Dr. Barbarito at Morris County Surgical Center

Edward Barbarito’s journey as a gastroenterologist started well before it was time to even choose his medical specialty. He developed Ulcerative Colitis (or UC, a type of Inflammatory Bowel Disease) in his early 20’s. His own digestive illness inspired him to want to care for those suffering with similar kinds of illnesses. Today, his life experience gives him special and unique insights into the health and potential of his patients.

ED’S STORY

Ed’s ulcerative colitis diagnosis came just before medical school and he suffered from the disease for more than ten years. He was hospitalized numerous times with varying success. He eventually became gravely ill and, when all medical options were exhausted, had no choice but to have a total colectomy and ileal pouch anal anastomosis. “My entire colon was removed and an ‘artificial’ colon was created from my small intestine,” he explains.

“I often wonder had I paid more attention to my diet and food choices would my illness have been so particularly aggressive,” he reflects. The impact of diet on ulcerative colitis was simply not well understood at the time. “I am now disease free and quite healthy, but my digestive system is forever altered and I remain sensitive to different foods.”

Ed with his grandmother at his college graduation, just before the onset of his ulcerative colitis.

FINDING THE RIGHT WAYS TO EAT WELL & STAY FIT

“Over the past 10 years, through personal research, open dialogue with colleagues and patients, and trial and error I have found the foods best suited to my body’s altered digestive system,” he says. “I avoid gluten and wheat products, minimize carbohydrate intake and generally follow a low FODMAP diet plan. Thankfully this has worked well for me, and my personal experience with digestive illness and subsequent recovery has significantly impacted my approach to patients.”

Out for a run with Bingo!

Ed is an Epicured client and an Epicured supporter, who recommends the service to many of his patients. That’s because most of Ed’s patients share his sensitivities. He treats many patients with Inflammatory Bowel Disease, but he estimates that a staggering 50% of his patients come in for Irritable Bowel Syndrome (IBS). Their symptoms are varied, but the most common ones are debilitating bloating and gas, for which there is no conventional treatment and food is a go-to remedy.

Dr. Barbarito has a real appreciation for how food impacts him physically, emotionally, intellectually, but he always preaches patience when encouraging his patients to make dietary changes. “People need to understand that changing your diet can be a gradual process.” He reminds patients that it’s okay to cheat now and again if that’s what you need to stay motivated and feeling good. “For me, I eat ice cream twice a week! Wednesdays and Sundays!” Because he knows he always has this to look forward to, he can limit himself on other days.

“I truly believe that ‘food is medicine’ and gladly share my experience with my patients,” he continues. “I first and foremost encourage my patients to find their way to good health through proper diet and lifestyle choices as the backbone of their treatment. Conventional medicine has its place in improving many digestive illnesses, but it will never replace proper nutrition.”

Epicured lunch is served! Dr. Barbarito (2nd from right), Carena from Epicured (center), and the Morris County Surgery Center team.

FOOD & MEDICINE COMING TOGETHER

Dr. Barbarito sees a bright future ahead for his field. “Historically doctors would just give you a pill to fix your problem. It’s a tradition dating back hundreds, even thousands of years, but it’s limiting and patients should expect more. If they don’t, they are missing the opportunity to make therapeutic lifestyle changes through things like food and fitness that could have great impacts on their health.”

He sees patients looking beyond typical prescriptions. “The more that patients look to medications to fix problems first, the more exposed they are to all sorts of side effects. I have patients coming to me with chronic GI conditions who have been taking the same prescription drugs for years. They come to me and say ‘I don’t want to be on these medications anymore.’ I need to do something else. This is where the idea of ‘food as medicine’ has real power.”

WHERE DOES EPICURED FIT?

“I’d like to see it incorporated more into medical practices, where physicians and dietitians promote it, as well as in the fitness world,” he tells us. “It tastes great, it fits nicely into my life, and I’m going to continue recommending it to my patients. I want them to feel as good as I do.”

Watch Ed, Don Saladino & Chef Renee talk gut health:

Want to learn more?

Dr. Edward Barbarito, a northern New Jersey-based gastroenterologist, has been caring for patients with digestive illnesses for more than 20 years. He is in private practice at Morris County Gastroenterology Associates and sees patients at two hospitals: St. Claire’s and Morristown Memorial Hospital. Dr Barbarito attended New Jersey Medical School (now Rutgers) in Newark from 1993-1997. He did his internal medicine residency and gastroenterology fellowship there as well from 1997-2000 and 2000-2003 respectively, and was chief medical resident at Hackensack University Medical Center 1999-2000.

Check Out: The Morris County Gastroenterology Associates Website

Meet Sharon! A wonderful client and a savvy chef in her own right. Find out why Epicured has been a “game-changer” for this Fairfield County resident.

EPICURED: Tell is a bit about yourself… job, family, hobbies, anything that comes to mind!

Sharon: Married, overly nurturing mother of two grown children and a black mini poodle. I’m the administrative partner for a financial advisory firm and am lucky to be able to work from home most of the time. I exercise regularly, take walks and hikes with my dog daily, and volunteer with a local community service organization helping motivate low-income high school students in my town to connect to their full potential. I enjoy movies, books, creating delicious meals and gathering with family and friends. Oh, and I developed IBS about three years ago – guess I can’t leave that out!

EPICURED: Let’s start with the positive! You’ve found the low FODMAP diet. You’ve found Epicured. What’s it like for you to be able to eat foods that work well for you?

Sharon: It is AMAZING to be able to come home from a busy day and warm up a DELICIOUS, healthy, nurturing meal which is completely safe for me to eat without any risk of feeling badly in hours (or days) to come! The very best part for me, as an accomplished cook, is that there are so many choices for more exotic fare, things I wouldn’t cook for myself. Epicured is a game changer for me: delicious, well prepared, convenient and low fodmap! I couldn’t be more grateful they branched out to Connecticut.

EPICURED: What role has Epicured played in helping you day-to-day?

Sharon: I feel more energetic and have dropped several pounds. I had a feeling this would happen but was impressed by how FAST it happened.

One of the best things about having a supply of various Epicured meals on hand, is when you are invited to a friends home for a gathering and you can say “I’d love to come but since I have some food intolerances, don’t cook for me, I’ll bring myself something.” Then you don’t feel like a burden nor have to choose between going hungry or risking it. All you need is a microwave and you are good to go!

EPICURED: Any favorites from the menu?

Sharon: I love the Thai Green Curry, the Seared Lamb Medallions, the Pad Thai, The Chicken Lettuce Wraps and I always, always, order extra Turkey Chili as it freezes so well and is easy to thaw out if I know I’m going to have a busy day. I was a huge fan of the Warm Autumn Salad as well and look forward to it being added back to the offerings. And the two different kinds of Energy Bites are so delicious! They not only satiate my sweet tooth but they keep me full and are perfect to throw in my bag when I need to pack a snack.

EPICURED: How did you first discover a low FODMAP diet? What was going on in your life?

Sharon: After about 9 months of suffering with constant pain, distress, bloating and the inability to leave my house every morning, I started to do an intensive amount of research into what was going on with me. An Endoscopy and Colonoscopy ruled out any disease so I was diagnosed with the catchall “IBS” and told to give the low FODMAP diet a try. I had some fits and starts with it and wish I had seen a Registered Dietitian but I didn’t know to (my doctor never recommended it) and though I know a few Nutritionists, none of them were as well versed on IBS or low FODMAP as I had already become. Within a few weeks my stomach calmed down and through the elimination diet I was able to identify my triggers. Then came the arduous work of trying to eat at a restaurant (did you know that onion, garlic, shallots or scallion seems to be in almost everything?!?)

It’s been a journey but I will forever be grateful to the amazing dietitians who have some really smart and educational blogs. Additionally, I joined a few closed (meaning our posts to each other can only be seen by members) Facebook groups and IBS sufferers around the world have helped me learn the ins and outs of this way of life – and made me realize I wasn’t crazy! It was on one of those Facebook groups where I learned about Epicured. At that time they didn’t deliver to me yet, I was out of their range but within a few months they got in touch with me and I’ve been a tremendously happy customer ever since.

Credit: Martha McKittrick

EPICURED CLINICAL NETWORK MEMBER SPOTLIGHT: Martha McKittrick, RDN, CDE, CHWC is a registered dietitian with over 20 years experience and multiple specialty areas. In addition to begin an active member of the Epicured Clinical Network, Martha is on our menu development team where she reviews recipes for low FODMAP compliance.

EPICURED: Welcome! To start, tell us a bit about your practice. What do you like to focus on as a dietitian? What about the work gets you most excited?

Martha McKittrick: I’m a registered dietitian, certified diabetes education and Wellcoaches certified health and wellness coach. I have a private practice on the upper east side in NYC where I specialize in weight management, diabetes/prediabetes, heart health, PCOS, IBS and other GI conditions, sports nutrition and overall wellness. As a wellness coach, I take an integrative approach when counseling my clients and address nutrition, exercise, sleep and stress.

My typical client is a busy New Yorker who needs practical advice on how to fit a healthy lifestyle into a hectic schedule. What I love best about my work is being able to make a difference in someone’s life. I also love all the opportunities that are available to an RD – from working in private practice, to blogging, product development, writing, lecturing, virtual counseling, developing online programs to name a few. The profession has come a long way from when I first started 20+ years ago where most RDs worked in hospitals!

EPICURED: From your blog, I can see you’re a New York foodie! What role does eating out- menu selections – vs cooking at home – play in your practice?

Martha McKittrick: I must admit that my kitchen doesn’t see a lot of action! And these tiny NY kitchens aren’t so conducive to cooking. I tend to work long hours so prefer picking up healthy take-out on the way home from the gym or meeting friends for dinner. When I do cook, it tends to be something simple that I can prepare in 15 minutes or less. I find the majority of my clients work long hours as well. The fact that I can relate to them helps me give more practical advice.

EPICURED: Are you an advocate for having your patients use meal services that suit their goals and health needs? If so, what kinds of benefits have you seen from this? How have these services influenced your approach?

Martha McKittrick: I find most of my clients have hectic schedules and don’t have a lot of time to think about food. They often end up grabbing something “not-so-healthy” on the run. I’m a huge fan of meal delivery services… if they are they are healthy of course! It takes the guesswork of what to eat. Ordering greasy Chinese food or a pizza on seamless versus getting a meal made from wholesome ingredients delivered to your door… it’s a no brainer.

I am especially a fan of meal delivery services catered people with medical issues, including GI issues like celiac and IBS. Having these conditions can be stressful enough. Who needs the added stress wondering if your steak has been cross-contaminated with gluten or if your veggies are sautéed with garlic?

EPICURED: Let’s talk FODMAPs! What is your experience with using the low FODMAP diet for IBS patients? What kinds of successes have you seen?

Martha McKittrick: Years ago (before we knew about the Low FODMAP diet), I gave the standard nutrition advice for IBS such as avoid greasy food, no carbonated beverages or gum, etc.

Then about 5 years ago, I took a course on the Low FODMAP Diet & IBS by Patsy Catsos and Kate Scarlata. It was a game changer for my nutrition practice. I clearly remember counseling my first patient on the Low FODMAP diet. She had constipation and severe bloating for much of her life and was eating huge amounts of fiber in attempts to alleviate the constipation. Once we started the Low FODMAP elimination diet, her symptoms literally disappeared in a matter of 2 weeks. The best part was when we did the reintroduction. We were clearly able to tell it was the polyols and oligosaccharide group that caused her symptoms. She wrote me a note saying “you literally changed my life! For the first time in twenty years I was IBS symptom-free all thanks to the nutritional program you made for me.”

This sold me on the Low FODMAP elimination diet and reintroduction process. I use it very often in my private practice and find it helps the majority of my patients with IBS and other GI conditions.

The Epicured Pad Thai: one of Martha’s favorites! Credit: Ben Fink Productions for Epicured

EPICURED: You do such important work with Renee and culinary team reviewing recipes for low FODMAP compliance. Tell us a bit about that process. What are the biggest challenges? What kinds of things do you look out for during the review process?

Martha McKittrick: It’s important that each menu item be compliant with the Low FODMAP standards. So Renee and I review each ingredient closely to make sure they adhere to the [Monash University] standards.

It can be tricky as the foods allowed  – or not allowed – are always changing according to new research. And not all foods have been tested! Another challenge can be portion sizes. For example, TWO Brussels sprouts are considered Low FODMAP, but more than this is not.

EPICURED: How do you see Epicured helping your clients? What has been your experience so far?

Martha McKittrick: I’ve referred quite a few clients with IBS to Epicured and have gotten great feedback. Not only does it take the stress out of knowing what to eat, but I’ve heard only good things about the quality and taste of the food. I’ve even referred clients who don’t have GI issues, but who are just looking for a healthy meal delivery service.

EPICURED: Any favorites from our menu? Anything you’d like to see?

Martha McKittrick: I’ve tried numerous dishes for Epicured and it’s hard to pick a favorite. Two of my favorites are Pad Thai and the Wild Salmon.

Want to learn more?

Read: Martha’s Blog, “City Girl Bites”

Check Out: Martha’s Website

Read: “Healthiest Office Snacks, as Chosen by Nutritionists”: Martha featured on CNN.com

 

Epicured is a healthcare company that believes in the power of food as medicine. This is what we do…

Make food a celebration.

With our low FODMAP menu and digestion-focused product line, we are helping people with IBS & IBD completely change their relationship with food. What was once bland, stressful, and painful becomes delicious, simple, and joyful.

Prove how powerful food can be.

Thanks to our Michelin-star chefs, expert dietitians, and passionate network of like-minded clinicians, patients with digestive illnesses (IBD, IBS, Crohn’s Disease) are eating better than ever before.

Advance the role of food in healthcare.

We set the standard for collaboration between healthcare providers and food providers, making our culinary team an extension of the care team and the home a place of healing.


JOIN OUR CLINICAL NETWORK!

The Epicured Clinical Network is a group of doctors & dietitians that have made Epicured an extension of their care team. They come from health systems, private practices, academic centers, and wellness centers and are united by the belief that food is medicine.

As a Clinical Network Member, you get…

  • A Concierge Dietitian assigned to your practice to warmly receive patients you refer
  • Beautiful, educational print and digital materials, including our original “Low FODMAP Cheat Sheet”
  • Opportunities to collaborate on digital content, social media, and much, much more!

To join, contact our Clinical Affairs team! 

Carena Lowenthal, MS, RD, CHWC
Director, Clinical Affairs
carena@getepicured.com

Want to learn more?

Meet a few of our clinical network members: Gastroenterologist Edward Barbarito, Registered Dietitians Stefani Pappas & Martha McKittrick, and celebrity personal trainer Don Saladino

 

Credit: Ben Fink Productions for Epicured

Carena Lowenthal is a registered dietitian, certified health & wellness coach, and herself an IBS-sufferer. She works closely with members of Epicured’s Clinical Network to make sure that their patients have an excellent experience using Epicured to manage digestive illnesses.


LOW FODMAP ELIMINATION DIET

By now you probably know about what a FODMAP elimination diet is. You avoid an extensive list of foods that are high in FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols). But once you take these all out for the 2-6 weeks usually recommended by a Registered Dietitian, then what?

THE RE-INTRODUCTION PHASE

This is a basic overview, not to take the place of a dietitian-supervised approach.  Because if you go through the work of doing the elimination, you might as well be assured you are re-introducing correctly. That said – there is a way, an order, and a method for monitoring symptoms that you need to know – and working with someone with expertise in this area, you are more likely to get to the root of the problem, identify the food group(s), then narrow down your specific intolerance(s).

A quick overview:
During the “testing phase”, you will re-introduce one food group at a time with a washout period in-between the groups. On day 1 of a food, you will have a smaller portion size (1/2 the general normal size portion).  Then on day 2, if you had no symptoms from day 1, you will have a full portion size of that food. Then you wait at least 2 days before starting the next food.
The typical test foods are:
  • Polyols (Sorbitol) – Blackberries
  • Polyols (Mannitol) – Mushrooms
  • Lactose – Regular Milk
  • Fructose – Honey
  • Fructans – Garlic
  • Fructans – Onions
  • Fructans – Bread
  • GOS (galacto-oligosaccharides) – Black Beans

Note: Portion size counts when you do the re-introduction. The sequence of foods that you reintroduce also matters in some cases. Finally, once you know the food group, it is possible to narrow down further your specific intolerance(s).

HOW CAN EPICURED HELP?

Credit: Ben Fink Productions

All of the fresh, delicious and healthy food from Epicured is 100% low FODMAP and gluten-free. So you can safely use Epicured while you are on the elimination diet.

This is a huge help for anyone – especially those that typically order in, eat out, don’t like to cook, and really anyone that just wants to have help with the restrictions. Then when you are doing the re-introduction, well you are still safe to use any of the Epicured meals or snacks. And finally, once you are back to your personalized diet plan, you can still use Epicured whenever you like. While eating low FODMAP all the time is not recommended once you’ve identified your triggers, it’s fine to supplement many of your meals with Epicured.

 


LOOKING FOR MORE RESOURCES?
Try our Low FODMAP Cheat Sheet
This content is for informational purposes only and does not take the place of medical advice.

Credit: Stefani Pappas

EPICURED CLINICAL NETWORK MEMBER SPOTLIGHT: Stefani Pappas, MS, RD, CDN, CPT, works as a Clinical Dietitian at St. Francis Hospital and also sees clients in her private practice in Great Neck, NY.

EPICURED: Welcome Stefani! To start, tell us a bit about your practice. What do you like to focus on as a dietitian? What about the work gets you most excited?

Stefani Pappas: My practice is called Stef Health Tips and is located in Great Neck, NY. As a Registered Dietitian Nutritionist, I am dedicated to leading a healthy and active lifestyle, and inspiring others to do the same. My approach encourages whole, natural, and real foods, but works with clients to incorporate their favorite foods into a balanced diet. I enjoy seeing my clients fall in love with a healthy lifestyle and become their very own nutrition expert!

EPICURED: From your Instagram, I can see you’re a passionate cross-fitter! What role does fitness play in your practice?

Stefani Pappas: I truly believe that good health requires a balance of nutrition and physical activity; you just can’t have one without the other in my book! I’ve always been passionate about fitness and how empowered it makes me feel. With my Registered Dietitian and Certified Personal Training background, I’m able to create nutritious meal plans and “fitness prescriptions” for my clients. Sticking to a fitness regimen, even if it is just walking 30 minutes a few times a week, is a requirement to work with me!

EPICURED: Let’s talk FODMAPs! We first connected after you wrote a piece on the low FODMAP diet for Long Island Weekly. What inspired you to want to cover that topic?

Stefani Pappas: I work closely with Dr. Fred Gandolfo, a Gastroenterologist at Precision Digestive Care in Huntington, NY. We have collaborated on many different cases to show that proper nutrition and medical therapies can provide effective care to patients suffering from IBS and other GI diseases. Learning more about the low-FODMAP diet with my IBS clients inspired me to write the article! The diet is very specific but can be broken down into a simple, easy to understand way.

WATCH STEFANI’S EPICURED INSTAGRAM TAKEOVER:

EPICURED: What is your experience with using the low FODMAP diet for IBS patients? What kinds of successes have you seen?

Stefani Pappas: I have seen tremendous improvements in symptoms of my patients with IBS on a low-FODMAP diet. The re-introduction phase is fun because you realize how passionate people are about their food! We are typically able to incorporate back some of my client’s favorite foods, but portion sizes play a key factor in regards to tolerance.

Epicured’s Vanilla Coconut Raspberry Chia Seed Pudding. Credit: Ben Fink Productions

EPICURED:Any favorites from the Epicured menu? Anything you’d like to see?

Stefani Pappas: I never liked chia seed pudding until I tried Epicured’s version- it is delicious! The Tikka Masala is another one of my favorites. I loved the dragon fruit smoothie and would like to see more smoothies on the menu.

EPICURED: How have you seen the RD’s role change or grow in treating medical conditions such as IBS (or diabetes, heart disease, etc.)? Do you feel this relate to a broader “food as medicine” movement happening in healthcare?

Stefani Pappas: I take great pride in my role as a Registered Dietitian, and I truly believe that nutrition is the cornerstone of good health. I think my passion for the field, as well as results with my clients, has shown an example to the healthcare professionals that I work with. I’m seeing more and more doctors and other healthcare providers taking interest in nutrition and its role in good health.

EPICURED: What else should our readers know about you? When you aren’t working, what do you like to do (hobbies, volunteer work, family)?

Stefani Pappas: I come from a big Greek family, and I’m extremely passionate about Mediterranean cooking. My family’s interest in the Mediterranean Diet is one of the main reasons why I became interested in pursing a career in nutrition. I love whipping up my Grandmother’s delicious Greek recipes that are packed with good nutrition and flavor!

Want to learn more?

Read: “What is the Low FODMAP Diet” from Long Island Weekly

Check Out: Stefani’s Website

Follow: @stefhealthtips on Instagram

 

Carena Lowenthal is a registered dietitian, certified health & wellness coach, and herself an IBS-sufferer. She works closely with members of Epicured’s Clinical Network to make sure that their patients have an excellent experience using Epicured to manage digestive illnesses.

 


ABOUT IBS AND THE LOW FODMAP DIET: If you are one of the 15-20% of the population with IBS (Irritable Bowel Syndrome) and you haven’t heard of the low FODMAP diet, you are certainly not alone. I am a registered dietitian with a digestive issue and I only heard about it 5 years ago! The diet can be so valuable to people suffering from IBS, myself included, that I decided to take the elimination challenge and can now speak first-hand, about how life-changing this could be.

Let me start with what FODMAP stands for: Fermentable Oligo-, Di-, Mono-saccharides And Polyols.
FODMAPs are essentially a bunch of short-chain carbohydrates that are poorly absorbed in the small intestine and pass into the large intestines where there are fermented by the bacteria that live there. They may also pull water into the large intestine. Both of these actions may cause symptoms such as abdominal pain, gas, bloating, diarrhea and/or constipation.

THE FODMAP “ELIMINATION”

The list of permitted foods is very specific. While certain foods will be easily identifiable, for others you will need to consult with a list to get started. You’ll typically begin with a strict “elimination” diet that usually lasts between 2 and 6 weeks.

Low FODMAP Turkey Meatballs with Basil & Pomodoro Sauce. Photo: Ben Fink Productions for Epicured. 

If you are feeling relief during the elimination phase, you can add back certain foods, with one of the FODMAP groups at a time, in small amounts, to see what you are most sensitive to. This I would recommend doing methodically with a registered dietitian. There is a good chance that after the challenge you may be able to add back and tolerate a certain amount of a food you are sensitive to in a given day, or at a particular meal, but this will vary with individuals. I will go through the dietary carbohydrates and some of the foods that contain them, but definitely consult with a complete list from a reliable source.

“FODMAPS” 101

Fructose: a natural fruit sugar found in many fruits, honey, high-fructose corn syrup and agave can be a problem either due to the lack of an enzyme in the body or the ratio of glucose to fructose in a fruit. Fruits with a high glucose: fructose ratio are generally well tolerated, such as blueberries, strawberries, cantaloupe, honeydew and ripe bananas, but those with a high fructose: glucose ratio such as apples, watermelon and mangoes may not be.
Lactose: a carbohydrate found in dairy products can be a problem due to a partial or complete lack of the enzyme lactase which digests lactose. Foods such as cow’s milk, yogurt and ice cream are lactose containing foods.
Fructans: are carbohydrates that are completely malabsorbed because the intestine lacks an enzyme to break their fructose bond. Wheat accounts for most of people’s fructan intake, which can be found in breads, cereals, and pasta, but they can also be present in onions, garlic and other vegetables. This is not to be confused with Celiac Disease, or a gluten sensitivity which is related to the wheat protein, gluten.
Galactans: are carbohydrates that are also malabsorbed because the intestine does not have the enzyme to break them down. Beans, peas, and lentils are primary examples.
Polyols: also known as sugar alcohols, are found naturally in some fruits and vegetables and also added to sugar-free gum, mints, and cough drops. The names of some of these artificial sweeteners end in ol- like sorbitol, xylitol, mannitol, and malitol. Apples, pears, stone-fruits, mushrooms, and cauliflower would also be high sources of polyols.

GETTING STARTED

It may seem like a lot of foods will be “off limits.” But keep in mind this is only during the elimination phase and hopefully you will be able to add back some of your favorite foods, or other versions of them.
More importantly, we are here to help you! Epicured’s Michelin-star chefs and registered dietitians have developed wonderful low FODMAP, digestion-friendly recipes for all of your favorites, like: Pad Thai, Tikka Masala, even chili! Our entire menu is even permitted during the elimination phase!

 

LOOKING FOR MORE RESOURCES?
Download: The Monash University FODMAP App
Follow: @katescarlata on Instagram