Claxton Dietetic Solutions Articles

Nutrition App Spotlight
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We have all heard the saying, “There’s an app for that,” signifying that nowadays there is a digitally based application to help you with just about any task. But, in reality we now have about 100 apps to help with any need we can think of. This is true for the nutrition world as well. A plethora of apps are available to help you and your clients achieve their health and wellness goals. So how do we know which apps are worth downloading or buying? To help with your search, I have highlighted 3 top rated health and wellness apps below! Noom: Noom is an app focused on building healthy lifestyle. Creating healthy habits leading to an overall healthier body. The app's free tier provides users with the ability to log food and exercise use and even has an in-app pedometer. Noom steps it up though with customized premium plans that provide daily goals and personalized coaching to help you achieve your fitness goals. This version does cost money, but seems to provide an incredible value for the money invested. My Fitness Pal: Created in 2005, MyFitnessPal is a powerhouse of an app with a large food database that allows users to track calories the calories and macros of the foods you eat as well as calories burned through exercise. Users can import recipes and calculate estimated calorie needs with their goal weight in mind. Fooducate: Similar to MyFitnessPal, Fooducate is a weight loss, health improvement-based app that allows you to track calories in/out. Fooducate helps you shop and eat healthy by allowing users to quickly pull up nutritional information about food products from barcodes. Fooducate gives a letter grade A-D with a quick nutritional summery helping you make the best choices based on your goals. There are MANY more apps out there, but these three seem to be the highest rated and offer extremely helpful information and accountability. And it’s always helpful for us, as practitioners, to guide our clients to helpful resources outside of our office! Visit your app store and check some out for yourself! Let’s not get lost in this digital age. Happy downloading! 
Fuel to Move!
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Registered dietitians are typically known as the “food and nutrition experts.” Here on the blog, topics usually center around food, nutrients, weight, eating habits, etc. But did you know that dietitians have a knowledge about exercise as well? I do want to be clear though, that registered dietitians are not exercise experts. We are not exercise physiologists, personal trainers and those of the like. But we do have a general knowledge of physical activity and understand the importance of implementing physical activity into a person’s life to not only achieve and maintain a healthy weight but attain an overall sense of wellbeing. There are many different types of exercises. Examples include but are not limited to: aerobic, strength training, low intensity, high intensity, stretching, interval and circuit training. As a clinician, it’s important to assess your patient or client’s current views towards exercise, current exercise habits and his/her attitude towards increasing physical activity (if deemed appropriate). Promoting increased physical activity should be in line with the person’s ability and affinity as well as within their desired schedule. Keep in mind we want to work within our scope of practice so if a patient/client is wanting a specific exercise regimen, it would be best to refer them to a local exercise specialist to meet those needs. One of the best ways we can help our patients/clients as they embark on an increased physical activity journey is to educate them on how to properly fuel their body for that exercise. A simple education on pre and post exercise foods will be immensely helpful to them. Here are a few tips to communicate to them during this time. Tips: 1) Overall, it’s important to utilize the “buddy system”- that being carbs + protein. Balanced meals and snacks will help keep a person fueled and satisfied not only through an exercise period but the rest of the day as well. 2) Pre Exercise: Utilize the “buddy system,” but focus more on the carbohydrates. Examples of good pre exercise snacks include a banana with 2 TB peanut butter, ½ cup grapes with one stick of string cheese, or a yogurt parfait with fresh berries and granola. 3) Post Exercise: Utilize the “buddy system,” but focus more on the protein. Examples of good post exercise snacks include 1 piece of fruit with a handful of nuts, whole grain wrap with turkey/cheese/veggies, or 1 piece of whole wheat toast with 2 scrambled egg whites. Again, these are just examples and the specific amounts of each food will be determined by you (the RD) for each patient/client to help meet their individual estimated needs and health goals. Remember to be specific and incorporate his/her personal food preferences to ensure compliance and sustainability! Head on over to the recipe page for an example of a great pre OR post exercise snack!
Food First Philosophy
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Working as a dietitian in long term care or within a skilled nursing facility is a special job. You are getting to work with a population that has very real nutrition needs and most likely has nutritional deficiencies and/or weight loss. In fact, the most common issue you will see within this population is weight loss. How can we fight against this? Even prevent it? The answer- food first. The food first philosophy aims at increasing calorie/protein/nutrient intake while preserving quality of life; something that is very important in all stages of life, but especially this stage. So, what does “food first” mean? Well, it means exactly what it says. When trying to increase calorie/protein/nutrient intake utilize real food first before turning to oral supplements. Dietitians can sometimes come under the stereotype “supplement pushers.” But we are so much more than that. And yes, oral nutrition supplement have a very real place in our job and in some cases are the most appropriate option. But the food first philosophy encourages us to exhaust all real food options first (if appropriate) before recommending an Ensure, Boost, Magic Cup, etc. Below are some tips to help you implement the food first philosophy in your facilities: Food Preferences: Don’t neglect collecting food preferences for all new patients. This is crucial. This ensures the patient is getting foods and beverages he/she actually likes, getting them off on the best food possible. If your CDM gathers the food preferences, make sure and references these when making a recommendation for a patient. You don’t want to add fortified oatmeal at breakfast if the patient dislikes oatmeal. Fortified Foods: Speaking of fortified oatmeal… Utilize the fortified foods offered at your facility (or talk with the CDM/FSM about adding some to the menu). Fortified foods are simply foods with a little extra bang for their buck. Examples include cheesy eggs, fortified potatoes (made with butter, sour cream, etc.), fortified oatmeal (made with butter, brown sugar, etc.), fortified soup (usually a cream based soup with added protein). Energy Dense Foods: Educate the patient on energy dense food choices and/or make recommendations on how they can add them to their daily meal plan. Two examples of energy dense foods include nuts/nut butters and full fat dairy foods/butter. If a patient still has poor PO intake or is still losing weight after utilizing all real food options, then you move to oral nutrition supplement choices. These include but are not limited to Ensure/Boost, Magic Cup, Ensure pudding, MedPass 2.0, or  TF if medically appropriate. Be sure and consult the patient before making a recommendation for a certain supplement. Always be sure they are on board! The good news is, we have a lot of tools in our tool box when it comes to helping fend off weight loss and increase PO intake in the geriatric population; it’s just important to know which tools to use first.
Why Meal Plans Don't Work
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If I have heard it once, I have heard it 100 times…” Can you make me a meal plan? I want to lose 10 lbs.” “I need to be healthier. Can you make me a meal plan?” “Can you make me a meal plan? I was just diagnosed as a type 2 diabetic.” It never fails. And do you know what my answer always is to them? My answer is always “No!” Normally this leads to a confused face on the other end, so I always follow my answer with an explanation. You see, people are always looking for an easy way out. They want someone else to do the work for them. And I get it. I am a busy woman. I work full time and have a three-year-old and a one year old. Not to mention a grocery shopping list, laundry to do, dishes to washes, etc. I get it. An easy way out sounds nice. But when it comes to making healthy lifestyle changes, the easy way out can actually slow the progress of true lifestyle change. It’s important to communicate this to your client prior to your first session or at the very latest during your first session with them. As RDs we are tasked with the responsibility of cultivating change in the way people eat, drink and even exercise. Cultivating long lasting, sustainable change takes time, effort and lots of input from the client’s perspective. Giving them a preset meal plan may help them lose weight in the short term, but they have not learned how to make healthy choices on their own and independence is key for the client to experience lifelong change.   Once they are on board with your “No Meal Plan” plan you can both begin the process of setting SMART goals (as talked about in a previous blog post). If you are having a hard time getting your client or prospective client to ditch the idea of a preset meal plan, try discussing the benefits of following a more flexible or intuitive eating plan instead of focusing on the negatives of a preset meal plan. I have posted some of those benefits below. Benefits of an Intuitive Eating Plan:- You will be getting rid of the diet mentality forever! - You will learn to not only recognize you hunger and fullness but honor it as well. - There will no longer be “good” and “bad” foods. - You will learn that meal satisfaction is a full circle experience involving not only the taste and texture of food, but also qualities of the environment around you. - You will learn to honor and respond to your feelings without using food. I believe intuitive eating leads to an overall healthier relationship with food and harnessing these techniques will ultimately lead to healthier and happier clients. Good luck!
Invest In Your Health
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Today on the blog we are talking to private practice RDs, those who own their own nutritional counseling business. One of the hardest parts about being in private practice is building a clientele. You not only have to make yourself and your services known to the community but you have to make the community see and understand your worth in PAYING for those services. Everything costs money these days. We are all trying to stay on budget, determine the difference between wants and needs and prioritize the goods and services we need now and those we can either wait on or do without. As a private practice dietitian you have to make the community see that your help, your expertise is worth paying for. And that can be an uphill battle. Here are some tips on how to boost your community presence, exemplify your worth and build a clientele. First: Determine the clientele or the population of people you want to reach and serve. This is completely up to you but will help guide your future marketing techniques and choices. Some RDs choose to be general and counsel any and everyone while others choose to focus on a few types of illness or topics and specialize in them. Second: Become credentialed with insurance providers. People are much more likely to utilize you if you take their insurance. This process can be long and tedious but is worth the time and effort in the long run. Third: Start developing relationships with medical and therapeutic providers in your community. Get to know your internal medicine doctor, your child’s pediatrician, your dentist, your friend’s personal trainer, your therapist etc. Word of mouth goes a long way. And have your business cards ready to hand them. Oh yeah…get business cards 😊. Fourth: Offer free general nutrition education sessions to the community (with business cards ready to go!). Offer a session at the senior center in your community on geriatric nutrition, offer a lunch and learn for therapist on how you can partner with them in treating eating disorders, offer a kid friendly education on MyPlate at a local library. The possibilities are endless.   Fifth: Be patient. This process can and likely will be slow. But as I have said in past blogs, slow and steady wins the race. Take your time, do your best with each client and word will spread! Good luck in all of your future business endeavors fellow dietitians! I hope this blog has been helpful to you!
Let's Eat!
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Generally speaking, the average American eats 3 meals a day, sometimes snacking in between meals. But how do we know when it's time to eat? Does someone tell us? Do we just innately know? Well, in a perfect world we would feel physical hunger, respond to that hunger by eating, eat until we feel satisfied and then stop eating. But for most of us, our desire to consume food is driven by much more than physical hunger and fullness. It's driven by a combination of both internal and external cues. If a person is not utilizing a strong self awareness as to why he or she is eating it could let to overeating or undereating if these cues are being ignored. Lets take a look at the difference between internal and external hunger and fullness cues. Internal hunger cues include the physical feeling of hunger. This could manifest as a stomach pain or cramping and/or an audible "growl" when hungry or slight stomach distention or feeling bloated when full. When hungry, it could also be a physical feeling of tiredness or lightheadedness from a lack of energy. These internal cues are driven by hormones and nerve signals released in the body in response to a lack of or replenished energy as it applies to hunger and fullness, respectively.  It's these types of cues you want your clients and patients to be aware of and listen to when deciding when and how much to eat. External cues are more prevalent and tend to be the cues the public rely on when deciding when and what to eat. External cues can include the actual site of food, it's presentation, the knowledge of what time of day it is and certain environment factors (aroma, lighting, etc.). Some people may not physically be hungry, be see food offered during a work meeting and eat simply because it is there. Also, someone may be physically full but still see more food on their plate so they continue eating. I believe a powerful tool in helping people establish balanced eating habits and practice effective weight management is first recognizing there innate INTERNAL hunger and fullness cues. Here are some ways you can implement this tool in your practice as a dietitian.1) Add this question to your initial assessment form. You could ask, "When deciding when and what to eat, do you find you listen to your body's hunger and fullness cues or respond more to the environment/presence of food?" You will find, more often than not, that people say they respond to their environment more than their physical bodies. 2) Educate the client/patient on the difference between internal and external cues 3) Challenge them to complete a "Self Awareness Log" for a week that requires them to identify and write down which cue they responded to when deciding when to eat, what to eat and when to stop eating.I hope you have enjoyed this blog post and find it applicable to your daily work! Happy practicing, dietitians!
Food Product Spotlight!
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The importance of eating fruits and vegetables is well known around the world. And for the most part, the general public is willing and even happy to incorporate more fruits into their daily diet. But vegetables…well that is another story. Their lack of sweetness compared to their counterpart make them less appealing to not only kids but adults as well. But one food producer is changing the vegetable game drastically by fresh freezing flavorful, premade vegetable side dishes, entrees, etc. Green Giant is producing a wide selection of products and they are a wonderful addition to grocery stores everywhere. Now to educate the public! Some of their newest products include the Harvest Protein Bowl, Cauliflower pizza crust, Veggie Spirals, Veggie Tots, Riced and Roasted Veggies. See below for further details on each product. Harvest Protein Bowl: A plant protein based entrée bowl that comes in 4 varieties- Asian, Southwest, Italian and CaliforniaCauliflower Pizza Crust: This pre made crust comes in 2 varieties, original and tuscanVeggie Spirals: Vegetable based noodle spirals made from fresh butternut squash, carrots, zucchini and even beets. Veggie Tots: These tots come in 4 varieties, corn, sweet potato and cauliflower, broccoli, broccoli and cheese and cauliflowerRiced Veggies: Perfect for the low carb fan, this "rice" comes in 11 varieties!Roasted Vegetables: These vegetables have already been roasted making then a quick and easy side dish! They come in 5 varieties.As a dietitian, it's important to stay up to date on the latest food trends, products, etc. so that we can successfully equip our clients to implement and lead healthy lives. This website also has premade recipes using their products so our clients can feel adequately prepared to put an entire meal together. Green Giant is not the only food producer streamlining the meal preparation process and making vegetables more appealing. Do some research for yourself (either online or in the grocery store itself) and see what you find! You will be pleasantly surprised! And check out the recipe page for a highlight from the Green Giant website. 
The Mind Body Conenction
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Nutritional neuroscience is an emerging field of research that has already identified some pretty interesting and applicable pieces of information as it pertains to the link between diet and mental illness. In the recent article “Understanding nutrition, depression and mental illness” multiple nutrition interventions were found to be successful complimentary or alternative medicine options when it comes to treating mental illness, specifically depression. Whether we are clinically or community-based dietitians, we will likely come into contact with a patient affected by this particular mental illness, so this is exciting news. Learning about the involvement of both macronutrients and micronutrients in our mental health will help us better inform and treat our clients/patients. Read below to find out more! Macronutrients: Fats: The first interesting finding in this study was that those who suffer from depression were found to have insufficient dietary intake of omega 3 and omega 6 fatty acids. “The main poly unsaturated fatty acid in the brain is DHA, derived from the omega-3 fatty acid α-linolenic acid, arachidonic acid (AA) and docosa tetraenoic acid, both derived from omega-6 fatty acid linoleic acid. Experimental studies have revealed that diets lacking omega-3 poly unsaturated fatty acids lead to considerable disturbance in neural function.” Their deficiency can also accelerate cerebral aging by preventing the renewal of membranes. Proteins: “Many of the neurotransmitters in the brain are made from amino acids. The neurotransmitter dopamine is made from the amino acid tyrosine and the neurotransmitter serotonin is made from the tryptophan. If there is a lack of any of these two amino acids, there will not be enough synthesis of the respective neurotransmitters, which is associated with low mood and aggression in the patients.” Carbohydrates: As dietitians, we know that eating a meal rich in carbohydrates stimulates the release of insulin into the body which allows glucose to enter cells and be used for energy. But it also stimulates the uptake of tryptophan into the brain positively effecting neurotransmitter levels. Low carbohydrate diets exacerbate depression symptoms as there is less production of the brain chemicals serotonin and tryptophan. Micronutrients: B Vitamins: The article found that those suffering from symptoms of depression were likely to be deficient in B complex vitamins, vitamin B12 and folate and supplementation of these vitamins showed a decrease in said symptoms. Iron: Iron deficiency is thought to play a role in the onset of depression as this deficiency causes fatigue and apathy. Zinc: “At least five studies have shown that zinc levels are lower in those with clinical depression. Furthermore, intervention research shows that oral zinc can influence the effectiveness of antidepressant therapy. Zinc also protects the brain cells against the potential damage caused by free radicals.” Calcium: Research shows that SSRIs can inhibit the absorption of calcium which can lead to lower bone density and increase the rick of fractures (especially in the geriatric population). As you can see this emerging research is of great use to us as Registered Dietitians. Practical takeaways from this article could include (all while using clinical judgement) starting all patients/clients on a multivitamin with minerals, possible a B complex supplement, folate and or omega 3 fatty acid supplement. Having an iron level and calcium level checked for all clients/patients who take SSRIs may also be of benefit. One thing is for sure, this field of research is gaining more exposure and will help us better treat our clients/patients. Some of the article was quoted in this blog post, but click on the link below to read it in full! https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738337/
Micronutrient Deficiencies in the Elderly
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“Macros” has become an almost commonplace phrase in the health and wellness community lately.  Anyone on a weight loss journey who has visited you as a Registered Dietitian, has probably asked you to assess his or her macro intake. Although “macros” or macronutrients have a large impact on energy availability, muscle structure and lipid levels; micronutrients play an equally important role in sustaining human life. More often than not though, it’s the micronutrients that are ignored and forgotten about. A population of individuals that is particularly at risk of micronutrient deficiencies is the elderly.  Some of the leading causes of micronutrient deficiencies include 1) age related physiological changes such as forgetfulness, and loss of appetite, resulting in poor dietary intake, 2) financial factors that limit food purchasing and 3) medications that decrease the body’s ability to absorb nutrients. Common micronutrient deficiencies you will see in this population include calcium, vitamin D, magnesium, vitamin C, vitamin E, and vitamin B6. These micronutrients play a powerful role in the human body. Calcium is needed for strong bone density. Low calcium levels can lead to osteoporosis and subsequent bone fractures from lowered mobility and falling. Vitamin D is calcium’s best friend and helps calcium to be absorbed. Magnesium is the jack of all trades mineral that plays a part in blood pressure regulation, muscle contraction, making DNA and participating in hundreds of cellular reactions. Deficiency in this mineral can manifest as fatigue, muscle weakness/twitching and even depression. Vitamin C helps with the absorption of proteins, increases immunity and is an antioxidant helping to prevent cellular damage. Deficiency in this micronutrient can lead to delayed wound healing. Vitamin E is also an antioxidant that supports immune function. Vitamin B6 is largely involved in promoting adequate cognitive function, but also play a part in protein absorption like our friends, Vitamin C and E. Where are good sources of these micronutrients? Well, I’m glad you asked!Calcium: dairy products, dark leafy greensVitamin D: absorbed by the body through sunlight but can also be found fortified foods like orange juice or milkMagnesium: dark leafy greens, nuts, seeds, whole grainsVitamin C: citrus fruits, bell peppers, tomatoesVitamin E: nuts, seeds, vegetable oilsVitamin B6: organ meats, fish, starchy vegetables (like potatoes)If you are an RD working in a LTC facility, make sure your menus contain a variety of these foods to ensure adequate nutrition for this age group. Community RDs can focus on education, or better yet, host a grocery store tour for this age group and show them where to find these foods! There are many ways to get the word out there and help our fellow neighbors. Check out the most recent recipe page for an example of a calcium rich meal/snack!