Nutrition: The Complete Guide
Second Edition
International Sports Sciences Association CERTIFICATION COURSES
Second Edition
Nutrition: The Complete Guide
800.892.4772 • ISSAonline.edu
1015 Mark Avenue • Carpinteria, CA 93013
1.800.892.4772 • 1.805.745.8111 (international) • 1.805.745.8119 (fax)
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International Sports Sciences Association CERTIFICATION COURSES
International Sports Sciences Association
John Berardi, PhD, CSCS
Ryan Andrews, MS, MA, RD
Brian St. Pierre, MS, RD, CSCS
Krista Scott-Dixon, PhD
Helen Kollias, PhD, CSCS
Camille DePutter
John Berardi, PhD, CSCS
Ryan Andrews, MS, MA, RD
Brian St. Pierre, MS, RD, CSCS
Krista Scott-Dixon, PhD
Helen Kollias, PhD, CSCS
Camille DePutter
Nutrition
The Complete Guide
issaonline.edu
Nutrition: The Complete Guide (Edition 2)
Official course text for: International Sports Sciences Association’s Certified Nutrition Specialist program
10 9 8 7 6 5 4 3 2 1
Copyright © 2018 International Sports Sciences Association.
Published by the International Sports Sciences Association, Carpinteria, CA 93013.
All rights reserved. No part of this work may be reproduced or transmitted in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including xerography, photocopying, and recording, or in any information storage and retrieval system without the
written permission of the publisher.
Direct copyright, permissions, reproduction, and publishing inquiries to:
International Sports Sciences Association, 1015 Mark Avenue, Carpinteria, CA 93013
1.800.892.4772 • 1.805.745.8111 (international)
DISCLAIMER OF WARRANTY
This text is informational only. The data and information contained herein are based upon information from various published and
unpublished sources that represents training, health, and nutrition literature and practice summarized by the author and publisher.
The publisher of this text makes no warranties, expressed or implied, regarding the currency, completeness, or scientific accuracy of
this information, nor does it warrant the fitness of the information for any particular purpose. The information is not intended for use
in connection with the sale of any product. Any claims or presentations regarding any specific products or brand names are strictly the
responsibility of the product owners or manufacturers. This summary of information from unpublished sources, books, research journals,
and articles is not intended to replace the advice or attention of health care professionals. It is not intended to direct their behavior or
replace their independent professional judgment. If you have a problem or concern with your health, or before you embark on any health,
fitness, or sports training programs, seek clearance and guidance from a qualified health care professional.
About the Authors | iii
About the Authors
Dr. Berardi has been recognized as one of the top exercise nutrition experts in the
world. He earned a PhD in Exercise Physiology and Nutrient Biochemistry at the
University of Western Ontario, Canada. His work has been published in numerous
textbooks, peer-reviewed academic journals, and countless popular exercise and nutrition books and magazines.
As an elite nutrition coach and exercise physiologist, Dr. Berardi has worked with
over 50,000 clients in over 100 countries, including Olympic gold medalists, world
champion UFC fighters, and professional sports teams. He is also an advisor to Apple,
Equinox, Nike, and Titleist.
Dr. Berardi was recently selected as one of the 20 smartest coaches in the world and
one of the 100 most influential people in fitness.
With a PhD from York University in Toronto and 10 years of university teaching,
Krista Scott-Dixon has over 20 years of experience in research, adult education, curriculum design, and coaching and counseling. In addition, she has spent over 20 years
pursuing self-education in health and fitness.
Through writing, coaching, speaking, teaching, and curriculum development, Krista
has galvanized thousands of clients to transform their health and fitness for the better,
and is guiding a new generation of fitness professionals to a higher level of success and
satisfaction.
Krista is the author of several books, dozens of popular articles, and many academic
publications. She also inspires readers at her groundbreaking women’s weight training
website, Stumptuous.com.
Ryan Andrews is a world-leading educator in the fields of exercise science and
nutrition.
Ryan is a Registered Dietitian with two master’s degrees. He completed his education
in exercise and nutrition at the University of Northern Colorado, Kent State University, and Johns Hopkins Medicine.
A highly respected coach who has been a part of the Precision Nutrition team since
2007, Ryan’s body of work includes an impressive number of articles, presentations,
books, and certification manuals on the topics of eating, exercise and health.
A nationally ranked competitive bodybuilder from 1996-2001, and now a certified
yoga instructor, Ryan is also an active volunteer with non-profit organizations to help
promote a sustainable future.
International Sports Sciences Association
iv |
Brian St. Pierre is a renowned expert in performance nutrition.
Brian is a Registered Dietitian with a Masters in Food Science and Human Nutrition
from the University of Maine. He is also a certified strength and conditioning specialist, a certified sports nutritionist, and the author of five books including the High
Performance Handbook Nutrition Guide.
As Precision Nutrition’s Director of Performance Nutrition, Brian contributes to
ground-breaking research, education and curriculum development at PN, where he is
also an esteemed coach.
Brian shares his expertise on a global scale by presenting at conferences around the
world, serving as a nutrition consultant for pro sports teams such as the San Antonio
Spurs, Brooklyn Nets, and Cleveland Browns, coaching professional and Olympic
athletes, and writing for popular publications including Precision Nutrition.
Camille DePutter is an author, speaker, and communications consultant with a rich
portfolio of experience in marketing, public relations, and storytelling.
Camille received her HBA in English from the University of Toronto and trained at
the Humber School for Writers. An advisor to Precision Nutrition, Camille lends her
communication expertise to Precision Nutrition publications, course materials and
marketing content.
As a consultant, Camille has helped dozens of top brands and business leaders refine
their messaging and improve their customer relationships. Her work has been published extensively in popular websites, magazines and newspapers.
Camille writes for the Precision Nutrition Encyclopedia of Food and is a frequent contributor to the Precision Nutrition blog. She is also the author of the workbook Share
Your Story, and self-publishes at camilledeputter.com.
Dr. Helen Kollias is a researcher and L1 Certification advisor at PN. She is also a
regular content contributor to the blog, where she uses her witty and articulate writing
style to make complex science accessible and entertaining.
Helen holds a PhD in Molecular Biology from York University, specializing in the area
of muscle development and regeneration, and a Master’s degree in Exercise Physiology
and Biochemistry from the University of Waterloo. She has also held research positions at some of the most prestigious institutions in the world, including John Hopkins University and Toronto’s Hospital for Sick Children.
Outside the lab, Helen has played and coached varsity soccer, and has been involved
in fitness and weight training for almost two decades. She also has two daughters with
whom she wants to share her joy of inquiry and experimentation, but above all, she
wants to teach them resilience, bravery, and grit.
Nutrition: The Complete Guide
How to Use This Text | v
How to Use This Text
When faced with new information, students usually wonder one thing:
“Will I ever need to know this in the real world?”
Whether it’s the cosine of an angle, Kepler’s laws of planetary motion, or the enzyme
responsible for forming citrate, students’ most common questions about what they’re
learning are:
“Will this be on the test?”
“Will I ever need to know this again in my life?”
We, the authors, know these questions well. We’ve asked them ourselves, most often
during our own high school, undergraduate, and graduate studies.
So now, as instructors living in the “real world”, we’d like to level with you: Probably
not.
Unless you become an engineer, you probably won’t need the cosine stuff. Unless you
go to work for NASA, you can probably forget Kepler. And the Krebs cycle? Well, you
won’t need that unless you teach biochemistry.
So why learn all this information?
Well, most of us don’t know what we want to be when we grow up. Work (and life) is
full of surprises.
You never know what career path you’ll follow, or what hobbies you’ll take up.
Be prepared for anything. Learn as much foundational knowledge as possible. Now
you have options.
But there’s another, more inspiring, reason for learning this stuff.
It’s actually kinda interesting. It helps explain your world. And makes you super-fun at
parties.
In fact, when you really dig into this knowledge, you might just change what you want
to do for a living because of it.
What this means
In this program, we’ll provide a lot of foundational knowledge.
We give you more details below.
This foundational knowledge — about stuff like cells, digestion, metabolism and
whatnot — can feel a little heavy at times. Especially if you’re new to this material. Or
you’re a practical, hands-on kind of person who would rather spend more time doing
than reading.
Hang in there.
International Sports Sciences Association
vi |
The payoff comes in the second section, where that foundational information gets
applied.
We’ll give you case studies. Strategies for working with real-world clients. Questionnaires and assessments to use with your clients. Psychological strategies for getting
clients excited about working with you. And all kinds of other fun things.
Even if you’ll never use the more theoretical material we teach you, you’ll still need
to know the science to apply it under “test conditions” — in other words, when you’re
sitting across from a client.
By the end of this course, we expect you to understand:
•
how the body works;
•
how to apply that knowledge to working with clients;
•
how to assess, monitor, and revise client programs;
•
how to communicate your knowledge effectively; and
•
how to get your clients on board with your nutrition plans and programs — hopefully feeling just as inspired as you about making progress and changing their nutrition
habits.
How the program is organized
This course is split up into two units.
Section 1: Nutrition science
In Section 1, we’ll go through all the nutrition information you’ll need to know, such
as:
•
•
How and why your cells work the way they do
How carbohydrates, fats, vitamins, minerals, and other nutrients interact with
your cells
•
How food becomes energy for maintenance functions, physical work, and repair
•
How your body balances out the food you eat with the work it does
•
How exercise affects nutritional needs and how nutrition affects exercise
Section 2: Nutritional practice
In Section 2, we’ll introduce you to how to coach, including:
Nutrition: The Complete Guide
•
What it means to be a good coach
•
How to prepare for clients
•
How to interact with different clients
•
How to assess clients
•
How to know which approaches are best for which clients
•
How to meet clients where they are (not where you want them to be)
•
How to keep clients progressing from day one until they reach their goals
How to Use This Text | vii
Other learning tools
Throughout the textbook, look for things like:
Unit objectives
Each unit contains clear objectives at the beginning. This will tell you what to focus
on, and give you goals before you even start reading.
Unit summaries
At the end of each unit, we’ll summarize the most important points from that unit.
These will confirm that you’ve learned what really matters, and give you another handy
tool for review.
Key terms
The first time a key term appears in the text, it is highlighted and a definition provided
in the margin. Familiarize yourself with each key term.
Case studies
Most units end with relevant case studies. These give you “real-life” examples of applied nutrition.
Each story describes a client’s nutrition challenges, then provides practical solutions to
work through these challenges.
References
We’ll provide a comprehensive list of references used to create this course. If you’re
interested in learning more about nutrition and health, you can look up and read more
of this primary source literature.
How to focus your learning
Just like coaching or training, learning should be focused and systematic, with a clear
purpose.
Here are some ways to stay on track and on target with your Level 1 journey.
Learn what you need to learn
You know your own learning style. (And if you don’t, now’s a great time to discover it.)
Help yourself succeed by building a system that suits you.
Use as many ways of processing the material as possible: reading, writing, thinking
and reflecting, listening, watching, talking about the material, drawing maps and
flowcharts of ideas, etc.
We suggest…
International Sports Sciences Association
viii |
1.
Read the unit. (textbook)
2.
Watch the video. (online)
3.
Answer the workbook questions. (study guide)
4.
Take the quiz. (online)
Set up a weekly self-study schedule so you get into a routine. Consistency and structure will help you move forward steadily and confidently.
Focus on key concepts
As the scientists working on the 1999 Mars lander mission found out when their
precious spacecraft wandered off into oblivion because they mixed up imperial and
metric measurements, details are important.
But details usually aren’t the most important things in this program. You don’t have
to memorize entire units, nor usually recall minute details (such as the exact body
density equation by Jackson & Pollock).
As long as you learn the concepts and study as we recommend, you have a great
chance of doing well on the quizzes.
Plus, you’ll always have your text available for reference. If you get stumped during a
quiz or a client interaction, you can always look things up.
It’s more important to know how to think. How to learn. How to connect ideas.
And to understand why things are important (and how they relate to one another) than
to recall specific details. (Unless detail memorization is your thing. Then go for it.)
What to look forward to
If you show up consistently, ready to learn and grow, and if you engage with this material using all the learning methods that work best for you, then this course will make you
a better coach.
Seek to master both the basic science (Section 1) and the applied art of coaching
(Section 2).
If you do, you’ll finish this program as a highly trained professional with the knowledge to support your recommendations; the ability to communicate them effectively
and well; and a foolproof system for delivering outstanding, reproducible results.
Let’s get started.
Nutrition: The Complete Guide
Acknowledgements | ix
Acknowledgements
It’s really important to us that everyone who helped bring this major project to completion is recognized for their work. Because, as we all know, nothing worth doing can
be done alone.
To this end we’d like to thank Paul Bradbury, Rachael Bell, Phil Caravaggio, Al Cimino, Alwyn Cosgrove, Alison Dungey PhD, Georgie Fear MS RD, Carmelo Galati RGD,
Jonathan Goodman, Sean Greeley, Mariane Heroux PhD, Timothy Jones, Bedros
Keuilian, Helen Kollias PhD, Sarah Maughan MS, Bob Moesta, John Nadalin, Spencer
Nadolsky DO, Tom Nikkola BA, Eric Noreen PhD, Prasanna Paul, Alex Picot-Annand
MS, Pat Rigsby, Francisca Ruff, m.c. schraefel PhD, Chris Spiek, Bryan Walsh ND, and
Erin Weiss-Trainor.
International Sports Sciences Association
Contents
5
How metabolism changes , p138
How exercise affects metabolism, p139
Introduction — Nutrition: The big picture, p2
Muscle and metabolism, p140
What is food?, p3
Energy demands of muscle, p143
What is good nutrition?, p6
Oxygen consumption, p144
What’s the best diet?, p11
Anaerobic versus aerobic exercise, p146
The cycle of food, p15
How we adapt to exercise, p148
What is nutrition coaching?, p16
Summary, p154
What this program will cover, p20
Summary, p20
6
Cells, p23
Cell structure and function, p24
Summary, p195
7
Vitamins, p199
Nutrition and cellular interaction, p28
Minerals, p201
Parts of cells, p31
Getting vitamins and minerals right, p203
Body function, p39
Vitamin and mineral overview, p205
Cell types, p42
Phytonutrients and myconutrients, p226
Summary, p44
Through the GI Tract, p45
Controlling the digestive process, p65
Summary, p229
8
Body water imbalances, p235
Summary, p76
Body water regulation, p241
Energy Transformation and Metabolism,
p77
Hydration strategies, p245
Summary, p251
Energy intake, storage, and transfer, p78
4
Water and Fluid Balance, p230
The big picture, p233
How do we absorb our food?, p70
3
Micronutrients, p197
Micronutrients, p198
How the body is organized, p25
2
Macronutrients, p155
Macronutrients, p156
Section 1: Nutritional science, p22
1
Aerobic and Anaerobic Metabolism, p137
How are nutrients metabolized?, p87
Section 2: Nutritional practice, p252
Summary , p111
9
What It Means To Be a Good Coach, p253
Energy Balance in the Body, p112
Why talk about coaching?, p254
Energy value of food, p113
What’s your story?, p255
Estimating energy needs and energy intake,
p119
What do great coaches do?, p259
Energy balance and imbalance, p124
Mental skills, p264
Achieving energy balance… naturally, p133
Communication skills, p267
Summary, p136
Summary, p269
Understanding clients, p262
10 The ISSA Nutrition Coaching
Methodology , p270
The process of change, p271
The 6 steps of coaching, p272
The early stages of the change process,
p278
Assessment and triage, p279
Identifying and clarifying values, priorities,
and goals, p283
15 Special Scenarios, p431
Start with the basics, p432
Disordered eating, p433
Food addiction , p442
Alcohol , p446
Nutrition and immunity, p447
Injuries / inflammation, p452
Sex and gender , p454
Choosing a direction for coaching and
building an early action plan, p287
Ethnicity, heritage and genetics, p461
Working through normal client
ambivalence, p290
Food sensitivities, p469
How to communicate effectively, p295
How we fit into the food system, p473
Putting it into practice: What’s ahead, p296
Summary, p299
11 Nutritional Levels, p300
Working with nutritional levels, p301
Summary, p316
12 Working with Level 1 Clients, p317
Level 1: Where it all begins, p318
Level 1 clients and your coaching process,
p321
Level 1 limiting factors and coaching
strategies, p327
Troubleshooting Level 1, p353
Summary, p359
13 Working with Level 2 Clients, p360
Life stages and aging, p462
Plant-based eating, p471
Summary, p478
16 Business 101 for Fitness and Nutrition
Pros, p479
What’s next for your coaching practice?,
p480
Smart business strategies for nutrition
coaching, p481
How to attract clients: Frequently asked
questions about sales and marketing, p488
Making it work: Avoid common mistakes,
p491
Summary, p492
17 Continuing Ed for the Coach, p493
Keeping up to date, p494
Taking it further, p495
Level 2: An introduction, p361
Staying on top of research, p496
Level 2 strategies, p370
Developing your coaching practice, p497
Troubleshooting Level 2, p393
Summary, p499
Summary, p397
14 Working with Level 3 Clients, p398
Level 3: Special situation nutrition, p399
Level 3 strategies, p404
Troubleshooting Level 3, p424
Summary, p429
References, p500
Index, p522
INTRODUCTION
Nutrition: The Big Picture
Nutrition: The Big Picture | 3
Unit Outline
1.
Objectives
5.
The cycle of food
2.
What is food?
6.
What is nutrition coaching?
3.
What is good nutrition?
7.
What this program will cover
4.
What’s the best diet?
8.
Case Study
9.
Summary
Objectives
This unit will introduce you to the big picture of good
•
nutrition.
You’ll learn:
•
how we define and think about food
•
how we define and think about good nutrition
why good nutrition matters for personal health, as well
as community and global health
•
how to answer the often-asked question: “What’s the
best diet?”
•
some of the things to think about when you sit down
to eat a meal
What is food?
Seems like a dumb question with an obvious answer. Food is stuff we eat that
fuels our body. Right?
Well, that’s one way to think about it. Food contains energy. Or, more correctly, “chemical bonds that, when broken, are used to create ATP, the fuel for our
cells.” (More on that in a later unit.)
But food also includes micronutrients, phytochemicals, zoochemicals, fiber,
water, and perhaps even organic molecules that we haven’t yet discovered. All of
these substances play crucial roles in our body, even though they don’t necessarily “fuel” it directly.
Zoochemicals: Components
found in animal food sources
Organic: Obtained from living
things
Micronutrients: Vitamins and minerals
We need vitamins and minerals in our diet. Without them, our body breaks
down.
Vitamins: Organic compounds
required by an organism as a vital
nutrient in limited amounts
For example:
Minerals: Naturally occurring,
inorganic substances
Vitamin C (also known as ascorbic acid) is a powerful antioxidant that can help
control inflammation and cellular damage.
The mineral magnesium plays a role in more than 300 enzyme systems and helps
with protein synthesis, muscle and nerve function, blood sugar control, blood
Inflammation: The reaction
of a tissue to injury or infection,
characterized by heat, redness,
swelling, and pain
International Sports Sciences Association
4 | Introduction
pressure regulation, energy production, and transport of
other minerals.
when you fill your car’s tank with gas, you know more or
less how far you can drive.
The list could go on and on. You’ll learn more about
these and other nutrients in later chapters.
But if you’ve spent any time doing “calorie math”, you’ll
know that trying to calculate precise inputs and outputs
for a human body is frustrating.
While none of these nutrients provide “fuel”, we still
need them to live and thrive.
When you’re missing key vitamins and minerals, your
body doesn’t work properly. You feel rotten. And you get
sick. That’s true no matter how much fuel is in the tank.
Phyto- and zoochemicals
Phytochemicals (whose name comes from the ancient
Greek phuto, or plant) are nutrients that only occur in
plants. Phytochemicals are one of the main reasons that
eating fruits and vegetables is good for us.
For instance, phytochemicals have been shown to:
•
offer DNA protection against free radicals;
•
protect against cancer;
•
decrease the risk of heart disease; and
•
reduce overall mortality.
Zoochemicals (from the Greek zoion, or animal) are
nutrients found only in animal products, such as CLA (a
fatty acid), creatine, and carnosine.
Zoochemicals have been shown to:
•
reduce inflammation and blood clotting;
•
protect against heart disease;
•
suppress cancer cell development; and
•
inhibit complications from diabetes.
•
Maybe you ate more calories than you thought you
should… but got leaner.
•
Or you ate fewer calories than you thought you
should… and gained weight.
•
Or you started eating breakfast instead of skipping
it…or vice versa... and dropped a couple of inches off
your waistline.
According to the simplistic “food as fuel” view, none of
this should be possible. Yet it happens all the time.
Human bodies aren’t combustion
engines.
They’re complex, dynamic, organic, and infinitely sensitive systems.
For example: Research now shows that all food isn’t created equal, and what we eat isn’t necessarily what we absorb
or use. Dozens — maybe even hundreds — of factors
affect how we digest, process, and utilize the food we eat.
This means that the fuel, or calorie, value of food
outside the body isn’t necessarily the same as the value
inside the body.
Plus, our body has its own priorities.
Phyto- and zoochemicals don’t provide “fuel.” Which
means that the “food as fuel” story leaves them out too.
For instance, the body will extract nutrients to keep you
alive by any means necessary, often making tough compromises along the way. This would be sort of like your
car suddenly driving itself to the gas station and holding
up the cashier until it gets what it needs, or cannibalizing its own headlights for fuel.
Food is so much more than fuel.
What’s more…
Living organisms are not machines.
Your body isn’t even completely
“human.”
They’re incredibly complex, self-regulating, and dynamically responsive — almost magical — systems.
Machines have precise inputs and outputs. For instance,
Nutrition: The Complete Guide
The trillions of microbial critters living in and on us do
much of our digestion and nutrient extraction. Analysis
Nutrition: The Big Picture | 5
of our bacterial environments shows that each of us has an individual gut flora
“microbiome”, like a fingerprint.
Changing our microbiome changes our digestion and absorption, and hence our
body composition and health.
Microbiome: The genetic
content of all the microorganisms
that inhabit the GI tract
We’re incredibly complicated, self-organizing, agenda-driven, only-sorta-human
systems. Frankly, the machines should be jealous. So, if the “food as fuel” idea
doesn’t give us the whole story, what is food?
Food is — in part — information.
When we eat, we’re delivering messages to our body.
•
Do this.
•
Don’t do this.
•
Release this hormone.
•
Don’t release that one.
•
Express this protein.
•
Don’t express that one.
Food (and the act of eating) sends instructions that kick off a chemical chain
letter. Each molecule of food contributes to a beautiful cascade of events, sending
all kinds of signals throughout our body.
Make hormones! Trigger immune cells! Switch genes on and off! Tell the work
crew to clean up and the builders to get on standby! Lights! Camera! Action!
It’s like the biggest, busiest movie set you can imagine. And somehow — unlike
many film sets — it runs almost perfectly.
Our body processes millions of calories and (let’s be scientific about this) zillions
of chemical compounds a year, with nearly 100% efficiency. (Just for comparison,
gas-powered engines, like our car, would be happy to hit 30% efficiency.)
Even cooler: Our thoughts, feelings, and environment can affect these processes. If we smell a tasty meal, have a positive or negative thought about food (or
anything else), are happy and relaxed or worried and rushing…it affects nutrient
processing.
Food is smart. And so is your body.
Thinking about food only as fuel reduces food to gasoline, your body to a dumb
machine, and you to a calorie accountant. You’re more than that.
Food and your body deserve a lot more recognition and honor.
The more we learn, research, and work with clients, the more we’re amazed at the
power of food.
International Sports Sciences Association
6 | Introduction
Food is packed with meaning,
information, and communication.
For a nutrition coach, knowing these stories is relevant.
Crucial. Powerful, life-shaping knowledge.
Every food decision we make sends a message to our
body.
Take a few minutes and consider these questions:
Every food choice is an opportunity to direct, shape, and
remake our health. Our body composition. Our performance. Our wellbeing.
Food tells a story.
Many of us in this field are physiologists and biochemists. Sure, we look at food through a science lens. But
that’s not our only perspective.
We know, too, that sharing food is a fundamental human act. Breaking bread (or whatever other food is on
the table) is part of our history. Our culture. Our legacy
as humans.
Food isn’t just a chemical story. It’s a story about
people.
How we eat, where we eat, and what we eat (or don’t)
tells a story. Food helps us communicate about who we
are, what we think about, and what’s important to us.
For instance:
•
I’m sophisticated. I’m a “foodie.”
•
I’m a thoughtful consumer. I’m a regular at the farmers’ market.
•
I’m from Mexico / Italy / Nigeria / Laos / [insert region
/ origin / ethnicity] and proud.
•
I’m the social hub for my big family. Come on over
this Sunday for dinner!
•
I’m adventurous. I’ll eat anything once. Once, when I
was traveling, I ate…
•
I’m careful with my choices. I avoid processed food.
•
I’m low maintenance; my fridge is empty. Let’s grab
something on the go.
•
I’m a bon vivant. I love eating at fancy restaurants.
•
I’m a caregiver. I love you. So I cook for you.
And so on.
These stories are essential information about ourselves,
about our family and friends, and about our clients.
Nutrition: The Complete Guide
•
What is food?
•
What is food… for you?
•
For your clients?
Is it fuel? Is it information? Is it personal freedom? Is it
shame? Is it self-esteem? Is it comfort?
Then consider these questions:
•
What would you like food to be?
•
What do you imagine it could be?
We encourage you to think big. Get imaginative. Learn
a little more about physiology. Learn a little more about
humanity. Discover what makes food one of the greatest
stories ever told.
A story of the wonder of evolution and biology. A
collective grand epic of our humanity. A chemical story
written in molecules, not words. It’s a story that shapes
your daily life, your health, and your function.
Food is fuel? No. It’s so much more than that.
What is good nutrition?
If food is more complicated than just fuel, then good
nutrition is probably more complicated than “following
the rules.”
Take a minute to answer this question for yourself: What
is good nutrition?
We’ve given this question a lot of thought over the years.
As of today, here’s how we answer it:
Good nutrition controls energy
balance.
As we’ve seen, food is more than fuel… but it does give
us energy.
Without enough energy coming into the body, we just
don’t work right. Our body starts to shut down processes
that we don’t absolutely need to survive, such as reproduction, some aspects of metabolism, and brain function.
Nutrition: The Big Picture | 7
Too much energy coming into the body also causes problems. We can become
resistant to important hormones (such as insulin or leptin). Inflammation may
increase. Plaques can form on vessels and blood pressure can go up. We risk
getting many chronic diseases.
Good nutrition helps control energy balance. We don’t eat too much or too little.
We can stay healthy, fit and strong. We feel good, and our body shows it.
Chronic diseases: A long-acting
disease that does not quickly
resolve, e.g., cardiovascular
disease, cancers, chronic
respiratory diseases and diabetes
Good nutrition gives us nutrients.
Each food has a certain nutrient density, or nutrients per amount of food. Since
we want to eat the right amount of food for our needs, we want to make sure that
that food is loaded with nutrients.
Imagine several plates, each one full of one type of food:
•
a plate of kale
•
a plate of lentils
•
a plate of cookies
•
a plate of salmon
•
a plate of berries
•
a plate of saltine crackers
Now, per plate of food, ask:
•
How many calories are in each plate?
•
How many nutrients are in each plate?
In some cases, like the cookies, there are lots of calories but few nutrients. That’s
called low nutrient density.
On the other hand, with the kale, there are lots of nutrients but few calories.
That’s called high nutrient density.
We need nutrients to live, and to thrive. Nutrients help us be as healthy as possible, perform at our best, and live long, active and vibrant lives.
Good nutrition helps us balance energy intake and getting enough of these
valuable, essential nutrients.
Table I.1: High- versus low-nutrient-density foods
Higher nutrient density
Lower Nutrient Density
Bright or deeply colored vegetables
Potato chips
Bright or deeply colored fruits
Soda and fruit juices
Beans, meats, eggs
Hot dogs, deli meats
Whole grains
Refined grains/flours, pastries
International Sports Sciences Association
8 | Introduction
Good nutrition helps us look, feel,
and perform our best.
Good nutrition — and good nutrition coaching — helps
our clients do what is most important to them, without
other things getting out of balance.
Performance
An athletic client might be focused mostly on performance. You can also help them stay healthy and strong
as they train. Or to be the right weight (or body fat
percentage) for their sport.
Body Composition
An older client might want to simply live healthier and
better. You can also help them keep the bone and muscle
that will keep them active and mobile.
A client who dreams of looking good at the beach or at a
big event (such as a wedding) might want to lose weight.
You can also help them prevent chronic diseases.
Good nutrition is about helping people look better. Feel
better. Perform better. Live better. And just be better
overall.
As a nutrition coach, take a holistic approach. Help your
clients balance specific goals with general benefits —
perhaps even benefits they didn’t realize were possible.
Good nutrition is outcome-based.
Every nutrition choice you make will lead to an outcome. Those outcomes can be measured. And they’re a
great mirror of reality.
That’s why we love the question “How’s that working for
you?”
Whenever someone tells us they eat really “healthy” —
which is just a concept in their head — the best follow-up is “Great! How’s that working for you?”
We use this question because it tests perception
against reality. If someone thinks they’re eating really
“healthy”, but they just don’t have the body, health,
or performance that could be expected, maybe that
person’s idea of “healthy” doesn’t match reality. Maybe
they’re not making outcome-based decisions.
Indeed, lots of people in North America think they have
a really healthy and balanced diet.
Yet, for example:
Nutrition: The Complete Guide
Health
Figure I.1 Good nutrition resides in the intersection between
health, performance, and body composition.
•
A study of Canadians found that over 60% of the calories they eat come from highly processed foods.
•
In the US, just over 11% of calories come from fast
food.
•
That “5 servings a day of fruit and vegetables” habit?
Data show that only 30% of people in the UK are doing it… and only 8% of Australians. (And often, those
vegetable servings are potatoes.)
•
Over 90% of clients report eating at least one meal in
a cafeteria or restaurant a day. While some people are
undoubtedly making healthy, less-processed choices
when they eat out, many folks are probably not.
That’s why good nutrition includes using outcomes (data
and reality) to inform future decisions.
Good nutrition is sustainable for
both us and the planet.
Can we keep eating and producing food the way we are
now? For how long?
Research suggests that we waste between 30 and 50% of
all food produced.
Nutrition: The Big Picture | 9
Food often travels thousands of miles between the farm and our dinner plate.
While global food production has gone up, hunger and malnutrition are still big
problems worldwide. And more crops than ever before are being grown to feed
livestock (not people).
With a planet that isn’t growing and a population that is, our food decisions need
to be more sustainable and environmentally considerate than ever before.
Luckily, what helps the planet usually helps our body and health as well. That’s why
good nutrition is about finding a diet that is sustainable for us and the planet.
Good nutrition is about removing limiting factors.
If you can help your clients identify their limiting factors — the things that stand
between them and reaching their goals — you’ll become a great nutrition coach.
While you’re building up your expertise, here’s a quick list of possible limiting
factors to look for. (We’ll share more examples later on.)
Genetics and epigenetics
Genetics (the blueprints of our body) and epigenetics (factors that control how
our genes are expressed) can affect how your clients respond to nutrition.
For example:
•
Few clients will have the genetic makeup to reach the upper limits of human
Epigenetics: The study of
changes in organisms caused by
modification of gene expression
rather than alteration of the
genetic code itself
performance.
•
Some clients will have genetic factors that can make losing weight, gaining
muscle, completely avoiding chronic diseases, or other physical outcomes
easier or harder.
•
Some clients will be genetically more or less able to metabolize certain foods
or chemicals, such as caffeine or particular amino acids.
Genes are not destiny. Epigenetic factors — such as nutrition, stress, or a healthy
environment — can strongly affect genetic expression. So you might carry several of the known gene variants for obesity… but you can also choose what to eat
for dinner, or put on running shoes and get outside.
Almost everyone can make daily choices that will keep them as healthy, fit, and
vibrant as possible, for their individual body.
Exercise
Amino acids: The building
blocks of protein. Organic
compounds containing both
COOH and NH2
Gene variants: Diversity in gene
sequence within a population
or among populations that are
most commonly due to single
nucleotide polymorphisms (SNPs)
or copy number variants (CNVs)
Activity changes how our body uses nutrients. Active and fit people can eat
more, use nutrients more efficiently and effectively, and keep their metabolisms
healthier than sedentary and unfit people.
So exercise (or lack thereof) can be an important limiting factor.
International Sports Sciences Association
10 | Introduction
At the same time, exercise alone isn’t enough to keep your clients healthy or lean.
(Which is one reason that your work as a nutrition coach is so important.)
Physiology
If you’ve ever had a serious metabolic or hormonal problem, or an imbalance of
neurotransmitters, you’ll know: Physiology is powerful.
Work with, rather than against, your clients’ unique physiological makeup, and
help them understand what’s realistic. (But stay hopeful.)
Take an integrated approach: Collaborate with your clients’ health care providers, if needed, to work together as a team.
Mindset
Every action starts with a thought. Thoughts become things.
Negative, sabotaging or inaccurate thoughts, self-talk and beliefs can hold your
clients back. Not only do negative mental dynamics affect clients’ behavior, they
also have physiological effects: Our brain and body treat these like any other
stressor, and respond accordingly.
Luckily, as a nutrition coach you can help replace negative mindsets with things
like positive self-talk or better information.
Notice how your clients think, and the stories they tell themselves. Consider how
you can also improve those thoughts and beliefs as part of your nutrition coaching. (We’ll look more at this in Section 2.)
Also consider how you can help your clients move from knowing information to
taking action.
A winning mindset plus a great nutrition action plan… that’s a recipe for success.
Environment
What’s around your clients?
Who is on their team? (Besides you.) How are their relationships at work, home,
school, or elsewhere?
What’s their schedule like?
What’s their physical environment like? Are healthy choices close and
convenient?
Most of our daily decisions are unconscious. We don’t think about them. We
just make them. So our environment strongly shapes what we do, eat, and think
about.
Even if your clients really want to make better choices, they’ll probably also need
to adjust their environment to do so.
Nutrition: The Complete Guide
Nutrition: The Big Picture | 11
Good nutrition looks for strengths and wins.
Good nutrition isn’t about “following the rules” or “being strict.” It’s about enabling happier, healthier, fuller lives.
As a nutrition coach, you’re looking for limiting factors, but also for your clients’
advantages, strengths, and opportunities for success.
How can you take what’s already working, and improve on it?
Now, of course, if you’re looking for strengths and wins, you’ll probably wonder...
What’s the best diet?
As a fitness professional, one question you will often get asked is which “nutrition camp” you fall into. Are you into Paleo? What about vegan? Intermittent
fasting? Detoxing? Or any number of other “flavors of the month” (so to speak)?
And clients will want to know:
“What’s the best diet?”
Paleo: A diet built upon foods
presumed to have been eaten by
early humans
intermittent fasting: A diet
that cycles between periods of
eating and not eating
The secret:
There isn’t one.
Here’s why.
Clients are diverse.
Here are just a few ways that your clients can differ:
•
Body type: Some clients are tall and thin; others short and stocky. Or everything in between.
•
Fitness level and body composition: Some clients are active, strong, lean,
and dense. Some clients have been sedentary for the last 50 years and may be
frail, without a lot of muscle.
•
Dietary preferences and exclusions: Whether kosher, halal or Jainist;
plant-based or carnivore; scavenger or “picky eater”; iron stomach or “allergic
to everything”, clients have a vast range of food preferences and many reasons
for them.
•
Budget: Your client might be a broke student, a middle-class family trying to
make ends meet, or a highly paid executive — perhaps even a pro athlete.
•
Organic / conventional: Some clients live on boxed and packaged foods.
Some clients try to read labels, sometimes. Some clients may choose only kale
that has been lovingly grown by a sect of Californian monks who hand-pluck
the bugs off.
International Sports Sciences Association
12 | Introduction
•
Nutrition knowledge and diet history: Some
clients will be devout followers of a certain dietary
practice, or a history of trying different diets. Others
have very little nutrition knowledge at all.
•
Time: Some clients have an open schedule, ready for
any kind of health and fitness project. Others have
a crowded daily schedule and countless conflicting
priorities.
•
Ethnic background and heritage: Our coaches
practice all over the world. Our clients live, and come
from, all over the world. A meal or cuisine that suits
an Anglo family may not suit their Hispanic, Somali,
or Punjabi neighbors. A client from a northern European ethnic group may digest dairy easily, while the
client of Japanese heritage next to them may not.
•
Age: As we age, our metabolisms change, our food
tolerances and appetites change, and our digestive
•
Good coaches stay skeptical, think critically, and take a
broad perspective.
Indeed, here’s one crucial piece of evidence:
The healthiest people in the world
don’t have a single nutrition
philosophy.
Physiologically, the human body can do well under all
kinds of different nutritional conditions.
We can see this clearly if we look at the traditional diets
of indigenous groups and ethnic groups throughout the
world.
•
ucts, with few vegetables.
•
Conversely, Kitavans in the South Pacific, the Hadza
of East Africa, and many groups in the Amazon basin
As a nutrition coach, your job is to help your clients — as
unique people — get to their goals. To do what matters
to them, in the way that’s best for them.
The best coaches don’t have a single
nutrition philosophy.
For example, the Arctic Inuit and African Masai eat
traditional diets that are high in fat and animal prod-
abilities change.
You get the picture.
“real-life” testing and client experience.
(such as the Tsimane of Bolivia) eat traditional diets
that are low in fat but high in vegetables and starchy
carbohydrates.
•
The !Kung of Africa eat traditional diets that are made
up of mostly nuts and seeds.
You might have the approach you like, or one that
worked for you. Great. That’s a solid start.
This is also true if we look at the world’s Blue Zones,
areas where people live exceptionally long and healthy
lives.
But good coaches take a flexible approach. They borrow
the best ideas from everywhere and everyone, and are
always looking for new insights or tools. They don’t get
stuck in dogma.
You probably wouldn’t mistake Okinawan cuisine for
the Mediterranean cuisine of Sardinia, Italy or Ikaria,
Greece. Or the Central American cuisine of Costa Rica’s
Nicoya peninsula.
The best coaches use data and
evidence to make decisions.
These cuisines and dietary patterns differ.
Throughout this course, we’ll encourage you to wear
your scientist hat and gather data for outcome-based
decision making.
Good coaches look at the evidence. This can include:
•
peer-reviewed clinical and scientific research;
•
understanding the basis of how and why things work
(or don’t); and
Nutrition: The Complete Guide
Yet people eating these ancestral or traditional diets have
much fewer of the chronic “diseases of affluence” (such
as cardiovascular disease, stroke, diabetes, obesity, etc.)
considered normal in industrialized areas.
The human body adapts amazingly
well to many different ways
of eating.
You can be healthy and fit whether you eat mostly meat
Nutrition: The Big Picture | 13
or mostly veggies, mostly fat or mostly carbohydrates, many times a day or just a
few times, and so on.
Carbohydrates: A group of
compounds including sugars,
starch, and cellulose
Which means that, as a nutrition coach, you shouldn’t really belong to any specific nutrition camp at all.
When you work with actual human beings, you must be a nutrition agnostic:
•
•
Explore and try anything and everything that could work.
Be willing to test new methods, even if they fly in the face of current beliefs or
practices.
•
Be humble and open-minded enough to let yourself be wrong, even if you
really like being right. (Which we do.)
Don’t focus on the food itself. Or on making sure everyone follows your “nutrition rules.”
Focus instead on your clients. What do they need to be their best?
Good nutrition is more similar than different.
You might be wondering: How can such varied diets all keep people fit and
healthy? Well, despite their disparities, most effective nutrition programs are
more alike than different.
1. Good nutrition asks people to care about their food
and eating.
Research shows that your actual choices are probably less important than simply
paying better attention to what you eat.
When you really care about what you eat, and make mindful, deliberate choices,
you almost inevitably eat better.
2. Good nutrition focuses on food quality.
Almost no decent diet plan asks you to eat more processed, nutrient-depleted
pseudo-food.
Instead, pretty much every camp recommends eating whole, minimally processed, nutrient-rich foods — foods with which our body has a longstanding
relationship.
Regardless of the macronutrient breakdowns or specific choices, just eating better quality food will improve most people’s health significantly.
3. Good nutrition helps eliminate nutrient deficiencies.
When we care about what we eat, choose foods mindfully, and try to get the
best-quality foods we can afford, we usually get lots of valuable nutrients along
for the ride.
Often, when people start a certain diet program, they just start eating better
International Sports Sciences Association
14 | Introduction
overall. They get more nutrients. They may get more variety. Or fresher foods. Or
less-processed foods. Or foods they chose mindfully.
Because of these factors, they feel better. And that’s one reason they start making
wild claims about the rejuvenating power of their new diet.
They didn’t do anything special, really. They often just started getting what their
bodies needed.
4. Good nutrition helps control appetite and food intake.
Hyper-palatable: Foods that
are exceptionally pleasing to the
sense of taste.
For most people, “it’s hard to eat just one” of the hyper-palatable deliciousness
bombs of processed foods. We often keep eating and eating them, but don’t feel
satisfied.
We may also eat them on the go, when we’re rushed and busy. So not only are we
eating foods that encourage us to eat more of them, we’re not even really paying
attention to the experience at all.
Conversely, when we’re more aware of what we’re eating; choose a variety of
more satisfying, higher-quality foods; and eliminate nutrient deficiencies, we
almost always end up eating less food overall.
We feel more satisfied — both physiologically and psychologically. We lose fat,
gain muscle, and perform better.
Notice that you don’t need calorie counting here. Focusing on food awareness
and food quality is usually enough for people to tune into their own hunger and
appetite. That means calorie control without the annoying calorie math.
It also means that your clients can stick with this, since almost nobody can count
calories (or wants to) forever.
5. Good nutrition promotes regular exercise.
When people start paying attention to their eating, they usually start thinking
about physical activity too. Or vice versa: If you take up an activity you love,
eventually you start wondering if your nutrition could help you do that activity
better.
Good nutrition fits with regular activity like a key into a lock.
And most nutrition programs suggest that people exercise along with eating well.
What this means for you as a nutrition coach
Stay open-minded and flexible. Question everything.
Learn more about global nutrition and eating habits. Broaden your focus.
Expand your world. (If possible, travel and actually experience different foods,
cuisines, and food philosophies.)
Test your theories and programs. See how they work on actual clients with real
lives and real bodies in the real world. Look for evidence. Gather data and measure outcomes.
Nutrition: The Complete Guide
Nutrition: The Big Picture | 15
Remember to ask our favorite question: “How’s that
working for you?”
And where possible, look for underlying themes that
make all good nutrition programs “work.”
One key feature about successful diet plans — especially in the Blue Zones — is that good nutrition connects
people to the food itself.
So now that you’ve thought about what food is, and what
good nutrition involves, let’s think about where food
comes from. Or where it goes.
The cycle of food
Check your fridge and pull out a fruit or vegetable.
•
Where was it grown?
•
How was it grown?
•
Who picked it for you?
•
How did it get to you?
•
What steps did it take?
•
How far did it have to travel?
•
What factors ensure you can get more of that fruit or
vegetable?
•
Do you think that people could still be eating that
fruit or vegetable in 100 years? What about 500?
Why?
In the world of nutrition for health, performance, and
body transformation, we don’t talk much about where
food comes from. Or where it ends up if we discard it.
Sure, we might check a few labels for the word “organic.”
But beyond that… well, many folks think that chicken is
just “protein” that comes in rectangular plastic packages.
(Wait… a chicken is a bird? That has feet, and feathers,
and stuff?)
Food as information about the world
Just as food is information for your body, food is also
information about ecosystems and the environment.
Food is information about how things get produced,
processed and sold all over the world.
Someone had to grow that fruit or vegetable from your
fridge. Other people picked it, and packed it, and transported it, and sold it.
Obviously, a full discussion of the social, political, economic, and environmental issues involved in agriculture
is beyond the scope of this text. We’ll touch on it briefly,
to help you understand a few more parts of the bigger
picture of food. If you’d like to learn more about these
issues, check out the agriculture resources in Unit 17.
Sustainability
Something sustainable is something that you can do
for a long time. That could be a well-planned nutrition
program, of course. Or in this case, a way of growing
and producing food.
Sustainable agriculture is agriculture that we can do for
a long time. It involves things like:
•
preserving and replenishing soil with nutrients;
•
preserving and replenishing water reserves, especially clean fresh water;
•
growing a wide range of diverse crops that are properly adapted for their surroundings;
•
making the best use of valuable farmland;
•
making animal welfare a priority;
•
understanding the interaction of living organisms as
a complex ecosystem rather than as a food factory;
•
making sure that people involved (such as growers or
pickers) are safe and fairly treated;
Figure I.2 The food life cycle
•
ensuring food safety and public health; and
•
minimizing waste and pollution.
International Sports Sciences Association
16 | Introduction
At its most basic level, sustainable agriculture is about
ensuring that we can produce safe, high-quality food for
everyone, for a long time to come.
Sustainability in agriculture isn’t just a nice thing to
have. It’s what will ensure we can keep eating the things
we want and need to eat.
We’ll talk more about sustainability and organic versus
conventional foods in a later unit.
Food as a set of choices
We’ve suggested that food is information, and a way of
telling a story.
Here’s another thing to think about: Food and eating is a
set of choices.
As a nutrition coach, one of your jobs is to make your
clients more aware of what they’re doing. Indeed, awareness itself can often change people’s behavior. (We’ll talk
about this more in Section 2.)
As we’ve stressed, nutrition coaching isn’t about getting
people to follow “the rules.” It’s about helping them
make more conscious choices. Choices that align with
their values, priorities, and goals.
We (and our clients) think about lots of things before we
buy and eat a food, such as:
•
what’s convenient;
•
what it costs;
•
what’s healthy (or not);
•
what we’ve done before (and in that case, we don’t
really “think” about it);
•
what’s available;
•
what might taste good;
•
what might feel good, distract us, or change our
emotional state; and
•
what is better for the environment, or more
sustainable.
Each client has their own decision-making process and
priorities.
Your role as a nutrition coach is to help your clients
Nutrition: The Complete Guide
become more aware of these processes and priorities —
to help them see that choices are at the end of a pathway.
And, if needed, you can help them change those pathways to change their choices.
As you look to deepen your own practice and increase
your awareness, think about food within a larger web.
We’ll talk more about how to implement small, manageable habits later in the course.
For now, just get the general idea:
•
Think about the big picture of nutrition, food,
and eating. Notice how adding some context helps
expand your understanding of what nutrition, food,
and eating are all about.
•
Think about what might be most important
for both you and your clients. Notice how there
are lots of options for diverse clients. (Don’t worry,
we’ll help you sort things and focus later.)
•
Think about how you might work towards
those values and priorities as part of nutrition
coaching. We know it’s a long-term project. Just
start with today… and keep reading.
What is nutrition coaching?
We’ve started to give you some ideas about what nutrition coaching is.
Let’s look more closely now at what the role of nutrition
coach involves.
First, congratulations.
Being a nutrition coach is an
important job.
You’re often the first person a client sees when
they want to look, feel, and / or perform better.
They might not go to their doctor or another health care
provider. Instead, they might come to see you.
You’re part of your client’s social support system.
Many clients don’t have family or friends who are willing
Nutrition: The Big Picture | 17
to help and support them as they improve their exercise
and nutrition choices. In fact, sometimes those family and
friends can actively sabotage your client’s efforts.
In the beginning, you may be the only team member a
client has.
You have the power to change lives.
If food and eating is information and a story, we can offer
new information and revise that story.
You can help change your clients’ bodies. You can also
help change their mindset about who they are and what
they can do. You can help change their ability to make
choices and try new things — to fully experience the
world around them.
Keep learning. Stay up to date.
Your clients want reliable, current, practical information
they can understand and use.
This means that you should have a process of ongoing
learning, information gathering and filtering, and sharing that knowledge.
Collaborate.
Being a nutrition coach is a big and important job. But
you don’t work alone.
Good nutrition coaches build and maintain a professional network with other health care professionals such as:
•
doctors
By helping prevent chronic diseases or nutrition-related
disabilities, or helping them change their relationships
with food, you might even save their lives sometimes.
•
registered dietitians
•
nurses
•
physical therapists
What does a good
nutrition coach do?
•
naturopaths
Fundamentally, a nutrition coach is a guide for change.
We’ll talk about this more in Section 2.
Here are some things that all good nutrition coaches
should do.
Be client-centered.
This means you’re an advocate and ally of the client. You
want to help them do what matters most to them… not
what matters most to you.
You listen to them. Try to understand their needs. Try to
understand their lives.
You see them as unique individuals, and try to match
your nutrition programming to what’s best for them.
Think collaboration rather than competition. You’re all
working together on your client’s team.
We also suggest you build a professional network to support your own practice. Look for people such as:
•
business coaches
•
accountants
•
marketers
•
web designers
Have good boundaries. Know your scope
of practice.
You’re not a therapist, medical doctor, or general fixit
person. Good nutrition coaches understand clearly what
they can and can’t do.
Help clients take action.
We’ll look more at client assessment and scope of practice in Section 2, but here’s a general overview.
Knowledge and information are great, but they’re not
enough. Your clients need to do stuff.
What’s your scope of practice?
Good nutrition coaches create clear, goal-driven, evidence-based nutrition plans that clients can immediately
start putting into action.
You’re probably here because you’d like to be able to
talk about nutrition with your clients, and to help them
International Sports Sciences Association
18 | Introduction
improve their food and eating habits. But it’s not always
clear what you can and can’t talk about with clients.
Here are the guidelines.
You can talk about nutrition with your
clients… if you’re qualified to do so.
In most jurisdictions, certified personal trainers or other
licensed health care professionals who have fundamental
nutrition knowledge can answer questions or address
concerns that their clients may have about nutrition.
Notice we emphasize the “fundamental knowledge”
part. With specific training, such as that provided in this
course, you’ll have that fundamental knowledge and be
able to discuss nutrition with clients.
Know your options where you live.
Each state, province, and country has different rules for
dispensing nutrition advice.
We’ve given you some resources below, and on our website, for learning more.
Offer general nutrition advice, not
medical nutrition therapy.
(Unless you’re qualified to do so, of course.)
With this ISSA credential, you’re able to make general
nutrition suggestions in most jurisdictions. You can also
share nutrition education using materials from a public
or well-known entity such as the American Heart Association, the Centers for Disease Control and Prevention,
and the Academy of Nutrition and Dietetics. (And of
course, ISSA.)
But unless you’re licensed or otherwise certified to do
so, you can’t offer specific advice in the form of medical
nutrition therapy.
Nutrition: The Complete Guide
This means you can’t prescribe nutrition for specific
health conditions and illnesses, such as:
•
post-surgical nutrition
•
diabetic nutrition
•
cancer therapy nutrition
•
nutrition to treat liver disease or kidney stones
•
nutrition for clinical eating disorders such as anorexia
Of course, the general advice you give your clients will
probably improve their health and lower their disease risk.
You just can’t offer directed advice that could reasonably be considered part of medical therapy. You can’t
use words like “diagnose”, “treat”, “cure” or “prescribe.”
(And unlike a lot of kooks on the Internet, you can’t
claim to magically eliminate all human suffering with
your wondrous diet plans.)
It’s not always completely clear where the boundaries
are, so when in doubt:
Collaborate with your professional
network of other health care providers.
It’s important to establish relationships with other health
care professionals, such as registered dietitians, nurses,
physical therapists, chiropractors, and physicians. By
networking and creating a cross-referral system, you’ll
not only be able to expand your business network, you’ll
have experts to turn to when you don’t know the answers
to certain questions.
Learn the rules and regulations of your
area.
The Center for Nutrition Advocacy provides a
comprehensive guide to statue laws. Visit www.
nutritionadvocacy.org/laws-state to fully understand
your states statutes.
Nutrition: The Big Picture | 19
Case Study
Many clients come to us with “diet experience.”
Some have done lower-carbohydrate diets, like the Atkins Diet. Others have done low-fat diets, like the Ornish
Diet. And others have done more “balanced” plans, like
the Zone Diet.
One client followed all three plans at one point or another, along with exercise.
In each case, the process and results were the same:
•
He followed the diet.
•
He lost about the same amount of weight.
•
He gained it all back… and usually more.
•
He tried another diet.
No matter what diet he tried — despite how “different” these diets were from each other — the same stuff
happened.
How can this be?
Well, instead of focusing on what makes diet plans different, let’s look at what makes them similar.
The client got the same results with different diets
because all three plans forced him to follow a key rule of
good nutrition:
All three plans, together with his exercise plan, forced him
to control his energy balance.
To lose weight, we need a negative energy balance. In
other words, we need to take in less energy (in the form
of food) than we expend (in the form of metabolism and
activity).
If someone loses weight, they’ve somehow managed to
get into negative energy balance.
carbohydrates. Or reducing fat. Or a specific macronutrient ratio.
All three plans create a negative energy balance in three
ways:
1. When clients follow a “weight loss plan”, they usually eat less. This decreases “energy in.”
2. Exercise increases “energy out.”
3. Both Atkins and Ornish ask dieters to restrict either
dietary carbohydrate or dietary fat. The Zone plan
asks dieters to eat a specific ratio of macronutrients — which usually means that people eat less of
whatever they were eating “too much” of. Is it any
wonder that by asking dieters to avoid eating something, they’ll end up eating less?
It wasn’t some magical macronutrient mix that made the
client lose weight. It was plain old energy deficit. (You’ll
learn more about energy balance in an upcoming unit.)
However, all three experiments ultimately failed.
Each time, the client rebounded. He gained more
weight after losing it. After giving up, he got off track,
stopped exercising, and started eating poorly again.
However, it wasn’t the food that caused this rebound.
It was many other lifestyle factors. The problem wasn’t
what he was eating necessarily… but how he was eating
and living.
Only when we started to address these key factors did
the client change his fundamental habits… and lose his
excess body fat for good.
In this program, you’ll learn that both the what (i.e., the
food itself) and the how (i.e., how we eat and live) are
crucial elements in change.
In this case, that’s what did the trick — not the lack of
International Sports Sciences Association
20 | Introduction
What this program
will cover
You should finish this course with both a better understanding of exercise nutrition and the tools used to deliver nutritional recommendations.
Here’s what we’ll do in the rest of this textbook and this
course.
Important note
•
Dispel common myths and fallacies associated with
nutrition.
•
Give you the foundational knowledge you’ll need
to make general nutritional recommendations to a
variety of clients.
•
Provide and explain nutrition theory and science.
•
Give you a clear process and walk you through the
steps of preparing for, assessing, evaluating, and
making recommendations for clients.
•
Give you a set of resources that you can use almost
immediately in your coaching practice (if you have
one already).
Completing this course will not qualify you as a
registered dietitian, licensed dietitian, or licensed
nutritionist. Check with the licensing bodies in your
area if you are hoping to get licensed.
Nor will this course allow you to provide medical
nutrition therapy.
Instead, this course will provide you with continuing
education in the field of nutrition.
It will enhance your credibility, your confidence, and
your skill set.
And it will help you overcome the biggest limiting factor
your clients face every day: poor nutrition.
Summary
Food is fuel, but it’s so much more than that. Food gives
us important substances such as micronutrients, phytoand zoochemicals. We need all of these nutrients to live
and thrive.
•
give us nutrients;
•
help us look, feel, and perform our best;
•
are outcome-based;
Living organisms are not machines. Human bodies
aren’t combustion engines. They’re more complex than
simple inputs and outputs.
•
are sustainable for both us and the planet;
•
are about removing limiting factors; and
•
look for strengths and wins.
Food is information and a story. Physiologically, socially,
and even environmentally, food and eating gives us
important information about things like:
•
chemical interactions in our body;
•
how we relate to ourselves and one another socially
and culturally;
•
how we make choices about what to eat (or not); and
•
how larger forces shape how food is produced and
consumed.
Good nutrition plans:
•
control energy balance;
Nutrition: The Complete Guide
What’s the best diet? Trick question! There isn’t one. The
best coaches don’t have a single nutrition philosophy,
and use data and evidence to make decisions.
Clients are diverse. The human body adapts amazingly
well to many different ways of eating. You can be healthy
and perform well on many diets.
Good nutrition is more similar than different. It:
•
asks people to care about their food and eating;
•
focuses on food quality;
•
helps eliminate nutrient deficiencies;
Nutrition: The Big Picture | 21
•
helps control appetite and food intake; and
•
promotes regular exercise.
Being a nutrition coach is an important job. You’re often
the first person a client sees when they want to look, feel,
and / or perform better. You’re part of your client’s social
support system. You have the power to change lives.
•
therapy.
•
be client-centered;
•
help clients take action;
•
keep learning; stay up to date;
•
collaborate; and
•
have good boundaries; know your scope of practice.
•
•
Know your options where you live.
•
help to dispel common myths and fallacies
•
give you the foundational knowledge you’ll need
to make general nutritional recommendations to a
variety of clients
•
provide and explain nutrition theory and science
•
give you a clear process for preparing, assessing,
evaluating, and making recommendations for clients
•
give you resources that you can use almost
immediately
You can talk about nutrition with your clients… if
you’re qualified to do so.
Learn the rules and regulations of your area.
This program will:
What’s your scope of practice?
•
Collaborate with your professional network of other
health care providers.
A good nutrition coach will:
•
Offer general nutrition advice, not medical nutrition
•
give you a better understanding of exercise nutrition and the tools used in delivering nutritional
recommendations
International Sports Sciences Association
SECTION ONE
NUTRITION SCIENCE
1
Cells, p23
2
Through the GI Tract, p45
3
Energy Transformation
and Metabolism, p77
4
Energy Balance in the Body, p112
5
Aerobic and Anaerobic Metabolism, p137
6
Macronutrients, p155
7
Micronutrients, p197
8
Water and Fluid Balance, p230
UNIT 1
Cells
24 | Unit 1
Unit Outline
1.
Objectives
2.
Cell structure and function
3.
How the body is organized
4.
Nutrition and cellular interaction
5.
Parts of cells
6.
Body function
7.
Cell types
8.
Summary
Objectives
You should be able to recognize:
In this unit, you’ll learn how your body’s cells:
•
get nutrients from the food that we eat, and
•
the main cell organelles;
•
use these nutrients for the raw materials and fuel to
•
what each organelle does; and
•
how each organelle interacts with organic molecules
keep us alive.
to do its most important jobs in the body.
At the end of this unit, you should have a working knowledge of how humans are organized, from the organismal
level all the way down to the atomic level.
You’ll start to build the foundation of physiological knowledge that you’ll need to make and apply nutrition plans.
Cell structure and function
The cell is the most basic structural and functional unit of all living things. All
living tissues are built from ells.
In terms of nutrition, our cells have two basic roles:
•
to get nutrients from the food that we eat, and
•
to use these nutrients for the raw materials and fuel to keep us alive.
How your body works depends on how each cell works.
Adult humans have trillions of cells. All work together to keep us alive.
To do these basic jobs, cells must:
metabolism: Sum of reactions
that take place to build up and
break down the body
Nutrition: The Complete Guide
•
grow, mature, and die;
•
exchange gases like oxygen and carbon dioxide (i.e., respiration);
•
absorb and digest nutrients;
•
circulate blood and other fluids;
•
get rid of waste; and
•
reproduce.
Together, these cellular tasks are known as metabolism.
Cells | 25
F. Organ
Tissues combine
to form organs.
Example: heart.
E. Tissue
Cells form tissue.
Example: cardiac
muscle tissue.
D. Cell
Organelles work together
to form cells. Example:
cardiomyocytes (cardiac
muscle cells).
C. Organelle
Molecules and atoms combine
to form organelles.
Example: nucleus.
B. Molecule
Atoms combine to form a molecule.
Example: deoxyribonucleic acid
(DNA).
A. Atom
Chemicals, such as carbon,
hydrogen and oxygen, are
the basic units of matter.
Example: carbon.
G. Organ System
Organs work together to form
organ systems.
Example: circulatory system.
H. Complex Organism
Organ systems sustain
complex organisms.
Example: you.
Figure 1.1. Organization of the human body. Atoms combine to form molecules. Molecules and atoms combine to form organelles.
Organelles work together to form cells. Similar types of cells form tissue, and tissues join to make up the various bodily organs. Groups of organs
that work closely together form organ systems, and it is these organ systems that ultimately sustain an organism.
We need proper nutrition for our cells to work properly. This means getting the right nutrients in the right
amounts.
And the body lives within even larger systems.
When we eat well, our cells function well. When we
don’t eat well, problems happen.
Our body lives within ecosystems — dynamic, interactive, interconnected networks of living things.
Healthy cells means healthy metabolism. Unhealthy cells
means unhealthy metabolism.
Some scientists even think that given how many bacteria
are on us and in us, humans aren’t even really “separate”
bodies at all!
How the body is organized
Organism
Cells — and by extension, the body — is organized into
systems, each system nested into another. See Figure 1.1.
Ecosystem
The organism is, well, you.
An organism is a definably self-contained living system.
International Sports Sciences Association
26 | Unit 1
For the purpose of this program, we can say that you as a human are a distinct
organism. (Bacterial buddies notwithstanding.)
homeostasis: The body’s ability
to maintain a stable and constant
internal condition
As an organism, the human body can reproduce, replace, and repair itself, all to
stay alive and to maintain homeostasis: the state of balanced function in the body.
Organ systems
Complex organisms, such as humans, are made up of organ systems.
•
Integumentary system: This system protects the body from external
damage. It includes your skin, hair, nails, sweat glands, and other external
structures.
•
Skeletal system: This system gives the body a rigid structure so that it can
move and hold itself up. It includes your bones, tendons, ligaments, and other
structures.
•
Muscular system: This system moves us, whether it’s to move you across the
room, to move your blood through blood vessels, or to move food through
your intestines. This system includes your skeletal muscles, cardiac muscles (in
your heart), and smooth muscles (part of arteries and veins, bladder, gastrointestinal tract, respiratory tract, uterus, and more).
•
Nervous system: This system sends electrochemical signals that trigger
thoughts, emotions, and movement as well as involuntary activity (such as
breathing). It includes your brain as well as a vast network of nerves and supporting structures.
•
Endocrine system: This is your cellular communication system. It includes
your hormonal organs and glands, including the hypothalamus, pineal gland,
pituitary gland, thyroid gland, liver, pancreas, kidney, adrenal glands, testes,
ovaries, and more.
enzyme: Substance that helps
catalyze chemical reactions
•
Circulatory system: This system transports hormones, enzymes, nutrients,
and other chemicals throughout the body. It includes your heart, blood, and
blood vessels.
•
Immune system: This system protects against pathogens, tumor cells, and
other foreign invaders. It includes your thymus, lymph nodes, spleen, tonsils,
and other similar organs.
•
Respiratory system: This system brings in oxygen and excretes carbon
dioxide. It includes your nasal cavity, trachea, lungs, and other airways and gas
exchange organs.
•
Digestive system: This system breaks down and absorbs nutrients from food
and drink. It includes your oral cavity, esophagus, stomach, intestines, and the
other organs associated with digestion including the liver, gallbladder, pancreas, and bile duct.
•
Urinary system: This system produces, stores, and eliminates urine. It includes your kidneys, ureters, bladder, urethra, and related organs and glands.
•
Reproductive system: This system controls reproduction as well as sexual
development. It includes your sex organs and glands.
Nutrition: The Complete Guide
Cells | 27
While these organ systems have distinct jobs, they also work closely together.
This is important for nutrition coaching.
For instance, if something is out of order in the gastrointestinal tract (say, with a
client who often gets an upset stomach), it’s probably out of order elsewhere (for
instance, in the endocrine system or nervous system). We’ll talk more about this
in later units.
Organs
Organ systems are made up of individual organs. Each organ has at least one specific job, and often several.
Tissues
Collectively, our tissues make up our organs.
•
Epithelial tissues make up our skin.
•
Connective tissues make up structures such as our joints and fascia.
•
Muscle tissues make up our skeletal muscles and heart, and are part of several other organ systems
Nervous tissues make up our brain, nerves, and associated structures.
Our tissues do many things, such as:
•
form protective barriers against outside invaders (epithelial tissues);
•
hold us together (connective tissues);
•
move the body around (skeletal muscle tissues); or
•
communicate between cells (nervous tissues).
Cells
Tissues are made up of large groups of cells.
Cells range in size from about 7 to 300 micrometers. To give you some perspective, the dot over this letter “i” is about 100 micrometers.
Cells show us how living matter is wonderfully unique in its diversity. For example, immune cells can engulf pathogens and destroy them, while muscle cells
have sliding filaments that cause muscle contraction and relaxation. (Fun factoid!
The axon of a motor neuron in the spinal cord can be up to 1 meter long.)
Organelles
Each cell is like a tiny city. Within each cell are organelles, collections of molecules / chemicals that have particular jobs, much like different utilities (such as
power production or waste disposal) within a city.
organelle: Component of the
cell that is responsible for a specific task
There are over 24 known organelles. We’ll talk about the most important ones —
such as the endoplasmic reticulum (ER), Golgi apparatus, and mitochondria — in
this textbook.
These organelles do their jobs in a semi-fluid matrix called the cytosol.
cytosol: Internal fluid portion of
the cell
International Sports Sciences Association
28 | Unit 1
Chemicals
Fundamentally, we are a soup of chemicals.
atom: Basic unit of a chemical
element
molecule: Group of atoms
bonded together
macromolecules: A large
molecule
Chemicals are built from structures of varying sizes, from atoms (smallest), to
molecules, to macromolecules (largest).
Macromolecules are made up of groupings of molecules. Molecules are made up
of tiny particles called atoms. And these atoms, which are invisible to the naked
eye, make up all material things of the universe.
So if you think about it, nutrition coaching is really about harnessing the fundamental particles of everything that exists.
As astronomer Carl Sagan famously said, “The cosmos is also within us. We’re
made of star stuff.”
Our body can only do what it does if our cells, and the organelles within them,
can do what they do: send and receive messages, create proteins, etc. Indeed,
nearly everything that happens in the body is based on making proteins, and
what those proteins do.
Think of the body as a manufacturing plant — that also manufactures itself. The
proteins we make not only break down and rebuild the plant itself, they break
down and rebuild the machines, the workers, the messengers, and lots of other
stuff.
We’ll get more into this idea as the unit progresses. For now, just remember that
every level of human organization depends on the health of important subunits
— our cells — and the proteins they make.
Nutrition and cellular interaction
macronutrient: Nutrient the
body requires in large amounts
(i.E., Protein, fat, carbohydrates)
micronutrient: Organic compound the body requires in very
small amounts (i.E., Vitamins and
minerals)
compounds: Consisting of two
or more substances
potential energy: Energy stored
within a physical system
In general, the macronutrients (proteins, carbohydrates, and fats), micronutrients (vitamins and minerals), phytochemicals, and zoochemicals we eat are broken down through the digestive process into smaller compounds such as amino
acids, glucose, fatty acids, etc.
These digested and absorbed compounds then travel through our bloodstream
to interact with our cells. Our cells use those compounds in many ways, such as:
1. To provide potential energy that’s later released by breaking the chemical
bonds between the macronutrients.
2. To provide raw materials that can then be incorporated into our body structures,
including tissues and organs.
co-factor: Non-protein compound that interacts with
another substance to facilitate a
transformation
3. To act as co-factors for chemical reactions in the body. All of the chemical
reactions that take place in the body require the help of particular proteins called
enzymes. These enzymes often use nutrients gathered from the food we eat to
do their job.
hormone: Compound created by
one cell that travels to and stimulates another cell
Nutrition: The Complete Guide
4. To stimulate the release of hormones, which act as chemical messengers,
directing overall body function with their unique messages.
Cells | 29
Cell nucleus contains chromosomes.
DNA provides cellular instruction
for making proteins.
Chromosomes contain DNA.
Figure 1.2. DNA inside the nucleus. Wrapped up in chromosomes, our DNA, or genetic code, dictates which proteins are
formed in the body. The nucleus of each cell contains this genetic code. Each person has a unique genetic code that influences how
we respond to ingested foods.
Because of these various and important roles that nutrients have, the food we eat
can fundamentally change how our body works. No wonder nutrition is so critical!
Nutritional individuality
In the previous unit, we looked at why there is no one “best diet.”
One reason is that not everyone responds the same way to the digestion and
absorption of particular foods — or to the uptake of particular nutrients into
the cell. Research suggests that although the basic mechanics are the same, there
are important and intriguing individual differences, which are likely due to our
unique genetic makeups.
Each cell in our body houses our genetic code, a series of nucleic acids called
DNA, in an organelle called the nucleus. This code, which is unique to each of
us, provides cellular instructions for making proteins we need for our structure
and function.
As we all have slightly different genetic profiles, the proteins we make may also
differ. These variations are responsible for our individual responses to the food
we eat. See Figure 1.2.
genetics: Specific, inherited DNA
of an organism, which influences
what they become, although
environment also plays a key role
in the expression of an organism’s
genetic code
DNA: Nucleic acids that contain
instructions for heredity
nucleus: Organelle where genetic material is housed
In general, these differences are quite small. All humans share over 99.9% of
International Sports Sciences Association
30 | Unit 1
gene: A particular sequence in
DNA or RNA that controls the
expression of a protein, and, by
extension, influences the characteristics of an organism
evolutionarily conserved:
Something that’s remained essentially unchanged throughout
evolution
the same genes. You may have even heard that humans and chimpanzees share
between 95% and 98% similarity in their DNA, which is also true.
In addition, many important genes have been evolutionarily conserved. This
means that those genes appeared very early in our evolutionary history, perhaps
even back in the days of single-celled bacteria.
For instance, much of what we know about the health effects of fasting comes
from research on a tiny, primitive flatworm known as Caenorhabditis elegans.
C. elegans has nearly 200 known genes that respond to dietary restriction. These
genes are involved in things like knowing when metabolism is disrupted; looking
for and repairing DNA damage; and hunting for cancer-type overgrowths. We
share 45 of those genes.
Thus, we are much more alike than we are different.
genetic polymorphism:
Variation in the form of one or a
sequence of genes
However, these small genetic differences, called genetic polymorphisms, explain
why some people respond slightly differently to various types of foods. These
differences may also explain why many research studies seem to have confusing
or conflicting conclusions.
Differences in nutrient processing
For example, we all have a gene in our liver for making a particular enzyme that
breaks down caffeine. However, due to these small genetic differences, some of us
have the enzyme that breaks down caffeine quickly. Others have the enzyme that
breaks down caffeine slowly.
•
In people with the fast enzyme, caffeine is processed and removed quickly,
while the antioxidants found in coffee can help protect against free radicals.
•
However, in people with the slow enzyme, the caffeine hangs around longer,
causing health problems.
So imagine a study that asks: “Is 1-3 cups of coffee a day healthy or unhealthy?”
The answer would be: “For whom?”
Differences caused by nutrients themselves
bioactive: Having a biological
effect
Not only are there individual differences in response to the same foods, different
foods have particular nutrients and other bioactive components that can actually
change the message expressed by our unique genes.
For example, isothiocyanates found in broccoli can switch on a gene in the liver
that detoxifies cancer-causing chemicals and other toxins.
upregulated: An increase of a
cellular component
Without the broccoli, this gene stays inactive. Our body looks for other detoxifiers. With the broccoli, this gene is upregulated and participates more actively in
the detoxification process.
Some of us have this gene, and some don’t. If we don’t have the gene, broccoli
can’t help us fight cancer in this particular way. (Of course, broccoli does other
good things.)
Another example is cooked tomatoes, which contain compounds (lycopenes)
Nutrition: The Complete Guide
Cells | 31
that switch off growth-promoting genes in the prostate. With cooked tomatoes in
the diet, prostate cancer risk decreases; without the tomatoes, risk increases.
Fish oil is yet another example. Fish oil (specifically DHA — a fatty acid found in
fish, other marine animals, and fish / algae oil supplements) might signal genes
in the brain to produce a chemical that preserves brain function with age. People
who consume more omega-3 fats tend to have better cognitive function as they
age, compared with those who consume less.
Thus, nutrition can strongly influence our gene expression. And our genes, in
turn, affect how we respond (or don’t) to a given nutrition plan. This genetic diversity and its relationship with nutrition is an emerging area of research called
nutrigenomics.
Needless to say, there is an important relationship between what we eat and how
our cells function. Throughout this course, this interaction will become clearer.
DHA: Docosahexaenoic acid, an
omega-3 fatty acid
nutrigenomics: Study of how
genes respond to nutritional
intake
By the end of this course, you should have a better grasp of how to optimize
health, body composition, and performance by controlling nutrient intake.
However, before we talk more about food, let’s discuss the cell in depth, and in
particular, the main cellular components and organelles.
Parts of cells
To better understand how the food we eat interacts with our body, it’s important
to learn about the structures, chemicals, and organelles within each of our cells.
In this unit, we’ll review the following organelles:
Plasma membrane
Golgi apparatus
Mitochondrion
Lysosome
Nucleus
Peroxisome
Endoplasmic reticulum
These organelles and approximately 17 others (there are about 24 or so in total)
give our cells their structure and function, which are in turn often shaped by our
nutrient intake.
Plasma membrane
Around the edge of each cell is a boundary, known as the plasma membrane,
which separates the cell from its neighbors and from the rest of our body. The
plasma membrane’s bilayer (double layer) acts like a protective wall, keeping
important chemicals in while keeping harmful chemicals out.
The plasma membrane is made up of lipids, proteins, cholesterols, and other
chemicals. It has an interesting nature: while it forms a structural boundary
between the cell and the rest of the body, this boundary is flexible and fluid-like.
Membranous organelles — specialized sacs and canals — can float around within the plasma membrane, rather like icebergs floating around in the ocean.
This fluid-like boundary is made up mostly of phospholipids, molecules with
phosphate “heads” and fatty acid “tails.” The phosphate “heads” of the lipid
molecules that form the bilayer are hydrophilic (water-loving) and therefore can
plasma membrane: Lipid bilayer that is permeable to certain
compounds that contains the cell
lipids: Any class of organic compounds that are fatty acids or their
derivatives
cholesterol: Synthesized in the
liver; precursor of bile acids and
steroid hormones
phospholipids: A type of lipid
with a hydrophilic phosphate
group “head” and hydrophobic
fatty acid “tail” that forms cell
membranes
hydrophilic: Strong affinity for
water
International Sports Sciences Association
32 | Unit 1
Extracellular space
Hydrophilic
region
Phospholipid
Hydrophobic
region
Hydrophilic
region
Intracellular space
Figure 1.3. Plasma membrane. The plasma membrane is composed of lipids, proteins, cholesterol and other chemicals. The lipid
bilayer has water-loving (hydrophilic) heads and water-fearing (hydrophobic) tails. Substances generally pass through the plasma
membrane via a transmembrane protein.
hydrophobic: Lack of affinity for
water
bond to water-based molecules. On the other hand, the fatty acid “tails” of the
lipid molecules that form the bilayer are hydrophobic (water-fearing) and bond
best with fat-based molecules.
This dual-purpose membrane creates a boundary that regulates what gets into
and out of cells. See Figure 1.3.
The cell needs to be choosy about what can enter and exit. Thus, most molecules
must enter the cell through one of several membrane proteins. These proteins are
like gates in a fence, allowing only particular molecules to pass through. We’ll
talk more about these cellular proteins later in this unit.
Because of this lipid structure, the types of fats we eat can change how fluid or
flexible the cell membrane can be.
Nutrition: The Complete Guide
•
Too much saturated fat may cause the membrane to be too rigid.
•
Too much polyunsaturated fat may cause the membrane to be too fluid.
Cells | 33
Because most people eat too many saturated and trans fats, we often need to
balance that with getting enough mono- and polyunsaturated fats. We’ll look
at this more later on. For now, just remember that fat balance affects how the cell
works in important ways.
Cytosol
saturated fat: A fat with no double bonds between the individual
carbon atoms of the fatty acid
chain
trans fat: Fat derived from the
partial hydrogenation of vegetable oils
The interior space of the cell is composed of a gel-like solution called cytosol.
Many organelles, enzymes, salts and other organic molecules, including stored
carbohydrates and fats, are suspended and maintained by the cytosol. The body
carries out many of its chemical reactions in this gel-like matrix, including most
of its enzymatic reactions. Cytosol, together with all the organelles, except the
nucleus, are called cytoplasm.
monounsaturated fat: A fat
with one double bond between
the carbons in the fatty acid chain
The cytosol is rich in stored carbohydrates that can be broken down quickly and
used to transfer energy. This process is controlled by cytosolic enzymes.
cytoplasm: The protoplasm
within a cell, excluding the
nucleus
polyunsaturated fat: A fat
with two or more double bonds
between the carbons in the fatty
acid chain
Exercise and other physical activity creates a demand for more energy. The cell
responds by making more of these enzymes along with storing more carbohydrate and fat for future use. The cell also gets better at breaking down these
carbohydrates for energy. This is especially true in skeletal muscle cells, since this
is where active people need most of their energy.
A key point here for nutrition coaching is that regular exercise and other activity
can powerfully affect cellular makeup, metabolism and function. Activity can fundamentally change how the body uses, processes, and stores nutrients. Active bodies will thus respond differently than inactive bodies to the same nutrition plan.
Mitochondria
Mitochondria (plural of mitochondrion) convert nutrients into energy.
Just like you can’t eat an egg until you crack open its shell (well, at least we don’t
recommend it), you can’t use the energy stored in carbohydrates, proteins, and
fats until you break their chemical bonds. Mitochondria convert the energy
released from this process into adenosine triphosphate (or ATP), the energy
currency of the cell.
mitochondria: Organelles that
supply the cells’ energy / ATP
(singular: mitochondrion)
adenosine triphosphate: ATP,
source of energy for physiological
reactions
Mitochondria produce most of the body’s energy — about 95% of it. The rest is
produced in other parts of the cell. If mitochondria don’t work well, we don’t
work well. (Or at all.)
Mitochondria make ATP in their inner mitochondrial membranes. The outer
membrane of the mitochondrion is porous, while the inner membrane is the
main barrier between it and the rest of the cell. The inner membrane contains
folds called cristae, which are studded with the enzymes and structures that help
make ATP.
mitochondrial membrane:
The double biomembrane surrounding the mitochondrion
Since the mitochondria generate power for the cell, more mitochondria means
more energy, and more active cells. Conversely, the more active we are, the more
mitochondria we likely have (and since your heart is beating all day, every day, it
also has plenty of mitochondria to keep pace). More mitochondria means more
total energy production for a muscle.
International Sports Sciences Association
34 | Unit 1
Nutrition in practice
Your skin color, body size, hair type, and risk of specific illnesses all depend on
how your genes interact with your environment.
For instance, your genes may suggest that you’ll grow to somewhere between
5’5” and 5’8.” But your actual height is an interaction between genes and environment. If you grow up malnourished, you won’t ever reach 5’8.”
What we eat early in life (and what our moms eat while they’re pregnant) can
affect our genes and regulate our traits — including the development of diseases, even decades later.
For example, data from the WWII Dutch Famine show that children of undernourished mothers had higher risk for cardiovascular disease, obesity, and breast
cancer later in life. (In fact, this “famine memory” can persist for generations,
“remembered” by descendants’ genes.)
Our genes can be influenced by all kinds of things, such as:
•
nutrient deficiencies or excesses (especially at crucial developmental
stages);
•
dietary components (e.g., omega-3 fats, phytoestrogens, cruciferous
vegetables, lycopene, folate, carotenoids, and so forth);
circadian: Any biological process
that recurs naturally on a daynight cycle
•
sunlight and vitamin D;
•
toxins (such as industrial chemicals, pesticides, heavy metals);
•
bacteria and viruses;
•
exercise and activity;
•
alcohol and other drugs;
•
stress, trauma, and mood;
•
circadian rhythms (such as sleep, shift work, light-dark cycles, and travel
across time zones); and
•
a host of other factors we probably don’t even know about yet.
If that sounds a little scary, consider it from the opposite perspective: While we
can’t control our genes themselves, we can affect their expression — whether
they’re likely to get “switched on” or off.
Our genetic expression is strongly shaped by our environment… over which we
do have some power. So, if we know more about our genetic variants, we might
be able to adjust our lifestyle or environment in order to prevent some illnesses
or become healthier.
Nutrition: The Complete Guide
Cells | 35
For example, certain gene variants can tell us:
•
how food is metabolized;
•
whether carcinogens in cooked meats will influence the development of
colon and prostate cancers; or
•
our inflammatory response and efficiency of DNA repair / replication.
If we know more about our own unique risk factors, we might be more likely to
make healthier choices — choices that could improve our genetic expression.
Genetic screening may show us the way to individualized nutrition and exercise
prescriptions. But we’re not quite there yet. Here’s what we know right now.
One size doesn’t fit all.
Genetic subgroups might respond differently to different foods and activity
types. In theory, genetic screening might help us customize food (and supplement) intake and exercise prescriptions for each person’s unique needs.
The details are kinda hazy.
In practice, it’s not as clear how genetic diversity might play out or how much it
even matters. After all, we also choose food and exercise based on other things
like taste, preference, convenience, price, and cultural norms.
Gene expression isn’t a destiny. It’s a set of possibilities.
What if your genes show you’re all slow-twitch endurance athlete but you think
fast-twitch sprint events are more fun? How closely should you stick to your
“blueprint”? How much can you affect your genetic expression through environment and habitual choices?
We don’t have all the answers yet.
Measuring nutrient-gene interactions takes time and effort. Genetic mapping is
complicated, sometimes expensive, and error-prone. And for any of this to matter, gene testing has to tell us what to actually do with that information. Genetic
testing is interesting. Provocative. Complex. And let’s be honest, kinda cool. But
for now, it raises more questions than it answers.
Stay tuned.
When genetic screening companies are able to more cost-effectively test the
entire genome (again, most only test a part of it) we should have a greater
understanding of gene sequencing and its use in nutrition. Most experts predict
that’ll happen within a few years, as the cost of sequencing the entire genome
drops from $10,000 to $500.
International Sports Sciences Association
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Matrix
Cristae
Outer membrane
Inner membrane
Figure 1.4. Mitochondria. Inside the mitochondria is where energy converts to ATP. The number of mitochondria in a cell is directly
related to the activity of the cell.
Elite athletes usually have a high mitochondrial density.
This means they not only build more total mitochondria
with training, they also build more mitochondria per
unit of muscle mass. This gives them the ATP they need
for high-level performance. Once again, we can see how
regular movement and activity can change the fundamental structure and function of cells.
Having a lot of mitochondria is good, but we also want
them to be effective. In other words, we want mitochondrial quality as well as quantity. In order to understand
this, let’s look at a little bit of biochemistry.
When we make ATP for energy, our cells consume
oxygen, and produce reactive oxygen species (ROS) as a
byproduct. Just as with nutrient processing, not everyone does this at the same rate.
Different people may make ATP at different rates. They
may use different amounts of oxygen to do this; they may
need different amounts of food energy to do this; and they
may produce different amounts of ROS in the process.
Nutrition: The Complete Guide
In general, although ROS are a natural part of this reaction, we don’t want to make too many at once, or have
them hanging around too long. ROS can cause cellular
damage, including damaging our DNA.
Scientists used to think that the more oxygen we consumed, the more ROS we’d make. However, we now believe that mitochondrial efficiency changes this equation.
•
People with less-efficient mitochondria make more
ROS with every unit of ATP they produce.
•
People with more-efficient mitochondria make fewer
ROS for the same amount of ATP.
So if your mitochondria are efficient, you make lots of
energy with fewer damaging waste products. You feel
great, you perform well, and you live longer.
While there is a genetic component to mitochondrial
function, it’s strongly affected by how we live, what we
eat, and what we do.
See Figure 1.4 for more.
Cells | 37
Nutrition in practice
Nutrient deficiencies can affect our mitochondrial function. Statin drugs, depression, fibromyalgia, or Parkinson’s disease are all associated with low levels of
co-enzyme Q10 (CoQ10). We need this compound for energy production in the
mitochondria.
Another compound, an amino acid called L-carnitine, is also involved in energy
production in the mitochondria. L-carnitine is found mainly in animal foods.
While our body can make L-carnitine, clients who eat a mostly or entirely plantbased diet might find supplementation helpful.
Nucleus
The nucleus, usually found in the central part of the cell, is the largest organelle.
Most cells have only one nucleus, though muscle cells have more than one. The
nucleus is Mission Control, home of our DNA, also known as the genetic code.
Wrapped up in chromosomes, our DNA dictates which proteins are formed in
the body. This ultimately determines everything from how the body develops,
to how it repairs itself, to how it transports and / or metabolizes every chemical
introduced into circulation. In many ways, our DNA also determines how muscular we can get.
chromosomes: Located in
the nucleus, contain genetic
information
As we’ve discussed, there is an important link between our DNA, our food
intake, and our health. In fact, much of what we eat interacts directly with our
DNA or causes hormonal cascades that influence our DNA.
transcription: The synthesis of
RNA using a DNA template
These relationships begin in our nucleus: Chemicals can bond with our DNA to
begin making cellular proteins, processes called transcription and translation.
translation: Forming a protein
molecule based on the information contained in the mrna
ER and Golgi apparatus
endoplasmic reticulum:
Cytoplasmic membrane that
translates proteins
The endoplasmic reticulum, or ER, is a “circulatory” network found inside the
cytosol, near the nucleus.
When our DNA sends out a signal to make proteins, the ER and Golgi apparatus
receive this genetic message. They then make and transport the proteins.
There are two types of ER: smooth and rough.
Golgi apparatus: Cytoplasmic
organelle necessary for the modification and transport of proteins
ribosomes: A complex rich in
RNA and protein found in cells
Rough ER is lined with ribosomes, which give it a “rough” appearance. Ribosomes are the protein factories of the cell.
steroid hormones: Hormones
possessing steroid ring system,
including androgens, estrogens,
and adrenocortical hormones
Smooth ER doesn’t have ribosomes, so it doesn’t make proteins. Instead, it builds
lipids, steroid hormones, and carbohydrates to use in glycoproteins.
glycoproteins: Protein that
contains a carbohydrate group,
involved in membrane integrity
International Sports Sciences Association
38 | Unit 1
Rough endoplasmic
reticulum (ER)
Nucleus
Transport vesicle
from ER
Cis (C) face:
receives transport
vesicles from ER
Golgi apparatus
Transport vesicle
from Golgi apparatus
Trans (T) face: produces
vesicles for cellular
use or for excretion
Figure 1.5. Endoplasmic reticulum and Golgi apparatus
protein synthesis:
Manufacturing of proteins from
amino acids; guided by DNA
Making proteins, or protein synthesis, takes place using ribonucleic acids
(RNA).
ribonucleic acids (RNA):
Various nucleic acids on a single
strand containing ribose and
uracil, necessary for the control of
cell activities
Once these proteins are synthesized in the ribosomes of the rough ER, they move
towards the Golgi apparatus. This organelle prepares the newly formed protein
molecules that will leave the cell.
cisterna: Flattened membrane
disc of Golgi apparatus (plural:
cisternae)
vesicles: Fluid filled pouch/
sac that can transport and store
compounds
The Golgi apparatus contains cisternae (tiny disc-like “holding tanks”, similar to
the word “cistern”) that are stacked on one another and small, circular vesicles.
These vesicles (small sacs) act like little chaperones, engulfing the protein molecules and transporting them to the cell membranes, where they’ll either be sent
elsewhere into the body, or incorporated into the membrane itself. See Figure 1.5.
Proteins are thus always being built up and broken down within our cells. This
takes energy and protein for raw materials. If we don’t eat enough, or don’t eat
enough protein, our cells can’t do their jobs of synthesizing and transporting
the proteins we need. Over time, this can lead to problems such as hormonal
imbalances, depressed immune function, or poor recovery from exercise (perhaps even injuries).
Lysosomes and peroxisomes
lysosome: Organelle containing
hydrolytic enzymes
microorganism: Organism of
microscopic size
peroxisome: Cytoplasmic organelle with enzymes that help with
the breakdown of fatty acids and
other macromolecules
Nutrition: The Complete Guide
Lysosomes are the “garbage disposal units” of our cells. They are vesicles, containing more than 50 different enzymes, which can break down cellular components and protect cells. If a large molecule, such as an old cellular structure
or a microorganism, enters the cell, the lysosome will engulf it then digest and
dispose of it. By keeping the cells clear of waste and debris, lysosomes help renew
and protect the cell.
Peroxisomes are similar to lysosomes: they are small membranous sacs
Cells | 39
containing enzymes (catalase and oxidase), which also detoxify harmful substances that enter cells. Found commonly in liver and kidney cells, peroxisomes
are also important in cholesterol synthesis, bile acid synthesis, ß-oxidation, and
prostaglandin metabolism.
Like mitochondria, peroxisomes are able to break down fats for energy. However,
when they do this, they produce 30-40% more energy as heat but 30% less energy
as ATP.
Since dietary omega-3s increase fat breakdown through peroxisomes, more fat
is burned to do the same daily activities when omega-3 intake is high. Unfortunately, omega-3 supplementation is not a magic fat loss method: The overall
impact is minor.
Body function
detoxify: To remove a poison or
toxin from the body
cholesterol: Synthesized in the
liver of humans and other animals.
A precursor of bile acids and steroid hormones
bile: A yellow or orange fluid produced by the liver, concentrated
and stored in the gallbladder, and
released into the small intestine
for fat digestion
ß: Beta, the second letter of greek
alphabet
prostaglandin: Class of physiologically active fatty acid compounds present in various tissues;
can have hormone-like effects
Let’s look now at how these cellular components, and the chemicals they make
and use, work together within the body.
Enzymes
Enzymes make up the largest group of proteins in the body. You can often spot
enzymes by their names, which typically end in “-ase”, such as:
•
lipase (enzymes that break down lipids);
•
protease (enzymes that break down proteins); or
•
amylase (enzymes that break down carbohydrates).
Enzymes are important biological catalysts, substances that jump-start and
speed up nearly every chemical reaction that occurs in the body.
Enzymes work by exposing their own “active sites” to connect with particular
molecules. Once the enzyme can hold these molecules in place, reactions can
occur. One model of this process is the lock-and-key model. In this model, the
catalyst: A substance that accelerates a chemical reaction
lock-and-key model: Model
that explains enzyme specificity
Products
Substrate
weakened
substrate bonds
active site
Enzyme
Enzyme-Substrate
Enzyme
Figure 1.6. Enzymes. Enzymes expose their own “active sites,” connecting with specific molecules. Holding these molecules in place, they allow reactions to occur, which
allows for product formation.
International Sports Sciences Association
40 | Unit 1
induced fit model: Model that
suggests enzymes are rather flexible structures
enzyme and its chemical partner fit together tightly and carry out their reaction.
In another model, the induced fit model, the enzyme and chemical partner
undergo structural changes when close to one another, eventually fitting together
properly and starting the reaction. You can think of this like puzzle pieces that
change their shape when they are near each other.
No matter what model you apply, the key idea is that enzymes must somehow fit
and connect with their chemical partners. Lipase can only work with lipids; it can’t
work with proteins.
See Figure 1.6.
Many environmental, genetic, and nutritional factors — including temperature,
pH, substrate concentration, and vitamin and mineral status — influence how enzymes work. Thus, nutrition plays an important role in most enzymatic reactions.
Co-enzymes
co-enzyme: Non-protein compound that forms the active portion of an enzyme system
catalyze: Initiate or increase the
rate of a chemical reaction
Just like a co-pilot works with a pilot, co-enzymes work with enzymes. Coenzymes are non-protein molecules, made up wholly or partly of vitamins. We
need them for enzyme-catalyzed reactions.
For instance, pyridoxal phosphate, the active form of vitamin B6, acts as a co-enzyme in all transamination reactions, a particular kind of chemical reaction
involving amino acids. We’ll talk about these types of chemical reactions later in
the text.
And you may already have heard of co-enzyme Q10, which we mentioned earlier,
and which is involved in cellular respiration reactions.
Protein receptors
Protein receptors are found both in the plasma membrane and inside the cell.
As we’ve discussed, cell membranes help control what gets in and out of our
cells. They do this, in part, with membrane protein receptors that act like little
chemical gates.
signal transduction:
Conversion of one signal to another by a cell
Cells get information about their outside world by signal transduction. The
process is a little bit like the telephone game you played as a kid.
receptor-ligand binding complex: A complex formed between
a receptor and a substance to
allow for further cellular activity
A receptor on a cell binds to what is known as a ligand, forming a receptor-ligand
binding complex. A ligand attaches to its specific receptor and no other. The
ligand activates its receptor, which then activates a second messenger inside the
cell. Then the second messenger activates another second messenger, and so on
until the last second messenger goes into the nucleus and triggers changes in gene
expression that leads to some sort of cellular response.
ligand: An ion or molecule that
binds to another molecule or
metal atom
second messenger: Substance
that mediates intracellular activity
by relaying a signal from an extracellular molecule
An example of this process is our cellular response to insulin.
•
After we eat, insulin is released from our pancreas and travels through the
bloodstream.
•
From there, it can bind to specific, insulin-friendly protein receptors on the
membrane of our cells.
Nutrition: The Complete Guide
Cells | 41
Once bound, this connection signals to proteins inside the cells — usually called
second messengers — to get more channels to the membrane and accept glucose
more readily.
As we’ve stressed already, physical activity changes how our cells respond to
nutrients. Repeated muscular contractions (for instance, 30 minutes of pumping
our legs on a bike) tell the cell to move more protein receptors to the cell membrane. This helps glucose get into the cell more efficiently and effectively to help
refill the fuel tank.
What we eat can also influence second messengers. For instance, caffeine in
coffee / tea, theobromine in cacao, and theophylline in tea / cacao can all inhibit
phophodiesterase, an enzyme that breaks down second messengers in cells. So,
in the case of caffeine, this means stronger / faster heart muscle contractions,
greater blood vessel constriction, and enhanced stomach acid secretions.
Transport proteins
Transport proteins are also involved in cellular communication. These live in
cell membranes and let molecules pass between spaces inside the cells and spaces
outside of cells.
This movement across the plasma membrane can take place via one of two
mechanisms:
•
passive transport (which doesn’t need energy), or
•
active transport (which needs energy).
Active transport allows vitamins, minerals, glucose, and amino acids into cells. See
Figure 1.7
In the next unit, we’ll look at how some of these chemical processes and cellular
structures and tasks are involved in digestion.
Extracellular space
Intracellular space
Figure 1.7. Transport proteins. Transport proteins specifically allow the passage of
water-soluble molecules between the spaces inside the cells and the spaces outside the
cells. Movement across the plasma membrane can take place via one of two mechanisms:
facilitated diffusion or active transport. Cellular transport allows things like vitamins,
minerals, glucose and amino acids into cells.
International Sports Sciences Association
42 | Unit 1
Nutrition in practice
Salivary amylase is an enzyme in saliva that starts the digestion of starch. It helps
to improve our “mouth experience” while eating (e.g., enhanced taste of certain
foods). We’ve known about it for over 100 years.
Just recently, researchers found a correlation between obesity and a person’s
ability to make amylase. People with fewer AMY1 genes — thanks to genetic
polymorphisms — might not tolerate carbohydrates as well. People whose
ancestors traditionally ate diets higher in starch seem to have more AMY1. This
is another example of the interaction between our environment, culture, genes,
and optimal dietary choices.
Cell types
In the next unit, you’ll meet some different cell types.
You’ll notice that many types end in the suffix “cyte.” This suffix will tell you that
something is a cell. (For more on this, see the “Language matters” sidebar.)
Each cell’s structure can tell you about its job. For instance:
•
Enterocytes, which line the intestine, are shaped like little brushes. This increases their surface area and helps them absorb nutrients.
columnar epithelial cells:
Pillar-shaped cells that line many
surfaces of the body
goblet cells: Mucus-secreting
epithelial cell that distends, taking
on the form of a goblet; found
often in respiratory and intestinal
tracts
•
Much of the gastrointestinal tract is lined with columnar epithelial cells.
These are tall skinny cells.
•
If their job is to absorb nutrients, there’s only one layer of them.
•
If their job is to secrete things (like saliva), they’re stacked on top of each other
like cases of beer. Stacked cells are known as stratified cells.
•
Some columnar epithelial cells are known as goblet cells because of their
shape.
•
Cuboidal, or cube-shaped cells, are found in the salivary glands and the lining
of the mouth. Because of their shape, they tend to be a little stronger and
tougher, so they’re often used as structural cells.
•
Squamous cells are flat cells that look a bit like layers of fish scales. They line the
esophagus and help protect it from stomach acid. They’re easily sloughed off
and replaced.
•
The structure of myocytes, or muscle cells, allows them to produce force in
order to move our body around.
There are many types of cells within the human body. You won’t learn them all.
Just get the general idea: Cells are not only diverse inside, they’re diverse outside
too. Each unique cell type and structure is adapted for a specific job.
Nutrition: The Complete Guide
Cells | 43
Language matters
Many of our English medical terms come from ancient Greek or Latin, or even
older sources. You’ll notice we often mention where these terms come from.
Obviously, you don’t have to brush up on the classics to become a nutrition
coach.
But you may find it helpful to understand where words come from, so that you
can guess at what an unfamiliar word might mean.
For instance:
“Entero” comes from the Greek enteron, or intestine.
“Hepatic” comes from the Greek hepatikos, or liver.
“Gastric” comes from the Greek gaster, or stomach.
“Cyte” comes from the ancient Greek kyto, which refers to a hollow or empty
container. We now use it to refer to cells.
“Epi” comes from the even more ancient Proto-Indo-European epi, meaning near,
at, or against.
So any time you see a form of these words, you’ll know what you’re dealing
with.
For instance, enterocytes are intestinal cells. Hepatocytes are liver cells. Epithelial
cells are cells that are the top layer of something, such as the innermost layer of
the esophagus.
This study of where words come from is known as etymology. This can give us
clues about what those words mean. It can also help you if English is not your
first language.
If you’re having trouble recalling a particular term in this course, try Googling
“etymology” and that term. You might learn a little factoid or two about that
term that helps it stick with you.
Get to know the language of your field and where it comes from, and you’ll
probably find that your understanding and comfort with the terminology improves. (And you’ll remember it better when tested!)
International Sports Sciences Association
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Summary
The trillions of cells of the human body work together
to form tissues, organs, and organ systems. The total of
all of the activities taking place in these systems is what
most people refer to as “metabolism.”
There are many levels of organization in the body, from
microscopic atoms up to fully functional organisms (and
beyond, to ecosystems). These systems are interconnected, and all must work properly for organisms to thrive.
Our cells have many jobs, including:
•
converting nutrients into energy (particularly ATP)
•
making proteins (under the direction of our DNA)
•
moving those proteins, nutrients and other substanc-
as enzymes and co-enzymes, or protein receptors) to
begin and carry out chemical reactions; to send cell
signals; and / or to transport other molecules.
The food we eat interacts with the small chemical reactions and processes taking place in our cells.
Food thus affects our health in five ways. It:
1.
provides energy
2.
provides molecules involved in chemical reactions
3.
is incorporated into body structures
4.
influences chemicals such as hormones and
neurotransmitters
es around (including in and out of the cell across the
membrane) and
•
clearing waste and debris from the cell.
Our cells use specialized structures and molecules (such
Nutrition: The Complete Guide
5.
affects genetic protein-making signals as well as the
quality of the proteins that are made
UNIT 2
Through the GI Tract
46 | Unit 2
Unit Outline
1.
Objectives
4.
How do we absorb our food?
2.
Digestion
5.
Case study
3.
Controlling the digestive process
6.
Summary
Objectives
In this unit, you’ll learn:
•
•
•
how nutrients are transported to and into cells.
how your body transforms the food you eat into
By the end of this unit you should be able to describe and
material that your cells can use
understand the basics of how these processes work, and
how your digestive system breaks down your food
how they generally apply to the practice of fitness nutrition.
into smaller molecules and controls how nutrients are
absorbed into the bloodstream
Digestion
In order to use nutrients, our body has to process them
first. This is known as digestion, from the Latin digerere
— to separate, divide, or arrange — a term that captures
exactly what our body does:
•
separate molecules and break up more complex
substances;
•
sort and divide molecules by type and where they
should go; and
•
arrange and transport them throughout the system
to our cells.
It’s often said that you are what you eat. More accurately,
you are what you digest, absorb, and transfer to your
cells. Our body carefully manages these processes to
control what gets into our cells, and to keep a dynamic
balance within the body.
What is food?
As you’ll remember from the Introduction, there are
many ways to think about food: food as fuel, food as
information, food as a story, etc.
Nutrition: The Complete Guide
Food is more than just nutrients
In this unit, we’ll focus on the chemistry and components
of food. But as you learn the details of food chemistry and
how it relates to digestion, keep the big picture in mind.
Food isn’t just a pile of nutrients. It has physiological,
psychological, social-cultural, and environmental
dimensions.
This is important to remember as you practice fitness
nutrition. Most people don’t eat “nutrients” — they eat
foods and meals. Complex foods aren’t just macronutrient sources.
So: Learn and understand the science, then translate it
when communicating with clients.
To a client (and hopefully, most of the time, to you too),
chicken is chicken, not “protein.” Chicken is part of
a meal like curry, rotis, a fajita, or chicken soup. And
a meal is part of a complex set of social and cultural
behaviors.
When working with clients, always take a holistic view
of nutrition and eating, no matter how awesome and
interesting the science is.
Through the GI Tract | 47
The composition of food
For now, let’s look at what food is made of. Food contains:
•
macronutrients: proteins, carbohydrates, and fats
•
micronutrients: vitamins, minerals
•
phytonutrients and zoonutrients
•
water.
Food also contains other substances, such as fiber, that we don’t use directly, but
that are used by the bacteria living in our intestines.
Because food was once other living organisms (such as plants or animals), it’s
chemically complex. Our body has to take this complexity and simplify it. We
must break food into smaller pieces that can be moved safely and easily around
the body, then transported into cells in forms that those cells can use.
phytonutrients: Used
interchangeably with
phytochemicals. Components
found in plant food sources
zoonutrients: Used
interchangeably with
zoochemicals. Components found
in animal food sources
For instance:
Most proteins must be broken down into amino acids.
Most carbohydrates must be broken down into glucose.
Most fats must be broken down into fatty acids.
We’ll look more at the production of energy, and how these macronutrients are
broken down and used, in upcoming chapters.
How digestion works
The gastrointestinal tract
Our gastrointestinal (GI) tract is a muscular canal through our body that’s
about 26 feet (8 m) long and includes everything from mouth to anus. While
digestion is one of its main roles, the GI tract does more than that.
•
It brings in and processes nutrients.
•
It gives us a physical and chemical barrier against pathogens.
•
It detoxifies potentially harmful substances and excretes waste.
•
It contains a “second brain”, known as the enteric nervous system.
•
It secretes some hormones and helps process others.
•
It helps regulate our immune system.
•
It’s innervated by nerves also involved in social engagement and emotion, giv-
gastrointestinal (GI) tract:
The long tube through the
body composed of stomach and
intestines
ing us important (often instinctive and subconscious) signals about the world
and how we feel.
In this unit, we’ll focus on the GI tract and its role in digestion, but bear in mind
that the GI tract does lots of other cool things too.
Fundamentally, the process of digestion involves a few key steps:
International Sports Sciences Association
48 | Unit 2
When we see or even think about food, the brain tells
the rest of the body to prepare for eating.
After all, most of us don’t like uninvited surprise guests
who wake us up and expect us to start partying with
them immediately. The same is true of our GI tract — it
likes to know in advance what’s coming down the pipe.
Mouth
Esophagus
Stomach
Liver
Gallbladder
Large Intestine
Pancreas
Small Intestine
Every stage of digestion alerts the next stage to expect
food and nutrients to arrive.
Thus, if food seems nearby, our brain immediately tells
our mouth to start salivating, our stomach to start
secreting digestive enzymes, and so forth. (If you think
about how often we see food cues during an average day,
you can imagine that these ever-present reminders can
cause our appetite to get out of whack. In the 21st century, our brain is constantly told that it’s chow time.)
We’ll look more at this process later.
The nervous system
Figure 2.1 Digestive system.
Our digestion is controlled by our autonomic nervous
system (ANS), which regulates our internal organs outside of our conscious control.
The ANS has two branches:
•
breaking down foods mechanically and chemically
•
or flight” system
into smaller pieces, and eventually smaller molecules;
•
moving those molecules from inside the GI tract to
•
excreting whatever our body doesn’t want or won’t
use.
Our GI tract responds to both SNS and PNS signals.
•
SNS activation (with intense activity, stimulation, or
stress) tends to shut down digestion and appetite.
Where digestion begins: The brain
and nervous system
We might think of digestion as starting in the stomach.
In fact, digestion starts in the brain and is organized by
the nervous system.
the parasympathetic nervous system (PNS), aka our
“rest and digest” system
elsewhere in the body (either for use or storage); and
•
the sympathetic nervous system (SNS), aka our “fight
Our mouth goes dry, we stop wanting food, our GI
tract stops moving food through the system, and we
may get “butterflies” in our stomach.
•
PNS activation (with rest and relaxation) tends to regulate digestion and movement through the GI tract,
so that things proceed steadily and calmly. (However,
The brain
in situations of extreme fear or trauma, once our SNS
Hunger activates systems in our brain that tell us to get
up and get moving. To go find food, we have to override
our natural desire for staying put and staying safe. Thus,
the parts of our brain that help us find food are also involved in movement, stimulation, curiosity, reward, and
looking for things.
activate. Since intestinal motility is one of the PNS’s
Nutrition: The Complete Guide
response has been exhausted, the PNS might also
jobs, we might lose bowel control.)
Digestion can be affected by both internal signals (such
as what’s happening elsewhere in the body) as well as
environmental signals (such as outside stressors).
Through the GI Tract | 49
This relationship between our nervous system, the GI tract, and our outside environment is important for nutrition coaches to understand. For instance:
Internal or external stress can affect our digestion and how our GI tract behaves.
What we think and feel (internal), or what we see or smell (external) can affect
our appetite, hunger, and fullness.
Nose and mouth
Olfaction
It’s not technically part of digestion, but smelling our food (known as olfaction)
is an important part of eating.
olfaction: Action of smelling
Smelling food before we eat it not only tells our GI tract that food is coming, it
helps us decide whether to eat something in the first place.
Then, retronasal olfaction happens when odors from food travel up the back of
our throat into our nasal passages as we chew and swallow.
Interestingly, retronasal olfaction seems to be important for satiation, or fullness.
Keeping food in our mouth longer, which lets us smell and taste it better, tells
our brain that we’re getting enough nutrients. This is probably why slow, mindful
eating leaves us feeling more satisfied with less food. (And why many cultures
seem to be able to combine delicious, decadent cuisine with smaller portions and
leaner people.)
retronasal olfaction: Smelling
from behind the nose
And of course, if we don’t smell food, we can’t taste it properly. You’ve probably
found that when you have a cold, food just isn’t as appealing.
Salivating and chewing
Once food is in our mouth, our teeth rip, shred, and grind it into smaller pieces
with help from our powerful jaw muscles. Our saliva moistens the food and saturates it with enzymes that start to break it down. Our tongue tastes the food and
eventually push it back into our throat to swallow.
Teeth, jaw, and palate
Teeth are uniquely adapted to each organism’s diet. We have omnivore teeth — a
mix of cutters, choppers, and grinders that allow us to masticate, or chew, many
types of foods. Teeth are covered by enamel, the hardest and most chemically
stable substance in the human body.
In terms of the amount of force they can produce for their size, our jaw muscles are among the strongest in our body. Chewing also stimulates pleasurable
neurotransmitters, which is one reason we may enjoy eating (or chew on things
when we’re anxious).
The palates on the roof of the mouth separate the nasal passages and the mouth.
They also protect the teeth and help us create sounds.
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Tongue, taste buds, and mucous membranes
Our tongue is covered with papillae, tiny bumps that increase the surface area of the tongue and help move food
around the mouth. Most types of papillae also contain
taste buds.
The mouth is lined with a mucous membrane. Because
this membrane is thin, somewhat porous, and rich with
blood vessels, we can absorb many substances through
it, such as sublingual (under the tongue) drugs.
Is sweet taste enough to refuel us?
As you’ll learn later, carbohydrates in the form of glucose are an important fuel for our body.
Glucose is absorbed and processed by our small intestine and our liver, and sent to our cells to help make
energy in the form of ATP. We can use this ATP to power
us through exercise.
But you may be surprised to know that often, a sweet
taste in our mouth — without that sweetness ever getting further into our GI tract — may be enough to give
us energy.
Recent research suggests that when athletes swish out
their mouths with a sweet carbohydrate-containing
solution, but don’t swallow it, their bodies act as if those
carbohydrates got into circulation. This means the athletes can perform better and exercise longer — again, as
if they had really consumed those carbohydrates.
has receptors that signal the brain that carbohydrates
are available. Functional MRI (fMRI) studies have found
that sweet taste activates areas of the brain associated
with movement.
Indeed, studies that have injected athletes with glucose
(thus bypassing the mouth, so athletes taste nothing)
have found that their performance doesn’t necessarily
improve. We may have to taste sweetness “centrally”,
i.e., with our conscious awareness and our taste receptors, in order for it to work best.
But not every study finds that a carbohydrate “mouthwash” improves performance. Research on this topic is
still ongoing.
Still, the idea offers some intriguing possibilities. At the
very least, it tells us that taste is more than just a pleasant side effect.
Scientists speculate that this works because the mouth
Salivary glands
We have salivary glands under our tongue (sublingual),
along our bottom jaw (submandibular) and in our
cheeks, along the backs of our jaws (parotid), along with
up to 1000 tiny minor salivary glands scattered through
our mouth.
Saliva is about 95% water, with the rest being mucus, enzymes, glycoproteins, and antimicrobial chemicals that
help prevent pathogens from getting into our system.
Saliva moistens our mouths, keeping our mucous membranes healthy and washing away harmful bacteria.
Nutrition: The Complete Guide
In the 1.5 or so liters of saliva we make every day, we find
digestive enzymes like amylase and lipase.
Amylase begins the digestion of starch.
Lipase begins the digestion of fats. However, we don’t
digest much fat in our mouth. It takes a relatively long
time to digest fat, and unless you like sucking on pats of
butter, dietary fat doesn’t usually stay long in our mouth.
As with all aspects of the GI tract, salivary secretion is
connected to both our parasympathetic and sympathetic
nervous systems. When we are anxious or stressed, our
mouth tends to go dry.
Through the GI Tract | 51
Oral microbiome
Although our saliva washes away unwanted bacteria, our mouth is not sterile.
Like most other places in and on our body, our mouth contains an active microbiome, or microbial community.
There are nearly 300 known species of friendly bacteria in our mouth; researchers speculate there may be as many as 700. Each species lives in its own little oral
neighborhood (such as along the gumline or under the tongue).
Digestion, metabolism, and your mouth
Getting a regular dental checkup may do more than keep our pearly whites
shiny and cavity-free. It may also help ensure your clients can chew and swallow
their food properly, and aren’t suffering any underlying health problems.
For example:
•
Older clients, clients with dental work, or clients with misalignment of
the temporomandibular joint (TMJ) may find it hard to chew properly.
•
Bad breath can signal gum disease or a love of garlic, but it can also be a
sign of digestive problems such as acid reflux. (See more below.)
•
Gum disease can signal untreated diabetes, potential cardiovascular disease, inflammatory bowel disease (IBD) or other inflammatory conditions
— even colon cancer.
•
Clients with bulimia that includes vomiting may have tooth erosion and
damage to their mouths.
Most of these are outside your scope of practice, but you may find yourself collaborating with your clients’ dentists at some point as part of a holistic approach
to fitness nutrition.
Swallowing
Once the food mass is chewed, lubricated, and formed into a lump, it’s known as
a bolus. The bolus is passed to the pharynx.
While we can move the bolus to the back of our mouth voluntarily and decide
whether to swallow it, the process of swallowing itself is actually involuntary.
When swallowing, the epiglottis involuntarily closes to stop food from entering
our trachea. The uvula also closes off the nasopharynx, preventing food from
entering the nose.
These actions stop food from getting into our airway. However, sometimes fluid
amylase: Of pancreatic and
salivary origin, this enzyme
catalyzes the hydrolysis (splitting)
of starch into smaller compounds
lipase: Catalyzes the splitting of
fats into glycerol and fatty acids
bolus: A formed mass of soft,
partially chewed food
pharynx: Throat
epiglottis: Lid-like cartilaginous
structure suspended over the
entrance of the larynx; swallowing
closes the opening to the trachea
by placing the larynx against the
epiglottis
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sneaks down before the closing of the epiglottis. This is what people describe as
water “going down the wrong pipe.” (And of course, most of us have accidentally
snorted liquid through our nose when our dinner companion cracks a joke.)
The esophagus
The esophagus is a tube, lined
with a mucous membrane, that
transports food and water from
the mouth to the stomach. Its
name is derived from the ancient
Greek oiesin, “to carry”, and
phagein, “to eat” — thus, the
esophagus carries what we eat
from the mouth to the stomach.
Mouth
Esophagus
peristalsis: Waves of involuntary
muscle contraction moving the
contents of the GI tract forward
The saliva that moistened food
in the mouth now helps move it
through the esophagus, with the
help of the mucous membranes
Stomach
in the esophagus. Gravity does
Liver
much of the job. A series of wavelike muscular contractions, called peristalsis,
Pancreas
handles the rest.
Gallbladder
lower esophageal sphincter
(LES): Also known as the cardiac
sphincter, a thick, muscular
ring surrounding the opening
between the esophagus and
stomach
The esophagus ends in a ring-like
Largemuscle,
Intestineknown as the lower esophageal
sphincter (LES) (or cardiac sphincter), which regulates food entering the stomach. The LES also prevents food and acidic stomach juices from splashing back
upwards. an unwanted situation known as gastroesophageal reflux disease
(GERD).
gastroesophageal reflux
disease (GERD): Condition in
which acidic stomach contents
flow back up into the esophagus
Gastroesophageal reflux is caused by the sphincter opening more often than it
should, or opening at the wrong times. While your diet doesn’t likely cause gastroesophageal reflux, it can make it worse. (See sidebar “Gastroesophageal reflux
disease (GERD)” for more.)
Small Intestine
Most people experience GERD as heartburn, usually after eating. GERD can also
involve other unpleasant symptoms such as:
•
burning in the back of the throat, or a persistent cough or hoarseness;
•
nausea and vomiting;
•
pressure and / or pain in the chest;
•
bloating and burping; or even
•
tooth erosion.
If you have a client diagnosed with GERD, consider the simple dietary action
plan we suggest in the sidebar.
Nutrition: The Complete Guide
Through the GI Tract | 53
Gastroesophageal reflux disease (GERD)
As of 2014, the third-most prescribed and top-selling
Processed foods, especially fatty foods, can cause
drug in North America was Nexium. This drug type,
problems. In part, this is due to how our GI tract pro-
known as a proton pump inhibitor (PPI), causes the
cesses fat.
stomach to produce less acid. This in turn reduces the
painful symptoms of GERD.
•
When dietary fat enters the small intestine, it
triggers relaxation of the LES. Medium and long-
However, PPIs don’t help everyone, they have side
chain fatty acids seem to create the strongest
effects, and they don’t solve the fundamental problem
response.
underlying GERD. In addition, reducing stomach acid
may leave us with less protection from whatever patho-
•
Dietary fat slows gastric emptying, meaning that
food and acids stay in the stomach longer. This
gens stomach acid normally kill.
increases stomach pressure, which in turn can
It’s not surprising that Nexium and over-the-counter
promote reflux as stomach contents are pushed
remedies such as antacids are selling so well: As many as
upwards.
one-quarter of people in North America will suffer from
GERD at some point.
GERD hurts, but it can also increase people’s risk for
abnormal esophageal tissue growth, and perhaps even
esophageal cancer. The long-term damage and inflammation caused by stomach acid and undigested food
can lead to these more serious problems.
It’s hard to know exactly what causes GERD. Most likely,
there are many factors.
Gravity can play a role. Eating a big meal then lying
down often causes heartburn, as the fluids slosh back
Having a lot of body fat may worsen GERD as visceral
fat (around the internal organs) compresses the space
around the stomach.
Bacterial overgrowth, such as Helicobacter pylori, the
bacteria responsible for ulcers, may also be involved.
Age tends to weaken muscles, including sphincters.
Over time, the LES is less able to seal the esophagus
properly.
Smoking can worsen not only GERD but also increase
the risk of esophageal cancer.
upstairs and it’s harder for the LES to block the entrance
There may even be a genetic component to GERD risk.
to the esophagus. If you have clients with night-time
As a nutrition coach, you can offer some simple steps to
heartburn, try having them elevate the head of their bed
help your clients alleviate GERD:
slightly, prop up on pillows, or simply eat earlier in the
•
eat slowly;
to empty itself.
•
eat mindfully in a relaxed setting;
Stress also affects digestion. When we’re rushed and
•
eat smaller meals;
•
keep a food journal to see if there is a link be-
evening if possible, so that the stomach has more time
stressed, we tend to eat faster and less mindfully. We
may not chew properly, and gulp our food in chunks.
tween what they eat and their GERD symptoms;
Additionally, stress activates the SNS, which then slows
and
down gastric and intestinal motility, or the movement of
food through the GI tract.
•
choose less-processed, whole foods.
Your heavier clients may also notice that if they lose
body fat, their GERD eases as well.
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The stomach
The stomach is a roughly J-shaped pouch that sits more or less around the base of
your breastbone, slightly to the left.
A normal stomach capacity ranges from 0.25-1.7 liters. The stomach has stretch
receptors that tell us when it’s filling up. (You can help clients learn to “tune in”
to this feeling of expansion and fullness to better decide when it’s time to stop
eating.)
short-chain fatty acids:
Fatty acid with fewer than eight
carbons that is taken up directly
through the portal vein, and
produced while fiber is fermenting
in the colon
While we absorb most nutrients in the small intestine, our stomach can absorb a
few. Certain drugs, water, some vitamins, alcohol, and specific short-chain fatty
acids (e.g., acetate, butyrate, and propionate) can cross the thick stomach lining
and enter general circulation.
Stomach anatomy and function
The stomach is divided into three parts. (See Figure 2.2):
chyme: Partly digested food
formed as a semi-fluid mass
pyloric sphincter: Thick,
muscular ring of mucous
membrane surrounding the
opening between the stomach
and the duodenum
hiatal hernia: Protrusion of the
stomach through the esophageal
hiatus of the diaphragm
•
the fundus (the first part, just below the esophagus)
•
the body (the central part)
•
the antrum (the lower part)
While in the stomach, food is churned and mixed into a liquid called chyme.
Another ring-like muscle, the pyloric sphincter, lies at the end of the antrum
and controls the passage of chyme into the small intestine.
Interestingly, because the stomach begins toward the left side of the body and
ends toward the right side, lying on your right side will help the stomach contents pass through the pyloric sphincter. In a famous comedic novel, A Confederacy of Dunces, the main character, who is having problems with his pyloric
sphincter, lies down on his right side and bounces, taking advantage of gravity
and this anatomical situation to help move things along.
A hernia occurs when tissue pokes through tissue, such as the abdominal wall,
that should normally contain it. In a hiatal hernia, a small piece of the fundus
peeks through a small tear in the diaphragm. Hiatal hernias usually improve
with exercise, weight loss, sleeping on a slight incline, or prescription medications. Most cases don’t need surgery.
Gastric mucosa
gastric juice: Acidic fluid
secreted by the stomach glands
and involved in digestion
hydrochloric acid: Solution of
hydrogen chloride in water; found
in gastric juice
The innermost layer of the stomach, the gastric mucosa, secretes a variety of
substances that are collectively known as gastric juice.
Chief cells secrete enzymes such as pepsin or gastric lipase to begin protein and
fat breakdown, respectively.
Parietal cells secrete the stomach’s main acid, hydrochloric acid, along with
intrinsic factor, a glycoprotein that we need to absorb vitamin B12.
Aging, gastrointestinal diseases, bariatric surgery, and alcoholism can make it
harder for us to produce intrinsic factor. This means we might not get enough
Nutrition: The Complete Guide
Through the GI Tract | 55
Figure 2.2 The stomach.
vitamin B12 from food or vitamin supplements that we
swallow. We might need to supplement B12 by injection
or sublingually (under the tongue) to bypass the need for
intrinsic factor.
about the same as battery acid. This helps kill most pathogens and further breaks down the food.
Other gastric mucosal secretions include:
After working its way through the stomach, the chyme
(which consists of partially digested food, water, acids,
and digestive enzymes) begins to empty into the small
intestine.
•
histamine (which is involved in the immune response
and increases gastric acid production)
•
glucagon (a hormone that helps release glucose into
the bloodstream)
•
serotonin (a neurotransmitter)
As its name suggests, the gastric mucosa is also lined
with mucus, which helps protect it against the powerfully
corrosive hydrochloric acid. When acid secretion is at its
highest during digestion, the stomach has a pH nearing 1,
Stomach emptying
This happens very slowly — only a few milliliters at a
time. Thus, it usually takes between one and four hours
for the stomach to empty, depending on what we’ve eaten.
•
Carbohydrates empty first, then proteins. Fats and
fiber move the slowest.
•
Liquids empty more quickly than solids.
•
Small particles more quickly than large particles.
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Helicobacter pylori: Friend or foe?
At first, you’d think that stomach bacteria is a bad
H. pylori is sneaky and versatile. It can easily slip past
thing. Certainly, when the bacterium known as Helico-
our immune system, and may even have modified
bacter pylori was discovered as the cause of ulcers by a
our immune response to suit its needs. If allowed to
courageous (or crazy) scientist who purposely infected
over-colonize, H. pylori can lead to inflammation of the
himself with it, it seemed to be.
stomach and / or esophagus, ulcers, tissue damage and
However, as we are learning more about the role of
our microbiome, the microbial communities that live in
and on us, H. pylori seems like less of a supervillain and
more of an evolutionary co-pilot that has been with us
for millions of years of co-evolution.
Most bacteria would wither and die in the extremely
acidic environment of the stomach. Yet H. pylori seems
to live there happily, snuggled into the gastric mucosa
along with approximately 200 other known bacterial
species.
The secret to this wary yet potentially useful co-existence seems to be a dynamic balance between the host
(that’s us) and H. pylori’s growth.
Stress / anxiety, many medications, over-eating, hormones, and other factors can all affect gastric emptying.
scarring, and perhaps even cancer.
Yet not everyone infected with H. pylori gets sick.
Why not?
Different strains of H. pylori seem to have different
effects. Our microbiomes are not only unique to us, but
also may depend on things like our genetic or ethnic
subgroup, our immune system makeup, our diet, where
we live, and other factors in our environment.
Somewhat ironically, H. pylori may even protect us by
preventing the overgrowth of other species of bacteria.
As we learn more about our microbiome, we will
undoubtedly learn more about our bacterial friends…
and foes.
•
like feeling hungry: You might make sure their meals
are higher in fat, slow-digesting proteins and fiber to
All of this is useful to know when considering how to
plan meals with your client.
For instance:
•
For a client who is trying to lose weight, but doesn’t
slow down gastric emptying and help them feel more
satisfied for longer.
•
For a client under stress: You might have them eat
For a client who needs a quick energy boost that
smaller meals, and take an extra 5-10 minutes at each
won’t weigh them down, such as an athlete with
meal to eat a little more slowly.
several training sessions a day: You might make one
or more of their meals a liquid meal that’s lower in
fat and higher in carbohydrate, with quick-digesting
proteins (such as whey or rice protein powder).
Nutrition: The Complete Guide
We’ll look more at designing nutrition plans later. Just
get the basic idea of how understanding gastric function
might apply to your fitness nutrition recommendations.
Through the GI Tract | 57
Does gastric bypass do more than shrink the stomach?
More and more people are opting to have some kind of bariatric surgery for
obesity.
bariatric: Often related to GI
surgical procedures to control
bodyweight
One of the most common surgeries is gastric bypass surgery. This type of
surgery re-sections the stomach, making it a much smaller pouch that can only
hold a few ounces of food.
The initial idea behind this surgery was simple: Smaller stomach means less food
in there. Less food means weight loss.
But then doctors discovered unexpected side effects of bariatric surgery: changes in appetite and other gut hormones.
Many people found, for instance, that after surgery, their insulin sensitivity
improved and consequently their Type 2 diabetes improved. Or they secreted
fewer hunger hormones and more satiety hormones.
Not every patient experienced this. Nor is weight loss surgery a magic process.
Many other people struggled with malabsorption syndromes, vomiting, and
other unpleasant after-effects. In addition, many people did not address the
lifestyle and behavioral factors that led to obesity in the first place.
Nevertheless, the fact that changing the physical structure of the stomach can
change hormones gives us intriguing clues about how the GI tract might work
as an integrated signaling system.
The small intestine
Once chyme enters the small intestine, peristalsis propels it along slowly. It takes
between 4-8 hours or more just to get through the small intestine.
This plodding pace lets the small intestine absorb most of the nutrients we’ve
eaten, such as:
•
electrolytes including potassium and sodium
•
minerals including iron, calcium, magnesium, and zinc
•
carbohydrates
•
amino acids
•
fats
•
water-soluble vitamins (such as vitamin C or the B vitamins)
•
fat-soluble vitamins (such as vitamin A or E)
•
cholesterol and bile salts
•
nutrients we have yet to identify
We also absorb most oral drugs, such as alcohol and other medications, in the
small intestine.
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Small intestine anatomy and function
enterocyte: Absorptive cell of the
intestine
villi: Small projections (singular:
villus) covering the surface of the
mucous membrane lining the
small intestine, through which
nutrients and fluids are absorbed
intestinal brush border: All
of the villi that form a brush-like
border inside the intestine
villus atrophy: When the
threadlike projections covering
the lining of the small intestine
decrease in size
The small intestine is lined with cells called
enterocytes. These are shaped a bit like
brushes, full of folds, pits, and finger-like
projections known as villi. This distinctive
cellular shape and lining, known as the
“brush border”, dramatically increases the
surface area of the intestinal lining.
Healthy villi are important. When they’re
damaged, we don’t absorb nutrients
properly. This can happen, for instance,
with inflammatory bowel disease, untreated celiac disease, food poisoning,
or untreated food intolerances. Indeed,
a “flattened” brush border with villus
atrophy is a common sign of intestinal disease.
The small intestine is subdivided into
three main parts.
duodenum: First portion of
small intestine
•
jejunum: Second portion of
small intestine
•
ileum: Distal portion of small
intestine
•
Liver
Stomach
Large Intestine
Small Intestine
Rectum
Anus
Figure 2.3 Small and large intestines.
The duodenum is the first section
past the stomach. In adults, it’s about 1.5 feet (45 cm) long.
The jejunum is the second section and is 7-10 feet (about 2-3 m) long. Most
nutrient absorption takes place in these two portions of the intestine.
The final section of the small intestine is the ileum. It is 10-13 feet (about 3-4
m) long. It absorbs vitamin B12, bile salts, and whatever products of digestion
were not absorbed by the jejunum.
Duodenum
pancreas: Large gland behind
the stomach that secretes
digestive enzymes and the
hormones insulin and glucagon
The first segment of the intestine, the duodenum, secretes juices from the pancreas. The juices, which contain bicarbonate, lipase, amylase, and proteolytic
enzymes, have two tasks:
bicarbonate: Organic salt (HCO3
) that can neutralize acids
•
proteolytic enzyme: Enzyme
that hydrolyzes (breaks down)
protein or peptides
•
gallbladder: Muscular sac where
bile is stored
emulsification: To disperse,
convert and suspend one liquid as
droplets into another
first, to neutralize the formerly acidic chyme with the very alkaline bicarbonate; and
second, to further break down the foodstuffs into their component parts.
During this time, the gallbladder releases bile (made up of bile salts and cholesterol) to emulsify fat. Emulsification happens when two otherwise unblendable
substances (such as oil and water) are mixed. (A salad dressing, for example, is
usually an emulsion, as is dairy cream.) Mixing fat with bile makes the fat more
soluble and thus more easily absorbed.
You might have noticed that we included bile salts above in the list of nutrients
that our small intestine can absorb. This is because our body partially recycles
these salts by re-absorbing them. If we didn’t, we wouldn’t be able to make new
bile salts quickly enough for digestion.
Nutrition: The Complete Guide
Through the GI Tract | 59
A key part of digestion and detoxifying any potentially harmful chemicals (such
as medications or hormones) is moving substances from the small intestine to
the liver and back. This process, known as enterohepatic circulation, happens
through the portal vein, a sturdy network of vessels that shuttles material between the intestines and the liver. This includes bile salts.
Once food passes through the duodenum, jejunum, and ileum, which absorb
as many nutrients as possible, it goes to the large intestine. To do so, it passes
through another sphincter-like structure called the ileocecal valve.
By this point, any intestinal contents are no longer acidic, thanks to the actions
of bicarbonate earlier in the duodenum. So food entering the large intestine will
have a more or less neutral pH.
The liver
enterohepatic circulation:
Circulation of substances such as
bile salts between the intestine
and the liver
portal vein: A vein conveying
blood to the liver from the spleen,
stomach, pancreas, and intestines
ileocecal valve: Two folds of
mucous membrane that form a
valve between the large intestine
(cecum) and the small intestine
(ileum)
hepatic portal system:
Veins that carry blood from
the capillaries of the stomach,
intestine, pancreas, and spleen to
the liver
Before we get to the large intestine and the next stage on
the journey, let’s stop briefly and take a detour. There are
several other organs involved in this part of digestion. First
up is the liver.
The liver is between 3-4 lb (1.4-1.8 kg), and roughly the
size of an American football, which makes it the largest
gland in the body. It lies in the upper right portion of
the abdomen, just under the diaphragm and next to the
stomach. It’s made up of two main lobes, called the right
and left lobes.
As we’ve mentioned, blood from the liver’s hepatic portal
system passes through the liver for “inspection.”
The cells of the liver metabolize molecules by either building
them up or breaking them down as needed. The liver also
makes about one pint of bile per day, which is made up of
bile salts, bile pigments and cholesterol. This bile secretion, as
discussed earlier, helps emulsify fats.
Figure 2.4 The hepatic portal system. Responsible for directing blood from parts of the GI tract, through the portal vein
to the liver for inspection before going to the heart.
Most of our nutrients (and anything else that’s come along
for the ride) are screened in the liver. See Figure 2.4.
Fats
The liver can convert fatty acids to triglycerides or release them into circulation
as plasma lipoproteins (such as HDL and VLDL), molecules that are able to
transport fats in water-soluble blood.
When fat intake is very high and carbohydrate intake very low or absent, the
liver can form compounds called ketone bodies to use as another fuel source.
Carbohydrates
The liver helps maintain carbohydrate homeostasis.
triglyceride: Compound with
three molecules of fatty acids
bound with one molecule of
glycerol; the storage form of fat in
humans
lipoprotein: A class of proteins
with hydrophobic core of
triglycerides or cholesterol
surrounded by hydrophilic
phospholipids, apolipoproteins
and cholesterol
ketone body: Either
acetoacetic acid, acetone or
beta-hydroxybutyric acid with a
carbonyl group attached to two
carbon atoms
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Synthesis
tion
ec r e
Bili
a
S
ry
Colon
Ileum
Portal Venous Return
Fecal Excretion
Figure 2.5 Enterohepatic circulation. Moving substances from the small intestine to the
liver, and back.
glycogen: Chief source of stored
glucose in selected tissues
hepatocyte: Liver cell
•
If blood glucose is high, the liver stores it as glycogen in its own hepatocytes
for later use.
•
If blood glucose is low, the liver provides glucose to the blood from previously
stocked up liver glycogen stores.
•
The liver also converts other sugars, such as fructose and galactose, to glucose.
Proteins
deamination: Removal of an
amine group from a compound
The liver can deaminate amino acids, converting them into glucose derivatives
and free nitrogen for excretion through the urine.
first pass metabolism: When
a substance is swallowed and
absorbed, it first travels through
the hepatic portal system for
metabolism by the liver; this “first
pass” can reduce the availability
of the substance to the body
Other substances
Nutrition: The Complete Guide
Finally, the liver will filter toxins, drugs, or many of our own hormones before
allowing them into general circulation.
In the pharmaceutical industry, this is referred to as first pass metabolism.
Through the GI Tract | 61
Proteins
Carbohydrates
Fats
Amino acids
TG
Glycogen
Gluconeogenesis
Free fatty acid
(FFA)
B 12, B 6, Folate, Biotin
Lactate
Glucose
Ketogenic
amino acids
Glycerol
Riboflavin,
Niacin, Biotin
Thiamine,
Niacin
Pyruvate
Glucogenic
amino acids
Thiamine,
Niacin
Lipogenesis
Thiamine,
Pantothenic acid
Niacin, Biotin
Acetyl-CoA
Alcohol
Ketones
Muscle
Blood
Amino acids
Glucose
FFA
O2
Lipolysis
Krebs cycle
Glucose
Amino acids
FFA
Glycogen
Protein
TG
Electron
transport
chain
CO2
ATP
H2O
Figure 2.6 Interrelationships among macronutrients in metabolism
It’s why the liver is so often damaged by oral drug overdoses or even too many
“healthy” supplements.
We’ll learn more about how macronutrients are processed in later chapters. For a
general overview, see Figure 2.6
The gallbladder
This small pear-shaped sac sits next to the small intestine. It stores the bile that
the liver produces.
The pancreas
The pancreas is about the length of your hand, and sits next to the small intestine. It releases pancreatic juices through the pancreatic duct into the duodenum
at the same point that bile is released.
The pancreas is about 98% exocrine acinar cells, which secrete pancreatic
juice containing digestive enzymes. These are released in an alkaline bicarbonate-based fluid that helps to neutralize stomach acid. Pancreatic enzymes
include:
•
trypsin and chymotrypsin, which help to digest proteins;
•
amylase, which helps to digest polysaccharides; and
•
lipase, which helps to digest fats.
The other 2% of the pancreas is made of endocrine cells, which produce several
important glucoregulatory hormones including insulin, glucagon, amylin, and
somatostatin.
exocrine: Secretion, such as
saliva or bile, released outside its
source by a duct
endocrine: Secretion, such as a
hormone, distributed in the body
by the bloodstream
glucoregulatory hormone:
Hormone that balances blood
glucose levels, such as glucagon
or insulin
feces (next page): Waste
discharged from the body
through the anus
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Cholesterol and dietary fiber
You may have seen ads for breakfast cereals claiming
that they help lower cholesterol because they’re high in
fiber. How does this work?
clients who find it hard to get enough high-fiber foods
such as whole grains, beans and legumes, or fruits and
vegetables.
While we recycle some bile salts, we excrete others.
Soluble dietary fiber can bind to bile salts in the small
intestine and help us eliminate them.
Conversely, if you have a female client who is suffering
from low sex hormone levels and disrupted menstrual
cycles, review her fiber intake.
Since we need cholesterol to make new bile, if we get
rid of bile salts by binding them to fiber, our body has
to use up more cholesterol. This is why dietary fiber can
help lower blood cholesterol.
Many “health-conscious” women, especially plantbased eaters or women trying to lose weight, eat a lot of
fiber but have a lower energy intake. They may also have
less body fat and be physically active. All of this can tell
their bodies to gear down sex hormone production.
Fiber can also bind to other fat-soluble chemicals, such
as sex hormone metabolites, and help excrete those too.
Of course, you’re not allowed to officially treat medical
conditions such as high cholesterol or a sex hormone
imbalance such as estrogen dominance. But you can
generally mention that your clients could increase fiber
intake from whole foods, or add a fiber supplement for
The higher fiber intake then binds what little hormones
are being produced, and removes them from the body.
So these women are getting rid of scarce hormones
too readily.
In this case, review your female clients’ energy intake and
fiber intake to make sure they’re getting enough to eat,
and not literally flushing their hormones down the toilet.
The large intestine
Once the remaining food enters the large intestine (also
known as the colon), it will stay in there about 12-25
more hours, moving along at about 2 inches (5 cm) per
hour, before being excreted as waste.
What’s left at the end of this process is the semi-solid
waste we call feces.
While the small intestine absorbs most nutrients, the
large intestine can absorb a few leftovers, including:
The large intestine is, well, larger than the small intestine, at least in diameter. However, it’s much shorter,
only about 5-7 feet long (1.5-2 meters).
Large intestine anatomy and function
•
water
•
salts such as sodium and potassium
•
vitamin K
•
the cecum
•
acids (e.g., acetate, butyrate, and propionate)
•
the ascending portion
•
gases (e.g., hydrogen and carbon dioxide. Note:
•
the transverse portion
You might have heard of a hydrogen breath test for
•
the descending portion
•
the sigmoid portion
testine when someone isn’t properly breaking down
•
the rectum
food. This hydrogen can then enter the bloodstream,
•
the anus
someone with a suspected digestive disorder. An
overproduction of hydrogen can occur in the large in-
where it travels to the lungs and is exhaled).
See Figure 2.7: Principal absorption sites for nutrients for
more on where nutrients are absorbed.
Nutrition: The Complete Guide
The large intestine is subdivided into several parts:
The sigmoid portion of the colon is shaped like an “S”
that bends toward the left. Thus, a person getting an
Through the GI Tract | 63
Esophagus
Fundus
Body
Stomach
Minerals
Antrum
Bile
Vitamins
A&D
Pancreatic
enzymes
Water-soluble
vitamins
Duodenum
Jejunum
Vitamin
B12
Fatty acides, monoand diglycerides
Bile salts
Amino acids and
simple peptides
Disaccharides
Monosaccharides
Water and sodium
Pylorus
Ileocecal valve
Ileum
Cecum
Ascending colon
Water, sodium,
potassium, vitamin K
Figure 2.7 Principal absorption sites for nutrients. For nutrients to reach cells, they must cross the gastrointestinal-body barrier.
This barrier has a vast surface area to assist with nutrient absorption. Nutrients are absorbed at various sections along the GI tract.
enema will be turned on their left side, to let gravity
help the flow of enema fluid.
Different species of animals will have differently sized
and shaped colons. These differences can tell us about
the animals’ diet, as well as the specific jobs of each
portion of the GI tract.
•
Meat eaters (such as dogs or cats) usually have a
relatively longer small intestines and relatively shorter
large intestine.
•
Plant eaters (such as horses or cows) have a relatively
shorter small intestine and relatively longer large
intestine. Rabbits, for instance, have a very large cecum that branches off from the ileum, almost like the
letter “Y.” This intestinal structure lets plant eaters (or
at least, their GI bacteria) spend more time digesting
Humans are somewhere in the middle, signaling that at
least in evolutionary terms, we are omnivores — able to
eat and digest a wide range of foods.
Understanding how colon size relates to diet is important because it helps us appreciate the role that GI bacteria play in digestion.
The role of bacteria
The large intestine contains many diverse species of bacteria, making this organ the most metabolically active in
the body.
Just as bacteria can ferment sugars and starches in
cabbage or milk to create sauerkraut or yogurt, intestinal bacteria ferment dietary carbohydrates such as fiber,
plants’ fibrous material.
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oligosaccharide: Saccharide
composed of a small number of
monosaccharides
oligosaccharides, and sugars (such as lactose and sugar alcohols) that our small
intestine can’t digest and absorb on their own. This fermentation process turns
these carbohydrates into beneficial short-chain fatty acids, producing strong-scented gases in the process. Bacteria can also ferment other things, such as enzymes,
dead cells, bacterial cells, and the collagen and elastin found in foods.
Along with simple fermentation of undigested nutrients, a healthy balance of
these bacteria may help to:
•
prevent harmful bacteria and yeast from colonizing the gut;
•
remove carcinogens and boost the immune system;
•
prevent allergy;
•
regulate inflammation;
•
regulate our moods and nervous system function;
•
regulate our hormonal responses;
•
regulate our level of body fat; and
•
prevent inflammatory bowel disease.
As you can see, our GI microbes have lots of important and wide-ranging jobs.
prebiotic: Compound that is not
digested but rather fermented by
microflora and stimulates growth
of healthy bacteria in the GI tract
probiotics: Live microorganisms
that help to restore beneficial
bacteria in the GI tract
Many things can disrupt this healthy bacterial balance, such as taking antibiotics.
In this case, some clients may benefit from supplementing with (or eating) prebiotics and probiotics.
•
Prebiotics give bacteria stuff to eat, such as dietary fiber.
•
Probiotics are foods (such as sauerkraut, yogurt, or kimchi) that are fermented
and thus colonized with bacteria, or supplements containing bacteria (and
sometimes friendly yeasts).
Why do farts smell?
As part of their natural metabolic activities, bacteria produce several gases,
including methane and hydrogen sulfide (H2S). These gases are what give farts
their distinctive smell.
gastrotransmitter: Gases
which act as neurally released
transmitters
adipocyte: Fat cell
Although it seems like a pointlessly stinky waste product, hydrogen sulfide is
actually an important gastrotransmitter, or signaling molecule within the GI
tract. H2S helps regulate processes like GI motility and inflammation, and may
keep our epithelial cells healthy. It may even play a role in regulating adipocyte
(fat cell) function.
As with all things biological, balance is important. If a person is over-producing
H2S, it may be a symptom of an underlying health problem, disrupted colonic
bacterial flora, or trouble digesting particular foods.
Clients who have IBS (irritable bowel syndrome), bloating, flatulence,
or room-clearing gas can do a hydrogen breath test to look for problems like:
Nutrition: The Complete Guide
•
difficulty absorbing particular sugars, such as fructose or lactose;
•
difficulty absorbing sugar alcohols, such as sorbitol or mannitol;
•
intestinal bacterial overgrowth or imbalance;
•
poor gastric motility; and / or
•
production of H2S and methane gases.
Through the GI Tract | 65
Transit and excretion
Once food passes through most of the large intestine, it
compacts into feces and moves through the rectum to be
eliminated through the anus.
In case you’ve ever wondered what your poop is made of:
•
About 1/3 is dead bacteria.
•
About 1/3 to 1/2 is inorganic material (e.g., calcium
phosphate and iron phosphate) and fats / cholesterol.
•
The rest is made up of protein, sloughed-off cells, cellulose (plant fiber), digestive juices and bile pigments
(which give feces its color).
How fast food moves through our body depends on
many things, such as stress, how much we eat, what we
eat, and how active we are.
A high-fiber diet moves things faster. Physical activity
does too. Stress usually slows things down, although some
folks find that stress has the opposite effect — they might
have nausea, vomiting, or a quick run to the bathroom.
Do you need an appendix?
You’ll find the appendix in the cecum, the portion of the
large intestine just after the small intestine ends.
The appendix is shaped like a little worm, giving it the
name “vermiform”, from the Latin vermis, or worm.
Scientists used to think the appendix was vestigial, or an
evolutionary holdover with no purpose now — like our
tailbone that no longer carries a tail.
However, we are now learning much more about the GI
tract’s role in immunity. And it seems that the appendix
still has a job to do.
Specific tissues in the gut — known as gut-associated
lymphoid tissues, or GALT — are part of our immune system. In fact, the GI tract has the most lymphoid tissue of
anywhere in the body! These tissues store, release, and
regulate immune cells and cell signals.
The appendix may be a reserve tank of friendly gut
bacteria. Research shows that people who’ve had their
appendix removed are more likely to have inflammatory
bowel conditions or get GI tract infections, such as Clostridium difficile.
Some say that health begins in the gut… and they may
be right.
Controlling the digestive
process
Earlier in this unit, we started to look at how the brain
and nervous system are involved in digestion. Let’s
look more closely at that now, along with the role of the
endocrine system.
The endocrine system
The endocrine system is a chemical messaging system that
identifies changes in the body and sends out messengers
(called hormones) to tell the body how to respond. Several
important hormones do this in the GI tract.
Ghrelin
This hormone is found in many places: It’s released by
cells of the stomach, pancreas, placenta, kidney, pituitary
and hypothalamus.
Ghrelin is a hunger hormone that acts directly on the
brain.
•
It’s released when food and energy intake is chronically low (for example, on a restrictive diet) or when
fasting.
•
After meals, ghrelin goes down.
Gastrin
When food enters through the lower esophageal sphincter into the stomach, it triggers gastrin release from G
cells in the stomach and small intestine.
Gastrin starts the digestion process by helping to
signal the release of hydrochloric acid and pepsinogen
(a substance that helps digest peptides, or proteins)
in the stomach. This has several important functions,
including:
•
increasing stomach peristalsis;
•
keeping the lower esophageal sphincter closed;
•
causing gallbladder contractions; and
•
promoting the release of bicarbonate from the
pancreas.
Foods high in protein seem to stimulate the most gastrin
release.
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Secretin
When stomach acids reach the small intestine, they
trigger cells known as S cells to release the hormone
secretin. Secretin tells the pancreas and bile ducts to
produce pancreatic fluid high in bicarbonate to neutralize the acids.
Secretin also inhibits gastrin release (to slow down
the stomach related processes, which should now be
complete) and enhances the effects of another hormone,
cholecystokinin (CCK).
Cholecystokinin (CCK)
When partially digested proteins and fats enter the small
intestine, mucosal epithelial cells in the duodenum
secrete the hormone CCK.
CCK tells the pancreas that the small intestine is ready
for pancreatic enzymes to help out with digestion. Like
secretin, CCK also inhibits gastrin (again, to slow down
the stomach and its acid production). CCK also stimulates gallbladder contraction so that bile is forced into
the small intestine along with the pancreatic enzymes, to
help with emulsification.
CCK is a satiety hormone: It indirectly tells your brain
that you’re full and should wait longer to eat again.
Gastric inhibitory polypeptide (GIP)
Epithelial cells of the small intestine secrete GIP while
CCK is doing its work. GIP enhances insulin release,
preparing the body for the glucose that’s about to appear
in the blood with further digestion and absorption.
As the name suggests, GIP inhibits gastric secretions
and motility since these processes should no longer be
needed — at least until the next meal time.
Glucagon-like peptide 1 (GLP-1)
GLP-1, like GIP, can enhance insulin release and slow
gastric emptying.
When your small intestine detects carbohydrates, it
helps tell your pancreas to respond with insulin. This
intestinal action of GLP-1 is why you get more insulin
in response to eating glucose than to injecting it directly
into your veins.
Nutrition: The Complete Guide
Pharmaceutical companies now sell analogues of GLP-1,
which have made a big impact on diabetes treatment.
Glucagon-like peptide 2 (GLP-2)
This form of GLP increases nutrient uptake in the GI
tract. It’s not clear how or whether it affects appetite.
Motilin
When bicarbonate is dumped into the small intestine to
create a less acidic / more alkaline environment, the cells
of the small intestine also release the hormone motilin.
While secretin and CCK are responsible for slowing
down stomach-related digestive functions and speeding
up intestinal digestion, motilin promotes smooth muscle
contractions of the GI tract. This moves chyme along
through the intestines and breaks it up further through
the process called segmentation.
Motilin is also released at regular intervals between
meals. This is one of the reasons we may notice a “growling stomach” when we’re hungry.
Somatostatin
Somatostatin is a hormone secreted by the stomach,
intestine and pancreas. In the stomach it suppresses the
release of the hormones discussed above. Thus somatostatin slows gastric emptying, reduces smooth muscle
contractions, reduces blood flow, and reduces enzyme
release.
Between meals, somatostatin reduces digestive activity.
Peptide YY (PYY3-36)
This hormone is released in the hours following a meal.
It directly signals the brain to suppress appetite and
slows down stomach motility and pancreatic enzyme
secretion, while increasing water and electrolyte absorption in the colon.
These are both important between meals, as food should
now be arriving in the large intestine. Meals high in
protein cause PYY3-36 to go up the most. For your clients,
this means that getting enough protein will help them
feel full longer.
Through the GI Tract | 67
Pancreatic polypeptide
Released after meals by the pancreas (and in small
amounts by the colon). It is secreted in proportion to calorie intake. The more released, the more it will suppress
appetite. It also reduces gastric emptying.
Oxyntomodulin
Leptin can also help to regulate GI organs such as the
liver or ß-cells of the pancreas.
Like many hormones, leptin has a diurnal 24 hour
pattern, peaking between midnight and 4:00 AM and
bottoming out at around noon. (So when you get the
mid-afternoon munchies, blame your leptin.)
The pancreas releases oxyntomodulin after meals in
proportion to calorie intake, together with GLP-1. The
more oxyntomodulin released, the more it will suppress appetite.
Amylin
Bombesin
Insulin
Bombesin peptides have wide-ranging effects in the GI
tract, including stimulating gastric motility and helping to regulate food intake, as well as the secretion and
release of gastric neurotransmitters.
We mention insulin here because its influence goes
far beyond glucose disposal. Insulin is released from
the pancreas and suppresses appetite by acting on the
brain. This satiety effect is one of the lesser-appreciated
roles of insulin.
Obestatin
Produced by the stomach and small intestines, obestatin
may suppress appetite and reduce gastric emptying.
Leptin
Although it works throughout the body, leptin is secreted mainly by fat cells. In general, the more fat we have,
the more leptin we usually have. Thus, one of leptin’s
main jobs seems to be as an energy sensor and regulator
of energy balance in the body. It also helps control appetite by acting directly on the brain.
•
When we have a lot of body fat or energy coming in,
leptin is usually high. Because they normally signal
that we’re well fed, insulin and blood glucose can
stimulate leptin production. When leptin is high,
we’re not hungry.
•
When we don’t have a lot of body fat or energy coming in, leptin is usually low. When leptin goes down,
we get hungry. Leptin can also be suppressed by SNS
activity, catecholamines, and free fatty acids. This is
one reason why stress and / or restrictive dieting can
make many people ravenously hungry.
Leptin plays many other roles as well, such as in bone
metabolism or the regulation of other hormones. For
instance, leptin levels are low in women with hypothalamic amenorrhea, in which sex hormone production
goes down and women stop normal menstrual cycles.
Released from the pancreas along with insulin after
eating, amylin suppresses appetite by directly acting on
the brain.
The Nervous System
As we’ve seen, the nervous system also regulates digestion
along with the endocrine system through nerve impulses
and neurotransmitters (hormone-like chemicals).
Indeed, the nervous system is the master controller
of the entire process. Every function; every secretion;
and every chew, squish and squeeze is governed by the
all-seeing, all-knowing nervous system.
To coordinate this large operation, the nervous system
uses many branches.
Central nervous system (CNS)
The central nervous system (i.e., the brain and spinal
cord), controls energy balance, appetite and food-seeking behavior, and our response to sensory input and
food cues (such as the smell of food). It also stores ideas,
thoughts, beliefs, and memories about food.
Peripheral nervous system (PNS)
The peripheral nervous system of our body, limbs, and
skeletal muscle is also involved in eating, as it helps us
move towards food, grab it, put it in our mouth and
chew it. Indeed, some of the very first movements we
make after birth are grasping and sucking.
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Sensory part of PNS
SNS
Motor part of PNS
Somatic and special sensory
receptors and neurons
ANS
Autonomic sensory
receptors and neurons
ENS
Sensory receptors and
neurons in GI tract and
enteric plexuses
CNS:
brain and
spinal cord
Acts on:
Somatic motor neurons
(voluntary)
Skeletal muscle
Autonomic motor
neurons (involuntary):
sympathetic and
parasympathetic
divisions
Smooth muscle,
cardiac muscle
and glands
Enteric motor neurons
(involuntary) in enteric
plexuses
Smooth muscle,
glands, and endocrine
cells of GI tract
Figure 2.8 Signaling in different branches of the nervous system
Autonomic nervous system (ANS)
As we’ve seen, the ANS is what controls our internal organs and involuntary
functions like breathing, heart rate, and of course, digestion. Again, the ANS has
two branches:
•
The sympathetic nervous system (SNS), our “fight-flight” system
•
The parasympathetic nervous system (PNS), our “rest-digest” system (sometimes also known as the “feed and breed” system).
Enteric nervous system (ENS)
The digestive system has its own, localized nervous system. This system is referred to as the enteric nervous system and can be thought of as a second brain
located in your gut.
There’s two-way traffic between the CNS and ENS, with much of it going “back
upstairs.” In other words, the ENS gives important signals to the CNS about
what is going on, including our physiological emotional state. “Gut feelings” are
a real thing.
Neurotransmitters
neurotransmitter: Substance
that transmits nerve impulses
across a synapse
vasodilation: Widening of blood
vessels
Nutrition: The Complete Guide
While each nervous system has its own main jobs, it uses the same types of structures (e.g., neurons) and signaling chemicals (e.g., neurotransmitters). Thus, all
neurotransmitters found in the gut are found in the brain, and vice versa. However, neurotransmitters often have different jobs depending on where they are.
Through the GI Tract | 69
Gamma aminobutyric acid (GABA)
GABA is mainly an inhibitory neurotransmitter — it
acts as a “downer” on the CNS. However, GABA has the
opposite effect on many other tissues of the body, and
can act as an excitatory neurotransmitter, or stimulant.
In the ENS, GABA can either excite or inhibit, depending on which cellular receptors it binds to. However,
GABA mainly stimulates gastrointestinal motility and
gastrointestinal mucus production.
GABA’s inhibitory role in the brain but excitatory role in
the gut makes sense: Digestion happens when we’re calm
and restful.
Norepinephrine
This catecholamine, one of our “fight or flight” hormones, shuts down digestion, which makes sense during
stressful situations: We need immediate, decisive, or
aggressive action more than nutrient absorption.
Unfortunately, our body can’t tell the difference between an actual threat and something like a traffic jam,
upcoming deadline or argument with a loved one. Acute
or chronic stress of any kind — real or imaginary — can
shut the GI system down.
Acetylcholine
Although acetylcholine tells muscles to contract, it’s
actually part of the parasympathetic action in the gut,
allowing “rest and digest” by stimulating smooth muscle contractions (i.e., peristalsis) that help move food
through the GI tract.
It also stimulates the release of many of the hormones
discussed earlier, dilates blood vessels, and increases
intestinal secretions.
This “rest and digest” role opposes the “fight or flight”
actions of norepinephrine.
Neurotensin
As dietary fat reaches the ileum, the last section of the
small intestine, N cells in the intestinal walls release
neurotensin. Neurotensin relaxes the lower esophageal
sphincter, blocks the release of stomach acid and pepsin,
and regulates gastrointestinal contraction and relaxation.
This makes sense, as we don’t need our esophagus or
stomach to be working by the time a meal is making its
way into the large intestine.
Neuropeptide Y (NPY)
NPY goes up when body fat is low or food is scarce.
In the brain, NPY tells us to eat and stop wasting energy by
moving around. It also works with leptin and corticotropic
releasing hormone (CRH) to regulate metabolism and body
composition.
In the gut, NPY slows gastric emptying and transit time,
which makes sense: If our body thinks we’re hungry or
too lean, it’ll want us to get the most nutrition possible
from our food.
Serotonin
Serotonin is one of our natural antidepressants and
mood regulators. It also controls other basic functions
like sleep, appetite, and body temperature.
Although we often think of serotonin as a brain hormone, about 90% of our body’s serotonin is used in the
GI tract and made by enterochromaffin cells in the small
intestine. Here, serotonin helps with smooth muscle
contractions and gut secretions.
After we eat, serotonin goes up. This is why many people
feel more relaxed and calm after eating.
Too much serotonin can cause nausea, which is why
antidepressant drugs like Prozac or party drugs like
MDMA (Ecstasy) can sometimes lead to diarrhea and
nausea: They cause serotonin to go up in the brain (to
make us feel happier) but also in the gut (where they can
cause serotonin excess).
Nitric oxide and Substance P
Both of these substances help improve blood flow to the
gut through vasodilation. This circulation helps transport and absorb nutrients.
Vasoactive intestinal peptide (VIP)
VIP relates to the hormone secretin and has many important jobs in digestion.
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It inhibits gastrin release and acid secretion while stimulating bicarbonate secretion from the pancreas and pepsinogen in the stomach; smooth muscle relaxation and vasodilation; and the secretion of water and electrolytes into the small
intestine (which will be re-absorbed later in the digestive process).
Most of these slow down stomach activity while stimulating intestinal activity.
A complex process
While the list of hormones and other cell signaling molecules above might seem
daunting, it’s only a handful of the chemicals involved in regulating the physiological processes of energy balance, appetite, hunger, fullness, gastric motility,
and gastric secretions.
Other hormones and cell signals help regulate psychological processes and behavior that are related to food and eating, such as seeking rewards or soothing
emotions.
We are learning about new chemicals all the time, as well as how those chemicals
and their effects vary from person to person.
Moreover, hormones and cell signaling molecules aren’t the only things that tell us
what, when, how, and how much to eat. Our eating habits are also shaped by who’s
around us, what’s important to us, what’s available, what we think tastes good, and
potentially dozens of other factors. We’ll look at this more in upcoming chapters.
How do we absorb our food?
Somehow, nutrients must get through the lining of the gastrointestinal tract and
into the rest of our body. This process of absorption happens in many ways.
simple diffusion: Spontaneous
movement of particles from an
area of high concentration to an
area of low concentration
While there are three major processes (simple diffusion, facilitated diffusion,
and active transport), there are hundreds of enzymes and carrier proteins present in the small intestine, each designed to help absorb particular nutrients.
facilitated diffusion:
Transport that requires a carrier
molecule; occurs when diffusion
of a substance on its own is not
possible
These three different systems enable the body to absorb many things in a controlled way. The most critical nutrients are easily taken in; unwanted substances
are kept out.
active transport: Movement
of particles from an area of low
concentration to an area of high
concentration; requires energy
and enzymes
concentration gradient:
Difference in the concentration
of solutes in a solution between
two areas
Simple diffusion
Simple diffusion doesn’t need a carrier protein or energy. Compounds just move
from an area of higher concentration to an area of lower concentration (known
as a concentration gradient).
Water is often transported this way.
Facilitated diffusion
Facilitated diffusion is like simple diffusion, in that substances move from higher
to lower concentrations, and it doesn’t require energy. However, facilitated diffusion uses a carrier protein to do this. Thus, how fast this happens (or whether it
happens at all) depends on how many carriers are available.
Nutrition: The Complete Guide
Through the GI Tract | 71
Fructose absorption, which requires sugar transport proteins, is an example of
this type of transport.
Active transport
Active transport relies on a carrier protein. This form of transport also uses energy,
because it moves against the concentration gradient (moving from low to high),
like swimming upstream. Thus the rate of absorption can be limited by whether
both carriers and energy are available.
Examples of nutrients absorbed this way include glucose and galactose.
Table 2.1
The three major processes that allow for controlled cellular transport
Simple
diffusion
Facilitated
diffusion
Active
transport
Needs energy
No
No
Yes
Needs a carrier protein
No
Yes
Yes
Concentration
gradient
With
(high to low)
With
(high to low)
Against
(low to high)
Rate of absorption
limited by
Difference in
concentrations
Available carrier
proteins
Available carrier
proteins
Available energy
When absorption goes wrong
The digestive system is a complex yet well-coordinated system. However, problems can sometimes happen.
Ulcers
Ulceration of the gut can develop when alkaline mucus production slows down,
when tight cellular junctions are pulled apart, and when cell turnover rate is
reduced. You may be familiar with peptic ulcers, which we discussed earlier.
Duodenal ulcers can form when the pancreas and duodenal cells of the small
intestine can’t properly buffer the acidic chyme coming from the stomach.
Vomiting
Otherwise known as emesis or reverse peristalsis, vomiting can result when
neural signals are sent to the vomiting centers of the brain. This can have many
causes, such as:
•
excess serotonin
•
inflammation
•
microorganism irritation of the intestinal wall
•
stress or anxiety
•
disrupting the vestibular (balance) system
tight cellular junctions:
Intercellular junctions between
epithelial cells in which outer
layers of the cell membranes
fuse, reducing the ability of larger
molecules to pass between cells
peptic ulcer: Found on the wall
of the duodenum or stomach, this
ulcer results when gastric juices
and H. pylori combine
emesis: Vomiting
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Epithelial cell of villus
Glucose
Galactose
Secondary active
transport with Na+
Fructose
Facilitated diffusion
Amino acids
Secondary active
transport with Na+
Capillary
Monosaccharides
Facilitated
diffusion
Amino acids
Diffusion
Diffusion
Peptides
Secondary active
transport with H+
Short-chain
fatty acids
Simple diffusion
Short chain FA
Micelle
Simple diffusion
Triglycerides in
chylomicrons
Lacteal
Figure 2.9 Absorption in the small intestine. Adapted from: http://www.sharinginhealth.ca/biology/small_intestine.htm
Clients with some forms of disordered eating may also
deliberately make themselves vomit.
Gallstones
Gallstones are solid deposits of cholesterol or calcium
salts that form in the gallbladder or nearby bile ducts.
Inflammatory bowel diseases
Inflammatory bowel diseases, such as ulcerative colitis
and Crohn’s disease, cause chronic inflammation, especially in the intestines. These are characterized by a few
features:
•
There are few symptoms; however, in severe cases, gallbladder attacks can cause nausea and a steady ache in
the upper abdomen and between the shoulder blades.
Gallstones are formed when too much cholesterol or too
much bilirubin is produced relative to bile production.
If either of these situations occurs, the bile becomes idle
in the gallbladder and crystallizes into a stone. Since
this may prevent bile formation, fat is not digested or
absorbed properly, which leads to fatty stools.
Gallstones can also be a symptom of yo-yo dieting. Eating a lot of fat followed by eating very little fat can cause
idle bile in the gallbladder, since at least 10 g of dietary
fat are needed to stimulate bile release.
Nutrition: The Complete Guide
Inflammation causes a lot of water and salt to be secreted into the intestines — too much for the colon to
completely re-absorb. This results in chronic diarrhea,
intestinal cramping, and other unpleasant symptoms.
•
Inflamed digestive tract tissues bleed and ulcerate.
The quality of the intestinal wall degrades.
•
Enzymes are less active and we absorb fewer nutrients. This can result in malnutrition and weight loss,
even if we are eating enough.
Diarrhea
Diarrhea usually occurs when the epithelium of the
intestines becomes infected and / or inflamed. This can
Through the GI Tract | 73
lead to a lot of water and ions moving into the intestines,
or not being well absorbed.
else, because they can travel in the bloodstream. This
makes many food allergies hard to track down.
Diverticulosis and diverticulitis
Any food can cause an allergic response. So far, more
than 170 foods have been reportedly linked to IgE-mediated reactions. The most common foods involved in an
allergic reaction include eggs, fish, shellfish, milk, peanuts, tree nuts, soy, and wheat. These eight foods account
for 90% of all food allergies. It’s also estimated that 40%
of food allergies in children disappear by age 5.
This condition, which is common as people age, occurs
when small pouches in the colon (known as diverticula)
bulge outward through weak spots in the colon wall.
This creates increased pressure and small tears in the
colon, resulting in inflammation. When bacteria become trapped in a outpouching, it can lead to infection
and diverticulitis.
Since the outpouchings often occur in the sigmoid colon,
people may feel pain in the lower left of the abdomen.
People may also notice other symptoms such as vomiting, bloating, bleeding, and frequent urination.
Food allergies
Our immune system makes antibodies to help fight
viruses and bacteria. Antibodies work by binding to
invading pathogens and provoking the body’s immune
system to attack them.
Allergies happen when our body makes antibodies to
substances that would normally be harmless. The main
antibody in most food allergy conditions is called immunoglobulin E (IgE). IgE antibodies are produced in
response to an innocent food molecule.
Millions of mast cells line our skin, nose, intestines, and
bronchial tubes, and they’re covered in IgE antibodies.
Think of the mast cell like one of those loud, obnoxious
car alarms. It doesn’t always go off due to a true car thief
(car thief = virus, bacteria, and / or parasite). It may be
triggered by a strong wind or a passing jogger (the innocent food molecule).
When chemical messengers such as histamine are
released from mast cells, the body generates a powerful
inflammatory reaction. Blood vessels dilate, blood pressure drops, and the mouth, throat, and airway swells.
This combination of symptoms, when powerful enough,
is referred to as anaphylaxis.
A common example of this is a peanut or shellfish
allergy. If someone eats one of these foods and has a true
allergy, they could die without medical assistance. It’s a
severe condition with severe consequences.
Food allergies may also cause symptoms somewhere
Food intolerances
Many people say they are “allergic” to foods when they
are actually intolerant.
This can often happen when we can’t properly digest
particular foods or their components. For instance:
•
If we don’t have the enzyme lactase, we won’t be
able to digest lactose, the main sugar in milk.
•
If we don’t digest complex carbohydrates or sugar
alcohols well, we’ll often have trouble with particular
fruits or vegetables.
Food intolerances are uniquely individual, and have a
range of symptoms.
Some symptoms are obvious (such as an upset stomach or bloating) and appear fairly soon after eating the
offending food.
Other symptoms don’t affect the GI tract, and may appear later, such as hives or rashes, headaches, mouth ulcers, stuffy nose, mucus buildup in the lungs, and more.
Keep in mind that recommendations for food intolerances and allergies fall under medical nutrition
therapy. So, unless you are a health professional with
appropriate training and credentialing in that area,
you’d want to refer out.
However, as a nutrition coach, you can help your client
become aware of potential patterns. (More on this in a
moment.)
Leaky gut syndrome
In leaky gut syndrome, the intestinal lining becomes extremely permeable, which means that it may allow large
molecules and toxins to enter the body undigested.
This can happen when the intestinal lining becomes
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Healthy intestinal lining
‘brush-like’ absorption surface of cells lining the small intestine
cells fit tightly together
blood capillaries
Leaky gut
damaged absorption surface of cells lining the intestine
gaps between cells are wider - partially digested food particle can slip through
blood capillaries
Figure 2.10 Leaky gut syndrome
inflamed or damaged, which disrupts the normal function of the villi and microvilli.
“Spaces” develop between the cell walls, and unwanted
macromolecules, antigens, and toxins sneak in. As these
molecules invade the GI wall more frequently, more
damage occurs. Carrier proteins and enzymes may also
become damaged, which can cause nutrient deficiency.
The body may also treat these molecules as foreign invaders and trigger immune defenses. The body aggressively rejects otherwise healthy food, and potentially
damages its own cells.
Leaky gut syndrome can cause GI distress (bloating, flatulence, and abdominal discomfort), immune reactions
(including hives, mucus buildup in the lungs and nasal
passages), and nutrient deficiency. Indeed, some of the
symptoms of leaky gut syndrome are similar to those of
food intolerances.
See Figure 2.10.
Nutrition: The Complete Guide
Working with GI health problems
You don’t have to be a gastroenterologist to work with
clients who are dealing with these GI complaints. (Although you may want to work with their gastroenterologist if their problem is severe, or doesn’t respond to basic
good nutrition.)
Following the fundamentals of fitness nutrition will
often reduce or alleviate these symptoms of GI distress.
Gather information about your client. What is the
problem like? When and how does it happen? What are
the specific symptoms? We’ll cover assessment in more
detail in Section 2.
Monitor and track data. Look for patterns. Having
your client keep a journal of their food and symptoms
can help you see patterns — such as an upset stomach on
a stressful day or after eating a particular food.
Teach clients to eat slowly and mindfully. It’s amazing
Through the GI Tract | 75
Case study
As we’ve seen in this unit, it becomes much easier to
understand the nutrition and exercise-related problems
your clients are experiencing when you understand how
the digestive system works. Of course, many problems
are well beyond the scope of your practice.
and absorbing fat efficiently, the answer to his problem
became clearer: There was probably something wrong
with his gallbladder.
However, sometimes your knowledge can help in the
diagnostic process. This was the case with an Olympic
triathlete.
The most likely causes were either gallstones blocking
his bile duct or biliary dyskinesia, a condition in which
there is gallbladder pain and improper bile release. This
blockage could have caused the gall bladder spasm that
was prompted by intense exercise.
For months this athlete had complained of pain and
cramping in his right upper abdominal region with intense
exercise. MRI, CT, and standard blood chemistry revealed
nothing, which ruled out most forms of muscle damage
and / or severe organ damage.
As we aren’t medical doctors and have no training
in medical diagnosis, we found him a specialist, who
confirmed the gallbladder assessment. Together with
this doctor, we treated this issue first by changing the
athlete’s diet.
This led the client’s doctors to think it was a nutritional
condition and might be related to either a nutritional
deficiency that caused muscle cramps, or a reaction to
a nutritional supplement this athlete was taking. His
doctor sent the athlete to us to talk about his diet.
After doing a full diet analysis, working with the client
for about six weeks to improve his diet, and removing
all nutritional supplements, we were disappointed to
see that the pain continued and exercise was still very
difficult. Indeed, the only way he was able to continue
to compete was to freeze the area with local anesthetics
prior to racing — not an ideal solution at all!
At this point we’d need some additional tests, so we
did a host of standard gastrointestinal tests, looking for
digestion and absorption problems.
Interestingly, all the test results came back within the
normal range except for one: his fecal fat content (the
amount of fat measured in his feces over the course of a
day) was high — indeed, at 21 g, it was three times the
normal value of 7 g. This gave us another important clue.
•
We lowered his total dietary fat intake.
•
However, we added medium chain fats such as
MCT oils (medium chain triglycerides) and coconut oils. These oils are more easily digested and
absorbed.
•
We also added fish oil to his diet to prevent essential fatty acid deficiency.
•
We increased his intake of protein and carbohydrates.
•
Finally, we included a high-quality lipase supplement to help with the digestion of the dietary fats
that remained on his plan.
While these changes helped with the fat absorption
part, the athlete did need a medical procedure to improve his gallbladder function.
Although we’re not medical doctors, nor do we pretend
to be, our fundamental knowledge of digestive function
helped this athlete get back to competition.
After considering the organs located in the right upper
quadrant of the abdominal region (namely the gallbladder) and considering the fact that he was not digesting
We hope it also provides a real-world example of how
learning the fundamentals, even when you think you
might never use them again, can be very important in
your practice.
how many cases of mild GI distress respond to careful,
conscious eating.
Conversely, foods higher in soluble fiber may help slow
down diarrhea.
Help clients move towards less processed, whole-food
diets. Many GI problems go along with eating a lot of
processed foods that may be higher in industrial fats or
sugar, and low in fiber.
Try to correct nutrient or fluid deficiencies where possible. If diarrhea or vomiting has left your client depleted,
you can try supplementing with an electrolyte solution.
Avoid a one-size-fits all approach. Some IBD clients may
find that higher-fiber foods irritate them during flare-ups.
If appropriate, encourage regular physical activity. Exercise is usually a good habit for gastrointestinal health,
as it helps move things along.
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Nourish the microbiome. Clients may benefit from
adding prebiotics and probiotics to their diet. However,
again, using targeted supplementation to treat a specific
disease is outside of your scope of practice.
Keep the big picture in mind. Look at all aspects of
your clients’ lives as much as possible. Do they smoke or
drink? Are they stressed out? On any medications? Have
they traveled recently? And so on.
Let’s go back to our three transport systems:
•
simple diffusion
•
facilitated diffusion
•
active transport
Regardless of the differences between them, these systems need a variety of membrane bound proteins and
transport receptors to:
Nutrient delivery
•
After nutrients are processed by the liver and enter systemic circulation, they need to be delivered to the cells of
our body.
•
bind to the most appropriate nutrients; and then
•
start moving them into the cells.
Most nutrients dissolve in the blood and are transported
by floating along in general circulation. Lipids, however,
need lipoprotein carriers: proteins that can bind to the
fat portion while still floating in the water-soluble blood,
much like little passengers on a whitewater raft.
Often when people talk about their “cholesterol”, they
really mean lipoproteins such as HDL, IDL, LDL, VLDL,
and chylomicrons.
recognize specific nutrients as they approach our cell
membrane structures;
The most important destinations for nutrients are our
muscle tissues, our adipose (fat) tissues, our brain, and
our liver.
We’ll look more at where nutrients go and what they do
in upcoming chapters.
We’ll also explore how these nutrients can provide
energy for everything from daily function to high-level
athletic performance.
Summary
While it’s interesting and important for nutrition coaches to learn about specific nutrients, we must remember
that people eat food and meals within a particular social,
cultural, and environmental context.
(from the intestines / pancreas) combine with rhythmic
contractions to break our foodstuffs down into smaller
pieces while breaking complex molecules into simple
molecules.
Our physiological response to food is determined by the
nutrients in that food, but also by many other factors such
as our genetic makeup, our activity levels, our microbiome, our age, potential food intolerances or allergies.
Digestion is centrally and locally controlled by the nervous and endocrine systems.
The GI tract is a complex yet well-coordinated system
that recognizes, separates, and selectively absorbs and
uses nutrients while protecting us from potentially
harmful toxins and pathogens.
The digestive system starts at the mouth and ends at the
anus. Throughout this 25 foot muscular canal, acidic
secretions (from the stomach) and alkaline secretions
Nutrition: The Complete Guide
After digestion occurs, nutrients must make their way
into cells to be useful. For nutrients to be absorbed into
the body, they must cross the gastrointestinal-body barrier through one of three mechanisms: passive diffusion,
facilitated diffusion, or active transport.
Many diseases, disorders, and intolerances can interfere
with these processes. Thus, we need a healthy gastrointestinal tract for optimal digestion, absorption, and
nutrient delivery.
UNIT 3
Energy Transformation and Metabolism
78 | Unit 3
Unit Outline
1.
Energy intake, storage, and transfer
3.
Case study
2.
How are nutrients metabolized?
4.
Summary
Objectives
The sum of all chemical reactions in the body is known as
By the end of the unit, you should have a basic understand-
metabolism. Most of these reactions turn the food we eat
ing of how the body stores and uses protein, carbohydrate,
into energy that our body can use.
and fat energy to both stay alive and perform when we ask
it to.
In this unit you’ll learn:
•
•
how this important process happens
how the body changes food energy into the energy
we need for daily physiological tasks and activity
Energy intake, storage, and transfer
In the previous unit you learned that after nutrients are digested and absorbed, the
liver screens them and sends them into general circulation throughout the body.
Once these nutrients get into cells, our body can do many things with them,
such as:
•
oxidize them for energy;
•
use them to build the body’s components;
•
store them to use later; and / or
•
excrete them.
In this unit, we’re going to focus on the first of these: how we produce and transfer energy.
laws of thermodynamics:
Principles that govern energy
exchange, including heat
exchange and the performance
of work
energy transfer: Movement
of ATP from one compound to
another so that it can be used
Nutrition: The Complete Guide
Well, to be more accurate, we don’t really produce energy. According to the laws
of thermodynamics, energy is never really created nor destroyed — it just moves
around or gets transformed from one form to another.
Human bodies are no exception to these laws. So, instead of making energy for
metabolic function, what we’re really doing is converting energy that’s already
stored within our food.
Breaking the chemical bonds that normally hold the molecules of our food
together releases energy. This energy, in turn, fuels the processes we need to form
ATP. We call this process energy transfer.
Energy Transformation and Metabolism | 79
Thus, we eat, we digest, we absorb, we circulate, we store, we transfer energy, we
use the energy, and then we repeat.
Let’s look at this general process in more detail.
What is ATP?
ATP is the body’s “energy currency.” We need ATP for nearly every action in the
body.
•
It moves our skeletal muscles.
•
It contracts our digestive muscles.
•
It produces enzymes.
•
It carries molecules across cell membranes.
We even need it to form more ATP.
Where do we get energy from?
With all these important jobs going on all the time, we need a constant stream
of ATP. We can get this ATP from “new” nutrients (i.e., nutrients that we have
recently absorbed and passed through the liver) and from stored nutrients (i.e.,
nutrients that have been stored in the liver, in the muscle, or in the fat cells, waiting for a call to action).
We can carry some nutrients in our bloodstream to use immediately, but not
enough to keep us going for long. So, our body often needs to use stored nutrients. Indeed, most of the energy you require today is derived from nutrients that
you ate (and stored) yesterday, the day before, and the day before that.
Most of the time (including during shorter-duration exercise) our energy comes
from nutrients that have been stored in our hepatocytes (liver cells), myocytes
(muscle cells), and adipocytes (fat cells).
hepatocyte: Liver cell
The two most important “raw materials” for making ATP are:
adipocyte: Fat cell
•
myocyte: Muscle cell
triglycerides, the storage form of fatty acids, which are kept in both fat cells
and, in smaller amounts, in muscle cells; and
•
glycogen, the storage form of carbohydrate, which is kept in both muscle cells
and in liver cells.
You’ll notice that these types of fuel are stored in one form and used in another,
and that these two forms may be different from the form in which they were
eaten.
So, for instance, if we eat some beans with avocado guacamole:
•
Our digestive system breaks down the beans’ complex carbohydrates
(polysaccharides) into simple sugars (glucose) for energy, and fiber for our GI
bacteria to eat (and convert into short-chain fatty acids such as acetate, propionate, and butyrate).
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•
We break down the beans’ protein into amino acids.
•
We break down the avocado’s fat into fatty acids.
•
The glucose goes to our liver, where it’s packaged and stored as glycogen.
•
The short-chain fatty acids that our bacteria make from fiber are usually used
for energy within the colon by intestinal epithelial cells.
•
The avocado’s longer-chain fatty acids pass through the liver to be converted into
triglycerides.
•
amino acid pool: Amino acids
available for protein synthesis at
any given time in the body
The amino acids become part of the body’s amino acid pool, which the body
normally uses for building new proteins, but which can also be used for fuel
when needed.
Notice how this complete meal thus gets broken down into smaller pieces and
repackaged. By the time glycogen, amino acids, short-chain fatty acids, and
triglycerides find their way to our cells, they no longer look anything like their
original forms.
In a moment, we’ll look at how fuel gets converted from “storage format” to “active use format” (and sometimes, back again).
See Figure 3.1 for a broad overview of our metabolism.
Proteins
Carbohydrates
Fats
Fatty acid, glycerol
Amino acids
Glycogen
Glucose
6-phosphate
glycogenesis
OPO
3
Nitrogen pool
Lipogenesis
glucose
gluconeogenesis
glycogenolysis
Tissue
protein
pyruvate
lactic acid
NH3
Fatty
acid
spiral
glycolysis
N
ADP
Acetyl-CoA
CO2
ADP
ADP
H+
Urea
Urea
cycle
Electron
transport
chain
Krebs cycle
CO2
2e-
ATP
ATP
Figure 3.1 Summary of metabolism
Nutrition: The Complete Guide
ATP
O2
H2O
Energy Transformation and Metabolism | 81
How ATP makes “energy”
ATP is an adenosine molecule with three phosphate
molecules attached to it. The molecules are “glued”
together with (covalent) bonds, as are the molecules that
make up carbohydrates, fats, and proteins. Breaking
these bonds releases energy.
When we need ATP to power cellular work, we break
one adenosine-phosphate bond. This leaves us with ADP
(adenosine bonded to two phosphates) and P (a free
phosphate) floating around in the cytosol of our cells.
Although ATP is crucial, we don’t have much of it hanging around. Our body stores only about 80-100 g of ATP
— just enough for a few seconds of intense effort.
In fact, we use so much ATP per day — about 51 kg (or
about 112.5 lb) for a 68 kg (150 lb) person — that the
total weight of ATP used and regenerated would equal
about 75% of our bodyweight.
So it’s much easier for our body to make what it needs
as it goes along. When we break those adenosine-phosphate bonds, we have to regenerate ATP quickly to help
supply energy for our daily needs. That’s where energy
transfer comes in.
In this process, the free ADP and P floating around in
the cytosol re-attach, and thus regenerate the ATP that’s
been broken apart. It’s like breaking apart and re-building Lego blocks, over and over.
All life can be boiled down to this straightforward exchange of breaking and fixing chemical bonds.
Our body can make and replenish ATP in many different ways, depending on:
•
how quickly we need the energy;
•
how fast the reactions are happening;
•
what nutrients are available (carbohydrates, fats, and
/ or proteins); and
•
whether there’s enough oxygen to contribute to the
reaction.
The three main processes or systems are:
1. The ATP-PCr system
2. The glycolytic pathway
3. The oxidative phosphorylative pathway
As we explore these more below, you might get the
idea that only one energy system is active at any time.
In fact, all three systems are always running to some
extent. Our body coordinates these complex activities
elegantly and neatly.
The energy systems in action
ADP
Pi
O–
–
O–
–
O–P–O
+
As you read through the descriptions of each energy
system, imagine an example.
O–
adenine
–
O – P – O – P – O – CH2
O
O
O
ribose
Energy used
from food to
bind phosphate to ADP
Energy available
for physiological
processes
O–
–
O–
O–
adenine
O – P – O – P – O – P – O – CH2
O
O
O
ribose
ATP
Let’s say you are standing at the edge of a running track.
In this moment, you don’t need much extra ATP.
Suddenly, you burst into a sprint. The first explosion of
movement uses up your stored ATP.
After a second or two of running, you need help from
the ATP-PCr system. This will give you about 10-15
seconds’ worth of energy, enough to run that Olympic
gold medal sprint.
As you keep running, the ATP-PCr system can’t keep up,
so your body switches to the glycolytic pathway. This is a
little slower, so you can’t run quite as fast.
After about a minute or two, depending on how accustomed you are to this type of training, your glycolytic
pathway also can’t keep up. You have to switch to the
Figure 3.2 ATP turnover
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oxidative phosphorylative pathway. This is the slowest system, so you have to
drop your pace even more.
Eventually, you gear down to a shuffling jog or a walk around the track, out of
breath with your heart pounding. Your oxidative phosphorylative pathway can
keep you going for a long time. But you can’t keep up that sprint pace forever.
The differences between the systems help explain why you have to run this
way. (And why you end up huffing and puffing afterward.) Let’s explore them
further now.
The ATP-PCr system
ATP / PCr system: Composed
of ATP and phosphocreatine, this
system replenishes energy rapidly
without the use of oxygen
creatine kinase: Isoenzyme
found in muscle and brain tissue
that catalyzes the formation of ATP;
higher after tissue injury
creatine: Nitrogenous substance,
derived from arginine, glycine and
methionine, found in muscle tissue
phosphocreatine (PCr):
Compound of creatine (Cr) and
phosphoric acid (P) found in
muscle
When we start to demand more energy (for instance, when we start exercising
intensely), the ATP / PCr system is usually the first to kick in.
This system, which operates in the cytosol of cells, helps to make more ATP
from ADP and P. It uses an enzyme called creatine kinase to break the chemical
bonds between creatine (Cr) molecules and phosphate (P) molecules that are
already joined in a phosphocreatine molecule (PCr).
To help you remember what this enzyme does, remember that “-ase” usually
refers to breaking something, and “kin” comes from the ancient Greek kinein,
“to move.” Usually, a kinase breaks a phosphate from one molecule and moves it
to another.
Breaking these bonds releases creatine and phosphate molecules (as well as energy) into the cell. This helps to regenerate ATP.
This energy (as well as the new phosphate molecules that have been released in
this reaction) in turn helps to regenerate ATP. With this new ATP, our body can
supply energy to meet the new, and higher, physiological demand.
Yet this new ATP can only help out for a short time. Although we have about
six times more PCr than ATP, during times of intense energy demand, such as
sprinting, it can only help provide energy for about 10 seconds.
This is one reason supplementing creatine can help improve muscular performance: With more creatine in the muscles, more creatine (and PCr) is available
for high-intensity, short-burst muscle contractions. This means we can exert
more force (for instance, when lifting weights) and perform better in high-intensity exercise bouts.
The glycolytic pathway
After your 10-15 seconds of sprinting, your PCr stores begin to run out. The
glycolytic energy system takes over to help make ATP.
Interestingly, this glycolytic system turns on at the same time as the ATPPCr system. But it makes ATP much more slowly. So it doesn’t help out much
during the first 10 seconds of exercise.
The glycolytic system in the cytosol breaks down stored muscle glycogen, immediately available blood glucose, and the glycerol backbone from triglycerides to
help regenerate ATP. The suffix “-lysis” comes from the ancient Greek luein, or
“loosen.” So glycolysis literally means “breaking glucose.”
Nutrition: The Complete Guide
Energy Transformation and Metabolism | 83
glucose
ATP
ADP
ATP
ADP
fructose
diphosphate
PGAL
PGAL
NAD+
NAD+
NADH
NADH
ADP ADP
ATP
ADP ADP
ATP
ATP
pyruvate
ATP
pyruvate
to Krebs cycle
Figure 3.3 Summary of the ATP input and output of glycolysis
The glycolytic system is much more complex than the ATP-PCr system, using
10 enzymatically controlled chemical reactions to make ATP. It regenerates
four molecules of ATP (from ADP and P) for every molecule of glucose put
through the system. However, because the process of glycolysis “costs” two
molecules of ATP, we actually only get two ATP for every glucose molecule
that goes through the system.
Also created during glycolysis are two molecules of a chemical called pyruvate and
two molecules of a chemical called NADH. And at the point of pyruvate generation, the last step of the glycolytic pathway, we come to a biological crossroads.
When the glycolytic pathway is running quickly (for example, when we’re still
trying to run fast), we end up producing a lot of pyruvate as a byproduct. This is
a good thing: The faster glycolysis occurs, the more ATP we regenerate.
pyruvate: Salt of pyruvic acid;
the end product of glycolysis
NADH: Reduced form of NAD;
used to transfer electrons
But a fast glycolytic process also releases a lot of hydrogen ions into the cell when
it breaks chemical bonds. These hydrogen molecules can quickly fatigue the
muscle cells. So our body must “buffer” this hydrogen to keep going.
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NAD+: Co-enzyme of
dehydrogenases; plays a role in
intermediary metabolism as an
oxidizing agent or reducing agent
for metabolites
lactic acid: An organic
byproduct of anaerobic
metabolism derived from pyruvic
acid; can be used as an energy
source for cells
Through glycolysis, the natural hydrogen acceptors NAD+ and pyruvate come
to the rescue. Grabbing hydrogens as fast as they can, NAD+ becomes NADH
and pyruvate becomes the infamous lactic acid. Contrary to popular opinion,
rather than causing muscle burning, fatigue and the soreness that comes after a
workout, lactic acid buffers hydrogen ions and carries them out of our cells. In
essence, NAD+ and pyruvate let us keep exercising.
About 90 seconds after you start exercising intensely, you’ll come to another
biological crossroads.
If you keep running fast or exercising hard, the hydrogen ions being produced
will make the muscles so acidic, you’ll have to slow down again. Now another
energy transfer system has to take over. Again, this one is slower, so you’ll have
to drop your running pace or exercise intensity.
See Figure 3.3 for a summary of glycolysis.
The oxidative phosphorylative pathway
If you keep exercising but slow your pace down, oxidative phosphorylation will
come to your rescue to give you energy.
Oxidative phosphorylation is the less glamorous work horse of the energy transfer systems: It shows up late and plods along at a leisurely pace. It doesn’t give you
the spectacular “blast off the sprint blocks”, but it’ll keep you going indefinitely if
you just move slowly enough.
The oxidative phosphorylative pathway is made up of two processes:
Krebs cycle: A major metabolic
pathway that involves a series of
enzymatic reactions that convert
pyruvic acid from food to acetylCoA for energy
1. The Krebs cycle. (Is also known as the citric acid cycle and tricarboxylic acid
cycle [TCA])
electron transport chain:
Set of compounds that transfers
electrons to a donor that creates
energy
You’ll remember that during glycolysis, the body uses pyruvate to make lactic
acid to buffer hydrogen ions. This is when exercise intensity is high.
acetyl-CoA: Co-enzyme that
plays a role in intermediary
metabolism; can enter the Krebs
cycle to produce energy and be
used for fatty acid synthesis
Nutrition: The Complete Guide
2. The electron transport chain.
But if things slow down and glycolysis is slow enough to match the Krebs cycle,
the body funnels the pyruvate into the Krebs cycle instead.
This pyruvate from the breakdown of carbohydrates (via glycolysis) is then converted into a chemical called acetyl-CoA. Both fats and proteins can be broken
down to acetyl-CoA. Acetyl-CoA is the chemical entry point into the Krebs
cycle. See Figure 3.4.
You don’t need to memorize the 11 steps (or the 9 enzymes) involved in a single
rotation of the Krebs cycle, which takes place in the inner chamber of the mitochondrion. Just remember that a few things come out every turn of the wheel:
•
1 ATP molecule
•
2 carbon dioxide (CO2) molecules
•
8 hydrogen (H+) ions (NADH and FADH2)
Energy Transformation and Metabolism | 85
from glycolysis
pyruvate
NADH+
H+
+
NADH
CO2
CoA
H+
Acetyl CoA
to electron transport chain
HH++
NADH
NADH
NADH
+
CoA
CO2
CO2
+
NAD
++
NAD
NAD
Krebs Cycle
ADP
ATP
FADH2
FAD
Figure 3.4 Summary of the input and output of the Krebs cycle
Since two acetyl-CoA molecules are produced from each glucose molecule, this
means that the wheel turns twice for each glucose molecule. So, after two turns of
the wheel, you have:
•
2 ATP;
•
4 CO2; and
•
16 H+ ions.
As you can see, the Krebs cycle produces lots of hydrogen ions. Unlike those made
during glycolysis, these hydrogen ions won’t fatigue us quickly. Instead, they’re
bound to the chemicals NAD+ and FAD+ within the mitochondria. Then, they
move quickly into the next portion of the oxidative phosphorylation process: the
electron transport chain, where all of this cellular effort starts to pay off.
The NADH (NAD+ and hydrogen) and FADH2 (FAD+ and two hydrogens)
formed during the Krebs cycle carry these hydrogens through the mitochondria
and transfer their energized electrons to a set of special molecules (called cytochromes) embedded in the cristae of the inner mitochondrial membrane.
FAD+: Riboflavin-derived
hydrogen acceptor in the Krebs
cycle
FADH2: The reduced form of
FAD+
cytochrome: Protein found in
mitochondria (inner membrane)
that transports electrons
Here, these hydrogen molecules (namely, their electrons) jump between these
five cytochromes and as they jump, their energy is used for a very interesting
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cytosol
FADH2
inner chamber
H+
plex
I
V
H+
Com
ATP Synthase
NAD+
H+
H+
Complex III
Complex II
H+
NADH
H+
outer chamber
Complex I
H+
H+
H+
H+
ADP
H+
ATP
Figure 3.4 The electron transport chain.
proton: Particle with a positive
charge, usually regarded as
a hydrogen ion; when the
proton gradient shifts in the
electron transport chain, energy
conversion occurs
reactive oxygen species
(ROS): Any oxygen-containing
compound that is particularly
reactive
purpose. This energy actually pumps the hydrogen molecules (namely, their protons) from the inner chamber to the outer chamber of the mitochondria.
While this may seem like a waste of energy, since we’ve got so much ATP to
make, this pumping action has an important job. When these protons build
up in the outer chamber, they rush forcefully back into the inner chamber, like
water rushing through a dam, through a special carrier called the ATP synthase
complex. This rushing in of hydrogen protons yields a lot of energy: 32 molecules
of ATP per molecule of glucose if everything is just right. Now we’re getting
somewhere, energy-wise.
Biology is full of trade-offs, and oxidative phosphorylation is no different.
Although it’s an excellent source of slow-burn energy, it also produces reactive
oxygen species (ROS). ROS can damage cells if there are too many or if they
stay too long.
Luckily, there are trade-offs to trade-offs: Our cells have antioxidant enzymes
and vitamins to counteract ROS. We can also eat antioxidants in foods such as
colorful fruits and vegetables (although it seems that supplementing with isolated
antioxidants isn’t as useful, and may be actively harmful, perhaps because it may
interfere with our cells’ naturally balanced antioxidation process).
transamination: The transfer
of an amino group from one
molecule
to another
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Nutrition in practice
Activity and nutrition can affect how fast and how well
our energy systems work.
We can make our energy systems more efficient and
effective with regular exercise, especially if we directly
target individual systems with specific activities (such
as training the ATP-PCr system with short-distance
sprinting, or the oxidative phosphorylation system with
longer-duration, lower-intensity endurance exercise).
Now, remember our hydrogen carriers NAD+ (nicotinamide adenine dinucleotide) and FAD (flavin adenine
dinucleotide)?
So although these B vitamins don’t actually give us
energy directly, you can imagine how we might need
them to help with the transfer of energy and the regeneration of ATP throughout glycolysis, the Krebs cycle,
and the electron transport chain.
You can also imagine what might happen if we don’t get
enough. Indeed, people who are deficient in B vitamins
often report that they feel sluggish and tired.
We can thus also improve how our energy systems work
by ensuring we eat a varied diet and correcting any
nutrient or enzyme deficiencies.
These two molecules act as co-enzymes and are derived
from the vitamins B3 (niacin) and B2 (riboflavin).
How are nutrients metabolized?
Each macronutrient follows a unique path on its quest to
help replenish ATP.
Here’s a quick overview. We’ll look at each of these in
depth.
Carbohydrate metabolism pathways
1. Glycogenesis: From glucose to stored glycogen
2. Glycogenolysis: From glycogen to glucose
3. Glycolysis: From glucose to pyruvate
4. Krebs cycle and electron transport chain: Acetyl-CoA to ATP, CO2 and H2O
5. Gluconeogenesis: Non-carbohydrates to glucose
Fat metabolism pathways
1. Fat transport and lipogenesis
2. Fat mobilization and lipolysis
3. Fatty acid synthesis
4. ß-oxidation
5. Ketone formation
6. Cholesterol synthesis and catabolism
Protein metabolism pathways
1. Protein turnover (protein synthesis and breakdown)
2. Amino acid catabolism and deamination
3. Transamination
Pathways for carbohydrate
metabolism
Carbohydrates are the fastest-acting macronutrient source
for energy transfer. But we don’t store much of them.
For instance: Although a 150 lb (68 kg) person who
has 15% body fat carries around 22.5 lb (or 10.2 kg) of
stored fatty acids, they can only store about 1.1 lb (or
0.5 kg) of glucose.
Put in terms of calories, this is the difference between
carrying almost 92,000 fat calories on your body and
2,000 carbohydrate calories on your body.
The fat would last a long time during a famine. The carbohydrates? Barely a day.
This means that to have glucose available for energy
transfer, it’s easiest to get it from our diet. However, we
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can also make glucose from dietary protein and triglycerides. This means that
your clients can fuel up and thrive on many types of diets.
Carbohydrates travel through five main metabolic pathways to help make ATP.
1. Glycogenesis: From glucose to stored glycogen
2. Glycogenolysis: From glycogen to glucose
3. Glycolysis: From glucose to pyruvate
4. Krebs cycle and electron transport chain: Acetyl-CoA to ATP, CO2 and H2O
5. Gluconeogenesis: Non-carbohydrates to glucose
We’ll look at each one now.
Carbohydrate pathway 1: Glycogenesis
Glycogen is the storage form of dietary carbohydrate. Glucose molecules are
chemically bound together to form tightly packed glycogen molecules which are,
in turn, stored in tissues like the muscles and the liver.
glycogenesis: Synthesis of
glycogen
This process is called glycogenesis, or the creation of new glycogen from glucose.
(Think of the word “genesis”, or beginning, to remember this.)
For glucose to be added to glycogen stores, it must enter the muscle or the liver
Highly branched glycogen molecule
CH2OH
O
H
OH
O
O
OH
CH2OH
CH2OH
O
O
OH
Branching occurs here
CH2
O
O
OH
OH
O
OH
CH2OH
O
OH
O
O
OH
OH
O
OH
Glucose monomer
Figure 3.5. Glycogenesis. Glycogenesis is the synthesis of glycogen from glucose.
Glycogen is variable in size and stored in the liver and muscle cells. The enzyme necessary for this process is glycogen synthase.
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Energy Transformation and Metabolism | 89
using membrane carrier proteins (known as glucose transporters, or GLUT).
Once in these tissues, it’s converted into a high-energy carbohydrate called glucose 6-phosphate, a process that costs the body one molecule of ATP.
Once glucose 6-phosphate is formed, the glucose is added to a previously
existing chain of glucose molecules (i.e., glycogen). The most important enzyme in this process is glycogen synthase.
Glycogen molecules can vary in size, depending on how much excess carbohydrate is currently available, versus how much carbohydrate the body needs for
energy transfer.
•
If there is extra glucose from the breakdown of dietary carbohydrate, and we
don’t need that glucose for energy, insulin tells muscle and liver cells to bring
the glucose inside. Insulin also ramps up glycogen synthase enzymes to help
make glycogen for storage. We release insulin in proportion to carbohydrate.
Thus, more glucose normally means more insulin, which eventually means
more glycogen storage in the liver and muscles.
•
On the other hand, if we need energy and / or don’t have enough glucose
around (for instance, during fasting or exercise), hormones like epinephrine
and norepinephrine tell glycogen synthase to stop making glycogen. These
hormones also promote glycogen breakdown (glycogenolysis) by increasing
the activity of an enzyme called glycogen phosphorylase.
Glycogenesis isn’t perfectly efficient. We lose about 5% of the available energy.
Carbohydrate pathway 2: Glycogenolysis
When we need to tap into that stored glycogen fuel for energy, our body kicks off
glycogenolysis to break off glucose units from the ends of the long glycogen molecules. (Notice that suffix “-lysis” again. Glycogen + lysis means we’re splitting
up glycogen.)
glucose 6-phosphate:
Phosphorylated form of glucose
that won’t diffuse out of a cell
glycogen synthase: Enzyme
necessary for the conversion
of excess glucose into stored
glycogen
epinephrine: Hormone and
neurotransmitter; also known as
adrenaline
norepinephrine: Hormone and
neurotransmitter; also known as
noradrenaline
glycogen phosphorylase:
Enzyme necessary for
glycogenolysis; breaks glycogen
into glucose units
glycogenolysis: Breakdown of
stored glycogen to glucose
To do this, our body activates the glycogen phosphorylase enzyme. This enzyme
adds a phosphate group to one of the glucose units packed into glycogen, which
breaks the bond holding the glucose unit to the glycogen molecule.
This glucose+phosphate compound (known as glucose 6-phosphate) can do
two things.
•
In the muscle, glucose 6-phosphate can enter glycolysis and run through the
glycolytic pathway in order to regenerate ATP.
•
In the liver, glucose 6-phosphate can either be used in the creation of ATP, or it
can become free glucose that the liver can release into the bloodstream.
This brings up an important point. As with real estate, glycogen is all about
location.
•
The liver can use glycogen to regenerate ATP or release it into the blood. This
is especially important for tissues such as the brain or red blood cells that can’t
store their own glucose.
•
Muscle tissue can’t do this trick. Once stored in the muscle, glucose must
be used in the muscle.
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Carbohydrates
glucose
Glycogen
galactose
fructose
Glucose
6-phosphate
cogenesis
gly
Glucose
glucose
OPO3
glucose
is
s
stored in muscle
and liver cells
to blood and brain
o l y si s
g e n ol ys
g ly c
yc o
neogene
uco
si
gl
gl
pyruvate
lactic acid
O
O
OH
OH
OH
O
Figure 3.6 Summary of carbohydrate metabolism
Glycolysis
Glucose
C6
ATP
Pyruvate
molecules
C3
C3
Cytoplasm
Transformation of pyruvate into acetyl-CoA
Pyruvate C3
CO2
Acetyl-CoA
CoA
Krebs cycle
CO2
Mitochondrial matrix
ATP
Oxidative phosphorylation
e-
ATP
e-
ATP
e-
ATP
e-
ATP
H2O
2H+ + O2 +
Figure 3.6 Overview of cellular respiration
e-
e-
Electrons removed
from glucose, pyruvate,
and acetyl-CoA
Redox reactions
Mitochondrial
inner membrane
Energy Transformation and Metabolism | 91
Glycogenolysis is stimulated largely by two hormones: glucagon and
epinephrine.
•
glucagon: Hormone secreted by
the pancreas to increase blood
glucose levels
Glucagon is a hormone secreted by the alpha cells of the pancreas in response
to low blood glucose and stress.
•
Epinephrine is a hormone released primarily from the adrenal medulla. It also
responds to stress and intense exercise, helping to mobilize carbohydrates for
quick “fight or flight” energy.
adrenal medulla: Central part
of the adrenal gland that secretes
epinephrine, norepinephrine and
dopamine
Carbohydrate pathway 3: Glycolysis
Now that we have our glucose 6-phosphate compound from the previous step,
the body needs to do something else with it.
Using enzymes, the body transforms the glucose 6-phosphate into pyruvate. This
process is known as glycolysis. (Here we have “glyco”, or glucose, plus “-lysis”:
The breaking up of glucose.)
You may remember that during this process, hydrogen atoms are released, which
glycolysis: Series of reactions in
the cytosol that converts glucose
into pyruvic acid and ultimately
ATP
glucose
energy investment
ATP
ADP
ADP
ADP ADP
ATP
ATP
ADP
ADP
ATP
NAD+
NAD+
ATP
ATP
NADH
NADH
energy payoff
pyruvate
net
glucose
ADP ADP
Pi
+P
i
+
NAD
NAD+
pyruvate
pyruvate
ATP
+ H2O
H2O
ATP
NADH
NADH
+
H+ +
H
Figure 3.7 Glycolysis
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need to be buffered to prevent fatigue. These atoms are picked up by NAD+,
forming NADH.
As glycolysis cannot continue unless NADH gives up its hydrogen atoms and
recycles back to NAD, the hydrogen atoms either end up joining with pyruvate
(to form lactic acid) or being passed along to the Krebs cycle and eventually to
the electron transport chain.
Where hydrogen atoms end up depends on how fast glycolysis runs.
•
If energy demand is high and glycolysis runs quickly, as in the case of anaerobic exercise, the hydrogens are bound to pyruvate. Lactic acid is formed with
the help of the enzyme lactate dehydrogenase. This allows NAD+ to be recycled, glycolysis to continue to regenerate ATP, and the excess hydrogen ions to
be shuttled out of the cell before they cause fatigue.
•
If energy demand is more moderate, as in the case of activities below the
anaerobic threshold: The point
at which lactic acid begins to
accumulate in the bloodstream
anaerobic threshold, the Krebs cycle can keep up with the rate of glycolysis.
Hydrogens are passed along to the electron transport chain, creating a lot of
ATP in the process. See Figure 3.6.
Carbohydrate pathway 4: Krebs cycle and electron
transport chain
H+
ATP
Unlike other energy systems, the Krebs cycle is not picky about which nutrients
it can use. Carbohydrates, fats and proteins can all be broken down into acetyl-CoA, the major entry molecule into the Krebs cycle.
H+
ADP
Mitochondria
H+
H+
fructose
diphosphate
NAD+
NADH
NADH
ADP ADP
Acetyl-CoA
H+
NAD+
ATP
ATP
ATP
FADH2
ADP ADP
ATP
CO2
CO2
FAD
pyruvate
NAD+
pyruvate
Inner Membrane
PGAL
H+
PGAL
Electron Transport
Chain: + 32 ATP
ADP
H+
ADP
ATP
H+
ATP
H+
glucose
Krebs Cycle
+ 2 ATP
NADH
H+
H+
Glycolysis: + 2 ATP
Cytosol
Figure 3.8 Krebs cycle and the electron transport chain
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NAD+
AD
ATP
P
Energy Transformation and Metabolism | 93
Other substances can also enter the Krebs cycle but this occurs further along the
pathway. We’ll discuss these entry points later.
Remember that our previous pathway ended with pyruvate after carbohydrates
went through glycolysis. Now, at this stage, the body can convert pyruvate to
acetyl-CoA by removing CO2 and adding co-enzyme A to the pyruvate molecule.
See Figure 3.9 for more.
Depending on how fast pyruvate is produced (in other words, how much energy
we need, and how quickly), the mitochondria will convert some to most of that
pyruvate to acetyl-CoA.
•
When the energy demand is high, only some of the pyruvate is converted to
acetyl-CoA, since the pyruvate will be created at a rate faster than it can be
converted to acetyl-CoA and run through the Krebs cycle.
•
When the energy demand is lower, most of the pyruvate is converted to acetyl-CoA since the relatively slower rate of glycolysis will match the rate of Krebs
cycle activity.
Carbohydrate pathway 5: Gluconeogenesis
Brains are kinda important. So they’re usually first in the cafeteria line for nutrients. Maintaining blood glucose, especially to the brain, is one of the highest
physiological priorities.
But what happens when we haven’t eaten for a while, and no glucose is immediately available? The body has to find another way to get glucose to our brain and
potentially other working parts.
As our blood glucose master commander, our liver is called into action. The first
line of defense against low glucose is glycogenolysis, which you learned about. In
this case, glucose can be released from stored liver glycogen and shipped out into
the blood.
However, if liver glycogen concentrations are low, the body has a back-up system:
The liver can also make glucose from non-carbohydrate compounds.
This process of creating glucose from non-carbohydrate sources is called gluconeogenesis, or the genesis of new glucose. Gluconeogenesis can produce around
130 g of glucose per day without carbohydrate ingestion (if other nutrients are
abundant), which is just about how much the brain requires each day. Convenient system.
gluconeogenesis: Conversion
of non-carbohydrate compounds
(i.e., amino acids, pyruvate,
glycerol) to glucose
See Figure 3.8 for more.
There are four main compounds that can go through the process of
gluconeogenesis:
•
pyruvate from glycolysis;
•
lactate from glycolysis;
•
most amino acids; and
•
glycerol from triglycerides.
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Occurs mainly in the liver
Glucose
6-phosphate
Glucose
glucose
OPO3
oxaloacetate: Sometimes known
as oxaloacetic acid, a molecule
involved in many metabolic
processes
glycerol
from lipids
amino acids
lactic acid
gluconeogenesis
glucose
pyruvate
O
O
OH
OH
to blood and brain
OH
O
Figure 3.9 Gluconeogenesis
These nutrients, which are either already available in the liver, or exported from
muscle and other tissues, can be converted into glucose through a process that’s
pretty much the reverse of glycolysis. While the liver takes care of most of the
gluconeogenesis required by the body, during periods of extreme energy imbalance (such as starvation), the kidneys can also contribute to gluconeogenesis.
Remember our lactic acid (lactate) production from high-intensity exercise?
Well, this gluconeogenic pathway can also help control the high levels of blood
lactate that go along with high-intensity activity.
Indeed, lactate released from the muscles is circulated to the liver, where it’s
converted to glucose. This glucose can then travel back to the muscle for further
energy transfer.
Cori cycle: Process during which
lactate produced in the muscles
goes to the liver and is used for
the production of glucose.
This process is known as the Cori cycle. Even when carbohydrate intake is low,
we can still produce glucose for energy by breaking down proteins and fats. This
means we can still maintain blood glucose even when we’re on a “low-carbohydrate diet.”
Also note: Sometimes, even gluconeogenesis is limited. In these situations, we
can make ketone bodies for fuel. Our body’s mission: Fuel the brain by any
means necessary!
Speaking of ketones, we’ll now look more at fat metabolism.
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Nutrition in practice: Low or high carbs?
As a fitness professional, you may have heard the expression: “Fats burn in the carbohydrate flame.” People
typically use it to suggest that we need dietary carbohydrates to burn fat.
They’re right, to some degree. Here’s why.
For the Krebs cycle to run best, acetyl-CoA likes to join
with a compound called oxaloacetate, or oxalocetic
acid, as a first step. This occurs with the help of an enzyme called citrate synthase.
Without enough oxaloacetate in the cells, acetyl-CoA
doesn’t gain access to the Krebs cycle and the Krebs
cycle doesn’t run properly.
When we transform glucose to pyruvate, we can then
convert pyruvate into oxaloacetate. So oxaloacetate is
also a byproduct of carbohydrate metabolism.
Without adequate carbohydrate metabolism, oxaloacetate will be in scarce supply, acetyl-CoA will accumulate,
and the Krebs cycle will slow down.
This is partly why many people feel more sluggish on
a low-carbohydrate diet, especially when they first
decrease their carbohydrate intake. They simply aren’t
regenerating enough ATP through the Krebs cycle and
electron transport chain to meet their energy demands.
In this situation, the liver doesn’t have enough stored
glucose to ship it out to the brain and red blood cells.
Everything from brain function to physical activity levels
slow down to match this new, reduced nutrient and ATP
availability.
Does this mean that everyone always has to follow a higher-carbohydrate diet?
Not necessarily.
For starters, for this reduction in Krebs cycle activity to
occur, carbohydrate intake would have to be very low
— probably less than 100 g of carbohydrates per day.
And this is far less than most people, even those on a
carb-controlled diet, would take in.
Second, if people have enough body fat and are eating
enough dietary fat, the body compensates after 7-14
days to this new intake with an increased production
of ketone bodies as well as an increase in Krebs cycle
enzymes.
Indeed, as carbohydrate intake drops off and carbohydrate metabolism dwindles, the liver starts to take the
extra acetyl-CoA that’s not being run through the Krebs
cycle and converts it into ketone bodies. These ketone
bodies are then shipped out to tissues such as the muscles, the brain, etc. where they’re converted back into
acetyl-CoA.
At this point this acetyl-CoA is more usable, since the
Krebs cycle will have upregulated (increased) its activity,
even though there is less oxaloacetate.
This adaptation is commonly referred to as “fat adaptation” since much of the acetyl-CoA formed comes from
the metabolism of fatty acids.
When this happens, some people feel good — better
than they did while eating more carbohydrates. However, other people feel worse. For them, a moderate to
high carbohydrate diet is better.
As a nutrition coach, you should remember that there is
no one-size-fits all approach.
Thus, even though fat does “burn in the flame of carbohydrates” via the Krebs cycle, this doesn’t mean everyone needs a lot of carbs to thrive.
Indeed, the body adapts surprisingly well to many types
of diets. Monitor your clients’ energy levels and other
physical indicators to see which diet ultimately works
best for them.
Pathways for fat metabolism
Fatty acids and triglycerides have four key roles in our
body:
•
They provide the structure of our plasma
membranes.
•
They provide the raw materials for many hormones,
and help regulate the function of other hormones.
•
They help transport certain vitamins and minerals.
•
They’re the largest fuel depot in the body.
Fat is involved in the energy transfer process in several
important ways. It’s the nutrient we use most for energy
when we don’t need a lot of that energy quickly — for instance, when we’re sleeping, puttering around the house,
or going for a leisurely stroll.
Although we can make most of our own fatty acids,
there are a few fats we can’t make. So we have to get
them from our diet.
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There are six important metabolic pathways related to fat breakdown and
synthesis.
1. Fat transport and lipogenesis
2. Fat mobilization and lipolysis
3. Fatty acid synthesis
4. ß-oxidation
5. Ketone formation
6. Cholesterol synthesis and catabolism
Fat pathway 1: Fat transport and lipogenesis
Most fatty acids are transported as triglycerides (although some, usually those
released by adipose tissue, circulate through the blood as free fatty acids).
Triglycerides are made up of three fatty acid molecules joined together by a
3-carbon molecule called glycerol, with one fatty acid hanging from each carbon.
Because blood is water-based, triglycerides need to bind to special types of proteins to travel around in it.
chylomicron: A lipoprotein
that transports cholesterol
and triglyceride from the small
intestine to tissues of the body
lipoprotein: A class of proteins
with hydrophobic core of
triglycerides or cholesterol
surrounded by hydrophilic
phospholipids, apolipoproteins
and cholesterol
lipoprotein lipase: An enzyme
that catalyzes the hydrolytic
cleavage of fatty acids from
triglycerides
adipose tissue: Tissue made of
fat cells
lipogenesis: The formation of fat
Protein-fat packages that pass into circulation from food are called chylomicrons, a type of lipoprotein. Protein-fat packages that pass into circulation from
liver synthesis are packaged as other types of lipoproteins. Lipoproteins circulate
through the body and can be taken up by the cells with the help of an enzyme
called lipoprotein lipase.
These triglycerides are stored in many tissues including our liver, our adipose
tissues, and our muscle tissues.
When we digest and absorb triglycerides, we break them down into monoglycerides, diglycerides, and free fatty acids. These partially or fully broken down
triglycerides are then put back together into triglycerides as they enter lymphatic
and portal circulation.
Just as glucose molecules are packaged together to form glycogen, stored fatty
acids are joined together in tightly packed molecules (triglycerides) through a
process known as lipogenesis. The fat in our food and in our cells is made up of
triglyceride units. We have to break these triglycerides down into fatty acids to
use them.
Triglycerides can’t easily pass through plasma membranes. So lipoprotein lipases
break down the triglycerides into three individual fatty acids and one glycerol to let
them enter the cell. Once they’re in the cell, fatty acids are either oxidized and used
to transfer energy, or converted back into triglycerides for storage by adding the
fatty acids back to the glycerol molecule.
The glycerol backbone has three carbon “docking stations” to which fatty acids
can bind. And glycerol isn’t picky. It’ll bind to all kinds of fatty acids. So different fats can bind to each one of those carbons. For example, a single triglyceride
could be made up of one saturated fatty acid, one polyunsaturated fatty acid, and
one monounsaturated fatty acid. Another triglyceride could be made up of three
saturated fatty acids. And so on.
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Do “fat burning supplements” work?
Hormones like epinephrine and norepinephrine, part of our “fight or flight” hormone roster, stimulate lipid mobilization. In other words, when these hormones
go up, it tells the body to release fatty acids into the bloodstream for energy.
These hormones can go up for a few reasons. Exercise and stress are two of the
most common. In both cases, the “fight or flight” hormones release fuel for
quick energy to the muscles. As you learned in the previous unit, these hormones also suppress appetite and gastric function, so we’re not hungry.
You’d think that it would be good to have these hormones high if you wanted
to lose body fat. This is the basis for almost all “fat-burning” supplements. They
contain stimulants, such as caffeine, that amp up our epinephrine and / or norepinephrine. They also lower our appetite temporarily.
However, without exercise, releasing our “fight-flight” hormones isn’t as effective for losing fat, since the signal is “artificial.” Although the fats are available
to use as an energy source, there’s no increased muscle activity that needs the
energy. The fats thus simply recycle back into fat storage.
So the fats may be released, but if we’re not exercising, they don’t do anything.
Eventually, they shrug and go back home again.
As the saying goes, stimulants don’t give you energy (because energy can’t be
created or destroyed). Instead, stimulants borrow energy. And if we don’t use
energy, it gets put back, often leaving us feeling less energetic than before. (Or
worse, hungrier.)
But if we combine mild stimulants (such as a cup of coffee) with an exercise
session where those fatty acids can be used, now we’re in business. Caffeine is
an ergogenic aid (a substance that can boost performance).
Be aware that most stimulants are banned in athletic competition. Help your
clients’ choose supplements wisely!
Fat pathway 2: Fat mobilization and lipolysis
When we need triglycerides for energy, we break them down with a process
called lipolysis, or the “-lysis” (splitting) of lipids. This process, carried out by an
enzyme known as hormone sensitive lipase (HSL), breaks triglycerides down
into their constituent parts: three individual fatty acids and one glycerol.
If we need energy in the tissues where lipolysis is happening, the glycerol can enter the glycolytic pathway while the fatty acids are further broken down through
a process known as beta oxidation (more on this later).
If our body needs energy elsewhere, these components can be released into the
blood. This process of triglyceride breakdown and fatty acid release into the blood
is called lipid mobilization. It happens when our energy needs go up. Indeed, the
concentration of free fatty acids in the blood is directly related to our muscle cells
using that fat during physical activity.
Lipid mobilization, including the activation of HSL, is stimulated by high concentrations of the hormones epinephrine, norepinephrine, glucagon, and growth
hormone. Each of these hormones is released during exercise to tell your fat cells
that the muscles need energy.
lipolysis: Breakdown of
triglycerides into fatty acids and
glycerol
hormone sensitive lipase
(HSL): Enzyme of the cytosol that
frees fatty acids and glycerol
lipid mobilization: Using lipids
as a fuel source
growth hormone (GH):
Anabolic hormone that causes
growth and cell reproduction;
also known as somatotropin
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How do we get fat?
Fatty acid synthesis happens when energy intake is high and energy demands
are low. In other words, we package and store fat when we eat more than we
burn through metabolism and activity.
It’s a basic law of thermodynamics: Energy has to go somewhere. If we can’t
expend it as heat, movement, or some other metabolic activity, we have to store
it. And our body’s preferred storage method is adipose tissue, or fat.
This synthesis of fatty acids can come from either excess dietary fat, or excess dietary
carbohydrate (which is called de novo lipogenesis). Theoretically it could also occur
from excess dietary protein, but this requires a unique set of conditions.
In general, the body tends to follow these three rules:
1. Excess dietary fat is directly stored as body fat (some of which gets synthesized into different types of fat).
2. Excess dietary carbohydrate increase carbohydrate oxidation, thus impairing fat oxidation, and cause more dietary fat to be stored as body fat
(along with a very small amount of de novo lipogenesis).
3. Excess dietary protein increases protein oxidation, thus impairing fat
oxidation, and causing more dietary fat to be stored as body fat.
This means that no matter what combination of macronutrients you eat, if you
eat more than you expend, you’ll store the excess energy.
Other factors affect how our body processes nutrients. These include:
•
•
•
•
•
•
•
exercise and daily-life movement;
body composition;
hormones;
genetic programming;
age;
our gastrointestinal microbiome; and
the type of food we eat.
Outside of a lab, we will never know exactly how many calories we are taking in
or expending. But this doesn’t mean that energy balance doesn’t matter. It just
means that we don’t know all the inputs and outputs, so doing a lot of precise
and complicated “calorie math” won’t help us very much.
Energy balance is the ultimate equation that determines weight loss or gain.
If we take in more energy than our body needs or uses, we will gain weight.
If we take in less energy than our body needs or uses, we will lose weight.
Since calorie math isn’t very useful, we have to track our clients’ intakes, outputs, and long-term results closely to know what the right amount of food for
each individual client is.
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Fat pathway 3: Fatty acid synthesis
The synthesis of new fat takes place mostly in the liver, although it can also happen in adipose (fat) tissues when energy intake from food is high, energy output
from metabolism and activity is low, and when insulin is high (so nutrients are
easily transported into cells). More on this in a moment.
This process is governed by a complex of enzymes called the fatty acid synthase
system. This system is activated when energy demand is low but high concentrations of acetyl-CoA are present in the liver (in other words, when we’ve eaten a
lot of nutrients, but don’t have any demand for that energy).
fatty acid synthase system:
System of enzymes involved in the
synthesis of fatty acids
During this seven-step process:
•
2 carbon units are added to an ever-growing fatty acid chain until it becomes
the saturated fatty acid palmitate.
•
From here, the palmitate can be elongated (to make a longer saturated fatty acid, such as stearic acid) or desaturated (to create monounsaturated
fatty acids such as palmitoleic acid or oleic acid).
•
The liver can package these fatty acids, whether saturated or unsaturated, as
triglycerides in very low density lipoprotein particles (VLDL) and ship
them out to other tissues for fat storage.
Although we can synthesize most fatty acids, there are two polyunsaturated fats
that we can’t make:
•
alpha linolenic acid (an omega-3 fat)
•
linoleic acid (an omega-6 fat)
We must get these from our diet.
Fat pathway 4: ß-oxidation
Once we’ve converted triglycerides to fatty acids, the next step is beta oxidation
(the Greek letter beta is often written as “ß”). This process breaks down fatty
acids into acetyl-CoA, which you should realize by now is an essential molecule
in energy transfer. ß-oxidation is sometimes called the “fatty acid spiral” because
it is similar to a cycle, like the Krebs cycle with a series of enzymes. It is called a
spiral because each time through the process the fatty acid gets shorter as acetyl-CoA is made.
Fatty acids are long chains of carbon-hydrogen bonds. Acetyl-CoA is made up of
only two carbons. So most fatty acids can produce a lot of acetyl-CoA.
Each 16-carbon fatty acid (like palmitate) can regenerate approximately 106 ATP.
Since triglycerides contain three fatty acid molecules, multiply that Figure by
three and you end up with 318 ATP molecules per triglyceride.
Since glycerol also contributes to ATP regeneration, helping to produce 19 more
ATP molecules, the breakdown of each triglyceride generates a whopping 337
ATP molecules.
palmitate: Common saturated
fatty acid; end product of
mammalian fatty acid synthesis
elongation: Addition of carbons
on a fatty acid chain
saturated fatty acid: A fatty
acid with no double bonds in the
chain
desaturation: Removal of
hydrogen atom(s) to form a
double bond
monounsaturated
fatty acid: Having a single
double bond in the fatty acid
chain
very low density lipoprotein
particles (VLDL): Particles used
in lipid transport; assembled
in the liver by cholesterol and
apolipoproteins, converted to LDL
polyunsaturated fat: A fatty
acid with multiple double bonds
in the chain
alpha linolenic acid (ALA):
Unsaturated omega-3 fatty acid,
see linolenic acid
omega-3: Family of unsaturated
fatty acids characterized by a
carbon-carbon double bond three
spaces in from the methyl end
linoleic acid: Unsaturated
omega-6 fatty acid considered
essential to the human diet
omega-6: Family of unsaturated
fatty acids characterized by a
carbon-carbon double bond six
spaces in from the methyl end
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Compared with the 36 ATP molecules generated by one glucose, fat emerges as
an ATP superstar.
Fat oxidation is efficient but slow, because it’s aerobic (from the ancient Greek
aero, or “air”). It needs oxygen to accept hydrogen ions after they’ve moved
through the electron transport chain. And we can only take in and transfer a
certain amount of oxygen. So there’s a limit to how much energy we can get from
ß oxidation.
aerobic: A process that requires
oxygen
If we need a lot of energy but don’t have a lot of oxygen (for instance, while
sprinting), we stop using the ß oxidation pathway for energy and use mostly
glycolysis instead. This process is described as anaerobic.
anaerobic: A process that does
not require oxygen
Fat pathway 5: Ketone formation
When we need energy but don’t have a lot of carbohydrate coming in (and / or
don’t have enough oxaloacetate), our liver can make ketones for energy.
Liv
e
ß oxidation dominates when available carbohydrates are low (for example, after
a long period of fasting). As a result of this process, fatty acids create a surplus of
acetyl-CoA. If there aren’t enough oxaloacetate molecules to run this acetyl-CoA
through the Krebs cycle, the cycle stops. Acetyl-CoA builds up.
Ketogenesis
r
Increased
ketone
production
ed
reas
Dec lin
insu
tty
Fa
d
se
ea gon
r
c
In uca
gl
Increased ketones
in bloodstream
id
ac
s
rea
c
n
Pa
Fat cell
Fasting State
Figure 3.11 Ketone formation
Nutrition: The Complete Guide
Blood vessel
Energy Transformation and Metabolism | 101
This build-up of acetyl-CoA shifts the liver into ketone
body formation. Ketone bodies can then be sent out to
other tissues for energy. Using ketone bodies for energy
is known as ketosis.
There are three basic ketone bodies:
•
ß-hydroxybutyrate
•
acetoacetate
•
acetone
These ketones are water soluble and can be reconverted
into acetyl-CoA to help supply the brain, red blood cells,
and muscle tissue with energy transfer nutrients when
glucose is low. This isn’t how our body prefers to get fuel,
but it’s an excellent back-up system when glucose isn’t
available. See Figure 3.9.
It’s not clear what the long-term effects of ketosis are.
Ketogenic diets do seem to help certain health conditions, such as childhood epilepsy. And it’s early, but
these diets might also benefit other neurological disorders. Unfortunately, there seem to be some potential
drawbacks to permanent ketosis, such as:
•
high blood lipids;
•
lowered neutrophil (white blood cell) function;
•
optic neuropathy (damage to the nerves of the eye);
and
•
lower bone density.
And children who follow ketogenic diets to prevent seizures have developed hydration problems, constipation,
decreased bone mineral density, and kidney stones.
In addition, because people following ketogenic diets
must cut out so many foods, they may not get enough
food variety for good health.
Fat pathway 6: Cholesterol synthesis and
catabolism
Cholesterol is a molecule with several essential roles.
Because cholesterol is so important, we make our own,
and lots of it. Indeed, we usually make much more than
we eat — about 1 g per day, although it varies.
Our body synthesizes cholesterol from acetyl-CoA.
(Yes, here it is again, that ever-present acetyl-CoA!)
Through a series of about 26 enzymatic reactions,
acetyl-CoA units are joined together to eventually form
the end product, cholesterol.
Nearly all tissues in the body are able to make cholesterol. How much we make, and where we make it, seems to
depend on how much cholesterol we eat and absorb from
food. The liver often plays a major role here.
Interestingly, as dietary cholesterol goes up, cholesterol
synthesis goes down, and vice versa. There is a dynamic
balance that also seems to vary from person to person.
Some people seem genetically predisposed to have higher cholesterol levels than others.
Like many other types of fats, cholesterol is not especially water soluble. To get around the body, it has to hitch a
ride on lipoproteins.
Apolipoproteins, the protein portion of lipoprotein
molecules, form the surface of these particles. Currently, there are five known classes of apolipoproteins (A
through E). Each class has distinct subclasses. These
lipoproteins carry cholesterol, among other molecules
such as triglycerides, phospholipids, and apoenzymes,
throughout the body.
The ratio of protein to lipids in each lipoprotein determines the density of that lipoprotein. Protein is denser
than fat, so lipoproteins higher in protein and lower in
fat are known as high-density lipoproteins (HDL). Low
and very low density lipoproteins (LDLs and VLDLs)
have more triglycerides and cholesterol. (Ever see that
T-shirt saying “I’m not fat, I’m fluffy”? Well, it’s actually kind of true. Relative to protein, fat molecules are
“fluffier.”)
Lipoproteins have different jobs.
•
Our LDL particles deliver cholesterol and tri-
•
It helps cell membrane function.
•
It helps absorb dietary fat.
to build and maintain cell membranes, to make
•
It’s the basis of steroid hormones (including vitamin
hormones, or for storage.
D).
•
It helps synthesize bile salts.
glycerides to our cells. Our cells then use those fats
•
Our HDL particles carry cholesterol from cells
and other lipoproteins to the liver where it can be
excreted in the bile, or recycled to be sent out again
to tissues that need cholesterol.
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HDL
Liver
excess cholesterol
from cells
LDL
cholesterol to cells
VLDL
chylomicrons
(lipoprotein lipase)
(from enterocytes)
TAG to cells
Figure 3.10 Cholesterol transport
LDL particles: A lipoprotein
that transports triglyceride and
cholesterol from the liver to body
tissues
HDL particles: A lipoprotein
that transports fatty acids and
cholesterol from the body tissues
to the liver
lecithin-cholesterol
acyltransferase (LCAT): An
enzyme that is used to convert
cholesterol to a transportable
form for lipoproteins
cardioprotective: Something
that is protective to the
cardiovascular system
atherosclerosis: Development
of plaque in the lumen (interior
space) of blood vessels
Nutrition: The Complete Guide
Interestingly, HDL can bind to both cellular receptors and to LDL receptors. Thus
HDL can “steal” cholesterol from LDL and carry it out of the body. They do this
with the help of an enzyme called lecithin-cholesterol acyltransferase (LCAT),
which allows cholesterol molecules to be freely released from the cells of our body,
as well as from LDL, to travel back to the liver.
This is why HDL is cardioprotective. As LDL particles take cholesterol to other
tissues, these molecules can unfortunately drop off cholesterol in our blood vessels, sort of like boxes falling off a truck. Fatty plaques can build up, eventually
leading to atherosclerosis.
HDL, on the other hand, carries this cholesterol back to the liver for excretion,
reducing the risk of plaque build-up. This is why high HDL is known as “good”
cholesterol, and why doctors look for higher HDL levels and lower LDL levels. See
Figure 3.10 and the sidebar “Is high cholesterol bad” for more.
Energy Transformation and Metabolism | 103
Is high cholesterol bad?
One of the most common types of drugs prescribed in
turned out to have many unwanted side effects, like:
North America is statins. These drugs work by blocking
• muscle pain and damage;
an enzyme that the liver needs to make cholesterol.
• lower CoQ10 levels;
Initially, many health care providers saw statins as a
• diabetes or problems controlling blood glucose;
good thing. Statins could lower cholesterol production
by up to 70%.
and / or
• elevated liver enzymes.
But just making HDL cholesterol go up or LDL cho-
Combining statins with niacin (vitamin B3) can in-
lesterol go down with drugs doesn’t actually seem to
crease the risk of serious myopathies (muscle damage),
decrease heart disease incidence much. There is more to
including rhabdomyolysis. This is important for clients
this story than that.
to know if they are combining these medications with
Recent research has found that the amount of these lipoprotein particles may be far more important than simply
their cholesterol content. In essence, the more particles
supplements (even apparently harmless multivitamins).
Conversely, grapefruit juice can inhibit the action of
many medications, including statins.
you have, the longer they stay in the vascular system,
So if you have any clients on medication, work with
and the more likely they are to eventually penetrate the
their doctor and pharmacist to make sure any supple-
endothelium and start progressing into atherosclerosis.
ments you recommend will be safe.
Thus, both particle size and particle amount matter.
Given how important cholesterol is in the body, statins
Luckily, many doctors are now recommending a much
cheaper and safer alternative to drugs: good nutrition
and exercise.
Pathways for protein metabolism
The name protein derives from the ancient Greek protos,
meaning first, primary, or most important. Indeed,
proteins are the body’s building blocks. The amino acids
that make up our proteins:
except in the case of gluconeogenesis, as we discussed
previously. Most of the time, proteins do other things.
Let’s look at how that works now.
There are three important protein pathways to know.
•
give our body structure and strength;
•
make many hormones and cell signaling molecules;
•
make enzymes;
•
make immune system chemicals such as immuno-
3. Transamination
globulins and antibodies;
But first, let’s talk about amino acid pools.
•
make transport proteins; and many other things.
We can make some amino acids. But we have to get
most from our food. And since proteins are always being
broken down and rebuilt, we need to get enough protein
to stay healthy.
Our cells don’t often use proteins directly for energy,
1. Protein turnover (protein synthesis and breakdown)
2. Amino acid catabolism and deamination
Amino acid pools
Biologically, we use the term “pool” to describe a group
of particular molecules in a specific location or tissue
(e.g., adipose tissue triglyceride pool, plasma amino acid
pool). There are several amino acid pools in the body.
When we digest protein, it is broken down to its
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Figure 3.11 Amino acid pool and the eventual fates of individual amino acids
essential amino acid: Amino
acid that must be included in the
diet
individual amino acid components. After we absorb these amino acids and they
pass through the liver, they enter the bloodstream and become part of what’s
known as the plasma pool of amino acids. This is a collection of essential and
non-essential amino acids, which also includes the amino acids broken down in
our body tissues and shipped out into the bloodstream. In total, this blood-based
pool usually has about 100 g of amino acids, which can easily interact with other
amino acids and proteins in our cells.
non-essential amino acid:
Amino acid that does not need to
be included in
the diet
This regular exchange, or flux, of amino acids into and out of our body tissues
is an important protein-related metabolic pathway that can then be used to produce important molecules such as:
plasma pool of amino acids:
Reserve of amino acids found in
blood plasma
•
enzymes
•
hormones
•
neurotransmitters
•
antibodies
•
transport proteins
•
muscle proteins
Our body normally prefers to use amino acids for these important metabolic
functions. However, as we’ve seen, if our body needs energy and no other nutrients are easily available, it can also break protein down to either help create other
nutrients (such as glucose, fatty acids, cholesterol, or ketone bodies) or to help
regenerate ATP. See Figure 3.11.
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Energy Transformation and Metabolism | 105
Indeed, we lose some of our body’s amino acids to breakdown. How much we lose
will depend on our energy balance: If we’re well fed and / or energy demands are
low, we won’t lose much. If we’re poorly fed or fasted, and / or need a lot of energy,
we’ll lose more amino acids.
Where those amino acids come from depends on our protein balance. Because
we’re constantly “leaking” amino acids from the pool, we have to keep it topped
up by eating enough protein.
If we need more amino acids than we’re eating, the body starts to get those aminos from elsewhere. It’ll start cannibalizing muscle tissues, structural proteins
(such as bone and connective tissues), hormones and other chemicals, etc. If this
deficit goes too long, vital functions will shut down.
Luckily, almost all foods contain some protein. And the body doesn’t discriminate: Amino acids are amino acids, no matter what their source. While some
foods have more protein than others, it doesn’t matter whether that protein is
plant or animal.
Protein pathway 1: Protein turnover (protein synthesis
and breakdown)
The process by which cellular proteins are continually “recycled” by being degraded and re-synthesized is called protein turnover.
All tissues of the body go through a regular course of turnover. We can see this,
for instance, in the skin, which sloughs off dry, dead skin cells while new, healthy
skin cells take their place. Bone cells respond to loading and stress in their
process of resorption and new bone formation. (Yes, bones are mostly protein!)
Indeed, every cell that makes up our bones is different than it was a year ago
today. Of course, muscles need protein turnover to become bigger and stronger
when stimulated by exercise.
The turnover of these tissues is governed by two independent processes: protein
synthesis and protein breakdown.
Both protein synthesis (putting amino acids together into new protein structures) and protein breakdown (breaking down proteins into amino acid units)
are regulated by several factors including:
•
nutritional intake;
•
exercise habits;
•
health and illness;
•
stress;
•
hormonal status; and
•
genetic programming.
protein synthesis: (Re)building
of proteins
protein breakdown:
Degradation of proteins
There are three types of protein status, depending on the relationship between
protein synthesis and breakdown.
If we’re building new proteins at the same rate as we’re breaking them down, our
protein status is neutral. Proteins have been equivalently turned over and replaced.
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+
Positive protein status:
synthesis rates exceed
breakdown rates
no
am
i
N
Amino Acid Pool
in
am
o acid anabolis
atabolism/de
a
m
id c
ina
ti
m
ac
protein
synthesis
protein
breakdown
on
Negative protein status:
breakdown rates exceed
synthesis rates.
-
Figure 3.12 Summary of protein breakdown and protein synthesis
If we’re building new proteins faster than we’re breaking them down, our protein status is said to be positive.
We’ve renewed and built new things.
Finally, if we’re building new proteins more slowly than
we’re breaking proteins down, our protein status is
negative. We may have renewed some proteins, but we’ll
soon run out. We need to eat more protein to replenish
the body’s protein pools.
This process of protein turnover uses the amino acid catabolism / deamination steps that we’ve already discussed.
Our DNA directs protein synthesis. Signals such as exercise, hormones, and so forth trigger DNA to start the
process of transcription and translation. New proteins
are then made, with the help of the muscle amino acid
pool and ribosomes in the endoplasmic reticulum. After
processing in the Golgi apparatus, these new proteins
either stay in the cell or are shipped out. Now they can
do their jobs, whether that’s being enzymes, providing
structural support, etc.
Eventually, however, they’ll also be broken down into
individual amino acids for recycling back into body
proteins or for the transfer of energy. And when the
original proteins are gone, new proteins will take their
place. See Figure 3.12.
Nutrition: The Complete Guide
Protein pathway 2: Amino acid
catabolism and deamination
Amino acids have three eventual fates in the body:
1. They can be joined together to create new proteins.
2. They can be catabolized to form non-protein compounds (as in gluconeogenesis).
3. They can be catabolized in order to transfer energy
(i.e., regenerate ATP).
In this section, we’ll discuss the latter two processes,
both involving amino acid catabolism, or breakdown.
All amino acids contain nitrogen in their chemical
structure, along with their carbon-hydrogen bonds.
When new proteins are synthesized from individual
amino acids, these nitrogen molecules stay with the amino acid as the growing peptide chain gets larger.
However, when amino acids are needed to form non-protein compounds or to transfer energy to ATP, these nitrogen groups must be eliminated. This process of nitrogen
removal is called deamination. See Figure 3.13.
As we’ve seen, the proteins within our cells are continually being broken down and rebuilt. This protein
turnover allows our cells to adapt quickly to changing
Energy Transformation and Metabolism | 107
O
NH 2
HO
C
C
OH
HO
+
C
C
O
O
OH
NAD
O
O
glutamic acid
alpha-ketoglutaric acid
+
H2O
NADH + H
+
+
NH3
ammonia
Urea
cycle
Figure 3.13 The process of deamination
environmental and physiological conditions by synthesizing new and better
proteins to replace those recently broken down.
For example, the mechanical and chemical stress of physical activity tells our
body that our current enzymes don’t work well enough; that our current carrier
proteins don’t transfer nutrients fast enough; and that our current contractile
proteins aren’t strong enough. The body adapts to this stimulus by breaking
down and restructuring proteins in stronger and more efficient forms.
Once proteins are broken down, many of the resulting amino acids hang out in
the muscle protein pool for recycling into new muscle proteins. Some of these
amino acids (for example, the branched chain amino acids, or BCAAs for short)
can be used locally in the muscle (especially during longer-duration exercise,
where BCAA contribution to energy transfer can increase several-fold).
peptide chain: Short polymer
formed from linking amino acids
deamination: Removal of an
amine group from a compound
branched chain amino acid
(BCAA): Amino acid with
aliphatic side chain that is nonlinear
This process happens in 3 steps:
1. Nitrogen is removed from these amino acids.
2. This nitrogen is bound to hydrogen and flushed out of the body.
3. The remaining carbon-hydrogen chain (called a carbon skeleton) is used for
energy transfer, or is exported for further processing in the liver.
carbon skeleton: Chains,
branches or rings of carbon atoms
that form organic molecules
In addition to local muscle metabolism, some of the amino acids are shipped
out into the blood, returning to the plasma amino acid pool, where they join
with dietary amino acids and other amino acids that have been exported by
other cells of the body.
As the plasma amino acid pool circulates throughout the body, the liver can grab
some of these amino acids. It will deaminate and catabolize over half of them in
order to use them for gluconeogenesis, ketone body formation, cholesterol synthesis, fatty acid synthesis, or, finally, energy transfer. See Figure 3.14 for more.
When bound to amino acids, nitrogen groups typically appear in the form of
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Amino Acid Pool
Catabolism
Deamination:
Nitrogen groups
eliminated
non-protein
products (as in
gluconeogenesis)
N
α-keto acid residues =
carbon skeletons of
amino acids
urea, ammonium,
and other waste
products in urine
energy metabolism
in glucose or fatty acid
metabolism pathways
Figure 3.14 Summary of amino acid catabolism pathways
amine: One of a group of organic
nitrogen compounds
ammonia: Also known as NH3 , a
very basic end product of protein
metabolism
urea cycle: Cycle that takes place
in the liver and creates urea from
ammonia and carbon dioxide
NH2 or NH3 (one nitrogen bound to two or three hydrogens). These groups, typically called amines, are removed from amino acids in the first step of amino acid
catabolism (deamination).
When amine groups break away from the amino acids, they form free NH3 (ammonia) and a carbon skeleton. Ammonia is very toxic to humans. So we must
convert it to a non-toxic chemical. Using a process called the urea cycle, CO2 and
NH3 are joined together to form urea, a non-toxic, water-soluble chemical that
can safely diffuse in the blood and be excreted in the urine. This is why you’ll
often see more urea in the blood and urine of someone who eats a lot of protein.
In people with kidney or liver disease, the urea cycle may not work properly, and
ammonia levels can increase in the blood.
α-ketoacid: An organic acid
containing a functional ketone
group and a carboxylic acid
The portion of the amino acid that remains after the amino group has been removed is called its carbon skeleton or α-ketoacid. (“α” is the Greek letter alpha.)
This carbon chain can be converted to five important substances:
1.
glucose;
2.
ketone bodies;
3.
cholesterol;
4.
fatty acids; or
5.
a Krebs cycle compound for entry into oxidative phosphorylation and the
eventual resynthesis of ATP.
Nutrition: The Complete Guide
Energy Transformation and Metabolism | 109
Proteins
Carbohydrates
Fats
Amino acids
Glucose
Fatty acids
ATP
pyruvate
Acetyl CoA
N
Krebs Cycle
ATP
CO2
Electron
Transport
Chain
ATP
H2O
Figure 3.15 Summary of metabolic pathways for proteins, carbohydrates, and fats
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Protein pathway 3: Transamination
In addition to deamination, some amino acids can undergo a process known as transamination. Rather than
the amine group being lost, in this process it’s simply
transferred to another amino acid carbon skeleton. The
fate of the original amino acid can be the same as with
deamination reactions.
In this unit, we’ve looked at how we get energy from food.
Understanding the details of how this works helps us
understand what we should eat and why. It also helps us
understand how changing our diet can change our body’s
health, performance, and composition.
In the next unit we’ll take this one step further to explore the concept of energy balance, or the relationship
between energy input and energy output.
Case study
Potatoes. Bread. Pasta.
What comes to mind when you read those words? Many
of our clients think of “enemy”, “evil”, “off-limits”, and
“fat-inducing.”
One client in particular had such a fear of carbohydrate-dense foods that he eliminated all of them. No
wild rice. No baked potatoes. No oatmeal. No apples.
Instead, his meals were built around meats, eggs, fish,
oils, nuts, seeds, butter, and non-starchy vegetables.
He created “good” versus “bad” food rules in his head.
All non-carbohydrate foods were “good”, and all carbohydrate-dense foods were “bad.”
“Bad” meant “Don’t eat any.” “Good” meant “Eat as
much as you want.” Since the “good” foods didn’t have
carbohydrates, he figured they couldn’t possibly result
in accumulation of body fat. So he ate the “good” foods
until he was stuffed.
Well, we channeled our inner Dr. Phil and asked him,
“How’s that working for you?”
After six months, his answer was: “Not so good.”
Instead of losing weight (like he’d hoped), he’d gained
weight. He also felt worse in general and his doctor said
his lipid panel wasn’t moving in a healthy direction.
After some troubleshooting and sanity checking, we
worked with him on building more balanced, reasonable meals. No more 22 oz steaks with veggies soaking
in butter. Instead, his meals looked more like a 6 oz
steak, a baked potato, and plenty of veggies, drizzled
with a little olive oil. He would even include a reason-
Nutrition: The Complete Guide
ably sized dessert after some meals.
With this new plan, his diet was nutrient-rich and
satisfying. He didn’t feel deprived and compelled to
over-eat. He didn’t end up with too much or not enough
carbohydrate. He simply ate reasonable portions, based
on his body’s needs. Imagine that!
With this new plan, he felt better and saner. He got rid
of strict “food rules” and eventually, some of that extra
body fat too.
Dividing foods, or entire groups of nutrients, into
“good” or “bad”, almost never helps. If people take in
more energy than they expend, they’ll gain weight no
matter what they’re eating. Period.
As a nutrition coach, one of your jobs is to help clients
develop perspective and reasonable limits.
A slice of toast with breakfast, a side of brown rice at
lunch, a piece of fruit as a snack, and a baked potato
with dinner likely won’t be “limiting factors” for most of
your clients.
Instead, it’s probably the sugary sodas, candy snacking,
forgotten late-night desserts, and weekend bingeing —
ironically, that often go along with stringent restriction
— that are the real problems.
With most clients, the more they restrict, the more likely
they are to make up for it in other ways. Classifying all
carbs as “bad” will probably lead to eating more — in
the form of processed carbs or just excess calories in
general — in the long run.
Energy Transformation and Metabolism | 111
How much protein can we use?
At some point, you’ll be asked the following question:
“Can I absorb more than 30 g of protein per meal?”
First, we absorb most of the protein we eat, because
absorbing simply means digestion followed by digestive
products entering circulation.
Second, how much protein we can use will differ from
person to person.
Think about:
• an adolescent going through puberty
• a 70-year-old trying to preserve lean mass
• a woman who is pregnant
• an athlete new to intense physical training.
• a person on a restricted calorie diet.
They will all need more protein.
Then think about a sedentary adult. They won’t need as
much protein.
Later, we take a closer look at meal templates and how
to make sure your clients are getting what they need. For
now, just remember that while we need protein, like any
other nutrient we want to eat it in the right amounts.
Summary
Adenosine triphosphate (ATP) is the energy currency
of our cells. Breaking ATP’s chemical bonds to create
adenosine diphosphate (ADP) and phosphate (P) releases
energy.
The ATP-PCr pathway gives us energy when we need it
quickly. This process, which uses stores of creatine phosphate in the muscle, can transfer energy very quickly.
Though fast-acting, it’s short-lived.
When the energy in ATP is released, ADP and P must be
recycled so that we can keep going.
The glycolytic pathway uses glucose molecules and
glycerol to transfer energy when it’s in high demand
and when the ATP-PCr pathway has been depleted. This
system can provide energy for about 80 seconds before
it’s maxed out.
We store only a little ATP. So we must get more energy
from nutrients like carbohydrates, fats, and proteins.
Carbohydrates, fats, and proteins transfer their energy
through many different metabolic pathways in the body,
which split the carbon-hydrogen bonds in these nutrients and help replenish ATP.
There are three main energy transfer pathways: the ATPPCr pathway, glycolysis, and oxidative phosphorylation.
Oxidative phosphorylation gives us lots of ATP but it’s
relatively slow and needs oxygen to run. Through the
Krebs cycle and the electron transport chain, oxidative
phosphorylation takes acetyl-CoA derived from carbohydrates, proteins, and / or fats and uses it to transfer
energy to form a large amount of ATP.
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UNIT 4
Energy Balance in the Body
Energy Balance in the Body | 113
Unit Outline
1.
Energy value of food
5.
Case study 1
2.
Estimating energy needs and energy intake
6.
Case study 2
3.
Energy balance and imbalance
7.
Summary
4.
Achieving energy balance… naturally
Objectives
In this unit, you’ll learn about energy balance: the rela-
We’ll also explore how food type (for instance, minimally
tionship between energy we take in (in the form of food)
processed versus highly processed foods) affects energy
and energy we put out (in the form of activity and basic
balance and our body’s natural abilities to control our
metabolic functions).
appetite, hunger, and fullness.
Energy balance affects many processes in the body, ranging from bodyweight to hormones — even our moods.
Energy value of food
As you learned in previous chapters, the food that we eat contains potential
energy. Potential energy is energy that’s stored in a physical system and can be
converted into work, or kinetic energy. As we’ve also discussed in previous chapters, the chemical bonds in our food give us a rich source of potential energy.
When we break these bonds, we can transfer this energy to regenerate ATP, and
eventually, the ability to do the work of metabolism and movement.
potential energy: Energy stored
within a physical system
kinetic energy: Energy
generated by motion
Joule: Unit of energy; 4.184 Joules
equal 1 calorie
Measuring energy
With most energy systems, the standard unit of measure for potential energy
is the Joule. Technically speaking, one Joule is the amount of energy it takes to
move an object that weighs one Newton (0.445 lb) across a one-meter distance.
If you live or travel outside of North America, you’ll often see Joules or kilo-Joules (1000 joules) as units of measurement on food labels. In North America, it’s still most common to measure this energy in Calories.
One Calorie equals 4.18 Joules. Therefore, if you eat a 1000-Calorie diet, you’re
getting 4180 Joules of potential energy. Technically speaking, a Calorie is a unit
of heat measurement. (If you speak Spanish — or know your ancient Latin —
you’ll know the term calor, or heat.)
There are small calories (cal) and large Calories (Cal or kcal).
•
Small calories represent the amount of heat required to raise the temperature
of one gram of water by 1 degree Celsius.
•
Large Calories represent the amount of heat required to raise the temperature
of one kilogram of water by 1 degree Celsius.
Calorie (large calorie):
Amount of energy required to
raise the temperature of one
kilogram of water by 1 degree
Celsius; equal to 4184 Joules
calorie (small calorie): Amount
of energy required to raise the
temperature of one gram of water
by 1 degree Celsius; equal to
4.184 Joules
kcal: Used to express food
energy, represents a Calorie
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In other words, one large Calorie (kcal) equals 1000 calories (cals).
This can seem a little confusing at first. However, just think of it this way:
•
Small calories are smaller and use a lower case c.
•
Large Calories are 1000 times larger and, appropriately, use an upper case C.
We have to be careful to refer to our Calories correctly. When it comes to food
Calories, we usually mean large C or kilocalories (kcals). So, when we tell our
friends that we ate a 500 “calorie” lunch, we actually ate 500 Calories or kcals. In
this textbook, we’ll generally use the layperson term most often used to describe
food energy (for instance, on food labels), which is “calories.” Just remember that
most of the time, this less-precise use of “calories” actually means kilocalories.
Why use units of heat (calories or Calories) to measure the potential energy in
food versus units of work (Joules)?
bomb calorimeter: A rigid
vessel used for measuring heat of
combustion
Well, scientists measure the energy content of food by combusting the food
(i.e., burning it) in what’s called a bomb calorimeter. This device is sort of like
a little kid’s Easy Bake oven toy.
Food goes into the chamber, which is sealed. Electrical energy ignites the
food. As the food burns, it heats up the surrounding air in the chamber, which
expands and escapes through a copper tube. As the air escapes, it also heats
up the water outside the tube. Observers can then calculate the food’s calorie /
Calorie content by measuring the change in the water’s temperature.
Here, the amount of energy in the food determines how hot the water can get. So
in this case, it makes sense to describe food energy in terms of heat units.
Energy differs by nutrient type
Different macronutrients and substances make different amounts of heat. Here
are some examples of the energy released from particular molecules in a bomb
calorimeter.
1 gram of fat
=
9.44 kcal
1 gram of starch
=
4.18 kcal
1 gram of sucrose
=
3.94 kcal
1 gram of glucose
=
3.94 kcal
1 gram of protein
=
5.65 kcal
1 gram of alcohol
=
7.09 kcal
Perhaps you’ve heard that fat contains 9 kcal per gram, carbohydrates 4 kcal per
gram, protein 4 kcal per gram, and alcohol 7 kcal per gram.
Are these just rounding errors?No, not really.
This seems like a contradiction only because the numbers you’ve heard are actual
physiological values (in other words, how the substance behaves in the body) while
the numbers above are those obtained outside the body (in a bomb calorimeter).
Nutrition: The Complete Guide
Energy Balance in the Body | 115
The mystery of the microbiome
Decades ago, most people probably never thought that
the medicine of the future would involve swapping
poop around.
However, now that we have learned how important
the microbiome is for our GI and overall health, fecal
transplants (which transfer, well, poop from one person’s colon to another person’s colon) have become a
low-tech medical miracle for many formerly devastating
illnesses such as Crohn’s disease or Clostridium difficile
bacterial infections.
Fascinatingly, fecal transplants can actually change our
body composition. Scientists have turned fat mice into
lean mice and vice versa by swapping their intestinal
microbes (though this is unlikely to be as effective in
humans).
And in early 2015, news agencies reported that a
woman became obese, rapidly gaining over 40 lb (18
kg), after a fecal transplant from her daughter, who also
rapidly became overweight herself.
“It is now our policy to use non-obese donors for fecal
microbiota transplantation,” concluded the woman’s
doctors dryly.
What affects the energy we can get from food?
This brings up an important point: Humans are not
bomb calorimeters. As you’ve learned in previous chapters, there are many factors that can affect how food is
digested, absorbed, and used. Biological systems are not
the same as simple machines.
Even if we know exactly how many calories are going
into the body (which we usually don’t), it’s very hard to
know exactly how many calories we will absorb and use.
This means that for the most part, precise calorie counting won’t help you or your clients. Here’s why.
Factors affecting digestion and
absorption, and use
We lose some energy through the process of digestion.
So even if food contains a given amount of energy, we
will always lose at least a little bit of it.
The health and function of our GI tract — including that
of our intestinal bacteria — can affect how much energy
we absorb and use. Some evidence suggests that the
bacteria living in the guts of obese people are better at
getting energy out of food than the bacteria living in the
guts of lean people. See sidebar below for more.
We may also lose energy in excretion. For instance,
some of the potential energy stored in protein’s nitrogen
bonds can be lost through deamination (which we covered in the previous unit) and excretion. So some energy
remains trapped in the protein’s nitrogen bonds, and we
urinate it out.
Although we lose some of the potential energy in our
food through digestion and excretion, we still do a pretty
good job of saving much of this potential energy for the
resynthesis of ATP. We use about 91% of the energy in
our food. That’s pretty efficient! (By comparison, the
efficiency of a car’s internal combustion engine — how
well it uses the gas to get you to your destination — is
estimated to be around 12-30%.)
Factors affecting nutrients and energy
in food
As you can see, there are many things about our body
that can affect how much and how well we get energy
from our food. The food itself can also vary.
Although numbers on food labels may seem scientific,
they’re just approximations. Most foods aren’t directly
measured in a lab. Imagine trying to combust a sample
of every one of the 40,000 foods on grocery store shelves
as the food comes out of the ground, is removed from
the animal, or is dispensed by the assembly line. It’s not
happening!
Here are just a few of the factors that can change the
nutrient and energy content of foods:
Resistant starches / fibers
These will be shown on labels as kcal and grams of carbohydrate. But we don’t get as much energy from them
as a bomb calorimeter does. So energy counts can be
overestimated here.
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Outdated data
Some data on foods can be out of date and inaccurate,
throwing off energy and nutrient calculations on the
label or in nutrient databases.
Imprecise analytical methods
An analysis is only as good as its testing method. And
the way we currently test nutrients and energy doesn’t
always provide reliable results, for many reasons beyond
the scope of this text.
Product variety
Different batches of both natural and processed foods
vary in their exact contents. A single test at a single point
in time can’t accurately describe all batches.
Soil and growing conditions
Plants are dynamic organisms. They differ depending on
soil, climate, sunlight, latitude, and other factors. This
will affect the nutrients and energy they contain. (Winemakers refer to this as terroir, the subtly varying and
characteristic flavor or composition of a wine depending
on the very specific location where its grapes are grown.)
Ripeness at time of harvest
Ever had a fresh-picked tomato at the end of the summer? Completely different than a tomato you bought at
the supermarket in mid-winter, right? Produce picked
fresh, at its seasonal peak, will have a much different
nutrient makeup than produce picked out of season
and / or unripe. And some foods, such as wheat, can be
harvested at different times of the year, which changes
the nutrient composition.
may be wildly different from reality — as much as 25%
more or less than what the package claims. Research also
shows that some frozen foods can contain 8% more calories than the package lists. And some restaurant meals
can have up to 18% more calories than they claim.
All of this means that, outside of a lab:
•
We can’t know exactly how many calories and nutrients we absorb, use, and / or excrete.
•
We can’t know exactly how many calories and nutrients are in our food.
•
We can’t know exactly how many calories and nutrients we expend through metabolism and movement.
All this points to one thing: Calorie counting as a way
to manage diet and exercise is time consuming, difficult,
and grossly inaccurate. We’ll talk about a better way to
balance energy intake later.
The body’s need for energy
As we’ve discussed previously, the total amount of energy
required for each of our physiological actions is referred
to as metabolism. We can group these into five general
categories:
1. Basal metabolic rate (BMR)
2. Resting metabolic rate (RMR)
3. Thermic effect of feeding (TEF)
4. Exercise activity
Animals’ diets
The nutrients / energy found in milk, meat, and eggs
vary based on what animals eat and how they live.
5. Non-exercise activity thermogenesis (NEAT)
Length of storage
There’s a big difference in nutrient count between
produce harvested this morning and produce harvested
three weeks ago in a different time zone.
1. Basal metabolic rate (BMR)
Preparation / method and cooking time
Eating raw produce is different than eating cooked
produce. The amount of cooking and processing affects
the amount of energy and the nutrients we are able to
get from the food. In fact, cooking usually makes more
energy available to us.
All of these factors combined mean that the energy and
nutrients listed on food labels or in nutrient databases
Nutrition: The Complete Guide
Let’s look at each one in turn now.
Imagine you’re asleep and haven’t had a meal in a while.
You’re breathing. Your heart is beating. Your cells are
doing the bare minimum to keep you alive. But you’re
not digesting, moving, or doing much else. That’s your
basal metabolic rate, or BMR.
The BMR is the minimum level of energy we need to use
to maintain vital functions of the body. To accurately
measure a person’s BMR, scientists make them fast (so
there’s no digestive activity) and then lie motionless in
an environmental chamber.
Energy Balance in the Body | 117
Since oxygen consumption is related to energy production, scientists then measure BMR by figuring out how much oxygen that person consumes per minute.
This can be done in a laboratory setting using what’s called a metabolic cart.
What’s especially interesting is that BMR accounts for over 70% of the oxygen
(and energy) we consume each day! That’s right, 70% of the energy we expend goes
toward non-movement related physiological activity. Keeping us alive is hard work!
2. Resting metabolic rate (RMR)
Like BMR, RMR is measured during rest. However, it’s easier to figure out RMR,
since measuring BMR requires extreme conditions (e.g., fasting, extended bed
rest, tight environmental control).
RMR is measured in a similar way as the BMR, using measures of oxygen
consumption. Although RMR is slightly higher than BMR, it’s usually no more
than a 10% difference. Small amounts of movement, different environments, and
digestion will affect RMR.
3. Thermic effect of feeding (TEF)
Digestion, absorption and assimilation of ingested food / nutrients is an active
process — it takes energy. The very act of eating food increases the metabolism.
How much our metabolic activity goes up depends on which macronutrients we
eat. We often speak of this in terms of thermic effect, which comes from the ancient Greek therme, or heat, and which also gives us the term “thermogenesis”,
or the production of heat.
thermogenesis: The process of
heat production in the body
Proteins tend to have the highest thermic response, as it takes the body more energy to process them, while fats tend to have the lowest thermic response. (You’ll
know this if you’ve ever had the dreaded “meat sweats.”)
TEF is usually around 10% of total daily energy expended. It can be affected by
other factors, such as insulin resistance, which lowers TEF.
4. Exercise activity (EA)
The energy used to perform purposeful exercise (like going for a run, or doing a
gym workout) is typically called EA. Of course, this component of daily energy
expenditure varies widely from person to person.
•
For sedentary folks, this component of metabolism can make up 10-15% (or
less) of their daily energy demand.
•
However, for highly physically active folks, it can be 30% or more.
As you may already know, higher-intensity exercise activity not only creates a
demand for energy transfer during the actual activity; it also creates a higher
demand after the activity. This increase in excess post-exercise oxygen consumption (also known as EPOC) helps to make up for the energy deficit created during
the activity itself. It also increases daily energy expenditure / metabolism.
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Total daily energy expenditure for sedentary
and physically active individuals
Physical activity - 30%
Physical activity - 15%
Other factors
(Cold, effect of food intake) - 10%
Basal metabolic rate - 75%
Basal metabolic rate - 60%
Sedentary person
(Low physical activity)
Physically active person
Energy expended
Other factors
(Cold, effect of food intake) - 10%
Figure 4.1 Total daily energy expenditure (or metabolic rate) breakdown
5. Non-exercise activity thermogenesis
(NEAT)
But it’s an important part of weight loss or gain. And it
can vary a lot between people. See sidebar below.
Non-exercise activity thermogenesis (NEAT) is another
part of metabolic rate. This is all the daily-life movement
that isn’t deliberate exercise, such as:
Total daily energy expenditure (TDEE)
•
moving around our homes or workplaces;
•
fidgeting and pacing, wiggling or tapping our feet;
•
housework or yard work;
•
playing with our kids or pets;
•
carrying groceries; and
For most folks who don’t have physically active jobs,
NEAT contributes the least to daily energy expenditure.
Nutrition: The Complete Guide
Together, these metabolic and movement activities make
up our total daily energy expenditure (TDEE).
Since RMR = BMR + metabolic maintenance activity
and physical activity = EA + NEAT, we can represent
TDEE like this:
RMR + physical activity + TEF = TDEE.
See Figure 4.1 for how these vary in sedentary and physically active individuals.
Energy Balance in the Body | 119
Eating more but not gaining weight? Well, that’s NEAT.
While it’s true that our weight depends on energy in
versus energy out (aka energy balance), it’s not always a
straightforward mathematical equation.
Our body has all kinds of tricks to maintain homeostasis,
or a dynamic equilibrium.
Have you ever wondered why some people seem to be
able to eat more but not gain weight? (And why there’s
always That Guy who runs in shorts in the winter?)
The answer may lie in NEAT.
Humans and other animals can regulate their bodyweight and eating behavior in many ways, which we
look at throughout this textbook. One interesting feature of this dynamic balance is that over the long term,
the body often tries to stay or get back to its preferred
weight.
Most of us know this happens on crash diets. People
eat a lot less. They lose weight. And then they gain it all
back. We saw this in one of our earlier case studies.
But did you know that this can also happen when people try to gain weight?
Scientists have tried to make humans and other animals
fat by overfeeding them. Interestingly, while some
humans and animals gain weight pretty well and keep it
on, many don’t.
Instead of storing that extra energy in fat tissue, many
people’s bodies expend it as heat and movement.
When over-fed, many people just get warmer and move
around more, instead of getting fatter.
Some people are able to burn off nearly 700 extra calories per day from NEAT, while others hardly burn off any!
Many people also naturally compensate later on: If overfed one day, they’ll eat less the next day, without even
thinking about it.
Somehow, their appetite and hunger regulation systems
know exactly how much they should be taking in and
expending through NEAT to maintain homeostasis.
So if you have that family member or friend who seems
to stay “naturally lean”, look at how they move and
whether they wear a coat on cold days.
Or perhaps you are that “naturally lean” person who always wondered why you “eat a lot” but don’t gain much
mass. Now you know: You’re a human furnace (that,
and the arcuate nucleus region of your hypothalamus is
simply better at maintaining homeostasis than most).
Estimating energy needs and energy intake
In this section, we’ll get into some equations. If math
isn’t your thing, don’t get freaked out: We won’t ask you
to remember exact numbers (without help from your
open textbook). The exact numbers are not the point.
What matters is that you understand the relationship
between things, such as:
•
oxygen consumption goes up as energy demands go
oxidative phosphorylation. Thus, knowing how much
oxygen we consume can help us estimate energy cost
and metabolism.
Energy transfer will differ slightly depending on whether
we are oxidizing fat or carbohydrate.
•
of oxygen is consumed in the oxidation of fat.
up;
•
there are many ways to measure energy balance; and
•
bodies will differ in their energy needs depending on
factors such as genetics, bodyweight, age, and sex.
Oxygen and energy balance
You may remember from the previous unit that we need
oxygen for the electron transport chain activities of
About 4.7 kcal of energy are transferred when 1 liter
•
About 5 kcal are transferred when 1 liter of oxygen is
consumed in the oxidation of carbohydrate.
But remember, we never really burn just fat or just carbohydrate for energy. We’re always using a mix. Thus:
On average, about 4.82 kcal of energy are transferred
when 1 liter of oxygen is consumed in the oxidation of
this mixed fuel.
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To put this into perspective, at rest we typically consume about 3.5 milliliters of
oxygen per kilogram of bodyweight per minute.
Let’s look at a sample person who’s 154 lb (70 kg).
At rest, they’d consume:
3.5 mL of oxygen x 70 kilograms of bodyweight x 60 minutes =
about 14,700 mL or 14.7 liters of oxygen per hour
14.7 liters x 24 hours = 352 liters of oxygen a day
4.82 kcal x 352 liters of oxygen = 1700 Calories a day
Add exercise and our 154 lb person would breathe harder and faster, consuming
more oxygen. As more oxygen is consumed, more kcal are burned, increasing
total Calorie cost and total metabolic rate.
Again, the exact numbers don’t matter. The most important thing to understand
here is that oxygen consumption and energy demand are directly linked.
As we need and use more oxygen, we need and use more energy.
Measuring metabolic rate
Indirect calorimetry
indirect calorimetry:
Estimation of energy expenditure
via the measurement of oxygen
consumption and carbon dioxide
production
In the laboratory, the main measurement technique used to quantify metabolic
rate is known as indirect calorimetry.
When using this technique, researchers give a test subject a mouthpiece (attached
to a computerized measurement device) and a nose clip. As all air exchange
happens through the mouth in this set-up, the computer can then measure how
much oxygen is consumed and how much carbon dioxide is produced during a
given activity.
This air sampling is recorded, providing direct, real-time measurements of
oxygen consumption. Based on these measures, testers can determine the energy
cost of whatever activity is being measured, whether it’s lying on a bed or running on a treadmill.
Respiratory quotient
Here’s an interesting side note. You may have wondered: How can someone know
exactly what mix of fuel types they’re using?
respiratory quotient (RQ):
Ratio of the volume of carbon
dioxide expired to the volume
of oxygen consumed in a given
period of time, indicative of the
substrates being used
Nutrition: The Complete Guide
During indirect calorimetry, testers can estimate the fuel mixture using the
respiratory quotient (RQ). The RQ is calculated by dividing the number of carbon dioxide molecules produced by the number of oxygen molecules consumed
during the activity.
RQ = VCO2 produced / VO2 consumed
Energy Balance in the Body | 121
Substance
Volume (in l/g)
0 2 consumption
CO2
production
Respiratory energy equivalent
O2
CO2
RQ
Protein
0.94
0.75
4.46
5.57
0.80
Carbohydrate
0.81
0.81
5.05
5.05
1.00
Fat
1.96
1.39
4.74
6.67
0.71
Alcohol
1.46
0.98
4.86
7.25
0.67
Figure 4.2 Respiratory quotients (RQ) for the major macronutrient categories
For instance:
•
The RQ for glucose is 1.0. (6 CO2 molecules are produced as 6 O2 molecules are
consumed during the oxidation of glucose.)
•
The RQ for fat is 0.7. (16 CO2 molecules are produced as 23 O2 molecules are
consumed during the oxidation of fat.)
•
Since proteins are broken down into individual amino acids and the nitrogen
groups are removed, the RQ for protein is about 0.8.
See Figure 4.2.
Direct calorimetry
Another measurement strategy used for this purpose is called direct
calorimetry.
With direct calorimetry, energy expenditure is recorded by measuring the rate at
which heat is produced by the body. This method is more precise as it puts subjects in an air-tight chamber that carefully measures all the heat lost and gained.
direct calorimetry: Direct
measurement of heat output by
the body; used as an index of
energy expenditure
However, this method requires large, expensive environmental chambers that
few research laboratories can afford.
Predictive equations
Both indirect and direct calorimetry measure oxygen consumption and energy
expenditure accurately. But they’re not very practical for everyday use.
Instead, we can use predictive equations to estimate how much energy the body
uses. These are based on a number of factors such as sex, age, height, and weight.
They’re less accurate than calorimetric methods, but they can give us some reasonable estimates of normal energy expenditures for particular types of people.
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Table 4.1 Sample RMR values from various equations
Male, 80 kg,
178 cm tall,
45 years old
RMR
Female, 54 kg,
160 cm tall,
19 years old
RMR
Harris-Benedict
Owen
Mifflin-St. Jeor
66.5 + (13.75 x 80)
+ (5.0 x 178)
– (6.76 x 45)
879 + (10.2 x 80)
(10 x 80) + (6.25 x 178)
– (5 x 45) + 5
1,752.3
1,695
1,692.5
655 + (9.56 x 54)
+ (1.85 x 160)
– (4.68 x 19)
795 + (7.2 x 54)
(10 x 54) + (6.25 x 160)
– (5 x 19) – 161
1,378
1,183.8
1,284
Here are a few examples of commonly used equations:
Harris-Benedict equation for RMR
Owen equation for RMR
For men
For men
RMR (in kcal / day) =
RMR (in kcal / day) =
66.5 + (13.75 x weight in kilograms) +
879 + 10.2 (weight in kilograms)
(5.0 x height in centimeters) - (6.76 x age in years)
For women
For women
RMR (in kcal / day) =
RMR (in kcal / day) =
655 + (9.56 x weight in kilograms) +
(1.85 x height in centimeters) - (4.68 x age in years)
Note: You can adjust the Harris-Benedict equation if
you want to lose weight. This will give you a formula
for the RMR of your desired weight. Use the following
formula, plugging the adjusted weight (in kg) into the
formulas above.
Adjusted weight (in kg) =
[(actual bodyweight in kg - ideal weight in kg) x
0.25] + ideal wt in kg
So, for instance, if you are a 6’2” (188 cm), 40-year-old,
250 lb (113.4 kg) man and want to get to 200 lb (90.7 kg):
(Actual bodyweight of 113.4 kg ideal weight of 90.7 kg) x 0.25 = 5.68
5.68 + ideal weight of 90.7 kg =
96.4 as adjusted weight
Then you would use the men’s formula and keep your
age the same, but put in 96.4 kg as your ideal weight.
Thus:
RMR = 66.5 + (13.75 x 96.4) +
(5.0 x 188) - (6.76 x 40)
RMR = 66.5 + 1325.5 + 940 - 270.4
RMR = 2062 kcal per day
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795 + 7.2 (weight in kilograms)
Mifflin-St. Jeor equation for RMR
For men
RMR (in kcal / day) = 10 (weight in kilograms) +
6.25 (height in centimeters) - 5 (age in years) + 5
For women
RMR (in kcal / day) = 10 (weight in kilograms) +
6.25 (height in centimeters) - 5 (age in years) - 161
Table 4.1 shows an example of the RMR values that two
hypothetical people might achieve with each equation.
Welcome to the wonderful world of variations.
You may wonder why age and biological sex are so
important. On average, younger people have more lean
mass than older people, and men have more lean mass
than women. Lean mass costs energy to maintain, and
so it’s a major factor in RMR.
Yet even when we match subjects based on their lean
mass, age, and sex, they can still vary quite a lot from
one another (up to 30% difference).
Restrictive dieting and chronic physical stress can also
lower RMR significantly (usually 5-10%, up to 15%).
Many dieters, for instance, report being cold. Persistent
Energy Balance in the Body | 123
Go on a diet
(restrict energy intake)
Weight re-gain
(often heavier than before)
Lower energy intake
reduces metabolic activity
Despite more energy coming in,
metabolism may not go back up
to previous baseline; RMR stays
lower than before dieting
Body tries to restore
energy balance with
increased appetite
Dieter “falls off the wagon”
(or simply stops dieting
once goal is achieved) and
increases food intake
By far, the most commonly used predictive equation is
the Harris-Benedict equation, which was developed in
1919. However, as you can see in Table 4.2, the Mifflin-St.
Jeor equation predicted metabolic rate better (when compared with calorimetry) than the other equations.
No equation is perfect. Even the best equations only get
within about 10% of the actual RMR value measured in
a lab.
Therefore, if a predictive equation approximates your
RMR at 1700 kcal / day, consider yourself lucky if your
RMR is actually anywhere between 1530-1870 kcal / day.
If you’re obese, or just someone for whom the equation
doesn’t really work, this number could be off by as much
as 43%!
Figure 4.3 The diet-overeat-repeat cycle
dieters may find that their thyroid function or sex
hormone production goes down, or that they become
constipated as their GI tract slows its pace.
If you have a client who presents with signs of a lowered metabolic rate, ask about their history of dieting.
See Figure 4.3.
So unless you live in a research lab and can measure both
your intake and expenditure with tightly controlled laboratory observation, trying to count calories and measure
them against expended calories is a losing battle. Food labels and energy expenditure equations are just estimates,
and not very good ones at that. Although they get you
in the right ballpark, following the numbers as if they’re
true and accurate can lead to immense frustration.
Table 4.2 Accuracy of RMR equations versus actual measurement
Equation
Nonobese, 20-82 y,
BMI = 18.5-29.9
Obese, 20-82 y, BMI >30
Older adults, 60-82 y,
nonobese and obese
Mifflin-St. Jeor
82% of estimates are
accurate
Error range: Underestimation by 18% to overestimation by 15%
70% of estimates are accurate
Error range: Underestimation by
20% to overestimation by 15%
Accuracy within 10% not available
Error range: Underestimation by 18% to
overestimation by 5% in men
Underestimation by 31% to overestimation
by 7% in women
Harris-Benedict
Actual bodyweight
45-81% of estimates are
accurate
Error range: Underestimation by 23% to overestimation by 42%
38-64% of estimates are accurate
Error range: Underestimation by
35% to overestimation by 43%
Accuracy within 10% not available
Error range: Underestimation by 19% to
overestimation by 9% in men
Underestimation by 27% to overestimation
by 12% in women
Harris-Benedict
Adjusted bodyweight
N/A
26% of estimates are accurate
Error range: Underestimation by
42% to overestimation by 25%
Individual prediction accuracy using ABW is
not reported for older adults
Owen
73% of estimates are
accurate
Error range: Underestimation by 24% to overestimation by 28%
51% of estimates are accurate
Error range: Underestimation by
37% to overestimation by 15%
Accuracy within 10% not available
Error range: There is no error range for men
In white women, maximal underestimation
by 27% to overestimation by 12%
Table adapted from: Frankenfield D, Roth-Yousey L, Compher C. Comparison of predictive equations for resting metabolic rate in healthy nonobese and obese
adults: a systematic review. J Am Diet Assoc 2005;105:775-789
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124 | Unit 4
What does your daily energy expenditure involve?
Take a minute to think about all of the various factors
that might affect your energy expenditure each day.
Let’s walk through a sample day of a hypothetical you.
You wake up early because your child is sick. You run
around the house trying to clean up after your child,
transfer him to your caregiver, and get ready for work.
No time for breakfast. You chug a cup of caffeinated
coffee instead.
You get in the shower. Darn it! No hot water left! You
take a cold shower.
You get dressed (having to fling some clothes out of the
dryer to find your pants) and run out the door. The bus
is on its way. You sprint to catch it while carrying your
heavy briefcase.
It’s mid-summer and the bus doesn’t have air conditioning. You’re sweating like crazy.
You hop off the bus and scurry to work. The escalator is
packed with people standing, so you rush up the stairs
instead.
At work, you eat a bowl of lentils and steak for lunch
while thinking about your looming deadline. Your heart
rate goes up just thinking about all the PowerPoints and
TPS reports you have to do. Plus you’re fretting about
your child.
Late in the afternoon, you think maybe your kid’s virus is
starting to infect you. You’ve got a slight fever.
Sitting, you notice your belly is hanging over your waistline a little bit. You think about aging and your own
mortality for a few minutes.
Okay, end of work and you need to chill out. One more
call to the caregiver while you walk to yoga. Your child
seems better, so you relax a little bit.
Yoga is relaxed and meditative. No fancy poses or grunting today.
After yoga (one more call to the caregiver — child is
happy, healthy, and playing with action figures) you go
out for dinner. You treat yourself to white pasta, dessert,
and two glasses of wine.
You arrive home, tuck your little one into bed, and relax.
You tuck yourself into bed, where you enjoy a deep
sleep and surge of growth hormone release.
Of course, this is just a random combination of events
for one made-up person.
Think about how each one of those variables might
influence energy expenditure. Then think of the vast
numbers of combinations that take place each day in all
of our lives.
You could probably never capture all of those variables
for each unique person with a simple mathematical
equation that predicts energy expenditure.
Energy balance and imbalance
As we’ve seen, energy balance affects bodyweight.
energy imbalance: When the
amount of energy intake doesn’t
meet, or exceeds, the amount of
energy output
•
If we take in more energy than we use or excrete, we gain weight.
•
If we take in less energy than we use or excrete, we lose weight.
In either case, when the input and output sides of the energy balance equation
don’t match, we say there is an energy imbalance.
Energy balance and imbalance don’t just affect bodyweight. They can affect every
physiological function right down to our cells’ function.
Energy balance: Simple, and not simple
In one sense, losing or gaining weight seems simple. You just take in less or more
energy than you expend. So you change what you eat and you change how much
exercise you do.
But there are many other factors at work. (As several frustrated dieters trying
Nutrition: The Complete Guide
Energy Balance in the Body | 125
to lose weight or skinny folks trying to put on muscle
have found.)
Among others, these factors include:
•
our individual environments;
•
our genetics and epigenetic expression;
•
our hormones;
•
what we can digest and absorb; and / or
•
physiological and psychological stressors.
All of these can work together in subtle (or obvious)
ways to affect how much you eat, how much you move,
and how much energy your body uses for metabolism
and movement.
This doesn’t mean the energy-in versus energy-out
equation doesn’t hold. Bodies can’t break laws of thermodynamics. (Even though sometimes it might feel that
way.) We just don’t always know all the pieces of input
or output.
bones and lean muscles to body fat. For this to happen,
the body needs a signal to store nutrients in this lean
tissue.
Signals for lean mass building can include things like:
•
puberty
•
exercise
•
pregnancy
•
anabolic hormones such as testosterone (either what
we produce, or what we supplement)
•
some nutritional supplements
•
other anabolic drugs
Yet even if we have the right signals, our body can only
build lean mass so fast. So if we eat much more than our
body can keep up with, we’ll still gain fat along with that
As a Certified Nutrition Specialist, your job will often
involve hunting for the mystery input or output that is
affecting your clients’ results.
Gaining weight
When we take in more energy than we put out, we have
to store that energy somewhere.
As we’ve seen:
•
The main storage form of carbohydrate is glycogen
(stored primarily in the muscle and liver).
•
Glycogen
Phosphorous
Calcium
The main storage form of fat is triglyceride (stored
Water
42 kg
Other
Mg, Cl,
Fe, Zn, Cu
Potassium
Sodium
primarily in the muscle and adipose tissue, and sometimes the liver).
•
Protein doesn’t quite get stored in the same way as
carbohydrate or fat. But you can still think of the
Fat 12 kg
Protein 12 kg
body’s amino acid pools and protein sources as a
“reserve” of protein.
Everything, no matter what it is, has to go somewhere.
More energy in than out means we gain mass.
We can either gain that mass as fat (with triglyceride
storage) or lean mass (with carbohydrate storage and
muscle gain, along with things like proteins in bone
and connective tissues).
Of course, most of us would prefer having strong, dense
Figure 4.4 Body composition of a normal-weight male
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Liver glycogen level
126 | Unit 4
An evening
snack
Lunch
Breakfast
Dinner
8:00
12:00
16:00
20:00
24:00
4:00
8:00
Time
Figure 4.5 Typical daily variation in liver glycogen concentrations
valuable lean tissue. (This is why the “seefood diet” —
eating everything in sight — isn’t a great plan even for
clients who really need to put on some muscle.)
Losing weight
When we take in less energy than we put out, we lose
weight.
As you now know, about 70% of our daily energy goes
towards simply keeping us alive. Even if we don’t exercise, we’re still always using energy. Of course, if we add
exercise, we increase energy output. We also send our
body signals about how to use nutrients (i.e., for energy
regeneration, or to preserve lean mass). Thus, exercise is
an important part of a weight loss plan.
As you’ve already learned, glycogenin the liver (which
fluctuates throughout the day, as shown in Figure 4.5)
and muscle is broken down to glucose, which can in
turn, regenerate ATP (see Figure 4.5). Our triglycerides
in muscle and adipose tissue are broken down into fatty
acids and glycerol.
If energy intake is low enough, or our carbohydrate and
fat stores are in short supply, our body will turn to protein from our muscles and other structures (such as bone
or internal organs). We definitely don’t want this, which
is why proper nutrition + resistance training is essential
for healthy and sustainable weight loss.
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Exercise and energy balance
We can’t control many of the factors that make up our
basal metabolic rate, and hence about 70% of our daily
energy demand. For instance, we can’t do much about
how old we are.
But we can change how much and how intensely we
exercise. Different types of exercise have different effects
on how we use energy.
•
High-intensity, short-duration activity burns a
modest amount of energy during the activity. However, after the activity, total energy expenditure can
stay up for hours (depending on the activity type and
intensity).
•
Low-intensity, long-duration activity burns
more energy during the activity (since the person is
exercising for such a long time). However, after the
activity, total energy expenditure returns quickly to
the resting baseline.
Both forms of exercise can help us control energy
balance.
High-intensity, short-duration activity
Here, we might find things like CrossFit, short track
cycling or downhill mountain biking, speed skating or
hockey, strength sports, or sprinting.
Energy Balance in the Body | 127
During these types of activity, our body prefers to use carbohydrates for energy.
This happens for a few reasons:
•
As we learned in previous chapters, the ATP-PCr system and the anaerobic glycolytic system run much quicker than the oxidative phosphorylation system.
•
Muscle glycogen isn’t fully depleted during short-duration activity. Thus, we
often have enough glycogen on hand for energy transfer early in our training
session.
•
We use mainly fast-twitch muscle fibers in high-intensity activity. These
fibers use glycolysis as a main energy transfer pathway.
These activities tend to create an “afterburn effect.” We still use more fuel after
they’re done — often for several hours afterwards.
Yet while we use mostly carbohydrates during these activities, after these activities, we use mostly fats.
fast-twitch muscle fibers:
Muscle fibers, characterized
by fewer mitochondria and
capillaries, which contract quickly
and with relatively more force, yet
fatigue more quickly than slowtwitch muscle fibers; includes
three subgroups
Low-intensity, long-duration activity
Here, we find endurance activities such as hiking, long-distance running or cycling, cross-country skiing, leisurely swimming, or even plain old walking.
During these types of activity, our body prefers to use fat for energy. This
happens for a few reasons:
•
Lower-intensity energy demands can easily be met by the Krebs cycle and
electron transport chain.
•
This type of activity involves mostly slow-twitch muscle fibers, which use
slower pathways. Thus more fat can be used to meet energy demands through
ß-oxidation.
•
As low-intensity activity stretches out over time and muscle glycogen becomes
depleted, our body will use more of the available muscle triglycerides and
plasma free fatty acids released during the activity.
See Figures 4.6, 4.7, and 4.8.
Choosing the right activity
This difference in fuel type has led to debates about which type of exercise is
“best” for losing weight and body fat.
As a Certified Nutrition Specialist, the most important consideration is what
your client actually enjoys and will do consistently. Don’t get too bogged down in
finding the “perfect” form of exercise, and don’t assume that one method will fit
everyone’s body or lifestyle.
But if you have the freedom to plan your clients’ exercise programs (and you
know that those exercise programs are right for those clients), consider a few
things.
First, the fuel used during any activity is just a percentage of the total, not all the
possible energy someone could expend.
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100
Figure 4.6
How macronutrients
are used at different
exercise intensities
2 - 5%
2 - 5%
5 - 10%
2%
90
Protein
80
35%
40%
Glucose + Glycogen
% of contribution
70
60
Fats
75%
50
95%
40
30
60%
55%
20
10
15%
3%
0
Figure 4.7
Percentage of energy
derived from the
four major substrates
during exercise
Rest
Light to moderate
exercise
High-intensity
endurance
exercise
High-intensity
sprint-type
exercise
100
90
Muscle triglycerides
% of Energy expenditure
80
70
Plasma free fatty acids
60
50
40
Blood glucose
30
20
Muscle glycogen
10
0
1
2
3
4
Exercise time (hours)
Figure 4.8
Energy substrate
contribution during
endurance exercise
Substrate as percentage of oxygen uptake
100
Muscle glycogen
Plasma free
fatty acids
75
50
25
0
Blood glucose
0
100
200
Minutes
300
Energy Balance in the Body | 129
So, let’s say a client expends 200 calories during a very short, high-intensity
exercise session. During that session, 80% of the fuel may come from carbohydrates. But your client has still expended only 200 calories.
Conversely, let’s say your client goes on a long hike with a backpack. During
that session, 80% of their fuel may come from fat. But they’re hiking for 3
hours, so they expend around 1500 calories.
Second, look at all the time your client realistically and consistently has available.
They may have, for instance, 45 minutes available, 4 times a week, no matter
what. Any activity of any type has to go in that slot. In that case, you might
prioritize higher-intensity activity so that your client spends those 4 x 45 minutes
doing the highest-demand exercises possible.
Third, look at what your client can do and manage. Higher-intensity work is hard
on the body. Most people can’t recover from doing “beast mode” high-intensity
work every day. One client’s “all-out sprint” may be racing Usain Bolt. Another
client’s sprinting may be a fast walk or a jog uphill.
All of this simply means that for most people, a mix of high- and low-intensity
exercise, and a range of activities, is probably the best choice. Clients are most
likely to recover well, enjoy what they’re doing, and (most importantly!) stick
to the plan when they have this kind of variety.
One more note on training and energy use: Different bodies respond differently
to exercise.
•
A highly trained body will be very efficient at exercising. For instance, a longtime runner will have a well-developed circulatory system with lots of vascularization. They’ll have plenty of the enzymes they need to transfer energy.
vascularization: The
development of vessels in a tissue
Their mitochondria will be well-oiled machines. And their heart will pump
more blood with every beat.
•
An exercise beginner’s body, or the body of someone switching sport types,
will be very inefficient. They’ll huff and puff with the slightest effort. Even
simple movements will seem hard.
Contrary to what you might think, we don’t always want to be efficient at
exercise.
•
If we’re trying to be the best in the world at a certain sport, then efficiency is
good. We want our body to use less energy to do more stuff.
•
If we’re trying to lose weight, we want the body to work harder and use more
energy. We want our energy output to go up as the body struggles to do things.
Again, if you’re in charge of helping clients with their exercise, you’ll probably
want a variety of efficient and inefficient. Clients need to be challenged, but they
also want to see progress. Nobody wants to feel inefficient all the time!
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130 | Unit 4
Nutrition and energy balance
As we’ve seen, nutrition can affect your energy balance
and total daily energy expenditure (TDEE) in important ways.
Overall energy intake
If energy intake is too low for too long (or if output is
too high for too long, which is less common but can
happen), the body will slow down important metabolic
functions to preserve what energy is left.
This will also usually slow down people’s exercise activity and NEAT. Athletic performance will get worse, and
people will feel sluggish.
Thermic effect of food
What matters is the amount of energy expended versus
the amount of energy consumed over time, not the precise fuel burned during a workout or training session.
Energy balance and body functions
Along with weight gain and loss, energy balance affects
other processes in our bodies, such as reproduction,
cognitive functions, metabolic functions, and repair
and regeneration.
Reproductive functions
Low energy intake
Reproduction and fertility take energy. The body monitors energy balance carefully to decide whether it’s safe
to make a baby.
As we’ve seen, protein is costly to process, and thus increases the thermic effect of food, or TEF. A higher-protein diet will thus raise TDEE.
This is especially true for women, whose bodies are extremely sensitive to changes in energy. But men can also
be affected, as many male athletes, particularly those in
physique or weight-cutting sports, have found out.
Nutrition and macronutrient use
When energy intake is low (and especially if energy
demands are high, such as for athletes), the body cuts
down production of sex hormones such as testosterone
and other androgens, estrogen, and progesterone.
Nutrition can also affect what macronutrients we use
during exercise.
If we eat a lot of carbohydrates around our exercise
sessions, that’s what we’re more likely to use for energy
regeneration. For clients doing long exercise sessions,
or clients trying to gain mass, taking in carbohydrates
during training can help keep their energy up, and the
body won’t have to turn to stored nutrients as much.
For women, this can mean irregular or lost menstrual
cycles, hormone disruptions (such as higher levels of
androgens, or masculinizing hormones), pre-menopause
symptoms or even early menopause. See Figure 4.9.
Conversely, if we eat meals with lots of protein and fat,
our body is more likely to use fat during exercise. Higher
levels of the hormone glucagon, combined with lower
levels of blood carbohydrate and insulin, tell our body to
do this.
And for both sexes, this can mean infertility, loss of
interest in sex, and mood changes.
But remember: The body is all about the big picture and
long-term regulation.
Loading up on fat before training may not actually help
your client burn more body fat during training (especially since fat is so calorie-dense… and since few people
want a big fatty meal in their stomachs during training). The body will usually just figure out other ways to
manage energy balance over the course of that day, or
the next few days.
Nutrition: The Complete Guide
For men, this can mean impotence and lowered energy.
Our body can’t tell the difference between real and potential starvation through self-imposed dietary restriction or even just obsessing about food and dieting. It
shuts down either way, just to be safe.
High energy intake
Having too much energy coming in and not enough
going out can also affect reproductive function.
Adipose tissue stores fat, but it also produces hormones.
Indeed, it’s one of the main sources of estrogen for women as their ovaries shut down in later life.
Energy Balance in the Body | 131
Normal nutrition
Brain
Under-nutrition
Gonadotrophin
releasing hormone
(GnRH)
Pituitary
Gland
GnRH
Brain
Leptin
_
Fat
cells
Insulin
LH
FSH
+
_
Pancreas
Testosterone (T)
Estradiol (E2)
Progesterone (P)
Sex steroids
Leptin
+
Puberty
Menarche
Ovulation
_
+
Sex steroids
Pancreas
Insulin
Insulin
T
E2
P
Insulin
LH
Pancreas
Ovary
'Physiological'
hyperinsulinaemia
at puberty reduces
SHBG and thus
amplifies normal
production of
sex steroids
Fat
cells
Insulin
LH
FSH
Insulin
Ovary
GnRH
Brain
Leptin
(+ other metabolic signals)
Fat
cells
Overweight / PCOS
Ovary
T
P
Delayed
puberty
Amenorrhea
Sex steroids
Anovulation
Hirsutism
Hyperinsulinaemia
reduces SHBG levels
and thus amplifies
ovarian androgen
production
Figure 4.9 Influence of nutritional status on sex hormone production in females
When we have a lot of body fat, we get a lot of hormone
production — more than we need. When the adipose
hormone factories get too active, they release eicosanoids, cytokines, and hormones (over 300 compounds
in total!) that disrupt the endocrine balance and cause
reproductive problems.
For instance, women with polycystic ovary syndrome
(PCOS) usually have insulin resistance and sex hormones out of balance.
Obese men often convert too much testosterone to estrogen, which can deposit fat onto their chests or even lead
to the growth of breast tissue (aka gynecomastia).
Cognitive functions
We also tend to get crabbier, lethargic, and / or anxious.
When energy is chronically low for a long time, we may
even get depressed, or have hair-trigger tempers.
Metabolic functions
Along with our brain, our other organs also cost a lot to
maintain.
For instance, every day:
•
Our heart needs around 600 kcal per kg of heart
weight.
•
Our kidneys need around 400 kcal / kg of kidney
weight.
•
Our liver needs around 300 kcal / kg of liver weight.
The brain needs a lot of energy constantly, around 300
kcal / kg of brain weight every day. While it can use both
glucose and ketone bodies to regenerate ATP, severe
energy imbalances can slow down brain metabolism. See
Table 4.3.
Compare this to the “metabolic superstar” skeletal
muscle, which checks in at only 17 kcal per kg of muscle
weight per day.
This means we get dumber when energy is low. We forget
things. Our thinking is foggy. We find it hard to be creative or have ideas.
Our RMR adjusts itself to match energy intake. When
energy intake goes down for a while, RMR goes down
too. When energy intake goes up for a while, the opposite
So, just keeping our insides healthy and functioning
each day requires a basic level of kcal intake.
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132 | Unit 4
Table 4.3 Energy requirements of the human brain from birth to adulthood*
Bodyweight (kg)
Brain weight (g)
Brain’s energy
consumption
(kcal / day)
Body’s energy
consumption
(kcal / day)
Energy to brain
bodyweight (kg)
(% of whole body)
3.5 (newborn, term)
400
118
161
74
5.5 (4-6 months)
650
192
300
64
11 (1-2 years)
1045
311
590
53
19 (5-6 years)
1235
367
830
44
31 (10-11 years)
1350
400
1160
34
50 (14-15 years)
1360
403
1480
27
70 (adult)
1400
414
1800
23
* Modified from Holliday (1971)
happens: RMR goes up. (This adjustment up or down is
the arcuate nucleus of the hypothalamus at work).
This metabolic decline with low energy intake happens
for three reasons:
•
Thyroid hormone output goes down. (And other
important hormones that affect weight and body
composition also change - leptin, testosterone, and
sympathetic nervous system output go down; cortisol goes up.)
•
TEF goes down (because less food is being eaten).
•
We lose both total and lean mass (a smaller body
burns less energy).
This “gear up / gear down” mechanism helps prevent
large fluctuations in weight status.
It also makes controlling energy balance difficult when
people are strictly controlling their intake. When energy
intake goes down for too long, the body simply “downshifts” metabolism to adjust. Research suggests that the
largest decreases in RMR occur when diets reach about
1000-1200 kcal (or fewer) per day.
Likewise, when energy intake goes up, RMR goes up.
People trying to gain mass often struggle to eat enough
to put on weight.
Yet in both cases, the energy-in versus energy-out equation still applies. It’s just that the body has changed the
rules of the game. They aren’t static, mutually exclusive
numbers ­— every time you take steps to affect energy
in, the body takes steps to adjust energy out accordingly (though not perfectly, or it would be really hard to
change bodyweight).
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You can still make people lose weight if their bodies are
gearing down… you just have to starve them. You can still
make people gain weight if their bodies are throwing off
energy as heat and NEAT… you just have to stuff them.
Of course, we try to avoid starving or stuffing our clients.
There are other, better, saner and more humane ways to
change body composition or lose / gain weight. We’ll look
at those later.
Repair and restoration
As we’ve seen, our body’s tissues are always being broken
down and rebuilt or replenished. This is especially true if
we damage them, as with exercise.
If active people don’t eat enough, they won’t recover and
/ or refuel properly. Conversely, if they eat enough to
meet their energy demands, new and healthy tissues will
be created, and the fuel stores will be topped up, ready to
kick butt in the next bout of training.
Vitamins, minerals and energy
balance
Vitamins and minerals don’t directly transfer energy in
the regeneration of ATP. However, they can play important roles as co-factors and / or co-enzymes in the
energy transfer processes. This means we need them for
a healthy metabolism.
When certain micronutrients are too low, this can
affect the energy producing processes of the body. For
Energy Balance in the Body | 133
Hungry!
165
Stuffed!
in
— Weight —
160
Lower
metabolism
155
145
140
<<
>>
igh
we
s
os
tl
h
eig
Higher
metabolism
a
tg
w
Eat too little
Just right.
Ideal intake
Eat too much
— Calories per day —
Figure 4.10 Resting metabolic rate scales with chronic energy intake
instance, iron deficiency can lower oxygen transport, while a deficit of vitamin
B3 (niacin) can limit NAD and NADH activity.
The main nutrients involved in energy transfer are biotin, riboflavin, niacin,
pantothenic acid, thiamin, pyridoxine, cobalamin, and choline.
In addition, some dietary minerals such as sodium and potassium can act as
electrolytes, which are important regulators of muscle contraction, fluid balance
and nerve impulses. As these functions are strongly related to energy expenditure, these minerals are critical to energy balance as well.
electrolyte: Compound that
when placed in solution becomes
an ion; regulates flow in and out
of cells
When vitamins, minerals, and electrolytes are low, important metabolic functions and energy production don’t occur.
Achieving energy balance… naturally
We may sometimes want to change our body. But our body doesn’t like to
change. It looks for dynamic balance, aka homeostasis.
As far as the body’s concerned, the ideal scenario would occur when energy
intake perfectly matches energy expenditure. In fact, one definition of homeostasis is “unchanging” — although in the body’s case, several complex mechanisms
are in place, and many regulatory processes must occur, in order to keep things
the same. You can think of it like standing on a moving subway train: You must
always move slightly to keep standing still.
Yet many of these processes, which evolved over millions of years, aren’t always
well matched to the way we live now.
For instance, wild animals naturally match their food intake to their activity and
bodies’ needs. If they eat more, they move more. Or they eat less later on.
This works great in the wild. Not so great in the 21st century, where we have
abundant tasty and convenient food but fewer opportunities for daily movement.
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On top of that, we have other stressors and factors affecting our appetite, hunger and fullness cues, such as stress
or light exposure at night.
highly processed foods that are engineered to be too
good to put down. They overpower our normal satiation
mechanisms. And we over-eat.
In fact, we depend on movement and activity to help
us regulate ourselves. When we stop moving, we stop
working well. When we get too sedentary, our energy
regulation mechanisms get out of whack. Since appetite
can only drop so low, it often outpaces the sedentary
metabolism, making us gain weight.
This problem of energy balance in the modern age
is one reason it’s so important to help our clients eat
whole, less-processed foods (along with getting regular
movement and living a healthy lifestyle). These types of
foods work best with our physiology. Our body recognizes them and knows what to do with them. And these
foods help us regulate our energy intake as well.
And our food culture today is made up of energy-dense,
Case study 1
Why can’t some people lose weight despite eating less?
After all, each of us knows an overweight or obese person that doesn’t “seem” to eat a lot of food. Maybe you
too struggle to get or stay lean despite a “healthy” diet.
One problem is that perception and memory are very
inaccurate. It’s very, very easy to under-report food and
energy intake.
That’s not because we’re all liars. It’s because we’re all
human. And it’s very hard to keep accurate food logs
and energy intake records (as research has shown us
over and over again).
Plus, as we’ve seen, even if we’re diligently reading
food labels, those food labels can be inaccurate. A few
restaurant meals over the course of a week, with lots of
hidden calories, can easily add up, even if we’re doing
our best to choose the “healthy” salad option.
Some of us are also invested in forgetting. Who wants to
remember the moment of grabbing an extra muffin at
the morning meeting, or picking off the kids’ plates as
dinner is cleared? Not us, that’s for sure.
But what if you truly do have a client who seems to be a
medical mystery? Like our client who went through two
rounds of chemotherapy for lymphoma. In this case, it
seemed like he was breaking all the laws of nature by
gaining weight.
As you probably know, chemotherapy makes you nauseated and vomit often. During his time in the hospital,
our client barely ate two small meals a day, usually just
an Ensure shake and a bowl of soup. And most of the
time he couldn’t even keep these small feedings down.
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He wasn’t expending much energy. He slept about 12
hours per day. His only exercise was walking around the
hospital corridors pushing around an IV pole.
Still, according to calculations, his energy needs were
around 1800-2200 kcal a day. Many days he probably
ate much less. He almost never ate more.
You would have expected him to lose weight quickly.
But that’s not what happened. Instead, during his treatments, he gained over 50 lb.
Indeed, most people think the typical cancer patient
gets skinny during treatment. Nowadays, chemotherapy
drugs lead to something called “sarcopenic obesity.” In
other words, cancer patients lose a lot of lean mass while
easily gaining fat weight.
According to most conventional metabolic assumptions, you’d have to guess that this client “gained
fat without over-eating.” After all, his energy intake
(around 1000 kcal per day) was less than his estimated
energy expenditure (around 2000 kcal per day).
Of course, you may have guessed the reasons why. The
calculations are based on average healthy people, not
cancer patients on drugs.
The chemo (plus, probably, his bed rest) changed the
inputs and outputs of energy balance.
The energy-in versus energy-out rule didn’t change.
Only the factors on each side of the equation did.
The bottom line: Weight gain or loss is always a function
of energy balance.
Nobody’s body — not even a cancer patient’s — breaks
the laws of thermodynamics.
Energy Balance in the Body | 135
Case study 2
Lowering energy intake to lose weight seems logical. And
for many people, it can be as simple as that. But for athletes, who need more nutrients and energy overall, losing
fat may require a little more fine-tuning.
Here are some possible explanations.
•
She ate more protein. Since she wasn’t eating
much protein to begin with, more protein may
have led to both a faster metabolic rate and an
increased protein turnover in the body.
•
She ate more food energy. The severe energy
imbalance from training a lot but eating relatively
little may have depressed her metabolism. Maybe
more food stimulated her metabolic rate. Or
maybe it just let her train harder, which meant
she expended more calories during and after
training.
•
She changed the types of food she ate. She
started out eating lots of sugar and saturated fat,
and ended up eating more whole foods, fiber,
slow-digesting carbohydrates, and protein. Plus
she balanced out her fat intake. This may have led
to a hormonal environment that helped her lose
fat.
One of our clients was an elite cross country ski athlete.
At 5’6” (1.71 m), 165 lb (75 kg), and 23% body fat, she was
heavier than most elite participants in her sport who are,
on average, closer to 135 lb (61 kg) and 12% body fat. She
needed to lose both bodyweight and body fat to become
more competitive.
Before coming to see us, she tried a higher-carbohydrate, energy-restricted diet. See September data
below for a summary of the nutritional prescription.
She lost a combination of fat and lean mass, ending up
at 160 lb (73 kg) and 22% body fat. Needless to say, a
bit discouraging.
Then she came to see us for nutrition coaching. After
twelve weeks of following a modified set of recommendations (outlined below), she achieved the results in
Table 4.4.
It was likely a combination of all of these factors and
more.
Why did this happen? How did she lose 25 lb (11 kg) of
body mass while eating more?
Table 4.4 Comparison of 12-week results
September
December
Net result – 12 weeks
Height and weight
5'6" / 160 lb
5'6" / 135 lb
25 lb lost1
Body composition
125 lb lean, 35 lb fat
123 lb lean, 12 lb fat
23 lb fat lost 2, 2 lb lean mass lost 2
Body fat %
22%
9%
13% lost
Exercise expenditure
~1200 kcal / day
~1200 kcal / day
Same
Energy intake
~2500 kcal / day
~4000 kcal / day
+1500 kcal / day3
Macronutrient
15% protein
65% carb
20% fat
35% protein
40% carb
25% fat
+20% protein
-25% carb
+5% fat
Notes:
1. This dramatic and rapid shift in body composition was achieved with a large increase in food intake – from 2500 kcal per day to 4000 kcal per day.
2. Body composition data was recorded via a calibrated-weigh scale and air-displacement plethysmography (Bod Pod). In addition, energy intake
data was collected and analyzed as weighed diet records, and expenditure data estimated based on ACSM MET values.
3. Note: not all clients will benefit from a similar increase in energy intake. Indeed, many clients are likely over-eating on a weekly basis, relative to
their activity levels, and this is putting them into a positive energy balance. So, rather than a prescription for all struggling clients, this case study
provides a simple example of when the concept of “eat less, exercise more” is insufficient.
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Summary
Energy balance is the relationship between energy we
take in from food, and the energy we use or excrete
through metabolism and activity. This relationship determines our bodyweight as well as our overall health.
We measure energy intake, or the potential energy present in our food, in Calories or kcals.
The body’s energy needs include the amount of energy
required for maintenance at rest; the amount of energy
required for physical activity and movement; and the
amount of energy required for food digestion, absorption, and transport.
We can estimate energy needs by measuring how much
oxygen we consume, either directly in the laboratory or
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approximately with one of several equations. The equations can have a wide margin of error.
When we take in more energy than we put out (or vice
versa), we have an energy imbalance. This will lead to
changes in bodyweight. Other functions such as reproduction, cognition, metabolism, and recovery can also
be affected. Eventually this can make us sick or injured,
and we won’t perform well.
The exercise we do and the food we eat affects our energy
balance and the fuel we use, determining whether we use
more carbohydrates or fat for energy transfer.
Micronutrients act as co-factors and / or co-enzymes to
help us get energy from food. We need to get enough of
them to properly regulate energy.
UNIT 5
Aerobic and Anaerobic Metabolism
138 | Unit 5
Unit Outline
1.
How metabolism changes
6.
Anaerobic versus aerobic exercise
2.
How exercise affects metabolism
7.
How we adapt to exercise
3.
Muscle and metabolism
8.
Case study
4.
Energy demands of muscle
9.
Summary
5.
Oxygen consumption
Objectives
In this unit you’ll learn about how the human body re-
We’ll explore the structure and function of skeletal muscle
sponds to the metabolic demands of exercise. Creating cel-
tissue, and how energy is transferred within skeletal muscle
lular stress through exercise changes the body’s processes.
during both aerobic and anaerobic exercise.
This can affect both energy balance and long-term health.
How metabolism changes
In the previous unit, you learned about metabolic differences. Many factors affect our metabolic function. But
one thing is the same for all of us: We’re all getting older.
If you’re younger than mid-20s, you’re probably enjoying
a revving metabolism. If you’re fit, strong, active and
healthy, you have plenty of lean mass. Your fertility and
hormone production is likely at its peak.
If you’re older than 30, you may have started noticing a
few changes.
Maybe your digestion is a little slower.
Maybe you can’t drink as much alcohol as you used to.
After 25, on average, people lose about 2-4% of their
RMR every decade. Most of us don’t notice right away.
We’re too busy finishing school, getting our first big jobs,
raising young families, or having other adventures.
By around age 35, reality starts to set in. Even if we exercise faithfully and eat well, we notice changes. It’s harder
to lose fat, gain muscle, or get stronger. And we have to
be more careful about how we exercise.
If you started out with an RMR of 1500 kcal at age 25, by
35 it’ll be around 1400 kcal. By 55, it’ll be down around
1200 kcal. And so on.
Maybe you don’t recover from tough workouts quite as
well as you did before. Or you need more warm-up time.
We lose lean mass too. On average, people lose about 5
lb of lean mass per decade between the ages of 25 and 65.
So, in addition to dropping around 300 kcal of metabolic
power by the age of 65, most folks also lose about 20 lb of
lean mass.
Maybe your periods or fertility aren’t as reliable, if you’re
a woman. (And if you’re a man, you may have occasionally noticed a little less mojo.)
Because lean tissue such as muscle and bone is so metabolically active, this loss is probably directly responsible
for much of the metabolic losses.
And hey… where did that extra little bit of squish
around your middle come from?
This suggests that metabolic decline isn’t about chronological age. Rather, it’s about “body age” and our lifestyle
Maybe some foods now upset your stomach.
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Aerobic and Anaerobic Metabolism | 139
Bad news: We can’t turn the clock back. Good news: We
can control, to some degree, our biological aging process. If we focus on smart nutrition and preserving that
valuable muscle, we’ll age well and healthily.
How exercise affects
metabolism
We are meant to move. Movement makes our bodies and
brains work better.
For instance, after surgery, nurses get us up and moving
as soon as possible. The more we sit at desks, the more
we risk chronic disease. Emotions are really just strong
movement cues (for instance, to move towards a loved
one or away from a threat). The more we move, the better
we think, learn and remember.
Metabolism
choices. What we think of as “normal” aging may, in
fact, result from inactivity and poor nutrition.
0
1
2
3
4
5
Time (days)
Figure 5.1 Change in metabolism after intense resistance
training
begins to contract their muscles during exercise. Let’s
review that quickly now.
Movement is the engine of health, wellness, and a long
vibrant life.
Imagine yourself bursting into a sprint, running as fast
as possible. Here’s what happens in your body.
Why? The secret lies in movement’s metabolic effects,
particularly the effects of exercise.
1. Within 3 seconds, muscle cells use up most of their
available ATP.
Whether it’s skateboarding, canoeing, or trampolining,
purposeful exercise of any kind contracts the skeletal
muscles over and over. Our lungs work harder and our
heart beats faster. Our brain needs fuel for the ever-changing motor and cognitive demands of movement,
such as balance, body positioning, muscular coordination, and decision making.
2. You need more ATP to keep running. The ATP-PCr
system then kicks in. This lasts for about 10 seconds.
Because ATP regeneration takes time, you start to
slow down a bit.
Muscles use energy when they contract. The more
intense the exercise, the more energy used with every
passing minute.
For example, a Tour de France cycling pace burns four
times as much energy per minute as a leisurely cycle on
a beach cruiser bike. Likewise, sprinting at a 100 m dash
pace, or up a hill, burns more kcals per minute than running at a slow, shuffling jog.
As we discussed in the previous unit, high-intensity activity not only demands more energy while we’re doing
it, but also afterwards, when the body needs more energy
for recovery and repair. Figure 5.1 shows how metabolic
activity can go up after intense physical exercise.
In Unit 3, we looked at what happens when a person
3. As you keep running, and you deplete your ATP-PCr
stores, the glycolytic system starts providing most of
the energy transfer for ATP regeneration. This lasts
for about 90 -120 seconds or so, depending on the
intensity. As the glycolytic system generates ATP
more slowly than the ATP-PCr system, you have to
slow down a bit more.
4. If you keep running, the oxidative phosphorylation
system will then provide most of the energy transfer
for ATP regeneration. Because the oxidative systems
are slower than the anaerobic systems, you’ll have
to slow down again. In fact, if you slow your pace
enough, you can keep running (or walking) for quite
a long time.
Now, let’s consider another scenario.
What if you blast into a sprint… but only run for about
30 meters? Then, you slow down, stop, and stroll back.
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a quick jogging pace or a few sets of squats is an easy
warm-up.
% of maximum rate of energy production
ATP Store
ATP-PCr System
Lactic Acid System
•
For a couch potato or older person, a moderate jog, a
few jumping jacks, or even a brisk walk may count as
Overall Performance
high intensity at first.
Aerobic System
So what counts as “high intensity” varies from person to
person because our body must adapt to the demands of
exercise.
2 sec
Th 10 sec
Th 1 min
Time
In a moment, we’ll look more closely at what actually
happens when muscles do their work. But think generally now about what might happen in your body during
high-intensity exercise… and what the metabolic effects
could be.
2 hrs
•
Th = Threshold Point
Figure 5.2 Contribution of each energy system to total energy use during prolonged exercise
We damage our muscles a little bit, which means we
have to repair them later.
•
We ask our cells to produce more energy.
•
We challenge our body’s defenses and immunity.
•
We must circulate more oxygen and nutrients around
our body.
You wait 5 minutes. Then burst into another 30-meter
sprint. Stop. Wait. Repeat.
What happens in this case? As you might guess, the glycolytic and oxidative phosphorylation systems won’t play
such big roles. Waiting between short sprints lets your
ATP-PCr system quickly replenish the available ATP so
you can blast off again.
Would the metabolic effects of these two different types
of exercise be different? Yes.
Because of these different fuel pathways, different exercise intensities and types affect our physiology differently. This is especially true when it comes to preserving
muscle and metabolism with age. Intense exercise seems
to prevent muscle loss and preserve our RMR most
effectively. Lower-intensity activity — while nevertheless
important — doesn’t seem to do this much at all.
You might wonder what qualifies as “high-intensity exercise.” We’d say you’ll know it when you do it. Anything
that gets your heart pounding, sucks your oxygen, gets
your whole body working, and maybe even lights your
muscles on fire a little is high-intensity exercise.
High intensity is relative.
•
For a top middle-distance runner or CrossFit athlete,
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•
We put stress on our skeleton and connective tissues.
•
We might even have more brain activity as our motor
cortex and senses are called on to process a lot of
incoming signals.
You can imagine what the body might need to do to
deal with these demands, as well as to repair and recover itself afterwards. And, as we’ll see, nutrition is an
essential part of these processes.
Muscle and metabolism
Did you know that the stronger your grip, the healthier
you’ll probably be as you age? Yep. The hand-grip test,
which tests how well you can crush a handshake, is one
of the best indicators of longevity and robust aging.
Does this mean you should run out and start tearing
phone books? Or take up arm wrestling?
Well, those are fun hobbies. But the relationship between
your grip strength and your senior citizen shenanigans
doesn’t mean that a hearty grip causes healthy aging.
It means that if your grip is strong, you’re probably
strong. If you’re strong, you probably have lots of lean
body mass, strong connective tissues, a good dense
Aerobic and Anaerobic Metabolism | 141
Epimysium
Tendon
Perimysium
Bon
e
Fascicle
Muscle Fiber
Myofibril
Thin
(actin)
filament
Troponin
Tropomyosin
Sarcomere
Z-disk
Myosin head
Thick
(myocin)
filament
Actin
Myosin/actin
cross bridge
Figure 5.3 Skeletal muscle structure
skeleton, and the motor control to recruit all these things. If all that stuff is working well, the rest of your systems are probably working well too.
Interestingly, the hand-grip test is a better predictor of healthy aging than your
cardiovascular function (VO2 max), your flexibility, and your balance — although, of course, you want all that other stuff working well too.
To understand why this is, and why muscle is so essential to a healthy metabolism, you need to understand muscle structure and function.
Muscle structure and function
Skeletal muscles contain long, slender fibers, known as muscle cells, that are
bundled together. These bundles merge with tendons that are in turn attached to
bone. When a muscle contracts (or gets smaller), its tendon ends (or attachments)
pull on the bones, and the bones move.
myofibrils: One of the threadlike
components of a muscle fiber
Muscle cells are formed from smaller bundles of myofibrils. These consist of
thick and thin filaments called myosin and actin. When muscles contract, actin
and myosin form cross-bridges that slide across each other, pulling the ends
of the muscle together. (You might say they “interact to contract.”) Myosin and
actin are thus known as contractile proteins.
actin: Thin fibrous muscle protein
that is necessary for cell shape and
can bind to myosin
Sarcomeres are made of strands of actin and myosin attached to natural breaks
in the muscle, called Z-discs. If you look at muscle under a microscope, you’ll see
that it looks striated. That characteristic appearance comes from the Z-discs. See
Figure 5.3.
sarcomeres: Repeating structural
units of striated muscle fibers
myosin: Thick fibrous muscle
protein that can split ATP and bind
with actin
cross-bridges: Formed when
the head of myosin temporarily
attaches to actin
Z-discs: Region of the sarcomere
into which actin is inserted
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When called upon to contract, the actin and myosin are pulled together, shortening the space between
the Z-discs. ATP is needed for the ongoing cycle of
actin-myosin binding and release during muscle
contraction.
Most cells have only one nucleus. Skeletal muscle cells
can have several nuclei, just under the muscle cell membrane. Like nuclei in other cells of the body, muscle cell
nuclei control protein synthesis in the muscle.
Muscle organelles
In Unit 1, you learned about cell organelles. Muscles
have many of the same organelles as other cells, along
with some specialized ones, including:
Sarcoplasmic reticulum
The sarcoplasmic reticulum is the network of tubules
and sacs in the muscle cell, similar to the endoplasmic
reticulum. It uses a significant amount of ATP during
exercise. And it contains calcium that when released
allows for muscle contraction.
Myofibrils
Myofibrils are the bundles of very fine fibers made up of
actin and myosin.
Sarcomere
Sarcolemma
A sarcomere is the segment of a myofibril between two
successive Z-discs.
This is the plasma membrane of a muscle fiber.
T-tubules (transverse tubules)
Sarcoplasm
These tubes extend into the sarcoplasm. Imagine something like deep divots on the surface of the sarcolemma,
which plunge down and cut into the sarcoplasm.
This is the cytoplasm of the muscle cell, which contains
nuclei and mitochondria.
Since muscle cells need a lot of energy, they have a lot of
sarcoplasmic mitochondria.
Figure 5.4 Microanatomy of skeletal muscle
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T-tubules let nerve impulses travel along the sarcolemma, deep inside the cell, to tell the muscles to fire and
contract.
Aerobic and Anaerobic Metabolism | 143
Muscle fiber types
Humans have three general types of muscle fibers:
1. slow-twitch (or type I);
2. fast-twitch A (or type IIA); and
3. fast-twitch B (or type IIB).
These three fiber types differ in:
•
how fast they contract;
•
how well they resist fatigue;
•
their fiber diameter;
•
their capillary and mitochondrial density; and
•
their myoglobin content.
Slow-twitch fibers are dark, while fast-twitch fibers are lighter. This signals that
each has a unique makeup of contractile proteins, muscle cell organelles, and
myoglobin.
myoglobin: Oxygen-carrying
and storage protein of muscle.
Similar to hemoglobin
(You can think of light or dark meat in chicken or turkey. Breast meat is lighter
than leg meat, because these birds walk instead of fly.)
Next, let’s look at how this applies to different types of exercise.
Energy demands of muscle
In the previous unit, you learned about how we can measure the energy that our
body uses. Metabolic testing, which measures how much oxygen we consume
during a given activity, can tell us about how much exercise “costs.”
The more intense the exercise, and the more muscles we use, the more oxygen we
take in. And the more oxygen we take in, the more energy we use.
metabolic testing: Tests that
measure metabolic functions
(e.g., digestion and energy
production)
Let’s say you’re lying in bed, sleeping.
At that moment, you consume about 3.5 mL of oxygen per kilogram per minute.
You weigh 70 kg (154 lb). So, you’ll be taking in 70 x 3.5 mL, or about 245 mL, of
oxygen per minute.
That formula of 3.5 mL / kg / minute is equivalent to 1 MET (short for metabolic
equivalent). 1 MET represents 1 unit of metabolic rate, or the amount of oxygen
consumed during 1 minute of rest. When you’re sleeping, you’re using 1 MET.
Then, let’s say you wake up, get out of bed, and decide to walk briskly to the coffee shop for a morning brew.
MET: Oxygen cost of energy
expenditure measured at rest,
equal to 3.5 mL of oxygen per
kilogram of bodyweight per
minute
Your brisk walk requires five times the amount of oxygen you used while sleeping — 5 x 245 mL, or 1.225 L. Now you’re using 5 METs.
Before you can get to the coffee shop, you hear barking and growling. Your
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Oxygen consumption
Table 5.1 Metabolic equivalents (METs) of
selected daily activities
Daily Activity
METs
Sexual intercourse with established partner
Lower range (normal)
2-3
Lower range orgasm
3-4
Upper range (vigorous activity)
5-6
Lifting and carrying objects (9-20 kg)
4-5
Walking 1.6 km (1 mile) on the level in 20
minutes
3-4
Golf
4-5
Gardening (digging)
3-5
Do-it-yourself, wallpapering, etc.
4-5
Light housework, e.g., ironing, polishing
2-4
Heavy housework, e.g., making beds, scrubbing floors, cleaning windows
3-6
Each 1 MET is achieved at rest and is equivalent to 3.5
mL of oxygen consumption per kg of bodyweight per
minute. To determine energy expenditure per hour of
exercise, multiply MET values by bodyweight in kg.
Muscle activity generally matches how much oxygen you
consume.
But when you start moving, there’s a bit of a lag. Your
oxygen consumption doesn’t immediately match your
new level of muscle energy demands. Your muscles will
need more oxygen than you’re taking in. This is known
as oxygen deficit.
During this time, your movement will be powered by
anaerobic energy transfer from the ATP-PCr and the
glycolytic systems. Thus, even if you’re just going for a
slow stroll that would normally use the oxidative phosphorylation system, that walk will be fueled by anaerobic
energy production at first.
Imagine a new company — a startup. It doesn’t have
money to run its business at first, so it borrows cash to
get going.
•
If the startup is relatively small and doesn’t have a lot
of overhead costs, it won’t need much money. It won’t
have a lot of debt. And soon it can stand on its own.
•
If the startup has big dreams and needs a lot of machinery, and if it wants to expand quickly, it’ll need
more money. It’ll have a lot of debt before it breaks
neighbor’s angry, crazy guard dog has snapped its leash
and is coming right for you. You break into an all-out
survival sprint, running the few final meters uphill to
the coffee shop, where you dive inside and slam the door
against Cujo.
That uphill sprint to safety, fueled by primal fear, put you
at 10 METs, a near-maximal effort. Now you’re sucking
in 2.45 L of oxygen per minute.
You can use METs to estimate how much energy you use
during exercise. By multiplying the MET intensity by
bodyweight in kilograms, you can easily calculate your
energy expenditure per hour of activity.
For example, if you’re 70 kg and cycling at 10 METs
(which is very high-intensity activity), you’d be expending about 700 kcal per hour (10 METs x 70 kg).
Now of course, different people will take in different amounts of oxygen, and have different metabolic
demands. METs are just one way to estimate energy
expenditure.
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even. And it’ll take a while to pay down that debt.
The same idea applies here.
•
If you’re going to continue to do low-intensity work,
you don’t need to borrow much energy from the other energy systems to get started. Your oxygen deficit
will be small.
•
If you’re going for broke with a high-rep squat set, a
round of Ultimate Fighting, or skating like heck for the
last few crucial moments of a hockey game, you’re
going to incur a lot of energy and oxygen debt.
The higher the intensity, the greater the deficit.
Eventually, once you slow down or find a steady pace
you can do for a long time, your oxygen consumption
will catch up. But you still owe oxygen. Once you stop
exercising, you still keep consuming oxygen to pay that
debt back.
This period of increased oxygen consumption and
Aerobic and Anaerobic Metabolism | 145
3.0
Oxygen Consumption
2.7
O2
deficit
2.4
2.1
1.8
1.5
1.2
0.9
0.6
O2
debt
Resting oxygen uptake
0.3
0
0
1
2
3
4
5
6
7
8
oxygen deficit: Difference
between oxygen uptake of the
body during early exercise and
during a similar duration of steady
state exercise
Time (minutes)
Figure 5.5 Oxygen deficit and debt with exercise
250
225
200
0%
10
175
EPOC (ml/kg)
ax
m
2
VO
%
150
90
VO
125
80%
100
75
ax
2m
x
VO 2ma
70% VO2max
50
60% VO2max
25
0
5
10
15
20
25
30
35
40
45
50
55
60
Time (minutes)
Figure 5.6 Relative EPOC after exercise of different intensities and durations
energy demand has been called the period of “oxygen debt” or EPOC (excess
post-exercise oxygen consumption). It can last for a few minutes, or even a few
hours. (If someone is training REALLY intensely, EPOC can last from several
hours up to two days!)
To see how it might look when charted on a graph, check out Figures 5.5 and 5.6.
oxygen debt: Extra oxygen
required above basal needs after a
period of intense exercise
EPOC: Increased rate of oxygen
uptake following strenuous
activity
Our body needs to repay the oxygen debt for three important jobs:
•
metabolizing additional nutrients;
•
replenishing the energy stores that have been used up; and
•
reloading the depleted oxygen stores in the muscle and blood.
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Anaerobic
Aerobic
16%
29%
71%
200m run
34%
57%
43%
48%
400m run
66%
800m run
84%
1500m run
Figure 5.7 Comparison of aerobic and anaerobic energy contribution to total energy expenditure across track events
In addition to these recovery-type activities, the following also contribute to EPOC:
•
a higher body temperature after exercise
•
harder working heart and respiratory muscles
•
more metabolism-boosting hormones
•
converting energy transfer products such as lactate
into other things
•
more protein synthesis
•
helping stressed and damaged muscles recover
However, in practical terms, most clients do best with
a mix of higher- and lower-intensity exercise. As lower
intensity exercise can help facilitate recovery from higher-intensity exercise, while still expending energy and
maintaining fitness.
Anaerobic versus aerobic
exercise
In Unit 3, you learned about the three main energy
systems:
The more intense the exercise, the bigger and longer-lasting the EPOC values. Check out the figure below for
more detail.
1. The ATP-PCr system
Thus:
3. The oxidative phosphorylative pathway
•
When exercise intensity is higher, we consume more
oxygen and use more energy for each minute of
exercise we do. We also use more oxygen and energy
afterwards. And we stimulate muscle mass to grow.
•
When exercise intensity is lower, we take in less oxygen and use less energy for the same amount of time.
There is a small oxygen debt afterwards, and this gets
smaller and smaller with training adaptations. And
we don’t really stimulate muscle mass to grow (unless
we’re very deconditioned).
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2. The glycolytic pathway
You may also remember that all systems are well-coordinated and work together. During exercise, all three
systems are activated. How active they are, and how
much ATP they contribute, defines activities as either
anaerobic (without oxygen) or aerobic (with oxygen).
The first two systems, the ATP-PCr and glycolytic
systems, are anaerobic systems. They supply most of the
ATP that we need during high-intensity exercise. Oxygen
uptake and oxidative metabolism simply can’t keep up.
Aerobic and Anaerobic Metabolism | 147
indicates end of test
Blood lactate concentration (mmol/L)
25
400m track race,
excellent performance (50s)
20
400m track race,
average performance (60s)
15
10
10K race
5
fast running
easy running
0
0
5
10
15
20
25
30
Time (minutes)
Figure 5.8 Lactate accumulation during runs of different intensities and durations
The third system, the oxidative system, as its name implies, is an aerobic system.
It uses oxygen.
Figure 5.7 shows how much anaerobic versus aerobic systems contribute to energy expenditure for varying track and field events.
You may recall that as exercise intensity increases and the glycolytic energy
system is working full force, mitochondria can’t keep up with the amount of
pyruvate being produced. This leads to the conversion of pyruvate to lactate (ie.
about 10-90 seconds into high intensity exercise) and significantly increased
levels of H+ (hydrogen ions) that spill into the bloodstream. When we’ve reached
this level of exercise intensity, the body can’t keep up for long and it’s referred to
as the anaerobic threshold (AT).
If we lower our intensity below the AT, we can exercise more or less indefinitely.
This is due to the aerobic pathway of ATP supply and our ability to efficiently use
lactate as an energy substrate, keeping H+ levels low. However if we stay about
the AT (perhaps through Herculean willpower, or running from that angry dog),
exercise will be so anaerobic that we’ll only be able to do it for a short while longer. The body just can’t keep up.
anaerobic threshold: The point
above which the muscles derive
their energy from non-oxygenic
rather than oxygenic sources
during exercise
Figure 5.8 shows how lactate accumulation (a market of hydrogen ion build
up) occurs during runs of different intensities and durations.
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Can we buffer lactate?
If chemistry is your thing, you may be wondering why
we don’t somehow buffer lactic acid and hydrogen ions
with something alkaline. In fact, our body has natural
buffering systems, including:
• sodium bicarbonate
• phosphate
• carnosine in muscle tissue
You might recognize sodium bicarbonate as household
baking soda. Indeed, many athletes have tried eating
baking soda as a way to avoid lactate and hydrogen ion
buildup. And in some cases, it worked. Sodium bicar-
bonate solutions do seem to improve performance in
various medium-duration events, such as rowing, swimming, or middle-distance running.
Unfortunately, baking soda also leads to lots of unpleasant gastrointestinal side effects such as diarrhea. Which,
as far as we know, does not improve athletic performance.
ß-alanine and carnosine supplements may be more
promising and less intestinally explosive. So far, it seems
that ß-alanine may provide minor performance improvement during higher-intensity exercises.
How we adapt to exercise
Our body is always adapting and adjusting — to the food
we eat, to what’s around us, to ever-changing physiological processes, and of course, to exercise and movement.
Fundamentally, our body tries to adapt to exercise
by making us stronger and better at it. This includes
breaking down and removing damaged tissues, building
new structures, and improving cell function so that we
become more effective and efficient.
Exercise is a stressor — normally a good one, but a
stressor nonetheless. The higher the intensity of exercise,
the greater the stress. This is one key reason we should
balance high- with low-intensity exercise, and why we
need to support athletic training or other high-intensity
exercise with enough energy from a nutrient-rich diet.
Muscular adaptation
You’ve learned about muscle fiber types. Our body
prefers to activate different fiber types depending on the
type of exercise we are doing.
Anaerobic exercise
During anaerobic exercise, type IIA (aka fast oxidative
glycolytic) and type IIB (aka fast glycolytic) muscle fibers
are still recruited, but contribute very little), as they contract more quickly. Over time, this will lead to particular
metabolic adaptations as the body repairs and rebuilds
damaged muscle tissue.
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For instance:
•
Our muscles store more ATP and PCr.
•
Our muscles store more glycogen (intramuscular
storage).
•
We improve the activity of ATP-PCr system enzymes
(such as creatine kinase and myokinase).
•
We improve the activity of glycolytic system enzymes (such as glycogen phosphorylase and
phosphofructokinase).
These adaptations help us use fuel more effectively the
next time we do anaerobic exercise.
Anaerobic exercise, particularly short-duration, high-intensity strength and / or power training, also makes
muscles bigger. This is known as muscle hypertrophy.
Muscle fibers can increase their size. And we can make
more contractile proteins (actin and myosin), which
make muscles stronger. This is known as myofibrillar
hypertrophy.
We can also increase fluid and fuel storage in the muscle
cells. This is known as sarcoplasmic hypertrophy.
Five other factors can contribute to muscle hypertrophy.
•
We can make more, and bigger mitochondria.
•
We can make more myoglobin.
Aerobic and Anaerobic Metabolism | 149
•
We can improve our muscles’ intracellular storage capacity.
•
We can store more intracellular glycogen.
•
Increasing cytosol volume (this is another way creatine works, by increasing
intra-myofiber volume).
While exercise provides the stimulus for all of this to happen, we need the raw
materials to rebuild structures and replenish fuel. So if we don’t get enough energy, enough protein for building blocks, enough carbohydrates for glycogen, or
enough micronutrients to help the process, we can’t recover and get stronger.
Aerobic exercise
During aerobic exercise, oxidative type I (aka oxidative) and type IIA muscle
fibers do most of the work. Though they contract more slowly and with less force,
they can last longer.
As with type II fibers, activity in type I fibers will lead to particular metabolic
adaptations.
•
We improve oxidative (or mitochondrial) enzyme activity.
•
We store more fuel such as intramuscular glycogen and triglycerides.
These adaptations help us do better the next time we do aerobic exercise.
Aerobic exercise, of course, depends on oxygen. So adapting to aerobic training
involves supporting oxygen transport and delivery in these fibers.
For example, in response to regular aerobic exercise:
•
We make more red blood cells, which carry oxygen bound to their hemoglobin. More red blood cells means more oxygen transport.
•
We make more and bigger blood vessels through increased capillarization
(i.e., developing more capillaries per unit of muscle). This helps deliver oxygen
muscle hypertrophy: Increase
in the size of muscle cells
myofibrillar hypertrophy:
Enlargement of a muscle fiber as it
gains myofibrils
sarcoplasmic hypertrophy:
Increase in the volume of the
sarcoplasmic fluid in the muscle
cell with no concurrent increase in
strength
hemoglobin: Oxygen-carrying
and storage protein in blood
capillarization: Development of
a capillary network
and fuel to muscle cells, remove CO2 and waste products, and transfer heat
away from the muscle.
•
We make more myoglobin, another protein that can bind and carry oxygen.
While more capillarization gives us more oxygen transport, more myoglobin
means more muscle oxygen uptake.
•
We make more and bigger mitochondria, which let us put that oxygen to work
through the Krebs cycle and electron transport chain.
Structural adaptation
It’s not just our muscles that need to recover. Our bones and connective tissues
also need to get stronger.
Movement and mechanical loading are essential stimuli for our skeleton and
joints. Receptors in bone and connective tissues (such as ligaments, tendons, and
joint cartilage) respond to changes in position and force being placed on them,
sending cell signals to increase protein turnover.
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Hormonal adaptation
Our hormones, too, need to adapt to exercise.
Catecholamines
As we saw in previous units, high-intensity exercise can
stimulate catecholamines such as epinephrine (adrenaline) and norepinephrine (noradrenaline).
This can change fuel use as well as post-exercise appetite
(although how each person’s appetite and hunger signals
respond to exercise will vary).
Catabolic hormones
Exercise can change the levels of catabolic hormones, which
tell our body to break things down.
One of the major catabolic hormones is cortisol. Cortisol
is a steroid hormone (which you may remember is made
from cholesterol, like our sex hormones) and one of the
major regulators of our blood sugar.
In its breaking-down role, cortisol helps break down stored
macronutrients for energy. It temporarily suppresses the
immune system as well as rebuilding of bone and connective tissues. And it affects our electrolyte balance, making
us retain sodium but excrete potassium and water.
Cortisol release depends on how intense the exercise is.
•
High-intensity exercise raises cortisol during and
afterwards.
•
Low-intensity exercise, such as gentle walking or
yoga, tends to lower cortisol.
Changes in cortisol can affect our immune system and
how we use fuel for energy.
Too much cortisol too often (i.e., with lots of high-intensity training) is a problem. Eventually we stop recovering. And our body keeps getting the signal to break
down stored fuel for energy, which can keep our blood
sugar constantly high. Thus, chronically high cortisol
can also change where body fat is deposited. (An easy
tip-off is body fat on the upper back.) You may see clients
with disrupted cortisol from chronic stress.
Since our body may prefer to use cholesterol to make
cortisol rather than our sex hormones, chronically
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elevated cortisol from training or other stressors can
also suppress sex hormone production.
But temporarily elevated cortisol, when balanced with
lowered cortisol from low-intensity or other relaxing and
recovery activities, is good. It gives us a healthy stressor
that stimulates repair and regeneration, without overwhelming our ability to rebuild.
Anabolic hormones
Exercise can change the levels of anabolic hormones,
which tell our body to build things up.
Two of the major anabolic hormones are testosterone
and growth hormone. Both of these hormones increase
protein synthesis and stimulate the growth and rebuilding of lean mass.
Growth hormone increases blood glucose and free fatty
acids, and promotes gluconeogenesis in the liver.
Though women have some testosterone, men have much
more. This is why, on average, men have more muscle
and denser bones than women.
High-intensity exercise stimulates anabolic hormone
production. As always, there is a “sweet spot.” The right
amount of resistance training or sprinting will prompt
us to release anabolic hormones. Too much, too intensely, too often, will suppress them.
Growth hormone, interestingly, is considered a stress
hormone. So it will be released with exercise (a good
stressor), fasting (potentially good or bad, depending),
and low blood sugar.
Anabolic hormones go down with age, which makes it
harder to rebuild and repair as we get older.
Sleep also improves the secretion of anabolic hormones
— just one more reason recovery is so important.
Insulin
Insulin is an anabolic hormone, but it deserves its own
listing.
We often think of insulin as a hormone related to
glucose. But like other anabolic hormones, insulin also
helps stimulate protein synthesis, prevent protein breakdown, and promote a positive nitrogen balance (in other
Aerobic and Anaerobic Metabolism | 151
words, excreting less nitrogen than we’re using, which
means we’re using protein effectively).
Our insulin is most available and effective when we’re
well fed and have enough energy. For most people,
ensuring carbohydrates around workout times helps
insulin do its job.
Other factors
Protein synthesis and exercise adaptation are also affected by:
•
the amount of mRNA in cells;
•
ribosomal number;
•
ribosomal activity;
•
amino acid availability;
•
other hormones and cell signals; and
•
our native genetic code and epigenetic state.
There are many good reasons to exercise. Our metabolic
and structural adaptations to both anaerobic and aerobic
activities can make us stronger, fitter, and healthier, as
well as give us a better quality of life for longer.
High-intensity (anaerobic) and low-intensity (aerobic)
exercise can have different metabolic effects. These are
important to understand if you are programming exercise for your clients, as well as if you are thinking about
how to support this exercise with a nutrition plan.
As you develop your practice, always keep the bigger
picture in mind. Think of the body as a dynamic, ever-changing system. Nothing happens in isolation, and
we rarely do just one type of activity. The metabolic and
structural effects of one kind of training can influence
the other.
When we’re young, protein synthesis and exercise adaptations happen quickly. We can easily recover from a tough
workout in a couple of days, or perhaps even train twice
daily. When we’re older, these processes slow down.
Figure 5.9 shows how combining proper nutrition with
a proper physical activity stimulus can lead to healthy
adaptations.
Essential amino acids and energy
The bigger picture
Systemic
Both regular anaerobic and aerobic exercise, as well as
daily-life activity and movement, can have other effects.
For instance, both types of exercise can help you:
•
Calm the sympathetic nervous system, lowering the
perceived stress of exercise over time. This means
that if you want the same amount of adaptation, you
have to increase the workload.
Hours
+
Mechanical or energetic stress
Storage
Full adaptation without amino
acid or energy restrictions
Local
Day
Adaptive potential
Figure 5.9 How exercise stress and nutritional inputs influence human adaptation
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Aerobic
exercise
Variable
Resistance
exercise
Glucose metabolism:
Glucose tolerance
Insulin sensitivity
Serum lipids:
HDL cholesterol
LDL cholesterol
increased values
decreased values
Blood pressure in rest:
Systolic
Diastolic
unchanged values
or
or
Body composition:
% of fat
Fat free body mass
or
small effect
intermediate effect
large effect
Basal metabolism
Muscular strength
Aerobic capacity:
VO2max
Time of maximal or submaximal aerobic exercise
Figure 5.10 Typical changes with exercise
•
Improve insulin sensitivity. With regular activity and
muscular contraction, insulin works as it should, thus
nutrients go where they should: into the cells for use
and storage.
•
Get fatty acids out of storage, transport them, and
use them effectively for energy.
•
Utilize / tolerate lactate better. You get more blood
flow to the liver plus better uptake of lactate by other
organs and skeletal muscles to be used as an energy
substrate and keep hydrogen ion levels low.
See Figure 5.10 for more.
Interestingly, even the process of recovering and adapting to our exercise training demands is metabolically
costly. Breaking down and building up proteins takes
energy. Protein turnover accounts for between 10 and
25% of resting energy expenditure.
We need energy not only to do exercise itself, but for two
jobs after exercise:
•
paying back the oxygen debt; and
•
repairing and rebuilding.
Thus, when thinking about how exercise relates to TDEE,
make sure to consider the big picture.
Each activity type will have its own unique profile of adaptation. The more often and consistently you exercise,
the faster you’ll adapt.
Most adaptations begin within days of beginning a new
exercise routine. However, some adaptations continue
indefinitely. For example, Krebs cycle enzymes keep increasing even after two years of intense aerobic training,
while the cross-sectional area of muscle fibers continually fluctuate.
And of course, we must use it or lose it. Each of these adaptations depends on constant protein turnover. So each
depends on regular activity for a stimulus, and good
nutrition for the raw materials.
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Aerobic and Anaerobic Metabolism | 153
Case study
It should be clear by now that exercise has wide-ranging
effects in our body.
Both anaerobic and aerobic activities can help us get
stronger, fitter and healthier by stimulating metabolic and structural adaptations. They can also help us
prevent the metabolic decline of aging and improve our
quality of life.
Yet training and nutrition are somewhat energy system-specific. In other words:
If an athlete does an anaerobic sport, their training and
nutrition should support the particular demands of the
ATP-PCr and glycolytic pathways.
If an athlete does an aerobic sport, their training and
nutrition should support the particular demands of the
oxidative pathways.
(Of course, if athletes do both, then you support both.)
Here’s an example that illustrates this important principle.
Lacrosse, like hockey or soccer, involves brief bursts of
fast movement (such as running down the field) as well
as power (such as checking and throwing). While there’s
a component of aerobic endurance to it, it’s mostly an
anaerobic sport.
We then changed his nutrition plan.
We asked him to drink a protein-carbohydrate drink
(with added creatine) during each training session.
The carbohydrates would help fuel his high-intensity
glycolytic efforts.
The protein would help promote muscle protein synthesis, helping him build muscle mass and strength,
improve his enzyme quality, and a host of other positive
exercise adaptations.
The creatine would help build up his muscle Cr stores to
support ATP-PCr system energy transfer.
With this new regime, this athlete consumed 15 g
protein, 30 g carbohydrate, and 1 g creatine per hour of
exercise. Thus:
If his training lasted an hour, he consumed 15 g of protein, 30 g of carbs, and 1 g of creatine.
If his training lasted two hours, he consumed 30 g of
protein, 60 g of carbs, and 2 g of creatine.
And so on.
We also added another meal to his daily menu. This
well-balanced meal gave him more energy and more
important nutrients.
A 17-year-old lacrosse athlete came to us complaining
of early fatigue. His energy levels would fade midway
through games and his performance would drop off
fairly dramatically.
During tournaments and multiple event weekends, he
kept a cooler well stocked with between / after game
foods and drinks to ensure recovery and energy for the
next event.
We reviewed what he was doing. It became clear that he
was training like an endurance athlete, and eating like
an average person. Even though his growing male body
plus his athletic training demanded more energy and
high-quality nutrition, he wasn’t getting it. He couldn’t
repair his muscles nor replenish his fuel stores.
We tracked his results carefully and saw big improvements right away. Within one month:
Our first step was to adjust his training program,
weighting it much more towards anaerobic activities
such as sprinting, plyometric drills, and full-body resistance training.
The athlete gained lean mass and lost body fat.
He had lots of day-to-day energy.
He also had lots of energy for training: Now he was
just as strong toward the end of his games or training
sessions as he was at the beginning.
The lesson here: Help your clients get the right kind
of training, and the right kind of fuel, for their specific
activities.
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Summary
Resting metabolic rate (RMR) changes as we age. On
average, after age 25 we lose 2-4% of our RMR every
decade.
intimate link with the nervous system (T-tubules), and
an extensive network of energy transfer (large, numerous mitochondria).
This decline is not inevitable. Good nutrition and regular activity, especially high-intensity anaerobic activity,
help build lean mass that slow the aging process and
keep us fit, healthy, and functional for life.
Oxygen consumption goes up both during and after
exercise. How much and how long it goes up for depends
on exercise intensity and duration.
Exercise requires energy, both during the activity itself,
and — in the case of anaerobic activity — for hours or
even days afterwards.
We can measure this energy cost by looking at oxygen
consumption using METs. 1 MET = 3.5 mL of oxygen
consumed per kilogram of bodyweight per minute. To
determine the hourly energy cost of an exercise bout, you
can multiply the MET intensity by bodyweight in kg.
Our skeletal muscles help us move with an efficient
network of contractile proteins (actin, myosin, etc.), an
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The intensity of energy demand determines the fate
of our macronutrients both during and after exercise.
Aerobic exercise uses mostly fatty acids, glycogen, and
a small amount of protein through the slower-burning
oxidative pathways. Anaerobic exercise uses mostly ATP
and PCr, glucose, and glycogen through the fast-burning
ATP-PCr and glycolytic pathways.
Both types of exercise, as well as daily-life movement,
lead to beneficial metabolic adaptations. But for best
results, make sure you match exercise and nutrition
programming to client needs and activities.
UNIT 6
Macronutrients
156 | Unit 6
Unit Outline
1.
Macronutrients
4.
Macronutrient 3: Protein
2.
Macronutrient 1: Carbohydrate
5.
Case study
3.
Macronutrient 2: Fat
6.
Summary
Objectives
In this unit, you’ll learn all about the three major macronu-
our ability to do work, our recovery from exercise, chronic
trients (carbohydrate, fat, and protein), their chemical com-
disease risk, body composition, and much more.
position, and why they’re important to health. Different
macronutrients can significantly affect our energy levels,
You’ll also learn how each of the energy systems discussed
in previous units depends on our dietary intake of the
macronutrients.
Macronutrients
Macronutrient 1: Carbohydrate
In previous units, you learned about macronutrients:
carbohydrate, fat, and protein.
Carbohydrate structure
These three macronutrients, for the most part, make up
our food. (Of course, remember that food also contains
micronutrients, which we’ll look at in the next unit,
and food is more than just a “macronutrient delivery
system.”)
We typically classify carbohydrates by their general
chemical structure, and divide them into three general
groups of saccharides (from the Latin saccharum, or
sugar) based on their level of complexity (for examples of
each, see Table 6.1): monosaccharides, oligosaccharides,
and polysaccharides.
Macronutrients can affect many processes in our body,
including:
You can think of saccharides as looking like links in a
chain.
•
our ability to digest our food and absorb nutrients;
•
our hormone production;
•
our immune system health;
•
our cells’ structure and function;
•
our body composition (i.e., how much lean mass and
Monosaccharides are the simplest form of carbohydrates, since they contain only one (“mono”) sugar
group, or chain link.
•
our metabolic function; and
Oligosaccharides are short chains of monosaccharide
units linked together in the form of disaccharides (“two
sugars”), trisaccharides (“three sugars”), etc. The most
common oligosaccharides are the disaccharides, including maltose, sucrose, and lactose.
•
much more.
Maltose = glucose + glucose
body fat we have);
In this unit, we’ll look at some of these processes, and
how each macronutrient plays an important role in them.
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Sucrose = glucose + fructose
Lactose = glucose + galactose
Macronutrients | 157
Table 6.1 Carbohydrate Classification
Monosaccharides
Oligosaccharides
Polysaccharides
Glucose
Sucrose
Fructose
Maltose
Galactose
Lactose
Digestible
Starch and dextrins
Glycogen
Mannose
Trehalose
Ribose
Partially digestible
Inulin
Raffinose
Indigestible
Cellulose
Pectin
Polysaccharides have many (“poly”) saccharides. They are long, complex chains
of linked monosaccharide units, which can be either straight or branched.
Typically, when we refer to starches, glycogen, or fiber, we’re referring to
polysaccharides.
monosaccharides: The simplest
form of carbohydrate
oligosaccharides: Saccharide
composed of a small number of
monosaccharides
polysaccharides: More than
about 10 linked monosaccharides
that form a polymer
Different carbohydrate structures affect not only how the carbohydrates behave
when they are cooked, but also how we digest and absorb them.
glucose: A monosaccharide
found in foods and blood; the
end product of carbohydrate
metabolism and the major source
of energy for humans
Plant cells make starches by joining glucose monosaccharides together. Amylose
and amylopectin are the two main forms of starch. The links are connected with
glycosidic bonds, which join monosaccharide molecules.
fructose: A monosaccharide that
is very sweet; possesses a ketone
rather than an aldehyde, which
distinguishes it from glucose
Amylose is a linear polysaccharide. This means it looks like a single long chain.
galactose: A monosaccharide;
less soluble and sweet than
glucose
amylose: A component of starch
characterized by straight chains of
glucose units
Hydrogen
amylopectin: A component of
starch characterized by its highly
branched structure and fast
digestion
Oxygen
Carbon
CHO
H – C – OH
HO – C – H
3D model of Glucose
H – C – OH
H – C – OH
C6H12O6
Molecular formula for Glucose
CH2OH
Fischer projection
(2D representation)
of Glucose
Figure 6.1 Structure of glucose
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Amylopectin is a highly branched polysaccharide. This means it looks like several chains hooked together.
Glycogen is like starch, but made by animal cells from glucose monosaccharides
in the process of glycogenesis.
Cellulose, which gives plants their rigid cell walls, is another polysaccharide
similar to amylose. We know it as fiber. But unlike starch, fiber’s chemical bonds
resist human digestive enzymes. We can’t break fiber down well in our GI tract.
So we don’t digest or absorb it, although it can be broken down and used a bit
by the bacteria in our GI tract. Animals that live on high-cellulose plants (such
as cows that eat grass, or termites that eat wood) have bacteria in their stomachs
that can digest it and extract the energy from it.
Which potatoes should you choose?
You may have noticed that particular potato recipes call for specific kind of potatoes. This is because potatoes differ by their content of amylose and amylopectin.
Potato types high in amylose are fluffy and floury. They’re best for mashing,
frying, or baking.
Potato types high in amylopectin are waxy. They’re best for boiling, and tend
to hold their shape rather than falling apart. If you try to mash them, they’ll go
gluey.
Waxy-type potatoes are also higher in resistant starch. When they’re cooked,
then cooled, their molecules align to trap water and resist digestion.
Carbohydrate digestion, absorption, transport and
metabolism
We can’t absorb larger carbohydrate molecules (polysaccharides). We need to
break them down into monosaccharides (glucose, fructose, and galactose) and
eventually release them into the bloodstream as glucose.
This process occurs throughout the GI tract, and begins the moment we put
carbohydrate in our mouth.
The mouth
salivary amylase: Enzyme
found in saliva that catalyzes the
hydrolysis of starch
As soon as we take a bite of carbohydrate, salivary amylases help to hydrolyze,
or break down, these polysaccharides into smaller carbohydrate chains.
Salivary amylase, however, can only help with about 20% of carbohydrate
breakdown, depending on how long food stays in our mouth. The less we chew,
the faster we swallow, and the less salivary amylase has a chance to work on our
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food. Conversely, if we eat slowly and chew well, we digest our food better with
the help of these salivary enzymes. (A good reason to eat mindfully.)
The stomach
After the carbohydrate food is swallowed, it travels down the esophagus to the
stomach. In the stomach, carbohydrates (and all other swallowed food) get mixed
into a homogenous mixture known as chyme. There is no further digestion of
carbohydrates here, as the job of the acidic environment of the stomach is to
destroy potential harmful pathogens. And it stops the action of salivary amylase.
The small intestine
Once the carbohydrate is passed on to the small intestine, pancreatic amylases
take over, turning these smaller carbohydrate chains into disaccharides.
•
The enzyme maltase breaks down maltose into two monosaccharide units of
glucose.
•
The enzyme lactase breaks down lactose (milk sugar) into glucose and galactose monosaccharides.
•
The enzyme sucrase breaks down sucrose (table sugar) into glucose and fructose monosaccharides.
Remember, starch is made up exclusively of glucose molecules joined together
into long chains. Thus, the end products of starch digestion are always glucose
monosaccharides.
All of these monosaccharide end products pass through the intestinal cells into
blood vessels that take them to the liver (via the portal vein) before they enter
general circulation.
The liver
The liver takes what it needs for energy transfer and glycogen storage and then
ships the rest out as glucose monosaccharides.
You may have noticed that we can absorb galactose and fructose from our diet,
but they don’t usually end up in the bloodstream. Why not?
First, they’re both mostly converted to glucose by the liver. If there’s any
leftover glucose that the liver doesn’t think we need, it’ll turn that into triglycerides (especially in times of caloric excess).
Second, our liver actually prefers to use fructose rather than glucose for energy
and liver glycogen replenishment (though it can use glucose too). Again, once the
liver takes what it needs and does the appropriate chemical alchemy, the glucose
units released into circulation work their way through the blood until they’re
taken up into our cells.
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Is fructose “bad for us”?
One of the most important things to understand about
sweeteners is that their chemical structure affects the
way the body processes and stores them.
The word “fructose” comes from the Latin fructus, or
fruit. Fructose is mostly found naturally in fruit, but also
in other sweeteners such as honey… and more importantly, in high-fructose corn syrup and table sugar.
Some experts think that over-consuming fructose will
lead to Type 2 diabetes and other types of metabolic
disruption and diseases. The more we consume, the
worse it is. Many people even claim we shouldn’t eat
fruit at all.
drink sweetened beverages. Combine that with other sweetened foods, and the sugar adds up fast. For
instance, let’s look at what our average North American
might eat in a day:
Meal
Foods eaten
Sugar
content
Breakfast
Honey Nut Cheerios with
sweetened soy milk
45 g
Glass of orange juice
On the way to work
Starbucks Grande Frappuccino (Vanilla Light)
39 g
What does the research say?
Mid-morning snack
Nutrition bar
25 g
Based on the most current studies, most people should
get no more than 50 g of added fructose per day. Added
fructose includes things like sugar, high fructose corn
syrup (HFCS), juice, honey, and other sweeteners.
Lunch
Chicken wrap
46 g
Mid-afternoon snack
Can of Slim-Fast
18 g
Whole foods like fruit don’t seem to contribute to the
sugar problem because of their fiber, water, and phytonutrient content.
Dinner
Stir-fry with sweet and
sour sauce
21 g
More than 50 g of added fructose, and we start to see
problems. Less than that, especially if we’re otherwise
healthy and active, and we’re fine. (Some active and
healthy people can have more than 50 g daily; usually
sedentary people are more at risk for metabolic disruption.)
15 oz can of sweetened
iced tea
Salad with bottled
French dressing
Dessert
Bowl of low-fat ice cream
or frozen yogurt
30 g
But what does that mean in reality?
That’s 224 g of sugar. If most of that is table sugar, then
about half of it (112 g) is fructose.
First, the average North American adult gets 20% of
their daily energy intake as added sweeteners. That
means they’re eating a lot of processed foods with lots
of extra sugar in them.
And that’s definitely not an outrageous day of eating
in North America. Some people might even consider it
healthy. (After all, they chose the Light Frappuccino and
the low-fat ice cream.)
Second, let’s translate 50 g of fructose to real foods and
drinks.
However, with whole, minimally processed foods, it’s
a lot tougher to get that much fructose, or sugar in
general.
For instance:
•
A 32 fl ounce soda sweetened with either high
fructose corn syrup (HFCS) or sugar has about 50
g of fructose.
•
A 32 fl ounce sports drink has about 22 g of
fructose. 1 bag of Skittles would provide another
24 g.
It’s especially easy to rack up sugar grams when you
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For instance, you’d have to eat about 11 apples to get
that much fructose… or an unimaginably intestinally
distressing quantity of red beets.
No matter which sweetener you choose, the real issue is
quantity.
If sweeteners — from any source — regularly make up
more than 5 to 10% of your diet, that’s probably bad
news for your health.
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The bloodstream
On average, we move about 20 g of glucose through our blood every hour. Our
body prefers to keep this more or less stable.
If our blood sugar drops too low, the body will immediately use the new glucose
supply for preserving blood glucose levels and for immediate energy.
If our blood sugar goes too high, the liver and muscles will take up what they can.
The liver can store about 80-100 g of glycogen before it’s full. And the muscles can
store between 300-600 g of glycogen before they’re full (this obviously depends on
the amount of muscle mass someone has, as well as their training status).
If blood sugar is still too high after liver and muscle storage, extra glucose can be
converted into body fat, though that’s not as common. Instead the body oxidizes more glucose (because there’s more available) and less dietary fat, leading to
more of our dietary fat being stored as body fat.
The glycemic index
Many of you are probably familiar with the glycemic index (GI), a measure of
how quickly and significantly a given food can raise our blood sugar.
The GI tells us how much blood sugar goes up when we consume 50 g of usable
carbohydrate from a particular food. It’s a relative measure, determined against
a specific reference food — 50 g of carbohydrate from pure glucose — which is
given a GI value of 100. Each food’s GI score is then calculated relative to this
value of 100.
glycemic index (GI): Measure of
the rate of which an ingested food
causes the level of glucose in the
blood to rise
In general, the less processed and higher-fiber a food is, the more complex its
carbohydrate molecules usually are. Because of this, those foods will usually take
longer to digest and have a lower GI. See Figure 6.2.
Blood glucose (mmol/l)
8
High GI
7
(glucose)
6
Low GI
5
(beans)
0
50
100
150
Time after intake (minutes)
Figure 6.2 Glycemic index
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For instance, high glycemic foods include sugar, candy, breakfast cereal and
bagels. Lower glycemic foods include legumes, whole grains, and vegetables.
When blood glucose goes up quickly, insulin usually responds quickly. The
amount of insulin released usually matches the amount of glucose present.
This has led some people to suggest that a low-GI diet is a healthy one.
While an interesting measure of the physiological response to carbohydrate in
the diet, the GI doesn’t tell the whole story.
First, we don’t eat most foods by themselves. (When was the last time you ate a
plain slice of bread as a meal?) Since protein, fat, and fiber all change GI, eating
food as part of a meal will change the GI.
Second, many other factors can affect how quickly a food is converted to glucose,
including when we eat that meal during the day, whether we’ve been active, and
so forth. GI measurements vary from person to person, and from day to day and
meal to meal in the same person.
Third, the score can be easily manipulated by the type of sugar in the food.
Foods with large amounts of fructose tend to have low GI scores, simply because
fructose does not immediately raise blood glucose levels. But this doesn’t make
these foods any healthier.
Finally, the glycemic index is based on a standardized amount of carbohydrate,
not a standardized amount of food. In order to calculate the GI of 50 g of carbohydrate, we’d only need a small amount of sugar, but quite a lot of carrots, for
example.
Although it’s very easy to get 50 g of sugar in one sitting (for instance, a chocolate
bar plus a can of cola amounts to about 75 g of sugar), it would take about five
cups of carrots to get the same amount. Few people would eat this many carrots
in one sitting. This makes for an unfair and unrealistic comparison.
Glycemic load (GL)
glycemic load: Equal to the
glycemic index of a food times the
number of grams of carbohydrates
in the serving
Researchers often use the glycemic load (GL) as another, more realistic measure.
The glycemic load of a food is based on the glycemic index multiplied by the serving size of the food.
While this gives a better picture of how fast or significantly blood sugar may
go up after a meal, GL still has some of the same problems as GI. And it too
doesn’t take into account the other elements the food may have to offer (fiber,
micronutrient, and phytonutrient / zoonutrient content).
Insulin index (II)
insulin index (II): Measure of
the rate of which an ingested food
causes the level of insulin in the
blood to rise
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While GI and glycemic load are somewhat useful in determining overall glucose
load, they aren’t the best predictors of insulin response to a meal, which is the
measure most closely correlated with health.
Another index, the insulin index (II), measures the amount of insulin the body
produces in response to a particular food.
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Interestingly, the II does not always match the GI. You may be surprised to
know, in fact, that high-protein and high-fat foods can stimulate greater insulin
responses than you’d expect, while some high GI foods produce surprisingly low
insulin responses.
In addition, when people with underlying insulin resistance eat moderate and
high GI foods, their bodies produce more insulin than a healthy person’s.
Choosing carbohydrates wisely
The bottom line is that GI, GL, and II don’t give us the whole story. Most clients
probably shouldn’t be “eating by numbers.” Nor should these theoretical measures dictate what kinds of carbohydrates we eat and enjoy as part of normal
daily life.
We’ll discuss other, easier, and more effective methods for choosing foods later in
this unit.
Our cells
Let’s now look at what our cells do when glucose is available to them in the
blood.
Glucose transport
Cells take glucose from the blood using facilitated diffusion (and active transport), which you’ll hopefully remember from previous units. In this process,
transport proteins on the cell membrane grab the glucose monosaccharides and
transfer them into the cells.
In muscle and fat tissue, glucose uptake is stimulated primarily by the hormone
glucose
glucose
Binding
Transport
glucose
Recovery
Dissociation
glucose
glucose
=
chair representation
of glucose
Figure 6.3 Insulin dependent glucose transport
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GLUT family: Group of
membrane proteins that transport
glucose from the blood into cells
insulin. Insulin tells glucose transport proteins (members of the GLUT transporter family) to move to the cell membrane so that they can pick up glucose
floating past and bring it into the cell.
Muscle contraction also brings glucose into cells, even without insulin. This is
why insulin sensitivity and glucose uptake are usually better after exercise, and
why exercise helps keep us metabolically healthy.
isoforms: Any of the proteins
with the same function and similar
amino acid sequence, encoded by
different genes
Fourteen isoforms, or related types, of GLUT have been described (GLUT1
— GLUT14). All cells have at least one of these on the plasma membrane. But
generally, GLUT transporters like to live in particular tissues.
GLUT1 — GLUT3 live in red blood cells, at the blood brain barrier, in the placenta, in fetal tissues, in the liver, in pancreatic beta cells, in the kidneys, in the
brain, in muscle tissue, and in the small intestine. They are responsible for basal
glucose uptake and don’t depend on insulin.
GLUT4 however, is sensitive to insulin (and muscle contractions). It lives in adipose cells, and heart / skeletal muscle. GLUT12 also appears to be sensitive to insulin. It was originally cloned from human breast cancer cells, and appears to be
expressed more in ductal cell carcinomas. This may tell us that glucose uptake in
breast cancer tissue is significant. Of course, we need further research to be sure.
Figure 6.4 Summary of carbohydrate-related metabolic pathways
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Macronutrients | 165
Table 6.2 Summary of the properties of facilitative glucose transporter family members
Protein
Major sites of expression
Proposed function
GLUT1
Ubiquitous distribution in tissues
and culture cells
Basal glucose uptake; transport across blood tissue barriers
GLUT2
Liver, islets, kidney, small intestine
High-capacity low-affinity transport
GLUT3
Brain and nerves cells
Neuronal transport
GLUT4
Muscle, fat, heart
Insulin-regulated transport in muscle and fat
GLUT5
Intestine, kidney, testis
Transport of fructose
GLUT6
Spleen, leukocytes, brain
Not determined
GLUT7
Small intestine, colon, testis
Transport of fructose
GLUT8
Testis, blastocyst, brain, muscle,
adipocytes
Fuel supply of mature spermatozoa; Insulin-responsive transport in
blastocyst
GLUT9
Liver, kidney
Urate / glucose antiporter (transports urate out and glucose in, and both
have to happen for the transporter to work); glucose transport
GLUT10
Liver, pancreas
2-deoxy-glucose and galactose transport
GLUT11
Heart, muscle
Muscle-specific; fructose transporter
GLUT12
Heart, prostate, mammary gland
Insulin-responsive glucose transporter
GLUT13
Neurons and glial cells
Transport of myo-inositol
GLUT14
Testis
Not yet known
After glucose enters most cells, it becomes phosphorylated via ATP to become glucose 6-phosphate. This process
activates glucose for entry into the metabolic pathways of
the body (including glycogenesis, glycogenolysis, and glycolysis) while preventing the glucose from leaving the cell.
Carbohydrates: The big picture
You can refer back to previous units for a reminder of
the specifics of how glucose is used for energy.
There is no “correct” amount of carbohydrates that is
the same for everyone, all the time.
Carbohydrates in the diet
Carbohydrate intake will depend on factors such as:
We need glucose to live. As we saw in previous units,
energy transfer depends on it. Tissues such as our brain
and red blood cells, which can’t make their own glucose,
need a continuously available supply of it.
Our brain needs about 130 g of glucose a day. We can
get this from our diet. Or, when carbohydrate intake is
low (or we’re fasting), gluconeogenesis and ketosis can
provide what we need, assuming we have enough protein
and fat to process.
This is important to understand: While our body needs
a certain amount of glucose, that glucose can come from
several sources.
By now, we hope it’s clear, but we’ll reiterate:
There is no single “best” diet.
•
how big or small someone is;
•
how much lean mass or body fat they have;
•
how active they are;
•
how intense, long-lasting, and / or frequent that
activity is;
•
how old they are, and what stage of life they are at;
•
intake levels of other macronutrients;
•
genetics;
•
what foods they like, tolerate, and prefer to eat; and
•
what they want to do.
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Same as others
SD = Standard deviation
Probably more
than others
Probably less
than others
Definitely more
than others
Definitely less
than others
-2
SD
2%
-1
SD
14%
+1
SD
Mean
score
34%
34%
+2
SD
14%
2%
Percentage of people
Figure 6.5 How much carbohydrate do people likely need?
For example, a muscular young male athlete who
competes in heavyweight-class boxing and trains twice
daily will probably do best with more total energy and
carbohydrates in his diet. A sedentary 68-year-old
woman who does Tai Chi once a week will need less
overall energy and relatively fewer carbohydrates. When
it comes to carbohydrate intake, there is a distribution of
how intake will vary. A small percentage of people will
function best with more carbohydrates than average; another small percentage will function best with less than
average. And most people are somewhere in the middle,
doing best with a moderate portion of carbohydrates (especially from higher-fiber, nutrient-rich, slow-digesting
sources such as vegetables, fruits, legumes, and whole
grains). See Figure 6.5.
We’ll look at some types of carbohydrate next.
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While it’s important to learn about the specific features of each carbohydrate type, keep the big picture
in mind.
Focus on these key points:
•
Humans evolved eating a varied and seasonal diet.
We thrive best on a mix of carbohydrate types that
occur naturally in different types of foods.
•
Most of the time, we want relatively slower-digesting,
higher-fiber carbohydrates.
•
We easily get these types of carbohydrates if we
choose a wide selection of diverse, whole, less-processed foods such as:
•
fruits and root vegetables
•
whole grains
•
beans and legumes
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•
Occasionally, faster-digesting, lower-fiber carbo-
Fiber
hydrates can be helpful, particularly for athletes or
people looking to gain weight.
•
Match your nutrition plan to each client’s unique
body, preferences, and needs.
We’ll give you some more specific recommendations in
Section 2.
Carbohydrate type
“Carbs” are not all created equal. While they all meet
more or less the same fate in the body, the process by
which they end up as glucose (and then, perhaps, glycogen or triglycerides), will differ. This will create different
effects in the body.
For instance, compare:
•
Cellulose, technically a carbohydrate, isn’t used for
energy at all. Our GI bacteria munch on it a little bit,
and then we excrete most of it. As fiber, it can bind
to other things in our GI tract, such as fat-soluble
hormones or other dietary fats.
•
A highly branched chain of amylopectin must be broken down slowly in our small intestine. It will release
its glucose gradually.
•
A spoonful of table sugar in our coffee will be easily
broken into glucose and fructose for quick disposal in
our liver and possibly bloodstream.
These differences are important.
Complex carbohydrates that come from whole-food
sources like vegetables, fruits, legumes, and whole
grains tend to keep us feeling full longer. They also
travel with passengers: micronutrients, phytonutrients,
fiber and water — perhaps even some protein and
healthy fats. They keep our blood sugar and insulin
levels stable, releasing their energy gradually.
Simple, refined and highly processed carbohydrates
digest quickly but tend to leave us unsatisfied.
They’ve been stripped of nutrients. Their passengers are often high amounts of sodium along with
industrial chemicals such as flavorings, trans fats or
preservatives. They stimulate our appetite and leave
us wanting more. They can cause fluctuations in our
blood sugar and insulin levels.
In general, we should try to eat mostly complex carbohydrates from whole-food sources.
Fiber comes in two different forms: soluble and
insoluble.
We can’t digest these, but they have important jobs.
Our GI bacteria love to ferment them, producing shortchain fatty acids like acetate, propionate, and butyrate.
Emerging evidence shows these fatty acids can provide
various health benefits.
Soluble fiber is so called because its carbohydrate
molecules are water soluble. It will often turn to a gel in
water (for example, think of the pectin that gives jelly
its structure).
Soluble fiber is found in oats and oat bran, dried beans
and peas, nuts, barley, flax, chia, fruits like oranges,
bananas, blueberries, and apples, and vegetables such
as artichokes, tomatoes, and carrots. You can also
find it in supplements such as glucomannan or konjac
(which is often used in East Asian cuisine for jellies or
shirataki noodles).
Soluble fibers can decrease enterohepatic recycling of bile
acids (instead of bile acids being recycled, they will be
excreted in the stool), which can decrease serum cholesterol
levels. They can also help excrete other fat-soluble substances such as sex hormone metabolites (byproducts).
Insoluble fiber is found primarily in the structures that
make up plants’ rigid cell walls. This includes vegetables
such as celery, root vegetables, dark green leafy vegetables, fruit and vegetable skins, whole-grain seed hulls,
seeds, and nuts.
Insoluble fibers will add bulk to stools and help to ensure
regular bowel movements.
Thus, fiber can:
•
help us feel full longer;
•
lower our blood lipids and cholesterol;
•
lower our risk of colon cancer;
•
keep things moving through our GI tract; and
•
boost our overall gut health.
Although the minimal recommended intake for fiber is
25 g / day, the optimal amount seems to be closer to 35 g
/ day for women and 48 g / day for men.
Not every client will do well with this amount of fiber.
Some clients with inflammatory bowel disease (IBD) or
colitis may feel better with less during flare-ups.
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Keep complex carbs simple
When it comes to the actual carbohydrates, we suggest making things complex — at least, in terms of the
carbohydrates themselves. As often as possible, choose
less-processed, whole foods with slow-digesting carbohydrates such as complex starches and fiber.
But when it comes to nutrition programming, keep it
simple.
In other words, don’t get lost in GI lists or nutrient timing if your clients aren’t eating their vegetables.
Instead, start with the real priorities: Making sure your
clients are eating the right foods, in the right amounts,
for the right reasons.
Use this list as a checklist.
1. How much food are they eating each day?
Are they eating the right amounts for their goals? We’ll
look more at portion sizing later.
2. How are they eating each day?
Are they slowing down to taste and enjoy their food
mindfully?
3. Why are they eating each day?
Are they eating when they’re truly physically hungry?
4. What are they eating each day?
Are they eating mostly whole, fresh, minimally processed foods, such as fruits, vegetables, lean proteins,
healthy fats, whole grains, and / or beans and legumes?
5. Are they doing #1 to #4 properly and consistently?
STOP here until your client can do the above at least
75% of the time. (For best results, we prefer to get closer
to 90%, depending on their goals.) And wait a little
while to make sure they can keep doing it.
And only then, if they really need it, and their goals dictate it, should they consider timing of specific carbohydrates after workouts.
We’ll give you some more specific recommendations in
Section 2.
Resistant starch
As its name implies, resistant starch resists digestion. You
can think of it almost as a third kind of dietary fiber.
competition, especially if they have multiple events in one
day. In those situations:
Some types occur naturally in foods such as green bananas or beans.
•
Insulin sensitivity is high.
•
Liver and muscle glucose uptake is rapid.
Another type is starch that has been cooked then cooled.
When cooled, this starch arranges its molecules in a
different configuration. This can include cold cooked
potatoes, cold cooked oats, cold cooked pasta, or sushi
rice. (See? Leftovers are good for you.)
•
Carbohydrates will go to replenishment and oxida-
Like dietary fiber, we can’t fully break down or absorb
the nutrients from resistant starch. Rather, our intestinal
bacteria turn it into short-chain fatty acids.
Special considerations
Simple, fast-digesting carbohydrates can be useful in a
couple of situations.
First, these types of carbohydrates can help higher-level athletes who need rapid refueling around training /
Nutrition: The Complete Guide
tion, rather than storage.
•
The athlete needs this process to happen quickly and
easily. (Especially since they may not want to train or
compete with lots of food in their stomachs.)
In this case, simple processed food sources of carbohydrates around training or competition times are an
appropriate choice.
Second, simple processed carbohydrates can help people
who are underweight and having trouble eating enough.
These types of carbohydrates can help people get enough
energy when needs are very high (e.g,. endurance athletes). They can also help replenish fuel stores after training, which can help people gain weight if needed.
Macronutrients | 169
Thus:
•
Carbohydrate amount, along with total energy, is important.
•
Carbohydrate type, along with the other nutrients in a given food, is
important.
•
Carbohydrate sensitivity matters: Active people need and use carbohydrates
most effectively.
•
Carbohydrate timing can matter for higher-level athletes who are already
following a good-quality basic diet consistently, and who are looking for the
“extra edge” for their training or competitions.
For more on individualizing carbohydrate intake, see Section 2.
Macronutrient 2: Fat
Fat structure
Fats are organic molecules made up of carbon and hydrogen elements joined
together in long groups called hydrocarbons. The arrangement of these hydrocarbon chains, and their interaction with each other, determines fat type.
hydrocarbons: Organic
compounds that contain only
carbon and hydrogen
The simplest unit of fat, analogous to a carbohydrate monosaccharide, is the fatty acid. Fatty acids are made of simple hydrocarbon chains with special chemical
groups at each end:
•
a methyl group (CH3) on one end; and
•
a carboxyl group (COOH) at the other.
methyl group
fatty acid: Chain of carbon
atoms with a carboxylic acid and
aliphatic tail
carboxyl group
Figure 6.6 Differences in fatty acid structure. Saturated fats contain no double bonds between carbons. Monounsaturated fats
contain one carbon-to-carbon double bond. Polyunsaturated fats contain multiple carbon-to-carbon double bonds.
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Hydrogen atoms can bond to the hydrocarbon chain. This is known as saturation. The more hydrogens bonded, the more saturated the fat is.
saturated fatty acids: A fatty
acid with no double bonds in the
chain
unsaturated fatty acids:
Having double bonds between
carbons in the fatty acid chain
If hydrogens have filled up all the available bonding spots on the chain, the fat
is saturated. Because of this chemical structure, saturated fats (such as butter,
coconut oil, or cocoa butter) are usually solid or semi-solid at room temperature.
If only some hydrogens have bonded, the fat is unsaturated. Unsaturated fats
are usually liquid at room temperature. The less saturated the fat, the more fluid
it is. (Indeed, omega-3 fatty acids act like “natural antifreeze” for cold water fish,
preventing their cells from stiffening up in icy temperatures.)
Unsaturated fatty acids can be broken down into;
•
monounsaturated fatty acids (in which only one carbon is unsaturated); and
•
polyunsaturated fatty acids (in which more than one carbon is unsaturated).
The often-discussed omega-3 and omega-6 fats are both polyunsaturated fatty
acids. Their names come from the location of their double bonds.
Alpha-linolenic acid (ALA): polyunsaturated, essential fatty acid
Figure 6.7 Determining the location of double bonds
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Macronutrients | 171
Table 6.3 Foods highest in saturated, monounsaturated, and polyunsaturated fats
Highest in saturated fats
Highest in monounsaturated fats
Highest in polyunsaturated fats
Butter
Almonds (almond butter)
Chia seeds (chia oil)
Coconut (coconut oil, coconut milk,
shredded coconut)
Avocado (guacamole)
Cod liver oil
Brazil nuts
Corn oil
Canola oil
Fish (fish oil)
Dark chocolate (70%+ cacao)
Cashews (cashew butter)
Flaxseeds (flaxseed oil)
Fatty beef, lamb / mutton and pork
Egg yolk
Grapeseed oil
Palm and palm kernel oil
Hazelnuts (hazelnut butter)
Hemp seeds (hemp oil)
Whole fat milk, cheese, and yogurt
Lard
Mayonnaise
Macadamia nuts (macadamia butter,
macadamia oil)
Pine nuts
Cream (half & half, heavy whipping,
sour)
Olives (olive oil)
Peanuts (peanut butter, peanut oil)
Sesame seeds (tahini, sesame oil)
Soybean oil
Pecans (pecan butter)
Sunflower seeds (sunflower seed
butter)
Pistachios (pistachio butter)
Walnuts (walnut butter)
Safflower oil (this oil can be altered, so
check label)
Sunflower oil (this oil can be altered, so
check label)
Chicken and duck fat
To determine where the double bonds in fatty acids are located, simply count
from the terminal methyl carbon toward the carbonyl carbon (Figure 6.7). Omega-3 would mean a double bond on the third carbon.
As you may remember from Unit 3, fatty acids can be joined together to form
triglycerides. As the name implies, three (“tri”) fatty acids join together with a
glycerol molecule to make up a triglyceride. Triglycerides are the major form of
fat found in the diet, and the major storage form of fat found in the body.
Fat digestion, absorption, and transport
You’ll hopefully recall that to digest fat, the body breaks down triglycerides into
fatty acids and glycerol, which are repackaged in various ways before entering
the bloodstream.
This takes place mostly in the small intestine, where bile emulsifies triglycerides in the food we’ve eaten. Emulsification divides the fat into small
droplets that offer more surface area to digestive enzymes than the original
larger triglyceride droplet.
The pancreas secretes pancreatic lipase, the major enzyme of triglyceride
triglycerides: Compound with
three molecules of fatty acids
bound with one molecule of
glycerol; the storage form of fat in
humans
glycerol: Sugar alcohol that is the
backbone of a triglyceride
pancreatic lipase: Enzyme
secreted from the pancreas that
hydrolyzes fat
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Triglyceride
H
H
H
C
OH
H
C
OH
H
C
OH
O
H
C
H
C
H
C
O
O
H
O
O
H
Glycerol
O
OO
Free fatty acid
Figure 6.8 Triglyceride structure
digestion, into the small intestine where it hydrolyzes the triglycerides and removes the fatty acids from their glycerol backbone.
chylomicron: A lipoprotein
that transports cholesterol
and triglyceride from the small
intestine to tissues of the body
After they are broken down, fatty acids can diffuse across the intestinal cell layer
(mucosa). Intestinal cells repackage them into large lipoprotein particles called
chylomicrons. Chylomicrons are released into the lymphatic system, which slowly empties into general circulation through the thoracic duct (via the left subclavian vein, if you’re interested).
Because it takes a long time to break down and transport, fat enters the blood
several hours after we’ve eaten it. See Figure 6.9 for more.
Packaged in chylomicron
5.
Triglyceride
reassembled
H
O
H
C
H
C
H
C
O
O
O
O
H
O
Cells of small intestine
Triglyceride
hydrolyzed
1.
4.
2.
3.
Triglyceride
Figure 6.9 Triglyceride absorption
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You’ll remember from previous units that these packaged triglycerides circulating in the blood (carried by chylomicrons) are again broken down into free
fatty acids and glycerol with the help of an enzyme called lipoprotein lipase. This
occurs so they can pass through yet another cell membrane and into the tissues
of our body.
Once through the membrane, they’re either:
•
oxidized (through the process of ß-oxidation) and used to transfer energy in
skeletal muscle or other tissues; or
•
converted back (again) into triglycerides for storage in adipose tissue, skeletal
muscle, etc.
The role of lipoproteins
As we’ve seen, because fat doesn’t dissolve in water, it can’t travel in the blood on
its own. To get around the body, fat (such as triglycerides and cholesterol) must be
carried in a lipoprotein.
This is where phospholipids (which you may remember make up cell membranes)
come in handy. The phosphate “head” is hydrophilic: It can hang out in water.
The lipid “tail” is hydrophobic: It doesn’t like water. But it sure likes other fats.
See Figure 6.10.
Lipoproteins’ coats are studded with apolipoproteins, which act as receptors that
can bind to other things and help control what a specific lipoprotein does.
hydrophilic: Denoting the
property of attracting or
associating with water molecules
apolipoproteins: Proteins
that assist in the transport and
regulation of lipids.
You’ll remember from Unit 3 that there are several kinds of lipoproteins (in fact,
there are over a dozen when including sub-classes, but for our purposes, we’ll just
focus on a handful).
Figure 6.10 Basic lipoprotein structure
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Classification of Lipoproteins
Chylomicron
and
Chylomicron remnant
VLDL
(Very low
density lipoprotein)
LDL
(Low density
lipoprotein)
HDL
(High density
lipoprotein)
99% lipid
1% protein
92% lipid
8% protein
80% lipid
20% protein
50% lipid
50% protein
Figure 6.11 Classification of lipoproteins
Chylomicrons are the biggest. They carry triglycerides (fat) from the intestines to
the liver, to skeletal muscle, and to adipose tissue.
lipoprotein lipase: An enzyme
found in endothelial cells lining the
capillaries; hydrolyzes lipids into
fatty acids and glycerol
Very-low-density lipoproteins (VLDL) carry newly created and packaged triglycerides from the liver to adipose tissue.
Low-density lipoproteins (LDL) carry cholesterol to all cells in the body, and
come in two general types:
•
large buoyant LDL (lb LDL) particles (which indicates good health); and
•
small dense LDL (sd LDL) particles (which indicates poor health).
High-density lipoproteins (HDL) bring fat and cholesterol from the body’s
cells back to the liver. This is an important process known as reverse cholesterol
transport.
You may also see Lipoprotein (a) (LpA) listed on a client’s lab work. Scientists
aren’t totally sure what it does yet, but high LpA is linked to cardiovascular
disease. Its levels are genetically determined, and are not affected by cholesterol-lowering drugs. Niacin (vitamin B3) therapy seems to help. L-carnitine may
also lower LpA.
The total amount of each type of lipoprotein, and how much of each type we
have, can affect our health.
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HDLs are considered heart healthy lipoproteins
because of their role in reverse cholesterol transport ­— the removal of excess cholesterol from cells,
including arteries, and transportation back to the
liver. In general, we want the cholesterol content of
HDL particles to be higher. This usually indicates a
well-functioning reverse cholesterol transport system
and lower cardiovascular disease risk.
LDLs are often considered dangerous lipoproteins
because of their role in depositing cholesterol into
our arteries. Recent research seems to indicate that
the total number of LDL particles may be the most
important risk factor, even more important than the
cholesterol content of the LDL particles, which is the
number seen on most blood lipid panels. In general,
we still want the cholesterol content of LDL particles to be lower, as well as the total number of LDL
particles.
The Total Cholesterol to HDL Cholesterol ratio is a good
marker. The goal for males is 5:1 or lower, with 3.5:1
or lower being optimal. The goal for females is 4.4:1 or
lower, with 3.4:1 or lower being optimal.
Another ratio, Triglycerides to HDL Cholesterol, was recently determined to be the best predictor of risk among
the commonly available blood lipid tests. The goal is 4:1
or lower, with 2:1 or lower being optimal.
Fortunately, eating an appropriate amount of less-processed, whole plant and animal foods significantly improves blood lipids. Maintaining a healthy bodyweight
and body composition, and engaging in regular physical
activity also significantly improve blood lipids. But keep
in mind that our lipoprotein makeup is highly genetic.
A full discussion of lipoproteins and their effects is
beyond the scope of this textbook. Just remember some
basic ideas:
Now, as you can see, the world of lipoproteins can be a bit
hard to grasp. Let’s try an analogy.
•
Your bloodstream is like a highway. Lipoproteins are
like cars (LDL) and ambulances (HDL). Cholesterol
and fats are like passengers in those cars and ambulances. The guardrails on the highway are like the
lining of your vessels.
•
If there are too many cars (LDL), there are likely to be
more crashes into the guardrails. When an LDL particle crashes into the lining of the vessel, it can initiate
the process of plaque formation on an artery. HDL
particles would be like the ambulance who comes to
the scene of the crash and takes passengers back to the
hospital (the liver).
As you can see, it’s not the passengers (cholesterol) that
are the main concern, it’s the number of cars on the road
(LDL). Someone who goes to the doctor to get general
blood work will likely get a test for total cholesterol
(measuring the number of passengers). We also want to
know the number of cars (the number of LDL particles)
and ambulances (the number of HDL particles).
Unfortunately, most general blood work won’t provide
you with the number of LDL particles or apolipoproteins
(another way to measure LDL particles). But there are
still some good markers for measuring cardiovascular
disease risk.
We have a range of lipoprotein types, which have
different physical structures and different jobs.
The total and relative amounts of each lipoprotein
can affect our health.
•
When talking about “cholesterol”, be sure you are
clear on what you mean. Most of the time, when
doctors or news articles talk about “cholesterol”, they
usually mean the cholesterol content of various lipoproteins. Not the size or the number of lipoproteins
(which are both important).
Fat in the diet
Dietary fat has six major roles:
•
It provides us with energy (in fact, it’s the most energy-dense macronutrient).
•
It helps make and balance hormones, particularly our
steroid hormones (such as sex hormones and corticosteroid hormones).
•
It forms our cell membranes.
•
It forms our brains and nervous systems.
•
It helps transport the fat-soluble vitamins A, D, E, and
K.
•
It gives us two fatty acids that we can’t make on our
own:
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100
39%
66%
9%
47%
22%
17%
90
Saturated fat
19%
80
Monounsaturated fat
Fat content (%)
70
Polyunsaturated fat
60
43%
31%
37%
47%
46%
50
40
30
49%
27%
20
18%
72%
10
0
4%
4%
gs
Eg
r
tte
u
B
ax
Fl
s
ed
se
Be
ef
fu
To
lm
Sa
on
Figure 6.13 How foods differ in fat content
linoleic acid: Unsaturated
omega-6 fatty acid considered
essential to the human diet
•
linoleic acid (an omega-6 fatty acid), and
•
linolenic acid (an omega-3 fatty acid).
linolenic acid: Unsaturated
omega-3 fatty acid considered
essential to the human diet
As you’ll remember, most dietary fat comes in the form of triglycerides: three
fatty acids attached to one glycerol backbone. Also remember that the glycerol
backbone doesn’t care what fatty acids attach to it. So most dietary fat sources are
made up of some combination of saturated, polyunsaturated, and monounsaturated fatty acids.
For example, while most people consider eggs to be foods rich in saturated fat,
eggs actually contain more monounsaturated fatty acids than saturated fatty
acids. Indeed, 39% of the fat in eggs is saturated while 43% comes from monounsaturated fat and 18% from polyunsaturated fat. See Figure 6.12.
Fat: The big picture
We’ll look at some types of fat next.
While it’s important to learn about the specific features of each fat type, keep
the big picture in mind.
Focus on these key points:
•
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Macronutrients | 177
of fat types that occur naturally in different types of
foods.
•
We want a relatively equally balanced mix of fat
types.
•
This balance comes naturally if we choose a wide
selection of diverse, whole, less-processed foods,
such as:
• nuts and seeds
• poultry
• avocados
• wild game
• dairy
• beef, pork, and lamb
• eggs
• olives and extra-virgin olive oil
• fatty fish
•
When feasible, getting fish and animal products that
•
beef, pork, and lamb (although the animals’ diet will
significantly change their fat type and content)
•
full-fat dairy (such as butter or cheese)
and cost).
•
coconut
Try to minimize or eliminate refined and processed
•
cacao (chocolate)
foods containing industrially produced fats and artificially hydrogenated fats.
At times, it may be useful to supplement particular
fat types, especially omega-3s (e.g., fish, krill, or algae
oil).
•
We find saturated fats in such foods as:
eggs
fatty acid profiles (balanced against availability, goals,
•
Because of this hydrogen bonding, saturated fats are
chemically stable. They don’t oxidize, or degrade easily,
because there are no spaces for any other molecule to
stick to. (In fact, recently a farmer in Ireland uncovered
a 22 lb (10 kg), 2,000-year-old chunk of butter that had
been preserved in a peat bog. It’s said to smell like a
strong cheese. “You could eat some”, said a researcher,
“but we don’t advise it.”)
•
are wild-caught or pasture-raised provides improved
•
Importantly, this saturation happens naturally, unlike
artificially created “hydrogenated” fats, which we’ll look
at in a moment.
Match your nutrition plan to each client’s unique
body, preferences, and needs.
We’ll give you some more specific recommendations in
Section 2.
Saturated fats
Saturated fats, as you’ll hopefully remember, are hydrocarbon chains that are “saturated”, or filled with hydrogens. There are no empty spaces on the chain for any
other hydrogens to bond.
methyl group
As you may have noticed when cooking with some of
these, saturated fats tend to be solid at room temperature
(think of the fat on a steak or a lump of butter). Again,
this comes from their chemical structure. With all the
hydrogens packed in there, there’s not much room to be
liquid. (We’ll come back to this idea later when we look
at hydrogenation.)
Saturated fats sometimes get a bad rap for causing heart
disease. (See “Is saturated fat ‘bad for us’?” on the next
page.) The relationship seems simple and logical:
•
If we eat saturated fat, then it should raise our cholesterol levels.
•
Foods high in saturated fat are also often rich in
cholesterol.
•
If we eat cholesterol, then it will also raise our cholesterol levels.
carboxyl group
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Is saturated fat “bad for us”?
If you remember the 1980s and 90s, you’ll remember
the “low-fat” craze. Fat (especially saturated fat) became
Public Health Enemy #1.
People tossed out their butter, bacon, and eggs, and
replaced these with margarine, “low-fat” turkey bacon,
and cartons of egg whites. They bought “fat free” commercial salad dressings and baked goods.
Ironically, we didn’t really get any healthier. Or slimmer.
Or fitter. (And actually, when you crunch the numbers,
we also didn’t actually lower our TOTAL fat intake, just
the percentage of total energy from fat).
Meanwhile…
•
•
Folks like the French, Greeks, and Scandinavians
kept eating olive oil, fatty sardines, butter, cream,
fatty meats, full-fat yogurt and cheese… but they
seemed perfectly fine.
In many Southern Hemisphere countries like
Costa Rica and Vanuatu, they chowed down on
avocado and coconut (not to mention starchy
tubers), and still managed to live healthy lives
relatively free of cardiovascular disease.
•
Ethiopians and Mongolians put butter in their
coffee and tea.
•
Arctic indigenous peoples like the Inuit ate whale
and seal blubber. While Arctic people now have
many health issues thanks to modern processed
foods, they do not seem to have chronic metabolic diseases if they live on their traditionally
foraged diet.
•
Traditional East African cattle herders like the
Masai drank full-fat milk straight from the cow,
not to mention living mostly on meat, milk, and
blood.
During the low-fat years, this drove researchers nuts (so
to speak) in North America.
How could people around the world eat that “bad stuff”
and stay so lean and healthy?
Scientists even started calling this the “French paradox.”
Of course, there are no paradoxes in nature. A “paradox”
means we don’t fully understand what’s happening.
What really occurred was that:
•
People ended up eating a lot more processed
foods.
•
People focused on the “badness” of a particular
nutrient, rather than on eating high-quality, delicious food mindfully.
•
People often felt less satisfied with their meals
(because, as you’ll remember, eating fat releases
satiety hormones), and ended up eating more
overall.
•
People ate more processed sugars and salt to
make up for the missing fat, not to mention plenty of industrial chemicals that reproduced fat’s
viscosity and mouthfeel.
•
People focused on the nutrient itself, instead of
considering their whole diet in a broader context.
This last point is perhaps the most important one.
Always look at the big picture.
Always look at a diet as a whole-life pattern — a set of
choices we make against a background of social and
cultural norms and environmental conditions.
In other words, don’t just look at some small part of
what we eat.
Look at how we eat, why we eat, and with whom
we eat.
•
Continental Europeans were living it up with
small portions, eaten slowly and joyfully with
others around a table.
•
Indigenous, foraging, and / or farming people
were moving around all day hunting that blubber, herding those cows, or churning that butter.
•
Healthy, long-lived populations were eating a
variety of fresh, seasonal foods — often foods they
grew or raised themselves.
We, on the other hand, were snarfing fat-free Snackwells in our cars, spreading industrially created fats on
our white bread, and eating second helpings of fat-free
ice cream for dessert because the first portion didn’t do
the job.
Think about it.
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As usual, human physiology is more complex than this.
For instance, a 2013 article in the British Medical Journal
points out that “Now two thirds of people admitted to
hospital with a diagnosis of acute myocardial infarction
[heart attack] really have metabolic syndrome — but
75% of these patients have completely normal total
cholesterol concentrations.” It concluded that “high total
cholesterol is not a risk factor in a healthy population.”
In previous units, you learned that:
Here’s what we know about saturated fat and health.
•
Raised cholesterol levels will then cause cholesterol to
be deposited into our arteries.
•
If we deposit it into our arteries, we will then form
arterial plaques that lead to cardiovascular disease
(CVD) and coronary heart disease (CHD).
•
Our own liver (and other bodily tissues) make most of
the
cholesterol
in our body.
methyl
group
•
Our liver tightly controls the relationship between the
cholesterol we eat and the cholesterol we make.
•
We need cholesterol for many important jobs in our
body.
•
Our steroid hormones — i.e., our sex hormones (such
as testosterone and estrogen) and mineral or glucocorticoid hormones (such as cortisol) — are made
from cholesterol.
So cholesterol is not “bad.” We need it to live. Indeed, artificially decreasing our liver’s cholesterol synthesis (for
instance, with statin drugs) can cause dangerous side
effects (though it can be a life-saving measure for many).
A recent meta-analysis (a type of study that looks at a
bunch of other studies and puts all the findings together)
found that “there is no significant evidence for concluding that dietary saturated fat is associated with an
increased risk of CHD or CVD.”
Other meta-analyses have found that:
•
We can’t predict a food’s disease risk by how much
A lot of saturated fat combined with a lot of sugar and
/ or processed / refined carbohydrate (in other words,
a low-quality dietcarboxyl
with group
lots of processed foods) is
unhealthy.
Saturated fat should be balanced with other fat types
(monounsaturated and polyunsaturated fats).
Our body seems to know what to do with naturally occurring saturated fats (for instance, stearic acid, found
in cocoa butter and beef). Many naturally occurring
saturated fats can even make us healthier.
But this doesn’t mean, as some types of diets claim, that
it can be “all bacon, all the time.” Fats are still energy-dense. And an unchecked intake of saturated fat is
not the answer.
Omega-3 and omega-6 fatty acids
You’ll hopefully remember that
we need to get omega-3 and
omega-6 unsaturated fatty acids
from our diet.
Omega-3 fatty acids
saturated fat it has.
•
Different saturated fats have different health effects.
Some, such as the stearic acid that naturally occurs in
beef and cacao, may even be good for us.
•
Foods that contain saturated fats, especially if they
The most important omega-3 fats are alpha-linolenic
acid (ALA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA).
•
are rich in ALA.
are processed, have other things in them (such as
sugar and sodium) that probably affect CHD and CVD
•
Plant sources such as flax, chia, hemp, and walnuts
•
Marine sources such as fish (and fish oil) and algae
risk as much or more (especially since that combina-
(the original omega-3 sources for fish) are rich in EPA
tion often leads to over-eating).
and DHA, which are widely recognized as the most
The biggest culprit in many chronic diseases, including cardiovascular disease, is excess body fat, which
leads to systemic inflammation and metabolic disruption from things like insulin resistance.
beneficial omega-3 fats.
Recall also that we don’t convert ALA to EPA / DHA
very well, so wherever possible, look for direct dietary
sources of EPA / DHA.
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stearic acid: An 18-carbon
saturated fatty acid
docosahexaenoic acid (DHA):
An omega-3, polyunsaturated
fatty acid, found mainly in fish and
algae; can be formed from ALA
eicosapentaenoic acid (EPA):
An omega-3, polyunsaturated fatty
acid, found mainly in fish and algae
As we’ve seen, cell membranes are fat-based. One reason omega-3 fats are so important is that they keep our cells’ membranes more “fluid”, which provides several
benefits. For example:
•
When brain cell membranes are relatively fluid, messages from neurochemicals
such as serotonin can be transmitted more easily. Getting enough EPA / DHA
early in life helps with brain development; getting it later in life helps prevent
or slow neurodegenerative disorders.
•
When muscle cell membranes are more fluid, it increases insulin sensitivity.
These essential fats also play a role in many other areas, including cardiovascular
function, nervous system function, and immune health.
eicosanoids: Signaling molecules
of the body that control many
systems
Eicosanoids are signaling molecules that help regulate processes such as immunity or inflammation. Both omega-3 and omega-6 intake can affect eicosanoid
production.
Omega-3 fats are considered anti-inflammatory. They tend to promote eicosanoids that do things like:
•
dilate (open up) our blood vessels;
•
lower inflammation;
•
prevent blood coagulation and clumping;
•
decrease pain; and
•
dilate our airway.
Omega-6 fatty acids
Three key omega-6 fatty acids are:
•
linoleic acid (LA);
•
gamma-linolenic acid (GLA); and
•
arachidonic acid (AA).
Omega-6s are considered pro-inflammatory. They promote eicosanoids that do
the opposite of omega-3 eicosanoids, such as:
•
constricting blood vessels;
•
increasing inflammation;
•
causing blood clotting;
•
increasing pain; and
•
constricting our airway.
These processes may sound unhealthy, but we need them. Without them, we
couldn’t heal from injuries or recover from training sessions.
We mentioned that lipoprotein makeup has a genetic component. Genes may
also affect metabolism of polyunsaturated fats too.
Because of variants in key genes, people from some ethnic groups (particularly
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folks with some types of African ancestry) may synthesize more AA and thus
potentially pro-inflammatory eicosanoids. This means that people carrying these
genes can have a higher rate of chronic diseases such as cardiovascular disease,
especially if they eat a lot of omega-6s.
Balancing omega-3s and omega-6s
As you can see, omega-3s effects oppose omega-6s effects. We need them both.
Indeed, fat balance is crucial.
As we’ve emphasized, humans evolved eating diverse diets that included
•
marine life (fish, seafood, and seaweed),
•
small and large wild game (including insects and reptiles)
•
eggs
•
nuts and seeds
•
various types of plants
Early humans would also eat as much of the animals they caught as possible,
including:
•
bone marrow and soft bones
•
organs
•
brains
•
connective tissues such as cartilage
•
eyes
•
the eggs of fish
•
skin and blubber
Not only did this give them abundant micronutrients (such as the minerals
and iron from bone marrow), it also gave them a relatively balanced omega-6 /
omega-3 ratio. Researchers studying indigenous diets estimate that this would
have been around 2:1 to 8:1 in favor of omega-6.
omega-6 / omega-3 fatty acid
ratio: Balance of dietary fat intake;
critical to overall health
Currently, in North America and western Europe, that ratio is now more like
10:1 to 20:1. We eat fewer foods that naturally contain omega-3s, and more foods
with omega-6s, particularly from oils in processed foods, especially soybean oil.
To improve the omega-3 to omega-6 ratio for yourself and your clients:
1. Eat fewer industrially processed and refined foods and fats (such as corn and
soybean oil).
2. Eat more varied plant and animal foods, especially fatty fish and wild game.
3. Once you’ve addressed the two most important steps above, consider whether
supplementing omega-3s (in the form of fish, krill, or algae oil) might be a
good idea.
We’ll look more closely at specific meal recommendations and supplementation
in Section 2.
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Trans fats
trans fat: Unsaturated fat with
a trans- isomer fatty acid; created
through hydrogenation
The trans fats are another group of fats. Their name — trans — is based on the
chemical configuration of the double bond in unsaturated fats.
Wherever a carbon-carbon double bond exists, there’s an opportunity for either
a “cis” or “trans” configuration. See Figure 6.15. Almost all naturally occurring
unsaturated fatty acids have a cis configuration, although there are a few naturally occurring trans fats.
Most trans fats come from industrial fat processing. This takes an unsaturated fat
(soft or liquid at room temperature) and bubbles hydrogen ions through it until
it’s solid at room temperature. This is known as “hydrogenation.”
There are two types of hydrogenation: full and partial.
•
Full hydrogenation makes a saturated fatty acid from a polyunsaturated fatty
acid.
•
Partial hydrogenation makes a trans-fatty acid from a polyunsaturated fatty
acid.
You may remember we mentioned earlier that saturated fats are chemically stable, because all of their hydrogen “parking spots” are full.
Polyunsaturated fats are normally reactive — they quickly oxidize and go rancid,
because other things such as oxygen can bond to their hydrocarbons. But since
hydrogenated fats are polyunsaturated fats that have been artificially “filled up”
with hydrogens, these fats now have a longer shelf life.
Figure 6.15 Trans versus cis fat
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While hydrogenation is good for commercial food production, it’s not so good
for our body. Especially the partially hydrogenated trans-fatty acids. Trans fats
don’t kink, or fold upon themselves like cis fats do. They pack into the cell membrane of our body very tightly.
This physical configuration changes how fats are processed in our body. For
instance, eating a lot of trans fats can:
•
lower HDL;
•
suppress the excretion of bile acids;
•
increase our own cholesterol production;
•
compete with essential fats for transport into the cells; and thus
•
create and worsen essential fatty acid deficiencies.
Over time, this can add up to a higher risk of many chronic diseases. Even
one meal with a high trans fat content can diminish blood vessel function and
elasticity.
In 2015, the FDA concluded that artificial trans fats in processed foods are not
GRAS (generally recognized as safe) and partially hydrogenated oils will need to
be phased out of all food products.
Importantly, the few naturally occurring trans fats, such as conjugated linoleic acid (CLA), which is formed in the rumen of cows and sheep, don’t seem to
harm us. They may even help us. As always, eating whole, less-processed foods is
usually best.
Macronutrient 3: Protein
Protein structure
Like carbohydrates and fats, proteins are made up of carbon and hydrogen molecules. Unlike carbohydrates and fats, proteins also contain nitrogen as part of
their amino groups.
The smallest unit of protein (similar to the monosaccharide or the fatty acid) is
the amino acid. All amino acids have four main characteristics (as seen in the
Figure 6.16):
•
an amino group (NH2) on one end;
•
a carboxyl group (COOH) on the other end;
•
a central carbon (called the alpha, α, carbon); and
•
a side chain (R group), which differentiates one amino acid from another.
When amino acids are joined together, they form what are called peptides or
peptide chains. These peptide chains, or groupings of amino acids, make up the
primary protein structure.
But most proteins aren’t just long chains of amino acids. Rather, these chains
form secondary, tertiary, and quaternary structures.
A protein’s secondary structure is formed as amino acids bind to their neighbor
α: Alpha; the first letter in the
Greek alphabet.
peptides: A molecular chain
composed of two or more amino
acids linked by the carboxyl group
of one amino acid and the amino
group of another
secondary: Pertains to the folding
of a polypeptide chain, resulting
in an alpha helix, beta sheet, or
random coil structure
tertiary: Refers to a protein’s
three-dimensional structure by
complete folding of the sheets and
helices of a secondary structure
held in position by hydrophobic
and hydrophilic interactions
quaternary: Refers to the
assembly of multiple folded
protein molecules in a multisubunit complex
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as well as to other amino acids further down the
chain. These secondary structures give proteins
strength and stiffness.
Many enzymes, transport proteins, and immunoproteins in the body have tertiary structures, which
are formed when the protein, in secondary structure
formation, loops together to form globular shapes.
When one or more proteins in tertiary structure join
together, we get quaternary structures. Each protein
is considered a separate sub-unit but we need the
entire protein, including this new shape, for optimal
function within the body.
Molecules’ chemical structures are important, but so
are their physical structures and shapes, which can
affect how they behave and fit together with other
Figure 6.16 Basic chemical structure of amino acids
molecules. This is particularly true for proteins,
which can be very large and complex molecules.
You’ve also gotten a sense of how this might work for trans and cis fat molecules.
Within our body’s own structures, and within the foods we eat, most proteins are
found in complex secondary, tertiary, and quaternary forms. But when we digest
complex proteins, we break them down into small peptides and amino acids. We
also judge protein quality based on amino acid content, not structural formations,
since we can then use those broken-down amino acids to build new things.
See Figure 6.17.
Protein digestion, absorption, metabolism, and transport
The stomach
The process of digesting complex proteins down into small peptides and individual amino acids starts in the acidic environment of the stomach.
gastric hydrochloric acid:
Produced by parietal cells in
the stomach, this acid liquid is
necessary for digestion
Here, gastric hydrochloric acid denatures (breaks apart) the secondary, tertiary, and quaternary structures of the ingested proteins, while the enzyme pepsin
begins to break down peptide bonds.
Then, the resulting polypeptides and single amino acids are passed along to the
small intestine.
The small intestine
proenzyme: Inactive enzyme
precursor that requires a
biochemical change to become
active
In the small intestine, proenzymes (aka zymogens) secreted by the pancreas
now enter the picture. These chemicals include trypsinogen, chymotrypsinogen,
procarboxypeptidases, proelastase, and collagenase.
Normally inactive, these proenzymes must be activated (by other enzymes and
chemicals also released into the small intestine) in order to form the enzymes
necessary for carrying out further peptide digestion.
Nutrition: The Complete Guide
Macronutrients | 185
Protein structures
Level
Description
Stabilized by
Primary
The sequence of amino acids in a polypeptide
Peptide bonds
Secondary
Formation of a-helices and ß-pleated sheets
in a polypeptide
Hydrogen bonding between groups along the peptide-bonded backbone
Tertiary
Overall three-dimensional shape of a
polypeptide
Bonds and other interactions between R-group, or between
R-groups and the peptide-bonded backbone
Quaternary
Shape produced by combinations of
polypeptides
Bonds and other interactions between R-groups, and between peptide backbones of different polypeptides
Figure 6.17 Four structures in which proteins are found in the body
This breaks down proteins further to produce small diand tripeptides as well as free amino acids.
Intestinal absorption
Different amino acids and peptides are absorbed in
different ways through the cells of the intestinal brush
border. All need ATP for active transport, using carriers.
Amino acids compete for transport by common carriers in the small intestine. As di- and tripeptides use
different carriers than individual amino acids do, short
peptides are actually absorbed more quickly than free
form amino acids. This is important to note, since large
dietary intakes of free amino acids (usually in supplement form) may create a “traffic jam” as these amino
acids “pile up” waiting for transportation. This means
they get into the bloodstream more slowly.
Once absorbed, these amino acids and peptides can
experience one of a few fates.
First, in the intestinal cells, some of these amino acids
can be used for energy or to synthesize new proteins
such as hormones, and new digestive enzymes.
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Figure 6.18 Protein absorption in the GI tract
glutamine: An amino acid that’s
only essential under certain
conditions (certain illnesses and
physical trauma)
plasma amino acid pool:
Reserve of amino acids found in
blood plasma
For example, our intestinal cells use the amino acid glutamine for energy. Glutamine also promotes gastrointestinal cell growth. Thus, much of the glutamine we
eat goes to intestinal cells. If we don’t get enough glutamine from our food, our
body will get it from the plasma amino acid pool and from muscle cells to meet
our intestinal cells’ demands.
Ingested amino acids and peptides can also be delivered to the liver (via hepatic
portal circulation) for processing and distribution to other cells of the body. See
Figure 6.18 for the process of protein absorption.
The liver
Most amino acids go to the liver. For every 100 g of amino acids taken in:
Nutrition: The Complete Guide
•
About 20 g will be used for protein synthesis in the liver.
•
About 60 g will be catabolized in the liver.
•
About 20 g will go into systemic circulation.
Macronutrients | 187
For every 100 g
of amino acids
ingested:
Liver 80 g
Catabolized 60 g
Protein synthesis 20 g
Remains in liver 14 g
Exported to plasma 6 g
Systemic circulation 20 g
Figure 6.19 On average, this is how 100 grams of ingested amino acids are distributed in the body
Protein synthesized in the liver
Of the 20 g of protein synthesized in the liver:
•
14 g of this protein will remain in the liver; and
•
6 g of this protein will be exported to the plasma
energy, glucose, ketone bodies, cholesterol or fatty acids.
Exactly what happens here will depend on factors like:
•
amino acids can only be used to make glucose);
in the form of plasma proteins (albumin, globulins,
lipoproteins, etc.), glutathione, carnitine, creatine,
and more.
Within the liver, proteins can be turned into enzymes
and nitrogen-containing chemicals for the liver to use.
Protein broken down in the liver
The liver will remove the amino group to produce
which amino acid is being broken down (e.g., some
•
what other nutrients are available;
•
how much energy is available (i.e., are we fasted or
fed?); and
•
what our body needs.
If our liver needs to make other amino acids, it can
transaminate them (which we covered in Unit 3). After
deamination and transamination you are left with ammonia, which is used for urea synthesis and excreted.
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Figure 6.20 Importance of the amino acid pool in maintaining homeostasis
Proteins exported from the liver
Whatever the liver doesn’t use, it sends out to feed the plasma amino acid pool and
other cells of the body. (Review Unit 3 for more on the plasma amino acid pool.)
branched chain amino acid
(BCAA): Amino acid with
aliphatic side chain that is nonlinear
cytokine: Hormone-like
substance secreted by various cells
that regulate immune response
Of the 20 g of amino acids that pass through the liver to the bloodstream, about
14 g of these are the branched chain amino acids (BCAAs). See Figure 6.20 for
more on the amino acid pool.
Our body’s cells can then extract amino acids from the plasma for various tasks
such as synthesizing:
•
muscle proteins
•
skeletal and connective tissues (e.g., bones, tendons, ligaments, cartilage),
•
neurotransmitters
•
enzymes
•
immune system chemicals (e.g., immunoglobulins, antibodies, cytokines)
•
transport proteins (e.g., carrier proteins, lipoproteins)
Where new proteins end up is controlled by genetic signaling and depends on
which amino acids and how much energy is available in the body.
Nutrition: The Complete Guide
Macronutrients | 189
Protein in the diet
As you can imagine from even the brief list of protein’s jobs above, we need
dietary protein to survive and thrive.
As you saw in Unit 3, we are always breaking down and building up new proteins. While we can store carbohydrate and fat, we can’t store protein in the same
way. We’re always losing little bits of aminos along the way, so we need to get
enough protein from our diet to keep the process of protein turnover happening.
Protein: The big picture
We’ll look at some types of protein and amino acids next.
While it’s important to learn about the specific features of each protein type,
keep the big picture in mind.
Focus on these key points:
•
Humans evolved eating a varied and seasonal diet. We thrive best on a mix of
amino acids that occur naturally in different types of foods.
•
In particular, our body needs a range of essential amino acids.
•
This balanced range comes naturally if we choose a wide selection of diverse,
whole, less-processed foods.
•
At times, it may be useful to supplement with protein powders, especially for
clients who have trouble eating whole-food protein sources. You may also
want fast-digesting proteins (such as whey or rice) for clients who need quick
replenishment, such as athletes.
•
Match your nutrition plan to each client’s unique body, preferences, and
needs.
We’ll give you some more specific recommendations in Section 2.
Amino acids and protein quality
Amino acids are grouped into three general categories.
•
We can make 12 amino acids in our body. These are known as non-essential
amino acids. We don’t need to eat them.
•
We do need to get 8 other essential amino acids from food. We can’t make
these ourselves.
•
We may also need to eat extra conditionally essential amino acids
sometimes, particularly when under physical stress (such as from hard athletic
training, or when we’re sick). We can synthesize these aminos, but not always
effectively. Or having extras around helps us rebuild tissues when those tissues
non-essential amino acids:
Amino acid that does not need to
be included in the diet
essential amino acids: Amino
acid that must be included in the
diet
conditionally essential amino
acids: Essential under specific
conditions, for example childhood,
stress, aging, etc
are damaged.
Almost all foods contain some protein.
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Table 6.5 Amino Acids
8 Essential
Amino Acids
4 Additional Essential Amino
Acids
8 Conditionally Essential Amino
Acids
Cannot be made by the body, must be
obtained from the diet.
Required for infants and growing
children.
Necessary in special populations without adequate synthesis.
Isoleucine (BCAA)
Arginine
Arginine
Leucine (BCAA)
Cysteine
Cysteine
Lysine
Histidine
Glycine
Methionine
Tyrosine
Glutamine
Phenylalanine
Histidine
Threonine
Proline
Tryptophan
Serine
Valine (BCAA)
Tyrosine
For instance:
•
A fist-size portion of broccoli has about 3 g of protein.
•
A thumb-size portion of peanut butter has about 3 g
of protein.
•
The average baked potato has about 4 g.
•
The average avocado has about 4 g.
•
A cupped handful of quinoa has about 5 g.
And of course, you may already have a roster of foods
that are considered high in protein:
•
Lean meat such as beef, pork, wild game
•
Poultry such as chicken, turkey, or duck
•
Fish and seafood
•
Eggs
•
Dairy such as cottage cheese or strained plain Greek
yogurt
•
Protein powder such as whey, egg, vegetarian blends
•
Beans and legumes
•
Tempeh or tofu
Nutrition: The Complete Guide
All protein adds up. So eating, for instance, beef chili
with beans and guacamole will give you the accumulated protein from meat, beans, and avocado together.
This is important to remember for nutrition coaching:
Your clients can get protein from many sources.
Yet you may have wondered whether some protein
sources are better than others. Helpfully, there are
protein quality indices that measure how well a given
protein source provides the amino acids we need. We’ll
look at those in a moment.
None of the measures are perfect. And most are not
important unless you are dealing with clients who are
malnourished. For instance, the Food and Agriculture Organization of the UN (FAO-UN) recommends
the Protein Digestibility Corrected Amino Acid Score
(PDCAAS). But remember that the FAO-UN is largely
concerned with ensuring adequate nutrition in poorer
areas of the globe.
Additionally, many protein indices are calculated for
animal feed. Farmers want to know how much their
animals need to eat for optimal growth. So a measure of
protein quality may not account for human health needs.
Macronutrients | 191
So, as always, remember the big picture.
•
•
Few people in affluent Western countries will be truly
protein-deficient or living on a single food source
such as rice and have to worry about the specifics of
their protein quality. (Though they may be getting
sub-optimal amounts of protein for performance or
body composition purposes.)
For our purposes, protein scores must apply to real
humans in the real world, and represent how we
actually eat, digest, and use proteins in our body.
Protein efficiency ratio (PER)
Protein efficiency ratios (PER) are determined using
mice or rats rather than humans.
PER studies look at the relationship between what specific protein is in the animals’ feed and how big and healthy
they get. The PER value is calculated as the growth of the
animal (in grams of bodyweight) per gram of ingested
protein.
So the PER is a measure of “feed efficiency” and is reported in comparison to casein as a reference protein.
Biological value (BV)
The biological value (BV) of a protein, like the PER value, is determined using studies on rats and mice. The BV
is calculated as a percentage: how much nitrogen goes to
tissue building, divided by the amount of nitrogen absorbed from the food. In other words, how much protein
did the animal get, and how much of that did it use?
Along with the problem of applying rodent data to humans, BV doesn’t take into account certain factors that
influence protein digestion. It measures how good a protein could possibly be at its best, rather than how useful it
is when consumed as part of a normal diet.
Net protein utilization (NPU)
Net protein utilization (NPU) was developed to improve
on BV measures. NPU calculations are based on the
product of biological value and true digestibility, which
corrects one of the problems of BV measures. In other
words, NPU looks at not only how good a protein could
be, but how well it’s actually used.
Protein Digestibility Corrected Amino Acid Score
(PDCAAS)
The Protein Digestibility Corrected Amino Acid Score
(PDCAAS) is the current “gold standard” of determining protein quality, because unlike PER, BV, and NPU,
it’s based on human amino acid requirements.
PDCAAS also accounts for the number of limiting
amino acids in a protein. A limiting amino acid is the
essential amino acid found in the smallest quantity in a
particular food.
Once the limiting amino acid is calculated, the PDCAAS compares the amount of this amino acid in the
test protein versus the amount of this amino acid in a
high-quality reference protein. Then, this value is multiplied by how truly digestible the protein is.
This gives a measure of protein quality that takes several
factors into account.
Meeting protein needs
The “average person” baseline
The average person eating a standard Western diet is
probably not protein deficient. This is because most of
these eaters are relatively sedentary omnivores, which
means:
•
They don’t need much protein for repair or
rebuilding.
•
They are probably including animal products and
dairy, both of which are common sources of protein.
Yet “not deficient” does not mean optimal. It just means
people have enough to get enough protein turnover and
prevent malnutrition.
For sedentary, generally healthy adults, about 0.8 g of
protein per kg of body mass is enough to cover basic
daily requirements. This translates to about:
•
55 g of protein per day for a 150 lb (68 kg) person;
and
•
72 g of protein per day for a 200 lb (90 kg) person.
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Table 6.6 Protein recommendations
Source
Recommended
amount
What this means
for a 150 lb (68 kg)
person
What this means for a
200 lb (90 kg) person
American College of Sports Medicine
1.2-1.7 g of protein per
kg of body mass
82-116 g of protein daily
108-153 g of protein daily
International Society of Sports Nutrition
1.4-2.0 g of protein per
kg of body mass
95-136 g of protein
daily
126-180 g of protein daily
Some other recent research reviews
1.2-2.2 g of protein per
kg of body mass
82-150 g of protein
daily
108-200 g of protein daily
Academy of Nutrition and Dietetics
Adjusting intake upwards
Remember that protein is involved in repair and rebuilding of tissues, hormones, and our immune system.
Recommendations for athletic protein intakes vary. See
Table 6.6.
So our protein needs can go up if:
We probably don’t need more than 2.2 g of protein per
kg of body mass per day. For most people, even this relatively higher intake appears to be safe, but not necessarily advisable on a regular basis (the exception might be in
very rare situations when lean athletes with high levels
of muscle mass are undergoing a calorically restricted
diet).
•
we are training hard frequently (e.g., as athletes) or
have a heavy physical job;
•
we are injured or sick, or are recovering from surgery;
and / or
•
we are losing protein for some other reason (e.g.,
chronic physical stress or poor digestion).
We may also need more protein if we are trying to lose
weight, and thus in a negative energy balance. Protein
helps keep us feeling full longer.
Indeed, the upper limit (translation: you don’t want to
spend much time in this range) of what healthy livers and
kidneys can handle is around 3.5-4.5 g per kg daily. (Thus,
our 150 lb, or 68 kg, person could theoretically metabolize
around 238-306 g of protein daily.)
What rabbits can teach us about protein metabolism
Protein is pretty important. It can do almost anything:
repair stuff, build stuff, give us energy…
You might think that given protein’s powers, an
all-protein diet might be extra-healthy.
In fact, we always need some carbohydrate and / or
fat in our diet to metabolize protein properly. And our
liver and kidneys can only process so much protein per
day, although they can adjust over time to changes in
protein intake.
Early European explorers in North America found this out
the hard way. When conditions were tough and food was
scarce, they tried living on wild game such as rabbits.
Nutrition: The Complete Guide
Unfortunately, free-living game is usually very lean, especially during the winter. Many Europeans were also not
accustomed to eating animals’ organ meats, brains, bone
marrow, and / or eyes, which might have contained some
valuable fatty acids. So they threw them away.
Thus, many hapless explorers became ill or even died of
hunger even though they were eating.
This sickness and death from an all-lean-protein diet, a
phenomenon well-known to North American indigenous groups, has become known as “rabbit starvation.” (This is also why you should always listen to the
locals when it comes to regional cuisine.)
Macronutrients | 193
Adjusting intake downwards
•
avoid building their diet around cereals, grains and
processed foods, which are often lower in amino
While most clients will do best with slightly more
protein, some clients may have health conditions that
require a lower-protein diet.
acids or have important nutrients processed out; and
•
are having trouble meeting their protein requirements, and/or are taking in less energy.
These can include:
•
kidney disease
•
certain metabolic diseases (e.g., PKU)
•
liver disease
•
problems with gastric emptying
•
homocystinuria
Remember that you cannot provide medical nutrition
therapy. But you can suggest a meal plan that suits their
doctor-prescribed needs (and / or collaborate with their
health care team on helping clients implement any specific care providers’ recommendations).
Plant-based eaters
People choose plant-based diets for many reasons,
including the sustainability of their protein sources.
It takes a lot more energy and resources to produce a
kilogram of beef than it does to produce a kilogram of,
say, kidney beans.
(By the way, many people are looking to “micro-farming” — raising “mini-livestock” such as insects — as a
solution to global nutrition and sustainability. Insect
protein is a cheap, easy, and relatively more sustainable
alternative to other animal protein. Commercial cricket
and other insect flours and protein powders are already
available. We predict you’ll see a lot more of this in the
upcoming decades.)
For your clients who eat a plant-based diet, review the
following checklist with them. They should:
•
be eating enough energy to meet their needs;
•
be eating as much variety as possible. This includes a
wide range of fruits, vegetables, beans and legumes,
nuts and seeds, and tubers;
•
include at least a 1 cup of beans / legumes each day.
Legumes are a rich source of lysine, which can be
low in plant-based diets. We need 30-45 mg / kg of
lysine per day. This translates into 2-3 grams for a
150 pound (68 kg) adult. 1 cup of legumes usually
contains about 1 gram of lysine;
be taking a plant-based protein supplement if they
Supplementation
Our approach is “Real food first.” Always start with
real, whole, less-processed foods to give clients the
nutrients they need.
Yet many clients struggle to get enough protein. For
instance:
•
They may be busy and find it hard to make good
protein choices on the go.
•
They may be ill or not able to get around easily to
cook and prep whole foods.
•
They may be athletes who are on the road, traveling
from game to game or training session to training session (or to work / school between training
sessions).
•
They may be students who don’t have kitchens in
their dorms.
These types of clients can get the protein they need by
supplementing with protein powders such as:
•
whey
•
casein
•
milk protein blend
•
egg white
•
plant-based proteins (e.g., pea, hemp, rice, sacha
inchi proteins)
Other supplement possibilities include:
•
Branched-chain (BCAA) supplements (particularly leucine) are good options for clients restricting
energy intake, training fasted, and / or needing some
extra peri-workout and / or post-workout recovery.
•
Glutamine supplementation can improve immunity
and gastrointestinal health.
•
Arginine supplementation can improve wound
healing.
•
Lysine supplementation can reduce cold sore severity,
frequency, and healing time.
However, individual amino acids can be effective only
when there’s a specific need for that amino acid. In
Section 2, we’ll discuss this idea more in depth, covering
specific needs-based supplement recommendations.
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Case study
it was getting a takeout burger for himself and a
About halfway through the year while working with a
veggie burger for his wife.
Coaching group, we got this frantic email:
“Coach,
My wife and I eat dinner together each night. It’s a
good chance for us to connect. And lately we’ve been
•
on dinnertime arguments).
•
based diet. So, dinners often don’t include meat for
He wanted to eat healthy foods that met his nutritional needs, made him feel satisfied, and tasted
alternating food preparation duties.
About two years ago my wife started eating a plant-
He wanted to support his spouse (and cut down
good.
•
They both wanted meals that were easy to prepare and cost-effective.
her.
I’m trying to eat more plant-based meals at dinner as
We can work with this.
well (mainly so I don’t have to prepare two dinners).
First, we introduced him to a broader variety of foods,
But I’m also a bit worried that I’ll be missing out on
and showed him how to build some basic (yet delicious)
important nutrients if I don’t eat meat (mainly protein).
meals around beans and legumes, fruits and vegetables,
I’m not quite sure how to prepare a meal that is plant-
and nuts and seeds along with a wider range of grains
based and offers balanced nutrition for both me and
(such as brown, red, and wild rice; quinoa; millet; ama-
my wife.
ranth; buckwheat).
Can you help?
Here were the first few recipes we encouraged him to try:
Client”
For anyone who grew up in a culture building meals
around animal products, starting to eat meals with less
•
kebabs, and brown rice.
•
Lentil / pumpkin seed / quinoa burgers, roasted
potato wedges, and salad
of them (or none at all) can be intimidating, even scary.
This is particularly true if people aren’t sure how to make
Falafel with hummus and tahini sauce, veggie
•
Black bean chili (including black beans, veggies,
meals that are nutritious, convenient, and — dare we say
cashews, and topped with avocado), and corn-
it — actually taste good.
bread made with 50% almond meal and 50%
As nutrition coaches, you always look to understand
whole grain flours.
your clients first, before making any recommendations.
As you can see, these kinds of meals provide plenty of
So before we suggested anything to our client, we asked
protein, fat, and other nutrients, mostly from whole
him to tell us more. What did he want out of this arrangement, and what was he concerned about?
Here’s what we discovered.
•
When his wife cooked, the meal was bland and
boring. It usually revolved around a processed
starchy food such as pasta, with little else.
•
When he cooked, it wasn’t so much “cooking” as
Nutrition: The Complete Guide
foods. And if our client still wanted to include smaller
amounts of animal protein with those dinners, he could
always cook some on the side and add it only to his
plate.
The next step was to talk with him about basic protein
and fat needs.
We broke down the meals above and showed him their
nutrient composition. He could see that he was getting
Macronutrients | 195
what he needed (not to mention lots of other good stuff
And they both felt better financially because they often
from the whole foods). He felt reassured.
had leftovers to use later in the week.
Over time, as they both got better at cooking and trying
As you can see, being a coach doesn’t just mean know-
new foods, our client and his wife discovered that they
ing about “nutrients” (although, of course, that’s a
both enjoyed them.
good start). It also means that you’re able to understand
He felt better (and more satisfied) after eating
a nutritionally balanced meal. His wife felt better because he wasn’t getting fast food burgers
clients’ needs, wants, lifestyles, and most important
priorities, and work with those to create a real-life action
plan that they can do…and feel good about.
and takeout.
Summary
The three macronutrients are carbohydrates, fat, and
protein.
Carbohydrates, fat, and protein come in many forms
ranging from very simple to very complex molecules.
The makeup of these molecules determines how they
will be processed in our body.
Simpler molecules are digested relatively quickly.
More complicated molecules, such as polysaccharides,
triglycerides, and quaternary proteins, must be broken
down into their most basic components so that we can
absorb, transport, and use them.
All digestible carbohydrates are broken down into
glucose, fructose, and galactose monosaccharides. Most
cells use glucose. The liver can also use fructose.
All indigestible carbohydrates (such as soluble and
insoluble fiber and resistant starch) are either partially
digested by our GI bacteria and converted to short-chain
fatty acids, or excreted. They may bind to lipids in the
intestines and help to remove them.
Most fats in our diet are triglycerides, which is made up
of three fatty acids bound to glycerol. Any type of fatty
acid (saturated, monounsaturated, or polyunsaturated)
can be part of a triglyceride.
All fats are broken down into fatty acids, then reassembled into triglycerides.
To travel to our cells, triglycerides (and other lipids such
as cholesterol) must be transported using lipoproteins.
When we refer to “cholesterol levels”, we usually mean
lipoproteins.
Different fat types have different effects in our body.
Contrary to popular opinion, naturally occurring saturated fats are not harmful.
We must get omega-3 and omega-6 fatty acids from
food. They have opposite effects in our body: omega-3s
lower inflammation, while omega-6s stimulate it. Thus,
getting enough omega-3 to omega-6 is important.
Minimize or avoid processed foods, which contain
industrially produced trans fats and seed oils along
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with other unwanted things such as refined sugars and
sodium.
leave the liver are used to make up the body’s plasma
amino acid pool.
We need protein for nearly every metabolic activity.
Because we lose small amounts of amino acids every day,
we need to eat enough protein to keep protein turnover
healthy.
Protein deficiency is rare in industrialized countries.
However, many groups of people (such as athletes) need
more protein to thrive and optimize key metabolic processes such as recovery and repair. Protein also helps us
feel full longer, which helps people trying to lose weight.
All proteins are broken down into very small peptides or
individual amino acids. Some of this protein is used in
the intestinal cells themselves. The rest goes to the liver
for processing.
Of the amino acids that reach the liver, about 20% (most
of which are BCAAs) are shipped out. An equivalent
amount (20%) is used to make proteins in the liver and
the majority (60%) is catabolized. The amino acids that
Nutrition: The Complete Guide
Most foods have some protein. Protein adds up from all
the foods that we eat.
Don’t “eat by numbers.” While each nutrient has specific
types and qualities, take a holistic perspective. Treat
the body as a system and encourage your clients to eat a
wide range of whole, less-processed foods.
UNIT 7
Micronutrients
198 | Unit 7
Unit Outline
1.
Micronutrients
6.
Phytonutrients and myconutrients
2.
Vitamins
7.
Zoonutrients
3.
Minerals
8.
Case study
4.
Getting vitamins and minerals right
9.
Summary
5.
Vitamin and mineral overview
Objectives
Micronutrients are vitamins, minerals, and other compounds such as phytonutrients. We need them — in appropriate amounts — for many metabolic and physiological
•
how to recognize the symptoms of micronutrient
deficiencies;
processes.
•
how to recognize the symptoms of micronutrient excess
In this unit, you’ll learn
•
strategies to correct both of these
•
You’ll also learn why you should choose whole-food sourc-
what micronutrients do in our body;
es of micronutrients as often as possible.
Micronutrients
micronutrient: A chemical
element or substance required in
trace amounts for normal growth
We need vitamins, minerals, and other compounds such as phytonutrients (plant
chemicals) to be healthy. But we need much less of them than protein, carbohydrates, and fats. Thus, we call these compounds micronutrients.
We also need them in the right amounts.
If we don’t get enough micronutrients, we won’t function properly. We may get
sick, and key processes can break down.
If we get too much (usually from supplements, but occasionally from foods too),
we may also get sick, or disrupt other key processes.
In this unit, we’ll cover:
• the main micronutrients
• their effects
• what you might see when someone is deficient in them, or getting too much of
them
The big picture
When learning about micronutrients, it’s easy to get overwhelmed with details.
Remember that you can always come back to this unit and use it as a reference.
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Micronutrients | 199
Indeed, this unit is just an introductory overview. Nature’s biochemistry is vast
and complex — scientists still don’t know all the compounds in food, or what
they do in our body. And even the most common and well-known micronutrients (such as, say, vitamin A or calcium) come in many forms and we sometimes
discover new functions they have.
As you go through this unit, think about the underlying patterns and big picture.
For instance, here are some common themes:
• Eating a wide range of whole, less-processed plant and animal foods can help us
get abundant micronutrients easily and naturally.
• Some foods in particular (such as colorful fruits and vegetables) are treasure
troves of vitamins, minerals, and other phytonutrients. Build your clients’ diets
around these.
• Often, supplementing a particular micronutrient will not have the same effect as
eating a food that contains that micronutrient (but not always).
• Micronutrients often work together.
• Getting a lot of one particular micronutrient can sometimes disrupt the balance
of another.
• Deficiency symptoms (or symptoms of excess) can often seem like other things.
Micronutrient deficiencies and excesses can contribute to nagging, chronic,
often-puzzling health problems.
• Different people will have different micronutrient needs. While “real food” is the
first and most important tool in your nutrition coaching toolbox, some people
will benefit from specific micronutrient supplementation.
Vitamins
The word “vitamin” comes from the Latin vita, or “life.” This is the same word
root as “vitality.” Indeed, vitamins are organic compounds that we need to live
and thrive.
organic compounds: Molecules
with a carbon component
Vitamins participate in all metabolic processes such as growth, repair, digestion,
energy transfer, nervous system function, and immunity.
One of their most important jobs is as co-factors for enzymes. For instance, you
might recall that vitamin B3 (niacin) is a co-enzyme involved in the formation of
NAD, an electron transporter important to the energy transfer process. However,
vitamins don’t give us energy directly, as, say, carbohydrates or fats do.
co-enzyme: Non-protein
compound that forms the active
portion of an enzyme system
We need vitamins in our diet, because we can’t make most of them ourselves.
Luckily, vitamins are naturally found in food.
fat soluble: Able to be dissolved
in fat
Vitamin digestion and absorption
Vitamins are generally categorized as either fat-soluble or water-soluble. This
chemical makeup affects how we digest, absorb, use, and excrete them, and thus
particular vitamins’ bioavailability.
water soluble: Able to be
dissolved in water
bioavailability: The proportion
of a substance that enters
circulation when introduced into
the body and so is able to have an
active effect
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For micronutrients, cooking matters
Different methods of food preparation can affect that
food’s vitamin content and bioavailability.
•
Some micronutrients are most available, and best
absorbed, when foods are eaten raw.
•
Some micronutrients are most available, and best
absorbed, when foods are cooked.
•
Some micronutrients are most available, and best
absorbed, when foods are eaten with other foods.
•
Some micronutrients are most available, and best
absorbed, when their structures are broken down
first (e.g., by cutting or crushing).
For instance…
We digest anthocyanins (the blue-red compounds in
foods such as plums or eggplant skins) relatively quickly,
often even starting in the stomach. Many types of anthocyanins, such as those in berries, are readily available
when eaten raw.
Water-soluble vitamins can be lost in water during
cooking and storage. This means the best methods to
preserve vitamins include blanching, steaming, sautéeing, roasting, and microwaving.
Boiling in water, and then discarding the water, will usually mean you lose nutrients. (However, if you keep the
liquid for something like soup stock, you’ll retain many of
those nutrients. And again, keep the big picture in mind.
Boiled and mashed potatoes are still far superior to fries.)
Some micronutrients, such as the lycopene in tomatoes
or many carotenoids in yellow / orange / red plants, are
often better absorbed when cooked.
Some micronutrients, such as the minerals in dark
greens or bones, or fat-soluble vitamins, become more
(or less) available when cooked and / or eaten with other
foods. For example:
•
We need to eat fat to absorb fat-soluble vitamins.
So put some olive oil, avocado, and / or nuts on
your salad.
•
We need vitamin C to best absorb iron from leafy
greens, so add some fresh-squeezed lemon to
your kale.
•
Some micronutrients (e.g. polyphenols) in
grapefruit can enhance the absorption of some
minerals (such as calcium, magnesium, phosphorus, copper, and zinc) yet inhibit the absorption
of other substances (such as iron).
•
Chopping or crushing garlic, then letting it sit for
a few minutes before cooking with it, will release
allicin, a powerful disease-fighting chemical.
You’ll notice here that, as always, people don’t eat “nutrients.” They eat foods and meals.
Often, traditional or ancestral diets have figured out
how to make the most of micronutrients. For instance:
•
The famed Mediterranean diet includes both
crushed garlic and cooked tomatoes, not to mention the antimicrobial powers of the phytonutrients in fresh herbs.
•
South Asian cuisine does the same and throws in
some anti-inflammatory turmeric and ginger plus
painkilling hot peppers for good measure.
•
Arctic cultures such as Scandinavians and Inuit
make sure to eat fish liver to give them enough
vitamin D during the long, sunless winters. (The
famous Icelandic sheep’s head dish, or svið, offers
phosphorus and vitamin A to brave eaters who
consume the eyes.)
As you learn more about nutrition, look at world
cuisines and notice what foods they traditionally put
together in dishes and meals. There may be a reason
beyond just taste!
Nutrition: The Complete Guide
Micronutrients | 201
Fat-soluble vitamins
Fat-soluble vitamins are mostly absorbed passively in
the GI tract. They usually travel bound to dietary fat.
This means that if we don’t eat enough fat, we may not
get these key vitamins, let alone effectively transport,
absorb, or use them.
Once in our body, fat-soluble vitamins snuggle into
lipid-based structures, such as our cell membranes, our
eyes, and lipid droplets in adipose cells.
Because fat-soluble vitamins live in fatty tissues, we
don’t need to eat them every day. Indeed, they can
accumulate and cause toxicity (for instance, if we
over-consume particular supplements, or go on a liver-eating spree). Like other lipids, we can also excrete
fat-soluble vitamins through our feces.
Vitamins A, D, E, and K are classified as fat-soluble
vitamins.
Water-soluble vitamins
These vitamins are absorbed by both passive and active
mechanisms in the GI tract, using carrier proteins for
active transport.
Because we’re always taking in and excreting water, we
don’t store large amounts of water-soluble vitamins.
Thus, we need to get these more often.
The B vitamins and vitamin C are water soluble.
Complex compounds
We tend to think of vitamins (and minerals) as single
things. For instance, we tend to think of vitamin A as
just one type of substance.
In fact, many vitamins are more like groups of related
chemical cousins. “vitamin A” covers several molecules,
such as retinol, retinal, retinoic acid, and many carotenoids — the chemicals that make foods such as carrots
or peppers yellow, orange, and red. Some of these (i.e.,
the carotenoids) are “provitamins”, which means that
they are converted in our body to vitamins.
A vitamin’s specific molecular form can also affect its
bioavailability. For instance, our body uses retinol more
readily from food than beta-carotene. See Table 7.1. A
provitamin will need to be converted into a vitamin;
this conversion process may limit how much of that end
product we can absorb.
Table 7.1
Retinol equivalents for various carotenoids
Vitamin A source
Micrograms of retinol
equivalent per microgram of the substance
Retinol
1
Carotenoids commonly found in food
beta-carotene
1/12
alpha-carotene
1/24
gamma-carotene
1/24
beta-cryptoxanthin
1/24
Literally hundreds of compounds thus fall into the category of “micronutrients.”
Of course, you needn’t memorize exactly how much of
any vitamin or its relatives we absorb. Just get the general idea:
• Vitamins come in different molecular forms.
• Those molecular differences affect how that particular
vitamin form behaves in our body — how we digest,
absorb, use, and / or excrete it.
• Different foods have different vitamin forms. Thus, getting a wide range of foods is important.
Minerals
We pluck minerals from the earth’s skin. Soil and water
contain minerals that plants absorb and use. Animals eat
the plants. Humans may eat both the plants and the animals. Thus, the health of our environment (particularly
our soil) determines the quality of our food.
Like vitamins, minerals don’t give us energy directly.
Yet we still need them. They help build body structures
such as teeth and bones. They help regulate our body
fluids. And they are co-factors in enzymatic reactions, or
perhaps even enzymes themselves.
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macrominerals: Minerals
required in larger amounts
microminerals: Minerals
required in trace amounts
We can classify minerals as macrominerals (minerals the body requires in larger
amounts) or microminerals (minerals the body requires in trace amounts).
Mineral digestion and absorption
We absorb most minerals in our small intestine, either through passive or active
transport. Minerals are already in the simplest form possible: elements. We don’t
need to break them down before absorbing them. Nor will minerals break down
when heated. So unlike often-fragile vitamins or phytonutrients, minerals in
food easily survive storage and cooking.
Factors affecting absorption
Compound type
Usually minerals must bind to other things, such as amino acids, for us to absorb
and use them most effectively. (For instance, we can’t just eat straight-up calcium… unless we’re looking for a fiery fiesta upon contact with the water in our
mouth.)
Luckily, Mother Nature has cleverly done this compounding pharmacology
for us. Minerals are best absorbed and used when we eat — you guessed it — a
variety of whole, less-processed foods that contain minerals in their naturally
occurring format, along with other foods that help us extract those minerals.
For example, some foods contain minerals bound to oxalic acid (a compound
known as oxalate) or phytic acid (known as phytate). These forms make it harder
for us to absorb minerals. Yet this is only a problem when those high-oxalate and
high-phytate forms are all we eat — for instance, isolated and poor regions of the
world where the main menu item is rice or corn; or urban and affluent regions
where the main menu item is green smoothies. With a mixed diet, oxalate and
phytate rarely pose problems (and even seem to have health benefits).
On the other hand, many minerals are better absorbed when they work with other
micronutrient “partners.” For instance, phosphate likes to trade places with sodium using the same transporter, and vitamin D enhances phosphate’s absorption.
electrolyte: Compound that
when placed in solution becomes
an ion; regulates flow in and out
of cells
ionic state: A given ion’s charge:
positive, negative or neutral
concentration gradient:
Difference in the concentration
of solutes in a solution between
two areas
hemochromatosis: Hereditary
disorder that causes the body
to retain excessive amounts of
iron, leading to serious health
consequences
Nutrition: The Complete Guide
Fluid balance
As biological organisms, we are a chemical soup driven by electrical motors.
Thus, we need substances that can help generate and regulate electrochemical
impulses. These substances are known as electrolytes.
We need mineral-based electrolytes such as sodium and potassium to contract
and relax our muscles, balance our body fluids, and shoot signals across our
nerve cells.
We can absorb electrolytes from food in an electrically charged state (or an “ionic
state”). Either the minerals are missing an electron (positive charge) or have extra
electrons (negative charge). This lets minerals bond readily with water. In our body,
this charged state helps create concentration gradients across cell membranes,
which then lets electrolytes do their jobs.
Micronutrients | 203
Imbalances
As with vitamins, mineral balance is important. You can
have too much or not enough.
For example:
• Eating too little sodium while drinking too much water
can lead to hyponatremia, a dangerous and potentially
fatal condition.
• If calcium is too high and magnesium too low, you’ll
often get muscle cramps.
• If you supplement too much potassium, you risk heart
arrhythmias.
We’ll learn about electrolyte and fluid balance more in
the next unit.
This concept can also be important for people who are
taking mineral supplements and want to maximize
absorption.
For example:
• Tannins and polyphenols in tea and coffee can inhibit
iron absorption. A person taking an iron supplement is
usually told to avoid taking it with those drinks.
• Conversely, the acidity of vitamin C can change iron
from ferric (3+) to ferrous (2+) form, which we absorb
better.
Supplements are usually sketchy shadows of real food.
Mineral supplements are no exception. Micronutrients
in whole foods are a symphony of compounds that make
beautiful biological music together. It’s hard to duplicate
that with an isolated supplement.
Indeed, researchers stopped a few large-scale studies
when they found that certain supplements had the opposite effect than that of food: while the micronutrients in
food were helpful, the same isolated micronutrients in
supplements were harmful.
Getting vitamins and
minerals right
In the next section, you’ll learn about what each vitamin
and mineral does in the body, and what happens when
we get too much or too little.
As you read these, remember a few key points:
• There is no one best diet.
• Not every person needs the same micronutrients in the
same amounts.
• Many factors can influence vitamin requirements.
These factors can include:
• biological sex;
• age (especially being very young or old);
• medications;
• food choices and energy intake;
• stress;
• activity levels and intensity;
• pregnancy or menstruation; and / or
• illness or injury.
For example, when it comes to iron:
• Women still menstruating should probably include
plenty of iron in their diet, especially if they are athletes.
• Yet for men, excess iron can be a problem, since they
don’t lose it as readily.
• Too much iron may actually be dangerous for someone
with primary or secondary hemochromatosis, leading to overload and organ damage.
• Plant-based eaters may not get enough iron from their
food, since plant-based or fortified food (non-heme)
iron is not as well absorbed as animal-based (heme)
iron.
Plant-based diets
As the example above suggests, plant-based eaters may
need extra supplementation. Plant sources of some
micronutrients may not be as bioavailable as animal
sources. 100% plant-based eaters may also avoid particularly rich sources of micronutrients, such as dairy, organ
meats, or eggs.
We’ll cover supplementation and special considerations
for plant-based eaters in later units.
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Athletes
In general, athletes will need more micronutrients than sedentary people, especially if they are training hard while trying to lose fat or weight.
Medications
Ask about any medications or other supplements your clients may be taking, as
these can interfere with proper micronutrient absorption.
For instance, oral contraceptives (which many female clients will be taking) can
interfere with vitamin B2 absorption.
Work with your clients’ doctors and pharmacists to check for any potential micronutrient deficiencies or excesses.
Disordered eating and restriction
Longtime dieters, food restrictors, and clients with various forms of disordered
eating will probably have micronutrient deficiencies.
Indeed, some have speculated that dieting, restriction, and disordered eating
behaviors (such as purging) actually make the deficiencies worse.
The more people do these behaviors, the more micronutrient-deficient they
become. The deficiencies then cause people to keep doing the exact behaviors that
caused the problem, since deficiency symptoms can include:
• anxiety / OCD / controlling behaviors;
• GI upset or loss of function;
• loss of appetite;
• mood disorders (e.g., depression); and
• problems with thinking and reasoning.
It becomes a vicious cycle. The more they do, the worse it gets.
You can’t treat clinical disordered eating within your scope of practice. But
you can consider basic multivitamin / multimineral supplementation as part
of an overall nutrition plan for clients with a history of dieting and disordered
behaviors.
Malabsorption syndromes
Malabsorption syndromes:
A group of disorders marked by
suboptimal absorption of dietary
constituents
ostomies: Artificial opening
created for the discharge of body
wastes
Malabsorption syndromes occur when our body can’t properly absorb the
micronutrients we eat.
This is common with many diseases, particularly those that involve damage to the
GI tract, such as Crohn’s disease, ulcerative colitis, celiac disease, or pancreatitis.
It’s also a major risk of bariatric or other abdominal surgeries such as ostomies.
Some other chronic health problems, such as HIV, severe anorexia, cancer, or
alcoholism, can also create malabsorption.
Nutrition: The Complete Guide
Micronutrients | 205
In the case of vitamin D, which we can get from sunlight, deficiency can happen
if we don’t get enough exposure, such as:
• when we spend most of our time indoors;
• when we live in non-tropical regions;
• when we’re extra-diligent with the sunscreen; and / or
• when our skin is dark.
Again, health doesn’t just come from how many micronutrients we eat; it comes
from the micronutrients we absorb and use safely, appropriately, and effectively.
Assessing vitamin and mineral status
Next we’ll look at some common symptoms of vitamin and mineral deficiency.
But never assume anything. Symptoms are just a starting point.
If you’re concerned about deficiencies in your clients, suggest that they get vitamin and mineral lab tests. This will give you a clear and accurate picture of your
clients’ needs (and potentially allow you to test improvement over time).
Use evidence. If you’re not assessing, you’re guessing.
And, again, if you find deficiencies, work with your clients’ doctors and pharmacists to explore potential causes and solutions.
Vitamin and mineral overview
Vitamins
Vitamin A (and carotenoids)
As we touched on earlier, the vitamin A family includes:
• Animal sources: retinol, retinal, retinoic acid; and
• Plant sources: carotenoids — the chemicals that make foods such as carrots or
peppers yellow, orange, and red.
Some of these (i.e., the carotenoids) are “provitamins”, which means that they are
converted in our body to vitamins.
Hypervitaminosis is caused by consuming excessive amounts of preformed
vitamin A (retinyl palmitate), not the plant carotenoids. Preformed vitamin A
is absorbed rapidly but excreted slowly.
hypervitaminosis: Vitamin
toxicity from excess
It’s involved in:
• Forming pigments in the eye
• Synthesizing proteins
• Immune function and wound healing
• Embryonic development
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• Stem cell differentiation
• Red blood cell development
We get it from:
• Red / orange / yellow vegetables and fruits such as car-
We get it from:
• Beans and legumes
• Sunflower seeds and tahini (seed paste)
• Marmite
rots, pumpkin or winter squash, orange sweet potatoes,
• Nutritional yeast
beets, orange melons
• Whole grains such as oats and barley (many cereals will
• Dark leafy greens such as spinach, collards, kale, mustard greens
• Liver (polar bear liver provides toxic levels of vitamin A,
as it can have 20,000 IU of retinyl palmitate per gram of
liver)
• Egg yolks
Not getting enough can result in:
• Difficulty seeing in dim light
• Dry eyes
• Rough / dry skin
• Acne
Getting too much can result in:
also be fortified)
Not getting enough can result in:
• B1 deficiency (known as beriberi) which can cause
burning feet, weakness in extremities, rapid heart rate,
swelling, loss of appetite, nausea, fatigue, GI distress,
nystagmus (eye twitching).
• Chronic B1 deficiency in alcoholics, which can lead to
Wernicke-Korsakoff syndrome, with confusion and memory loss. (Alcohol makes it difficult for the body to absorb
B1 from food).
• B1 deficiency isn’t common today, as many foods are
fortified. But B1 deficiency is common with malnutrition
and may contribute to symptoms of anorexia (especially
over time, as nutrient intake dwindles).
• Nausea
Vitamin B2 (riboflavin)
• Headache
B2 helps regulate levels of other B vitamins.
• Fatigue
• Loss of appetite
• Dizziness
• Dry skin
• Birth defects when pregnant (thus prenatal vitamins
contain less vitamin A)
Vitamin B1 (thiamin)
Vitamin B1 is found in many foods, so deficiencies are
rare. It’s water-soluble and easily excreted, so there’s no
known excess or toxicity.
It’s involved in:
• Producing energy (as a co-enzyme)
B2 is only somewhat water-soluble, so it’s not well absorbed. We tend to excrete the excess as bright yellow
urine (which is harmless but potentially entertaining,
especially for clients who may be new to taking vitamin
supplements).
Some medications such as oral contraceptives can interfere with B2 uptake.
B2 deficiency (known as ariboflavinosis) isn’t common
today, as many foods are fortified.
However, B2 deficiency is common with malnutrition
and may contribute to symptoms of anorexia (especially
over time, as nutrient intake dwindles).
It’s involved in:
• Synthesizing DNA and RNA
• Being part of the electron transporter FAD
• Potentially treating diabetic retinopathy and
• Metabolizing drugs and toxins in the liver
nephropathy
Nutrition: The Complete Guide
• Neutralizing hydroperoxides (antioxidant)
Micronutrients | 207
• Red blood cell production
• Maintaining health of skin, nervous system, and GI tract
• Purine metabolism
• Iron metabolism
• Red blood cell production
Purine: Compound that is the
nucleus of adenine and guanine.
Can be synthesized in the body or
consumed in diet
We get it from:
• Soybeans
• Mushrooms
• Spinach
• Whole grains, especially wheat
• Almonds
• Eggs
• Shrimp
• Beef liver
• Dairy (there will be seasonal variations due to what the animals are eating)
• Nutritional yeast
Not getting enough can result in:
• Damage to mucous and skin membranes, such as mouth inflammation or rashes
• Conjunctivitis
• Light sensitivity (photophobia)
• Anxiety
• Loss of appetite
• Anemia and fatigue
Vitamin B3 (niacin)
A deficiency of Vitamin B3 (known as pellagra) is rare in industrialized regions,
but can happen to people who live in poor regions with limited diets, such as
rural people in South America who may live mostly on a corn-based menu. It can
also happen to people with chronic diseases such as HIV or alcoholism.
Niacin from foods is safe. Toxicity generally comes from supplementing
excessively.
Niacin can be created from tryptophan in the human body.
It’s involved in:
• Making up the electron transporter NAD
• DNA repair
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• Maintaining health of skin, digestive system, and nerves
• Liver toxicity
• Cellular signaling
• Insulin resistance
• Controlling cholesterol levels by influencing lipid syn-
• Flushing of the skin (this can also happen when getting
thesis in the liver
a normal amount)
Vitamin B5 (pantothenic acid)
We get it from:
• Whole grains such as whole wheat and buckwheat
Our gut bacteria may produce a little B5 on their own.
• Mushrooms
• Canned tomato products (such as tomato paste)
Deficiency is very rare, and excess / toxicity only happens with supplementation in very high doses.
• Beef
It may be a helpful supplement for treating acne.
• Fish
The name “pantothenic acid” inspired Pantene shampoo.
• Pork
It’s involved in:
• Chicken
• Forming acetyl-CoA. See Figure 7.1.
• Liver from any source
• Synthesizing cholesterol, steroid hormones, and
Not getting enough can result in:
neurotransmitters
• Damage to mucous and skin membranes, such as
mouth inflammation or rashes
• Drug metabolism
• Maintaining skin health
• Diarrhea
We get it from:
• Dementia
• Mushrooms
Getting too much can result in:
• Corn
• Nausea
• Avocado
• Headache
• Peas
• Diarrhea
OO
CH3
C
Acetyl
group
NH
S
Pantothenic acid
(vitamin B5)
O
P
O
OO
P
O
CH2
O
ß-mercaptoethylamine
O
-O
P
O
3’,5’-ADP
Figure 7.1 Structure of Acetyl-CoA, which includes vitamin B5
Nutrition: The Complete Guide
O
Micronutrients | 209
• Lentils
• Poultry
• Fish and seafood
• Egg yolk
• Yogurt
• Potatoes and sweet potatoes
• Beef liver
Not getting enough can result in:
• Tingling feet (only in severe malnutrition)
Getting too much can result in:
• Nausea
• Diarrhea
• Heartburn
Vitamin B6 (pyridoxine)
It’s involved in:
• Working as a co-enzyme to form PLP,
which is needed for more than 100 enzymes involved in protein metabolism
• Glycogen breakdown
• Red blood cell metabolism
• Nervous and immune system
function
• Forming neurotransmitters
and steroid hormones
We get it from:
• Potatoes and
sweet potatoes
• Bananas and
plantains
• Sunflower seeds
• Pork
• Chickpeas
• Beef
• Spinach
• Poultry
• Fish
Not getting enough can result in:
• Damage to mucous and skin
membranes, such as mouth
inflammation or rashes
• Nervous system disorders
• Confusion
• Anxiety, sleeplessness,
• Depression
irritability
• Anemia
Getting too much can result in:
• Painful neurological symptoms (look for excess B6 from supplementation in people
with things like carpal tunnel syndrome or tennis elbow)
Vitamin B7 (biotin)
Intestinal bacteria can produce biotin.
Eating a lot of raw egg whites, which contain avidin, can create a biotin deficiency.
Avidin can bind up to four molecules of biotin and carry them out of the body.
avidin: A compound found in
raw egg albumen that inactivates
biotin
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It’s involved in:
We get it from:
• Forming four vital enzymes known as carboxylases,
which are involved in gluconeogenesis, leucine metabolism, energy production, and the synthesis of fats
• DNA replication and transcription
We get it from:
• Beans and legumes
• Leafy greens such as spinach, and other greens such as
asparagus or broccoli
• Chicken liver
Not getting enough can involve:
• Nuts and peanuts
• Beans and legumes
• Anemia
• Sweet potatoes
• Egg yolks
• Low white blood cells (leukopenia) and platelets
• Onions
• Dairy
• Mushrooms
• Liver
• Weakness and weight loss
• Cacao (chocolate)
• Fish
• Cracking / redness of tongue and mouth
• Tomatoes
• Pork
• Diarrhea
• Whole grains, especially oats
(thrombocytopenia)
• Low birth weight and preterm delivery in pregnancy,
neural tube defects in newborns
Not getting enough can result in:
• Dry or rashy skin
• Nausea and loss of appetite
• Hair loss / thinning hair
• Conjunctivitis
• Depression
Vitamin B9 (folate)
“Folate” is found in foods while “folic acid” is a synthetic
supplement.
Folate deficiency is one of the more common in the US.
Folate is particularly important for pregnant women, as
it helps prevent neural tube defects.
It’s involved in:
• Metabolism of nucleic and amino acids as a co-enzyme
• Breaking down and using vitamins B12 and C
• Forming new proteins
• Red blood cell formation and circulation
• Fetal development
Nutrition: The Complete Guide
Getting too much can result in:
• Masking Vitamin B12 deficiency (beyond 1,000 mcg of
supplemental folic acid)
Vitamin B12 (cobalamin)
We can store literally decades’ worth of B12 in our liver.
This is good, because as we age, we often absorb less
B12. In particular, low intrinsic factor (IF) can result in
a Vitamin B12 deficiency. (Folks on antacids or proton
pump inhibitors will likely have problems absorbing
vitamin B12 in the gut and may benefit from a sublingual
supplement).
This relationship between low IF and low B12 is known
as pernicious anemia. A symptom is large, immature,
red blood cells with nuclei (mature red blood cells don’t
normally have nuclei) called megaloblasts.
Only bacteria can produce B12. Yet it’s only found in animal products (thanks to bacterial symbiosis). So plantbased eaters will need a B12 supplement.
It’s very hard to get too much B12, so there are no real
toxicity symptoms.
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It’s involved in:
• Forming and maintaining healthy nerve cells and red blood cells
• DNA synthesis
We get it from:
• Fish and shellfish
• Dairy
• Beef (especially liver)
Not getting enough can result in:
• Neurological problems (including
poor memory, mania, dementia, and
psychosis)
• Megaloblastic anemia (a symptom of
pernicious anemia)
• Loss of appetite and weight loss
• Fatigue / weakness
• Depression
• Mouth inflammation
Choline
Choline is a water-soluble nutrient that’s often grouped together with the other B
vitamins.
Choline metabolism can vary widely from person to person. Up to half of people
in North America may carry gene variants that make them susceptible to choline
deficiency. Our body’s regulation of choline may also be regulated by estrogen.
Toxicity / excess is rare without supplementation.
However, some people have a genetic condition known as trimethylaminuria, in
which they over-excrete trimethylamine, a byproduct of choline. This will give
them a fishy smell, even when eating normal amounts of choline.
intrinsic factor (IF):
Glycoprotein secreted by the
stomach that enables the body to
absorb vitamin B12.
It’s involved in:
• Building cell membranes and neurotransmitters (e.g., it’s used in synthesizing
acetylcholine, an essential neurotransmitter for muscle impulses)
• Liver metabolism
• Nutrient transport
• Controlling homocysteine levels in fetus during pregnancy
• Possibly lowering inflammation
We get it from:
• Shellfish
• Salmon
• Legumes and beans
• Beef and beef liver
• Pork
• Tomato products
• Eggs
• Chicken
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Not getting enough can result in:
• Problems metabolizing fats
• Muscle and nervous tissue damage
• Liver disease
• Cognitive and memory problems
• Kidney disease
Getting too much can result in:
• Hypotension
Vitamin C (ascorbic acid)
It’s involved in:
• Protecting cells from free radicals
(antioxidant)
• Improving iron absorption
• Regenerating vitamin E supplies
• Building collagen, an important structural protein throughout the body
• Synthesizing norepinephrine and
carnitine
• Metabolizing cholesterol to bile acids
We get it from:
• Most colorful fruits and vegetables
• Organ meats (such as thymus)
Not getting enough can result in:
• Poor wound healing and structural repair (e.g., bruising, slow collagen
rebuilding)
• Poor dental health
Getting too much can result in:
• Diarrhea
• A higher risk of kidney stones
Vitamin D (ergocalciferol / cholecalciferol)
Most of our vitamin D can and should come from the sun. (Take note: If you live
north of the line that connects Philadelphia, San Francisco, Athens, and Beijing,
there is a good chance you don’t get enough vitamin D from the sun, especially
in winter). We can’t overdose on sun-based vitamin D, so any excess will come
from supplementation (however, you can get skin damage, so be reasonable).
prohormones: Precursor to a
hormone(s)
Vitamin D is really a group of prohormones. Vitamin D must be metabolized to
its biologically active form in the body.
• After it is consumed or synthesized in the skin, it enters the bloodstream and goes
to the liver.
• There, it’s hydroxylated to form 25-hydroxyvitamin D.
Nutrition: The Complete Guide
Micronutrients | 213
Major
Source
Minor Source
Dietary intake
Skin
Vitamin D3 (fish, meat)
Vitamin D2 (vitamin supplements)
7-Dehydrocholesterol
Cholecalciferol
(Vitamin D3)
25-dihydroxyvitamin D3
Liver
K
n
id
ey
1,25-dihydroxyvitamin D3
Increases calcium absorption (small intestine)
Increases calcium reabsorption (kidney)
Increases bone mineralization
Maintains calcium balance in the body
Figure 7.2 Pathways of vitamin D production and its influence on calcium absorption
• In the kidney, a second hydroxylation results in calciferol, or 1,25-dihydroxyvitamin D – the most potent form.
calciferol: Vitamin D
cholecalciferol: Vitamin D3
• In animals, this forms cholecalciferol, or vitamin D3.
• In plants, this forms ergocalciferol, or vitamin D2.
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It’s involved in:
• Maintaining serum calcium levels
• Modulating gene transcription
• Cell differentiation
• Immune system function
• Regulating glucose tolerance
• Regulating the renin-angiotensin cascade and blood pressure
Note: vitamin D can interact with certain prescription drugs
We get it from:
• Fish
• Shrimp
• Egg yolks
• Beef liver
• Mushrooms
• Fortified dairy products such as milk
Not getting enough can result in:
• In children: Rickets, deformed bones, retarded growth, and soft teeth
• In adults: Low bone density, tooth decay
Getting too much can result in:
• Elevated blood calcium
• Itching
• Loss of appetite
• Muscle weakness and joint pain
• Nausea and / or vomiting
• Disorientation
• Fluid imbalance
• Calcification of soft tissues
Vitamin E (tocopherol / tocotrienol)
tocopherols: Fat-soluble alcohols
with vitamin E
The vitamin E family contains eight antioxidants: four tocopherols and four
tocotrienols. Alpha-tocopherol is the chief form found in blood and tissues.
tocotrienols: Vitamin E
compounds
Deficiency is rare unless someone is very malnourished.
It’s involved in:
• Scavenging free radicals (antioxidant)
• Cell signaling
• Expression of immune and inflammatory cells
We get it from:
• Nuts and seeds; peanuts
• Dark leafy greens such as spinach, Swiss chard, turnip greens
• Avocado
Nutrition: The Complete Guide
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Not getting enough can result in:
• Egg yolks
• Muscle weakness
• Grass-fed butter
• Damage to red blood cells (hemolysis)
• Chicken, duck, goose liver
• Movement coordination problems (ataxia)
• Beef
• Impaired vision
• Dairy
• Acne
Getting too much can result in:
• Impaired blood clotting (as vitamin E interferes with
vitamin K metabolism)
Vitamin K1 (phylloquinone) and
Vitamin K2 (menaquinone)
Vitamin K is a family of fat-soluble vitamins. Two of the
main forms are:
• Vitamin K1 (plant-based)
• Vitamin K 2 (animal-based)
In plants, K1 helps with photosynthesis, which is why it’s
found most often in dark leafy greens.
We can convert K1 to K 2, mostly with our GI bacteria.
But some other tissues such as testes, pancreas, and arterial walls can convert K1 to K 2 as well.
Synthetic forms of Vitamin K (such as K3) may be toxic.
It’s involved in:
• Blood clotting (K1 and K 2)
• Amino acid metabolism co-factor (K 2)
• Cell signaling in bone tissue (K 2)
Not getting enough can result in:
• Tendency to bleed or hemorrhage; bruising
• Anemia
• Calcium going to the wrong places: not enough in
bones, but too much in blood vessels
Getting too much can result in:
• Negating anti-clotting effects from blood-thinning
drugs (which work as vitamin K inhibitors).
Note: As far as we know, there’s no upper limit to K1 or K 2.
Do not supplement with the artificial form of K3.
Minerals
Calcium
Calcium is the most common mineral in our body. Calcium levels are regulated by complex systems that involve
the interplay of parathyroid hormone, calcitonin, vitamin
D, and bone cells such as osteoblasts and osteoclasts.
It’s involved in:
• Transmitting nerve impulses
• Muscle contraction
• Hormone secretion
We get it from:
• Forming teeth and bone
K1:
• Acting as a co-factor for enzymes
• Leafy greens such as kale, collards, spinach, turnip
greens, beet greens, dandelion greens, Swiss chard
• Cruciferous greens such as Brussels sprouts and broccoli
• Asparagus
K 2:
• Cheese
We get it from:
• Dairy
• Rhubarb
• Dark green vegetables
• Fish
• Beans
• Calcium-fortified foods
• Nuts and seeds
• Natto (fermented soybeans)
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Not getting enough can result in:
• Poor bone metabolism (e.g., low bone density, rickets
in children)
• Muscle stiffness / cramps
• Low blood pressure
Getting too much can result in:
• Nausea and / or vomiting
• Constipation
• Dry mouth and thirst
• Kidney problems
• Calcium deposits in the wrong places (e.g., in soft
tissues)
Chloride
Almost every whole food (e.g., fruits and vegetables, lean
meats) has some chloride. And processed foods generally
have a lot of sodium chloride (salt).
Thus, chloride deficiency is rare and only occurs as a result of excessive fluid loss (e.g., through severe diarrhea
or vomiting).
It’s involved in:
• Maintaining an electrochemical gradient across cell
membranes (membrane potential)
• Digestion and absorption of many nutrients (part of
hydrochloric acid in stomach)
Chromium
High-sugar diets can increase chromium excretion
in the urine, which means people may need more
chromium.
Vitamin C can improve chromium absorption; antacids
and NSAIDs can decrease it.
Although chromium is important for glucose and fat
metabolism; and low chromium may increase risk for
chronic diseases, there’s still not enough evidence to
support chromium supplementation for health problems
like Type 2 diabetes. True chromium deficiency is rare.
Chromium toxicity is generally limited to industrial
exposure. However, long-term supplement use may
increase DNA damage.
Nutrition: The Complete Guide
It’s involved in:
• Glucose and fat metabolism; supporting the effects of
insulin
• Lipoprotein metabolism and oxidation of
macronutrients
We get it from:
• Broccoli
• Mushrooms
• Potatoes
• Oats
• Prunes
• Nutritional yeast
• Beer / red wine
• Aged cheese
• Beef / organ meats
Copper
You may have heard that wearing copper helps prevent
arthritis. Unfortunately, there’s no evidence that that’s
true.
Indeed, copper deficiency is relatively rare.
However, supplementing with high doses of zinc can
result in copper deficiency by increasing intestinal
proteins that bind and prevent certain metals from being
absorbed. Also, a high intake of vitamin C supplements
may impair copper absorption. (Note that some herbal
cold remedies include both zinc and vitamin C, and
people may take high doses of these.)
It’s involved in:
• Oxidation-reduction reactions and free radical scavenging (antioxidant)
• Cellular energy production
• Collagen and elastin cross-linking
• Synthesis and metabolism of neurotransmitters and
myelin
• Regulating protein synthesis
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We get it from:
• Cacao (dark chocolate)
• Beans and legumes
• Mushrooms
• Beef liver
• Nuts and seeds
• Seafood, especially oysters
Not getting enough can result in:
• Anemia that doesn’t respond to iron therapy
• Low white blood cell count
• Loss of skin and hair color (hypopigmentation)
Getting too much can result in:
• Nausea and / or vomiting
• Diarrhea
• Abdominal pain
• Liver damage
Iodine
Between iodized salt and fish and seafood consumption (along with seaweed
in some regions), iodine deficiencies are rare in industrialized countries (as is
iodine excess). Yet, iodine deficiencies are amongst the most common worldwide.
Low iodine is possible, especially given that some plant foods contain goitrogens. When iodine is too low, the thyroid swells and tries to harness more iodine,
leading to a goiter.
Equipment used to process dairy may be sanitized with chemicals containing
iodine. Thus, higher levels of iodine can make their way into dairy products.
goitrogens: Substances that
disrupt the production of thyroid
hormones by interfering with
iodine uptake in the thyroid
gland
It’s involved in:
• Forming T3 and T4 thyroid hormones
We get it from:
• Saltwater fish and seafood
• Dairy
• Seaweed
• Eggs
• Iodized salt
Not getting enough can result in:
• Impaired growth and neurological development
• Decreased production of thyroid hormones, enlarged thyroid
Getting too much can result in:
• Burning mouth / throat / stomach, fever
• Diarrhea
• Enlarged thyroid
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Iron
Hemoglobin and myoglobin are two proteins that bind with oxygen to move it
around the body. Iron forms an essential part of hemoglobin and myoglobin.
heme iron: Form of iron bound
with carrier proteins found in
animal products
non-heme iron: Form of iron
not bound with carrier proteins;
found mainly in plant foods
Dietary iron comes in two forms: heme iron and non-heme iron.
Heme iron comes mainly from the hemoglobin and myoglobin in red meat
(which includes dark-fleshed fish such as tuna, and poultry such as ostrich and
duck). Heme is better absorbed than non-heme.
Non-heme iron is found in plant sources and iron salts. (The story that Guinness
beer is highly nutritious and a good source of iron is, sadly, a myth.)
Vitamin C, organic acids, and meats enhance iron absorption.
On the other hand, zinc, calcium, phytates and polyphenols inhibit iron
absorption.
Iron deficiency is the most common nutritional deficiency worldwide.
This has many causes:
• Plant-based eaters or people whose diet depends heavily on grains may eat ironrich plant foods, but not absorb much of that iron.
• Vitamin A deficiency can intensify iron-deficiency anemia, and we need enough
copper to metabolize iron properly and form red blood cells.
• Women need more iron to support menstruation and pregnancy. Yet they
often eat fewer iron-rich foods (and are more likely than men to be plant-based
eaters, or restrict their food intake).
However, iron overload can also be a problem.
Iron can poison children who over-eat vitamin pills. And excess iron is a particular problem for men. Some people have speculated that our less-active lifestyle
(in which we are less likely to lose blood, bruise, or do hard physical work) may
be out of sync with our evolutionary past, and thus lead to iron overload. Luckily,
men can lower their risk by regularly donating blood.
It’s involved in:
• Forming hemoglobin (which stores about 2/3 of the body’s iron) and myoglobin;
oxygen transport and storage
• Forming red blood cells and blood vessels
• Producing anaerobic energy
• Forming cytochromes involved with cellular energy production and drug
metabolism
• Making up hundreds of proteins and enzymes
Nutrition: The Complete Guide
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We get it from:
• Non-heme food sources
• Beans and legumes
• Dark leafy greens
• Molasses
• Olives
• Jerusalem artichokes
• Raisins
• Seaweed
• Peppers
• Seeds, especially pumpkin seeds, sunflower
seeds, sesame seeds
and tahini
• Whole grains, especially brown rice, whole
wheat, teff, amaranth,
and quinoa
• Dark poultry (e.g.,
• Prune juice
• Heme food sources
• Fish
• Shellfish
• Organ meats
• Potatoes
• Red meats (e.g., beef,
chicken and turkey dark
pork, wild game)
meat, duck, ostrich)
Not getting enough can result in:
• Anemia
• Behavioral abnormalities (in children)
• Spoon-shaped nails that curl upwards (Koilonychia)
• Low immunity
Koilonychia: Dystrophy of the
nails in which they are abnormally
thin and concave from side to
side, with the edges turned up.
Getting too much can result in:
• Nausea and vomiting
• Shock; potentially death
• Increased risk of CVD, cancer, neurodegenerative diseases
Magnesium
Magnesium is found mostly in the skeleton, but also in skeletal muscle and
inside / outside of cells.
We need magnesium for many processes. Yet most Americans don’t get the basic
dietary requirements for magnesium. Low-level magnesium deficiency might
play a role in hypertension and Type 2 diabetes. Magnesium also seems to have a
calming effect, making it useful for helping muscle cramps, anxiety, and sleep.
It’s involved in:
• Carbohydrate and fat metabolism
• DNA and protein synthesis
• Active transport of ions across cell membranes
• Phosphorylation of second messengers
• Cell migration and wound healing
• More than 300 enzymatic reactions
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We get it from:
• Beans and legumes
• Cacao (dark chocolate)
• Dark leafy greens
• Potatoes
• Nuts and seeds
• Whole grains, especially quinoa, buckwheat,
brown rice, and barley
Not getting enough can result in:
• Muscle cramps and twitching
• Abnormal heart rhythms
• Nausea and loss of appetite
• Problems with thinking, moods, and memory
Getting too much can result in:
• Diarrhea
• Very low blood pressure
• Weakness or sleepiness
• Shortness of breath
Manganese
Manganese is found widely in many foods.
Phytates found in many foods can decrease manganese absorption, as can iron,
magnesium, and calcium supplementation.
Manganese excess is rare and limited mostly to industrial exposure (e.g., in
miners).
It’s involved in:
• Antioxidation
Proteoglycan: A compound
consisting of a protein bonded
to glycosaminoglycan groups,
present especially in connective
tissue
• Proteoglycan synthesis
metabolism
We get it from:
• Tea
• Beans and legumes
• Nuts
• Dark leafy greens, especially spinach and kale
• Cacao (dark chocolate)
• Whole grains, especially teff, oats, and barley
• Seaweed
• Okra
• Peppers
• Berries
• Garlic and onions
• Pineapple
• Mushrooms
Nutrition: The Complete Guide
• Carbohydrate, amino acid, and cholesterol
Micronutrients | 221
Molybdenum
The active form of molybdenum is called molybdenum co-factor.
Since molybdenum helps to get rid of purines, molybdenum deficiency can lead
to increased uric acid in the body and gouty arthritis.
Both molybdenum deficiency and excess are rare.
It’s involved in:
• Carbon, nitrogen and sulfur metabolism
• Nucleotide breakdown
nitrosamines: A class of organic
compounds present in certain
foods and products, appear to be
carcinogenic
• Metabolism of drugs / toxins (e.g., purines, nitrosamines)
We get it from:
• Legumes
• Potatoes
• Almonds and peanuts
• Bread
• Oats
• Green vegetables
• Yogurt
Phosphorus
Remember ATP? Phosphorus is the P, in the form of phosphate. Every cell in the
body needs phosphorus to function.
Both phosphorus deficiency and excess are rare, except in cases such as severe
malnutrition.
Phosphoanhydride bonds
O
-O
P
O
OO
P
OO
O
P
Phosphoester
bond
O
adenine
CH2
O
ribose
Adenosine (ribose + adenine)
Adenosine monophosphate (AMP)
Adenosine diphosphate (ADP)
Adenosine triphosphate (ATP)
Figure 7.3 Phosphorus and ATP
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It’s involved in:
• Bone formation
• Energy transfer (see image of ATP in Figure 7.3)
• Hormone production
• Enzyme production
• Cell signaling
• Buffering acidity
• Helps regulate oxygen delivery from hemoglobin
We get it from:
• Beans and legumes
It’s involved in:
• Maintaining an electrochemical gradient across cell
membranes
• Enzyme activity (ATPase and pyruvate kinase)
We get it from:
• Vegetables
• Dairy
• Potatoes
• Fish
• Beans and legumes
• Whole grains
• Fruits
Not getting enough can result in:
• Nuts and seeds; peanuts
• Cheese (especially ricotta)
• Fish
• Beef and beef liver
• Cardiac arrhythmia
(possibly leading to
cardiac arrest)
• Muscle cramps
• Eggs
Potassium
Potassium is the principal cation (positively charged
ion) of the intracellular fluid. (Sodium is the main cation
of the extracellular fluid.)
Sodium and potassium are both essential for maintaining an electrochemical gradient across cell membranes.
This gradient must be tightly regulated to have healthy
nerve impulse transmission, cardiac function and muscle contraction.
• High blood pressure
• Glucose intolerance
• Kidney stones
• Bone loss
Getting too much can result in:
• Tingling of extremities
• Muscle weakness
• Nausea and / or vomiting
• Diarrhea
• Cardiac arrhythmia
Selenium
Potassium works to balance sodium. In fact, some
estimate that our ancestors ate 10 times more potassium than sodium in their hunter-gatherer diets. This
balance helps regulate blood pressure.
Selenium is a powerful antioxidant, but it’s easy to get
too much. Just six Brazil nuts can contain as much as
800 mcg of selenium, exceeding the upper limit of recommended intake. Excess selenium can be a risk factor
for Type 2 diabetes.
Potassium deficiencies are usually caused by protein-wasting conditions, severe diarrhea, or the use of
some diuretics. The USDA states that the average American consumes around 60% of their potassium needs.
Since selenium appears in a wide range of animal foods,
selenium deficiency is rarely seen in industrialized
countries.
Potassium excess happens when there is more potassium
than the kidneys can excrete. This often happens with
kidney failure and potassium sparing diuretics, or with
potassium supplementation.
It’s involved in:
Excess potassium can be quite dangerous, given potassium’s role in regulating some of the body’s essential
activities such as heart function.
Nutrition: The Complete Guide
• Working with selenoproteins, selenium-dependent
enzymes
• Antioxidation
• Deiodination of T4
Micronutrients | 223
We get it from:
cations: Positively charged ion
• Brazil nuts
• Sunflower seeds
• Whole grains (especially whole
• Poultry
wheat and brown rice)
• Fish and seafood (especially tuna,
shrimp, and salmon)
• Red meat (including beef and pork)
• Eggs
Not getting enough can result in:
• Excess oxidation / free radical production
• Juvenile cardiomyopathy (also known as Keshan disease)
• Problems in skeletal and connective tissue metabolism and growth
• Inflammatory arthritis (Kashin-Beck disease)
• Acne (possibly)
Getting too much can result in:
• Skin problems
• Fatigue
• Brittle hair and nails
• Nervous system abnormalities
• GI upset
• Garlic odor on skin / breath
Keshan disease:
Cardiomyopathy due to the
deficiency of selenium
Kashin-Beck disease:
Degenerative disease of bone,
believed to be caused by
ingestion of cereal grains infected
with a fungus
Sodium
Sodium is the principal cation (positively charged ion) of the extracellular fluid.
(Potassium is the main cation of the intracellular fluid.)
We need both sodium and potassium to maintain an electrochemical gradient
across cell membranes. This gradient must be tightly regulated to have healthy
nerve impulse transmission, cardiac function and muscle contraction.
Thus, our body controls sodium carefully with the renin-angiotensin-aldosterone system and antidiuretic hormone (arginine vasopressin).
Most foods have some sodium. Processed foods generally have a lot. Clients eating a lot of processed foods will almost certainly be getting much more sodium
than they need.
In the next unit, we’ll look at what happens when sodium levels drop too low, a
condition known as hyponatremia. But in general, high blood sodium usually
results from excessive water loss; low blood sodium usually comes from more
fluid retention.
renin-angiotensinaldosterone system: A hormone
system that regulates blood
pressure and fluid balance
antidiuretic hormone
(arginine vasopressin):
Pituitary hormone that acts to
promote the retention of water by
the kidneys; and increases blood
pressure
It’s involved in:
• Absorbing chloride, amino acids, glucose, and water
• Regulating extracellular fluid status, blood volume, and blood pressure
• Maintaining the electrochemical gradient
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Not getting enough can result in:
• Nausea and vomiting
• Headache
iron, dietary calcium, and dietary phytates can impair
zinc absorption.
It’s involved in:
• Cramps
• Growth and development
• Fatigue
• Neurological function
• Disorientation
• Reproduction
Getting too much can result in:
• Increased fluid volume and edema
• Nausea and / or vomiting
• Diarrhea and / or abdominal cramps
Sulfur
Sulfur is the third most abundant mineral element found
in our body, and is part of three important amino acids:
cysteine, methionine, and taurine.
Since we get sulfur from foods containing protein, deficiency is rare unless someone is following a very strict,
low-protein, plant-based diet or has some type of malabsorption syndrome.
It’s involved in:
• Acid-base balance
• Antioxidant
• Liver detoxification
• Immunity
• Apoptosis (programmed cell death)
• Acting as a catalyst in chemical reactions
• Cell structure and health
• Gene expression
• Cellular signaling and hormone release
• Nerve impulse transmission
We get it from:
• Beans and legumes
(including peanuts)
• Nuts and seeds
• Whole grains (especially
quinoa, rye, and wild
rice)
• Seafood (especially
oysters)
• Beef
• Lamb
• Pork
• Poultry (especially dark
meat)
• Eggs
• Wild game
• Mushrooms
• Collagen synthesis
We get it from:
• Protein-dense foods (e.g., meat, seafood, eggs)
• Garlic and onions
• Cruciferous vegetables
Zinc
Zinc in animal sources is usually more bioavailable than
that from plant sources. Plant sources may contain zinc
compounds that are not easily broken down, or that
interfere with zinc absorption.
Taking too much zinc can result in copper deficiency.
The amino acids cysteine and methionine can improve
zinc absorption. Excessive dietary folate, supplemental
Nutrition: The Complete Guide
Not getting enough can result in:
• Delayed growth and
sexual maturation
• Poor wound healing
• Low immunity
• Skeletal abnormalities
• Night blindness
• Hair loss
• Loss of appetite
• Acne (possibly)
• Dry eyes
Getting too much can result in:
• Nausea and / or vomiting
• Abdominal pain
• Diarrhea
• Blocking copper absorption
Micronutrients | 225
Table 7.1 Symptoms by body part
If you have...
You may be or have...
Ankles
You may be or have...
Hands
Swollen ankles
Sodium excess
Pitting edema
Vitamin C deficiency
Bones
Soft / weak bones
Vitamin D, C, calcium, phosphorus,
or fluoride deficiency
Joint pain
Vitamin D toxicity. Sulfur deficiency
Gout
Molybdenum deficiency or toxicity
Growth problems
Zinc, vitamin D, or iodine deficiency
Brain
Memory problems, disorientation or dementia
Vitamin B3, B6, B12, choline, or sodium deficiency
Sleeplessness
Vitamin B6 deficiency
Sleepiness
Magnesium toxicity
Depression
Vitamin B7 or B12 deficiency
Eyes
Dry eyes
If you have...
Vitamin C, A, or zinc deficiency
Dry eyes with gray spots
Vitamin A deficiency
Red or difficult-to-control
eyes
Vitamin B1 or B2 deficiency
Difficulty seeing in dim
light
Vitamin A or zinc deficiency
Impaired vision
Tingling / burning hands
Vitamin B6 or potassium toxicity.
Phosphorus deficiency
Numbness
Magnesium deficiency
Head
Headache
Vitamin A or B3 toxicity. Sodium
deficiency
Dizziness
Vitamin A toxicity
Fever
Iodine toxicity
Heart
Rapid heart rate
Vitamin B1 deficiency
Arrhythmia
Potassium or magnesium deficiency.
Potassium toxicity
Lips
Cracked lips
Vitamin B2 or B6 deficiency
Lungs
Shortness of breath
Magnesium toxicity
Mouth and mucous membranes
Dry mucous membranes
Calcium deficiency
Numbness around
mouth
Calcium deficiency
Sore / burning mouth
Iodine toxicity
Vitamin E deficiency
Excessive thirst
Vitamin D toxicity. Calcium deficiency
Sensitivity to light
Vitamin B2 deficiency
Vitamin B9 deficiency
Conjunctivitis
Vitamin B7 deficiency
Cracking / redness of
mouth
Increased salivation
Choline toxicity
Taste changes
Zinc deficiency
Ears
Hearing loss
Manganese deficiency
Face
Acne
Vitamin C, E, A, zinc, or selenium
deficiency
Feet
Tingling / burning feet
Vitamin B1, B5, or phosphorus
deficiency. Vitamin B6 or potassium
toxicity.
Numbness
Magnesium deficiency
Gums
Sore and spongy or red
and swollen
Vitamin C deficiency
Muscles / tendons
Muscle spasms
Calcium, magnesium, or vitamin D
deficiency
Muscle cramps
Calcium, sodium, potassium, or magnesium deficiency
Muscle weakness
Vitamin B9 or B12 deficiency. Potassium or magnesium toxicity
Weak tendons /
ligaments
Vitamin B1 or manganese deficiency
Neurological problems
Vitamin B12, choline, chromium, or
manganese deficiency. Molybdenum,
selenium, or fluoride toxicity
Nails
Hair
Hair loss
Vitamin B7, C, or zinc deficiency
Brittle, thin nails
Selenium toxicity
Dry hair
Vitamin C deficiency
Spoon-shaped nails
Iron deficiency
Brittle hair
Selenium toxicity
Whitened nail beds
Selenium deficiency
Hypopigmentation
Copper deficiency
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226 | Unit 7
Table 7.1 Symptoms by body part (cont)
If you have...
You may be or have...
Neck
Enlarged thyroid
If you have...
Stomach
Iodine deficiency or toxicity
Nausea
Vitamin A, D, B3, B5, calcium, sodium, potassium, zinc, fluoride, iron,
or copper toxicity. Vitamin B1, B7,
sodium, or magnesium deficiency.
Diarrhea
Vitamin B3 or B9 deficiency. Vitamin B3, B5, C, sodium, potassium,
magnesium, zinc, iodine, or copper
toxicity
Loss of appetite
Vitamin A or D toxicity. Vitamin B1,
B2, B7, B12, phosphorus, magnesium,
or zinc deficiency.
GI distress
Vitamin B1 deficiency. Sodium
excess. Zinc, selenium, fluoride, or
copper toxicity
Heartburn
Vitamin B5 toxicity
Constipation
Calcium toxicity
Nose
Sensitivity to smell
You may be or have...
Molybdenum deficiency
Skin
Dry, scaly, pale or bruises
easily
Vitamin B7 or C deficiency
Hypopigmentation
Copper deficiency
Red spots under the
skin’s surface
Vitamin C deficiency
Scaly, greasy skin
Vitamin A or B2 deficiency
Itchy
Vitamin D toxicity
Tendency to bleed
Vitamin K deficiency or vitamin E
toxicity
Dermatitis
Vitamin B2, B3, B6, or B7 deficiency
Flushing
Vitamin B3 excess
Unusual fishy body odor
Choline toxicity
Unusual garlic body odor
Selenium toxicity
Increased sweating
Choline toxicity
Lesions
Selenium toxicity
Rash
Selenium toxicity
Jaundice
Copper toxicity
Teeth
Cavities
Vitamin C or fluoride deficiency
Soft teeth, decay
Vitamin D deficiency
Tongue
Purple, white, or smooth
and slick; painful
Vitamin B2 or B6 deficiency
Sore tongue
Vitamin B6 or B12 deficiency
Cracking / redness of
tongue
Vitamin B9 deficiency
Urine
Excessive urination
Vitamin D or calcium toxicity
Brightly colored urine
Vitamin B2 excess
Kidney stones
Calcium or vitamin C toxicity. Potassium deficiency
Phytonutrients and myconutrients
Plants and fungi are cool. They’re the original chemical
masters, turning soil, water, and (in the case of plants)
sunlight into thousands of organic compounds.
Over millions of years, plants and fungi have evolved
things like:
• pigments that turn them all shades of the rainbow;
• chemicals that repel pests and pathogens;
Nutrition: The Complete Guide
• chemicals that fight diseases;
• chemicals that attract helpful animals such as bees;
• chemicals that protect against environmental damage;
• chemicals to store nutrients; and even
• chemicals that help them communicate with each
other (yes, plants and fungi do communicate… though
they’re not exactly philosophers).
Micronutrients | 227
Many of these chemicals have potential nutritional benefits for us. (And some are
potent poisons.)
Phytonutrients are found in plants (the prefix “phyto” comes from the ancient
Greek phyton or plant).
Myconutrients are found in fungi such as mushrooms (the prefix “myco” comes
from the ancient Greek mykes, or mushroom). Some traditional Northern diets
also include lichen, which is a symbiotic organism made up of algae / bacteria
and fungi. Lichen is now used as a vegan source of vitamin D3.
Like vitamins and minerals, phytonutrients and myconutrients don’t directly
give us energy. Yet they do help keep us healthy and thriving.
We know of over 10,000 phytonutrients and myconutrients so far, and discover
new ones all the time. We don’t know what all of them do. But we do know that
eating a lot of different plants and certain kinds of fungi is good for us.
Phytonutrients and myconutrients do many different things.
• They scavange free radicals as antioxidants.
• They influence hormonal function. For instance, isoflavones in soy and lignans
in flax can mimic estrogen in the body. Liver enzymes that block estrogen action
can be upregulated by indoles, a phytochemical found in cruciferous vegetables.
If you use progesterone cream, it may have come from wild yam.
• They help with DNA repair.
• They help fight bacteria, viruses, and other pathogens, as well as preventing
them from getting a foothold (e.g., the proanthocyanidins found in cranberries
can actually inhibit certain pathogens from adhering to cell walls, potentially
preventing urinary tract infections). Some chemicals in plants may also help repel
pests such as mosquitos.
• They lower inflammation.
• They lower blood clotting and coagulation.
• The inhibit fat synthesis and storage.
This is just a brief overview. We have yet to discover many of the wonders of
nature’s medicine pharmacy.
Phytonutrients and myconutrients work in complex ways. For example, some
work by mildly stressing cells in the body, ultimately making them stronger by
building internal defense mechanisms (this is called hormesis). Given this complexity and how little we still understand, the best sources of phytonutrients and
myconutrients are, as always, whole foods rather than supplements.
Zoonutrients
Zoonutrients are the cousins of phytonutrients and myconutrients. As their
name implies, they’re found in animal foods.
hormesis: Phenomenon of
dose-response relationships in
which something (such as a heavy
metal or ionizing radiation) that
produces harmful biological
effects at moderate to high doses
may produce beneficial effects at
low doses
International Sports Sciences Association
228 | Unit 7
These include compounds such as:
• carnitine
• creatine
• carnosine
• conjugated linoleic acid (CLA)
These and other zoonutrients can do many things, such
as:
• suppress tumor growth;
• lower our risk of heart disease;
• support healthy brain function;
• help us build stronger, more powerful muscles;
• lower oxidation; and
• prevent glycation of blood cells.
As with phytonutrients and myconutrients, zoonutrient
substances can be complex, and interact in many ways
in our body. Often, zoonutrients in whole foods (such as
meat or dairy) act quite differently than similar nutrients
in supplements.
Zoonutrients will depend significantly on the animal’s
diet, environment, and age. The healthiest animals raised
in the best conditions (such as pastured beef or chickens,
or wild-caught fish) will usually have the most nutrients.
As you can probably guess by now, nature is quite the
biochemistry whiz. We’ve just scratched the surface of
what there is to know about vitamins, minerals, and the
vast array of chemical compounds in plant, fungi, and
animal foods. And, as you’ll note, a diverse, varied diet
of whole foods is the best way to get these incredible
compounds. In upcoming units, we’ll teach you how to
help your clients eat more of these nutrient-rich foods.
Case study
Many people struggle for years with dieting. They try
this diet and that diet, restricting their food intake and
hoping for the best. At times, they may feel desperate
and try more extreme measures.
Unfortunately, they often end up disappointed, as
stringent diet plans are not sustainable. And the weight
comes back on.
But disappointment, regaining weight, and having to
buy one more darn diet book aren’t the only problems
serial dieters can have.
A woman in her 50s, who’d been diligently working to
lose weight for several months, came to see us.
She felt tired. More unsettlingly, her fingers and toes
tingled. At first, the tingling was just occasional. Now, it
happened more and more.
We put on our nutritional detective hats and got to
work. As all good coaches do, we gathered data and
looked for clues.
Was she supplementing too much Vitamin B6? As you’ve
learned, this can result in neurological damage and similar “tingling” symptoms in hands and feet.
No. Our assessment showed that she wasn’t taking
any vitamin or mineral supplements besides a calcium
supplement.
Hmm.
We looked at what she had been eating. Which was not
much. She wanted to lose weight, of course. She also
relied on processed calorie-controlled snacks (such as
Nutrition: The Complete Guide
Ensure or nutrition bars) to meet her energy needs.
So: She was not only eating less food overall, she was
eating far fewer micronutrients than she needed.
This led us to a second hypothesis: that the client was
not consuming enough vitamin B12 and her limited
stores were becoming exhausted. Vitamin B12 deficiency can result in neurological changes and a tingling
sensation in the hands and feet. As our liver stores some
vitamin B12, these symptoms might not show up right
away.
Since she was in her 50s, it was also likely that she
wasn’t digesting her food well, and that her stomach
was producing less intrinsic factor (IF). Even if she had
been supplementing with a vitamin supplement, she
might not have absorbed B12 properly anyway.
We proposed our hypothesis: Low vitamin B12 from
lower energy and micronutrient intake, along with older
age. We sent her to her doctor to confirm and collaborate with our nutritional recommendations.
The doctor agreed with our suggestion, and the client
began taking a sublingual B12 supplement. Her “tingling” symptoms quickly disappeared, and she started
to feel more energetic.
Over time, we kept working with her to help her keep
losing weight while eating nutrient-rich whole foods, to
ensure she was getting all the micronutrients she needed. Bonus: Since whole fresh foods taste much better
than packaged “diet” foods, she also enjoyed her daily
menu much more!
Micronutrients | 229
Summary
Micronutrients are vitamins, minerals, and other
compounds such as phytonutrients, myconutrients, and
zoonutrients.
Vitamins, minerals, and other micronutrients do not
give us energy directly. However, they are involved in
almost all biological processes and keep us healthy and
thriving. So we need to get them from our diet.
If we don’t get enough micronutrients, we won’t function
properly. We may get sick, and key processes can break
down. If we get too much (usually from supplements,
but occasionally from foods too), we may also get sick, or
disrupt other key processes.
Micronutrients often work together synergistically. Getting a lot of one particular micronutrient can sometimes
disrupt the balance of another.
Vitamins, minerals and other micronutrients are complex compounds that come in many forms. They are best
absorbed from whole foods, although different foods and
forms of the compounds will be differently absorbed.
Thus, what is in our food (or supplements) may not be
what our body actually uses.
Vitamins are generally categorized as either fat-soluble
or water-soluble because they dissolve well in either
lipids or water, respectively. Fat-soluble vitamins are
stored in fatty tissues and may accumulate, while most
water-soluble vitamins are less well stored and easily
excreted.
Minerals support biochemical processes. Some are electrolytes that maintain electrochemical gradients across
cell membranes. Other minerals can act as co-factors and
enzymes.
People vary widely in their needs for dietary micronutrients. Many factors, including health conditions and
medications, can affect how well people absorb and use
micronutrients.
If you suspect micronutrient excess or deficiencies in
your clients, get them tested to know for sure. Work with
their doctors and / or pharmacists if you recommend
any supplementation, or want to know how their health
status or medications may interfere with micronutrient
absorption and use.
As much as possible, recommend whole foods that are
micronutrient-rich. These include:
• colorful fruits and vegetables
• mushrooms
• herbs and spices
• lean proteins such as red meat (particularly organ
meats), wild game, poultry, fish, seafood, and eggs
• beans and legumes
• whole grains
• dairy
International Sports Sciences Association
UNIT 8
Water and Fluid Balance
Water and Fluid Balance | 231
Unit Outline
1.
The importance of body water
2.
Fluid balance
3.
Body water imbalances
4.
Body water regulation
5.
Hydration strategies
6.
Case study
7.
Summary
Objectives
We need water to live. Yet we lose it through many
processes: respiration, sweating, excretion and, of course,
exercise.
In this unit, you’ll learn all about hydration and how our
body regulates and balances our fluids. You’ll also learn
balance to work with specific types of athletes and recreational exercisers.
how you can use the principles of fluid and electrolyte
The importance of body water
Evolutionarily speaking, we came from the ocean.
Mineral-rich fluid gave us life, let us move around, and
regulated our biological functions. We still carry that
ocean with us.
All of our cells soak in water. Water makes up over half —
around 55 to 60% — of who we are.
Table 8.1 Intracellular and extracellular fluid
Found
Intracellular
fluid (ICF)
Extracellular fluid
(ECF)
Enclosed within
cell membranes
Outside of cell
membranes
If you are 200 lb (91 kg) and male, you are about 120 lb
(54 kg) of water.
• 25% within vascular
system, makes up
plasma portion of
blood volume
If you are 130 lb (59 kg) and female, you are about 72 lb
(33 kg) of water. (And some days, depending on your
menstrual cycle, it probably feels like more than that.)
• 75% known as interstitial fluid, which
surrounds cells and
connective tissues
If you’re a baby, you’re about 75% water. (Congratulations on learning to read so early in life. However, please
get a grownup’s help with your nutrition coaching.)
Water is on the inside of our cells as intracellular fluid
(ICF), and on the outside of our cells as extracellular
fluid (ECF). See Table 8.1.
Makes up
About 2/3 of the
body’s water
About 1/3 of the body’s
water
Higher in
Potassium and
magnesium
Sodium and chloride
Lower in
Sodium and
chloride
Potassium and
magnesium
International Sports Sciences Association
232 | Unit 8
Different cells contain different amounts of water. For
example:
•
Bone is about 22% water.
•
Adipose tissue is about 25% water.
•
Muscle and brain tissue are about 75% water.
•
Blood is about 83% water.
•
Eyes are about 95% water.
Thus, our body composition (along with other things
such as hormones) determine how much water we carry
around.
Water has important jobs.
•
It dissolves other substances.
•
It transports substances.
•
It catalyzes (starts) chemical reactions.
•
It lubricates tissues.
•
It regulates our temperature.
•
It provides minerals.
Let’s look at each one of these now.
Water as a solvent and transporter
A solvent is a liquid that can dissolve other solids,
liquids, or gases. You’ll soon see how this is important
when we get to fluid balance.
Water dissolves proteins (including enzymes, DNA) and
moves them around the body. Water brings nutrients to
cells and carries waste products away from them. Thus,
we need water to synthesize proteins, glycogen, and
other macromolecules.
Water as a catalyst
Dissolved chemicals spend much of their time hanging
out in water. Thus, water is the arena for many intracellular metabolic reactions. Indeed, many chemical
reactions need water to happen. Water is a catalyst that
speeds up enzymatic interactions with other chemicals.
Water as a lubricant
As anyone who’s slipped on a wet floor knows, water
decreases friction. Water lubricates joints and acts as a
shock absorber for the eyes and spinal cord.
Amniotic fluid, which is mostly water, protects a growing fetus from bumping around inside its mother.
Water as a temperature regulator
When our body temperature goes up, we sweat. As sweat
evaporates, it cools us.
Water as a source of minerals
Both seawater and naturally occurring fresh water are
full of dissolved minerals.
As our drinking water is processed, pollutants are
removed and fluoride and minerals are added. Many
bottled waters add extra minerals.
How can you measure body fat with water?
You’ve probably seen the scales that estimate your body
fat percentage along with your weight.
These scales are based on the bioelectrical impedance
analysis (BIA) method, which sends an imperceptible
electrical current through the body.
This current travels differently through water or other
cellular materials.
Muscle contains lots of water and electrolytes. Electrical
current flows through easily.
Nutrition: The Complete Guide
Fat has much less water and fewer electrolytes. Current
does not flow well through it. (This is also why our
nerve cells are insulated with a fatty sheath, much like
the plastic or rubber on electrical cords.)
The BIA device then measures your body fat based on
how quickly the current moves through your body.
Because they depend on water and electrolyte balance,
BIA scales can be thrown off by how hydrated or dehydrated you are, or your unique mix of fat to lean tissue.
So they are not very accurate for many people.
Water and Fluid Balance | 233
The big picture
Fluid balance
In this section, we’ll look at how much fluid we need and
lose. We’ll also look at what things can change our fluid
balance.
Fluid balance is the relationship between fluid coming in
and fluid going out.
While there are formulas to calculate fluid needs and
losses (which we’ll give you at the end of this unit), don’t
get too caught up in the numbers. Most of the time, this
doesn’t need to be an exact science.
•
sorb a little water through our skin, although it stays
there and doesn’t go into the rest of the body.
•
Fluid balance is a dynamic equilibrium between
what’s coming in and going out.
•
Many factors can affect fluid input and output.
•
Some people might need to drink more water than
others.
•
we’re ill, vomiting).
•
On average, we get around 1 L (4 cups) of water from our
food each day. This depends on what we eat (see Figure
8.1). For instance:
•
Raw fruits and vegetables are mostly water.
•
Cooked whole grains and legumes, since they absorb
cooking liquid, also have some water.
Our biological cues may differ from actual fluid needs
(at least temporarily).
You may sometimes need to drink more, even if
We lose water through sweating and the air we
breathe, and excrete it in urine and feces (plus, if
Just understand the general ideas of fluid balance:
•
We take in fluid from food and drinks. We can also ab-
High-fat foods like nuts, seeds, oils, butter, and lard have
very little water.
you’re not very thirsty.
100%
Percentage of water
80%
60%
40%
20%
e
ar
m
ch
rd
ha
ga
r
ee
in
se
d
ea
br
gs
eg
ge
s
an
or
ts
rro
ca
cu
c
um
be
r
s
0%
Figure 8.1 Water content of various foods
International Sports Sciences Association
234 | Unit 8
How much fluid do we need?
Of course, along with food, fluid also comes from
drinks. Our body regulates our thirst so that we take in
more fluid when we need it.
We get thirstier when:
•
it’s warmer;
•
the air is drier;
•
we’ve eaten something salty;
•
we’ve drunk alcohol; and / or
•
we’ve been sweating.
We are less thirsty when:
•
it’s cooler;
•
it’s humid; and / or
•
we haven’t sweated much.
There may be a bit of a “lag time” between losing fluid
and being thirsty. Even slight dehydration can mean that
we think, focus, and perform worse.
While this is only a minor problem for a person sitting
at a desk in a comfortable room, it can be dangerous for
people exercising in extreme conditions, such as heat,
desert climates, and / or high altitude.
So how much should you drink? Obviously, it depends.
•
Most adults need around 3 L (12 cups) of fluid each
day as a baseline. Since 1 L (4 cups) comes from
our food, this means that 2 L (8 cups) comes from
drinking.
•
Bigger people usually need more fluid than smaller
ones (although babies and children can dehydrate
quickly).
•
People who are sick and losing water through diarrhea and / or vomiting will need fluid and electrolyte
replenishment.
•
If it’s warmer and / or drier, you might need 500 mL
(2 cups) more.
•
If you’re exercising hard, you might need up to 6 L
(24 cups) per day.
Calculating basic fluid needs
If you enjoy math, you can estimate fluid needs by bodyweight. For every kilogram of bodyweight, ingest 30-40
mL of water.
Nutrition: The Complete Guide
•
Thus, if you weigh 50 kg (110 lb), you’d need 1.5-2 L
of water per day.
•
If you’re 100 kg (220 lb), you’d need 3-4 L of water
per day.
How much fluid do we lose?
Our daily fluid loss balances our fluid intake. We can
lose water in many ways.
Breathing and skin evaporation
Our nasal passages and lungs moisten the air we breathe.
Our skin is always losing water through evaporation. We
can’t usually feel this if we aren’t actively sweating, but
it’s happening.
We lose about 0.4-0.5 mL of water per kilogram of bodyweight per hour this way. Thus, a 70 kg person would
lose about 650-850 mL every 24 hours.
Sweating
We don’t sweat much when we’re comfortable and / or
not moving around. But during intense exercise, especially in hot climates, we can lose quite a lot of water. The
sweatiest exerciser on record is distance runner Alberto
Salazar, who sprayed a sweat-soaked trail of 3.7 L — 8
pounds! — of fluid per hour as he prepared for the 1984
Summer Olympics.
Interestingly, scientists have recorded even more fluid
loss — up to 5 L per hour and 11 lb (5 kg) of bodyweight
—in hot environments with no exercise. You might wonder how this could be. Some suggest that we can actually
lose more water this way, because blood is going mostly
to our skin rather than to working muscles.
In general, we sweat out around 0.5-2.0 L per hour of
activity.
Excretion
We lose fluid through both feces and urine.
An average healthy adult needs about 400-500 mL of
water per day for kidney function. This is an absolute
minimum. At this fluid intake, our urine becomes
highly concentrated, and we risk kidney stones and
other problems.
If we don’t get enough water, we also tend to become
constipated. Conversely, we may lose a lot of fluid if we
have severe diarrhea (and / or vomiting).
Water and Fluid Balance | 235
The “magic secret” to fast weight loss?
Later in this unit, we’ll talk about how athletes can purposely and quickly
change their body weights by manipulating fluid levels.
The same trick can be used by low-carb diet promoters.
If you are used to eating a lot of carbohydrates, and you suddenly go low-carb,
you’ll probably lose a few pounds of water in a few days.
This can make it seem like a low-carb diet is the “magic secret” to fast weight
loss.
Unfortunately for dieters, they haven’t lost fat. But fortunately for athletes such
as wrestlers or boxers, they can “make weight” without losing too much lean
tissue.
Conversely, if you aren’t used to eating a lot of carbohydrates, and you have
a high-carb meal or two, you’ll also often notice yourself being thirstier afterwards (plus retaining water).
Bodybuilders and physique athletes about to go on stage use this water retention effect to “fluff up” their fluid-depleted muscles at the last minute. If they
time it right, extracellular fluid will stay relatively low but intracellular fluid in
muscles will go up. This makes them look both more muscular and leaner.
Many people losing weight notice that weight loss is not linear. Instead, it often
seems to happen in bursts. People can often be surprised by sudden weight loss
the day after a big meal. Some refer to this as “the whoosh.”
“Whooshes” can seem like a paradox. How can we lose weight after eating
more?
One possible explanation is that energy restriction can cause fluid retention, in
part from changes in hormone levels (such as increased cortisol) or the different
osmolarity of dissolved proteins and electrolytes.
Briefly eating more after a period of eating much less changes the osmotic balance. Our body rebalances our fluids.
End result: We lose water… and weight.
Thus: Weight fluctuation from changes in fluid balance is one reason the bathroom scale doesn’t always give us the whole picture.
Body water imbalances
Fluid in versus fluid out is only part of the picture of fluid balance. The other part
is what is dissolved in that fluid, such as electrolytes. Substances dissolved in a
solvent are known as solutes.
If you understand the basic idea that fluid balance is about fluid in versus fluid
out, as well as the relationship between a solute and its solvent, you can see that
imbalances can happen in two ways:
•
solute: The minor component in a
solution, dissolved in the solvent
Dehydration means there is not enough water, and too much solute. We are
losing more water than we are taking in.
International Sports Sciences Association
236 | Unit 8
Losses through sweating
(minimal with no exercise)
~100 mL
Losses through feces
~100 mL
Insensible losses through
the skin and respiration
~800 mL
Losses through urine
(assuming no excess intake)
~500 mL
Total: ~1500 mL
Figure 8.2 Daily water losses without exercise
•
Hyponatremia means there is too much water relative to solute (in this case, sodium). We are taking in
more water than we are losing (or the water-sodium
solution is becoming too dilute).
We can also have problems with fluid regulation for
other medical reasons (for instance, if the systems that
transport fluid break down). If the medical problem
results in water retention, we usually call this edema.
Dehydration
Dehydration can simply mean that we’re healthy, but
don’t drink enough fluid as we go about our daily-life
activities. This type of dehydration is usually mild.
Nutrition: The Complete Guide
However, more severe and potentially dangerous dehydration can result from such serious physiological
problems as:
•
vomiting
•
diarrhea
•
fever and sweating
•
dialysis
•
burns
•
trauma
•
kidney failure
•
diuretics
Water and Fluid Balance | 237
Table 8.2 Percentage of body water loss and consequences
0.5%
Increased strain on heart
1%
Reduced aerobic endurance
3%
Reduced muscular endurance
4%
Reduced muscle strength, reduced motor skills, heat cramps
5%
Heat exhaustion, cramping, fatigue, reduced mental capacity
6%
Physical exhaustion, heatstroke, coma
10-20%
Death
•
disordered eating
•
diabetes mellitus with ketoacidosis
•
hypoaldosteronism
•
diabetes insipidus (caused by a lack of antidiuretic hormone [ADH])
•
and more
Exercise and sweating
We lose both water and salts when sweating. But since we lose more water than salts,
we risk electrolyte imbalance when exercising hard for a long time. Losing even small
amounts of water can affect our athletic performance and energy. See Table 8.2.
Because blood plasma is mostly water, losing water through sweating will lower
blood volume. Our heart must work harder to pump blood through our body.
Heart rate must go up to deliver the same cardiac output. This is a particular
problem for endurance athletes, since their performance depends on an efficient
heart rate.
Our body can, to some degree, control the effects of dehydration. For example,
as we lose more water than sodium, sodium concentrations in the extracellular
fluid go up.
This change in blood osmolarity sends signals to receptors in the hypothalamus
(called osmoreceptors), which then triggers thirst.
osmolarity: Concentration of
osmotically active particles in a
solution
Symptoms of dehydration
osmoreceptor: Sensory receptor
that detects changes in osmotic
pressure
We don’t usually notice thirst until we’ve lost about 1-2% of our body water.
Unfortunately, at this point, our performance has already started to suffer. Beyond a 2% loss, we can start to see some more serious symptoms of dehydration,
including:
•
headache
•
nausea
•
fatigue
•
flushing
•
low blood pressure
•
rapid heart rate
•
dizziness and / or fainting
If this sounds like a hangover to you, you’d be right. Alcohol can suppress hormones that control thirst and body water regulation.
International Sports Sciences Association
238 | Unit 8
Water loss as
body weight percentage
10%
8%
6%
4%
Reduced muscle
strength, reduced
Reduced muscular endurance time,
endurance time
heat cramps
2%
0%
Severe heat
cramps, heat
exhaustion,
heatstroke,
coma, death
Impaired
thermoregulation
Effects of water loss
Figure 8.3 Effects of dehydration on physical performance
If we keep losing fluid without replenishing, these symptoms can become more dire. In the worst case, we can
die. See Figure 8.3.
Unlike many biological stimuli, we don’t “adapt” to
dehydration. We can’t “train” to become better at being
dehydrated. There is no “cure” or “adaptation” to fluid
loss. We must replenish those lost fluids.
Athletes and exercisers should thus be careful to drink
regularly and expect that they may need more fluid than
they anticipate.
Hyponatremia
Hyponatremia means having too much water relative to
sodium content.
“Hypo” means “low.” The elemental symbol for sodium
is Na. Thus, hyponatremia equals low sodium.
(You may also see hypokalemia, or low potassium
[which has the elemental symbol of K]. The Arabic root
of al-qily, which originally referred to ashes, also gives us
the word alkaline.)
Our body prefers to keep blood sodium (and all electrolytes) in a narrow range, generally between 136-145 mEq /
L (milliequivalents of solute per liter of solvent).
Nutrition: The Complete Guide
Hyponatremia occurs when the plasma sodium concentration drops below 135 mEq / L.
There are three common types of hyponatremia.
•
low blood volume
•
high blood volume
•
normal blood volume
Symptoms of hyponatremia
Initial symptoms of hyponatremia include:
•
GI discomfort (including nausea and / or vomiting);
•
headache;
•
swollen hands and feet;
•
confusion; and / or
•
restlessness.
Note that some of these are similar to dehydration
symptoms. This mix-up can lead to giving people more
water, which makes the problem worse.
As brain cell water increases, the brain swells (cerebral
edema). In advanced stages, hyponatremia is a very serious, potentially deadly condition.
Water and Fluid Balance | 239
Table 8.3 Three common types of hyponatremia
Blood
volume
Low blood
volume
Normal blood
volume
High blood
volume

Goes down

Total body
water

Goes down
Stays normal



Goes down (outpacing
blood volume and
TBW decrease)

Stays normal
Goes up
Total body sodium
Goes up

Goes down

Goes up (less than
blood volume and
TBW
Caused by
Vomiting, diarrhea, pancreatitis, peritonitis,
burns, rhabdomyolysis, diuretics, osmotic
diuresis, mineralocorticoid deficiency and
salt-losing kidney diseases
Diuretic use, hypothyroidism, glucocorticoid deficiency, increased antidiuretic
hormone (ADH) and excessive thirst / water
consumption
Congestive heart failure, liver cirrhosis, various kidney disorders, and excessive water
consumption.
Exercise and hyponatremia
Athletes are particularly at risk for hyponatremia. In their zeal to replace lost
fluids, or perhaps because they feel thirsty during intense exercise, they may
drink too much by mistake. They may also drink too much plain water, rather
than balancing their electrolytes (with, for instance, a sports drink that contains
sodium and potassium).
Other people, too, have died from hyponatremia after drinking too much water.
Notable examples include:
•
The university student who died from drinking too much water during a fraternity hazing.
•
The woman who died from drinking too much water during a water-drinking
contest.
•
Several people who died from drinking too much water after taking the drug
Ecstasy, which affects thirst, body fluid balance, and sodium balance.
Thus:
•
While fluid replenishment is crucial, don’t over-drink or guzzle a lot of water at
once.
•
Plain water is usually fine for normal people under normal conditions, and
when exercise bouts are short or not very intense.
•
When replacing a lot of fluid, consider an electrolyte solution (such as a sports
drink or something like Pedialyte) instead of plain water.
Edema
Edema occurs when fluid builds up where it normally shouldn’t, such as in the
extracellular space of tissues. This can happen in any body part, such as:
edema: Swelling from fluid
accumulation
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anasarca: Massive edema in
subcutaneous space
•
system-wide edema (sometimes known as anasarca);
•
our hands, feet, and legs (known as peripheral edema or pitting edema);
•
around our heart and lungs (known as pulmonary edema); and / or
•
our brain (known as cerebral edema).
Edema is also common in the later stages of pregnancy.
Edema may be related to electrolyte imbalances, but more often it’s a result of
a variety of health problems. While most medical conditions that cause edema
(such as kidney disease or heart failure) are beyond your scope of practice as a
nutrition coach, there is one interesting case that is relevant: nutritional edema.
Nutritional edema
Starvation and malnutrition can cause edema, or water retention. As hunger
and famine have always been with us, humans have known this for thousands of
years.
In 700 BCE, for instance, the Greek poet Hesiod described the stark contrast
between lean faces and swollen hands of starving people. Originally known as
“dropsy”, edema appears anywhere there is hunger: famine, crop failures, malnutrition, and among people just barely surviving on meager, nutritionally limited
diets.
Orthorexia: Obsessiveness
about the quality of the food
being ingested, ensuring that
it’s the most healthy, organic, etc.
Sometimes it was called “war dropsy” to describe what happened to soldiers
and civilians whose food supplies were cut off. A report on the defeated French
army at Naples in 1528 described starving soldiers with “swollen legs and bloated
bellies.” A 1917 medical article describes the phenomena among POWs captured
by the Germans, who called it Kriegsoedem (war edema).
A post-WWI medical article from 1920 notes that “war dropsy” often goes
with “emaciation, muscular weakness, depression, anemia, and very frequently
gastro-intestinal disturbances.” While most of us are not living in war zones or
famine-blighted regions, we can recognize these symptoms in restrictive dieters,
people missing key food groups in their diets, and people with disordered eating.
In the 21st century, we typically call this nutritional edema. It can have many
causes. Here are a few.
Not enough protein
Kwashiorkor, or severe protein deficiency, is a common problem of childhood
malnutrition.
A Jamaican pediatrician who first described the phenomena in the 1930s suggested the name should come from a Ghanaian term: “the sickness the baby gets
when the new baby comes.” In other words, the malnutrition that results when
an older baby is weaned off nutrient-rich breast milk to accommodate a new arrival, and then must subsist on a high-carbohydrate diet without enough protein.
Nutrition: The Complete Guide
Water and Fluid Balance | 241
Kwashiorkor doesn’t just happen in poorer regions of the
globe. In the United States, there have been dozens of cases of well-meaning parents who have placed their children
on “special” diets, with disastrous results. (Mineral-deficient diets can have similar edematic effects.)
One of kwashiorkor’s most distinctive symptoms is a
distended belly.
Proteins dissolved in water create what is known as the
colloid osmotic pressure. This balances the osmotic pressure of dissolved electrolytes, and helps regulate fluid
movement and absorption. With no protein to balance
the osmotic gradient and pull water back into the bloodstream, fluids pool in tissues.
Body water regulation
Body water and electrolyte levels are regulated by the balance between water intake and water excretion through
the kidneys. Both thirst and kidney excretion are, in turn,
influenced by:
•
pituitary hormones such as ADH;
•
adrenal hormones such as aldosterone; and
•
concentrations of blood osmolytes (soluble substances that can affect osmosis, such as ions, proteins, or
other molecules).
Malabsorption
These mechanisms stimulate thirst when body water volume is low or solute concentrations are high. In addition,
they may slow down urinary excretion to conserve water.
Many malabsorption syndromes, such as Crohn’s
disease, IBD or celiac disease, can interfere with proper
nutrient absorption. This can result in edema.
They also stimulate urinary excretion (and decrease
thirst) when body water volume is high or solute concentrations are low.
Restrictive dieting
Generally, when we are healthy and these systems are
working well, we regulate our body fluids and electrolytes effectively.
The restrictive dieting of lifetime yo-yo dieters, severe
orthorexics, physique athletes such as bodybuilders,
people doing intermittent fasting, and other forms of
disordered eating can also create nutritional edema.
Antidiuretic hormone (ADH)
In some cases (for instance, physique athletes), protein
deficiency may not be the main problem.
Ever wonder why bars serve salty snacks? More salt
means more thirst, which means buying more drinks.
In others (for instance, extreme “raw” vegans), protein
deficiency may play a role.
Here’s how the process works.
What to do with nutritional edema
Many causes of nutritional edema are outside of your
scope of practice unless you are licensed or otherwise
certified to treat them.
However, if a client complains of water retention, puffiness, swollen ankles, etc., pay attention. At the very least,
you can:
•
help your client understand that chronic water retention may be a symptoms of a more serious problem;
and
•
suggest that your client discuss this (and any other
possibly related symptoms) with their doctor.
1. When blood levels of sodium go up (for instance,
after having a few handfuls of pretzels at your local
pub), this creates higher blood osmolarity. Our blood
becomes “salty.”
2. This triggers osmoreceptors in the hypothalamus,
which stimulate thirst while also stimulating the
release of ADH.
3. ADH reduces fluid output through the kidneys.
4. Thus, we bring in more fluid (because we’re thirsty)
but excrete less fluid (thanks to ADH’s effects on the
kidneys).
5. More fluid coming in + less fluid going out = less
salty blood. Body is happy.
ADH, also referred to as arginine vasopressin or AVP,
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Low water and/or high sweat
triggers the posterior
pituitary to produce ADH.
ADH
Aldosterone
High blood potassium,
low blood volume, and
low blood pressure
stimulate the adrenal
gland to secrete
aldosterone.
Kidney conserves
and reabsorbs water.
Figure 8.4 Mechanisms of body water conservation
is a powerful controller of water and salt levels in the
body. Anything that lowers body water or increases
relative sodium levels (such as sweating) can stimulate
ADH release.
Renin-angiotensin system
As ADH slows kidney flow, this activates the renin-angiotensin system.
First, the kidneys secrete renin. The prefix “ren” comes
from ren, the Latin word for “kidney.” This also gives us
words like “renal.” “Angio”, derived from the Greek word
for “vessel”, typically refers to the circulatory system.
(Note: Renin, with one n, should not be confused with
Nutrition: The Complete Guide
rennin, the enzyme in rennet, a substance derived from
cow stomachs that is used in the production of cheese.)
Then, the release of renin will eventually lead to the
release of angiotensin II, which constricts blood vessels
(aka vasoconstriction) and thus increases blood pressure.
Angiotensin II can also interact with the central nervous
system to stimulate thirst and to reduce fluid excretion.
Aldosterone, which is also part of the renin-angiotensin
system, is a hormone secreted by the cortex of the adrenal
glands (which sit atop the kidneys). Its job is to help the
body retain sodium by increasing how much sodium our
kidneys re-absorb. Since sodium pulls water in the direction it’s headed, aldosterone helps to conserve body water.
Water and Fluid Balance | 243
Aldosterone is released in response to:
•
low blood volume, and / or
•
low blood pressure, and / or
•
a high potassium concentration in extracellular fluid.
All of these signal that our body needs more fluid. Aldosterone is also generated in response to high levels of
angiotensin II. See Figure 8.4.
Should hypertensives eat less salt?
Because angiotensin II raises blood pressure in response
to high sodium concentrations, you may have heard
that people with high blood pressure should lower their
sodium intake. This is one possible method of keeping
angiotensin II under control.
Indeed, some people have speculated that high blood
pressure is exacerbated by the availability of processed
food, much of which is high in sodium.
Drugs are another method of lowering blood pressure.
One of the medications that lowers blood pressure does
so by inhibiting the formation of angiotensin II. Angiotensin II is formed from angiotensin I when angiotensin
converting enzyme (ACE) acts on it. Drugs known as
ACE inhibitors can thus prevent angiotensin II formation
by blocking the action of ACE that’s required to convert
angiotensin I to II.
Since angiotensin II helps to preserve water in the
body, including maintaining plasma volume, preventing the formation of angiotensin II reduces this fluid retention, getting rid of body water and plasma volume,
and thus reducing blood pressure.
Why don’t I have to pee as often in the middle of the night?
Like many hormones, aldosterone has a natural ebb and
flow. It’s pulsatile, which means it’s released in small
bursts.
Likewise, our blood pressure naturally goes down at
night, with circadian changes in the renin-angiontensin
system. Indeed, slow-wave sleep can actually predict
hypertension: The less deep sleep we get, the higher
our blood pressure will likely be during the day.
Aldosterone pulses also correlate with sleep, especially
deep sleep. As we sleep through the night, we drop in
and out of deeper sleep cycles. As we enter a deep sleep
cycle, we also release a pulse of aldosterone.
This helps ensure that our deep sleep periods don’t get
interrupted by having to go to the bathroom.
Shift workers sometimes note that they have to go to
the bathroom more often during a night shift. This is,
perhaps, because they aren’t getting their normal nocturnal aldosterone pulses.
If your evening involves some alcoholic drinks, you’ll
also probably notice a few runs to the bathroom. Alcohol briefly suppresses aldosterone. This means you’ll
urinate more for a while, then (if you haven’t replaced
your fluids) become dehydrated. Result: hangover.
We all know sleep is important. But because of its powerful effects on the renin-angiotensin and aldosterone
systems, getting Zs can also affect our fluid balance and
healthy blood pressure.
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Fluid and the menstrual cycle
As most women know from experience, menstrual
cycles (and pregnancy) can significantly affect fluid
balance.
In theory, this should mean that women lose water
when progesterone goes up. And in fact, this does happen in women who supplement extra progesterone.
Because they have the same chemical origin and similar
structures, our sex hormones interact with aldosterone,
and can often even act on aldosterone receptors. (This
includes many hormonal contraceptives and hormone
replacement.)
In contrast, when progesterone goes up endogenously
(i.e., is only secreted by women’s bodies, rather than
being supplemented exogenously), women’s bodies
may compensate with increased aldosterone. In other
words, since the body knows that progesterone will
be blocking aldosterone, it makes more aldosterone to
balance things out.
Aldosterone levels and progesterone levels go up during
the luteal phase of the menstrual cycle (the period after
ovulation, before menstruation begins).
Indeed, many women complain of feeling bloated or
puffy, or gaining weight, during this time as aldosterone
decreases urinary output (leading to fluid retention).
You may already have heard this from many of your
female clients or noticed this in yourself, if you’re female
and cycling — a premenstrual weigh-in is not always a
happy event.
The result, once again: Feeling sloshy, craving salt, failed
attempts to zip up jeans, and avoiding the bathroom
scale.
During their reproductive years, women are much less
likely than men to have high blood pressure, thanks to
the regulating and possibly protective effects of ovarian
hormones such as estradiol.
However, progesterone (which goes up after ovulation,
in the second half of the cycle) inhibits aldosterone
binding to the mineralocorticoid receptor.
But after menopause, these hormones go down and
renin activity goes up. Thus after menopause, women’s
hypertension risk is nearly the same as men’s. And older
women may also notice more water retention overall.
Macronutrients
Electrolytes
Dietary carbohydrate and protein also affect fluid
balance.
Electrolytes are minerals such as sodium, potassium,
chloride, calcium and magnesium that carry an electrical charge (positive or negative) when dissolved in water.
These charged ions conduct electrical currents that let
fluid pass through cellular membranes. Essentially,
they’re electrical transporters.
Carbohydrate
As we briefly mentioned, carbohydrate storage increases
water storage in the body. (Ever noticed that the word
“carbohydrate” contains the word “hydrate”?)
For every gram of stored carbohydrate (glycogen), we
also store 3-4 grams of water.
Thus, again:
Every process in our body depends on electrolytes. We
need them, and we need them in the proper balance. As
with energy balance or water balance, electrolyte balance
is about input versus output.
•
On higher-carbohydrate diets, we store more water.
We take in electrolytes in our food and drinks.
•
On lower-carbohydrate diets, we store less water.
We can lose electrolytes in our urine and sweat, but not
as much as we lose water. But if we sweat a lot, we lose
enough electrolytes for it to matter. Urinary excretion of
electrolytes depends on intake: The more electrolytes we
consume, the more we lose through urine.
We also store less water when we eat more protein,
because our body must remove urea, a byproduct of
protein / amino acid deamination. See Unit 3 for more
on deamination.
Nutrition: The Complete Guide
6
7
8
dark brown
pale gold
5
light brown
soft yellow
4
gold brown
3
dark gold
2
gold
1
colorless to
slightly yellowish
Water and Fluid Balance | 245
A urine chart such as this can
help you assess a client's
hydration status (level of
dehydration) in extreme
environments.
If the urine sample matches
#1, #2, or #3 on the chart,
they are well hydrated. If
their urine color is #7 or
darker, they are dehydrated
and should consume fluids.
Figure 8.5 Urine color and hydration status
Thus, again, if we are sweating a lot, we will need to
replace both fluid and electrolytes. (You will hopefully
remember that over-consuming fluid without electrolytes can throw off the fluid balance.) Yet here again, we
needn’t be overzealous.
Replenishing electrolytes for exercisers
Athletes and exercisers who need fluid and electrolyte
replacement can simply drink a diluted carbohydrate
drink that also contains electrolytes.
Taking in carbohydrates during and after exercise can:
•
improve how quickly fluid is absorbed;
•
enhance endurance;
•
increase blood glucose and glycogen synthesis;
•
lower the stress response and inflammatory damage
of training;
•
improve immunity;
•
enhance whole body hydration; and
•
improve muscle and liver glycogen synthesis.
However, this drink should be dilute, ideally less than
10% concentration. More concentrated solutions will not
only absorb slowly, they’ll likely cause GI upset. (Not
something you want during a hard training session or
competition!)
If appropriate, you can also add protein to carbohydrate-electrolyte drinks. This will do many of the same
things as a carbohydrate drink, with the added benefits of more muscle protein synthesis and less protein
breakdown.
Hydration strategies
Match the plan to the client
As a nutrition coach, you’ll see all different kinds of
clients.
You’ll have endurance athletes pushing their limits
outdoors in hot, dry climates and / or high altitudes.
You’ll also have beginners who have never done anything physically active, who start their exercise program
by walking slowly on an indoor treadmill for 5 minutes
per day. And, of course, you’ll probably have everyone in
between. So: Match the hydration plan to the client.
Remind the treadmill walker to have a glass of water
with their meals, and / or whenever they feel thirsty.
For the elite endurance athlete, you may want to calculate their hydration needs based on bodyweight, and
make sure they get carbohydrates, electrolytes, and
protein in all their recovery drinks.
Safe hydration and proper fluid-electrolyte balance is
important. In extreme cases, your client’s life could
depend on it. Thus, if you’re ever unsure about a hydration situation, or feel it’s outside your knowledge base
(for instance, IV-rehydrating a pro MMAer), refer out to
a specialist.
You can make an informed guess about someone’s
hydration status by using simple color charts like the one
in Figure 8.5.
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Factors affecting hydration types
General hydration requirements
The baseline
For moderate-intensity activity under 2 hours
and / or high-intensity activity under 1 hour
For normal people who aren’t exercising, and who are
spending their time in comfortably temperate environments: About 2 L (8 cups) of water per day along with
water-rich whole foods (such as fruits and vegetables)
should be enough.
When to consider sports drinks
Step 1:
Consume 0.5-1 liter (2-4 cups) of water during
activity.
Step 2:
Consume 0.5-1 liter (2-4 cups) of water after
workouts.
Step 3:
Consume 0.25-0.5 liter (1-2 cups) of water at
each meal.
For average people, plain water is just fine.
But in some situations, sports drinks that contain glucose and electrolytes can help exercisers replenish and
recover, including:
•
hot, dry, and / or high-altitude climates, which increase fluid needs and electrolyte losses;
•
repeated bouts of training (e.g., multiple daily training sessions or competition rounds);
•
endurance training;
•
high intensity training; and
•
professional / elite athletes (who train more and harder, and need more recovery).
Keep the big picture in mind
Next, we’ll give you some specific guidelines for particular
types of clients in particular situations.
Remember that most of these are higher-level strategies. Most beginner clients, or clients who struggle
with consistency, will not need these strategies. Nor
will they need this level of detail.
One easy and simple way to both remind your clients to
drink enough and to advertise your services is to get a
large refillable water bottle with your name or coaching
practice logo on it. As one of their regular habits, ask
them to fill up the bottle once or twice during the day,
then keep it near them. They’ll drink more, and remember you as well.
Or you can just start by asking your beginner clients
to drink a glass or two of water with each meal. Start
simply. You can always make things more complex
later. You want your clients to succeed immediately and
consistently.
Add-ons
For recreational exercisers who want a little extra recovery boost: Add 10-15 g of BCAAs to Step 1 or 2.
For clients who need to gain weight or who want to
gain a lot of muscle mass: Add a protein + carbohydrate
drink during workouts. The general formula: 30-45 g
carb + 15 g protein in 500 mL-600 mL water every hour
during training. (You don’t have to get it perfect, but
if the drink is too concentrated it can upset the stomach, and if it isn’t concentrated enough it won’t be as
effective).
For moderate-intensity activity lasting longer
than 2 hours and / or high-intensity activity
lasting longer than 1 hour
Step 1:
Consume 0.25-0.5 liters (1-2 cups) of water 3060 minutes before activity.
Step 2:
Consume 30-45 g carb + 15 g protein + electrolytes (sodium & potassium) in 600 mL water
every hour during activity.
Step 3:
Consume 30-45 g carb + 15 g protein +
electrolytes (sodium & potassium) in 600 mL
afterwards.
Step 4:
Consume 0.25-0.5 liters (1-2 cups) of water at
each meal.
Implementation tips
Most clients won’t need this type of strategy, which
applies mostly to:
•
clients who are training or competing in multiple
bouts (such as a day-long tournament); and
•
clients who are training relatively harder and / or
longer, such as triathletes and long-distance adventure racers.
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Water and Fluid Balance | 247
Advise them to sip, not chug. First, their GI tract will
thank them. Second, we can only absorb about 1.5 L (6
cups) of liquid per hour.
They don’t have to get the numbers perfect. They should
try to get close, though. Err on the side of more dilute.
If a hydration drink is too concentrated, it might cause
stomach upset.
You can find recipes to create your own formula for
these recovery drinks, or advise your clients to buy a
preformulated drink.
Endurance athletes who will be sweating a lot need more
electrolytes. This is one of the reasons many companies
have an “endurance” line of supplements.
get sick when trying to rehydrate, as their stressed GI
tract rejects the fluid, carbohydrates, and electrolytes.
The most successful water manipulation and weight
cutting practices use the physiology of fluid balance.
Athletes can drop water weight quickly and effectively
for competition by manipulating their fluid, carbohydrate, and sodium intakes.
The big picture
The general guidelines below give you a starting point,
which you can then customize to meet the needs of different athletes, different goals, and different bodies.
As you read through these guidelines, make sure you
understand why and how they might work.
Body water manipulation for
physique contests, weigh-ins, and
photo shoots
For instance: Why does drinking a lot of water for a
few days, then drinking much less, cause an athlete to
lose weight? What homeostatic mechanisms might be
operating here?
Bodybuilders, fitness athletes, models, and weightclassed athletes are masterful manipulators of fluid
balance in the body.
Also remember: This type of water manipulation is relatively safe… but not without risks. As we’ve seen, fluid
balance affects every process in the body. If you suggest
these protocols to clients, make sure to monitor them
closely and stop the process if any symptoms of fluid
imbalance become serious. No competition or fight is
worth serious physical damage.
For physique athletes, water manipulation creates the illusion of leanness plus muscularity. When water balance
is just right, paper-thin skin stretches across bulging
muscles.
Weight-classed athletes such as powerlifters or grapplers play with body size and strength. A heavier body
is a stronger, denser, and more muscular one. This puts
naturally lighter opponents at a disadvantage.
Thus, the trick here is to be as heavy as possible in real
life (known as “walking-around weight”) while weighing
in as light as possible for the few moments it takes to step
on a tournament’s weigh scale.
And many weight-classed athletes like to push their
boundaries. 10-15 lb is considered a relatively easy
weight cut. Many male athletes in particular are proud
of their ability to “make weight” by dropping 20 or even
30 lb of water rapidly.
Unfortunately, of course, there are costs to this. Some
water manipulation and weight cutting practices are
dangerous, even potentially deadly. Even if an athlete
survives a drastic cut, they may then perform poorly. Or
Sex differences
A quick note: You may see sex differences in water manipulation and weight cutting.
•
Women’s normal hormonal changes may cause
them to retain or release water at different times in
their cycles.
•
Women tend to have more body fat than men, which
does not hold as much water as muscle. This, along
with an average smaller body size, will usually mean
that the average woman cannot cut as much weight
as the average man can.
•
Women’s hormonal systems are much more sensitive to disrupted energy balance than men’s. Weight
cutting can fall into this. Repeated weight cutting
and / or water manipulation may cause hormonal
problems for women.
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Physique competitors
8 days before the contest
1. Double your water intake. For example, if you’re
drinking 2 L (8 cups) per day, start drinking 4 L (16
cups) per day. Drinking a lot more water means you’ll
be urinating a lot more. For now, this will be matched
by the increased water intake, so net water balance
remains fairly constant.
2. Do this for two days.
6 days before the contest
1. Double your water intake again. Now you’ll drink
four times your normal water intake. If you started
with 2 L (8 cups) per day, you’ll now drink 8 L (32
cups). Again, you’re telling your body to get rid of
water.
2. Lower your carbohydrate intake. For most people, this
means eating around 50-100 g of carbohydrate per
day. By doing this, you’ll begin to lose muscle glycogen as well as 3-4 g of water per gram of glycogen lost.
3. Increase sodium intake: Add lots of salt to meals and
/ or even small amounts of salt to your drinking water. This will tell your system to start actively excreting lots of both salt and water.
4. Do this for four days, until you’re two days out from
the contest.
3. Finally, lower your sodium intake as much as you
can. Cut all extra salt out of your diet and avoid foods
higher in sodium. Just like with the water manipulation above, the body has gotten used to excreting a
lot of sodium. It will keep doing this for a little while,
even when salt intake drops. For a brief period, more
sodium will leave the body than enter it; as it goes,
this sodium will draw additional water from the body.
4. Continue until one day out from the contest (i.e.,
about 24 hours).
1 day before the contest
1. Drop your water intake again by 50%. For example, if
you’re now drinking 2 L (8 cups) per day, drop down
to 1 L (4 cups) per day. This second drop will ensure
that additional water is lost from the body as excretion rates should still be high.
2. Keep your increased carbohydrate intake the same.
This will keep filling up muscle glycogen and
drawing any remaining extracellular fluid into your
intracellular spaces.
3. Keep your sodium low. This will continue to draw
sodium and additional extracellular fluid out of the
body.
4. Keep doing this for about 24 hours, until the contest
day.
Contest day
2 days before the contest
1. Avoid water until the contest.
1. Drop your water intake down fourfold. For example,
if you’re now taking in 8 L (32 cups) per day, drop
back to 2 L (8 cups). Since your body’s gotten used to
excreting a lot of fluid, and adjustments take a few
days to catch up, this sudden drop means a negative water balance. In essence, you’ll be temporarily
dehydrating the body by forcing it to lose more water
than it takes in.
2. Keep carbohydrate intake high.
2. Increase your carbohydrate intake. For most people,
this means eating two to four times what they’ve
been eating for the last few days. So, if you’ve been
eating 50-100 g of carbohydrate per day, increase
your intake up to 200-400 g. By doing this, your body
will supercompensate muscle glycogen stores, filling
out the muscles with stored glycogen as well as drawing some water into the intracellular spaces. This
means that you’ll look more muscular and leaner at
the same time.
Nutrition: The Complete Guide
3. Keep sodium intake low.
4. Be sure to rehydrate carefully after your event. You
may want to have an electrolyte solution close at
hand.
Weight-classed athletes
Weight-classed athletes, such as strength athletes, wrestlers, and / or fighters, often weigh in and compete on
different days.
Below is an example program for an athlete, such as an
MMA athlete, who needs to weigh-in 24 hours before
their competition.
Water and Fluid Balance | 249
8 days before the contest
3 days before the contest
1. Double your water intake. For example, if you’re
drinking 2 L (8 cups) per day, start drinking 4 L (16
cups) per day. Drinking a lot more water means you’ll
be urinating a lot more. For now, this will be matched
by the increased water intake, so net water balance
remains fairly constant.
1. Cut your water intake in half again. So, if you started
with 2 L (8 cups) per day, you’d be down to 0.5 L (2
cups) now.
2. Increase sodium intake: Add lots of salt to meals and
/ or even small amounts of salt to your drinking water. This will tell your system to start actively excreting lots of both salt and water.
3. Do this for two days.
6 days before the contest
1. Cut your water intake back to normal. So, if you
started with 2 L (8 cups) per day, go back to 2 L now.
2. Lower your carbohydrate intake. For most people, this
means eating around 50-100 g of carbohydrate per day.
By doing this, you’ll begin to lose muscle glycogen as
well as 3-4 g of water per gram of glycogen lost.
3. Decrease sodium intake. Cut all extra salt out of your
diet and avoid foods higher in sodium. Just like with
the water manipulation above, the body has gotten
used to excreting a lot of sodium. It will keep doing
this for a little while, even when salt intake drops. For
a brief period, more sodium will leave the body than
enter it; as it goes, this sodium will draw additional
water from the body.
4. Do this for about 24 hours, until five days out from
the competition.
5 days before the contest
1. Cut your water intake in half again. So, if you started
with 2 L (8 cups) per day, you’d be down to 1 L (4
cups) now.
2. Keep carbohydrate intake low.
3. Keep sodium intake low.
4. Do a short sauna session (15-20 minutes) in the
evening.
5. Do this for one day.
2 days before the contest
1. Cut your water intake in half again. So, if you started
with 2 L (8 cups) per day, you’d be down to 0.25 L (1
cup) now.
2. Keep carbohydrate intake low.
3. Keep sodium intake low.
4. Do two short sauna sessions (15-20 minutes) in the
morning and evening.
5. Do this for one day.
Until weigh-in
1. No water until after weigh-in.
2. Keep carbohydrate intake low.
3. Keep sodium intake low.
4. Eat 1-2 very small meals until weigh-in.
5. Use a sauna as needed to make weight. (Be sure to
have someone keep an eye on you during this time, as
you’re in the danger zone for fluid balance.)
After weigh-in
2. Keep carbohydrate intake low.
1. Start re-hydrating immediately.
3. Keep sodium intake low.
2. Keep it as gradual as possible to avoid GI upset.
Aim for no more than 1.5 L (6 cups) of fluid rehydration per hour (using carbohydrate, protein, and
electrolytes).
4. Do this for 2 days, until 3 days out from the
competition.
3. Continue until bodyweight is back up to normal.
International Sports Sciences Association
250 | Unit 8
For weight-classed athletes who might have less time
between weigh-in and competition (e.g., with a morning weigh-in combined with an afternoon competition,
or even a ringside weigh-in where they weigh in then
immediately compete) we generally recommend avoiding extreme water manipulation. This means making
sure your “walking around weight” is very close to your
“competition weight.”
Our experiments have shown that athletes who deplete
more than 5-10% of their body weight can lose tremendous amounts of muscle strength, anaerobic power, and
endurance. And while a full day of rehydration generally
gets them with a few percentage points of their original
performance capacity, ringside weigh-ins don’t leave
enough time for this sort of recovery.
Case study
Perplexed. That’s how we felt after working with a patient admitted to the medical center.
He was diagnosed with hyponatremia and muscle wasting. But standard medical tests and labs showed nothing unusual. Where did his hyponatremia come from?
Good coaches are curious and look for clues. So we
asked more questions about his nutrition. What was
he eating? What supplements or medications was he
taking? What was he drinking? And so on.
After about 20 minutes of discussion, he mentioned that
he consumed an occasional alcoholic beverage.
Aha.
We asked him to define “occasional.”
Well, “occasional” wasn’t so occasional. He was drinking
a six-pack of beer every night. That’s about 2 L of beer…
every night.
And thus, a potential cause of his mystery condition
was revealed: severe hyponatremia secondary to beer
potomania, or the regular consumption of high volumes
of beer.
This situation was created by two factors.
First, most people who drink a lot regularly usually have
Nutrition: The Complete Guide
lousy diets. It’s pretty rare to find a dedicated drinker
who alternates vodka coolers with kale smoothies. This
means they aren’t getting a lot of vitamins, minerals,
protein, and / or valuable electrolytes.
Second, beer (and most alcohol) is a poor source of
electrolytes, particularly sodium.
Low salt intake and low protein intake, combined with
about 2 L of daily liquid from the beer equaled hyponatremia.
We immediately treated him with an IV solution of isotonic sodium chloride. This raised his sodium concentrations to normal levels and triggered the normal, healthy
clearance of both water and solute.
However, that was a temporary fix. To prevent this in the
future, we suggested he scale back on the beer intake
while increasing his intake of healthy foods.
Fortunately, he took our advice.
But let’s say he didn’t. Luckily, there’s another easy (if
imperfect) fix: salty snacks. At the very least, the added
sodium would help regulate the fluids. And if he chose
foods like beef jerky or roasted / salted edamame, he’d
get a little protein in there too. It’s not perfect… but at
least it’ll keep him off the IV bag.
Water and Fluid Balance | 251
Summary
We need water to live. All our cells soak in it, though
some tissues (such as muscle) have higher water contents
than others (such as body fat).
Water is a solvent, catalyst, lubricant, temperature regulator, mineral source and regulator of growth.
Fluid balance is the relationship between fluid input
(from foods and drinks) and output (from processes like
respiration, sweating, and excretion).
Electrolytes are minerals that, when dissolved in water,
become electrically charged. Like fluid, we get them
from foods and drinks, and lose them as part of normal
physiological processes.
Normally, our body tightly regulates body water and
electrolytes with complex, interconnected systems of
sensors and hormones. We need proper fluid balance
and electrolyte balance to be healthy.
However, fluids can get out of balance. As a nutrition coach, you will typically see three types of fluid
imbalance:
•
dehydration (too much water out; too little water in)
•
hyponatremia (too much water; not enough sodium)
•
edema (fluid building up where it shouldn’t)
While these can have different causes, and many are
outside your scope of practice, you can understand the
basic principle behind them: Somehow, fluid input is out
of sync with fluid output; and / or fluid is in the wrong
place in the wrong amounts.
Edema can be a sign of malnutrition and / or restrictive
dieting.
For most average people under normal conditions,
drinking about 2 L (8 cups) of water per day along with
water intake from food is enough.
Athletes and recreational exercisers should be careful
to replace fluids lost through respiration and sweating,
especially in hot, dry, and / or high-altitude conditions,
and / or when activity lasts a long time.
Normal changes in women’s hormones with menstruation, pregnancy, and / or menopause can significantly
affect their fluid balance.
You can use the principles of fluid and electrolyte balance to help clients such as physique athletes or weightclassed athletes.
International Sports Sciences Association
SECTION TWO
NUTRITIONAL PRACTICE
9
What It Means To Be a Good Coach, p253
10
The ISSA Nutrition Coaching Methodology , p270
11
Nutritional Levels, p300
12
Working with Level 1 Clients, p317
13
Working with Level 2 Clients, p360
14
Working with Level 3 Clients, p398
15
Special Scenarios, p431
16
Business 101 for Fitness and Nutrition Pros, p479
17
Continuing Ed for the Coach, p493
UNIT 9
What It Means To Be a Good Coach
254 | Unit 9
Unit Outline
1.
Why talk about coaching?
5.
Mental skills
2.
What’s your story?
6.
Communication skills
3.
What do great coaches do?
7.
Case study
4.
Understanding clients
8.
Summary
Objectives
In this unit, we’ll give you the “big picture” of coaching.
•
what skills are part of coaching
You’ll start to learn:
•
how a coach shares information with clients
•
how a coach thinks and makes decisions
•
what a coach is
•
what a coach does
Why talk about coaching?
Nutrition coaching isn’t just about nutrition.
In fact, the more you work with clients, the more you’ll
realize: Helping people change food behaviors and
choices is almost never just about the food.
Because coaching is about people. About how they
think. How they feel. How they live. Why they act the
way they do.
Coaching is also about being a working professional.
Yes, coaching is a calling for many people. It’s also a job.
Maybe even a lifelong career.
That means you have to show up every day in the real
world, with real people, to deal with real situations. And
real struggles with change.
Thus, effective nutrition coaching has a lot more to do
with psychology and interpersonal skills than knowing
the specifics of macronutrients.
What kinds of things do you need to
know?
Here’s a brief list of the kinds of stuff you’ll need to consider in your coaching.
•
What enables people to make changes?
•
Why do people resist change, or have mixed feelings
about it?
•
What do people think they need… and what do they
really need? (And why are these two things often so
different?)
•
What stories are your clients telling themselves about
who they are as people, and how does that affect
their choices?
•
How do you know what level of difficulty and complexity is appropriate for each client?
•
How do you properly assess clients and track their
progress?
Sure, nutrition coaches need to know about nutrition.
You should probably know, for instance, that a green
vegetable is healthier than cotton candy.
•
How can you help people set realistic goals?
•
How can you help people understand the trade-offs
But there’s a lot more to nutrition coaching than carb
grams and sodium.
•
Nutrition: The Complete Guide
required to get to those goals?
How can you figure out what’s standing in the way of
those goals?
What It Means To Be a Good Coach | 255
•
How can you work with special populations, such as athletes, older clients, or
clients with food sensitivities?
•
If we can’t make people change, how can we at least create the conditions that
will support change?
Over the coming units, we’ll look at all of these. First, let’s start with Ground
Zero of coaching: You.
What’s your story?
Why do you want to be a coach? You likely have many reasons.
Maybe you want to help other people. That’s a great motivation.
But here’s a funny paradox about helping other people: You help them best when
you know more about yourself.
This includes things like:
•
what you think is important, and what you value most;
•
what you prioritize;
•
your unique coaching style;
•
your life experiences;
•
how you learn and communicate;
•
what work environment suits you best; and
•
your coaching “super powers” (Yes! You have them.)
In this unit, we’ll look at some of what you bring to the table as a coach. Knowing this is essential.
coaching super powers:
Coaching skills you are
particularly good at, or coaching
skills that come more naturally
to you
For instance:
•
When you have a clear goal, you can stay focused on it.
•
When you recognize your own patterns and tendencies, you can take advantage of your known and proven “success strategies.” You can also avoid or
defuse situations that might trigger you into unproductive habits.
•
When you know why you’re doing something, you stick to it when times get
tough. (This may be a good time to mention that it’s pretty hard to become a
millionaire doing nutrition coaching.)
•
When you know exactly what you hope to get out of coaching, and how you
prefer to work, you can choose the workplace and the coaching support team
that you think will fit you best.
•
When you know what “fills your tank” and keeps you going, you can build a
career for life, rather than burning out or looking for short-term gains at the
expense of long-term, sustainable growth.
This is an opportunity to get to know yourself as a person, as a coach, and as a
professional working in the field of nutrition.
The more you know YOU, the better your coaching will be.
International Sports Sciences Association
256 | Unit 9
to whip up tasty healthy snacks in 10 minutes, to how to
rehydrate a weight-cutting athlete.
What is a coach?
“Coaching” others in nutrition can mean many different
things. You might work with all kinds of people, in all
kinds of settings, helping them do all kinds of stuff.
But when you step back and look at the big picture,
coaches have four key tasks:
1.
Define clearly what to do, and why.
So let’s think about the general job description of a
“coach.”
2.
Develop a plan to do that thing (in collaboration
with the client).
It can include:
3.
Help the client become able to do that thing.
4.
Build relationships that make this possible.
•
teaching
•
directing
•
knowing information
•
helping
•
knowing how to do things
•
planning
•
communicating
•
problem-solving
•
learning
•
troubleshooting
•
analyzing
•
brainstorming
•
motivating
•
guiding
Some of what coaches do is cognitive, like planning and
reasoning. Some of it is emotional, like empathizing or
building relationships. Some is plain old “gut feeling”
and instinct.
It’s a harmonious blend of science and art.
Coaches give clients information, perspective, tools, and
strategies. Coaches can push when a client has become
too comfortable. Or pull back when a client has been
pushing too hard.
Coaches are not best friends, drill sergeants, or
all-knowing gurus. They’re more like facilitators, navigators, or guides.
Indeed, one of our favorite definitions of a coach is:
A coach is like a tour guide to a place where you already
live.
In other words, a coach can help a client explore their own
potential and resources — potential and resources the
client already has, but doesn’t recognize or trust. And a
coach can help clients translate knowledge into action.
The four jobs of coaching
As you might guess, a coach’s job can involve a wide
range of abilities, skills, and daily-life tasks. Nutrition
coaches in particular need all kinds of stuff in their
toolbox, ranging from how to feed picky eaters, to how
Nutrition: The Complete Guide
In the coming units we’ll help you start to develop these
four key areas.
For now, let’s start with the “why” of coaching.
Why coach?
Whether it’s a client’s nutrition habit or your own career
choices, it’s important to understand why you’re doing
something. As much as possible, your coaching decisions
should be deliberate and purpose-driven.
Of course, you won’t always know why you’re doing
something. Nor will your clients.
So here’s a little thought exercise: The 5 Whys.
The idea is that you ask a “why” question, like:
Why do you want to be a nutrition coach?
You answer that question as best you can. For instance,
you might answer:
I want to help people.
Then, you ask “why” again. Like this:
Why is helping people important to me?
You answer that question as best you can. Maybe you
might say:
I believe that helping people is an essential value.
Then, you ask “why” again, like this:
But why is helping people an essential value for me?
And you answer that question.
Well, because...
What It Means To Be a Good Coach | 257
And so on, five times in total. (Or as many times you as
want.)
•
for a role that challenges you and helps you keep
Each “why” builds on the previous answer.
By the time you’ve gotten to the fifth “why”, you should
have a pretty good idea of some of your core values and
motivators.
After all, you didn’t just put on a blindfold and point to a
random list of careers, winding up on “nutrition coach.”
Something happened in your life that made you want to
coach other people in nutrition.
If possible, figure out what that reason is. Because when
you can harness this reason, you’ll be able to come back
to it when business finances are tight, when you have a
5 AM client, and / or when you’re feeling symptoms of
burnout.
Or maybe right now you don’t have a strong “why” for
your coaching. That’s okay too. And that’s useful to
know. That can also help you make career decisions.
For instance:
•
If nutrition coaching is a deep passion for you, you
might decide to take a more difficult but more personally rewarding coaching job.
•
If nutrition coaching is just a way to pay the bills, you
might decide to take a position that’s less personally
rewarding, but more steady and financially secure.
Either way, the more you know, the stronger your strategic position can be.
Your coaching identity
Identity is who we think we are. Who we want to be.
And who we want others to see us as. It’s almost like
we’re characters in a story.
Our values and priorities — what we think is truly
important, and put first — flow from our identity.
For instance:
•
If part of your identity is “yoga instructor”, you may
think it’s important to offer clients a calm, restful
space.
•
If part of your identity is as a parent, you might make
certain decisions about work hours or traveling.
If part of your identity is as an athlete, you might look
pushing your own limits.
Now, notice we say “part of your identity.” Because we
are all a collection of “identities”, plural. For instance,
the same person can be:
•
a husband
•
a mountain biker
•
a father
•
someone with a knee injury
•
a son
•
a lover of Scrabble
•
a brother
•
a nutrition coach
And in fact, all of these parts of yourself can come in
handy in nutrition coaching.
You never know when a teenage athlete may walk
through your door… and need some wise-dad-style insight. Or when a mountain biker might ask for trail tips.
Or when you might need to spell out “GLYCOGEN” for
an epic Scrabble win.
So don’t limit yourself. And don’t feel like you can only
be a “nutrition nut” to be a good coach. Instead, think
about all the things you bring to nutrition coaching as
a complete human being with all kinds of interests, life
skills and experiences.
Your sense of identity can also shape who you choose to
work with.
For instance, think about what kinds of clients you connect with the best.
If part of your identity is being a competitive “go-getter”,
you might seek out high-performance clients who challenge you and themselves.
If part of your identity is being older and wiser, you
might want to mentor younger clients… or work with
other older people who are on the same wavelength.
If part of your identity is as a caregiver, you might seek out
vulnerable clients who need a lot of love and compassion,
such as obese clients considering bariatric surgery.
You might already have a strong identity as a nutrition coach. You might even have a niche market (e.g.,
bodybuilders, CrossFitters, vegetarian eaters, endurance
athletes). Or maybe this is a second or third career for
you and your identity has been deeply rooted in accounting or parenting.
International Sports Sciences Association
258 | Unit 9
Although there are skills that all coaches should have
(such as communicating clearly), there is no “right”
identity to have as a coach.
All kinds of people can coach effectively.
The trick is to know who YOU are, what YOU need,
and where you fit best.
What really matters as a coach?
Now, maybe you can answer those easily. Most folks
can’t. At least not right away.
So let’s break it down into something more practical.
How do you think different coaches would handle these
coaching situations?
To get a better sense of what your coaching identity is,
try a little thought exercise.
My client keeps over-eating. I’m the type of coach
who will approach it like this… because…
What kind of person are you?
Another kind of coach might… because…
Grab a pen and paper and write out as many answers as
possible to the following:
My client is late for each appointment. I’m the
type of coach who will approach it like this…
because…
“I’m the kind of person who _____.”
Another kind of coach might… because…
“I want to be the kind of person who ____.”
“I would never be the kind of person who
____.”
My client is following along with everything I’ve
outlined for them. I’m the type of coach who will
praise them like this... because…
“People who know and love me would say I’m
the kind of person who ____.”
Another kind of coach might… because…
“If I were a movie character, I’d be ____.”
No right responses here. Just play around and see what
pops for you as you brainstorm.
Then go back and change “person” to “coach.” For
instance:
“I’m the kind of coach who _____.”
“I want to be the kind of coach who ____.”
And so on. Again, no right answers. Simply see where
your pen and paper take you.
(For fun, check your answers with a friend or family
members. Ask them how they think you’d fill in those
blanks.)
What do you value?
The identity game isn’t just a pointless existential exercise. Again, our values and priorities flow from our
identity. And our values and priorities shape what we do
in coaching.
The “because” part here tells you about your values and
priorities. There’s a reason you choose to do what you do.
Your identities, values, and priorities are like your “inner
compass” that helps direct you and navigate through
life’s tricky situations. If you’re business-minded, you
might also think of your identities, values, and priorities
as your personal “brand.”
When you know who you are, what you stand for, what’s
most important, and what you have to offer coaching,
you don’t wonder and worry about doing a good job.
You can feel when you’re on track and aligned with what
truly matters to you. And you can see it in strong client
relationships that get results.
Of course, this takes time to figure out. Which is why
you’re here.
•
(such as a small boutique gym, a large chain, or
self-employment).
•
•
Who do you want to be as a coach?
•
Nutrition: The Complete Guide
You might have to try different kinds of clients (such
as endurance athletes or seniors).
For instance, consider the following Big Questions:
What is “right” as a coach?
You might have to try different work situations
You might have to try different coaching styles.
You might have to ask yourself, “What the heck am I
doing here, anyway?”
What It Means To Be a Good Coach | 259
That’s okay. Keep experimenting until you find what
matches who YOU are as a unique individual. And then
consider how you can apply that to working with clients
during a coaching career.
You don’t have to figure out any of this now. Just think
about it a little bit. This process of becoming a better
coach is a lifelong journey.
Congratulations: You’ve already taken the first few steps.
What do great coaches do?
Take a moment and think of the most awesome teacher,
professor, instructor, or coach you’ve ever had.
•
What was that person like?
•
What did they do?
•
How did they do it?
•
What made working with them such a great
experience?
There are lots of ways to be a great educator, trainer,
and coach, but generally they all have some things in
common.
In this section, we’ll show you some of those things, and
suggest how you can put them into practice for yourself… so that maybe someone will remember you as the
most awesome coach they ever had.
(If after you’re done this program, you want to learn
more about great coaching, check out our Level 2
Master Class. It’s the year-long nutrition coaching
mentorship we use to train our own in-house super
coaches. Yep, we’re finally making it available for Level
1 students and graduates too.)
Table 9.1 The principles of great coaching
1
Principle
Description
What it might look like
Unconditional
positive regard
This is a fancy way of saying you
treat all clients with respect and
compassion. You see their potential and value. Even though you’re
helping them change, you accept
them as they are.
Smile and say hello to every single person that comes
into your gym.
Treat klutzy adolescent or unsure beginners with the
same professional courtesy as you would treat elite
athletes.
Make everyone feel valued and welcome.
2
Client-centeredness
and humility
Helping the client meet their
goals, not yours.
Looking for what’s important and
meaningful to them.
Being a guide, not a guru.
3
Observation
Looking, listening and learning.
Paying attention to cues and all
information.
Being curious.
Ask your client: “Tell me about what’s most important to you here. What are your goals? What’s a priority for you to do first? How would you like me to work
with you and help you?”
When working with a client one on one, give them
your full attention. Don’t talk on your cell phone or
send emails or texts. Make them feel like they’re the
most important thing in the world right now.
Watch your client’s non-verbal cues and body
language.
Listen to them carefully.
Look at their behaviors.
Notice their tendencies and patterns.
4
Assessment and
information
gathering
Learning as much about your
clients as possible.
Trying to get a big picture.
Collecting data in different forms.
Ask questions.
Learn about clients’ lives, and what they’re doing.
(You obviously don’t have to know every detail, but
try to get a broad understanding.)
Use many types of input: assessment forms, lab work,
body measurements (if appropriate), photos, consistency checklists, journals, etc.
Keep careful records.
International Sports Sciences Association
260 | Unit 9
Table 9.1 The principles of great coaching
5
Principle
Description
What it might look like
Understanding
As much as possible, you understanding what makes your clients
tick.
You are curious about each of your clients.
Grasping their motivations, limiting factors, and worldviews.
Seeing their starting points and
how far they’ve come.
You “get” them.
6
Monitoring and
measuring
Deciding what counts as “progress” and how to measure it.
Then measuring it, consistently, looking for change and
improvement.
When you chat with them, ask questions to help
explore their sense of identity, values, and priorities,
such as, “Given X or Y, which one matters most to
you right now? Why?”
Explore their motivations: “What’s driving this? Why
does this goal feel urgent or important for you right
now?”
Collaborate with your client on what they would consider “progress” (e.g., weight loss, better blood work,
better recovery from training).
Then, periodically, collect data on those progress
indicators and see what has changed.
Have a regular schedule and system for “check-ins.”
7
Solution- and
strengths-focused
mindset
Looking for what is going right,
and where your client is strongest. Then you want to do more
of the good stuff.
Not focusing on “flaws” or “weaknesses.” Instead, you play to each
client’s strengths and assume
all problems have some kind of
solution… which your client has
probably already tried without
realizing it.
8
9
10
Skill building
Appropriate
progression
Appropriate
regression
Point out every success and victory a client has, no
matter how small or silly.
Look for how a client may already have tried to solve
their problems (even if imperfectly), then just building on what already works.
Teaching clients how to do
the stuff they need to do,
consistently.
Show clients how to book food prep or exercise
sessions as appointments in their calendar, and set
reminders.
Breaking complex tasks down into
smaller, simpler pieces, so clients
can learn and practice without
getting overwhelmed.
Show clients how to grocery shop effectively and
efficiently.
Keeping the client in their optimal
“growth zone.”
Introduce a new task that is relatively easy. When the
client gets it, you make it a little harder. Repeat.
Over time, continuing to challenge the client appropriately —
enough to keep them engaged,
improving, and pushing their
boundaries a little, but not so
much that it’s overwhelming or
damaging.
Monitor closely and know your clients well enough
to understand where each person’s optimal “zone of
challenge” lies.
Scaling back where necessary.
If a client can’t do a new habit consistently, make the
habit easier to execute (e.g., do 10 minutes of daily
exercise instead of 20).
Understanding when you need to
make things easier.
Focusing on “what is”, rather than
“what should be.”
Nutrition: The Complete Guide
Reframe a client’s mindset (for example, from “I’m a
busy parent” to “I can be a healthy role model for my
kids”).
Noticing if clients are tired, stressed, overwhelmed or
burned out, and giving them a smaller task (or some
active recovery) while their attention and energy is
elsewhere.
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Table 9.1 The principles of great coaching
11
12
Principle
Description
What it might look like
Analysis and insight
Looking for patterns and relationships in what your client is
thinking, feeling, and doing.
Looking at a food journal to see that most over-eating
happens in the evenings.
Deciding what to do next based
on the data you’ve collected.
After taking client measurements and tracking progress in the gym, you decide that the current nutrition
program may need some adjustment.
Outcome-based
decision making
As much as possible, making
choices based on known evidence, rather than speculation or
what you think “should” happen.
13
Collaboration
Building a strong support team.
Having a solid network to whom
you can refer (e.g., doctors, physiotherapists, counselors).
Treating other coaches as colleagues and potential collaborators, rather than as competition.
14
Rewarding
behaviors, not
outcomes”
Noticing that food intolerance symptoms occur after
eating a certain food.
After implementing a new habit and tracking consistency, you notice that your client has successfully
done this habit 95% of the time, and loves doing it.
Although you were thinking about a different habit
for the next step, you change course: Further refine
and improve this proven success habit.
Leave your brochures at a local physiotherapy clinic
or doctor’s office. Ask them to refer clients for you,
and you can refer clients back to them.
Be a good team member. Play well with others. Be
courteous, professional, and interested in the work
that other coaches and practitioners are doing.
Improving your client’s mastery
of process, skills, and consistency. The results will take care of
themselves.
Ask your clients: “What would make it easier for you
to do Habit X consistently? If we look at all the steps it
takes to get to doing Habit X, where do you need the
most help?”
Success comes from what we do,
over and over and over.
High-five your clients for eating 2 servings of vegetables every day this past week. Then see if they can
try 3 servings. Look at what they might need to do in
order to make that possible.
With more experienced clients, seek mastery and
consistency. Whatever they’re doing, help them do it
better, more often.
When you praise progress, praise hard work, effort,
determination, and consistency. “You lost 5 lb over
the last 2 weeks. You can see how working on that
‘eating slowly’ habit really makes a big difference.
Congratulations on sticking to that habit; it’s a tough
one… but it paid off.”
15
Lifelong learning
Committing to a practice of
lifetime self-development and education. Looking for information,
ideas, and insight everywhere.
Read books.
Listen to podcasts.
Make PubMed and Google Scholar your friends.
Talk to people in the field whom you admire.
Go to professional conferences.
Take continuing education or professional certification courses.
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Table 9.1 The principles of great coaching
16
Principle
Description
What it might look like
Practice what you
preach
Speaking, acting and working
with integrity.
If you tell clients to get more sleep, go to bed on time
yourself. If you tell clients to eat their vegetables, put
some green leafy stuff in your own mouth too. If you
tell clients to get active, you’d better be lacing up
those sneakers regularly too.
If you give a client something
to do, you should have at least
tried it yourself. Take your own
medicine.
Block time off each day to stay active, make nutritious
food choices, and do other healthy behaviors, even if
it means taking fewer clients at first.
Prioritizing your own fitness, nutrition, and health even over that
of your clients.
17
Communication
Get your own coach. This helps you experience what
your clients experience, and helps you stay on track.
Being able to communicate effectively in various formats, whether
in writing or in conversation.
Expressing yourself clearly, accurately and respectfully.
18
Humor
Write simple, clear, professional-looking emails. Spell
words correctly.
Be polite, courteous, and enunciate clearly. Make eye
contact.
When explaining things, use plain language and
everyday concepts rather than technical language
(unless you’re talking to other experts). Say “get in
shape” rather than “body recomposition.”
Having a sense of humor. You’ll
need it.
Laugh. Joke.
Celebrate successes joyfully.1
Making coaching fun. It’s not
supposed to be serious.
1. Mark Fisher Fitness in New York has made a brand out of silly, fun stuff like ninjas, glitter, goofy dancing, and unicorn
outfits. Their tagline is “Ridiculous Humans. Serious Fitness.” Check out markfisherfitness.com.”
Understanding clients
If you look at the table above, you’ll see that good coaches do a lot of listening, learning, observing, and careful
analysis.
To help your clients succeed, you need to understand
them as individuals. Each person is coming to you with:
•
different life experiences;
•
different needs and wants;
•
different personalities;
•
different problem-solving abilities; and
•
different attitudes about change and trying new
things.
In upcoming units, we’ll look at three different levels of
clients. Each client can be sorted into these three nutritional levels based on:
•
what they want and need;
•
what they know;
Nutrition: The Complete Guide
•
what they can do; and perhaps most importantly
•
what they can do consistently.
And of course, just like coaches, clients will have
different:
•
identities;
•
priorities
•
values;
•
goals
Thus each person will need a different coaching style.
This can change from client to client, or even for the
same client on different days. For instance, the day your
client shows up after their favorite pet goldfish dies is
probably not the day to get on their case about why they
aren’t eating their vegetables, even if normally that client
loves a challenge and being pushed.
Luckily, you don’t have to come up with a completely
new approach each time.
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Along with three nutritional levels (which we’ll look at
in an upcoming unit), most people’s coaching needs can
be sorted into four general categories depending on two
criteria: motivation and skill, as Table 9.2 shows.
As you work with your clients, think about how to filter
and prioritize.
•
•
What level of motivation do they have?
•
What level of skill do they have?
While each client is a unique individual, there will also
be common themes in their experiences, and in your
approach.
What nutritional level are they?
Table 9.2 Four types of clients and how to approach them
Client type
Coaching
style
Description
High-motivation,
high-skill
Delegate
High-motivation, high-skill clients are typically people who are good at everything and
motivated to get better.
Keep these clients constantly involved and in tune with your process by making them
active drivers rather than passive passengers. For example, with this type of client you
should give them assignments and research to do on their own. You should explain to
them that the truest measure of the most successful clients is their ability to learn, understand, and become sensitive to what works best for them.
Offer ideas and generalized concepts that you want this client to think about or research,
or give them a problem to solve. Let them know that during the next session, you want
to have a spirited conversation with them about their findings. Follow up by having these
discussions.
Low-motivation,
high-skill
Inspire
To be good at something but lose zeal for it is often the result of overwhelming internal or
external pressure. These characteristics describe the low-motivation, high-skill client.
Clients with this temperament do not respond well to overly critical feedback or overly
hyped rhetoric. To coach this type of client, you must find the glimmers of wisdom that
inspire them to reclaim their drive for improvement.
Coaching this type of individual isn’t easy, and common coaching styles just don’t work.
To the low-motivation, high-skill client, “rah, rah” strategies and training or nutrition
strategy pitches sound like more work that they don’t have the time or energy for.
You will need to take the pressure off and find ways to ease them back into the coaching
process through subtle inspiration.
High-motivation,
low-skill
Guide
“More enthusiasm than skill” describes this type of client, who often suffers from too
much motivation rather than too little.
This type of client may be so motivated (and yet so unskilled) that they risk making too
many corrections or lifestyle transformations all at once, which can be both dangerous
and limit potential long-term success.
You will need to guide them through well-staged and progressive steps so that they get
it, but don’t let them try to get it all at once!
Low-motivation,
low-skill
Direct
This type of client is typically quiet, shy, and introverted. Respect that personality, and
don’t become their cheerleader. They aren’t looking for the loud, motivational coach
who constantly tells them “YOU CAN DO IT!” They are looking for someone to provide
direction and develop a relationship at a pace that doesn’t make them feel uncomfortable
or want to push back.
Even positive reinforcement offered too hastily can have negative consequences with a
low-motivation, low-skill client.
(Adapted from Grasso 2007)
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Mental skills
You’re probably getting a good idea about what nutrition skills you might need in
your work as a coach. For instance, you will probably need stuff like:
•
recipe reading skills;
•
nutrition planning skills;
•
shopping skills;
•
food preparation skills; and
•
dietary modification skills.
But as we’ve emphasized, the game of nutrition coaching isn’t just about the food.
Coaching is mostly a mind game.
mental skills: Skills for
managing your impulses and
emotions
Thus, both coaches and clients will also need mental skills. These are skills for
thinking, reasoning, problem-solving, self-awareness, and self-regulating (in
other words, managing your impulses and emotions).
For instance, at some point in the coaching process, both you and your clients
will need to:
•
deal with the discomfort and anxiety of trying new things;
•
focus on realistic goals (and let go of unrealistic goals);
•
negotiate with other people (like spouses or family members);
•
stay resilient, adaptable, and optimistic in the face of setbacks;
•
allow your beliefs about who you are and how things work to evolve; and
•
manage stress.
Are you squirming yet?
The challenge of stress
For instance, consider the problem of stress. Coaches feel stress. Clients feel
stress. All of us feel stress sometimes.
High levels of stress can make us crummy coaches.
We may feel snappish, rushed, distracted, or overwhelmed. We may forget
things, or get burned out.
High levels of stress can affect your clients’ ability to change too.
Think about the last time you were overbooked and / or overstressed. Now imagine that someone suggested you make some major life changes, including putting
time and effort into meal prep, exercise, sleep, meditation, and so forth.
What’s your response?
Probably: No way.
When you’re in day-to-day survival mode, you aren’t open to learning Turkish
get-ups and / or stir-fry combinations.
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When we feel stressed, we all try to cope as best we can.
But without mental skills, we usually choose badly —
maybe even self-destructively. We eat too much (usually
stuff that makes us feel rotten afterwards). We drink
too much. We shop too much. We binge-watch TV. We
smoke. Or we do a variety of other unwanted habits.
•
rebound quickly from setbacks; and
•
have a “growth mindset” — that all events and outcomes are just information that can help them learn
and develop (rather than “failures” or commentary
on their “goodness” as a human being).
All of these mental skills will:
Much of what you’ll see in clients is simply a normal
reaction to being stressed. It’s not stupid or lazy or crazy.
It’s just a way to get through a busy day or a difficult
time.
•
lower clients’ overall stress (and yours);
•
help clients make better, more thoughtful choices;
and
Stress isn’t going away.
•
It’s part of being human. We can’t change many stressors
(such as the weather, or random life events).
But we can change how we deal with it.
And we can change how much stress we create for ourselves (for instance, with taking on more and more work,
or not getting enough sleep).
As a coach, you can help your clients:
•
deal with stress more effectively and thoughtfully;
•
calm themselves and plan ahead;
•
set clear priorities;
enable clients to stay “in the game”, moving forward.
Mental skills
Table 9.3 is a brief overview of some types of mental
skills, and how they might help both you and your
clients.
Like any skills, mental skills can be learned, practiced,
and improved.
•
You can practice and develop these skills to build
your “inner game” of coaching.
•
And you can help your clients practice and develop
these skills to get better results from their nutrition
programs.
Table 9.3 Mental skills
What it might look like for
a coach
What it might look like for
a client
Deciding on a course of
action and then staying true to it. Ignoring
distractions.
Giving clients your full attention during sessions.
Focusing on your clients’ goals
and priorities, even if other
options seem more appealing.
Sticking to a single eating plan
rather than jumping from diet
fad to diet fad.
Doing one habit at a time.
Re-focusing
Getting back on track after
getting distracted or “falling off the wagon.”
Having a way to “switch gears”
between clients so that each
client gets a “fresh coach.”
Showing up to each coaching
session as your “best self”,
no matter what happened
previously.
Scheduling a session with
coach immediately after the
holidays.
Having a plan to get back
into normal routine after a
disruption.
Setting goals
Having a clear idea where
you want to go. Adjusting
as needed, when things
change.
Working as a team with your
client to set clear objectives
that are meaningful to them.
Asking: “Where do I want to be
at the end of 4 weeks? Why is
that important?”
“What specifically will I work
on this week?”
Mental focus
Description
Focus
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Table 9.3 Mental skills
What it might look like for
a coach
What it might look like for
a client
Knowing and living your
core values and priorities.
Coaching with integrity
despite temptations to “sell
out” or take the path of easy
reward.
Deciding purposefully how
you want to “show up” as a
coach — what kind of coach
you want to be, and what’s
important to you.
Saying things like: “I value
my family and being there for
my children. So I want to get
healthy to be a role model for
your kids.”
“I value confronting life’s challenges. So I’m going to push
my limits a bit, on purpose, as
part of growth.”
Self-awareness
Noticing and naming
thoughts, feelings, behaviors, and how all of these
things are related.
Staying “checked in” with
your own thoughts, feelings,
responses and actions as you
work with clients.
Noticing which clients or
situations “trigger” you into
feeling annoyed, frustrated,
etc. Choosing to act maturely.
Asking “How might my emotions affect my eating behavior?”
“How does my 7 AM breakfast
affect my 9 AM workout?”
Reframing and rewriting stories and scripts
Noticing when we are
writing scripts and
stories for ourselves to
explain the facts of our
lives. Then, consciously
reframing and rewriting
the endings.
You reframe “I don’t know
enough” to “I’m always learning and growing.”
You reframe “I don’t want to
make mistakes” to “It’s important to me to do a good job. I’ll
try my best.”
Reframing “I hate cooking” to
“I prefer simple food preparation strategies.”
Reframing “I fail every diet” to
“I have fallen down a lot but
always picked myself back up
and tried something else.”
Confronting anxieties,
fears, or worries
Dealing directly with anxieties, fears, and worries
rather than avoiding them
or trying to make them go
away. Allowing “failure”
to be an option, so that it
becomes less of a threat.
Focusing on what you are
learning and doing well as a
coach.
Taking risks. Experimenting.
Treating all setbacks as opportunities to learn and grow.
Speaking openly with your
coach about what you’re worried about.
Focusing on what can be
learned from setbacks so that
“failure” is not paralyzing.
Recognizing and
changing limiting
factors
Identifying the things that
hold you back or block
you from moving forward,
then either removing
them or working around
them.
You think about what is working and how to do more of
it. Or how to remove or work
around blocks.
Sample limiting factors can
include a heavy client load or
a tough work schedule that
makes it hard for you to take
care of yourself, or spend time
learning.
Thinking about what is working and how to do more of
it. Or how to remove or work
around blocks.
Sample limiting factors can
include a stressful job or not
having cooking skills.
Self-regulation
Being aware of and
managing emotions and
impulses.
Noticing when a client interaction is frustrating or annoying
you.
Having techniques to calm and
refocus yourself.
Noticing when you may eat
impulsively or emotionally.
Having techniques to help
yourself pause and choose
more thoughtfully.
Discomfort tolerance
“Sitting with” uncomfortable sensations or
thoughts, without rushing
to respond.
Allowing a few moments of
silence in a client conversation
to let a client share an idea.
Allowing a client to progress
more slowly than you would
like, because it’s better for
them.
“Sitting with” urges to over-eat
or make a poor food choice.
Learning a new habit.
“Feeling silly” while learning a
new movement.
Mental focus
Description
Following the “inner
compass”
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Communication skills
Your ideas may be awesome. Your expertise may be stellar. Your care for your clients may be all-encompassing.
But if you can’t communicate these things effectively,
nobody will ever know.
Good coaches communicate well. This includes:
•
listening actively to what clients say (and don’t say);
•
speaking clearly, courteously, and thoughtfully;
•
writing clearly and professionally;
•
observing non-verbal cues and being aware of your
own; and
•
filtering and prioritizing information for your clients.
We cover these topics in greater depth in our Level 2
program, and to some degree in upcoming units. But,
for now, let’s look at the last point: Filtering and prioritizing information.
What you should know versus what your
clients should know
What you should know and what your clients need to
know are two different things.
As a coach, you need to know a wide range of nutrition
(and coaching) concepts, theories, methods, and terminology. You may use technical language like “oxidative
phosphorylation” or “cognitive dissonance.”
Your clients don’t need to know this stuff. And they talk
in plain everyday language, not jargon. (Many of your
clients may also be younger athletes, and / or not even
speak English as a first language.)
All your clients need to know is: What they should be
doing, right now.
They need to know just enough of the “what” and “how”
to take action. The details and the “why” are mostly up
to you.
In Table 9.4 you’ll find some examples of technical messages that you should know along with some practical,
teachable, take-home messages your clients should know.
Notice here how you transform and translate more
complicated, theoretical information into practical
information that your clients can understand and act on
immediately. You can also combine this with handouts
and other resources (such as shopping lists or instructional videos) that clients can use right away.
Case study
Learning about fitness and nutrition is cool. It’s easy to
get wrapped up in it and forget to apply what you’re
learning. This is true whether you’re a coach or a client.
After all, most of us know what we should be doing. But
are most of us doing what we should be doing?
Acquiring knowledge and applying that knowledge are
two different things.
As a coach, you want to help your clients get better at
doing.
A long time ago, a client called us to ask about our
coaching services. We asked her to tell us more about
herself.
The client told us that she had been working out for
about 10 years, had read every article and book we’d
ever written, and was fairly advanced. She simply wanted to take her fitness to the next level.
Impressive. So we scheduled her first appointment.
Given her expertise and interest, we imagined that she
would look, operate, and perform like an athlete.
When we met this client in person, we discovered that
this client’s reality did not match her self-assessment.
She was at least 50 lb overweight, and we determined
that she was over 35% body fat. She could not do basic
movements well, and had multiple muscle imbalances.
Now, there’s nothing inherently wrong with this. Many
clients start out exactly this way. The problem here
is that this client considered herself “advanced” even
though she was not even doing the basics consistently.
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Table 9.4 Technical messages and how to translate them for clients
Technical message (what you should know)
Translation (what your client should know)
To optimize protein turnover, protein synthesis, thermic
effect of feeding, and muscle recovery, most clients should
be getting around 0.7-1.0 g protein per lb of bodyweight.
See your hand? We’ll use your palm for a serving size.
Eat 1-2 palms of higher-protein foods at most meals. This
includes things like chicken, fish, beef, lentils, and tofu.
Here’s a list of foods high in protein. Just pick from the list
each time you eat.
To stabilize hormone and blood glucose levels, assist recovery, and fuel training, emphasize consuming carbohydrates
with more complex structures, fiber, and resistant starch.
Cup your hand. That’s what we’ll use for a serving size.
At most meals, eat about 1-2 cupped handfuls of minimally
processed carbohydrate-dense foods.
Here’s a list to give you some ideas. We’ve got fruits, whole
grains, beans, root vegetables, potatoes, etc. Just pick from
the list each time you eat.
To optimize the dietary fat profile, your clients should be
getting roughly 1/3 of their dietary fat from polyunsaturates, 1/3 from monounsaturates, and 1/3 from saturates.
This balance helps create a favorable hormonal environment in the body, helps to manage inflammation, and
helps support healthy immune function.
Look at your thumb. That’s a fat serving.
At most meals, eat about 1-2 thumbs of healthy-fat foods.
Here’s a list to give you some ideas. You can see that it includes stuff like olives, olive oil, avocado, coconut, coconut
oil, nuts and seeds. Oily fish like salmon or herring are also
good.
If you like, you can take a fish oil or algae oil supplement
regularly.
The phytonutrients present in veggies (and fruits) have
been shown to influence genetic expression, reduce cancer, heart disease, and diabetes risk.
Think about all the different colors of vegetables: Red
peppers, green broccoli or spinach, purple cabbage, white
onions, orange pumpkin, etc.
Now, go to the grocery store and pick out all the colorful
vegetables you like.
Here’s a list to give you some ideas.
At every meal, try to eat about 1-2 fist-size servings of a colorful vegetable. Eat the rainbow!
Someone who is trying to reduce body fat will have less
kcal flexibility. So, decreasing carbohydrate and / or fat
intake can help to repartition intake and control overall
kcal consumption.
Since you’re trying to lose weight, let’s work towards reducing your number of portion. Here’s an easy way to start: Remove 1-2 handfuls of carbs and / or 1-2 thumbs of fats from
your daily intake. You can also try eating with smaller dishes.
Someone trying to gain muscle mass should increase
carbohydrate and / or fat intake to increase overall kcal
consumption, and create a more optimal metabolic and
hormonal profile for weight gain.
Since you’re trying to gain some muscle, let’s work towards
getting you to eat a bit more. Here’s an easy way to start:
Let’s add another small meal to your roster. Do you know
how to make a Super Shake?
Research is equivocal on the optimal macronutrient profile
for metabolic improvement and reducing chronic disease
risk. A number of systematic research reviews have concluded that a vast array of nutritional profiles can result in
weight loss, metabolic improvements, and overall health.
Adherence is the most salient factor in determining optimal
outcome.
What’s the best diet? Well, it depends. I can give you some
general principles to follow. But what’s most important is
that we find something that you enjoy, and can realistically
stick to.
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She simply didn’t see the difference between knowledge
and application. She had an extensive fitness library at
home. She had read every single article and book we’d
ever written. And she was familiar with most of the popular strength training and nutrition theories of the time.
In her mind, her knowledge made her an advanced athlete, even though the evidence said otherwise.
How does this apply to your clients?
Here are some things to look for.
First, the more intelligent and cerebral the client, the
more likely it is that they will have trouble applying
knowledge.
For example, the client in this example was a PhD student
who always excelled in school, and had been in school
her entire life, but had never had a non-academic job or
played a sport. Her entire existence was cognitive (thinking and reasoning) so it was a real challenge for her to be
kinesthetic (moving and physically experiencing).
Second, clients who want to know the “whys” will often
have trouble distinguishing between what they’re learn-
ing and what they should be doing. This client always
wanted to know why we were doing something before
we actually did it. This can become a real challenge.
Focusing too much on acquiring information or understanding (which is otherwise good) can prevent people
from acting.
Over time, we had some success with this client in the
gym and in the kitchen.
We were able to show her the evidence of gaps between
her knowledge and application.
We also included her in the decision-making process,
and discussed ideas with her before implementing them.
This helped her feel engaged and recognized her prior
learning.
This client needed a mix of action, evidence, and careful
coaching to change her perspective and start moving
forward.
Remember that helping your clients improve is only partly about physiology. The other part is psychology.
In upcoming units (and in our Level 2 course), we’ll
show you how to shift clients from cognition to action.
Summary
Being a nutrition coach is as much about the art and
science of coaching as it is about the nuts and bolts of
nutrition. This is especially true if nutrition coaching is a
long-term career path for you.
Effective nutrition coaching includes nutritional knowledge along with an understanding of psychology and
interpersonal skills.
•
Good coaching starts with YOU.
•
Know yourself.
•
Know your motivations.
•
Know who you are.
•
Know what matters to you.
Self-knowledge and self-awareness can guide you towards a coaching practice that fits YOU, and serves your
clients in the best way possible.
While each coach and client are unique individuals,
there are principles that guide good coaching and create
a sustainable coaching practice. These include having
(and teaching) good mental and communications skills.
What you need to know and what your clients need to
know are different things. Part of your role is to filter
and prioritize information for clients. Speak in plain,
everyday language, not jargon.
International Sports Sciences Association
UNIT 10
The ISSA Nutrition
Coaching Methodology
The ISSA Nutrition Coaching Methodology | 271
Unit Outline
1.
The process of change
2.
The 6 steps of coaching
3.
The early stages of the change process
4.
Assessment and triage
5.
Identifying and clarifying values, priorities, and goals
6.
Choosing a direction for coaching and building an
early action plan
7.
Working through normal client ambivalence
8.
How to communicate effectively
9.
Putting it into practice: What’s ahead
10. Case study
11. Summary
Objectives
In this unit, we’ll introduce you to the ISSA coaching system
decision making. We’ll also look at how to communicate
and method. We’ll take you through the general process
effectively and address clients’ natural and normal resistance
we use, from assessment, to action step, to outcome-based
to change.
The process of change
There’s a lot more to coaching than making meal plans or portioning out calories
and percentages of macronutrients.
Fundamentally, nutrition coaching is about two things:
1.
Helping people change.
2.
Helping them take meaningful action in their own lives.
It’s not just about nutrition. In fact, ironically, nutrition coaching often has very
little to do with actual nutrition. Nutrition coaching often involves understanding clients’ psychology, worldview, lifestyle, environments, and a host of other
factors that shape food and eating.
Nutrition coaching is iterative. That means you try things. Learn. Gather
data. Change. And adapt.
There are no “rules.” No formulas. Only general principles, which you must then
tailor to each client’s unique situation, and revise over time.
At ISSA we’re recognized for being world-class at nutrition coaching. Yet even we
keep experimenting, evolving, and improving our practice. We observe our clients
carefully, noting what works and doesn’t work. We constantly learn and revise.
And so should you.
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Coaching for change
Nutrition coaching is about facilitating and supporting
change, and guiding your clients towards doing something different and better.
You’ll notice that most of these are collaborative tasks.
You’re not the “expert” or “authority” telling your clients
what to do. You’re a guide and a facilitator, working with
your clients to help them move forward with their goals.
But what does that mean, exactly?
Sure, you have opinions, knowledge, and insight to
share. And you should share them.
Here are some of the general coaching tasks you’ll do
with clients. We’ll look at how to organize these into a
process a bit later.
But remember: This is a team approach. You and your
client are working together to advance the client’s
agenda.
Your coaching tasks
The 6 steps of coaching
1.
2.
3.
4.
Assess and gather data about your clients.
Organize that data into a coherent, meaningful
Let’s look more closely now at the coaching system from
start to finish.
story.
Step 1: Assess and gather data; identify client goals.
Use data to make informed decisions, and to help
Step 2: Understand the client and “build the story.”
your clients understand their situation.
Step 3: Create an action plan and possible “next steps.”
Observe and monitor your clients over time, looking
Step 4: Choose one next action step and test it.
for change, progress, opportunities for relation-
Step 5: Observe and monitor what happens.
ship-building, and “learning moments.”
5.
Seek to understand your clients’ values, priorities,
goals, mindset, and underlying motivations.
6.
Help clients understand basic nutrition / exercise
/ behavior change material (and answer questions
when needed).
7.
Help clients reflect on insights, ambivalence, resistance, and shifts in perspective that come up.
8.
Provide clear, concrete, immediately usable feedback (e.g., connecting the dots between how clients
are living and what results they’re getting).
9.
Be “present” with clients on their journey.
10.
Help clients self-regulate, focus, and manage the
normal feelings that come with change.
11.
Help them plan, anticipate, strategize, and decide
on a course of action.
12.
Help them execute that action plan.
Nutrition: The Complete Guide
Step 6: Use outcome-based decision making.
As you’ll see from Figure 10.1, the process of coaching is
iterative and cyclical. It loops back on itself.
So, for instance, you’ll probably do Step 1 (data gathering) on your first day with a new client, but you’ll
also probably do it periodically as the client’s situation
evolves and you track their progress. Step 5 also looks
a lot like Step 1. And as you gather more data and learn
more about your client, you’ll revisit Step 2, building
understanding.
Step 1: Assess and gather data;
identify client goals
As a coach, you are almost always gathering data in
some form.
For instance, you may notice that one day your client
seems full of energy; the next session they seem listless
and tired. This may be a clue about how well your nutrition plan is meeting their needs, or how well they are
recovering from their exercise.
The ISSA Nutrition Coaching Methodology | 273
ASSESS & OBSERVE
BUILD UNDERSTANDING
PLAN & STRATEGIZE
TAKE ACTION
STEP 1
Assess & gather data.
Identify goals.
STEP 2
Understand the client
and ‘build the story’.
STEP 3
Create an action plan
and possible ‘next
steps’.
STEP 4
Choose next action
step and test it.
STEP 6
Use outcome-based
decision making.
STEP 7
Choose new next action
based on Step 6.
STEP 5
Observe and monitor
what happens.
Figure 10.1 6-step coaching process
In other words, you’re always paying attention to what
your client is up to.
•
However, you’ll probably start with an initial assessment, and periodically gather data to track progress.
•
family, work hours and demands, travel;
physiological indicators, e.g., blood work, other
lab tests, digestive function, immunity, heart rate
variability, genome, microbiome;
•
body composition and measurements, e.g.,
height, weight, body girths, lean mass, body fat,
bone density;
•
other health needs, e.g., known allergies or food
intolerances, medication use, other health problems,
the other health care providers they work with;
•
function and physical capability, e.g., mobility,
daily-life tasks, athletic performance;
•
psychological state and mindset, e.g., readiness
for change, resilience, problem-solving;
goals and desired outcomes, e.g., a specific goal
weight or body composition change, decreased
medication usage, improved performance measures,
This can include data about your client’s:
•
environment and lifestyle, e.g., social support,
improved relationship with food.
What to do at Step 1
At this stage, you’re mostly collecting information,
including:
•
Objective indicators (e.g., heart rate, measurements,
other numeric data)
•
Subjective indicators (e.g., how your client feels, their
quality of life)
•
Descriptions of what is happening right now, or
recently happened (e.g., food journals)
•
Identifying and clarifying your client’s values, priorities, and goals
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active listening: To fully
concentrate on what is being said,
not just passively hearing what
the person is saying
You’re also doing a lot of “active listening”, observing, and asking questions.
We give you assessment forms that you can use to gather these types of data in
the forms package.
Step 2: Understand the client and “build the story”
Data doesn’t stand alone. You have to make sense of it, and put it together into a
“story” that starts to explain your client’s situation and needs.
For instance, high triglycerides, poor glucose tolerance, a demanding job, crummy sleep, and family stress aren’t just randomly unrelated data points. When you
put them together, they start to “build a story” of a client who is dealing with
physical and psychological stressors that are creating a variety of problems.
As a coach, you are also seeking to clarify and understand each client’s values,
priorities, motivations, goals, and perspectives. In particular:
•
You want to know what matters most to them right now.
•
You want to know how ready, willing, and able they are to make change.
•
You want to look for any ambivalence or tension they might feel about changing their behaviors. (For example, “I want to take time for myself” can conflict
with “My family needs me” or “I’m so busy with work.”)
If you like, you can even create a little template of “client stories” by filling in the
blanks:
“As a ____, I want to ____ so that I can ____.”
For instance:
“As a working parent, I want to find quick and easy nutrition solutions so that I
can help my whole family eat better without a lot of disruption to our routine.”
“As an older recreational athlete, I want my nutrition to improve my recovery and
support my training so that I can stay injury-free, boost my immunity, have lots of
energy, and keep doing the sports I love for life.”
We’ll talk more about client stories later in the unit.
What to do at Step 2
At this stage, you will:
•
put data together; analyzing and synthesizing it; drawing conclusions about what
it means
•
try to understand what makes your client tick; and what’s most important to
them right now
•
bright spots: Things that are
already going well
Nutrition: The Complete Guide
identify where their roadblocks are and what might be holding them back
from change
•
identify “bright spots” — things that are already working, or abilities that
The ISSA Nutrition Coaching Methodology | 275
OUTCOME:
End goal
Today
I will:
This month
I will:
This week
I will:
Figure 10.2 The 4-circle exercise
you can apply (e.g., client is very organized or follows
instructions well)
•
•
identify what they’re capable of doing and
understanding
•
At this stage, you will:
hypothesize what might work most effectively for
your client.
•
map out a course of action that works towards the
identify their nutritional level (more on this later in
client’s goals; and / or a roster of possible tasks that
the unit)
the client might do.
Step 3: Create an action plan and
possible “next steps”
What to do at Step 3
In Step 3, you apply what you discovered and digested in
Steps 1 and 2.
•
break this larger course of action or “to do list” into
smaller steps that your client could potentially do
immediately. You can use the Make It a Habit
Worksheet found in the forms package.
For instance, here’s one way of thinking about moving
from goal to next action steps. We illustrate this approach in Figure 10.2.
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C
Make It a Habit Worksheet
NAME
Ready, Willing and Able Worksheet
DATE
NAME
PROPOSED TASK
How to make goals into habits: a quick reference
1.
Start with the awesome.
2.
Let the client choose the direction.
3.
Set the right kind of goal.
4.
Break the goal down.
5.
Choose ONE small piece.
6.
Shrink the task even further.
7.
DATE
How ready are you to do this task?
NOT AT ALL
1
2
3
4
5
6
7
8
9
10
LET’S GO
NOW!
5
6
7
8
9
10
DYING TO
DO IT
5
6
7
8
9
10
100%
CONFIDENT
I CAN DO IT
What might make you more ready to do the task?
Confirm the fit.
8.
Set up an accountability system.
9.
Use outcome-based decision making to assess how well the habit worked and plan next steps.
How willing are you to do this task?
Step 1: Start with the awesome
NOT WILLING
AT ALL
What are your client’s existing:
To ask your client:
• skills
• Where / how are you already successful? How can you do
more of that?
• solutions to other problems
• successes
• strengths
• superpowers
1
2
3
4
What might make you more willing to do the task?
• In what situations do you tend to be successful? How can we
reproduce that for you in the service of a new nutrition-related
task?
How able are you to do this task?
• Where do you feel strongest? How can we build on those
strengths?
CAN’T DO IT
AT ALL
1
2
3
4
What might make you more able to do the task?
Revised task
What’s awesome about your client?
REVISED TASK
Revised task score

© 2018 ISSA issaonline.edu
Ready

Willing

Able
© 2018 ISSA issaonline.edu
Find the Make It A Habit worksheet; Ready, Willing, and Able worksheet, and others in your forms package
1.
Start with the end result. What does the client
want to do, be, feel, and / or see at the end of their
2.
You probably have some good ideas, but you won’t know
which action step works best until you try it.
coaching process?
Here’s what this means.
Work backwards. In order to get to the goal, what
What to do at Step 4
might the client need to do:
a. This month?
b. This week?
At this stage, you will:
•
tential next action steps, or general areas to work on.
c. Today?
(For instance, “Given what you’ve mentioned about
having trouble in the mornings, I’m thinking we
Note that at this stage, you’re still mostly guessing about
what could work for your client. They’re informed guesses — aka hypotheses — but you’ll still need to test them.
Step 4: Choose one next action step
and test it
Once you have some possible next actions in mind,
you’ll need to pick one and make sure it matches what
your client is ready, willing, and able to do.
Nutrition: The Complete Guide
Offer the client your expert suggestions on 1-3 po-
could either tackle your breakfast menu, or your sleep
habits. Which would you prefer?”)
•
Allow the client to choose what they’re willing to
work on, and / or what they think is most important.
•
Make sure this action is meaningful to the client and
not just “some random thing coach says I should do.”
•
Break each step down into the easiest, most consistently do-able format.
The ISSA Nutrition Coaching Methodology | 277
•
•
Ensure that the client clearly understands what the
with regular check-ins that are less frequent and
task involves.
more of a casual conversation, perhaps even with the
Important:
1.
2.
distance of email.
Get full confidence and buy-in from the client.
do only ONE thing at a time.
Make sure that the client is completely confident about this task, and ready, willing,
and able to do it. To do this, try out our Ready,
Willing, and Able Worksheet. You can find that
Decide together in advance how often you will check in,
monitor and follow up, and how you’ll do it.
You can and should also schedule regular progress
updates, where you gather and update specific types of
information, such as:
•
body measurements and photos
•
athletic performance indicators (e.g., strength,
mobility)
in the forms package.
3.
Collaborate on the next action. Don’t just tell
•
recovery)
your client what they “should” do. Remember that
you and your client are a team who decides on tasks
together.
Step 5: Observe and monitor what
happens
Once you’ve assigned the action step to your client, and
you’ve both agreed on what constitutes “doing the task”,
track how often and well the task gets done.
At this stage, you’re experimenting. There is no failure,
only feedback.
This stage is much like Step 1. You’re gathering data
again.
•
How often / consistently did your client do the assigned task?
•
How well did your client do the assigned task?
•
Did any challenges or questions come up?
•
Was there anything that went particularly well? (Use
this to shape your decision making. As often as possible, play to your clients’ strengths.)
You’re also monitoring your client and staying in relatively regular contact.
How, and how often you do this will depend on the
client’s needs and preferences. For instance:
•
Your initial assessment and ongoing conversations with
your client should tell you what is important to track.
If you aren’t sure, talk to your client about what “progress” means to them.
Don’t assume your idea of “progress” is the same as
theirs.
We recommend you use something like this:
•
•
•
Other clients may prefer a more “hands-off” style,
Weekly or biweekly: Reviewing together with your client how well and consistently they did their assigned
task
•
Monthly: Assess overall progress indicators
•
Quarterly: Assess goals and overall strategic direction
of coaching program
What to do at Step 5
At this stage, you will:
•
track how often and well the client’s assigned task
got done
•
agree on what measures you will track, based on the
client’s goals and definition of “progress”
•
gather any additional data that might be useful. Observe your client carefully
•
agree on regular scheduled check-ins, monitoring
and follow-ups
calls. They may like a lot of in-person contact and
“hand holding.”
Daily: Client tracks their assigned task (a simple yes /
no checklist is fine)
Some clients do best when you’re “on their case”
with frequent text messages, emails, and / or phone
other wellness indicators (e.g., sleep, energy,
•
agree on how, and how often, these check-ins / follow-up sessions will occur
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outcome-based decision
making (OBDM): Deciding what
to do next based on the outcomes
of what someone just experienced
Step 6: Use outcome-based decision making
After you observe how well your client did their assigned action, decide what to do
next, based on the results of your experiment. This is known as outcome-based
decision making (OBDM).
Remember: What you choose to do next should be based on the data you collected. Don’t stick to dogma, rules or plans rigidly when the data tell you otherwise.
There are no “shoulds” in coaching — only what is.
Your regular schedule of checking in and monitoring your client should eventually give you some data about how well things are working.
What to do at Step 6
At this stage, you will:
•
review and analyze the data you gathered from Step 5.
•
based on your analysis, assess whether you are moving in the right direction.
Are you getting the results you seek?
•
look for trends, patterns, and relationships between things (e.g., every time
your client does A, it leads to B)
•
choose the next task and / or strategic direction of the coaching program
based on the results of your experiment. This can include:
•
assigning the client a completely new task, or deciding to go in a new direction;
•
changing the original task;
•
shrinking the original task so that it’s easier or more manageable (if the client
struggled with it initially); and / or
•
making the original task more challenging (if the client found it too easy).
The early stages of the change process
In the rest of this unit, we’ll look at the early stages of coaching clients through
the change process.
This includes:
triage: Assigning degrees of
urgency
Nutrition: The Complete Guide
•
assessment and triage (including sorting clients into nutritional Level 1, 2,
and 3)
•
identifying and clarifying clients’ values, priorities, and goals
•
setting realistic expectations and negotiating trade-offs
•
choosing a direction for coaching and building an early action plan
•
identifying “small wins” and bright spots
•
identifying limiting factors
•
working through normal client ambivalence and testing client confidence
•
communicating and giving feedback clearly
The ISSA Nutrition Coaching Methodology | 279
Assessment and triage
The value of assessment
Good coaches are always gathering, analyzing, and using
data to make informed, outcome-based decisions about
what to do next.
This means you need to do some comprehensive initial
assessments of your client, and have an ongoing system
of “checking in” to update the data you’re collecting.
You also need to triage — to understand what’s most
important, right now, for each unique client. This helps
you figure out “first things first” and set priorities.
A good initial assessment helps you match your coaching plan to what the client can actually understand,
manage, and do. This ensures that your clients go steadily from success to success, rather than swinging wildly
from resistance to anxiety to failure.
A very small, simple plan that a client can do — and
feel good about — every day beats an awesome plan
that a client can’t do consistently.
The initial assessment will:
•
help you give your client an objective appraisal of
what and how they’re doing;
•
help you identify whether your client is at risk for
illness and / or injury;
•
determine if you need to refer the client out, either
because they fall outside your scope of practice or
because the relationship would be a mismatch (remember, referring out is an important and valuable
•
ents with documentation in the beginning. And don’t
try to fix everything at once.
•
help you focus on what matters to your client;
•
give you vital information on what your client’s limit-
How to assess your clients
Assess new clients immediately, or as soon as possible.
Then, schedule ongoing assessments regularly.
You can ask a new client to start filling out your forms
in advance, and / or you can work through the forms
together. We recommend you do both.
Filling out forms in advance gives your client time to
think and remember details. Then, going through the
forms together and discussing them in your first consultation gives you both an opportunity to fill in any gaps
and make sure you’re on the same page.
Using the ISSA Certified Nutrition
Specialist assessment forms
Assessment forms and data gathering
We suggest you start with the ISSA Initial Assessment
& Triage Questionnaire. Ask the client to fill it out
beforehand if possible, and bring it to your first session
together. Then, discuss their responses and look for additional information and understanding where required.
Using the Initial Assessment & Triage Questionnaire,
you’ll cover:
•
provide you with information that serves as a baseline
change, and what behaviors they’d like to focus on or
change
•
What to focus on
At the assessment stage:
•
Keep it simple. Use only the forms and information-gathering tools you need.
social factors such as social support, stress, and
relationships
•
for comparison when monitoring progress in the
future.
the client’s perspective, such as expectations,
goals, self-identified limiting factors, willingness to
ing factors may be; and
•
Set priorities. Look for the most important things
to focus on.
option);
•
Go slowly, step by step. Don’t overwhelm new cli-
health indicators and conditions such as injuries,
medication use, and digestion
•
lifestyle factors such as how often they see the
doctor, whether they smoke, how they spend their
time, and how their kitchen is set up
Once you review the initial questionnaire together, you
as the coach can also assess your client’s nutritional
level.
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Identifying nutritional level
Initial Assessment & Triage Questionnaire
NAME
C
DATE
1. What does this client know?
Coaching tips
• You can use this form both for an initial baseline assessment and to track progress periodically.
• Client responses to questions can suggest what areas to work on and track.
• You can also use questions such as the 1-10 numeric scores to track objective progress in particular areas (e.g., “Right now,
how would you rank your overall eating / nutrition habits?”).
Tell me more about yourself.
By learning more about your lifestyle and your habits, I can take better care of you and make sure coaching is a good fit for your goals
and individual needs.
DATE OF BIRTH
Please print clearly.
MOBILE PHONE
HOME PHONE
How do you prefer me to contact you?


Email

Skype or other video chat


Text
Emergency contact name:
Phone
Emergency contact phone number:
Other (please specify):
Coaching tips
• Ensure that all contact information is complete and correct.
• Confirm with client how they would like to be contacted, and how often.
© 2018 ISSA issaonline.edu
Find the Initial Assessment & Triage Questionnaire in your forms
package
After the first session, if you feel like the Initial Assessment & Triage Questionnaire raises some questions that
you’d like to immediately answer, you can also use any of
the worksheets listed in Table 10.1, which may help you:
•
identify what is most important to your client right
now
•
3. What does this client want to do? (In other words,
what are their goals?)
In the next unit, we’ll give you a breakdown of Level 1, 2,
and 3 clients, and how to properly categorize them.
Review and follow up
As you go through the Initial Assessment & Triage
Questionnaire with your new client, don’t make any decisions or commit to any next actions. At this point, just
gather information and seek to understand.
Afterwards:
•
Take some time to review what you learned.
•
Decide what level the client is at. (Hint: It’ll almost
always be Level 1.)
•
•
collaborate on next actions together
•
ensure that your client is able to execute any tasks
you give them
troubleshoot as needed
Keep in mind that you don’t have to use any of these
worksheets. We recommend you try one at a time. Feel
free to use these throughout the coaching process, and
only if you find them useful in your coaching decisions.
Nutrition: The Complete Guide
Start to identify potential pathways for coaching
them.
•
Establish if you’ll need to give them additional forms.
Then:
•
Set up a second meeting with your client to discuss
next steps and programming. (For convenience, you
identify what “progress” means to your client, and
track it
•
2. What can this client do right now?
4. What can this client do consistently?
GENDER
Staying in touch
EMAIL
As part of your initial assessment, we suggest you place
each client into one of three nutritional levels, based on
four questions:
can also book this at the end of the first session.)
During this follow-up meeting, you can also discuss
things like:
•
what counts as “progress” and a schedule for monitoring it;
•
adjusting the next step to make it do-able;
•
how your client would like to work with you (e.g., by
email / phone, in person); and
•
what to expect in your work together.
The ISSA Nutrition Coaching Methodology | 281
Table 10.1 Index of forms
Worksheet, assessment, or
questionnaire
What it’s used for
Versions
Initial Assessment and Triage
Questionnaire
Helps you match your coaching plan to what the client can
actually understand, manage, and do. Also helps you to give
clients an objective appraisal of what and how they’re doing,
helps you identify clients who are at risk for illness and / or
injury, and helps you determine if you need to refer a client
out.
Coach version1
4 Crazy Questions Worksheet
For helping clients think through the benefits of the status
quo and what they’ll have to give up to change.
Client version
A-B-C Worksheet
For negotiating which specific exercises and / or foods clients
can / will do or eat. (At least right now.)
Coach version
For helping clients see choices as a continuum versus all or
nothing.
Coach version
Athletic Nutrition Needs
Questionnaire
For understanding a client’s training goals, training volume,
current recovery practices, and current nutrition practices.
Coach version
Baseline Blood Chemistry
Assessment
For coaches who find blood work useful in the decision-making process.
Coach version
Behavior Awareness Worksheet
For helping clients change unwanted habits and behaviors
(such as stress eating).
Client version
Body Measurements Form
For tracking body composition in clients who might benefit
from regular measures.
Coach version
Eating Habits Questionnaire
For learning more about a client’s eating patterns.
Coach version
All-or-None Worksheet
Client version2
Client version
Client version
Client version
Client version
Food journals
3-Day Diet Record
For recording exactly what a client is eating; most often for
Level 2 eaters.
Client version
80% Full Meal Journal
For helping clients learn how to eat until satisfied versus
stuffed and tracking progress in this area.
Client version
Athletic Performance Indicators &
Athlete Nutrition Journal
For correlating mood, energy, and motivation with dietary
intake in hard-training athletes. Includes Athletic Performance Indicators worksheet.
Client version
Eating Behaviors Journal
For capturing a client’s urges, cravings, and behaviors
around meals.
Client version
Eating Slowly Meal Journal and
Meal Duration Journal
For tracking a client’s meal speed and whether they’re
consistently eating slowly and mindfully. Use Eating Slowly
for subjective self-assessment or Meal Duration for objective
self-assessment.
Client version
Emotional Eating Journal
For capturing a client’s emotions and thoughts and how they
might lead to different food choices.
Client version
How Food Feels Journal
For capturing a client’s physical sensations (like allergies or
intolerances) related to food.
Client version
Hand-Sized Portion Guide
A simple guide to calorie control without calorie tracking.
Coach version
Client version
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Table 10.1 Index of forms
Worksheet, assessment, or
questionnaire
What it’s used for
Versions
Suggestions for daily movement outside of scheduled
“exercise.”
Coach version
For helping highlight the relationship between a client’s
environment and their food habits.
Coach version
Limiting Factors, Advantages, and
Behavior Goals Log
For identifying a client’s struggles, their advantages, and
how to turn them into a plan for change.
Coach version
Make It A Habit Worksheet
For moving from vague idea or outcome goal to specific
habit and behavior goal.
Coach version
Meal Consistency Worksheet
For tracking a client’s consistency with agreed-upon behaviors and practices.
Coach version
Medical History and Present Medical Condition Questionnaire3
Provides more detailed information about the client’s overall
health.
Coach version
Planning & Time Use Worksheet
For clients who have problems with time management.
Client version
Fitness Nutrition Plate
A simple way to structure each meal the ISSA way.
Client version
Push-Pull-Habit-Anxiety Worksheet
For identifying what’s pushing clients away from old ways of
doing things and pulling them towards new things.
Coach version
Ready, Willing, and Able Worksheet
For helping establish how ready, willing, and able a client
is to make a given change. Also helps coaches “shrink the
change” to make it more manageable.
Client version
Sleep & Recovery Ideas
For helping coaches discuss sleep rituals and stress
management.
Coach version
Social Support Form
For showing how social support influences a client’s eating
and movement decisions.
Coach version
Sphere of Control Worksheet
For helping clients identify what they have control over… and
don’t.
Coach version
For showing patterns of sleep, stress, and recovery.
Coach version
Ideas for Movement
Kitchen Set-up Assessment
Stress & Recovery Questionnaire
Client version
Client version
Client version
Client version
Client version
Client version
Client version
Client version
The Hunger Game
For helping clients better tune into hunger and appetite
cues.
Client version
Want-Willing-Won’t Worksheet
For negotiating what clients want, and what they’re willing
to do (or not do) for that goal right now.
Coach version
Client version
1 Coach versions contain scripts or background information that you can use to either explain the form to your clients, or to understand why we’ve asked certain questions.
It’s like a “Teacher’s guide” for school teachers.
2 Client versions of forms are for the clients to take home and fill out themselves.
3 Remember that Medical Nutrition Therapy is off limits unless you’re a registered dietitian. We include this form so you can have access to the client’s medical history in
case that needs to inform your advice.
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Identifying and clarifying values, priorities, and goals
Ultimately, coaching is about helping clients further
their agendas.
Each client’s situation will be unique. What they want
will be unique. Assume nothing.
You’re a champion for your clients. An advocate. An ally.
Of course, you’ll hear some common things, like “lose
weight” or “get in shape.” But as a coach, you have to
dig a little deeper than that to truly understand what
matters to each individual client, and why.
You help them get where they want to go.
But first, you have to figure out where exactly that is.
This involves exploring questions like:
•
What does your client want to do?
•
What do they really want to do?
•
Why do they want to do that? Why is this goal meaningful to them?
•
What’s realistic for your client? Do they understand
that?
•
•
You should start talking to your clients about these
things during your first session together. Each session
after that is to learn more, understand more, and clarify
more about what matters most to your client (and how
that may change over time).
Clarifying goals
Work towards figuring out a clear “what” and “why.”
What’s most important to your client?
1.
goals?)
What should come first? What does your client want
to prioritize?
•
What do they need in order to move towards their
goals?
•
What’s holding them back or blocking them from
those goals? (In other words, why haven’t they already achieved those goals?)
•
What do their goals mean in the context of their lives?
(For instance, wanting to lose weight in the face of
a health scare will be different than wanting to lose
weight to look good at the beach on a honeymoon.)
As you think about these questions, and work through
them with your clients, notice how there are no “rules”,
buzzwords, or slogans.
What does your client want to do? (What are their
2.
Why do they want to do it? (What motivates them?)
The more specific, concrete and well-defined a goal is,
the more it can become “real” for the client.
The more meaningful and resonant a motivator is, the
more it’ll keep your client on track when things get
tough. (Which they will.)
Table 10.2 offers some examples of clear and unclear
“whats” and “whys.”
Notice here how unclear goals and motivators often include unclear terms like “eat better”, “tone up”, or “better
shape.” It’s hard to track “tone up” as a coach.
So your role here is, in part, to help clients get more concrete and specific. Here are some exercises you can try.
Table 10.2 Clear versus unclear “whats” and “whys”
Why
Goals
Clear
Unclear
I want to get my blood lipids back into the normal
range.
I want to learn to eat better.
I want to run a 5K in April.
I want to bench press 200 lb.
What
Motivators
My father just died of a heart attack, and I’ve decided
that I don’t want to go out like that.
I need to gain / lose weight to compete in X weightclass division in my sport.
I want to tone up.
I want to add some muscle.
I dunno, I just feel like I should be in better shape.
Ummm… I’m not sure...
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5 Whys
5 Whys: Asking someone
“why” at least five times to
elicit introspection and deeper
motivations
The 5 Whys is an exercise that helps get at a client’s deeper motivations.
Deeper motivations help you tailor the coaching plan to the client. And they
keep your client on track when the going gets tough.
The concept is simple: Ask why five times, building on the previous answer, until
you arrive at a deeper understanding of what drives the client, or what meaning
this goal has to them.
Here’s an example.
Client: I want to lose weight.
Coach: Why do you want to lose weight?
Client: Well, I just don’t feel very attractive at this weight.
Coach: Why don’t you feel attractive at that weight?
Client: I can’t wear my old clothes, or dress up and go out.
Coach: And why is wearing those clothes or going out important to you?
Client: My wife and I used to go out a lot when we were first dating. But now…
we just… don’t.
Coach: So why is that an issue for you?
Client: It sorta seems like a lot of the magic is gone. You know?
Coach: And why does that bother you?
Client: Well, I really miss those times. With the kids… you know how it is…
being so busy and over-scheduled… And I worry that my wife doesn’t think I’m
attractive any more. So I guess it’s about just wanting some of that back.
You went from a vague “lose weight” to a pretty good understanding of this
client’s deeper motivators and lifestyle challenges in under one minute of
conversation.
Now you know that their goals involve feeling more attractive but also possibly
managing their time more effectively and having more fun in their life again.
Nice work, coach.
Of course, be sure to use a diplomatic, curious, interested tone rather than a
judgmental or interrogating one.
What will be different?
Ask your client:
“If you get what you want, how will you know? What specific things will be different? Once you get what you want, how specifically will you feel? What specifically
will you be doing, or able to do?”
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Table 10.3 Behaviors as goals
Step 1: Show how behaviors lead to outcomes
Step 2: Help the client
understand what they
can control
Step 3: Identify possible
behavior goals
Step 4: Assign a small
specific task as the goal
“You’ve said you’d like to
lose X lb. Tell me what you
think needs to happen to get
there. I have some ideas, but
I’d like to hear yours first.”
“Now, just to be clear: We
can’t set a timeline on this.
Everyone’s body is different.
But what we can control is
what you choose to eat, and
how much.”
“From your list of possible
behaviors, it looks like portion control is an important
part of losing weight. Would
you like to start working on
some basic portion control
as our first goal together?”
“What seems easiest? Using
plate size? Okay, cool. So
let’s start simply: How about
for this week, you’ll eat dinner off this smaller plate?”
“Let me ask you a question.
What do you think fit people
do? How do you think they
live? What choices do you
think they make day to day?
If you had to imagine those
things… what might you
say? Fit people do _____.”
“So obviously a fit body
doesn’t happen by accident.
Fitness is something we have
to prioritize every day, right?
And for most people, that
usually means scheduling
some time in advance.”
For instance, a client might talk about:
•
feeling more confident;
•
fitting into a certain clothing size;
•
doing a new activity; or
•
doing an everyday activity more comfortably and
easily.
This helps you get a better idea of what the client’s goals
mean to them.
Outcome versus behavior goals
Help your client distinguish between outcome and
behavior goals.
Outcome goals specify what will happen at the end of
things — the outcome.
Behavior goals specify what actions must be taken to get
there — the processes, actions, steps, and behaviors that
must occur in order to progress toward the outcome.
Outcomes are usually out of our control. Behavior goals
are usually fully within our control.
For example:
•
We can’t control our hormones and activity of fat
cells. But we can control what we eat.
•
We can’t control how effectively our muscle cells grow.
But we can hit the gym regularly and work hard.
“Okay, you said fit people
make time for exercise every
day. What would that look
like for you? How could
you work towards that
behavior?”
“Given what you’ve suggested, do you think booking
10 minutes of walking every
day would be do-able as a
first behavior goal for this
week?”
Help your client move from the outcomes they want to the
behaviors that will get them there.
Step 1: Show how behaviors lead to outcomes.
Outcomes don’t “just happen.” There is a process for how
to get there.
Step 2: Help the client understand what they can
control, and what they can’t. Focus on changing what
they can control (e.g., what they eat), and steer them away
from thinking about what they can’t (e.g., how fast they
will lose weight).
Step 3: Identify some possible behaviors that lead
to the outcome the client wants. Together with your
client, you can “reverse engineer” the behaviors that will
have to happen to get to their goals. Start with the end,
and work backwards.
Step 4: Choose one behavior and set it as a goal.
See Table 10.3 for a couple of examples.
Expectations and trade-offs
Asking what matters most to your clients, why it matters
to them, and what they can reasonably manage, can also
help you talk about realistic expectations and trade-offs.
Many of your clients have never lived in a lean, muscular,
athletic, and / or healthy body. Thus, many of them will
have no idea what type of daily behaviors it takes to get
those outcomes.
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Explore trade-offs
Set realistic expectations
As part of your assessment and ongoing monitoring,
explore the “Want-willing-won’t” questions with your
clients:
Clients may also not know there is a “middle ground”
between “extremely unfit” and “fitness magazine model.”
To them, the only way to “be in shape” or “be healthy”
may be a Photoshopped image, a grueling workout regimen, and / or a very restrictive eating plan. They may
also think that major changes will happen very quickly
(e.g., the “6-week beach body plan” mentality).
1. What do you want?
2. What are you willing to do for that goal right now?
3. What won’t you do for that goal right now?
Some clients might start to realize that they don’t want
to make certain trade-offs.
So, part of your job as a coach is to help them see a range
of possible options, particularly those that are achievable
and realistic.
Some clients might be willing to make trade-offs, but
based on where they currently stand (e.g., a certain percentage of body fat, a certain body type, a certain age, a
certain history with disordered eating), it might be unrealistic (or unhealthy) for them to pursue a certain goal.
For example:
As the coach, part of your job will be to help your clients
stay safe and sane about their trade-offs.
“I know you’re worried about the health effects of sitting
all the time. The good news is that even quick movement
breaks throughout the day, maybe a 15 or 20 minute walk
at lunch, can make a big difference.”
Use the Want-Willing-Won’t Worksheet to help facilitate this discussion.
Want-Willing-Won’t Worksheet
NAME
C
DATE
“Research is showing that even losing 5-10 lb can help
improve health. You don’t necessarily have to lose 50 to
feel better or improve your blood work.”
A-B-C List Worksheet
NAME
DATE
Take a few minutes to fill out the lists below. It doesn’t have to be an exhaustive list. Just do the best you can.
How to explain this form to your clients
Here’s a sample script you can use to introduce this form to your clients.
FOODS A
FOODS B
FOODS C
“I’d like to understand more about your current goals, limitations, and priorities. When we are trying to change our body and
health, we have to make certain trade-offs. In order for X to happen, you may have to change Y. And not everyone is ready to
take certain actions. That’s okay.
Like
Might eat
Not right now
ACTIVITIES A
ACTIVITIES B
ACTIVITIES C
Can do easily
Maybe
Not right now
I just want us to get clear on what you are willing — and not willing — to do right now. Of course, this can change. We can revisit this discussion any time you like.
Please be honest. There are no right or wrong answers. The more truthful you are, the more I can match your coaching
program to your unique situation. I just want to help you stay safe and sane about your trade-offs.”
Please answer the questions as honestly as you can. There are no right or wrong answers.
1. What do you want?
2. What are you willing to do for that goal right now?
3. What won’t you do for that goal right now?
© 2018 ISSA issaonline.edu
© 2018 ISSA issaonline.edu
Find Want-Willing-Won’t, the A-B-C worksheet, and others in your forms package
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List A
List B
List C
Like
Might Eat
Not right now
Apples
Spinach
Broccoli
Bananas
Shrimp
F ish
Oranges
Grapes
Chicken
Celery
Peas
Hamburgers
Watermelon
Olives
Brown rice
Quinoa
Carrots
Lentils
Corn
Brussels sprouts
Protein powder
Can do easily
Maybe, sort of
Not right now
Walking
Running (up to 15 min)
Sprinting
Squats
Lunges
Rows
Most mobility work
Pullups (assisted) or
pulldowns
Deadlifts (light)
Running over 15 min
Pressing, pushups
Hip hinge (light)
A-B-C worksheet examples
“In my experience, it takes longer than that for most clients
to bounce back from that type of surgery. The good news is
that we can focus on other things while you heal.”
You can also ask your client what they think is realistic
versus ideal. Direct their attention to “a little bit better”
or “a small step forward.”
“Of course, most of us would like to be Superman / Superwoman. Let’s set that aside for a minute and talk about
what you think is most realistic for you, given your lifestyle,
abilities, and everything else we’ve discussed. What would
a small step towards your goals look like?”
As part of this, you can use the A-B-C Worksheet, which
helps clients see what is on their “A” (for sure, no problem), “B” (maybe), and “C” (no way) lists respectively.
Choosing a direction for
coaching and building an
early action plan
As you work with your client to understand their
motivations, values, priorities, and goals, your overall
coaching strategy should start to become clearer.
Sometimes, you’ll have an intuitive sense of what to do
next and why, and how that fits into the bigger picture. Other times, it won’t be as clear. You can then ask
yourself:
•
What are they already doing well, and how can I help
them do more of that? (Otherwise known as small
wins and bright spots.)
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•
•
What is holding them back? Why haven’t they already
part of that? The part that makes you feel the most
changed? (Otherwise known as limiting factors.)
stuck or frustrated?” (This question helps you figure
What are some small actions that can start moving
my client in the right direction?
•
What can my client reasonably and realistically do?
Identifying small wins and “bright
spots”
One easy (and often motivating) way to keep clients
motivated and moving towards their goals is simply to
ask them:
•
“What have you already tried that seemed to help?”
•
“What is already working well for you?”
•
“What could work in your favor here?” (For instance,
client already knows how to cook; client is organized;
client lives near the gym)
•
“You’ve mentioned struggling with X. Are there times
when X doesn’t happen? Times when dealing with X
is actually a little bit easier?” (For instance, client can
eat a healthy breakfast and lunch but has trouble with
dinner.)
•
“It sounds like you had some motivation to start
working with me. What was that motivation? What
pushed you to come here today, and not wait, say,
another few months?”
As a next action, you can then just suggest that the client
build on what is already going well (i.e., small wins and
“bright spots”). You can also help them strengthen their
initial motivation.
out what you could tackle first. It also helps the client
clarify what exactly is bothering them most, rather
than giving you just a vague “feeling bad.”)
The client may have a long list of limiting factors. Don’t
get bogged down. Don’t get freaked out. You’re going to
work through these systematically, one by one.
Once you’ve brainstormed your list of limiting factors,
help your client then choose the one they’d like to work
on.
Have them pick either the biggest boulder in their path,
or the tiniest, easiest-to-grab pebble.
“Okay, out of this entire list, think about two things. Either: What’s the biggest blockage — the thing that would
make the biggest difference if we fixed it right now? Or:
What’s the easiest thing to do? … Uh huh. Great. Okay, so
which one would you like to work on first?”
Sometimes, we like the “documentary film crew”
question.
“Let’s say a documentary film crew is making a movie of
your life. They follow you around all the time, filming everything you do. What you ate. When you ate it. How you
ate it. Where you ate it. And so on. If we were to sit down
together this evening and review this footage, what do you
think would stand out? If you imagine your life as this
kind of movie, what might we see as some of the behaviors
that are blocking you from getting what you want?”
In fact, you’ll see this question appear on the Initial
Assessment & Triage Questionnaire.
Identifying limiting factors
We’ll look more at specific limiting factors and potential
solutions in upcoming units.
Another way to keep clients rolling along is to remove
whatever is in their way and preventing them from moving forward (i.e., limiting factors).
Figuring out the right type of action
•
“What’s blocking you from doing X?”
Once you identify bright spots and limiting factors, and
think about them in the context of your client’s lifestyle,
values, priorities, and goals, you’ll probably have some
ideas for next actions.
•
“Sometimes, there are good reasons for not chang-
Ask the client to choose first
•
“Why haven’t you already done what you’d like to
do?” (Make sure to ask this in a friendly, neutral way.)
ing. What would you say is the advantage for you of
not changing right now?”
•
“You mention struggling with X. What’s the worst
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Clients believe what they hear themselves say. Instead of
telling a client what to do, ask questions that get them
generating their own solutions.
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“So, given all this, what do you think you’ll do next?”
Start very, very, very small
“You say now might be a time to consider cutting back
on sugar. How would you go about it if you were ready?
What steps do you need to take to get started?”
Always start small. Smaller than you think or want.
(Even if you choose a Big Kahuna option — tackling the
massive life-altering change.)
“You mentioned that you want to start eating more
vegetables each day. Where do you think you could start
building more vegetables in right now?”
Here are four guiding principles for establishing small
next actions:
You can also ask your client what they might want to do
next, while combining it with the assurance that you’ll
provide expert guidance if they get stuck.
1.
you’re proposing. (We allow 5% wiggle room because some tasks may be new, and your client may
be willing to try them, but not entirely certain about
them.)
“After reviewing all of these, I have some ideas, but I’d like
to hear yours first. Knowing yourself and what you want
to do, what might you like to work on first? What seems
most urgent for you?”
2.
Start big / start small
3.
If you’re stuck for ideas, you can try this quick triage for
deciding which direction to pursue.
4.
The Big Kahuna — the piece or action which, if
altered, would yield the most benefit. Changing this
2.
being asked to do.
The task must be very clear, specific, and concrete.
“Eat healthy” is no good. “Eat an orange with breakfast” is what you want.
To facilitate this, try the Make It A Habit Worksheet.
Test ready, willing, and able
The Low-hanging Fruit — the piece or action that
Ask your client:
•
change. Changing this will be simple and make the
client feel immediately successful.
With each proposed change, check which path the client
would prefer: Big Kahuna or Low-Hanging Fruit.
We suggest you apply the 80/20 rule to choosing next
actions:
“On a scale of 1 to 10, how ready are you to do this
task?”
•
“On a scale of 1 to 10, how willing are you to do this
task?”
•
“On a scale of 1 to 10, how able are you to do this
task?”
Use the 80/20 rule
In the forms package, we’ve given you a Ready, Willing,
and Able Worksheet.
80% of the time, focus on expanding and im-
You want 9/10 or higher on each of these.
proving bright spots. If your client already walks
If you don’t get it, make the task smaller / easier. Then
ask again.
for 15 minutes a day, get them walking for 20. Then
offer them praise of an affirmation.
•
Your client must fully understand what they are
will be hard, but will yield massive payoffs.
the client feels is easiest and least troublesome to
•
Your client must score 9/10 or more on ready, willing, and able to do the task. (More on this below.)
With your client, choose one of these two options.
1.
Your client must be 95-100% on board with what
20% of the time, focus on removing limiting
factors. If your client can’t walk more than 20 minutes without knee pain, get them to physio.
Focusing on what your client already does well, and
making use of their existing strengths, will keep them
feeling motivated, capable, and successful.
Keep asking until you get 9/10 ready, willing, and able or
higher.
You can also simply ask:
•
“On a scale of 1 to 10, how confident are you that
you could absolutely, for sure, no matter what, do
this task every day?”
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Again, adjust and scale back the proposed task until the client tells you they are
at least 9/10 confident they can do it each day.
No task is too small to start with. Set aside your grand dreams and get that 9/10.
Set realistic expectations (again)
Your client may want to DO ALL THE THINGS all at once. Your job is to stop
them from doing that. (Or, assign it as a one-week experiment where they must
take notes, and then ask them to tell you how it went.)
Clients will often seek a solution that befits the scale of change they want to
make. They want to get magazine-cover-ready by next week so they look for the
“one week magazine cover model diet.”
Or they may want big changes right now. They may be anxious, or worried about
failure. This may feel like their “last chance.” So change may feel urgent to them.
They may be angry about going too slowly.
Big solutions and overnight results are fantasy. Call out “magical thinking” when
it occurs (diplomatically, of course).
“I know, I know. It would be awesome if we could just do X and get completely
ripped. I hear ya. Unfortunately, that’s not how it works. Here’s what you can
actually expect…”
“Yeah, losing X pounds in Y weeks isn’t realistic for most people. But there is hope.
I had another client similar to you and s/he got great results like this [showing
photo]. However, it actually took about Z months. The good news is, s/he was able
to maintain this rather than rebounding.”
Help them scale accordingly and be realistic.
Working through normal client
ambivalence
ambivalence: Having mixed
feelings or contradictory ideas
about something or someone
Change naturally involves mixed emotions and ambivalence.
Even if we really want to change, we may feel “stuck” or attached to something
that keeps us from changing. We may feel pulled between different things,
such as taking care of others versus taking care of ourselves; or wanting to lose
weight but not wanting to give up comfort eating.
This ambivalence is absolutely normal.
Ambivalence and mixed feelings (or contradictory behavior) don’t mean your
clients don’t want to change. Neither do they mean your clients are dumb, illogical,
“difficult”, and / or “not motivated.”
Change always involves competing drives and forces.
Unless you have a very specific, advanced / elite client population, most clients
will feel at least a bit “stuck” or conflicted. Many people will come to you having
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had some kind of recent painful confrontation with “needing to change”, but
they still may not be “ready, willing, and able.” And this can happen to all clients,
even if your client is an educated expert in the field of health / nutrition.
In fact, clients may not know why they are doing certain things. (“I start out
trying to eat healthy, and then… I dunno… it just kind of goes off the rails.”)
As a coach, you can help them:
•
normalize this ambivalence and understand that it’s okay — all part of the process
of change;
•
talk through this ambivalence, clarifying what’s actually going on and why the
ambivalence might be there;
•
identify the resistance, i.e., the forces that are acting against change;
•
understand that they might be invested in not changing right now, or attached
to ways of coping that might be working against their goals (e.g., emotional
eating, over-training, restricting food or rigidly controlling their diets).
Here are a couple of sample coaching scripts:
“Don’t worry, it’s pretty normal to have mixed feelings about changing. It happens
to everyone. In fact, most of the time, there are good reasons for not changing. I’d
be curious to hear about yours. If you want to make Change X, why haven’t you
made that change already? What do you think is blocking you from that?”
“It’s pretty common to want to change, then get blocked somehow. I’m here to help
get you un-blocked. Tell me more about where you seem to get stuck in particular.
You have great intentions, and want to do better, and then…? What happens? Talk
me through that.”
Talking through ambivalence
Coaching isn’t about always telling people what to do. In this case, coaching is
about collaborating with your clients to help them make changes.
Coaching is a dialogue — a conversation.
There are many ways to facilitate change through discussion. One that we
strongly recommend is Motivational Interviewing (MI). This style of dialogue
provides clients with a safe place to contemplate change.
A full description of MI is beyond the scope of this book. However, we strongly
recommend you check out William Miller and Stephen Rollnick’s classic textbook Motivational Interviewing: Helping People Change (3rd ed.), and / or even
look for an MI training workshop near you.
Motivational Interviewing
(MI): A directive, client-centered
counseling style for eliciting
behavior change by helping
clients to explore and resolve
ambivalence
However, here are a few small MI-style exercises you can try immediately. These
are designed to simply highlight ambivalence for clients, and get them thinking
about their dilemma in new ways.
If you’re interested in learning more about practical application of MI techniques, our Level 2 Master Class course covers MI in great detail.
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Use the ambivalence 4-square.
In the forms package, you’ll see two worksheets that
you can download and fill out with your clients.
The 4 Crazy Questions Worksheet: Simply ask your
clients four questions:
1.
What is GOOD about NOT changing?
2.
What might be BAD about changing?
3.
What is GOOD about changing?
4.
What might be BAD about NOT changing?
The Push-Pull Habit Anxiety Worksheet: With your
client, identify:
•
What is pushing them AWAY from their old ways of
doing things?
•
What is pulling them TOWARDS trying something
different?
What HABITS might they have to change to try this
new thing?
•
What ANXIETY does potential change create?
Show how two things are happening at
the same time.
Subtle changes in language can affect how your client
thinks about their situation.
Point out that this thing and that thing are both happening for your client simultaneously.
“On the one hand, you say you want to eat better. On the
other hand, you’re finding yourself getting a lot of takeout
food because you’re so busy.”
“So it sounds like you’d like to get back into ‘pre-baby
shape’ with healthy eating and regular workouts. At the
same time, you’re finding that raising a new baby is taking
all your energy, and your eating is inconsistent.”
“You’re trying to work towards X, and you feel like Y is
blocking you.” (Notice here how “and” is used instead of
“but.” Small but important difference.)
4 Crazy Questions Worksheet
NAME
•
Push-Pull-Habit-Anxiety Worksheet
DATE
NAME
C
DATE
(Adapted from Jobs To Be Done)
1. What is GOOD about NOT changing?
What is working for you with the status quo? What are the benefits of staying the same?
2. What would be BAD about changing?
If you changed, what might you have to give up or lose? How would your regular routine be disrupted?
3. What might be GOOD about changing?
If you changed, how would that be helpful or beneficial? What new opportunities or possibilities could open up?
4. What might be BAD about NOT changing?
If you didn’t change, what bad things could happen? If you keep going the way you’re going, what might things look like in the future
(say, 10 years from now)?
© 2018 ISSA issaonline.edu
Push
Pull
What is pushing you AWAY from your old ways of doing things?
What feels uncomfortable, annoying, and / or unworkable about your previous routine?
What is pulling you TOWARDS new ways of doing things?
What’s appealing about this potential change? What seems valuable, fun, useful, helpful, etc. about your goals?
Habit
To try something new, what old habits and routines would you have to change?
Thinking about how you normally do things, what would have to be different if you tried this new path?
Anxiety
When you think about changing or doing something new, what do you worry about?
What are your concerns and / or questions about changing?
© 2018 ISSA issaonline.edu
Find 4 Crazy Questions, Push-Pull-Habit-Anxiety, and other worksheets in your forms package
Nutrition: The Complete Guide
The ISSA Nutrition Coaching Methodology | 293
Develop discrepancy.
In MI, “discrepancy is the engine of change.”
To develop discrepancy, point out the gap between where the client is and where
they say they want to be.
discrepancy: Enables someone
to see that their present situation
does not fit with their values
For instance:
“Hmmm. Help me figure this out. You’ve mentioned that you want to be around
a long time for your kids and grandkids. It’s something you really value. So I’m
wondering — how does your current eating fit in with this?”
“Okay, so on your assessment form you say you eat ‘pretty healthy’, and that’s
definitely a priority for you. Now, when I look at the food journal, I’m noticing that
five evenings out of seven involved a fair bit of alcohol. Tell me about how you see
those two things matching up?”
Be careful to be neutral and non-judgmental here. You’re just observing the mismatch and being curious about it, not telling the client what they should be doing.
Don’t fight their resistance
Just roll with it. Be patient. Clients always have the option not to change. Paradoxically, often just knowing this makes them more willing to change.
“Okay, so it sounds like you’re not willing to do X right now. That’s totally cool. You
never have to do X if you don’t want to. We can try Y instead.”
You can also try negotiating and exploring. It may not be a solid “no”, but rather
a “no right now” or “no, but I didn’t realize I had other options.”
“Okay, so it sounds like you’re not willing to do X right now. That’s totally cool. Just
out of curiosity, would X done in a different way / place / time work for you? Would
doing X with a friend work for you? Could you ever see yourself doing X, maybe six
months from now? What about 10% of X? I’m just wondering. Feel free to say no.”
Don’t push against your client’s resistance. You’ll only meet more resistance.
Pushing includes things like:
•
“You should…”
•
“What you need to do is…”
•
“Look, I don’t see what’s so hard about this, you just have to…”
•
“Research says that if you don’t ___, you’ll end up in big trouble.”
Don’t try to “argue”, “persuade”, or “convince.” (Yes, even if you’re 100% correct
and it’s excruciating to keep your mouth shut. It doesn’t matter.)
If you’re working harder than the client to “make” them change, you’re coaching wrong.
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Expect “failure.”
Reframe
Mistakes, “failures”, screw-ups, challenges, setbacks,
roadblocks — whatever you call them, they’re inevitable.
We all have stories and scripts in our heads about “how
things work” or “what is going on here.”
Expect them and welcome them. Get curious and compassionate about them.
Our perceptions and ideas about our lives make up a
“frame” that limits what we think we can do. Or what we
choose to see.
These are opportunities to learn, iterate, and clarify the
coaching tasks.
Setbacks will tell you where the gaps in your client’s
knowledge and abilities are.
For example:
•
Did your client need to know more about the task?
•
Did your client not understand what to do?
•
Did you skip an important step in the process?
When you ask about where the setbacks happened, be
aware of vocal tone and word choice.
Don’t abruptly ask: “Why aren’t you doing what we
talked about?” (Unless you want an anxious, defensive
client.)
Instead, you might ask: “You mentioned that you weren’t
able to carry out the vegetable behavior we discussed.
Can you tell me more about this?”
Your client may object to something because they are
focused on what they can’t do, rather than what they
can. Although there are real solutions to nearly every
nutrition and exercise objection imaginable, once a client has made up their mind that their case is impossible,
their brains will shut down and accept failure.
They simply won’t be able to solve their own problem,
regardless of how easy or obvious the solution may seem
to you. For the client, the solution lies “outside the frame.”
They can’t see it.
So don’t get frustrated with them. Rather, understand
that the ideas and perceptions that make up their current frame prevent them from seeing the solutions to
their problems.
Help them “re-frame” their situation.
Reframing involves three parts.
1.
From that, you might learn:
•
The task might have been too difficult.
•
Or they forgot.
•
Or they didn’t know how to buy / prepare
vegetables.
•
Or vegetables taste boring to them.
Acknowledge the client’s concerns rather
than dismissing them outright. These obstacles
feel real to a client. If you brush the concerns off, the
client will probably feel embarrassed and / or more
resistant. But if you respect and recognize the concerns as valid, you’ll show empathy and create trust.
2.
Tell a different story about “how things
work” or “what is going on here.” Move from
This insight will guide your next actions.
focusing on the obstacles that hinder their progress
Again, we recommend you check out MI. But even
if you don’t right now, just remember: Coaching is a
conversation.
such as existing fitness knowledge, enjoyment of
•
Ask rather than tell.
•
Open a dialogue rather than giving a monologue.
•
Treat your client as a collaborator who is courageously facing the challenge of change, rather than an
unmotivated idiot who needs your coaching genius.
Nutrition: The Complete Guide
to the advantages that each client may already have,
cooking, or a flexible work schedule.
3.
Work with the client to solve perceived problems and develop strategies to get around
the obstacles. This also helps the client feel like an
active participant in the process.
You can reframe with openers like:
The ISSA Nutrition Coaching Methodology | 295
Table 10.5 Reframing
Client says / does...
You respond...
Client then responds...
“I want to eat more vegetables.”
“Tell me more about why you’ve already started to improve your diet?”
“Huh. Well. I guess I have started improving
already. I was reading the labels on yogurt the
other day...”
“I really tried to eat to 80% full today,
but fell off the wagon around dinner.”
“Wow, what made you decide to
listen to your hunger cues today?”
“Hm, I guess I woke up and I thought ‘Today,
I’m going to try to make it happen, just give it a
real effort, you know?”
“I used to eat better.”
“What was happening in the past,
when you were eating better?”
“I was really good about shopping for myself,
not getting a lot of takeout… which I guess I
could do more of now.”
“I don’t have time.”
“Sounds like you have a lot on the
go. How do you get everything
done?”
“I have to schedule everything! I use my calendar all the time.”
“Thanks for getting in touch! What
made you want to take the time to
call me back?”
“Well, I’d really like to get started… I know I
haven’t done it yet… but I want to…”
Nothing, but they take the time to
email or call you.
“That’s one way to look at it. Another way to look at it
is…”
“From my perspective, here’s how that looks…”
“Is there another story you could tell about that?”
A classic example is the client who comes to us having
“failed” at dieting.
Client: I suck. I can’t stick to a diet. I’ve tried so many and
have failed them all.
Coach: How many diets have you tried?
Client: Oh, I don’t know. I’ve just tried and tried for the
last 20 years.
Coach: Well, from my perspective, that’s actually very
impressive. You kept trying things that were difficult,
intimidating, and potentially upsetting for 20 years. You
persisted over and over and over again in the face of
setbacks. That tells me you really want to change and you
have quite a lot of resilience.
Client: I never thought of it like that.
Client in charge
A powerful reframe is the “client in charge” or “better
than expected” frame.
(Coach can then respond: “What about booking
time for grocery shopping?”)
We all want to be in charge of our own decisions. And
when you, the coach, can ask a client the right questions,
you can get them to talk themselves into changing.
Consider the following examples. Notice how the coach
draws the client’s attention to how they’re already on the
path to change, or demonstrating some ability to be a
little bit better.
By answering the coach’s question, the client is compelled to comment on their own change or motivation.
When they do that, they’re forced to realize that somehow, they are moving towards change, even just a little
bit. Or things aren’t as unworkable as they assume. See
Table 10.5 for more on reframing.
How to communicate
effectively
You may have guessed by now that effective and clear
communication is an essential part of coaching.
As a coach, you may be the first person a new client sees
when they decide to change their habits. Or, you may be
the latest fitness professional in a long (possibly disappointing and frustrating) line.
Either way, your role is very important. You may need
to give new clients a great introduction to the joy of
eating healthy and living actively. Or you may need to
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296 | Unit 10
un-do the damage of your clients’ previous experiences
with other fitness, health, and / or nutrition professionals and “experts.”
9.
To do this, you must communicate effectively, simply,
and encouragingly, particularly in these early stages of
assessment, triage, understanding, and action planning.
10.
them to show you or demonstrate if needed. You
may have to say things several ways to make it clear.
Make your messages clear, simple, and direct.
guage, and / or explain why it is important for them
to understand.
11.
Communicate for the listener, not for the
speaker. Create connection and understanding.
Use plain language. Avoid technical jargon or nutri-
2.
Get and keep your client’s attention. Use their
name, make appropriate eye contact and body lan-
Here’s how.
1.
Test that the client has understood you. Ask
tion industry buzzwords.
Don’t just speak to convince or impress someone.
Make your messages clear and consistent.
need to hear?
Imagine yourself in their position. What might they
Make your words match your actions and other
non-verbal cues.
3.
If you have expectations, state them clearly. If
you have underlying assumptions, test them first.
4.
Separate fact from opinion. (For example, “I
notice that you have been 15 minutes late to the last
two sessions” is a fact. “You are inconsiderate” is an
opinion.)
5.
Focus on one thing at a time.
6.
If you have feedback or relevant guidance,
8.
In Unit 9 and 10, we’ve given you a broad overview of the
ISSA Coaching approach and system.
In the next several units, we’ll take you step by step
through coaching different types of clients, at different
nutritional levels.
•
Unit 11 introduces you to the concept of nutritional
level.
•
Unit 12 covers Level 1 clients.
•
Unit 13 covers Level 2 clients.
like what the client is giving you, but it’s what you
•
Unit 14 covers Level 3 clients.
have to work with right now.
•
Unit 15 covers some special populations and top-
give it immediately.
7.
Putting it into practice:
What’s ahead
Be supportive and accepting. You don’t have to
ics, to help you further refine and deepen your
Speak to the client on their own terms. Listen
knowledge.
for and use their language. Mirror their non-verbal
cues and speech patterns a bit (though not enough
to be creepy or do that childhood game where your
little brother repeated everything you said). Figure
out how they learn best, and cater to that.
Then, we’ll also show you how to develop your own
practice.
•
coaching business and career.
•
Nutrition: The Complete Guide
Unit 16 shows you how to start building a sustainable
Unit 17 shows you how to keep learning for life.
The ISSA Nutrition Coaching Methodology | 297
Case study
Real people need patient, careful, empathetic coaching.
This means:
•
Doesn’t it taste disgusting? What do they do, put
a tuna in a blender? Gross!
•
Listening to the client’s needs and what they
want to accomplish.
•
This bottle has X mg of EPA / DHA. Is that right?
What about Y mg of EPA / DHA?
•
Learning how they live.
•
What about flax oil? Isn’t that good?
•
My doctor / pharmacist says the dose is too high.
•
I’m pregnant / nursing / taking other medications
/ etc. Is fish oil safe?
• Discovering what’s really important to them.
•
And then working together to create the right nutritional approach for them: personal and unique,
based on their goals and lifestyle.
It also means changing your approach and / or plan
when the data tell you to do so — as we had to do when
we changed a foundational habit in our Coaching program.
Clients used to start their Coaching journey with a supplement habit right off the bat. Our standard instructions were:
1. Take omega-3 fatty acids (usually liquid fish oil)
plus a multivitamin or probiotic.
2. Start now.
3. Do it every day.
As a research-based company, we’d done our homework. So we knew that supplementing would, in most
clients, kick-start better health and fat loss.
As health-conscious, fitness-oriented researchers who
make a living learning about this stuff, to us coaches,
taking fish oil and other supplements was obvious and
easy:
• We knew what fish oil was and why it was important.
•
We’d read the research and seen it help us and
our clients.
•
We knew where to get it and how to take it.
•
Most of us were taking it already anyway.
We’d all been taking fish oil for so long that the habit
had become a no-brainer.
Yet to most of our clients, this stuff wasn’t obvious or
easy in any way:
•
Wait… you can get oil from fish?
•
What does it do? Do I actually need that?
•
Where do you buy that? My small town doesn’t
have that. I need to drive 20 miles to the nearest
health food store.
So they “resisted.”
They got confused, anxious, rebellious. They asked
about what we thought were irrelevant details, demanded to see the supporting research, or got stuck on
“finding the perfect brand.” Some outright refused to
take the supplements.
We wondered why our clients were being so “difficult.”
Why didn’t they listen to us, the geniuses at ISSA?
We’d forgotten what it was like to be a client.
We’d forgotten that our clients had to learn, know, and
do dozens of things in order to understand, support,
and execute the fish oil habit consistently.
It was way too much, too soon, at the beginning of a
program that’s already full of new things — new software, new workouts, new community of people, new
coach, new way of eating, etc.
Our clients were already nervous. Unsure of themselves.
Laden with the baggage of past diet disasters. And confronted with change.
Asking them to do a task that was actually pretty complicated… well, it was doomed to fail.
And that failure was our fault.
We created resistance by asking too much, too soon.
Moral: There’s no one-size-fits-all habit.
Giving a few thousand people the same supplement as
the first in a long, overwhelming chain of new habits —
even if in general that supplement is safe and well-proven — was not a good approach.
Eventually, we realized: People hate being told what to
do. As soon as a “maybe” becomes a “must”, people
instinctively panic or rebel.
Clients need time to process and consider things — to
learn, understand, and decide for themselves whether a
given habit is right for them.
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So we went back to the drawing board. We realized
that, in order to guarantee our clients’ success, we need
to help them feel:
• safe and secure;
• autonomous;
• like what they’re doing has purpose and meaning;
With each tiny piece, clients get to decide for themselves:
•
Is this right for me right now?
•
If so, how can I do this consistently and well?
•
If not, how can I adjust it to match my needs?
• supported and guided;
Good news! Our clients liked this new direction. They’re
happier, more relaxed, and excited about being in
charge of their own progress.
• like they can go at their own pace; and
Fish oil is still a good supplement for most people.
• free to choose their own path, with expert help
available when they need it.
We still recommend it, along with a few other supplements.
Now, instead of telling clients what to do at the outset
and pushing them to do it, we ask them:
But it’s no longer a required habit for everyone. It’s an
option.
• What do you want?
• Where are you trying to go? How can we help
you get there?
•
Out of these available options, which one would
you choose? Why?
• What are you willing to do and not do right now?
• What would make a given habit work for you
right now?
We recognize that things that seem simple to us (such
as having a healthy kitchen or working out regularly)
are actually very complex behaviors for clients. Just like
the skills that are second nature to them (like software
design or knitting or building ice sculptures) would
take us coaches a long time to develop.
Each skill has to be learned, step by step, and divided
into several tiny pieces.
Now, we break tasks down and build skills cumulatively.
Each one is an experiment, not a “rule.”
Nutrition: The Complete Guide
Instead, we focus on:
•
building skills, crucial behaviors, and consistent
practices that can help people learn and do any
habit; and
•
helping people understand how to consciously
choose healthier behaviors that meet their needs,
wants, and lifestyles.
No matter how great a supplement, task, or exercise
program is — and we think fish oil is great — it’s no good
if clients can’t or won’t do it, or if it doesn’t match their
needs.
We pouted and snorted when our clients didn’t immediately jump through our hoops. Didn’t they know we
were the experts?
Then we got over ourselves and realized we’re here to
serve and guide… not be all-knowing dictators.
In other words: We shifted from being coach-centric
(i.e., proving ourselves “right,” or establishing our authority) to being client-centric (i.e., helping our clients
find the right path for them).
The ISSA Nutrition Coaching Methodology | 299
Summary
Fundamentally, nutrition coaching is about two things:
1.
Helping people change.
2.
Helping them take meaningful action in their own
lives.
You have six general coaching tasks:
As part of the coaching process, you will need to help
clients:
•
identify and clarify their values, priorities, and goals;
•
define what “progress” is, and how to measure it;
•
set realistic expectations and decide on trade-offs.
Choosing a direction for coaching and building an early
action plan starts with:
•
Step 1: Assess and gather data.
•
Step 2: Understand the client and “build the story.”
•
identifying small wins and “bright spots”; and
•
Step 3: Create an action plan and possible “next
•
identifying limiting factors
steps.”
•
Step 4: Choose one next action step and test it.
•
Step 5: Observe and monitor what happens.
•
Step 6: Use outcome-based decision making.
Assessment and triage, which includes gathering information as well as sorting clients into nutritional levels, is
an essential first step.
Make sure the client is ready, willing, and able to do any
action suggested.
Ambivalence and “mistakes” are both normal and natural parts of the process of change.
Coaches communicate clearly and effectively.
International Sports Sciences Association
UNIT 11
Nutritional Levels
Nutritional Levels | 301
Unit Outline
1.
Working with nutritional levels
2.
Case study
3.
Summary
Objectives
In this unit, you’ll learn about the concept of nutritional
of each group, and some important caveats about
level (Levels 1, 2, and 3) and why it is so important to sort
progression.
clients appropriately. You’ll learn the various characteristics
Working with nutritional levels
In the previous unit, you learned about assessment and
triage. We suggested that you sort clients into the right
nutritional level at this early phase. In this unit, we’ll
take a closer look at the idea of nutritional level and
how it works.
You’ll learn about the specific levels in upcoming units.
•
Unit 12: Level 1 clients
•
Unit 13: Level 2 clients
•
Unit 14: Level 3 clients
The nutritional level concept
A nutritional level is like a stage of development. We
divide clients into three nutritional levels (aptly named
Levels 1, 2, and 3), based on:
•
Goals: What clients want to do
•
Knowledge: What clients know
•
Competence and skill: What clients can do
•
Consistency: What clients can do, repeatedly and
well
This distinction is crucial.
Many clients will have the first three categories nailed
down, but don’t follow through consistently enough to
get the results they desire. Most often, consistency is the
factor that tells you which level your clients are in.
Why nutritional level is so important
You must know what level your clients are at, and
structure their programs accordingly.
Different nutritional goals, and different starting points,
require different tasks, effort, skill, diligence, and
consistency.
You’ll see what we mean in a minute.
What you need to know about
nutritional levels
Nutritional level is progressive.
Each level builds on the previous one, step by step.
As clients master basic skills and learn to do them consistently, they build a base.
Nutritional level is about the quality of the
process.
In 1980, Rosie Ruiz won the women’s division of the
Boston Marathon with a time of 2:31:56. This was the
fastest women’s time in Boston Marathon history as well
as the third-fastest women’s time ever recorded in any
marathon. Even more remarkably, this was a 25-minute
improvement over her New York City marathon performance six months prior.
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Wow, great results.
Just one problem: Ruiz never ran the Boston marathon,
or the New York marathon. Turns out, she’d just hopped
on the NYC subway and then sneaked back into the race.
Trying to get great results without having fundamental
skills and a consistent, repeatable process is like trying
to win a marathon by having someone drive you to the
finish line. It looks good for a few minutes, until you’re
busted.
Quality process leads to quality outcomes.
Most clients never need to progress any
further than Level 1.
We strongly encourage you to focus on the
fundamentals.
Mastering the basics and doing them consistently is
almost always enough for optimal fitness, health, body
composition, performance, and life balance.
For instance, consider this large survey done in North
America. Guess how many people meet the following
four criteria?:
Every link in the behavior and mindset chain should be
solid.
•
Don’t smoke tobacco
•
Eat five servings of fruits / vegetables daily
A client who tries to “white-knuckle” or cheat their
way into a lean body or a top athletic performance will
eventually crash.
•
Exercise five times a week for 30 minutes
•
Maintain a healthy body-weight
At best, they gain some weight back, get a minor injury
or illness, or spend a few weeks of quality time with the
cookie jar.
At worst, they wreck their physical and mental health
and spend months or years recovering.
(Rosie Ruiz never really got in shape, and she never tried
to run another marathon.)
You must always start at the beginning.
This is a step-by-step progression that always begins
with the easiest and simplest steps, and at the lowest
level.
Do not give a Level 1 client a Level 2 program. They
will fail.
Level 1 clients will not be ready, willing, nor able to do
more complex tasks. (Even if they think — perhaps even
insist — that they are.)
Your clients should be winning at every stage, and doing
every task you give them. Their process should eventually be bulletproof and their results should show it.
Success should breed success.
“Failure” is not only demotivating for clients, it sets up
a dangerous cycle of compensation and control. Clients
may “fall off the wagon” immediately if the program is
too complicated, rigid and restrictive. Or hang on for a
few weeks, then have a spectacular blowout.
Nutrition: The Complete Guide
Only 3% of North Americans were doing this simple
four-part combination of basic healthy lifestyle tasks.
That’s just four basic things. Never mind all the other stuff like sleeping, eating enough protein, having a
healthy mindset, and so forth.
Most people don’t need complexity.
They need help with the absolute basics of a healthy,
sustainable lifestyle.
Even clients who can progress to Level 2 or 3
may only be there briefly.
For most people, living permanently at Level 2 or 3 is
impossible… and even if it’s possible, it’s usually a bad
idea. Trying to live at Level 2 or 3 — which, again, most
people can’t even do — creates serious disordered eating,
mental health issues (such as anxiety and obsession), and
often physical harm. It disrupts work, relationships, and
other life pursuits.
Past a certain point, “healthy eating” is not healthy.
Clients must demonstrate skill, competence,
and consistency at each level before being
allowed to progress.
You don’t get to enroll in calculus if you haven’t mastered basic arithmetic.
You don’t get to pass your driver’s test if you can’t park
the car or change lanes.
Nutritional Levels | 303
Likewise, don’t let a client move to Level 2 if they can’t
eat vegetables consistently, or are sleeping six hours a
night.
The word “demonstrate” is important here. It’s not
enough for a client to say they’re doing something. “I eat
pretty well” is worthless.
We like two magic words: “Show me.”
“You’re eating your protein at every meal,
consistently? Great! Show me your photo food
journal.”
“You’re following your workout plan? Great!
Show me your workout notebook.”
“You ate slowly to 80% full at every meal for
the last month? Great! Let’s grab the measuring
tape and skinfold calipers and check it out.”
•
Competence and skill: What clients can do
•
Consistency: What clients can do, repeatedly and
well
To figure out a client’s level, use a mix of objective and
subjective assessment.
Some factors can be measured (e.g., body composition,
athletic performance). Other factors will be based more
on a feeling after you get to know them (e.g., their history with food, their lifestyle, their mindset).
It’s not clearly defined; there are gray areas. Use your
coaching intuition, wisdom, and gut instinct.
Most importantly:
•
your client is. Fundamentals first, always. You can’t
do Level 2 tasks unless and until you have mastered
Level 1 essentials.
Talk is cheap. Perceptions are often wrong.
The only thing that counts is data.
•
Once again, your criteria should be:
•
Goals: What clients want to do
•
Knowledge: What clients know
When in doubt, go backwards. And always regress a client to a lower nutritional level, rather than
assuming they can handle more complexity.
Show me.
How to assess nutritional level
Always start with Level 1 tasks, no matter who
•
Clients must be able to demonstrate that they
can do assigned tasks consistently. Saying they
can do it, or knowing information about the tasks, is
not enough.
Table 11.1 provides an overview. We go into more depth
later.
Can you judge nutritional level from body composition alone?
Humans are remarkably diverse. Clients come in all
shapes, sizes, ages and backgrounds.
Body composition is one tool that we can use to assess a
client’s nutritional level.
On the one hand, it’s a useful tool.
You can measure body composition objectively, using
tools such as body girths, skinfold calipers, BIA, DEXA
scans (which can also tell you about bone density), functional MRI, and so forth.
The American Council on Exercise distinguishes body fat
percentages by levels of athleticism.
Description
Women
Men
Essential fat
10–13%
2–5%
Athletes
14–20%
6–13%
Fitness
21–24%
14–17%
Average
25–31%
18–24%
Obese
32%+
25%+
A recent study found that the average American man
had about 28% body fat, while the average American
woman had about 40%.
Body composition can indeed give you clues about
International Sports Sciences Association
304 | Unit 11
Table 11.1 Overview of nutritional levels
Goals
level 1
level 2
level 3
Improve general athletic performance and recovery
High-level recreational / amateur
athletic performance and / or
physique competition
Elite / professional athletic performance and career
Elite / professional physique
/ fitness competition and / or
modeling career
Level of athletic
performance or body
composition required
Daily-life function; regular
activity
Dedicated recreational / amateur
athlete
Elite / professional; nationally or
internationally competitive
Body composition
desired or required1
Normal, sustainable, metabolically healthy to lean-healthy
body composition
Lean-athletic
Extreme leanness and / or
muscularity
Men: 13-20% body fat
Women: 17-22% body fat
Men: 8-12% body fat
Women: 23-30% body fat
Men: below 8% body fat
Women: below 17% body fat
Training load
<6 hours a week
6-12 hours a week
12-20 hours a week or more
Knowledge
None to moderate
Moderate to high2
Expert3
Competence and skill
None to moderate
Moderate
High
Can do simple tasks when given
clear instructions and the coach
monitors completion
Can do complex tasks when
given clear instructions and the
coach monitors completion
Follows a complex plan to the
letter
Can do simple tasks easily
and intuitively, often without
supervision
Consistency
None to moderate
Moderate
High
Can do simple tasks up to 75% of
the time
Can do simple tasks 90% of the
time or more
May struggle to sustain habits or
“stay on track”
Can do more complex tasks up
to 75% of the time
Can do any task, no matter how
complex, 90% of the time or
more
Has a base of sustainable habits
and a consistent foundation of
essential behaviors
Mindset / psychology
“I have a lot of questions and / or
worries.”
“Many things are distracting me
from full focus on this.”
“This is just one part of who I
am. I have a lot of other things
going on.”
Has a base of sustainable habits
and a consistent foundation of
essential behaviors
“I feel relatively confident.”
“Don’t ask; just do.”
“I can stay on track pretty well.”
“Everything is secondary to this.”
“This is a priority for me.”
“This is my life / job.”
“I want to be better than
average.”
“I want to be one of the best in
the world.”
Some; most major roadblocks
have been cleared
Everything in the client’s environment (routines, people, physical environment, etc.) supports
execution of tasks; client is 100%
dedicated to getting things done
and everything around them
facilitates that
“I just want to be healthier, fitter,
stronger, leaner, and / or better
at the stuff I do regularly.”
Limiting factors
Many
1 Note: Clients will vary widely in their body compositions depending on their age, sex, genetic makeup, etc. What is “unreasonably lean” for one person may
be another person’s “normal.” Look for natural tendencies and try to get a baseline of what is appropriate for each client. “Normal” is the body composition
that a client can easily and sanely maintain doing basic Level 1 habits consistently.
2 Most clients at Level 2 will have coaches. So the clients themselves need not be experts, but they should be guided by someone who is.
Nutrition:
Complete
GuideSo the clients themselves need not be experts, but they should be guided by someone who is.
3 Most clientsThe
at Level
3 will have coaches.
Nutritional Levels | 305
clients’ habits. A client who is 40% body fat probably
doesn’t exercise every day.
Conversely, a heavyweight strength athlete may have
superb conditioning and metabolic health.
But we shouldn’t rely on body composition alone.
What does this mean for you?
A lean body isn’t always a fit or healthy body, or belong to a person with good habits. A body with more
fat isn’t always an unfit or unhealthy body.
Testing body composition is part of that client’s story.
But it isn’t the entire story.
For instance, a teenage male may stay lean easily,
despite an exercise routine of video games and a diet of
Pizza Pockets.
Conversely, a fit and active woman in her 70s may have
lower bone density and more body fat, but still be in
great shape with excellent lifestyle habits.
A light body doesn’t mean a fit or healthy body. A big
or heavy body isn’t always an unfit or unhealthy body.
Clients can have a low Body Mass Index (BMI) yet
still be unfit and unhealthy. For instance, a client who
has lost weight during chemotherapy is hardly a model
of athletic performance and wellness.
Even if your client is leaner, start with Level 1 approaches. Why?
You want to make sure they’re doing all the basics consistently.
You may be able to get them into fantastic shape with
only a few fundamental behaviors. Why make it any
more complicated than it needs to be?
Body Mass Index (BMI): A weight-to-height ratio used
as an indicator of healthy body size. It’s calculated by
dividing one’s weight in kilograms by one’s height in
meters squared
Level 1: Essential skills and building a foundation
What you need to know about Level 1
Most clients are Level 1s.
Even if clients say they’re “more advanced”, they probably aren’t. (Check their consistency, lifestyle, and mental
health. You’ll find Level 1 stuff to work on. Trust us.)
Level 1 is about basics. Fundamentals.
Level 1 tasks build the essential skills that all clients need
in order to sustain good health, a lean and strong body,
and athletic performance for life.
Level 1 coaching is about
•
making nutritional change do-able;
•
creating a solid, repeatable, high-quality process;
•
ensuring ongoing success (because clients can almost
always do the assigned tasks);
•
building foundational skills that clients can do sustainably for life; and
•
helping clients be consistent enough to do what they
want to do.
Most clients — even athletes — can and should
stay at Level 1 forever.
You can get (and more importantly, sustain) great results
from Level 1 basics, done consistently.
Clients never need to “graduate” to the next level.
Most clients don’t need complexity and can’t
do it anyway.
Make things as simple as possible, not as complicated
as possible.
Level 1 skills and tasks aren’t the sexy, headline-grabbing stuff of “instant” body transformation. In fact, they
might seem a little boring sometimes.
But remember, nutrition coaching isn’t about using cool
and / or fancy nutrition strategies just because you can.
And it’s not about demonstrating your depth of knowledge by having clients try complex dietary approaches,
unless this is what the client needs and can actually do,
consistently.
This should be — and feel — easy for clients.
International Sports Sciences Association
306 | Unit 11
Level 1 coaching tasks
Most Level 1 clients will have one or more of the limiting
factors and needs detailed in Table 11.2. (In fact, you
might have several of them yourself.)
The center and right-hand columns show the types of
tasks you could assign to your Level 1 clients, as well
as what skills they need to master in order to move to
Level 2. See Figure 12.2: Hand sized portions for a better
understanding of the size references we use.
Table 11.2 Level 1 coaching tasks
Level 1 clients struggle with...
So help them with...
Sample coaching tasks could be...
Replacing processed foods with whole,
minimally processed foods (such as fruits
and vegetables)
Find two whole-food substitutes for processed foods you commonly eat right now
(e.g., an orange instead of orange juice)
Building a roster of high-quality, nutrient-rich foods that the client enjoys and
will reliably eat
Eat 1-2 palms of lean protein at each meal
Food choices
Eating too many processed foods
Not eating enough nutritious,
whole, minimally processed foods
Not meeting basic nutrient
needs (macronutrients and
micronutrients)
Supplementing to fix basic deficiencies
Creating meal templates that “cover the
bases” (e.g., protein, healthy fats, colorful
plants)
Add two servings of colorful fruits and /
or vegetables to your daily menu
Take a multivitamin / multimineral supplement every day
Addressing any major “nutrient leaks”
(e.g., nutrient depletion from activity or
medications, GI malabsorption)
Getting dehydrated1
Drinking more water
Drinking too many sugar-sweetened drinks
Exploring better-quality drink options
Drinking too much alcohol;
“drunkorexia”2
Not feeling satisfied by their meals
Cutting back on alcohol3; adjusting social
drinking behaviors
Creating satisfying, nutrient-rich meals
and eating them properly — slowly, mindfully, with enjoyment
Drink a glass of water when you get up,
and one at each meal
Progress from regular to diet soda, then
to soda water
Add 1-2 thumbs of healthy fat to each
meal
Include a cupped handful of slow-digesting, high-fiber carbs at each meal
Eat slowly and chew thoroughly
Eating behaviors
Eating too quickly and while
distracted
Slowing down and focusing
Add 5 minutes to each meal
Recognizing their physical hunger
and fullness cues
Appetite awareness
Keep a hunger / fullness journal for a
week
Irregular eating habits (missing
meals or not eating enough at
some times and / or eating too
much at other times)
Creating a regular, balanced eating
schedule
Eat every 3-4 hours
Disordered eating (restricting,
purging, orthorexia, controlling,
bingeing, etc.)
Creating “normal”, healthy, balanced
eating habits and mindset
Sit with uncomfortable feelings for 10
minutes
Nutrition: The Complete Guide
Eliminate meal-time distractions (e.g., TV)
Work directly with an eating disorder
counselor (along with nutrition coaching)
Nutritional Levels | 307
Table 11.2 Level 1 coaching tasks
Level 1 clients struggle with...
So help them with...
Sample coaching tasks could be...
Over-eating
Awareness of physical fullness and satiety
Pause for 10 minutes after each meal to
notice fullness
Appropriate portion sizing
Use food to manage feelings
Use hand size portions of nutrient-dense
foods template4
Separating food from feelings; learning
to regulate and express their emotions in
healthier ways
Keep a “food and feelings” journal for a
week
Getting enough regular physical
activity
Adding activity to their daily lives and
building consistent exercise habits
Commit to X minutes of activity each day
as a minimum
Over-training and not managing
training loads
Balancing intensity and recovery; addressing chronic injuries
Work under the supervision of a coach /
trainer to properly plan training program
Choose and practice 1 other option for
noticing, expressing, and regulating
emotions (e.g., writing, drawing, talking
to friend)
Exercise and activity
Do rehab exercises 5-10 minutes daily
Recovery
Not getting enough sleep
Building a sleep ritual and good sleep
behaviors
Schedule and do a pre-bed sleep ritual
each day
Sleeping 7-9 hours a night consistently
Get outside at morning and mid-day for
10 minutes each of bright light exposure
Boosting nutritional quality
Add daily omega-3 supplement
Adding regular recovery-type activities
(e.g., massage, yoga)
Add 10 minutes of relaxation and mobility
work daily
Basic food preparation skills
Learning to cook and prepare food
Learn to cook, then practice, 2 “go-to”
meals
Basic shopping and food awareness skills (e.g., reading labels)
Learning to shop efficiently and effectively; being an informed food consumer
Shop with a shopping list
Not getting enough recovery
Life skills
Try a farmers’ market
Read labels at the grocery store
Not being able to ask for what
they want and need; not being
able to define clear boundaries
with others (e.g., people pushing
food; other household members
sabotaging or criticizing)
Learning to communicate effectively and
clearly, learning to define boundaries and
expectations with others
Work with coach to practice crucial conversations with family, friends, coworkers,
etc. who are sabotaging
Making impulsive choices, feeling
“too busy” or “too rushed”, not
having good options available and
convenient
Planning and preparation; time management; thinking proactively
Schedule key activities in calendar
Making choices on a continuum; trying
to be “just a little bit better”; looking for
incremental improvement
For each decision, ask, “What would be a
bit better?” and “What would be a little
bit worse?”
Having self-compassion
Notice and name self-critical thoughts
Weekly and / or daily ritual of food (and
life) prep and planning
Mindset / psychology
All-or-nothing thinking (e.g., yoyo dieting, restrict-binge cycles,
big “diet challenges”, weekend /
night-time over-eating, “Either I’m
perfect or I’ve failed” mentality)
5 minutes of self-compassion practice
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Table 11.2 Level 1 coaching tasks
Level 1 clients struggle with...
So help them with...
Sample coaching tasks could be...
Fixed mindset (I’m broken; I don’t
have what it takes; I’m a failure,
etc.)
Adopting a growth mindset (anything is
possible; just keep practicing and trying)
Refer to habits as “experiments”, “games”,
and / or “practices”
Not being consistent
Achieving consistency
Track consistency for assigned task daily;
reward consistent execution rather than
“being perfect”
Busy-ness and stress; overwhelming life demands; feeling rushed
and pressured
Slowing down, prioritizing, being more
mindful and choice-ful
Taking a 5 minute “time out” to practice
relaxation and refocusing
Daily review of goals and motivators
Having “on the road” or “last-minute”
strategies for travel and unexpected
obstacles
Environment
An environment that requires
too much active “willpower” and
mental strength to stay on track
Creating environments and surroundings
that support their goals
Kitchen cleanout (with coach present if
possible)
Making better choices simple, easy and
convenient
Stocking up on convenient healthy options (e.g., pre-washed baby veggies)
Unsupportive social networks
(family, friends, coworkers, etc.)
Finding “fit friends” and “team members”
Joining a group exercise class or activity
meet-up (e.g., a hiking group)
1 This is especially important for clients who eat a lot of processed foods, which usually have a lot of sodium.
2 Drunkorexia means eating less in order to be able to drink more without gaining weight. It’s especially common among younger women.
3 Note: This can be a tricky area to address. Many clients fall into the category of “problem drinker” and are often reluctant to change their alcohol
habits, even just a little bit. You may find that it works better to refer out to an addictions counselor if this is a serious problem for your client.
4 You can find Hand-Sized Portion Guide in your forms package.
Level 2: Getting leaner, boosting performance
Once your client can do all the Level 1 behaviors well
and consistently, they can progress to Level 2.
Level 2 approaches are mostly about looks and
/ or performance.
What you need to know about Level 2
Level 2 clients want to get leaner or improve athletic
performance beyond what they can do with the Level 1
approach.
Most clients do not need to go further than
Level 1.
Yes, we harp on this, but it’s important.
More than likely, 90-95% of your clients will thrive at
Level 1, and get all the results they need and want. They
can stay at Level 1 forever, happily, sanely, and healthily.
Nutrition: The Complete Guide
Level 2 strategies don’t make clients any healthier or give
them a better quality of life.
Indeed, depending on how far someone takes them...
Nutritional Levels | 309
Level 2 (and Level 3) behaviors can become
actively unhealthy.
Level 2. (You’ll see what we mean when you review the
list of Level 2 behaviors in Table 11.3.)
If a client engages in Level 2 (or 3) behaviors too stringently and aggressively:
As a coach, it’s your role to inform your clients
about all the trade-offs.
•
Body fat can start to drop too low. Hormones and
recovery can be disrupted.
•
Behaviors, thoughts, and feelings about food,
eating, and training can become disordered. Your
client may start to have mental or emotional health
problems such as anxiety, depression, and / or OCD.
•
Social relationships and other interests — which we
need for overall wellness and quality of life — may
suffer.
Level 2 behaviors are usually short-term
strategies.
Generally, clients do Level 2 tasks for a specific, shortterm goal, such as a competition, or to support higher
levels of athletic training at certain times in their competitive season.
Few clients can live consistently, sanely, and happily at
Help clients know what to expect and look for as they
progress into Level 2 habits. Keep it real.
Monitor clients carefully.
At Level 2, most clients should be keeping some type of
record of what they are doing.
Track your client’s physical, psychological, and social
indicators closely. (More on that in Unit 13.) Make outcome-based decisions using data.
Have an “escape plan” at all times to help guide your
client back to balance if needed.
Level 2 coaching tasks
At this stage, you’ll have to adjust some Level 2 tasks for
fat loss, athletic performance, and / or mass gain. We’ve
given you some notes in the table.
Table 11.3 Level 2 coaching tasks
Level 2 clients can consistently...
So the “next level” involves...
Sample coaching tasks could be...
Make mostly nutritious food choices
Refining food and nutrient quality
Choose mostly organic
Choose grass-fed / pastured / wildcaught meats, poultry, fish, seafood,
eggs, dairy
Eat mostly whole, minimally processed
foods
Eating almost entirely whole, minimally
processed foods
Eliminate almost all processed foods
(except for sports supplements, e.g.,
protein powder)
Cook most of the week’s menu from
scratch
Meet basic nutrient needs (macronutrients and micronutrients)
Adding phytonutrients, zoonutrients,
myconutrients
Testing for nutrient status and supplementing specifically
Expand the colorful fruit and vegetable
repertoire
Choose grass-fed / pastured / wildcaught meats, poultry, fish, seafood,
eggs, dairy
Review lab test results of nutritional
status; create a targeted supplement
plan
Stay hydrated
Drink mostly non-caloric beverages
Decreasing caffeine intake
Minimizing and / or completely eliminating caloric beverages
Switch to green tea from coffee
Cut out or drastically minimize alcohol
intake
Food choices
International Sports Sciences Association
310 | Unit 11
Table 11.3 Level 2 coaching tasks
Level 2 clients can consistently...
So the “next level” involves...
Sample coaching tasks could be...
Feel satisfied by their meals
For fat loss: Feeling slightly less than
satisfied by their meals
For fat loss: Leave the table feeling a
little hungry; accept the presence of
low-level hunger much of the time
For mass gain: Feeling a bit too full
For mass gain: Leave the table feeling a
little overstuffed; accept the presence
of fullness much of the time
For fat loss: Slowing down even more
Add 5-10 more minutes to usual meal
time
Eat entirely without distractions
For mass gain: Speeding it up
Shorten meal times; focus completely
on getting the food down before satiety signals kick in
For fat loss: Going into the “hunger
zone”
For fat loss: Practice tolerating the discomfort of mild to moderate hunger
For mass gain: Ignoring fullness cues;
eating even if not hungry
For mass gain: Ignore fullness cues;
stick to an eating schedule even if not
hungry
For fat loss: Experimenting with occasional intermittent fasting
Once a week, skip breakfast or dinner
For mass gain and / or athletic performance: Sticking to a regular eating
schedule
Athletic performance and mass gain:
Eat every 3-4 hours, especially around
training
Closely monitoring eating psychology
and mindset
Staying alert for any compensatory
behaviors (e.g., bingeing, purging,
over-exercising)
Keep a daily record of eating behaviors,
thoughts, and feelings
Keep a daily record of all training and
activity
Be active regularly for at least 60 minutes a day
For fat loss: adding more activity
Add a 30-minute walk daily
Manage training loads
Having all training under the supervision of coach / trainer
Schedule 10-15 minutes more of active
recovery daily
Follow specified training and recovery
program
Sleep 7-9 hours
Adding 15-30 minutes of sleep or improving sleep quality
Daily nap
Supplement to enhance sleep (e.g.,
ZMA, L-theanine)
Refine sleep ritual
Get enough basic recovery
Adding recovery protocols1
Add peri-workout nutrition (BCAAs for
fat loss, carb + protein drink for muscle
gain and / or athletic performance)
Foam rolling for 10 minutes daily
Record daily recovery indicators (e.g.,
sleep quality, HRV)
Manage stress productively and
effectively
Adding stress management protocols
Add 10 minutes of relaxation / mindfulness
Practice time management and
prioritization
Eating behaviors
Eat at a moderate pace, without too
many distractions
Recognize physical hunger and fullness
cues
Maintain regular eating habits
Have a relatively sane, healthy mindset
about eating for performance or body
composition changes
Separate food from feelings
Exercise and activity
Recovery
Nutrition: The Complete Guide
Nutritional Levels | 311
Table 11.3 Level 2 coaching tasks
Level 2 clients can consistently...
So the “next level” involves...
Sample coaching tasks could be...
Prepare basic meals and menus
Improving meal preparation and planning skills
Add 5 meals to “go-to” roster
Try a new cooking challenge (e.g., new
food, new prep method)
Shop efficiently and be aware of food
quality
Improving shopping options
Improving food quality
Shift more food purchases towards
local / organic / seasonal, farmers’
markets, etc.
Choose grass-fed / pastured / wildcaught meats, poultry, fish, seafood,
eggs, dairy
Ask for what they want and need
Define clear boundaries and priorities
Establishing Level 2 tasks as priorities
and negotiating with others
Have a crucial conversation with family
and friends about Level 2 priorities
and tasks; set clear expectations about
what this will involve (e.g., removing
“junk food” from the house)
Make thoughtful, informed choices
Ensure that good options are available
and convenient
Establishing purpose; setting clear
priorities and abiding by them
Making the decision process as easy
and streamlined as possible by eliminating unwanted options
Daily goal review
Make as many decisions in advance as
possible; leave fewer things to chance
(e.g., plan meals beforehand)
Hire a meal delivery service
Cut down on restaurant meals
Think on a continuum from “better” to
“worse”
Continually moving along the continuum towards “better”
Identify choices that are “just a little bit
better” and make them consistently
Have a growth mindset
Seeking continual refinement and improvement of process and self-awareness
Using outcome-based decision making
Weekly review and retrospective with
coach; outcome-based decision making
Try to improve one small part of the
process each week, based on data
collected from the week before
Repeat a quality process
Tightening up the process:
a) Looking for inefficiencies and remove them
b) Adding more process metrics and
tracking them
Weigh and measure food portions
Create and use a checklist for important processes (e.g., taking supplements)
Record ongoing food and other logs;
coach to review these weekly (or as
appropriate)
Organize most of their life around executing Level 2 tasks
Planning, prioritizing, and scheduling
Cutting back on lower-priority activities and other demands
Schedule not only workouts but also
food prep times, recovery times, sleep
ritual, etc.
Keep a 1-week time diary
Remove 1 low-priority “time sucker”
based on results of time diary
Maintain an environment that enables
Level 2 choices
Further refining environment along
with schedules and systems
Kitchen cleanout and organization
(e.g., supplements packed into pill
holders)
Add home exercise options
Access supportive social networks
(family, friends, coworkers, etc.)
Getting more coaching
Finding more teammates
More frequent coaching check-ins
Add a coach for other aspects of goals
(e.g., sport-specific skills coach)
Work with a team, group, and / or
support network (e.g., running group,
competition team)
Life skills
Mindset / psychology
Environment
1 At this point, much of what you’re adding for Level 2 clients are additional stressors. They’re training and potentially competing more (which may
also involve things like travel). If they’re trying to change body composition dramatically, they’re either eating much less or much more than is comfortable for their body. All of this can cause other stresses such as financial stress, relationship stress, and time management stress. So this recovery
angle is critical.
312 | Unit 11
Level 3: Elite performance
Once clients can do all the Level 2 behaviors well and consistently, and if they
absolutely need to do these protocols in order to compete and perform at the elite /
professional level, they can progress to Level 3.
What you need to know about Level 3
Level 3 approaches are mostly about looks and / or performance.
Level 3 clients want to get leaner or improve athletic performance beyond what
they can do with the Level 2 approach. Level 3 strategies definitely don’t make clients any healthier or give them a better quality of life. Indeed, depending on how
far someone takes them...
Level 3 behaviors can become actively unhealthy.
If a client engages in Level 3 behaviors too stringently and aggressively:
•
Body fat can start to drop too low. Hormones and recovery can be disrupted.
•
Behaviors, thoughts, and feelings about food, eating, and training can become
disordered. Your client may start to have mental and emotional health problems such as anxiety, depression, and / or OCD.
•
Social relationships and other interests — which we need for overall wellness
and quality of life — may suffer.
Level 3 behaviors are usually short-term strategies.
Generally, clients do Level 3 tasks for a specific, short-term goal, such as a competition, or to support higher levels of athletic training at certain times in their
competitive season.
Few clients can live consistently, sanely, and happily at Level 3. In fact, no one is
meant to live at this level. (You’ll see what we mean when you review the list of
Level 3 behaviors in Table 11.4.)
As a coach, it’s your role to inform your clients about all trade-offs.
Help clients know what to expect and look for as they progress into Level 3 habits.
Keep it real.
Monitor clients carefully.
At Level 3, all clients should be working under supervision and keeping detailed
records of what they are doing.
water manipulation:
Intentionally consuming more
or less fluids, along with certain
nutrients, in order to lose or gain
weight
Nutrition: The Complete Guide
Track your client’s physical, psychological, and social indicators closely. (More
on that in Unit 14.) Make outcome-based decisions using data.
You’ll notice that many of these coaching tasks (such as water manipulation or
caloric restriction) put your client at risk.
Nutritional Levels | 313
Working with your Level 3 client to decide on acceptable
risk in advance and have an “escape plan” at all times to
help guide your client back to balance if needed.
Level 3 coaching tasks
At this stage, you’ll have to adjust some Level 3 tasks
for fat loss, athletic performance, and / or mass gain.
We’ve given you some notes in the table.
Table 11.4 Level 3 coaching tasks
Level 3 clients can consistently...
So the “next level” involves...
Sample coaching tasks could be...
Following a very detailed, very specific meal plan with all choices tightly
controlled
Follow this meal plan exactly
Food choices
Follow a basic meal template using ISSA-style portion sizes and food options
Weigh and measure all food.
Cycle calories
Cycle macronutrients (usually carbs /
fat)
Meet basic nutrient needs (macronutrients and micronutrients)
Testing for nutrient status and supplementing specifically
Follow this specific, targeted supplement plan exactly
Choose only approved supplement
brands
Stay hydrated
Drink mostly non-caloric beverages
Following specific hydration
recommendations
Manipulating water levels to cut weight
or change the look of a physique
Cut out caffeine except as a training aid
Cut out alcohol
Rehydrate with this exact recipe for a
hydration solution
Follow this specific, detailed water
weight cutting protocol exactly
For fat loss: Tolerate being almost constantly hungry
Consistently eating a lot less than the
body needs / wants
For fat loss: Leave the table feeling a
little hungry (or even quite hungry);
accept the discomfort of hunger much
of the time
Intermittent fasting
For mass gain: Tolerate being too full
Consistently eating a lot more than the
body needs / wants
For mass gain: Leave the table feeling a
little overstuffed; accept the discomfort
of fullness much of the time
Having all training under the supervision of coach / trainer
Follow specified training program
exactly
Adding 15-30 minutes of sleep or improving sleep quality
Daily nap
Exercise and activity
Manage training loads
Recovery
Sleep 7-9 hours
Allowing the risk of not sleeping
Supplement to enhance sleep (e.g.,
ZMA, L-theanine)
Refine sleep ritual
International Sports Sciences Association
314 | Unit 11
Table 11.4 Level 3 coaching tasks
Level 3 clients can consistently...
So the “next level” involves...
Sample coaching tasks could be...
Get enough basic recovery
Following specific recovery protocols
Add peri-workout nutrition (BCAAs for
fat loss, carb + protein drink for muscle
gain and / or athletic performance)
Allowing the risk of not recovering;
pushing into the “danger zone”
Foam rolling for 10 minutes daily
Record daily recovery indicators (e.g.,
sleep quality, HRV)
Decide the cutoff in advance for what
is tolerable (e.g., minor injuries okay;
major injuries mean stopping Level 3
protocols)
Life skills / environment
Plan and prepare meals
Preparing and planning all meals
Cut out restaurant meals
Plan and prepare all meals for the week
in advance (or hire a meal prep service)
Establish clear priorities and
boundaries
Focusing exclusively on Level 3 goals
and priorities
Create and maintain a supportive
environment
Making sure everything in environment
supports goals
Cutting out all things that don’t support these
Make thoughtful, informed choices
Ensure that good options are available
and convenient
Establishing purpose; setting clear
priorities and abiding by them
Making the decision process as easy
and streamlined as possible by eliminating unwanted options
Set clear expectations with family and
friends about eating, training and competition schedule, etc.
Create a highly systematized, structured daily routine
Eliminate all distractions / triggers from
immediate surroundings
Daily goal review
Make as many decisions in advance
as possible; leave almost nothing to
chance
Limit choices1
Mindset / psychology
Have a growth mindset
Repeat a quality process
Seeking continual refinement
and improvement of process and
self-awareness
Weekly review and retrospective with
coach; outcome-based decision making
Using outcome-based decision making
Refine one small part of the process
each week, based on data collected
from the week before
Tightening up the process:
Weigh and measure food portions
a) Looking for inefficiencies and remove them
Create and use a checklist for important
processes (e.g., taking supplements)
b) Adding more process metrics and
track them
Record ongoing food and other logs;
coach to review these weekly (or as
appropriate)
1 You’ll notice that while Level 2 tasks sometimes involve expanding choices (e.g., add a new food), Level 3 tasks usually involve limiting choices.
Nutrition: The Complete Guide
Nutritional Levels | 315
Case study
Several years ago, Brian (co-author Brian St. Pierre) was
visiting his girlfriend (who is now his wife). She made
him a delicious dinner from scratch. They’d recently
begun dating, and this was the first time she’d made
dinner for him.
She worked for hours making a wonderful beef stew,
with potatoes, carrots, onions and other delectable items.
It contained a little bit of everything: lean protein, lots of
vegetables, quality carbs, and healthy fats. And it tasted
amazing. What wasn’t to love?
Well, at the time Brian was a big proponent of an older
approach: dividing meals into Post-workout (PW) and
Anytime (AT). The basic idea was to have the majority
of carbs after workouts (PW meals), and keep other
meals low in carbs (AT meals).
These days we view that as a Level 2 strategy. But at the
time, this was standard practice. And in this case, it bit
him in the ass.
As they began eating, Brian started intentionally removing potatoes from his bowl. Because, you see, he hadn’t
recently worked out. He thought he hadn’t “earned” his
carbs.
(Mind you, this was probably half a potato’s worth. At
most, one whole potato. We’re not talking about a large
amount of carbs or calories here.)
Midway through his potato removal surgery, it dawned
on him that his girlfriend had gone strangely silent. He
looked up from dissecting the stew.
His girlfriend was looking at him unhappily. “What are
you doing?”
“Uh. Removing the potatoes. I didn’t work out recently,
so I don’t want a lot of carbs.”
“Brian, it took me four hours to make this stew. It’s probably not even an entire potato.”
“But, the carbs…”
[Continued look of disapproval]
Brian ate the potatoes.
And you know what? He didn’t magically get fat. In fact,
it made the meal more enjoyable. And kept him satisfied
for hours (which wasn’t normal for him at the time).
More importantly, this made Brian a much more gracious guest and boyfriend. It helped him see the bigger
picture: how eating a meal with someone is more than
just fueling a body. It’s a part of the social fabric of life.
In this moment, he realized that maybe he didn’t need
to worry so much about timing his carbs. Brian began
to play with spreading out his carbs more evenly, even
increasing the amount of carbs he ate (and decreasing
the fat to keep total calories in check).
He began having clients experiment with the same
thing.
And the results were overwhelmingly positive.
Clients began to find more satisfaction in their meals.
They were less hungry between meals. They could enjoy
social situations more.
They could have more “normal meals”, eating wraps,
sandwiches and other meals with moderate carb intake.
They weren’t obsessing about when they could have
carbs and when they couldn’t. And they weren’t feeling
guilty for having carbs when they “shouldn’t.”
Or reasoning that since only having carbs post-workout
would help them lean out, that skipping the carbs then
would only help them get leaner.
They were developing sane and sustainable approaches
to food.
And it wasn’t hurting their health, body composition, or
performance either. Most of them were actually getting
better.
As Brian dug deeper into the research, and as more
long-term data on nutrient timing came out, he became
less and less inclined to use it as a front-line strategy.
When Brian came to, we began to experiment with the
same changes in our Coaching program. And you know
what? We discovered the same thing happening on a
much larger scale.
Thousands of clients reported back on how much they
enjoyed the new approach. How it simplified their food
choices. And allowed them to just modify beloved recipes by just incorporating fewer processed ingredients,
or adjusting portion sizes, rather than reinventing the
wheel.
He will point out that this doesn’t necessarily discredit
the PW / AT approach. It’s simply not a strategy to start
with.
Carb timing and cycling are Level 2 strategies. These
types of strategies can and should be utilized with
clients who have advanced goals, and who have demonstrated mastery of the fundamentals.
Hopefully this story simply showcases how using Level 1
strategies, even for fitness pros like Brian, can provide a
sustainable way to have the body we want, while living
a life we really enjoy.
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Summary
Nutritional level is like a developmental stage; it’s a stepby-step progression of difficulty and complexity.
Always match your coaching to your client’s nutritional
level.
We divide clients into three nutritional levels. We
suggest that you do the same during the early stages of
assessment.
Always start at the beginning; most clients never need to
progress any further than Level 1. Even clients who can
progress to Level 2 or 3 may only be there briefly.
Each nutritional level has unique features, limiting factors, and needs.
Clients must demonstrate skill, competence, and consistency at each level before progressing.
Nutrition: The Complete Guide
UNIT 12
Working with Level 1 Clients
318 | Unit 12
Unit Outline
1.
Level 1: Where it all begins
4.
Troubleshooting Level 1
2.
Level 1 clients and your coaching process
5.
Case study
3.
Level 1 limiting factors and coaching strategies
6.
Summary
Objectives
In this unit, you’ll learn more about Level 1 clients. We’ll
to these clients to identify, understand, and work with their
show you how to apply the ISSA Nutrition Coaching process
specific goals, motivations, needs, and limiting factors.
Level 1: Where it all begins
What does a Level 1 client look like?
Here’s a quick review of the criteria for defining nutritional level:
Almost everybody.
•
Goals: What clients want to do.
•
Knowledge: What clients know.
•
Competence and skill: What clients can do.
•
Consistency: What clients can do, repeatedly and
well.
To figure out a client’s level, use a mix of objective and
subjective assessment.
We’ll look at that more in this unit.
Most importantly:
•
Always start with Level 1 tasks, no matter who
your client is. Fundamentals first, always. You can’t
do Level 2 tasks unless and until you have mastered
Level 1 essentials.
•
When in doubt, go backwards. And always regress a client to a lower nutritional level, rather than
assuming they can handle more complexity.
•
Clients must be able to demonstrate that they
can do assigned tasks consistently. Saying they
can do it, or knowing information about the tasks, is
not enough.
Nutrition: The Complete Guide
In the previous unit, we gave you a brief overview of
Level 1s. Now let’s look more closely at the features that
Level 1 clients might have.
Not all Level 1 clients will have all of these characteristics,
but this gives you the general idea.
Level 1 client features
Note that goals, knowledge, body composition, athletic
performance, and training load alone do not define Level
1. For instance:
You may have a high-level recreational athlete who is
quite lean and muscular... but who binge-eats regularly, doesn’t get enough sleep, and / or doesn’t eat their
vegetables.
You may have a client who has an “expert” level of
knowledge, perhaps even graduate degrees in nutrition… but who can’t actually do fundamental behaviors
consistently.
Most fundamentally, nutritional level is about competence and consistency:
What can you do repeatedly and sustainably in your
daily life?
Working with Level 1 Clients | 319
Table 12.1 What does a Level 1 client look like?
Typical goals
Improve general athletic performance and recovery
Feel better
Look better
Lose weight
“Get in shape”; “tone up”
Get stronger; add muscle
Have more energy and vitality
Get into regular, sustainable “healthy living” habits
Improve health markers (e.g., blood cholesterol, blood pressure, glucose control)
Work through food intolerances and/or digestive issues
Have a better relationship with food; manage unwanted eating patterns such as emotional eating
Sleep and recover better
Level of physical performance
expected
Daily-life function
Regular activity; keeping up with workouts
“Healthy normal”
Body composition desired or
required1
Normal, sustainable, metabolically healthy to lean-healthy body composition
Men: 13-20% body fat
Women: 23-30% body fat
Training load
<6 hours a week
Knowledge
None to moderate
Competence and
skill
None to moderate
Consistency
None to moderate
Can do simple tasks when given clear instructions and the coach monitors completion
Can do (or only want to do) simple tasks up to 75% of the time
May struggle to sustain habits or “stay on track”
Mindset /
psychology
“I have a lot of questions and / or worries.”
“Many things are distracting me from full focus on this.”
“This is just one part of who I am. I have a lot of other things going on.”
“I just want to be healthier, fitter, stronger, leaner, and / or better at the stuff I do regularly.”
Limiting factors
Many (see next page)
1 Note: Clients will vary widely in their body compositions depending on their age, sex, genetic makeup, etc. What is “unreasonably lean” for one
person may be another person’s “normal.” Look for natural tendencies and try to get a baseline of what is appropriate for each client. “Normal” is
the body composition that a client can easily and sanely maintain doing basic Level 1 habits consistently.
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Speaking Level 1 language
As a coach, you might think and talk in technical terms,
jargon, or “nutritionspeak.”
For instance, you might be familiar with language like:
maybe gently explain the real deal over time, as you
build a relationship.)
•
Ask them to clarify if possible. What does “get
in shape” or “look better” mean to them, exactly?
Could they give specific examples of what they’re
•
macronutrient split
•
oligosaccharides
•
glycemic index
page? Do you both comprehend what the other is
•
contralateral
saying?
•
body composition
•
hydrostatic weighing
•
dialed in
•
bioavailable
Remember that unless you are coaching other fitness
and nutrition pros, most people don’t think or talk like
that.
A client will usually have goals like:
describing?
•
Check for understanding. Are you on the same
Do the same when you discuss limiting factors with
them.
Clear communication is important for all clients, but
especially so for Level 1 clients, who may feel confused,
anxious, or overwhelmed by complex or technical
language.
Level 1 limiting factors
•
“tone up”
In the previous unit, we also looked at common limiting
factors for Level 1 clients.
•
“get in shape”
These can include (but are not limited to):
•
“get rid of my gut”
Food choices
•
“look better on the beach”
•
“get my pre-baby body back”
•
“look good for occasion X”
•
Eating too many processed foods
•
Not eating enough nutritious, whole, minimally
processed foods
Not meeting basic nutrient needs (macronutrients
And, as we’re fond of reminding you, most people don’t
eat “macronutrients”, “polyphenols”, or “antioxidants.”
They eat food and meals.
•
•
Getting dehydrated
Don’t lecture them on correct terminology or drown
them in jargon. Instead:
•
Drinking too many sugar-sweetened drinks
•
Drinking too much alcohol; “drunkorexia”
•
Not feeling satisfied by their meals
•
Keep it simple. Clients don’t need to know technical terms or all the scientific rationale for things.
•
Listen carefully and assess. What are your clients’
goals and how do they describe them? What level
of terminology and scientific explanation are they
comfortable with?
•
Match your language to theirs. If they say “tone
up”, swallow your ego and say “tone up.” Don’t
and micronutrients)
Eating behaviors
•
Eating too quickly and while distracted
•
Trouble recognizing their physical hunger and fullness cues
•
enough at some times and / or eating too much at
spend 10 minutes explaining why “toning” is a
other times)
myth. Instead, tell them that your plan, if they stick
to it consistently, will get them toned as heck. (And
Irregular eating habits (missing meals or not eating
•
Disordered eating (restricting, purging, orthorexia,
controlling, bingeing, etc.)
Nutrition: The Complete Guide
Working with Level 1 Clients | 321
•
Over-eating
•
Under-eating / strictly controlling food
•
Using food to manage feelings
Exercise and activity
•
Not getting enough regular physical activity
•
Over-training and not managing training loads
Environment
•
power” and mental strength to stay on track
•
Not getting enough sleep
•
Not getting enough recovery
•
Too much sympathetic nervous system “fight /
flight” activation (i.e., spending too much time in the
“amped up” and overstimulated zone)
•
Not enough parasympathetic “rest and digest”
activation
Food and cooking skills
•
•
Not having basic food preparation skills (or confi-
•
before bed)
This is a long list. Reading this, it’s easy to get discouraged or overwhelmed. Or feel like you have to tackle
everything at once.
Stay calm, coach. One thing at a time.
Here’s how to begin working with your Level 1 clients.
Level 1 clients and your
coaching process
Review the six-step coaching system.
dence in the kitchen)
Step 1: Assess and gather data; identify client goals.
Not having basic shopping and food awareness skills
Step 2: Understand the client and “build the story.”
Step 3: Create an action plan and possible “next steps.”
Life skills
Step 4: Choose one next action step and test it.
Not being able to ask for what they want and need;
Step 5: Observe and monitor what happens.
not being able to define clear boundaries with others
Step 6: Use outcome-based decision making.
(e.g., people pushing food; other household members sabotaging or criticizing)
•
Making impulsive choices
•
Feeling “too busy” or “too rushed”
•
Not having good options available and convenient
Mindset / psychology
•
Too much stimulation and / or stress, especially
during periods that should be “down times” (e.g.,
(e.g., reading labels)
•
Unsupportive social networks (family, friends, coworkers, etc.)
Recovery
•
An environment that requires too much active “will-
All-or-nothing thinking (e.g., yo-yo dieting, restrict-binge cycles, big “diet challenges”, weekend
/ night-time over-eating, “Either I’m perfect or I’ve
failed” mentality)
We covered assessment in previous units.
In this unit, we’ll focus mostly on Steps 3 through 5. But
here’s a quick review of
Steps 1 and 2.
Steps 1 and 2: Assessment and
understanding
As we’ve mentioned, you’ll probably find a lot of things
to work on with Level 1 clients. You may feel like:
Fixed mindset (I’m broken; I don’t have what it takes;
•
You have to do everything at once.
I’m a failure)
•
Everything is so broken it can’t possibly be fixed.
•
Not being consistent
•
You have to give the client a complicated plan.
•
Busy-ness and stress; overwhelming life demands;
•
You don’t know where to start.
•
feeling rushed and pressured
None of these things are true. Instead:
International Sports Sciences Association
322 | Unit 12
•
Get VERY clear on what, exactly, your client
wants to do. All things should connect to your client’s goals. Make sure you know precisely what those
goals are.
•
Do one SMALL thing at a time. Break down critical skills, such as food choices, into smaller, discrete
habits (e.g., protein, carbs, veggies, fats).
•
Play the long game. Think six months, a year, or
even five years ahead. Imagine how much further
along your client will be with incremental changes,
done consistently.
•
Keep it simple. As simple as possible. Ridiculously
simple.
•
Start at the beginning — with whatever you and
your client agree is the best thing to address first. (As
we suggested in Unit 10, try either a piece of the Big
Kahuna, or the Low-hanging Fruit / Easy Win.)
Assess first; understand first
Before you give any direction, make sure you understand your client as well as possible.
Gather relevant data. (You can collect more over time.)
(Nor should you try.) But everything you do and assign
to your client should somehow “advance the game.”
Every task should move your client towards their goals.
Choose wisely. Choose strategically.
Every task should have a clear “why.” You should be
able to explain, simply and clearly, what the purpose of
each task is. Every habit you assign your client should
“earn its rent.”
Figure 12.1 is a refresher of the exercise we use to work
backwards from a desired goal. With this exercise, you
can see how the outcome your client wants must come
from what they do every day.
We suggest you map out at least a few weeks of a longer-term plan for your client — or even better, a few
months.
Table 12.2 provides one type of template you can use.
In Table 12.3, you can see that you have already created a
simple, understandable 8-week action plan that your client can immediately start doing. (It can even be longer,
if your client has trouble with any of the behaviors and
needs some extra time.)
Clearly identify your client’s goals. What do they want
to do? Where do they want to go? Why are these goals
significant and meaningful?
Understand what is most important to your client, and
what they want to prioritize.
OUTCOME:
End goal
Review, analyze, and put the pieces together after consultation with your client.
Schedule at least one session to do all of this before giving any action steps.
Today
I will:
This month
I will:
Step 3: Creating an action plan
Now we get to the heart of coaching: Planning and
taking action.
Long term; short term
This week
I will:
As a coach, think about your overall long-term plan as
well as your immediate, short-term plan.
Remember, you don’t have to do everything at once.
Nutrition: The Complete Guide
Figure 12.1 The 4-circle exercise
Working with Level 1 Clients | 323
Table 12.2 Behavior map template
What do I want to do:
___________________________________________________________________
What does it involve?
Why does this matter?
How will I know if I’ve
done it?
What will tell me it’s
time to move on?
Behavior 1
Behavior 2
Behavior 3
Behavior 4
Behavior 5
Behavior 6
Table 12.3 Behavior map sample
What do I want to do: Build muscle
Behavior 1
Work out
regularly
Behavior 2
Add 1 nutrientrich, highquality meal
Behavior 3
Add lean
protein
What does it
involve?
Why does this
matter?
How will I know if I’ve done it?
What will tell me it’s
time to move on?
Train 3 days
per week,
following
specific
workout plan
Regular
workouts
stimulate
muscle growth
and improve
strength.
I’ll have completed my
workout journal for the
day.
I will have done 3
workouts per week
consistently for two
weeks.
Make and
drink 1 Super
Shake per day
This gives me
lean protein,
fruits and
vegetables, and
healthy fats,
conveniently.
I will have made and
drunk a Super Shake every
day. I’ll tick this off on
my consistency sheet.
Have 2 palms
of lean
protein at
each meal.
Lean protein
is essential
for building
muscle.
I will stock my fridge
with lean protein options.
I’ll schedule time for
grocery shopping and go
to the store with a list.
I will plan menus to
ensure that each meal has
protein.
Behavior 4
Create and use
a sleep ritual
Plan, develop,
and use a
sleep ritual
before bed
to ensure I
get (or try to
get) at least 7
hours of sleep
every night.
Creating an
anabolic
environment
requires
recovery.
I’ll tick off each meal on
my consistency sheet.
I’ll plan my bedtime in
advance. 30-60 minutes
beforehand, I’ll be
preparing for restful sleep.
As much as possible I will
aim for at least 7 hours of
sleep every night.
I will be planning
and preparing for
my workouts using a
calendar and trusted
systems.
I will have made
and drunk a Super
Shake every day for
two weeks. I will
have planned this
into my routine and
have trusted systems
to get it done.
I will have had lean
protein at almost
every meal for two
weeks, as shown
by my consistency
sheet.
I’ll be adhering
consistently to my
sleep ritual most
nights.
If possible, I’ll be
getting at least
7 hours of sleep
consistently.
I’ll have done this
for two weeks.
324 | Unit 12
With this type of structure:
•
do a little more of what you want to do? What was
happening at that time? How did you make that
The client knows what they need to do right now.
possible?”
They can focus on what is immediately in front of
•
them: doing their single assigned task, today.
•
“So, given all this, what do you think you’ll do next?”
The client knows why they are doing each behavior,
•
“You say now might be a time to consider cutting
back on food X. How would you go about it if you
but they’re not overwhelmed by information.
•
were ready?”
Both you and your client know clearly what is to be
done, what counts as “done”, and how to track prog-
•
preparing more of food X?”
ress and consistency.
•
As the coach, you know what is coming up.
•
All behaviors support the goal.
Use a collaborative approach
•
Practice this line:
ing more food X in right now?”
•
•
“Has there ever been a time when you were able to
“Let’s break this down and draw out all the steps here
on the whiteboard. Let’s say doing less of behavior X
and doing more of behavior Y is your goal. Let’s map
this out, piece by piece. Step 1 might be…?”
•
“Let’s imagine you’ve achieved goal X. What has to
be true in order for that to occur?”
•
“Let’s brainstorm a bunch of ideas here before we
choose any. Off the top of your head, what are all the
possible things you could try here? I’ll write them
“I have some ideas here, but I’d like to hear
yours first.”
Here are some questions that you can ask your client to
start exploring limiting factors and generating solutions
to them.
“You mentioned that you want to start eating more
of food X. Where do you think you could start build-
Remember that you and your client are working together
as a team to address these behaviors.
Thus, each time you tackle a new limiting factor, treat it
as a chance to build teamwork and create a collaborative
problem-solving process.
“What steps do you need to take to get started on
down as you suggest them. Then, we’ll go through
and see which ones we like.”
Not all clients will be able to come up with solutions.
That’s fine too. Then you can offer suggestions if they are
open to it. See Table 12.4.
Table 12.4 A collaborative problem-solving process
Do
Don’t
Ask your client which limiting factor they would like to address first. Suggest a few options if needed.
“Should” your client.
Ask them for their input and ideas on how to start working
through that limiting factor.
Tell them what to do outright. (Unless you are absolutely
sure your client will like and benefit from this approach.)
Ask questions that get them generating their own solutions.
Assume you know the best solution to their problem. (You
might, but hang back and let them start figuring it out.)
Help clients explore their own resistance, curiously and
without judgment.
Lecture, preach, or “information dump.”
Provide suggestions and guidance.
Be the boss or unquestioned “expert.”
Help with problem-solving, planning, and strategizing.
Try to “convince” or argue.
Make them feel like they are in control of their own change
process.
Make it about you.
Give them “principles” to work from, e.g., “Eat the rainbow”
or “Use your hand for portion sizing.”
Give “rules” or strict plans. (Save that for your Level 3
clients.)
Treat each client as a unique individual. (Even if their story is
familiar.)
Compare clients or ask them to compete with each other
(unless you’re absolutely certain they’ll find this inspiring
and motivating).
Nutrition: The Complete Guide
Working with Level 1 Clients | 325
Step 4: Choosing and testing the
next action step
•
In Unit 10:
•
•
•
ture of a meal, or what a daily menu might look like).
•
•
ate progress indicators.
•
has “graduated” to the next level of difficulty, or is
ready for a new task.
Tracking progress
Here are some key principles of tracking progress.
•
Use as many other progress indicators as you can.
•
Look for progress everywhere. Call it out, no matter
now small.
•
•
salient to the client. Make sure the indicators you
Make sure the client understands exactly what to do.
words.
Make sure the client understands how the assigned
task relates to their goals.
Make sure the client has all the tools and information
they need to do the task.
choose relate to your client’s goals.
Let’s explore some ideas for both outcome-based and behavior-based indicators. Of course, not all clients will need
or want all measures. And you can certainly come up with
more than these.
We’ll look more closely at what to do when progress
stalls later on in the unit.
Set clients up for success.
We give you some ideas for next actions, and how to scale
them up or down, later in the unit.
Step 5: Monitoring progress
You’ll notice that in the Behavior map template, we
clearly define what “progress” or “done” involves. The
client must know what counts as executing the task.
Thus, as you develop the action plan:
•
Choose relevant, useful, and meaningful progress
indicators. Don’t measure what is not important or
Ask them to tell you what is to be done in their own
•
As much as possible, focus on tracking behaviors
instead of outcomes (such as body measurements).
Thus:
•
Agree on what would show the coach that the client
smaller.
A very small task, done consistently, helps Level 1 clients
feel increasingly successful, confident, and empowered.
As they build small achievement on small achievement,
and solve little problem after little problem, Level 1 clients learn crucial skills. They are repeatedly confronted
with evidence that they can make different, and better,
choices in their daily lives.
•
Agree on how often the coach will review and evalu-
they are less confident, make the task easier and / or
These pieces are particularly important for Level 1
clients, who usually have limited skill, motivation, time,
knowledge, and / or other resources.
•
Agree on what defines “progress.” Show how completing the task moves the client closer to their goals.
We suggested that you ensure that your client is at
least 9/10 confident they can do the assigned task. If
Agree on a target for consistency (e.g., every day,
three times a week).
We emphasized that you should choose only ONE
next action at a time.
•
like. If possible, show examples (for example, a pic-
We explained how to test “ready, willing, and able”
with your clients.
Make sure the client understands what “done” looks
Clearly define what doing the task involves.
Sample progress indicators: Outcomes
Body measurements
•
Bodyweight and girths
•
Body fat skinfolds (or other reliable methods of analysis, such as BodPod or DEXA)
•
Subjective measures, such as belt loops, or tightness
of clothes
Objective physiological indicators / lab tests
•
Blood work, such as:
International Sports Sciences Association
326 | Unit 12
small intestinal bacterial
overgrowth (SIBO):a condition
in which abnormally large
numbers of bacteria are present in
the small intestine
•
blood lipids
•
fasting glucose, glucose control
•
red and white blood cell counts
•
Blood pressure (including orthostatic hypotension2)
•
Nutrient status (i.e., vitamin and mineral levels)
•
Tests of GI health, (e.g., SIBO, gastric motility, GERD)
•
Hormone levels and hormone health
•
Heart rate variability, resting heart rate
•
Morning temperature
•
Medication use
Subjective physiological indicators
•
Pain
•
Inflammation
•
Sense of physical wellbeing, vitality, overall wellness
•
Gastrointestinal symptoms; digestion
•
Energy and fatigue
•
Sleep quality
•
Joint mobility / stiffness
•
Immunity
Subjective psychological indicators
•
Mood and emotional stability
•
Overall outlook and resilience
•
Calm and relaxation
•
Clarity of thought; ease of learning and remembering
Subjective social and daily-life indicators
•
Participation in daily-life activities
•
Social engagement and confidence
•
Quality of relationships and social network
Sample progress indicators: Behaviors
•
Consistency (this is the big one)
•
Quality of task completion (i.e., how well does the client do the task?)
•
Confidence of task completion (i.e., how confident is the client when doing the
task?)
•
Complexity of task (i.e., how much skill and knowledge does the task require?)
•
Sense of being “aligned” with the task (i.e., the assigned task feels purposeful,
meaningful, relevant, and important to the client)
Nutrition: The Complete Guide
Working with Level 1 Clients | 327
Level 1 limiting factors and
coaching strategies
50% (in some cases over 75%) of the average American’s intake. Most people eat most of their food highly
processed.
Let’s look more closely now at some of the most common
Level 1 limiting factors, and how you can start working
through them.
People who eat a lot of processed foods typically:
Limiting factor: Food choices
Too many processed foods
•
have trouble regulating their appetite and hunger
cues;
•
are poorly nourished; and / or
•
are less metabolically healthy, with undesirable body
composition.
Why might clients struggle with this?
Possible strategies
We live in a time of abundance. And we no longer have
to raise, harvest, process, and make all our foods from
scratch. Convenient, tasty, shelf-stable processed and
refined foods are cheap and easily available year-round.
Dietary displacement
On the one hand, this makes life much easier.
grind, leaven, and bake the grains.
Help Level 1 clients transition gradually to adding nutritious foods, without explicitly asking them to eat less of
the processed ones. In fact, you can actually tell clients
that they don’t have to give up the “bad stuff.” (This, paradoxically, will often make them more likely to change.)
We can open a bag of peas that have been harvested,
For instance:
For instance:
•
•
We can buy bread instead of having to grow, gather,
shelled, blanched, and frozen for us.
•
When we fill up on “good stuff”, there’s less room for
junk.
•
Keep eating those Subway sandwiches if those are
We can keep a can of tomatoes on the shelf for
the most convenient option for you right now, but
months instead of worrying about fresh tomatoes
add more vegetables to them.
going bad.
Some minimally processed foods, such as frozen vegetables, canned tomatoes, cold-pressed olive oil, or yogurt
can be convenient and nutritious parts of your clients’
diets.
•
Have a salad or some cut-up veggies to start your dinner, before you get into the main course.
•
Before you have that 3 PM brownie, have a piece of
fruit. Then go ahead and eat that brownie if you still
want it.
Why is this a problem?
Healthy substitutions
On the other hand, most processed foods don’t add value
to our health or body.
Ask clients to come up with a list of potential substitutes
for some of their most common processed foods. Then
ask them to try one or two of these.
Most processed foods are high in calories but low in nutrients. They usually have a lot of sugar, salt, and / or industrially produced fats (not to mention other things like colors
and preservatives).
Processed foods make it hard for us to know when we
are physically hungry or full. It’s easy to over-eat them,
and we still want more (that’s how they are designed).
Processed foods are readily available and heavily promoted. Indeed, highly processed foods make up over
For instance:
•
An orange instead of orange juice
•
Steel-cut or rolled oats instead of sugary breakfast
cereal (with some fruit to sweeten it)
Moving along the continuum
Ask them what might be “just a little bit better” (i.e., a
little less processed). Then ask them to try one or two of
them.
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For instance:
•
Higher-fiber noodles rather than plain white pasta
•
Natural peanut butter instead of regular peanut
butter
•
Regular coffee instead of a flavored coffee drink (or to
decrease the amount of additives used, such as sugar
and / or cream)
Noticing behavior patterns
Some clients will be more likely to eat processed foods
at certain times, or in certain situations. Have them
keep a “processed food journal”, in which they simply
identify when and where they tend to eat more (or fewer)
processed foods.
For instance, they may choose processed foods:
•
when they are busy and stressed;
•
when they are traveling; or
•
when they want to relax or “comfort eat.”
You can use the Behavior Awareness Worksheet to help
them notice these patterns, and then work backwards to
“break the chain.”
Behavior Awareness Worksheet
NAME
DATE
Research shows that while our behaviors may seem “spur-of-the-moment”, when it comes to over-eating the
groundwork is laid several hours in advance by our daily rituals, habits, mindset, and automatic thinking. Over-eating
is simply the last link in a long chain. If you can break the first link, you have a much better chance of never getting to
the last link.
The goal of this exercise is to build awareness of what your eating episodes have in common. Maybe it’s a time of day, or a situation, or
a type of food, or another person (or being alone), or a feeling – or all of these.
Describe in as much detail as possible what you are experiencing, or remember experiencing, at each stage. Then go back and review.
Look for common features. Look at the steps you took.
This helps you build understanding of the process, which you can then use to disrupt these patterns. For instance, if you habitually
over-eat in your kitchen at 6 pm when stressed, then figure out strategies to deal with a stressy dinner hour before it happens – as far in
advance as possible. If you habitually think certain thoughts beforehand (e.g., “I’m a failure”, “This will make me feel better”, etc.) then
come up with ways to respond to those thoughts before they hit you.
Complete this worksheet every time you have an episode of over-eating. Be honest and thorough. You are collecting data so that you
can analyze your own patterns and eventually develop strategies to deal with them.
1. In the 1-2 hours beforehand:
What are you doing?
What are you thinking?
What are you feeling, emotionally?
What are you feeling, physically?
Where are you?
What time is it?
Who’s with you?
© 2018 ISSA issaonline.edu
Find the Behavior Awareness Worksheet in your forms package
Red-yellow-green light foods
Ask clients to take notes on their “red, yellow and green
light” foods.
•
“Red light” foods are foods that are just bad news for
the client. Maybe they make the client feel sick, or
they trigger the client to eat too much, or the client
just knows they’re an unhealthy choice, etc. Red
means “no go.”
•
“Yellow light” foods are foods that are sometimes
okay, sometimes not. Maybe the client can eat a
little bit without feeling ill, or can eat them sanely at
a restaurant with others but not at home alone, or
they can have these foods as an occasional treat, etc.
Yellow means “approach with caution.”
•
“Green light” foods are foods that make the client
feel good mentally and physically, and that the client
can eat normally, slowly, to a relatively easy 80% full.
These are usually things like fruits and vegetables,
lean protein, and legumes. Green means “go for it!”
Nutrition: The Complete Guide
Each person will have a slightly different list of red, yellow, and green lights.
One client might leave ice cream in the freezer untouched for months, whereas another client might need a
restraining order from Ben & Jerry’s.
Once the client has come up with their red, yellow, and
green light list, ask them which foods they would like to
eat more of and less of, and why. Let them choose which
foods to add and subtract, and discuss their rationale. Be
willing to give suggestions when asked, but don’t force
your personal preferences on them.
Also be sure to discuss how to do this rather than just
saying “Okay, give up food X.”
Working with Level 1 Clients | 329
Shape the path / Kitchen cleanout
Berardi’s First Law states:
If a food is in your house or possession, either
you, someone you love, or someone you marginally tolerate, will eventually eat it.
The corollary of Berardi’s First Law is:
If a healthy food is in your house or possession,
either you, someone you love, or someone you
marginally tolerate, will eventually eat it.
In other words:
•
Keep healthy stuff nearby and convenient. Help the
client create routines and environments (home, work,
•
Help your Level 1 client review their immediate environment, especially their house and kitchen, to see where
they can make changes. (Of course, ensure that the client
collaborates and agrees to any changes. Changes may
need to be small and incremental. The client will often
need to work with other household members as a team.)
We like a “kitchen makeover” that:
•
removes “red light foods” and anything else the
client thinks is a problem; and
•
stocks up on “green light foods” and convenient,
healthy options.
This means the client doesn’t have to over-think things,
make too many decisions, or use “willpower.”
etc.) that support their goals.
“Red lights” are gone; “green lights” are there.
Keep unhealthy stuff far away and inconvenient.
Easy.
Make it hard for unhealthy stuff to get to the client.
(Just making them less visible can help.)
Those stay versus those go
Level 1 clients need strategies that are realistic, simple,
and fit with their everyday lives as “imperfect” human
beings. So don’t create a bunch of strict rules or say
things like “Processed foods will kill you.”
Level 1 isn’t about eliminating 100% of processed foods
and being a purist.
If you try that approach, your Level 1 clients will resist
you, and / or get anxious, and / or “fall off the wagon”
big time, and / or develop disordered eating patterns.
It’s about finding the processed foods that clients can
do without.
Such as the pointless, excessive eating that doesn’t really mean much to them. Maybe it’s a handful of candy
between meals. Free samples at the store. A cookie just
because.
Or maybe the processed foods that your clients eat
because they don’t know about, or don’t know how to
make, alternatives. (“Really? You can make your own
salad dressing?”)
Those “don’t need to have” foods can go.
At the same time, help clients identify the processed
food opportunities they really value. Pizza night with
the fellas? Sunday pancakes with the family? Wine,
cheese, and crackers with friends?
Those can — and should — stay. (For now. Unless and
until your client wants to change them later.)
As a coach, help your client decide which foods and
food habits really matter to them, and why.
Help them keep “treat foods” in balance… as treats.
Focus on quality and quantity of daily overall intake,
along with appetite awareness.
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Not enough nutritious, whole,
minimally processed foods
Along with eating too many highly processed and refined foods, many clients don’t eat enough nutrient-rich,
whole, minimally processed foods, such as:
This type of diet may also mean:
•
Clients don’t feel confident cooking or preparing
food.
•
Clients will have trouble applying principles like “eat
more lean protein.”
•
fresh fruits and vegetables
•
whole grains
•
beans and legumes
•
whole, fresh cuts of meat or poultry
•
fresh fish and seafood
Possible strategies
•
nuts and seeds
Try 1 new ____ every ____
They also tend to eat a fairly limited range of all of the
above. For instance:
•
Clients feel their choices are restricted because they
don’t know there are lots of options out there.
•
Clients have learned to prefer the taste, texture, and
hyper-palatability of processed foods.
Encourage clients to experiment with trying new:
•
foods
chickens, chicken livers / hearts, etc.
•
types of foods (e.g., different types of apples)
•
only chicken instead of turkey, goose, duck, quail, etc.
•
flavors
•
only iceberg lettuce instead of radicchio, arugula,
•
recipes
Boston lettuce, endive, red leaf lettuce, escarole, etc.
•
cuisine styles
•
cooking and food preparation techniques
•
only chicken breasts instead of chicken legs, whole
Why might clients struggle with this?
Many people in industrialized countries have lost the
skills of cooking from scratch and preparing whole
foods.
This could be every day, every week, every two weeks,
every month, etc.
Field trip
We’re further from our agricultural roots, and few of us
recognize or know what to do with unprocessed foods.
(How do you cook an artichoke? What do you do with
pork necks? Wait… pigs have necks?) In addition, we
may see only a small range of food varieties in the supermarket, such as one type of tomato or pepper.
Suggest a field trip to the farmers’ market (or fish store,
butcher, “pick your own” farm, etc.) — anywhere that a
client could learn more about whole foods, see a variety
of them, and learn more about how they’re produced.
It’s often easier to just “grab and go” with processed
convenience foods.
Identify easy yet essential cooking or food preparation
techniques that would benefit your client, then assign
one technique as a weekly task to practice. For instance:
Why is this a problem?
Humans evolved to thrive on diverse diets with a wide
range of naturally occurring nutrients. When our diet is
limited and highly processed, we don’t get this.
Nutrition: The Complete Guide
Cooking / food prep techniques
•
Use a slow cooker
•
Chop and store vegetables in bulk
•
Roast or grill meat or vegetables
•
Steam vegetables
Working with Level 1 Clients | 331
•
Make a Super Shake
•
Make a basic salad
super shake: A recipe base for a
nutrition shake
More on food preparation techniques shortly.
Make it easy
Clients may feel that eating more whole, minimally processed foods is too difficult. Show
them how it can be easy with choices like:
•
pre-washed vegetables or salad greens
•
ready-to-eat vegetables (baby carrots, gourmet cucumbers, celery stalks)
•
fresh, easy-prep fruit (such as apples or fresh berries) or pre-cut fruit (such as
pineapple or melon)
•
canned beans or lentils
•
a whole rotisserie chicken (a better option than most fast food)
•
boiling up a pot of eggs or potatoes to have on hand
•
whole grains done over night in the slow cooker (which avoids soaking and
waiting for grains to cook)
•
grating a fresh tomato on a cheese grater to make a quick pasta sauce
Remember to help your client make these choices on a continuum and look for
“just a little bit better.” A rotisserie chicken from the supermarket may not be a
pastured, lovingly hand-raised, heritage Chantecler roasted in a high-end convection oven… but it sure beats chicken nuggets. Progress, not perfection.
Not meeting basic nutrient needs (macronutrients and
micronutrients)
Research shows that most people — including athletes — don’t meet basic nutrient needs, whether that’s macronutrients (e.g., higher-fiber carbs, healthy fats) or
micronutrients
(e.g., vitamins, minerals, phytonutrients).
If so many people are deficient in key nutrients, can’t we just load them up on
supplements? Well, we can. But we’re not sure if it’s the same. And based on
what we know so far, it likely isn’t.
The human body has a long standing relationship with whole foods. And nutrients come as a package deal in those whole foods, not isolated and delivered out
of context.
Thus, in situations where it’s possible to get nutrients from whole foods, choosing
a supplement can be a step in the wrong direction, and overdoing unnecessary
supplements may actually cause harm.
But we do live in the real world. And getting enough nutritious foods each day
will take some organization and forethought, especially for Level 1 clients who
are new to this, and / or may have to learn lots of life skills in order to plan, prepare and do the tasks of healthy eating.
International Sports Sciences Association
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Your palm determines
your protein portions
Your fist determines
your veggie portions
Your cupped hand
determines your carb
portions
Your thumb
determines your fat
portions
Figure 12.2 Hand size portions
Thus, if a supplement will prevent a deficiency, then it
can be a helpful tool for Level 1 clients as you help them
move towards more nutrient-rich foods. While we don’t
generally recommend supplements for Level 1s, there are
a few that can help.
This works well for many reasons.
Be sure that any supplements you recommend do not interfere with other health conditions or medications your
clients may be taking. Check with your clients’ doctors
and / or pharmacists if you are not sure.
Second, hands are scaled to the individual. Bigger people
need more food, and tend to have bigger hands, therefore
getting larger portions. Smaller people need less food,
and tend to have smaller hands, therefore getting smaller
portions.
Possible strategies
Third, it provides reasonable amounts of nutrient-dense
foods and their specific macronutrients (thus preventing
deficiencies). It helps most clients to meet their protein,
vegetable, carb, fat, and calorie needs without them having to count a gram or weigh a food.
Hand size portions of nutrient-dense foods
Educate clients about what nutrient density means, and
how to get it. Work on building meals around nutrient-dense foods using hand size portions (as shown in
Figure 12.2).
•
The palm determines your protein portions (~ 20-30
g protein).
•
The fist determines your veggie portions.
•
The cupped hand determines your carb portions (~
•
First, hands are portable. They come with you to work
lunches, restaurants, social gatherings, grandma’s
house, etc.
Assuming clients are active and eat about four meals per
day, this is what we find to be a great starting point for
most clients:
For each meal, men might begin by eating:
•
2 palms of protein-dense foods
20-30 g carbs).
•
2 fists of vegetables
The thumb determines your fat portions (~ 7-12 g fat).
•
2 cupped handfuls of carb-dense foods
•
2 thumbs of fat-dense foods
Nutrition: The Complete Guide
Working with Level 1 Clients | 333
And for each meal, women might begin by eating:
•
1 palm of protein-dense foods
•
1 fist of vegetables
•
1 cupped handful of carb-dense foods
•
1 thumb of fat-dense foods
Hand-Sized Portion Guide
NAME
DATE
It’s important to note a few things here.
To start, men don’t need twice as much food as women.
And women don’t need half as much food as men. These
per-meal numbers simply make it very easy to appropriately portion out a meal. But they don’t necessarily
provide perfect total daily intakes for everyone.
Your palm determines
your protein portions
In reality, most active men likely need a total daily
intake of:
•
6-8 palms of protein-dense foods
•
6-8 fists of vegetables
•
6-8 cupped handfuls of carb-dense foods
•
6-8 thumbs of fat-dense foods
And most active women likely need a total daily intake
of:
•
4-6 palms of protein-dense foods
•
4-6 fists of vegetables
•
4-6 cupped handfuls of carb-dense foods
•
4-6 thumbs of fat-dense foods
For men, these intakes range from approximately
2300-3000 kcal. And for women, these intakes range
from approximately 1500-2100 kcal. Obviously, these
exact numbers depend on the size of the individual, as
well as the foods eaten. But they represent the intake of
Your cupped hand
determines your carb
portions
Your thumb determines
your fat portions
This works well for many reasons.
First, hands are portable. They come with you to work lunches, restaurants, social gatherings, etc.
Second, hands are scaled to the individual. Bigger people need more food, and tend to have bigger hands, therefore getting larger
portions. Smaller people need less food, and tend to have smaller hands, therefore getting smaller portions.
When you do out the math, our hand size portion guidelines come out to 8 daily servings of each food group
for men (2 servings of each per meal x 4 meals). Which
yields roughly 3000 kcal. And 4 daily servings of each
food group for women (1 serving of each per meal x 4
meals). Which yields roughly 1500 kcal.
Some men need fewer calories than the 8 daily servings
of each food group provided by the per-meal template,
and some women need more calories than the 4 daily
servings of each food group provided by the per-meal
template.
Your fist determines
your veggie portions
Third, it provides reasonable amounts of nutrient dense foods and their specific macronutrients (thus preventing deficiencies). It will help
you meet your protein, vegetable, carb, fat, and calorie needs without having to count a gram or weigh a food.
Assuming you’re active and eat about 4 meals per day, this is what we find to be a great starting point:
For each meal, men might begin by eating:
• 2 palms of protein dense foods;
• 1 cupped handful of carb dense foods; and
• 2 fists of vegetables;
• 1 thumb of fat dense foods.
• 2 cupped handfuls of carb dense foods; and
It’s important to note a few things here.
• 2 thumbs of fat dense foods.
And for each meal, women might begin by eating:
• 1 palm of protein dense foods;
• 1 fist of vegetables;
To start, men don’t need twice as much food as women. And
women don’t need half as much food as men. These per-meal
numbers simply make it very easy to appropriately portion out a
meal. But they don’t necessarily provide perfect total daily intakes
for everyone.
© 2018 ISSA issaonline.edu
Find the Hand-Sized Portion Guide in your forms package
average-size men and women eating a mixed diet. And
for most clients, these numbers are more than close
enough.
Be aware that clients will need to adjust the number of
portions they consume to best meet their needs. The
portion sizes themselves are static, but the number of
portions each client needs will vary.
Also keep in mind that even these per-day recommendations are just starting points. They are to help people
more easily meet their protein, vegetable, carb, fat, and
calorie needs without having to do kitchen math. But
they aren’t unchanging “rules.”
Adjust actual number of portions up or down, depending on each person’s unique needs and goals. For
example:
•
Men who want to gain lean mass or who are very active might need to add 1-2 cupped handfuls of carbs
and / or 1-2 thumbs of fats to a few meals.
•
Women who want to gain lean mass or who are very
International Sports Sciences Association
334 | Unit 12
active might need to add a 1/2-1 cupped handfuls of
carbs and / or a 1/2-1 thumbs of fats to a few meals.
•
Men who want to lose body fat or who are inactive
might need to remove 1-2 cupped handfuls of carbs
and / or 1-2 thumbs of fats from a few meals.
•
Women who want to lose body fat or who are inactive might need to remove a 1/2-1 cupped handfuls
of carbs and / or a 1/2-1 thumbs of fats from a few
meals.
Adjust portions based on hunger, fullness, preferences,
goals, overall activity level, and most importantly, results. Start with the basic template and then adjust portions at any time using outcome-based decision making.
See the Hand Size Portions Guide form for more.
The Fitness Nutrition plate
The Fitness Nutrition plate is another option to help
clients visualize how to build a plate when they sit down
to a meal.
Fitness Nutrition plate is just a starting point – A tool
to help someone learn how to build a balanced meal. It’s
not magic. And it might not resonate with some clients
(especially clients who eat a lot of “mixed” meals, like
casseroles).
Make adjustments based on hunger, fullness, preferences, goals, overall activity level, and most importantly,
results. Start with the basic template and then adjust
portions at any time using outcome-based decision making. See Figure 12.3.
Protein powder
For clients who struggle to get enough protein, or find
“real food” protein difficult to prepare, a high-quality
protein supplement can help.
Whey protein in particular has been shown to contain valuable components that help boost immunity,
increase protein synthesis, and improve satiety. Other
protein powders, such as casein, egg, pea, rice, hemp,
and pumpkin seed, each offer unique features and can
also be helpful.
Just like the hand size portions, keep in mind that the
Water
or tea
Fruit
for dessert or
after exercise
Protein
• Eat slowly and stop eating
when you’re 80% full.
including red meat,
chicken, fish, eggs, or
plant source
• Eat more vegetables than fruit.
Veggies
Starches
including sweet potatoes,
potatoes, whole grains, bread
Fats
including healthy oils,
nuts and seeds
Nutrition: The Complete Guide
including a wide variety
of non-starchy vegetables
• Choose mostly whole foods
with minimal processing.
• Choose local or organic foods
when possible.
• Use smaller or larger plates
based on your own body size.
Working with Level 1 Clients | 335
One to two servings per day is fine for helping clients
meet protein needs, but try to avoid having more than
this on a regular basis.
Work with your Level 1 client’s health care providers
on any targeted supplementation plans when treating a
deficiency.
Essential fatty acid supplement
Dehydration; poor beverage choices
For clients who aren’t ready, willing, nor able to eat more
whole-food sources of omega-3, we recommend an omega-3 supplement, such as:
Many clients will:
•
•
•
be chronically dehydrated;
•
consume too much caffeine;
bined DHA+EPA).
•
choose high-calorie drinks instead of water; and / or
krill oil: 2-6 g of total krill oil per day (or 500-2000 mg
•
consume too much alcohol.
fish oil: 3-9 g of total fish oil per day (or 1-3 g of com-
of combined DHA+EPA).
•
algae oil (plant-based): 500-1000 mg of combined
DHA+EPA.
Multivitamin / multimineral supplement
Add a good quality multivitamin / multimineral supplement as a daily habit to help prevent deficiencies.
Do some research to find reputable brands available in
your area that offer no more than around 100% of DV
(whole-food based multi supplements often contain this
amount), and have a list ready to share with clients. The
goal for a multi is deficiency prevention, not treatment of
an actual deficiency. That should be done under medical
supervision.
Powdered greens supplement
A greens powder (which is a mix of dehydrated fruits
and vegetables) can help Level 1 clients who don’t (yet)
get enough fruit and veggies, and / or who may be traveling and find fresh produce hard to get.
Nutrient testing
This isn’t a typical Level 1 strategy, but it’s worth noting.
If you suspect a serious nutrient deficiency, suggest that
your client get tested so that you know for sure.
Most often, you will find:
•
vitamin B12 deficiency in plant-based eaters;
•
vitamin B deficiencies in clients with mental health
issues;
•
vitamin D deficiency; and
•
iron deficiency in women and plant-based eaters.
Get a clear diagnosis before supplementing randomly.
Why might clients struggle with this?
Like processed and nutrient-poor food choices, processed and nutrient-poor drink choices are everywhere
and heavily promoted.
Clients may be looking for a pick-me-up from caffeinated drinks; believe that orange juice is “a great source of
vitamin C”; and / or use alcohol to manage their social
situations or emotions.
Why is this a problem?
As you saw earlier in this textbook, we need proper fluid
balance for our body to function well. Many processed
foods are high in sugar and sodium, which means we
need even more water to compensate. Even mild dehydration can cause problems such as dizziness, fuzzy
thinking, headaches, and muscle cramping.
Clients may depend on caffeine and / or alcohol as unhealthy coping mechanisms.
Sugar-sweetened / higher-calorie beverages may replace
water and add unnecessary energy intake.
Clients may mistake thirst for hunger.
Possible strategies
Keep a “drink journal”
Clients can start with simply tracking their beverage
intake, whether that’s alcohol, sugar- sweetened drinks,
caffeinated drinks, or water intake.
Get a baseline and then discuss potentially changing
that baseline with your client by:
International Sports Sciences Association
336 | Unit 12
•
scaling back (e.g., 2 drinks per evening instead of 4;
choosing a small coffee instead of a large); and / or
•
substituting (e.g., diet soda instead of soda; soda
water instead of diet soda).
Have a “water trigger”
One simple way to both remind your clients to drink
enough and to advertise your services is to get a large
refillable water bottle with your name or coaching practice logo on it. As one of their regular habits, ask them to
fill up the bottle once or twice during the day, then keep
it near them. They’ll drink more, and remember you as
well. (Go for a glass or stainless steel bottle if possible.)
Or you can just start by asking your beginner clients to
drink a glass or two of water with each meal.
Have a crucial conversation; use referral networks
A lot of clients struggle with alcohol — in fact, many of
our clients have mentioned that this is something they’d
like to change.
Aside from getting your client to agree to scale back or
substitute, changing alcohol habits (along with managing other addictions) is mostly out of your scope of
practice. However, you can certainly use a drink journal
to start a dialogue about whether your client might
be ready, willing, and / or able to change their alcohol
habits.
If so, and if they would benefit from some help with this,
refer out to a qualified health care professional such as
an addictions counsellor.
Coaching note: how before what and how much
It’s very common for clients to focus on two things:
1. WHAT they are eating: carbs, gluten, calories,
protein, vitamins, and superfoods, etc.
2. HOW MUCH they are eating: how many grams,
how many calories,
what % of fat, etc.
Obviously, those are important topics.
But HOW clients eat is just as critical (maybe more so).
If your client is eating meals in under 90 seconds standing over the sink or one-hand eating while driving to
work, it doesn’t matter if they are eating organic kale
and imported goji berries. HOW they are eating will
likely hold them back.
So, before you worry about WHAT or HOW MUCH
someone is eating, consider HOW they are eating. (And
later on, look at WHY too.)
The good news is that if you start with HOW and WHY…
WHAT and HOW MUCH often takes care of itself.
Limiting factor: Eating behaviors
Eating too quickly and / or mindlessly
Why might clients struggle with this?
Almost all of us in industrialized countries eat too fast,
with too many distractions around us. It’s hard not to.
Time is money, and we’re busy.
Plus there are lots of things demanding our attention:
electronics, TV, kids, coworkers… We may be rushing
between activities or work obligations, commuting, and
/ or trying to “get on top of things” by multitasking.
Nutrition: The Complete Guide
North Americans in particular aren’t very good at consciously making time to eat slowly and mindfully. Many
of us pride ourselves on our fast-paced, hard-working
culture while we gobble food at our desk or in our car.
Why is this a problem?
When we eat too quickly and without full attention, we
miss important hunger and fullness cues, along with
other body cues (such as how certain foods make us feel
physically).
If we get used to eating while doing other things (such
Working with Level 1 Clients | 337
as watching TV or working at the computer), we’ll start
to feel like we should be eating when we do those things.
(Have you ever noticed at the movies that people devour
almost an entire meal’s worth of buttered popcorn and
other cinema goodies before the film even starts?)
Research also shows that eating while driving makes our
driving significantly worse. We’re distracted and more
likely to get into an accident — driver inattention, including eating, causes about one-quarter of all accidents.
Possible strategies
Meal timer
Clients can time how long it takes them to eat a meal,
and record a baseline for a few meals. You can then use
this data to discuss potential improvements.
Clients can use the timer for subsequent meals to pace
themselves or set goals (e.g., “I will aim for X minutes for
this meal”).
Doing something between bites
Clients can do something else between taking bites of
food, including:
the slowest-eating person and match their speed. Little
kids are often a great “pace setter” for slow eating.
Notice what affects your eating speed
Ask clients to simply notice and name what affects their
eating speed or focus, such as:
•
who they eat with;
•
when they eat;
•
what they eat; and
•
where they eat.
Once your client has gathered some data, discuss their
findings and decide together what to do next to improve
on what is already working well, or change what isn’t
working well.
Use an app
This is one case where a mobile device can actually be
helpful. There are many apps that track and enable slow
eating. Encourage your client to try one or more, and see
which one works for them.
Trouble recognizing hunger and
fullness cues
•
setting down their utensils;
•
taking a breath (or three);
Why might clients struggle with this?
•
taking a sip of water; and / or
•
focusing on table conversation.
Do you remember that class you had in school, the one
that helped you learn all about your personal physiological hunger and fullness cues?
”Wine taste” your food
Ask clients to practice chewing slowly, sniffing, and
savoring their food, as if it were a fine wine. Have them
record what they observe about their meals when they
do this.
We don’t either.
None of us had that class. In fact, most of us learned
exactly the opposite:
•
Eat whatever you like, whenever you want, wherever
Distraction-free eating
Ask clients to eat without distractions such as TV, mobile devices, books or newspapers.
This is often a surprisingly difficult task, so it’s best to
ease clients into this one with an experimental feel, such
as, “Try eating just one meal today without distractions,
and see what that’s like.”
Pace yourself to the slowest eater
Ask your client to eat with a group of people, then find
Eating has no relationship to our physiological needs.
you are!
•
Stop when the plate is empty, not when you’re physically satisfied. Don’t waste food.
As adults, most of us now eat based on social norms,
advertising, what’s around us, and our family / friends /
peers. We eat when:
•
it’s a certain time;
•
it’s a certain event (or no event in particular);
•
it’s a certain emotional situation (or we’re bored); or
•
we’re reminded of food (which is nearly always).
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338 | Unit 12
Most adults have no idea what physical hunger and / or
fullness actually feel like. We have no appetite awareness.
Some clients might be able to identify extreme variations (e.g., I’ve been on a diet for a week and I’m ready
to binge; I just ate so much I’m uncomfortable), but not
healthy ranges.
Just as some folks will consistently eat when they aren’t
really hungry, some folks will avoid eating when they are
hungry. They might be wrapped up in a work project,
family commitment, or volunteering. Or maybe they’re
consciously trying to suppress hunger with loads of coffee, chewing gum, and diet sodas. They might be skipping meals and / or stringently restricting their intake.
In other words: Few people start eating when they’re
truly physically hungry and stop when they’re physically satisfied.
Why is this a problem?
Basic appetite awareness is one of the most useful and
accurate ways someone can recognize how much food
their body needs.
We need to pay attention to both physiological hunger
and fullness cues in order to properly regulate our intake
and energy balance.
And when we can learn to recognize these cues, eating becomes much simpler and more intuitive. Level
1 clients don’t need “food rules”, cognitive control, or
tight restrictions; they have their own bodies to tell them
when to start and stop.
Possible strategies
Practicing noticing cues
Not all clients will be able to recognize hunger and
fullness cues right away, particularly if they have a history of dieting, restricting, and / or binge eating. Some
may also be dissociated from their bodies and physical
feelings in general.
Nevertheless, you can ask clients to simply observe and
notice what hunger or fullness feels like. What physical
sensations do they feel? (You can suggest things to look
for, such as growling stomach or lightheadedness; a
sense of abdominal emptiness or heaviness)
If people eat when they aren’t hungry (and don’t stop
when they’re physically satisfied), they’ll probably end up
with less-than-ideal body composition and overall health.
They may feel out of control of their eating and not sure
how to manage it. There are no clear “start” or “stop”
signals.
If people don’t eat when they’re physically hungry — for
instance, if they purposely skip meals or stringently
restrict their physical intake — they’ll often end up with
nutrient deficiencies and the consequences of ongoing
energy deprivation.
People may also feel caught in the “scarcity” mindset,
especially if this restriction is part of “dieting.” In this
case, they alternate between eating what they don’t need
(“Another potential dietary restriction lurks around
every corner… better eat now while I can!”) or not eating
what they do need (“Fat makes you fat! I don’t eat that!”)
Hunger is a normal and healthy biological response, just
like going to sleep, going to the bathroom, or getting
thirsty. It exists to keep us alive.
Fullness and satiation tell us when we’ve had enough.
The Hunger Game
NAME
DATE
The “how you should feel timeline”
Today, notice how you feel before, during, and after eating. Rank your physical hunger on a scale from 1 (no hunger) to 10 (worst
hunger ever). When you’re truly physically hungry, eat. Eat slowly, and stop at 80% full. Adjust your meal size and frequency depending
on your body cues.
Just before
eating
Are you physically hungry? Pause and check in. Look for signals like a rumbling stomach,
lightheadedness, irritability, etc. You want to be around a 7 out of 10 on the hunger scale.
Immediately
after eating
To be 80% full, shoot for about a 2 or 3 out of 10 on the hunger scale. Pause for 15-20
minutes before you eat more. This will give your brain time to catch up. You want to feel
satisfied, not stuffed.
One hour
after finishing
You should still feel physically satisfied with no desire to eat another meal.
Two hours
after finishing
You may start to feel a little hungry, like you could eat something, but the feeling isn’t
overwhelming.
Three to four
hours after
finishing
Check in. You may be getting a bit hungry, perhaps a 4 to 6 out of 10. If you’re around a 7,
eat. Not really hungry yet? That’s OK. Follow your body cues.
Four or more
hours after
finishing
You’re probably quite hungry, like nothing is getting between you and the kitchen. If you’re
around a 7 or higher, eat. Not really hungry yet? That’s OK. Keep checking in with your body.
You may find you need to act fast once your body decides to be hungry — so be prepared
with a healthy and quick option, just in case.
© 2018 ISSA issaonline.edu
Find The Hunger Game worksheet in your forms package
Nutrition: The Complete Guide
Working with Level 1 Clients | 339
Ask clients to drink a big glass of ice water and notice
the sensation as it goes down. They can also put one
hand on their stomach as they do so, just below their
sternum. This can help them “locate” and physically
sense into where their esophagus and stomach are.
•
create sustainable healthy habits; and / or
•
normalize many health indicators.
Appetite awareness tracker
Of course, there can be some variation (especially if
clients are learning to follow their own natural appetite
cues), but in general, some type of structure and regular
schedule works best for most Level 1 clients.
Use the The Hunger Game with clients. Ask them to
track both:
Possible strategies
•
how hungry they were when they started a meal; and
Scheduled meal times
•
how full / satisfied they were when finished.
For Level 1 clients who want to improve athletic performance and / or gain muscle, scheduled meal times work
well. This needn’t be a rigid routine. Simply suggest that
clients eat approximately every 3-4 hours, and help them
plan and prepare for this.
Ask them to also notice how much food it took for them
to feel “satisfied” or “no longer hungry” versus “full /
stuffed.”
Irregular eating habits
Many clients miss meals, or don’t eat enough on some
occasions, while eating too much at other times.
Why might clients struggle with this?
Life is busy. People are rushed and distracted. They may
not plan properly.
They may unwittingly miss meals because of other commitments, or they may purposely skip meals if they’re
trying to lose weight.
They may over-eat when they’ve let themselves get too
hungry or stressed, or when they’ve skipped a meal
earlier. They may keep things in check during the day (or
during the week), but “lose control” in the evening, or
on the weekend. They may alternate between restriction
/ control and over-eating / bingeing / “anything goes.”
Why is this a problem?
Most of the time, most people do best with some kind
of routine. Our body tends to prefer some predictability
and homeostasis, including relatively regular meal times.
Regularly spaced, relatively predictable meals that are
roughly the same size usually work best for almost all
Level 1 clients looking to:
•
lose weight / fat;
•
improve athletic performance;
•
gain muscle;
Scheduled appetite check-ins
Most of the time, Level 1 clients looking to lose weight /
fat need to learn to follow their hunger cues rather than
eat on a schedule. Instead of scheduled meal times, try
scheduled appetite / hunger check-ins.
Ask clients to simply “check in” with their appetite every
3-4 hours, and note how hungry they feel. If their hunger
is greater than, say, a 6 or 7 out of 10 (where 10 is absolutely, life-threateningly starving), then it’s time to eat. If not,
check back in after another half hour or so.
Meal planning / stocking up on healthy options
Meal planning in advance can help clients who either
“forget” to pack a healthy meal, who might be confronted with a variety of poor options at certain times, and /
or let things go too long (then lose control).
Clients can also stash things like nuts or fruit to have
on hand in case the munchies strike and they need a
healthy choice.
Using food to manage feelings /
emotional eating
Many Level 1 clients eat for comfort, and to manage
their emotions or unwanted physical feelings (such as
stress or anxiety).
Why might clients struggle with this?
Food is a great way to self-medicate. It tastes good, it
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340 | Unit 12
makes us feel better (at least for a few minutes), it’s easily
available and legal.
Food comforts and soothes us. It stimulates pleasure
pathways in the brain.
Food has emotional associations. It has meaning and
memory, reminding us of home, childhood, or that time
we went to Italy or Vietnam; visited our grandmother;
had our favorite holiday meal; etc.
Food connects us to others, to our family, heritage, and
culture. It’s often a way we express love, care, concern,
and / or celebration to others. Or preserve our history
and who we are.
Why is this a problem?
Using food as comfort, to feel good, and to stop feeling
bad isn’t a problem on its own. Almost all of us do it
sometimes. It’s normal and it makes sense.
The problem happens when:
•
we do it to excess;
•
we feel out of control, or compelled to do it;
•
we can’t or don’t stop when we’re satisfied; and
•
we don’t have any other way of creating connection
HALT
HALT stands for:
•
Hungry
•
Angry (or anxious)
•
Lonely
•
Tired
When a client notices an urge to eat emotionally, ask
them to pause for a minute and ask themselves if they
are hungry; angry or anxious; lonely; and / or tired.
Many Level 1 clients do not recognize what they are
thinking, feeling, and / or experiencing. Getting in the
habit of “checking in” helps clients notice and name
what is actually going on, even if they don’t change the
behavior (at first).
Discomfort deal
If a client is ready, willing, and able to start changing
FOOD JOURNAL
Emotional Eating Journal
or comfort, or managing our feelings.
NAME
Possible strategies
MEAL TIME
Food and feelings journal
Use a simple food journal or the Emotional Eating
Journal. Along with asking for food type and amount,
ask clients to jot down any thoughts and feelings they
have at meal time (or times when they are deliberately
skipping meals, purging, and / or compensating with
exercise).
DATE
Instructions: Capture any urges or behaviors that you notice, especially around eating time.
WHAT DID YOU EAT?
WHAT ARE YOU FEELING, DOING OR THINKING?
7 AM
Black coffee
Remember to stay on track with diet today! Doing
intermittent fasting - no breakfast. Stay strong!
Did 45 minutes fasted cardio.
10 AM
Large coffee with cream & sugar
Muffin
Hoping to wait until lunch time.
Gave in and ate the muffin at the meeting.
Feeling guilty and ashamed.
12” Subway sandwich
Feeling rushed and anxious. Urge to over-eat is
strong. Got extra-large sub and ate it quickly.
Planning longer workout tonight to make up for it.
12 PM
Diet soda
For clients who don’t even want to record their food
intake, simply ask them to record thoughts and feelings
around meal times, without noting what exactly they ate
(or avoided eating).
After gathering data for a few days or a week, look at the
journal together with clients and ask them to identify
any patterns.
In particular, notice links between specific thoughts /
feelings / situations and behaviors.
Nutrition: The Complete Guide
© 2018 ISSA issaonline.edu
Find the Emotional Eating Journal in your forms package
Working with Level 1 Clients | 341
their emotional eating behaviors, ask them to start with
a simple “discomfort deal”:
“When you feel the urge to eat emotionally, just
take five minutes and sit with that urge. Set a
timer if you like. During this time, simply notice what you are thinking or feeling, whatever
comes up. And notice that you feel uncomfortable, but it’s okay. After that five minutes, you
can make any choice that feels right.”
Over time, this will help clients learn to tolerate the
discomfort of not eating to soothe themselves. It will
also increase their faith in themselves and their ability to
self-regulate.
•
using food and eating (or not eating) to manage or
avoid unwanted feelings.
Importantly, a single incident of these behaviors (such
as forgetting a meal once when busy, or having extra
helpings at a holiday meal) doesn’t mean that a client has
disordered eating.
Disordered eating is a chronic, systematic pattern of behavior, thinking, and feeling. (Notice that in many cases,
it dovetails with emotional eating, described above.)
A full discussion of disordered eating is beyond the
scope of this textbook, but be aware of it. Also see Unit
15 for a more in-depth discussion.
Coming up with alternatives
Why might clients struggle with this?
Once you and the client have identified what the client is
actually seeking with the emotional eating (e.g., to calm
down, to have fun, to connect with others), work with
the client to come up with a list of alternatives, such as:
Fundamentally, disordered eating is usually about control, or the lack of control. Clients have many reasons for
engaging in disordered eating, such as:
•
trying to manage or avoid unwanted feelings and
•
basic relaxation techniques;
•
taking a yoga class;
•
trying to “self-medicate” or cope;
•
going for a walk;
•
trying to distract themselves from other things;
•
having a hot shower or bath;
•
trying to “numb out”, “check out”, and / or dissoci-
•
getting a massage;
•
journaling; or
•
calling a friend.
Ask clients to choose one or two options and try these
alternatives when they notice impulses to eat emotionally. If possible, ask them to jot down a few notes on how it
went, or what they noticed about the experience.
Disordered eating
By definition, most of our nutrition clients are experiencing disordered eating. Disordered eating includes a
wide range of behaviors, thoughts, and feelings, such as:
sensations (e.g., anxiety, sadness, anger, grief, stress);
ate; and / or
•
trying to either maintain control or enjoy the release
of losing control.
Disordered eating is, essentially, a misguided attempt to
solve a problem.
Why is this a problem?
Disordered eating has a wide range of negative effects on
body, mind, spirit, and relationships.
•
Physiological consequences can include:
•
GI upset, damage, and slowed motility
•
over-eating / binge eating;
•
oral health problems
•
under-eating / restricting food;
•
electrolyte imbalance; nutrient deficiencies
•
a preoccupation with controlling food type and in-
•
hormonal disruption
take (including an obsession with “healthiness”);
•
loss of bone density
•
compulsions and intense urges;
•
insomnia and other sleep disorders
•
compensation for eating (such as purging or over-ex-
•
lowered immunity and increased inflammation
ercising); and / or
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342 | Unit 12
•
•
Psychological consequences can include:
anxiety, perfectionism, obsessive and compulsive
urges and impulses
•
depression, detachment, dissociation
•
alexithymia (being unable to identify and express
emotions)
•
disordered thoughts, beliefs, and assumptions
•
shame, guilt, regret
•
Social consequences can include:
•
isolation from others
•
withdrawing from normal activities
Possible strategies
Refer out
Important note: As a nutrition coach, you can use some
simple tools and techniques to help your client become
more aware of disordered eating patterns. However, your
scope of practice is limited here.
Refer out to a qualified health care practitioner, addictions counsellor, and / or specialist in disordered eating
whenever necessary.
2 Crazy Questions
We like the 2 Crazy Questions approach to opening a
discussion about disordered eating behaviors.
•
•
What is GOOD about these behaviors, thoughts, and
Limiting factor: Exercise and activity
Not getting enough regular physical
activity
Why might clients struggle with this?
Daily-life movement is declining in industrialized Western countries. Thanks to mechanization, labor-saving
devices, and shifts in where goods are manufactured,
fewer people now move their bodies for a living.
We’ve moved out of the forests, farms, and factories to
become “professional sitters” parked at desks. We’ve
swapped long walks or horseback riding for sitting in
moving vehicles. Most of us no longer run, throw, haul,
carry, climb or dig as part of our daily routine.
Why is this a problem?
As humans, we need to move. We evolved to move — as
often as possible, in as many ways as possible. When
we stop moving, we stop living, repairing, healing,
and functioning well. Recent research in neuroscience
shows that we think and feel through movement, and
vice versa.
Activity changes the way our body processes nutrients.
Movement prepares our body to handle incoming food
properly — for instance, directing nutrients to be stored
as lean mass instead of fat.
Less movement means:
feelings for you?
•
poor metabolic health;
What might be BAD about changing them?
•
faster aging and physical decline;
•
loss of physical function and mobility;
•
poorer brain function (including learning, prob-
For more on this style of dialogue, see Unit 10.
Remember that this is a conversation, not a lecture
from you. Your goal is to understand why your client is
struggling with disordered eating thoughts, feelings, and
behaviors, rather than to tell them what they “should” be
doing or not doing.
Break the chain
If clients are ready, willing, and / or able to start changing their disordered eating habits, try the Behavior
Awareness Worksheet with them. You can find this in
the forms package.
Nutrition: The Complete Guide
lem-solving, and memory);
•
poor emotional / psychological health; and
•
slower transport of materials around the body.
When we don’t move regularly, our energy requirements
become so low that the body can get crossed signals, and
it’s tough to get enough nutrients.
Working with Level 1 Clients | 343
Possible strategies
Daily-life movement
Physical activity doesn’t just mean Olympic athlete-style
workouts. Household chores, walking, biking, food
preparation, taking stairs, carrying items, or volunteering outdoors can be a healthy and safe mix of daily
movement.
Collaborate with your Level 1 client on how they could
add a little more basic movement into their day. See the
Ideas for Movement form.
Scheduling and preparing for exercise
If you’re a regular exerciser, it’s easy to forget that having
an exercise routine requires skills such as preparation,
planning, and scheduling, as well as a commitment to
engage in these activities and make them a priority.
So help your Level 1 clients build an exercise habit by
teaching and practicing the skills they’ll need to do it
consistently. Help them learn to prioritize exercise, and
help other people (such as family members, and spouses)
know that this is important.
Build an “activity team”
While many people thrive on solo activity, most people
find it more motivating to have some kind of “activity
relationships” that give them accountability and social
support. For instance:
Help your clients discover the fun of activity, doing
things like:
•
playing with their kids;
•
taking active holidays (e.g., learning to surf, going
hiking, or trying walking tours of new cities); and / or
•
choosing recreational sports as part of their activity
(e.g., Ultimate Frisbee, community softball, indoor
climbing).
Over-training and not managing
training loads
While some clients don’t move enough, other clients
move too much. These are your recreational or amateur
athletes who are devoted to particular sports or activities, or the gym rats who live at the temple of iron.
Why might clients struggle with this?
Exercise feels good, as does mastery of a sport. Many
people are naturally competitive and driven to succeed.
Some folks love the “high” of a tough workout.
Amateur athletes may also feel pressure from teachers,
parents, coaches, and other team members to train harder; improve performance; get leaner, stronger, and / or
more muscular; and win at all costs. Many competitive
seasons are long, demanding, and / or intense, often with
short recovery periods or off-seasons.
Many sports also encourage athletes to ignore pain,
fatigue, and discomfort. People become dissociated
from their bodies, and simply don’t notice basic signs
of over-training or poor recovery.
•
walking the dog;
•
walking or running with a friend or neighbor;
•
joining a running, hiking, or other activity group;
•
doing physical activities as a family;
Why is this a problem?
•
joining a group fitness class; and
•
joining a community gym.
Not balancing training with proper recovery leads to
injury and illness. Long-term over-training can have serious physiological and psychological effects that include
chronic or permanent injuries, hormonal disruptions, and
persistent mental and physical health problems.
Work with your Level 1 client to identify people (and
animals) that can help them add more activity and build
social support at the same time.
Make it fun
Possible strategies
Many Level 1 clients think of movement as a chore. It’s
just one more un-done obligation, staring at them from
their long to-do list.
Training journal
Ask your client to keep records of their training (many
hardcore exercisers and athletes will already do this).
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344 | Unit 12
After a week or two of data collection, review and discuss with your client.
Collaborate with your clients’ coaches, parents, teachers,
etc. if needed.
Schedule regular, nutrient-dense meals
Schedule regular meals that include:
•
lean protein
•
colorful fruits and vegetables
•
slow-digesting, high-fiber carbohydrates
•
healthy fats
Athletes and frequent recreational exercisers should aim
to eat about every 3-4 hours.
Limiting factor: Recovery
“Recovery” is a broad concept. In general, it refers to
being able to:
•
bounce back from stressful and traumatic events
(whether large or small);
•
effectively and repeatedly meet physiological and
psychological demands; and
•
repair and rebuild after damage to be more robust
and resilient than before.
As a coach, no doubt you want clients to rebound
physically, mentally, and emotionally from whatever life
throws at them… and get even stronger afterwards.
Poor recovery generally involves some combination of:
Improve nutrient intake; targeted supplementation
•
not getting enough sleep;
See the “Limiting factor: Food choices” section, beginning on page 380.
•
poor sleep quality;
•
too much sympathetic nervous system “fight /
flight” activation (i.e., spending too much time in the
Incorporate recovery techniques
See the “Limiting factor: Recovery” section.
“amped up” and overstimulated zone);
•
activation;
Explore athlete / exerciser mindset
Review the techniques from Unit 10 and 11 on understanding and communicating with clients.
Explore your athlete / exerciser client’s mindset, beliefs,
and feelings about their training. Look for limiting factors that you can adjust, change, and / or remove.
For instance:
•
Why is training important to them? What does it
mean to them?
not enough parasympathetic “rest and digest”
•
inadequate nutrient intake to support activity or
manage stress.
Recovery and its components, like good sleep, are outcomes. You can’t control outcomes. But you can control
behaviors.
Why might clients struggle with this?
Our industrialized Western culture does not support
recovery well.
•
What forces are driving them to train hard?
•
What might impede or block them from taking
are out of sync with our natural rhythms. Many peo-
enough recovery? (e.g., busy schedule, not knowing
ple work shift work.
about recovery, not thinking recovery is important,
•
•
lack of planning)
Remember that this is a conversation, not a lecture from
you. Your goal is to understand why your client is training hard, rather than to tell them what they “should” be
doing or not doing.
Cycles of light and dark, which support normal sleep,
We are surrounded by constant stimulation, stressors,
distractions, and demands.
•
We don’t value sleep, quiet time, silent reflection, or
simple boredom.
•
We are often socially isolated, struggling to connect
meaningfully with others in supportive, affirming
relationships (which humans, as mammals, need for
overall wellbeing).
Nutrition: The Complete Guide
Working with Level 1 Clients | 345
•
Culturally, we promote fast-paced living, doing more,
•
acquiring more, “having it all”, being “busy”, and
“chasing the dream” of success. We are always “on
the treadmill”, running faster and faster.
•
We often judge “weakness” harshly in ourselves and
chological stress.
•
We don’t perform well athletically, or in daily life.
•
We can’t learn, remember, think, or make decisions
well. Going 24 hours without sleep is similar to per-
others. Needing rest, care, and recovery is sometimes
forming with a blood alcohol level of 0.10%. (Good
seen as a personal failure or a waste of time.
•
luck navigating the grocery store and / or gym while
Work is increasingly precarious and stressful; many
people work long hours and travel long distances for
it. And we must balance paid work with unpaid work
“intoxicated” from minimal sleep.)
•
•
Our food is processed and nutrient-poor. We get plenty
of calories but are often malnourished.
•
they must be balanced with recovery.
In addition, many Level 1 clients may be struggling with
physiological factors that actively hinder their rest and
recovery, such as:
sleep apnea or other breathing difficulties (which
increase as body fat and weight increase);
•
hormonal imbalances;
•
perimenopause, menopause, and andropause (male
menopause);
•
pain or discomfort from chronic illness and / or
injuries;
•
medication use;
•
insomnia related to anxiety or other mental health
issues; and / or
•
diseases.
•
We are less able to notice or obey hunger and fullness
cues. Being tired is also a common trigger for emotional eating.
Level 1 clients in particular may also not understand
how training stress and life stress interact, and that
•
We end up with more chronic illnesses like heart disease, Type 2 diabetes, cancer, and neurodegenerative
such as domestic chores; caregiving for children,
people with disabilities, or aging parents.
We’re less able to cope with physiological and psy-
poor immune function and / or inflammation.
Why is this a problem?
Possible strategies
Sleep ritual
Most of us can’t go from 0 to 100 immediately in the
morning. We need time to wake up and “get the motor
running.”
The same is true in reverse: Most of us can’t go from 100
to 0 before bed.
Help Level 1 clients create and gradually incorporate a
“transition plan”: a sleep ritual.
30-60 minutes before bed, they should find ways to wind
down, activate the parasympathetic nervous system, and
tell the body it’s time to relax.
You may also have to help your Level 1 clients lower
their caffeine and stimulant intake gradually, especially
within 8-9 hours of bedtime.
Sleep or recovery journal
We need proper recovery to survive and thrive.
Have clients track a baseline of recovery behaviors and
which ones seem most helpful.
If demands outweigh our ability to compensate, we
begin to break down.
Or, have them track their sleep (if they want, using an
app) to gather data and track progress.
Sleep is a master regulator of metabolism and brain
function. If we don’t get it, our body and mind suffers.
For more ideas, see the Sleep and Recovery Form.
•
We age faster, become sicker, and feel crappy.
International Sports Sciences Association
346 | Unit 12
Sleep and Recovery Ideas
NAME
FOOD JOURNAL
C
How Food Feels Journal
NAME
DATE
DATE
Instructions: Capture any physical sensations that you notice throughout the day, especially after eating.
How to explain this to your clients
MEAL TIME
Here’s a sample script you can use when discussing this with your clients:
WHAT DID YOU EAT?
ANY PHYSICAL SENSATIONS? IF SO, WHAT?
8 AM
Whole wheat bagel and cream cheese
Glass of milk
Noticed stuffy nose and headache about half
hour later. Stomach a bit rumbly.
12 PM
Bowl of vegetable soup
Medium-sized bowl of bean salad with tuna
Ate until just satisfied. Feeling good, not overstuffed.
Large coffee
Low energy; hoping coffee would pick me up. Now
I have a headache.
“Based on the assessments we did, it appears that you are having some trouble with sleep.
Most of us can’t go from 0 to 100 immediately in the morning. We need time to wake up and “get the motor running”.
The same is true in reverse: Most of us can’t go from 100 to 0 before bed.
Developing a “transition plan” or “sleep ritual” can really help.
30-60 minutes before bed, you can find ways to wind down, activate the parasympathetic nervous system, and tell the body it’s
time to relax.
If you are interested, I have some ideas that I can share with you now.”
Sleep hygiene best practices
1.
Keep a regular schedule — our bodies like regularity. Try to go to bed and wake up at the same times. With
a regular schedule, your body will know when to release calming hormones before bed, and stimulating
hormones to wake up.
2.
Keep alcohol and caffeine moderate — both will interfere with sleep. Try to avoid caffeine within 8-9 hours of
your bedtime.
3.
Eat and drink appropriately — a regular to smallish-sized meal about 2-3 hours before bed, one that is balanced
in nutrients, can help facilitate sleep. Try not to drink too much liquid in the hours before bed, which will help
you avoid waking up for bathroom breaks.
4.
Do a brain dump — take a few minutes to write out a list of whatever is bugging you. Whatever is in your brain,
get it out and on to paper.
5.
Turn off electronics — digital devices stimulate our brain. We recommend unplugging from all screens at least
30 minutes before bed. This includes television, computers, and smartphones. The screens release a blue light
that prevents our brain from preparing for sleep.
6.
Stretch / read / de-stress before bed — maybe some yoga poses, reading, or meditation.
7.
Go to bed before midnight — this is better aligned with natural light cycles.
8.
Sleep at least seven hours — work backwards here. If you need to wake up at 6 AM, 11 PM will be the latest you
want to hit the pillow.
9.
Exercise regularly — physical movement (especially outdoors) can promote restful sleep at night.
3 PM
Muffin
10. Take a bath or shower — a warm bath with epsom salts or even a cool shower (depending on personal
preference) can promote restful sleep.
© 2018 ISSA issaonline.edu
© 2018 ISSA issaonline.edu
Find Sleep and Recovery and How Food Feels worksheets in your forms package
Nutrient-dense eating; supplementation
Improving Level 1 clients’ food quality and nutrient
intake will help boost overall recovery. See the strategies
from the “Limiting factor: Food choices” section.
Food intolerance journal
More advanced Level 1 clients can track symptoms of
food intolerance and inflammation that may be connected to what they eat. Try the How Food Feels Journal.
You can find this in the forms package.
Over time, relationships between foods and symptoms
of poor recovery may become clear; you may be able to
improve clients’ overall recovery by simply removing a
few offending foods.
Nutrition: The Complete Guide
Limiting factor: Food and cooking
skills
Many Level 1 clients:
•
don’t have basic food preparation skills (or confidence
in the kitchen); and / or
•
don’t have basic shopping and food awareness skills
(e.g., reading labels).
Why might clients struggle with this?
In previous generations, food preparation skills were
essential parts of home, school, religious, and military
education. Knowing how to correctly prepare, store, and
use food could literally be a life or death issue — getting
Working with Level 1 Clients | 347
sick from spoiled food, or running out of food before
fresh food was available, was an ever-present concern.
Modern transportation, refrigeration and food processing
means that we don’t ever have to learn to cook. Cooking
has been eliminated from many school curriculums.
Grocery stores are designed to entice us to buy convenience foods. Food labels can be confusing and unhelpful, and vary from region to region. Clients often aren’t
sure how to make informed decisions.
Why is this a problem?
It’s tough to eat nutritious foods when there are no nutritious foods around. Or when they are unprepared and
packed into the back of the fridge / freezer / pantry.
Practicing basic food preparation is essential to nutrition success. And we aren’t talking high-level chef
skills, rather, just having a working knowledge of how to
assemble some meals.
Food and cooking skills improve choices, opportunities,
and confidence.
When clients can’t cook or prepare food, they’ll rely
on convenient and processed foods. They’ll often feel
anxious and inept in the kitchen, and avoid trying new
recipes.
When clients can’t shop or read labels effectively, they’ll
be misled by food manufacturers and make poor choices. Their grocery shopping will be unorganized and
impulsive.
Most importantly, clients without skills will not be able
to do their assigned tasks. In order to eat more protein, or
plan meals in advance, or try new colorful vegetables, they
have to know:
Clients with limited incomes may worry that “healthy
food” is expensive. If they don’t know how to stretch a
food budget, or know that whole foods can be affordable,
nutritious and delicious, they’ll choose cheaper processed foods.
Possible strategies
Grocery store visit
Go to a grocery store with your client. Walk them
through some basic label reading and food choices. Show
them how to create a menu and shop from a list.
Cheap, nutritious tasty food
As part of the grocery store visit or shopping list creation, educate your client about cheaper healthy options,
such as:
•
cheaper cuts of meat / poultry that are ideal for stewing or braising in a slow cooker
•
buying vegetables and fruits in season
•
buying and cooking in bulk (e.g., whole grains, dried
beans / lentils, whole chickens rather than chicken
breasts)
Help them come up with and then choose options for a
food budget.
Go-to meals
Working with your client, come up with a list of 3-5 simple meals that your client can either make, or is willing
to try making. Good beginner options include:
•
salads with pre-prepped protein (such as canned
tuna and / or canned beans)
•
stir-fries
•
what those things are;
•
simple stews, such as chili
•
where to find them;
•
boiled or scrambled eggs
•
how to choose them;
•
beans / lentils with seasoning
•
how to prepare them; and
•
fruit and cottage cheese
•
how to make them taste good.
•
Super Shakes
Clients who are looking to gain weight / muscle, or fuel
athletic performance, have to eat more. If they can’t
choose and prepare food well, this will be tough.
Ask your client to practice making their 3-5 “go-to
meals” until they feel confident enough to try a new
meal that builds on the theme (e.g., adding new vegetables to the stir-fry)
International Sports Sciences Association
348 | Unit 12
Start with a “core” of meals and build outwards from
there.
Cooking education
Have some handy resources on food prep, cooking, and
shopping handy, either as handouts or as videos.
Limiting factor: Mindset, psychology,
and life skills
Most often, we are not limited by our actual circumstances. Rather, we are limited by our assumptions;
beliefs; thoughts; and the stories we tell ourselves. We
may also be limited by not having important life skills,
such as communication.
Problem is, following external rules almost inevitably
leads to over-eating. Because once a client deviates from
diet rules (as everyone eventually does), they’ll have
nothing left to guide them. They end up seeing food as
something to get while they can, before the next diet
starts. It’s all or none.
Why is this a problem?
All-or-nothing thinking is part of the root of diet cycles.
“Dieting” clients swing between rigid control or diligent
restriction and uncontrolled release. They are either “on
the wagon” or “off the wagon.”
In between is the “f*** it moment”, known formally as
“disinhibition.”
While addressing clients’ mindset, psychology, and life
skills is outside your scope of practice, you can still work
with these areas a bit, using a general approach.
Consistency is perhaps the most important factor in success. All-or-nothing clients typically can’t be consistent.
Instead they are either “on” or “off.” (Usually “off.”)
Mindset and psychology issues
When they “fall off the wagon”, this confirms the “I’m a
failure” mindset. Clients become frustrated, demotivated, and even more convinced that they cannot succeed.
Or that they are somehow different and broken.
Issues here can include (but aren’t limited to):
•
all-or-nothing thinking (e.g., yo-yo dieting, restrict-binge cycles, big “diet challenges”, weekend
/ night-time over-eating, “Either I’m perfect or I’ve
failed” mentality)
•
Consistency doesn’t mean perfection. Help clients determine a level of consistency they feel they can comfortably achieve. Progress, regress, or maintain as needed.
fixed mindset (I’m broken; I don’t have what it takes;
I’m a failure, etc.)
Possible strategies
•
not being consistent
Sensing in to body cues
•
busy-ness and stress; overwhelming life demands;
feeling rushed and pressured
Why might clients struggle with this?
There are many reasons a client may have an unproductive mindset, most of which are beyond the focus of this
unit.
However, many of these factors are simply part of life
(i.e., busy-ness, feeling rushed) while others often come
from chronic dieting.
When someone doesn’t trust themselves, they will look
for rules and regulations to follow. This is the basis of
diets. Most people don’t have a basic idea of what reasonable eating looks like. So, they find some doctrine to live
by.
Nutrition: The Complete Guide
Level 1 clients may feel they need rigid “rules” because
they can’t trust their own bodies. See the “Limiting
factor: Eating behaviors” section for ideas on teaching
appetite awareness.
The continuum / “Just a little bit better”
Work with clients to identify how choices are on a continuum from better to worse.
Ask clients:
“In situation X, what might be a slightly better
choice? Why?
What might be a slightly worse choice? Why?
What choice do you feel able to make right
now? Why?”
Working with Level 1 Clients | 349
•
All-or-None Worksheet
Are they looking to socialize and have fun? How can
they still have fun without going overboard? How
C
can they connect with other people in more healthy
ways?
NAME
•
DATE
Here’s a sample script you can use when discussing this with your clients.
“Sometimes it can be tough to consider the big picture when it comes to nutrition. We have so many things we are trying to
juggle. It can often feel like we do the ‘healthy thing’ or do ‘nothing’.
activities can they do? (e.g., hobbies, volunteering)
We start to feel like healthy nutrition is taking away from something else we value, like social time or hobbies. We think to
ourselves, ‘I can eat a healthy meal OR go out with friends to dinner.’
Instead, we can find ways to integrate the two. We can avoid ALL or NONE, and embrace the middle ground.”
Life skills
Consider the following continuum and how it relates to your current situation/decision.
ABSOLUTE WORST CHOICE
1
2
3
ABSOLUTE BEST CHOICE
4
5
6
Are they feeling a void without the distraction of
work or weekday obligations? What other meaningful
How to explain this form to your clients
7
8
9
10
First, what would you say is:
The absolute WORST choice?
The absolute BEST choice?
Now, think about the choice you’ve made. Think about where it fits on the continuum and write it in.
Like “recovery”, the category of “life skills” covers a wide
range of things. Here are some common skills that many
Level 1 clients lack:
•
being able to ask for what they want and need;
•
being able to define clear boundaries with others
(e.g., people pushing food; other household members sabotaging or criticizing);
Finally, what would be a slightly better choice? Where would it rank on the continuum?
What would be a slightly worse choice? Where would it rank on the continuum?
© 2018 ISSA issaonline.edu
Find All-or-None in your forms package
•
making informed, thoughtful, evidence-based
choices;
•
strategic, long-term thinking;
•
time management and scheduling;
•
planning and prioritization; and /or
•
self-care
Why might clients struggle with this?
Help clients identify what “slightly better” may be for them
in each situation. Encourage them to focus on moving one
small “notch” along the continuum, rather than trying to
do it all perfectly.
Check out the All-or-None Form for how to approach
this with clients.
Weekend and night-time over-eating journal
Explore with clients what happens when they over-eat at
night or on weekends.
Use the Behavior Awareness Worksheet (in forms package) to surface underlying patterns and the possible root
of the behaviors. For instance:
•
Are they bored? What other options for stimulation
and creativity do they have?
•
Are they frustrated or stressed? What options do they
have for stress management?
Like hunger and fullness cues, we don’t learn a lot of
these life skills anywhere.
Plus, the world is full of people and things that are happy
to distract us, grab our attention, pressure us, and push
us to follow their agenda.
People who have been socialized to be “pleasers”, “helpers”, and / or “caregivers” may find it hard to take time
for themselves, or identify and advocate for their own
needs — especially if they become parents or other types
of caregivers.
Why is this a problem?
Clients without life skills often:
•
act impulsively;
•
make poor decisions;
•
can’t advocate for themselves and / or communicate
their needs effectively;
International Sports Sciences Association
350 | Unit 12
•
don’t prioritize health, good nutrition, and / or regu-
•
lar activity;
•
sacrifice their wants and needs for others, to their
try a day of mindful eating and “going with the flow.”
•
own detriment;
•
have poor boundaries (other people run their lives
and / or criticize them); and then feel resentful of
others as a result;
•
feel out of control and / or like they “can’t get it
together”;
•
are reactive rather than proactive, constantly “fight-
Destination postcard
This is both a fun exercise and a valuable way to re-route
negative thinking.
Many of our clients know what they don’t want. Fewer
know what they do want.
“Don’t-want” is not an action plan. So help
your clients clearly imagine, identify, and work
towards what they do want. Start a discussion
by asking this question:
can’t stick to a program consistently.
Practice planning, prioritization, and preparation
Help your client practice basic planning, prioritization,
and preparation techniques, such as:
•
“Let’s imagine the future. Maybe it’s X months
/ years from now. And let’s imagine that you’ve
met all your goals and gotten everything you
want. Let’s not worry about being ‘realistic’
right now.
using a calendar and automated reminders to book
workouts, schedule grocery shopping, etc.
•
looking ahead to their upcoming week and anticipat-
“What, specifically does that future look like?
If you could send a ‘postcard from your future
self’ back in time to yourself now, what might
that postcard say?”
ing obstacles and setbacks
•
deciding in advance what their daily or weekly priorities will be, and making sure good nutrition and
healthy behaviors are on that list
Opposite day
Often, clients with poor life skills are entrenched in
routines and habitual response patterns that actively
work against them. Rather than trying to fix all of these,
encourage your clients to simply play a game: Try an
Opposite Day.
For instance:
•
If your client is used to making snap judgments, work
If your client is used to self-criticism, ask them to take
a day (or an hour) for self-care and self-compassion.
ing fires”; and / or
•
If your client is used to strict dietary rules, ask them to
Once your client has come up with a response, use that
vision of the future to start building an action plan. For
instance, if the client wants to take a tropical beach vacation, start framing your exercise program as “building
fitness for surfing, sailing and swimming.” Also encourage them to collect images or other meaningful objects
that remind them of the future they want (e.g., a picture
of a turquoise ocean, a little fish).
As much as possible, remind clients of how specifically
they are working towards the future they want.
with them to make one informed, evidence-based
decision.
•
If your client is used to jumping from program to
program, ask them to commit to your program for a
certain number of weeks. Follow up with them often
Limiting factor: Environment
Our environment can include:
•
the physical space around us, such as our home and
workplace, as well as outdoor environments;
to ensure accountability.
•
our relationships and the people we interact with
regularly; and
•
Nutrition: The Complete Guide
our culture and society.
Working with Level 1 Clients | 351
Why might clients struggle with this?
Environments can be limiting factors when:
•
we need too much active “willpower” and mental
strength to stay on track;
•
our physical environment is stressful and over-stimulating, and / or discourages regular physical activity;
•
people in our social networks (family, friends, coworkers, etc.) are unsupportive (or worse, actively
sabotaging); and / or
•
our cultural group and broader society around us
doesn’t support healthy choices (for instance, if our
workplace culture enforces long hours; if our ethnic
group views a lean and muscular body as unattractive or exercise as a waste of time; if our social
norms involve food cues everywhere, all the time,
etc.).
Why is this a problem?
We make thousands of decisions every day, most of them
relatively unconscious and automatic. These decisions are
powerfully influenced by what’s around us, whether we
realize it or not.
If our physical and social environment supports our
choices, we’ll find it easier to make those choices.
If our physical and social environment doesn’t support
our choices, we’ll struggle and find ourselves frustrated,
demoralized, and unsure why we can’t “stay on track.”
Even the most “motivated”, determined, and driven person can’t white-knuckle all their choices forever if their
environment acts against them.
While clients can practice strengthening their “willpower
muscle”, it can still eventually fatigue.
If we make hundreds of decisions all day at work and our
willpower tank drains because we’re trying not to yell
at our lousy boss, we’ll often come home ready to quit
being a grownup. If we have to exert more willpower at
home because our kitchen is full of poor food choices,
and people around us are getting takeout pizza again...
we’ll often just give up.
We can either beat ourselves up each day for being a
willpower weakling... or just create an environment that
doesn’t require so much willpower.
Possible strategies
Habit triggers / Habit pairing
Automatic behaviors are usually triggered. For instance,
starting your favorite TV show may be a trigger to put
some popcorn in the microwave.
The good news is that we can use triggers to jump-start
healthy habits too.
Clients can either:
•
decide on a cue they’ll use as a reminder to do their
new healthy habit (e.g., when my phone alarm goes
off, I’ll stand up and stretch); or
•
put two habits together — an old habit and a new
one (e.g., I’ll stretch while I brush my teeth; I’ll keep
my workout shoes right next to where my car keys
usually go, so I’ll be reminded to take them with me).
Other ways to “shape the path”
See other suggestions from the “Limiting factor: Food
choices” section on “Shaping the path.”
Also see “Build an ‘activity team’”, earlier in the unit.
Encourage clients to make new social connections and
“fit friends.”
Ask clients what small environmental changes they
could make to make things easier for themselves to
remember and do habits consistently.
International Sports Sciences Association
352 | Unit 12
Coaching: A game the whole family can play
Unless your client is an anti-social orphan and only child who lives alone on an island, chances are good they’ll have to negotiate some choices with other people.
Help clients have that discussion with a simple checklist for communication.
*******
Set up the discussion so other people are on your team. It’s not you
versus family and friends; it’s you along with loved ones together against The
Problem.
“I’d really like your support. Can you help me ______?”
“You’re really good at coming up with solutions for things. Can you help me
figure out how to ______?”
Explain what you’re trying to do, and why.
“I’m trying to take better care of my health. I was really scared when I got that
warning from my doctor, and I’ve realized that I need to change some habits.”
State clearly what you would like help with, and how.
“What would help me most is ______.”
Negotiate a compromise if needed.
“I don’t want you to have to give up / change ______, because I know you
enjoy it. Is there a way you can still have / do it, but I can still stay on track with
my own choices?”
*******
If necessary, help your client practice going through this checklist, and role
playing sample dialogues.
This may be the first time your Level 1 clients have asked other people for assistance and support. Help your clients prepare for this big event.
And recognize that for some people, it takes a lot of courage to do this. They
might be going up against years of avoidance, the expectations of others, or
entrenched behavior patterns.
Call out and reward their bravery as an important marker of progress.
Nutrition: The Complete Guide
Working with Level 1 Clients | 353
Troubleshooting Level 1
Setbacks, obstacles, lapses, and sticking points are inevitable with Level 1 clients. Anticipate these as best you can,
but treat them all as part of the natural process of change.
Be compassionate and generous with them and yourself.
It doesn’t mean you’ve failed as a coach or they’ve failed
as a client.
Sure, they’re not very good at the new skill you just
gave them. At least not yet. You were probably a lousy
walker when you were nine months old. They’re learning, growing, and developing.
What do you do when a baby falls down while learning
to walk? You pick them back up, comfort them if they’re
upset, and help them get re-started. Same with clients.
Sometimes it’s just a matter of taking things in a new direction or giving things a new perspective.
Here’s how to troubleshoot with Level 1 clients.
measure “progress” still matters to them. For example,
do they still want to:
•
get stronger, as measured by lift X?
•
run faster, as measured by run time X?
•
lose weight, as measured by the scale?
•
lose body fat, as measured by skinfolds?
•
have fewer over-eating episodes, as measured by
their food journal?
If so: Identify where the expected outcome is different
than the measured outcome. Identify whether the measured outcome is different than the baseline.
If not: Discuss changing the progress metrics and any
new goals that may have emerged.
Are you focusing mostly on behaviors?
Look for what is already working
While outcomes are important, they’re mostly out of
your and your clients’ control. Most of your attention
should focus on tracking behaviors and consistency.
In all this discussion of limiting factors, it’s tempting to
make coaching about looking for and “fixing” problems.
When troubleshooting, include a review of key behaviors, such as:
Instead, we encourage you to look for “bright spots” —
to seek out:
•
what is already working;
•
where “the problem” (e.g., over-eating, lack of exercise) does not happen;
•
what your client can already do confidently and well;
and
•
what interests, excites, and engages your client.
Review progress indicators and
outcomes
Are progress metrics still meaningful?
Check with your client that the way they want to
•
eating the right types of foods in the right amounts;
•
prioritizing rest and recovery; or
•
eating slowly and mindfully (for clients looking to
lose weight).
If consistency with assigned coaching tasks is less than
80%, discuss how to make the task easier and / or more
do-able.
Also ensure that the client is focusing on important,
essential behaviors that really matter, rather than
“majoring in the minor.” Meeting protein needs is more
important than eating local or nutrient timing. First
things first.
Are expectations reasonable?
Sometimes, there’s nothing wrong with the process at
all. The problem lies with what clients expect.
International Sports Sciences Association
354 | Unit 12
Look for what is
already working. Could
you do more of that?
Y
Did that fix
the problem?
Do it.
Great, you’re
done for now.
Y
N
Not sure
N
Review progress
indicators and
outcomes
Assess and find out
Look for:
• What is already working;
• Where ‘the problem’
(e.g., over-eating,
lack of exercise) does
not happen;
• What your client can
already do confidently
and well; what engages
them.
2
Are progress
metrics still
meaningful?
3
1
Y
Identify where the expected outcome is
different than the measured outcome.
Identify whether the measured outcome is
different than the baseline.
N
Discuss changing the progress metrics and
any new goals that may have emerged.
Are expectations
reasonable?
Y
N
Are you focusing
mostly on
behaviors?
Y
N
Awesome. That’s
rare and special.
Celebrate!
Why not?
If consistency is less than 80%,
discuss how to make the task easier
and/or more do-able.
Ensure that the client is focusing
on important, essential behaviours that
really matter.
Review inputs
and outputs
N
Make expectations reasonable if
possible. Help clients understand
what is involved for a given outcome.
Could something be refined
or improved?
Improve what needs
to be improved.
Y
Could routines be streamlined
or made more effective?
Could the client be doing
a task more skillfully?
Are you absolutely,
positively, 100% sure?
N
Yes! I have investigated
every possible avenue!
Okay, fine. Reframe plateau
as a period of consolidation.
Wait a week or two and see
what happens.
Figure 12.4 Level 1 client troubleshooting
Nutrition: The Complete Guide
Well...
Could the client be doing
a task more consistently?
Could you calibrate the client’s
performance objectively, rather
than relying on self-reporting?
N
Does task
difficulty match
expected result?
Do outcomes
match behaviors?
Y
Y
Review the quality of the process.
Working with Level 1 Clients | 355
Level 1 clients often have inappropriate and unreasonable expectations. They expect things to move faster,
changes to be more significant, and transformations to
be more dramatic. For instance:
•
Clients who lose a lot of body fat are often shocked to
discover that they are left with some excess loose skin
(especially if they’ve been quite over-fat for a long
time).
•
Women who’ve been pregnant find out the same
thing, as well as the fact that their abs may now
“pooch” outwards.
•
Older clients realize they can’t eat like they did in
college, and their formerly hourglass or V-tapered body
is looking more like a beer keg as visceral fat collects
around their midsection.
Most Level 1 clients don’t become the immaculately bulletproof cover models they imagined. And certainly not
in the few weeks or months they had hoped for.
Level 1 clients often don’t realize that in the course of
nutrition coaching, they don’t become radically different people. They stay themselves… and hopefully
become a healthier, fitter, and more energetic version of
themselves.
They also don’t realize how much work it takes to get
extremely fit.
So, as the coach, you may have to remind clients what
outcomes are reasonable.
This includes:
•
the type of changes they can likely expect;
•
how quickly or slowly these changes might happen;
•
how much time, energy, and focus they must invest
to get the results they seek;
•
how consistently they must adhere to the assigned
coaching tasks to see progress;
•
Does task difficulty match the expected
result?
Clients who are starting with very simple changes (such
as switching to diet soda, or walking 20 minutes a day)
may wonder why body fat is not falling off them.
Clients who are training 2-3 times a week may wonder
why they don’t look like Arnold Schwarzenegger yet.
Help clients understand the relationship between task
difficulty and results.
Small changes can add up to big results… but it takes
time, and tasks need to progress.
Do outcomes match stated behaviors?
Even if you think your clients are eating well enough, if
they don’t have the results to show for it, then their food
intake isn’t what it needs to be. Even if your clients swear
that their food amounts, selections, and reasons for
eating are perfect, if their body isn’t getting better, they
need some nutritional adjustments.
Only results tell you whether a client is truly doing what
they say they’re doing.
Working with plateaus
Plateaus, like setbacks, are inevitable. Bodies like homeostasis and will always look to “settle” somewhere.
Eventually, all clients will get to a point when what
they’re doing is not enough to further change things.
Luckily, with Level 1 clients, there are so many limiting
factors that you can almost always make some simple
improvements and adjustments.
Review the list of limiting factors and pick the most
obvious to work on.
(Hint: It’s often food amount and quality.)
whether the results they seek are even possible given
the “raw material” your clients are working with
(such as their age, sex, ethnicity, health history and
status, or natural body fat distribution).
International Sports Sciences Association
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UNHEALTHY
Athletes at this level of body fat
Do more
Almost none.
Eat processed foods.
Benefits
Easy fallback for some folks.
Does not require much thought or work.
Tradeoffs
Poor health.
Low energy levels.
Eat big portions.
Eat quickly.
Do less
Exercise of any kind.
Eat fewer whole foods.
Sleep less.
Poorer life expectancy.
>20%
>30%
Risks of metabolic syndrome.
May need medications to manage various conditions.
HEALTHY
Very EASY Transition
Athletes at this level of body fat
Do more
College-aged athletes.
Eat slowly until satisfied at 60% of meals.
Off-season elite bodybuilders.
Include 1-2 palms of protein-dense foods in 1-2
meals per day.
Olympic shot putters.
Benefits
Improved health and energy.
Improved sleep.
15-20%
25-30%
Include 1-2 fists of vegetables in 1-2 meals per
day.
Exercise 3-5 times per week, any activity you
enjoy, any intensity level.
Exercise is easy and enjoyable.
Do less
Tradeoffs
Eat fewer desserts and processed foods.
Requires some thought and planning.
Drink fewer caloric beverages.
You’ll look good but not super lean.
HEALTHY
EASY Transition
Athletes at this level of body fat
Do more
Olympic canoe and kayak athletes.
Eat slowly until satisfied at 75% of meals.
Professional baseball players.
Include 1-2 palms of protein-dense foods in 2-3
meals per day.
Professional softball players.
Benefits
Fairly easy to maintain.
13-15%
23-25%
Include 1-2 fists of vegetables in 2-3 meals per
day.
Energy levels will continue to improve.
Exercise 30-45 minutes daily, with 1-2 sessions
breaking a sweat
Will probably be able to reduce or eliminate many medications.
Sleep at least 7 hours per night.
Trade-offs
Do less
Requires some planning and may require minor social sacrifices,
e.g., exercising instead of hanging out with friends at a bar.
Eat desserts / processed foods 3-5 times per week,
within reason.
May require effort and attention to maintain this much sleep.
Drink up to 3-5 caloric beverages per week.
May require some increased food prep skills and effort.
HEALTHY
MEDIUM Transition
Athletes
at this
levelofof
body fat
Figure 12.5 What’s required
for different
levels
leanness
Do more
Olympic swimmers.
Eat slowly until satisfied at 90% of meals.
Professional hockey players.
Include 1-2 palms of protein-dense foods in each meal.
Olympic volleyball players.
Include 1-2 fists of vegetables in each meal.
Benefits
Nutrition: The Complete Guide
Fit appearance and good overall health.
Fewer food cravings due to balanced diet and exercise regime.
Include 1-2 thumbs of healthy fats and 1-2 cupped
handfuls of quality carbs at most meals.
Exercise 45-60 minutes daily, with 3-4 sessions
breaking a sweat.
13-15%
23-25%
Trade-offs
Do less
Requires some planning and may require minor social sacrifices,
e.g., exercising instead of hanging out with friends at a bar.
Eat desserts / processed foods 3-5 times per week,
within reason.
May require effort and attention to maintain this much sleep.
Drink up to 3-5
caloric beverages
week.
Working
withperLevel
1 Clients | 357
May require some increased food prep skills and effort.
HEALTHY
MEDIUM Transition
Athletes at this level of body fat
Do more
Olympic swimmers.
Eat slowly until satisfied at 90% of meals.
Professional hockey players.
Include 1-2 palms of protein-dense foods in each meal.
Olympic volleyball players.
Include 1-2 fists of vegetables in each meal.
Benefits
Include 1-2 thumbs of healthy fats and 1-2 cupped
handfuls of quality carbs at most meals.
Fit appearance and good overall health.
10-12%
20-22%
Fewer food cravings due to balanced diet and exercise regime.
Exercise 45-60 minutes daily, with 3-4 sessions
breaking a sweat.
Relatively easy to maintain once practices become habitual.
Sleep at least 7-8 hours per night.
Trade-offs
Do less
Requires more planning and greater overall attention to diet.
Eat desserts / processed foods 1-2 times per week,
within reason.
Requires a greater time commitment for the more consistent
exercise regime.
Drink up to 1-2 caloric beverages per week.
May need assistance or coaching to achieve this amount of
consistency.
HEALTHY
HARD Transition
Athletes at this level of body fat
Do more
Olympic-level boxers and wrestlers.
Eat slowly until satisfied at 95% of meals.
Olympic sprinters (100-400 meters).
Include 1-2 palms of protein-dense foods in each meal.
Olympic-level gymnasts.
Include 1-2 fists of fibrous vegetables in each meal.
Benefits
Will probably look extremely lean; will have that six-pack.
Overall health will probably be good due to carefully balanced
and minimally processed diet.
6-9%
16-19%
Include 1-2 thumbs of essential fats in each meal.
Exercise 60-75 minutes daily, with 4-5 sessions breaking
a sweat.
Sleep at least 8 hours per night.
Will likely have high work capacity and good stamina.
Do less
Trade-offs
Limit carbs to post-workout or designated higher-carb
days.
May struggle in social situations, especially those involving
food.
May not have time for social opportunities outside of exercise.
May have to give up other hobbies and interests outside fitness.
Eat desserts / processed foods once every 1-2 weeks,
within reason.
Drink a caloric beverage once every 1-2 weeks.
UNHEALTHY
Very HARD Transition
Athletes at this level of body fat
Do more
Elite bodybuilders on contest day.
Eat slowly until satisfied or even a little bit hungry
at 99.9% of meals.
Fitness models on the day of the photoshoot.
Benefits
May feel pride at achieving an athletic goal.
Trade-offs
Will have difficulty socializing in most typical situations
where food is involved.
May miss out on fun events with family and friends.
<6%
<16%
Big time commitment to measure, weigh, and track all
foods.
Incorporate calorie / carb cycling.
Follow meal plan with predetermined foods and
amounts, and measure food specifically.
Include exact amount of lean proteins, fibrous veggies,
and healthy fats in each meal.
Exercise 45-75 minutes, twice daily, with 6-7 sessions
breaking a sweat.
Sleep at least 8-9 hours per night.
Do less
Hyper focus on diet and exercise may contribute to
disordered eating.
Limit carbs to post-workout or designated higher-carb
days.
Time required for exercise may crowd out all other pursuits
and interests.
Eat desserts / processed foods once every 10-12 weeks.
Avoid caloric beverages.
International Sports Sciences Association
358 | Unit 12
Focus on the quality of the process
Plateaus are a good time to revisit consistency and behavior quality.
•
Could something be refined or improved?
•
Could routines be streamlined or made more
eventually physical improvements have to level off. And
eventually, they’ll level off for good.
Help clients reframe the concept of a plateau away from
“failure” or “being stuck” to:
•
an opportunity to refine their practice;
effective?
•
an opportunity to get better at existing skills;
•
Could the client be doing a task more skillfully?
•
an opportunity to try new tasks and learn new skills;
•
Could the client be doing a task more consistently?
•
an opportunity to take the pressure off for a little
•
Could you calibrate the client’s performance objectively, rather than relying on self-reporting? (In other
while;
•
do start happening; and / or
words, what does the client’s “80% full” or “working
out really hard” actually look like?)
an opportunity to be grateful for results when they
•
an opportunity to experiment with a “new normal.”
Reframe plateaus
Wow. Plenty of opportunities there!
While change is inevitable in human experience,
You can even ask the client, “What does this time give
you the chance to do, that maybe you wouldn’t have otherwise had?” See how they choose to reframe things.
Case study
Let’s look at how this entire six-step coaching process
might look in action.
ing TV, mainly because he is bored and / or anxious
about the next day, and it is an ingrained habit.
Someone emails you expressing interest in nutrition
coaching. You invite them in to meet and go over the
Initial Assessment & Triage Questionnaire.
After this, he often notices he is very “full” before bed.
(This may explain why he’s rarely hungry in the morning.) He doesn’t sleep very well, partly because he’s
noticed some issues with breathing, and also because
his stomach is uncomfortably stuffed.
You find out his name is Roy. He’s 35 years old, 220 lb,
and 5´9˝.
His family is originally from Mexico and Guatemala; his
ethnicity is partially Hispanic and partially indigenous
Mayan. (He’s just gotten back from a trip to the Yucatán
to see his abuela (grandmother). He shows you the
photos on his iPhone.)
He wants to feel better, have more energy during the
day, sleep better at night, and look better.
Here’s his daily menu right now.
•
Breakfast: He skips it. He says he’s not hungry in
the morning. He drinks a sweetened coffee drink
on the way to work.
•
Lunch: Eaten at his computer. Usually takeout.
•
Dinner: Eaten while watching TV. Usually a frozen
meal, likely a “diet dinner.”
He snacks in the afternoon while at work (candy in the
break room). And he snacks after dinner while watch-
Nutrition: The Complete Guide
He’s not much of a cook. Traditionally, the women in his
family were the caregivers and food preparers.
Since his divorce, eating’s been a bit of an afterthought.
(Abuela was shocked at this state of affairs, and immediately stuffed him with a four-course traditional Guatemalan feast.)
Plus, with the stress of the divorce, his already crummy
sleep has gotten worse.
So he’s been living mostly on convenience foods: white
bread, deli meat, processed cheese, breakfast cereal,
and snack foods like chips and sweets.
He can only identify extreme variations in appetite (i.e.,
being either very full or very hungry).
With his sedentary job as an IT technician, he rarely gets
any physical activity.
He often resolves to start a diet every January, but this
ends after a couple of weeks.
Working with Level 1 Clients | 359
As you can see, he fits most of the criteria for a Level 1
client:
• lacks sleep and recovery
•
doesn’t engage in regular physical activity
• eats too fast and while multitasking
•
doesn’t have appetite awareness
• misses meals (and then eat meals that are too
large) and / or doesn’t eat satisfying meals
• over-eats highly processed foods
• under-eats nutritious whole foods
• doesn’t have basic food preparation skills
• drinks sugar-sweetened beverages (and doesn’t
drink enough water)
has an environment that requires too much
willpower (including an unsupportive social
network)
•
isn’t consistent
You are able to learn all of this about Roy during the assessment, along with the fact that the Yucatán is lovely
and you should probably drop in on Abuela yourself
for a great stick-to-your-ribs Guatemalan meal.
Roy is able to identify many of the areas that are “bad
nutrition.” And he has a basic grasp on what foods
might be better for him to eat.
With all of these potential areas to modify, how would
you approach your next steps with Roy?
Some areas to consider:
• uses food to manage feelings
•
•
has all-or-none thinking (this includes yo-yo
dieting, weekend over-eating, and night-time
over-eating)
•
What would you start with first? Why?
•
Would you use any forms of body composition
measures?
•
After you come up with a plan, how would you
determine if it’s the right plan?
Summary
Remember the six basic steps to coaching:
•
Life skills
Step 1: Assess and gather data; identify client goals.
•
Mindset / psychology
Step 2: Understand the client and “build the story.”
•
Environment
Step 3: Create an action plan and possible “next steps.”
Step 4: Choose one next action step and test it.
Step 5: Observe and monitor what happens.
Step 6: Use outcome-based decision making.
Most clients are Level 1 clients. All they will need are
small, relatively simple changes.
Addressing the Level 1 limiting factors will ensure that
the client builds a strong nutritional foundation.
Level 1 clients tend to have similar limiting factors. The
clients themselves can often identify these when going
through the Initial Assessment & Triage Questionnaire.
Until a Level 1 client is consistently addressing all of
the most common limiting factors, don’t use any more
advanced Level 2 approaches.
Limiting factors fall into several categories:
•
Food choices
•
Eating behaviors
When implementing Level 1 solutions, keep things simple. Focus on one small, do-able, and helpful behavior
change at a time. Check that the client is ready, willing,
and able to do each one.
•
Exercise and activity
Use outcome based decision making.
•
Recovery
•
Food and cooking skills
Set realistic expectations and help Level 1 clients understand the trade-offs involved.
International Sports Sciences Association
UNIT 13
Working with Level 2 Clients
Working with Level 2 Clients | 361
Unit Outline
1.
Level 2: An introduction
4.
Case study
2.
Level 2 strategies
5.
Summary
3.
Troubleshooting Level 2
Objectives
Level 2 clients are those who have mastered Level 1 strat-
nutrition, moderate carb and calorie cycling, meal frequen-
egies, have progressed as far as they can, need a bit more
cy adjustments, simple forms of intermittent fasting, food
individualization, and are emotionally mature enough to
log troubleshooting, workout nutrition adjustments, and
try more advanced strategies.
competition day nutrition.
In this unit, you’ll learn about how to work with these
You’ll also learn about some more advanced methods of
clients and use these strategies, which include body type
supplementation.
Level 2: An introduction
Here’s a quick review of the criteria for defining nutritional level:
•
Goals: What clients want to do.
•
Knowledge: What clients know.
•
Competence and skill: What clients can do.
•
Consistency: What clients can do, repeatedly and
well.
Most importantly:
•
Always start with Level 1 tasks, no matter who
your client is. Fundamentals first, always. You can’t
do Level 2 tasks unless and until you have mastered
Level 1 essentials.
•
When in doubt, go backwards. And always regress a client to a lower nutritional level, rather than
assuming they can handle more complexity.
•
Clients must be able to demonstrate that they
can do assigned tasks consistently. Saying they
can do it, or knowing information about the tasks, is
not enough.
Even clients who can progress to Level 2 or 3
may only be there briefly.
For most people, living permanently at Level 2 or 3 is impossible… and even if it’s possible, it’s often a bad idea.
Trying to live at Level 2 or 3 — which, again, most people can’t even do — can create serious disordered eating,
mental health issues (such as anxiety and obsession), and
physical harm. It can also disrupt work, relationships,
and other life pursuits.
Past a certain point, “healthy eating” is not healthy.
Before individualization, consistency
Stop.
Before you progress to Level 2 with someone, double
check that your client is doing most or all of the following consistently and well:
Food choices
•
Eating few processed foods
International Sports Sciences Association
362 | Unit 13
•
Mindset / psychology
Eating plenty of nutritious, whole, minimally processed foods
•
•
Meeting basic nutrient needs (macronutrients and
ter” (and imagine “a little bit better”)
micronutrients)
•
Staying hydrated
•
Rarely drinking sugar-sweetened drinks
•
Drinking alcohol rarely or moderately
•
Feeling satisfied by their meals
•
•
Eating slowly and mindfully
•
Recognizing their physical hunger and fullness cues
•
Establishing regular eating habits and behaviors
•
Eating the appropriate amount for physiological
•
Reasonably managing stress and life demands
STOP here until your client can do the above at least 75%
of the time. (For best results, we prefer to get closer to
90%.)
This is critical.
Exercise and activity
Managing training loads appropriately
Environment supports goals
Make sure they can keep executing these crucial behaviors, and creating an environment that supports them.
Separating food from feelings
•
•
Wait a little while.
needs and / or goals
Getting enough regular physical activity
Consistent
Environment
•
•
Growth mindset (“Things are possible with effort and
practice”)
Eating behaviors
•
Able to think on a continuum from “worse” to “bet-
Most people struggle to do the Level 1 strategies consistently and reliably. It takes time, practice, and effort —
much more time, practice, and effort than people expect.
Recovery
So, before measuring anything else, measure consistency.
We’ve provided a Meal Consistency Chart that many of
our clients have used.
•
Getting enough sleep
•
Getting enough recovery
•
Enough parasympathetic “rest and digest” activation
Food and cooking skills
•
Has basic food preparation skills
•
Has basic shopping and food aware-
C
Meal Consistency Worksheet
ness skills (e.g., reading labels)
Life skills
•
Able to ask for what they want and
need; can define clear boundaries
with others
•
Making mostly thoughtful and informed choices
•
Able to organize one’s time and
NAME
How to use this worksheet
• Each time you eat a meal that’s consistent with the habits you’re working on, put an X in the box.
• Each time you eat a meal that’s NOT consistent, put an O in the box. (Leave a cell blank if you didn’t have that many meals.)
• At the end of the week, total up all your Xs and divide by the number of meals to get a consistency percentage.
Coaching tips
• Emphasize “consistency” rather than “compliance”.
• Use this as both a progress tracker and as a way to surface limiting factors.
• As a progress tracker: Client has made progress when consistency (as a percentage of all meals) improves.
• Treat improvements in consistency as progress in and of themselves (in other words, simply being more consistent is worth celebrating).
• Look for the reasons why consistency improved, and build on those “bright spots” as well.
• As a way to show limiting factors: Use non-adherence / non-consistency to open up a discussion about why the client didn’t do the task.
• Do NOT treat non-consistency as “failure” or “mistakes”. Treat it as useful data.
• Explore “ready, willing, able”.
• Look for patterns over the course of a day, and over the course of a week.
• For example, the client does well in AM, struggles in PM; client does well Monday-Thursday but struggles Friday-Sunday.
• NOTE: not all clients need to achieve the same amount of consistency to reach their goals.
• Level 1 clients, or clients with more moderate goals, will do incredibly well shooting for 75-80% consistency.
• Level 2 clients, or clients with more advanced goals, will need to aim for 90% consistency or higher.
schedule reasonably well
•
Has good options available and
convenient
© 2018 ISSA issaonline.edu
Find the Meal Consistency Worksheet in your forms package
Nutrition: The Complete Guide
DATE
Working with Level 2 Clients | 363
Table 13.1 Level 2 client features
Typical goals
Improve athletic performance and recovery
Further optimize health
Further tailor nutrition to specific needs
Get and sustain a “lean-athletic” body composition1
Work towards competing in physique or modeling
Experiment and tinker with tailoring and optimizing nutrition for individual goals and
needs
Level of physical
performance expected
Dedicated recreational or amateur athletic performance
Body composition desired
or required
Lean-healthy to lean-athletic
Competitive at moderate levels of athletics (e.g., regionally competitive)
Men: 8-12% body fat
Women: 17-22% body fat
Training load
6-10 hours a week
Knowledge
Moderate to high2
Competence and skill
Moderate
Can do complex tasks when given clear instructions and the coach monitors completion
Can do simple tasks easily and intuitively, often without supervision
Consistency
Moderate
Can do simple tasks 90% of the time or more
Can do more complex tasks up to 75% of the time
Has a base of sustainable habits and a consistent foundation of essential behaviors
Mindset / psychology
“I feel relatively confident.”
“I can stay on track pretty well.”
“This is a priority for me.”
“I want to be better than average.”
Limiting factors
Some; most major roadblocks have been cleared
1 Note: Clients will vary widely in their body compositions depending on their age, sex, genetic makeup, etc. What is “unreasonably lean” for one
person may be another person’s “normal.” Look for natural tendencies and try to get a baseline of what is appropriate for each client. “Lean-athletic” is the body composition that is lower than average, yet that a client can easily and sanely maintain doing basic Level 2 habits consistently.
2 Most clients at Level 2 will have coaches. So the clients themselves need not be experts, but they should be guided by someone who is.
International Sports Sciences Association
364 | Unit 13
And only then, if they really need it, should they consider
the Level 2 strategies we cover in this unit.
performance beyond what they can do with the Level 1
approach.
What does a Level 2 client look like?
Level 2 strategies don’t make clients any healthier or give
them a better quality of life.
In Unit 11, we gave you a brief overview of Level 1s, 2s,
and 3s. Now let’s look more closely at the features that
Level 2 clients might have.
Level 2 clients are those who:
•
have mastered Level 1 strategies;
•
have progressed as far as they can with Level 1 but
need / want to go further;
•
need a bit more individualization; and
•
are psychologically stable and emotionally mature
Indeed, depending on how far someone takes them...
Level 2 (and Level 3) behaviors can become
actively unhealthy.
If a client engages in Level 2 (or 3) behaviors too stringently and aggressively:
•
recovery can be disrupted.
•
Not all Level 2 clients will have all of these characteristics,
but this gives you the general idea.
Level 2 client features
Note that goals, knowledge, body composition, athletic
performance, and training load alone do not define Level
2. For instance:
•
You may have a high-level recreational athlete who
is quite lean and muscular... but who binge-eats
regularly, doesn’t get enough sleep, and / or doesn’t
eat their vegetables.
•
You may have a client who has an “expert” level
of knowledge, perhaps even graduate degrees in
nutrition… but who can’t actually do fundamental
behaviors consistently.
Most fundamentally, nutritional level is about competence and consistency:
behaviors, thoughts, and feelings about food, eating,
and training can become disordered. Your client may
enough to try more advanced strategies.
Level 2 clients generally want to get leaner or improve performance more than is likely possible with the Level 1 approach
(generally, body fat goal ranges of <12% for men, and <22%
for women).
body fat can start to drop too low. Hormones and
start to have mental and emotional health problems
such as anxiety, depression, and / or OCD.
•
social relationships and other interests — which we
need for overall wellness and quality of life — may
suffer.
Level 2 behaviors are usually short-term
strategies.
Generally, clients do Level 2 tasks for a specific, shortterm goal, such as a competition, or to support higher
levels of athletic training at certain times in their competitive season.
Few clients can live consistently, sanely, and happily at
Level 2. (You’ll see what we mean when you review the
list of Level 2 behaviors in Table 13.3.)
As a coach, it’s your role to inform your clients
about all the trade-offs.
Help clients know what to expect and to look for as they
progress into Level 2 habits. Keep it real.
Monitor clients carefully.
What can you do repeatedly and sustainably in your
daily life?
At Level 2, most clients should be keeping some type of
record of what they are doing.
Level 2 approaches are mostly about looks and
/ or performance.
Track your client’s physical, psychological, and social
indicators closely. Make outcome-based decisions using
data.
Level 2 clients want to get leaner or improve athletic
Nutrition: The Complete Guide
Working with Level 2 Clients | 365
Table 13.2 Assessing Level 2 client readiness
Level 2 client
Not a Level 2 client (yet)
Can use objective indicators (such as measurements) in the
appropriate ways.
Does not use objective indicators appropriately or maturely. Either gets anxious / obsessive about measurement, or
doesn’t bother to measure at all.
Understands that indicators, metrics, and outcomes are a
means to make informed decisions.
Sees indicators, metrics, and outcomes as a judge of their
personal “goodness” and “badness.”
Actively seeks coaching and other feedback (e.g., performance indicators) at appropriate intervals.
Avoids feedback, or does the opposite — constantly seeks
validation in a needy and anxious way.
Receives feedback productively and looks to apply it.
Becomes defensive, resentful, frustrated, and/or demoralized when feedback is given.
Able to step back and see the big picture.
Becomes lost in details, paralyzed, and/or over-anxious.
Able to detach self-concept from food and eating. In other
words, they don’t define themselves by their diet.
Can’t detach their own self-concept from food and eating.
Food and eating choices define who they are.
Able to detach emotions from food and eating.
Uses food / eating to manage emotions; food / eating
decisions driven by emotions or other un-met psychological
needs.
Can stop Level 2 strategies any time.
Deeply attached to Level 2 strategies and outcomes.
Reluctant to give them up; may be anxious about “losing
control.”
Understands and is willing to accept trade-offs. Balances
short- and long-term needs effectively and intelligently.
Does not fully understand trade-offs.
Driven in part by intrinsic factors: this project is somehow
meaningful and valuable to them at a deeper level.
Driven entirely by external factors (e.g., get a trophy, get
approval from others).
Growth mindset: Willing to practice and expend effort consistently and over time. Seeks understanding and personal
development.
Fixed mindset: Wants results without effort; gives up easily;
views setbacks as personal deficiencies.
Takes responsibility for their choices and the outcomes.
Does not take responsibility for themselves. Victim or blaming mentality.
Have an “escape plan” at all times to help guide your
client back to balance if needed.
Assess mindset and maturity.
You’ll notice that nutritional level isn’t just about physiology. It’s about psychology too.
To “graduate” to Level 2, clients must have a healthy,
growth-oriented mindset along with emotional maturity
and resilience.
Here are some criteria you can use to assess your potential Level 2 clients’ readiness.
May be willing to sacrifice long-term value or health for
short-term gains. (Or the perception of short-term gains.)
Avoids growth opportunities.
Speaking Level 2 language
You’ll remember that in the previous unit, we advised
you to keep things simple for Level 1 clients. The same
is true for Level 2s, but you can often use slightly more
technical or complex language or concepts.
A Level 2 client will usually have goals like:
•
“improve my performance in sport X” (often with
specific metrics)
•
“get down to X% body fat”
•
“improve recovery in activity X, especially under Y
conditions”
•
“do an elimination diet to pinpoint some food
intolerances”
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366 | Unit 13
At Level 2, things get more technical, more measurable,
and more specific.
•
A few communication principles:
•
•
•
of anxiety or obsession)
Listen carefully and assess. What are your client’s
and wrong” are
•
all grains without a measurable grain intolerance)
of terminology and scientific explanation are they
•
Match your language to theirs. Some Level 2s
may have advanced knowledge. Others will not.
Speak in a way they will understand.
•
Eating behaviors
•
Eating too quickly and while distracted
•
Can recognize their physical hunger and fullness
cues, but may ignore them (especially if rushing or
Ask them to clarify if possible. What does “better
performance” or “more recovery” mean to them,
exactly? Could they give specific examples of what
they’re describing? Level 2 clients will often have
busy)
•
Potentially overly structured eating habits
•
Disordered eating (restricting, purging, orthorexia,
controlling, bingeing, etc.)
specific metrics already (e.g., “Get into the X weight
class” or “Cut X minutes off my Y mile run”).
•
•
right” or optimally “healthy”
page? Do you both comprehend what the other is
Do the same when you discuss limiting factors with
them.
Clear communication is important for all clients. Don’t
overestimate your Level 2 client’s ability to assimilate
and use what you’re saying right away.
Level 2 limiting factors
Some limiting factors will cut across all nutritional
levels. For instance, almost everyone struggles with time
management.
But here are some limiting factors that you may find
with Level 2 clients.
Food choices
•
•
Over-training and not managing training loads
Recovery
•
Not getting enough sleep
•
Not getting enough recovery
•
Too much sympathetic nervous system “fight /
flight” activation (i.e., spending too much time in the
“amped up” and overstimulated zone, doing high-intensity training almost exclusively)
•
Not enough parasympathetic “rest and digest”
activation
•
Over-training / over-use injuries
Food and cooking skills
•
Stuck in a “food routine” with familiar favorites
2s, often relying too much on energy bars, gels or
•
May assume that certain types of foods are always
“good” (e.g., if it’s organic, if it’s bought at a “health
food store”)
Assuming (incorrectly) that more activity will compensate for poor food choices, or eating too much
•
Exercise and activity
Eating too many processed foods (in the case of Level
powders, “healthy junk food”, etc.)
•
Doesn’t use food to manage feelings as much, but
may feel some distress or anxiety if food isn’t “exactly
Check for understanding. Are you on the same
saying?
Limiting food choices without correctly assessing
whether this is appropriate (for instance, cutting out
goals and how do they describe them? What level
comfortable with?
Overly rigid food rules or excessive worry about “eating the wrong thing” once they know what “right
Keep it simple. You can always make things more
complicated. Start with the basics.
Concern about the health value of food (to the point
Drinking too many sugar-sweetened drinks to fuel
workouts
Nutrition: The Complete Guide
•
May assume that they always have to buy the most
expensive or premium types of foods
Working with Level 2 Clients | 367
Life skills
•
•
Feeling “too busy” or “too rushed”
•
Not having good options available and convenient
•
Time management (especially with more time devot-
over outcome-based decision making
Environment
•
•
•
/ night-time over-eating, “Either I’m perfect or I’ve
before bed)
•
or body composition goals
Busy-ness and stress; overwhelming life demands;
feeling rushed and pressured
•
Overly driven to succeed; not satisfied with incremental progress
•
Extrinsic motivation: May measure “success” solely by
external factors (e.g., winning)
•
Consciously limiting environment and social network;
narrowing of interests and focus to support athletic
failed” mentality)
•
Too much stimulation and / or stress, especially
during periods that should be “down times” (e.g.,
All-or-nothing thinking (e.g., yo-yo dieting, restrict-binge cycles, big “diet challenges”, weekend
Unsupportive social networks (family, friends, coworkers, etc.)
ed to exercise / training / competition)
Mindset / psychology
Rules orientation: May want to “follow the rules”
Extrinsic cues: May rely too much on external cues
(e.g., time to eat, pre-measured food amounts, specific macronutrient splits) and not use internal cues
Possible Level 2 coaching tasks
At this stage, you’ll have to adjust some Level 2 tasks for
fat loss, athletic performance, and / or mass gain. We’ve
given you some notes in Table 13.3.
A few more tips:
Few clients will permanently use the strategies we
mention here.
Set expectations appropriately.
Table 13.3 Level 2 coaching tasks
Level 2 clients can
consistently...
So the “next level” involves...
Sample coaching tasks could be...
Refining food and nutrient quality
Shift more food purchases towards local / organic /
seasonal, farmers’ markets, etc.
Food choices
Make mostly nutritious food
choices
Choose grass-fed / pastured / wild-caught meats,
poultry, fish, seafood, eggs, dairy
Eat mostly whole, minimally
processed foods
Eating almost entirely whole, minimally
processed foods
Eliminate almost all processed foods (except for
sports supplements, e.g., protein powder)
Cook most of the week’s menu from scratch
Meet basic nutrient needs
(macronutrients and
micronutrients)
Stay hydrated
Adding phytonutrients, zoonutrients,
myconutrients
Testing for nutrient status and supplementing specifically
Consuming adequate fluids
Expand the colorful fruit and vegetable repertoire
Choose grass-fed / pastured / wild-caught meats,
poultry, fish, seafood, eggs, dairy
Review lab test results of nutritional status; create a
targeted supplement plan
Tracking fluid intake and urine color output; ensure
proper hydration status
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368 | Unit 13
Table 13.3 Level 2 coaching tasks
Level 2 clients can
consistently...
So the “next level” involves...
Sample coaching tasks could be...
Drink mostly non-caloric
beverages
Minimizing and/or completely eliminating
caloric beverages
Cut out or drastically minimize alcohol intake
Feel satisfied by their meals
For fat loss: Feeling slightly less than satisfied
by their meals
For fat loss: Leave the table feeling a little hungry;
accept the presence of low-level hunger much of the
time
For mass gain: Feeling a bit too full
For mass gain: Leave the table feeling a little overstuffed; accept the presence of fullness much of the
time
For fat loss: Slowing down even more
Add 5-10 more minutes to usual meal time
Drink coffee and/or tea without sweeteners
Eating behaviors
Eat at a moderate pace, without too many distractions
Eat entirely without distractions
For mass gain: Speeding it up
Shorten meal times; focus completely on getting the
food down before satiation signals kick in
For fat loss: Going into the “hunger zone”
For fat loss: Practice tolerating the discomfort of mild
to moderate hunger
For mass gain: Ignoring fullness cues; eating
even if not hungry
For mass gain: Ignore fullness cues; stick to an eating
schedule even if not hungry
For fat loss: Experimenting with occasional
intermittent fasting
Once a week, skip breakfast or dinner
For mass gain and/or athletic performance:
Sticking to a regular eating schedule
Athletic performance and mass gain: Eat every 3-4
hours, especially around training
Closely monitoring eating psychology and
mindset
Keep a daily record of eating behaviors, thoughts,
and feelings
Staying alert for any compensatory behaviors
(e.g., bingeing, purging, over-exercising)
Keep a daily record of all training and activity
Be active regularly for at
least 60 minutes a day
For fat loss: adding more activity
Add a 30-minute walk daily
Manage training loads
Having all training under the supervision of
coach / trainer
Schedule 10-15 minutes more of active recovery daily
Adding 15-30 minutes of sleep or improving
sleep quality
Take a nap every day
Recognize physical hunger
and fullness cues
Have regular eating habits
Have a relatively sane,
healthy mindset about eating for performance or body
composition changes
Separate food from feelings
Exercise and activity
Follow specified training and recovery program
Recovery
Sleep 7-9 hours
Supplement to enhance sleep (e.g., ZMA, L-theanine)
Refine sleep ritual
Get enough basic recovery
Adding recovery protocols3
Add peri-workout nutrition (BCAAs for fat loss,
carb + protein drink for muscle gain and/or athletic
performance)
Foam rolling for 10 minutes daily
Record daily recovery indicators (e.g., sleep quality,
HRV)
Manage stress productively
and effectively
Adding stress management protocols
Nutrition: The Complete Guide
Add 10 minutes of relaxation / mindfulness
Practice time management and prioritization
Working with Level 2 Clients | 369
Table 13.3 Level 2 coaching tasks
Level 2 clients can
consistently...
So the “next level” involves...
Sample coaching tasks could be...
Prepare basic meals and
menus
Improving meal preparation and planning
skills
Add 5 meals to “go-to” roster
Shop efficiently and be
aware of food quality
Improving shopping options
Shift more food purchases towards local / organic /
seasonal, farmers’ markets, etc.
Life skills
Ask for what they want and
need
Improving food quality
Try a new cooking challenge (e.g., new food, new
prep method)
Choose grass-fed / pastured / wild-caught meats,
poultry, fish, seafood, eggs, dairy
Establishing Level 2 tasks as priorities and
negotiating with others
Have a crucial conversation with family and friends
about Level 2 priorities and tasks; set clear expectations about what this will involve (e.g., removing
“junk food” from the house)
Make thoughtful, informed
choices
Establishing purpose; setting clear priorities
and abiding by them
Daily goal review
Ensure that good options are
available and convenient
Making the decision process as easy and
streamlined as possible by eliminating unwanted options
Define clear boundaries and
priorities
Make as many decisions in advance as possible; leave
fewer things to chance (e.g., plan meals beforehand)
Hire a meal delivery service
Cut down on restaurant meals
Mindset / psychology
Think on a continuum from
“better” to “worse”
Continually moving along the continuum
towards “better”
Identify choices that are “just a little bit better” and
make them consistently
Have a growth mindset
Seeking continual refinement and improvement of process and self-awareness
Weekly review and retrospective with coach; outcome-based decision making
Using outcome-based decision making
Try to improve one small part of the process each
week, based on data collected from the week before
Tightening up the process:
Weigh and measure food portions
a) Looking for inefficiencies and removing
them
Create and use a checklist for important processes
(e.g., taking supplements)
b) Adding more process metrics and tracking
them
Record ongoing food and other logs; coach to review
these weekly (or as appropriate)
Planning, prioritizing, and scheduling
Schedule not only workouts but also food prep
times, recovery times, sleep ritual, etc.
Repeat a quality process
Organize most of their life
around executing Level 2
tasks
Cutting back on lower-priority activities and
other demands
Keep a 1-week time diary
Remove 1 low-priority “time sucker” based on results
of time diary
Environment
Have environment that enables Level 2 choices
Further refining environment along with
schedules and systems
Kitchen cleanout and organization (e.g., supplements packed into pill holders)
Have supportive social
networks (family, friends,
coworkers, etc.)
Getting more coaching
More frequent coaching check-ins
Finding more teammates
Add a coach for other aspects of goals (e.g.,
sport-specific skills coach)
Add home exercise options
Work with a team, group, and/or support network
(e.g., running group, competition team)
3 At this point, much of what you’re adding for Level 2 clients are additional stressors. They’re training and potentially competing more (which may also involve
things like travel). If they’re trying to change body composition dramatically, they’re either eating much less or much more than is comfortable for their body.
All of this can cause other stresses such as financial stress, relationship stress, and time management stress. So this recovery angle is critical.
370 | Unit 13
Most people can’t walk around with lean-athletic body
fat all the time, or train heavily every week of the year.
There’s a reason there are seasons for competition.
Look for the best results for the least amount of complexity or effort.
Level 2 strategies will require more trade-offs from
clients. But if you can help someone achieve their goals
by focusing on foundational Level 1 strategies that don’t
require as many trade-offs… it’s probably worth doing!
Don’t add complexity for the sake of complexity.
A difficult program is not necessarily better, especially if
you could get the same results with a simple program.
Level 2 strategies
Here are types of strategies we recommend for Level 2
clients:
•
Continuing with all of the Level 1 recommendations
•
More precise observation and analysis (e.g., of food
logs)
•
Improving food quality and variety
•
Improving food selection, preparation and cooking
skills
•
Workout nutrition to fuel performance and enhance
recovery
•
Improving recovery protocols
•
Eating according to body type (e.g., ectomorph,
Understand the ideas behind the recommendations, then
come up with your own possible Level 2-style strategies.
Test stuff and see what works. If it works, use it.
Strategy: More precise observation
and analysis
At Level 2, the food log is your friend. Now you can ask
for more detailed records, and more careful measurement of food quantity.
This helps you get a baseline, identify limiting factors
(and bright spots), and track progress.
Food logs give you great insight into the daily nutritional
habits of your clients, and often help to make them more
aware of their own intake (and often spot some of their
own limiting factors that might have gone unnoticed).
Food log options
•
3-Day Dietary Record: Your standard food log
•
Athletic Nutrition Journal
FOOD JOURNAL
3-Day Diet Record
NAME
DATE
Please record everything you eat and drink for 3 days. Be as thorough and detailed as possible.
Please be as honest as you can be. I am gathering data, not judging. Don’t change your normal routine. Just record what you are doing.
If your eating habits change over the week, pick 3 days that are representative (e.g., 2 weekdays plus 1 weekend day).
mesomorph, endomorph)
•
To measure, simply use hand-sized portions (e.g., 1 palm, 1 fist, 1 cupped handful, 1 thumb) or something else standardized (e.g.,
baseball, deck of cards). You can use measuring cups or a food scale if you want, but you don’t have to.
Record any other notes about other things we’ve agreed you’ll record, such as why you are eating, physical sensations from eating, how
you felt after you ate.
Moderate carb and calorie cycling (e.g., emphasizing
Example
carb-dense foods only after workouts allows for a
MEAL TIME
natural carb cycling rhythm)
•
Basic supplementation if appropriate
•
Competition day nutrition
These aren’t the only Level 2-style tools and techniques
that you can use.
You may find as you work with your Level 2 clients that
you come up with your own Level 2-style strategies and
habits. Great!
Innovate. Create. Apply the key principles in new ways.
This is the essence of experimentation and outcome-based decision making.
Nutrition: The Complete Guide
WHAT YOU ATE / DRANK AND HOW MUCH
NOTES
2 pieces whole-grain toast
7 AM
2 thumbs peanut butter
Rushing out the door; busy day
1 mug of coffee with milk + 2 sugars
Bran muffin (about 1 fist sized)
10:15 AM
1 medium-sized orange
In a meeting
Medium coffee from Dunkin Donuts
12:30 PM
3:30 PM
12” Subway turkey sandwich
1 can Diet Coke
1 strawberry Greek yogurt
2 handfuls Triscuits
No cheese
Ate at desk
3 slices meat-lovers pizza
6:30 PM
2 light beers
Got home late, no energy to cook
1 bowl moose tracks ice cream
© 2018 ISSA issaonline.edu
Find the 3-Day Dietary Record in your forms package
Working with Level 2 Clients | 371
Athletic Nutrition Needs Questionnaire
NAME
DATE
What activities do you do?
Please list all the types of physical activity / exercise / athletic training you do, and how much / often.
ACTIVITY TYPE
HOW OFTEN AND HOW MUCH?
e.g., Recreational hockey
Walking
On-ice training 2x weekl y , 2 hours per session; 1 game per week
Dail y , with the dog, 30 minutes
Revisit and clarify expectations. What exactly is the
client hoping to achieve? And is it realistic? They might
actually be doing great. Yet they want to look like they
did 15 years ago, or like a magazine cover model. At this
point, a chat about realistic expectations, and potential
trade-offs, might be in order. (More on setting expectations later.)
What to look for in the food record
Once they have submitted the food log, it’s time to put
on your coach hat and troubleshoot with them.
Look for anything that could be limiting progress. Look
for anything that doesn’t quite add up.
Consider it a mystery that you are investigating.
Here are some things to look for.
Are you a professional, amateur, and / or devoted recreational athlete?



Professional athlete
Amateur, compete at national or international level


Amateur, compete at local level
I don’t compete, but I train like I do
Not being consistent with Level 1 behaviors
Amateur, compete at regional (state / provincial) level
If you compete, what phase are you in?


Pre-season preparation

Off-season

Currently in competitive season
Rehab / injury recovery
© 2018 ISSA issaonline.edu
Find the Athletic Nutrition Needs Questionnaire in
your forms package
This seems like an obvious problem… but it’s not always
obvious, especially with a client who wants to be at Level
2 and may insist they “already eat really well” or “are
doing everything right.”
Start by reviewing the basics in the food log:
•
Appropriate portion sizes and energy intake for the
client’s goals.
•
Photo food journal: Ask the client to snap an image of
their food each time they eat. For people with smartphones this is often a much simpler alternative.
Set expectations clearly and
appropriately
Close analysis of food and other records can be tricky.
Clients may feel judged or anxious.
Before moving to the more detailed food log:
Remind clients that you are on their team. You are not
a judge of their goodness or badness. You are collaborating with your client, working together to collect
evidence, analyze that evidence, and draw informed
conclusions about what to do next, based on their goals.
View data collection and analysis as a win-win. Whatever you find will be helpful. The client will have something
to work on. You’ll be able to troubleshoot with them.
Everyone is happy.
•
A relatively regular eating schedule.
•
Food quality and variety.
•
Evidence of planning and preparation, and an environment that supports your client’s goals.
Also ensure that other basic factors like sleep and recovery are covered.
Never assume a client is truly consistent with the essential basics unless you have clear evidence. (Again, clients
aren’t bad people. They’re just human.)
Then look for some sneaky additions:
Too much dietary fat
Fat is not bad. It’s just calorie-dense.
Clients who want to get significantly leaner will have to
watch their overall intake, and fat is a sneaky source of
excess energy. (Plus, it’s delicious and easy to over-eat.)
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For instance:
Excess oil: Clients may be doing a fantastic job of getting
their vegetables in salads, or roasted. But sometimes
those veggies are a vehicle for too much oil. 1 tablespoon of oil is over 100 calories of ready-to-absorb
triglycerides.
Too many nuts / too much nut butter: 1 thumb of nuts
(the recommended serving size for an average woman
at each meal) is really, really small. Like 8-12 almonds.
Sit down and count out 8 almonds. It’s a sad little pile,
isn’t it? Same deal with 1 thumb of nut butter. It’s really
easy to lose a lot of nut butter into a Super Shake, or get a
little generous with the spoonfuls straight from the jar.
Too much of fat-based condiments. Things like guacamole and pesto are delicious and nutritious. But their
calories add up fast, and it’s easy to eat too much.
Cheese and other high-fat dairy. Two cubic inches of
Brie cheese has 120 calories. That’s about the size of a
pair of dice. Goat cheese is a common salad topper. 1
thumb of it has about 100 calories. We don’t know about
your wine and cheese parties, but we definitely like to eat
more than 2 dice worth of Brie at ours. Unfortunately for
Level 2 clients, these calories can accumulate quickly.
On that note…
Super Shakes
Super Shakes are awesome.
At the same time, clients may simply be consuming too
much of a good thing, throwing a few extra bananas
or spoonfuls of nut butter in there, or treating a Super
Shake as a calorie-free drink instead of a liquid meal.
Review the ingredients and make sure the portions are
appropriate.
Strategy: Improving food quality and
variety
Level 2 is an ideal time to experiment and expand horizons; to seek mastery and depth.
At this stage, you can challenge your Level 2 clients to
try things like:
•
new types of protein-dense foods or fruits and
vegetables);
•
Too many protein-dense foods
Many people give protein-dense foods a “free pass.”
They’ll eat lots of meats, eggs, cottage cheese, protein
powder, fish, jerky, and so forth.
But if you’re trying to get lean, too much food is still too
much food.
You might have a client who doesn’t eat “sweets”, but
they’ll polish off a protein bar or two every day. And
they won’t touch ice cream, but they don’t think twice
about an 800-calorie protein pudding recipe with berries, nuts, coconut milk, and protein powder. This is fine
when those calories are needed, but they can add up very
quickly and become excessive.
Look also for “juicing”, smoothies and the like. Review
all ingredients.
Nutrition: The Complete Guide
upgrading their food expectations and spending
a little more to get better-quality items (Note: This
doesn’t mean pointlessly spending on luxuries or premium items; it means making food quality a spending
priority.);
•
Pseudo-health-foods / concoctions
Bars and shakes are most common. But into this category also fall things like “Paleo cupcakes”, “healthy
cookies”, baking with protein powder, etc.
expanding their food repertoire (for instance, trying
•
buying more of their food from:
•
organic sources
•
local sources
•
small farms / wild-caught sources
•
environmentally friendly, sustainable sources
•
Fair Trade / fair labor sources; and
exploring other cuisines.
The Phytonutrient Checklist
This is a strategy for your longevity clients — the ones
who want to attain optimal health outcomes, prevent
chronic diseases, and live to be 100.
Phytonutrients are the countless chemicals starting to
be identified in plant foods that appear to have various
Working with Level 2 Clients | 373
health benefits. It appears that the greater variety we consume, the greater the
health benefits.
fair trade: Trade in which fair
prices are paid to producers in
developing countries
Since some clients are very predictable and routine with food selections, they
might only eat the same 2-4 veggies and / or fruits over and over.
In order to help them break this rut, challenge them with the Phytonutrient
Cheat Sheet (www.precisionnutrition.com/color-chart)
Another way to encourage more variety with veggies and fruits is to simply encourage a client to eat seasonally and / or join a Community Supported Agriculture (CSA) program.
In some regions, this will be easy. Indeed, in some areas of the world, seasonal
and local eating is one of the major (or even only) options.
In the United States, clients can check out http://www.localharvest.org/.
Community Supported
Agriculture (CSA) : A system
in which a farm operation is
supported by shareholders within
the community who share both
the benefits and risks of food
production
In Canada, clients can check out http://www.usc-canada.org/
Outside of North America try an Internet search or go here: http://urgenci.net/
Strategy: Improving food selection, preparation and
cooking skills
As above, Level 2 is an ideal time to experiment and expand horizons; to seek
mastery and depth.
At this stage, you can challenge your Level 2 clients to try things like:
•
expanding their cooking repertoire with new dishes, menus, and flavors;
•
improving their ability to shop efficiently and effectively;
•
learning how to choose the best quality food (e.g., buying in season, testing
ripeness or quality);
•
improving their foundational cooking skills and trying new methods of cooking
and preparation;
•
getting involved in the food production process, e.g., picking their own
produce or learning how to butcher (Some clients may already be raising
their own animals or hunting / fishing for food. This is a particularly important
strategy for clients in remote and rural areas, and clients from indigenous backgrounds, such as Inuit, First Nations, Native American or Hawaiian, Australian
Aboriginal).
Strategy: Workout nutrition to fuel performance and
enhance recovery
At Level 2, most clients should be regularly active. Many will be athletes; most
will be training intensely at least occasionally. Thus, at this stage, you can consider adding some specific and targeted workout nutrition.
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Workout nutrition has two key goals:
Priority #1: Improve recovery.
Priority #2: Improve performance.
Most athletes do this the wrong way around — they focus on eating to perform, which often means short-term
strategies like grabbing a candy bar before a training
session. But ultimately, if you don’t recover, you don’t
perform.
Recovery can include:
•
providing adequate hydration;
•
ensuring a steady supply of fuel and nutrients to
the client’s individual tolerance for food / liquids
around training times
Begin with a general template. Observe and assess. Then
make adjustments accordingly.
The value of carbohydrates
Of course, all nutrients are important. But for most athletes, carbohydrates can be a “make or break” factor.
When training or competing, even in strength and
power sports, blood sugar levels can dictate how well an
athlete feels during the session.
•
If blood sugar drops too low, they might fatigue
working bodies (so that those bodies don’t have to
faster (both mentally and physically), and / or feel like
break down valuable lean tissue);
they have less “gas in the tank.”
•
reducing muscle soreness;
•
managing inflammation;
•
improving immune function;
•
increasing protein synthesis while inhibiting protein
breakdown; and
•
•
optimizing body composition (i.e., building strong,
dense muscle, bone, and connective tissues while
keeping body fat down).
Fundamentally, good workout nutrition helps exercisers
replenish and rebuild.
Individualizing workout nutrition:
General guidelines
We can divide workout nutrition into three categories:
1. Pre-workout nutrition (i.e., before the workout)
2. Intra-workout nutrition (i.e., during the workout)
3. Post-workout nutrition (i.e., after the workout)
Exactly what this looks like for each athlete or exerciser
will depend on a few things:
•
how long the physical activity lasts
•
how intense the activity is
•
how often the activity happens within a given period
(e.g., single versus multiple daily training sessions)
•
the client’s goals
•
the client’s body type / composition
Nutrition: The Complete Guide
•
If blood sugar stays constant, they’ll feel like they
have adequate energy. They’ll also feel mentally
“sharp” and emotionally “tough.”
Therefore, one of the goals of every workout, whether
it’s in the gym, on the field, or on the road, is to prevent
blood sugar from dropping.
Activity itself creates a demand for glucose; stress and
adrenaline can eventually deplete sugar stores too.
(While adrenaline, or epinephrine, gives a fast blast of
glucose, this runs out and may leave athletes feeling
shaky or weak. The effect will be amplified if athletes
are using pre-workout stimulants such as caffeine or
ephedrine.)
As you learned in previous units, activity eventually
depletes muscle and liver glycogen. These stores must
be filled.
Our body can do this without more fuel coming in, but
that requires breaking down stored fuel and valuable
lean tissue. Eventually, if we consistently ask our body to
dig into its “savings account”, we run a deficit: We start
losing muscle, getting injured, knocking our hormones
out of balance, and compromising overall recovery.
Thus, for optimal recovery, we replenish our glycogen
fuel tanks with carbohydrates during and / or after
training.
This means that most athletes do best with a steady
supply of carbohydrates before, during, and / or after
exercise.
Working with Level 2 Clients | 375
Athletic activity = Managed body damage
Training session 1
Training session 2
BASELINE
DAMAGE
RECOVERY
SUPERCOMPENSATION
DAMAGE
Not enough recovery / session too hard
Training session 1
DAMAGE
Training session 2
RECOVERY
SUPERCOMPENSATION
DAMAGE
Figure 13.1 Importance of recovery in athletic nutrition
International Sports Sciences Association
376 | Unit 13
What type of carbohydrates are best for workout nutrition?
For regular day-to-day meals, we generally want higher-fiber, slow-digesting carbohydrates, such as:
•
starchy tubers (like potatoes and sweet potatoes)
•
fruit
•
beans and legumes
•
whole grains
• higher-fiber versions of bread, pasta, etc. (e.g.,
sprouted bread, bean pasta)
And of course, we want to eat normally most of the
time, including before and after training.
For intra-workout nutrition, we want faster-digesting
carbohydrates. This is especially true if we’re drinking
them in a shake or solution.
For this purpose, you can still use whole foods, or supplements.
Again, remember that not all clients or athletes will
require intra-workout carbs. See Table 13.4 for more.
However, there are other options available, many of
which are modified sugars or starches, such as:
•
hydrothermally modified corn starch / waxy
maize (sometimes called “Superstarch” or “GlycosadeTM”)
•
unprocessed corn starch
•
maltodextrin
•
dextrose
•
trehalose
•
isomaltulose (PalatinoseTM)
•
VitargoTM, made from barley starch
The different molecular configurations of each type
of carbohydrate can alter its effects (which you may
remember from our unit on nutrients).
For instance:
•
GlycosadeTM is a high-amylopectin starch, originally developed to treat glycogen storage diseases, while other types of modified corn starch may
be high-amylose.
•
Some studies have looked at galactose as a workout carbohydrate. Although it’s a monosaccharide and thus technically a simple sugar, it does
not have the same effects as glucose.
Whole-food options
If your client has a blender and wants to use whole
foods for intra-workout nutrition, try blending (along
with protein):
•
banana or cooked plantain
•
other fruits
•
cooked white or sweet potatoes
•
soaked rolled oats
One study found that raisins were just as effective as
“Sport Jelly Beans” (which are essentially sugar + vitamins).
Supplement options
As you can imagine, there are many supplement options
for workout carbohydrate. Though some researchers
feel that high-glycemic options (in other words, simple sugars that convert quickly to glucose) are best for
intra-workout carbs, this is not yet conclusively proven.
The most basic supplement option is a sugar-sweetened
protein powder or BCAA supplement.
Nutrition: The Complete Guide
Vitargo’s manufacturers claim that it has a low osmolality, which means that unlike many starches, it doesn’t
pull a lot of water into the GI tract. This means an
athlete can theoretically consume quite a lot without an
upset stomach ­— replenishing a lot of glycogen relatively quickly and efficiently.
Be aware that many claims about supplements are
based on small studies that may not be well replicated.
(For instance, one of the most-mentioned waxy maize
studies involved nine people, and maltodextrin actually
increased blood glucose more.)
A larger study of 51 endurance athletes (cyclists and
triathletes) found that the best results came from a solution of 1:1:1 glucose-fructose-maltodextrin, ingested at a
rate of 78 g per hour.
This matches up well with other research that has
found a 2:1 glucose to fructose carb makeup is ideal
during exercise (since maltodextrin is essentially the
same as glucose).
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As always:
• Focus on consistency first. The exact type of “perfect” carbohydrate is less important than simply
ensuring athletes are consistently consuming
some type of carbohydrate during and / or after
exercise.
•
Be a skeptical consumer.
• During workouts, for clients who need carbs,
a mix of 15 g of protein with 30-45 g of carb
mixture for every hour of training is usually
appropriate.
•
Observe your clients closely. Look for things like
GI upset, blood sugar swings, or unwanted fat
gain and adjust accordingly. Test performance indicators when you change the nutrition variables.
•
Use the evidence of your clients’ performance
and wellbeing to test all dietary choices.
Table 13.4 Next steps for workout nutrition
Client type
What to do
Clients with better carbohydrate tolerance
Drink a protein + carbohydrate drink during training
session
Clients who need more carbohydrates (e.g., endurance athletes)
Clients who want to gain weight
Clients with lower carbohydrate tolerance
Clients who don’t need as many carbohydrates (e.g., low-intensity movement such as yoga)
Drink BCAAs during training
session
Clients who want to lose fat
General workout nutrition
For most athletes, most of the time, it’s enough to simply:
•
Follow a normal, regular eating schedule of
high-quality Level 1 meals with a good balance
of lean protein, healthy fats, and slow-digesting
carbohydrates (such as fruits, vegetables, and whole
grains).
•
Make sure to get carbohydrates in most meals —
enough to support the athlete’s general level of
activity.
•
Eat these meals every 3-4 hours, as needed or appropriate (depending on goals).
For many athletes and recreational exercisers, these basic
guidelines are enough to support their training.
Indeed, given many athletes’ busy schedules, simply
planning and preparing regular, high-quality Level
1 meals will be an important skill to master and do
consistently.
Once the client is doing the basics above consistently,
you can add the following, depending on goals and
needs:
Like most things, carbohydrate requirements will fall on
a bell curve.
Does exact timing matter?
Early research suggested that there was a short, rapid
“anabolic window” for nutrient replenishment, and that
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athletes should rush to replenish lost nutrients immediately after training (within 30-60 minutes).
muscle adaptation, and / or training with high volume
and intensity (potentially multiple times every day).
More current research suggests that as long as athletes
eventually refill the “fuel tank” with protein and carbohydrate within 1-2 hours after training (or, within 4-5 hours
of their pre-workout meal), they’ll recover sufficiently.
However, someone exercising for general health and
fitness — or simply to look and feel better — should only
consider this question once they’ve nailed all the other
strategies consistently. Even a top-performing Level 2
client may never need to “graduate” to Level 3.
Thus, we recommend that athletes stick to a regular
eating schedule and simply make sure they get adequate
protein and carbohydrates within the first 1-2 hours
both before and after an intense training session.
Individualizing workout nutrition:
Targeted template
Here’s a starter workout nutrition template that takes activity intensity and duration into account.
The exact timing and type of post-workout nutrition
doesn’t really matter for anyone but an elite athlete or
Level 3 eater who is training specifically for maximal
Remember, these aren’t “rules”, just principles. A
Same as others
SD = Standard Deviation
Probably more
than others
Probably less
than others
Definitely more
than others
Definitely less
than others
-2
SD
2%
-1
SD
14%
+1
SD
Mean
Score
34%
34%
+2
SD
14%
2%
Percentage of clients who will do best with a given amount of carbohydrate
Figure 13.2 How much carbohydrate do people likely need?
Nutrition: The Complete Guide
Working with Level 2 Clients | 379
framework with which to begin. Observe, assess, and
adjust as necessary based on the data.
For more on competition day nutrition, in the “Competition Day Nutrition” section on page 455.
For moderate-intensity activity under 2 hours
and / or high-intensity activity under 1 hour
Strategy: Improving recovery
protocols
Step 1: Eat normally 1-2 hours before training.
Step 2: Drink 0.5-1 liter (2-4 cups) of water during activity.
Step 3: Drink 0.5-1 liter (2-4 cups) of water after activity.
Step 4: Eat normally within 1-2 hours after training.
Step 5: Drink 0.25-0.5 liters (1-2 cups) of water at each
meal.
At Level 2, your clients should be sleeping 7-9 hours
a night, and doing some form of active recovery (i.e.,
non-exercise movement that helps clear out waste products, mobilize the joints, and is — ideally — fun).
Where appropriate, you can add other targeted recovery
protocols, such as:
•
Add-ons
•
PNS activation exercises (such as gentle yoga or massage therapy);
For athletes who want a little extra recovery
boost, more advanced clients looking to lose
•
more sleep (including daytime naps);
fat and maintain muscle, or for strength sport
•
anti-inflammatory supplementation;
•
workout nutrition;
support (e.g., powerlifting): Add BCAAs during
workouts. Aim for 10-15 g of BCAAs every hour
during workouts.
•
specific breathing, relaxation, stress reduction, and
•
more, and more diverse, phytonutrients (i.e., colorful
fruits and vegetables along with other bio-active
For advanced clients who want to gain weight,
substances such as those found in herbs, green tea,
have a high need for carbs / calories, or for
onions and garlic);
specific sport performance (e.g., endurance or
intermittent sport): Add protein + carbohydrates
•
increasing protein intake;
during workouts / competition. The general formula:
•
balancing healthy fats (looking for a 1:1:1 ratio of
30-45 g carb + 15 g protein in 500-600 mL water
polyunsaturated to monounsaturated to saturated
every hour during activity.
For moderate-intensity activity lasting longer
than 2 hours and / or high intensity activity
lasting longer than 1 hour (and for those with
multiple events in one day)
Step 1: Eat normally 1-2 hours before activity.
fat; decreasing omega-6 intake from industrial seed
oils if necessary);
•
omega-3 (EPA / DHA) supplementation;
•
further limiting processed foods, particularly trans
fats;
•
reducing and / or eliminating any foods that seem to
provoke an inflammatory response in your client;
Step 2: Drink 0.2-0.5 liters (1-2 cups) of water 30-60 minutes before activity.
•
reducing and / or eliminating alcohol; and
Step 3: Consume 30-45 g carb + 15 g protein + electro-
•
reducing and / or eliminating caffeine, if your client
lytes (sodium and potassium) in 600 mL water every hour
during activity.
Step 4: Consume 30-45 g carb + 15 g protein + electrolytes (sodium and potassium) in 600 mL afterwards.
Step 5: Eat normally within 1-2 hours after.
Step 6: Consume 0.25-0.5 liters (1-2 cups) of water at each
meal.
doesn’t tolerate it well5.
Strategy: body type eating
If you’re anything more than a casual observer of human
beings, you might have noticed that — much like breeds
of dogs — they come in different shapes and sizes.
You’ll see everything from the giant wolfhound to the
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I types (ectomorphs)
V types (mesomorphs)
O types (endomorphs)
Figure 13.3 Body types
Table 13.5 General tendencies in body types
Ectomorph (I type)
Mesomorph (V type)
Endomorph (O type)
Skeletal structure and
morphology
Light and lean
Medium and balanced; naturally muscular
Heavier; more body fat
Metabolism / response
to energy excess
“High-revving” and “fast”
Flexible
“Slow”
Excess energy tends to...
Be expended through activity (e.g., fidgeting) and heat
Build lean mass
Get stored as fat
Appetite regulation and
eating behavior
Easily satiated; rarely hungry
Normal appetite, hunger
and satiation
Often very sensitive to appetite and hunger cues; may
feel as if they are “always
hungry” and “never full”
(potentially less sensitive to
satiation and satiety cues)
Hormonal environment
May have longer limbs
Some may say they aren’t
all that interested in food or
often “forget to eat”
SNS dominant
Thyroid dominant
(hyper-thyroid)
Carbohydrate tolerance
Higher on average
Nutrition: The Complete Guide
May be more hungry if
active
May have shorter limbs
Testosterone and growth
hormone dominant
PNS dominant
Normal
Lower on average
Working with Level 2 Clients | 381
Chihuahua; everything from the slim and wiry whippet
to the muscular bulldog to the rotund little Corgi.
— principles that can potentially help us target our
nutritional strategies.
Dog breeds also vary in their body composition, energy
levels and metabolic rates… just like humans. Some people seem to be always fidgeting, always in motion; other
people tend naturally to be more sedentary.
Body types are not “carved in stone.” They are not the
basis for “nutritional rules”, nor are they any specific system. (In other words, not all ectomorphs will be exactly
the same, and being an ectomorph doesn’t necessarily
cause anything to happen.)
Different body type groups — aka “somatotypes” — typically include a few general characteristics:
•
morphology and skeletal structure;
•
hormonal environment; and
•
metabolism (including metabolic rate and how nutrients are processed).
If you specialize in a particular sport, especially at
an elite level, you’ll often see that certain body types
gravitate towards certain activities, or specific positions
within sports.
We divide body types loosely into three groups:
•
I types (ectomorphs)
•
V types (mesomorphs)
•
O types (endomorphs)
Body types are simply a starting point.
Body types are a proxy for thinking about possible
differences in metabolism, activity types, and nutritional
needs. As a coach, you can create some working hypotheses using body types, which you can then test.
Here’s a brief comparison of some of the general tendencies that you are likely to see with body types.
Trained versus untrained
It’s easy to think that being an ectomorph is somehow a
“get out of nutritional jail free” card — these lucky folks
seem to devour donuts with impunity, while the poor
downtrodden endomorphs must watch every calorie and
gram of carbs.
As usual, reality is more complex.
Importantly, these are just general conceptual categories
Indeed, instead of thinking of only three body types, we
Table 13.6 Trained versus untrained body types
Trained /
active
Ectomorph (I type)
Mesomorph (V type)
Endomorph (O type)
Likely easily maintains a
“lean-normal” to “lean-athletic”
body fat %
Likely above-average muscularity
and “lean-normal” to “lean-athletic” body fat
May have denser bones than
average
May struggle to put on muscle
May have denser bones than
average
May have a fair bit of lean mass;
potentially able to produce significant power
May still have relatively higher
body fat % or struggle to stay
lean
Untrained /
inactive
Higher % of body fat despite
looking trim in clothing (i.e.,
“skinny-fat”)
May have trouble maintaining
adequate bone density (especially dangerous with aging)
May lose muscle easily (aka
sarcopenia)
May be overweight / have high
body fat % along with a fair bit
of lean mass; may “carry it well”
(i.e., look proportionate even
with a fair bit of excess body fat)
May be metabolically unhealthy
Overweight to obese; high % of
body fat
May have more bone density
and muscularity in areas bearing
weight
May be metabolically unhealthy
May be metabolically unhealthy
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might almost think of six: trained / active and untrained
/ inactive versions of each.
You’ll notice that while the three body types may differ
somewhat in their trained and untrained / inactive
versions of themselves, being inactive is still a recipe for
poor metabolic and overall health and function.
Ectomorphs’ natural appetite control and carb tolerance
may help them dodge a health bullet for a while… but
unfortunately, almost nobody escapes the long-term
consequences of sedentary living. An inactive ectomorph
is likely to lose scarce muscle tissue (a process known as
sarcopenia), and become “skinny-fat” and frail.
They may be tall and long-limbed (which is helpful
in sports that need both height / reach and low bodyweight), or they may be smaller (which is helpful in
sports where low absolute bodyweight is important, such
as cheerleading or horse racing).
Ectomorphs tend to prefer endurance activities, and / or
sports where a good strength-to-mass ratio is important.
Their engine speed is set to “high revving.” They tend to
be thyroid- and sympathetic nervous system-dominant
with either a higher output or higher sensitivity to catecholamines like epinephrine and norepinephrine. They
typically have a fast metabolic rate.
Conversely, a very active endomorph may have a larger
body with more body fat, but still be metabolically
healthy and perform well physically.
They’re high-energy. They’re often fidgeters and pacers.
They tend to burn off excess calories with near-constant
movement throughout the day.
Regular movement / activity and a well-trained body ensures that all three body types use and partition nutrients
effectively, and maintain a healthy body composition for
their somatotype.
They tolerate carbs well. These are the rare folks who
seem to eat starches with impunity. And because of the
activities they tend to gravitate to, they often need more
carbs.
I types / ectomorphs
I types therefore generally do best with more carbohydrates in the diet, along with a moderate protein and
lower fat intake. Thus, we recommend more healthy
carbs and less fat with a moderate amount of protein.
Elite endurance athletes, climbers, female gymnasts and
dancers are typically light and lean; sparsely muscled
and light-framed, with delicate bones.
2 palms of
protein-dense
foods
2 fists of
vegetables
3 cupped handfuls
of carb-dense
foods
1 thumb of
fat-dense foods
Figure 13.4 Type I meal portion
Nutrition: The Complete Guide
1 palm of
protein-dense
foods
1 fist of vegetables
2 cupped handfuls
of carb-dense foods
0.5 thumb of
fat-dense foods
Working with Level 2 Clients | 383
A nutrient distribution for this body type might be
around 55% carbs, 25% protein, and 20% fat. (But don’t
drive yourself crazy with the math. Just think “higher
carbs and lower fat.”)
Assuming clients eat about 4 meals per day, here’s what
that might look like using our portion control guide.
For each meal, I type men might begin by eating:
For each day, I type men might aim to eat:
•
6-8 palms of protein-dense foods
•
6-8 fists of vegetables
•
10-12 cupped handfuls of carb-dense foods
•
2-4 thumbs of fat-dense foods
For each day, I type women might aim to eat:
•
2 palms of protein-dense foods
•
4-6 palms of protein-dense foods
•
2 fists of vegetables
•
4-6 fists of vegetables
•
3 cupped handfuls of carb-dense foods
•
7-9 cupped handfuls of carb-dense foods
•
1 thumb of fat-dense foods.
•
1-3 thumbs of fat-dense foods
For each meal, I type women might begin by eating:
V types
•
1 palm of protein-dense foods
•
1 fist of vegetables
•
2 cupped handfuls of carb-dense foods
•
0.5 thumb of fat-dense foods
Football running backs and safeties, soccer players,
hockey players, wrestlers / MMA fighters, rugby backs
and flankers, and other sports that combine all-around
athleticism with speed, strength and power are typically
mesomorphs: solid, strong-framed bodies that easily put
on muscle.
But remember, even these meal totals aren’t set in stone.
They are a simple way for folks to ballpark their daily
total intake. The actual daily intake has more flexibility.
2 palms of
protein-dense foods
If they’re taller, you might find them in sports like rowing, rugby, hockey, or basketball. If they’re shorter, you
might find them in weightlifting or gymnastics.
1 palm of
protein-dense
foods
2 fists of vegetables
1 fist of vegetables
2 cupped handfuls of
carb-dense foods
2 thumbs of
fat-dense foods
1 cupped handfuls
of carb-dense foods
1 thumb of
fat-dense foods
Figure 13.5 Type V meal portion
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V types (mesomorphs) have a medium-size bone structure and athletic
body, and if they’re active, they usually
have a considerable amount of lean mass.
100
90
Protein
Their bodies are designed to be powerful machines. Excess calories often go
to building muscle, strong connective
tissues, and dense bones.
Carbohydrates
Fats
30%
35%
55%
40%
25%
20%
30%
40%
Ectomorph
Mesomorph
Endomorph
70
60
They tend to be testosterone and growth
hormone dominant.
50
Thus, they can usually gain muscle and
stay lean easily.
40
V types therefore generally do best on
a mixed diet, with balanced carbohydrates, proteins, and fats. So that’s what
we recommend.
20
A nutrient distribution for this body
type might be around 40% carbohydrate,
30% protein, and 30% fat. (Again, don’t
drive yourself crazy with the math. Just
envision a roughly balanced mix of all
three macronutrients.)
25%
80
30
10
0
Figure 13.7 Macronutrient differences based on body type
Assuming clients eat about 4 meals per day, here’s what
that might look like using our portion control guide.
For each meal, V type men might begin by eating:
For each day, V type men might aim to eat:
•
6-8 palms of protein-dense foods
•
6-8 fists of vegetables
•
2 palms of protein-dense foods
•
6-8 cupped handfuls of carb-dense foods
•
2 fists of vegetables
•
6-8 thumbs of fat-dense foods
•
2 cupped handfuls of carb-dense foods
•
2 thumbs of fat-dense foods
For each day, V type women might aim to eat:
•
4-6 palms of protein-dense foods
For each meal, V type women might begin by eating:
•
4-6 fists of vegetables
•
1 palm of protein-dense foods
•
4-6 cupped handfuls of carb-dense foods
•
1 fist of vegetables
•
4-6 thumbs of fat dense foods
•
1 cupped handful of carb-dense foods
•
1 thumb of fat-dense foods
But remember, even these meal totals aren’t set in stone.
They are a simple way for folks to ballpark their daily
total intake. The actual daily intake has more flexibility.
Nutrition: The Complete Guide
O types
O types (endomorphs) have a larger bone structure with
higher total body mass and fat mass. Football linemen,
heavyweight powerlifters, and throwers are typically
endomorphs, as are some rugby players (especially those
in the pack).
Working with Level 2 Clients | 385
2 palms of
protein-dense foods
1 palm of
protein-dense foods
2 fists of vegetables
1 fist of vegetables
1 cupped handful
of carb-dense foods
0.5 cupped handful
of carb-dense foods
3 thumbs of
fat-dense foods
2 thumbs of
fat-dense foods
Figure 13.6 Type O meal portion
Their engine speed is set to “idle.” They tend to be
parasympathetic nervous system dominant. Unlike
ectomorphs, endomorphs are built for solid comfort,
not speed.
They’re naturally less active. Where the ectomorphs tend
to burn off excess calories with near constant movement,
excess calories in endomorphs do not seem to cause that
same increase in expenditure. This means that excess
calories are more likely to be stored as fat.
They typically have a slower metabolic rate and generally
don’t tolerate carbohydrates as well, particularly if they
are sedentary.
O types therefore generally do best on a higher fat and
protein intake with carbohydrate intake being lower. So
that’s what we recommend: more fat and protein, less
carbohydrate.
A nutrient distribution for this body type might be
around 25% carbs, 35% protein, and 40% fat. Again, no
math gymnastics. Just think higher fats and protein,
lower carbs.
Assuming clients eat about four meals per day, here’s what
that might look like using our portion control guide.
For each meal, O type men might begin by eating:
•
2 palms of protein-dense foods
•
2 fists of vegetables
•
1 cupped handful of carb-dense foods
•
3 thumbs of fat-dense foods
For each meal, O type women might begin by eating:
•
1 palm of protein-dense foods
•
1 fist of vegetables
•
0.5 cupped handful of carb-dense foods
•
2 thumbs of fat dense foods
But remember, even these meal totals aren’t set in stone.
They are a simple way for folks to ballpark their daily
total intake. The actual daily intake has more flexibility.
For each day, O type men might aim to eat:
•
6-8 palms of protein dense foods
•
6-8 fists of vegetables
•
2-4 cupped handfuls of carb dense foods
•
10-12 thumbs of fat dense foods
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For each day, O type women might aim to eat:
•
4-6 palms of protein dense foods
•
4-6 fists of vegetables
•
1-3 cupped handfuls of carb dense foods
•
7-9 thumbs of fat dense foods
Testing and outcome-based decision
making
Once again: These body types and meal templates are
not “rules.” They’re possibilities, tendencies, and starting
points.
Consider all relevant factors along with body type,
including age, activity level, goals, needs, and other metabolic issues (e.g., other hormonal health, any known
glucose tolerance).
Observe your clients carefully, monitor results closely,
and use client data to make decisions. Stay flexible and
“steer dynamically.”
Strategy: Carb and calorie cycling
Some clients who are looking for below-average leanness
and above-average body composition may find it useful
to cycle their carbohydrate and calorie intake.
Important: This, like all Level 2 strategies, is not “magic”,
or a “rule.” It’s a tool and a technique. Which may work.
Or not.
Despite the fancy name, carb and calorie cycling are
quite simple concepts.
•
Carb cycling refers to eating more carbohydrates
on some days; and fewer carbohydrates (and often,
as a result, fewer calories) on other days. A client may
also do a “mini carb cycle” during a day, eating more
carbs around activity and less at other times.
•
Calorie cycling refers to (you guessed it) eating
more calories on some days, and fewer calories on
other days. This can also include some rudimentary
forms of intermittent fasting. (For more on IF, see Unit
14, “Working with Level 3 Clients.”)
You can, of course, combine carb and calorie cycling, so
that, for instance, higher-carb days are also higher-calorie days and vice versa.
Nutrition: The Complete Guide
Why carbs?
We focus on carbohydrates (and not protein or fats) because carb needs are the most variable of the macronutrients, and fluctuating them can have a large impact on
many important hormones (namely insulin, glucagon,
thyroid and leptin).
Generally, protein remains as constant as possible, although there may be rare situations where a low protein
intake is called for.
By changing carbohydrate and therefore calorie intake on particular days, we can keep fat loss going and
metabolic rate humming along, without the ill effects of
stringent calorie or carb restriction.
Why cycle?
There are a few cases that particularly benefit from carb /
calorie cycling.
For example:
Clients who want to see their six-pack must endure a
lower-energy intake for long periods.
Cycling calorie intake (for instance, with a simple higher
day / lower day) helps stave off metabolic downregulation that often occurs with a chronic, ongoing energy
deficit.
Plus, cycling intake can make an energy deficit feel like
less of a “grind” by blocking off “eat less” days into small,
manageable units instead of several weeks of miserable,
hungry slogging.
Clients who don’t tolerate carbs well may nevertheless
use them effectively when active.
So, they can literally have their cake and eat it too
— by getting the bulk of their carb intake around
their workouts. (Even better, with time and sustained
activity, they may become more metabolically healthy,
which means improved overall carb tolerance and more
dietary flexibility.)
Clients with underlying metabolic issues (such as poor
glucose control or elevated inflammation) may benefit
from short bursts of fasting. Periodic, brief intermittent
fasting has also been shown to improve many indicators
of metabolic health.
For clients who can do this protocol safely and sanely,
Working with Level 2 Clients | 387
short periods of lowered calories (or no calories) may
improve these health markers.
Clients who are trying to safely manage stress (including training stress) may find that cycling carbs and calories helps them “dance at the edges” of an energy deficit
or significant change to their body, without incurring
major hormonal disruption.
Periodically “topping up” energy and carbohydrate
stores can tell the body that everything’s okay, and starvation is not imminent. This is particularly useful for:
•
For some clients, this could mean having specific lowcarb or high-carb days, or low-calorie / high calorie
days. These days could simply be alternated, or clients
might deliberately deplete their carb stores over a period
of several days.
Method 1: High / low days
The carb and calorie cycling approach is pretty simple,
and based on the client’s activity.
•
eats a baseline diet of mostly protein, vegetables and
female clients (whose central hormonal regulation
healthy fats with minimal carbs (maybe a total intake
systems may be very sensitive to nutritional deficits)
•
leaner clients (who usually have less circulating
leptin)
•
of 2-4 cupped handfuls).
•
Clients who are trying to cut weight or change the
appearance of their physique for competition can also
benefit from carb cycling in particular, because carbohydrate intake affects fluid balance in the body. For more
on this, see “Competition Day Nutrition” on page 455.
Clients with religious observations may “naturally”
do calorie cycling on fasting days such as Ramadan,
Yom Kippur, or Lent. While they may not specifically be
doing this for Level 2 goals, you can advise them on how
best to manage their nutritional needs, especially if they
are active.
(maybe a total intake of 8-12 cupped handfuls).
And that’s pretty much it. No need to measure grams or
count calories. Just follow a baseline diet on lower-carb
days. And add carbs on higher-carb days.
Method 2: Post-workout / anytime
Another approach is to put the bulk of a day’s carbohydrate intake in the meal that follows physical activity
(post-workout), while minimizing carbohydrates at
other meals (anytime).
This would be the Post-workout and Anytime meal
approach.
An Anytime meal, as its name implies, can be eaten any
time outside of exercise. An Anytime meal:
•
For some clients, this could mean eating more carbs
around a day’s workout or training session, with fewer
carbs at other times.
has an appropriate serving of lean protein (about 1-2
palms)
•
has an appropriate serving of healthy fats (about 2-3
thumbs)
Scheduling cycling
Usually, higher-carb / higher-calorie periods occur
during times with lots of activity, while lower-carb / lower-calorie periods occur during times with less activity.
On days with physical activity and / or planned
exercise: They add starchy carbs to the baseline diet
anyone who has a relatively lower stress tolerance
Getting enough carbs and energy is key for hormonal as
well as psychological health. Many people find they feel
mentally sluggish, moody, anxious, and / or depressed
in the face of chronic carb or energy deficits. Cycling calories and carbs can help avoid these problems as clients
work towards below-average leanness or higher-level
athletic performance.
On days with minimal physical activity: The client
•
fills out the remainder with non-starchy vegetables
(ideally colorful ones)
An Anytime meal can also include a small portion of
high-fiber, slow-digesting carbohydrates, such as beans,
lentils, or fruit (about 0.5-1 cupped handful).
The Post-workout plate is for meals that take place after
physical activity. This meal type helps us take advantage
International Sports Sciences Association
388 | Unit 13
Water
or tea
Water
or tea
Starches
including
potatoes, pasta,
rice or bread
Protein
including red meat,
chicken, fish, eggs or
vegetarian source
Protein
Veggies
Fats
including healthy
oils, nuts and seeds
including red meat,
chicken, fish, eggs or
vegetarian source
including a wide
variety of vegetables
Anytime Meal
Veggies
& Fruit
including a wide
variety of vegetables
and some fruit
Post-workout Meal
Figure 13.8 Anytime / Post-workout meals
of the body’s metabolic response to exercise, and the improved glucose tolerance that occurs during the post-exercise period (or any period following higher amounts of
physical activity).
So, here is how this might play out in a few sample days:
Monday
Workout day
Tuesday
No workout, but
still physically
active
Wednesday
No workout,
and not physically active
Meal 1:
Anytime
Meal 1:
Anytime
Meal 1:
Anytime
Workout
Ride bike to work
and work physically active job
Meal 2:
Anytime
Meal 2:
Post-workout
Meal 2:
Post-workout
Meal 3:
Anytime
Meal 3
Anytime
Ride bike home
from work
Meal 4:
Anytime
Meal 4
Anytime
Meal 3:
Anytime
(possibly
Post-workout if
extra calories
needed)
A Post-workout meal:
•
has an appropriate serving of lean protein (about 1-2
palms)
•
is lower in healthy fats (about 0.5-1 thumb)
•
has an appropriate serving of carbohydrates (often
simpler, faster-digesting carbohydrates, about 3-5
cupped handfuls)
Note:
•
A baseline level of protein is included for all meals
(1-2 palms).
•
As carbs go up, fat goes down. As carbs go down, fat
goes up.
•
We say “appropriate serving” and give some examples. Of course, the actual serving size depends on
each client’s body size, body type, needs, and goals.
Begin with the hand size portions of nutrient-dense
foods form, and tailor accordingly.
Nutrition: The Complete Guide
Meal 4:
Anytime
Working with Level 2 Clients | 389
Remember: Level 1 strategies performed consistently
must come first. If your client hasn’t done those yet (and
doesn’t have the psychological maturity to try this structured form of eating), this strategy usually backfires.
•
that this supplement does what manufacturers say it
can do — without causing harm?
•
What interactions could this supplement have with
other medications or supplements that my client is
Strategy: Basic supplementation
The topic of nutritional supplements is controversial, to
say the least.
What objective, peer-reviewed research demonstrates
already taking? Other foods they’re already eating?
•
Do I trust this supplement and its manufacturer? Why
or why not?
Some argue that we need nutritional supplements for a
healthy, energetic life; others argue that nutritional supplements have little to no value and simply make supplement companies rich.
This doesn’t have to be an all-or-nothing choice. If a
client does well with their food intake some days but not
so well on other days, perhaps they can be a part-time
supplement user.
Both views are overly simplistic. Sure, they make
answering supplement questions easy, but they prevent
critical thinking.
For example, they might take a protein supplement
on days that their protein intake from whole foods is
low; on higher-intake days, they can skip the protein
supplement.
As a health care practitioner, it’s your job to evaluate the
evidence and decide what’s best for your clients.
Begin with assessment and
understanding
As we’re fond of saying, supplements are supplemental
— to a consistently high-quality diet.
At Level 1, your supplementation may be geared towards
correcting deficiencies. At Level 2, your supplementation
may become more sophisticated.
Your approach to supplements should be pragmatic
and evidence-based: If you recommend a nutritional
supplement to your clients, it should be based on a strict
supplement needs analysis.
Ask yourself the following questions before choosing to
use a nutritional supplement:
•
How do I know for sure that my client needs and will
benefit from this supplement? (For instance: Have
you done nutritional testing? Reviewed their food
intake? And so on.)
•
Which physiological system do I hope to target with
this nutritional supplement? Does my client need
that?
If you’re going to recommend a client take a supplement,
you should know which system you hope to affect.
For example, creatine targets the ATP-PCr energy
system and can also help to increase lean body mass by
improving the body’s work capacity. If a client doesn’t
need to target this system (due to low-volume or infrequent workouts, for example), then they might not
need creatine. However, if a client is training hard, is
looking to add lean mass, and performs high-intensity,
ATP-PCr-dependent exercise bouts, creatine may be a
useful supplement for them.
Choosing nutritional supplements is tough. There’s
so much information available, and most of it is from
parties who may be biased in one direction or another.
Therefore, it’s best to ignore marketing messages and
turn to an appropriate body of knowledge to decide
whether a supplement is useful and / or safe.
This knowledge can include scientific reviews, scholarly
textbooks, and academic journals, which are monitored
by other researchers in the field (aka peer-reviewed) for
accuracy and scientific rigor. Do not depend on mainstream magazine or newspaper articles, books published
in the popular press, websites, or anecdotal evidence (in
other words, someone else’s opinion on “what worked
for them”), as the quality of these is not controlled.
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What you might recommend
Here are some possible supplements that you might
consider at Level 2, depending on each client’s individual
needs:
•
a multivitamin / multimineral supplement (also a
Level 1 strategy)
•
an omega-3 (EPA / DHA) supplement (also a Level 1
strategy)
•
For instance:
A multivitamin / multimineral supplement
•
•
protein powder (also a Level 1 strategy)
•
probiotics (balance gut microbiome)
•
digestive enzymes (reduce digestive issues, enhance
food absorption)
creatine (support strength, power, and anaerobic
activity)
•
beta-alanine (support anaerobic activity)
•
pre-workout caffeine (enhance fuel utilization and
•
branched-chain amino acids (BCAAs; support performance and recovery)
•
levels and training stresses.
An omega-3 supplement
•
•
specific vitamins (e.g., vitamin D, B12; prevent deficiency or enhance function)
•
electrolyte solutions (support performance and
re-hydration)
•
anti-inflammatory formulations (e.g., curcumin,
ginger)
•
antioxidant formulations (e.g., resveratrol, green tea
catechins)
•
bone and joint support (e.g., glycosamingens, eggshell membrane)
•
supplements to support sleep (e.g., L-theanine,
5-HTP, valerian, ZMA, melatonin)
Have clear goals and rationale for
supplement use
You may notice that some of these supplements (such
as a multivitamin / multimineral supplement) are also
Nutrition: The Complete Guide
For a Level 1 client, may correct some basic deficiencies caused by a poor diet.
•
For a Level 2 client, may help control inflammation
and enhance fat loss.
A greens supplement
•
For a Level 1 client, may correct some basic deficiencies caused by a poor diet, and help clients transition to a “whole-foods” diet that includes fruits and
vegetables.
•
For a Level 2 client, may be part of an “on the road”
strategy for athletes who may not always have access
specific minerals (e.g., magnesium; prevent deficiency or enhance function)
For a Level 2 client, the same supplement may address potential deficiencies caused by higher activity
CNS drive)
•
For a Level 1 client, may correct some basic deficiencies caused by a poor diet.
a powdered or liquid greens supplement (also a Level
1 strategy)
•
Level 1 strategies. This shows that we may do the same
thing for different reasons.
to fresh produce.
Protein powder
•
For a Level 1 client, may make it easier to increase
protein intake (especially for plant-based eaters).
•
For a Level 2 client, may be an essential supplement
for convenience, portability, post-workout recovery,
and / or boosting protein intake to the levels necessary for top athletic performance or optimal body
composition.
Notice that “correct basic deficiencies” or “help client
transition to a better diet” are two of the most common
reasons to supplement at Level 1, while “improve performance”, “increase recovery”, and “eat well when training, competing, and traveling” are the most common
reasons for Level 2 supplementation.
There are many possibilities for supplementation for
Level 2 clients, depending on their needs and goals.
Working with Level 2 Clients | 391
Choose supplements wisely
For all supplement recommendations:
•
Review the evidence supporting their use.
•
Choose only trusted brands and manufacturers that have been independently
tested for quality. Be aware that poor-quality supplements may contain toxic
materials (such as heavy metals or other contaminants) or banned ingredients
(such as stimulants or substances that can cause a positive hormone test); or
simply not enough of the ingredient you want.
•
If your client is an athlete, review all supplement guidelines for their sport
federation. In sports or competition levels with stringent testing, be extremely
careful.
•
Only use supplements if appropriate and if your client will genuinely benefit
from them.
We recommend:
•
ConsumerLabs.com (for brand testing and reviews)
•
Examine.com (for research reviews of the evidence supporting specific
supplements)
To learn more about which products we recommend, check out www.precisionnutrition.com/supplements.
Safety first
While many consumers believe that if a product is on the market, it must be okay
to use, that isn’t always the case.
Not all jurisdictions legislate or control supplements equally.
For instance, in the United States, the Food and Drug Administration (FDA)
does not test the effectiveness, safety, or purity of nutritional supplements. Dietary supplements do not need approval from the FDA before they are marketed.
And except in the case of a new dietary ingredient, where pre-market review for
safety data and other information is required by law, a supplement manufacturer
does not have to prove a supplement is safe or effective before it goes to market.
It’s impossible to know whether a supplement contains what the label says it
should contain, whether a supplement actually does what it’s supposed to do,
or whether taking a supplement will lead to health benefits or health problems.
However, products verified by independent third-party labs (such as ConsumerLab, NSF) should come as advertised.
On the other hand, in other countries like Canada, stricter regulations are in
place. Before any supplement is produced / marketed, this product has to be
cleared by the Natural Health Products Directorate (NHPD). The NHPD ensures that each supplement company and manufacturer has a proper license, that
each manufacturer follows good manufacturing practices (GMP), that there
Food and Drug
Administration (FDA): A
federal agency in the United
States responsible for monitoring
trading and safety standards in US
food and drug industries (but not
dietary supplements)
ConsumerLab, NSF: Third-party
labs that can verify supplement
ingredients
Natural Health Products
Directorate (NHPD): The
regulating authority for natural
health products for sale in Canada
good manufacturing
practices (GMP): Practices
helping to ensure that
supplements are consistently
produced and controlled
according to quality standards
International Sports Sciences Association
392 | Unit 13
is thorough adverse event reporting, that clinical trials
support claims and safety, and that standard labeling
conventions are used.
Similar regulations are in place across most of the European Union (EU). For instance, any herbal preparation
must show data on the supplement’s quality, safety and
efficacy before being allowed on the market.
This means that supplements coming out of Canada or
the EU are more likely to be labeled properly, safe, and
effective.
(Although when it comes to athletes, it doesn’t necessarily ensure that supplements are free of banned substances. After all, some IOC-banned substances are perfectly
legal in non-athlete populations.)
Most other regions, such as Eastern Europe, Asia, Africa,
or Central and South America, are much less regulated
in both drugs and supplements.
Here are some steps you can take to cover your bases:
•
If you’re working with an athlete, be sure that the
supplement you’re recommending isn’t on a banned
substance list.
•
Be sure that the supplements / foods you recommend
don’t have any interactions with any medications /
drugs your client is taking. The pharmaceutical company Merck has a comprehensive listing of dietary
supplement- and food-drug interactions in their
online Merck Manual of Medical Information (Home
Edition). The Natural Medicines Comprehensive Database also has a useful online tool. We also recommend talking to your client’s pharmacist if possible.
•
•
Choose a larger company that’s been doing business
for quite some time, that provides certificates of
analysis, and that is certified by a third party. The NSF
does the most comprehensive third-party certification
/ testing of nutritional supplements for sport. Another
organization, HFL Sport Science, is an independent
drug surveillance laboratory providing doping control and banned substance testing for supplements
through the Informed-Sport program. Another option
is to visit www.consumerlab.com or www.labdoor.
com. These comprehensive websites are devoted to
reviewing purity and label claims for a variety of nutritional supplements on the market today.
Choose supplements that only have a few ingredients. If you’re looking for creatine, buy creatine only.
If you’re looking for a protein supplement, make sure
there’s only protein. Review the ingredient list; usually the fewer the better.
Nutrition: The Complete Guide
•
If you’re working with a sports team or organization,
consider partnering with a trusted manufacturer to
provide custom product(s) for your clients / athletes.
Rather than buying from commercial supplement
companies, go behind the scenes to set up a deal
with the manufacturing company. This way you can
get exactly what you want for your clients / athletes
and you can reduce your risks of being exposed to
a banned substance or impure product. (Note that
manufacturing companies will typically only do custom supplements for very large product orders.)
As you can see, supplementation offers some real risks
and challenges.
Before making supplement recommendations, educate
yourself.
If you’re not interested in doing all this homework, that’s
fine. After all, many clients with high-quality diets and
appropriate recovery protocols, all done consistently,
don’t need more than that.
Yet, if you believe your client is falling short and / or
would benefit from targeted supplementation, you may
want to refer to someone in your health care network.
Competition day nutrition
Since many of your Level 2 clients will be athletes, they’ll
undoubtedly want to know more about what to eat just
before and during a competition.
First, remember: What and how an athlete eats every
day is most important. Just as athletes must drill and
practice their sport skills consistently, they must start
with good consistent training nutrition. See “Workout
Nutrition.”
On the competition day, they should only have three
goals:
Goal 1: Do what they’ve practiced
Athletes should practice and rehearse their competition-day routine.
Warming up at 10 a.m. and competing at 12? Then
they should do a trial run well before the competition
day. Wake at the same time, eat the same foods, and
perform the same athletic feat.
Don’t leave things to chance. Don’t try anything new on
competition day.
Working with Level 2 Clients | 393
Prepare, rehearse, anticipate. Keep things as familiar as
possible. Control as many variables as you can.
Goal 2: Supply the body with energy for
the competition
On competition days, an athlete should ensure that the
nervous system is stimulated for performance and that
they have a constant supply of blood glucose to prevent
them from bonking.
Therefore, the competition day strategy is simple:
•
Eat small, easily digested foods frequently throughout the day.
•
Ensure that these smaller meals contain proteins, fats,
and most importantly, quality carbohydrates.
•
Eat familiar foods — the foods they know and trust.
Certain sports supplements (even caffeine) can help with
nervous system stimulation and others can help to provide carbohydrate energy. In fact, liquid nutrition is very
useful for sipping between events if an athlete is going to
have several heats or events during the same day.
Liquid protein plus carbohydrate (P+C) drinks help replenish fluids, are often better tolerated, and can provide
rapidly and easily digested protein and carbohydrates for
between-event recovery.
Test the level of caffeine your athletes can tolerate under
these more stressful conditions. Competition day nerves
(plus things like travel) may compound the effects of any
stimulants, leaving your athletes a tweaked-out mess if
they have even their normal doses of caffeine.
Goal 3: Avoid foods that make them
uncomfortable
Don’t rush to over-feed or over-hydrate an athlete who’s
cut weight, unless you want them to spend their tournament time with GI upset.
No alcohol until afterwards, especially if the athlete has
traveled across time zones and / or by air.
A note about post-competition partying
If you’ve ever cut weight or simply been very ampedup and nervous for a competition, you’ll know that
the combination of adrenaline and energy demand
can make you ravenous afterwards. Plus, if you’re with
a team, you might want to go and celebrate a win (or
drown your sorrows after a loss).
Many sports teams are legendary for post-game partying
and taking down all-you-can-eat platters with beastlike
abandon. This may include alcohol and recreational
drugs, plus losing valuable sleep.
Partying and celebrating are fine if they don’t cut into
your athletes’ performance, optimal body composition,
and recovery. A post-championship blowout comes
along only once a year, for instance.
But if you’re finding that your athletes are spending
more time in the bar or at the buffet than they are on the
field, have a conversation with them about balance.
Troubleshooting Level 2
Realistic expectations
Most people would readily admit that expecting to lose
10 lb of fat or gain 10 lb of muscle, to correct serious
blood lipid issues or to cut their 40-yard dash time from
5.5 to 4.4 seconds in two weeks is unrealistic.
As many athletes are hyper-stimulated on competition
day, they find it more difficult to tolerate large meals or
slowly digested foods.
Yet subconsciously, many people want to believe that
these results are not only possible, but likely.
They should eat foods that make them feel good, that
don’t aggravate their stomachs, and, for most athletes,
that make them feel “light.”
While many books, experts, programs and products may
promise results like these, they are not reality. In reality,
things are often less difficult than we think they’ll be,
but take longer than we think they’ll take.
During the practice run we suggested, experiment with
different foods until you find a routine that works well
for you. Even foods that aren’t part of a usual “good nutrition” plan are acceptable here as long as blood sugar is
managed and the athlete feels energetic and comfortable.
Failing to achieve an impossible goal, even with perfect
nutrition, tells someone nothing about how to achieve
their goal. If a client’s nutrition plan hasn’t produced the
results you expected, consider whether their expectations (and yours) were realistic.
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Determine three things about goals:
So how do you go about getting them?
What is the upper limit of achievement?
Find someone who has achieved what your clients want
to achieve.
How much can someone truly hope to achieve, assuming
they do everything right, and do it consistently for as
long as it takes?
Do they really have the genetic makeup to run a 4.4-second 40-yard dash?
Can they really be 225 lb at 5% body fat?
Are they young enough, talented enough, and hungry
enough to succeed in elite athletics?
How long will it take to get to this upper
limit?
What is a realistic rate of achievement?
Will they improve at a consistent rate or will improvement come faster at some times than at others?
If consistent, how much improvement should they expect every two weeks?
If variable, how little improvement should they be willing to accept during periods of slow returns, and how
long should they expect those periods to last?
Are they willing to do what it takes?
Do they have what they need?
If not, are they willing to change things? Spend money?
Focus on their goals to the exclusion of everything else?
If they want to run a 4.4-second 40-yard dash, do they
have all the other resources in place to do so, like a great
running coach and a great training program?
If they want to be 225 lb and 5% body fat, are they
willing to do everything it takes to get there? Are they
willing to sacrifice family dinners, social events, restaurant meals, perhaps even health, relationships and / or
job opportunities?
These are not simple questions to answer. In some cases
you won’t have the expertise to answer them.
But if you want to have a standard by which to judge a
client’s progress, you need those answers.
Nutrition: The Complete Guide
Consult as many people as you can find and take an
average of their responses. Generally, other knowledgeable coaches will help you out with this for free or for a
low cost.
Ask about their methods, how they track progress, and
what they look for in terms of goal criteria (e.g., in order
to achieve X later, a client must be able to do Y now).
Look for small, continual progress.
Kaizen is a Japanese word for the concept of small, incremental, continual progress. The idea is that by making
these tiny gains consistently, you can achieve goals you
thought were beyond your reach.
For instance, the motivational speaker Tony Robbins
used the principle to convince people to make small
strides toward personal development goals. Strength
coach Charles Poliquin used it to support or explain the
concept of “microloading” — using load increases of as
little as half a pound to ensure continual strength gains.
We’ll use the concept to help measure our progress.
When the client can’t settle on an expected result for a
two-week measurement, choose the smallest increment
that you can measure and make sure they improve by
that increment every two weeks.
Let’s say your client is trying to put on muscle mass, but
all they have at their disposal to measure progress is a
bathroom scale.
A simple but effective tactic is to simply make sure that
every time they step on the scale, the measured weight
increases by at least the smallest measurable increment.
Every two weeks, the goal is to see that needle move one
notch to the right. That’s it.
Certainly, you could do a much more detailed measurement than that, but if that’s all they do, you’re
already ahead of the game, as they’re at least moving
in the right direction. The magnitude of that change
(i.e., how much actual progress they make) is important, but secondary.
Working with Level 2 Clients | 395
So here’s the process, which is essentially a feedback loop
of observe - orient - decide - act (OODA):
1. Choose a goal.
2. Broadly determine whether that goal may be realistic.
(You’ll revisit this over and over.)
3. Select a metric to track progress toward that goal.
4. Start moving towards the goal using whatever means
you have available.
7 steps to individualization
Here’s the basic outline for individualization:
Step 1: Ensure that the client has mastered Level 1 strategies and can do them consistently, even under stressful
conditions.
Step 2: Consider your client holistically. In particular,
consider their:
5. Observe what happens.
•
goals
6. Revise and refine progress metrics. If your client can’t
•
needs
•
skills and abilities
•
knowledge
•
willingness to follow direction and get feedback
•
mindset
•
lifestyle
•
physiological makeup
determine a realistic rate of achievement for the goal,
try to progress by the minimum measurable increment
every two weeks.
7. Revise and refine the process as needed (e.g., Does the
client need more guidance or a different system?).
8. Keep moving towards the goal.
9. Observe what happens.
10. Revisit whether the goal is realistic.
And so on.
Step 3: Design the baseline individualized plan. Treat it as a
starting hypothesis and a prototype.
Guidelines vs. needs
Step 4: Take the new plan for a test drive.
Remember that all of the recommendations in this textbook are guidelines, not rules. They’re starting points
and ideas on how to tailor your nutritional advice.
These recommendations are the first step of the journey, not the final destination.
We know you want answers and you want them now.
There are a lot of answers here. All of this information
is based on years of experience, trial and error, and the
best available research.
Still, science is always provisional. Our knowledge is
always partial, always subject to change when new and
better evidence comes along. (For instance, new findings
in genetics, epigenetics, and our microbiome are literally
rewriting our textbooks on human physiology.)
Every set of recommendations we make is a best
guess. An informed approximation of needs.
It’s only once clients begin to apply these recommendations that true individualization begins.
Step 5: Monitor your client closely and measure their
progress regularly.
Step 6: If the plan delivers the results they’re looking for,
keep it up.
Step 7: If the plan doesn’t deliver the results they’re looking for, use outcome-based decision making to make
adjustments.
What to do afterwards
Most of these strategies aren’t permanent. For instance,
most people won’t stay extra-lean, or at the peak of their
competitive athletic career forever.
Once your Level 2 client has gotten to their goals, then
what?
The simplest step is just scaling back to Level 1. This
allows clients to transition to normal, sustainable eating
with reasonable trade-offs.
This also prevents the “feast / famine” cycle that often
follows periods of higher dietary restraint.
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For example, someone might follow a more regimented eating routine, but after the goal has been reached,
it becomes a food “free for all.” Over-eating ensues.
Sometimes this urge to over-eat can be so strong after a
restriction that it can wipe out all progress they’ve ever
made, leaving them worse off than they were originally.
So, a better option for the client would be to ease back
into a Level 1 approach, preventing any extremes.
back all the way to Level 1, you can also explore this
with them. Find out what aspects of Level 2 nutrition
were most do-able and reasonable, and build the next
program around that. Eliminate or minimize the most
troublesome or difficult aspects. Level 1.5 if you will.
An example might be carb / calorie cycling.
If possible, talk about this transition with clients before it
happens. Some clients will be so focused on the immediate goal at hand that they haven’t given any thought to
what happens for breakfast the morning following the
competition / event.
Maybe the client was only eating 1 cupped handful for
carb-dense foods on lower-carb days, and this was a bit
too low. Maybe increasing to 1.5 cupped handfuls would
be a next step. Or maybe they stay at 1 cupped handful,
but instead of 5 lower-carb days (and 2 higher-carb days)
each week they aim for 4 lower-carb days (and 3 higher-carb days).
Now, if the client wants to test the waters of Level 2 and
spend time finding a sustainable strategy without going
Adjust the variables until the client finds the sweet spot
of sanity and sustainability.
Case study
You’ve been working with a 34-year old female client
named Shannon for the past year.
Shannon has gotten to 90% consistency with the Level
1 strategies and has met all of her initial goals. She has
no history of disordered eating and appears to be quite
rational about food choices. She is only taking one medication, a birth control pill.
Shannon has decided that she wants to pursue a figure
competition — a physique competition requiring lower
body fat and more muscularity (but less extreme than
bodybuilding).
You’ve discovered that for Shannon, following the
Level 1 strategies alone won’t be enough to make her
competitive in the figure competition. After a discussion with Shannon about this, you both agree that
higher-level strategies will be needed in order for her to
reach her goals.
She has 12 weeks to prepare for the competition.
Currently, she’s:
•
5´8˝ (1.72 m) tall
• 150 lb (68 kg)
•
21% body fat
Nutrition: The Complete Guide
She wants to reach 15% body fat. So, that would mean
she needs to lose ~0.5% body fat every week up until
the competition.
A few questions to consider:
Would Level 2 strategies be safe and appropriate for
Shannon?
If yes, what would be your first step? Why?
If not, why not?
Would any supplements be appropriate for Shannon
during this 12-week period?
If yes, which ones and why would you choose them?
If not, why not?
Are Shannon’s goals realistic for the given time frame?
If yes, how so?
If not, what might be more realistic?
What would you do after the 12 weeks are over?
Why?
Working with Level 2 Clients | 397
Summary
Before progressing with Level 2 strategies, make sure
that the client is consistent with Level 1 strategies.
Most clients will be able to reach their goals with Level
1 strategies.
•
Calorie cycling is taking in more energy (calories) on
some days and less energy on other days. This can
include basic forms of intermittent fasting.
•
Carb and calorie cycling can be combined.
Level 2 clients are those who have mastered Level 1 strategies, have progressed as far as they can, need a bit more
individualization, and are emotionally mature enough to
try more advanced strategies.
Supplementation is an add-on to existing good habits
and a high-quality diet. When well-chosen and carefully
applied, it can be valuable for clients.
Most Level 2 clients will require more precise observation, measurement, and analysis, using tools such as
food journals. Food logs give the coach great insight into
the daily nutritional habits of a clients and often help to
make clients more aware of their own intake.
Be careful and smart about your supplementation.
Review evidence, think critically, match supplements to
your client’s goals and needs, choose reputable manufacturers and brands, and use extra caution when supplementing athletes’ diets.
Most Level 2 clients will be active; many will be athletes.
For clients doing longer, more frequent, and / or more
intense bouts of physical activity, adding intra-workout
nutrition can help with recovery, performance, and optimal body composition.
Competition day nutrition should help athletes maintain
constant energy and alertness throughout their event.
Rehearse all food choices and procedures well before the
actual event.
Body type eating is when food intake is adjusted based
on macronutrients to better align with the tendencies of
certain body compositions and activities.
The concept of “cycling” here refers to varying energy
intake and macronutrients over time.
•
Set realistic expectations. Not everyone can look like the
professional model on the cover of a magazine or achieve
at the highest levels of athletics.
All of the strategies we outline in this unit are a starting point. Adjust based on feedback and measures with
the client.
Carb cycling is simply eating more carbohydrates on
some days — usually on high-volume or high-intensity physical activity days — and eating fewer carbohydrates on other days — usually low-volume, low-intensity, or days with minimal physical activity.
International Sports Sciences Association
UNIT 14
Working with Level 3 Clients
Working with Level 3 Clients | 399
Unit Outline
1.
Level 3: Special situation nutrition
4.
Case study
2.
Level 3 strategies
5.
Summary
3.
Troubleshooting Level 3
Objectives
In this unit, you’ll learn about the Level 3 nutritional strate-
they need, and how to monitor them. You’ll learn some es-
gies, meant to be used for short periods of time in order to
sential Level 3 techniques, and how to support your client
peak for an event.
in executing them as safely and sanely as possible.
You’ll learn about what qualifies as a Level 3 client, what
Level 3: Special situation nutrition
Welcome to the land of numbers and exacting precision:
Level 3. It’s a foreign land that most clients don’t visit…
and never should.
Once again, the vast majority of your clients will be —
and stay — Level 1s. Some more advanced exercisers or
athletes, or people with higher-level physique goals, can
move to Level 2 after mastering all of Level 1.
And then, there’s Level 3: The few, the proud, the highly
restrictive, the counters of grams, timers of intake, and
measurers of portions.
Unless you work exclusively with bodybuilders, physique competitors, elite endurance athletes, elite weightclassed athletes, and / or professional models, almost
none of your clients will be Level 3s.
Table 14.1 provides an overview of what Level 3 clients
look like.
What you need to know about Level 3
Level 3 approaches are mostly about looks and
/ or performance.
Level 3 clients are special situation clients.
Level 3 clients want to get leaner or improve athletic
performance beyond what they can do with the Level 2
approach.
Level 3 strategies are for the rare, nutritionally experienced people with specific, aggressive goals such as:
Level 3 strategies definitely don’t make clients any healthier or give them a better quality of life.
What does a Level 3 client look like?
•
competing in a physique contest
•
preparing for elite-level competition
•
needing to reach very specific body composition
numbers for performance, competitive, or aesthetic
reasons (likely body fat goal ranges of 4-8% for men,
and 12-18% for women)
Indeed, depending on how far someone takes them...
Level 3 behaviors can become actively
unhealthy.
If a client engages in Level 3 behaviors too stringently
and aggressively:
International Sports Sciences Association
400 | Unit 14
Table 14.1 Level 3 client features
Typical goals
Elite/professional athletic performance and career
Elite/professional physique/fitness competition and/or modeling career
Level of athletic performance
or body composition require
Elite/professional; nationally or internationally competitive
Body composition desired or
required1
Extreme leanness and/or muscularity
Men: below 8% body fat
Women: below 17% body fat
Training load
15-20 hours a week or more
Knowledge
Expert2
Competence and skill
High
Follows a complex plan to the letter
Consistency
High
Can do any task, no matter how complex, 90% of the time or more
Has a base of sustainable habits and a consistent foundation of essential behaviors
Mindset / psychology
“Don’t ask; just do.”
“Everything is secondary to this.”
“This is my life/job.”
“I want to be one of the best in the world.”
Limiting factors
Everything in the client’s environment (routines, people, physical environment, etc.)
supports execution of tasks; client is 100% dedicated to getting things done and
everything around them facilitates that
1 Note: Clients will vary widely in their body compositions depending on their age, sex, genetic makeup, etc. What is “unreasonably lean” for one person may be another person’s “normal." Look for natural tendencies and try to get a baseline
of what is appropriate for each client. “Normal” is the body composition that a client can easily and sanely maintain doing
basic Level 1 habits consistently.
2 Most clients at Level 3 will have coaches. So the clients themselves need not be experts, but they should be guided by
someone who is.
•
Body fat can start to drop too low. Hormones and
recovery can be disrupted.
•
Behaviors, thoughts, and feelings about food, eating,
and training can become disordered. Clients may
start to have mental and emotional health problems
such as anxiety, depression, and / or obsessive-compulsive tendencies.
•
Social relationships and other interests — which we
need for overall wellness and quality of life — may
suffer.
Nutrition: The Complete Guide
Level 3 behaviors are usually short-term
strategies.
Generally, clients do Level 3 tasks for a specific, shortterm goal, such as a competition, or to support higher
levels of athletic training at certain times in their competitive season.
Few clients can live consistently, sanely, and happily at
Level 3. In fact, no one is meant to live at this level. (You’ll
see what we mean when you review the list of Level 3
behaviors below.)
Working with Level 3 Clients | 401
As a coach, it’s your role to inform your clients
about all the trade-offs.
Help clients know what to expect and look for as they
progress into Level 3 habits. Keep it real.
You’ll notice that while Level 2 tasks sometimes involve
expanding choices (e.g., add a new food), Level 3 tasks
usually involve limiting choices.
Monitor clients carefully.
At Level 3, all clients should be working under supervision and keeping detailed records of what they are doing.
Track your client’s physical, psychological, and social
indicators closely. Make outcome-based decisions using
data.
You’ll notice that many of these coaching tasks (such as
water manipulation or caloric restriction) put your client
at risk.
In conjunction with your clients, decide on acceptable
risk in advance and have an “escape plan” at all times to
help guide your client back to balance if needed.
What you need to know about yourself
It might seem a bit strange to talk about you, the coach,
when we’re supposed to be talking about Level 3 clients.
But coaching Level 3 clients is both an art and a science,
and it’s not for everyone.
You must be sane and balanced — exceptionally so.
Otherwise you can get sucked down the rabbit hole of
compulsive, self-scrutinizing behaviors and body image
dysfunction with your client.
You must be calm, cool, and collected. Otherwise your
client’s inevitable anxiety and pre-event jitters will freak
you out. Nutrient depletion and stress can do strange
things to people. Your client may have mood swings,
strange obsessions, crying jags, or any number of other
psychological outbursts and dysfunctions. You’ve gotta
stay chill and keep them on track.
You must be highly organized. You’ll need to keep track
of a lot of little things, particularly during times of high
stress (such as before a big competition, on the road).
You must love numbers, details and precision. You
must be the kind of thorough, meticulous watchmaker
that loves to get things just right, and tune them into
glorious harmony. You must be diligent, careful, and
consistent. Essentially, you’re an engineer of the human
body.
You must play the long game. Never sacrifice your clients’
long-term health for short-term gains. And make sure you
monitor them almost as closely after the big event as you
did beforehand.
If this doesn’t sound like a good fit for you as a coach,
that’s okay. Have a Level 3-friendly coach in your support network and refer out as needed.
And if at any point you feel the strategies we recommend below are beyond your ability, outsource the
nutrition plans of your Level 3 clients to a sports nutritionist whose nutrition programs will account for food
type, timing, and amount for different activity levels
and body types.
While you’ll certainly be able to help clients with this
level of fine-tuning, and this unit should help clarify just
how to do so, it’s okay if you either don’t want to get this
involved or you feel like this level of individualization
should only be done by licensed professionals.
Just decide on your comfort level and boundaries, know
where you operate best and most confidently… and outsource the rest. Go team!
Level 3 limiting factors
By Level 3, people won’t have many limiting factors.
Their routines, environment, mindset, schedule, social
network, etc. should almost completely support their
goals. Level 3s typically organize their entire life around
their needs and pursuits — which often means things
like:
dropping relationships (or restricting relationships only to
people who are in a similar situation);
quitting jobs (or working jobs that can be organized
around eating and training); and / or
•
reducing or eliminating other pursuits such as hobbies or education.
For most people, this is unhealthy. Indeed, for Level 3s,
it can become unhealthy.
At the same time, for Level 3s who are emotionally mature
International Sports Sciences Association
402 | Unit 14
and relatively sane and grounded, it’s what needs to be done in order to achieve
world-class performance. Such performance doesn’t last. So most people don’t live
at Level 3 forever, or even longer than a few weeks or months at most. Even the
most dedicated Level 3s usually scale back to Level 2 or even Level 1 periodically.
Level 3s will often encounter some key limiting factors, though. Most are related
to the toll that Level 3 takes on the body, mind, and spirit.
•
They may deal with chronic injury and / or illness as they push the edges of
human performance or training loads.
•
They may deal with loneliness and isolation, since almost nobody around them
will be living a Level 3 lifestyle, and they have to forgo many social events.
•
They may find themselves anxious and obsessive with ongoing nutrient restriction and the focused, compulsive behaviors required.
•
They may deal with major hormonal disruption as the body rebels against
semi-starvation and / or the chronic stress of training and competing.
•
They may find themselves binge eating or developing seriously disordered
thoughts, beliefs, and behaviors around food and eating.
•
They may develop a skewed body image or sense of their own performance,
always feeling distressed and dissatisfied about “never being good enough."
performance-enhancing drug
(PED): Any substance taken by to
improve performance
anabolic-androgenic steroids
(AAS): Compounds that are
derivatives of testosterone used
medically or recreationally, often
to promote tissue growth and/or
performance
prohormones: A precursor of a
hormone
nootropics: Any agent
(e.g,. drug, functional food,
nutraceutical or nutritional
supplement) which is thought to
improve mental function
Some of your Level 3 clients may also be taking a variety of performance-enhancing drugs (PEDs) and gray-area “supplements” such as:
•
anabolic-androgenic steroids (AAS) and prohormones
•
growth hormone
•
insulin
•
thyroid hormone
•
stimulants such as thermogenics, “fat burners” (ranging from caffeine to stronger stuff)
•
nootropics
•
painkillers
Because of these distinctive and potentially dangerous limiting factors, we recommend that you have a strong referral network that includes:
•
health care practitioners such as sports medicine doctors;
•
recovery and body work specialists such as massage therapists;
•
pharmacists, registered dietitians, and naturopaths (for consultation on drug
and supplement use);
•
counsellors and psychotherapists.
Level 3 coaching tasks
At this stage, you’ll have to adjust some Level 3 tasks for fat loss, athletic performance, and / or mass gain. We’ve given you some notes in Table 14.2.
Nutrition: The Complete Guide
Working with Level 3 Clients | 403
Table 14.2 Level 3 coaching tasks
Level 3 clients can
consistently...
So the “next level” involves...
Sample coaching tasks could be...
Following a very detailed, very specific meal plan with all choices tightly
controlled
Follow this meal plan exactly
Food choices
Follow a basic meal template
using ISSA-style portion sizes
and food options
Weigh and measure all food.
Cycle calories
Cycle macronutrients (usually carbs / fat)
Meet basic nutrient needs
(macronutrients and
micronutrients)
Testing for nutrient status and supplementing specifically
Stay hydrated
Following specific hydration
recommendations
Drink mostly non-caloric
beverages
Follow this specific, targeted supplement plan
exactly
Choose only approved supplement brands
Manipulating water levels to cut weight
or change the look of a physique
Cut out caffeine except as a training aid
Cut out alcohol
Rehydrate with this exact recipe for a hydration
solution
Follow this specific, detailed water weight
cutting protocol exactly
For fat loss: Tolerate being
almost constantly hungry
Consistently eating a lot less than the
body needs / wants
For fat loss: Leave the table feeling a little
hungry (or even quite hungry); accept the
discomfort of hunger much of the time
Intermittent fasting
For mass gain: Tolerate being
too full
Consistently eating a lot more than the
body needs / wants
For mass gain: Leave the table feeling a little
overstuffed (or even a lot overstuffed); accept
the discomfort of fullness much of the time
Having all training under the supervision of coach / trainer
Follow specified training program exactly
Adding 15-30 minutes of sleep or improving sleep quality
Nap every day
Exercise and activity
Manage training loads
Recovery
Sleep 7-9 hours
Allowing the risk of not sleeping
Supplement to enhance sleep (e.g., ZMA,
L-theanine)
Refine sleep ritual
Get enough basic recovery
Following specific recovery protocols
Allowing the risk of not recovering;
pushing into the “danger zone” of
over-training and/or under-recovering
Add peri-workout nutrition (BCAAs for fat loss,
carb + protein drink for muscle gain and/or
athletic performance)
Foam rolling for 10 minutes daily
Record daily recovery indicators (e.g., sleep
quality, HRV)
Decide the cutoff in advance for what is tolerable (e.g., minor injuries okay; major injuries
mean stopping Level 3 protocols)
I