Dale Kline, MS, RD, LD As I write this, it is hot outside my home in southern Oregon. One hundred degrees to be exact, with smoke in the air from nearby forest fires. All I can think about is the bounty of food available locally, what this heat wave means to the crops and the impact on availability and prices. I should be thinking about and reading nutrition-related journals, newsletters and blogs to help me stay current on the latest nutrition-related news and studies. I also should be editing the nutrition-related courses to keep Nutrition Dimension customers up-to-date. Then, I got to thinking about how food is my job and how I love to cook. I bet many of you do, too. Most weekends you will find me at local farmers markets and produce stands where I go crazy buying so much produce that bowls full of vibrant-colored and nourishing veggies and fruit take up all of my available counter and refrigerator space. The fresh produce’s colors are amazing and so are the flavors. It is a joy to cook with such fresh ingredients and make delectable dishes. With these thoughts in mind, I decided to take a break from serious topics that have been the theme of past editions and instead focus on eating, which is the best part of what nutritionists help people do. My nickname for this edition of the magazine is “The Joy of Eating,” in celebration of food and why so many of us became dietitians and nutrition professionals in the first place. We love to eat and share our passion for food with others. It was hard to determine which articles to include in the magazine as [...]
Dale Kline, MS, RD, LD Director Food, Nutrition and Dietetics, Nutrition Dimension Happy Registered Dietitian Nutritionist Day, and an even happier National Nutrition Month! Dietetics has been my life for almost 35 years. I am honored to be a dietitian. When I started my career there were limited options for dietitians – hospitals, nursing homes, WIC, government, academia and other institutions. There were dietitians who were “doing their own thing” but they were few and far between. In 1986, I started Nutrition Dimension with my husband and began the transformation from employee to entrepreneur, which is not as easy as it sounds. While being an entrepreneur I was not able to give up my other passion, clinical dietetics and nutrition support, which I kept on doing for 25 years. Filling in the cracks and thriving When I look at the profession, I am astounded at the transformation. No longer do we have to be in “traditional” jobs as there are many more opportunities for us now. Entrepreneurial dietitians abound in private practice, as authors, spokespersons, bloggers, business owners, etc. Dietitians are found working for major league sports teams, health insurance companies, health communication companies, corporations, fitness centers, newspapers, and radio and public relations companies. Some of those public relations companies are even owned by dietitians! I am so impressed with the ingenuity of RDNs who have created businesses or found a niche inside an institution. What we do is hard, and you are all to be commended. Most important of all, we are now looked upon as thought leaders, decision makers and professionals who influence consumers. Have you ever wondered why so many companies target their marketing to dietitians? The answer is simple. We control budgets [...]
Starting July 11, 2014, Registered Dietitian Nutritionists will be able to order diets in hospitals under Centers for Medicare and Medicaid Services (CMS) regulation. According to CMS, "the addition of ordering privileges enhances the ability that RDNs already have to provide timely, cost-effective, and evidence-based nutrition services as the recognized nutrition experts on a hospital interdisciplinary team." While this is a big win for dietitians, it is important to understand that the new CMS rule allows dietitians to write orders, but it is not a requirement for hospitals. What you need to know about the new regulation: CMS revised the proposed regulatory language from the draft. In this final rule CMS requires that all patient diets, ‘‘including therapeutic diets, must be ordered by a practitioner responsible for the care of the patient, or by a qualified dietitian or qualified nutrition professional as authorized by the medical staff and in accordance with State law governing dietitians and nutrition professionals.’’ This regulation does not require hospitals and medical staff to grant or authorize specific privileges to specific practitioners, but only allows them the flexibility to do so if they choose, and only if State law allows for it. “Qualified dietitian” and “qualified nutrition professional” is the termed used by CMS in this regulation. This means an RD, RDN and “qualified” nutrition professional “…is to include all qualified dietitians and any other clinically qualified nutrition professionals, regardless of the modifying term (or lack thereof), as long as each qualified dietitian or clinically qualified nutrition professional meets the requirements of his or her respective State laws, regulations, or other appropriate professional standards.” RDN’s can be included as part of the medical staff. This is not a requirement, but something [...]
I hope you all had a chance to see the Spring issue of the Nutrition Dimension magazine (either via the mail or the digital version) which is devoted to the topic of obesity. So many of us have been touched professionally and personally by this epidemic. How can we not when over 60% of the U.S. is either overweight or obese. We are inundated with stories and information about the obesity epidemic. News stories discuss a multitude of ways to prevent obesity, while TV shows and ads declare they have found the magic cure for obesity. In theory, losing weight should be simple: Decrease food intake and/or increase exercise output. In practice, however, losing weight is never simple. The reality is that 90% to 95% of people who lose weight do not keep it off. That is a dismal success rate. Yet more discussions and energy are devoted to helping people lose weight. Despite all the attention, more than 112,000 Americans die of obesity-related diseases each year and it contributes to four of the leading causes of death in the United States. The estimated total costs to society—including medical treatment, lost workdays because of obesity-related illness, and sales of diet products, foods and services—surpass $100 billion a year. In 2011, when Medicare began reimbursing primary care providers for intensive behavioral therapy for obesity, registered dietitians and registered dietitian nutritionists, were not among the providers allowed to be paid directly for Intensive Obesity Counseling. However they can be a part of a Medicare-compliant obesity program. To learn more about what comprises a Medicare-compliant obesity counseling program and how to increase the odds for success, take the time to read the continuing education course in the Nutrition [...]
I need help. Today I was putting the final touches on the update of Functional Foods Part 2: Fermented Foods and Macronutrients (RD86). While I was double checking a list of foods with added stanols and sterols to make sure they are still available from the manufacturer, I found many in the list were not. So I searched the internet for a list of foods that have added sterols and stanols and to my disbelief, I could not find one. What I did find was information on the heart health benefits, which are many. When it came to the foods containing stanols and sterols, websites were vauge, saying you can find stanols and sterols added to margarines, oils, salad dressings, breads, yogurts but no specific food name nor a manufacturer. That got me wondering if the addition of stanols and sterols to food was just a fad or if food companies found they could not make money off of these products. I am not sure of the answer to that question. What do you think? Here is how you can help. If you know of a product that contains added sterols and stanols, please post the name of the food and the manufacturer below in the comments. I will take your input, compile the list and post it on NutritionDimension.com for anyone looking for something to share with clients. Thanks for your help!
Counseling people who are trying to live gluten-free is no easy task. Simple questions are so much more complicated than they appear on the surface. Foods that have been touted as gluten free in the past have been found to contain more than the 20ppm limit necessary to be called gluten free. Tricia Thompson, MS, RD started Gluten Free Watchdog and the Gluten Free Dietitian to help both professionals and consumers navigate a gluten free diet. Gluten Free Watchdog was started to test consumer products for gluten content, since it is so difficult to determine if some foods are safe, as there is so much contamination of foods with gluten. The Gluten Free Watchdog has a special report "Is Barley-Based 'Gluten-Removed' Beer Safe for People with Celiac Disease?" posted on the website. For those of you unfamiliar with this type of beer, an example is Omission beer, brewed in Oregon. After reading the report, would you recommend it to your clients or family members? Do you have a favorite gluten-free blog to share? Please let us know!
Have we got it all wrong? Happy Holidays! December is the season to celebrate and enjoy time with family and friends. It is also a time that our diets and good intentions go out the window. There are sugary treats everywhere. We go to parties with high fat foods that we normally do not eat. The stress of trying to get through the holidays without gaining weight is definitely a challenge. You might think this post is about how to healthfully get through the holidays, but you would be wrong. While I was contemplating the foods we eat over the holiday I saw an article today that got me thinking that some of it might not be as bad as we think. Sweden is the first country in the world to adopt national dietary guidelines recommending a low-carbohydrate, high fat diet, which counters what we are taught and is recommended by the U.S. Dietary Guidelines and guidelines of most organizations: American Heart Association, American Cancer Society, World Health Organization and I could go on listing association after association. Here is the link to a news story about the change in Sweden: http://www.dietdoctor.com/swedish-expert-committee-low-carb-diet-effective-weight-loss Do you think there is compelling evidence that Sweden is on the right track? Post your comments below!
As the role of the registered dietitian expands and evolves, what will the future bring? What skills and knowledge will we need to be successful nutrition practitioners? In the past our role was to assess, counsel and teach. We gathered information and then tailored a diet based on the information we had available, which often was very skimpy. We see a different future, one in which the nutrition practitioner is an active participant with a more “hands on” role, literally and figuratively. Nutrition-focused physical assessment requires dietitians to do more than talk; they must do a clinical assessment by looking, touching and talking, similar to what nurses and physicians do. Some dietitians are already inserting feeding tubes, listening for bowel sounds, teaching how to give insulin shots and other “hands on” clinical activities. With the emergence of nutrigenetics and epigenetics, there is a much greater understanding of the importance of nutrition in preventing and treating illness and a way to test for it! Nutrition practitioners are already ordering tests and changing diets based on the genetic and epigenetic make-up of their clients. Instead of giving clients overly broad diets that may or may not work for them, more of us will be ordering tests to individualize a diet that will work and improve outcomes! To get to the point where we are adept “hands on” practitioners, new skills and knowledge are required. Nutrition Dimension will develop educational courses to meet the present and upcoming needs of nutrition practitioners. In this magazine there are courses that can get you started. Check out the courses on nutrigenetics, epigenetics, critical thinking and obesity management for a taste of what’s to come. What do you see as the future [...]
The typhoon that hit the Philippines is a tragedy. The extent of destruction is almost too much to comprehend. Along with the physical destruction is the loss of lives and the emotional toll that it takes on individuals, communities and countries. The healing and rebuilding will take a very long time. Nutrition Dimension and I have a special connection to the Philippines. In a twist of fate, the picture included in the blog (on the Nutrition Dimension.com) discussing FNCE, dated October, 29, 2013 is of myself and an RD from the Philippines, Buena Virgith. Every year Buena is at FNCE she seeks me out to chat about nutrition, dietetics, and Nutrition Dimension, as well as find out what is happening in my life. We have developed this relationship over the years as Buena has been using Nutrition Dimension courses in the Philippines to teach nutrition students and practicing RDs for a long time. She is so thankful to have these materials that a number of years ago she sought me out so she could thank me personally and even gave me a gift! I was so touched. That was the beginning of our friendship which has continued to this day. Virgith’s generosity is, I think, part of the culture of the Philippines. It may be that since the Philippines is too often hit by disaster they have adapted by enjoying life and being upbeat and positive. So please join me in supporting the people of the Philippines in anyway you can. They have a long road ahead to put their lives back together.
Malnutrition Awareness Week was just a few weeks ago and the spotlight was once again on malnutrition. Are we any better at diagnosing and treating it? In 2012, the Academy of Nutrition and Dietetics and the American Society of Parenteral and Enteral Nutrition published a consensus statement concerning the characteristics recommended to identify malnutrition. For years RDs had been using serum albumin and prealbumin as markers for nutritional status. We now know that those acute-phase proteins are better markers of the severity of inflammation and not nutritional status. What do we use instead? Recognizing there was and still is no single, universally accepted approach to the diagnosis and documentation of adult malnutrition, in 2009 ASPEN and their European counterpart ESPEN, began developing criteria to use. The consensus statement, using the work of ASPEN, recommended 6 characteristics to diagnose malnutrition: • Insufficient energy intake • Weight loss • Loss of muscle mass • Loss of subcutaneous fat • Localized or generalized fluid accumulations that masks weight loss • Diminished functional status as measured by hand grip strength The 6 characteristics of adult malnutrition are etiology based…meaning that not all malnutrition is due to the same root cause. Malnutrition may be related to starvation due to environmental or social issues, or related to mild to severe inflammation from chronic or acute disease. Three of the six characteristics require hands on physical assessment. Clinical skill is a necessary part of diagnosing malnutrition. Moving Forward With that background, there are a number of questions that I have. Here goes: • Where do you think we are as a profession and as individuals in our ability to accurately define, diagnose and document malnutrition? • How did Malnutrition Awareness Week impact [...]