Laura Manning is a Clinical Dietitian at The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai. Today, she is discussing the Benefits of Staying Hydrated.

Getting Comfortable with the Elimination Phase

The Elimination Phase of the Low FODMAP Diet means that we remove all foods containing fermentable carbohydrates that may be causing IBS-type symptoms.  This is a highly effective method to help determine our trigger foods.  When consumed and combined with our gut bacteria, trigger foods can cause potential gas, bloating, constipation and diarrhea.  The feedback we receive from following the Low FODMAP diet can provide us with lifelong tools to optimize our digestion. Understanding which foods we may be intolerant to can help us modify what we eat when dining out, traveling or simply having a comfortable belly during the workday.  It has become a widely used therapy, backed by science, to help people with gastrointestinal issues learn how they can manage their symptoms with food choices. (do you need me to list the studies, there are many…)

The Elimination Phase involves limiting lactose, fructose, fructans, galacto oligosaccharides and poyols, including foods such as certain dairy products, honey, garlic, onions and mushrooms, to name a few.  The most common (almost panic) questions I receive when speaking to patients is “how am I going to avoid garlic and onions when it is in everything I eat at home and at restaurants?” and “I thought garlic and onions were good for me?” The truth is that garlic and all other FODMAPs are not bad for you at all, but certain patients need to take a break from them for a while, then add them back in at a later date to determine their tolerance threshold.

It is true that garlic, onion, shallots and leeks are the base of most cuisines worldwide and appear on every restaurant menu. They also serve as healthy additions to a diet and have been proven to have cardiovascular health benefits due to the sulfur compounds (allicin) they contain when they are crushed, chopped cooked with and chewed. These ingredients also impart such a fragrance that as soon as you begin to cook with them, they fill your home with an aroma that makes you feel as though you’re dining al fresco on the Mediterranean Sea. As a dietitian, knowing that a patient who is reporting so many of the classic IBS symptoms, and uses so much of these fructans everyday, makes me feel confident that the Low FODMAP diet will be successful in improving their symptoms.

So, how do you flavor your meals while doing a low FODMAP diet?

There are so many other ways to add flavor without adding garlic and onions – trying new options may even expand your palate! Other flavorful options include dried or fresh herbs, such as basil, thyme, parsley, oregano, cilantro, and spices, such as pepper, mustard, cinnamon, chili powder, paprika, saffron and turmeric. However, it is important to know that dried versions of garlic and onions in powder form are not used in the elimination phase. These items have just been simply dehydrated – all FODMAPs remain in a concentrated form. A solution for those missing onions is to use a pinch of an Indian spice called asafetida, available at specialty spice markets. Additionally, you can use the green parts of spring onions and chives to retain a bit of onion flavor.

A perfect solution for those who still don’t know what to do without garlic flavoring is to sauté whole garlic cloves in oil and remove the bulb before eating.  Another tip is to use infused oils, which is an excellent way to keep the flavor of the garlic without the FODMAPs (see recipe below). This is because FODMAPs are not soluble in oil, so the flavor can be extracted from the fructan without the fermentable carbohydrate remaining.  Since fructans are soluble in water, cooking with them in soups and stocks will contain the fructan and will not be allowed in the Elimination Phase. An important tip to remember when shopping for soups and stocks is to read the product ingredient labels to see if they contain a FODMAP. Whether the stock comes in liquid or powder form to be reconstituted, most do contain garlic and onions and should be avoided.  Simply make them with infused oils and other herbs and spices and you will be able to enjoy all of your favorite dishes. There are now soups, stocks and dressings on the market that are Low FODMAP certified! It is great to know that there are now many seasoning options on the market that do not contain FODMAPs and can be a very helpful way of adding combinations of flavor to meals.

How to Make Infused Oil

For the best infused flavors, start with the right oils.

It is best to use an olive oil that is light to mild to highlight the infused herbs instead of a stronger, grassy-type like extra virgin that may mask the infused flavors. It is also recommended to use canola, sunflower, or safflower oils because of their neutral flavors.

Cold infused

  • Best for using fresh herbs (parsley, basil, thyme, etc.)
  • Use 1 cup of loosely packed fresh herbs to 1 quart of oil
  • Use a food processor to chop up the herbs and then combine with oil
  • No need to let it sit for a long period of time.  Just strain it and be sure to store in a glass bottle in the fridge.  This type will last about 1 week.

Heat infused

  • This method is best for using woody herbs and dried spices (rosemary, chiles, peppercorns, garlic, etc.)
  • Heat the oil to 250°F and add ingredients after the oil has been removed from the stove and cools for 30 minutes. Let it sit until you reach your desired flavor. Strain it and store in a glass bottle.
  • This oil does not need to be refrigerated.

ENJOY!!!

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DISCLAIMER: Mount Sinai is an investor in Epicured. This material is for informational purposes only, and Mount Sinai makes no representation or guarantee as to any results or experience with Epicured. You should consult with your physician before using a dietary program such as Epicured. Mount Sinai employees do not receive material benefit from endorsing or recommending Epicured. 

Laura Manning is not employed by Epicured. Laura is a full-time employee of the Mount Sinai Health System and receives no compensation, monetary or otherwise, from Epicured. 

Laura Manning is a Clinical Dietitian at The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai. Today, she is discussing the basics of lactose intolerance.   

THE BASICS

According to the 2020 Dietary Guidelines for Americans, it is recommended that adults consume 3 servings of low fat or fat free dairy products daily as part of a healthy diet.[i] Dairy products consist of milk, yogurt, cheese and kefir and supply the primary source of calcium for Americans. Calcium is associated with improved bone health and is especially important to consume during childhood and adolescence, as bone mass is being built at this time.[ii] In adults, dairy intake is associated with lower blood pressure[iii] and a reduced risk of cardiovascular disease[iv] and type 2 diabetes. [v],[vi]

One 8-ounce glass of milk from cows, sheep and goats consists of carbohydrates (12g of lactose) for energy, protein (6-8g of casein) for growth, fat for brain health, and the all-important calcium for bone development. The fat content can vary widely as there are a variety of milk choices on the market; from milk that contains zero fat (skim) to milk with a full fat content (whole). Additionally, dairy milk is comprised of phosphorous, potassium, magnesium, vitamins A, D, B12, niacin and riboflavin. It is a widely consumed beverage and supplies us with important nutrients across the lifespan.

Fact: Most people are born with the innate ability to digest dairy, as lactose is found in breast milk. However, the ability to digest dairy milk may become more and more difficult as we get older. It is estimated that about 30 million Americans are lactose intolerant by the age of 20.[vii]

WHAT CAUSES LACTOSE INTOLERANCE?

We typically digest milk with an enzyme (lactase) found in our small intestine. Lactase cleaves the sugar from milk into glucose and galactose to make it more digestible. This product is then absorbed into the bloodstream to be used for energy. However, some people may not produce adequate amounts of the lactase enzyme and, as a result, may experience symptoms such as gas, bloating and diarrhea soon after consuming milk products. Low enzyme levels cause the lactose to remain intact as it travels to the colon, where it attracts bacteria and begins to ferment. The uncomfortable symptoms associated with an intolerance are a result of this fermentation process.

TYPES OF LACTOSE INTOLERANCE

Primary lactose intolerance is the most common food intolerance in the world and is more prevalent among certain cultures. It is the most common form of the disorder and is often founds in people of African, Asian, Hispanic, Mediterranean and southern European descent. Secondary lactose intolerance may arise due to an injury, surgery or illness where inflammation or changes in the small intestinal structures occur. Crohn’s and Celiac disease are the two most common intestinal diseases associated with having lower levels of lactase production. This is a very frequent topic that I discuss with patients at the IBD Center at Mount Sinai. Lactose intolerance can also present during a Crohn’s or Ulcerative Colitis flare.

There is a small subset of people who may have intolerance to casein, the protein component in milk. Of the 6-8 grams of casein in milk, 2-3 grams are known as beta casein and come in two forms, known as A1 and A2. Most cows contain an even distribution of A1 and A2, but before milk became industrialized, most cows were producing A2. A2 milk may be an easier to tolerate form of milk and you will see it beginning to pop up in the dairy aisle.

YES, THERE ARE LACTOSE-FREE CHEESES!

If you have lactose intolerance, it does not mean that you should avoid all dairy products. This is a common misconception and can lead people to miss out on the important nutrients that dairy products provide. There are varying levels of lactose in dairy products, ranging from 12 grams in a glass of cow’s milk to 1 gram in a serving of aged cheddar cheese. Most people with lactose intolerance can tolerate up to 12g of lactose in one sitting, and approximately 18g of lactose if spread throughout the day.[i] However, some individuals may need the help of an added enzyme to assist with their digestion. Over-the-counter enzyme pills and chewables consumed at the time of meal will help break down the lactose, making it more enjoyable to eat without all of the gas and bloating that typically accompanies digestion. It may even be possible to train the body to tolerate lactose if given small amounts over a period of time.[ii] Additionally, having lactose-containing dairy as part of a meal, rather than on an empty stomach, will further help aid in the digestion process.[iii]

On a Low FODMAP diet, lactose is one of the fermentable sugars that should be lessened in the elimination phase of the diet. You are able to consume dairy products on the Low FODMAP diet, but the lactose content should be small. Take a look at the Nutrition Facts label. The lactose will be considered ‘low’ if there are 4 grams of carbohydrate or less per serving. Just be sure, keep it to the serving size indicated and have one single serving per meal. Low lactose cheeses permitted with this diet include aged cheeses such as cheddar, Swiss and Parmesan. Greek yogurt is low lactose as well, but try stick to the unflavored/original yogurts and add fruits for natural sweetness. You’ll be happy to know that butter is almost completely lactose free! You can also select dairy products that contain the lactase enzyme in them. Dairy can be challenging to tolerate for many people, but following a few guidelines on food choice and quantity allows you to keep it in your diet and reap all the nutritional benefits dairy has to offer.

Resources that can help you:

Mount Sinai Make an appointment at the Feinstein IBD Clinical Center here or contact the office at 212.241.8100.

Epicured For exceptional low FODMAP, IBD-friendly prepared meals delivered right to your door, visit our menu.

DOWNLOAD the Low FODMAP Cheeseboard infographic!

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DISCLAIMER: Mount Sinai is an investor in Epicured. This material is for informational purposes only, and Mount Sinai makes no representation or guarantee as to any results or experience with Epicured. You should consult with your physician before using a dietary program such as Epicured. Mount Sinai employees do not receive material benefit from endorsing or recommending Epicured. 

Laura Manning is not employed by Epicured. Laura is a full-time employee of the Mount Sinai Health System and receives no compensation, monetary or otherwise, from Epicured. 

REFERENCES: 

[1] Dietary Guidelines for Americans 2015-2020. Recommended amount of dairy to be consumed daily for Americans 9 years and older. www.choosemyplate.gov. accessed June 8, 2018.

[1] Weaver CM, et al. The National Osteoporosis Foundation’s position statement on peak bone mass development and lifestyle factors: a systematic review and implementation recommendations. Osteoporosis Int. Published online Feb 8, 2016.

[1] Machin DR, Park W, Alkatan M, Mouton M, Tanaka H. Effects of non-fat dairy products added to the routine diet on vascular function: a randomized controlled crossover trial. Nutr Metab Cardiovacs Dis. 2015;25(4):364-369.

[1] Dalmeijier, GW, et al. Dairy intake and coronary heart disease or stroke: A population-based cohort study. Int J Cardiol 2013;167:925-929.

[1] Margolis, KL, et al. A Diet High in Low Fat Dairy Products lowers diabetes risk in in post menopausal women. J Nutr 2011;141:1969-1974.

[1] Sluijs I, et al. The amount and type of dairy product intake and incident of type 2 diabetes: results from the EPIC-InterAct Study. Am J Clin Nutr 2012;96:382-390.

[1] Lactose intolerance. Statistics accessed from the web June 6th, 2018. U.S. National Library of Medicine. https://grh.nlm.nih.gov/condition/lactose-intolerance#statistics.

[1] Corgneau M, Scher J, et al. Recent advances on lactose intolerance: Tolerance thresholds and currently available answers. Crit Rev Food Sci Nutr. 2017;57(15):3344-3356.

[1] Pribila BA, Hertzler SR, Martin BR, Weaver CM, Savaiano DA. Improved lactose digestion and intolerance among African-American adolescent girls fed a dairy rich diet. J Am Diet Assoc. 2000; 100(5):524-8.

[1] Shaukat A, Levitt MD, et al. Systemic Review: Effective management strategies for lactose intolerance. Annals Int Med. 2010; 152(12):797-803.

 

 

 

 

 

 

 

 

Laura Manning is a Clinical Dietitian at The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai.

Inflammatory Bowel Diseases (IBD) such as Crohn’s disease and ulcerative colitis are believed to be caused by a combination of genetic predisposition and alterations in the gut microbiota. These disorders are on the rise in industrialized areas like North America and Western Europe [1], forcing scientists to reconsider the role of modern diets in the development and management of these diseases. Indeed, our gut bacteria look quite a bit different from our ancestors’ as we eat more and more processed foods to help us keep up with our busy lives and to allow us to prepare foods quicker and easier.

Can Food Choices Descrease Your IBD Risk?

Studies show that certain dietary patterns may put people at greater risk for IBD [2]. For example, having a low-fiber, high-fat diet may increase inflammation and cause disease relapses. This is typical of a diet with a lot of processed foods. In contrast, a diet high in soluble fibers, fruits and vegetables and low in saturated fat may be beneficial to our microbiome and have anti-inflammatory properties. [3,4]

Our Low FODMAP Lemon Rosemary Chicken meets many of Laura’s “IBD-friendly” requirements. Photo credit: Ben Fink Productions for Epicured.

FOOD AS IBD TREATMENT

In addition to conventional medication focused on modifying the immune-inflammatory pathways in the gastrointestinal (GI) tract, diet can also play an essential role in the management of IBD, especially for patients with a lot of unpleasant GI symptoms such as diarrhea, urgency and abdominal cramps. Unfortunately, there is not enough scientific evidence to suggest that there is a “silver bullet” diet for IBD, or, for that matter a single diet approach that can take someone with IBD from a very severe flare-up all the way down to remission (i.e. no signs of inflammation at all).

The good news is that in academic medical centers across the world (including at Mount Sinai where I practice), there are studies underway to look at the link between IBD and a variety of diets, including, of course, low FODMAP.

Low FODMAP & IBD: What We Know Today

There is very strong evidence showing the benefits of the Low FODMAP diet for managing symptoms in patients with Irritable Bowel Syndrome (IBS), a much more common disorder of gut-brain dysregulation with many of the same symptoms as IBD [5].  We are now seeing that the diet can help manage symptoms in patients with IBD as well, especially when they’re in remission. Here’s why:

Often times, a person with IBD can be technically in remission (a healed intestinal tract) but continue to experience symptoms that mimic an IBD flare-up. This is known as IBD with IBS overlay and it is extremely common, affecting 40-60% of IBD patients. High FODMAP foods can trigger IBS symptoms in people with IBD and make them feel like they are experiencing a flare-up [6]. In fact, in a recent study, the Low FODMAP diet was shown to lower symptoms like gas, bloating, diarrhea, nausea and fatigue [7,8] in patients with IBD.

FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are hard to digest sugars which pass through the small intestine without being properly broken down by enzymes. Once these sugars reach the colon, they cause an osmotic shift bringing more water into the lumen which causes all the potential unpleasant side effects of pain, bloating and diarrhea. Additionally, the bacteria ferment (think of brewing beer), and the residual FODMAPs give off gas, as if there wasn’t enough to manage!

“OK… SO WHAT CAN I EAT?”

The most common question patients with IBD ask me is “what can I eat?” My goal is to help patients find ways to eat that will allow them to manage symptoms and feel like they are in control. That’s where the low FODMAP diet becomes so useful. A FODMAP elimination and reintroduction process can be a life-changing tool for IBD patients to identify the triggers that add to their daily stress. We know food alone does not cause IBD but many patients will begin to notice “trigger foods” that increase their symptoms of gas, bloating, and diarrhea. The best way to identify your trigger foods is to simply keep a journal of what you eat. Note if there are changes that occur in our bowel function when certain foods are eaten more than others.

IT’S NOT: ‘ONE SIZE FITS ALL’

Don’t get frustrated. What works for one person with IBD may not work for another. This is one of the many challenges that I have as a dietitian working with patients at the Feinstein IBD Center at Mount Sinai. Having worked with patients with IBD for over 15 years, I have seen many different diet therapies work and not work, and I must tailor suggestions to each individual person.

Food is a very important topic because it evokes a lot of emotion in people. People with IBD must carefully think about what to eat and the timing of their meals and if I can offer suggestions that help ease this stress, then I can successfully increase their nutrition, allow people to eat comfortably at work and at gatherings and lessen anxiety that commonly accompanies mealtime. Food is a large part of our culture as well as a basic human need and patients with IBD welcome guidance to help manage their disease and lead the healthiest life they can.

Resources that can help you:

Mount Sinai Make an appointment at the Feinstein IBD Clinical Center here or contact the office at 212.241.8100.

Epicured For exceptional low FODMAP, IBD-friendly prepared meals delivered right to your door, visit our menu.

IBD 101 Here are the basics: IBD (including Crohn’s Disease and Ulcerative Colitis) is an autoimmune condition where the digestive tract becomes inflamed and forms ulcerations that can cause a wide range of symptoms including frequent bowel movements, weight loss, and vitamin deficiencies. The gastrointestinal (GI) tract contains harmless bacteria that aids in digestion and the metabolism of vitamins. In people with IBD, the body mistakes the bacteria as foreign invaders and cells travel from the blood system to the GI tract, creating an inflammatory response and causing a variety of GI symptoms [9]. IBD can also affect your eyes, skin and joints and can have a profound impact on daily life.

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DISCLAIMER: Mount Sinai is an investor in Epicured. This material is for informational purposes only, and Mount Sinai makes no representation or guarantee as to any results or experience with Epicured. You should consult with your physician before using a dietary program such as Epicured. Mount Sinai employees do not receive material benefit from endorsing or recommending Epicured. 

Laura Manning is not employed by Epicured. Laura is a full-time employee of the Mount Sinai Health System and receives no compensation, monetary or otherwise, from Epicured. 

REFERENCES: 

[1] Molodecky, N.A.; Soon, I.S.; Rabi, D.M.; Ghali, W.A.; Ferris, M.; Chernoff, G.; Benchimol, E.I.; Panaccione, R.; Ghosh, S.; Barkema, H.W.; et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 2012, 142, 46–54.

[2] Hou JK, Abraham B, El-Serag H. Dietary intake and risk of developing inflammatory Bowel disease: a systematic review of the literature. Am J Gastroenterol 2011;106:563–73.

[3] Brown, K.; DeCoffe, D.; Molcan, E.; Gibson, D.L. Diet-induced dysbiosis of the intestinal microbiota and the effects on immunity and disease. Nutrients 2012, 4, 1095–1119.

[4] Ananthakrishnan AN, Khalili H, Konijeti GG, et al. A prospective study of long-term intake of dietary fiber and risk of Crohn’s disease and ulcerative colitis. Gastroenterology 2013; 145:970–977.

[5] Schumann D, Klose P, Lauche R, Dobos G, Langhorst J, Cramer H. Low fermentable, oligo-, di-, mono-saccharides and polyol diet in the treatment of irritable bowel syndrome: A systematic review and meta-analysis. Nutrition, Jan 2018;45:24-31.

[6] Selina R Cox Alexis C Prince Clio E Myers Peter M Irving James O Lindsay Miranda C Lomer Kevin Whelan Fermentable Carbohydrates [FODMAPs] Exacerbate Functional Gastrointestinal Symptoms in Patients With Inflammatory Bowel Disease: A Randomised, Double-blind, Placebo-controlled, Cross-over, Re-challenge Trial Journal of Crohn’s and Colitis. Dec 2017; 11

[7] Zhan, Y.L.; Zhan, Y.A.; Dai, S.X. Is a low FODMAP diet beneficial for patients with inflammatory bowel disease? A meta-analysis and systematic review. Clin. Nutr. 2017.

[8] Prince AC, Myers CE, Joyce T, et al. Fermentable carbohydrate restriction (low FODMAP diet) in clinical practice improves functional gastrointestinal symptoms in patients with inflammatory bowel disease. Inflamm Bowel Dis 2016;22:1129–1136.

[9] What are Crohn’s and Colitis. http://www.crohnscolitisfoundation.org/what-are-crohns-and-colitis/what-is-crohns-disease/. Accessed from the web May 12, 2018.

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

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

 

Our delicious Autumn Salad has just the right amount of broccoli and brussels sprouts to be FODMAP-friendly.

PASSOVER ON THE LOW FODMAP DIET

Passover time can be a real dietary challenge for anyone following their centuries-old family traditions, but even moreso for people with IBS following a low FODMAP diet. Here’s how Epicured can help!

We have Passover-friendly (Kosher style, not Kosher) meals that will work with your body to help you feel good.  So, you can steer clear of the heavy, traditional dishes that you may normally give in to…

Here are some of my FAVORITES:

Zucchini “Spaghetti” Pomodoro
Hawker Lettuce Wraps with Chicken
Frittata Muffins with Tomato and Herbs
Dragonfruit or Coco Berry Smoothies

And for those of who are eating rice, beans, nuts, and seeds, you might like:

Thai Green Curry with Chicken, Tofu or Veggie
Tofu, Chicken or Beef Teriyaki Donburi
Tofu Tikki Masala
Veggie Tacos Especiales
Sesame Crusted Wild Salmon
Truffled Mac and Cheese
Pulled BBQ Chicken
Veggie Tortilla Soup
Warm Autumn Salad

With the NEW and unique Epicured Concierge Program, our “Concierge Dietitians” personally receive and manage new clients that are referred to us by our Clinical Network members.

This FREE concierge service ensures that when your patients look to Epicured for their low FODMAP solution, someone knowledgeable and considerate is always there to help them through the process. The program also provides a seamless hand-off between the healthcare provider (that’s you) and the food provider (that’s us).

What the Concierge Dietitian Does

As you probably know, the low FODMAP diet is very complex! Since we launched our low FODMAP menu in July 2016, we get the same kinds of questions time and time again…

Why do you use garlic-infused oils? How many grams of celery do you use? Which of your cheeses are lactose-free?”

Often times, when patients become Epicured clients, they still have lots of questions about low FODMAP. We’ve found that, by putting someone with expertise into a client service role, we can provide the best possible service and we can help you provide the best possible care.

Many clients also simply enjoy that personal touch. The Concierge Dietitian can take food orders, recommend meals, and put together a menu based on the client’s preferences.


How the Concierge Program works:

  • Once you enroll, we will give you a very simple patient referral form.
  • You send it to us via fax/efax.
  • The form is HIPAA compliant and goes directly to our team of Concierge Dietitians.
  • The concierge team will immediately follow up directly to help your patient understand the Epicured low FODMAP service and provide a helping hand throughout.

Managing a digestive illness is complicated. This is just one more way that we’re collaborating with doctors and dietitians to make it easier.

To enroll your practice in the concierge program, contact our Clinical Affairs team! 

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