Placement update no. 2

Before I started my placement this summer, a lot of friends and family were asking me what I would be doing in my day-to-day and, to be honest, I wasn’t really sure myself. Dietetics is such a varied job that until I started I didn’t know which areas of dietetics practice I would be working in. In reality, it has been extremely varied, especially working in the community as I have been working with different specialist dietitians each day and in different areas of the borough. Therefore, I thought I would give you guys an update on what I’ve been getting up to over the last week.

Monday

For the past couple of weeks, I have been working with a diabetes education group on a Monday. It is a whole day event that works with groups of about 10 newly diagnosed Type 2 diabetics. The topics covered during the day include explaining what diabetes is, its complications and various medications used to control it as well as dietary and physical activity information. It’s run by a diabetes nurse and dietitian, with a lot of participant interaction throughout the day.

For the last two weeks, I have been delivering the physical activity section of the day. I invite the group to share their experiences of physical activity and exercise as well as giving advice on the government recommendations and how to overcome barriers. (You can read more about physical activity in some of my earlier blog posts here.)

This group session has given me the opportunity to work with people from very different backgrounds, with diabetes of varying severity and a multitude of challenges in their daily life. It’s also taught me that I can give group presentations without getting nervous and that I’m actually sometimes quite good at them.

Tuesday

Recently, I have been accompanying a malnutrition dietitian on home visits. This has potentially been the biggest learning curve for me so far. Many of the patients are receiving nutritional support through a feeding tube (either because they can’t eat anything at all or because they are not managing to eat enough to sustain them). I across plenty of patients in hospital with a feeding tube on my previous placement, but when you see people in their homes, it becomes apparent what the realities, and difficulties, of living long-term with a feeding tube are.

The feed amount must be carefully calculated by the dietitian based on an individual’s energy needs (which can be very different for each person). People may also often need help to attach the bags or bottles of feed to their feeding tubes, and this is where family, friends and carers come in to play. Each person will also be on a very individualised feeding plan. For example, one may be fed through their tube only overnight, giving them the opportunity to eat and carry out more normal daily activities during the day, whereas others may need to be fed for longer periods throughout the day. Another thing that dietitians must consider when working out someone’s feeding regimen is their medications, as some must be taken on an empty stomach, and others are not.

When the dietitian visits patients at home they often check people’s weight, their appetite, current diet (if they are able to eat anything), and how they’re getting on with the tube.

Wednesday

On Wednesdays, I have been sitting in on and taking part in a general dietetic clinic. Here we’ve seen people who have been referred to the dietitian by their GP for a variety of reasons, the majority of which have been weight loss, oral nutritional support and IBS (irritable bowel syndrome). It has been interesting to work with a variety of conditions and has given me the opportunity to work on my consultation skills.

Thursday

I have been working as part of the adult mental health team on Thursdays, which so far has involved working with patients with dementia. Once dementia gets more progressive people often either forget to eat (so lose weight), or forget that they have already eaten (so gain too much weight). It often takes delicate management to help people with their diets, taking other lifestyle and health factors into account, as well as their dementia diagnosis.

Friday

So far, I have been working in paediatrics (with children) on Fridays. I have thoroughly enjoyed this, and learnt a lot about managing the diets of children with allergies or other health conditions. It has also been an eye-opener as I’ve realised that a consultation doesn’t always run smoothly when you are working with children! Being flexible and adapting to the child and their parents is essential. I’ve learnt to remember that you often need to factor in the whole family’s diet and lifestyle as no child ever wants to be singled out as different. However, something that the paediatric dietitians have reiterated is that you often get to work with families for a long time and see these children grow up.

I think that is one of the biggest things that I have enjoyed so far about working in the community – you often work with people for a long time, so are able to build a rapport with them, and really see their progression.

 

I hope this post has given you a little insight into my experiences so far as a student dietitian. I may update you guys again a bit later on in the summer to let you know how I’m getting on!

Hope you have a good week.

x

The Nutrient Series – VITAMIN D

The “sunshine vitamin” has had a lot of press recently, and for good reason! Vitamin D helps our bodies absorb calcium and phosphorous from the food that we eat, which are both essential nutrients for healthy bones, muscles and teeth. Even if you consume enough calcium, if you are deficient (don’t have enough in your body) in vitamin D, your body won’t be able to use the calcium where it’s needed. Children who are deficient in vitamin D can develop rickets (permanent bone deformities), whilst low vitamin D intake in adults can increase the risk of developing osteomalacia (bone pain and muscle weakness).

Where does vitamin D come from?

Most of the vitamin D that our body needs is made under the skin in response to daylight – that’s where its nickname comes from. You make more vitamin D in bright sunshine in the middle of the day than on a cloudy day. In the UK, the sun is strong enough for us to make vitamin D between April and September. The rest of the year your body uses vitamin D that has been stored in our bodies, or has comes from food or from supplements.

However, you don’t need to sunbathe for your body to be able to make vitamin D. It isn’t known yet how long is the optimum length of sun exposure due to many different factors affecting vitamin D production (such as skin colour or how much skin is exposed). The NHS suggest that a short period of sun exposure every day should be enough, but to make sure you take precautions not to get burnt.

Foods high in vitamin D

Oily fish such as salmon, mackerel and herring are relatively high in vitamin D, as is cod liver oil (don’t take this if you’re pregnant, though,  as it also contains very high levels of vitamin A which could harm your baby). Some foods are fortified with vitamin D such as margarine, some dairy-free alternatives, infant formula and yoghurt.

How much should we have?

The Scientific Advisory Committee on Nutrition (SACN) published a report in 2016 stating the importance of vitamin D in maintaining good muscle and bone health. They recommend taking a 10-microgram supplement daily, especially in the winter months, which can be found in most pharmacies. This is because in the UK we don’t have strong enough sunlight all year round to produce vitamin D, and because there are not a huge number of foods high in vitamin D.

Groups at risk of low vitamin D

There are some groups of the population who are at risk of low vitamin D, and who SACN suggest should consider taking a vitamin D supplement all year round.

  • Elderly – skin is not as efficient at making vitamin D in over 65’s
  • Those who are housebound, work in an office or shift workers – these people tend to spend less time outside during daylight
  • Pregnant women and breastfeeding mothers
  • People with dark skin tones living in the UK and northern countries where there is less sunlight
  • People who cover most of their skin when outside

 

Remember to contact your GP, a health visitor or a dietitian if you are worried about your vitamin D status.

 

Sources

BDA Food Facts – https://www.bda.uk.com/foodfacts/VitaminD.pdf

Essentials of Human Nutrition, Jim Mann & A. Stewart Truswell, 2012.

NHS Choices – http://www.nhs.uk/Livewell/Summerhealth/Pages/vitamin-D-sunlight.aspx

SACN vitamin D and health report – https://www.gov.uk/government/publications/sacn-vitamin-d-and-health-report

 

Photo: @lauraheck

Dietitians Week 2017

Today is the beginning of Dietitians Week, run by the BDA. The theme of Evidence and Expertise is aiming to raise awareness about the importance of taking nutritional advice from properly qualified nutritionists and dietitians. 

According to the BDA, almost 60% of people would trust nutritional advice given by an unqualified individual. 

To help illustrate the complex work that dietitians do and their importance, the BDA have produced this fantastic poster to show all of the things that a dietitian is thinking about when trying to help you make the right food choices. 

First placement update

My first couple of days of placement have been busy but luckily not too long so far – although I’m sure that is set to change soon. This week I’ve been doing various inductions (including IT training – yay!) and shadowing a few dietitians.

So far, I have only got involved in taking diet histories of the patient as part of the initial consultation. This entails me asking the patient to describe a typical day’s food and drink in the context of their usual routine. I may then focus in on certain aspects of the diet history that might be important. For example, I may ask an IBS patient a little bit more about their caffeine intake and their stress levels as these are particular triggers for many people with the condition. A detailed diet history enables the dietitian to understand current food habits and lifestyle, not just so that we know what to improve on, but also so we can get a greater understanding of the patient’s day to day life. (There’s no point making a suggestion or recommendation that the patient has no chance of implementing.)

 

Being on placement out in the community this summer means that I am doing a lot of walking and catching various buses. Luckily, I’ve got a couple of things which are making my life much easier whilst I’m on placement.

Trainers

I have finally accepted (after years of blisters) that it’s essential for me to have comfortable shoes to walk around London in. It does mean that I need to take work shoes with me, but I’m happy to go to that effort to be able to power walk with ease!

Music & Podcasts

My commute/walk to most of my sites is about an hour to an hour and a half so I listen to my favourite songs or podcasts on my way.

I even went so far as to make a playlist of my current favourite tunes to listen to at the moment on Spotify: https://open.spotify.com/user/1138014904/playlist/6HUiSAs6iEw63Cb42h8W7E

A few of the podcasts that I have been listening to recently include:

The One Girl Band Podcast with Lola Hoad

BBC Radio 4 Woman’s Hour (especially interesting in the lead up to the election)

Don’t Salt My Game with Laura Thomas, PhD

Letters to My Fanny – Cherry Healey (I think Cherry is on a break from doing podcasts at the moment but her old ones are absolutely hilarious and definitely worth going back to listen to!)

Diary

I still much prefer using a paper diary to my phone, and I don’t know where I’d be without mine at the moment! I’m also a complete sucker for beautiful stationary – I got my silver diary from kikki.K (in the sale, though).

Lunchbox

Very unglamorous, but essential! There aren’t always places for me to buy food at the different placement sites, but it also saves me a lot of money to make packed lunches. Why don’t you check out my previous blog posts on meal planning and salad inspiration for some tips and ideas?

 

I’ll try to keep you guys posted on how I’m getting on during my placement throughout the summer. I know you guys will understand that I will never divulge details about where exactly I am working or any specifics about the consultations to ensure that I maintain complete patient confidentiality. But I am very happy to share what I’m learning about dietetics as a profession and my own personal development.

 

Have a good rest of the week!

 

Tips for meal planning

I start my placement as a student dietitian today, working at lots of different health care sites all over South East London. In preparation I spent yesterday planning some of my meals for this week.  It can be a great way to stick to a weekly food budget, reduce food waste, and maintain a healthy diet when you’re busy, but it can sometimes be tricky to know where to start.

I often eat similar things for breakfast and lunch each day (fruit, yoghurt and muesli and various salads), especially during the week. However, I really enjoy trying out a new recipe from one of my many recipe books once a week if I have time. It’s a really nice way to increase the variety of meals that I eat.

Another good way to plan your meals is to think about each meal as a sequence;

  1. Choose the meat or protein source: beef mince
  2. Decide on a main meal: chilli con carne
  3. Think about accompaniments: wholegrain rice
  4. Remember fruit and veg: Broccoli and kidney beans in the chilli

It’s a good idea to try and include at least 2 portions of fruit and veg with your main meal to contribute towards your 5-a-day.

I also find it really helpful to cook double quantities and have it reheated the next day for lunch or dinner, or freeze it for another time. If you’re doing this remember to make sure that reheated food is piping hot before serving and always follow the instructions with your microwave for reheating.

You can get some very quirky stationary to help you meal plan which can be fun to use, but I just use a blank notebook or cheap diary. If you have a favourite meal planner or some go to mid-week meals feel free to share them here in the comments section or on my Instagram post – find me @jess_rann.

Happy meal planning!

Acai Bowl Recipe

I discovered the delight of acai bowls (delicious smoothies thick enough to spoon, covered in a multitude of toppings) when I was in Australia during my gap year – the cafés on the Gold Coast were ace at serving up the most delicious (and most faddy, trendy) dishes. Since then, I’ve only found it at rather pricey London cafés so I decided to take the plunge and buy some acai powder from Amazon and experiment myself. You do need a food processor which is a bit of a faff but if you have one, acai bowls are really fun to make (although they do create rather a lot of washing up!). You can put on some summery music and kid yourself that you’re eating breakfast on a tropical beach!

A little note on the nutrition of acai…

Acai (pronounced ahh-sah-ee) is a berry from Brazil which has been credited as being packed full of antioxidants, substances that have been found to be protective against vascular disease, diabetes and cancer (1)(2). However, many of these studies have only been done in vitro (in a lab) and haven’t been replicated in human studies yet, or are pilot studies (have only used a small number of people so do not provide strong evidence).

The most important thing to remember, though, is that there isn’t a magic bullet to health – a well-balanced diet including a variety of fruit and vegetables of all colours, lean protein, complex carbohydrates and unsaturated fats is recommended for optimal health.

 

Acai Bowl Recipe

Serves 1

100g frozen sliced banana

80g frozen mixed berries

1 tbsp acai powder

150ml milk (whichever type you prefer)

2 handfuls of spinach

Optional toppings: almonds, chopped fruit, mixed seeds, granola, chopped coconut, shavings of dark chocolate, cacao nibs – the list is endless!

 

Add all the ingredients to the food processor or smoothie-maker (like Vitamix) and blend at high speed until a thick and creamy consistency. You may need to stop blending a couple of times to scrape down the sides of the food processor. If the consistency isn’t creamy enough add more milk or water. Once completely smooth, serve immediately topped with your favourite fruits etc.

 

Beachy tunes whilst eating aren’t compulsory but highly recommended! (My personal choice at the moment: Summertime Music – Shwayze & Cisco https://www.youtube.com/watch?v=8UsPxcFcu8Q)

 

Sources

  1. Schauss, A.G., Wu, X., Prior, R.L., et al. Antioxidant Capacity and Other Bioactivites of the Freeze-Dried Amazonian Palm Berry, Euterpe oleraceae (Acai). J Agric Food Chem. 2006; 54:8604-8610. [Online]. Available at: http://www.vinosalacarta.com/monavie/estudios/2_antioxidant_capacity_and_other_bioactivities.pdf
  2. Udani, J.K., Singh, B.B., Singh, V.J., & Barrett, M.L. Effects of Acai (Euterpe oleracea Mart.) berry preparation on metabolic parameters in a healthy overweight population: A pilot study. Nutrition Journal. 2011; 10:45. [Online]. Available at: https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-10-45

A weekend trip to the coast

I did it! I made it through what has felt like the most difficult revision and exam period so far. To celebrate finishing, my boyfriend and I escaped down to the Kent Coast with friends for a weekend. We stayed in Westgate-on-Sea, a stone’s throw away from Margate. I know what you’re all thinking – Margate for a weekend escape? But give it a go. There are some beautiful shops, cafes and restaurants to try, and let’s not forget the huge sandy beaches – and the fact that it’s only an hour and a half from London!

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@annagregson

We were extremely lucky with the weather and had such a beautiful weekend that I wanted to share some our finds.

 

Margate

I highly recommend taking a stroll around the cobbled streets of Margate Old Town, home to some lovely little homeware and vintage shops, galleries and coffee shops.

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Margate Harbour: @dane_rock

 

Buoy and Oyster, 44 High Street, CT9 1DS

Looking out over Margate harbour, Buoy and Oyster offers stunning views, whether it’s a sunny summer’s day or stormy winter weather. This gorgeous restaurant serves seasonal fish and seafood with a modern British slant, as well as offering delightful-looking cocktails. The four of us ordered oysters (most of us trying them for the first time), a bottle of white wine and a main meal each, coming to a total of £29 per person, including service. Being used to London restaurant prices we practically skipped out of the restaurant, having enjoyed such a delightful lunch! I highly recommend the halibut on their current menu.

 

The Cupcake Café, 4-5 Market Place, CT9 1EN

Situated in a little courtyard, this café serves cakes, coffees and snacks all day. If you’re lucky you might be able to bag a table outside in the sun and people watch to your heart’s content! Next door is The Greedy Cow café, which we didn’t get to try, but about which I’ve heard very good things!

 

The Light Keeper, 8 Broad Street, CT9 1EW

A beautiful lighting emporium tucked away in Margate Old Town, this is definitely worth checking out even if you don’t need to buy a light fitting. The unique designs are fascinating and constantly updated.

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The Light Keeper: @dane_rock

 

Qing Interiors, 3 Lombard Street, CT9 1EN

Unique and bespoke designs sit next to exquisite vintage oriental home furnishings. I highly recommend a visit to Qing Interiors – it couldn’t feel further away from what you’d expect in an English coastal town.

 

Etcetera Interiors Ltd, 35 Hawley Street, CT9 1QA

One of many beautiful homeware shops in Margate, they sell minimalist designs. I had to keep reminding myself that I live in a small flat and that I definitely don’t need any more cushions/throws/plants…

 

Turner Contemporary, The Rendezvous, CT9 1HG

This art gallery is situated on the edge of the harbour and runs various exhibitions throughout the year, most of them free of charge. With a lovely coffee shop as well, it can provide some entertainment or a couple of hours.

 

Whitstable

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Whitstable wall art: @dane_rock

Whitstable is an old fishing village, famous for its oysters in particular. Down by the harbour there are some fishing huts selling local crafts and sweet treats. If you walk further along through the harbour you come to the fish markets which, even if you’re not keen on eating fish, are well worth a wander round as they’re selling a huge range of produce. Many of the fishmongers may also be happy to let you try local delicacies such as oysters or cockles if you’ve never had them before.

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Whitstable Harbour: @dane_rock

 

The Forge, 1 Sea Wall, CT5 1BX

I’m going out on a limb here to suggest that this was the best fish and chips I’ve ever eaten! The Forge looks like a converted beach hut but don’t be fooled. It serves the crispiest, fluffiest chips I think I have ever eaten with the usual selection of fish. The real secret of this place, however, is that it sells deliciously fresh oysters and lobster as well. The half lobster and chips with salad for £13.50 was such a treat! Eating it on the beach in 23 degree heat felt as though we were truly on holiday!

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Lobster on the beach: @dane_rock

 

I also recommend taking a wander round Whitstable village and having a look in the shops or admiring the beautiful cottages. And if pretty cottages and the beach won’t suffice, Whitstable Castle and Gardens are well worth a visit.

 

In case you hadn’t noticed, we tended to veer towards homeware shops on this trip – early twenties going on middle-aged, clearly! This is by no means an extensive list of what’s available to see and do in Margate, and this post is not sponsored – just a selection of our favourite finds from last weekend.

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Our beautiful holiday apartment

I hope you have a great weekend and enjoy the sun – let’s hope it lasts!

 

Main photo: @edenmorse21