Saturday, 1 December 2018

December 2018: indigestion




INDIGESTION


“The simple way to feed a healthy gut is to eat a varied diet, especially fruit and vegetables”...……[1]
Not easy, nowadays. We’re busy, and all those tempting ready meals, snacks, sweeties and drinks, are paraded in front of us all day, every day. They are not generally made with our best interests at heart. 
How do we cope? With indigestion. 
Drug companies have no incentive to search for a long-term indigestion cure - especially when that cure involves simple diet changes. It's like killing the goose that lays the golden eggs. Indigestion delivers trillions of dollars into their coffers every year. So they’re not going to tell you about simple dietary remedies: they’re too busy finding ways to give you temporary relief [2].
So what to do?

Indigestion is a general term that describes a group of unpleasant symptoms: pain in your upper abdomen, burning, discomfort, feeling full too soon while eating; and feeling unpleasantly full afterwards. 
Common factors that cause it include overeating, eating too quickly or fatty, greasy or spicy foods; smoking, anxiety, too much caffeine, alcohol, chocolate, carbonated beverages and medicines like NSAIDs, steroids, narcotics, or antibiotics.
Here is a list of possible problems, though they often overlap. 

Heartburn, acid reflux, and GERD are terms which are often used interchangeably. They actually have different meanings.
Acid reflux: most people reach for antacids when they’re experiencing indigestion and bloating, but low stomach acid is very often the culprit …. and you may be doing serious damage to your health while taking antacids. 
When stomach acid is too low, the proteins in your stomach can start to ferment, which creates pressure. This pressure pushes open the valve at the top of your stomach, splashing into your esophagus and causing acid reflux and heartburn. Gastroesophageal reflux disease (GERD) is the chronic form of this [3].
Simply supplementing the nutrients which produce stomach acid can fix the whole problem at its root: vitamins B2 (riboflavin), B3 (niacin) and B6 (pyridoxine) are the most common ones [4]. In fact, vitamin and mineral deficiencies can cause a vicious cycle of low stomach acid and malnutrition because they are all needed for the acid production [5].

Gastritis means the lining of your stomach is inflamed. Mostly caused by excessive use of certain painkillers, alcohol consumption, injuries or stress, it’s usually easy to treat. Changing your diet (and other ways!) normally cures it. See [6]. For if not dealt with early, ulcers can follow and increase the risk of developing cancer [7].

Gallstones may be the problem if your indigestion is worse after fried foods. The symptoms are very similar to general indigestion: bloating, burping, pain in the upper abdomen. It may come on after a fatty meal, starts 30-120 minutes after eating and is worse on the right-hand side where gallbladder and liver lie. Obesity, diabetes, a high-fat diet, sedentary lifestyle, and pregnancy increase the risk of developing them. Once you have them, see [8]. 

And then there is coeliac disease: see the Thought of September ’18 about gluten. 
If the pain in your stomach area radiates towards the back, you have pancreatitis [9].
For the causes, symptoms and prevention of stomach cancer, see [10]

You may or may not have heard of FODMAPs, the latest fashion in food research. ’Fermentable Oligo-, Di-, Mono-saccharides And Polyols’ can cause digestive discomfort in some people. A low-FODMAP diet might help to improve short-term digestive symptoms in adults with functional gastrointestinal disorders, like irritable bowel syndrome. But in fact, in the long term, these FODMAPs actually produce beneficial alterations in the gut flora and help avert problems. Apples, wheat, milk, beans, peas, onions, sweeteners: this is just a tiny fraction of foods you can’t eat if you want to avoid FODMAPs [11]. However, as luck would have it, you should not stick to it for too long for that’s very bad for your gut [12].

For indigestion in general, here are some things you can do to start with.
Do
cut down on tea, coffee, cola or alcohol
prop your head and shoulders up in bed – this can stop stomach acid coming up while you sleep
lose weight if you're too heavy
Don't
eat 3-4 hours before going to bed
have rich, spicy or fatty foods
take ibuprofen or aspirin – this can make indigestion worse
smoke
But see a GP if you are in bad pain, have lost a lot of weight without meaning to, have difficulty swallowing, keep vomiting, have iron deficiency anemia, feel a lump in your stomach, have bloody vomit or poo [13].

More tips for those who get bloated:
  • Eat small meals, eat slowly, and chew well.
  • For some people, fruit causes bloating when eaten straight after a main meal. Eat it separately, 30 minutes before, or two hours after. And don’t have raw veg and fruit at the same meal. They require different enzymes to digest.
  • Eat proteins first. They need lots of hydrochloric acid for proper digestion. If the stomach is first filled with carbohydrate foods which don’t require this acid, the protein will remain undigested. And eat salads and breads with the meal or last, not first.
  • Eat yoghurt and other lactic acid foods with every meal, like sauerkraut, sourdough bread, cottage cheese, garlic.
There are herbs and spices which improve digestion, each in a different way: aloe vera, aniseed, caraway, cardamom, cayenne, chamomile, coriander, cumin, dandelion, dill, fennel, ginger, lemon balm, marjoram, mint, nutmeg, parsley, rosemary, turmeric. Try and see what suits you. In general fresh is better than dried, due to the high levels of preservatives used [14].
Bone broth, too, is excellent [15]. 

Oyez oyez: Bad news for the producers of aspirin. A recent trial shows that taking daily low-dose aspirin doesn't prolong health in otherwise healthy people aged 70 and older. In fact, the group taking aspirin had a slightly increased risk of death (https://health.usnews.com/health-care/articles/2018-09-16/is-daily-low-dose-aspirin-really-worth-it-for-seniors).


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EAT:
Veg: Brussels', beet, sprout tops, cabbage, celeriac, celery (with Stilton!), corn salad, Jerusalem artichokes, carrots, salsify, kale, kohlrabi, landcress, leeks, parsnips, pumpkin/squash, rocket, spinach, swede, turnips, winter (= black) radish, endive, winter purslane.
Meat: wood pigeon, pheasant, wild duck, goose, grouse, partridge, venison. For (Christmas) game recipes, see [16].
Fish: coley, megrim, hake, clams, crab, cuttlefish, mussels, oysters, scallops, whiting
See also [17] for what to eat this month.

PLANT:
Shallots are traditionally planted on the shortest day. You can still plant garlic.
If you leave veg in the ground, apply a thick mulch (straw, bracken or newspaper): for protection, and so as to get them out easily.

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The following recipe appealed to my sense of humour. Though it’s nice as well, and dead simple! Serve for a party, or for guests after dinner.
The better the quality of the cheese of course, the better the apple.
SPICED APPLE CHEESE BALL
240g grated Cheddar, 125g cream cheese, 1 small squashed garlic clove, pinch red pepper, paprika, 1/4 cinnamon stick, small bay leaf.
Mix cheeses, garlic and red pepper well. Shape into a ball, tapering it a bit at the bottom, and make an indentation in the top to resemble an apple. Chill for 30 mins.
Coat heavily with paprika; cover and chill 1 hour. Insert cinnamon stick and bay leaf into the indentation to resemble apple stem and leaf. Serve with crackers.

FANCY LAMB CHOPS for 2.
2 lamb chops, 1 tblsp olive oil, 2 tsp Worcestershire sauce, (15g butter), 1 sprig rosemary, 1 clove garlic, 60ml ruby port, some olives (much nicer with their stones I think!).
Mix oil and Worcestershire, dip the steaks in it. Cook the lamb as normal in this oil mix, but ab. 5 minutes before the end put in the finely chopped rosemary, garlic, port and olives. If the lamb did not have much fat, add butter. Cook till it’s all done, maybe let the sauce reduce if necessary. 

ALOO KEEMA - MINCED LAMB with POTATOES
This recipe is slightly more complicated than my normal fare. Don't be put off by all the ingredients though: use what you have, and/or substitute, and don't worry! You can make lots and freeze some for the future. 
450g minced lamb, 2 cubed potatoes, cubed, 3tblsp oil, 1 bay leaf, ½tsp mustard, 3 green cardamom pods cracked open,  2½cm cinnamon stick, 2 chopped onions, 3 chopped garlic cloves, ½tsp ginger, 180ml chopped tinned tomatoes, 1/4tsp turmeric, chilli powder, 3tblsp yoghurt, salt. Chopped coriander leaf to garnish.
And coarsely grind together:
1tsp cumin seeds, ½tsp coriander seeds, black peppercorns, 4 cloves, 1/4tsp fennel seeds.
In a pan with lid, heat up oil slowly. Add bay leaf, cinnamon stick and cardamom pods. Add onions, cook till they turn light brown, 3-5 mins. Add garlic and ginger and saute for about 1 min. Add ground spices, toast for another min. Add tomatoes with turmeric and chilli. Cook for 3-5 mins or till you see oil separating on the sides of the pan. Add potatoes, mix, reduce heat to low. Let cook, covered, for 10-15 mins till the potatoes are nearly done. Remove lid, turn heat to high and add lamb. Heat for ab. 8-10 mins on medium, stirring often. Add yoghurt, 60ml water and salt, mix. Completely switch down the heat, cover and simmer for ab. 25 mins. Stir and check periodically to ensure it's not sticking. Add more water if needed, but not too much!! Remove lid, check salt and cook on high again for 5 mins till everything comes together. Garnish with chopped coriander, serve warm with flatbreads and salad.
My chicken (3k) was probably too big, it seemed to need quite a bit longer, but once done the taste was delicious.
FESTIVE CHICKEN serves 4-6.
150ml red wine, 100g tomato paste, 3 sprigs of thyme, 3 sprigs of marjoram or ½tsp dried, 100ml red wine vinegar, 1 whole chicken cut into 8 pieces (approx. 1½kg), salt and ground black pepper, 500g small potatoes, 3 onions in quarters, 6 carrots cut into quarters lengthways.
Mix wine, tomato paste, herbs and wine vinegar. Season chicken pieces with plenty of salt and pepper then marinade in fridge for at least 30 mins. Boil potatoes for 1-2 minutes, drain. Place onions, carrots and potatoes in a tray big enough to fit chicken as well, pour over 125ml of water. Preheat oven to 200°C. Arrange chicken pieces skin side up, on top of the veg. Pour the rest of the marinade over. Cover with foil and roast for 30 mins. Remove foil and baste chicken with the cooking liquid. Roast uncovered, for another 15 mins or until the skin is crisp. Serve immediately.


For more recipes, check old winter Thoughts. Or go to https://thoughtforfoodaw.wordpress.com, which still has eight recipes for this year.
We also have an alphabetical index of subjects, which you will see if you click on this month, in the top right hand corner.

Next month:"Listen when the body whispers: don't wait for it to shout!" To see this now, go to https://thoughtforfoodaw.wordpress.com and scroll down.


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[1] “What’s up with your gut?” Chloe Lambert in the New Scientist 15/9/18 - see 'New Scientist - gut problems' on the right hand side of this page.
[4] in, respectively:
B2: liver, mackerel, kale, cabbage, (+ brussels, broccoli, meat, cheese, almonds, mushrooms, marmite/brewer’s yeast, eggs, milk. Damaged by light. 
B3: (esp. organ) meat, fish, peanuts, mushrooms, legumes.
B6: garlic, cauli banana, kale. potatoes, nuts/seeds, fish, poultry/meat, dried fruit, capsicum, broccoli, marmite/brewer’s yeast, whole grains, beans/peas, potatoes in their skins.
[5] https://bodyecology.com/articles/low_stomach_acid_symptoms.php
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