In this episode transcription we discuss all the things in relation to gut health with our expert- Brittany Roman-Green!
Cassie: Welcome to “The Real Life Show Living with A Chronic Illness.” We are your hosts, Cassie and Chelsea. I’m Cassie, a single mom, living with a chronic illness who is extremely passionate about living a full and happy life.
Chelsea: And I’m Chelsea, a mindset coach that has a passion for helping people learn to put themselves first and be the best version of themselves each and every day.
Cassie: We came together to create Spoonies Unite, an uplifting community that offers resources, guidance, and support so you can live your best life while giving you the space to be yourself, be heard, and feel understood. We hope that by providing education from experts, we help spoonies and their loved ones thrive.
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Cassie: Today’s interview is with Brittany Roman-Green, who is a virtual private practice registered dietitian, nutritionist, certified personal trainer, and member of the Northern California Chapter Medical Advisory Committee, the CMAC National Task Force for the Crohn’s and Colitis Foundation. Brittany is also the leader of the registered dietitians in IBD practice group for the Academy of Nutrition and Dietetics. She specializes in helping people with gastrointestinal conditions such as Crohn’s and ulcerative colitis get into symptom remission, maximize their energy, and gain a better relationship with food so that they can finally live their life instead of living under the constraints of their disease.
Chelsea: We had a really great time talking to Brittany. Her energy is just so amazing, she is such a sweetheart, and she does an amazing job of not just looking at food, but also looking at the other aspects of people’s life, stress, exercise, those other things that can impact the severity of your symptoms. So, we hope you enjoy our conversation with her.
Hello, everyone, and welcome to today’s episode of “The Real Life Show Living with a Chronic Illness.” Cassie and I are joined today with Brittany Roman-Green. Hi, Brittany.
Brittany: Hi. Thanks so much for having me.
Chelsea: Yay, we’re so excited.
Cassie: It’s going to be fun.
So, Brittany, you are an RD, you struggle with IBD; you have so much fun information to share with us today. We’re so excited. Do you want to start off by letting our listeners know a little bit about who you are, what you’ve been through in your life, and kind of what’s brought you to where you are today?
Brittany: Sure. So, I guess–Sorry, should I do like a little quick bio of what I do now?
Chelsea: If you want to, but we will, like that bio you sent us will–Which we probably should have told you this but earlier.
Cassie: I know. This is why I needed to not start the introduction, Chelsea. This is why. Because Chelsea always goes in and says all this stuff and I fuck it up.
Chelsea: We’ll have that bio you sent us, we will have read it. The way our episodes kind of flow is–
Brittany: Okay. Got you.
Chelsea: We have a little intro music, and then we’ve got the bio, and then Cassie and I kind of give like a little like teasers of experience talking to you, so then people listen to the entire episode.
Cassie: Yeah, sorry about that.
Chelsea: So, people will know that–
Brittany: No, don’t be sorry. That’s okay.
Chelsea: But feel free, because I know if I do podcast interviews and someone has my bio, I still kind of give the really short–“I do this,” the one-sentence thing. So, that’s totally fine. But, yeah, here you go. Who are you?
Brittany: Okay. So, I was diagnosed with ulcerative colitis in high school, but I actually started having symptoms as a change in my bowel movements as early as the end of elementary school. And, I just–
Cassie: Oh, wow.
Brittany: I guess I thought, urgent trips to the bathroom, and diarrhea multiple times a day was normal or something.
Chelsea: Well, it’s hard to tell it’s normal when you’re so young.
Brittany: Yeah, and the change happened gradually, too. Initially, I started having large bowel movements that were almost tree trunks, hard to pass. And then, from somewhere, it turned into loose stools. But, I also have IBS, and I also have another autoimmune condition called primary sclerosing cholangitis, which is actually–
Cassie: I’ve never heard of that.
Chelsea: I was just thinking something else, I haven’t heard, it’s a new one.
Brittany: It’s actually a phenotype of IBD, it’s a very rare one. It’s a rare medical condition but–
Cassie: Wait, will you say it again?
Brittany: Yeah, primary sclerosing cholangitis.
Brittany: But, basically it’s an autoimmune condition where there’s inflammation in the bile ducts between the liver and the gallbladder. And, what that can do over time is it causes them to become more narrow and harden, and then it can slowly affect the liver. And then, cause liver failure at one point, and you may need a liver transplant, or it puts me at significantly high risk for bile duct cancer as well as colon cancer.
Brittany: But, I’m fine now.
Chelsea: Yeah. I love how you’re like, “It’s all good y’all, it’s fine, no one panic.”
Brittany: Yeah. I mean, I think the initial diagnosis of the PSC was–I was just diagnosed with that one a few years ago, so that was definitely a harder one to kind of accept, because there’s just so much, it’s so rare. But, with time and realizing that it hasn’t progressed, it just kind of helped you realize help me focus on the moment, living in the moment, as opposed to worrying about my future health. And, I think that’s something that anyone with IBD or any chronic condition can definitely relate to.
Brittany: But, at the time of my UC diagnosis, I mean, I was really, really sick. I was hospitalized, I was 20 pounds underweight, I was running to the bathroom 15 – 20 times a day, blood in all my stools–Everything was diarrhea, it was pain, it was a complete exhaustion.
Cassie: So, exhausting when you are sick.
Brittany: And, it kept because my immune system was so low from the flare, I was getting sick with something every few weeks. So, that was kind of where I started. And, after a few a bunch of tests, a bunch of specialist doctors, then someone was finally, “Let’s do a colonoscopy on her.” And then, I was finally diagnosed with UC, and from there, I tried a bunch of different medications, had side effects to pretty much everything, until I found one that worked for me. And then–
Chelsea: Do you mind sharing which one worked for you?
Brittany: Yeah, initially it was Colasol, and then, I actually had switched to Lialda. And then, I went back to Colasol, and then, I’m back on Lialda, and have been on that for years. But, in high school, I basically ate a pretty, not a great diet. And, I took a chef’s class, which is pretty cool in my high school even with that.
Cassie: That’s so fun.
Brittany: But, they actually had a nutrition component of it which I loved. I thought it was so interesting. And, so, I think between that and the fact that I realized that certain foods were triggering my symptoms, like my dad’s delicious but spicy chili, both of those things kind of helped me decide that I wanted to become a registered dietitian.
Chelsea: That’s awesome.
Brittany: So, while I was in school, in college, I learned more about nutrition and realized, “Oh, wow, I really need to change my diet,” and made a bunch of changes. I’m still to this day, I think it’s a process that you always need to, or I always focus on, all these ways that you can improve and be healthier and stuff like that. But, I made a lot of changes in those four years of college.
Cassie: Which is one of the hardest times to make, nutritional changes one would think, being a college student. And so, that’s pretty cool that you made those changes and learned so much and what a gift that you kind of knew what you wanted to do from a class in high school.
Brittany: Yeah, I mean, I think I actually had, I figured I was going to change my major, but I ended up loving it. So, I actually shadowed, I was a volunteer at a hospital in between high school and college. And I shadowed a dietician in it, and I was like, “Oh, this is amazing,” which is funny because I would never want to be a dietitian in a hospital again. But, at the time, that was enough to help me get hooked.
Chelsea: Oh, that’s cool. So fun. And so, you obviously must have found that everything you were learning with the nutrition, and then, like you said, “Oh, I need to make a change with my diet,” you must have started making those changes for yourself, is that right? And then, you started noticing differences, too?
Brittany: Yeah, definitely. The changes have, I mean, I know that–Because I also have IBS, which a lot of people with IBD have in addition to their IBD diagnosis, I have food intolerances. And so, there’s certain fruits and vegetables that are going to trigger symptoms because I’m sensitive to them. And so, finding those, and really figuring out all my trigger foods has been, I mean, life-changing. Also, adding more variety into my diet, because I ate a very delicious diet in high school, but I did not eat a wide variety. And so, I think that I’m not saying that caused my flare or caused anything but it definitely didn’t help me feel great. Whereas now, I think that my diet and lifestyle help me to feel as best as I possibly can.
Cassie: Okay. So, I’m really interested because especially with you saying that you are diagnosed with IBS in addition to IBD and how many of us are diagnosed with both. So, I really appreciate that because I was also diagnosed with IBS in addition to IBD. And, I have to admit, being totally honest on The Real Life Show that I was in the doctor’s office, and I was like, “Fuck that, don’t be trying to take away my validation of my Crohn’s symptoms.” And, I was like, “This is not IBS, this is IBD.” And I felt that where I was like, “Don’t dismiss me with IBS, I have Crohn’s, it’s flaring, I’m fucked up.” But, now with you saying it, I’m like super receptive. We do all struggle with it. And, for all of those out there that have IBS, by the way, this is totally not taking away from any of your experiences. My sister-in-law has IBS, and it can be–I have witnessed the potential shitting off the pants. So, I get how difficult that is. I just, at the time, was trying to be heard for my medication changes, etcetera. So, like you said, you kind of found your trigger foods and etcetera, do you feel that really helped to treat the IBS side of all of the issues that you were having then?
Brittany: That’s 100%. Because with IBS, it’s all about, or one of the factors is finding your food triggers, because there’s triggers in your diet that you’re sensitive, too. And so, when you find those, in addition to lifestyle factors that can definitely help reduce your symptoms, stress management, exercise, getting a good night’s sleep, all that stuff can help as well. But, diet is a big part of that, and, you’re right, it can be debilitating symptoms. And, oftentimes, a lot of patients with IBD don’t know, like I ask them, “Are you in a flare?” and they have no idea. Because sometimes people are misled to thinking that symptoms mean your disease is active when that is not necessarily the case. You can have your symptoms could be from a disease flare-up from the inflammation, but it could also, or, be from food intolerances, or stress.
Cassie: Because that’s really interesting, too, because they kind of say that food doesn’t really matter for your IBD. They’re, “You need medication. Food and nutrition doesn’t matter, it’s not going to make a difference.” And I’ve heard that from several doctors and I’m like, “What the F? It’s your digestive organ that has disease. Food has to be a contributing factor to helping that situation.” But, it’s funny because I have not heard of any doctors saying that food doesn’t help IBS. People always say you need to change your diet if you have IBS. So, that’s kind of interesting that it’s maybe they are prescribing a medication to treat your IBD, but then you need to manage your symptoms of your IBS with diet and nutrition. So, this is kind of the first time that I’m thinking, “Oh, my God. What if we approach it this way?” That’s really interesting.
Chelsea: One thing I’m going to ask because this might be just because I haven’t lived it myself, but for maybe anyone listening. Brittany, and maybe Cassie, you can kind of add in a little bit, but can you guys go in a little bit more in-depth of the difference between IBD and IBS.
Brittany: Oh, you go Brittany?
Chelsea: I think that you both can kind of give a good definition. Because we do have people that listen that don’t know that stuff, and I don’t think I have the best understanding of it myself. But, that could be kind of good to help give some verbiage for people to use to describe, “Okay, well, I have IBS and IBD, but this is how they’re saying, this is how they’re different.”
Cassie: That’s a good question.
Brittany: So, I mean, the simplest way–I’m not a physician, so they would probably be the best one to answer this question. But, what I can say in the simplest way is, with IBD, there’s some sort of underlying inflammation, whereas with IBS, there’s not. And so, in my understanding–
Cassie: That’s simplicity. And so, also irritable bowel disease versus irritable bowel syndrome, too, is what they all stand for. Okay, continue.
Brittany: Inflammatory bowel disease.
Cassie: Thank you. What did I say?
Brittany: I think you mix them up a little bit. So, irritable bowel syndrome.
Cassie: Oh, shit. Thank you that’s what I wanted to say. Okay. I wanted to say inflammatory bowel disease, irritable bowel syndrome. So, thank you for fixing me. Totally I got fucked up there. So, say that again. Repeat that, inflammatory bowel disease–
Brittany: Irritable bowel syndrome.
Cassie: Yes, okay. Exactly. Now, our listeners know.
Brittany: Usually, a doctor will diagnose, I mean, obviously, again, I’m not a doctor, but, my understanding is that the doctor would either do a fecal test to assess whether they have inflammation or not. So, if you’ve ever heard of fecal calprotectin level, that’s one that can assess, “Do you have IBS?” Well, it can say, “Do you have IBD?” And then, an endoscopy or colonoscopy would be the other way that they would make sure that there’s no underlying inflammation.
Cassie: And, checking some of those inflammatory blood markers, too, like the seed reactive protein and stuff like that, too. I know that that’s part of what got them to test me with a colonoscopy. They did the fecal test, they did a blood test, they saw inflammatory markers, did the colonoscopy, and then diagnosed me with a severe Crohn’s disease. But, that’s also really interesting like you said about the difference of determining if you’re in a flare or just experiencing symptoms. Because, for example, I don’t go symptom-free ever, and so, sometimes, it’ll get worse than others, of course.
Part of what helps, I think for me, to determine if it’s a Crohn’s flare, I’ll also have a lot of joint pain with my disease and such. But, for example, in January, I mean, I was going to the bathroom pooping 10 times plus a day. So exhausted, super loose stools, just miserable. And, I had a colonoscopy, and my colonoscopy actually looked pretty good. It wasn’t disease-free but because they still saw inflammation in the small bowel. But, it was the best of all of my colonoscopies yet. And so, for example, they wanted to keep me on the medication that I’m on right now which is Stelara. And so, this is really interesting, this conversation even just this far to me because I’m like, “Well, what if this Stelara is treating my IBD, inflammatory bowel disease, and what if I could be taking more proactive action to try and treat the IBS side.” So, I’m very intrigued by your differentiation of it.
Okay. So, with the foods, continue a little bit on your story. You started playing with some trigger finding out what your triggers foods are, and then, like you said, adding in variety of your diet. And so, I mean this might be like a really loaded question, but how long did it take until you were feeling some improvement in your symptoms?
Brittany: Well, I think the thing is, I made these changes, I improved the overall nutritional quality of my diet and found some better alternatives over the span of, I mean, really even to this day. So, I think over the span of 10 years. But, certainly, I help some of my clients in three months find their trigger foods or whatever it is. And, usually, people can start–well, I don’t want to obviously guarantee anything. But, some people can start seeing results faster than others, some people within a week of making changes see a pretty substantial change. It just depends on the person, and their trigger foods, and where they are.
Chelsea: So, we had talked a little bit before the show about like you said you had a lot of bowel movements in a day and really loose and it’s draining, it’s just so exhausting. And, I feel sometimes, that will be enough that it takes away all my spoons for the day. And, my sister-in-law, I said she has IBS, and she would be able to relate because she’s had moments like that. And, it’s just exhausting. And, it’s hard to stay hydrated, and then, it’s you want to eat because maybe it’ll help if I eat, but then I don’t even want to put anything else into my body because I don’t want anything to have to come out of my body. I mean, I’ve been in that place more than I could count. So, I’m curious what you may be found for your foods or lifestyle that helped you go from those 10 plus bowel movements a day down to a more normal 2 to 3. What sort of, I don’t know, was there anything magic that happened there or was it a combination of things? Was it over a lot of time? Can you talk about that a little bit?
Brittany: Yeah. So, I mean, I think that my medication helped as definitely part of that. Over the past few years–well, it’s actually interesting because my last flare-up was, I believe triggered from the stress from planning my wedding, as I planned it last minute for some reason. But, interestingly, right after my wedding–and so, that was kind of an ah-ha moment for me because I realized, “Oh, I’m doing all these other things for my health, but I’m like completely neglecting mental health.”
And so, that was kind of the ah-ha moment to help me start implementing a daily stress management activity. And so, I realized, before that I was like, “Yeah, exercise helps me, but it makes me feel good, but it’s not building stress resilience for me.” So, that’s where I learned how important that has been and that has been really helpful for me in reducing symptoms overall. But, on top of that, certainly–wait, I’m sorry, what else did you ask?
Chelsea: No, you’re answering it. What–
Brittany: Oh, what has changed? Sorry, go ahead.
Chelsea: What is your daily stress management kind of practice? What do you do for that?
Brittany: So, I meditate before bed or do some sort of diaphragmatic breathing, which is basically focusing on your breath.
Cassie: Oh, my God, Chelsea, I feel you starting this breathwork, the timing of it. So, Chelsea just started this breathwork course and this is our third podcast interview that people are talking about breath and the change it made. And so, Chelsea, I totally feel this was the missing element for you and these are signs.
Chelsea: I struggle with anxiety and stress, which is kind of funny because I also teach people how to help me. Because I’ve been stressed so much in my life, I have lots of good tricks, but I kind of felt I got to a point where it’s not getting any better on my own. And so, I was like, “Oh, it’s my breathwork.” And so, the fact that it has come up in the past couple interviews that we’re doing. I guess now we have to do an episode on breath work, Cassie.
Brittany: Yeah, I know. For me, it’s really–And also, I think especially in the past few years, I really tuned into my body, trying to listen to my body even more than I ever have. So, part of that is listening to the cues, the stress cues it gives when it’s like an SOS. You just had a nightmare last night, that’s probably a sign that you’re a little stressed and it’s taking it into your–because during the day, I’m like, “Yeah, I can handle stress, I got this.” But, that doesn’t mean that it’s not being internalized and affecting my disease. So, that’s why I have to do something actively every night, build up some stress resilience, and also listen to my body cues. Sometimes I get really tight in my shoulders or neck, that’s also a signal to me to myself that I need to stop working 12 hours or 14 hours a day and give myself a little more time to relax and unwind, and it makes a huge difference.
Cassie: Gosh, that’s so inspiring. I mean, especially with you saying that you got more in tune with your body even on a deeper level. Because I know that Chelsea and I have talked with people also on this podcast and in-person and ourselves, that sometimes when you have a chronic illness, you don’t want to be in tune with your body, it’s hard to do it. And, that having to connect on that level is really hard. And, I know that I kind of go in and out, there’s some ways that I’m super in tune with my body and I know what’s going on. But, I’m actually similar with you where I’m really good in high-stress situations, but then, the physical fallout, I still haven’t fully acknowledged how that is truly affecting me. I’ll be like, “I’m great at handling this,” and then it’s the next week that when things calm down or that stress is done, that then my body is like, “Okay, no, you didn’t handle that well.” And now, I’m really sick and all this stuff.
And so, only in recent months, actually during the coronavirus, quarantining and actually really having that time at home and being able to be more in tune have I begun to realize that. So, meditation and breathwork is huge. And, that diaphragmatic breathing, that really helps with–Isn’t it the vagus nerve?
Cassie: Vagus nerve. Because my physical therapist was talking about that. And, in fact, when I would talk to her about having frequent bathroom moments and rectal spasming is a big one of my symptoms. And, she was like, “Why don’t you give it a try doing that vagus nerve diaphragmatic breathing. See if it can help relax it and show me how it’s all connected.” And, it did make a little difference. So, maybe I should be doing more to give it a chance to make a bigger difference.
Brittany: I mean, I have a client who I just finished working with. And, she has a pouch, she’s had one for about two years. And she–
Cassie: Will you tell people what a j-pouch is? They may not, or any kind of pouch just like Chelsea said, maybe some of our listeners don’t know.
Brittany: So, I guess, I’m not really sure how to fully describe it, but I know that they connect your intestines into a j.
Cassie: It’s a version of an ostomy bag, I don’t know, because when you get an ostomy and there’s various different ways, like you said, that you have your ostomy bag, like j-pouch. Stoma is the part that goes into the bag, I think, I don’t have
Brittany: The opening.
Cassie: The opening, right. So, basically, for the listeners who don’t know, there is a part of your colon that has been surgically adjusted and your pouch takes most of your waste.
Brittany: So, I believe, usually in that situation with the j-pouch, your colon is completely removed, I believe.
Cassie: Yeah, okay. I think it is mostly completely removed, like you said, too. Because then there’s I’ve heard of what they call the “Barbie Butt surgery,” where they take out your rectum and everything, too. So, there’s definitely variations of intensity with that. So, you have a client who has a pouch?
Brittany: Yes, and she used to–When we first started working together, she was going to the bathroom still, multiple times a day to change her bag. And, even actually throughout the night, usually once or twice. And, simply focusing on breathwork and relaxing her body at night, she’s now able to make it through the night without going to the bathroom.
Brittany: So, initially, it was almost out of a habit that she would frequently get up to go to the bathroom. And, also in her bed, she would have these moments of, “Oh, well, do I have to go to bathroom? I don’t want to have an accident. I’ll just go.” And so, it was a lot of this mind-body reaction where when you start thinking about having to go to the bathroom or worrying about having to go to the bathroom, even if you don’t have a pouch. A lot of patients with IBD have the same kind of anxiety in those types of situations. This is especially where the breathwork and stress management meditation can really play a huge role in reducing the symptoms because of those types of reactions.
Cassie: Gosh, that’s fascinating. That’s super interesting. Now, I’m wanting to try that in the morning. Because you’re right that–because I even remember, I started one of my GI doctors prescribed me Dicyclomine. Dicyclomine is a drug that essentially suppresses the nervous system in your gut. It’s a gut anti-spasmatic, it’s the name of this medication or the purpose of it. And so, again, I have a lot of this rectal spasming, but also I have so much chronic pain in my abdomen. And the doctor was saying, sometimes those nerves and the neuro, the pathways and the receptors, because they have had trauma for so long, they think they have trauma or pain or are experiencing that when actually they’re not. And, that was really interesting to have him explain it that way.
And so, sometimes I take that, which is it essentially suppresses the nervous system in the gut. And so, if you could get your breath to help with that. Because that is really interesting, like you said. It’s almost like phantom limb in a sense of if you are so used to having to go to the bathroom all the time, and maybe in reality, you realistically don’t actually have to go but your body and your nervous system is like, “No, I do. No, I do.” Or, you don’t want to have an accident, or you have anxiety about going. That’s like super interesting, I never quite thought of it that way.
Chelsea: I’m having so many epiphanies right now.
Brittany: Oh, good. Yeah, I say this, but I know it’s not, and it’s not like, “Oh, well, now everything has changed.” It’s a slow process just like anything else where you need to stick with it, but you can see pretty amazing results from that alone for sure.
Cassie: Gosh, that’s so awesome. That’s so awesome.
Chelsea: It’s so interesting to see how stress can just impact our body in such a physical way. Even though it’s a mental experience, it’s just a physical manifestation all the time. So interesting.
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Brittany, since you talked a lot about trigger foods, finding trigger foods, is there a process that you recommend to people that are trying to maybe figure out, “Oh, does this food trigger me? Does it not?” Because I know there’s some foods that I know don’t make me feel the best, but I’m sure there’s some out there that everyone kind of experienced, a little bit of that’s not the best food for me. So, how do you kind of recommend people going about figuring out, “Okay, this is the trigger food and this is kind of what it leads to”?
Brittany: So, personally, I think it’s really hard to find this stuff on your own if you’re not trained in it, to be completely honest.
Chelsea: That’s really fair.
Brittany: So, I would recommend, mainly because food intolerances can be both time and dose-dependent. So, you could eat, let’s say, a bite of an apple today and have an immediate reaction, or, it could take three days for your symptom to manifest. You could also eat a bite of an apple and be totally fine, symptom-free, but if you eat the whole apple, have symptoms for days. So, partly because of that, it makes–it’s interesting because when I was first diagnosed, I’ll never forget that my gastroenterologist told me, everyone always says, “Oh, do write down all the foods that you’re eating, do a food diary to find your food triggers.” I was like, “Okay, I’ll do that.” And, I wrote it out, I wrote everything I ate for a week, brought it in to the next appointment, and I was like, “I did it, I wrote out all my food.” And he was like, “Great, keep doing it, see if you find anything.” And I was like, “What? No, that’s not helpful.”
Cassie: But I did the work, you’re supposed to tell me what it means.
Brittany: Which frankly, he should have at that point been like, “No, let me refer you to a dietitian who’s trained in this.” Because he probably wasn’t even trained in it. But, I think that because of that, I don’t know, maybe other people are more well-versed than I was which could be very possible. But, I know I didn’t have any idea what to look for. And, certainly, there’s some of those common ones that probably you already know about, but if something’s really spicy, you might have an immediate reaction to stuff like that. If it’s a really fatty or greasy meal, a lot of added sugars. But, the thing is, sometimes there’s because of that dose-to-time reaction, there could be other trigger foods that you just don’t know about because of that. So, it’s really hard to find all of your trigger foods unless you truthfully get an expert.
So, I know there’s a bunch of food sensitivity testing out there, none of them have been validated by research studies. So, basically, none of those tests have been validated to see for their reliability and their accuracy. So, we don’t know if you do the same test today and next week, if you’ll get the same results. We also don’t know if those results mean anything.
Brittany: So, when clients come to me with like, “Hey, I have these test results from this sensitivity test.” I’m like, “You don’t even have to bring them in.” They’ll always say like, “Oh, yeah, it basically–” And, I also just, I’m very upset with all those sensitivity tests because they’re having you do all these testings and then what happens is I get a ton of clients who are eating five or ten different foods every single day and it’s just such a limited diet. And, because of all these sensitivities that they have that they actually don’t have. So, it’s something, if you can tell, very angry about because it makes there’s already so much conflicting information about nutrition and IBD. And so, when someone is trying to make money off of that, it just kind of upsets me.
Cassie: Yeah, totally. Well, that’s again, fascinating. I’m sitting here like wow. Because I’ve done food sensitivity stuff, and I did–The most recent one I did was Viome, which is like stool sample food sensitivity to check your gut microbiome. And, there’s a couple things on there that it was like, “You have a sensitivity to that.” And, I was like, “Yeah, I do, I just was ignoring it.” I could tell tomatoes really are not the best for me. And so, I was like, “Okay, validated, taking that out.” But you’re right that often, and I’m sure this has to be true for many chronic illnesses beyond just IBD like RA and stuff, you end up eating like five to ten foods. And, I know that I’m in that rut right now, and I’m super unmotivated to cook food, I feel very lack of joy when it comes to food. But, I was raised in an environment where we ate rainbows on our plates and all the different types of food, I’m really grateful that I was raised with such because I don’t think that was the norm. My mom was definitely a hippie for a while, and she literally would, with the plate of food, she’d be like, “Oh, that needs a little bit of this color, and doesn’t that look, doesn’t that just make the salad pop when you add this coloring to it.” And, I’d be like, “Oh, yeah, it does.” So, we were not only introduced to a giant variety of foods and also the different colors of foods. But then also, taught to appreciate what you’re eating and enjoy it and savor it and flavor it, and all the great things that they say that you should do with food.
And, I’m not doing any of it anymore, these days except for maybe when I’m like, “This chocolate chip cookie and this cake is the bomb, I’m going to enjoy every bite of this.” But, you’re right. We do so often end up being afraid to eat so much and then there is so much restriction, too, that we eat like five to ten things. So, are you able to eat a lot of vegetables?
Brittany: I am. So, I am, but I think again, it was a slow process. And, I believe that every person, unless I’ve come across someone, unless you just recently if you have toxic megacolon, or you’re probably about to get surgery at that point. There’s pretty much not a lot of times where you can’t have any vegetables, I can’t think of any time. But, it’s a matter of finding the vegetables that you can tolerate that you don’t have any sensitivities to and also making them easier to digest.
For instance, instead of one vegetable group that works well with most people with IBD is basically any squash. Butternut squash, spaghetti squash, acorn squash, zucchini, yellow squash, and that’s a bunch of foods right there that you can tolerate. And, they’re as long as your vegetables are cooked well, and you don’t have any of that tough skin on, because insoluble fiber which is prevalent in those tough skins is hard to break down for really anyone. Even healthy people, let alone people in a flare, which it could trigger worsening of IBD symptoms, like running to the bathroom or anything like that. So, but the interesting thing about insoluble fiber is that if you actually just wrote a paper for dietitians on this, but if you break down the fiber, the insoluble fiber into smaller particle size, it’s much easier to tolerate. And, there’s actually no research, there’s minimal research studies that support a low fiber diet in IBD patients.
Chelsea: Oh, really?
Brittany: That’s very–It’s actually quite interesting, there was just 2020 guidelines published in, I believe the Journal of Clinical Gastroenterology and Hepatology. But, basically, they say it’s all about restricting insoluble fiber in certain population groups in IBD. So, if you recently had a stricture, if you’ve ever had a history of a blockage, those are cases that maybe you would need to restrict insoluble fiber. There’s still not a lot of research on that to support it, and again, in my experience, I’ve helped clients work from eating one, for instance, well, she didn’t. So, I’ve had clients who work from eating one or no fruits or vegetables, up to five-plus servings of fruits and vegetables a day. So, it’s a matter of how slow you do it, it’s a matter of finding the right, breaking down the insoluble fiber, whether that means to cook it heavily, blend it, puree it, juice it, anything like that will help increase the tolerability of fruits and vegetables. So, it’s not a matter, in my opinion, fruits and vegetables provide so many vitamins, nutrients, we should be consuming these just as often as the general population. It’s just a matter of finding the right ways to tolerate them and finding the ones that work for you.
The 2020 guidelines basically said unless you have stricture, blockage, if you had recent surgery, and if you have toxic megacolon, in those cases you may need to restrict insoluble fiber for everyone else. Pretty much you can continue eating it. In any situation, even with healthy people, you’d want to slowly increase it in your diet rather than going from no fiber to eating nuts all day, that would cause an increase of trips to the bathroom for a healthy person. So, it’s also going to do the same for people with IBD.
Cassie: Oh, my gosh. This was gold, everything that you just said just now, this was totally what I was hoping. We could get into some on the episode, too, especially the talks about fiber. Because I was put on a low fiber diet for a freaking year and a half after I had a small bowel obstruction. And then, I was scared to eat fiber after that, I was on AIP for two and a half years before that which is the autoimmune protocol. And, they told me in the hospital, they’re like, “Well, you were eating too many vegetables, your gut can’t digest it. And so, basically, because you’re eating so much salad, you have a small bowel obstruction.” And, I was like, “You’re wrong, that can’t be the case. Vegetables are good for you, you people are insane. This is nuts.” And then, after having an NG tube up my nose for a week, then I was like, “Okay, now I’m afraid to eat salads.” But, then I have also read some articles from Healthline or Mind Body Green, and stuff that talk about more fiber the right way healing IBD. And so, this is super interesting.
Brittany: Yeah, I mean, I wouldn’t use the word healing IBD. But, certainly, and I think for you, in that case, you just had surgery, or I’m sorry, you just had a blockage. So–
Cassie: I was in that–
Brittany: I would not recommend going right into salads. And certainly, salads are high in insoluble fiber. So, doing a cooked salad would be much better for you.
Cassie: Is it correct that steaming vegetables is one of the best ways to keep the nutrition? Maybe that’s too much of–
Brittany: It is a great way of maintaining the vitamins and minerals. I really have the mindset of, I find that gross, I don’t know if other people do, but if you’re not going to eat the vegetables because you don’t them steamed, then find another way. I love roasting pretty much all my vegetables because I have the biggest sweet tooth ever. So, I like getting them a little caramelized, and so, that they’re even sweeter when I taste them. So, I think it’s really about, it’s like, “Okay, I’m losing a little bit of vitamins and minerals but if I’m consuming 10 servings of fruits and vegetables a day, I’m okay to lose a little bit of that if it means I’m eating more of it.”
Cassie: Well, that’s so awesome, too.
Brittany: I think it’s really finding what works best for the individual situations. But, back to what you had said about the fiber and IBD is actually there’s a research study that in Crohn’s disease patients who did not have a history of complications. So, they didn’t have strictures or blockages any of that kind of stuff, they didn’t have surgeries, in those patients actually there’s a research study that suggests those who consumed the least amount of fiber were the most likely to flare within a six-month time frame. So, actually, in that population group, it’s recommended for them to increase their intake of fiber.
Cassie: Oh, interesting. Okay, cool. That’s really interesting. Because when I did read some of those articles, there was this part of me that–Because I actually love vegetables, like I said how I grew up, I like ALL food. But, there’s this food fear that kind of goes along with some of that stuff, too. And so, when I read that article there was this little part of me that was like, “Oh, maybe I can eat all these foods that I love so much.” And so, I have a client also who has gastroparesis, and I think she has IBS and pots. Chelsea, you know her, too, and EDS. And, her doctor at Mayo said that the best vegetables to tolerate, the best way to tolerate or the easiest way to tolerate vegetables is canned vegetables. Because they have already been processed in a sense that they’re more easily digested. Do you ever have people starting with canned vegetables? Because to me, they’re not even nutritious at this point, but that might not be true.
Brittany: I, personally, like to try to have everyone try to eat more whole foods rather than canned or processed. If they’re sensitive to–I’m just going to give an example of, if they’re sensitive to certain types of fibers and sugars in peas, and they’re doing canned peas, if you drain and rinse the peas multiple times, you actually make it easier to digest that because you’re washing away that water-soluble component that can just potentially be triggering symptoms. But, that’s not–I wouldn’t say, for most, I would never recommend that as my first line.
Cassie: I found it kind of interesting.
Brittany: I try to go with the whole foods that are best tolerated.
Cassie: Yeah, that’s especially you talking about the squash thing, that’s great to know. Like you said that’s there’s a bunch of different squashes, and when she did tell me that, I did find that interesting where I was like, “Man, it makes sense because they are more processed and one generally, even when you get given the Crohn’s and colitis pamphlets, with your diagnosis. ” And they’re like, “Eat donuts because they’re easy to digest. White bread, it’s easy to digest. Canned vegetables.” And, it was devastating, because I was like, “Okay,” but I’m not giving my body nutrients.
And then, you have chronic fatigue and joint pain and probably blood sugar issues. And, it’s like, “Well, I’m not being able to give myself whole foods, real foods. And again, I think that this conversation although it has mostly stemmed around IBD, people, it’s true for many autoimmune disorders because it may not be that you’re running to the bathroom 10 times a day, but you might have crippling joint pain with rheumatoid arthritis, or terrible chronic fatigue or with endometriosis. There’s all this, cramping or hormonal stuff, a lot of endometriosis patients, too, have a lot of bowel issues. And so, it is a conversation that hopefully everyone, you can all benefit from whether you have IBD or not, I think. And, Chelsea, I know that you’ve nodded your head and been like, “Wow” this whole time, too, with having it was super interesting.
Chelsea: Well, I think the biggest takeaway that I’m hearing from you, Brittany, is with something that I think a lot of people need to embrace a little bit more. And, I actually just happened to see, I can’t remember whose Instagram story it was, but it’s basically the concept of, “Don’t do everything at once, start slow, and make small little changes and see how that goes. And then, keep making small little changes, we live in a society.” And this is what the Instagram story, I wish I could remember who it was from but they were kind of talking about we live in a society that we want instant gratification. We want our problems fixed yesterday, we don’t always want to go through the process of getting better. We would rather try something that was going to take 30 seconds of our time, but just maybe we keep what–We want to keep trying to 30 second quick fixes to see which one sticks instead of just being, “It’s going to be a long process, but I know at the end, I’m going to feel pretty dang good.” How you said even you’ve been going through this process for 10 years and it’s still a constant process. But, I mean, to me, isn’t it better to start small and make small little changes than just starting over?
Brittany: No, I actually, I always tell this one. Because I have a lot of clients that obviously, patience–I understand it because people especially when they start a program, they’re like, “I want to make all the changes now, I want to see results.” When you’re feeling terrible all the time, you want those changes as soon as possible. But, a story I like to remind them of is the childhood story of the tortoise and the hare, about how they’re racing to a finish line, and the hare runs past him, and sprints ahead, gets tired, decides to take a break, falls asleep. And, in the meantime, the tortoise, who obviously had a much slower pace, ends up crossing the finish line first because he never stops. And, I think it’s so true, the moral of that story is that small consistent steps are almost always more successful than taking drastic, multiple changes at once. And, I think in a society where it’s very diet-focused, I mean, there’s so many IBD diets that you could potentially do out there. But, in my understanding, they’re all so restrictive and they’re going to be drastically different than what you’re doing already. So, when you go on one of these diets, it’s so hard to maintain for the long haul because it’s so restrictive. And, if you feel restrictive with your diet, there’s no way you’re going to be able to maintain that for the long haul. So, you need to add more variety, you need to add more things into it, so it can be something that you can maintain for the long haul, but you have to do it in a slow way. And, I think that’s where getting the support of a coach, I know that you’re a coach as well, or a dietitian that specializes in this help you through the process so that you can stay focused on it and actually get to where you want to be.
Cassie: I’m so glad that you said that. Finding something that you can maintain, seems to also be a theme that with various people we’ve had discussions with in the medical field or in the nutritional field like you’re in. That does seem to be one of the big keys is finding something that you can actually maintain and do because then you can stick with it and do it. It’s kind of same thing with exercise, too, finding an exercise regime or movement regime that feel you can stick with is going to make it, so you do it.
Cassie: I mean, this was such an informative hour. I’m so glad that we got to talk with you about all this stuff. I really feel I had some huge ah-ha moments, especially I think where I’m at with my disease, my mindset, my health, this was really interesting for me and I’m sure all of our listeners are going to find it fascinating. So, can you tell people what you do with your website, your coaching, and then how people can find you if they want to work with you or get more information, and all of that good stuff?
Brittany: Yeah, so, I work with clients usually with Crohn’s or colitis, and I help them find their trigger foods, get more energy, help them gain weight or lose weight depending on where they are with that, regulate their bowel movements, slowly increase adding exercise into their diet, and reduce stress, and all that. And, probably most importantly gain a better relationship with food, and I have more of a more programs rather than like, “Here’s a session,” because just like anything else, you need support and that’s how people become successful in making changes. So, I have programs, and if you’re interested in working with me, you can always reach out to me on Instagram, my handle is @brittanyb_therd. Or, you can go to my website, www.brittanyroman-green.com, it’s a long one. And then, there’s a contact form on that that you can reach out.
Cassie: Perfect. And, we’re going to put those in the show notes, of course.
Chelsea: Well, Brittany, thank you for spending time with us today. This has really been a great conversation; I’ve learned a lot, I hope our listeners have learned a lot. And, I also just want to thank you for doing the work that you do, because it is very much needed in our world. I think doctors and medical professionals and healthcare professionals do a really good job, but they unfortunately just don’t get the education on nutrition and exercise and it sounds like you were a really good person for people to go to get that expertise that they need. Because you’re right, everyone’s different, everyone’s gut is different, the way foods react with people will be completely different. So, having the accountability and the support of someone who actually knows what to look for, and the fact that you’ve struggled with this yourself, you get what people are going through and you can really help them in a way that’s actually going to help them feel their best in the long term. So, thank you for your time, and thank you for what you do.
Brittany: No, thank you guys for inviting me and having me today. And, thank you for what you do in you’re in the community as well.
Cassie: We hope you enjoyed today’s episode. Please write us a review to help us reach more people like you.
Chelsea: If you’d like to connect with Cassie and I, you can find us on Instagram, at The Real Spoonies Unite. You can also join our private Facebook community, Spoonies Unite, or you can visit our we
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