RD Q&A vol. 28

Happy Wednesday! Another great line-up of questions…here we go!

Brooke: Hi Nicole, It is so strange that you posted the question about the internship. In was going to email you a similar question. I know the internships are often picked by computer, how does that work. I am a single mom trying to figure out how to go back and finish my degree and I would like to do it in dietetics. I do not have the luxury of moving for an internship so it would have to be close to home. Is this something you usually have to move for. Also what can you do with the degree if you can not get an internship? I know you can not be an RD. Thank you!

Prevention RD: Hi Brooke! Great questions! Dietetic internships and the entire process is…confusing. Basically how it works is that you apply to various programs that you would like to attend (in your case, close to home) and then rank them based on your preference. The schools then rank their applicants and through a “mutual matching process” the “match” is generated. At that point, you either accept or deny. Since you applied and ranked that school, it is basically assumed you go there unless there are extenuating circumstances. I’ll be honest. I applied to 6 programs. My first choice was ranked #1 because it offered a comfy stipend. My second choice was “comfortable” because I had interned at that particular hospital one summer. My third choice was close to home and a good, but very expensive program (internship + master’s + thesis). I got matched with my 3rd choice and attended…and it cost me a lot of money…money to the tune of $70k in 15 months (which included my very modest living expenses)! That said, the “match rate” is about 50% — if you’re matched and want to be an RD…you go. I wish I could speak more on nutrition professionals that are not RD’s, but I do know that jobs exist. At the wellness center associated with my hospital, there’s a nutritionist who works 8 hours a week and has another great job working for the state’s dairy council. She is wonderful and loves her jobs. While I don’t think the opportunities are as abundant for nutritionists who are not RD’s, there are opportunities. I hope this helps some. Good luck pursuing the path. If it’s the right fit, it will all come together 🙂 Please keep me posted!

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Samantha of Samantha Menzies: My brother-in-law has Crohn’s disease and it is very severe. Unfortunately, his diet is craptastic and consists of lots of fast food, caffeine, sugar, and refined carbs. He says that eating a lot of vegetables can be painful to his stomach but I’m pretty concerned that his bad diet combined with the inability to absorb nutrients because of his damaged intestines is causing him to be nutrient deficient. I can even witness this in his inability to focus and his poor sleeping patterns (and those are just the problems that I see!). I know that part of the problem is just getting him to eat right to begin with, but I’m also curious what sort of diet is recommended for someone with Crohn’s to ensure that they are getting all their nutrients?

Prevention RD: Hi sweetie 🙂 (I’ve been a bad blog friend…I blame the cookbook! Forgive me! Hope all is well!). I am sorry to hear about your brother-in-law. Crohn’s is…terrible. The “general rule” I tell people to go by is that when they feel good, they need to be eating their best — fiber, whole grains, fruits and vegetables, healthy fats, etc. As soon as symptoms start to flare up, it’s best to eat what is tolerated and every Crohn’s patient will DEFINITELY be able to tell you what works and what doesn’t…it’s very individualized. The vegetables he eats should be very well cooked (think canned soup vegetables soft…or softer) and eaten in small, but frequent measures. His fast food/high fat habits are likely promoting flare ups, so perhaps encourage lean meats, eggs, dairy? Protein is very important and the leaner the better. I would also HIGHLY recommend a daily multivitamin. Adding a Boost or Ensure or two to his daily regimen may be a great option, as well. These products are calorie and nutrient-dense and generally tolerated very well, even during flare ups in many patients. I hope that helps a bit…poor guy 🙁

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Danielle: My husband and I are trying to make a baby but ever since we started trying, my period has become irregular (go figure). I’m wondering if you have and diet recommendations to increase fertility, ovulation or to help regulate the monthly visitor! Thank you so much!

Prevention RD: Hi Danielle! Congrats on beginning to try for a baby! While there is no “fertility nutrient”, a balanced diet, a prenatal vitamin, regular exercise, and a healthy body weight are of utmost importance when trying for a baby. If you’ve had any weight changes or increases in stress (even the idea of trying for a baby may be stress-inducing!), this can also cause your period to go a little wonky. I would use temperature tracking to see if you’re ovulating and let things work themselves out for a few months before worrying too much. Getting pregnant is a different story for each and every woman. Other than a healthy weight, healthy eating, and a prenatal, the rest is up to mother nature! Best wishes!

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Karina: I wanted to know what your thoughts are about drinking apple cider vinegar. It seems to be very popular in the blogging world but I have never heard about any real scientific studies done with it to see if it actually does what they claim it does (fight acne, diminish bloating etc.)

Prevention RD: Hi Karina! You know, I was told this same myth about 10 years ago when I was losing weight. It took me about one swig to figure out that vinegar tastes horrible on its own. I now know that apple cider vinegar is a cure-all for nothing, the pH of my stomach is just fine, and apple cider vinegar has no calorie or “fat burning” (as if that exists!) powers. Wouldn’t that be nice? Some of the advertising and “research” out there seems so compelling but the truth is…it’s all a big fib! I’m sorry!

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Samantha: I am learning about heartburn in my nutrition class and heard that tums can help it, but that they’re not good for it. My professor said tums are not bad -they just don’t help the problem enough if it’s happening very frequently. My boyfriend has heartburn and he heard that tums are bad and should be avoided because of the calcium which leads to kidney stones. Who is right??

Prevention RD: Hi Samantha! Great question! Tums are very effective for indigestion and heartburn — they “neutralize” the acid. Your professor is right in that frequent acid reflux or GERD (gastroesophageal reflux disease) needs to be addressed proactively (diet/lifestyle and perhaps drug therapy) rather than reactively with an antacid. Tums are basically just calcium, but taking that much calcium on a regular basis can be harmful and can lead to serious issues, such as kidney stones like you mentioned. Incorporating diet and lifestyle changes to aid in acid reflux/indigestion relief are highly effective. Avoiding large meals and tight fitting clothes, not exercising after eating, drinking fluids between meals (rather than with), limiting highly acidic foods (tomato products, chocolate, citrus, etc.), not eating late at night, smoking cessation, limiting alcohol, and avoiding high fat foods are helpful for relief. There are also drugs such as Prilosec (omeprazole) that are great for treatment of chronic acid reflux. I hope that helps!

Thanks for another great Q&A session! Please feel free to pass along YOUR question to me at preventionrd (at) gmail (dot) com!

Work and then heading to Kalamazoo for a Southwest Michigan District Dietetic Association mini conference!

Be well,

Share With Your Friends!

23 Comments

  1. September 19, 2012 / 6:46 am

    You know I LOVE these posts! Ok, so I’m so thankful for two of these questions. First, the one about the apple cider vinegar. I get this question ALL THE TIME!! And of course I say the same thing you say; it’s a MYTH! Apple cider vinegar works well on my kitchen floor, NOT my body for weight loss or whatever else Dr. Oz says.

    Second, the Tums question was a great one. There is more research coming out about calcium POOR diets and the increased risk of kidney stones (because oxalates can’t bind the calcium, therefore it’s absorbed and then ends up in the kidneys, vs, the feces) BUT Tums are used as candy by so many people (ie: they use it reactively, like you said) and that’s not good at all (I used to do this when I had gastroporesis and thought it was heartburn!). Great answer, you explain it so well!!

    • Nicole, RD
      Author
      September 19, 2012 / 10:03 am

      Thank you, Gina! And um, ARE YOU GETTING EXCITED?!?!?!??!?!!?

  2. September 19, 2012 / 6:47 am

    I am SO glad someone asked about apple cider vinegar! It seems that everyone is blogging about it and I have to confess I bought a bottle last time I was at the grocery store – and it’s been sitting there unopened for a week now 🙂

    • Nicole, RD
      Author
      September 19, 2012 / 10:02 am

      Well, it makes a killer salad dressing 😉

  3. September 19, 2012 / 7:08 am

    RE: The Chrons – I have ulcerative colitis and had to laugh at DEFINITELY knowing what can be tolerated during a flare. I will warn that for most too much fiber is going to cause a problem.

  4. Brooke S
    September 19, 2012 / 9:45 am

    Thank you Nicole for answering my questions! I had thought to legally practice nutrition you had to be an RD, was I wrong on that? Sorry I am so confused. I also had no idea an internship could COST money. If someone is not matched up with an internship that works for them, can the reapply the next year? Thank you so much again for answering all these questions.

    • Nicole, RD
      Author
      September 19, 2012 / 9:58 am

      Brooke, no problem! These are both great questions! I had to edit my response a bit as I forgot to mention my dietetic internship was in conjunction with a master’s. In 15 months, I completed the internship, master’s, and a thesis. Intense! The set-up was interning Tuesday through Friday, classes Monday and in the evenings + some Saturdays. But yes, even programs that are just the internship without a master’s do cost money many times. You’ll see a HUGE range depending on whether you go with a hospital-based internship vs. a college/university based internship. If you are not matched, you can reapply. There’s actually a spring match (the “big one”) and a fall match, I believe…definitely 2 per year, though. As for practicing nutrition, you cannot give medical/nutrition advice (also termed “medical nutrition therapy” or MNT), but you can do research, community outreach and wellness, etc. I hope that helps to clarify some!

      • Brooke S
        September 19, 2012 / 10:40 am

        Can you clarify what community outreach and wellnes oth are, or what MNT therapy exactly is? I was getting so confused as to why a school would offer a degree in nutrition but was not a track to being an RD, now I understand a little more. I am in IL so if I was to get a nurtition degree but was not yet an RD I could still do something to educate others about nutrition? Can a nurtitionist set up a practice on their own legally? Sorry for so many questions 🙂 I can not find where to find all this info. I have looked at eatright.org and other sites and get more and more confused. It is nice to be able to ask someone 🙂

        • Nicole, RD
          Author
          September 19, 2012 / 2:22 pm

          Brooke: Here is a great article on MNT — http://www.foodcalc.com/blog/2012/09/18/what-is-medical-nutritional-therapy/. Community outreach would include things in the public health sector, school nutrition/wellness, writing, programming, WIC, etc. I wish I could speak to more specifics, but I can’t :-/ Legally, anyone can “practice” nutrition but it will not be reimbursed through private insurers, Medicare, Medicaid, etc unless it’s an RD — a “nutritionist” would have to rely on private pay (which, let me tell you, few and far people are willing to pay for). I attended school in Illinois, as well. I attended Benedictine University and had interest in Illinois State and Rush University Medical Center. I also applied to Ball State, Kent State, and Bowling Green as they were close by. I know there are several other programs in the area, too. 🙂

          • Brooke S
            September 19, 2012 / 2:43 pm

            Thank you so much Nicole! I really want to become an RD, now I just have to make it happen. I am looking into online degrees. I work full time and am a single mom of 2 without much help. I can’t move to be close to a University. Hopefully I can figure this out. I just wanted to make sure there was something I could do with the degree if by chance things do not work out with an internship. I don’t want to waste hard work, time and money and have nothing come of it. Thank you again.

          • September 22, 2012 / 11:30 am

            Another idea for Brooke that wasn’t mentioned (yet!) is to take the DTR (dietetic technician) exam if she has trouble finding an internship. If you’ve finished an accredited bachelor’s degree program that includes the DPD (Didactic Program in Dietetics) components, you can take the DTR exam to become a dietetic technician as of 2009. If you don’t match for an internship the first time around, you could become a DTR, get more experience in the field, then re-apply. Here’s more info on CDR’s website: http://www.cdrnet.org/programdirector/NewPathwayIII.cfm Also, I’ve had friends that did distance programs – typically it seemed like they had an easier time matching. Just a couple more things to look into!

  5. September 19, 2012 / 9:45 am

    Thanks for answering my question, Nicole! I’ll pass down the information to my BIL.
    I know you’re super busy with the cookbook (can’t wait to see it BTW!) so no worries! 🙂

    Also I literally gasped at the $70K to intern. That sounds like an insane amount of money, is that normal? Most internships I’ve heard of (although not dietetic) pay you to work, or don’t pay you at all, but I’ve never heard of having to pay to intern.

    • Nicole, RD
      Author
      September 19, 2012 / 9:53 am

      Hey 🙂 I just had to edit a bit. It was my internship + master’s, however, many internships still cost a lot of money. I would always get so upset to think, “I’m paying to work!” Not cool at all.

  6. D
    September 19, 2012 / 8:19 pm

    Thank you for answering questions. I had a crazy summer and my exercise has decreased and my weight has increased so I’m thinking that’s the culprit! I love your blog!
    Danielle

  7. September 19, 2012 / 9:30 pm

    Maybe the apple cider vinegar tastes so bad you don’t want to eat, and then you lose weight?

  8. Nicole Olson
    September 19, 2012 / 9:36 pm

    Hey there, Nicole! All of us were at LifeCare Alliance today and me and Heather and Ashley were gabbing about you and how much fun we all had with you. Anyway, I always love the Q & A’s. I feel like there’s more than ever lately! I wanted to comment on Brooke’s question a little, but in my circumstances…. I Ohio, if someone went on to get a Bachelor’s Degree to become a RD, but did not get an internship or maybe did not pass the exam, they are now allowed to work as a DTR, correct? ( I believe this recently happened ) Also, and correct me if I am wrong, but DTR’s are in many community nutrition sites, such as WIC, but if one were, hypothetically speaking ( since I can’t think of anything better right now), work in a heath food store or open up her own “healthy cooking” restaurant/ store, couldn’t a DTR give advice on how to utilize their food in the best way possible? We, as DTR’s, just cannot write diet orders, prescribe in any way, or say,” you need 2 ensure’s a day”, without a RD present, correct? I was also curious as to what the title of the nutritionist at your work is? As you know, we are taught that anyone can call themselves a nutritionist, but in order to know your stuff, you are an RD or DTR.
    p.s. if Gina see’s this…I am hearing lot’s of wonderful things about her wedding from her Aunt Joane ( Codrea). It sounds like its going to be a beautiful wedding and an amazing time! Congrats!

    • Nicole, RD
      Author
      September 19, 2012 / 9:49 pm

      Hey Nicole! I miss you guys! I hope you’re able to come this winter when Doreen and a few others visit…should be a good time! 🙂 I miss teaching…obviously because I had the best students EVER! 😉 The DTR is very specific, just like the RD path. There are “diet tech” jobs, but they are different from DTR jobs. Though I think in the past 8-10 years, medicine has recognized DTR’s as the professional and the fact that not anyone can be a diet tech. I know this because when I was completing my bachelor’s I worked as “diet tech” (not a DTR) in a HUGE medical hospital (900+ beds) in Chicago. This was in 2004ish, so I know things have changed since then. DTR’s do a lot of the education, but to be honest, their role vs. an RD role is still a bit grey to me. My understanding is that diet techs screen for nutritional risk in acute settings and can then work solo giving nutrition education (more blanketed information like iron, etc.) in a WIC-like setting, or even a hospital. For instance, my new hospital doesn’t have a DTR, it’s just me, so I perform the Coumadin education. If I had a DTR, that would be something I would like to see delegated to them. I would also see DTR’s in an acute setting giving general heart healthy diet information, low sodium, high fiber, etc. When it gets into “this patient’s diagnoses is blahblahblah, their labs and meds are blahblahblah”…it would fall under the scope of a dietitian. I hope that didn’t confuse you more. CLEARLY, this can be a very grey area!!

  9. Nicole Olson
    September 19, 2012 / 9:59 pm

    Yes, that makes total sense, of course. In community setting, blood work isn’t typically drawn, so diagnoses aren’t usually done, unless a RD was there ( more like private practice, though ). I didn’t know you worked as a diet tech awhile back. And yes the title and position seems to have shifted a bit. A diet tech, then, would be more like a dietary aid now…like a meal passer or, if you were to go waaaay back, a candy striper! Havn’t heard of one of those in awhile have ya? anyway, I am loving this year so much better than last year! Thank God! I heard about the trip Doreen planned to come see you. That topic came up when Heather, me and Ashley were “standing around by the water cooler” ! lol

    • Brooke S
      September 20, 2012 / 11:11 am

      Thank you for adding that in there Nicole, Do you work as a DTR? All this is so confusing 🙂 I am glad that there are options if the internship does not pan out. That is a lot of time, money and hard work.

      • Nicole, RD
        Author
        September 20, 2012 / 12:46 pm

        Brooke, Nicole is in school to become a DTR. I know this because I was her teacher in her DTR program 😉 The DTR path is separate from the RD path, but if you complete a DPD program to become an RD, it’s a matter of transferring the credits, completing the internship portion (much less than a dietetic internship), and sitting for the DTR exam.

        • Brooke S
          September 20, 2012 / 1:03 pm

          If you transfer your credits and do the internship and DTR exam is there more schooling involved? Sorry for so many questions, I want to make this all work some way and like I said I don’t want to get a degree I end up not being able to use for some reason. Thanks SO MUCH!!

  10. September 19, 2012 / 10:16 pm

    Fantastic Q&A! I had to laugh about the surprise over paying to do an internship — I remember when I was telling people I had to pay regular tuition to work at hospitals, etc. for free (a CUP program, so a little different), friends who were not dietitians were like, “you have to PAY to work for free???” I’m so glad I’m not a student any more!

    I do think it’s a shame that there are only enough spots to guarantee 50% of internship appliers a spot. I understand that it’s a lot of time and money to set up and maintain an internship program, but it’s terrible to spend a lot of time and money to take all the required classes, and then not be able to get an internship. I’m glad there’s the DTR option now 🙂

    • Nicole, RD
      Author
      September 20, 2012 / 12:47 pm

      Isn’t it bananas!? I still don’t understand it! It is not surprising that students are now able to set up their own rotations to keep up with the demand. You’d think internship programs would be popping up all over the place, but that sure doesn’t seem to be the case!

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