Latest / Nutrition Connection by Dr. Kristen Hicks-Roof / 72: Dani Pezzuto RD, CCTD, CNSC, LDN - CLINICAL / TRANSPLANT
Transcript
- Kristen Hicks-Roof PhD, RD: Welcome back to the Nutrition Connection Podcast, the show where science meets storytelling. I'm your host, Dr. Kristen Hicksroof, dietitian, researcher, and lifelong advocate of the role of nutrition, health, and wellness. Each episode, I sit down with dietitians and nutrition experts all across the food and healthcare landscape, leaders whose work touches nearly every aspect of our lives. 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. Today I'm excited to bring out a new connection of mine. we have Danny Pizzuto. She is a transplant dietitian at University of Chicago Medicine. Welcome to the show, Danny. Dani Pezzuto, RD, CCTD, CNSC: Thank you so much for having me, Doctor Hickthroof. I appreciate it. Kristen Hicks-Roof PhD, RD: And I love, you know, I bring on all sorts of niches. And when I saw your application in, I was like, yeah, transplant dietitian. Like, what an awesome niche within clinical that I think people are curious about. And we're gonna dive a lot deeper into some of your credentials about transplant as well as everything you do in the clinical space. So let's start it from the beginning though, Danny. What inspired you and made you want to become a nutrition professional? Dani Pezzuto, RD, CCTD, CNSC: Okay, so I actually was interested in engineering in high school and I went to college with that being my focus. But I took a nutrition class, Nutrition 101, my first year, my first semester. and I just loved getting to understand what what the biomechanics behind what is behind nutrition, how it works in the body, how food works in the body, how food is digested. Something about understanding how what we eat then turns into components of our health and also wellness is something that's so fascinating to me. And I think that it's something that we all find important because food is such a bridge between cultures and people. so I just love the opportunity to get to talk to people about food, which is something that I really love, and how to make it work for you, which is something that hopefully is helpful for for people's overall physical health. Kristen Hicks-Roof PhD, RD: Almost see too, like there are some niches within nutrition that really almost have like an engineering foundation, like where you like processes and you like structure and you like solving this type of problem. My husband's an engineer, and so we have different Dani Pezzuto, RD, CCTD, CNSC: Love it. Mm-hmm. Kristen Hicks-Roof PhD, RD: brains, but then we also are like, okay, if we have to replace a light fixture, like what are all the parts that we need? And what are the you know, so I wonder if that is also like a a theme in a way that's carried through, especially on the transplant side, which I know we're gonna get into, but like you really gotta look at all the lab values, all the numbers and calculations, like all of that is pivotal for those critically Dani Pezzuto, RD, CCTD, CNSC: Absolutely. Kristen Hicks-Roof PhD, RD: ill patients. so so let's talk Dani Pezzuto, RD, CCTD, CNSC: Absolutely. Kristen Hicks-Roof PhD, RD: about your journey. You ultimately decided you wanted to go into nutrition, which is a very different angle from engineering. What sort of jobs have you had? I know you said you're still early in your career. So yeah, what kind of jobs have you had ultimately to get you to a transplant dietitian? Dani Pezzuto, RD, CCTD, CNSC: Absolutely. So I was really lucky in that I started out as a contract dietitian. and I was also able to work as a PRN dietitian, which is where you just get hours that you can at different hospitals. so I worked in just general hospital nutrition on the floor, mainly serving people who came in and who were screened for malnutrition. And as a contract dietitian, I was lucky enough to get off offered a role as a cover for a transplant dietitian. When I worked as the fill-in for this transplant dietitian, I loved my job. I loved getting to build connections with the patients. I loved getting to understand how dietitian or how nutrition works for transplant and how many touch points there are. in nutrition for transplantation. And so I was really, really invested in this position. And luckily I was able to then get a full-time role as the as a transplant dietitian. So it's definitely something that I didn't know about as in in my dietetic internship. I don't know if if you got any experience in your dietetic internship with transplant either. Kristen Hicks-Roof PhD, RD: No, not at all. That's what I was saying. When when I saw your name come in, I was like, that is super cool. I mean, when I was faculty in Jacksonville, Florida, we had Mayo Clinic right there. And there were s Dani Pezzuto, RD, CCTD, CNSC: Sure. Kristen Hicks-Roof PhD, RD: we, you know, we had interns going through transplant. And I also had a a friend who was a transplant dietitian. And you're right, the fact that you get and you have to have so many different touch points with these patients, both pre-op, you know, right after, following, you know, more long term to make sure that. Everything is going good. So talk to us a little bit like what is that process? How many touch points do you get? And what do you like about that? Dani Pezzuto, RD, CCTD, CNSC: So we are involved from the moment a patient signs a consent for a transplant evaluation. Our job is to assess for malnutrition and frailty and to identify any factors that would put a patient at risk of developing malnutrition or frailty. A lot of these patients are in end stage organ failure, so they do have a higher risk of developing malnutrition and frailty, whether because they aren't able to eat enough. their body's working a lot harder and the the amount of food that they think is appropriate is actually way under what they need. So we work with the evaluation, we identify any interventions that need to be implemented for these patients. So if they're malnourished, we work with them on their nutrition optimization. If they're frail, we get physical therapy involved and we make sure that they're getting in enough food, calories, protein to help. boost their their mobility and their functional capacity as much as possible. And we also make sure that they are unfortunately there is a BMI range for a lot of transplant centers and depending on which type of transplant you are, there's different BMI cutoffs. So we do also work with patients on healthy weight loss in order to get them to the surgical table. During the transplant episode, we sometimes might need to get involved in nutrition support, whether that be enteral nutrition or parental nutrition. and then post-transplant, it's a lot of you know, food safety education. And then also managing medication side effects, including high blood sugars, seroid-induced hypoglycemia. and also low magnesium, a lot of different medications that these patients are on post-transplant that they're gonna be on for the rest of their life cause some some side effects that we get involved in. So really it's it's a very broad amount of information that we cover, which I think is so, so interesting. Kristen Hicks-Roof PhD, RD: Well, and I love how you talk about the interdisciplinary team, you know, like you have Dani Pezzuto, RD, CCTD, CNSC: Mm-hmm. Kristen Hicks-Roof PhD, RD: start to identify both pro before and then after, like you identify, hey, here's a risk, whether it's pharmacy or you're working with physical therapy, or obviously the, you know, physician or nursing team as well. So I love that part of it. And it really makes you think like you gotta you have to be with this patient the whole process and really know them almost as a person. more in depth, right? When you talk about food safety, like what is their home environment? What what Dani Pezzuto, RD, CCTD, CNSC: Exactly. Kristen Hicks-Roof PhD, RD: sort of you know access to grocery stores or buying power do they have? And then what about their medications? Like do they make those choices on being able to have medication or food? Like there's so many layers to this as a person. Dani Pezzuto, RD, CCTD, CNSC: Absolutely. Absolutely. And I love that you brought in the team factor because I think that's something that really means a lot to me. Not only getting to know, you know, the pharmacists and the social workers, working together with the nurses, the advanced practice nurses, the doctors, I think that we're we're part of the piece of the puzzle. And I really value that we can all work together and come up with plans in order to help the patient best. Kristen Hicks-Roof PhD, RD: Yeah, I mean, I as someone who has dedicated a good chunk of my life to nutrition integration in the healthcare team, there are Dani Pezzuto, RD, CCTD, CNSC: Yeah. Kristen Hicks-Roof PhD, RD: a few subsets within clinical environments. So when you think about like enteral parental nutrition, when you think pediatrics, NICU or ICUs, and then now I'm learning transplant, like it's foundational where you don't always see that in quote unquote general medicine, right? Whether that's you know, your med surge cases or whatever. And it should be because I think, you know, the data that y'all can showcase of how you contribute to patient care could be evident across the health systems. And hopefully we'll continue to go that direction, you know, with billing and reimbursement and stuff like Dani Pezzuto, RD, CCTD, CNSC: Yes. Kristen Hicks-Roof PhD, RD: that to make ensure that dietitians are part of the entire process and not just say ancillary consultation, which only can do so well. Dani Pezzuto, RD, CCTD, CNSC: Absolutely. Yeah. Yeah. Getting involved and being, you know, a se in a seat at the table where all the multi all the people in a multidisciplinary fashion are sitting is is crucial for all dietitians. Kristen Hicks-Roof PhD, RD: So your day to day, you talked a little bit about how you, you know, work with patients across this process, but like what does a day to day look like for you? I mean, in clinic, outside of clinic, charting, have you seen any use of like AI and technologies in these processes? I'm curious. so. Dani Pezzuto, RD, CCTD, CNSC: Yeah, so day-to-day is very different. It's definitely a great position for people who love to not have the same routine every single day. so I'm lucky enough to get to work in inpatient and outpatient settings. So we have certain days for in for outpatient clinics where people will come in and be evaluated or they'll come in for follow-up appointments. but I also just have a list of patients that are admitted inpatient in the hospital that I keep an eye on and see regularly. So and then there's you know different meetings. There's listing meetings for patients to get on the transplant list. There's meetings to discuss how the patients are doing pre or post transplant. So there's a lot of meetings where input is necessary for dietitians. And my team is so great they have you know, they make sure that, we they call it the trifecta, the pharmacy, social worker, and dietitian all get a chance to speak so that we can make sure that everybody's input is considered. and then I'm so sorry. Would you mind repeating the second part of AI. Mm-hmm. Kristen Hicks-Roof PhD, RD: Yeah, I was just curious, you know, you're starting to see, especially you're in a big medical system, which is also a training facility to my knowledge. Dani Pezzuto, RD, CCTD, CNSC: Absolutely. Yeah. Kristen Hicks-Roof PhD, RD: You know, do you see any use of like AI technologies or like things to help you streamline some of your charting and notes? And I don't know the answer to that. I'm just curious. Dani Pezzuto, RD, CCTD, CNSC: So for my role specifically, no, we haven't seen a lot of AI, but a lot of the doctors are using what I've seen. So this is second person. I've seen doctors being able to use AI to help writing to help write their notes. I think there is an opening for social workers to start using AI to help with their notes as well. And so I think, you know, as it gets disseminated across all the different disciplines. Eventually we will likely get a chance, but at this moment Kristen Hicks-Roof PhD, RD: I mean, I just think it could be allowing so much efficiency because ultimately, as dieticians, you know, you're really wanting to spend as many minutes with the patient as possible, right? And you can only do Dani Pezzuto, RD, CCTD, CNSC: Absolutely, yes. Kristen Hicks-Roof PhD, RD: that so much because you're like, okay, well, if I have an hour, I can't stay the whole hour because I have to finish my chart or I'm writing my note during and maybe I'm not giving a hundred percent eye attention or, you know. So I I really hope you start to see more medical systems, obviously a HIPAA compliant, but Dani Pezzuto, RD, CCTD, CNSC: Yes. Kristen Hicks-Roof PhD, RD: more medical systems going in this direction to help with some of like just the the time sink on that. So I'm curious, Dani Pezzuto, RD, CCTD, CNSC: Absolutely. Absolutely. Kristen Hicks-Roof PhD, RD: you know, Danny, as you were like talking about your day to day, and I'm especially thinking food safety is earlier this summer, there was just so many of these like food safety recalls. And so how does like Scientific data as well as for you, almost food safety data. How does that come into your day-to-day? Dani Pezzuto, RD, CCTD, CNSC: It's very much involved in our day-to-day work. I actually have a Google alert for scientific papers that have nutrition and transplant or heart transplant, so that whenever any new transplant papers come out, I can see what they're what they are, and maybe give them a read. food safety is also really important, so I try to stay on top of the recalls. with regards to all of the things that are happening over the summer, last summer, science based eviden or evidence based interventions are really, really important to me. And I think that I do try to make a point of of making sure that there's a lot of research into what I'm recommending. and, you know, if there's something that maybe I'm unsure about, I do always go back to that drawing board to make sure that I'm getting evidence-based evidence based information so that way I'm providing the best care to my patients. That's the most important thing. I'm I'm sure you agree it's nutrition is a rapidly evolving field. So there's so many new opportunities for new research to come out and new new oral supplements, new vitamins, new all all the all these different types of things that are coming out and so I think it's really important that we stay on top of them so that we can ha have information to give our patients if they ask us those questions. Kristen Hicks-Roof PhD, RD: When I loved how you talked about that you set up the Google alerts to get, you know, the most recent papers. So what an easy way, especially if you're in a particular niche or you you really need some of the latest evidence on your topic. it's an easy do where you can get some of that. You know, and for me, my God, I am subscribed to so many newsletters and research alerts because I am You know, I have to look across so many different areas within the research realm, but I'm also just personally Dani Pezzuto, RD, CCTD, CNSC: Right. Kristen Hicks-Roof PhD, RD: curious, like what is coming out? Like, especially I was at earlier this year in in March, I think it was, I was at Expo West, which was like all the new products that are coming to retail. I mean, I walked fast. I mean really fast. And I didn't even get through the entire expo floor in three days. And so it's like Dani Pezzuto, RD, CCTD, CNSC: Gosh. Kristen Hicks-Roof PhD, RD: when you think about not only on the science side, but then you Dani Pezzuto, RD, CCTD, CNSC: Mm-hmm. Kristen Hicks-Roof PhD, RD: have people coming to you with like, Can I eat this product or this new, you know, supplement that's out there? Because I heard it on a podcast. I mean, there's so many different angles that I feel like we get asked about as dietitians, and I remember it so vividly as a corporate dietitian. People would come to me with, you know, diet plans and and different foods that they're buying on the shelf. And I was like, I don't even know what that is. Like, you know, and so I'm like, okay, step one, I have to figure out what product you're even talking about or what routine you're talking about. Then Dani Pezzuto, RD, CCTD, CNSC: Exactly. Yep. Kristen Hicks-Roof PhD, RD: step two, you're like, okay, is there any evidence on this? And then step three is okay, if there's not evidence, can I make the best clinical judgment to say that might make sense for you? And so There's all these layers that I think people often are like, Well, you're the nutrition expert. I'm like, Yeah, but I I can't know everything. I mean, right? Especially when you think about like Dani Pezzuto, RD, CCTD, CNSC: Right. Exactly. Yeah. Kristen Hicks-Roof PhD, RD: your process your role in this transplant process, like going from before, whether that's you know, weight management or or different biomarkers within the system, all the way to after on the food safety, which is like a whole nother area of discipline. Do you see that too? Dani Pezzuto, RD, CCTD, CNSC: Absolutely. Yes. I think that there's so many new things coming out. And I do believe I I there's I don't want to say it's impossible because I don't think anything's impossible, but it is very difficult to know everything about nutrition, especially with all the new areas of research, supplements, everything coming out. so being able to identify where to get information is also really important. and I imagine, you know, walking through that expo I've definitely been there in terms of getting as many info cards as possible, as many business cards to be able to reach out to people. and I think that is really special too, to be able to get all of that access firsthand. Kristen Hicks-Roof PhD, RD: Right. Well, and and it's such a great immersion. That's one of the things I love about conferences. You're just like, okay, just hit me with all the information, slowly Dani Pezzuto, RD, CCTD, CNSC: Mm-hmm. Kristen Hicks-Roof PhD, RD: be able to digest it, and then figure out, okay, where does this apply or can it apply? so yeah, I think I think it's a tricky part. And hopefully, you know, I AI can help so much. Like if people are using, you know, Claude or Chat or whatever platform they're using, it can help with some of the information. But to me, I found like I have to go back. Buy the product, right? Like Dani Pezzuto, RD, CCTD, CNSC: Mm-hmm. Kristen Hicks-Roof PhD, RD: if it's a high protein pasta, like how do they cook it? How do they best, you know, make sure that it tastes good of for them to be able to want to eat it over and over. And so, and Dani Pezzuto, RD, CCTD, CNSC: Absolutely. Kristen Hicks-Roof PhD, RD: that's just like one example that I just thought off top of mine. But I remember when I was a corporate dietitian, I there was like a new it was like a tofu spaghetti. So it wasn't a Dani Pezzuto, RD, CCTD, CNSC: Interesting. Kristen Hicks-Roof PhD, RD: It wasn't a grain spaghetti. It was actually in the in the salad area. Like where the salads and tortillas and stuff kinda were, like the colt. And it's a refrigerated, like a protein spaghetti, 'cause there's no grain. Dani Pezzuto, RD, CCTD, CNSC: Interesting. absolutely. Yep. Kristen Hicks-Roof PhD, RD: And so I was like, Well, I have to like try it because like what does it taste like? You know? And so yeah, that that example just I always love to go to the grocery store and pick up one new product I've never seen before. so Dani Pezzuto, RD, CCTD, CNSC: Yes. I love doing that too and then getting to test it out with different flavor combinations so that I can let people Kristen Hicks-Roof PhD, RD: So fun. Dani Pezzuto, RD, CCTD, CNSC: know this is how I liked it. I don't know if you're gonna like it this way, but this is how I liked it. Mm-hmm. Kristen Hicks-Roof PhD, RD: Right. Yeah. Has there been anything that you've done lately that you're like, that's cool. I never heard of that product or thought of it or seen it. Dani Pezzuto, RD, CCTD, CNSC: Mm. I guess so we focus a lot on protein pre-and-post-transplant. So I'm always looking at the new protein products that are coming out and trying them. Kristen Hicks-Roof PhD, RD: They're everywhere. Dani Pezzuto, RD, CCTD, CNSC: They're everywhere. there's like protein water now. so I've tried every time I go to the grocery store, I try to get a new protein snack to try out. because there's only so many protein foods. And there's only so many ways you can have different proteins. but it is important to make sure that everybody gets enough and for for transplant specifically. And so I've definitely had my fair share of protein powders, protein bars, to try. Kristen Hicks-Roof PhD, RD: You need to go to XOS. I'm telling you, you can't walk one step without getting a protein option. and maybe Dani Pezzuto, RD, CCTD, CNSC: Mm-hmm. Kristen Hicks-Roof PhD, RD: it's a phase, I don't know, but yeah. So what's been your favorite or something you're most proud of in your career so far? Dani Pezzuto, RD, CCTD, CNSC: I would say my favorite part about my career is getting to see people post-transplant, recovered and back to their life. I also work with kids, so getting to see them after their transplants and see them grow. a lot of times these kids are way off on the growth curve, like they're so far down because of their end stage disease or maybe their congenital renal disease, their liver disease. So being able to see them recover and climb back up to like the 50th percentile in the growth curve is so rewarding to me. I just love getting to build the relationships with my patients and see how well they do post transplant because I think that's like that's that's what we're doing. So I I just love getting to see that outcome. Kristen Hicks-Roof PhD, RD: When and you're in such a unique spot that like you get to work with the patient and their families over such a Dani Pezzuto, RD, CCTD, CNSC: Mm-hmm. Kristen Hicks-Roof PhD, RD: long period of time, which I think Dani Pezzuto, RD, CCTD, CNSC: So the Kristen Hicks-Roof PhD, RD: one of the things that I've heard from people who've worked in some of the other niches within clinical, you get a little bit of burnout because and you might Dani Pezzuto, RD, CCTD, CNSC: Mm-hmm. Kristen Hicks-Roof PhD, RD: get burnout too, but you get burnout because you're helping people, but it may be a, you know, a one time or I'll see them again in six months, and you don't necessarily like along the entire process. Dani Pezzuto, RD, CCTD, CNSC: Exactly. I think Kristen Hicks-Roof PhD, RD: So I do feel like you're fortunate in that part. Dani Pezzuto, RD, CCTD, CNSC: yeah, absolutely. I because I've worked in other areas of clinical and I think that it is so special being able to get to know somebody really well and get to know their circumstances really well and have that much more of an impact and ability that support where we're needed. think that's so powerful and that's something that I really appreciate about being a transplant dietitian. Kristen Hicks-Roof PhD, RD: Yeah, no, I would too. That was one of the things I loved about being a corporate dietitian. Dani Pezzuto, RD, CCTD, CNSC: Mm-hmm. Kristen Hicks-Roof PhD, RD: Like I worked with some people for like three years. I mean, and it was awesome. Like, you know, Dani Pezzuto, RD, CCTD, CNSC: Awesome. Yeah. Mm-hmm. Kristen Hicks-Roof PhD, RD: they come in and it's like, how's your family? How is your daughter's birthday party? Like you get to also develop this like really nice, deeper rapport. And then it also helps build the trust. Like, there's so many layers to it. so Danny, if you were to think about someone who's interested in a role like yours or in the transplant niche, what tips would you have? And I would love for you to talk about some of the credentials you have because I've never seen some of them. And yeah, just did that help you in getting the roles that you have or did you get them after? Dani Pezzuto, RD, CCTD, CNSC: So I did get my credentials after my role. I think that specifically where I work, and from what I've seen as I've connected with other transplant dietitians, is that it the person who likes to get involved and ask for things and make sure that you're reaching out, networking with people. is really important in transplant because you are working with so many different disciplines. You're working with diabetes educators, you're working with endo, you're working with nephrology, cardiology, your habitology. So it's important to make sure that you're, you know, you're touching base with a lot of different people and making sure that you're putting yourself out there to get some of these opportunities. I think, you know, transplant wasn't something in my dietetic internship that we got a lot of experience in. so I remember, you know, you have a an option to reach out to different people to to get experience on things that you're interested in. I remember reaching out to people about like critical care, parental nutrition to make sure that you get like a very well rounded education, which I think is important. but people from all different places, dietitians from all different places can come over into transplant because it's so there's so many different, I don't know how to put this exactly, but there's it there's something for everybody in transplant nutrition. people from if you work in dialysis, you likely see pre-transplant patients all the time. So you've got that understanding but with you. I think I think for people who want to get involved in transplant, I think just being able to have an open mind about where you're going, making sure that you are prioritizing that patient care relationship, I think it's also really important to be a go-getter. I think it's important to make sure that you're you're consistently trying to learn new things. I think that that's a really valuable skill to have as a dietitian, but especially as a transplant dietitian, because you know, there's not really a specific there's a there's a book on transplant nutrition, but there's not really like a textbook or anything involved like that. So there's NATCO which is really important. that's the transplant conference. So you can get a lot of different information about transplant nutrition and about transplant in general from that from that website. and Aspen has a short guideline on transplant nutrition, but really it's it's a lot of piecing together different parts of nutrition and putting it together to make sure that the plan is well rounded for the patient. my CCTD is the transplant dietitian certification. you there are a couple different requirements in order to get this certification. So one is you need to be involved in transplant for a certain number of hours. And then you also need to be involved in research or presenting information on transplant nutrition. Which I think is really I I think that getting the CCTD was really helpful in my role, but it wasn't necessary to get to be a transplant dietitian. the CNSC is the nutrition support certification, which I think was really helpful for me because it talks through a lot of pharmacologic interactions with medications, enteral nutrition and parental nutrition access, line access, which I think is very important during the transplant episode. so the certifications that I got were really just a way of making me better at my job. Yeah, that makes sense. Kristen Hicks-Roof PhD, RD: Yeah, no, and I'm glad you talked about some of the resources and you dove a little bit deeper on their credentials because I think some people they don't know if they have to get those before the job or after Dani Pezzuto, RD, CCTD, CNSC: Mm-hmm. Kristen Hicks-Roof PhD, RD: the job. But I do think what to what I'm understanding with you is you can go into the role, be open and eager to learn and want to work hard, but then you can get some of these additional trainings afterwards to be able to say, okay. It will help me with a better understanding of the clinical management, right? Of entral and parental nutrition support, which don't bring me back to those days. I did not like those days. I th I like some math, but I no, I th that was so hard for me, I remember. so I think that's super helpful and some really good tips of hey, like just start to build your network if you want to go into this space or go to that. you know, that website and the conference, like with people who are in these spaces, because I imagine that this is not like a widely advertised job, you know, because there's it's not like a standard quote unquote clinical dietitian. Dani Pezzuto, RD, CCTD, CNSC: for example, like we work with the diabetes educators and you know, getting to know them really well can lead to asking, Hey, would you wanna help me get my C D C E S and that can help you then become, you know, a little bit more knowledgeable with diabetes and educating your patients on that. So just an example. Kristen Hicks-Roof PhD, RD: When and because you were talking about I mean, you have so many different organ systems. So you are working with renal and heart and kidney and liver, right? Like there's all these different organ systems. So you really have to be somewhat a jack of all trades to understand the physiology and the nutrition among each of those systems, as well as all the social and cultural and demographic factors. So yeah, there's a lot of intricacies there where I could see additional certifications would really just give you the leg up to be able to support these patients to the best of your ability. Cause it's very clinically intense over a period of time. So Danny, if you had a crystal ball, what do you think is coming next in nutrition? Dani Pezzuto, RD, CCTD, CNSC: So I think, and we touched on it a little bit earlier, like with the food recalls going on. I think that right now there's kind of this not storm, but there's like this perfect environment. So GLP one medication is becoming increasingly more popular and more prescribed. and there's also a lot more food recalls going on. There's so you know, there's a lot of blackouts going on across the country. I think that processed foods are likely going to become a lot more popular, things that are shelf stable. we've seen it with like protein powders, we see it with like fiber bars, fiber powders, vitamins. I think that there's a very interesting area for growth of making sure that people who can't eat as much, whether that's because of GLP1s or because the lack of food access or maybe they have they don't have power for periods of time. I think that there's a an opportunity for like a oral nutrition supplement that is meant for just people in general. I know that There's NSHR, there's Lucerna, there's all different types of oral nutrition supplements now, but I think that people are looking for like a one a one size fits all or a one fix fixes everything. so I'm interested to see what kind of development that will look like. Kristen Hicks-Roof PhD, RD: It's so interesting you say that because you really do have you almost have two sides of the coin that are happening though. Like I see what you're saying where you know you have GLP one and recalls where it's like, okay, you gotta push people towards something that's maybe more shelf stable and food safe, right? But Dani Pezzuto, RD, CCTD, CNSC: Mm-hmm. Kristen Hicks-Roof PhD, RD: then you have the flip side of the coin, which is like eat real food and you know, getting Less process, less ultra pro quote unquote, less ultra processed food sources. And so there's almost like this dichotomy that's happening that it's like, where do you have this synergy between these? Because yeah, we want people to eat a fresh food item, but if there are recalls, then that's maybe not be an option. Or if you have like a GLP one patient, which I've worked with and talked with many people on these, they don't have an appetite. So you need to put Something that is so nutrient dense in them that in a minimal quantity of food too, right? So like Dani Pezzuto, RD, CCTD, CNSC: Yeah. Kristen Hicks-Roof PhD, RD: you talked about like the protein water. Like, is that what the direction we're going? I just I have such a hard time with this as a dietitian, too, because I'm like, there's enjoyment out of food, right? Like you should Dani Pezzuto, RD, CCTD, CNSC: Yes, exactly. Kristen Hicks-Roof PhD, RD: want to eat a meal with your family, or you go Dani Pezzuto, RD, CCTD, CNSC: Mm-hmm. Kristen Hicks-Roof PhD, RD: and have a happy hour with a friend or a work colleague. And so it's like, Are we getting to the point where food is a substance versus the the opportunity about like going to the store and cooking a fresh meal together? I don't know. I don't know what the right Dani Pezzuto, RD, CCTD, CNSC: Absolutely. Kristen Hicks-Roof PhD, RD: answer is. It'll be interesting to see these things converge. Dani Pezzuto, RD, CCTD, CNSC: Definitely. And I do see I see a trend towards like f making like raising your own gardens, raising your own meat birds, you know, getting your own food, growing your own food. So I'm I'm interested to see how it will play out. I'm hopeful that food doesn't become a luxury item, and that it still can be something that we can all enjoy and afford. Kristen Hicks-Roof PhD, RD: When and man, I used to do when I was an academic, I did some work in like food forest and you know, at home gardenings. It's like that's great in theory. Most people don't have the skills, the knowledge, the time, the resources to do a lot of that. Like it's like I've told my husband, like, I would love to get chickens. I would love to homestead. He's like, You're crazy. You don't like cleaning poop or you don't Dani Pezzuto, RD, CCTD, CNSC: Yeah. Kristen Hicks-Roof PhD, RD: like and I'm like, Yeah, but let's forget about that. Like I just wanna have chickens in my backyard. He's No, you don't. Dani Pezzuto, RD, CCTD, CNSC: Yeah. Kristen Hicks-Roof PhD, RD: So, well, Danny, thanks so much for being on the show and walking us through your experience as a transplant dietitian and giving some nice tips and advice there. if you like the show, make sure you like, subscribe, leave a review. But most importantly, check out the next episode because every episode I bring out a different dietitian and nutrition expert to share their story and give you tips and advice on how to be successful.