The Digest

I was fortunate to sit down with Laura Manning, Clinical Nutrition Manager at Mount Sinai and nationally recognized expert in gastrointestinal nutrition, for her take on the Low FODMAP diet—its utility, patient selection, and practical implementation. This conversation is especially useful for providers supporting patients with GI disorders. Dr. Saba Khan: Laura, thank you so much for joining me and sharing your deep clinical insights. Let’s jump right in. Starting from the beginning… What clinical indicators guide your decision to initiate a FODMAP elimination diet, and how do you determine which foods to remove? Laura Manning, RDN: In my practice, patients are typically referred by a gastroenterologist, often with a recommendation to consider a Low FODMAP diet to manage persistent GI symptoms. My first step is a comprehensive nutritional assessment. I screen for red flags such as risk for malnutrition, a history of disordered eating, or food insecurity. If any of these are present, I might pivot to a “FODMAP Gentle” approach rather than a full elimination. It’s all about tailoring the strategy to the individual’s needs and safety. Dr. Saba: I love that you bring a risk management lens to this work. That first step—ensuring a patient is nutritionally and psychologically ready—is critical. How do you balance symptom relief with nutritional adequacy during the elimination phase? Laura: My goal is always to preserve dietary diversity. I ensure that each meal includes a balance of protein, complex carbs, fruits, vegetables, fiber, and healthy fats. I spend time learning about the patient’s food preferences so I can make culturally and personally relevant suggestions—all within Low FODMAP guidelines. That way, the diet feels familiar and achievable, not punitive or restrictive. Dr. Saba: That’s such a thoughtful approach—meeting nutritional needs while personalizing for success. What is your approach to reintroduction, and how do you track patient response to specific foods? Laura: I follow the Monash University protocol closely. We reintroduce one FODMAP group at a time, starting with the patient’s choice. Over three days, they consume increasing amounts of a challenge food, watching for symptoms. If they tolerate it well, we move on after a brief break. If symptoms flare, we stop, remove the food, and resume the baseline diet until they stabilize—then we pick up the process again. I ask patients to keep a detailed log so we can review together and adjust as needed. Dr. Saba: So it’s very much a partnership. I love how actively patients are involved in the process. How do you support adherence, especially in cases involving food insecurity, cultural food preferences, or disordered eating? Laura: If there’s a history of an eating disorder, I won’t recommend a Low FODMAP diet. Full stop. For food insecurity, I try to work within what’s available—guiding patients on what they can get with EBT/SNAP benefits. Sometimes I’ll do a “reverse FODMAP” approach—rather than changing everything, we look at their existing meals and identify one or two high-FODMAP ingredients we can swap or remove. This also applies when working within cultural traditions—I find ways to modify dishes rather than eliminate them. I often recommend resources like Epicured or point them toward culturally relevant Low FODMAP recipes. Dr. Saba: Thank you for the Epicured shoutout! And yes—acknowledging cultural preferences is essential for long-term success and buy-in. What metrics do you use to evaluate success—clinical outcomes, symptom improvement, patient-reported quality of life? Laura: In the elimination phase, I look for a 75–80% improvement in symptoms as a marker that we’re on the right track. Once we achieve that, we start reintroduction. This part can take time—people may have travel plans, get sick, or hit life interruptions, so we move at their pace. Success, to me, means personalization: the patient understands their triggers, can manage their diet independently, and is symptom-free or much improved. I also do a 6-month follow-up to ensure they’re still eating a balanced diet, and we may re-challenge foods as needed. Dr. Saba: That’s a great reminder—real success means patients feel empowered to manage their diets sustainably and return to living their lives fully. Thank you, Laura, for sharing your deep expertise and real-world strategies for Low FODMAP implementation. This kind of physician-to-RDN collaboration is critical to delivering truly personalized, evidence-based care.

At Epicured, we believe food is more than fuel—it’s care, connection, and medicine. In this special feature, Dr. Saba Khan, our Chief Medical Advisor, sat down with our internationally acclaimed Chief Culinary Officer, Chef Dani Chavez-Bello—known for his global culinary accolades and deeply rooted commitment to using food as a vehicle for health. Their exchange reveals what’s possible when a doctor and a chef talk not just about nutrients or recipes—but about values, vision, and the future of healing through food. 1. Opening & Origins DR. SABA: You’ve earned global recognition for your culinary artistry, but not as many know how deeply your work is grounded in the principles of Food Is Medicine. Can you tell us about the moment you realized that food could be more than delicious—it could be therapeutic?” CHEF DANI: Being a chef and working on four different continents gives you a global perspective about cultures and ingredients. Working closely with nutritionists and doctors makes you understand the human body—and that it can heal itself, but it needs the right food and nutrition to do it. It’s about balance as well.” 2. Philosophy & Ethos DR. SABA: How has your understanding of food evolved over the years—from award-winning Michelin-star kitchens to now integrating wellness and nourishment into your menus? CHEF DANI: In some ways, I think it was always there. I come from a family of professionals who deeply understand food, and I’ve had the privilege of having doctors and scientists as relatives. That kept me curious about the quality of ingredients. Natural, unprocessed ingredients taste better. Mother Nature designed them that way—and human intervention in food production should respect that. Working in many kitchens and labs reaffirmed my belief. Also, coming from fine dining, you see how limited access is to great food. That drove a desire to make excellent, nourishing food available to a broader audience. 3. Translating Nutrition into Experience DR. SABA: Dietitians are trained to talk about nutrients and guidelines. Doctors like me might try to learn some of this, but it’s not central to our training. Even when dietitians try to bring guidelines to the plate, they face limitations. What’s your process for transforming dietary restrictions into joyful meals—experiences, really? CHEF DANI: A real chef must deeply understand the ingredients. When grown the right way, they taste great and have excellent texture. We must also cook them properly to preserve their nutritional density—without adding too many other ingredients. Understanding the bioavailability of ingredients helps activate the body’s healing process. It’s about preserving what nature already perfected. 4. Cultural and Emotional Dimensions DR. SABA: You’ve cooked in so many countries and cultures—how do tradition, memory, and emotion play into your philosophy of healing through food? CHEF DANI: My memory is like a sketchbook full of aromas. Olfaction is key for me—I associate memories, places, and experiences with smells. That process generates emotions. I sketch my recipes so others can understand them, regardless of language. Food plays a huge role across diplomacy, business, mediation—we often make decisions over a meal. Yet food hasn’t historically been part of global education or healthcare. But now we know its healing power, and we can learn so much by observing how different cultures use food. 5. Collaborating with Clinicians DR. SABA: What’s been your experience working with medical professionals, dietitians, or health systems? How do you see chefs and clinicians co-creating solutions in this space? Obviously, Dani, we have a lot to do together—let’s go! CHEF DANI: My first reaction is how complementary different disciplines are. I’ve studied food science, but as a chef, I’m a practitioner—I touch food every day and make it beautiful. Why should a nutritionist only talk about carrots? Let’s turn that carrot into something better with heat, humidity, and good fat. Then it’s healthy and delicious. If a doctor says, ‘You need vitamin B,’ and the nutritionist says, ‘Eat a carrot,’ I say, ‘Let me make you a carrot purée you’ll love.’ We all learn from each other. Food is medicine, and this collaboration is a win-win. You can even go further and explore how food increases the bioavailability of certain drugs. It’s powerful. 6. Barriers & Opportunities DR. SABA: What do you think still gets in the way of making healing food the only choice—whether in restaurants, hospitals, schools, or family homes? CHEF DANI: Education and economics. We need better food education as a society. We must understand the difference between whole ingredients and ultra-processed ones. The food industry has been driven by economics, and we’re hurting ourselves because of it. The amount of chemicals allowed in food in America is staggering. Compare that to Europe—there are only a few banned substances here, versus over 1,200 there. The GI tract is the most exposed internal organ—we eat and drink several times a day. That’s a huge exposure risk. We must take care of that. 7. The Future of Food Is Medicine DR. SABA: If you could design the future of food in healthcare, what would it look like? What do we need more of—and what should we leave behind? CHEF DANI: We need to reduce unnecessary drug prescriptions and prioritize feeding our microbes—they’re essential to the body’s healing capacity. We also need to shift our priorities. I don’t understand how food is such a low priority in collective decision-making. Educating ourselves on the connection between food and health is key. Final Thoughts DR. SABA: This has been so energizing. I’ve learned a lot just from hearing how you think about flavor, care, and connection. Any final words as we try to create and curate this brave new world and build ‘Food Is Medicine’ as the only way we eat, live, and heal? CHEF DANI: Education. Collaboration. Multidisciplinary teams. Real food! This conversation is just the beginning. At Epicured, through Partners in Health, we’ll continue to spotlight bold thinkers and doers like Chef Dani—those who bring excellence, empathy, and innovation to the table. Stay with us as we build the future of healing—one dish at a time. Eat well. Be well. Live well.