Friday, May 22, 2009

My Clinical Nutrition Experiences

Despite the fact that I completed my PhD just recently, I'm still not done my educational path. Currently, I'm finishing up my Registered Dietitian Internship through UMass Amherst so I can finally become a Registered Dietitian.

I started the internship last August (right after my wedding) and will graduate at the end of June this year (YAY!!). For the internship, I've gone through the various "rotations" that all interns go through to become a RD. I started in community nutrition, then went to food service (at an elementary school) and am now in clinical.

Clinical has been pretty interesting. I always told myself that I never wanted to work as a Clinical Dietitian, because working in a hospital just really isn't any fun. Well, I was wrong and right all at the same time.

My clinical rotation is through Baystate Medical Center in Springfield, MA, which is one of the top teaching hospitals in the US. We get to see some of the craziest cases/patients here, which is what has made it so interesting. Through my experience in the ICU (Intensive Care Unit), I've learned to ALWAYS wear my seatbelt and never drink and drive.... (we see TERRIBLE car accident victims, which is so sad). I also learned that people do some stupid things and get really hurt, like cooking on a grill inside their home in the winter.... uh... Hello? Anyone in there? My goodness.

Anyhow, the frustrating part of being a clinical dietitian is that I don't agree with the nutrition guidelines and nutrition treatments that we have to give to most patients.

For example, if you have a patient who developed diabetes because of illness stress or the high-carb nutrition in the hospital, we're not allowed to cut back their carbs. Instead, we have to give them "counted carbs" and then dose them with insulin accordingly!!! It just doesn't make sense; why not just remove the insulting issue and lessen the use of drugs?

I put a picture of Ensure at the top of the page, because this is the "Beverage of Choice" that we offer patients when they don't have a good appetite, or they need more protein. The issue I have with this product though is that nothing in it is natural. Just take a look at the ingredient list:

Water (UD), Corn Syrup, Corn Maltodextrin, Sugar (Sucrose), Sodium, Calcium Caseinates, Canola Oil, Corn Oil, High Oleic Safflower Oil, Cocoa Powder (Processed with Alkali), Soy Protein Isolate, Soy Lecithin, Natural & Artificial Flavor, Carrageenan, Vitamins & Minerals: Magnesium Chloride, Potassium Citrate, Calcium Phosphate Tribasic, Sodium Citrate, Potassium Chloride, Choline Chloride, Ascorbic Acid (more synthetic vitamins...)

Since when is Corn Syrup a complete food that can help someone heal quicker or feel better?

Then, the protein choice is less than desirable (soy, calcium caseinates), and in the end, only provides someone with 13 grams of protein alongside the 50 grams of carbohydrates (from mostly sugar!).

It really goes against all I've researched and learned under my PhD supervisor to give people some of the foods that we give them here while they're sick and in the hospital.

Why not just blend up a healthy shake for someone made with real food instead of synthetic items if they have a hard time getting in enough calories?

There are some hospitals out there that do this kind of thing, but unfortunately, the choice we make are driven by BigPharma and Medical Insurance companies.... sad, sad.

I must say, thankfully, the dietitians at Baystate that I'm learning under are very smart and do appreciate the importance of additional protein in the diet, fiber for constipation instead of drugs, probiotics to help combat antibiotics, and essential fats from fish oil to help with healing. I'm happy I've had my experience here in clinical dietetics, because I've heard horror stories from some of my fellow interns in other areas.

Bottom line: if you get sick and are stuck in the hospital, fight for the best nutrition you can get. Some people even bring in their own food and supplements, which in my opinion, can be one of the best options out there.

Now, stay healthy, and remember: don't try to put out a fire with gasoline (true story... it happened here in MA).


Linda said...

what a great post! ensure?!

I've seen the same things with my friend's daughter with type 1 diabetes. She's 8 and they are supposed to give her up to 75 grams of carbs at meal and then dose insulin. huh?

The same was true for my late father. He had heart disease so they took fat out of diet and then he became Type 2 diabetes (no surprise there) and they wanted him to have oatmeal, a banana and OJ for breakfast. I kept telling him about a better way to eat and he just trusted his doctor. Right before he died I had him eating under the Schwarzbein principle with portioned good carbs, good fats, lots of veggies and good proteins. His blood sugar was stable and he felt amazing. But it was too late.

I am so frustrated with the advice out there that I just applied back to school (again!) for a double master's in Public Health and Nutrition and Wellness. I see the next generation having even more problems with obesity and we have to make some changes. You inspire me!

UofMWolverine81 said...

Miss Forsythe,

What do you think of using 3-5 grams of leucine with elderly patients in the hospital in order to help stimulate protein synthesis and promote as much lean mass maintenance as possible.

Obviously a lot of other factors need to be adjusted and a subar level of nutrient intake will make this an uphill struggle, but can the leucine strategy be of use in such a population?

I've even heard that leucine can help improve insulin signaling and have wondered if this may be of any help with type 2 diabetics.

But I am not a researcher and someone on the level of a hard-working expert like you, so I may be completely off base here.

Thank you for your insightful posts.

Barbara C. said...

My mother has stage IV lung cancer and I also questioned some of the foods they gave her in the hospital (including a bag of Doritos).

Let's hope people like you can go out in the world and make a difference!

Cassandra Forsythe said...

OfMWolverine81: I'm not sure yet about Leucine as I've not done much research into that. The issue with supplements in the hospital in general is who is going to PAY for it. Insurance companies try to pay as little as possible; hence the crappy nutrition supplements we do have available. If Leucine became available, I bet it would cost a fortune. Then, would it outperform all the other drugs patients are on (doctors LOVE Rxing the most catabolic drugs possible).