University of Maryland Dietetic Internship

Developing an Effective Cooking Class

By Danny Turner

Making your own food can be incredibly rewarding, and oftentimes a lot healthier than eating out, but many do not cook the majority of their meals. The convenience of buying premade meals or going to a restaurant is a large part of this, but many also simply lack knowledge and experience with cooking. Preparing your own food with whole ingredients will almost always result in a meal that is lower in fat, salt and sugar than an equivalent meal at a restaurant. It would be great if there was time in a patient session with a dietitian to go into details about how to buy the right ingredients, prepare them, and cook them, but unfortunately there isn’t. Some dietitians have developed cooking classes as a creative solution to this issue. I spent time with a dietitian at Children’s National Medical Center who did just that.

*The impressive demo kitchen at Children’s National Medical Center*

According to research from the Minneapolis Heart Institute Foundation, cooking classes can make kids more likely to choose healthier food options. The program I helped develop aims to do just that. The goal is to introduce kids to new ingredients and foods, teach them a bit about nutrition, and have them learn to prepare new foods themselves! For many, this is probably the first time they will have cooked their own meal. We also wanted to find a way to provide some fresh ingredients for the kids to take home and recreate the recipes they had practiced.

I was given recipes that the dietitian had sourced and tested and was tasked with creating a lesson plan and educational materials to give to our audience. For each recipe, I wrote a sort of script for us to use. It would go over the steps of the recipe, particularly the trickier parts, and include a little bit about why the ingredients we chose were good for us. As an example, the blueberry pancake recipe we made used half white and half whole wheat flour, so we used that as a springboard to discuss making at least half of your grain choices whole grain.

To give more general advice about produce that the kids may not have tried, I created small handouts that explained what nutrients were in each fruit or vegetable, and some suggestions for easy ways to prepare them. Doing research for this even taught me a couple things. For instance, did you know that pumpkins and zucchini are the same species?

After all of the content creation, shopping and prep, we were ready to hold our class. I had a great time demoing a recipe and talking the kids through the cooking. The class was a success: everything we made turned out tasty, everybody had fun, and we didn’t even start any fires! I sincerely hope that this wonderful program continues to grow, and that dietitians keep putting in the time and effort necessary to do work like this. Cooking classes empower patients to make healthier food choices and give them a stronger personal connection to the food they’re eating.

Celebrating in style, no matter the texture

By Julia Werth

Until a few years ago, when I heard the word “diets” I always thought of weight loss. Cutting calories, cutting fat, cutting whatever foods and beverages it took to lose weight. As I spent more time in nutrition classes and hospital settings (especially during my clinical rotation) diets came to be defined by disease state: diabetic, renal, cardiac, etc. But as I began my food service rotation at a the Maryland VA long term care facility, the meaning of “diets” again began to change.

It came to be defined by textures: pureed, dysphagia-mechanical (also sometimes known as ground), mechanical and the occasional regular (but in reality still pretty soft).

Instead of worrying about calories, carbohydrates or grams of protein, the constant refrain became “is that too tough? Can they chew that?”

Are chicken tenders rethermed with or without a cover the proper texture? Is pulled pork okay for a mechanical diet? How do you make pureed anything look appetizing?

In a facility focused on providing veterans with care and comfort in a place that feels at least a little more like a home, patients are not kept on strict, carb-controlled diets. They can order snacks, second servings or a soda every single day – but if they can’t chew regular-textured food without risk of choking then a modified texture is necessary.

As my partner Adam and I began planning a Luau themed meal for the veterans, we wanted to ensure that all residents no matter their texture would be able to attend. We chose foods that could be easily ground or pureed, that tasted good without a crisp outer edge and that could look appealing in any form. We added alternative veggies that wouldn’t be too crunchy and made color-coded menus for all the food service staff to help us stay organized during the restaurant-style event.

We decided on pulled pork – because it could be enjoyed by regular, ground and mechanical. We picked pineapple rings, because pureed versions were available. We learned that rice is always a great choice because it truly looks yummy whether the grains are really fine or not.

As we plated the food during the meal, I was starting to second guess myself. Maybe the residents on regular-textures would resent the lack of bread? Maybe the veterans requiring purees would notice that their pineapples weren’t grilled? Maybe the sweet potato casserole really didn’t go with the rest of the meal?

Despite my worries, however, the meal seemed to be progressing well. A few peeks into the dining room gave me a view of over half of the veterans who live at Loch Raven digging into our Hawaiian themed food, but the next day was the true litmus test.

“So, did you attend the Luau yesterday?” Adam and I asked several veterans on a variety of textures throughout the morning after. “What did you think? Did you like the food?”

And far more often than not, regardless of texture, the answer was “Oh the Luau? That was delicious!”

Expanding Our Nutrition World

By Emily Glass, Alexandra Long, Melissa Talley and Julia Werth

Fruits, vegetables, protein, grains, and dairy – the five food groups. That’s nutrition 101 for every dietetic intern. Or so we thought…

Recently, four of us had the opportunity to attend a global maternal, infant, and young child nutrition (MIYCN) event held on April 30 in Washington, DC. Alive & Thrive (A&T) is an initiative to save lives, prevent illness, and ensure healthy growth and development through optimal maternal nutrition, breastfeeding, and complementary feeding practices. Over the course of the event, we learned that internationally there aren’t just five food groups studied; in fact, there are double that number.

Fruit, iron-rich vegetables, vitamin A-rich vegetables, other vegetables, cereals, dairy, fats, fish, nuts/seeds, and meat are the ten food groups generally used in A&T programs to monitor intake and outcomes related to nutrition policies and programs. This division makes it easier to compare the intakes of nations worldwide, many of which have larger populations of vegetarians and less access to certain fruits and vegetables than we do in the United States.

Screen Shot 2018-05-23 at 7.16.29 PM — Melissa Talley, Julia Werth, Emily Glass and Alexandra Long (from left to right) at the Alive&Thrive conference on April 30.

And the considerations and alterations made to best serve and address the needs of families globally don’t stop there. With every country and culture comes different social norms and traditions that may be different to here in the US.

Take fasting for instance. The Ethiopian Orthodox Church (EOC) requires followers over age seven to fast for over 180 days a year, which includes abstaining from all animal source foods and consuming their first meal of the day after noon. Although children under seven are excused from participating, they still receive little to no food during fasting times. A&T has spent time evaluating the impact of fasting practices on young child diet quality and diversity and has worked with EOC religious leaders, mothers, and fathers, on the delivery of messages around child feeding during fasting periods.

Findings of these efforts have showed that mothers were willing to try adding animal source foods into their child’s diet, specifically eggs and milk, during the fasting season, if reassured that this would not break their own fast. Priests were willing to teach about proper child feeding practices during fasting, and work with health extension workers (HEWs) to reach the community as long as the instruction came from formal, authoritative religious channels.

Screen Shot 2018-05-23 at 7.16.16 PM.png — Photo Credit: Alive & Thrive: Manisha Tharaney, A&T Senior Technical Advisor, Nutrition,
presents on the A&T project in Ethiopia on April 30 in Washington, DC.

As dietetic interns, we know the crucial role nutrition plays in growth and development of infants and young children. During this event, we had the opportunity to learn about how A&T uses an evidence-based approach in Ethiopia and other countries to improve infant and young child feeding practices. To say our experience at this conference was eye-opening would be an understatement. As future registered dietitian nutritionists, it is important for us to know not only what is happening with nutrition research and programs in the US, but also what is happening internationally. There is much to learn from these successful programs that we could adapt into our own public health practice. Throughout our time at the A&T event, we met and heard from extremely unique and talented individuals who were all there for the same purpose: to optimize maternal, infant, and young child nutrition for all women and their families.

Learning the Ropes of Renal

Danielle Ferguson

Honestly, ever since my Anatomy 2 class where I learned about kidneys and the role they play in the body, I’ve been obsessed. If it’s possible to have a favorite organ, the kidneys may be mine. From the way they regulate blood pressure, to filtering the blood, to secreting different hormones, I find them fascinating. I have always been curious what it would be like to be a renal dietitian so I am thrilled to have the opportunity to explore the role of a dietitian in a dialysis center during this internship.

Dietitians play many roles in a dialysis center, including exploring the clinical aspects of patients care, counseling, providing nutrition education on the renal diet, and aiding in the management of medications, vitamins and minerals. One of the aspects I love in this focus of nutrition is the relationships that you are able to buildwith the patients. The dietitians I worked with at Fresenius manage about 120 patients, sometimes at 2 different clinics. This is a large caseload. Due to the nature of dialysis, however, they work with these patients throughout an extended amount of time. They have the ability to build rapport and mutual respect. Beginning dialysis can be a very overwhelming time for patients, and the dietitian can help make this time a bit more manageable with the education and information they provide.

During my rotation, I was able to provide nutrition education to patients. Some of the most important counselling I provided was explaining the different types of foods patients can have and those they should avoid. The two nutrients that are often necessary to limit in the renal diet are potassium and phosphorus. Potassium is found in foods such as bananas, potatoes, beans, and tomatoes, while phosphorus is found in foods such as dairy products, dark cola, chocolate, processed and packaged foods, and beer. Although there is an extensive list of foods these patients are advised to avoid, the dietitians I worked with chose to guide the patients towards the foods they can have. Emphasizing adequate protein intake is important with this disease state. Patients on a pre-dialysis renal diet often must restrict protein intake because it overworks the kidneys to have to remove protein waste products from the blood. However, once dialysis begins, this protein restriction is lessened since when the dialysis machine filters wastes from your blood, it can also remove protein. During this rotation, I learned the nuances of factoring in a patient’s disease, type of treatment, and nutritional status to determine an appropriate goal for protein intake.

Learning how to nutritionally manage a disease as complex as kidney disease is an exciting challenge that I will continue to practice throughout my career. In this blog post, I have only presented a snapshot of my experience working with these amazing and passionate dietitians who put their hearts into their work. Seeing the importance of a renal dietitian in a dialysis setting has me excited about yet another potential career path. There are so many ways to make an impact on the lives of others, and having explored the crucial role of a dietitian, I know I have chosen the right career for me to help others.

Digging Into Sustainability- Part Two

By Kelsey Felter

With spring in full bloom, now is a great time to start thinking about local produce! Local produce was certainly on my mind as I spent two weeks experiencing and learning about sustainable farming at University of Maryland’s (UMD) Terp Farm. Because the Terp Farm is a sustainable farm, it is able to produce crops without compromising the ability of the future generation to meet its needs. The crops that the farm grows all go to UMD to be served to students in the dining hall or sold at UMD’s farmers market. The Terp Farm has helped the school increase its sustainable practices and reduce its carbon footprint. Emily, my internship partner, and I spent a split two-week rotation there; we had one week in early March and another week in the middle of May. As you would expect, the farm was a very different place between these two experiences! Just during these two week stints, we were able to see much of the full agricultural circle: prepping for spring season, planting seeds, transplanting seedlings, harvesting crops, and distributing to the community.

Winter: Prepping for Spring

You may be thinking, “What could possibly be growing in the 30-degree weather of early March?” This was my thought before visiting the farm for my first time. As Emily mentioned in her blog, “Preparing for a Successful Harvest on the Terp Farm,” mixed greens were already growing in the farm’s high tunnel, but other than that, the colder months are all about preparing and maintaining the farm’s soil to be ready for spring and summer’s most fertile months. So what benefits are there with local, sustainable farming? The advantages of sustainable farming are numerous!

After our first, chilly visit to the Terp Farm, Emily and I realized how much preparation goes into the crops that the farm yields throughout the spring and summer season. If you have not had a chance to read Emily’s blog about our experience on the Terp Farm, check it out here so you can experience the amazing transformation of the farm from winter prep to spring in full bloom!

Spring: Planting, Growing, and Harvesting

Two months after our first visit to the Terp Farm, my partner and I went back to the Terp Farm for round two of our adventure. This time it was sunny, with temperatures in the high 70’s, blue skies, and lots of green seedlings growing in the greenhouse. We got our hands dirty as we planted hundreds of flower seeds that will be sold at UMD’s farmers market throughout the summer. To plant the seeds, we used the trays we had cleaned back in March! It was wonderful to see this process in full circle, from preparation to actual planting season.

At the end of the day, we transitioned to the high tunnel where we helped Guy harvest spring mix that would be transported to UMD’s dining halls and served to students. The last time we had been in the high tunnel, there were just three rows of spring mix growing. This time, we opened the doors to the tunnel and were blissfully blinded by five rows of beautiful spring mix, all different shades of green! Guy used a portable machine to cut and gather the spring mix, and we walked through the rows behind him, gather the spring mix in large buckets. After our harvest, we had filled nine large baskets of fresh spring mix to be transported to UMD dining halls!

Our last day at the farm, we took on a new task: plotting a field for future crops. We were honored that Guy trusted us with this task. This will be the home of thousands of new seedlings and we got to create it from ground zero! Together, Emily and I used a 100-foot measuring tape to plot the dimensions of a 300’ by 430’ field where future crops will be planted. We spent hours in the field, using flags to indicate where each section would be mowed and tilled. We tediously measured, twelve beds measuring 40’ by 200’ with 10’ gaps in between each bed. After we perfected our plots, I felt that I truly understood the full circle of life at the farm, from planning to planting to harvesting.

Distribution: UMD’s Farmers Market

The Terp Farm not only grows produce, but it also grows flowers and then sells them by single bouquets or through a Community Supported Agriculture (CSA) program. This CSA encourages the UMD and local Maryland community to attend the farmers market and purchase flowers from the Terp Farm. By purchasing a CSA membership for 96 dollars, members receive a bouquet of flowers (20 stems) every other week for the duration of the season. If customers are not ready to commit to the CSA membership, they can buy a single bouquet at the farmers market. The benefit of the CSA is a reduced cost per bouquet as well as a guarantee that you will receive your bouquet at each farmers market, because the flowers often sell out! My partner and I helped promote the flower CSA by handing out a sunflower seedling to anyone who stopped at the Terp Farm’s table to learn more about the CSA program.

I left the Terp Farm with a lot of dirt in my shoes and a lot more knowledge on sustainable farming in my head. There is extensive manual labor, planning and patience required with sustainable farming, but I feel it is worth every second to be a part of it. From what I could tell, Buddy, the Terp Farm’s biggest and fluffiest fan, agrees!