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Nutrition Experts Podcast Episode 37 Elimination Diets Explained with Patsy Catsos, MS, DN, LD

January 14, 2019 by matheaford Leave a Comment

Patsy Catsos, MS, RDN, LD began using the FODMAP approach with her Portland, Maine, patients in 2007. The 8-step program in her book, The IBS Elimination Diet and Cookbook, introduced consumers and health care providers around the globe to the power of the FODMAP elimination diet. Patsy happily divides her time between caring for her own patients, developing new recipes, keeping tabs on the latest digestive health research, and teaching other health care providers how to get great results for their IBS patients.

Mathea Ford: [00:00:27] Hey there! It’s Mathea. Welcome back to the Nutrition Experts Podcast. The podcast featuring nutrition experts who are leading the way using food starts today right now with our next guest. It’s great to have Patsy Catsos on the show today. She is an author of an excellent book called The IBS Elimination Diet and Cookbook available wherever books are sold. And Patsy I want to welcome you to Nutrition Experts.

Patsy Catsos: [00:00:54] Well, thank you for having me on the show.

Mathea Ford: [00:00:56] I’m excited to have you on the show I want to talk about this IBS. We’ve gotten into it and a couple other episodes of my podcast with with other guests. And I really want to get into some more detail with you. So, tell my listeners a little more about you and what you do.

Patsy Catsos: [00:01:13] Okay. Well, I’m a Registered Dietitian in private practice in Portland, Maine where I see patients three days a week and at the beginning of my time in private practice I was mostly helping patients with more general nutrition problems like helping them reduce their cholesterol or manage their high blood pressure. But about 10 years ago I learned about a special diet that can really help people with irritable bowel syndrome. And when I found out how effective that was, I was really excited and that led me to eventually write my book. But also I’ve been helping patients ever since with gastrointestinal problems. So, that’s really become the focus of my practice over the years.

Mathea Ford: [00:01:58] So, Patsy what is the biggest issue that you would say that you help your patients work on?

Patsy Catsos: [00:02:04] You know there’s lots of general advice for people out on the Internet. Many books many websites and so on, lots of Facebook groups but helping people find a really individualized diet or you know selection of foods that work for them specifically is what I help the most with.

Mathea Ford: [00:02:26] What sorts of symptoms are they experiencing? What is it about their condition that they come to you to talk about?

Patsy Catsos: [00:02:32] So, gastrointestinal symptoms can include abdominal pain. I would say that right up there as the primary complaint that most of my patients have. They can also experience excess gas and bloating. They may have diarrhea or constipation or both. And those symptoms can be very general. They can be related to a number of different problems.

Mathea Ford: [00:02:58] So, how do you help people figure out if it’s something more than just the stress they’re experiencing you know eating too much fast food, having too much weight all those things can cause those types of symptoms that you talked about. How do you help people to figure out if there’s a deeper cause to that?

Mathea Ford: [00:03:18] Well, hopefully they’re working with their primary care provider or a gastroenterologist to evaluate those symptoms. Dietitians don’t diagnose people with medical problems right? We diagnose them with nutrition problems. But if a patient were to approach me first for help with their GI complaints and told me about any alarming symptoms like passing blood in their stool for example or having a fever in conjunction with their bouts of GI symptoms if they reported to me and the abnormal lab values they had that I thought might suggest a problem with absorption of nutrients. Those kinds of things would cause me to refer the patient back to their doctor to get a really good evaluation and diagnosis. So, the ideal scenario for me as a dietitian working with the patient if they’ve already been through that process.

Mathea Ford: [00:04:15] Can you talk a little bit about what is an elimination diet and how it’s used with IBS or other gastrointestinal issues?

Patsy Catsos: [00:04:22] There are a number of different elimination diet out there. They should have a really pretty clear theme or plan and they typically have three steps. First of all, the patient or the client eliminates all the foods that might be suspected of causing the problem. And then the second step they reintroduce the foods in a logical way to try to narrow the problem down to only the foods that can be proven to trigger the problem again. And then third, moving on from there to a modified diet that the person can live with over the long term that will both support good nutrition and help them manage their symptoms and feel great. That’s my goal for my patients.

Mathea Ford: [00:05:13] What are the different things that people might call whatever they have or how they’re picking their elimination diet? Does that matter based on what they’re diagnosed with?

Patsy Catsos: [00:05:24] Well a lot of the patients that I see irritable bowel syndrome that is considered a functional disorder. Which means that your guts aren’t functioning right. Even though you don’t seem to have an actual medical problem that would explain it. Many of the patients that I work with have that as a diagnosis but people who have other G.I. problems like inflammatory bowel disease. In other words Crohn’s or colitis have very much the same symptoms and we can often use diet to help them manage their symptoms which is awesome even if they have another diagnosis. I also work with patients who have celiac disease and who have been on a gluten free diet for a long time but they still have some of those symptoms that I mentioned. Patients with other GI complaints like reflux or GERD or diverticulitis or there’s quite a long list of potential problems. I can often help them with those as well.

Mathea Ford: [00:06:25] So, let’s talk about foods because I think obviously it’s dietitians we talk a lot about guts and stuff but sometimes we forget that where it all comes from is the food we put in our mouth. So, what are some of the top foods that seem to create this bloating feeling or diarrhea or even constipation?

Patsy Catsos: [00:06:45] Okay. This was a big surprise to me. You know when I first started learning about FODMAPs. Some of the foods I’m going to mention are really healthy foods. And so I just want to say that I’m not suggesting they are bad foods in any way shape or form but some of the foods that we actually try to eat to improve our diets can actually increase G.I. symptoms. And I’m thinking of things like milk products, fruit on certain fruits like apples and watermelon are especially problematic. But just large servings of fruit in general are difficult for some people to handle. You know some vegetables like cauliflower and broccoli and mushrooms and they are very healthy but if you eat a whole plateful of them for dinner you might regret it later on or even the next morning. Certain whole grains that would normally be healthy choices could be really troublesome for people with irritable bowel syndrome for that particular wheat richh products and even things like nuts and seeds that are really healthy for us now, in a small portion like a handful at a time could cause GI distress if you overdo it.

Mathea Ford: [00:08:02] You mentioned the word fried map and I mentioned it earlier too. So, tell us what does that mean? What is it that if fad map diet is and what does it do?

Patsy Catsos: [00:08:12] Okay. So, the theme that ties all those foods I just mentioned together is the fact that they have a lot of FODMAPs in them. And FODMAP is an acronym and I usually tell people it stands for a bunch of jargon that is referring basically to a group of certain sugars and certain fibers in food that can cause GI distress and they can do that because they have a few things in common. FODMAPs are the favorite foods of the normal gut bacteria that we all have. And so if they’re too much of them available for the gut bacteria they will ferment them too rapidly or too much and fermentation. It sounds like a little bit of a scary word but it’s actually a really normal part of human physiology so we don’t want to get rid of it altogether. But again if it’s too rapid or too much it can cause your intestines to you know I guess blow up a little bit like a balloon and that can be a very painful sensation. The other thing that these FODMAPs have in common is that they can sometimes pull too much extra water into the gut and that can promote loose stools or diarrhea and sometimes some pretty significant urgency to get to the toilet. A couple other interesting things about FODMAPs, they have a cumulative effect. That means that it’s the FODMAPs from all the different foods that we eat that can kind of add up to affect us if we eat too much of them in too short a time like in a single meal. That is one reason that we learn more if we take kind of a big picture overview and use a process like an elimination diet to stop eating all the high FODMAP foods for a few weeks. That can often be a more effective way to learn than if we tried eliminating just one suspect food at a time. That’s really the main reason for using the process.

Mathea Ford: [00:10:16] So, how do you do that? So, basically you give them a list of all the FODMAP food once you’ve determined that or you’ve been referred because they have IBS not necessarily Crohn’s or colitis or anything like that? What are your steps that you do with patients?

Patsy Catsos: [00:10:35] I’m glad you brought that up. There is a little bit of a determination process there at the beginning. The first thing I do actually is to make sure the person’s a good candidate for this type of approach. Not everybody can do an elimination diet safely or easily. So, I like to make sure the person does an appropriate diagnosis and that it looks like they actually are consuming FODMAPs on somewhat of a regular basis because if they’re already eating nothing but chicken and rice and they’re still symptomatic there’s really nowhere, no room for improvement. But if they seem to be a good candidate for the diet, I first do give them a list of low FODMAP foods and I ask them to stick as closely as they can to that list for a few weeks or until our next visit. If they seem to be a good candidate for the diet, I ask them to eat only low FODMAP foods for a few weeks and ideally they’re going to feel much better and that improvement can start almost immediately but usually within two or three weeks they’re going to know the answer to the question. Our FODMAPs part of my problem. And then they come back for a second visit typically. And at that point I asked them to begin reintroducing FOD MAPs so that we can find out more specifically what the triggers are for them. Because some people are more sensitive to some FODMAPs than others. We don’t want to have to limit anything that isn’t really making a difference.

Mathea Ford: [00:12:11] What is kind of the research behind or the data behind where they found out about FODMAPs?

Patsy Catsos: [00:12:19] The individual parts of this map idea have been known for a long time. For example, lactose intolerance is an old idea right and everybody knows what happens if you eat too many beans you’re going to be gassy and have a little GI distress. So, what was really new here was around 2000 a group of researchers at Monash University in Australia realised that some of these foods that cause GI distress probably have some things in common. They decided to create this acronym to describe them FODMAP and really it’s looking more at the forest than the trees. Looking at at the big picture here. And that’s where the idea came from. And when they began to try this in the research setting with patients they found that up to 80 or even 85 percent of patients with IBS who were good candidates for the diet experienced significant improvement of their G.I. symptoms. And there have since been many many other studies that have been performed in various places all around the world that back that up. Of course, the results are always best and are really controlled setting like in a clinical research centre. But even in people that are free living as they say but who are just taught the diet and asked to carry it out on their own. The vast majority of IBS patients get significant improvement with this approach.

Mathea Ford: [00:13:52] Yeah! I imagine there’s a lot of motivation to try it and then especially once you start to experience some of the effects. What foods you typically add back first because you mentioned everything from apples to milk to whole grains? So, where do you start adding foods back?

Patsy Catsos: [00:14:10] I’m going to list the FODMAP categories real briefly and I’m going to do that because I add foods back one category at a time rather than food by food. Sometimes you know sometimes the food by food reintroduction comes later.

Mathea Ford: [00:14:26] If you’re trying to narrow down?

Patsy Catsos: [00:14:28] Exactly! But the map categories that I work with our number one lactose. Which is also known as milk sugar and there’s a lot more of it and some milk products than others. So, things like regular old glass of milk is high in lactose. Yogurt is medium but aged cheeses are low in lactose. The next FODMAP is fructose and that’s found in sugars that are added to our food for example honey, high fructose corn syrup, agave but it’s also naturally present in all fruits. Of the next category of FODMAP is called sugar alcohols and these are easy to spot when they’ve been added to foods like sugar free gum and candy because they usually end with OL so things like xylitol, sorbitol, maltitol, mannitol. Those are easy to spot but I mentioned earlier they’re also naturally found in certain fruits and vegetables. So, those three I just mentioned are the sugar type FODMAPs and then moving on to the fiber type FODMAPs. They go by the umbrella term of oligosaccharrides which is the O in FODMAP and they are contributed to our diet by whole grains, nuts, seeds, beans and also by fibers that are added to boost up the fiber content of our food such as inulin and chicory root. So, those are the big categories. That’s the theme that I follow during the reintroduction process. It’s one category at a time.

Mathea Ford: [00:16:11] Yeah. I think that once people start seeing the results they probably are happy to follow this. Is there any part of the diet that ends up being too restrictive over the long term?

Patsy Catsos: [00:16:25] Yes. As a you know we discussed at the very beginning when you first asked me about individual foods we know these are healthy foods right? Especially the whole foods that are good sources of fiber and that’s probably the nutrient that deserves the most special attention ongoing is to make sure that you’re eating enough fiber. Even if you have to cut back somewhat on high FODMAP fiber. There are plenty of good options and I encourage people to continue eating a wide variety of fruits and vegetables and beans and nuts and seeds right up to the limit of what they can tolerate so that they can get the benefits of those foods without distress.

Mathea Ford: [00:17:12] So, we’ve been talking about FODMAP but you also mentioned at the beginning that Gerd was something that you help people with or reflux type things. So, what types of things do you do with people to help them with reflux or GERD?

Patsy Catsos: [00:17:26] This low FODMAP diet is not I guess not intended directly to help people with GERD but if people have IBS and GERD, I can tell you that their reflux symptoms often improved quite a bit with this low FODMAP at the same time. If they have GERD only no IBS, I would probably review some of the basics that have actually been known about for quite a long time for managing that problem. Things like eating smaller more frequent meals perhaps, not eating too close to bedtime, elevating the head of the bed makes a big difference because gravity can then help the contents of the stomach remain in the stomach instead of refluxing up into the esophagus. And then there are a few food choices that they might want to consider. There are certain foods that have a bit of a reputation for making GERD worse although I do find that’s pretty individual as well. And so I encourage people to try eliminating these foods from their diet but if it doesn’t make a difference they don’t necessarily have to stick with it but some of those foods would be things like chocolate, coffee, tea. Things that are real peppermint based high fat foods are often a trigger for GERD. Acidic foods. But again you know give it a try but if it doesn’t make a real difference for you you can move on.

Mathea Ford: [00:18:58] I’ve heard recently that GERD or reflux is not necessarily because you have too much acid in your stomach it’s because maybe you don’t have enough. So, is there any research you’ve seen about that or any comments about that?

Patsy Catsos: [00:19:12] I would say it’s pretty anecdotal and a lot of functional providers I think rely a lot more on their own experience with patients than necessarily the clinical research foundation. They’re you know they’re willing to try to implement some things without an evidence base. That’s not how I practice. So, I don’t really initiate that kind of treatment with people that would be based on that idea. But if they are doing it on their own or they’re also working with a functional provider that wants them to try to increase acidity by taking a supplement for example, I probably wouldn’t interfere with it or ask them to stop.

Mathea Ford: [00:19:51] Well, that’s a good point though. It’s just something that’s recently been in the news that I’ve heard and it is very intriguing thought. So with IBS and G.I. issues how are these handled in our current health care system? Because you mentioned you know that people typically come to you with the diagnosis from their doctor but I know a lot of times people suffer for a while before they either put their foot down with their doctor and say “you’ve got to figure this out” or are just some of the symptoms too general or too hard to recognize by doctors or how do you see it coming through the system?

Patsy Catsos: [00:20:27] So, years ago, it was quite a difficult and even expensive process to arrive at an IBS diagnosis. It used to be considered a diagnosis of exclusion. And people would have to go through the process of having a colonoscopy and multiple other tests that could be invasive and difficult and expensive before they would get the diagnosis. But these days we have some clinical guidelines that suggest that really it can be a diagnosis that’s made with out all of that. If the patient has a particular pattern of symptoms, these are called the Rome IV Criteria for irritable bowel syndrome. If they have a particular pattern of pain and altered bowel habits and the absence of those alarm symptoms I talked about earlier, then they can be diagnosed with irritable bowel syndrome right in the doctor’s office and that can pave the way for them to be treated more effectively.

Mathea Ford: [00:21:30] So, doctors are basically a little bit have a little bit more guidelines to say these are some of the typical patterns for that?

Patsy Catsos: [00:21:38] Absolutely! Absolutely! And so more people are being diagnosed with IBS right with their primary care provider instead of having to go through the referral process to see a gastroenterologist.

Mathea Ford: [00:21:51] How do you think this information can be used by our listeners in their day to day life? So, our listeners are dietitians doctors nurses and just regular individuals.

Patsy Catsos: [00:22:01] Okay. So, first of all if you’re suffering from abdominal pain, excess gas, bloating, bowel habits that are not satisfactory to you. Bring it up with your physician. Absolutely do not have to suffer in silence. It’s not something you should just have to put up with. Have your doctor evaluate you and if necessary you know maybe you do need to be seen by a gastroenterologist. But don’t just live with this situation. Then if you do get diagnosed with irritable bowel syndrome ask your doctor whether he or she can refer you to a registered dietitian who’s skilled in this area and see if they can help you work through whether food is contributing to your symptoms or not.

Mathea Ford: [00:22:48] So, if you’re a dietitian you work with just regular you know like you mentioned cholesterol, heart disease that type of stuff. What types of things are people going to be saying to you that help you to recognize “Okay, I need to mention to them that they should possibly follow up with their doctor about these things?”.

Patsy Catsos: [00:23:06] Okay. So about 20 percent of your patient population is going to have irritable bowel syndrome. So, whether you’re seeing people for diabetes or cholesterol or or anything else you could be listening for for signs and symptoms that might suggest IBS. And if you’re hearing patients complain about you know not only abdominal pain, diarrhea and constipation, excess gas and bloating. You know you can make that referral back to their doctor. Most patients that you’re going to be able to help with a FODMAP elimination diet for example are going to be aware that food has something to do with their symptoms. In fact they’ve probably been trying to manipulate their diet on their own long before they ever met you or heard of FODMAPs. Some patients will say you know “bread really really bothers me when I or when I was following the Atkins diet or paleo diet or some other variation of a low carb diet that they were feeling better.” Patients might say “the healthier I try to eat the worse I feel.” A lot of patients that have done programs that really promote the fruits and vegetables and skim milk and all that. For example Weight Watchers, patients can feel more symptomatic because they’re eating a lot more FODMAPs in those foods. So, those are some of the clues I would be listening for if I were in a more general practice.

Mathea Ford: [00:24:35] I think that’s great especially that is surprising to me to say that 20 percent of people have IBS because I did not realize it was that prevalent.

Patsy Catsos: [00:24:44] The statistics of course vary a little bit depending on who produces them. But that is pretty consistent around the world.

Mathea Ford: [00:24:51] So, Patsywe’ve been talking a lot about food and I’m going to ask you the question I ask everybody is what is your favorite food?

Patsy Catsos: [00:24:59] Well, I think that salmon is probably my favorite food both because I like it myself but also because I when I’m a hostess I feel like it checks almost all the boxes as dietitians we’re all is kind of aware of the dietary needs of our guests. Righ?. So I feel like I served salmon. I’m doing a good job for my guests who have irritable bowel syndrome or celiac disease. We’re eating the low carb diet and also most vegetarians seem to be willing to enjoy fish once in a while. So, all in all it’s a great food, very nutritious and delicious.

Mathea Ford: [00:25:44] So, how do you like to cook it?

Patsy Catsos: [00:25:46] My favorite recipe is a baked salmon which is kind of a crumb crust made of walnuts and olive oil and a little Parmesan cheese. Some something like bread crumbs or crushed potato chips or something to give it a little crunchiness. It’s really delicious and we usually have that on holidays.

Mathea Ford: [00:26:06] Oh that sounds delicious. So Patsy, thank you so much for being on the podcast today. It was a pleasure to have you on the show. I know my listeners have learned a lot about IBS and FODMAPs and I appreciate you going into such detail about those. So, if listeners want to connect with you what’s the best way to do that?

Patsy Catsos: [00:26:24] I think the best way to connect with me is to visit my website which is IBSfree.net and from there you’ll find plenty of links to everything from my book to my social media. So, I look forward to connecting with you.

Mathea Ford: [00:26:42] All right! Well guys this has been another great episode of the Nutrition Experts Podcast. The podcast that is all about learning more so you can do more with nutrition in your life.

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Nutrition Experts Podcast Episode 36 News Edition, New Products, IBS and New Year’s Resolutions with Janet Brancato, RD

January 7, 2019 by matheaford Leave a Comment

Janet Brancato is a Registered Dietitian Nutritionist with a Masters degree in Nutrition from New York Medical College, Valhalla, NY. She did her undergraduate studies and received a Bachelors of Science in Nutrition from Montclair State University, NJ.

She is experienced in the field of Nutrition for over 20 years, teaching groups, and counseling individuals on diet modifications and lifestyle changes to promote health. She is experienced with kids, teens, and adults. Her specialty is weight management but she also works with various medical challenges.

The past 15 years she has worked at a local hospital in NJ as an outpatient dietitian and community health speaker.

Janet decided to expand her scope of practice and created Nutopia, LLC a virtual private practice about 5 years ago. She can meet with clients using telehealth technology from the comfort of their home or office.

The motto for her business is “Simplified & Personalized” taking the information and breaking it down into manageable goals and giving clients a personal experience. She motivates and supports clients in between visits.

Janet is also a food blogger, you can check it out on her website www.mynutopia.com.

Follow her on social media:

Facebook – @Nutopia, LLC
Twitter/IG – @janetmsrd

Mathea Ford: [00:00:26] Hi there! It’s Mathea. Welcome back to the Nutrition Experts Podcast. The podcast featuring nutrition experts who are leading the way using food starts today right now with our next guest this week is our News Edition with Janet Brancato. So, Janet welcome to the show.

Janet Brancato: [00:00:46] Thank you Mathea. It’s so great to be back and Happy New Year to you.

Mathea Ford: [00:00:49] Oh thanks! Happy New Year to you too. I’m excited to have you on the show. Talk about our topics today. If somebody hasn’t listened before will you tell them a little bit about yourself?

Janet Brancato: [00:00:59] Again, I’m Janet Brancato I’m a registered dietitian I’ve been a dietitian over 20 years and I’ve worked with groups and individuals, adults and pediatrics and counseling them in various stages of health. Currently, I have an online virtual practice telehealth practice mynutopia.com. I have a food blog and I provide tools like meal planning and recipes as well.

Mathea Ford: [00:01:24] Great! So, let’s get into the topics. I have a few topics to talk about this morning and then we’re going to talk a little bit about New Year’s resolutions since it’s been about a week and you may or may not still be sticking with your resolutions but we have some ideas to help you if you’re still wanting to do some changes. So, I want to talk first about Moringa because it’s a new kind of supplement that I get a few questions about and I actually take it myself just because I believe that it helps with the antioxidant factors. But I wanted to talk about Moringa because I think it’s becoming something dietitians are getting asked more about. So, there’s research that talks about what it’s good for. There was a review that says it was it has anti inflammatory anti oxidative properties and these are animal studies that showed it helped with glucose a little bit and some anticancer products properties which have been studied but they’re not really sure about human roles. So, Janet have you ever heard of Moringa.

Janet Brancato: [00:02:32] I really haven’t. It was something new to me but very interesting to read about. You know there’s so many types of plants natural sources out there that could be so beneficial. You know natural sources of anti inflammatory and high in antioxidants. And this one they say the entire plant is edible – the leaves, the bark, the flower, the fruit, the seeds and the root. I thought that was pretty interesting but commonly what’s used in the United States are the leaves and like you said it could be part of a supplement blend or sometimes they’re found in smoothie mixes, teas, kombucha. You can find it in different forms and like you mentioned it’s been possible applications are for diabetes, hypertension, asthma and cancer prevention.

Mathea Ford: [00:03:21] I do want to warn the listeners if you are taking medications you don’t want to just start taking moringa. You want to make sure you talk to your health care practitioner and verify that it’s not going to interact with any of your medications and they may or may not know that. So, they may steer you away from it but we just wanted to talk about it because I think it’s an up and coming thing that we as dietitians and doctors and nurses are probably going to get more questions about. I’ve known people put it in their smoothies. I’ve seen that. Course you can get it in a pill where you can take it in a pill.

Janet Brancato: [00:03:57] And I think these supplements you just have to make sure it’s a reputable source that you’re getting it from because sometimes the concentrations might be different and you have to be careful what else is maybe in that supplement. You know so always reputable sources. Yeah! You want to make sure it has testing.

Mathea Ford: [00:04:17] Yes. So, think about moringa in the new year and it has a antioxidants and accidents are always helpful. And maybe you know you don’t like Vitamin C or whatever you may consider it as a different source. Okay, so another topic I want to talk about I’ve talked to a few dietitians in the last couple of weeks about FODMAP diets. Something I did not know anything about before I started doing some interviews with dietitians about FODMAPS. So, let’s talk about this. It’s F-O-D-M-A-P apostrophe s and it stands for Fermentable Oligo-, Di-, Monossacharides and Polyols. So, it’s a specific diet. And the reason I use the word FODMAP is because they don’t want to assail those words. It’s a diet where it’s shown to improve some symptoms in IBS. And basically if you start out by removing all these FODMAP items and then I think you slowly bring them back into the diet a little bit at a time. Janet, have you ever worked with anybody doing a FODMAP.

Janet Brancato: [00:05:28] Yes, I have you know patients with irritable bowel or G.I. symptoms. Many different symptoms. Do find and it has been documented too that 50 to 70 percent has been affected by it. I think it’s great and some sort of good resource for people that are suffering to give it a try. But work with someone work with a dietitian. Don’t do it on your own. It can be very overwhelming because these types of carbohydrates that we’ve mentioned in the acronym you know there’s a lot of lists of those that are higher in the FODMAPS which could increase those symptoms. So you want to work with somebody especially with the elimination aspect to know what to eat because you know you’re eliminating groups of foods. And so now the challenge is “Okay, now what can I eat?” So working with somebody really does help. I’ve worked with clients’ elimination and then there’s a reintroduction phase where you slowly start to reintroduce one by one to see if there’s any symptoms or reactions. As we start to reintroduce some foods. With some people you know getting the gut to sort of heal and relax and take a break from these foods during that elimination phase and then you can slowly see is there any particular food within those categories that are really the irritant. So instead of leaving out a whole category you’re kind of going one by one to see you know and you keep a diary you know the client will keep a diary to see if symptoms return with particular. It’s not a long term diet, it’s a short term diet but it’s a way of sort of isolating foods that might be the triggers.

Mathea Ford: [00:07:15] I think that’s a great way to think about it is it’s not a long term but you are you’re eliminating all the groups and then you kind of bring them back in a group and a small amount at times. And it’s 70% 50 to 70% of people with IBS seeing results from this change in their diet is amazing. But I think it’s great if what you talked about speaking with the dietitian because if you eliminate some of these things like some of the dissacharides are things that are in milk. So, if you eliminate milk and ice cream and yogurt because it helps heal your gut that’s good but then you’re missing some of those nutrients that those foods provide. So, you want to make sure that you’re not totally cutting out calcium. You can get calcium in other products but you just might have to be more cautious or take a supplement if that’s the food that’s going to affect you the most.

Janet Brancato: [00:08:13] Yes! Yes. So, working with someone to find out choices that would be you know if you’re cutting out some of the you know if you’re using more gluten free versus the wheat or lactose free type choices you know but working with someone to sort of give you a good balance so you get those nutrients that you need.

Mathea Ford: [00:08:30] Now, what do they think that it does like these FODMAP foods, are they broken down easily by our gut bacteria and then they cause gas?

Janet Brancato: [00:08:41] The fermentation process in the gut. So, with fermentation it’s sort of we’ll see if these particles are not being digested properly. There’s sort of fermentation going on with the bacteria. So, it’s giving off gases you know it could cause diarrhea you know with absorbing more water with trying to get your gut to sort of dissolve or digest these food particles but when they’re not digestible it sort of can cause the diarrhea or bloating or other G.I. symptoms, pain so it has to do with you know your body trying to digest amd ferment these carbohydrate sources.

Mathea Ford: [00:09:22] So, even your good gut bacteria is digesting this and causing the bacteria you want in your gut but it’s affected by this and your body is just not as able to..?

Janet Brancato: [00:09:34] There might be a lack of enzymes/. You know you need certain enzymes to break down the lactose you may need those lactase enzymes or certain enzymes that you need to help break down these sugars, carbohydrates, complex carbohydrates and if they’re not present or not present enough you know you have enough present at that time. Like I said these are sort of a byproduct of these symptoms and pain of your of the fermentation process.

Mathea Ford: [00:10:00] Just if you have IBS or you have some gut issues going on it’s recommended you go see a dietitian but you may want to talk to him about a FODMAP diet you may want to find a dietitian who specializes in that. It can be if they don’t work with it often it can be a little bit confusing. Okay. So, I wanted to also talk about the new year. Everybody’s not everybody but a lot of people started a new diet. Started different changes in their life to be healthier and happier and all those things. So, there is a new labeling law that came out last year and you probably noticed it in your restaurants when you go. They have if they have over 20 establishments then they have the menu boards and they have calorie levels which the first time I found I was kind of like “Oh gosh! Yeah, maybe I want to change my diet my choice” which I think is the point.

Janet Brancato: [00:10:57] Yes. So, yeah I’ve seen them definitely in chain restaurants, convenience stores you will see the calorie count and it can help you to be again we talk about being mindful, being aware. So, it just is giving the person a chance to make that decision with the awareness. Because you know most people underestimate the calorie content on a menu. So, just being aware and whether you choose to make a change or not at least you know you know with the calorie count is. So, I think it’s I think it’s a good thing. It can definitely help people make changes to improve you know maybe help with weight loss or reduce chronic diseases. You know that kind of thing. The more information I think the better. So, it’s just another tool to help people make good choices.

Mathea Ford: [00:11:51] I think the interesting thing that has come out of this. Like I’ll use Panera for an example. They have online the ability to kind of create your own food and so you can go to their website and you can look and they’ll tell you the calories but you can also check off and add or subtract different new different ingredients and it’ll change the nutritional profile. So, if you’re watching the amount of carbs or the amount of fat that you’re eating or the amount of protein, if you have a sandwich and you don’t want the mayo for example but you do want lettuce you can check and mark those. And I really appreciate the fact that restaurants have done that. I know Panera does it. I know I’ve seen it at Arbie’s on their website. You can really get down into the details and I appreciate them letting consumers have some of that control because then you can go into the restaurant and say at Panera for example, I want a chicken salad sandwich but no this, this or this and it’ll make you and the important thing also I think is to know those numbers before you take a bite of your food because it’s really hard afterwards to subtract calories if you’ve already eaten it.

Janet Brancato: [00:13:08] Yeah and a lot of these restaurants have like you said the online menus. So, I tell a lot of clients you know look on line first because sometimes when you get to the restaurant or you get to the place and you’re hungry, you smell those delicious smells and you know you get overwhelmed by all the choices and it gets hard to make that decision. But if you think about it before you go like you said and you peruse the menu and you look at the calories some people are looking more at sodium levels you know they’re trying to watch their sodium intake so you can find that out online and it will help you to feel more confident once you get to the restaurant or the store or wherever it is that you’re going, you’re going to feel more confident. This is what you want to have and you’re ready for it. So, I think that if you if you do have the time to look ahead of time like we mentioned last month with the Starbucks menu. You know if you kind of have your order in your head or you write it down or something that’s actually a good practice. That’s a good tool and a practice to include when you’re going out especially if you go out frequently. There’s people like you out lunch at every day or they’re getting these coffees out every day. So, it’s a good tool to kind of look online ahead of time so that you know and you know what your choices are going to be.

Mathea Ford: [00:14:25] Yeah. I think you don’t realize all the stuff that they add to food at a restaurant. Like you at home when you make a sandwich you may not naturally put mayo and ketchup or whatever on it but at a restaurant or at a store at a quick service place they probably do. So, looking online ahead of time you can see “oh yeah they’re going to add this. So, I want to tell them not to add that” and that way you have a lot more control. And so that’s a great way to help control your calories. And also just be more aware consumer. So, it also mentioned a little bit about this being an opportunity for dietitians to go in and help customers or restaurants reformulate recipes. So, that’s something I do with Renal Diet Headquarters, I do… I don’t help restaurants necessarily but I take recipes that I like or use and I adjust them to be appropriate for people with kidney disease. For example, so I’ll switch out some of the higher potassium foods, I’ll reduce the amount of protein and I’ll increase maybe the amount of some other vegetables and that recipe is adjusted and changed so that it’s good for people with kidney disease based on their nutritional needs. So, dietitians can offer that type of service if you like doing recipes if you like cooking for example and you want to help they can. You can work with them of course on a paid basis but adjust their recipes if they want to have lower fat recipes, if they want to have lower calories. You may even do this with local restaurants if they’re looking to have a light menu or develop some lighter options.

Janet Brancato: [00:16:10] It sounds like a great opportunity for dietitians to get involved in the process helping restaurants and helping customers and kind of almost like a teamwork. I think that’s excellent.

Mathea Ford: [00:16:20] There’s a lot of gluten free stuff going on. People are moving towards you know less simple carbs and those types of things but also gluten free flours and there’s already some gluten free flours out there that are pretty common. I think there’s almond flour there’s…I’m trying to think of some other ones there’s like oat flour, potato flour…

Janet Brancato: [00:16:44] Quinoa flour, oat flour, chickpea. There’s a lot of bean based flours now too.

Mathea Ford: [00:16:48] Yes, so this article that we were looking at is on Today’s Dietitian for May but it talks about some other alternative gluten free flours that you may not have heard of and how they work. Each one has kind of its own type of characteristics but one of them was banana flour which was kind of surprising to me.

Janet Brancato: [00:17:07] Yeah. Made from unripe green bananas. Peeled, sliced, dehydrated and ground to make its alternative gluten free flour.

Mathea Ford: [00:17:15] Yes. So it’s going to have more starch because bananas are naturally a little higher and starch and carbohydrate. I think they say it would work well on its own because it’s mimics a little bit more of the gluten type flours but it can be a little higher in calories too.

Janet Brancato: [00:17:31] It’s a light and fluffy texture and does have a hint of banana flavor when you use it for baking but it’s high in that resistant starch which again we were just talking about the fermentation process. So it’s kind of a pre biotic for the good bacteria.

Mathea Ford: [00:17:49] Yeah it works on a low FODMAP diet too. It talks about sweet potato flour probably very similar. You know they’re dried and ground into a flour. It’s going to have sweet potatoes. They’re going to have a decent amount of carbohydrate in them.

Janet Brancato: [00:18:05] It works really well and a quick bread, cookies, breading, coating and adds a nice little sweetness to the flour.

Mathea Ford: [00:18:14] Yeah! And you can use it to thicken up some gravy and sauces to just it has a little bit more that corn starch or flour feel to it. So and then pumpkin flour, similar I was thinking with two sweet potato flour. Usually, you’re not going to use it as the only replacement you’re going to mix it. And any of these you know these are going to be more expensive the ones we’re talking about. So, you want to mix them with some probably with like some almond flour, chickpea, quinoa flour just to not only reduce the costs but also to get some of those properties that are closer to you want it to taste like a regular gluten bread but not obviously have the gluten.

Janet Brancato: [00:18:55] Exactly! Yup you can mix it with other flours, you can use it for baking pancakes and even to smoothies too.

Mathea Ford: [00:19:02] The one I liked was the wine flour. Did you read about the wine flour?

Janet Brancato: [00:19:09] I did. Wine flour which I was you know surprised about that one but it’s actually from fermented grape skins the juices pressed out of the wine grapes and the skins are dried and ground into a fine powder and it gives it a really stunning color. There’s flavor aroma of the glass of wine without the alcohol. So, and again you use it sparingly mentions not to use it in large quantities. Small quantities can really make a good effect and give it a little sweet wine flavor could even be good in like gravies and sauces but definitely can be pretty versatile.

Mathea Ford: [00:19:48] Yes. So, I was watching. Speaking of wine a little bit I was watching Rachael Ray the other day and she was adding a little wine to her dish and she said “just make sure you know it’s okay to buy a little less expensive wine but make sure it’s wine that you enjoy when you drink it because it’s going to get concentrated and be stronger with that less obviously not the alcohol you’re going to bake out the alcohol you’re not going to have alcohol in wine flour but you’re going to have a flavor from that wine from those grapes. So, if you don’t like that or if it’s not appealing to you it’s going to be more concentrated probably so it’s going to have a little bit of a grape flavor to it.” I wouldn’t buy a big batch of it at first. Obviously it’s something you want to try if you’re interested in this but make sure that you’re interested in that flavor. I guess that’s what I’m trying to say.

Janet Brancato: [00:20:44] Yeah! I like that it mentioned that it could be a great rub for steaks so you could rub it on your steak. You can pair it with a cheese sauce. It’s pairs well with red berries and dark fruits and it could be a thickness for gravy, goes best with apples peaches and citrus fruits. So, it sounds interesting. I will definitely be on the lookout for that one.

Mathea Ford: [00:21:07] And the last one they mentioned was coconut flour. Basically they dry the coconut and grind up the coconut meat. And I know I’ve seen a lot of gluten free stuff that uses coconut flakes in the recipes.

Janet Brancato: [00:21:21] It’s a good replacement for regular flour and corn meal and you can use it as a coating like you mentioned. That’s really great. And it’s very absorbent helps to retain moisture so you may need some more liquid in the recipe because of the absorption of the flour.

Mathea Ford: [00:21:39] Yes. So, I was attending this event with the chef from Parade Magazine. His name’s John I can’t remember his last name. Sorry John but he was talking about he had several questions and he was talking about how to make great pizza. He talked about having higher gluten levels in your flour which helps with rising and the recipe and of course there was the question about gluten free bread or dough. And he mentioned that you do want to mix some difference of the types of flours because until you find a blend that you like. So, maybe you use almond flour and some quinoa flour and you add in a little bit of coconut flour and it gives you the texture that you like cauliflower pizza crust. You know if you’re going to make a cauliflower pizza crust you may not want that. I don’t think it has a strong flavor but you may want to add some other flours to it that are gluten free so that you get maybe a little bit of that rising result that you’re looking for with the pizza crust and that crispness. Also I think just like with low sodium, gluten free you kind of get used to the flavor of these flours. So, trying something new can be good and just be aware that they’re always coming out with new ones.

Janet Brancato: [00:22:56] I think like you said experimenting with different combinations is a great idea and you know try it in different forms like you said if you’re making you’re making a big bowl or you’re just coating trying to coat some chicken or meat you’re baking you know. You know now with these new flours you can really you know get different colors and flavors and textures. So, I think it really is great to add to that variety within your recipes.

Mathea Ford: [00:23:24] All right. So, Janet did you make a new year’s resolution?

Janet Brancato: [00:23:27] I’m not big on resolutions. I do try to take a little assessment from the last year and sort of say well, what can I do different or is there anything you know kind of break it down between you know goals that I have personal goals or goals with my family and just different things like that. I know I’m always trying to maybe do some different lifestyle goals for myself, maybe new challenges to keep me active. So, I always look for ways to do that. Cooking, I love cooking. Always a goal of mine is to maybe take a cooking class. You know now that I feel a little inspired with some of these new flours maybe trying something out like that but I do like taking cooking classes and experimenting with new cuisines. So, that’s always on my sort of bucket list and travel. I’m big on travel. I like to travel with my family so I know you get end of the year we kind of think about what we want to do as a trip for the summer you know together. Have some business goals and I’m working on. So, it’s in progress. I wouldn’t say I have a specific justified list just yet but you know when it comes to resolutions I try to think on things that I would do long term not short term you know. Changes that I want to make in my life that are going to just help improve myself as a person and as a part of my family or as part of my business. That type of thing.

Mathea Ford: [00:24:57] Yes. So, when you think about resolutions, the reasons why people tend to not keep them or give them up quickly I think is a lot because they bit off more than they really can chew. Saying you want to lose weight or lose 100 pounds you’re not going to do that overnight. You’re not going to do that without making a significant amount of changes and choices daily, weekly, monthly right?

Janet Brancato: [00:25:24] Exactly. Every goal that you have. Like you said if it’s losing weight or taking a trip you have to break it down into steps. If you’re going to even plan a trip you have to break it down into steps. You know what time of year do you want to go away? You know how much money do you want to spend? So, even if it’s weight loss or whatever it is they’re going to be steps to that process. It’s not fun it’s just like you said you know you want to have a plan. You want to have some steps in line with whatever the goal is that you have in mind.

Mathea Ford: [00:25:54] I read a book this year or actually well it was early this year and it was about a concept called Lead and Lag Indicators. And it talked about creating goals using lead and lag indicators. So, a lag indicator is something that changes after you make it your kind of your end goal. Maybe it’s 100 pounds weight loss or something like that. But if you’re constantly looking for the hundred pound weight loss, it’s hard to find the steps to get there. So, the lead goals are things like drink more water, drink water between meals and exercise 30 minutes daily. So, those are the things that you know if you change those then it will lead to that result that you’re looking for with the lag. So, think about your goals. Whether its eat healthier, get more exercise, go on a vacation. Think about the things that you need to do the small steps that you need to make to get to that big goal. So, for me some things for weight loss might be exercising every day but you also can’t out exercise a bad diet. So, I know you’ve got to make choices whether it’s a smaller plate, whether it’s getting rid of your snack foods between meals those types of things that can help you break down that big goal into doing things that you think are going to make a difference over the long run. And maybe you don’t know what those are. But I think we mostly know if it was just knowing that was the problem. It’s the doing part. So, make those small things and work on those everything an account, hold yourself accountable to those. Did I exercise this week? Did I drink water? Did I have less snack foods? Did I eat more vegetables? Those things when you put them all together are going to lead to that big goal.

Janet Brancato: [00:27:52] Yeah that’s great! And sometimes even putting a time on to things you know meaning trying to be as specific as you can with if you’re picking exercising more. You know look at it as an appointment with yourself. Like think about the days the times. Specifically what is it you want to do. I think if you can get even a little more specific with those goals that helps too. It helps you know to put it in your schedule you know or certain amount of time you know. Kind of assess are you a morning person or you are more apt to do it later in the evening but take each goal and sort of break it down a little more specific. And you know like I said steps in mind that will help you to achieve that goal. And like you said every day that you do it you’re getting closer to your overall big goal. You sort of just chipping away you know every single day leading to that big goal.

Mathea Ford: [00:28:45] I think you need to realize that the person that weighs a hundred pound less or 50 pounds or 20 pounds less than you do today has different habits. And so if you want to even lose 20 pounds or you just want to exercise more and be healthier you have to create those habits that that person that is when you think of yourself when you’re there what sort of things are you doing. Are you always eating you know green vegetables or colorful that she pulls on your plate? Are you always parking far away and walking in? You know what are those habits that healthy you has? And how do you get there? So, I have this friend who has the little challenge that she did and it was called… She had a friend named James. It was called What Would Awesome James Do? This guy changed his habits and his activities and what he would do is think about what he was going to do. So he’s going to go to McDonald’s for example not the McDonald’s is bad but… And he thought to himself “What would awesome James do?” Which was the future James that he wanted to be and awesome James would not choose a Big Mac and french fries. He would choose maybe a small fry and a cheeseburger maybe a salad. But he started making those choices. Every time he made a choice he would ask himself “what would the future me do or what would the awesome me do that I’m trying to get to?” And he improved his relationship with his family. He lost weight and he did just basically have a healthier, happier life because he said think about what I want to be when I grow up you know ,Awesome James and started making those changes. So I think that if you can do those types of things what would awesome Mathea do? What would awesome Janet do? You can get there.

Janet Brancato: [00:30:38] And I think that people in general tend to get overwhelmed because they get such a big goal for themselves and a few weeks into the new year they’re not where they want to be. They sort of give up or get frustrated. Well, like you said keep visioning yourself there in the future. You know it may take a little bit more time but that’s okay. You know you’re like I said you’re chipping away at it and having that vision you know having a vision of yourself completing that goal. That’s how you want to keep your mindset very positive. You know as much as you can. Well, I think that’s a great way of looking at it you know looking at you know making those decisions being mindful of these I think somebody like that is very tuned into themselves and their habits. And you know just slowly making those changes and over time it’ll get easier and easier. Beginning is when it seems all the more challenging. But as you be consistent with it. And every day you kind of wake up ready for battle you know you’re ready to kick it into gear. That’s really very important.

Mathea Ford: [00:31:42] Yeah. If you stop thinking that the minute you fall off the wagon everything’s over. You now realize.

Janet Brancato: [00:31:48] We’re human. You know we’re gonna have good days and we’re gonna have not so good days. And that’s okay. You get back on track. That’s all. One day isn’t such a great day. No worries. Just get back on track. You always have that new day to just start over again.

Mathea Ford: [00:32:02] All right Janet thank you so much for being on the podcast today. We talked about fun stuff for the new year and some things that happened last year that people should be looking forward to. So, you mentioned a little bit at the beginning but if listeners want to connect with you what’s the best way to do that?

Janet Brancato: [00:32:17] So, you can connect with me at mynutopia.com. That’s my website and you will find my blog, a little bit about me, possibly working together about meal planning and some tools that I have. I’d love to connect.

Mathea Ford: [00:32:31] Okay. Well guys this has been another great episode of the Nutrition Experts Podcast. The podcast is all about learning more so you can do more with nutrition in your life.

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Nutrition Experts Podcast Episode 35 Low FODMAP Diets and IBS with Bethany Frazier MS, RD, LD

December 31, 2018 by matheaford Leave a Comment

Bethany Frazier is the voice behind the Kansas City Dietitian. The name, The Kansas City Dietitian was actually kind of an inheritance. Her mom is also a dietitian and passed down the name when she retired. She have always loved to cook and experiment in the kitchen. Although she grew up in the presence of an amazing dietitian, she didn’t just fall into it. In fact, it took her a while to come around to it. She started her career in corporate wellness and realized that if her real goal was to help people she needed some specific training. That is when she decided to return to school to become a dietitian.

She have called Kansas City home for over 20 years. She and her husband have made their home in Kansas City with their two children and their sweet pup.

As the Kansas City Dietitian, she coach individual clients, provide corporate wellness opportunities, serve as a media spokesperson and blog every once in a while. Her specialities are: IBS, the Low FODMAPS diet, GI Issues, picky eating, sports nutrition, and weight management (mindful eating).

Contact Bethany to get started on your journey towards better health through https://www.kansascitydietitian.com/contact-bethany/

Mathea Ford: [00:00:27] Hi there! It’s Mathea. Welcome back to the Nutrition Experts Podcast. The podcast featuring nutrition experts who are leading the way using food starts today right now with our next guest. It’s great to have Bethany Frazier on the show today. Bethany, welcome to Nutrition Experts.

Bethany Frazier: [00:00:44] Thanks for having me.

Mathea Ford: [00:00:46] I’m excited to have you on the show and share your expertise with my tribe. So, Bethany let’s start out with letting you tell my listeners a little more about you and what you do.

Bethany Frazier: [00:00:56] Yeah. So, I’m a private practice dietitian. I’ve been a Registered Dietitian. Mostly, it was actually five years. I have a private practice in Kansas City. I mostly deal with probably about 75 percent of the patients that I see are for gut health problems. And then I also do some consulting work. I have two children – I have a one year old and a three year old. So when I’m not working or while I’m working maybe sometimes too I’m busy chasing them around. That’s the little thing that in my life in Kansas City.

Mathea Ford: [00:01:28] I’m so excited to talk to you today because you mentioned you talk about Gut Health. What do you mean when you say Gut Health?

Bethany Frazier: [00:01:36] Well that’s a pretty loaded question. There is a lot of it seems like you just type in gut health or you just are scrolling through your Facebook feed or interim feed and there’s going to be someone telling you to do something about that health. I think it’s because it’s changing so quickly and realizing that a lot of what we do can influence our gut health and just how we feel in general. So, gut health can be everything from the actual bacteria together present like that. So a lot people think of probiotics all the way to explain how your gut function. So, then not a bad or best in it. Then how your stomach contracts the program or your stomach and your intestines contract and then the symptoms are usually what people know. So anything from your mouth down from reflux or heartburn, dtomach pain, some bloating gas, diarrhea, constipation all the fun things that we see on the infomercial that seems like…

Mathea Ford: [00:02:27] When people come to you what are their typical things that they’re wanting to see you for? Does their doctor refer them? Do they find you?

Bethany Frazier: [00:02:36] I think I see a pretty healthy mix of both. It’s not uncommon. Most people will have at least been to their doctor and they have tried to get some idea of what they should do to improve their symptoms. I usually tell people because people will come to me in desperation and that’s usually what happens. People don’t come to me because from my gut health standpoint. They don’t come to me because they want to prevent it. Usually they’re coming to me because they’ve tried everything else. They Googled every answer and nothing is working. So they’re at that point where they need an expert and they need an intervention now. So, sometimes their doctors will refer to me as well. I have a couple of practitioners that I work with in Kansas City that will work for me knowing that I can help their patients. The doctors also are now realizing that a lot of our symptoms can be at least helped, sometimes alleviated, sometimes completely improved or balanced that with medications that they’re recommending through the diet but they often don’t have time and they don’t send them tons of specifics on what to do. So sometimes the doctor will for a month sometimes the patient will say “I went to the doctor and they pretty much said you know just help your symptoms along and they didn’t give me any other any other resources but I’m trying to help my symptoms and I think diet can help some.” So, their own advocate just kind of all across the board that that’s at my doorstep saying “I need help. How can I feel better?”

Mathea Ford: [00:03:59] So, is that something that you would refer to in general as like irritable bowel? Or what people are coming to seec you for? Or is that in general what you work with?

Bethany Frazier: [00:04:10] I occasionally will see some patients that have more of a definitive diagnosis so like IBD, would be Crohn’s or ulcerative colitis. But sometimes will see patients like that, sometimes I’ll see patients that have like GERD or reflux one of those gastritis but IBS is pretty common it is an actual diagnosis. If you probably talked to any of your friends they’re like “oh I have IBS or irritable bowel syndrome.” I really estimated that about twelve percent of the population worldwide actually has a diagnosed version of IBS and there’s a couple of criteria that physicians or experts will use to diagnose IBS. So, I don’t I can’t say diagnosis of the dietitian IBS but patients will come to me either they’ve diagnosed themselves. But the actual criteria for being diagnosed with IBS is that you have to have pain or discomfort one day per week over the last three months. And then, so that’s the overarching umbrella. And then you have two out of these three symptoms which are pain during a bowel movement, a change in your stool frequency or a change in the appearance of your stool. So, atleast two out of those three things is be classified as an actual diagnosis of IBS.

Mathea Ford: [00:05:27] People have come to you and say “I have IBS or I think I have IBS.” If they haven’t been diagnosed, what are the symptoms that they’re experiencing?

Bethany Frazier: [00:05:36] Anything across the board. I’ve had everything from people who have headaches or fatigue to bloating. Again, coz people usually come to me when they’re in dire straits but they haven’t. Nothing else has worked. Usually they have at least one bowel problem. Either they’ve had an increase in frequency, they went from being every other day to multiple times a day or sometimes the opposite. They went from being once or twice a day to once a week. So, flipping back and forth between those sometimes cycling back and forth between diarrhea and constipation. Sometimes it will just be bloating after they have a meal that’s where I think people will start to realize “oh what I’m eating might be impacting my bowel habits” because they will say “I eat something and then I’m bloated but I refresh it and I can’t figure out what it is. I’ve taken out all the foods that I can think of it could possibly be. I eat really healthy.” All of those criteria they’ll say “I did it myself and I’m still having the bloating after I eat or I’m having reflux sometimes after I eat.” Sometimes pain. Pain will be another symptoms that people often will say some pain either in their stomach and you were along, cramping along their intestines sometimes. What they’ll say is leathal and usually it’s influencing their life. So, it’s making them stay in bed. Maybe it’s making them not fearing being away from a toilet. So, they need to be close at all times which can definitely influence your life and the choices that you make. Whether you’re able to travel; whether you are able to go to kids baseball games when there’s no bathroom close. So, usually it’s impeded in their life and that’s their saying “I can’t go on with this” and there’s plenty of people who are living with probably mild symptoms. I think usually what I tell people is that over the course of about 10 years its when your symptoms develop. Sometimes it’s one thing that really sets it off. You’ll get approximate you’ll have either hormonal fluctuation or you’ll have an event that happens. You get the stomachache bug,you get maybe food poisoning something like that actually shift and then all of a sudden you’re like “I just can’t bounce back from this. I don’t know what’s wrong with me” but usually we can point to some or a very stressful occurrence that they just can’t bounce back from. And then so that’s not uncommon that that’s where it will start. But usually people who are more in the gradual that they have slowly developed those problems over about 10 years where they almost think “I can’t remember the last time I had a regular bowel movement.” So they don’t think about it until it becomes very problematic.

Mathea Ford: [00:08:13] So, IBS is not the same as you said Crohn’s, is there celiac all that it’s completely different?

Bethany Frazier: [00:08:22] It’s different. It’s not completely separate in the treatment we would do of it. And so Celiac is actually an auto immune disease and so the IBD categories the Crohn’s and ulcerative colitis so they are have that immune function to act as most people know cannot have any gluten in their diet and IBS patients often will do in elimination any food with Crohn’s and ulcerative colitis. Because gluten can be inflammatory for some people. It’s not for everyone but it can be inflammatory for some people so that can transpose all those categories we were talking about removing gluten but for people that have IBS it’s not always gluten that’s going to be the trigger for them or wheat that’s going to be the trigger for them so you have to be cautious in that because you want to make sure that you’re having good nutritional diversity and that’s challenging with someone that has celiac often that’s their only symptom. They can have complete symptom resolve just by maintaining a gluten free diet. There are times where they have to have a couple extra layers and that’s where you might implement some of the other IBS related interventions which would be appropriate for people in ulcerative colitis or Crohn’s. They sometimes will use the same interventions for dietary interventions for managing IBS not when they’re in their play areas but during their kind of day to day life they might use some of the other dietary things that IBS patients will try and implement.

Mathea Ford: [00:09:52] So, Bethany what are their general recommendations for people with IBS? What type of treatment do you usually do with them?

Bethany Frazier: [00:10:00] It depends on the patient. From a if they’ve gone to see their doctor then some are they’re on medications that are supposed to alleviate their symptoms. Everything from an antidepressant because they’re trying to manage that gut brain to an antibiotic that’s often question especially if they’re affecting maybe a SIBO or that small intestinal bacterial overgrowth. So, that might be an intervention that a patient might come to me on. Sometimes, their doctors have tried to do some just symptom management. So, diarrhea just taking immodium or something like that. Or they might come with you like a laxative for constipation. Those types of things that’s often that they’ll come in with those on. Sometimes their doctors will even recommend something like follow a “get rid of all your dairy and your wheat.” Do some sort of elimination diet. And with my patients depending on what their symptoms are that they present in and so it’s really specific to the patient. But I find that probably close to anecdotally, totally anecdotally but I feel like close to 75% of the patients that I have see that have IBS will respond really positively to the Low FODMAP diet. And so that’s been… That’s usually I do some variation and that I’ll even have patients that are referred to me because they have crypto sensitivity which can cause some IBS. The diagnosis is actually a rule out diagnosis so that means they’ve figured, they’ve tried everything else and you don’t test positive on any other. There’s no other reason you are having these symptoms. And one of those rule out diagnosis is fructose malabsorption and so they can test for that and they can say “yes, you have it or no you don’t.” And so sometimes people won’t have got all the way to earliest diagnosis because they had fructose malabsorption so similar criteria will say “Oh can you alleviate all your symptoms with right removing fructose from your diet or eliminate fructose in your diet. And if they can’t then we might edge them for the FODMAP diet to see if that or a low FODMAP diet to see if that will alleviate their symptoms. There’s lots of that’s a little bit more restrictive. So people that can not be on quite a restrictive a diet we might just suggest. So if there’s someone that has lots of constipation we might talk about increasing their water or decreasing their caffeine, having more fiber in their diet consistently and seeing if that alleviates the symptom. Of course we don’t want them on a restrictive diet. Any sort of restrictive diet long term if they don’t have to be. So my goal is always to try and find the least restrictive version of a diet that they can follow to alleviate their symptoms get some of essentially some of the inflammation down so that we can really see what the root cause of why they’re having these symptoms and how we can prevent them long term.

Mathea Ford: [00:12:48] I totally agree with you there about the least restrictive diet. People come and talk to me about kidney disease and they’re like “I’ve cut out potassium and phosphorous” and I’m like “did your doctor tell you you had to do that?” So because I’m like that’s just making it more complicated if you start simple. So you did mention a low FODMAP diet and for our listeners what does FODMAP stand for and what is it?

Bethany Frazier: [00:13:13] So, the low FODMAP diet is actually based of carbohydrates that are in the food that we eat and fibers that are either poorly digested or slowly digested and can cause symptoms. They actually they’re small and they can cause action and they cause extra water to be pulled into your gut and the FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols. What letter was that? So, those are just fancy terms for carbohydrates basically so you oligosaccharides would be things like wheat, onion, garlic. The disaccharides, the most popular one is lactose. About 70% of people actually have difficulty digesting lactose which is in the sugar that’s in milk. Monosaccharides, one that we usually are concerned about is fructose that I mentioned fructose malabsorption. So, this pulls actually extra water in the gut and it’s really not too much of a problem for some of our fruits. This is the fruit sugar. As long as it has equal parts with glucose and other sugar. Some things that most would be in would be things like honey that’s a popular culprit especially for people that think they’re eating really healthy. They’ll say “I eat really healthy. There’s subbing out their regular table sugar for honey and that’s a higher in fructose. So, high fructose corn syrup obviously its high in fructose you can guess that by the name. Apples, pears, mangoes are some popular fruits that are also really high fructose and then Polyols are sugar alcohols which could be artificially and things like mints or gum that someone’s chewing a lot of mints or gum especially if they’re having symptoms they often will think “oh I feel a little bit better when I have sugar free mint” and that can be actually making your symptoms worse. And then the two naturally occurring sorbitol, xylitol and mannitol which are in our stone fruit like peaches and plums and then cauliflowers another one. So, you can see that a lot of the foods that are in these different categories are healthy foods that we should include in our diet on a regular basis like our fruits and vegetables and even more like garlic touted for helping with heart disease. So things like that that were spread that message but it can be very problematic for people that struggle in this IBS category because the belief no one really knows. I don’t think that they have a complete idea at least. I don’t have a clear idea but they think that people that struggle and with hese FODMAP food that’s not necessarily that they are absorbing them differently. Sometimes it is but usually its their sensitivity to that. So, most people if they eat these foods they’re actually going to respond. They’re fully digested but these people are sensitive to that sensation and it causes them problems. So with all all that connection of how your body is working all together to cause you actually worst symptoms.

Mathea Ford: [00:16:10] How do you do the low FODMAP diet with someone? Do you just eliminate everything in the beginning and then add them back a little bit to see how people respond or how does that go?

Bethany Frazier: [00:16:22] The low FODMAPdiet is not meant to be a permanent diet because it’s so restrictive. So, our goal is to get you back to the least restrictive version. There might be a couple trigger foods or trigger categories. But for most people I find they might respond to one category but they’re going to be able to have most of the food. That’s usually a layering about having too much in one day. We don’t know that until we’ve removed them from your diet. So, usually what I do is I require at least 10 days of following a very pretty strict elimination diet that doesn’t have any or very few FODMAP in it. And I think 10 days just I feel like people are more compliant when it’s just 10 days. Some experts will say up to six weeks if that ten days they are not improving. I want to know so that I can move them on to different intervention but if at 10 days they’re improving then we can continue on a little bit longer until their symptoms are mostly managed and then we can start systematically reintroducing the food and seeing what their responses are. So, the goal is to see which foods they’re responding to negatively and be able to pinpoint those so that they can understand those foods are probably going to be problematic for them in the long run but get them also the best case scenario afterward then we usually do some sort of gut feeling to make sure that that inflammation is reduced and they can move forward and not feel like they have to be on this restricted diet forever.

Mathea Ford: [00:17:54] It probably takes a lot of work and intervention for them to kind of get those things out but then do you find most people at the beginning of that at least after those 10 days they’ve got relief from their symptoms and they’re able to clearly identify by adding them back in what is causing the problems?

Bethany Frazier: [00:18:11] Usually. So, it’s a kind of a long process or it can be a long process. We want to really identify those things but usually people can help to identify which foods are problematic and if they have a little bit sometimes it’s too much of a layering effect. So, some of the foods that are okay on the low FODMAP list or elimination they actually have a little bit. So, someone who says “I’m going to go or accidentally buy the wrong peanut butter that has high fructose corn syrup in it or they’re having too much sugar.” Sugar is allowed but too much sugar not necessarily FODMAP but can cause problems for our gut. So, sometimes or a lot of extra stress. They’re traveling for work and they don’t know exactly what’s in their food or they’re just stressed in general that they’re not sleeping enough. So, there’s lots of different factors that we’re trying to evaluate to see why they’re responding to these foods but I find that in general most people by the end of the process have their symptoms pretty well under control and can manage them from a low FODMAP standpoint to be able to move forward and kind of make some of those adjustments their diet that aren’t going to be life altering.

Mathea Ford: [00:19:19] So, if somebody is maybe got a little bit of a problem with their stomach or they’re constipated or they’re having diarrhea but they’re not necessarily to the level of IBS. Are there some general guides that you tell people to have good gut health foods that they should eat ways they should eat that would help them to just possibly improve some of that?

Bethany Frazier: [00:19:44] Yes. I think we have to. Our interventions have to start all the way from our lifestyle to looking at how much you’re sleeping. There’s a lot of research for what our sleep habits do. So,, how much are sleeping and when you’re sleeping and the exercise we’re getting if you’re someone that’s a chronic. So, I’m not a long distance runner. People that are marathon runners or that do prospect of high intensity making sure you’re allowing your body adequate rest can influence or get help. Those are simple lifestyle factors that you need to kind of go into the equation and your stress. How can you help manage your stress so that that’s not negatively influencing your gut. And then we can move on to talking about food and some of the foods we want to talk about are anti-inflammatory foods. So, things like fatty fish, salmon, or nuts and seeds are usually anti-inflammatory for most people and there are fruits and vegetables are going to be anti-inflammatory for most people and then putting in good bacteria. The good bacteria would be things like a probiotic potentially but eating the fermented food are even better for people that are not struggling with really bad stomach issues. I usually try and start with “let’s talk about our foods and how we can make sure our foods are providing what we need.” So, things like yogurt or kefir or kombucha is really popular, sauerkraut or kimchi those types of things. Having them on a regular basis to introduce those good probiotic and then some of the pre-biotic which can be some of extra fibers that actually feed the gut bacteria. So, doing a little bit of a overhaul from your gut to make sure that you’re getting the right food.

Mathea Ford: [00:21:26] If thinking about like healthcare and you mentioned that doctors do studies or they do labs or tests and then do some diagnosis but that IBS is kind of that elimination like you said like we can’t figure out anything else why you’re having these symptoms. How do you see it affecting healthcare? Do you see this group of people who have IBS growing? Do you see it being managed better? How do you see it affecting health care?

Bethany Frazier: [00:21:55] I think it’s definitely growing. Like I said some of the lifestyle things that we’re doing and our diet in general are not doing any favor. So, I think that’s something growing but also our understanding of it is growing. So, if someone that… Its not uncommon I’ll meet someone that says “well, my grandparents you know my grandpa always have these stomach issues. But I didn’t really ever think about it. So we’re understand there’s a genetic component to it as well.” And their grandpa might not have done any treatment for it. He was just like “oh I would take a gas bag or you know I’d get a little constipated and just continue on a day by day basis taking a laxative or something like that.” So, we’re doing a lot more treatment methods for it. And there’s just a lot more awareness to it. It seems maybe it’s just me because I’m in the gut health community but I feel like every time I turn on the TV there is a different commercial for probiotics or something like that with the help with your… Impact your gut. So, I think we’re a lot more aware of it and a lot of people are interested into and ensuing it. So, the marketing around it is heightened further a billion probiotics. When I started as a dietitian which is only five years ago, we kind of touched on probiotics in school and I worked in my first job as dietitian was working as a retail dietitian. We had a handful of probiotics. There was my favorite one was one that we kept behind the pharmacy counter because it was refrigerated. We have a refrigerated section. Now, you walk into any grocery store and there are a thousands about usually people say “oh! Make sure you get a good probiotic” and a doctor will tell a patient “go get a good probiotic” and they come to me like “I don’t even know. There’s thousands. How can I possibly decide which one is a good probiotic for me and my symptoms” and they can be very daunting for patients. So, I think that awareness is increasing and we’re going to we’re going to see patients seeking out help which is going to influence the ways that physicians interact with it. But I also think a big picture of it is the actual microbiome which is all the bacteria that makes up and fungus that make up our gut tracks. So, as we understand that they’ve just started sequencing it. We started having a better understanding of it and research is coming out on a daily basis and on how we can understand that and apply that information that I think we continue to dig into that research we’re going to understand our gut a lot better and how it influences and how we can influence that with our different interventions. We might do diet, exercise, all of those things can influence and do influence it.

Mathea Ford: [00:24:44] I know my listeners are thinking to themselves what is a good probiotic to get at the store if I don’t like yogurt and kefir and kombucha and sauerkraut and kimchi?

Bethany Frazier: [00:24:54] Yes. So, there’s a couple that I think are better. I think in general the rules of thumb are it doesn’t have to have thousands of different strands by usually like just be ones that have a couple of the lactobacillus strands and then a couple that have this bifidobacteria strand. And I think most people also benefit especially if you have a little bit of stomach problem. If you’re someone who’s like “I just want add general probiotic.” I don’t know that there’s a ton of research for people that they should have on a daily basis for the rest of their life. Maybe that research will come out. Right now, I think making sure you have a good one that’s altering your gut bacteria. Part of the problem with some probiotics is the capsule that is put in. Whether that actually can survive your stomach acid in your stomach to make it to the GI tract. The remaining GI Tract aimed to proliferate your intestines that’s the whole goal. And some of them are not put in the right way that they can. So that can be very confusing for consumers too. Sometimes the delayed relief will help that a little bit. Just reading that on the label and you don’t need a 100 billion. You can do just a 10 billion would probably be fine but the quantity that sounds like a lot but at 10 billion would probably be fine. And our gut is very transient. It changes from a daily basis so if you’re someone that has a little bit of tummy troubles and you think “I should start taking a probiotic and I got sick instantly” that’s a possibility. So either gradually build up to it. Don’t try and take the recommended dosage of eight in a day or something like that. Try and gradually build up to it and that can help as well and I actually recommend that the other strand that I think the lactobacillus and bifido. I think a lot of people with that problem benefit from the fungal strain which is saccharomyces boulardii. That’s a really…. I said a lot of really fun long words. But they’re common ones that you can find or just walk into a good grocery store – a good natural market that has some support. Someone that works there say those words or google it. In fact, saccharomyces boulardii and they will be able to point you in that right direction but that’s another one that has good research as far as kind of help managing some of that gut. Just by that disruption and gut bacteria. So I think those are good things to look for in a probiotic but I do recommend talking to a practitioner if you have that availability because like I said going into your regular grocery store and just buying one off the shelf you have no idea if that’s helping you other than how you feel. So, sometimes your practitioner will have a recommendation. This one’s well researched, this one’s not well researched or this one’s good for people that just have more predominant diarrhea or more prolonged constipation. So, there’s so many different factors that they can kind of help you navigate through and make a better selection.

Mathea Ford: [00:27:53] You mentioned some of the recent changes like with the microbiome tracking and what are some of the more recent advances made in the treatment of this issue or is there any research going on that you think is really exciting that may provide some great insight?

Bethany Frazier: [00:28:10] Well, I think one of the more interesting areas of research. Well, I’m on that area, so I think everything that has to do with the gut is super interesting. But one of the interesting pieces is that they’re noticing different populations of bacteria in your gut influenced the way that you absorb nutrients. So you can actually now absorb nutrients based on the bacteria that you have a predominant in your gut which can also influence how much you can serve people, two people the exact same plate of food and they can actually absorb one person over the other commends or more of the calories and nutrients from it which is usually more predominant in people that are overweight or obese. I think that’s really interesting just to be able to understand that it’s not you know people who struggle to lose weight or to maintain their weight that sometimes it’s a lot deeper than just the calories that they’re eating next to their skinny friends. It can be the calories. It can be actually what their gut are doing with those calories and we have the ability to test that. But I already said that the gut is very transient so it can change and fluctuate with seasons and different times of day and all of that. We can influence that and I think they’re still trying to figure out how they can on a population wide make that available and whether that information is going to be super reliable. I think that will come out soon enough that people will be able to and there are some tests that I’ll use on patients to see what the composition is of their microbiome to understand it and see what types of things are they’re going to benefit from the most as far as what type of bacteria from a probiotic they might need, which type of foods they might benefit from and kind of look at that whole picture be able to see what’s going on inside and why they might be having some other symptoms that they have.

Mathea Ford: [00:29:59] So, thinking about the listener’s being dietitians or even just people just more interested in nutrition how can this information that we’ve talked about, what would be some key takeaways for people to use in their day to day life either with patients they’re working with or just with themselves?

Bethany Frazier: [00:30:18] I think for practitioners that are working with patients, being during ask some of those questions especially if you’re doing something that’s not at all related to gut health. Seeing that there’s so many connections so you’re talking with someone for a weight loss or like you you’re talking to someone for kidney disease, asking them some of those questions just to get them aware of those issues. “How are your bowel movements?” They might say “fine!” “Well, how many times a day do you go? Is that normal for you?” Just asking a couple of questions I think will only expand you as a practitioner help you understand some of the trends. So, you don’t have to do the research you’ll be the first to see the trends in your population on what is normal and what’s not normal for bowel habit and how that really influences. How their health as the population. So, I think that’s a great takeaway for practitioners. If I am doing more research because you’re going to get asked about the FODMAP diet. Like I said everyone seems like everyone has IBS but there’s smaller things that you can do besides applying the low FODMAP diet depending on what people’s symptoms are. So, looking at their caffeine intake, looking at their drinking enough water. How much soda they’re drinking if they’re getting enough fruits and vegetables. It’s always a really easy thing that dietitians love to talk about. Are you getting enough fruits and vegetables and fiber. Good sources of fiber to continue to support your bowel health. I think those are all in and probiotic that’s probably getting behind a good probiotic. It’s impossible as practitioners or as people wanting to improve our health. I think it’s impossible for us to know every single probiotic that’s out on the market. But doing a little bit of research or reaching out to a trusted resource or some really great dietitians that you can follow on social media. Finding some distance or check on their website. Things like that that you can trust and kind of keep ahead even gut health is not your primary occupation like it is for me. I still feel that most of us all of us does and we need to do all we can to improve those things and keep them healthy so that you don’t end up at my door saying “I need help!” I want to prevent you from getting there. I want you to be able to have the resources to stay healthy so try to incorporate your fermented foods when you can and staying exercising and getting enough sleep. Simple things that you don’t have to really even see a dietitian to know that you need to do. But being consistent in that will only improve your gut health for a long term.

Mathea Ford: [00:32:49] Are there a couple dietitians that you follow that talk about gut health a lot that you would recommend?

Bethany Frazier: [00:32:54] So, those two at least on the FODMAP side there’s two dietitians that I think are kind of the predominant ones in the US and that’s Patsy Catsos and Kate Scarlata. They’re both. They have written books about FODMAP. They’re great resource kind of how I got my start with FODMAP with what’s with both of their resources and they both have lots of great resources on their website that are for free. So if you’re someone that wants to read more about it you think about I have tummy troubles I think FODMAP good solution for me. You can go on their websites and get good resources from that and just in social media they both have some in that world, in that realm. I also really like Andrea Hardy. She is from Canada and she has lots of great from the social media side she’s hads lots some great resources for gut health. So, she does FODMAP and she also does a lot of other areas of gut health. So she’s a fun one to follow too.

Mathea Ford: [00:33:52] So, you said Patsy Catsos? Okay and who is the other one?

Bethany Frazier: [00:33:59] Kate Scarlata.

Mathea Ford: [00:34:06] Yeah that’s good. So people are interested in learning a little bit more about it, they can also get that information from a qualified source. I always ask my guests what is their favorite food. So, what’s your favorite food?

Bethany Frazier: [00:34:21] I know with my outlook here you would say my answer and this is probably like a special occasion favorite food and this is totally a dietitian answer I don’t really know why this is my favorite food but I love Salmon Salad. I know that sounds a dietitian answer and I don’t mean to be but I if I go out for a special I think I don’t prepare it at home. I have a family of picky eaters. So, we don’t ever eat salad. We do occasionally eat salmon but if we eat a salad I’m eating it alone because my family will not eat it. I love to go out and get a really good salad. Not a low calorie salad. We don’t care about that. We want it really good salad. Fresh and had lots of fun ingredients in it. I just love fun food. I think good and I like to experiment with that. I like to go find places and try new things.

Mathea Ford: [00:35:03] I love salads too. I know.

Bethany Frazier: [00:35:05] That’s the dietitian answer but to prove we can’t help it it makes everybody feel good. As soon as it is inside where we know the things that make us feel good and I mean I like to have a brownie every once in a while too but a salad makes me feel good and it taste good.

Mathea Ford: [00:35:19] Great! Bethany, thank you so much for being on the podcast today. It was a pleasure to have you on the show. I know my listeners have learned a lot about gut health and IBS and how that can affect them even or just like a friend if they know somebody “hey this is what I heard about that.” So if listeners want to connect with you what’s the best way to do that?

Bethany Frazier: [00:35:41] I’d love to connect with you on social media. You can find me on Facebook or Instagram or Twitter. It’s @theKCDietitian like Kansas City Dietitian. I mean that with pretty or my website is KansasCityDietitian.com.

Mathea Ford: [00:35:59] Great! So, guys it’s been another great episode of the Nutrition Experts Podcast. The podcast that is all about learning more so you can do more with nutrition in your life.

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Nutrition Experts Podcast Episode 34 Vegetarian Diets for Kids with Jessica Spiro

December 24, 2018 by matheaford Leave a Comment

Jessica Spiro, RD is a plant-based registered dietitian based in San Diego, California. In addition to having her own practice where she specializes in vegan and vegetarian nutrition for families, Jessica also has a blog and makes regular appearances on the San Diego local morning TV news. Jessica’s goal with her business is to help parents raise plant-based kids with confidence!

www.jessicaspirord.com

Mathea Ford: [00:00:27] Hi there! It’s Mathea. Welcome back to the Nutrition Experts Podcast. The podcast featuring nutrition experts who are leading the way using food starts today right now with our next guest. It’s great to have Jessica Spiro on the show today. Jessica welcome to Nutrition Experts.

Jessica Spiro: [00:00:44] Thank you so much for having me on your show.

Mathea Ford: [00:00:46] I’m excited to have you on the show and share your expertise with my tribe. So, Jessica let’s start out with letting you tell my listeners a little more about you and what you do.

Jessica Spiro: [00:00:57] Yes. So, I’m a registered dietitian I’m based in San Diego and I specialize in the organ and vegetarian nutrition for kids. So, plant based diets for children. And I decided to go into this specific area because of my own personal experience. So I had a daughter two years ago and she was basically mostly vegetarian since probably I was 12 years old. And then when she started eating I found out she was allergic to milk and eggs. So, I started to research more and more about diets mainly because I was trying to look up recipes and also make sure that she was getting her adequate nutrition and calcium and all of that. And I was one learning more about veganism and the ethical aspects of that really resonated with me. And in addition I also found that there was a big gap in information. So there’s really not much information pertaining to specific nutritional needs for vegan children in particular. And so I felt that being a Registered Dietitian and also having my own personal experience trying to look for that information I decided to go into that area.

Mathea Ford: [00:02:12] You talked to… You said mentioned the ethical aspects of vegetarian vegan foods. What would be some examples of that?

Jessica Spiro: [00:02:21] So, in terms of you know a plant based diet. Plant based diet is really where you’re incorporating more fruits and vegetable, you’re eating predominantly plant based sources of proteins etc. Veganism is it encompasses the ethical aspects including you know just your everyday living including you know not buying leather products and things like that. So, vegans omit any type of animal products. So, dairy, eggs, you know things like honey for example. Their specific nutrient needs that you know we need to pay extra attention to especially if we’re raising vegan children.

Mathea Ford: [00:03:01] So, the ethical side is really just not using animal products? Is that what you’re saying?

Jessica Spiro: [00:03:06] Yes!

Mathea Ford: [00:03:07] Okay. So, would you say that children that you work with seem to find that extra value or they’re inspired by that or is it something that is different for kids?

Jessica Spiro: [00:03:19] You know interestingly enough I thought it was going to be a lot of parents coming to me because they decided to go vegan and wanted to get their family on board. But actually it’s been a lot of times that I’ll have moms reach out to me because their child wants to go vegan. They were impacted by a story that they heard and so their families want to support them and their believe somewhat of course make sure that they’re providing them adequate nutrition.

Mathea Ford: [00:03:48] What age typically are you working with kids when they’re kind of making these choices?

Jessica Spiro: [00:03:54] If parents aren’t already raising them from a young age it’s usually pre-teen teenagers that I find I don’t know. That’s like you know the statistics of course but that’s just generally what I’ve seen in my practice.

Mathea Ford: [00:04:07] So, let’s talk for a minute because you specialize in plant based nutrition for kids. Can you talk about what is Plant Based Nutrition? Is it the same as a vegetarian diet? And as a vegetarian the same as vegan? Or is plant based nutrition… Which one is how are they different?

Jessica Spiro: [00:04:26] Yes. So plant based there is no legal definition for plant based. But most people assume it to mean a diet where the majority of your nutrition is coming from plants. So, you know I love the type the label plant based but really it’s actually what dietitians have been recommending since for forever really where we should be eating more fruits and vegetables, more whole grains. And perhaps a little too you know or maybe less on the you know processed meats things like that. So, eating more fruits and vegetables and more grains is probably you know at the epicenter of the diets. And then veganism takes it another step because it encompasses more of the ethical aspects that I was talked about before. So you know vegans don’t necessarily have to be plant based so there is a vegan alternatives to almost every type of food. And it doesn’t of course doesn’t necessarily mean it is healthy. So, you know you can do vegan nuggets for example you can do vegan macaroni and cheese. So, veganism is about the the ethical component. The animal welfare as well as environmental impact of our eating habits and plant based is more focused on the diet and the health aspects of it. And of course people can be both. You know a combination and vegetarianism there’s different components of vegetarian. So vegetarians typically eats. Lacto-Ovo eats milk and eggs and Pescaterian include fish in their diets. And then of course there’s varying degrees and of each people might not be all vegan they might be mostly vegan or you know things like that so. But those are pretty much the definitions.

Mathea Ford: [00:06:12] So, plant based doesn’t necessarily mean that you’re not eating meat. It just means that the majority of your food 80-90 percent is plant based and you may have some meat products or other chicken that type of stuff every now and then?

Jessica Spiro: [00:06:26] Exactly!

Mathea Ford: [00:06:28] Okay. What type of meat substitutes do vegans usually eat or you know to get. I’m guessing protein and other components that we typically get out of meat?

Jessica Spiro: [00:06:39] So in terms of like if you look at the vegan alternatives that you can buy sort of more processed versions that they’re going to typically be soy that’s the most common one that you’ll see. But in terms of finding vegan replacements to protein so. Well, first you know all plant foods do have protein. You know whole grains have protein and pasta has protein. All those foods do have varying degrees of protein but typically a protein replacement on your plate for example would look like more like beans for example tofu, even nuts and seeds. So a lot of people make and I did this at home to a I make my own vegan cheese using soaked cashews, a little bit of nutritional yeast and so there’s ways that you can kind of give that cheesiness without necessarily having to buy one at the grocery store an alternative. So, typically the replacements are going to be those proteins and those types are legumes and nuts seeds things like that.

Mathea Ford: [00:07:42] So, I’ve heard of nutritional yeast but I have no idea what it is or how you would use it or how it enhances food. So can you talk about nutritional yeast?

Jessica Spiro: [00:07:51] Nutritional yeast has a little bit of a cheesy flavor so it’s a really great way to add a little bit of that flavor to foods especially when you’re trying to get things more palatable for children but it’s also a fortified source of B12 which we know in a vegan diets it’s the number one nutrient that vegans need to supplement in their diet because you cannot get B12 in your diet other than through meat or meat products or animal products rather.

Mathea Ford: [00:08:26] So, what exactly is nutritional yeast? Is it like a yeast or?

Jessica Spiro: [00:08:30] Yes exactly! It comes in flake form. So and a lot of people don’t really like this. So it’s a divide it’s almost like cilantro. I find that 50 percent of people really like it and 50 percent of people can’t stand it. So I hear a lot about it of course in vegan diet but it’s not a necessity. You don’t have to be vegan. You don’t necessarily have to have nutritional yeast but it’s just an easy way to add a little bit of that that cheesy flavor to sauces and things like that.

Mathea Ford: [00:08:56] Interesting. So, you just put it in kind of a little bit and…

Jessica Spiro: [00:09:00] Yeah! You mix it in sauces. Some people just top it. Just do sprinkle some on the tapping a pasta or any other kinds of dip. You can really just… There’s if you go online there’s tons of recipes that where you can you can use it. And again it’s a really great way to make sure you’re fortifying your diet with B12.

Mathea Ford: [00:09:20] What are the risks for kids being raised on a plant based diet or a vegetarian diet? Are there certain nutrients they need to supplement? Are there certain things that they do differently versus an adult?

Jessica Spiro: [00:09:32] There’s definitely a lot of benefits of eating a plant based diet. People that follow plant based diet have lower incidences of cancer, heart disease and lower BMI is overall so. But there are some concerns. There are some nutritional nutrients that vegans do need to pay attention to. B12 as I mentioned is the number one because it can’t met with the diet. So, actually interestingly enough B12 is a bacteria. In the past we we got it through our diet because we didn’t have no clean water, we ate food maybe from the ground. And thank goodness we now have clean water so we cannot get it through our diets that means we do have to have it fortified. Animals get it through eating you know from the ground or wherever. So, that’s when we in turn get it from the animals so people that follow a vegan diet do need to supplement. And this is really key for children especially so. Especially if you’re starting them off on a vegan diet at young ages can B12 stores last in our bodies are about five to seven years so someone to an adult who may have gone bigger vegan later on in life. It’s really important not to have a kind of a casual attitude about B12. B12 Deficiency does exist and people who follow vegan diet and so it’s really important to supplement and for children who might not have had developed those stores deficiency can happen very quickly and those deficiency can lead to issues with your nerves, cognitive function etc. It’s an incredibly important nutrient to get in your diet. You can get it through fortified foods. So, cereals, plant based milks not all of them so you definitely check the labels but they’ll typically have B12. They’ll be fortified with B12. That’s not a reliable source because you know with children especially it’s hard you know they don’t always eat their full bowl of oatmeal they don’t always drink that glass of milk, might go to have a drink in the whole day. So, it’s important to supplement and I recommend people you know work with their doctor, dietitian to find out you know how much do supplements or you can go to the you know look up where the dietary references to the idea arise for those nutrients and make sure you’re supplementing.

Mathea Ford: [00:11:52] So, are there any other nutrients you’d ever worry about iron or vitamin D or anything like that?

Jessica Spiro: [00:11:58] Yes. So iron and vitamin D are nutrients that really we should know that vegetarians, vegans and people to follow you know just regular omni diets as they call them. They are all iron is a nutrients that we can typically be lacking in all of our diets. So, vegans they’re not getting the heme iron so it’s recommended heme iron that’s found in beef for example is considered to be better absorbed than non heme iron found in beans. So, it is generally recommended to have about double the iron and that’s pretty easy to get in a vegan diet. It’s well planned. So a cup of beans for example is going to have about six to seven milligrams of iron and that’s actually almost double the amount that you’re going to find in a three ounce serving of beef. So, you can get a lot of iron through the diet if you make sure to have beans in your food. Also tofu also has iron. So those are some easy ways to get iron in the diet. And as for vitamin D we know as a sunshine vitamin is a hormone that you know now that we want to make sure that we have proper sunscreen or if you’re living in colder climates of course we can all be deficient in vitamin D. It’s fortified in milk – in cows milk. So that’s how most kids are getting their vitamin D. So, likewise it’s also fortified in a lot of plant milks as well. So that’s some ways that you can you can get vitamin D make sure that you’re getting adequate amounts.

Mathea Ford: [00:13:40] Okay. Great! I know that the AND American Nutrition Dietetics group and they have a position statement on the appropriateness of a vegan or vegetarian diet and they say it’s appropriate for all ages. So, what reasons do you parents you mentioned that parents often bring their kids because they’ve the kids have decided they want to be vegan but what reasons do parents have for wanting to do like a plant based diet with their kids?

Jessica Spiro: [00:14:11] So, yes. I’m glad you mentioned the Academy of Nutrition Dietetics their statement their position statement on begin vegetarian diets. They said that it’s safe for all stages of life from infancy pregnancy breastfeeding. Of course they added you know added a key element to that physician statement as well planned. So, a well planned vegan and a vegetarian diet are safe and they’re not.. And they said they’re not it’s not only safe and adequate it also help has a lot of health benefits as well in reducing the occurrence of chronic diseases. So in terms of parents deciding to go more plant based you hear about a lot more. There’s a lot more research that’s coming out on plant based diet. So, you know I’d love to reference the particular study or group of studies that they did on the Seventh Day Adventist. It’s a really one of the most cited studies for people that follow vegan and vegetarian or plant based diet. And it’s actually one of the largest studies looking into the health benefits of plant based diets. And basically that there’s a large concentration of Seventh Day Adventists in Loma Linda, California where people follow healthy vegan and vegetarian diet for religious reasons. It was funded by the National Cancer Institute and the last one had over 90. They looked at over ninety five thousand people and over a period of time. And what they found was there was significant health benefits of following those diets including for example a 70 percent reduction in lung cancer even compared to nonsmokers eating the standard American diet. They also found that the Adventists who eat legumes at least a couple of times a week had about a 30 to 40 percent reduction in colon cancer. And women also had reduced rates of ovarian cancer. So, we’re getting a lot more research and a lot more understanding of the health benefits of following a plant based diet so typical standard American diet is maybe one we think of where it’s heavy on the meats and you know there’s more processed foods so incorporating more fruits and vegetables, more whole grains that has so many health benefits and we’re really seeing the research coming out supporting that particular diet.

Mathea Ford: [00:16:29] Well, and Oreos are vegetarian right?

Jessica Spiro: [00:16:31] Exactly! That’s why the plant based is a really nice term because it makes sure it also incorporates that health aspect to make sure that it’s not just the substitution of for example Dino chicken nuggets to your vegan chicken nuggets they’re both going to be processed foods that of course as parents are busy it’s not bad to include on occasion but being a staple in the diet. When to look at incorporating more whole foods.

Mathea Ford: [00:17:00] So, can you talk a little more about the word the term that you used of well planned?

Jessica Spiro: [00:17:06] So, well planned diet we want to include variety in a plant based diet. So for example zinc is a nutrient where another nutrient where we want to make sure we’re getting on a vegan diet because it is lower levels in plant based foods. So if you’re including a variety of foods it’s going to be much easier to make sure you’re meeting your nutrient needs. You don’t want to just think about if you’re starting to go plant based or go vegan, you want to make sure you’re not just taking away certain foods you don’t want to just take away milk and just take away meat and not consider how you’re going to make up for those nutrients. So for example calcium is incredibly important for growing children. Children as young as toddlers they need about 700 milligrams and when you get into teens they’re going to need almost as much or they’re going to need actually as much or even more calcium or they can have more of the calcium requirements than many adults. So, of course they you know toddlers are going to eat a lot less.

Jessica Spiro: [00:18:05] So, just relying on broccoli for your calcium source for example isn’t going to be sufficient enough so a couple of broccoli has about 60 milligrams of calcium. Want to make sure that we’re getting good sources of calcium into our children’s diets. Get that again from tofu or fortified soy milk. It’s going to be a great way. So it’s definitely not study hard to do it but you just want to take those nutrients into consideration and make sure you’re planning your children’s diet appropriately.

Mathea Ford: [00:18:36] So, as a vegetarian. Are people still worried about the whole complete versus incomplete protein? Or do they need to worry about mixing red beans and rice for example? Or is there another way that you go about looking at the sources of of nutrients?

Jessica Spiro: [00:18:53] That’s a great question. So luckily they found that you don’t need to pair those. Specifically, so basically you know proteins are made up of essential amino amino acids essential, not essential. And basically we want to so that came about that if a particular food is low and one of those essential amino acids like or one of the amino acids like methionine and that you want to you know do beans and rice together to make sure that it forms the complete protein but you actually don’t have to do that at the same meal they did bunks that I believe what I had heard that it came about in a book and then 50s I’m not quite certain on this but and then it’s sort of became a standard recommendation for vegetarian diet but luckily they’ve gone back on that and found there really wasn’t evidence to support that you don’t have to include you don’t have to pair them but you know what? I think that by the making sure planning of a meal it kind of just happens naturally so typically you’re going to be doing beans with some type of grain because you know you’re not really just going to be eating a bowl of beans anyway. So, I think it sort of happens naturally but you don’t have to do it at a specific meal.

Mathea Ford: [00:20:02] I think it’s good to know that. Yeah like you said you can mix proteins but you don’t. That’s not part of the whole plan you have to do. Why do you find that kids are usually like enthusiastic or interested in starting the style?

Jessica Spiro: [00:20:18] I think it depends for a variety of reasons but the one that I see most often is the ethical aspect of it. It’s the animal welfare I think you know people learn about. A little bit more about factory farming and I find that you know for some reason at that age you know like I was talking before that adolescent age I do hear a lot more. I have a lot more families coming to me just telling me that their children have decided to go that route. It’s funny because that was my story too. That’s how I became vegetarian when I was 13. So that’s really the main reason. And then for families like maybe the parents have decided to go more plant based or even perhaps they saw this is obviously more common now with with the influx of documentaries that have come out of a lot of families coming to me and wanting to go that route and I think that the most important thing is a lot of people want to just change overnight and I think that you know if you’re an individual that might work. But I think especially when you’re involving your families it’s important to do it maybe more gradually. So, focusing more on what foods that you can add or what dishes that you can add to your diet as opposed to what you’re just gonna be taking out so that’s kind of how I ended up going to more vegan route was adding in slowly into my diet you know with my daughter when I found out she’s allergic to eggs and milk. She was about 7-8 months old so I was in a rush to make these changes. So, I did it slowly and found there’s so many different recipes that are really delicious. It was actually funny because I remember that before I was mostly vegan that you know anytime a recipe turns battle I would do is just throw a bunch of cheese on it and instantly it was good. So I had to learn some strategies to cooking more plant based. I think that it does take time so I think that people need to be you know kind with themselves and you know especially when they’re thinking about kindness to the animals and the environment so we also have kindness towards ourselves and you know maybe doing things gradually like I said and getting the kids involved in the process like cooking and picking out ingredients. You know getting kids to eat plant based or even fruits and veg or maybe not fruits and vegetables has been you know a struggle of parents for a very long time. So, I think oftentimes when I’m working with parents you know if they’re very concerned about the nutritional aspect. Oftentimes, I’m focusing especially on my young children on preventing picky eating and helping them work with their children to eat more variety. So, it’s really of course great to have this well planned vegan diet but it was a vegetarian diet or any kind of diet for that matter that’s healthy. But if they won’t eat it then you know it doesn’t matter. So, it’s just you know it’s a process with kids regardless of their diet to eat more vegetables and eat more whole grains. So, oftentimes in a session or know appointments with clients I’m referring a lot to the Ellyn Satter website and talk about a lot about the division of responsibilty and which is if people aren’t familiar with it it’s basically you know parents deciding what foods to offer, when and where and children decide how much. So it helps make meal times a lot less stressful. You know you want to make sure you’re giving something to your tribe they’re going to eat and then allow allowing them to get more exposed to different types of vegetables and whole grains. And it’s a process. So you know I think that that’s where sometimes a supplement for can come in handy. But of course you know like I said when I say talk to your doctor, dietitian because it’s well we want to make sure we’re focusing on getting adequate nutrition. We also want to build a healthy relationship to food. We also want to take the stress out of meal times because any parent knows it’s just it can be a challenge to get your child to eat particular foods like I said again no matter what type of diet you’re following.

Mathea Ford: [00:24:32] Yeah! That makes a lot of sense. So, you didn’t we haven’t said anything about like organic or non GMO. Is there anything of that that goes into the plant based or vegetarian diet or are they two completely different topics?

Jessica Spiro: [00:24:47] So, I think that they are that is really a choice that I think it’s up to the family. I don’t think that there’s sufficient evidence on either side to make a wide claim on whether to include more organic or not include organic. The goal is really to include more fruits and vegetables organic or not so organic food can be especially in particular seasons or in particular areas can be so much more expensive and you don’t want to not eat fruits and vegetables because it’s not organic. So, I try as much as possible to not go into that of course I get asked about that. So I really emphasize that benefits of eating fruits and vegetables that are non organic are going to… There’s just not sufficient evidence for avoiding non organic foods so. And same thing with GMOs. So, I know actually this is something where I do see frequently in the vegan community because a lot of people are concerned about soy because most times so it can be genetically modified. So, I tried to help dispel some of the myths about GMOs. And of course we’re still learning more about it so it’s hard to make a you know a recommendation based on the current research. So you know I think it’s a personal choice you can easily avoid GMO soy by choosing organic soy or tofu. But I think that that’s really a personal and family decision. But I do try to help dispel some of the myths and or not even assert some of the myths but some of the fear around those foods are those or you know topics.

Mathea Ford: [00:26:22] Yeah. I think you make an excellent point. It’s more value more important to get the fruits and vegetables vs. like you said if you can afford the organic to just not eat them. That’s not as healthy as eating the one that may be non or may not be organic but still is a fruit and vegetable that you’re getting in your diet.

Jessica Spiro: [00:26:43] Exactly! And you know I’m actually very happy to see that there’s a lot of dietitians now specializing in this area for Vegan Nutrition and plant based nutrition because it’s a growing growing area for dietitians and I think it’s really needed. Like I said when I was trying to find it was vegetarian. And then more vegan because of my daughter’s allergies and I was just really surprised by how little information there was out there so I’m so glad there’s more dietitians entering this area because I think that a lot of people that make for example an ethical choice to go vegan they’re turning to perhaps more you know some of those quote unquote nutrition experts that may not have degrees and you’ll see a lot I feel like I see a lot more myths in these circles. I’m a part of a lot of different online communities for vegan parenting and sort of just kind of listen in and see what you know people are saying. And so I think that not having information out there so I’m just really glad that there’s more dietitians entering this arena of plant based nutrition so that people on parents can get the correct and credible information.

Mathea Ford: [00:27:54] So, thinking about the kids that you work with what are some foods that kids really like that almost surprises you that you’re like “I didn’t think kids would like that?”

Jessica Spiro: [00:28:06] Beans. I’m Really surprised how many children do really like beans. And it really makes sense me even from a young age. Beans are really soft so it’s easy to eat. Then you can just do so many things with beans. You can make veggie burgers, you know you can just do such a wide variety of things. I mean this is a dessert but it’s still finding like black bean brownies. Different recipes that you can make with beans but I’m surprised how well kids take to take the different legumes.

Mathea Ford: [00:28:34] Yeah! My kids really like because they are not vegan ham and bean soup. But I was a little surprised by that too because I was like “really?”.

Jessica Spiro: [00:28:43] Yeah. I know kids are actually very surprising sometimes with the foods they like.

Mathea Ford: [00:28:48] What would be your words of advice to how to use this information we’ve talked about in their day to day life?

Jessica Spiro: [00:28:54] The key thing is really that know parents, most parents really want to do what’s best for the children. I think that a lot of parents you know are because there’s doctors, dietitians we’re maybe not trained so much weight on the Vegan Nutrition so because maybe if we don’t have the knowledge for it we get concerned about it. So I think it’s met with sometimes with resistance or people feel like it’s not with resistance in the medical community so I think it’s really important to listen to parents and then just help meet them where they are. So, I think that where it when the Academy of Nutrition Dietetics came out with a position statement I think that that was really helpful and I think that that was gave all things a lot of dietitians a much more confidence in working with vegan families to know that it is an appropriate diet. I think with children of course and and rightfully so we get very concerned because we want to make sure that they’re getting proper nutrition. So, I think knowing that’s a like a set of well planned vegan or vegetarian diet is adequate. Not only adequate but it does have a lot of benefits but it’s important to be educated make sure that they’re getting getting their adequate nutrition.

Mathea Ford: [00:30:09] So, really just not assuming that it’s not a good thing for kids but really trying to find out how we can support that decision.

Jessica Spiro: [00:30:19] Exactly!

Mathea Ford: [00:30:20] Great! So, Jessica, my question I ask everybody is what is your favorite food?

Jessica Spiro: [00:30:26] So, I know I talk a lot about beans. There’s many other plant based proteins out there but I do love lentils. I just. They’re easy to make. They don’t have to do any soaking. And my daughter loves them so I would say lentils are my favorite, my favorite food.

Mathea Ford: [00:30:43] All right! I didn’t know you didn’t have to soak beans.

Jessica Spiro: [00:30:47] Yes, lentils are that one of the only ones you don’t have. We do not have to soak you just took at 20 minutes and then good.

Mathea Ford: [00:30:53] That’s a good tip there. Okay. Jessica, thank you so much for being on the podcast today. It was a pleasure to have you on the show. I know my listeners have learned a lot about the different aspects of vegetarianism, vegans especially for kids. So, if listeners want to connect with you what’s the best way to do that?

Jessica Spiro: [00:31:11] So, my website is JessicaSpiroRD.comnd then I’m also on Instagram, Facebook. @JessicaSpiroRD.

Mathea Ford: [00:31:20] Great! So, guys this has been another great episode of the Nutrition Experts Podcast. The podcast that is all about learning more so you can do more with nutrition in your life.

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Nutrition Experts Podcast Episode 33 Making Sense of Nutrition For The Everyday Joe with Joel Feren, RDN

December 17, 2018 by matheaford Leave a Comment

Joel Feren is The Nutrition Guy (TNG), an Australian Accredited Practising Dietitian and Accredited Nutritionist. He regularly consults to the food industry and in private practice, helping clients to achieve improved health with good nutrition.

Joel is a self-described foodie and recipe developer. On the weekends he is often found perusing the food stalls at his local market or trialing new recipes in the kitchen. Joel’s food philosophy is that any dish can be made more nutritious by swapping ingredients and by using alternative cooking methods.

Mathea Ford: [00:00:25] Hey there! It’s Mathea. Welcome back to the Nutrition Experts Podcast. The podcast featuring nutrition experts who are leading the way using food starts today right now with our next guest. It’s great to have Joel Feren on the show today. Joel welcome to nutrition expert.

Joel Feren: [00:00:43] Thanks. Thanks for having me on.

Mathea Ford: [00:00:45] I’m excited to have you on the show and share your expertise with my tribe. Let’s talk a little bit about you’re obviously not from America. Where do you live and tell us a little bit about what you do?

Joel Feren: [00:00:57] No, I think my accent’s probably a dead giveaway. So, I was in Australia. In Melbourne and I’ve been a dietitian there for six years. I mean some of your listeners may have seen me pop up on the social media feeds. I guess I wear a number of different hats. It’s quite funny I often find it really difficult to describe what I do particularly to people who don’t practice in the nutrition space. So I wear a number of different hats. I consult in private practice. I consult to the food industry. I do some media work as well. I’m actually a media spokesperson for the Dietitians Association of Australia. I do a lot of work in aged care. I’m fortunate enough to be invited on various podcasts. Yeah! It’s no two days are ever the same and I think that’s what I love about being a dietitian and certainly love about my role. Opportunities will pop up and I know when I first graduated I had no idea what my career might look like. And almost six years later. It’s certainly not what I had intended. I always get really enthusiastic about career prospects and even just talking about my career path and journey. So, I think it’s probably not too dissimilar to a lot about the dietitians who I sort of working in the consulting space.

Mathea Ford: [00:02:14] So, you don’t actually work at a hospital you kind of have your office and you do consulting and different things?

Joel Feren: [00:02:20] Yes. So, my office will vary sometimes it’s home office sometimes it’s the family home sometimes it’s my private practice clinic. But you’re right. I don’t actually work in a hospital. When I went into dietetics I actually thought I did want to work in a clinical setting but having done my clinical training when I was back at university I realised that it just wasn’t for me. So, I think when I graduated. While I was open to opportunities I think that was the one I did close myself off to. I was forced to look at other other options. But yeah I love that my home office is really relaxed environments and it’s something I can wear my Trekkie decks and I don’t have to wear I don’t have to get dressed up in a suit or nice clothes and you can just sort of do my work when I like.

Mathea Ford: [00:03:05] So, what’s the favourite thing that you work on? Like what’s your favorite topic or nutrition specialty kind of thing?

Joel Feren: [00:03:12] At the moment. I love working in food industry. I love working on media and nutrition communications. I think that’s sort of my my forte but I think one of the things that I’ve been really fortunate enough to do is actually develop recipes. When I was 16, I actually wanted to be a chef and my parents talked me out of out of it because of the working load and the hours and I think now I’m sort of able to marry two wheels because I’m able to marry my love for cooking but also married my love of nutrition together. So, often I know well I’ve just talked about my home office sometimes I joke that my home office is actually my kitchen because I get to cook and develop recipes. So it’s a lot of fun. I get to do it in my own time at my own pace. And yes it’s certainly a thrill. I think friends sometimes shake their heads and think “Jeez! What on earth does Joel do for a living?” It’s the other way. I was making peanut butter slices and peanut butter smoothie balls and today I’ve got to make a peanut butter pancake mix so I’m actually working. “Do you work for peanut butter company?” Well I’ve been lucky enough to work for one large corporation and actually develop some recipe books for them. So that’s a real thrill for my end that I get to be able to cook for a living.

Mathea Ford: [00:04:34] That is something that probably a lot of dietitians you mentioned not being so clinically focused or working in the hospital. I kind of get that really well because clinical is not my strong suit either. And I love food, I love cooking, I love making recipes. So, that is just the dream there to me to work. So, can you talk a little bit about your health journey and how it influenced what you do as a dietitian?

Joel Feren: [00:05:02] It’s such a great question. It’s funny when I meet other dietitians I often talk about a health journey and I guess everyone’s had a little bit of a different one. And I know Andy the RD who’s one of my idols and we’ve done some work together on YouTube. He often talks about his journey and he sort of came from the other end that I did. He was quite a skinny kid back in high school and he had a poor diet, he wanted to gain weight. Whereas I was always the overweight kid. I was interested in food and and to some extent nutrition but I guess I really wasn’t that healthy now that I reflect on my childhood. We had a really unhealthy relationship with food. I’m not quite sure where that came from if that was sort of directly from influences being family or outside of that community or even friends. But I think now when I meet with private practice clients is I think the biggest thing that I can do to help someone is actually improve their relationship with food. I take very much a non diet approach. I don’t fully subscribe to haste or even the non diet approach but I love the idea of eating mindfully and knowing that all foods can form part of a healthy diet. So I’ve really changed my philosophy if you like around food. I say wonderful opportunity for dietitians to differentiate themselves from some of these other nutrition gurus talk about do’s and don’ts. And I think there’s a wonderful opportunity for dietitians to help people improve their relationship with food. So I guess for my end now at the age of 34, my relationship with food is the best it’s ever been. I love to eat. I love to cook and I love that all foods can form part of a healthy diet. So I guess that’s sort of in a nutshell my health journey and that’s what probably drove me to becoming a dietitian in the first place. Sort of you know wanting to improve my health and wanting to improve that relationship with food.

Mathea Ford: [00:07:02] So, you said you were a little bit of an overweight kid. What happened to change your basically your habits or whatever did you lose weight? Did you start exercising? What kind of things did you do along your journey?

Joel Feren: [00:07:17] I was actually always quite sporty as a kid. I used to… I was always one of those kids that used to play Aussie rules at lunchtime or soccer at lunchtime and I used to do things on the weekends but I always did battle with my wife. I think I just eat too much and I probably just eat the wrong types of foods. Something that I made a conscious decision once I finished high school at the age of 18 to lose weight. And it was scary to admit that I really did it in the wrong way. I lost about 20 kilos so that’s the equivalent of probably almost forty five pounds in only a few months and it was almost like a starvation diet. So, I shake my head at myself sometimes and think “Geez! Why did I do that?” But I think I was just so desperate to to drop the weight so I was eating two meals a day and avoiding carbs you know because that was sort of the talker and then back in the early 2000s with no carbs we’re getting a bad name and obviously that’s that’s still lingering. But yeah I dropped a lot of weight and obviously didn’t do it in the healthiest way. Probably feeds off after that my life sort of you know I like this idea of a set point it sort of it got to where I think it should be. So for the last 10 years or so I’ve actually been fairly white stable. I mean it’s something that I’m acutely aware of at times and if I do let myself go you know sometimes I need to rein myself in again. But I like this idea that I can eat normally. I don’t have to go on a starvation diet and certainly don’t have to avoid carbohydrates. I actually love carbohydrate rich foods. I think there’s so much more than a single nutrient. Yeah. I mean I sometimes admit that to my clients who want quick results and I think you know coming from that shared experience where I didn’t do it in the right way I think actually resonates with my clients. And I think it’s about having a long term view of health it’s not just about weight. Yeah I think that’s influenced how I practice. It’s certainly influenced my philosophy as a dietitian and as I said it probably was one of the factors and may actually becoming a dietitian in the first place.

Mathea Ford: [00:09:22] I think it’s interesting that you mentioned your clients because I believe it’s important for us to express to them how whatever stage they’re going through as long as they’re making forward progress or you know little changes they’re going to add up and then it’s completely normal to have some frustration, to have some days when nothing seems right and but it’s like you said the long term staying on the path is an important message to convey.

Joel Feren: [00:09:55] Absolutely! It’s about creating that new normal. I think it’s about creating those healthy habits that are going to be sustainable in the long run. And I think it’s actually about teaching people how to weight and that might sound a little bit strange but actually giving them the tools to navigate sort of their nutritional journey because there always going to be things that pop up. Be it Family events, social events, Christmas and even at times of grief. It’s constantly changing. So, I think if we can get diets right to some extent. I’m going to say right because there’s no rush or wrong. I guess if we can focus on those healthier habits more often than not and I think you’re right those changes do add up and then people will see those results and I think sometimes we you know we hang our head on that one noticeable change be it weight. But I like to look at the things that we can’t say you know how someone improving their blood sugar control, someone reducing their cholesterol, someone improving their blood pressure I think that’s the changes that I want to say it doesn’t necessarily have to be right. I think there are so many more objective measures of success that we can be focusing on.

Mathea Ford: [00:11:08] Yeah non-scale victories type thing. The things that you’re right make the difference long run. What I find is a lot of times my clients or customers don’t always know how to cook. So, they’ve grown up and they’ve gone through a process where they have either had food made for them or they used frozen meals or they would eat out so much and they never learned the process of making a meal, reading a recipe or cooking. Do you find that’s pretty common or?

Joel Feren: [00:11:44] Absolutely! I actually love working with those types of clients because I think there’s so much we can do. And I think at the moment you know there’s the there’s all these cooking shows and all these recipe books and people just don’t really have the time to meet a lot of people who work long hours and I get home and maybe 7p.m. 8p.m. And then last thing they want to do is actually cook. So, I kind of feel like it’s it’s my job to help make their life a lot easier. And it’s funny because I actually do think that frozen meals have their place. I certainly am a big supporter of frozen vegetables. But at the end of the day if we want some key elements on the plate be some lean proteins some low G.I., high fiber carbohydrate and also some veggies. I mean I think there’s so many so many options at our disposal. My wife and I often joke around that you know one meal of the week is like frozen night. So we’ve got things like frozen fish fillets or frozen veggie burgers in the freezer. You know we’ve always got fresh veggies in the crisper but we’ve always got a safe option there and frozen veg. We’ve always got a can of lentils or chickpeas in the pantry so you can actually create a wholesome balanced meal very quickly. So, people don’t necessarily have to be a master chef to create a nutritionally balanced meal. And I think that’s the top message that I’ll have to get across to my clients. You can still eat well and you can still eat tasty foods but you don’t have to spend a long time in the kitchen.

Mathea Ford: [00:13:08] So, that leads me to my next question. Let’s talk a little bit about your Get Your Man in the Kitchen campaign. So, tell me what started that? Why you decided to do it? And how it’s going?

Joel Feren: [00:13:21] It was early 2015. And look, I guess I always felt that there was an opportunity for me to pinpoint my communication towards men you know being a male health professional but also being that male dietitian. I think the sarcastic nutritionist refers to my dietitians as unicorns because we’re definitely few and far between. But I think it’s interesting. I mean working with a lot of men. You’re right. I think women often do most of the cooking. It beat their wives their partners or their mothers growing up. I know there was some research done by the Australian Dietitians Association looking at behaviors of men in the kitchen and or just in the home and I think a lot of men have an interest in cooking but they just don’t they just don’t get getting the kitchen so I guess the You Man in the kitchen campaign was really just to encourage men just to have a crack. It’s such an Australian term just. Just to get in the kitchen and whip up anything. I mean it could be anything from eggs on toast to something a little bit more elaborate you know a spaghetti bolognese or you know a roast with all the trimmings. It doesn’t matter what it is it’s really just about encouraging men to get in there and cook something healthy because once again the evidence actually shows that when people cook at home they tend to have better balanced meals. They tend to consume less fat, less sugar, less salt. You know from our perspective I think that’s a wonderful outcome. I mean there’s a social media hashtag I predominantly use Instagram to get that message out there and it’s great that it’s resonating amongst other dietitians. It would be great to get some further traction in the wider community but I think slowly but surely man taking a little bit more ownership and sharing some of those household duties. I always tell my wife that she married really well because I do ninety five percent of the cooking. So she’s quite lucky in that regard but I certainly know my friendship circle a lot of my mates enjoy cooking barbecues and smoking them mates. I think that’s that’s a great thing that they can do and I think it’s about all of us encouraging men of all ages just to get back in the kitchen. It’s really about getting back to basics. I can’t stress that enough. I Mean there’s really not much to it other than just having a crack.

Mathea Ford: [00:15:46] Honestly, as a woman I would love it. I love it when my husband cooks. I love it when he makes the whole meal. When I come home and he’s got the salad and he’s cooking on the grill and everything’s ready. That is so nice. So, I’m all for You Get Your Man in the Kitchen campaign. I noticed you mentioned also that you are a media spokesperson for your Dietetic Association and you can tell me what that is again. Tell me about that and what led you to that and what you typically do in that job.

Joel Feren: [00:16:19] Yeah! look I took on that role in June 2016 so that do over two years ago now. And it’s funny when I was at uni we talked a little bit about media but it was something that I never thought I would put my hand up for. I never thought I’d feel comfortable. And it’s funny, I don’t know if I actually ever do feel comfortable talking in front of a media. But I think these days you know I think you know we had a brief chat about it earlier and the proliferation of some of these nutrition gurus and people who want to put out a non evidence based approach to diet, food to nutrition. I think we’ve got to counterbalance that and actually get our credible voice heard too. Selling is is a wonderful opportunity for dietitians to be out in the media. I put my hand up initially for a few media interviews and an opportunity arose in the middle of 2016 to become a media spokesperson for the Dietitians Association of Australia. And I thought “Yeah! Why not? Let’s have a crack!” As you can say that’s a bit of a theme so yeah I put my hand up and I was lucky enough to get that role and I’m often contacted by journalists who want to chat about different topics. I did one yesterday on nutrition in the same year and I guess about a year of expertise it’s probably geriatric nutrition. We haven’t really talked about yes but it was something that I’m really passionate about and often asked to speak about some of the media topics will vary. I’ve recently done some things on paleo diet and often ask that coconut oil and I’ve talked about hemp seeds and the list goes on. So, it’s amazing what’s out there and I think being a nutrition professional we’ve got to actually stay on top of some of these nutrition trends and to sort of be able to give our two cents worth to the conversation. So it’s something that I really enjoy. I don’t know if I’ve ever felt truly comfortable talking to the media. But I find it a really good challenge and I think being you know I’ve got a science background and I like the nitty gritty of science. But I think our job as dietitians is really to dumb it down so that the everyday Joe can actually make sense of this. So, yeah I think there’s a bit of an art. There’s certainly a bit of a science to how we talk to the media and look I’m constantly learning and constantly evaluating and yeah hopefully I will hold my skills in the future. But it’s certainly something that I love doing despite some of the challenges.

Mathea Ford: [00:19:02] So if a dietitian is interested in doing more media you have any tips for them on how to maybe get some opportunities or even things not to do?

Joel Feren: [00:19:10] And this is probably a once again a bit of a story my career so far but I think it’s about putting yourself out there as much as you can. I’ve always had an interest in media. I love politics and everyday I read the newspaper. I’d love to say from cover to cover but I probably don’t have the time these days. But you know world affairs, politics. There’s a strong interest there. So, I think these days with social media particularly Twitter there’s a wonderful opportunity to contact journalists directly. And I think if you’ve got a burning question or something that you really wanted to discuss is actually pitch to some of these journalists. Don’t be embarrassed. Don’t feel bad if you’re going to get knocked back or you’re going to be. Well your response is not going to be responded to. Just keep putting yourself out there and the other thing as well is and this is a lesson that I learned very early on is write something. Put it out there shock it around. If it gets picked up, great! And if it doesn’t well posted on a blog or give it to a community based newspaper.

Mathea Ford: [00:20:13] Yeah! I love the idea of just getting your message out there and the more voices we have out that are speaking evidence based and presenting you know truthful information, the more people realize that we are than nutrition experts and I think that’s definitely what we want as a profession. So, you mentioned a little bit you you have a little bit of a passion for geriatric nutrition. What about geriatric nutrition makes you excited or interested in it or whatever?

Joel Feren: [00:20:51] There’s nothing romantic about working in an aged care environment but I think there’s a crucial role for dietitians to play in the management of someone who’s a little bit old, grown and particularly with dementia. I see a lot of residents and patients if you like with dementia. And I think often nutrition is that forgotten piece of the puzzle. So, I’ve been lucky enough to have working in aged care since I graduated. It was actually my first job my first real dietetic job out of uni. I think food is so much more than a source of nutrition. It’s also about promoting quality of life. You know if I take my clinical head off I think some of the residents that I say you know they might be in the end stage but I think there’s such a role for food to play at the end of their life. And I’m really big on particularly nutrition and palliative care because no matter what someone’s dealing with or facing I think that providing something that’s not only nutritious but also ticks the box of enjoyments I think is really a wonderful thing and I love the idea that food can evoke certain memories and I think there’s really a wonderful opportunity at the end of someone’s life is to provide those things that are not only going to be nourishing for their body but also nourishing for their soul and it sounds so cliched that it’s something that I’m I’m truly passionate about. But if we get to the heart and soul of that dietetic side of things in aged care, I think there’s a wonderful opportunity to help as I always say “keep the meat on someone’s bones because we know that some of the negative effects of muscle loss in the elderly can change the fuel supply of the brain and it can lead to further deterioration of their cognitive state. And we know that people who are at risk of malnutrition or who are already malnourished have higher mortality and morbidity rate. So, I think there’s a wonderful opportunity for dietitians to play in that role. So, while it might not be a sexy environment I think it’s certainly a very rewarding, a rewarding place to work in.

Mathea Ford: [00:23:03] Well, I think that just shows how much you love food because I think if you think about palliative care, if you think about end of life you’re thinking about different textured diets or you know different choices. And you’re right that food brings back memories and comfort. And then I was like chicken noodle soup you just love to have that when you’re sick maybe that’s what your mom gave you when you were a kid. So you know having the opportunity to have those foods that you can eat at that point is very comforting. So I think that’s awesome because I don’t know that people think about on that level beyond you need a pureed diet or you need a you know thickened liquid or whatever. So.

Joel Feren: [00:23:50] Yeah! I’m often having that discussion with clinical staff is sometimes we’ve got to treat the person rather than the condition. I think that particularly with an older population, I mean I know I was just having this conversation with my grandmother who’s in their early 80s who’s actually caring now for my elderly grandfather is in his late 80s and my grandfather she has Parkinson’s disease and likely Lewy body dementia and she was concerned about the sugar that he adds to his breakfast cereal. And I was like “for goodness sakes just let he make, enjoys it. He’s needing it for all of his life. I think it’s the least of his worries.” But if I can give him a little bit of enjoyment I think from my perspective that’s a wonderful outcome and if he has some negative consequences as a result of adding a little bit of sugar so his bowl of wheaties in the morning then so be it. But I think. Yeah I think it’s about taking that clinical head off sometimes and actually just giving somebody what they want. I would say you know sometimes we need to shift the goalposts when it comes to food and nutrition and the elderly. We’ve got almost treat these residents, treat these patients like we’re on our own family and what would we want to do for those for those family members who may be struggling with those types of issues.

Mathea Ford: [00:25:10] Okay, so a little bit different topic we’ll switch a little bit since you’re in Australia, I wanted to ask you what would dietitians in the US think is weird or different about being a dietitian in Australia? Is there anything like that?

Joel Feren: [00:25:25] I know you pose these questions for me earlier off line and it’s I really not quite sure how it differs. I mean I know our Dietetic Guidelines slightly differ to yours. I think they’re a little bit more prescriptive when it comes to probably the donts. Talking about the foods to avoid as opposed to the Dietetic Guidelines in your neck of the woods they talk about having no more than 10 percent of your energy intake derived from things like total fats and saturated fats and added sugars and the like. But I’m not quite sure if the job of a dietitian is all that much to a job to being a dietitian in America. I’m not quite sure what your other guests have posted before or your own thoughts on this topic question. Happy to have a chat about it. But I’d certainly be interesting to hear your comments.

Mathea Ford: [00:26:24] Yeah that would be. I’ve never been to Australia so I don’t know. It would be interesting probably to think about the different foods as you mentioned kind of that’s not necessarily the guidelines but maybe the meals. I know in Britain they have tea you know at certain times of the day and that’s part of a daily routine that you would need to incorporate if you were working in that country. If that was something that a person was interested in so I just thought it’d be interesting to know you know is kangaroo a big meat that you guys eat or?

Joel Feren: [00:27:02] Happy to discuss those types of questions and so we’re looking at specific foods, I mean I think we’re the only the only country in the world that eats the animal on it coat of arms. I’ve never really been able to get my head around eating Skippy.

Mathea Ford: [00:27:15] So, what animal that? Kangaroo?

Joel Feren: [00:27:17] Oh that’s the kangaroo. Sorry, I thought that Skippy was in a television show in the 1970s and 80s and I think it gained worldwide notoriety of a little kangaroo that went hopping around. It’s incredibly lean actually and it’s a wonderful source of iron but it’s funny a lot of the lot of the clients I see in private practice I don’t tend to eat it so I’m not quite sure if it’s more of a rural thing or people outside of Melbourne tend to eat it more than the Melburnians but certainly it’s an interesting option. I have tried it. Me personally I’ve actually just sort of moved over more to a vegetarian based diet so I’m actually no longer eating meat. So if you put in front of me a kangaroo fillets I will probably decline that time. Yet look at certainly another option that people can have. And being a lean protein source that’s obviously once the source of other micronutrients. I think it’s some it can certainly play a role in someone’s diet.

Joel Feren: [00:28:20] So, Joel thinking about the stuff we’ve talked about like media spokesperson, geriatric nutrition and non diet approach, Getting Your Man in the Kitchen type thing. How? What types of tips or final thoughts would you have the listeners could use in their day to day life that they could either change habits or just something to think about any sort of overall tips that you might have?

Joel Feren: [00:28:45] It’s about being proactive, getting a voice out there. Also thinking outside of the square. I actually recently wrote a blog post because it’s been on my 6 years since I graduated so I sort of wanted to write a reflective piece on my job and my career so far and I know when I went to uni and we touched on it earlier. A lot of the focus was more on a career in clinical or community or even food service. There was very little talk about the role that dietitians can play in food industry. Media or even developing a voice or presence on social media. When I think about my role as we sort of joked about Aliath, I find it hard to describe exactly what I do because no two days are the same. There are so many job opportunities out there for dietitians and sometimes it’s about creating their own path and it might not seem like it’s the norm. I think there’s so many other things that we can be doing from corporate health to rescue developments like I mentioned already. So, obviously media and social media and all the opportunities that can present as a result of being out there. I think what I would recommend to people who might be looking to forge their own path or a university is you know be open to opportunities but put yourself out there as much as you can because you never know what it can lead to. Very quick story. I was lucky enough to be asked to present on a TV show early last year and I think as a result of that one experience it’s really changed my career so I’m very grateful to have had that experience. And I Don’t think I would have closed myself off to you know being in the media and being on social media I wouldn’t have had my career wouldn’t look as it’s looking now. I think I’d probably be working in private practice and doing my little bits in aged care but we wouldn’t be having as much fun as I’m having now. Yeah. Put yourself out there. Say what opportunities present. You can always say no but I’m a bit of a yes man and I think sometimes that pays off.

Mathea Ford: [00:30:51] Yeah! Just give it a try. What’s the worst that can happen? That’s what one of my friends said yesterday.

Joel Feren: [00:31:00] Exactly! And that’s a question often posed to my clients. You know I actually don’t like a food what’s the worst that can happen? It’s the same goes in with jobs. What’s the worst that can happen? You don’t like it? You don’t go back. You try something. But I mean I don’t know how this is over in America but I know in Australia particularly in Melbourne there’s some new grads who into the field each and every year and they’re just so few clinical jobs out there. So few community jobs that I think we need to keep reinventing ourselves and finding our point of difference. And as I said earlier you know my point of difference was a little bit more obvious being a male but yet from the rescue development to media side to consulting to food industry, I’ve sort of been able to create my own little one – my own little niche – and I think it’s really important that other dietitians also do the same. That’s my little motivational talk this morning.

Mathea Ford: [00:31:58] Well thank you.

Joel Feren: [00:31:59] Pleasure.

Mathea Ford: [00:32:00] Joel, I’d like to ask all my guests what’s your favorite food? Obviously not Kangaroo.

Joel Feren: [00:32:06] Yes you got me there. Look I’m probably going to have to say ice cream and I can probably eat ice cream all year round so it’s not necessarily as I’m afraid for me. It’s a winter and full and spring food as well.

Mathea Ford: [00:32:23] You can eat it year round.

Joel Feren: [00:32:24] I’m sorry.

Mathea Ford: [00:32:25] Ice cream is year round.

Joel Feren: [00:32:26] Yes! Yeah! Absolutely! So, that’s probably my favorite food amongst others. So it’s a little bit hard to narrow down but let’s go with ice cream. So this one.

Mathea Ford: [00:32:37] What about flavor of ice cream? Which flavor?

Joel Feren: [00:32:40] Yeah. Look I’m a sucker for chocolate. Double choc, triple choc, choc chip.

Mathea Ford: [00:32:45] Brownies, cookies.

Joel Feren: [00:32:49] Exactly! Exactly. I might even try it myself and ask and after the interview.

Mathea Ford: [00:32:54] Now, that we’ve talked about I’ve made you hungry.

Joel Feren: [00:32:56] Is that an acceptable for breakfast choice?

Mathea Ford: [00:32:59] I think all foods can fit. So, sure!

Joel Feren: [00:33:03] Okay.

Mathea Ford: [00:33:04] Hi Joel! Thank you so much for being on the podcast today. It was a pleasure to have you on the show. I know my listeners learned a lot about different topics that we talked about. So, if listeners want to connect with you what’s the best way to do that?

[00:33:17] Yes sure. So jump on my web site thenutritionguy.com.au or my social media handle particularly Instagram where I am mostly found is @the_Nutritionguy. So feel free to connect say Hi and I love to start a conversation.

Mathea Ford: [00:33:39] Post a picture of your man in the kitchen right?

Mathea Ford: [00:33:41] Absolutely! With the hashtag Get Your Man in the Kitchen. Quickie Apron is optional. I know it’s sort of my thing on social media but yeah I’d love to see you encouraging older men in your life to just you know whip up something and have a crack. Thank you so much for inviting me along. It’s been an absolute pleasure and I hope your listeners got something out of it.

Mathea Ford: [00:34:03] Thanks Joel. Well, guys this has been another great episode of the Nutrition Experts Podcast. The podcast that is all about learning more so you can do more with nutrition in your life.

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Nutrition Experts Podcast Episode 32 Never Be Caught Off Guard Regarding Research with Casey Colin, MS, RDN, LN, CNSC, ACSM, CPT

December 10, 2018 by matheaford Leave a Comment

Casey Colin is a registered dietitian nutritionist with more than 10 years professional experience and a Master’s degree in dietetics. Casey is board certified in nutrition support (intravenous nutrition) and she is an American College of Sports Medicine Certified Personal Trainer. Casey is also a proud Veteran of the US Army. She has a strong love for God, her family, avocados, and personal growth.
My link: www.lettucetalk.blog

Mathea Ford: [00:00:27] Hi there! It’s Mathea. Welcome back to the Nutrition Experts Podcast. The podcast featuring nutrition experts who are leading the way using food starts today right now with our next guest. It’s great to have Casey Colin on the show today. Casey welcome to Nutrition Experts.

Casey Colin: [00:00:44] Hi! Thank you so much for having me today. I’m glad to be here.

Mathea Ford: [00:00:48] I am so excited to have you on the show and share your expertise with my tribe. I want to know if you can tell our listeners a little more about you and what you do.

Casey Colin: [00:00:57] So, my main gig is an outpatient dietitian with and a clinic. A local VA clinic in town. But I have multiple sort of branches off of my main job. One of them is I am a dietitian with Army Reserve and the one that I have the most fun with is I am a blogger with lettucetalk.blog Lettuce like the food yet.

Mathea Ford: [00:01:27] What made you want to start a blog?

Casey Colin: [00:01:29] I sort of take away a lot of the trials and tribulations of an outpatient practice. I take these things home with me and I needed an avenue to sort of channel some of the challenges, some of the funny things I experienced but also I have a lot of friends and family who really want to know more about nutrition. So this was a way to funnel all of those things into one I’ll call it a therapeutic resolution. I can answer some of those questions with no filter and have a little fun with it.

Mathea Ford: [00:02:07] I have to admit I read several of your blog posts in the last week and yeah, you definitely feel like it is. I mean it’s not good or bad it’s just it is sometimes you have to say it. So what’s your favorite article you’ve written in the past few weeks?

Casey Colin: [00:02:26] The “Does Pooping Make You Sad” article mainly because the title makes me laugh but I kind of toggle between whether I love the title or the actual article I wrote at any given time. Sometimes I write an article because I think of a fun title.

Mathea Ford: [00:02:46] So what “Does Pooping Make You Sad?” about?

Casey Colin: [00:02:49] I’m inspired by different things throughout the week, throughout the day depending on what’s going on. And I had a friend who had mentioned some difficulties with that in all seriousness with some digestive issues that had sort of come on and some other things that were pointing toward food sensitivities and rather than have a conversation with this person and then separate conversations with all the others that deal with this. I just decided to roll it into a blog about digestive issues.

Mathea Ford: [00:03:22] We were talking before the call and you told me you just got your Masters and what was that experience like getting your Masters after you’ve been a dietitian for a while?

Casey Colin: [00:03:32] It was interesting. I had been in practice for about ten years when I had decided to go to grad school and it was enlightening because we always can learn new things which I of course did. But having been in practice for so long I was able to better apply the information. You know we went into a lot more complex detailed data on how nutrition impacts our body on a cellular level but being able to translate this a little more after seeing what people struggle with on a day to day basis was really I felt useful getting my master’s degree at this point in my life.

Mathea Ford: [00:04:13] Yeah. I think there’s a lot more biochemistry and labs and other information that we have now. When I became a dietitian twenty one years ago we didn’t have. So it’s interesting to be able to put them together into “I’ve seen that and this is where I see the labs and I can now see how I can help that person better or yeah that application having gone through it.”.

Casey Colin: [00:04:40] Right! It dug a little deeper into the “why” not the “what” but the “why.” Why is this happening?

Mathea Ford: [00:04:47] So, you said you did a capstone project about saturated fat and cardiovascular disease so can you talk a little bit about that?

Casey Colin: [00:04:56] Yeah! It’s pretty fresh. And as a matter of fact, hopefully everyone listening can keep their fingers crossed by the time this airs hopefully it will be accepted for publication in a journal. It’s sort of just waiting there right now. I am anxiously awaiting acceptance but this was a narrative review on what the title was “Should Saturated Fat Be Limited To Treat Or Prevent Cardiovascular Disease.”

Casey Colin: [00:05:23] And I think especially as dietitians, we hear a lot of people coming to us because they’re told they need to implement a low fat or a heart healthy diet because they have high cholesterol or they have all these different things. I really wanted to explore that. You know. Basically, because the more emerging research that I had seen was a little bit against the grain in terms of saturated fat. And so I did a narrative review and I started by examining three hundred and seventy four articles that were found as a result of my specific search terms. I had some intricate exclusion and inclusion criteria but ultimately three hundred seventy four articles were found, 211 actually were excluded after combing through the very specific criteria that I use. And then I was left with 37 primary research articles and 21 reviews. So, although I was doing my own review I did feel compelled to include reviews because they have such an impact on this particular topic. So, long story long, it was a fairly complex project but the evidence that we do have surrounding a reduction in saturated fat to prevent cardiovascular disease is very limited in sound reputable really good methodology. We’ve sort of been taught to limit saturated fat for a number of years and it seems like this is not supposed to be the focal point. So, there’s still of course as with any research more research needs to be done. That’s what I’m left with is the conclusion is more research needs to be done but we really have to kind of use these results as a means to look at things totally differently. In my opinion, my professional opinion.

Mathea Ford: [00:07:22] What did the review show you has better evidence or has good evidence or is nothing really showing good evidenc?.

Casey Colin: [00:07:30] Well, as you can imagine doing a review of this caliber there’s so many different branches that I thought of. If only I had the time to do more reviews on it. Starts to open a whole Pandora’s box of I need to explore this further because there were some indications of different avenues that we could look at. One was indicated as a result of this research that reducing reactive oxygen species. In other words free radicals that we get from heating a lot of our polyunsaturated fats could be an entire review in and of itself. But that was something that I got a glimpse of when combing through this research is that you know we’re looking at inflammation, we’re pointing at inflammation as a risk factor for cardiovascular disease. Pretty intense one regardless of what our actual cholesterol numbers are. I think our focal point has gotten a little off track. So, if we have a lot of cholesterol but we have damage in our arteries that’s where our cardiovascular disease is coming from is that inflammation not the higher the low cholesterol in and of itself. So, the way I’ve explained it to some of my patients is “if we have a lot. This is going to be a Casey analogy so bear with me. If we have a lot of leaves and gook going into the drainage and our street after a rainstorm. Most of that drain system is designed for all the leaves and gook. So, in this case that would be cholesterol. The leaves and gook would be our cholesterol but if a twig or a branch or something gets hung up in that drainage system now all the leaves and gook are going to get stuck on that branch. So, the the twig in this case would be inflammation or damage to the lining of our arteries. And so looking at things that cause that damage or contribute to that damage in the arteries is far more valuable in preventing you know these blockages and these different things than the cholesterol itself and so much attention has gotten put on the actual cholesterol levels themselves. In some ways rightfully but we’ve got to look at how do we better serve the lining? How do we better reduce that inflammation that precludes that damage in the first place?.

Mathea Ford: [00:09:49] It’s very interesting because I hear a lot of talk about inflammation contributing to all kinds of diseases, affecting us in lots of ways. And I’ll be the first shipment that I didn’t this wasn’t even a topic when I did my studies. So, what types of things are causing inflammation for people are creating inflammation in bodies? Did you look at that at all or was that part of your research?

Casey Colin: [00:10:13] That was not part of this project that I had but again it was a it opened up Pandora’s box of things that I would love to spend some time doing entirely different reviews on inflammation itself. And as you can imagine, a person would have to dedicate particular reviews to each aspect of inflammation not just inflammation as a whole but what I feel it is you know supported by the research is that inflammation is multifaceted. It’s that some things that we have control over and some that we don’t. So, there is a genetic influence that could probably preclude our inflammatory risk but also a whole lot of stuff that we have control all over and as a registered dietitian of course some will look toward what we eat. Some of the standard things that we know are really valuable for preventing inflammation. These haven’t changed. Even with decades upon decades of research, we know that eating mostly fruits and vegetables is going to be useful for us. So, sometimes getting back to the basics I think could help people to really reduce their risk for inflammation if that’s a concern even without having done the reviews and things on inflammation particularly getting back to the basics could be a really valuable tool that we have to reduce inflammation. And of course different health conditions would have their own different conversation. Yeah! I mean just kind of the old tried and true stuff first.

Mathea Ford: [00:11:45] Having done this review when you see people with cardiovascular disease or heart disease or whatever, what is the type of advice that you typically are giving them now that you’ve done this review?

Casey Colin: [00:12:00] So, I haven’t changed a lot because this review sort of solidified some professional opinions I already had but some things that really have been useful for my patient population is the results in this narrative review indicated that saturated fat was not negatively impacting our health when we were consuming enough fiber and when we were consuming enough omega 3 fats and so I really tried to incorporate that explanation into my conversations with these these patients is that you know bacon and butter are not harmful for us independently. They’re harmful when we consume them with very little fiber, with very little omega 3s with a lot of added sugar, refined carbohydrates. So, just explaining that if we have the bacon and eggs with a whole bunch of vegetables at breakfast for example. Maybe we throw you know onions and peppers and spinach into a nice omelet and we have that with our eggs and bacon. That changes how these nutrients work into our body and making sure we’re having things like salmon or tuna or sardines or other omega 3 rich foods at least three times a week. That changes how these foods work in our body. And so it’s a conversation that includes not just teaching people to go wild and crazy with their saturated fat intake. Where is the saturated fat coming from? Is it coming from Whole Foods sources? Is it coming from nutrient dense food sources? And if so, then great! Especially when it’s consumed with those dark, rich, colorful vegetables and maybe some fruits but really looking at where is the saturated fat coming from not how much are we having, what kinds are we having and what are we having it with.

Mathea Ford: [00:14:01] So, when you look at the Omega 3 and I know you mentioned eating certain types of fish. Did any of your reviews show any sort of value to taking supplements or did any of them look at that like the omega 3?

Casey Colin: [00:14:16] No. Because of the particular studies I looked at we’re really focused on specifically the impact of saturated fat. I think kind of going off on one of the branches of things and discoveries that I learned from this. That would be a very useful thing to look at is you know do we get the same impact from Omega 3 supplements? And you know my knee jerk reaction to this based on the evidence is that maybe not the evidence from this review in particular but making sure that we’re getting good quality omega 3 supplements if and only if we are truly unable or unwilling to have adequate omega 3 throughout the week. So, for example I have certain patients that absolutely refuse to eat any kind of fish and they’re just not the type to have chia seeds or flax seeds as part of their world. They’re a little off the reservation kind of people. And so in these cases that would be where a supplement would be useful. A good quality supplement which again would be an entirely different conversation but yeah! I mean we always want to try to get the foods first mentality.

Mathea Ford: [00:15:32] We expect large corporations, large organizations to kind of have a dual level of review if they’re doing it, if they’re going to spend the money on it. So, that’s very interesting. And I agree that people should probably read it and review it to understand kind of the full implication of it. Thinking about that. What can RDs do to find research, to look at research and implement it in their practice? Kind of on an ongoing basis because I know there’s always new research coming out. And so how do RDs or other health practitioners find ways to get research and implement it in their practice?

Casey Colin: [00:16:13] I’m actually really glad you asked that because that’s something I’m pretty passionate about. I will admit early on in my career, I wasn’t a big researcher. I just wasn’t. I thought I was ready to save the world. That right out of my internship as a fresh RD and what I have found is setting aside the time to truly look things up as basic as that sounds. So, even when I hear a friend or a family or some something on Good Morning America or a TV of any sort of a new hot topic or a new trend, I try to keep a running list whether it’s on on the notes on my iPhone or literally a post it note or something and I jot these things down these buzz worthy things so that in between patients or when I have a block of time at work or even at home. I mean even though we’re dietitians, we can leave work at work but it’s sometimes useful to spend a little time at home looking some of this up. But you know jumping on to you know search engines like PubMed or Cochrane Reviews or some of the other very useful research databases you know setting aside the time to look up those things you have listed some of those buzz worthy terms because somebody is going to ask you. And so that’s something I think as a registered dietitian, I have to keep up on this stuff if it’s talked about on the news. I can almost guarantee that within the next seven days somebody is going to ask me about that and if as registered dietitians we want to be sought after as the Premier Nutrition experts we actually have to be. So, something that I really set out to do is to never be caught off guard. And in order to do that, every moment that I have especially in my work day where I have better access to these things, I spend 15 minutes looking up some of the latest reviews. And if you really are pressed for time reviews or where is that. You can look up a Cochrane Review. That’s one of the you know the well or if not the gold standard for analysis and systematic reviews of the literature and then plug in some of these new buzz worthy terms and plug in things that you’ve been wanting to learn more about. See what you see what comes up. You know type in diet soda and the microbiome into PubMed and you’ll be blown away at what pops up. Some of it might be reputable and useful and some of it might not. But if you have 10 minutes or 15 minutes or more, really taking that time to be prepared for these questions that we’re going to get.

Mathea Ford: [00:19:06] Cochrane review is that like a website? Or?

Casey Colin: [00:19:09] So, it’s kind of like PubMed. It’s another sort of database of the literature and you know for a lot of RDs, you know a lot of people might not have a subscription to it. So, for people who are employed by other entities, a lot of these different you know subscribed oriented databases might be very reachable through the employer but typically it would have to be a subscription I believe. I’m not completely sure on that but even at the very least, PubMed can really brought in some things in and that’s something that everyone has access to. We might not always have access to the full text but you know different libraries can help with that too. Whether it’s through an employer or university. A lot of times connecting with librarians through these entities, even a local library might be able to help you get a full text for minimal or no cost at all. I’m a big advocate for free. So, if you can get it for free you do. But just really you know start to sift through what’s out there so that we can actually be the experts because nutrition information changes by the second. And then it’s really easy to be caught off guard and if someone has a question about a lot of these hot topics and we can’t answer it as registered dietitians, they’re going to keep asking until someone can even if it’s not the greatest advice that they get.

Mathea Ford: [00:20:37] Yeah I know my local library. Speaking of PubMed, I believe that through just having a library card that we can access PubMed for the full text online and so that is a great resource. You might check with your local library if you don’t have access to like a hospital type database or something. So, that’s a great example. How do you think the information we talked about can be used by the listeners in their day to day life? How can they implement some of this besides going out and looking at the research studies?

Casey Colin: [00:21:07] So, first and foremost I would say for someone who is not immersed in the professional nutrition field, being able to critically review the literature is difficult and it’s difficult enough for us as professionals. Let alone someone who’s not immersed in the field. Try not to feel like you know as a person that’s not a dietitian going into PubMed that you’re going to find your answers because you might end up more confused than you anticipated or maybe not. But the real thing is to have a cynical ear and a cynical eye when you are reading about nutrition information because we’re in a day and age where we are inundated with nutrition advice. I would say every single day. Even when I’m in my office at work, I hear people talking about nutrition all the time and it’s not an exaggeration to say everyday. Whether I’m at the coffee shop, whether I’m you know passing by. I was on a hike one day and I was telling my husband and I get nutrition information everywhere I go and on the way up the hill people coming down we’re talking about nutrition and it wasn’t the greatest of advice I’ll tell you that.

Casey Colin: [00:22:22] So, for people listening is to really you know gather up all the knowledge. Knowledge is power but really be cynical about the source because we can be really easily misled by people who we trust and people who we think are the Mecca of knowledge but don’t have that background or that ability to truly critically review the research in a way that we can use that properly in our daily life. And also you know not to forget the basic tenets of healthy living and healthy eating is to eat mostly plants. Even if you’re not vegetarian or vegan still eating mostly plants is a really great thing to live by. Drink water as your main beverage. Try not to get so convoluted with the latest and greatest that you forget about the basic stuff that really fuels our body and makes us healthier.

Mathea Ford: [00:23:20] You have additional certifications. Can you talk about those a little bit and how they contribute to your practice?

Casey Colin: [00:23:27] Yes! So, I have CNSC which for non dietitians, that stands for Certified Nutrition Support Clinician. Which means I am certified to administer the intravenous nutrition if you are in a coma in a hospital bed. That actually came about because of graduate school, I was immersed in the nutrition support curriculum for a minute and I thought well I hate to waste this fresh knowledge in my brain. Plus in the nutrition world that is a coveted certification and I was you know as fresh as I was going to get with it. So, I decided to study for and take the test and the other really underlying big reason why I took that certification is because having to study for it I knew would make me better at what I do in ways that I wouldn’t have the self-discipline to do, to learn about otherwise. I’ll just be completely honest about that. Because diving into a really specific critical care nutrition and the cellular processes that are involved in that, are things that are you know really helpful. But again, I wouldn’t have dedicated the time and energy to it without an end goal. So, that was one of the reasons why I did that one. I also took the American College of Sports Medicine Certified Personal Trainer Certification. Funny enough, I had started studying for this in 2009 and I bought all the materials and got super jazzed up and motivated and then didn’t do anything for what is that? 8 years, 9 years. Anyway, but what happened was the reasons for that one were more multifaceted I’ll say. One of them is that as a registered dietitian, I think to be well-rounded I think we have to have a little more training and education in the fitness realm because a lot of our clientel whether young or old are into “I want to be healthier. I want to increase my fitness. I want to eat healthier. I want to do the whole bit” and we know having both fitness and nutrition is really useful and critical for good health and so I wanted to be a little more well-rounded and educated in that sense on the fitness side of things. A little bit small of a reason but definitely a reason why I did the Personal Trainer Certification is that I often have encountered personal trainers who educate people on nutrition and I thought “I want to know what exactly they learn. What’s in the curriculum” and so the only way to truly understand what’s being taught and what the level of expertise in nutrition is for a personal trainer with no other nutrition background is to go through the motions. And so I did. And what I found is the nutrition education aspect of preparing to be a Certified Personal Trainer is very limited and very basic and I will credit the American College of Sports Medicine heavily for explaining in their curriculum for the personal trainer to refer to a registered dietitian over and over and over and that recommending supplements and different therapeutic diet techniques is not in the scope of practice for a Certified Personal Trainer that is not also a nutrition professional like a registered dietitian of course but. So, yeah I mean it made me a better practitioner because I have that fitness side of things but I’d be lying if I said that was the only reason I did it. So, I’m being completely transparent today.

Mathea Ford: [00:27:41] I have my bachelor’s in Nutrition and a bachelors in Exercise Science and I do when I listen to people advising who are doing training advising about nutrition. It’s one of those things where I’m like “Oh! I understand.”.

Casey Colin: [00:27:57] It’s well intended I think. The nutrition advice but there is just a lot of times it’s misleading without intending to be because of that lack of background.

Mathea Ford: [00:28:10] So, all of that said I love to ask my favorite last question is tell me your favorite food because I like to know what dietitians eat.

Casey Colin: [00:28:20] So, it’s not really a meal but a food that is my absolute favorite in the entire universe is avocado and I don’t think I had an avocado until I was 24 because it’s not something that was part of our farm country Midwestern repertoire.

Mathea Ford: [00:28:40] I don’t think I had avocado till I went to Texas and had Tex Mex food. But I love avocados too. They’re great!

Casey Colin: [00:28:49] I’m obsessed.

Mathea Ford: [00:28:50] A wonderful healthy fat.

Casey Colin: [00:28:52] Yes! Yey fat!

Mathea Ford: [00:28:56] All right Casey, thank you so much for being on the podcast today. It was a pleasure to have you on the show. I know my listeners learned a lot about cardiovascular disease and the review that you did and just some different aspects, different ways to look at it. So, if listeners want to connect with you what’s the best way to do that?

Casey Colin: [00:29:13] The best way to connect with me would be through my blog. On my blog it’s Lettuce Talk, like the food. Lettucetalk.blog and there is a Contact Me section where you can e-mail me your thoughts or questions and also a lot of other useful information that you’ll find along the way.

Mathea Ford: [00:29:35] Well, guys this has been another great episode of the Nutrition Experts Podcast. The podcast is all about learning more so you can do more with nutrition in your life.

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