How can a clinical nutritionist help?

The following are recommendations from Catherine DiSanto, RD, LD, Clinical Nutrition Specialist.


The Role of a Clinical Nutritionist
My role as a dietician is to assess patients, and then either to prevent depletion of their nutrition status or to replete them, depending on what state their nutrition status is in when they come to see me. Nutrition does play a really important role in the management of IBD and in their outcomes. What I try to do is to really think about what a patient is normally eating and identify a kind of personalized plan.


Continuous Process
If a child with IBD has a lot of diarrhea, I think sometimes they are afraid to eat. And changing nutrition status is slow and steady it takes a lot of time to have someone come into your office and to work with them, and then have them work on these things at home. It’s a continuous process, unlike taking a medication, where you take the medication and it’s done. So I think that’s where it gets hard. Even once you educate people and they know what to do, in the adolescent population they may just not want to do it or just not see the significance of it, because it is slow. I think for clinicians it’s a matter of both presenting the knowledge and then taking the next step of thinking about how to really work it in. And I think that second step is what is difficult.


Special Diets
Sometimes parents are looking for a quick fix, and they may tap into some of the “fad diets” for IBD, so to speak. But I always approach that with an open mind. If they’re really eager to try something, that’s fine, as long as it’s not omitting key nutrients or major food groups. The best nutrition plan is the one that works for that patient.


Ideas for Taking Nutritional Supplements
Parents can mix up canned supplements such as Boost to make puddings or different shakes with them. Oftentimes they do find, with the older population, that even Carnation Instant Breakfast works. It’s fortified with some vitamins and minerals and protein, and definitely allows someone to increase their caloric intake with a limited volume, but it doesn’t have that tinny taste. I have recipes that I give parents for different shakes, and uses for the shakes too. Sometimes with the kids they’ll make them into popsicles. I think the biggest thing is trying to find something that they can incorporate daily so that it almost becomes second nature to have a bedtime shake, for example.


Increasing Calories
Oftentimes what I like to do is to increase the calories in a food that is already a healthy food, if children need more calories in their diet. So if someone is having mashed potatoes, they could add a little bit of heavy cream or butter to them. Or, to be even healthier, they could add olive oil or nuts. Other people in the family can then have what is still a healthy meal, but without the extra calories. I think that’s better than saying, “Well, at least we’ll give them more calories in general” and giving them Krispy Kreme donuts and Cheetos. That’s not the way to go, because it’s just giving empty calories and not really increasing their nutritional status. We really like to focus on the key nutrients such as iron, protein, calcium, and vitamin D, and make sure they’re getting enough, and not just eating carbohydrates and junk food. A patient can actually present without any weight loss they can maintain a normal weight but be undernourished. I think we can increase calories by adding healthy oils and nuts and that sort of thing to someone’s diet, rather than just saying, “Okay, you can just eat a gallon of ice cream a day.”