Shireen: In today’s episode, we are thrilled to welcome Dr. Patricia Davidson, a renowned dietician expert to talk about Medical Nutrition Therapy, or MNT, to delve into the profound impact of personalized dietary approaches, dispel fad diets from facts, and utilizing MNT to manage and prevent chronic conditions. Stay tuned. 

Dr. Patricia Davidson is a professor in the nutrition department at West Chester University Pennsylvania and has practiced clinically as a registered dietician and certified diabetes care and education specialist, both in and outpatient. Her research centers on the prevention and management of diabetes and chronic disease using MNT. She has presented and published in these areas. Welcome, Dr. Davidson.

Dr. Davidson: Well, thank you for having me today. I am really excited to be able to discuss the topic of MNT and really what it means cause I think it’s something that’s not truly understood very well. So our Medical Nutrition Therapy, maybe we should let everybody know what MNT stands for.

Shireen: Absolutely. And before we dive into that, Dr. Davidson, just really want to help people understand a little bit about your own background. Could you share with us what inspired you to pursue a career in nutrition and some of the issues you find in diets that are related to chronic diseases.

Dr. Davidson: Absolutely. My pathway was very interesting in that I actually started off, nutrition was not my initial choice. It wasn’t even a career that I had heard of at all. I actually was on the pre-med and pharmacy track. I grew up in a household where medicine or law was the two things we were allowed to choose from. 

I was a competitive runner on a scholarship at, at a university and my coach was providing me with nutritional information and insisting that I would perform better if I were to lose weight. And at that time, I was really barely 90 pounds but I attempted to lose weight and I was hungry all the time. And then I, a friend of mine that was also on the team. We decided that we had to get more calories in somehow, so we learned how to make chocolate chip cookies and things like that on a popcorn popper. And then we realized that probably wasn’t a healthy way to go either.

And so we both decided we want to improve our performance. So I started doing my research on my own and discovered the role of nutrition and what it plays in health and athletic performance. And that’s when I switched to my major and found that it really does make a difference. 

So the saying is I live by this saying when I teach my students as well as when I talk to clients, the saying you are what you eat answers this question very well. The problem is, is we need to understand that basic principle. We could actually, in, reduce the incidence of a number of diet and lifestyle related chronic diseases such as diabetes, cardiovascular disease. But often people don’t even think about things like gastrointestinal diseases and other metabolic or inflammation, diseases or associated diseases.

And oftentimes people ask, well, what is inflammation? So me, to me, the biggest underlying problem with chronic disease is this idea of inflammation in a person’s body. And it’s a response typically to your body’s immune system to bacteria, viruses. But in this case, it, it’s, it’s a reaction to an imbalanced diet and your body is trying to find all the nutrients it needs it, it is not able to do it. And so it can’t make the body feel whole. And so that causes inflammation. 

So a little bit of inflammation is ok because we need that for healing. But ongoing inflammation actually triggers the chronic disease response. And diet components. can actually, there’s certain ones that we really relate to this. And one of these is a thing called high fructose corn syrup or fructose is another one, table sugar is another, but high fructose corn syrup if you look back in time that when we started seeing the exponential growth in our chronic diseases. And this is also including, not just diabetes, but other chronic diseases like Crohn’s and GI inflammations and things like that, that these are the two or three main sugars that we need to focus on.

Another thing is fried foods. But we could see that basically, as we restrict one thing and we increase another, it actually we see increases in these chronic diseases. But fried foods basically have a type of fat that can actually create this inflammation. And so then there’s things that like doughnuts and egg rolls, things like that, things that you don’t think about. And the third thing is that people tend to give carbohydrates a bad reputation. Yes, refined carbohydrates where we’ve taken away the fiber out or we’re not eating whole foods is important. And so basically, we need to get back to being feeling safe and happy about carbohydrates. And so in other words, we need to think of that, we need a well rounded diet. 

Shireen: you know, understandably from your own journey and trying to figure out exactly and just being giving poor advice and sort of working off of there to now making this, you know, your, your your work, you know, can you first and I want folks here to understand exactly what MNT is first. We use that acronym. Can you provide an overview of what MNT or Medical Nutrition Therapy entails and how it differs from just general dietary recommendations that one has provided.

Dr. Davidson: This is actually a hard question to answer completely because we don’t want to separate it completely because Medical Nutrition Therapy actually leads to nutritional recommendations that are based on evidence. So nutrition based treatment that is provided by a registered dietician, that is what medical nutrition therapy, the definition is, it needs to be provided by a registered dietician nutritionist.

It includes a nutrition diagnosis and that’s a unique concept that people don’t often think about. We often think about the medical diagnosis and that we’re treating a disease, are preventing a disease. But actually a nutrition diagnosis could be therapeutic intervention or a counseling service to help management or prevent the chronic disease. 

It’s individualized. It’s based on that nutrition diagnosis. For example, it could be something as simple as a person doesn’t really understand or lacks the knowledge or education about carbohydrates or the importance of certain vitamins. The nutrition diagnosis can also be a behavioral, where it could be a lifestyle change, or it could be that they’re not ready for change, lifestyle changes.

So the important thing is it’s not focusing on the medical diagnosis. It’s focusing on the person and individualizing the care. And it also involves basically getting a thorough assessment of not just a person’s weight and height and all that. It’s actually looking deeply into what influences they’re eating. Then we come up with that nutrition diagnosis and then we come up with the intervention and set small goals and you may have heard of such a thing as called smart goals.

And so we, it’s really a stepwise process where dietary recommendations are a guidelines that we’re expecting the public to synthesize and make sense of. And you may read it one way in one place and read it in another and it just causes confusion. So Medical Nutrition Therapy is more of an evidence-based structured way to help people better understand these recommendations.

Shireen: And so how does medical nutrition therapy play a pivotal role in managing or even preventing chronic conditions?

Dr. Davidson: As I just mentioned, it’s kind of a formalized method to really be able to determine what is the ultimate problem that, or I hate to say problem, but the issue that is contributed to increasing their risk. So that’s why that nutrition assessment is so important. So there’s four quadrants that come into play with medical nutrition therapy: nutrition assessment, which looks at the person’s body composition and anthropometry. It looks at their labs a little bit just we don’t treat labs. We look at to see what labs are important or are influenced. 

And then more importantly, we look at their lifestyle, their social history, their past medical history, their culture, all of the things that are necessary for us to understand who they are. So we can actually come up with that new diagnosis is what’s the appropriate intervention. So in other words, it’s not cookie cutter. 

So there are several chronic diseases that can benefit from this. I think that was part of the question that you asked and I can’t limit it to one because I really think there is a systematic way to provide counseling and advice to tailor to the individual and looking at their family history can tell us a lot of how we need to tailor this.

Remember we are what we eat, and I will say that probably a number of times today, that the counseling advice needs to be based on changing those key things that can decrease their risk for developing a complication from a condition they may already have, but more importantly, make living with a chronic disease easier and not feel so isolated.

Shireen: That’s interesting. And you know, when we’re talking about and I love the approach on MNT is not a one size fits all, it seems like a very customized approach for the individual where they are, where is their motivation to change sort of all of those different things. And that’s certainly one of the things that, you know, we, we focus on at Yumlish, we’ve got dieticians on our staff who work very closely with individuals. 

The challenge becomes, you know, for the most part is really one meeting the person where they are, right? That’s always one part of the equation, and then motivating them or hopefully they bring that motivation to the table, whereby they are, you know, motivated to change modified behaviors as needed. You know, how might the dietary recommendations differ even across the various chronic conditions?

So, on the one hand, diabetes, heart disease, even kidney disease for that matter, these chronic conditions are so different, right? And the dietary needs are somewhat different, especially when we’re talking about kidney disease. How do you work across both motivation, willingness to change and on top of that, the condition itself within the context of MNT.

Dr. Davidson: So I agree with you that they’re different, but I really think that they are the same. The foundation dietary approaches are similar and one of the things that’s important is we only wanna modify the eating pattern for someone depending on where they are in the stage of the condition they have. 

So in the case of kidney disease, they, in the early stages, they may only need to improve the amount of salt they take in. They don’t need to worry as much about or be concerned about the amount of phosphorus or potassium. And so keeping the diet fairly liberal, but focusing on what is the stage, they are at, at that point. Similarly, with diabetes or cardiovascular disease. 

So I always start with the foundation of balancing your plate. And one of the things that’s important is really focusing on getting enough fruits and vegetables. That is the antioxidant or the anti-inflammatory food that we really need to make sure people are receiving. And in general, the average person in America, I should say, is barely consuming a half a cup to a cup of vegetables a day. And they need probably three times that and maybe consuming a couple of fruits. 

So we need to look at the why and then the other is they hear a lot about plant based versus animal and so forth. Well, they all fit and it’s a matter of looking at what foods they like and what they’re, they would, they’d like to try and maybe even just one plant-based protein a week or a day, you know, or three times a week could make a difference or just focusing on the type of protein. Is it lean? Is it a lower fat type not fat free necessarily? 

And really stay focused on what are our goals for of medical nutrition therapy? One is to have an individualized plan that focuses on whatever the key thing we’re trying to control. Is it their blood sugar? Is it their blood pressure? Is it their cholesterol? Is it their body weight? Is it a combination to delay or prevent that chronic disease from progressing or having complications. 

The other is a base the individual’s needs on personal or cultural preferences. We need to take that time to talk to them. And the other part is, is their literacy or their health literacy. Now, health literacy, it’s not a matter of reading and writing. It’s a matter of being able to understand what we’re telling them. And numeracy, I mean, nobody really thinks about how much numbers are involved in a nutrition program. 

And access to healthy foods. That’s one thing that we found out is that, you know, this health disparities can really be where a person lives and their food choices. And working with those food choices, if they only can get to a dollar store or that’s their, that’s the closest place where they can get fruits, vegetables and things like that, then we need to look at what they have there and help them develop a menu. So it’s really the ability to help them make the behavioral changes. 

And then the other is make sure it’s gonna be pleasurable, providing positive messaging and then lastly provide the person with practical tools. We can’t just hand them and say you can’t eat this and you can’t eat that. I’m a strong believer that you can eat this and you can eat that rather than the can’ts. So this way, we can make sure that they are actually receiving all the nutrients, the the big ones, the carbohydrate, protein, and fat and balance. And we can see that they’re getting the micronutrients, which are those vitamins and minerals that are so important to make those bigger nutrients work. So, that’s my philosophy is to stick with the basics and realize that it really is not a big difference. It’s just fine tuning.

Shireen: You know, one of the things that I’m sure you hear this all the time are these weight loss programs that promise, you know, some crazy weight loss in, in, in, you know, in a very short period of time in an unsafely short period of time. But you know, how do you or how does one differentiate fad from facts? Right? So you’ve got weight loss programs, you’ve got all these different fad diets that are coming at you from all different angles on TV, social media, all the way, how does one sit there and differentiate exactly how to navigate fad from facts?

Dr. Davidson: Very good question. This is one I get all the time and that is first you gotta remember that MNT is evidence based. So one of the ways that you can distinguish a fad diet from and craze is where’s the evidence? The second is who is the one presenting this information? And oftentimes as much as I like the medical profession, I do, we often expect them to be able to know everything. And let’s face it, dieticians have gone to school a very long time and they, this is their focus and a doctor has to go to school for a long time, but they have to know a lot about diseases. 

So let’s work together and individualize it and make it comprehensive. So the key thing, fad diets are not individualized. They’re typically temporary, they provide quick fix. So these are key things for a person to look out. And the other biggie is testimonials. January is my least favorite time of the year because of all the quick fixes. A person should check as I said, the background and promote and who’s promoting the program. And what is that quick fix? How fast are you supposed to see the results. 

Shireen: That’s helpful. So I think those are some key sort of indicators. We should keep in mind when looking at some of these things that come our way. How does MNT, Medical Nutrition Therapy really take into account an individual’s various differences, we talked earlier about, you know, motivation to change being one of them. How does MNT take that into account when designing dietary plans for those again, with chronic conditions? 

Dr. Davidson: Again, it’s important for us to remember that that go back to that definition of Medical Nutrition Therapy. It’s a focus on individualized care which begins with that assessment. The assessment usually can take about in the first visit that I have can take anywhere from 20 to 30 minutes. I may not even have an intervention at the end of that consultation. 

It’s not focusing on their weight. We need to include a comprehensive inquiry about a person’s lifestyle, about their past medical history, their family history, social history, food and food dislikes. Where do they live? What are their barriers? And one of the classics that I can remember is people were concerned about this client of mine who was eating nothing but canned vegetables, but he was eating vegetables. And I was thrilled and I complimented him eating the vegetables. Everyone else was focusing on the fact that he’s getting too much sodium. He had diabetes and kidney disease. So I gave him a tip, rinse those vegetables and eat them.

So because he was going to a food bank, this is where he was getting those vegetables. And so we need to really enquire. So that’s how MNT is different and that it really focuses on that person and their barriers, their lack of time and things like that, that, you know, we need to focus on their, their thought process about diet. And I usually take that word out, I take the word diet out completely because it’s time bound.

Shireen: That’s extremely helpful. You know, as medical research really continues to evolve and there’s new research that is coming out at a, you know, quite, quite a fast pace here, jow do you foresee the future of Medical Nutrition Therapy, especially in terms of advancements and broader adoption?

Dr. Davidson: I really like this question that you’re asking because one of the things that I teach and I do myself is I say you really have to keep up with the research cause research in nutrition is one of the hardest because it is changing all the time. And that’s why clients think it’s that we’re changing our mind. But it’s ever evidence based and it’s growing the role of nutrition, prevention and treatment of expanding a number of diseases we need to really consider that it’s actually gonna help us grow. 

Concurrent growth will occur with nutrition therapy and we need to be very strong about it. Scientific evidence-based MNT is important and that nutrition is definitely moved away from being a complementary or adjunct therapy and it’s a central component. So that’s how we keep up with it and it’s important to stick with and keep up with the advanced evidence. And that’s why everyone should read the dietary guidelines and, and really see what they do in regarding the changes.

Shireen: Lovely, what are some common challenges that you see patients face for the most part either internally in their environment, outside, within the environment, within which they play, work, live, community based, what are some of those challenges that you see today?

Dr. Davidson: I would say one of them, the biggest one I see is lack of time. We’re trying to work oftentimes both members of the household are working or it’s a single parent household and just like anything else. you want to achieve, you have to plan for a healthy eating and planning doesn’t mean it has to take a lot of time. But I teach clients how they can actually, maybe on the weekend, plan a menu plan, you know, plan the grocery list, pick a time where it’s convenient for them to shop.

Also they often feel overwhelmed and they don’t know which way to turn because of all the information overload that’s out there. And so many of my clients will try to make too many changes too fast. And so slowing them down, and that’s the benefit of Medical Nutrition Therapy, we can slow them down, we can develop those smart goals, focus on one thing and really take their look off of low weight loss or whatever that is and focus more on just making that change.

Sometimes I, I thank them for coming back for their follow-up appointment because that’s a big change because if they’re not feeling like they’re losing weight, they may not come back. Even if that’s not the focus. Taking on the all or nothing principle is another one. And then diet confusion you’ve already mentioned. But the other thing is, is feeling deprived when everyone else is enjoying the holidays, are enjoying things when they really don’t have to.

It’s not all or nothing. It’s not a quick fix and their culture, they need to be able to be part of their family. They shouldn’t feel like an outsider. The most classic for people with diabetes is somebody who says, oh, well, we have these desserts, but I made you a fruit salad. Well, there’s a way to include your favorite dessert and you don’t have to feel like you have to eat fruit salad because everybody else and, and in reality, you could be getting more sugar than that pumpkin pie or whatever the pie is that you like. 

So if MNT is done correctly, you don’t need to feel deprived. You don’t need to be separated from your family and you don’t need to be told that this is your diet and this everybody else. In other words, person first. They are a person with diabetes. They’re a person with kidney disease. They aren’t the disease and that’s how we need to move forward.

Shireen: A great, great note to end, for the podcast, Dr. Davidson. With that we are toward the end of the episode. How can our listeners connect with you and learn more about your work?

Dr. Davidson: I’m more than happy. I mean, I have, I gave you my, LinkedIn and so forth. That that’s a good way. but I’m more than happy if they want to reach out to me through the email that you have.

Shireen: Lovely. And what we’ll do is we’ll just link up all of your social media and the show notes for this episode, so folks can click on there and you know, connect with you and continue the conversation as needed. With that Dr. Davidson, thank you so very much for your time. It was such an absolute pleasure going through and breaking down MNT. I feel there’s a lot of misconception around MNT. And so this was certainly a useful conversation 

And to our listeners, you know what time it is. Head over to our social media, find this podcast post and tell us how have you tailored your diet to attain better long term health outcomes while still enjoying your meals. Again, head over to our social media, Facebook or Instagram. Find this very podcast post. Comment below to tell us how have you tailored your diet to attain better long term health outcomes while still enjoying your favorite meals. We’ll continue the conversation there and with that, thank you again, Dr. Davidson.

Dr. Davidson: Thank you for having me.

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