Dietetic Internship · Life · Topic of the Week

7 Things I Learned As A Dietetic Intern

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I’ve been slacking…I meant to write this post right after ending the internship. 

My laziness has gotten the best of me. Not to mention that starting a new job is EXHAUSTING! 

Anyways, looking back on the internship I’m realizing there was a lot that I learned that would have been helpful to know beforehand and I thought it would be worth pulling together a post solely dedicated to that topic. 

I know internships are different depending on where you go, but I think there are some things that can be applied no matter where you’re interning.

1) Dietetic internships are a learning experience. At the beginning of my internship I know everyone was struggling to complete study guides and try to review as much as they could. I was no different. It may sound silly, but I think it really took a while for it to sink in that you are in an internship to learn and in order to learn you can’t start by knowing everything. Dietetic internships are intense and interns are held to very high standards, but it’s okay to admit you don’t know everything. Start the internship as prepared as you can be but remember that you are supposed to be learning. 

2) You will never have a routine. By nature, internships don’t really allow yourself to establish a routine. I went into mine thinking I would have some kind of routine but that ended up not being the case at all, which honestly stressed me out a bit. Maybe you’ll have a routine for a month or so, but then it will switch. Being a dietetic intern is all about being adaptable, that is for sure!

3) You’ll feel like you’re starting a new job every time you start a new rotation. You’ll be learning your way around new facilities, meeting new people, trying to establish relationships with new preceptors, completing new projects, attempting to blend in to the day to day routine, and as soon as you feel confident and know what you’re doing….you’ll switch rotation sites. Don’t let it stress you out, just go with the flow. 

4) Ask questions, take notes, gather handouts/resources whenever possible. As I said above, this is a learning experience. Ask questions when you think of them, write things down that you’re learning, ask if you can keep copies of handouts/resources that you’re shown by preceptors…do everything you can to assure that you don’t leave your rotations without at least some record of what you learned. 

5) If you want to include a specific experience in your internship, ask. It took me way to long to realize that it is okay to ask if you can see/experience certain things. The interns in my internship were split up between 2 hospitals and at one hospital the interns got to watch NG tube placements but where I was we didn’t…so I asked if I could watch one. Of course they said yes and I was able to watch the placement and learn a LOT. If you want to see something, ask. The worst you can get is no for an answer. 

6) Send thank you notes to your preceptors. I didn’t even think about doing this until I was at my third rotation and noticed that my preceptor had a thank you note from one of the other interns. Immediately, I started sending them after completing rotations and I realized how important it really is. I had to use quite a few preceptors as references when I applied for my job and it was nice to know I had fully articulated to them how much I appreciated them taking the time to teach me. 

7) The internship is not forever. I think everyone reaches the point in the internship where they are just plain worn out and tired. It’s hard going to multiple rotation sites, it’s hard not getting paid and feeling like you’re working for free, it’s hard to always feel like you don’t know enough, but it’s not forever. Unless you’re doing an MS DI, your internship is probably somewhere between 6-12 months long. It’ll be over before you know it, trust me! 

I know I probably learned a lot more in the 9.5 months that I was in my internship…but this is all I can think of now! 

Happy Friday, enjoy you’re weekend 🙂

Community Nutrition · Topic of the Week

Intuitive Eating

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If there is one thing I’ve really started to notice in the last few months, it’s that most people don’t give their bodies the respect that they deserve.

What do I mean by that? I mean that every time I get on Pinterest I see something someone has pinned about a new fad diet, or a way to drop 10 pounds in a week, or the new “superfood” that everyone should be eating. I see it on the side bar advertisements on Facebook. I see Instagram pictures of girls I went to high school with who are incredibly tiny, posing in a bikini, with a caption “not where I wanna be, but getting closer every day.” Almost every single day I hear someone justify a food choice or why they haven’t worked out.

The question that has come to my mind more and more recently when I see all these things happening is “is that what your body really wants? Is that what it really needs?”

Why do we feel like we need to all fit into a set of rules?

The more we focus on rules when it comes to eating and health, the more we teeter on a dangerously fine line that can lead to a full blown eating disorder.  The average individual who has a healthy, normal relationship with food spends about 10-20% of their day thinking about food.  Not that much time at all, right? Right.  Well, those who are dieting or have a disturbed eating pattern spend about 20-65% of their day thinking about food.  Those with bulimia spend 70-90% of their time thinking about food, and those with anorexia spend 90-100% of their time thinking about food.

Essentially, it’s not healthy to spend a significant amount of time thinking about food.  If you’re dieting to be “healthy” you might actually be setting yourself up for some not so healthy habits in the future.  Habits that in no way respect your body or it’s needs.

So what can we do to stop this?

The concept of intuitive eating was introduced to me a few weeks ago and I think it’s probably the answer we all need. Intuitive eating has 10 principles that focus on respecting and honoring your body instead of focusing on an arbitrary set of rule that we’ve set for ourselves.

1) Reject the diet mentality.  Stop dieting, it doesn’t work.  Sure, you may start a diet and see some instant results, but do they last? Likely not. There is nothing more depressing than losing weight and then gaining it all right back. The best thing we can all do is stop looking for those quick fixes, they can be detrimental to a healthy relationship with our bodies and food.

2) Honor your hunger. I think this is huge and can be a really scary step for a lot of people.  Our bodies need fuel throughout the day and it’s our responsibility to give our bodies the fuel that they need.  If we’re hungry and we don’t honor that hunger and try to fight it, we’re much more likely to overeat later once we’ve reached that ravenous hunger point. We need to learn to recognize our hunger and refuel our bodies with the appropriate amount of food. If you’re hungry, eat!

3) Make peace with food.  Stop fighting with food. Stop labeling it as “bad” or saying you “shouldn’t have it.” Depriving yourself of certain foods can lead to uncontrollable cravings and binges that lead to feelings of guilt, which is worse than just allowing yourself the food in the first place.

4) Challenge the food police.  The food police is that little voice in the back of your head that tells you you’re “good” for saying no to the cookie or that you’re “bad” for not ordering a salad at lunch instead of a sandwich.  Stop listening to the food police and start listening to your body.

5) Respect your fullness. Make sure you’re taking the time to think “Am I still hungry?” when you’re eating.  This often requires pausing in the middle of a meal and asking yourself if you’re full or if you need to keep eating.  Eat until you’re comfortably full, not until you’re absolutely stuffed.

6) Discover the satisfaction factor. Eating should be satisfying!  When you eat what you really want, it’s much more satisfying than when you eat what you “should.”  When you allow yourself to have a much more satisfying eating experience you often don’t need to eat as much to feel like you’ve had enough.

7) Honor your feelings without using food.  Don’t let food distract you from other emotions, it can’t fix them.  Allow yourself to take time to identify what you’re feeling and find more constructive ways to work through them.  Eating to fix emotions will likely leave you feeling worse in the long run.

8) Respect your body.  We are all uniquely made by our own genetic blueprints.  As soon as we accept our bodies the way they are and stop trying to change them we will feel much better about ourselves.  Stop being critical and learn to love the beautiful body that you’ve been given.

9) Exercise- Feel the difference. Exercise doesn’t have to be a structured routine you follow because you “have” to in order to lose weight or because it’s what you’re “supposed” to do. Exercise can be passive.  Any kind of active movement counts! Most importantly you should exercise because it makes you feel good, not because you have to. Focus on how great it feels to be active instead of how many calories you’ve burned or how many miles you’ve gone.

10) Honor your health. Remember, one good meal doesn’t make you healthy and one bad meal doesn’t make you unhealthy. It’s a balance over time. Being healthy is a lifestyle, not a trend or a fad that you only have to stick to for a period of time. Health looks different for each individual person, so stop comparing yourself to others and focus on your body and how you feel!

 

Although this is an approach commonly used for those suffering from an eating disorder, I think everyone can benefit from eating more intuitively because we all probably have more disordered eating habits than we would like to admit. We can learn so much from our bodies, the more we listen to them the more they can tell us what they need and in turn we can start living healthier lives!

Topic of the Week

TOTW: The Sugar Epidemic

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This is a post I’ve been wanting to write up for a while, but I get overwhelmed every time I try.

Bottom line: this post is not going to answer all the questions about sugar. It’s probably not going to even get below the surface.

It’s just going to summarize the information I included in my big presentation at the end of my food service rotation…well, minus the part about healthy aging and obesity.  Not that it’s not an important topic, I just feel like it doesn’t flow with everything else in this setting.

We should probably start with the basics…

What is Sugar?

Sugars are chemically-related, sweet flavored substances that in their simplest form are the monosaccharides glucose, fructose, and galactose.

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These three monosaccharides are what your body absorbs and uses for energy.  Sugar is found naturally in the tissue of most plants and milk products but they all have varying types and amounts of sugars in them.

When most of us think of sugar we probably picture the white, granulated sugar you buy in a bag and use for baking.  That sugar is sucrose, which is 50% fructose and 50% glucose.  It’s different from lactose, the sugar found in milk, which is 50% glucose and 50% galactose.

What is High Fructose Corn Syrup?

Sugar is definitely a controversial topic right now, but I think it’s safe to say that high fructose corn syrup (HFCS) takes center stage in a lot of the debates.  HFCS is made from dent corn, the same kind that is used to make tortillas and tortilla chips.  That corn is turned into cornstarch through milling process, made into a liquid corn syrup, which is mostly glucose, through hydrolysis, and then an enzymatic process turns some of that glucose into fructose.

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Confused?

Basically, the name is misleading.  HFCS is not actually high in fructose compared to sucrose, it’s high in fructose compared to corn syrup.  HFCS actually has about the same amount of fructose as sucrose.  There are two types, HFCS-42 and HFCS-55.  The number corresponds to the percentage of fructose…so HFCS-42 is 42% fructose.

The sweet syrup gained popularity in the 1970s when the price of cane and beet sugar began to rise.  When manufactures realized they could make sugar out of corn, a popular US crop, the answer was obvious.  The sweetener was cheap and readily available, so manufactures began to add it liberally to their food products.

USDA data shows that from the 1970s to 2000, consumption of HFCS increased and consumption of cane and beet sugar decreased.  The calories in the average American diet also increased, from 2076 daily in 1970 to 2534 daily in 2010.  Interestingly enough, of that 458 calorie increase, only 34 calories are from added sugars.

Where is the Sugar Hiding?

It’s hiding in a lot of places…and it goes by a lot of different names that make it hard to find on food labels.

We expect sugar to be in sweet foods, like cakes, candy, soda…all those super sweet things.  Without putting too much thought into it it’s pretty easy to identify those sweet foods and cut them out of our diets if we want to avoid sweets, right?

Unfortunately, there is added sugar in a lot of other products too, like cereal, granola bars, salad dressing, vegetable juice, chips, pretzels, crackers, and even infant formula.

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It’s nearly impossible to escape if you’re eating processed foods.

So what can you do?

Eat more home cooked meals.  Eat less processed foods.  Read food labels!

Making any one of those changes can be completely overwhelming so start slow.  Rome wasn’t built in a day, after all.  If you are wanting to cut back on sugar a bit, look for these names on the ingredients list, they’re you’re hidden sugars!

•Brown sugar
•Confectioner’s powdered sugar
•Corn syrup
•Corn syrup solids
•Dextrose
•Fructose
•High fructose corn syrup
•Honey
•Invert sugar
•Lactose
•Malt syrup
•Maltose
•Maple syrup
•Molasses
•Nectars
•Pancake syrup
•Raw sugar
•Sucrose
•Sugar
•White granulated sugar
Overwhelmed? Don’t worry, you’re not alone.  The good news is that a new nutrition facts panel is in the works that will include “added sugars” as a separate category, making it easy to distinguish between the natural sugar that occurs in foods and the sweet stuff that’s added.
Honestly, it’s the added stuff that’s more of a concern if you ask me.  Some foods just have sugar in them naturally and it’s not that big of a deal if you’re not eating obscene amount of them.
The added stuff just shouldn’t be there though…it’s no good!
So take your new found knowledge and read some food labels!

 

Clinical Nutrition · Community Nutrition · Topic of the Week

TOTW: Lactose Intolerance

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Hello everyone!  It’s been a crazy week so far.  I’m currently living in Portland with my aunt’s in-laws, so my uncle’s parents.  My cousin’s other grandparents.  Following me?  Good.

Anyways, so I am with them for this week and the next while I have my rotation at the dairy council.  I’ll tell you more about that this weekend though.  Right now I’m in my “grandparents” kitchen writing this on my laptop.  I don’t have internet here unless I get on their computer.  Needless to say, I’m probably using a lot of data on my phone…

So since I’m at the dairy council, a large amount of the focus is, you guessed it, dairy. My first project I worked on this week was a blog post dedicated to a consumer question that gets brought up frequently.  Thankfully, they didn’t make me write about breakfast.  I think that topic is over exhausted.  Instead, I go to write about lactose intolerance!  Something I have personal experience with.  I found some really interesting things so I thought I would share them with you!

Me and lactose intolerance became friends in senior year in college.  I started having some uncomfortable symptoms typically associated with a food intolerance.  Since I was a nutrition major, I knew it could either be something minor or something major, so I went ahead and went to the doctor about it.  After a few visits and a few trial elimination diets, it was concluded that I have irritable bowel syndrome (IBS) and that lactose seems to be a big culprit in that.

Now IBS is a whole other topic, but basically it’s very individual.  Since I first pinpointed that as my problem I have discovered that it rears its ugly head during times of stress.  I also have discovered that when I’m stressed lactose tends to make things a whooooole lot worse!

So what exactly is lactose intolerance?  Lactose intolerance is sensitivity to lactose, the sugar in milk.  Those who are lactose intolerant have low levels of lactase, the enzyme in the intestine that is responsible for the breakdown of lactose during digestion.  This difficulty with digestion produces symptoms such as diarrhea, bloating, and constipation.

It would make sense to eliminate dairy from the diet then, right?  Well, this actually isn’t necessary!

Every lactose intolerant person out there should be doing a happy dance right now.

A few dairy products, like cheese, cheese, and Greek yogurt are fairly low in lactose and often can be tolerated well.  There is also thought that the live, active cultures in yogurt help to digest lactose.  Of course, there are also lactase tablets that can be taken before meals with milk or ice cream and a wide variety of lactose free dairy products are available now.

Dairy products are an important part of a balanced diet.  They contain calcium, vitamins, minerals, and protein that are difficult to replace if the entire food group is eliminated.  For that reason, it’s really important for those who are lactose intolerant to find a balance of quantities and types of dairy products that work for them.

You should also see your doctor before you self diagnose yourself!  There could be something else going on that could be otherwise overlooked.  Proper diagnosis is essential.  Lactose intolerance is not a dairy allergy but since they could potentially present similar symptoms, it’s important to eliminate that possibility before you start eating dairy again.  Those with a dairy allergy should NOT eat dairy!

Studies have found that those who completely eliminate diary from their diet have a lower quality diet.  If you can include it, it is actually much more important than you might realize!

 

For more information visit http://www.oregondairycouncil.org/resources/healthy_eating/beyond-bellyaches-sfai-handout.pdf

Holidays · Life · Topic of the Week

TOTW: Holiday Meals

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If we’re being honest, a lot of us have some kind of apprehension or anxiety when it comes to holiday meals.

At least I do.

If we’re being honest, last year my anxiety about food almost ruined my holidays.

I wish I was exaggerating about that.

Although I won’t consider large holiday meals “bad” meals, I think it’s important to remember that going overboard a few times during the holiday season is just the same as eating healthy a few days, your overall health is what really matters, not just those few meals.  If you eat healthy most of the time and work out regularly, letting yourself enjoy the stuffing and potatoes and pie is not going to ruin everything you usually do.

Last year, I was way too obsessive about how much I ate on Thanksgiving and Christmas.  I found myself focusing more on that then the people I was surrounded with and in the end it just made me feel gross.  I actually know I ate more last year because I was obsessing so much.  It was also my first year away from home for the holidays and instead of taking the time to get to know new people I really think I just ate my feelings.

Like I said, we’re being honest today.

This year, I am happy to report that Thanksgiving went a lot different for me.  I was yet again inspired by the Real Life RD and her post about enjoying Thanksgiving.  I really took this one to heart and it made a world of difference.

I was with Meghan’s family again this year for Thanksgiving and I really think that helped.  Everyone was familiar and I wasn’t spending time introducing myself and trying to feel comfortable.  That being said, her family is awesome.  They are so welcoming and so much fun to be around.  It makes me want a big family, my tiny family never has as much fun as they do!

Instead of worrying about what I was eating, I just ate.  It was Thanksgiving! There are so many other things to think about, like how incredibly blessed I am to have a friend like Meghan whose family will open their arms to friends and visitors.  So I ate appetizers and drank wine and stood in the kitchen just talking and getting to know everyone better.  When the turkey was done I took my plate (and of course my wine) and went down the buffet line filling my plate with all the things I wanted to eat.  I took too many potatoes (like actually too many) but you know what, I love potatoes so I ate them all.

I took a little bit of everything I love (and too many potatoes) on my plate and after I had finished everything, I had no desire to get seconds.  Never in my life have I said that before.  Now listen, there is nothing wrong with seconds and if I hadn’t taken so many potatoes the first round, I know I would have gotten more.  However, this year, I just didn’t want them.  I wasn’t obsessing over my food and it felt soooo good.  So we sat around and talked and drank more wine and then pretty soon it was dessert time.  I took the things I wanted and ate them and after that I was stuffed.  And I was okay with being stuffed.

I felt so happy this year and I can’t remember the last time I’ve felt that way on a holiday that involves a big meal.  I was away from my family this year again and I missed them a ton but I felt lucky to be surrounded by the people I was surrounded with.  After dinner, we went and played apples to apples and I started thinking about how little I had thought about how much I was eating and how much better I felt.  My full stomach made me feel content.  It made me feel lucky that I had that much food to choose from.  I made me grateful that I never have to worry about where my next meal will come from.  It didn’t make me feel guilty about how much I had eaten, like I normally would have.

So for the rest of your holiday meals, whatever they may be, focus on the people around you, not the food you’re eating.

If we’re being honest, I think it’ll make your holidays a lot more enjoyable 🙂

 

 

Clinical Nutrition · Dietetic Internship · Topic of the Week

TOTW: Celiac? Allergy? Gluten Intolerance?

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Hello all! I finished my rotation at the hospital yesterday, it was a bittersweet moment.  I’ll get to that later though.

One of the many things I learned, or learned more about, in my time in outpatient was celiac and gluten intolerance.  I’m very aware of the fact that there is a difference between the two, but I never really had anyone break it down for me.

Well, when we had another person not show, D spent some time talking to me about the differences.  She gave me a handout from the Gluten Intolerance Group titled “Celiac, Allergy or Non-Celiac Gluten Intolerance: What is the Difference?”  Basically, this handout is really detailed and helpful for someone like me, who already knows a fair amount about the disease and can build off that knowledge. If I was just learning about it, this handout would make me overwhelmed and confused.

It has a lot of good information though, so I will summarize it for you.  I think there is a need for more knowledge about celiac and gluten intolerance out there.  It’s really more than just a fad.

Celiac Disease

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Celiac is an immune and autoimmune reaction the protein gluten.  It affects different parts of the body and those reaction may change with each exposure or over time.  It is commonly associated with GI discomfort such as IBS, indigestion, abdominal pain, bloating, nausea, vomiting, and diarrhea.  Along with that it can cause fever, fatigue, constant headaches, migraines, rashes, hives, joint pain, and muscle pain.  A person with celiac disease experiences at least some of these symptoms when they eat a food that contains gluten.

Although all those symptoms can make someone uncomfortable or just feel downright sick, the overall discomfort is really the smallest concern here.  Someone with celiac who eats gluten is actually causing damage to their intestine.  Since this is the case, anyone with celiac has to follow a strict gluten free diet for the rest of their life.

Due to the severity of celiac, it’s important to have it diagnosed with a blood test (called tTG) and an intestinal biopsy.

The good news for celiac is that in a few years there may be drug therapies available that would make celiac disease easier to deal with overall.

Allergy

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A gluten allergy is considered an IgE-mediated allergy. What does that mean?  To put it simply, IgE-mediated allergies are “common allergies” and the IgE is an antibody (a type of protein) that works against certain foods.  Most children with common food allergies, like a wheat allergy, outgrow them, but adults aren’t as lucky and usually keep them for life.  At this point, it’s not clear if the allergy is to wheat or gluten but either way it is a reaction to a protein or chemical in the food.

Allergies have fast reaction times, some are almost immediate and happen in minutes and others take hours.  Unlike celiac, allergies can be potentially deadly depending on what kind of reaction you have to them.  Anaphylaxis is a serious reaction that can include airway swelling, shortness of breath,  low blood pressure, unconsciousness, and in serious cases, death.  Other less serious reactions are similar to those in celiac disease.

A wheat or gluten allergy can be tested for with a RAST test, a skin prick test, or a double blind placebo test.  Like celiac, an allergy also requires a strict gluten free diet.  For some this may be for a lifetime.  It’s not recommended that anyone reintroduce gluten into their diet without an allergy test being done to show the allergen is gone.

Gluten Intolerance 

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Not as much is known about non-celiac gluten intolerance.  It is a reaction to proteins, carbohydrates, or other chemicals in the foods and is not an immune or autoimmune response.  It has a really slow reaction time, taking up to several hours, and is difficult to detect.  Unlike the previous two, and intolerance is only an irritant and won’t cause any damage nor death.  The symptoms are similar to celiac as well.

In order to determine if someone has an intolerance, a trial elimination diet is really the best method.  If the symptoms disappear with the elimination of gluten, then that person should avoid or limit the gluten in their diet.

 

The bottom line here is if you think you have any one of these, you should go see your doctor.  Due to the severity and potential damage of undiagnosed celiac it’s important to know for sure if you have it and not to falsely attribute the symptoms to gluten intolerance.