CDC’s Diabetes Prevention Program – Questions and Answers #3

Q. Will Medicare pay for the program participants that are in the pending recognition status?

A. Pending recognition status is the initial application process for CDC diabetes prevention program recognition (DPRP) for the NDPP.  A program with pending recognition is not eligible for Medicare payments.  Medicare will be requiring organizations to have Full CDC Diabetes Prevention Program Recognition to enroll as Medicare Suppliers.  CMS is considering another category of recognition which would be addressed in future rule-making.

Q. It was mentioned that NDPP will only be reimbursed from Medicare for face-to-face groups initially.  Would a live, telephone group be considered face-to-face?

A. No, telephonic delivery is not considered face-to-face.  CMS will not pay for non-face-to-face delivery of the program in 2018.  Future rule-making will address virtual delivery and payment.

Q. How different is the CDC approved DPP from the American Diabetes Association’s Diabetes Self-Management and Education Program?

A. The National DPP and Diabetes Self-Management and Education (DSME) program are different programs altogether.  The National DPP is intended to prevent the onset of type 2 diabetes in populations with prediabetes.  DSME programs provide standardized education and training for populations already living with
diabetes.  DSME programs are recognized by the American Diabetes Association or accredited by the American Association of Diabetes Educators.  Programs that deliver the National DPP are recognized/accredited by the CDC.  DSME programs that also wish to deliver the National DPP must go through the process to become CDC-Recognized (full) and enroll as a Medicare Supplier to deliver the National DPP to Medicare beneficiaries with prediabetes.

Q. Does one need to be a certified diabetes educator (CDE) to be a DPP Lifestyle Coach?

A. One does not have to be a CDE, health care provider, or have certain credentials to become a DPP Lifestyle Coach.  Please see slide 26 for eligibility and skills.

Q. Is the NDPP/MDPP a voluntary program that RDNs engage in?  Is there a financial incentive, billing etc.?

A. The National DPP is the overarching program/framework for implementation of the lifestyle change intervention for those with prediabetes/high risk for type 2 diabetes.  The MDPP refers to the new Part B benefit for the National DPP lifestyle change intervention for Medicare beneficiaries.  The National DPP and MDPP are linked and are not really two separate programs.  Organizations must become part of the National DPP since they must attain full recognition by the CDC to deliver the MDPP benefit to enroll as a Medicare Supplier and be paid by Medicare.  CDC Recognition for DPP programs is voluntary, but is increasingly being used by payers as a requirement for
reimbursement/payment as it is with the MDPP benefit.

Programs with CDC recognition have the ability to offer the National DPP to consumers with private insurance who have benefits and coverage for diabetes prevention programs, and/or to provide the program for a fee in instances where consumers do not have an insurance benefit for diabetes prevention programs.  Not all payers require full recognition to begin offering the program.  Some payers may provide consumer coverage and pay for programs with pending status, but are likely to expect the program to achieve and maintain full recognition.  Depending on the setting, there can be numerous benefits from offering the National DPP, not to mention the benefits of providing a program demonstrated to prevent the onset of disease.  Benefits of offering the National DPP and of becoming a Medicare Supplier of the MDPP were highlighted in Marcy Kyle’s presentation of the webinar.  We recommend that you listen to the recorded webinar provided.


About the Author: Joyce Green Pastors, MS, RD, CDE, VAND Member and one of the Virginia Diabetes Council Board Members, participated in a webinar on May 24th, 2017 for the Academy of Nutrition and Dietetics about diabetes prevention.  We thank them for sharing information from this webinar with us.

CDC’s Diabetes Prevention Program – Questions and Answers #2

Q. Is it possible for someone in private practice to offer the MDPP as a solo practitioner?

A. Solo practitioners would need to start a National DPP and obtain full CDC Recognition to apply to enroll as a Medicare Supplier for the MDPP.  Individuals in private practice can also partner with existing or new programs to provide the lifestyle coaching or serve as a program coordinator as independent contractors.  The program would need to obtain the solo practitioner’s NPI for the coach roster.  Medicare pays the recognized Medicare Supplier, and the program would pay the practitioner providing services for lifestyle coaching.

Q. If someone is <65 and has prediabetes but is not overweight, is he/she eligible for the program (i.e., the MDPP benefit)?

A. No. Medicare beneficiaries with a body mass index (BMI) of < 25 are not eligible to participate in the Medicare DPP benefit.  The Medicare criteria for the Part B benefit is a BMI of ≥ 25 and abnormal blood glucose results.  The Medicare DPP is an important new benefit to help Medicare beneficiaries prevent and/or delay diagnoses of diabetes, yet it does not meet the needs of all populations with prediabetes.

A note about individuals with Medicare Advantage plans or other individuals < 65 with private insurance: It is possible that individuals with private insurance, including Medicare Advantage plans, who have prediabetes and BMI < 25, have a benefit for MNT that may cover a diagnosis of prediabetes. Individual plan benefits and coverage policies determine what services are covered benefits and terms/conditions for coverage. We encourage RDNs and organizations to confirm benefits for MNT in persons with prediabetes.

Q. How do you become a Master Trainer?

A. As of the date of the webinar, there are three organizations (Diabetes Training and Technical Assistance Center at Emory University, American Association of Diabetes Educators, and the Diabetes Prevention Support Center of the University of Pittsburgh) that currently provide Master Training.  The minimum required qualifications for application to a Master Trainer Program are:

  • Previous completion of Lifestyle Coach Training from a CDC-recognized national provider
  • Affiliation with an organization that has pending or full CDC recognition
  • Successful delivery and experience with the National Diabetes Prevention Program

Some of the organizations also require the applicant to be a health care professional with a minimum of a bachelor’s degree in a health-related field or if not, substantive experience.  There is an application form to be completed, letters of recommendation from a supervisor or a professional who can provide information about your experience and performance in delivery of a lifestyle change program, and often a phone interview.  Successful applicants attend a 2-day training, similar to the Lifestyle Coach Training Program, to become qualified to become a Master Trainer.  The fees range from $1500-$1650 which includes the training and the membership/agreement fee for post-training technical assistance and licensing of the training materials.  Master Trainers can train lifestyle coaches in their own and partner organizations.

Q. Can RDNs in private practice order blood tests for diabetes screening?

A. The Academy recommends that RDNs refer to the Comprehensive Scope of Practice Resource for the RDN which can guide the RDN to the resources and options that can be used to evaluate whether the RDN can safely and effectively provide an expanded practice skill and advance individual practice.  Case Study: Initiating Orders for Nutrition-Related Laboratory Tests for RDNs Practicing in Hospital, Ambulatory and Private Practice Settings Academy Store:

Quality Management Webpage:

Quality Management Short Link:  Scroll down to Case Studies on the Scope Webpage.

Q. How long will Medicare pay for maintenance sessions?

A. Beneficiaries will have access to ongoing maintenance sessions after the MDPP core benefit (1st 12 months of the program).  At the time of the webinar CMS had not placed any limits on how long CMS will pay for ongoing maintenance sessions.  Eligible beneficiaries will have access to ongoing maintenance sessions after the MDPP core benefit if they achieve and maintain the required minimum weight loss of 5%.  CMS is defining maintenance of weight loss, which allows a beneficiary to access ongoing maintenance sessions, as achieving the required minimum weight loss from baseline weight at any point during the previous 3 months of the core maintenance or the ongoing maintenance sessions.  CMS will propose a limit on the duration of CMS payments for ongoing maintenance sessions in future rulemaking.  As a reminder, there are six monthly core maintenance sessions in months 6 through 12 of the year-long program in which beneficiaries are eligible to participate, regardless of weight loss, but CMS has not issued final rules about payment for the core maintenance component or any component of the MDPP benefit.


About the Author: Joyce Green Pastors, MS, RD, CDE, VAND Member and one of the Virginia Diabetes Council Board Members, participated in a webinar on May 24th, 2017 for the Academy of Nutrition and Dietetics about diabetes prevention.  We thank them for sharing information from this webinar with us.

CDC’s Diabetes Prevention Program Questions and Answers

Do you have questions regarding the National Diabetes Prevention Program?  Over the next few weeks we will feature posts that address questions about the program.

First let’s begin by defining the terms.

Diabetes Prevention Program (DPP) was the research trial led by the National Institutes of Health with financial and scientific expertise from Centers for Disease Control and Prevention (CDC), and others.

National Diabetes Prevention Program (National DPP) is the overarching program/framework for implementation of the lifestyle change intervention for those with prediabetes/high risk for type 2 diabetes.

The Medicare Diabetes Prevention Program (MDPP) refers to the new Medicare Part B benefit for the National DPP lifestyle change intervention for eligible Medicare beneficiaries.

Q. What is the difference between the National Diabetes Prevention Program and the Medicare Diabetes Prevention Program?

A. The National Diabetes Prevention Program (National DPP) is the overarching program/framework for implementation of the lifestyle change intervention for those with prediabetes/high risk for type 2 diabetes.  The Medicare Diabetes Prevention Program (MDPP) refers to the new Medicare Part B benefit offering coverage for the National DPP lifestyle change intervention for eligible Medicare beneficiaries.  Programs must have recognition by the Center for Disease Control and Prevention (CDC) to deliver the MDPP benefit.

Q. Is it mandatory for lifestyle groups to be certified for program accreditation and Medicare reimbursement?

A. Medicare will require NDPP programs to have full CDC recognition (administered by the CDC Diabetes Prevention Recognition Program, part of the National DPP) to be eligible to enroll in Medicare as Medicare Suppliers.  CMS may consider another category of recognition that would be addressed in future rulemaking.

Q. Can an RDN apply for a National Provider Identifier (NPI) number even if not planning to use it quite yet?  Does
it require renewal?

A. A registered dietitian nutritionist (RDN) can apply for an NPI at any point in time, whether for current or future use.  The Academy recommends that every RDN have an NPI regardless of employment status or place of work, or whether the NPI is being used by the RDN or an organization for billing purposes.  NPIs are one way to demonstrate RDN workforce availability to payers including Medicare, private payers, and state Medicaid agencies.  An NPI does not require renewal and it never expires.  Nutrition and dietetics technicians, registered (NDTRs) and other nutrition and dietetics practitioners can also obtain NPIs at any time.  There is a specific NPI taxonomy category for “dietetic technician, registered.”  Nutrition and dietetics practitioners who are not RDNs or NDTRs can select “Health Educator” for the taxonomy.

For more information on how to obtain an NPI, visit

Q. I’m unclear as to whether each health coach needs an individual NPI or if the program can use the hospital NPI?

A. Each Lifestyle coach who delivers the NDPP to Medicare beneficiaries under the new Medicare benefit (MDPP) will need an individual NPI.  Programs that apply to enroll as Medicare Suppliers of the MDPP are required to submit and maintain a coach roster with NPI numbers for all coaches.  Individual coach NPIs will not be used forbilling purposes in the MDPP.  The Medicare Supplier (must be a program) will use the program NPI to submit claims to CMS.

Q. When do you apply for the MDPP NPI number?

A. Organizations who want to deliver the MDPP benefit will need to provide a list of coaches and their NPIs when they apply to enroll as a Medicare Supplier. Organizations can apply for Medicare Supplier enrollment if the NDPP program has already obtained full CDC Recognition.

About the Author: Joyce Green Pastors, MS, RD, CDE, VAND Member and one of the Virginia Diabetes Council Board Members, participated in a webinar on May 24th, 2017 for the Academy of Nutrition and Dietetics about diabetes prevention.  We thank them for sharing information from this webinar with us.

Obesity Advocacy Day 2017

On Monday, February 27, 20107 the Obesity Care Advocacy Network (OCAN) and dietitians from across the United States met in Washington, D.C. to meet with members of Congress to advocate for the Treat and Reduce Obesity Act (TROA) of 2017 and the establishment of a National Obesity Care Week (NOCW).  Obesity Advocacy Day attendees were divided into groups and traveled to various legislative offices to meet with Congress men and women to discuss and advocate for the TROA.  The TROA consists of two parts which aim to:

  • Enhance Medicare beneficiaries’ access to additional qualified healthcare professionals that are best suited to provide Intensive Behavioral Therapy (IBT)
  • Allow Medicare Part D to cover FDA-approved obesity drugs

Currently, CMS coverage for IBT is limited to being provided by a primary care provider in the primary care setting.  Because of this narrow coverage, nutrition professionals, endocrinologists, bariatric physicians, psychiatrists, clinical psychologists, and other specialists are unable to be reimbursed for providing these services.  When Congress enacted Medicare Part D, (the Medicare prescription drug program), obesity was not recognized as a disease, but rather a lifestyle condition.  Additionally, there were no widely-accepted FDA-approved weight loss medications on the market.  It was for these reasons that pharmaceutical weight loss aids were not covered under Medicare Part D.  Due to Medicare’s current limitation on providers of IBT and Medicare Part D’s lack of coverage on pharmaceutical weight loss aids, the TROA aims to change these aspects of Medicare coverage.  Lastly, the establishment of a NOCW aims to elevate societal awareness of obesity and weight bias as well as facilitate a shift to science-based treatment for those living with obesity.  The act proclaims the week of October 29-November 4 as National Obesity Care Week.


About the author: Katie Couch

Katie is currently a dietetic intern at the University of Virginia Health System. She completed her undergraduate degree in Nutrition Science and Master’s degree in Nutrition Science from Auburn University.  She enjoys cooking, reading, and exploring her new city of Charlottesville!







Announcing VAND’s New Executive Director

Over the past six weeks, VAND’s Executive Director Search Committee comprising Carlene Thomas (Chair) Lesley McPhatter, Kimberly Lunsford and me, has been recruiting for a new Executive Director. We are pleased to let you know that Jillian Davis, RDN, has accepted the position!

Jillian Davis, RDNJillian is very excited to serve the VAND community of nutrition professionals as the new Executive Director!  She has enjoyed past experiences in many different areas of nutrition including the clinical setting, food marketing and promotion, and community education.  She has worked as a School Marketing Manager with the Mid-Atlantic Dairy Association, supporting nutrition education programs throughout northern Virginia, and most recently served as Family and Consumer Sciences Extension Agent in Charlottesville and surrounding counties, as well as in Fairfax County.  Her experience with individuals, families, and nutrition professionals throughout the state has provided her with a unique view of the diverse communities we serve in Virginia.  In addition to her work as a Registered Dietitian Nutritionist, Jillian enjoys walking, jogging, knitting, reading, gardening, and experiencing the fullness of life with her family.

She will begin learning the ropes over the next few weeks by working with Jackie Darling, Interim Executive Director; Shirley Scrafford, Cvent Coordinator;  Kristen Chang, Website Coordinator; Cindy MacIntyre, Treasurer, and the rest of the Executive Board.

Please plan on attending the Annual Meeting so you can meet Jillian in person!


Nicole V Brown, MS, RDN, LD ACSM EP-C, VAND President


Nicole V. Brown, MS, RDN, LD, ACSM EP-C
President, VAND

VAND March President’s Message

Savor the Flavor. . .

March is National Nutrition Month!

We made an Impact at Legislative Day on February 24th!

Almost 100 RDNs, DTRs, interns and students spent a rewarding day in Richmond visiting our legislators. We split into two groups so when we were introduced (the famous “shout out) to the Assembly and the Senate, 50 of us stood in unison in each gallery to represent Virginia’s nutrition experts who promote the health of Virginians! This record-level attendance required leadership and coordination and for that we thank Angie Hasemann, State Policy Rep; Faye Krause and Alex Wahlberg Assistant SPRs, Christine Gries, State Regulatory Specialist, our five District Legislative Representatives, Blue Ridge (Sara Mastrantonio), Northern (Jackie Darling), Richmond (Nana Ofosu-Benefu), Southwest (Susan Noble) and Tidewater (Amber Rivera) Andrew Lamar, Legislative Consultant, and Amy Scott-MacLean. Attendees were surprised to actually meet with legislators who had time to talk about legislation VAND was supporting.

VAND Legislative Day 2016

Read more about Legislative Day in the NEWSLETTER posted on the website and check back for even more information that will provide a more in depth discussion about VAND’s MOST SUCCESSFUL LEGISLATIVE DAY to date and lots of photos! Please plan on attending next year’s Legislative Day!

Blogging… Another Way to Make an Impact!

By now you all know that we have launched a very successful blog on our website!   What you might not know is why we started this blog and why we want YOU to contribute to it.  Blogging increases our online presence and helps us establish authority as the nutrition experts in the Commonwealth, provide educational opportunities for other RDNs, healthcare professionals, and the public, and promote the professional brand of VAND.  It helps public policy and advocacy professionals, like our state legislators and their aides, learn who we are and what we do.  Publishing on our blog can also help YOU build your professional brand and online presence.  With National Nutrition Month this month, we would love to flood the blog with pictures of NNM activities throughout Virginia, and educational posts and healthy recipes to help Virginians “Savor the Flavor of Eating Right”!  Submit your materials to our Professional Education Chairpersons at – we can even help edit your post if you would like us to!

Thank you in advance for your submissions!

~ Wendy Phillips and Kristen Chang

Go to and click on “Blog” to view recent submissions:

Facts about coconut oil, VAND election candidate profiles, Nutrition Myth Busters, Order Writing Privileges. . . .

Virginia Academy of Nutrition & Dietetics 87th Annual Meeting
April 10-12, 2016 – 
Fairfax, VAlogoAM2016

Have you seen the speaker line up? Have you seen the workshop topics? This is a meeting not to be missed! Margo Wootan, D. Sc. Center for Science in the Public Interest (restaurant nutrition labeling); Patsy Catsos, MS, RDN (FODMAPS), Scott Kahan, MD, MPH (What RDNs need to know about medications for weight reduction), Alanna Moshfegh, MS, RD (Chew on This Changes in Americans’ Eating Habits) to name a few!


Up to 23 CPEUs are being offered over three days.  VAND’s 87th Annual Meeting will host many nationally renowned speakers and local experts presenting hot topics in food and nutrition to advance practice in all areas.  Log onto VAND’s website at and click on the Annual Meeting announcement to check out the meeting site.  Here you can view the program agenda, meet the speakers, access hotel information and register online with a credit card.

Early bird registration fees are available NOW through March 18th

Fairfax Marriott at Fair Oaks, 

11787 Lee Jackson Memorial Highway,

Fairfax, VA  22033

Academy Elections

The final numbers are in and 14.48% of VAND’s membership voted in the Academy elections coming in 3rd place in Category 3 behind Georgia’s 26.15% (Donna Martin from GA was selected as AND’s President-Elect so they had lots of GOTV energy) and Alabama’s 16.09%. In 2015, VAND had 9.1% of its members vote so a 37% increase in participation is great improvement.

Upcoming Events
  • March VAND Elections—will be announcedMarch Webinarwill be announced soon, stay tuned!
  • March 2016 National Nutrition Month: “Savor the Flavor of Eating Right” has lots of resources for RDNs and NDTRs to use.
  • April 10-12: Annual Meeting:, Fair Oaks Marriott, Fairfax, VA
  • April 10: Board Meeting 5:30 pm
  • July 8-9: Board Retreat – Roslyn Center – Richmond, VA
As always, I am interested in your insights, your questions, and requests.

Nicole V Brown, MS, RDN, LD ACSM EP-C, VAND President

Nicole V Brown, MS, RDN, LD ACSM EP-C
703.969.6114 | Springfield, VA

Delegate’s Desk – February 2016

Please see the February 2016 Delegate’s Report below. Topics include Lead Exposure, the Spring HOD Meeting, Sponsorship, a new Position Paper, Primary Care Resources, and the latest from ACEND. 

 Flint, Michigan & Lead Exposure

The Academy is actively supporting our members’ efforts related to the lead exposure crisis in Flint, Michigan and we are continuing to raise the issue to a national level. Information about how to fight lead exposure with nutrition is available on the Academy website. The Michigan affiliate membership total is 2,174 and of that, five members reside in Flint.

Spring 2016 HOD Virtual Meeting

The House Leadership Team met in January to begin plans for the Spring 2016 HOD Virtual Meeting. While the HOD Leadership Team originally planned to discuss telehealth as the mega issue, there has been a change.  For day 1, the HOD Leadership Team will engage the HOD in discussions to help inform a vision for the profession in the next century. On day 2, the HOD will explore digital health and technology, focusing on how we can transform dietetics practice by being at the cutting edge in these evolving areas.

Please see below excerpts from the January 19 letter from AND President, Evelyn Crayton, PhD, RDN,  LDN, FAND, to members; more specifics regarding sponsorship to follow. 

“…The Board received the SATF report at our January 13 meeting and found it to be thoughtful, balanced, and helpful. The Board voted to implement a pilot program encompassing many of the SATF’s recommendations. The one-year pilot program includes appointing a Sponsorship Committee to review national-level sponsor opportunities and to develop assessment tools that will support the sponsorship process.
The Board of Directors approved the following newly revised sponsorship guidelines, which take effect immediately for all Academy organizational units. Dietetic Practice Groups and Member Interest Groups will be required to adhere to these guidelines and Affiliates are encouraged to adopt them.

Sponsorship approval requires that:

The sponsor’s vision and mission align with the Academy’s Vision, Mission and Strategic Goals. The sponsor’s product portfolio is broadly aligned with the Academy’s Vision: Optimizing health through food and nutrition. The sponsor relationship and sponsor product portfolio are broadly aligned with official Academy positions. All aspects of the sponsorship (such as research, consumer messaging or professional education for members) align with the Academy’s Scientific Integrity Principles. The Academy does not endorse any company, brand or company products, nor does the Academy’s name or logo appear on any product. Such endorsement is neither actual nor implied. The Academy maintains final editorial control and approval of all content in materials bearing the Academy name or logo. There is clear separation of Academy messages and content from brand information or promotion. Relevant facts and important information are included. The Board is confident that these revised guidelines and the new Sponsorship Committee pilot program will enable the Academy to better serve the organization and our members.

The Board is committed to transparency in our processes and we welcome member feedback. Please send an email to  …”

Interventions for Treatment of Overweight and Obesity in Adults

Excess weight and obesity among adults results from many influences including personal factors, the communities where people live, and government policies. Therefore, successful weight loss must include multiple strategies addressing each of these influences, as well as the expertise of registered dietitian nutritionists, according to an updated position paper from the Academy of Nutrition and Dietetics.  The position paper, “Interventions for Treatment of Overweight and Obesity in Adults,” was recently published in the AND Journal. The position paper states: It is the position of the Academy of Nutrition and Dietetics that successful treatment of overweight and obesity in adults requires adoption and maintenance of lifestyle behaviors contributing to both dietary intake and physical activity. These behaviors are influenced by many factors; therefore, interventions incorporating more than one level of the socioecological model and addressing several key factors in each level may be more successful than interventions targeting any one level and factor alone. The position paper updates the Academy’s 2009 position on this issue.

Free Webinar!
How to Integrate RDN Services in the New Primary Care

Payment models are rapidly changing in health care and require a team of healthcare professionals working collaboratively within the primary care practice. This webinar, at 1:00 p.m. Central time on Tuesday, February 23, will describe some of these new payment models and discuss the opportunities to integrate RDNs and nutrition counseling into primary care practices. 1.5 CPEUs pending. Click to register here.

Updated Toolkit Now Available
RDNs in the New Primary Care: A Toolkit for Successful Integration 

The toolkit has new information and practical tips to help RDNs be successful in new models of health care delivery that emphasize team-based care.  Learn how to expand the role of the RDN in Patient Medical Homes and Accountable Care Organizations and gain a better understanding of Alternative Payment Models that have the potential to expand patient access, as well as payment for services.   Free to members available here.

ACEND Updates

The Accreditation Council for Education in Nutrition and Dietetics (ACEND®)

ACEND  is pleased to announce the release of the DRAFT 2017 Accreditation Standards for public comment. The draft 2017 Standards are the result of a planned five-year review cycle of the current 2012 Accreditation Standards to ensure compliance with USDE regulations. Please note that the 2017 standards are different from the future education model associate’s, bachelor’s, and master’s degree standards that will be released for public comment later this year. The draft standards, the February Standards Update, and a Webinar, which provides an overview of the 2017 Standards development process and key changes from the 2012 Standards, are posted on the ACEND standards committee webpage. We value all stakeholder input and encourage you to provide input on the 2017 Standards at the following survey link.

The February Standards Update also addresses questions received at the January 14 Virtual Town Hall Meeting. The virtual town hall meetings are open to all stakeholders and are held the second Thursday of each month at 11:30 a.m. Central Time. The next meeting will occur February 11. Information for connecting to the virtual town hall is posted on the ACEND standards committee webpage. If you have questions, please send them to or call 312-899-4872

Stay in contact with HOD for good information and resources:

Thank you!

Phyllis Woodson, MS, RD, CDE
VAND Delegate |

Nutrition & Immune Health

Salmon SaladWith the arrival of colder temperatures in the winter months also arrives cold and flu season. While it may seem like getting sick at some point is inevitable, there are many nutritional strategies that can be applied (year round, really!) to boost the strength of your immune system and decrease your chances. As a sports dietitian, I am often counseling athletes on the importance of a healthy diet in maintaining a strong immune system to ensure consistent training year round. Today, I am here to share a few top nutritional strategies that have been shown to boost immune health:

  1. Consume a diet that is adequate in overall calories, balanced among the all three macronutrients, and rich in nutrient dense foods. Chronic calorie deficit over time, whether through failure to meet needs or intentional dieting for weight loss, can lead to impaired immune health in that it decreases the energy available to support normal bodily functions. Calorie deficit without careful consideration of diet quality can also lead to insufficient intake of vitamins and minerals related to immune health, including vitamins C, E, B6, A and D, Folate, Iron, Selenium and Zinc. Aim to include not only fruits and vegetables with each meal, but also quality lean proteins and whole grains too. A few high antioxidant foods to consider in boosting immune health include grapes, blueberries, raspberries and strawberries, nuts and seeds, any dark leafy greens, sweet potatoes and other orange vegetables, beans, fish and whole grains!
  2. Swap unhealthy (saturated) fats in your diet for healthy (unsaturated) fats, which are both anti-inflammatory and immune boosting. Instead of aiming for low-fat foods, aim to replace sources of saturated fat in your diet for healthy fats, especially omega-3 fatty acids, which support hormone production and help fight inflammation in order to keep our immune system strong. More specifically, essential fatty acids (omega-3’s and Omega-6’s) play a role in the production of eicosanoids, a class of chemical messengers involved in your body’s immune and inflammatory response. These healthy fats can be found in avocadoes, nuts (especially walnuts!), sunflower, sesame and pumpkin seeds, olives, flaxseed and wheat germ, chia seeds and fatty fish varieties.
  3. Ensure adequate Vitamin D intake for optimal immune strength. While we are able to naturally synthesize Vitamin D through sun exposure, it’s not uncommon for Vitamin D levels to drop off in the winter when colder whether forces us inside more. Low Vitamin D levels have a direct effect not only on bone health, but immune health as well, and it’s never a bad idea to have your levels checked by your primary care physician. To ensure you’re getting enough Vitamin D through diet, aim to consume a few of these foods daily: Cod Liver Oil, oily fish (trout, salmon, swordfish, mackeral, tuna and sardines), mushrooms, fortified cereals, tofu, dairy products, pork and eggs.
  4. Consume foods with naturally occurring probiotics to improve gut health. Gut health has a direct impact on both the health of our brain and our immune system. By incorporating foods with natural probiotics, including yogurts and cheeses, kefir, sauerkraut, miso, sour pickles and kombucha, you are feeding the healthy bacteria in your gut that in turn can lend to a stronger immune system.
  5. Flavor your foods with healthy herbs & spices. Many of the herbs and spices that we use to flavor our foods also have potent anti-microbial, anti-inflammatory and immune boosting properties. Garlic, onion, turmeric, ginger and cinnamon are a few herbs and spices that top the list.
  • Garlic is not only known for it’s unique and pungent flavor contribution to many dishes, but also it’s role as a potent anti-inflammatory, anti-viral and cancer preventative food. Garlic’s numerous beneficial immune benefits are due to sulfur compounds and being a quality source of vitamin C, vitamin B6, selenium and manganese.
  • Onions are not only a quality source of Vitamin C, but also one of the richest sources of flavonoids, especially quercetin, which has been shown to inhibit inflammation. Onions also contain the trace mineral selenium, which helps to initiate the body’s immune response.
  • Curcumin is a component of the spice turmeric and helps give it its distinct orange-yellow color. Turmeric is commonly found in curry spices and dishes. Curcumin is traditionally known for its anti-inflammatory effects but in recent decades has also been shown to be a potent immune-modulating agent.
  • Ginger, more commonly known for its anti-nausea benefits, also boosts anti-inflammatory and antioxidant activity within the body. Ginger is best consumed uncooked in it’s natural form, so aim to buy ginger whole and use a grater to include it in your dishes where possible.
  • Cinnamon is another spice that is not only rich in antioxidants, but also a quality source of manganese, calcium, fiber and iron. The essential oils found within cinnamon have also been shown to boost the immune system since they have antiviral, antibacterial and antifungal properties.

Wintertime doesn’t have to inevitably spell out cold and flu season. To boost your immune system and decrease your chances of getting sick aim to follow some of the tips above, and don’t forget to get plenty of sleep at night too!!


Kristen Chang
Kristen Chang

Kristen Chang is the current Co-Chair of Professional Education for VAND. She is an adjunct instructor for Virginia Tech and Radford University and the owner of the nutrition private practice, Real Food For Fuel, LLC.

Breastfeeding in Winter

Oh the cuddles and coos and sweetness of a newborn baby! Snuggling in tight on a cold winter night in front of a warm fire brings such a soothing comfort. But what about those days when mom and baby must be out and about when the snow is on the Blue Ridge Mountains and the Appalachian Trail is lined with bare trees and frigid temperatures?

There are many reasons why breastfeeding is beneficial for both mom and baby, but breastfeeding during the cold winter months presents unique challenges for moms. Cold winter months can mean an influx of germs and sickness, and breastfeeding is not only nurturing to mom and baby, but is protective of baby’s immune system. In the earliest days of life when baby is most susceptible to germs, mom’s colostrum (foremilk) has the highest concentration of antibodies, immune molecules that mom makes against illnesses that she has been exposed to that she then passes to the baby through her milk. Even more amazingly, if baby is exposed to germs that mom has not been, the baby passes these germs to mom at the next feed, mom makes antibodies, and passes them back to baby! As baby grows and mom’s milk matures, this natural immunity continues to pass between mom and infant; the baby may still get sick, but the illness will be less severe and less lengthy than would have been expected.

Tips for managing winter illness and breastfeeding:

  • If mom must take medications for an illness she has, be sure the doctor prescribes a medication that is safe for breastfeeding.
  • If buying an over the counter medication, check with the pharmacist to ensure the medicine is safe for baby.
  • As always, it’s important to practice good personal care and hygiene by washing hands frequently, coughing or sneezing away from baby, and getting plenty of rest.

Removing jackets or sweatshirts to allow babies access to mom’s breasts exposes moms to the cold winter temperatures. This can be minimized by mom layering her clothing or choosing a long sleeved nursing top, zip-up sweatshirt, or button-up sweater to wear. Babies can be kept warm in swaddling blankets, one piece, long-sleeved sleepers or sleep sacks, and a removable lightweight jacket in case the day warms up unexpectedly. A set of hat and mittens will keep baby warm in especially chilly weather. Skin-to-skin contact promoting bonding between baby and parents, facilitating breastfeeding and regulating baby’s temperature should be continued throughout the winter to keep baby warm and cozy in their moms’ loving embrace.

Some mothers have reported a higher incidence of plugged ducts during the winter months. This may be due to the restricting nature of tighter cold weather clothes or from the colder weather itself. Treatment for plugged ducts includes frequent feedings, breast massage, warm compresses, and wearing looser clothing. Some moms may experience nipple coldness, pain, or discoloration when exposed to cold temperatures for a long time. This can be prevented by warming the rooms where baby will be breastfeeding, wearing warm clothing, and using warming packs before nursing.

Janelle Webb & Wendy Phillips, Certified Lactation Educators
Janelle Webb & Wendy Phillips, Certified Lactation Educators

Consistent and frequent breastfeeding will help establish and maintain mom’s milk supply, promote bonding, stimulate oral motor development for baby, and ensure a healthy start to life. Remember, breastfeeding warms babies’ bodies and hearts during the cold winter months! Contact your local agency for the Women, Infants, and Children’s (WIC) program through the Virginia Department of Health ( or your local La Leche League at for support and resources if needed!

~Janelle Webb, MBA, CLE & Wendy Phillips, MS, RD, CNSC, CLE, FAND

Janelle and Wendy are both Certified Lactation Educators, working with moms to help them breastfeed their babies and helping worksites develop baby friendly processes. Wendy is VAND’s immediate past president.

Welcome to the Official VAND Blog!


Welcome to the official blog of the Virginia Academy of Nutrition and Dietetics! We are excited to host this site for YOU, our members, to have a forum to connect with each other, hear about nutrition practices in Virginia, and help us fulfill our mission to empower members to be Virginia’s food and nutrition leaders. Through this blog, we can provide nutrition education to the public, to optimize the health of Virginians through food and nutrition expertise.

We are soliciting blog posts from RDNs and NDTRs throughout Virginia, featuring original content. Have an idea for a post but not sure if it is what we’re looking for? Email us and ask – we will help you develop it into something for our blog! Please contact Wendy Phillips or Kristen Chang, VAND’s Co-Chairs for Professional Education to submit a blog post or idea. And of course, we will ask you to send a professional headshot to accompany the post.

Wendy Phillips
Kristen Chang
Kristen Chang

We look forward to hearing from you! Contact us at

Kristen Chang, MS, RDN, CSSD & Wendy Phillips, MS, RD, CNSC, CLE, FAND
Professional Education Chairpersons
Virginia Academy of Nutrition and Dietetics