Connections UPDATE!

August 1, 2014    

FROM THE CHAIR Lisa Eckstein, MS, RD, LD DHCC Chair 2014-15

     

Dear Members,  

As I write this, I am amazed that summer is 2/3 over! The year is already moving quickly! I know that you are all busy as well with work, family, vacations, etc. I hope that each of you is having a wonderful summer!  

THANK you to Beano for sponsoring this edition of UPDATE! For more information, please visit their website at http://www.beanogas.com/ .  In less than three months we will be at the Academy’s Food & Nutrition Conference & ExpoTM (FNCE®) in Atlanta GA. Beginning October 18, 2014, FNCE® will be in Georgia for the first time in 15 years. FNCE® is a wonderful opportunity to enhance your career with motivational sessions, networking receptions and educational excellence.  When FNCE® was in Atlanta in 1999, I was serving as Secretary of the Georgia Dietetics Association (now Georgia Academy of Nutrition and Dietetics). It was the first conference in which I embraced networking at a national level and connected to a Dietetic Practice Group, Dietetics in Healthcare Communities (DHCC). I attended the Pre-FNCE® conference and was inspired by the Executive Committee and the DHCC members. The sessions improved my clinical skills and challenged me to boost my career. From the contacts I made, I became more involved in the DPG and volunteered to assist. Soon I was on the ballot and have served as Area Coordinator, Secretary, Treasurer and Professional Development Coordinator. Now as FNCE® returns, I am Chair of DHCC and assisted in planning the Pre-FNCE® program. This year, FNCE® will be special as I serve as hostess for DHCC members in my home state and my DHCC journey comes full circle.  

This year, PreFNCE® will be held on Saturday, October 18 from 7 am – 3:00 pm, entitled Sharpen Your Skills! Physical Assessment, Infection Control, Quality Management. We have an outstanding lineup of speakers and topics with 6 hours CPEUs applied for, Level II:  

Nutrition Focused Physical Examination, Kathy Hammond, MS, RN, BSN, BSHE, RDN, LD  

Hand Grip Dynamometry, Lindsay Dowhan, MS, RD, CSO, LD, CNSC

Hands on Physical Examination  

The Facts, Fallacies and the Future for Hand Hygiene for Reducing HAI, Vickie Patterson, CFSP III  

Quality Management Skills for the RD: Do you want to make an improvement by next week? Linda Kluge, RD, LD, CPHQ

 

For complete information on the Workshop, click here.

Saturday evening from 6:30 pm until 8:00 pm is the Member Networking Reception. We hope you can join us for this – networking with colleagues – both old and new friends – is wonderful! The Executive Committee (EC) loves this opportunity to meet members face-to-face.

 For complete information on the reception, click here.

  

The EC will also be available at DPG/MIG Showcase, the Sub-Unit Meeting, CMS Meeting, and at the DHCC Booth # 1531 on the Exhibit Floor. See the complete schedule below.

We hope to see many of you in Atlanta!

THANKS again to BEANO!  

  

 

Lisa Eckstein DHCC Chair 2014-15

    

EVENT  

DATE TIME  

LOCATION

PreFNCE® Workshop Saturday, October 18 7 am – 3 pm Omni at CNN Center International Ballroom F

Member Reception Saturday, October 18 6:30 – 8:00 pm Omni at CNN Center International Ballroom ABC

Sub-Unit Meeting Sunday, October 19 5-6:30 pm Marriott Marquis M304

CMS Meeting Monday, October 20 5-6:00 pm Omni at CNN Center Dogwood

      

 

www.beanogas.com

Parkinson’s Disease: Overcoming Obstacles to Good Nutrition Kathrynne Holden, MS, RD

Ms. Holden is author of the nutrition handbook “Eat well, stay well with Parkinson’s disease.” She performs medical nutrition therapy for individuals with PD, and coauthored the pilot study Risk for malnutrition and bone fracture in Parkinson's disease, J Nutr Elderly, 1999; Vol.18:3. She offers a seminar: Nutrition and Parkinson’s: what the health professional needs to know. References for this article are available by e-mail upon request — e-mail <fivestar@nutritionucanlivewith.com>

Many nutritionists sooner or later help to care for someone with Parkinson’s disease (PD). Although most of the one to one and one-half million people in the U.S. diagnosed with PD are older adults, about ten to fifteen percent are under age 60. Characteristic of this disease is a gradual death of the dopamine-producing cells of the brain. This results in loss of motor functions, causing uncontrollable shaking, rigidity, slow movement, poor balance, and inability to walk normally. Many people with PD fall frequently, probably due in part to this loss of motor function. Non-motor functions may also suffer – slowed peristalsis is common and can result in dysphagia, gastroparesis, small intestine bowel overgrowth, and constipation and fecal impaction.

Medications used to treat PD have improved greatly over the years; nevertheless, they frequently cause side effects that can be obstacles to good nutrition: nausea, constipation, heartburn, confusion, depression, fatigue, loss of the senses of smell and taste, loss of appetite, dry mouth, anorexia, and sleep disruption. Unexplained weight loss is common, as is orthostatic hypotension. Furthermore, those who use levodopa, considered the gold standard of PD medications, must deal with a major food-medication interaction, that of protein and levodopa.

Many people with PD require a combination of levodopa and carbidopa; however, dietary protein can interfere with levodopa absorption, both from the gut and at the blood-brain barrier. Without the benefits of levodopa, the individual may be unable to move, perform normal activities of daily living, self-feed, or turn over in bed. Additional concerns include both adverse medication effects, disability, sensory changes, and changes to the gastrointestinal tract. Levodopa can cause excessive urination; however, people with PD may avoid drinking sufficient fluids, knowing that slowed movement may make it difficult to reach the bathroom and unfasten clothing in time. In later stages, choking, dysphagia, and/or dementia may occur. Additionally, perhaps because of sensory changes, patients frequently develop a craving for sweets, eating them in preference to nutrient-dense, high-fiber foods; this can contribute to the constipation which is already prevalent due to the disease and/or its medications. These conditions are direct or indirect risk factors for malnutrition, dehydration, bone loss, bowel impaction, and/or unplanned weight loss.

Bone loss and loss of muscle mass, combined with poor balance, shuffling gait, and increased incidence of falling, greatly increases the risk for bone fracture, and probably explains the rate of hip fractures in patients with PD. Indeed, when bone mineral density was compared with values for age-matched groups, PD patients had a higher incidence of severe osteoporosis.

Additionally, Parkinson’s patients have been shown to have lower levels of fat-free mass yet similar resting metabolic rates versus a control group. The resulting sarcopenia (loss of muscle mass) may contribute to

poor muscular control and incidence of falling. Furthermore, postoperative rehabilitation was found to be longer and less successful in PD patients with hip fractures than in other patients with similar fractures.

Unplanned weight loss (UPWL) and low body mass index (BMI) are significant predictors of morbidity and mortality in older adults; both are common in patients with PD. Because patients with PD may be at risk for bone fracture, and are more likely to experience UPWL, it is important that nutrition bolster bone strength and prevent loss of lean body mass. Yet, due to the numerous difficulties listed above, patients may not make food choices helpful to maintaining bone strength and muscle mass. Also, due to confusion, depression, fear of falling, fatigue, and social withdrawal, patients may not perform weightbearing physical activity, or receive exposure to sunlight, again implicated in bone health.

Some further complications can occur. In my practice, I frequently observe patients with PD who have missing teeth. Upon questioning, I have learned that many experience dry mouth, leading to a form of tooth decay that cannot always be treated; often, the tooth must be extracted. If bone loss in the jaw area also occurs, dentures and bridges may not fit properly, leading to poor mastication — another obstacle to good nutrition.

Another problem that can lead to weight loss is inability to finish meals on time. This can be due to poor coordination, and/or inability to properly use the muscles of the tongue and mouth in the chewing and swallowing process. When this is the case, I often counsel patients not to eat foods like tossed salads, which may be difficult to spear on a fork and place in the mouth; or which require a great deal of chewing. I encourage use of softer vegetables, or juices instead.

PD and/or the medications used to treat PD may slow the body’s natural peristalsis, leading to difficulty swallowing, delayed stomach emptying, heartburn, and constipation. All of these can, of course, be regarded as further barriers to overcome in an effort to obtain adequate nutrition.

Overwhelmed by the progressive nature of the disease, and the need for frequent changes in type and amount of medications and their side effects, patients may sometimes ignore constipation. However, bowel impaction occurs often, and can be especially difficult for people with PD, who are often emotionally labile. Stresses and trauma can quickly lead to downward spirals in physical, mental and emotional health. Patients hospitalized with bowel impaction may not regain their former state of health, and in fact have been discharged to long-term-care facilities, unable to perform their usual activities of daily living any longer.

Heartburn is also quite frequent, and may cause patients to avoid eating in fear of extreme discomfort. I encourage frequent low-protein meals and snacks in this case, to avoid overfilling the stomach, and advise against eating anything for several hours before bedtime.

In later stages of PD, protein-rich foods often begin to interfere with levodopa absorption, and protein redistribution diets are available. One plan entails avoiding protein throughout the day, for better mobility; then eating all protein foods at the evening meal. This can work well for some patients. However, I have observed patients who then complain that reduced mobility at night leaves them unable to turn in bed at night, sometimes becoming tangled in their sheets. Also, they cannot get up to urinate at need. It is not uncommon for patients to decide to avoid protein at the evening meal as well as during the day, in order to gain mobility throughout the night. RDs must educate patients carefully with regard to their protein needs.

Mild to severe dehydration is also not uncommon, again, often due to fear that one will be unable to reach the bathroom. I caution patients about such complications as urinary tract infections, and encourage them

to drink as much water as possible when they take their medications. The ensuing “on time” with its increased mobility (as opposed to “off time” when medications wear off and mobility decreases) should be used to empty the bladder frequently. Then the bladder will be empty during “off time” when the patient is less able to move about.

Patients also need to be well educated with regard to the need for fiber, both soluble and insoluble. Some individuals experience abnormal blood glucose levels, possibly due to medications, and soluble fiber can help to control this. Insoluble fiber is needed to help with constipation. Sources of calcium and vitamin D are important areas of discussion, too. Few older adults are aware that the recommended amounts of both nutrients have changed recently, and many people do not even meet the current RDA levels. PD patients can have difficulty with these two nutrients, because milk, which is one of the most common sources of both calcium and vitamin D, is also high in protein, and can interfere with the absorption of levodopa.

Parkinson’s can be highly individualized, presenting conditions unique to each patient. This may require extra care and attention on the part of the RD. As an example, protein redistribution may need to be carefully calculated for people who have diabetes or elevated triglycerides, and may not be possible at all for those with COPD. For other patients, protein redistribution may result in the need to reduce the amount of levodopa used. It is important to work closely with physicians to achieve optimal results for each patient.

Gerontological nutritionists, as well as registered dietitians working with older adults in other practice areas, need to be well-informed about the nature of Parkinson’s disease, and the highly specialized nutrition needs of patients with PD. It may be necessary to educate other health professionals as well. For example, timing of medications is crucial in hospitals, and long-term-care institutions, as well as in home care. Without medications, patients are unable to achieve the mobility they need in order to feed themselves or perform other functions. Meal timing is equally important, as the levodopa may not be absorbed if taken with protein foods. Delayed gastric emptying can affect protein-levodopa interactions, as well. Understanding of the various protein redistribution diets is important.

Medical nutrition therapy is needed for this population group and should begin as soon as possible following diagnosis of PD. Early intervention to educate patients and/or caregivers regarding need for an energy-and-nutrient-dense diet, suitable sources of calcium and vitamin D, adequate hydration, and control of constipation, is of the utmost importance. Education of this type may aid in maintaining bone density and muscle mass, help prevent weight loss, dehydration, and bowel impaction, and assist in prevention of dental caries related to dry mouth. RDs should check patients’ weight regularly. Weight loss should be followed by counseling and design of individualized nutrient-dense meals and snacks. Patients should be advised of the need for interaction with their dentists regarding dry mouth and need for oral hygiene.

Upon diagnosis of PD, patients should be referred to a registered dietitian for counseling. Further, as the patient’s abilities and needs change throughout the stages of this disease, dietitians should be part of the health care team, working to maintain adequate nutrition, and prevent traumatic and costly hospitalizations. RDs should inform neurologists, dentists, home health and long-term-care agencies of our ability to provide the highly specialized nutrition counseling necessary to meet the individual nutrition challenges of patients with PD.

Kathrynne Holden graduated from Colorado State University with a Master's degree in human nutrition. She is the author of books and articles on Parkinson's disease for both health professionals and patients.

She has presented her work in Australia, Canada, and London, as well as the United States, and has spoken frequently at Parkinson symposia. She has authored "Eat Well, Stay Well with Parkinson's Disease," “Cook Well, Stay Well with Parkinson’s Disease,” “Parkinson’s Disease and Constipation,” and the professional’s manual "Parkinson's disease: Guidelines for Medical Nutrition Therapy." Visit her website www.nutritionucanlivewith.com or Facebook page www.facebook.com/Parkinsons.Chew.On.This

..

 

 

 

  

     

To my fellow Academy members:   

At the FNCE Opening Session in 2010, then Academy President Judith Rodriguez, PhD,

RD, LDN, FADA, announced a need for a certification option for baccalaureate degree

graduates who meet Didactic Program in Dietetics (DPD) requirements. A certification

would respond to the demand for increased consumer access to credible food and nutrition

information and would allow DPD graduates, who have completed an Accreditation Council

for Education in Nutrition and Dietetics (ACEND)-accredited program to remain connected

to our profession.  

 In July 2013, the Board approved the Nutrition and Dietetics Associate (NDA) designation.

Since then, the NDA and associated issues have generated many discussions. Recently,

the Board of Directors appointed a Task Force to look more closely at moving to multi-levels

of practice, and Academy members were asked for comments and recommendations. We

were delighted that hundreds of members offered thoughtful, passionate remarks on all

sides of the issue. Thank you to all members who provided feedback. We assure you that

your voices were heard and your viewpoints were considered.

The Task Force reviewed all the information surrounding the NDA designation, including:

Comments from educators, employers, practitioners and students dating back to  

2011  

The Academy’s ongoing need to proactively and strategically position the nutrition

and dietetics profession in the marketplace now and in the future

The fact that individuals with a baccalaureate degree are qualified for

licensure/certification in 30 states if they complete a licensure board approved

supervised practice/work experience and examination. These states do not require

completion of ACEND-accredited academic programs or ACEND-accredited

supervised practice.

Recommendations from the 2012 Visioning Report and related House of Delegates  

(HOD) dialogue  

Recommendations from the Individualized Supervised Practice Pathways Workgroup

..

 

 

   

 ACEND, Commission on Dietetic Registration (CDR) and Council on Future Practice

documents

Data analysis from Nutrition and Dietetic Educators and Preceptors (NDEP) area

meetings and member polls

HOD portal postings, member emails  

Feedback to the online Change Management matrix for five key constituent groups  

(RDNs, DTRs, DPD graduates, employers and public/consumers.    

The Board accepted the Task Force recommendation that builds upon the existing DTR

Pathway III and differentiates between degree levels to obtain the credential Nutrition and

Dietetics Technician, Registered (PhD, MS, BS or AS-NDTR). This recommendation follows

the nursing model (the RN examination is open to AS-, BS-, and MS-prepared individuals).

Individuals who have earned the DTR credential could choose to retain this designation or

adopt the NDTR; those with the four year degree likewise could choose BS-DTR or

BS-NDTR.   

The Board believes this decision takes into account thoughtful member feedback and

provides several advantages, including:

 Maintaining the integrity of current professional designations (RDN, RD, NDTR, DTR)

Providing a timely opportunity for eligible DPD graduates to become certified and to

remain connected to the Academy

Allowing the Academy to collect and analyze data on the utilization and practice

implications of the enhanced DTR Pathway III, and making evidence-based decisions

on what, if any, changes are needed.    

DTR Pathway III requires “Completion of a Baccalaureate degree granted by a U.S.

regionally accredited college/university, or foreign equivalent, and completion of an ACEND

DPD.” After successfully passing the NDTR exam, credentialed individuals will be required

to comply with CDR recertification requirements, the Code of Ethics for the Profession of

Dietetics and the Standards of Practice. In 2015, CDR will conduct a practice audit to

differentiate practice parameters of NDTRs (DTRs) and RDNs. The results will provide

valuable information about evolving practice roles to inform future deliberations on title,

practice role and examination for NDTRs.  

 More information on the NDTR credential will be made available as it is developed. All

members and students who are interested in the NDTR credential should visit

http://www.cdrnet.org/certifications/registration-eligibility-requirements-for-dietetic-

..

 

 

   

 technicians.

  

Thank you again to all members who made their voices heard during the past several

weeks. As a Board, we are committed to listening to you and carefully examining every

issue as we continue to move the profession forward. We can only do that as members

passionately engage in providing feedback, responding to calls for action and volunteering

their time to continue to tackle the challenges that arise, including our current preceptor

shortage. Working together we can help ensure the public has access to credible food and

nutrition guidance from our credentialed practitioners.  

 Sincerely,

 

On behalf of the 2014-2015 Academy Board of Directors   

Sonja L. Connor, MS, RDN, LD, FAND

President  

 Dr. Glenna R. McCollum, MPH, RDN

Immediate Past President 2013-2014  

 Ethan Bergman, PhD, RDN, CD, FADA, FAND

Past President 2012-2013  

 Sylvia Escott-Stump, MA, RD, LDN

Past President 2011-2012  

  

Dietetics in Health Care Communities (DHCC) Executive Committee 2014-2015

Chair: Lisa W. Eckstein, MS, RD, LD Chair-Elect: Kathy Weigand, RD, LD/N

Past Chair: Pat Dahlstrom, RD, LD Secretary: Jamie Ritchie, MS, RDN, CSG, LDN

Treasurer: Lorie Stake, MS, RD, LDN DPG House of Delegates Delegate: Angela B. Sader,

MBA, RD, LD Professional Development Coordinator: Membership Coordinator: Patricia Iorio, MS, RD, LDN Laura Goolsby, MS, RD, LD/N

Newsletter: Paula Bohlen, MS, RDN, LDN, LNHA Sponsorship Coordinator: Katy Adams, MDA, RD,

CSG, LD Policy and Advocacy Leader (PAL): Karin Palmer, Corrections Sub-Unit: Marlene Tutt, MS, RD RDN, LD, CDE

eNCPT: Nutrition Terminology Reference Manual

The eNCPT (formerly IDNT Online) is now on a new website platform and continues to offer all the peer-reviewed content of the previous version, but with new features to improve the user’s experience.

New Features

• Translations: The Academy will collaborate with international dietetics associations to produce eNCPT translations. These translations will be easily accessible to subscribers via tabs on the webpage.

• Easy Navigation: Every page in the new eNCPT includes a file path at the top so that users can never get lost. Additionally, with the improved toolbar at the top of the screen, users can now easily get to any section of the eNCPT immediately, no matter where they are on the site.

• Modern Functionality: The Scribd tool allows the user to scroll through PDFs on the screen without downloading first.

• Improved Organization: The new online platform follows the layout of the print edition so that charts are left intact and information flows in a logical way.

URL: NCPT.webauthor.com

To learn more about the NCP and other available resources, visit www.eatright.org/NCP.

Please direct any further questions to Kay Howarter, Director of EAL/NCP Business Development (khowarter@eatright.org)

or Katie Gustafson, Research Assistant (kgustafson@eatright.org).