Eating Disorders

Attentional Bias Video

Nutrition in Recovery is thrilled to announce our new monthly newsletter! Get the latest information on Nutrition for Addiction and Disordered Eating! Check out our latest video on Attentional Bias!

This video is about Attentional Bias, which is the tendency for one’s perception to be affected by their recurring thoughts at the time. In other words, one’s bias towards noticing what they are already thinking of. How does Attentional Bias related to Disordered Eating? Find out!

Nutrition in Recovery is a group practice of Registered Dietitian Nutritionists and other health professionals who specialize in the treatment of addictions, eating disorders, body image, mental health, as well as general wellness.

We send out a monthly Newsletter summarizing the latest research linking nutrition and mental health. Each newsletter will include a short video with some helpful hints and actions you can implement to improve mental, spiritual, and physical wellbeing for yourself and for your clients. You will be among the first to hear the findings and insights from cutting-edge data, and we are providing references so you can do your own research if interested.

Within the next year you can look forward to the following topics being covered:

Vaping (E-cig)

Bariatric Surgery

Child Nutrition

Circadian Rhythms

Men and Eating Disorders

View last month’s video on Alcoholic Liver Disease

About Nutrition in Recovery 3

 

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Journal Publication: Nutrition Services in Los Angeles Substance Use Disorder Treatment

Rapid Assessment of Nutrition Services in Los Angeles Substance Use Disorder Treatment

One of our research studies “Rapid Assessment of Nutrition Services in Los Angeles Substance Use Disorder Treatment Centers” was recently published in the Journal of Community Health.

We assessed the prevalence of nutrition services in Los Angeles treatment centers and found that is was quite low! The article offers some important ideas about the addiction crisis.

Much thanks to Maria Schellenberger and Dr. Michael Prelip for their assistance with this research.

Link to article: http://link.springer.com/article/10.1007/s10900-018-0557-2
Direct download HERE

Journal Publication: Nutrition Services in Los Angeles Substance Use Disorder Treatment

Abstract

The objective of this study was to determine the prevalence of nutrition services and utilization of registered dietitian nutritionists at substance use disorder treatment centers in Los Angeles. This cross-sectional descriptive study utilized phone interviews with facilities within a 25-mile radius of the Los Angeles metropolitan area using the Substance Abuse and Mental Health Services Administration Treatment Services Locator to identify facilities that included a listing of substance abuse as primary focus of care (n=128). Facilities were asked if they offered any kind of nutrition services, the type of services that were offered, and the credential of the professional providing the services. We compared facilities that offered a residential level of care to those offering outpatient services only. The Fisher’s exact test was used to determine statistical significance. The study showed that only 39 sites (30.5%) offered any type of nutrition services on site, and the odds of a residential level of care offering nutrition services was 2.7 times higher than outpatient only facilities (p=0.02). Of the 39 facilities offering nutrition services, only 8 (20.5%) utilized a registered dietitian nutritionist. Overall fewer than 7% of the facilities utilized the services of a dietitian. Recovery programs for substance use disorder should consider using a registered dietitian nutritionist as a member of the treatment team, which may contribute to better clinical outcomes.

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Addiction Transfer via Nutrition During Pregnancy

Addiction Transfer via Nutrition During Pregnancy 

Ever wondered about the impact of nutrition during pregnancy? This presentation reviews the evidence from animal models.

Preclinical evidence for the addiction potential of highly palatable foods: Current developments related to maternal influence

by David Wiss, Kristen Criscitelli, Mark Gold, Nicole Avena

Abstract:

It is well established that obesity has reached pandemic proportions. Over the last four decades the

prevalence of obesity and morbid obesity have risen substantially in both men and women worldwide.

Although there are many causative factors leading to excessive weight gain including genetics and

sedentary lifestyle, the transformation of the food environment has undoubtedly contributed to the

dangerously high rates of obesity. The current food landscape is inundated with food engineered to

contain artificially high levels of sugar and fat. Overconsumption of these types of food overrides the

homeostatic mechanisms, which under normal circumstances regulate appetite and body mass, leading

to hedonic eating. Evidence from the animal literature has illustrated nutrition-influenced perturbations

that occur within the mesolimbic dopamine pathway, as well as maladaptive behavioral responses that

result from chronic ingestion of highly palatable foods. These neurobehavioral adaptations are similar to

what is observed in drugs of abuse. Recent evidence also supports that maternal exposure to these foods

is capable of provoking neurobehavioral alterations in offspring. Therefore the purpose of this review is

to summarize the current developments on the addictive potential of highly palatable foods, as well as

illuminate the impact of maternal hyperphagia and obesity on the reward-related neurocircuitry and

addiction-like behaviors in the offspring.

Journal Article HERE

Recorded webinar below!

This is a mini-webinar reviewing recent evidence of the impact of highly palatable foods on the neurodevelopment of the offspring, using animal models. The video is 10:19 and is highly recommended for those interested in brain chemistry, hormones, and epigenetics. This is a sensitive topic. Feedback is always welcome!

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From Private Practice to Public Health

David- Tell us more about your background and private practice. Tell us about your current vision, and your decision to get your doctorate.

Five years ago, after completion of my master’s degree in Family and Consumer Sciences and becoming a Registered Dietitian Nutritionist (RDN) I founded a company called Nutrition in Recovery which specializes in treating patients with challenging eating and substance use disorders (SUDs). The group now comprises six RDNs who supervise educational groups at SUD treatment centers throughout Los Angeles. My continuing interest in this patient population led me to develop specialized dietary and educational curriculum for people in early recovery. When possible, I have used evidence-based principles to better manage patients with nutrition-related abnormalities. This has led to three journal publications, two book chapters, two poster exhibits, seven webinars, and over 20 podium presentations. I have also written six articles for the Behavioral Health Nutrition Dietetic Practice Group who recognized my work with the “Excellence in Practice” award presented at the national Food and Nutrition Conference and Expo (FNCE) in October 2017. I have also been a master’s thesis committee member for students enrolled at California State University, Long Beach. What I am particularly proud of is my commitment to research and academics from my private practice setting.

I am finishing my first year as a Ph.D. student in Community Health Sciences at UCLA, hoping to improve the role of nutrition interventions in patients with various SUDs. My overall goal is to reduce the incidence of disordered eating in early recovery and to improve the quality of life for patients with disabling addictive disorders.  SUDs are associated with malnutrition, preference for nutrient-poor food, compromised gastrointestinal health, and disordered eating. Given the current addiction epidemic, consideration should be given to prioritizing efforts to improve eating habits and overall health in recovery programs. Nutrition interventions during recovery may promote abstinence and prevent or minimize the onset of chronic illness including eating disorders (EDs). Currently there is an urgent need for improved treatment modalities for SUDs to prevent overdose and death, reduce healthcare burden, and to improve quality of life. Nutrition protocols in SUD treatment are not widely utilized. My goal is to develop evidence-based guidelines for nutrition interventions for various addictive disorders, which will hopefully lead to better policies and procedures.

Introducing the concept of food and nutrition into an SUD treatment program faces many obstacles. Many patients in early recovery are not ready for multiple health behavior changes, since most are simply trying to get past the immediate crisis of addiction and the associated life adjustments of abstinence. In several of the treatment centers where I work, patients are surprised when they discover that making small nutritional changes (such as drinking water or eating breakfast) can impact energy levels, overall sense of wellness, and optimism about being sober. There are numerous questions that relate to food, SUDs, disordered eating, and recovery that remain unanswered. Can nutrition be used to improve SUD outcomes? What is the best practice for treating co-occurring eating and substance use disorders? How can RDNs help with recovery from mental health disorders? What policy implications can address food addiction on a societal level? What new programs can be developed for underserved populations that struggle with SUD and nutrition-related challenges?

My goal in pursuing a doctorate in public health is to produce data that guides treatment. I am confident that my work in this area will create better evidence to improve funding for nutrition services, creating opportunities for dietitians to work in publicly-funded as well as underserved SUD treatment centers. RDNs desperately need more evidence of effectiveness in order to advance our profession. With new information, it may be possible to change the way we approach SUD treatment, but more importantly to improve the recovery process amidst the current opioid crisis.

About Nutrition in Recovery

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Night Eating Syndrome Video

Nutrition in Recovery is thrilled to announce our new monthly newsletter! Get the latest information on Nutrition for Addiction! Check out our latest video Night Eating Syndrome!

Nutrition in Recovery is a group practice of Registered Dietitian Nutritionists and other health professionals who specialize in the treatment of addictions, eating disorders, body image, mental health, as well as general wellness.

We will be sending out a monthly Newsletter summarizing the latest research linking nutrition and mental health. Each newsletter will include a short video with some helpful hints and actions you can implement to improve mental, spiritual, and physical wellbeing for yourself and for your clients. You will be among the first to hear the findings and insights from cutting-edge data, and we are providing references so you can do your own research if interested.

Within the next year you can look forward to the following topics being covered:

Food Politics

Alcoholic Liver Disease

Attentional Bias

Vaping (E-cig)

Bariatric Surgery

Child Nutrition

Circadian Rhythms

Men and Eating Disorders

View last month’s video on Impulsivity

Nutrition in Recovery

Please SIGN UP HERE so you will not miss out on this revolutionary information!

Do you know someone who might be interested in the link between nutrition and mental health or any of the topics mentioned above? Please forward this to them so they can join us and don’t keep us a secret!

Thank you for all your support as we embark on the journey of improving the health and wellbeing of our clients and their loved ones.

Have thoughts about Night Eating Syndrome? Reach out to us, we would love to hear your thoughts!

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Impulsivity Video

Nutrition in Recovery is thrilled to announce our new monthly newsletter! Get the latest information on Nutrition for Addiction! Check out our seventh of many videos! This video is on impulsivity!

Nutrition in Recovery is a group practice of Registered Dietitian Nutritionists and other health professionals who specialize in the treatment of addictions, eating disorders, body image, mental health, as well as general wellness.

We will be sending out a monthly Newsletter summarizing the latest research linking nutrition and mental health. Each newsletter will include a short video with some helpful hints and actions you can implement to improve mental, spiritual, and physical wellbeing for yourself and for your clients. You will be among the first to hear the findings and insights from cutting-edge data, and we are providing references so you can do your own research if interested.

Within the next year you can look forward to the following topics being covered:

Night Eating Syndrome

Food Politics

Alcoholic Liver Disease

Attentional Bias

Vaping (E-cig)

Bariatric Surgery

Child Nutrition

Circadian Rhythms

Men and Eating Disorders

View last month’s video on Trauma & Disordered Eating

Nutrition in Recovery

Please SIGN UP HERE so you will not miss out on this revolutionary information!

Do you know someone who might be interested in the link between nutrition and mental health or any of the topics mentioned above? Please forward this to them so they can join us and don’t keep us a secret!

Thank you for all your support as we embark on the journey of improving the health and wellbeing of our clients and their loved ones.

Have thoughts about impulsivity? Reach out to us, we would love to hear your thoughts!

Read more

Trauma & Disordered Eating Video

Nutrition in Recovery is thrilled to announce our new monthly newsletter! Get the latest information on Nutrition for Addiction! Check out our sixth of many videos! This video is on trauma & disordered eating!

Nutrition in Recovery is a group practice of Registered Dietitian Nutritionists and other health professionals who specialize in the treatment of addictions, eating disorders, body image, mental health, as well as general wellness.

We will be sending out a monthly Newsletter summarizing the latest research linking nutrition and mental health. Each newsletter will include a short video with some helpful hints and actions you can implement to improve mental, spiritual, and physical wellbeing for yourself and for your clients. You will be among the first to hear the findings and insights from cutting-edge data, and we are providing references so you can do your own research if interested.

Within the next year you can look forward to the following topics being covered:

Impulsivity and Decision Making
Night Eating Syndrome
Food Politics

View last month’s video on ADHD & Disordered Eating

Monthly Newsletter

Please SIGN UP HERE so you will not miss out on this revolutionary information!

Do you know someone who might be interested in the link between nutrition and mental health or any of the topics mentioned above? Please forward this to them so they can join us and don’t keep us a secret!

Thank you for all your support as we embark on the journey of improving the health and wellbeing of our clients and their loved ones.

Have thoughts about trauma & disordered eating? Reach out to us, we would love to hear your thoughts!

Read more

ADHD & Disordered Eating Video

Nutrition in Recovery is thrilled to announce our new monthly newsletter! Get the latest information on Nutrition for Addiction! Check out our fifth of many videos! This video is on ADHD and disordered eating!

Nutrition in Recovery is a group practice of Registered Dietitian Nutritionists and other health professionals who specialize in the treatment of addictions, eating disorders, body image, mental health, as well as general wellness.

We will be sending out a monthly Newsletter summarizing the latest research linking nutrition and mental health. Each newsletter will include a short video with some helpful hints and actions you can implement to improve mental, spiritual, and physical wellbeing for yourself and for your clients. You will be among the first to hear the findings and insights from cutting-edge data, and we are providing references so you can do your own research if interested.

We will only send out one video per month and you can unsubscribe at any time!

Within the next year you can look forward to the following topics being covered:

Trauma and Eating Disorders
Impulsivity and Decision Making
Night Eating Syndrome
Food Politics

View last month’s video on Social Media and Body Image

Monthly Newsletter

Please SIGN UP HERE so you will not miss out on this revolutionary information!

Do you know someone who might be interested in the link between nutrition and mental health or any of the topics mentioned above? Please forward this to them so they can join us and don’t keep us a secret!

Thank you for all your support as we embark on the journey of improving the health and wellbeing of our clients and their loved ones.

Read more

Nutrition for Opioid Overdose

Nutrition for Opioid Overdose

On September 15, 2017 The Academy of Nutrition and Dietetics issued a statement to the CDC regarding Nutrition Interventions and Drug Overdose Response Investigation (DORI) Data Collections. The statement was written by Registered Dietitian Nutritionist David Wiss and essentially advocates the role of nutrition for opioid overdose.

The official statement which is reproduced below can be viewed HERE

Re: Drug Overdose Response Investigation (DORI) Data Collections (Docket No. CDC-2017-0055)

The Academy of Nutrition and Dietetics (the “Academy”) appreciates the opportunity to submit comments to the Centers for Disease Control and Prevention (CDC) in response to the data collection published in the July 17, 2017 Federal Register regarding the Drug Overdose Response Investigation (DORI) Data Collections (Docket No. CDC-2017-0055). The Academy is the world’s largest organization of food and nutrition professionals, with more than 100,000 members comprised of registered dietitian nutritionists (RDNs), nutrition and dietetic technicians, registered (NDTRs), and advanced-degree nutritionists. We are committed to improving the nation’s health through food and nutrition and providing medical nutrition therapy (MNT) and other nutrition counseling services to meet the health needs of all citizens, including those with eating disorders (EDs) or substance use disorders (SUD).

The Academy supports the proposed data collection as necessary for the proper performance of the functions of the agency, particularly given the practical utility resulting from the collections. We respectfully offer recommendations below from Academy member David A. Wiss, MS, RDN, on behalf of our Behavioral Health Nutrition Dietetic Practice Group for potential improvements to the data collections and as support for the claim that nutrition can play a very important role in promoting wellness during the recovery process, thereby helping to reduce relapse and accidental overdose or death.

Eating Patterns and Substance Use Disorders

There are several studies that document substandard eating patterns during drug use, including inadequate intake leading to micronutrient deficiencies [1-6] and malnutrition [7-11]. Abnormal preference for sweetened foods and beverages have been documented in alcoholics [12-14] and other SUDs [15, 16] particularly opioids [17-25]. While micronutrient deficiencies and malnutrition are often corrected by abstinence and recovery, dysfunctional eating patterns such as bingeing and night-eating are often exacerbated during sobriety. Early recovery should be considered a critical time to get nutritional support (e.g. dietary counseling) by a qualified professional such as an RDN.

The overlap between SUDs and EDs has received significant attention in the scientific literature [26-41]. Authors have recently begun to suggest that these disorders be treated concurrently rather than separately. In members’ personal experience working in both fields, patients will oscillate between treatments and are seldom treated concurrently. While it is true that RDNs are a requirement for ED treatment, there is no present requirement for RDNs in SUD treatment settings. Based on members’ experience working with SUD treatment centers, the use of RDNs is rare most likely because nutrition services are not covered by insurance for SUD. We note that the failure to address food and body image issues in SUD treatment is likely contributing to poor outcomes.

It is predictable that individuals entering treatment for SUD will find other substances to abuse, including food [42-45], caffeine [46, 47], and nicotine [46, 47]. While some would argue that it makes sense to allow unlimited access to such substances during early recovery, others believe that the lack of nutrition and health standards are contributing to poor treatment outcomes. Evidence suggests that gastrointestinal health is linked to mental health [48-51] with strong implications for anxiety and depression. Given what is known about the importance of gut health, it seems that improved health and nutrition should be considered a prime intervention for SUD recovery. RDNs in treatment settings are highly qualified to discuss health habits including caffeine and nicotine in the context of nutrition and gastrointestinal health.

Nutrition Education and Interventions During Treatment

Several studies have demonstrated links between nutrition education and positive outcomes in SUD treatment settings [52-57]. Some of the studies have suggested that nutrition education has led to reduced rates of relapse, but higher quality research with greater sample sizes are needed to confirm these findings. Given the opioid epidemic and alarming number of overdose and deaths, however, it seems unwise to wait for more data before using nutrition as an intervention strategy.

Nutrition interventions during recovery may promote abstinence and prevent or minimize the onset of chronic illness, improving resource allocation. A review article from the United Kingdom on the role of healthy eating advice as part of drug treatment in prisons concluded that “substance-misuse is a major factor in recidivism and if this could be reduced through improvement of nutritional status, it could be a cost effective means of helping to tackle this problem” [58]. Given the opioid epidemic, public health measures necessitating nutrition standards in treatment settings should be considered critical. There is a timely need for specialized nutrition expertise in SUD treatment centers, and RDNs are highly qualified for the job.

References

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  16. Hamamoto, D.T. and N.L. Rhodus, Methamphetamine abuse and dentistry. Oral Dis, 2009. 15(1): p. 27-37.
  17. Alves, D., et al., Housing and employment situation, body mass index and dietary habits of heroin addicts in methadone maintenance treatment. Heroin Addict Relat Clin Probl, 2011. 13(1): p. 11-14.
  18. Canan, F., et al., Eating disorders and food addiction in men with heroin use disorder: a controlled study. Eat Weight Disord, 2017.
  19. McDonald, E., Hedonic mechanisms for weight changes in medication assisted treatment for opioid addiction. 2017.
  20. Morabia, A., et al., Diet and opiate addiction: A quantitative assessment of the diet of non-institutionalized opiate addicts. British Journal of Addiction, 1989. 84: p. 173-180.
  21. Neale, J., et al., Eating patterns among heroin users: a qualitative study with implications for nutritional interventions. Addiction, 2012. 107(3): p. 635-41.
  22. Nolan, L.J. and L.M. Scagnelli, Preference for sweet foods and higher body mass index in patients being treated in long-term methadone maintenance. Subst Use Misuse, 2007. 42(10): p. 1555-66.
  23. Richardson, R.A. and K. Wiest, A Preliminary Study Examining Nutritional Risk Factors, Body Mass Index, and Treatment Retention in Opioid-Dependent Patients. J Behav Health Serv Res, 2015. 42(3): p. 401-8.
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  26. Baker, J.H., et al., Eating disorder symptomatology and substance use disorders: prevalence and shared risk in a population based twin sample. Int J Eat Disord, 2010. 43(7): p. 648-58.
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  34. Eichen, D.M., et al., Weight perception, substance use, and disordered eating behaviors: comparing normal weight and overweight high-school students. J Youth Adolesc, 2012. 41(1): p. 1-13.
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  41. Specter, S.E. and D.A. Wiss, Muscle Dysmorphia: Where Body Image Obsession, Compulsive Exercise, Disordered Eating, and Substance Abuse Intersect in Susceptible Males. 2014: p. 439-457.
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  43. Muele, A., T. Hermann, and A. Kubler, Food addiction in overweight and obese adolescents seeking weight-loss treatment. European Eating Disorders Review, 2015. 23: p. 193-198.
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  46. Junghanns, K., et al., The consumption of cigarettes, coffee and sweets in detoxified alcoholics and its association with relapse and a family history of alcoholism. Eur Psychiatry, 2005. 20(5-6): p. 451-5.
  47. Yudko, E. and S.I. McNiece, Relationship between coffee use and depression and anxiety in a population of adult polysubstance abusers. J Addict Med, 2014. 8(6): p. 438-42.
  48. Huang, R., K. Wang, and J. Hu, Effect of Probiotics on Depression: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients, 2016. 8(8).
  49. Rieder, R., et al., Microbes and mental health: A review. Brain Behav Immun, 2017.
  50. Singh, R.K., et al., Influence of diet on the gut microbiome and implications for human health. J Transl Med, 2017. 15(1): p. 73.
  51. Skosnik, P.D. and J.A. Cortes-Briones, Targeting the ecology within: The role of the gut-brain axis and human microbiota in drug addiction. Med Hypotheses, 2016. 93: p. 77-80.
  52. Barbadoro, P., et al., The effects of educational intervention on nutritional behaviour in alcohol-dependent patients. Alcohol and Alcoholism, 2011. 46(1): p. 77-9.
  53. Grant, L.P., B. Haughton, and D.S. Sachan, Nutrition education is positively associated with substance abuse treatment program outcomes. J Am Diet Assoc, 2004. 104(4): p. 604-10.
  54. Curd, P., K. Ohlmann, and H. Bush, Effectiveness of a voluntary nutrition education workshop in a state prison. J Correct Health Care, 2013. 19(2): p. 144-50.
  55. Cowan, J.A. and C.M. Devine, Process evaluation of an environmental and educational nutrition intervention in residential drug-treatment facilities. Public Health Nutr, 2012. 15(7): p. 1159-67.
  56. Cowan, J.A. and C.M. Devine, Diet and Body Composition Outcomes of an Environmental and Educational Intervention among Men in Treatment for Substance Addiction. Journal of Nutrition Education and Behavior, 2013. 45(2): p. 154-158.
  57. Lindsay, A.R., et al., A gender-specific approach to improving substance abuse treatment for women: The Healthy Steps to Freedom program. J Subst Abuse Treat, 2012. 43(1): p. 61-9.
  58. Sandwell, H. and M. Wheatley, Healthy eating advice as part of drug treatment in prisons. Prison Service Journal, 2009.
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FNCE 2017 Reflection

FNCE 2017 Thoughts and Recap

I have attended the Food and Nutrition Conference and Expo for the past several years. Traditionally I have attended as a representative of Dietitians for Professional Integrity, which is an advocacy group we formed back in 2013, to promote responsible and ethical sponsorship within the Academy of Nutrition and Dietetics. In 2016 I wrote a recap which highlights concerns around industry-sponsored continuing professional education (CPE) units for registered dietitian nutritionists (RDNs).  FNCE 2017 was a celebration of 100 years and this theme was certainly central at the event.

I was not planning to attend this year but was alerted that I had won an award, so felt an obligation to show up! My award was for “Excellence in Practice” for Addictions and was presented by the Behavioral Health Nutrition Dietetic Practice Group. The award was presented at a breakfast at 6:30am Monday morning. There was also awards given to an RDN for excellence in practice in eating disorders, mental health, and intellectual and developmental disabilities. We all had a few minutes to give a speech and received little plaques. It’s always great to be recognized for accomplishments.

On Monday I went to a session called “Food Fraud” which was about deception in our food supply. Fake honey, mislabeled seafood etc. The focus was on seafood since there is much fraud happening globally. There is a website with more info. On Monday I spent an hour wondering the expo floor. It has improved from previous years, but of course Monsanto and The Sugar Association were present. It didn’t upset me like it has in the past, and I did not take photos since it is no surprise to anyone that these companies are here. Monday afternoon I attended a talk called “Intolerance vs. Avoidance” which discussed the intersection between food allergies and eating disorders. A certified eating disorder registered dietitian discussed common concerns around food allergies with restrictive patients and those with “orthorexia nervosa” while an MD gave some background on testing for food allergies.

Tuesday I went to talk on “Nutritional Genomics” where the speakers summarized the latest advances in the intersection between genetics and nutrition. They discussed a website called 23 and Me where one can send in a spit sample to get personalized nutrition information. Unfortunately, the recommendations are pretty generic, but I am still curious and will request a kit! The closing keynote was a physicist (Dr. Michio Kaku) who discussed “The Future of the Mind” where he outlined current advances that could revolutionize healthcare. I was most impressed by the contact lens with a screen on it. Digitized healthcare definitely sounds intriguing, but much of what he described seems like a potential disaster for mental and spiritual health. Overall, my experience for FNCE 2017 was different this year. I was not at the event as an undercover journalist. Just another RDN trying to make a difference in people’s lives…

 

FNCE 2017

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