jstefanski

About Julie Stefanski MEd, RDN, CSSD, LDN, CDE

Julie Stefanski MEd, RDN, CSSD, LDN, CDE is the Editor of Food, Nutrition & Dietetics for Nutrition Dimension, a division of OnCourse Learning. Julie is a spokesperson for the Academy of Nutrition & Dietetics and has extensive experience in pediatric nutrition, gastrointestinal disorders, sports nutrition, and neurology issues. You can connect with Julie on social media @foodhelp123

You Can Make a Difference When It Comes to Malnutrition

Julie Stefanski MEd, RDN, CSSD, LDN, CDE

What if you had the potential to save your facility thousands of dollars?

A growing body of evidence is demonstrating that significant revenue is lost when malnutrition goes undiagnosed and untreated.

Up to 50% of hospitalized patients are at risk for or already have malnutrition, but only 7% actually receive a diagnosis and treatment.1,2  Malnutrition can significantly impact Medicare reimbursement and the case mix index for a facility.

Our new interdisciplinary continuing education course Malnutrition Alert! How to Improve Patient Outcomes for nurses, dietitians, and physicians is designed to help you recognize the role that protein-calorie malnutrition plays in adult morbidity and mortality and to focus on the tasks required of the interprofessional team in preventing, diagnosing, and treating malnutrition.

Written by Terese Scollard, MBA, RDN, LD, FAND, a leading expert in malnutrition, and a member of the Academy of Nutrition and Dietetics work group that in 2012 designed and released the Consensus Statement on malnutrition, this course provides the guidelines you need to tackle this important condition.

Patients who are malnourished may not only have longer lengths of stay of up to 4 to 6 days, but hospital costs are on average twice as high for patients with malnutrition.2,3

Malnutrition can also lead to:

An increased risk of adverse events and complications
A 54% higher likelihood of hospital 30-day readmission4
Up to a 5 times more likely in-hospital death than a non-malnourished patient2

Prior to 2012 it was difficult to diagnose malnutrition in the past as there were no widely accepted characteristics that clinicians could use to classify this condition consistently throughout all care settings.  That all changed with the publication of the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition […]

Do You Screen Your Nutrition Clients for Depression?

Julie Stefanski MEd, RDN, CSSD, LDN, CDE

While the word “hangry” was only added to the Oxford English Dictionary in 2018, the connection between our food choices and our mood is clear to anyone who’s ever gotten testy when mealtime was delayed or turned to a comfort food for emotional support.

October 11, 2018 is National Depression Screening Day https://mentalhealthscreening.org/media/fact-sheet-national-depression-screening-day.

Registered Dietitian Nutritionists are in a unique position to screen for mental health issues including depression that may not have been addressed appropriately. While clients may seek help regarding excessive weight gain or weight loss from a dietitian, those two nutrition issues are just one example of a possible side effect from an underlying psychological issue such as anxiety or depression.

Jennifer Pelton, LCSW, a licensed social worker in York, PA points out that depression can take many forms depending on the persons’ identified type of disorder according to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders. Pelton explained, “There are a few types of patterns an RD may identify in a client. One type could be someone who can’t perform daily activities due to extreme lack of energy and engagement in everyday jobs/roles. Another person may be over eating or using binge type behaviors in order to compensate for negative emotions, and is using eating as a form of coping.”

Screen for Depression

During the task of gathering medical and social history on a client, a dietitian may casually pick up on signs of depression, but there are also some tools to assist healthcare providers in screening for depression including PHQ-9 or Mood and feelings Questionnaire (MFQ) – short version.

Dietitians should be on the lookout for other food related behaviors that may indicate depression such […]

Time to Add Mushrooms To Your Menu

Mushrooms are definitely one of those foods that people either love or hate!

Being from Pennsylvania, the state that produces the most mushrooms, I thought we’d take the time to shine a spotlight on this unique nutritional powerhouse since it’s Mushroom Month!  My other inspiration was a revelation by one of our dietitian experts.

Mushrooms are an excellent source of B vitamins, selenium, copper, and even potassium.  But what often gets the most attention is the claim to fame of being a vegetarian source of vitamin D.  Did you know that certain commercially grown mushrooms have 25 times the vitamin D content compared to others?

Not only do our customers learn new things about nutrition from our courses, our authors do too!  Lauren Manaker MS, RDN, LD, CLEC who recently tackled the update to our course “Vitamin D: Should “D” Stand for Deficiency?” was reminded that vitamin D deficiency is linked to a significant number of health issues including certain risks of cancer and preeclampsia as she revised the course.

One point about mushrooms really stuck out to Lauren, “I’ve been studying human nutrition since 1998 and I don’t know how I missed the fact that some companies are exposing mushrooms to UV light, resulting in Vitamin D production.”

While all mushrooms have some vitamin D2, the nutrient can be significantly increased in commercial mushrooms by exposing them to ultraviolet light.  Lauren explained, “Quick pulses of ultraviolet light flash over the mushroom’s surface, going through it, and setting off a chemical process that converts a compound similar to cholesterol inside the mushrooms into vitamin D. Does anyone else think that’s cool, or just me?”

As the local food movement has grown in strength so has the activity of foraging.  Last […]

American Association of Diabetes Educators Meeting Wrap Up

For clinicians working with individuals living with diabetes, the challenges of keeping up with the latest changes in medications, insulin delivery devices and glucose monitoring devices can be daunting.

OnCourse Learning staff spent a valuable few days speaking with attendees at the 2018 American Association of Diabetes Educators (AADE) Annual Meeting in Baltimore. Thanks to everyone that stopped by to talk about their challenges as diabetes educators.  Here are some of the most interesting highlights from the meeting for those who didn’t make it to Baltimore.

 Meet DANA

According to Lorena Drago, MS, RDN, CDN, CDE, a member of the editorial board for American Association of Diabetes Educator in Practice, DANA was one of the top buzzwords of the meeting.

“The Diabetes Advanced Network Access, known as DANA, is an online central resource that allows AADE members to access the best available diabetes technology,” Drago said.  She visited the DANA lab to learn how to navigate the website and identify the most salient features AADE members can use to enhance and advance their practice.

Hope Warshaw, MMSc, RD, CDE, BC-ADM, author of several best-selling consumer books published by the American Diabetes Association and diabetes expert agreed, “DANA is a one stop shop to learn about all of the latest diabetes technology and have a gateway to product websites to learn more.”

According to Drago, once practitioners access DANA, there are eight different categories to choose from (see screenshot used with permission of DANA staff).

Under each category, clinicians can find information about pens, meters, continuous glucose monitors, insulin pumps, infusion sets, insulin delivery devices, medication delivery devices and digital health platforms.

“You can click on each product to obtain the technical specification and sponsor information,” Drago said. “This is a great way […]

If Clinical Nutrition Isn’t Your Niche

Part 2 of Should you Kick Your Career Off Clinical Style?
Choosing an area of practice in dietetics after graduation is an exciting, but often conflicted time.  Thankfully dietitians have the option now of expanding their job prospects into areas of fitness, food service management, or grocery store based nutrition.  While these jobs may differ from a clinical setting, do new dietitians still need to start their career there?

Here’s part two of our two-part blog. (Click here to check out Part 1.)

For some, becoming a dietitian is a stepping stone to expanding an already existing career.  Amy Gorin, MS, RDN, owner of Amy Gorin Nutrition in the New York City area, entered the dietetics field after a successful start in journalism.  According to Amy, “Although many of my nutrition professors suggested starting my nutrition career with a clinical focus, I decided not to go this route full-time—and you don’t have to, either! You can have a very successful and meaningful career with an alternate path. In addition to working with clients, I decided to jump right into nutrition communications—writing for media outlets and helping reporters with their nutrition-focused articles, consulting with brands and commodity boards, and offering media coaching services to other dietitians.”

Jenna Gorham, RD, LN, owner of Jenna Gorham Nutrition Consulting feels that although the mentorship in a clinical setting was beneficial she knew that her strengths lay elsewhere.  Jenna explained, “I learned quite a bit in clinical, however I think you learn a lot in most entry level positions.  I now work in business and wellness and honestly don’t use my clinical skillset much at all. For me, the main benefit of my clinical position was being able to work with and learn from […]

Should You Kick Your Career Off Clinical Style?

It’s that time of the year when the job hunt for new dietitians is in full swing.  Although the bulk of available opportunities remains in the clinical setting, with ever expanding roles of dietitians in areas of media, culinary work, and retail dietetics, new grads have the option of skipping the traditional route of hospital-based practice after getting those well-earned RDN credentials.

Is it necessary for new dietitians to start their careers in clinical nutrition? Check out part one of our two-part blog.
The Case for Clinical
For many new dietitians, work in a hospital or long-term care facility takes the number one spot on their list of desired job possibilities.  Sari Schlussel-Leeds, MS, RDN, CDN, a dietitian based in New York agreed, “Starting out in clinical nutrition is a must in my opinion. It’s a great opportunity to hone your knowledge and skills and the clinical information is so valuable to any future endeavors relating to medical clinical findings for those you serve. The people skills that are heightened when dealing with a vast population of differing socioeconomic strata will serve a dietitian not only professionally, but personally as well.”

Zachari Breeding, MS, RDN, LDN, FAND, an executive chef who specifically entered the dietetics field to help him confidently assist his mother who was having some health issues, feels a clinical base is an absolute necessity.  “As a dietetic internship preceptor, I have always advised my mentees and students to begin their careers in the clinical setting. Medical Nutrition Therapy (MNT) is the basis of everything we do in dietetics, from culinary nutrition to community nutrition to public policy.” Zac added, “Regardless of their eventual professional goals, it is beneficial to the new RD to practice independently […]

Experts Offer Easiest Ways to Add More Plants to Your Plate

As healthcare professionals, we strive to keep our choices based on evidence-based practice. What’s holding you back from applying what we know about nutrition to your life?  While June is national fresh fruit and vegetable month, any way that you can make your diet more plant based all year is a good move for health.
Fresh or not, we asked Registered Dietitian Nutritionists for the easiest ways to get those five recommended cups of valuable plants into your daily routine.
First Things First
Opting for vegetables at breakfast is a favorite of many nutrition experts.  Kate Chury, RD, of Thinkybites.com suggests keeping a good supply of frozen vegetables on hand for both convenience and their nutritional value.

“My personal favorites for frozen vegetables are broccoli, spinach and asparagus,” Chury said. “I often use these frozen veggies in my scrambled eggs at breakfast. It can be hard to eat vegetables at breakfast time, and I’ve found this is an excellent way to get some in the morning. Frozen vegetables are also great to add to soups, pastas, curries or just to have as a simple, quick side.”

Kelly Jones, MS, RD, CSSD, LDN, of Kellyjonesnutrition.com agreed.

“I always have frozen vegetables on hand, especially broccoli and cauliflower, which I’ll roast on the convection setting in my oven, and in 15 minutes they’re ready to go with any protein or starch for dinner,” she said. “Any leftovers can be added to omelettes or used with lunch the next day.”

The rest of your day will probably take a turn for the healthier when you start off with some good choices.

EA Stewart, MBA, RD, of the The Spicy RD Blog recommends, “Start your day with leafy greens, like scrambling baby spinach with eggs, blending a […]

What to Know Before You Go Gluten Free

When Robin finally decided to head to the doctor for a checkup it was after months of not feeling well. Her main complaint was bloating after eating foods like pasta and bread. Certain foods like ice cream, granola bars or beans also caused significant abdominal pain, gas and diarrhea. After asking a few questions, the doctor suggested a diet change, she was handed a paper on the gluten free diet and asked to return in a month. Within a week Robin began to feel significantly better. Problem solved, right?

You probably know someone with celiac disease. With the prevalence rising to 1 in 133 people, nearly 3 million individuals in the United States have this autoimmune disorder. Unfortunately, 80- 90% of people who have celiac disease don’t actually know it. Randomly starting a gluten free diet without understanding how celiac disease is identified can do more harm than good.

What is Gluten?

Gluten, a protein found in wheat, rye, and barley is a common food ingredient in the United States. Gliadin, a part of gluten, cannot be fully broken down by the intestine in those with celiac disease, and can pass through the barrier of the intestinal wall causing an inflammatory response. Over time, the ability of the small intestine to absorb nutrients is decreased due to damage by exposure to gluten.

Symptoms of Celiac Disease

Symptoms of celiac disease include abdominal pain, abdominal bloating, diarrhea, constipation, gastrointestinal reflux, or vomiting. People with undiagnosed celiac disease often become lactose intolerant due to the damage in the area of the small intestine that produces enzymes which help us break down and absorb our food. Although this sounds a lot like irritable bowel syndrome the cause and treatment is different.

When someone […]

Support Your Health During Stressful Times

For thirteen years as a nursing professor I posed this question to my nutrition students– “How does stress and life as a nursing student effect your eating habits?

Inevitably students always had one of two answers:

“As a nursing student I have a very busy schedule with studying. I know I have to make good food choices to keep myself healthy to do all the work I need to do.”

OR

“As a nursing student I have a very busy schedule with studying. I have no time to make good food choices with all the work I need to do.”

What is the difference between these two groups? Does the group that prioritizes healthy eating have more time? Do they have more money?

The difference between the two groups is their attitude.

April is Stress Awareness Month. Stress can have a significant impact on our immune system and overall health. While we sometimes have little control over the stressors in our life, we can control our attitudes towards stress and how we take care of our bodies while under stress. Research has shown that our immune systems function best when supported by adequate sleep, regular exercise, and balanced food choices.

If your stress level is high make sure to do your best in these key areas:
• Make it a priority to go to bed earlier. Poor quality sleep is a trigger for inflammation and can increase your sensitivity to stressors in your life. Important health supporting hormones are released during each stage of sleep, but hormones produced in the early stages of sleep can especially be beneficial while under stress.
• Our quality of life, energy level, and health are significantly impacted by our daily dietary choices. Stress can also interfere with the […]

Tackling Problem Feeding Behaviors

Shawn wasn’t your typical four-year-old. Extremely thin and unable to communicate verbally, his entire diet consisted of infant oatmeal cereal with pureed fruit mixed in. For three meals a day, that was it. No meats, no vegetables, no solid food whatsoever. The response of the doctor’s office? “He’ll grow out of it.”

Luckily Shawn’s family was able to find help. During his first visit to a feeding clinic, staffed by an occupational therapist, registered dietitian, and speech language pathologist, Shawn screamed and banged his head on the floor when chicken nuggets were simply brought into the same room. Beyond simple picky eating, this type of response can be common among children on the Autism Spectrum.

April is world autism month. It’s now believed that 1 in every 68 children meets the criteria for Autism Spectrum Disorder (ASD). Common behaviors include problems interpreting social interaction cues, repetitive patterns of behavior, and interests. Gastrointestinal difficulties are common, but the cause and preferred treatment for issues such as constipation, diarrhea and reflux disease hasn’t been fully determined. Problems with communication skills can make it difficult for caregivers to interpret food preferences when attempting to feed, prepare or serve food to their child. Basically, every meal is a battle.

Call it what you will- Food selectivity, sensory integration with food, or problem feeding behaviors, children with ASD are five times more likely to have feeding behavioral issues. In 2013, a new eating disorder diagnosis was added to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) described as Avoidant Restrictive Food Intake Disorder or ARFID to reflect this type of restrictive eating.

A child with these behaviors may refuse to accept certain textures — rejecting those that are more complex […]