Friday, November 27, 2015

Lactose Intolerance

The Latest on Lactose Intolerance: What It Is, How It's Diagnosed, and Tips for Counseling Clients - Today's Dietitian Magazine

Lactose intolerance is a common condition that can cause extremely uncomfortable gastrointestinal symptoms.  Although the condition is benign, the nutritional consequences of being lactose intolerant are not benign. Those who are lactose intolerant will generally limit or eliminate dairy products which can lead to the lack of Vitamin D and calcium.  Lactose-free options and/or consumption of small amounts of dairy can be recommended.

Lactose (milk sugar) must be broken down into the simple sugars glucose and galactose by the intestinal enzyme lactase in order to be absorbed in the intestinal tract. Lactase is usually able to break down lactose in the small intestine.  If you are lactose intolerant, this enzyme is lacking, so lactose cannot be digested.  When the undigested lactose moves from the small intestine to the large intestine, the lactose will ferment in the large intestine by the bacteria. The bacteria give off hydrogen and methane gases and symptoms result.

According to the article by Denise Webb, PhD, RD, it is believed that as much as 80% of the African-American population is affected, 53% of the Hispanic population, and about 15% of the Caucasian population. Almost 100% of some Asian countries are lactose intolerant. Most people are born with the ability to digest lactose, but this ability may lessen significantly after about age 2.

Many with lactose intolerance feel that they cannot consume any dairy products.  However, each person may have a different “lactose threshold", which would allow them to consume some lactose without discomfort.  Each threshold is different so the individual would have to introduce lactose slowly into their diets to determine the threshold.  For those who are not willing to do this, lactose- free dairy products are available to help meet nutritional needs.

Several lactose-free dairy products are available that may make it easy for people to meet their calcium and nutrient needs. A lactose-free product, in which the lactose is hydrolyzed or predigested, is an option for lactose intolerant individuals.  Some of these products include Lactaid, Horizon Organic, and Dairy Ease lactose-free milks. Lactose-free ice cream, yogurt, and cottage cheese are also available. These products typically contain between 0 g to 2 g of lactose per serving, well under the typical threshold for symptoms.  Choosing these lactose-free options along with the introduction of small amounts of dairy into the diet can help lactose intolerant individuals meet calcium and other nutrient needs.

Webb, D. (2015).  What it is, how it’s diagnosed, and tips for counseling clients.  Today’s Dietitian, 17(5), pg. 38


Thursday, November 26, 2015

Weight Gain During The Holiday

Whats the Latest on Holiday Weight Gain?

I’ve always believed that the average amount of weight gained during the holiday (Thanksgiving through New Year’s Day) ranged from five to 10 pounds.  However, according to the article “What’s the Latest on Holiday Weight Gain”, there is no research to support this belief.  A study conducted by the New England Journal of Medicine proposed that on average, the gain is only about one pound. 

            The study was based on 195 participants who were weighed at six week-intervals before, during and after the holiday season.  Although most of the participants believed that they had gained at least four pounds, most only gained one pound.  Only 10% gained more than five pounds during the holidays.  Participants who gained five or more pounds were overweight or obese before the holidays. This may be an indication that the holiday season may present special challenges for those individuals who are already overweight or obese. 

            Participants, who engaged in physical activity, experienced less weight gain during the holidays. This suggests that physical activity can be a successful way to reduce the chance of weight gain during “high-risk times such as the holiday season. Another way to reduce the chance of weight gain was noted in an article published in August, 2013.

            The article compared the success of counseling of overweight women by registered dietitians to maintain their weight during the holiday season versus the standard of care offered by the primary care physician suggesting they lose weight and adopt a healthy lifestyle.  It was found that encouraging women to maintain their current weight while providing them with individual goals was more successful than general recommendations to lose weight.  The study shows the importance of registered dietitians in “facilitating behavior change strategies that can lead to weight loss or maintenance”.  Primary care physicians are just not equipped to address the issues involved in helping the client to maintain or lose weight.   Registered dietitians are trained to help clients learn new ways to think about the holidays, which can help them maintain control of their weight during the holiday season and other “high-risk” times.
Cunningham, E. (2013).  What's the latest on weight gain?  The Academy of Nutrition and Dietetics.  Retrieved from


Monday, November 23, 2015

Mediterranean diet

Upton, J. (2015, October). More reasons to eat a Mediterranean style diet. Retrieved from

The benefits from following a Mediterranean diet are ample, decreasing the risk of heart disease, stroke, inflammation, depression, and asthma and helps reach weight loss goals.  It’s main focus is on consuming natural, plant-based foods, such as fruits, vegetables, nuts, legumes, and healthy fats in the form of olive, nut, or seed oil.  Almost every meal is begun with a salad or tomato based soup and finished with fresh fruit or fruit-based soup.  About 50% of energy comes from complex carbohydrates, such as oats, bulgur, couscous, bread, and pasta.  It is high in omega-3 fatty acids due to the availability of fresh fish and seafood from the Mediterranean.  It also encourages the consumption of walnuts as a protein source instead of beef or other red meat.  This lifestyle is low in sweets and candy, fried food, and sugar-sweetened beverages, all leading to healthy benefits. 

An example of a Mediterranean menu includes:

1 c cooked oats topped with ½ c nonfat Greek yogurt and ¼ chopped walnuts

Hummus with whole grain pita chips and fresh veggies

Lentil soup with two slices whole grain bread and a fresh fruit salad with chopped fresh mint

3-4 whole grain crackers
8-10 olives
1 oz low fat Manchego cheese

Tossed Greek salad with olive oil and red wine vinegar dressing
Homemade Mediterranean chicken burgers
Fresh fruit for dessert
Glass of wine :)


Sunday, November 22, 2015

Virtual Nutrition Counseling

Advances in technology are contributing to the growing popularity of dietitians moving away from the traditional office counseling setting and toward telehealth and telenutrition services (Zanteson, 2014). Telehealth and telenutrition services are virtual forms of nutrition counseling which offer a convenient way to meet client needs. Many medical professionals are using virtual health services already, such as video conferencing, email, Internet counseling, and over smartphones. Dietitians have started to pick up on the trend in order to accommodate the needs of clients. In addition, these services are now officially recognized by the Academy of Nutrition and Dietetics with formal definitions (Zanteson, 2014). According to the Academy, “telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration” (Zanteson, 2014). Subsequently, “telenutrition involves interactive use, by a RD or RDN, of electronic information and telecommunications technologies to implement the Nutrition Care Process […] with patients or clients at a remote location, within the provisions of their state licensure as applicable” (Zanteson, 2014). The Academy also offers information for RDs about this area of practice if it is something they want to begin.

            There are many benefits of virtual nutrition counseling. Some clients may dislike the face-to-face interaction associated with counseling and be more inclined to choose a virtual option if available. Also, this form of counseling is convenient for travelling clients or those who have a difficult time attending meetings due to transportation troubles. Virtual counseling can be quick and efficient and potentially reach more individuals than the traditional setting would allow. It also gives a lot of flexibility to RDs as well as the potential of limiting office-space costs associated with a business. However, there are also some disadvantages to consider. Phone calls eliminate the ability of the RD to read nonverbal physical cues as well as maintain eye contact that is essential to building a trusting bond between the client and the dietitian. Therefore, virtual counseling is not suitable for all clients, such as patients with eating disorders, and needs to be determined on an individual basis (Zanteson, 2014). Some other challenges include cancellations, lack of insurance coverage for virtual sessions, and potential legal issues with HIPAA privacy and security (Zanteson, 2014). However, this area continues to be a growing trend and interested dietitians could benefit from implementing these services to their scope of practice.


Zanteson, L. (2014, April). Virtual nutrition counseling. Today’s Dietitian. (16)4, 42.

Friday, November 20, 2015

Supermarket Tours

The face of public health and retail in America is changing. Because, supermarket dietitians.
Supermarket dietitians are helping bridge gaps in community health one grocery store at a time. Dietitians are hoping that nudging customers toward healthier options, educating at the point of purchase, and providing shopping lists and menus for specific health concerns or diseases/conditions, to name a few, would fill these gaps (Webb, 2015). Right now, there are about 1,000 supermarket dietitians nationwide complete with corporate and retail dietitians (Webb, 2015). Supermarket dietitians offer unrivaled access to nutrition services and information to consumers. This is a big deal because it allows consumers to come into the store and speak directly with a dietitian with no added hassle. In-store supermarket dietitians are there to counsel shoppers, provide nutrition education, answer questions on the stores’ website, and help consumers make healthful choices (Webb, 2015).
Supermarket tours, nutrition classes, cooking demonstrations, food sampling, and collaboration between physicians, pharmacists, and chefs are but a few of the ways change was being implemented. In the last few years, grocery store chains have been offering supermarket/nutrition store tours. Often, these tours are intended to convey needed information/facts about nutrition to improve knowledge, motivate shoppers to establish healthy eating practices and gradually change habits related to nutrition, help consumers eat more healthfully on a budget, and increase healthful food purchases. Barbara Ruhs, MS, RDN, LDN weighed in, saying that these tours “can be the first line of defense in preventing and treating chronic disease” (Ruhs, 2015). The impact in-store dietitians’ have on public health and retail business is huge.  
Ruhs (2015) has identified 10 strategies dietitians can use to plan their tours and improve success. These include (1) Coordinate efforts with store personnel; (2) Use store layout and design and selling psychology; (3) Plan the tour in key departments (i.e., Can start in produce first then move to the dairy section); (4) Schedule tours to accommodate participants (Choose a convenient time; limit tours to about 60-90 minutes per session); (5) Customize the tour; (6) Build trust with shoppers; (7) Make learning interactive (i.e. Offer product samples; do an interactive nutrition facts labeling and ingredients list exercise); (8) Highlight resources; (9) Offer incentives to shoppers (i.e., free reusable bags filled with coupons, product samples, recipe cards); and (10) Take advantage of resources (ie., Share Our Strength’s Cooking Matters at the Store program; The Whole Grains Council Whole Grains Store Tour Kit; Network for a Healthy California retail program) (Ruhs,2015).
For supermarket dietitians, hosting tours can prove useful. The thing about hosting supermarket tours is that to be effective, dietitians should consider the above strategies. The benefits behind this are increased awareness and knowledge about food, label reading, and healthy eating, which can lead to improved health in the community. Two additional benefits that have been highlighted are improved sales and customer satisfaction (Ruhs, 2015).
As demand for healthier products increases, so too has the reliance on dietitians in retail settings. Dietitians: Good for business. But most importantly, good for providing nutrition advice to shoppers, providing encouragement and support, and helping shoppers make meaningful health changes to improve health and well-being.
Ruhs, B. (2015). Hosting supermarket tours. Today’s Dietitian, 17(11), 40.
Webb, D. (2015). Retail RDs’ impact on public health. Today’s Dietitian, 17(3), 40.

Thursday, November 19, 2015

Home Parenteral Nutrition

Long-term home parenteral nutrition (HPN) is a life-saving therapy for patients with chronic intestinal failure (Fessler, 2011). The most common indications for parenteral nutrition (PN) in the home include “severe short bowel syndrome-insufficient enteral absorptive capacity; complete small bowel obstruction with failure of enteral tube feeding; malnutrition with malabsorption that has not improved with the use of medications or altered nutrient content of enteral formulas; malnutrition and motility disorder that has not improved with medications; high output enterocutaneous fistula with inability to enteral feed distal to it; inability to maintain nutrition/hydration due to high ostomy output that has improved with the use of medications” (Fessler, 2011; Nelson, 2007).

Interdisciplinary involvement by the health care team is important for effective patient care in the home and is an area of ASPEN focus. Collaboration among team members including physicians, nurses, dietitians, and pharmacists, are important to monitor and manage patients on HPN. Interdisciplinary collaboration in all aspects of care can potentially improve quality of patient care and outcomes (Fessler, 2011).

As the concept of HPN has grown, it has become apparent that there is a need for dietitians in the care of patients receiving parenteral support at home. For dietitians involved in home care, the issues to consider include:

  • Determination of medical necessity and financial coverage
  • Determination of goals of therapy
  • HPN monitoring
  • Electrolyte disturbances and hydration status
  • Appropriate diet advancement (when possible)
  • Signs of infection
  • Micronutrient status
  • Long-term PN complications
  • Liver and bone health
  • Quality of life and psychosocial issues

A summary statement for the above issues are discussed in the article.


Fessler, T. (2011). Optimizing care in home parenteral nutrition: the RD’s role. Today’s Dietitian, 13(7), 38.

Nelson, M. (2007). Medicare reimbursement of home nutrition support. Today’s Dietitian, 9(1), 12-21. 


Heart Healthy Trend among Baby Boomers Population

            With the large population of the ageing baby boomers generation focus on a healthier way of life is demanded especially in areas of the heart. Heart health a multifactorial issue is a serious concern among Americans due cardiac events and cardiovascular disease which can be a result of unhealthy dietary behavior or unhealthy lifestyle habits. According to the American Heart Association half of Americans will suffer a cardiac event in their lifetime, and 1/3 of Americans will die of cardiovascular disease. In regards to nutrition, dietitians play a major role in promoting heart health. Through appropriate nutrition, heart health can be promoted in a simply manner (possibly without medication). Therefore, dietitians play a crucial role in this area and should be up to date on emerging research in this area. 

            An article by Gillespie, (2013) discussed health benefits of grains and soy in regards to its beneficial effects to heart health. Oats and barley which are packed in beta-glucan are beneficial to heart health by lowering cholesterol. Some studies suggest that replacing most of the grains in an individual’s diet with barley and oats to promote heart health. Soy foods such as soy milk, soybeans, and tofu provide high quality protein with cholesterol lowering effects. Research has also shown that carotid intima media thickness (thickness of the carotid artery which supplies the neck and brain with blood) is thinner (reducing the risk of a stroke or a cardiac event) in postmenopausal women of Japan, a culture where soy products are largely consumed.  

H. K. Seligman, C. Lyles, M. B. Marshall, K. Prendergast, M. C. Smith, A. Headings, G. Bradshaw, S. Rosenmoss, E. Waxman. A Pilot Food Bank Intervention Featuring Diabetes-Appropriate Food Improved Glycemic Control Among Clients In Three States. Health Affairs, 34 (11). DOI: 10.1377/hlthaff.2015.0641