Connecting with My Roots: Cambodian Recipe Post

 Written by: Selena Oum, SLU dietetic intern

Throughout my life I had never fully embraced my culture, especially the food. During the end of my undergraduate, I noticed that there was not much cultural diversity within the dietetics field. Moving to Saint Louis University to start my internship, was the first time that I have moved out of my parent’s house. After living on my own and away from my own cultural roots, I realized how much I missed some comfort from home. Therefore, I started to learn how to cook Cambodian food. 

Growing up as a Cambodian-American, one of my favorite Cambodian dish is Salaw machu, also called Sour Soup. Salaw Machu is a popular soup base dish in Cambodia, located in Southeast Asia, that can be served for breakfast, lunch, or dinner. My family typically makes this dish during family gatherings. For me, it’s associated with a memory of getting to laugh with my cousins and playing games with them all night. A popular ingredient that Is used for Salaw Machu and in almost every Cambodian dish is Koreung. This gives the soup its sour umami flavor.

Koreung can be used in other soups, marinated with meats, or stir fried with other ingredients. Koreung a mixture of lemongrass, ginger, turmeric, and kaffir lime leaves that is pounded into a paste using a clay or wood mortar and pestle, which can be seen being used in other cultures such as Hispanic cultures. Each ingredient brings in many different health benefits.

Typically, salaw machu is made with beef and water spinach, but these ingredients can be swapped out for healthier options such as fish or chicken instead of beef and adding in more vegetables such as carrots, green beans, and Chinese eggplant. The dish is versatile, and I have had them in many different varieties.

I hope that future dietetic interns/students won’t be afraid to embraces their own culture and not to be afraid to eat what you grew up eating just because it doesn’t fit into the typical diet normality.  Your culture is what brings the uniqueness to the dietetics field.

My greatest takeaway from this program is that there is always so much to learn about other people’s culture and the foods that are connected to it. Always be open minded to listening to what other people’s favorite meals or recipes are that their parents or grandparents passed on down to them.

Approaching the Topic of Weight in a Sensitive Manner

written by: Jessica Mueller

The culture here in the United States is obsessed with the topic of weight. How often do you hear your family members and friends commenting on “how good” someone looks during your holiday gatherings because they shaved off a few pounds? Vice versa, how often do you hear gossip about an old acquaintance of yours that has gained a noticeable amount of weight? These comments are often seen as “normal” topics of conversation, and, in the case of weight loss, complimentary, the subject of weight may seem completely harmless.

The emphasis and lack of sensitivity towards weight continues in the healthcare setting. Earlier this year at one of my clinical rotations at a residential eating disorder clinic, one of the clients was sent out to a cardiology appointment due to heart complications related to prolonged, severe restriction of food intake. Per usual eating disorder (ED) protocol, the patient was weighed backwards so they did not see their weight. When meeting with the doctor, he told his patient that they did not need to gain any more weight or be at an eating disorder clinic because while their BMI was on the lower side, it fell within the normal range. This patient returned to the residential eating disorder clinic extremely confused. They had been restricting food for so long that their heart did not work properly and other complications were present; however, her doctor just told her that her weight was normal and not to worry. The eating disorder clinic RD explained that even though their doctor told them that their weight appeared fine on paper, the phycological strain her ED was putting on her in addition to the physical complications of prolonged, severe food restriction called for their body to be at a higher weight. What was supposed to be a cardiology appointment that lead towards a safe and successful recovery of an ED, turned into an additional road block and source of confusion for this patient.

Stories like the previous one are not uncommon. Whether intended or unintended, many healthcare professionals (and Americans in general) show weight bias. Weight bias is when a person has negative, prejudiced attitudes towards an individual perceived to have an excess amount of weight. These attitudes often manifest into weight stigma and/or discrimination (Puhl and Brownwell, 2001; Dennet, 2019).

Weight bias leads to many people in bigger bodies to have decreased quality of healthcare for a myriad of reasons. Healthcare practitioners spend 28% less time with patients who are obese than patients at a normal body weight (Phelan et al, 2015) and 40% of these professionals are reported to have negative reactions to patients with obesity (Fruh et al, 016). Additionally, healthcare providers are more likely to suggest weight loss and “lifestyle changes” to people in larger bodies as a treatment option while choosing to delay diagnostic testing and/or treatment for symptoms (Phelan et al, 2015). Both direct and indirect weight bias from healthcare professionals contributes to anxiety, depression, disordered eating, medical non-adherence, antisocial behavior, reduced patient satisfaction, and reduced self-esteem in patients who have fallen victum to weight bias and discrimination (Dennett, 2019; Papadopoulos and Brennan 2015; Phelan et al, 2105). These negative interactions related to weight status in the healthcare setting sometimes cause people to delay or avoid seeking treatment for illness or preventative care (Fruh et al, 2016).

Discussing weight status with patients and peers is difficult. After all, ample evidence connects obesity with cancer development, insulin resistance, and high blood pressure, and more. What’s an effective and sensitive way to portray this information to patients and peers? When is the correct time to bring up the conversation of weight? During my clinical rotations, my weight-inclusive preceptors have shared their own strategies on tackling this difficult topic. I have also received resources from the Health at Every Size approach to healthcare, the Obesity Action Coalition, weight- inclusive articles on the Harvard Health and Cleveland Clinic websites, as well as listened to many personal testimonies from the creators, Aubrey Gordan and Michael Hobbes, and the fans of my favorite podcast, Maintenance Phase. Below are some ways to approach weight in a sensitive manner as a healthcare professional and peer.

How to discuss weight with patients as a healthcare professionals:

Treat the patient.

If a patient arrives to an appointment complaining of ear pain, treat the ear infection. It does not make sense to bring up their weight in an appointment unrelated to their weight. Always ask yourself if weight status if relevant to the conversation you are having with your patient.

Provide the same care for all patients.

This recommendation should seem like a no-brainer, but according to the evidence stated above, patients in larger bodies often have decreased quality of healthcare because of their weight status. Spend the same amount of time with patients with obesity as you would with patients at a normal body weight. Order the same tests and procedures as you would for a patient at a normal body weight at the same point in treatment as you would for a person at a normal body weight.

Keep numbers out of the conversation surrounding weight and weight status.

Using numbers and categories can be really triggering for a person with an eating disorder or disordered eating. Stay away from mentioning numbers in order to prevent avoidable triggers that can lead to or worsen eating disorders. As a side note, make sure to scour a chart for previous evidence or note of disordered eating before discussing weight.

Build rapport.

Before discussing weight with your patient, you want to build rapport. Trust is essential for discussing weight in a sensitive manner.

Focus on the mental health of a patient.

Eating disorders, disordered eating, and obesity all have phycological components. Before congratulating a patient on their weight loss or condemning a patient for weight gain address their mental health status. Ask questions in a sensitive manner and search for patterns of disordered eating such as fad dieting, restrictive eating practices,  fear of gaining weight, negative attitude towards weight gain or people in larger bodies, bingeing, depression, anxiety, or other conditions related to altered patterns in diet. Treating the root cause of weight gain or loss can help healthcare professional more effectively treat the whole patient at one time.

Refer patients looking for nutrition advice to Registered Dietitians- they are the experts!

Registered Dietitians complete a 4 year undergraduate degree in nutrition as well as an internship with 1200 supervised clinical, food service, and community nutrition hours. All of the training and education dietitians go through make them the experts on food and nutrition. If a patient is seeking medical nutrition advice related to their weight status or simply wants more information on eating healthy, a Registered Dietitian can provide personalized information and counseling that benefits the patient and can be extremely effective to their overall health.

How to Discuss weight with your peers and family members:

Don’t.

Discussing weight often encourages people to want to lose weight. It is important to remember that a weight loss technique that might have worked for you, or your cousin, or your cousin’s hairdresser’s, next-door-neighbor might not be the tactic that works for everyone. Vice versa, if you comment on “how good” a person looks since you last saw them, you could be unintentionally encouraging disordered eating habbits. When complimenting or critiquing another person, it’s best to stick to the “5 Minute Rule”. Unless a person change some the aspect you are commenting on in 5 or less minutes, do not comment on it.

But what if they bring it up?

Weight loss, dieting, and nutrition are common hot topics and themes of gossip sessions. If someone brings up their recent weight loss efforts or unexpected weight gain, change the subject or refer them to healthcare professionals trained to teach on the subject area. Adding to weight-related gossip fuels Weight Bias and Weight Stigma.

    But what if I’m really concerned about someone and their weight status?

    If you have a rapport with a person you feel needs an intervention related to their weight status, go about it in an extremely sensitive manner. Focus on their mental health and make observations about their attitudes and behaviors instead of their appearances. Always encourage them to get help from a trained professional if you believe their habits and emotional state are harmful to themselves.

   By approaching weight in a sensitive manner in the healthcare setting and with our friends and family, we can create a more inclusive environment for people of all body types. Improving attitudes around weight and reducing weight stigma, patients can have improved satisfaction in their appointments and procedures, healthcare professionals can improve their quality of care, and patients and healthcare professionals can have better, more meaningful relationships with one another.

 Resources:

 Implicit weight bias test: https://implicit.harvard.edu/implicit/selectatest.html

Health at Every Size: https://haescommunity.com and https://www.sizediversityandhealth.org/health-at-every-size-haes-approach/

Maintenance Phase Podcast: https://www.maintenancephase.com

Discussing Weight in the Healthcare Setting:

https://health.clevelandclinic.org/weight-bias-in-healthcare-can-it-be-prevented/

https://www.health.harvard.edu/blog/addressing-weight-bias-in-medicine-2019040316319

https://www.obesityaction.org

 

Citations:

Dennett, C. (2019, May). Weight Bias in Dietetics Education. Today's Dietitian, 21(3), 36. 

Fruh, S. M., Nadglowski, J., Hall, H. R., Davis, S. L., Crook, E. D., & Zlomke, K. (2016). Obesity stigma and Bias. The Journal for Nurse Practitioners, 12(7), 425–432. https://doi.org/10.1016/j.nurpra.2016.05.013 

Papadopoulos, S., & Brennan, L. (2015). Correlates of weight stigma in adults with overweight and obesity: A systematic literature review. Obesity, 23(9), 1743–1760. https://doi.org/10.1002/oby.21187 

Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity Reviews, 16(4), 319–326. https://doi.org/10.1111/obr.12266 

Staying Fit with Type 1 Diabetes

 Written by: Mikayla McTigue, SLU Dietetic Intern, MS of Nutrition Student, Type 1 Diabetic

Being in healthcare, it is astonishing to hear that diabetes has impacted the health of nearly every American. To put this into perspective, about 34 million Americans—just over 1 in 10–are living with diabetes in addition to 88 million having prediabetes.¹ But this data doesn’t account for the many individuals who go undiagnosed every year. The American Diabetes Association has predicted that 1.5 million people will be diagnosed by the end of 2022. While it’s unbelievable to hear, is it really all that surprising? For some, it can be prevented with healthy dietary habits and regular exercise; however, that cannot be the case for everyone suffering. This impacts individuals who have no say in what affects their health because of it being genetic, viral, autoimmune disorder, etc. Either type of diabetes can be affected; but, in type 1s, it is the only influence of diagnosis. In fact, researchers have not determined a specific cause but all their leads point to it being an immune system dysfunction.

Top Myths about Diabetes Fitness

Living with type 1 diabetes (T1DM) has brought me a whirlwind of hardships. One of my biggest challenges is managing my blood sugars while exercising. But don’t just take my word for it. In one of my *many* clinical rotations, I had educated a T1DM patient on making better eating choices and exercising regularly. They responded with, “I am afraid of exercising because of what it can do to my blood sugars.” Every diabetic is different when it comes to what works for them in keeping their blood sugars in a normal range while exercising. Personally, I am also trying to figure it out!

There are some popular misconceptions surrounding fitness for diabetes. Some of these myths, if not all, can discourage Type 1s from exercising and eating healthy. As a diabetic, I have heard quite a handful, but below are the top 3 common heard:

MYTH #1: Type 1 diabetics can only eat low-carb foods.

This is one of the most common myths heard in the diabetic world! What surprises me is that I have heard some nurses and doctors tell their patients this. While this is totally untrue, it is also frustrating. Wouldn’t you get mad if someone told you that you couldn’t eat cake anymore?!

It is common knowledge that carbs play a big role in diabetes, but the nutrient has been painted out to be the villain. This is due in part to early research. Their limited resources only gave them the conclusion of carbs raising blood sugars. While that is correct, that is not the whole truth. Carbs have one of the biggest roles in our bodies, meaning we are all wired to metabolize carbs as our main energy source (i.e., “the gas that fuels the car”). In type 1s, the individual is unable to transport it in the blood to provide energy; thus, it stays in the blood and raises “blood” sugar levels. Eating too many carbs is not necessarily the problem. Yes, more will have a greater impact on blood sugar levels, but insulin is what lowers them. No insulin, no maintenance of blood sugars.

What I’ve learned in higher education and being a diabetic, there is no real difference as to what a healthy diet should look like between a person with T1DM and a non-diabetic. As long as our insulin is calculated and given properly, we can eat the same food as a normal, healthy individual.

MYTH #2: When people with diabetes experience episodes of highs or lows, it means that they aren’t taking care of themselves.

Managing blood sugars in T1DM is a 24/7 job and we don’t get paid overtime. Everyone’s body reacts differently to various stimuli (e.g., food/drink, alcohol, stress, exercise, additional medications, etc.). Additionally, we must do math every time we want to eat something. The burn out can be real.

In my personal experience with diabetes, I have had bad days and I have had good days. None of that means that I am bad at taking care of myself. In fact, it feels strange to not have a bad day in a while. But all of this means I am human. A human that faces more challenges in my days than others. I’ve found it important to take it one day at a time, and to not criticize myself for something that isn’t and never will be my fault (which feels impossible to do sometimes).

MYTH #3: Diet and exercise will “cure” your diabetes.

If this were true, a lot more elite athletes would surface (including myself). T1DM is a lifelong condition that can be diagnosed at any age. Currently, there is no cure for it (no, having better lifestyle habits or using insulin does not cure T1DM, but instead it only manages your condition).

Managing the condition does come with a bit of skill, but eating a healthy, balanced diet of all foods and exercising regularly could help make it easier. Some say that their diagnosis was a blessing in disguise. Making them realize eating better and exercising more consistently, has lessened their highs and lows.

On the other hand, some people have found some challenges maintaining good blood sugar levels while trying to live healthier, especially during exercise. There are some common physiological reactions that occur to most, if not all, diabetics when they work out.² They may experience extreme lows when using the treadmill for 15 minutes, or even a steady incline when doing a resistance training workout (like CrossFit). Exercising is what causes insulin to become more sensitive (meaning it works better and transports more glucose), thus lowering blood sugar level faster. This could happen if you are new to exercising or have been off it for a while. It is best to talk with your doctor, to set up a lower/higher basal calculation when you exercise. Once you get into a routine of exercising regularly and eating healthier, it gets a little bit easier to maintain.

Tip: Try to keep a journal of what foods you eat and exercises you did that played a significant impact on your blood sugar levels.

Stay on top of your blood sugars while exercising

Physical activity is important to health and wellness regardless of whether you have diabetes or not. But if you have T1DM it is crucial to balance insulin doses with the type of activity you are doing. This chart describes how exercise can affect your blood glucose levels during various activities:

Figure 1. Different types of exercise and how they affect T1DM.

https://www.jdrf.org/t1d-resources/living-with-t1d/exercise/exercise-impact/

OK, so what do I need to do?

If you are new to exercise, or just getting back into a routine, you might want to engage in some trial and error. Keep in contact with your doctor about exercising, so they know how to change your insulin to match what you are doing.

Preventing LOWs

If you are below 100 mg/dl or your sugars seem to be trending down, eat something before you start.³ Keep a fast-acting carb with you at the gym or somewhere else (I like regular Gatorade or Skittles). Personally, I eat about 20-30 carbs worth and wait until my sugars are around 130-150 mg/dL before I continue. Additionally, I cut back on my basal rate during a cardio exercise by about half my normal rate. Everyone is different, so this may be another question for your doctor to help you sort through. Don’t be afraid to annoy them with questions. It’s their job to help you!

Preventing HIGHs

If you are wanting to start resistance training, it would be helpful in keeping your insulin pens/PDM and glucose monitor nearby. If your sugars are sunning high before you start, it may be better to start with a little warm-up cardio, then go into weightlifting. Be cautious if you decide to do cardio after. In this scenario, your doctor might increase your basal rate to match your rising levels.

It may seem intimidating to exercise, while risking the maintenance of good blood sugars. But, there will come a time when you understand what affects you during it and after. It is different from person-to-person, so take my personal experiences with a “grain of salt”. I believe the best thing you can do is talking with your doctor and researching on your own (from reputable sources!). I like to refer to the American Diabetes Association, JDRF, Beyond Type 1, and the CDC for when I do my own research.

I hope that you got a lot out of this information but if not, please remember this: Accept that you aren’t going to get it right every time. There is no such thing as “perfect” health, so why would there ever be such a thing as “perfect” diabetes management.

References:

1. National Diabetes Statistics Report. Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html. Published January 7, 2022. Accessed February 22, 2022.
2. Oerum C. 3 diabetes fitness myths you shouldn't believe. Beyond Type 1. https://beyondtype1.org/3-diabetes-fitness-myths-you-shouldnt-believe/. Published September 7, 2021. Accessed February 27, 2022.
3. Exercise and type 1. American Diabetes Association. https://www.diabetes.org/healthy-living/fitness/exercise-and-type-1. Accessed February 27, 2022.

The Life of a Culinary Entrepreneurship Dietetic Intern

written by: Libby McCaslin

Hi everyone, SLU dietetic intern Libby here!

Often when mentioning to new people that I am currently completing a dietetic internship and studying to become a registered dietitian, most assume that I am going to work clinically or start a private practice. It is no secret that there are many different directions one may go within the profession of dietetics, but I feel like the culinary entrepreneurship realm deserves a bit more of a spotlight and I am here to do just that by answering a few questions I often get! 

Why did you decide to apply to the culinary entrepreneurship concentration of the dietetic internship?

When doing research on different dietetic internships to apply for in undergrad, SLU’s program pulled me in for many reasons, but the fact that they have a culinary entrepreneurship track was at the core of it all. This concentration provides interns the opportunity to not only practice medical nutrition therapy, but also develop strong business skills and learn how we can become entrepreneurs as dietitians. It is a long-term goal of mine to open a restaurant someday with a focus on sustainability and highlighting local, in-season foods. I strongly believe that it is important to have a nutritional lens when one is cooking, and I want to share with my community how that can be produced and consumed in fun ways in a location where all are welcome. This concentration and internship has truly been a dream come true and I am very thankful to be a part of it!

Typical Day Schedule:

Every Monday all of the interns gather to have have sessions dedicated to different important topics where local dietitians come to talk to each SLU intern about what they do and how we can improve our own patient/client care. On some Mondays we also have garden sessions at local schools, nutrition educations and post clinicals. Tuesday through Friday we are all at our different sites seeing patients/customers/clients or completing rotation checklists. Depending on the semester, concentration-specific Master’s classes are in full swing as well!

How does the culinary entrepreneurship concentration compare and differ from the other concentrations (MNT, Pediatrics, Sports Nutrition)?

Here at SLU, day-to-day culinary entrepreneurship internship life in terms of rotation experience really doesn’t differ much from the other concentrations. We each are set up to complete around 1200 hours of rotations divided among clinical, community and foodservice sites within a 15-month period. And just because I’m a culinary intern doesn’t mean I get more time in foodservice rotations than the others. This is one of my favorite aspects to this program because we are all provided equal opportunities to learn in each of the different parts of the dietetics world, but there also is a strong culinary focus for community rotations and the master’s portion of the program.

Where concentrations do differ comes down to our master classes and capstone/thesis topics. The culinary entrepreneurship program includes nutrition-based classes, new venture entrepreneurship classes where you get to practice creating your own start-up company, sustainable food systems, finance, marketing and organizational management. Our capstone/thesis is to be culinary or foodservice based as well.

I have teamed up with 2 other culinary interns, Samantha and Mikayla, and we are creating a book for our capstone project called “Everyone Has to Eat”. It is a 2-in-1 cookbook and guide with over 60 delicious, plant-forward recipes, as well as guide to making intuitively healthful decisions when dinging out. We hope to provide the tools to making better, budget and time friendly food choices to the busy young adult. We are still in the development process but plan to be selling it come mid-April, so keep your eyes peeled for a post about it on the SLU Nutrition and Dietetics Instagram page - @slunutrition1818.

What has been your favorite rotation this far and why?

I was lucky enough to get to spend 6 weeks of my foodservice rotations working at Fresh Gatherings, the café located in our departments Allied Health building. This has been my favorite rotation because it was really my first experience working in a fast-paced foodservice environment where I got to do the all of prepping and cooking. I was able to work with a team to develop several lunch special menu items, as well as a few salads for the grab n’ go refrigerator. This was the first time I really got the opportunity to menu plan, develop and serve menu items for the masses and it was a very exciting experience. Two really fun items I got to help create were a Birria Crunchwrap and a Thanksgiving burrito with all of the classic fixings – which may sound interesting but sure was delicious. My experience at Fresh is something I know I will carry with myself throughout my future career as a dietitian to come!

My Experience with the Integrative and Functional Nutrition Academy

 written by: Samantha Larkin, dietetic intern

During my undergraduate experience, I was struggling to find my niche within nutrition. Most of my professors taught about in-patient, clinical experience, and I knew that was not for me. I learned of the Integrative and Functional Nutrition Academy (IFNA) through one of my mentors during the summer of 2020. After researching the organization and their values, it seemed like a perfect fit.

To better understand IFNA, it is an evidence-based, whole systems approach to patient and client care. They combine modern science, clinical wisdom and thinking, while focusing on six key clinical areas: whole body systems approach; root cause analysis; therapeutic elimination diets and food plans; conventional and functional diagnostic labs; the art and science of dietary supplements; and mind-body modalities. 

If this sounds interesting to you, here are the basics of the program:

●       A 2 year online program plus an exam.

●       5 tracks with 33 modules.

●       Available to RDNs and RD to be students.

●       A new guest lecturer for every module.

●       Estimated cost of the credential program: $5,660.

Initially, the expenses were a concern for me, but as I go into detail below, there were aspects that allowed me to justify the price. The first track has a student discount, the subsequent four do not. However, you pay for one track at a time, so the total price is spread out over two years.

The greatest appeal was that I could complete this program prior to becoming a registered dietitian. The functional and integrative nutrition field is a competitive area to break into; I knew it would set me up for success in finding a related job.

You might be wondering how it is possible to complete a 2 year program while in school. Personally, setting aside a couple hours each weekend for IFNA was the best way to balance schoolwork and the lectures. I had to switch up my tactic during the internship due to my weekends being chalk full of rotation and class assignments. I made the most of my winter break to finish the final track. I found the information from IFNA deviated enough from the school curriculum that it did not resemble homework. And the cost was a significant motivator!

If you are currently in the SLU dietetic internship, or are about to start, you might wonder which concentrations IFNA applies to. The foundations of integrative and functional nutrition can be applied to many different areas of dietetics including all four concentrations offered at SLU. I am in the culinary concentration, and through IFNA, I learned of the synergistic qualities of certain foods when combined. I have seen an improvement in my understanding of how to enhance flavors and create a deliciously healthy meal. Many of the underlying themes in the IFNA program is food as medicine, so having a culinary background can lay the groundwork for a functional dietitian.

Regardless of your concentration, if you are interested in learning more about different labs, nutrigenetics, and the latest science regarding human nutrition, this program will beneficially serve you.

My greatest takeaways from this program include being able to interpret different laboratory results, learning about genetic variations and their impacts on nutrition status, and understanding the pathophysiology of different disease states using a functional lens.

If you are still on the fence about whether this is a realm you want to pursue, the Academy of Nutrition and Dietetics has a dietetic practice group tailored to integrative and functional medicine. Their website has great resources and more information on what it means to be a functional and integrative dietitian.

 

The Raw Truth: Should You Try a Raw Diet?

By Parker Lane, SLU Dietetic intern

Coming into a New Year you may be thinking “New Year New Me”. Many people took to diet and exercise for things to put on that resolution list. In fact, according to Study Finds a little over half (53%) of New Year’s resolutions revolved around these two categories¹.

Which may lead some of you scrolling through medical journals and peer reviewed data to find your next diet, right? No! It will probably lead many to social media or an influencer that praises a diet for their good looks. And hey, I too find myself looking into what they claim to be their secret. Last year it may have been keto diet but this year I’m seeing the raw diet left and right. But I’m telling you now, you may want to do a double take after I tell you what the research says about the raw diet.

What Is the Raw diet?

The raw diet, which is also known as raw foodism, has a couple different criteria depending on where you look. The broadest was eating raw fruits, vegetables, nuts, seeds, eggs, fish, meat, and dairy. It also allows minimally processed foods like fermented or dehydrated items (using temperatures below 118 degrees F)².  The raw diet is being described as a “anti-diet”, as it is not a diet but a lifestyle³. However, by definition according to the Mariam and Webster dictionary, a diet is “a special course of food to which one restricts oneself, either to lose weight or for medical reasons.”⁴_.  Therefore, it is a diet.

The raw diet isn’t new despite its newer popularity. It has been around since 1300 CE; however, its purpose through history was used for things like connecting back to nature, to anecdotal evidence of treating disease ^1,7. Present day popularity has come from celebrity followings⁷ but although it’s marketed as a lifestyle, it often seems to be used for weight loss. Looking at that from a nutritional standpoint it seems like a recipe for deficiencies as it is a restrictive diet on top of an energy deficit.

Figure 2:Karits E. Brown Monkey Eating Green Vegetable.; 2020.

Chewing on Science

Some of the arguments provided for the raw food diet is that it reduces your intake of processed foods, while increasing your intake of nuts, seeds, fruits, and vegetables. These items contain phytochemicals, fiber, vitamins, and minerals. It claims to have benefits like reducing blood pressure, triglycerides, and cholesterol⁴. There are also anecdotal claims that it will help with:

• Weight loss
• Lower inflammation
• Preventing cancer
• Give you more energy and more³.

All of these things make sense. More fruit and vegetable foods in the diet lead to less consumption of saturated fats, carcinogens, and processed foods which can in turn lead better health given that it is balanced with all the things our body needs.

However, it seems like with most restrictive diet there’s a catch. One study looking at long term adherence found that there was a significant amount of weight loss in both men and women⁵. However, it also had correlation with low BMI and amenorrhea in women⁵. And low BMI, just as high BMI, is associated with adverse health outcomes.

Additionally, many of the studies didn’t focus solely on eating raw fruits and vegetables. Rather most of the blogs in favor cited similar studies that focused on getting more fruits and vegetables in general, regardless of if they were cooked. 

This diet is highly restrictive and often does not condone eating out as most foods on the menu will have been processed in one way or another. However, with its celebrity following and popularity there are more restaurants now catering toward the raw food diet⁷. But for most this diet means eating at home. Well, that’s good because its less expensive right? Well yes, it’s probably less expensive than eating out; however, it is also likely more expensive than eating a nonrestrictive diet. There is specific focus on having fresh fruits and vegetables. Meaning those prices are going to fluctuate a lot throughout the seasons with availability.

Elephant in the Room

Figure 3:Rizkiyanto F. Elephant in the Room.; 2018. https://www.behance.net/gallery/66261629/Elephant-in-the-room

Don’t get me wrong when I say this, I love sushi and tartare, but eating raw meats, dairy, and fish all increase your risk of contracting a foodborne illness. Additionally, foodborne illness can come from raw plant sources too, and even the process of dehydrating can promote the growth of bacteria. Even if you’re not pregnant or immune compromised, foodborne illnesses can have serious and potentially fatal effects⁶. Cooking foods has evolved with humans and helps to kill harmful bacteria. In addition, cooking food helps increase bioavailability, meaning we can more readily absorb those nutrients⁸.

Now what about the enzymes in them that help break down food? Don’t those help with the bioavailability and digestion? The answer to that is they could if they made it to our small intestine. Which with the low pH of our acidic stomach they don’t. Lucky for us though, we have our digestive processes that start taking place from the moment that food enters our mouths which helps to break down our food to be absorbed⁷.

Finally, a lot of the evidence that they used did not focus only on raw foods and found that higher fruit and vegetable consumption and plant-based foods was likely to improve health outcomes⁹. So maybe the diet to try this year is trying not to diet at all. Instead, just trying to get a few more plants in our diet, maybe some raw and some cooked.

What’s Next?

To recap, the raw diet does show potential health benefits from its increased fruit and vegetables, nuts, seeds, increased fiber, and reduced consumption of processed foods. However, it does not come without potential detriments, like inadequate intake and nutrient deficiencies. Additionally, as many of their studies pointed out, similar benefits are achievable from eliminating processed foods and focusing on eating more plant based in general. So maybe this year instead of trying a new diet lets set a goal, one we think we can stick to all year. Let’s remember to fuel our bodies with a balanced diet, one that includes fruits and vegetables, but also other foods you enjoy as those can also be part of a balanced diet.  

Last, when setting a resolution, you want to be specific, have a way to measure your progress, make it reasonable to achieve, relevant to your goal, and set a time frame you want to achieve it by. You can have an overarching goal while having smaller milestones throughout the year to help you make it to that finish line. But also, it is important to keep in mind that change takes time and what ever your goal maybe, be sure you are patient with yourself and celebrate your smaller progress milestones.

*This blog is not meant to provide any medical nutrition therapy advice. Please follow/consult your health care physician or Registered Dietitian for advice on dietary changes. 

Bibliography

1. Anderer J. New year, same me: Most people give up on New Year’s resolutions within a month. Study Finds. Published April 1, 2021. Accessed January 19, 2022. https://www.studyfinds.org/give-up-on-new-years-resolutions/#:~:text=Over%20half%20of%20the%20resolutions%20described%20to%20researchers

2. Raw foodism. Wikipedia. Published September 11, 2021. https://en.wikipedia.org/wiki/Raw_foodism

3. Levy J. Raw Food Diet: Benefits, Risks and How to Follow. Dr. Axe. Published 2017. https://draxe.com/nutrition/raw-food-diet/

4. The Raw Food Diet | Diets & Weight Loss | Andrew Weil, M.D. DrWeil.com. Published February 15, 2019. https://www.drweil.com/diet-nutrition/diets-weight-loss/raw-food-diet/

5. Koebnick C, Strassner C, Hoffmann I, Leitzmann C. Consequences of a long-term raw food diet on body weight and menstruation: results of a questionnaire survey. Ann Nutr Metab. 1999;43(2):69-79. doi:10.1159/000012770

6. CDC. Foodborne Illnesses and Germs. Centers for Disease Control and Prevention. Published February 16, 2018. https://www.cdc.gov/foodsafety/foodborne-germs.html

7. Cunningham E. What is a raw foods diet and are there any risks or benefits associated with it? Journal of the American Dietetic Association. 2004;104(10):1623. doi:10.1016/j.jada.2004.08.016

8. Platel K, Srinivasan K. Bioavailability of Micronutrients from Plant Foods: An Update. Crit Rev Food Sci Nutr. 2016;56(10):1608-1619. doi:10.1080/10408398.2013.781011

9. Block G, Patterson B, Subar A. Fruit, vegetables, and cancer prevention: a review of the epidemiological evidence. Nutr Cancer. 1992;18(1):1-29. doi:10.1080/01635589209514201

 

5 Things You Need to Succeed During the Dietetic Internship

By Sabrina Johnston, SLU Dietetic Intern

Over the first half of my internship, I have encountered a number of patients, and I have been able to implement what I have learned over the last few years and what I am still learning. But I realized that being an intern and being a Registered Dietitian takes much more than just learning and reciting nutrition information (although it is important). I have compiled a list of what I think are the 5 most important aspects of my internship that I have developed personally.

Time management.

Time management is at the top of almost all lists on how to succeed, and I think that it is fundamental for succeeding during the dietetic internship. Juggling classes, projects, and rotations at the same time feel hectic, and there were times where I felt overwhelmed and swamped. I learned to create a schedule and timeline to follow and I found myself finishing projects more efficiently and that I even had some free time on my hands. With my schedule under control, I found more time for doing the things I like, such as reading, running, talking with family, and even more time to sleep!

Life is manageable during the dietetic internship, you just have to get organized and stay organized. I kept time management at the top of my list because I realised that once I was organized, everything started falling into place and I could really start enjoying the internship for what it is: an opportunity to learn and have first-hand experience working as a professional in nutrition and dietetics.

Jumping in.

We have a good foundation of nutrition knowledge before starting the internship, but the actual internship is an entirely new journey. What I’ve learned works best for me is jumping in whole-heartedly during each rotation. I learned that the thrill of a new situation or a particularly complex case can be very exciting. I am still learning and every new patient I see is experience gained, every question I ask is more knowledge in my toolbelt for the future.

Secondly, the dietitians that I have worked with want to help, so taking the extra seconds to ask a question or ask for elaboration is well worth my time. Diving head-first into a new rotation is daunting, but with an optimistic attitude, I have had some of the best experiences and have learned so much more by rolling up my sleeves and just going for it.

So far, the most intimidating rotation that I faced was GI - there are so many complex conditions and I was worried that I would be overwhelmed. I told myself to run with it, and I learned so much information by observing then jumping right into it, and I enjoyed myself so much more than any of the previous rotations. Now, I know I am going to face even more challenging situations in the future, but I have grown and I feel that I am ready to face what is ahead of me. I have recently started my oncology rotation, but instead of feeling intimidated, I felt giddy with excitement and I cannot wait to learn more.

Being personable.

Nutrition knowledge can be memorized and spat out like a robot, and I have learned the value of gauging who I am talking to and how to approach them with education and counseling. I have learned how to build rapport with patients quickly and effectively, and I can more easily cater my advice and information to their needs. By seeing patients as people and using a conversation to guide the nutrition information I give, I have noticed much better reception of information.

Not all people are the same, and I have to take into consideration their viewpoint to cater the best intervention that I can. I have seen patients who will talk your ear off about their lives, and I have learned to guide the conversation back to the most pertinent information I need. I have also talked to patients who have told me that they will not listen to what I have to say and have asked me to leave. These interactions are just a glimpse of the many interactions that I will have, so it is important for me to be prepared for anything.

Being personable pertains to those you work with as well. Everyone has their place and their role in helping the patient, and understanding this helps everything move much more smoothly. I have established great relationships with my preceptors and staff at some of my rotations, and it has made my internship experience so much more positive.

Being confident.

I believe my confidence has grown the most during my internship so far. I will start with an example. The first patient I saw on my own was nerve-racking. I walked into my room and I introduced myself, albeit quietly. When the patient responded that they couldn’t hear me, I was shattered, and the thought “I’m not going to make it” ran through my head. I have had a lot of support and guidance from preceptors, teachers, and family. I know the information, confidence just comes from time and experience. Now, I have no trouble at all going into a patient’s room alone, introducing myself, and getting straight to business. I really enjoy speaking to and helping people, and I have gained a lot of confidence along the way.

Life is too short to worry about speaking too quietly and loudly, and I think being confident relates a lot to my previous statement about jumping in. By trusting your gut and diving into a new situation, you gain confidence in yourself and you will see yourself grow because of it.

Enjoy yourself.

To wrap it up, the dietetic internship is straining on time, energy, and brain power. I found that if I focused on what I needed to do in the future and looked at everything at once, I would shut down. Going into every day of the internship positively with an open mind and an open heart, I learned so much more. I connected closely with my preceptors and my patients, and I found myself falling in love with dietetics all over again. As I learned to enjoy myself during my rotations, I found that my paperwork afterwards wasn’t as daunting. I could finish my work more efficiently, and I found more time to relax, read a book, or cook myself a tasty meal.

The dietetic internship is too short to get lost in everything that needs to be done. It is an opportunity to experience what it is like to work as a professional in dietetics, and it is fun to see what opportunities lie ahead.

All pictures are sourced from Canva.