2020 Top 10 Epicurator Tips



We took our Epicurators’ advice and found a little more health and a lot more happiness in 2020! Let’s take their sage words of healing into the New Year and look back on the top 10 tips, in no particular order.

We hope your 2021 Resolutions look more like Solutions and that you find even more health and happiness in the New Year!




5. Be Proactive — Assess for Nutrient Deficiency

Malnourishment is common in IBD patients. It may result from malabsorption from inflamed segments or from the surgical resection of those same segments. Likewise, the symptoms can be so debilitating that malnutrition may ensue simply from a complete loss of appetite.

One of the most common deficiencies observed is iron deficiency anemia from chronic blood loss from the intestinal ulcers. Different segments of small bowel are responsible for absorption of specific nutrients. Small bowel inflammation may result in deficiencies in fat soluble vitamins such as Vitamin A, D, E and K or of critical elements such as magnesium or zinc. Ileal inflammation may impair B12 or folate absorption from our diet. Chronic vomiting or diarrhea promotes low potassium. Some medications such as prednisone can cause low calcium and Vitamin D which are essential to strong bone health. Other medications such as methotrexate or sulfasalazine can promote folate deficiency as well. 9

Careful assessment and proactive supplementation through diet or nutrient supplements is critical to providing comprehensive and complete counseling to our IBD patients.

         – Neilanjan Nandi, MD, FACP


4. Look for an Integrated Care Team

Collaborative care teams consisting of dietitians, behavioral therapists, and gastroenterologists provide more effective care for IBS patients than traditional care offered by a gastroenterologist or even just a gastroenterologist and a dietitian or just a gastroenterologist (GI) and psychologist.

Here’s the thing: there’s a big difference between a fully-trained GI dietitian or a GI behavioral therapist and a general dietitian or a general psychologist. The application of specific dietary interventions like the low FODMAP diet or GI-focused cognitive behavioral therapy or hypnosis really does require some additional training. Here’s the proof: there are recent studies that were conducted in Melbourne, Australia that showed that integrative care with a team consisting of a GI dietitian, a GI behavioral psychologist, as well as a gastroenterologist offered tremendously increased outcomes compared to traditional, GI-only care. Traditional GI care in the study was a gastroenterologist who could order a consultation with a dietitian or a psychologist from outside of his or her health system.

In the United States, it’s sad to say, but many gastroenterologists don’t have access to any dietitian or psychologist, let alone a GI dietitian or a GI behavioral therapist. To attach some numbers, the collaborative care model led to around 84% response rate in terms of improvement and overall IBS symptoms compared to 57% response rate with traditional GI care. The results of this study were published in The Lancet Journal of Gastroenterology and Hepatology.

         –  William D. Chey, MD, AGAF, FACG, FACP


3. Seek Evidence-Based Treatment First

Evidence-based healthcare simply means that the practitioners administering care have an obligation within the scope of their credential to provide only recommendations that are founded in clinical research and have been proven to be effective. By seeking treatment from evidence-based providers (e.g., licensed physicians, registered dietitians, licensed psychotherapists, etc.), there is less of a likelihood that the patient will be sent on a wild goose chase, wasting money and time (and developing treatment fatigue!) on treatment methods that are not proven to work. I think many people also have the misconception that evidence-based or medical treatment options discount a holistic approach, and that is not the case. Holistic by definition means “characterized by the treatment of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease”. This is also the responsibility of all evidence-based practitioners, so you can trust that when you seek treatment from a credentialed healthcare provider, you are receiving a standard of care that is vetted in science.

         –  Lauren Cornell, MS, RD


2. Look at the Big Picture

Digestive troubles aren’t only caused by food. Take a look at the full picture by keeping a detailed journal that documents food and drink, sleep, stress, movement, medications, supplements, and symptoms, so you can better understand what is triggering you. Each one of these things can have an impact on your symptoms. From there, work with your dietitian or medical provider to see the full picture and find patterns. This will help tailor your plan to meet your individual needs.

         –  Erin Judge, RDN


1. Practice Diaphragmatic Breathing!

The ability to relax and clear your mind is a helpful coping skill for managing life’s stressors. However, if you have many stressors, such as those that can be associated with having a chronic disease or pain, you may have some difficulties with relaxation. You may even wonder, “where would I begin?” Your breath is a wonderful place to begin when it comes to relaxation. There are many advantages to learning how to diaphragmatic breathing (i.e. belly breathing, deep breathing). Here are just a few:

  1. Lowers heart rate and blood pressure
  2. Decreases muscle tension
  3. Oxygenation of your blood
  4. Brings warmth to the hands and feet
  5. Increases energy and motivation
  6. Improves concentration 
  7. Strengthens the immune system
  8. Reduces stress hormones
  9. Activates the relaxation response of the body (reversal of the stress response)
  10. Can be easily implemented, doesn’t require medication and won’t cost you a thing

The activation of the diaphragm through diaphragmatic breathing, allows for a gentle massage of the internal organs (intestines and stomach). This can aid with abdominal pain, urgency, bloating, and constipation. 

For those that experience diarrhea and urgency, use diaphragmatic breathing in those moments of panic (i.e. “I MUST get to the bathroom immediately”) to aid with calming down your digestive tract. 

For those with constipation, use diaphragmatic breathing while sitting on the toilet attempting to have a bowel movement. The relaxed breathing can aid with calming and massaging your system, which may lead to a more complete bowel movement. Below is a video demonstration of diaphragmatic breathing.

         –  Megan Riehl, PsyD




, ,