Season 3, Episode 11: The Overlap Between Food Insecurity & Digestive Disorders

Welcome back to The Gut Show! I'm your host, Erin Judge, and today's episode is extra special because we have guest Kate Scarlata, a dietitian based in the US with over 30 years of experience. Kate's expertise ranges from GI disorders, food intolerance, and she specifically is focused on the low FODMAP diet for functional gut disorders in her practice. Kate is a leading dietitian in the country, she's involved in speaking, in research, and helps train dietitians across the country and the world.

What is so great about today's conversation is that we get to highlight a specific area of interest that Kate has had, and that is food insecurity and the pain that comes along with that for those who live with digestive disorders and food intolerances. We're talking about her campaign, #EndHungerPain initiative, and we are just going to talk about some of the nuances that are involved in food insecurity, specifically for those who have specific food needs, like allergies and intolerances. So whether that's you or not, we're going to cover resources for you, and we're also going to talk about ways to get involved, just increasing our own awareness so that we can support our own communities in a more productive and helpful way.

Enjoy today's episode and as always, if you want to connect with us, ask questions or share a resource yourself, join us over at The Gut Community on Facebook. We'd love to hear from you and hear your takeaways as you wrap up the episode!

This episode is brought to you by Nerva - a non-invasive, evidence-based, at-home IBS management tool. Nerva is an app that provides gut-directed hypnotherapy through a structured six-week program, followed by a maintenance plan.

Use this link to try Nerva today at 30% off!

Erin Judge: Hey, Kate, thank you so much for being on the podcast today! I want to go ahead and just get started with your story. How did you become the leader that you are now in the area of nutrition for digestive disorders?

Kate Scarlata: So great question! You know, when life gives you lemons, you make lemonade, and in 1994, when I was pregnant with my middle son, I developed a strangulated intestine and required major small intestinal resection, I lost six to eight feet of my small intestine, and the surgeon just said, go out and eat a big steak, see later. And, you know, of course, I had a number of manifestations from the surgery, and so it just prompted really, you know, the whole notion that patients are kind of left out on their own sometimes, like navigate this space, and we certainly see this in the irritable bowel syndrome space, both of us. It just prompted me to really dig into the research and get to know what we do know is fact versus fiction and really be able to translate that science into tools for patients. 

I am a nerd, and I love reading science, and this area of GI nutrition has just really expanded. I would print out about 15 articles a week, I loved every minute of it, just highlighting, reading, forming my own critical analysis of where the research was going, always following the science. I found that I really enjoy amplifying the voice of the patient, but also my fellow dietitians, which led me into researching with gastroenterologists most recently, you know, what they found to be the barriers and benefits of using a dietitian in the GI space. So it's an area that started with kind of a bad situation, but it has been really a phenomenal journey and a rewarding career!

Erin Judge: That's awesome! And I like that you brought that up, because I know a lot of dietitians in specialty areas do have personal experience and that's what kind of leads that as the connection to the patients, the connection to care, the evidence and the science, but also some of that personal, which allows a bit for more empathy, which I know that you share a lot. And you know, for those who are not familiar with you and your work, you're an author, renowned author, which is probably what a lot of people may recognize first, you’re a speaker in the professional space, you're an advocate on the patient side, but you also have a practice. Tell us a little bit more about that, and what that looks like and how you actually were on the ground kind of working as you were gaining this knowledge and experience.

Kate Scarlata: Absolutely. So you know, I've been in practice for a gazillion years, so like late 1980s, which is crazy. I had to really, when the FODMAP space sort of started permeating the research area, there were no patient education handouts. There were no GI nutrition assessments, there was nothing, and so I really had to think, okay, what am I writing down a million times to educate the patient? Where are the gaps in patient education tools? So that's really where I think I helped this area a lot is just really translating science into tools for patients and clinicians to use, educational tools that I've created. Every day I get an order, and it's South Africa, you know, Barcelona, Spain, it's really interesting. So it's nice to see that they've made a difference, they've been used in research centers. So things have really evolved over this time and I've had to create a lot of the tools and shared a lot of tools with other clinicians to help move the field forward.

Erin Judge: That's something a lot of people may not know if you're not in the area of nutrition, or maybe you are a patient and you've gotten a handout from somebody, that doesn't just happen by chance, and especially in the field of nutrition, and then diving even deeper to the field of GI nutrition. Nutrition is so new and evolving, GI nutrition is also new and evolving every single day, so those handouts and resources and books and even the talks that you've been able to give have played such a major role in what we do and what I get to do as a dietitian, four years in my practice with GI.

So one thing that you've done a great job of is, you're on stages around the world, you've been on stages leading talks for clinicians and looking at kind of this high level view of what the science is saying, what we do and how to train dietitians. But you've also done is you've been on the ground with patients and you've done that really well through your online space. You were blogging I know before that was really a big thing, right? You were blogging before even FODMAPs were hot and you were at the start of that. You've also been really active on Instagram and through communities, and I want to talk a little bit about that, because I know you've had some initiatives that have come out of that to connect. But where did that begin? Was the goal to connect with the patient directly? Was there just a creative outlet that you wanted personally? Or how did you begin to form kind of this online presence and connection space?

Kate Scarlata: Great question. To backtrack, I was in patient care, I’ve seen thousands and thousands of patients for 30 years, so that was really a bulk of my career, the love of my life, and rewarding experiences. I decided to blog a while back, and I really should look exactly when that was, but the intent was really to share my lifestyle because I felt like my husband and I really had a well-balanced life. We were traveling and enjoying each other and really loving on our three kids and just really balancing things really nicely. It was something that my friends always said you figured it out; you figured that way to do that. So I started a blog, and it was well-balanced food, life, travel, and that was my intent. You can see on the back end what people are looking for, and everyone was looking for FODMAP information, and I thought to myself, well, if the audience wants FODMAP information, I can bring that, I'm happy to do that. And so it sort of was driven by my followers, so to speak. And yet it was such a big platform for me, because no one was blogging really about FODMAPs except for Patsy Catsos, another colleague in this space, so it just kind of blew up. And you know, being in the right space at the right time and listening, right? Listening to what people want and I also wanted to honor what I wanted. And I wanted to share that information, so it was a marriage made in heaven. 

Twitter became kind of an interesting platform, and I had an entrepreneurial colleagues say get on Twitter, you need to get on Twitter, and so I jumped in really early. It's been an interesting platform, and what I love about Twitter is, really you get access to early release of articles, and I use that from a professional standpoint. Someone will share their article they just published and boom, I'm right in and printing it out. I love reading, so that's been really the big asset for me I think for Twitter.

And then Instagram, I've always been a creative, my mother was an artist, my three kids are in creative careers because of her I believe, because she had a really big influence on them, and certainly had a big influence on me. I had a card making business when I had young kids and used to sell my cards to boutiques in Boston, in the coastal community and did that with a friend. I've always really liked the creative outlet, so Instagram kind of came naturally, you know, photography was something I enjoyed. One of my kids is a videographer, one's a photographer and so you know, it just kind of came hand in hand. So that got me into the Instagram world. And I love that, I love the creative aspects.

I would say, having been in the platform for a long time, I loved the authenticity that Instagram used to be, it's really moved into this very curated space, which you know, is beautiful, and I love beautiful photography, but it's just a little less authentic and I think puts a lot of pressure on professionals to constantly up their game. And I wish we could move a little bit away from that because I think it's unnecessary pressure and yet you've got to rally if you want to play in the pool. So that's my take on those platforms. But absolutely, you have to go where people are right? And people are on social media, so it's important as professionals that we're on there, too.

Erin Judge: Yes, and it makes such a big difference for patients and for those who are seeking information to see professionals who are following the science, sharing the science, breaking it down into application, encouraging, you know, seeing a side of professionals that they may not see every day at an appointment, or maybe they don't have access to professionals who are specialized. It can make such a huge difference!

You mentioned that one thing that you've done from the beginning is listen, you take time to listen to what people are saying, you listen to the scientists, you also listen to the patients. One big campaign that you launched last year, which I know came out of listening, so I want to hear kind of more about that backstory, was your end hunger pain initiative. What was the purpose of this, what were you hearing that led to you starting this? And what did you really accomplish out of that campaign?

Kate Scarlata: Yeah, so I'll tell you that my mom and I share this where we would say we have a bee in our bonnet, right? So you gotta bee in your bonnet, and you got to act on it; I definitely got that from my mom. We were a year into the pandemic and people were really hurting. And there was, you know, a lot of people out of work, and I thought, just kind of had some aha moments, honestly, where it was, like, you know, how is this food insecurity affecting people that are also food intolerant or have allergies to foods, because we know that these specialized foods one, are more expensive. Two, they're very rarely found at a food pantry, and three, for IBS patients, and just in general, when they do face interactions, focus groups, people don't like to talk about digestive health. You know, one organization, it was even yogurt that said lactose free on it, people didn't want to have that in their cart, they wanted the lactose free to be small, because it's embarrassing that they need a lactose free yogurt. So there's a lot of layers. 

It's difficult to go to a food pantry and admit you need help and then you're adding on this layer of food intolerance or food allergies, that you know, just compound it. And I just kept thinking about it; honestly, it just struck a nerve, and I said, I need to understand this food insecurity space, what is going on in the US and how can I help people that have food intolerance? And so, really, it was an aha moment and I decided that I was going to do an awareness campaign. I gave myself six weeks to get everything together, which was ridiculous. I was really discouraged by a couple of family members to be honest, like, you're crazy, what are you thinking? You're what? And I'm like, I am doing this. 

First and foremost, you have to learn, you need to understand the space. So what is food insecurity? What is hunger? What is a food pantry? What's a food bank? How does this all work together? What is the infrastructure? Is anyone talking to one another? Who's helping people with food intolerance? Do they ask this question? Are we screening for food insecurity in our clinic settings? There's so much that I uncovered. You always have to understand the problem first, you can't just dive in. I spent hours calling, interviewing, talking to people, calling the National Celiac Association, talking to Food Rescue, which is an incredible organization. What are they doing? How are they helping? What are they seeing? Clancy Harrison fellow dietitian, what are you doing? What's happening? So many different people interviewing, talking. So that was understanding the space in realizing that food insecurity is different than hunger. So hunger is, you know, that physical sensation of feeling hungry. And many people, I shouldn't say don't experience that, but you can quell hunger with potato chips, right? You can quell hunger with some cheap crackers. Food Insecurity is really lack of access to nourishing food to live a healthy life, so it's a little bit different and it's important that we understand that. 

So in that six weeks prior, I had this vision being a creative, I wanted an Airstream and I wanted it full of food and we were going to travel down the East coast and I was going to meet with a number of different food pantries and food rescue and a number of different organizations. We're going to bring food, we're going to start discussions, we're going to raise media attention. And we did all of that. I raised money for sponsors, so Fody and Schar did financial donations which I was able to then push forward to the National Celiac Association which was doing incredible work helping get gluten free foods to people in need. I was able to donate to Clancy Harrison, she was doing a lot of work in the food pantry space and in her work, which is food dignity.

Then we filled the airstream full of food and we brought that down. I had low FODMAP handouts and I talked about the intersection. I looked at what they had at these food pantries, and it was beans and it was bread and it was onion soup. I remember walking into one food pantry, being FODMAP sensitive to onions, and seeing a whole refrigerator filled with onions. And I almost just was like, oh, you know, like, this is great for the vast majority of people, but not for my FODMAP sensitive folks. And so just starting the conversation, leaving grocery lists, this is what someone with a FODMAP sensitivity can do. 

Multiple media reached out, we were on two news stations in two cities, we had press that really did raise awareness and then, sort of the aftermath of that was getting, my goal was to leverage my connection with industry in this space. How can I have them bring the food to the pantries that are actually asking the right questions and serving these patients with food intolerance or clients or guests. So you know, it's one thing to bring low FODMAP food to a food pantry, but if you're giving it to someone that doesn't require it, that's sort of missing the point. So we really started the conversation around that. We initiated the first ever low FODMAP section in a food pantry in Massachusetts, Project Just Because, which was incredible, and really opened up the dialogue between the National Celiac Association and a number of industries. Frito Lay, Quaker jumped on board. I'm constantly getting, you know, questions about where can we drop this off? What's going to be the best place, you know to do that? So I know this is a long winded answer, there was a lot that happens and it was incredibly rewarding. It was another one of those highlights really of my career!

Erin Judge: It was so needed. And whenever I saw that you were doing that I was, it was one of those well of course, you know, that moment of like, yes, this is needed, this is absolutely needed, we know that, why has this taken so long? And so I'm really glad that you spearheaded that. With that awareness gained and starting with the amount of food pantries you were able to start with, what is that going to look like? Or is there a way to expand that throughout the rest of the United States? Is that something that is just going to take time? What is your vision for how that might expand in the future?

Kate Scarlata: The vision really, you know, from a very Kate Scarlata what I can do, you know, we need a lot of boots on the ground. But the goal is to really build, and I’m starting the list, these are pantries that are going to address the needs of people with food intolerance, because I will tell you, I've got pushback from many. You think like oh, how, why? But during the pandemic, it was a whole different can of worms, you know, they were no longer having people come into the pantry and select what they wanted to select. They couldn't do that anymore, there was too much risk associated with that. People were getting pre packaged boxes, you know, you're a family of six, here's your box for six people. It was wonderful. But it wasn't, you know, there was one issue that came out with Clancy Harrison, and she said, you know, people were leaving canned beans on the church steps and the staff at the food pantry were saying, you know, how dare they? Why are they leaving this, we're packing this beautiful package of food?

The reality was, you know, having a conversation with me, I said, many people can eat those beans, they wanted to leave them for someone else. It wasn't an insult or we don't want your beans, it was these beans don't work for me and maybe someone else can have them. So I think there's a lot of learning that needs to go on, but the goal for me, Kate Scarlata, is to connect industry with food pantries and hope to grow those food pantries that will accommodate those that need special diets. It's a side hustle that I do and continue to do, and it's slow and there's certainly more conversations to be had. That's where we need to raise awareness and then willingness on the side of the pantry to care for those patients or guests.

Erin Judge: Absolutely. And you mentioned you know that this isn't a preference, right, for a lot of people who are living with food intolerances, especially food allergies, you know, it's not just about preference, it's about quality of life, symptom management and control. When someone's living in food insecurity, they also have the stress, there's a lot of layers to this where food and having access to the foods that will be nourishing and feel good can make such a huge difference. I think for those who maybe don't live with that, it can be easy to make a judgment without understanding if you've never been in those shoes. What would you say, so kind of get into what is the impact of poor access to food for those who are living with digestive disorders or GI conditions? Like what does that impact really look like from what you've seen in your experience, as well as in the conversations that you had throughout this campaign?

Kate Scarlata: The impact is, you know, it's complicated. So there's a lot of layers, and that's why listening is always really important, right? So if you don't feel well, to your point, you're not going to function in society well. You’re not going to be the mother that you want to be, the father that you want to be, the worker that you want to be, the friend that you want to be because you're rolled over in pain. So, there's layers certainly, we see IBS is the second reason outside of colds that people call in sick to work or school, so it makes an impact if those symptoms are controlled, then you're gonna have more efficient work or a more efficient society, right?

I think there's a lot of layers that I uncovered. One of them was that in one of the lower income clinics that I attended, a vast majority of their clients did not read. And so if you don't read, then they were not educating them on modifying. How would you educate someone to modify FODMAPs if they can't read? Well, it took me 30 seconds, and I created a low literacy picture graph of foods to include and foods to minimize, very simple graphic, I'm happy to share it as one of the notes, but I did that for the clinic and they were able to use it to educate their patients that had low literacy. So low literacy may be mixed in this low socio economics that are mixed and food insecurity is a complicated mix, right?

The other thing that was interesting that I learned was this same group, this was in North Carolina, had gotten vouchers for the farmers market, and they were going to give their food insecure patients a voucher. And that sounds beautiful, right? Well, the individuals thought that a food farmers market was uppity, they didn't feel comfortable there. They didn't listen. So everyone has to be at the table when you're talking about what the needs are, particularly the people that are affected. You know, and I think sometimes we forget that, it gets too hierarchical and people are like, oh, we you know, the science, blah blah blah. No, the people that are living with this need to also be brought into the conversation. What can we do to help them feel better and what are they willing to do? Going to a farmers market sounded beautiful, but it was not a very accepted donation amongst their clients and patients. I think it's important to know who you're talking to, what their needs are, what they see their needs are, and then come up with solutions. You can educate someone on inexpensive groceries, but if they're working two jobs, and they have three kids, they want something quick and easy. They don't want the beans and rice that they have to cook, they want to whip into McDonald's because they have a one hour break between jobs. So there's a lot of layers to it and understanding how you can help someone just like, you know, helping someone with IBS. It's not one size fits all, you need to understand the demographics and desires of the people that you're hoping to help.

Erin Judge: Absolutely. And for those listening who are not struggling with food insecurity, who are able to kind of step up and help right advocate help. stand in the gap, if you will, so that those who are struggling aren't having to lift the weight of the work themselves, what are some of the ways that they can do that? Listening you mentioned is number one, and are there ways that you've learned through your advocacy that those who are listening might be able to do in their local community? Or is there a resource that you would recommend or anything someone could take action on right away?

Kate Scarlata: First and foremost, I do have on my website an #EndHungerPain link, which identified a lot of organizations that would benefit from financial help, so there's a starting point there. All of these organizations are working with special diet needs and there's ways to comment, so you make sure the money gets allocated towards that needs. I think it is important to ask food pantries in your community, what is the best way to help, because a lot of people think donations is the best way to help, but the reality is that food pantries have access to purchasing at very low cost from food banks, so their dollar goes a lot further than your dollar.

The other thing is, when the post office or other people do food banks, take a moment and think, am I donating the cans in the back of the closet that I know I'm never going to eat? You know, that's not eating or food dignity, per se. So thinking about could you donate something that might be a little bit more special, or might be more appropriate for someone with a gluten free needs, maybe get a gluten free product, and donate that. So, you know, with the intention that hopefully it gets in the right hands. You don't always know that depending on what the pantry does, if you know your local pantry, and you know, they may be doing those kinds of special diet needs. It varies, right?

You want to ask the questions, contact your local food pantries, what is it they need and what is the best way that you can help? Some people show up to volunteer one day, they don't really benefit from that. You benefit from that, because it feels good. So yeah, definitely ask because what you think might be like, oh, I went to the soup kitchen one day to help and then I disappeared for four years. It's a lovely gesture, but it might not be what's really going to be helpful.

I will tell you, and this is a plug for Food Rescue, but I love this organization, I have no financial beneficial, you know, reason to advocate for them, but what they do is they save the planet by saving food. So they rescue food that would normally be destroyed, which creates methane, which is not good for our planet. And so they'll go to Trader Joe's, pick up a collection of food and distribute it immediately. And they work off an app and they're located in several states, so you can just get on the app and if you have time, you can click and sale say pick up at Giant Supermarket and drop off at St. Joe's pantry. And if you have the time you can do it that day. If you don't have the time you pass it and you just you know, so it's no dedicated commitment. But it's a great organization, not so much for the food intolerance space, they're really just rescuing food and getting it in the hands. But you know, beautiful produce, beautiful food, really beautiful organization. So that's something you know, individuals could look into, it's a low lift at your own timetable.

Erin Judge: That's a great resource, and I can link all of that in the show notes as well, just so everyone has those resources to easily click on and move on from. For those listening that are struggling with access to food, because a lot of the people who are listening to this show are those who are living with digestive concerns, whether that be you know, celiac disease, IBD, IBS, undiagnosed issues that they've been struggling with, and if they're listening, and they're thinking, you know, well, that's me, I don't have access to foods, whether it be that they're out of work, or maybe even that they live in a food desert where there's not a grocery store or something close by that they can go to or, you know, there's a strain on their family to buy those special foods, if they're just feeling that way, what are some resources that they could seek out and maybe even some ways, let's say that their providers haven't done a good job screening and are making recommendations that aren't lining up with where they're at. What are some ways that they could potentially, you know, advocate for themselves in those spaces or just some resources that they would have to help them out?

Kate Scarlata: So you know, a lot of local churches have pantries associated with them. So in their local area, they may be reached out to some of the local churches or organized prayer groups. The other, through their health care provider, they should have access to a social worker and a social worker could really help them connect with the right resources that are in the community. There was a number of reaching out when I was in North Carolina with Atrium Health. You know, I identified a number of pantries and a number of organizations that were offering services for Atrium Health, and connected them, which was really interesting. And those providers just, you did mention screening, and I know, it's a simple two questions screen for food insecurity and it is within the past 12 months, we worried whether our food would run out before we got money to buy more or within the past 12 months, the food we bought just didn't last and we didn't have money to get more. That's it, those two simple questions. If you say yes to those, you are experiencing food insecurity.

I mean, I was food insecure in college, no question about it. I did not have the funds to provide a healthful diet to myself, I'm the youngest of nine kids, I was very lucky to be in a private college but I didn't have a food plan provided by my father, and I didn't enroll in it, and it was a struggle. So even people we know have experienced food insecurity. It's not like it's this small, little collection of people. During 2021 it was one in six people, it's actually gotten a little bit better, maybe one in eight right now. But a lot of people are struggling with getting healthy food, not necessarily hunger, they may be getting, you know, chips and cookies and crackers and filling up their bellies, but they're not nourishing themselves with adequate nutrients. So I would work with the social worker, and then some of the local, depending on their age, you know, if there's youth groups or organizations, usually the churches are the first sort of, or areas of worshipping, are the first sort of area to at least reach out and see what's in the local area, if they're not familiar with that.

Erin Judge: Great, that's a good resource. And then for the social worker, would that be something that they would just request like with the kind of office manager with their provider? What's a really easy way for them to get in touch with their social worker and ask in a way that maybe doesn't feel like there's a lot of attention on them? I know that that can be a hard thing to ask for, so is there a kind of a best way to do that?

Kate Scarlata: That's a great question. It would be through the primary care, their general practitioner should be the linchpin to a social worker. It could simply, you know, I'm not sure, that's a really good question, like, what the best way would be. I would just say, I'm concerned that my money is not accommodating for a healthy, nourishing, lifestyle, and that I may need help. That might be a hard ask, I know it is for a lot of people, or just to discuss nutritional needs and access might be just a simple I'm concerned about my nutritional needs and access to healthy food.

Erin Judge: That's a great thing. We do have The Gut Community, it's our Facebook group, where members of The Gut Show, those listening can connect and have conversations after the show, so if anyone has had a good experience with this, where you've been able to connect to a good resource or something that's been able to help you, feel free to go to The Gut Community and share that with others in that space too so that you guys can connect with one another center that that can be so valuable, because just like with, you know, IBS and digestive concerns, food insecurity is common like you mentioned, it's common, others are probably going through it as well and it helps to talk about it to not feel so alone in that.

Kate, is there anything else that you want to share about this work or about what you're hoping for the future? Just anything else that you want to share with our audience?

Kate Scarlata: Well just so we're all in this together, you know, and I think it's important that you know, every little bit helps, and it might be a small gesture. I don't want to discount a volunteer at a soup kitchen, you know, but what can you do to help? A very it's a very challenging time on a number of levels, you know, we have mental health issues are through the roof right now, alcoholism, drug use, suicide risk. There's a number of things going on right now just in our country and globally. And you know, just being kind to one another and patient, as a general rule, I think we can all benefit from that.

Working together, raising awareness about food insecurity so that it isn't stigmatized, because it's very, very common. And one other last bit was the National Celiac Association is helpful in meeting gluten free needs, so that’s at a national level for individuals that may benefit. We don't have a FODMAP National Association yet, but the National Celiac Association is helpful from a gluten free standpoint if that is a diet modification that you require.

Erin Judge: Awesome! Thank you so much, Kate, for all of your help and your work in this area! We look forward to seeing how that goes forward, and I really recommend that anyone listening follow Kate, connect with Kate as more comes out with the in hunger, pain and I believe in your story campaign, everything that's there for patient advocacy, whether you are someone with IBS or not, join in and get behind that because it's going to do a lot of good. So thank you so much, Kate.

Kate Scarlata: You're most welcome, thanks for having me Erin!