By: Anna Bougie

Did you know that about 34.2 million Americans—just over 1 in 10—have diabetes? Chances are you know someone with diabetes or have at least heard of the disease. However, how much do we really understand about how diabetes affects the body? During my time studying nutrition as an undergraduate student, I learned about diabetes and how critical nutrition is to diabetes management. I memorized all of the terms, how insulin works within the body and how to treat someone with diabetes by the textbook. I thought I knew everything there was to know about diabetes by earning good grades on assignments and exams. However, it wasn’t until I went to Anne Arundel Medical Center to experience inpatient diabetes care that I realized there was so much more to learn. In this blog I will first share an overview of diabetes and then go into my personal experience.

People with diabetes have trouble processing and using all the energy from the foods they eat. This means the energy from food, which is broken down into sugar, stays in their blood rather than being used by their cells or stored. It can be very dangerous if blood sugar levels rise too high or drop too low. The body’s natural way of regulating blood sugar levels is through the hormone insulin. Insulin is what regulates the metabolism of carbohydrates, fats and protein within the body. This helps promote the absorption of sugar from the blood into the rest of the body.

Now, what is the difference between Type 1 and Type 2 diabetes? When you consume food, your blood sugar levels rise and your pancreas should naturally release insulin, which allows the sugar to enter your body’s cells or your liver to store any extra sugar. Type 1 diabetes is where the pancreas produces little or no insulin at all. This means people with type 1 will be insulin dependent throughout their lives. With Type 2 diabetes, the pancreas makes insulin, but the body’s cells don’t use it as it should.  Some people with type 2 diabetes won’t need extra insulin and can manage their diabetes with healthy eating and exercise or with oral medications. Regardless of the type, people with diabetes need to keep their blood sugar levels in a normal range in order to prevent dangerous complications. 

The experience I had in the inpatient setting at Anne Arundel Medical Center with inpatient diabetes care was so fascinating. Through encountering newly diagnosed diabetes patients, I have gained insight on how to best provide patient-centered care. Additionally, I have learned that diabetes is a demanding disease where it is crucial that the patients understand their diagnosis and how their medication or insulin works to regulate their body’s blood sugar. During this rotation, I helped diagnose patients with type 2 diabetes. I know that a new diagnosis can be scary, especially one that involves multiple finger pricks a day and new medication or insulin. It was a great experience to be able to really connect with the patients by listening to their concerns and answering their questions. I also got a chance to show someone how to use an insulin pen and syringe! These are the experiences you cannot get from a textbook. 

During my inpatient diabetes experience, I also had a chance to educate patients who have already been diagnosed with diabetes. With these patients, I would educate them on what foods they should have in their daily diet. Their diet should consist of high fiber foods which include beans, vegetables, fruit and whole grains. I was surprised to see how many people were unaware of how many carbohydrates they could eat each day. My preceptor and I taught the patients that they should have a consistent amount of carbs (around 30-60g) each meal to maintain steady blood sugar levels. It was fun to see their reaction when I explained to them why the body needs carbohydrates and, for some, how they should be eating more! 

Lastly, my favorite experience at Anne Arundel Medical Center was being able to wear a Libre for 2 weeks. A Libre is a blood glucose monitoring device which sticks to the back of your arm. It has Bluetooth capability to an app on your phone, where you can scan your phone on the device and it reads your blood sugar level. This is a great alternative to getting blood sugar levels without having to prick your finger! I even got to put the device on myself, so I feel comfortable applying it on patients in the future. I will never forget giving out a free Libre to a patient who had horrible neuropathy in her fingers from pricking her fingers for 20 years. She was so down when she was in the hospital for an amputation procedure. We went to her room to give her a free Libre and she was so thankful to have one less thing to worry about when she left the hospital. 

Co Uk, D. (2021). Libre Glucose Monitor. FreeStyle Libre eases burden for people with diabetes and dementia. Retrieved 2021, from https://www.diabetes.co.uk/news/2019/Nov/freestyle-libre-eases-burden-for-people-with-diabetes-and-dementia.html. 

Even though my time at inpatient diabetes was only two weeks, I learned more than a textbook could ever supply. My experiences ranged from teaching a newly diagnosed patient on how insulin works, to discussing consistent carbohydrate diets, to wearing a glucose monitoring device myself. I will never forget the connections I made with the patients and I learned from my preceptor. If you’re looking for more information on diabetes, check out the American Diabetes Association to learn more about causes, treatment and care of diabetes. 

Successful Practices From Farm To School

By: Felix Pan

Where does our food come from? As a child, I knew that my food came from my home’s kitchen and the school cafeteria. I didn’t know the true origin of the food. But how did the food get into these locations? Surely, it wasn’t growing in the kitchen or behind the cafeteria doors. At the time, the answer to this was beyond me. Thanks to the Farm to School program, children can now learn the answer to this question. Recently, I had the opportunity to rotate at Frederick County Farm to School for two weeks. During that time, I learned about the essentials for program planning and evaluation, created educational materials for children, and practiced fostering in-person and virtual relationships.

The Farm to School Network is a grassroots national program that aims to improve the health and wellbeing of children and communities by increasing access to locally grown foods and curating nutrition education resources.  There are many Farm to School programs at the local level, including the one in Frederick County Maryland. Initially developed as a pilot initiative to increase the consumption of locally grown fruits and vegetables at elementary schools, Frederick County Farm to School has plans to expand and provide such produce to middle and high school students as well. In addition to sourcing locally grown produce for schools, they support school gardens and create food educational resources for children, families, and teachers. By doing so, Frederick County Farm to School strives to provide students access to nutritious, high quality, local foods so they are ready to grow and learn; provide farmers financial opportunities by opening the doors to institutional markets; and strengthen the local community by building community engagement.  

Developing a program is difficult, but careful planning and forethought may ease the process. I was excited to learn about the organizational structure that helped Frederick County Farm to School grow and improve.  Alysia Feuer, the Frederick County Farm to School Program Director, strongly recommends using logic models to do so. A logic model is extremely beneficial for keeping programs on track. Creating a logic model involves recognizing and recording your resources; activities; outcome measures; and expected changes in knowledge, skills, and behavior. One of the most powerful benefits of the logic model is the ability to visualize all the information on a single page. It becomes a modifiable guide to keep program-related decisions and actions mission-oriented. Furthermore, creating an evaluation plan that describes methods of data collection, roles and responsibilities of the team, and timeline of the program are important to assess the impact of the program. When reviewing these outlines, I was able to quickly understand the logistical organization of the program. Using these resources, Frederick County Farm to School is able to continue expanding and working towards its mission.

As part of its mission to educate children, Frederick County Farm to School has recently started its Food Waste Series. I had the pleasure to develop a handout (left) to educate children and their families about home-orientated food preservation methods. As I created my content, I quickly realized that something needed to be changed…but what was it? Stuck, I turned it over for review to Madeleine Reinstein, the Frederick County Farm to School Education Coordinator and a University of Maryland Dietetic Internship graduate. Her changes (right) were simple but powerful. The alignment of the text, emphasis with bolding, and color contrast of text and background all but changed the handout’s delivery entirely.

Infographic 1: First Draft

Infographic 2: Final Draft

What was her secret? She answered, “During my internship, I wanted to spend time improving my design and writing skills. So at every rotation, I asked my preceptor if I could make a nutrition educational handout or infographic. “

Powerful. Formatting text and asking questions are both simple yet powerful actions. A simple, straightforward approach may sometimes be best. This experience was a humble reminder to return to the basics. I strove to use this at my next task: video development. 

In addition to the new Food Waste Series, Frederick County Farm to School’s “Harvest of the Month” series educates children about the locally grown produce served on their school lunch menus. For this, I introduced radishes and turnips by creating an engaging video. This began with a field trip to Pleasant Hill Produce. While seemingly nonchalant, our visit had an important goal: to foster relationships with local farms and learn about how they seed, grow, and harvest local produce. “Relationships are the key to success,” Alysia would say. Human connections and technical outlines enable movements to go above and beyond. When creating my video story, I needed to consider both of these concepts. 

I learned that creating an impactful story requires outlining the purpose of telling it, recognizing the audience, identifying key points of the story, connecting with the audience, determining the intended impact and taking action to make the story come alive. Building a relationship and connecting with the audience through a screen… that’s no small task. To overcome this challenge, I recalled what I had taken away from making the educational handout: return to the basics. One of the most basic connections and instincts we all have is our five senses. I set to work to find ways for the viewers to experience everything about radishes and turnips through the screen. Check out the results below! 

Video: Harvest of The Month: Radishes and Turnips

My experience at Farm to School expanded my understanding of working with a bottom-up approach to improve the food system. I learned about and practiced effective communication with the audience through different media. While doing so, I was reminded that simple and straightforward considerations such as making outlines, asking questions and finding shared interests can establish the foundation for success. I will take this framework with me on my future rotations and practice. I am grateful for this opportunity to learn from and contribute to Frederick County Farm to School’s efforts to provide local foods, support local farms and strengthen the community through education and awareness. 

Food Service Heroes

By: Jerrick Knippel

We can all agree COVID19 has changed our daily life. But have you wondered how the pandemic has impacted the school food service system and the student lunches? Missing ingredients, menu requirements, low staffing, new protocols; these are just a few of the challenges that are faced every day. Have no fear! Students are provided with meals every day because the food service heroes of our schools are taking these challenges head on. 

My partner Olivia and I were given the eye opening opportunity of working alongside some of the food service staff of County Public Schools. On our first day we visited an elementary school. We observed how the school breakfast program was run. It wasn’t long before we were put into the kitchen to help the workers. I was slightly taken off guard as I walked through the lunch line doors into the kitchen as it was much smaller than expected. The room was about the size of an average classroom. One third of it was for the lunch line and food holding stations with the remaining two thirds filled with ovens, tables, and other kitchen equipment. 

Eventually, we made our way into the middle of the kitchen so we could assemble dinner bags to send home with some of the students. Mac and cheese, dried fruit, juice and cereal were put into a plastic bag and then tied. Meanwhile, some of the students filed through the lunch line creating their lunch trays. The three workers were frantically heating up food, stocking the holding stations and helping the students with their selections. Pancakes were being served as a lunch option that day, and were to be paired with yogurt to make a grain protein alternative combination. The yogurt could only be served with the pancakes because there was a limited supply. One of the cafeteria staff helped the students with their selections, so that those who selected the pancakes also got yogurt. So many things were happening at once. Between all of the staff members cooking and students making their choices, I didn’t know what to watch. Yet, amidst all of the multitasking, the kitchen staff handled the lunch rush flawlessly.  Olivia and I eventually ran out of food after putting together a couple hundred bags. This marked the end of our time at the school. We thanked the kitchen staff for introducing us to a school foodservice kitchen, then went home to prepare for the next day. 

The next school we visited was a middle school. Walking through the cafeteria doors I was taken back by how different this kitchen was. It was huge! There were three lunch lines, two giant new ovens, two cooling stations, two heating stations and two giant stainless steel tables. After getting a tour, we quickly got  to work. We assembled hot dogs, chicken patties and cheese steaks then wrapped them up to be sold at lunch. It wasn’t long before the kids came knocking at the lunch line doors. Bursting through, the kids filed through the lunch lines grabbing whatever food options appealed to them — most had their eyes, stomach and heart on that pepperoni pizza.  

The kids were moving so fast we almost couldn’t keep the holding stations stocked with food options. Sadly, there was much less pizza available than normal that day because of food shortages. The pizza supply would run out half way through each of the lunch shifts. It was interesting to see that a few students walked out of the lunch line without grabbing an alternative meal. Some students would rather go hungry the rest of the day than grab a meal other than pizza. Wow. The MCPS food service heroes didn’t let this go unchallenged. They took the extra step of talking to the students hoping they could entice them to grab another meal. Sometimes the students would grab something else, and sometimes they wouldn’t. Either way, it was great seeing some of the passion these staff members have for helping their students. This was another great experience that really helped me understand some of the obstacles the food service staff faces.

Going into this rotation, I really wasn’t expecting these two experiences to be that different from one another. If the schools are in the same county then they should function the same right? Wrong. Every school’s food service staff is faced with their own unique obstacles. They do, however, have one thing in common – they receive their food from the same place. All of the schools in the county are dealing with food shortages because of the COVID19 pandemic. This poses a serious challenge for the food service workers on a daily basis. How can each of the schools serve their predetermined lunch menus if they aren’t receiving all of the food they need? How are the food service workers able to fulfill all of the food group requirements for lunch if they’re piecing together menu items last minute? The knowledge and experience of the Montgomery County Public School food service heroes are the answer. The staff members use their critical thinking skills to substitute menu items with what is available in their kitchen. The middle school we visited was low on some of the food items needed for some of the meals that the menu advertised. Adapting to the challenge, the staff members then cooked and sliced spicy chicken patties that they placed on top of salads. Not only was this substitution genius, but the salad looked delicious! We were told making these last minute decisions has become the new normal. These substitutions are no easy task. The kitchen has to look at what items weren’t delivered, what’s in stock, what combinations of food will follow the meal component requirements and how to vary the vegetables offered throughout the week to ensure color requirements are met.  

Though the food service workers face several obstacles stemming from the COVID19 pandemic, they step up to ensure the students are well fed throughout the year. The adaptability and passion behind these workers is astonishing. These heroes deserve much appreciation for their work. Hopefully the food systems that fuel our public schools will normalize soon so students can eat all of the pepperoni pizza they please, and help to lighten the load of the public school food service workers. Thank you school food service staff members for everything that you do.

Tour of District Farms: A Hydroponic Facility

By: Olivia Heinz

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Hydroponic agriculture is an alternative and innovative farming method that has the potential to drastically affect climate change, food insecurity, and the food industry as a whole.  Through my rotation with Frederick County Farm to School, I had the opportunity to tour District Farms. District Farms is a hydroponic facility located in Frederick, Maryland that utilizes greenhouse growing in order to provide the community with high-quality local produce year-round. Prior to this rotation and tour, I had recognized ‘hydroponics’ as a buzzword in the agriculture community but was not totally confident on what this term meant and what the advantages of this farming technique were. I have now discovered that hydroponics is a type of horticulture wherein plants are grown without soil, usually inside a greenhouse where the moisture, air temperature, and fans are controlled and computerized. 

As I first entered through the doors of District Farms, I was utterly shocked by the amount of green that I saw. The entire greenhouse was packed full of varying types of leafy greens, as far as the eye could see! The plants were all aligned in rows, with the irrigation system situated down the aisles and connected to every row of plants. The irrigation system provides the plants with nutrients and water through an aqueous solution, due to the fact that soil is not utilized in the process. These nutrient solutions provide plants with the essential elements that they need. Some minerals that are commonly included in hydroponic nutrient solutions include calcium, magnesium, sulfur, and trace elements such as zinc, iron, boron, and manganese. Micronutrients are more readily available at a lower pH, making the optimal pH for hydroponic nutrient solutions around 5.8-6.3.  During my tour, Lara Meehan, the Sales & Marketing Manager at District Farms, informed me that hydroponic facilities use 90% less water than traditional farming techniques. The actual greenhouse we were in, she stated, produced the same amount of product that would be produced from 5 times the amount of traditional farmland. These statistics shocked me. I couldn’t wait to learn more about the technology and advantages of hydroponic facilities and to share that information with others. 

Our tour began in the seed germination area, where the process begins with the sprouting of singular seeds. As we continued on our tour, Lara showed us the different types of crops that District Farms produces. The first crop that we saw was crunch lettuce, one of their specialties. We also were able to see different types of microgreens that are currently in demand from the culinary and restaurant industry. Microgreens are young plants that are approximately 1-3 inches in height. Some examples of these microgreens included a crunchy mix, a spicy mix, micro arugula and micro basil. We even got to pick a stalk of micro cilantro straight from its hydroponic chamber, and I have never tasted something so intensely flavorful! Currently, business is booming for District Farms in the foodservice industry, and they are hoping to initiate a larger push into the retail industry.

Towards the end of our tour, we each got to harvest our own head of butter lettuce, package it into the signature plastic clamshell and stick the District Farms label on the outside. District Farms estimates that they currently produce about 37,000 heads of lettuce annually, but with their current expansion plans, this number will increase.

Lara shared with us a couple of her favorite ways to enjoy District Farms’ products. With the signature butter lettuce, Lara likes to make Thai chicken wraps or use the leaves as a taco shell substitution. She also likes to use a combination of the Lola Rosa and crunch lettuce to put together a delicious watermelon and feta salad that must taste like summer.

Hydroponic farming techniques allow for produce to be grown at a faster pace, using less land and in areas where traditional farming methods may be futile due to urban development or weather and climate factors. Additionally, the factors that most significantly affect the flavor of produce (air temperature, humidity, and moisture) can all be tightly controlled in order to deliver the most optimal product. These are significant traits of hydroponic farming methods that could aid in increasing the average consumption of fruits and vegetables and could not be more applicable to the field of dietetics. District Farms currently has partnerships with the Farm to School programs at Frederick County Public Schools and Baltimore City Public Schools where they plan to bring in hydroponic lettuce and basil into the schools. I am sure that these school districts look forward to promoting hydroponics, as well as providing their students with more local, Maryland-grown produce.

I could not be more grateful for such an unforgettable and educational experience at District Farms through Frederick County Farm to School. I look forward to seeing more hydroponic products being implemented in the school meals and sold on the shelves of grocery stores in order to raise awareness of this innovative farming technique and the advantages that it provides!

Chef For a Day

By: Meredith Murdock

Making a meal for yourself is toilsome. Between the planning, preparation and cooking, there is a lot of time and thought that goes into the process. It can be exhausting! Have you ever thought about what it would be like to plan a meal for 100? During the last week at my food service rotation with Ascension Saint Agnes Hospital, my partner, Jen, and I had the opportunity to choose and plan our own meal to serve in the retail cafeteria. Through this experience I learned a lot about the importance of planning and being time efficient. I also gained an immense amount of appreciation for all the staff. 

Our first step was to figure out what dishes we wanted to serve. Our selections were based on seasonal foods, both rich in flavor and with high nutritional value. We knew we wanted to combine a soup and salad of some sort because of its comfort and warmth going into the fall season. Additionally, Jen and I decided to add a less popular green choice, kale, into our menu to introduce and educate consumers on the health benefits. We saw a need to emphasize the proper way to massage the kale before serving; a step that is crucial in loosening the fibers to produce a softer texture and less bitter flavor. Therefore, our final menu consisted of a chicken pesto panini, butternut squash soup and a fall harvest apple kale salad. 

Jen and I then needed to scale each recipe and determine how much of each ingredient we would need in order to serve 100 people. Between estimating the amounts and ordering the food through Saint Agnes’s online system, this was definitely one of the harder tasks we came upon. We needed enough ingredients, correctly estimated, plus extra in case. The day before we served our meal, we prepped our ingredients; we cooked the chicken, cut produce and made the salad dressing. The morning of our big day, we came in an hour earlier than usual. This ended up being the most crucial hour in all of our prepping and planning. This was when we added the last few spices to our soup, set up our exhibition station display, and stored extra ingredients for refills. 

Planning and cooking in bulk is not easy, as we learned very quickly. However, with the help from all the staff and chefs, we successfully made and served about 75 people that day. We have so much admiration for those that work in the kitchen for hours preparing, planning and cooking both patient meals and cafeteria meals for the staff and visitors to the hospital. Jen and I also reflected on how many potential consumers glanced at our menu and quickly decided it was too healthy because of its incorporation of kale and butternut squash. I spoke with one woman who initially was hesitant, but decided to try it; she loved it so much she asked for the recipe so she could make it at home. This positive feedback among others was exciting to receive and makes me feel more inclined to introduce other vegetables that aren’t as wildly popular in the future. I hope this encourages the customers to use vegetables such as kale and butternut squash in their future cooking as well as being flexible to trying a new ingredient or meal.