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.

Why Dietitians Should Practice Cultural Humility and How to Make a Habit of it

 By Sarah Bostic, SLU Dietetic Intern

In the clinical realm, I have heard the ambiguous term “cultural competency” tossed around (might I say) haphazardly, with little regard for the confusion it causes. As far as we, the health sciences students, know, cultural competency is a standard. The American academic system requires most of us healthcare professionals to complete a workshop, take a class, or ace a test to ensure future practitioners meet a standard for understanding of diversity. But does anyone actually know what it means to achieve cultural competency? Can we actually become fully competent in culture?

Spoiler alert: We can’t.

Disheartening? Perhaps. As dietetics professionals, we aspire to be worldly. We want to soak up every ounce of cultural and culinary knowledge to best relate to patients. But frankly, as humans, we are naturally limited in our knowledge of the world. We will never be fully “competent” in culture, no matter the number of hours we study, years we practice, or multitude of crash courses we take in history or culture. No length of education is sufficient enough to lead healthcare professionals to full understanding of the needs and desires of unique individuals in this diverse world. Therefore, instead of striving for competence, I propose we should encounter the backgrounds of patients and clients with cultural humility. 

Practicing Cultural Humility: Explained

Cultural humility is a relatively new tool in healthcare; it was developed in 1998 to teach US doctors how to treat populations with diverse cultures, races, and ethnicities. It has since taken hold in various settings around the world, one of them being dietetics.

Cultural humility allows healthcare workers to obtain a comprehensive understanding of a client’s personal beliefs and values without relying on preconceived ideas about their culture.

Rather than “achieving” cultural humility, the practice is regarded as a lifestyle. We are asked to continually educate ourselves, engage in conversation, reflect, recognize and overcome biases, and work toward compassion and understanding in every interaction. Practicing cultural humility allows workers to enter relationships with patients openly, seeing that their patients are uniquely wonderful individuals. The interaction is doubly fruitful-- the client can aid in providing the most culturally appropriate (and likely most effective) intervention, AND the client will feel deeply heard, valued, and safe. Who doesn’t love that? 

Practicing Cultural Humility: Clinical Implications

Dietitians, among all healthcare professionals, have a great opportunity and responsibility to be the experts that practice cultural humility and lean in when we encounter unfamiliar cultural practices. Food is intimately tied to an individual’s culture, tradition, and upbringing. Meals are a communal experience, so in using cultural humility, we can capitalize on our curiosity about food to gain a beautiful insight into the client’s practices and values.

Practicing Cultural Humility: Personal Growth and Development

As dietitians and dietetics students, we must use our greatest tool-- the commonality of food-- as a ground for understanding, learning, and offering improved patient-centered care. In little increments, we can use our knowledge to inform future interactions and grow as professionals and people.

 In addition to learning from patients, we can intentionally choose to grow daily in our knowledge of history, culture, and food habits. With greater exposure to new thoughts and ideas through engagement with the world, we can uncover and break free from our ethno-centric American biases and encounter clients and patients from a more compassionate and informed standpoint.

Cultural humility is a tool for facilitating personal growth and development; it is grounded in the understanding that there is always something valuable to learn. 

How to Make Cultural Humility a Regular Habit

Though there are no concrete steps to follow, the following practices that will help you grow in your approach to cultural humility:

●     Develop Awareness-- Recognize diversity and how your unique identity and experiences shape the world around you.

●     Evaluate Perspective-- Welcome discomfort when your personal views are challenged. Work to understand why you feel the way you do. Address bias. Work toward respecting others and the beauty their unique perspective brings.

●     Practice-- Listening, reflecting, analyzing, and empathizing with other perspectives.

●     Gain Exposure-- Inform yourself through conversation, non-fiction reading, films, documentaries, podcasts, trying new restaurants, traveling, and regularly following trusted media outlets.

●     Include and Engage-- Make a habit of inclusion by promoting diversity in every decision you make. Ask if there is more you can do to ensure your actions have equitable and sustainable outcomes.

●     Act-- Utilize your position to actively work against inequity. Encounter individuals with love and openness.

Adapted from Baylor University's “Developing Cultural Humility” https://www.baylor.edu/diversity/index.php?id=948078

For more information on Cultural Humility:

With a limited budget, I, personally, have taken up reading as a hobby to expand my knowledge of the world and create a foundation for patient interaction. Reading books on populations I do not interact with regularly has opened my eyes to the diversity of needs that exist. The following resources may be a great start!

●     Cultural Competence v Cultural Humility, Public Health Culture Podcast

●     “What is Cultural Humility?” https://www.youtube.com/watch?v=c_wOnJJEfxE

●     Recommended reading:

○     Ask Me Why I Hurt by Randy Christensen, MD

○     Tattoos on the Heart by Fr. Gregory Boyle

Final Thoughts:

As a dietetics student, I am lucky that “autopilot” has not yet set in. I am always looking for new things to learn and often feel a strong sense of humility any time I speak with a patient. More often than not, I know, when I walk into my patient’s room with sweaty palms and a handful of questions, that I will be learning much more from the interaction than the patient will be learning from me. That has been my greatest take-away-- I sincerely hope that all Dietitians, no matter their tenure, will encounter patients with this same vulnerability as they carry out their important work. Dietitians should always approach patients with fresh eyes and anticipate there is something to learn from their patients.

Image taken from https://a-thousand-words.tumblr.com/page/3

Avoiding Diet Talk This Holiday Season (and beyond)

 Written by: Haley Jensen, SLU Dietetic Intern

With the Holidays quickly approaching, you may find yourself cornered in unwanted conversations about diet and weight loss. This is one of the busiest seasons of the year, often surrounded by friends, acquaintances and family. For a lot of people talking about diets feels like a “safe topic”. It’s often thought of as a causal conversation, just like discussing the weather. Even though the people you are around are comfortable discussing diets and diet culture doesn’t mean you have to be. This guide is meant to inspire you and give you tools to navigate uncomfortable conversations. Ultimately my hope is that the sample responses and coping techniques provided give you a sense of comfort and confidence this holiday season and beyond.

Helpful reminders

More than likely this holiday season you will find yourself in diet/weight-talk and you many not be sure what to say. Understand that its okay, building comfort around diet talk conversation takes time.

You’re not always going to have the “perfect“ thing to say.

You are allowed to say the “wrong” thing. There might be times where you need to take a break and not say anything at all.

You’re allowed to have boundaries.

You get to decide how much you share about your recovery, your relationship with food, your feeling towards your body and how your past experiences have brought you to where you are now. You do not need to have any conversations that make you uncomfortable.

You don’t always have to be a vocal advocate for anti-diet culture.

Conversations defending diet culture can sometimes be exhausting. It is perfectly acceptable to not educate up to your friends and family on the determinants of diet culture for a day.

Tips for Social Events

This season is filled with cocktail parties and mixers. Your might be meeting a lot of new people and the conversations surrounding diet culture are popular around the hors d’oeuvres table.

Your coworker is talking about their own diet/exercise plan… and they won’t stop.

• “I actually made a New Year’s Resolution to always talk about something new at parties- don’t you feel like we always talk about diets? Have you seen any good movies recently?”

Your friend makes a comment about having to “make up” for the holidays at the gym and asks you to join

• “You know that’s not how bodies work, there‘s really no need to make up for what the food we eat. I prefer to just enjoy delicious food with people I care about”

An acquaintance says “oh we are being so bad aren’t we”

• “The only bad foods are the foods that you stole”
• “My only food rule is that I don’t eat foods that are poisoned”

Tips for Family Events

We love our families but that doesn’t mean they can’t cross the line sometime. Navigating conversations gently can be difficult but that doesn’t mean that you shouldn’t say something if you want to.

Your aunt says “wow, you’ve lost so much weight since last time we saw you!”

• “I know I used to talk about diets and weight with you but I’ve recently realized it makes me feel pretty anxious, but I would love to talk about something else. Tell me how your and your family has been.”

Your cousin comments on your plate “oh, so calories don’t count today, do they?”

• “Actually, I don’t count calories today or any day. I prefer to let my body tell me what it needs, and today it needs my favorite holiday meals.”

A sibling tells you about the new diet their coworker is on

• “I love spending time talking with you but I would prefer if we talked about ourselves. I saw you went to Florida recently how was your trip?”

Overcoming Triggers

Now that we have discussed how to respond to diet talk, its important to understand how to not let those words someone said effect you negatively. You have chosen to take a journey into avoiding diet culture and its important to not let the word of someone else trigger you into diet, or feeling guilt for not participating in diet culture.

Work on your mindset

·         Use mantras and affirmations to help you remember why you’re trying to avoid diet conversations, some examples include:

• I understand that the holidays are about creating memories, and I won’t let food rules ruin that
• I will show my body that it can trust me by not restricting food
• I am more than the food I eat
• I give my body permission to change
• It’s okay to not know what my body needs right now, I am figuring it out

Have coping mechanisms ready

• Breath work- focus on your conscious awareness of your inhales and exhales. Using deep and focused breathing to create a therapeutic and calming effect. There are a variety of apps and techniques available.

• Create a happiness folder of photos on your phone filled with photos that cheer you up.

References

https://colleenchristensennutrition.com/diet-talk-how-to-respond-what-to-say/

https://alissarumsey.com/how-to-respond-to-diet-talk/

https://www.washingtonpost.com/lifestyle/wellness/thanksgiving-weight-diet-talk-advice/2021/11/08/2d4c4a3e-4007-11ec-9ea7-3eb2406a2e24_story.html

https://www.katiehake.com/blog/anti-diet-affirmations