Online Health Chat with Julia Zumpano, RD, LD
July 30, 2014
Good digestive health habits are important to practice and can help with avoiding common discomforts such as stomach pain or stomach cramps, diarrhea and feeling bloated. Understanding allergies or intolerances to certain food groups, such as gluten, dairy or wheat, and making simple changes can help your digestive system to the job it was made to do.
Discover ways your diet can contribute to digestive system health and difficulties. Determine if you are getting the adequate amounts of fruits, vegetables and fiber your body requires for good digestive health. What about exercise? What about probiotics? How do all of these work toward optimum digestive health?
About the Speaker
Julia Zumpano, a registered dietitian with Preventive Cardiology and Rehabilitation and the Women’s Cardiovascular Center, focuses on patient counseling for a cardio-protective diet with an emphasis on cholesterol reduction, controlling hypertension and weight management. Her approach emphasizes strategies and behavior modifications individualized to each patient’s lifestyle, needs and readiness to change. She is also involved in nutrition program development, research projects and studies, patient and employee education, and community outreach.
Completing her undergraduate degree at the University of Akron and her Dietetic Internship here at the Cleveland Clinic with Nutrition Therapy, Julia was involved in a variety of clubs and organizations throughout her academic endeavors including the Cleveland and Ohio Dietetic Associations. She is also a certified fitness instructor.
Let’s Chat About Optimum Digestive Health
Moderator: Welcome to our Online Health Chat with Cleveland Clinic nutritionist Julia Zumpano, RD, LD. We are thrilled to have you here to learn more about mindful eating. Let's get started with our questions...
General Digestive Health
acho7: Could you please discuss the effects of stress on the digestive system and what non-drug options can help?
Julia_Zumpano,_RD,_LD: Like your brain, your gut is highly sensitive and full of nerves. This is referred to as the ‘gut-brain connection.’ When stress is a factor, it can cause physical digestive symptoms such as butterflies, stomachaches or even diarrhea. Even small daily stressors can affect the gut.
The best advice is the non-drug option – reduce stress! Try exercise, meditation, deep breathing or any type of stress management technique.
trundanely: I have been diagnosed with GERD. I am presently taking 20 mg of omeprazole. I was taking it along with ranitidine 150 mg, which did not work. I am trying to not have the rest of my life under the control of medication manufacturers and doctors, and I am not sure if my problem is too much acid on my stomach or too little. Do you have a different approach, other than the doctor line-up, to control this kind of problem?
Julia_Zumpano,_RD,_LD: Have you attempted to change your diet to avoid foods that have been associated with GERD: foods such as caffeine, chocolate, spicy foods, fried or fatty foods, tomatoes and tomato products, citrus (lemon, lime, orange and grapefruit), carbonated beverages and alcohol? Eat small, frequent meals; drink plenty of fluids; exercise; and avoid eating at least two to three hours before bed or lying down.
trundanely: Thanks for your response. Of all the things you mention for me to avoid, the only thing I have continued to eat is dark chocolate. Other than that, I do not eat fried foods, fast foods or tomatoes. I do eat small portions of food three or four times daily, eat three hours before bed and exercise. I avoid spicy foods and alcohol, and I drink plenty of water. I still experience a burning sensation, bloating, burping and general digestive discomfort. I did have a colonoscopy, an endoscopy and a CT scan of my abdomen, and all they found is GERD and mild gastritis. I am lost. I have followed all the advice given by professionals and nothing. What else can I do?
Julia_Zumpano,_RD,_LD: I would recommend as the next step to meet with a dietitian so that your specific medical history, diet and symptoms can be thoroughly reviewed and a plan can be advised specific to you.
loveitaly: My daughter is 32 years old and she has developmental disabilities and several medical conditions, severe GERD being one of them. This began 20 years ago due to specific anti-seizure medications. The variety of foods she can eat is very limited (no berries, no citrus, many vegetables have to be avoided because of bloating, cramps, etc.). She takes Prevacid® twice a day and has to be seated at least two hours after every meal. Should she take probiotics on a daily basis? Because of GERD, her stomach is smaller, and the amount of food she eats is not enough for her age. She is petite and is healthy; her illnesses are due to her condition. We visited a registered dietitian to help her gain some weight. It didn't go well. She couldn't tolerate olive oil, snacks during the day and extra amounts of food, as the dietitian suggested. We kept doing some of the things the dietitian recommended, but others we couldn't. Is there something specific she could do to gain weight? (She takes BOOST Plus®, Ensure®, etc.)? Thanks for your time.
Julia_Zumpano,_RD,_LD: I think attempting a nutrition supplement of calories and protein in liquid form would be a good place to begin. Start slowly, with 1/2 can or serving at a time to assess tolerance and then increase to offer several times per day. Encourage her to sip on the beverage throughout the day as opposed to drinking it all at once. Choose a product with the most calories and protein to help better meet her needs.
songcanary: My stomach has been the bane of my existence since childhood; my symptoms being mainly nausea and cramping. I had a very stressful childhood, I get it. At age 59, I have finally found some relief with a probiotic containing 10 mg of bifidobacterium infantis. It seems to curtail the gas and urgency, but I have also been trying to lower my stress level through yoga and other means at the same time. My question is: can stomach sensitivity be inherited, and if so, what are the best means to address it? I would love to live the rest of my life without stomach problems. Thank you so much.
Julia_Zumpano,_RD,_LD: It is difficult to say if these issues are inherited without knowing your family history. There is a chance that your stomach sensitivity is inherited, but you should speak to a gastroenterologist or your PCP regarding this question. The best means to address the problem would be to continue to follow a healthy lifestyle - high fiber diet, plenty of fluids (64+ fl. oz.), regular exercise and if the probiotic is helpful, continue.
leese: I've had thrush off and on for a year and I can't get rid of it. I've been on antibiotics five times for UTI's this past year. I've been prescribed Nystatin suspension each time and it never really takes it away. I've changed my diet also, no sugar/no carbs. What should I do?
Julia_Zumpano,_RD,_LD: It is important to continue with no added sugar or desserts/sweets. Strive for sugar-free beverages (stevia sweetened) or water, complex carbs in small to moderate portions - quinoa, brown rice, beans, legumes - no more than 1/2 cup at a time.
tcglas: My mother died from pancreatic cancer at age 63. I am in my mid 40s and a female. What preventive measures do I need to take to assure good digestive health to avoid a similar cancer?
Julia_Zumpano,_RD,_LD: Here are some suggestion:
1) Eat a high fiber diet - fruits, vegetables, whole grains.
2) Minimize processed foods.
3) Maintain a normal body weight.
4) Get regular exercise.
5) Have regular bowel movements and get a GI screening.
tcglas: I have read a lot about how bad corn is for your digestive track. I love eating corn in the summer. Can you comment on the issues with corn and say more about foods that negatively impact digestive health?
Julia_Zumpano,_RD,_LD: I am not familiar with the negative effects of fresh or frozen corn. Do avoid corn-based products made with GMO - genetically modified organisms.
chickbull: Is dark chocolate beneficial or not for digestion?
Julia_Zumpano,_RD,_LD: No, dark chocolate is not considered beneficial for digestion but is considered to be heart healthy.
Fiber, Constipation & Gas
Alberta: Hello. I am a 69-year-old female and have been dealing with occasional constipation accompanied by gas since the age of 16. I have no bowel movements for several days at a time and then they are often hard and small. Use of herbal medication only causes constipation yet again after working for a couple of days. I eat an organic diet with lots of fiber, fresh vegetables, fruit and water. I consume a maximum of 2 cups of coffee or tea daily. I exercise by walking and sleep well. I would, of course, like to have regular bowel movements but am at my wit's end as to how to achieve this normal function.
Julia_Zumpano,_RD,_LD: I would suggest keeping track of your fiber intake. Shoot for a minimum of 25 to 35 grams per day. Double your fluids with fiber with and after a meal to better soften and activate the soluble fiber to form a gum or jell. Consider a fiber supplement or bulking agent - natural sources include ground or milled flaxseeds or chia seeds, wheat germ, prunes or prune juice, or over the counter aids such as Metamucil® or FiberCon®. If none of these things works, consider a stool softener or laxative at least one to two times per week to get your bowels moving.
MaxKey: As I am aging, I have developed difficulties with certain specific foods, such as onions, celery and broccoli. It's more than just flatulence. It's actually painful during the digestive process that lasts for hours. I've had Type 1 diabetes for 35 years, and I had my thyroid irradiated in 2001.This problem limits me severely on food choices. Any advice?
Julia_Zumpano,_RD,_LD: You should consider limiting portions first to see if symptoms improve. Start with small (1/4 cup) servings, as these specific foods you mentioned commonly cause flatulence.
kimwar: What is a good fiber vitamin or supplement to take?
Julia_Zumpano,_RD,_LD: There is natural fiber – wheat germ ground flaxseeds, chia seeds, hempseeds – or over-the-counter products such as Metamucil, FiberCon, Benefiber®, etc.
Grannyscott: I am an 85-year-old senior who has great difficulty with gas, which I used to think came from the high-fiber cereal I eat. But lately, I have just as much trouble if I do not eat that cereal, and then, occasionally, after having it on a day when I do not have to go out, I do not have the gas problem. The only time of day I have it is late morning, but it is an embarrassing problem when I have to be out somewhere.
Julia_Zumpano,_RD,_LD: It may or may not be related to the high-fiber cereal exclusively. You should avoid high fiber foods or cruciferous vegetables such as cabbage, onion, broccoli, cauliflower, brussels sprouts and dark leafy greens before leaving the home, as they also produce gas.
chickbull: I have a smoothie every morning, mostly fruit, almond milk or coconut water, or water. I add a tablespoon of either chia or flaxseed, also greens. Would you suggest anything else that might help constipation? I am 80.
Julia_Zumpano,_RD,_LD: You should double your amount of greens, and try adding 2 T of chia/flaxseed in your smoothie. Make sure you drink at least 16-24 fl. oz. of water during and after your smoothie to see if that helps with your constipation.
chickbull: Does coconut oil have any benefit for relieving constipation?
Julia_Zumpano,_RD,_LD: Not particularly. Coconut oil is high in saturated fat and total fat; therefore, caution with intake is recommended. Coconut oil could increase blood cholesterol levels if taken in high amounts. I would consider castor oil for constipation.
meleliko: I began a restrictive diet for weight loss and would like guidance on how to ensure regular elimination with a minimum of food intake. Much of the food intake is in liquid or shake form with a minimum of solid food consumed.
Julia_Zumpano,_RD,_LD: If your food amount is minimal, stools will be small and possibly less frequent. To promote bowel movement, seek a high-fiber diet, increase fluids and exercise.
Yolandalmeyda: I have had a colostomy since Feb 2014, and I am little confused about the use of probiotics and fiber. I understand that yogurt has probiotics and there are pills I can take as well. Should I do both? Is it possible to do too much of it? What is the amount of probiotics recommended daily? What about fiber? I eat oatmeal daily but should I take a fiber supplement? What is the amount of fiber recommended daily?
Julia_Zumpano,_RD,_LD: Daily fiber recommendations are 25 to 35 g of fiber. Try ground or milled flaxseed or chia seeds in your oatmeal; eat more dark, leafy greens; and double your fluid intake. Probiotics differ according to strain, and different ones are specific to different conditions. Because it is so individualized, you should discuss this with your physician.
Simplicity: Do you prescribe probiotics for any particular GI problem or for all of them on a "maybe they will work" basis?
Julia_Zumpano,_RD,_LD: There is a lack of evidence to conclude whether probiotics are helpful for certain conditions. Supplements are not regulated by the FDA; therefore, it is questionable whether a product is truly providing what is claimed. There are also several strains and some can be more helpful than others based on the reason for taking them - constipation, diarrhea, etc. Talk to your doctor and thoroughly review a product before taking it. Check consumerlab.com for testing and additional information.
percussion: I am a female, age 70. Until three years ago, my elimination pattern was once or twice daily. I had a sudden onset of constipation. Since that time, I have been dealing with bouts of constipation and severe pain. All medical tests have shown nothing except for a 'tortuous' colon, which I understand to be extra colon. How does this condition affect bowel movements, if at all? I understand as we age our good 'bugs' diminish. What is the proper amount of probiotics to take?
Julia_Zumpano,_RD,_LD: There is no’ recommended dosage’ for probiotics because each strain is different for different conditions. I would refer you to an excellent website that discusses dosing by the California Dietary Research Foundation.
Mugs1932: In allergy testing it showed high candida. I have had bloating, gas and general digestive problems, IBS and aching joints, even though I eat a very healthy diet. I discovered probiotics through Whole Body Research, which makes Keybiotics, $90 per 30 day supply! It has really helped with bloating. I still have some gas, but it is definitely helping the IBS, and no aches or pains! I no longer crave sweets, don't use raw sugar or white flours and watch my intake of carbohydrates each day. My cholesterol and BP are excellent. My questions are: are probiotics helping to control the candida in my digestive system, and was the high level of candida causing my digestive problems? Can you recommend a lower priced probiotic that would work as well?
Julia_Zumpano,_RD,_LD: Yes, probiotics help control Candida and help increase healthy bacteria in your gut. I would suggest you continue with the probiotic that you have found to work. Unfortunately, it is very difficult to find a blend of healthy bacteria that would provide what you lack or need more of. Continue for now until you can properly heal the gut. Once your candida level is normalized, you can switch to a lower cost probiotic. I would suggest consumerlab.com for website reviews and tests, supplements and suggestions based on testing.
eatveggies: Do the active bacterial cultures in frozen yogurt survive the freezing? Does the high sugar content in refrigerated yogurts containing fruit affect the benefits of the active bacterial cultures in those products?
Julia_Zumpano,_RD,_LD: There is much less bacteria in frozen yogurt when compared to regular yogurt. Sugar does not necessarily affect the benefits of the cultures, but certain forms of sugar such as sugar alcohols, fructose and some artificial sweeteners have been shown to cause some stomach distress.
tcglas: There are many probiotics on the market. What are the essential things to look at to differentiate better probiotics?
Julia_Zumpano,_RD,_LD: Different probiotics provide different bacteria, which are in turn specific to different conditions. It is important to discuss the use of a specific probiotic with your physician. One size does not fit all. Some differences include:
- Dosage or potency (the number of viable bacteria per dose)
- Strain – Different strains are specific to different conditions.
Check consumerlab.com for accuracy and testing to ensure that a product is safe.
heather R: I'm a 77-year-old female with Afib and take 400 mg magnesium oxide two times daily. I'm trying to get added fiber from fruits etc., but too much causes loose stools. How much fiber should I get per day in addition to magnesium? What other probiotics should I take? My parents died from colon cancer. Thanks.
Julia_Zumpano,_RD,_LD: Again, when talking about probiotics, one size does not fit all. Certain strains are more specific for certain conditions. Are the loose stools a cause of the magnesium dosage or the increased fiber? I would consult your doctor to see if the dosage of magnesium can be decreased in order to be able to handle a high fiber diet. The daily fiber goal is 25 g fiber per day.
janiceasad: How do you know which probiotics are the best to purchase? I get mine from BioTech. Cleveland Clinic sells their D3 in the pharmacy. However, I don’t know if it is the best one to buy.
Moderator: Here is a link to a website with an article reviewed by Cleveland Clinic.
Gluten & Your Gut
charyvon: Can gluten symptoms come and go? Is there a way to determine if you are gluten sensitive without totally eliminating gluten from my diet?
Julia_Zumpano,_RD,_LD: Gluten is a protein found in grains, and it is always present in grains-containing foods. The best way to determine intolerance is to eliminate certain foods for a period of time (two to four weeks) and see if symptoms improve.
charyvon: Is there a way to determine if you're gluten sensitive without totally eliminating gluten from my diet?
Julia_Zumpano,_RD,_LD: The most effective way to determine if you’re gluten sensitive is to completely eliminate gluten products from your diet for a period of time, two to four weeks.
Yolandalmeyda: Can you please give samples of protein found in grains-containing foods - gluten food?
Julia_Zumpano,_RD,_LD: Some examples are quinoa, brown rice, wheat berries, farro, oats, barley, bulgur and whole wheat couscous.
Rus7590: The protein found in grain list--are these gluten foods? I thought quinoa and rice did not contain gluten.
Julia_Zumpano,_RD,_LD: Some grains are gluten containing such as barley, wheat berries and couscous while some are not. Non-gluten grains to consider are gluten-free oats, quinoa, brown rice, buckwheat and millet.
Moderator: I'm sorry to say that our time with nutritionist Julia Zumpano, RD, LD, is now over. Thank you again, Julia, for taking the time to answer questions today.
Julia _Zumpano, RD,_LD: Thank you for joining me today and for your thoughtful questions. I wish you all the best in your journey as you practice becoming more mindful eaters!
To make an appointment with Julia Zumpano, RD, LD, or any of the other specialists in our Cleveland Clinic Center for Human Nutrition, please call 216.444.3046 or toll-free at 800.223.2273, ext. 43046, or visit us online at www.clevelandclinic.org/nutrition.
For More Information
On Digestive Health
There are a number of health resources that may help to clarify some common questions. You may also visit clevelandclinic.org/health.
On Cleveland Clinic
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.
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