Scott Webb (Host): March is National Nutrition Month. And I'm joined today by clinical dieticians Hannah Reed and Stevie Flynn, and they're going to explain how they help patients, clear up some misconceptions, and tell us how they work with patients to develop a sustainable lifestyle once they're home.

 Welcome to Wise and Well, presented by Community Memorial Healthcare. I'm Scott Webb. Hey, and I know we're kicking off National Nutrition Month here on Wise and Well. And before we dive into the, you know, clinical side of things, what is one "nutrition truth"—I'm putting that in quotes—or a favorite healthy habit you wish every person in the community knew about.

Hannah Reed: It's a little tricky because there's so much, I think, black and white that people want in nutrition. So, I really wish that people knew that it's very nuanced, that it's not really like a hard yes or a hard no. And I feel like an example of that is a lot of people think, "Well, I want to get healthier, I need to lose weight." And so, they just equate healthiness and weight loss. And I wish we could kind of separate those thoughts and let people know that you could have healthy habits, eating more fruits and vegetables and exercising more, and you might not lose any weight. You might, but you might not. And that would still result in improved health outcomes.

Host: Yeah, I see what you mean. Like, that would make us healthier even if we didn't reach our desired weight goal, right?

Hannah Reed: Right, right. You still might be lowering your blood sugar, or you might be lowering your cholesterol, or you might be sleeping better, having more energy, you know, kind of looking from other sides of health other than just the scale.

Host: Yeah. And, Stevie, many people see a dietician, right, in an outpatient clinic for weight loss. But you both work primarily inpatient. So, how does your day-to-day role differ from what people might expect?

Stevie Flynn: In the outpatient sphere, I feel like a lot of people think that dieticians only see clients for weight loss. But we actually see them for continuing care, which can include weight management, but it's also helping people to advance their health outside of the hospital. So, a lot of the time in the hospital, we will address malnutrition rather than overweight or obesity. We're very much in the clinical sphere, so we deal with nutrition support, wound healing, therapeutic diets for various disease states in medically fragile patients. And here in the hospital, nutrition can mean the difference between recovery and decline.

Host: Yeah. I think that's such an important point, Stevie, that how important nutrition is to all of us for many things, in addition to addressing a craving for something or whatever, but there's just so many health benefits, right?

Stevie Flynn: Right, exactly.

Host: Yeah. And Hannah, I know there's six RDs in Ventura and two in Ojai. How do you collaborate with doctors, nurses, and the entire care team to manage a patient's recovery?

Hannah Reed: It's really a big part of the whole healthcare team, so we call it our interdisciplinary team. So, the doctors, the nurses, dieticians, physical therapists, we all kind of work together to make sure that the patient is recovering and on the right track. So as a dietician, maybe a patient comes in with unmanaged diabetes and they need some diet education, and we need to put in a specific—we call it like a therapeutic diet—to to help them get better, and work with the doctors to see if we need to make any changes, work with the nurses to make sure the patients are actually eating their food and not lying to us when we check in with them and see how it's going. And so, we really do have to communicate with everyone really regularly to get the best results for the patients and, hopefully, make sure they're not in the hospital for very long and prevent them from coming back in.

Host: That's so funny when you say check with the nurses, you know? "Oh yeah, I'm eating. I ate everything." Well, did they? Yeah. So, the nurses get to be the eyes and the ears there. And, Stevie, what's a misconception, or maybe the biggest misconception patients—and maybe even medical professionals—have about hospital nutrition?

Stevie Flynn: I think that a lot of the time, patients specifically feel that RDs are there just to take their meal orders or tell them what they can and can't eat, when actually we're providing medically tailored meals to all sorts of, like Hannah said, that therapeutic diets or depending on the chronic or acute illness a patient comes in with. We're looking at patients labs. We're providing our insight and our recommendations as far as what kind of electrolyte management a patient might need. It's very all-encompassing. It's a very comprehensive nutrition assessment that we do, and we do this daily.

And then, one more thing I might add is that some people think that malnutrition might not be possible in obese patients, but we see malnutrition at all sizes.

Host: Yeah. And Hannah, in the ICU, I know patients often can't eat physically. Maybe you can talk about the complexities of tube feeding and IV nutrition support, you know, how all that works for patients.

Hannah Reed: I actually love both tube feeding and IV nutrition. It's incredibly important. It's absolutely life-saving. I think a lot of folks get a little afraid of it, because that must mean, "Well, I'm really sick if I can't eat." But a lot of times, people in the ICU, they are very sick and they may need to be intubated or sedated, so they can't physically eat. So, we're able to feed them either with our tube feeding, we call it our enteral support, with usually a temporary NG tube. So, that'll drop down into their stomach and directly feed their gut. If there is a case where maybe they're having some kind of complicated GI issues and we aren't able to do tube feeding, the IV nutrition support will go directly either into a peripheral vein or central vein, and we're able to feed directly via IV. So, it's really incredible technology. And most times, once patients are better and they recover, they're able to discontinue it and work with the rest of the team and get right back to eating.

Host: Just wondering, Stevie, like, what are the three most impactful nutritional habits maybe we could share with listeners that we could adopt today to, no offense, but stay out of the hospital.

Stevie Flynn: Right. Yes. That's what we want actually. I think eating regular balanced meals. When we're skipping meals, it actually stresses the body more than people realize. So, just really focusing on, you know, persistent balanced meals, focusing on protein. Protein is a great macronutrient for supporting muscle, immune function, and recovery.

And then, I would also encourage people to look for early warning signs. If you have any changes in bowel habits or unintentional weight loss or loss of appetite, chronic fatigue, those are early warning signs that you definitely would need to get checked out with a primary doctor

Host: Yeah, that something else may be going on. And as we know, so many things in medicine, early diagnosis is key and getting on these things early. And Hannah, does our local geography—you know, in Ventura, Ojai—or culture influenced the nutritional challenges or successes you see in our patient population?

Hannah Reed: Definitely, yeah. We're really lucky to live in beautiful Southern Southern California, Tri-County's such a nice place. So, we have a lot of variety of so much fresh foods and farmer's markets. And it's great, because a lot of folks do have access to that. It could almost be a challenge that people kind of get in their head that they need to really healthify all the foods and it gets a little restrictive, for lack of a better word, like they might think that they only need to eat certain foods to be healthy and cut out the other foods. So, that could be one challenge.

, We have a really large Hispanic population, which is great. And so, there's a lot of cultural foods that we like to try to incorporate, and I've found when I'm talking with patients and working with them, a lot of times they think that they have to cut out all of their cultural foods. And they think, "Well, I can never eat the foods that I enjoy anymore because they're just unhealthy." And so, I usually use that as an opportunity to be like, "No, these foods could be very healthy." And we could definitely incorporate a lot of still fresh foods and vegetables and homemade things without really altering the core of the cultural foods, you know what I mean?

Host: Yeah. Folks can still enjoy some of the stuff that they typically enjoy, maybe since childhood, maybe in moderation, maybe some variation, right?

Hannah Reed: Right, right. I'm never going to tell somebody when they say, like, "Well, I eat a lot of Hispanic food and it's a lot of rice and beans and carbs." It's like, "Well, we could still have those foods, but—

Host: Let's add some protein.

Hannah Reed: Yeah, let's add some protein to it. Let's like load up on the salsa, load up on the onions and the radishes, and create variety within those cultural foods that we have, so we're not cutting them out or limiting, that's not going to work. You know, somebody tells me I can never eat ice cream again, it's not realistic, I'm just going to be sad and binge on ice cream.

Host: Yeah, that's right. Yeah, that's right. When I check out, say, "Thank you for your help, but I'm going to need to eat ice cream the rest of my life," of course. Stevie, when a patient is discharged, the journey doesn't end, right? So, how does our nutrition coaching program help patients take the knowledge they received in the hospital and then turn it into a sustainable lifestyle at home?

Stevie Flynn: Yeah, the journey definitely doesn't end. The discharge is just the beginning. In the hospital, we stabilize patients, and then outpatient dieticians are there to help patients implement our recommendations that we've provided in the clinical setting. A lot of the time we like to work towards making sure the patients discharging with any resources they need. So, that can be medically tailored meal deliveries for elderly populations or those that can't make it to the grocery store. We try to work with case management and make sure that they are given all the resources they need.

And then, the outpatient dieticians can help with things like grocery shopping, meal planning, label reading, making sure the patient understands blood sugar management or heart healthy eating, things like that. So, the continuity of care is where the long-term transformation really happens, and we make sure that they are given the proper tools for that.

Host: Right. And the RDs are available at the health centers, right?

Stevie Flynn: Yes. So, we have our outpatient clinics, all the way from Camarillo through Ventura and Oxnard. Just at like our satellite clinics. And we normally make sure that we provide the resources for those clinics. And then, we make sure that the patient is communicating with their primary care provider to get a referral if needed, depending on their insurance.

Host: Stevie, this has been good stuff today. I just want to ask you, like, what's the most rewarding part of seeing a patients health turn around, you know, through nutrition? You know, I'm sure it's really gratifying, right?

Stevie Flynn: Definitely. It's very gratifying. Seeing a patient go from medically fragile to stable because their body is finally being nourished properly never gets old to us. Watching a patient regain their strength or energy levels and just become themselves again is very, very, amazing. A lot of the time, we'll see patients coming in with altered mental status, whether that's from dehydration or malnutrition. They can be very weak and just not have the energy to eat. So finally, having them be empowered instead of overwhelmed by food is really great.

Host: Yeah. That's great. Going to finish up with you, Hannah. This has been great today. Great information to put out in the world. Appreciate your time, both of you today. Same question to you, basically, what's the most rewarding part of seeing a patients health turn around through the nutrition and the nutritional advice and everything you do to help them?

Hannah Reed: I would have to agree with Stevie. It's just amazing when patients come in very critically ill and maybe they do start off their hospital stay in the ICU and they need tube feeding, and then we're able to see them progress and leave on a regular diet and feeling so much better and kind of having a new lease on life and being really motivated to make some changes and be strong and nourish themselves a little bit better.

So, it's nice to know too that we are such an important part of the healthcare team. I think a lot of times people think, like, "Well, dieticians are just making the meal plans," or "They're just lecturing people and telling them not to eat cake" or whatever.

Host: No ice cream for you.

Hannah Reed: Exactly. So, it's nice being in the more clinical side of things and really providing lifesaving nutrition support and, yeah, just watching patients thrive afterwards.

Host: Great. Yeah. As you say, it's really a team effort. Patients, their families, all of you folks. It's just great to hear everything that's going on in Ventura, Ojai, and that region. So, thank you so much.

Hannah Reed: Yeah. Thank you Scott.

Stevie Flynn: Thank you, Scott. Thanks for having us.

Host: For more information, go to mycmh.org. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for additional topics of interest. I'm Scott Webb. Thanks for listening. This is Wise and Well, presented by Community Memorial Healthcare.