Peak Performance: A realistic approach to nutrition.

Kathy LaBella RDN, CDN, CSSD, ACE-CMES/CPT      860-339-5493

Musician Dangers And Prevention Of Gastroesophageal Reflux

Photo by Kathy LaBella, RDN, CDN, CSSD

Gastroesophageal reflux disease known as GERD is both uncomfortable and dangerous for anyone,
and especially for those who use their voice as a profession, or for musicians who play wind instruments. This is because with GERD the gastric contents of the stomach reflux back into the esophagus by way of the lower esophageal sphincter known as the LES. Under normal circumstances the LES has high pressure that prevents the backflow of stomach acid, mainly hydrochloric acid back into the esophagus, but with GERD the LES has low pressure, it’s weak and remains open allowing backflow of stomach acid that can lead to inflammation of the esophagus known as esophagitis. Erosion and ulcerations can occur, and at times strictures of the esophagus narrow the opening, and there is a higher risk for esophageal cancer. When people have GERD they often complain of heartburn after eating or after laying down too soon. For musicians, it is not only the discomfort, but the physical attributes leading to decreased vocals and performances because this can also damage the larynx. In addition to GERD there is laryngopharyngeal reflux, this is acid reflux into the larynx that can cause laryngitis, or a sore throat, or mucous, and in some cases reflux in general can make swallowing difficult.

There are several causes of GERD, one being a hiatal hernia; other common causes are excessive alcohol and smoking that irritate or exacerbate the condition of GERD by lowering the pressure of the LES. Additional irritants include increased amounts of coffee and tea due to the acidity, high fat foods, calcium, chocolate, spearmint, peppermint, citrus foods, and nicotine in general. Years ago I would often have people avoid many spices including pepper, cloves, and chili, today I often recommend spices as tolerated, but depending on the individual, the major offenders through my years of experience is excessive alcohol, coffee, smoking, and chocolate, and to a lesser degree spearmint and peppermint.

Nutrition prevention for GERD include foods that increase the pressure to keep the sphincter closed and the esophagus comfortable include higher protein content from lean sources other then fatty meats, or dairy due to the calcium content. Lean protein can include fish, skinless turkey or chicken, a lean roast beef, or vegetable protein. Consuming smaller frequent meals, decreasing weight as necessary if overweight, and waiting a couple of hours after eating before laying down, or propping yourself up with a pillow to prevent contents coming back up from the stomach. Consume plenty of fluids, preferably water, and avoid tight clothing. There are antacids, however I am not a personal fan of antacids because they decrease necessary hydrochloric acid needed to absorb B12, therefore I prefer to correct the problem rather than cover it up. In some instances, your physician may prescribe a proton pump inhibitor such as Prilosec or Nexium that unfortunately may have some long term side effects, therefore it is up to each individual to discuss this with his or her physician, and weigh out the options, or start with medication to ease the pain to stop the reflux pre-performances, and then work on diet to omit or decrease the medication as able.

For more information on healthy ways to include calcium, preserve bone health, or consume your favorite foods with GERD – stay tuned to Peak Performance RD as new programs about nutrition and health for musicians will be available soon! And as always, individual counseling sessions are available and covered by many insurance plans, please visit Nutrition for Musicians.

March Is National Nutrition Month® Savor The Flavor Of Eating Right

“Savor the Flavor of Eating Right” is this year’s theme for National Nutrition Month® that is focusing on cooking at home, following your traditions, and expanding your tastes by trying new adventures with food.

 Eating Right with grilled scallops
Broiled scallops over grilled vegetable salad

Eating right and eating healthy can be made simple with a little planning, especially now that spring is here and local fruit and vegetables stands are opening up all over. Eating right can actually save time and money with simple quick meals made at home or packed daily for your lunch and snacks.


Fruits and Vegetables – I encourage many fruits and vegetables for their abundance of nutrients, fiber, and antioxidants, as well as the ability to be a quick fix we can grab on the run from bananas and apples, to berries and grapes, to carrots, celery and peppers to take on your way out the door. Whether you opt for weekly shopping or daily stops along small markets, adventure out to try something new by adding a variety to prevent boredom. While at home, bring on the flavor and add a little cinnamon or nutmeg to your cut up fruit. And be sure to enhance your vegetable dishes with sautéed or grilled garlic, onion and herbs!

Nuts and Grains – Incorporating nuts and seeds are easy to pack along in a small container, or spreading peanut butter on whole grain bread for the road is simple while providing protein, and fueling your body with carbohydrates and healthy fats for the energy to get you through a few hours. In the evening making long grain rice only takes 30 minutes while you prep the rest of your meal or cut vegetables. If you have no time for rice, try thinly slicing a sweet potato for indoor grilling combined with your other vegetables and sprinkled with pine nuts; it only takes about 10 minutes to grill up a healthy meal. Another simple quick fix is adding nuts and seeds to a salad mixed with fresh herbs for dinner, combining taste, color and nutrients.

Protein – There are many choices today for protein that you can add into your day from Greek yogurt or soy yogurt to protein packed smoothies for a quick nutritious breakfast or a snack while at work that will keep you full without all the calories. Pack lunch the night before by adding lean fish, poultry, or beans in with a salad for lunch consisting of dark greens such as spinach with cut up broccoli, tomatoes, peppers, cucumbers, and a few olives topped off with a touch of olive oil and balsamic vinegar, or pack leftovers from your dinner to take to work or school the next day to ensure you’re eating well. Top off your meats and seafood with rosemary, oregano, pepper, fresh squeezed lemon or orange for flavor.

 Eating Right
Spinach, broccoli, tomato salad w/olives

Savoring the Flavor – Take the time to enjoy your meal! It does not take any more time to put your food onto a nice plate, add a little flavor with your favorite spices and herbs, and pour yourself a cold water in a nice glass with a lemon wedge, or add fresh chocolate mint leaves to green tea. Use a cloth napkin, light a candle, relax and enjoy your meal. It doesn’t have to take long, only long enough to enjoy and savor the flavor.

Nutrition For Musicians: Protein

Today I’m discussing one very important nutrient for musicians: protein. Join me as I share some helpful tips on how to include protein in your diet. For more information about nutrition for musicians, be sure to check out the other videos in this four-part series and visit my website at! Videographer Kate Eberle

Building Confidence 101: Successful People Are Built From Within

successful peopleI recently read a headline ad about building confidence. At first I thought, oh how nice, a therapist must be giving a talk to people on how to build their confidence. Then I read on, no it wasn’t this at all. It was an ad for face lifts and cosmetic surgery for the body. I sighed, and thought to myself if you want to build confidence it has to start with inner peace.

Wrinkles or a few extra pounds are not necessarily high on the priority list of genuinely confident or successful people. If confident people were that fixated on changing their outer appearance they wouldn’t be as successful, focused, or as happy as they are today. Cosmetic surgery is not a solution to true inner confidence because the outer results often do not last.

My advice has always been if you want to change your looks start with treating your body well. As I’m known for saying if you want a bigger chest do some bench presses or push ups. Want a firmer butt? Try some squats or go for a walk. As for the face; hydration and a good moisturizer, sun screen, or an anti-wrinkle cream work well along with a healthy diet.

In a recent conversation with a male friend he said to me “I’m glad I’m not a woman so I don’t have to wear make-up”. My response back was “I don’t need make-up, I just like it”. He laughed, but he also knew where I was coming from having seen me comfortably walking around without make-up. There’s a difference, there’s nothing wrong in dressing up and having fun, but to permanently change your body or face thinking it would build confidence is not the real solution.

Real confidence is within, and if you want to build your confidence while reducing your waist size, and enhancing your appearance, start with proper nourishment for your brain and body. For a long term sustainable solution, begin with a registered dietitian nutritionist (RDN) versus cosmetic surgery. Not only is it more cost affective and non-invasive, it’s feeding your body, and building your mind that boosts your inner feeling of well being, and confidence.

A registered dietitian nutritionist can’t take the place of a therapist; we do however council and often work in conjunction with a therapist for a client to receive better treatment for the mind, body, and self love. RDN counseling helps to change how you feel inside and out because improved nourishment fuels the mind, increases your energy that leads to a greater fitness level, decreases stress and disease risk and in turn leaves you truly feeling more confident on the outside, and most importantly peaceful and strong from within, and that’s a genuine and sustainable change that will last forever.

Proper Nourishment Is Necessary To Alleviate Musician Stress Factors

musician stress factorsBeing a dietitian nutritionist and exercise specialist who works with musicians, playing guitar and music for me has to come last as it’s more important to keep up with the latest nutrition research to help my clients versus what can I learn next with music. On the other side I enjoy playing guitar and do so as time allows. Playing also connects me to insight as to what stressors, musician stress factors, musicians may have because I am always paying attention to body mechanics.

We all become accustomed to what we do whether it be our work, a sport, playing an instrument, or a combination of both work and performing as it is with the professional musician. When we become accustomed to what our body becomes comfortable with, we often forget the importance of repairing our body by way of food, stretching, or activity to relieve joints of inflammation or pain.

Musician Stress Factors

As for myself, my body has become accustom to weight training, over and over very similar routines at least four days per week for over 30 years. Therefore, it’s rare for me to feel much discomfort or tightness following a tough work out, and when I do feel any discomfort I don’t always pay attention to it. However, I do know enough to nourish my body both pre and post work-out to prevent and repair any damage that’s been done. Perhaps this is why I feel less stress. This same method holds true for any musician working the same muscles and tendons day after day. More flexibility and strength develops over time, and on the downside unfortunately over time there is more ware and tear on the joints leading to arthritis for some. The other downside is by only working certain muscle groups as it is with playing an instrument, there is more room for stress factors, and weakness in other muscles not being used. Similar to any athlete who only performs one exercise day after day that leads to increased risk for stress fractures.

This week as I’ve been learning a couple of new songs on the guitar, perhaps playing a little more than usual, and like any new song it’s new moves, new exercise for the fingers, wrists, and hand, and new repetition over and over, thus leading to tightness and joint pain I’m not used to feeling because I am not a professional seasoned guitarist as I am with regular exercise. At first I thought this shouldn’t be happening, I perform all kinds of exercises including forearm exercises and wrist stretches as I’m a kayaker, but yet this was a new pain never felt before. What this told me is two things; one that I need to stretch more and probably get a little more nourishment into my body post playing guitar, and two it tells me that a seasoned musician requires nutrients as much as any athlete repetitively using the same body parts over and over. Proper nourishment can help to alleviate impending inflammation or joint pain, and repair or prevent damage from happening down the road that may include arthritis or osteoporosis.

Proper nourishment means consuming adequate nutrient rich carbohydrates with antioxidants and phytochemicals, plenty of protein sources to repair damaged tissue, adequate hydration, as well as rich sources of essential fatty acids and calcium to name a few. It means not going hours without eating, and if you’re practicing three hours at a time, it means having something to eat before and after playing. This is how you can help alleviate musician stress factors.

Nutrition For Musicians: Hydration

Hydration is important for everyone, but especially for musicians – today I’m going to show you how to stay hydrated along with alternatives other than water. For more information about nutrition for musicians, be sure to check out the other videos in this four-part series and visit my website for further information on hydration or individual nutrition needs at! Videographer Kate Eberle

Preventing Drummers Fatigue With Nutrition

Preventing Drummers Fatigue with NutritionRecently drummers have come to me with a common complaint involving arm fatigue during performance, ranging from minor fatigue to complete stiffness. One drummer claimed his arms had “locked up”. Arm fatigue, also known as drummers fatigue can be caused by a number reasons, including tendonitis, lack of conditioning or flexibility, dehydration, increased body temperature, a change in altitude, body pH or decreased energy from not consuming adequate nutrients, predominately carbohydrate pre-performance.

After speaking with drummers I found that the lack of energy and fatigue was commonly due to inadequate nutrition and hydration before and on the day of performance. The lack of energy is often no different then a runner “hitting the wall”, meaning they’ve run out of fuel. This fuel is supplied by glycogen, a storage of glucose in the body.

Fatigue can occur while musicians are often too busy to eat while getting ready, packing their gear, or practicing. This results in a lack of calories, consisting of carbohydrates necessary for fueling the working muscles upon entering the stage. Dehydration is the second leading component.

Carbohydrate stored as both liver and muscle glycogen are broken down to glucose, providing adequate energy to prevent fatigue while playing. Muscle glycogen is a major source of carbohydrates that function as a reserve for glucose available to working muscle cells. While liver glycogen helps maintain our glucose in the blood stream. A combination of all nutrients including protein and fats are necessary to perform. Fat is our second source of energy following glycogen but ultimately results in fatigue due to the predominate lack of carbohydrates.

The problem and complaint I hear, is what to eat pre performance? Unless you have a personal chef or someone to cook for you, you’re left alone to figure out how to fit in food. Think in simple terms of carbohydrate foods that include nutrients but break down fast for energy and won’t leave you with cramps or an unsettled stomach. This can include a light meal with salad greens or a small amount of rice, pasta or quinoa with some chicken or fish on the side for protein, to a simple peanut butter sandwich, or a fruit and yogurt smoothie if you’re pressed for time. Other foods to help prevent cramping that may lead to muscle fatigue include protein sources in the form of either meat or vegetarian. In addition to foods that are nutrient rich in potassium, magnesium, calcium, and sodium. Potassium is commonly found in bananas, potatoes, raisins, or tomatoes, while foods rich in magnesium can include walnuts. Since calcium commonly comes from dairy, incorporate if tolerable, or consume vegetarian sources of calcium. Sodium is essential to help retain fluids efficiently, especially if you tend to sweat a lot. It’s often presumed that cramping may be caused from low potassium however magnesium and sodium can actually play a larger role, especially when sodium is lost in sweat. The bottom line is all of these nutrients can help to reduce arms locking up and drummer’s fatigue. The key is to start incorporating some of these foods into your regular diet and not to consume large amounts anything, especially too much fiber for a pre-performance meal that can cause an uncomfortable feeling. It’s best to keep it simple the day of performance, consume your larger amounts of carbohydrate a day or two before performance to ensure adequate glycogen stores the day of your performance or concert. Along with small amounts of simple carbohydrates the day of the show to top off your glycogen stores to prevent fatigue. It is equally important to stay hydrated! Drink mostly water throughout the day, and while performing. If you’re going to be on stage more than an hour it may be best to consume a sports drink or diluted juice with fifty percent water and a pinch of salt to replace your electrolyte losses in sweat. Be aware that low blood sodium from too much water can equally cause fatigue. The added sugar in a sports drink or juice will ensure energy, but never consume a full strength juice as it may tend to cause cramping.

Other helpful foods include natural nitrates found in vegetables such as spinach, beet greens, and beet juice that is not only beneficial for cardiovascular health, these natural nitrate foods also shown positive results in reducing time to exhaustion in high performance athletes. This is something I recommend considering incorporating into a drummer’s diet due to their high level of performance, but like anything new, do so on a practice day first.

So when you think about it, a quick fix can easily be blended up with yogurt, fat free milk or a dairy alternative, to a protein powder with a banana, small amount blueberries, spinach, kale or beet greens, and a few walnuts will give you all the necessary nutrients you need in the form of calories, carbohydrates, proteins, fats, vitamins and minerals, along with the added bonus of antioxidants to get you through your performance without too much bulk.

The amount of carbohydrates needed vary depending on your size, gender, age, and activity level, but in general for a drummer’s activity level you need about 2.25 grams of carbohydrate per pound of body weight, and 0.55 grams of protein per pound of body weight, and healthy fats are necessary to consume as well for working muscles to function properly. And much less carbohydrate is needed on the day of performance, depending on your tolerance, don’t overdue it.

Post performance it’s very important to replace your energy loss by consuming carbohydrate to replace glycogen stores, and to consume plenty of protein as well to repair any muscle damage from playing that in turn can cause soreness. The protein is most important post performance for this reason.

In addition to adequate nutrition, as most drummers know, but an important reminder is to stretch both upper and lower extremities on a regular basis and especially on the day of performance. At the very least stretch your arms, shoulders, forearms and wrist as well as back muscles, but do include your legs as well to keep circulation going and prevent any cramps or stiffening while sitting. If you want to increase your level of performance, weight training or yoga along with endurance activity such as running or cycling is beneficial for both strength and conditioning for both working muscles and respiratory function to help you perform at your top level. If you are already doing all of this and your fatigue and locked up arms or pain persists, please consult with your physician to rule out any form of arthritis or other inflammation that may need medical attention. Meanwhile stay hydrated and consume plenty of healthy carbohydrates!


Part 1 Of 2: I Never Exercised A Day In My Life, But I’m More Fit Than Many Half My Age

I Never Exercised a Day in My Life, but I’m More Fit than Many Half My AgeI once heard Steve Vai say during an interview, “I never worked a day in my life”. Vai is a Grammy award winning guitarists and songwriter who has produced several albums and performs world tours that have ranged from playing with top rock bands to symphony orchestras, yet Vai says he has never worked a day in his life. That’s because Steve Vai is doing what he loves; it does not feel like work to him, it’s a passion that is clearly exuberated as he performs, a passion he only happens to make a living at it.

I can’t say I never worked a day in my life, but being a registered dietitian nutritionist and an advanced health and fitness specialist with American Council on Exercise, I can say I never exercised a day in my life! I may be affiliated with exercise, but yet I don’t feel I’ve ever done it. I say this because the word “exercise” sounds like work to me, it projects a negative connotation. Who wants to exercise? It’s like telling someone they have to do something and it’s saying you have to work at it. Adult physical activity guidelines indicate we need a minimum of 150 minutes of activity or exercise per week that include a combination of cardiorespiratory, resistance, flexibility, and neuromotor exercises such as balance. I agree we need to be active and I educate people on what the guidelines mean and how to achieve them, but the guidelines can be a little overwhelming if you’re not sure where to begin. I prefer to play, have fun and enjoy activities I choose to make part of my lifestyle. It only happens to be that I enjoy activities that keep my body and mind in motion and in return it keeps me more fit than many people who are half my age who choose to be inactive.

I grew up swimming, skiing, biking, dancing, walking and running through trails in the woods. This was never felt like exercise, it was fun; doing what I loved and trying new adventures as they came along. As children, we don’t think about the correlation of exercise and the prevention of heart disease, cancer, diabetes, osteoporosis and bone density, or maintaining a waistline; children only think about the activities that are enjoyable to them. At the age of fourteen, I was introduced to weightlifting machines in gym class. It wasn’t exercising for me because it was too much fun! I was tall and I was much lighter in weight than other kids in my class due to my small bone structure, but I discovered I was one of the strongest of my female classmates. Therefore, I found something that was both fun and easy for me to do. That’s the key, enjoying what you’re doing. Weight training and feeling comfortable in the weight room only became a passion of mine once I entered into my twenties, a lifestyle I continue in my home gym today at least four days a week that begins at four in the morning following meditation and before my workday. But I never exercised. It is relaxation to me that ensures a happier day to follow, a ritual that’s only part of my life along with several other activities that became passions, but never exercise.

In college I remember classmates frantically studying for exams without taking a moment to relax. I would see their jaws drop at times when I would get up in the middle of studying to run to the gym for an hour. Some thought I didn’t care about my studies, but the reality was it was my way of regrouping, clearing my mind, relaxing my body, getting rid of any anxiety by doing what I enjoyed. What many didn’t realize is that a one hour break away to the gym helped me to perform better on exams.

Throughout most of my twenties, I taught at a modeling school and agency that included teaching group exercise classes in addition to the runway, communication, and media classes. It was the exercise classes that were my favorite to teach because to me it was fun, it was a pressure-free high energy class that felt more like dance and left everyone feeling good at the end. During my prior runway days, I was fortunate enough to have a group of close friends I worked with who truly loved going out dancing and not drinking. It was our way of socializing and having fun while staying fit.

In my mid to late thirties, while having a private practice as a sports nutritionist and consulting dietitian, I ventured out to try other activities. It went from golfing a few days a week to cycling long distances through the hill towns near surrounding Northampton, Massachusetts where I lived at the time, too long hikes through the mountains, to trying my hand at rock climbing and learning whitewater kayaking. I also skied at least one day a week in the winters. Much of it was part of my career at the time where I was affiliated with a fitness club where I had an office location, and I also lifted weights there, but never considered any of this to be a form of exercise.

Activity can change as we change and age, unexpected injuries or illness can occur, and there’s marriage, family, children, divorce, the death of a spouse, child, or parent, to the loss of a job and financial changes or moving away to new demographics. Staying active and finding new passions are all part of the change and I found it’s important not to let roadblocks get in the way. I’ve been through many of these changes, one event, in particular, was before moving away from Northampton, Massachusetts I had an automobile accident that caused a cervical spinal cord injury, a fluid-filled cavity in my spinal column referred to as Syringomyelia that caused inflammation and pinching of nerves along with numbness and excruciating headaches. Being intolerant to medication I opted for nothing or an occasional Aleve. I was told I would never lift weights again and told to never ski or run, and I was given a diagnosis with a possibility of being wheelchair bound before my fortieth birthday. I was thirty-eight years old at the time…

Part 2 Of 2: I Never Exercised A Day In My Life, But I’m More Fit Than Many Half My Age

Kathy LaBellaI was told I would never lift weights again and told to never ski or run, and I was given a diagnosis with a possibility of being wheelchair bound before my fortieth birthday. I was thirty-eight years old at the time.
To Be Continued…

Part Two
I immediately started thinking of things that I could do for work and activity if by chance I would lose much of my mobility, and at the same time being single and self-employed I had to keep going and couldn’t miss a day of work! I was accepting of what could be, but at the same time tenacious and determined to regain strength in my upper extremities by imagining holding invisible dumbbells, and soon started lifting actual weights at home until I moved onto five pounds and up. I eventually regained 75 percent of my strength and I skied cautiously as tolerated, and accepted not to do the activities that weren’t tolerated such as sea diving, whitewater kayaking, and at the time underwater swimming, in general, was painful.

In my early forties, I moved to Essex, CT located near the Connecticut shore at the mouth of the Connecticut River. It was a new lifestyle, and new activities to venture out to. I built a new home, office and nutrition and fitness practice where I had a large industrial home gym all in one location. Although I missed my old activities, I immediately wanted to emerge myself into this new area and explore new passions to be learned and I wanted to learn what my future clients might be doing for their activity. I took a few days of sailing lessons and later discovered many of the shoreline bike trails, but my real passion became sea and river kayaking without the Eskimo rolls; it was absolutely incredible! I found my new love! At the time, I was still having problems road running, although I did run one race and decided road races weren’t for me, just not all that fun to me. Instead, I learned of the many trails near where I lived and the softer ground was the way to go. Not only was I connecting with nature and animals, but it was easy on my neck, back, legs and feet. Trail runs and hikes were fun and stress relieving, not at all like exercise or work. After moving to Essex, I decided that driving to Vermont to ski on a regular basis was a bit too far at three hours away and opted for snowshoeing. It’s not quite the feel of downhill skiing, but it was a good compromise that gave me a challenge in the snow and it was free! Therefore, I accepted, adopted and loved the new activities brought into my new life. And then there was gardening… massive gardening in the new two plus acre house I built! It was another new discovery that was fun and active, but it wasn’t in anyway exercise.

Now in my fifties, I have moved onto Waterford, Connecticut, leaving many Essex adventures and my former practice behind, and while discovering new activities along with playing music again, I spent two years researching to form a new practice based on the special nutrition needs for musicians, particularly active and touring musicians. While living on the mouth of the Niantic River that opens up into Long Island Sound, it gives me the ability to paddle in my kayak frequently as the water’s edge is in front of my cottage. In the winter, I resort to using my indoor rower and I discovered beach running is more enjoyable than the wooded trails, yet soft on the spine. And this year I stopped using a landscaper to mow my yard and bought an electric push mover that’s become an enjoyable weekly ritual following a weekend beach run.

Music helps with activity along the way. I’m always plugged in and have portable speakers for the Kayak, and yes, sometimes Steve Vai is playing, along with my many other selections of music.

As for today, I will continue to kayak, beach run, meditate, and lift weights in my small cottage gym because it is not like work or exercise, it is only a way of life, and an extra forty to seventy minutes a day that takes the place of what could be wasted time otherwise. Being active at whatever it is you enjoy is important. It’s only a bonus that fun activity keeps your body and mind fit while staving off arthritis, preserving muscle mass, preventing cardiovascular disease, diabetes, osteoporosis and increasing endorphins all while reducing stress, enhancing immunity, memory, and quality of life. Activity keeps you younger than your chronological years.

So as this evening falls when many people are sitting on their sofa watching their television and I’m a bit tired after a long day of activity and work, I turn off National Public Radio that’s playing in the background. I sit down in silence and at first, turn toward my piano but instead, I pick up my guitar to play before I go to bed, and then think Steve Vai has never worked a day in his life, and I an exercise specialist and dietitian nutritionist has never exercised a day in my life.

I encourage you to find your passion- a new activity, get out and play or learn a new musical instrument, and remember to eat well, stay healthy, happy, and active because the benefits have endless rewards!

Kathy LaBella, RDN, CDN