Marathon Taper Nutrition

You’ve been working hard for months, getting up early to train in the dark, in the cold and wind and snow.  The big day is almost here! Make sure that you keep your focus as you finish up your season of training with the week leading up to it: the taper.

FOUNDATION:

The foundation of any runner’s diet, at any time of training, should be healthy and balanced: lean proteins, whole grains, unsaturated fats, and plenty of fruits and vegetables. A base of carbohydrates (from grains, vegetables, fruit, and dairy) should be complemented with protein and fat.

WEEK PRIOR:

Decrease intensity and duration of activity. Increase proportion of carbohydrates 3 days prior; increase even more for the last 4 days. Keep mealtimes consistent and don’t try new foods. Hydrate!

DAY BEFORE:

Don’t overeat samples at the Expo; ask to take one to try later. Stick with familiar foods that you have been successful at eating the day before a long run. These should be foods that are easy on your stomach. Attempt regular meal and snack times, and remember to hydrate. Try to get some sleep.

MORNING OF:

Keep in mind timing of waiting for the start. You may have several hours of waiting and may or may not be provided with snacks and drinks while you wait. Does that work with your race-day nutrition plan? If not, bring your own.

Upcoming Event: Taper Nutrition at True Runner

Wondering what to eat in the week leading up to a marathon? Come to True Runner in Chestnut Hill, MA on Friday, April 11th at 6pm to hear Katrina speak about taper nutrition. Have questions prior to the event? Leave them in the comments and they'll be answered that night!

Happy Nutrition Month!

Yesterday was "Registered Dietitian Day" and while I didn't get breakfast in bed or a bouquet of flowers delivered to my door, I did have the pleasure of listening to a patient tell me how much he loves the meal plan that we came up with together at his initial visit and have his mom tell me "we've been waiting for you forever." It feels so good to help others, and patients like this one balance out others who might not be quite as ready to make necessary changes to the way that they eat.

This month is National Nutrition Month and this year's theme, declared by the Academy of Nutrition and Dietetics, is Enjoy the Taste of Eating Right. Many people think of healthy food as being flavorless. Perhaps this is due to the way that vegetables were prepared for them as children, or maybe it's because unhealthy foods tend to be filled with delicious flavors like sugar, oil, and salt. Whether you've known it forever or are just starting to realize that healthy food can taste amazing, take a moment this month to really enjoy the taste and flavor of your favorite healthy dish.

Eating Disorders: I Had No Idea

This week is National Eating Disorders Awareness Week and the theme this year, announced by the National Eating Disorder Association (NEDA) is: I Had No Idea. I've had friends in the past who were dealing with an eating disorder and have had the pleasure over the past six months to get to know a lot of new people with eating disorders as they seek treatment at the clinic where I work as a dietitian. Sticking with the theme of "I Had No Idea", here is some information about eating disorders you might find surprising.

Definitions. There are several different ways to define an eating disorder. There are official definitions in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM 5).  Then there are more fluid definitions that indicate a broken relationship with food, regardless of current or past weight.

Food on the Brain. Jessica Setnick is an RD who has a training curriculum called Eating Disorder Boot Camp. In it, she states that people with anorexia nervosa spend 90-110% of their day thinking about food. I use this as a quiz question when teaching medical residents about eating disorders: who spends the most amount of time thinking about food, people who are on a diet, people with bulimia nervosa, or people with anorexia nervosa? Last week I had the first group get it right - most guess that it is people on a diet. Sadly, it is those who are eating the least who are thinking about food the most.

No One Image. When you think of a person with an eating disorder, does an image of a skinny female model with her ribs poking out pop into your head? Frail women are often portrayed as the image of a severe eating disorder. But in reality, this disease spares no one and affects people of all genders, race, shapes, and sizes. We're seeing an increase in our clinic of patients who had been told they were overweight or obese and began to lose weight, which everyone around them applauded, not knowing that they were doing so in an unhealthy and potentially dangerous way.

Mental and Physical. There is almost no part of the body or mind that an eating disorder will spare.

Whether you know someone who has been officially diagnosed or just someone who struggles with self-esteem and has a disordered attitude towards food, take a moment this week to think about them and what they might be going through.

Why You Should Meet with an RD

A Registered Dietitian (RD) is a healthcare provider who specializes in nutrition; how food affects your body and how your body reacts to food. Like some other medical specialties, it can be confusing to know whether or not you need an RD or could benefit from meeting with one. To help figure this out, the Academy of Nutrition and Dietetics put out an article, What a Registered Dietitian Can Do For You. Here is an excerpt to help you better understand whether or not an RD can help you:

The highest level of nutrition counseling. Anyone can call themself a nutritionist, but only a registered dietitian (RD) has completed multiple layers of education and training established by the Academy of Nutrition and Dietetics. In addition to holding a bachelor's degree, an RD must fulfill a specially designed, accredited nutrition curriculum, pass a rigorous registration exam, and complete an extensive supervised program of practice at a health care facility, foodservice organization or community agency.

Personally tailored advice. When you see an RD, the last thing you'll get is one-size-fits-all diet advice.  After learning about your health history, favorite foods, eating and exercise habits, an RD will help you set goals and prioritize. Follow-up visits will focus on maintenance and monitoring your progress.

Guidance navigating food allergies, sensitivities and intolerances. When you suffer from conditions such as celiac disease, food allergies or lactose intolerance, it's easy to be overwhelmed by what you think you can't eat. That can translate into a boring diet and may even lead to nutrient deficiencies. An RD can teach you how to read food labels so you’ll know which ingredients to avoid and a help you find substitutions to keep your diet balanced and tasty, too.

A weight loss program that really works. Fad diets may sound like the quick ticket to weight loss, but they rarely work for very long. A registered dietitian will partner with you to develop a safe, effective weight loss plan that you can stick with for the long haul. 

If you're convinced that now is the time for you to see an RD, contact me for an appointment today by e-mailing eatdrinkandbeactive@gmail.com or calling 617-431-8006.

What's Getting in Your Way?

As I was rinsing off the salt-crusted soles of my running shoes tonight, I realized how warn down they are. A quick calculation and I realized that I've probably been wearing the shoes longer than the recommended 300 miles. I also remembered that every time I've put them on recently I've been a little bit grumpy about the way that they feel. Have they ever explicitly stopped me from going out on a run? No. But "old, warn shoes" are one thing that I could write in my list of the barriers that I feel get in my way of being as active as I could be.

What do your barriers look like?

In nutrition counseling we often talk about barriers. Part of being a successful dietitian is helping people to overcome or at least recognize whatever barriers they might have getting in the way of healthy eating. This could be a practical barrier such as lack of grocery stores with fresh produce or it could be something more internal such as feeling sad lately and feeling the need to find comfort in food.

Is there something that you're having a hard time accomplishing? Try making a list of barriers and potential solutions. Here's are a few examples - the first is one of my personal barriers and others I've drawn from patients.

Goal: run more often during the week
Barriers: cold weather, uncomfortable old shoes, darkness
Ideas to break barriers: put together a chart of outside temperatures with appropriate clothes that will keep me warm, buy new running shoes, find friend to run with consistently after work

Goal: eat more vegetables each day
Barriers: fresh produce just goes bad whenever I buy it, vegetables are hard to cook and expensive
Ideas to break barriers: stock freezer with selection of frozen vegetables that I know I like, find Pinterest boards featuring easy vegetable recipes to bookmark for trying each week, buy produce with recipe in hand on the day I know I have time to prepare it to avoid spoilage

Goal: lose weight in order to better fit into clothes
Barriers: gym membership is expensive, family doesn't like 'health' food, low motivation
Ideas to break barriers: find a friend to go for walks with outside on a consistent schedule, try making current favorite family meals using healthier ingredients, put sticky notes with inspirational quotes on car dashboard to remind myself of goal

These are just a few ideas of ways to get into the mindset of breaking through barriers. If you can think up some ideas for overcoming your own barriers, try writing them down. Even if you're not ready to take action yet, looking at your list of solutions can motivate you to take small steps in the direction of your goal! Now I'm off to buy some new running shoes...

94 Years Old and Still Running... on Carbohydrates

If you're a runner or endurance athlete or have ever read up on sports nutrition, you are likely aware of how important carbohydrates are. They give you energy to "go the distance" and are the main source of fuel for an active lifestyle. People have even made a science of carbohydrate "loading," finding ways to pack as much carbohydrate into their body's stores before a big endurance event. I've been reading a lot about sports nutrition lately, in part because I've started a small private practice counseling athletes and also because it's a fascinating topic.

In reading the newly published 5th edition of Nancy Clark's Sports Nutrition Guidebook, she really drives home the focus on carbohydrates for athletes and how your body (and possibly performance) will suffer if you focus too much on protein or go gluten-free for no medical reason without replacing it with enough non-gluten carbohydrates.

It's no secret that carbohydrates get a bad rap in general, but if you're an athlete the cold hard truth is that you need them and they will help you if you use them right. As Nancy emphasizes, carbs don't cause you to gain weight; extra calories, especially from fat, and not enough physical activity cause you to gain weight.

I was reading an inspirational story in Parade magazine recently about Olga Kotelko, a 94 year-old track star. She's broken all sorts of records and is still going strong. Obviously they asked her about her diet, and this is part of how they reported on it:

"She is no stranger to carbs, often having toast in the morning (perhaps topped with cheese and honey) and bread again in her lunchtime sandwich."

I could be adding emphasize in the wrong places here, but when I read that I could just picture some readers across the country thinking to themselves "BREAD?! TWICE a day?!" The way that it is phrased, that she is not a stranger to carbs, seems to imply that eating bread twice a day is excessive. In reality, active people need a whole bunch of carbohydrates in order to fuel themselves properly (the amount depends on the athlete's weight and the intensity of the activity) and no one should ever be a stranger to carbs. Has your relationship with carbohydrates taken a turn for the worse? Consider making 2014 the year you mend that bond - you'll be amazed by what carbohydrates can do for you!

A Chunky as Heck Chicken Soup Recipe

I don't share too many recipes on this blog, but tonight I made a chicken soup (originally billed as a stew) for the second time and it was so good I just had to share it! This is a great chicken soup that can be modified in any way that you want. You can change the flavors, the ingredients, the vegetables, the spices - whatever you like! My favorite part about this is that you cook the chicken in the broth which gives it a delicious, rich flavor and then you shred it. I've had some failed chicken soup attempts where you add little chunks of chicken that are hard to get just right. With this recipe you don't worry about the size, just shred it!

Ingredients:
olive oil
around 2 cups of chopped vegetables such as:
   onion
   celery
   carrot
   zucchini
   mushrooms
14.5 ounce can diced tomatoes (try fire roasted for extra flavor)
14.5 ounce can low sodium chicken stock
1/2 teaspoon of each spice such as:
   thyme
   basil
2 chicken breasts with bones and skin (at both my local grocery store and at Trader Joes I've found this in the Kosher meat section)

Directions:
Heat olive oil in a large pot and saute vegetables for approximately 5 minutes. Add entire can of tomatoes, broth, and spices. Submerge chicken and allow to simmer for about 25 minutes (longer if the chicken breasts are thick), turning chicken and stirring occasionally. Remove the chicken from the pot, allow to cool, and discard skin. Shred or chop chicken and discard bones, then return shredded chicken to the pot. Simmer for 10 more minutes, let cool, and enjoy! Serve atop quinoa, couscous, whole wheat noodles, or with a hunk of whole grain bread.

Good Advice from England

This is a cute and creative video showing how our eating and living habits have changed over time and how that can affect obesity rates.

Less Yellow, More Insecurity

Nutrition-related headlines tend to catch my eye, for obvious reasons. Last week there were two headlines that made all the news sources and got lots of media attention - national, local, and social. These headlines differ greatly but both sparked outrage...

Mac N Cheese to Be Less Yellow!

Millions Lose SNAP Benefits 

So, Kraft has agreed to remove some of the artificial yellow food coloring from it's Mac N Cheese (but only some varieties and not yet). Here is the AP News story which also got covered by such news sources as Perez Hilton who proclaimed "It's a good thing AND a sad thing! But mostly good!" People flocked to their facebook pages and twitter accounts to bemoan the loss of the color yellow, many (it seems) not realizing that the yellow dyes are not being removed from the original Mac N Cheese, just some of the kid-focused shapes like Sponge Bob. Others hailed Kraft for listening to the people and making the product more natural, though Kraft denied that implementing the change had anything to do with a Change.org petition.

I love a good bowl of macaroni and cheese as much as the next person (maybe a little bit more) but thought it was really unfortunate for these headlines to be happening on the same day, and for one to seemingly be getting more attention than the other.

One in seven Americans (47 million people) just lost some of their supplemental food money from SNAP (supplemental nutrition assistance program). Food insecurity is already rampant in America and this decrease in funds just increases that feeling. According to the Food Research and Action Center: 

"The U.S Department of Agriculture estimates that the reduction in benefits amounts to 21 fewer meals per month. Viewed differently, it leaves the average participant with just $1.40 to spend per meal, not enough to sustain health, learning or productive work. And even as these cuts are going into effect and families across the country are trying to figure out how to further stretch their impossibly tight food budgets, Congress is discussing even more drastic cuts to SNAP."

These headlines brought to mind a food drive that my middle school hosted many years ago. The classroom that collected the largest quantity of food got a special prize. The winning group was a class where one boy had gone to Sam's Club and bought a palate of ramen noodles. I'm sure there were a lot of boxes of Mac N Cheese in that drive as well, something else cheap, non-perishable, and to easy to contribute. This connection came to mind because as food stamp benefits decrease, use of places like food banks and other emergency food organizations tends to increase. So maybe the headlines are not so unrelated after all - they could be affecting some of the same people. If SNAP recipients turn to food banks once their supplemental income has run out, what will they find there? Hopefully more than just palates of ramen noodles and still-just-as-yellow Mac N Cheese.

Please consider making a donation to a local food bank during this time or starting a virtual food drive. I won't judge you if you donate ramen or macaroni, but something green (canned vegetables or cash money) might help out a little bit more.

Boston Food Bank: http://gbfb.org/
Feeding America: http://feedingamerica.org/

Hey Restaurants! Where's the (Vegetarian) Protein?

General recommendations are for healthy adults to eat around .8-1g of protein per kilogram of body fat (take your weight in pounds, divide by 2.2, multiply by .8). So someone who weighs 150 pounds would need around 55g protein throughout the day. Most any dietitian that you speak to would suggest that you spread that protein out throughout the day and make sure that each meal has some protein in order to help rebuild and repair your body, as well as to help you feel full after each meal. However, it doesn't have to be spread precisely equally throughout the day by any means. 

I was recently talking with a family member about the fact that when she makes a meatless choice at a restaurant these days it often does not include what you might think of as vegetarian protein, ie: tofu or beans. She was saying this might be a portabella mushroom sandwich with some cheese or an eggplant pasta dish. Is it OK to skip the meat if it also means skipping the protein at a meal? Let's take a look...

Clearly I love eggplant, but this isn't the best option if you're looking for protein

According to the USDA nutrient database (which thankfully is back up and running now that the government has resumed business!) here is the protein in some of these non-meat dishes that restaurants are selling as a complete meal...

Portobella Mushroom
1 cup grilled: 4g protein
Fresh Mozzarella
1oz (about 1/8 of a ball of fresh mozzarella): 6g protein
 Eggplant
1 cup cooked : <1g protein
Cheddar Cheese
1 oz: 7g protein

If the dish comes with some sort of whole grain (brown rice, whole wheat pasta, whole grain bread) that would add some protein to the dish as well. Bottom line? If you want to avoid meat and you're faced with no veggie-protein options, something with mushrooms (and cheese if you're eating dairy) is the better choice than something with just eggplant.

If you think gluten is the culprit...

I don't often get into clinical nutrition in this blog; it's more of a consumer-friendly space for thoughts on eating, nutrition, and exercise that might apply to a diverse range of people. However, I went to a talk yesterday and thought it was worth sharing some advice that I learned.

If you are having stomach pains or other symptoms when you eat products that contain gluten like pasta, bread, soy sauce, muffins, pancakes, beer, wraps, couscous, etc. then you might think to yourself "I'll just try cutting out gluten and see if I feel better." So you cut it out of your diet, you feel better, and just go on living a life of not eating gluten. No problem, right? Wrong. Here are some reasons why you need to see a doctor immediately if you think that you have non-celiac gluten sensitivity (NCGS) or celiac disease:

A tart with a crust full of gluten

1. The way that doctors test for celiac is by seeing if your body produces certain autoantibodies via a blood test. You need to have been eating gluten (the equivalent of one slice of bread per day) for around 6 weeks prior to the test for this blood test to give a definitive diagnosis. If you self-diagnose yourself and just avoid gluten for the rest of your life, you'll never know if you have celiac (or will have to start eating gluten-containing foods in order to find out).

2. Why do you need a definitive diagnosis? When the GI doctor asked the group she was presenting to, I raised my hand and guessed "because you don't want someone cutting out entire food groups if they don't have to." It's a very nutrition-focused response and, while true, is not the most pressing reason. The reason someone who suspects celiac should get a definitive diagnosis is because while the treatment of celiac is not eating foods with gluten, the medical care is and follow-up is more complicated. When someone is diagnosed with celiac, their immediate family members also need to be tested because the disease is hereditary; the patient will also need to be followed closely to monitor for thyroid disease and other commonly co-occurring issues.

3. Celiac can have such devastating effects on the body that a gluten-free diet needs to be followed 100% of the time with no exceptions. If you haven't had a diagnosis but just know that avoiding foods with gluten makes you feel better, you might be less inclined to check food labels each and every time and might be OK with a little exception here and there.

Having NCGS or celiac disease is not fun for anyone. But do yourself a favor and get checked out by a doctor sooner rather than later if you suspect that you have either of these diseases - it could save you from needing to bring back symptoms for 6 weeks in order to get tested and it could help your family members to get diagnosed sooner as well. For more information on celiac disease, click here.

Indulgences: "Permissible" or Not?

I read an article recently in the Wall Street Journal that conveyed how more and more companies are creating snack foods out of "healthy" ingredients because consumers are looking for "permissible indulgences." For example, salty fried chips made from sweet potatoes rather than white ones or a  "snack" made of 100% seaweed sheets.

Being a person who craves salty and crunchy, I've tried a number of these products. Seaweed seems like such a great snack food! Until you realize that you just paid at something like $1.00 per wafer thin sheet. True, it was healthy, but the vitamins and minerals it gave you probably would've been cheaper in some other whole form of vegetable and you would've stayed full longer to boot.

I've also fallen victim to items like vegetable chips (usually potato chips with a little bit of color added from other vegetables) and those amazingly delicious crunchy vegetable slices which often don't say, but always are, deep fried (which does make them delicious!).  Sure, they're dehydrated before they are deep fried, but I personally used to always stop at the fact that they're dehydrated thinking that the wonderful food production companies had found a way to extract liquid from vegetables and thereby make them crunchy (without then frying them in oil).

Looks like vegetables, tastes like (and is) fried, salted vegetables (sort of like a potato chip!)

Now, when I say "fallen victim" I don't mean that it was bad to eat these foods. As we try to teach people who need help normalizing their eating, foods are not "good" and "bad." What I think we can classify as good or bad though is the intention behind eating something that is marketed in a certain way, especially if words are used to make it seem healthier when in reality it is not. Do I think that the crunchy vegetable packing needs to say "you may as well eat potato chips" on it? No. But I think that the preparation method should be made explicitly clear by stating, for example: Deep fried green beans, carrots, and beets instead of: Garden Chips. That way the consumer can see that, think to themselves "this might not be healthy enough to become an everyday snack but it looks delicious so I'll try it knowing that it is probably not a magical alternative to an unhealthy snack."

An indulgence should be just that - something that you crave, something that you want. If you have to put the word "permissible" in front of it, that gives control not only to the food but also to the food production companies who want you to think that their product is more permissible than others. Chances are if you're thinking to yourself that something in a permissible indulgence, it's not really an indulgence at all. I've read that for some people, if they deny themselves the food item that they really wanted, they'll end up eating even more of the alternative choice because it will never fully satisfy them in the way that the original item would have; they then end up consuming more calories and being unsatisfied.

... And We're Back! aka Why Not Walk?

I've been thinking a lot about walking recently. Last week I started a new job at a hospital that is 1.5 miles from my new apartment. Google maps told me that it would take me 10 minutes to drive, 15 minutes to talk the bus, 15 minutes to bike, and 30 minutes to walk. Parking is crazy there so driving is out, the bus is crowded at that time of day, and by the time I get my tires pumped and my bike outside it's been more than 15 minutes. So I've been electing to walk there and back, getting a nice 3 mile roundtrip walk in every day. I love it because if I'm too tired to exercise when I get home at least I know that I've been a bit active during the day - and I'm only dependent on my own two feet (plus stop lights!) not on the bus running on schedule or finding a spot for my bike on the crowded racks.

The hospital has a Parking Department where you can get a parking pass, a discounted train pass, and a reimbursement for bike parts/maintenance if you bike to work. But for some reason, they have no monetary incentive for people to walk to work. When you think of how small of a city Boston is, it's sort of silly not to incentivize walking. I'm often struck by how few miles away my destination is (when I type it into my gps and it tells me it will take 45 minutes of sitting in traffic to make it 6 miles for example!).

It's one thing for me to walk myself to my destination - I'm a grown up, I know where I'm going and know not to cross the street outside of a crosswalk. But what about kids who as a population are less active than ever before? I recently read an article that said only 1/3 of students who live within a mile of school walk or bike and less than 3% of students who live within 2 miles of school walk or bike. I also just got an e-mail today from the Alliance for a Healthier Generation about a meeting that they're having to discuss programs like Safe Routes to Schools and Fire Up Your Feet. I think it's great that there are programs out there to encourage kids to walk to school and make it safer to do so, but in a way it's also sad that these programs are necessary.

Let's try to be a good example to everyone around us by choosing to walk next time your GPS tells you that your destination is less than 2 miles away. It'll take you a little over 30 minutes to get there and I bet you'll notice things about your neighborhood along the way that you never saw from you car. Let me know how it goes!

This blog brought to you by a REGISTERED DIETITIAN

Nope, it's not a guest blog -- I took the RD exam today and I passed which officially makes me a Registered Dietitian. I am so relieved, mostly that I can stop studying! Once that initial relief wears off though I'm sure I'll be able to better contemplate the fact that passing this exam is the final step on a three year long career change. Reflecting on those three years, there were so many people that made such a big difference and while many of them may not see this blog I'd like to say a big THANK YOU (and I'll make sure to tell them individually as well).

The journey started three years ago when I was working as an editor at a publishing company. I began thinking about a career in dietetics, but I'd never been much for science classes growing up, so I wasn't sure I could do it. I looked at the list of required classes and thought 'well, I guess I'll start with Bio 101 and if I pass that I'll keep going.' I knew I could always go back to publishing if it got too hard and with that safety net I kept taking class after class after class... until I found that I had completed my Didactic Program in Dietetics (DPD) certification from Simmons College.

Probably the two most stressful days of my life thus far have been during this journey. The first was the night that I found out whether or not (and where) I got matched to a dietetic internship. There were several options: I could be placed in Minnesota, Boston, or New Orleans, or I might not have gotten matched. My heart was pounding as I kept hitting refresh, waiting with thousands of other hopefuls across the country to find out my fate. I was so fortunate to be matched to the Simmons Dietetic Internship and be able to stay in Boston with all of my friends and support system.

The other stressful day was today. After taking the exam I awaited my results with my heart pounding, not knowing if I had finally completed this stage of my training or if I had more studying to do. Upon finding out that I had passed I finally stopped shaking, but all of that heart pounding adrenaline definitely made me cry (which really confused my mom when I called to tell her the good news - since I hadn't even told her that I was sitting the exam today!).

I don't know where the path leads from here, but I feel confident that with this credential I will find a way to fulfill my goal of helping people lead healthier, happy lives.

-Katrina S, RD

The 117th Running of the Boston Marathon

It's Friday of marathon weekend and I approach the expo hall with the usual mixture of excitement and dread. Excitement to interact with tens of thousands of marathon runners and their families and friends, and dread at how I know, from several years of experience, my body will feel by Sunday night. Over the next several days I spend hours on my feet handing out samples of Clif Bars, talking to runners about when they should use Shot Bloks versus Shot Gel, and answering the question over and over again: are any of our products gluten-free? (The answer: wheat free but not oat free so they may contain trace amounts.)

By Sunday afternoon I'm ready to finally sit down, so I head to the other side of the hall where I finish out the weekend by volunteering at registration, which is where runners come to pick up their bib number. I have several friends who volunteer with me and we all smile while family members take our picture as we hand the number to their runner, answer questions about where the runner needs to be in the morning to catch the shuttle to the start, and help calm nerves about the race that at that point is only a little over 15 hours from starting. This is my sixth year volunteering (that's every year but one since I ran the marathon in 2006) and I absolutely love it. During one point when I don't have any runners at my station a couple of students from Suffolk University approach and ask if I would mind answering some questions for them. They set up the camera and ask me whether or not I think the marathon is a good thing for Boston. Of course! I answer. It brings in people from all over the world, it increases tourism to Boston, everyone is out and about and seeing what a great city we have here full of active people. Next question: do I think that the marathon is a good thing for people in Boston to see happening. Definitely! Anything that might encourage people to get active and inspire them is a great thing, especially since people need to move more in order to increase health.

At 6:30pm on Sunday night I leave the expo hall having just spent what feels like every waking minute of the last three days there. I fall asleep on the couch after eating dinner but wake up in the morning feeling refreshed and ready for what many consider the best day of the year in Boston: Marathon Monday. My boyfriend lives on the course, so we have friends over and we alternate between watching outside on the street and coming inside to watch the finish line on TV. We cheer for some of the fastest people in the world as they stream by, just a few feet from his front door. It happens every year and yet every year it feels so special.

Today's Boston Marathon, the 117th running, will forever be remembered for the senseless loss that occurred when two bombs exploded at the finish line and to be honest I'm not sure that I'll ever have another weekend like the one I just described. I think that today's events will have a lot of people asking the same question that I was asked by the students yesterday: is the marathon good for the city? But now more questions will be added to that one: can we ever have another Boston Marathon? Will other running and sporting events everywhere be affected by today's violence?

My heart goes out to the people hurt today and their families. It also goes out to every runner and every spectator, both today and in the future, for what today's events might mean for us and our healthy, active, supportive lifestyles that were threatened today in an unimaginable way.

The Various Roles of an RD: Community Health Center Dietitian

Different community health centers have different services that they offer patients. Some have dental  and vision offices in addition to their medical practice. Some even have a WIC clinic located within the center. Some will also have a Registered Dietitian or two on staff to provide nutrition counseling.

At the community health center where I was placed during my dietetic internship, there was a bilingual dietitian who saw patients of all ages, from people newly diagnosed with diabetes to new mothers who needed prenatal nutrition counseling. There was also a dietitian on staff who was in charge of a program focusing on reduction of childhood overweight and obesity.

Several health centers run programs similar to this one where there is a case manager who helps the kids find physical activities that they are interested in and an RD who takes care of the nutrition counseling sessions. The nutrition counseling sessions are often done with several members of the family present. When a child is struggling with weight issues, the parents (who are often the ones providing the food) need to be part of the conversation. The counseling sessions would focus on small, realistic steps that the child and parents could make in order to best benefit the child's health. For example, based on the dietary recall the main suggestion may be the cut back on juice. In that case we would explore alternatives that the child might enjoy drinking or ways that the whole family could replace juice with water and still enjoy it - for instance by adding fresh fruit.

The RD in a community health center setting needs to have the ability to remain focused in a potentially hectic environment (for example being able to focus on the conversation with the parent while several siblings are playing loudly in the background) and be flexible when patients do not show up or re-schedule at the last minute. This is different from a hospital setting where patients are a captive audience or a private practice setting where patients may be paying out of pocket and are therefore more motivated to show up for their appointment.

Got Vitamin D in Your Milk? Got Fat?

You may have a negative association with fat - when there is extra on your body you might not be happy so you may attempt to avoid it when you hear the term associated with your food. And it is definitely a healthy choice to avoid meat that has a lot of fat, foods that are deep fried with fat soaking into every crevice, and other foods that slide down nice and easy because they're coated in the stuff (ie: pizza, nachos, anything else smothered in cheese).

If you have some basic vitamin knowledge, you probably also know that we need some dietary fat in order for our bodies to absorb the fat soluble vitamins which you can remember using the image of a deck of cards: ADEK. Other vitamins are water soluble so our body doesn't have a very hard time absorbing them and also any excess that we have in our body comes out in our urine, just as excess water does that is not needed by the body. But back to our friends ADEK.

I learned early on that these vitamins need fat in order to be absorbed. That's all well and good. Many foods containing these vitamins are naturally often served with fats (A and K found in veggies might either be sauteed in oil or served with a dressing for example). But it took a rotation during my dietetic internship for a lesson to really sink in about vitamin D.

A little bit of quick back story: I grew up in Wisconsin, drinking milk with meals. Because my parents were health conscious, the milk that I grew up drinking was skim milk. It has calcium, protein, and 0% fat - healthy, right? Well, mostly right.

Vitamin D, the sunshine vitamin, can be hard to find in natural dietary sources. Those places you can find it, like some types of fatty fish or beef liver, also have a lot of fat. But one of the main sources of vitamin D for many people, especially in the winter, is in milk where it has been added. It makes sense to add vitamin D to milk because it helps with calcium absorption. And if you drink a delicious, refreshing glass of skim milk, which has 0% fat, or your pour some skim milk into your fat free cereal, or you get a latte made with skim milk, you're not able to absorb any of that good vitamin D that has been added to your milk for your health benefit!

This is why just about any dietitian that you talk to will likely recommend that you switch from skim to 1% milk unless you have a weight issue. If you often drink your milk with meals that contain fat, you can also stick with the skim stuff. But if you tend to consume your milk either on it's own or with a meal or snack that doesn't contain fat, the bottom line is: switch it up and treat yourself to 1% milk. After all those years of drinking skim, trust me, it'll taste decadent!

Clever companies use the science behind fat-soluble vitamins as a marketing tool. This salad dressing's label reads: "Naturally helps better absorb vitamins A&E from salad with the oils in [the dressing]"

The Various Roles of an RD: WIC Nutritionist

I had the wonderful opportunity to do a rotation in the state WIC office at the Department of Public Health which included one week at a local WIC office. For those who might not be familiar, WIC stands for Women, Infants, and Children and is a nutrition program where pregnant women, moms, and children who meet income requirements are eligible for nutrition education, breastfeeding resources, and supplemental food coupons. Unlike SNAP or Food Stamps, WIC coupons are only good for very specific foods (these vary but the basics are: milk, whole grains, and fruit and vegetables) and the participants must attend nutrition counseling on a regular basis. WIC also highly encourages breastfeeding as it is the best nutrition for newborn babies by offering peer counselors, lactation consultants, and incentives for women who choose to breast feed exclusively.

The role of an RD at the state office differs greatly from that of an RD or nutritionist at a local WIC clinic. Obviously at the state level they are more focused on statewide programs, grants, and overseeing the local clinics, making sure that they are meeting the standards set forth by the state. At the local level, all WIC clinics employ nutritionists, and these may or may not be RDs. Some are LDNs (Licensed Dietary Nutritionists), some are DTRs (Diet Tech, Registered) and some have met other levels of education in order to qualify.

In the day-to-day role of a WIC nutritionist, they will see participants throughout the course of the day either from appointments or on a walk-in basis. These appointments range from pregnant mothers to mothers who have infants to children up until age 5 and they differ slightly based on the type of appointment (initial, low-risk follow-up, high-risk follow-up, etc). When a participant arrives they first have their height and weight taken. Then the nutritionist will sit with them to go over the child’s growth chart and where they fall on the weight for height chart. After that he or she will take a diet recall which might result in the number of ounces of formula per day a baby is drinking or what a toddler eats during the course of the day depending on the participant. Once the diet recall is complete the nutritionist will focus on any problems identified and methods for changing (for example if a child is not drinking the recommended amount of milk per day, they will work with the mom to identify where in the diet to include an extra serving). At the end of the appointment the nutritionist goes over the participant’s “package” which is what specific coupons they receive. Any changes are made based on a few factors such as whether the participant has decreased the amount that they are breastfeeding or whether the participant would rather get whole wheat tortillas instead of whole wheat bread. When the appointment is done the coupons are printed.

There are a wealth of handouts produced by WIC in several languages that are available for the nutritionists to distribute. At the local clinic where I spent the week many participants spoke Vietnamese or Spanish, so there are nutritionists on staff there who speak those languages. WIC also provides referrals to other organizations such as parenting groups, fitness classes, and community activities. WIC is a national program and employs many dietitians, making it a good career option for any RD or RD hopeful across the country.

The Various Roles of an RD: Community/Non-profit Dietitian

There are lots of opportunities for an RD to work in a community setting. Many non-profits employ RDs. This could range from someone working for an organization that delivers healthy meals to people who are chronically ill to someone who teaches urban or low-income teens how to grow vegetables in a city.

I was fortunate enough to be placed at the Greater Boston Food Bank (GBFB) for a rotation and got to see what it might be like to be an RD working under the hunger umbrella. There are actually a few RDs who work at this particular organization and they serve a variety of roles. They help to ensure that all of the food that goes out to pantries and organizations is safe (ie not expired), train people from pantries and organizations in food safety, and help to teach people at these organizations about healthy eating. This may sound a bit abstract so I'll focus mainly on what I did while I was there:

• Design and implement lesson plans about nutrition for kids at a Boys and Girls Club. The GBFB supports a program called Kids Cafe where kids get an evening meal served for free at the Boys and Girls Club. I taught the kids about sodium, calcium, and the importance of fruits and vegetables by playing games and making recipes.
• Create and cook a recipe for a School-based Pantry. These pantries, as well as Mobile Markets, are one way that the GBFB donates food directly to consumers. They set up in a school cafeteria in the community and parents can come and take a variety of foods such as vegetables, fruit, bread, hummus, and yogurt. The day that I went we found out that we'd be handing out acorn squash so I made an acorn squash pasta bake. I handed out samples as well as recipes so that they could make good use of their squash!
• Write nutrition newsletters for different audiences. A few other programs that GBFG implements are the Backpack and the Brown Bag program. Backpack ensures that kids have a bag of shelf-stable food to take home on the weekends and Brown Bag gives bags of groceries to seniors in a supermarket bag to remove any stigma associated with receiving donated foods. Within each bag of food is a nutrition newsletter geared at either the seniors or the kids. These feature a recipe, some cooking tips, and a game.

Working at the food bank is just one example of how an RD can make a difference by working within the community. While it is a very different role from a clinical or counseling position, it is important in the effort to make the community a healthier place!