Irritable Bowel Syndrome (IBS)

What is IBS?

Irritable Bowel Syndrome does not cause permanent damage to the colon. It appears as cramping, abdominal pain, bloating, gas and alternating bouts of diarrhoea and constipation. It is uncomfortable and can seriously affect a person's quality of life. Around one in five Australians experiences the unpleasant symptoms of IBS at some time (Source: Better Health Victoria).

Normally when you eat food the muscles of your gastrointestinal tract contract and relax rhythmically, moving food through your digestive system until it exits your body. It's thought that in IBS the contractions are sometimes stronger and longer lasting than normal. As a result food is hurried along the GI tract without being properly digested - causing gas, bloating and diarrhoea. But sometimes the contractions may be weak and short lived, causing constipation. IBS is estimated to affect 11% of the global population, but since there are no biological markers to test for it clinically, it's thought to be largely undiagnosed.

What causes IBS?

The cause of IBS isn't clear, but stress, altered gut bacteria, genetics and food sensitivities may all be involved. Whatever the cause, multiple factors can exacerbate IBS symptoms. These include certain foods, stress, hormonal changes and mood issues such as anxiety and depression. Research has shown that the neurotransmitter serotonin may be important in the symptoms of IBS, by altering the function of nerve cells in the bowel and causing changes in pain sensation and bowel function (Source: Better Health Victoria).

Other bowel complications

Inflammatory Bowel Disease is becoming increasingly common among the population and include: 

• Ulcerative Colitis - usually limited to inflammation of the innermost lining of the large intestine and colon
• Crohn's Disease - causes inflammation anywhere along the digestive tract and can penetrate into the deep layers of the intestinal wall.

Because these are diseases of ongoing inflammation, infection is a prime culprit for the cause. Research also shows they may also be autoimmune disorders meaning that your body reacts as if it is fighting a pathogen when in fact no threat is present.

Coeliac Disease is a condition in which you cannot tolerate gluten, a food protein. In these cases, eating gluten damages the small intestine and causes adverse side effects.

Intestinal Obstruction occurs when the intestines become blocked. As a result, the intestines are unable to complete processing food or pass stool (Source: Health Line).

What can I do?

• see your Doctor for advice - they may suggest certain medications for controlling diarrhoea or constipation
• increase fibre and water intake
• alcohol, nicotine and caffeine can be triggers for some people, cut down or stop completely and see if things improve
• keep a food diary and eliminate foods which cause uncomfortable symptoms
• graze during the day instead of having 3 large meals
• add yoghurt to your diet - a quality yoghurt with the good bacteria, acidophilus or take acidophilus supplements
• do other elimination tests like removing lactose and gluten from your diet - do things improve?
• try supplements like Effervescent Magnesium Ascorbate Crystals, Peppermint Oil or Artichoke Leaf Extract
• Peppermint tea and Ginger tea are known for relaxing stomach muscles
• remember to exercise (Source: Health Arizona and Best Health Magazine).

A personal perspective

I have suffered from IBS for most of my adult life. To make matters worse, when I had a colonoscopy, the surgeon discovered I also have a twisted bowel. I needed to eliminate or drastically reduce the following from my diet:

• full fat products
• highly processed foods
• full cream milk, cheese and dairy- I switched to lactose free and skim
• gluten and/or wheat
• excessive amounts of pasta
• deep fried food

If I keep these foods to a minimum (only splurge once in a while) then I'm OK. After years of suffering excruciating abdominal pain, I now know what the triggers are and avoid them as much as possible. However it isn't always possible to avoid them, i.e. eating birthday cake at your friend's birthday, so I simply have a very small piece and flush it out with lots of water. My general rule of thumb is be good to your gut 80% of the time and allow yourself to be naughty 20% of the time...it's called living!

Previous blog post...Organic Farming

Quinoa and Tuna Salad - low FODMAP and gluten free

I've never bought Quinoa before so I ventured off to the health food store to see what all the fuss was about. I had a few recipes in mind, so ended up buying the black quinoa. It also comes in white and red. Here are two images of before cooking and after cooking...

uncooked

 cooked

It is very important to rinse the quinoa before eating it, however I didn't have a mesh colander with small enough holes so I placed the quinoa in boiling water and let it cook for about 2 mins. In this time it swelled slightly, making it large enough not to slip through the holes in my colander. Then I removed it from the stove, poured it through my mesh colander into a large bowl, replaced the water and put it back on the stove.

This recipe was adapted from two recipes I found. Then I adjusted it so it was low FODMAP for IBS sufferers. This serves 3 generous serves or 4 side dishes.

Ingredients:

• 300g black quinoa, rinsed
• 3 cups water
• 185g tin of tuna (unflavoured)
• 1 tomato, diced
• 2 tablespoons of chopped red capsicum
• 2 tablespoons of chopped green capsicum
• 2 tablespoons of chopped yellow capsicum
• 1 cup mint leaves, finely chopped

Dressing:

• ⅓ cup fresh lemon juice
• ⅓ cup good quality olive oil
• ½ tsp white sugar
• ¼ tsp chopped chilli

Method:

1. Combine the rinsed quinoa and water together in a medium saucepan, bring to the boil then reduce to a simmer for about 15mins or until the water has absorbed
2. Remove from stove, place into a large bowl and let cool
3. In another large bowl, combine the tuna, capsicums, tomato and mint
4. In a small bowl, combine the lemon juice, oil, chilli and sugar and stir until the sugar has dissolved
5. Once the quinoa has cooled, pour it into the bowl with the tuna and vegetables
6. Add the dressing and mix well…D-E-L-icious  XD

Chicken and Noodles - low FODMAP and gluten free

I've been adapting my favourite recipes to accommodate the fact that I now need to follow a low FODMAP diet because of my irritable bowel and lactose intolerance.

One of my favourite meals is chicken with noodles. I've always added chilli, garlic, onion and sauces to this dish, but today I made it totally low FODMAP.

I used Tamari instead of soy sauce. You will find Tamari in the health food section of your local supermarket. The other thing I changed is the stock cubes I use. Massels 7 are suitable for IBS sufferers and are considered low FODMAP because they contain no onion and garlic. Read more about Massels 7 here. This recipe serves 2.

Ingredients:

• 1/2 packet vermicelli rice noodles
• 200g chicken breast fillet
• 1 shallot (spring onion) but only the green part, finely chopped
• 1 red chilli, finely chopped
• 1 Massels 7 chicken stock cube with water (as per instructions on packet)
• Splash of Tamari sauce

Method:

1. Cook the vermicelli noodles as per packet instructions. I find just placing them in a large bowl of boiling water with the stock cube cooks them without having to actually cook them on the stove
2. Steam the chicken until cooked through, turning once. Depending on the thickness, between 5 and 10 mins should do
3. Place the cooked noodles on a plate
4. Slice the cooked chicken breast and place on top
5. Garnish with the shallots and chilli and splash with Tamari... D-E-L-icious  XD

Easy meatballs - low FODMAP

I love meatballs. The kids love meatballs. Who doesn't like meatballs? These meatballs are made with low-fat heart-smart lean mince beef and IBS acceptable tomato sauce. This serves 4 with pasta of your choice. You could use gluten-free pasta for celiacs. Or alternatively serve it with rice.

Ingredients:

• 500g lean heart-smart mince beef
• 1 tablespoon gluten-free rice crumbs
• 1 egg
• Tablespoon of sauce or paste of your choice. I find tandoori paste is excellent, but if your tummy can't handle that, a thick sauce of your choice, ie BBQ, thick soy, curry paste, chilli paste, etc
• 2 tablespoons good quality olive oil
• 1 carrot peeled and finely chopped
• 1/2 capsicum finely chopped
• 1 tablespoon celeriac (turnip) peeled and finely chopped
• 1/4 cup stock of your choice
• 680g tomato cooking base (with no hidden ingredients) * see note below
• 1 tablespoon thyme

Method:

1. In a bowl place the egg and whisk briefly, add the mince, sauce/paste and rice crumbs
2. Mix with your hands really well until everything is mixed together
3. In the palm of your hands roll mince into 2cm diameter meatballs. 500g of mince should yield 40-42 meatballs of this size
4. Heat the oil in a large pan and cook the meatballs in batches until browned on both sides. It took me three batches in the pan I was using. It would be faster if you used a large electric frying pan
5. Once you've browned all meatballs on both sides, remove them to a plate
6. To the juices in the pan, add the capsicum, carrot and celeriac (turnip) and the stock
7. Scrape the bottom of the pan so all the bits of browned mince mix with the vegetables and stock
8. Add the thyme and mix well
9. Add the tomato cooking base and mix well
10. Carefully add the meatballs to the sauce, gently pushing them under the surface
11. Bring to the boil, then turn down to a simmer while your pasta or rice is cooking
12. Serve whilst hot either on rice or pasta and your favourite (tummy safe) grated cheese. I used Grana Padano...D-E-L-icious  XD

Note: It's important to check your tomato bases and pasta sauces at the supermarket. Most of them have garlic and onion in them, so if you are following the low FODMAP diet and/or suffer from IBS, you will need to avoid these. This tomato base is the CHEAPEST in Woolworths and is low FODMAP. You can add whatever herbs and spices your tummy can handle while preparing the sauce for your meatballs...or for any bolognaise dish you are making.

Low FODMAP diet for Irritable Bowel Syndrome (IBS)

I've always been an IBS sufferer but have mainly ignored it and eaten whatever I like. However from time to time, the "poisons" I will call them - build up in my stomach and bowel to a point where I can no longer ignore it. Two weeks ago I had a weekend where I overindulged with friends and ate too much cheese, crackers, dips, salami, cabanosi and processed food! Tsk Tsk! I suffered for two weeks!!!

It was so painful I went to the doctor thinking I had a bladder infection as the pain had migrated to my bladder, but the urine test was negative. She assured me it was only IBS and sent me home with a printout of the low FODMAP diet. WTF!? As a long time sufferer of IBS I had never heard of this diet. It had never been offered to be before. I took home the printout, read it and it all made sense.

There is a lot of information online about low FODMAP foods, but I will briefly explain it here.

"Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder (FGID) affecting one in seven Australian adults and is also common in the USA, Europe and many Asian countries. This condition is characterised by chronic and relapsing symptoms; lower abdominal pain and discomfort, bloating, wind, distension and altered bowel habit (ranging from diarrhoea to constipation) but with no abnormal pathology." (Monash University).

"The research team at Monash University have developed a diet to control gastrointestinal symptoms associated with IBS/FGID. The team has focused on a group of carbohydrates they have named FODMAPs (stands for Fermentable Oligo-saccharides, Disaccharides, Mono-saccharides and Polyols).
FODMAPs can be poorly absorbed in the small intestine. Mal-absorbed carbohydrates are fermented by gut bacteria to produce gas. Current research strongly suggests that this group of carbohydrates contributes to IBS/FGID symptoms. FODMAPs are found in a wide range of foods." (Monash University).

Referring to the above chart, you can see which foods create problems for IBS sufferers, and those which do not. 

Other links:

• The cooking and/or storing process of some foods may alter the levels of FODMAP's in them. See this link for more information  
• If you're a cheese lover like me, this link is helpful about which cheeses are OK
• Also if you love garlic like me, this link explains about cooking with it for flavour and then removing it
• This link explains why creams, sauces and gravies are problematic
• If you're a big bread eater - sour dough is better for you. This explains why
• I've also noticed if I reduce gluten in my diet it helps. This article explains the different between gluten-free and wheat-free
• The low FODMAP diet doesn't have to be a lifestyle change. It recommends trying it for 2-6 weeks (like an elimination diet) and then slowly re-introduce foods and monitor your symptoms. More info here.

There is lots of information about IBS and the low FODMAP diet on the Internet. Let your fingers do the walking and Google it. Good luck XD