Claxton Dietetic Solutions Articles

Invest In Your Health
Today on the blog we are talking to private practice RDs, those who own their own nutritional counseling business. One of the hardest parts about being in private practice is building a clientele. You not only have to make yourself and your services known to the community but you have to make the community see and understand your worth in PAYING for those services. Everything costs money these days. We are all trying to stay on budget, determine the difference between wants and needs and prioritize the goods and services we need now and those we can either wait on or do without. As a private practice dietitian you have to make the community see that your help, your expertise is worth paying for. And that can be an uphill battle. Here are some tips on how to boost your community presence, exemplify your worth and build a clientele. First: Determine the clientele or the population of people you want to reach and serve. This is completely up to you but will help guide your future marketing techniques and choices. Some RDs choose to be general and counsel any and everyone while others choose to focus on a few types of illness or topics and specialize in them. Second: Become credentialed with insurance providers. People are much more likely to utilize you if you take their insurance. This process can be long and tedious but is worth the time and effort in the long run. Third: Start developing relationships with medical and therapeutic providers in your community. Get to know your internal medicine doctor, your child’s pediatrician, your dentist, your friend’s personal trainer, your therapist etc. Word of mouth goes a long way. And have your business cards ready to hand them. Oh yeah…get business cards 😊. Fourth: Offer free general nutrition education sessions to the community (with business cards ready to go!). Offer a session at the senior center in your community on geriatric nutrition, offer a lunch and learn for therapist on how you can partner with them in treating eating disorders, offer a kid friendly education on MyPlate at a local library. The possibilities are endless.   Fifth: Be patient. This process can and likely will be slow. But as I have said in past blogs, slow and steady wins the race. Take your time, do your best with each client and word will spread! Good luck in all of your future business endeavors fellow dietitians! I hope this blog has been helpful to you!
Let's Eat!
Generally speaking, the average American eats 3 meals a day, sometimes snacking in between meals. But how do we know when it's time to eat? Does someone tell us? Do we just innately know? Well, in a perfect world we would feel physical hunger, respond to that hunger by eating, eat until we feel satisfied and then stop eating. But for most of us, our desire to consume food is driven by much more than physical hunger and fullness. It's driven by a combination of both internal and external cues. If a person is not utilizing a strong self awareness as to why he or she is eating it could let to overeating or undereating if these cues are being ignored. Lets take a look at the difference between internal and external hunger and fullness cues. Internal hunger cues include the physical feeling of hunger. This could manifest as a stomach pain or cramping and/or an audible "growl" when hungry or slight stomach distention or feeling bloated when full. When hungry, it could also be a physical feeling of tiredness or lightheadedness from a lack of energy. These internal cues are driven by hormones and nerve signals released in the body in response to a lack of or replenished energy as it applies to hunger and fullness, respectively.  It's these types of cues you want your clients and patients to be aware of and listen to when deciding when and how much to eat. External cues are more prevalent and tend to be the cues the public rely on when deciding when and what to eat. External cues can include the actual site of food, it's presentation, the knowledge of what time of day it is and certain environment factors (aroma, lighting, etc.). Some people may not physically be hungry, be see food offered during a work meeting and eat simply because it is there. Also, someone may be physically full but still see more food on their plate so they continue eating. I believe a powerful tool in helping people establish balanced eating habits and practice effective weight management is first recognizing there innate INTERNAL hunger and fullness cues. Here are some ways you can implement this tool in your practice as a dietitian.1) Add this question to your initial assessment form. You could ask, "When deciding when and what to eat, do you find you listen to your body's hunger and fullness cues or respond more to the environment/presence of food?" You will find, more often than not, that people say they respond to their environment more than their physical bodies. 2) Educate the client/patient on the difference between internal and external cues 3) Challenge them to complete a "Self Awareness Log" for a week that requires them to identify and write down which cue they responded to when deciding when to eat, what to eat and when to stop eating.I hope you have enjoyed this blog post and find it applicable to your daily work! Happy practicing, dietitians!
Food Product Spotlight!
The importance of eating fruits and vegetables is well known around the world. And for the most part, the general public is willing and even happy to incorporate more fruits into their daily diet. But vegetables…well that is another story. Their lack of sweetness compared to their counterpart make them less appealing to not only kids but adults as well. But one food producer is changing the vegetable game drastically by fresh freezing flavorful, premade vegetable side dishes, entrees, etc. Green Giant is producing a wide selection of products and they are a wonderful addition to grocery stores everywhere. Now to educate the public! Some of their newest products include the Harvest Protein Bowl, Cauliflower pizza crust, Veggie Spirals, Veggie Tots, Riced and Roasted Veggies. See below for further details on each product. Harvest Protein Bowl: A plant protein based entrée bowl that comes in 4 varieties- Asian, Southwest, Italian and CaliforniaCauliflower Pizza Crust: This pre made crust comes in 2 varieties, original and tuscanVeggie Spirals: Vegetable based noodle spirals made from fresh butternut squash, carrots, zucchini and even beets. Veggie Tots: These tots come in 4 varieties, corn, sweet potato and cauliflower, broccoli, broccoli and cheese and cauliflowerRiced Veggies: Perfect for the low carb fan, this "rice" comes in 11 varieties!Roasted Vegetables: These vegetables have already been roasted making then a quick and easy side dish! They come in 5 varieties.As a dietitian, it's important to stay up to date on the latest food trends, products, etc. so that we can successfully equip our clients to implement and lead healthy lives. This website also has premade recipes using their products so our clients can feel adequately prepared to put an entire meal together. Green Giant is not the only food producer streamlining the meal preparation process and making vegetables more appealing. Do some research for yourself (either online or in the grocery store itself) and see what you find! You will be pleasantly surprised! And check out the recipe page for a highlight from the Green Giant website. 
The Mind Body Conenction
Nutritional neuroscience is an emerging field of research that has already identified some pretty interesting and applicable pieces of information as it pertains to the link between diet and mental illness. In the recent article “Understanding nutrition, depression and mental illness” multiple nutrition interventions were found to be successful complimentary or alternative medicine options when it comes to treating mental illness, specifically depression. Whether we are clinically or community-based dietitians, we will likely come into contact with a patient affected by this particular mental illness, so this is exciting news. Learning about the involvement of both macronutrients and micronutrients in our mental health will help us better inform and treat our clients/patients. Read below to find out more! Macronutrients: Fats: The first interesting finding in this study was that those who suffer from depression were found to have insufficient dietary intake of omega 3 and omega 6 fatty acids. “The main poly unsaturated fatty acid in the brain is DHA, derived from the omega-3 fatty acid α-linolenic acid, arachidonic acid (AA) and docosa tetraenoic acid, both derived from omega-6 fatty acid linoleic acid. Experimental studies have revealed that diets lacking omega-3 poly unsaturated fatty acids lead to considerable disturbance in neural function.” Their deficiency can also accelerate cerebral aging by preventing the renewal of membranes. Proteins: “Many of the neurotransmitters in the brain are made from amino acids. The neurotransmitter dopamine is made from the amino acid tyrosine and the neurotransmitter serotonin is made from the tryptophan. If there is a lack of any of these two amino acids, there will not be enough synthesis of the respective neurotransmitters, which is associated with low mood and aggression in the patients.” Carbohydrates: As dietitians, we know that eating a meal rich in carbohydrates stimulates the release of insulin into the body which allows glucose to enter cells and be used for energy. But it also stimulates the uptake of tryptophan into the brain positively effecting neurotransmitter levels. Low carbohydrate diets exacerbate depression symptoms as there is less production of the brain chemicals serotonin and tryptophan. Micronutrients: B Vitamins: The article found that those suffering from symptoms of depression were likely to be deficient in B complex vitamins, vitamin B12 and folate and supplementation of these vitamins showed a decrease in said symptoms. Iron: Iron deficiency is thought to play a role in the onset of depression as this deficiency causes fatigue and apathy. Zinc: “At least five studies have shown that zinc levels are lower in those with clinical depression. Furthermore, intervention research shows that oral zinc can influence the effectiveness of antidepressant therapy. Zinc also protects the brain cells against the potential damage caused by free radicals.” Calcium: Research shows that SSRIs can inhibit the absorption of calcium which can lead to lower bone density and increase the rick of fractures (especially in the geriatric population). As you can see this emerging research is of great use to us as Registered Dietitians. Practical takeaways from this article could include (all while using clinical judgement) starting all patients/clients on a multivitamin with minerals, possible a B complex supplement, folate and or omega 3 fatty acid supplement. Having an iron level and calcium level checked for all clients/patients who take SSRIs may also be of benefit. One thing is for sure, this field of research is gaining more exposure and will help us better treat our clients/patients. Some of the article was quoted in this blog post, but click on the link below to read it in full!
Micronutrient Deficiencies in the Elderly
“Macros” has become an almost commonplace phrase in the health and wellness community lately.  Anyone on a weight loss journey who has visited you as a Registered Dietitian, has probably asked you to assess his or her macro intake. Although “macros” or macronutrients have a large impact on energy availability, muscle structure and lipid levels; micronutrients play an equally important role in sustaining human life. More often than not though, it’s the micronutrients that are ignored and forgotten about. A population of individuals that is particularly at risk of micronutrient deficiencies is the elderly.  Some of the leading causes of micronutrient deficiencies include 1) age related physiological changes such as forgetfulness, and loss of appetite, resulting in poor dietary intake, 2) financial factors that limit food purchasing and 3) medications that decrease the body’s ability to absorb nutrients. Common micronutrient deficiencies you will see in this population include calcium, vitamin D, magnesium, vitamin C, vitamin E, and vitamin B6. These micronutrients play a powerful role in the human body. Calcium is needed for strong bone density. Low calcium levels can lead to osteoporosis and subsequent bone fractures from lowered mobility and falling. Vitamin D is calcium’s best friend and helps calcium to be absorbed. Magnesium is the jack of all trades mineral that plays a part in blood pressure regulation, muscle contraction, making DNA and participating in hundreds of cellular reactions. Deficiency in this mineral can manifest as fatigue, muscle weakness/twitching and even depression. Vitamin C helps with the absorption of proteins, increases immunity and is an antioxidant helping to prevent cellular damage. Deficiency in this micronutrient can lead to delayed wound healing. Vitamin E is also an antioxidant that supports immune function. Vitamin B6 is largely involved in promoting adequate cognitive function, but also play a part in protein absorption like our friends, Vitamin C and E. Where are good sources of these micronutrients? Well, I’m glad you asked!Calcium: dairy products, dark leafy greensVitamin D: absorbed by the body through sunlight but can also be found fortified foods like orange juice or milkMagnesium: dark leafy greens, nuts, seeds, whole grainsVitamin C: citrus fruits, bell peppers, tomatoesVitamin E: nuts, seeds, vegetable oilsVitamin B6: organ meats, fish, starchy vegetables (like potatoes)If you are an RD working in a LTC facility, make sure your menus contain a variety of these foods to ensure adequate nutrition for this age group. Community RDs can focus on education, or better yet, host a grocery store tour for this age group and show them where to find these foods! There are many ways to get the word out there and help our fellow neighbors. Check out the most recent recipe page for an example of a calcium rich meal/snack!
Farmer's Market Finds
Summertime has arrived! School’s out, temperatures are hot and…the farmer’s market is open! The perfect Saturday morning outing comes equipped with local vendors, fresh produce and maybe even fresh coffee. It’s no secret that eating seasonally is beneficial not only for your health but for your finances as well. Somehow though, the summer farmer’s market brings this year round truth back into focus.  The main health benefit of buying seasonal produce is that you get exposure to a wide variety of fruits and vegetables therefore increasing your intake of vitamins and minerals. Financially, seasonal produce is cheaper. And who doesn’t want that? Let’s look at what foods are popular in which season and then discuss how we can implement this into our dietetics practice! Spring - artichokes, asparagus, chives, fava beans, green onions, leeks, lettuce, parsnips, peas, radishes, rhubarb, Swiss chard Summer- berries, corn, cucumbers, eggplant, figs, grapes, green beans, melons, peppers, stone fruit (apricots, cherries, nectarines, peaches, plums), summer squash, tomatoes, zucchin Fall- apples, Brussels sprouts, dates, hard squash (acorn, butternut, spaghetti), pears, pumpkin, sweet potatoes Winter- bok choy, broccoli, cauliflower, celery, citrus fruit (clementines, grapefruit, lemons, limes, oranges, tangerines), collard greens, endive, leafy greens (collard, kale, mustard, spinach), root vegetables (beets, turnips) Now, how can we as dietitians put this knowledge into practice in new and interesting ways? Here are a few ideas I have.  ·     Community Education- Ask your local Parks and Recreation Department if you can set up a table or booth at your local farmer’s market advocating for seasonal eating. This would be a great way to get good face to face contact with your community and give them an immediate opportunity to put their newfound knowledge into practice.·     Clinical Education- Highlight seasonal eating through a “Recipe of the Week.” This would involve getting preauthorization from your FSM and/or CDM but would be a great way to educate both staff and patients on what is in season.·     Home Education- If you are an RD and a parent, exploring seasonal eating is a great way for you to boost your child’s exposure to fruits and vegetables. Allow them to get involved and pick a particular fruit or vegetable to try each week. Find a kid free recipe and let them help prepare it to get them even more involved!I hope this week’s blog post has been helpful! Get out in the community and shop your local market this weekend. And check out the recipe page for a great summertime recipe!
Slow and Steady Wins the Race
I have a vivid childhood memory of reading an old copy of Aesop’s fables at my grandmother’s house when I was a little girl and one of my favorite fables to read was “The Tortoise and the Hare.” The well-known fable tells of rabbit and tortoise that set out on a race to prove who is faster. The hare quickly leaves the tortoise behind and, confident of winning, takes a nap halfway through the race. When the Hare awakes though, he finds that the Tortoise, crawling slowly but steadily, has beaten him to the finish line.This story is a lot like ones we hear daily from clients, neighbors, family members, coworkers…really anyone who has set out on a weight loss journey. People nowadays are intrigued by fast results, making extreme lifestyle changes like cutting out entire food groups and restricting intake beyond necessity all in the name of better health and weight loss.  As dietitians we are taught to help our clients make “SMART” goals = Small, measureable, attainable, realistic and time oriented goals. This concept is on the complete opposite end of the dieting spectrum. Telling a hare to embrace the attitudes and pace of a tortoise is no easy task, but I believe we are up to the challenge and our clients will thank us in the end.  Here are some examples of SMART goals:  S: Small: Address making healthier choices at one meal (either breakfast, lunch or dinner) instead of addressing all meals at one time M: Measurable: If a client is wanting to decrease their fruit juice intake, help him/her to specify the amount of juice. “Decrease juice intake” becomes “drink 4 oz of juice at breakfast.” Then make sure the client has the necessary equipment to measure this out.  A: Attainable: Set goals that are actually achievable. 1-2 lbs of weight loss per week is something that can actually be done. Setting out to lose 5-10 lbs is, scientifically, not attainable. You as the counselor will need to help the client understand what is attainable and what is not based on particular time frames. R: Realistic: Again, this will involve you helping and counseling your client to understand that the goal of better health, weight loss, etc. are lifelong goals. Changes need to be realistic in their everyday lives.  For example, it would not be realistic for a client who loves grains to cut out all grains to lower carbohydrate intake. Portion control would be a better option for this client. T: Time Oriented: This aspect helps specify goals even further giving them an endpoint. “Lose up 1-2 lbs of weight in 1 week,” “Drink 4 oz of juice with breakfast for 1 week” and “increase physical activity to 30 minutes of cardio 3 times a week” are examples of time oriented goals.  SMART goals not only help your clients achieve what they have set out to accomplish, but they also help you serve your client better. So lets preach it loud and clear-- Slow and steady wins the race!
Carbs--The Misunderstood Macro
All clinical dietitians have been there…. sitting in morning meeting (or standing by the water cooler, nurse’s station, etc.) and we overhear another staff member talking about their latest diet. And usually this diet does not involve reducing portion size, embracing moderation or upping their physical activity level. It usually involves an extreme measure of restriction or selectivity and is likely unsustainable. In short, it’s another fad.  And you don’t just have to be a dietitian to experience this scenario. People all over the world are fascinated and mesmerized by fad diets. Looking for that magic pill to help them reach their health goals, the general population falls victim to a series of diet cycles and more often than not, does not succeed.  The latest of these fad diets is the Ketogenic Diet or “Keto.” This encourages a very low carb intake, no more than 50 grams net carbs per day, preferably 20 grams/day to put your body into a state of “ketosis.” Ketosis is when your body does not have a steady supply of glucose (carbs) so the liver starts to burn fat and turn it into ketones for energy instead.  It makes sense, and many people have experienced success using this technique, but this diet, in my opinion, is not sustainable. We also don’t know the long-term effects the keto diet will have on our bodies. But most importantly, I think this diet aids in an overall, nationwide misconception of what carbohydrates are, why they are important to the body and how we can eat them in moderation. Let’s break these down. What are carbohydrates? Carbohydrates are the sugars, starches and fibers found in fruits, vegetables, gains and dairy products.  Why are carbohydrates important? They are a macronutrient, meaning they are one of three sources of energy for our bodies. Our brains and skeletal muscles use this form of energy primarily.  Now for the “how.” I believe it’s very important for individuals to understand how to eat carbohydrates in moderation. This is a lifestyle skill that is essential to maintaining a healthy lifestyle in our oversized, overstuffed, over served Western culture.  How can we as dietitians help the general public better understand and ingest this nutrient? Simply put, education. Education, education, education. Let us not grow weary of trying to educate an uneducated society. It may seem unwanted at times, unheard, or unpopular at times, but there are individuals out there (especially diabetics) who need to hear this and most importantly need a professional to walk through this lifestyle change with them. Enter Registered Dietitians! 
Rapport Galore
A consulting dietitian is somewhat of a jack of all trades. Beyond having a full circle knowledge of clinical nutrition, sanitation and food safety policies, dietitians must also have strong relational skills to see true progress in their facilities. You might think its possible to do this job simply by going in, getting the work done and leaving with little to no interaction with the staff. That’s possible, but not what’s best for our residents or the facility. The secret to success for both yourself and your facility (s) is in the relationships.   Relationships are a tricky thing. They take time. It takes getting to know another person and making them feel heard, understood and cared for. Genuinely. This may seem a little mushy gushy for the workplace but the underlying concept isn’t. Relationship development builds trust and trust is the bridge to better communication. And let me tell you, communication is the key to EVERYTHING. So who do you need to develop a relationship with in your facilities? And furthermore, how do you do that when you are on site minimal amounts of time per week? Let’s dive in.   Who it’s important to build a relationship with at your facilities is as follows: DON/ADON, RNs, CNAs, CDM, Cooks/Aids. I know this seems like a lot of people, but let me explain why I suggest this.   -DON/ADON: They are the captains. They have a lot of pull. The DON/ADON can and will help you get information that you need if they like and trust the work you are doing. You want to be on the same team.   -RNs: They are in charge of communicating which weights need to be done and following up to ensure they were completed. In some cases they are even the ones that have to log the weights into the EMR. If the RNs like you, understand you are more than the “weight police” and care about the residents as much as they do they will help your cause. They will want to help you succeed at your job.   CNAs: This population, I believe, is one of the most important groups on the clinical side to develop relationships with. They are the ones responsible for getting your weights and reweights. And we all know we CANNOT do our job without this information. You want these people to like you, trust you and again, want to help you do your job well.   CDM: This is the most important person to develop a relationship with on the foodservice side. This person is responsible for getting you all of the information you need, for ordering, menu writing, applying recommendations, MDSs, and so much more. With a strong relationship, a CDM and RD can make a lot of positive change for a facility. But it’s important that they feel as if the relationship is one between two equals and not one between a superior and inferior.    Cooks/Aides: Consulting dietitians can sometimes feel not only like the weight police, but the cleanliness police as well. With monthly audits being done and recommendations being given, success in this area depends on whether or not the cooks/aides follow the guidelines/rules while you are away and follow them consistently. They are more likely to adhere to the rules of sanitation and food safety if they respect you as a leader and feel cared for.   Now for the how…how to get this done, with a limited amount of time available. Here are 2 quick tips to start building better relationships:   -Remember names: This one is simple. Remember the names of the staff and call them by name each time you are on site.   -Listen and ask:Listen to what is talked about during the down time (the minutes before morning meeting and/or weight meeting, at the nurses station, while CNAs are passing out trays, etc.). This does not have to seem sketchy or like you are eavesdropping. It simply means paying attention and listening to your surroundings. This is a great way to learn about your fellow staff members. Then, follow up, maybe the following week and ask them a personal question. Something that says, “I care about your life and how it is going.”   Implementing these small steps will not only help you professionally, but will help you on a personal level as well. Enjoying and trusting those you work with allows you to find more joy in your work day. Here’s to more joy!