Posts Tagged With: nutrition

Passed my RD exam!

So happy to have passed the RD exam today. It’s been a long 6 years (4 years undergrad, 2 years grad school/internship) and it is great to have the RD credential to show for all the hard work. Next on the¬†agenda is paying the outrageous fee for being licensed by the state of Florida. ūüėČ

I was pretty nervous for the exam, but it was surprisingly easier than I thought it would be!  I thought I might do a quick blog post about the study methods I used, in case some of you out there are wondering how to study.

1) Inman’s Review (CDs, Book, 1054 practice questions):¬†¬†This was perhaps the most helpful review method I used. The cost is pricey ($380!) but I believe it was worth it, because it helped me pass the exam on the first try, and some of the practice questions were identical or very similar to the ones I had on the real exam.¬† You can attend an in-person session, or get the lecture on CDs. I chose the CD method because I figured it’d be easier for me to rewind the CD, pause the CD, etc in order to take notes. The book (3-ring binder) is lengthy (about 200 pages) but goes over all 4 domains: Principles of Dietetics, Nutrition Care for Individuals and Groups, Management of Food and Nutrition Programs and Services, and Foodservice Systems. And if you don’t know how a certain answer was reached in the practice questions, you can email them and get the explanation! So that is also a great service. I emailed about one of the practice questions and got the explanation less than 24 hours later.

2) RD Exam App, by MedPreps: This is a super awesome app for your phone or tablet!! It is $19.99 and I stumbled upon it while searching to see if there was an actual RD study app that existed. There are a few other ones, but I went with this for the design layout and the positive reviews.¬† Glad I got this!! It has over 1900 multiple-choice practice questions, and you can answer questions in random order (“quick start”), or just get questions from a certain domain/area of dietetics. The app also lets you check your results. It gives you a pie chart and percentages of your lifetime as well as the pie chart and percentages for your current session. Additionally, there is an “explain” button for each question, so after you answer it you can hit “explain” to get the reasoning.¬† GREAT for on-the-go studying while in waiting rooms, by the pool, during commercial breaks when you’re watching TV, and using when you are on an elliptical or stationary bicycle. It can be addicting, too.¬† Beware, however, that some of the words are spelled incorrectly, or a few of the explanations had nothing to do with that particular question, so there are mistakes in some of the questions/answers, which the makers of the app should fix!

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3) Test Prep Review’s RD Exam Question of the Day Email Service:¬†¬†This is a FREE question-of-the-day service that is sent directly to your email. The questions tended to be essay questions rather than multiple choice, so it’s not in the same format you will be tested on, but it does give great explanations and definitions that are helpful to know. I did notice that the email service ends after 31 days – so I imagine if you re-signed up after that, you’d get the same 31 questions again. But it is a nice service to take advantage of.

4) DietitianExam.com Question of the Week: This is another free email service, where you get a free multiple choice question per week, with a full explanation of the answer. The email gives you a link, so the question is only available for that week, and you won’t be able to access it after that week…so make sure you stay on top of it, otherwise you will lose that question. These questions were multiple-choice so they are in the same format you will be tested on. Worth it! Go sign up.

5) RDstudy.com Video of the Week: This is also a free email service you sign up for! You get a link emailed to you once a week, which you can open up and access that week (so the video is only available for 1 week, don’t get behind). The videos are short (a couple minutes) and are in power-point with voice-over format. At the end of the video is a small multiple-choice quiz (5 questions maybe) and you get scored at the end. You can watch the video and take the quiz as many times as you want. This is a great free study service for those of us that learn better from watching and listening to videos rather than reading black and white text. The videos I recently received talked about TPNs and FTEs.

So those are some suggestions to keep in mind when preparing for the RD exam…as you can see, there are a lot of different formats to fit any learning style — in-person lectures, smart phone apps, CDs, paper notes, videos, and emailed questions. I just touched on the 5 things I used, because there are a lot of¬†other study materials available (including RD in a Flash flashcards). Hope you find what works for you!

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On Rotation with West Virginia WIC

WV WIC

This week¬†I have been¬†on my dietetic internship rotation with¬†WIC, the “Special Supplemental Nutrition Program for Women, Infants and Children”.¬† I have been familiar with the program for a while, but had never been inside a WIC clinic or really spoken¬†with a WIC recipient before, so I have learned quite a bit about how it works in just the 3 days I’ve been there so far.

As you may know, WIC provides its participants with free monthly food vouchers that can be used at grocery stores (such as Walmart or Kroger) to receive specific food items.  In that way, WIC is not like SNAP (Food Stamps). SNAP benefits can be used on any food items, including junk food like chips, soda, cookies, ice cream, and candy bars.  WIC, instead, provides participants with the basic, healthy foods that can assure families they are getting the nutrition they need.

WIC approved food list

Not every WIC participant receives the same package — it can all vary based on whether an infant is breastfeed exclusively, partially, or is formula fed.¬†¬†When a child reaches 6 months, age 1, and age 2, the food packages also change.¬† Examples of the foods on the various vouchers include:

  • Canned fish (tuna, salmon)
  • Eggs
  • Peanut butter
  • Beans (dried or canned)
  • Milk (whole, 2% or less, depending on age of participant, as well as soy milk/lactaid in some cases)
  • Cheese
  • Infant formula
  • Infant cereal, fruits, vegetables, meats
  • Fresh produce
  • Juices (apple, grape, grapefruit, tomato, vegetable, orange, pineapple)
  • Whole grain breads
  • Cereals (certain brands, such as Cheerios, Wheaties, Life, Corn Chex, Special K, and Honey Bunches of Oats)

WIC is far more than a program that provides food vouchers to women, infants, and children. Although that is a large part of what WIC does, it also has an incredible amount of valuable resources that families can utilize.

WIC clients can receive personalized nutrition education and counseling from RDs¬†and WIC nutritionists.¬† International Board Certified Lactation Consultants are there to provide information about breastfeeding, hold breastfeeding classes, offer to weigh your baby pre/post nursing to find out exactly how much breastmilk¬†the baby is receiving in a feeding, rent out breastpumps, and provide breastfeeding support and education.¬† Children can be immunized at the WIC center in Morgantown and hemoglobin¬†levels can be checked.¬† The child’s height/length, weight, and BMI can also be measured over time in order to track the child’s development and growth.¬† At WIC, families can also receive referrals for other programs like Birth to Three¬†and the WV Tobacco Quitline,¬†and other medical professionals, such as local dentists who will see young children.

To be eligible to be a WIC participant, several criteria must be met.  Pregnant women, women who are breastfeeding an infant under 1 year of age, postpartum women to the 6th month after delivery (ie: moms who are formula feeding their 5.5 month old), and children from 0-5 years of age can qualify for WIC.  The participants must also exhibit nutritional risk, such as low iron levels or inadequate dietary intake.  Additionally, certain income guidelines must be followed.  A single mother of 2 children who makes less than $35,317 a year could qualify for WIC benefits.  A woman, pregnant with her first child, who makes less than $20,665 a year could also qualify.  Or, a family of 6 (mom, dad, and 4 kids) who makes less than $57,295 could also qualify. Full income guidelines, which are reviewed for updates each year can be found here.

I think WIC is a pretty great resource that provides nutrition and health education to a population that needs it.¬† By providing nutrition education and counseling, breastfeeding support and education, and other health screenings, it helps kids get off to a healthy start. And I think that’s something we can all agree is a great thing!

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Walnuts in a Nutshell

Walnuts

Looking to incorporate a healthy snack or a new source of healthy fats into your diet? Why not add walnuts to your next grocery list.  A serving of walnuts (1 ounce, or about 14 halves) are rich in antioxidants and are an excellent source of ALA, an omega-3 fatty acid found in plant sources.  In fact, they are the only nut that contain omega-3s!  Walnuts are healthy for your heart and have anti-inflammatory benefits (hello, happy joints and skin!).  Plus, they provide a concentrated source of energy for anyone who is physically active.

1 oz walnuts provide:

  • 185 calories
  • 18.9 g fat
  • 1.7 g saturated fat
  • 13.4 g polyunsaturated fat
  • 2.5 g monounsaturated fat
  • 125 mg potassium
  • 3.9 g carbohydrate
  • 1.9 g fiber
  • 4.3 g protein
  • vitamins & minerals such as vitamin B-6, vitamin E, copper, folate, iron, magnesium, manganese, phosphorus, thiamin, and zinc

Vegetarian Walnut Burgers

  • 1 1/3 cup shelled walnuts
  • 4 slices of whole wheat bread, toasted
  • 1 red onion, finely chopped
  • 2 eggs, beaten
  • 2 oz Gorgonzola, crumbled
  • a handful of chives

Grind the walnuts in a food processor. Add the bread and process again. Add the remaining ingredients and process to form a firm mixture. Shape into 1/2-inch patties. Bake in a preheated oven at 375 degrees F for 25-30 minutes until crisp, then serve.

(Recipe from The Top 100 Fitness Foods by Sarah Owen, 2009)

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Test Tube Meat…yay or nay?

testtubemeat

Is your new years’ resolution to earn a million dollars? If so, PETA may have the answer for you. PETA (People for the Ethical Treatment of Animals” has offered a $1 million dollar reward for the first laboratory to produce “in vitro” chicken meat made from chicken cells. How does this work? It is very similar to how we grow an organ for human transplantation. Stem cells from an adult animal are placed into a 3-D supportive scaffolding structure in a medium which would allow the cells to grow and reproduce. When fully developed, these cells will have grown into a product that mimics animal flesh that can be cooked and eaten.

PETA states that the chicken meat product must have the same taste and texture of “real” chicken, and will be judged via a taste test from meat-eaters and non-meat eaters alike. The million dollar prize also comes with the stipulation that the meat product will be produced in large enough quantities to be sold in at least 10 US states at a competitive price.

Why would an organization like PETA support the research for test-tube meat? According to PETA president Ingrid Newkirk, it all comes down to reducing animal suffering. “Americans eat 1 million chickens an hour. [In vitro meat] is both practical and pragmatic. We can’t afford to look at this from a purist’s standpoint. We need to reduce animal suffering now.”

Not only would large-scale production of in-vitro meat decrease animal suffering, it would also benefit the environment. There would be less greenhouse gas emissions caused by livestock digestion (especially in cattle). Less freshwater would be wasted from meat processing. In addition, since in-vitro meat could be produced in an urban area closest to the greatest consumer demands, transportation costs and environmental impact would be reduced. And all that corn, soy, and feed that chicken consume? These crops could be used for human consumption either here in America or overseas to help fight hunger in third world countries.

I think test-tube/cultured/in-vitro chicken is a great idea with many possible benefits. First, it has the possibility of being cheaper for consumers than buying traditional chicken. Secondly (and most exciting of all), when we are creating our own chicken meat, we could modify it to be more nutritious. Says Nicholas Genovese, PhD, researcher at the U of Missouri’s division of animal sciences, “In vitro, culture methods may be optimized to improve ratios of poly-unsaturated fats to saturated fats, thereby generating a healthier dietary protein source.” Also, “by engineering tissues on plant or fungus-based scaffolds, cultured meat technology opens the possibility to produce a meat produce rich in dietary fiber.”

I just recently over Christmas break watched the film documentary Food, Inc which has made me more aware of where my meat (especially chicken) comes from. The film covers the food industry in America today, at one point highlighting the shocking and very real process of how our chickens make it from the farm to our plate. After watching that film, I personally think that in-vitro chicken could be a safe and healthy alternative to traditional chicken meat.

Source: Food & Nutrition magazine, Jan/Feb 2013 issue “Exploring the Global ‘Cultured Meat’ Effort

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Autism Spectrum Disorders & Nutrition

Autism Spectrum Disorders include autism, Asperger’s¬†syndrome, and other disorders not specified.¬†¬† Recent estimates put the prevalence of ASDs¬†to 1 in every 110! It is highly likely then that health care professionals, including dietitians, will come across a patient with an ASD.

According to the Nutrition Care Manual:

“Autism spectrum disorders (ASDs) are characterized by three key manifestations:

  1. Impaired sociability, empathy, and ability to read other people’s moods and intentions, with resulting inadequate or inappropriate social interactions
  2. Rigidity and perseveration, including stereotypies (purposeless repetitive movements and activities), the need for sameness, and resistance to change
  3. Impaired language, communication, and imaginative play”

Children with ASDs will benefit from using a variety of approaches– behavioral health, developmental, and social.

Having an autism spectrum disorder can affect a person’s food pattern and eating behavior in several ways:

  • A need for a structured routine can affect food pattern- a patient may not be accepting of eating in a different place, at different times, with different dishes/utensils, or trying different foods.
  • Increased sensitivity with taste, texture, smell, and temperature – a patient may have a restricted intake of foods due to texture issues (too soft, too crunchy), smell issues (aversions to strong smells like fish, broccoli, garlic), taste issues (sweet, bitter, salty, sour, umami), temperature (too cold, too hot), and color (aversion to red foods, for example).¬†A patient can have difficulty adjusting to new temperatures and tastes, and may have gagging/vomiting issues as a result.¬† In addition, patients can have problems with noise levels (in a noisy school cafeteria), lighting, and can even have¬†issues with metal utensils (metallic taste, sound of fork scraping teeth) all of which affect the patient’s nutritional status.
  • Short attention span – a patient may lose interest in eating quickly, or forget to eat altogether.
  • Impaired social interaction – a patient does not recognize appropriate eating behaviors from others, does not mimic or learn these behaviors from others.

Children with ASDs¬†may have a list of just a dozen different foods that they will willingly eat. They also may eat the same food over and over again for months, then all of a sudden have an aversion to it.¬† Combined with a short attention span, it can be difficult to get a child with an ASD to eat the appropriate amount of calories needed to maintain a healthy body weight.¬† It is also important to make sure the child is getting enough fiber and fluid in their diet. Often when a child isn’t getting enough calories because they’re not eating enough, they’re also not getting enough fluids and fiber in their diet, which can lead to gastrointestinal problems such as chronic constipation.

Suggestions to increase bodyweight, improved gastrointestinal health, and improving protein status include encouraging the child to try new foods, keeping mealtime distractions low, modeling appropriate mealtime behaviors,¬†introducing new foods along with favorite foods, and in age-appropriate portions. Make small, gradual changes and avoid overwhelming a child. Introduce new foods that are similar to already accepted foods (ie: child likes mashed potatoes, try mashed sweet potatoes or mashed cauliflower).¬† It may also benefit the child to use some “stealth health” — sneak new foods or high-calorie/high-protein foods into accepted foods such as casseroles, soups, shakes, and sandwiches.

Of course in order to encourage the child to gain weight and get enough macronutrients, vitamins, and minerals each day, nutrition supplementation can be very helpful.¬†¬†Pediasure Sidekicks¬† come in chocolate, vanilla, and strawberry shakes as well as juice drinks in wild berry and tropical fruit flavors.¬† There’s also Carnation Instant Breakfast, which can be purchased in a powder form and mixed into smoothies and shakes, or a bottled drink form. ScandiShake¬†can also be used- when mixed with 1 cup of whole milk, it totals 600 calories.

The nutrition diagnosis that dietitians would use when charting the nutrition care process could include diagnoses from intake, clinical, or behavioral.  Possibilities are included below, from the Academy of Nutrition and Dietetics International Dietetics and Nutrition Terminology, 4th edition.

Intake
  • Increased energy expenditure (NI-1.1)
  • Inadequate energy intake (NI-1.2)
  • Inadequate oral intake (NI-2.1)
  • Excessive oral intake (NI-2.2)
  • Limited food acceptance (NI-2.9)
  • Inadequate fluid intake (NI-3.1)
  • Excessive fluid intake (NI-3.2)
  • Increased nutrient needs (NI-5.1)
  • Malnutrition (NI-5.2)
  • Inadequate fiber intake (NI-5.8.5)
  • Inadequate protein intake (NI-5.7.1)
  • Inadequate mineral intake (NI-5.10.1)
  • Inadequate vitamin intake (NI-5.9.1)
Clinical
  • Swallowing difficulty (NC-1.1)
  • Biting/chewing (masticatory) difficulty (NC-1.2)
  • Altered gastrointestinal function (NC-1.4)
  • Impaired nutrient utilization (NC-2.1)
  • Food‚Äďmedication interaction (specify) (NC-2.3)
  • Unintended weight loss (NC-3.2)
Behavioral
  • Self-monitoring deficit (NB-1.4)
  • Disordered eating pattern (NB-1.5)
  • Limited adherence to nutrition-related recommendations (NB-1.6)
  • Undesirable food choices (NB-1.7)
  • Physical inactivity (NB-2.1)
  • Inability to manage self-care (NB-2.3)
  • Impaired ability to prepare foods/meals (NB-2.4)
  • Self-feeding difficulty (NB-2.6)
  • Visual disturbances that cause interrupted mealtimes

PES statements could include:

  • Inadequate energy intake related to diagnosis of Asperger’s syndrome as evidenced by patient at 68% ideal body weight.
  • Limited food acceptance related to Autism disorder as evidenced by patient’s reports of limited food/beverage intake inconsistent with nutrition reference standards.
  • Malnutrition related to current medical diagnosis as evidenced by BMI < 5th percentile.
  • Inadequate mineral intake (iron)¬†related to food selectivity and hypersensitivities, as evidenced by food record analysis (iron intake < 3 mg/day) and low hematocrit.
Categories: Clinical Nutrition | Tags: , , , , , , | 1 Comment

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