IBS? Heard of FODMAPs?

New low FODMAP diet for IBS: 75% see significant improvement

If you were to tell me 15 years ago, when I was a newly qualified dietitian at St George’s Hospital in London, that I would specialise in treating IBS, I would have thought you were crazy. Back then we just didn’t have good answers for people suffering with Irritable Bowel Syndrome.

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. The diagnosis of IBS is usually made when other conditions such as coeliac disease, Crohn’s Disease, colitis, have been ruled out. Symptoms include bloating, wind, diarrhoea, constipation, acid reflux, nausea and abdominal pain.

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 and other digestive conditions. In February 2015 it was added to the National Institute of Clinical Excellence’s IBS treatment guidelines.
Elimination phase: high FODMAP foods eliminated for 2-4 weeks
Reintroduction phase: high FODMAP foods systematically reintroduced to identify your problem foods (not everyone reacts to the same FODMAPs)
It is important to have the advice of an experienced dietitian to help guide you along your low FODMAP journey

Here some great information all about the low FODMAP Diet: FODMAPs

And here is what some of my patients say:

Miss VG, IBS, marathon training (April 2016) The low FODMAPs is going very well, it has helped a lot with my symptoms. I was quite surprised how well it has worked!

Mr RD, IBS (March, 2016): Hi Sarah. Hope you’re well; I came to see you a year ago to help with IBS issues which have improved dramatically. I very rarely suffer any of the symptoms I used to – brain fog, stomach cramps etc and find I’ve been able to reintroduce a lot of foods that did give me problems previously, so thanks again!

Miss J, IBS (February, 2016): This week is my 4th week on the FODMAP diet and so far so good. I’m actually really enjoying it and have discovered some lovely new recipes. It’s made a very noticeable difference in terms of bloating, cramping and wind which is fantastic. My skin has also improved too.

Super Healthy Flapjacks – no butter or sugar

March 30, 2016September 5, 201771 Comments

It can be frustratingly difficult to find a healthy flapjack recipe that isn’t loaded with butter, sugar or syrup. If you would rather not load up on these ingredients, here is an alternative recipe to try.

Here’s why they are so great:

Super quick to prepare the mixture
No sugar, syrup or butter.
Ripe bananas and raisins add the sweetness.
If you feel the need for some extra sweetness, you can some honey, but you really don’t need too much.
Oats provide soluble fibre to keep you feeling full up, reduce cholesterol, keep your digestive system healthy and blood sugar levels steady.
Berries/Raisins are choca-block full of antioxidants and fabulous phytochemicals
Seeds/peanut butter are full of protein and healthy fats.

Top tip 1 For a seriously healthy and delicious Bircher Muesli breakfast, keep a few tablespoons of the pre cooked mixture in a bowl overnight in the fridge. In the morning, loosen with more milk.

Top tip 2 Did you know that the chunkier the oat the slower it is digested and will keep you full up for longer?

Basic Flapjack Ingredients (makes about 9): each provides 90 calories, 1.5g fat, 15g carbohydrate, 3g protein

150ml milk – or a milk alternative e.g. soya, almond, rice milk etc.

2 mashed bananas – the riper the better as sweeter and easier to mash

150g porridge oats (about 2 handfuls)

Ideas for optional extras:

a handful of whole/chopped/ground up sunflower or pumpkin seeds
1 heaped teaspoon of cinnamon
a tablespoon of cocoa powder
a handful raisins or cranberries
a few tablespoons of dessicated coconut
1 cup frozen berries (defrosted)
1 tablespoon honey
1 tablespoon peanut butter
2 tablespoons ground flaxseed with a little extra milk (very good for constipation!)
For extra protein e.g. as post exercise snack, you can add a scoop of protein powder

Mix all the ingredients together. Put in to cake tin lined with greaseproof paper, or silicone bun cases. You can also make them in to cookies by placing the mixture in cookie shaped blobs on the greaseproof paper.

It can sometimes be a bit tricky to peel the greaseproof paper off, so you can grease the paper first with some oil.

Bake for about 40 minutes at 170 degrees C. Or until they are browning and you can smell the lovely aroma……..this is my method to check for readiness as I usually forget to look at the time I put them in! Enjoy playing around with variations of ingredients 🙂

If you like these, you’ll also LOVE Seriously Healthy Pancakes (2 ingredients), and Low Sugar Biscuits

IBS: Are you the 1 in 5?

How to choose a healthy yogurt

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Sainsbury’s sell about 400 different yogurts, with two aisles at my local one devoted to a technicolor of the tubs, pots and bottles.

So what’s the difference between them all. How do you choose a good one? What is the difference between plain and natural, Bio and live cultured, Greek and Greek Style, are low fat yogurts always loaded with sweeteners and thickeners, why does natural yogurt have sugar on the nutrition label? I’m an avid nutrition label reader (it’s part of my job), and I have to admit to being left confused and overwhelmed.

Yogurt is big business. In 2014, 80% of us bought it – that’s almost 42 million British stocking up on the (mostly) good stuff. 57% of British adults have yogurt as a dessert. Natural yogurts are the only variety that men are more likely to buy than women.

What makes yogurt ‘yogurt’??

Yogurt is made by fermenting milk with two very specific types of harmless bacteria Lactobacillus bulgaricus and Streptococcus thermopiles (these are the only 2 cultures required by law to be present in yogurt).

The bacteria that are added to milk convert the naturally occurring sugar in milk (lactose) into lactic acid, which causes the milk to thicken, giving yogurt its characterised consistency and tangy taste. People who have difficulty digesting lactose in milk are generally able to tolerate yogurt better: this is because some of the lactose in yogurt has been broken down by the harmless bacteria used to make the yogurt.

Extra bacterial cultures, such as Lactobacillus acidophilus, Lactobacillus casei, and Bifido-bacteria may be added to yogurt as probiotic cultures. These probiotic cultures benefit human health by improving lactose digestion, gastrointestinal function, and stimulating the immune system.

In the UK, yogurt is most commonly made from cows’ milk and can be made using full-fat or lower-fat milk. New variations are also available: soy, coconut, sheep’s, goat.

Plain/natural: yogurt at its simplest, with no additional ingredients. Just milk and the bacteria
Flavoured: with added sugar, honey, fruit juice, natural flavours, sweeteners, syrups, whole or puréed fruit and/or cereals.
Low-fat: contains no more than 3 grams of fat per 100 grams.
Fat-free: contains no more than 0.5 grams of fat per 100 grams.
Light: contains 30% less of a specific nutrient (for example, sugar or fat) compared to a range of similar products.
Greek yogurt (not Greek Style yogurt): genuine Greek yogurt is made by straining regular yogurt, removing the liquid whey and resulting in 2 to 3 times higher protein content. Greek yogurt is available in full fat, reduced fat and 0% fat. Even the 0% fat Greek yogurt is much thicker than regular yogurt. Total by Fage is a popular one.
Live yogurts: The majority of yogurts sold in the UK are ‘live’ yogurts – this means that they contain live bacteria, even if not stated on the label. Some yogurts have extra beneficial bacteria added e.g. Lactobacillus acidophilus, Lactobacillus casei, and Bifido-bacteria. To identify if there are these extra biocultures added, you need to look on the ingredients label (due to EU legislation a manufacturer can not claim on the front of the pot that it contains ‘probiotics’)

Calcium: Yogurt made from milk is one of the best absorbed dietary sources of calcium. Calcium is needed for the development and maintenance of healthy bones and teeth and is also important for blood clotting, wound healing and maintaining normal blood pressure. Most yogurts also contain varying amount of vitamins B6 and B12, riboflavin, potassium and magnesium.

This unsweetened natural yogurt has 6.5g of natural milk sugar (lactose)

Sugar: This is where it can get confusing. Many people ask me about yogurts and sugar, or make the comment that all yogurts are high in sugar. Because yogurt is made from milk, it will contain some naturally occurring sugars (lactose), from 3g/100g to 7g/100g; the amount of lactose depends on how much of it the bacteria has turned in to lactic acid. So although a plain/natural yogurt does not have added sugar, on the nutrition label you will read that there is sugar……confusing!

However, many manufacturers load their yogurts with sugar and very sweet fruit purees or juice. Unfortunately, the label does not differentiate between the naturally occurring lactose and this added sugar.

This yogurt has a 15.2g sugars. About 7g of this is naturally occurring milk sugar (lactose = good), the remainder is added sugar (not good)

This yogurt has a 15.2g sugars. About 7g of this is naturally occurring milk sugar (lactose = good), the remainder is about 2 teaspoons of added sugar (not good)

How to choose a healthy yogurt

Ideally, choose a plain/natural yogurt and if you want flavour or sweetness, add your own e.g. fruit, puree, vanilla extract, jam, sugar or honey. That way, you have more control over the amount of added sugars. One teaspoon of honey, jam or sugar is approximately 5g of sugar.

If choosing a flavoured yogurt, look for one that has below 12g/100g of sugar. This generally indicates that there has been less than a teaspoon of sugar added.

Below is a comparison of just a few of the most popular yogurts in UK supermarkets. I’m a fan of the Total Greek yogurts, due to the high protein, low sugar and extra bacteria probiotic bacteria Unknown-6 added (high protein yogurts have been shown to make you feel full up for longer and reduce appetite). I must give St Helen’s Goat yogurt a try, nutritionally I would award it second Unknown-9 place, but I’ve never tasted it! Onken Naturally Set also has a great nutritional profile, although lower in protein than Total.

All amounts are per 100g (about half a cup)

	Calories	Sugars	Protein	Fat	Extra Probiotic bacteria added
Sainsbury’s Greek Style	120	5	4	9
Yeo Valley Full Fat Plain	82	7	5	4	Lactobacillus acidophilus and Bifidobacterium
Onken Naturally Set	68	3	4	4	Lactobacillus acidophilus, Bifidobacterium
Yeo Valley Greek Style	150	14	3	8	Lactobacillus acidophilus Bifidobacterium
Total Full Fat	96	4	9	5	Lactobacillus Acidophilus, Bifidus and L. Casei
Total 0%	57	4	10	0	Lactobacillus Acidophilus, Bifidus and L. Casei
Danio flavoured	100	12	7	2
Activia Strawberry	99	13	4	3	Bifidobacterium Lactis (Bifidus ActiRegularis®)
Yeo Valley Fruity Favourites	107	13	5	4	Bifidobacterium, Lactobacillus Acidophilus
Alpro Soy Cherry	73	9	4	2
Muller Crunch Corner Choc & Vanilla balls	148	18	4	5
Co Yo (coconut yogurt)	183	1	3	19
Woodland Sheep Natural	92	5	5	6	Lactobacillus acidophilus
St Helens Goats Natural	105	3	6	7	Lactobacillus acidophilus Bifidobacterium

Children’s yogurts are a WHOLE new ball game which deserve a post all of their own……watch this space!

8 Cures for Constipation

9 of the Healthiest Supermarket Ready Meals

January 8, 2016April 13, 2016Leave a comment

Microwavable Ready Made Meals: the antithesis of healthy eating. In an ideal world we’d spend the morning tending our vegetable patch/chickens in the back yard, then the afternoon pootling about in the kitchen performing alchemy with our produce.

Historically, ready meals have been relegated by chefs and dietitians to the bottom of the culinary and nutrition pile. Little boxes of mush, hidden from view in cardboard boxes, often providing your full daily requirement for unhealthy fats, salt, and sugar.

I took a detour down the ready made food aisle at my local Sainsbury’s the other day (that loon taking photos of the food was me). Things have changed. We appear to have had a quiet food revolution.

Aware of the growing market for health foods, supermarkets have used dieticians, nutritionists and chefs to develop a new generation of microwavable ready meals. Can you now ping yourself to health (on full power) in 3 minutes? Is a healthy microwavable meal a contradiction in terms? I’m prepared to eat my words and cautiously say, yes, maybe……

What to look for in a healthy ready meal:

you want to see what you are going to eat, so a clear container
an ingredients list that only has the names of actual food, like carrots, beans, chicken and rice. Not modified maize starch, stabilisers, di-, tri- and polyphosphates, citric acid, firming agents and maltodextrin
aim for 300-400kcal
how much veg can you see? Look for meals with about 1/3-1/2 colourful veggies
a good protein portion: 20-30g: the label on the back will tell you this, make sure you look per portion
Not too much carbohydrate – about 1/4 of the meal. Extra points for wholegrain rice, baby potatoes, quinoa, beans, lentils
Below about 1g salt per portion: Colour-coded nutritional information on the front tells you at a glance if the food has high, medium or low (red means high, amber means medium, green means low)

Here are some of the best of the supermarkets’ own ranges:

Sainsbury’s My Goodness range: (£3.25, currently on offer £2.50) typically 300-400kcal per pack, plenty of lean protein, a lovely mix of colourful veg, with a controlled portion of carbs. Look for the ones with a green circle stating ‘high protein’.

M&S Balanced For You range: high protein, moderate carbohydrate meals. All meals provide slow release carbohydrate from various sources such as beans, pulses and vegetables.

Miso Chicken Noodles; Aromatic CHicken Skewers; Spiced Cauliflower Rice and Chargrilled Tikka Chicken

Tesco Healthy Living: £2.00 Some of the Healthy Living range meals can be high in salt, lacking veg or a bit low on protein. Here are two of the better ones: Chicken Noodle Laksa, South Individual Indian Curry With Pilaf.

Waitrose Love Life range: (£3.30, currently 3 for 2) fresh ingredients, 300-400kcal, high in protein (typically 27g per pack), lots of veg.

Chicken Madeira; Green Thai Chicken Curry

8 reasons you’re exercising more and not losing weight

January 7, 2016January 25, 20214 Comments

So you’ve started eating better, walking more, going to the gym, or you’re training for a 5km race. Brilliant! You expected the weight to drop off, so why aren’t you seeing RESULTS?

Here are 8 top reasons:

You are ‘good’ all day with your eating and are distracted enough to avoid eating too much. But by the evening you are hungry and attack the bread, cheese, breakfast cereal, biscuits, ice-cream etc. This is the most common mistake I see my clients making. You need to eat more during the day to stop the evening over eating.
Exercising can result in an increase in your appetite, so you eat more. If you are genuinely more hungry, ensure you are eating protein at each meal (eggs, fish, chicken, cottage cheese are great choices), lots of fruit/veg, a high protein yoghurt, milky coffee or tea, water. Consider bringing a meal forward by an hour if you are ravenous.
You eat more before and/or after your session to fuel the exercise. One of the most common mistakes I see is someone having a milkshake drink after 40 minutes in the gym to aid recovery, often followed with in a few hours of a normal meal. A typical bottle of milkshake will provide 300-400kcal, essentially replacing the calories you’ve just burned off. If you are exercising to lose weight, then you need a calorie deficit ie. burning more than you eat/drink.
Post exercise shakes have their place, but watch the extra calories!

Although extra food/drinks may be necessary for long and strenuous workouts, for shorter workouts less than an hour, the need isn’t as significant. Normal meal and snacks around exercise should be enough eg. snack of an apple or banana 1-2 hours before a workout, yoghurt after.
You are trying to be too healthy – yes really! You’re think you’re doing all the right things – snacking on nuts or rice cakes with peanut butter; lots of avocado in salads; extra pumpkin seeds and flaxseed in your porridge. Thing is, even healthy fats are high in calories: a tablespoon of most nutty things have about 120 kcal. Half an avocado has about 150 kcal. They all add up.
You think you can eat what you want because you exercise – if only! A 3 mile run will burn approximately 300 kcal. Not an excuse to have 6 biscuits or a whole pizza. Rewarding yourself with high fat/calorie ‘treat’ food can cancel out the good work done. Even professional athletes who have multiple training sessions each day have to be careful with their diets.
You need to change your workout – you run for 40 minutes three times a week, or sit on a exercise bike and do some crunches. Your body adapts to what you do day in day out. You need to challenge your body. If you want to change, you need to change what you are doing!
You sit down for the rest of the day – You have an intensive workout for an hour, so you don’t feel so bad about taking the car for journeys that you could walk. You need to stay as active as you can, humans are born to move. If you feel too exhausted to do anything but sit down for the rest of the day, you are probably over doing the exercise.
Finally, if you feel that you really are exercising more and not over eating, you should visit your GP as you may have an underlying health condition e.g. Polycyctic Ovary Syndrome or under active thyroid. Signs of PCOS include irregular periods, acne, hairiness, anxiety/depression. Under active thyroid symptoms include feeling cold, tired, dry skin, constipation and depression. If you suspect