Originally Published in Quality Health & Wellness Magazine | Fall 2020
It’s not always clear when or why we should seek out the expertise of a Registered Dietitian Nutritionist. Debra Loder, RDN at Wickenburg Community Hospital, provides answers to some frequently asked questions.
What is a Registered Dietitian Nutritionist (RDN), and what is the difference between an RDN and a Nutritionist?
Every Dietitian is a Nutritionist, but not every Nutritionist is a Dietitian. To become an RDN, one must have a 4-year degree in dietetics or nutrition, complete an internship program, and pass a board-certified national examination. In addition, an RDN must complete 75 hours of continuing education every five years.
For a long time, we were just referred to as Registered Dietitians, but then Academy for Nutrition and Dietetics added the word Nutritionist to make sure all bases were covered. Some people call themselves “Nutritionists”; they may have a degree or may not have any education and may still say they are Nutritionists. To make sure you are talking to someone who is giving you excellent nutrition advice, seek out a Registered Dietitian Nutritionist.
What role does medical nutrition therapy play in preventive medicine and disease management?
Medical nutrition therapy is what an RDN does; it is what we do. Meaning we are basing that therapy on how medicine and nutrition work together. An RDN can teach a patient how their diet affects any disease they may have. Diabetes, heart disease, and kidney disease are a few examples. But we also help prevent disease. We hear the term “diabetes runs in my family.” If that is the case and you don’t have diabetes, an RDN can help you change your diet and exercise program so that you may not get diabetes. Helping you manage or prevent disease through proper nutrition are examples of medical nutrition therapy.
How can seeing an RDN benefit your nutrition lifestyle?
There are a few things we can do based on how you are eating now. Using a food journal, we look to see if we find something that you might want to change to align your diet with your nutrition goals. We will discuss changes you might want to consider. Helping you set reasonable goals for improving diet, losing weight, improving labs, or other goals that you may have. Accountability is one of the things that can be hard when trying to make dietary changes. You can speak to an RDN about how you are doing, just like you would talk to your physician about your goals. Those discussions can help you be more accountable and meet your goals.
We hear that eating a healthy diet can help strengthen our immune system to help us fight off viruses and diseases.
This is important today as we face COVID, other viruses, and the flu and cold season. A healthy diet, along with regular exercise, can help you maintain a healthy weight. All three work together to strengthen your immune system and are critical in defending against disease. A diet rich in phytochemicals, which are essential food compounds, is very important to the immune system. We are finding more and more that the immune system and these phytonutrients work together to help fight inflammation. Inflammation is damage to our bodies that causes pain and other complications. For instance, arthritis and surgical scarring are examples of inflammation. Phytonutrients really help defend our body against inflammation and help improve our immune system. Thus, helping prevent or lessen the effects of COVID, other viruses, or other diseases.
How would one know what vitamins they lack in their diet?
There are a few ways we can detect vitamin and mineral deficiencies. One way is through lab tests; you can ask your medical provider to discuss this option with you. They will do blood work that will show if you lack any vitamins or minerals.
The two I think about right now are vitamin B12 and vitamin D. Those are important vitamins to pay attention to, especially as we get older. Another thing you can do is keep a food journal and review that with an RDN. The RDN can help determine what vitamin and minerals you may be lacking. For example, if you never drink milk, you might lack calcium. So, we can help you find foods that are good sources of specific vitamins and minerals and recommend a supplement if necessary.
What should I bring to my first appointment with an RDN?
Good question. If you have a current set of lab tests, you can bring those. I love it when a patient brings their last set of labs in a folder ready for me to review. The next thing is a weight history. When I see a patient for the first time, I always ask them about their highest and lowest weight as an adult and if they have lost or gained weight in the last three months. From there, we can discuss why that might be. For example, some elderly patients will lose weight unintentionally, so we will want to explore reasons for that and look at ways to help them regain, or at least stop, the weight loss.
A food journal is an important thing to have to review so we can figure out what you usually eat and what you may want to change. I always do what we call at 24-hour diet recall. So, we sit together and go over what you ate at breakfast, lunch, dinner, and snacks for the previous day. But that is only one day, so I love it when someone keeps a record of five to seven days, especially if they record what they eat during the week and over the weekend since we tend to eat differently on the weekend.
The next thing I recommend is an open mind. Talking about nutrition can be uncomfortable for some people because people tend to think RDN’s may judge them based on what they eat. That is not the case at all. We don’t judge; we just want to help. So, if you come with an open mind and a willingness to work with an RDN and provide feedback, that is a really good thing. We just love that open-mindedness.
How do you know when it’s time to make an appointment to see an RDN?
Another good question. There are some obvious things. Blood glucose is one of them. Suppose your doctor has said your blood glucose is a little high and orders a hemoglobin A1C blood test, which is a picture of your blood glucose over the last three months. If that comes back and the doctor says your blood glucose is high and your A1C is high, then you might want to make an appointment to see an RDN.
Another thing your doctor might talk to you about is your blood lipids, which are your cholesterol and triglycerides. You might want to see an RDN if your doctor says you need to watch your fat intake to get your lipids in line.
Other reasons to make an appointment with an RDN would be for weight or appetite concerns, food cravings, or worry about the quality of your diet. Those are all excellent reasons to see an RDN. Right now, a lot of us are stress eating due to COVID. I have heard people refer to the COVID fifteen, meaning people are gaining an average of fifteen pounds because they are stressed about COVID. An RDN can help you make a meal plan that focuses on good nutrition and can help you with strategies to help control stress eating and improve your health.
Do I need a doctor’s referral to make an appointment?
You can always make an appointment with an RDN without a referral. However, if you want to submit to your insurance company, it is a good idea to have a referral from your doctor, who has a specific code that describes the diagnosis related to your nutrition health. I am currently credentialed with Medicare Cigna, Humana, and Aetna/Coventry & First Health. Of course, private pay is an option as well. If you call to make an appointment, we can go through any insurance questions you may have.