The Varying Shades of "Nutritionist"

Inspired by the ChicagoTribune and my own confusion when I started at the ITPCU, I thought a post on definitions for nutrition counselling was appropriate.  Personally, I field questions on the difference between an M.D. and a D.O. all the time, and I think that Certified Nutrition Specialists and Registered Dieticians can cause similar confusion.

Certified Nutrition Specialist  (CNS):  These practitioners have an advanced degree (Master’s or higher) in nutrition or a related field from an accredited university.  They take certification exams (the Certification Board for Nutrition Specialists, or CBNS) to qualify them to practice as a CNS. Post-graduate study includes many hours of supervised experience in nutrition.  A CNS aims to improve health through science-based nutrition therapy and evidence-based practice.  CNS may work in hospitals, outpatient medicine, or in private practice.

Registered Dietician (RD):  These practitioners have an undergraduate degree or more in nutrition, dietetics, food sciences, or food service management from an accredited college or university.  The Commission on Dietetic Registration of the American Dietetic Association (ADA) registers RDs, requires them to pass a exam by the Commission of Dietetic Registration, and necessitates continuing education requirements in order to upkeep certification.  RDs much also complete a practical internship and have many hours of supervised experience.  RDs are more likely to work in private practice and some go on to get advanced degrees such as a CNS.  RDs also often work in school or hospital cafeterias, nursing homes, or as community educators. 

Note:  Since there are no national guidelines for nutritionists, people can be called a “nutritionist” with varying levels of education and training.  Check for up-to-date certification in any CNS, RD, or anyone else you see for nutrition counseling!  Other nutrition degrees may include Licensed Dietitian/Nutritionist, Registered Dietetic Technician, Certified Clinical Nutritionist, and Certified Nutrition Consultant.  

Food for Fatigue!

Its that time of year where sunlight is rare, the air is cold, and it's a bit more difficult to keep your energy up.  The holiday season - while sparkly and exciting - is also exhausting!  If you're having difficulty with fatigue for whatever reason, these tips are a quick and delicious way to get that energy up!  

Food Remedies for Fatigue: 

·         Squeeze fresh lemon or lime on foods and in drinks.  Lemon and lime are natural “pick-me-ups.”

·         Add garlic to foods.  The stronger the flavor, the more effective it is at improving fatigue.

·         Brown rice balls are an easy “grab and go” snack.  Prepare at home or buy at your local health food store.  Cook one cup of brown rice until sticky and coat by rolling or sprinkling with gomasio or a seaweed gomasio.

·         Barley or wheat grass juice: Drink 1 to 2 ounces of juice per day (available in most health food stores).  If fresh wheat grass juice is not available, you can juice fresh greens or use a premade powder. 

To prepare your own juice:

o   Kale (1 bunch)

o   Spinach (1 bunch)

o   Garlic to taste

o   Beets (especially if you have a low platelet count)

o   Ginger

Directions: Wash well and put through a juicing machine.  For a slightly sweeter taste, add pure fresh apple juice.

·         Use rosemary as a spice.  It particularly helps with mental tiredness.

(all tips are taken from our book, Integrative Strategies for Cancer Patients: A practical resource for managing the side effects of cancer therapy.)    

 

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Another Reason to Stay Up During the Night

The Study:  

 This study looked at coffee consumption and cancer risk in 67,470 females in the Nurses’ Health Study over 26 years.  Originally surveyed in 1980, these women were between the ages of 34 and 59 at the first timepoint.  Coffee consumption was measured in 1980, 1984, 1986, 1990, 1994, 1998, and 2002 through a Food Frequency Questionanire (FFQ) and converted to Cumulative average coffee intake.  Excluded patients include any participants who died, or reported any type of cancer (exceptfor nonmelanoma skin cancer) before 1980, had a history of hysterectomy, and did not complete the 1980 food frequency questionnaire.  Over the study course, participants with missing BMI information, dietary intake information, or had a new diagnosis of cancer or hysterectomy were also excluded.

672 cases of endometrial cancer occurred in the study population.  Fewer than 4 cups of coffee per day were not associated with a change in endometrial cancer risk.  Women consuming 4 or more cups of caffeinated coffee per day had a 30% lower risk of endometrial cancer compared with those who drank less than 1 cup per day.  For decaffeinated coffee, a non-significant inverse association was found among women who had 2 or more cups a day (22% less risk).  Tea consumption was not associated with endometrial cancer risk.

Limitations: 

 FFQs are notoriously at estimating a person’s dietary intake, though this study claims that it is accurate for tea and coffee intake.  The amount of cream, milk, creamer, or sugar was not measured in this study.  Variations in coffee drinks may alter the amount of caffeine and other biologically active compounds in each drink, leading to an incorrect measurement.  While confounders like alcohol intake and smoking were investigated, there may be more confounders such as employment, considering all of the participants were nurses.  Nurses in inpatient settings or overnight shifts may ingest more coffee than other nurses, and increased stress during these shifts may affect the incidence of endometrial cancer; making employment a confounder.  The study did not look at what biologically active substance may cause this decrease in endometrial cancer.

What this Means:   

 High caffeinated coffee intake may lead to a decreased incidence of endometrial cancer.   This association may not be true for decaffeinated coffee or for tea.  More research is needed to determine what substance may cause this decrease in endometrial cancer incidence. 

My Take: 

Good news for female coffee drinkers!  You may have an excuse to drink even more.  You may have trouble sleeping though.

However, this study underlined one point for me – watch what you put in your drinks!  While 4+ cups of coffee a day may be helpful,  4+ servings of cream, sugar, etc. is definitely harmful.  I am known for putting only hot chocolate mix in my coffee, and that would add 420 calories (for 4 envelopes)!  That’s almost 25% of daily recommended caloric intake.   So sip away, just watch what you put in that cup.

ITPCU Media Blitz!

Come look and listen to ITPCU in the news! Many thanks to WABC7 and The Skillful Living Room for such wonderful work!

http://abclocal.go.com/wabc/story?section=news%2Fhealth&id=8459627

http://www.businesstalkradio.net/weekend_host/Archives/tslr.shtml

- click on "Sat, Nov 26" to hear the full podcast!

Acupucture is Largely Safe is Kids…As Long as You Know the Risks

The Study:  

This is a literature review of 18 databases searching for studies on pediatric acupuncture.  The primary reported value was the number of adverse events (AEs) in the pediatric patients who received acupuncture.  Of the 9537 references identified, 450 were assessed for inclusion and a final 37 studies were deemed appropriate for evaluation.  Eligible studies were  (1) contained original patient data published in a peer-reviewed journal, (2) included children from birth to 17 years, inclusively, (3) involved needle acupuncture, and (4) included assessment of AEs in a child.

279 AEs were identified; 25 were serious, 1 was moderate, and 253 were mild.  Of the serious AEs, 12 were thumb deformities, 5 were infections, and 1 of each: cardiac rupture, pneumothorax, nerve impairment, subarachnoid hemorrhage, intestinal obstruction, hemoptysis, reversible coma, and overnight hospitalization.  On review of the severe adverse events, the majority of them may have been secondary to acupuncture technique and not the acupuncture itself.  The mild AEs included pain, bruising, bleeding, and worsening of symptoms. Overall incidence of mild AE In patients was 168 in 1422, or 11.8%.

Limitations: 

This study was limited primarily by the English language.  There may be multiple studies in Chinese or Japanese who were missed or not entered in PubMed due to the lack of translation.  Therefore, the study may be missing multiple of cases with or without AEs.

What this Means:   

Overall, acupuncture is safe in children.  However, acupuncture still has its risks.  Like in Western medical care, it is extremely important to ensure that your acupuncturist has appropriate training and credentials before getting treatment.  It is also important to check that your acupuncturist has experience, uses sterile needles and cleans your points beforehand.  Regardless, you or your child may still experience bruising, bleeding, or pain from the needles. 

My Take: 
Similar to taking a new medication, everyone responds to acupuncture in a different way.  It is important to learn and understand the risks of ANY treatment before you get it, including acupuncture.  Your new acupuncturist should briefly summarize the risks of the treatment and give you a consent form to read and sign beforehand. If you have any questions about the treatment, this educational pause is the time to ask!  Your signature is proof that you understand and accept these risks.

Overall, acupuncture is safe in pediatric populations.  While needle fear is real and understandable, it is important to remember that every medical treatment has risks – even though acupuncture’s risks may be more obvious (like needles in your skin).  I know people who are scared of acupuncture but will pop pills without a second thought.  With either the needles or the pills, it’s important to be clear what you’re treating, if the treatment will help, and what the risks are.  But bleeding, pain, and other risks of acupuncture happen rarely and are largely minor.

I’m excited that this study was published, especially in such a high-impact journal.  Hopefully, the use of CAM will slowly be accepted in the pediatric population. The ITPCU has actually been conducting a study looking at the acceptability and safety of acupuncture in our pediatric oncology population for multiple years.  We’ve presented results from this study multiple times at various conferences, the last one being at the Society for Integrative Oncology (SIO) in 2012.  Sagar, our research assistant, even won the Young Investigator Award for the presentation!  In addition, we’ve published a paper on the safety of acupuncture in pediatric thrombocytopenic patients (patients with low platlets) (1).  Stay tuned for more results of the study…it’s truly great clinical research. 

1. Ladas EJ, Rooney D, Taromina K, Ndao DH, Kelly KM. The safety of acupuncture in children and adolescents with cancer therapy-related thrombocytopenia. Supportive Care in Cancer. 2010;18(11):1487-90.