Lost in the Supermarket

Managing Food Intolerances while Grocery Shopping

January 28, 2020 SupermarketGuru
Lost in the Supermarket
Managing Food Intolerances while Grocery Shopping
Chapters
Lost in the Supermarket
Managing Food Intolerances while Grocery Shopping
Jan 28, 2020
SupermarketGuru

Today’s topic is about food intolerance, an issue that impacts about 20% of people around the globe.  

Kate Scarlata, MPH, RDN, LDN is a registered, licensed dietitian with a nutrition consultation business in Medway, Massachusetts. She has 30 years’ experience providing nutrition consultation to patients with irritable bowel syndrome, celiac disease and inflammatory bowel disease. Ms. Scarlata is considered a global expert in the low FODMAP diet and food intolerance. She is an invited speaker to numerous conferences in the US and abroad. Kate is a New York Times Best Selling author for her co-authored book, 21 Day Tummy Diet, author of The Complete Idiot’s Guide to Eating Well with IBS and co-author of The low FODMAP Diet Step by Step. Ms. Scarlata earned her B.S. in Nutrition from Simmons College in Boston, Massachusetts and her MPH at the University of Massachusetts. She was awarded the Outstanding Dietitian of the Year by the Massachusetts Dietetic Association and voted Boston’s Best Dietitian award by Boston Magazine.

Show Notes Transcript

Today’s topic is about food intolerance, an issue that impacts about 20% of people around the globe.  

Kate Scarlata, MPH, RDN, LDN is a registered, licensed dietitian with a nutrition consultation business in Medway, Massachusetts. She has 30 years’ experience providing nutrition consultation to patients with irritable bowel syndrome, celiac disease and inflammatory bowel disease. Ms. Scarlata is considered a global expert in the low FODMAP diet and food intolerance. She is an invited speaker to numerous conferences in the US and abroad. Kate is a New York Times Best Selling author for her co-authored book, 21 Day Tummy Diet, author of The Complete Idiot’s Guide to Eating Well with IBS and co-author of The low FODMAP Diet Step by Step. Ms. Scarlata earned her B.S. in Nutrition from Simmons College in Boston, Massachusetts and her MPH at the University of Massachusetts. She was awarded the Outstanding Dietitian of the Year by the Massachusetts Dietetic Association and voted Boston’s Best Dietitian award by Boston Magazine.

Phil:

Welcome to Lost in the Supermarket, the podcast that goes behind the shelves with a look at the latest grocery trends, the latest health information and how to make every shopping trip the best it can be for every shopper. I'm Phil Lempert and on today's podcast we talk about food intolerance, an issue that impacts about 20% of the people around the globe. Our guest today is Kate Scarlata, registered and licensed dietician with 30 years experience providing nutrition consultation to patients with irritable bowel syndrome, celiac disease and inflammatory bowel disease. She's considered a global expert in the low FODMAP diet and food intolerance. Kate is a New York times bestselling author for coauthored book 21 day tummy diet, author of the complete idiot's guide to eating well, something I need to read with IBS and coauthor of the low FODMAP diet step by step. She was awarded the outstanding dietitian of the year by the Massachusetts dietetic association and voted Boston's best dietitian award by Boston magazine. It's a pleasure, Kate. Welcome to Lost in the Supermarket.

Kate:

Thank you so much for having me on file .

Phil:

So Kate, I guess the first step is what's the difference between a food intolerance and a food allergy?

Kate:

So both food intolerance and food allergies involve adverse reactions to food. A food allergy involves the immune system. Well , a food intolerance would not involve the immune system. It's a non immune mediated reaction. The other important thing about food allergy versus food and tolerance is that a food allergy can be life threatening while it food intolerance is not life threatening. It's certainly can impact someone's quality of life.

Phil:

It's just uncomfortable.

Kate:

It's uncomfortable. Absolutely.

Phil:

So what I'm hearing from a lot of consumers, and I don't know whether this is real or not, so I need you to help me is that a lot of them are saying that they're intolerant to dairy. What, what's the real truth about dairy intolerances?

Kate:

That's a really complex question and I think a lot of people believe they're dairy intolerance just because of a lot of the social media and pseudoscience platforms. That dairy intolerance is not quite as prevalent as some sites would like you to believe. Lactose intolerance is a fairly common , um, and that is when , um, an individual has a reduction in the enzyme, lactase as such, they can't break down that lactose, the milk sugar in, in cow's milk and, and really she Oh, a number of different mammals. Aand they're unable to digest that and that can trigger gas and bloating and digestive distress. Dairy allergy is absolutely, you know, milk is a top allergen, but it's not that common overall. So , I think that there are people that believe they have dairy intolerance , don't really have dairy intolerance. And then also what's kind of part of this conversation is there's different types of protein and milk. So when we think about allergies, it's the protein in, in a food that prompts a food allergy, where in intolerances it's often the carbohydrate. It can also be the protein, but sometimes it's the carbohydrates . So that's a little bit of a differential. There is different types of beta casein in milk. So if you look at cows milk, okay . Ordinary cow's milk often has a combination of a one and a two beta casein where sheep and goats milk only has a2 beta casein. So part of this conversation around dairy and tolerance in my patient population, I'll have an individual for instance that comes to my office, is intolerant to lactose free dairy, his seemingly intolerance to all types of Dairy. And then we will explore the possibility that maybe their intolerance is more related to this beta casein, which makes up about 30% of the protein in milk . And so there is , um, I'll either start them with goat cheese to try to see if they can tolerate goat cheese. There's also a new product, relatively new to the U S market, a two milk that they could try. So we might incorporate some , um, just a 2 million product . Yeah . Okay . Or cheeses, goat and she cheese again, only have that a2 beta casein to see if it's more of a beta casein intolerance and in fact a full dairy intolerance .

Phil:

Gotcha. So , um, help me, help me understand the difference between intolerance and malabsorption as it relates to milk and dairy as well.

Kate:

Great question. Because I think a lot of even health professionals think of, someone having lactose malabsorption for instance, means they have lactose intolerance and they're very different. So you can malabsorbed lactose. And a lot of people do because the enzyme that lactase enzyme production tends to decline after we wean from the bottle as an infant. And so people will malabsorbed lactose but not necessarily be symptomatic. So they have no symptoms. In that case, they just go about their business. They don't even know they're really malabsorbing lactose. Those that malabsorbed lactose subset of them have lactose intolerance. Those are the people that malabsorbed lactose but also become quite symptomatic after they ingest lactose. So it's different. The intolerance means you're having your be symptoms where malabsorption can occur and you don't even know that that's happening. So we see that in lactose. We also see that in fruit toast malabsorption. So fruit toast, unlike lactose, lactose requires an enzyme to help your body digest it. Fruit toast is a one change sugar. It doesn't require an enzyme, but some of us don't have a lot of transporters that to get that fruit toast into our bloodstream. And so the extra fruit those can get into our, our colon where it pulls a lot of water in , bacteria will eat that fructose in some people, not all, probably dependent somewhat on the sensitivity of their intestine how fast their intestine moves, what type of bugs live in their intestine. Some of those individuals will have fruit toast intolerance and so they'll experience symptoms. So it is very individual and i t malabsorption and intolerance truly do mean something different. Y eah.

Phil:

And what this discussion really underscores for me in addition to all the great information that you just shared, is that forget about going to websites, forget about Googling. You know, if you've got these kinds of conditions, you've got to be talking to a registered dietitian such as yourself because these are very complicated issues. This is not something you can Google and then figure out yourself.

Kate:

Absolutely. And we certainly don't want people, for instance, to feel that using the milk as an example, well I don't tolerate milk. So that's it. When we could explore trying a to milk, we could explore trying lactose free products. The , you know, there's lots of different options here. So we don't want for instance in the dairy discussion, we know that milk has calcium and protein and riboflavin, a number of B vitamins. We don't want them removing all of that.

Phil:

Yeah, no , that's good. That's good stuff. You want that? Yes . So I, I've also heard a lot in the past few years about irritable bowel syndrome. In looking it up, it actually impacts about one in seven Americans. What exactly is, you know , irritable bowel syndrome and why should we be concerned?

Kate:

So irritable bowel syndrome, we should be concerned. And I think as a provider for many of these patients is, it, is, can be quite debilitating. Um, I, I cite this study often because I think it's really important for , for all of us to hear . Um, there was one study done looking at about 2000 individuals with irritable bowel syndrome and it was assessing their quality of life. And in that study they found that people with irritable bowel syndrome, we're willing to give up 25% of their remaining life for a symptom cure, something that would give them symptom relief, 25 percent. So this is, you know, it's it may be not cancer, it's, it doesn't sound like something very dramatic, but it really does impact people's quality of life.

Phil:

Absolutely. So, so we need to pay attention to those TV commercials

Kate:

we do. And really maybe those individuals in your life that could use a little TLC. But to answer your question, it's, it's a GI motility disorder. U m, people with IBS really have a heightened sense of pain or sensations in their i ntestines, so they're more sensitive to gas in their intestine. Someone might eat a bowl of chili that does not have IBS and feel fine. They might p ass a little more gas the next day where someone with IBS could be really troubled for the next couple of days. Maybe the in bed with t he heating pad, u m, the pain is quite debilitating, so it's, u m, although the name sounds like it might not be that serious a condition, it really can be a life stopping condition. Wow.

Phil:

Um, so in, in going up and down the aisles at various trade shows, food trade shows, I see a lot of discussion, a lot of signs about FODMAP, what's the FODMAP diet and is this something that's a fad or a trend ? We pay attention to this.

Kate:

I would say absolutely pay attention to this. Um, it is a very , um, therapeutic diet for people with IBS. In fact, and I'll back track with what a FODMAP is and what the diet is in just a second. The low FODMAP diets been shown to manage symptoms, debilitating symptoms of IBS in 50 to 80% of people that try the diet. So it's quite effective. Um, the word FODMAP is an acronym and it stands for fermentable. So these are carbohydrates that are small carbohydrates that are highly fermentable by our gut bacteria and they create gas. And then the O, D M and P stand for different types of carbohydrates that are commonly malabsorbed. And I'm going to give you their scientific name, but promise you don't have to remember that. So always , yeah , oligosaccharides the P foods that have oligosaccharides include onion and garlic and wheat, primarily D is die saccharide which is referring to lactose, which is a to change sugar. Uh , the M N FODMAP is monosaccharide, which is a one change sugar referring to fruit toast. And then the P and FODMAPs refers to polyols, which are sugar alcohols that are found in some foods like cauliflower and stone fruits such as peaches and plums, but also in a lot of sugar free gum and mints and products such as that.

Phil:

Got it. I want to go back to intolerance for, for a moment. I've also read about histamine i ntolerances and you know, other intolerances that, that are out there like sucrose intolerance. Y ou talked a little bit about fruit toast intolerance earlier. U m, how important or prevalent are those intolerances, u h, for the average person? And again, is this something that people should be aware of? How can they determine if they've got these intolerances? Is it just eating a food a nd, and feeling weird after eating it?

Kate:

You know, I think the sucrose intolerance is somewhat new. As far as an adult and tolerance. We've , we , there's congenital sucrase ICL maltase deficiency that we see in children, and that's a condition where the enzyme complex sucrase I sell maltase, which helps digest sugar as well as starches is decreased just from a genetic condition , but we weren't really recognizing the same condition in adults until recently. And so now it's sort of termed genetic sucrase ISO maltase deficiency. And they're finding and people that present with irritable bowel syndrome symptoms that tend to be more diarrhea predominant , that sucrase ICL maltase deficiency may be playing a role and there are supplements and dietary modifications that can help those patients as well. So this is an emerging area in the adult population, very new. Um, but I think that we're going to see more and more about that. Histamine intolerance has been around and probably more well-researched in the European scientific literature t hen here. Um , but we're , it's getting some traction at the research conferences. I don't think it's quite ready for the [ g rocery store dietitian, or that we're going to see low histamine products emerging on the markets in the next year or two. But I do think it's part of the discussion. And histamine intolerance is unique in the sense that it presents with a number of t hings, different types of, u h, symptoms. It can be from headaches to low blood pressure to hives t oo, u m, flushing of the skin, and t hey're so variable that it does take people that are diagnosed with histamine intolerance generally quite a long time, up to 10 years to get that final diagnosis. But one thing to know, I'm similar, lactose and sucrose intolerance, there is an enzyme that helps individuals degrade histamine. It's called diamine oxidase. And some people can have a reduction in this enzyme after they've experienced gastroenteritis or foodborne illness that affects the gut and maybe causes a little inflammation. U m, so I would say that in adults, the sucrase isomalt i s deficiency that might lead to sucrose intolerance and histamine intolerance a re just emerging as a little getting some traction and awareness. So s tayed tuned and watch that space, but they're not ready for primetime really. I don't k now, I think in the grocery store yet.

Phil:

So Kate , and in listening to this wealth of information that you've got, I've got a wonder that now that I'm seeing a lot of these DNA kits that are available for consumers from a health standpoint to really talk about the genetics that, that you mentioned a moment or so ago, is this a good idea for people to go out to get these DNA kits to really look to see whether or not they have a predisposition genetically too , to some of these allergens , uh , to some of these intolerances?

Kate:

I'm not sure that we're really quite there yet. For instance, in some of the genetic testing, for instance, for celiac disease, which is an autoimmune condition where gluten, you can't tolerate gluten. Some of these genetics tests will test a number of the different and , uh, genetic markers for celiac disease, but they don't often include all of them. So you might get that test and say, geez, I have no genetic markers for celiac disease. I'm good to go. And kind of rule that out. In fact, that happened recently. I worked with a dietician , colleagues husband actually, and they had used one of those tests to rule out Ciliac disease. And I said, no, no, no, no. You need to go and have it done properly at the doctor's office and come to find out he does have genetic markers and now we're having them assessed for celiac disease or had they had ruled it out based on some of these tests. So I would say the tests miss a few things. Um , but it is emerging and I think we are going to start seeing , uh , this whole genetic conversation come into play, add our primary care doctor and our GI doctors coming soon. It's , it's almost ready for prime time. And certainly we're using genetics to look at sucrase ICL maltase deficiency. Um, and that's starting to happen in GI offices around the country. Um, and we're certainly doing genetic markers for celiac disease regularly these days. So it's happening and it will continue to increase in other areas, I imagine .

Phil:

But these kits are not a replacement for Kate.

Kate:

They're not a replacement for the physicians , so I'm not really ordering these, but I'll take that. I'll take that. Yeah . For me. Yeah, they're not a replacement.

Phil:

Let, let's go back into the supermarket. You mentioned early on a2 milk. I had , I had tasted and we actually did a taste test , um , and a product evaluation of a two milk when a first came out and frankly we gave it rave reviews. What's been your experience with a two milk as it relates to your clients?

Kate:

I can tell you when and while I was working with clients in those that I tried it, it worked 100% of the time. So, and I have friends that have tried it that have , cannot do dairy whatsoever but can do a two milk. So when the select person that perceives, you know , digestive symptoms after dairy, it's worth a try. It absolutely is worth a try, especially in, of course, you want to make sure that they don't have a dairy allergy. I mean, it's 100% dairy. There's , it's delicious. There's nothing alternative about it. They've just selected the cows that only make a two. So, you know, you shouldn't be surprised that it's a lovely product because milk is a lovely product. There's nothing altered about a two .

Phil:

You know, I just want to go back and underscore the point that you just made. This is not milk that has been altered or filtered or anything added to it. They're just finding cows that have the aid to protein without the a one protein. Am I understanding that correct?

Kate:

That's correct.

Phil:

How doesa2 milk actually determine which cows have the a2 protein versus cows that have both proteins?

Kate:

So it's really interesting. This is done using a simple and noninvasive DNA test, which analyzes the sample here from the tail of each dairy cow.

Phil:

Wow .

Kate:

I know. Isn't that interesting? Thanks .

Phil:

Yeah, very cool.

Kate:

So they also , um , in addition to testing all the cows to confirm they are a two producing cows, they also test each batch of milk to confirm that no a one protein is detected. So there's sort of a dual process in place.

Phil:

So last question. What would you like retailers and retail dietitians to be doing in store to help shoppers that have food allergies, food intolerances, all the things that we've talked about , um, in order to make their food experiences and their lives better?

Kate:

Well, I think, you know, what helps with a lot of patients coming into the grocery store is to have either dedicated sections of the , of the grocery store or even printed handouts where they can find foods that are low in lactose or low end FODMAPs. Do they have products that have certification on them? For instance. Um, for instance, in the FODMAP realm , uh , there's two certification programs that certify something as low FODMAP . So if , uh , a shopper came in and they saw those certification stamps on the food such as we see it's gluten free, it gives them that assurance perhaps having signage that says, you know , um, you know, digestive friendly or, you know, just to kind of direct them to where they should be going. The grocery store has so many products and it can be really overwhelming. Um , having a dietician of course on staff that can help them, that have an awareness of these various food intolerances can be very helpful in any handouts that they could provide individuals so that they could , um, assess what types of products , um, specialty products for their particular food intolerance that the store carries. All of those things can be really quite helpful.

Phil:

Well, Kate, thanks so much for joining us today. You're, you're a pleasure. You know , want to have you back , uh , whenever you want to come back. In the meantime, if people want more information, whether they be a registered dietician, a retail dietician, or a consumer about you and about eight to milk, where can they go?

Kate:

Well, first and foremost, they can come to my website, Kate scarlata.com. That's KATESCARLATA for consumers. Go to a2milk. com. And for health professionals, go to A2nutrition4professionals.com. So A2nutrition4professionals.com

Phil:

Great. Well, Kate, thanks again for joining us today on Lost in the Supermarket.