By: Samantha Adas

I recently had the opportunity to attend the Maryland Academy of Nutrition and Dietetics (MAND) Annual Meeting that was held in Baltimore, Maryland.  The conference had three separate session tracks for the attendees to choose and follow. While you could mix and match sessions, I chose to stick with the “Fact versus Fiction” track as the topics covered best matched my interests.  

Two of the three talks I attended focused on dispelling common myths nutritionists and dietitians often hear. Soy has long been one of many foods struck with controversy; many often question whether it is “good” or “bad.”  I knew that the research revolving around soy’s potential harm regarding women’s health was not very strong. However, I wanted to have more concise information to be able to better communicate the research behind soy as I often get asked this question by friends and family.

Dr. Mark Messina shared that the research against soy was either solely based on animal studies, which are known to metabolize components of soy differently than humans, or were based upon two case studies in which the two men were consuming over 12 cups of soy milk a day. In contrast, there is research demonstrating that soy is associated with benefits including decreased breast cancer risk, fewer hot flashes during menopause, and possibly skin improvements.

Another subject surrounded by controversy is organic foods and pesticide use. As a future dietitian, I want to make sure I have a good understanding of the actual facts. A panel comprised of a scientist, farmer, and crop advisor dived into this topic and discussed the use of pesticides in farming, along with other related topics in the following session. Regardless of  where I end up in the field, I want to encourage fruits and vegetables whenever possible. With growing media influence, including social media, it can sometimes seem that if produce isn’t organic than it is not healthy. The public seeks out “clean” food but is often mislead by labeling. Some view an organic label as a stamp of health. However, the lesser-known truth is that organically grown crops use pesticides too, and often in larger amounts than that of conventionally grown crops.  However, neither farming method should be of concern to consumers and their health. Lists such as the “dirty dozen” taint the reputation of beloved fruits and vegetables such as strawberries, however, even with the highest pesticide amounts, one could consume 1,500 strawberries a day without any negative impact from pesticide residue.

After a busy day, the meeting wrapped up with a talk by the Senior Director of Nutrition at the International Food Information Council, Kris Sollid.  I really enjoyed this talk on the general public’s perception of nutrition and food trends. It is true that media plays a large role in the public’s perception of what is healthy or what is the best diet. However, it will be my role as a dietitian to use and disseminate evidence-based knowledge in a way that is understood by my target audience.  I know that in order to do this successfully, I will need to stay aware of what the public believes regarding health and nutrition, because it may not always align with what health professionals know to be true. I am grateful to the American Dairy Association North East for sponsoring my registration to this event. I must admit that I was a little nervous going into the day as the only student there from my program. However, I know that it is important to get outside of my comfort zone and network with others who I look up to. I am thrilled I was able to learn such valuable knowledge that I will take with me and use when working with future clients or patients.

 

Reference: Fact Checking the Headlines: Pesticide Residues in Food and Insights into Food Production on the Farm. Common Ground. MAND Annual Meeting. 2019.

 

 

– by Kira Bursaw

Throughout my time as a dietetic student in university, professors would always brush over the topic of dialysis. Renal nutrition, they indicated, was something we would learn lots about during the dietetic internship. Given this, I was feeling trepidation the first time I walked into a Fresenius Kidney Center on a cold January morning for my renal rotation.

I was greeted in the front lobby by Jackie, the dietitian I would be working with for the week; she was waiting after seeing me pull into the parking lot. I was immediately struck by how observant and considerate that was of her, especially since I had no idea where I was going or who I was looking for. This first impression immediately reassured me that the rotation wasn’t going to be of the sink-or-swim variety.

Our first day together was spent reviewing what a dialysis dietitian does in a typical day. First, she ran through the schedule of the patients. Patients come in for one of three 4-hour shifts during the day starting before 7:00 am and finishing after 7:00 pm. The staff weighs patients before treatment begins, then the patient heads off to a treatment chair. I learned about the different healthcare team members patients’ meet with while in the treatment chair. The final step for the patient is the post-treatment weigh-in to determine the amount of fluid that was taken off. Before making rounds in the treatment area, Jackie reviewed the charts and most recent labs of each patient and made note of any changes that need to be addressed. Since many of the patients have been at the kidney center for years, Jackie has established a solid rapport with each of them and knows their social history well enough to inquire about family members by name and specific leisure activities.

For me, one of the most surprising aspects of Jackie’s role in the dialysis center was in regards to medications. She is very involved in the management and titration of each patient’s medication dose, often speaking to the doctor and the charge nurse about adjustments to make. We spent a lot of time each day reviewing patients’ lab results and comparing them to the corresponding medication trend. I hadn’t been expecting to have such an in-depth discussion of medications and the effects they have on patients, but it was very refreshing and a welcome challenge.

Since the dialysis center is only open to patients on Monday, Wednesday, and Friday, I spent the day Thursday creating a bulletin board for the treatment area. The board itself hangs over the floor scale by the door, and almost all of the patient chairs face it. My topic of choice was bone health, with an emphasis on phosphorus, due to the high number of patients that went above the target range for their phosphorus lab values during their last blood draw. The board I designed consisted of an explanation of end-stage renal disease, the dialysis process, high and low phosphorus foods with corresponding pictures, how to control phosphorus levels in the body, consequences of high phosphorus levels regarding calcium movement, and the target ranges for phosphorus, potassium, and calcium. I also included a great visual of the various medications patients are taking through FreseniusRX, the Fresenius Pharmacy. During our patient rounds on Friday morning, Jackie encouraged me to speak with each patient about the new information available to them. Many of the patients were excited to have a change in the treatment room and thanked me for taking the time to provide them with the material. They especially loved the purple background, which had been green for several years. It was nice to see my work noticed and appreciated, and to hear that it actually made a difference for the patients.

The renal rotation was a very valuable experience, and I hope to one day work in a dialysis center as a dietitian. There is a very close-knit, family-like relationship amongst the staff and patients, where everyone knows everyone. I greatly enjoyed my time with such a wonderful group of people. I can understand now why the work of renal dietitians wasn’t heavily emphasized during undergrad- it wouldn’t have done the role justice. The unique interpersonal environment is what makes the dialysis center stand out, more so than at any other rotation I have been in.

By: Rachel Miller

Eating with a sustainable mindset is about choosing foods that are both healthy for our bodies and our environment. Determining whether a food is sustainable begins with understanding the production of that food and whether the farming practices used in its production have minimal impact on the environment. The University of Maryland (UMD) College Park has established an active working relationship with the Menus of Change initiative and a Sustainable Food Action Plan. Both entities are used in UMD Dining Services to increase sustainable food availability on campus and ensure that resources used today will remain available in the future.

My partner, Sammie, and I began our first week of this rotation developing content to market a variety of vegetables grown on the Terp Farm throughout the year. I learned how to incorporate sustainably sourced, healthy food options into UMD’s dining menus. We developed different forms of signage to promote the newly featured foods and the recipes in which they would be found.  I learned how to incorporate healthy options and sustainable sources into dining menus using signage. This content serves two purposes; it encourages chefs to become more comfortable with ingredients that are new or unfamiliar to them, and it educates students on these ingredients. In addition to creating content, such as posters, to highlight certain ingredients, we also gathered a few recipes for each ingredient that could be featured in the weekly cycle menu. Ideally, these recipes will spark creativity and encourage chefs to utilize new vegetables, especially when they are in season. This resource highlights one farm vegetable per month. We created content for okra, garlic, tongue of fire beans, parsnip, snow peas, and spring brassicas (i.e. white salad turnips, napa cabbage, purple/green daikons). From doing this activity, I gained more insight into the benefits of buying local, seasonal produce and how it can be aligned with menus to emphasize fresh foods during peak growing season.

Having learned how to bring the “farm to table,” Sammie and I were able to get our hands dirty on the Terp Farm itself. In doing so, we discovered how the Terp Farm uses farming practices that have a minimal impact on the environment. During our time at the farm, we had the opportunity to plant spring salad mix in one of the three green houses, given that it was still winter! To begin our seeding process, we first used a broad fork to loosen the soil. Then we used a tractor native to Italy, known as the BCS tractor, with a power harrow attachment to further prepare the seedbed. This tool helps to preserve soil structure by not mixing layers and reduces weed growth. Following the BCS tractor, we used a rake to flatten the bed surface and even out all four beds. Then we used a tool to create rows of six to lay seed. Finally, we used a seeder to plant the salad mix. It was so interesting seeing how much goes into to planting only four rows of crops in a greenhouse. We also heard about the work that goes into maintaining the two acres of land the Terp Farm will cultivate to grow additional produce for UMD’s dining halls.

Maintaining the land in the greenhouse is far less challenging than maintaining the two acres outside. Guy, the farmer, shared with us how he sustainably maintains the land so when it comes time to plant in the spring, the soil is rich with nutrients and ready to be used. Cover crops are a form of sustainable soil maintenance allowing recycling of nutrients. Instead of keeping the fields fallow (unsown or inactive) for a period, cover crops are planted to recycle the nitrogen in the atmosphere and turn it into soil nitrogen which can then be used by plants. If a farmer chose not to use cover crops, then the soil would erode and the nitrogen in the soil would risk polluting water. With a cover crop keeping the soil fertile and nutrient rich, there is no risk for erosion. Guy likes to plant legumes and rye as cover crops. Legumes especially, play a major part in nitrogen conversion, allowing 30 to 60 percent of the nitrogen it converts to be used by plants following its removal. This is just one example of a sustainable farming practice that we were able to see in action during our rotation.

We were not at the farm long enough to see the harvest of our salad mix, but we did get to taste some that was planted prior to our visit to the farm. Sammie and I loved tasting the different leaves as Guy explained the flavor profile to us using his culinary background. I think the future of the Terp Farm is looking very bright. Programs like Menus of Change and the Sustainable Food Action Plan are valuable tools for universities and restaurants across the country to increase sustainable food offerings. By implementing these programs into their food service systems, they can make positive changes for today and spread the importance of sustainable farming for the future of food and health for generations to come.

 

 

 

 

 

 

 

 

The Kids Are Alright

Michelle Guarnieri

During my time at Children’s National Medical Center (CNMC) in Washington D.C., I experienced a lot of change and excitement. After all, I was working with children for the first time! I finished my clinical rotation in December, and thought I knew what to expect at Children’s, but I had no idea of the variety of roles the dietitians fulfilled in this facility. Children’s has both a hospital and several outpatient clinics scattered around the D.C./Maryland area. I was lucky to spend time with three wonderful dietitians in both of these environments and learned more than I could have expected.

For my first week at CNMC, I was in the outpatient gastroenterology clinic. My first day consisted of observing the dietitian and how she counseled patients and their families, but I was sent to see patients on my own in the days that followed. Patients presented with problems ranging from Crohn’s Disease to picky eating to breastfeeding difficulties. Prior to this rotation, I hadn’t learned much about baby and child formulas. My preceptor provided education on the basics of infant and child formulas, and this knowledge was extremely valuable when the dietitian had me counsel a mother on how to mix formula for her underweight baby girl. It was a whirlwind of a rotation, but I gained so much knowledge.

Interns are asked to complete a case study while at CNMC, and I chose to work with a child with behavioral eating difficulties. He was highly selective with his foods and became very anxious and scared when other foods were presented to him. Children with issues of this caliber require an entire feeding team to overcome their fears of food. This team consists of a psychiatrist, nurse practitioner, dietitian, and for this specific case, me! My role was to complete a full three-day nutritional analysis and point out nutrients the child wasn’t consuming adequately. His diet was extremely limited, so he was likely deficient in several nutrients. The nutritional analysis I completed confirmed that this boy needed more fiber, vitamin D, and omega-3, to name a few. In addition to completing the nutrient analysis, I was able to observe this patient during a family meal. The clinic uses a double sided mirror, not unlike those in crime shows.  During this observation of the child and his parents, we looked at eating patterns, reactions to foods, and anxiety levels. Afterwards, we met with the team and parents to discuss the treatment options. It was so interesting and I was very fortunate to have this as my case study.

On Friday, I spent time in the IDEAL weight management outpatient clinic with a fantastic dietitian. Most of these patients were young teenagers, but there were some even younger children that needed weight management counseling. The dietitian really tried to get to the root of the issues at home and why the child is obese, which was both emotional and highly informative. Just this eight-hour day sparked my interest in weight management, a field I hadn’t even considered before this!

Finally, my second week was spent in the inpatient neurology unit. I was able to learn about a variety of cases, and at times I felt like I could barely keep up. That being said, my preceptor and I mainly worked with children with seizure-causing disorders. We helped start them on a high-fat, low-carbohydrate ketogenic diet, which has been shown to reduce the prevalence of seizures and the advancement of diseases like Glut1 Deficiency. I had always thought of “keto” as a trendy weight loss diet, but I learned that it can be an effective treatment option for several neurological disorders. A ketogenic diet alters energy metabolism, reduces inflammation and modulates neurotransmission. Seeing this first hand at such a renowned hospital was extremely informative and a fantastic opportunity.

All in all, my experience at CNMC was a whirlwind of information, valuable experiences, challenges and enjoyment. I feel very lucky to have spent time at this leading institution, and will use all that I learned in my future career as a Registered Dietitian Nutritionist!