The Bloated Belly Whisperer
Do you or does someone you know have “tummy issues”? Have you gone to doctor after doctor and no one has been able to solve the issue?
You’re in the right place! We are fortunate to have a special treat today – Registered Dietitian Tamara Duker Freuman has some insights for us on this topic.
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This information is really interesting and I know it will help a lot of us who have belly issues and have not been successful in figuring out how to solve them.
Her expertise has earned her the nickname of “The Bloated Belly Whisperer” by grateful patients and now she has written a book to show people how to fix the problems of bloating, gas, stomachaches, sensitive stomach, gluten sensitivity and so much more — THE BLOATED BELLY WHISPERER: See Results Within a Week and Tame Digestive Distress Once and For All (St. Martin’s Press: Dec 24, 2018)
Bloating is the #1 complaint that patients bring to her.
As a dietitian in a clinical practice alongside a leading gastroenterologist, Tamara has developed expertise in helping identify the many possible causes of gas, bloating, diarrhea and constipation – with a science-based evaluation. She helps patients achieve symptom control and improved quality of life. After years of treating gastro issues, Tamara has come to be known to her patients as “The Bloated Belly Whisperer.”
In her book, you can take the “Bloated Belly” *diagnostic quiz*.
Your score will then direct you to a corresponding chapter in the book that can provide the most promising leads as to the medical cause of your bloating or stomach distress.
*The quiz can:*
– Help identify the most likely cause of the bloating that plagues you
– Equip you with the right descriptive terminology and questions to take to your next doctor’s visit to help speed up a proper diagnosis.
– Teach you the most effective dietary remedies for your particular brand of bloating so you can get that bloated belly under control for good.
– Inspire you with 50 belly-friendly recipes.
– Review dietary supplements commonly used for digestive health, with a science-based evaluation of their effectiveness and safety.
Please touch on the various causes of gas/bloating?
Bloating can be caused by problems in the stomach and/or the intestines, and it’s not always associated with gas. When bloating is caused by gas, it can be gas in the stomach due to swallowed air or chemical reactions between stomach acid (often from an over-hungry stomach) and the food. If the gas is in the intestine, it may be caused by bacterial fermentation of certain sugars, fiber or other carbohydrates in the diet– ingredients collectively known by the acronym “FODMAPs”. It can also be caused by a very high burden of stool, as in the case of constipation. There are other more ‘mechanical’ causes of bloating in both the stomach and the gut– these result from dysfunction of the nerves and muscles in the digestive tract, pelvic floor and/or abdominal wall– and these are not necessarily associated with gas.
What about for diarrhea?
This is not really a question I can answer by email. I could literally write an entire book about the various causes of diarrhea– there must be dozens of them.
Among the more common ones I see are dietary– possibly as a result of an imbalance of the types of fiber in the diet (too much “insoluble fiber” or roughage that speeds up digestive transit time for some people and not enough ‘soluble fiber’ that slows it down); malabsorption of certain sugars, like lactose, fructose, sucrose (breath tests are available to see if this is someone’s problem) or high intake of sugar alcohols from low carb/low sugar processed foods (sorbitol, erythritol, mannitol, xylitol, etc); malabsorption of fat due to various medical causes; too-high doses of magnesium or Vitamin C or side effects of other meds. But diarrhea can have many non-dietary causes as well– it can be infectious (parasites, bacterial/viral); inflammatory (Crohn’s disease and colitis)… and have many, many, many, many other causes, too.
And for constipation?
Constipation, like diarrhea, can also have too many causes to list. At the most basic level, not eating enough fiber or having an abnormally slow-moving colon can contribute. When waste sits around too long in the colon, it gets very dried out and hard to pass. Sometimes the fiber balance in one’s diet can exacerbate this– again, if its heavily skewed to insoluble fiber (which doesn’t hold onto water) and not toward enough soluble fiber (which can hold onto moisture). An under-recognized cause is pelvic floor dysfunction (PFD) and I talk about this a lot in my book– if the nerves/muscles involved in defecation aren’t working properly, then people struggle to move their bowels completely and regularly even with adequate fiber and normal colon motility rates. But there are many other causes, too. A whole host of commonly-used medications can cause constipation (opioid painkillers are a common one), as can a variety of medical conditions (from hypothyroidism to colon cancer and many in between.) New onset constipation that does not correspond to a change in diet should generally warrant a trip to your doctor.
How did you discover these?
I’ve worked in a gastroenterology office for almost a decade. I pretty much see a constant march of gas, bloating, diarrhea and constipation all day, every day. You start to pick up on the patterns after a while.
How long did it take you and how was your research done (personal patients, a clinical study/trial, or research based on journal submissions, or other ways)?
My expertise was developed mainly from working with patients, often in close consultation with a few exceptional gastroenterologists, which helped me understand how their underlying medical issues were contributing to the symptoms they were describing to me. The more I understood about the pathophysiology (what was going wrong in the body), the better able I was able to understand why people were having specific reactions with specific food choices or eating patterns, and guide them to a more comfortable way of eating. Over the years, I’ve also tried to keep up with emerging research published in journals and presented at leading gastro conferences to help place my own solo observations into bigger context and understand how others were treating some of the conditions I saw regularly.
Can you quickly touch on some ways that people can cut down on these GI issues that may surprise them?
Because bloating can be caused by so many different things, I can’t offer a simple solution that will work across the board for all people. What I can offer, however, is that tuning in to how your body feels after eating– even/especially after eating objectively “healthy” foods— can yield surprising insights. Many of my patients feel (awful) after eating salads, for example, but they continue eating them every day because they feel they ‘should.’ Some patients with GI problems feel terrible when using a probiotic but continue taking them because they’re ‘supposed to be’ good for you. It often surprises patients when I TAKE AWAY things like kale, cauliflower or probiotics– and advise them that in the world of health, there is no single food or supplement that we *all* have to consume. Forget the “shoulds.” Focus on what healthy foods you CAN consume comfortably– there are plenty of them even for the most bloated of my patients– and try to tune out the endless evangelizing that takes place in the online wellness community about the fad diet or trendy superfood that has most recently captured the internet’s attention.
About what percent of the population do you think suffers from at least one of these that can just make your recommended adjustments and help themselves feel better?
The majority of people who suffer from chronic bloating will find the cause of their problem in the pages of my book, and should feel substantially better by adopting the recommendations I make– though for some people, medical interventions may be required in addition to dietary/lifestyle change for complete or near-complete symptom relief. If I were to base my estimate on my patient practice, then I don’t think it’s a stretch to assume a solid 80% of people will feel better. There are some less common causes of chronic bloating or GI disturbances that my book does not cover, which is why books like mine are not meant to replace the care of a qualified, attentive gastroenterologist.
What can you tell us about healthy eating, probiotics, and anti-inflammatory diets with regard to these kinds of issues?
Probiotics are rarely a silver bullet for bloating, and in some cases, can actually make things worse (see the chapter on SIBO). Certain species and strains have been shown to be modestly beneficial for traveler’s diarrhea, antibiotic-associated diarrhea and/or constipation… but again, these are rarely a magic solution. If you get lucky and happen upon a beneficial species/strain, it may have a marginal benefit.
‘Healthy eating’ can sometimes dramatically improve GI issues if the source of your problem was a low fiber diet and excess gas caused by ingredients typical of processed foods like high-fructose corn syrup, added fiber from inulin/chicory root or fake sugars. In other cases, ‘healthy eating’ can make GI issues worse– like if you go from a balanced omnivorous diet to a healthy, high-fiber vegan diet and all of a sudden start eating loads of beans, cashews, cauliflower that can be very gassy, especially in higher amounts. In other words, the healthfulness (e.g., nutrient density) of one’s diet is not a great indicator of whether someone will have a high risk or low risk of GI issues. Our bodies are all very different, and can react to foods in different–and often surprising–ways. A good goal would be to work toward identifying the healthiest diet you comfortably tolerate.
I question to what extent many of the self-proclaimed anti-inflammatory diets are as anti-inflammatory as they claim to be. Actual research science very clearly suggests that some of the most inflammatory foods out there are saturated fats (which absolutely include coconut oil, ghee, butter, red meat… all of which are staples on many popular “anti-inflammatory” diets), and some of the most anti-inflammatory food compounds are found in foods that many of these diets prohibit, including soy, beans/legumes, the phytochemicals in “nightshade” vegetables and chocolate. If I were building an anti-inflammatory diet from scratch, it would look an awful lot like the Mediterranean diet and a lot less like an AIP diet, a Whole 30 diet or a Dr. Gundry diet.
In any event, because most causes of bloating are not inflammatory per se, I’m not sure that a true ‘anti-inflammatory’ diet would necessarily remedy them. Having said that, a true anti-inflammatory diet is rich in a diverse array of fiber and that is generally associated with better gut health overall.
What success story is the most memorable from your career in helping people conquer some of these issues?
There is no one single success story I would point to. Every day, I see multiple success stories, and after awhile they all start to blend together. The thing that sticks with me the most is when I work with someone who has been suffering for years– and sometimes even decades– with chronic bloating and bowel problems that have come to dominate their day-to-day life, and I send them off for a two-week trial of what I consider a pretty simple remedy. They return two weeks later at once elated and also frustrated that they are feeling miraculously better– nearly cured– but wondering “I’ve seen X different doctors over the years and had every test under the sun– why are you the first person who’s ever mentioned this to me??” It’s incredibly gratifying to help them get their lives back, but it also makes me incredibly sad that so many people are suffering needlessly due to lack of access to an experienced GI dietitian who could probably help them tremendously. It’s one of the reasons I wrote this book.
Where can people get in touch with you or find out more, or make an appointment with you if they need to?
About the Author
Thank you, Tamara. Her book, The Bloated Belly Whisperer, can be found on Amazon or wherever you buy your books.
Have you read her book and gotten relief? Tell us your story in the comments! We would love to hear your story.