You’d have to be living in a mole hole to not have heard of the ketogenic diet. Everyone knows someone who’s on it. What everyone wants to know is whether or not keto is safe and effective. Does the keto diet work for weight loss? Is it dangerous?  Is the keto diet nutritionally balanced? Is it easy to follow? There is SO much to say about keto so I’m going to make this post a quick overview. I’ll make more in-depth posts about these topics along the way (with a lot more references), so check back for more info!

What does the research say about the keto diet?

Research about the effectiveness of the keto diet (or similar low carb, high fat diets) for weight management is somewhat mixed. Most of the time, keto-like diets are successful at causing weight loss.^1-2 Unfortunately, the research also indicates that the success of keeping that weight off long term (1 year or more) is low (and no better than with other types of diets).^3-5

Research on keto’s effects on other health markers (cholesterol, blood glucose, insulin, inflammation, etc) is also mixed. Some studies show the keto diet improves cholesterol markers, others demonstrate that it makes them worse.^1,6 Research on inflammation is once again, annoyingly, unclear and conflicting.^6-7 For the most part, blood glucose and insulin levels do tend to improve^1,6, likely because carbohydrates (and therefore the need for insulin) are largely a non-factor in a ketogenic diet.

With all of the conflicting information, it’s no wonder everyone is so confused about the keto diet. In a future post, I will go much more in-depth about what the research says and what conclusions we can pull from it.

Is the keto diet dangerous?

This answer is a little convoluted (you’re shocked, I know). Short-to-moderate length studies looking to evaluate the safety of the ketogenic diet have mostly unearthed no dangerous results (other than those mentioned above).¹ However, few of those studies have looked at the long-term effects of the ketogenic diet (or similar very low carb diets) on metabolism.^2,8 By far and away, my largest caution with the keto diet is its long-term effects on metabolism. This is also the main reason I do not recommend the keto diet for my clients and I am not following the keto diet during this feature.

Eating so few carbs mimics a “famine” situation, causing your body to rely more on its body fat stores than on blood glucose. So far, that sounds great, right? But your body expects this to be temporary (think caveman days – in Spring/Summer, the carbs will come back!). After a while, if carbohydrates don’t increase, your body resorts to a more sustainable long-term plan. Your body knows it can’t keep burning through the fat stores – it would rather slow down metabolism and try to preserve its fat stores as much as possible. This nearly always leads to fatigue, brain fog, feeling cold, and a weight loss plateau. Often at this point people become frustrated with the lack of results and begin to eat more carbohydrate. Your body is jazzed – “Spring/Summer is here! We survived! Boy, that was a long one. Next time, we will be even more prepared for Winter.” Translation: we will store more fat. These shifts are backed by documented hormonal changes in mice and humans,^4,8-9   and are linked with the weight regain mentioned earlier.

The take-home message: In the long run, very low carb diets like keto teach your body how to store fat more effectively.

Is the keto diet nutritionally balanced?

The answer is a big it depends. I would venture to say that the average keto diet is not nutritionally balanced. I would follow that up by saying that it is possible to eat a nutritionally balanced keto diet, but it takes a lot of intention. Here are some of the nutritional weaknesses I see in keto diets:

• Fiber – Fiber is a type of carbohydrate that composes the structure of certain plant-based foods. Since fiber doesn’t break down into blood glucose, it is not actually limited on the ketogenic diet and will not interfere with ketosis. At the same time, it comes in primarily carbohydrate foods, so the carb limitations often make it quite tricky to get enough fiber while avoiding other carbohydrates. It can be done with certain high-fiber foods such as nuts and seeds, avocados, and berries.
• Vitamin C – While you can certainly get vitamin C from certain keto-friendly vegetables (hey, peppers!), a lot of the best vitamin C sources are fruits, which are very limited on a keto diet. You can definitely make a point to eat vitamin-C containing foods, but you have to make the point to do so.
• Saturated fat – These are the types of fats that are primarily found in animal foods. Being a high-fat diet, unless someone is being very intentional in their food choices, a keto diet is typically quite high in saturated fats. While there are some debates around the appropriate recommendations for saturated fat,¹⁰ most keto-dieters I’ve talked with are eating WAY more than even some of the higher evidence-based recommendations. High saturated fat intakes are associated with high levels of cholesterol and increased occurrence of dementia.^11-12 Keto dieters can buffer this impact by limiting intakes of high fat meats (sausage, bacon, ribs, hot dogs, etc) and dairy in favor of lean and grass-fed meats and reduced fat dairy. Focus on including a variety of plant-based fats like nuts, seeds, avocado, and olive oil.

Is the keto diet easy to follow?

This kind of depends (do you see a theme here? It seems nutrition rarely has a clear answer). Some people absolutely LOVE meat and veggies and aren’t so big on the carb-y stuff, and keto totally rocks their world. Others – most, if we’re honest – enjoy at least some carbohydrate foods (or the option to eat them without ruining ketosis) on a regular basis. With ketosis, it’s kind of an all-or-nothing thing. You either need to be in and mostly stay in ketosis or regularly meet your carbohydrate needs. Bouncing back and forth or riding the low-carb-but-not-quite-low-enough-for-ketosis train is generally not an enjoyable ride. Many clients complain about low energy, brain fog, fatigue, and weight fluctuations, particularly coming in and out of ketosis. Digestive disturbances come up frequently as well.

My average client finds keto to be a social and nutritional bummer, because it restricts a lot of foods – particularly delicious and commonly social foods. It can also be a challenge for some to consume enough fat to promote ketosis and meet caloric needs. I can’t even count how many clients and friends have followed keto for a few weeks or months, convinced it was going great, only to decide it was too restrictive and they weren’t enjoying their food quality of life or feeling their best. The same high dropout trend is commonly seen in studies about low-carbohydrate diets.³ When deciding about a diet, be sure to take the nutritional and safety factors into account as well as your personality, favorite foods, and family/friends.

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References

1. Dashti, Hussein M et al. “Long-term effects of a ketogenic diet in obese patients.” Experimental and clinical cardiology vol. 9,3 (2004): 200-5.
2. David S Ludwig, The Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed, The Journal of Nutrition, nxz308, https://doi.org/10.1093/jn/nxz308
3. Phelan, S., Wyatt, H., Nassery, S., DiBello, J., Fava, J.L., Hill, J.O. and Wing, R.R. (2007), Three‐Year Weight Change in Successful Weight Losers Who Lost Weight on a Low‐Carbohydrate Diet. Obesity, 15: 2470-2477. doi:10.1038/oby.2007.293
4. Cardillo, S., Seshadri, P., Iqbal, N. The effects of a Low Carbohydrate vs. Low Fat Diet on adipocytikines in severely obese adults: a three-year-follow-up on a randomized control trial. Eur Rev Med Pharmacol Sci vol. 10 (2006): 99-106.
5. Foster, G., et al. A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med (2003); 348:2082-2090
   DOI: 10.1056/NEJMoa022207.
6. Rosenbaum, M., et al. Glucose and lipid homeostasis and inflammation in humans following an isocaloric ketogenic diet. Obesity. 2019 Jun;27(6):971-981. doi: 10.1002/oby.22468. Epub 2019 May 8.
7. Shen, Y., Kapfhamer, D., Minnella, A.M. et al. Bioenergetic state regulates innate inflammatory responses through the transcriptional co-repressor CtBP. Nat Commun 8, 624 (2017). https://doi.org/10.1038/s41467-017-00707-0
8. Goldberg, E.L., Shchukina, I., Asher, J.L. et al. Ketogenesis activates metabolically protective γδ T cells in visceral adipose tissue. Nat Metab 2, 50–61 (2020). https://doi.org/10.1038/s42255-019-0160-6
9. Cooper, E. The Metabolic Storm: The science of your metabolism and how its making you fat. Seattle Performance Medicine. 2015. 2nd edition.
10. Enos, R., et al. Influence of dietary saturated fat content on adiposity, macrophage behavior, inflammation, and metabolism: composition matters.
11. Enos, R., et al. Influence of  The Journal of Lipid Research. doi: 10.1194/jlr.M030700 (2013), 54, 152-163.
12. Greenwood, C., Winocur, G., High-fat diets, insulin resistance and declining cognitive function. Neurobiology of Aging. Volume 26, Issue 1, Supplement (2005) 42-45. https://doi.org/10.1016/j.neurobiolaging.2005.08.017.
13. Barnard, N. D., Bunner, A. E., Agarwal, U. Saturated and trans fats and dementia: a systematic review. Neurobiology of Aging. Volume 35, Supplement 2 (2014) S65-S73. https://doi.org/10.1016/j.neurobiolaging.2014.02.030.

You voted, and my next diet feature is the Mediterranean Diet!

The Mediterranean-style diet is often praised for its associations with improved longevity and low rates of chronic disease and certain cancers. The diet is based on the eating patterns of countries bordering the Mediterranean Sea, particularly Greece and southern Italy.¹ The exact parameters of the Mediterranean diet are not entirely clear and vary somewhat depending on who you ask.² Part of this stems from the fact that there are several different Mediterranean countries – each with their own unique culture. Their diets are distinct and therefore have different characteristics.

In general, however, there are some trends that are consistent. According to the American Heart Association and the American Journal of Clinical Nutrition, the Mediterranean Diet includes:

• high consumption of fruits, vegetables, bread and other cereals, potatoes, beans, nuts and seeds
• fresh fruit as a daily dessert
• olive oil as the prominent fat source
• dairy products, fish and poultry in low to moderate amounts
• less than 2 servings of red meat per week
• 0-4 eggs per week
• wine in low to moderate amounts^1-2

The Fundación Dieta Mediterránea developed a food guide pyramid reflecting Mediterranean Diet recommendations as well:

Starting next Monday, I will be following these recommendations for 3 weeks and detailing the experience for you! I’ll be keeping tabs on how much it costs to follow, the challenges of following it, and more. Comment below with what you’d like to know about the Mediterranean Diet!

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References

1. Willet W C, et al. Mediterranean diet pyramid: a cultural model for healthy eating. June 1995. 61:6(1402S-1406S). https://doi.org/10.1093/ajcn/61.6.1402S.

2. American Heart Association. Mediterranean Diet. Reviewed April 2018. Accessed September 2019 at https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/nutrition-basics/mediterranean-diet.

Today we’re continuing our series looking into what food and nutrition experts typically eat. If you haven’t read part 1 or my What I Eat in a Day as a Registered Dietitian post, be sure to check those out too! Altogether, you’ll see 10 days worth of dietitian food. Hopefully it helps you to see how varied and delicious a healthy life can be – everyone’s healthy life looks different! Enjoy!

Kayci Sterzer, MSN, RDN, LDN, CEDRD

Allison Davies, MS, RD

Allison lives in Vancouver, WA. She worked as a primary practice RD for about four years but has stayed home with her 14-month old son for the last year. She loves going for walks and reading historical fiction books. Her favorite foods are tacos and Thai red curry and her favorite candy is Skittles.

Best nutrition advice: Make a meal plan for the week before grocery shopping. It’s a good way to make sure you’re eating a variety of different foods and also cut down on food waste.

What she ate in a day:

My typical day usually revolves around my son’s nap schedule and some sort of outing in the afternoon. On this day, I packed a lunch to eat at my parents’ house. There are a few things I do every week that keeps the stress off of meal prep while trying to tend to my son. On Sundays I sit down and meal plan every meal. There are definitely meals that repeat, especially breakfast, but it takes the guesswork out of what to make and ensures that I buy enough ingredients at our weekly grocery store stop. I will also prep veggies and cut up meats in the evening after my son goes to bed to be ready for the next day. My son and I eat at the same times and primarily the same foods, except for choking hazards like nuts (and I do cut his foods differently). One part of this day that is not so typical is actually the cup of coffee! I only have coffee drinks once or twice a week and it’s usually a vanilla latte. 🙂

For breakfast at 7 am I ate scrambled eggs with 1 slice turkey bacon (the bacon was cooked the night before), an apricot, 1/2 bagel with cream cheese, and a cup of coffee with splash of whole milk. My lunch was around 11:30 am and included a turkey and Swiss sandwich on Dave’s Killer thin sliced wheat bread with 1/2 avocado and some sour cream and onion Pop Chips. Around 2:30 I ate a snack of homemade trail mix made of walnuts, almonds, peanuts, sunflower seeds (all unsalted), and dark chocolate chips. I prepped the trail mix earlier in the week.

We ate dinner around 5-5:30 pm. The dinner included chicken sausage and zucchini I had prepped the night before, as well as red beans and rice. Around 7:30 I snacked on one or two clusters of these dark chocolate nuggets from Costco.

Diana Reid, MPH, RDN

Diana currently lives in Europe with her husband and three children, in the tiny country of Luxembourg. She provides nutritional counseling and coaching both in-person and online or via telephone to clients throughout the world through her practice The Global Dietitian. She also spends part of the summer (and often the December holidays) in the Seattle, WA area. Diana holds a Masters of Public Health degree in nutritional sciences from the University of Washington. Additionally, she has a Bachelor of Arts degree from Western Washington University in the field of marketing and business administration.

Best nutrition advice: Focus on what you can add to your diet rather than always worrying about what to take out. Can you add more fruit and veg? Can you drink more water? These are underestimated, powerful tools.

What she ate in a day:

My day started with fruit, Greek yogurt, granola, and a bit of cottage cheese for breakfast. I was on the run during lunch and ended up eating lentil salad with some sriracha sauce for extra flavor. Later for an afternoon snack, I had cherries and a protein bar to get me through until dinner. Dinner was shrimp, rice and quinoa salad with tomatoes and avocado. Finally, to top it all off, ya gotta have dessert! Tonight’s was a fruit plate topped with some chocolate sauce for good measure. 🙂

Jessica Forsman, RD, CD

Jessica Forsman has her bachelor’s degree in Food Science & Human Nutrition and has been a Registered Dietitian for 11 years. She initially practiced as a clinical dietitian before transitioning into hospital dietary management and later into healthcare administration. She is currently an Executive Director over Physician Services at a hospital in western Washington. Outside of work, she loves having downtime at home with her husband and spending time with family.

Best nutrition advice: Keep it simple. Focus on fruits and vegetables. Don’t go to extremes or overly restrict. Enjoy what you eat!

What she ate in a day:

I chose a fairly typical Monday to highlight. I woke up late, but had prepped lunches the night before and had blueberries and almonds on hand for an easy breakfast. I’m not always motivated to prep our lunches a day ahead, but I’ve found that it makes all the difference when it comes to getting out the door on time and eating well throughout the day. Plus, it just feels good to be organized.

Breakfast included blueberries & roasted almonds and coffee with half & half. Later for lunch I ate ½ sandwich with 2 slices of smoked turkey, 1 slice cheddar & a thin layer of mayo on Dave’s Killer Bread. On the side were fresh veggies, kettle cooked chips, cherries and sparkling water. Nutrition tip: when buying deli meats, I usually look for natural brands without added nitrates/nitrites and where I can recognize all of the ingredients on the label. I especially like Applegate Naturals.

Later in the afternoon I ordered a double tall iced white chocolate mocha without the whipped cream. It’s important to choose foods that are satisfying – and for me, that usually means opting for the real thing. I rarely eat light or diet foods simply because I don’t enjoy them. By not restricting the foods that I enjoy, I find that I’m usually content with less. For an afternoon snack I ate string cheese & the rest of the cherries that I didn’t finish at lunch.

After work I snacked on seasoned tortilla chips. I do my best never to get too hungry and will frequently opt for snacks. In this case, dinner was only about 20 minutes away, but I still felt like I would be too hungry by the time dinner was ready if I didn’t eat something. Snacks are a tool that I use to avoid overeating.

We had company over the day prior and had two crab cakes, asparagus and roasted potatoes left over. Not enough on its own to feed two of us, so I added salad with Annie’s Papaya Poppy Seed Dressing, ½ piece of toast on Dave’s Killer Bread with a 50/50 butter/canola oil blend, and blueberries. I usually only have time to cook 2-3 nights in a given week, but I try to leverage (and even plan for) leftovers whenever I can. I also try to keep easy dinners on hand for those days when things don’t go as planned. Finally, I topped the night off with an evening snack of chocolate peanut butter granola with milk!

More to come?

I would like to sincerely thank each of these dietitians who were willing to take the time to help me with this project and allow us a peek into their day-to-day. This is a series I would love to continue to show the variety of options out there in regard to healthy eating. Within the community of Registered Dietitians, there are men, women, vegan/vegetarians, dietitians with food intolerances, dietitians from all different cultures, and more. If you or someone you know is a Registered Dietitian who would be willing to share their “what I eat in a day,” I would love to feature it! Let me know with this contact form.

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My last two posts covered the basics about what dietitians are (and do) and what I eat in a day as a Registered Dietitian. In the latter I talked about how everyone’s healthy life looks different. It’s important to find what works in your own life, not to follow a random diet plan or copy what someone else does. Along those lines, I thought it might be fun to explore what a normal day looks like for other dietitians. This two-part series will feature several different dietitians working in different areas and what they ate in a given day. You’ll read about three different dietitians below – stay tuned for more in an upcoming post!

Molly Koczarski, MS, RDN, LDN

Molly is a Registered Dietitian located in Whispering Pines, North Carolina. She has been a dietitian for 11 years and she recently graduated with her Master’s Degree from Central Michigan University. She is just about to start a new position as an outpatient dietitian for First Health of the Carolinas where she will be working with a wide variety of medical conditions including diabetes, obesity, heart disease, food allergies, etc. When Molly isn’t working she likes to spend her time with her husband, 4-year-old daughter, and dog. She enjoys fitness, cooking, and coming up with new recipes. She is an avid peanut butter lover and loves a good glass of wine.

Best nutrition advice: There is no “one size fits all” diet. Focus on moderation and mindful eating. Food should be enjoyed, not restricted. Building a healthy relationship with food is the key to success!

What she ate in a day:

The day started at 6:30 with a hearty breakfast of eggs (1 egg + 2 egg whites) mixed with some arugula, a side of fresh strawberries, and a Birch Benders protein waffle with slices of avocado on top.  After seeing a few patients at work I found myself pretty hungry and snacked on this delicious Greek Yogurt by Light and Fit with a serving of Trader Joes “Just a Handful” trail mix. Hit the spot!

After going on a 30-minute lunch walk I found myself ready to eat again. I prepped a macro bowl for lunch today and it consisted of spring mix and some raw vegetables, some instant pot shredded chicken, and a side of brown rice and quinoa mix. I added some oil and vinegar on my salad for some healthy fats, as well as sprinkled some hemp seeds on top. At 3:30 with an hour to spare at work, I found myself once again ready for a snack so I chomped on a yummy and delicious apple to hold me over until dinner.

After a good workout it was time to eat dinner. With the weather being so nice lately we decided to grill some turkey burgers. We had a salad on the side for our veggie. I added some avocado on my bun (but you can’t see it in the photo). Before getting settled for the night I wanted to have a little “dessert” so I had some chamomile tea (not pictured) with one of my delicious homemade protein muffins. My dog Izzy wanted some too, as you can see.

That’s a typical day for me. I usually eat 3 meals plus 2-3 snacks throughout the day. I always try to balance out my carbs, protein and fat and really focus on getting in my vegetables. I also opt for healthy fats and definitely don’t deprive myself of any particular food or food group.

Anne Corley, MSM, RDN, CD, LC

As a Life Coach and Registered Dietitian with over 26 years in clinical practice, Anne is passionate about promoting wellness (physical, mental, emotional and spiritual) with her clients. She loves helping people have “A Ha!” moments in improving their life and their health, and moving their dreams into the realm of the possible. She has partnered with clients who have made significant, meaningful changes in their lives in many areas; health, career, relationships, etc. through her practice Nourish Your Wellness Now. In all areas she has truly enjoyed the opportunity to share her knowledge and experience through coaching, training and instruction in order to help improve the well-being of her clients/patients.

Best nutrition advice: Listen to your gut, literally and figuratively. Eat when you are hungry and stop when you are satisfied.

What she ate in a day:

Today I woke up in Dingle, Ireland on a long-awaited trip with my 3 sisters. We’ve been staying at Bed & Breakfasts all along the way; today was no exception. Breakfast was a fairly typical offering of Continental and hot breakfast. Always there is the push for the traditional Irish breakfast which is bacon, eggs, sausage, black & white “pudding” (blood sausage), tomatoes, (optional sautéed mushrooms & baked beans), and brown bread & toast with butter & jam. Also fruit, yogurt, cereal, croissants, etc. along with tea and coffee. My normal breakfast is a Shakeology smoothie on my way to work, but I figured “when in Ireland…” Plus, have you ever tried to tell an Irish woman who is your host, “No, thank you”? Apparently you just don’t do that here. 😉

So up to this point I have been ordering the bacon, eggs, tomatoes, mushrooms (and once the beans…I’ve never been a fan of baked beans but I thought somehow these might be different. Nope. Not doing that again!) I have not tried the “pudding” at all; I just can’t bring myself to do it. Today I ordered bacon (Irish bacon is more like our ham or Canadian bacon), tomatoes and mushrooms, and I had Muesli and plain yogurt with berries. Also, lots and lots of tea using part sugar/part stevia and milk (not sure what type of milk, but it was at least 2% if not whole). I ended up eating two bowls of Muesli and only one of the pieces of bacon.

After breakfast we packed up and left for our Air B&B at the Cliffs of Moher (about a 3 hour drive) with a trip by ferry included. When we stopped at a “quickie mart,” as we frequently do, I got a sparkling water and I added True Lemon to it (I drink a lot of water but have never learned to like it plain, so I usually add True Lemon, True Orange, or fresh lemon or lime).

Because the breakfasts have been so big and usually later than I normally eat, we have had “linner” most days and then something light or fun later. Once we got into town, we stopped at a restaurant to have “linner” (lunch/dinner) before our hike on the cliffs at 4:00pm. I had the most delicious salad! Here’s the quote from the menu: “mixed leaves, sundried tomatoes, fresh tomatoes, caramelized onion, shredded carrot and honey roasted sunflower seeds with Spanish goats cheese, a hint of pesto and grilled chicken fillet.” I had soda water and lime to drink. Normally I would have also checked out the dessert menu, but we didn’t have time. We had to hurry through “linner” because we were running short on time. We started the hike a little after 4:00pm; it was 10k distance and about 850 feet of elevation gain and it took us about 3 hours. It was very windy, but we were blessed with some of the most breathtaking views I’ve ever seen!

When we returned from the hike (around 7:00pm) our host had made fresh scones for us, with jam and butter and tea or coffee. I had one scone with jam and a nice sized cup of tea, with milk and sugar/stevia. And then chugged a big glass of water!

Danae Shelley, RD, CDE

Danae is a dietitian and nutrition supervisor at a nonprofit group of medical clinics based in South Seattle. In July of 2019, she will have been a dietitian for 6 years. For Danae, the years of being an RD have really flown by!

Danae got married in September 2018 and lives in Renton with her husband and their min-pin, Max. They love spending time together and going out and meeting new people. They also enjoy traveling (both around Washington and elsewhere), taking Max to the dog park, dancing (especially salsa and bachata), and trying out new ice cream places!  

Best nutrition advice: Just aim to make one small positive choice every day toward improving your health!

What she ate in a day:

During the work week, I tend to get up with just enough time to shower, get ready, and feed the dog, etc., so I don’t normally leave a whole lot of time to make breakfast. Breakfast is usually on the go and usually eaten on my way to work or when I get to work as I prepare for the day ahead. This morning I whipped together a strawberry protein shake made with 1% milk for some added protein that keeps me full all morning, along with my much needed cup of coffee with a few tablespoons of creamer.

Due to a meeting I had at my normal lunch hour, I had to have a little snack to tide me over until I was able to eat. I had forgotten I had an English cucumber in the fridge, so last night I sliced it up and portioned half of it into a Ziploc bag.

In my house, we are the king and queen of leftovers (when we have them)! My husband is tall and eats a lot, so sometimes he eats all of the meal and there isn’t any for leftovers. Today was left over vegetable burger soup (I know it’s too hot outside for soup, but it’s cold in my office with the a/c, so it’s not that bad). The soup has lean ground beef (93/7), stewed tomatoes, tomato sauce, mixed vegetables and onion soup mix. I also had a small cup of strawberry yogurt. It’s hard to find yogurt that is low in sugar, but this one has 2 grams of sugar and 12 grams of protein. I originally had the fruit cup planned to go with my lunch, but I was feeling a little full after my soup and yogurt, so I decided to hold off and have it for a snack later. I normally don’t do a lot of canned fruit, but I had a coupon for this product and thought I would give it a try. It was a mixture of mango and chia seeds, which are a great source of omega-3. It was a burst of fruitiness to get me through the rest of the work day!

For dinner, Queen of the Leftovers strikes again! After a bit of a longer of a commute that normal, I got home later than I usually do, and therefore was hungry. The night before, I intended to make some enchiladas, however due to a tortilla malfunction, I had to turn it into enchilada lasagna, made up of ground turkey, chili beans, seasonings, layered with whole wheat tortillas and topped with Monterey jack cheese and enchilada sauce. I had a square of that with a little helping of sour cream on top.  I washed it down with a glass of water. After doing some stuff around the house and yardwork outside, I was feeling a bit hungry, so I reached for a small bag of popcorn with light sea salt and green tea. Its low calorie and high in fiber. You can see from the picture, it’s so yummy even Max wants a taste!

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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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Ahhh pre-made meal plans…I gotta tell ya, I love to hate ’em. Finding them, selecting them, and most of all, following them. They are stinky, like fish. That will make more sense in a few paragraphs. Promise.

Why are they stinky, you ask? Well I would be more than happy to tell you.

The food we eat is connected to everything in our lives. Everything. Your budget, your spouse (or lack of spouse), your kids (and their preferences, allergies, and appetites), your schedule, your culture, and your mood all play in to the food you choose to eat. That being said, someone would have to thoroughly understand all of those things about you in order to select foods that are good options for a meal plan for you. Now, how many meal plan makers know you that well?

Let’s take, for example, some meal plans I’ve been on in the past for different blog experiments. For the heart healthy meal plan I followed, the ingredients increased my grocery budget by 75%! Typically I use dinner leftovers for lunches, but that meal plan used NO leftovers for ANYTHING. You know what that gets you (besides an expensive grocery trip)? A fridge full of leftovers waiting to go bad. It also leaves you cooking two meals every night – dinner and tomorrow’s lunch. Not sustainable, functional, or enjoyable.

My final gripe about following meal plans made by others? Sometimes I just don’t like the food. Like, for example, coleslaw. I’m not a huge fan, but it’s on the meal plan, because the person who made it didn’t know me and my lack of appreciation for coleslaw. So here I am, either eating coleslaw or feeling as though I somehow “failed” my meal plan because I didn’t like it.

And you know what else (yes, I lied about the final gripe part)? As a dietitian, my goal is to empower my patients to live a healthy life they love. Now even if I gave them the perfect meal plan that worked great for their lifestyle, are they empowered? What will they do when the week-long meal plan is over? Will they just eat the same food week after week forever?

Of course not.

Remember the old saying, “Give a man a fish and feed him for a day, but teach a man to fish and feed him for the rest of his life”? Well, a meal plan is a fish.

I can give someone a meal plan fish and they can meet their nutritional goals for a week (if they manage to stick with a meal plan someone else made), or I can teach someone how to plan for themselves and meet their health and quality of life goals. Truly, they are the only ones who know themselves well enough to do it. So usually, if my client’s would like to have weekly meal plans, we set aside a portion of each of their appointments and make the meal plan together. It’s not easy and it’s awkward at first, but once they get the hang of it they are empowered. After a few sessions they’ve got the hang of it and they’re making their own meals plans (that they love, that fit their budget and their health goals). They can eat for life – on a budget and with foods they love! And that is why I love what I do.

And why I hate stinky meal plan fish. End rant.

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The New Year is almost here! So why not put out my dietitian two cents on New Year’s resolutions, particularly as they apply to healthy eating goals? Do you want to become healthier in the new year? That’s excellent! The next thing to do is determine specifically how you plan to do that. Are you going to exercise more? Eat more fruits and vegetables? Drink more water?

Too often the answer is, “I’m going to lose weight by following _______ diet.”

I encourage (and plead and beg of) you NOT to make that commitment this year. Here’s why:

Whoever made _______ diet did not have you in mind.

They don’t know about your budget, your son’s food allergy, your love for lattes, your busy, busy mornings, or your picky, picky toddler. They made _______ diet with the goal of getting pounds off of people and more than likely, selling some books/supplements/shrink-wrap belts/etc along the way. You may be able to fight, claw, and scratch for a few days, weeks, or even months. But the chances that the entire diet plan fits so effortlessly into every part of your life that you can maintain it forever are slim to none. It’s likely that you’ll throw your hands up at some point and say, “I’m DONE!”

Here’s the other reality about weight-loss diets: they aren’t necessarily good for you. If the goal is only to take pounds off, most of them work like a charm. They do! The pounds come off for most people (not all) if they really follow a diet plan. The problem is, if the goal is to keep weight off, most diets are total failures for most people.

Most weight-loss diets in some way mimic starvation (often with a myriad of dietary contortions that are miserable and difficult to follow). Do you know what mimicking starvation does to your body? It tells it to live off of stored fat (hence, weight loss) and it teaches it that starvation is a very real possibility in your life. In fact, it has happened! It teaches your body that every time it gets a chance it should take every single extra calorie and store it away as fat to help you survive starvation. That means that as soon as you are sick of your diet (or reach your weight loss goal) and begin to eat normally, your body will be itching to build up its “savings account” of fat again to weather the next starvation storm.

This also means that every time you “cheat” your body will store that innocent little piece of cake or that perfectly acceptable apple crisp and send it straight to fat storage. Have you ever thought, “it seems like if I even look at dessert I gain weight”? It is practically true for some dieters. Your body will not happily burn through something that it sees as a vital deposit in a dwindling emergency fund.

Most weight-loss diets teach your body to store fat!

These diets slow down your metabolism (bye, bye energy!), prepare your body to regain weight, and let’s be honest…just suck to follow. Let’s be real.

Here’s what to do instead:

1. Don’t get married without dating first!

What I mean is, don’t commit to stick to a plan if you have no clue how well it is going to work for your body and your life. If it feels like fighting, clawing, and scratching, then it’s not the right change for you. Avoid committing to any plan that you haven’t tried out first. Honestly evaluate how it fits into your life and if it doesn’t, it’s not your failure – it’s the wrong plan!

2. Commit to a habit, then figure out how to make it work in your life.

Instead of a whole plan, pick a healthy habit. Want to drink more water? Great! Pick an ounce goal (80-100 oz is a good start for most folks) and try however many strategies you must in order to find the one that actually helps you get there. Try carrying a water bottle everywhere. Try setting mini-goals (20 oz. by 10 am, 40 by noon). Try an app like My Fitness Pal. Try a cheesier app like Plant Nanny. Try fruit-infused water. Try tea. Try filling a gallon jug of water daily. Try whatever you need to try until you get closer to where you want to be. The real work is in finding the strategy that doesn’t feel like work.

Once you’ve figured that one out, choose another habit and stack it on top of the first. Ready to eat 5 servings of fruits and veggies per day? Walk for 20 minutes 3 times per week? Regardless of the goals you pick, this test-driving strategy means you’ll have the opportunity to make each change fit your life. Once you stack up all your new (and easy to stick with) habits, just think how much healthier you’ll be! Not to mention how much more enjoyable it will be than that “clean eating” cleanse you were thinking about trying…

3. Put your blinders on

This is the toughest part and it’s a total mental game. Your cousin’s on keto, your PTO pal is on paleo, and your fitness-nut friend is fasting 16 hours a day. They’re all losing weight and you’re over here working on your water intake. It can truly be maddening. Remember from before – most any diet will get weight off. Most any diet will not keep weight off. Remind yourself how many times you’ve watched someone (or you yourself have done this…it’s okay!) diet, lose weight, then gradually gain it all back and then some. All of these people you know are setting their bodies up to gain more fat in the long run. It’s sad, but it’s true!

So try not to let them influence you. It’s so, so hard, I know! I’m a dietitian – I’ve studied nutrition for 10 years – and I can still feel myself being influenced by social media progress photos from diets and supplements that I know are not safe or effective. It is a battle. But it’s a battle worth fighting, because even if keto is the perfect fit for cousin Kathy, you are not Kathy.

You must find your healthy life.

That means that you eat what works for your body, your family, your budget, your lifestyle, and makes you happy. Put in the work to find out what that is, and you’ll be so pleased with how easy it can be to be healthy!

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To Diet or Not to Diet: 5 Ways to Know if an Eating Plan is Right for You

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