Thank you, Leanne for this awesome guest post! Leanne Ray Nutrition
Have you ever considered getting a Master’s degree but felt unsure if you would reap any additional benefits later? If so, you are certainly not alone. I can count on two hands how many dietitians I have personally had conversations with who share this thought process. If graduate school has even remotely crossed your mind but you just can’t decide on whether or not to take the plunge, read on to hear my thoughts as a recent grad on the pros and cons.
The Upcoming CDR Requirement Change
First and foremost as most of you have probably heard by now, the Commission on Dietetic Registration (CDR) will be requiring that starting in the year 2024, entry-level registration eligibility education requirements for dietitians is changing from a baccalaureate degree to a minimum of a graduate degree. While this may elicit a slight panic in some of you practicing RDNs, keep in mind that if you are already credentialed when that time comes, you won’t be forced to go back to school and get your Master’s. This requirement only affects future dietitians who will just be starting a program at that time. CDR cites some valid reasons for making this change, including the following:
Note: All of these were shortened or paraphrased for readability but the full list can be found here.
You might be wondering if competition is going to make it increasingly difficult to find a job once dietitians start entering the market with those extra two letters behind their name. I don’t believe this is a given since experience can sometimes trump education (or at least match it) depending on the position. If you are a registered dietitian with seven or more years of experience, it’s hard to believe that your lack of a Master’s will derail your chance at getting a job, especially if going head-to-head with an entry-level RDN. One exception? Jobs that absolutely require a Master’s or PhD. In general I have found that positions in nutrition communications, management, academia and teaching hospitals tend to require an advanced degree (among others). Just be sure to do some research on the areas that interest you most to make sure you know what qualifications are preferred or required.
Can RDNs Expect Higher Salaries?
So what about pay? And will the cost of schooling show a return on investment if we put ourselves through two more demanding years of classes (namely, statistics)? This one is a little bit harder to predict. Dietitians have historically been underpaid, but are also the only member of the interdisciplinary health care team in which a B.S. is sufficient for credentialing (over half of dietitians have an advanced degree anyway). According to the Academy’s Compensation and Benefits Study, in 2015 the difference between the median wage of RDNs with a bachelor’s as their highest degree, and that of RDNs with a master’s degree, is $2.63 per hour (or just over $5,000 annually). That may not seem significant to some, but is worth noting especially since this figure only continues to increase.
The Intangible Benefits of Advanced Education
While graduate school likely won’t give you the dream raise you have been waiting for overnight, I can personally attest to the fact that you will most likely experience some of the following non-monetary benefits:
It’s obvious that I am a huge advocate for advanced degrees in our field. Education provides intangible benefits that just cannot be measured by a numerical figure or salary (as does any college degree). On the other hand, that doesn’t make it any easier to invest the time and money required and is not a decision that should be taken lightly. If you do move forward, investigate scholarships, inquire to see if your employer offers tuition reimbursement, and choose a program that is a great fit for your personality and interests.
Do you want to continue this discussion? I would love to hear from you and would be happy to share more about my personal experience with graduate school. Send me an email at email@example.com.
Leanne Ray, MS, RDN coordinates the employee wellness program for a local public health department. Her professional interests include promoting an intuitive eating approach in conjunction with cooking and meal planning education all in the name of self-care. Check out her personal blog or connect with her on Instagram where she shares her food-related adventures and inspirational anti-diet messages.
I'd first like to thank Tiffany Weir, PhD, professor at Colorado State University for presenting on this topic at the Denver Dietetic Association's September meeting. The microbiome has fascinated me on so many levels, so listening to an expert who specifically studies the microbiome was amazing. And, I'm pretty sure most people felt this way as we had record-breaking attendance compared to all of our past meetings.
Just think, no matter what type of nutritional field you're in, the microbiome is sure to play a role in your patients' heath in one way or another. In case you missed this awesome presentation, here is a recap along with a copy of her presentation.
A little background on the human microbiome:
The microbiome has been a hot topic in the biological and nutritional world over the past decade, and the information that has been uncovered through the numerous studies and mounds of research has been eye opening to say the least.
We know that a healthy (balanced) microbiome is essential for maintaining good health in general, free of disease and negative health conditions, but what exactly is the microbiome and what does it affect?
The microbiome is a community of microorganisms (such as bacteria, fungi, and viruses) that inhabit a particular environment and especially the collection of microorganisms living in or on the human body. Your body is home to about 100 trillion organisms. (1) Estimates of the number of bacterial species present in the human gut alone vary widely among studies, but it is generally accepted that individuals harbor more than 1000 microbial, species in the gut alone. (2)
Most people have heard that the microbiome plays an important role in Inflammatory Bowel Disease and overall health of our GI tract, but some don't realize that it also plays a role in just about all parts of our health from immune function, respiratory function, asthma and allergies, metabolic conditions, and brain health to dental health, cancers and anxiety and depression.
More fascinating, the microbiome plays such a central role in immune system development and homeostasis mainly due to the large number of immune cells that reside within the gastrointestinal tract that almost 70% of the entire immune system is in the gut (2), so you can see how maintaining a healthy microbiome is essential to keeping certain disease and conditions at bay.
What Dr. Tiffany Weir, PhD had to say:
The microbiome functions to keep us healthy and disruption to any of these functions may result in a variety of mild to severe health issues. What we eat can alter our gut microbiome by altering our gut bacteria, host metabolism, immune system production of pro- and anti- inflammatory metabolites, and lead to cancers and metabolic conditions.
It's no secret that the Western diet isn't the healthiest no matter how you look at it, and when it comes to the microbiome, studies show that a Western diet (that is low in fiber, fruits, vegetables, and whole grains and unsaturated fats) will lower the good bacteria (Bifidobacterium, Lactobacilli, Eubacteria – to name a few) essential for a healthy (balanced) microbiome and actually increase the less-favorable bacteria. A gluten-free diet has also been shown to do the same. On the other hand, the Mediterranean diet has been shown to increase the good bacteria supporting a well-balanced microbiome. Here's how specific macronutrients affect and interact with the microbiome.
The gut microbes primary source of energy is carbohydrates. And, through the microbiota metabolism, undigested carbohydrates are converted to fiber which is then fermented and short chain fatty acids (SCFA) are produced. SCFA show to stimulate proliferation of normal crypt cells, and inhibit growth of colon cancer cells, as well as, reduce the risk of developing inflammatory bowel diseases such as Crohn's and Ulcerative Colitis. Therefore, carbohydrates including fiber are an important part of maintaining colon health.
Animal protein which contains significant amounts of Choline and Carnitine have been shown to have a negative effect on our health and the microbiome. Trimethylamine N-oxide (TMAO) is a small colorless amine oxide generated from choline, betaine, and carnitine by gut microbial metabolism, which raises the risk of cardiovascular disease (CVD). Animal protein has also been shown to reduce the good bacteria in our gut and SCFA.
Plant protein on the other hand, has been shown to increase good bacteria, increase gut barriers (preventing leaky gut), reduce bad bacteria and reduce inflammation, reducing the risk of CVD and IBD.
Studies suggest that they type of fat consumed has a significant impact on the microbiome. Diets high in unsaturated fats have been linked to an increase in good bacteria, while diets high in saturated fat have been linked to a decrease in good bacteria.
When concluding the diet portion of her presentation, Dr. Weir mentioned how fermented foods are high in good bacteria, but finding those foods are hard to come by. Canned and jarred foods like sauerkraut, and pickles have been pasteurized, so they lack the live cultures that benefit the microbiome. Kimchi, kefir, yogurt (that says live cultures) and kombucha on the other hand are great for boosting your microbiome.
She also mentioned that taking a quality pre/probiotic can be beneficial, but the market is saturated with less-than quality products making it hard to find one that will work. She suggested taking medical food vs a dietary supplement, but the downfall to this is that medical food is hard to come by. It is usually prescribed by a doctor.
Eating a well-balanced diet full of fruits and vegetables and whole grains, healthy fats and fiber still appears to have the best health benefits of all.
Additional Observations in Regard to the Microbiome:
Dr. Weir also touched on the difference in microbiomes between breast-fed and formula-fed babies, stating breast-fed babies have more good bacteria and better immune system support due to higher levels of oligosaccharides in breast milk.
Current and Future Trends for Creating a Healthier Microbiome
There are a lot of new trends and practices coming to light that aim to support a healthier microbiome and prevent/cure diseases and conditions, and one that I've personally read a little about is showing a lot of promise.
It is the swabbing of babies born via C-section called vaginal microbial transfer. Studies show that babies born vaginally have a healthier microbiome will be at lower risk than C-section babies for developing allergies, asthma, type-1 diabetes and obesity later in life. Samples of microbes from the mother's vagina are collected before delivery and swabbed (or rubbed) all over the infant within minutes after delivery exposing the baby to many essential and beneficial microbes.
Another rising procedure is Fecal Transplant. Just as it sounds. This procedure takes fecal matter from a healthy donor and is placed in a person with a disorder or condition. Usually, this treatment is used on patients with C. Diff., or a type of IBD.
There are also tons of other paths being followed to obtain a healthier microbiome. Functional medicine, diagnostic platforms, genetically engineered probiotics, supplementation with butyrate, custom therapeutic solutions, gene sequencing.
I've attached a copy of Dr. Weir's presentation here.
By Leanne Ray, RDN
Are you an “RD2be” or a newly credentialed dietitian unsure of what your career has in store for you? Or are you a seasoned dietitian who is considering a job switch for something fresh and new? If so, consider workplace wellness for a fun and dynamic setting where you can utilize your multiple super-dietitian talents!
Making the case for workplace wellness
Take a second to think about how many hours you spend in the workplace each week. For most people, this number is probably somewhere around 40 hours. If you have a 30-minute commute (each way), take an hour-long lunch break and average eight hours of sleep, this equates to >60% of your waking hours! For many, a 40-hour work week is unheard of, so this might even be on the low end of the spectrum. Because of this, there is a huge need for wellness programs to promote healthy habits where people “hang out” for so much of the day. Even the Centers for Disease Control and Prevention state that “worksites have the opportunity to encourage healthy habits and help prevent health problems such as diabetes, depression, and heart disease.” The connection between a wellness culture and worker well-being, productivity and reduced number of sick days has been demonstrated over and again1. What kind of organization wouldn’t want all of these things? And why not hire a dietitian to fill this need?
What skills are necessary?
In addition to evidence-based nutrition programming, registered dietitians are well-versed in some of the necessary attributes of a successful workplace wellness professional including:
How to get the job
There are a few ways to get hired in a wellness setting including as a full-time program coordinator, a contractor or as a one-time presenter. The first option is a bit less common since companies often designate a human resources professional or other staff member double as a wellness program coordinator. Some companies will contract professionals to develop a few challenges or seminars (which could be you!). The third option, which is probably most common for dietitians, involves a presentation or other service for a one-time event. Each of these could be really beneficial for a future career in workplace wellness. Interested? Don’t be afraid to pitch yourself! After all, we know far too well that if dietitians aren’t doing this, someone else probably is.
Leanne works for a local public health department as a worksite wellness specialist and also has her own food and lifestyle coaching business, Leanne Ray Nutrition LLC (visit her website: www.leanneray.com). Have questions on opportunities for dietitians in workplace wellness? Feel free to reach out to her directly at firstname.lastname@example.org. You can also find her on Twitter where she shares both wellness and nutrition related tidbits daily.
1. Centers for Disease Control and Prevention. Worksite Wellness. https://www.cdc.gov/sustainability/worksitewellness/
By Dana Eshelman, RDN
Nicole Withrow, PHD, MS, RD is an Assistant Professor and Dietetic Internship Coordinator at University of Northern Colorado. She presented her research on Autism Spectrum Disorder (ASD) at the third membership meeting of the year.
ASD affects 1 in every 88 children in the United States. Autism is presented as a spectrum disorder due to the variety of symptoms and degree of intensity within each category. ASD is characterized by core deficits including social interactions, speech, repetitive behaviors, and restricted interests. The repetitive behaviors and restricted interests are why we often see children with ASD have selective food choices. They desire foods to taste, look, smell and feel the same as they remember these foods.
Often times, children diagnosed with ASD have co-occurring diagnoses. These includes learning disabilities, heightened generalized anxiety, problematic eating behaviors, gastrointestinal issues, sleep problems and obsessive compulsive behaviors. Children may become more selective with food choices as a result of adverse gastrointestinal symptoms and eating behaviors, which can inhibit proper growth and development. A child’s heightened generalized anxiety can detract parents and caregivers from introducing new foods into their child’s diet. A child with normal development may accept a food when being exposed ten times via whereas a child with ASD can take thirty to forty times.
Diets such as the elimination diet, the FODMAPS diet, and the gluten-free and dairy-free diet have all been explored in decreased autism behaviors. There has been no conclusive evidence saying specific dietary changes impact children with ASD. Nevertheless, it is important to continually offer a variety of foods and meals and snacks to deter children with ASD from having a selective diet.
Dana is a newly Registered Dietitian at InnovAge. She graduated with her Bachelors of Science in Nutrition from the University of Colorado Colorado Springs in May 2015. One year later, June 2016, she completed her dietetic internship at UCCS. In her free time she enjoys lifting weights, trying new, one of a kind restaurants, cooking, running, hiking, going to concerts & yoga. She is thrilled to a part of the DDA Board of Directors and help spread her passion for food and nutrition.
By Shane Spritzer, Regulatory Chair, DDA
This year’s Public Policy Update meeting was held on October 25th at Tri-County Health Department. During the first half of the meeting, members viewed a webinar put together by Jamie Daugherty, President of the Colorado Academy of Nutrition and Dietetics (CAND), and Bonnie Jortberg, Public Policy Coordinator for CAND’s board of directors.
Jamie discussed the restructuring of CAND’s strategic framework, which will place focus on three goals: improving public trust and choice of RDNs and DTRs as nutritional experts, improving the health of Coloradoan’s through advocacy, and having CAND members and prospective members view the Academy as key to professional success. They are also working on completing a sponsorship policy/procedure as well as a membership survey.
Bonnie then talked about the importance of advocacy, both for our profession and for the wellbeing of our patients and communities. Nationally, there are four main public policy priority areas we are facing: disease prevention and treatment, lifecycle nutrition (including the Older Americans Act), healthy food systems and access, and quality health care. And of course, we will continue to be facing the issues of state licensure as well as RDNs as Medicare providers.
During the second half of the meeting, we had Candace Johnson enthusiastically speak about her experience as a public policy advocate and how we can be involved. She expressed how important it is for all nutrition professionals to realize that public policy affects our jobs, regardless of which area we work in, so it is important for our voices to be heard. She also walked us through the Academy’s Advocacy Action Center, where members can quickly and easily contact their representatives about important issues – it takes all of 60 seconds.
Two of these issues are still ongoing, and could use your voice!
Support National Clinical Commission Legislation in U.S. Senate
The National Clinical Care Commission Act (H.R. 1192) has already been passed in the House of Representatives, and we are trying to get the Senate to agree to a vote prior to the new session of Congress begins. This bill would establish a commission within HHS to better coordinate care for people with prediabetes, diabetes, and chronic conditions that result from complications of diabetes.
Treat and Reduce Obesity Act
The Treat and Reduce Obesity Act (H.R. 2404) would amend the Medicare portion of the Social Security Act to cover intensive behavioral therapy (IBT) for obesity, and specifically lists RDNs as an appropriate provider, and would also provide coverage for FDA-approved weight loss medications that complement IBT.
To visit the Advocacy Action Center and let your voice be heard, visit:
Shane Spritzer is currently completing his dietetic internship as part of the inaugural class of MSU Denver’s ISPP program, after graduating from MSU in May, 2016. He is also pursuing his MPH through Colorado School of Public Health, with concentrations in applied biostatistics and maternal and child health. After passing the RD exam, he hopes to enter the field as a clinical pediatric dietitian. This is his first year on the DDA board, and with a strong interest in politics he is excited to be the regulatory chair to be a voice for positive changes through nutritional policy. In his limited free time, he likes to cook, read, see shows at the Denver Center for the Performing Arts, and keep up with a few more TV shows than he probably has time for.
By Dana Eshelman, RD
There are hundreds of pre-workout drinks and supplements on the market, making it difficult to know what to choose or how to decipher what products are safe. These performance-enhancing supplements are unregulated, meaning there is no standard or oversight on what these products can contain. Often times, these supplements include harmful substances and chemicals within a propriety blend, such as a recent find of dimethylamylamine (DMAA).1 DMAA is a sympathomimetic drug which causes vasoconstriction; this can elevate blood pressure, cause chest tightness or shortness of breath, and lead to heart attack. That does not sound like an ideal state for a workout. So, how can you obtain focus and energy and beat muscle fatigue without the added chemicals?
Fuel your workout with a delicious pre-workout snack or drink. Foods with too much fiber and fat can cause an upset stomach. Instead, look for snacks with complex carbohydrates and a little protein for long-lasting energy to fuel your workout. Find the right fuel for your sweat sesh with these snacks:
Guarana contains caffeine for mental alertness and focus. Blend with 1 c. milk, ½ a banana, and 1 T. peanut butter. This shake provides carbohydrate and protein to fuel your workout. Top with oats or whole-grain cereal for an added carbohydrate punch to fuel long workout sessions.
Combine 1 cup Greek yogurt, ½ cup oats, 1 T. flax meal, a dash of vanilla extract and 1 T. cocoa powder. Mix and leave in refrigerator overnight for quick fuel before your morning workout sesh. Greek yogurt, oats, and flax are a powerhouse combination, providing carbohydrate and protein.
Use ½ peeled, cooked sweet potato (or 1 small one), ½ c. Greek yogurt and a dash of cinnamon. An equal combination of carbohydrates and protein to provide lasting energy for your workout.
For an early morning workout, blend ½ c. Greek yogurt, ½ c. brewed coffee, 1 c. spinach, ½ banana. Coffee provides the caffeine to shake those cobwebs and get you moving. The remaining ingredients provide carbohydrates, protein, and minerals essential for your workout
Goji berries increase energy and enhance the body’s ability to handle stress while supporting a healthy mood, mind, and memory. Combine with raw almonds, pumpkin seeds, sunflower seeds, walnut halves and dried apricots. The Goji mix contains healthy fats, carbohydrates, fiber, protein, and minerals for long lasting energy.
Dana Eshelman is a newly Registered Dietitian at InnovAge. She graduated with her Bachelors of Science in Nutrition from the University of Colorado Colorado Springs in May 2015. One year later, June 2016, she completed her dietetic internship at UCCS. In her free time she enjoys lifting weights, trying new, one of a kind restaurants, cooking, running, hiking, going to concerts & yoga. She is thrilled to a part of the DDA Board of Directors and help spread her passion for food and nutrition.
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