I've been busy preparing for my exam to be a Certified Diabetes Educator and guess what? All that hard work paid off! I finally got the letter today with my passing results. For anyone who is interested in diabetes management, I strongly recommend going through the certification process. The hard part for most professionals is getting the 1,000 hours of teaching experience for eligibility. If you are currently not in a position that gives you this experience, don't give up. Look for opportunities in your current location and don't be scared to let your employer know about your interest. Once you get your certification there are many different routes that you can take; my future goal is to team up with other healthcare professionals to create our own accredited Diabetes Education Program within the community.

Over the weekend I was asked by OK Magazine to comment on the Miss. Universe Australia finalist Stephanie Naumoska. Her extremely thin physique has started a stir of controversy over the need for stricter regulations in beauty pageant application criteria. Although the contestant reports eating multiple times a day and denies having an eating disorder, with a BMI of just 15.1 malnutrition is a major concern.

In the past couple years, after several anorexia related deaths occurred in models the Spanish and Italy Associations of Fashion Designers have banned models with body mass indexes less than 18. And now the Australian Medical Association is encouraging the Miss Universe Pageant to enforce a similar rule for a minimum BMI= 20 for contestants.

There is concern not only for the health of the contestants themselves, but for the young girls that look up to them. Especially for girls that already suffer a poor body image, having such a role model may increase their likelihood of developing an eating disorder.

Lack of insurance reimbursement for medical nutrition therapy is a concern among dietitians. Evidence is needed to support the benefits of nutritional counseling to establish a stronger case for physician referrals and insurance compensation.

A randomized trail funded by Pfizer was recently published in the February 2009 Annals of Internal Medicine. The study compares five different methods for delivering a lifestyle modification program for obese patients taking the weight loss drug Meridia. The 376 participants were given a lifestyle manual, access to a weight loss web site and randomly selected to receive one of five different treatment plans; high-frequency face-to-face dietitian counseling, low-frequency face-to-face counseling, high-frequency telephone counseling, high-frequency e-mail counseling, or no dietitian contact. After six months all groups showed improvements in waist circumference, high-density lipoprotein cholesterol and triglyceride levels. The high frequency face to face counseling and high frequency telephone counseling groups showed the highest percent of weight loss (8.9% and 7.7% respectively), while the no dietitian contact, self help group showed the least (5.2%).

One of the biggest challenges that I face in nutritional counseling is getting patients to keep their food journals on a regular basis. Whether the patient is seeking weight loss or treating a digestive disorder, food journals are an important part of nutritional counseling. This simple act of self-monitoring is a way to discover patterns in patient eating and uncover opportunities for change.

The benefits of food journals have been well established; most recently researchers at Kaiser Permanente Center for Health Research completed a large weight loss study that was published in American Journal of Preventive Medicine. For six months, the 1,685 overweight adult participants kept food diaries and were encouraged to eat healthy and be physically active. They also attended weekly group meetings to review their food diaries and learn healthy eating skills. At the end of the study, participants had shed an average of 13 pounds. Those who wrote down everything that they ate and drank for six days a week lost about twice as much weight as those who kept food records one day or less per week.

I often tell my patients that even if no one else views them, the accountability that comes with the process of recording food intake is extremely beneficial. Some patients rely on computer programs or cell phone pictures, but a simple pen and paper is all that is needed. I typically recommend including what time the meal was eaten, the portion size of the food, and a before and after hunger level on a scale of 1-10.

Last week, I was on the FOX News channel for a story about unpasteurized dairy products. As more people become interested in the beneficial aspects of naturally grown foods, the demand for unpasteurized or raw milk has increased.

The FDA does not allow these products to be sold across state lines, but depending on the state raw milk can be purchased directly from the farm or at the grocery store. Pasteurization is the heating processes that milk undergoes to reduce the number of disease causing organisms. Supporters of raw milk claim that it tastes better and is healthier because vitamins, proteins and beneficial bacteria have not been "destroyed" by the heat. However, clinical studies have shown that unpasteurized milk may contain the very bacteria that the pasteurization process was meant to destroy. Namely, bacteria such as Salmonella, Listeria and E. Coli, in healthy individuals, ingestion may lead to gastrointestinal distress ranging from mild to severe. More serious and possibly life-threatening dangers exist for the elderly, pregnant women, children and those with medical conditions that suppress the immune system.

The bottom line is that natural food enthusiasts should be aware that despite regulatory oversight of these raw dairy farms, cases of food borne illnesses have been reported and it might not be worth the improved taste.