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 [...]
It’s hard to believe that the Food & Nutrition Conference and Expo is right around the corner. In my mind that means change is coming (and I don’t just mean the weather). Every year Nutrition Dimension unveils new products and services at FNCE — this year is no different. I am extremely excited to announce that we are launching a brand-new website for Nutrition Dimension in October. The revamped site now provide a "one-stop shop" for all your continuing education needs. Manage your CE account, learn about upcoming events, get the latest nutrition-related news, and interact with your colleagues through our new blog. We can’t wait for you to see the new site because we know you will agree that NutritionDimension.com is the place to go for nutrition- and dietetic-related continuing education, news and resources. As if a new website and blog are not enough, Nutrition Dimension will have its own magazine! Nutrition Dimension teamed up with Nutrition411.com to provide quality tools and resources to enhance your knowledge and practice skills. A continuing education course and selected resources from Nutrition411 will be included. Look for the magazine in your mailbox beginning of October. Our new products will be showcased Oct. 19-22 at FNCE in Houston. Please stop by booth 1642 to see the new products, give us your feedback or just to say hello. Meeting Nutrition Dimension customers is my favorite part of the job. See you in Houston!
As I was reading yet another article about new findings in the area of nutrition, I began to wonder if I would ever be able to stay abreast of the ever-changing world of food, nutrition and dietetics. In my job as the clinical editor, I need to know the latest happenings so I can provide cutting edge courses you will learn from and enjoy. I recently saw a post from a new dietetics graduate who, six months after graduation, felt like she was already falling behind in her knowledge and wanted ideas from other professionals. If she fells that way just out of school, practicing dietitians and nutritionists, who have been out of school more years than we like to admit, must feel the same. Staying current is not an impossible task if you put your mind to it and spend just a little time organizing your flow of information. The best news is that it can be done for free or with a small investment. 3 Steps to Staying Current: 1. Decide what area of practice or knowledge you want. Give up the idea that you can stay current in all areas of nutrition. You can’t. Focus your efforts on knowledge you need (for work) and knowledge you want (your passion). Then fill in the gaps when you need to. This approach saves a lot of time. If you need information you do not have, you can get it in a hurry. 2. Join an organization(s). Many dietitians belong to the “Academy of Nutrition and Dietetics” for the sole purpose of joining practice groups that have listservs, newsletters, webinars, seminars and other events and resources in your area of interest. You can also join [...]
In November 2011, the Centers for Medicare and Medicaid Services announced that Medicare would reimburse Primary Care Providers for Intensive Behavioral Therapy for Obesity, but not Registered Dietitians. Why would practitioners who are not trained in weight loss counseling be able to set up IBT programs when the knowledgeable and experienced practitioners, RDs, could not? The Academy of Nutrition and Dietetics and other organizations tried to get CMS to reverse their decision, to no avail. Since the decision could not be reversed, the best course of action was to teach PCPs how to successfully set up and run an IBT program, and how to incorporate the services of an RD in their IBT programs — a win-win for practitioners and clients! To enhance the content, Nutrition Dimension partnered with the Academy of Nutrition and Dietetics on this project. The Academy toolkit, ’Meeting the Need for Obesity Treatment: A Toolkit for the RD/PCP Partnership’ contains practical billing and business information that has been incorporated into the course. After a year of hard work, the 12-hour continuing education program, "Obesity Management: A 911 Call to American Healthcare" is available on ContinuingEducation.com for RDs and MDs and on Nurse.com for RNs. It’s a complete package that contains background information on obesity, the CMS requirements for an IBT program and the tools to implement the program — data collection forms, readiness-to-change questionnaire, food diaries and education handouts. There are more than 50 pages of resources to help create a successful program. As you use this course or have an opportunity to review it, please send me any suggestions to make it even better. By working together we can start to make a difference in the obesity epidemic.
The American Association of Diabetes Educators (AADE) convention in Philadelphia is just around the corner. In preparation for this event, I have been thinking about diabetes in the U.S. and how much progress has been made since I became an RD more than 30 years ago. In 1980 there were 5.8 million diabetics, which grew to 20.9 million in 2011 — about 8% of the U.S. population. Back then, there were fewer treatment options and diabetics were more restricted from activities in which they could participate. It’s true that the "cost" of diabetes is high - not just in economic terms but also in overall health. Many diabetics have complications and health problems that decrease the quality of life and increase the risk of death. Having diabetes does not mean giving up the things you love to do. A few years ago, I went on a group dive trip, and one of the members had type 1 diabetes and was on an insulin pump. She did not let diabetes stop her from doing the things she loved to do - travel and scuba dive. She was so confident of her ability to control her diabetes that she went diving in Fiji! How did she do it? She knew what her blood sugar levels should be so she wouldn’t become hypoglycemic. She tested her blood sugar before each dive and, if it was not high enough, she ate some carbohydrates to bring it up. Just in case she became hypoglycemic, she carried glucose gel in a tube, which she could use underwater if necessary. How inspiring! To learn more about diabetes, the scope of the problems and new treatments, check out the 14 Nutrition Dimension courses [...]