Day 1: I made it Philly! On the way, I was reminded on the way how easy it is to travel without any little people - took a coffee on the plane without spilling it on my white tennis shoes, listened uninterrupted to Malcolm Gladwell's Talking to Strangers audiobook for the ENTIRE flight, and didn't have to frantically check my bags to make sure I got everything before getting off the plane. Don't worry though, I will miss my people - ask me tomorrow :)
Once I made it and got checked into my hotel, I headed over to FNCE for the opening session. During the session, we got an update from Academy president, Terri Raymond, and then heard from Dr. Marty Makary. Dr. Makary is a surgical oncologist and professor of healthy policy and management at Johns Hopkins, and he is the author of New York Times Best Seller Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Healthcare and has recently published his third book, The Price We Pay: What Broke American Healthcare - And How to Fix It.
He spoke on the future of healthcare - specifically addressing what our healthcare system will look like in 10 years - outside the political lines that the country has drawn. Spoiler alert: no one knows for sure but what we're doing now definitely isn't sustainable. He advocated for a team approach - doctors, nurses, dietitians, therapists of all kinds, and navigators working together for the best outcomes - and viewing the patient as a whole person rather than a product of their symptoms.
He identified two major issues going on in our current system:
Appropriateness of medical care
Are we giving the right care to the right patients at the right time? Are we over-prescribing, too quick to put people under the knife, and using the right data? He gave examples of this with the blood testing we use to indicate risk factors for early heart attacks (aka not looking at the right things), tooth decay or cavity filling in children (and adults) that can be avoided in some instances by using silver diamine fluoride, and the unnecessary surgical intervention for every case of appendicitis.
"Not having a randomized trial for something doesn't make it untrue, it makes it unknown."
He also talked about a study he did in which he polled physicians on the percentage of medical care (outside their own practice) they believed was likely unnecessary. The average reported answer was 21%. And what factors did they report were driving this? The consumerist culture created in which patients are demanding prescriptions, interventions, and care when they aren't necessary, fear of being sued for malpractice, and the current fee-for-service model that is so complicated health system employees can not even untangle it, meaning billing abuse has skyrocketed.
Pricing Crisis
60% of medical care is shoppable - let that sink in. We never get upfront pricing when you go into a doctor's visit or for a procedure - no one says "this is how much it's going to cost." - but they should, and places are now beginning to do that - posting their pricing on their website so you can compare and so that there is accountability for the widespread price gauging that occurs in hospitals and from healthcare providers all over the nation and leads to deep mistrust from patients and healthcare consumers.
So how does all this mess translate over to you? And what did I take away from this?
The future measure of health will likely be inflammatory state.
My biggest takeaway here is that the future of healthcare starts with nutrition and prevention. It is more important than ever for people to understand that inflammatory state is directly tied to the foods we eat (among other factors - see here). We must know, teach and practice good nutrition so that we can prevent many of these chronic, debilitating diseases. This carries over into every aspect - quality of life, performance, education, etc. It also strengthens my belief that nutrition should be a core line of care for a sick person and that the urgency to make sure our kids eat well is larger than ever. I've practiced anti-inflammatory nutrition for several years now - seeing patients with inflammation-related issues ranging from acne to food sensitivities, allergies, and intolerances to PCOS to gastrointestinal issues and just general discomfort.
One of the great blessings of being in the nutrition field is the ability to operate with transparency in pricing - working in a stand-alone business allows for the flexibility to see and know patients personally and be able to work with them to find a service that fits both their needs and their budget. I believe good nutrition education shouldn't be expensive.
Finally, I think a huge takeaway is we have to start providing nutrition education to all kids in school - how I wish I had been taught good nutrition from childhood on. And if the future of healthcare relies on disease prevention through good nutrition and wellness practices, then why is there not a dietitian in every school advocating for kids through the food service companies, educating them from the earliest age on how to eat for good health, and educating parents on how to encourage kids to eat well? Some schools are doing this already - on the forefront of giving a gift of good health to the students and families that receive this education. As parents, we invest so much in our kids education, in assuring they perform their best on the field, in the classroom, and in life and yet we're still missing the crucial component that is good food and nutrition and the fact that it contributes to all of this: performing well, making good decisions, and protecting your overall health.
Day 1 was great and I was thrilled to hear from Dr. Makary and reinvigorated by all that nutrition has to offer. I'm excited for a packed day 2 - stay tuned as I take in sleep, brain-gut gastrointestinal connection, brand-building in the nutrition world, and the relationship between eating and body-image.
Day 2:
Whew - a good night's sleep in a crisp hotel bed was AMAZING. I woke up refreshed and ready to learn all the things. On my agenda for Day 2: sleep, brain-gut GI disorders, brand building, and eating + body image. I don't know who really cares but I'm going to just give you a play-by-play of the day as well as a quick little review of each session (I'm talking like 3 sentences) because I'm just gonna write this the way I would want to read it - #powerhungry.
It was pouring in Philly so I postponed my original plan of doing a morning walk (like for exercise) around the city and instead opted for a slow morning drinking coffee and getting ready and reading. I've been in intermittent fasting mode most days (other than once or twice on the weekend or if I have breakfast plans) so I skipped breakfast and took my coffee and headed over to the convention center for the first session of the day.
Session 1 - Best of the Rest: Improving Health Through Better Sleep
This session was taught by Dr. Michael Grandner, an expert in sleep medicine and director of the Sleep and Health Research Program at The University of Arizona. He gave a good overview of sleep in general - the patterns and stages, how it's measured, things that can go wrong, etc. and then spent some time discussing circadian rhythms and the connection with our hormones. He talked about melatonin and caffeine, things you can do to get better sleep, and finally, the impact the foods we eat have on our sleep.
Some of my favorite life-relevant takeaways:
Sleep (unlike healthy eating and exercise) fits in with both health and productivity, making it appealing to a wider range of people - some people don't care about health but do care about working harder, smarter, better and sleep fits into that narrative as well as the health-focused narrative sleep has traditionally been known for.
As it relates to students -
You need sleep to integrate information into your brain so pulling an overnighter the night before a test is counterproductive - if you're going to pull an overnighter do it two days before the test then get plenty of sleep afterward.
Caffeine - does not help rescue the negative impact on decision making due to lack of sleep - it just leads to bad decisions made quicker.
The endocrine system & hormones contribute to your circadian rhythms - this is why getting what you need, when you need it nutritionally is so important. Unbalanced hormones lead to sleep disturbances.
Session 2 - Rome Foundation Criteria for Brain-Gut Gastrointestinal Disorders
The first half of this session was dedicated to looking at the scientific research being done that looks at the brain-gut axis and what happens to cause the inflammation that tells you your intestines aren't happy. The second half looked at the FODMAP diet and how it can be used to treat people with the full range of GI disorders.
Some interesting takeaways:
There are 53 brain-gut/functional GI disorders (IBS being the most commonly known) and the Rome criteria used to treat individuals these disorders takes into account the complexity of the system - what part of the pathway is impaired and how does that relate to the gut - to make treatment recommendations.
The FODMAP diet is generally recommended based on high-quality data attesting to the efficacy of the treatment for disorders but is not meant to be wholly restrictive long-term.
The FODMAP foods behave the same in all of us but it is the hypersensitivity in patients with digestive issues experience that cause the symptoms of the GI disorders.
Different types of fiber are used for certain GI issues, FODMAP groups and the relationships to food allergies and proteins as well as non-immune reactions with sensitivities and intolerances, and intake of fat as it affects motility and sensitivity.
I took a lunch break at this point and walked the Reading Terminal Market, grabbing a smoothie and a traditional Philly Cheesesteak (delicious!). Then I headed back for my two afternoon sessions.
Session 3 - Career Essential: Create and Build Your Personal Brand
With the changes happening in the nutrition field and the opportunities to do your own thing in this profession (hello, self), I figured this would be a good session for me, personally. I honestly didn't hear much I wasn't familiar with BUT it was a great reminder to be authentic and that you don't have to do what someone else is doing - showing up everyday, being consistent, and being authentic will be key to creating your personal brand.
Session 4 - Yours, Mine, and Ours: A Conversation about Body Image
My final session was a frank look at body image and how even as we gain knowledge about food's physical effects on the body, we also have to be aware of the relationship between eating and body image that no one (including a nutrition professional) is immune to. I thought there were some great takeaways from this session that could be useful in real life:
An exercise in identifying things you like about your body & drawing awareness to the difference between seeing something positive about yourself vs something positive through the eyes of someone else.
Looking at perceptions of self and body-image in conjunction with nutrition and not as something separate - this would be in terms of teaching nutrition or educating others on nutrition.
Self-compassion as a topic for nutrition education - students learning to trust themselves as opposed to only trusting what others told them. There is ample opportunity to combine nutrition education with counseling or guidance-type education experiences.
After all that sitting and learning, I decided to take a walk over to the Rittenhouse area and stroll the shopping area and grab a salad from sweetgreen. I've been eyeing sweetgreen for a while now and just hoping they come to Nashville - great new take-out option, right? No such luck yet but never say never and I got an opportunity to try it and it was so great! I do think I could pretty easily recreate the salad I had - The Chicken and Brussels - so I may give that a go when I get home.
Finally, I headed back to the hotel, Facetime'd my people, took a shower, grabbed my book and tucked myself into bed. It was glorious.
