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Dietary and Herbal Supplements

My sister had some questions for me about herbal supplements and the benefits vs. cons of them. Are they really worth the money? Will they really benefit me? Here is my low down on three of the new “superfoods.” Disclaimer: I always recommend that if you are on multiple prescription medications that you consult with your MD and/or pharmacist before taking any herbal/dietary supplements, a lot of these products have negative interactions with prescription drugs that could be fatal to your health or cause your medication to not work properly.

 

Wheatgrass: From the research that I have reviewed it shows that wheatgrass does contain vitamins and minerals that are beneficial to general health, for example, wheatgrass contains – vitamins C, E and K, niacin, biotin, choline, lutein, copper, folic acid, and calcium as well as small amounts of fiber. There are tons of research articles about wheatgrass possibly helping with fighting cancer especially during chemotherapy or other cancer treatment or even preventing your risk of cancer, but none of those studies have conclusive evidence to show a direct link or correlation. It seems like if you are getting enough fruits and vegetables daily, especially green leafy vegetables that contain chlorophyll (which is a plant pigment with proven health benefits and aids the body in normal metabolic processes) you won’t necessarily be getting any benefit from the wheatgrass supplements. Key point – if you are already eating a healthy balanced diet with plenty of fruits and vegetables, adding the wheatgrass shot might be pointless due to your body already being trained to  excrete  extra vitamins/minerals that it already has enough of.  If you already have enough of these vitamins and minerals in your diet then I would recommend avoiding the wheatgrass so your kidneys don’t have to go through excess work to filter and excrete the unneeded vitamins and minerals.

Other quotes that I read when reviewing RD blogs that discuss wheatgrass- “Although there is a lack of evidence, wheat grass may be beneficial in treating fatigue, aging and circulation disorders. It may also improve energy, boost the immune system and detoxify the liver.“ Additional uses include the treatment of arthritis, allergies, cancer and diabetes, although there is no indication that the herb produces any beneficial effects in treating these conditions. “Wheat grass juice has a very strong and well, grassy taste. The herb is generally safe, but it may cause side effects in some, including headache, nausea and throat swelling. Do not consume wheatgrass if you have a grass allergy or a wheat allergy, and do not take the herb if you are pregnant or nursing.”

 

Maca Root: Adaptogenic root vegetable grown in Peru, known for its claim to help with balancing hormones and increasing libido. I personally used this powder by adding it to smoothies to help with normalizing my hormones when I was having issues with irregular periods but no changes were seen or could be attributed to the addition of maca root in my diet. Can I also add that it tastes/smells TERRIBLE (to me at least), some people claim that it adds a nice nutty flavor to some recipes. Studies claim that maca root can help with other things like energy, anemia, stamina, and fertility but further research needs to be done to prove these claims. Maca root is considered a “superfood” due to its high mineral and vitamin content. I did do some research on drug/medication interacts for maca root and I saw quite a few disclaimers for interactions between blood clotting medications and maca root but I  believe that may only occur if maca root is taken in dosages greater than recommended or in excess amounts. As long as you are only adding small amounts of maca root to your diet I don’t believe you should have any side effects or issues, that being said, is it worth the money and will you see  benefits from it? I can’t tell you an absolute yes but you can always try it!

 

 

Spirulina: And our third “superfood” of the day is Spirulina! Considered a cyanobacteria/algae that is  closely related to other sea vegetables like kelp. Like the above two superfoods, it is also chock-full of vitamins and minerals but an extra bonus is it is considered a high protein food. it’s 50 to 70 percent protein by weight and contains all of the essential amino acids which makes it a “complete” protein.  It has been advertised and proven to be a wonderful addition in the diet of Vegans and Vegetarians due to its high protein content and high iron content, it can help with iron deficiency anemia and other blood health related issues including pernicious anemia. Other claims that are being made regarding this superfood  are benefits related to  immune boosting effects as well as anti-cancer and oxidative protection capabilities (due to its antioxidant content) which once again have not been completely proven but research is leaning towards it being a pro and not a con when added to the diet. I would definitely recommend this supplement to vegans and vegetarians but I would not recommend taking this supplement if you are on any type of immunocompromising/immune suppression drugs after running across a research article that discusses that spirulina  interacts  with medications that aid in immune suppression  like these listed below.

 

  • Adalimumab (Humira)
  • Azathioprine (Imuran)
  • Cyclosporine (Neoral)
  • Etanercept (Enbrel)
  • Infliximab (Remicade)
  • Leflunomide (Arava)
  • Methotrexate
  • Mycophenolate (CellCept)

 

Long story short, I wouldn’t add any of these supplements to your diet, I believe that you are probably getting enough of the minerals/vitamins from food sources which have a greater absorption capacity and bioavailability than pill/powder forms anyways. I would definitely steer clear of the spirulina though or discuss with a MD/pharmacist about the potential drug interactions before consuming.

Frequently Asked Questions.

As a Registered Dietitian in the Clinical setting I am bombarded with random nutrition questions all day long. The questions could range from weight loss to resveratrol, from what is a carbohydrate to how much potassium should I consume a day? Because of the wide array of nutrition questions I answer daily,  I decided that I am going to display them on this blog as well and hopefully other people who are looking for answers to the same questions or similar questions will find a credible and research based answer through my blogging! Some of the questions I wanted to provide back-up information on to show that they are scientifically proven so I have provided credible references after each answer as well. And as always, if you ever have a nutrition question that you want answered, please don’t hesitate to comment or message me!

 

FAQ’s.

  1. What is the difference (pro’s/con’s) between regular salt and sea salt?

Answer: Not much difference in amount of sodium per gram but due to the higher flavor content of the sea salt you may end up using a smaller amount than you would use with regular salt which would result in a lower sodium intake. Most of the salts are similar, consisting of sodium chloride and tiny amounts of minerals. The main benefit of choosing more “natural” types of salt is that you avoid additives and anti-caking agents that are often added to regular table salt. It is important to realize that sodium is used to add flavor and not nutrition.

References:

http://www.nuttynutritionandfitness.com/sea-salt-kosher-pink-himalayan-what-salt-is-best/

http://www.eatingwell.com/is_sea_salt_healthier_than_regular_salt

 

2.  What is Gastric Outlet Obstruction? Nutrition Treatment?

Answer: Gastric outlet obstruction is a disorder wherein there is an obstruction in the opening of the stomach (Pylorus), blocking the entrance of ingested food coming from the stomach to the duodenum. The best way to feed at this point in time (based on research) is via a j-tube and if inability to place or tolerate J-tube feedings then we would recommend parenteral nutrition as a last resort. It is always the best thing for your body to stimulate your GI tract in some way.

 

References:

http://ncp.sagepub.com/content/29/3/283.full.pdf+html

 

3. What should I avoid in my diet to prevent kidney stones?

Answer: Dietary changes should be made depending on what specific type of kidney stone you have. Your MD would be the person to determine what type of kidney stone you have.  Please keep in mind that  adequate hydration is key to preventing kidney stones.

Recommendations based on the specific type of kidney stone include the following:

Calcium Oxalate Stones

  • reducing sodium
  • reducing animal protein, such as meat, eggs, and fish
  • getting enough calcium from food or taking calcium supplements with food
  • avoiding foods high in oxalate, such as spinach, rhubarb, nuts, and wheat bran

Calcium Phosphate Stones

  • reducing sodium
  • reducing animal protein
  • getting enough calcium from food or taking calcium supplements with food

Uric Acid Stones

  • limiting animal protein

 

Above information was obtained from:

https://www.niddk.nih.gov/health-information/health-topics/urologic-disease/diet-for-kidney-stone-prevention/Pages/facts.aspx

 

August Top Recipes.

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Healthy Take on Tuna Casserole

Click Here for Recipe

Nutritional Information

Serving Size: 1 1/3 cup

Calories 422
Fat 16.5 g
Satfat 7.1 g
Monofat 6.3 g
Polyfat 1.8 g
Protein 27.4 g
Carbohydrate 40.6 g
Fiber 3 g
Cholesterol 88 mg
Iron 2.4 mg
Sodium 608 mg *(recommended to stay below 300mg sodium per serving to help fit into a <2,000mg sodium diet)
Calcium 293 mg
The break-down: This is an easy casserole dish that I cook at the beginning of the week and pack for my lunches for the rest of the week. It is has high protein content so it keeps me full for the rest of my workday. The sodium content and the fat content are not preferable but when its home cooked meals versus eating at the cafeteria, home cooked meals are almost always going to be better for you. Also, the tuna helped add some omega-3 heart healthy fats.

Tomato, Eggplant, and Zucchini Bake 

Nutrient Information Per Serving (1 cup)
69 Calories
4 g Protein
10 g Carbohydrate
3 g Dietary Fiber
6 g Sugar
0 g Added sugar
*plus hundreds of nutrients, minerals, and vitamins packed into all these vegetables. 
The breakdown: this is a super easy dish to create at the beginning of the week as well. Put the veggies in small Tupperware containers and  pack for work and school lunches. An easy way to get in your vegetables servings for the day. Plus its delicious and packed with vitamins that are essential for our body to function.
And now that we are on the vegetable topic, how many vegetables do you need a day? Myplate.com has a Daily Vegetable Table that shows how many vegetables you need a day based on sex, age, and gender. I am attaching the table and link here for those of you that are interested. It is so vitally important that we meet our vegetable goals every day to promote general health.

“How many vegetables are needed?”

The amount of vegetables you need to eat depends on your age, sex, and level of physical activity. Recommended total daily amounts and recommended weekly amounts from each vegetable subgroup are shown in the two tables below.

DAILY VEGETABLE TABLE
DAILY RECOMMENDATION*
Children 2-3 years old

4-8 years old

1 cup

1 ½ cups

Girls 9-13 years old

14-18 years old

2 cups

2 ½ cups

Boys 9-13 years old

14-18 years old

2 ½ cups

3 cups

Women 19-30 years old

31-50 years old

51+ years old

2 ½ cups

2 ½ cups

2 cups

Men 19-30 years old

31-50 years old

51+ years old

3 cups

3 cups

2 ½ cups

Diverticulosis: Nutrition Standpoint

I am currently working on the Gastrointestinal Surgery floor as a clinical dietitian, so GI conditions are pretty much what I live and breath. I have had a lot of co-workers/co-dietitians ask me what type of diet I recommend for diverticulosis patients. I have had so many people ask me this that I thought I should just go ahead and write a post about it! Maybe I can help some followers who may be struggling with this increasingly prevalent gastrointestinal issue.

First off, what is Diverticulosis? 

Diverticulosis of the colon is an acquired condition resulting from herniation of the mucosa through defects in the muscle layer of the bowel wall. The hypothesis is that decreased dietary fiber intake can result in diverticulosis due to the lack of fiber causing smaller size of the lumen which in turn causes the muscular contraction pressure to exert itself on the wall of the colon rather than the contents of the lumen. For a shorter explanation – the lack of fiber causes people to have a harder time passing stools which will cause strain to the colon and result in pouches in the wall of the colon. When the pressure is exerted on the colon instead of the lumen, diverticula are formed at the weak points in your colon wall (especially the sites that are penetrated by blood vessels). Diverticulosis is the term used when you have those diverticula present in your bowels, diverticulitis is when those pouches are infected, inflammed, or irritated. Causes of diverticulitis are vary and can range from a perforation of the diverticula, obstriction of the intestine,  bleeding of the diverticula, or even an abscess developing from the diverticula.

Diet Treatment: As a Registered Dietitian and a firm believer in the more fiber the better, I would recommend following a high fiber diet to prevent diverticulosis, the amount of grams of fiber needed per day would vary based on age and gender, here are the USDA dietary guidelines – 

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The daily fiber recommendations for most healthy adults:

  • Men 50 years and younger: 38 grams (g) fiber per day
  • Men 51 years and older: 30 g fiber per day
  • Women 50 years and younger: 25 g fiber per day
  • Women 51 years and older: 21 g fiber per day

HOLD ON, this is where things get confusing. I would recommend following a high fiber diet to prevent diverticulosis but what about when you already have diverticulosis and then it gets infected or irritated and becomes diverticulitis? In this case, I would then recommend following a low-fiber diet. The reasoning for the diet change is due to the fact that the bowels need to heal, providing a low fiber or sometimes even only a full liquid diet allows the bowel time to heal and avoids the risk of high fiber foods irritating the already inflammed or infected diverticula. We do not recommend following the low fiber diet for a prolonged period of time, we recommend gradually increasing fiber intake daily as you can tolerate (post infection and as your MD see’s fit) until you are back to following a high fiber diet for your overall goal in managing your diverticulosis. Unfortunately there is not set guideline on how much time you should allow yourself before beginning back on fiber containing foods, research still pending on that. I normally educate my patient to try one fiber containing food at the beginning and assess how they feel before overloading on raw vegetables and oatmeal. You know your body more than anyone, be cautious and listen to what it has to say.

*To finish up, here is a link to Today’s Dietitian Article on the “Top Fiber-Rich Foods,” so you can properly educate yourself on high fiber containing foods. Today’s Dietitian: High Fiber Foods

 

And on the other side of the spectrum, here is a short list of foods considered “Low-Fiber.” Obtained from – Low Fiber Diet

Foods that are generally allowed on a low-fiber diet include:

  • White bread without nuts and seeds
  • White rice, plain white pasta, and crackers
  • Refined hot cereals, such as Cream of Wheat, or cold cereals with less than 1 gram of fiber per serving
  • Pancakes or waffles made from white refined flour
  • Most canned or well-cooked vegetables and fruits without skins or seeds
  • Fruit and vegetable juice with little or no pulp, fruit-flavored drinks, and flavored waters
  • Tender meat, poultry, fish, eggs and tofu
  • Milk and foods made from milk — such as yogurt, pudding, ice cream, cheeses and sour cream — if tolerated
  • Butter, margarine, oils and salad dressings without seeds

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(research information obtained from pubmed database articles that have been published within the past five years, if you would like to review the research articles I used just send me a message and I will provide you with links!)

Top Recipes This Week

I have been forcing myself to start trying new recipes and branching out with my cooking lately, this is a byproduct of me watching too much “Cutthroat Kitchen” and “Chopped.” With this branching out phase I have also found out how many recipes online are just NOT good. I feel like sometimes people just write down a ton of ingredients, make up some steps, and then BOOM -recipe. So here I am to help you sort through some of the good recipes and the bad recipes, here are my top pics for this week.

Kale and Turkey Naan Pizza

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Nutrition: 

Per serving: 498 calories; 28 g fat (8 g sat, 12 g mono); 86 mg cholesterol; 33 g carbohydrates; 2 g added sugars; 4 g total sugars; 30 g protein; 6 g fiber; 718 mg sodium; 396 mg potassium.

Nutrition Bonus: Vitamin A (75% daily value), Vitamin C (66% dv), Calcium (34% dv), Vitamin B12 (21% dv), Iron (20% dv)

Pro’s: 

  • Quick and easy to make (almost as quick as throwing a frozen pizza in the oven or microwave, yet so much healthier).
  • Lower in carbohydrates due to using the whole wheat naan and only a small amount of cheese.
  • GOOD PROTEIN SOURCE and you get a serving of veggies.

Con’s: 

  • The recipe could use a little bit more flavor, I would recommend adding tomatoes and maybe even some mushrooms to give it a little more variety.
  • The red wine vinegar took over the flavor, season moderately.
  • A lot of fat…. 28 gram fat per serving and the sodium level is pretty high as well (718mg). These numbers are better for you then any microwaveable, frozen pizza out there, just make sure you are only consuming high fat/high sodium foods in moderation. I wouldn’t recommend cooking this more than once a week due to the nutritional content.

 

Skillet-Pouched Huevos Rancheros

 

Nutrition:

Per serving: Calories 325 calories, Fat 13, Sat Fat 6 , Cholesterol 232 mg, Sodium  1119 mg, Protein  14 g, Carbohydrate  40 g, Fiber  5

Nutrition Bonus: Iron  3 mg, Calcium  115 mg

Pro’s: 

  • DELICIOUS, the egg adds something to the salsa and bean mixture that is amazingly good and the texture is perfect.
  • This recipe is also quick and easy to make, it took me around 20 minutes total which is nice on days that I really don’t have the energy to cook for hours at a time.
  • This recipe is good for vegetarians due to its high protein and iron containing foods.

Con’s: 

  • Red alert on the high sodium (1119mg).
  • Too much salsa was used in the recipe, I recommend using half the salsa and doubling up on the black beans. Also, make sure you put a lid on the pan once you start cooking the eggs to allow the yolk to cook thoroughly.
  • If you are not a bird eater, then you are like me and probably need two servings instead of one – in that case the carbohydrate content is pretty high (40grams per serving, 80grams if you were super hungry like me).

Quick, On the go, weight loss tips.

Hello Readers!
I have a friend who recently ended her engagement and reached out to me for some expert advice on weight loss and healthy eating. She stated that she no longer felt confident in her body and her Doctor had placed her on metformin for blood sugar issues (pre-diabetic). While coming up with information for her on healthy eating, I compiled a list of my top weight loss tips and I figured I might as well share them with you all! I hope this information helps you all lead healthy and happier lives!

 

Weight Loss Tips To Remember:

  • I believe that starting a diet is better achieved when you look at what you normally consume in a 24hour period and calculate exactly how many calories and protein you intake a day.  When you have that exact number or average that you consistently stick around, I would then begin  to decrease that amount by 200-500kcals/day. Once you reach that goal of negative 200-500kcals/day then I would begin decreasing your intake by 100-200 kcal/day further until you are within your estimated calorie and protein goals that you have set for yourself or a registered dietitian has provided you with. This may take weeks or months! But that is okay! Because every day is a new day to make positive progress and changes.
  • DRINK WATER (half the time you feel hungry it is only your body being confused because you are dehydrated), carry a bottle of water around with you at all times and avoid sodas or limit to one/day. If you do drink a soda – consume the diet version and make sure you include the calories in your daily intake.
  • Only take nutrition information from Registered Dietitians, you can find tons of credible information on blogging forums like http://www.nutritionblognetwork.com/ and https://www.nugonutrition.com/blog/article/10-great-nutrition-blogs-by-registered-dietitians/
  • Consume three meals a day and snacks in between meals, do not go longer than 3-4 hours without eating, your body goes into starvation mode and starts holding onto fat.
  • Eat within one hour of waking up – it gets your metabolism going and you start burning calories first thing.
  • SNACKS, snacks are good. Carry snacks with you at all times so you are less likely to stop at a fast-food restaurant and binge on high calorie, high fat foods. Examples of good snacks – granola bars, yogurt, cheese sticks, pretzels (low salt), nuts, bananas, peanut butter, etc.
  • Once your stomach starts growling you have 20 minutes to eat before your body goes into starvation mode and you start holding onto fat.
  • Consume wheat bread products and not white bread products – wheat bread, wheat pasta, wheat crackers, and wheat bagels. Wheat products are digested slower in your body so you stay full longer due to high fiber content.
  • READ NUTRITION LABELS, become an expert on the products you frequently consume. I recommend focusing on the calories, total carbohydrates, and sodium content of the foods you eat the most of.  Always take note of what the actual “serving size” is so you do not underestimate what you are actually taking in.
  • Buy the majority of your groceries from around the perimeter of your grocery store, stay away from the center of the grocery store as much as you can. We want to buy as little processed, canned, and packaged foods as possible.
  • Limit your sodium, if a nutrition label says that one serving size of an item is greater than 300mg per serving size then you should stay away from it (your body just doesn’t need that much sodium, it makes it harder for your heart to work). You should limit your  sodium intake to 1,400- 2,000 mg/day.
  • Download a food app to count your calories throughout the day so you become more aware of what you are eating and how many calories are in certain foods.
  • Eat your meals slowly when you can, it takes your body awhile to understand when it is full, give yourself time to fill up so you won’t eat as much. Drinks sips of water in between bites.

Exercise Tips:

  1. I recommend yoga, it is absolutely great for your body. It makes you flexible, toned, and leaned without sweating profusely. Here is my favorite yoga instructor and she offers free yoga camps on her youtube site. You can do it at home and you have no excuse not to! http://yogawithadriene.com/
  2. CARDIO. I encourage any type of cardio (biking, swimming, treading water, walking, running, treadmill, elliptical, etc). Start with a goal of at least 10 minutes/day and increase that goal 2-4 minutes everyday until you are consistently doing 30 minutes of cardio a day. Walking up and down the stairs is even considered cardio.
  3. I try to do most of my workouts at home so I bought myself some 5-10 lb weights that I use for arm exercises and ab workouts. I recommend this! I will lift weights while I am watching TV which helps me not think about the fact that I am working out!
  4. Jump Rope, so good for you and a great form of cardio.

Product Review: Whole Fruit, Fruit Bars

I am on a Popsicle, ice, sweet, dessert, and summery kick these past couple weeks. I am loving me some fresh fruit Popsicle’s that are made with minimal ingredients and taste so pure/natural. The strawberry flavor is by far the BEST, the mango flavor is kinda lacking and I would recommend straying away from them. I bought these on sale at Publix for BOGO and ended up only paying $3.99 for 12 bars! I was one happy Dietitian. These are definitely Dietitian approved.

Pros:

  • No dairy, so okay for lactose intolerance
  • Vegan
  • Vegetarian
  • Minimal ingredients
  • Low fat
  • Lower sugar (only 17g per bar)
  • Low calories = 70 kcals (and curbs the sweet tooth)

Cons:

  • Some of the flavors (i.e. mango) do not have much “flavor’ and tastes more like you are just eating ice.

Dietitian Approved. 

Product Reviews: Simply Balanced Raspberry Sorbet

The best thing about being a Dietitian is every time I want to try something new, I use it as an excuse to make a product review blog post. I am all about curbing my sweet tooth and indulging every now and then, which is why I try to find the best/healthiest desserts out there. This weekend I was dying for some ice cream on the way home from a shopping trip with the fiancé. We couldn’t find any ice cream shops that were open and probably for the best seeing as I am lactose intolerant and would have regretted it immensely later on. Instead we stopped at  Target and I indulged in “Simply Balanced Raspberry Sorbet”, only $2.99 per container as well which is much cheaper than if we had splurged at a Baskin Robbins or Cold Stone.

  • Perks: ABSOLUTELY DELICIOUS, low calorie, gluten free, vegetarian and vegan approved,  minimal ingredients, minimal processing, and low fat.
  • Cons: 26g of Carbohydrates per serving, only a con if you are a diabetic and need to monitor your blood sugars closely. I would recommend only one serving of 0.5 cup if Diabetes is an issue you deal with, still a better option than ice cream or other high fat/processed desserts though.

Nutrition Facts:

Dietitian Approved.

How to pass the CNSC Exam.

A year and a half into becoming a clinical dietitian, the thrill of not having any school or homework wore off and I decided that I once again wanted to progress my career in some way. I feel like I am always searching for some way to push myself or gain more knowledge, which is sometimes a good thing but sometimes also exhausting. I decided that I was going to take the Certified Nutrition Support Clinician Exam (CNSC) which would not also make me more credible as a clinical dietitian but it would also make me more “attractive” if I wanted to find another job.

Now why would I decide to do this and what does it mean to be a CNSC? I stole this definition off of – ASPEN CNSC (go here for information on how to register/sign up)

Why Certify?

NBNSC certification provides an avenue to demonstrate that you have attained the skills and knowledge necessary to provide quality nutrition support care. We have determined the body of knowledge needed to have an understanding of nutrition support and developed a fair and valid means to test care providers including physicians, dietitians, pharmacists, physician assistants, and nurses.

Certified professionals are recognized as quality providers of nutrition support by the public, their colleagues, other members of the healthcare team, and administrators. The Certified Nutrition Support Clinician ® (CNSC®) certification can provide job mobility, open up job opportunities, and, in some cases, lead to promotion and monetary gain.

Objectives of Certification

To promote enhanced delivery of safe and effective care through the certification of qualified clinicians in nutrition support by:

  • Recognizing formally those individuals who meet eligibility requirements of the National Board of Nutrition Support Certification, Inc. and pass the certification examination for nutrition support clinicians.
  • Encouraging continued professional growth in the practice of nutrition support.
  • Establishing and measuring the level of knowledge required for certification by a nutrition support clinician.
  • Providing a standard of minimum knowledge deemed appropriate for clinicians practicing nutrition support; thereby assisting the public, healthcare professionals, and employers in the assessment of nutrition support clinicians.

So you want to know how I passed?

  • 6 months of studying, the first two months I studied pretty extensively and continuously. The last two months I was so over studying and barely even reviewed before the exam (probably wouldn’t recommend that method).
  • Study materiel:  The A.S.P.E.N Adult Nutrition Support Core Curriculum (2nd Edition), A.S.P.E.N Self Assessment Study Questions, and The A.S.P.E.N Pediatric Nutrition Support Core Curriculum.

 

Examples of ASPEN/CNSC questions and topics to study!

1. anemia types (what causes microcytic anemia?

2. What foods contain gluten and what foods are gluten free (multiple choice questions)

3.  TPN and chemo interactions (contraindications?)

4. Ethical questions about what to do in certain situations (power of attorney/what is a health care proxy/what does autonomy and beneficence mean. etc).

5. What medications cause hypokalemia/hyperkalemia

6. When are certain feeding tubes indicated or contraindicated (PEG, NG, NJ)

7. Multiple TPN calculation questions.

8. Pediatric questions  about fluid needs (know how to calculate fluid needs based on the Holiday Seger Method)

10. Adult fluid calculation questions.

11. Nitrogen balance equation

12. What to do in cases of hypokalemia and hyperkalemia?

13. Lots of questions that gave a case study on a pt and you had to choose what was the appropriate feeding regimen (oral/tubefeeding/TPN)

14. Need to know the different types of TPN access devices and when to use them (long-term/short term, etc.)

15. Types of TPN infection depending on the pt sign’s and symptoms and what to do first when evaluating for infection (obtain blood culture, get labs drawn, etc.)

16.When do you need to replace TPN access device?

17. Hang time of TPN.

18. Hang time of EN

21. What is pinch off syndrome?

23. What increases calcium-phosphate solubility (PH, temp)

24.What does medicare cover (goes into specific types of medicare, like what does medicare part B cover and what does medicare part A care?)

25. What lab tests need to be regularly checked in TPN patients? (how often do you need to check labs, how often do you need to check Iron levels, how often do you need to check triglycerides)

26.    What is an appropriate triglyceride level with TPN (when do you d/c lipids, when do you add lipids)

27. What lab do you use to assess for EFAD, what lab would signify EFAD, what are signs of EFAD?

28. Signs/symptoms of nutrient deficiency’s/toxicity’s?

I hope these topics give you a better idea of how you need to study for the exam, take the full four hours and try to troubleshoot all the questions and go with your gut feeling. I went through the test twice and re-read all the questions just to ensure that I was answering them correctly. Good luck and I hope this helps you too become a Certified Nutrition Support Clinician.

 

How to pass the RD exam.

So here is what everyone is dying to know… How did I pass the RD exam? I think I googled “How to pass the RD exam” at least 3x/day when I was studying for the RD exam and there were only a few blogs I came across that gave me any significant insight or information on the best way to study/prep for the exam. Seeing as I am now a Registered Dietitian, I feel like it is my duty to help others out that may be searching the same thing that I did in the google search bar.

1. How to become eligible to take the RD exam: Information obtained from Eligibility and Registry for RD exam

ACADEMIC REQUIREMENTS

Academic Degree:

Minimum of a Baccalaureate degree granted by a U.S. regionally accredited college/university

SUPERVISED PRACTICE REQUIREMENTS

All dietetic education programs accredited by ACEND must be in the U.S. or its territories. Supervised practice requirements stipulate completion of one of the Accreditation Council for Education in Nutrition and Dietetics accredited pathways:

  • Accredited Dietetic Internship Program
    Provides for the achievement of performance requirements for entry-level dietitians through a minimum of 1200 hours of supervised practice. The program follows completion of the Didactic Program in Dietetics and a Baccalaureate degree. Some programs may be completed part-time with supervised practice.
  • Accredited Coordinated Program
    Academic program in a U.S. regionally accredited college or university culminating in a minimum of a Baccalaureate degree. The program provides for the achievement of knowledge and performance requirements for entry-level dietitians through integration of didactic instruction with a minimum of 1200 hours of supervised practice.

*I completed four years of schooling at The University of Alabama with my major being:  Nutrition and Dietetics, I then applied for and was accepted into the Coordinate Program for Dietetics at the University of Alabama which I was able to complete within that 4 year time-span as well. Students who complete the Coordinated Program in Dietetics during their undergraduate careers graduate with a Bachelor of Science degree and are eligible to sit for the Registration Examination for Dietitians. I was able to do my course-work as well as my internship at the same time so that when I graduated I could immediately start focusing on passing the exam and starting my career.

2. Take the exam as soon as possible, don’t take a break!

*I began studying for the RD exam before I had even graduated, my senior year finals week was probably the least strenuous finals week of my entire college career. I was so used to having piles upon piles of studying that I went through the entire Breeding and Associates 2013 RD Study Exam Review in one week.  I took a total of three months of studying before I took the exam, I moved to Orlando, Fl during this time period and was hired on as “Registered Dietitian Eligible” at Florida Hospital Orlando. Some hospitals will hire you before you pass the exam but you are given a specified time period to pass the exam (mine was 90 days) or you will no longer have the job position. Since my job was on the line, you better believe I studied my butt off. I think working at the same time that I was studying really kept my mind refreshed on the materials daily, tying my studying into real life application was very beneficial for me.  I would recommend taking the exam as soon as possible after you have finished your internship or nutrition studies, there is so much information on the test that there is no way that you are going to know all of it but the more familiar you are with all the different categories of questions the better (food service, clinical, community nutrition, etc.).

3. Use a variety of study materials/tactics.

*Everyone’s brain has a different technique of learning or memorizing that works better for them than others. I would recommend studying in various different ways to make sure you optimize your learning capacity. I created flash cards, I made quizzes online at Quizlet.com , I read through material, I re-wrote material over and over again to drill it into my head, and I studied with friends to discuss things out loud and bounce questions off of each other. The materials listed below are the study materials I used (but the current year 2015-2016) not the 2013-2014 versions that I used.

4. Give yourself a break.

I recommend giving yourself a full 24 hours of no studying prior to the exam, I was so burnt out on studying that I gave myself a full day of relaxation and did not let myself look at the material. Like I said before, there is NO WAY you can know every single question but if you are refreshed and not burnt out on studying you will have a good change of using deductive reasoning on the ones you don’t know. Also, don’t drink coffee before the exam. I was so jittery with a case of restless leg syndrome the entire exam. Take my advice and stick to water before the exam. Coffee did not help me focus, it did the exact opposite because I was so nervous.

5. Take your time.

Don’t rush the exam, read the questions thoroughly and take your time going through them. I finished with over 60 minutes left on my timer and most likely got a few questions wrong because I didn’t take enough time on them to fully understand the question. The RD exam has some tricky questions so like I said, read carefully.

6. What was on my exam? What types of questions?

Well now that I am two years past the RD exam I can’t remember as many questions but I do remember the ones I had the hardest time on: I was asked many questions about converting a small batch recipe into a bulk recipe (multiplying the ingredients, etc.), I was asked questions about different size scoops and how much they contain (example: a #4 scoop can hold 12 tablespoons), I had many tube-feeding  questions (how to calculate how much protein/kcals or how to determine how much the pt needs), I had BMI calculation questions and predictive equation questions, I had questions about micronutrient deficiencies as well as which diet restriction is needed for different diseases (heart failure, cystic fibrosis, etc.), and I remember having questions about different type of restaurant service (buffet, ala carte), and about what foods different religious cultures can or cannot have. That’s all i got! If I had been smarter I would have written down all the questions I could remember after the exam but I was just too excited to have passed it!

I hope this helps some future Dietitian! Good luck and trust your knowledge!

-Cinthia DeVoe, RD, LD, CNSC 99c631d0-0ddc-447b-a230-00d684f87123

Introduction to Engaged Nutrition

This is the excerpt for your very first post.

Hello, hello, my name is Cinthia DeVoe  and I am a Licensed and Registered Dietitian in the state of Florida as well as a Certified Nutrition Support Clinician. I am on my second year as a clinical Dietitian and I have decided that it is now time to start sharing all my factual, evidence-based, nutrition knowledge with the maybe not as educated public or other dietitians who are interested in hearing  peer opinions on food and nutrition matters!

I am not a great writer, so please excuse any and all grammatical errors that may occur and most definitely will occur. I didn’t go to school for English, unfortunately. In this blog I hope to de-bunk as many nutrition myths as I can,  as well as provide information on how I became an RD as well as a CNSC for others who are interested in the nutrition career path. We are living in a world where food and nutrition are some of the top subjects of conversations and I believe that so many people are taking advice on diet/nutrition from uneducated sources.  I want to be a source that you know you can trust and can look to for advice on any nutrition/food related matter you could possibly think of. I am open to any and all questions you may have, so please ask away! Also, food and nutrition is an ever-expanding field and no one person can have all the answers. If  I don’t have the answer I will do research based searching to provide you with my most evidence based answer there is, and in this way I will be growing and learning with you in the process.

Quick Author Background: 

To sum it up in a sentence, I am a 24 year old, Alabama Alumni (Roll Tide), recent transfer to Florida, yogi, Jesus lover, foodie, traveler, and soon to be Mrs. I love promoting optimism and looking at the glass half full, I want to inspire people and share my beliefs with everyone who will listen. I hope you choose to join me on my new adventure in blogging.