Kate Scarlata,RD,LDN is a registered and licensed dietitian with private practice offices in Boston and Medway, Massachusetts. Kate provides individual and group consultations as well as interactive nutrition workshops. As a digestive health expert,particularly in the area of FODMAPs, Kate has authored The Complete Idiot’s Guide To Eating Well With IBS. Her health writing also includes Real People Real Food: A Guide To Healthy Eating For Families Living In A Fast Food World, a family nutrition book she co-authored as well as numerous articles for Today’s Dietitian and local Boston media publications including The Boston Herald and Bay State Parent Magazine. Kate has been interviewed by Fox News, Fitness Magazine, Christian Science Monitor, and Spa Magazine sharing her wide range of nutrition expertise. She is the author of Irritable Bowel Syndrome: Fodmaps, Fat, Fiber, and Flora, an eight credit CPE self study course for nutrition professionals (available from Wolf Rinke Associates, Inc. and CDR approved). LIDA had the pleasure of recently interviewing Kate for this blog.
LIDA: How and why did you become interested in gastrointestinal nutrition and particularly the FODMAP diet approach? Kate: When I researched current therapies for IBS in writing my Complete Idiot’s Guide: Eating Well With IBS, I stumbled upon the research for the low FODMAP diet and IBS symptom management. This approach made such sense to me from a dietitian perspective that I started to use it right away with my clients. One by one, the vast majority of my client’s symptoms improved – dramatically!! I found helping IBS patients feel better and regain their lives back to be so rewarding. It has become my life’s work ever since. LIDA: What do you want other registered dietitians to know regarding IBS and the low FODMAP diet approach? Kate: Please get trained in the FODMAP diet! IBS symptoms impact millions of Americans -quite significantly-and understanding the diet specifics will help your clients while they attempt this dietary approach. There are many nuances with the diet so take the time to read the literature and get up to date with this new and evolving diet. Also, I have seen just how helpful this diet can be to people who suffer from IBS symptoms; it has therefore become a serious mission for me to get other registered dietitians on board with the FODMAP diet approach. LIDA: The Monash University in Australia seems to be at the forefront with research regarding IBS, gastrointestinal symptoms, and FODMAPs. Why do you think this is so and what about research here in our own country? Kate: Quite honestly, I think it has a lot to do with funding – most US studies are pharmaceutical driven and Australia has government support. But certainly, since the Australian’s researchers defined this dietary approach, it makes sense that they remain at the forefront as it continues to evolve. LIDA: What do you think of the high fiber diet approach for IBS? Kate: For some patients, simply adding fiber does the trick for their IBS symptoms but despite the fact that adding fiber seems to be the universal first line therapy, the research supporting the efficacy for use of fiber in IBS patients is limited. LIDA: You address small intestinal bacterial overgrowth (SIBO) in your self study guide. Do you have any suggestions regarding raising awareness about SIBO among registered dietitians? Kate: I wrote an article for Today’s Dietitian – and since then there have been other articles in this publication. Registered dietitians are an integral part of the healthcare team for their patients and they should be reading up on digestive health and be aware of these conditions such as SIBO. In too many cases to count, I was the first healthcare professional to push for small intestinal breath testing (a test for diagnosing SIBO) for my clients. And I would have to say, that the majority test positive for SIBO. I am a firm believer of advocating for my clients! LIDA: Could you comment on why a totally gluten free diet is not indicated with the low FODMAP diet approach. Kate: The low FODMAP diet approach focuses on small chain carbohydrates and their aftermath when not absorbed in the small intestine. FODMAPs are rapidly fermented by gut bacteria and have an osmotic effect, drawing water into the bowel contributing to common IBS symptoms. Gluten, of course, is a protein. In a recent study by Jessica Biesiekierski and other Monash researchers – gluten had no impact on gut symptoms in individuals with non-celiac gluten sensitivity (NCGS). It was likely the FODMAPs that trigger gastrointestinal symptoms. Please refer to http://www.ncbi.nlm.nih.gov/pubmed/23648697. The study conclusion: In a placebo-controlled, cross-over rechallenge study, we found no evidence of specific or dose-dependent effects of gluten in patients with NCGS placed diets low in FODMAPs. For additional information, you can visit Kate’s website at www.katescarlata.com her blog at http://blog.katescarlata.com and also follow Kate on twitter https://twitter.com/KateScarlata_RD.
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Webinar—Change Talk: Using a Patient’s Own Words to Support Behavior Change
Written by: Amanda Proscia, Registered Dietitian Nutritionist In order for an individual to positively alter their lifestyle, it is vital that they increase their commitment to change. As Registered Dietitians (RDs), we must encourage positive behavior change among our clients in order for them to transform their unhealthy lifestyle habits. Unfortunately, difficult challenges may arise when patients express resistance to change or demonstrate non-compliance. Molly Kellogg, RD, LCSW aims to teach RDs how to overcome those challenges by discussing motivational interviewing (MI) techniques in her webinar, “Change Talk: Using a Patient’s Own Words to Support Behavior Change.” Motivational interviewing is defined as “a collaborative, goal-oriented method of communication with particular attention to the language of change. It is designed to strengthen an individual’s motivation for a movement toward a specific goal by eliciting and exploring the person’s own arguments for change.” Counselors and their clients must work together to foster constructive lifestyle changes through positive reinforcement, listening skills, and the “MI spirit.” The spirit of MI consists of collaboration, evocation, autonomy, and compassion. Both the RD and the client must listen to each other. Commitment to change is enhanced when clients think of their own plans; however, an RD can still offer advice. By asking open ended questions, it helps to elicit responses from clients. It is important for the RD to understand that the patient will ultimately do what he or she deems fit for their lifestyle. The ability to express empathy for ones struggles is also another key component that will help decrease client hostility. RDs have the abilities to impact a clients’ resistance, it just takes a little time and patience…on both ends. Kellogg identifies seven different types of statements that helps RDs recognize “change talk.” Each type of expression statement is categorized under words, which are as follows: desire, ability, reasons, need, commitment, activation, and talking steps. Examples of clients’ “change talk,” which may include, “I want to…,” “I could…,” “I would probably feel better if…,” “I have to…,” “I will…,” “I’m willing to…,” “I am now doing…,” respectfully. A critical role of the RD is to uncover the different forms of “change talk” that take place during counseling sessions. Sometimes a “change talk” phrase can be straightforward and other times it may be embedded in a statement. Each counseling session is different therefore it is essential for the RD to determine how to tackle clients’ issues using a specific “language.” Responses to “change talk” are critical. Kellogg reminds us that the best ways to reply to clients’ “change talk” are to elaborate with open questions, affirm efforts and strengths, reflect “change talk,” and summarize all the “change talk” heard. It is important to reinforce, reiterate and reflect “change talk” to clients in order for behavior change and forward thinking to begin. Reflections of a clients’ affirmation should be made a bit stronger in order to be effective. A positive affirmation in response to a clients “change talk” may go above and beyond what they stated in order for lifestyle adjustments to occur. Successful outcomes of motivational interviewing are reached when both the client and RD work together to facilitate change. Most of the time, neutral advice from the RD does not spark client resistance. Kellogg’s suggestions include: to elicit (what client already knows and wants to know), offer (information in a neutral manner), and elicit (client’s response to, interpretation of the information). Hopefully, with more neutral conversation, client resistance to change is decreased and commitment to change is increased. The objective of using a patient’s own words to support behavior change is to enhance client adherence to the program, improve outcomes, and foster constructive lifestyle modifications. Motivational interviewing allows an RD to coach their client to help them reach their full potential. Patience, listening, understanding, communication, and guidance are all key ingredients that make up a successful counseling session. By incorporating both nutrition education and motivational interviewing into counseling sessions, clients are more likely to alter their lifestyles for the better. |
Lisa Samuels is a Long Island native who is currently a Dietetic Intern at LIU Post. She has a B.A. in Art History from Ithaca College, a B.S. in Nutrition from LIU Post & was also a practicing baker for two years. Lisa has finally found her calling. Combining her love for food, writing, and nutrition, she strives to bring you the latest news in the field.
Check out even more posts from Lisa at her website: www.haveabitenutrition.com Archives
June 2015
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