A Digestible Chat with FODMAP diet expert registered dietitian, Patsy Catsos

Hi Everyone!

I am excited to share my latest digestible chat interview with my dear friend and colleague, Patsy Catsos MS, RDN. Patsy and I have shared some incredible educational and global traveling speaking opportunities together  in the field of gastroenterology and nutrition.

Here’s a picture of Patsy with with her sweet pup, Stella.

Kate: You are a well-known RD in the low FODMAP diet space, can you share a bit about how you learned about this diet?

Patsy: My curiosity about FODMAPs was piqued when I heard a speaker mention the term in passing during a talk at an educational event. It was 2007. I wanted to know more, because at the time there was very little we had to offer our IBS (irritable bowel syndrome) patients in terms of diet. They had been told for years that it didn’t matter what they ate, as long as they consumed enough fiber, and drank enough water. If that didn’t help, they’d have to learn to live with their IBS symptoms. Though the patients themselves knew darn well it did matter what they ate, IBS patients were rarely, if ever, referred to a dietitian for specialized gastroenterology care.

The next day I located a paper about FODMAPs, published a year earlier by researchers at Australia’s Monash University. It actually made sense! With hope in my heart, I drafted some rudimentary handouts based on the paper, and I started offering the information to clients who told me about their IBS, even though they were seeing me for help with their cholesterol or blood pressure. It was immediately apparent that low FODMAP diets worked to relieve IBS symptoms, sometimes dramatically!

IBS can be so deeply debilitating, and the number of people affected by it so large, that I really felt getting the word out about this new way of treating IBS with diet couldn’t wait. So the next year, after more practice implementing the diet with patients, I wrote the very first book on FODMAPs, IBS—Free at Last! (currently published as The IBS Elimination Diet and Cookbook, 2017 Harmony Books). I went to Australia in 2013 to meet the FODMAP team at Monash, and I’ve remained in close contact with them over the years. I’ve traveled far and wide to interact with scientists and clinicians studying gastrointestinal disorders and diet, and I’ve trained many dietitians in how to use FODMAP diets with their patients. Research continues to show that low FODMAP diet is effective for managing IBS symptoms, and today many experts consider low FODMAP diet a first-line treatment for IBS.

Although I enjoy writing, it is working one-on-one with patients that really makes my day. I love helping people build confidence in their ability to nourish themselves while minimizing symptoms and enjoying their food! Some patients come to me when they are newly diagnosed with IBS or another GI conditions. Others need help when they’ve started a diet on their own but feel stuck and aren’t sure what to do next. Many of my clients are concerned about their nutrition status after being on a limited diet for a long time. Some people are just looking for an expert with whom to discuss the fire hose of information they’ve read (and tried) on the internet. I work via telehealth, so I can see clients throughout the US where licensing laws permit. Your readers can learn more about my practice at here.

I also thoroughly enjoy my work as a consultant and advisor to ModifyHealth, a healthcare company whose services include delivery of fully prepared low FODMAP meals. It’s been great to see them collaborate with doctors and dietitians to make it more convenient for patients to follow a low FODMAP diet.

Kate: Has the way you applied the low FODMAP diet changed at all over the years?

Patsy: The basics of a FODMAP elimination diet process have not changed much. Other things about my practice have changed more, such as the prior knowledge my patients often now have about IBS and FODMAPs, and the clinical complexity of my patient panel.

Fifteen years ago, I typically was introducing the idea of FODMAPs to my patients. Most had never heard of it, and almost all seemed to get excellent results from the elimination diet process! Today, with abundant low FODMAP books, blogs, meals and apps available, many people try special diets like this on their own. The “easy” patients are treating themselves. Fifteen years on, I am more often called upon to help complex patients who got only a partial response from low FODMAP diet, or those who can’t seem to get away from low-FODMAP diet without symptoms and need help liberalizing their intake.

I also work with an increasing number of clients who just aren’t good candidates for elimination diets, for example people with disordered eating, or elderly patients, or people with multiple nutrition-related medical problems. I can help them reduce their intake of FODMAPs to an effective level without asking them to do a formal elimination diet. While this isn’t a new idea (I’ve written about it since day 1), I do find myself using this alternative approach more frequently over the years.

Kate: What do you wish all people living with IBS knew about diet & symptom management?

Patsy: Diet is a very important factor in managing IBS. Everyone deserves the opportunity to explore it. If you discover food triggers for your symptoms, you can do something about them! And yet, IBS symptoms aren’t always caused by something you have eaten. IBS is multi-factorial. That means your condition might be affected by a multitude of potential factors including anxiety, hormones, endometriosis, pelvic floor function, medications, gut microbiome, and so on. To optimize your IBS symptom management, ask for professional help evaluating and treating these other factors too.

Kate: Can you provide 5 tips that you commonly share with IBS patients in your practice?

Patsy: My top five tips for IBS patients in my practice are:

1. See a doctor for a proper evaluation of your symptoms if you haven’t done so already. Don’t diagnose yourself with IBS.
2. Take things one step at a time. Don’t try to combine two diet ideas at once.
3. If we agree that you will try a special diet, eat a wide variety of appropriate foods to make sure you get a variety of nutrients. Don’t cut out foods or food groups beyond the requirements of the diet unless medically necessary.
4. Don’t forget the reintroduction phase of an elimination diet. Better symptom management during the low-FODMAP phase of the diet is great, but the reintroduction process is where you learn more specifically what your symptom triggers are. That paves the way for enjoying a wider variety of foods.
5. For constipation-predominant IBS, fiber supplements are for prevention, not “rescue”. Take your fiber supplement daily. Don’t just think of it when you are already constipated. At that point it will only make you more uncomfortable.

Kate: Are there other diet changes outside of a low FODMAP diet that you have tried with success in your patients living with IBS?

Patsy: Briefly, I make sure my patients aren’t overlooking the obvious. Most people benefit from eating meals and snacks on a regular basis, chewing their food thoroughly, drinking enough fluids, and avoiding too much sugar, caffeine, and alcohol. Many patients report feeling better when focusing on simply prepared foods rather than highly processed foods. Finally, I take a conservative and very individualized approach to the use of dietary supplements with my patients. There are none that I recommend across the board. But for selected patients, they can play a role in successfully living with IBS.

Kate, thanks for asking me to share my thoughts. You were one of the first to connect with me about FODMAPs, and it’s been my pleasure to call you a trusted colleague ever since. And I admire your contributions to the field, especially your commitment to educating medical providers about the role of diet (and dietitians) in managing GI conditions. I’ve enjoyed our collaborations, and I look forward to many more!

Kate: The feelings our mutual, Patsy and I appreciate your very kind works and for taking the time to share your insightful answers to my questions!

For more on Patsy’s work check out her latest book here and her website here.

Have a great week, everybody!