My 6 Tidbits of Advice for Dietetic Interns

Last year, before I started my Dietetic Internship, a girl in the class above me reached out to provide some advice and answer any questions I had about the dietetic internship that I would be starting.

She told me, “You will learn more about what you don’t like, rather than what you do like during the internship”.

This didn’t faze me as earth shattering advice at the time, but let me tell you, when 5 months of clinical rotations had passed and I couldn’t name a single area I really enjoyed, nor could I ever envision myself being a clinical dietitian, that advice was life saving. I still had a few moments of panic (I knew I still wanted to be a dietitian, but suddenly I had no idea what I wanted to do as a dietitian), but knowing that it is okay to not enjoy parts (or whole chunks) of the internship was very reassuring. There are so many areas of dietetics that you may not be exposed to in your internship, so there is still so many other opportunities to find where you fit in. And don’t worry- I’m still trying to figure out what that niche is for me.

Anyways, since I received that invaluable piece of advice prior to starting my internship, and now having completed an internship myself, I thought I would share a few pieces of advice for any RD2Be’s out there.

  1. Going along with the advice I was given, I would tell people to find an internship with tons of different rotations/areas of experience – especially if you don’t really know what area you want to go into. I worked in more than 25 different clinical areas during my internship, and although a didn’t love any of them, there were definitely some I liked more than others and I discovered interests that I didn’t know I had. Even if you do have a specific area of interest, gaining experience in a number of different fields will make you a better dietitian all around.
  2. Practice what you preach as a dietitian. Dietetic internships can be extremely busy and stressful, especially if you are also completing as masters degree at the same time (like me). It can be easy to slack off, skip workouts, and order pizza for dinner, but as future RDN’s, we all know that those choices aren’t the best for our physical or mental health. Make sure you have plenty of fruits and veggies to snack on and especially get a solid 7-8 hours of sleep every night.
  3. Ask lots of questions! I was terrified starting my first rotation because I felt like I didn’t know enough. Guess what…you aren’t supposed to know everything – that is why you are there. I never had a preceptor who wasn’t willing to answer my oodles of questions – especially regarding areas of nutrition that I didn’t learn a lot about in undergrad.
  4. Similarly, take advantage of all the knowledge your preceptors have to offer. This goes for nutrition knowledge (again, ask questions!), but I also liked to pick their brains about life and career advice. They all landed a job as a clinical dietitian and most had other jobs and experiences prior to their current job, so they have lots of valuable information to offer about careers in dietetics.
  5. I know I probably don’t have to say this to a bunch of type A, aspiring dietitians, but say on top of your work and manage your time well. I guess this mainly goes for interns who are also getting their masters at the same time (like I did), but you definitely don’t want to fall behind and let the workload pile up. Start your assignments early, chip away at them every day, and you will definitely still have time to enjoy life!
  6. Finally, your internship is the greatest study tools and experience to prepare you to be a dietitian. I remember worrying during the first few weeks of my internship that I needed to start taking notes or studying for the RD exam (this was when I still had 11 months of internship ahead of me!). Now, having passed the RD exam, I can confidently say that there is nothing to worry about. Those 1,200+ hours spent working during your internship aren’t for nothing and prepare you very well to be a dietitian and pass your exam.
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I’m a Registered Dietitian!

Wow, the past few weeks have felt like quite the whirlwind! I finished up the last of my four weeks working as the pediatric ICU dietitian, graduated from my dietetic internship, studied hundreds of pages of dietetics information, made and learned oodles of flash cards, and took (and passed!) the Registered Dietitian Exam yesterday!!

I am officially Dana Goldberg, RDN!

(Not to mention, this is also my 100th blog post!)

With all of these milestones comes lots of self-reflection and things I want to share about my experiences, so first I thought I would use this post to share my thoughts 1-week post- dietetic internship.

I’ll start off by saying that these past 11 months have been some of the toughest months of my career as a student- both academically and mentally. Taking almost a full graduate degree course load and working 32 hours a week as an intern sometimes made me want to pull my hair out, but I am proud to say that I successfully made it out alive. There aren’t many things that I am ever really proud of myself for; it just isn’t my personality and I tend to be pretty hard on myself. Graduating high school didn’t faze me (I was livid and embarrassed when my mom tried to put a congratulatory sign on our lawn), graduating undergrad kind of seemed impressive (but everyone around me was also graduating college so I didn’t feel like it was that special), but I will confidently say that I am proud to have completed a dietetic internship and passed the RD exam. It feels like the hardest part – the uphill climb – is over and I can finally catch my breath.

I know I have shared this in a few previous posts, but I honestly didn’t love my time working at a hospital as a clinical dietitian. I didn’t feel like I really made any lasting impact on patients’ lives nor helped improve their long-term health. However, spending over 1,500 hours 27 different areas of the hospital, plus working with over 35 different dietitians, I learned so much about clinical nutrition that will set me up for success in any nutrition field that I end up going into. Although I dreaded walking into that hospital some days, I don’t think I would have wanted to do it any other way.

Finally, I can’t talk about my experience as a dietetic intern without mentioning my staff relief rotation. During the last four weeks of the internship, each intern got to choose an area of the hospital where she would act as the dietitian. We still had a dietitian to co-sign our charting documents, but we were basically on our own as if we were the sole dietitian covering that area. I chose to spend those four weeks in the pediatric intensive care unit (PICU), and it was my favorite four weeks on the entire internship. I chose the PICU because I found I enjoyed all of the enteral and parenteral nutrition (nutrition via tube feeds and IVs) calculations in the ICU setting. I also went into my internship wanting to work with kids – and especially enjoyed my pediatric rotations during the internship. The first week of staff relief was absolutely terrifying but by the end, I felt like I had the confidence to go out into the field and be a dietitian (which was very reassuring!). Also, I have to give a huge THANK YOU to the PICU dietitian and my staff relief preceptor Melanie for teaching me more than I thought I would ever know (and also making me laugh every day – even when I was working with kids who were critically ill).

Now, one week since the end of the internship, these are my main thoughts, but I’m sure as time goes by I will have more thoughts and reflections to share.

If you are a current RD2Be, dietetics student, or dietetic intern, be sure to stay tuned for my posts over the next few weeks because I’ll be sharing my dietetic internship and RD exam advice. Feel free to send me all your burning questions and I can answer them in my posts 🙂

Nutrition for Bone Health

Calcium
When you think bone health, what is the first nutrient you think of? I’m going to go out on a limb and guess that you said Calcium! Yep, calcium is crucial for bone health. It is the key component of hydroxyapatite, which makes of the mineral matrix that keeps you teeth and bones sturdy and strong. Our bones are also constantly breaking down and building up – and in order to properly build, they need adequate amounts of calcium. This “adequate amount” ranges from 1,000mg- 1,300mg per day depending on age and gender and mainly comes from dairy products, almonds, leafy greens, tofu, beans, lentils, and some fish fish.

Vitamin D
Now, while calcium is the key component in bone, it pretty much is no good without its partner in crime, vitamin D. Vitamin D is needed for calcium absorption, so no matter how much calcium you eat (or drink), your body isn’t absorbing much of it if you lack vitamin D. Vitamin also helps in that bone remodeling (breakdown and building) process I mentioned.

Vitamin D has become a pretty hot nutrition topic recently. In fact, vitamin D deficiency is on the verge of becoming a global public health issue. Why? Well, if you are reading this post right now, you are likely sitting inside staring at a computer or phone screen as opposed to soaking up the sun’s UV rays. Our primary source of vitamin D comes from the sun so the decreased time spend outdoors and the increased use of sunscreen that have been seen around the globe are causing vitamin D deficiency rates shoot through the roof!

There are a few food sources of vitamin D, including fortified dairy products, some fatty fish, and mushrooms, but these can’t really provide enough to meet our need of 600-800 IU per day (and most people need up to 2,000 IU per day if they are deficient).

Exercise
The final key player in bone health isn’t a nutrient; it is exercise!- specifically weight-baring exercise. Simply carrying the weight of your skeleton in activities like walking, running, jumping, and stair climbing all help in that formation of strong bones. Not to mention, exercise improves strength and balance, which can help decrease risk of falls and broken bones.

Other Nutrients
In addition to these top three, researches have also found that low vitamin C and vitamin K levels also put people at risk of poor bone mineralization. On the other hand, people who had diets high in fruits and vegetables were found to have stronger bones… just one of the millions of reasons to eat more fruits and veggies!

Controversy
A few studies have found that high calcium intake, greater than the recommended daily intake doesn’t provide any additional benefit when it comes to bone mineral density. There have also been associations between high calcium intake (especially from supplements) and heart disease risk. Moral of the story- more calcium isn’t always better.

Artificial Sweeteners: Not so sweet after all

The next time you are about to tear open that yellow, blue, or pink packet or reach for a diet beverage, you may want to think twice. Throughout the 1900’s, artificial sweeteners seemed to be the miracle food – all the delicious sweetness people enjoy, without any of the sugar or calories. But now this “miracle food” might not be such a miracle after all. Recent research has been showing that these artificial sweeteners may be doing more harm than good!

One study of over 400,000 people found that, even though artificial sweeteners don’t have any calories, they did not help people lose weight. In fact, they found consuming more artificial sweeteners lead to weight gain and obesity, diabetes, and heart disease.

How could this be possible? Less calories should mean more weight loss, right? Well, just because the sweeteners aren’t providing any calories, doesn’t mean we aren’t getting more calories elsewhere. One Harvard doctor explained that artificial sweetener consumption could cause overstimulation and desensitization of our sugar receptors, which causes people to crave sweeter and sweeter foods. It can also end up making un-sweet foods (such as vegetables) unpalatable. These sugar cravings and vegetable aversions lead to people eating more sugary and high calorie foods, which cancel out any reduction in calories from using artificial sweeteners.

Also, remember the gut microbiome I talked about in my post about Probiotics? Well, researchers found artificial sweeteners can change your gut bacteria…and not in a good way! The sweeteners increase the number of Bacteroides, an “energy hoarding” bacteria species that make it nearly impossible to lose weight. Other changes in the microbiome, caused by artificial sweeteners, make it more difficult for your body to breakdown sugar – leading glucose intolerance and diabetes.

If you are looking for any bright sides, using artificial sweeteners in place of sugar can decrease likelihood of cavities and tooth decay, and while there is a lot of hoopla around artificial sweeteners causing cancer, there haven’t been any concrete studies to prove this. But! We only have short-term studies…we don’t really know what the effects of long-term use are.

In the end, regardless of weight gain, cravings, and diabetes, artificial sweeteners are, well, artificial. I don’t know about you but I would rather avoid putting artificial chemicals in my body and stick with the real stuff (in moderation, of course) if I had the choice.

Cruising to the Finish Line

Happy April! I guess it has been quite a while since I wrote my last official update on my Dietetic Internship in December. It seems like every day goes by so slowly but suddenly I only have 4 weeks left of this semester of school and 15 weeks lefts of my Internship.

Since December I have had my bariatric rotation, renal (kidney) rotation in a dialysis unit, critical care rotations in the Medical, Surgical, Trauma, and Neuro Intensive Care Units, and now I am in my pediatric rotations. I definitely enjoyed critical care more than I thought I would and more than I enjoyed my general medical/surgical rotations earlier in the year. It was a lot less talking to patients (mostly because they were sedated and on a ventilator), and a lot more tube feeding and TPN (IV nutrition) calculations.

I originally started my Internship thinking I would want to work in pediatrics, but by the time I started peds I knew it probably wasn’t where I really wanted to end up. The past three weeks in my general pediatrics were definitely a nice change of pace getting to see kids, but it is also a whole new world. I feel like I am back at square one trying to learn all the different infant formulas. My next three weeks are in the Neonatal and Pediatric Intensive Care Units, which I think I am going to like a lot more than general pediatrics since I liked the adult ICUs.

Between all of my clinical rotations, we also had a ton of activities in March for National Nutrition Month. We had one full week dedicated to doing things in the community, including playing fruit and vegetable games with kids at a Head Start preschool, teaching a nutrition health class at a high school, participating in a high school health fair, and doing a food demo for hospital employees. Our biggest event was the National Nutrition Month Celebration Day in the atrium cafeteria at the hospital. Each intern, including myself, put together a big presentation board, an activity, and several handouts about a specific nutrition topic.img_1214.jpg My topic was plant-based diets (don’t worry, I’m not saying you should become a vegetarian or vegan). I discussed the importance of limiting meat consumption and encouraged more beans, vegetables, and whole grains. Not only are there lots of health benefits of plant based foods, you also get more variety of nutrients by switching things up. (I have included my plant based grocery list and plant based protein source handouts here, too!)

Plant Based Grocery List

Plant Based Protein Sources

From all of these community events I realized that I take for granted how much I know about nutrition. Because nutrition is the world I have been living in for the past 5 years, I sometimes forget what the average person knows. Some of the questions I got during the week really reminded me that people don’t know enough about nutrition and I have a lot of valuable knowledge to share.

I also had a big presentation for all of the hospital dietitians in March, which was probably the most nerve-racking experience ever. So, now that March/National Nutrition Month is over, I feel like I am just cruising to the finish line. I have a few big papers do before the end of April for school, one more big presentation at the hospital, and only three more major rotations until my Internship is over!

And for the final (and most exciting) update, I recently found out I won a scholarship for an educational international travel experience once I graduate in December! The location of my trip has not been confirmed, but I will keep you posted when I decide.

I guess I need to do these updates more often so they aren’t so long. Until next week, Happy Easter and Happy Passover from this RD2Be!

When you are stuck in a rut…

When I was planning my blog post for the week, I had in my head that I was going to do a Dietetic Internship update and talk about all of my exciting National Nutrition Month activities from this month. I’ll definitely do a post on this but it is going to sit on the back burner until next week.

As I have shared here on my blog several times, I have a lot on my plate working as a Dietetic Intern and going to graduate school. Between work, school, assignments, papers, and everything in between, it feels like this semester has sucked the lift out of me. I felt like my mantra was “work, sleep, homework, repeat”. I wasn’t feeling like myself and I even skipped out on going to the gym for two full weeks (which is 100% not like me- exercise is my stress reliever and boost of energy)

This lack of motivation and “blah” feeling really hit me a few weeks ago. I had to get back to my workouts to relieve some stress and give me a jolt of energy. Clearly my typical routine of going to the same gym everyday after work and doing my Kayla Itsines BBG circuit training wasn’t working so I decided to try something new.

In the past, I have found group fitness classes are much more motivating than working out alone. The energy of all the people around me always motivates me so I thought this would be a good place to start. I frequent yoga and spinning classes, but in order to pull me out of my rut I had to jump outside my comfort zone. The solution: find every fitness studio in Cleveland that offers a free first time class and give it a shot.

…And that is exactly what I have been doing. In the last week I went boxing for the first time (something I never thought I would do) and tried out a climbing class on a versa-climber (which, holy s***, was the hardest 30 minutes ever!). Since the weather has been a little bit nicer this week (ie. The sun made a few appearances), I have also been able to go for a few runs outside. Boy, does fresh air do wonders for your mood and energy.

To be completely honest, the last week has been amazing. I feel like a new person, I have so much more energy, my friends can’t get me to shut up about my new favorite workout classes, and I also happened to get some exciting news this week (tune in to next week’s post to find out!).

What is the point of all this and why should you care about my rut?

Well, because I think I can confidently say that everyone falls into a rut at some point. We are all busy with dozens of responsibilities being pulled in dozens of directions that sometimes cause us to get burnt out and lose motivation. Maybe you lose motivation to workout (like me), but maybe it is your schoolwork, job, or something else.

If you get stuck in a rut, don’t just sit down there. Figure out how to pull yourself out. There is no way that we can all be motivated all the time. Einstein famously said, “The definition of insanity is doing the same thing over and over again, but expecting different results”. If what you are doing now isn’t working then try something new…something that excites you or makes you feel good. Even just stepping outside for 30 minutes a day to get some fresh air can completely change your mood. It might not be easy to step outside your “normal” but it can definitely be worth it!

Healthy and Fast Meals with (almost) No Cooking Required

I’m not going to lie, I have slacked off a little (or a lot!) when it comes to cooking this year. Between school, work, trying new workout classes ;), and trying to get a decent amount of sleep, cooking just hasn’t been a priority. But don’t get me wrong, this doesn’t mean I’m having frozen meals or fast food – it just means my meals are a little more simple and don’t take much time to make.

Whether you are a student like me, a working professional, home taking care of kiddos, or have other responsibilities, time is always the number 1 excuse for not eating healthy, so today I thought I would share my tips and tricks for fast and easy, healthy meals.

1. Cook ahead of time – I typically only turn on my oven and stove one or two times a week. I’ll make some chicken, roast some veggies, brown some ground turkey, and cook some rice or quinoa. From start to finish, it usually takes me no more than an hour. I keep everything in separate containers in the fridge so it’s ready when I get home from a long day at work.

2. Build a meal – Now that you have all the food is cooked and ready to be eaten, all you have to do is put it together. Think of it like an assembly line…add some rice, chicken, broccoli, and sauce to a bowl, pop it in the microwave and voila, dinner is served.

3. Oh, wait – there is no step three 😉 It is so easy there are only two steps! See, no excuses!!

Here is a little cheat sheet for building a healthy meal:

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  • Tricks if you are really short on time:
    Choose canned tuna, buy a pre-baked chicken, or try canned beans which don’t require cooking for your protein sources
  • Use frozen veggies that you can steam in the microwave – no baking or chopping required.

Now that you have the “recipe” to build your own healthy meal, I thought I would share some of my favorites. Some might sound strange, but I promise they are tasty! Also, lots are vegetarian since I was experimenting with being a vegetarian for a month.

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No excuses now! What are your favorite meals to build?