I recently wrote a post called What I Eat in a Day as a Registered Dietitian. Some of you may be wondering what exactly a Registered Dietitian is, and probably even more of you are wondering if or how it is different from a nutritionist. I can help! Here are some of the basics about Registered Dietitians and what we do.

What is a Registered Dietitian?

Registered Dietitian is the designation given by the Academy of Nutrition & Dietetics (at least in the US) to people who have completed certain requirements to be considered nutrition experts. Here are the requirements from the Academy to become an RD:

• Complete a bachelor’s degree – The classes you take must meet nutrition-related requirements set forth by the Accreditation Council for Education in Nutrition and Dietetics, a brand of the Academy. Some course requirements include anatomy, physiology, chemistry, biochemistry, basic nutrition, macronutrients, micronutrients, clinical nutrition, food science, weight management, and medical nutrition therapy.
• Complete nutrition internship hours in a variety of settings – Since dietitians work in so many different types of roles, internships need to include several of those experiences. My internships included clinical inpatient nutrition, outpatient nutrition counseling, food service management, dialysis nutrition, childhood nutrition at a WIC clinic, and senior nutrition with Meals on Wheels.
• Pass the RD exam – This test covers all of the required competencies put forth by the Academy

Registered Dietitians must also complete 75 hours of continuing education every 5 years to maintain their registration.

How are dietitians different from nutritionists?

Simply put, “nutritionist” is not a protected term, while “dietitian” is. Nutritionist is a term for anyone who teaches about nutrition, while dietitian is reserved for those who have met the criteria described above. So all dietitians are inherently nutritionists, because they teach nutrition, but not all nutritionists have completed the requirements to become dietitians.

This obviously creates a bit of confusion for consumers – I get these types of questions all the time! A few years ago, the Academy of Nutrition & Dietetics also coined the term “Registered Dietitian Nutritionist,” and allows their RDs (or RDNs) to use that term if desired to help clarify their roles as nutritionists.

Where do dietitians work?

Dietitians are working all around you, and you may not even realize it! Dietitians may do all of the following:

• Calculate recommendations for tube and IV feedings and nutrition supplementation for critically ill patients in hospitals
• Plan nutritionally balanced menus for large food service operations at long-term care facilities and schools
• Teach nutrition for general health, managing and preventing chronic medical conditions, and navigating food allergies/intolerances in private practices, hospitals, medical clinics, and chiropractic offices
• Provide nutritional guidance to low-income populations in WIC clinics and community health centers
• Teach specialized diets for clients in dialysis centers
• Monitor the nutritional health of residents in long-term care facilities
• Provide nutrition information to the public via social media, blogs, websites, newspapers, etc.
• Support athletic performance with proper nutrition in health clubs, gyms, on military bases, and with sports teams

These are just some examples of roles that dietitians fill. Stay tuned, because I plan to make a post soon featuring “a day in the life” of several different dietitians who all work in different settings, to give you an idea of what all kinds of different dietitians eat!

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What the Research says About Intermittent Fasting

There are several foundational concepts behind the Trim Healthy Mama plan that are designed to improve health and help with weight management. As I mentioned in my intro post, for the most part these concepts line up with research and make practical sense. There are some aspects of the plan that don’t, and I’ll explain some of them below. Here’s your chance to get the overview of what research has to say about the basics of the Trim Healthy Mama Plan.

Moderation

Age-old and still good, the advice to eat in moderation is always relevant. By including protein at each meal and limiting carbohydrate portions, the Trim Healthy Mama Plan does a great job of preventing carbohydrate overeating. Overeating carbohydrates leads to storage of extra blood sugar as fat and can also increase inflammation, so regulating blood sugar by moderating carbohydrate intake can be key to weight loss or maintenance.

The weakness I see in this area is with fat moderation. The authors do repeatedly mention the importance of not abusing fat intake, but there is no official limit on fat intake for S meals. This might make it tricky for some to keep fat intake in check (my fat intake was quite high during my first week). Since fat is very calorie dense, it’s possible this could interfere with weight loss or weight maintenance goals. Fortunately fat is filling, so that does help promote natural moderation of fat intake, but keep in mind that the desires of our tastebuds can easily override that moderation if we aren’t careful. Fat is awfully tasty!

Glycemic Index

Besides limiting portions of carbohydrates, the Trim Healthy Mama Plan is designed to manage blood sugar (and thus weight and inflammation) by limiting carbohydrate options to those that raise blood sugar more slowly and gradually. This is quantified using a tool called the glycemic index. Foods with a low glycemic index raise blood sugar slowly, while foods with a high glycemic index raise blood sugar rapidly. For example, barley (allowed on the THM plan) has a glycemic index of 25, while white rice (not allowed on the THM plan) has a glycemic index of 72.¹ This is generally a good way to choose healthful carbohydrates and as a bonus, it typically increases fiber intake since high-fiber carbohydrates tend to have lower glycemic indices.

Researchers have since taken this concept a step further to include not only how rapidly a food raises blood sugar, but also the actual amount of carbohydrates in a standard portion of the food.² This helps differentiate between foods that contain only a few carbohydrates (like watermelon, which has a high glycemic index but contains so few carbohydrates that it barely affects blood sugar), and those that have more carbohydrates and send them in quickly (like sweet potatoes). This new measure is called glycemic load, and it is a more complete representation of how a food actually affects blood sugar.¹ A glycemic load of less than 10 is considered low and a glycemic load of greater than 20 is considered high.

Taking glycemic load into account places some not-on-plan foods like whole wheat bread (which has a glycemic load of 9) and whole wheat tortillas (glycemic load = 8) into a much more favorable position as blood sugar regulators. They fall well below some on-plan foods like sweet potatoes (glycemic load = 22). Utilizing glycemic load rather than glycemic index would allow quite a few more foods and make the THM plan less restrictive while better honoring the spirit of managing and regulating blood sugar. My personal philosophy is always to help clients find the plan that is the least restrictive way to achieve their goals – it makes food more fun!

Fuel Isolation

The authors of THM also encourage that for weight loss or maintenance, you should focus on only one fuel (fat or carbohydrate) per meal. The reason for this is that our bodies prioritize the use of carbohydrate fuels over fat fuels, and will burn blood sugar before using fat. The authors state that by restricting fuels to one at a time, you can ensure that all fuels (including fats) are fully burned before eating the next meal.

This is true as long as the total amount of fuel eaten still matches one’s energy needs in that window. For (an overly simplified) example, if someone ate a meal that contained 450 calories for lunch, and they used 500 calories before they ate again at dinner time, they will have burned all of the 450 calories they ate at lunch (first the energy from carbohydrates, then from fat) and tap into their fat stores to make up the last 50. On the other hand, if they ate a 700-calorie lunch and then only needed 500 calories, they would burn through those 500 (first from carbohydrates, then fat if carbohydrates ran low) then end up storing the extra 200 as body fat. Like I said, this is overly simplified for explanation’s sake and there’s a lot of physiology missing here, but it gives you a rough idea.

To bring this back to the THM concept, restricting fuels to either carbohydrate or fat is one practical way to moderate intakes overall, though it certainly is not the only way and it also doesn’t guarantee that the total amount of energy eaten would match energy needs. The key is whether or not the structure of THM makes it easier for you personally to moderate. For some personalities, the structure of S and E meals makes moderation much more clear and easy to follow. If you prefer or it makes more sense to you, you can balance fuels at each meal with moderated portions of carbohydrates, proteins, and fat as long as the total amount of energy you eat matches the total amount of energy you need (or a little less if you’re trying to lose weight).

The Verdict

Overall, Trim Healthy Mama provides a structure for moderation that is mostly based on valid concepts and is likely to generate weight loss (if desired). It will also direct your eating to healthier pastures, as it eliminates quite a bit of junk food, empty calories, and inflammatory foods. Basically, if this plan works for your personality and lifestyle, go for it! It is more restrictive than is necessary for health and weight management, but keep in mind that your lifestyle is your own – so you can choose parts of the plan that work for you and parts that don’t! In fact, many of the blog articles I have read about THM say that their writers follow “a version of ” THM. Good for them! They made it their own, and finding a plan that works for your life is just as important as finding one that works for your body.

1. https://www.health.harvard.edu/diseases-and-conditions/glycemic-index-and-glycemic-load-for-100-foods
2. https://academic.oup.com/ajcn/article/76/1/5/4689459

I started the Trim Healthy Mama plan yesterday and I’ve been S-mealing and E-mealing all over the place! Yesterday was actually an interesting day for me to start because it wasn’t my normal routine at all. My dad had a (minor) surgery so I picked up my grandma and we headed to the surgery center to keep my mom company and help out. This change in schedule was a bit of a test for my first day since I was out and about for much of the day. Here’s a rundown of my first crack at THM:

7:15 am – Breakfast (E meal)

Breakfast time! It was trickier than I expected to come up with a meal, mostly because I do my grocery shopping on Mondays and hadn’t bought food specifically for the plan yet. I started with an E meal of oatmeal with strawberries, cinnamon, and stevia. On the side, I had some plain fat free Greek yogurt with a drop of vanilla and some stevia. I was concerned that this meal wouldn’t have enough protein to make it all the way to lunch, but I was pleasantly surprised that I didn’t get hungry until 11 am. I tossed some oranges in my bag for a snack but never did eat them.

11 am

Dad went in for his surgery and our stomachs were starting to rumble. I volunteered to drop off dad’s prescriptions and grab us some lunch to bring back. Most of the portable options in the vicinity of dad’s pharmacy were fast food. I remembered reading the chapter in the Trim Healthy Mama Plan about eating out. The authors say S meals are the easiest to do while eating out because of the low-carb options at many restaurants. After some quick Googling for ideas on low-carb fast fooding, I discovered that Wendy’s has a lettuce-wrapped burger option, so I dropped off the prescriptions and headed over there.

12 pm – Lunch (S Meal)

When I was ordering, I was a little unsure how much food I would need to be satisfied. Generally, if I get fast food I order a kids’ meal or a cheeseburger with a small serving of french fries. French fries are a no-go on the Trim Healthy Mama plan because they are high in both fat and carbohydrates (not to mention that they are made of white potatoes, which are also discouraged). I’m a sucker for a salty carbohydrate so honestly that was a bit of a bummer. I planned to order a lettuce-wrapped cheeseburger but then wondered if that would be enough when I’m used to also having a bun and some french fries too. I decided to embrace the concept of an S meal and got a double cheeseburger. Now, as a dietitian, I would consider this meal too high in saturated fat and too high in calories (not to mention sodium), but it fits the THM concept. I thought about ordering a side salad also but their online reviews were less than enticing.

The lettuce-wrapped cheeseburger was messy but delicious. I would order one any time! I noticed that eating a low-carb meal didn’t satisfy me as quickly as a balanced meal with carbohydrates does, but after 10-15 minutes the meal’s fat kicked in and I was satisfied for hours.

3 pm 

Time for grocery shopping! For the most part, I was able to buy the usual foods my family eats when planning for THM this week. The exceptions included a handful of specialty foods that are recommended to make the diet easier and more interesting to follow. I bought pressed peanut flour (a low-fat alternative to peanut butter, used mostly as a protein source in E meals), almond flour (for grain-free baking), and coconut oil (recommended by the plan for cooking, along with butter). These products were more expensive than the alternatives I typically buy and upped my grocery bill for the week by about $25. The containers I bought will most likely last for the next 3 weeks and probably beyond, so I imagine the extra costs will average out.

6:30 pm – Dinner (E Meal)

After running around a bit and making sure dad was settled at home, I ended up making a recipe I had planned for last week but never got around to cooking (and just so happened to be a type of burger…déjà vu, anyone?). I was able to use up the ingredients with just a few tweaks for THM. I put my black bean veggie burger (which didn’t hold together well but tasted  good) on a bed of lettuce and a slice of sourdough. I made baked sweet potato fries and a strawberry banana smoothie as sides. It was very satisfying and lasted all the way until bedtime!

Overall, definitely not a bad day. It’s taking a bit of getting used to, thinking carefully about all of the parts of my meal to make sure to balance fuel sources per the THM plan. I have a feeling my husband and boys will particularly love the S meals I have planned for the week!

Disclaimer: This is not a sponsored post and I have no affiliation with the producers or manufacturers of this product; however, as an Amazon Associate, I receive compensation for any purchases of products through the links on this post.

Thank you so much for all of your votes and comments, everyone. I’m so glad that you are searching for eating plans that help you live a healthy life! And now, the moment you’ve all been waiting for: the winner is…

Trim Healthy Mama!

Stay tuned for more information on what Trim Healthy Mama is, how to follow it, what the research has to say about it, and more!

It’s here! The Dietitian on a Diet/i’mPowered Nutrition & Fitness giveaway challenge begins today! To participate for the chance to win a beautiful goal-tracking planner/journal from The Simple Elephant, planner stickers, and a set of Papermate Inkjoy pens, follow Dietitian on a Diet on Instagram or like Dietitian on a Diet on Facebook, and follow the instructions on my giveaway post

Based on my experience with intermittent fasting, I have discovered a few characteristics of a person who might really thrive on intermittent fasting. Check out the list below to see if you might be one of them!

Likely Good Candidates:

• Absent or minimal hunger cues or doesn’t mind being hungry – I often hear “I often forget to eat” or “I could go all day without eating”
• Not usually hungry in the morning/prefers to skip breakfast
• Dislikes the structure of tracking calories daily
• Prefers limiting intakes significantly sometimes and not regulating at all at other times
• Schedule that allows eating at “unconventional” times (for 16:8 protocol)
• Goals might include: weight loss, decreased inflammation, reduced risk for chronic diseases like diabetes, heart disease, Alzheimer’s

Likely Not Good Candidates:

• Frequent hunger (every 3-4 hours or less)
• Regular breakfast eater
• Prefers more structured eating regimen
• Prefers moderating intakes a little each day to an “all or nothing” mindset
• Goals might include: weight loss, muscle gain, reduced risk for chronic diseases like diabetes, heart disease, Alzheimer’s

If you want to learn more about creating a personalized plan to meet your goals and fit your lifestyle, visit my practice website and set up an appointment!