Nutrition in a Nutshell: Lessons Learned as a Dietetic Intern

by Katelyn Castro

I was one of those few teenagers who knew exactly what I wanted to be when I grew up. Now, after four years of college and two years of graduate school combined with a dietetic internship, a career as a registered dietitian is not far out of reach. While my passion for nutrition has never dwindled over these last six years, my approach nutrition has changed significantly.

Nutrition tips on the sidebar of Self magazine, an over-simplified nutrition lesson in a health class in middle school, and a quick nutrition lecture from my pediatrician, summed up my understanding of nutrition before entering college. Now­—six years of coursework and 2000+ hours of dietetic rotations later—I not only know the nitty-gritty details of nutrition science, but I also have learned some larger truths about nutrition that are not always talked about.

Beyond what you may read as you thumb through your social media feed, or even what you may learn from an introductory nutrition textbook, here are some of the lessons that I have acquired about nutrition along the way:

1- Nutrition is an evolving science.

First, let’s be clear that nutrition is a science that relies on concepts from biology, chemistry, anatomy, physiology, and epidemiology to study how nutrients impact health and disease outcomes. Understanding how diabetes alters carbohydrate metabolism allows people with diabetes to live without fear of dying from diabetic ketoacidosis or seizures due to unsafe blood glucose levels. Understanding how ulcerative colitis impacts mineral absorption and increases protein losses helps those with the condition manage nutrient deficiencies with adequate nutrition supplementation. These are only a few examples of the many ways our knowledge of nutrition science makes it possible to improve individuals’ health outcomes.

However, the more I learn about nutrition, the more I realize that the research still holds many unanswered questions. For example, previous nutrition guidelines, like when to introduce hypoallergenic food to children, are being disproven and questioned by more recent studies. On the other hand, research on the gut microbiota is just beginning to uncover how one’s diet interacts with their gut microbiota through hormonal and neural signaling. Staying up-to-date on the latest research and analyzing study results with a critical eye has been crucial as new scientific discoveries challenge our understanding of nutrition and physiology.

Who would have thought a career in nutrition would require so much detective work?

 2- Food is medicine, but it can’t cure everything.

The fact that half of the leading causes of death in the U.S. can be influenced by diet and physical activity highlights the importance of nutrition for long-term health. Using medical nutrition therapy for patients with variety of health problems, ranging from cancer and cardiovascular disease to cystic fibrosis and end-stage renal disease, has also allowed me to see nutrition powerfully impact the management and treatment of many health conditions. High cholesterol? Avoid trans fat and limit saturated fat in foods. Type 2 diabetes? Adjust the timing and type of carbohydrates eaten.

While making simple changes to eating habits can improve lab values and overall health, nutrition is often only one component of treatment accompanied by medication, surgery, therapy, sleep, and/or stress management. Interacting with patients of all ages and health problems, and working with health professionals from a range of disciplines has forced me to step out of my nutrition bubble and take a more comprehensive approach to patient care: Improving quality of life and overall health and wellbeing is always going to be more important than striving for a perfect nutrition plan.

3- Nutrition is political and nutrition messages can be misleading.

Back when the Academy of Nutrition and Dietetics was one of many health organizations sponsored by Coca-Cola and PepsiCo, I realized how much influence large food industries have on food advertising, marketing, and lobbying. With known health consequences of drinking too many sugary beverages, the concept of health organizations being sponsored by soda companies was perplexing to me. Learning more about the black box process of developing the government dietary guidelines has also made me more cognizant of government-related conflicts of interest with industries that can color the way nutrition recommendations are presented to the public.

Industry-funded nutrition research raises another issue with nutrition messaging. For example, only recently a study revealed that the sugar industry’s funded research 50 years ago downplayed the risks of sugar, influencing the debate over the relative risks of sugar in the years following. Unfortunately, industry-sponsored nutrition research continues to bias study results, highlighting positive outcomes, leaving out negative ones, or simply using poor study designs.  While sponsorships from big companies can provide a generous source of funding for research, as both a nutrition professional and a consumer, I’ve learned to take a closer look at the motives and potential bias of any industry-funded nutrition information.           

4- Nutrition is not as glamorous as it sounds, but it’s always exciting.

When the media is flooded with nutrition tips for healthy skin, food for a healthy gut, or nutrients to boost mood, the topic of nutrition can seem light and fluffy. With new diets and “superfoods” taking the spotlight in health magazines and websites, it’s easy to think of nutrition as nothing more than a trend.

However, any nutrition student or dietitian will prove you otherwise. In the words of one of my preceptors, “my job [as a dietitian nutritionist] is not as glamorous and sexy as it sounds.” Throughout my dietetic rotations, my conversations with patients and clients have gone into much more depth than just aesthetics and trendy nutrition topics. If I’m working with a patient with Irritable Bowel Syndrome, bowel movements (a.k.a poop) may dominate the conversation. If I’m counseling someone who has been yo-yo dieting, I may be crushing their expectations of fad diets while encouraging more realistic, sustainable healthy goals. If I’m speaking with a group of teenagers with eating disorders, I may not talk about nutrition at all and focus more on challenging unhealthy thoughts and behaviors about food. It is these conversations, discussing what really matters when it comes to food, nutrition, and overall health that make a career in nutrition ever-changing and always exciting.

Katelyn Castro is a second-year student graduating this May from the DI/MS Nutrition program at the Friedman School. She hopes to take advantage of her experiences at Tufts to make positive impact on individuals’ health and wellbeing through community nutrition outreach. You can follow on her journey as she blogs on all things relating to food and nutrition at nutritionservedsimply.com.

 

 

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What’s the Deal with “Repeal the Seal?”

by Marissa Donovan

The Academy of Nutrition and Dietetics, the worlds largest organization of food and nutrition professionals, faced criticism recently after establishing an agreement to display their Kids Eat Right seal on Kraft Singles. This controversy sparked debate regarding Academy endorsement of specific food products both within the nutrition community and extending further out to consumers.

Over the last month, the Academy of Nutrition and Dietetics (AND) has encountered backlash after licensing its Kids Eat Right seal on Kraft Singles.  After The New York Times ran the story “A Cheese ‘Product’ Gains Kids’ Nutrition Seal,” many expressed confusion that the Academy of Nutrition and Dietetics would “endorse” a Kraft product. Kraft informed The New York Times that the Academy had endorsed this product, although according to the Academy, this was not an endorsement.

Instead, the Academy stated that: “As part of this nutrition education initiative, the Kids Eat Right logo will appear on KRAFT Singles packaging, identifying the brand as a “proud supporter” of Kids Eat Right and encouraging parents to visit www.KidsEatRight.org/cheesyfacts for tips to help kids get more vitamin D and calcium.”

Soon after The New York Times article ran, Academy members began a campaign and drafted a petition against the Kraft Kids Eat Right seal, appropriately named #Repealtheseal. With nearly 12,000 signatures, the petition caused a huge uproar. As of April 1, the Academy made the decision to terminate the Kids Eat Right initiative with Kraft.

Leaders of the #RepealtheSeal campaign, Rachel Begun, MS, RDN, Kate Geagan, MS, RDN, and Regan Jones, RDN responded: “It takes courage to sit down and listen to criticism and then do something about it. They did just that—and we believe it will ultimately improve our profession, our organization and our public trust.”

Although the initiative was terminated, it is important to note that the logo will appear on products until at least July 2015, as some packaging has already been manufactured.

So why is this such a big deal?

In the business world, a logo, such as the Kids Eat Right logo, placed on a product conveys an endorsement or recognition of a paid relationship – in this case between the AND and Kraft. Whether or not the logo was an AND “endorsement,” it would undoubtedly cause confusion for shoppers searching for healthy options.

Having the AND “endorse” products threatens the credibility of the organization and its practicing members. Members of the AND as well as the general public deserve full transparency regarding the relationship between the AND and industry, including Kraft.

As the AND is the professional association for registered dietitians, it is important that it remains an unbiased resource for nutrition information. If not, the AND could lose all credibility, notably expressed by The Daily Show’s Jon Stewart who, following this controversy, claimed that “the AND is as much an Academy as (Kraft Singles) is cheese.”

This controversy is not the first of its kind. The Academy has been criticized in the past regarding its relationship with industry, causing AND member and public concern about corporate sponsorship.

Although this event is unfortunate, it does show that AND members won’t stand for occurrences such as this. AND members are professionals, passionate about what they do and what they represent, shown by their overwhelming support and commitment to #RepealTheSeal.

As Dr. Marion Nestle, nutrition professor and author of Food Politics, told TakePart regarding this incident, “the capital N news is that dietitians are fighting back at last.”

Marissa Donovan is a registered dietitian and first year student in the MS Nutrition Communications program at the Friedman school. She loves hiking, traveling, finding new restaurants and, of course, Netflix. You can follow her on twitter at @marissadonovan1

March is National Nutrition Month

by Cailin Kowalewski

We’d like to thank the Academy…

But not that academy. We’re talking about The Academy of Nutrition and Dietetics (AND), whose annual education and information campaign, National Nutrition Month®, takes place this March. This year’s theme, “Bite into a Healthy Lifestyle,” offers timely, practical, lifestyle-centric messages promoting healthy weight maintenance, chronic disease risk reduction, and overall health promotion. Sounds good, right? Sure does. Should you care? You bet! And why? Because no one else does.

A perusal of the AND’s website provides a good sense of their offerings to support nutrition in March. These include promotional resources like PSAs, a “Good Nutrition Reading List,” and information about Registered Dietitian Day on March 11. But while these resources may be useful to nutrition professionals, it is undeniable that the campaign lacks a sense of user-friendliness for the layperson. It lacks interactive appeal. It doesn’t encourage engagement. It doesn’t encourage excitement.

The AND’s campaign exemplifies efforts to secure a place for science-based nutrition information in the conscience of the American public. Unfortunately, it also exemplifies how gloriously these campaigns continue to fail.

For example:

The National Nutrition Month Facebook page has 11,294 likes. The Food Babe has 922,723.

A search for National Nutrition Month’s #NNM handle on Twitter brings up results for Nerd Nite at Melbourne University and Noname Magazine Studio’s radio updates.

Finally, we can observe the campaign’s striking presence in the blogosphere:

Screen Shot 2015-02-28 at 8.20.35 PM

Ouch.

To be fair, the AND campaign may be wildly successful despite its lackluster performance on social media. “Dial a dietitian night” on local radio stations, cooking demos, recipe contests, and brochure handouts may be great ways to pique interest in our time-strapped, data-saturated culture. But more likely, these strategies will slip through the cracks and the general public will not realize the AND even exists.

The issue is one that rings true throughout the field of food and nutrition policy. How do we stay relevant? How can science earn a trusted place in the minds of Americans? On the heels of significant events like the release of the Dietary Guidelines for Americans Committee’s scientific report, an overhaul of the Congressional seating chart, and the rise of Vani Hari’s (aka the Food Babe) latest book to national best-seller lists (God help us), how can we build momentum that embraces and propels nutrition science?

Friedman students are equipped with a unique awareness of these questions, and with skills that make us uncommonly well-suited to proposing informed, innovative solutions. I bet that there is a Friedman graduate working at the AND, and I would be shocked if Friedman staff weren’t themselves involved in the current campaign. The question remains, how can something as potentially impactful as a National Nutrition Month remain as underutilized as it is?

The time for formality and organizations focused on providing resources for professionals has passed and a respect for the public, communal nature of American health and wellness is essential. As a school, Friedman should be leading the charge by leveraging the skills and talents of its students, facilitating our growth, and placing into our hands the most difficult challenges in nutrition policy that can be conceived.

We are ready to speak on behalf of science, and we are ready to be heard. But unlike academies and organizations like the AND which operate top-down communication campaigns, Friedman students have firsthand exposure to the dialogue that is necessary for understanding something as simultaneously complex and personal as nutrition. In short, we know how to listen, and it would behoove the organizations that will likely hire us in the near future to start acknowledging what we hear and want to hear.

Cailin Kowalewski is a second-year FPAN student at the Friedman School of Nutrition.