Just finished 1200 hours of dietetic internship rotations. It was an enriching experience.
This week I had a chance to work with a registered dietitian in a clinic of children and adolescents with special needs. This experience was an eye opener of the challenges the families and caretakers have to go through to provide adequate nutrition to these kinds of patients. Most of the special need children have stunted growth, are small for age, short for their age, experience feeding difficulties due to motor and psychological developmental delays, and other challenges. Most of the children are on special formulas due to their disease conditions or due to their incapacity to consume adequate nutrients orally. Others have malabsorption problems and others have excretion problems. Because of all these complications, the dietitian works very closely with the doctor, therapists, social workers and caregivers, to provide optimal care and ensure proper growth and development of these patients.
What’s in flour?
With many ‘diets’ restricting consumption of breads and grains, the public need to be educated that grains and breads are not our enemies. They still make a big component of essential nutrients, vitamins and minerals that we need, especially when consumed whole and in the right amount. According to MyPlate, 25% of the meal should contain grains. Many people do not understand that other than the carbohydrates provided by the grains, common flours contains appreciable amount of proteins, fiber and minerals. For instance ¼ cup of spelt flour contains 4g proteins, 4g fiber and 1.5g iron. Legumes flours such as almond flour, peanut flour and millet flours are rich sources of proteins. Flours from other ethnicities are also rich in nutrients, for example Teff flour used for making Ethiopian flat bread, injera contains twice the amount of iron and 3 times calcium as that of regular wheat flour. Garbanzo four, common in Italian cuisine, also known as chana flour, is high in proteins. For those who want glutein free diet, there is a lot of ethnic flour that are glutein free, and taste delicious. Most common are cassava flour used for making Nigerian gari, Dal flour from mung beans, common in Indian cooking, fufu flour, common in Nigerian cooking and millet flour common in Indian and Pakistan cooking. Grains and flours are necessary for our normal metabolism, variety is even better.
Gluten containing grains: wheat, rye, oats and barley
Grains without gluten: corn, rice, potato and tapioca
Inactive ingredients in pharmaceuticals that are likely to have gluten:
• Dusting powder
• Pregelatinized starch
Inactive ingredients in pharmaceuticals that are least likely to have gluten:
• Sodium starch glycolate
When doing my rotation at WIC, I had the opportunity to visit and consult with the dietitian at several group homes in the area. Group homes are an area of challenge for many dietitians because most of the clients have several nutrition related health issues such as obesity, food and drugs interactions, psychological food aversions such as compulsive eating, most are on diet consistency modifications of some form due to swallowing or other developmental issues, reflux and GERD and constipation. Other cases that I came across were pregnancy, postpartum nutrition, fluid intake and staff training. Although group homes may not be an area most dietitians are aware of or consider working, it is an area that require the skills and knowledge a dietitian can offer because nutrition of this group of people can be marginalized when determining their healthcare needs.
Nutrients required for proper teeth development are proteins, calcium, phosphorous and fluoride. Proteins help in forming the foundation of the teeth, and the minerals are deposited on the foundation to form the hard tooth structure. Fluoride, especially when continuously incorporated help decrease acid erosion that predispose the teeth foundation to dental caries. Dental caries are caused by streptococcus mutans which forms dental plaque in the mouth. Acid is produced after fermentation of the plaque and other sugars in the mouth, causing enamel erosion. Using infants’ bottles and sippy cups especially at night increases the exposure period of these fermentable carbohydrates hence increase the chances of baby bottle tooth decay.
PKU (Phenylketonuria) is well controlled and managed in developed countries, but it’s still a major cause of mental retardation in developing countries. PKU is caused by lack of the enzyme phenylalanine hydroxylase (PAH) resulting in accumulation of the essential amino acid phenylalanine. Accumulation of the amino acid in the brain causes damage and hence mental retardation. This condition is inherited through a recessive autosamal gene, which means both parents must have the recessive gene for the child to have the condition. In United States, all children are screened for PKU at birth, a test commonly known as heel prick; however in developing countries, PKU is a major cause of mental retardation. This is part due to political landscapes and policies involved in implementing the tests, lack of awareness and largely due to economic reasons. Public health agencies have campaigns and initiatives to increase awareness and availability of such tests in order to manage and reduce the burden caused by such inborn diseases like PKU.
DeGeorge syndrome is a congenital anomaly resulting from deletion of the entire or part of chromosome 22. The syndrome is characterized by various birth defects, immune disorders, feeding difficulties and developmental retardation. This condition can occur due to gene mutation or in more rare cases by inheritance. Those with complete chromosome deletion do not have a thymus or the parathyroid glands. Since parathyroid glands are important in calcium regulation, people with this condition have abnormal serum calcium and vitamin D in their system. They are therefore put on calcium and vitamin D supplements and low phosphorous diet. The syndrome cannot be prevented or treated. Management of the symptoms help the patient have a close to normal life especially when started early.
Methemoglobinemia also known as blue baby syndrome is a condition that occurs when the baby’s blood cannot transport enough oxygen to the tissues due to build up of methemoglobin. Methemoglobin is a non-oxygen carrying enzyme produced by the body that is converted to oxygen carrying hemoglobin by methemoglobin reductase. Infants younger than 6 months old have very low methemoglobin reductase and therefore methemoglobin can easily build up to toxic levels when the infant is exposed to some food or environmental factors. These factors includes; high nitrate consumption from drinking water or high nitrate foods. This is especially common in rural agricultural areas where nitrate rich fertilizers leach to the water, soil and in vegetables. Collards greens, spinach and beets are associated with higher nitrate concentration and may not be very appropriate choice of vegetables in very young infants. Blue baby syndrome can also be caused by cyanotic heart defect.
Just finished my institutional food service production and manangement rotation. This was a 6-weeks rotation at WVU dining services. It was a good experience, with alot to learn with different managers at different levels of food service management and production. Also a unique and eye-opening experience working with a sports dietitian during athletes counseling sessions.