Savor Health

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.

Personal Favorites

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.

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Susan started Savor Health after losing a close friend to a brain tumor and, through that experience, becoming aware of the significant unmet nutritional needs of people with cancer.  Struck by the fact that her friend was told “nutrition doesn’t matter” and “eat whatever you want,” Susan read the evidence-based literature on the subject, interviewed oncologists, oncology nurses and oncology dietitians, as well as patients and caregivers, and found that, in fact, nutrition does matter in oncology. Armed with solid scientific evidence supporting the clinical and quality of life benefits of proper nutrition, Susan left Wall Street and created Savor Health, an AI-based provider of personalized and clinically appropriate nutrition solutions for cancer patients, their caregivers and health enterprises. Susan brings to Savor Health over 25 years of industry experience in healthcare and business as well as expertise in strategy, finance and management.

Susan is an outspoken and tireless advocate for cancer patients receiving proper nutrition and nutrition support before, during and after treatment. She strongly believes that the U. S. healthcare system requires new innovation to transform it into a more holistic and integrated system of care whereby multiple disciplines coordinate care together for the benefit of the whole patient. As part of this, her goal is for nutrition to be an integral component of such an integrated cancer care delivery system.  Susan’s commitment to the field of oncology extends beyond Savor Health to volunteer work at Memorial Sloan Kettering Cancer Center in pediatrics and as a runner for Fred’s Team to raise money for research at Memorial Sloan Kettering. Susan participated in the Cancer Moonshot in June of 2016 where she was a breakout session group “igniter” tasked with starting and leading discussion. Susan’s first book, the Meals to Heal Cancer Cookbook, was published in March 2016.

In addition to her role as CEO of Savor Health, Susan speaks nationally about the importance of ensuring proper nutrition in the cancer patient and on topics including leadership and startups. She has been a speaker at the Harvard Medical School’s Career Advancement and Leadership Skills for Women in Healthcare, ESMO World Congress on GI Cancer, BioPharm America, AARP Live @50+, Lake Nona Impact Forum, and IIR ePharma Summit.

Prior to starting Savor Health, Susan had a successful career on Wall Street as a healthcare services investment banker working at prestigious firms including Donaldson, Lufkin & Jenrette, Wasserstein Perella and Robertson Stephens. Susan earned a B.A. from Duke University and M.B.A. from the University of Virginia’s Darden Graduate School of Business.

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Marissa Buchan is a registered dietitian, with advanced practice certifications in Oncology Nutrition (CSO) and Clinical Research (CCRP). She received her Bachelor’s degree in Psychology from Duke University, and Master’s of Science degree in Clinical Nutrition from New York University. Marissa worked for 10 years at Memorial Sloan Kettering Cancer Center in both the clinical research and nutrition departments.  In addition to counseling patients before, during, and after cancer therapy, she spearheaded nutrition-research efforts for the bone marrow transplant service. She has co-authored over 20 articles and has a particular interest in the role of nutrition on the intestinal microbiota and its impact on patient outcomes. When Marissa’s not wearing her lab coat, she’s in her apron whipping up healthy and delicious recipes that you can find on her blog, Get Off Your Tush and Cook.

Marissa is Chief Operating Officer of Savor Health where she leads operations working with the technology, clinical, and business development teams and management. Prior to assuming the role of COO in March 2020, Marissa was Vice President, Clinical Research and Operations at Savor Health where she worked closely with Savor Health’s Chief Medical Advisor, Scientific Advisory Board, and Clinical Operations Team to evaluate, design and conduct clinical research.  She also counsels patients on oncology nutrition issues and contributes to the Company website’s clinical content.

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Dr. DeFrance has a unique background including clinical interventional cardiologist, chief medical officer, educator, outcomes researcher and entrepreneur. He has expertise in Lifestyle medicine in which he was board certified in 2020 and is highly interested in the prevention and reversal of chronic disease. Dr. DeFrance also has expertise in appropriate utilization of technology in medicine, healthcare economics, value-based metrics, and educational design and delivery. He worked as Chief Medical Officer for HealthHelp, one of the largest specialty benefit managers in the US, and led large teams of healthcare professionals in writing evidence based appropriate care guidelines and rule sets which improve the quality and safety of medicine for over 20 million people in the US while also creating sustained savings in healthcare. He has also designed clinical decision support systems that are currently in use helping to improve patient care.

In 2018 Dr. DeFrance founded MedMentor Education, a company that provides state of the art CME content using the latest in eLearning science and online delivery platforms. Dr. DeFrance is also the founder and President of Digimedica, a consulting and educational design and delivery company for healthcare professionals, hospitals, and universities. He is passionate about creating systems to optimize knowledge transfer and has won numerous awards for teaching excellence during his career. He is an expert in cardiovascular CT imaging and has taught more than 3,000 physicians how to perform and interpret cardiac CT nationally and internationally and has lectured extensively on this subject.

Dr. DeFrance has a stellar reputation in the medical field and continues work to improve the quality and safety of patient care in the US.

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Alyson is a registered nurse and is certified in oncology nursing (OCN) through the Oncology Nursing Society (ONS). She also has her certification as an ONS Biotherapy and Chemotherapy Provider. Alyson studied nursing at Thomas Jefferson University where she obtained her Bachelor’s of Science in Nursing (BSN). Since starting her nursing career in 2004, Alyson has had a strong dedication and commitment to oncology patients. She has worked inpatient specializing in Bone Marrow and Peripheral Blood Stem Cell Transplantation. Alyson currently works in outpatient oncology at the North Shore-LIJ Monter Cancer Center. Alyson is part of the clinical team at Savor Health where she counsels patients on oncology and oncology nutrition issues and contributes to website and other Savor Health content.

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Chelsey is a Registered Dietitian and Board Certified Specialist in Oncology nutrition (CSO). She completed her Dietetic Internship at Northwell Health, received her BS in Dietetics at the University of Wisconsin-Madison, and her MS in Nutrition at Stony Brook University’s School of Medicine. Chelsey works as an outpatient dietitian at Mount Sinai covering all of the downtown cancer services at Mount Sinai Beth Israel and Philips Ambulatory Care Center. Chelsey works with patients and families before, during and after treatment to optimize their nutrition through dietary counseling and support. Chelsey has experience counseling clients with a variety of diagnoses including breast cancer, lung cancer, prostate cancer, head & neck cancer, and more. Chelsey also enjoys sharing nutrition knowledge with her peers by running a monthly Employee Wellness program that showcases healthy topics, recipes and food demos.

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Michelle is a Registered Dietitian specializing in oncology. She works as a clinical dietitian at an ambulatory cancer center in New York City and is a consultant for Savor Health. She is passionate about educating oncology patients on the importance of nutrition during their fight against cancer and helping them to optimize their nutrition through all phases of treatment. Michelle received her Bachelor of Science degree in dietetics from the University of Wisconsin-Madison and her Master of Science degree in Clinical Nutrition from New York University.

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Denise Sievering is a Registered Dietitian who is board certified in Oncology Nutrition as well as Nutrition Support. A fluent Spanish speaker, Denise joined the Savor Health team to support Spanish speaking cancer patients and to continue to expand the Platform’s nutritional strategies and recommendations in Spanish. Denise holds a Bachelor of Science degree from Rutgers University, and completed her internship at New York Presbyterian Hospital (NYP). Denise started her career as a registered dietitian at NYP-Columbia University Medical Center, primarily covering inpatient Oncology units. Denise also holds a Master of Arts degree in Mental Health Counseling from New York University, and incorporates her advanced training in motivational interviewing and empathic listening in her patient encounters, particularly those whose lives have been forever changed by a cancer diagnosis. A New Jersey native, Denise now resides in sunny San Diego, CA where she works as a part-time outpatient Oncology dietitian at Scripps Health-MD Anderson Cancer Center, and also works as an inpatient dietitian at Kaiser Permanente. In her spare time, Denise can be found at a mom-and-pop taco shop, one of the many local craft breweries, and exploring her new city of San Diego with her husband and her rescue pup, Ripley.

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Karen is a Registered Dietitian, Board Certified Specialist in Oncology Nutrition and registered in New York as a Certified Dietitian Nutritionist. Fluent in Spanish, Karen joined the Savor Health team to support Spanish speaking cancer patients and to continue to expand the Platform’s nutritional strategies and recommendations in Spanish. Karen received her Bachelor of Science degree from Ithaca College and her Master of Science degree from Hunter College. She works as an outpatient oncology dietitian in New York. Karen often works with local community centers to host nutrition programs for cancer survivors and their families, leading classes on how to live healthier lifestyles throughout their continuum of care. The American Institute of Cancer Research selected to showcase one of her many programs at their conference in 2019. Karen has written for and lent commentary to various publications and truly enjoys teaching people how to eat better. She loves to cook and strongly feels that healthy food doesn’t have to taste bad.

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Allie is a Registered Dietitian and a Certified Specialist in Oncology (CSO). She joins Savor in 2023, bringing years of experience from the John Theurer Cancer Center in New Jersey, where she worked with patients with a variety of cancers. Her goal is to help people feel their best, both mentally and physically, when physical health challenges arise. She believes in the power of nutrition ever since the impact it made on her athletic career as a volleyball player during college. Allie graduated with her Bachelor of Science degree from University of Maryland-Baltimore County and has her Master’s degree in Human Nutrition from the University of Wisconsin Stout. She enjoys travelling, enjoying different cuisines, cooking, and hiking and other outdoor activities with her family and dog.

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Julia Penberg is a seasoned healthcare professional with more than 30 years of experience focusing on maximizing operational excellence, leading clinical program development and building strong cross-functional teams. Her previous roles include overseeing the performance of clinical managers and nurse practitioners across multiple markets within United Healthcare-Optum’s Medicare Advantage and dual-eligible special needs populations, payer outreach and program development at Mayo Clinic, ground level specialty hospital development and direct patient care as a family and dermatology nurse practitioner. Julia volunteered as an operating room nurse and nurse practitioner on several mission trips to Romania and was a support group leader for the Kansas City chapter of the International Myeloma Foundation. Her motivation throughout her career has been with wellness promotion, disease risk modification and ensuring the best patient experience across the health continuum. Ms. Penberg received an MBA from the University of Dallas; a MS in Nursing from the University of Kansas and a BS in Nursing from the University of Texas-Austin. She is board certified as a Family Nurse Practitioner.

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Rachel is a Registered Dietitian and Board Certified Specialist in Oncology Nutrition (“CSO”). She joined NYP-Columbia as the outpatient oncology dietitian in 2020 after working at Jamaica Hospital Medical Center for two years. Rachel completed her dietetic internship through Keene State College in 2017. She is pursuing an MS in Integrative Nutrition at Stony Brook University and has a BS in Human Nutrition, Foods and Exercise from Virginia Tech. Rachel provides nutrition counseling to all types of oncology patients and helps them understand the mental and physical benefits of nutrition as an ally in their fight against cancer. In her free time she enjoys slow meals with family and friends, Pilates, and tending to her fire escape garden.

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Allie Werner is a Registered Dietitian at Fresenius Kidney Care where she provides medical nutrition therapy diet counseling to patients on Dialysis. She received her Bachelor’s Degree in nutrition from Indiana University and completed her Master’s Degree and dietetic internship at Loyola University Chicago. In her free time she enjoys spending time with friends and family, checking out the amazing food scene in downtown Chicago, and exercising on her Peloton bike.

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Immersed in the tech world for a decade, I've coded, led teams, and honed my skills in architecture and design. As a tech enthusiast, I've seamlessly woven through full-stack projects, fusing my love for code with the art of leadership.

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Mohit is a full-stack developer with expertise in Python and JavaScript, known for his efficient coding and ability to deliver scalable software solutions. His technical contributions are highlighted on GitHub and Stack Overflow, demonstrating his commitment to the tech community and problem-solving skills. With a solid educational foundation and a diverse project portfolio, Mohit excels at navigating complex challenges and is well-equipped to contribute to dynamic software projects.

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Rayna McCann is a Registered Dietitian and Board Certified Specialist in Oncology Nutrition. She is a Registered Yoga Teacher and yoga4cancer certified. She received her BS in Nutrition at Penn State University and her MS from Stony Brook University. For work, Rayna wears many hats in the world of nutrition and worked for years in clinical settings focusing on oncology nutrition. She is also an Adjunct Professor and passionate about inspiring the future of dietitians. Throughout her career, she has received awards recognizing her dedication to patient safety and her contributions to improving malnutrition awareness. In 2022, Rayna was proud to accept the ‘Dietitian of the Year’ award through the Long Island Academy of Nutrition and Dietetics. Rayna has co-authored abstracts for poster presentations within the American Institute for Cancer Research conference, as well as, the Nutrition and Dietetics Food and Nutrition Conference Expo and subsequent publication. She has enjoyed authoring articles, including an article for The Cure magazine regarding Multiple Myeloma and nutrition. When Rayna is not participating in nutrition related activities, she is dedicated to dog rescue.

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