Registered Dietitians Help Patients Improve Their Relationship Between Diet and Health
In our last edition, we introduced you to one of the unsung heroes of a cancer patient’s care team: the oncology pharmacist. In this edition of Real World Health Care, we’re shining the spotlight on another member of a patient’s professional care team: the Registered Dietitian Nutritionist (RDN).
RDNs are food and nutrition experts with a degree from an accredited dietetics program who have completed a supervised practice requirement, passed a national exam, and continue professional development throughout their careers. They work in a variety of settings, including hospitals and other health care facilities, where they educate patients about nutrition and administer medical nutrition therapy as part of the health care team.
While dietitians don’t necessarily cook in a kitchen, they focus on the nutritional aspects of food prepared in the kitchen.
“RDNs are experts in the use of food and nutrition to promote health and manage disease,” said Kimberly Snodgrass, a national spokesperson for the Academy of Nutrition and Dietetics, who practices in a kidney disease clinic in Detroit. “We know how food can be used to help mitigate chronic illnesses, and we can teach people how to use foods to lead healthier lives and thrive.”
Tailored Nutrition Plans for Complex Diseases
Proper nutrition is not a “one size fits all” approach. That is why RDNs develop tailored plans to meet each patient’s needs.
“Even for healthy people, nutrition requirements are highly individualized based on the person’s environment, genetics, behavior, and lifestyle,” said Monique Richard, an Academy spokesperson who owns a private practice in Johnson City, Tenn. “When you add a complex disease state like cancer, liver disease, cardiovascular disease, or diabetes on top, it increases the complexity and uniqueness of the nutritional intervention or the treatment required.”
Richard pointed to cancer as a prime example of this complexity and noted that the type of cancer, type of treatment, state of the patient’s immune system, and the patient’s overall resilience can all impact their nutritional requirements.
Added Snodgrass, “Good nutrition is vital if you have cancer because both the illness and its treatment can change the way you eat. They can also affect the way your body tolerates certain foods and uses nutrients.”
During cancer treatments, patients may need to change their diet to help build up their strength and withstand the effects of the cancer and its treatment. This is where RDNs can play a significant role in helping to identify nutrition goals and develop plans to help meet them, according to Snodgrass.
Richard cautioned that without proper nutrition, a patient’s disease could progress, affecting both their quality of life and their health.
“The body’s systems – respiratory, cardiovascular, skeletal, muscular, neurological – can all start to be affected when nutritional needs are not being met,” she said.
Bolstering Nutrition with Vitamins and Supplements
In addition to designing and helping patients follow a healthy, whole-foods diet, RDNs can help them decide which, if any, vitamins and supplements are recommended to fill in the gaps.
“Our environment has changed drastically over the years,” Richard said. “The soil has become depleted of micronutrients, thus decreasing the nutrient density of the foods grown and harvested. Foods also are exposed to many more chemicals and pesticides. So, even if you ‘eat healthy,’ you may not be getting all the nutrients you need from a whole foods diet.”
RDNs, she said, can evaluate every single micronutrient a patient consumes, by monitoring food logs over time and using blood tests and functional lab tests to identify and track deficiencies. She cautioned patients against thinking that any one supplement can offer a “quick fix,” noting that adding one vitamin or supplement to correct one deficiency can affect or deplete something else.
“Answers to complex questions about nutritional supplements should come from evidence-based research, not the latest fads on social media or anecdotal stories,” Richard said. “RDNs have that big-picture view.”
Tackling Food Insecurity
Because RDNs can devote significant one-on-one time with patients, they are in an excellent position to get to know the patient and learn about their relationship with food and nutrition. In some cases, this involves identifying whether the patient is food insecure, meaning they do not have access to, and/or cannot afford healthy food.
“Social determinants of health, including disparities in food, housing, and transportation, can affect a patient’s ability to manage chronic diseases like cancer,” Snodgrass said. “Eating the healthiest food possible will help their bodies fight and recover while battling disease processes, but healthy food is expensive.”
She added that food insecure patients may choose less expensive, calorie-dense foods that don’t deliver all the nutrients they need. This may lead to unintended weight gain, or in some cases, symptoms of food addiction.
“There is poor nutritional content in these highly processed, addictive foods,” she said.
RDNs can help patients facing food insecurity by connecting them with social workers and programs such as food banks, school breakfast and lunch programs, low- and no-cost food delivery programs, and government assistance programs.
The Academy’s web site contains resources as well, including articles focused on stretching a dollar and how to eat well on a budget.
Nutrition Expertise That Is Practical, Accessible and Applicable
Richard encouraged patients to make full use of the RDN on their care team, noting that the Academy’s vision is for every patient’s care team to include an RDN.
“While RDNs can share great recipes, ideas and food inspiration, our expertise extends far beyond telling you what to eat,” she said. “It’s about creating a relationship with each client or patient and making our advice practical, accessible and applicable to each specific condition.”
For those without an RDN on their care team, Richard recommends finding one through the Academy’s Find a Nutrition Expert service, which is searchable by zip code.