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.

Emotional Eating & Food as Fuel

This past Sunday was commencement at Case Western, and even though I wasn’t graduating, I still got to do a lot of celebrating because two of my best friends from undergrad were graduating. What I really mean by celebrating was going out to a lot of nice and yummy restaurants. My friends’ families’ were kind enough to include me at dinner on Saturday and lunch and dinner on Sunday.

If you know me, you know that I love a good meal out at a restaurant (especially if it is somewhere I’ve never been), but this weekend was a lot… I am not use to going out so much! I stuck with healthy choices (mostly protein and veggies) at my meals and shared some dessert, but the whole weekend got me thinking about how we view food as a culture.

In the caveman times, food was merely fuel to keep us going. Today, we eat to celebrate (graduations and birthdays, for example), we eat when we are sad (cue the break-up pint of ice cream), we eat/munch out of boredom (like the popcorn while watching TV), and we eat when we are stressed (you should see the university library during finals!).

As you can see, we strongly associate food with emotions and feelings…no wonder so many people struggle with emotional eating! If you think about it though, most of us are conditioned from a very young age to associate food (usually unhealthy food) with our emotions or actions. For example, say little Billy keeps crying as he gets a shot at the doctor so he gets a lollypop to cheer him up or his mom says he can have ice cream if he quietly and patiently waits while she buys the groceries. In these cases, Billy now associates (again, unhealthy) food with unhappiness/pain and with doing something good/behaving.

Why do we always use unhealthy foods as rewards? That’s because sweet and salty foods cause our brains to release dopamine, the hormone that makes you feel happy. While this sounds great (of course we all want to feel happy), dopamine is also the hormone that can create addiction – just one of the reasons why so many American’s are addicted to sugar and salt. Also, remember that although those foods may cause immediate happiness, sugar and salt are ultimately not good for you. They can lead to high blood pressure, inflammation, and even throw off all sorts of hormones that could cause anxiety or depression (the exact opposite of the initial feeling of happiness!).

So while almost everyone may struggle with emotional eating (including me!), it is important to think back to what food is really for – to fuel our bodies. I don’t think you would intentionally put fuel in our car that you knew would clog the pipes, so the next time you are reaching for the bag of chips or box of cookies, ask yourself, is this fueling my body with good, healthy nutrients that won’t “clog the pipes”?

And if you are a parent of little kiddos, try not to use food as a reward or use food to fill a need other than hunger. It is, of course, part of life to have cake and ice cream on your birthday (don’t give that up!!), but try not to use foods (especially sweet and salty ones) as bribes or treats for desired behaviors. It can help prevent some of those food-emotion associations later on.

My Experience on Whole30

Don’t mind me just sitting over here indulging in a big bowl of ice cream.

The cycle of restricting foods (and dieting) and then binging on “unhealthy” or “forbidden” foods has never been as clear to me as it is right now. That’s because I just completed day 30 (the last day) of the Whole30 diet.

After my experiment as a vegetarian for a month, I thought I would try out another diet. The lucky winner- Whole30. Whole30 is a diet designed to “end unhealthy cravings and habits, restore a healthy metabolism, heal your digestive tract, and balance your immune system”. Sounds great until you hear what is involved. On Whole30 you aren’t allowed ANY grains, legumes, sugar, sweetener (including things like honey), dairy, soy, or alcohol. What does that leave you ask? I have pretty much spent the last month eating only meat, fish, eggs, fruits, and vegetables. It got real boring, real fast to say the least.

If you catch my drift, it was not an enjoyable experience. If you have read many of my previous posts or know me well, you know that I am not one to cut any foods out of my diet – you name it, I’ll probably eat it (yes, even as a nutrition student and future dietitian I eat (and love) chocolate, ice cream, buttered popcorn, and even a loose with chili cheese fries from Detroit’s Lafayette Coney Island), so having to cut so many things out of my diet was a challenge.

In theory, sticking to a diet made up of whole foods is great, but not allowing any wiggle room leads to overeating all of the “forbidden foods” later on (aka the big bowl of ice cream I am having). Cutting out foods can create an unhealthy relationship with food, it is restrictive, not sustainable, and most of all, it isn’t fun.

So, how was Whole30?

Like I said before, it is really boring because there wasn’t a lot of variety. It was also very difficult to go to restaurants or gatherings with food since there were so many things that were off limits.

Do I feel better?

Honestly, I don’t feel any different – aside from the fact that all I want to do is eat dessert, bread, and a big chipotle burrito bowl. But also remember, my diet was pretty rich in fruits, vegetables, and lean proteins before. It wasn’t like I was starting out eating McDonald’s on the daily.

Would I recommend Whole30?

That would be a big fat NO! I see no reason why you have to cut out things like whole grain bread that is packed with fiber, beans that are a good source of plant based protein, and dairy products that are full of calcium and protein. I actually think you end up in an even worse situation after Whole30. Think about the restricting and binging cycle I mentioned — after 30 days of restricting, all you want to do is overeat/binge on the foods you avoided for a month. (It has even been difficult for me, someone who is very aware of these restrict and binge patterns, to resist eating an entire pint of ice cream and a loaf of bread right now.)

On the other hand, I do think the emphasis of fruits, vegetables, and lean protein is great! Everyone could benefit from eating a few more of these and a few less sugary and starchy foods (since they make up the majority of a standard American diet). Note that I said “a few less”, not “eliminate” the sugary and starchy foods. There is no reason why pizza and chocolate can’t make there way into a healthy, balanced diet.

I think this pretty much sums up my thoughts on Whole30. Have you done Whole30? If so, what are your thoughts?

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!