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 🙂

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.

Back to the Beverage Basics

This week, I am going back to some basics. While I love writing about all the cool, new nutrition research I learn at work and at school, I sometimes forget that many people have a tough time making basic healthy choices – especially when it comes to what they are drinking.

In many of my rotations at the hospital, people overlook drinks as a source of nutrition. I have seen overweight patients who just can’t figure out why they aren’t losing weight while eating eggs for breakfast, a salad, for lunch, and grilled chicken for dinner. Guess what? These people also drink crazy chocolate-y, sugary Starbucks drinks, several glasses of orange juice per day, and bottle on bottles of pop/soda. I even had one patient who admitted to drinking over 2 liters of orange juice every day – that’s about 946 calories and 176 grams of sugar!! I know this is an extreme scenario, but it is so easy to lose sight of how easily those fluid calories can add up.

When I am working with patients who want to lose weight, my number one piece of advice is to switch to zero calorie beverages with no artificial sweeteners. Yes, diet coke is zero calories, but all the artificial sweeteners wreak havoc on your digestion and bacteria in your gut (more on this in a future post, but for now, avoid all artificial sweeteners).

So what type of beverages do I recommend?

Number 1 is always water! Hot, cold, with lemon, berries, or cucumbers…water is always the best option. I love mine ice cold with a wedge of lemon, of course!

If you aren’t a fan of water, try the unsweetened, flavored, sparking waters that are all over Instagram and Facebook, like LaCroix or Bubly. While these are all better options than pop or sugary drinks, I still encourage people to stick with fluids that aren’t sparkling. There is some newer research showing that all the carbonation can acid reflux and increase ghrelin levels (the hormone that makes you feel hungry).

You can also pick up a cup of coffee. No, not a double chocolate Frappuccino with umpteen pumps of flavor or even a cup with some Splenda…just a plain old cup of black coffee (maybe with a splash of milk). Two to three, 8 ounce cups of coffee per day has been found to decrease risk of many diseases and help you live longer. Unsweetened tea, hot or cold, is also a good option.

Ultimately, my top beverage recommendations are:
1. Water
2. Unsweetened tea
3. Black coffee
4. Zero-calorie flavored water
*1-2 glasses of milk each day (any variety) is also okay. There is lots of new and controversial research about milk, but I’ll save that topic for another day.

Stay away from:
1. Pop/Soda (diet and regular)
2. Juice (even the 100% natural kind)
3. Fancy, sugary coffee drink
4. Gatorade and other sports drinks (unless you are a competitive athlete)

I challenge you to cut out all fluid calories – that could add up to a few hundred calories per day or ½ pound per week!

 

Turmeric & Golden Milk

If you don’t have a trail of this yellow/orange powder around your kitchen, you might be missing out. Turmeric is a hot topic right now and for good reason – it has tons of health benefits.

Historically, turmeric was used in Ayurvedic, eastern medicine for pain and fatigue. Turns out they were on to something… Recent research has found that curcumin, the active compound in turmeric, has some serious anti-inflammatory effects.

Why is “anti-inflammatory” a good thing?

In a few cases, inflammation is a good thing – like healing cuts or wounds and fighting foreign pathogens in the body. However, when there is a chronic, low level of inflammation in the body it can increase risk for heart disease, cancer, metabolic syndrome, and Alzheimer’s, among many others. Stress, environmental toxins, and chemicals and preservatives in our food can all cause some of this chronic inflammation, which turmeric can help counteract.

Does turmeric sound appealing now?

If adding turmeric into your diet sounds more appealing now, here are a few things to consider:

  1. Whether you’re adding turmeric to your stir fry, eggs, golden milk (see my favorite recipe below!), salads, or soups, make sure you add some black pepper – this boosts absorption of the curcumin in turmeric up to 2000%
  2. While it is more of a pain to cook with, raw turmeric root more potent than the powdered spice form of turmeric

Remember…

Just like any other food or supplement, turmeric is not a magic pill. In order to get the real anti-inflammatory benefits of turmeric, it is also important to be eating a diet rich in whole, real foods (not the processed stuff), fruits and vegetables, and fiber.

My favorite turmeric recipe – Golden Milk

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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.

Are egg yolks bad for you?

It is no secret that egg yolks are packed full of cholesterol (I think they win the gold medal for cholesterol content and are typically the number one source of cholesterol in our diets). People commonly opt for egg white omelets or low cholesterol egg substitutes to cut back on their cholesterol intake.

What is cholesterol?
Cholesterol is a waxy substance both in food (like egg yolks) and made by your liver, which is needed by all of your body’s cells in order to function. In other words, without cholesterol, we wouldn’t be able to survive.

Cholesterol Recommendations
In the 1960’s, American Heart Association, along with many other health organizations, recommended limiting cholesterol intake after researchers found high blood cholesterol levels were linked to heart disease. The typical recommendation was no more than 3 egg yolks per week.

But wait! Researchers are rethinking their “low cholesterol” recommendations. High blood cholesterol levels are still liked to heart disease, but we aren’t so sure that eating cholesterol really increases cholesterol levels in the blood. I know that seems illogical, but our liver actually produces way more cholesterol than we eat, so cutting back on your egg intake won’t really affect your cholesterol levels.

Don’t worry, I’m not just spewing science here… the U.S. government agrees and the Dietary Guidelines for Americans (published every 5 years by the USDA) eliminated the recommendation of limiting cholesterol in 2015.

Dietary Fat
While monitoring your cholesterol intake can be a thing of the past, you should keep saturated and trans fat on your radar. Newer research is showing that these two types of fat play a much more significant role in increasing blood cholesterol levels and heart disease risk compared to dietary cholesterol.

So when it comes to eggs, there is no need to trash the yolk. The yolk won’t increase your cholesterol levels, and it is full of healthy vitamins and minerals! Plus, eating whole eggs has been found to keep you more full, promote weight loss, protect brain health, and decrease inflammation.

Don’t Forget…
Diet isn’t the only thing that affects heart disease risk. High levels of inflammation, stress oxidative damage, along with high blood pressure, smoking, and low physical activity levels can all increase your risk, too.