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Prakash Chandran (Host):  Between what you hear on TV and read in the news, eating right can seem like a real challenge. But it doesn’t have to be. And a registered dietician can partner with you to educate and help you develop a healthy eating plan. Let’s talk about it today with Jenna Middleton, a Registered Dietician at Pioneers Memorial Hospital. This is Pioneers Memorial Health Talk, the podcast from Pioneers Memorial Hospital. I’m Prakash Chandran. So, Jenna, let’s start with the basics. What exactly does a Registered Dietician do?

Jenna Middleton (Guest):  That’s actually a really good question because I think a lot of the public gets us confused with a nutritionist which is very different. A Registered Dietician is highly qualified, has a Bachelor’s Degree, most likely a Master’s Degree since that’s a requirement now and we can work in any medical field. We can work with infant and children. We can work in the community and we can outreach to anywhere. As where a nutritionist is very limited. They only thing they can do is they can work in a gym; they can help with weightloss plans and they are only required to have an Associate’s Degree.

Host:  Okay so certainly a lot more education is involved, and you can work in any capacity. But tell me a little bit about as a Registered Dietician what your day to day looks like at Pioneers.

Jenna:  So, there are so many outlets that a Registered Dietician can go to. But I’m in the hospital setting. And so I’m in a clinical inpatient hospital setting at Pioneers Memorial Hospital so a typical day to me usually includes rounding in our intensive care unit, checking on all our ventilated patients, making sure we are feeding them because they will be fed through tubes, they are not eating orally, obviously. And then we go to all of our other units, pediatrics, our medical surgical units, even the NICU with the little babies and we’re just checking on everyone, seeing what the different issues are. Some people have intestinal problems, some people just had their gallbladders taken out, some people are just barely being diagnosed with diabetes so, it’s a round about kind of field of what we deal with. It’s nothing the same. Everything is different every single day.

Host:  Yeah, that’s really interesting and you made the distinction between what a nutritionist does and what you do as a Registered Dietician. And from what I’m hearing, the former is much more about like weightloss like you said, like going on a diet but it seems like the Registered Dietician does something actually pretty comprehensive and puts together a plan to bring you back to health through your diet. Is that correct?

Jenna:  Correct. Yeah, we get a lot of like elderly patients that come in malnourished, you know just skin and bones and then it’s our job to make sure that we are getting them back where they need to be or we have people who come in with just had a massive heart attack, how do we make sure that that doesn’t happen again to them. We have other people who come in with heart failure; how do we make sure that we control it through their diet. Almost every disease that you will see out there in the medical world, usually goes back to diet and eating right and so how do we get them back on track.

If their kidneys have failed and they are on dialysis; how do we make sure that we’re getting their potassium levels where they need to be. So, it is a very comprehensive approach to seeing all the different patients.

Host:  Okay and I’m curious about like what is a common health issue that you see day to day that can be eased with a better diet? Like who is coming in most often?

Jenna:  So, that’s an interesting question. We have two things that we see in the Imperial Valley that is more common than any other county that’s out there and I know that from the doctors who come in. They will come from other hospitals and they’ll say you guys have more diabetes than I have ever seen at a hospital. Which is true. So, the Imperial Valley unfortunately, has a really high rate of diabetes and that all comes down to weight. I think a lot of people are confused; they think that it has to do with eating too much sugar which is actually not true. Sugar doesn’t cause diabetes. It’s eating too much and gaining weight is what causes diabetes.

So, maintaining a healthy weight more often than not will prevent you from getting diabetes unless it’s something that’s in your family. The other thing that we see here in the Imperial Valley more than anything else is having the gallbladder removed and that has to do with having too high fat of a diet. We see people here with such a high fat diet that it actually causes problems with the gallbladder and then we have to take it out. So, those are two things that simple eating right, healthy diets probably would prevent but we’re not seeing those healthy diets.

Host:  Okay and let’s talk about some of these high fat diets because you always hear about things like keto and other diets that while helping you lose weight do so in such a way where you have to take in a lot of fats. So, talk to us about your opinion on those and if they have long term effects that can potentially be negative.

Jenna:  Yeah so that’s actually a very good question. Keto is very popular right now, much to my dismay. If it was up to me, I would not advise anyone to go on a Keto diet. The idea behind a Keto diet is eliminating all carbohydrates; breads, pastas, rice. That whole wonderful group of breads that we all love that we should have too much of. But it’s completely eliminating it and completely eliminating fruits so there’s no sugar, no carbohydrates in the diet. And it is supposed to put your body in a state of ketosis, that’s where the word Keto comes from. And when you are in a state of ketosis, your body will actually – because your body needs carbohydrates to function and when it doesn’t have it; the body has to convert fat into what we call a ketone and then it starts to use those ketones as sort of a carbohydrate to still function.

Certain things like the brain can only function on carbohydrates. It cannot function on a fat molecule. It cannot function on a protein molecule. It has to function on a carbohydrate. And so when those carbohydrates are not in the body; the body panics and it creates ketones in order to still feed the brain. The problem with that is when your ketones go too high; it can actually cause kidney failure. It can actually cause some other problems as well.

So, going into a state of ketosis without the supervision of a doctor, is not recommended at all. And then we also see other effects of that diet. We see the cholesterol levels starting to rise because it’s all protein and all fat. There’s very little fiber in the diet because fiber generally comes from whole wheat breads which they are avoiding. So, overall, it’s not a healthy diet. You will see weight loss, absolutely, you will. But it’s always short term. As soon as you get off of a Keto diet, which no one can stay on a Keto diet for the rest of their life. Once you get off it, you will 100% gain back all of the weight.

Host:  Yeah, I think what I’m picking up on it is the sustainability of the diet. These popular diets like Keto you might be able to maintain for 30 days; but anything beyond that is just untenable or it’s just not enjoyable and could come with those side effects that you are talking about. So, I think what people really are looking for is that sustainable long term diet that they can follow, that really doesn’t have any gimmicks to it, but I feel like people don’t really know what that looks like. So, can you speak a little bit to that?

Jenna:  Yeah and you’re absolutely correct. So, the Keto diet, I see people get on it for a month, get off of it, get on it, get off of it and then their weight is just going up and down because they can’t keep it going. I have seen some people, they kind of do a keto-ish diet where they are just still allowing some carbs but it’s mostly very high protein, high fat and they’ve been able to do it for six months or so, but eventually, you cannot keep that up. You really need to find a healthy lifestyle that you can maintain for the rest of your life. And I don’t ever like to use the word diet because I feel like people think there’s an end to that or that there’s a negative connotation associated with that word. So, I always tell people, let’s figure out a way for you to eat healthier. What are two or three main problems in your life that we can maybe eliminate? And they don’t have to be eliminated at once. But let’s start with number one.

Is soda a real problem for you, if it is, let’s try to cut those out and substitute it with something else that you enjoy but doesn’t have a ton of sugar and calories in it. After we accomplish that, let’s move on to your next problem, you are always getting seconds after dinner. Can we cut that down? So, it’s actually individually addressing what are the main top three problems in your life that are preventing you from eating healthy and taking them out one at a time and slowly developing a new lifestyle that you can actually keep up with.

And then if once in a while, once a month, you have a soda, it’s not the end of the world. But at least you are not having it every single day like you used to.

Host:  Yeah, that is really good advice and cutting things out one and a time feels like it’s something that is going to be more sustainable in the long run. So, just to wrap up here, I’d love to learn a little bit more about what you enjoy most about the work the you do at Pioneers.

Jenna:  So, I think the one thing that I like the most is seeing the patients. I think I get consults every single day, so I’ll have 15 patients I need to see throughout the day and some of them are for a little bit lesser problems and some more extensive. I’ve had a scale of one all the way to the other, but I think the most enjoyable part for me is when I go in and talk to them. Especially when it’s something that – it’s about weightloss or being a newly diagnosed diabetic or a problem that they are going to have with their food and finding a way to connect with the patient, so they don’t see it in a negative light. They see it as okay, she’s here to help me until we can get this problem solved or she’s here to help me to create a new lifestyle for myself. And I love it because I go in and I think they’re a little defensive at first and by the time I leave, they are smiling, they are thanking me. They are super glad that I came in to help them with this.

So, it’s always that satisfaction you get with talking with somebody and knowing that you made a difference for them.

Host:  I love that. Changing hearts and minds through nutrition, right?

Jenna:  Right. Correct. So you should become a dietician.

Host:  Well maybe I will Jenna. I really appreciate your time today. That’s Jenna Middleton, a Registered Dietician at Pioneers Memorial Hospital. Thanks for checking out this episode of Pioneers Memorial Health Talk. For more information, visit www.pmhd.org. if you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll see you next time.