Hey There RD2Be's! 

We have some excited things lined up for 2020! Check it out: 

1. New Edition of The Road to RD (3rd Edition)!  Available Jan 1, 2020

• Updated salary and job outlook info
• Increased information about military internships, active duty and reserve opportunities
• New information on how the Master's degree requirement is changing the pathway and internships
• Guidance on online degrees
• Social media skills, leveraging technology 
• More information on scholarships and paying for school 
• More resources than the 2016 edition! 

Available on Amazon in digital and print versions. 

No other race I've ever completed has been so rewarding. This was an all around incredible experience.

For starters, let me describe what this race is for anyone unfamiliar. A 70.3 is a Half Ironman, or HIM as it is sometimes referred.  What does this race look like? 

1.2 mile swim 
56 mile bike
13.1 mile run 

I got into triathlons almost exactly 2 years prior to this race. In fact, Facebook reminded me with the first photo I took of the goggles and swim cap I bought to start swimming.  It took a long time before I could swim even 20  minutes without stopping and I was SO slow! Not that I'm fast now, but SO SLOW. I had completed a few sprint and olympic distance triathlons prior to this race so I at least had my feet wet on what to expect. 

​

I can describe my training in one word: inconsistent. 

Is that ideal? NO. But I also wasn't trying to break records.

As a first timer, I didn't see any reason to set a goal beyond just finishing within the time constraints. Luckily I set my expectations just right because I hit a LOT of hurdles in fitting in any amount of training! 

Being a full time military dietitian, plus grad school, plus keeping up with volunteering with Team RWB means.. I'm busy. Training for a HIM takes time.  I was able to get by with high intensity interval training during the week (Thanks Hawaii Triathlon Center for the workouts!) and endurance workouts over the weekends. 

For a while there I was doing really well with a swim, bike,run brick workouts every Wednesday and a solid swim/run workout on every Monday. Right up until I became sick with pneumonia.  Leading up to having pneumonia, I was in charge of planning an M16 range for my unit, which also took a lot of time - worth it- but a lot of time. So training during that time was more of just barely holding on to the fitness I had built rather than improving it.  -- This was April, less than 2 months before race day. 

May was a little kinder to me. I travelled to Texas for a week and as able to fit in a gorgeous long bike ride one day, and a medium length run the next. That was perhaps the best training bout I had my entire train up. Training was going well until the move across town happened. Moving is a workout on its own. The move took place the last weekend before the race and my fear was that I wouldn't fit in those much needed last workouts. 

 As of Wednesday, my clothes had not yet been unpacked from the move into the new place. It was a mad rush to pack what I needed for a crazy early flight the next morning. I packed everything I needed for the race but really missed the mark on clothing for outfits... here I was in this gorgeous, expensive resort, walking around in yoga pants because I didn't have a good shirt to wear..whoops! 

Set up for T1 (transition from swim to bike) was scheduled for the day before the race. That meant riding my bike 7 miles to the beach to drop it off. My gears have historically been a little... crunchy -- for lack of a better word. The shifting from the small ring to the large ring in the front is always off. I've learned to adjust it some myself, and I HAD THOUGHT I did  good job except the chain fell off on that ride when I switched from small to large-- after several times of shifting back and forth beautifully, so that was frustrating.    The bike tech's were back at the resort, so it seemed like I was SOL during the race and doomed to be in my large ring the whole time. 

Race day morning, I brought all my gear to set up T1 and found that bike techs are available on site. Fortunately we were able to get my bike adjusted-- especially since the bike course started on a hill! 

I started in the very last wave. I had the opportunity to watch every other age group start,  and even some exit the water  before I had to line up for the start.

Nutrition is so important for these endurance races... for any sport really, but I find this to be make or break for all athletes, well trained included. Since I'm studying to take the Certified Specialist in Sports Dietetics exam in July, I'll explain my nutrition plan along with the narrative, labeled with the plan in green and  what actually happened in red: 

2.5 hours pre race: bagel- followed, though I could only eat half. 
1 hour before race: take Hammer pre workout, 8 ounces of water - followed
30 min before race: 16 ounces water - followed
15 min before race: gel and salt tab + water  - had trouble stomaching the gel due to nerves, ran out of water and wasn't any available in the corral for racers , lesson learned, take salt tab with the 16 ounces of water 30 min before the race.  Resulted in some pretty bad heartburn which lasted the entire race and 2 days afterward. 

-I'm waiting in my corral and the nerves start getting the best of me, nerves likes I've never felt before a race! I start putting myself through some deep breathing exercises and talking myself through it.  "its just a swim, just like you've practiced. You're just going for a 1.2 mile swim, you've done this before, this is nothing" It worked...a little.  I'm normally very good at controlling fear and pain. I can recognize that I'm feeling those things but compartmentalize them so they don't affect me. This is one reason I love challenging myself physically,  because it makes these skills even stronger, and, I believe, makes my mental toughness stronger. 

- This year the race organizers tried something different to reduce congestion and improve safety. Instead of all age groupers starting at the same time, they had a rolling start. We lined up by age group (mine was 25-29) according to when we thought we would finish the swim and they let 4 people go every 5 seconds. This worked out really well. I didn't have any swimmers around me.... though, being in the 25-29 age group, I was sure I was the oldest amongst all 25 year olds by the looks of it, and they all left me in the dust once we hit the water. 

- I had a lot of trouble seeing the next buoy in the swim which severely slowed me down. My goggles also leaked a little on the second half of the swim, causing me to have to stop and drain one of my goggles.  The water was so clear I could see the bottom of the ocean floor and even some fish! Which was horribly distracting! I got out of the water feeling great but realized I was a little slow on my swim. I finished the swim in 57 minutes and the cut off was 1 hour and 10 min, so I was still safe there. I think by this point adrenaline had kicked in because even running up the sandy hill of the beach felt easy. 

 Seeing how salt sort of sucks for chaffing I took the time to rinse off when i found the beach showers. Standing there by the shower was a man with an Ironman Staff shirt holding a big push broom.... I was very confused and a little afraid. I didn't make eye contact and rinsed very quickly, ran up the remainder of the hill, grabbed my transition bag on my way up the hill and found my bike. 

Right out of the swim: gel, begin drinking with a goal of 28-32 ounces of water (plus electrolytes if using water), 60 grams of carb per hour .   - followed. kept both gatorade and water with me on the bike at all times. Actually took in more fluid than planned in the first two hours (with electrolytes to avoid hyponatremia), also took 3 gels in the first two hours, then a gel and a gatorade on the third and fourth hour washed down with water. Ended up taking another salt tab during the bike. 

On the bike I went! My longest training ride was 37 miles on a hilly route and 40 miles in the trainer. Knowing I had 56 ahead of me seemed daunting but within reason for my training. I felt GREAT. I've learned to become very comfortable letting loose on the downhills and just flying!  My gears disappointed me AGAIN, but they did the job and got me up the first hill before getting stuck on the big ring.  Given my monster thighs It wasn't so bad. I recover quickly from hard bouts of high intensity in my legs so hill climbs are my jam!  Not much to report from the bike except it was gorgeous, I had a blast and I yelled "WEEEEEEEEEE!" when I got up to 37 MPH on the downhill.  I did have to deal with the heart burn with every sip of gatorade and gel, but it was manageable and I got through it. Around mile 45 I started to really feel it but hadn't lost my grit yet. Finished strong and felt ready for the run.  

Take a gel right before the end of the bike to prep to the run followed

Fatigue was just starting to set in my this point and I was not thinking clearly when I got to T2. I was moving slow. During the bike I realized I never reapplied sunscreen out of the water and it had all washed off. I could FEEL my skin burning. My Portuguese skin does NOT burn easily! I'm very fortunate to get away with the small sun burn that I did! ( I have a few small blisters on my hands and mid back for the record)  I was able to find some sunscreen at the transition, put on my Ironman hat- feeling badass- and hit the pavement. I was very surprised at myself and how good I felt. All those brick runs really paid off even though they were short! The run was the part I was most nervous about because of the time of day, the heat, and the lack of long runs in the weeks leading up to the race (thanks pneumonia) 

Stop at every aid station (approx 1 mile apart) and take both water and gatorade, as well as ice. - I followed this as if my life depended on it! Even more so, I carried a cooling cloth with me and dumped water over my head at every aid station ( it was 84 degrees by the time I started running), I also dumped ice into my bra, the front and back of my top, and in my hat. 

 I was not lady like through these transitions. If there was ice it went in my bra. If there was any left it went down the front of my shirt and into my shorts, then leftovers went into my hat. i dumped water over my head every chance.  

When I was running (rather than walking),  my pace was much faster than I thought was possible. I planned 10-11 min paces while running and an overall 12 min pace average with walking, but was running 8:40-9:30 when I was running. I took walk breaks, probably more than I needed but I played it conservative.
​
 I had heard SO many stories about how hot it was. I'm someone who HATES training in the heat so my head was filled with images of me, sluggishly putting one foot in front of the other, feeling dizzy, heart rate higher than it should be, and dehydrated.  I didn't have any of those problems. I hydrated so well on the bike and stuck to my hydration/fueling/cooling plan on the run and felt great the entire time. At no point did I feel that exasperated "OMG ITS SO HOT!".  I also trained appropriately in heat to acclimate, that makes a big difference. 

Ice and water over the head did wonders. At one point I actually took too much nutrition at an aid station and ended up irritating the heartburn from the beginning of the race. I had to walk for about a mile to shake that off. 

On my second loop I felt more determined. I ran more than the first and when I had 2 miles left I decided to drain the tank.  I felt extremely strong on those last 2 miles. So strong, I probably should have pushed more on the rest of the run. The only problem was....... I was beginning to get emotional.

I don't mean to TMI you guys but this has been a rough year, I know I know..... it's always awkward when any of us puts out there publicly that we're having a rough time with something because we're all supposed to be strong and show our best face on social media, take perfect make up selfies, and show nothing but the best, blah blah blah... but guys.. we're all human, we all go through the suck every now and then.... airing your dirty laundry  in a drama mama manner on Facebook is one thing, but admitting you're life isn't perfect is okay. And hey, my life isn't perfect, it has some shit.

And rather than post our Khardashian-like lives (as gorgeous as they are and as much as I model my fitness clothing choices off theirs) I think we should all be a little more real with each other because many of us have more in common than we think.  And if we could all just connect and support those common moments of trying and difficulty, rather than feel judged and ashamed.... we'd all be better off.  I know from discussions with friends, acquaintances and patients that we are all very good at hiding behind what seems to be right in our lives and secretly harboring the junk that isn't. It doesn't have to be that way. We're all flawed. We don't have to be flawed alone. If I've learned anything from working with veterans, this is the message I want to drive home. None of us has to go through anything alone, whether it's as serious as grieving or as trivial as a big ass pimple on your nose on prom night.    So this is me, sticking my neck out, and admitting my life isn't pristine, it's got some shit.  And I invite you to admit to your own lack of perfection in your life.  

One reason I don't find this embarrassing is because I find these moments to give life its uniqueness. Life isn't interesting without the mountains to climb and the deserts to traverse. Without struggle we aren't challenged.  Perhaps that's why I seek out such physical challenges. 
​

​..... And that's what got me emotional in the last 2 miles. This race is a spirit tester.  It pushed me to  my limits - a place I love to visit, by the way.   I worked hard for this. I lost sleep over this race. Made sacrifices. And after a year of feeling like trudging through the mud I wanted my moment and despite all my fears that I couldn't finish this race, I was about to have my moment. I had to really focus to keep from crying because once I start crying I can't breath!  There were some moments coming into the finisher chute I thought I was going to pass out because I was choking up and couldn't breath. I ran hard. The "atta girls" and "that's what I'm talking about!" were heard but not acknowledged because I needed all that focus just to keep myself together. I wanted that strong finish. It was almost a metaphor for real life, that despite the sweat, the doubt, the ugly running, and delirious singing at mile 10, the butt pain and spit from the bike, the salt water in my eye at the swim, and the heartburn that tried to make it all fall apart........... despite all that I could still finish strong.  ​

A Plan for Packed Lunches
By: Tracy Williams
Healthy eating is important so that busy adults can keep up with their strenuous work schedules. Lunches on the go or at the workplace do not always have to be boring sandwiches. It is quite easy to run out of ideas and fall back into the restaurant rut. Everyone thinks it is easiest to eat out with colleagues. People are looking for fast, easy and good tasting foods to fit into their hectic days. There are always healthy, creative options for making a quick and tasty lunch.
​
What are some ideas to plan a healthy lunch? : It is important to make sure your lunch is balanced. Lunches that do include some lean or low-fat protein along with carbohydrates will keep your body fueled for long afternoons of stressful meetings. To have a creative lunch, pack leftovers of a black bean, brown rice and salsa dinner casserole, topped with shredded cheddar cheese. To add extra beneficial fiber and antioxidants, add some carrots, celery, and pepper strips for a hearty satisfying lunch. Convenience foods can also make quick and easy lunches. Canned soups and frozen meals can be inexpensive, especially if people stock up when they are on sale, and all you have to do is grab one when you are running out the door. To add more fruits and veggies in your diet, you could add a side salad or piece of fruit to provide enough calories, along with a portion controlled items like frozen meals. On the weekend, make a big pot of chili, soup or rice and freeze into individual portions that are ready to conveniently take to work.

Creative Lunch Ideas:

• 1 pita with lettuce and grilled chicken with light Caesar dressing; baby carrots and an apple
• Salmon  lettuce wraps with light sesame Asian dressing; 1  can of broth based soup; and an orange
• Tomato & cucumber salad with olive oil and vinegar; tuna salad on pita; baby carrots; and an apple
• 1 can of soup; grilled chicken on a bed of romaine with sliced apple and light vinaigrette
• Garden salad with salmon, tomato, cucumber, and baby carrots ; an orange; and 1 can of soup
• Whole wheat tortilla wrap of hummus, lettuce, sliced tomatoes, feta cheese and black olives; a carton of fat-free vanilla yogurt and berries
• Whole wheat pita stuffed with vegetarian refried beans, salsa, lettuce and shredded cheddar cheese; and apple slices with almond butter
• Whole wheat tortilla roll with sliced turkey, sliced low-fat mozzarella cheese, red pepper strips, and lettuce leaf; with fruit salad and a glass of skim milk

How Can You Have a Safe Lunch?: It is important to start off each day fresh by washing lunch boxes and lunch bags with warm, soapy water after each use. It is important to wash your hands before, during and after preparing lunches, and make sure counters and surfaces are clean to prevent cross contamination. Perishable foods should not be left out of the refrigerator for more than two hours, but some workplaces do not provide employees with access to a refrigerator at the workplace. It is important to pack lunch in an insulated lunch bag or lunch box and include and ice pack or frozen beverage container. If refrigeration is not available at work, consider substituting perishables with shelf-stable foods, such as trail mix, individual boxes of cereal, granola bars, bagels and celery sticks, whole fruit, dried fruit, single serve applesauce and whole grain crackers with almond butter.

Healthy Restaurant Choices: If you do go out to eat, it is important to take time to look over the menu and make careful selections. It is important to read restaurant menus carefully for clues to fat and calorie content. It may be a good choice to order the regular or child-sized portions instead of larger portions. It is okay to make special requests, just remember to keep them simple. For example, ask for a baked potato or side salad in place of French fries; limit mayonnaise or bacon on your sandwich; sauces served on the side. It is important to think about food choices from your entire day. It might be a good idea to share an extra-large sandwich or main course with a friend or take home for another meal. At a sandwich shop, choose lean beef, ham, turkey, or chicken on whole grain bread. In place of fries or chips, choose a side salad, fruit or baked potato. You can always try new foods, such as Chinese stir-fry, vegetable stuffed pita or Mexican fajitas, just go easy on the sour cream, cheese, and high sodium sauces. At a salad bar, pile on the dark leafy greens, carrots, peppers, and other vegetables. Lighten up on mayonnaise based salads, and high fat toppings. It is great to enjoy fresh fruit as a dessert. If you are ordering pizza, load it up with vegetable toppings. If you add meat, make it lean ham, Canadian bacon, chicken or shrimp. When grabbing dinner at the supermarket deli, select rotisserie chicken, salad-in-a-bag and freshly baked bread.
      Healthy eating is important for nutrition to keep up with a busy schedule. There are many decisions to make when planning a healthy lunch. It is best to be creative in making lunch choices. It is important to always have a safe meal for lunch without the risk to food safety. There is always a healthy choice to choose from weather the lunch meal is made from home or from a local fast food restaurant or any other type of restaurant.
Tracy Williams graduated with her degree in Nutrition and Dietetics from Dominican University. She enjoys freelance writing and public speaking on nutrition topics. I have been a five time recipient for nutrition education grants from the Academy of Nutrition and Dietetics Foundation. She is a very passionate advocate for diversity, especially advocating for people who happen to have physical or cognitive disabilities. You can connect with her at www.tracysplate.com.
 

Watch the video below, then I want YOUR thoughts on leadership! 
Answer any or all of the following questions (RDs welcome too!)

What's leadership mean to you?
What does it mean to demonstrate leadership as a dietetic student/intern? 
What will it/does it mean to be a leader in the dietetic field? 

Comment below or send to Road2RD@gmail.com

​Name: Jill Rohlfs
Bio: Jill Rohlfs is a first year Nutrition and Dietetics student at Rowan University in New Jersey. She is a vegan that follows a plant-based diet and enjoys distance running, practicing yoga, trying out new recipes, and spending time with her family when she is not studying or working. Jill is working towards a BS in Nutrition and Dietetics and a MS in Nutrition as she hopes to become a Registered Dietitian. 

​What is mindfulness?
Before defining mindful eating, it is useful to know what mindfulness is. Mindfulness is defined as deliberately paying attention, without judgement, to all internal processes as well as your environment.1 To be mindful is to be aware of your current mental, physical, and emotional state during each moment.1
What is mindful eating?
Knowing what mindfulness is useful when defining mindful eating. Mindful eating is being aware, both physically and emotionally, of what and why you are eating.2 Mindful eating also means bringing awareness to the opportunities that food preparation and consumption presents, choosing to eat food that is pleasurable as well as nourishing, acknowledging positive and negative responses to food.1 Most importantly, mindful eating is listening to your body’s hunger and satiety cues and allowing yourself to make mindful decisions regarding when to begin and stop eating.1 It makes sense that mindful eating is being studied and discussed more and more as the number of people with diseases of excess, especially obesity, are increasing. The prevalence of obesity in adults 20 years or older has more than doubled from 1960 to 2010.3 It is likely that because of this increase, people are becoming more interested in mindful eating.
While it is easy to define what mindful eating is, it is harder to imagine what mindful eating looks like. A person who eats mindfully understands that there is not one way to experience food and accepts their individual experiences with eating.1 Additionally, he/she understands that their relationship and experiences with food and eating can change over-time.1 Knowledge and the ability to reflect on the effects of mindful eating versus mindless eating on both the individual and on their environment is also a part of mindful eating.1 While mindful eating is unique to every individual, these are some of the characteristics of a person who eats mindfully provided by The Center for Mindful Eating. It is important to recognize that mindful eating is a lifestyle, not a traditional diet.
What are the benefits of mindful eating?
            Many people use mindful eating as a way to lose and maintain weight. Because mindful eating is a lifestyle and not a diet, there is more potential for the changes in weight to be permanent.4 This is especially true because mindful eating isn’t centralized around restricting and starving, but it focuses on making reasonable, long-term changes in lifestyle.4 It is well-known that Americans are exposed to a variety of drastically different diets and most of those diets are not successful long-term. When someone goes on a popular diet, it is likely that their weight will fluctuate drastically during their experience. When someone adopts mindful eating habits, it is more likely that their weight will decrease and be maintained more easily.
            Overweight and obese individuals are likely victims of the dieting culture in America. By determining why food choices are made and educating people to make better choices, they will be more likely to incorporate healthy eating into their lifestyle.2 After participating in a mindful eating intervention lasting six weeks that included: weekly two hour classes, mindful meditation, mindful eating, and group discussions, ten obese patients lost a significant amount of weight as well as a lower BMI score.6
Mindful eating can also be beneficial to mood, energy, and mental capacity because it encourages people to use food as nourishing fuel for both the body and mind.4 If a person looking to make positive changes to their physical, mental, and emotional well-being, focusing on mindfulness and mindful eating is a great place to start.
How do I eat more mindfully?
            One theory, the on-demand feeding theory, says that there are three steps to mindful eating: eating when we are physically hungry, eating what we are physically craving, and stopping when we are full.7 This theory suggests that if we tune into our bodies and listen to its natural cues, we can govern when, what, and how much we eat.7 In other words, the theory is based on the assumption that our bodies can regulate its weight as well as our eating as long as we learn to listen.7
                One way to implement mindful eating is to take up a mindful meditation practice. A unique example of mindful meditation, a Raisin Meditation, specifically addresses both mindfulness and mindful eating. The University of West Virginia provided a roadmap that guides you through the eight stages of a Raisin Meditation. The eight steps are: holding, seeing, touching, smelling, placing, tasting, swallowing, and finally, following.8 First, you take the raisin in your hand and focus on it as if you have never seen it before. Second, you take the time to really look at the raisin carefully and notice the uniqueness of the raisin. Next, you explore the way that the raisin feels to the touch. After examining the way the raisin feels in your hand, you bring the raisin to your lips and then into your mouth to explore the raisin with your tongue. Next, you take your time chewing the raisin slowly and noticing how it feels to chew and taste the raisin. When you are ready, you take the moment to recognize the intention to swallow and notice what that experience is like, and then you swallow the raisin. Finally, follow the raisin on its journey into the stomach and take notice of how your body feels after the experience.8 This raisin meditation is meant to bring awareness and mindfulness into your daily life and experiences with food.
 
           
Resources
1. Principles of Mindful Eating. The Center for Mindful Eating. Available at: http://www.thecenterformindfuleating.org/principles-mindful-eating.
2. Berdal LM. The Relationships of Eating Mindfulness and Demographic Characteristics, Physical Activity, and Focus of Academic Major among College Students. 2012.
3. Overweight and Obesity Statistics. Overweight and Obesity Statistics. Available at: http://www.niddk.nih.gov/health-information/health-statistics/pages/overweight-obesity-statistics.aspx.
4. Kelly, T. (2014). Mindful eating techniques to answer the question: "am I hungry?". Bariatric Surgical Practice and Patient Care, 9(1), 50. doi:http://dx.doi.org/10.1089/bari.2014.9963
5. The Center for Mindful Eating - Meditation. The Center for Mindful Eating 2015. Available at: http://thecenterformindfuleating.org/meditation.
6. Dalen, J, Smith, BW, Shelley, BM, Sloan, AL, Leahigh, L, Begay, D. Pilot study: Mindful Eating and Living (MEAL): Weight, eating behavior, and psychological outcomes associated with a mindfulness-based intervention for people with obesity. Complementary Therapies in Medicine. 2010;18(6):260–264.
7. White KM. MINDFUL EATING FOR CHILDREN. Journal of Psychology and Theology. 2014;42:308.
8. Williams M, Teasdale J, Segal Z, Kabat-Zinn J. Eating One Raisin: A First Taste of Mindfulness. 2007. Available at: http://hfhc.ext.wvu.edu/r/download/114469.

 Nutrition in space is a hot topic! Just today, Build Up Dietitians shared a link to an article about NASA dietitians and their food lab, and in my inbox I received this wonderful infographic! Major kudos to two of our Road to RD Members who wrote on this subject in February! Proud of you, ladies! You've started a trend! 

Read Findley's Blog here: Nutrition in Space: Is it all it's dried up to be? 
Read Nickie's Blog here: Growing Plants in Space: NASA Leaps forward to fresh produce. 

Name: Risa Latinka

Bio: Risa Latinka is a senior studying Dietetics and Global Health at the University of Arizona. She is a lacto-ovo-vegetarian and enjoys trying new recipes when not studying, working, volunteering or watching Netflix. She’s interested in community nutrition and international nutrition. She aspires to get an MPH and become a RD. 
​

Supplement Use in the United States

In 2014, $5.7 billion was spent on multivitamin and mineral (MVM) supplements in the United States. Many MVMs contain most or all of the micronutrients (vitamins and minerals) in adequate amounts that help the consumer meet the Dietary Reference Intakes (DRIs) and are specially formulated for different life stages because our nutritional needs change as we get older.1 

According to an analysis of National Health and Nutrition Examination Survey (NHANES) data, 33% of the American population aged 1 year and older took an MVM in a given month. Further analysis shows MVM use is more common among women and their children; the elderly; those with higher education levels, higher incomes, healthier lifestyles, and lower body-mass indexes; and residents of the western United States. MVM use is lowest among smokers, African  Americans, Hispanics, and Native Americans.1

The 2015-2020 Dietary Guidelines for Americans emphasizes that foods should be the primary provider of our nutritional needs and that “fortified foods and dietary supplements may be useful in providing nutrients may be useful in providing one or more nutrients that otherwise may be consumed in less-than recommended amounts.”2 The logic behind this statement is that fruits and vegetables contain phytonutrients which have beneficial effects such as reducing the risk of developing cardiovascular disease or certain types of cancer. Phytonutrients found in supplements may not be as effective as their whole food counterparts.

 Which, if any, Americans should be consuming a MVM daily? There are some factors that need to be taken into consideration. If you consume an adequate diet that is well balanced in all of the food groups, then chances are you don’t need a daily MVM. Unfortunately, the American diet is low in vegetables, fruits, and dairy products which are good sources of many micronutrients.2

One of the most well-known, supplement-taking population is expecting mothers. Most Americans know the importance of taking prenatal vitamins due to the increased needs of the mother and baby. Another group that can benefit from taking an MVM is the elderly population. People in this age group commonly suffer from difficulties eating and swallowing, decreased appetites, and dementia which all affect their nutrition status. In both situations, a MVM can be taken to fill in the gaps and meet the DRIs. 

Clinical Uses of Supplements in Disease States

In recent years, there has been a lot of research involving supplements and their effects on many different diseases. In all of the literature that I have read, the conclusion is that more research needs to be done to ensure the safety and efficacy of using supplements as primary treatment. A typical MVM contains adequate amounts of folic acid, iron, vitamin B12, and vitamin D that can help prevent anemias, neural tube defects, and bone disease.3 In addition to these disorders and diseases, there are other clinical uses of supplements. 

Hypertriglyceridemia, or elevated triglyceride levels, affects 33% of the American population and is associated with an increased risk of developing cardiovascular disease and acute pancreatitis.4 There are many medications that are currently being used to treat hypertriglyceridemia and two medications include high doses of micronutrients. Niacin, or vitamin B3, lowered triglycerides levels by 20%, increased HDL by 16%, and decreased LDL by 12%. Niacin has also been shown to reduce the rates of cardiovascular events and improve coronary atherosclerosis.4 The second type of drug is the consumption of around 4g of long-chain omega-3 fatty acids. These medications, on average, lowered triglyceride levels by 25-34% and increased HDL levels by 1-3%. In addition, LDL levels were increased by 5-11%.4 It should be noted that these medications are prescribed by a physician and taking the same dosage of over the counter supplements is not recommended. 

Many gastrointestinal (GI) disorders require supplementation due to malabsorption, maldigestion, and/or diarrhea. Gastritis, or inflammation of the stomach, requires a vitamin B12 supplement due to the lack of intrinsic factor which is involved in the absorption of B12.5  General malabsorption and increased losses in patients with Celiac disease or irritable bowel syndrome should also take a daily MVM to ensure that all DRIs are met. When some GI disorders damage sections of the GI tract, those sections have to be removed and their removal may cause micronutrient deficiencies. For ileal resections, fat soluble vitamins, calcium, magnesium, and zinc should be supplemented. For ileostomies, vitamin C and folate should be supplemented due to low fruit and vegetable intake. For colectomies, vitamin B12 should be supplemented.5

Drug and Nutrient Interactions

Certain drugs can also cause nutrient deficiencies even if the person is consuming a well-balanced diet that is providing adequate levels of all micronutrients. For this specific population, supplementation is often recommended to ensure adequate levels are consumed while taking the medication. Thiazide diuretics which are used to treat high blood pressure and edema may cause deficiencies in magnesium, potassium, sodium, and zinc.6 For patients with asthma or other airway diseases inhalers are often prescribed which may cause deficiencies in calcium, magnesium, phosphate, and potassium.6 Metformin is popular drug to treat type 2 Diabetes and may cause deficiencies in folic acid and vitamin B12.6 These are just three examples of how drugs may cause nutritional deficiencies, but the list is much more extensivethan this. It is extremely important that professionals are aware of these interactions and inform their patients to avoid the consequences of nutrient deficiencies.  

Nutrient deficiencies are common in the United States due to the lack of fruits and vegetables in our diet. Eating a well-balanced diet would be the preferred method to eliminate the deficiencies, but picky eaters and those who may not have access to fresh produce may benefit from a daily MVM. In addition, people with certain diseases or taking certain medication should also consider supplementation. Dietary supplements do have a place in medical care today. 

References

1. Office of Dietary Supplements. Multivitamin/mineral supplements. Office of Dietary Supplements website. Last updated July 8, 2015. Available at: https://ods.od.nih.gov/factsheets/mvms-healthprofessional/. Accessed February 12, 2016. 

2. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/. Accessed February 12, 2016. 

3. Ward, E. Addressing nutritional gaps with multivitamin and mineral supplements. Nutrition Journal Nutr J. 2014;13(1):72. 

4. Ito MK. Long-chain omega-3 fatty acids, fibrates and niacin as therapeutic options in the treatment of hypertriglyceridemia: a review of the literature.Atherosclerosis. 2015;242:647-656.

5. Mahan, LK, Escott-Stump, S, Raymond, JL, Krause, MV. Krause's food & the nutrition care process. St. Louis, MO: Elsevier/Saunders; 2012.

6. Moss M. Drugs as anti-nutrients. Journal of Nutritional and Environmental Medicine. 2007;16:149-166.

Dietitians are never cornered into just a single area. In fact, many dietitians branch out in innovative ways and deliver products and services that are unlike any other.  With that in mind I'd like to introduce you to Ryan Hartz! Ryan is the owner and creator of Visual Veggies which offers an RD Exam Prep software which offers a multiple choice practice exam to help students study for the big scary RD Exam! My favorite aspect of the program is the ability to contact an RD with questions if stumped! Read more about the software and our interview with Ryan below! 

1. Tell me about your journey to becoming a dietitian?

  I started out in school not really knowing what I wanted to be when I grew up but knew it had to involve science and math since these were my strong areas in school.  After a few years at another school, I decided on pursuing nutrition as my career and found a school locally.  I loved the first several nutrition classes in my first year and knew this was the path for me.  After obtaining my bachelors degree and passing my RD Exam, I chose to stay on and continue in the new masters in sports nutrition program my school was offering.

2. Can you recall a moment in your undergraduate/graduate/internship time when you felt you just couldn’t wait for your future as an RD?

 Just like many nutrition students, I had the hopes and dreams of making a difference in people’s lives, and I couldn’t wait to get to the workforce.  The internship was definitely a critical time in my life.  I got to experience the many possibilities of what a dietitian can do.  During the internship, I found a greater love for clinical nutrition and not as much of a desire for foodservice.  Without the internship, I would’ve had to try out these areas on my own.

3. Think back to what you imagined your career would be like when you were in school, how is it the same or different?

 I had a big desire to work with athletes while in school, hence the decision to pursue the sports nutrition degree.  My hopes were to score a job with a sports team, college or professional.  As luck would have it, the number of sports nutrition positions were not in the highest demand.  Right out of school, I took a few jobs working in long-term care as the clinical dietitian and loved it.  At one of my positions, a very unique job opened up locally where they were looking for a sports dietitian.  I then applied for the job and graciously accepted the position where I worked for a large food company who had a sports nutrition line of products.  My job entailed speaking directly to consumers using the products and discussing how it can help with their athletic performance.  This position taught me so much about customer service and groomed me to excel in this category.  Learning this very critical trait has been essential in my business.  I treat every customer as my number one client.

4. Tell me more about Visual Veggies and how you created it. 

 Software development began as a hobby when I was in my internship.  I bought how-to books and was active on software development forums.  Much of the learning came through trial and error.  As I was finishing up my internship, I knew I had my own RD Exam in my near future.  I went through all of my textbooks and notes from school and developed a question database.  This was actually my method of learning for the exam.  After the database had been completed, I started working on the actual RD Practice Exam program and had the project completed in a few short months.  I then sent out mailers to all the nutrition schools in the US to spread the word, and that was just the beginning.  From there, the software had evolved, the question database had grown, and the majority of sales simply came from word-of-mouth.

5. Is Visual Veggies your full time job or do you work other dietitian related positions on the side?  

Currently, I do have a full-time position and the business is a side job.  However, I do foresee the software as being my full-time job in the near future.

6. Where do you see your future as a dietitian?

 I will continue my work as a software developer and keep current with my learnings in nutrition.  My desires are to build the software company and to continue to support students preparing for their registration exams. 

7. If you could only share one resource with soon to be interns and/or soon to be dietitians what would you share?

 If you are stuck or don’t know the answer, don’t be afraid to ask.  I was a doe-eyed young nutrition pup myself once too.  We all were.  I had some wonderful mentors,preceptors, and colleagues who I could turn to and ask anything I needed more clarification on, and they were more than happy to instruct.  This is a valuable way we learn.  Then, what goes  around, comes around.  As you develop and become wiser in the profession, you very well may have some student dietitian, intern, or new employee who needs your help.  Pass on the torch and be the mentor to them.

8. What are your hobbies?

 Besides software development, I also enjoy exercising, competing in triathlons, and watching movies.