Nutrition Essentials | Inside the Mind of a Dietitian

Podcast Transcript

John Horton:

Hey there, and welcome to another episode of Nutrition Essentials, a spinoff of our popular Health Essentials Podcast. I'm John Horton, your host.

What do you see when you look at an apple? For most of us, the answer is fruit. Maybe it's red-colored fruit, maybe it's green-colored fruit, but it's basically just a piece of fruit that we consider healthy. A registered dietitian, on the other hand, sees a bigger picture. They look at that same apple and see fiber to aid digestion and gut health. They see vitamin C to boost the immune system. They see potassium to help control blood pressure. In their eyes, food is more than just something to eat when you're hungry. It's a nutritional opportunity to better your body.

So today, we're going to go inside the mind of a registered dietitian to learn more about what they do and how they think. We've got the perfect candidate for this educational exploration: Julia Zumpano, our resident dietitian on the podcast. Julia has been with Nutrition Essentials since day one to unlock the secrets of food so that you can be the best version of yourself. It's what she's been doing at Cleveland Clinic every day for more than 20 years. It's safe to say she feels strongly about the connection between diet and health. She's got quite a story, too. Let's get to know a little bit more about Julia, as well as what she does on the job.

Well, Julia, I have to say, it almost seems odd to say, “Welcome to the podcast,” but I guess, welcome to the podcast! You are our guest today.

Julia Zumpano:

Well, thank you so much for having me.

John Horton:

To get things started, we're here to talk about just being a registered dietitian and everything that goes with that. But let's start with a little bit of getting to know you a bit. There's no better way to do that than with just: What did you have for breakfast today? I want to know what a dietitian uses to get going in the morning.

Julia Zumpano:

Well, it's a great question. I typically — and this is not an answer that I think most people would think that I would say — but I typically skip breakfast.

John Horton:

What?

Julia Zumpano:

Yeah.

John Horton:

It's the most important meal of the day!

Julia Zumpano:

Well, it is. It is for some. For others, I think we can incorporate that meal later into the day. I do love breakfast — it's one of my favorite meals to prepare and eat, especially on a Saturday morning with my family. But day-to-day, I generally start my day off with a workout. I do better when I'm working out fasted. I do follow an eating window most days and start my meal off usually around 11, late morning. I'll start off-

John Horton:

…that's a late breakfast, yeah.

Julia Zumpano:

…a late breakfast, getting a workout in, and getting situated for the day. Then, I'll settle down to have something.

John Horton:

Well, what did you have at 11?

Julia Zumpano:

I usually start off ... today, I made some baked oatmeal. I usually bake it in the oven and throw as much as I can hide in there for my kids and myself. I made baked oatmeal with some ground flaxseeds, and I used a couple eggs and some cinnamon, a little maple syrup, and mashed some bananas in there, some apples. Sometimes, I'll throw a scoop of protein powder, some peanut butter in there, and bake it up. Usually, snack on that during the week.

Then, a couple hours later, I'll have a protein shake. Usually, a pretty loaded protein shake. I throw all sorts of things in there. Depending on what I have, I'll throw some frozen veggies in there, chia or flaxseeds, obviously, some protein powder. I'll throw beets in there, celery, some spinach or kale. Whatever I have around, I'll load it up there, too.

John Horton:

Well, I don't know how it's possible, but you somehow made a bowl of oatmeal sound even healthier than it normally sounds. I guess that comes with being a registered dietitian.

Julia Zumpano:

Well, this is baked oatmeal, which I would highly recommend. I'm not a huge fan of a bowl of oatmeal.

John Horton:

The mushy stuff?

Julia Zumpano:

Yeah. I'll make it into baked or muffins. Or overnight oats, I'm a huge fan of, too.

John Horton:

Alright. Well, obviously, just from the way that you talk about making food and what you eat, you're obviously very passionate about it. Tell us a little bit about how you decided you wanted to become a registered dietitian.

Julia Zumpano:

I always was very interested in healthcare. My mom was sick my whole life, so I was in and out of hospitals with her, recognizing the value of good health as a child. My father struggled with his health. I had two elderly grandparents that lived next door to me. I went through a lot of health concerns. I was actually one of the only fluently English-speaking family members out of the four of us, so I was definitely a primary caregiver for my parents, as well as my grandparents, and helping them navigate through their health. Just keeping well, I guess, I just learned the value then, so early on.

As a child, I always wanted to be a pediatrician. Then, as time went on, I realized how much school went into that. I worked at a little restaurant and a dietitian worked there in the kitchen. She told me about what she did and what her training was. I had actually never even heard of a dietitian, but the second she told me what she did, I was very confident that that's what I wanted to do. That was the path-

John Horton:

…wow.

Julia Zumpano:

...that was mapped out for me.

John Horton:

Oh, that's really cool. Does she know that she was your inspiration?

Julia Zumpano:

You know what, I don't know. I was quite young, I was 15, I think, at the point. I'm not sure if she even knows I'm a dietitian.

John Horton:

That's kind of neat how people just enter your life and send you on a certain path.

Julia Zumpano:

Absolutely. It just proves that you can influence people just by your words and actions every day. You may not ever know what influence you had on them.

John Horton:

You just shared a lot about your backstory. You started us there when you were 15 and you were working in this restaurant and you head down this path. What did you do after that to build your credentials and become the fabulous dietitian you are today?

Julia Zumpano:

Sure. I actually started working for the hospital system in the Akron area as a diet tech. I worked in the kitchen and took food orders. Learned a lot about the way that the inpatient part of nutrition worked. I worked there through college, as well as several other service jobs as a server. I was embedded in the food industry quite a bit. Went to the University of Akron and was a part of their coordinated program, where you're coordinating your internships and all your schooling. Then, that program was quite intense, so I decided to take a break. I went back to the didactic program, and then landed an internship at the Cleveland Clinic, which is where I started and where I continue.

John Horton:

Yeah. It sounds like there's a very dedicated educational program to become a dietitian, right?

Julia Zumpano:

Absolutely, yeah, it's a four-year bachelor's degree in science. Then, about a one-year-long internship, and then a registration exam and licensure. They've just required, as of 2024, to have a master's degree in nutrition to be able to be a registered dietitian. It's definitely pretty intense.

John Horton:

Wow. I thought, too, now, you have a specialty with your dietitian role, too, correct?

Julia Zumpano:

I do specialize in preventative cardiology, that's where I've spent most of my career at the Cleveland Clinic. About 20 years in preventative cardiology.

John Horton:

Wow. It's a great place to be. I'd imagine there's a lot you can do there to really make a difference for people.

Julia Zumpano:

There is. What I've always loved about preventative cardiology is that they very strongly value nutrition. Almost every patient that comes through the doors is referred to a dietitian, whether they want to or not. They're at least encouraged to consider it or at least be seen at least once. In cardiac rehab, which is a part of preventative cardiology, we do phase two cardiac rehab. They are required to have at least one visit with a dietitian.

John Horton:

OK. Well, all you ever hear about is “heart-healthy diet.” It seems like that's constantly a phrase that comes up. I know that there's heart-specific diets, cardiology ones, but it goes with just about everything in the body. There's certain diets that are better for your gut or your lungs, or anything really.

Julia Zumpano:

Absolutely. There are so many different specialties within the realm of nutrition. You have gut health, brain health, you have metabolic health, including things like diabetes, pre-diabetes. Obviously, heart health and prevention. Overall wellness and disease prevention. You have oncology, which is dealing with cancer patients. Bariatrics, which is dealing with bariatric surgery or medical weight management. There are so many areas. There's even things like intestinal rehab and IV nutrition, which is what we call parenteral nutrition. There's so many different areas of nutrition.

John Horton:

What's amazing, while there's similarities between all those, they all have slight differences that just make each one unique to what it's working for in your body.

Julia Zumpano:

Yeah, they all do have similarities, but then some of them are so vastly different. If you're treating a patient with parenteral nutrition, you're really making sure ... it's a lot of numbers, calculating the exact amount of calories, fat, protein, nutrients this person needs in a formula to provide them their sole form of nutrition.

Then, when you're counseling patients in maybe an outpatient setting, you really have to look at their lifestyle factors. Their economic factors. Where they live, what kind of food they have available to them. Who they're eating with. There's so many things that influence how you eat and what you eat, and it's not just a matter of you should eat this because it's good for you. It's a matter of how can we incorporate the foods that are available to you, are reasonable for you to consume on a regular basis to enhance your health.

John Horton:

Wow, that's an awful lot to remember. That's why I'm glad I'm usually the one just asking questions here and I don't have to have all that information because that's a lot to remember.

You've given us a lot on your professional background and your route there. Tell us a little bit about yourself personally. Your home life … you mentioned you had kids. What's your crazy life like there?

Julia Zumpano:

Sure. I do, I have three children. They are 13, 10, and eight.

John Horton:

That is a crazy time, yeah.

Julia Zumpano:

Very crazy. They keep me busy. They're very active. My husband's also very active. We do try to focus on being a very active family. I was a fitness instructor, a group fitness instructor for about 12 years prior to having kids. Fitness has always been a huge secondary hobby to me. I love working out, I love all forms of working out. I've tried them all, I vary throughout them all. It makes me feel good. I've always craved it ever since I was young. I started playing soccer in high school. I was a gymnast and swam when I was younger. I've always been active. My parents always had to keep me moving because otherwise, I would drive them crazy. I'm one of those people who have a lot of energy, not necessarily suffer from not enough energy. Which is a blessing in most times, most cases.

I'm very active. As I mentioned, very active with my family. In the summers — my all-time favorite season — we have a boat, so we tend to go boating a lot in the summer, which I find very relaxing. Just wonderful to enjoy. What we have in Cleveland, the beautiful lakes we have in Cleveland and really, all around the U.S. We've traveled around with the boat, too. Those are the types of things I really enjoy.

John Horton:

I'd imagine with three kids, you have had some rather interesting discussions with them as to the value of nutrition and what's good to eat and what's not so good.

Julia Zumpano:

Absolutely. It's interesting because I do a lot of media for the Clinic. My son's like, "Oh, my teacher saw you on TV talking about food dyes." Then he's like, "Oh, I guess I shouldn't be drinking this Gatorade™," or whatever sports drink, not to call out specific names. It's interesting because not only do I preach it at home, but I preach it to the masses and whoever will listen. It's starting to influence, certainly them, and our surroundings as well.

John Horton:

Well, do you have a personal approach to eating? Is there a certain way in which you go about it?

Julia Zumpano:

Yeah. Personally or professionally?

John Horton:

Personally, yeah. Like you-

Julia Zumpano:

…yeah.

John Horton:

…when you're setting up your meal plan for the week and when you're scheduling something, you go to the grocery store, what's it look like?

Julia Zumpano:

Yeah. I try to really focus on variety. Of course, I'm going to take into play what everybody enjoys because you're feeding five people. If I ate on my own, my menu might look a little different than it does for the family. But I really focus on balance. Every meal is very balanced. It always has a carbohydrate, a protein and a vegetable. Usually, I serve several vegetables just to be sure we have something someone will like and consume. That's usually the basis for all my meals and that's how I plan my meals.

I may even just have all of those things available. I don't necessarily plan each day out. But I may say, “OK, well, tonight, we're going to have steak, potatoes and green beans.” Or I'm going to roast vegetables. Or we're going to do an Asian night. But I usually try to have an inventory of a lot of options, and then, based on how my week goes and my evenings go, which with three kids and activities, there's very little time to prepare-

John Horton:

…you have tons of time, right?

Julia Zumpano:

…yeah.

John Horton:

Just tons of time.

Julia Zumpano:

There's very little time to prepare meals some nights. I base it on the nights we're really busy, we do quick meals or I double-batch what I'm making the night before so we have leftovers. Then, those nights that we have a little bit more of an open schedule, I will take a lot of extra time to do more of a glorified meal.

John Horton:

I'm guessing that you have a pretty stocked freezer.

Julia Zumpano:

I do.

John Horton:

With things that you can pull out in a moment's notice to — bam — instant meal.

Julia Zumpano:

I do, I do. I have a good inventory. I think that's always been the key for me is having a good-stocked freezer. I have an outside fridge. I'm rotating stock. I have berries in the inside fridge and things that go quick, and then I have things like apples, an extra bag of oranges. I never want to run out of fruits, vegetables or good food, so I always have a stockpile of stuff.

John Horton:

That's so much of it. I know I've learned this in just working with you on all these podcasts, healthy eating often comes down to good planning. We tend to fall to the side or go off the rails when we just need something right then and we don't have something sitting in our fridge ready to go. That's when you order up the pizza or go grab a couple burgers or do something else like that.

Julia Zumpano:

Absolutely. It totally comes with good planning. Everyone's gotten to the point where they're like, "Oh, I'm starving and I don't know what I'm going to eat for dinner. I don't know what to have a snack, I haven't prepared." Then, you have to choose something from wherever you're at. Usually, those choices, those convenient, quick choices, are not ideal.

One trick I've always done, my kids come home and they're starving when they get off the bus...

John Horton:

Right.

Julia Zumpano:

I'll put a tray of fruits and vegetables out. They'll start opening the cupboards and I'm like, "Nope, go to the fridge. We're not starting with the cupboards. Whatever you want has to come from the fridge." Or I'll start cutting it all up. It doesn't even matter what I put out, they'll devour it because they're starving. That's a really great time to harness that hunger and plan ahead because when we're searching, we're looking, it's hard to decipher: Are we hungry? Are we looking for a snack? We're trying to satisfy not only maybe a physical hunger need, but a little bit of an emotional need. “I'm finally home, I'm done with this hard day. I just want to relax and eat something that's going to make me feel good.”

But I think planning ahead a little bit for that will help set the bar of making good decisions. And also, just feeling your best in that moment. Getting maybe the energy you're looking for, getting some nutrients that you might need, and then also just feeling good digestive-wise of what you ate, and being able to move on with the rest of your day.

John Horton:

I'm always amazed. You make it sound so easy. Then, I go upstairs and hit the kitchen, I can hear that bag of pretzels calling my name.

Is it hard or was it hard for you to get to that point where you just go for that healthy choice as your first choice?

Julia Zumpano:

I think that's ... I can't be compared to normal, the average normal person. I don't think that's fair. I tell my patients that all the time, I tell them I'm nutritionally brainwashed. I'm completely brainwashed. I can't go into the cupboard and grab pretzels without thinking, "This is not the healthiest snack. I should have done this." Or "This doesn't have enough fiber." I'm brainwashed. It's all just programmed in my mind. I've done this for so long, I have so much compassion and value toward it that I think I can't be compared to just the everyday Joe. It's not fair to any of my patients or anyone listening to say that.

It does take time. It's taken me a lot of time. I've evolved and learned a lot. I put myself through so many tests, I'm my own guinea pig. I've tried multiple ways of eating styles, of different ways to prepare food. I like the challenge and the test. That just makes me be able to become a little closer to that normal Joe that I can maybe try to connect with them on a more in-depth, personal approach, versus the way that I look at things — I recognize are not the way that everybody else does.

John Horton:

Do you have that food, that temptation that's there, that one food you're like, "Oh, this is my cheat food"?

Julia Zumpano:

Yeah, I would say for sure I do. From a savory perspective, french fries are ultimately my all-time favorite.

John Horton:

It's hard to say no to them. There's just something about them.

Julia Zumpano:

So good. Then, from a sweet side, I just love chocolate. I love anything that's chocolate. A flour-less chocolate torte is one of my favorites, something nice and rich and heavy, you don't need a lot.

But I try to indulge in those on a regular basis because I don't like the thought of deprivation for anyone. I have a piece of dark chocolate almost every day. I don't ever feel like I'm deprived or I need to crave something because I allow myself it every day. I don't eat french fries every day, but I do allow myself to have french fries when I want. Or I make these roasted potatoes that, in my eyes, just fulfill that need. I introduce things that I want and regularly crave. I try to make them more healthy versions. Yes, I have the unhealthy versions on occasion. But the fact that I get them more regularly in a healthy version allows me to not feel like I need the unhealthy version that often.

John Horton:

Wow. Even when you talk about your cheat foods, they somehow seem healthy. You turn french fries into somehow roasted potatoes and your sweet treat into dark chocolate. But I guess that's a mindset that you start to build where food is good, and you can find the joys in the things that are also good for you. It's not healthy stuff is yuck and all the bad stuff tastes great. It's the healthy stuff tastes great, too. You have to embrace that.

Julia Zumpano:

I completely agree, I do. I think it's a mindset. I think just like anything else. Running a marathon is a mindset. Most of our bodies can sustain it. Of course, we're worried about if we can run it. But really, if our mind's telling us we can't do it, we could be in the most pristine shape, but we may not ever be able to complete that because our mind is inhibiting us from doing it.

It's really a mindset. It's really just being able to look at nutrition in a different way, look at food in a different way. Look at food as something that nourishes us, that provides us health, that provides us just so much nutrition to help us become the best version of ourselves. I do think it's switching that a little bit.

John Horton:

As a dietitian, I would imagine any time you're out, you're at a party or something like that, you are getting questions from people. Whether they're holding up something they're eating, asking if it's healthy, or going over what their meal plan is. What are the most common questions that you get? Or even, some of the funniest ones.

Julia Zumpano:

Sure. I often have very random people just telling me what they're eating all day. They'll go through their whole day and tell me about it.

John Horton:

It's like a confession.

Julia Zumpano:

I'm not really sure if I'm supposed to be commenting, encouraging. I just nod and be like, "Good job." I'm not on the clock right now.

I will take any opportunity if they ask. I love when people want to know more. I'm definitely there to answer questions. I do tend to stay within my lane because I think food, in a personal and social setting, people are like, "Oh no, here's the dietitian. Hide my plate." A lot of times, my answer is like, "I really don't care what's on your plate." I'm proud of whatever you put on that plate because it makes you happy and that's what you want. That's what I'd want for you. Trust me, I'm not nutritionally analyzing your plate. I'm not judging what you're doing. I just want you to be happy and enjoy food. If you would like some information from me, I'm happy to answer any questions. I don't like to be known as the “food police” — I really don't like that analogy.

John Horton:

At a party, maybe people aren't looking for that detailed information.

Julia Zumpano:

No.

John Horton:

But let's go now, if somebody comes in, they make an appointment, they're going to come visit you because they want to go to a registered dietitian and get their diet in order. What's a visit to a dietitian like?

Julia Zumpano:

In general, in an outpatient setting — that's the setting that I work in — there's an inpatient setting, which, you're in the hospital, that looks very different than an outpatient setting. But in an outpatient setting, we usually, whether it's virtual or in-person, start off with a lot of basic demographic information, as well as an assessment. I start off with a full assessment. I'm looking at height, weight. I look at exercise. I ask a lot of questions about activity. I'll ask questions about sleep. Then, I'll get a full diet history.

The diet history, depending on how much the person wants to share, might look like exactly what they were eating or what they typically eat. Or it might look … if they're not really into sharing or they're just ... a lot of people can't recall what they ate because they don't really put that much thought into it. They're like, "I don't even know what I ate. I can't even remember what I ate for lunch yesterday. I don't even know, I just eat what's around." Those are the hardest for me. I tend to just ask, "Well, how often do you eat out? How often do you eat red meat? How often do you eat cheese?" I'll pinpoint foods and ask how often or what kinds of those foods they eat to get a little bit more of an understanding.

I think the assessment piece is key because it tells me where they're at at that moment. I'm not going to suggest a plan that's completely opposite of what they're eating. I think that's also a misconception. They're like, "Oh no, here we go."

John Horton:

Right.

Julia Zumpano:

"You're going to tell me I can't eat anything." I'm like, "That's actually the opposite of what I'm going to do here." I don't want to be restrictive. Most dietitians are trying to enhance people's nutrition, so they're not trying to take away. We're trying to add.

That piece is key for me is to look at a full picture of where they're coming from. Then, I also assess what their readiness to change is. I'm also trying to see, "What changes have you made? What has worked for you? Where are you at? What are you looking to change or accomplish?" Then, I base my plan on all of those facets. If it's a busy mom like myself, I might just focus on a couple main points that I see will make a big influence. Or if it's maybe a retired male that just had heart surgery and has a little more time, I might focus on education with him and his wife on how to change their cooking, and change their meal prep and planning and snacks. It really just depends on where they're coming from.

John Horton:

How far back do you go in somebody's life to figure out where they develop their eating pattern and their habits?

Julia Zumpano:

It really depends on what they're seeing me for as to how far back I go. If we're looking at weight management and someone who's really struggled with their weight, I'll look back pretty far just to see what's worked, what hasn't worked, what they've tried. What their struggles, pitfalls are. If it's someone that's a post-operative cardiac patient, then I'll probably look more at what we've done in the past, I'll have an idea, and still try and incorporate some of the things that they did in the past. But just try to build and improve on choices versus changing everything. Then, of course, I would focus post-operatively on nutrient density because they're still after surgery, healing, et cetera. It's all very dependent on why I'm seeing them.

John Horton:

I was going to say, is there such a thing as a “typical” patient? Or is everybody unique, and you see people from the very young to the very old?

Julia Zumpano:

Yeah. I do focus on adults. I do not see children. There is a specific pediatric nutrition department that they see kids. I am seeing anyone 18, 20 and then older. I would say that in my clinic, and in my department, since it is so specialized, I am seeing people within their 40s to 80s.

John Horton:

Yeah.

Julia Zumpano:

I'm spanning in that era of their life. No, there is not a typical patient because there's not a typical person.

John Horton:

Yeah.

Julia Zumpano:

We're all so different, we eat differently. We wake and sleep differently. We exercise, we have different jobs. We have different upbringings that have influenced our ideas and habits around eating. I don't think there's anything typical.

I would say that there's typical criteria. You may have a patient that's pretty well versed in nutrition, but they get in these traps, these cyclical traps of some bad choices or bad habits. Then, it's just helping them break through those traps. But they have the core information and knowledge. They know a lot. It's just a matter of working with their behaviors. Or then, you have patients that really have not been exposed to a lot of nutrition information or didn't seek it out on their own, or maybe never had to worry about it or never thought about it. Now, all of a sudden, they had a very scary event and they're ready to upload and change everything. It's very variable, based on what brought them there.

John Horton:

Do you find most people are really willing to make those changes? Healthy eating, you want to just talk about it like it's hard. But in reality, it feels like it's not. We all know what's healthy and what's good. We can look at broccoli and go, "This is probably something that should be on my plate a little more."

Julia Zumpano:

Right.

John Horton:

As opposed to a piece of pie.

Julia Zumpano:

Yeah. I think that's where I assess that readiness to change. I think some people are more ready to change than others. Then, I would base my plan on that. I think some people are really very motivated to do anything they can to improve their health, anything. I tell them to do it, they'll do it. But they've already changed their mindset — back to that mindset piece. Then, there's some that they may have been referred by their doctor, or they're not sure why they're there, they didn't really request seeing a dietitian. I tend to back off on those patients and just pinpoint a couple small changes that will make a positive impact on their health.

John Horton:

You always do emphasize that, which is one of the things I love about the advice you give. It's always you make these small, incremental changes and adjust. Maybe you don't have to overturn your entire diet in a day. But if you fix a thing or two a week, or make one or two substitutions, over time that makes a huge difference.

Julia Zumpano:

It does. It does make a difference. Plus, when you're slowly making substitutions, instead of uploading everything, it doesn't feel so drastic. Then, you'll find that these substitutions aren't so bad and you'll find that you'll start to enjoy them. Then, you'll get a little more appreciation for healthy food, and then that appreciation hopefully will spill into meals and drinks, and other parts of your day.

Some people work better with small changes, some people work better with big, drastic changes. That's where that assessment piece is really key.

John Horton:

Well, what I find, too — and I'm at that age where I've started making some dietary adjustments, because I'm of that age — when you start eating better, if you regress and you have a night where maybe you eat something that's not so good for you, you feel like garbage the next day. You start to realize what food does to your system. If you put the wrong fuel in, your system just doesn't really like it.

Julia Zumpano:

I completely agree. I do think, whether it's as you're aging and maybe some food you can't handle as well, or you have a health condition that causes you to maybe retain fluid or be more inflamed, or whatever the case might be, there are certain foods that can trigger some negative responses in the body. Once we pinpoint what those foods are and what the trigger is and manage them or control them, you start to feel better. I think that's everyone's biggest motivation. That is always my goal is to get someone to feel better because then, that's what will drive their motivation to continue to change and make changes. And come back for a follow-up visit.

John Horton:

Well, I hear your voice all the time when I'm making those little decisions. Like you said, you don't maybe deny yourself some treats or things you really enjoy, but you make sure to do them a little more in moderation.

Julia Zumpano:

Yeah.

John Horton:

If you like a baked good — I've got a baked good problem — if there's anyone who listened to the show knows, I have a big baked good problem. But you have certain times where you have them or certain instances, but you don't just make it a regular everyday thing.

Julia Zumpano:

Right. I like to work into special occasions or treats. I don't like to use food as a reward because I don't think we should get in that trap of “you did good, you reward yourself with food.” I like to make it more of just a tradition. Every Sunday is when I get my baked good. Or every Friday is maybe when I get my one drink a week. Whatever we or you decide on as being reasonable. But I think it's not necessarily a reward, but a celebration. Make foods that you enjoy more celebratory versus something you have every day. Then, you'll create much more value. The hope is that you create more mindfulness around eating them, so you'll slow down, you'll enjoy, you'll savor.

When I watch my daughter eat something sweet, she slowly eats one little bite at a time, and she takes all her time. She loves every moment of it. I'm like, "Man, we should all do that." Then, we'll enjoy and savor it, and then we don't feel like we have to scarf something down because we're never going to get it again.

John Horton:

Yeah. Unfortunately, I look like those dogs in those Facebook Reels I think.

Julia Zumpano:

I know.

John Horton:

I put them down like nothing.

Julia Zumpano:

I eat fast, too. I'm like, "Slow down."

John Horton:

How do you go about working with somebody to create their personalized eating plan?

Julia Zumpano:

Sure. I do that assessment piece. Then, based on their labs, or what they're there for, or what their health goals are, I try to make suggestions. I may give a meal plan. A meal plan might look like a calorie-controlled plan, which targets a certain amount of carbs, proteins, fats. Someone who's a little bit more number-oriented, detail-oriented, wants to write things down, wants to track, is where I'd go the meal plan route.

I may educate on a certain diet or plan, such as the Mediterranean Diet. I may try to infiltrate that within their day. Give them easy, healthy swaps to try to get more Mediterranean-style foods in and pull out some of the foods that aren't serving them as well. I may recommend a restriction, like a sodium-restricted diet. Being in cardiology, I do that a lot. I try to educate on the effects of sodium and how to limit sodium. Then, obviously, things I always add, to try to add potassium-rich foods because potassium helps offset sodium. I just try to see what they're there for and then develop a reasonable plan to meet their health goals.

John Horton:

What are the biggest hurdles that most people face as they start trying to make these adjustments and changes?

Julia Zumpano:

I'd say, if they didn't plan ahead. Going blindsided and trying to make the change in the moment, at the exact moment, versus planning ahead. I try to educate people on you have to fill your cupboards with the foods you can eat, fill your fridge with the foods you can eat. Start to take out the foods that you're consuming that shouldn't be there on a regular basis. Start to educate yourself.

I think education is key. Reading labels. Reading ingredient lists. Being more aware of how you react to foods, how you feel when you eat a certain meal. I ask people all the time. "I messed up, I had fast food." I'm like, "Well, you didn't mess up. You just had a meal that may be not ideal for you. How did you feel after you ate it?" Just recognizing how you feel after you eat and then taking note of that. Because that's where, again, some of that change occurs. Like you said, sometimes when you're having things that you used to be able to eat and get away with, or have no side effects from, now you're eating them and you're like, "I don't feel so great." I like to pinpoint that for people and recognize that. And say, "Well, what can we do next time to prevent us from grabbing fast food? What can we have available that's quick and easy, just as easy, will take just as much time as going through the drive through, but you're not going to have that negative feeling after it?" Or you're not going to negatively impact your health.

John Horton:

Yeah. So much of that is the planning.

Julia Zumpano:

Yeah.

John Horton:

It goes to the importance of when you go to the grocery store, you're going there with a plan. I still love the advice you give where you say, "Shop the perimeter."

Julia Zumpano:

Yeah.

John Horton:

That's where you get all your fresh foods, your whole foods. If your diet's based on that, odds are you're going to be in a much better spot than if you're just hitting all the heavily processed stuff that's in those middle aisles.

Julia Zumpano:

Definitely. We want to fill our cart with as much produce as possible. You want to think about how many fruits and vegetables you can have. I always try to rotate stock. I think of things that are going to go bad quickly. I start with maybe the berries and grapes, and then I always grab some fruit that I know will last a week or two. Some oranges and grapefruit, and even apples. We grab a good variety of stuff. We don't have an excuse not to eat enough produce because it's there. We don't want to waste it, we don't have to throw it away. I feel like that's people's issues. They're always like, "I'm going to waste it." I'm like, "Well, just eat it and you won't waste it." If you just put it out every day and you eat it at every meal, you won't waste it, I promise you. If you rotate stock, and think about it and plan it a little ahead, you'll be able to keep it going.

A quick tip, too. If you do feel like you can't get to the produce, especially the veggies, making a big pot of soup is super easy with anything that you see going bad. Then you could always freeze that soup, making smoothies. Grabbing them before they get bad and putting them in Ziploc™ bags, and freezing them to throw into smoothies are another great way. That could be fruits or vegetables. Just a little thought process, a little bit ahead.

For me … we have a bunny, so I give all my scraps, all my bad stuff to the bunny so it gets used completely. But I will throw some bananas in the freezer. If I see they're going bad … or whatever greens I'll throw in the freezer and keep it for a smoothie or a soup, or whatever I end up using it for later in the week.

John Horton:

I have to say, “get a bunny” may have been the most unexpected tip.

Julia Zumpano:

Yeah.

John Horton:

Unexpected out of today. I did not see that one coming.

Julia Zumpano:

Yeah. We used to have a bunny and a guinea pig. The poor guinea pig just passed. Yeah, they would eat a ton. Our bunny is very fat and it's mainly from fruits and vegetables.

John Horton:

Well, aside from getting a rabbit to take care of the produce that's near the end of its life, what are some of the other top tips you give people? Just to stay motivated to eat healthier.

Julia Zumpano:

I tend to tell people to take it one step at a time because I think people have this long-term vision or goal of, "I want to lose 50 pounds." I'm like, "That's a wonderful goal. I will be here to support that goal forever. But let's take it one step at a time. Let's try to make small changes, to incorporate losing about a pound or two pounds a week. Let's do four to eight pounds in a month, versus looking at 50 pounds." Because I think when you look at 50 pounds, and you look at how daunting that is, and how much you feel inside, drastic changes need to happen for that to occur. Then, most people are like, "Forget it. It's too much work."

John Horton:

Yeah.

Julia Zumpano:

"I can't even do that. I can't even fathom that, that's way too much." If you just take it a small step at a time, it just seems so much more reasonable, doable, attainable. We don't want to upload anyone's life. We're trying to make small, reasonable changes that will create a positive impact.

I can't say enough about … I talk a lot about this on the podcast, but the composition of your meals. Being able to have balanced meals is really key for you to feel the best you can. Meaning, you manage your blood sugar, you manage your appetite. You have an adequate amount of nutrients that you need. If we're not adequately balancing our meals, we're going to be left hungry, searching, and that's when most people get into trouble. It's just planning well-balanced meals, having them properly timed based on your schedule, your needs, your desires and what you decided. But trying to stick to somewhat of a schedule and somewhat of that balance will keep you more on track.

John Horton:

Yeah. You talk about what to put on your plate, how to visualize your plate. I think it's half fruit and vegetables, or half vegetables, quarter protein and then another quarter-

Julia Zumpano:

…quarter carbohydrate.

John Horton:

…carbs, yeah.

Julia Zumpano:

Yeah, complex carbs.

John Horton:

Yeah, that's a nice way to break it down. I think most people can visualize that. I don't think a lot of us fill half of our plates with veggies.

Julia Zumpano:

Right. I think most of us don't. As I mentioned, when I meal plan for the week or just grocery shop, I have that image in mind. I'm always like, "Well, what's going to be my carbs, what's going to be my protein, what's going to be my veggies?" I have to have enough of those.

John Horton:

Yeah.

Julia Zumpano:

Just make sure we have plenty. Then, I just serve that balance every time. I feel like that will help the fiber in the fruits and vegetables, the fiber in the grains that fills us up. The protein sustains your appetite, it helps with building muscle. Fat is that sealer, it seals the deal. It makes the food taste good, it makes you feel like you had something that's filling, sustainable. Fat takes the longest for us to digest, so it's keeping us more sustained an hour, an hour-and-a-half after our meal. There's that balance and including all of those macronutrients is so essential.

John Horton:

Yeah. I know when we talk, too, there's such a big mental side to how we eat. I think all of us struggle with weight a little bit. Sometimes, you have to feel like you're part psychologist in addition to being a dietitian. How do you help people get over those hurdles?

Julia Zumpano:

Yeah, that's so true. My dietitian colleagues and I always say that we are definitely part psychologist or social workers.

John Horton:

You have to be.

Julia Zumpano:

Yeah.

John Horton:

Because we all struggle with that.

Julia Zumpano:

It's a true struggle and it's a justifiable struggle. Our society puts a lot of influence on body image and weight and nutrition. And more now than ever. There's so much conflicting information. You're looking online at people who some people can't humanly possibly look like that.

John Horton:

Right.

Julia Zumpano:

Images are altered. We have so much technology and even cosmetics that can make people enhance their look so much that we try to strive for this image, it's not even real. I think that it's coming back to understanding what your health goals are, what you want to accomplish, and try to really limit outside influences as much as possible. Staying positive, I think, is important. Celebrating milestones, even small ones. "Hey, I went a week and I had a vegetable every day." That's huge! That's awesome. Let's celebrate that. Let's be happy about that. That's a big step.

I think, as you change your mindset around it and create more positivity around what you're doing — because any change you're doing from a nutrition perspective, you're making a positive change — you're improving your health. You're improving your health outcomes, your longevity, your mortality, it's all improving. Your sleep. Your skin. Your inflammation, your joints. All of it. All of it is being improved by every little food you put in your mouth. Any little change, especially if you create a habit out of it, will really create a huge impact in the end.

John Horton:

Just listening to you talk, it's very coach speak. I do feel like a dietitian is like a nutrition coach for people. If you're looking for that, if you want this extra coaching, you want to be coached up to eat better, how do you go about establishing a relationship with a registered dietitian? Getting an appointment, do you need a prescription, do you need to be referred to one? What's the process?

Julia Zumpano:

Sure. Most dietitians do not need a referral. Usually, you can call up any dietitian and make an appointment with him or her. Although, some insurances require referrals.

John Horton:

Yeah.

Julia Zumpano:

It's just based on what your insurance requires. A good place to start is your primary care physician or whatever practitioner you see on a regular basis and ask them for a referral to see a dietitian. You can also ask friends or family members — that's a great way to find someone in your area that someone's worked with and had success with. That's also, word of mouth is great. The only issue there is this insurance piece. If you're using insurance, we got to make sure we find someone that's covered within our plan.

John Horton:

Got it.

Julia Zumpano:

That's the one piece. If you're really concerned about nutrition coverage, I would go straight to your insurance company and say, "Can you tell me what dietitians are within my network? What do I have as an option for nutrition counseling? Do I have a certain amount of hours or allotted money? Is there a copay?" Start to figure that out with your insurance company, too, if that's a big concern for you.

Really, there's the Academy of Nutrition and Dietetics, the website is eatright.org. They have a database of dietitians nationwide. You can search your zip code and find dietitians in your area. Again, that's a great list, we just have to take that a step further if you do want to check insurance coverage.

John Horton:

We should add here that the podcast, of course, is free, so, therefore, covered by all insurances.

Julia Zumpano:

Absolutely.

John Horton:

You can also get great advice here.

Julia Zumpano:

Free information. Yeah.

John Horton:

Which is why we're here every week.

Julia Zumpano:

Absolutely.

John Horton:

This is a silly question, too — you often hear there's dietitians and there's nutritionists — are they the same person or are they slightly different?

Julia Zumpano:

They're different.

John Horton:

OK. I figured there was.

Julia Zumpano:

It's very confusing. Then, as I mentioned, the Academy of Nutrition and Dietetics has now ... we were always registered dietitians, and now they have labeled it registered dietitian nutritionist.

John Horton:

OK.

Julia Zumpano:

Which I think is creating even more confusion.

John Horton:

It does sound more confusing.

Julia Zumpano:

Yeah.

John Horton:

It's like meshing them both.

Julia Zumpano:

Yeah. Registered dietitians have taken a registration exam, have passed it and gotten their registration, and keep up that registration with continuing education units every five years.

John Horton:

OK.

Julia Zumpano:

We do 75 hours of continuing ed. We apply for re-registration, and we re-register with the Academy of Nutrition and Dietetics. Then, we re-license with the state that we're practicing in, or states, every year. It's very clinically based, We're doing continuing education. We've completed a bachelor's degree, a master's degree, a dietetic internship and a registration. We are continuing to keep up our continuing education and registration.

John Horton:

OK.

Julia Zumpano:

And licensure by the state. That is a registered and licensed dietitian.

John Horton:

OK. Now, what about a nutritionist then?

Julia Zumpano:

A nutritionist, on the other hand, is more of a blanket term. Someone could take a course — an exercise specialist can take a nutrition course and call themselves a nutritionist. There's no credentials surrounding it. There's no registration or licensure around a nutritionist.

Now, that's the tricky part. A registered dietitian could consider and call herself a nutritionist, but she would have to have RDN after her name to be registered and licensed.

John Horton:

Look for “registered” it sounds like is the big thing, whether you're dealing with a registered dietitian or a registered dietitian nutritionist.

Julia Zumpano:

Yeah.

John Horton:

“Registered” signifies that they've had some training, they're continuing with their training and they're keeping up with everything that's going on in the world of health and nutrition.

Julia Zumpano:

Absolutely, you got it.

John Horton:

Well, we've covered a lot here, as we always do. This has been fabulous, just to get to know you a little bit better and just everything that drives you. As we've been doing this — and Julia, you and I have been doing these podcasts now for a couple years, which is hard to believe — why do you do this? Why are you so passionate about sharing this information just to help people make better decisions for their health?

Julia Zumpano:

Well, as I have had 20 years of patient care, I noticed that we can reach the patients that are accessible to us and the people that are accessible to us. But really, everyone needs to know this information. To me, I just wanted to spread this information to anyone and everyone who can access it, who wants to hear it, who seeks it out for free, no strings attached.

Then, I love to empower people to make decisions and make change on their own.

Of course, seeing a dietitian is great — I'm all for seeing a dietitian. But you can take one step at a time and educate yourself and empower yourself to make change through the food you put in your mouth. It really will make a huge impact in the end. I love to see people take their own health in their own hands, take ownership of it, educate yourselves and make small changes that will positively impact your health.

John Horton:

Well, thank you for all you do. I know, and I've told you this all the time, you have helped me, I know. I think about all the things we talk about whenever I go to the grocery store or whenever I'm in the kitchen. It does make a difference. Change comes one person at a time. Thanks for helping us spread the message.

Julia Zumpano:

Thank you so much.

John Horton:

Julia, I got to say, it felt a little weird having you just as a guest because you're the cohost I always have here with me. But that was fabulous just getting to know you a little more, and really hearing all your stories.

Julia Zumpano:

I agree. It was a little odd being the actual guest, being the host. But I loved it, I love to share my personal story, as well as where my passion comes from. Just knowing that it's an ever-evolving field and an ever-evolving journey toward overall health.

John Horton:

Well, that is why we're here. I think you make it so easy to look at eating and nutrition and go, "How can I use this information to make my life just a little bit better, and maybe live a little bit healthier?"

Julia Zumpano:

Completely agree. It's all about just gaining more information, just learning more and then applying what you learned to your life and what you think will resonate and work for you.

John Horton:

Well, that's what the podcast is all about.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, eat well.

Speaker 3:

Thank you for listening to Health Essentials brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts. Or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.