Online Health Chat with Julia Zumpano, RD, LD

October 16, 2017


In this web chat, learn about how to keep your gut healthy and active. Some symptoms of gut disorders include:

  • Gas
  • Bloating
  • Indigestion
  • Reflux
  • Constipation
  • Diarrhea
  • Weight gain
  • Abdominal obesity

About the Center for Human Nutrition
The Center for Human Nutrition provides evaluation, education and treatment to people who have disease-related nutrition problems. Additionally, the Center is involved with a multitude of programs to promote health and wellness. Both of these efforts are driven by a dedicated team of registered dietitians, dietetic technicians, nurses, pharmacists, physicians and surgeons who work together to provide comprehensive support for patients with specialized nutrition needs.

What is a Registered Dietitian?
A registered, licensed dietitian practices the science of medical nutrition therapy. Based on your nutritional status, condition, illness or injury, a dietitian will work with you to optimize your treatment and aid your recovery. Not all "nutritionists" have the same expertise or training. It is important to check their training and credentials.

All of the dietitians employed at Cleveland Clinic are registered with the Commission on Dietetic Registration, Academy of Nutrition and Dietetics and are licensed dietitians in the State of Ohio. Every dietitian at Cleveland Clinic has completed a four-year baccalaureate degree from an accredited college or university and a dietetic internship or comparable supervised experience. Several dietitians also have advanced degrees and/or specialty certifications.

About the Speaker

Julia Zumpano, RD, LD, has been a registered dietitian with Nutrition Therapy for the past 12 years. Her position involves mainly patient counseling for a cardio-protective diet, with a focus on reducing cholesterol, controlling hypertension and diabetes, and managing weight. Her approach is unique in the way that she focuses on strategies and behavior modification individualized to each patient’s lifestyle, needs and readiness to change. Her position also entails involvement in nutrition program development, research projects and studies, patient and employee education, and community outreach.

Let’s Chat About Gut Health

Probiotic Possibilities

zman949: Do you recommend taking prebiotics and probiotics on a daily basis, and if so, is one of them better to take over the other one?

Julia Zumpano,_RD, LD: Both are very helpful to keep the gut healthy.

JumpinJoe: Are there any specific strains of probiotics that are especially good at controlling C-Diff?

Julia Zumpano,_RD, LD: This site: is a good resource for information. I suggest you talk to your doctor about a specific probiotic, but I would suggest one with at least 10 billion live cultures.

Gail Ann: When taking a probiotic, are there any restrictions, i.e., with a meal, with other vitamins or medications, specific time of day, etc.? Should probiotics be kept refrigerated? Thank you for answering my questions.

Julia Zumpano,_RD, LD: Some probiotics do require refrigeration. I would read the label for instructions for use and storage. Probiotics differ in the strains they provide. The label will be your best indication on how to take them. These are not regulated. Consider discussing the use of a probiotic with a dietitian or health professional for specific recommendations.

Food and Supplies

earl359: What is your opinion on GMO foods and the effects they have on a person’s health? What foods do you think are the best ones to buy organic?

Julia Zumpano,_RD, LD: I would suggest avoiding GMO foods. Environmental Working Group is a resource that I use to find the best organic foods. The list changes yearly, so you should check back often.

jfkac: My husband's DEXA report indicated he needs supplemental calcium; however, he has been advised not to take calcium supplements because of his kidney stone issues (three types). As it is, his diet is very limited to low-oxalate food (greens, etc.) and low uric acid intake. He teases saying, "Just give me water," but I know he's frustrated diet-wise. Do you have any suggestions?

Julia Zumpano,_RD, LD: I would continue to avoid supplemental calcium, but increase dietary calcium, which has been shown to be helpful with kidney stones. Refer to this article for more information.

pilatesgirl: What do you think of the new enzymes for celiacs that help with digestion?

Julia Zumpano,_RD, LD: I am not sure which specific enzymes you are referring to, but you may find this article helpful:

cerim: As a weight lifter, I am always trying to get more protein in my diet. I really prefer to not take protein shakes. What foods do you recommend that are high in protein, not very expensive and will leave me feeling full?

Julia Zumpano,_RD, LD: Eggs, Egg whites, tofu, dried beans, nuts, cottage cheese, tuna and chicken breast (canned is less expensive) are some good sources of protein

Medicine Miseries

earl359: I am currently on metformin and have started having diarrhea. Are there any things I can do to help this problem?

Julia Zumpano,_RD, LD: Consider ingesting some soluble fiber or a fiber bulking agent to help bind your stools. Examples include psyllium husks, Metamucil, Benefiber, flaxseeds, chia seeds, bananas, apples, pears, oats and brown rice.

martdove8: My husband is post prostate surgery and currently on ELIGARD and bicalutamide. How can he lose his fat gut and weight?

Julia Zumpano,_RD, LD: I would advise he meet with a dietitian for a specific meal plan. He can begin with a low-sugar, high- to moderate-protein diet using lean meat/beans/nuts/seeds, whole grains, fresh fruits and vegetables (ideally organic or well washed/cleaned to limit risk for inflection).

Discussing Diet

earl359: For someone who has recently had a heart attack and only has 15 percent heart function, what are some dietary things he can do to help strengthen his heart?

Julia Zumpano,_RD, LD:: Choose minimally processed foods and limit salt intake. Consider a whole foods-based diet such as the Mediterranean diet.

martdove8: What is the best way to lower your LDL without medicine?

Julia Zumpano,_RD, LD: Follow a diet low in saturated fat and free of trans fat. Also, limit or avoid fatty meats, specifically red meat (beef, pork, veal, lamb); the skin of poultry; full-fat cheese or dairy; solid fats such as butter, stick margarine, shortening, lard, palm oil, coconut oil. Also avoid fried foods, fast foods, commercial baked goods, snack foods, which have more than 2g saturated fat, or any foods that have ANY trans fat or partially hydrogenated oil.

Xomue: I'm 77 years old, and I started having GI issues several years ago. The typical scenario is this: About 30 minutes after I eat a normal-size meal, I begin feeling discomfort, nausea, sometimes bloating and downright miserable. I never actually throw up. The misery lasts from 30 to 50 minutes, and then I'm back to normal. This doesn't happen at every meal, maybe four or five times a week. I've seen GI doctors and have had various tests (including for celiac: negative). I've tried to analyze my diet and what I ate. Nothing seems consistent. I know about FODMAP, but it didn't seem to apply to me when I tried the diet (although only briefly). Does this pattern of GI misery suggest any avenues that I could try or suggest to my doctor?

Julia Zumpano,_RD, LD: An elimination diet would provide the best assessment of which foods could be triggers to these symptoms. I would suggest you begin with a low FODMAP diet for a minimum of three weeks. Keep a food diary and add one food in your diet at a time to assess tolerance. Consider meeting with a dietitian for specific guidelines and a review of symptoms to help you determine dietary/environmental triggers.

jeffrey: What, in your opinion, is the most effective diet for losing weight and belly fat?

Julia Zumpano,_RD, LD: A whole foods based diet with minimally processed foods and very low added sugars of any form. Consider the Mediterranean diet.

jfkac: There is a lot of emphasis today on "gut" health being the cure-all for everything from allergies to anxiety to cancer. What do you recommend for the best gut health protocol? As a plus, if it's easy to follow, more of us would stick with it.

Julia Zumpano,_RD, LD: The easiest diet for "gut" health is to minimize processed foods and added sugars. Choose a whole foods based diet (fresh vegetables, fruit, grains, beans, nuts/seeds, fish, olive oil), such as the Mediterranean diet. Check here for more information.

Condition Combinations

pilatesgirl: I am celiac and very careful (as can be) with gluten. Do you often find that the other grains, such as rice, can be irritating in an allergic way as well? I think I ate a good amount of rice while growing up, not knowing I was celiac, and had a gut injury. Could that have lead to an allergy to that grain? Do you agree that most grains have some type of gluten protein, although not the same as wheat, rye and barley?

Julia Zumpano,_RD, LD: Grains can be inflammatory; therefore, for someone with celiac you want to avoid anything that could promote inflammation. There is also a risk of cross contamination of gluten-free grains such as rice and oats in foods. Care not to contaminate was not as strictly enforced several years ago. If you find that you are sensitive to gluten-free grains, I would limit them in portion size and increase dried beans and lean protein in your diet.

sbdav: I have pretty bad IBS-D. I take Robinul two times per day, but still need to take Imodium if I go out to eat to avoid uncontrollable diarrhea. I know the consequences if I eat dairy, spicy food and big salads. Do you know of any other treatment options, a low FODMAP diet, perhaps?

Julia Zumpano,_RD, LD:: I would highly suggest the low FODMAP diet, in addition to significantly reducing triggers: eating out, spicy foods, raw salad or roughage and dairy, which can promote diarrhea.

llong: What are the symptoms of candida, and what is the name of the test for it?

Julia Zumpano,_RD, LD:: Some people may not present any symptoms of high levels of "yeast," or candida. Your symptoms could include sugar cravings, GI distress and itchiness. Ask your doctor to order a blood test.

sarita: Hello. I have recently been diagnosed with atrophic gastritis and SIBO. My internet searches are overwhelming, i.e., there are many recommendations for diet and supplements to repair the lining of the stomach and intestine. I am currently on an antibiotic. I have also started using a probiotic, which has helped with the diarrhea. What do you recommend for ongoing care for gastritis and SIBO? Can the lining REALLY be repaired?

Julia Zumpano,_RD, LD: The lining can be improved and further damage can be prevented. Continue the probiotic and review this article for more information on gastritis.

llong: What is the name of the blood test for candida, and what is the dietary treatment?

Julia Zumpano,_RD, LD: The test is for IgG, IgA and IgM. A dietary treatment has not been proven, but some see reduction of symptoms from a low sugar, low carbohydrate diet. See a dietitian for specific recommendations.

rcoe: My mom suffers from GERD due to a hiatal hernia. She also has gastritis and esophagitus. Recently, I've noticed that her blood pressure drops dangerously low (e.g., 50/39) to the point of almost fainting within 15 minutes of eating. Do you think the cause of this might be gastrointestinal or some type of hormonal imbalance such as secondary adrenal insufficiency due to low levels of cortisol and/or adrenocorticotropin?

Julia Zumpano,_RD, LD: I would highly suggest she meet with a health care provider to further assess these concerns.

Access Inquiry

jfkac: We have met with a dietitian on two occasions, a couple of times for each of us. The waiting list for an appointment with a Cleveland Clinic dietitian is discouraging. We have not found it possible to follow our physician’s appointment recommendations in a timely matter. Do you know if this is being addressed on a long-term basis?

Julia Zumpano,_RD, LD: Thank you for your question. We agree this is an issue, and we are aware of this concern. We are working on providing additional time slots for patients to meet with a dietitian. I would consider calling 216.445.9353 to schedule to meet with a dietitian for the appointment times that are available.


That is all the time we have for questions today. Thank you, Miss Zumpano, for taking time to educate us about Gut Health.

On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online.

For Appointments

To make an appointment with Julia Zumpano, or any of the other specialists in Cleveland Clinic’s Department of Nutrition Therapy, please call 216.444-3046, toll-free at 800.223.2273 or visit us at for more information.

For More Information

Visit the Center for Human Nutrition’s website.

About Cleveland Clinic Digestive Disease & Surgery Institute
Welcome to the Cleveland Clinic Digestive Disease & Surgery Institute (DDSI). We offer patients the most advanced, safest and proven medical and surgical treatments primarily focused on disorders related to the gastrointestinal tract.

Of the top digestive disease centers in the United States, DDSI is the first of its kind to unite all specialists in gastroenterology and hepatology, bariatric surgery, colorectal surgery, hepato-pancreato-biliary and transplant surgery, and nutrition within one unique, fully integrated model of care – aimed at optimizing the patient experience.

This exciting model of care also helps us offer effective and patient-friendly service, including shorter waits for appointments and more seamless interaction with all of our specialists. In addition, our institute model enhances opportunities for cutting-edge research and physician education.

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