Tuesday, February 23, 2010

Co-Creating a History of Dietetics in Canada

From David:

One of the most exciting times for me as an undergraduate was discovering that books (whole books!) about the history of our profession in Canada had been written. In order of publication, these are: The Dietetic Profession in Canada (Margaret Lang and Elizabeth Upton, Eds., 1973), and Canadian Dietitians: Making a Difference (Eleanor Brownridge and Elizabeth Upton, Eds., 1993). Reading these books were important moments for me because they connected me to the enduring stories of the profession that I was joining – how it had grown, the struggles and adversities it had overcome, and how it had strategized for the future. As I finished reading Canadian Dietitians: Making a Difference I thought about the internal and external changes that have affected dietetics over the last 20 years. These include changes in government funding of healthcare in the 1990s and 2000s, the change from the Canadian Dietetic Association to Dietitians of Canada, the creation and growth of the Canadian Foundation for Dietetic Research, and the development of the Vision 2020 plan. I wondered how an updated resource could be made of the history of dietetics in Canada that would encompass and inform about these times.

From Cathy:

I met David at the Beyond Nutritionism Workshop at Ryerson University in June 2009. We discovered our shared interest in the history of dietetics and had a few quick conversations about how one could go about composing such a history. After I returned home, I thought that it would be a fascinating and lifelong project to co-create a history, not just with David, but by inviting others who were interested to contribute. I shared this idea with David, he loved it, and the result is this invitation to join us in a history project. My interests in the history of dietetics are twofold; what practitioners actually did, and how social, political and technologic developments influenced practice; and the evolution of dietetics education. These areas of research differ from, but are complementary to, the focus of existing publications about dietetic history in Canada (those David mentioned and Roseann Nasser’s article on the Saskatchewan Dietetic Association in issue 46 of Practice) that focus on the creation and accomplishments of dietetic associations. Years ago, I invited readers of Practice to send me any documents, books or resources they were planning to throw out so that I could begin to compile an archive of materials to support history projects. To this day boxes and packages of these cast offs arrive at my house that frequently contain treasures. There is now a nice collection of diet manuals from different parts of the country, as well as records of local, provincial, and national initiatives. These are the sorts of things that can be digitized for widespread access in support of historical research.

A constantly updated history of dietetics in Canada would inform and connect students and practitioners to the course that their profession has charted to the present day, and it would provide a new vehicle for the public and researchers from other disciplines to discover more about the history, spirit, and specialized skills of dietitians. We imagine presenting information in different formats such as a website, book or book series, and/or film(s), whatever media would best achieve the goal of connecting people with the emerging history.

We are interested in connecting with any dietitians, currently practicing or retired, from all decades of practice who have an interest in contributing materials or thoughts about the history project, or who have written history papers for course work, presentations to colleagues, or for personal interest.

Other possible contributions to the history include accounts of areas of specialization or super-specialization, resources or tools formerly used in practice, government documents that influenced practice or policy, recollections of practitioners or educators, and narratives of the evolution of practice. Please be in touch with either of us if you are interested in participating in helping to document our story.


David Smith, BASc. - Dietetic Intern
The Ottawa Hospital Dietetic Internship Program
T: (819) 777-0815
E: djmsmith@gmail.com

Catherine Morley, PhD, RD, FDC
West Vancouver, BC
T: (604) 925-1209
E: catherine.morley@gmail.com

Friday, February 19, 2010

Self-Running PowerPoint Presentations – Part 2

This article continues from Part 1 (last issue), a description of how to create and share selfrunning PowerPointTM presentations (SRPP), and outlines how to convert presentations to video.

Conversion (the easiest way to share them on the Internet) is challenging and requires patience (or a friend with computer/video knowledge).

Converting the SRPP to Video and Uploading tothe Internet:
Several computer programs can convert a SRPP into a video file. PPT 2 VideoTM ($50 from http://www.acoolsoft.com/) is designed for this purpose and works well. Fast computer processing is necessary. Download the 30-day free trial to make sure it works on your computer. Another option is to use a screen capture program. As the SRPP plays on your computer, the program converts the visuals and audio into a video file. CamtasiaTM ($300 from www.techsmith.com/camtasia.asp) is more expensive, but the program is quicker and more versatile (e.g., you can do a lot more than capture PowerPointTM presentations). A 15-minute presentation takes 15 minutes to record with a screen capture program; the same presentation would take about 2 hours with PPT 2 VideoTM. One of the challenges is deciding what codex to convert to (a topic beyond the scope of this article) and the resolution (i.e., the number of pixels in the width and height). High definition (1280 x 720 pixels) creates a sharper image but is difficult for anyone with a slow Internet connection to view.

There are several websites to which you can upload videos without charge (e.g., YouTubeTM and blip.TVTM). These are great choices if you want to reach a large audience as people search these websites. Many companies also offer video hosting services but the fees can be high. The videos can also be embedded into a website.

Video Editing Software for Creativity:
The SRPP video can be edited with a video editing software program. This works well for combining the SRPP with another video, and works better than trying to insert a video into a PowerPointTM presentation. The other video could be something recorded with a video camera or captured from a computer screen. For example, I incorporated videos demonstrating product use into an SRPP about specialty food products. My favourite video editing software program is Vegas Movie Studio 9TM ($90 US from http://www.sonycreativesoftware.com/).

Converting an SRPP to video, editing, and uploading to the Internet is not a simple task. However, the effort and patience to develop the knowledge and skills to make this happen can by worthwhile. In addition to the professional possibilities, creating personal home videos is a fun and fulfilling hobby.


Wendy Busse, RD, MSc
Red Deer, AB
T: (403) 986-5267
E: wendybusse@foodallergynews.com

Tuesday, February 16, 2010

Chinese Delegates’ Visit to Toronto

From July 27 to 29, 2009, a group of senior physician delegates from China attended a special three-day visit to Toronto and Ottawa hosted by the Canadian Diabetes Association. We, the Diabetes Education care team, were honoured to be able to participate in hosting the Chinese delegates’ visit to our Diabetes Education Centre DEC) at the Toronto General Hospital (TGH).

The Canadian Diabetes Association (CDA) indicated that an objective of the Chinese delegates’ visit was for the DEC to share and exchange knowledge in the area of diabetes education services including nutrition therapy and lifestyle management perspectives in diabetes management. Diabetes is a growing health concern in China. According to data from the International Diabetes Federation’s 2007 Diabetes World Atlas, 40 million Mainland Chinese are living with diabetes leading to many challenges for Chinese healthcare professionals. The high population of Chinese with Type 2 diabetes may well be linked to China’s growing and prospering economy leading to major dietary and lifestyle changes.

It was our great desire to have an open line of communication between the Chinese delegates and Canadian healthcare professionals. With limited knowledge of the Chinese health care system, clinic and hospital environments, and the distinct provincial backgrounds of the Chinese delegates, the diabetes care team found this visit extremely interesting and insightful.

On the second day of the visit, the 13 delegates arrived at the TGH DEC. They were warmly welcomed by Dr. Rene Wong, Director of Diabetes Care and Education; Marianne Sigmond, Endocrine Program Manager; Ana Offenheim, Patient Care Coordinator; and me (LL), Clinical Dietitian.

Due to time constraints, the delegates had only an hour long visit to the Centre. In a half-hour presentation, the Centre personnel shared information on the diabetes program (program structure, content and focus), and a nutrition management session. Ms. Offenheim presented in English that was translated into Mandarin. I then presented in Mandarin on nutrition management. This created a warm environment close to the delegates’ background so that they could freely express their views, and led to strong, constructive interactions with our foreign guests. Thus, we learned about that multilingual resources and skills are very beneficial in this growing global community.

The delegates responded with great enthusiasm and appreciation that we shared our knowledge and counsel for a successful and effective Diabetes Education program. The delegates applauded our efforts and commitment in creating a solid and well structured program, and commended such a wide availability of services. Our multiprofessional approach toward diabetes management was of great interest to the Chinese delegates as China moves in a new direction toward a widely available and well-constructed diabetes education program.

One major challenge that the Chinese delegates expressed was that the Chinese healthcare system has a high patient consultation to doctor ratio. Massive patient volumes can make it difficult for physicians to include education in patient care.

Acknowledging nutrition management and the Chinese nutritionists’ role as key components in diabetes management, the Chinese delegates were open to new ideas that could successfully lead to positive dietary changes. In recent years, China started to provide professional nutritionist training programs to meet the nation’s growing needs in nutritional management. China and Canada would benefit from sharing nutrition practices and knowledge; such a relationship would help expand professionalism in nutritional care across the two nations.

The Chinese delegates showed great interest in advancing their diabetes education resources, especially after reviewing the array of our educational resources. One of their goals was to enhance quality educational materials to meet the learning needs of the Chinese with diabetes.

Although the Chinese delegates’ visit to the DEC was brief, it proved to be a successful and rewarding experience for both parties. The Chinese delegations’ appreciation of the visit was well demonstrated in their smiles and the warm expressions on their faces. They wished to learn more about diabetes education and practices in Canada. Before their departure, many of the delegates took pictures with the hosts to bring home the memorable moments of this visit. It was evident that the objective of the Chinese delegates’ visit was fulfilled, and that the visit provided them with knowledge, a Canadian perspective, and insights in advancing diabetes education programs. The DEC care team welcomes and embraces future opportunities to share our knowledge, experience and counsel with China as well as other nations, and looks forward to continuing international collaboration in the growing global community.

Louisa Li, RD, CDE
University Health Network
Toronto Western Hospital
Toronto, ON
T: (416) 603-5800 (5968)
E: Louisa.Li@uhn.on.ca

Saturday, February 6, 2010

Supplemental alpha-tocopherol: A Perspective on Approaching an Evidence-based Project

As part of a Continuing Professional Development project with ARAMARK Canada Ltd. at the Toronto Rehabilitation Institute (Toronto Rehab), I reviewed the literature on supplemental α-tocopherol. My objectives were to weigh the potential risks versus benefits of supplemental α-tocopherol in primary and secondary prevention of cardiovascular disease (CVD) to determine specific practice considerations for supplemental α-tocopherol including the type of supplement, dose and duration. This was an opportunity for me to hone my skills using evidence-based methods. As expected, a plethora of literature on this topic existed, so I focused on randomized controlled trials (RCTs).

Reading, critiquing, and comparing the many papers that exist on the topic was time consuming, but necessary. Some studies looked at α-tocopherol alone, while others looked at α-tocopherol in combination with other antioxidant supplements. Studies were inconsistent in terms of dose, unit of measure (mg versus IU) and source (natural versus synthetic). I discovered there are specific conversion factors to use depending on the unit of measure, as well as the source (natural or synthetic). Taking the Dietary Reference Intake (DRI) course in the past proved helpful as I was able to easily retrieve required information on α-tocopherol.

Working on such a large project really put my organizational abilities to the test. Initially feeling overwhelmed, I decided to arrange the stack of papers. Primary prevention papers were filed in one binder and secondary prevention in another. Within the secondary prevention group, where I devoted most of my time, I compartmentalized further. For example, the outcomes of short term trials (under five years) were examined separately from studies longer than five years. Within these groups, I looked at the dose and type of supplement (natural versus synthetic) and made the necessary conversions.

I highly recommend reading Deborah (Boyko) Wildish’s chapter on micronutrient supplementation (Wildish, 2008), a resource that helped me immensely in my critique.

Factors considered for each article:

  • Population being studied
  • Type of chronic disease(s) or conditions the participants experienced
  • Form of supplemental E
  • Dose and timing (i.e., when was it administered)
  • Study duration
  • Inclusion of other antioxidants e.g., vitamin C, β-carotene
  • Outcome measures

The checklist (p. 190) details factors impacting the strength of study design and quality of evidence.

Keeping to a schedule was paramount for completing such a large project. When I was away from the task for an extended period, I found I wasted valuable time simply reviewing what I had done. The next time I take on such a project, I plan to consistently devote a few hours each week to keep the project alive and the momentum flowing.

I highly encourage involving members of the interprofessional team. I liaised with our program physician, pharmacist and other RDs on issues related to α-tocopherol. Our staff librarian was most helpful in assisting me with the literature search and in obtaining journal articles. This was a huge time saver!

Project Conclusions

For Primary Prevention: No benefits or risks reported with 20-660 IU/d for three to 10 years. Thus, not enough evidence to support recommending supplemental α-tocopherol for primary prevention of CVD.

Secondary Prevention: Equivalent evidence reporting both risk and benefit associated with 22.5 to 800 IU/d for 1.4 to 9.4 years, and increased risk of mortality observed with α-tocopherol supplementation >150 IU/day. It was questionable whether lower doses offered any benefit. More research is required. Therefore, supplementation with vitamin E is NOT recommended for secondary prevention of CVD.

The experience of completing this project left me with several salient points of learning. Firstly, studies generally are not designed to measure treatment risk because inflicting potential harm on humans is unethical. Thus, whenever risk emerges in a study, even if small, it may be more serious than reported because the researchers focused on treatment benefits. Secondly, I learned that you must have a keen interest in your topic to sustain your interest. Finally, there must be practical application of your findings to your daily practice with clients and colleagues. Sharing the results of project work communicates our expertise to colleagues. Not only is this self-empowering, but it helps raise the profile of RDs, and fosters interprofessional relationships.


Wildish DE. (2008). Addressing clinical queries for micronutrient supplementation in the management of diseases and medical conditions: What can I tell my patient? In: Yoshida T, Ed. Micronutrients and Health Research. Publishers, Inc.: 181-205.

Other references available upon request.

Maria Ricupero, RD, CDE
ARAMARK at Toronto Rehab
T: (416) 597-3422 (5239)
E: ricupero.maria@torontorehab.on.ca

Monday, February 1, 2010

Thyroid Cancer, Radioactive Iodine Therapy,and the Low Iodine Diet

Although rare at only 2.6% of all cancers, thyroid cancer incidence is the most rapidly increasing cancer in Canada. Thyroid cancer includes four different types of cancers and predominantly affects young women. It is the most prevalent cancer in Canadian women age 15 - 29 and in adults age 20–39, and is the second most prevalent cancer in adults age 40-49. Thyroid cancer patients have the highest survival rate of all cancers, yet have a high recurrence rate (up to 30%).

In December 2007, I underwent a total thyroidectomy for thyroid cancer. The Canadian Thyroid Cancer Support Group (Thry’vors) Inc. provided critical information and much-needed support to me during this difficult time. The main impetus for writing this article is to raise awareness and invite discussion betw een Thry’vors and Registered Dietitians (RDs) on the merits of the Thry’vors Low Iodine Diet (LID)as preparation for radioactive iodine therapy, also known as I-131 remnant ablation (RAI).

Thyroid cancer is typically treated with either a partial or complete thyroidectomy (surgical removal of part or all of the thyroid gland respectively) and often followed by RAI. RAI has been used since 1946, and since the mid-1960s studies have been conducted to investigate the efficacy of the LID in preparation for RAI. These studies have generally concluded that using the LID before, during and just after RAI improves the effectiveness of the treatment.

Patients looking on the Internet for advice are faced with many versions of the LID and a variety of conclusions regarding the ideal duration of the diet, which may be different from what their own doctor is telling them. The Thry’vors LID is a key component of care for thyroid cancer patients when being treated with RAI. It was prepared with the help of more than 50 experts from nutrition and medicine, food manufacturing and labelling, and others.

The LID is a safe, short-term diet (roughly one to two weeks prior to, and a couple of days following RAI) used only in preparation for nuclear medicine thyroid treatment or scan. The main foods to be avoided are iodized salt and any foods prepared with iodized salt, fish and seafood, dairy products, egg yolk, cured meats, soybean products, all restaurant food and all foods or products containing red dye #3. Iodine-free calcium supplementation is an option as the LID is deficient in calcium.

The LID works by emptying the body of its natural iodine stores. When RAI is administered, it puts radioactive iodine into the body. Because thyroid cells require iodine to produce hormones, they pick up the radioactive iodine. This has two outcomes: the radioactive iodine makes any residual thyroid cells visible on the scan, and destroys any remaining thyroid tissue, benign or malignant. The RAI therapy or scan can be compromised if even a relatively minute amount of natural iodine is present in the body. Any natural iodine that may be present will compete with radioactive iodine for entry into the thyroid cells, and may block uptake and limit the effectiveness of the RAI.

In spite of its short-term use, maintaining a LID can be difficult. As patients prepare to undergo RAI, they may experience the following challenges: Patients may:

  1. be simultaneously discontinuing their thyroid replacement medication, therefore they experience the negative effects of being in an induced hypothyroid state (“going hypo”).
  2. feel frightened about the upcoming treatment and anxious about the required isolation for several days post-therapy. Patients must take certain precautions to minimize the risk of radiation exposure to others, depending on the amount of RAI administered.
  3. lack confidence to follow the diet as it requires label reading and meal preparation ‘from scratch’ and they may feel they do not have the necessary food skills.
  4. still be coping with the shock of their cancer diagnosis and recovery from surgery.

Thry’vors is reaching out to health professionals across the country to help advocate for the use of the evidenceinformed and patient-friendly Thry’vors LID to be used in preparation for the administration of RAI to thyroid cancer patients. RDs are well-positioned to describe to physicians the evidence supporting the use of the LID, and the key role of the dietitian in explaining the diet to patients. RDs can help people maintain the diet by counselling on preparing food ahead of time, reading labels, and using appropriate foods from their respective cultural food practices. Iodinefree recipes are available on the Thry’vors website (www.thryvors.org/) and from low-iodine cookbooks.

Thry’vors can provide copies of the 2009 Thry’vors Low Iodine Diet, Menu Planner, and Shopping List. To request copies of the LID material, to obtain a list of references used to write this article and for further information, questions or comment, please contact Thry’vors through the website or by emailing me.

REFERENCES - Available upon request.

Charna Gord, RD
Community Nutritionist
Toronto, ON
E: cgord@sympatico.ca