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Dietitians complement medical profession by Mary Helen Yarborough Public Relations As Americans grow fatter and older, dietitians’ role in preventative and therapeutic care is becoming a critical, albeit subtle, link between holistic and medical providence.   At MUSC, eight dietetic interns will graduate this month to enter a vastly expanding field in which professionals trained and skilled in the science of nutrition work with doctors, caregivers, institutions and communities to improve health.   Registered dietitian Stephanie Tranen has guided the 10-year-old dietitian program housed in the Digestive Disease Center at MUSC for the past five years. She describes the program as excellent.   “It’s very competitive. …In order to be eligible to apply to this program, an applicant must have a bachelor’s degree in food, nutrition or dietetic sciences from an approved, accredited university,” Tranen explained. “And they’re accepted through a national matching program much like the medical  residents.”   Out of 57 applicants, MUSC accepted eight interns who began their internship in August. They hail from all around the country: Michigan, Indiana, Florida, Georgia, Rhode Island, Virginia and Tennessee. And when they finish on May 20, they will join other graduating interns from an estimated 250 internship programs nationwide and become eligible to take the national registered dietitian (RD) exam, which is administered through the Commission on Dietetic Registration.   The interns will have put in more than 900 hours of clinical training. They will have worked with MUSC physicians, community centers, the Food Bank’s Kid’s Café, developed and managed campus nutrition campaigns, such as “Lose to Win,” and they will have conducted research that has been useful to hospital administrators and health care providers.   When they graduate, a wide universe of opportunities awaits them. Large employers of RDs include the federal government, which employs more RDs than any other sector; state agencies, large corporations, school districts and the health care industry.   The growth of the field has been, in essence, market-driven. Tranen noticed a shift toward community and corporate recruitment of RDs about 15 years ago.   “Years ago, dietitians received their undergraduate education through the old home economics programs,” said the 30-year RD veteran. “Most of the dietitians went to work in nursing homes or hospitals.”   Of course, dietitians still work in hospitals and nursing homes, or, as Tranen said, “anywhere where people are fed,” but the market, driven by cost-conscious employers also have meant more opportunities for RDs.   Major corporations have learned that healthier employees drive down the cost of insurance and reduce absenteeism, Tranen said. “As a result, large employers are hiring dietitians, or consulting with them,” to help establish healthier meal selections in cafeterias and counsel employees regarding nutrition and health, , she added.   Fields also include restaurants and publishers, including Southern Living magazine and others that focus a key part of their editorial content on culinary arts, diet and recipes. Tranen said that CNN was the first major broadcaster to feature an RD whose beat was health and nutrition. Meanwhile, some dietitians go on to become researchers in universities, hospitals and government agencies.   “When I started out, most of the jobs were in hospitals,” she recalled. “But today, hospitals employ a smaller percentage of dietitians. Graduates go into private practice, work in community settings, school districts or in the corporate arena. And more are involved in the culinary aspects of food by writing about it.”   In the past century, acute diseases were more prevalent, which called for quick-acting medicines, such as penicillin for cures. In our modern era, chronic diseases have become prevalent, Tranen said. So, prescribed diets have become as important as dispensing pills, especially when one considers that some of the chronic diseases: diabetes, heart disease, and certain forms of cancer, all have links to nutrition.   “Interest in health spawned the growth in this field,” Tranen said. “I think chronic diseases have highlighted the important role that nutrition plays in our overall wellness. It’s a big role, not only in prevention but in health maintenance. …Good, balanced nutrition is the key to good health.”   RDs, like a chemist, know what certain food combinations do to or for the body.   For example, a vegetarian who eats no meat must  plan this intake of protein from other sources. “The combination of red beans and rice contains ‘complete’ protein as does a hamburger,” Tranen said. “You have to mix plant proteins appropriately in order to make up for what you would get from meat. All plants have proteins, but they aren’t ‘complete.’ If you combine them correctly, you can be a very healthy vegetarian.”   Other foods, such as pizza, can be healthy meals in themselves, but it depends on the topping. “Pizza is healthy. You can top it with eggplant or other vegetables, but not sausage. In this case, it’s not  the pizza that is unhealthy, but how much of it you eat.” Community and campus action Many of the dietetic interns are involved with the Junior M.D. program that was developed by graduate students. This year, interns worked with second and third graders at Fraser Elementary School.   Tranen said that not only were the interns trying to educate children about basic good nutrition, they were trying to inspire the children’s interest in entering the field of health as a future career option. The notion, even when working with a young child, is that when they understand that there is a connection between food, activity and health, they are more inclined to be interested in the subject and practice better judgment.   The interns conducted three sessions with the children at Fraser, and then they worked with the children’s parents. The parents expressed great interest in what they could do at home to provide healthier meals for their children, which in turn, help their children perform better academically and behaviorally. Kid’s Café The Kid’s Café is a program for at-risk children from low income homes. The cafés are set up through the school or church where children get a healthy meal and a safe haven between school and home. It is a program of the Lowcountry Food Bank.   The internship has been a partner in the program for the past four years as part of their MUSC Gives Back efforts in the community.   The current team of interns went to four locations where the Kids Cafés were set up and talked with the children about nutrition. They made up nutrition games and used the updated food guide pyramid as a platform for fun learning.   The interns also were asked to develop a nutrition survey for the children and the centers’ directors. Tranen said they used the results of the survey to focus on future interactions with the cafés, which next year, would focus on working with directors to increase their knowledge of nutrition. Research and applicable findings As part of their internship, the interns conduct research in a specialized area of nutrition and produce a poster and abstract for presentation. Some of these presentations have been accepted at national meetings in previous years.   Examples of research and finding by the interns included studies on nutritional supplements given in hospitals, dental caries in African-Americans with type 2 diabetes, and diets of incarcerated youth.   Other studies looked at the maternal nutritional differences between white and non-white lactating women; whether stickers placed in medical charts are effective in alerting providers to certain serious conditions; how much pediatricians know about the ketogenic diets of epileptic patients; and whether “telenutrition” should be incorporated to educate children in rural schools where access to an RD is infeasible. Interns speak up Leanne Kaye plans to practice in an acute care setting for a year, then work toward her doctorate in nutrition research. “If there is any field that complements the medical world best, it is nutrition. Nutrition may be considered a smaller component in health care, but it is an essential one. Dietetics has allowed me to practice something meaningful while educating patients and Americans in general in how to care for their bodies through nutrition,” she said.   Kay said the dietetic field has evolved.   Nutrition is no longer a field of home economics. It moved out of the kitchen and diversified into many areas of industry- corporate and hospital research, acute care, food product development, food service and private counseling services to name just a few,” she said.   Kay expects the field to grow as more and more research uncovers interactions between food and human health. “Nutrition isn’t something we should start worrying about at age 50. It is a component that should be part of our lives from birth,” she said.   Elissa Murphy chose the field of dietetics because of interest in the human body and sharing her understanding with others. She would consider a career in the foodservice and community health fields, but hopes to work with school districts helping them develop lunch programs and teaching nutrition in the classrooms.    “I think the most important thing about nutrition is obtaining accurate information. I would like everyone to have the freedom to make choices that influence their health and their family’s health with as much information as possible.   “The field of dietetics is going to increase in importance. Interest in health and proper nutrition is growing and I hope people will turn to registered dietitians for sound nutrition information and counseling,” she said.     Friday, May 12, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island papers at 849-1778, ext. 201.