Latest / Nutrition Connection by Dr. Kristen Hicks-Roof / 49: Brittany Buchholz MFA, RD, CNSC - CLINICAL / ENTERAL NUTRITION

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49: Brittany Buchholz MFA, RD, CNSC - CLINICAL / ENTERAL NUTRITION · Nutrition Connection by Dr. Kristen Hicks-Roof

• Kristen Hicks-Roof PhD, RD: Welcome back to the Nutrition Connection Podcast, the show where science meets storytelling. I'm your host, Dr. Kristin Hicks-Roof, dietitian, researcher, and lifelong advocate of the role of nutrition, health, and wellness. Each episode, I get to sit down with dietitians and nutrition experts all across the food and healthier landscape, leaders whose work touches nearly every aspect of our lives. So whether you're a student, a seasoned professional, or someone simply curious about food, nutrition, and health, this podcast is just for you. The views, thoughts and comments on this podcast do not reflect those of my employer nor the employers of my guests. So let's go ahead and get connected. Y'all, I'm super excited to bring on a enteral nutrition experts today. We're fairly new, newly connected, but we have Brittany Buchholz. She is the director of nutrition and the Western region clinical liaison at Whole Story Meals. Welcome to the show, Brittany. Brittany Buchholz: Thank you. Thank you so much for having me. Storytelling is right up my alley. And so this is a perfect opportunity to get on, have a discussion, and yeah, happy to be here. Kristen Hicks-Roof PhD, RD: Yeah, and before we started recording, I always like to get to know some of my guests a little bit. And she talked about how she loves art. She actually has a master's in fine art and she'll dive a little bit deeper into that. I love how you talked about storytelling is so key. And I think, you know, in nutrition, we have all like the hard, tangible data, but we have to craft it in these beautiful stories, whether that's written or verbal or, you know, how we're communicating that. So I'm sure your background really allowed you to do the storytelling that you do today. Well, let's start from the beginning. What inspired you from the get-go, ⁓ to become a nutrition professional? Brittany Buchholz: Yeah, um, I didn't want to be a nutrition professional. I wanted to be an artist. That was what I saw myself doing coming out of high school. I have always loved art. I really was into sketching charcoal sketching and would focus on people's faces. I loved sketching faces because for me that was a real way to kind of get intimate with a person and get into the emotions they're feeling and maybe things that are said or unsaid down to, you know, like the wrinkles in a person's face, the sunspots, ⁓ the story you can tell from that. So anyway, you can probably tell I'm still passionate about sketching. But ⁓ I come from a family, Irish Catholic, Catholic heavy emphasis on academics, and had always ⁓ also been a pleaser. Still am a pleaser for my whole life. That's like my Achilles heel. And so my parents were like, well, your art is great. You know, we'll continue to hang it on the walls, but we need you to go to school for something a little more academic. And so I really then looked to the healthcare sciences and landed in the field of dietetics. I think it really appealed to me because dietetics is very right brain. We're very analytical, science-based. And that said, it was one of the areas that I saw that there still is this whole space for creativity, for storytelling, ⁓ patient counseling. You're still getting to know people intimately in this beautiful way. And you're centering the conversation around food and food science and nutrition and health, as opposed to charcoal sketching. So ⁓ it really was. Kristen Hicks-Roof PhD, RD: I'm sure there's some crossover there, right? I love how you talk about storytelling because that's something that I've really learned when I was an academic. I used to talk to my students, let's not talk at our patients, but rather let's build that rapport. Like let's get to know them as real people and you'll start to figure out what matters most to them, what drives them, what challenges or opportunities that they face. And now all of sudden there's this huge window of opportunity to actually make realistic recommendations with real behavior change because you built that story and created them, you know, this dual conversation. So I think storytelling can happen on the individual level when you're doing patient consulting, but it can also happen, like one of my favorite things is storytelling and presentations, like really bringing that authenticity and connecting with people's hearts. because that's how they remember the content. And it sounds like you do that. Maybe you're more on the graphical form, I don't know. Brittany Buchholz: Yeah, ⁓ it's so true. And less graphical these days, I have three small children and a big job in my career. And so, no, most of my sketching now is like cleaning up the finger painting for my table. That's what that looks like more now. But yes, and I think it's so important for us as dieticians and all healthcare providers to have a skill and a passion for storytelling because We have this current climate where reimbursement is challenging. Every area of healthcare is all but competing for floor time for its own reimbursement. It's all important. And that reimbursement piece, I think, is really only powerful when we're able to translate it to common vernacular and tell a patient's story to grab someone's heartstrings that can move the reimbursement conversation. Kristen Hicks-Roof PhD, RD: I was literally just giving that as an example at a conference recently. So I think it can be so powerful. So there's a cue to action for everyone listening. Use your experiences and storytelling to tell everyone, especially if you're advocating for the profession and advocating for reimbursement or whatever it might be. Use that when you're talking with senators or congressmen or whoever that you want to advocate for. So let's talk about your journey though, Brittany. Brittany Buchholz: in the next Kristen Hicks-Roof PhD, RD: You had this really creative brain, but you ultimately decided that you wanted to become a dietician. So you went to school to go become a dietician. Now, what happened after you finished schooling? What sort of careers did you have? talked a lot, or you talked before about you really had this passion about two feeding. So how did you develop that? And then how did you get ultimately to where you are today of director of nutrition for Whole Story Meals? Brittany Buchholz: Yeah. So really I landed in a wonderful rotation for nutrition support in my dietetic internship at St. Joseph's Hospital in Illinois. If this makes it to any of them, some of those dietitians are still there and they were just amazing mentors to me. They took me under their wing. I was really lucky to work with some very confident ladies. They were confident in their hospital system. They were confident in an IDT team. And they didn't let me hide as an intern. know, when we were in rounds, they would look to me and they would say, well, Brittany is gonna teach you about that. And it would just kind of be on a whim. And at the time it would make me sweat. It was really scary, but it helped me form that callous of not being afraid to contribute. ⁓ Kristen, I was in one of your recent webinars you gave where you said, nobody is going to ask for your feedback if you haven't introduced yourself. You have to be in the room. You have to introduce yourself. you have to participate and then you'll be included. And so that was really great for me to build confidence, not only in my nutrition support skills inpatient, but also just in my capacity to participate as an IDT team member. And I ended up staying on at that hospital. They happened to have a job opening right at the end of our internship. So I stayed for a year and then I said, I love you guys, but I really don't want to live in Illinois anymore. I want to live in Colorado. And so I moved to Colorado. ⁓ didn't have a job lined up yet, really just drove out, cast my resume out and ended up getting hired by a large DME system. At the time, really, I had no idea about home care. I knew about nutrition support, not the home care side. And I thought, well, this is a job in the location I want to live, so I'm going to take it. And that ended up being the best. thing that has happened to me career wise. It started about a 10 year career in home DME. within that 10 years, I did a lot of direct nutrition care, patient support. DME dietitians are the cream of the cream when it comes to nutrition support because in a hospital setting, realistically, you might have anywhere from five to 10, 15 patients in a large ICU. Home DME, you're touching about 20 accounts a day of only nutrition support, no oral eaters. So the experience you get is just incredible and very hard, sometimes stressful, but you learn about what's going in the feeding tubes. You learn about the reimbursement. You learn about the actual plastic pieces of the feeding tube, the pump, the syringe, things that in the hospital, we don't touch the tubes, right? Like we write our recommendations, but if a patient goes to show you their tube, typically we're like, ⁓ I don't know. I'll get the nurse in here. DME, you're not getting the nurse in there. It's you. Kristen Hicks-Roof PhD, RD: And can you clarify what is DME? What does that stand for? Brittany Buchholz: ⁓ yes, durable medical equipment. So whenever a patient is discharged from the hospital, that prescription for their home tube feeding is going to be sent to a DME. The DME then is the company that provides them with the tube feeding formula and any supplies they need at home. Yeah. Kristen Hicks-Roof PhD, RD: Okay. That's crazy. Yeah, I would have met. It is so funny that you say that because like I go back a long time to my clinical rotation where tube feeding, I was scared out of my boots. I hated that rotation. I love math, but like that was like beyond my comprehension. And I was like, ⁓ my God, like I don't want to, you all I remember is residuals and don't overfeed them. And then are they going to the bathroom or you know what I mean? I was like, I don't know. This sounds so stressful. Like what happens if the tube doesn't get placed right? Now, at least the interns, one of the competencies is to place a tube, which I think is so cool. You talk about that, how when you're in clinical, you're like, let me go get the nurse, which shout out to interprofessional teams. I think that is important. However, I also think it's equally important when we think about clinical and internal nutrition, it should should be part of that whole process. Brittany Buchholz: Isn't it? Yes. Yes. Yes. And it takes a level of confidence. And that is a big area that I think we as dieticians can still step up to having confidence in the IDD team, knowing, hey, even if this feels scary for me right now, right away, I can work through it. Because after I do it a few times and I speak up a few times, it's not going to feel as scary anymore. But yes, I actually spoke with a DME, durable medical equipment company in my current role last week that those dietitians now are replacing the tubes. If they have patients with a clogged tube or just needing a routine replacement, those patients are coming into their DME office and the dietitians are popping out to replace the tube, which is incredible. Yes. Kristen Hicks-Roof PhD, RD: love that though. We are so skilled in so many areas and I think you're so right of like, what's crazy is we're so type A. We know everything. We are super planners, we're organizers, we have all the details. Why don't often, this is a generalization obviously, right Brittany? But why are we not having the confidence to be able to say like, yeah, I can do that. Is it just because we're not having ⁓ enough or adequate experiences in that? If you think about like a medical resident or even nursing, like you are in the clinic in and out for months, if not years, versus ours is much more condensed because you're doing community and you're doing whatever other rotations, food service. Interesting. Brittany Buchholz: ⁓ it's such a good question. I've spent a lot of time with it. I think that with dieticians too, there's a little bit of a fear of failure, ⁓ a fear of if you try something and you get it wrong, what is it going to look like on the IDT team? What is it going to look like to that patient? And that's a real thing. You know, it is important that we best prepare ourselves and educate ourselves so that we are acting as responsibly as possible. And then I think, like me myself, when I get a little afraid and in my head, I play the worst case scenario game. Like, okay, if worst case scenario, something happens, what does that look like and what's it gonna feel like and can I deal with it? And in dietetics, yes, there are some worst case scenarios. Maybe we didn't do a good job teaching and that patient isn't flushing their tube and that has led to a tube clog. and they need their tube exchanged, or maybe we selected the wrong formula and now their blood glucose is going to go high. I will say what I want all dieticians to know is every discipline has the opportunity for failure. Every discipline will try something and maybe something goes wrong, but then you course correct. And in nutrition, usually our margin for failure and the ability to course correct is a heck of a lot more than some of the other disciplines areas, you know? I don't know, I'm curious to hear your thoughts on that in your niche of the world if you see that as well. Kristen Hicks-Roof PhD, RD: I mean, I completely agree. think we, everyone can continue to grab a seat at the table and it all starts from that introduction, right? And I did give, I gave that presentation with ⁓ Great Valley Publishing, today's dietician, because it's really, if we are going to be the nutrition expert, which we are as a profession, but if we're gonna collaborate with... physicians or nurses or physical therapists or social worker, whoever you might be working with, either in clinical facilities or outside. I give examples in retail and food service and research and food is medicine. If we're gonna be going there, we have to be able to confidently say, hey, here's what we do. Here's what we bring to the table. Here's the skillsets that we can help support that process or the patient care or whatever ⁓ arena you're sitting in. So yeah, I think. I think everyone has a little fear, right? You know, just like my fear with enteral nutrition, right? That was very real. It was very real. A lot of people face that, but you gotta get over it because that is how we grow as individuals. And I think you can attest, like this is just, that was your first job. Now at Whole Story Meals, I'm sure you've learned so much over the last 10 years that you are making better clinical decisions. Like if I go back to when I was an early provider, like I shiver, I'm like, oh, I was so terrible. Like the advice I used to give was, Brittany Buchholz: Yeah. Kristen Hicks-Roof PhD, RD: unrealistic, general, mean, not relevant to the people. And now I'm like, no, I really have to build that rapport. If I want to change and help a person, I got to get to know them as a person. Otherwise, I'm never going to go anywhere. And I've really learned that over my, you know, 15 years of experiences. And we all do that. We all grow. So let's talk about it. So you were in endural nutrition. Brittany Buchholz: So, yeah. Mm. Kristen Hicks-Roof PhD, RD: That was your bread and butter, it sounded like, something that really you're passionate about, which I always love, dietitians, because we all find our niche and you're just like, that's my jam. I love doing that, right? But then how do you continue to grow within that space and ultimately get to a whole story meals? And I would love for you to describe what whole story meals is. Brittany Buchholz: Yeah. Yeah. Sure. I think my philosophy in life is I always say yes. If I am asked to do something, if I have an opportunity to do something, I always say yes. I kick myself later because 10 minutes before whatever it is starts that you've said yes to, you sweat, right? And you like regret it. And you think, why did I say yes to this? This is so uncomfortable. And I'm always grateful, you know, after the fact, after I push myself, push myself, push myself. So That's my advice to any dietician in the field and kind of just life advice, I think, that has served me well so far. so within the DME I worked in, I would always say yes. And so I found myself in so many roles within it, doing reimbursement, doing PRN, where basically whoever called off for the day, I would do their job, the direct patient care. ⁓ Sometimes when marketing materials were needed, I would offer to craft the marketing material since I have an MFA. There was a little bit of a surprise staffing change where we had no sales all of a sudden ⁓ for a few months. And so I said, hey, I can do this remotely. have Zoom tag me in. I'll set up meetings with our referral sources. And in doing all that, what happens after a career of 10 years in DME, two years in the hospital, once you've said yes to so many uncomfortable things, you have a really great resume. And I was able to look back and say, I've kind of figured out how to do all of these very specific things. And so I feel qualified to almost enter any role now in dietetics, is, it was an empowering spot to feel. And so my current company, Whole Story Meals, presented to us at my DME to tell us about their products. We had just recently started carrying them. And I had thought, wow, this is like the bee's knees in enteral nutrition. Many things have already been done before in this space, but this is something that hasn't and I see it filling a real need. And so I sent them my resume later that day. I ordered samples in my cover letter. I basically said, I'm not applying for any specific position. I just want to tell you about myself. I think I'm extremely qualified and I would love to work for your company. So let me know if you have any role that might suit me. I would be really excited to talk to you about it. And it took. a little bit of back and forth. initially had said, ⁓ you know, thank you so much. I think something generic. And I had thought like, okay, I shot my shot and it was what it was. But through just some back and forth communication, after about a year, the director of nutrition actually reached out and said, I'm stepping away to spend more time at home with my family. And I was curious if you might be interested in my position. And that was an amazing feeling because even though I knew that I was extremely qualified and had all of this background in nutrition support was a CNSC. Still to hear somebody reach out and say, but we think you're qualified for the director position was like, ⁓ okay. Like, yeah, all right, yeah, I'll interview for that. And yeah, here I am. So Whole Story Meals, we make whole food tube feeding and we're the only powdered form of real food. tube feeding available in North America, which is very niche and just a really fun, creative little part, I would say, of the enteral nutrition industry to be working in. Kristen Hicks-Roof PhD, RD: love how you talked about like, you you sent your resume, you sent your cover letter, like, I don't even know what I'm applying for, but I'm just, you know, I'm just telling you about me. ⁓ And then it didn't happen right away. I think that is probably the most important takeaway because I've had a very similar experience. I reached out ⁓ in my doctorate degree, I was doing education and I worked with Texas Medical Association to develop continuing education for physicians. That was a lot of the work that I did. And I reached out to Texas when I knew I was moving to Florida. And I said, hey, I've been doing this for Texas. I'd be happy to do this for you if you guys are ever interested. And then it was like six months later, they were like, hey, we're looking for a dietitian. I remember you emailed me and you're the only dietitian I know. Do you want to do modules for us? And it was like, yeah, I would love to. You know what I mean? And so sometimes you just never know. Like you just put yourself out there and have that confidence of like, hey, it may work and it may not. And that happens all the time. Like it may have folded and never gone anywhere. However, you had your patience, you still loved your job of what you're doing. And now all of sudden that job did open up. So I think that's a really good story and message for people that maybe are scared to put themselves out there and also don't. get frustrated when it doesn't pull all the way through right away. Because it likely will not pull all the way through right away. So I think that's helpful. I also thought that when you said, when you had reached out to me or we're having this back and forth, I was like, number one, enteral nutrition is terrifying for me still. I don't know why, but it's still like this like scary unknown, I guess you could say. But I love the idea of whole food and powdered formula. Like that's really outside the box. How? Brittany Buchholz: Right. Right. Kristen Hicks-Roof PhD, RD: How do you think that is so much different, it being powder than a liquid, and what makes that unique and not? Like, is that more challenging for dieticians or easier for them to be, you know, using those types of formulas? Brittany Buchholz: ⁓ that's such a good question. More challenging for dieticians, less challenging for patients. And so part of, yeah, part of what I see as my challenge is Kristen Hicks-Roof PhD, RD: ⁓ interesting. Brittany Buchholz: taking down the barriers for dieticians, which typically is just that it's something new, that it's something new, it's different than what they've been doing. And so there's that confidence level, like we were talking about, no dietician wants to be the first one in their clinic to try something new. And you can see it in their face when they're thinking it, because the question that they ask is, well, do you have a case study of someone else that has done this? Because it's like, we want that. the feeling of security, right? So that's the challenge of a small up and coming company is that we really need some brave dieticians. You gotta be brave if you're the first one trying something in your space. That said, patients are brave because if you're not tolerating a tube feeding formula, you wanna try something different and a patient has maybe the blessing of they haven't done. a million other products. They're not working all day in nutrition support. They're just looking at their own story and then wondering, well, if I'm not tolerating this formula with these ingredients, why couldn't I try food? so patients have a lower threshold, I think, of discomfort with it. And especially, you know, when we think of like infant formulas are powdered and we mix them with fluid all the time. We put that through the tube. We're very comfortable with that. And so it's not too far of a leap then to think of food being mixed with fluid and put through the tube. And the incredible difference for patients is, you know, we say, yes, we can be a great option for traveling, but really it's even if you're leaving your house, you know, people that rely on tube feeding for nutrition are often still leading lives. They're leaving the house. Parents with a child with a feeding tube often have multiple children. or even if it's their only child, they have to leave the house to go to a medical appointment. Well, if they have to carry, you know, tetrapacks of their formula that contains the fluid in there, each tetrapack is gonna be about a pound. That's a lot of weight. It's clumsy. It's hard to leave the house and lead life. Whereas if you have a powder, you can add the fluid to it wherever you're at. Usually just water, shake it up, just like infant formula. and they're ready to go. So it helps alleviate the anxiety of, my gosh, how am I going to feed myself? How am going to feed my child? It's convenient so that you can eat to live, not live to eat, which is exactly what we would try to preach for patients eating by mouth. Kristen Hicks-Roof PhD, RD: I love that. And trust me, I echo your sentiment. I'm a mom of three. I can't tell you how many diaper bags and suitcases and toys and stuffies and blankets and water bottles. Like I didn't know. I almost like grow five hands every time I leave my car to be able to carry everything. So I can only imagine the ease, especially in the pediatric space. But I do think, you know, as people get older, they're like, I'm tired of feeling unwell. This is not working. I need another alternative. So I always think patient choice and autonomy and being able to have that flexibility of, you know, I want a whole food formula or I want something manufactured. There's safety in both of those, right? Like there's, there's reasons why we have variety, just like when you go and there's 90 different peanut butters on the shelf, like there's a peanut butter for everyone, right? What you like at peanut butter is probably not what I like. And that is there's purpose. It's the same crossover there. And that's why I love the role of industry dietitians as well. Like industry dietitians like this allow for more variety, right? For new products to come on the market to help with from clinical to retail. Like it's giving you more options. Brittany Buchholz: Yeah. Kristen Hicks-Roof PhD, RD: Let's dive into your day to day. What do do? Number one is a director of nutrition, but then you also hold the second title of Western region clinical liaison. So give us a day to day. Brittany Buchholz: Sure, I will say working for a small company as opposed to a large company, I've done both. And for the small company, the title is a title and mostly we all do it all because there's less of us. And so the crossover I would say is daily. We have huddles. We talk about what's happening, what needs to be done. And if something falls within your umbrella of expertise, you're in charge of it. And so they are big titles. And part of what I love in that is I get a chance to kind of do it all and cast my opinion widely where it's invited and ⁓ beneficial. So in my day to day, typically it looks like I'm making appointments with providers in whatever way that comes. Sometimes it's a patient reaching out and saying, my provider's not familiar. Could you meet with them and tell them a little bit about how to use these meals? Sometimes it's me approaching them directly and saying, hey, your patient population could really benefit from knowing about enteral nutrition options like this. Could I meet with you and tell you more about it? ⁓ Opportunities come up in a myriad of ways, but it's really cool. I just get to meet with other very intelligent people, talk about what they're using, what barriers they're seeing, and maybe how they could troubleshoot or alleviate some of those things. ⁓ Sometimes we're talking about two-feeding formula options, and then sometimes we just end up nerding out and talking about. other industry related things. It's really fun. feel like I get to network all day long. And then part of that then on the nutrition side is working closely with our marketing director to help review our marketing, put a little bit of a clinical spin on our marketing materials. Our company is really cool and unique in that we are owned by a parent of a tube fed child. and the director of our marketing is the parent of a previously tube-fed child. And so it's neat when we come together. The dieticians can really bring some clinical aspects, but then I would say more than not, we are educated by the consumers of enteral nutrition products about the real lived aspect. ⁓ They call it... real world. So we'll share our dietitian aspect and they'll say, okay, but in the real world and then share their lived experience aspect and we can come together and make sure not only that our products are being made for both for the users in the real world, but also for clinicians that have certain specific nutrition goals. And then also that our marketing materials are speaking to both, right? Because we need to be able to speak to clinicians who need that level of confidence, but also to patients. They're the ones at the end of the day using this product and this is their food, their nutrition. So yeah. Kristen Hicks-Roof PhD, RD: when practical and theoretical are often very different things, right? Because I remember when I was having my first kid, and I'm sure you probably share somewhat of a similar sentiment since you have three little kids. Like I'm like, I'm a dietician. I know how to breastfeed. I know the benefits. Like this is gonna be a walk in the park. I got it. I went to school for this, people. No, it was so hard. I was in pain. wasn't... wasn't latching right, my kids had tongue ties. I was like, wait, I feel like I should know this. And then I ended up becoming a lactation consultant because I'm like, I need to know more of this. And it helped me with my next two kids. But I think that's really interesting because you talk about that practical life. And I think sometimes we try our best as clinicians to, quote unquote, be in our patient's shoes to... understand what they're going through, but sometimes we can't. And it is really nice to have that perspective on your team that you can bring in this clinical, like here's what I see from the science of being able to apply to meeting nutrient gaps or having lower residuals or whatever. I don't even know if they count residuals anymore. And then here's what. Did you what? Brittany Buchholz: We could do whole different episode on the residual topic. We'll table it. Kristen Hicks-Roof PhD, RD: ⁓ I, I'm telling you, I have like horror memories of the residuals. Like, how do I remember that 15 years later? I know nothing about enderal nutrition. Like if someone were to put me in that role, I would just all be the janitor. Like I will, I will let someone else do that. It's just not my, yeah, I'll take pretty good. So let's talk about science, right? Because you have to bring this clinical expertise. How does scientific data and evidence fuel what you do in your day to day role? Brittany Buchholz: Yes. Tag me in. Tag me in. Yeah. Yeah. Mm-hmm. Yes. I have this analogy in my head again being a mother I think of when we watch a little kid soccer game and I posted this on LinkedIn recently to share with everybody When you watch a little kids soccer game the ball goes from one end of the field to the other and the kids all chase it So they're just running back and forth on the field, know, they're not they're not playing the field they're not standing their ground and it's because They're so undeveloped in that area. They lack the confidence to know I play my area and I'm going to play this area well, but I don't need to chase the ball back and forth across the field. This is how I see the world of dietetics. I think there's a difference between being based in science and based in research and chasing and changing recommendations to suit every new research paper that comes out. We practice in a world where we really communicate through poster presentations and research studies. We love them. I love them. I'm not knocking them. I'm hoping to work on a case study right now for Aspen for next year. And that being said, I think we have to keep in mind, we can't chase it. We have to use it to inform what we already know about nutrition. And so at the end of the day, what we know is a diet high in variety is healthy for the gut microbiome, we know that we need a combination of phytonutrients, a variety of fruits and vegetables, whole grains, unprocessed foods as much as possible, these really simple concepts. And that needs to ground us so that when the poster presentation comes out about this source of carbohydrate or that source of carbohydrate or this source of protein isolate or that protein isolate, we can take it in and process it, but we have to process it through a rooted. understanding and nutrition. And that really, I think, helps me have the confidence to advocate for real food and true nutrition. It's so fascinating in the world of clinical dietetics. We have one set of standards for an oral diet, and we're less confident about those standards for a tube-fed diet. And so it takes confidence to say something as bold as a tube going into a person doesn't change what their body thrives on. And that seems so simple, but it hasn't become so simple. And so that's where I think my job is to stay grounded in my confidence and be able to translate that simply so that other people can also be reminded of, yes, let's take in the newest research. is important and let's stay grounded in what we know to be true. Kristen Hicks-Roof PhD, RD: When I also like how you talked about, you get so much more from whole foods than just the micronutrients themselves, right? Of course you're getting iron and zinc and vitamin C or whatever it might be. We also get these antioxidants and these phytochemicals and some of these nutraceuticals in a way from real food. it's something that I'm like, I really am trying to dive and understand the research, but I feel like the research is so early on. Brittany Buchholz: Mm-hmm. Kristen Hicks-Roof PhD, RD: this whole food matrix. Like food is built in these complex structures that either help or hinder bioavailability, your metabolism. And that is part of the structure. When we go out and we start formulating products to have the nutrients, right? Like there's nothing short of the nutritional value of it. But there's like this gray area. And I think that's kind of what you're saying. like, Brittany Buchholz: Mm-hmm. Kristen Hicks-Roof PhD, RD: You're rooted in science and you're rooted in this whole food framework, yet we have a disconnect in practicality of like, what does this mean? ⁓ So I think it's cool. Like Whole Story Meals, I've never used it, but I just think it's a cool concept of using real whole foods in a dehydrated format to try and boost beyond just providing the vitamins and minerals and key nutrients, but then something beyond. So yeah, it's just really cool. Well, you've had quite a career in tube feeding and enteral nutrition, I'm sure have impacted hundreds, if not thousands or more lives of these very complex clinical cases, but what's been your favorite part of your career or something you're most proud of? Brittany Buchholz: ⁓ I would say I have, speaking of storytelling, a pretty crazy story. When I was in DME, we had just recently discontinued carrying a certain product, which, you know, when you're working in that field, that happens all the time for a variety of reasons, certain products come, go. We had a very specialized renal product that we had just stopped carrying. It wasn't actually discontinued, but we could no longer offer it. And a renal dietitian had called through and we were just having a conversation about this child that she had who was kind of end stage chronic kidney disease needed the specific product. It was no longer available. How could we use what was available to essentially craft that same product out of what was available? And so we're putting on like our best clinical thinking hats. We're going through the inventory, doing our math for everything that's available. We couldn't come up with it. And I had told her, there is this product that's available, but we don't carry it. I think you should call the company and see if any of the other DME's who they could essentially contract with would carry this product. essentially kind of referred her away from us because I'm like, I think this other thing would be it for this patient based on what you're describing. Well, now I'm with Whole Story Meals. It's coming up on a year I've been here. that dietician emailed in and I recognized the name and I said, ⁓ my gosh, I think you and I worked together when I was in my previous role at this DME. And she said, ⁓ my gosh, I have to tell you about that kid. So it was one of Whole Story Meals products, their chronic kidney disease product. And she said, I had contact them after you and I talked, we found a DME for this child to get it. And it's been amazing. I really think it's kept him off of dialysis. And so that actually is the case study that I think she's working on, hoping to present it as been next year to tell the story of this patient. But that was just an incredible coincidence of the world of dietetics, I think is small. And it just reiterated for me, always have the conversations, you know, I'm so glad that I did it not mention that product because it wasn't currently available in my company. ⁓ just, I think that really painted out for me when we share knowledge with one another, it can have real outcomes, which in this patient case, it's a little boy who has been able to put off dialysis. mean, that's, that's huge. So yeah, there's been several little stories like that, but that one just really wowed me at the coincidence of it. And then finding her again on this side of the spectrum when I'm now with the manufacturer and hearing that patient story. Kristen Hicks-Roof PhD, RD: Well, talk about full circle. Holy cow, that is crazy. It is cool, cool though. When you do connect with other health professionals, whether they're dietitians or other, and you're all working towards the same goal, right? You want that patient to live a healthy, prosperous, you know, no pain, no whatever life. You want them to have a happy life. And I think sometimes we forget that, right? You talk about my company maybe didn't own that product and you could have not said anything about this other product that you learned about, but you did. You were called to kind of do that. And I always think that there's things happen for a reason. And I do think that is really cool. It's a great story to tell like, hey, reach out to that person or give this bit of knowledge that maybe you got at a conference that you can share with someone else to say, ⁓ here's a good option or here's a good resource because you never know how that person may use it. So. Really good takeaway. Well, speaking of takeaways and tips, what suggestions or tips do you have someone who maybe wants to get into the integral world? Like you jumped in right after your internship, but what if someone has not come from an integral nutrition, know, depth of a background? What tips would you give them? Brittany Buchholz: Hmm. I think a clinical foundation is always really helpful if you're wanting to go into a world that is heavily clinically oriented, like tube feeding is like TPN is. So if you have the opportunity to get in at a hospital, get some experience under your belt at high volume, high acuity, I think that's the best place to start. You don't have to stay there if it's not your jam, but put in the time. ⁓ I've always been a fan of PRN roles. And I know for a variety of reasons that's not ideal for people, but if you can make it work, especially right out of your internship, I think PRN is the best way to get the widest note of experience because you get put everywhere and you really have to learn quickly. You know, I have horror stories from PRN. I would be like in the NICU trying to figure out how to do this poor child's TPN, you know, at that time. I didn't have the confidence level I have now. And then I'd get paged and they would say, we need you for an outpatient appointment in like 30 minutes. And I'd be like, ⁓ my gosh, okay. Now, so PRN I think can be not ideal long-term always for everybody, but great to gain quick experience. And then working in DME, if you have the opportunity, I really just feel that if somebody has the interest in nutrition support, whether it's TPN or tube feeding, DME is a Ray area to not only learn how to be relevant, you learn to make your recommendations translatable outside of a hospital environment, but also networking. Some of the best, most amazing dietitians and nutrition support either are currently working through the DME's or have in the past, and then they have moved into a different role. And so the network of dietitians and nutrition professionals I've met through DME is second to none. ⁓ It's really some powerhouses. You walk into then some of the big conferences and you can just look around and it's all previous coworkers, which is really nice to have. I think it helps with the level of confidence as well. When you're, when you're a nutrition professional to know that you have some confident powerhouses of dietitians in your court. So I love DME and I will always support our DME dietitians. Kristen Hicks-Roof PhD, RD: Well, I feel like every person who I've met who work in clinical nutrition support, like they know they're one of their own. Like they kind of know each other. It's like a small world in a way. You're right, because like people may go in and out of roles. So, you know, ask, get a mentor, right? Find a mentor in an area that you want to go into. And, you know, you'll have Brittany's LinkedIn contact information to be able to look up or look up whole story meals to be able to just broaden your understanding. And one of my favorite things is take a webinar on a topic that you are interested in. So if it's agriculture or if it's end-to-end nutrition or if it's sports nutrition or whatever area you're interested in, take a webinar, start learning who these people are. What lingoes do they use? What conferences do they go to? And then all of sudden you can find yourselves bridging that gap from whatever position you come from, where you want to go. My favorite question, Brittany, we're going to close out on is if you had a crystal ball, what do you think is coming next in nutrition? Brittany Buchholz: could I tell you, I'm just going to say it to create it. Here's what I think. I think historically, we have based on central nutrition reimbursement on a model that requires patients to fail synthetic formula before they have access to real food and true nutrition formulas. I feel it in my heart. it's going to change. It's tipping. I think the industry trends are tipping and reimbursement will follow. And I really think that in the next 10 years, we're going to look at reimbursement, taking a look at the healthcare spending that is caused by this fail-first model and how it could improve by prioritizing a whole food diet for patients with feeding tubes the same way we do for patients without feeding tubes. And so that's my vision. That's what's gonna happen. Kristen Hicks-Roof PhD, RD: You're like, I'm going to put this good juju out there. Like, come on, baby, let's go that direction. I'm in for it. I do think you're seeing a momentum, right? Driven, whether political or not, I think this whole concept of real food and whole food and minimally processed food, like, I don't think anyone can argue like that is the North star. That's where we want to go for all feeding types, right? Like whether you're infants to elderly, enteral or oral feeding, I think it's all going that direction. So Brittany Buchholz: That's my wife. Kristen Hicks-Roof PhD, RD: But ultimately, billing and reimbursement is a huge barrier, right? Whether that's offering clinical nutrition services or medical nutrition therapy or whatever it is, or even food is medicine in retail, we have to have reimbursement. And hopefully this is like the nudge to the ball, just like rolling down the hill to elevate nutrition services, to elevate dieticians across industries, to elevate just the role of nutrition. Brittany Buchholz: Absolutely. Yes. So dietitians listening, any dietitians, nutrition support, oral industry, whatever area it is that you're in, have the confidence, step in there. And especially in nutrition support and CNSCs. Oh my goodness, if you're a CNSC, this is for you. We are the ones, it's up to us. We have to say what our patients need because if not us, who? Kristen Hicks-Roof PhD, RD: Yep, no, I totally agree. Well, thank you, Brittany, so much for being on the show. So if you like the podcast, make sure you like, subscribe, leave review, but most importantly, check out the next episode because every episode I bring out a different dietician and nutrition expert to share their story and give you tips and advice on how to be successful in the field.