forget this is a high fat meal so it is for occasional consumption only – when you really need a lift midwinter after going for a long walk in the snow perhaps!😉

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