Fibre

Dietitians and other healthcare professionals can often be heard talking about how we should eat more fibre. You may understand that it is “good for you” to have fibre in your diet. But have you ever thought about why?

This post explains the different types of fibre, looks at some of its benefits and suggests how you can include more of it in your diet.

Types of fibre

Fibre-rich foodsAn easy way to remember foods that contain fibre is that they all come from plants. Meat, fish and dairy foods do not contain fibre.
Fibre can be split into two different types, soluble and insoluble. Both have different health benefits, so we should try to include both types in our diets.

  • Soluble fibre
    As the name suggests, soluble fibre dissolves in water. In the gut, this helps soften your stools. Consequently, if you suffer from constipation, gradually increasing your intake of soluble fibre can help make it easier to go. Soluble fibre can also help lower cholesterol levels.
    Foods such as oats, pulses, lentils, golden linseeds, potatoes and vegetables are all good sources of soluble fibre.
  • Insoluble fibre
    Insoluble fibre cannot be digested, instead it is used as a ‘food’ source for good bacteria we have in the gut, helping keep our gut healthy. Insoluble fibre also acts as a sponge, helping keep us fuller for longer and move food through our digestive system.
    Good sources of insoluble fibre include; bran, wholegrain and wholemeal foods, skins of fruits and vegetables and nuts and seeds.

To help differentiate between the two different types, think about making porridge (or oatmeal) on the stove, the oats ‘dissolve’ into the liquid. When cooking brown rice, the rice does not dissolve, but rather absorbs the water and goes soft. This is because the oats are high in soluble fibre, whilst brown rice is high in insoluble fibre.

Benefits

As fibre can help you feel full for longer, it can be a useful tool when trying to manage your weight. It can also help control your blood glucose and cholesterol levels. Having a diet high in fibre can also reduce your risk of cardiovascular disease, type 2 diabetes and bowel cancer.

How much?

According to EFSA (European Food Safety Authority) adults should be aiming for around 25g of fibre per day. Most people aren’t eating enough. On average, people manage to eat around 14g of fibre per day.

Increase your fibre intake

If you want to increase your intake of fibre, it is important that you do so gradually. Increasing your intake too rapidly can result in stomach cramps and leave you feeling bloated. You should also make sure you drink plenty of water, aim for 6-8 glasses per day.

You can increase the amount of fibre in your diet by ensuring your diet contains plenty of fruit and vegetables, opting for wholegrains (brown rice/bread/pasta over white), leaving the skin on potatoes and adding beans or lentils to your soups and salads. Ensuring a vegetarian meal once per week is a great way of upping your fibre intake #meatfreemonday!

What does 25g a day look like?

fibre in a dayIBS

People who have digestive problems or IBS (irritable bowel syndrome) may need to adjust the type and amount of fibre they have in their diets depending on their symptoms. This is something that needs to be assessed on an individual basis. You should see your doctor or dietitian for more advice regarding this.

More information

Fibre-rich foods
General information on fibre from patient.co.uk
NHS information on constipation
NHS information on diarrhoea
NHS information on IBS

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Allergies and Intolerances

allergy

I get so many questions regarding allergies and intolerances, so I decided it was time to write a post about it!

People are often not sure on how to go about getting a proper diagnosis, and there is a lot of self-diagnosing going on. As a dietitian, I recommend as varied a diet as possible, so will always recommend that people seek advice from a qualified professional who uses recognised diagnosis methods to avoid them cutting out foods unnecessarily.

Reactions to foods are common, but most are caused by an intolerance rather than an allergy. Let’s start at the beginning and understand the difference between an allergy and an intolerance.

The difference

A true allergy is defined as “a response of the body’s immune system to a normally harmless substance”. The key word here is IMMUNE system. When someone has a true allergic reaction, this triggers an immune response, or, in other words, the body releases histamine. The release of this histamine will in turn cause a series of reactions which present themselves as symptoms. The presence and nature of these symptoms plays a key part in determining the diagnosis.

An intolerance does not involve the immune system, and therefore does not trigger the release of histamine. An intolerance can be triggered by various things, such as missing crucial enzymes needed to digest foods (as in lactose intolerance), IBS (see my post on irritable bowel syndrome here) or increased sensitivity to naturally occurring substances or food additives.

Symptoms

People who have an intolerance can often consume a small amount of the food and not experience any symptoms, whereas those with allergies can have severe reactions even to small amounts. Allergic reactions can also get progressively worse the more times the person consumes that food.

Allergic reactions are caused by the release of histamine, and generally happen quite soon after the offending food has been consumed. Typical allergic symptoms include; a bumpy, red rash formed around or inside the mouth, tingling or itching around the mouth and throat or swelling of the lips, tongue or throat. In severe cases, people can go into anaphylaxis, which can be life threatening.

Symptoms associated with an intolerance are likely to be less serious than allergic symptoms, take longer to appear* and are often linked to digestive problems. However, this does not mean that they are unimportant. Intolerance symptoms can be debilitating and very uncomfortable for the individual. Typical symptoms include; bloating, abdominal pain and diarrhoea.

*To complicate things a little bit further, there are different types of allergies, IgE and IgG. IgE allergic reactions tend to cause immediate onset of symptoms. However, IgG symptoms can take much longer to develop, sometimes several days. People with allergies often experience a mixture of both types of symptoms. This is why it’s important to get the opinion of a qualified professional so that they can help you determine the nature of your allergy.

Diagnosis

If you think that you, or your child, may have a food allergy or intolerance, the first thing to do is to make an appointment with your GP. When you speak to your GP, they will ask you several questions to help determine the type of reaction you are having. Questions may include what type of symptoms, how long they took to appear, how long they lasted and also whether there is a family history of allergies. Sometimes it helps to begin keeping a food and symptom diary when you suspect an allergy to help you answer these questions!

If your doctor suspects an allergy, there are then a couple of options depending on the symptoms. The best, most accurate diagnosis is likely to come from a combination of your clinical history and the following tests:

Skin-prick test. This is where small amounts of the suspected allergens (foods likely to cause a reaction) are placed into the skin on the forearm. If the skin-prick becomes red, itchy or swollen, this indicates a positive reaction. This test is painless but should be carried out an an allergy centre or doctors clinic, due to it carrying a slight risk of anaphylaxis if your reaction is severe.

Blood test. This involves testing a sample of your blood for presence of certain anti-bodies.

Food elimination. As the name suggests, this is when you cut out the food that you suspect is causing the reaction from your diet. After a period of about 2-6 weeks, the food should then be reintroduced. If the symptoms disappear during the time when you’re not eating the food, and reappear on its reintroduction, then this can be used as a diagnosis. Before starting such a diet, you should seek advice from a dietitian to ensure that you are not losing out on nutrients by eliminating the offending food(s).

Non-evidence based testing. There are some shops that sell kits for allergy testing or outlets that offer testing hair/blood samples for presence of allergens. The principles on which these tests claim to be based are unproven, and research into their effectiveness has found them unreliable.

Unfortunately, tests used for diagnosing food intolerance (with the exception of lactose intolerance) are not always reliable. Some practitioners use IgG blood tests as a result for intolerances, however the evidence is patchy and most allergy specialists consider IgG results unhelpful in isolation.

It is also important to note that none of the allergy tests above are 100% conclusive all of the time. Usually, these tests are used in combination with your clinical history and symptom description. Your GP or doctor will probably have his suspicions upon talking to you, and then the tests will sometimes be used to confirm the diagnosis.

Again, because of the significance of clinical history in diagnosing allergies/intolerances, you can appreciate how important it is to involve a qualified professional.

More information

Allergy UK
NHS Choices
Patient.co.uk
MayoClinic

IBS – ‘facts and triggers’

First things first, this post is about IBS (irritable bowel syndrome), very different to IBD (inflammatory bowel disease). IBD involves chronic inflammation of sections of the intestines and can require hospitalisation during bad flareups. IBS has no known structural cause and, although it can be inhibiting, symptoms can be improved through making sensible lifestyle and dietary changes.

IBS is quite a common disorder; it is estimated that it could affect up to 25% of the UK population. IBS is thought to be caused through a mixture of psychological and physical factors including; infection, altered gut motility, ‘sensitivity’ to certain foods (I’ll explain this later) and stress.  Many patients who suffer from IBS report symptoms being worse during times of stress, and also recall initial onset to have occurred around the time of a stressful event.

There’s no diagnostic test for IBS, so the first step in diagnosis is excluding presence of more serious conditions, such as IBD. The doctor will then talk through your symptoms with you, and may suspect IBS if you match certain criteria.

Symptoms of IBS differ widely from person to person. Sufferers may experience diarrhoea, constipation (or a mixture of both), bloating, abdominal pain and swelling, wind, urgency to go to the toilet and the feeling of having not been properly. Consequently, the dietary advice varies depending on an individual’s symptoms.

IBS is not a life-threatening condition, but it can cause a significant social impact on those who suffer with it. The good news is that once you’ve learned what foods tend to ‘set it off’, you can work on avoiding these and often improve symptoms. A handy way of doing this is by keeping a food and symptom diary, so you’re able to identify trends in how foods affect your bowel.

As I mentioned earlier, some IBS sufferers can be ‘sensitive’ to certain foods, this is a kind of intolerance whereby specific foods can trigger IBS symptoms. It’s important to stress that these reactions are rarely indicative of food allergy.

Below, I have suggested some things that may help with IBS symptoms. However, because dietary advice will differ so much depending on symptoms, you should also consult a professional for personalised advice. It is important that you don’t cut out too many foods as this will impact the nutritional adequacy of your diet.

  • Eating a healthy diet  This may sound obvious, but you should try to eat as close to the Eatwell Plate recommendations as possible. There’s no need for most IBS sufferers to follow any specific diet. It’s also important to drink plenty of fluids; water can help ease constipation and you’ll be needing to replace increased losses if you’re suffering from diarrhoea.
  • Establishing a regular meal pattern Having some sort of routine is important for preventing feelings of hunger, picking at less healthy foods and can help instill healthy habits. 
  • Stress less! – Heightened emotions such as stress and anxiety can trigger hormonal changes that can affect digestive system mechanisms. Try taking up a new hobby or doing something active to take your mind off what is causing you stress.
  • Prebiotics and Probiotics – Yes, they’re different! Probiotics are live microorganisms that get into the gut and help aid digestion. Prebiotics are non-living substances that encourage the growth of good bacteria in the gut. I think about it as prebiotics being the “food” for probiotics, both of these can be found in certain yoghurt drinks. Although it has not been categorically proven, many patients find that when taken regularly they can help ease IBS symptoms. Remember to always adhere to the manufacturers recommendations.
  • Avoid food triggersTriggers will be different for each person, but some typical ones include; caffeine, alcohol, fizzy drinks, spicy food, sorbitol (artificial sweetener) and fatty foods. Resistant starch found in processed foods can make bloating worse. Resistant starch is also formed when starchy foods (such as potatoes and rice) are reheated. 
  • Fibre – It may be necessary to modify the amount and/or types of fibre in your diet. Recommendations about what to change will be based on your own diet and symptoms, so it’s best to talk fibre through with your own GP or a dietitian.

Please note that this post contains information for the general public, this advice should not replace that given to you by your own doctor or healthcare professional. If you think you may have IBS, make an appointment to go and see your doctor.

More information on IBS provided by NHS Choices is available here.