Re: Statement in Purple book - Nutrition Diagnosis and Intervention

[Guest guest]

If you think the term needs editing, there is a process in place to

do that. In the back of the book are forms that can be completed and

submitted to the SLC/NCP Committee. There is a process in place to

ensure that the terminology truly reflects dietetics practice.

Regards,

Pam

Pam Charney PhD, RD, CNSD

Author and Consultant

Member, SLC/NCP Committee

Seattle, WA

> I wondered how others felt about the statement under the following

> problem noted in the book above;

> Problem; Harmful Beliefs/Attitudes About Food or Nutrition-Related

> Topics;Etiology . . . " Desire for a cure for a chronic disease through

> the use of alternative therapy "

> For those of us who believe in and utilize complimentary medicine,

> don't you feel this statement should be re-visited to clarify our

> involvement in complimentary medicine? Perhaps, adding a statement

> like " knows the difference between alternative medicine and

> complimentary medicine approaches and their uses in medical nutrition

> therapy? "

> How do others feel about this statement? Should it be revised?

> Kathy Shattler, M.S.,RD

>

>

>

[Guest guest]

What Purple book? Did I miss something? I don't understand what book is

being referenced?

Carol

CarolSCasey@...

" You'll never do a whole lot unless you're brave enough to try. " Dolly

Parton

http://nutritionalmatters.blogspot.com

" I am a border ruffian from the State of Missouri. I am a Connecticut Yankee

by adoption. In me you have Missouri morals, Connecticut culture; this,

gentlemen and ladies, is the combination which makes the perfect woman. "

Paraphrased from Mark Twain's speech " Plymouth Rock and the Pilgrims, "

December 22, 1881

" My weaknesses have always been food and men - in that order " . Dolly Parton

_____

From: rd-usa [mailto:rd-usa ] On Behalf Of

kathy shattler

Sent: Friday, August 10, 2007 1:48 PM

To: rd-usa

Subject: Statement in Purple book - Nutrition Diagnosis and

Intervention

I wondered how others felt about the statement under the following

problem noted in the book above;

Problem; Harmful Beliefs/Attitudes About Food or Nutrition-Related

Topics;Etiology . . . " Desire for a cure for a chronic disease through

the use of alternative therapy "

For those of us who believe in and utilize complimentary medicine,

don't you feel this statement should be re-visited to clarify our

involvement in complimentary medicine? Perhaps, adding a statement

like " knows the difference between alternative medicine and

complimentary medicine approaches and their uses in medical nutrition

therapy? "

How do others feel about this statement? Should it be revised?

Kathy Shattler, M.S.,RD

[Guest guest]

In a message dated 8/10/2007 11:52:34 A.M. Mountain Daylight Time,

kshattler@... writes:

I wondered how others felt about the statement under the following

problem noted in the book above;

Problem; Harmful Beliefs/Attitudes About Food or Nutrition-Related

Topics;Etiology . . . " Desire for a cure for a chronic disease through

the use of alternative therapy "

For those of us who believe in and utilize complimentary medicine,

don't you feel this statement should be re-visited to clarify our

involvement in complimentary medicine? Perhaps, adding a statement

like " knows the difference between alternative medicine and

complimentary medicine approaches and their uses in medical nutrition

therapy? "

How do others feel about this statement? Should it be revised?

Kathy Shattler, M.S.,RD

Yep, I agree it should be adjusted as well.

Jan Patenaude, RD

Director of Medical Nutrition

Signet Diagnostic Corporation

(Mountain Time)

(toll free)

Fax:

DineRight4@...

Mediator Release Testing and LEAP Diet Protocol for Irritable Bowel

Syndrome, Migraine, Fibromyalgia and more, caused by food sensitivity

IMPORTANT - This e-mail message is intended only for the use of the

individual or entity to which it is addressed, and may contain information that

is

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you have received this message in error, you are hereby notified that we do not

consent to any reading, dissemination, distribution or copying of this

e-mail message. If you have received this communication in error, please notify

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E-mail transmission cannot be guaranteed to be secure or error-free as

information could be intercepted, corrupted, lost, destroyed, arrive late,

incomplete, or contain viruses. The sender therefore does not accept liability

for

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result of e-mail transmission.

************************************** Get a sneak peek of the all-new AOL at

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[Guest guest]

Thanks Pam, I'd not noticed the forms! Care to provide more info? I'm still

unclear on the concept.

I'm still having a bit of difficulty in identifying whether this book is

trying to be " complete " or just " something to get us thinking. "

For example:

Impaired Nutrient Utilization, p 140. Why no mention of testing for celiac

disease, food sensitivities, lactose intolerance, fructose malabsorption, etc?

Intake of Unsafe Food (NB-3.1)

Definition mentions " allergens " - but then nothing else later refers to

consumption of allergens or trigger foods, or additives (as in food sensitivity

related to solanine or food dyes, etc.)

Reports intake of potential unsafe foods:

Then, Wild plants, berries, mushrooms.

I consume wild plants, berries and mushrooms frequently. It's sure not an

" intake of unsafe food " - or are you only using the Diagnosis IF there's a

documented health problem, and then LATER learn about consumption of wild foods

that " might " have caused the problem? (Obviously RoundUp Ready GMO Soy foods

heavily doused in herbicide or poisonous mushrooms would fit here then, but no

mention of GMO foods.)

Harmful Beliefs/Attitudes about Food or Nutrition Related Topics (NB-1.2)

Now, THIS one is ripe for discussion.

I'd suggest that this fits 75% of the US population that eats the " standard

American Diet " of processed and fast foods!

But, then, " food faddism " is right there with " Avoidance of foods/food

groups (e.g. sugar, wheat, cooked foods) . . .

HUH??? So, avoiding sugar is a problem??? Avoiding wheat a problem? (Esp

if gluten intolerant, or even undiagnosed gluten intolerance, but client knows

wheat causes GI problems? - Why were those singled out as examples? Why not

add diary or GMO foods while your at it. That would seem to fit the ADA

paradigm of corporate sponsorship over-ruling sound science.)

And, where does Food allergy/sensitivity problems fit in this entire book?

The closest I could come was to use: Food and nutrition related knowledge

deficit (NB1.1)

.. . . related to lack of understanding of delayed food sensitivies and

elimination diet protocols as evidenced by continued consumption of test

reactive

foods and continued symptoms.

Okay, off my rant, but is this supposed to be just a " simple guide " or

" comprehensive guide. " Seems we still write or " own " diagnoses!

TIA.

Jan

PS. I'm truly wanting to consider charting my notes in this direction, and

guiding other LEAP RDs to do likewise, but having a difficult time getting my

brain around this.

In a message dated 8/30/2007 10:34:16 P.M. Mountain Daylight Time,

pcharney@... writes:

There is a procedure to submit suggested changes to the terminology.

If you look in the back of the book there are forms to be submitted.

I've been on the terminology committee for five years now. We look at

each submitted change, send out to expert reviewers, and then look

again. We discuss in small groups and then bring recommendations to

the committee as a whole. It's a very fair process, so feel free to

submit!

At our last meeting we had only two submissions to deal with. I'd

love to be busier than that!

Regards,

Pam

Pam Charney PhD, RD, CNSD

Author and Consultant

Lecturer, Nutrition Sciences

University of Washington

Seattle, WA

Jan Patenaude, RD

Director of Medical Nutrition

Signet Diagnostic Corporation

(Mountain Time)

(toll free)

Fax:

DineRight4@...

Mediator Release Testing and LEAP Diet Protocol for Irritable Bowel

Syndrome, Migraine, Fibromyalgia and more, caused by food sensitivity

IMPORTANT - This e-mail message is intended only for the use of the

individual or entity to which it is addressed, and may contain information that

is

privileged, confidential and exempt from disclosure under applicable law. If

you have received this message in error, you are hereby notified that we do not

consent to any reading, dissemination, distribution or copying of this

e-mail message. If you have received this communication in error, please notify

the sender immediately by e-mail and telephone ( toll free) and

destroy the transmitted information.

E-mail transmission cannot be guaranteed to be secure or error-free as

information could be intercepted, corrupted, lost, destroyed, arrive late,

incomplete, or contain viruses. The sender therefore does not accept liability

for

any errors or omissions in the contents of this message, which arise as a

result of e-mail transmission.

************************************** Get a sneak peek of the all-new AOL at

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[Guest guest]

It needs adjusted!

Dawn, KC

Dineright4@... wrote:

In a message dated 8/10/2007 11:52:34 A.M. Mountain Daylight Time,

kshattler@... writes:

I wondered how others felt about the statement under the following

problem noted in the book above;

Problem; Harmful Beliefs/Attitudes About Food or Nutrition-Related

Topics;Etiology . . . " Desire for a cure for a chronic disease through

the use of alternative therapy "

For those of us who believe in and utilize complimentary medicine,

don't you feel this statement should be re-visited to clarify our

involvement in complimentary medicine? Perhaps, adding a statement

like " knows the difference between alternative medicine and

complimentary medicine approaches and their uses in medical nutrition

therapy? "

How do others feel about this statement? Should it be revised?

Kathy Shattler, M.S.,RD

Yep, I agree it should be adjusted as well.

Jan Patenaude, RD

Director of Medical Nutrition

Signet Diagnostic Corporation

(Mountain Time)

(toll free)

Fax:

DineRight4@...

Mediator Release Testing and LEAP Diet Protocol for Irritable Bowel

Syndrome, Migraine, Fibromyalgia and more, caused by food sensitivity

IMPORTANT - This e-mail message is intended only for the use of the

individual or entity to which it is addressed, and may contain information that

is

privileged, confidential and exempt from disclosure under applicable law. If

you have received this message in error, you are hereby notified that we do not

consent to any reading, dissemination, distribution or copying of this

e-mail message. If you have received this communication in error, please notify

the sender immediately by e-mail and telephone ( toll free) and

destroy the transmitted information.

E-mail transmission cannot be guaranteed to be secure or error-free as

information could be intercepted, corrupted, lost, destroyed, arrive late,

incomplete, or contain viruses. The sender therefore does not accept liability

for

any errors or omissions in the contents of this message, which arise as a

result of e-mail transmission.

************************************** Get a sneak peek of the all-new AOL at

http://discover.aol.com/memed/aolcom30tour

[Guest guest]

Thank you Pam for a well written response. A lot of information to digest,

and I wish there were more hours in the day to address each point, but each

point well taken, and I do see the need for more RDs to be involved/speak out.

(Those that provide MNT and write progress notes.)

(Re: GMO. Do consider reading the text, Genetic Roulette-The Documented

Health Risks of Genetically Engineered Foods -- 40 pages of Scientific

References

with about 25 references per page - about the science behind the dangers of

GMO foods and how often the FDA " dismissed " the negative trials, etc. - I

think the only " Jury " that's still out is the one with blindfolds on, or

corporate money in their pockets. I still have more to read, but based on what I

read so far, I'll be making a concerted effort to avoid GMO foods and will

suggest all my clients do so as well.)

Being an active member of ADA and many DPGs, it's impossible to " do " all the

things that need " doing " - but, I will take this into consideration, and

submit a few comments one of these days.

Looking forward to other RD contributions on the subject. I think the

premise is good, and thanks for the final clarification on " SLC/NCP committee

strongly suggests not editing or changing the

terminology. " If that's the case, then we do need to submit some

suggestions that fit " patients sick cuz they're eating a lot of stuff that's

causing

their illness, and don't yet know it " or something to that effect. It's

specific to allergy/food sensitivity essentially. . .

Jan Patenaude

In a message dated 8/31/2007 9:12:56 A.M. Mountain Daylight Time,

pcharney@... writes:

For impaired nutrient utilization we considered listing medical

diagnoses that might lead to changes in nutrient utilization but

decided that we'd end up missing something, so left the etiologies to

be broad enough to encompass medical conditions. You'll see that

celiac is listed in the defining characteristics (signs and symptoms)

under patient history.

Intake of unsafe foods might need some work. If I remember correctly

(this was 5 years ago), we started off looking at issues related to

bioterrorism and what happens when the food supply goes bad. Then our

expert reviewers found another concept that needed to be covered.

That's one of the problems of terminology development. Everyone wants

a special term to call their very own....but I digress.....a special term

that allergens was put in because we considered that we had to have

something to describe what the RD would do for the patient who

arrives at the hospital having consumed a food or substance that they

were allergic to...the wild berries, etc, was referring to those who

go out mushrooming and have no clue what's safe or not. You are the

exception to that rule. So, you might submit wording to edit that

phrase to identify perhaps toxic berries or mushrooms. At this time

of the morning, I'm not caffeinated enough to come up with a better

thought.

As for GMO foods, herbicides, etc, we did not feel that the dietetics

terminology was the place to address controversial issues. Weather we

like it or not, the jury is still out on exactly what the " harm " is

from these substances, so they are left out. The individual RD could

certainly say that something is " due " to something else ingested but

there has to be a tight cause-effect link.

Again, the concept of " harmful beliefs " is controversial. We decided

to use current science-based nutrition standards. Like it or not,

there's not thought to be " harm " from eating processed and fast foods

unless consumed in excess. Then you have an intake problem. Again, I

think we could edit the defining characteristics some to better

define; we were aimed at those who have adversely impacted their (or

their children's or family's) nutrition quality of life by going over

board with certain beliefs and attitudes. We know those folks are out

there. I've heard of recent cases where infants have been starved to

death b/c the parents believed in certain food patterns and thus

caused harm. Avoiding sugar can be a problem if taken to some of the

extremes I've seen. Folks who won't eat fruit because it has " sugar " .

Avoiding wheat can be a problem for the reasons I expressed above.

I've seen families who are following gluten free diets for autistic

kids who end up with nutrient deficiencies because they aren't

properly monitored. The individual who has celiac disease, or a food

allergy is not an individual with harmful beliefs.

I would argue your comment about ADA and industry and sound science.

Please take a look at ADA's industry sponsorship policies. Please

take a look at the a standard research methods text. Huck's " Reading

Research and Statistics " comes to mind. I use it when teaching

evaluation of research. While there are problems with science, I'd

argue that the scientific method is strong and is the best we have at

this time. Food and nutrition raise some very emotional issues and we

have to stand behind solid science and that's what we've got to this

point. If you have suggestions to change the terms, feel free to

submit them. Keep the committee busy.

The SLC/NCP committee strongly suggests not editing or changing the

terminology as there is no way to manage individual changes, nor to

develop the information we need to demonstrate the worth of the RD.

If you consistently see things that don't fit, submit them. I guess

the tagline should be " If the term don't fit you must submit " .

Regards,

Pam

Pam Charney PhD, RD, CNSD

Author and Consultant

Lecturer, Nutrition Sciences

University of Washington

Seattle, WA

On Aug 30, 2007, at 10:43 PM, _Dineright4@..._

(mailto:Dineright4@...) wrote:

>

>

> Thanks Pam, I'd not noticed the forms! Care to provide more info?

> I'm still

> unclear on the concept.

>

> I'm still having a bit of difficulty in identifying whether this

> book is

> trying to be " complete " or just " something to get us thinking. "

>

> For example:

>

> Impaired Nutrient Utilization, p 140. Why no mention of testing for

> celiac

> disease, food sensitivities, lactose intolerance, fructose

> malabsorption, etc?

>

> Intake of Unsafe Food (NB-3.1)

> Definition mentions " allergens " - but then nothing else later

> refers to

> consumption of allergens or trigger foods, or additives (as in food

> sensitivity

> related to solanine or food dyes, etc.)

> Reports intake of potential unsafe foods:

> Then, Wild plants, berries, mushrooms.

>

> I consume wild plants, berries and mushrooms frequently. It's sure

> not an

> " intake of unsafe food " - or are you only using the Diagnosis IF

> there's a

> documented health problem, and then LATER learn about consumption

> of wild foods

> that " might " have caused the problem? (Obviously RoundUp Ready GMO

> Soy foods

> heavily doused in herbicide or poisonous mushrooms would fit here

> then, but no

> mention of GMO foods.)

>

> Harmful Beliefs/Attitudes about Food or Nutrition Related Topics

> (NB-1.2)

> Now, THIS one is ripe for discussion.

> I'd suggest that this fits 75% of the US population that eats the

> " standard

> American Diet " of processed and fast foods!

> But, then, " food faddism " is right there with " Avoidance of foods/food

> groups (e.g. sugar, wheat, cooked foods) . . .

>

> HUH??? So, avoiding sugar is a problem??? Avoiding wheat a problem?

> (Esp

> if gluten intolerant, or even undiagnosed gluten intolerance, but

> client knows

> wheat causes GI problems? - Why were those singled out as examples?

> Why not

> add diary or GMO foods while your at it. That would seem to fit the

> ADA

> paradigm of corporate sponsorship over-ruling sound science.)

>

> And, where does Food allergy/sensitivity problems fit in this

> entire book?

> The closest I could come was to use: Food and nutrition related

> knowledge

> deficit (NB1.1)

> . . . related to lack of understanding of delayed food sensitivies and

> elimination diet protocols as evidenced by continued consumption of

> test reactive

> foods and continued symptoms.

>

> Okay, off my rant, but is this supposed to be just a " simple guide " or

> " comprehensive guide. " Seems we still write or " own " diagnoses!

>

> TIA.

>

> Jan

> PS. I'm truly wanting to consider charting my notes in this

> direction, and

> guiding other LEAP RDs to do likewise, but having a difficult time

> getting my

> brain around this.

>

> In a message dated 8/30/2007 10:34:16 P.M. Mountain Daylight Time,

> _pcharney@..._ (mailto:pcharney@...) writes:

>

> There is a procedure to submit suggested changes to the terminology.

> If you look in the back of the book there are forms to be submitted.

> I've been on the terminology committee for five years now. We look at

> each submitted change, send out to expert reviewers, and then look

> again. We discuss in small groups and then bring recommendations to

> the committee as a whole. It's a very fair process, so feel free to

> submit!

>

> At our last meeting we had only two submissions to deal with. I'd

> love to be busier than that!

> Regards,

> Pam

>

> Pam Charney PhD, RD, CNSD

> Author and Consultant

> Lecturer, Nutrition Sciences

> University of Washington

> Seattle, WA

>

> Jan Patenaude, RD

> Director of Medical Nutrition

> Signet Diagnostic Corporation

> (Mountain Time)

> (toll free)

> Fax:

> _DineRight4@..._ (mailto:DineRight4@...)

>

> Mediator Release Testing and LEAP Diet Protocol for Irritable Bowel

> Syndrome, Migraine, Fibromyalgia and more, caused by food sensitivity

>

> IMPORTANT - This e-mail message is intended only for the use of the

> individual or entity to which it is addressed, and may contain

> information that is

> privileged, confidential and exempt from disclosure under

> applicable law. If

> you have received this message in error, you are hereby notified

> that we do not

> consent to any reading, dissemination, distribution or copying of this

> e-mail message. If you have received this communication in error,

> please notify

> the sender immediately by e-mail and telephone ( toll

> free) and

> destroy the transmitted information.

>

> E-mail transmission cannot be guaranteed to be secure or error-free as

> information could be intercepted, corrupted, lost, destroyed,

> arrive late,

> incomplete, or contain viruses. The sender therefore does not

> accept liability for

> any errors or omissions in the contents of this message, which

> arise as a

> result of e-mail transmission.

>

> ************ **** **** ************<WBR>*********<WBR>******

> new AOL at

> _http://discover.http://discovehttp://disco_

(http://discover.aol.com/memed/aolcom30tour)

>

>

[Guest guest]

Jan -

It's only a problem if in your professional opinion, the client/patient is

avoiding a food group for an UNNECESSARY reason. In the case of your clients,

there is a NECESSARY reason, so that is not the proper diagnosis to use. And,

remember, if there is no nutritional problem (i.e. you will not be doing an

intervention), then there is no nutritional diagnosis.

In my opinion, avoidance of fast foods would never need to be the etiology of

any nutritional diagnosis. Or avoidance of sugar. Or avoiding anything that is

an allergen or trigger food. However, avoiding entire food groups because of

some off-the-wall diet book tells them that they should never eat that type of

food, or for no scientific reason, that would probably fit the diagnosis - if

that is the nutritional problem for which you need to focus your intervention.

For example, let's say I have a patient who is underweight, they are a known

celiac, and via my interview/review of their food intake, of course they think

they are avoiding wheat/rye/barley, but it turns out they are still consuming

hidden sources, they are still having diarrhea, and maybe they are so afraid to

eat they are not consuming adequate calories. I would probably use Inadeq PO

intake (or inadeq energy intake) r/t limited choices as evidenced by xxxx kcal

from food record.(cause there is not enough food) and Knowledge Deficit r/t

limited education about gluten free diet as evidenced by continued intake

gliadin(because they don't realize about the cross contamination). Because my

intervention will consists of education and providing more food options for them

to increase their intake of appropriate food choices.

There are a lot of diagnosis statements I will never use except maybe as an

etiology or sign/symptom. For example, I don't use Swallowing or Chewing

difficulty as a diagnosis (but I will often use it as the etiology for Inadeq PO

intake if that is one of the reasons for someone not able to meet their needs

via PO). I use the Knowledge Deficit a lot in educational settings (your

example is very appropriate).

Here is what I have been suggesting in my seminars. Think about your

intervention first! We are all professionals so we know WHAT to do in the

situation. If you start with your intervention, and you know that your

intervention should be to change the problem, you can determine your diagnosis.

The vast majority of the time, my interventions are about education,

counseling, or related to nutritient intake. So I use the Diagnostic statements

in those realms.

For example, if you are going to educate, that is solving (or making

improvements) in Knowledge Deficit. If you are going to counsel, that is

working on Limited Adherence. If you are adding supplements, changing

consistency, starting a TF, you might be addressing Inadeq PO intake, Inadeq

energy intake, Inadeq protein-energy intake (I use that one for NPO patients

when recommending/starting TF or TPN), etc.

I'll only use Abnl Labs only when the intervention is about changing

medication (i.e. I've assessed that the blood glucose problem isn't d/t

excessive or inadeq carbohydrate intake or knowledge deficit or limited

adherence, the problem is inappropriate insulin/other diab medication so I want

to MD to change the Rx).

And I rarely use Underweight or Overweight as the diagnosis - to me that is a

sign/symptom of Excessive or Inadeq Intake or activity pattern (cause we are

trying to solve the energy balance issue which will change the weight issue).

But these are my interpretations of the NCP/diagnosis statements. I always

bow to Pam Charney's guidance.

Holly Lee Brewer, MS RD CDE

Pediatric Dietitian, Las Vegas, NV

hlbrewer@...

Dineright4@... wrote:

Harmful Beliefs/Attitudes about Food or Nutrition Related Topics (NB-1.2)

Now, THIS one is ripe for discussion.

I'd suggest that this fits 75% of the US population that eats the " standard

American Diet " of processed and fast foods!

But, then, " food faddism " is right there with " Avoidance of foods/food

groups (e.g. sugar, wheat, cooked foods) . . .

HUH??? So, avoiding sugar is a problem??? Avoiding wheat a problem? (Esp

if gluten intolerant, or even undiagnosed gluten intolerance, but client knows

wheat causes GI problems? - Why were those singled out as examples? Why not

add diary or GMO foods while your at it. That would seem to fit the ADA

paradigm of corporate sponsorship over-ruling sound science.)

And, where does Food allergy/sensitivity problems fit in this entire book?

The closest I could come was to use: Food and nutrition related knowledge

deficit (NB1.1)

.. . . related to lack of understanding of delayed food sensitivies and

elimination diet protocols as evidenced by continued consumption of test

reactive

foods and continued symptoms.

Okay, off my rant, but is this supposed to be just a " simple guide " or

" comprehensive guide. " Seems we still write or " own " diagnoses!

---------------------------------

Choose the right car based on your needs. Check out Yahoo! Autos new Car Finder

tool.

[Guest guest]

For impaired nutrient utilization we considered listing medical

diagnoses that might lead to changes in nutrient utilization but

decided that we'd end up missing something, so left the etiologies to

be broad enough to encompass medical conditions. You'll see that

celiac is listed in the defining characteristics (signs and symptoms)

under patient history.

Intake of unsafe foods might need some work. If I remember correctly

(this was 5 years ago), we started off looking at issues related to

bioterrorism and what happens when the food supply goes bad. Then our

expert reviewers found another concept that needed to be covered.

That's one of the problems of terminology development. Everyone wants

a special term to call their very own....but I digress.....I believe

that allergens was put in because we considered that we had to have

something to describe what the RD would do for the patient who

arrives at the hospital having consumed a food or substance that they

were allergic to...the wild berries, etc, was referring to those who

go out mushrooming and have no clue what's safe or not. You are the

exception to that rule. So, you might submit wording to edit that

phrase to identify perhaps toxic berries or mushrooms. At this time

of the morning, I'm not caffeinated enough to come up with a better

thought.

As for GMO foods, herbicides, etc, we did not feel that the dietetics

terminology was the place to address controversial issues. Weather we

like it or not, the jury is still out on exactly what the " harm " is

from these substances, so they are left out. The individual RD could

certainly say that something is " due " to something else ingested but

there has to be a tight cause-effect link.

Again, the concept of " harmful beliefs " is controversial. We decided

to use current science-based nutrition standards. Like it or not,

there's not thought to be " harm " from eating processed and fast foods

unless consumed in excess. Then you have an intake problem. Again, I

think we could edit the defining characteristics some to better

define; we were aimed at those who have adversely impacted their (or

their children's or family's) nutrition quality of life by going over

board with certain beliefs and attitudes. We know those folks are out

there. I've heard of recent cases where infants have been starved to

death b/c the parents believed in certain food patterns and thus

caused harm. Avoiding sugar can be a problem if taken to some of the

extremes I've seen. Folks who won't eat fruit because it has " sugar " .

Avoiding wheat can be a problem for the reasons I expressed above.

I've seen families who are following gluten free diets for autistic

kids who end up with nutrient deficiencies because they aren't

properly monitored. The individual who has celiac disease, or a food

allergy is not an individual with harmful beliefs.

I would argue your comment about ADA and industry and sound science.

Please take a look at ADA's industry sponsorship policies. Please

take a look at the a standard research methods text. Huck's " Reading

Research and Statistics " comes to mind. I use it when teaching

evaluation of research. While there are problems with science, I'd

argue that the scientific method is strong and is the best we have at

this time. Food and nutrition raise some very emotional issues and we

have to stand behind solid science and that's what we've got to this

point. If you have suggestions to change the terms, feel free to

submit them. Keep the committee busy.

The SLC/NCP committee strongly suggests not editing or changing the

terminology as there is no way to manage individual changes, nor to

develop the information we need to demonstrate the worth of the RD.

If you consistently see things that don't fit, submit them. I guess

the tagline should be " If the term don't fit you must submit " .

Regards,

Pam

Pam Charney PhD, RD, CNSD

Author and Consultant

Lecturer, Nutrition Sciences

University of Washington

Seattle, WA

>

>

> Thanks Pam, I'd not noticed the forms! Care to provide more info?

> I'm still

> unclear on the concept.

>

> I'm still having a bit of difficulty in identifying whether this

> book is

> trying to be " complete " or just " something to get us thinking. "

>

> For example:

>

> Impaired Nutrient Utilization, p 140. Why no mention of testing for

> celiac

> disease, food sensitivities, lactose intolerance, fructose

> malabsorption, etc?

>

> Intake of Unsafe Food (NB-3.1)

> Definition mentions " allergens " - but then nothing else later

> refers to

> consumption of allergens or trigger foods, or additives (as in food

> sensitivity

> related to solanine or food dyes, etc.)

> Reports intake of potential unsafe foods:

> Then, Wild plants, berries, mushrooms.

>

> I consume wild plants, berries and mushrooms frequently. It's sure

> not an

> " intake of unsafe food " - or are you only using the Diagnosis IF

> there's a

> documented health problem, and then LATER learn about consumption

> of wild foods

> that " might " have caused the problem? (Obviously RoundUp Ready GMO

> Soy foods

> heavily doused in herbicide or poisonous mushrooms would fit here

> then, but no

> mention of GMO foods.)

>

> Harmful Beliefs/Attitudes about Food or Nutrition Related Topics

> (NB-1.2)

> Now, THIS one is ripe for discussion.

> I'd suggest that this fits 75% of the US population that eats the

> " standard

> American Diet " of processed and fast foods!

> But, then, " food faddism " is right there with " Avoidance of foods/food

> groups (e.g. sugar, wheat, cooked foods) . . .

>

> HUH??? So, avoiding sugar is a problem??? Avoiding wheat a problem?

> (Esp

> if gluten intolerant, or even undiagnosed gluten intolerance, but

> client knows

> wheat causes GI problems? - Why were those singled out as examples?

> Why not

> add diary or GMO foods while your at it. That would seem to fit the

> ADA

> paradigm of corporate sponsorship over-ruling sound science.)

>

> And, where does Food allergy/sensitivity problems fit in this

> entire book?

> The closest I could come was to use: Food and nutrition related

> knowledge

> deficit (NB1.1)

> . . . related to lack of understanding of delayed food sensitivies and

> elimination diet protocols as evidenced by continued consumption of

> test reactive

> foods and continued symptoms.

>

> Okay, off my rant, but is this supposed to be just a " simple guide " or

> " comprehensive guide. " Seems we still write or " own " diagnoses!

>

> TIA.

>

> Jan

> PS. I'm truly wanting to consider charting my notes in this

> direction, and

> guiding other LEAP RDs to do likewise, but having a difficult time

> getting my

> brain around this.

>

> In a message dated 8/30/2007 10:34:16 P.M. Mountain Daylight Time,

> pcharney@... writes:

>

> There is a procedure to submit suggested changes to the terminology.

> If you look in the back of the book there are forms to be submitted.

> I've been on the terminology committee for five years now. We look at

> each submitted change, send out to expert reviewers, and then look

> again. We discuss in small groups and then bring recommendations to

> the committee as a whole. It's a very fair process, so feel free to

> submit!

>

> At our last meeting we had only two submissions to deal with. I'd

> love to be busier than that!

> Regards,

> Pam

>

> Pam Charney PhD, RD, CNSD

> Author and Consultant

> Lecturer, Nutrition Sciences

> University of Washington

> Seattle, WA

>

> Jan Patenaude, RD

> Director of Medical Nutrition

> Signet Diagnostic Corporation

> (Mountain Time)

> (toll free)

> Fax:

> DineRight4@...

>

> Mediator Release Testing and LEAP Diet Protocol for Irritable Bowel

> Syndrome, Migraine, Fibromyalgia and more, caused by food sensitivity

>

> IMPORTANT - This e-mail message is intended only for the use of the

> individual or entity to which it is addressed, and may contain

> information that is

> privileged, confidential and exempt from disclosure under

> applicable law. If

> you have received this message in error, you are hereby notified

> that we do not

> consent to any reading, dissemination, distribution or copying of this

> e-mail message. If you have received this communication in error,

> please notify

> the sender immediately by e-mail and telephone ( toll

> free) and

> destroy the transmitted information.

>

> E-mail transmission cannot be guaranteed to be secure or error-free as

> information could be intercepted, corrupted, lost, destroyed,

> arrive late,

> incomplete, or contain viruses. The sender therefore does not

> accept liability for

> any errors or omissions in the contents of this message, which

> arise as a

> result of e-mail transmission.

>

> ************************************** Get a sneak peek of the all-

> new AOL at

> http://discover.aol.com/memed/aolcom30tour

>

>

[Guest guest]

For impaired nutrient utilization we considered listing medical

diagnoses that might lead to changes in nutrient utilization but

decided that we'd end up missing something, so left the etiologies to

be broad enough to encompass medical conditions. You'll see that

celiac is listed in the defining characteristics (signs and symptoms)

under patient history.

Intake of unsafe foods might need some work. If I remember correctly

(this was 5 years ago), we started off looking at issues related to

bioterrorism and what happens when the food supply goes bad. Then our

expert reviewers found another concept that needed to be covered.

That's one of the problems of terminology development. Everyone wants

a special term to call their very own....but I digress.....I believe

that allergens was put in because we considered that we had to have

something to describe what the RD would do for the patient who

arrives at the hospital having consumed a food or substance that they

were allergic to...the wild berries, etc, was referring to those who

go out mushrooming and have no clue what's safe or not. You are the

exception to that rule. So, you might submit wording to edit that

phrase to identify perhaps toxic berries or mushrooms. At this time

of the morning, I'm not caffeinated enough to come up with a better

thought.

As for GMO foods, herbicides, etc, we did not feel that the dietetics

terminology was the place to address controversial issues. Weather we

like it or not, the jury is still out on exactly what the " harm " is

from these substances, so they are left out. The individual RD could

certainly say that something is " due " to something else ingested but

there has to be a tight cause-effect link.

Again, the concept of " harmful beliefs " is controversial. We decided

to use current science-based nutrition standards. Like it or not,

there's not thought to be " harm " from eating processed and fast foods

unless consumed in excess. Then you have an intake problem. Again, I

think we could edit the defining characteristics some to better

define; we were aimed at those who have adversely impacted their (or

their children's or family's) nutrition quality of life by going over

board with certain beliefs and attitudes. We know those folks are out

there. I've heard of recent cases where infants have been starved to

death b/c the parents believed in certain food patterns and thus

caused harm. Avoiding sugar can be a problem if taken to some of the

extremes I've seen. Folks who won't eat fruit because it has " sugar " .

Avoiding wheat can be a problem for the reasons I expressed above.

I've seen families who are following gluten free diets for autistic

kids who end up with nutrient deficiencies because they aren't

properly monitored. The individual who has celiac disease, or a food

allergy is not an individual with harmful beliefs.

I would argue your comment about ADA and industry and sound science.

Please take a look at ADA's industry sponsorship policies. Please

take a look at the a standard research methods text. Huck's " Reading

Research and Statistics " comes to mind. I use it when teaching

evaluation of research. While there are problems with science, I'd

argue that the scientific method is strong and is the best we have at

this time. Food and nutrition raise some very emotional issues and we

have to stand behind solid science and that's what we've got to this

point. If you have suggestions to change the terms, feel free to

submit them. Keep the committee busy.

The SLC/NCP committee strongly suggests not editing or changing the

terminology as there is no way to manage individual changes, nor to

develop the information we need to demonstrate the worth of the RD.

If you consistently see things that don't fit, submit them. I guess

the tagline should be " If the term don't fit you must submit " .

Regards,

Pam

Pam Charney PhD, RD, CNSD

Author and Consultant

Lecturer, Nutrition Sciences

University of Washington

Seattle, WA

>

>

> Thanks Pam, I'd not noticed the forms! Care to provide more info?

> I'm still

> unclear on the concept.

>

> I'm still having a bit of difficulty in identifying whether this

> book is

> trying to be " complete " or just " something to get us thinking. "

>

> For example:

>

> Impaired Nutrient Utilization, p 140. Why no mention of testing for

> celiac

> disease, food sensitivities, lactose intolerance, fructose

> malabsorption, etc?

>

> Intake of Unsafe Food (NB-3.1)

> Definition mentions " allergens " - but then nothing else later

> refers to

> consumption of allergens or trigger foods, or additives (as in food

> sensitivity

> related to solanine or food dyes, etc.)

> Reports intake of potential unsafe foods:

> Then, Wild plants, berries, mushrooms.

>

> I consume wild plants, berries and mushrooms frequently. It's sure

> not an

> " intake of unsafe food " - or are you only using the Diagnosis IF

> there's a

> documented health problem, and then LATER learn about consumption

> of wild foods

> that " might " have caused the problem? (Obviously RoundUp Ready GMO

> Soy foods

> heavily doused in herbicide or poisonous mushrooms would fit here

> then, but no

> mention of GMO foods.)

>

> Harmful Beliefs/Attitudes about Food or Nutrition Related Topics

> (NB-1.2)

> Now, THIS one is ripe for discussion.

> I'd suggest that this fits 75% of the US population that eats the

> " standard

> American Diet " of processed and fast foods!

> But, then, " food faddism " is right there with " Avoidance of foods/food

> groups (e.g. sugar, wheat, cooked foods) . . .

>

> HUH??? So, avoiding sugar is a problem??? Avoiding wheat a problem?

> (Esp

> if gluten intolerant, or even undiagnosed gluten intolerance, but

> client knows

> wheat causes GI problems? - Why were those singled out as examples?

> Why not

> add diary or GMO foods while your at it. That would seem to fit the

> ADA

> paradigm of corporate sponsorship over-ruling sound science.)

>

> And, where does Food allergy/sensitivity problems fit in this

> entire book?

> The closest I could come was to use: Food and nutrition related

> knowledge

> deficit (NB1.1)

> . . . related to lack of understanding of delayed food sensitivies and

> elimination diet protocols as evidenced by continued consumption of

> test reactive

> foods and continued symptoms.

>

> Okay, off my rant, but is this supposed to be just a " simple guide " or

> " comprehensive guide. " Seems we still write or " own " diagnoses!

>

> TIA.

>

> Jan

> PS. I'm truly wanting to consider charting my notes in this

> direction, and

> guiding other LEAP RDs to do likewise, but having a difficult time

> getting my

> brain around this.

>

> In a message dated 8/30/2007 10:34:16 P.M. Mountain Daylight Time,

> pcharney@... writes:

>

> There is a procedure to submit suggested changes to the terminology.

> If you look in the back of the book there are forms to be submitted.

> I've been on the terminology committee for five years now. We look at

> each submitted change, send out to expert reviewers, and then look

> again. We discuss in small groups and then bring recommendations to

> the committee as a whole. It's a very fair process, so feel free to

> submit!

>

> At our last meeting we had only two submissions to deal with. I'd

> love to be busier than that!

> Regards,

> Pam

>

> Pam Charney PhD, RD, CNSD

> Author and Consultant

> Lecturer, Nutrition Sciences

> University of Washington

> Seattle, WA

>

> Jan Patenaude, RD

> Director of Medical Nutrition

> Signet Diagnostic Corporation

> (Mountain Time)

> (toll free)

> Fax:

> DineRight4@...

>

> Mediator Release Testing and LEAP Diet Protocol for Irritable Bowel

> Syndrome, Migraine, Fibromyalgia and more, caused by food sensitivity

>

> IMPORTANT - This e-mail message is intended only for the use of the

> individual or entity to which it is addressed, and may contain

> information that is

> privileged, confidential and exempt from disclosure under

> applicable law. If

> you have received this message in error, you are hereby notified

> that we do not

> consent to any reading, dissemination, distribution or copying of this

> e-mail message. If you have received this communication in error,

> please notify

> the sender immediately by e-mail and telephone ( toll

> free) and

> destroy the transmitted information.

>

> E-mail transmission cannot be guaranteed to be secure or error-free as

> information could be intercepted, corrupted, lost, destroyed,

> arrive late,

> incomplete, or contain viruses. The sender therefore does not

> accept liability for

> any errors or omissions in the contents of this message, which

> arise as a

> result of e-mail transmission.

>

> ************************************** Get a sneak peek of the all-

> new AOL at

> http://discover.aol.com/memed/aolcom30tour

>

>

[Guest guest]

For impaired nutrient utilization we considered listing medical

diagnoses that might lead to changes in nutrient utilization but

decided that we'd end up missing something, so left the etiologies to

be broad enough to encompass medical conditions. You'll see that

celiac is listed in the defining characteristics (signs and symptoms)

under patient history.

Intake of unsafe foods might need some work. If I remember correctly

(this was 5 years ago), we started off looking at issues related to

bioterrorism and what happens when the food supply goes bad. Then our

expert reviewers found another concept that needed to be covered.

That's one of the problems of terminology development. Everyone wants

a special term to call their very own....but I digress.....I believe

that allergens was put in because we considered that we had to have

something to describe what the RD would do for the patient who

arrives at the hospital having consumed a food or substance that they

were allergic to...the wild berries, etc, was referring to those who

go out mushrooming and have no clue what's safe or not. You are the

exception to that rule. So, you might submit wording to edit that

phrase to identify perhaps toxic berries or mushrooms. At this time

of the morning, I'm not caffeinated enough to come up with a better

thought.

As for GMO foods, herbicides, etc, we did not feel that the dietetics

terminology was the place to address controversial issues. Weather we

like it or not, the jury is still out on exactly what the " harm " is

from these substances, so they are left out. The individual RD could

certainly say that something is " due " to something else ingested but

there has to be a tight cause-effect link.

Again, the concept of " harmful beliefs " is controversial. We decided

to use current science-based nutrition standards. Like it or not,

there's not thought to be " harm " from eating processed and fast foods

unless consumed in excess. Then you have an intake problem. Again, I

think we could edit the defining characteristics some to better

define; we were aimed at those who have adversely impacted their (or

their children's or family's) nutrition quality of life by going over

board with certain beliefs and attitudes. We know those folks are out

there. I've heard of recent cases where infants have been starved to

death b/c the parents believed in certain food patterns and thus

caused harm. Avoiding sugar can be a problem if taken to some of the

extremes I've seen. Folks who won't eat fruit because it has " sugar " .

Avoiding wheat can be a problem for the reasons I expressed above.

I've seen families who are following gluten free diets for autistic

kids who end up with nutrient deficiencies because they aren't

properly monitored. The individual who has celiac disease, or a food

allergy is not an individual with harmful beliefs.

I would argue your comment about ADA and industry and sound science.

Please take a look at ADA's industry sponsorship policies. Please

take a look at the a standard research methods text. Huck's " Reading

Research and Statistics " comes to mind. I use it when teaching

evaluation of research. While there are problems with science, I'd

argue that the scientific method is strong and is the best we have at

this time. Food and nutrition raise some very emotional issues and we

have to stand behind solid science and that's what we've got to this

point. If you have suggestions to change the terms, feel free to

submit them. Keep the committee busy.

The SLC/NCP committee strongly suggests not editing or changing the

terminology as there is no way to manage individual changes, nor to

develop the information we need to demonstrate the worth of the RD.

If you consistently see things that don't fit, submit them. I guess

the tagline should be " If the term don't fit you must submit " .

Regards,

Pam

Pam Charney PhD, RD, CNSD

Author and Consultant

Lecturer, Nutrition Sciences

University of Washington

Seattle, WA

>

>

> Thanks Pam, I'd not noticed the forms! Care to provide more info?

> I'm still

> unclear on the concept.

>

> I'm still having a bit of difficulty in identifying whether this

> book is

> trying to be " complete " or just " something to get us thinking. "

>

> For example:

>

> Impaired Nutrient Utilization, p 140. Why no mention of testing for

> celiac

> disease, food sensitivities, lactose intolerance, fructose

> malabsorption, etc?

>

> Intake of Unsafe Food (NB-3.1)

> Definition mentions " allergens " - but then nothing else later

> refers to

> consumption of allergens or trigger foods, or additives (as in food

> sensitivity

> related to solanine or food dyes, etc.)

> Reports intake of potential unsafe foods:

> Then, Wild plants, berries, mushrooms.

>

> I consume wild plants, berries and mushrooms frequently. It's sure

> not an

> " intake of unsafe food " - or are you only using the Diagnosis IF

> there's a

> documented health problem, and then LATER learn about consumption

> of wild foods

> that " might " have caused the problem? (Obviously RoundUp Ready GMO

> Soy foods

> heavily doused in herbicide or poisonous mushrooms would fit here

> then, but no

> mention of GMO foods.)

>

> Harmful Beliefs/Attitudes about Food or Nutrition Related Topics

> (NB-1.2)

> Now, THIS one is ripe for discussion.

> I'd suggest that this fits 75% of the US population that eats the

> " standard

> American Diet " of processed and fast foods!

> But, then, " food faddism " is right there with " Avoidance of foods/food

> groups (e.g. sugar, wheat, cooked foods) . . .

>

> HUH??? So, avoiding sugar is a problem??? Avoiding wheat a problem?

> (Esp

> if gluten intolerant, or even undiagnosed gluten intolerance, but

> client knows

> wheat causes GI problems? - Why were those singled out as examples?

> Why not

> add diary or GMO foods while your at it. That would seem to fit the

> ADA

> paradigm of corporate sponsorship over-ruling sound science.)

>

> And, where does Food allergy/sensitivity problems fit in this

> entire book?

> The closest I could come was to use: Food and nutrition related

> knowledge

> deficit (NB1.1)

> . . . related to lack of understanding of delayed food sensitivies and

> elimination diet protocols as evidenced by continued consumption of

> test reactive

> foods and continued symptoms.

>

> Okay, off my rant, but is this supposed to be just a " simple guide " or

> " comprehensive guide. " Seems we still write or " own " diagnoses!

>

> TIA.

>

> Jan

> PS. I'm truly wanting to consider charting my notes in this

> direction, and

> guiding other LEAP RDs to do likewise, but having a difficult time

> getting my

> brain around this.

>

> In a message dated 8/30/2007 10:34:16 P.M. Mountain Daylight Time,

> pcharney@... writes:

>

> There is a procedure to submit suggested changes to the terminology.

> If you look in the back of the book there are forms to be submitted.

> I've been on the terminology committee for five years now. We look at

> each submitted change, send out to expert reviewers, and then look

> again. We discuss in small groups and then bring recommendations to

> the committee as a whole. It's a very fair process, so feel free to

> submit!

>

> At our last meeting we had only two submissions to deal with. I'd

> love to be busier than that!

> Regards,

> Pam

>

> Pam Charney PhD, RD, CNSD

> Author and Consultant

> Lecturer, Nutrition Sciences

> University of Washington

> Seattle, WA

>

> Jan Patenaude, RD

> Director of Medical Nutrition

> Signet Diagnostic Corporation

> (Mountain Time)

> (toll free)

> Fax:

> DineRight4@...

>

> Mediator Release Testing and LEAP Diet Protocol for Irritable Bowel

> Syndrome, Migraine, Fibromyalgia and more, caused by food sensitivity

>

> IMPORTANT - This e-mail message is intended only for the use of the

> individual or entity to which it is addressed, and may contain

> information that is

> privileged, confidential and exempt from disclosure under

> applicable law. If

> you have received this message in error, you are hereby notified

> that we do not

> consent to any reading, dissemination, distribution or copying of this

> e-mail message. If you have received this communication in error,

> please notify

> the sender immediately by e-mail and telephone ( toll

> free) and

> destroy the transmitted information.

>

> E-mail transmission cannot be guaranteed to be secure or error-free as

> information could be intercepted, corrupted, lost, destroyed,

> arrive late,

> incomplete, or contain viruses. The sender therefore does not

> accept liability for

> any errors or omissions in the contents of this message, which

> arise as a

> result of e-mail transmission.

>

> ************************************** Get a sneak peek of the all-

> new AOL at

> http://discover.aol.com/memed/aolcom30tour

>

>

[Guest guest]

Holly, Jan, et al,

Holly gives a great explanation here; very worth reading.

I'd only suggest that we (dietetics in general) must start to think

as diagnosticians. RDs are not taught the traditional diagnostic

process that other healthcare providers learn. To start with a

detailed client history, conduct the physical exam, gather data, and

develop diagnostic hypotheses (the differential) and then to identify

the need for additional information or tests to rule in or rule out a

given diagnosis. It's not as easy as it sounds but we have to learn

these skills. The diagnosis leads to the intervention. You can then

double check to see if all are in line but should first identify the

diagnosis. Holly has exceptional skills so can work this way.

However, I see those who are less skilled being biased toward a given

intervention that they are comfortable with and then simply

identifying a diagnosis to support that incorrect reasoning. Always

start with the assessment and the data there.

I'd also suggest that it is entirely within the scope of dietetics

practice to diagnose overweight/obesity. In fact, we almost have to

step up to the plate on this one. There's an entire body of research

showing that physicians, PAs and NPs do not diagnose obesity. It's

harder for them; think about the average visit, which is around 15-30

minutes. Many patients come to see the MD or whoever for another

reason, which must be addressed first. There's no time to have that

weighty (no pun intended) discussion, so everyone just ignores it.

There are RDs out there who are fully qualified to identify

swallowing and chewing difficulties as they relate to dietetics

practice.

Pam Charney PhD, RD, CNSD

Author and Consultant

Lecturer, Nutrition Sciences

University of Washington

Seattle, WA

> Jan -

> It's only a problem if in your professional opinion, the client/

> patient is avoiding a food group for an UNNECESSARY reason. In the

> case of your clients, there is a NECESSARY reason, so that is not

> the proper diagnosis to use. And, remember, if there is no

> nutritional problem (i.e. you will not be doing an intervention),

> then there is no nutritional diagnosis.

>

> In my opinion, avoidance of fast foods would never need to be the

> etiology of any nutritional diagnosis. Or avoidance of sugar. Or

> avoiding anything that is an allergen or trigger food. However,

> avoiding entire food groups because of some off-the-wall diet book

> tells them that they should never eat that type of food, or for no

> scientific reason, that would probably fit the diagnosis - if that

> is the nutritional problem for which you need to focus your

> intervention.

>

> For example, let's say I have a patient who is underweight, they

> are a known celiac, and via my interview/review of their food

> intake, of course they think they are avoiding wheat/rye/barley,

> but it turns out they are still consuming hidden sources, they are

> still having diarrhea, and maybe they are so afraid to eat they are

> not consuming adequate calories. I would probably use Inadeq PO

> intake (or inadeq energy intake) r/t limited choices as evidenced

> by xxxx kcal from food record.(cause there is not enough food) and

> Knowledge Deficit r/t limited education about gluten free diet as

> evidenced by continued intake gliadin(because they don't realize

> about the cross contamination). Because my intervention will

> consists of education and providing more food options for them to

> increase their intake of appropriate food choices.

>

> There are a lot of diagnosis statements I will never use except

> maybe as an etiology or sign/symptom. For example, I don't use

> Swallowing or Chewing difficulty as a diagnosis (but I will often

> use it as the etiology for Inadeq PO intake if that is one of the

> reasons for someone not able to meet their needs via PO). I use the

> Knowledge Deficit a lot in educational settings (your example is

> very appropriate).

>

> Here is what I have been suggesting in my seminars. Think about

> your intervention first! We are all professionals so we know WHAT

> to do in the situation. If you start with your intervention, and

> you know that your intervention should be to change the problem,

> you can determine your diagnosis.

>

> The vast majority of the time, my interventions are about

> education, counseling, or related to nutritient intake. So I use

> the Diagnostic statements in those realms.

>

> For example, if you are going to educate, that is solving (or

> making improvements) in Knowledge Deficit. If you are going to

> counsel, that is working on Limited Adherence. If you are adding

> supplements, changing consistency, starting a TF, you might be

> addressing Inadeq PO intake, Inadeq energy intake, Inadeq protein-

> energy intake (I use that one for NPO patients when recommending/

> starting TF or TPN), etc.

>

> I'll only use Abnl Labs only when the intervention is about

> changing medication (i.e. I've assessed that the blood glucose

> problem isn't d/t excessive or inadeq carbohydrate intake or

> knowledge deficit or limited adherence, the problem is

> inappropriate insulin/other diab medication so I want to MD to

> change the Rx).

>

> And I rarely use Underweight or Overweight as the diagnosis - to me

> that is a sign/symptom of Excessive or Inadeq Intake or activity

> pattern (cause we are trying to solve the energy balance issue

> which will change the weight issue).

>

> But these are my interpretations of the NCP/diagnosis statements. I

> always bow to Pam Charney's guidance.

>

> Holly Lee Brewer, MS RD CDE

> Pediatric Dietitian, Las Vegas, NV

> hlbrewer@...

>

> Dineright4@... wrote:

>

>

> Harmful Beliefs/Attitudes about Food or Nutrition Related Topics

> (NB-1.2)

> Now, THIS one is ripe for discussion.

> I'd suggest that this fits 75% of the US population that eats the

> " standard

> American Diet " of processed and fast foods!

> But, then, " food faddism " is right there with " Avoidance of foods/food

> groups (e.g. sugar, wheat, cooked foods) . . .

>

> HUH??? So, avoiding sugar is a problem??? Avoiding wheat a problem?

> (Esp

> if gluten intolerant, or even undiagnosed gluten intolerance, but

> client knows

> wheat causes GI problems? - Why were those singled out as examples?

> Why not

> add diary or GMO foods while your at it. That would seem to fit the

> ADA

> paradigm of corporate sponsorship over-ruling sound science.)

>

> And, where does Food allergy/sensitivity problems fit in this

> entire book?

> The closest I could come was to use: Food and nutrition related

> knowledge

> deficit (NB1.1)

> . . . related to lack of understanding of delayed food sensitivies and

> elimination diet protocols as evidenced by continued consumption of

> test reactive

> foods and continued symptoms.

>

> Okay, off my rant, but is this supposed to be just a " simple guide " or

> " comprehensive guide. " Seems we still write or " own " diagnoses!

>

> ---------------------------------

> Choose the right car based on your needs. Check out Yahoo! Autos

> new Car Finder tool.

>

>

[Guest guest]

Pam-

Please don't assume that RDs don't diagnose. Some of us have been RDs for over

20 years and we stay on the cutting edge. Many of us teach medical residents on

a daily basis. The doctors, PSa, ARNPS I work with are very pleased that I

proactively do this on a routine basis. I order labs, take detailed histories,

etc. Please don't sterotype RDs!

Judy Simon MS,RD,CD

Univ Washington Medical Center

> Holly, Jan, et al,

>

> Holly gives a great explanation here; very worth reading.

>

> I'd only suggest that we (dietetics in general) must start to think

> as diagnosticians. RDs are not taught the traditional diagnostic

> process that other healthcare providers learn. To start with a

> detailed client history, conduct the physical exam, gather data, and

> develop diagnostic hypotheses (the differential) and then to identify

> the need for additional information or tests to rule in or rule out a

> given diagnosis. It's not as easy as it sounds but we have to learn

> these skills. The diagnosis leads to the intervention. You can then

> double check to see if all are in line but should first identify the

> diagnosis. Holly has exceptional skills so can work this way.

> However, I see those who are less skilled being biased toward a given

> intervention that they are comfortable with and then simply

> identifying a diagnosis to support that incorrect reasoning. Always

> start with the assessment and the data there.

>

> I'd also suggest that it is entirely within the scope of dietetics

> practice to diagnose overweight/obesity. In fact, we almost have to

> step up to the plate on this one. There's an entire body of research

> showing that physicians, PAs and NPs do not diagnose obesity. It's

> harder for them; think about the average visit, which is around 15-30

> minutes. Many patients come to see the MD or whoever for another

> reason, which must be addressed first. There's no time to have that

> weighty (no pun intended) discussion, so everyone just ignores it.

>

> There are RDs out there who are fully qualified to identify

> swallowing and chewing difficulties as they relate to dietetics

> practice.

>

>

> Pam Charney PhD, RD, CNSD

> Author and Consultant

> Lecturer, Nutrition Sciences

> University of Washington

> Seattle, WA

>

>

>

>

>> Jan -

>> It's only a problem if in your professional opinion, the client/

>> patient is avoiding a food group for an UNNECESSARY reason. In the

>> case of your clients, there is a NECESSARY reason, so that is not

>> the proper diagnosis to use. And, remember, if there is no

>> nutritional problem (i.e. you will not be doing an intervention),

>> then there is no nutritional diagnosis.

>>

>> In my opinion, avoidance of fast foods would never need to be the

>> etiology of any nutritional diagnosis. Or avoidance of sugar. Or

>> avoiding anything that is an allergen or trigger food. However,

>> avoiding entire food groups because of some off-the-wall diet book

>> tells them that they should never eat that type of food, or for no

>> scientific reason, that would probably fit the diagnosis - if that

>> is the nutritional problem for which you need to focus your

>> intervention.

>>

>> For example, let's say I have a patient who is underweight, they

>> are a known celiac, and via my interview/review of their food

>> intake, of course they think they are avoiding wheat/rye/barley,

>> but it turns out they are still consuming hidden sources, they are

>> still having diarrhea, and maybe they are so afraid to eat they are

>> not consuming adequate calories. I would probably use Inadeq PO

>> intake (or inadeq energy intake) r/t limited choices as evidenced

>> by xxxx kcal from food record.(cause there is not enough food) and

>> Knowledge Deficit r/t limited education about gluten free diet as

>> evidenced by continued intake gliadin(because they don't realize

>> about the cross contamination). Because my intervention will

>> consists of education and providing more food options for them to

>> increase their intake of appropriate food choices.

>>

>> There are a lot of diagnosis statements I will never use except

>> maybe as an etiology or sign/symptom. For example, I don't use

>> Swallowing or Chewing difficulty as a diagnosis (but I will often

>> use it as the etiology for Inadeq PO intake if that is one of the

>> reasons for someone not able to meet their needs via PO). I use the

>> Knowledge Deficit a lot in educational settings (your example is

>> very appropriate).

>>

>> Here is what I have been suggesting in my seminars. Think about

>> your intervention first! We are all professionals so we know WHAT

>> to do in the situation. If you start with your intervention, and

>> you know that your intervention should be to change the problem,

>> you can determine your diagnosis.

>>

>> The vast majority of the time, my interventions are about

>> education, counseling, or related to nutritient intake. So I use

>> the Diagnostic statements in those realms.

>>

>> For example, if you are going to educate, that is solving (or

>> making improvements) in Knowledge Deficit. If you are going to

>> counsel, that is working on Limited Adherence. If you are adding

>> supplements, changing consistency, starting a TF, you might be

>> addressing Inadeq PO intake, Inadeq energy intake, Inadeq protein-

>> energy intake (I use that one for NPO patients when recommending/

>> starting TF or TPN), etc.

>>

>> I'll only use Abnl Labs only when the intervention is about

>> changing medication (i.e. I've assessed that the blood glucose

>> problem isn't d/t excessive or inadeq carbohydrate intake or

>> knowledge deficit or limited adherence, the problem is

>> inappropriate insulin/other diab medication so I want to MD to

>> change the Rx).

>>

>> And I rarely use Underweight or Overweight as the diagnosis - to me

>> that is a sign/symptom of Excessive or Inadeq Intake or activity

>> pattern (cause we are trying to solve the energy balance issue

>> which will change the weight issue).

>>

>> But these are my interpretations of the NCP/diagnosis statements. I

>> always bow to Pam Charney's guidance.

>>

>> Holly Lee Brewer, MS RD CDE

>> Pediatric Dietitian, Las Vegas, NV

>> hlbrewer@...

>>

>> Dineright4@... wrote:

>>

>>

>> Harmful Beliefs/Attitudes about Food or Nutrition Related Topics

>> (NB-1.2)

>> Now, THIS one is ripe for discussion.

>> I'd suggest that this fits 75% of the US population that eats the

>> " standard

>> American Diet " of processed and fast foods!

>> But, then, " food faddism " is right there with " Avoidance of foods/food

>> groups (e.g. sugar, wheat, cooked foods) . . .

>>

>> HUH??? So, avoiding sugar is a problem??? Avoiding wheat a problem?

>> (Esp

>> if gluten intolerant, or even undiagnosed gluten intolerance, but

>> client knows

>> wheat causes GI problems? - Why were those singled out as examples?

>> Why not

>> add diary or GMO foods while your at it. That would seem to fit the

>> ADA

>> paradigm of corporate sponsorship over-ruling sound science.)

>>

>> And, where does Food allergy/sensitivity problems fit in this

>> entire book?

>> The closest I could come was to use: Food and nutrition related

>> knowledge

>> deficit (NB1.1)

>> . . . related to lack of understanding of delayed food sensitivies and

>> elimination diet protocols as evidenced by continued consumption of

>> test reactive

>> foods and continued symptoms.

>>

>> Okay, off my rant, but is this supposed to be just a " simple guide " or

>> " comprehensive guide. " Seems we still write or " own " diagnoses!

>>

>> ---------------------------------

>> Choose the right car based on your needs. Check out Yahoo! Autos

>> new Car Finder tool.

>>

>>

[Guest guest]

And, remember, if there is no nutritional problem (i.e. you will not be doing an

intervention) , then there is no nutritional diagnosis.

I thought 1of the points of this process was " justify " why invention wasn't

neccessary. Am I confused?

hl brewer wrote:

Jan -

It's only a problem if in your professional opinion, the client/patient is

avoiding a food group for an UNNECESSARY reason. In the case of your clients,

there is a NECESSARY reason, so that is not the proper diagnosis to use. And,

remember, if there is no nutritional problem (i.e. you will not be doing an

intervention), then there is no nutritional diagnosis.

In my opinion, avoidance of fast foods would never need to be the etiology of

any nutritional diagnosis. Or avoidance of sugar. Or avoiding anything that is

an allergen or trigger food. However, avoiding entire food groups because of

some off-the-wall diet book tells them that they should never eat that type of

food, or for no scientific reason, that would probably fit the diagnosis - if

that is the nutritional problem for which you need to focus your intervention.

For example, let's say I have a patient who is underweight, they are a known

celiac, and via my interview/review of their food intake, of course they think

they are avoiding wheat/rye/barley, but it turns out they are still consuming

hidden sources, they are still having diarrhea, and maybe they are so afraid to

eat they are not consuming adequate calories. I would probably use Inadeq PO

intake (or inadeq energy intake) r/t limited choices as evidenced by xxxx kcal

from food record.(cause there is not enough food) and Knowledge Deficit r/t

limited education about gluten free diet as evidenced by continued intake

gliadin(because they don't realize about the cross contamination). Because my

intervention will consists of education and providing more food options for them

to increase their intake of appropriate food choices.

There are a lot of diagnosis statements I will never use except maybe as an

etiology or sign/symptom. For example, I don't use Swallowing or Chewing

difficulty as a diagnosis (but I will often use it as the etiology for Inadeq PO

intake if that is one of the reasons for someone not able to meet their needs

via PO). I use the Knowledge Deficit a lot in educational settings (your example

is very appropriate).

Here is what I have been suggesting in my seminars. Think about your

intervention first! We are all professionals so we know WHAT to do in the

situation. If you start with your intervention, and you know that your

intervention should be to change the problem, you can determine your diagnosis.

The vast majority of the time, my interventions are about education, counseling,

or related to nutritient intake. So I use the Diagnostic statements in those

realms.

For example, if you are going to educate, that is solving (or making

improvements) in Knowledge Deficit. If you are going to counsel, that is working

on Limited Adherence. If you are adding supplements, changing consistency,

starting a TF, you might be addressing Inadeq PO intake, Inadeq energy intake,

Inadeq protein-energy intake (I use that one for NPO patients when

recommending/starting TF or TPN), etc.

I'll only use Abnl Labs only when the intervention is about changing medication

(i.e. I've assessed that the blood glucose problem isn't d/t excessive or inadeq

carbohydrate intake or knowledge deficit or limited adherence, the problem is

inappropriate insulin/other diab medication so I want to MD to change the Rx).

And I rarely use Underweight or Overweight as the diagnosis - to me that is a

sign/symptom of Excessive or Inadeq Intake or activity pattern (cause we are

trying to solve the energy balance issue which will change the weight issue).

But these are my interpretations of the NCP/diagnosis statements. I always bow

to Pam Charney's guidance.

Holly Lee Brewer, MS RD CDE

Pediatric Dietitian, Las Vegas, NV

hlbrewer@...

Dineright4@... wrote:

Harmful Beliefs/Attitudes about Food or Nutrition Related Topics (NB-1.2)

Now, THIS one is ripe for discussion.

I'd suggest that this fits 75% of the US population that eats the " standard

American Diet " of processed and fast foods!

But, then, " food faddism " is right there with " Avoidance of foods/food

groups (e.g. sugar, wheat, cooked foods) . . .

HUH??? So, avoiding sugar is a problem??? Avoiding wheat a problem? (Esp

if gluten intolerant, or even undiagnosed gluten intolerance, but client knows

wheat causes GI problems? - Why were those singled out as examples? Why not

add diary or GMO foods while your at it. That would seem to fit the ADA

paradigm of corporate sponsorship over-ruling sound science.)

And, where does Food allergy/sensitivity problems fit in this entire book?

The closest I could come was to use: Food and nutrition related knowledge

deficit (NB1.1)

.. . . related to lack of understanding of delayed food sensitivies and

elimination diet protocols as evidenced by continued consumption of test

reactive

foods and continued symptoms.

Okay, off my rant, but is this supposed to be just a " simple guide " or

" comprehensive guide. " Seems we still write or " own " diagnoses!

---------------------------------

Choose the right car based on your needs. Check out Yahoo! Autos new Car Finder

tool.

[Guest guest]

You can certainly provide an assessment that there is nothing nutritionally

wrong with a patient/client if you are not providing any intervention. I use

this in context in a hospital for an example. I might get consulted to take a

look at a child's tubefeeding - in my assessment of the rate, the formula, the

growth history, the stooling, the medications, the medical issues, I determine

that the current feeding order is appropriate. I will not be making any

recommendations for any changes. In this case I will chart that the current TF

is appropriate, pt w/ demonstrated nl growth & nl nutritional status. No current

nutrition dx. I will certainly remain available if there is any significant

change in nutritional status, but I won't be doing any intervention so there is

no nutrition dx.

HLB

Kathy Bingham wrote:

And, remember, if there is no nutritional problem (i.e. you will not be

doing an intervention) , then there is no nutritional diagnosis.

I thought 1of the points of this process was " justify " why invention wasn't

neccessary. Am I confused?

hl brewer wrote:

Jan -

It's only a problem if in your professional opinion, the client/patient is

avoiding a food group for an UNNECESSARY reason. In the case of your clients,

there is a NECESSARY reason, so that is not the proper diagnosis to use. And,

remember, if there is no nutritional problem (i.e. you will not be doing an

intervention), then there is no nutritional diagnosis.

.

---------------------------------

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