Monday, June 19, 2017

3 Life Skills I’ve Learned Throughout my Dietetic Internship

As the internship comes to a close (I graduate on Friday – yay!), I’ve found myself reflecting on all the things I have learned throughout this past year. Of course, I have learned more about nutrition than I could ever put down on paper: the ability to assess nutrition risk, educate and counsel patients, calculate EN/PPN/TPN formulas, and to write educational materials geared towards numerous different populations, to name a few. When I began the internship, I expected to strengthen my knowledge in the field of dietetics, but I did not anticipate gaining so many life skills throughout the process.

Teamwork

If I had to choose one skill where I have seen the most personal growth throughout the year, I would say teamwork. Although I have always considered myself a “team player,” I previously felt most comfortable working on projects individually. I quickly learned that I would have to step outside of my comfort zone to be successful throughout the internship. At the beginning of the internship, each intern was assigned a partner. My partner, Ben, is extremely creative and clever, and I am organized and systematic. We quickly learned each other’s strengths and used them to our advantage. Together, we were stronger as a team than we would have been as individuals.

Me and my partner, Ben. 

As a dietitian, this skill is essential in all workplaces, especially a clinical environment. I witnessed this firsthand during my pediatric oncology rotation. My preceptor and I attended rounds each day with the entire oncology team. Each team member was valued as an integral part of the team. My preceptor was in constant communication with the doctors, nurses, and social workers to determine the best nutritional care for the patient. For example, the nurse reported the intake and output and weight of their patients, which my preceptor used to determine the appropriate tube feeding for the individual.

Flexibility

This one is huge. I have rotated through 14 different facilities this year. You know that awkward, nervous feeling you have when you start a new job? I had that feeling 14 times over the past 10 months! Each rotation and workplace is very different. Flexibility is key to making a good impression with the preceptors. During my rotation at the International Food and Information Council (IFIC), I was asked to switch between tasks often. On one occasion, my preceptor asked me to compile a list of universities that offer graduate degrees in nutrition. At the time I was in the middle of creating a blog post, but, after assessing the priorities of my projects, I was able to switch tasks quickly to assist with the more pressing project.

Flexibility is a skill I know I will use in my career as a dietitian. I found this skill particularly useful at my long-term care rotation. My preceptor had various tasks to do each day. She had to attend numerous care plan meetings, screen and visit patients, and chart on them, including filling out the Long Term Care Minimum Data Set. The meetings were intermittent throughout the day, so my preceptor had to be able to make the best of her time between meetings to fulfill her other duties. Seeing this skill in practice opened my eyes to the importance of flexibility as a Registered Dietitian in all types of workplaces.  

Communication

You know what they say: “communication is key.” I have definitely found this to be true over the past year. Email has become my best friend. I now know how useful it is to have things in writing that I can refer back to. This helps ensure everyone is on the same page.  Plus, email seems to be the communication method that most people prefer. I use email to clarify expectations for projects with my mentors, prepare for new rotations, and network with dietitians I’ve met at conferences and during rotations.

Communication is extremely important when speaking to patients. I’ll be honest, I was pretty nervous when I initially started speaking to patients on my own. My interviewing skills were a little bit rocky at first. With time and practice, I learned the importance of tailoring my discussions with each patient to their specific needs. For example, some older patients were hard of hearing. I would make an effort to speak especially loudly and clearly to these patients. At my pediatric rotation, I used fun metaphors to explain nutrition so it was easy for the children to understand. Communicating with patients in a way they can understand enables them to comprehend their condition and dietary goals, a necessary first step to positive dietary changes.   

Me and my fellow interns on our last class day of the internship

Although, I like to think I have always been pretty good at these skills, I definitely have the internship to thank for helping me fine-tune them and apply them to a work environment. These skills will be invaluable as I start my career. Between the nutrition knowledge and life skills I have gained through the internship, I am confident in my ability to succeed in any workplace.

Thursday, June 15, 2017

Shadowing a Wound Nurse

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Nutrition plays a key role in healing wounds, and during my long term care rotation at Villa Rosa Nursing and Rehabilitation Center, I spent a morning peeking over a wound nurse’s shoulder as she assessed patients’ wounds. Although my time shadowing the nurse was short, I was able to watch her change the dressing of three different wounds: a sacral pressure injury, a heel pressure injury, and a scrape. It was my first time seeing a pressure injury in real life! We reviewed medications pertinent to wound healing such as “calcium alginate” dressings, which create moist healing environments for wounds, and “santyl” ointment which works to remove dead skin surrounding a wound. I also learned that wounds heal best at normal body temperature. Of course, we didn’t forget to talk about the importance of good nutrition to promote wound healing!
Here are a couple of nutritional components that I learned which aid wound healing:

  1. Increased Protein needs
It is recommended that healthy adults get 0.8-1.0 grams of protein/kg/day, while the elderly get 1.0-1.2 grams of protein/kg/day. However, in patients who have wounds or pressure injuries, or are at risk for acquiring them, protein recommendations can go up to 1.5-2.0 grams/kg/day in order to make up for any protein lost in wound exudate and to help synthesize new skin tissue. In the long term care facility where I rotated, protein supplements were often ordered for patients who had inadequate nutrient intake, in order for them to reach their increased protein needs. This need for increased protein can also be accomplished through eating foods high in protein, such as meat or eggs.

  1. Vitamins and Minerals
Getting enough vitamins and minerals can usually be accomplished through a balanced diet, however, a healing wound can often benefit from supplementation of certain vitamins and minerals. Specific nutrients that my preceptor at the long term care facility often recommended in patients with wounds were Zinc and Vitamin C. Zinc helps wounds because it plays a role in collagen and protein synthesis, cell proliferation, and immune function. It is important to note that Zinc supplementation should be recommended with caution because too much zinc can interrupt iron and copper absorption. Vitamin C is beneficial for collagen formation and its antioxidant functions.

  1. Blood Sugar Control
Sometimes patients have non-healing wounds due to elevated blood sugar, which is a concern in patients with uncontrolled diabetes. High blood sugar causes small blood vessels to become rigid, resulting in poor blood circulation. This prevents wounds from receiving the oxygen, nutrients and immune cells they need for skin repair. The healing process can take months due to this and can even lead to dangerous infections, which sometimes require amputations. Controlling blood sugar is an especially important task for anyone with diabetes and a wound.

As a dietetic intern, it was a great opportunity to see several wounds first hand! I now have a better understanding how good nutrition promotes wound healing.  

Monday, June 5, 2017

Let the Hunt Begin

With three weeks left of the dietetic internship you would think the stress levels have come down to an all-time low, right? WRONG. My next task is to take the CDR exam and secure my first job. I would be lying if I said that taking the first steps into the “real world” is not a bit scary. Luckily, I came across several resources that make finding and applying to jobs a little less stressful.

Employment Websites
Employment websites such as Indeed, LinkedIn, and Monster have become tremendously popular in the past few years. The concept is simple: businesses and organizations with openings post their listing to the websites; from there all it takes is a keyword search to find the perfect job. Employment sites are great because it allows anyone to easily see which companies are hiring. One of my favorite features is that you can create a list of jobs that you can access at any time, allowing you to apply immediately or at a later time. Since the listings are posted by the hiring business they are updated or taken down instantly and contain links leading to more information about the position and organization. I have taken advantage of an option which sends me email notifications about new openings related to my recent searches. I uploaded my resume to some of these sites where it will be reviewed by recruiters who may reach out with an opportunity. Employment sites are beginning to transition to phone apps, allowing the job search to continue from virtually anywhere. I personally take advantage of those few minutes before getting out of bed to scroll through job apps and see if there are any new postings.
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Personal Network
One of the mantras given to us at the beginning of this internship was “think of this as a 10.5 month job interview.” This set the tone for networking during rotations and inspired me to create my own personal connections. What many do not realize is how connected practicing dietitians are to other dietitians in the field. Assuming some connections have been maintained from their DPD and dietetic internship, a dietitian typically has is a minimum of 10-15 contacts. I have been fortunate enough to establish and maintain a connection with a dietitian I shadowed for some time during my undergrad career. She has not only been immensely helpful as a mentor, but has offered to aide me in my job search by contacting clinical nutrition managers in her network. Whether it’s serving as a preceptor for dietetic interns or reaching out to a contact about a potential job opportunity, dietitians are more than willing to lend a helping hand. Luckily for us, establishing these connections can be easy as we are introduced to many of them through the course of our rotations.

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Professional Organizations
One of the lesser known benefits of being a member of the largest professional organizations for dietitians, the Academy of Nutrition and Dietetics, is having access to their career resources. These resources include job boards similar to the employment websites, expert referral services aimed at those looking to start their own business, and a career development guide for those interested in creating a 10-20 year plan.  When you become a member of the Academy, you are required to select a state affiliation. Most state affiliations have their own websites with a job board and will host an annual meeting, which is the perfect place to network. In addition to helping me search for jobs, the Academy offers resume templates and online marketing tips to its members which I have used to the fullest extent. Finally, a good reason to pay a yearly recurring fee!

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These are just a few of the resources and methods I have been using to find jobs. Now if only I could get a call back from one of them…


Tuesday, May 30, 2017

Is Veganism Right For You? Our Visit to the Vegetarian Resource Group

According to the Vegetarian Resource Group (VRG), approximately 8 million Americans eat a vegetarian diet! A well planned vegetarian diet provides health benefits that may help with the prevention and treatment of diseases such as heart disease, diabetes, high blood pressure, and some cancers. On May 15, 2017, the University of Maryland Dietetic Interns visited VRG to learn about vegan and vegetarian diets and resources. VRG states that it “is a non-profit organization dedicated to educating the public on vegetarianism and veganism and the interrelated issues of health, nutrition, ecology, ethics, and world hunger. In addition to publishing the Vegetarian Journal, VRG produces and sells cookbooks, other books, pamphlets, and article reprints.”

A lot of people believe it’s impossible to meet their nutrient needs without consuming animal foods; while at VRG we discussed rich vegan and vegetarian sources of calcium, iron, B12, and protein. Did you know that dark green leafy vegetables, tofu made with calcium sulfate, calcium-fortified soy milk and orange juice are all rich sources of calcium? Or that dried beans and dark green leafy vegetables are good sources of iron, especially if you pair them with vitamin C, such as tomatoes or citrus foods? Check out these resources if you’re curious about nutrients in a vegan or vegetarian diets. As long as you are diligent about your nutrient consumption, it is possible to receive enough nutrients from vegan or vegetarian foods.
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While at VRG we were able to hear a few VRG interns share their personal stories about their decision to choose a vegan lifestyle. They mentioned that while it was difficult at first to adjust to such a different lifestyle, they have since overcome the challenges (such as peer pressure or inconvenience) and have maintained a vegan diet for years. Overall, we learned that there are five main reasons a person may choose a vegan diet:
1] Compassion for animals
2] Ecological
3] Health benefits
4] Religious
5] Belief in nonviolence

To finish the afternoon, we all shared vegan dishes that were both colorful and delicious. A couple of interns made tabbouleh, while others made vegetarian salads and entrees. We finished the potluck with a large fresh fruit salad and carrots and tortilla chips with hummus and guacamole. It was extremely tasty!
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While a vegan lifestyle may not be for everyone, it is a good option for some. And even if you don’t want to eat vegetarian or vegan all the time, it’s great to switch up your diet to include more fruits, vegetables, legumes, and nuts. As a future Registered Dietitian, I may counsel clients who want to adopt a vegan diet or who are vegetarian or vegan and need dietary advice for a health condition. I look forward to working with them to tailor a diet to their needs. Both eye-opening and insightful, this visit to VRG showed me a different perspective, and I am grateful for the experience!

Sunday, May 21, 2017

The Role of Theme Meals in Dietetics

What does planning and organizing a theme meal have to do with dietetics? That was the question I asked myself at the beginning of a 6 week food service rotation. But as my partner and I started the planning, I realized that I was using a lot of information I learned during undergrad classes--like recipe conversions and calculating staffing needs. I also realized that I was gaining a lot of information that will help me as a future dietitian.


Dietitians can play vital roles in food service operations, even as a clinical or community dietitian. I learned a lot about patience, compromise, and trial-and-error from planning our theme meal. Those are valuable life lessons that I’m sure I’ll use throughout my career, even though they’re not specific to the field of dietetics. However, there are components of planning a theme meal that directly relate to being a Registered Dietitian (RD).



Salmon that my partner and I cured for a recipe


Menu Building
The first step in planning our theme meal was building the menu.  We had a basic menu pattern for our meal: two salads, three sides, three entrees, and two desserts. Next we needed to apply our Hawaiian theme and select items that were suitable for our patrons. This was easier said than done. After spending hours upon hours researching authentic Hawaiian recipes, we chose a few selections that we felt would both be nutritionally sound and appeal to the seniors who would eat the meal. Only half of those recipes ended up on our final menu, though.  We eliminated one selection because that certain type of fish was difficult to prepare for mass production; another one was ruled out because a key ingredient would completely blow our budget. This process reminded me of an experience I had working with a patient who was just diagnosed with renal disease;  I suggested a number of foods that fit for his health condition, but each was shot down for various reasons, most often a dislike of the food. The patient and I worked together to craft a meal plan that worked for him, just like my partner and I crafted a menu that fit for our theme meal. I was happy to get this menu building experience because dietitians should be well versed in building well-rounded menus which are suitable for their populations.


Nutrient Analysis and Recipe Evaluation
To plan a successful meal, we needed to convert recipes for mass production, convert ingredients to different units for accurate ordering, and analyze the nutritional value of the recipes. Analyzing the nutritional value of a meal may seem like a no-brainer, but it’s essential for RDs to know how to calculate the nutritional value of a meal without using the crutch of an online tool. And let me tell you--this was a long and tedious task for someone who hasn’t taken a basic math class in 4 years. Now that I’ve had the experience of doing so, I feel competent to calculate a nutrient analysis by hand in the future.



Hawaiian-decorated dining room for the theme meal


Budgeting
A huge component of planning our theme meal was making sure we stayed on budget. Our budget included food cost and decorations. Thankfully, our food service facility managed the staffing, although we did get to play with the puzzle that is building a schedule of employees with irregular availabilities. Budgeting is a skill that, frankly, everyone needs to perfect. As a future RD, I can foresee using budgeting skills in many areas of dietetics, especially in a management role.


Quality Analysis
During our meal, we passed out short surveys to ask customers about their opinion of the meal. After the meal was complete, we collected all of the surveys and compiled the results. We used this data to determine the least and most popular menu items and offer suggestions to future interns planning a theme meal. Quality assurance is a practice that I believe is of utmost importance to being a dietitian. Conducting any kind of quality analysis, whether it be formal or informal, is vital to knowing what you’re doing well and how you can improve.


My partner and I spent many long days working together to carefully prepare and plan for this 2.5 hour event. While the process was not as fun as I thought it would be, I did learn a lot.  I am glad I had this opportunity to develop many skills that I will continue to use as a professional; some directly relate to dietetics and some relate to professionalism in general. Thankfully our Hawaiian theme meal was successful, and despite those stressful weeks leading up to the event, I would do it again in a heartbeat.



Tuesday, May 16, 2017

Nutrition and Food Science Department Poster Day


On Friday, May 5 the UMD dietetic interns had the opportunity to present abstract posters for the University of Maryland’s Department of Nutrition and Food Science Research Day, which was held at the National Agricultural Library.

The day started off with a keynote speaker, Dr. Eric Brown, Ph.D. Dr. Brown is the director of the Division of Microbiology in the Office of Regulatory Science at the Food and Drug Administration (FDA). The topic of his presentation was “The Rise of Whole Genome Sequencing for Food Safety and its Role in Augmenting Traceback of Foodborne Pathogens Back to Their Source.” To put it simply, we learned about the advancements in technology that the FDA is using during foodborne illness outbreaks, such as salmonella, to determine the original source of the bacteria. While the topic is serious, Dr. Brown was able to add an element of humor to this presentation by showing a decision tree for how people determine whether they will eat something they dropped on the ground.  Points to be considered included “did anyone see,” “was the food sticky,” etc.


Dr. Brown and his decision tree presentation slide
After the keynote presentation and lunch, we presented our posters to four judges, all of whom are in the dietetics field. Posters were either in the “case study” category or “special project” category. We spent approximately ten minutes talking with each judge about our posters, explaining our topic, and answering questions.

My abstract poster was about Recovery Record, an application (app) for eating disorder treatment. There are two different apps: one for the clinician and one for the client. The client can log food, feelings and behaviors in their app. The clinician uses the app to see a newsfeed of clients and their current moods, eating patterns, and behaviors. This app can be used for any kind of eating disorder and eliminates the need for a 24-hour food recall or counting on the client’s memory when determining what foods have been eaten recently. The client’s version differs from food trackers in that it does not include  calories, macronutrients, or a food database. Food is entered in as free text and then the client is prompted to document if they ate too much food (binged), an adequate amount of food, or not enough (restricted).  The clinician can easily see progress being made by the patient in a HIPAA compliant app, and can send messages back. The app allows for more frequent communication between the clinician and client between visits. This is important for those recovering from eating disorders. I believe the concept of this app, encouraging mindful and intuitive eating rather than calorie-based tracking, could be successfully used for apps for weight loss and other disease states.

Me (left), Angela, Ben, Tuesday (middle), and Paula (right) with our abstract posters. (Click to view larger.)


After presenting my poster to the judges, I was able to view the graduate students’ posters. The  research poster topics ranged from social determinants of food insecurity to respiratory quotients in men related to blackberry consumption. The event concluded with a poster award ceremony. From our internship class, Angela won the “case study” category with her abstract poster “MNT in Stage 5 Chronic Kidney Disease (CKD): diet instruction with a cultural twist” and I was thrilled to have won the “special project” category with my poster “New Technology Tool: Aid in Eating Disorder Management.”

Me (left) and Angela (right) with our certificates of excellence for our abstract posters.

Friday, May 12, 2017

Hail to the Kidney!


Three years ago while visiting my family in Argentina, I had the opportunity to shadow a renal dietitian at a dialysis center. At that time, I knew little to nothing about the nutritional implications of renal disease or the role the kidney played in maintaining a balance of fluid and chemicals in the body. I learned a little about what a renal dietitian does during that visit, but perhaps more importantly, the exposure piqued my interest.  A few weeks ago, I completed a highly anticipated renal rotation where I learned so much about managing renal disease with nutrition and dialysis.  Nutritional therapy is critical to manage and slow the progression of renal disease from Chronic Kidney disease (CKD) to end-stage-renal disease (ESRD). Once the disease has progressed to ESRD, dialysis or kidney transplantation is required to stay alive. A dietitian can provide nutrition education critical for successful management of ESRD. Two key nutrients of concern in ESRD patients are phosphorus and albumin. These nutrients are the hardest laboratory values to keep within range.
Phosphorus:
Dialysis does a great job in removing the extra potassium and sodium from the body, but it is less effective with phosphorus or “Phos.” It is very important patients know how to control their dietary phosphorus intake.

So, why is phosphorus hard to control for people in dialysis? During my rotation I became aware that phosphorus is ubiquitous in foods. There are natural sources of phosphorus, such as from dairy products, fish and meat; additionally phosphorus is added to most processed foods, such as  Gatorade, twinkies, chocolate pudding, etc. I was able to teach patients how to read food labels to help them recognize and avoid foods that are either naturally high in phos or contain phosphorus additives. They should check the label for long words that contain “phos,” such as “monosodium phosphate,” “dicalcium phosphate,” etc.

Another important topic that I covered with patients was the importance of compliance with phosphate binders. Unfortunately, non-compliance was a common issue.  Since keeping phosphate within normal range is so difficult for most people undergoing dialysis, it is vital that they remember to take phosphate binders with each meal. For that purpose, I had fun delivering key chains designed specifically to carry the phosphate binding pills for patients to use when they will be away from home during meal times.

Albumin:

Another potential problem with ESRD is low blood levels of albumin. It was very unusual to see a patient with a normal level of this protein.

Albumin is the most abundant protein in our body. Our body needs protein to help build muscle, repair itself, and fight infections. Since so many patients on dialysis need to eat a good amount of quality protein, I made sure to discuss how to make good protein choices with the patients. It was very challenging, but critically important to tailor a diet specifically for their underlying disease; the diet typically needed to be high in protein but lower in sodium, potassium, and phosphorus.

After having this experience, I have a clearer understanding of the role the kidneys play in normal bodily function.  Additionally, I realize the importance of regulating key nutrients such as sodium, potassium, phosphorus, and protein when the kidneys are not functioning properly.  I was taken aback with renal nutrition three years ago because of the major impact diet plays in the outcome of this terrible disease. Now, after completing my renal rotation, I understand the complex, but fascinating world of renal nutrition a bit more. I am not only convinced that my true passion lies in renal nutrition, but also about the importance of leading a healthy lifestyle to help keep our kidneys healthy.

Saturday, May 6, 2017

Maryland Day 2017

Saturday, April 29th was the 19th annual Maryland Day!  Each year, the University of Maryland (UMD) invites families, alumni, faculty, staff, students, and prospective students to “Explore [Their] World of Fearless Ideas.”  Maryland Day 2017 offered over 400 events all around campus and had 75,000 visitors!

This year’s Maryland Day featured events at multiple different “learning neighborhoods”:
  • Art & Design Place – The Art & Design place offered theater, music, and dance events, many of which involved getting the whole family up and moving!
  • Biz & Society Hall – Events in this neighborhood helped prepare you for the professional world! The Department of Communication offered events to conquer speech anxiety and improve writing.
  • Science & Tech Way – Learn food safety 101 and the importance of hand washing in this neighborhood!
  • Sports & Rec Row - This neighborhood was all about games, physical activity, and living a healthy lifestyle. It featured a rock wall, family yoga and dance sessions, sand volleyball, gymnastics and acrobatics, elements of a challenge course, and some free health screenings.  Since a good diet is an important part of a healthy lifestyle, the UMD School of Nursing at Shady Grove shared dietary guidance related to obesity, diabetes, and hypertension.
  • Terp Town Center – Everything you can imagine happened in the middle of Maryland’s campus. BikeUMD offered free bike valet for all attendees, there were 1-hour campus walking tours, the Counseling Center offered mental health and wellness sessions, and UMD chefs discussed initiatives to support food security for everyone.
  • Ag Day Avenue – This is where our booth was.  Located in the courtyard of the Animal Sciences Building, our table featured information about portion sizes, sugar sweetened beverages, and how to build a healthy plate. We had information for everyone - from preschoolers to adults!
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We also had a corn hole game for kids! Instead of a traditional corn hole game where the two boards are placed across from each other, our boards were placed next to each other to make it easier for kids to get their bean bags in the holes.  When placed next to each other, our boards illustrated a healthy plate!  The kids had a lot of fun with the game, most of them wanting to play multiple times. Their prizes were a MyPlate coloring book with a word-search and crossword puzzle, and a pack of crayons.

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People of all ages were interested in our table!  My fellow interns and I greeted visitors to our table and answered their questions on nutrition.  People asked about food myths (i.e. “I heard pineapple was bad for you”) and for more information on how to build a healthy plate.  Many  were shocked at the amount of sugar in sodas and sports drinks. We helped them see why water and unsweetened beverages are a better choice. Our table also featured three examples of healthy plates, complete with food models.  One kid even showed off his food knowledge by naming all the foods on the plates!  We gave our visitors handouts to take home and hopefully inspired them to eat a healthier diet.
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I really enjoyed my time at Maryland Day.  I had fun playing with the kids and teaching people about nutrition.  As a bonus, I even got to take home an herb plant which I’ll use in cooking endeavors! For more information about Maryland Day or to see the hundreds of events you might be able to expect next year, visit: https://marylandday.umd.edu/index.html.

Monday, April 24, 2017

Food Insecurity in Montgomery County

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Over 42 million Americans suffer from food insecurity, which is over 13% of people in the U.S. People are considered food insecure if they do not have reliable access to a sufficient quantity of affordable, nutritious food. In other words, someone who is food insecure may not know where their next meal is going to come from or may fear that they will run out of food before they have money to buy more. In Montgomery County, Maryland, around 80,000 people are food insecure, including many children. This, along with other things I learned during my rotation at the Manna Food Center, has inspired me to write this blog post.

Food Insecurity in Montgomery County

According to Montgomery County Public Schools, over 30,000 elementary school students are eligible for Free and Reduced Meals (FARM), but only 11% of those are actively participating in the FARM program. Other programs aimed at reducing food insecurity are the Supplemental Nutrition Assistance Program (SNAP), the National School Lunch Program (NSLP), and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Unfortunately, some Americans don’t know about these programs or don’t know how to enroll in them. To help increase enrollment in these programs, some local organizations offer information, resources, and services to food-insecure members of the community. The Montgomery County Food Security Collaborative partners with other local organizations to address this issue. Their mission is to reduce hunger in Montgomery County by 2020 by redistributing fresh, perishable food and increasing collaboration among businesses, non-profits, food providers, and families in need for this purpose. Their partners include Manna Food Center, Women Who Care Ministries, GaithersburgHELP, Full Plate Ventures, and more. I also recently heard about Volunteer Income Tax Assistance (VITA), which helps low-income individuals prepare taxes free of charge. There are many dietitians who volunteer to help sign these individuals up for food assistance programs while they are waiting for their appointment.

Get Involved

If you’ve read this far and you would like to help reduce food insecurity in your community, one of the easiest ways to get involved is to volunteer your time to a local food bank. Other ways to get involved include donating money or food, organizing a fundraiser, or organizing a food drive. I volunteered at Manna Food Center by helping put together boxes of food for distribution. Each box consisted of fresh fruits and vegetables, non-perishable canned and boxed goods, a few pounds of protein foods, and bread. For most families, it was enough food to last two to three days. That may not sound like much, but it could be the difference between eating and going without until the next paycheck.  

Food Insecurity and Health

Good nutrition is one of the most important factors that affects a person’s health. People who suffer from food insecurity are also at risk for developing chronic illnesses, such as cardiovascular disease and diabetes. I want to continue to help these individuals by reducing food insecurity and promoting good nutritional health wherever and whenever I can. One way that I was able to do this during my rotation at Manna was to create educational inserts for the food boxes. These inserts accompanied boxes that were designated for special diets. For example, some of the inserts were related to diabetes. Each diabetes insert contained information about diabetes and how it relates to food and had a recipe using five or fewer ingredients so that clients could learn new ways to use the foods that are provided for them to create healthy meals. I’ve included an example below for you to see. This concept can continue to be expanded on so that every box that a client takes home has good, nutritious foods and information that will help make Montgomery County healthier and happier.

Diabetes Myths

Monday, April 17, 2017

Joint Class Day: Nutrition Taking A Frontline Role in the Military

The Walter Reed National Medical Center is one of the nation’s largest military medical centers, and it’s located right in Bethesda, MD! Earlier this spring, our class was able to attend a joint class day to gain a deeper insight on the role RDs play in nourishing the country’s military. Many dietitians influence the success of the US Military, whether they deal directly with the civilian or military population. The nutritional health of civilians determines how many civilians are eligible to become a part of the military. Once enlisted, soldiers are expected to maximize their health and performance, but this isn’t always happening. Currently, 5% of active duty soldiers are prescribed sleep medications, 5% fail their Army Physical Fitness Test (APFT) and 13% are clinically obese. The Performance Triad has been designed to address these issues.

The Performance Triad is a strategic initiative aimed at improving soldier performance by targeting the areas of sleep, physical activity and nutrition. Each of these categories have targets and goals that soldiers work toward in order to maximize their performance:

Sleep
  • Get 8 hours of quality sleep per 24 hour period
  • Go caffeine free 6 hours before bedtime
Physical Activity
  • Aim for at least 10,000 steps per day, with the ideal goal of getting an additional 5,000 steps throughout the day
  • Include at least 2 days of resistance training per week, plus one day of agility training
  • Incorporate at least 150 minutes of moderate aerobic exercise, plus 75 minutes of vigorous intensity exercise per week
Nutrition
  • Eat at least 8 servings of fruits and vegetables per day
  • Re-fuel 30-60 minutes after strenuous exercise

Nutrition is now on the frontlines of improving military effectiveness. Accomplishing these nutritional targets and goals requires teamwork. It starts with meal planning so that the right nutrients are available. The diet developed to support the Performance Triad consists of 4,875 kcal and 155 g pro, strategically timed as follows:

Breakfast (06:00)
Hot Line and Beverages
1,000 kcal/40 g protein

Morning Snack (09:00)
Complex carb, produce, protein source
500 kcal/10 g protein

Lunch (12:00)
Meal Ready-to- Eat (MRE)
1,345 kcal/45 g pro

Afternoon Snack (15:00)
Complex carb, produce, protein source
500 kcal/10 g protein

Dinner (18:00)
Hot Line with Beverages, Salad Bar and Dessert
1,200 kcal/45 g protein

Midnight Snack (23:00)
Complex carb, produce
350 kcal, 5 g pro

I am surprised to see how much higher, the recommendations are for the active duty military compared to those for the civilian population, but providing all those calories helps support the increased physical activity of active duty military members. This meal pattern is coupled with nutrition education that teaches the importance of different nutrients and promotes increased fruit and vegetable intake. To make it easier green, yellow and red labels are used to make healthier choices immediately identifiable with one glance. Green foods should be eaten often, yellow occasionally and red avoided.




The Performance Triad has shown to increase fruit and vegetable intake by 1.5 servings/day, as well as increase the frequency of refueling after exercise. Food is fuel and this program is the perfect example of the impact food choices have on overall health and performance!

Learning how the military is shifting its focus to nutrition was very encouraging to hear as a dietetic intern. Research has proven that proper nutrition improves performance and the military is listening! As the focus on nutrition continues, RDs will need to continue their advocacy and research to support and empower our country’s military.