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RD Tamara Duker Answers Questions about the Low Fodmap Diet

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I recently had the pleasure of interviewing Tamara Duker, a Registered Dietitian (RD) with a master’s degree in Clinical Nutrition.  She knows a thing or two when it comes to food and nutrition, cooking and eating, recipes and healthy living. She is a cake lover challenged with gluten intolerance (like so many other ladies!).  Her practice is based in New York City and she has expertise in helping people with:

  • Soft diets for dysphagia
  • Gluten-free diets
  • Low-FODMAP diets for IBS and SIBO
  • Lactose-free or low-fructose diet for digestive intolerances
  • Medically-supervised elimination diets for Eosinophilic Esophagitis

Here is Part One of our interview – please read and then check back next week for Part Two:

tamara dukerCF – What would you say is the average age of people coming to see you for the first time?  Are they a mix of male and female or mostly female?  Do you find that they’ve come to see you because someone else has recommended they see an RD, or do you find you’re receiving more e-patients?

TD – While I see patients of all ages– from 11 at youngest to 80-somethings at the higher end, my “typical” patient is a woman in her 20s-40s.  Commonly she reports having had a “sensitive stomach” or “stomachaches” since childhood that has recently gotten worse, but in other cases I hear she was totally fine until one time she got sick when traveling, and then her bowels have never been the same since.  They come to see me out of desperation– either they find me via google (my name comes up a lot when you google “bloating” or FODMAP-related search terms, as I write extensively on these topics for US News), or their gastroenterologist referred them to me.

CF -What are the lactose-based products they are most unhappiest to part with?

TD – My lactose intolerant patients are unhappiest to part with pizza, ice cream and yogurt.  Often, they part with the yogurt and then suffer through the pizza and ice cream.  The problem with pizza/ice cream is that often its the high fat content that triggers IBS symptoms rather than the lactose per se–so even if they take a lactase supplement, they still may not tolerate these foods well.  They are beyond ecstatic to learn that there is a lactose-free, low fat  real dairy yogurt available, as soy yogurt tastes awful, coconut milk yogurt is a FODMAP bomb and almond milk yogurt is a sugary, carb bomb.  Healthy snacking is much more convenient when yogurt is an option.

CF – Can you please describe Medical Nutrition Therapy?

TD – Medical nutrition therapy is different from nutrition counseling or education in that diet is a prescription to treat or improve a medical condition.  Some examples of this would be: gluten-free diet for celiac disease, using soluble fiber therapy to improve IBS-D, using the low FODMAP diet to manage symptoms of chronic bloating in IBS, etc.  Medical nutrition therapy, importantly, is evidence-based and employed by credentialed clinicians, often in close collaboration with a medical doctor.

CF – Can you provide other tips for the lactose intolerant crowd/FODMAP fans?

TD –

  • Watch out for protein powders, drinks or bars that use whey protein concentrate or milk protein concentrate.  These can be very high in lactose.
  • If you use lactase supplements to help digest conventional dairy, use chewables, not tablets.  Chewables are much more effective.Take with the first bite.  Take additional dose mid-way through the meal/snack if there’s a lot of lactose.
  • Green Valley Lactose Free yogurts are the most FODMAP-friendly yogurts I have ever encountered.  If Green Valley Organics yogurt is not available in your market, look for Redwood Hill Farm goat’s milk yogurt instead– its about 40% lower in lactose than conventional yogurt, which is comparable to your typical Greek yogurt.  To reduce its lactose content even further, you can strain it for 2 hours in a paper-towel lined seive/strainer over a pot, which yields a thicker greek-style texture (lactose is water soluble, so it leaches out with the excess liquid).  I have a recipe for “Goat’s Milk Labne” here which I absolutely love.

If you have any comments, please share them below!  Thanks!  Check back next week for Part Two.

~ Colleen

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3 Comments

  1. Jessica Frederick

    Would like to do a phone conference with Tamara as I live in the north bay
    outside of San Francisco. If not could she refer me to a nutritionist that is knowledgeable about FODMAPS. Would be very grateful. I know a lot about nutrition and my triggers, but need motivation and guidance so I will follow through. Thanking you in advance.
    Jessica Frederick

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