By: Stephany Singh

Did you know that as of 2021, about 20 million people;16 million (6.2%) US adults and 4 million (5.8%) of US children have food allergies?

I am stoked to report that I gained experience testing for the “Big 9 Food Allergens” at the University of Maryland, College Park dining services rotation this spring. This experience helped me expand my knowledge further from the work I did on my last blog about the (9) nine major food allergens. Allow me to walk you through my experience and how I am better equipped to plan and execute a food station while being cognizant of those who may have an allergy. I hope that by reading about my experience, you become empowered to become certified as an allergen tester too.

Have you ever heard of AllerTrain? During my first rotation with the University of Maryland’s College dining services, my colleague and I completed a rigorous 1-hour training to be certified as allergen testers.

The course consisted of multiple modules with a quiz. Each module provided new and intriguing information; from debunking myths to simply realizing how easily cross-contamination happens while being unaware. The experience was both shocking and eye-opening. I am grateful to have been provided with such valuable training.

After the computer training, my colleague and I were able to go to and work in the “Purple Zone.” It is UMD’s secret weapon to ensure their students who have allergies, food sensitivities, or a predisposition/disease (IBS, Crohn’s Disease, etc.) are safe while eating. It was a pleasure to work with the chef and his staff to prepare specific foods for the students. For me, the highlight of the experience was being able to test and confirm the kitchen was truly safe and allergen-free. Chef explained that they do monthly compliance tests/checks to guarantee that the stations are allergen-free. In the kitchen, they either check the foods directly to ensure they do not contain an allergen or multiple allergens, or they test the surfaces to ensure cross-contamination is not occurring. During this test, my colleague and I swabbed the surfaces to check for the nine allergens: eggs, milk, nuts, fish, crustaceans, shellfish, wheat, soy, and sesame. I am happy to report that all of our tests were negative.

The Purple Zone specifically tailors food to each student’s needs and considers those who may have multiple allergens that span beyond the major nine. If this occurs, the chefs often need to prepare separate meals for students. UMD’s Purple Zone was ahead of the game even before the introduction of sesame as the newest allergen. In the future, I too, aim to be a proactive dietitian who remains ahead of emerging trends and research. My goal is to think long-term and create structured strategies that address problems before they occur, quite like UMD did with their PurpleZone, to address the “big 9 allergens”  and all possible food threats to make eating safer for those who need it.

   For more information go to: https://dining.umd.edu/allergy

 By: Julie Henderson

One thing that I have learned during my dietetic internship is to go into each new experience with a smile, and an open mind. Each rotation within the dietetic internship is a new hands-on experience and you don’t know what to expect. Many times, it is up to you to make the experience the best it can be. This was especially true as I entered my rotation at The University of Maryland (UMD) Dining Services. Food service had not been high on my dietetic career plan throughout my education. I always aspired to be a clinical nutrition dietitian. I believe this is one of the reasons we are required to complete an internship program, to expose us to a variety of possible options and helps us determine which path is the right fit.

I was happy to have two intern colleagues with whom to share the experiences of this food service rotation. We worked incredibly well together during the three weeks at UMD Dining Services. Thankfully, the UMD dietetic internship allows for the partnering of interns during some of the rotations. On our first day, we were provided with a schedule of activities for the rotation. Many of our days began in the building on campus that housed the South Dining Hall and the dining services staff offices. We started with an allergen certification course to allow us to work in the Purple Kitchen. The Purple Kitchen is an allergen-free kitchen to serve students, staff, and faculty with food allergies/intolerances. It is open to everyone, not just those with allergies. It is located within the North Dining Hall on campus. We were also introduced to the nutrition students and given a list of projects to be completed during our rotation. Many of these included developing infographic materials such as table tents, stall seats for bathroom stalls, and nutritional newsletter information. I enjoyed being creative with these nutrition-related assignments and knowing that they would be shared across campus.

UMD campus is very large, and we were able to be a part of many different experiences across the campus.  During this rotation, we visited the North Dining Hall, South Dining Hall, Yahentametsi Dining Hall, and Jones-Hill House. While at the North Dining Hall, we had the opportunity to do an allergen test in the Purple Kitchen. This test was sent to a governing body to ensure that the Purple Kitchen is free from the top nine allergens. While at the South Dining Hall, we met with many staff members to learn the operations of UMD’s independent food service functions. We also provided training to staff in the dish room on the safety of using the pot and pan cleaning chemicals. We were only able to tour the Yahentametsi Dining Hall, but it was a very popular place for the students to eat and had amazing food options for them. Yahentametsi and Jones-Hill House are the newest dining facilities on campus. Jones-Hill House is where the football athletes are taken care of. It was an amazing facility and experience. We spent our downtime in a beautiful room that had huge windows and overlooked the campus including the football field. It made us feel like VIPs. I even interviewed a football player about his opinions on having a dietitian on staff to care for the players. He had a personal experience and was grateful for the dietitian’s assistance with his nutritional health. Having a personal connection to football, I appreciated seeing how well nutrition is emphasized for the football student-athletes including help with individualized proper meal adjustments, lab results, hydration, and strong bone health. However, I would like to see all the athletes at UMD have this opportunity.

The work culture throughout UMD Dining Services was one that shined brightly! The food selections consider the many different cultures within the student population. The interns and I worked with many different chefs throughout the dining halls who introduced us to the many behind-the-scenes food operations. The employees are state employees and seemed very happy with their jobs. The care that goes into feeding the students at UMD is amazing. We were informed that they have made changes to the student meal plans, to better serve their student population and so that no student goes hungry. At one time they were using a point system but now have transitioned to an unlimited or all-you-can-eat style. The UMD Dining Services staff make sure the students’ voices are heard by having a student advocacy group with whom they meet and discuss concerns and needs to include many cultural topics such as Halal. From what I witnessed, the students were pleased with the food options provided on campus. I know I was, as we were allowed to eat lunch in the dining halls and the food was delicious. We had so many options to choose from and I am pretty sure that I gained a couple of pounds during this rotation.

Food service may be a lot of work and may not be a popular path for a dietitian, but working with the staff at UMD Dining Services was rewarding. If a job was available here, I would apply. I had not imagined myself working in food service until this rotation. It was surprising and I think it is because of the independent food service operations and the friendly and happy staff that work at UMD. I could go on and on about the experience; we did so much in such a short time and everyone we met was very kind and welcoming. During our end-of-rotation evaluations, we were told that the staff expressed appreciation for our kindness and being welcoming. I believe this is because we came on board with a smile and an open mind to enjoy and learn from this experience and did just that!

By Dietetic Intern: Lily Sheridan

The Maryland Academy of Nutrition and Dietetics (MAND) held the annual Advocacy Day event in person for the first time since COVID in Maryland’s state capital, Annapolis, this past February. MAND organizes the day and invites dietetic interns, registered dietitians (RDs), and the MAND lobbyists to participate. MAND provides support, comments, and amendments to many health and nutrition related bills during the legislative session. For Advocacy Day, the focus was on six bills related to nutrition that MAND was supporting. I was fortunate to attend the MAND 2023 Advocacy Day this year! Come along as I share my experience with you.

In the morning we discussed each of the six bills: what they stood for and how they were relevant to dietitians in the state of Maryland. After learning about the important pending bills, it was time to meet with legislators and their staff to advocate for the bills and provide more information on the expertise that dietitians can provide. We were split into small groups each led by experienced registered dietitians/MAND members. Each group met with different legislators. As nutrition professionals and soon-to-be professionals, we could approach the conversation with a unique perspective and area of expertise.

The six bills included: 

1. Public Schools  – Anaphylactic Food Allergies Guidelines ( HB0078/SB0120)
2. Primary and Secondary Education – Breakfast and Lunch Programs – Universal Expansion (HB0628/SB0557)
3. Education – Maryland Meals for Achievement In-Classroom Breakfast Program – Annual Appropriation (HB0514/SB0559)
4. Preserve Telehealth Access Act of 2023 (SB0534) 
5. Counties and State Legislative Districts – Food Environment Reports (HB0008)
6. Maryland Food System Resilience Reports (HB0032)

Since time was limited with the legislators, it was important to be strategic in how information was communicated. My group decided to pick bills where we could tie personal experience and nutrition knowledge together to share with our delegates why the bill is worth supporting. This tactic was very successful, and we found out the Anaphylactic Food Allergies Guidelines bill even passed in the House of Representatives on the very morning we were there! 

The bills I have personal experience to share included expanding the Breakfast and Lunch Program to be universal in schools, and the “In Classroom Breakfast Program Meals for Achievement” bill. Growing up in Maryland, I attended a public high school where several students relied on these programs for a hot meal. It made me realize how people my age were struggling with food security and it hit close to home. The Breakfast and Lunch program directly addresses the needs of these students. Making these meals universal would expand access to all students, and therefore, would not isolate or single out the students that rely on them. Additionally, if students need before school breakfast and are late to school, the “In Class Breakfast Program Meals for Achievement” will still allow them to eat once classes have begun. Students go to school to learn and should not have to worry about when their next nutritious meal will be.        

Understanding the role of nutrition policy as a future dietitian is so important! Policy plays a role in dietitians’ work environments, how they can reach clientele, the type of licensing required for practice, and the health of those that they are working with. Food insecurity, sustainability, and cultural inclusiveness regarding food are policy focuses at a state and federal level. 

With the experience and knowledge I gained from the MAND 2023 Advocacy Day and my dietetic internship, I plan to be more involved in health and nutrition legislation at the state and federal level. I will educate myself on how policy can be changed and implemented and the current bills introduced. Then, I will write to or meet with my legislators and use my voice to advocate for what I believe in to positively influence the lives of my peers and community members regarding health and nutrition. There are many ways to be involved and learn more. You can write to your local representative, educate people around you, and attend in-person events to influence legislation. How can you be more involved in advocating for changes?

UMD Dietetic Internship Class outside of Harry Browne’s in Annapolis, MD.

By Dietetic Intern: Cameron Carter

Whenever you see a canned item or a box of cereal with a date that has passed, what do you do? Do you throw it away because it is expired? Do you put it back in the pantry and let the next person deal with it? Are you confused about what to do? As part of my dietetic internship community rotation at Manna Food, I got the opportunity to provide an in-service to educate their volunteers and answer these questions. 

Manna Food Center is a non-profit organization in Montgomery County, Maryland. They provide services to fight food insecurity in the county. As an intern, I got the opportunity to help in many areas. These included handing out food packages at one of their food drop-off locations, working in the grocery store with volunteers, and working in the warehouse where I prepared special food boxes for participants with dietary restrictions. The warehouse was filled with donations that needed to be sorted and this was the perfect opportunity to educate the volunteers on food dating. 

I covered 3 facts about food dating in the in-service. I chose food dating to reduce food waste for Manna and overview of the wording volunteers typically see in the warehouse. “Best if used by/ before”, “Freeze-by”, and “Sell-By” are the three types of verbiage I covered. I started off by asking the volunteers, “Who regulates food dating in the USA?” I got an abundance of answers, but they were shocked to find out that food dates are not regulated. 

When discussing “Best if used by/ before”, I reviewed that the date on the item is an indicator of flavor or quality and that it is okay to keep food if the date has passed and there are no signs of spoilage. Manna did a great job at providing USDA guidelines on how long they can keep foods in the warehouse past their date. I told volunteers to focus more on the USDA guideline dates and the signs of spoilage before throwing out an item. 

 When it comes to “freeze-by” dates, we discussed that “these dates indicate when an item should be frozen to maintain peak quality. Furthermore, I reviewed that if items have icicles or show signs of improper temperature storage, they should be thrown away. 

Lastly, I covered the “Sell-By” dates which indicate how long to keep a product on shelves for inventory management. If a food is past the “sell-by” date it is okay to eat. 

Providing education on food dating was a cool opportunity. I got the chance to practice public speaking as well as become a catalyst for reducing food waste. The major takeaway that the volunteers had was that these types of package dates are more about quality and less about food safety. Except for baby formula, canned foods and goods can be eaten past the date if no signs of spoilage are present. You do not have to throw away “expired” canned goods! This in-service gave me the opportunity to educate and be a part of Manna’s efforts to reduce food waste. 

By: Elizabeth O’Donnell

Have you ever known anyone who has been on a special diet for medical reasons? Individuals, for multiple reasons, might be placed on a special diet for a medical condition such as diabetes or kidney disease. Additionally, there are reasons why texture or consistency may be altered such as poor dentition or swallowing difficulty.

I recently completed a two-week rotation at a non-profit organization named Food & Friends in Washington DC. Food & Friends offers medically tailored meals and groceries for clients living with cancer, HIV/AIDS, and other serious medical conditions. Some of the meals they offer their clients include pureed meals. Individuals might need a pureed meal diet because of swallowing/chewing difficulties or digestive issues.

On two separate occasions, I was able to test four pureed dishes with a dietitian to determine which aspects of the dish would be able to follow the International Dysphagia Diet Standardization Initiative (IDDSI) guidelines. We tested the meals for accuracy and consistency to see what needed to be adjusted. We also tested them to see if they had a pleasant taste. All the meals were prepared with intention to fit within the IDDSI level 4 standards. However, the puree meals are still in the testing process. Eventually, after continued testing and changes made, these
meals will be able to meet standards and be appropriate to serve to clients. There are 5 levels for IDDSI foods which are, level 3-liquidized, level 4-pureed, level 5-minced and moist, level 6-soft and bite sized, and level 7-regular/easy to chew. Levels 5-7 are considered transitional foods. Transitional foods are considered as food that begins as one texture but changes to a different texture when a temperature change or moisture is introduced to the food. Examples of
transitional foods are ice cream and cotton candy.

The four pureed foods I got to test included a tomato cinnamon soy strip, whole wheat pasta, oatmeal, and peaches. I had never tried foods pureed intentionally for certain medical conditions and, as many people do, I anticipated them to be bland, boring, and unappetizing. However, they are not with the utilization of plating techniques and the addition of various flavors. I expected the tomato cinnamon soy strip and the whole wheat pasta to taste worse than they did, but I found them to be flavorful.

There are other aspects that were tested in the specific IDDSI based audit we performed. This included lumpiness of the food, the ability of the food to hold shape on a teaspoon, whether or not the food drips or flows through a fork, and whether or not a fork can make indentation marks in the puree. Out of the four foods that were tested, ultimately none of them were ready to be served as a level 4 pureed meal according to IDDSI guidelines. Because none of the tested pureed meals were ready to be added and served as part of the pureed meal plan, the dietitians and chefs at Food & Friends will continue to work together to alter the components and test the
meals so they can meet the guidelines in the future and can be served to clients. The chefs and dietitians are currently in the process of updating and revamping their pureed meal plan, which I was able to help with.

Overall, it is very important to perform these audits before serving the meals to clients in order to make sure food intended to meet a certain IDDSI level does and is consistent. Serving IDDSI level foods that are not qualified or labeled incorrectly can pose serious health threats such as aspiration (when food or liquid enters the airway accidentally), vomiting, choking, or breathing
difficulty while eating. Performing the test audits prepared me for future experiences I may have as a dietitian. By taste testing different types of medically tailored meals, I can provide accurate feedback and knowledge to my patients on how a food tastes, what the texture is like, and if I personally enjoy it. This is important as I want to relate and bond with my future clients and patients.