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.

“Wow, is it a type of diet? Isn’t it a type of salt?” That was my thought when people asked me about a Kosher diet. Born and raised in Vietnam, the only times I heard about Kosher was the salt brand used in cooking. After I came to the US, I learned more about this term and the diet associated with it. And I learned even more about it when tasked with creating a Kosher diet handout during the clinical rotation of my dietetic internship at Baltimore Washington Medical Center (BWMC).  

During the 10-week clinical rotation, I was assigned to design an educational handout about a topic that I am interested in. The handout was given to the food services and kitchen team during the monthly meeting to educate the staff so that they can better serve the patients. 

At the beginning of the project, I started researching about the Kosher diet and its restrictions. Kosher is a term used to describe food that strictly follows Jewish dietary laws. These rules are also known as Kashrut. Kosher foods fall into three basic categories: meat, dairy, and “parve.” Kosher meat includes animals that have split hooves and chew partially digested food from their stomach such as goats, cows, or sheep. Certain parts of the animal including fat, blood, and nerves are not kosher. All dairy products such as milk, yogurt, and cheese must come from kosher certified animals. The parve group includes vegetables, fish, fruits, packaged foods, and eggs. In the kosher diet, there are many laws that fall below each category of food. I asked the dietetic manager how kosher food is served at the hospital. She explained that the dish is sealed and only opened by the patient or by someone at their request.

Although the dietitian provided a lot of information to me about the kosher diet, I only included the key information on the handout. The goal when creating educational handouts is to be detailed yet brief to hold the reader’s interest. I used Canva, a website, to design the handout. The first page of the handout shows key information about the diet and its rules. The second page has multiple choice questions that ask how to serve the food and what are the restrictions. This helps to enhance the readers’ knowledge and retention of the information.

Image credit: by Amino Science

Educational handouts like this are important resources in food service operations. Dietitians and food service workers must consider and understand  various cultures in hospitals and long-term care facilities when serving a variety of customers. This minimizes miscommunication, decreases health risks, and improves customer satisfaction. 

After completing this assignment, I felt more confident talking about a kosher diet. If someone approached me and asked about Kosher, I could easily explain it and provide examples of allowed foods in this diet as well as some of the rules.

In this experience, I not only learned about a special diet, but I also learned new technology skills to create effective nutrition education handouts. I know I will use this skill set a lot when I become a registered dietitian. Creating concise, reliable, and evidence-based nutrition education materials engages your target audience and reinforces the behavior changes they need to make which can result in positive health outcomes.

By Dietetic Intern: Rachel Amsellem

Part of becoming a registered dietitian is being able to effectively communicate with your patients through verbiage, facial expressions, or visuals. During my rotation with Manna, my visual communication skills were put to the test as I was tasked to create a video of a recipe they could use for their collection.

Manna is a food center whose mission is to eliminate hunger through education, advocacy, and food distribution. They do this by feeding residents at many pop-up pantries, markets, and distribution centers in Montgomery County, Maryland. In America, one in every eight people experience food insecurity.  And after the pandemic, almost 100,000 people did not have sufficient food in Montgomery County. With the increased cost of living and rising supermarket prices, Manna is seeing increased traffic. Growing up in this area, I previously volunteered with Manna as a Girl Scout packing boxes at one of their sites. I assumed my experience here this time would be the same, but I was so wrong. There is so much all-encompassing work that goes on behind the scenes from the committed employees, county, volunteers, and Manna participants.

My two-week experience at Manna was filled with a variety of activities and I truly saw the ins and outs of what this incredible organization does for its community. I packed individualized boxes for people with certain needs such as lack of microwave access, specific diets, and mobility restrictions. I initially thought that these boxes would solely be filled with canned items. However, they were packed with a variety of fresh produce and meats. I was impressed with an organization of  its size tailoring personalized care for its participants. In addition, we were able to speak with a representative from the Montgomery County Food Council and get a legislative perspective on how their work influences changes in the law. From making infographics,writing a newsletter, and participating in team meetings, I was a part of it all.  

I’m going to highlight a small glimpse of my work at Manna and discuss the food recipe video I created. These videos are a way to encourage people to use and showcase the versatility of different foods. The inspiration for my video was based on a combination of previous Manna videos posted on their YouTube account and Tasty videos from BuzzFeed. I wanted to pick a recipe that was simple, easy, and affordable.

After volunteering at Manna Market, I noticed that foods such as zucchini and eggplant were readily available. However, people don’t readily choose these foods; they gravitate towards more common options such as apples and oranges. Like myself, people can be hesitant in picking zucchini or eggplant because they perceive them to be difficult to prepare. In addition, they do not have much flavor on their own and can sometimes turn out to be soggy, spongy, bitter, or mushy. There was a great eggplant lasagna recipe already posted on Manna’s YouTube account, so I decided to come up with a recipe that would use zucchini. I researched some recipes and decided to make baked zucchini with breadcrumbs and parmesan cheese. I have never prepared zucchini this way, but I have always enjoyed when they are cut in spears instead of round circles.

My first predicament was figuring out how I was going to record a birds-eye view video from my phone by myself . I had only recorded and edited one recipe video for a group project in college, so I thought it was time to get creative. I first planned to use cardboard, tape, and scissors to create a device to hold my phone while I recorded. Fortunately though, Manna has a tripod that would securely hold my phone and record the video from an aerial view.

I recorded myself making the recipe, taking pauses to show ingredients, and snapping pictures along the way. The total time from setting up, to recording, to baking the zucchini, and then to plating was 45 minutes. Recording a video was much harder than I thought it would be. Getting the lighting correct and centering the item with the tripod was challenging. I even had my head blocking some of the camera when I was chopping the zucchini. It was a lesson learned for future recipe videos that I intend to record. Unfortunately, the video did not turn out as expected and I think it’ll take more practice to get the perfect shot. Here is the recipe handout for the zucchini if you want to try it out:

I had such a great time at Manna as it opened my eyes to the real food insecurity problem that is right in front of us. This experience was a catalyst for my future involvement in communities and how I can use various methods of communication to advocate and help eliminate hunger. 

By Dietetic Intern: Haley Flambaum

Winter, Summer, Spring, Fall. Each season has unique nutrition recommendations, tips, and seasonal produce that can offer health benefits. At my rotation with the University of Maryland Campus Dining, my colleague, Rachel, and I were tasked to create a nutrition bulletin board to be displayed around the South Campus Dining facility. The board had to highlight nutrition tips, cooking/kitchen tips, a recipe, and a featured food.  After much collaborating and thinking we decided to create our board with a winter season theme. 

For our nutrition tips, we wanted to focus on elements of nutrition that can be lacking in the winter. So we addressed how it is more common to become deficient in vitamin D in the winter because sunlight is a major natural source of this vitamin. We emphasized the importance of incorporating good food sources of this vitamin such as salmon, tuna fish, eggs, and fortified milk in the diet. Vitamin D is needed to help build and maintain healthy bones and teeth. And it also plays a role in our nervous, musculoskeletal, and immune systems. 

For cooking/kitchen tips, we focused on stocking the pantry, utilizing soup as an easy meal, and adding more light to beat the winter blues. In the winter months, the market may not have as many fresh fruits and vegetables available. You can remedy this by stocking up on things like canned goods, frozen options, and dried lentils/legumes. These options can be used in soups, stews, or curries which offer a hearty meal on a cold winter night. When schedules get busy or you are feeling under the weather, soup can be a great option for an easy meal. Try prepping your soup in advance and packing it in the freezer for a quick meal on busy nights. 

For wellness and self-care tips, we discussed the importance of making a daily schedule for self-care activities such as regular physical activity and sleep. People tend to hibernate in the winter so this is a good time to catch up on sleep. While catching up on sleep, it is still important to have scheduled meal times and some regular physical activity. One tip we gave for increasing physical activity, despite the cold weather, was meeting up with family or friends and walking around your local mall. We also explained that YouTube can be a great resource for at-home workouts with little to no equipment required. Some people are negatively affected by the longer nights and reduced light of fall and winter. So another tip we focused on was how to get more light by adding string lights in your house to help beat the winter blues. 

Our featured food was winter squash. We talked about why it is called winter squash, provided nutrition facts, and reviewed the different types. The recipe we provided was for a Winter Squash Soup and you can see the recipe in the picture below. 

After finishing the board, we translated it into Spanish to reach a greater audience. We enjoyed making the bulletin board as it gave us creative freedom as well as an opportunity to share nutrition and wellness tips we have learned throughout our education. This experience helped me not only trust my creative ability but also helped me hone my skills to create content in a visually appealing way to educate my audience. Additionally, I learned the importance of staying on top of the latest evidence to provide helpful and accurate information. I look forward to using these skills as a future registered dietitian.