We at Savor Health are excited to introduce Tamara Duker Freuman, MS, RD, CDN in this guest blog post on digestive health and the gastrointestinal (GI) tract. Tamara is known as the Bloated Belly Whisperer, which is also the name of her new book. She answers our questions about a healthy digestive system, managing cancer treatment side effects, and her favorite belly-friendly foods!
Digestive Symptoms and a Healthy GI Tract
Question 1: Because everyone’s digestive system is so individualized, when starting to investigate triggers for IBS-like symptoms, do you recommend first and foremost keeping a food diary to track food and symptoms? Do you have specific apps you like to recommend to your clients?
Answer: I don’t generally make my patients keep a food diary before seeing me, as often I can make an educated guess based on a conversation about “typical days” and typical symptom patterns. However, keeping a food/symptom diary is not necessarily a bad idea for people who struggle with mystery digestive problems—though in my experience, it can be tricky for the average person to know how to interpret the data they collect in a meaningful way. If I do have people track, I’ll often given them a printed food/symptom tracker sheet. A few popular apps I’ve seen people use include “My Symptoms” and “My GI Health,” and there’s a new one called “Cara” that’s recently emerged, and they can help people remember important details to share when we meet. The most important attribute for any tracking device—paper or electronic—is the ability to capture the TIME of symptoms relative to the TIME of foods eaten. The data are somewhat meaningless without this essential detail!
Question 2: In addition to food, do you recommend a focus on stress-management and exercise with your clients as they are related to their symptoms?
Answer: It really depends to what extent a patient feels their symptoms are triggered by stress and helped by exercise. Some people with IBS know that stress is a major trigger for their symptoms, whereas others have chronic daily symptoms regardless of mood or stress levels. When people come to me as a dietitian, though, they are expecting diet recommendations first and foremost. I have to be careful not to emphasize stress management and exercise above and beyond diet, because sometimes when you do that, people can interpret that as being told that their symptoms are “all in their head” and can feel like they’re being dismissed. In my experience, even if someone is very triggered by stress, the right dietary pattern or supportive supplement/medication regimen can still promote symptom improvement even if the stress persists. When people do also want to address such non diet triggers, I will sometimes refer them for gut-directed hypnotherapy, an emerging practice area that’s showing good results for a subset of people with IBS.
Question 3: What are your thoughts on the Mediterranean diet and a plant-based eating pattern for digestive health and keeping the GI tract feeling comfortable?
Answer: There are versions of both of these eating patterns that can be modified to promote comfort digestively—either by keeping the texture softer (more cooked foods than raw) or reducing the load of “FODMAPs” (poorly digested carbohydrates that can give some people excess gas and bloating). It can be somewhat trickier for people on fully plant based diets to keep the GI tract feeling comfortable if they are very sensitive to FODMAPs, though, because many staples of vegan diets—from beans and lentils to cashews and cruciferous vegetables—can provoke excess gas and discomfort in predisposed people. (Though in some cases, enzyme supplements can help). Someone with chronic digestive issues may have more options on a lacto-ovo vegetarian diet or a flexitarian diet than a fully vegan one.
GI Symptoms and Cancer
Question 4: What recommendations do you have for bloating during and after cancer treatment?
Answer: It really would depend on what’s causing the bloating. Some bloating during/after cancer treatment may be caused by slow transit through the digestive system as a medication side effect. In other cases, bloating may be caused by malabsorption due to surgeries. The first thing I like to do in these cases is understand to what extent the bloating may be worsened by having a high stool burden (constipation) and/or excess gas in the GI tract. Getting on a good bowel regimen (laxatives and/or fiber), using Gas X and/or avoiding high FODMAP foods that contribute to excess intestinal gas often can help reduce the amount of ‘stuff’ in the digestive tract that can lead to feelings of bloating. In many cases, I might also suggest switching to softer-textured foods eaten in a small, frequent meal pattern to reduce the degree of distention that a meal introduces to the GI tract, and to facilitate faster passage out of the stomach (helpful if you’re having bloating from reflux) and faster assimilation of nutrients—which is helpful if you are prone to malabsorption following an intestinal surgery or radiation enteritis.
Question 5: Do you have one or two recommendations for a low FODMAP nutritious meal/snack that would be well-tolerated for those with difficulty swallowing from cancer treatments?
Answer: I’m a very big fan of smoothies for people with FODMAP restrictions and swallowing difficulties, because they can be fully customized to an individual’s taste preferences and tolerances.
- The base can be lactose-free kefir for people who enjoy dairy—or a non dairy alternative, like coconut or hemp milk. People who prefer to avoid thickeners and gums in plant based milks can even try the new oat milks that are naturally thick without added emuslifiers.
- Similarly, you can add low FODMAP fruits—like banana or frozen berries—and even low FODMAP veggies if you want—like spinach or carrots.
- People who want to use a protein powder can choose simple low FODMAP options without added sweeteners or fibers—like a plain Whey Protein Isolate (Bluebonnet is my brand of choice) or Rice Protein (I like Jarrow or Nutribiotic). Alternatively, you can add peanut butter or a peanut butter powder as a whole foods-based protein source that’s low FODMAP and very tasty.
Question 6: What is your favorite recipe featured in your book?
Answer: I have a few favorites. I probably make the low FODMAP pumpkin seed coconut granola the most often, because my husband has it for breakfast every day. I literally make a double batch every weekend. But the book features many of my family recipes adapted by a Bon Appetit food editor, and these also have a special place in my heart. The Butternut Squash Spoonbread is a recipe we make for many family holidays, and is definitely a favorite as well. I like to warm up leftover slices for breakfast and top them with a sunny side up egg and some melted cheese.
Question 7: Your favorite belly-friendly sweet treat?
Answer: It’s always changing, but lately I’ve been recommending the sorbettos from Talenti. The Cold Brew Coffee flavor is creamy and indulgently textured like an ice cream because it’s made with eggs, but since it’s totally dairy-free, it’s well tolerated by many of my patients who just don’t do well with milk or cream. For those who can’t do coffee or who are sensitive to fat, the Roman Raspberry would be a very delicious, fat-free fallback.