Have You Heard of SIBO?

This past weekend I attended an entire symposium dedicated to SIBO, which stands for Small Intestinal Bacterial Overgrowth. This symposium was put on by the SIBO Center for Digestive Health at the National College of Natural Medicine in Portland, Oregon. I wasn’t lucky enough to be there in person, but attended the entire symposium via webinar.

SIBO occurs when bacteria from the large intestine creep up into the small intestine. Because the small intestine is so narrow and the bacteria shouldn’t be there, it causes bloating, gas, and other digestive issues. It is UNCOMFORTABLE, to say the least.

Dr. Mark Pimentel, an expert in this field, hypothesized that more than half of people with IBS have bacterial overgrowth. If you experience extreme bloating and gas, I highly suggest you get yourself to a gastroenterologist to be tested for SIBO. The practitioners at the symposium agreed that a lactulose breath test that measures both methane and hydrogen gas is the best way to measure SIBO. The treatment will depend on the results of the breath test. For more information about treatment, I recommend Dr. Allison Siebecker’s website: www.SIBOinfo.com.

Diet is also important for SIBO and very individualized. There are no clinical studies on diet and SIBO, but there are a few diets that work well to control symptoms: the low FODMAP diet, the specific carbohydrate diet (SCD), a combination of SCD and low FODMAP, and Dr. Pimentel’s Cedar Sinai Low Fermentability Diet. These diets all have conflicting advice, so it gets confusing. We certainly need more research in this area!

If you do have SIBO, one important thing to remember is to space meals 4-5 hours apart to allow your body’s migrating motor complex (also called cleansing waves) to work. The cleansing waves occur in the small intestine every 90 minutes in between meals. Grazing during the day limits those cleansing waves. So remember that goûter I wrote about? If you have SIBO, you may want to skip the goûter, or have it in the late afternoon and eat a late dinner.

For a more detailed report about the SIBO conference, check out the following terrific blog posts by Kate Scarlata, RD and Patsy Catsos, MS, RD.

Lemon Pomegranate Greek Yogurt (Goûter #1)

What in the world is a goûter? Goûter (pronounced goo-tey) is a French word that literally means “to taste.” In France, children get a small 4pm meal called a goûter. Here in the States we would call this a snack, but my French sister-in-law insists that it is a goûter, not a snack. This is because it is considered just as important nutritionally as other meals. It has been very interesting to learn about the differences in each of our cultures food and eating patterns. When my nephew was born a year ago, my sister-in-law received a pamphlet about food and meal times. Written at the bottom it said, “No snacking.” In the States we encourage children and adults to snack, maybe even a little too much.

I personally like the idea of an afternoon goûter for everyone (if you’re hungry that is). People often ask me what I recommend for a snack – what should a snack entail? How big should it be? To answer these questions I’m going to post a series of healthy nutritious FODMAP friendly snacks over the next few months. First up, Lemon Pomegranate Greek Yogurt. The sweetness of the pomegranate and tartness of the lemon go wonderfully together. I can’t seem to get enough of pomegranates this season.

photo (3)

Snacks keep you fuller longer if they contain protein + fiber. Greek yogurt is packed with protein, and pomegranate seeds are one of the most fiber-rich fruits.  Add some chia seeds to this and you are good to go!Goute1.final

Note: Four ounces of Greek yogurt is very low lactose, so considered FODMAP friendly.

Lemon Pomegranate Greek Yogurt 

Ingredients: 4 oz lemon Greek yogurt (such as Chobani) 1/4 cup pomegranate seeds 2 tsp chia seeds (optional)

Instructions: Mix Greek yogurt with chia seeds. Top with pomegranate seeds and enjoy!

Butternut Squash Lasagna with Sage and Nutmeg

Lasagna is typically a FODMAP nightmare. It’s filled with ricotta (full of lactose), wheat noodles, and tomato sauce made with garlic and onions. This revamped lasagna recipe eliminates all of those FODMAP ingredients, but remains delicious and also nutritious. The nutmeg and sage pair well with the butternut squash and the spinach brightens it up at adds vitamins A & C, magnesium, and a little bit of iron. Also, it just so happens to be red and green, perfect for a Christmas celebration.
The first step is to tackle the butternut squash (unless you bought an already peeled one). Cut it in half and peel off the thick skin with a knife. Scoop out the seeds, then cut into slices. Toss the slices with olive oil, sage leaves, and salt and roast at 375 degrees F.
butternut squash
While the squash is cooking, it’s time to prep the rest of the ingredients. Cook your lasagna noodles, saute some fresh spinach, and mix together Farmer Cheese, shredded mozzarella, 1 egg, and fresh nutmeg. Both Farmer Cheese and mozzarella are very low lactose. If you are lactose tolerant, feel free to use regular ricotta cheese.
Have you ever cooked with fresh nutmeg? It’s easy to do if you have a small grater called a microplane and is much more fragrant than already ground nutmeg.
Once you have all of your ingredients: roasted squash, lasagna noodles, sauteed spinach, and cheese mixture, it’s time to assemble the lasagna.
Here’s the breakdown of the layers:
Half of the cheese mixture
Butternut squash
Half of the spinach
Second half of the cheese mixture
Butternut squash
Second half of the spinach
Mozzarella cheese
Cook the lasagna at 350 degrees F about 40 minutes until the cheese is brown and bubbling.
1 butternut squash
10 sage leaves
2 tsp olive oil
Salt to taste
9 gluten-free lasagna noodles, such as Tinkyada brown rice lasagna noodles (cook a few more just in case)
16 oz Farmer Cheese
1 cup shredded mozzarella + 1/2 cup for topping
1 egg
1/2 tsp nutmeg
1 jar Rao’s Sensitive Formula tomato sauce or 24 oz of homemade sauce
1 9-oz bag fresh spinach (or 1 bag chopped frozen spinach)
1. Preheat the oven to 375 and put a large pot of water on the stove to boil for the noodles
2. Cut the squash, scoop out the seeds, peel it, and cut into slices that are 1/8 inch thick.
3. Toss the squash with sage leaves, olive oil, and salt. Roast at 375 degrees F for 10 minutes, flip and roast for another 10 minutes or until soft.
4. While the squash is roasting, cook the lasagna noodles according to package directions.
5. Gently saute the spinach until just cooked through. Squeeze out as much water as you can. If using frozen spinach, defrost it and then squeeze out the water.
6. In a medium bowl, mix together the Farmer Cheese, mozzarella, egg, and nutmeg. Set aside.
7. Once you have all of your ingredients it’s time to assemble the lasagna. You should have: cooked noodles, roasted squash, cooked spinach, cheese mixture, and sauce
8. On the bottom of a 9×13 baking dish, spread a thin layer of tomato sauce, then place 3 lasagna noodles over the sauce. Spread half of the cheese mixture over the noodles. You may have to use your hands to flatten out the mixture because it will be thick. Next, evenly distribute half of the spinach over the cheese mixture, then half of the butternut squash, and then about 1/3 jar of sauce. Repeat this process so there is two layers of filling. For the top layer, place your last 3 lasagna noodles over the filling, cover with a thin layer of sauce, and sprinkle the reserved 1/2 cup of mozzarella cheese over the top.
9. Turn down the oven to 350 degrees F and bake for about 40 minutes until the cheese is brown and bubbling.

Crispy Gluten-Free Chicken Nuggets

Last night we got a lot of snow here in Boston. Unfortunately the snow interfered with my dinner plans, so at 7:30 I had to whip up something fast. In the fridge: stir-fry chicken, kale, potatoes. On the shelf: gluten-free bread crumbs made by Mary’s Gone Crackers. Dinner = home-made chicken nuggets, roasted potatoes, and steamed kale. Note: this recipe can be made vegetarian by substituting tofu for the chicken.

The bread crumbs are cleverly named “Just the Crumbs.” I like that they’re made from brown rice, quinoa, and seeds, which make them healthier than other bread crumbs and have more fiber too. You can order them here. (I have no financial interest in the company.) This was my first time using them and I was delighted with the result — crispy nuggets with no deep fryer involved.

just the crumbs

To make the chicken nuggets, purchase stir-fry chicken meat or cut up boneless skinless chicken breasts. Mix together one egg,  one tablespoon dijon mustard, and a pinch of salt. First dip the chicken in the egg mixture, then in the breadcrumbs. Bake for about 20 minutes and you’re done! Serve with roasted potatoes and steamed kale or any other veggies you happen to have in your fridge.

chicken nuggets2

Crispy Gluten-Free Chicken Nuggets

1 pound stir-fry chicken meat or cut up boneless skinless chicken breasts (you can substitute tofu)
1 egg
1 Tbs dijon mustard
1 cup “Just the Crumbs” breadcrumbs
Olive oil for greasing the pan

1. Preheat oven to 350 degrees F. Mix together the egg, mustard, and salt in a small bowl. Pour the breadcrumbs in another small bowl.
2. Dip each chicken piece first in the egg mixture, next in the breadcrumbs. Make sure the entire piece is coated.
3. Placed on a greased baking sheet and bake for about 20 minutes until chicken is cooked through.

Banana Berry Cottage Cheese Pancakes (low FODMAP)

I love making pancakes on weekend mornings. Today I decided to experiment with cottage cheese in my pancakes to bump up the protein content. These pancakes also have a good amount of soluble fiber because they’re made with oat flour. Soluble fiber is healthy for a few reasons. First, it can help lower cholesterol levels in the body. Second, it can help with…dare I say the D-word…diarrhea. Soluble fiber helps to form a gel in the intestines which absorbs extra water, helping to firm things up. The fiber/protein combination in the pancakes will keep your belly full and happy.

To make the pancakes, first combine the wet ingredients (lactose-free cottage cheese, vanilla, milk, egg, banana) in a blender or immersion blender. Pour into a bowl and add the oat flour and baking powder. Mix well. At this point I added some chia seeds (even more soluble fiber!)

banana berry pancake ingredients

Pour batter onto a heated greased skillet and drop in some blueberries. I used frozen wild blueberries.

cooking pancakes

Flip the pancakes when the batter starts to bubble and cook until golden brown. Serve the pancakes with blueberries, bananas, and maple syrup. My aunt and uncle gifted me with maple syrup from Black Pup Sugarmakers in Peacham, Vermont. I have to tell you that not all maple syrup is created equal. This one is thick and has a rich full flavor. Absolutely delicious.

banana berry pancake stack_DN

Banana Berry Cottage Cheese Pancakes
Serves 2

1/2 cup lactose-free cottage cheese (or regular cottage cheese if you tolerate lactose)
3 Tbs lactose-free milk or milk alternative
1/2 tsp vanilla
1 egg
1/2 banana
1/2 cup oat flour
1 tsp baking powder
1/4 cup frozen or fresh blueberries + 1/4 cup for serving

1.  Combine cottage cheese, milk, vanilla, egg, and banana in a blender or immersion blender and blend until smooth.
2. Pour blended ingredients into a bowl, add oat flour and baking powder. Mix until combined. (Optional: add 1-2 Tbs chia seeds)
3.  Pour batter onto a heated buttered skillet (medium heat) in 3-4 inch rounds. Sprinkle blueberries onto the batter. Flip pancakes when golden brown and cook until the opposite side is golden brown.
4.  Serve with blueberries, sliced banana, and maple syrup.

Rainbow Salsa

This recipe is much tastier in the warmer months  when tomatoes are delicious and in season. Some of you, who live in warmer climates can enjoy this all year round. Those of us in New England can settle for greenhouse tomatoes – don’t worry, it will still taste mighty fine.
(Recipe originally posted October 3rd 2013)
Pinterest and blog posts are exploding with pumpkin brownies, cakes, smoothies, and muffins, but I’m still hung up on summer! I know it’s October, but it’s almost 80 degrees today, and there are still a few fresh tomatoes out there.
For lunch I threw together a quick fresh rainbow salsa and served it on top of what I call egg tacos. What I do is fry an egg on top of a corn tortilla – it’s delish.
Egg Taco
For the salsa I chopped up a fresh tomato, cherry tomatoes, avocado, bell peppers, and cilantro. If you like spice you can add some hot pepper flakes.
Salsa Ingredients
I mixed everything together, then added fresh lime and salt. Easy!
Rainbow Salsa
If you’d like to make my egg tacos, add a little oil to a frying pan on medium-low heat. Place one or two corn tortillas on the pan, then crack eggs on top of the tortillas. When the whites start to cook, break the egg yolk and let it cook a few more minutes. Flip the tortillas  and cook until the egg is cooked through.
Rainbow Salsa

1 medium tomato
10 cherry tomatoes
1/2 avocado
1/2 yellow bell pepper
1/2 green bell pepper
1/2 orange bell pepper
1/4 cup fresh cilantro, chopped
1/4 of a fresh lime, squeezed
Salt to taste
1.  Chop the tomatoes, avocado, and bell peppers into small squares.
2.  Mix all the veggies together and add the cilantro, lime juice, and salt.

Lemon Raspberry Tartlets with Macaroon Crusts

I originally posted this recipe at the beginning of October. It would be a delicious dessert for the new year.

I was visiting my family recently and my mom bought 16 pints of fresh fall raspberries to make chocolate raspberry jam. Wow!

 I was happy just eating these raspberries fresh, but wanted to challenge myself to develop a lemon raspberry FODMAP friendly recipe. After playing around with a few things, I came up with a macaroon crust filled with a healthier version of lemon curd, topped with a delicious raspberry.
This macaroon crust is quite simple – unsweetened coconut, egg whites, and sugar. Mix the three together and press the mixture into mini muffin tin molds. Bake for about 15 minutes on 300 degrees F until the shells are lightly golden brown.
macaroon crusts
The next step is to make the lemon curd. This part is a little more intensive. Whisk together eggs, sugar, lemon juice, and salt, then heat over a double broiler or a make-shift double broiler (instructions below). Whisk until the mixture thickens, stir in the butter, and let cool.
lemon curd
After the lemon curd cools in the fridge for a few hours, mix one cup of the lemon curd with a one cup of 0% Greek yogurt. Adding the yogurt keeps the mixture creamy, but makes the dessert a bit healthier. Fill the macaroon shells with the lemon curd mixture. You’ll have quite a bit of extra lemon curd mixture. Try eating it for breakfast with granola or on top of pancakes.
Top each mini tart with a fresh raspberry. You can also make larger tarts and top with multiple raspberries.
Macaroon Crusts
1/2 cup sugar
2 egg whites (save the yolks for the lemon curd)
2 1/2 cups shredded unsweetened coconut
Butter or oil for greasing
1.  Preheat the oven to 300 degrees F.
2.  In a medium bowl, mix together the sugar, egg whites, and coconut until combined.
3.  Grease a mini muffin tin and press the coconut mixture in with your fingers to form the mini crusts. You will need about a tablespoon for each one.
4.  Bake for 10-15 minutes until the crusts are lightly golden.
5.  This recipe will make about 25 mini crusts.
Lightened Lemon Curd
2 large eggs
2 large egg yolks
1/3 cup sugar
1 Tbs lemon zest
1/3 cup fresh lemon juice
1/4 tsp salt
6 Tbs unsalted butter, cut into pieces
1 cup 0% Greek yogurt
1.  Whisk together the eggs, egg yolks, sugar, lemon zest, lemon juice, and salt in a a double boiler. If you don’t have a double boiler, find a small pot or bowl that will fit into a larger pot with simmering water. Make sure the bowl on top does not touch the water.
2.  Whisk the lemon mixture constantly until the mixture starts to thicken, about 5 to 6 minutes. Don’t let the mixture boil. Remove from heat.
3.  Stir the butter into the mixture until it melts.
4.  Refrigerate the lemon curd for a few hours.
5.  When the lemon curd is cool, mix one cup of Greek yogurt with one cup of the lemon curd.
Lemon Raspberry Tartlets with Macaroon Crusts
Fill each macaroon crust with Lightened Lemon Curd and top with a fresh raspberry.

Back up and running!

After about a month of technical difficulties with my blog, I am back up and running! I will repost the recipes that were deleted and there will be more delicious ones to come.

While I was out I have been busy starting my private practice. I now have offices in Medway and Boston, MA. I’m looking forward to helping people heal their GI tracts.

In other exciting news, a FODMAP friendly certification was released in Australia. Click here to read about it.

FODMAP Friendly LogoI look forward to the day when we have a certification like this in the United States!