Bloated? Tummy pain? – how low FODMAP can help you

Since starting my practice as a private dietitian, the most rewarding thing I have done is advising people with a new dietary treatment for IBS. For many of my patients seriously affected by IBS, it has been life changing. Have you heard of the low FODMAP diet?

What is IBS?

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Irritable Bowel Syndrome is a disorder where the bowel looks normal, but it doesn’t function properly. It is incredibly common, affecting about 1 in 5 people in the UK. Symptoms include bloating, abdominal pain, constipation and diarrhoea. The diagnosis of IBS is usually made when other conditions such as coeliac disease, Crohn’s Disease, colitis, have been ruled out.

Causes of IBS:

The causes of IBS are not fully understood, however, it is believed to be due to a number of complex factors:

  • genetic – tummy problems run in the family
  • gastroenteritis – alters the gut bacteria
  • antibiotics – alter the gut bacteria
  • stress
  • a highly sensitive gut that is more sensitive to gas forming foods
  • food intolerances e.g. lactose intolerance

Until recently, dietary advice given by health professionals for IBS has been, at best, vague and unsatisfactory. For many people the NICE guidelines, used in the NHS by GPs for treatment of IBS, aren’t very successful. Current advice from your GP may include: reduce stress, adjust fibre intake, regular meals, restrict caffeine, fruit juice, fruit and sorbitol, exercise and probiotics. Medications such as laxatives, anti-diarrheals, anti-spasmodics and anti-depressants are often prescribed. Unfortunately, IBS patients can be left frustrated because these medications in conjunction with the dietary and lifestyle changes are unsatisfactory solutions.

New low FODMAP diet: 75% success

The low FODMAP diet has been published in international medical journals and is now accepted and recommended as one of the most effective dietary therapies for IBS. The low FODMAP diet significantly reduces symptoms in 75% of people. FODMAPs are indigestible sugars which ferment in the gut causing bloating, diarrhoea, constipation and gut pain. By reducing the amount of FODMAP foods in your diet, IBS symptoms can be dramatically reduced or resolved.shutterstock_52604065

Some common high FODMAP foods include wheat (so in bread, pasta, biscuits etc), apples, pears, garlic, onions, lentils, beans, some vegetables, milk, and some artificial sweeteners. The low FODMAP diet involves many dietary changes that are best described to you in consultation with a dietitian. Additionally, not everyone reacts to the same FODMAPs, which is why it is important to have the advice of an experienced dietitian to help you negotiate the various phases of the diet.

Where do I start?

The low FODMAP diet is carried out in two stages. The aim is to identify the FODMAP foods causing problems that are specific to YOU. Every person reacts differently to each food category, and can tolerate certain amounts.

Phase 1 –  all high FODMAP foods are eliminated for 2-4 weeks. Symptom relief can be experienced with in days.

Phase 2 – a sequential reintroduction of FODMAP food categories over a few weeks. This allows you to identify the foods causing you problems.

A dietitian with experience in the low FODMAP diet can guide you through the phases of the diet, providing practical advice, menu ideas that suit your lifestyle and food preferences, advice on reading food labels etc. Appointment information

KIDS – Health by Stealth!

Unknown-9In an ideal world, our children would sit politely at the table and eat what was put in front of them. Some children do, but there are many that don’t! 99% of the time, fussy eating is just stage, never the less, parents get immensely stressed out about it. Here are some ways to Health by Stealth!

Strawberry milk

Strawberry milk

Strawberry Milk Whizz up some milk (calcium and protein), natural yogurt (calcium, protein and probiotics), frozen berries (vitamins and antioxidants) and honey (sweetness).

Hide the veg

By making your own Tomato Sauce, it is possible to hide mountains of veg and even lentils in it. By blending it before serving, it’s nice and smooth. Grate onions, carrots, add tomato puree to bolster the veg count. You can even slip some lentils in without anyone noticing!

Meatballs with multi veg tomato sauce

Meatballs with multi veg tomato sauce

Another tip came from a mum of a very selective eating child with autism: add grated apple to mince to make burgers. I tried this and it’s fab!

Tell them it’s just for the big children/grown ups/they probably wouldn’t like it This works  brilliantly when preparing vegetables e.g chopping pepper/carrots/grated cheese. Say “no touching!” in a playful way. This can turn it in to a game where they try to ‘steal’ the food from the chopping board.

Distract with a book It’s not ideal, and in a perfect world our children would sit politely at a table. If you are desperate to shovel some good food in, distraction can work well. Look at a book together, while you spoon feed (I resort to doing this on occasions with my 2 year old). 

It’s all in the name for children (and adults!) what you call a dish can affect how they think about it. “Barbeque chickeny rice” will be eaten, but if I called it my it’s real name “Chicken Jambalaya” it would be met with great suspicion and clamped shut mouths.

  • Sausage Surprise – I cook the sausages, chop them up and put them in to pasta with
    Banana 'Cake' (definitely not Banana Bread!)

    Banana ‘Cake’ (definitely not Banana Bread!)

    tomato sauce (with hidden veg, see above). They have a treasure hunt to find the sausages.

  • Banana Cake – ever so much more appealing to have ‘cake’ than Banana ‘bread’
  • Chocolate Cocoa Bars are made with ground up nuts, raisins, dates and cocoa powder. They are deliciously chocolatey!

Probiotics many children can suffer from ‘tummy trouble’ after taking antibiotics or after a tummy bug. Probiotics can help replace the good bacteria in the gut which are essential for the immunity and digestion. Many probiotics that are in capsule can be broken apart and added to food (not hot food, it destroys the good bacteria!)

Fish oil essential for health and brain function, many children dislike the taste of oily fish so it is advisable to take a supplement. Liquid omega 3s can be added to yogurt or even Ready Brek or porridge.

Omega 3 supplement

Omega 3 supplement

A final essentil tip for fussy eaters is for parents. Back off, chill out, and, even if it takes an Oscar winning performance, pretend you are not too bothered.

When to be concerned:
If your child has weight loss, is lethargic, irritable or weak, see your GP to rule out underlying problem e.g anaemia or coeliac disease

If issues continue consider seeing a dietitian with experience in children with eating and digestive issues.

Banana Bread

“What have you got for me to eat, Mum?” or “I’m starrrrrrrrving!”

That is how I am greeted by Evie, 4, when she comes out of school. The wee girl is always ravenous (no matter how much I provide in the packed lunch). I sometimes struggle to come up with healthy things for after school. It needs to be something filling, but not too filling because then Evie and her little brother, Conor, will struggle to eat their dinner at 5pm. Beth, 7, has a fabulous appetite, and a penchant for pleasing her mum, so will eat most of her dinner without any nonsense. The other two are a different matter! Here’s an article in a local magazine called Families Upon Thames on strategies to get your kids to eat their meals Table wars!

I digress. Snacks for after school: fruit (not popular), homemade flapjacksoaty biscuitscocoa Unknown-1bars. Anything that comes out of a packet is met with glee and great excitement. Yoyo Fruit Bars are popular, or anything remotely sweetie or chocolate.

Today I am trying a something new, here’s the recipe. Make with gluten free self raising mix for a  FODMAP friendly version!

Banana Bread

2oz butter/margarine

5oz caster sugar

2 eggs lightly beaten

Unknown-27oz self raising flour (or I use gluten free Dove’s Farm self raising flour blend)

2 ripe bananas mashed

Optional extras: 1 teaspoon cinnamon, handful of raisins.

Mix the butter and sugar together until light and fluffy. Slowly mix in the beaten eggs. Add the sifted flour, gently mix in. Add the mashed bananas and mix. Pour into a greased loaf tin. Bake at 170c for about 40 minutes, you can check to see if it ready with a knife – it should come out clean if you stick it in to the middle.

Photo on 17-03-2014 at 12.36

Granola

Not one to deviate from routine, you can imagine my disbelief when my husband suggested a change from porridge might be good. To a granola perhaps! Wouzers!!!!!!!!

I love food, and I love shopping for it and preparing it and making it. So my excitement at the prospect of changing from porridge (which I do love) filled me with disproportionate glee!

I did some research online, and came up with my own basic recipe. Prerequisites for anything I make include that is is quick, easy and I can get all the ingredients at my local supermarket.

The first batch was quite delicious if I do say so myself. Him Indoors had it with natural yoghurt, ignoring my expert opinion that milk was the way to go. But Dec being Dec, chose to Photo on 17-03-2014 at 12.34ignore my expertise on all things food (actually, I am an expert on ALL THINGS). His verdict was that it was a bit “mehhhh”. Of course it was a bit “mehhhh” if you have it with yoghurt and no milk. That is just plain wrong, and I suspect something he learnt from some trendy suburban London breakfast joint. So with gentle persuasion, my granola with milk went down a treat. It’s now the new favourite, with it being had at breakfast AND as an evening snack. I’m delighted it is the hit that it deserves. We are getting through vast quantities so it’s good that it is so easy to make. ……5 minutes to mix it all together, and 30 minutes in the oven.

Dietitian bit – why it’s good for you:

  • high fibre carbohydrate from oats – chunky oats are filling and full of soluble fibre, energy
  • protein – from the milk, seeds and and a little bit from the oats, muscle maintenance & building
  • fruit – raisins, chocca block with antioxidants and fibre
  • healthy fats – vegetable oil and seeds, help to keep you full up, good fats are essential in moderation

And here’s something I’ll tell you for free. This is from my MSc research on antioxidants in oats: toasting oats produces something called the Maillard Reaction which increases the antioxidant capacity (antioxidants are good for you). I spent many long hours in a lab at University of Ulster to come up with that.

Recipe:

300g oats – I mix chunky with finer oats

2 tablespoons vegetable oil

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Just out of the oven

4 tablespoons honey

1-2 handfuls pumpkin/sunflower seeds

handful raisins or sultanas

sprinkle of cinnamon (about a teaspoon)

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chunky oats

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finer oats

Method: mix the oil and honey together in a bowl. Add the oats, cinnamon and seeds, stir throughly ensuring the oats are coated. Spread on to baking sheet and put in the oven at 150c for 30 minutes. Half way through cooking time, add the raisins/sultanas. Remove from oven and allow to cool.

4 x Avocado-tastic!

I had the pleasure and luxury of pootling through Kingston Market this morning by myself. I don’t usually take the time to slow down and browse, so was delighted to come across 4 avocados, lovely and ripe, for £1.

Although very high in calories, avocados are little nutrition bombs with a multitude of health benefits:

  • monounsaturated fats which have heart health credentials (lower the bad blood cholesterol, raise the good)
  • Fats enhance absorption of fat soluble vitamins A, D, E & K
  • Fats and fibre good for appetite control
  • High in vitamin E, A and B vits
  • Twice the potassium of a banana
  • Anti inflammatory compounds – may be protective against cancer
  • Very low in sugar
  • people who regularly eat avocado are more likely to have a lower body weight, BMI and waist circumference

So what the heck will I do with 4 ripe avocados?

  1. Green Smoothie Breakfast – blend 200ml water, 1/2 avocado, a kiwi, a handful of greens e.g. spinach or watercress, juice of half a lime, some ginger, and a tablespoon of Total greek yogurt (high in protein).
  2. Simply sliced and piled on wholemeal toast with some salt and pepper
  3. In Superfood Salad
  4. Mashed as a substitute for mayonnaise
  5. Freeze the rest! Best results if they are pureed with some lemon or lime juice and stored in an air tight container.

Apparently, avocados are also good for the wrinkles…….definitely something I need then (I think I have aged about 10 years in the last two). In fact, scrap the recipes I’ll be slapping this stuff straight on to my face!

Oats:10 ways to add oomph!

Oats are a staple in this house with 4 out of five of us having them for breakfast, and daily batches of Seriously Healthy Flapjacks and Oaty Biscuits.

What’s so good about oats?

Oats are very filling, high in soluble fibre, provide slow release energy, keep the blood sugar levels steady for concentration at school/work, calcium and protein from the milk, and fibre and antioxidants from the raisins/berries/banana. And for those of us getting on a bit, oats contain ‘beta glucan’ which is clinically proven to be one of the great cholesterol lowering foods. If you want a low Glycaemic Index oat, go for the chunky ones, as the finely ground ‘instant’ oats e.g. Oats So Simple are actually digested quite quickly, giving you less of the longer term sustained energy release.

Jazzing it up!

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Please sir can I’ve some more? Yak, no thanks!!

Porridge can be a bit, well, dull and have a bit of a ‘gruel’ image. My clients sometimes pull a yuck face if I suggest oats for breakfast. But keep an open mind and try something new! There are a million and one ways to jazz up your breakfast oats to make them tasty and delicious…..

It’s an alchemy of three parts:

  1. the oats: There is a wide variety of oat chunkiness. Finely ground e.g. Ready Brek for ultra IDShot_90x90-1smooth, to jumbo and chewy like Flahavins. Slow cook them in a saucepan on the stove, zapp in the microwave in 90 seconds, or just add a smidge of hot water to the chunkies (how I like it).
  2. Water or milk? The debate is on among porridge devotees on the perfect ratio of milk to water. Each to their own………I’m a water only fan, my husband is 50:50 milk to water, youngest daughter Evie likes the oats cooked in water only, with cold milk added (?!) You don’t have to stick to cow’s milk, try almond, rice, oat, soy, or Koko for a change. All of these have added calcium and vitamin D, so you’re not missing out on these essential vitamins!
  3. The Fun Part: jazz your bowl up with a menagerie of ingredients which can be combined to provide endless possibilities! Peanut or cashew nut butter, raisins, coconut, cinnamon, banana puree, honey, maple syrup, grated apple, toasted pumpkin or sunflower seeds, cashew nuts, berries, yogurt. The list is endless……….

10 ways to add OOOMPH to oats:

  1. Power Smoothie – blend a handful of oats, 200ml milk, dollop of yogurt*, frozen berries and honey

    Smoothie

    Smoothie

  2. Puree banana – roughly mash a ripe banana, put in a cup with enough water to almost cover the banana, microwave for 90 seconds, and voila, a lovely smooth puree to add to you porridge. The more ripe the banana the smoother and sweeter!
  3. Berries – fresh berries can be expensive, so I use supermarket frozen basics range (£1.20for a bag that lasts about a week). Quickly defrost a cup full in the microwave and add to chunky oats with a big dollop of Total yogurt.
  4. Summer Oats - this is soooo good and a refreshing alternative to hot oats. Prepare the night before so that all the lovely flavours develop and are soaked up by the oats. Good for taking to work if you’ve no time first thing in the morning to eat breakfast.
  5. add a dollop of high protein yogurt* to bump up the protein, keeping you full up for longer, and to make it really creamy!
  6. Homemade Flapjacks - eat them as the are, or one of my clients takes two to work, Photo on 01-02-2014 at 07.15 #4crumbles them in a cup with hot milk for a warming breakfast at her desk.
  7. smooth (Ready Brek) – for the non-chunky lovers out there, Ready Brek can be good as it is made from oats, and has the added benefit of vitamins and mineral e.g. lots of iron
  8. Vary the milk – there is such a wide variety these days…..almond, rice, Koko. All have added calcium and vitamin D, so you’re not losing out!
  9. Honey/maple syrup/agave nectar – there’s nothing wrong with adding a bit of sweetness, especially if it means kids gobbling up a bowl of oats.
  10. Dollop of peanut butter – adding good fats and protein, add a tablespoon before cooking so that it melts and you can stir it through.

Husband Dec’s current favourite is a massive bowl of chunky oats with raisins and banana

Homemade muesli

Summer Oats

puree (he needs as many calories as he can fit in with daily intense rugby training). This week, I’m loving Summer Oats……..wishful thinking that this awful rain is going to stop soon!

Benefits of greek yogurt! - e.g. Total, Danone, Liberte (not greek ‘style’)

Super Boost Salad

I love this recipe because it is a simple list of ingredients that you can get in your local supermarket. It is ready in minutes………. just chop everything up and toss in to a bowl. I tend to roast the pumpkin and sunflower seeds as I much prefer the flavour and texture to raw (just grill for a few minutes until they start to turn brown). The zingy ginger dressing is delicious. I cheat make a sensible short cut by using ginger in a tube.

The intense colour of the red cabbage gives away it’s superb antioxidants, the humble carrot contains a fascinating combination of phytonutrients, carotenoids, anthocyanins and are a very good source of biotin, vitamin K, potassium, vitamin B6, and vitamin C. Apples are full of polyphenols, fibre and vitamin C. Seeds, a fabulous combo of healthy fats, fibre and protein. Ginger has anti inflammatory properties. The amazing medley of nutrients in this recipe truly make it a super food.

If you feel sleepy and lethargic after your usual lunch of a bagel, sandwich or jacket potato, try a big bowl of this instead! Add some protein from fish or chicken, and this can help you to feel full up, bright and alert for the rest of the afternoon. If you are very active or are an athlete in training, add some wholegrain rice or quinoa to boost the healthy carbs.

Make a big batch, and you’ll have enough for the next day too!

  • 350g red cabbage grated/shredded
  • 3 carrots grated
  • 20g pack parsley, roughly chopped
  • 2 Cox’s apples (or any red apple), quartered, cored and sliced
  • handful of radishes or 2 celery sticks, sliced
  • 1 tbsp pumpkin seeds
  • 2 tbsp each sunflower seeds

For the dressing

  • 2 tsp grated root ginger
  • 1 tsp clear honey
  • 2 tbsp lemon juice
  • 4 tbsp light olive oil