Issue 129 diets for IBS beyond low FODMAP

CONDITIONS & DISORDERS

DIETS FOR IBS: BEYOND LOW FODMAP Alex Gazzola Freelance writer, Editor and Author Alex is a UKbased freelance writer specialising in food allergy and intolerance, coeliac disease, gut health, freefrom food, IBS and digestive disorders. He also writes on skin/cosmetic allergies. www. alexgazzola.co.uk

IBS: Dietary advice to calm your gut by Alex Gazzola and Julie Thompson RD, is out this month.

The book highlights that, with a good understanding of IBS and careful management, much can be done to bring the condition under control. In his article for NHD, Alex offers advice on low FODMAPs. Like anyone else, IBS patients to some degree must navigate a swirling world of nutritional advice coming at them from assorted, often suspect sources, and characterised by dubious terminology: ‘superfood’, ‘clean eating’, ‘detox’, and the rest.

No matter how much dietitians emphasise the importance of following the evidence base, many people remain vulnerable to the alluring promise of glowing health and wellbeing - and often a so-called ‘clean’ bowel - typically associated with faddish and purifying regimens.

Specialist gastro dietitian Julie Thompson and I wrote our new book, IBS: Dietary advice to calm your gut (Sheldon Press, £9.99), as a realistic, achievable and supportive guide to eating well and reducing symptoms.

Neither of us wanted to come across as the diet police, but we felt it essential to warn readers that so-called clean eating and detox diets aren’t friends to anyone, let alone those with IBS. Although the backlash against them is now in full flow, spearheaded by ‘Angry Chef’ Anthony Warner and a social media-savvy squad of dietitians and anti-faddists, we’re likely to be dealing with the after-effects of the phenomenon for some years.

Some of the typical foods given evangelical prominence in these regimens - avocados and coconut water, for instance - are high-FODMAP and may well trigger symptoms; as is date

syrup, touted as a ‘sugar free’ alternative, when it is anything but. Purportedly ‘cleansing’ aloe vera, discouraged in NICE guidelines for IBS, can trigger the abdominal cramps and diarrhoea from which patients are often looking to escape. And any plan which stipulates the unnecessary adherence to only raw or home-prepared food may result in the omission of ‘processed’ foods that are nutritious, tasty and gut-kind too.

This is particularly true for those already following other dietary restrictions - be they due to palatability, for moral, ethical or religious reasons, or because of food hypersensitivities such as coeliac disease or food allergy - which aren’t widely addressed in the context of FODMAP-restricted plans.

Finding FODMAP friendly products isn’t always easy, but there are promising signs to suggest this situation may improve. New certification programs - namely the FODMAP Friendly program, and Monash University’s Low FODMAP Certified™ program - offer distinctive logos which, if they become popular, will assist the identification of suitable foods.

The launches of a few dedicated low FODMAP brands and start-ups are also www.NHDmag.com November 2017 - Issue 129

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CONDITIONS & DISORDERS

14 Allergens The way allergens are labelled on prepacked foods has changed. The Food Information Regulation, which came into force in December 2014, introduced a requirement that food businesses must provide information about the allergenic ingredients used in any food they sell or provide.

There are 14 major allergens which need to be mentioned (either on a label or through provided information such as menus) when they are used as ingredients in a food. Here are the allergens, and some examples of where they can be found:

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Celery This includes celery stalks, leaves, seeds and the root called celeriac. You can find celery in celery salt, salads, some meat products, soups and stock cubes.

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Cereals containing gluten Wheat (such as spelt and Khorasan wheat/Kamut), rye, barley and oats is often found in foods containing flour, such as some types of baking powder, batter, breadcrumbs, bread, cakes, couscous, meat products, pasta, pastry, sauces, soups and fried foods which are dusted with flour.

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EU labelling regulations names 14 food allergens, which account for 90%+ of food allergies in Europe . . . .

Crustaceans Crabs, lobster, prawns and scampi are crustaceans. Shrimp paste, often used in Thai and south-east Asian curries or salads, is an ingredient to look out for.

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Eggs Eggs are often found in cakes, some meat products, mayonnaise, mousses, pasta, quiche, sauces and pastries or foods brushed or glazed with egg.

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Fish You will find this in some fish sauces, pizzas, relishes, salad dressings, stock cubes and Worcestershire sauce.

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Lupin Yes, lupin is a flower, but it’s also found in flour! Lupin flour and seeds can be used in some types of bread, pastries and even in pasta.

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Milk Milk is a common ingredient in butter, cheese, cream, milk powders and yoghurt. It can also be found in foods brushed or glazed with milk, and in powdered soups and sauces.

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Molluscs These include mussels, land snails, squid and whelks, but can also be commonly found in oyster sauce or as an ingredient in fish stews

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MUSTARD

Mustard Liquid mustard, mustard powder and mustard seeds fall into this category.

This ingredient can also be found in breads, curries, marinades, meat products, salad dressings, sauces and soups.

Nuts Not to be mistaken with peanuts (which are actually a legume and grow underground), this ingredient refers to nuts which grow on trees, like cashew nuts, almonds and hazelnuts.

You can find nuts in breads, biscuits, crackers, desserts, nut powders (often used in Asian curries), stir-fried dishes, ice cream, marzipan (almond paste), nut oils and sauces.

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Many products are naturally free of the 14, but carry ‘may contain traces’ warnings – the bane of food allergy sufferers.

Peanuts Peanuts are actually a legume and grow underground, which is why it’s sometimes called a groundnut. Peanuts are often used as an ingredient in biscuits, cakes, curries, desserts, sauces (such as satay sauce), as well as in groundnut oil and peanut flour.

to be welcomed, although many remain small enterprises: Foddies, SOME 14 Foods and Fodmapped in Australia, Trueself and Fody Foods in the US, and Lauren Loves, Slightly Different Foods and Fodify Foods in the UK - the last of which being the brainchild of two dietitians, Janet Hopkins and Hannah Hunter.

But for now, until all these become more mainstream, those with multiple restrictions can still find it a challenge to find suitable, palatable and nutritionally adequate foods. Although our book considers many diets, here are some pointers for just a few.

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Sesame seeds

These seeds can often be found in bread (sprinkled on hamburger buns for example), breadsticks, houmous, sesame oil and tahini.

They are sometimes toasted and used in salads.

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Soya

Often found in bean curd, edamame beans, miso paste, textured soya protein, soya flour or tofu, soya is a staple ingredient in oriental food. It can also be found in desserts, ice cream, meat products, sauces and vegetarian products.

Sulphur dioxide (sometimes known as sulphites)

This is an ingredient often used in dried fruit such as raisins, dried apricots and prunes. You might also find it in meat products, soft drinks, vegetables as well as in wine and beer. If you have asthma, you have a higher risk of developing a reaction to sulphur dioxide.

Beer

For more information, visit: food.gov.uk/allergy or nhs.uk/conditions/allergies

Sign up to our allergy alerts on food.gov.uk/allergy-alerts, or follow #AllergyAlert on Twitter and Facebook Let’s keep connected at food.gov.uk/facebook Join our conversation @foodgov

The same goes for vegan yoghurt alternatives, but a small pot of plain soya yoghurt (or flavoured with low FODMAP fruits) is usually fine.

Watch us on food.gov.uk/youtube

DAIRY-FREE/VEGAN

Lactose-reduced animal milks are off the menu for those following milk-free diets, be it for ethical reasons or food allergy.

Although there are lots of plant-based milk alternatives, not all are suitable for all diets.

Check ingredients for high FODMAP apple juice and recommend a calcium-fortified option if applicable. Be aware that Provamel Soya Natural calcium-fortified contains apple juice, though.

Alpro Almond Unsweetened Fresh, Hazelnut Original and Coconut Original are three that we recommend in the book. Oatly Oat Drink (fortified) and Provitamil Oat Milk are safe options but neither is gluten free; Rude Health Oat Milk, which is gluten free, is not calcium fortified.

Vegan cheese alternatives are not always low FODMAP. Check for onion and garlic flavourings and all sources of added vegetable fibres. Bute Island’s Sheese products are typically a safe bet.

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www.NHDmag.com November 2017 - Issue 129

LOW-ALLERGEN/‘14 FREE’

Those with IgE-mediated allergies to a number of foods have an unenviable task in trying to source safe FODMAP friendly products. EU labelling regulations names 14 food allergens, which account for 90%+ of food allergies in Europe, and which must always be emphasised on food ingredient labels. Many products are naturally free of the 14, but carry ‘may contain traces’ warnings – the bane of food allergy sufferers.

Increasingly, brands are making a virtue of any ‘14 allergens free’ status, and the following should be safe for low FODMAP diets: • Rizopia organic brown rice pasta • Bfree gluten-free breads, wraps and rolls (oats used in some products) • Dove’s Farm Gluten Free flours, pastas and biscuits • Venice Bakery UK’s plain free-from and vegan pizza bases (the seasoned varieties contain garlic powder) • Just Gluten Free Bakery – rolls and sliced breads • Good Hemp Milk Unsweetened • Functional Food Company’s IBsnacks A regularly updated list of ‘14 free’ brands can be found on my site, Allergy Insight, here: www.allergy-insight.com/free-from-food/14allergens-free. Do bear in mind that not all products from all brands will be suited to a FODMAP-restricted plan.

The Low FODMAP Diet App from Food Maestro . . . gives details of suitable and unsuitable foods.

Their general Food App is free and is useful for those on restricted diets (allergies, intolerances) to help them validate safe products.

JEWISH KOSHER

Following religious restrictions and specific diets for food intolerances can be a challenge. Kosher rules are complex and are not just a matter of eating foods approved via the Beth Din. The status of products can change depending on manufacturers’ use of ingredients, so advice is to check regularly.

Email, text alerts and telephone information is available from the Kashrut London Beth Din (KLBD). Their site states the pareve status of foods: www.kosher.org.uk/koshersearch. The Manchester Beth Din site is also useful: www. mbd.org.uk/site/kosher-products. The website www.isitkosher.uk may also be helpful.

Suitable low FODMAP products which are Kosher certified include the following: • Barkat gluten/wheat-free matzo crackers; some supermarkets stock a brand called Yehuda, imported from Israel, and made with potato and tapioca.

• Yarden Aubergine and Mayonnaise • Mr Freed’s Tuna Salad and Coleslaw are gluten free and dairy free • Eskal brand is kosher certified - they have gluten-free pretzels and other baked goods • Schwartz Cheddar, Sol Edam slices, The Milk Company Original Mozzarella Rolled

(these are Chalav Yisreal supervised milk products) • Kellogg’s Cornflakes and Rice Krispies (neither is gluten free) and Kallo Puffed Rice The KLBD’s Really Jewish Food Guide has a good selection of free-from products suitable for the low FODMAP diet.

Note that supervised kosher milk is not likely to be lactose free. Lactose drops are a possibility, however, note that the drops are not explicitly approved. The local Beth Din or Rabbi can offer advice.

ONLINE /PHONE SEARCHES

The Low FODMAP Diet App from Food Maestro (www.foodmaestro.me) costs £3.99 and gives details of suitable and unsuitable foods. Their general Food App is free and is useful for those on restricted diets (allergies, intolerances) to help them validate safe products.

One way of finding products online is to use search functions and filters, eg, gluten free and Kosher can be selected on Ocado, but there are filters for Halal, vegan and other all allergens too. Sadly, low FODMAP filtering options don’t seem to be available yet for supermarkets, but surely it’s only a matter of time . . .

WE HAVE FIVE COPIES OF IBS: Dietary Advice to Calm Your Gut by Alex Gazzola and Julie Thompson to give away in an NHD FREE prize draw.

The book, published by Sheldon Press, examines diets for IBS, such as gluten free, dairy free and carbohydrate-aware (low FODMAP). It also explains why some popular diets and detox regimes may not be helpful, and looks at how lifestyle factors can affect IBS. For your chance to win a copy, please email us at info@networkhealthgroup.co.uk stating that you want to be included in the IBS Dietary Advice NHD book giveaway.

Closing date for entries is Monday 4th December 2017.

www.NHDmag.com November 2017 - Issue 129

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