Today I did a nutrition assessment for a friend to help improve her nutrition and meet some health goals. After our hour long session and giving her my "nutrition prescription" for the week I asked her if she had any feedback for me and if what she got was what she expected. What she said totally blew my mind, basically to the point of being an epiphany. "I thought that you would give me a list of foods that I needed to eat to help fix the specific problems." Woah! Mind blown! Okay, your mind probably isn't blown because if you are like 99% of the population you thought the exact same thing. This makes complete sense when you consider our health care system. You get sick, go to the doctor, they give a specific thing that you  take (aka a pill), you take it, you get better. Pretty much any health care profession I could think of has a similar approach. But dietetics is not like that. Why? Because foods are not isolated compounds and eating is not a one time event. Before you are totally confused and stop reading, let me explain. 

First, food, even in its simplest form, is made up of many different components. Fiber, vitamins, minerals, phytochemicals, protein, carbohydrate, fats, and water are just a few of the main components of our most basic foods. For each of those categories I just named, there are sub categories. Types of fiber, vitamins, minerals, phytochemicals, proteins, carbohydrates and fats. There are over 5000 phytochemicals alone! Are you starting to get the picture? Food is very complex. Pills and medicines are isolated compounds, put together in a very specific way meant to have a specific outcome. If you give someone a pill you have a pretty good idea what the outcome is going to be because you know exactly what you gave them. Food is not like that because no compounds are isolated. (And trust me, you don't want them to be. I have tasted isolated amino acids before. Lets just say there is a reason its generally given through a feeding tube). 

Second, who wants to eat the same way we take pills? Every day count out what you need at breakfast, lunch and dinner, and then eat it just because you need whatever is in that food. It would be awful, and quite frankly, its not what your body needs. It needs nutrients coming in to fuel it, and it knows what to do from there. It needs a wide variety of things all working together to make it function, and you get that wide variety from eating different foods. There are times when a specific element is missing (a common example is iron), but that doesn't mean I would recommend sucking on rusty metal or even drinking blood (a great, but disgusting,  source of iron).  I would recommend eating foods that are high in iron and teach you food combinations that help your body absorb more iron because that works with how our body is naturally designed to function. 

So what does a dietitian do when they see you? 
First step is to do a nutrition assessment using what I call the ABCs. 
A- Anthropometircs: This is your basic height, weight, BMI, mid-arm circumference, and hip-to-waist ratio type of things. Dietitians use this information to assess your body, what it needs, and what it might be at risk for. 

B- Biochemical: This is blood work checking for things like iron levels, protein levels, and other things that tell us what is going on inside your body. 

C- Client History: Basically we ask you really random questions about your lifestyle and history that seem really weird to you but have meaning to us. Things like bowel movements, your exercise habits, and your job. This gives us a picture of who you are, what your lifestyle is like, and how it impacts your nutrition. 

D- Dietary: This is the part you probably would expect; we ask you what you eat.

After completing an assessment we talk with you about what things you need to change to be healthy, we educate you on how to do those things, we set goals with you, and send you off to give it a try. A week or so later (depending on the client and the dietitian), we meet up with you and see how it went. If you were able to meet your goals and feel confident you can keep doing them we add a new goal. If you weren't able to meet your goals we figure out why, change our approach so that you can meet your goals, and repeat the process. How long this process takes depends a lot on the client, how drastic the changes are they need to make, and how well they are able to follow the goals. Some people like to meet often to be accountable, others like to meet with a dietitian once every couple months. Either way is good. 

What is the purpose? 
To help you make healthy lifestyle changes that will keep your body healthy and happy. A dietitian looks at your past history (and even your family's history)to see what diseases and problems you might be at risk for or are already having problems with. They then educate you on what changes you need to make, give you tips on how to make those changes easily, and keep helping you change until you feel you've got it or until the health problem is under control. 

What's the catch? 
We can't make the changes for you. We can talk to you until we are blue in the face, we can help you by reminding you and encouraging you every day if needed, but if you aren't willing to do what we say nothing is going to change. Shocker. The other catch is that if you can't do the simple things (like eat your fruits and vegetables), we won't get into the more complex things (like combining foods to increase iron absorption). I think that is the hardest thing for clients. Everyone wants a magic pill, and with nutrition there are no magic foods or cure-alls. To get lasting benefits it really is all about making slow and steady changes. Boring, right? Don't even worry! Nutrition has more exciting things than you could ever imagine! After you eat your vegetables I'll tell you about them. :)

As a dietitian I am often faced with the dilemma of what to put on my plate in public. If I put only fruits, vegetables and quinoa on my plate those who know I am a dietitian will look at my plate and label me as the food police who takes away all good foods and never eats anything unhealthy. If I put dessert or white bread on my plate they will look at my plate and judge me to not be a good dietitian because I ate unhealthy foods and therefore everything I say is no longer credible. I have to say, it makes things tough at gatherings centered around food. 

I began pondering on this dilemma months ago while watching Tara Stiles' global YouTube following hang on her every word about diet, nutrition and what she ate. I realized it was a dilemma I face when a woman from church came over to introduce her self bearing a chocolate bar as a gift. Upon finding out I was a future dietitian she was completely mortified that she had brought the chocolate and apologized profusely. I assured her that I ate chocolate (yes, even Hershey’s milk chocolate) and that I greatly appreciated the gift. A month later she was back, this time with a box of CostCo clementines. While it is true I sat down and ate 4 clementines for a snack while I ate the chocolate bar only one square at a time over a mater of days, it does not make the chocolate bad. But still my every food choice seems to bring me yet again to the dilemma of what does my plate say about me to others. 

Here is what I have decided. Foods are like people; they all have their redeeming qualities. My favorite oatmeal cookies, while loaded with fat and sugar are also whole grain. Sweet potatoes, while being loaded with fiber, antioxidants, vitamins, and minerals is also really high in carbs and therefore calories. I could categorize the “good” and “bad” parts of foods all day long, but it makes me go crazy when I do it with my own plate. So what do I do to eat healthy?

1) I make 1/2 my plate fruits and vegetables at every meal (Seriously. Make 50% of what you eat fruits and veggies.)

2) I say “no” to foods I don’t really like (Nachos? Yuck. Cake? Likely dry and not worth it. Chocolate? I’ve got to be in the mood. You get the point.)

3) I don’t reward myself with food (You are not a dog; don’t do it.)

4) Focus on new nutrition goals regularly (Always focus on new, positive ways to propel yourself forward into living a better lifestyle.)

5) Don’t stress it! (You will drive yourself, and everyone around you, crazy. I’ve been there, done that, and am so done with it.)

Overly simplistic? Maybe. But it is what works for me and I am always trying to do a little better. You’ve got to find what works for you and stick with it. 

What works for you? Leave me a comment and let me know. I love getting new ideas from all of you! 

Last year I was walking to campus and saw an acquaintance of mine on the way. "What class do you have so late?" she asked. "I'm going to a biochemistry review," I replied.  "No way! You mean your major is hardcore? I thought it was just cooking and stuff. I have so much more respect for you now." This scenario happens surprisingly often.

Most people have no idea what a dietitian does. Some people pull out the root "diet" and assume I am a diet coach or food nazi. Other people just pull out the die part and get a little worried. What most people don't catch on to is that dietetics actually has a medical and business background before getting into all the nutrition "stuff."

Before starting the dietetics program students have to take:

Essentials of Human Nutrition (basic nutrition)
Nutrient Metabolism (the biochemistry behind nutrition)
Essentials of Food Science (the chemistry and physics of food)

Introductory Chemistry and Introductory Bio-organic Chemistry (so you can hopefully understand all those other chemistry related classes you take)
Accounting 200 (because "accounting is the language of business")
General Microbiology (so we know the importance of washing hands and about all the bacteria that grow on food)

Human Anatomy and Physiology (a medical field basic and a necessity for future clinical classes)
General Psychology (to better understand counseling with patients and clients)
Principles of Statistics (to help us translate all the technical 
research articles we read)

After we take all the prerequisites and get accepted into the dietetics program we move onto the good "stuff."  

Clinical Nutrition I (we learn about half of the major diseases with nutrition implications and their medical nutrition therapy) 
Clinical Nutrition II (we learn, and then teach, the other 
half of the major nutrition related diseases)
Pathophysiology (we learn about the broken physiology that causes all the diseases we are learning about in clinical)

Food Production Management (we learn how to manage a commercial kitchen)
Food Production Management Lab (we do the dirty work in a commercial kitchen, better known as Pen Court)
Foodservice Systems (we learn more about managing commercial kitchens effectively)

Community Nutrition (we learn how public policy affects nutrition in the nation and about counseling different cultures) 
Community Nutrition Fieldwork (we volunteer at community programs such as the food bank, WIC, Food and Care Coalition and Senior Centers to learn how they are run)
Nutrition Assessment Lab (we learn how to take blood pressure, do skin folds, take blood and urine samples, and take other anthropometric measurements) 

Nutrition Through the Life Cycle (nutrition for specific age groups) 
Nutritional Biochemistry (the "hardcore" nutritional chemistry class) 
Teaching Methods (we learn how to effectively teach all we've 
learned)

Management in Dietetics (we learn the basics of management) 
Advanced Dietetics Practice (we "build a freakin' hospital" (to quote one of my classmates) for our capstone project and learn more clinical nutrition)
Research in Dietetics (we learn how to write those complicated 
research articles we've been reading all along)

Plus I took the recommended: 

Sports Nutrition (an attempt to explain why athletes do the crazy food things they do)
International Nutrition (common nutrition problems in other countries) 

Incase you missed it, we do more than just cooking. After taking all of these classes and graduating with a bachelors of science  we apply for a dietetic internship. This is basically a 6-12 month period of supervised practice while taking even more classes. Its like a combination of going to grad school and doing residency for med school. After that is completed interns take the RD exam and become registered dietitians or RDs. From there the possibilities are almost endless because we are pretty hardcore.