What a Clinical RD Does

Well, it’s been a quick minute, and in honor of National Nutrition Month, I thought there was no better time to resurrect the blog. I additionally thought it would be a good idea to talk about what exactly a clinical dietitian does. I wanted to write this post for students who are thinking about applying to a dietetic internship and/or a career in nutrition after they graduate. Or I thought this would be helpful for anyone looking to make the switch into dietetics. I know when I was in school I would have found a blog like this helpful in letting me know what to expect.

So, a lot of people ask me what I actually do, and a few have asked me to walk them through a typical work day for me. Here’s how it goes….

what-dietitians-do

I come into work around 8:00 AM and log onto a program called CBORD, where I print out the floors that I’m assigned to. This is basically a roster of patients who are admitted, their diet orders, and when they’re due to be seen for a nutrition assessment or a follow up. I make up my list of patients that are due for that day and then log into the electronic medical record. Then, I look up my patients’ past medical histories, their labs, their weight histories, and their medications, and basically try to get a big picture about what’s going on with each individual patient. I take note of anything pertinent to their nutritional status and what may be interfering with their food intake. Then, once I have all of my patients’ information, I go up to the units and attend interdisciplinary rounds with the doctors, case managers, physical therapists, and social workers. There, I can figure out which patients have pressing nutrition issues, who should be seen by a dietitian, and can give recommendations to the doctors about my patients. Then, I’ll go around to each patients’ room and interview them. I find out how their appetite is, how they’ve been eating, if they’re having any nausea, vomiting, diarrhea, or constipation, any chewing/swallowing issues, any weight changes, etc. etc. etc. There’s surprisingly a lot of talk about bowel movements with strangers, so you really cannot be shy if you want this job.

If it’s necessary, I will give diet education to the patient and family members. I cover a cardiac unit and give a lot of heart healthy and diabetic diet education. I also cover a surgery unit so I talk a lot about appropriate diets for gastrointestinal surgeries. If a patient is having issues with eating or are likely not meeting their estimated calorie and protein needs (which can lead to weight loss, trigger pressure ulcer development, and impair the ability to fight off infections, among many other medical complications), we help the patient figure out how to increase their intake. If necessary, we may have to calculate tube feeds, which is a specialized formula consisting of calories, protein, vitamins, and minerals and is delivered to the patient via a tube through the nose or directly into the stomach. If the GI tract isn’t functioning, then we will write something called total parenteral nutrition, or TPN, which is basically a solution of dextrose, amino acids, lipids, and electrolytes that is infused via an IV.

There’s a lot more to being a clinical dietitian than it may initially seem. There’s a lot of math involved if calculating a TPN, tube feed rate, or even a calorie count (where the nurse writes down everything the patient eats to determine if a patient requires alternate means of nutrition). There’s also a lot of patient advocacy and explaining to doctors why we are recommending what we’re recommending, and getting them to implement your recommendations. Also, at least where I work, there’s a lot of camaraderie amongst my fellow RDs, and we work together as a team on interesting patient cases to determine the best solutions to nutritional problems.It’s a challenging and rewarding job, and you get to see and learn about a lot of very interesting medical conditions and procedures.

So that is what I do on a day-to-day basis. In the meanwhile, if you are a student currently applying to dietetic internships, good luck! If you’re thinking about becoming a dietitian, feel free to reach out with any questions, I would be happy to answer them!

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Which Oil Loves Your Heart More?

In the hospital where I work, I cover two floors that treat patients specifically for heart disease and its related comorbidities. Therefore, a fair percentage of my patients ask questions pertaining to diet and what they “should” and “should not” be eating. A big question that’s been asked many times lately is what the best type of oil is to use while cooking. More specifically, is coconut oil better than olive oil? It’s a valid question, considering coconut oil has been recently touted in the media as a superfood with many multi-faceted health benefits.

I personally use both coconut oil and extra virgin olive oil, but for different purposes. For instance, I like to use a teaspoon of coconut oil when sauteing vegetables, because I feel as though it can take to higher heat a little better. Meanwhile, I like to drizzle olive oil over proteins and vegetables when roasting them in the oven, and to dress up my salads and pastas.

The truth is, you can Google “coconut oil benefits and uses,” and a million pages from unreliable blogs and websites will pop up. But, when doing a brief search through scientific publications, I found that straightforward human studies comparing the health benefits of coconut oil consumption to olive oil consumption is limited. One review article I found reported that virgin coconut oil (less processed than refined coconut oil), does have some heart healthy benefits secondary to its medium-chain fatty acid (MCFA) content. A little background: MCFAs are absorbed in the intestine faster than long or short-chain fatty acids, and are used up for energy more quickly in the liver, reducing fatty acid levels circulating in the blood. Virgin coconut oil also has antioxidant properties, which can lead to improved cardiovascular health and reduced inflammation. Studies examined in this article found that MCFA supplementation helped promote weight loss and healthy cholesterol levels. This all sounds great, but the authors were unable to make a conclusive statement that coconut oil was actually better than olive oil, because coconut oil is also rich in saturated fatty acids (which cause it to be solid at room temperature, like butter). Saturated fatty acids are more greatly associated with inflammation and high cholesterol, which can worsen your overall risk for cardiovascular disease. So clearly, there’s no conclusive evidence here that coconut oil consumption may actually be amazing for your heart health or if it deserves to be lauded as a superfood.

If you want a simple, straightforward, side-by-side comparison between coconut oil and olive oil, I found this infographic from the Cleveland Clinic that breaks down the main differences between olive oil and coconut oil. The conclusions are to stick with olive oil, because it is higher in monounsaturated fats (or MUFAs, which allow it to be liquid at room temperature as opposed to solid. I know, there are SO MANY KINDS of fats). MUFAs have been extensively studied and are known to decrease overall inflammation and cardiovascular disease (even more so than medium chain fatty acids). Other good sources of MUFAs include salmon, almonds, and avocados. You can check it out below, and find the full article here.

The Cleveland Clnic. http://health.clevelandclinic.org/2013/10/olive-oil-vs-coconut-oil-which-is-heart-healthier/

Bottom line: If a patient with heart disease were to ask me which oil they should use, I would recommend olive oil, and to use coconut oil sparingly due to the saturated fatty acid content. What else have you heard about coconut oil? Sound off in the comments!

Source: Babu AS, Veluswamy SK, Arena R, Guazzi M, Lavie CJ. Virgin Coconut Oil and Its Potential Cardiac Effects. Postgrad Med. 2014 Nov;126(7):76-83. doi: 10.3810/pgm.2014.11.2835.