What does a dietitian do?

Top five ways dietitians move TBI patients forward in their recovery

Read to me!

Do you have a dietitian on your healthcare team?

I’m talking to both you the TBI survivor and you the healthcare provider.

By the time my clients come to me, they’re usually years out from their injury. They’ve likely seen every other health professional and have maybe even amassed a list of supplements and food restrictions.

My brain injury clients are often struggling to plan meals or cook due to the TBI. On top of that, they may be so focussed on what NOT to eat that they have a hard time to make a decision about what TO eat.

Plus low energy, cognitive problems and mobility issues may lead to reliance on convenience or packaged foods.

The stress and the isolation of the injury can also trigger emotional eating.

Oh yeah, and then there’s all the digestive issues that come up post TBI too!

I often wish I was made accessible to my TBI clients sooner in their recovery journey. It’s hard for them to participate in other therapies, stay focussed & engaged, and do the rehab homework when at the very foundation these brain injury survivors may not even be getting just ENOUGH food to basically function on a daily basis.

“It’s difficult for a client to participate to their full potential in a rehabilitation program if they aren’t well nourished.“

Charlene Kennedy, RD

Yup, malnutrition is a real life issue that holds our clients back in rehab.

So I’m writing this article, but it’s more like penning a letter to case managers, healthcare providers, insurance adjusters, injury lawyers, and the like to ADVOCATE for nutrition therapy for the TBI survivors who both need and deserve it.

Is this something you’ve ever done before?

Referred to a dietitian?

Pushed to get a dietitian assessment and follow up?

Approved dietitian services for your clients?

I think there’s a lot of misconception amongst healthcare providers about what we all do, our roles, and how we collaborate.

So to clear things up on what a dietitian ACTUALLY does, in hopes that this piece of advocacy will make nutrition therapy more accessible and funded, I’ve compiled a top five list of ways dietitians move brain injury survivors forward in their recovery alongside the rest of the team.

And to make sure this isn’t just my opinion, I reached out to other dietitians who work in the motor vehicle collision industry.

At the end I will give you resources on how to refer to a dietitian near you.

What does a dietitian do? Top 5 ways dietitians move TBI patients forward in their recovery

#1 Make fuel for rehab accessible

Think about the balance and coordination tests you might do with your clients in the controlled environment in your office. Or those vision exercises you have your clients do scanning and reading lines of letters…

Well cooking is that but with higher stakes when food can easily burn or things can catch fire. Grocery shopping raises the challenges exponentially requiring a person to identify foods, read labels, and compare prices in a noisy environment. Such a hard task may drain a TBI survivor for a few days.

When it comes to food decisions, planning, and preparing meals, our brain injury clients deserve help and guidance so that they can have the energy for their other treatments.

Amy Simmonds, a dietitian in Toronto, helps her clients overcome this:

“Word finding difficulty is a common issue so [I] try to help by creating grocery lists that have categories and check-boxes for each item – ie: list of all produce, grains etc or that include pictures for each item.“

Lekha Lutchmansingh, RD also takes a very practical approach:

[I eat] with the client… to ensure they are chewing their food well and then to swallow and eat slower… when they actually taste their food and enjoy it they may [be] more aware of what food is for, fuel and satisfaction of taste/texture etc.

I really like what Lekha shares here. It highlights how nutrition isn’t simply just math of nutrients in and out.

Making nutrition accessible means supporting a person from planning, to eating, to digesting, and this takes an approach that considers the emotional connection to food too.

#2 Getting nutrition in the face of appetite and digestive issues

Problems with appetite are super common post TBI. Many TBI survivors I meet think they simply have to live with this forever. But this doesn’t have to be the case!

As dietitians we assess everything that relates to food in and food out 🙂

If someone is struggling to eat due to nausea or vomiting, gut pain or poop problems, we figure out ways to get them the nutrition they need.

Amy Simmonds:

Some people lack usual hunger/thirst cues or lose track of time – sometimes having tracking sheets posted in a familiar spot cues eating/drinking.

Charlene Kennedy, a dietitian in Ottawa says:

[I work] with the client, their team and their family. I look for small, yet impactful, diet changes that we can add to over time… After a TBI, there are good days and bad days… these days can be unpredictable. I work with clients to come up with a back-up plan for those difficult days when symptoms are in full force.

This can be especially important when it comes to digestive issues.

A number of people I work with became afraid to eat different foods when their symptoms were high. I work with my clients to come up with a “safe foods list” based on their individual food sensitivities and other nutrition interventions we know to be helpful with a sensitive gut.

Through this process we can also help narrow down what gut issues our clients are actually dealing with. Many people are told they have “IBS,” however there are subtypes and digestive problems that look similar.

#3 Emotional eating

I’ve written about emotional eating before on this site. 

The first thing I want to say is that this isn’t out right all bad. I think “emotional/stress eating” gets a bad rap. As dietitians, we know how to put this into context.

There’s no quick fix and I will say this is best managed with both an RD and psychologist on the team. This helps guide our clients to a solution that’s more in line with what they want and what’s supportive of their health.

Aimee Hayes, a dietitian in Ontario, has specific ways to help clients with emotional eating:

Many clients turn to food to self soothe. I use a five step worksheet to help clients address their emotional eating. Part of our work together is to bring awareness by educating on the difference between physical and emotional hunger. We also explore triggers of emotional eating and develop a list of alternative activities.

#4 Help building food skills

Many people think that a dietitian’s main role is to provide meal plans. However, you may be surprised to hear that this often doesn’t work! 

There is definitely a time and place to fully calculate and spell out what and when to eat.

However, the real goal and the real work is helping clients to build autonomy when it comes to planning and cooking nutritious meals that are right for them.

Lekha describes this:

[I help my] client to make their own meal plan with protein ideas, fibre rich ideas and healthy fat ideas… This allows [me] to see if [they] understand what to include and pick choices they like, usually more buy in and education can be given at that time.

This also helps to make nutrition more real. As Amy describes:

If our goal is to increase fibre, we work on making high fibre recipes together instead of just providing a tip sheet on ways to increase fibre. It helps people make a real life connection, allows for visual/tactile learning, provides support when following a recipe alone can be overwhelming and a deterrent.

Charlene also talks about some specific meals she helps her clients make:

Bulk meal prep/freezing with help from friends and family… Quick and simple “snack” meals to get you through a tough day… Smoothie ideas, particularly if symptoms are leading to poor appetite.

#5 Clinical nutrition therapy

A lot of the actual work people see dietitians do is the very practical work that gets people to eat! Behind all of that is the translation of research. As dietitians we can spot nutrition misinformation from miles away 🙂

When we are putting together our plans for our clients, we are considering nutrient timing to address clinical symptoms.

We’re looking at the evidence behind supplements and comparing the potential benefits to the extra costs and pill burden.

We’re taking the data from research on dietary patterns and putting that into context of the whole person in front of us.

This might be looking at a person’s daily intake and suggesting timing changes to better manage blood sugars, hormones, and symptoms.

This might be choosing the correct form and dose of supplements and trialling them one at a time to evaluate benefit vs potential side effects.

This might be using our clinical judgement to hold off on elimination diets if a person is struggling with low intake or disordered eating…

Krystal Merrells, RD

Sometimes the problem is that research results are translated into a narrative that makes one nutrient, one supplement, or one diet look like it’s the perfect solution for everyone.

However as dietitians, we have seen those diets fail.

We’re “on the ground.” We know when a therapeutic diet is worth trying vs when it’s harmful. And we know how to do it properly — when to stick to the small details vs when to modify for better overall results.

And this comes from doing this job, day in, day out.

Recently I was listening to a podcast where another healthcare provider was interviewed about all things concussion.

When the topic turned to nutrition, this healthcare provider expressed that diet wouldn’t really do much — that is’ not a magic bullet for concussion.

Yeah… Nutrition isn’t a cure or fix all.

And neither is any physio or physical treatment.

Neither is any psychological therapy.

Neither is any OT intervention.

Neither is any medication…

And yet those are all therapies that are generally offered, approved, and covered in the medical world of TBI.

Physio, physical therapy, psychology, OT, pharmacology don’t cure a TBI. 

But when assessed and appropriately recommended, they improve a person’s quality of life. They help TBI survivors better cope and live life post injury.

And considering food is something we need to interact with multiple times a day, then DEAR GOD let’s accept that nutrition therapy is needed too!

Refer to a dietitian now. Here’s how:

Dietitians of Canada: Find a Dietitian online search

Academy of Nutrition & Dietetics in the US: online search

From this article:

Charlene Kennedy, RD: website

Amy Simmonds, Lekha Lutchmansingh, and Aimee Hayes are a part of Aimee Hayes & Associates

And yours truly,

Krystal Merrells, 

Registered Dietitian

Concussion Warrior