Recently I had the chance to sit down with Tamara Duker Freuman, registered dietician and GI nutrition expert. I interviewed her for my podcast, Crohnically Mom, and she provided helpful insight into navigating nutrition and IBD. You can listen to the interview here.

​How I was introduced to Tamara was through her newest book “REGULAR”. It is one of the most helpful books about GI symptoms I have ever encountered. Many books focused on addressing GI symptoms focus on things you are doing wrong – the wrong diet, not getting enough sleep, eating “bad” foods, etc. This is demeaning for a reader, especially one with IBD. A lot of the time we have tried everything and it hasn’t worked so the generalized assumption that people with GI issues can “do something about it” is incredibly frustrating. “REGULAR” has a totally different tone that I would describe as empowering. 

​Tamara starts the book by providing a thorough, yet completely understandable, explanation of how your digestive system works. This is one of my favorite parts of the book and we were only in the first few pages. She breaks down the anatomy in a way that doctors rarely do during a 15 minute appointment or if they do, it usually isn’t communicated in a way that is, excuse my pun, digestible. This knowledge is so crucial because it allows someone experiencing GI symptoms to accurately explain to their doctor what they are experiencing. It also saves them from hours of Google research and perusing through unverified information. This is straight to the point, reliable information about what the heck is going on in your digestive tract. 

After the helpful introduction, Tamara guides you through a quiz. The quiz allows you to answer questions about your symptoms and narrow down the chapters that could be most relevant to you. Most people are reading this book not for their interest in GI disorders, like me. They are looking for help, a solution. This quiz helps them get to the most relevant information quickly and because of that, I love this style of book for non-fiction reads. The chapters address a range of GI symptoms/issues from Irritable Bowel Syndrome, to pelvic floor dysfunction, to Inflammatory Bowel Disease.

The IBD section was where I spent most of my time. I was looking forward to hearing Tamara’s recommendations, but I admit at first I was a bit nervous. Usually I get nervous reading any book that mentions “diet”. So often they are filled with unrealistic overhauls of your current lifestyle that put foods into categories of “good” and “bad”. As someone who has struggled with an eating disorder in the past, this can be very triggering and also just not helpful. “REGULAR” is refreshing as it doesn’t do either of these things. Tamara explains how foods navigate through your system and how they are absorbed. She never says “do not eat this.” Instead she suggests ways to make certain foods more tolerable (e.g. changing their consistency). You will hear in our conversation, how passionate in her practice Tamara is about providing customized nutrition counseling. She isn’t about just throwing a blanket “fix all” meal plan out there and hoping it works, so she doesn’t do that in “REGULAR” either. 

Overall, this book is full of fresh takeaways even for someone who is not new to being a GI patient. Tamara’s approach is meant to leave the reader feeling empowered, whether it’s speaking to their provider, looking for answers to their symptoms, or exploring a type of food they always thought was out of reach. This will now be a “go to” recommendation from me for anyone suffering from a GI condition. 

You can hear my in depth conversation with Tamara on this week’s episode of Crohnically Mom. You can also grab Tamara’s book, “REGULAR”, on Amazon. 

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​Traveling is one of my greatest joys in life so when I was diagnosed with Crohn’s Disease, I refused to let my symptoms prevent me from doing what I love. Flying can be a big source of anxiety for those with Inflammatory Bowel Disease. There are many factors that can play into the feeling, but one of the most common ones is the concern about not being near a bathroom. Flying is also a necessity in some situations - work travel, family visits, etc. Your travel schedule and GI symptoms unfortunately don’t coordinate to make sure you have a comfortable experience. That being said, anything to reduce the anxiety around flying when experiencing GI symptoms is a welcome suggestion. One of the most simple ways to combat a common concern is to make sure you are positioned near a bathroom on the flight. 

On certain airlines, you can choose your seat ahead of time. This means locking in that prime aisle seat right next to the facilities. No stepping over other passengers mid bathroom emergency and you are close by so you won’t have to fumble down the aisle as you’re trying to make it to the facilities. This is great for airlines that offer this preselection option.This isn’t always the case, though. I most frequently fly Southwest which has open seating (i.e. no preselected seats). This has caused me a lot of anxiety over the years - panicking when I didn’t get an early boarding group, having to ask passengers to switch seats with me and awkwardly explaining why, and trying to do anything I could to avoid having to use the bathroom on flights (which was not very effective). 

A few years ago, I saw some fellow IBD patients share a travel tip and it instantly changed traveling for me. Southwest offers disability preboarding and Inflammatory Bowel Disease is a disability. When I first found this out, I was in the stage of denying IBD was a disability that impacted functions of my life, but now looking back I wish I would have accepted this sooner so that I could utilize the resources that are there for IBD patients. That is why they are there, to help us!

​I check in like I normally would for my Southwest flight and once I get to the gate, I speak with the gate attendant. I explain that I require disability boarding due to my Crohn’s Disease and need to be seated next to a bathroom. I always have my doctor’s note on hand to show if it is needed. The gate attendant updates my boarding pass to list preboarding status and I am good to go. 

Disability preboarding includes passengers with all types of disabilities. This means you will often be boarding with wheelchair users and other passengers with mobility challenges. I understand that for them it is more necessary that they have the seats closer to the front of the plane, while for me I have the option of sitting near the rear bathrooms. That being said, I make sure not to take the front seats if they are needed by others. When I board the plane, I confirm with a flight attendant that there are functioning bathrooms at the back of the plane and head on back to secure my seat. 

This small tweak to my travel routine has made a significant impact on my anxiety level while traveling. The knowledge that I will be able to have easy access to a bathroom while in the air is a huge comfort. I recently realized how many fellow IBD patients don’t know that this is an option. I didn’t for the longest time, until I saw a patient advocate share the information ( I wish I remembered specifically who because I would definitely shout them out!). I know how much that information helped me so I want to help spread the word that Southwest does offer this option to support passengers with visible AND invisible disabilities. 

As I mentioned before, I went through a period where I was in denial that IBD was a disability. For a while when I started to actually utilize these types of programs, I would feel embarrassed. I thought people were looking at me strangely because they couldn’t see that I was sick. I went out of my way to awkwardly over justify why I needed certain accommodations. It has taken me years to work through and I still struggle with it, but I have gotten a lot more comfortable. Just because my condition isn’t visible doesn’t make me any less deserving of the programs that are in place to assist people like me. I am not saying to utilize every offered accommodation “just because,” but if it is something that will impact your condition, symptoms, or quality of life, you should feel empowered to use these resources that are there for you. 

As an IBD patient did you know that this was an option for you? How would an accommodation like this impact your travel experience with IBD?

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 At the beginning of my IBD journey, I had the pleasure of working with Oshi Health in their early days. At the time, they were mainly a tracking app for GI symptoms. My mom and I attended a user research group in New York and met with some of the consulting physicians. This was the first time I was introduced to the concept of integrative care. It wasn’t something that was a reality yet for many patients, but the idea that providers could work together and treat the whole person was a positive one. 

Almost 5 years later, I had the pleasure of sitting down with Michael Currier, a GI Physician Associate at Oshi Health, to get an update on how the company and the app have evolved. Oshi Health has grown from a tracking app for GI conditions to a full service option for receiving integrative GI care. Through the app, you are matched with an Oshi GI provider who you see virtually. The appointments are on average around 45-minutes as opposed to the usual in office 10-15 minutes that are standard practice for most of us. Your provider gets to really know you and dig into the whole story your body and symptoms are telling. They can order labs or diagnostic procedures for you with their local partners (they have a scheduling team that takes care of this for you!), and you are matched with an entire team of providers at Oshi. They understand that the best GI care is multifaceted and consideration needs to be given to the effects both diet and mental health have on GI conditions. Through Oshi, you are paired with a Registered Dietician and a GI Psychologist to help you feel better from all angles. The best part, in my opinion, is that your GI provider, dietician, and psychologist all work together behind the scenes to collaborate on the best care plan for you. 

A few other highlights for me are: they will work with a doctor you are already seeing if you want additional support, but aren’t ready to make a complete switch and you have access to your Oshi team via chat so you never are without a line of support. Another important call out is that they partner with many insurance companies that will cover your care through Oshi. 

On an individual level, Oshi Health is changing the game for patients. They are breaking down barriers of accessibility when it comes to GI care. They are empowering patients by treating them as a whole person, not just patients. This is also revolutionary for our healthcare system in general. It is rare that there is so much collaboration between different providers despite how much of a positive impact it could make. Oshi Health has designed a model that flips that statement on its head and is challenging what we currently accept as the status quo.

​You can listen to my conversation with Michael Currier from Oshi Health on this week’s episode of Crohnically Mom. He explains more about the benefits of integrative care, how Oshi is creating more accessible GI care, and how their model gets patients better.

You can check out the incredible work Oshi Health is doing via their website and on Instagram. 

I am truly in awe of the strides they have made in GI care over the past 5 years and I can only imagine the kind of update they will be giving me 5 years from now.

xx

One of my favorite sessions at DDW focused on pediatric IBD. This is a topic that is near and dear to my heart as members of my family have been diagnosed with IBD in childhood and I know my own children are at a greater risk. Nisha Thacker, an Accredited Practicing Dietician at Sydney Children’s Hospitals Network in Australia, presented her team’s findings, which provided some very valuable insight into pediatric IBD risk factors, but also left me with some questions. I am going to share some slides with key takeaways I gained from the presentation and share my thoughts on the findings from the perspective of a patient and a mom.

A few background pieces of information that were shared prior to reviewing the findings were:

• Pediatric IBD rates are on the rise in high and low-and-middle income countries
• Family history of IBD is a risk factor
• Twin studies show a stronger influence of environmental factors in IBD development

Nisha shared a diagram mapping out the influence of dietary, lifestyle, hygiene, and clinical factors and their effect on pediatric IBD risk, which I share below. 

​Many of the factors that have a negative impact on IBD risk are commonplace in our Western society. Western diet in general is a risk factor, but there are a lot of factors that paint the picture of middle class or upper class Western life. Things like having more than one toilet in a home, urban living, and early antibiotic exposure are all contributing risk factors. On the other hand, having more siblings, being exposed to pets or cattle, and not being formula fed are all contributing factors to lower IBD risk. I thought the most telling though, was that a non-Caucasian child living in a developed country has a higher risk of developing IBD.


You can’t review this information without thinking to yourself that maybe we are doing something wrong here in the West.  In other cultures, there is a greater focus on holistic treatments instead of jumping straight to antibiotics. There are larger, generational households with more children. Mothers have more family and societal support postpartum, which encourages successful breastfeeding. There is less consumption of sugary or processed foods, and really a different dietary structure. Our lifestyle in the West does not bode well for avoiding the development of IBD.

One of the things that really struck me about these findings was the impact that not breastfeeding has as a risk factor for IBD. I found this interesting because this is identified as a negative factor in other pediatric and maternal health outcomes. If we know that supporting a mother to breastfeed will influence pediatric outcomes then why don’t we have more support? Why do we not have adequate maternity leave to support breastfeeding mothers? Why do we not have healthcare coverage that universally provides continued lactation support? I would love to see a study on IBD rates in countries with longer maternity leave or countries with higher breastfeeding rates. 

This also speaks to parental support as a whole. Western culture does not champion multigenerational households like other countries and cultures do. With multigenerational households come additional people to help – whether that be in watching older children so a mother can breastfeed, preparing homemade meals for the family, or having more adults contributing to a family’s income so maybe a mother can stay home with her newborn longer. This isn’t always the case, but I think it could be worth diving into. 

​The biggest takeaways I have as a parent are what I can do to lower the risk of IBD for my children. There are things I can’t change, like genetics or the fact that my children had to be at least partially formula fed, but there are things I can do that can make a difference. 

Pet exposure is a big one that is actionable. I am working to get more information on the science behind this, but unrelated to IBD our pediatrician has mentioned the benefit of having a dog in building stronger immunity as a child. I am putting a pin in this and I hope to come back with more information. 

The other two easily actionable factors are diet (higher consumption of vegetables, lower consumption of sugar/candy) and antibiotic exposure. To be clear here, I believe that antibiotics are necessary in some cases and can save lives. The recommendation isn’t to never expose your child to antibiotics, it is to expose them only necessarily. The same goes for diet. This study won’t motivate me to never let my kids have cupcakes again, but it will encourage me to continue packing their diets with vegetables any chance I get. 

I do want to address the factors that we can’t control or we choose not to. “Mom guilt” rang in the back of my mind during this whole presentation. When I originally posted these slides on my Instagram, I received countless messages of moms freaking out. It is our nature to want to do whatever we can to protect our children, but some things truly are out of our control. I wanted to call out a few things in particular. 

Low socioeconomic status is an identified “protective factor” in avoiding IBD, but has many other potentially negative effects on a family. This study is viewing that data in a bubble as opposed to the whole impact of low socioeconomic status.

Having more than two siblings is another “protecting factor” in IBD development. This again is something that is being looked at in a bubble. There is no recommendation to have more children for the sole purpose of protecting against IBD. The same goes for other factors such as urban living. There are some benefits in other regards when it comes to urban living. We can’t just change where we live to hopefully avoid IBD.

As a mom to two little ones, there are two factors that give me a pit in my stomach. One is the risk factor of not being breastfed and the other is early life antibiotic exposure. Breastfeeding is something that is so deeply personal and challenging. Sometimes there are medical reasons (physical or mental) that prevent breastfeeding. Other times mothers are not able to breastfeed due to lack of resources or support. There are also scenarios where breastfeeding is not an option at all. This is such a complex issue and emotionally charged on both sides. As a mom,  if you read this and get a pit in your stomach, try to remember that this information is again, in a bubble. Just because you didn’t breastfeed does not mean your child will have IBD. The same goes for early antibiotic usage. This is something that can be out of a parent’s control. If a baby has an infection that needs to be treated with antibiotics, that is the best course of action. There are situations where the benefit outweighs the risk and there is nothing that can change that. 

In conclusion, this session provided some very interesting insight and shared some low risk lifestyle changes that we can adapt to help lower our children’s risk of IBD. On the other hand, I am curious to see additional studies that evaluate these factors on the basis of risk/benefit. I also am interested to see how the findings may change if the study was conducted outside of a Western environment. 


What questions do you have after reviewing and reading? Are there any key points you would want to hear more about?

Here are my top share worthy pieces of content I've stumbled across in the past week! This list is a little shorter than usual because (if you've been following along you know) I unplugged for a bit to do Disney World with my family. Now that I am getting myself back up to speed, here is what has caught my eye.

April was Alcohol Awareness Month - @neda did a great post sharing that about 20% of eating disorder patients develop an alcohol use disorder. This week at Digestive Disease Week I have also been learning about the correlation between IBD and developing an alcohol use disorder. This topic is very top of mind for me right now and I like that this post highlights some resources for those looking for support.

May 4th was the first Terminated for Medical Reasons Awareness day. This topic is an emotional one and often hard to talk about, but with abortion rights continuing to diminish we need to be talking about this. @postpartumsupportinternational shared a powerful post about one mother's experience with TFMR and her explanation of why it is so critical to protect this right. 

NPR on Messy House Shame - My mom actually sent me this article because she knows how hard I stress over keeping my home together. This article provides some relief in validating that you are running your home just the way you are supposed to for your family. 

I'm kicking off your week with a roundup of content I've found really valuable over the past two weeks! The last roundup was a hit so I am even more excited to share a bit of what has been filling my content plate recently.

Always feel free to drop a link to your favorite article, podcast, or post you "saved" this week. I would love to check it out!

Black Maternal Health Week - Posts & Resources
Black Maternal Health Week was 4/11-4/17 so I wanted to first and foremost highlight some of the resources related to the topic. The Womb Room, a Baltimore based perinatal support center, shared a post on Instagram that pointed out so harrowing statistics about maternal mortality rates for black mothers. This post serves as a somber reminder of the disparity in healthcare and the importance of bringing awareness to this issue. The post doesn't just share WHY we need to care, it also shares specific ways that you can make an impact. We shouldn't just wait for this week to occur to bring awareness to this issue. This needs to be at the forefront of our minds constantly until changes are made. This article on The Every Mom from a couple years ago is also very helpful if you are looking for a deeper dive into the disparities in Black Maternal Health and some suggested ways to help.

Addressing Healthcare Inequity with IBD Advocate @kimberlymhooks
Kim and I are both part of the American Gastro Association Patient Influencer Program. That is how I discovered her content and have been finding everything she puts out to be so helpful. She is a great follow for those in the IBD community. She shares a lot about her life with IBD and the advocacy work she is doing all with an incredibly positive attitude. 

78% of the Mental Load Falls on Mothers with @mamapsychologists
Mental load is a hot topic right now and rightfully so. We are finally putting a name to all of the extra work that moms do and recognizing that work. It's not just magic behind the scenes, there are hard working mom's making life happen. This post really spoke to me as I recently recorded a podcast episode about the mental load of traveling as a mom.

Podcast: Skimm This: State of Women... and Society
My last pick of this week is a podcast. The Skimm just launched Skimm This Special Edition where they are diving into different issues impacting women in America. The first episode called State of Women... and Society was one of the best podcast episodes I have ever listened to. It so eloquently described the social landscape we are facing as women and even had the author of Fair Play on to weigh in. The Fair Play card game has been a game changer in my marriage after having kids so I was thrilled to hear more about how this tool can help other women. The second episode of the mini series dropped a few days ago and it is at the top of my queue to listen to while working this morning.

If there is a full size product in my line up, chances are its because I tried a mini version first. One of my favorite things about Sephora is the extensive selection of mini products they offer and here are a few reasons why.

• I love frequently trying new products so committing to a full size version won't happen for me until I am really sold. Minis allow me to mix and match until I find the right product combination I can commit to. 
• I can see what works for me before investing. Especially during pregnancy my skin was temperamental. I relied on minis to test out how a product would effect my skin before I purchased the full size. 
• They allow me to add more expensive products into my routine. I want a little of the luxury without the price tag. Having some minis of more expensive products allow me to incorporate them into my routine when they will be put to best use (special occasions, dealing with a serious breakout, etc.).

Also remember that your products expire! You can see how long their shelf life is right on the bottle. If you want to have a treatment on hand for just the summer months or to deal with occasional breakouts, buying a full size version might not make sense. By time you get around to using the whole thing it could be well past the optimum timeframe. 

My rule: When in doubt, go for a mini version! Below are my favorite skincare and haircare minis that you can grab during the Sephora sale this year!

**Disclaimer: Products that I deem "pregnancy-friendly" are based on my research and comfort level with those ingredients. Always consult a medical professional with questions on product safety. 

Caring for. your hair extensions is a commitment. The better you care for them, the longer they will last you, which I guess makes them more of an investment! I've had semi- permanent sew in extensions for almost a year now so I've tried quite a few products to narrow down the perfect combination to keep my faux locks in good shape. Before I share my picks, here are some tips I've picked up along the way.

• Oil is your best friend. Oil the heck out of your ends to keep them smooth. They aren't getting natural oils from your scalp so your extensions need all the help they can get when it comes to keeping them moisturized.
• Heat protectant is essential. I like a detangler, leave in conditioner, protectant combo. 
• Investing in good tools is worth it. The Dyson Airwrap seemed insane to me when I first say the price tag, but after getting one for myself I see that there is a serious return on investment. It has helped keep my hair looking healthier and cut down on my dry time by a lot. I can also curl and dry my hair simultaneously so I am limiting the amount of heat I have to use on my hair.
• 
  

You can disregard this last portion if you don't have well water. I unfortunately do (the only downside to our big move), but I've found a few products to help my hair stay in tact. In addition to our water treatment, using reparative shampoo, and lathering my extensions in hair masks, I also use one of these products every few times I wash my hair. Both I've found to be effective in giving your hair a little detox from buildup and there is a noticeable difference after use. 

Whether it's replenishing your supply of favorites or trying some new products, the Sephora sale is one of the best times to stock up on skincare and makeup. Pregnancy can require a major overhaul of your beauty routine (which can add up) so in the past I've used this opportunity to purchase pregnancy friendly products. It can feel overwhelming trying to figure out which items are pregnancy friendly and effective so I put together a list of my favorites to help you out. 

A quick disclaimer: I am not a medical professional. These products contain the ingredients that I felt comfortable using during pregnancy based on my research and discussions with my doctors. Please do your own research and make your own decision on what you feel comfortable using. This is just what worked for me.

I follow so many incredible content creators who share about IBD, motherhood, and mental health. I find myself saving and screenshotting a ton of posts each week that I’ve found interesting or have made an impact on me. Instead of just keeping these to myself I want to highlight my favorites each week and magnify some of the voices that I find so valuable. 

The articles and posts range from scientific to just fun and helpful - really a compilation of my “Saved” folder this week. 

NSAIDs and IBD: Are They Really a No-Go?
Lights Camera Crohn’s
Article Link | IG Link

America Erased the Postpartum Pause New Parents Need—Here’s How to Get That Time Back
Parents Magazine, Shared by Postpartum Support International
Article Link | IG Link

Crohn’s & Colitis Foundation’s IBD Ventures Invests $2.4 Million in Developing Novel Products to Address Unmet Needs of IBD Patients
Crohn's & Colitis Foundation
Article Link | IG Link

The Best Parenting Books for Every Age and Stage
The Everymom
Article Link | IG Link


What did you "save" this week?

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