Despite the fact that her on-campus kitchen has prepared more than 500,000 research meals since she started with UAB, don’t call Betty Darnell a cook.
Darnell, director of Bionutrition Research in the Clinical Research Unit (CRU) of the CCTS, is a registered dietitian who has been with UAB for more than 30 years, first in the General Clinical Research Center (GCRC), which became incorporated into the CCTS. She went from early days using a calculator and a composition book to concoct finely calibrated menus for research participants, to overseeing a high-tech kitchen complete with eight freezers, four refrigerators, and a stove.
“Thirty years ago we had three people in the kitchen and an inpatient-only unit serving some food from the hospital’s main kitchen,” Darnell recalls.
Darnell came to UAB as head of nutrition research in 1977 from the University of Alabama, where she taught nutrition to premed students. “I had had experience in research, and used ‘real-life’ examples to explain nutrition to my students, which they appreciated,” she recalls. Prior to that, she worked at the GCRC at the University of Kentucky in Lexington.
The first nutrition study in which she participated at UAB was a diabetic neuropathy study, conducted with an endocrinologist, she says. As the program grew, Darnell assisted with a hypertension study with nephrologist Dr. John Curtis, who is still with UAB. Most of the work being done at that time was research with inpatients, Darnell says, as the center rented hospital space for inpatient studies.
“Among GCRCs, we were one of the top nutrition components in the country serving research patients,” Darnell says. “We were preparing many, many more meals per staff member than any other GCRC in the country.”
Among the diseases for which Darnell and her staff assist on dietary research are obesity, heart disease, and “whatever the doctor wants to study,” she says. Examples of services she and her staff perform regularly are taking accurate patient measurements of skinfolds, or anthropometrics, and preparing specific research diets for various studies such as polycystic ovary syndrome (PCOS) and obesity in adults and children. A recent challenging research diet Darnell cites is one that examined phosphate additives in foods and the effect on patients with kidney disease.
Darnell, with the help of registered dietitian Suzanne Choquette (MS, RD, LD) devises diets for each particular research study. These can include low- or high-glycemic diets, lipid modification, low sodium diets, and timed meals, among others. Then the Bionutrition Core staff—including five full-time research cooks in the newly renovated kitchen—carefully prepares each meal and snack, then helps participants keep accurate records of their food intake. This involves making sure the food meets the standards set for each study for weight, nutritional contents, calories, and so on. The Bionutrition Core uses the Minnesota Nutrition Data System for Research (NDS-R) software program to obtain nutritional analysis of research participants’ food intake records, recalls, and weighed food intakes. Sometimes meals, once they’ve been prepared according to the specific diets, are mixed in a blender then tested in a lab, to be sure the nutrients, calories, vitamins, and all match the desired outcome.
Investigators typically come into the CRU with their own funding, but the CRU can subsidize the cost of some CRU nursing and bionutrition services for pilot studies.
“Several investigators will include us as coauthors if we help write the protocols,” Darnell says. Investigators may submit protocols that are approved and funded, and an executive committee meets regularly to decide the feasibility of that study. Darnell cites two main reasons to bring a nutrition study to UAB: local patient population, and the strength of the nutrition program.
“We’re the one area on campus that does feeding and nutrition studies and actually prepares the food,” she points out. “We’re not a treatment program, we’re looking at what we can recommend to the general population.”
In her three decades at UAB, Darnell says she has done “a little bit of everything; I believe you have to be willing and able to do everything.”
Darnell could be credited for being involved in initiating one of the country’s more popular cooking magazines, when she wrote a cookbook for diabetics and their families. “In those days, the diabetic cookbooks were really weird and not very appetizing,” she recalls. With the help of Birmingham-based Oxmoor House (Southern Progress), Darnell printed the cookbook and when it quickly sold out, they realized they had a niche hit on their hands and published two additional cookbooks for diabetics that sold not only nationwide but extended to other countries. “Eventually, UAB made more than $1 million in royalties, which we used to recruit and fund graduate trainees—up to three per year—some of whom stayed on to do their PhDs here,” she says. “The editors at Oxmoor House told me that the success of the cookbooks was the catalyst for Cooking Light magazine.”
Dr. Jessica Alvarez, a former student of Darnell’s, counts herself as one of those graduate trainees. Alvarez, a postdoctoral research fellow at Emory University’s Division of Endocrinology, Diabetes & Lipids, became one of the first CCTS TL1 trainees. She says working with Darnell was a career-changing experience. Alvarez is currently working on a study looking at the role of vitamin D in enhancing the immune system in people with Cystic Fibrosis. She recalls:
I started with Betty as a master’s student as a nutrition trainee, funded off the cookbook she started on diabetes,” Alavarez recalls. “Betty mentored me through everything from finding a research project to performing the research, and finally writing the master’s thesis. Then she convinced me to stay and get my PhD [in Nutrition Sciences]. She mentored me through the PhD process.”
While at UAB, Alvarez published an article in the American Journal of Clinical Nutrition about how vitamin D and parathyroid hormone (PTH) may independently affect whole-body insulin sensitivity. The piece has been recognized by the CTSA Consortium and used as an example of the Consortium’s contribution to research.
Alvarez says she and other former students who see Darnell as a mentor have a nickname for her.
“We call her our champion—if anything went wrong with our dissertation committee, Betty would stick up for her students. If we were too scared to say something, Betty would say it for us,” she says. “I miss the support terribly. She’s been wonderful to every single student that has gone through there.”