I have a notoriously delicate constitution. My innards tend to react like an angry toddler needing its bedtime over all kinds of things. Some of it is because I am an expert maker of gallstones (despite having my gallbladder removed when I was 18) leading to my digestive system reacting angrily to say the least. I’ve done a lot of exclusion diets in my time.
There was the post cholecystectomy low fat diet that meant all I could safely eat without a trip to A&E was bread and jam which in turn meant having to do a candida exclusion diet. Not only am I prone to yeast issues in my gut but because it was the mid 90s and it was the current solve all your internal ills idea at the time. I also dabbled with wheat and dairy free for a while and didn’t achieve much effect apart from sending myself gently bonkers around food. I’m sure I’d have excluded gluten too if I’d heard of it then.
I thought I’d just have to put up with feeling terrible all the time and existing on a heavy routine of peppermint oil capsules and mint tea and then I saw a new and wonderful gastroenterologist about some other gallbladder related issues you don’t want to read about over breakfast. While not denying I had a problem, he mentioned that about 80% of his current caseload is down to three things: poor gut flora, Chorleywood bread and Fodmaps.
The first, I know well. The second makes sense since it relies on underproving yeasts and gluten and making bread much harder to digest. The third? I had no earthly idea what he was on about. But I trusted him (I should, he swears like a sailor on shore leave, keeps a sourdough starter in his office for patients and is Michael Mosley approved, all on the NHS no less) so I went off and looked these Fodmaps up.
Discovered by Monash University in Australia, it identifies that there are certain sugars and carbohydrates that the human body finds hard to digest leading to problems. These are the Fermentable, Oligo, Di and Mono Saccharides and Polyols the diet is named for. Often confusing for people because many healthy foods are an issue, it’s a complicated diet that should only ever be undertaken with the help of a trained medical professional, hopefully via the NHS these days,
However it’s worth looking into doing it if you find you have issues after eating wheat or rye, all dairy products not just lactose based ones, certain fruits and vegetables, especially onions and garlic or pulses beyond the normal response to large amounts. Meat substitutes like Quorn can also be a big Fodmap trigger. People are further confused by Fodmaps because everyone’s tolerance is different. I am absolutely fine with wheat (and other members of the galactan family) and have no issue with lactose.
Yet give me a fructan in the shape of an onion or garlic especially and I am utterly miserable. My problems are compounded by the fact I am also fructose malabsorbing so react terribly to high fructose fruit, any kind of fruit juice and anything like agave syrup that’s high in it. It’s best for everyone to only consume fructose when it comes with the natural fibre of the fruit to prevent overloading your system but for fructose malabsorbers like me, any amount is difficult. A glass of orange juice or a whole apple will be both cause my mouth to swell and break me out in a sweat and itchiness and nausea. I suspect many people have this issue these days but have simply never heard of it. Innocent times. Literally.
I have to be incredibly careful in what I eat so that I don’t end up lying down feeling faint and bloated at best or triggering off my more intense bowel issues. Fruit and pulses are occasional treats for me (which is why I become murderously annoyed when people tell me how great lentils are when you are poor) and alliums are to be eaten only when I can’t avoid them and can be alone soon after. I will never eat a Jerusalem artichoke or chicory root or take a prebiotic again as they contain inulin, a form of indigestable fibre that is problematic for everyone but triggers debilitating biliary pain for me.
I’m particularly careful of so called health foods such as ‘good bacteria’ yoghurts and seed mixes or granolas (yes, The Food Doctor I’m looking at you) which contain chicory inulin for its prebiotic qualities and increased fibre. For non Fodmap people, this is good for one’s digestive transit. For me, it makes me pray for death to take me. I’m a careful label reader these days and also help myself by not eating packaged food very much. Dried onion and garlic powder are my nemesis and are everywhere these days. I also have to adapt recipes to be able to eat things and enjoy them. I never ever eat onions or garlic at home now. I can manage them when out thanks to the swanky probiotics I take daily which have given me some extra coping skills digestion wise.
(Just to clarify: probiotics are the actual gut flora you need for a heathy bowel. Prebiotics are different and they simply create a welcoming environment for your probiotics to thrive. As I can’t have the latter, I have to take the former daily and as I have no gallbladder, I need posh bile tolerant ones that feel like they cost a fortune but are actually much cheaper than of Yakult or Actimel would be since they survive past the stomach and have billions more bacteria to boot. They are also multi strain for ease of absorption and thus less likely to stop working than the single strain drinks. Tl,dr: buy decent pills, not the wee drinks. They don’t do anything if you already have decent gut flora.)
My main Fodmap weapon is slow cooker caramelised onions. I cut up huge batches of onions and slow cook them until they are golden and sweet and absolutely teeming with fructans. Then I bag them up and freeze them until I need to find non Fodmappers. I cook my meal without alliums and serve my portion, then I add the slow cooked onions to the rest and it tastes like nothing is missing for those who can’t imagine life with onions (or lucky bastards as I call them…)
The rest of the time I eat stuff that looks so unhealthy to other people. White bread all the way, very little fruit and only certain veg. I really struggled with the NHS booklets that accompanied my Fodmap exclusion diet as it was full of pre made food rather than ways to adapt your own cooking. A useful blog to consult is On the Fold of the Fodmap if you prefer to cook from scratch.
The one useful suggestion from the booklets was that preparing things certain ways helps especially with fruit which is where this dish came about. Inspired by Diana Henry in the Telegraph last week, it made use of some perfect plums I couldn’t resist buying in the market despite knowing they are something I shouldn’t really eat.
I find cooked fruit much easier to deal with so they went into the pot along with some outdoor reared pork fillet I got at Waitrose which was only £2.38 for a whole fillet that would feed four. I skipped the honey as it’s high fructose and added some sourness with tamarind instead. It all went into the oven for 30 minutes and was served with rice and cucumber salad. A perfect quick, cheap autumnal dinner.
Spiced Pork and Plums (serves 4)
- 390g (approx) pork fillet or tenderloin
- 2 tablespoons red wine or rice vinegar
- 2 tablespoons soy sauce
- 4 plums, halved and stoned
- 1/2 teaspoon tamarind concentrate
- 2cm piece fresh ginger
- 2 star anise pods
- 1 teaspoon five spice powder (check for garlic powder just in case)
- 1 cinnamon stick
- 1 blade mace (optional)
- 1 heaped teaspoon Sichuan peppercorns
- 200ml stock (chicken or vegetable)
- salt and pepper
- chopped red chilli to serve (optional)
Take the pork fillet out of the wrapping and swaddle it in a clean tea towel for a few minutes to dry it off. Then cut it in half and put it in a ziploc bag with the vinegar and the soy sauce. Seal and swoosh it all around to coat the pork and pop in the fridge to marinate overnight or while you are out at work.
Preheat the oven to 200℃ and take the pork out of the fridge. Cut the two halves into 1.5 inch medallions and place in a heavy dish with a lid. My Le Creuset was perfect and excited to be used instead of the trusty slow cooker. Allow the pork to come to room temperature while you halve the plums and scatter the spices and flavourings over it all. Dissolve the tamarind in the warm stock and pour it all over. Season it all generously and put the lid on. Roast for 30 minutes.
While the pork cooks, cook some brown rice and prepare a simple cucumber salad. Halve your cuke, scoop the seeds out and slice into a bowl. Drizzle with about a tablespoon of rice vinegar, a scant teaspoon of brown sugar, a shake or two of fish sauce and heaps of black pepper and sea salt. Allow to sit for half an hour and scatter with a few sesame seeds if you have them.
Serve the pork, plums and spiced juices over the brown rice and with the cucumber on the side. I love my slow cooker, but it was wonderful to have a casserole style meal on the table in 45 minutes or less which was so simple and economical to make. Although it did remind me that my oven door is borked and I spent the rest of the evening happily replete, shopping for a new cooker on the internet…
*since originally posting this recipe, I can no longer eat any fruit and am not sure I’d recommend this recipe to fodmappers, but it was delicious.