{"id":3033,"date":"2017-08-29T03:00:48","date_gmt":"2017-08-29T03:00:48","guid":{"rendered":"https:\/\/eatrightpa.org\/?p=3033"},"modified":"2021-10-30T03:39:48","modified_gmt":"2021-10-30T03:39:48","slug":"dear-future-doctor","status":"publish","type":"post","link":"https:\/\/www.eatrightpa.org\/blog\/2017\/08\/29\/dear-future-doctor\/","title":{"rendered":"Dear Future Doctor…."},"content":{"rendered":"

By Julie Stefanski MEd, RDN, CSSD, LDN, CDE<\/a><\/p>\n

Psst.\u00a0 Hey you!\u00a0 Yea, the one in the short lab coat with the big brain.\u00a0 Recently I referred a friend to the primary care doctor you\u2019re currently training under.\u00a0 You see, my friend had been complaining about a lot of uncomfortable gastrointestinal symptoms which she had never discussed with a doctor.\u00a0 Rather than just starting her on a diet for IBS (which as a registered dietitian I very well could have), I sent her in for an appointment to make sure all other medical causes of her symptoms beyond diet were ruled out.\u00a0 Without even asking her what she was actually eating (and prior to seeing the doctor), you promptly diagnosed her with Irritable Bowel Syndrome and provided a handout from the Internet on the low fermentable oligosaccharide, disaccharide, monosaccharide and polyol diet or FODMAP for short.\u00a0 Helpful?\u00a0 Maybe not.<\/p>\n

The FODMAP diet has gotten great media attention recently and for good reasons.\u00a0 For individuals who have IBS it may be the key to finding relief from bloating, diarrhea, gas and other uncomfortable GI side effects which occur when consuming certain foods.\u00a0 In this situation though, applying a complicated, although well researched diet to a person whose food intake you haven\u2019t actually assessed?\u00a0 There may be a better approach.<\/p>\n

Is it simply lactose intolerance?<\/strong><\/p>\n

Poor digestion of lactose, or the sugar in cow\u2019s milk, is prevalent throughout the U.S. If your patient\u2019s diagnosis is simply lactose intolerance you\u2019ve now advised her to avoid multiple vegetables, fruits, wheat, beans, and various sources of fiber.\u00a0 Does she really need to limit her portion of avocado or pistachios when she simply needs to swap her two daily glasses of cow\u2019s milk for a lactose free option?<\/p>\n

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What\u2019s in that bar?<\/strong><\/p>\n

What if the real problem is that every morning at breakfast she’s eating a bowl filled with 15 grams of chicory root fiber or a bar with inulin as the second ingredient? Could the source of gas and bloating be her sugar free ice cream with both mannitol and sorbitol as ingredients? Without assessing her actual food intake and symptoms there would be no way to know that she simply needs to stop consuming those particular products, rather than restricting her intake of more than one hundred food items.<\/p>\n

Water, water everywhere?<\/strong>
\nCould the fact that her caffeine habit, a can of soda twice a day (a source of high fructose corn syrup) along with a fruit smoothie is the cause of the diarrhea?\u00a0 Fructose intolerance can occur in the same way as lactose intolerance, but is often ignored as a source of GI problems.<\/p>\n

Unknown Antibodies?<\/strong><\/p>\n

What if the real problem is celiac disease? By handing her the fodmap diet without testing for celiac antibodies you have now rendered this mode of testing completely inaccurate.\u00a0 This is the number one reason I ask a primary care physician to check for anti-gliadin antibodies BEFORE we implement a gluten free diet.\u00a0 Her choice to avoid wheat, rye and barley prior to testing for autoimmune disease will result in a false negative as she has now removed the trigger for an immune response.\u00a0 But why does this matter if she\u2019s feeling better?\u00a0 Knowing you have an autoimmune disease versus simply avoiding gluten because you feel better will have significantly different influences on someone\u2019s attitude and future decisions when presented with Grandma Susie\u2019s famous gluten-laden chocolate cake.<\/p>\n

There are other organs of digestion?<\/strong><\/p>\n

A few years ago a client that had been struggling with significant abdominal pain for 15 years told me she was sent to my office as a \u201clast resort.\u201d Seriously? During so many years of suffering, seeing a registered dietitian was never suggested by her physicians.\u00a0 And guess what? Fodmap didn\u2019t fix her.\u00a0 We tried three different approaches to her diet and I played food detective for several weeks until we discovered the answer.\u00a0 In the end, a low fat diet was the perfect match for her undiagnosed bile reflux and persistent nausea.\u00a0 Her message thanking me for helping her escape the abdominal pain that had been plaguing her for 15 years was truly a blessing.\u00a0 Could I have resolved the issue without assessing her food choices and symptoms?\u00a0 Probably not in the next 15 years.<\/p>\n

No diet will work if someone isn\u2019t equipped to follow it.\u00a0 Inevitably if someone doesn\u2019t truly understand and apply the diet guidelines accurately they won\u2019t feel better.\u00a0 And if they don’t feel better they typically won\u2019t continue with any of it.\u00a0 Six months later you\u2019ll encounter someone who is still having issues. Is handing someone a paper a good substitute to reviewing food and beverage choices thoroughly with a client for 30 minutes?\u00a0 The answer is no.<\/p>\n

As the only healthcare providers that extensively study food science along with medicine and evidenced based nutrition guidelines, registered dietitians understand thoroughly the subtle differences in how foods are digested and in this case, how they affect gastrointestinal symptoms.\u00a0 Medical nutrition therapy doesn\u2019t center on handing someone a paper or pulling a diet out of a hat.\u00a0 In that hour that I spend with a patient I will assess, evaluate and educate on the most appropriate foods to choose based on that individual.\u00a0 I\u2019m not a gambler, but I would put money on the fact that my training and experience may just trump your google search.<\/p>\n

As a future physician you will be the authority figure among healthcare professionals.\u00a0 You will also be the gateway to comprehensive care.\u00a0 If you only have five minutes to truly help someone, why not hand them information about making an appointment with a registered dietitian nutritionist? Have them see an RDN and let us collaborate with you to truly help your patient.\u00a0 That\u2019s what we\u2019re here for!<\/p>\n

Anyone can consult with and find a registered dietitian nutritionist at http:\/\/www.eatright.org\/find-an-expert<\/a><\/p>\n

Julie Stefanski is a PA Academy of Nutrition & Dietetics PR\/Social Media Chair and an effective food detective at Leg Up Farm<\/a> in Mt. Wolf, PA and Leg Up Farmers Market<\/a>, a full service natural foods grocery store in York, PA.\u00a0 As a reviewing editor for Nutrition Dimension, a division of OnCourse Learning, she makes sure that the continuing education courses provided to healthcare professionals are not only interesting, but are based on evidenced based research.\u00a0 You can find her on social media @foodhelp123.<\/p>\n

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Save<\/span><\/p>\n

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By Julie Stefanski MEd, RDN, CSSD, LDN, CDE Psst.\u00a0 Hey you!\u00a0 Yea, the one in the short lab coat with the big brain.\u00a0 Recently I referred a friend to the primary care doctor you\u2019re currently training under.\u00a0 You see, my friend had been complaining about a lot of uncomfortable gastrointestinal symptoms which she had never […]<\/p>\n","protected":false},"author":18,"featured_media":3035,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[69,1],"tags":[74,75],"class_list":["post-3033","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-august","category-uncategorized","tag-fodmap","tag-mnt"],"_links":{"self":[{"href":"https:\/\/www.eatrightpa.org\/blog\/wp-json\/wp\/v2\/posts\/3033","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.eatrightpa.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.eatrightpa.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.eatrightpa.org\/blog\/wp-json\/wp\/v2\/users\/18"}],"replies":[{"embeddable":true,"href":"https:\/\/www.eatrightpa.org\/blog\/wp-json\/wp\/v2\/comments?post=3033"}],"version-history":[{"count":1,"href":"https:\/\/www.eatrightpa.org\/blog\/wp-json\/wp\/v2\/posts\/3033\/revisions"}],"predecessor-version":[{"id":10715,"href":"https:\/\/www.eatrightpa.org\/blog\/wp-json\/wp\/v2\/posts\/3033\/revisions\/10715"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.eatrightpa.org\/blog\/wp-json\/wp\/v2\/media\/3035"}],"wp:attachment":[{"href":"https:\/\/www.eatrightpa.org\/blog\/wp-json\/wp\/v2\/media?parent=3033"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.eatrightpa.org\/blog\/wp-json\/wp\/v2\/categories?post=3033"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.eatrightpa.org\/blog\/wp-json\/wp\/v2\/tags?post=3033"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}