Specialist in Fitness Nutrition John Berardi, PhD Ryan Andrews, MS/MA, RD Specialist in Fitness Nutrition (First Edition) Official course text for: International Sports Sciences Association’s Specialist in Fitness Nutrition program 10 9 8 7 6 5 4 3 2 Copyright © 2010 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 inquiries about 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 (local) • 1.805.745.8119 (fax) 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 The data and information contained herein are based upon information from various published and unpublished sources that represents training, health, and nutrition literature and practice summarized by the author and publisher.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 This summary of information from unpublished sources, books, research journals, and articles is not intended to replace the advice or attention of health care professionals.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. AUTHORS ABOUT THE AUTHORS John Berardi, PhD Dr. John Berardi made his mark as a leading researcher in the field of exercise and nutritional science, and as a widely read author, coach, and trainer who has helped thousands of men and women achieve their health, fitness and performance goals. Through his highly acclaimed nutrition education and solutions company, Precision Nutrition, John has reached nearly 40,000 clients in 87 countries. Dr. Berardi earned a doctorate in Exercise and Nutritional Biochemistry from the University of Western Ontario and currently serves as an adjunct assistant professor of Exercise Science at the University of Texas. He provides nutrition consultation services for athletes and sports teams including a number of Canadian Olympic programs, the University of Texas Longhorns, and numerous individual professional football, hockey, and baseball players. Dr. Berardi has written and contributed to many books and has published more than 300 articles in major health and fitness magazines, including Men’s Health, Men’s Fitness, Women’s Health, Oxygen, and more. You can learn more about Dr. Berardi and his visionary approach to fitness and nutrition at www.precisionnutrition.com. Ryan Andrews, MS/MA, RD After earning his BS in Exercise Science from the University of Northern Colorado and two Master’s Degrees from Kent State in Exercise Physiology and Nutrition, Ryan Andrews completed a Medical Center Dietetic Internship at Johns Hopkins—one of the most recognized and awarded research institutions in the world. Ryan has applied his comprehensive education and enthusiasm for helping others to his work as a dietitian, strength and conditioning specialist, and invaluable contributor to various non-profit organizations. Ryan has presented on topics related to fitness and nutrition to numerous groups and has written hundreds of articles about nutrition, exercise, and health. He currently serves as Director of Education for Precision Nutrition. For more on Ryan, visit www.precisionnutrition.com. iii TABLE OF CONTENTS Preface: How to Use This Text, viii Section I: Nutritional Science Introduction: What Is Good Nutrition?, 1 Cell Structure and Function, 19 Nutrition as a Limiting Factor, 2 The Cell, 21 Good Nutrition Defined, 4 Organism, 21 How You Can Help Clients Improve Their Nutrition, 11 Nutrition and Cellular Interaction, 26 Your Scope of Practice, 12 Cellular Proteins, 35 Applying Nutrition Technologies, 15 Summary, 38 Summary, 18 Cellular Components, 28 Food Intake, Digestion and Absorption, 39 Food Versus Nutrients, 41 Digestive System Structure and Function, 44 Controlling the Digestive Process, 53 Nutrient Absorption, 58 Fate of Nutrients after Absorption, 63 Nutrient Delivery, 65 Summary, 68 Energy Transformation and Metabolism, 69 Energy Intake, Storage, and Transfer, 71 Energy Transfer Process, 72 Pathways for Nutrient Metabolism, 79 Summary, 104 Energy Balance in the Body, 105 The Micronutrients, 177 Energy Value of Food, 106 Vitamins, Minerals, and Phytochemicals, 178 The Body’s Need for Energy, 109 Water-Soluble Vitamins, 183 Estimation of Energy Needs and Energy Intake, 111 Fat-Soluble Vitamins, 189 Consequences of Energy Imbalances, 115 Summary, 206 Roles of Vitamins and Minerals in Energy Balance, 124 Water and Fluid Balance, 207 Summary, 126 All About Body Water, 208 Aerobic and Anaerobic Metabolism, 127 How Exercise Impacts Metabolism, 128 Muscle Structure and Function, 130 Muscle Energy Requirements, 133 Physiology of Anaerobic Exercise, 136 Minerals, 193 Fluid Balance, 211 Body Water Imbalances, 214 Body Water Regulation, 218 Electrolytes, 220 Hydration Strategies, 220 Summary, 224 Physiology of Aerobic Exercise, 138 Special Needs, 225 Adaptation to Exercise, 139 Sport Nutrition, 227 Summary, 146 Nutrition for Injury and Rehabilitation, 232 The Macronutrients, 147 Plant-Based Diets, 239 Carbohydrate Structure, 149 Carbohydrate Digestion, Absorption, Metabolism, and Transport, 150 Eating Disorders, 243 Nutrition and Diabetes, 246 Nutrition and Cardiovascular Disease, 250 Carbohydrates in the Diet, 155 Nutrition and Pregnancy, 257 Fat Structure, 157 Summary, 260 Fat Digestion, Absorption, Metabolism, and Transport, 158 Fat in the Diet, 158 Protein Structure, 166 Protein Digestion, Absorption, Metabolism, and Transport, 168 Protein in the Diet, 171 Summary, 175 Section II: Nutritional Practice Step 1: Preparing For Your Client, 261 What It Means to Be a Good Coach, 266 Understanding the Potential Client’s Mindset, 270 Step 3: Evaluating Client Information and Explaining What It Means, 307 Physical Activity Readiness Questionnaire, 308 Understanding Your Client’s Goals, 272 Medical History and Present Medical Condition Questionnaire, 309 Overcoming Client Objections, 276 Comprehensive Client Information Sheet, 309 What You Should Know and What Your Clients Should Know, 278 Three-Day Dietary Record, 322 Summary, 280 Step 2: Collecting Preliminary Client Information, 277 Physical Activity Readiness Questionnaire, 280 Medical History and Present Medical Condition Questionnaire, 281 Readiness for Change, Kitchen Makeover, and Social Support Questionnaires, 323 Assessments, 324 Determining Your Client’s Level, 325 Communicating Results with Clients, 326 Summary, 328 Three-Day Dietary Record, 287 Step 4: Offering Nutritional Suggestions and Providing a Nutrition Plan, 329 Readiness for Change Questionnaire, 291 USDA Food Pyramid, 331 Kitchen Makeover Questionnaire, 293 Habit- and Superfood-Based Nutrition, 335 Social Support Questionnaire, 295 Individualization, 346 Initial Body Composition Assessment, 297 Special Dietary Strategies, 351 Initial Recovery Assessment, 299 Pre-, During-, and Post-Workout Nutrition, 360 Initial Performance Assessment, 301 Competition Days, 361 Baseline Blood Chemistry Assessment, 302 When to Discuss Nutrition, 362 Baseline Visual Assessment, 302 Summary, 364 Comprehensive Client Information Sheet, 284 Summary, 306 Step 5: Offering Nutritional Supplement Suggestions, 365 Step 8: Providing Continuing Education and Support, 433 When to Suggest Supplements, 366 The Big Picture, 435 Supplement Categories, 369 Celebrating Client Successes, 435 Supplements in Sport, 371 Creating New Social Support Circles, 436 Supplement Risks Versus Rewards, 373 Lesson Plan 1: Grocery Shopping Tour, 439 Five Staple Supplements, 374 Lesson Plan 2: Kitchen Makeover, 441 Nonessential Nutrient Supplements, 374 Lesson Plan 3: The Sugar Lesson, 443 Summary, 380 Lesson Plan 4: The Fruit and Veggie Lesson, 446 Step 6: Setting Behavior Goals and Creating Monitoring Strategies, 381 Lesson Plan 5: The Fat Lesson, 449 Goal-Setting and Managing Expectations, 383 Lesson Plan 6: From North American to Nutritious, 451 Compliance and Adherence, 389 Lesson Plan 7: Eating on the Go, 453 Monitoring Strategies and Assessments, 390 The Assessments, 391 Lesson Plan 8: Understanding Energy Balance, 454 Follow-Up Body Composition Assessments, 395 Summary, 456 Follow-Up Visual Assessments, 395 Appendixes, 457 Follow-Up Performance Assessment, 396 Follow-Up Blood Chemistry Assessment, 396 Glossary, 465 Summary, 400 References, 479 Step 7: Making Nutritional Adjustments, 401 The Outcome-Based Coach, 402 Judging Your Client’s Progress, 403 Improving Client Adherence, 404 Making Program Changes, 414 Improving Your Troubleshooting Skills, 420 The Decision-Making Chart, 414 More Advanced Troubleshooting Scenarios, 420 Summary, 432 Introduction at a Glance Nutrition as a Limiting Factor; page 2 Good Nutrition Defined; page 4 How You Can Help Clients Improve Their Nutrition; page 11 Your Scope of Practice; page 12 Applying Nutrition Technologies; page 15 Summary; page 18 What You’ll Learn In this unit, you’ll learn how important a good nutritional intake is to overall physiological function as well as to the body transformation process. Specifically, through understanding the definition of good nutrition, you’ll not only be able to better help your clients improve their daily food intake, you’ll be better able to help them improve their lives. In addition to being better able to define good nutrition, by the end of this unit, you’ll better understand your scope of practice when it comes to making nutritional recommendations. In understanding what you can and cannot recommend, you can shape your coaching strategy to include both sound training advice and the systematic application of nutrition technologies. INTRODUCTION: WHAT IS GOOD NUTRITION? International Sports Sciences Association 2 Key Terms limiting factor positive energy balance genetics negative energy balance energy balance calorie density nutrient density satiation health ergogenic body composition social-support system performance cross-referral system outcome-based Medical Nutrition Therapy laws of thermodynamics NUTRITION AS A LIMITING FACTOR limiting factor: A limiting factor is anything that makes it more difficult for a client to achieve optimal results. To really achieve great results with a client, you only need to master one crucial skill: the ability to find your client’s limiting factors and remove them. That one skill will take you from being a good coach to being a great coach. From a student to a master. That one skill alone will generate more business than you can handle and produce better results than you ever thought possible. Find their weakness. Find what’s holding them back. Find what’s keeping them from succeeding. And fix THAT. Now, when it comes to specific limiting factors, there can be a lot of them. More, in fact, than we could likely cover individually in this manual. After all, there are lots of people out there with lots of different genotypes, lots of different lifestyles, and lots of different ideas about what’s good for them and what’s not. However, if you look at people’s limiting factors in terms of their ability to be healthy, to lose fat, and to gain muscle, there are really only three “big picture” limits: 1) their genetic makeup, 2) their physical activity patterns, and 3) their nutritional habits. Everything else really just falls into one of these three categories, doesn’t it? genetics: The specific, inherited genetic code of an organism. An organism’s genetics influence what they become. However, environment plays a key role in the expression of an organism’s genetic code. So let’s begin by talking genetics—specifically, is your client’s limiting factor genetics? Well, to be honest, I seriously doubt it. Out of the thousands of people I’ve worked with over the years, I can’t remember a single one that couldn’t improve in some very significant ways, despite their genetics. Let’s face it; few people will ever come close to realizing their genetic potential when it comes to health and fitness. So it’s a huge mistake to assume that your clients are standing on the brink of their upper limit, genetically. Sure, we’ve got to be realistic here. Each of us has certain limitations, indeed. For instance, some of your clients may not be equipped to play quarterback for WHAT IS GOOD NUTRITION? INTRODUCTION the Patriots, play center for the Lakers, or win the Tour de France. In other words, they may not have the genetic makeup to reach the upper limits of human performance. But, with the right advice, and despite their genetics, they can improve their health, lose fat, and/or gain muscle. In ten years of working with people of all stripes, from office managers to elite athletes, I’ve yet to see a single case where we couldn’t make significant body composition changes. And with these changes almost always come improvements in health profile and performance. Let’s now turn to exercise—specifically, is your client’s limiting factor their physical activity pattern? Well, maybe, especially if an individual is completely sedentary. Indeed, if their daily activity involves nothing more than moving from one piece of furniture to another, their exercise habits (or lack thereof) probably represent one of their limiting factors. Getting more fit, getting leaner, improving health, and looking good naked all require both an active lifestyle as well as a commitment to engaging in purposeful, intense exercise. Make no mistake about it— if a client sits at a desk all day and then goes home to sit some more, they’re probably on the fast track to metabolic decline, fat gain, muscle loss, and lifestylerelated disease. They just don’t take enough steps in a single day. Indeed, when the number of steps people take per day is measured, those taking under 5,000 steps are considered sedentary and at higher risk for early death, disease, and being overweight. On the other hand, those taking 10,000 steps are considered active and have lower body weights, body fat, and improved health. Further, when people bump up their level of this type of basic physical movement, in conjunction with doing at least three hours of purposeful, high-intensity exercise per week, the magic starts to happen. However, don’t get the wrong idea. Exercise isn’t usually enough. As I’ve seen time and time again with clients, and as research at major universities is starting to prove, even with the best exercise program, many clients lag behind because of a different limiting factor. To drive home this point, I’d like to share with you the results from a recent study. In this study, overweight participants were either assigned to a control group for 16 weeks (where they didn’t exercise at all) or an exercise group for 16 weeks (where they exercised for three hours per week performing strength exercise with an Olympic weightlifting coach, and spent two hours per week performing circuit training with a group exercise instructor). During this time, body composition and a host of other measures were collected. So, what were the results? Well, as you might have expected, the exercise group did get better results than the control group; but these results were embarrassingly unimpressive. Check it out: Control Group: gained 1 pound of lean mass, lost 0.5 pound of fat, and lost 0.5% body fat Exercise Group: gained 3 pounds of lean mass, lost 2 pounds of fat, and lost 1.5% body fat Again, it’s obvious that the exercise group did better and that the exercise helped a bit. However, if I were your client, and I had paid $4000-$8000 for 80 training sessions (5 sessions per week for 16 weeks), and I left having lost only two pounds of fat after four months, I’d probably demand my money back and your head on a platter. Seriously, is this what we expect our clients to put up with? They come to us overweight and unhealthy, and after months of time, effort, and large amounts of money, they leave only slightly less overweight and unhealthy. If I were in the client’s position, I would have rather: a) sat at home on my arse, b) read more books, c) learned to play the guitar, d) learned to speak French, or done any number of other things rather than waste my 80 hours and 4-8K on two measly pounds of fat loss! OK, I’ll be honest; I’m exaggerating my indignation here . . . but just a little . . . and only so I can drive home the point. And the point is that purposeful exercise alone, while marginally better than nothing, never seems to produce the results that purposeful exercise plus increased general physical activity (i.e., more steps) plus nutritional control can produce. That leads us to the next, and biggest, limiting factor your clients face . . . their nutritional habits. People who are overweight and unhealthy, with too little muscle and too much fat, usually have a few 3 International Sports Sciences Association 4 problems. They probably move too little and eat too much (or at least, too much of the wrong stuff). As discussed above, you should absolutely get them moving more; that’s a prerequisite. But, as also discussed, getting them to move more for three, four, or five hours per week isn’t usually enough. If this is true (and it is), their real limiting factor must lie beyond their exercise. It’s not their genes. It’s not their training program. It’s what they’re eating—and sometimes more importantly, what they’re not eating. Their limiting factor is their nutritional habits. energy balance: The relationship between all sources of energy intake and energy output. An organism is said to be in energy balance when energy flow into the body and out of the body is equal. This is often evidenced by a stable body weight. Whether your client wants to gain muscle, lose fat, live healthily, or even compete at the highest levels of sport, the limiting factor is almost always nutrition. Poor nutrition is what holds clients back. And good nutrition is what will move them forward. Good nutrition is what will feed muscle and shed fat. It’s what will improve nearly every measurable health marker. It’s what will drastically improve recovery and mood so they can exercise—whether it’s purposeful or just part of their daily lifestyle—harder, longer, and more frequently. Good nutrition is what will get them the body they never thought they could have. nutrient density: Foods that provide substantial amounts of nutrients with only the necessary calories. GOOD NUTRITION DEFINED health: Health can and should be assessed through a number of medical tests, including blood assessments, cardiovascular tests, and other screening modalities. body composition: Body composition is the relative relationship between lean body mass (which includes bone mass, body water, muscle mass, and organ mass) and fat mass (which includes adipose tissue and intra-tissue fat deposits). performance: Performance means functioning or operating; high performance means functioning or operating on a high level. Each of us is asked to perform on a daily basis, regardless of whether we’re an athlete or not. outcome-based: Basing nutritional decisions on specific, measurable outcomes rather than nebulous definitions of what’s “good” or “correct.” At this point I hope you’re convinced of the importance of good nutrition since this entire course is devoted to teaching you exactly what good nutrition is and how to help your clients eliminate poor nutrition as a limiting factor. Of course, to begin with, it’s important to have a working definition of the concept of “good nutrition.” This phrase may mean different things to different people, and if you ask a hundred different people what “good” or “healthy” eating means, you’ll likely get a hundred different answers! Some think good nutrition means eating fewer sugary desserts. Others think it means eating more fruits and vegetables. Others think it means eating less meat. Others think it means eating fewer carbs. And then there’s the often cited and common sensical idea of the “balanced diet.” Sure, most of the definitions you’ll hear are simple and easy to remember. Yet most of them will be incomplete, and some of them will be flat-out wrong. So, in this course, it’s our goal to help reprogram your brain when it comes to nutrition. It’s our goal to help you dump out all the ridiculous, oversimplified, often erroneous media mythology you’ve been exposed to in order to make some room for the right info. It’s our goal to help you understand how to judge the “goodness” of a nutrition plan. And, to begin, we’ll start with four important criteria that all good nutrition plans must meet. 1. Good nutrition properly controls energy balance 2. Good nutrition provides nutrient density 3. Good nutrition achieves health, body composition, and performance goals 4. Good nutrition is honest and outcome-based Let’s now discuss each of these more specifically. WHAT IS GOOD NUTRITION? INTRODUCTION GOOD NUTRITION AND ENERGY BALANCE The phrase “energy balance” represents the relationship between “energy in” (food calories taken into the body through food and drink) and “energy out” (calories being used in the body for our daily energy requirements). It’s this relationship, defined by the laws of thermodynamics, that dictates whether weight is lost, gained, or remains the same. However, there’s a lot more to energy balance than its physical manifestation in weight change. Energy balance also has a lot to do with what’s going on in your cells. As you continue reading this manual, you’ll learn more about what’s happening in your body on the cellular level. And you’ll see that both when you’re in a positive energy balance (more in than out) and when you’re in a negative energy balance (more out than in), everything from your metabolism, to your hormonal balance, to your mood is impacted. Indeed, in a study looking at military recruits, severe negative energy balance led to massive metabolic decline, reductions in thyroid hormone production, reductions in testosterone levels, an inability to concentrate, and a huge reduction in physical performance. The same is true of anorexics. They lose physical fitness, metabolic fitness, mental fitness, bone mass, and muscle mass. Doesn’t a negative energy balance lead to weight loss? Of course! An intense negative energy balance leads does lead to weight loss. But so does getting thrown in a prison camp or living in an impoverished village without adequate food. And that’s exactly what our body perceives when we impose a large negative energy balance. It thinks it’s starving, so it slows down or shuts down all laws of thermodynamics: The laws of thermodynamics describe the specific principles that govern energy exchange including heat exchange and the performance of work. positive energy balance: An organism is in positive energy balance when energy flow into the body exceeds energy flow out of the body. This is often evidenced by an increasing body weight. negative energy balance: An organism is in negative energy balance when energy flow out of the body exceeds energy flow into the body. This is often evidenced by a decreasing body weight. 5 International Sports Sciences Association 6 Figure I.1 Stable weight requires a balanced relationship between energy in and energy out, in the form of calories. non-survival functions including reproductive function, metabolic function, brain function, and more. Of course, on the other hand, we’ve got positive energy balance and its consequences. Overfeeding (and/or under exercising) has its own host of repercussions not only in terms of weight gain but in terms of health and cellular fitness. With too much overfeeding, plaques can build up in our arteries, blood pressure can increase, blood cholesterol can increase, we can become insulin resistant and begin to suffer from diabetes, we can increase our risk for certain cancers, and the list goes on. So, in the end, the take home point here is that good nutrition programs help to properly control energy balance. When properly controlled, excessive swings in either direction (positive or negative) are prevented and the body can either lose fat or gain lean mass in a healthy way. GOOD NUTRITION AND NUTRIENT DENSITY Another criterion for a good nutrition plan is that it provides a high level of nutrient density. Nutrient density is defined as the ratio of nutrients (vitamins, minerals, fiber, etc.) relative to the total calorie content in a food. Therefore, a food with a high nutrient WHAT IS GOOD NUTRITION? INTRODUCTION density contains a large amount of key nutrients (i.e., protein, iron, zinc, Bvitamins, etc.) per 100 calories of food. Examples of foods with a high nutrient density include: a) bright or deeply colored vegetables, b) bright or deeply colored fruits, c) high fiber, unprocessed grains, and d) lean meats. Examples of foods with a low nutrient density include: a) table sugar, b) soda, c) white flour, and d) ice cream. In contrast to nutrient density, we have calorie density. Calorie density is defined as the ratio of calories (which are merely units of potential energy in food) to the actual weight of a food. Therefore a food with high calorie density would have a lot of calories per 100 grams of food, while a food with low calorie density would have few calories per 100 grams of food. Examples of foods with a high calorie density include: a) cookies, b) crackers, c) butter, and d) bacon. Examples of foods with a low calorie density include: a) fresh vegetables, b) broth based soups, c) fresh fruits, and d) chicken breast. calorie density: The ratio of calories to the actual weight of food. As you might imagine, the best combination of nutrient and calorie density for improving health and promoting fat loss is a diet high in nutrient dense foods (a lot of nutrients per calorie) and low in calorie dense foods (few calories per gram of food weight). Such a diet would promote the following benefits: • Easily controlled calorie intake (without calorie counting) • Longer periods of satiation after meals satiation: Pleasantly fed to satisfaction. • Difficulty overeating • A higher total essential nutrient intake • More essential nutrients per volume food Also note that if someone is interested in weight or muscle gain, the recommendation above might be altered in favor of high nutrient dense, high calorie dense foods. This would allow for increases in both nutrient intake and calorie intake, both essential for gains in lean mass and total body weight. Table I.1 Key nutrients found per 100 calories of sample foods. The higher the nutrient value per 100 calories, the more nutrient dense the food. The lower the nutrient value, the less nutrient dense the food. Food Protein Fiber Iron Zinc Thiamin Riboflavin Niacin B6 B12 Spinach 14g 10g 12.5mg 2.5mg 0.4mg 0.9mg 3.3mg 0.9mg — Lean Beef 14g — 1.4mg 3.2mg 0.1mg 0.1mg 1.9mg 0.1mg 1.2mg Bagel 3.8g 2.2g 1.3mg 0.3mg 0.2mg 0.1mg 1.7mg 0.1mg — Low Fat Milk 6.7g — 0.1mg 0.8mg 0.1mg 0.3mg 0.2mg 0.1mg 0.7mg Soda 0.1g — 0.1mg — — — — — — 7 International Sports Sciences Association 8 GOOD NUTRITION AND YOUR GOALS As I hinted above, good nutrition is about more than weight loss or gain. Weight loss and gain are just transient indicators of energy balance since energy balance and weight can change from one day to the next. Therefore, finding a long-term set of dietary habits should be based on the intersection of the following three goals: 1. Improved body composition 2. Improved health 3. Improved performance Yes, a large majority of your clients are working out with aesthetics in mind. They want to lose fat, gain muscle, achieve a flat stomach, and generally look great naked. Often, as a result of these strong motivators, they can easily be lured into a world of powerful drugs, invasive and risky surgeries, and ridiculous crash diets. Yet these strategies, while sometimes improving the way your clients look in the mirror temporarily, can sacrifice the clients’ health and well-being in the long run. So rather than focusing soley on body composition as an outcome, it’s incumbent on you to also focus on improving a client’s health and performance as well. Therefore, the strategies you employ should be those that also act to reduce blood lipids, increase insulin sensitivity, reduce diabetes risk, increase good cholesterol, reduce body fat percentage, and increase lean body mass. In addition to boosting health and body composition, recommendations should also be in place to help your clients improve performance, regardless of whether they’re elite athletes or people who only watch such athletes on TV. This means targeting everything from improved energy levels, stamina, and the like to working toward improvements in athletic performance at the elite, world-class level; it all depends on your client’s goals and activities. ergogenic: Physical or mental performance-enhancing strategies. While there is a lot of overlap here—for example, if someone begins to look better, they should also begin to feel better and perform better—the overlap isn’t all-inclusive. As mentioned above, some plans help folks lose weight in a hurry while sacrificing their health and performance. Similarly, there are a lot of programs out there that cater to the “I just want to be healthy” market. And while some of these approaches (calorie restriction, the avoidance of certain foods, and high doses of certain vitamins, for instance) can improve one or two indicators of health, many actually degrade a host of other health markers. Finally, there are a lot of programs out there designed to improve performance but that include such components as powerful ergogenic (performance-enhancing) drugs, crash dieting, diuretics to shed weight for competition, unresearched nutritional supplements, and more. And while these approaches might improve performance acutely, they often lead to a degrada- WHAT IS GOOD NUTRITION? INTRODUCTION Performance Health Body Composition Figure I.2 Good nutrition resides in the intersection between health, performance, and body composition. tion of health, something counterproductive to long-term performance. In the end, I hope you can see that a strict focus on any one of the goals above, to the exclusion of the others, can lead to problems. In other words, an excessively single-minded focus on “performance” or “weight loss” or “health” might, in some cases, actually produce negative, long-term consequences. And it’s your job to prevent this type of “coaching gone bad.” Your focus should be on a nutrition plan that improves the way your clients look, improves the way they feel, and improves the way they perform. To ensure you stay on track, a host of metrics (questionnaires and assessments) are provided later on in this manual. These metrics will help you keep an eye on each of these three important variables, making sure that each area is looked after properly. GOOD NUTRITION IS HONEST AND OUTCOME-BASED While we know that good nutrition controls energy balance, boosts nutrient intake, and targets health goals, body composition goals, and performance goals, we must also be honest about whether or not it hits the mark. After all, how many times have you heard the following: “I eat really well, but . . . I’m still 20 pounds overweight.” “My diet is perfect, but . . . I often feel sluggish and have a low level of energy.” “I make good nutritional choices, but . . . I’ve got high blood pressure, high cholesterol, and type II diabetes.” 9 International Sports Sciences Association 10 Table I.2 Food Group Servings: Perceived, Average Daily Consumed, and Recommended by Age Group Grains Females 19-24 Perceived 3.2 Consumed 4.2 Females 25-50 Perceived 2.9 Consumed 4.6 Females 51+ Perceived 2.5 Consumed 4.7 Males 19-24 Perceived 2.9 Consumed 5.5 Males 25-50 Perceived 2.9 Consumed 5.9 Males 51+ Perceived 2.7 Consumed 6.2 Other Fruits Vegetables Milk Meat, etc. 2.6 0.8 2.6 1.7 3.2 1.2 3.5 1.6 2.2 3.0 2.2 0.8 2.5 2 2.3 1.0 3.0 1.7 2.1 3.2 2.4 1.5 2.6 2.2 2.1 1.0 2.7 1.7 1.6 3.1 2.1 0.6 2.2 2.3 3.1 1.6 3.7 2.3 2.1 4.1 2.2 0.9 2.4 2.5 2.2 1.2 3.4 2.5 2.1 4.0 2.2 1.3 2.5 2.7 2.1 1.1 3.1 2.4 1.7 4.5 (fats, oils, sweets) * Recommended servings based on energy RDA for gender/age groups. BASIOTIS, PP AND LINO, MARK. “CONSUMPTION OF FOOD GROUP SERVINGS: PEOPLE’S PERCEPTIONS VS. REALITY.” NUTRITION INSIGHTS 20 (2000) Is it possible that someone can eat really well and have a “perfect” diet yet be overweight, low in energy, and have a host of lifestyle-related diseases? Sure, it’s possible, but it’s not likely. In other words, most people who believe they’re doing a good job, yet don’t have the physique or the health profiles to show for it, simply aren’t. They either have a good plan that they’re not executing. Or their plan isn’t very good. Of course, as someone committed to finding limiting factors and removing them, it’s your job to help your clients improve both their plan and their execution. So make sure that you help your clients remain honest and outcome-based in their approach. Table I.2 is a great example of how, psychologically, we can be dishonest with ourselves, whether we intend to be so or not. In the table, a research study is described in which researchers compared how many servings of each of the major food groups study participants thought they had eaten each day (perceived) and how many servings of the major food groups they actually ate (consumed). Notice how people in every age group erroneously reported their intake. Indeed, their perceptions did not always reflect reality. In reviewing these data, it’s clear that in all age categories, both men and women ate more grains, fats, oils, and sweets than they thought they had eaten. They also ate less fruits, veggies, milk, and meat than WHAT IS GOOD NUTRITION? INTRODUCTION they thought they had eaten. In other words, they ate more carbs, fat, and junk food than they thought, while eating less protein, fruits, and vegetables than they thought. Now, I doubt these people were trying to be dishonest with their food records. Rather, I believe this study points out a common phenomenon. People simply don’t have a good idea of what their dietary intake really looks like unless they take the steps to record it accurately. And, for you, the personal trainer, this points to an important lesson. If you’re going to help a client improve their nutrition, you have to provide them with the right tools that force them to be accurate and honest in their nutritional assessment. (These tools will be provided in Section II). In addition to honesty, good nutrition also requires results, plain and simple. If one of your clients think he’s doing a good job yet has no results to show for his efforts, how effective is the job he’s doing? Not very. And this is where we see the significance of outcome-based nutrition. The effectiveness of a client’s nutrition plan is judged by evaluating what happens when your client follows it. So, in an outcome-based world, theory is meaningless, and results are everything. Your client shouldn’t believe he’s doing a good job based on what he has read in the papers, what he has read in magazines, what he has seen on TV, etc. He can only judge his plan based on the results his diet consistently produces. To this end, good nutrition equals results. HOW YOU CAN HELP CLIENTS IMPROVE THEIR NUTRITION Now that you know what good nutrition is, it’s important to also know that you’ll likely be asked to help clients make nutritional changes. After all, as a trainer, you occupy an important space within the health care industry and, accordingly, have a large set of responsibilities. For starters, you’re likely the primary health, body composition, and performance access point for your clients. In other words, they may not regularly see a physician or other health care provider to get information on these subjects. Or, if they do, this health care provider may not be equipped to dispense practical advice for preventative health measures, body composition change, or performance improvement. As a result, your client will turn to you for answers in each of these domains. If you’re prepared for this, that’s great. If not, your client may seek help elsewhere, and both a client and an opportunity may be lost. In addition, you may also become your client’s social-support system. Many new, or even long-term, clients won’t have friends and family committed to helping them improve their exercise and nutrition choices. In fact, those around them may be either uninterested or antagonistic to their lifestyle changes. And as a result, again, they’ll be turning to you for support. Although this places a large amount of responsibility on you to act as a trainer, an educator, and a friend/mentor, it also provides you with a real opportunity to help social-support system: A network of individuals that provides positive feedback, constructive criticism, and encouragement toward our lifestyle choices. 11 International Sports Sciences Association 12 your clients in a big way. In gaining a client’s trust this way, the advice and support you give can quite literally change their life. Here are two things that will help you prepare for this responsibility: 1. Keep Up-To-Date. It’s incumbent upon you as a trainer to be prepared for servicing your clients’ needs by keeping up-to-date on reliable information pertaining to exercise, nutrition, supplements, and health in general. Of course, it’s impossible to have a high level of specialty knowledge in each area. However, that’s not required; a working knowledge should be sufficient. cross-referral system: A system in which two health and fitness professionals actively recommend each other’s synergistic services to their own clients and patients. For example, a physician and a personal trainer would have just cause in setting up a cross-referral system since each possesses an exclusive knowledge set. 2. Establish a Network. 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. YOUR SCOPE OF PRACTICE Trainers are often asked by their clients to talk about exercise, nutrition, supplements, and more, yet they’re often unsure of what they should and shouldn’t talk about. As a qualified trainer, you likely possess a fundamental knowledge of human anatomy and physiology. And given your choice of profession, you’ve likely committed yourself to doing what you can to help clients improve their health, body composition, and performance. Your experience tells you that nutrition and training go hand-in-hand and that results come only when both are improved. So I have no doubt that you want to talk about both areas with your clients. However, it’s possible that employers, dietitians, and other health-care practitioners have discouraged you from discussing nutrition as it relates to your clients’ goals. Perhaps you’ve even been told that it’s illegal to talk about nutrition with clients. Well, that’s not exactly the case. Although each state and province in North America has different rules for dispensing nutrition advice, in most states it’s well within the scope of practice for personal trainers who possess fundamental nutrition knowledge to address questions and concerns their clients may have. Notice I emphasize the “fundamental knowledge” part. With specific training, such as that provided in this course, you’ll possess that knowledge and be better able to discuss nutrition with clients. Medical Nutrition Therapy: Nutritional advice with the purpose of treating a variety of conditions and illnesses. Providing MNT is the exclusive domain of trained and licenses nutrition professionals. Of course, it is true that the domain of the personal trainer is limited with respect to nutrition. Technically, in many North American states and provinces, anyone can make general nutritional suggestions. However offering Medical Nutrition Therapy (i.e., prescribing nutrition for a variety of health conditions and illnesses) is another story. For example, certain states have statutes that include an explicitly defined scope of practice. In these states, performance of the profession (Medical Nutrition Therapy) is illegal without first obtaining the dietitian credential WHAT IS GOOD NUTRITION? INTRODUCTION Many states have regulations that govern nutritional counseling. Familiarize yourself with the statutes in your state. and then applying for a license from the state. These states include: Alabama, Alaska, Arkansas, California, District of Columbia, Florida, Georgia, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Mississippi, Montana, Nebraska, New Hampshire, New Mexico, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, and West Virginia. It should be noted that in these states it’s perfectly legal for you to make nutritional suggestions for healthy, active individuals. It’s also legal for anyone to share nutrition education through materials that originate from a public or well-know entity such as the American Heart Association, the Centers for Disease Control and Prevention, the American College of Nutrition, the ISSA, etc. It’s only illegal to prescribe nutrition for medical conditions unless you’re a licensed dietitian. Others states have statutes that limit the use of titles such as “licensed dietitian,” “certified dietitian,” or “certified nutritionist.” Yet these states do not necessarily limit the practice of making nutritional prescriptions. These states include: Connecticut, Deleware, Hawaii, Indiana, Nevada, New York, Oregon, Utah, Vermont, Virginia, Washington, and Wisconsin. In these states the laws are more liberal, allowing for those without dietetics licensure to offer specific nutrition recommendations as long as they’re certified in nutrition and registered with the state as certified. In analyzing these definitions, the differences between “general nutritional suggestions” and Medical Nutrition Therapy aren’t always apparent. After all, what’s the difference between a co-worker giving some general tips on weight loss for cholesterol reduction and a personal trainer giving the same tips in between sets of squats? And what’s the 13 International Sports Sciences Association 14 difference between recommending certain breakfast foods for general good health in a type II diabetic and recommending the same breakfast foods for controlling blood sugar? Well, in the case of gray areas, the decision is made by the state, so it’s best to check your state’s laws, rules, and regulations regarding nutritional recommendations. Now, in plain language, I’ll be completely candid here. The likelihood of a trainer’s getting in trouble for making general nutritional suggestions to otherwise healthy clients is low. And this is why the best trainers, those with nutrition continuing education credits such as those obtained in this course, often make suggestions related to optimal rest, hydration, and food intake. Such topics directly relate to gym performance and usually include recommendations for adequate sleep (7 to 9 hours per night), adequate hydration (6 to 12, eight-ounce cups per day), preworkout nutrition (a light meal within an hour or so of training), and post-workout nutrition (usually some protein and carbohydrate nutrition). Further, trainers often make suggestions to support in-thegym weight loss and muscle-gain efforts, providing ideas or education on the following topics: 1. Calorie management strategies such as eating less, eating more filling foods, avoiding calorie-dense drinks and snacks, etc. 2. Good food selection strategies such as choosing whole grains over processed carbs, choosing complete protein sources, choosing water over pop, etc. 3. Good food timing strategies such as eating in and around the workout, eating breakfast, not eating a large meal right before bed, etc. 4. Suppplement suggestions/information such as which vitamins, minerals, and other essential nutrients (protein, fat, etc.) may be useful 5. Healthy lifestyle choices such as meal options for breakfast, lunch, and dinner, alternative snack suggestions, and planning for upcoming social events Again, in most cases giving general advice on these topics is acceptable. However, it’s also important to recognize that there are many nutritional issues that fall outside the scope of practice. For example, giving nutrition advice for health problems such as diabetes, heart disease, liver dysfunction, kidney stones, etc., is definitely the domain of registered dietitians and medical practitioners, as is giving advice for eating disorders such as anorexia and bulimia. Giving this type of advice—again, Medical Nutrition Therapy—is well beyond the scope of the personal trainer’s practice (and likely expertise) and certainly goes against the regulations of many states. This is why every trainer should know when to refer, whom to refer to, and how to refer. I suggest developing a relationship with a qualified local nutrition partner (a dietitian who is also certified in sport nutrition) to refer clients to when necessary. In the end, your level of nutritional discussion with clients will likely be based on the following: 1. Your particular state or province’s regulations Most states do allow you to address client questions and concerns with respect to nutritional advice although different states have different regulations. 2. Your client’s likelihood of working with both you and a nutritionist If your client has the means to work with both you and a dietitian also trained in sports nutrition*, this is likely your best bet as long as you trust the dietitian’s advice. If not, you may want to talk about nutrition with your clients as long as you stay within your scope of practice. 3. Your client’s health If your client has health problems or specific nutrition-related diseases, it’s best to refer them to a licensed dietitian also trained in sports nutrition* as long as you trust the dietitian’s advice. There should never be a time when you, as a personal trainer, offer Medical Nutrition Therapy. * To find a Registered Dietitian in your area, visit www.eatright.org. To find a Sports Dietitian in your area, visit www.scandpg.org. And to find a Sports Specific Nutritionist, go to www.theissn.org. WHAT IS GOOD NUTRITION? INTRODUCTION APPLYING NUTRITION TECHNOLOGIES Although most trainers that dispense nutrition suggestions do so in and around workout sessions, this is never the ideal time to talk about nutrition. Can you imagine trying to listen to, process, and absorb new information before, during, or after a tough workout? This is definitely not the best learning environment, is it? Yet even good trainers often make the mistake of trying to deliver important nutritional information in this context. A better model for making nutritional suggestions is the one nutrition professionals use, the one you’ll learn more about in this course. This systematic coaching process is all about talking nutrition when clients are most receptive to learning, during separate nutrition sessions, which, of course, you can bill for as if they were regular training sessions. It’s during these sessions that the client will be ready to share and receive nutritional information. The 8 Steps to Effective Nutrition Coaching Step 1: Prepare for the client Step 2: Collect preliminary client information Step 3: Evaluate client information and explain what it means Step 4: Offer nutritional suggestions and provide nutrition plan Step 5: Offer nutritional supplement suggestions Step 6: Set behavior goals and create monitoring strategies Step 7: Make nutritional adjustments based on client results Step 8: Provide continuing education and support The eight steps outlined above represent a logical system of interacting with clients—from preparation for the first meeting to continuing education and support. They help systematize the coaching process so that every client gets the attention, education, and support they deserve. During this course you’ll learn about each step and be provided with tools that ensure a successful coaching environment. THE PURPOSE OF THIS COURSE So what can you hope to get out of this course? Well, first, the course is designed to help you dispel common myths and fallacies associated with nutrition. It’s designed to prepare you for talking about nutrition with your clients by establishing the knowledge base necessary make general nutritional recommendations, recommendations that support healthy eating behaviors in 15 International Sports Sciences Association 16 your clients. Finally, it is designed to teach you the practical, step-by-step approach sports nutritionists use to get optimal results. To this end, in addition to a descriptive treatment of nutrition, we’ll walk you through the actual steps sports nutrition practitioners use to prepare for, evaluate, and make recommendations for clients. As you work your way through the course, you’ll find that each step is accompanied by the sub-steps, descriptions, tables, and summary charts required to implement each step. And in the end, you should walk away from this course with both a better understanding of exercise nutrition and with a complete understanding of the tools used in systematically delivering detailed nutritional recommendations. It is important, though, to note that successful completion of the course examination will not qualify you as a registered dietitian, licensed dietitian, or licensed nutritionist. (Each state has individual rules and regulations about nutrition licensure; check with your particular state to ensure you are following legal protocol.) Nor will this course allow you to provide nutrition therapy. Instead, this course will provide you with continuing education in the field of nutrition. It will enhance your credibility and your skill set. And it will help you overcome the biggest limiting factor your clients face day-in and dayout—poor nutrition. Food for Thought In my years of coaching clients, I’ve had a host of them enter my practice with “diet experience.” Some have followed low-carb diets (similar to The Atkins Diet). Others have followed low-fat diets (similar to the Ornish Diet). And others have followed more “balanced” plans (similar to the Zone Diet). Even more interestingly, I had one client follow all three plans at one point or another and, in conjunction with exercise, achieve similar weight loss results with each of the three plans! Unfortunately, despite the divergent diet philosophies and consistent weight loss, his end result was always the same; he regained the weight (and then some) before trying the next diet. So, we’ve got three wildly different plans and successful weight loss with each one. Some would ask the question, “How can this be?” I would ask the question, “Are these plans so different after all?” You see, instead of focusing on the differences between three strategies that achieve the WHAT IS GOOD NUTRITION? INTRODUCTION same result, I think it’s more important to focus on the similarities. Indeed, perhaps the differences aren’t all that important, and the results lie in the similarities. So, what are the similarities? Well, the biggest one, the reason why my client got results with a low carb diet, a low fat diet, and a balanced macronutrient diet, is the fact that all three plans forced him to follow the first rule of good nutrition. All three plans, in conjunction with his exercise plan, forced him to control his energy balance. You might recall that it takes a negative energy balance to achieve weight loss. And if someone achieves successful weight loss with each of these plans discussed here, it must be due to the negative energy balance, not the lack of carbs or the reduction of fat or a specific macronutrient ratio. So how do all three create a negative energy balance? Here’s how: 1. The very process of following a weight loss plan tends to reduce calorie intake, helping decrease “energy in” and helping to shift the body toward a more negative energy balance. 2. Exercise programs also help to contribute to the negative energy balance by helping to increase “energy out.” 3. The Atkins and Ornish plans require dieters to restrict their intake of either dietary carbohydrate or dietary fat. And the Zone plan requires creating specific ratios of these macronutrients—ratios which lead to eating less total food. I hope it’s now evident why my client had weight-loss success with the Atkins, Ornish, and Zone plans. It was the negative energy balance that led to his short-term results, not some magical, mythical macronutrient mix. However, it’s also important to remember that all three experiments ultimately failed; this guy had rebound weight gain each time. And this weight gain was a result of several nonfood-related limiting factors. After giving up, he got offtrack, stopped exercising, and started eating poorly again. However, it wasn’t the food that caused this—it was a host of lifestyle problems that triggered the relapse. Indeed, it was only when, working with my team, he addressed these factors that he changed his fundamental habits, and he lost his excess body fat for good. 17 International Sports Sciences Association 18 SUMMARY 1. The best trainers are set apart by their unique ability to find limiting factors in their client’s progress and eliminate them. 2. Frequently, nutritional intake is the limiting factor for clients. 3. To help a client improve their nutrition, it’s important to understand that good nutrition is based on: a) controlling energy balance, b) improving nutrient density, c) finding the intersection of good health, performance, and body composition, and c) honesty and outcome-based evaluation. 4. As a front-line health service provider, you may have to fulfill many roles for your clients including the role of trainer, health information provider, and social support network. With this comes great responsibility but also a great opportunity to change your clients’ lives. 5. The trainer’s scope of practice does not include dispensing nutritional prescription, especially Medial Nutrition Therapy, yet nearly all trainers are expected to help with their clients’ eating plan. It’s up to you and your State/Provincial regulatory board to decide just how much information you can provide. 6. Trainers should establish partnerships with high-quality, local nutrition partners (dietitians also certified in sport nutrition) to refer clients to when necessary. Further, it’s essential to make sure these partners follow a systematic nutrition approach, such as the one outlined in this course. 7. When using nutrition technologies, a specific process should be followed, one that is based on a logical workflow and timeline. This process will be taught in this course. 8. Upon completion of this course, you will not be a registered/licensed dietitian or nutritionist; but, you will be prepared to address many of the nutritional concerns your healthy clients have.
