... 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!