100% found this document useful (1 vote)

1K views475 pages

PN Text 1

The Essentials of Sport and Exercise Nutrition Certification Manual, authored by Dr. John Berardi and Ryan Andrews, provides foundational and practical knowledge in nutrition science and coaching. It covers topics such as cell function, energy metabolism, and client interaction strategies, aiming to equip fitness professionals with the necessary skills to help clients achieve their nutritional goals. The manual includes case studies, chapter objectives, and references to enhance learning and application in real-world scenarios.

Uploaded by

Vương Vi Vu

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as PDF, TXT or read online on Scribd

100% found this document useful (1 vote)

1K views475 pages

PN Text 1

Uploaded by

Vương Vi Vu

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as PDF, TXT or read online on Scribd

You are on page 1/ 475

The Essentials

of Sport and
Exercise Nutrition
CERTIFICATION MANUAL
By John Be rard i, PhD ; Ryan Andrews, MS, MA, RD

www .precisionnutrition.com

Designed by Seesaw Creative Communications

Illustrated by Alison Dungey
Edited by Kris ta Scott- Di xon
About the Authors

Dr. John Be rardi has been recognized as one of the top exercise nutrit ion experts in the
world. His work has been published in numerous textbooks, peer-reviewed academic
journals, and count less popula r exercise and nu trit ion books and magazines.

Dr. Berardi has worked with over 50,000 clienls in over 100 countries through his company,
Precis ion Nutrition. These clients range from recreational exe rcisers to elite athletes , and
include the Cleve land Browns , the Toronto Maple Leafs, the Texas Longhorns, wor ld
champion UFC fighters, and Olympic ath letes, including the Canadian Olympic ski teams ,
bobsleigh and skeleton racers, and speed ska t ers.

No stranger to elite athlet ics himself, Dr. Berardi has competed at a high level in footbal l,
track and field, rugby, and powerlifting. He is a former Jr. Mr. USA bodybuilding champion.

In add ition 10 this wo rk, Dr. Berardi is active in two important , not-for-profit organizations devoted
to providing healthy food for those in need: the Hea lthy Food Bank and Spezzatino magazine.

Ryan Andrews is a world-lead ing educator in the fields of Exercise Science and Nutr ition.
Apart from hav ing earned nearly every accreditation availab le (Registe red Dietician, Certified
Strength and Conditioning Specialist, two Masters degrees , and more), Ryan was a national ly
ranked competitive bodybuilder from 1996-2001.

He's also an expert co ach who has trained and worked at the Johns Hopk ins Weight
Management Center, one of the most recogniz ed and awarded research institutions in
the wor ld. He's also the Director of Education for Precision Nutrition, Inc.. overseeing the
Precision Nutrit ion Lean Eating Coaching Program, a coaching Initiat ive that works with more
than 2,000 clients every year.

In his spare time, Ryan volunteers with a host of non-profit organizations to help promote a
sustainable future .
TABLE OF CONTENTS

PREFACE 4 UNIT 2
INTRODUCTION
What is good nutrition? 7
Nutritional practice 243
Introductory case study 21
CHAPTER 10
Step 1: Preparing for your client 245
UNIT 1
Case study 264
N utritiona I science 23 CHAPTER 11
Step 2: Collecting preliminary
CHAPTER 1
Cell structure and function
client information 267
25
, Case study 301
CHAPTER 2
Food intake, digestion and absorption 41 CHAPTER 12
Case study 55 Step 3 : Interpret in g client information 303
Case study 323
CHAPTER 3
Energy transformation and meta bolism 67 CHAPTER 13
Case study 94 Step 4 : Prov iding a nutrition pl an 325
Case study 351
CHAPTER 4
Energy balance in the body 97 CHAPTER 14
Case study 115 Step 5: Nutritional supp le mentation 363
Case study 372
CHAPTER 5
Aerob ic and anaerobic metabol ism 119 CHAPTER 15
Case study 135 Step 6: Setting behavior goals
and mon itor ing 375
CHAPTER 6
Case study 395
Macronutrients 139
Case study 162 CHAPTER 16
Step 7 : Making nutritiona l
CHAPTER 7 adjustments 397
Micronutrients 165
Case study 420
Case study 189
CHAPTER 17
CHAPTER 8 Step 8: Prov iding continu ing
Water and fluid balance 191 education and support 423
Case study A 205 Case study 44 1
Case study B 207
GLOSSARY 443
CHAPTER 9 APPENDICES 455
Special needs 209
REFERENCES
Case study 240 Unit 1 462
Unit 2 470
PREFACE:

HOW TO USE THIS TEXT

Stud en ts usual ly wonder whether what they learn in school can be ap plied to the "rea l
world." When the he ck will th ey ever re ally need to know the cos ine of a right angl e, or
Kepl er's laws of planetary motion' When they ' re 40 ·year·o ld accountan ts, will they need to
remember the Krebs cycle and the enzyme respon sibl e for forming citrate'

I know this we ll . As a st ude nt, I asked those questi ons too. Now tha t I'm the teache r, it's
time for me to be frank with my students. Will you ever need to kn ow this again ? Probably
not. My students will probab ly never need to know cosines again, unless they become
engineers. They'll proba bly never con ce rn th emselves with th e laws of planetary motio n
again , unless they go to work for NASA . And they ' ll probably never need to di scus s th e Krebs
cycle - ever Unless they sig n up for this ce rtification, that is .

If you ' ll ne ver need th is information in the "real world" , then why shou ld you learn it' Goo d
question. Th e typical answer - so met hing al ong the lines of: "It'll make you a sm arter, well·
rou nde d pe rson" - isn't all that inspir ing. Thus, I us ually respond with : "We ll, very few of you
know what you're goi ng to be 'wh en you grow up.' Heck, I don 't eve n know and som e might
argu e - others not - that I'm already 'grown up.' You 'd better get exposed to everything that's
out the re now. Further, and call me crazy, some of this in fo migh t actually be interesting to
you . You mig ht ju st decide to go down this career pat h bec ause of it. "

I kno w, I know. You 're st ill not convinced. Yet I th ink it makes a lot of sense. This bas ic
infor ma tion - math , physics , biology, etc. - may not seem rel evant to your life right now .
But yo u just never know what ca ree r pa th you'll be on or what ho bbies you'll develop as
you rol l down the road of life. If you'd told me 15 years ago that I'd earn a PhD studying th e
biochemistry of nutrition, I'd have sa id yo u were nuts. But here I am, wr iting thi s man ual and
studying nut riti on al bi oc hem ist ry. So act like a Boy Scou t, folks, and be prepared for anythi ng.

That sa id, some instructo rs (hopefully not me) ca n strip the fun right ou t of learning. Many
of th em simply recite or expec t you to reg urgitate fa cts or foundational in format io n. Oft en
th is information lacks any practical application. It's no wond er that students get lo st and
uni nte reste d. Th ere's li ttle to spa rk their imag in atio n. That's when they start wo nderin g
whether th ey'll need to know thin gs.

I ofte n wonder wha t would happen if these instr uc tors ca me up wi th some rea ll y
appli ed stuff ins tead . For example, instead of just describing, def ining , and deducing the
mathema ti cal formulae Kepler used , why not create a NASA mission out of the exe rcise'
Lau nch a hypothetical sp ace craft in to orbit, bound for Mars' Then, using Kepler 's laws,
chart your cou rse so tha t you conn ect with Mars at th e right time and plac e. Th at'd probably
be fun, even wi th all the math. As you can see in th is ex amp le, the fo undat ional knowledge
is st ill critical. You'd hav e to know Kepler's laws before firing up the ro cket en gines. Yet
there's now a reason to get excited about the information - yo u're going to Mars!
INTRODUCTION Prefa ce HoI'! to L~e t'lIS 'ed 5

In this course, I'll provide a lot of foundational knowledge (information about your cells, your
digestion and absorption, your energy transfer processes, your metabolic controls , and more)
and a lot of applied knowledge (case studies, strategies for working with rea l-wo rld clients,
questionnaires and assessments to use with your clients, psychological strategies for getting
clients exc ited about working with you, and more). By the end of this course , I expect you to
understand how the body wo rks , how to troubleshoot based on physio logical considerat ions,
how to intelligently discuss a host of nutritional issues, and how 10 convince your clients that
you have a deep knowledge of the subjects with which you're he lping them . You'll need this
basic science so that you can do your job properly, in th e "real world ." However, th ankfully,
we won't just stop at the scien ce . This certifica tion course is split up into two units so
that we can cover both nutritional science (Unit 1) and the art of nutritional coaching and
practice (Unit 2).

UNIT 1 COVERS ALL THE SCIENCE YOU'LL NEED TO UNDERSTAND THING S LIKE :

How and why your cells work the way they do

How ca rbohydrates, fats , vitamins, minerals, and other nutrients interact with your cells
How food becomes energy for maintenance functions, physical work, and repair
How your body bala nces out the food you eat with the work it does
How exerc ise affects nutri tional needs and how nutri tion affects exe rcise

UN IT 2 COVERS ALL THE HANDS -ON , PRAC TICAL KNOWLEDGE YOU'LL NEED TO
UNDERSTAND THINGS LIKE :

What it means to be a good coach

How to prepare for clients
How to inte ract with different personalities
Which questionnaires and assessments are most va luab le
How to meet clients where Ih ey are (nol where you want them to be)
How to keep cli en ts progressing from day one until th ey reach t heir goals

That may seem like a lot to learn. Don't get overwhelmed. We've included tools to enhance
yo ur learning expe ri ence as you wo rk your way th rough the two uni ts. Look for th in gs like:

CHAPTER OBJECT IVES

Each chap t er con tai ns clea r objec ti ves at the beginning. This will give you goals before you
even start reading. It'll also help you review and self-test before the fa teful exam tim e.

CHAPTER SUMMARIES

At the end of each chapter, we'll clear ly sum mari ze the most important pai nts rnade in the
chapte r. These will confirm that you 've learned what was outlined in the objectives , and
prov ide another excellent tool for exam review.

KEY TERMS

At Ihe beginning of each chapter, we'll list a num be r of key terms used in that chapter. Th e first
time one of th ese key terms appears in the text it'll be high lighted and a definition will be prov ided
in the marg in. These terms wi ll also appear in a glossary at the end of the manual. Fami liarize
yourself with each key term , because you'll likely see it again (you know, like, at exam time).
6 INTRODUCTION Preface H oI'; to ,Jse tillS t ~ ~ t

CASE STUDIES

Most chapters end with relevant case studies. These will give you "real-life" examples of
applied performan ce nutrit ion. Ea ch story descr ibes a client's nutrit ional challenges and then
provides practical sotutions to ill ustrate how these challenges can be overcome.

REFERENC ES

At the end of the manual, we 'l l provide a comprehensive list of textbooks and studies used to
create this certification. If you're interested in learning more about performance nutrition, you
can look up and read more of this primary source literature.

1. Their genetic makeup,

2. Their physical ac tiv ity pa tterns, and
3. Their nutritiona l habits.

Everything else rea ll y just falls into one of these three categories , doesn't it'

LIMITING FACTOR I, GENETICS GENETICS

Specific, inherited DNA
Are your clients lim ited by their genes' I seriously doubt it. Out of the thousands of peop le
of an organism, which
I've worked with over the years, I can 't remember a sin gle one that couldn't improve in some influences what they
very significa nt ways, despite their genetics. Few people ever come close to realiz i ng their become, although
genet ic potential for health and fitness . Don't assume that your clients are standing on the environment al so plays a
brink of their genetiC upper lim it. key role in the expression of
an organism's genetiC code
Of course, we must be realistic. Each of us has certain, very rea l, genetic limitations. For
instance, most of your clients will not be equipped to play quarterback for the Patriots, play
center for the Lakers , or win the Tour de France. In other words , they may not have the
genet ic makeup to reach t he upper lim it of el ite human performance. Desp ite this limiting
factor, all clients can still improve their health, lose fa t, and/or gain musc le by getting the
right advice and implementing i t. In fifteen years of work in g with all kinds of people, from
office managers to elite athletes , I' ve yet to see a sin gle case whe re we couldn't improve their
body composition , hea l th profile and performance , significantly.

LIMITING FACTOR 2: EXERCISE

Is your client's physical activity pattern their limitin g factor' It's possib le, especially if an
individual is completely sedentary. Ind eed, if their daily activity involves nothing more than
moving from one piece of furniture to another, thei r exerc i se habits (or lack the reof) are
probab ly one of their limiting factors. Ge tting fitter, leaner, and healthier all require both an
active lifestyle as well as a comm itment to purposeful, regular, intense exerc i se . If a client
sits at a desk all day and then goes home to sit some more, they're probably cu ltivating
metabolic decline, fat ga in, muscle loss, and lifestyle-related disease . They just don't take METABOLIC
Pertaining to the chemical
enough steps in a day. When the number of steps people take per day are measured, those
reactions and physiological
taking under 5,000 steps are cons idered sedentary and at higher risk for early death, processes necessary to
disease, and being overweight. In compariso n, those who do 10,000 steps are considered ensure life
active, not surprisingly, they have lower body we ights , less body fat, and imp roved health.
10 INTRODUCTION What is good nutrit ion?

When people increase their level of this Iype of basic physical moveme nt, in conjunction
with doing at least five hours of purposeful high intensity exercise per week, the magic
starts to happen ,

Howeve r, exercise alone isn't usually enough, As I've seen repeatedly with clients, and
as research at major universities is starting to show, many people l ag behind because of
a different limiting fac tor, even with a great exercise program. A recent study examined
overweight participants who were ei t her assigned to a control group for 16 weeks Iwhere
Ihey didn't exercise at all) or an exercise group for 16 weeks Iwhere they exercised for three
hours per week, performing stre ngth exercise with an Olympic weightlifting coach, and two
hours per week, performing circuit training with a group exercise instructor). During this
tim e, re searchers collected data on body composition and a host of ot her measures, As you
might have expected, the exercise group did get better results than the control group, but
these results were .. well.,. embarrassingly unimpressive:

The control group gained 1 Ib of lean mass, lost 0,5 Ib of fat, and lost 0.5% body fat

The exercise group gained 3 Ib of lean mass, lost 2 Ib of fat , and lost 1,5% body fat

Obviously, the exercise gro up did better and the exercise helped a bit However, if I were your
client and I had paid $4,000 to $8,000 for 80 training sessions (five sessions per week for
16 weeks), and I left having lost only 2 Ib of fat after four months, I'd probably demand my
money back, and your head on a platter. Is this what our clients can expect' They come to
us overweight and unhealthy and after spending a lot of time , effor t, and money, they leave
only slightly less overweight and unhealthy, If it were me, I would have rathe r sat at home on
my arse, read more books: learned to play the guitar, learned to speak French" or a host of
other activities instead of wasting my 80 hours and several thousand do llars on two measly
pounds of fat 10SSI

I'm exaggerating my indignation he re , But only just a little, Purposeful exercise alone, while
marginally better than nothing, never seems to produce the results thai purposeful exercise plus
increased general physical activity Ii.e" more steps) plus nutrilional control can produce.

People who are overweight and unhealthy, with too little muscle and too much fat, usually
have a few problems, They probably don't move enough and they eat too much lor at
ENERGY BALA NCE
least, too much of the wrong stuff). You should definitely get them moving more: that's
Relationship betvl een alf a prerequisite for success. But gett ing them to move more fo r a few hours per week isn't
sources of en ergy intake and usually enough, Their real limiting factor is more than their exercise, It's not their genes, It's
energy output; an organism is not their training program, It 's what t hey're eating - and sometimes, more importantly, what
said to be in energy balance they're not eating ,
wh en energy flow int o the
body and out of the body is
LIMITING FACTOR 3: NUTRITION
equal; often evidenced by a
stable body weight Whether your client wants to gain muscle, lo se fat, pursue a healthy lifestyle, or even
compete at the highest levels of sport, the most important limiting factor is almost
always nutrition Poor nutrition is what holds clients back . Good nutrition is what propels
them forward, Good nutrition feeds muscle and helps shed fat It improves nearly every
NUTRI ENT DENS ITY
measurable health marker. It drastically improves recovery and mood, so cJjents can
Foods that provide
exercise - whether it's purposeful or j ust part of Iheir daily lifesty le - harder, longer, and more
substantial amounts of
nutrients with only the frequent ly, Good nutrition will get them the body they never thought t hey could have, And it's
necessary calories the most significant factor determining their outcome.
INTRODUCTION Wha t is good nutritio n? 11

Good nutrition defined

Since this entire course is devoted to teaching you exactly what good nutri tion is and how to HEALTH
State of physical well ~be ing
help your clients eliminate poor nutrition as a limiting factor, it's important to have a work in g
and optimum fu nction that
defi nition of "good nutrition." If you ask a hundred different people wh at "good" or "healthy" should be assessed through
eating me ans , you'll likely get a hundred diffe rent answe rs' Some think good nutrition means medical tests, Including
eating fewer suga ry desserts . Others think it means eating more fru i ts and vegetables, less blood assessments,
meat, andl or fewer carbohydrates. And then t here's the often-cited , commonsens ical, and cardiovascular te sts. and
other screening modalities
largely meaningless "balanced diet." While most of the definitions you' ll hear are simple and
easy to remember, most of them will be incomplete and some of t hem will be flat -out wrong.
BOOY COMPOS ITION
This course will reorganize your unde rstanding of nu trition. You'll dump out all the ridiculous, Relative relationship
oversimplified, often erroneous media mythology you 've been exposed to in order to make between lean body mass
some room for the right information. We ' ll teach you how to judge the "goodness" of a (vthich includes bone mass.
body water. muscle mass.
nu trition plan . Let's start with four important criteria t hat all good nutrition pla ns must meet.
and organ mass) and fat
1. Good nutrition proper ly controls energy balance, mass (which includes
adipose tissue and intra-
2. Good nutrition provides nutrient density,
tissue fat deposits)
3. Good nutrition achieves health, body composition, and performance goa ls.
4 . Good nu trition is honest and outcome-based. PERFORMANCE
Fun ction, action. or
Let's now discuss each of these in more detail.
operation. whether
athletically or in daily life
1. GOOD NUTRITION PROPERLY CONTROLS ENERGY BALANCE
The phrase "energy balance" represents the relations hip between "energy in" (food calories OUTCOME · BASED
taken into the body through food and dr in k) and "energy out" (ca lories used in the body for Use of specific. measurable
our daily energy requirements). This relationsh ip, defined by the laws of thermodynamics. outcomes and evidence
dictates whether weight is lost, gai ned, or remains t he same. to make dec iSIOn s. rather
than nebulous or dogmatic
However, there's a lot more to energy balance than its physical manifestation in weigh t defmitions of what's "good"
change. Energy balance also has a lot to do with what's going on in your cells . In this or "correct"
manual, you'll learn more about what's happening in your body on the cellula r level. Both
a positive energy balance (more energy in than out) and a negative energy balance (more LAWS OF
energy out than in) affect everything from your rnetabolism to your hormona l balance to THERMODYNAM ICS
Principles that govern
your mood . For example, a st udy that examined military recruits found that severe negative
energy exchange, includmg
energy balance led to massive metabolic decline and an inability to concentrate; it reduced
heat exc hange and the
thy roid hormone production , testosterone levels, and physical per form ance . The same is true performance of work
in those with anorexia nervosa: they lose physical fitness, metabolic fitness, men tal fitness,
bone mass , and muscle mass. POSITIVE ENERGY BALANCE
When energy flow into
An intense nega t ive energy balance does lead to weigh t loss . But so does getting thrown in a
the body exceeds energy
prison camp or being in a poor African village wi t hou t adequate food . And that's exactly what
flow out of the body. often
our bod ies think when we impose a large negative energy balance: I'm starving. All "non~ evidenced by an increasing
survival" funct ions including reproduc t ive function, metabolic funct ion, and brain function body weight
slow or shut down.
NEGATIVE ENERGY
On the other hand, a positive energy balance from overfeed i ng (a nd/or under~exerc i sing) has
BALANCE
its own host of repercussions. Weight gain is the most obvious co nsequence, bu t hea lth and
When energy flo w out of
cellular fitness suffer too, plaques can build up in our arteries ; blood pressure and cholesterol the body exceeds energy
can increase ; we can become insulin resistant and begin to suffe r from di abetes; our fisk for flow int o the body. often
certain cancers increases, and the list goes on. eviden ced by a de crea sing
body weight
12 INTRODUCTION What is good nutrition?

Positive energy balance: WEIGHT GAIN

Calories in > Calo ries out a Negative energy balance: WEIGHT LOSS
~ Ca lorie s in < Calories out

Energy expendi ture

(Ca lon es burn ed)

+ ~
Neutral energy balance: WEIGHT STABLE
Ca lo ries in = Calo ries out a
Energy Int~ke EnerllY ex pend itu re
(Calories eaten) (C alor ies burned )
FIGURE 0. 1
THE RELATIONSHIP
BETWEEN CALORIES IN
AND CALORIES OUT

INSU LI N RES ISTANCE Good nutri tion programs he lp to properly contro l energy balance. Good nutrition prevents
Condition in which normal excessive swings in either direction (pos i tive or negative) and the body can either lose fat or
amounts of the hormone
ga in lean mass in a healthy way.
insulin are inadequate
to produce a normal
response from fat, muscle, 2. GOOD NUTRITION PROVIDES NUTRIENT DENSITY
and liver cells Nutrient density is the ratio of nutrien ts (vi tamins, minera ls, fiber, etc.) relative to the total
calor ie content in a food . Therefore , a food with a high nutr ient density wou ld contain a large
amount of key nutrients (protein, iron, zinc , B vitamins, etc.) per 100 calories of food .

High versus low nutrient density

EXAMPLES OF FOO DS W ITH HI GH NUTRI ENT DE NSITY EXAM PLES OF FOODS W I TH LOW NU TRIENT DENSITY

Bright or deeply coloured vegetables Table sugar

Bright or deeply coloured fru its Soda / soft drinks
High fibre, unprocessed grains White flour
Lean meats lee cream
INTRODUCT ION What is good nutrition? 13

Key nutrients found per 100 calories of sample foods

PROTEIN FIBRE I RON ZI NC THIAM IN RIBOFLAV IN NI AC IN 86 812

(gJ (gJ (mg) (mg) (mg) (mg ) ( mg) (mg) (m g)
~- - -- ---- - - -
---- ~ ~ ~ ~ ~ ~ ~"~ ~ ~ ~ ~ ~"- ~ ~ ~"~ ~ ~ ~ ~ ~ ~ ~ ~"" ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ - ~ ~ ~ ~" .. ~ ~ - ~ ~ ~ ~ ~ ~ ~ - ~ ~ ~ ~ ~ ~ -----
Spinach 14 g 10 g 12.5 mg 2.5mg 0.4 mg 0 .9mg 3.3 mg 0.9 mg
Lean beef 14 g 1.4 mg 3.2 mg 0.1 mg 0.1 mg 1.9 mg 0.1 mg 1.2mg
Bagel 3.8g 2.2 g 1.3 mg 0.3 mg 0.2mg 0.1 mg 1.7 mg 0.1 mg
LOW-fat milk 6.7 g 0.1 mg 0.8 mg 0.1 mg 0.3 mg 0.2 mg 0 .1 mg 0.7 mg
Soda 0 .1 g 0 .1 mg

Bo(d type: High nutrient density Italic type; MedIUm nutrient density Regular type; Low nutrient density

Calorie density is defin ed as the ratio of calories (which are mere ly units of potentia l energy
in food) to the actual weight of a food. Therefore a food with high calorie dens ity wou ld
have a lot of calories per 100 g of food wh ile a food with low calorie density would have few
calories per 100 g of food.

High versus low calorie density

EXAMPLES OF FOODS WI TH HI GH CALOR IE DE NSITY EXAMP L ES OF FOODS WITH LOW CALOR IE DENSI TY

cookies fresh vegetab les

crackers broth -based soups
butter fresh fruits
bacon chicken breast

As you might imagine, the best combination of nutrient and calorie dens ity for improving CALO RI E DENSITY
health and promoting fat loss is a diet high in nutrient-dense foods (a lot of nutrients per Energy provided per unit of
calorie) and low in calorie-dense foods (few calories per gram of food weight). Suc h a diet food; high caloric density
would have t he following benefits, foods provide many calories
in a smaf/ portion white
Easily controlled calorie intake (without calorie counting) low caloric density foods
provide fewer calories in a
Longer periods of satiation , or satisfaction/fullness, after meals
large portion
Difficulty overeating
A higher tota l essential nutrient in take
More essential nutrients per volume of food
14 INTRODUCTION Wha t is good nutrition?

SATI ATIO N Conversely, for someone interested in weight or muscle gain, the recommendation above
The state of being might be altered in favor of high -nutrient-d ense, high-calorie-dense foods. This would allow
satisfactorily tuff
for inc re ases in both nutrient intake and calorie intake , both essential for gains in lean mass
and total body weight.

3 . GOOD NUTRITION ACHIEVES HEALTH , BODY COMPOSITION ,

AND PERFORMANCE GOALS
Good nutrition is more than about weight loss or gain, wh ich are just transient indicators
of energy balance, si nce energy balance and weight can chan ge from one day to the next.
Therefore, finding a long-term set of dietary habits should be based on th e intersection of the
fol lowing three goals,

1. Improved body composition

2. Improved he alth
3. Improved performance

Yes, a large majority of your clients are working out with aesth eti cs in mind. Th ey want to
lose fat , gain muscle, achieve a flat stomach, and genera lly look great naked. Because of
these strong motivators, they can easily be lu red into a world of powerful drugs, invasive and
risky su rgeries and ridiculous crash diets. While these shor t-term strategies can sometimes
(and temporarily) improve the way your clients look in the mirror, in the long run such
strategies can of ten sacrifice their health and well-being.

Rather than focu sing solely on the visual outcome of body composition, focus on improving
a client's health and performance as well. Employ nutritional strategies that also reduce
blood li pids , inc rease insulin se nsitivity, reduce diabetes risk , increase good cholesterol,
reduce body fat percentage , and incr ease lean body mass. In addition to boosting health and
body composition, your recommendations should help your cli ents improve performance,
regard less of whether they're elite athletes or only watch them on TV. Depending on your
clients' goals and activities , performance outcomes range from improved energy levels and
stam ina to improvements in athletic performance at the elite, world-class level.

While th ere is a lot of overlap here (f or example, if someone begins to look better, they
should also begin to feel better and perform better), the ove rla p isn't all-inclusive. Some
plans help folks lose weight in a hurry while sac rificing their health and performance .
Other programs cater to the "I jus t want to be healthy" market. While some of these
approa ches (calorie restr iction, the avoidance of certain foods , high doses of certa in
vitami ns, and more) can improve one or two ind icators of health, many strategies actually
worsen health. Finally, there are a lot of performance enhan cem ent program s out there
ER GOGEN IC that include powerful ergogenic (per formance-enhancing) drugs , crash dieting, diuretics
Phys ical or mental to make weight for competi tion, unresea rched nutritional supplements, and more. While
performance-enhancing
these approaches might improve performance briefly, they often lead to a degradation of
strategies
health, which inhibits long-term achievement.

Focusing st ri ctly on anyone of the goa ls above to the exclusion of the others can lead to
problems. An excessively single-m inded focus on "performance" or "weight loss" or "health"
might, in some cases, actually produce negative long-term consequences. It's your job to
preve nt this type of "coaching gone bad." Provide a nutrition plan that Improves til e way
cli ents look , feel, and perform.

To ens u re you remain on track, we've provided a host of metrics (questionnaires and
assessments) later in this manual. These metncs will help you monitor each of the three
domains above , to ensure that each area is looked after properly.
INTRODUCTION What is good nutrition? 15

Performance Health

Body
composition
FIGURE 0.2
THE RELATIONSHIP
BETWEEN BODY
COMPOSITION. HEALTH .
AND PERFORMANCE

4. GOOD NUTRITI ON IS HONEST AND OUTCOME-BASED

While good nutrition contro ls energy balance. boosts nutrient intake. and targets health goals.
body composition goals. and performance goals. it also has to be honest about whether it
hits the mark. After all. how many times have you heard the fol lowing:

"I eat really well" .. .bu t. .... I·m still 20 pounds overweight."

"My diet is perfect" ... but. . "I often feel sluggish and fat igued."

"I make good nutritional choices" .. but .. "I've got high blood p re ssure. cholesterol .
and type II diabetes."

Is it possible that someone could eat really well and have a "perfect" diet yet be overweight.
fatigued. and riddled with lifestyle-related diseases? Sure. it's possible. but it's not likely. Most
people who believe they're "doing a good job" bu t who don't have the physique or the health
profiles to show for it. simply aren·t. Either they have a good plan that they're not executing
or their plan isn't very good. As someone committed to finding limiting factors and remov ing
them. it's your job to help your ctients both improve their plan and their execution. So make
sure that you help your clients remain honest and outcome·based in t he ir approach.

Here 's an example of how we can be psychologically dishonest with ourselves. regard less
of our intent. Figure 0.3 below illustrates a research study in which researche rs compared
how many servings of each of the major food groups study participants thought they had
eaten each day and how many servings of t he major food groups t hey actually ate. The chart
shows the di ff erences between perceived versus actual intake. In every age group people
reported their intake incorrectty. Their perceptions do not always reflect rea lity.

As you can see, both men and women of all ages ate more grains, fats, oils, and sweets than
they thought they h ad eaten . They also consumed fe w er fru its and vege tables and tess milk
and meat than they thought. In other words. they ate more carbohydrates. fat. and junk food
than they thought. wh i le eating less protein and fewer fruits/vegetables than they thought.
16 INTRODUCTION What is good nut ri tion?

I doubt these peop le were trying to be dishonest with their food records. Rathe r, th is st udy
points out a common problem, Peop le simp ly don 't have a good idea of what their dietary
intake rea ll y looks like unless they measure and record it accurately. This is an important
lesson for you as their personal trainer. If you ' re going to help a cl ien t improve their nutrition,
you have to provide them with the right too ls that will force t hem to be accurate and honest
in Iheir nutritional assessment. (We provide these tools in Unit 2.)

Beyond honesty, good nutrition also requ ires resuits . If one of your clients thinks t hey 're "doing
a good job" yet have no results to show for it, how "good" is the job they're do ing? Not very.
This is the definition of outcome -based , You evaluate the "goodness" of a client's nutrition plan
by observing what happens once your client follows it. In an outcome-based world, theory is
meaningless and results are everyth ing. Your cl ient shouldn't be lieve they're doing a good job
based on what they 'v e read in the papers or in magaz ines, what they 've seen on TV, etc . They
can only judge their plan based on the results the ir diet cons istently produces.

Good nutrition equals results.

1. Grains • 4. Vegetables
FIGURE 0.3
DIFFERENCE BETWEEN . 2. Other .5. Mi lk

2_
(fats, oils & sweets) • 6. Meat , etc.
ACTUAL AND PERCEIVED
INTAKE OF SELECTED . 3. Fruits
FOODS , BY SEX AND AGE
WOMEN 1
GROUP
19-24 3
4
5
6

25-50
~ --.
4
5
6

51+
~ ---
3
4
5
6

MEN
19-24
---41
-- ~
~ J:..,;==:::::::I

25-50

--- 41
~~
~ ----.
51+

·4 ·3 ·2
..--4.
-I
~~ ------
o
Difference between
1 2 3 4

ser ving sizes

Source
USDA Center for Nutr ition Po licy and Promot ion. Co nsumption of food group se rvings : people's perceptions vs . rea lity
Nutrition Insight 2000 October; 20
INTRODUCTION W hat is good nutriti on? 17

How you can help clients improve their nutrition

Now that you know what good nutrition is, you'll li ke ly be asked to help clients make
nutritional changes . After all , as a trainer, you occupy an important role within the health
care industry and accord ingly, have a large set of responsibilities.

For starters, you 're tike ty the primary health , body composition , and performa nce access
point for your cli ents. They may not regularly see a phys ician or other hea l th care provider
to get information on these subjects. Or, if they do, the ir hea lth care prov iderls) may not be
equipped to dispense pract ical adv ice for prevent ive health measures, body compos i tio n
change, or performance improvement. As a result, you r client will turn to you for answers in
eac h of these domains. If you're prepared for th is, that's gre at. If not, your cl ient may seek
help elsewhere and both a client and an opportunity may be lost.

You may also become yo ur client's social support system . Many new, or even long-term , SOCIA L SUP PO RT
clients wo n't have friends and fami ly committed to helping them improve their exercise and Network of ind ividua ls tha t
nutrition choices . In fact, those around them may be eit her un interested or antagonist ic pro vides pos itive feedback ,
constructive critic ism , an d
to the ir li festy te changes. Clients may look to you for support. Although this places a large
encouragement for one 's
amount of responsibitity on yo u to act as a trainer, an ed ucator, and a friend/me ntor, it also lifestyle chOIces
provides you with a rea l opportunity to help your clients Significantly. In ga ining a client's
trust this way, the adv ice and support you give can quite litera ll y change their lives.

Here are two things that will help you prepare for this respons ibility.

KEEP UP TO DATE
As a trainer, prepare to meet your clie nts ' need for re li able, curre nt information about
exerc ise, nut rition, supplements , and hea lth in genera l. While it's impossib le to have a high
leve l of special ized knowledge in each area, lucki ly that's not required , a working knowledge
sho ul d be sufficient.

ESTABLISH A NETWORK
Establish relationsh ips with other hea l thcare professionals such as registered dietitians,
nurses, phys ica t therapists , chiropracto rs, phys icians , etc. By networking and creating a
cross-refer ral system, you 'll not only expand your bus iness network, you'll have experts to
turn to when you just don 't know the answers to ce rta in quest ions.

Your scope of practice

Trainers are often unsure about what they can and can't ta lk about wi th clients. As a qual ified
tra iner, you likely possess a fundamentat know ledge of human anatomy and physiology. You 've
comm itted yourse lf to he lping clie nts improve their health, body composition , and performance.
Your experience te ll s you that nutrition and trai ning go hand-in -hand , and that resu lts come
only when both are improved. Thus , you'll probably want to talk about both areas with your
cl ients. Ye t emp loyers, dietitians , and other hea lth care pract itione rs may have discouraged yo u
from discuss ing nut rit ion's relat ionship to your clients' goals. Pe rhaps you 've even been told
that it's illegal to discuss nutrition with clients. Well, that's not exactly the case.

Although eac h state and province in North America has diffe rent rules for dispensing
nutrition advice, in most states it's well with in the scope of practice for persona l trainers who
possess fundamental nutrition knowledge to address quest ions and concerns their clients
may ha ve. Notice I emphas ize the " fundamental knowledge" part. With specific tra ining,
18 INTRODUCTION What is good nutritio n?

such as that provided in this course, you'll possess that fundamental knowledge and be able
to discuss nutrition with clients.

However, while technically, in many North American states and provinces, anyone can make
M ED ICAL NUTR ITI ON general nutritional suggestions, offering specific advice in the form of med ical nutrition therapy
THERAPY (MNT) (i.e ., prescribing nutrition fo r a variety of health conditions and illnesses) is another story. For
Nutritional advice intended example, certain states (see Table 0.4 below) have statutes that explicitly define the scope of
to treat a variety of practice. In these states, performance of the profession of medical nu tntion therapy is illegal
conditions and illnesses,
without first obtaining appropriate dietitian credentials and then applying for a license from
the provision of which is the
the state. In these states it's perfectly legal for you to make nutritional suggestions for healthy,
ex clusive domain of trained
and licensed nutrition active individua ls. It's also legal for anyone to share nutrition education through materials
professionals that originate from a public or well-known entity such as the American Heart Association, the
Ce nters for Disease Control and Prevention, the American College of Nutrition, etc. It's only
Hlegal to prescribe nutrition for medical cond itions unless you're a licensed dietitian .

Other states have statutes that limit the use of titles such as "licens ed dietitian," "certified
dietitian" or "c ert ified nutritionist." Yet these states do not neces sarily limit the practice of
making nutritional prescriptions . 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 nutri tion and registered with the state as certified.

In analyzing these defin it ions, the differences between "general nutritional suggestions" and
spec ific 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 difference
between recommending certain breakfast foods for general good health in a type II diabet ic
and recommending the same breakfast foods for controlling blood sugar' In the case of grey
areas, each state decides these differences. It's best to check your own state's laws, rules,
and regulations regarding nutritional recommend ations .

Allow me to be cand id: It's unlikely that a trainer will get in trouble for making general
nutritional suggestions to otherwise healthy clients . 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 as these directly relate to gym performance.
These topics usually include: recommend ing adequate sleep (7-9 hou rs per night),
recommend in g adequate hydration (6-12 8 oz cups per day), recommending clients eat before
a workout (a light meal within an hour or so oftrainmg), and recommending that clients ingest
adequate post-workout nutrition (usually some protein and carbohydrate nutrition) .

Trainers often go beyond these vague basics to make more spec ific recommendations such as:

Ca lorie management strategies such as eating less, eating more filling foods, avoiding
calorie-dense drinks and snacks, etc.
Good food selection strategies such as choosing whole grains over re fined ones, choos ing
complete protein sources, choosing water instead of sweetened drinks, etc.
Good food timing strateg ie s such as eating in and around the workout, eating breakfast,
not eating a large meal right before bed, etc.
Supplement suggestions/ informa tion such as wh ich vitamins, minerals, and other
essential nutrients (protein, fat, etc.) may be useful
Hea lthy lifestyle choices such as meal opt ions for breakfast, lunch , and dinner; alternative
snack suggestions; and planning for upcoming social events
INTRODUCT ION Wha t is g ood n u trit ion? 19

Nutritional pra cti ce re gulati ons , by state

STATES REQUIRI NG FORMAL CERTIFICATION AND LI CENSE STAT ES LIMITING TITLES BUT NOT T HE PRACTI CE
FOR MEDICAL NUTR ITION THERAPY OF NUTR IT IONAL PRESCRIPTI ON

Ala bam a Kentucky North Ca rolina Connect icut Oregon

Alaska Louisiana North Dakot a Delaware Utah
Arkansas Maine Ohio Hawaii Vermont
Ca liforni a Maryland Ok lah oma Indiana Vi rginia
Dist rict of Columbia Massac husetts Pennsylvan ia Nevada Washington
Flo rida Minnesota Rh ode Isl and New York Wisconsin
Georgi a Mississippi South Dakota
Idaho Montana Tennessee
Illinois Nebrask a Texas
Iowa New Hampshire Wes t Vi rginia
Kansas New Mexico

As indicated , 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 require medical
nutrition therapy and are thus beyond the scope of a trainer's pract ice, and against the
regulations of many states . Th is includes, for example, giving nutrition advice for hea lth
problems such as diabetes, heart disease , liver dysfunction, kidney stones, etc., as we ll as
giving advice for eating disorders such as anorexi a and bulimia.

Every trainer should know when and how to refer a client to an appropriate health CROSS ·REFERRAL SYSTEM
professional, and to whom they should refer. I suggest developing a relationship with a System in which two health
high quality local nutrition partner (such as a dietitian also certified in sport nu trition) to and fitness professionals
(such as a physician or
create a cross referral system you can turn to when necessary.
personal trainer) actively
Thus, what you discuss with clients will likely depend on the following, recommend each other's
complementary services
1. Your particular state or province's regulat ions : Most states al low you to address to their own clients and
client questions and concerns about basic nutrit ion, although different states have patients
different regu lations.
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 this person's advice. If not, you may want to discuss
nutrition with your clients as long as you stay wi thin 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 him or her to a licensed dietitian also trained in sports nutrition
as long as you trust this person's advice. As a personal trainer, you should never offer
medical nu trition 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. To find a sports specific nu tritionist, go to www.theissn.org.
20 INTRODUCTiON What is good nutrition?

Applying nutrition technologies

Although most trainers that dispense nutrition suggestions do so in and around workou t
sessions, this is never the ideal time to talk about nutrition. Can you imag ine trying to listen
to, process, and absorb new information before, during, or after a tough wo rkout? Defini te ly
not the best learning environment, is it? Yet even good t rainers often make th is mistake.

A better model for making nutritional suggestions is the one that nutrition professionals use,
wh ich is the one you'll learn more about in this course . This systematic coaching process
involves discussing nutrition when clients are most receptive to learning, during separate
nutrition sessions - which, of course, you can bill for as jf they were regular training sessions.
During these sessions the client wi ll be ready to share and receive nutritional informat ion.

The 8 steps outlined below represent a logical system of intera cti ng with clients from
preparatio n for the first meeting to continuing education/support. Th ey help systernatize the
coaching process so that every client gets the attention, education, and support they deserve.
Du ring this course, you'll learn about each step and be provided With tools tha t ensure a
successful coaching environment. We'll explore each step in greater depth in Unit 2.

The purpose of this course

Th is course will help you dispel common myths and fallac ies associated with nutrition. It will
prep are you to discuss nutrition with your clients by establishing the knowledge base necessary
to make general nutritional recommendations that su ppo rt healthy eat ing behaviours in your
clients. Along with providing nutrit io nal theory and science , we'll walk you step-by -step through
the actual process that sports nutrition practitioners use to prepare for, evaluate, and make
recom mendatio ns for clients . Each step is accompanied by the sub-steps , descriptions, tables,
and summar y charts req ui red to imp lement t hat step. You shou ld finish 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 to note, however, that successful completion of the course examination will
not qua lify you as a registered dietitian, licensed dietitian, or li censed nutrition ist. (Each state
has individual rules and regulations about nutrition licens ure; check with your particular state

8 ste ps to eff ecti ve nutrition coa chi ng

STEP 1 Prepare for the cl i en t STEP 5 Offer nutriti ona l supplement suggestions
STEP 2 Collect prelim inary client in formati on STEP 6 Set behavior goals and create monitoring

STEP 3 Evaluate client information and expla in stra t eg i es

what it means STEP 7 Make nutritional adjustments based on
STEP 4 Offer nutritional suggestions and provide client results
nutrition plan STEP 8 Provide continuing edu cation and support
INTRODUCT ION What is good nutrition? 21

to ensu re you are follow ing legal protocol.) Nor wi ll this course allow you to provide medical
nutrition the rapy. Instead, this course will provide you with continuing educ at ion in the field
of nutrition . It will enhance your cred ibil ity and your skill set. And it will help you overcome
the bigge st limiting factor your clien ts face every day, poor nutrition.

Many cl ients come to me with "diet experience. " How do all three plans create a negative energy
Some have followed lower-carbohydrate diets balance? Three reasons:
(simil ar to the Atkins Diet). Others have followed
1. The process of fo llowing a weight loss plan
low-fat di ets (simi la r to the Orn ish Diet). And
itself tends to reduce ca lorie intake, helpin g
others have followed more "balanced" plans
decrease "energy in" and helping to shift t he
(similar to the Zone Diet). One client followed
body toward a more negative energy balance.
all three plans at one point or another and , in
conjunction with exercise, achieved similar weight 2. The exercise program cont ributes to the negative
loss results wit h each of them! Unfortunately, energy balance by increas ing "energy out. "
despite the divergent diet philosophi es and 3. The Atkins and Ornish plans require dieters
consistent weight loss, his end result was always to restrict their intake of either dietary
the same: he regained all of the weight lost (and carbohydrate or dietary fat. The Zone
then some) before trying the next diet. plan prescribes specific ratios of these
macronutrients - rat ios wh ich lead to eat ing
In his case , fol lowi ng three wildly different plans
l ess total food . Is it any wonder that by asking
re sulted in similar weight loss . Some people
dieters to restrict their intake of something,
would ask, " How can this be?" I would ask,
whether it's carbohydrates or fat or the rat io of
"Are these pl ans so different after all?" Instead
carbohydrates to fat , they' ll end up eating less ,
of focusing on the differences between three
again reducing the ir "ene rgy in "?
strategies that ach ieve the same result , it's more
important to focus on the simUarities. Indeed, I hope it's now evident why my cl ient had weight
perhaps the differences aren't all that important loss success with the Atki ns , Ornish, and Zone
(despite what the diet authors fill their books plans. It was the negative energy balance that
with) and the results lie in the similarities. led to his short-term results, not some magical
macronutrient mix.
The most important similarity and the reason
why my client above got resu l ts with a low-carb However, all th ree experiments ultimately fa iled.
diet, a low-fat di et, and a ba lanced macronutrient This client h ad rebound weight-ga in each time,
diet, is this: all three pl ans forced him to follow which was a result of several non-food-related
the first rule of good nutrition . All three plans, in limiting factors . After giving up, he got off track ,
conjunct ion with his exercise plan , forced him to stopped exercising, and started eat ing poorly
control his energy balance. You might recall that it again. However, it wasn 't the food that caused
takes a negative energy balance to achieve weight this - it was a host of lifestyle problems that
loss. If someone ach ieves successful we ight loss triggered the relapse . On ly when these factors
with each of these plans discussed here, it must were addressed whi le working w ith my team did
be the negative en ergy balance that's caused the he change his fundamental habits and lose his
weight loss , not the lack of carbohydrates or the excess body fat for good.
reduction of fat or a specific macro nutrient ratio.
22 INTRODUCTION What is good nutri ti on?

1. The best trainers are characterized by their ab ility to find lim iti ng factors in their
client's progress and eliminate them.
2. The most significant limiting factor for most clients is their nutritional intake.
3. Good nutrition:
a. con trols energy balance;
b. improves nutrient density;
c. achieves the interlocking goals of good health, improved performance,
and opti mal body composition ; and
d. uses honesty and outcome-based evaluation.
4. As a front-line health service provider, you may have to fulfill many roles for your
cl ie nts including the ro le of trainer, health information provider, and social support
network. With this comes great responsibility but also a great opportunity to
change your client's lives.
5. The trainer's scope of practice does not include dispensing nutritional prescriptions
for specific health conditions, especially medical nut ri t io n therapy, yet most
clients expect trainers to help with their eating plan. It's up to you and your state/
provincial regulatory board to decide just how much information you can provide.
6. Establish partnerships with high-quality loca l nutrition partners (dietitians also certi fie d
in sport nutrition) to refer clients to when necessary. Ensure that these partners follow
a systematic nutrition approach, such as the one outlined in this course.
7. When using nutrition technologies, you should follow a specific process that is based
on a logical workflow and timeline. Th is process will be taught in this course.
8. You wi ll not be a registered/licensed dietitian or nutritionist when yo u complete
this course. However, you will be prepared to address many of the nutritional
concerns that your healthy clients have.
UNIT 1

..-.- Nutritional
Science
CHAPTER 1

CELL
STRUCTURE
& FUNCTION
Chapter objectives
Key terms
The cell
Chapter 1 Summary
KEY TERMS
metabolism mitochondrial
homeostasis density
pathogens mitochondrial
quality
proteins
reactive oxygen
enzymes
species (ROS)
epithelial tissue
free radicals
connective
chromosomes
tissue
transcription
muscle tissue
translation
nervous tissue
endoplasmic
organelles
reticulum (ER)
cytoplasm
Golgi apparatus
macronutrients
ribosomes
micronutrients
glycoproteins
phytochemicals
ribonucleic
potential energy acids (RNA)
co-factors cisternae
hormones Iysosomes
genetic vesicles
DNA microorganism
nucleus peroxisomes
genes detoxify
genetic receptor-ligand
polymorphisms binding complex
nutrigenomics signal
diurnal transduction
insulin second
plasma messengers
membrane transport
lipids proteins
cholesterol facilitated
diffusion
phospholipids
active transport
hydrophilic
substrate
hydrophobic
lock-and-key
cytosol model
mitochondria induced fit
oxidize model
adenosine co-enzymes
triphosphate catalyze
cristae
UNIT 1 Chapter 1 Cel l St ru ct ure and Fun c ti on 27

The cell
The way the body functio ns depends on how each of it s cel ls functions. A 150 pound adult
has approximately 100,000,000,000,000 (100 trillion) individual cells , all of wh ich must
work together in va rious ways in order to promo te life. Cellu lar and tissue re spo nse, signal
conduction throughout the body, tissue growth, cellular and organismal respiration, nutrient
digestion, nutrient absorption, fluid secretion, waste excretion, blood and biochemical
circulation, and cellular and organismal reproduction all depend on the harmony of these
100 trillion cells. Therefore, the cells of our body must function properly for optimal health,
body composition, and performance to occur. Optimal nutrient intake is a cornerstone of
proper cellular function. Nutrient deficiencies (or excesses) can disrupt the delicate balance
of cellu lar function , causing decreases in both health and pe rformance.

As ce lls are the building blocks of life , they are the simplest "organisms" that can have a
" life of their own. " Howeve r, there are further levels of organization within ou r cells. These
sub- cell ular structures and chemica ls are respons ibl e for our ph ys io logical functi on and
metabolism. You may often hear people talk about "the metabolism", whether fast or slow. METABOLISM
Since every single cellular process contributes to huma n metabolism, the term "metabolism " Sum of reactions that ta ke
thus desc ribes all of the dive rs e physiological processes (both physical and chemical) that place to build up and break
down the body
generate life. Functiona lly speaking, our cells form the foundat ion of our metabolism and our
metabolic rate.

In this chapter we'll discuss some of the cellular components and reactions that contribute
to our human metabolism and our ability to sus ta in life. However, before go ing deep into
cellular organization, let's start with the highest level of organization ~ the organism - and
progress through smaller levels until we get down to the cellular level. Next, we'll get even
sma ller st il l, working our way down to the atoms themselves. At the end of this chapter you
sho uld have an accu rate picture of how everything, from our organs all the way down to our
atoms, fits together.

ORGANISM
The organism is , we ll , you. It's a comp re he nsive unit of tissue structu res and chemica ls, built HOM EOSTAS IS
to withstand various env ironments from hot to cold, wet to dry, food-abundant to food-scarce. The body's ability to
The human body can reproduce , repla ce, and repai r itself, all to stay ali ve and to maintain main ta in a stable and
cons tant internal condition
homeostasis : the state of balanced functi on in the body.

ORGAN SYSTEM
Going deeper into our body's organization, we come to our organ systems. Organ systems are PROTE IN
exceptionally intricate and involve numerous organs arranged to perform complex functions Large and complex molecule
such as collecting oxygen, breaking down proteins into amino acids, and neutralizing for eig n consisting of amino acids
(which contain nitrogen) that
pathogens. The organ systems found in the human body are as follows:
are essential for living celts
Integumentary system : Your skin , hair, nails, sweat glands, and other external structures.
Th is system protects the body from externa l damage.
PATH OGEN
Skeletal system: Your bones , tendons , ligame nt s, and other str uctures. This system DIsease-causing agent;
supports the bod y by providing a rigid structure capable of resistance and movement. u5uafly ba cteria, virus,
or fungi
Mu sc ular system: Your skeletal muscles, cardiac muscles , and smooth muscles. These
mu scles are part of your arteries and ve in s, bladder, gastrO in tes tina l tract, respiratory
tract, and more. They prod uce movement , whether it's to move you across the room, to
move your blood through blood vesse ls , or to move food through your intes tines.
28 UN IT 1 Chapter 1 Ce ll St ructure and Function

Organism (You) Organ systems Cells Organelle

Made up of different
organ systems.
Group of diHerent
organs working
together.
Made up of
different
tissues.
Formed by
similar
cell types.
many
organelles
Made up of
different
chem i cals .
1,"'m'' 1

FIGUR E 1.1 Nervous system : Your brain as well as you r nervous tissues. This system is responsible
STRUCTURAL LEVELS OF
for electrochem ical cellular communication and sends signals that trigger thought,
ORGANIZATION IN THE BODY
movement, vo luntary, and invo luntary activity.
Endocrine system : Your hormona l organs and glands , inc luding the hypotha lamus,
pineal gland, pituitary gland, thyroid gland, liver, pancreas , kidney, adrenal gland , testes,
ovaries , and more . Th is system is responsible for chemical ce ll ula r communication within
the body.
Circulatory system: Your heart. blood, and blood vessels. This system transports
ENZYME hormones, enzymes, nutrients, and other chemicals throughout the body.
Substance that helps
Immune system : You r thymus, lymph nodes , spleen, tonsi ls, and other similar organs .
catalyze chemical reactions
This system protects against pathogens, tumor celis , and other foreign invaders.
Respiratory system : Your nasal cavity, trachea , lungs, and other airways and gas
exchange organs . Th is system excretes carbon dioxide and brings in oxygen .
Digestive system : Your ora l cavity, esophagus, stomach, intestines, and the organs
assoc iated with digestion inc luding the liver, ga l lbladder, pancreas, etc. This system
breaks down and absorbs nu trients from food and drink.
Urinary system: Your kidneys, ureters. bladder, urethra, and related organs and glands.
Th is system produces , stores, and eliminates urine.
Reproductive system : Your sex organs and glands. This system is responsib le for human
reproduction .
UNIT 1 Chapter 1 Cell Structure and Funct ion 29

ORGANS EP ITHELIAL TISSUE

Tissue composed of cellular
Our organ systems are made up of individual organs, which perform specialized functions
layers that protect outer
such as hormone manu facture , storage and release, building up or breaking down various surfaces of the human body
chemicals, and more. such as skin, mucosa, and
intestinal lining
TISSUES
Collectively, our tissues make up our organs, There are four major types of tissues, epithelial, CONNECTIVE TISS UE
connective, muscle and nervous, Epithelial tissues make up our skin; connective tissues Supportive tissue, such
as ligaments , tendons,
make up structures such as our joints and fascia; our muscle tissues make up our skeletal
and fascia. formed from a
muscles and hea rt, and are part of several other organ systems; and our nervous tissues
fibrous matrix
make up our brain, nerves, and associated structures. OUf tissues meet a host of the body's
diverse structural and functional needs, such as forming protective barriers against outside
invaders (epithe[ia[ tissues), moving the body through space (ske[etal muscle tissues), and MUSCLE TISSUE
Tissue consisting of bundles
communication between celJs (nervous tissues).
of cells that contract when
stimulated
CELLS
Our tissues are made up of large groups of cells, which are the smallest and most
NERVOUS TISSU E
abundant structural units in the body. A cell's size can range from 7.5 micrometres to
Tissue capable of
300 micrometres. (To give you some perspective, the dot over this letter "i" is about 100 conducting impulses
micrometres.) Ce lls reve al the uniqueness of all living matter in their diverse functions and that help to connect and
structures. For example, immune cells have the power to engulf pathogens and destroy them, communicate signals to
while muscle cells have sliding filaments that cause muscle contraction and relaxation. other parts of the body

ORGANELLES
Within each cell are a number of organelles, collections of molecules/chemicals that ORGANELLE
Component of the celf that is
perform specific individual functions, very much [ike position players on a sports team.
responsible for a specific task
The re are over 24 known organelles, the most important of which will be discussed in this
chapter. Examp[es of organelles include the endoplasmic reticulum (ER), Go [gi apparatus ,
and mitochondrion.

CHEMICALS
Within the cells, there's a semi-fluid mat ri x called the cytoplasm, which is composed CYTOPLASM
of a number of chemicals built from structures of varying sizes , from atoms (smallest) Fluid medium inside of
the cell. but outside of the
to molecules to macromolecules ([argest). Macromo[ecu[es are made up of groupings of
nucleus, that surrounds
molecules. Molecules are made up of tiny par ticle s called atoms . And these atoms, which organelles
are invisible to the naked eye, compose all material things of the universe .

The body is a highly organized entity designed to live and move comfortably within diverse
conditions and environments , However, its ability to do so relies heavily on the function of
our ce lls; in particular, the ability of certa in organelles to send and rece ive messages as well
as the ab ility of these organelles to create proteins .

Indeed, nearly everything that happens in the body is based on the production of proteins
and the function of the proteins that are produced. Th i nk of the body as a manufacturing
plant - that also manufactures itself. The proteins we make end up not only breaking down
and rebuilding the plant itself; they break down and rebuild the machines, the workers, the
messengers, and more. We'lJ get more into this idea as this chapter progresses. For now, just
remember that every level of human organization depends on the health of important sub-
units - our cells - and the proteins that they make .
30 UNIT 1 Chapter 1 Cell Structure and Fu nc ti on

MACRONUTR I ENT NUTR ITIO N AND CELLULAR INTERACTION

Nutrient the body requires
In genera l, the macronutrients (proteins. carbohyd rates, and fats), micronutrients (vi tamins
In large amounts (I.e ..
protein, fat. carbohydrates) and minera ls ), and ph ytochemical, (from th e Greek phyto, or pla nt s - Ihus , plan t che mica ls)
we eat are broke n down from our foo d through the digest ive process into smaller, more
distinct sub-units such as amino acids, glucose , fatty acids, etc. These digested and
MICRONU TRIENT
absorbed foodstuffs th en trave l through our bloodstream to interact with our cells.
Organic compound the
body requires in very small These nutrients are taken up in to our cells in particular ways to act in a host of life-giving roles_
amounts (i.e. , vitamins
and minerals) I. They provide potential en ergy that's later released by breaking the chemica l bonds
between the macronutrients.
POTENT IAL EN ERGY 2. They can prov ide raw materia ls that can then be incorporated into our body structures,
Energy stored within including tiss ues and organs.
a physical system
3. They can act as co- factors for chem ica l reactions in the body. All of th e chem ical rea ctions
that take place in the body re quire the help of spec ific protei ns, called enzymes. These
PHYTOCH EMI CAL enzymes ofte n use nutrients gathe red from the food we ea t to car ry out thei r fu ncti on_
Chemical substance obtained
(rom plants that is biologically
4_ They stimulate the releas e of hormo nes , which act as chem ical messengers, d irecti ng
active but non-nutritive overa ll body fun cti on wi th thei r unique messages.

Because of th ese various and important roles that nutrients have, the food we eat can thus
CO -FACTO R influence our physiological functioning as well as our overall health, body composition, and
Non-protein compound performance. No wonder nutrition is so criticaP
that interacts with another
substance to facilitate a Not everyone respond s the sa me way to the digestion and absorption of specific foods - or
transformation to the uptake of specific nutrients into the cell. Recent nutritional research suggests that
although the basic mechani cs are the same, there are important and intriguing individual
HORMON ES differences , which are lik ely due to our un ique genetic makeups. Ea ch cell in our bodies
Compound created by one houses our ge net ic code , a series of proteins ca ll ed DNA , in an organelle called the nucleus.
cell that travels to and
This code, which is uniq ue to each of us , provides cell ul ar instr ucti on for making proteins_
stimulates another cell
And , as discussed above, these prote in s are necessary for our structure and functi on . As
we all have sligh tl y different genetic profi les, the proteins we make may also differ; these
var iat ions are res ponsible for our individual re sponses to the food we eat.

FI GURE 1.2
DNA IN SI DE THE NUCLEUS

~~.--.- ....-.•.•....

)
............ ~-- -._//

Cell nuc le us contains chromosomes. Chromoso me s contain DNA. DNA provides cellular instruction
for mak i ng proteins.
UNIT 1 Chapt er 1 Cell S!rucl ure and Fu nc tlol1 31

In general, these differences are quite small. All humans share over 99.9% of the same GENETICS

genes. You may have even heard that humans and chimpanzees share betwee n 95% Specific. inherited DNA
of an organism. which
and 98% similarity in their DNA, which is also tr ue. As a resu lt, physiologica l functioning
influences what they
between individuals is surprisingly uniform. We are much more alike than we are different. become. although
However, these small genetic differences, called genet ic polymorph ism s, explain why some environment also plays a
people respond slightly differenlly to various Iypes of dietary intakes. These differences may key role in the expression of
also explain why many areas of nutrition research find apparently conflicting things. an organism's genetiC code

For example, we all have a gene in our livers that makes a specific enzyme necessary to
DNA
break down caffeine . However, due to these small genetic differences, some of us have the NucleiC acids that contain
enzyme that breaks down caffeine quickly, while others have the enzyme that breaks down instructions for heredity
caffeine slowly. People with the fast enzyme see an improvement in health when they drink
1-3 cups of coffee a day. In their bodies, the caffeine is processed and removed quickly
NUC LEUS
while the antioxidants found in coffee can stick around and help protect against free rad ica ls. Organelle where genetic
However, people with the slow enzyme are more likely to experience health problems with material is housed
the same 1-3 cups of coffee each day. When caffeine is allowed to remain in the body for
longer pe riods of time, it can become unhealthy.

Not only are there individual differen ces in respon se to the same foods, different foods
possess specific nutrients and other bioaclive components that can actually change the
message expressed by our un ique genes. For exampl e, broccoli contains compounds
(isothiocyanates) that can switch on a specific gene in the liver that detoxifies cancer-causing
chemicals and other toxins . Without the broccoli, this gene remains inactive and our bodies
look for other detoxifiers. Wilh the broccoli, this gene is upregulated and participates more
actively in the detoxification process.
GENE

Another example is cooked tomatoes. Cooked tomatoes contain compounds (lycopenes) that A particular sequence in
DNA or RNA that controls
switch off growth-promoting genes in th e prostate. With cooked tomatoes in the diet, prostate
the expression of a protein.
cancer ris k decreases; without the tomatoes, risk increases. and by extension influences
the characteristics of an
Fi sh oil is yet another example. Fis h oil (specifically DHA - a fatty acid found in fish oil)
organism
sig nals genes in the brain to produce a chem ica l that keeps Alzhe imer's disease at bay.
People who take fis h oil have belter cogni tive function as th ey age, rela tive to those who
don 't take fis h oil. GENETIC POLYMORPH ISM
Variation in the form of one
There are many examples like these of how nutrition can influence our gene expression
or a sequence of genes
to promote or degrade health. However, this area 01 research goes a bit beyond the scope
of th is certification course. If you're interested in this emerging area of research (ca lle d
nutrigenomics), check out our supplemental reading section in t he Appendix.
NUTRIG ENOMICS
Nutrient intake is also important in the regulation of our diurnal (daily) physiology. Things Study of how genes respond
like insulin release, glucose uptake, blood glucose, glucagon release, satiety hormones , to nutritional intake
enzyme release , nutrient transport, protein synthesis, excretion, and elimination are just a
few of the cel lular responses altered by food intake. Ne edless to say, there is an important
relationship between what we eat and how our cells fun ction. Throughou t th is course, this DIU RN AL
Daily cycle, e.g , of hormone
intera ction will become clearer. By the end of th is cou rse, you should ha ve a better grasp of
release
how to optim ize health, body composition , and performance by controlling nutnent intake.
However, before we talk more about food, let's discuss the ce ll in dept h, and in particular,
the main cellular compone nts and organ ell es. INSULI N
Protein hormone released
from the pancreas;
necessary for the
metabolism of nutrients
32 UNIT 1 Chapter 1 Cell Stru ct ure and Function

Plasma Mitochondria
membrane
Ly so some

Nucleus Cytoplasm

Goigi apparatus

Endoplasmic
o
Pero xisome
reticulum

FIGURE 1.3
CELL STRUCTURE
AND ORGANELLES

CELLULAR CO M PONENTS
To better understand how the food we eat interacts with our bodies, it's important to learn
abou t the structures , chemicals, and organelles that reside within each of our cells . In this
chapter, we'll rev iew the following important organelles,
PLASMA MEMBRANE
Upid bilayer that is Plasma membrane Golgi apparatus
permeable to certain Mitochondrion Lysosome
compounds that contains Nu cleus Perox isome
the cell
Endo plasmic re ti cul um

LIPID
These organelles and approximately 17 others (there are abo ut 24 or so in total) give our
Organic substance that is cells their structure and function, which are in turn often shaped by our nutrient intake.
insoluble in water; provides
structure . storage, and PLASMA MEMBRANE
messenger functions in
Around the edge of each cell is a boundary, known as the plasma membrane, that separates
the body
the ce ll from its neighbors and from the rest of our body. The plasma membrane's bilayer
(doub le layer) acts like a protective wal l, keeping important chemicals in while keeping
CHO LES TERO L
harm f ul chemicals out. The plasma membrane is made up of specific lipids, proteins,
Lipid/sterol contained in cholesterols , and ot her chemicals and it has an interesting nature: while it forms a structural
the body's cells and ffuids boundary betw een the cell and th e res t of the body, this boundary is flexible and Fluid -like.
that acts as a precursor Membranous organelles - speci alized sacs and cana ls - can float around within the plasma
to hormones and bodily membrane, rathe r li ke icebe rgs floating around in the ocean .
structures
This f luid-like bou nda ry is formed primarily of phospholipids, molecules with phosphate
"heads" and fatty acid "tails". The phosphate "heads" of the lipid molecules that fo rm the
bilaye r are hydrophilic (water-loving) and therefore can bond to water-based molecules.
On th e other hand, the fatly acid "tails" of the lipid molecu les that form the bilayer are
hydrophobic (wa te r-fearing) and bond best with fat-based molecules. This dual-purpose
membrane forms a bounda ry that regulates the free entry of substances into cells.
UNIT 1 Chapter 1 Cell Structure and Function 33

Extracellular space Hydrophilic

region

Hydroph ilic
region

Intracellular space

If a molecu le (such as an amino acid, a vitamin, a mineral , or a hormone) wants to enter the FIGURE 1.4

cell, it must flow through one of several membrane proteins. These proteins act like gates PLASMA MEMBRANE

in a fence, allowing only selected molecules to pass through. These cellu lar proteins are
discussed in more detail later in this chapter.

Because of this lipid structure, the types of fats we consume in our diets will influence the PHOSPHOLI PIDS
membrane's fluidity, or flexibility. For example, a diet high in saturated fat makes the membrane A type of lipid with a
more rigid, while a diet high in polyunsaturated fat makes the membrane more fluid . As a more hydrophilic phosphate group
fluid membrane improves the health of most cell types, we need an adequate intake of mono- "head" and hydrophobic
fatty acid "tail" that forms
and polyunsaturated fats as well as a ba lanced dietary fat profile. This type of intake prevents
cell membranes
tight packing of fatty acids in membranes, which allows better hormone and neurotransmitler
binding and thus improves cellu lar commun ication.
HYDROPHI LI C
A great example of this is the re lationship between membrane fluidity and i ns ulin sensitivity. Strong affinity for water
Recent research has shown that more tightly-packed membranes often have a st ronge r
resistance to insulin, leading to higher insulin concentrations in the blood and increased risk
of type II diabetes or diabetes-like symptoms. HYDROPHOB IC
Lack of affinity for water
CYTOPLAS M
The interior space of the cell , composed of a gel-l ike solution called cytosol . is called the CY TOSOL
cytoplasm. Many organelles, enzymes, salts and other organic molecules, including stored Internal fluid portion of
carbohydrates and fats, are suspended and maintained in the cytoplasm . The body carries out the cell
many of its chemica l reactions in this gel-like matrix, including most of its enzymatic re act ions .

Indeed, this is why the cytosol is rich in stored carbohydrates. As energy is required to do work,
these carbohydrates can be broken down quickly and used to transfer energy. Because this process
is governed by cytosolic enzymes, the high demand for energy in physically act ive people typically
stimulates an upregulation in the production of these key enzymes, along with both carbohydrate
and fat storage. Thus exercise increases both the cellular carbohydra te supply as well as the cell 's
ability to break down these carbohydrates to do more work. Th is is especially true in skeletal muscle
cells, since this is where highly trained individuals need most of their energy.
34 UNIT 1 Chapter 1 Ce ll Struct u re an d Fun ction

Outer membrane

Inner membrane
folded into cristae

FIGURE 1.5
MITOCHONDRION
Intermembrane
space

MITOCHONDR I ON
MITOCHONDR IA Mitochondria (plural of mitochondrion) are highly organized cellular organelles responsible
Organelles that supply the for converting things like protein, carbohydrate, and fat into energy. Much of the energy
cef/s' energy/ ATP (singufar: that's stored in carbohydrates, proteins, and fats is useless to the body unless it can be
mitochondrion)
oxidized, As it's oxidized, the energy stored in the chemical bonds is released. And, in the
mitochondrion, th is energy is converted into adenosine triphosphate or ATP.
OX IDIZE
To combine with oxygen Since ATP is the energy currency of the cell, mitochondria are respons ible for producing most
of the body's energy - about 95% of it. Thus, mitochondria are critical to overall health and
function. Without efficient mitochondria, our ability to live, breathe, move, and be energetic
ADENOS INE TRIPHOSP HATE
(ATPI is severely compromised.
Adenosine molecule with
ATP generation in the mitochondrion takes place in the inner mitochondrial membrane. The
three phosphate groups that
supplies energy for the celf outer membrane of the mitochondrion is porous, while the inner membrane serves as the
ma in barrier between it and the rest of the cell. The inner membrane contains folds called
cristae, in which the enzymes and structures responsible for making ATP are embedded .
CRISTAE
Internal compartments Since the mitochondria generate power for the cell, the number of mi tochondr ia in a cell is
of the mitochondria directly related to the activity of the cell. Frequent bouts of exercise can increase the number
of mitochondria inside muscle cells. This increase means more total energy production for
MITOCHONDRIAL DENS ITY the muscle. However, if muscle size also grows in proportion to mitochondrial increase, the
Quantity of mitochondria ATP production per unit muscle may not change. This is why we typically see an increase
per unit volume in mitochondrial density in elite athletes, they not only build more total mitochondria with
training, they also build more mitochondra per unit of muscle mass . This helps to supply the
oxygen and ATP required for high level endurance performance.
UNIT 1 Chapter 1 Cell St ruc ture and Fun ction 35

Mitochondrial quality is also linked to health and well-being. During ATP generation. our MITOCHONDR I AL QUA LI TY
mitochondria consume a specific amount of oxygen as electrons are passed down what is called Specific attributes of
mitochondria
the electron trans port chain (more on this later) . In the past. the relationship between electron
transport chain activity and ATP produced was assumed to be fairly constant between individua ls. REACT IVE OXYGEN SPEC IES
However, new data suggest that different people may make ATP at different ra tes, even with the (ROS)
same oxygen consumption/electron transport chain activity. This phenomenon may be related to Various substances
formed as a byproduct of
both a lower oxygen requi rement (and the related lower foed requirement) for the same ATP yield,
metabolism that are highly
as well as a lower production of reactive oxygen species (ROS), or free radicals . You see, when reactive due to the unpaired
oxygen is consumed in th e production of ATp, reactive oxygen species are formed. These unstable electron shelf
molecules can cause quite a bit of cellular damage, including some pretty serious DNA damage .
So it may be best to keep ROS production under control. FREE RADICALS
Reactive atom with one
In the past scientists believed that the more oxygen consumed, the more ROS were formed. or more electrons
However, it seems that in those with less efficient mitochondria, more ROS are formed per unit
CHROMOSOMES
ATP produced. With high efficiency mitochondria, the opposite is true: More ATP is produced per
Organized structure of DNA
unit oxygen consumed and per ROS formed. This may mean that those with higher mitochondrial
found within cells, that
efficiency will live longer, perform better athletically, and fee l more energetic . contains the genes of an
organism
While this research area is in its infancy, it's interesting to note that the relationship between
ATP generation and free radical production relies on mitochondr ia l quality. TRANSCR IP TION
ConstructIOn of mRNA from
NUC LEU S a DNA molecule
The nucleus is the largest organelle and is located in the central portion of the cell. Typically,
TRANS LATION
each cell has only one nucleus. The nucleus is critical to cellular function, as it's the Forming a protein molecule
residence of DNA, also known as the genetic code. Wrapped up in chromosomes , our DNA based on the information
dictates which proteins are formed in the body, which ultimately determines everything from contained in the mRNA
how the body deve lops, to how it repairs itself, to how it transports and/or metabolizes every
chemical introduced into circulation. ENDOP LASM IC RE TICULUM
Cytoplasmic membrane that
As discussed earlier, there is an impertant link between our DNA, our food intake, and our health . translates proteins
In fac t, much of what we eat interacts directly with our DNA or causes hormonal cascades that
influence our DNA. These relationships begin in our nucle us as specific chemicals can bond with GOLGI APPARATUS
Cytoplasmic organelle
our DNA to initiate cellular protein-making, called transcription and translation .
necessary for the modification
and transport of proteins
ER AND GOL GI APPA RATUS
The endoplasmic reticulum, or ER, is a "circulatory" network located inside the cytoplasm RI BOSOMES
and adjacent to the nucleus. Once our DNA sends out a signal to make proteins, the ER and A complex rich in RNA and
Goigi apparatus receive this genetiC message from the DNA and make and transport the protein found in celfs
required proteins fo r use inside and outside the cell.
GLYCOPROTEINS
There are two types of ER: smooth and rough. Rough ER is lined with ribosomes , which give Protein that contains a
it its "ro ugh" appearance. These ribosomes are the sites of protein synthesis and are therefore carbohydrate group, involved
in membrane integrity
considered "protein factories" of the cell. Smooth ER, on the other hand, does not have
ribosomes, therefore it doesn't directly form proteins. Rather, it synthesizes lipids, steroid
RIBONUC LEIC ACIDS (RNA)
hormones , and carbo hydrates to use in glycoproteins . Various nucleic acids on
a single strand containmg
The synthesis of proteins takes place using ribonucleic acids (RNA) and although the specific
ribose and uracil, necessary
steps of protein production are beyond the scope of this manual, it's important to kno w that
for the control of cell activities
once these proteins are synthesized in the ribesomes of the rough ER, they move towards the
Golgi apparatus, another organelle that is mostly responsible for preparing the newly formed
CIS TERNA E
protein molecules that are destined to leave the cell. The Golgi apparatus contains cisternae Flattened membrane disc
(tiny disc-like "ho lding tanks", similar to the word "cistern") that are stacked on one another of Goigi apparatus (plural:
cisternae)
36 UNIT 1 Chapter 1 Ce ll Stru cture and Function

Rou gh endoplasmic
reticulum (ER)

Smooth ER

Cis (C) face,

Transport vesicle receives transport
from ER vesicles from ER

Golgi apparatus

Trans (T) face , produces

vesi cles for cellula r
Transport vesicle
use or for excretion
from Go lgi apparatus

FIGURE 1. 6 and small, ci rcular ves icles. These vesicles act like litt le chaperones , engulfing the protein
ENDOPLASMIC RETICULUM molecules and tran sporting them to the cell membranes for releas e or incorporation.

VES ICLE S LYSOSOMES AND PEROXISOMES

Fluid filled pouch/sac that Lysosomes are enzyme -containing vesicles (small sacs) , capab le of breaking down cellular
can transport and store components and protecting cells. If a large molecu le, such as an old ce llu lar st ructure
compounds or a microorganism enters the ce ll, the lysosome will digest and d is pese of it. Basi cally,
Iysosomes are co nsi de rec "cell ular garbage disposals" that he lp in the process of ce llular
ren ewa l and/or ce llu lar protection.
LYSOSOME
Organelle con ta ining Peroxisomes are similar to Iysosomes: they are sma ll membranous sacs contain ing enzymes
hydrolytic enzymes (ca tala se and oxidase), whic h also detoxify harmful substances that enter ce ll s. Found commo nly
in liver and kidney cells, perox isomes are also impertan t in choleste rol synthesis , bile aci d
synthesis , B-oxidation, and prostaglandi n metabolism. Inte re sti ng ly, peroxisomes function in
MICROORGANISM
a manne r very sim ilar to mitochondria, but there's one very im portant differe nce in how they
Organism of microscopic size
hand le the breakdown of fat s. Specifically, when fats are broken down in th e peroxisome, 30-
40% more heat is produced and 30% less ATP is produced. Since dietary omega-3s, especi ally
PEROX I SOME
fish oils, increase fat breakd own through the peroxisomes, more fat breakdown is req uired per
Cytoplasmic organelle with unit of ATP production . Thi s means that more fat is burned to do the same daily activities.
enzymes for production and
breakdown of hydrogen CELLULAR PROTEINS
peroxide Now tha t we've covered the major cel lul ar organelles, let's cover the main proteins fo und in
our cells , protei n recep tors, transport prote ins , and enzymes.
OETOX IFY Understa ndi ng t he func tion of these cellula r proteins he lps us unde rs tand how molecules like
To remove a poison or toxin
nu trien ts , hormones, and othe r chemicals can infl ue nce our ce lls' functions.
from the body
UNIT 1 Cha pter 1 Ce ll Structure a nd Function 37

PROTEIN RECEPTORS AND CEL L SIGNALING RECEPTOR - LI GAND

BI ND I NG COMPLEX
Our plasma membranes typically prevent the entry of nutrients, hormones, and so forth from
A complex formed between
the bloodst ream. However, specific proteins embedded in the cell membrane can act as a receptor and a substance
rece ptors that, when bound to these chemicals, can produce a specific response. Of course, to allow for further cellular
not all receptors and chemicals are destined to fit together. Th is is a good thing, since specific activity
molecules need to be kept out of specific cells. However, if the chem ica l and the receptor
match, they bind together to form a receptor-ligand binding complex. Once this bond forms
SI GNA L TRANSDUCTION
successfully, a process called signal transduction can take place . Second messengers are
Conversion of one signal to
turned on and either direct cellular responses occur, or changes in gene express ion take
another by a cell
place in the nucleus of our cells.

An example of a protein receptor initiating a signa l transduction cascade is the cellular response
to insulin. Whenever we eat a meal , especially one higher in carbohydrate, the hormone insulin SECOND MESS ENGER
Substance that mediates
is released from the pancreas . This hormone then travels through the bloodstream and binds
intracellular activity by
to a specific protein receptor in one of our cell membranes. Th is ligand then alters cellular relaying a signal from an
function , in particular the cell's carbohydrate uptake, by upregulating the number and operation extracellular molecule
of protein molecules within the cell that bring glucose into the ce ll

Whi le a host of protein receptors are loca te d within the cell membrane, additional receptors
TRANSPORT PROTEIN
are located inside our cells. When bound to different nutrients, hormones, and so on, these
Protein that moves
receptors can also alter cellular function . compounds across a
membrane
TRANSPORT PROTEINS
Transport proteins are proteins in the cell membrane tha t act as channels or molecular
carriers. Unlike recepto r proteins, these proteins allow the passage of water-soluble FACILI TATED DIFFUSION
Transport that requires a
molecules between the spaces inside the cells and the spaces outside the cells. This
carrier molecule; occurs when
diffusion of a substance on its
own is not possible

o e--- ligand
(primary
messenger)
ACTIVE TRANSPOR T
Movement of particles
from an area of low
o o o
o oo Receptor
concentration to an area of
high concentration; requires
1. Receptor- energy and enzymes
ligand binding

CYTOSOL
FIGURE 1.7

< Second
messenger
PROTEIN RECEPTOR AND
CELLULAR SIGNALING
2. Signal
transduction 3. Cellular responses
(via second
messengers)
38 UNIT I Chapter 1 Cell Struc ture and Fu nction

Extracellular space
CJ
o
o o o
o

o
() ,
Intracellular space
o o

FIGURE 1.8 movement across the plasma membrane can take place via one of two mechanisms:
TRANSPORT PROTEINS facilitated diffusion or active transport.

This type of cellular transport allows necessary molecules, such as vitam ins, minera ls,
SUBSTRATE
Substance acted upon by an
glucose, and amino acids into the cells, where they can perform vital functions.
enzyme
ENZYMES
Enzymes make up the largest group of prote ins in the body. You can often spot enzymes
LOCK ·AND · KEY MODE L by their names, which typically end in "-ase", such as lipase (enzymes that degrade
Model that explains enzyme lipids), protease (enzymes th at degrade proteins), and amylase (enzymes that degrade
specificity
carbohydrates). Enzym es are important biological catalysts that facilitate and speed up
nearly every che mica l reaction tha t occurs in the body. A host of en vironmental, genetic , and
INOUCED FIT MODEL nutri tional fac to rs - including temperature, pH, substrate concentra tion, and vitamin and
Model that suggests mineral status ~ can influence enzymatic function. Thus nutrition plays an important role in
enzymes are rathe r flexible most enzymatic reactions.
structures
Enzymes work by exposing their own "active sites" to connect with specific mo lecu les.
Once the enzyme can ho ld these molecu les in place, reac tions can occur. One model of
CO -ENZYME this process is the lock-and-key model. In this model, the enzyme and chemical substrate
Non-protein com pound that fit together tightly and carry ou t their rea ction. In another model, the induced fit model,
forms the active portion of
the enzyme and chemical substrate undergo structural change s when close to one another,
an enzyme system
eventually fitting together properly and initiating the cata lyt ic reaction.

Just like a copilot operates alongside a pilot, co-enzymes operate alongside of enzymes.
CATALYZE Co-enzymes are non-protein molecules, composed wholly or partly of vitamins, and are
Initiate or increase the rate necessary to ass ist in enzyme catalyzed reactions.
of a chem ical rea ction
UNIT I Chapter 1 Ce ll Struc ture and Fu nct ion 39

This chapter has provided an introduction to the basic cellu lar anatomy and function that
you' ll need to understand the body's organization as well as its interaction with food and
nutrients . This foundational knowledge is critical to your development as a nutritional
thinker, and it will enab le you to fully comprehend the applied nutr i tional information that
we'll be sharing with you as this course progresses. Make sure you 're comfortable with the
information co nta ined in this chapter before moving on to the next and beyond .

substrate enzyme-substrate products FIGURE 1.9

WW
ENZYMES

Q
bo nds in substrate
are wea kened
40 UNIT 1 Chapter 1 Cell Stru ctu re a nd fu nct IOn

1. The tri llions of ce lls of the hu ma n body wo rk together to fo rm ti ssues, organs, and
organ systems. The total of all of the activities taking place in these systems is
what most peop le refer to as "metabol ism."
2. There are many levels of organization in the body, from microscopic atoms up
to fully functiona l organisms . Each level is necessary for opti ma l fu nctioning of
the next.
3. The food we eat interacts with the sma ll chemica l reactions and processes taking
pl ace in our cells. This interaction, especially w ith our genetic material, de termines
our health.
4. Food affects our hea lth in fou r ways: it provides energy; it provides metabolic co-
factors ; it's incorporated into body structures; and it influences chemicals such as
hormones and neurotransmitters.
5. Our organelles, which reside within our cells, convert food into ATP and make
protei ns.
6. Our genetic information directs protein-making signals. Our food can affect these
signals as we ll as the quality of the proteins that are made.
7. Enzymes and co -enzymes are compounds necessary for nearly every cellular
process in the body. Enzymes help reactions occur.
CHAPTER 2

FOOD INTAKE,
DIGESTION &
ABSORPTION
Chapter objectives
Key terms
Food versus nutrients
From food to nutrients
Digestive system structure
and function
Accessory digestive organs
Controlling the digestive process

. The endocrine system

The nervous system
Nutrient absorption
Nutrient delivery
Chapter 2 Summary
KEY TERMS
soluble carcinogens
general circulation prebiotics
monounsaturated probiotics
fats hepatic portal
triglycerides system
oxidation exocrine
gastrointestinal endocrine
tract glucoregulatory
calories hormones
organic molecules neurotransmitters
adenosine dl· neuromuscular
phosphate (AOP) junction
mastication parasympathetic
bolus nervous system
bile vasodilation
enterocytes microvilli
villi intestinal brush
border
amylase
simple diffusion
lipase
facilitated diffusion
pharynx
active transport
epiglottis
concentration
lower esophageal gradient
sphincter
peptic ulcer
gastroesophageal
reflux emesis
peristalsis inflammatory
bowel disease
chyme
food intolerances
pyloric sphincter
glycogen
hiatal hernia
hepatocytes
hydrochloric acid
deamination
pH
lipoproteins
ileocecal valve
first pass
pancreas metabolism
bicarbonate systemic
proteolytic circulation
enzymes transamination
gallbladder acetyl-GoA
emulsification ketone bodies
enterohepatic blood-brain
circulation barrier
feces
short chain fatty
acids
UNIT 1 Ch apter 2 Food Intake. Digestion & Absorp ti on 43

Food versus nutrients

The food we ea t is com posed of a variety of nut rients, some known, and some unknown.
The most well-known and abundant nu tr ients (mac ronutrients) are protei ns, carbohydrates,
and fat s. Food also co ntains sma lle r, less- abundant nut rie nts (micronu tr ients), such as wate r,
vit am ins, minerals , an d phytonutrients. Each of these cla sses of nutr ients is impor tant for
physi ological func ti on. As th e chemical structures of these nutr ie nts are fairly la rg e, we must
break th em down into smaller, unbound, and/ or more soluble units in order to be absorbed SOLUBLE
into the body. Dispo sed to being dissolved

On ce absorbed, these smaller uni ts - the amino acids that made up our prote ins , the glucose
units that made up our carbohydrates, and the fatty ac ids that ma de up our dieta ry fa ts, etc.
- become usab le by our cell s. Al though the speed of digestio n and the hormon al response
to speci fic amino aci d, glucose, or fatty aCid-containi ng foods can va ry, once the se smalle r
subunits enter the general circulation , th eir actua l food source doesn't really ma tter, once GENERA L CIRCU LATION
broken dow n and absorbed, th e body doesn't necessari ly recognize the difference between The flow of blood throughout
the entire body
the amin o ac id s derived from whey protei n in the form of protei n po wder or the amino acids
der ived from whey protein as it's na turally found in milk. Nor does it recogn ize the difference
between glucose derived from whole wheat bread or glucose derived from table suga r. And
it doesn't recognize the differe nce between monounsaturated fats from a ham bu rger or MONOUNSATURATED FAT
monou nsat urated fats from oli ve oil. Fatty acid containing one
double or triple bond
However, just because most carbohydrate foods eventua ll y become glucose mo lecules, mos t between carbons
protei n food s become amino acid s, and most triglycerides become fatty acids , it do esn't TRIGLY CERIDE
mean that the quality of the food we eat is unimpor tan t for health, performance, and body Compound with three
composition. Indeed, the hi gher th e food quality, the better the phYSio log ic al res ponse will molecules of fatty acids
bound with one molecule of
be du ring the digestive, absorptive , and nut rie nt deli ve ry process. Anyo ne who suggests
glycerol; the storage form of
otherwise might as we ll cla im that the taste of food doesn't matte r sin ce it "all en ds up in the
fat in humans
same place." Both argumen ts are eq ually absurd.

Understanding the nutrien ts th at make up our food is a fundamental part of learnin g nu trition
at the profess ional level. Yet many professionals becom e too focu se d on the nutrients and
not enough on th e foods. Th is is a mistake, for two reaso ns. The first is socia l. people ea t
food , not nutrients. While it may be inleresting to learn all about the nut rients we eat, it's
important to ta lk in terms of who le foods and the ir eff ects on the body. This is especia lly
so when discussing eating habit s with clie nts. Second, foods themse lves must be viewed
as unique combinations of nutrients , not single nutri en ts, in order to unde rstand how they
behav e in th e body.

Here' s an examp le , although both whol e wheat bread and table suga r end up as glucose in
t he bloodstream , there are key differences between them as whole foods . For instan ce,

1. Whole wheat bread is digested and absorbed much mo re slowly bec ause of its higher
fibe r content. This me ans that less suga r appears in the blood per unit ti me . As a resul t,
less insulin is released and less fat is likely to be stored.
2. If dietary fat appears in the same meal , the fiber in the wheat would likely bi nd some of OX IDATI ON

the fat whil e still in the in te stines, ca rr ying it out of the body before it can be abso rbed. Increase of positive
charges on an atom or the
3. Vita mins and minerals in th e whole wheat bread help assist in th e enzymatic processes of loss of negative charges;
digesti on, absorption, trans por t, oxidation , and more. This, in turn, would make us more the opposite rea ctIOn is
metabOlically active. reduction
44 UNIT I Ch apter 2 Food Intake , Digest ion & Absorplton

GAS TRO INT ES TINAL IG I) There are many more differences between whole wheat bread and tab le sugar, which
TRACT demonst rates that unde rstand ing food, not just the nutri ents it conta in s, is essen tial to
The long tube through the
learni ng how our nutri tiona l choices can affect OUf bodies.
body composed of stomach
and intestines

From food to nutrients

CALORIE
Amount of energy required The gastrointestinal (Gil tract functio ns as a management and coordination system that
to raise the temperature of allows beneficial substances in to the body while keeping harmful th ings out. When we
one kilogram of water by consume food and/or beverages, the GI trac t extracts and transpor ts the major nutrients from
1 degree CelsIus; equal to
them while blocking potentially harmful microorganisms trying to hitch a ride through to
4184 Joules
the bloodstream. Diverse and rob ust, a healthy GI tra ct is equipped to break down all sorts
of foods, and can d igest and absorb about 97% of the food we eat. After they are broken
OR GAN IC MOLECULES down , foods must be absorbed across th e ce lls lining our gastroin test inal tract. Finally,
Relating to or containing after processing (usually in th e liver), these food components get to tra vel through the
carbon compounds bloodstream, with one of three eventual fates: storage, energy production, or exc retion.

Let's begin with the production of energy. The main sources for energy production in the
ADE NOS INE DIPH OSP HATE body are the macronutrients: carbohydra tes, fa ts, and proteins. The amount of energy that
IA DP ) can be extracted from these macronutrients is exp ress ed in speci fic uni ts called calories .
Nucleotide produced in living
How can these macronutrients provide energy' All the nutrients we get from food are
celfs; made up of adenosine
conside red organic molecules since th ey contain carbon. The macronutrients contain
and two phosphate groups,
reversibly renewed to ATP for a host of special chemica l bonds that link this carbon with hydrogen molecules. In the
energy transfer presence of specific enzymes, thes e carbon-hydrogen bonds are broken in a controlled
manner, which releases energy. This , in turn, helps to join togeth er two key ene rgy
mediators hangi ng around in our cells: free adenosine di-phosphate ADP and phosphate
(P). When ADP and P join together, we get ATP. ATP is then used for things like muscle
contraction, nutrient uptake into the cells, and more.

®H-'
FIGURE 2. 1.
ATP SYNTHESIS o· o· adenine
I I
+ ·o - ~ - o -I-O- CH ?

o 0
ribose

Energy available Energy used from

for physiological food to bind
processes phosphate to ADP

o o· o·
I I I
·0 - p- 0- P -0- P - a- cHI
I I I
000
ribose
UN IT 1 Chapter 2 Food Intake. Diges t IOn & Absorption 45

Mouth

-t-Jft'c- - Stom ach

Liver

~Il--- Sma ll intes ti ne

La rge intestine --=--""'-:'1
FIGURE 2.2,
THE DIGESTIVE SYSTEM

In addition to energy produc tion , the body can also use these nutrients for energy storage
(in musc le tissue , li ver tissue , fat tissue, etc.) or, when excesses or breakdown products are
prese nt, excrete them (through sweat, urine, etc.). We' ll discuss these processes in fur ther
deta il as we move forward.

Digestive system structure and function

MAST ICATION
Also referred to as the alimentary ca nal, GI tract, or gut, the digestive system sta rts at the To grind, crush and
mou th and ends at the anus . Amaz in gly, although most of us are somewhere between fi ve chew food
and seven feet ta ll, this system is actually 25 fee t in length as it bends and twists its way
BO LU S
through the tru nk of our bodies. All 25 feet are made up of strong muscu lar tubes li ned
A formed mass of soft.
wi th thick and special ized cells. These tubes act as an important connection to (and barrier partially chewed food
between) the externa l environment.
BILE
The digestive process begins in the mouth with the process of mastication or chew ing . While Fluid produced by the lIVer
chewing , ou r food is mixed with secret ions of fluid released from our sal ivary gland , located and stored in the gallbladder,
adjacent to our ora l cav i ty. Once mixed with these flu id secretions, the food is formed into ultimately secreted mto the
a bolus . If all goes well upo n swa ll owi ng, this bolus trave ls down the esophagus and then small intestine to alkalin ize
and emu lsify foodstuffs
ente rs the stomach. The process of chewing also quickly triggers the appearance of specific
acids, mucus, enzymes and bile, all secreted by the stomach and a host of supporting EN TEROCYTE
organs. The purpose of this symphony of digestive action is to break down the incoming Absorptive ce f! of the intestine
bolus of food while extracting the nutrients.
VI LLI
The nutrients released during the breakdown process then travel to the small intestine . Small projections (singular:
villus) covering the surface of
There , the nutrients can be absorbed throug h specific intestina l ce ll s ca ll ed enterocytes .
the mucous membrane lining
The intestines have a tremendous amount of surface area , or exposed space, full of fo lds,
the small intestine, through
pits, and fingerlike projections known as villi. The amount of surface area in the intestine which nutrients and fluids are
is equivalent to that of a tennis court! In order for absorpt ion to occur, ou r now digested absorbed
46 UNIT 1 Chapter 2 Food Int ak e, Dige stion & Absorption

food must travel slowly through the intestines. Th is gives the GI system amp le time for
the nutrients to come in con tact wi th the enterocytes so that they can be grabbed and
transported in to blood circu lation, just on the other side of the intestina l wa ll. If ample time
isn't gran ted , or the nutrients are bound to fiber, etc ., these nutrients typically pass through
the intestinal tract unabsorbed , to be later excreted as waste.

Once the nutrients have been absorbed into circulation , they are passed along to the liver.
The liver acts as the body 's main bouncer, it decides what to do with the nutrients before
allowing them in to general circu lation. We'll look more at this process later ; fo r now , let's
exp lore each digestive structure in more detail.

THE MOUTH
The mouth is where food enters the digestive system . Once in the mouth, food is broken
apart by chewing (mastication), which reduces its size. Moistened and lubricated by saliva
du ring mastication, food is then formed into a bolus and passed onto the next digestive
structure (the esophagus) upon swallowing.

STRUC T URE

The mouth is lined with a mucous membrane that covers and protec ts it. This membrane
also contains the cells and assoc iated glands that secrete mucus. On the roof of the mouth,
the palates form a pa rtition between the nasa l passages and the mouth; they also protect
the teeth and all ow fo r proper speech . The lips , cheeks, and tongue make up the structures
surrounding the mouth. The undersurface of the tongue and the floo r of the mouth are
rich with blood vessels. In some cases, a small amount of absorption can take place in the
mouth , even before food gets to the stomach or the smal l intestin e. This is especially true
for certain soluble drugs (drugs that disso lve in water) that are placed sublingually (under
Ihe tongue). The teeth are essential for mastication and are covered by ename l, which is the
AMY LAS E
Of pancreatic and salivary hardest and most chemical ly stable tissue in the body.
origin, this enzyme catalyzes
the hydrolysis (splitting) DIGESTIVE MECHAN ISMS, SECRET IONS, AND ENZYMES
of starch into smaller
The sa livary glands are located next to the oral cavity. They produce about 1.5 litres of sa liva
compounds
per day, which contains digestive enzymes like amylase and lipase. Amylase (ptyalin) begins
the digestion of starch , althoug h it's rendered inactive as il reaches the acidic environment
LIP ASE of the stomach. Although lipase is essential for the digestion of fats, very little fa t is actually
Catalyzes the splitting of fats digesled in the mouth , as fat digestion takes a fairly long pe riod of time and dietary fat
into g/ycerof and fatty acids
usually spends little time in Ihe mou th.

EVEN T UAL DIGESTIVE PRODUCTS

PHARYNX
Throat Once Ihe food mass is chewed, lubricated, and formed, it is commonly referred to as a
bolus. The bo lus is passed to the pharynx under voluntary control , alt hough the process of
EP IGLOTTIS swal lowing is actua ll y involuntary. When swa l lowing , the epiglottis also involuntarily closes
Lid-like cartilaginous to prevent food from entering ou r trachea, which would be disastrous as food would then
structure suspended over block our airways. However, sometimes fluid sneaks down before the closing of the epiglottis.
the entrance of the larynx; This is what people describe as water "go ing down the wrong pipe."
swa llowing cfoses the
opening to the trachea by
THE ESOPHAGUS
placing the larynx against
the epiglottis The esophagus is a tube 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 ea t" - thus, the
esophagus carries what we eat from the mouth to the stomach.
UN IT 1 Chapter 2 Food Inta ke , Di ges tion & Ab sorp tion 47

STRUC TUR E

The esophagus , which extends between the pharynx and stomach, is a lO-inch , collapsible
muscular tube li ned with a mucous membrane. The lower portion of the esophagus ends
in a ring -l ike muscle, known as the lower esophageal sph incter (or cardiac sphincter), LOWER ESOPHAGEAL

which regulates food entry into the stomach , as well as out of it one of its important jobs SP HINCT ER
Also known as the cardiac
is to preve nt food and acid ic stomach juices from re-enter ing the esophagus , an unwanted
sphincter, a thick, muscular
siluation known as gastroesophageal reflux disease (GERD, more commonly referred to as ring surrounding the
heartburn) . Gastroesop hageal reflux is caused by the sphincter opening more often than it opening between the
should or opening at the wrong times . While your diet doesn't likely cause gastroesophageal esophagus and stomach
reflux, it can make it worse. Certain foods such as chocolate, pepperm int, alcoholic drinks,
GAST ROESOPHAGEAL
caffeinated beverages, citrus dr inks, tomato-based foods, and high fat/fried foods can often
REFLUX
exacerbate symptoms. Further, GERD symptoms can be minimized with small, more frequent Condition in which acidic
meals and avoid ing lying down immediately after mea ls. stomach contents flow back
up into the esophagus
DIGEST IVE MECHAN ISMS, SECRET IONS , AND ENZYMES

The mucous membrane lining the esophagus creates a smooth surface with minima l
resistance and/or friction to enable the passage of food . Due to the high traffic of food
through the esophagus, these mucosa l cells turn over frequently, they die off and are
rep laced at a rapid rate. Food moves through the esophagus wi th the help of gravity
(which is why GERD symptoms can be alleviated by staying upright for a whi le after
ea ting) and a series of wavel ike contractions , called peri stalsis , of the smooth muscle PER I STA LSIS
that makes up the esophagus . Waves of involuntary muscle
contraction moving the
THE STO MAC H contents of the GI tract
forward
The stomach is responsible for the first major stage of digestion. The stomach begins to
digest our food by releasing acids while breaking the original bolus down into smaller pieces
ca ll ed chyme . CHYME
Partly digested food formed
STRU CTUR E as a semi-fluid mass

The stomach sits in the upper part of your abdomen, slightly to the left, between your
esophagus and your small intestine . When empty, the stomach is quite small. However,
depending on your meal, it can distend to a vo lume of near ly 4 litres, which is almost 50
times its empty volume! To accommodate the food we eat, the stomach expands like an
accordion.

The stomach is divided into three parts ;

• the fundus (the first part, just beyond the esophagus),

• the body (the central part), and

• the antrum (the lower part) .

Another ring-like muscle known as the pyloric sphincter lies at the end of the antrum and PYLOR IC SP HINCTER
regulates the passage of chyme into the sma ll intestine . Interestingly, because the stomach Th ick, muscular ring
begins toward the left side of the body and ends toward the right side, when lying on your of mucous membrane
surrounding the opening
right side , grav ity will assist in the stomach contents passing through the pyloric sphincter.
between the stomach and
Indeed, in a famous comed ic novel, The Confederacy of Dunces, the ma in character, who is the duodenum
having problems with his pyloric sphincter, lies down on his right side and bounces, taking
adva ntage of this anatomica l situation and assisting in gastric emptying.
48 UNIT 1 Chapter 2 Food Intake, Digestion & Abso rption

Esophagus -~~ Gastroesophagea l

Cardiac sphincter
:::;~1~~@~~~~\- Gastric mucosa
1;'~iN~,j--- Submucosa
Duodenu

.t',1-""':"/-- Smooth muscle

FIGURE 2.3
THE STOMACH

You may be familiar with the te rm "he rnia", which describes a protrusion of tissue throug h
HIATAL HERNIA a rupture in a barrier tha t normally contains it. A hiatal hernia occurs when a small piece
Protrusion of the stomach of the fund us peeks through a small tear in the diaphragm . Hiatal hern ias typically improve
through the esophageal
wi th exerc ise, weight loss, sleeping on a sli ght inc lin e, or prescr ipt ion medications. Surgery is
hiatus of the diaphragm
only necessary in ex tre me cases.

DIGESTIVE MECHANISMS, SECRE TIONS , AND ENZYMES

The stomach wall has four layers. The first main layer is the gastric mucosa, which has cells
that secrete most of the gastr ic juice, a mucous fluid contain in g digestive enzymes and th e
HYDROCHLORIC AC I D stomach's main aci d, hydrochloric acid. Chief cells secrete th e enzymes of gast ric juic e, and
Solution of hydrogen par ietal ce lls sec rete hydroch oloric aci d and intrins ic fact or (IF). IF is essential for vitamin
chloride in water; found in
B12 absorpt io n.
gastric juice
The second layer is the submucosa, which consists of fibrous co nnective tissue designed to
join th e gastric mucosa to the next la yer of the stomach , a layer of smooth muscle called the
muscularis externa. This third laye r of the stomach contains smooth muscle fiber that run
circularly in orde r to sq ueeze food through the st omach toward the sma ll intestine . The fourth
and final layer of the stomach is the serosa. The serosa is anot her connective tiss ue layer that
co nn ects the muscu laris externa with the abdominal perito neum, a membrane that covers
most of th e intra -abdominal organs .

This network of cellular layers produc es and contains stomach acid, mixes enzymes, acids,
and foodstuffs, and moves food along to the intestine, where most of the absorpti ve process
takes p la ce in the body. Minima l absor pti on actually takes pla ce in the stomach. Only
certain dr ugs , water, some vitamins , al cohol, and specifi c short ch ai n fatty acids are able
to cross the thick stomach li ni ng and enter genera l circulation. The stomach is therefore
predominantly a digesti ve rather tha n an absorptive organ .
UNIT 1 Chapter 2 Food In take, Digest ion & Abs orp tion 49

In addition , the stomach acts as an important barrier against microorganisms. During the
digestive process, the pH of the stomach, a measure of acidity, moves closer to 1, making pH
it more acidic. Indeed, as the stomach contains hydrochloric acid , it maintains a pH Measure of acidity and
alkalinity; lower numbers
between 1 and 4 - the same pH as battery acid . This high acidity not only helps with the
are more acidic. higher
breakdown of food, it also he lps destroy most of the pathogenic bacteria swallowed with
numbers are more alka line;
food or mucus. 7 is neutral

EVENTUA L DIGEST IVE PRODUCTS

After working its way through the stomach, the chyme begins to empty into the small
intestine, but at a very slow rate - only a few millili tres at a time. This chyme cons ists of
partially digested food, water, acids , and digestive enzymes. With th is slow rate of movement
out of the stomach, it usually takes between one and four hours to empty, depending on the
meal composition. Ca rbohydrates empty first, proteins second, and fiber and fa ts empty last.

THE SMALL AND LARGE INTESTINES

The next struct ure in the digestive chain is the small in tes tine. This organ receives the chyme
from the stomach and begins the absorpt ive process.

STRUCTURE

The small intes tine is subd ivided into three main parts.

The duodenum is the first section past the stomach; it's about 1.5 feet long.
The Jejunum is the second section and is 7 to 10 feet long. Most nutrient absorption
takes place in these two portions of the intestine.

FIGURE 2.4
SMALL AND LARGE
INTESTINES

La rge intest in e

/·f.+~~~'--- Small intestine

W~---------Anus
50 UNIT 1 Chapler 2 Fo od Int ake. Diges tion & Abs orpt ion

ILEOCECAL VALVE The final section of Ihe small intestine is the ileum. It is 10 to 13 feet in lengt h. It
Two folds of mucous absorbs vitamin 812 , bile salts, and whatever products of digestion were not absorbed
membrane that form a valve by the jejunum.
between the large intestine
(ileum) and the small At the end of the ileum li es the ileocecal valve, another ring-like sphincter that blocks entry
intestine (cecum) into the large intestine.

PANCREAS Also referred to as the colon , the large intestine is, well, larger than the small intestine, at
Large gland behind the least in diameter However, it's much shorter in length , spanning only about five to seven
stomach that secretes feet. Subdivided into several portions, including the cecum, the ascendi ng portion, the
digestive enzymes and
transverse portion, the descending portion, and the sigmoid portion, the colon connects with
the hormones insulin and
glucagon the anus to complete the digestive tract. The sigmoid portion of the colon is shaped like an
"S" that bends toward the left. This is why a person receiving an enema will be turned on
BICARBONATE their left side, this position allows gravity to aid the flow of enema fluid.
Organic saft (HeO)) that
can neutralize acids DIG EST IVE MEC HANI SM S, SECRET IONS, AND ENZYM ES

PRO TEOLYTIC ENZYME Once chyme enters the intestines, it travels slowly, about 1 em per minute. It takes
Enzyme that hydrolyzes anywhere from four to eight hours for chyme to travel the full distance to the end of the
(breaks down) protem or small intestine and reach the ileocecal valve. During this time, the in testines are responsible
peptides
for segmentation, a series of muscle contractions that further breaks up the chyme, and
GALLBLADDER absorption.
Muscular sac where bile is
The first segment of the intestine , the duodenum, is where juices originating in the pancreas
stored
are secreted. The juices, which contain bicarbonate, lipase, amylase, and the proteolytic
EMU LSIFI CATION enzymes, have two tasks, fi rst, to neutralize the formerly acidic chyme with the very basic
To disperse, convert and (alkaline) bicarbonate; and second, to further break down the foodstuffs into their component
suspend one liquid as
parts . During this time, bile (composed of bile salts and cholesterol) is also released from the
droplets into another
gallbladder to assist with the emulsification of fat. Emul sification occurs when two otherwise
unblendable substances (such as oil and water) are mixed . (A salad dressing, for example,

FIGURE 2.5
SITES OF ENZYME
SECRETION

' - - - - - - - - Li ve r

~ _ _ _ _ _ _ _ _ Cystic duct

o-t""''<-'.------------:=-- Gallbladder

Co mmon bile d u (: t ----~~

j"f,i;;="---,.-L-------- P,ancrealt ic duct

------!;m"11 in te stine
UNIT 1 Chap te r 2 Foo d Int ak e, D igest ion & Absorp t ion 51

Pancreatic juices im portant to sma ll intest inal digestion and absorption

PROTEASES LlPASES AMYLASES

liberate peptides and amino acids liberate fatty acids , liberate maltose from starch
from prote i ns monoglycerides, and glycerol from
emulsified fats

is usually an emulsion , as is dairy cream.} In the case of dietary fat, this allows the fat to
become more solub le and ready for absorption .

During the process of chyme movement through the sma ll intestine, most of our nutrients
(inc lu ding electrolytes, iron, calcium, magnesium, zinc, carbohydrates, wa ter solub le
vitamins, am in o acids , fat, fat so lu ble vitamins, cholestero l, bile salts, alcoho l, and vitamin
B12) are absorbed . However, the exact locat ion of the absorption of spec ific nutrients
depends on several factors, including the time it takes to get through the small intestine.
You'll notice that bile salts are included in the li st of nutrients above . These salts, which are
introduced into the digestive process in the duodenum of the small intestine, are partially
recycled through re-absorpt ion. Without re-absorption, new bile salt production wou ld not be
able to keep pace with digestive processes . The process of bile sa lt recyc lin g is referred to as
enterohepatic circulation . So luble dietary fiber can bind to a port ion of the bile salts in the EN TERO HEPATIC
sma ll intestine and promote their elim ination from the body. As cholestero l is required for CI RCULATION
Circulation of blood between
new bile synthesis, this causes more cholesterol to be utilized for new bile synthesis. Hence,
the intestme and the liver
dietary fiber can lower cholesterol.

The large intest ine's first section past the small intestine is called the cecum. Once chyme
passes into the large intestine, it takes another 12-25 hours before waste materia l is passed
from the body. Movement of material through the large intestine/colon proceeds at a rate of
about 5 cm per hour. During this time, the large intestine absorbs sodium, potass iu m, acids,
gases and most of the remaining water in the chyme . What's left is the semi-solid waste we
call fec es. FECES
Waste discharged from the
The large intestine/colon contains most numerous and dive rse species of bacteria in the body through the anus
gastrointestinal tract, making this organ the most metabol ical ly active in the body. Just
as bacteria can ferment sugars and starches in cabbage or milk to create sauerkraut or

Int es tinal enzymes importa nt to sma ll intesti nal digestion and absorption

PEPTIDASES SUCRASES LACTASES MALTASES

liberate amino acids liberate glucose and liberate glucose and liberate glucose
from peptides fructose from sucrose galactose from lactose from maltose
52 UNIT 1 Chap t er 2 Food Int ake, Digestion & Absorption

yogurt, intestinal bacteria ferment dietary carbohydrates such as fiber, oligosaccharides,

and sugars (such as lactose and sugar alcohols) that our bodies failed to digest and absorb.
SHORT CH AI N FATTY ACIO This ferm entation process turns these carbohydra tes into beneficial short chain fatty acids ,
Fatty acid with fewer than prod ucing strong-scen ted gases in the process. Beyond carbohydrates, proteins such as
eight carbons that are enzym es, dead cells, bac terial ceUs, and the collage n and elast in found in foods, can also be
taken up directly through
fermented, creating less favorable mo lec ules - includ ing toxins and carci nogen s.
the portal vein. and are
produced as fiber is Along with simple fermentation of undigested nutrients, a heallhy balance of these bacteria may,
fermented in the colon
prevent harmful bacteria and yeast from colonizing the gut,

CARCINOGENS remove ca rcinogens and boost the immune system;

Cancer-causing substance prevent allergy, and
pre vent inflammatory bowel disease.

Taking antibiot ics (for example, when suffering infection) can cause disruptions in this
healthy bacterial balance , which can lead to runny stools, lack of short chain fatty acid
production, reduced carbohydrate digestion, overgrowth of yeast and harmfu l bacteria, and
immune system compromise. However, there is some evidence that individuals suffering
PREBIOTIC from a dim in ished gastrointestinal bacteria count can benefit from the use of preb iotics and
Compound that is not probiotics f rom food and nutriti onal supplements. These types of foods and supplements
digested but rather stimu late the growth of healthy bacter ia whi le he lping to con t rol the unhealthy type.
fermented by microflora and
stimulates growth of healthy EVE NTUA L DIGESTIV E PRODUC TS
bacteria in the GJ tract
After chyme proceeds through the intestinal structures , elimination/excretion occurs. This is
PROB IOTICS the discharge of unabsorbed digestive residues from which water has been remov ed. One -
Live microorganisms that third of the fecal matter is dead bacteria, while another third (or up to one-half) consists of
help to restore beneficial inorganic material and fat. Protein, cells, fiber, digestive jui ces and bile pigments make up
bacteria in the GI tract the remainder. The sme ll associated with fecal matter comes from the gases produced in the
large intestine/colon via bacterial act ion. Tota l trans it time through the body, from mouth to
anus, takes between 18 and 72 hours. Transit time can be accelerated and fecal frequency
improved with a higher consumption of fiber-rich foods and fluids . Fiber-r ich foods include
f rui ts, vegetables, whole grains and legumes. Adequate physical ac tivity can also decrease
transit time, leading to more frequent Irips to the t oilet.

Accessory digestive organs

Severa l organs assist the GI tract in the digestive process, includ ing the liver, gallbladder,
and pancreas.

THE LIVER
The liver is between three to four pounds, and roughly the size of a footbal l, which makes
it the largest gland in the body. It l ies in the upper right quadrant of the abdomen, just
under the diaphragm and next to the stomach. It's made up of two ma in lobes, called the
right and left lobes.

HEPATIC POR TAL SYSTEM Blood from the liver's hepatic portal system passes through th e liver for "inspection." The
Veins that carry blood cells of the liver metabolize molecules by either building them up or breaking them down as
from the capillaries of needed. The liver contributes to digestion by producing and secreting about one pint of bile
the stomach, intestme.
per day, which is made up of bile salts, bile pigments and cholesterol. This bile secretion, as
pancreas, and spleen to
the fiver
discussed earlier, aids in the emuls ific ation of fats.
UNIT 1 Chapter 2 Foo d Int ake . DlgesilOn & Absorpbon 53

:';;::~ .~L----- Pancreas

f iG URE 2.6
ACCESSORY DIGESTIVE
ORGANS

THE GALLBLADDER
This 3 to 4- inch long , pear-shaped sac sits adjacent to the small in test in e and is a sto rage
organ for bile produced by th e liver. It can hold abou t 30 to 50 mL of bile. As fatty food
enters the digestive t rac t, bile is sec reted thro ugh th e commo n bi le duct into th e smal l
intesti ne (du ode num).

THE PANCREAS
The pancreas is abou t 6 to 9 inches long and sits adjac ent to the small intestine . It releases
pancrea tic juices through the pan crea ti c duc t into the small intestine (duodenum) at the
same poin t that bile is released.

The pancreas is made up of 98% exoc rine acinar cells, whic h sec rete the pa ncreatic j ui ce EXOCRINE
containing digestive enzymes th at are released in an alkaline bica rb onate-based f luid that Secretion, such as saliva
helps to neutralize stomach ac id . Othe r enzymes include trypsin and chymotrypsin , which or bile, released outside Its
help to digest proteins, amy lase, whi ch helps to digests po lysacc harides ; and li pas e, which source by a duct

he lps to di gest lip ids. The other 2% of t he pancreas is comprised of endocrine ce ll s, which
produce seve ra l important hormones in cl uding insulin, glucagon , and somatostatin. Alo ng ENDOCR I NE
Secretion. such as a
w it h digestive enzymes, the pa nc reas sec ret es glucoregulatory hormones.
hormone. distributed in the
body by the bloodstream

Controlling the digestive process

GLUCOR EGULATORY
Now t ha t you 've learned ab out the various organs, secr et ions, and chemi cals that are HORMONE
Hormone that balances
involved in the digestive and absorptive proce ss, you migh t be wondering what phy siolog ical
blood glucose levels, such
conductor is in charge of th is elabo rate symphony. For examp le , you now know tha t bile is
as glucagon or Insulin
re le as ed from th e ga llbl adde r to he lp em ulsify die tary fat . However, you may be wo nd ering
how the body knows wh en dietary fat is presen t and how tha t signals the li ver to produce
bile and the ga ll bladder to release it. Or, you now know that the walls of your digestive tract
54 UNIT I Chapter 2 Food Intake . Digest ion & Abso,p t1on

are comp rised of muscles th at act to propel chyme al ong through th e stomach and small
intestine. However, you may be wonder ing how the body cont rols the involunta ry contraction
and relaxation of these muscles . These processes are governed by two organ systems of the
body: the endoc rine system and the nervous system .

The endocrine system

The endocrine system is a chemical messaging system that iden tifies changes in the body
and sends ou t messengers (called horm ones I to te ll the body how to respond. Several
imp ortant hormones act in this role within the GI tract.

GASTRIN
When food ente rs throu gh the lower esophageal sphincter into the stom ach, it triggers th e
re lea se of the hormo ne gas tr in into' the blood. Th is horm one is secreted by specific cells of
the stomach and small intestine, ca ll ed G ce lls, and starts the digesti on process by helpi ng
to signa l the release of hydrocho loric acid and pe psinogen in the stomach . Thi s has seve ral
important functions : it promo tes an increase in peristalsis thro ugh the stomach, keeps the
lo wer esoph ageal sphin cte r closed , ca uses gall bladder contractions, and promotes the release
of bicarbonate from the pancreas. Protein -contain ing foods seem to be the most potent
st imu lators of gastri n re lease.

SECRETIN
During th e digestive process, ac ids are prod uced in the stomac h to initiate digestion as
well as to kill microorganisms unfit for absorpt ion in the intestines. When these acids pass
through the stomac h and reach the small intestin e, they tri gger specific cells (cal led S ce lls l
to release the hormone secretin, wh ich trave ls to the pancreas and bile ducls to produce
pan cre atic fl uid high in bicarbon ate. This fluid then travel s throug h the pancreatic duct to the
small intestine and helps to neutralize the acids there . Therefore, the stomach can be high in
acidity but t he sm al l intest ine ca n be more basic. Secret in has two othe r impo rtant roles: It
inhibits gastrin rele ase (to slow down the stomach re lated processes, wh ich should now be
complete I and en han ces the effects of another hormone, cholescystokin in (CCKI.

CHOLECYSTOKININ (CCK)
When partially digested protei ns and fat s ente r the small intes ti ne, mucosal ep ith elial cel ls
in the duode num secrete the hormone CCK. CC K signa ls to the pa ncreas that the smal l
intestine is ready for panc reatic en zym es to he lp out with digesti on . like secretin, CCK
also inhibits gas trin (again, to slow down the stomach rela ted processes, as well as to slow
down stomach acid production since i t's no longer needed). CCK also st imulates ga ll bladder
contraction so that bile is fo rced into the smal l in testine along with the pancreatic enzymes ,
to he lp with emu lsi fica tion. CCK acts as a satiety hormon e that sends signals to your brain to
indi cate tha t yo u're full and shoul d wait longe r to eat again .

GASTRIC INHIBITORY POLYPEPTIDE (GIP)

GIP is a notewo rthy member of the sec retin fam ily. GIP is released by epithelial ce ll s of the
small intes tine while CCK is doing its work . GIP en hances the release of insulin, preparing
the body for the glucose th at's about to appear in the blood with furthe r digestion and
absorption . As the name suggests, GI P inhibits ga str ic secretions and moti lity since these
process shou ld no lo nger be needed - at least until the next meal time .
UNIT 1 Chapter 2 Food Intake, Di ges t ion & Abs orpt lO il 55

MOTILIN
When bicarbonate is dumped into the small intest ine to create a less acid ic/more alkaline
env iro nment, the cells of the small intestine also release the hormone mat i lin. Wh il e secretin
and CCK are responsib le for slow ing down stomach-re lated digestive functions and speeding
up intestinal digestion , motil in promotes smooth musc le contract ions of the GI tract. This
moves chyme along through the intestines and breaks it up further through the process
called segmentation. Interestingly, mot i lin is also released at regular intervals between
meals and in a fasted state. Th is is one of the reasons an individual may notice a "growling
stomach " when they are 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 somatostat in
slows gastric emptying, reduces smooth musc le contractions, reduces blood flow, and
reduces enzyme re lease. Phys iological somatostatin release typically occurs between meals
to reduce digestive activ ity.

PEPTIDE YY (PYY 3.36 )

This hormone is re leased in the hours following a meal, presumably to supp ress appetite.
It's released by the sma ll and large intestine is in proportion to the calorie content of the
meal and its function is to inhibit stomach motility whi le increas ing water and electro lyte
absorp tion in the colon, both important between meals as food sho uld now be arriv ing in
the large intest ine . This hormone may also suppress pancreat ic enzyme secretion, as small
intestinal digestion should be complete .

GHRELIN
This hormone is ubiqu i tous , it's re leased by ce ll s of the stomach , pancreas , placenta,
kidney, pituitary and hypot halamus. Generally, ghrelin is a hunger hormone that's re leased
in response to low food intake and/or fasting ; it stim ulates the re lease of growt h hormone
and encourages appetite. After meals, ghre[in concentrat ions dec rease. This means ghrelin is
important in the regulation of long-term energy ba lance.

The nervous system

The ne rvo us system also regulates digest ion along with the endocrine system , and acts
as a different type of physiologica l messenger. Through the use of nerve impulses and
neurotransmitters (hormone-like chemicals), the nervo us system directs nervous tissues , NEUROT RANSMITT ER
smooth muscles, and other organs of the body to move, mix , and propel foodstuffs that enter Substance that tra nsmits
the digest ive system . As a resu lt, the nervous system has strong authority over most digestive nerve impulses across a
synapse
processes. It influences gastrointestinal moti li ty, blood flow and ion transport assoc iated with
secretions and absorptions.

Some of th is control originates from nervous and hormonal connections between the digestive
system and the centra l nervous system (CNSlithe brain. However, the digestive system
possesses its own, localized nervous system . This system is referred to as the enteric nervous
system and can be thought of as a "mini-bra in" located in your gut. Several ne urotransmitters
are also released in this "mini-nervous system" between nervous tissue and other cells, These
neurotransmitters can likewise relay, amplify and modulate different signals between cells of
the body. We' ll discuss the major neurotransm itters invo lved with digestive activity below .
56 UNIT I Cha pter 2 Foo d In take Diges tion & Ab sorption

GAMMA AMI NOBUTYRIC ACID (GABA)

This neurotransmitter is chiefly an inhibitory neurotransmitter - it acts as a "downer" on
the eNS. However, GABA has the opposite effect on many other tissues of the body, and
can act as a stimu lant. In the enteric nervous system, GABA can act as an excitatory or
inhibitory neurotransmitter depending on wh ich cellular receptors it binds to. However, the
chie f role of GABA is to stimulate gastrointestinal moti lity and con tribute to gastrointestinal
wall mucosal fun ct ion.

NOREPINEPHRINE
This catecholamine is one of the "fight or flight" hormones that also acts as a
neurotransmitter in the enteric nervous system. Norepine phr ine decreases digestive activity,
wh ich makes se nse during fight or fl ight situations. When immediate , decisive, or aggressive
action is req uired , digestion is a muc h lower priority for survival. Unfortunate ly, stress that
doesn't require an immediate fight or flight type response (such as deadlines, re lat ionship
challenges, etc.) also provokes norepinephrine re lease and this can chro nically im pair
digestive fun ct ion .

ACETYLCHOLINE
Acetylchol ine is a major neurotransmitter that promotes muscle co ntraction via the
NEUROMUSCULAR neuromuscular junction as well as ceU-to-cell communication among neurons and between
JUNCTION neurons and other tissues of the body. In the digestive system, this neurotransmitter
Junction of an efferent nerve stimulates digestive activity by helping to initiate smooth muscle contractions in the digestive
fiber and the muscle fiber
organs that help move food through th e gast rointestinal tract. Acety lcholine also stimulates
celf membrane
the releas e of many of the horm ones discussed earlier, dilates blood vessels, and increases
intestina l sec ret ions. As acety lchol ine in the gut is re leased from para sy mpathetic nerve
PARASYMPATHETIC endings, the best way to describe the acti on of acetylcholine in the gu t is "rest and digest."
NERVOUS SYSTEM Th is runs co unter to the "fig ht or flight" actions of nore pi neph rin e, and therefore it's no
Part of the autonomic
surprise that these two neurotransm i tters are antagonistic.
nervous system that controls
secre tions and the tone of
smooth muscle, along with NEUROTENSIN
cardiac muscle activity As dietary fat reaches the ileum, th e last section of the small intestin e, N cells located in the
intestinal wal ls release neurotensin. Neurotensin relaxes th e lower esophageal sphincter,
blocks the release of stomach acid and peps in, and reg ulates gastrO intestinal contracti on and
re laxa tio n. This makes sense as esophageal and stomach acti ons are no longer req uired once
a meal is mak ing its way into th e large intestine/ co lon.

NEUROPEPTIDE Y (NPY)
This neurotransmitter is present in both the brain and the ente ric nervous system. In the
brain, it stimulates hunger and food intake while disco uraging phYSical activity. NPY works in
conjunc ti on with leptin and corticotropic re leasing horm one to regulate metabolism and body
compos ition. In this capacity, it's typica ll y released when body fat is low or food is scarce. In
the gut, NPY slows gastr ic emptying and transit time , which is logical considering that NPY is
typically released when food intake is low and a high digestive efficiency is required.

SEROTONIN
Serotonin is another neurotransm i tter released both in the brain and the enter ic ne rvous
system. In the bra in, se rotonin modulates anger. aggression, temperatu re, mood , sleep ,
appetite, and vomi ti ng. Serotonin concentratio ns reach a maximum wi thi n one to two hours
after meals. This is why many people fee l more relaxed and calm after eating ; serotonin
UNIT 1 Ch apter 2 Food In take, Digest ion & AbsorptIon 57

acts as an an tide pressan t and mood regulato r In the gut, serotoni n is produced by a host
of cel ls called enteroc hromaffin cells , which are loca ted in the sm all intes tine. In this
cap acity, serotoni n in cre ases sma ll intestinal motili ty and reduces stomach acid prod ucti on.
In excessive amoun ts, serotonin can cause nau sea, which is why ant idepressa nt drugs like
Prozac cause somet imes Jead to diar rh ea and nausea: these drugs make more seroto nin
available not only in the brain (where they exert their ant idep ressant effect) , but the gut ,
where they can ca use seroton in excess.

NITRIC OXIDE AND SUBSTANCE P

Both found in the brain and in enteric circulation , th ese compounds are associated with
vasodilation in the gut. They help improve blood fl ow to the gut for better nutrient delivery as
well as nu trient uptake.

VASOAC TI VE INTESTINAL PEPTIDE (VIP)

VIP relates to the hormone secret in and is important to the digesti ve process for several
reaso ns:

it inhibi ts the re lease of gastr in;

it inhibits the secretion of acid;
it stimulates bicarbona te secretion from the pa ncreas;
it ind uces smooth muscle relaxation and vasod ilation ; VASO DI LAT I ON
Widening of blood vessels
it stimulate pepsinogen release; and
it stimula tes the secret ion of water and electro lytes into th e small intestine (which will be
resorbed la t er in the digestive process).

Mos t of these fu nctions slow down stomach activily while stimulating inte stina l act ivily.

Nutrient absorption
As diverse and comp lex as they may seem , all of the digestive processes above have
one goa l, to de li ve r nut ri ents into our bloodst rea m for use in our ce lls. For this to occur,
nut rie nts must cross the gastro intes tin al- body ba rrier To assist with nut rient abso rption,
the gastro intestina l-body bar ri er has a hug e surface area created by an extensive network
of twis t s, turns, folds , pits, and projections. As the major area for nutrient absor ption is the
small intestine, it con ta ins the largest surface area, which is crea ted in part by projection s
(known as vi lli ) from the walls of the small intestines. Villi are finger-like structures , covered MICROV IL LI
with sma ll er structures called microvilli , that are involved in many digestive and absorpti ve Microscopic hair structures
functions. Often refe rred to as the intestinal brush border because the finger-like project ions that increase the surface
area of cells; many are
resemb le a brush, the small intestine's villi and microvilli are the most im portanl absorptive
found in the GI tract
str ucl ures in the body.
(singular: microvillus)
In genera l, we absorb nutrients well. We easily digest and absorb about 97% of our food.
However, if this brush border becomes irritated or flattened , as can occ ur with inflamma tory IN TE STINAL BR U SH
BO RDE R
bowel d iseases , food alle rgies and/o r food intolerances , our capacily for abso rpti on is severe ly
All of the villi that form a
limited. On ly when these iss ues are con trolled and/ or removed can hea lthy absorpti on occ ur
brush-like border inside the
Assum ing that our absorpt ion process is healt hy, once nutrient molecules are absorbed intestine

through th e gastrointes tinal-body bar rie r, they enter the blood and/or lymph . The molecules
will then travel (bound or unbound) to the liver. Once through the liver, these molecu les
become available to other cells of the body for direct utilization or further processing.
58 UNIT 1 Chapter 2 Foo d Intake, Digest ion & Ab so rp tion

Bod,

Stomach

T
I
Monosaccharides 1 T
Mmerals
Antrum

----1---T- TI - -f'~ ,:L~mo~o. - - V;;'';'!lA D

Disacchafldf'cs and dlglycendes
s &
Duodenum

1 1 T
-l---1T---
Water and sodwm
Amino acids and Water-soluble
Simple peptides vitamins

-1---
Blles.3l1s TvI/amI B12
lIocecal ~alve
Il eum
FIGURE 2.7 Gecum
PRINCIPAL ABSORPTION Ascending cokm
W~ler, sodIUm, -1
SITES FOR NUTRIENTS I- polasslUm,vilamlfl K

MECHANISMS OF ABSORPTION THROUGH THE GI BARRIER

In order for nutrients to be absorbed throug h the gastrointestinal-body barrier, one of several
absorptive mechanisms must occur. Some of these require energy input while some are
passive . While there are three major processes (simple diffusion, facilitated diffusion , and
active transport ), there are hundreds of enzymes and carrier proteins presen t in the small
intestine, each designed to help the absorption process of particular nutrie nts.
SIMPLE DIFFUSION
Spontaneous movement of SI MP LE DIFFUS ION
particles from an area of
high concentration to an Simple diffusion, which is a passive process, occurs when a substance passes through the
area of low concentration cellular barrier directly or via a channel protein as molecules in water move from an area
of high concentration to an area of low concentration - a good example of moving across a
FAC ILITATED DIFFUSION concentration gradient. If more water is on one side of a specific cellular barrier, the water
Transport that reqUires a will diffuse to the side where the re is less water. With simple diffusion, the rate of transport
carrier molecule; occurs is proport ional to the solubility of the substance, because molecules are exchanged freely
when diffusion of a
across the cell membrane, the rate of tra nsfer can be quite high.
substance on its own is not
possible
FACILITATED DI FFUS ION
ACT IVE TRANSPORT
This means of transport through the cellular barrier occurs when the molecules to be
Movement of particles
transported bind to specific transport/carrier proteins that shuttle them across the membrane.
from an area of low
concentration to an area of Th is form of transport is also called carrier media ted passive transport. Fructose absorption,
high concentration; requires which requires sugar transpor t proteins to occur, is an example of this type of transport.
energy and enzymes Unlike passive diffusion, with this type of transfer the ra te of absorption is dependent on the
numbe r of carriers available for transport.
CONCENTRATION GRADIENT
Difference in the ACTIVE TRANSPORT
concentration of sofutes In a
solution between two areas Like facilitated diffusion, active transport requires a carrier protein. However, since this type
of transport typically occurs against a concentration gradient, the process also requires
energy. Thus the rate of absorption can be limited by the availability of both carrie rs and
energy. Examples of nutrients absorbed this way include glucose and galactose.
UN IT 1 Chapter 2 Foo d Intake , Digest ion & Abs orpt ion 59

t rans po rted molecule

0<1~O
.0e
channel
protein
ca rrier
protein
~~Zl

~ mf m\TI~ ~~ ~

concentration
gradie nt

~ M 8~M

,~
')llli [
simple
diffusion
channel-
med iated
ca rrier-
med iated ~·O
<1
PASS IVE TRANSPORT ACTIVE TRANSPORT

ABSORPTIVE DYSFUNCTION
As discussed earlier, the GI barrier is a critical component to overall hea lth, because it FIGURE 2.8
protects us from harmful compounds that would otherw ise enter our bod ies. Many other HOW NUTRIENTS PASS
THROUGH THE INTESTINAL
organs , tissues, and ducts work in conjunction with the gas trointestinal tract to support
WALL
this function as we ll as the overa ll goa l of optimal digest ion and absorption , When this
environment becomes disrupted, many ill nesses can develop. The fol lowing are some of the
most common .

ULCERS

Ulceration of the gut can develop whe n alka line mucus product ion slows down, when tight
cellu lar junctions are pulled apart , and when cell turnover rate is reduced. In addition, you
may be familiar with peptic utcers . These are erosions of the stomach tining due to many PEPT IC ULCER
factors including excess stomach acid secret ion, the ability of the stomach lining to resist Found on the waIJ of the
erosion, and in fection with a specific bacterium , Helicobacter pylori (H. pylori) . Ulcers may duodenum or stomach,
this ulcer results when
be worsened by acid -prod ucing foods, non-steroidal anti-inflammatory pharmaceuticals
gastflc j uices and H. pylori
(NSAIDs), and stress, Smoking, caffeine, and alcoholism are also thought to playa role. combine
Symptoms include a burning feeli ng in the upper abdomen, usually descr ibed as heartburn,
lasting between 30 minutes and three hours . This pain can occur immediately after eating or
hours later. Decreased appetite and weight loss are ot her symptoms.

VOM ITING

Otherwise known as emesis , vomiting can result when neural signals are sent to the EMESIS
vomiting centers of the brain. As discussed ear li er, serotonin excess can cause vomiting. Vomiting
Vomiting can also be tr iggered by inflammation or microorgan ism irritation of the intestinal
wal l. Th is irritation signals receptors in the gut that respond to stretch and other specific
chemicals. When this happens, vomiting ensues .
60 UNIT 1 Chapler 2 Food Int ake, Diges tion & Abs orpt ion

GA LLS TON ES

Gallstones are solid deposits of cholesterol or calcium salts that form in the gallbladder or
nearby bile ducts. There are few symptoms; however, in severe cases, gallbladder attacks
can cause nausea and a steady ache in the upper middle or upper right abdomen. Gallstones
are formed when bile becomes chemically unbalanced due to an excess of cholesterol or too
much bilirubin. If either of these situations occurs, the bile becomes idle in the gallbladder
and crystallizes in to a stone . Since this may prevent bile formation, fatty acid digestion and
absorption can be compromised, leading to fatty stools. Interestingly, gallstones are often
symptomatic of yo-yo dieting. Indeed, excessive restric t ion of dietary fat intake can cause idle
bile in the gallbladder since at least 10 grams of dietary fat are needed to stimulate bile rele ase .

INFL AMMATION
I NF LAM MATORY BOWE L There are a few inflammatory bowel diseases, such as ulcerative colitis and Crohn's disease,
DISEASE and t hese diseases cause chronic inflammation, especially in the intest ines. The inflammation
Inflammation-based disorder
of the intestinal tract,
causes large amounts of water and salt to be secreted into the intestines - too much for the
such as Crahn's disease or colon to completely resorb . This results in chronic diarrhea, intestinal cramping, and other
ulcerative colitis unpleasant symptoms. Food moving through the digestive tract can cause bleeding and ulcer
formation in inflamed digestive tract tissue. As a result of the poor qual ity of the intestinal wall
in these conditions, enzyme activity is diminished and nutrient absorption is very poor. This can
result in a poor nutritional status even though nu trient intake may be gooo.

DIARRHEA

As discussed above, diarrhea usually occurs wi th a disruption in the epithelium of the

intestines. This may lead to either la rge secretions of wa ter and ions in to the intestines or
poor resorption of the normally secreted fluids. Due to the rapid transit of large amounts of
these secreted fluids in the intes tines, dehydration and severe electrolyte depletion can occur.

DIVE RTICULOS IS/ DIV ER TICU LI TIS

This condition , which is common as people age, occurs when small pouches in the colon
(known as diverticula) bulge outward thro ugh weak spots in the colon wall. This creates
increased pressure and small tears in the colon, resulting in in flammat ion, Those suffering
from diverticulitis typically have pain in the lower left side of the abdomen. Vomiting,
bloating, bleeding, and frequent urination can occur. The most common risk factors are lack
of exercise and too little fiber.

FOOD INTOL ERANCES

FDDDINTDLERANCE
Adverse reactIon induced
Food intolerances usually occur when the gut reacts poorly to a specific food or a specific
by food ingredient used in food preparation . These intolerances can result from the absence of an
enzyme needed to fully digest a food, as seen with lactose intolerance. In addition, certain
foods can trigger immune responses if the body views them as foreign invaders.

The most common food intolerances are dairy into lera nce (lactose intolerance), yeast
sensitivity (Candida infect ions), gluten sensitivity (including both celiac and wheat
sensitivity), and fr uctose or sugar se nsitivity. Fur t her, foods containing salicylate (some
juices, vegetables, spices, herbs, nuts, tea, wines, and coffee) have been implicated in food
intolerances. So have specific amines, monosodium glutamate, nitrates, and some anti-
oxidants. Reactions to apples, citrus fruits, and strawberries are typically associated with
salicylate into lerance . However, reactions to chocolate, cheese, bananas, avocados, tomatoes
and wine are usua lly attributed to amines .
UNIT 1 Ch apter 2 Food Int ake , Digestion & Absorption 61

It has been estimated that three out of four people have some form of food intolerance ,
whether mild or severe. These in tolerances are unique ly individual. Everything from the
nutrients and chem ic als above , to specific minerals , to specific food add itives can lead to
a host of symptoms. While some of t hese symptoms are be nig n, significant intolerances
can cause serious gastrointestinal comp laints that may resu lt in severe problems if left
uninvestigated. Other non -GI symptoms vary widely, and can include hives, head aches,
mouth ulcers, stuffy nose, mucus build-up in the lungs, and more .

LE AKY GU T SYNDROME

Leaky gut syndrome is poorly recognized and rarely tested for, but fairly common . With
leaky gut syndrome, the intestinal lini ng becomes extremely permeable, which means that
it may allow large mo lecules and toxins to enter the body undigested. This can occur when
the intestinal lining becomes inflamed or damaged, which disrupts the normal function of
the villi and microvilli. As a resu lt, "spaces" develop between the cell walls and unwanted
macromolecules, ant igens, and toxins sneak in . As these molecules invade the GI wall more
frequently, additional damage occurs, which exacerbates the problem. Besides damagi ng the
intestinal mucosa, these molecules, which are much la rger than the body prefers to absorb,
can be treated as foreign invaders and tr igger the body's immune defenses. This sets off a
cascade of antibody production. The body sets up a defense against otherwise hea lt hy food,
and potentially against its own cells, although this is speculative. To make matters worse , as
the damage to the intestinal mucosa increases, the carrier proteins become damaged as well,
which causes nu trient deficiency. There are many symptoms of leaky gut syndrome including
GI distress (bloating, fla tulence, and abdominal discomfort), immune reac t ions (includ ing
hives, mucus build up 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.

FATE OF NUTRIENTS AFTER ABSORPTION

Once nutrients cross the gastrointestinal-body barrier and enter the blood supply of the GI
tra ct, ve in s from the stomach and intestine carry most of these nutrien ts to the liver. This
takes place th rough a ve in called the hepatic portal vein. The live r can do a preliminary
examinat ion of what's been absorbed and determine whether it shou ld pass on to general
circulation immed ia tely or whether it needs further processing. Wh il e most nutrients flow
directly into portal circulation, this isn't the case for dietary fats. All but the short chain fatty
GLYCOGEN
acids take a different route. Most of our absorbed dietary fat is absorbed into our lymphatic Chief source of stored
circulation before slowly being released into the bloodstream and circulating to the liver. glucose in selected tissues

Always conscious of the body's overall protection, the liver plays an active role in
HEPATOCYTE
carbohydrate homeostasis. To this end, the liver may grab any excess glucose, storing it as
Liver cell
glycogen in its own hepatocytes for later use. Conversely, if the amount of glucose in the
blood entering the liv er is low, the blood can pick up glucose from previously stocked up DEAM INATION
liver stores for int roduction in to general circu lation. Beyond glucose , other sugars, such as Removal of an amine group
fructose and galactose, can be removed from the blood in the liver and then converted to from a compound
glucose. Just as it does with carbohydrates, the liver can remove excess amino acids from
th e blood and deaminate them, convert ing them into glucose derivatives and free nitrogen LIPOPROT EIN
for excretion. Further, it can also process new ly arrived free fatty acids , packing the m with A clas s of proteins
glycero l to form triglycerides for export into systemic circulation bound to lipoproteins (H DL with hydrophobic
core of triglycerides or
and VLDU. Fin ally, the liver will filter toxins and drugs newly int roduced before blood is
cholesterol surrounded by
returned to the rest of the body. In the phar maceutical indu stry, this is referred to as first pa ss hydrophiliC phospholipids,
metabolism. Beyond sending nutrients in to general circulation, as mentioned earlier, the liver apolipoprotems and
can send bile to the gastrointestinal tract via enterohepatic circulation as well as receive bile cholesterol
that's been reabsorbed. This pool of bile is thought to recycle at least twice per meal.
62 UNIT 1 Chapler 2 Fo od Intake. Digestion & Absor pt ion

' - - - - - Synthesis

@n7'''--- - - B i li ary secretio n

K:.R --Colon

FIGURE 2.9
ENTEROHEPATIC Portal venous return
CIRCULATION \ no.l - - - - - - - F e (:aIJ excretion

FIRST PASS METABOLIS M

When a substance is
Nutrient delivery
swaffowed and absorbed,
After nutrients are processed by the live r and enter systemic circulation, they need to
it first travels through the
be delivered to the cells of our body. Whi le most nutrients disso lve in the blood and are
hepatic portal system for
metabolism by the liver; this transported in a free-floating manner, lipids are the only exception, They're transported by
"first pass" can reduce the lipoprotein carriers. You're like ly familiar with these carriers as they're commonly referred to
availability of the substance as the different types of cholesterol, HDL, IDL, LD L, VLDL, and chylomicrons.
to the body
TISSUE UPTAKE OF NUTRIENTS
SYST EMIC CIRCULATI ON
When blood travels from In order for our dietary nutrients to affect our physiolog ical functioning, they must be
the heart to the arteries delivered effectively to target tissues in the body. The most critical target sites are the liver,
and capilfaries, exchanging the muscle, the adipose tissues, and the brain. Each of these will be discussed below .
oxygen for carbon dioxide However, for now it's important to remember the key points from Chapter 1, A variety of
and returning via the veins membrane bound proteins and transport receptors are responsible for a) recognizing specific
to the heart for pulmonary
nutrients as they approach our cell membrane structures; b) binding to the most appropriate
circulation
nutrients; and c) initiating cellular uptake.

THE LIVER
As discussed above, the liver plays an important role in the digestive and absorptive
processes. Indeed, most of our nutrien ts (and anything else that's come along for the ride)
are screened in the liver. The live r serves many other functional roles in the body.

1. When it comes to carbohydrate metabolism, glucose (and other sugars) that enter the liver
can be phosp horylated and stored as liver glycogen for eventual use in regulating blood sugar.
2. The live r also synthesizes many different proteins, both structural proteins and proteins
bound for general circulation . These proteins are formed from am ino acids de li vered
during the first pass of nutrients after a meal as well as after general circulation. In certain
UNJT 1 Chapter 2 Food Int ake , Digestion & Absorption 63

cases, these amino acids can al so be converted to non -protein products. For example ,
these amino acids can become hormones or, if the body is in need of glucose or fat in
times of li mited supp ly, amino acids can be transaminated , degraded to acetyl-CoA, and
converted into glucose or fatty acids. These nutrients can then be transported to muscle
and fat cells. With this conversion, nitrogen is released from the amino acids and bound
in what's ca ll ed urea . This urea is then excreted in the urine. TRANSAM INAT ION
The transfer of an amino
3. Fatty acids can be converted into stored triglycerides in the li ver (the major ox idative form
group from an amino acid to
of fue l to carry out liver function) or released into the circulation as plasma lipoproteins.
an alpha-keto acid
In situations where the li ver is metabolizing a lot of fat in the absence of carbohydrates,
special compounds called ketone bodies are formed . These ketone bodies are an ACETY L· COA

alternative source of fuel for key liver and brain functions, Co-enzyme that plays a role
in intermediary metabolism;
4 . Other nu trients (vitamins, minera ls , etc .) and the breakdown products of dietary can enter the Krebs cycle to
phytochem ica ls can be taken up into the live r to act in a numbe r of ways, especially in produce energy and be used
metabolic reactions requiring energy, and in the production of hormones, includ in g IGF-l, for fatty acid synthesis
angiotensinogen, and thrombopoiet in. KETONE BODY
Either acetoacetic
MUSCLE acid, acetone or beta -
Glucose, amino acids, and fatty acids are al l important for muscle func tion . Once passed hydroxybutyric acid with a
carbonyl group attached to
through the liver, glucose can be taken up by muscle cells and used for ATP production or
two carbon atoms
stored as muscle glycogen. Amino acids that have passed through the liver can be taken up
by these same ce lls and used for the synthesis of new proteins inc lud ing structural prote ins,
enzymes, etc . Finally, fatty acids in gene ral ci rc ulation can also be taken up by muscle
cells to provide energy; to be stored as intramuscular triglycerides (one storage form of fatty
acids); or to provide fatty acids fo r structures like the plasma membrane. In addition, other
nutrients (vitamins, minerals, etc.) and the breakdown products of dietary phytochemicals
(phytochemica ls) can be taken up into the muscle to act in a number of ways, especia ll y in
metabolic reactions requ iring energy,

Proteins Carbohydrates FIGURE 2 .10

~ OU e Fats
INTERRELATIONSHIPS
AMONG MACRONUTRIENTS

l "id{GI,oo"",,",,"
Am'",~ ~''" )}G ~ IN METABOLISM

",d
F,~ "tty

<I ~ Fc!~1e. Bt{Jt,n Lactal~'OGI,oo"

6,. G'y",,' )FF))
R'oofla \i ln lipolysis
Ketogenic ~~~: '" . ~ .'l 'acon . Bioti n
[
ammo aCIds .------

~
PYfUva::,a."",n . Lipogenes is
~
Glucogenic
amino acids
Th 'a m,n
NiaC in "'--
I ======---
=-- -
Acetyl CoA
!
Pa ntott>efilc at ,d
N' ~C ln .
81011n

~_
______ ' ------->==== '---.
~~t~~~~
,
: (
/'

\ Krebs Cyc le
\j : '

"-
T
/ :====:~GI UCOSe ~:::==~G~'y~cogen
Ami no acids
FFA
Prote in
TG

Electron
transport
chain
64 UN IT 1 Chapter 2 Food Intak e. DIge sti on & Absorp tion

AD IPOSE TISSUES
Adipos e ti ssues can use both glucose and fa tty acids for long- term energy storage. These
ce ll s can take up glucose and, throug h glu cose me tabolism , form glyce rol andlor fatty
acids, w hi ch are then joi ned toge th er to fo rm tr iglycer ides, the main sto rage form of fa t.
Our fat deposits are form ed by fatty aci ds that are take n up by adipocytes and re -esteri fied
with glycerol.

Adipose cel ls can tak e up other nutrients (amino ac ids , vitamins, minerals, etc.) and the
breakdown product s of dietary phytochemicals (phytochemicals) to act in a number of
ways , especially in metabolic reactions requiring energy, and the produ ction of hormones.
Indeed , the adipos e ce ll s are rich producers of hormones includ ing leptin, cy tokin es ,
adipsin , acylation -stimulating protein, angiote nsinogen , plasmi noge n activator inhibitor-l,
adiponectin, resistin, and a host of steroid hormones.

THE BRAIN
The brain is the body 's most sens itive and de licate organ . It's encased and shie lded by a
memb ra ne that protects it from the chemicals in the blood whi le st ill al low in g t he transfer
BL OOO · BRA IN BA RRI ER of necessary nutrien ts. Thi s barrier is cal led th e blood-brain barrier. On ly lipid-so lubl e
Natural barrier formed molecules (such as oxygen, carbon dioxide, etha no l, and stero id hormones) can free ly cross
by brain capiffaries that
the cell membranes of the blood-brain barrier. Ot her nutrients like sugars and some amino
prevents subs tances from
leaving the blood and
acids must be shuttled across this barr ier by specific transport systems.
ente ring brain tissue
The brai n and oth er tissues of the central nervous system are almost so lely dependent on
glucose as an energy so urce. Howe ver, glucose cannot be "stored " in t he brain. As a resul t,
a constant supply of glucose (either from the diet or from liver st ores) is ess entiat for hea lt hy
brain fu nction . If glucose is in limited supply, the bra in has a ba ck-up mechanism: Ketone
bod ies , synthes ized from dieta ry fat in the liver, can also be used for brain metabo lism .

In addition, other nutri en ts (ami no ac id s, fats, vitamins , mi nera ls, etc.) and the breakdown
produ cts of dietary phytoc hemicals ca n be taken up into th e brain to act in a num ber of
ways, especially in energy-requi ring metabo lic reac tions, st ructural composi ti on (i n the case
of fatty acids) , and in t he prod ucti on of horm ones and ne urotransmitters .

In t his cha pter, we've rev iewed the major activities of nutrient digestion, absorption, and
transp ort. The food we eat must be broken dow n into usable molecu les for eventua l cell ular
uptake and a) energy storage, b) energy production , or c) furt her phys iologica l activity
inc lu ding cell suppor t and the cre ati on of signaling molecu les.

This chapter has follow ed the path that most nutrients trave l, whether it's from mouth to
anus (in the case of und igested materials) or from mouth to target tissue. Know ing th ese
processes he lps you unders tand not only how the body receives nour is hm ent and what it
does once that nou ri shment has been re ceiv ed, but also where optimal function can break
dow n to pro duce maldigestion, low ene rgy, and more . In the comi ng chapte rs we'll talk more
in de pth about exactly how these nutrie nts can, in turn, provide energy for eve ryth ing from
daily function to high- leve l athletic pe rformance .
UN IT 1 Chapter 2 Food Int ake . Diges t ion & Absorption 65

As we 've seen in this chapter, it becomes much After cons idering the organs located in the right
easier to understand the nutrition and exercise~ upper quadrant of the abdominal region (namely
related problems your clients are experiencing the gall bladder) and considering the fact that he
when you understand how the digestive system was not digesting and absorbing fat effici ently, the
works. Of course, many problems are well beyond answe r to his problem became clearer: There was
the scope of your practice. However, sometimes probably something wrong with his gall bladder.
your knowledge can assist in the diagnostic The most likely causes were either gallstones
process. This was the case with a recent client, blocking his bile duct or biliary dyskinesi a, a
an Olympic triathlete, condition in which there is gall bladder pa in and
improper bile release. This blockage could have
For months this athlete had complained of pain
caused the gall bladder spasm that was prompted
and cramping in his right upper abdominal region
by intense exercise .
with intense exercise, MRI, CT, and standard
blood chemistry revealed nothing, which ruled As I'm not a medical doctor and have no training
out most forms of muscle damage and / or severe in medical diagnosis , 1found him a specialist ,
organ damage, This led the client's doctors to who confirmed the gall bladder assessment. In
think it was a nutritional condition and might conjunction with this doctor, we treated this issue
be related to either a nutritional deficiency first with an alteration of his diet. We reduced the
that caused muscle cramps, or a reaction to a athlete's intake of dietary fat and increased his
nutritional supplement this athlete was taking, intake of protei ns , carbohydrates, and medium
His doctor sent the athlete to me to discuss diet. chain fats such as MCT oils (medium chain
After doing a full diet analysis, working with the triglycerides) and coconut oils. These oils are
client for about six weeks to improve his diet, more easily digested and absorbed . We added
and removing all nutritional supplements, I was fi sh oil to his diet to prevent essential fatty acid
disappointed to see that the pain continued and deficiency. Finally, we included a high-quality
exercise was still very difficult. Indeed , the only lipase supplement to help with the digestion of
way he was able to continue to compete was to the dietary fats that remained on his plan. Wh i le
freeze the area w ith local anesthetics prior to these changes helped with the fat absorption
racing - not an ideal solution at all! part, the athlete did need a medi cal procedure to
improve his ga ll bladder functi on .
At this point I figured we'd need some additional
tests , so we did a host of standard gastrointestinal Although I'm not a medical docto r, nor do I
tests, looking for digestion and absorption pretend to be, my fundamental knowledge of
problems, Interesti ngly, all the test results came digestive f uncti on was integral to helping this
back within the normal range except for one: His athlete get back to competition. I hope it also
fecal fat content (the amount of fat measured in his provides a real-world example of how learning the
feces over the course of a day) was high; indeed, it fundamentals , even when you th ink you might
was triple the normal value at 21 g (normal is 7 g). never use them again , can be very important in
This gave us another important clue. your practice.
66 UNI T 1 Chapter 2 Food Intake , Diges tion & Absorpt ion

1. While learning about specific nutrients is interesting and important for nutrition
professionals, this information must be balanced by the understanding that a)
humans eat food, not nutrients; and b) our physiological response to food is a
response to the unique combination of nutrients present in that food.
2. When food and/or beverages are consumed, the gastrointestinal (Gil tract will
extract major nutrients from them, absorb necessary micronutrients, and act as a
barrier to potentially harmful microorganisms.
3. The digestive system starts at the mouth and ends at the anus. Throughout
this 25 foot muscular canal , acidic secretions (from the stomach) and alkal ine
secretions (from the intestines) combine with rhythmic contractions to break our
foodstuffs down into smaller pieces while breaking complex molecules into simple
molecules.
4. Digestive function is highly regulated by the nervous and endocrine systems. These
systems control the release of secretions and the function of muscles in order to
"turn on" or "turn off" specific sections of the digestive tract at appropriate times.
5. Although nutrients can appear in the bloodstream within minutes of ingestion,
when eating a mixed meal it typica lly takes a few hours for blood levels of the
nutrients to peak and then begin their return to baseline (fasted).
6. The digestive process can take 18-72 hours from mouth to anus.
7. 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.
8. Most nutrients, except for most fats, circulate directly to the liver where they're
screened and must be approved for entry into systemic circulation.
9. If nutrien ts get past the liver, they're sent to tissues of the body, including the
brain, the muscles, and the adipose tissues. Most nutrients are free-floating except
fats, which are bound to lipoproteins (HDL, LDL, etc.).
10. A hea lthy gastrointestinal tract is necessary for optimal digestion, absorption, and
nutrient delivery. Many diseases, disorders, and intolerances can interfere with
these processes, causing problems ranging from moderate to severe in otherwise
healthy-looking ind ividuals.
CHAPTER 3

ENERGY
TRANSFORM·
ATION &
METABO LI SM
Chapter objectives
Key terms
Energy intake, storage, and transfer
The process of energy transfer
Pathways for nutrient metabol i sm
Pathways for fat metabolism
Pathways for protein metabol i sm
Chapter 3 Summary
KEY TERMS
laws of growth hormone
thermodynamics aerobic
energy transfer anaerobic
hepatocyles monag/yeeride s
myocytes dig/yeerides
adipocytes fatty acid synthase
ATPIPCr system sys tem
creatine kmase elongat ion
creatme saturated fatty acid
phOsphocreatme (PCr) desaturatlon
glycolytic system monounsaturated fatty
pyruvate acid
NADH very 101'1 densi ty
lipoprotein part icles
hydrogen ions (VLDL)
NAD + lipogenic enzymes
laclic acid alpha linolenic acid
oxidativ e omega-3
phosphorylation
Imoleic acid
muscle acidity
omega-6
Krebs cycle
polyunsaturated fatty
electron trans port acid
chain
chy/om icron s
acetyl-CoA
lipoproteinS
beta ox/daltOn
cholesterol
FAD+
stalin dr ugs
FADH 2
apolipoproteins
cytochromes
LDL eho/e sterols
protons
HDL chole ster o/s
glycoge nesis
lec ithin-choles terol
glucose 6-phosphate acyltransferase (LCAT)
glycog en synthase atherosclerOSIS
epinephrin e plas ma pool of ammo
norepinephrm e. acids
glycogen non-essential am mo
phos phorylase acids
glycogenolysis ess ential amino acids
glucagon complete protem
a -cells peptide cham
adrenal medulla deamination
glycolysis branched chain
anaerobic threshold amino acids (BCAAJ
oxaloacetate carbon skeleton
fat adaptation ammes
plasma ammonia
gluconeogene sIs urea cycle
Cori cycle urea
adipose tissues u,-ketoa cld
lipolysis transammation
hormone sensitive protein turnover
lipase protem synthesis
lipid mobilization protein breakdown
UNIT 1 Chapt er 3 Energy TranstormaliOn & Met abolism 69

Energy intake, storage, and transfer

In the last chapter you learned that after nutrients are digested and absorbed, the liver
screens them and sends them into general circu lation throughout the body. You also learned
that once these nut rie nts are received by target cells, they can be subject to a variety of fa tes
including,

ox ida tion for energy production;

transformation and incorporation into struct ural components of the body;
storage for future energy provision; andlor
excretion and elim ination from the body.

In this chap ter, we 're going to foc us on the first of these key areas, energy produ ction.

It's probab ly best to begin our discussion of energy production by stating that we're not really
producing energy in the body. According to the laws of thermodynamics, which descr ibe LAWS OF
some of the rules by which the physical world is organized, energy is never really created and THE RMO OYNAMI CS
it's never really destroyed. Rather, energy is transferred between entities. Usually, one object Principle s that govern
loses i ts energy while another absorbs it. Huma n bod ies are no exception to these laws . energy exchange. including
hea t exchange and the
Instead of producing energy for metabo li c func ti on , what we're really do ing is convert in g
performance of work
energy that's already stored within our food. Yo u may recall that breaki ng the bonds between
the carbon and hydrogen molecu les in most of our food creates a burst of energy. This
burst of energy, in turn , fuels the processes required to form ATP. So, in th is chapter, when
the term Uenergy transfer" is used, it refers to this process of transferring energy from
ENERG Y TR ANSFER
carbohydrates , pro teins, and fats to the formation of ATP.
Movem ent of ATP from one
We eat, we digest, we absorb , we circu late , we store , we transfer energy, we use the energy, co mpound to another so
that it can be used
and the n we repeat. In this chapter we' re going to look at that genera l proces s in more detai l.
Here's t he first detai l, ATP is required for nearly every act ion in the bod y. We need it to move
our skeletal muscles. We need it to con tract our digestive muscles. We need it to produce
enzymes. We need it to carry molecules across cell membranes. And we even need it to form
more ATP.

Wi th all of these important functions to carry out every minute of every day, we pretty
much requ i re a constant stream of AT P. This ATP can be der ived from "new" nut rients (i.e.,
nutrie nts that ha ve recently been absorbed and have passed thro ugh the live r) and from
stored nutrients (i.e ., nutrien ts that have been seq uestered in the liver, in the musc le, or in
the fat cells, waiting for a call to act ion).

Although you might thin k that the body prefers to use "new" nutrients to live, breathe , and
move, it's actua ll y our st ored nutrients that supply the bulk of our daily functions . 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. The only notab le except io n to this is during longer
duration exe rcise . During th is type of ex erc ise , a lot of ene rgy is required , so the musc le
cells must tap in to both previously stored nutrients and recently absorbed nutrients (from a
HEPATOCY TE
mea l ingested before exercise, for in stance , or from sports drinks ingested du ring exercise)
Liver cell
to fuel the cont inued acti vity. This example aside, during most conditions (includ ing shorter
duration exercise activities) , most of the energy we require comes from nutrients that have
MYOCYTE
been stored in our hepatocytes (liver cells), myocytes (muscle cells), and adipocytes (fat
Mus cle cell
cells) for some tim e.

Triglyce rides (stored in both fat ce lls and , in smaller amounts, in musc le cells) as wel l as AOI POCY TE
glycogen (stored in both muscle cells and in liver cel ls) make up our two most important Fat cell
70 UNIT 1 Chapter 3 Energy Tr ansfor mation & Metabolism

Proteins Carbohydrates Fats

,vvv'
~ Ou j
...rJ'
j Vv\

~
Am ino acids Fatty acid, glyc erol

1
fa Nitrogen pool

Ic&d
Tissue
protein

88
/--'-.\~ [8
Electron r:::\
1- - -
..\ Kreb s Cycle trans port - ~

8 '--~ ,'C,
cham
FIGURE 3. 1 e,J "--H,O
SUMMARY OF METABOLISM
aa
nutr ien t stores for any of our tiss ues that need mo re ATP. Both of th ese nutrie nt types have a
lot of responsibility, Not only do they have to provide energy for the tissues in which they're
alr eady stored; they also are respo nsible for those cells that don't have their own capac ity to
store energy-producing nutrient s, suc h as the brain and the red bl ood cells , Wh en our cells
require ene rgy fo r ATP production , our stored glycogen and triglyc erides spring into act ion .

After glycogen (lo ng chains of tightly packed glucose mo lecules) is broken down into
glucose; tr iglyce rides (long chains of tightl y packe d f atty acid molecules) are broken down
into fatty acid s (or ketone bodies); and proteins (long chains of tightly packed am ino acid s)
are broken down into amino acids, these nutrie nt s can ac t loca lly in th e energy transfer
process. They can also be sh ipped out into gene ra l ci rculat ion to help peripheral cells
generate ATP. It 's a highly coordinated pro cess th at is esse ntia l for our survival, especially
in times of low food intake. Th e show must go on, whether or not we've got th e time (or
the resou rces) to eat a meal.

The process of energy transfer

As we've indicated, the main purpose of most of this activ ity is to make ATP. ATP is an
adeno sin e molecul e with three phosphate molecules attached to it. Th e bonds between this
adenos ine and the se three phosp hates are co nsidered "high energy ". Energy is released
when the ca rbon- hydrogen bonds of our carbo hyd ra tes, fats, and protei ns are broken, as well
as wh en these adenOSine-phosphate bond s are broken. Therefore, when ATP is used to do
cellular work , one adenOSine-phosph ate bond is broken, leaving ADP (adenosine bonded to
two phosp hates ) and P (a free phosphate) float in g around in the cytoplasm of our cells.

Alth ough ATP is crucial, we don't have much of it hanging arou nd in ou r cells . Indeed , it's
estimated th at we only have about 80-100 grams of ATP stored in our ent ire body. Th is is
on ly enough to pe rform maxima l exe rcise for a few seconds. It's also estim ated tha t we use
UN IT 1 Chapter 3 Energy Tr an stormat lon & Metabolism 71

energy released energy released

FIGURE 3 .2
ATP & ENERGY RELEASE

so much ATP per day - about 51,000 g (or, about 112.5 Ib) for a 150 Ib individual - that
the total weight of ATP used and regenerated would equal about 75 % of our bodyweight.
Therefore, when those adenosine-phosphate bonds are broken, th ey 've got to be reg enerated
pretty quickly to help supply energy for our daily needs. That's where the process of energy
transfer comes in to play. Our energy transfer ring processes re-attac h the free ADP and P
fl oa ti ng around in the cytop lasm , and thus rege ne ra te the ATP that's been broken apart.

Despite all of its com plex ity, the body has two simple priorities: to break the car bon-hydrogen
bonds con ta ined in our carbohydrates, proteins, and fats; and to use the energy released
to regenerate adenosine-phosphate bonds, forming ATP. All life ca n be boiled down to this
st raightlorward exchange of breaking and fixing chemical bonds. It's just tha t simple. (And
ATP / PC r SYSTEM
you always thought life was complicated I)
Composed of ATP and
Of course, as you might have guessed, th ere are several ways of mak ing th is process phosphocreatine. this system
replenishes oxygen rapidly
happe n. The key differences betwee n the va ri ous ATP generating systems are :
without the use of oxygen
a) how quickly the energy is requ ired;
CREATINE KINASE
b) how fast the reac tions are taking place; and
Isoen zyme found in muscle
cl wheth er adeq uale oxygen is present to contribute to the reac ti on. and brain tissue that
catalyzes the formation of
To better understand how this works, below we've descr ibed the main energy transfer ATP; higher after tissue injury
processes , or pathways, in the body.

The ATP-PCr system CREATINE

Nitrogenous substance.
When the body begins to use ATP at a rate more rapid than usual (for example , with Ihe derived from arginine. glycine
onset of physical activity or purposeful exercise), the ATP/PCr system is usually the first and metl1ionine. found in
muscle tissue
to kick in. Thi s system, which operates in the cytosol of our cells, assists in the rapid
regeneration of ATP from ADP and P It uses an enzyme called creatine kinase to break the
PHOSPHOCREATINE (PCR)
chemical bonds between creatine (Crl mo lecules and phosphate (PI molecu les that are
Compound of creatine (Cr)
already joi ned in a phosophocreatine molecule (PCrl. As these bonds are broken, creatine and phosphoric acid (P)
and phosphate molecules (as well as energyl are released freely into the cell. This ene rgy (as found In muscle
72 UNlT 1 Chapter 3 Energy Transformahon & Metabolism

well as th e new phosphate molecules th at have been released in this reaction) in turn he lp
to regenera te ATP. With this new ATP, energy can be supp lied to meet the new, and hig he r,
phys io logical demand.

However, this new ATP can only help out for a short time. Alt hough PCr supplies in the body
are about six times greater than the supp lie s of ATp, during per iods of intense energy demand
(such as max im al effort muscle contraction) they can only help provide energy for about
te n seconds. Think of spr int in g as a good example of this. After about ten seco nds of all -out
sprinting, the body is forced to slow down because of depleting concentrations of both ATP
and PCr in the muscles. Try an all-out sprint sometime , You'll notice that after about 8-12
second s, you'll need to slow down quite dramatically if you hope to continue runn ing. You ' re
slow in g dow n because you r PCr system has just been maxed out and yo ur PCr stores are
getting depleted.

This is one reason why creatine supplementation can help improve muscular performance,
By increa sing the intramuscular creatine pool , more creat ine (a nd PCr) will be available
for hig h in tensity, sh or t -b urst muscle contractions. Research has shown that higher
co ncentratio ns of intramu sc ular creati ne are linked with improved force dur ing maxim al
contraction , and improved stay ing power with high intensity exercise.

Now , if you're sti ll running, and you keep pushing yourself, you'll realize that you can go on
ru nning without any problem s. Howeve r, you will have to stow down and your muscles will
start to " burn ." This is becau se your body is seek ing ot her sou rces of energy. Now ot he r
metabolic pathways need to be activated to help rep le nish bot h PCr and ATP stores. We'll
talk about these pathways below. Keep in mind that while th ese pathway s are able to keep
you going, they generate ATP much more slowly than the ATP-PCr system .

Th e gl ycolytic pathway

When energy demands are hi gh and pers ist beyond te n seconds, your PCr stores begin
to deplete and another energy system takes the brunt of the work in regenerating ATP.

FIG URE 3 .3
GLYCO LYS IS
e
($$
°0
fru ctose
diphosphate
v~

PGAl

(~
..e
8
(

pyruvate pyruva te
aa
-- -- ---. .'.'.'
.'

.
'" .. '
to Krebs cycle
•
UNIT 1 Cha p te r 3 Energy Transfor ma ti on & Metabolism 73

Interestingly, this glyco lytic system is turned on at the same time as the ATP-PCr system. Yet GLYCOLYTIC SYSTEM

since it regenerates ATP much more slowly, it doesn 't cont ri bute as much to energy transfer Process of breaking down
glucose for energy; can be
within the first ten seconds of exercise. The glycolytic system, which occurs in the cytosol,
fast or slow
breaks down stored muscle glycogen, immediately available blood glucose, and glycerol from
triglycerides to help regenerate ATP. Indeed , the very name of the pat hway tells you what th is
pathway does; glycolysis literally means "breaking glucose ."

Th e glycolytic system is much more complex than the ATP-PCr system, and utilizes ten
enzymatically controlled chemical reactions to regenerate ATP. Specifically this process
regenerates four mo lecules of ATP (from ADP and Pl for every molecule of glucose put PYRUVATE
Ihrough the system. However, as the process of glycolysis "costs" two molecules of ATP, the Salt of pyruvic acid; the end
product of glycolysis
net energy gain is two ATP for every glucose molecule that goes through the system. Also
created during glycolysis are two molecu le s of a chem ical called pyruvate and two molecules
of a chemical called NADH . And at the point of pyruvate generation, the last step of the NADH
Reduced form of NAD; used
glycolytic pathway, we reach a "fork in the road".
to transfer electrons
If the glycolytic pathway is runn ing quickly, as it would be in higher intensity activity, we end
up producing a lot of pyruvate. This is a good thing, since the fas ter glyco lysis occurs, the
more ATP we regenerate. However, a fa st glycolytic process also releases a lot of hydrogen HYDROGEN ION
The cation of acids;
ions into the ce ll as a by product of th e breaking of chemical bonds. Since hydrogen
consists of a hydrogen atom
molecules can quickly fatigue the muscie cells, this rap id rate of hydrogen release must be whose electron has been
"buffered" so that muscle activity can continue. Through glycolysis, the natural hydrogen transferred to the anion of
acceptors NAD + and pyruvate come to the rescue. Grabbing hydrogens as fast as they can, the acid
NAD+ becomes NADH and pyruvate be comes the infamous lactic acid , Contrary to popular
NAD +
opinion, rathe r than causing muscle burning and fatigue, lactic acid actually acts as a Co -enzyme of
hydrogen buffer that carries hydrogen ions out of our cells. In essence, this binding of NAD+ dehydrogenases: plays
and pyruvate to these excess hydrogen ions allows us to continue exercising. a role in intermediary
metabolism as an oxidizing
Through th is system from glucose to pyruvate and lact ic acid, glycolysis is able to rege nerale agent or reducing agent for
ATP and suslain intense physica l activity for about 80 seconds or so beyond the init ia l metabolites
ten second burst the ATP-PCr system del ivered. At around that 80 second mark, however,
LACTIC ACID
hydrogen ion production will increase musc le acidity to the point where it forces cont raction
An organic byproduct of
rates to slow down again. At this poi nt, additiona l energy tran sfer systems must bear the anaerobic metabolism
brunt of the work. As discussed above , these systems operate even more slowly, taking derived from pyruvic acid;
longe r to regenera te ATP. Although you'll be ab le to continue exercising, you' ll have to lower can be used as an energy
your intensity. source for cells

When the glycolytic pathway is running so quickly that hydrogen ions are produced in high
quantities, and must be buffered by NAD + and pyruvate, th e ions wi ll eventually overwhelm
the system and cause fatigue. However, if th e glycolyt ic pathway is running more slowly
(due to more moderate energy demands)' pyruvate and NAD+/NADH have a different fate.
They're used in our next ATP regeneraling process , oxidative phosphorylation . OXIDATIVE
PHOSPHORYLATION
The oxidati ve phosphorylative pathway The phosphorylation of ATP
coupled to the electron
As maximal exercise act iv ity persists beyond about 80-90 seconds, in te nsity must decrease. transport system
This is due to three factors: the deplet ion of PCr; a maximal rate of glycolysis; and high
levels of muscie acidity. At this point, you're forced to slow down. Howeve r if yo u continue MUSCLE AC IDITY
to exercise at a moderate pace, oxidat ive phosp horylation comes to the rescue. Just as An acidic environment
glycolysis is taking place while th e ATP- PCr system is providing our first ten seconds of created when the pH level of
muscle cells falls below 7
energy, oxidative phosphorylation ramps up with the onset of increased energy demands .
However, because it's the slowest energy transfer system, it takes a while to begin
74 UNIT 1 Cha pter 3 Energy Tr an sforma tion & Metabolism

FIGURE 34 (rom glycolysIs

T HE KREBS CYCL E ••
•
( pyruvate)

~ .;~:,;. ::>~ s
+

iH'lh
'el
I ~ CoA
Acetyl CoA

+~ / ~A ~
~( '\
\ <". ~ . ~8
KREBS CYCLE
A major metabolic pathway
that involves a series of
.......... Em /)---
~ / e
enzymatic reactions that
convert pyruvic acid from
food to acetyl-eoA for
energy
regenerating ATP at th is new, higher rate. Further, it can't sustain the same high level of
ELECTRON TRANSPOR T intensity as the ATP-PCr system and the glyco lytic system. However, what it lacks in in tensity
CHA IN it makes up for in volume . This system has a tremendous capacity for ATP regeneration. In
Set of compounds that
essence, if the ATP-PCr system is a IOO-metre sprinter, the oxidative phosphorylative system
transfers electrons to a
donor that creates energy is an uJtramarathon runner.

ACETYL -eoA The oxidative phosphorylative pathway is made up of two processes, the Kreb s cycle and
Co-enzyme that plays a role the electron transport chain. When the rate of glycolysis matches the rate of Krebs cycle
in intermediary metabolism; activity, instead of using pyruvate to make lactic acid the body funnels the pyruvate into
can enter the Krebs cycle to the Krebs cycle. This pyruvate from the breakdown of carbohydrates (via glycolysis) is then
produce energy and be used
for fatty acid synthesis
converted in to a chemical cailed acetyl-eoA. As fats can be broken down to acetyl-CoA
through a process known as beta oxi dation (to be discussed later in this chapter), and
BETA OX IDATION
proteins can be broken down to acety l- CoA as weil, acety l-CoA is the chemical entry point
Breakdown of fatty
into the Krebs cycle. While you don't need to memorize the 11 steps (or the nine enzymes)
acids that takes place
in the mitochondria and that are involved in a single rotation of the Krebs cycle, it's important to know that this cycle,
peroxisomes which takes place in the inner chamber of the mitochondrion, ends up regenera ting one
molecule of ATp, creating two carbon dioxide molecules, and releasing eight hydrogen ions
FAD+
Riboflavin-derived hydrogen with every turn of the wheel.
acceptor in the Krebs cycle
Lots of hydrogen ions are produced during the Krebs cycle. However, these hydrogens won 't
FADH2 quickly cause fatigue, like those generated during glycolysis. Instead, these hydrogens are
The reduced form of FAD+ bound to the chemicals NAD+ and FAD + within the mitochondria and rapidly shuttled into
CY TOCHROME the next portion of the oxidative phosphorylation process, the electron transport chain, where
Protein found in ail of this ceilular effort comes to fruition.
mitochondria (inner
membrane) that transports The NADH (NAD + and hydrogen) and FADH2 (FAD + and two hydrogens) formed during
electrons the Krebs cycle carry these hydrogens through the mitochondria and transfer their energized
electrons to a set of special molecules (cailed cytochromes) embedded in the cristae of the
UNIT 1 Ch apter 3 Energy Transforma tIOn & Metabol ism 75

inne r mitochon d ria l memb rane. Here, these hydrogen molec ul es (namely, the ir electrons)
jump between th ese five cytoc hromes and as they jump, th ei r ene rgy is used for a ve ry
in teresting pu rpose. This energy actual ly serves to pump the hydrogen mo lecules (namely,
the ir protons) fro m t he in ner chamber to the outer chamber of the mi tocho ndr ia. While th is PROTON
may seem like a waste of energy since we've got so much AT P to make, this pump ing action Particle with a positive
serves an important pur pose . When these proton s build up in the ou te r chamber, they rush charge, usually regarded as
a hydrogen ion; when the
forcefully back in to the in ner chamber, like water rushing th rough a dam, throug h a special
proton gradient shifts in the
carrier ca ll ed the AT P sy nt hase complex. This rushing in of hydrogen proton s creates a electron transport chain,
massive energy yield, generating a whopping 32 mo lecules of AT P per molecule of glu cose. energy conversion occurs

The three processes we've ju st described are t he three main energy t rans ferring processes
necessary for living, breathing , and moving . When compared to the two net ATP genera t ed
with the ATP-PCr syste m and the two generated during the Krebs cycle, the electron tra nsport
ch ain emerges as a superstar of energy transfer. However, of co urse, all th ree systems are
importan t. Togethe r, they turn one mo lec ule of glucose into 36 mo lecu les of ATP. Fu rther,
although al l three systems are always runnin g to some extent , the ATP demand see n with
max im al exe rcise forces them to all ope rate at max imum speed and efficien cy. Whe n
this speed and/ or efficiency is comprom ised (as see n with nutrient defic ienc ies, enzyme
deficiencies , and mitochondrial inefficie ncies), metabol ic rate , overall hea lt h, and phys ical
perfo rmance are com promised.

Nutrition in practice

One clear example of this is the link between nutrition and the B-vitamins. Remember the two important
hydrogen carriers discussed above, NAD + (nicotinamide adenine dinucleotide) and FAD (flavin adenine
dinucl eotide). These two molecules act as co -enzym es and are actually derived from the vitamins B3
(niacin) and B2 (riboflavin). Although vitamins and mine rals don 't actually provide energy to the body,
you can now see how critical these two are for helping with the transfer of energy and the rege nerat ion
of ATP throughout glycol ysis, the Kreb s cycle , and the electron transport chain . Thus di ets deficient in
ke y vitamins lead to poor health , reduced energy leve ls , a worsening of body composition, and decreased
performance . This is why a belter di et, or th e addition of vitamin supplements in the absence of dietary
changes , can often help improve everything from the metabolic rate to body composition .

Pathways for nutrient metabolism

In the prev ious section we discussed Ihe th re e ma in energy transfer processes that break the
chem ical bonds Found in macronutrients like carbs , fats , and proteins and re generate the
chemi cal bonds that form ATP. Now , we're goi ng to ta lk abou t th e main metabolic pa thways
tha t each of the macron utri ents goes throug h in its quest to he lp rege nera te ATP.

Carbohydrate metabolism

Carbo hydra tes are important in the diet for two reasons. First , they prov ide the fast est-act in g
macronut rient sou rce for energy transfer. Second , their storage in the body is qu ite li mited.
Indeed , although a ISO Ib individual who has IS % body fat carries around 22.Slb (or
10,206 g) of stored fatty acids, this same ind iv idual can on ly store about 1.1 Ib (o r 500 g)
76 UNIT 1 Chapter 3 Energy Tr an sf orma tIO n & Metabo lism

inner chamber

FIGURE 3.5 of glucose. Put in terms of ca lories, this is the difference between carrying almost 92,000
THE ELECTRON TRANSPORT fat calories on your body and 2,000 carbohydrate ca lories on your body. The fat wou ld last
CHAIN
you qu ite some time durin g a fam ine. The carbohydrates' Not even a day. Thus, the gl ucose
we use for energy transfer must often be generated from our dietary intake of carbohydrates.
However, before assuming this means that humans shou ld always eat a high-carbohydrate
diet, it's important to note that wh ile dietary carbohydrate intake is the most readily available
form of glucose for energy transfer, glucose can also be derived from dietary protein. In
add ition, as you ' ll learn be low, dietary fats can also provide plenty of fue l for energy transfer.
So don't make the mistake of thinking that high-carbohydrate diets are always required for
opt i ma l energy transfer.

There are five ma in metabo lic pathways through which carbohydrates can travel in their
eventua l goa l of he lping with ATP generation.

1. Glycogenesis: From glucose to stored glycogen

2. Glycogenolysis : From glycogen to glucose
3. Glyco lys is: From glucose to pyruvate
4. Krebs cycle and electron transport cha in: Acetyl-CoA to ATP, C02 and H20
5. Gluconeogenesis: Non-carbohydrates to glucose

We'll look at each one in turn below.

GLY COGENES IS Pathway 1: Glycogenesis

Synthesis of glycogen
Glycogen is the storage form of dietary carbohydrate. Glucose molecules are chemically
GLUCOSE 6· PHOSPHATE
bound together to form tight ly packed glycogen molecules which are , in t urn, stored in
Phosphorylated form of tissues li ke the muscles and the liver. This process is cal led glycogenesis , or the genesis
glucose that wo n 't diffuse of new glycogen from glucose. For glucose to be added to glycogen stores, it must enter
out of a cell t he muscle or the liver via specific membrane carrier prote ins . Once in these tissues, it's
UN IT 1 Chapler 3 Energy Tra ns format ion & Me tabolism 77

Highly branched glycogen mo lecule

"Branch ing occurs here

, FIGURE 3 .6
Glucose monomer GLYCOGENESIS

converted into a high energy ca rb ohydrate called glucose 6-phosphate, a process that costs
the body one molecule of ATP. Once glucose 6-phosphate is formed, a series of chemical
reactions takes place to produce the energy required to add the glucose molecule to a
GLYCOGEN SYNTHASE
previously existing cha in of glucose molecules (I.e ., glycogen). The most im porta nt enzyme Enzyme necessary for the
in this process is glycogen synthase . conversion of excess glucose
into stored glycogen
Glycogen is a compound that can vary in size, depending on how much excess carbohydrate
is currently available versus how much carbohydrate is required for energy transfer. If there is
extra glucose from the breakdown of dietary carbohydrate, and the demand for this glucose
EP INEPHRINE
is low, insulin stimulates glucose uptake into muscle and liver cells as well as increased Hormone and
activity of the glycogen synthase enzyme. As insulin is released in proportion to the amount neurotransmitter; also
of carbohydra te digested and absorbed per unit time, dietary carbohydrate ingestion therefore known as adrenaline
stimulates the sto ra ge of glyc ogen in the muscle and the live r. On the other hand, if energy
demand is high and/or stored glucose is immediate ly required for energy transfer, hormones NOREP INEPHRIN E
like epinephrine and norepinephrine decrease the activity of glycogen syn thase. Dur ing Hormone and
neurotransmitter; also
fasting and exercise, these hormones are released to slow down glycogen synthesis and
known as noradrenaline
promote glycogen breakdown (glycogenolysis) by increasi ng the activity of an enzyme called
glycogen phosphorylase.
GLYCOGEN
Pathway 2: Glycogenolysis PHOSPHORY LASE
Enzyme necessary for
During periods of high energy need, when glucose is required for energy transfer, the body glycogenolysis; breaks
sends signals to stimulate the removal of glucose units from the ends of the long glycogen glycogen mto glucose units

molecules . This process is called glycogenolysis or the lys is (splitting) of glycogen. In order
GLYCOGENO LYSIS
for glucose to be released from glycogen molecules, the glycoge n phosphorylase enzyme
Breakdown of stored
must be activated. Th is enzyme adds a phosphate group to one of the glucose units packed
glycogen to glucose
into glycogen, which breaks the bond holding the glucose unit on to the glycogen molecule.

This glucose + phosphate compound can serve two roles . In the muscle, this compound can
enter glycolysis and run through the glycolytic pathway in order to regenerate ATP. However,
in the li ver, it can either be used in the creation of ATP, or it can become free glucose for
78 UNIT 1 Chapter 3 Ene rgy Tr ansform at ion & Metabolism

Carbohyd rates

GA
glyco genesis Glu cose
Gly cogen ~
y , 6-p hosphate

....."""ooo!.~ I ~ l
opo ,

" ,KG
glycogenolysis ' ---=='--- -'
@
1
stored in muscle
1
to blood and brain

'- -' - '-" '-

and Jive r cells

FIGURE 3.7
GLYC OGENOLYSIS ( lactic acid ) ......~-l.~

export i nto the bloodstream. This latter fac t brings up an important point Glycogen in the
liver can either be used for ATP regeneration within Ih e liver or for export into th e blood to be
circulated to oth er tissues running Iow an glu co se . The brain and red blood cells can 't store
the ir own glucose, so they rely on glucose from your last meal. Whe n that runs ou t, they rely
on glucose expor ted from your li ver. On the othe r hand , musc le tissue can' t export glucose to
othe r tissues , once stored in the musc le, glucose must be used in the muscle.

Whe n a person is well-fed and whe n energy demand is low, ins ulin rele ase and gl ucose
GLUCAGON
sto rage predom in ates. In this situation, Ihe body is in storage mode. There fore little
Hormone secreted by the
pancreas to increase blood gl ycogenolysis occu rs. Ho wever, du ri ng pe riods of hig h energy deman d (su ch as exe rcise),
glucose le vels low en ergy in take, an d low blood suga r, glycogen esis is shu t down and glycogeno lysis
predomina tes. This increase in glycogenolysis is sti mulated in large pa rt by two hormones,
(I -CELLS
glucago n and epinephr ine. Glucagon is a hormone sec reled by the ",- cells of the pancreas
Endocrine cells of the
in response to low blood glucose and st ress. Epine phrine , which also respon ds to stress,
pancreas that secrete
glucagon is a hormone released pri mari ly from the adrenal medulla . Bot h hormo nes slimulate the
breakdown of stored glucose to help out in energy Iransfer.
ADRENAL MEDUL LA
Cen tral p art of the adrenal Pathway 3 : Gly colysis
gland th at secretes
Glycolysis occurs in the cytop lasm of all cells . This pathway regulates the breakdown of
epinephrine. norepinephrine
and dopamine
glucose to form two molecu les of pyruvate. The glucose used in glycolysis can be der ived
from two sou rces: blood glucose and stored glycogen. To refres h you r memory, glucose ente rs
GLYCOLYSIS glycolysis as glucose 6-phospha te, wh ich is formed both when glucose firs t enters the cell
Series of reactions in the and when glucose is sep arated from glycogen. Through a ser ies of enzyme ca t alyzed st eps,
cytosol that converts glucose this glucose -6-phosp hate changes its shape. Afte r some additional en zym at ic activity, this
in to pyruvic acid and molec ule is sp lit in two and reconfigu red to form pyr uva t e.
ultimately ATP
You may recall that dur ing this process, hydrogen atoms are released, which need to be
buffered in order to prevent premature fatigue. These atoms are picked up by NA D+ , forming
NADH. As glyco lysis cannot continue un less NA DH gives up its hydrogen atoms and recyc les
back to NAD, the hydrogen atoms either end up joi ning with py ruvate (to form lactic acid)
or be ing passed along to the Krebs cycle and eventually to Ihe electron transport chain .
UN IT 1 Chapter 3 Energy Transf o rm at ion & Me tab() llsm 79

FIGURE 3.8
GLYCOLYSIS

energy in ve st me nt

---~8 8

8 888---~$$$$
~
energy payoff

py ru va te

( py ruv ate b+ 2HzO

NET

Again, this fate is determined by the rate at which glycolysis runs. If energy demand is high
and glycolysis ru ns quickly, as in the case of anaerobic exercise , the hydrogens are bound
to pyruvate and lactic ac id is formed wi th the help of the enzyme lactate dehydrogenase .
This al lows NAD+ to be recycled , glyco lys is to continue to regener ate ATP, and the excess
hydrogen ions to be shuttled out of the ce ll before they cause fatigue . On the other hand, if
ANAEROB IC THRES HOLD
energy demand is more moderate , as in the case of act ivities below the anaerobic threshold , The point at which lactic
the Krebs cycle can keep up wi th the rate of glycolysis . As a result, hydrogens are passed acid begins to accumulate
along to the elect ron transport chain, creating a lot of ATP in the process . in the bloodstream

Mitocho ndria
FIGURE 3.9
Innet membian e KREBS CYCLE AND THE
ELECTRON TRANSPORT
Elec tro n tran sport CHAIN
chai n: + 32 AlP

®J
'\
Kr ebs Cyc le: )
+ 2 ATP

/re e
80 UNIT 1 Ch apt er 3 Energy Tr ansformation & Metabolism

Pathway 4: Krebs cycle and electron transport chain

The Krebs cycle is the energy system that does not discriminate when it comes to nutrients.
Garbohydrates, fats and proteins can all be broken down into the major entry molecule into
the Krebs cycle, acetyl - GoA , transported into the mitochondrion, and used to regenerate ATP.
Note: other substances can ente r the Krebs cycle but this occurs further along the pathway
and we'll discuss t hese entry paints later.

When carbohydrates go through glycolysis, pyruvate is the end product. Depending on the
rate at which pyruvate is produced, some to most of this pyruvate is converted to acetyl-
GoA in the mitochondria. The amount of pyruvate converted depends on the intensity of the
energy demand. When the ene rgy demand is high, only some of the pyruvate is converted
to acetyl -GoA , sin ce t he pyruvate wi ll be created at a rate faster t han it can be converted to
acetyl -Go A and run through the Krebs cycle. When the energy demand is lower, most of the
pyruvate is conver ted to acetyl- GoA since the rate of glycolysis will match the rate of Krebs
cycle activity. The conversion of pyruvate to acetyl-GoA occ urs by remov ing GO, and adding
coenzyme A to t he pyru vate molecule.

Nutrition in practice

The Krebs cycle provides another great example of the importance of vitamins in the bod y. Pantothenic
acid (a B vitamin) is a necessary co mponent of co enzyme A. When acetyl-CoA enters the Kreb s
cycl e, a serie s of chemical reaction s occurs, turning the Krebs cyc le through one complete rotation .
Dur ing each turn of the cycle, one molecule of ATP is regenerated , two carbon dioxi de molecules are
released , and ei ght hydrogen io ns are carr ie d forward. The ATP is t hen used to do additional work,
the carbon dio xi de is sent out for exhalation duri ng your normal breathing cycle, and the hydrogen
ions are used in the electron transport chain to regenerate lots of ATP. Carried as NADH and FADH2,
these hydrogens are pass ed through the electron transport chain in the inner membrane of the
mitochondrion to pump protons (as discus sed earlier) and regenerate ATP.

If vi tamin B def icienci es exist, this process of ene rgy tran sfer ca n be impaired.

OXALOACETATE As a fitness professiona l, you may have heard the expression that "fats burn in the
Intermediate that couples carbohydrate flame" . People typically use it to suggest that die tary carbo hyd rates are necessary
with acetyl Co-A to form if we want to burn fat optimally. To a certain extent, they're correct. For the Krebs cycle to run
citrate optimally, the first step in the process is the jOi ning together of acetyl -CoA to a compound called
oxaloacetate (this occurs with th e help of an enzyme called citrate synt hase). Withou t adeq ua te
oxaloacetate in the ce lls , acetyl-GoA doesn't ga in access to the Krebs cycle and the Krebs cycle
doesn't run properly. Since oxaloacetic acid is also a by -product of carbohydrate metabolism
(glucose is metabolized to pyruvate and pyruvate can also be converted into oxaloacetate),
withou t adequa te carbohydra te metabo lism, oxal oacetate will be in scarce supply, acetyl-CoA
will accumulate, and the Krebs cycle will slow down.

Part ly fo r this reason , many individuals feel more sluggish on a lo w-carbohydrate diet,
especially when th ey first decrease their carbohydrate intake. They simply aren't regenerating
enough ATP through the Kre bs cycle and electron transport cha in to meet their ene rgy
demands. Fu rth er, the li ve r doesn't ha ve enough stored glucose to ship it out to the brai n and
UNIT 1 Chapter 3 Ener gy Trans formation & Metabo lism 81

red blood cells . Everything from brain function to physical activ ity levels slow down to match
th is new. reduced nutrient and ATP availabi lity.

However, this doesn't mean that one must always follow a high-carbohydrate diet. For
sta rters, for this reductio n in Krebs cyc le activity to occur, carbohydrate intake would have
to be very low - probab ly less than 100 g of carbohydrates per day. And this is far less than
most peop le, even those on a carb controlled diet, would take in. Second, if fat supplies
are abundant in the body and fat intake adeq uate, 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 ca rbohydrate intake drops off and carbohydrate metabolism
FAT ADAPTAT I ON
dw indles , the liver in itiates a process that takes the extra acety l-eoA that's not be ing run
A higher capacity to oxidize
through the Krebs cyc le and converts it into ketone bod ies. These ketone bodies are then fat
shipped out to tissues suc h as the muscles , the brain , etc. where they're converted back
into acety l- eoA . At this paint this acetyl -eoA is more usable since the Krebs cycle will have
upregulated its act ivity, even in the presence of re duced oxaloacetate. This adaptation is
common ly referred to as "fat adaptation" since much of the acetyl-eoA formed comes
from the metabolism of fatly acids. Interest ingly, some ind ividuals feel best and look best
once this metabo lic adaptation has occurred , even better than they did while eating more
ca rbohydrates. However, other ind ividuals have the opposite response, doing much betler
when ingesting mo re carbohydra tes .

Thus, even though fat does "burn in the fl ame of carbohydrates" via the Krebs cycle, this
PLASMA
phenomenon does not dictate that a high-carbohydrate diet is necessary for fat burning. Liquid component of blood
Indeed, the body is surpris ingly adaptable to a variety of carbohydrate intakes. Individual that suspends blood cells;
differences should therefore determ ine whic h dieta ry cho ices are best for different peop le. con ta ins water, glucose,
proteins and hormones
Pathway 5: Gluconeogenesis

For the ce ntral nervous system to function normally, plasma levels of glucose must be
sufficient to provide enough carbohydrate for energy transfer in the brain. Thus ma inta ining
blood glucose is one of the hig hest physio log ical pr iorities. Without adequate nutr ients to fue l FIGURE 3.10
bra in activity, we cease to ex ist. Therefore , during periods of high energy demand (such as GLUCONEOGENESIS

Occurs mainly in the liver Glucose

6-phosphate Glucose

e
opo,

• G
'"OJ
glycerol
from lipids )
'Vi
c:
OJ
b.O
0
OJ
c:
1
to blood and brain
amino acids ) 0
U
::l
bo
( lactic acid ) I(
• ( pyruvate )
82 UNIT 1 Chapter 3 Energy Tran sforma tion & M et abolism

exercise) or periods of low nutrient availability (such as fasting), when plasma gluco se leve ls
decreas e, th e body finds a way to rep lenis h this glucose.

As our blood glucose master commander, ou r liver is called into actio n. Through
glycogenolysis, which yo u just learned about , glucose can be released fro m stored liver
glycogen and shipped out into the blood. However, if li ver glycoge n co nce ntrations are low,
the body has a ba ck- up system. In addit ion to liberating glucose from glycogen, the liver can
also make gl ucose from non-carbohydrate co mpounds . Thi s process of creating glucose from
GLUCONEOGENESIS non-carbohydrate sources is called gluconeogenesis , or th e genes is of new glucose .
Conversion of non-
There are four main compounds tha t can go through the process of gluconeogenesis,
carbohydra te compounds
(i.e ., amino acids, pyruvate, a) pyruvate fro m glycolysis ;
glycerol) to glucose
b) lactate from glyco lys is ;
c) most amino acids; and
d) glyce rol fr om triglycerides .

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 reve rse
of glyco lysis. While the liver takes ca re of mos t of the gluco neogenesis required by the body,
duri ng per iods of ext reme energy imba lance (s uch as starvat ion) , the kidn eys can also
contribute to gluco neoge nes is.

Of relevance to fit ness profess io na ls is th e fact that this gluconeogenic pathway is responsib le
for helping cont rol the high levels of blood lactate that accompany high intensity activity.
Indeed, lactate released from the muscles is circulated to the liver, where it's conv erted to
glucose. This glucose can th en travel back to the muscle for fu rther energy transfer. Thi s
COR I CYCLE process is common ly referred to as the Cori cycle . Even whe n ca rbohydrate in take is low,
Use of lactate produced in glucose can still be generated for energy transfer thro ugh the breakdown of proteins and fat s.
the muscles by the liver for Therefore, blood glucose can be maintained even wh en we're on a "l ow-c arbohyd ra te diet".
the production of glucose
Also note, there may be times when even gluco neogenesi s is limited; in these situations our
bodies can jump -start the process of ketone body formation .

Pathways for fat metabolism

Dietary fat has bee n much mali gned fo r the last two or thr ee decades due to some high ly
specu lative links drawn between dietary fat in take and hear t disease ris k. However, thanks
to a wide body of recent dietary research, we now know that dietary fat is quite importa nt for
ove rall hea lth and performance. Fatty acids and triglycerid es have four key roles,

a) they prov ide the structure of our plasma me mbranes ;

b) they help regulate ho rmone funct ion;
c) they help transport ce rt ain vitami ns and mi nerals in t he body; and
d) t hey act as the la rgest fuel depot in the body.

Indeed , fatty acids are involved in th e energy transfer process in seve ral important way s.
Although we can synthesize our own fatty acids in most ci rcumstan ces, there are a few fat s
that can't be syn thesi zed and must come from the die t. To th is end, there are six important
metabo lic pathways rel ated to fa t breakdown and synthesis, each of which will be discussed
in this chapter.
UNIT 1 Chapter 3 Energ y Transformation & Met ah ohsm 83

1. Triglyceride and fatty ac id mobilization

2. p-oxidation
3. Ketone format ion
4. Fatty acid synthesis
5. Triglyceride synthesis
6. Cholesterol synthesis and catabolism

PATH WAY 1: TRIGLYCERIDE AN D FATT Y ACID MOBI LIZATION

Fatty acids are the predominant nutrients involved in energy transfer during periods of low
energy demand (for example, normal daily activities) , during long duration, low intensity
exercise (such as walking, logging, etc.), and during rest per iods between higher intensity
exercise (such as between interval exercise). Just as glucose molecules are packaged
together to form glycogen, stored fatty acids are joined together in tightly packed molecules
known as triglycerides. The fat in our food and in our cells is made up of triglyceride uni ts
and these triglycerides must be broken down to fatty acids in order to be used.

Triglycerides are made up of th ree fatty acid molecules joined together by a th ree carbon
molecule called glycerol, with one fatty acid hanging from each carbon. These trig lyce rides
are stored in a host of tissues including our liver, our adipose tissues , and our muscle AD IPOSE TISSUE
tissues . When required for energy transfer, triglycerides are broken down by a process known Fat tissue

as lipolysis, or the lysis (splitting) of lipids . This process, carried out by an enzyme known
LIPOLYS IS
as hormone sensitive lipase, breaks triglycerides down in to their constituent parts : three Breakdown of triglycerides
individual fatty acids and one glycerol. If energy transfer is required in the tissues in wh ich into fatty acids and glycerol
this breakdown occurred, 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 below). HORMONE SENSITIVE
If energy transfer is required elsewhere by the body, these components can be released into LI PASE
Enzyme of the cytosol that
the blood. This process of triglyceride breakdown and fatty acid release into the blood, called
frees fatty aCids and glycerol
lipid mobilization , occurs when the body's need for energy increases. Indeed , t he use of fat
by muscle cells during exercise is directly related to the concentration of free fatty acids in the LIP ID MOB ILI ZATI ON
blood . Therefore, the most effective way of increasing fat loss from our stored body fat is to Using lIpids as a fuel source
create a large demand for this fat with exercise .

This process of lip id mobilization, including the activation of hormone sensitive lipase, is
stimulated by high concentrations of the hormones epinephr in e, norepinephrine, gluc agon,
and growth hormone. Each of these hormones is released during exercise with the specific GROWTH HORMONE
task of carrying the message to your fat cells tha t energy transfer is needed in the musc les. Anabolic hormone that
causes growth and cell
Interest ingly, injecting these hormo nes into the blood also causes a rapid release of fatty acids reproduction ; also known as
into the bloodstream. However, this process isn 't as effective for fat loss since the signa l is somatotropin
"artificia l." In this case, although the fats are available for burn ing, there's no increased muscle
activity to do the burning. The fats would simp ly recycle ba ck into fat storage. Th is is also the
case with many nutritional supplements designed to promote fat loss with th ei r stimulant-li ke
effects. While supplement companies boast of their prod uct's ability to cause fat mob ilization,
this mobilization is use less if there isn 't an increased need for these mobilized fats .

PATHWAY 2: ~- O X IDATION

When fatty acids are needed for energy transfer, they are run through a process known as
beta oxidation (t he Greek letter beta is often written as "P"). Th is process breaks down fatty
ac ids into acety l-CoA , a molecule that you should now start to realize is critical to the energy
transfer process. As fatty acids are long chains of carbon-hydrogen bonds , and acetyl-CoA
84 UNIT I Chap te r 3 Energy Tra nsformati on & Metabolism

Hydration @ . . .-.- ~ - ......

--,----~/
(n{l yi caA! '
IrydrJtdse I
• •
1
Oxidation o . _ ....-
Hydl(Uyar:y/ eoA ( \ _ _ _ _ _ _ _ L ,A'
t/ehydf"llenJ5P V V V V V V 'IV" ¥

...0' OWlW • ~ Eledton Ii

'--lransport
cham """

Thiol oysis

8·lferorhflXlase I
Co.\ -5H
FIGURE 3.11
BETA- OXIDATION

is made up of only two carbons, typical fatty acids can produce a lot of acetyl-CoA. For
example, a fatty acid consisting of 16 carbons would produce eight units of acetyl -CoA. In
the splitting of two carbon units from fatty acids, NADH and FAD H2 are formed, just like
dur in g glyco lysis. Also similar to glycolysis, these molecules then transfer their hydrogen
ions th ro ugh to the electron transport chai n, regenerati ng AlP. Finally, just as is carried out
afte r the conversion of pyruvate to acetyl-CoA in glycolysis, the acetyl-CoA generated with
beta oxidation is then added to the Krebs cyc le; the byproducts generated support AlP
regeneration through the electron transport chain.

AEROB IC
Although the beta ox ida tion process is very simil ar to the glycolyt ic process, beta oxidation
With oxygen present regenerates much more AlP than glycolysis. Indeed, each 18-carbon fatty acid can
regenerate approximately 146 Al P. Since triglycerides contain three fatty acid molecules ,
multiply that figure by three and you end up with 438 Al P molecules pe r triglyceride. Since
glycerol also cont ributes to AlP regeneratio n, helping to produc e 19 more AlP molecules , th e
ANAEROBIC
breakdow n of each triglyceride generates a whopping 457 AlP molecules. Compared to the
Without oxygen present
36 AlP molecules genera t ed by one glucose, fat emerges as an AlP superstar.

At this point, however, it's important to know that fat oxidation can only occur at these
rates if oxygen is available, mak ing this process aerobic. Oxygen must be avai lable to
accept hydrogen ions afte r they' ve participated in the electron tra ns por t chain. If th e rate
of energy transfer required exceeds oxygen availability, as in high intenS ity anae robi c work ,
t he process of beta oxidation comes to a halt and the body reli es mostly on t he oxidat ion of
glucose through glycolysis, a process defined as anaerobic. Although fat oxidation is efficient,
car bohydrate oxidation is still prioritized during high intenSity activity for t his reason.

PAlHWAY 3: KETONE FORMAllON

l he liver creates molecules kn own as ketone bodies when energy demands are high ,
ca rbohydrat e intake is ins uffiC ien t, and oxaloacetate concentrat ions are low due to insufficient
carbohydrate metabolism. As beta ox idation dominates when carbohydrate demands exceed
UNIT 1 Chapter 3 Ene rgy Tran sforma tion & Met abolism 85

Blood
vessel
FIGURE 3 . 12
Fasting State KETONE FORMATION

carbohydrate in take, fatty acids create a su rplus of acetyl -CoA. As there aren't enough
oxa loacetate mo lecules to ru n this acetyl-CoA through the Kr ebs cyc le , it's halted and acety l-
CoA bu il ds up. Thi s build up of acetyl -CoA shifts the li ver into ketone body forma tion. Ketone
bodies can then be shipped out to peripheral tissues to help in energy trans fer.

There are three basic ketone bodies: p-hyd roxybutyrate, acetoacetate, and aceton e. Th ese
ketones are water soluble and can be reconverted into acetyl-CoA to help supply th e brain,
MONOG LYC ERIDE
red blood cells, and muscle tissue with energy transfer nutrients when glucose is in short A glycerol with one fatty
supply. Although this pathway isn't the preferred pathway for fue lin g the body during high acid chain
periods of ene rgy demand (such as exerc ise trai ning), it does se rve as an excellent back -up
DI GLYCERIDE
system when glucose is unavailable. A glycerol with two fatty acid
chains
PATHWAY 4: FATTY ACID SYNTHESIS
Fat consumed in the diet, usually in the form of triglyce rides, acco unts for a good portion FATTY AC ID SYN THASE
of our stored body fat. During th e process of digestion and absorption, these triglycerides SYSTEM
System of enzymes involved
are typically broken dow n into monoglycerides , diglycerides , and free fatty acids . These
in the synthesis of fatty
partia ll y or fully broken down triglycerides are the n reformed into tri glyce rides as they ente r acids

Fat synthes is:

triglyceride
syn the sis
satu rated fa tty monounsaturated - - . _ _ ----. triglycerides __
acety l CoA ma lonyl CoA
acyl CoAs fatty acyl CoAs

1
CPT

Fat breakdown:

mitoc hondria l
B-oxidation FIGURE 3. 13
FAT SYN THESIS
86 UNIT 1 Chapter 3 Energy Tr a ns fo rm ati on & Metabohsm

ELONGATION lymphatic and portal circulation. Next, they circulate and are taken up by muscle , fat, and
Addition of carbons on a other cells for ei th er energy transfer or for storage . Howev er, it's not only dietary fat that
fatty acid chain
becomes body fat. Extra nutrients of any kind can potentially become new fat through the
process of fat syn thesis .
SATU RATED FATTY AC ID
A fatty acid with no double
The synthesis of new fat takes place predomi nantly in the live r, although it can also occu r
bonds in the cham
directly in our adipose tissues during pe riods of dietary excess, low energy demand, and

DESATUR ATI ON
high insulin concentrations. This process is governed by a complex of enzymes called the
Removal of hydrogen atom(s) fatty acid synthase system. This system is activated when energy deman d is low yet high
to form a double bond concentrations of acetyl-CoA are present in the liver. Dur ing this seven-step process, two
carbon units are added to an ever-growing fatty acid chain until one specific saturated fatly
MONOUNSATURATED FATTY
ac id, palmitate, is for med. From he re , the palmitate can be alte red through elongation
AC ID
(to make a lo nger saturated fatty acid, such as stearic acid) or de saturation (to create
A single double bond in the
fatty acid chain monounsaturated fatty acids such as palmitoleic acid or oleic acid). And these fatty acids,
whether saturated or unsaturated, can be packaged (as triglycerides) in very low density
VERY LOW OENS I TY lipoprotein particles (VLDU and shipped out to peripheral tissues for fat storage.
LIP OP ROTE IN PAR TI CLES
IVLOL) At th is point you might be wondering what conditions cause fatty acid synthesis in the body.
Particles used in lipid Fatty acid synthesis typically occurs with a high sugar diet. Wi th the accompanying surges of
transport; assembled in glucose and in sulin, ca rbohydrate metabolism is increased without a parallel need for ene rgy
the liver by cholesterol and transfer. Acutely, this leads to excess acety l- CoA in the absence of a high energy demand,
apofipoproteins. converted
and these acetyl-CoA units join together to form new fats. Chronically, this leads to an
10 LDL
upregulation of fat synthesizing, lipogenic enzymes and high amounts of fatty acid synthesis.
LI POGEN IC ENZYME
This is no t good for those interesting in maintaining a lean and healthy body.
Enzyme involved with the
Final ly, although most fatty ac ids can be synth es iz ed by the body, two specific fats , alpha
synthesis of fat
linolenic acid (an omega-3 fat) and linoleic acid (an omega-6 fat), both polyunsaturated
fats , can on ly be obta ined from th e diet.
ALPHA LINOLENIC AC ID IALA)
Unsaturated omega·3 fatty
acid PATHWAY 5: TRIGLYCERIDE SYNTHESIS
As discussed earlier, fatly acids are stored in groups of triglycerides: three fatty acids bound
OMEGA -3 together with one three-carbon glycerol. When fats are consumed in the diet or synthesized
Family of unsaturated fatty in the liver, they're typically carried around the blood as triglycerides bound to proteins. Fatly
acids characterized by a packages of dietary or igin are called chylomicrons. Fatty packages from liver synthesis of
carbon-carbon double bond
proteins are cal led lipoproteins. These chylomicrons and lipoproteins ci rc ula te th rou gh the
three spaces in from the
methyl end
body and can be taken up by the cells with the help of a hormone called lipoprotein lipase.

Most fatty acids are transported as trig lycerides (although some, usually tho se released by
LI NO LEIC AC IO adipose tissue , circulate through the blood as free fatty acids). As triglycerides can't easily
Unsaturated omega-6 fatty
pass through plasma membranes, lipoprote in lipases break down the triglycer ides into three
acid
individual fatty acids and one glycerol so that these fatty acids can gain access to the interior
OMEGA-6
of our cells. Once they' re in the ce ll , they're either oxidized and used to transfer energy or
Family of unsaturated fatty converted back in to triglycerides by adding the fatty acids back to the glycerol molecule. The
acids characteflzed by resulting tr iglycerides are then stored for future energy transfer.
a carbon-carbon double
bond six spac es in from the In terestingly, during triglyceride formation, different types of fatty acids can co-exist bound to
methyl end the glycerol backbone. Re member, there are three glycerol carbons to which the fatty acids
can be bound. Different fats can bind to each one of those carbons. For example, a single
POLYUNSATURATED FATT Y
triglyceride could be made up of one saturated fatty acid, one po lyunsa turated fatty acid, and
ACI D
one monounsaturated fatty ac id. Another tr iglycer ide could be made up of three sat urated
A fatty acid with multiple
double bonds in the chain fatty acids. And so on.
UNIT 1 Chapte r 3 Energy Transf orma tIOn & Met abolism 87

PATHWAY 6: CHOLESTEROL SYNTHESIS AND CATABOLISM

Cholesterol , the focus of many a dietary campaign , is a molecule with several essential roles :
CHYLOM I CRON
a) in cell membrane function; A lipoprotein that transports
cholesterol and If/glyceride
b) in the abso rption of dietary fa t;
from the small intestmes to
c) in the synthes is of steroid hor mones (i ncludi ng vi tam in D) ; and tissues of the body

d) in th e synth esis of bile salts.

LI POPRO TEIN
Because chol esterol is so important, about two-thirds of th e choles terol in t roduced in to A class of proteins
with hydrophobic
the body each day is actuall y sy nthesi zed by the liver. That's right: we make our own
core of triglycerides or
cholesterol , and lots of it. Ind eed , the body's ow n cholestero l production far outweighs cholesterol surrounded by
dietary cho lestero l intake. hydrophilic phospholipids,
apolipoproteins and
Ou r bodies sy nt hesi ze cholestero l from acetyl-GoA. (Yes, here it is again, that ever-present
cholesterol
acetyl -CoAl) And nearly all tissues in th e body are able to make cholesterol; the liver makes
about 20% and a host of additi onal tissues, such as the small intestine, make th e rema inin g CHOLES TEROL
Lipid/sterol con tained in
80% . Through a se ries of about 26 enzymatic reactions, acetyl-CoA units are joined togeth er
the body's cells and fluids
to eventu ally form the end prod uc t, cho les terol. tha t acts as a precursor
to hormones and bodily
Int erestingly, as tota l body choleste rol increases , presum ably du e to a higher intake in
structures
dietary choleste rol, cholesterol syn thesis decreases (to a poi nt); and vice versa : as dietary
cholesterol decreases, cho lesterol synthesis increases . Howeve r, it 's important to note that
cholesterol sy nthesis can only downreg ulate so much. Even with very high intakes of di etary STATIN DRUGS
cholesterol, total cholesterol can sti ll increase. That's why drugs like the "statin " drugs Pharm aceu tic al agents
are often prescri bed: In the presence of high dietary cho lesterol or too high a synth esis of that decrease chofesterol
production wi thin the body
cholesterol, th ese drugs can red uce cholesterol synthes is in the liver. However, many med ical
via downregulatlon of HMG -
professiona ls also recognize that cholesterol leve ls can be alt ered by diet and exe rcise.
eoA reductase
Ch olesterol is not especia lly water sol uble and thus, once abso rbed or synthesized, it
must be transported in the blood by li poprote ins. Apolipoproteins, the protein portion of APOLIPOPROTEIN
lipopro tein molecules, form the surface of these particl es. Their stru ctures are unique in Lipid bindmg protein tha t is
tha t they determine where they'll grab their cho lesterol and where they'll take it. Currently part of a lipopro tein
there are five defined classes of apol ipoprotei ns (A through E) with each class hav ing
distinct subclasses. These li poprote in s, bot h the low density (LDL) and high density ones
(HDL) , carry cholesterol, amo ng other molec ules such as tri glyce rid es, phospholip id s, and

FIGURE 3. 14
3-hydroxy-3me thy l-gutar yl-CoA mevalonate
CHOLESTEROL
CH, 0 BIOSYNTHESI S
"--c"::?
o-c
~#O
I -c~
,I IIo OH I
,
HMG CoA
reductase
I
eo, I
CoA

acetyl
Coenzyme A

cholesterol
88 UNIT 1 Chapte r 3 Energy Tr ans form at ion & Met aboli sm

LDL CHOLESTEROL apoproteins, throughout the body. The relative ratios of these molecules make up the density
A lipoprotein that transports of these lipoprotei ns. The highes t de ns ity lipoproteins (HDU are made up of the least amoun t
triglyceride and cholesterol of triglycerides and cholesterol while the lowest density lipoproteins (VLDU are made up of
from the liver to body tissues
the highest amo unt of tri glyce rides and cholesterol.
HDL CHO L ESTEROL
Our LDL chole sterols (o ften referred to as "bad cholesterols") are primarily responsible
A lipoprotein that transports
fatty acids and cholesterol
for delivering cholesterol and tr iglyce rides to our cells for use in membrane construction,
from the body tissues to conversion into hormones, and storage while our HDL cholestero ls (often referred to as
the liver "good cholesterols") are primarily responsible for carrying cholesterol from ce ll s and oth er
lipoproteins to the liver where it can be excreted in the bile. In teresting ly, HDL can bin d to
LECITH IN-CHOL ESTERO L both cellular receptors and to LD L receptors. Therefore HDL can "steal" choleste rol from
ACYLTRANSFERASE ( LCAT) LDL and carry it out of the body. They do this with the help of an enzyme called lecithin-
An enzyme that is used cholesterol acyltransferase (LeAT). This particular enzyme allows cholesterol molecules to be
to convert cholesterol to freely released from the ce lls of our body, as well as from LDL, for transport back to the liver.
a transportable form for
lipoproteins This role of HDL is cardioprotective. As LD L particles deposit cholesterol in periphe ra l tissues,
these molecu les can unfortunately drop off cholesterol in the vascu lar system, lead ing to an
ATHEROSC LEROSIS increased risk of fatty plaque forma tion and atherosderosis . HDL , on the other hand, ca rries this
Development of plaque in
choles terol back to the live r for excretion, recuc ing the risk of plaque build-up. This is why higher
the lumen (interior space) of
blood vessels levels of HDL cholesterol are encou raged in conjunction with lower levels of LDL cholesterol.

Pathways for pro tein metabolism

The name protein derives from the Greek word protos, meaning first, primary, or most
important. This is especially relevant physiologically sin ce proteins are ubiquitous in the
human body. The amino acids that make up our proteins are respons ible for everything from
our structure (con traclile proteins, fibrous proteins), to our hormo nes (most of the non-steroid
hormones), to our enzymes, 10 our immune chemicals (immunoglobulins and antibodies),
to our transport proteins, and mo re. Although our metabol ic processes can make ce rt ain
am ino acids, we cease to functio n wi thout a diet ric h in the essential amino acids . It's no
wonder tha t protein is universally discussed, es pecially by exercisers. In the contex t of this
chapter, prote ins playa lesse r role as they're not all that impo rtant (unde r most conditions)

FIGURE 3.15
glucose
AMINO ACID POOL glycogen
lip ids

catabolism
ca rbon dioxide
Amino Acid Pool
water
urea
energy

non-prote in compo un ds
tissue pro tein he me
plasma protein heterocyc lic am ines
enzymes
hormones
antibodies
hemoglobin
UNIT 1 Chapter 3 En ergy Trans formation & Metabol ism 89

in th e energy transfe r process. Howeve r, the re are fo ur specific protein-re la ted physiological
processes re levant here ; we'll discuss them below.

AMINO ACID POOLS

In the body, the term "pool" is typically used to desc ribe a grouping of particular molecules
in a specific location or tissue (e.g., adipose tissue triglyceride pool, plasma am ino acid pool,
etc.). Th ere are several amino acid pool s in the body, and these collections of am ino acids
are responsible for a host of physiological reaction s.

Upon digestion, the protein we eat is broken down to its Individual amino acid components.
After absorption and clearance th rough the liver, these amino acids enter the bloodstream
and contri bute to what's known as the ptasma poot of amino acids , a collection of the PLASMA POO L OF AMINO
ACIDS
essential and nonessent ial amino acids, wh ich also incl ud es the amino ac ids broke n down
Res erve of amino acids
in ou r body tissues and shipped out inlo t he bloodslream. In lotal , this pool typically contains
found in blood plasma
about 100 g of ami no acids that can readily exchange with the am ino ac ids and proteins
located wi thin our cells.

Thi s regular exchange, or flux, of amino ac ids in to and out of our body tiss ues is respo ns ible
for ou r most impo rt ant protein -related metabo li c pat hways. Specifically, am ino acids wit hi n
the plasma amino ac id pool - as well as within th e free amino acid pool s in muscle ,
liver, etc. - are metabolized in response to var ious stimuli such as hormone activa tion ,
ne urotransmitter activation, feeding state, and so forth . These amino acids can then be used
in th e product ion of important mole cules such as:
enzymes antibodies
ho rm ones tran sport proteins
neurotransmitters muscle proteins

Cl ea rl y, the body canno t functi on prope rl y without an adequate protein supp ly.

As with the other ma jor nutr ien ts , if the re's a surplus of amino acids in the body, if energy
demands are hig h, or if one is in a fasted state , these amino acids can also be broken down
to eithe r help create ot her nut rients (such as glucose, fatty aci ds , cholest erol, or ketone
bodies) or to help regener ate AT P. Every day, a small po rt io n of our total amino acid co ntent
is lost thro ugh the process of am ino acid breakdow n. The amount of am in o acids lost has
most to do with our energy state. If we're well fed and/o r energy demands are low, fewe r
amino acids will be lost than if we're poor ly fed and/or energy deman ds are high.

Whil e ca rbohydrate and fa t stores can be fair ly well maintained even during fasted states, it's
actually quite difficult to maintain a cons istent amino ac id pool without dietary intervention .
Maintaining the plasma amino acid pool is li ke kee ping a si nk full without a drain plug . NON-ESSENT IAL AMINO
Amin o ac ids are cons tantly lost from the pool and therefore th e only way to replenish th em ACID

is to ingest protein through the diet. This is why achi ev in g an adequate protein in t ake each Amino acid that does not
need to be included In
day is essenti al to overall healt h and function. If amino acid intake falls be low daily amino
the diet
acid degrad ation , things like enzymes and structura l proteins are can ni bali zed. If this process
pe rsists fo r long enough , vi tal functi ons sh ut down. ESSENTIAL AMINO ACiD
Amino acid that must be
The body has the ability to make 12 of th e non-essential amino ac ids . However, 8 essential included In the diet
amino acids can only be supplied by the diet. Again, as some of th ese amino acids are lost
eac h day, they must be replaced from outs ide the body. Of course, the best way to do so is to
CO M PLETE PROTEIN
maintain an adequa te intake of complete protein .
Protem source that
contains aI/ of the
essential ammo acids
90 UNIT 1 Chapter 3 Energy Tran sfonna tlO n & Met abo lism

A comple te protein is defined as a protein source tha t contains each of the essential am ino
acids in sufficient qu ant ities to be useful to the body. Typically, complete protein sources come
from animal foods. However, there are a few plant-based foods that do contain a complete
complement of essent ial amino acids in sufficient quantit ies , Further, a varied and intel ligently
planned vegetarian diet, despite lacking proteins that are considered comp lete, may contribute
an adequate amino acid intake for optimal functioning. However, there is some debate on this
topic when it comes to athletes. Even thou gh vegetarian diets may con tain enough lotal amino
acids when measured over the course of an entire day, some scientists believe that meal-by-
meal amino acid intake may also be important to optimize protein turnover and synthesis. [n
other words, optimal protein status may require a full complement of essential ami no acids
de live red at each meal, rather than over the course of a full day. This conclusion is, however,
specu la tive and will be decided in Ihe research in coming years.

AMINO ACID CATABOLISM

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); and
3. They can be catabolized in order to transfer energy (i.e., regenerate ATP).

In this section, we'll discuss the second process, amino acid catabolism. All ami no acids
contain nitrogen in their chemical st ructure along with their carbon-hydrogen bonds. When
new proteins are synthesized from in dividua l amino acids, these nitrogen molecules remain
with the amino acid as the growing peptide chain gets l arger. However, when ammo acids
are needed to form non-prote in compounds or to transfer energy to ATp, these nitrogen
PEP TI DE CHA IN groups must be eliminated. This process of nitrogen removal is called deamination .
Short polymer formed from
linking amino acids As we've seen, t he protei ns within our cells are continually being broken down and
resynthesized . Some amino acids are lost during th is process. This short lifespan of prote in
DEAMINATION molecules is important it allows our cells to adapt qu ick ly to changing environmenta l and
Removal of an amine group physiological conditions by synthesizing new, more functiona l proteins to replace those recently
from a compound

FIGURE 3.16
AMINO ACID CATABOLISM

Amino acid pool

Catabolism

,~
Deamination:
Nitrog en groups
eliminated
'-"- ,~

I non-protein products
( as in gluconeogenesis)
I a-keto acid residues
= carbon skeletons of
urea, ammon ium , and
other waste products
amino acids in urine

energy metabolism
in glucose or fatty acid
metabolism pat hw ays
UNIT 1 Chapter 3 Energy Transfo rm at ion & Metabolism 91

broken down. Fo r examp le , during exercise, the mechanical and chemical stress associated
with physical activ ity sends signals to the body to suggest that our cur rent enzymes don't work
well enough; that our curren t carrier prote ins don't transfer nutr ients fast enough; and that our
current contractile proteins aren't strong enough. The body adapts to this stimulus by breaking
down and restruct uring proteins in stronger and more efficient fo rms.
Once proteins are broken down, many of the resulting amino ac ids hang out in the muscle
protein pool for recycling into new muscle proteins. Some of these amino ac ids (for example,
th e branched chain amino acids, or BCAAs for short) can be cataboli zed locally in the BRANCHED CHA IN AMINO
muscle. This occurs in a three -step process: ACID (BCAA)
Amino acid with aliphatic
1. Nitrogen is removed from these amino acids. side chain that is non-linear
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 CARBON SKELETON
transfer or is exported for further processing in the liver. Chains, branches or rings
of carbon atoms that form
During longe r durat io n exercise, BCM can con tr ibute significantly to overall ene rgy transfer, organic molecules
providing about 5% of the to tal energy requirement.

In addi tion to loca l muscle metabo lis m, some of the amino acids are shipped ou t into the
blood, return ing to the plasma amino acid pool, where they join with dieta ry am ino ac ids and AMINE
oth er amino acids that have been exported by other cells of the body. As the plasma amino One of a group of organic
acid pool circu lates th roughout the body, the liver can take up some of these amino acids; nitrogen compounds
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.
AMMON IA
Also known as NH 3' a very
DEAMINATION AND TRANSAMINATION basic end product of protein
When bound to amino acids, nitrogen groups typically appear in the form of NH, or NH J metabolism
(one nitrogen bound to two or three hydrogens). These groups, typically ca lle d amines , are
removed from amino acids in the first step of amino acid catabolism, called deamination. UREA CYCLE
When amine groups are liberated from the amino acids, they form free NH3 (ammonia ) and Cycle that takes place in
a carbon skeleton. As ammonia is extremely tox ic to the hum an body, it must be converted the /lver and creates urea
to a non-tox ic chemical. Usi ng a process called the urea cycle , CO, and NH3 are joined from ammonia and carbon
together to form urea, a non-toxic, water soluble chemical tha t can safely diffuse in the blood dioxide
and be excreted in the urine. The port ion of the amino acid that remains after the am ino
group has been removed is called its carbon skeleton or a-ketoacid. This carbon chain can UREA
be converted to five im portant substances, Water-soluble final
nitrogenous excretion
glucose; fatty acids; or product synthesized from
ketone bodies; a Krebs cycle compound for ent ry in to ammonia and carbon
cholesterol; oxidative phosphorylation and the dioxide, found in urine
eventual resynthes is of ATP.

In add it ion to deamination, some amino acids can undergo a process known as CI.-KETOAC ID
transamination. Rather than the amine group being lost, in this process it's simply An organic acid containing a
functional ketone group and
transferred to another amino acid carbon skeleton. The fate of the original ami no acid can be
a carboxylIc acid
the same as with deamination reactions.
Protein turnover TRANSAMINAT ION
The transfer of an amino
The process by which ce ll ular prote ins are continually "recyc led" by being degraded and re-
group from an amino aCId to
syn th es ized is called protein turnover . Muscles depend on protei n turnover to become bigger
an alpha-keto acid
and stronger when stimula ted by exercise. However, although as fitness professionals we
often focus on the protein turnover that occurs in muscle, all tissues of the body go through
PROTE IN TURNOV ER
a regular course of turnover. We can see this, fo r instance, in the skin, which sloughs off dry,
Balance between protein
dead skin cells while new, healthy skin cells take their place. Bone cells respond to loading
synthesis and breakdown
92 UNIT 1 Chap ter 3 Energy Trans form ation & Me tabolism

NH, o

HO --- C ~C---OH I HO --- C~C ---OH

II II II
o
II
o
o 0 I

- - -- ---- ------- -- --- --I ------- - - -- - - - - - - - - ---I

glutamic acid alpha-ketoglutaric acid

+ +
H,o NADH + H+ NH ,
ammon ia
\. /' ~ '\
'---- J Urea I
\ cycl e
,- ......1
FIG URE 3. 17
DEA MINATIO N and st ress in their process of resorption and new bone forma ti on . Indeed , every cell that
ma kes up you r bones is different than it was a year ago t oday! The turnover of these t issues
is governed by two independent processes : protein synthesis and protein breakdown .
PROTE IN SYNTHE SIS
(ReJbuilding of proteins Both pro t ein synt hes is (t he assembly of amin o aci ds into new protein struct ures) and protei n
breakd ow n (the d issembling of protei ns into amino acid un its) are regu lated by several
PROTEIN BREAKDOWN factors inc lud ing,
Degradation of proteins
nutriti on al in take; stress;
exerc ise habits; hor monal status; and
health st atus and illness; genetic programming.

There are three types of prote in status depending on th e relat io nsh ip be tween protein
synthes is and breakdown .

I . If protein synthesiS rates are the same as protein breakdown ra tes , no add i tio nal prote in
is formed in the body and yo ur protein stat us is said to be neutral. Howeve r, that doesn 't
mean that proteins haven't been renewed; they have simp ly been eq ui vale ntly turned ove r
and rep laced.
2. If pro tein synthesis rates exceed prote in bre akdow n ra t es, both renewal and protein
bu ild in g has occu rr ed and your protei n status is sa id to be posit ive.
3. Fi na ll y, if pro tein synt hesis ra t es are excee ded by protein breakdo wn ra tes, even thoug h
renewal has occu rr ed, prot eins wi ll be lost from the bo dy and yo ur protein stat us is
con side red negative. In this case , new am ino ac ids der ive d from the diet must en t er the
protein pools of the body in order to help build up new pro teins .

Regardl ess of protein status, however, unneeded, old, or damaged proteins are regu larly
broken down and many of the ir amino acid components are util ized for energy prod uct ion.

Th is process of protein turnove r utilizes the amino acid ca tabo li sm/deamination steps disc ussed
above . Prote in syn thes is is direc ted by our DNA. As described in Cha pter I, signals (suc h
as exerc ise, ce rta in hormones, etc.) trigger ou r DNA to sta rt the process of tra nscription and
transla tion. New prote ins are then ma de with the help of ou r muscle am ino acid pool and
ribosomes in the endop lasmic re ticulum. After processi ng in the Go igi apparatus, these new
prot eins eithe r remain in the cellar are shipped out of the ce ll. Now they can perform the ir
primary functions, whether enzymatic, st ruc tural, etc . Eventually, however, they 'l l also be
UNIT 1 Chapter 3 Energy Transformat io n & Metaboli sm 93

C±> Positive protein status:

synthesis rates exceed
breakdown rates

protein
synthesis
amino acid
anabolism
Amino acid pool )o-....""-~
amino acid
• protein
breakdown
(

catabolism!

I~
deamination

(
J
Negative protein status:
breakdown rates exceed
synthesis rates.
8
_ FIGURE 3.18
PROTEIN TURNOVER

broken down to individual amino acids for recycli ng back in to body proteins or fo r the transfer
of energy. And when the original proteins are gone, new proteins will take the ir place .

Energy transfer is the process of break ing carbon -hydroge n bonds present in ou r food-based
nutr ients and using the energy generated to fue l the re syn th esis of ATP. Th us, our biggest
and most important phys iological struggle is to find food and use it to make ATP so we can
cont inue livin g, brea thin g, and functioning.

Un de rs ta ndin g t he details of th ese processes he lps us determine what we should eat as we ll

as how altering our diet can affect both energy transfer and our body composit ion. In the
next ch ap ter we 'll take this one step fu rthe r to exp lore the concept of energy balance, or the
relatio ns hip between ene rgy intake and energy expenditure.

Proteins Carbohydrates FIGURE 3.19

Fats SUMMARY OF METABOLIC
PATHWAYS

Amino acid s
el---.$ Fatty acids
VVI--rJ'

pyruvate)

I
Acetyl GoA

~
• \
Krebs Cycle
)
/(
@
T
Electron
transport
chain
$-J ' - - H 10
94 UNIT 1 Chapter 3 Energ y Tra n:.forrna tlon & Metabo lism

A client of mine was interested in losing body fat a high-carbohydrate re-feed day once everyone
quickly for an upcom ing physi que contest, and to two weeks as needed during the first eight
he was curious about low-carbohydrate pre - weeks . This helped him refill his glycogen stores
contest diets. He had heard that many of the top periodically. It also helped him remain sane
bodybuilding competitors were using this type throughout the diet.
of diet in the final 8-12 weeks before a contest
Interestingly, after the first four weeks he felt
and wanted to know if this approach was best great. He felt more energetic than usual, his
for him. Since low-carbohydrate diets can help training was excellent, and his body was dropping
individuals lose fat quickly if the diet is structured fat at a rapid pace . However, after about four to
properly and is followed for short periods of time, five days on the 75 lifday carbohydrate intake, he
I decided to help him structure his plan with this hit the wall. He complained of feeling sluggish.
in mind. There was no harm in trying this type of He had little energy to train. And he complained
approach. Indeed, if it wasn 't working as well as that he felt stupid and mentally slow all the
we hoped, we could always switch our strategy. time. These were classic symptoms of a very
low-carbohydrate diet. Essentially his intake was
Therefore, in conjunction with his strength
training and his energy system work (cardia and lower than necessary to maintain carbohydrate
stores and blood glucose at an optimal level. He
interval exercise), we decided to systematically
started to feel really bad.
reduce his carbohydrate intake over the course
of 8 weeks and maintain th is lower intake for 12 But he wasn 't ready to compete just yet. He had
weeks in total. During the first two weeks, we more fat to lose. So, rather than increasing his
cut his existing carbohydrate intake of 500 g per carbohydrate intake to make him feel better, we
day by 50%, bringing it down to 250 g. During decided to have him tough it out. You see, I knew
the second two weeks, we cut his carbohydrate that within a few days he'd start to feel better. Of
intake again by about 50%, bringing it down to course, he didn't believe me. But I knew that the
125 g. During his third two weeks , we dropped body will adapt to lowered carbohydrate intake,
it by 50% again, reducing it to 75 g per day. and that he'd soon be using fat as his primary
Finally, during his fourth two weeks, we dropped energy source, would be producing an abundance
it down by about 50% again, to about 35 g per of ketone bodies, would become "fat adapted " ,
day. After the eighth week, he remained on this and would start feeling better. Most, but not all,
very low carbohydrate intake for a total of four peopl e do within 10-14 days.
additional weeks, right up to the week before hi s
Interestingly, about eight days into the 75 lifday
bodybuilding contest. period, his breath started to take on a unique
Of course, we didn't just alter his carbohydrate scent that concerned him. This sweet scent is
intake. During this time , his protein intake wel l-known by most low-carb dieters as the smell
remained the same (about 250 g per day), but his of ketone body producti on. As ketone bodies are
fat intake increased slowly throughout. With each formed in the liver and exported for use in the
two week drop in carbohydrates, we increased muscles , brain , etc. for energy transfer, excess
his fat intake a bit, although these increases ketones are lost in the breath and urine, and
were relat ively smaller than the decreases in consequently both take on the distinctive, sweet
carbohydrate because we also wanted to lower acetone smell. In fact, research shows that this
his total calorie intake. I encouraged him to have acetone smell on the breath is as reliable an
UNIT 1 Chapter 3 Energy Trans formation & Meta boll:; m 95

indicator of ketosis as measuring ketones in the were able to shift the body from burning mostly
urine. (Yes, some physique athletes will actually carbohydrates to burning fats almost exclusively
use a home urine test to determine whether and using the accumulating ketone bodies for
they're in ketosis.) As a result of my client's energy. Although this approach works quite well
"ketone breath," I knew he was on track and for many individuals, it does require caution. With
would be feeling belter soon. Indeed, at the end of an inadequate protein or fat intake, ind ividuals
this two week period, he was feeling much better typically don't get enough nutrition to function
and ready for another drop in carbohydrate intake. well and they end up struggling to lose fat while
feeling awful the entire time. Further, even with a
Now, he wasn't feeling his best, mind you. After
well-designed diet, some individuals never really
all, he was eating a low calorie diet, was eating
become fat adapted enough to feel good on a
very few carbohydrates , and was exercising about
low-carbohydrate diet. These individuals thus
ten hours per week. However, he was able to train
need a different approach for losing fat rapidly.
adequately and think clearly, and he wasn' t quite
As stated earlier, the body is quite adaptable
so cranky. This was a good sign, especially as his
and can survive under a host of environmental
fat loss kicked into overdrive with the next drop in
and nutritional conditions. Therefore individual
carbohydrate intake.
nutrition choices should be made based both on
In the end, this approach worked quite well objective measurements as well as how you (and
and he entered his physique contest very lean. your clients) feel.
With the help of this low-carbohydrate diet, we
96 UN IT 1 Chapter 3 Energy Tr ansform aliO n & Metabol ism

1. ATP is the energy currency of our cells. Its energy is made available to perform
cellular work or mechanical work when the adenosine-phosphate bond is broken .
2. When the energy in ATP is released, ADP and P must be recycled so that
additional work can be performed . As the body only stores a very sma ll amount of
ATp, it must be constantly recycled with the help of nutrients like carbohydrates,
fats, and proteins .
3 . Carbohydrates, fats, and proteins transfer their energy through a host of different
metabolic pathways in the body, wh i ch spl it the carbon-hydrogen bonds in these
nutrients and transfer this energy to ATP regeneration. There are three main energy
transfer pathways : the ATP-PCr pathway, glycolysis, and oxidative phosphorylation .
4. The ATP-PCr pathway provides energy transfer when energy demands suddenly
increase. This process, which uses stores of creatine phosphate in the muscle, is
able to transfer energy very quickly. However, due to very limited stores, it's very
short lived.
5 . The glycolytic pathway uses gluc ose molecules and glycerol to tra nsfer energy
when it's in high demand and when the ATP-PCr pathway has been depleted. Due
to a higher capacity, this system can provide energy for about 80 seconds before
it's maxed out.
6 . Through the Krebs cycle and the electron transport chain, oxidative
phosphorylation takes acetyl -C oA derived from carbohydrates, proteins, and/or fats
and uses it to t ransfer energy to form a large amount of ATP. While slow, due to
the requirement for oxygen inta ke to match the rate of oxidative phosphorylation ,
this pathway yields a large amount of ATP.
CHAPTER 4

ENERGY
BALANCE
IN THE BODY
Chapter objectives
Key terms
Energy value of food
The body 's need for energy
Estimation of energy needs and
energy intake
Consequences of energy imbalances
Energy balance and bodily functions
Vitami ns, mi nerals and energy
balance
Chapter 4 Summary
KEY TERMS
potential energy
kinetic energy
Joule
Calorie
calorie
kcal
bomb calorimeter
basal metabolic rate (BMR)
resting metabolic rate (RMR)
thermic effect of feeding (TEF)
exercise activity
non~exerciseactivity
thermogenesis
thermogenesis
indirect calorimetry
direct calorimetry
respiratory quotient (RQ)
energy imbalance
fast -twitch muscle fibers
slow-twitch muscle fibers
dysmenorrhea
amenorrhea
thyroid hormone
electrolytes
UN IT 1 Chapler 4 Energy Balance In t he Body 99

Energy value of food

As you learned in the previous chapter, the food that we eat contains potential energy , POTENT IAL ENERGY

Potentia l energy is energy that's stored in a physical system and has the potential to be Energy stored within a
physical system
converted into work, or kinetic energy . As we've also discussed in previous chapters , the
chemica l bonds in our food provide a rich source of potentia l energy; when these bonds are KIN ETIC ENERG Y
broken , we can transfer th is energy to ATP regeneration and , eve ntually, the ab ility to do Energy generated by motion
work in the body,

With most energy systems, the standard unit of measure for potentia l energy is the JOUle , JOU LE
Technically speaking, one Joule is the amount of energy it takes to move an object that Unit of energy; 4 Joules
we ights one Newton (0.445 lbl across a one- metre distance, In our everyday lives , however, equal 1 calorie
we use other, more fam il iar energy measures, such as Calories , watts, etc . Although some
scientists use Joules and kilo -Joules (1000 Joulesl to describe the amount of potentia l Calorie (LARGE CALOR IE)
Amou nt of energy required
energy in food, it's st ill most common to measu re this energy in Calories. There is a direct
to raise the temperature of
re lationship between Ca lor ies and Joules : one Calorie is equal to 4.18 Joules, Therefore, on e kilogram of water by
if you eat a 1000 Calorie diet, you 're actually ingesting food that contains 4180 Joules of 1 degree Celsius; equal to
potential energy, 4184 Joules

Technically speaking, a Calorie is a unit of heat measurement. However, histor ically, there
has been some confusion about the use of the term Ca lor ie, as there are small calories (cal) ca lorie (SMA LL CA LOR I E)
and large calories (Calor kcal) . Sma ll calor ies represent the amount of heat required to Amount of energy required
to raise the temperature
raise the temperature of one gram of water by 1 degree cent igrade , Large Calo ries represent
of one gram of water by 1
the amount of heat requ ired to raise the temperature of one kilogram of wa ter by 1 degree
degree Cels ius
centig rade . In other words, one large Calorie (kcal) is equivalent to 1000 ca lories (cals),
(I know, it can be confusing at first. However, just th ink of it this way: little ca lor ies
kcal
are smal ler and use a lower case c, while large Calories are 1000 times larger and , Used to express food
approp riate ly, use an upper case C,) energy, represents a Calone

Unt il now, this uni t distinction has been mere ly a question of mathemat ical prec ision, But
when it comes to discussing food, we have to be careful to refer to ou r Calories correct ly,

FIGURE 4 .1
BOMB CALORIMETER

Resting metaboli c rate

(60% -75%)
100 UNIT I Chapter 4 Lncl gy Ba lance In Ule Body

When it comes to food Calories, we usually mean large C or kilocalories (kcals). So, when
we tell our fr iends that we ate a 500 "calorie" lunch , we actually ate 500 Ca lories or kcals.
Of course, if we wanted to te ll them how many litt le c calories we ate - wh ich would be
500,000 - we could. (But that would probably freak them out.)

Why use units of heat (calories or Calories) to measure the potential energy in food vs. uni ts
of work (Joules)? Well, scientists measure the energy content of food by combusting the food
BOMB CAL OR IMET ER (i.e ., burn ing it) in what's called a bomb calorimeter. When using a bomb ca lorimeter, food
A ngid vessel used is placed in the deVice and electrical energy is used to ignite the food. As th e food burns, it
for measuring heat of heats up the surrounding air, which expands and escapes through a tube that leads the air
combustion
out of the calorimeter. As the air escapes through the copper tube it also hea ts up the water
outside the tube. The temperature of the water allows observers to calculate calorie/Calorie
content of the fuel. Th us, if you're measuring food energy in this way, it only makes sense to
report food energy in terms of heat units.

When com busting the three main macronutrients in a bomb calorimete r, on average, the
fo llow ing tota l Calor ie or kcal amounts are released pe r gram,

1 gram of fat ~ 9.44 Calories or kcal

1 gram of starch ~ 4.IB Calories or kcal
1 gram of sucrose ~ 3.94 Calories or kcal
1 gram of glucose ~ 3.94 Calories or kcal
1 gram of protein ~ 5.65 Calories or kcal
1 gram of alcohol ~ 7.09 Calories or kcal

At th is point you might be confused - perhaps you've heard that fat contains 9 Calories
per gram, carbohydrates 4 Ca lor ies per gram, protein 4 Calories per gram , and alcohol 7
Calories per gram. Are these just rounding errors? No, not really. This seeming contradiction
is because the numbers you 've heard are actual physiological val ues (in other words , how
the substance behaves in the body) while the numbe rs above are those obta ined outside
the body (in a bomb calo ri meter). The refore , while most of our macronutrients conta in
higher amou nts of total combustible ene rgy, some of that energy is lost through the digestive
process.

FACTORS AFFECT I NG THE NET COMBUSTIBLE ENERGY IN OUR FOOD

There are three main factors that contribute to the net combustible energy in our food, and
thus the potent ial energy of macronutrients that is available to the body.

I. THE MAC RONUTR IEN T' S HEAT RE LEASE D WI TH CO MBUST ION

The heat released with combus ti on is a measure of the total amount of potential energy
stored in a macronutr ient's mo lecular structure. However, th ings change when these
mac ronutrients enter the body.

2. THE MAC RO NU TR IENT'S PERCE NTAG E OF DIGEST IBILI TY

In addition to heat of combust ion, phys iological va lues are also based on the degree to which
the macronutr ient is absorbed into the body. If the macronutrient is only partia ll y absorbed,
the net (physiological) values are lower than the tota l (calorimeter) values . This is the case
with fat, starc h, protein, and alcohol.
UNIT 1 Chapt er 4 Ener g") Balance If' t 8 1"Jd)' 101

3 . TH E AMOUN T OF NITROG EN LOST IN THE UR INE

The net (physiological) va lues are also determined by how much energy is lost once a
macronutrient is excreted. Indeed, the amount of potent ial energy stored in protein's nitrogen
bonds can be lost through deamination (which we rev iewed in Chapte r 3) and excretion. As
a result of this, the ene rgy trapped in the ni trogen bonds leads to a reduction in prote in's net
potential energy.

Although some of our dietary potentia l energy is lost through digestion and excretion, we still
do a pretty good job of saving much of this potential energy for the resynthesis of ATP. About
91 % of the energy present in the food we eat can be used in the process of energy tran sfe r,
That's pretty efficient' (By compar ison, the efficiency of your car 's internal combustion engine
- how well it uses the gas to get you to your destination - is estimated to be around 12 -20%. )

However, I hope you can also see why "Calor ie count ing" in dieters is a very inexact exercise.
The macronutrient and Ca lor ie values con tained on food labels are mere approximat io ns;
they're not exactly measured in the lab. Imagine try ing to combust a sample of everyone of
the 40,000 foods on grocery store shelves as the food comes out of the ground , is remov ed
from the animal, or is dispensed by the assembly line . It's not happening' As a result, these
approximatio ns can var y a lot in the ir accuracy.

Beyond th is level of va ria bility, as you can also see from the above discussion, our d igesti on
and excretion rat es affect the amount of potential ene rgy that's available once the food is
actually ea ten. As digestion and absorption can vary from 2-5%, and excretion even more,
even if you knew the exact Calorie content of the food you're eating, you could n't know
exact ly how much of that energy will become usable energy. Even if you try your best to
measure you r Calo rie intake precisely, you cou ld be off by anyw he re from 8-10% or more.

In addit io n, if you we re exe rcising (as most peop le do when tr ying to manage th eir weight or BASAL METABOLIC RATE
(BMR )
body compos ition) you'd somehow be trying to balance this approxim ate intake with some
Level of energy required
known leve l of energy expenditure. This adds even more variability, since energy expend iture
to sustain the body's vital
is even hard er to measure than intake . We'll discuss that in the next section. functions In th e waking state

RE ST IN G M ETABO LI C RATE
The body's need for energy (RMR )
Level of energy required
As we 've d iscussed in previous chapters, th e total amount of energy required for each of our to sustain the body's vital
functions at rest
physiological actions is referred to as the metabo li sm. Alt hough th ere are tr ill ions of cells
consuming and regenerating ATP eve ry second during rest and exerc ise, the sum total of THE RM IC EFFECT OF
these energy consuming reactions can be summarized by five general metabolic compon en ts: FEEDING (T EF )
Metab OliC response to the
1. Basal melabolic rale (BMR) digestion of food and the
2. Resling melabolic rale (RMR) uptake of nutrients in the
blood
3. Thermi c effeel of feeding (TEF)
4. Exercise activity EXERC I SE AC TIVITY
Physical movement
5. Non -exerci se aclivity Ihermogenesis (NEAT) performed in structured
exercise sessions
We'll look at each one in turn below.
NON - EXERCISE ACT IVITY
1. BASAL M ETABOLIC RATE THERMOGENESIS (NEAT)
Spontaneous physical activity.
The basal metabolic rate (BMR) is the min im um level of ene rgy expendit ure needed to
such as tapping feet and
maintain vi tal fun cti on s of the body. In essence, the BMR represents the number of Calories moving hands
102 UNI T 1 Chapter 4 Ener gy Ba lance In the Body

req uired to sustai n life wit hout movement or digestive act iv ity. Th us, a pe rso n's BM R can
on ly be establis hed after a 12-hour fast, in a contro lled env ironm ental chamber, after lyin g
mot io nless for an extended per iod of ti me . Si nce oxyge n consumption is mat hemat ically
rel ated to energy production, measures of BMR are ma de by determi nin g how much oxygen
a person con sumes per minute. This can be done in a labo rator y setting us ing what's called
a metabolic cart. What's especially in te resting is that the BMR accou nts for over 70% of the
oxygen (and energy) we co nsume each day' That's right, 70% of th e ene rgy we expend goes
toward non-moveme nt related physiological activity. Keeping us alive is hard wo rk'

2 . RESTING METABOLIC RATE

The resting metabolic rate (RMR) is very similar to the BMR in that it's measured during
rest. How ever, th e RMR is more eas ily collected si nce measuring BMR requires extreme
cond itions (e.g., fa sti ng, extended bed rest , tight environment al controll. Since the RMR is
co llected in a simila r way as the BMR (us ing measures of oxygen co nsu mpt ion), th ere is
typ ica lly only a 10% di ff ere nce between the two, with RMR being highe r. Thi s makes sense ,
as measures of RMR are typically influenced by move men t, environmenta l va riabi lity, and
food ingestion.

3 . THERMIC EFFECT OF FEEDING (TEF)

Digestio n, absorption and assimilation of ingested food/nutrients is an active process - it
requ ires energy. The very act of ea ting food increases the metabolism. Th e extent of this
increase depend s on whi ch mac ronutrients we ingest. We often speak of thi s in terms of
thermic effect , which comes fro m the Greek therme, or heat, and which also gives us th e
THE RMOGENES IS term " thermogenesis ", or the produ cti on of heat. Proteins te nd to have the highe st thermic
The process of heat response , as it takes the bod y more energy to process them, while fats tend to have the
produc tion in the body lo west the rmic response. In general, however, the TEF is typica ll y estimated to be around
10% of total daily energy expended.

4. EXERCISE ACTIVITY
The energy used to pe rform purposeful exerc ise is typ ically cal led exerc ise acti vity. Of co urse,
th is compo nent of da ily energy expenditure is hig hly variabl e. For sedentary folks, th is
component of me tabol is m can make up 10-15% (or less) of their da ily energy demand .
Howeve r, for hig hly ph ysically active folks, it can be 30% or more. As you may already
know, exercise activity (if done with a higher intenSity) not only creat es a demand for energy
transfer during the actual activity; it also creates a higher demand after the activ i ty as we ll.
This increase in excess post-exerci se oxygen consumption (also known as EPOC) helps to
make up for the energy deficit created during the activity itself. It also in crea ses da ily energy
expenditure/metabo lism.

5. NON-EXERCISE ACTIVITY THERMOGENESIS (NEAT)

Non-exercise activity thermogenesis (N EAT) is another constituent of metabolic rate. NEAT is
the unplanned, low in te nSity physical activ ity that takes place every day. Thi s would incl ude
moving aro und the office, ca ri ng for child re n and pets, fidgeting, light phys ica l labo r, wa lk ing
stairs, going to the market, mow ing the lawn, stretchi ng, prepa ri ng fo od, foo t tapp in g, etc.
Th is component of metabolism is the smallest da ily cont rib ut or to ene rgy expendit ur e, yet it's
been fo und to be an important indicator of weight loss or weigh t gain.

Tota l daily energy expenditure (or metabolic rate) is typ ic ally repr ese nted by some
combination of these factors discussed above. In most cases, daily ene rgy expenditure is
UNIT 1 Chapter 4 Energy Ba lance In the Body 103

Tota l daily energy expend iture fo r sedentary

an d physic al ly active individuals

PhysIcal actIVIty - 15%

PhY~lcal actIvIty - 30%
Other factors
(Cold, effect of food intake) 10%

Olner fac tors

(Cold, effect of food intake) - 10%

Basal metabolic rate - 75% Basal mttabolic rate - 60%

fiGURE 4.2
TOTAL DAILY ENERGY
EXPENDITURE (OR
Sedentary person Physically active person METABOLIC RATE)
(Low phys ical ac tivity) BREAKDOWN

represented by RMR + physical activity + TE F. These three factors describe all metabolic
activity, as RMR represents BMR + maintenance activity and physical activity represents
exercise activity + NEAT.

Estimation of energy needs and energy intake

As discussed above, measuring oxygen consumption can help us estima te energy cost
and metabolism, since there's a di rect, mathematical relationship between the amount of
oxygen we breathe in and the amount of energy required by the body. This makes sense,
since oxygen actively participates in th e electron tra nsport chain activi ties of oxidative
phospho rylation.

Specifically, about 4.7 Cal ories of energy are transferred when 1 lit re of oxygen is cons umed FIGURE 4.3
in the oxi dati on of fat and about 5 Calo ri es are transferred when 1 litre of oxygen is ESTABLISHING A

e
RESPIRATORY QUOTIENT

+ 60 , 6CO, + 6H,0

CSH12 0S for glucose:

Respiratory Quotient = 6CO,

1.0
(RQ) 60 ,

(palmitic aCid) + 230 , 16CO, + 16 H,O

C" H" COOH
for fat:
16CO,
RQ = 230 ,
= 0.7
104 UNIT 1 Ch apter 4 En ergy Balance 111 t hl Bod y

consumed in the oxidatio n of carbohydrate. However, as we never really burn just fat or just
carbohydrate for energy transfer, the burning of a fuel mixture prov ides on average about
4.82 Calories of energy transfer per 1 litre of oxygen. To put this in to perspective, at res t we
typically consume about 3.5 millilitres of oxyge n per kilogram of bodyweig ht per minute.
Let's look at a sample person who 's 154 Ib (70 kg).

At rest, th ey 'd consume:

3.5 mL of oxygen x 70 kil og ram s of bodyweight x 60 minutes = about 14,700 mL or

14.7 litres of oxygen per hour

14 .7 lit res x 24 hours = 352 litres of oxygen a day

4.82 Ca lories x 352 litres of oxygen = 1700 calories a day

Add exercise and our 154 Ib person wou ld breathe harder and faster, co nsuming mo re
oxyge n. As more oxyge n is cons umed, more Cal ori es are burned, increasing to tal Calor ie cost
and tot al metabo li c rate. Hopefull y yo u ca n now see how well linked oxygen co nsum pti on
and energy demand rea lly is.

In th e laboratory, th e main measurement technique used to quan tify metabolic rate is

IND IRECT CALOR IM ETRY
known as indirect calorimetry . When using th is techn ique, researc he rs give a test subject
Estimation of energy
expenditure via the a mouthpiece (attached to a computerized measurement device) and a nose clip. As all air
measurement of oxygen exchange happens through th e mou th in this set-up, the computer can th en measure how
consumption and carbon much oxygen is consumed and how much carbon dioxide is produc ed during a give n activity.
dioxide production This air sampling the n is recorded , providing direct, real-time measurements of oxygen
consumption . Bas ed on th ese measures, testers can determin e the Calorie cost of whatever
activity is being measured , whether it's lying on a bed or running on a treadmill.

DIRECT CALORI M ETRY Anot her measurement strategy used fo r this purpo se is called direct calorimetry . With
Direct measurement of direct calorimetry, energy expenditure is recorded by measuring the rate at whi ch heat is
heat output by the body; produced by th e body. This method is mo re precise as it places subjects in an ai r-tight
used as an index of energy
cham be r in which all heat loss and gain is carefully measured. However, this method is
expenditure
ve ry expensive as it requires large, expens ive env ironmenta l chambers that few researc h
laboratories can afford.

While both indirect and direct calo rimet ry provide excellent laboratory measures of oxygen
co nsumpti on and energy expe nditure, neither method is practica l for everyday use. Thus,
mul tiple predictive equa tions have been created to estimate energy expend it ure by the
body. These equations, some of which you've probably heard of, are ba sed on a number of
facto rs such as sex, age, height , and weight. Although they're less accu rate than calo rimetric
methods, these equa tions provide reasonable est imates of normal energy expe nditure s for
specific population sub-groups . Here are a few examples of common ly used equat ions:

HARRIS-BENEDICT EQUATION FOR RMR

FOR MEN

RMR (in kcal/ day) = 66.5 + (13. 75 x weight in kilograms) + (5.0 x height in
centime tres) - (6.76 x age in years)

FOR WOM EN

RMR (in kca l/da y) = 655 + (9.56 x weig ht in kilograms) + (1.85 x height in
centimetres) - (4 .68 x age in years)
UN IT 1 Chapter 4 Energy Ba lance ,n t he Body 105

Note, The Harris-Benedict equation has a weight adjustment for desired or idea l weight
when weight loss is the goal. To adjust for Ihis weight, use the fo llowing formu la, plugging
the adjusted weight (in kg) into the formu las above ,

Adjusted weight (in kg) ~ [(actual bodywe igh t in kg - ideal weight in kg) x 0,251
+ ideal wt in kg

OWEN EQUATION FOR RMR

For men

RMR (in kcal/day) ~ 879 + 10,2 (weight in kilograms)

For women

RMR (in kcal / day) ~ 795 + 7,2 (weight in kilograms)

MIFFLIN EQUATI ON FOR RMR

For men

RMR (in kcal/day) ~ 10 (weight in kilograms) + 6,25 (height in centimetres) - 5 (age in

years) + 5

For women

RMR (in kcal/day) ~ 10 (weight in ki lograms) + 6,25 (height in centimetres) - 5 (age in

years) - 161

Table 4 ,1 shows an example of the values that two hypo thetical people might achieve with
each equa tion.

By far, the most common ly used predictive equation is the Harris-Benedict equation, which
was developed in 1919, However, according to the Tab le 4,2, you can see that the Mifflin
equation predicted metabo lic rate better (when compared to indirect calor imetry) than the
other two equations , Note that 82% of the non obese subjects were estimated to within 10%
of their actua l metabolic rate with the Mifflin equation , while only 69% of subjects using the

Sample RMR values from various equations

HARRIS· BENED ICT OW EN M IFFLIN

Male, 80 kilograms, 66,5 + (13,75 x 80) 879 + (10 ,2 x 801 110 x 80) + 16 ,25 x 178)
178 em tall, + 15,0 x 178) - 15 x 45) +5
45 years old - 16,76 x 45)

RMR 1752,3 1.695 1692 ,5

Female, 54 kilograms, 655 + 19 ,56 x 54) 795 + 17,2 x 54) 110 x 54) + 16.25 x 160)
160 em tali, + 11.85 x 160) - 15xI9)-161
19 years old - (4,68 x 191

RMR 1.378 1.1 83 .8 1 ,284

106 UNIT 1 Ch apter 4 Energy Balance In the Body

Harris -Benedict equation and 73% of subjects us ing Ihe Owen equalion were wilhin 10% of
their actual metabolic rale.

No equa tion is perfect. Indeed, it's considered acceptable for an equation to predict RMR to
within 10% of the actual measured value. Therefore, if a pred ictive equa tion approximates
your RMR at 1700 kcal/day, consider yourself lucky if you r RMR is actually anywhere
between 1530 kcal/d ay to 1870 kcal/day. If you're obese, or one of the folks for whom the
equation doesn' t really work, this number could be off by as much as 43%' So, unless you
live in a research lab and can subject both your inlake and expenditure to tightly controlled
laboratory measures, trYing to count calories strictly is a losing ba ttle. Food labels and energy
expendit ure equations are j ust estimates , and not very good ones at that. Al though they get
you in the right ballpa rk, following the numbers as if they're true and accurate can lead to
immense frustr ation.

Getting back to our laboratory measures, here's an interesting side note . During indirect
RESP I RATORY QUOT IENT calorimetry, the exac t fuel mixture used during an activity can be determ ined by something
IRQ) called the respiratory quotient (RQ). The RQ is calcu lated by dividing the number of
Ratio of the volume of carbon dioxide molecules produced by the number of oxygen molecules consumed during
carbon dioxide expired
the activi ty.
to the volume of oxygen
consumed in a given period RQ ~ CO 2 produced / VO, consumed
of time, indicative of the
substrates bemg used Note that the RQ for glucose is 1.0 because 6 CO, molecules are produced as 6 0 ,

Predi ctive metabolic equatio ns and thei r acc ura cy am ong the obese po pu lation

% OF SUB JE CTS % OF SUBJECTS WHOSE % OF SUBJECTS WHOSE

EST IMATED TO WITHIN ES TI MATE WAS> 10% HIGHER ESTIMATE WAS >10% LOWER
10% OF ACTUAL RMR THAN THEIR ACTUAL RMR THAN THEIR ACTUAL RMR

Harris·Benedict

Not obe se (8MI <3 0) 6 9% wit h in 10% 27% est imated higher 4% estimated lower
Obese (BMI >30) 64% withi n 10% 30 % estimat ed higher 6% es t imated lower

Adjusted Harris-Benedict

Not ob ese I BMI <30} 26% w ithin 10% 2% estimated hig he r 72% es timated lower
Obese (BMI >30) 60% wi thin 10% 5% estimated higher 35% estimated lower

Owen

Not ob ese (BMI <30) 73% w ith in 10% 6% es t im ated higher 21 % estim ated lower
Obese (BMI >30) 51 % within 10% 6% est im ated higher 43% estimat ed lower

Mifflin
Not ob ese (BM I <30) 82% within 10% 10% estimated higher 8 % estim ated lower
Obe se (BM I >30) 70% w ithin 10% 9 % estimated higher 21 % estima ted lower

Adapted from : Frankenfield DC, Rowe WA , Smith JS, Cooney RN . Validation of several establ ished equat ions for resting metabol ic rate
in obes e and non obese people. J Am Diet Assoc . 2003;103:1152-1159 .
As comp ared to ac t ual indirect calorimetry resul ts.
UNIT 1 Chapter 4 Ene rgy Ba lance In the BOdy 107

Substance

Protein
Volume (in I/g)
0 , consumption

0.94
CO ,
production

0.75
Respiratory energy equivalent

4.46
CO,

5.57
G 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

molecules are consumed during the ox idation of glucose. However, the RQ for fat is 0.7 as 16 fIGURE 4.4
CO, molecules are produced as 23 0 , molecules are consumed during the oxidation of fa t. RESPIRATOR Y QUOTIENT

Since protei ns are broken down in to indiv idual am ino acids and the nitrogen groups are
removed, the RQ for protei n is about 0.8.

Consequences of energy im balances

EN ERGY I MBALANCE
The relationship between energy expenditure and energy intake is usually discussed in terms Wh en the amount of energy
of weight con trol. If expenditure is greater than intake, we igh t is lost. And if intake is greater intake doesn't meet, or
exceeds, the amount of
than expenditure, weight is gained. It eith er case, when the expenditu re and intake sides of
energy output
the ene rgy balance equation are unmatched, it is said that there is an energy imbalance.

fIGURE 4.5
,------- Macro phys ica l, cu ltu ral, econom ic, and socia l environment REGULATION Of ENERGY
I
I BALANCE
I
I
I
I
I
I

;~~
" ~ .' "
I
I
I
I
I '''',~i, Dietary
\ '< 'I I
I
I
,------------, / \ ' ,' 1 : " .. intake
I
I
I
, "
L-------------" ~' J :, i~"~ ~ / i

,J
,
1 )~ I
~ ~
.,
\'.!, \
v,

I
I
I
I
I
I
I
I
I
I
I
I
Childhoo d Adolescence I
I
I
I I
1 ______ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ____ I
108 UNIT 1 Cha pter 4 t fl ergy Ba lance Hl the Body

Sometimes, an energy imbalance is required. For example, if so meone wants to lose fat. they
need an imbalance: thei r energy expen dit ure should be greate r than their intake. Likew ise,
if someo ne wants to ga in musc le, t hey also need an imba lance: t he ir energy intake shou ld
be greater than expenditure. Howeve r, these energy imbalances don't j ust affect bodywe igh t.
Ene rgy imba lances have effects on physiological function at eve ry level, f rom cellular energy
transfer to cell t urnover to hormonal status in the bo dy. Here, we'll discuss how energy
ba lan ce can affect ove rall function.

WEIGHT LOSS AND GAIN AS A FUNCTION OF ENERGY BALANCE

When so meo ne alters th eir food int ake, exe rci se program , or t he ir lifestyle in any way t ha t
in fl uences t he amou nt they eat and/or t he am ount they move, th eir ene rgy balance will
ch ange. However, most peeple think abou t this quite simply. They assume that the only
fac tors t ha t influence energy balance are how much food th ey eat and how much exe rcise
t hey do at the gym. This couldn't be further from the truth. In fact , ene rgy balance is a
mu lt i-fa ctorial regulation process , much more complex than a simple "food vs. exe rcise"
rela t io nship. Several factors aside from eating and activity influence t his process , including
ind ividu al environme nta l factors, genetic factors , hor monal responses, digestive/absorptive
capacity, and mo re. These many fac tors work subtly to in fl uence how much yo u eat , how
much you move, and how many calories your body requires during all activity.

The end re sul t of t his mul ti-fac torial cascade, howe ver, is the sam e. When ene rgy balance
is posit ive , an d nutrien ts are consumed in exc ess of your Cal orie needs, these nu trients are
stored in the body. As discussed, th e main storage form of carboh ydra te is glycoge n (stored
primari ly in th e muscle an d li ver), wh ile th e ma in storage fo rm of fat is triglyceride (stored
prim ar ily in the muscle and adipose tissue). Al thoug h prote in doesn't qu ite get sto red in t he
same way, the body's amino acid pools and protein sources provide a finite reserve of prot ein
and amino acids to meet physiological demands. In the end, as excess Calories are stored,
body mass increases .

This increase in body mass can come in the form of either fat m ass (t ri glyceri de storage)
or lean mass (ca rbohydrate storage and muscle gain). Of co urse , most individuals wou ld
prefe r excess nu tr ients to be converted into lean mass instead of fa t mass. However, for th is
to occu r, there must be a st rong st imulus for protein gain . Resis t ance training, genetically
determined growth (e.g. , puberty), and preg nancy all sti mulate t he ga in of lean mass .
In add it io n, so me nutrit io nal su pplements an d many anab olic drugs also provide this
stimul us . Ye t eve n wit h a stro ng stimu lus for ga in s in lean mass, the rate of gain can be
fi nite . Therefore overfeed ing beyon d re asonable rates of muscle ga in can begin to produce
add itional ga ins in fa t mass as th e ex tr a Calories can "spill over " into f at sto res .

On the ot her hand, whe n t he re is a calo ri e def ici t, the body 's demands exceed intake. As you
now k now, abo ut 70% of the body's daily ene rgy use goes toward mai ntenance functions.
Indeed, it's quite costly j ust to keep ourse lves alive . Therefore, even in t he absence of
exerc ise, when a deficit exists between wha t 's needed by the body and what's eate n, ene rgy
can be trans ferred by our already stored nu t rien ts . Add in exercise, and t his stored energy
begins to get used up quite rap idly.

As you've already learned , glycogen in t he li ve r and muscle is broken down to glucose , wh ich
can in turn, regene rate ATP. Our triglye rides in muscle and ad ipose tissue are broken down
in to fatty acids and glycerol. If the ene rgy deficit is great enough , or ou r ca rbohyd rate and fat
stores are in short supply, prote in from som at ic and vi scer al stores can be mo bilized to form
UNIT 1 Chapter 4 Energy Balance In the 80 () y 109

amino acids. As the loss of muscle and organ mass is ve ry undesirable, res istance train ing is
recommended to help preserve protein stores. Research has shown that this type of exe rcise
can stimulate protein syn thes Is, lead ing to a net positive protein status. Therefore , even if
some protein is lost due to increasing energy demands , the net result is more to tal protein
storage in the body, a positive shift in lean mass, and a higher metabolic rate.

EXERCISE AND ENERGY BALANCE

Although exe rcise makes up only a moderate portion (15-30%) of daily energy demand ,
exe rci se expendit ure is the most variable and con trollable metabolic component. Th ere fore,
increasing exercise vo lume or intensity is one of the best ways to crea te a negative energy
balance. On the other hand, re duc ing exercise volume and intensity can powerfully shift the
body into a posit ive energy ba lance.

All activity is no t created equal. Different exercise modes have different effects on energy
expenditure. Hi gh intensity, sho rt duration activity bu rns a modest amount of energy du ring
the activity. However, after th e activity, total energy expe nditure remains elevated for min utes
to hou rs, based on the acti vity type and in tensity. Low intens ity, long duration activity burns
more energy during the activ ity. However, after th e activity, tota l energy expe ndi tu re ret urns
quickly to the resti ng baseline . Th is makes both form s of exe rcise val uab le in con trolli ng
energy balance.

In addition to total energy expended, variable intensity activity can affect which fue ls are
utilized. During the activity, higher intensity, short er durat ion exe rcise causes relatively
more ca rbohydrate breakdown than fat breakdown. Thi s is because the rate of energy
transfer requi red for high intensity work may exceed th e maximal capac ity of the oxidative
phosphorylative system. With this system overwhelmed, the ATP-PCr system and the
anaerobic glycoly tic system must kick in to fuel the activity. This means that more
carbohydrates must be run throug h glycolysis for ATP regeneration. In addition, muscle

FIGURE 4.6
DIURNAL VARIATION OF
LIVER GLYCOGEN

An evening
snack

Lunch
Dinner

8:00 12:00 16:00 20:00 24:00 4:00 8:00

Time
110 UNIT 1 Chapter 4 Energy Ba lance 1(1 ti le Bod y

Water 42 kg +---

Glycogen - -
Mg, CI,
Fe , ln , Cu

Ca lcium - - - f -
Potassium
Sod ium

Fat 12 kg -------I' Prote in 12 kg

FIGURE 4.7
BODY COMPOSITION OF A
NORMAL WEIGHT MALE

glycogen isn't fully depleted during short duration activ ity_ Thus, readily avail able glycogen
FAST-TWITCH MUSCLE cont rib utes 10 energy transfer early during exercise_ Fin ally, because fast-twitch muscle
FIB ERS fibers are used exten sively in high in tensity ac l iv ity, and these fibers are designed to use
Muscle fibers, characterized glycolysis as a main energy transfer pat hway, more carbohydrates can be used to meet
by fewer mitochondria and energy demands.
captiJanes, which contract
quickly and with relatively Lower intensity, longer duration exercise has the opposite effect. This type of activity breaks
more force, yet fatigue more down more fat than carbohydrate, since lower intensity energy demands can be met by
quickly than slo w-twitch
the Krebs cycle and electron transport chain. In addition, because this type of activity uses
muscle fiber s; includes three
mostly slow-twitch muscle fibers , which are designed to use slower pathways, more fat can
subgroups
be used to meet energy demands through beta oxidation. Finally, as low intensity activ ity
SLOW-TW ITCH MUSCLE stretches out over time and muscle glycogen becomes depleted, more of the available muscle
FIBERS tr iglycer ides and plasma free fatty acids (released during the activity) are used.
Muscle fibers, rich in
mitochondria and dense Now, just because it appears that more fat is burned with lower intensity activity doesn't
with capillaries, which are mean that it's always better to do lowe r intensity activity exclusively when trying to drop body
able to repeatedly contract fat. Ind eed, if exe rcise volume and du rat ion is consistent - in other words, if you're going
for extended periods of time
to work out for 45 minutes fo ur times a wee k no matter what - hig her intensity activity is
typica ll y a much better choi ce. Higher intensity activity uses more total ene rgy per minute
of exercise, leads to more energy use within the hours after exercise, and leads to the same
amo unt of total fat burned than lower in tensity act ivity (i f not more l. However, because high
intenSity activity is very demanding on the body, a mix of high and low in tensi ty activity is
your safest bet for he lp ing control energy ba lance.
UNIT 1 Chapler 4 En ergy Ba la nc e In tile Body 111

100

90 Muscle tr iglycerides

80
~ 70
.a Plasma free fatty acids
'C
<= 60
'"x
Co

'"[<l
'"<=
UJ
'0
~
FIGURE 4.8
PERCENTAGE OF ENERGY
OERIVEO FROM THE 4
MAJOR SUBSTRATES
DURING EXERCISE

a 2 3 4
Exercise time (hours)

An acu te bout of exercise will thus affect energy expenditure and energy balance.
Training status wi ll also in fluence energy balance and fuel use . As an exerciser gets better
conditioned, they become more efficient at their exercise of choice. Eventual ly, they burn
less energy to accomplish the same amount of work . If you're competing in a sport, that's
great. It means that you can do more work for the same energy cost, or that the same
FIGURE 4.9
amount of work will leave more energy for later. However, if you want to lose fat , it's not
PERCENTAGE OF ENERGY
so good. Because your energy expenditure decreases with each incre ment of fitness, you
DERIVED FROM THE 4
must con tinua ll y increase the intensity, dura tion , and/or biomech an ical inefficiency of your MAJOR SUBSTRATES
workouts in order to keep the rate of energy burning high . DURING EXERCISE

300

• Muscle glycogen

D Muscle
tr iglycerides

'" .-c
'0
200
D Plasma free
fatty acids
-g:5
"'~
"'"
~ "Q3 • Blood glucose
6l~
~~
c -
w ~
100

25 65
% of Maximal oxygen consumption
112 UNIT 1 Chapter 4 Energy Ba:a nce In the Booy

100

-'"'"
.><

c.
Muscle glycogen

.'"
:::J
c:
,.,
x
0
75 Plas ma free
fatty acids

.-'"
'0

'"c:
50

'<;;"
u
c.
~

--'"
'"
~
~
.0
25 Blood glucose

:::J
en
0
0 100 200 300

Minutes

FIGURE ' . 10 NUTRITION AND ENERGY BALANCE

ENERGY SUBSTRATE
As discussed earlier, your nutritional intake can obviously affect your energy ba lance directly
CONTRIBUTION DURING
ENDURANCE EXERCISE through the TEF. Throu gh t his mec hanism, a higher protein diet, as well as more fr equent
meals during th e day, will li kely increase tota l da ily energy expend iture. In addition, a simple
way to shift your energy balance is to eat more - or less. Thus, in conjunclion with changes
in exercise, shifts in dietary intake can powerfully influence whether yo u' re in a positive or
negati ve ene rgy ba lance.

Nutritional status can also affect yo ur fue l use dur ing exercise. A hi ghe r·carbohydrate meal
wil l lead to greate r ca rbohydrate use during exercise. Conversely, a higher fat and protein
intake will lead to greater lat use du ri ng exercise. Thi s is largely a lunction of acu te hor monal
status and nutrient availability. When carbohyd rates are abundant from a high·carb meal,
the y're burned preferent ially. However, when they 're not and faVprotein is provided , highe r
levels of the hormone glucagon, combined with lower levels of bl ood carbohyd rate, can lead
to a relatively higher rate of fat burning.

In addition to th e pre·exercise mea l, supplementation with carbohydrates during th e exercise

session will in crease ca rbohydrate use while reduc ing the use of fatty acids as an energy
source . Again , this is due to availability. When these outside sources of nutrients are provided
during exercise. the body spares its ene rgy stores. This is great if you want to fuel exe rcise
without los ing stored nutr ients in the body. You might choose this rou te when you want
to gain or maintain body mass. However, for the person who wants to lose body fat and
bod yweight, this cou ld actually slow down progress since they' re not burn ing stored energy.

In addit ion to th e acute dietary effects of a high-carbohydr at e meal or a carbohydrate

supp leme nt taken during exe rcise, chronic dietary status can also affect fuel use d ur in g
exerc ise. Specilically, when muscle and liver glycogen levels are low, fatty acids and proteins
will be used in higher amounts as an ene rgy source, especia l ly duri ng high intenSity or ve ry
long duration exercise sessions.
UNIT 1 Chap te r 4 Ene rgy Balance In th e Body 113

Energy balance and bodily functions

Energy imbalances affect more than weight gain or loss. Indeed, drastic changes in energy
balance can impa ct other processes in th e body, such as reproduction , cognitive functions,
metabolic functions, and repair and regeneration .

REPRODUC TI VE FUNCTIONS
Bot h extreme posit ive and extreme ne gativ e energy balances can lead to unfavorable
changes in reproductive functio n. During periods of severe energy defici ts (via restricted
Ca lorie diets and/or very high vo lumes of energy expenditure) , estrogen and testosterone
hormone production/ re lease becomes very limited. Th is can lead to reduced fertility in men
and women as well as a host of other reproduct iv e dysf unct ions, including irregular or the
com pl ete cess ati on of periods for women (i.e., dysmenorrhea or amenorrhea ); impotence in DYsM EN ORRHEA
men; and reduced sexua l interest for bot h genders. Painful menstruation

Why would this be the case' On e possible explana tion is evo lutionary fitn ess th ro ugh AM ENORRH EA
reproductive survival. When starvation is a possibility and ene rgy intake is quite low, the body's Abnormal suppression or
energy reso urces are best spent fue ling the brai n and internal organs rathe r than produci ng absence of menstruation
offspring. So th is "non-essential function " is slowed or shut down . Although most high
performance ath letes, recreationa l exe rcisers, dietin g bodyb uilders, and/or ind ivi dual s with mild
eating disorde rs aren't in any dange r of starving, the body can 't tell the difference between true
starvation and se lf -i mposed dietary restriction. It shuts down either way, just to be safe.

However, extrem e positive en ergy balances ca n also negat ively imp act reproductive functi on.
Beca use adipose cells both store fat and act as ho rmone producti on fac tories , when adipose
tissue stores fill up and body fat increases, defects in the reproduc ti ve system can resul t
When the adipose hormo ne fa ctories becom e too ac tive, they release speci fi c eicosanoi ds,
cytokines, and hormones that interfere with reproductive fitness. For example, individuals FIGURE 4.11
INFLUENCE OF
with metabol ic syndrome, obes ity, and polycys tic ovary syndrome (PCaS) usually have
NUTRITIONAL STATUS
reduced and/or unbalanced concen trations of sex hormones. Therefore, both too Iowan ON sEX HORMONE
energy intake an d too high an ene rgy in take ca n create simil ar probl ems. PRODUCTION IN FEMALES

Normal nutrition Under-nutrition Over· weighVPCOS

I I
/-------------------, I
I I I
I I

B "~G","
,
\ ' .
I" I
I I
, ', . I I
, I I
... I Leptln I I

~
Fat 00000 " I
cel 15 I
I LH \ \ I nsulln : I
IFSH ~ II

+ ~ Pancfeas :
~ ns ulln
i _ •••. ,.'
:

.... ..
'.
~
,.,
CNalY ~ '. CN~ry . •
I I '-=---'

IJ
· P h)')lol~r
I I
hyperinsul inae mia
I TestostefOlltl (n
1 at puberty red utH
I
H
I
I
I
I
E~tradiQl (E I
Proges terone (Pl

Sex ~teroid,
jl Pu berty
Men arc h8
Ovulatioro
SHBG an<l t~U$
amp lrli es nOfmal
ptodue ti on of
se.-. ste":Hd s
I
I
I
I
I I
IE,
IP Oelayed
",b""
Am e nor~~
I
,,
114 UNIT 1 Chapter 4 Energy Balance In the Body

COGNITIVE FUNCTIONS
The brain needs a lot of energy constantly. While it can use both glucose and ketone bodies
to regen erate ATP, severe energy imbalan ces can slow down brain metabolism. With brain
cells operating at sub -optimal levels, several cogni tive processes are impaired, including
memory and recall, problem solv ing , and creative thinking. In addition, severe energy
imba lan ces can also affect mood, leading to decreased well -being and increased te nsion,
depression, anxiety, and fatigue.

METABOLIC FUNCTIONS
Our rest ing metabolic ra te (RMR) adjusts itself to matc h energy in take. Therefore, in most
peop le, when Calorie intake is lower than the amount needed to maintai n normal function ,
THYROI D HORM ON E RMR decreases. This metabolic dec li ne occurs for three reasons, lowering of thyroid
One of a group of hormone output; reduced TEF; and reduced muscle mass. When Ca lorie intak e is increas ed
metabolically active above dai ly needs, the oPPOsite happens - RMR increases.
hormones stored in the
thyroid gland This protect ive mechanism pre ven ts large disturbances in energy balance dur ing times of
Calor ie insuffici ency or excess. This mechan is m makes controlling energy balance quite
difficult when counting Calories. Indeed, decreasi ng Calori e intake in order to lose weight
slows down the RMR. Therefore, even though you're "dieting," it becomes increasingly
difficult to lose weight as both Ca lorie intake and RMR get progress ively lower. Research
suggests that th e largest decreases in RMR occur when diets reach about 1000-1200
Calo ries per day or fewer. On the other hand, RMR tends to increase as Calorie intake
increases. There fore, for those folks that try to force-feed themselves to gain weight, it
becomes increasing ly difficult to gain as both Ca lorie intake and RMR progressively increase .

REPAIR AND RESTORATIVE FUNCTIONS

In highly active individuals, ene rgy deficits can impair the resynthesis of muscle and liver
glycogen as well as the st im ulation of protein synthesis. Thi s means that their bodies don't

Energy requirements of the human brain from birth to adulthood*

BRAI N'S ENERGY BODV 'S ENERGY ENERGY TO BRA IN

BODYWEIGHT (kg) BRA IN WE IGHT (g) CONSU M PT I ON ( kcaVOAY) CONSU MPT I ON (kc aI/ DAY) (% OF WHOL E 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)

UN IT 1 Chapter 4 Energy Balance In ti le Body 115

160

155

Highe r
meta bolism

145

Just right.
140

Eat too little Ideal intake Eat too much

Calories per day

properly repair and restore from exercise, since with a negative energy ba lance the body FIGURE 4.12
is always function ing in a catabolic/breakdown state. With energy reserves being used to RESTING METABOLIC RATE
SCALES WITH ENERGY
ma inta in a minimum level of function, there's little left over fo r rebuild ing and repair.
INTAKE

Vitamins, minerals and energy balance

As discussed prev ious ly, vitamins and minerals don't directly transfer energy in the
regenera tion of ATP. However, they can play important roles as co-factors and/or co-enzymes
in the energy transfer processes. This makes them inva luable contributors to an overall
he althy metabolism. A diet too low in certain micronutrients can negatively aff ect the
energy producin g processes of t he body. Fo r instance, iron defic iency can dim inish oxygen
transpor t, while a deficit of vitamin 83 (niacin) can limit NAD and NAD H activ ity. The main
ELECTROLYTE
micron utrients involved in energy transfer are biotin, riboflavin, niacin, pantothen ic acid, Compound that when
thiamin, pyridoxine , and choline . In addition , some dietary minerals such as sodium and placed in solution becomes
potassium can act as electrolytes , which are important regula t ors of musc le contraction , fluid an ion; regulates flow in and
bala nce and nerve i mpulses. As these functions are strongly related to energy expendi ture, out of cells

these minera ls are critical to energy balance as we ll.

Deficiencies in electro lytes as well as other vi t am in s and minera ls can lead to clinical
complaints such as fa tigue, insomnia, impaired growth, poor circulation, dry hair or hair loss,
lower rates of steroid synthes is, diminished immune function, shortnes s of bre at h, bruising,
mu scl e atro phy, bone loss and muscle cramps. Some nutrition experts have even speculated
that the lack of nutrients in some North American diets may be a cause of obesity. If
someone is consumi ng a diet that lacks micronutrients , the ir appetite may remain very high.
This con tinued appetite increase , even in the face of a high calorie intake, may be the direct
re sult of the body trying to force the individual to kee p eating until the bas ic nutritional needs
are actu ally met.
116 UNI T I Chapter 4 Energy Bala nce In thl! Body

As you consider how energy intake and expenditure combine to ach ieve energy ba la nce,
remember tha t despite our own des ires and goals, the body seeks ba la nce first. It doesn 't like
chan ge. As far as the body's co ncerned, the ideal scenario wou ld occu r when energy intake
perfectly ma tches ene rgy expend iture. In facl, one definition of homeostas is is "unchanging" -
although in the body's case, several complex mecha nisms are in place, and many regu lato ry
processes must occur, in ord er to keep thi ngs the same. However, many of these processes ,
which evolved tho usands of yea rs ago, aren't always well suited to our current social contex t.

For example, app etite typically increases or decreases in response to energy reqUirements.
Therefore if you're exercisi ng more or eat ing less , you'll have a bigger appetite. And if you're
exercising less or eating more, you r appeti te will diminish. This ensures that you' re never really
over- Of unde r-eating . Unfortunately, because we live in a food-abundant, exe rcise-deprived
society, it's very easy to unwillingly create an energy imbalanced state, with too much energy
comi ng in relative to energy expended. Compound ing th e problem, when individuals become
too sedentary, the ir energy regula tion mecha nisms stop functioning opt ima lly. Si nce ap petite
ca n on ly drop so low, it olten out pa ces th e sedentary met abol ism, lead ing to weight gain.
A diet high in processed foods and high calorie beverages ca n al so ou tsma rt ou r meta bo lic
regula tors. It appears that foods high in sodium , beverages high in sugar, and processed foods
with a high calorie density and low nutrient de ns ity don't trigge r our appetite senso rs to signal
fu llness or satiety. So we end up just as hu ngry after scarfing down hundreds of calories of
these foods and we continue to eat. Since in modern society, we can't rely as much on our
natural regulatory mechanisms, ea ting better and exerc ising more have become very important.
Indeed, purposeful exercise and controlled energy intakes are now a pre-requis i te for most folks
to preserve a healthy appetite and a stable energy balance .

Calorie inta ke and ex pe nditure are closely intake, metabolic ra te, tissue turnover, and muscle
regu lated by th e body. Therefore, when trying mass. Furthermore, since th e micronutrient content
to manipulate bodyweight by decreasing food of the diet is often closely re lated to energy intake,
intake, energy expenditu re can be downregulat ed . dec reases in food intake may lead to micronutrient
Conversely, when trying to manipulate body weight deficiencies. The following case study provides a
by increasing food intake, energy expenditure can great example of th is phenom enon.
be upregulated.
Before she sought sports nutrition counselin g,
Let's take the example of an athlete trying to lose the athlete in question, an elite cross country
weight for competition by restricting food intake. ski athlete, was 5'6", 165 Ib , and 23% body
This seems logical at first, but when energy is fat. As most elite participants in her sport are,
decreased, not only will the athlete's me"bolic rate on average, closer to 135 Ib and 12% body fat,
eventually slow, preventing further weight loss , but she needed to lose bodyweight and body fat to
muscle mass wil l be compromised and performance be come mo re competi tive. After being counse led
ability will suffer. Indeed, optimal ath letic to ingest a higher-carbohydrate, energy -res tricted
performance and health are rela ted to total energy diet (see September 2002 data below fo r a
UNIT 1 Chapter 4 Energy Balanc e In the Body 117

summary of the nutritiona l prescription) , she lost both a faster metabolic rate and an increased
a combination of fat and muscle mass, ending up protein turnover in t he body.
at 160 Ib and 22 % body fat.
b) An increased food intake. Indeed , with her
After these unpromising early results, th is high volume of exercise and moderate food
ath lete came to us for nutritional coach i ng . intake, the athlete could have been sufferin g
After twelve weeks of following a modified set of from a depressed metabol ism due to a severe
recommendations (outlined below) , she achieved energy imbalance. Perhaps the increase in
the following re sults: food intake stimulated the metabolism to a
l arge extent. Or perhaps it en abl ed her to tra in
While surprising and (according to the
harder, leading to a greater Calorie expend iture
conventional view of energy balance) improbable,
during and after train ing.
this 25 Ib loss of body mass in the face of an
increase in food intake may have occurred due to c) A dietary shift in food type. As this at hlete
one or more th e following reasons: began by eating a diet hi gh in sugars and
saturated fat s, the shift toward fiber-rich , slower-
a) An increased protein intake. As the athlete's
digesting carbohydrates , a balanced fa t intake,
protein int ake was fa irly low to begin w ith,
and an increased protein intake may ha ve led to
the increased protein intake may have lead to
a hormonal profile that favored fa t los s.

Compariso n of 12 -w eek res ult s

SE PTEMBE R 2002 DECEMB ER 2002 NET RESULT - 12 WEEKS

Height and weight 5' 6"/160Ib 5'6" 1135 Ib 25 Ib lost'

Body composition 125 Ib lean, 35 Ib fat 123 Ib lean , 12 Ib tat 23 Jb fa t 10sF
2 Ib lean mass 10sF
Body fat % 22 % 9% 13% lost
Exercise expenditure -1 200 kcal/day -1200 kcal/day Same

Energy intake -25 00 kc al/day -400 0 kcal/day + 1500 kc al/day

Macronutrient 15% prot ein 35% protei n +20% protein
breakdown 65% ca rbohydrat e 40% ca rbohydrate -25% carbohyd rate
20% fa t 25% fat +5% fat

Notes :
L Th is dramatic and rapid shift in body comp osi tion was ach ieved With a large increa se in food in take
- f rom 2500 kcal per day to 4000 kcal per day.
2. Body composition da ta was reco rded vi a a calibrated·welgh sca le and air-displacement plethysmography
(Bod Pod) . In add i tion , energy intake da ta was co ll ected and ana lyzed as weighed diet records , and expend i ture
data estimated based on ACSM MET values .
118 UNIT 1 Chapter 4 En ergy Balance In th e BOdy

1. Energy balance is the relationship between energy intake and expenditure. This
relationship between the amount of Calories we eat in the diet and the amount
of energy we burn in the body determines our bodyweight as well as our overall
health.
2 . We measure energy intake, or the potential energy present in our food, in Calories
or kcals.
3. The body's energy needs include the amount of energy required for maintenance
at rest; the amount of energy required for physica l activity and movement; and the
amount of energy requ i red for food digestion, absorption , and transport.
4 . Our energy needs can be estimated by measuring the amount of oxygen we
consume , either directly in the laboratory or approximately with one of several
mathematical equations.
5. When energy intake is greater than expenditure, or vice versa, an energy
imbalance can exist. This will lead to changes in bodyweight. However, other
functions such as reproductive function, cognitive function, metabolic function,
and recovery function can also be affected. Eventually this can lead to disease
progression and an inability to perform optimally.
6. The exercise we do and the food we eat affects our energy balance and our fuel
utilization, determin ing whether we use more carbohydrates or fat for energy
transfer.
7. Micronutrients act as cofactors and/or coenzymes in the liberation of energy
from food. A limited intake can disturb energy balance and can lead to
numerous side effects.
CHAPTER 5

AEROBIC &
ANA ERO BI C
METABO LI SM
Chapter objectives
Key terms
How exercise affects metabolism
Muscle structure and function
Muscle organelles
Energy demands of muscle
Acute and chron ic oxygen
consumpti on
Physiology of anaerobic exercise
Physiology of aerobic exercise
Adaptation to exercise
Chapter 5 Summary
KEY TERMS
myofibrils
myosin
actin
cross-bridges
sarcomere
Z-discs
sarcolemma
sarcoplasm
sarcoplasmic reticulum
transverse (TJ-tubules
metabolic testing
MET
steady-state
oxygen deficit
oxygen debt
fPOC
anaerobic threshold
counter-regulatory hormone
muscle hypertrophy
myofibril/ar hypertrophy
sarcoplasmic hypertrophy
capillarization
sympathetic nervous system
UNIT I Chapter 5 Aerob ic & Anaerob ic Metabolism 121

How exercise affects metabolism

In the previous chapter, we examined factors that make up your metabolic rate. We noted
that exercise is a major metabolic upregulator. However, age-associated melabolic changes
are also important. Research shows that on average, indi vidua ls expe rience a 2-4% decline
in th eir resti ng melabolic rale (RMR) wilh each passing decade after Ihe age of 25. This
means that most peo ple can look forw ard 10 an ever-diminishing melabolic rale from the ir
mid-20s onward. A person with an RMR of 1500 kcal at age 25 may have an RMR around
1400 kcal a decade later. After another ten years, it'll be down around 1300 kcal. By 55, it'll
be down around 1200 kcal. And so on.

With this melabo li c loss comes muscle loss. On average , peop le lose about 5 Ib of lean mass
per decade between Ihe ages of 25 and 65 . So, in addition to dropping around 300 kca l of
melabol ic power by the age of 65, most folks also lose about 20 Ib of lean mass. Because
musc le is so metabolica ll y active, this muscle loss is probab ly di rect ly responsible for much
of the metabolic losses . This suggest s that metabolic decline isn't age -associated. Rathe r,
it's lifestyle-related - what we think of as "normal" aging may, in fact, be an outcome of
inactivity. Indeed, if people take steps to preserve their muscle mass with age, t hey' ll also
preserve the ir resti ng metabolic rate.

Enter prope r exercise programm ing. At its most bas ic level , exercise cons ists of repea ted ly
contracting th e skeletal muscles. These contract ion s can take place whi le run ni ng , lifting
weights , cycling, jumping rope , elc. Muscles use energy when th ey contract, the more
intense the exercise, the more energy used per unit time. For example, cycling at grealer than
20 mph (as you would in a race) burns four limes as much energy per minute as le isurely
cycling at 8-10 mph. Likewise, sprinling al a 100 m das h pace burns more kcals per minule
than runni ng at a co mfortable jog. This heighte ned energy cost associated with higher
inte nsity activity not only occ urs during exe rcise , but after Ihe aclivity as well , whe n the body
requ ires additiona l energy for re covery and repair.

For now, lei's take a pract ical look at what happens when someone begins to contract th ei r
muscles during exercise. If someon e were to immediately begin running as fasl as possible,
the follow ing secuence would take place.

1. Within 3 seconds, muscle ce li s wou ld use up all of their stored ATP.

2. As exercise co nl inues, th is ATP must be regenerated. Th e AT P-PC r system Ihen kicks In
to shoulder most of the lo ad. This lasts for about 10 seconds. Because ATP regene ralion
takes time, you start to slow down a bit.
3. As exercise continues, and you deplete your ATP-PCr stores, Ih e glycolytic system begins
to prov ide most of Ihe energy tra ns fer for ATP regeneration. This lasts for abo ul 90 -120
seco nds or so, depending on Ihe inlensity. As Ihe glycolytic system generates ATP more
slow ly Ihan the ATP-PCr system, you ha ve 10 slow down a bil more.
4. If exerc ise conti nues beyond Ihis time frame, the oxid ati ve sysle m will then provide mosl
of Ihe ene rgy tra nsfer for ATP regen era tion. Because the oxidative systems are slower than
th e anaerobic systems, the pace must slow again. In fact , if the pace is slow enough, the
exercise can last for quile a long time.

This example assumes Ihat you start out sprinting as fast as you can and co ntinue 10 run as
hard as you can until absolute exh au sti on. This would max oul all of your ene rgy syslems
and their capac iti es. However, th is rare ly happe ns with sport or pur poseful exercise. Ind eed ,
you 'd probably only experience Ih is type of activity if you were being chased by a rabid dog
122 UN IT 1 Chapter 5 AerobiC & Anaerobic Metabolism

ATP store
c
.,
o
u -.. ATP·Per system

~"c.
Lactic acid system
•• Overa ll performance
ATP store
••• Ae rob ic system

••
• ........... -."""'#...
Th = Threshold point

;'
;'
;'
.\
E
"E .; ' \
'x .. -.-\
_
,..... _ •••••• __ •• Aerobic "
'"E
b - .............
:
Lactic acid

* ------------- :, ------ --------------

2 sec 10 sec 1 min 2 hrs
Th Th
Time

fiGURE 5. 1 or grizzly bear. During most vo luntary ac tivity, exercise happens a bi t differe ntly. For example ,
ENERGY USE DURING with endurance exercise, you maintain a relatively slower pa ce that enab les the oxidative
EXERCISE system to take the brunt of Ih e exercise load. In thi s case, min ima l acid accumulation/lactate
production occ urs . Converse ly, the all-out effo rt of spr int exerc is e must be interspersed with
recove ry intervals that help rep lenish ATP and the ATP·PCr systems whi le remov ing muscle
acidity and, with it, fatigue.

Thus , there's no quest ion that different exercise intens ities and modal iti es affec t our
phys iology differently. This is espe cially tr ue when it comes to preserving muscle and
metabo lism with age . Indeed , it appears that in tense exercise prevents muscle loss and
preserves the resti ng metabolism most effectively, while lower intens ity activity offers ve ry
li ttle in th e way of muscle prese rv ation.

What qualifies as "inten se exerci se?" Resi st ance tra ining (strength training), interval
runni nglclimbinglcyclinglrowing, circuit traini ng, rope jumping, run ning hills, sq uat
th rusts, plyometrics, explosive med icine ba ll work , ex plos ive kettlebell exerc ises , and
strong(wo)man activities are all high in tensity ac tivities. Basica lly, high intensity act ivity
includ es any phy sically demanding tas k that incorporates many muscle groups and is
done near you r maximum hea rt rate .

The high inte nsity acti vities li sted above recruit a maximum of muscl e act ivity, lead ing to
high amo unts of ce ll ular stress and the need for muscle adapta tion. This muscle st re ss
and adaptat ion produces the maximum number of benefits , inc luding increased protein
turnover, muscle pres ervatio n and/or building, a high ene rgy cost, and even cardiovascular
benefit s. However, as important as exercise is to this process, nutrition is equa lly cri tic al. As
discussed in previo us chapte rs, rece nt resea rch has shown that in the abse nce of nutriti onal
inter vention, exerc ise tra ining res ults in ve ry few body compos ition benefits. Why is th at?

Fi rst, nutritional status can affect energy transfer. A good nut rition program ena bles
the top performance of each of the energy sys tems, ATP· PCr, glyco lys is, and oxidative
phosph orylatio n. Both macro nutrien ts and micronutrients are important here. A sub-optimal
nutri tional in take ca n red uce en zyme efficie ncy (d ue to defi cienc ies of co-enzymes and
UN IT 1 Chapter 5 Ae rob ic & Anaerobic Metabolism 123

co~fac t ors)
and lead to substrate deficiencies. This means poor exercise performance and
fewer calories burned both at rest and during exercise. So much for the metabolic and
muscle preservini?/building benefits of exercise' In addition, with an inadequa te intake
of dietary protein and fat, amino acid availability and the rat io of anabolic to catabolic
hormones can be compromised. This can lead to an inability to build/preserve musc le mass, MYOFIBR ILS
One of the threadlike
even with a solid exercise program.
components of a muscle fiber
Now, although you'll hear people estimate that body composition results are 80% diet
and 20% exercise, I don't like such estimations. Both are so important independen tly that MYOS IN
Thick fibrous muscle protein
I'd suggest the following; Both exercise and nutrition are 100% necessary. Without both,
that can split ATP and bind
reaching the upper limits of performance and body change is nearly impossible. with actin

ACTIN
Muscle structure and function Thin fibrous mu sc le protein
that IS necessary for cell
Optimal health, performance, and body composition depend upon our muscle mass in many shape and can bind to
ways. To understand the import ance of skeletal muscle with respect 10 exercise performance myosin
and metabolic rate, you need to understand muscle structure and function.
CROSS - BR IDGES
Skele tal muscles contain long, slender fibers, known as muscle cells, that are bundled Formed when the head of
together. These bundles of conlractile proteins then merge with tendons tha t are in turn myosin temporarily attaches
attached to bone. With this arrangement, the muscles can then move our bones by to actin

contracting (getting smaller).

SARCOMERE
Muscle cells are formed from smaller bundles of myofibrils , which consist of thick and Repeatmg structural units of
striated muscle fibers
thin filaments called myosin and actin. When muscle contraction is require d, the actin
and myosin form cross-bridges that slide across each other, pulling the ends of the muscle Z-OISCS
together. (You might say they "interact to contrac!"') Sarcomeres consist of strands of actin Region of the sarcomere into
and myosin attac hed to natu ral breaks in the musc le, called Z-discs. These Z-discs produce which actin is inserted

FIGURE 5.2
SKELETAL MUSCLE
STRUCTURE

Thin
(ac tin)
filament Tropon in Tropo myosi n

Thick
(myosin)
filament Myosin head MYOS in/ac ti n
cross bri dge

Sarcomere
124 UNI T 1 Chapter 5 Aerobic & Anaerobic Met abo lism

the striated appearance of muscle. When called upon to contract, t he actin and myosin are
pulled together, shortening the space between the Z-discs. This muscle action is fueled by
AT P and, of course, the energy provided by fue l oxidation helps to regenerate this ATP in
times of high energy demand.

Ske letal muscle cells also contain multiple nuclei ar ranged just under the muscle cell
membrane . Ju st like nuclei in other cells of the body, these nuclei in the musc le ce lls are
responsible for directing protein sy nthe sis in the muscle.

Muscle organelles
In addition to the act in, myosin, and nuclei within musc le cells, other organelles are presen t,
as with other cells of the body. However, in the muscle cells, some of these organelles have
slightly different names. Here's a list of t he organelles within muscle fibers.
SARCOLEMMA
Plasma membrane of a • Sarcolemma: the plasma membrane of a muscle fiber.
muscle fiber
• Sarcoplasm , t he cytoplasm of the muscle cel l, which contains nuclei and mitochondria. As
SARCOP LASM muscle cells require large amounts of ene rgy transfer, the sarcoplasmic mitochondria are
Cytoplasm of muscle fibers numero us.

SARCOPLASMIC RETICULUM • Sarcoplasmic reticulum , the network of tubu les and sacs in the muscle cell , similar to the
Endoplasmic reticulum of endoplasmic reticul um.
muscle that appropriates
cafcium • Myofibrils, the bundles of very fine fibers made up of actin and myosin.

• Sarcomere: t he segment of a myofibril between two successive Z lines.

FIGURE 5.3 H zone I band A band

SKELETAL MUSCLE
CONTRACTION Z-disk: Z- disk

~ =:m::= EE
,
\,
~

~',
\
\ Relaxed/
I
i
r
I
/

\ \ I I
\ \
,
\ I

Th in myofilamen t
Contracted

Muscle f ibre Thick myofilament

" lilliiii~! ("'''' !II.' Im,.2(~

UNIT 1 Chapter 5 Ae robiC & Ana erobiC Metaboli sm 125

• T-lubules (lransverse lubules), tubes that extend transversely across the sarcoplasm. TRANSVERSE IT)-TUB ULES

They are formed by inward extensions of the sarcolemma and allow nerve impulses to Inward-folded crevice of
the sarcolemma on muscle
travel along the sarcolemma . deep inside the cell. These nervous impulses initiate muscle
that forms tubular portions;
contraction. T-tubule depolarization
triggers calcium release and
muscle contraction
Energy demands of muscle
The costs of various types of exercise have been estimated through what's ca lled melabolic METABOLIC TESTING
testing, which measures oxygen consumpt ion during an activity. The more i ntense the Tests that mea sure metabolic
exerc ise, and the more muscles utilized , the more oxygen is consumed. And the more oxygen functions (e .g. , digestion and
energy production)
consumed , the more energy is expended .

As discussed in previous chapters, at rest, humans consume about 3.5 mL of oxygen MET
Oxygen cost of energy
per kilogram per minute. Put in terms of energy expendit ure, 3.5 mL x kg! x minute'! is
expenditure measured at
equivalent to 1 MET (short for metabolic equ ivalent!. In essence 1 MET represents 1 unit
rest, equal to 3.5 mL of
of metabo lic rate, or the amount of oxygen consumed during 1 minute of rest. Since METs oxygen per kilogram of
are representat ive units, exerc ising at 5 times the res ting level of oxygen consumption would bodyweight per minute
be equivalent to 5 METs. Exercising at 10 times the rest ing oxygen consumption would be
equivalent to 10 METs .

Whi le using METs may seem odd at first , METs are extremely useful when trying to estimate
ene rgy expenditure during exe rcise. Indeed, by multiplying the MET intensity by bodyweight
in kil ograms, you can eas ily calculate your energy expenditure per hour of exercise . For
example, if you 're cycling at 10 METs (wh ich is very high inten sity act ivity) and weigh 70 kg
(l54 Ib) , you'd be expend ing about 700 kcal per ho ur (10 METs x 70 kg).

Metabolic equivalents (METs) of selected daily activities

DA I LY ACTIVITY METS

Sexual intercourse with establ ished partner

Lower range (normal) 2-3
Lo wer range orgasm 3-4
Upper range (vigorous activity) 5-6
Lifting and carrying objects (9·20 kg) 4-5
Walking 1.6 km (1 mi l e) on t he level in 20 minutes 3-4
Go lf 4-5
Gardeni ng (digging) 3-5
Do·it-Yourself, wallpapering, etc . 4-5
Li ght housewo rk ; e.g., ironi ng, polish i ng 2-4
Heavy housework; e.g" making beds, sc rubbi ng 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 determi ne energy expenditure per hour of exercise, multiply MET values by bodyweight.
126 UNIT 1 Cha pter 5 Aerob iC & Anaerob iC Metabolism

Acute and chron ic oxygen consumption

Al though muscle activity is proportional to oxygen consumption, when you begin an
acute bout of exe rcise you r oxygen cons umpt ion does not immediately increase to match
STEADY· STATE your new energy demands or yo ur new steady-state . This means that even during low to
A level of metabolism during moderate intensity activity, the intensity of the exercise out-paces the amount of oxygen
exercise when oxygen being co nsumed duri ng the firs t few minutes. What does this mean' During this initial period
consumption matches
of "oxygen deficit ," ana erobic energy transfer from the ATP-PCr and the glycolytic systems
energy expenditure
contribute significantly to the ATP regenerated. Thus Ihe re is an in ilia I period of anaerob ic
OXYG EN DEFI CIT energy product io n even duri ng aero bi c activity.
Difference between oxygen
This anaerob ic "oxygen deficit" is represented by the difference in th e amount of oxygen
uptake of the body during
early exercise and during a consumed du ring the initial period of exercise and the amo unt consumed during a steady-
similar duration of steady state period of equal time (occ urri ng later in the exerc ise session). And the magnitude of th is
state exercise oxygen defic it is determined by the exercise in te nsity, the hig her the intensity, the greater
th e defi cit. Eventually, if t he in tens ity of the exercise is at a steady state and the exe rcise
is aerobic in nature, oxygen co nsumption catch es up to exercise intensity. Howeve r. even
though you've caught up, an oxyge n de bt must be paid after the exe rcise be ut has ended.

After a full exercise session , or even after a single inter val within an ent ire exercise session,
the oxygen deficit that's accumulated must be paid back . This means tha t after you've
OXYGEN DEBT
Extra oxygen required above stopped exercis ing and the amount of mechanica l work you're doing is no different then
basal needs after a peri od of you'd be do ing at rest, you st ill con tinue to consume more oxygen . This period of increased
intense exercise oxygen consumption and ene rgy demand has been called the period of " oxygen debt" or
EPOe (excess post- exercise oxygen consumpt ion). After exercise, th e amount of oxygen
EP OC
consumed can be eleva ted for minutes to hours to allow the body to do three esse nt ial tasks,
Increased rate of oxygen
update following strenuous
metabolize addit ion al nu trients; replenis h the energy stores that have been used up ; and
activity reload the depleted oxygen store s in the musc le and blood. In addition to these re cove ry-Iype
activ ities, the following also contribute to the EPOC,

• Elevated post-exercise body temperatu re

• Increa sed activ ity of the hea rt and res pira tory muscles
• Elevated levels of metabolism-boost in g hor mones

FIGURE 5.4
OXYGEN UPTAKE PATTERNS
WITH EXERCISE

"o
~
E resting oxygen uptake
'"
""'o
u
"
~
o
oxygen
debt

o 1 2 3 4 5 6 7 8

Time (minutes)
UNIT 1 Chapter 5 Aerobic & Anae robiC Me taho llsm 127

• Increased conversion of energy transfer products such as lactate into olher subslrates
• Increased protein synthesis
• Recovery of muscles stressed and damaged with the acti vity

Thus , the more intense the exercise, the bigger and the longer-lasting the EPOC values.

This means that with increased exercise intensities, more oxygen is consumed and energy
utilized per minute of exercise , just as more is used after the exerc ise and al l day long.
Further, as intense exercise aclivates more muscle mass, this type of activity can help in
building/preserving muscle as we age . With lower intensity exercise, or any easy physical
activity, plenty of oxygen is consumed and energy is utilized during the act ivity itself.
However, after the exerc ise, very little metabolic cost remains. Further, as muscle activation
is low, this type of activity does little to build muscle mass or preserve it with age.

Physiology of anae robic exercise

We've defined anaerobic exercise in previous chapters as higher inte nsity, shorter duration
activity. As our initial energy stores can only supp ly energy for about 3 seconds, our AT P
must be regenerated quickly in large amounts to support this type of exercise. Since the
ATP demand is so rapid, the rate of oxygen uptake and oxidative metabolism simply cannot
keep up during anaerobic exerci se . Thus the predominant anaerobic energy pathways, the
ATP-PCr system and the glycolytic pathway, are responsible for most of the energy transfer
activities with this type of high intensity activity.

It is important to note , however, that the energy systems do not work independently from
one ano ther. During vario us types of exercise , all three energy systems are activated.
However, the extent 10 which they are activa t ed, and the amount and proportion of ATP
they regenerate relat ive to the total ATP regeneration required, defines the activity as
anaerobic or aerobic.

For example , during short burst activity, the ATP-P Cr system is most important. When
immediate and explosive movement is desired, the brain initiates the contraction with a

FIGURE 5.5
EPOC

~
::::J
E
u
o
"-
w

o 10 20 30 40 50 60

Time (minutes)
128 UNIT 1 Chapter 5 AerobiC & Anae rob iC Metabolism

signal that's passed along the nerves to the muscles . The musc les then contract, using ATP
and depleting these immediate energy stores within a second or two. In order for the muscles
to continue to contract , the resulting ADP and P must be regene rated to ATP. Th is happens
with the help of int ra cellular stores of PCr. Wh il e this energy system can on ly provide energy
for 8-12 seconds when operating at maximum capacity, it can fuel short burst activities such
as the follow ing:

• The go lf swing
• Field events (shotput, discus)
• Gymn astics
• The te nnis swing
• 100 metre sprint
• The baseball swing or throw
• Div ing

Indeed , any activity done at a very high intensity for 12 seconds or less derives a large
pe rcentage of its energy transfer from the ATP-PCr system . This exp lains why, in part,
creatine supplementation he lps with short duration, strength and power performance-
especially repeated short duration efforts . By enhancing muscle PCr concen tration s, ATP
can be regenerated more qu ic kly, leading to improved subsequent efforts relative to exercise
performance without creati ne supplementation.

If an activity lasts longer than 10-12 seconds and up to 2 minutes, the glycolytic system
must kick in to provide most of the remaining energy for ATP regeneration. The following
ac tiv it ies therefore rely heavily on th is system:

• 200 and 400 metre run

• 100 and 200 metre swim
• Wrest li ng
• Soccer
• Tenn is
• Hoc ke y
• Basketball
• Football
• Boxing

Any activity done at a high intensity for longer than 10-12 seco nd s and up to 2 minutes
derives a large percentage of its energy transfer from the glyco lytic system. Most of th is
energy transfer is accompl ished via glucose and/ or stored glycogen, which is why high
inte nsity anaerobic perfo rma nce tends to suffer on very low -carbohydrate diets. The glycolytic
pathway needs a minimum of carbohydra te to operate most efficiently.

When exercising at low intens ities, levels of blood lactate rema in reasonab ly stab le compared
to re sting. However, when maximally employ ing the glycolytic system, going from low
intens ity to high intensity exercise , blood lactate levels rise markedly. When these blood
levels reach a certain point where the body canno t remove the lactate at the same rate it's
ANAEROB IC THRE SHOLD being released, the anaerobic threshold (AT or lactate thres hold) is reac hed. At intensities
The point at which lacllc just be low the AT, exercise can continue indefinitely as the AT P regeneration is accomplished
acid begins to accumulate by aerobic means. However, just above the AT, exercise dura tio n will be limited . At this point
in the bloodstream exercise is said to become anaerobic.
UNIT I Cha pter 5 AerobiC & An aerobic Metabolism 129

Humans have four general types of muscle f ibers,

1. slow twitch (or type I),

2. fast twitch A (or type IIA),
3. fast twitch B (or type li B) , and
4. fast twitch C (or type lie).

These four fiber types differ in,

• th ei r speed of con traction ,

• their resistance to fa tigue,
• their fibe r diameter,
• their capillary and mitochondrial densi ty, and
• their myoglobin conte nt.
Not surp risingly, different fiber types are act ivated preferentially based on the type of exe rcise
being performed. Dur ing anaerobic exerc ise, type IIA, type li B and type lie muscle fibers
perform the brunt of the work as they con tract more quickly. In response to this muscle
act iv ation, spec ifi c mid- and long-term metabolic adapta t ions can be ex pected. These
adaptations include,

• inc re ases in stored ATP,

• increa ses in stored PCr;
• increases in intramuscular glycogen storage; and
• increa sed ATP-Per and glyco lytic enzym e activities.

These adaptations improve exercise output during subsequent anaerob ic sessions. And they
are optimi zed wi th the help of an adequa te diet.
FIGU RE 5.6
ANAEROBIC THRESHOLD

o indica tes end of tes t

25
400m track race,
excellent performance (50s)
::;
""E
0 20
400m track race,
.5 average performance (60s)
.,"
0
15
~
c:
'"u
"0u
E 10
l!i
u
~

"0
0 5
iIi

O+----------r---------.----------,----------r---------.--------~
o 5 10 15 20 25 30

Time (minutes)
130 UNIT 1 Ch apter 5 Ae rob ic & An ae robiC Metabolism

Physiology of aerobic exercise

As discussed above, anaerobic exerc ise consists predominantly of any exercise performed
at high enough intensities to induce fatigue in 2 minutes or less. If an activity lasts longer
than 2 minutes, the oxidative system must kick in to provide the remaining energy for ATP
regeneration. Th is type of exercise is referred to as aerob ic.

As you now know, oxidative energy transfer takes place in the mitochondria of our cells
and utilizes a combination of musc le glycogen, intramuscu lar fatty acids, free fatty
acids, and amino acids. As the oxidative processe s utilize breakdown produc ts from both
glycolysis (glucose through to pyruvate) and beta oxidation (fatty acids through to acetyl -
coAl , energy transfer occurs at a slower rate. However, what this system lacks in speed, it
makes up for in Al P regeneration. As a result, oxida tive metabo lism can support activit ies
including the fol low ing:

• 800 metre run

• 2000 me t re rowing
• 1500 metre skating
• Cross-country skiing
• Jogging
• Walking
• Long distance swimmi ng

Any activity done at a high intensity for longer than 2 minutes derives a large percentage of
its energy transfe r from the oxidative system. To demonstrate the "switchover point" at which
an act iv ity moves from anaerobic to aerobic , here's an interesting comparison.

As you can see , with these track and field distances, the aerobic system becomes the largest
energy contributor between 400 and 800 m. Therefore, the longer the duration of the
activity, the more the aerobic energy contribution.

FI GURE 5.7
PERCENTAGE OF AEROBIC
ANO ANAEROBIC
COMPONENTS FOR
VARYING RUN DURATIONS

D Anaerob ic • Aer obic

200m run 400m run 800m run 1500m run

UNIT 1 Chapte r 5 Aerob iC & Anaerob ic tvl eta ooll "> m 131

Classification of exe rci se by duration and ene rgy supply

DU RAT ION CLASSIF ICATION LARGEST % OF ENERGY SUPPL IED BY

1 - 4 seconds Anaerobic ATP (in muscle)

4 - 10 second s Anaerobic ATP + PCr

10 - 45 seconds Anaerobic ATP + PCr + muscle glycogen

45 - 120 seconds Anaerobic, lactic Muscle glycogen

120 - 240 seconds Aerobic + anaerobic Musc le glycogen + lactic acid

240 - 600 seconds Aerobic Musc le glycogen + fatty acids + amino acids

Each of the energy systems making up the anaerobic and/or aerobic pathways relies on
limited amounts of stored nutrie ntS/subst rat es. When a substrate is about to be exhausted,
performance will suffer. This is one of the reasons that an eve nt like running, which depends
greatly on stored glycogen (and also stored triglycerides if longer in duration), cannot be
maintained indefinitely. When carbohydra te and fat res er ves are low, body proteins can also
be used, which can re sult in the loss of muscle mass. Therefore, it's impo r tant to always
consider energy balance when tra ining regularly . Ad eq uate intakes of food, vitamins and
minerals are necessary to prevent energy depletion and prote in losses.

Adaptation to exerc ise

In response to both regu lar anaerobic an d aerob ic exe rci se training, changes occ ur in th e
muscle that im prove the bod y's abi lity to respond to similar exe rcise challenges in the fut ure.
Ea ch of these processes is regu lat ed by prote in sy nt hetic mechan isms in iti ated within our

En ergy storage for a 70 kg non-ob es e ma n

MACRON UTR IENT S STORAGE FORM EN ERGY

Carbohydrate Blood glucose 60 kcal

Glyc oge n in muscle 1400 kcal
Glycogen in liver 240 kcal

Fat Intramuscu lar fa t 1440 kca l

Subcutaneous fat 70200 kca l
Protein Mu scl e protein 24000 kcal
Total 97340 kcal
132 UNIT 1 Chapter 5 Ae robiC & AnaerobiC MetabOlism

genet ic material (DNA) . Cel lular co mmu nica tion through hor mones is inti ma tely in volved
in this process. In the presence of adequa te nutrient availabi lity, the hormone ins ulin
encourages the stimu lation of protein syn thes is and a positive nitrogen balance. Insulin
ava ilabi lity is greatest during well· fed conditions and/or du ring peri ods of ene rgy su rplus .
Protein/amino acid intake is key here as protein-containing mea ls stimulate a positive protein
status. In addition, hormones like testosterone and growt h hormone have a stimulatory
COUNTER· REGULATORY effect on muscle adaptation. On the other hand, the counter·regulatory hormones such as
HORMONE gl ucagon, catecholamines, and glucocorticoids hav e a contradictory effect, promot ing protein
Hormon e that opposes the breakdow n and a negative nitrogen balance. These ho rmones are released in large numbers
action of insulin
during periods of fasting or energy deficit.

Protein syn thesis and exercise adaptation are also affected by,

• the amount of mRNA in our cells;

• ribosomal number;
• ribosomal ac tivity;
• amino ac id availability;
• the ho rmonal environme nt; and
• our native genetic code.

Interest ingly, even the process of recovering and adapt ing to our exercise train ing demands
is metabolically costly. As proteins are degraded and amino ac ids are re-synthesized into
pro teins, t his process of protein tu rn over accou nts fo r between 10 and 25% of res ting energy
exp endit ure while it builds more fu ncti onally ada pted enzyrnes, cont rac tile units, etc. As you
can see , not only does exercise increase to tal daily energy ex pend iture during th e activity,
it also increases post -exercise ex pendi t ure through two mechanisms after th e activity, the
oxyge n debt thai mu st be repaid and the increased protein turnover/synthesis jusl described.

FIGURE 5.8
INFLUENCE OF AMINO
Increased
AC I DS AND HORMONES ON Growth
amino acid
PROTEIN SYNTHESIS hormone

1 influx

Amino acids

1
Protein
I I
1
Amino acids

Testosterone
(and analogs)
1 Increased
amino acid
influx
UNIT 1 Chapler 5 Aerob ic & Anaerob iC Me ta bolism 133

Anaerobic adaptations
The primary adaptation to anaerobic exercise, particularly short duration, high intensity
strength and/or power training, is an increase in musc le cross- sectiona l area, known
as muscle hypertrophy. Musc [e fibers both increase in size and in myofibrillar number MUSCLE HYPERTROPH Y
in response to the high intensity contractions of weight training and/or sprint tra ining. Increase in the size of
muscle cells
Hypertrophy can be broken down into two types, Hypertrophy of muscle fibers is typically
referred to as myofibril[ar hypertrophy while increased fluid and substrate storage is referred MYOFIBRILLAR
to as sarcoplasmic hypertrophy. HYPERTROPHY
Enlargement of a muscle
A[though exercise is necessary, nutrition is critical to hypertrophy, Without adequate food fiber as it gains myofibrils
intake or protein intake, am in o acid avai[ability and/or surplus energy won' t be available to
stimu late this process. [n addition to changes in fiber number and size, fo ur other fac tors SARCOPLASM IC
HYPER TROPHY
can contribute to muscle hypertrophy,
Increase in the volume of
• increases in mitochondrial size and number; the sarcoplasmic fluid in
the muscle cell with no
• increases in myoglobin number; concurrent increase in
• increases in intr ace llu lar storage capacity; and strength

• increases in intracellu lar glycogen storage .

Adequate dietary energy, macronutrients, and micronutrients are required to assist in each of
these processes.

In addition to changes in cross-sectional area, anaerobic exercise can enhance the activity
of ATP-PCr system enzymes (creatine kinase, myokinase) and the glycolyt ic system enzymes
(g[ycogen phosphorylase, phosphofructokinase). These changes help to inc rease the rate of
energy transfer within the muscle, allowing fo r more rapid responses to energy demands in
the future.

FI GURE 5.9
CHANGE IN METABOLISM
AFTER INTENSE
RESISTANCE TRAINING

E
<J)

o
.0
ro
a:;
~

o 1 2 3 4 5

Time (days)
134 UNIT 1 Chapter 5 Aerob iC & Anae rob ,c fl. 1elaboll!>m

Aerobic adaptations
A different set of adaptations occurs with aerobic exercise. This type of lower intensity, lo nger
duration activ ity primarily influences muscle quality (rathe r than muscle size). Oxidative (or
mitochondrial) enzyme activi ty is enhanced preferentially and substrate storage, such as
intramuscular glycogen and triglyceride, may increase.

The primary muscle fiber types that contrib ute to aerobic exercise are the oxidative type I and
type II A fibers. As aerobic exercise is heavily oxygen dependent, training adaptations occur
in order to support oxygen transport and delivery in these fibers. Aerobic training increases
blood volume by increasing red blood cell content and oxygen -c arrying capacity of the
body. In particular, aerobic exercise can incre ase the number and size of the blood vessels
CAPI LLA Rl ZATION through increased capillarization (i.e., developing more capillaries per unit of muscle).
Development of a capillary This lengthened border between blood vessels and muscle fibers allows for enhanced
network de li very of oxygen/fuel to muscle ce lls, enhanced removal of CO , and waste products, and
the transfer of heat away from the muscle. In addit io n, th e myoglobin content of skeleta l
muscles will increase, which improves oxygen delivery across muscle cell s. While the greater
capillarization leads to more oxygen transport, the greater myoglob in leads to increased
muscle oxygen uptake, and the large r/m ore numerou s mitochondria allo w for greate r oxygen
use. Finally, the number and size of mitochondria increase with aerobic activity of high
enough in tensit y. This promotes greater oxygen utilization through the process of pyruvate,
fatty acid, and ket ones utilization through the Krebs cycle and electron transpo rt chain.

Some additional benefits of both regular aerobic and anaerobic exercise training include,
SY MPATHETI C NERVOUS
SYSTEM The attenuation of sympathetic nervous system activity : th e perceived stress of exercise
A division of the autonomic is minimized over time and therefore greater workloads are required to promote the same
nervous system that is amount of adaptation.
always active and provides
Greater insulin sensitivity, The body responds to carbohydrate intake with less insulin
sympathetic tone: its activity
increases dUfing times of re lease, allowing insulin to act in carbohydrate update and prote in synthesis without
bodily stress preventing fat loss/stim ulating fat gain.

FIGURE 5.10
TYPI CAL CHANGES WITH Aerobic Resistance
exerci se Variable exercise
EXERC ISE
Glucose metabolism:
rt Glucose tolerance rt
tt In sulin sens itivity tt
Se rum lipids:
t ....
..... HDl cholesterol
LDL cholesterol
t inc lusld va luu

.
l dec.u sed values

.....
.....
Blood pressure in rest:
Sy stol iC
Diastolic
........ +-+
l 01 t
unchan,ed val ues

sm all elfKt

ll ol tt Inte , me dla le effKI

•
Body composition:
% 01 fa t l U Of t tt la'ge eflKI
"Fat free body mass tt
t Basal me ta bolism tt
--- -------- ---- ------ --- -------- ---- --- -- ---- --------
+-+ Muscu la r str ength 1'11
Aerobic capacity:
ttt V02 ....
ttt Time 01 maximal or submaximal aerobic exe rcise
UNIT 1 Chapter 5 Aerobic & A n<leroblc MelaoQllsm 135

Improved fatty acid uptake and transport: Fats can be more easily mobili zed from
adipose tissue, transported , taken up, and broken down.
Le ss lactate produced per intensity: At every in tensity, less lactate will be prod uced.
This is due to greater aerobic production of ATP at every intensity, lower catecholamine
response, reduced carbohydrate metabolism , and changes in the isoen zymes of lactate
dehydrogenase to forms that favor the conversion of lacta te to pyruvate.
More lactate removed per unit of intensity: At every intensi ty, more lactate wi ll be
removed from the working musc le. Inc reased rates of lactate removal are du e to increased
blood flow to the liver and enhanced uptake of lactate by cardiac and skeletal muscles.
Better lactate tolerance: With training, at the highest intensities, the body can better deal
with high acid conditions and high leve ls of lactate. This means higher intensities can be
achieved and susta ined for short periods of time.

Of course , with each of these adaptations , the type of act ivity - aerobic or anaerobic - will
determine the nature, extent , and ti me course of the adapta tion. The hi gher the in tenSity
and frequency of exerc ise, assuming adequate energy balance and nutrient prov ision , the
more rap id and comp lete the adaptat io ns. Most adaptatio ns begin with in days of beg in ning
a new exe rcise routine. However, some adapt atio ns con tinue indefin itely. For example , Krebs
cyc le enzymes con tin ue to increase even after 2 years of intense aerobic train ing while the
cross-sectiona l area of muscle fibers continually fluctuate. In addition, since each of these
adaptations is subject to constant protein turnover, each is reversible and can stop occurring
when the exe rcise stimulus stops or nutritional intake becomes inadequate.

Whether you desire optima l performan ce or simply muscle and metabolic preservation with
age, it should be clear that training each of the three major energy system s, fo cusing on the
system provid ing the adaptations you want most, is of paramount importance. In order to
ensure that stimulated adaptations occur, you need to provide adequate tota l dietary energy,
protein , carbohydrate, and ess enti al fa ts . Withou t th e stimulus or the raw materials for
ad aptation , you simply won' t see the be nefits of exercise.
136 UNIT 1 Chapter 5 Aerob ic & Anae rob iC Me tabO lism

Although there is much crossover between the he was doing, would probably be the worst way
aerobic and anaerobic energy systems of the to train for lacrosse. Thus our first priority was to
body, training and nutritional strategies should adjust th is athlete's training program to match the
be energy system-spec ific to optimize adaptation . adaptations required for his sport.
In other words, if an individual participates in an
In addition to starting out with improper training
aerobic sport, their training and dietary intake
strategies, this athlete's nutritional intake was
should be designed to optimize the aerobic energy
inadequate. He was eat ing 3 average-sized
transfer pathways. Likewise, if an individual
meals per day and drinking only water during
participates in an anaerobic sport, their training
lacrosse games and during his endurance
an d d ie t should be designed to optimize the
training sess ion s. With the cumula tive load of his
anaerobic energy transfer pathways.
prac tice schedule, game schedu le , and ae robic
This important po int can be reinforced by conditioning workouts, his energy demands were
studying the following case. Recently, a 17 year high and remained unmet by his food intake. Th is
old lacrosse athlete came to us complaining put him in a negative energy balance, ensured
of early fatigue. His energy levels would fade that his muscle and liver glycogen stores were
midway through games and his performance depleted, and left him unable to build muscle,
would drop off fairly dramatically. After effectively recycle enzymes, or positively adapt to
administering a number of questionnaires and his exercise demands. Our next step was to help
performing a number of assessments, it was clear him eat appropriately for his activity.
that this athlete was spending the bulk of his
We re-structured the athlete's training schedule
tim e following training strategies best suited to
to include interval sprints, full body resistance
end uran ce athletes. In addition, his dietary intake
training sessions and plyometric drills. These
was that of the average person. Indeed, he had
anaerobic activities were designed to be lacrosse-
done nothing differently even though his training
specific and to help create improvements in his
and competition deman ds were significantly
strength, power, and anaerobic cond itioning .
greater than average.
When it came to nut rition, we recommended
While lacrosse athletes do re ly on the aerobic
that he drink a protein-carbohydrate drink (with
energy system to support their efforts on the field,
added creatine) during each training session. The
lacrosse is largely an anaerobic sport : It requires
carbohydrates in this drink would help fuel his
bursts of high intensity sprint activity followed by
high intensity glycolytic efforts, the creatine in the
periods of rest or slower- paced recovery. Thus,
drink would help build up his muscle Cr stores to
lacrosse training should be almost exclusively
support ATP-PCr system energy transfer, and the
anaerobic in nature. With the right anaerobic
protein in the drink would help promote muscle
training program, lacrosse athletes benefit from
protein synthesis - leading to increased muscle
improved sport-specific strength and power -
mass , strength , enzyme quality, and a host of
as well as sport-specific endurance. Indeed,
other positive exercise adaptations . With this
new research is showing that a well-designed
new reg ime , this athlete consumed 15 g protein,
anaerobic conditioning program can lead to
30 g ca rbohydrate, and 1 g creatine per hour of
important aerobic benefits that are independent of
exercise. If his exercise sessio n was only 1 hour,
endurance training. Exclusive aerobic training , as
he ingested the breakdown above. If it was 2
UNIT 1 Chapter 5 Aerob ic & Anaerobic Metaboli sm 137

hours, he would take in 30 g of protein, 60 g of We tracked his results carefully and could see
carbohydrate, and 2 g of creatine. And so on. these strategi es made a profound impact with in
one month. The athlete had gained lean mass,
We also added another meal to his daily menu,
lost body fat, and had higher day-to-day energy
This well-balanced meal helped to increase his
levels . In add ition , his orig ina l performance
total kcal and nutrient intake, leading to a more
complaint disappeared. Now he was just as
favorable energy balance and more of each
strong toward the end of his games as he was at
important nutrient. But we didn't stop there:
the beginning. The lesson here is that you can
During tournaments and multiple event weekends,
quickly eliminate performance barriers by training
we ensured that he kept a cooler well stocked with
for and providing the right type of fuel for your
between/after game foods and drinks to ensure
specific activity.
recovery and energy for the subsequent event.
138 UNIT 1 Chapter 5 Aerob iC & Anaerobic Meta bol ism

1. On average, individuals experience a 2-4% decline in their resting metabolic rate

with each passing decade after t he age of 25. In addition, they lose an average of
5 Ib of lean mass with each decade . The on ly way to prevent t h is decline is with
appropriate exercise traini ng and nutrit io na l inta ke.
2. H igh levels of exercise - aerobic or anaerobic - bring a greater dema nd for energy.
This occurs both during the act iv ity, and - in the case of anaerobic activity - for
hours/days after the activity.
3 . Ou r skeleta l musc les enable exerc ise via an effic ient network of contractile proteins
(actin , my osin , etc) , an inti ma te link w ith the nervous system (T- tubu les) , and an
exten sive network of energy transfer (l arge, numerous mitochondria).
4. At rest and during exercise , energy cost can be measu red by the amount of
oxygen consumed. This oxygen consumption can then be described in METs.
1 MET = 3 .5 mL of oxygen consumed per kilogram of bodyweight per minute.
5. To determine the hourly energy cos t of an exercise bout, you can multiply your
MET intensity by your bodyweight.
6. Oxygen consumption is elevated both during and after exercise . The magnitude
and length of the excess post-exercise oxygen consumption (EPOC) depends on
exerc ise intensity and duration.
7. Th e intensity of energy demand dete rmines the fate of ou r macronutrients both
du ring and after exerc ise . Aerobic exe rcise predom ina ntly uti liz es fatty ac ids,
glycogen, and a smal l amount of protein th rough the slower-burn ing ox idative
pathways . Anaerobic exercise predominantly uses ATP and PCr, glucose, and
glycogen through the fast-burning ATP- PCr and glycolytic pathways.
8. Aerobic and anaerobic activities are distinguished by the anaerobic threshold
(AT). Th is is the point at which blood lactate leve ls increase exponentially,
bei ng produced faster than th ey can be buffere d and removed.
CHAPTER 6

MACRO·
NUTRIENTS
Chapter objectives
Key terms
Macronutrient 1: Carbohydrates
Macronutrient 2: Fat
Macronutrient 3: Protein
Chapter 6 Summary
KEY TERMS
monosaccharides eicosanoids
oligosaccharides alpha-linolenic acid
polysaccharides (ALA)
glucose docosahexaenoic acid
(OHA)
fructose
eicosapentaeno;c acid
galactose (EPA)
amylose trans lats
amylopectin amino groups
salivary amylase pep tides or peptide
pancreatic amylase chains
glycemic index (GI) secondary, tertiary and
glycemic load quaternary structures
insulin index (II) gastric hydrochloric
acid
GLUT lamily
pepsin
glycogen synthase
glycogenolysis proenzymes
gl cogen phosphor lase branched chain amino
y y aCids (BCAAs)
satiety
plasma amino acid pool
soluble fiber
deamination
insoluble liber
net negative protein
hydrocarbons balance
fatty acid nonessential amino
saturated latty acids acids
unsaturated fatty acids essential amino acids
triglycerides Protein Digestibility
glycerol Corrected Amino Acid
Score (PCOAAS)
pancreatic lipase
complete proteins
chylomicrons
limiting amino acid
lipoprotein lipase
incomplete proteins
linoleic acid
healthy fats
omega -6/omega-3 fatty
acid ratio
UNIT I Chapter 6 Mac'cnul lle"ts 141

There are three major nu trient groups, aka macronutrients: carbohydrates, fat , and protein.

Ma cronutrien t 1: Carbohydrates
CARBOH YDR ATE STRUCTURE
Carbohydrates are made up of a collection of carbon, hydrogen, and oxygen molecules; all
FIGURE 6.1
carbohy drates have a 2, I rati o of hydrogen to oxyge n (see Figure 6.1). Becaus e of th eir CARBOHYDRATE
sim il ar chemical structures, sugars, starc hes, an d fib ers are all conside red carbohydr ates. STRUCTURE

,~--~-------~------ - -- -- --------------~--- - ------~---~- --,

OH H OH OH
I I I I MONOSACCHARIDES
OHC - C- C- C- C- CH OH The simplest form of
carbohydrate

I I I I 2 OLiGOSACCHARIDES

H OH H
--~-~~~-~~-~-~-~~-~~~~-~~~---~~--~~---~-~~-~~~-~~-~~-~~.!
H Saccharide composed
of a small number of
monosaccharides
2D representation of glucose
POLYSACCHAR I DES
More than abou t 10 linked
monosaccharides that form
a polymer
Molecular fo rmul a for glucose
GLUCOSE
A monosaccharide found
Carbohydra tes are typically classified by thei r genera l chemical structure and divided into in foods and blood; the end
three general groups of saccharides (from the Latin saccharum, or suga r) based on their level product of carbohydrate
of comp lexity: monosaccharides , oligosaccharides , and polysaccharides . Monosaccharides metaboli sm and the major
are the simplest form of carbohydrates sin ce they contain only one ("mono") sugar gro up. source of energy for human s
Oligosaccha rides are shor t chains of monosaccha rid e units linked together in the form
FRUCTOSE
of disacc ha rid es ("two sugars"), trisaccharides (" t hree sugars"), etc. The most common A monosaccharide that
ol igosaccharides are th e disaccha rides , includi ng maltose, sucrose, and lac tose. is very sweet; possesses
a ketone rather than
Maltose = glucose + glucose an aldehyde, which
Sucrose = glucose + fructose distinguishes it from glucose

Lactos e = glucose + galactose

GALACTOS E
Pol ysaccharides are long, complex chains of lin ked monosaccharide units, which can be A monosaccharide;
less soluble and sweet
ei th er straight or branched. Typ ically, when we refe r to starches , glycogen, or fibe r, we're
than glucose
referring to polysaccharides.
AMYLOSE
Plant cells make starches by joining glucose monosaccharides together. Amylose and
A component of starch
amylopectin are the two main forms of starch. Amylose is a linear polysa cc har ide with ch aracterized by straight
what are called a - l,4 glycosid ic bo nds (g lycos idic bonds join monosacch aride molecules; chams of glucose units
with amylase , these bonds link t he fi rst carbon of glucose unit # I and the fourth carbon
AMYLOPECT IN
of glucose uni t #2) while amylopec tin is a highly branched polysaccharide with what are
A component of starch
called a- I ,6 bo nds (t hese bo nds link the first ca rbo n of gl ucose unit # I and the sixth
characterized by its highly
carbon of glucose un it #2). Glycogen is very sim il ar to starch , but made by an imal cells branched structure and
from glucose monosaccharides. Dietary fiber (cellulose) is another polysaccharide simi lar fast digestion
142 UNIT I Chapter 6 ~acro ll1 1I1 ell :--

Three major classes of carbohydrates

MONOSACCHARIDE S OLi GOSACCHARIDES POlYSACCHAR IDES

Glucose Sucrose Digestible

Fructose Maltose Sta rch and dex trins
Galactose Lactose Glycogen
Mannose Trehalose Partially digestible
Ribose Inultn
Raffinose
Indigestible
Cellulose
Pectin

to amylose. However, instead of n- l,4 glycosidic bonds, fiber has P-l ,4 bo nd s, which
are res istan t to human enzymatic activity; in other word s, we can' t break th em do wn well
in our gastrointe stinal tracts . Thus, dietary fiber is not di gested or absorb ed by humans.
Nevertheless, fiber plays a cri tical ro le in digestiv e healt h.

CARBOHYDRATE DIGESTION , ABSORPT ION , METABOLISM ,

AND TRANSPORT
Carbohydrate digestion breaks down more com plex forms of carbo hydrates (oligo- and
po lysaccharides) into the monosaccharides glucose, fru ctose, and gal actose , for eventual
rele ase into the bloodstream as glucose. Thi s process occurs thro ug hout the gastro in tes ti nal
tract , and begins the moment we put carbohydra te in our mouth. (Indeed, since we are
sensitiv e to food cues in ou r enviro nm ent, part icula rly fo ods that we know to be sweet or
starch y, it could almost be sa id that th e process occurs even before inge sti on as we begin
to salivate in pre pa rati on for eating .)

THE MOUTH AND UPPER GI TRACT

SA LI VA RY AMYLASE As soon as we take a bite of car bohyd rate, salivary amytases help to hydrolyze, or break
Enzyme found in saliva down, these polysaccharides into sma ller carbohydrate chains. Digesti on continues in th e
that catalyzes the hydrolysis
stomach as these salivary amy la ses conti nue to work on the carbohyd rates.
of starch

THE SMA LL INTES TI NE

PANCR EAT IC AMYLASE Once the ca rbohydrate is passed on to the small intestin e, pancreatic amytases take over,
Enzyme found in pancreatic turni ng these sm alle r carbo hydrate ch ain s in to units of maltose di sac charides. Finally, each
juice that catalyzes the
mattose is digested by t he en zym e ma ltase into two un it s of glucose. Remember, starch is
hydrolysis of starch
comprised exclusivety of glucose molecules joined together into tong chains. Thus, t he end
produ cts of starch diges tion are alway s glucose monosac cha rid es.

Likewise, lactose and sucrose disaccharides are hydrolyzed by the enzymes lactase and
sucrase , respectively. This breakdown yield s glucose and ga ta ctose monosacchar ides (when
UNIT 1 Chapter 6 :..1acr on, JI ' ','rt ls 143

lactose is broken down) and glucose and fructose monosaccharides (when sucrose is broken
down). All of these monosaccharide end products can en ter the body through mucosal ce ll s
that form the lining of th e intesti ne. These simp le carbs pass thro ugh and exit th e inte stinal
ce ll s into blood vessels tha t transpo rt them to the liver (via the portal vein) before they ente r
the general circu lation.

THE LIVER

The liver tak es what it needs for energy transfer and glycogen sto rage and then ships the
rest ou t as glucose monosacc harides. Galactose and fr uctose are absorbed from the diet,
bu t are virtually absent from general ci rculation for tw o reasons . Fi rst, they are both prim arily
converted to gluco se by the liver (although with very high intakes of fructose some of th e
fructose can be conver ted to triglycerides). Second, fructose is actually a pr ima ry source
of energy and carbohydrate for liver glycogen rep lenishment, which the liver prefers to use
ove r glucose. Agai n, once the liver takes what it needs and does the approp riate chemical
alche my, the glucose units re leased int o ci rculation work thei r way through the blood until
they' re taken up into our cells.

THE BLOOOSTREAM

Typical ly, 20 grams of blood-borne glucose circulates every hour, and the body prefers to
keep this more or less stable. If our blood sugar drops below tha t, the body will immediately
use the new glucose supply for prese rvi ng blood glu cose levels and for immediate ene rgy.
If excess glucose is present , the live r and muscles will take up what they can. The liver can
store about 80 to 100 grams of glycogen befor e it's ful l. An d the musc les can slore betwe en GLYCEM IC IN DEX (Gil
300 and 600 grams of glycogen before th ey're full. Beyo nd thi s, additional glucose can be Measure of the rate of
transformed into body fa t. which an inges ted food
causes the (eve( of g(ucose
Many of you are probably familiar with the glycemic index (GI) , a measu re of how quic kl y in the blood to rise
and significantly a given fo od can raise blood sugar. In essence, the GI is the relat ive degree
of blood suga r elevation after the co nsumption of 50 g of carbohy dra te coming from FIGURE 6.2
a specific test food. Since thi s is a re la tive measure , the GI is dete rm in ed rela tive to a GLYCEMIC INDE X

:J
:::,
o
E
~
E
ClJ
'"o
U
:::J
"So
-g
o
CD
Low GI

a 50 100 150
Time after intake (minutes)
144 UNIT 1 Cha pter 6 MacrO"H.l tlients

specific reference food - 50 g of carbohydrates from tabl e suga r - which is give n a GI

va lu e of 100. Each food's GI score is the n calcula ted re lative to th is val ue of 100 .

Higher glycemic foods such as sugar, can dy, breakfast cereal, bagels, white potatoes, etc.
can rai se blood sugar leve ls very quickly, leading to a large spike in blood sug ar and a
corresponding spike in blood insulin concentration s. Lower glycemic index foods such as
legumes, nuts , unprocessed hi gh fib er grains, and vegetables do not cause the sam e spikes
in blood glu cose and ins ulin. Thu s, lower glycemic index foods are often recommended over
higher glycemic index foo ds. Managing blood glucose and insulin is an important way to
improve health, body composit ion, and performance.

White an interesting measure of th e ph ys iotogica t resp onse to carbohydrate in the diet, the
GI does n't tell the whole story. First , th e GI of an ind ivi dual food becom es fa irly meaningless
when combine d with other foods. Althoug h white potato has a fair ly high GI if it is consum ed
as part of a mixed meal of leg umes, vegetables, and lean prote in, the ov erall GI of t he meal
might be quite low; the low GI foods may slow the digestion and abso rption of the hi gh
GI pota to. Second , other factors can influence the GI of a foo d, inc lud ing food prep aration
met hods; the age of t he food , the meal's protein, fat, and/ or fiber con te nt ; the time of day the
meal is consumed; and th e time of the last exercise sessi on.

Fi nally, the glycemic index is based on a stand ardized amoun t of carbohydrate, not a
standardized amount of food. In order to ca lcula te the GI of 50 g of carbohydra te, we 'd onl y
need a small amou nt of suga r, but quite a lot of carro ts, for exa mp le. Although it's ve ry easy
to get 50 g of sugar in one sitting (for instan ce , a chocolate bar plus a can of co la amounts
to about 75 g of sugar) , it wo uld take about five cups of carrots to get the same amount. Few
people would eat this many ca rrots in one si tling. Thus , this ma kes for an unfair comparison .
GLYCEM IC LOAO For thiS reason, researchers ofte n use the glycemic load as another, more rea listi c measure.
Equal to the glycemic index The glycemic load of a food is based on the glycemic index multiplied by the servin g size
of a food limes the number
of the fo od . While this gives a better picture of post ingestion glycemia, some of the same
of grams of carbohydrates in
problems discussed above exis t.
the serving
While GI and glycemic load are somewhat useful in determ ini ng overall glucose load,
they aren' t the best predictors of insulin response to a meal, which is the measure most
INSULIN INDEX 1111 closely correlated with he al th. Another index, th e insulin index (II) , mea sures the amount
Measure of the rate of whic h of insulin th e body produce s in respons e to a set carbohydrate load in a particular food.
an ingested food cau se s the
Rat her tha n rely in g on the blood sugar response to a fo od to predict th e insulin response,
level of insulin in the blood
to rise
this index me as ures the blood insu li n response to a food directly. Interesti ngly, th e II is not
alw ays proport iona l to the GI. High-prote in and high-fat foo ds can sti mula te greater insulin
respon ses than predicted by the level of blood sugar produ ce d when eating the food, whil e
som e high GI foods produce surprisingly low insulin respo nses. In add i tio n, when peop le
wi th underlying insulin resis tance consume moderate and high GI foods , th eir bodies can
produce an infla ted insulin response.

Thus, while GI, glycemic load, and II rank ings help us pred ict how the body will respo nd to
our dietary ca rbohydrate intake, these measures should not govern one's carbohydrate choices
exclusively. We'll discuss other, rnore effective , methods for doing so late r in this chapter.

CELL UPTAKE

Now th at we've discussed blood glucose and insulin responses to a meal , leI's talk about what
happen s with this blood glucose. Ce lls take glucose from the blood by way of a process called
fa cili tated diffusion. In this process, transport protei ns spann ing the cell membrane grab th e
UNIT 1 Ch apter 6 Mdo on .Jt" en ts 145

FIGURE 6.3
FACILITATED DI FFUSION
OF GLU COSE

glucose monosaccharides and transfer them into the cells. In muscle and fat tissue, glucose uptake
is stimulated primarily by the hormone insulin. Insulin triggers the migration of glu cose transpert
proteins (members of the GLUT tran sporter family) to th e cell membrane for further glucose GLUT FAMILY
upda te. Muscle contraction also increases facil itated diffusion of glucose into muscle, even without Group of membrane proteins
in sulin. This is why insulin sensitivity and glucose uptake is typically enhanced after exercise. that transport glucose from
the blood into cells
Six isoforms, or related types, of GLUT have been described (GLUT!, GLUT2, GLUT3,
GLUT4 , GLUT5, GLUT7) . All cells exp ress at least one of these on the plasma membrane.
There are many forms and are specific to cer tain tissues. GLUT 1-3 (present 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 sma ll intestines, and in the brain) are respensible for basal glucose
uptake and not dependent upon insulin. GLUT4 (p resent in adipese ce ll s, heart and skeletal
muscle) is sensitive to insulin and muscle contractions,

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 th e
body (including glycogen esis, glycogenolysis, and glycolysis) while preventing the glucose
from leaving the cel l.

Le t's rev iew t he key processes of ca rbohydrate use that we introduced in Chapter 3.
Glycogenesis is the process of turning single glucose monosaccharides into glycogen
po ly saccharides. Glycogen is a compound that has a modi fiable size. It becomes bigger GLYCOG EN SY NTHAS E
when units of glucose are added to it, such as after a heavy carbohyd rate feeding. It Enzym e necessary for the
becomes smaller when units of glucose are removed from it, such as with exercise and conversion of excess glucose
into stored glycogen
fasting. Glycogen synthase is the enzyme that cataly ze s the addition of glucose to glycogen.
Insu lin can incr ease the activity of this enzyme.
GLYCOG ENO LYS IS
Glycogenolysis is the process of turn ing glycogen in to glucose. When the body needs more Breakdown of stored
glycogen to glucose
glucose, it removes units of glucose from the ends of glycogen molecules. (Recall that the
146 UNIT 1 Chapter 6 Mac·or .J:' ief'l !S

GLYCOGEN suffix lysis refers to splitting or breaking down.) Glycogen pho sphorylase is th e enzyme that
PHOSPHORYLAS E remo ves glucose molecu les from glycogen by phosphorolysis. This enzyme ha s higher act ivi ty
Enzyme necessary for during periods of exercise and when bl ood glucose levels are low. Only glycoge n stored in the
glycogenolysis; breaks
liver can contribute as a source of bl ood glucose. Once glycogen is stored in mu sc le cells , it
glycogen into glucose units
can onl y be used in glycolysis in that muscle cell.

Glycolysis is the process of converting glucose into pyruvate, directly forming ATP and
providing substrate for use in the Krebs cycl e and electron transport chain. Through
this process, pyruvate is conver ted to acetyl-co-enzyme A (acetyl-CoA) and moves into
the inner chamber of th e mitochondrion, where the Krebs cycle takes place. All of the
macronutrients can be converted to compounds that enter the Kr ebs cycle. When passed
from the Krebs cycle to th e electron transport chain, electrons can drive the resynthesis of
ATP to perform cellular work.

CARBOHYDRATES IN THE DIET

Carbohydrates are essent ial for life. The brain and central nervous system requ ire a
cont in uous ly available glu cose supply. When dietary carbohydrate supply is too low, lean
mass will be metabo li zed (and th e am ino acids deam inated) to provide glu cose for our
ce ll s. Thus , a min imum reco mmended intake for carbohydrate in order to me et basic energy
needs and supply the brain with enough glucose to function optimally has been established.
According to the American Dietetic Association, this minimum is 130 grams per day.

Of course, body size, activity levels, other macronutrient intake, and specific goa ls will alter
the recommendation. For example, highly active individuals may need considerably more
daily carbohydrate energy. (However, excessive car bohydrate consumption will be stored for
future use - oft en as body fat). On the other hand, some physique athletes trying to drop
body fat may consume fewer ca rbohydrates (comb ined with a higher dietary fat intake) to
faci litate rapid body fat losses.

FIGURE 6.4 Carbo hyd rates

~~
SUMMARY OF
CARBOH YDR ATE
M ETABO LISM

glyco genesr s Glucose

6-phosphate

l~l
lo6bd ~

~
glycogenolysis
e
oeo .

§
1
stored in muscle
1
/0 blood and brain
and liver cells

( la ctic acid) pyruvate

UN IT 1 Chapter 6 iV, acrcn:trre ll :~ 147

In addition to total amount of dietary carbohydrate, t he rate at which the carbohydrate is

digested and absorbed can influence body composition and health. Carbohydra te breakdown
that is "time-released" from lowe r glycem ic carbohydrates enh ances satiety, blood sugar, SATIETY
and body composition . These carbohydrates are found in vegetables, fruits, legumes, and The state of being
satisfactorily full
whole grains and shou ld predominate in the diet. On the other hand, the rapid digestion of
carbohydrates can be beneficial during speci fic pe riods of the day, namely during the workout
and post-workout periods.

Carbohyd ra tes that are digested and absorbed slowly are the most important ones for daily
consumption, as these carbohydrates help to contro l blood sugar, insu li n concentrations ,
ene rg y levels and body composition. When the diet cons ists of refined carbohydrates (regular
store-bought breads, white pastas, white rice, packaged oats, cereals, etc.) and added sugars
~ all of which enter the body at a rapid pace ~ ind ividuals experience elevations in blood
sugar, blood tr ig lyceride levels, and LDL cholesterol, as well as Insu lin resistance. Thus,
unprocessed carbohydrates (which are typically Io wan the GI and II scales) are preferred
over processed/refined carbohydrates (which are typically high on the GI and II scales) Other
benefits of a diet containing more unrefined carbohydrates include an increased micronutrient
intake; a greater fiber intake; enh anced satiety; a highe r thermic effect of feeding; and better
blood sugar control.

One of the few times that hig her intakes of rapidly digesting carbohydrates can be useful for
physically active people is du ring/after exercise. At this time, insulin sens itivity is high , liver
and muscle glucose uptake is rap id, and carbohydrate resy nthesis is prioritized. Therefore the
only time processed, rapidly digested, high GI and II calbohydrates should be consumed is
after intense exercise sess ions when carbohydrate stores in the body need replenishment.

As mentioned above, dietary fiber is present in many unprocessed, slow digesting

carbohydrate foods. Fiber comes in two differen t forms; soluble and insoluble . Soluble fiber SOLUBLE FIBER
is found in oats and oat bran, dried beans and peas, nuts, barley, flax, fruits like oranges, Relatively indigestible, water-

bananas, and apples, and vegetables such as artichokes , tomatoes, and carrots. Insoluble solubfe polysaccharides found
in plants (e.g., psyllium,
fiber is found primari ly in the structures that make up plants' rigid cell walls, and includes
pectin) that undergo
vegetables such as green beans, beets, and dark green leafy vegetab les, fruit skins and root metabolic processing to
vege ta ble skins, whole-g rain products, seeds , and nuts. enhance bowel health

Both types of fiber, wh ile indigestible, play important dietary ro les. They are readily
fermented by microfl ora of the small intestines, producing short chain fatty acids like acetate, INSOLUBLE FIBER
propionate, and butyra te. Soluble fibers can decrease enterohepatic recycling of bile acids, Indigestible, non-water-
soluble polysaccharides found
which can decrease serum cholesterol levels; insoluble fibers will add bulk to stoo ls and
in plants (e .g, wheat bran,
dec rease colonic transit time. This provides several benefits: increased satiety; lowered blood
nuts); Increases stool bulk
fat and cho lesterol; reduced risk of colon cancer; proper intestinal mot ility; and a boost in and enhance transit time
overall gut health. Although the minimal recommended in take for fiber is 25 grams per day,
the optimal amount seems to be closer to 35 gramS/day for women and 48 grams/day for men.

Carbohydrates are important and are required for optimal functioning. The best carbohydrates
to ingest are the slow digesting, unprocessed, hig h fiber ca rbohydra tes. These tend to be
highest in micronutrients and tend to better control dai ly food intake. There is, of cou rse,
one exception to thiS rule; After in tense , carbohydrate-depleting exercise, rapid digesting
carbohydrates can be ingested to help rep lenish carbohydrate stores. The total amount
of dietary carbohydrate needed is quite variable and based on activity and body size. In
addition, carbohydrate intake should be inversely proportiona l With dietary fat intake . When fat
intake is high, carbohydrate intake shou ld be lower. If fat intake is low, carbohydrate intake
should be higher. For more on individualizing carbo hydrate intake, see Unit 2.
148 UNIT I Chapter 6 MacrC!1 l1lr lenlS

Macronutrient 2 : Fat
FAT STRUCTURE
HYDROCA RB ONS Fats are organic molecules made up of carbon and hydrogen elements joined together in
Organic compounds long groups called hydrocarbons . The arrangement of these hydrocarbon chains, and their
that contain only carbon
interaction with each other, determines fat type.
and hydrogen
The sim plest unit of fat , analogous to a carbohydrate monosa cc harid e, is the fatty acid . Fatty
FATT Y ACI D ac id s are composed of simple hydrocarbon cha ins with special chemical groups at each end ,
Chain of carbon atoms with a methyl group (C H,) on one end and a carboxylic acid group (COOH) at th e other. Th ere are
a carboxylic acid and
two general types of fatty acids, based on the level of saturation (the number of hydrogens
aliphatic tail
associated with each carbon along the hydrocarbon chain), saturated fatty acids and
unsaturated fatty acids . Unsalurated fatty acids can be broken down into monounsaturated
SATU RATED FATI Y ACIDS fatty acids (in which on ly one carbo n is unsaturated) and polyunsaturated fatty acids (in
A fatty aCid with no double
which more than one carbon is unsatura ted). The often-discussed omega-3 and omega-6
bonds in the chain
fats are both polyunsa turated fatty acids; the specific locations of unsaturated carbons along
the fatty ac id chain give them the ir name and differen t functions.
UNSATURATED FATI Y AC IDS
Double bonds between Fatty acids can be joined together (just as monosaccharides are joined together to fo rm oligo-
carbons in fatty acid chain and polysaccharides) to form what are called triglycerides. As the name implies, three ("tri")
fatty acids jo in together with a glycerol molecule to make up a triglyceride. Triglycerides are
TRI GLYCERIDES the major fo rm of fat found in the diet, and the major storage form of fat found in Ihe body.
Compound with three
molecules of fatty acids FAT DIGESTION , ABSORPTION, METABOLISM , AND TRANSPORT
bound with one molecule of
To digest fa t, the body breaks down triglycerides in to fatty acids and glycerol , which
glycerol; the storage form of
fat in humans are repackaged in various ways before enlering the bloodstream. Th is takes place
predominantly in the small intestine whe re triglycerides from the diet are emulsified
by bi le. Emulsificalion divides t he fat into small droplets that offe r more surface area
GLYCE RO L
Sugar alcohol that is the to digestive enzymes than the original larger tr igl yce ride droplet. Pancreat ic li pase is
backbone of a triglyceride

PA NCREATIC LIPAS E
Enzyme secreted from the
pancreas that hydrolyzes fat
o IlYtter
~ T, Animall.ls
~P' CI I OlII(GocO/lUI I

OH ~
Olr.eoil
o

OH
smgle double bond

FIGURE 6.5
OH
DIFFERENCES IN FATTY
multiple double bonds
ACID STRUCTURE
UN IT 1 Chap ter 6 fVl aclon ulnell ls 149

Dietary fat classification

SATU RATED UNSATU RATED

MON OUNS ATURAT ED PO LY UNSAT URATED

Anima l fats Olive all Omega -3 / 0mega -6

Trop ica l oils Avocado Flax
Peanuts Hemp
Pecans Fi sh
Almonds Ca nola
Safflowe r

the major enzyme of triglyceride digestion ; it is secreted by the pancreas into the sma ll
CHYLOMICRONS
intestine where it hydrol yzes the triglycerides , removing t he fatty acids from t he ir A lipoprotein that transports
glycerol bac kbone . cholestero l and trigly ceride
from the small inte stine s to
After they are broken down, fatty acids can diffuse across the in testi na l cell layer
tissues of the body
(mucosa) . Once past this entry barrier into the body, the intestinal cells repackage
them into l arge pa rtic les comprised of fat and protein (lipoprotein particles) called
chylomicrons. Chylom icrons are released into the lymphatic system, wh i ch slowly
empt ies into general circu lat ion via the thoracic duct (via the left subclavian ve in, if
you ' re interested), Because of this lengthy breakdow n and transport process, absorbed
fat enters the bl ood several hours aft er the fat is actually co nsumed.

Pac kage d in chylomi cron FIGURE 6.6

TRIGLYCERIDE ABSORPTION
Tr iglyceride
reassemb led

Cells of sma ll in test ine

Triglyceride

hYdr~ •

~) ~ ~ 8 Triglyceride
150 UNIT 1 Chapter 6 'VIa c r 2 n J~ po· ts

LIPOPROTEIN LIPASE These packaged trig[ycerides circ ulat ing in the blood (in chy[omicrons) are again
An enzyme found in broken down into free fatty acids and glycerol with the help of a hormone called
endothelial celts lining the lipoprotein lipase. This occurs so they can pass through yet another cell membrane
capillaries; hydrolyzes lipids
and into the tissues of our body. Once through t he membrane, they're either oxidized
Into fatty acids and glycerol
(through the process of beta ox idation) and used to transfer energy in skeletal muscle or
other tissues or converted back (aga in) into triglycerides for storage in adipose t issue,
skeletal muscle, etc.

When required for energy transfer, fatty acids that have been removed from their
glycero l backbones are broken down via beta oxidation to form two-carbon acetyl units
attached to co-enzyme A (acety [-CoA). This acety[ -CoA moves into t he inner chamber of the
mitochondrion where the Krebs cycle takes place. When passed f rom t he Krebs cycle to the
electron transport chain, electrons can drive the resynthesis of ATP to perform cellu[ar work.

FAT IN THE DIET

Oietary fa t has six major ro les,

it provides an energy source (in fact, it's the most energy-dense macronutr ient);
it helps manufacture and balance hormones;
it forms our cell membranes;
it forms our brains and nervous systems;
it helps transport t he fat soluble vi tamins A, D, E, and K; and

UNOLEIC AC ID it provides two essential fatty acids that the body can't make , linoleic acid (an
Unsaturated omega-6 omega-6 fatty acid), and li nolen ic acid (an amega -3 fatty acid),
fatty acid
As ment ioned above, most dietary fat comes in the form of trig[ycerides. Reca [1that
trig[ycerides contain three fatty acids attached to one glycerol backbone; therefore, diHerent
fatty acids can join to form one of various permutations of possible trig[ycerides. Thus, most
dietary fat sources are made up of some combination of saturated, polyunsaturated, and
mono unsatu rated fatty acids. For example, while most peop le consider eggs and red
meat to be foods rich in saturated fat, eggs actually contain more monounsat ura t ed 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. Beef contains 55%
sa tu rated fat, 40% monounsatura t ed fat, and 4% polyunsaturated fat.

Although most trig[ycerides are comprised of mixed fatty acids, it's the predominant type
of fatty acid that contributes to the chemlca[ properties of the food . For example, foods
proportionately highe r in saturated fatty acids tend to be solid at room temperature while
foods proportionately higher in unsaturated fatty acids te nd to be softer (or liquid) at
room temperature.

Overall health is determined by the ba lance of fatty acids consumed. [n excess, and out
of balance with a mixture of unsaturated fats, a diet high in saturated fatty acids (inc[uding
[auric, myristic, and palmitic acids, which are three types of saturated fat) can lead to
increased cho lestero l [eve ls. Indeed, these types of saturated fat show a positive correlation
w ith the risk of cardiovascular disease (mai n[y due to cholesterol raising effects and
unfavorable shifts in the overall cholesterol profile). Further, excessive intake of these types
of saturated fats (again, out of balance with un saturated fats) has also been associated with
A[zheimer's d isease, poor blood viscosity, breast cancer, kidney disease, diabetes, multiple
sc lerosis, stroke and prostate cancer. Lauric, myristic, and palmitic acids can be found in
bee f, coconut oil, palm kernel oil, butter, cheese, milk, and palm oil.
UN IT 1 Chapter 6 VaclolL tllfllts 151

1- - ------ - --- -
Triglyceride

H - - C--OH
I I
H--C/
0

I
H - - C--OH I
H- - C- -O 0

I
H - - C - - OH I
H--C"---
I
H
I 0
o
I _____________ .! H

Glycero l o

- ---- ------------------------1
'0

,
1 ___ _ __ - - - - - - - - - - - ------------

Free Fa tty Ac id

However. not all saturated fats have these associations with chronic diseases. For example . FIG URE 6.7
stearic acid lanother saturated fat found in cocoa butter and beef) may actu ally lower LDL TRIGLYCERIDE STRUCTURE

levels . Therefore, sa turated fat shouldn't be universally regarded as unhealthy.

It's also important to note that prob lems associated with saturated fat intake aren 't
necessarily because of saturated fat consumption on its own, indeed , they may only
appear when other poor dietary choices are in place. For instance, excess body fat,
negative blood lipid changes. and increased card iovascula r disease risk all seem to occur
when saturated fat intake is high and two other dietary conditions are present , when the
diet is also high in sugar and processe d/refined carbohydra te, and when the saturated fat
intake is out of ba lance with unsa turates.

Thus, recommendations to avoid saturated fat are misguided. Saturated fat appears to be
fine when refined carbohydrate intake is low and when a he althy intake of unsaturated fa t is
also present. Just don 't combine a diet low in unsaturated fat with one high in saturated fat,
sugar, and refined carbohydrates (which, un fortunately, characterizes much of our modern
North American diets).

Saturated and unsaturated fat differ in their chem ica l bo nd structure . Saturated fats contain
no double bonds and a full complement of hydrogen molecules associated with each carbon .
Unsatu rated fats contain various degrees of double-bonding with fewer hydrogen molecules .
Fats such as omega -3 and omega-6 get their names from the location of their double bonds .
To determine where the double bonds In fatty acids are located, simply count from the
term in al methy l carbon toward the carbony l carbon .

"Healthy fats ", which includes the omega fa ts as well as the monounsaturates lall HEALTHY FATS

unsaturated fats), are so named for their beneficial effects on blood tr iglycerides and Fats that have been shown to
cholest ero ls, blood vessels, inflammation, and the metabo l ism . As we've mentioned, improve averalf health

it's important to balance saturated and unsaturated fat intake , yet the balance among
unsaturated fats is also important. Humans evolved to consume diets consisti ng of marine
life, small and large wild game, and/or inland plants, which provided abundan t omega-3
152 UN IT 1 Chapter 6 Macron ,l t" enl';

FIGURE 6.8 Omega-9 (double bond 9th carbon from the left)
a
FATTY ACID
NOMENCLATURE

Oleic acid (OA): monounsatura t ed

a
Linol eic acid (LA): polyuns atura ted, essen lial fatty aC id

Omega·3 (double bond 3rd carbon from the left) a

Alpha-linolenic acid (LNA): p ol yunsa turated, essential fatty acid

OM EGA -510M EGA-3 and omega-6 fatty acids_ This resulted in an omega-6/ omega-3 ratio that was around L l.
FATT Y ACID RATI O In the modern diet, this ratio has shifted to a highly disproportionate 16,1 to 2001_ This is
Balance of dietary fat intake; complete ly out of balance for optimal cellular hea lth and integrity. This imbalance comes as
critical to overall health
a result of a high intake of omega-6 fatty ac ids from corn oil, safflower oil, and meat from
feedlo t animals, which eat high amounts of corn_ To achieve a hea lthy ratio of omega-6 to
omega -3 fats, then , one must actively use less omega-6 rich vegetable oils and consume
more omega -3 ric h foods .

Don't el iminate omega-6 fats in the diet entirely. The omega-6 fats linoleic acid (LA),
EI COSANO IDS gamma -linolenic acid (G LA), and arachidonic acid (AA) libera te eicosanoids that promote
Signalmg molecules of blood vessel constriction, inflammation, blood clotting, pain, airway constriction, etc .
the body that control While each of these sounds unhealthy, each mechanism is critical to overall health when
many systems
controlled. Prob lems emerge when too many omega-6 fats are in the diet, and these
mechanisms predominate or operate unchecked_ As a result, individuals should try to
ALPHA- LINO LEN IC balance their intake of the omega-6 fats and the omega -3 fats_
AC ID (A LA)
Unsaturated omega -3 The most important omega-3 fats are alpha-linolenic acid (ALA) , docosahexaenoic
fatty acid acid (OHA) , and eicosapentaenoic acid (EPA) . Inland plant sources such as flax and
walnuts are rich in ALA, while marine sources such as fish oils and algae (the original
DOCOSAHEXAENO IC omega-3 sources for fish) are rich in EPA and DHA, which are widely recognized as the
AC ID (DHA) most beneficia l omega-3 fa t s_
An omega-3, polyunsaturated
fatty acid, found mainly in One reason omega-3 fats are so important is that their incorporation jnto the membranes
fish and algae ; can be formed of our cells helps to keep our cells more "fluid", which provides several benefits. For example ,
from ALA when brain cell membranes are relatively fluid, messages from neurochemicals such as
serotonin can be transmitted more easily. When muscle cell membranes are more fluid,
EI COSAPEN TAENO IC
it increases insulin sensit ivity. These essential fats also playa role in many other areas,
ACID (EPA )
An omega-3, polyunsaturated
including cardiovascular function, nervous system function , and immune health . Research
fatty acid, found mainfy in also shows that low DHA consumption (and blood levels) is associated with memory loss,
fish and algae difficulty concentra ting, Alzheimer's disease, and other mood problems.
UN IT 1 Chapter 6 MacrOIll tr le llts 153

Omega-3 fats also contribute to the formation of certain eicosanoids . The eicosanoids liberated
from omega-3 fats tend to promote things like blood vessel dilation, anti -i nflammatory effects ,
anti-coagulant effects, a decrease in pain, airway dilation, etc. As you can see, these are the
opposite actions of the omega-6 fats. Thus, this fundamental balance between the actions
stimulated by omega-3 and omega-6 fats keeps us healthy.

Another unique grouping of f ats also discussed quite often in the media are the trans fats. This TRANS FAT
name - trans - is based on the chemical con figuration of the double bond in unsaturated Unsaturated fat With a tran s-
Isomer fatty acid; created
fats . Wherever a carbon-carbon double bond exists, there's an oppo rtunity for either a "cis"
through hydrogenation
or "trans" co nf iguration. Now, virtua ll y all naturally occurring unsaturated fatty acids have
a cis configuration. While a few naturally occurr ing fatty acids have a trans configuration,
most trans fats appearing in the diet resutt from industrial fat processing, which takes an
unsaturated fa t (soft or liquid at room temperature) and bubbles hydrogen ions through it,
which then produces a trans configuration. Th is process "hydrogenates" a previously
liquid or so ft fat , causing it to harden at room temperature. Since consumers often prefer
the "mouth fee[" of hydrogenated fats , and because hydrogenated fats have a longer shel f
life , hydrogenation is good for companies' bottom line. [t seems to make oi ls taste better
and last [anger.

However, since trans fats do not kink, or fold upon themselves [ike cis fa ts do , they pack
into the cell membrane of our bodies very tightly. Unfortunately, ctinica[ and epidemiologic
studies suggest that this means an increased fisk for coronary heart disease, cancer, and
other chronic disease . For example, the trans-isomer of oleic acid, known as elaidic acid,
raises cholesterol and can contribute to heart disease. Trans fats also lower the good form
of choles terol - a doub le whammy. High trans fat in take is also [inked to ,

A higher risk of A[zheimer's disease

A higher risk of lymphoma
Suppressio n of the excret ion of bile acids
Increased liver cholesterol synthesis
Competition for essentia l fat uptake
Exaggerated essential fatty acid deficiency

Even a single mea l with a high "bad fat" conten t can dimin ish blood vessel function and
elastici ty' Th is can contri bute to the progression of heart disease as wei!. For i nstance,
a study published in the New England Journal of Medicine tracked the exercise and

FIGURE 6.9

~~
TRANS VS . CIS FAT

c=c

HI) \ H

H
Cis· configuraJlon
Bent molecule
I
~c=c~
I
H
T" " .",fig,,,fi,,
StraighJ molecule
J
154 UNIT 1 Cha pler 6 Mac ronu (r'en ts

nu tr i tio na l habits of 80,000 women over 14 years and found that the most impo rta nt
correlate of hea rt d isease was t he amount of trans fats in t he diet.

Not all trans fat configurat ions are harmful to health , however. Some trans fats occu r
naturally, such as conjugated linoleic ac id (C LA ), which is formed in the rumen of cows
and sheep. Thus, when consuming a diet based on natural, unprocessed, who le foods,
accumulating high amounts of harmful trans fat is nearly im possible .

A balance of dietary fat with a mixed intake of saturated, monounsaturated, and polyunsaturated
fats (w ith a balance of omega -3 fats and omega-6 fats) is critical for oplimal health and function.
Dietary fat and dietary carboh ydrates should be inversely proportional: When fat intake is
high, carbohydrate intake shou ld be lower, and vice versa. For mor e on Individualizing fat
in take, see Un it 2.

Macronutrient 3: Protein
PROTEIN STRUCTURE
Like carbohydrates and fats , proteins are made up of carbon and hydrogen mo lecu les
arranged in specific ways. However, unlike carbo hydrates and fats, proteins also contain
nitrogen as part of their amino groups .

The smallest un it of protein (similar to the monosaccharide or the fatty acid) is the amino
acid , All am ino acids have four main characteristics:
AMI NO GROUP S
Functional group a) an amino group (N H, ) on one end:
(abbreviated as NH 2 ) that
b) a carboxyl group (COOH) on the other end;
contams a nitrogen atom
c) a central ca rb on (called the alpha, 0: , carbon); and
d) a side ch ai n (R group), wh ic h differentiates on e amino acid from another.

When amino acids are joi ned togeth er, they form what are ca lled peptides or peptide
chains . These peptide chain s, or groupings of amino ac ids , ma ke up t he primary protein
structure. However, most proteins aren't just lo ng chains of am ino acids. Rather, these

FIGURE 6.10
BASIC STRUCTURE OF
AMINO ACID S
H H ,----------------

H N c
a-carbon

Amino group (NH 2)

-----..1
~
OH
_ _ _ _ _ _ _ _ _ J

l . _ _ _ _ ...

Carboxyl group (COOH)

Side chain
UNIT 1 Chapter 6 Wa.; ron,t llents 155

FiGURE 6 II
PROTEIN STRUCTURE
COMPARISON

Secondary:
chain of am ino acids li nked
by hydrogen

Primary: Tertiary: Quaternary:

cha in of am ino acids attrac tions present more th an one
bet wee n alpha helices amino ac id chain
and pleated sheets

chains form secondary, tertiary, and quaternary structures . A protein's secondary PEPTIDES OR
structure is forme d as amino acids bind to their neighbor as welt as to other am ino acids further PEPTIDE CHAINS
down the chain, formin g either a- hel ix or ~ -pleated stru ctures. These secondary structures Short polymer formed from
linking amino aCids
offer an im po rtant strength and stiffness to th e proteins. Many enzymes, transport prote ins,
and immu noproteins in the body have tert ia ry stru ctures, which are formed when the protein,
in secondary st ruc t ure formatio n, toops toge th er to form globular shapes. When one or mo re SECON DARY, TER TIARY, AND
proteins in tertiary structure join together, we get quaternary struc tu re s. Each protein is QUATERNARY STRUCTURES
considered a separate su b- uni t but the entire protein, including this new shape, is necessary Shape/formation that a
protein takes depending on
for optimal function within the body.
its biological function
Most dietary prote ins come bound in complex secon dary, tertiary, and quaternary forma tion
since they originate from plant and animal str uct ures. However, because these proteins are
digested into smalt peptides and ami no acids, we evatuate protein quality based on am ino acid
con tent, not structural form ations. In ot he r words, in the diet , th e primary structure, or the unique
grouping of amino acids , is most important. With adequale am ino acids and energy in the diet,
alt the proteins necessary for optima l physiological function ing, complete with their appropriate
secondary, tertiary, and qua te rnary structures, can be formed later.

PROTEI N DIGESTION , AB SORPTION , M ETABOLISM , AND TRANSPORT

GASTR IC
THE STOMACH HYDROCH LOR IC ACID
Produced by parietal cells in
Protein digestion invo lv es Ihe breakdo wn of proteins into smalt peplides and indiv idual the stomach, this acid liquid
amino acids. This process begins in the acid ic environment of the stomach, where is necessary for digestion
gastric hydrochloric acid denatures the secondary, tertiary, and quaterna ry structures of the
ingested proteins. The pe pt ide bonds between am ino acids, however, are unaffected by PEPSIN
hydroc hloric acids, so hydroch loric acid also begins the acliva tion of pepsinoge n to pepsin at Digestive protease released in
the stomach to degrade food
the same time. Pepsin begins to break down peptide bonds , primar il y remov ing amino acids
proteins to peptides
from the carboxy l end of th e peptide chain. At this point, the remai ning po lypep tides and
si ng le amino acids are passed along to the sma It intestine.
PROENZYME
THE SMA LL INTESTIN E Inactive enzyme precursor
that reqUires a biochemical
In th e sma It in test in e, proenzymes or zymogens secreted by Ihe pancreas now enter the change to become active
picture. Th ese chemica ls include trypsin ogen, chymotrypsinogen, procarboxypeptidases,
156 UNIT 1 Ch ap te r 6 Macrom.t[l(:'r ls

proelastase, and co llagenase. 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. As digestion proceeds, small di- and
tri-peptides as well as free amino acids are produced. Wh ile still in the small intestine, these
amino acids and peptides are transported across the intestina l brush border fo r absorpt ion .

Multiple ene rgy-dependent transport systems with overlapping specificity exist to aid in
absorption. In other words, different amino acids and peptides are absorbed in different ways
that all req uire ATP. Interesting ly, amino acids compete for transport by common carriers in
the small inlestine. As a result, branched chain amino acids (BCAAs) are absorbed faste r
than smaller amino acids. As di- and tri-peptides use different carriers than do individual
am ino acids , these peptides are actua lly absorbed more quickly than free form am ino acids.
Th is is importa nl to note since large dieta ry intakes of free amino acids (usually in supplement
BRANCHED CHAIN
AMINO AC I DS (BCAAS )
form) may lead to "congestion" at the transport level, delaying entry into the bloodstream.
Ammo acid with aliphatic side
Once absorbed, these amino acids and peptides can experience one of a few fate s. First,
chain that is non-Imear
in the intest in al cells, some of th ese amino acids can be used for energy or to synth esize
new proteins such as ho rmo nes, new digestive enzymes, etc. For example, the amino
acid glutamine is used as a primary source of energy in intestinal celis. Further, glutamine
appea rs to st imulate gastrointes ti nal cell growth . Th erefore a good po rtion of ingested
glu tamine is used at the intest ina l cell level. If glutamine is defic ient in the diet, glutamine
will be expo rted from the plasma amino acid pool and from muscle cells to provide raw
materials for intest inal glutamine needs. Beyond thei r use in intestinal cel ls , ingested amino
PLASMA AM )NO AC ID POOL ac ids and peptides can also be delivered to the liver (via hepatiC portal ci rcula tio n) for
Reserve of amino acids found
processing and distribulion to other cells of the body.
in blood plasma

THE LIVER
The liver is the primary site for amino acid uptake after a meal. For every 100 g of amino
acids taken in, about 20 g are used for protein synthesis in the liver, about 60 g will be

FIGURE 6.12
to th e liver
PROTEIN
AB SORPTION

Smal l '......
peptide , ~

Ami no •
• •
Pro teins ~ Peptid es ---+ acids

Di- and \
Iripeptid es
:
Blood
Intestine cell
UNIT 1 Chapter 6 MiicrOflulr,enls 157

catabotized in the tiver, and the rema ining 20 g will be released into systemic ci rcutation.

Of the 20 g of protein synthesized, 14 g of this protein witl remain in the liver and 6 g of this
protein will be exported to the plasma in the form of plasma proteins (albumin, globulins,
lipoprote ins, etc), glu tathione, carnitine, creatine, and more. Thus , the digested end products
of dietary protein intake serve a host of importa nt roles even before clearing the liver,
including the synthesis of enzymes and nitrogen contain in g chemicals important in the li ver;
the breakdown of amino acids for energy and/or the for mation of glucose, ketone bodies,
cholesterol, and/ or fatty acids; th e expo rt of important plasma proteins and other protein-
based molecules; an d the exp ort of amino acids to feed th e plasma amino acid pool and
oth er cells of the body.

Of the 20 g of amino acids that pass through the liver di rec t to the blocdstream, about 14 g of
these are the BCAAs. These BCAAs (and ot her amino acids) are now free to make up a portion
of what's cal led the plasma amino acid poel. This plasma pool is located in the bloodstream
and readily exchanges with the amino acids and proteins in cells. The amino ac ids in this pool
are rep lenished from the absorpt ion of dietary amino acids as well as from the brea kd own
of existing body tissues. The pool totals around 100 grams in the plasma along with smaller
pools in va riou s body tissues. Amino acids within the poc l are de livered to ta rget tissues and/or
metabo lized in response to var ious stimul i such as hormones and physio logical statu s.

Typically, after a meal, blood levels of amino acids in crease, part icularly t he BCAAs. As wi th
carbohydrate intake, the rate of increase is rela ted to the speed of digestion of the protein
in qu es ti on. Slower digesting proteins (mea t, casein, etc.) release amino acids more slowly
over time while fas ter digesting proteins (eggs, whey, etc.) re lease am ino acids qui ck ly.
These ra tes can be quantified, as with the glycemic index, and therefore the slower digesting
proteins are more like low GI carbohydrates while the faster digesting proteins are more like
high GI carbohydra tes.

Tissues can extrac t these ami no acids from the plasma for a host of functions including
muscle protein synthesis, the synthesis of neurot ra nsmitters in the brain, the synthesis of
tissue enzymes , and more . The eve ntu al production of new proteins is cont rolle d by ge netic

FIGURE 6.13
IMPORTANCE OF THE
• Nitrogen pool AMINO ACIO POOL
glucose IN MAINTAINING
glycogen
lipids HOMEOSTASIS

catabo lis m
Amino acid pool carbon dioxide
water
urea
energy

non -protein compounds

tissue protein heme
plasma protein heteroc ycli c am ines
enzy mes
hormones
antibod ies
hemoglobin
158 UNIT 1 Chapler 6 MaCf Ol'. u tfl CiI:S

signa ling and dependent on amino acid and energy ava il ability in the body.

Beyond new protein formation, these amino acids can be used in in tra -organ nitrogen and
carbon transfer. For examp le, during amino acid metabo lis m, the ammon ia (NH,) released
is bound to glutamate to form the amino acid gl ut amine. This amino acid then shuttles
ammon ia, which is potentially toxic in its free form, from the cells to other tissues of the body
for incorporation into body tissues or for eventu al excretion. During exerc ise, the amino acid
alanine is released from th e muscle and shuttled to the liver. The liver, after deamination ,
then converts the carbon skeleton Into glucose and the nitrogen group is removed for
incorporation into other amino acids or eventua l excretion.
DEAMINAT ION
Removal of an amine group PROTEIN IN THE DIET
from a compound Because the amino acids that make up our proteins are responsib le for everything from our
structure (contractile proteins, fibrous proteins), to our hormones (most of the non-steroid
hormones), to ou r enzymes, to our im mune chemicals (immunoglobulins and antibodies), to
our transport proteins, dietary protein is critical. Although our metabolic processes can make
certain amino ac ids , without a diet rich in the esse nt ia l amino acids (those amino acids we
can' t make) , we cease to function.

In addition, without adequate daily amino acid intake, small dai ly losses from amino acid
breakdown wi ll eventually put us in a net negative protein balance. While carbohydrate,
and especially fat content of the body are fairly well maintained, it's actually quite difficult to
maintain a consistent amino acid pool without dietary intervention. Maintaining the plasma
NET NE GATIV E amino acid pool is like keeping a sink fu ll without a drain plug. Amino acids are constan tly
PROTE IN BALANCE losl from Ihe pool and therefore the only way to replenish them is to ingest protein through
Nitrogen output that exceeds
the diet. If amino acid intake falls below daily amino acid degradation , Ihings like enzymes
nitrogen intake
and structural proteins are cannibalized. If this process persists for long enough, vital
functions shut down .

The body has the ability to make 12 amino acids, known as non -es sential amino acids .
However 8 amino acids can only be supplied by the diet, and are thus termed essential
amino ac ids. Again, as some of these ami no acids are lost each day, they must be

Amino acids

8 ESSENT IAL AM INO AC I DS 4 ADDITIONAL ESSENTIAL AMI NO ACIDS 8 CONDITIONALLY ESSEN TI AL AM INO ACIDS

(Cannot be made by the body, (Required for infants Necessary in special populations
must be obtained from the diet) and growing children) (without adequate synthesis)

Pheylalanine Cysteine Arginine

Valine Tyrosi ne Cysteine
Threomne Histidine Glycine
Tryptophan Arginine Glutamine
Isoleucine Histidine
Methionine Prol in e
l eucine Serine
lysine Tyrosine
UNIT 1 Cha pt er 6 M ac rOnt.. III CIl1<; 159

replaced from outside the body; th e best way to do so is to maintain an adequate intak e NONESSENTIAL
of complete protein. AM INO AC IDS
Ammo acid that does no t
Complete pro tei ns contain a co mplet e complem ent of essential am ino acids. Th ere are need to be In cluded in the diet
several protein qu ality indexes that measure the ability of a prote in to provide the necessa ry
ESSENTIA L AM I NO ACI DS
ami no acids for opt im al func tion ing, in cluding rati ng a protein 's Protein Efficie ncy Ratio
Amino acid that must be
(PER ), Biological Va lue ( BV ), Net Protein Utilizat ion (NP U), and Protein Digestibility included in the diet
Corrected Amino Acid Score (PCDAAS) . Unfortunately, most of these methods (except the
PCDAAS) use rod en t studies to determin e protein qua lity. Th e use of ra ts for establishing
protein qual ity has drawbacks, most notably the fact that rats have different amino PROTE IN DI GE ST IBILITY
acid requ irements than humans. Thu s the Food and Agricultura l OrganizationiWorld Health CORRECTED AMINO ACID
Organization (FAo.IW HO) has recommended using the PDCMS for regu latory pur poses. However. SCORE (PC DAAS )
A method ba sed on the
as differen t ind ividua ls and companies use different standards, we'll discuss each briefly below.
amino acid reQUirements of
When reviewing each of these, note the caveat about app lyi ng rodent data to humans.
young chifdren that takes
in to consideratIon digestibili ty
PROTEIN EFF ICIENCY RATI O (PER)
of the protein; a recently
Protein efficiency ratios (P ER) are determined using rodent models. In these studies , the develop ed and preferred
measure for determining the
animals are fed a diet containing a marginal amount of th e test protein. The PER value
quality of protein
is calculated as the growth of the animal (in gram s of body weight) per gram of ingested
protein. So the PER is a measure of "feed effic iency " and is repo rted in co mpa rison to casei n
as a reference prote in.

BIOLOG ICAL VALUE ( BV)

The biolo gica l value (BV) of a protein, like the PER value, is determined using rodent studies.
Th e BV is calcula ted as the amount of ni trogen used for tissue formation divided by the
amount of ni trogen absor bed from the food. Like PER , this makes BVa meas ure of "feed
efficiency ". And because of th is re lations hip between nitrogen in and nit rogen used to form
tissues, the BV is expressed as a percentage. Along with th e problem of applying rodent data
to huma ns, BV doesn' t take into account certain fac tors that influence prote in digestion. Also ,
it measure s a protein's max imal potential quality, rathe r than it s quality when consum ed at
a requirement level.

NET PROTEIN UTILIZATION (NPU )

Net protein utilization (NPU) was developed as an im proveme nt on BV meas ures. NPU
calcu latio ns are based on th e product of bio logic al value and true digest ibility, which corrects
one of the problems of BV measures. However, we sti ll have the problem of using a rodent
mode l to determine human needs.

PROTEIN DIGEST I BILITY CORRECTED AMINO ACID SCORE (PDCAAS )

This measure is the cur re nt "gol d standard" of determining protein quality because it is based
on human amino acid req uirements. PCDAAS takes the number of li miting amino ac ids in
a protein in to account. A limiting amino acid is defined as the essential am ino acid found
in the smallest quant ity in a part icular food. Once the limiting amino acid is calculated, th e
PC DMS is derived by comparing the amount of this amino acid in the te st protein ver sus the
amount of this amino acid in a high -q uality reference protein . Wh en this value is multiplied
by th e true digestibility of t he protein, the quality of the prote in can be reporte d.

Complete proteins rank the highest on th e protein qual ity measures above. Animal sou rces COMPLETE PROTE IN
of protein such as meat , po ultr y, eggs , fish, milk, and cheese are all co ns idered complete Protein source that conta ins
protein s, providing all the essentia l amino acids in adequate amounts . Some plan t sources of all of the essential ammo acids
160 UNIT I Chapter 6 Ma:: ron uillents

FIGURE 6.14
PDCAAS FOR SELECTED
Egg while
FOO DS/SUPPLEM ENTS
Soybean protem (concentrate)

Rapeseed ploleln (concentrate)

Soybean plotem (isolate)
Beef ,.
Pea pro tei n (concentrate)

Pea Il oLir
Peanut meal
Whole wheat

Sunflower protein (Isolate)

Wheat gluten

o O. 2S 050 0.75 ' 00

protein such as quinoa, buckwheat, hemp seed , and amaranth are also complete, although
these foods are often lower in total protein when compared to an imal foods.

Most plant foods are not cons idered complete in protein. Thus, those following plant-based
diets should consider using complementary protein cho ices in the ir diet. Foods that co ntain
LIMITING AMINO ACID low amounts of ce rtain limit ing ami no aci ds can be combined to form complete prote ins;
The essential ammo aCid therefore, while most plant foods contain incomp lete protei ns, different plant foods can be
found in the smallest
combined to provide the total complement of essential amino acids. For example. wheat
quantity in the food
and rice have limited amounts of the amino acid lysine yet ample amounts of tryptophan.
However. when combined with legumes, wh ich are limited in tryptophan but contain
INCOMPLETE PROTEIN adequate lys ine. this combination forms a comp lete protein meal.
A protein source th at
contains a lower amount of Beyond protein quality, there remains the quest io n of prote in amount. The recomme nded
an essential amino aCid minimum protein intake for sedentary. genera ll y healthy adu lts is 0.8 g of protein per kg of
body mass. This translates to about 55 g of protein per day for a 150 Ib individual. It should
be noted, however, that this amount is simply to prevent protein deficiency - in other words,
to cover the basic daily requirements for protein turnover. During high intensity training, these
needs may be increased to about 1.4 to 2.0 g of protein per kg of body mass. Th is translates
to between 95 and 135 g of protein per day for a 150 Ib individua l. Sim il ar increases in
prote in intake above the 0.8 glkg baseli ne are recommended during periods of low energy
intake or low carbohydrate intake.

While these recommendations may be adequate to cover protein turnover reqUirements, new
research has suggested that higher amounts of protein in the diet may be vital for immune
function, metabolism, satiety, weight management and performance. Therefore, many
experts recommend highe r in takes of prot ein that approach andl or exceed I g of protein per
pound of bodyweight. Indeed. physique ath letes have long re lied on the rule of 1 g of protein
per pound of bodywe ight - or 150 g per day for a 150 Ib individual.

In the past. some have questioned the safety of higher protein intakes , as individuals with
renal (kidney) disease and failure expellenced a worsening of function when eating a higher
protein diet. However, recent research has shown that in th ose with healthy kidneys, higher
protein intak es present no renal stress and are quite well tolerated. Further concerns about
calcium loss. kidney stones , etc. are all unsubstantiated. Within reason, higher protein
intakes appear to have no negat ive consequences.
UN IT 1 Chapter 6 '/acl:'I,.(",ts 161

Beyond food protein intake, protein and amino acids supplements have become popular in
exercise and sport circles , Prote in supplements can certain ly be used in situa tions where
whole food protein intake is li mited, inaccessible, or undesired. However, lean, whole food
opt ions are often prefer red to supplements due to the ir slower absorption (think low glycemic
index) and more comp lete micronutrient profile (think vitam ins and minerals).

In terms of amino acid supplements, the use of BCAA supp lements (particularly leucine)
has become popular for increasing post-exercise recovery. Glutam ine supp lementation has
been used for improving gastro intestinal heal t h. Arginine supplementation has been used
to improve wound healing. And lys ine supplementation has been used to reduce co ld sore
severity, freq uency, and healing time, However, specific am ino acids can be effective only
whe n there's a specific need for that amino acid , In Un it 2 we'll discuss this idea more in
depth, covering specific needs~based supplement re commendations ,

In this chapter, we've reviewed the main three macronutrients, includ ing their structures;
their digestion, absorption, transport and metabolism; and their re levance in the diet.
Consider this information in conjunction with the information presented in Chapte r 3
(cover ing the major energetic pathways in the body) before making dietary dec isions. The
understanding of how nutrien ts behave ou tside the body, inside the body, and re lati ve to one
another is complex and isn't even fully understood by modern science. However, we do know
enough to make informed dec isions about wh ich foods are best for us as we ll as for our
ind ividual clients. We'll discuss the application of this information further in Unit 2.
162 UN IT 1 Chapter 6 Ma cr om.. tll fn ts

Omega-3 polyunsaturated fats are powerful with corn oil. He sprinkled sunflower seeds into
compounds with tremendous health benefits. each daily lunch salad. Final ly, he 'd steam his
Without them, illness and disease quickly emerge, veggies and then top them with a large amount
as a 33 year old male client reminded us. of margarine. Red flags all around, Each of
these foods is very high in the pro-inflammatory
He came to us as an avid runner who was
omega-6 fats. Yes, even vegetable oils, margarine,
developing nagging injuries. He had debilitating,
and "healthy" sunflower seeds can cause
almost constant pa in in his lower legs. Each acute
problems if your dietary fat intake is out of
exercise session made it worse. We diagnosed it
balance. And he was certainly out of balance!
as chronic inflammation. After an in itial nutrit ion
Our analysis of his daily intake showed an
assessment (which you'll learn how to do in Unit
omega-6 to omega-3 ratio of 20: 1. That means
2), this cl ient was ready to take some steps that
he was getting 20 times as many inflammatory
would improve his nutritional program.
6s as he was getting anti-inflammatory 3s.
Since his diet was very low in omega-3s, and we Experts typically recommend an ideal omega-6
know that omega-3s will reduce inflammation , to omega-3 ratio of anywhere from L 1 to
we recommended that he supplement with a 4 ,1. No wonder he was having problems with
fish oil product, which is an ideal source of inflammation!
omega-3s. We suggested three fish oil capsu les
We needed to adjust this skewed omega-6 to
each day, for a total dai ly intake of 3 grams. We
omega-3 ratio by dramatically reduc in g his intake
also focused on other areas of his program that
of omega-6 polyunsaturates while ba lancing out
needed improvement. We had him increase his
his intake of the other dietary fats - omega-3
meal frequency from 2-3 meals per day to 4-5,
polyunsaturates, monounsaturates , and saturates.
and his vegetable intake from 2-3 servings per
We switched his cooking oils to olive (for medium
day to 5-6.
to low temperatures) and coconut (for high
After about one month of religiously using the temperatures). We replaced his margarine with
supplement and making some other moderate omega -3 rich wa lnut oil , which he sprinkled over
changes to his food intake, he was disappo inted his veggies. We reduced his intake of sunflower
to note that his pa in had barely improved. Since seeds, while in creasing his intake of omega-3 ric h
we've tested the anti-inflammatory benefits walnuts and hemp seeds. Finally, we increased
of omega-3s repeatedly, and they've always his omega-3-rich fish oil intake to 6 grams per
produced a noticeable effect, we decided to look day.
at his diet record again. This time, we did a
These combined intervent ions had a huge impact.
complete fatty acid analysiS, looking at his ratio of
When this client reported back in four weeks,
omega-3 to omega-6 polyunsaturated fatty acids.
he described a massive reduct ion in pain and
With this analysis , the answer to his prob lem
inflammation, an increase in weekly running
became obvious.
mil eage, and a host of other benefits including an
We discovered that this client had three key improvement in recovery after workouts, a clearer
problems with his fat inta ke, first, he cooked a lot complexion, and more stamina.
UNIT 1 Chapter 6 Mac'o ll .]tr lfnb 163

1. Carbohydrates are fo und in the diet as sugar, starch, and dietary fi ber. These
nutrients have a major role in the storage and transport of energy.
2. The fi na l digestion products of all dietary carbohydrates are glucose, fructose, and
galactose; glucose is the predominant form that reaches all cells.
3. The rate at which glucose appears in the blood is related to the speed of digestion/
absorption of the ingested carbohydrate source. Generally, the slower the better
(exceptions being during and after exercise).
4 . The mi ni ma l recom men ded inta ke for carbohydrate is 130 grams per da y.
However, ind ividual needs vary based on activity levels, body size, and goals.
Some individuals trying to aggressive ly lose body fat have been known to do well
on 50 g per day or fewer.
5. The inta ke of dietary carbohydrate shou ld also be inversely proportional to dieta ry
fat intake. The more fat in the diet, the less carbohydrate. The more carbohydrate,
the less fat.
6. Dietary fiber, whi le not digested and absorbed, is critical for satiety, blood fat
levels, colon health, intestina l moti lity, and gut health.
7. The primary subunit of fat is the fatty acid. There are three main types of fatty
acids - saturated, monounsaturated, and polyunsaturated. Each has subtle
chemica l differences that dictate how the fatty acid behaves inside and out of the
body.
8. Triglyceride, which is made up of three fatty acids bound to glycerol , is the major
form of fat found in the diet (as well in storage sites in the body).
9. To improve health and red uce the risk of chron ic disease, ba lance out your fat
intake with an ample amount of unsaturated fats and an even intake of omega-3
and omega-6 fats.
10 . ln excess, saturated fats are problematic; in balance, they are just fine. Howeve r,
industria lly produced trans fats shou ld be eliminated from the diet. This is possible
by minimizing/eliminating processed food .
11. Proteins are critical for nearly every metabolic activity from energy provision to the
creation of structural and fu nctional components of our cells.
164 UNIT 1 Chapter 6 Macro nll tr, cnls

12. Dietary protein , wh ich comes packaged in secondary, tertiary, and quaternary
co nfiguratio ns , is broken down into its individual amino acids for absorption.
Some of this protein is used in the intestinal cells themselves . The rest goes to
the liver for processing.
13.Of the amino acids that reach the liver, about 20% (most of w hich are BCAAs) are
shipped out. An equ ivalent amount (20%) is used to make protein in the liver and
the majority (60%) is catabolized. The amino acids that leave the liver are used to
make up the body's plasma amino acid pool.
14.Amino acids form the p las ma pool fl ow into and back out of cells for daily
physiological functioning. Some amino acids are degraded each day, so daily
protein intake is required.
15.Complete protein (containing all the essential amino acids in adequate amounts)
each day helps prevent protein deficiency and optimize functio n. Complete
proteins can be part of animal foods, some plant foods, or a combination of
different plants in a single meal.
16 . While a minimu m of protein is required for protein turnover, consuming higher
levels of protein help promote satiety and maintain a healthy body composition
and immune function.
CHAPTER 7

MICRO·
NUTRIENTS
Chapter objectives
Key terms
Vitamins
Minerals
Phytochemicals
Water soluble vitamins
Fat soluble vitamins
Macrominerals and Microminerals
Chapter 7 Summary
KEY TERMS
organic compounds
co -enzyme
fat soluble
water soluble
malabsorption syndromes
macrominera/s
microminera/s
electrolytes
ionic state
concentration gradients
phytochemicals
flavinuria
nicotinic acid
avidin
folic acid
retinol
hypervitaminosis
prohormones
calciferol
cholecalciferol
tocopherols
tocotrienols
subclinical deficiencies
electrochemical gradient
industrial exposure
heme iron
non· heme iron
diuretics
cation
UNIT 1 Chapter 7 M c r o l1l . t ll l' rl l ~ 167

Vitamins
Vitamins are organic compounds (which, as you'\! recall from earlier chapters, means ORGANIC COM POUNDS
carbon -containing) needed in trace amounts in the body. Although we don't require much Molecules with a carbon
of them, vitamins enable several important regulatory functions, playing roles in growth, component

digestion, energy transfer, nervous system function, and more. One of the most critical
responsibilities of our vitamins is their role as co - factors for enzymes. You might recall
that vitamin B3 (niacin) is a co -enzyme Involved in the formation of NAD (nicotinamide CO·ENZYME
aden ine dinucleotide), an electron transporter important to the energy transfer process. Non-protem compound that
While vitamins are essen tial in the diet (i.e., they generally aren't syn thesized in appreciab le forms the active portion of
an enzyme sy stem
amounts by the human body) and intimately involved in the energy trans fer processes of the
body, they do not act as direct energy sources or fuel sources.

What defines a vitamin' We use the fo llowing criteria:

Vitamins are natural components of foods; usually present in very small amounts
Vitamins are essential for normal physiologic function (e.g. , growth, reproduction, etc.)
Vitamins , when absent from the diet, will cause a specific deficiency

Vi tamins are generally categorized as either fat soluble or water soluble depending on FAT SO LUBLE
whether they dissolve well in either lipids (fat) or water, respe ctively. Vi tamins A, D, E, and Able to be dissolved m fat
K are classified as fat-soluble vitamins. Fat soluble vitamins are mostly absorbed passively in
the gastrointest inal trac t, and usually must be transported bound to dietary fat. In the body, WATER SOLUBLE
Able to be dissolved in water
fat soluble vitamins are usually found in the portion of the cell which contains fat, including
cell membranes, lipid droplets, etc. These vitamins are typical ly excreted through our feces.

The B vitamins and vitam in C are water-soluble. These vitamins are absorbed by both
passive and active mechanisms in the gastrointestinal tract. They rely on carrier proteins
for transport. Since body water is always being turned over, water soluble vitamins are not
stored in large amounts in the body; they're typ ically excreted in the urine along with their
breakdown products.

There is no one-size-fits-all approach to meeting vitamin needs . Many factors can influence
our vitamin requirements, such as sex, malabsorption syndromes, prescription medications ,
and age-related changes. For example , women still menstruating should probably include
plenty of iron in their diet. However, additional iron may actual ly be dangerous for men,
caus ing a condition called hemochromatosis and organ damage.
MA LABSORPTION
People suffering from malabsorption syndromes (e.g ., Crohn's disease, ulcerative colitis, SYNDROMES

ce li ac disease, cystic fibrosis, pancreatitis, etc), in which dietary vitamins may be present but Medical condition that
results when the intestines
poorly taken up by the body, may be deficient in multiple vitamins. These individuals shou ld
cannot absorb nutrients
be tested for vitamin and mineral deficiencies , and a vitamin and mine ral management from food
strategy adopted if required. In deed, assess ing vitamin status is likely a good strategy for
most adults, whether suffering from malabsorption or simply a generally poor diet. MACROMINERALS
Minerals required in
amounts of 100 mg/day
Mineral s or more

MICROM I NERALS
Minerals, like vitamins, are also required in small amounts by the body. While they aren 't
Minerals required in
direct energy sources either, they're considered essential and must be obtained from the diet. amounts less than
There are two types of dietary minerals: macrominerals (required in amoun ts of 100 mgl 15 mg/day
day or more) and microminerals (required in amounts less than 15 mglday). Co llectively,
the macrominerals and microm ine rals often serve as building blocks for body structures :
168 UNIT 1 Chapter 7 r'li ~ ' ''l .1", r'O,

they form the foundation of teeth and bones , and help to construct other cells and enzymes.
Minerals can act as co -factors in enzymatic reactions or as enzymes themselves . Moreover,
minera ls can also act as electrolytes that maintain the electrochem ical gradient across
ELECTROLYTES the ce lls of our bodies . Electro lytes are critical to the regulation of muscle contraction, the
Compound that when estab lishment of fluid balance, and the generation of nerve impulses.
placed in solution be comes
an ion; regulates flow in Our bod ies, and the foods we eat, conta in an abundance of minera ls, which we absorb in
and out of cells an electrica ll y charged state (or an "ionic state "): either the mi nerals are miss in g an electron
(positive charge) or have additional electrons surrounding them (negative charge). In the diet ,
I ON IC STATE this charged state allows the minera ls to bond readi ly with water, facilitating absorption. In
A given IOn's charge: the body, this charged state helps create concentration gradients across cell membranes,
positive , negative or neutral
which then enable the electrolytes ' functions .

CONCENT RATI ON Other molecu les found in food, such as phytates, oxalates and acids, can alter our ability
GRAD IENTS to absorb minerals. For example, phytates in tea and coffee can inhibit iron absorption.
Difference in the A person taking an iron supp lement is usually instructed to avoid taking it with those
concentration of solutes in a
beverages. Converse ly, the acidity of vitamin C can reduce iron from ferric (3 + ) to ferrous
solution between two areas
(2 + ) form , wh ich is ideal for crossing the gut barrier, enhancing absorption .

We should get the bulk of our micronutrients from food rather than from dietary supplements .
Food sources contain complex varieties of nutrients that may act synergistically to promote good
health. Indeed, some research has shown that vitamins and minera ls delivered via who le food
sources promote greater health benefits when compared to vitamins and minerals delivered in
supplement form . A few large-sc ale trials, such as studies of vitamin E, were even halted when
researchers found that supplementation had the opposite effect than observed with food sources
- when consumed in isolation, the supplements appeared to increase , rather than decrease,
PHYTOCHEMICALS
disease risk. In addition , many who le foods also contain non-vitamin and non-minera l chemicals,
Chemical substance
obtained from plants
called phytochem icals , which have been shown to playa role in human nutrition .
that is biologically active
but non-nutritive
Phytochem ic als
Phytochem icals are defined as non-nutritive (i .e., non·energy-providing) chemicals found
in plants. Scientists have only isolated a few of these in the laboratory, bu t it is estimated
that there are more than a thousand phytochemicals appearing in our food supply. Current
research indicates that many of these chemicals can help to protect humans from disease .
You're probably familiar wi th some of them , including:
Resveratro l in grapes/grape skins Lute in in spi nach
Isoflavones in soy Naringenin in grapefruit
Lycopene in tomatoes

Some of these phytochemica ls are so powerful that they can influence our response to drugs.
Indeed, naringenin, in addition to serving as an antioxidant, free radical scavenger, ant i-
inflammatory chemical, carbohydrate metabolism promoter, and immune system modu lator,
also inhibits the cytochrome P450 enzyme system in the liver. This system is responsible for
first pass metabol ism of numerous drugs. Thus indiv iduals tak ing statin medicat ion s for high
cholesterol are instructed to avoid grapefru it because naringenin will inhibit the breakdown of
statins and cause a dangerous level to accumulate in the body. Powerfu l stuff'
169

Interestingly, phytochemicals can help the body ward off disease through various mechanisms,

Many of them function as antioxidants , helping to scavenge free radicals. The oxidative
damage from free radica ls can exacerbate the progression of cancer and heart disease.
An example of this would be carotenoids in yams .
Phytochemica ls may also influe nce hormonal func tion. An examp le of this would be the
isoflavones found in soy and lignans in flax that can mimic estrogen in the body. There
are also enzymes in the liver thai can make estrogen less effective. These enzymes can
be up-regulated by indoles, a phytochemicals found in cruciferous vegetables.
Phytochemicals such as capsaicin, which makes peppers spicy, may help protect DNA
fr om carcinogens.
Ha ve you ever heard that garlic is anti-bacteria l? That is due to allicin, a phytochemica l
found in garlic. Ma ny ot her phytonutrients have anti-bacterial and ant i-vira l abilities. For
example, anthocyanins (red , purple , and/or blue plant pigments) found in many fruits
can actually prevent the adhesion of pathogens to cell walls. Thus cranberries can help
prevent urinary trac t infections .

While a varied diet rich in whole foods olfers t he best combina ti on of dietary micronutr ie nts
and phytochemicals , in the modern diet many of these whole foods have been disp laced by
processed convenience foods low in these vitamins, minerals, and phytochemica ls. Because
of th i s, nut rient deficienc ie s that haven't bee n seen for hundreds of years are begi nni ng to
reappear. With these deficiencies come poor health, in creased disease risk, obes ity, and
more. Many physio logists and nutritionists, including the expe rts at the Journal of the
American Medica l Association, have suggested that most adults would do well to take a
daily multivitamin/multimineral supplement.

In the following sections, we 'll prov ide an overv iew of dietary so urces, func ti ons, and
sympt oms of both deficiency and excess (toxicity) for each vi tamin and mineral.

Water soluble vit amins

VITAMIN B1 (THI AMINE)
DIETAR Y SOURCES

Th iam ine is fo und in asp aragus, le ttuce . mushrooms , sp in ach, sunflower seeds , tuna, peas,
tomatoes, eggplant. brussels sprouts, lent ils, and whole grain s.
FUNCTIONS Rap id heart rate
Fu nctions as a Swell ing
co-enzyme necessary Anorexia
for energy production from food Naus ea
Ass ists in the synthesis of DNA and RNA
Fatigue
DEFIC IENCY SYMPTOMS Gas trointest inal distress

Burn ing feet EXCESStrOX ICI TY SYMPTOMS

Weakness in extremities
None are known.
170 UNIT I Chapter 7 M:crocutrle.,ts

Some of the most studied phytochemicals, where they're found and their mechanism of action.

Phytochemicals

CLASS FOOD SOURCES ACTION

Phytoestrogens Soy products, flaxseed , seeds & nuts, yams , May bloc k some cance rs and aid in
Isoflavones alfalfa & red clover spro uts. licorice root menopausa l symptoms & helps improve
(not c andy) the memory

Phytosterols Plant oils, corn, soy, sesame, safflow er, BlOCks hormonal role in cancer, inhibits
wheat, pumpkin uptake of cholesterol from diet

Saponins Yams, beets, beans, cabba ge, nu ts , soy beans May prevent cancer cells from multiplYing

Terpenes Ca rrots, yams, win te r squash, sweet potatoes, Antioxidants - protects DNA from free
apples, cantaloup es radical-Induced damage

Tom atoes and tom ato-based products He lp s block UVA & UV 8 & may help
protect again st cancers , prosta te, etc.

Ci trus fruits OIavonoidsl. apples (quercetin ) Promotes pro tec ti ve enzymes; antiseptiC

Spina ch, ka le, beet & tu rnip greens, cabbage Protects eyes from macular degeneration

Red chi le peppers Kee ps ca rcino gens from bi nding to DNA

Phenols Fennel, parsley, carrots, alfalfa, Prev ents blood clotting and may have
cabbage, apples antic ancer prope rties

Citrus fruits, broccoli, cabbage, cucu mbers , Antioxidants - flavonoids block membrane
gree n pepp ers , t oma t oes receptor site s for certain ho rmon es

Grape seeds , apples St rong an tioxid an ts: fights germ s &

bacteria , strengthens immune sys tem ,
vein s & capillaries

Gr apes, especially skins An tioxidant, antimutagen: pro motes

detOXi fi cati on; acts as ca rcinogen
inhi bitor

Yellow & green skin squa sh Antihepaloxic, antitumor

Sulfur compounds Onio ns & garl ic (fresh is best) Promotes liver enzymes, inhibits
choles t erol synthesis, reduce s
tri glyc erides, lowers blood pressure ,
Improves immune response, fights
infections, germs and paras ites
UNIT 1 Cha pter 7 Mrcrol l ,lr".:m l':> 171

VITAMIN B2 (RIBOFLAVIN )
DIETARY SOUR CES

Riboflav in is found in mushrooms , aspa ragus, lettuce, spinach and other green leafy
vegetables, eggs, yogu rt, almon ds , salmon, halibut, and whole grains.

FU NC TIONS DEF ICI ENC Y SY MPTOMS

Helps to make up the electron Cracks, f issures and sores at corner of

trans po rter FA D (see Chapter 3) mouth and lips
Pa rtiCipates in the met ab olism of drugs Der matitis
and toxins in the liver Conjunctivitis
Ac ts as an antioxidant in the Photophobia (light avoidance)
neutrali zation of hydroperoxides
Glossitis (inflammation or infection)
He lps in the conversion of xanthine to of ton gue
uric acid
Anxiety
Helps with iron metabolism
Loss of appe t ite
Helps to maintain healt hy levels of other
Fatigue
B vi tamins
Invo lved in red blood cell prod ucti on EXCESS/ TO XI CITY SY MPTO MS

Inc reased risk of DNA st rand breaks in

the presence of ch romium
Inten sifying urine colo r (flavinuria ; FLAV INUR IA
although this is harmless) An intense yellow color of
the urme due to a high do se
of supplemental riboflavin
VITAMIN B3 (NIACIN)
DIE TARY SOU RCE S

Niacin is found in mushrooms, tuna, asparag us, halibut, sea vegetables, salmon ,
whole grains, peanuts, lentils, and lima beans .

FUNC TI ONS EXC ESS/TO XICI TY SYMPTO MS

Helps to make up t he electron Na usea

tran spo rt er NAD (see Chapter 3) Liver toxicity (with chronic supplemental
Assists in DN A repai r intak e of 750 mg or more per day)
Fac ilitat es cellular signaling Note; niacin from foods is not known to cause
Helps to control chole stero l levels by adverse effect s. However, supp lemen ta l
influencing lipid synthesi s in th e liver nicotinic acid may cause flus hi ng of skin, NICOTIN IC AC ID
itching , impa ired glucose tolerance and Vitamin 83
DEFI CI ENCY SYMP TOMS
gastrointesti nal upset.
Dermatitis
Diarrh ea
Dem entia
Stomatitis (inflammation of mu cous
membranes of the mouth)
172 UNIT I Chapt er 7 Mt(: r" lll illen:s

FIGURE 7.1 o· o·
STRUCTURE OF Pantothen ic acid I I
o NH 0- ~ - 0 - P -O-CH,

CH , - ~
(vit amin 85)
ACETYL· COA
_ s/""J I
o
I
0

Acety l B- rne rcaplo-

group elhylamine
o
I
o-p - o
I
o

3' ,5' -ADP

VITAMIN 85 (PANTOTHENIC ACID)

DIETA RY SOU RCE S

Pantothenic acid is found in mushrooms, cauliflower, broccoli, seeds, greens, tomatoes, berries,
eggs, yogurt, squash, corn, cod, split peas, lentils, avocado, sweet potato, and whole grains.

FU NCTIONS D EF ICI ENCY SYMPTOMS

Formati on of acetyl·GoA (see Chapter 3) Tingl ing feet (only in severe malnutrition)
Synthesizes choles tero l, stero id No other symptoms are likely
horm ones , and neurotra nsm itte rs
EXCESS/TQX ICITY SYMPTOMS
Assists in drug metabo lism
Nausea
Heartburn
Dia rrhea
Note; these are typically only experienced with high dose
supplementation,

VITAM IN 86 (PYRIDOX INE)

DIETARY SOUR CES

Pyridoxine is fo und in potatoes , bananas, beans, oats, seeds, spinach, trout, avocado , tuna,
salmon, peanut butter, wa lnuts, and ha ze lnu ts.

FUNCTI ON S DEFICIENCY SYM PTOMS

Works as a co·enzy me to form PLP, Chelosis (cracked, dry lips ), gloss it is ,

which is needed for more than 100 stomatitis, dermatitis (all simi lar to
enzymes involved in protein metabolism vitamin B2 deficiency)
Assists in the breakdown of glycogen Nervous system disorders
Helps with red blood cell metabolism Sleeplessness
Support s nervous and immune system Confusion
funct ion Nervousness
Helps to form neurotransmitters and Depression
steroid hormones
Irr itability
Anemia
Note ; prenatal deprivation of pyrldox.lne can result In
mental retardat ion and blood disorders for the newborn

EXCES S/TOX ICITY SY MPTOMS

Pa in ful neurological symptoms

UNIT I Chapter 7 M , c r o 1l. l ll ~ n l ' 173

BIOTIN (VITAMIN B7)

DI ETAR Y SOURC ES

Biot in is found in green leafy vegetables, whole grains, sa lm on, avocado, lettuce,
tomatoes, ca rr ots, almonds, eggs, cabbage, onio ns. cucumber, caulif lower, berries, ha lib ut,
oats, and walnu ts.
FUNCTI ONS DEF ICIEN CY SY MPTOMS

Formation of four vital enzymes known Symptoms are rare in humans as intestinal
as carboxylases, which are involved in bacteria produce enough biotin. Howeve r,
gluconeogenesis, leucine metabolism, consuming raw egg whites over a long
energy production, and the synt hesis of per iod of time can cause biot in deficiency
fats due to the protein avidin , which can AV IDIN

Assists in DNA replica tio n and bind up to four molecu les of biotin and A compound fDund in
carry them out of the body. In this case, raw egg albumen that
transcript ion
inactivates biDtin
dermatologic symptoms can occur.

EXCESSfTOXICITY SYMPTOM S

Not known to be tox ic .

VITAMIN B9 (F OLI C ACID)

DIE TAR Y SOURCES

Folic acid is found in beans, citrus fruits, whole grains, green leafy vegetables, beels ,
FOLIC ACID
cauliflower, le ttuce , and asparagus. Note that "fol ate" is found in foods while "folic acid" is a
Vitamin 89
synthetic supplement.
FUNCTI ONS DEF ICIENCY SYMPTOMS

Works as a co-enzyme in the metabolism Anemia (macrocytic or megaloblastic)

of nucleic and amino acids Leukopenia
Assists in vitamin B12 and C use and Thrombocytopenia
breakdown
Weakness
Assists in th e fo rmat ion of new proteins
Weight loss
Helps with red blood cell formation and
Crackin g and redness of tong ue and
circ ulation
mouth
Diarrhea
Low birth weight and preterm delivery in
pregna ncy

EXCE SSITOXICIT Y SY MPTOMS

None known from food.

VITA M IN B12 (COBALAMIN )

DIE TAR Y SO URC ES

Vitam in B12 is found in trout , sa lmon , beef, yogu rt, tuna, eggs, clams , crab, ro ckfish ,
fermented foods, and 812 fortified foods .
174 UNIT 1 Chapte r 7 M'crollut' e'lts

FU NCTIO NS DE FICIENCY SYM PTOMS

Acts as an enzyme co-factor in forming Pe rnicious anemia

and maintaining healthy nerve cells, red Ne urological prob lems
blood cells, and DNA synthesis
Sprue

EXC ESS/T OX ICITY SYMPTOMS

None known from supplements or food.

Since only a sma ll amount is absorbed via
the oral route, potential for toxicity is low.
VITAMIN C
DIETARY SOURCES

Vitamin C is fou nd in green leafy vegetables, broccoli, parsl ey, potatoes, peas, citrus fruits,
blackcurrants, kiwi , mango, bell peppers, straw berr ies, papaya, asparagus, and cauliflower.

FUNCT IONS Tissue swelling

Protects cells from free rad icals by acti ng Dry hair and skin
as an antioxidant Bleedin g gums
Improves iro n absorption by allowing Dry eyes
ferric iro n to reach its ferrous form Ha ir loss
Rege ne rates vitamin E suppli es Pitting edema
Develops collagen, an important Anemia
structural protein throughout the body
Del ayed wound healing
Synthesizes t he ne urotransm itter
Bone fragi lity
norepinephrine
Synth esi zes carn itine EXCESSfT OX1CITY SYMPTOMS

Assists in the metabolism of cholesterol Kidn ey stones

to bile acids
Rebound scurvy
DEFICIENC Y SYMPTOMS Inc reased oxidative st ress

Bruis in g Excess iro n absorption

Gum infections Vitamin B12 deficiency

Lethargy Erosion of dental enamel

Note : Up (0 10 grams of Vitam in C appea rs to be sa fe
Dental cavities based on mos t re searc h data However, ca utIOn IS
advised as 2 grams or more per day can cause diarrhea .

Fat soluble vitam i ns

VITAMIN A AND CAROTENOIDS
RETINOL Note : Vitam in A IS tile co llective name f or a group of fa t-sol ub le vl lamlnS The most usable form IS retino l. The caro tenO lds
Animal-derived form are precursors to vitam in A and are co nverted on ly when necessary
at vitamin A
DIETARY SOURCES

Carotenoids are found particularly in red, orange, and ye ll ow fruits and vegetab les, suc h as
yams , pumpkin, squash, carrots, red and yellow peppers, tomatoes , mangoes , and melo n.
They're also found in green leafy vegetables, eggs, and dairy foods.
UNIT 1 Chapter 7 M ICfo n " tr,(' fl b 175

FUNC TI ON S DEF I CIEN CY SY M PTO MS

Formation of vis ual pigmen ts Difficu[ty seeing in dim light

Synthes is of proteins Roug h/dry skin
Immune fu nction and wound healing
EXCESS/TOXICITY SYM PT OMS
Embryonic deve lo pment
Nausea
Stem cell differentiation
Head ache
Red blood cell development
Fatig ue
Note There are man y In te rrel ationsh i ps between vitam in
and m ineral status in the body. Fo r example, Zi nc Loss of appetite
deficiency ca n red uce th e syn th es Is of re ti nol blndmg
Dizziness
p ro tein as we ll as decrease en zy me ac ti vity involved In
releasmg sto red vitam in A. Fu rth er, vitam in A defic iency Dry skin
ca n enhan ce Iron de fi ciency anem ia
Birth defects when pregnant
Note : hypervitaminosis is caused by co nsum ing excessive HYPERVITAMIN OS IS
amoun ts of preformed vitam in A (reli nyl pa lm ita te), not Vitamin toxicity
the plant carotenolds . Pref ormed vitamin A is absorbed
rapidly but only cleared slow ly from th e b od y.

VITAMIN D (ERGOCALCIFEROLJCHOLECALCIFEROL)
Vi tam in D is really a group of prohormones. Vitamin D must be metabol i zed to its PROHO RMO NES
Precursor to a harmone(s)
bio log i ca[ ly active form in the body. After it is consumed or synthesized in the skin,
it enters t he bloodst ream for transport to t he liver. There it is hydroxylated to form 25 CAL C[FEROL
hydroxyvitam in D. [n the k id ney, a second hydroxylation results in ca[ciferot , or 1.25 Vitamin 0
di hydroxyvitamin D - the most potent form . [n animals, this forms cho[ecalcifero[ , or
vitam in 03. tn plants, this forms ergocalciferol, or vitamin 02. CHO LE CA LCI FER OL
Vitamin 03
DIETARY SOURCES

Vitamin D is fou nd in egg yolk; oily fish such as salmon, sardines , and mackerel; and vitam in
o fortified foods. Vitamin 0 is also the on ly vitami n that can be obtained via the sun.
FU NCTIONS DE FI CI ENCY SY M PT OMS IN ADULTS

Gene transcription modulation Osteoma lacia

Increases ca lcium uptake and Softened bones
reabsorption, ma intai ning serum calcium Spontaneous fractures
levels
Tooth decay
Cell differentiation
Tho se mos t at risk for deficiency include
Immune system function
in fa nt s, e[derly, dark skinned individuals,
Regu[ates glucose tolerance those with minimal sun exposure, fa t
He tps regutate the ren in-angiotensin malabsorption syndromes, inflammatory
cascade and blood pressu re bowel di seases , kidney fai lure, and
seizure disorders.
DE FI CIENCY SY MP TOMS IN CHI LDRE N

Rickets
Deformed bones
Retarded growth
Soft teeth
176 UNIT 1 Chapter 7 ~"" Cro l ' .J :

EXCESSl TOX ICITY SYMPTOM S Musc\e wea kness

Elevaled blood calcium leve ls Joint pa in
Loss of appetite Disorien ta tion

Na usea Calcification of soft tiss ues

Vomiting Hypervitaminosis is not a result of sun
Excess ive thir st exposure bu t from chronic supplementation.
Excessive urinat ion Only excessive supplement use will ca use
the symptoms ab ove.
Itching

VITAMIN E (TOCOPHEROLJrOCOTRIENOL )
TOCOP HE ROLS The vi ta min E fami ly contains eight ant iox idants: fou r tocopherols and four tocotrienol s.
Fat soluble alcohols with Alpha-tocop hero l is the chief form fo und in blood and tiss ues.
vitamin E
DIETA RY SO URC ES
TOCOT RI ENOLS
Vitamin E compounds Vi tam in E is found in vegetab le oils, nuts , gree n leafy vegetables, avocado , seeds, whole
gra ins, tomatoes, apples, and ca rr ots .

FUN CTIONS DEFICIENCY SY MPTOMS

Scavenges free radica ls and ac ts as an None are typ ically no tice d unless the re is
ant iox idant severe malnutrit ion . How ever, sub optimal
Plays a rol e in cell sig naling intake of vitamin E can be common, leading
SUBC LIN ICA L DEFI CI ENCI ES to subclinical deficiencies.
Nutrient deficiencies that Facilitates the expression of immune and
don't manifest as a clinical in flammat ory cells EXCESS/ TOXICITY SYM PTOMS
health problem
• Impa ired blood cl otting
No te; Min imal side eHec ts ha ve bee n noted in adults
tak i ng supplements in doses less than 2000 mg/day.

FIGURE 7 .2
PATHWAYS OF VITAM IN
D PRODU CTION AND ITS
INFLUENCE ON CALCIUM
ABSORPTION

M inor source - d ietary in take

Vi tamin 0 3 (fish , meat)
Vitamin O2 (vitamin supplements)
7-0ehydrocholesterol q Choleca lci ferol q
(vit am in ~ )
~
25-d ihydroxyvitamin ~

~
Major source
- sunl ig ht Skin
1 ,25 -d ihydrox YV ltami n D3
t Ca lcium absorption (s mall In tes tine)
t Urinary calC i um re -absorption (kidney)
t Bone mineralizati on
Mai ntains calcium in the bo dy
UNIT 1 Chapter 7 rl'k lon. lIL, _nlS 177

VITAMIN K (PHYLLOQUINONE & MENAQUINONE)

There are 3 types of vitamin K, phylloquinone (Vitamin Kll, menaquinone (Vitamin K2),
and menadione (Vitamin K3). Bacteria that colonize the large intestine can synthesize
vitamin K2. However, the contribution of this production to vitamin K status is unclear.

DIETARY SOURCES

Vitam in K is found in green leafy vegetables, vegetable oils, kelp, peas, lentils, lettuce,
and parsley.

FUNCTIONS DEFIC IENCY SYM PTOMS

Assists the blood clotting process Tendency to bleed or hemorrhage

Acts as a co-factor in amino acid Anemia
metabolism
EXCESS/TOXICITY SYMPTOMS
Cell signaling in bone tissue
• Interference with gl utathione activity
Prevents excessive bleeding in infant s
(infants get a vitamin K shot shortly Note Blood thinning drugs act as vitamin K antagon ists
to prevent excessive bl ood clotting Th us consuming
after birth)
too mu ch vitamin K In the diet (or from supp lements)
can nega te [h is anti· clotting eff ect and preven t
pharmace ut ica l efficacy

Macrominera ls and Micro minerals

CALCIUM
Calcium is the most common mineral in the human body. Parathyroid hormone, calc ito nin,
vitamin 0, osteoblasts, and osteoclasts all he lp to maintain calcium levels in the body.

DIETARY SOURCES

Calcium is found in beans, green lea fy vegetables, broccoli, almonds, turnips, tofu, dairy
foods, rhubarb, and calcium fortified foods.

FUNC TIONS EXC ESS;TOX ICITY SYM PTOMS

Regulates nerve impulse transmission Nausea

Regulates muscle contraction Vomiting
Regulates hormone secretion Constipation
Forms teeth and bone Dry mouth
Acts as a co-factor for enzymes Thirst
Increased ur ination
OEFICI ENCY SYMPTOMS
Kidney stones
Low bone mineral density
Soft tissue calcification
Rickets
Osteoma lacia
Osteoporosis
178 UN IT 1 Ch apter 7 t·h cronulllell"S

CHLORIDE
DIETARY SOURC ES

Chloride is found in whole grains, whole fruits, vegetables, lean meats, leg umes and nuts!
seeds. In addition, foods with sal t as a flavor enhan cer provide high er amo unts of Chloride.
However, these foods , such as potato chips, boxed pasta, soup, pretzels, deli meats, pickles,
etc. aren 't recommended. A majority of the sodium and chloride in the diet comes from salt.
A lower salt intake is associated with diets that emphasize unprocessed foods.

FUN CTI ON S Chloride deficiency is rare and only occurs

Maintains an ele ctrochemical gradient as a result of serious diarrhea, vomiting, or
ELECTRO CHEMICA L
GRAD IENT excessive fluid loss.
across cell membranes (membrane
Diffusion gradient of an /On, potential); tight regulation of this EXCESS/TOX ICITY SYMPTOMS
represents the potential
gradien t is imperative for nerve impulse
energy of an ion across a
tran smission, cardiac function and Increased fluid volume and edema
membrane and its tendency
to move based on that muscle con tra ction Nausea
membrane potentia' Aids in the digestion and absorption of Vomiting
many nutrients Diarrhea

DEFI CI ENCY SYM PTOMS Toxicity is rare and typically only occurs
with im paired chloride metabolism or in
Low blood pressure
kidney diseases.
Weakness

CHROMIUM
DIE TARY SOURCES

Chromium is found in broccoli, potatoes, whole grains, meat, apples , green beans, ba nan as,
onions, tomatoes and lettuce.

Diets wi th higher amounts of sugar can elevate chromium excre ti on in the urine, leading
to an increased chromium requirement. In addition, ingesting vitamin C wi th chromium
can enhance uptake.
FUNC TIO NS EXCESSrrOXIC IT Y SYMPTOMS

Enhances the effects of insulin DNA damage

Assists in glucose and fat metabolism Kidney failure

DEFICI ENCY SY MPTOMS Chromium toxicity is generally limited to

INDUSTRIAL EXP OSURE industrial exposure . However, long-term
Exposure to something in Impaired glucose tole ran ce supplement use may increase DNA damage.
the workplace Elevated circulating insulin
179

CO PPER
DI ETA RY SOU RCES

Copper is found in cashews, crab, sunflower seeds, lentils, hazelnuts, mushrooms, almonds,
chocolate, cocoa powder, nul butlers, whole wheat, soybeans, barley, tempeh , garbanzo
beans, organ meats, and navy beans,

Supplementing with high doses of zinc can result in copper defic iency by increas ing intestinal
proteins that bind and prevent certain metals from being absorbed. Also, a high inlake of
vitam in C supplements may impair copper absorption.

FU NCTIO NS DE FICIEN CY SYM PTOMS

Plays a critical role in oxidation-reduction Hypochromic anemia unresponsive to

reactions and free radic al scavenging iron therapy
Assists cytoc hrome c oxidase with Neutropenia and leucopenia
cellular energy Hypopigmentation of skin and hair
Helps wilh collagen and elastin cross-
Copper defic iency is rare . However, those
lin king
at risk include premature infants, infants
Forms enzymes responsible for fed only cow's milk formula , those with
the syn t hesis and me tabolism of malabsorpt ion syndromes, excessive zi nc
neu rotra nsm itters, as well as the consumption , and antacid use.
formation/maintenance of myelin
EXCES S/TOXI CITY SYMPTOMS
Regulates genes and transcript ion factor s
associated with protei n synthesis Abdominal pain
Nausea
Vom iting
Diarrhea
Liver damage with long-term exposure

FLUORINE
DI ETARY SOU RCES

Fl uorine is found in water, tea , ca nned fis h with bones , and some poultry.
Note Magnesium and calcium can for m an insoluble comple x. with fluofJde This can greatl y decrease absorption If
consumed at the same meal.

FU NCTIONS EXCESS/T OXICITY SY MPTOMS

• Prevents tooth decay Motlled tooth enamel (in children) from

swallowing toothpaste with fluoride
DE F IC I EN CY SYM P TO MS
Nausea
• Increa sed risk of dental caries Abdominal pain
Vomiting
180 UNIT 1 Ch apter 7 MI CrO'lt.: tl lenlS

IODINE
DIETARY SOUR CES

Iodine is found in iodized salt, seaweed, seafood, potatoes, navy beans, eggs, milk,
yogurt, and strawberries.

Iodine content in food depends on the soil. Food products from the sea tend to be rich in
iodine, since marine life can concentrate iodine from seawater. Th is incl udes seaweed.
FUNCTI ON S EXCEssrrOXIC ITY SYMPTOMS

• Helps to form T3 and T4 Burning mouth, throat and stomach

Fever
DEFICI EN CY SYMPTOMS
Diarrhea
Impaired growth and neurological
development Iodine toxicities are rare and typically only
occur with very large doses.
Decreased production of thyroid
hormones
Hypertrophy of the thyroid

IRO N
DIETARY SOU RCE S

Dietary sources of iron include two types: heme iron and non-heme iron . Heme iron is
better absorbed and comes ma in ly from the hemoglobin and myoglobin in red meat (which
includes dark-fleshed fish such as tuna, and poultry such as ostrich and duck). Non-
heme iron is found in dairy foods, iron salts , and plant sources such as soybeans, lentils,
spi nach, sesame seeds, kidney beans, potatoes, molasses, prunes , cashews, garbanzo
beans, pumpkin seeds, and navy beans. Vitamin C, organic acids, and meats enhance iron
absorption. On the other hand, phytates , polyphenols and soy protein inhibit iron abso rption.

FU NCTI ON S iron, zinc absorption is diminished. In

Helps to form hemoglobin (which addition, vitamin A deficiency can intensify
stores about 2/3 of the body's iron) and iron-deficiency anemia. Further, copper
myoglobin and assists in the transpor t sta tus needs to be adequate fo r normal iron
and storage of oxygen metabolism and red blood cell formation.

Assists in enzymatic activities DE FICIENCY SYMPTOMS

responsible for increasing red blood cell
Anemia with small and pale red blood cells
formatio n, blood vessel growth, and
production of anaerobic energy Behavioral abnormalities (in children)

Helps to form the cytochromes involved EXCESstrOXICITY SYMPTOMS

with cellular energy production and drug
metabolism Acute vomiting, nausea , shock and
polentially death
Forms an essen tial constituent of
hundreds of proteins and enzymes Chronic increases in risk of
cardiovascular disease, cancer, and
Ca lcium consumption (with iron) at a meal
neurodegenerative diseases
can reduce the absorption of iron while
vi tamin C consumption can increase the Note· iron overdose IS a commo n cause of pO isoning In
ch!ldren.
absorption of iron. When laking zinc with
UN IT 1 Chapter 7 M ICrG rl .J l' er ls 181

MAGNESIUM
DIETARY SOURCES

Magnesium is found In whole grains, almonds, hazelnuls, peanuts , green leafy vegetables,
HEME IRON
soy beans, avocados, bananas, apricots , apples, cashews, lima beans, molasses. pumpkin Form of iron bound with
seeds, sesame seeds, salmon, halibut, navy beans, and black beans, carrier proteins found in
animal products
FUNCTIONS DEFIC I EN CY SYMPTOMS

NON -HEME I RON

Asslsls in ca rbohy drate metabolism Very rare due to abundance of
Form of iron not bound
Assists in fat metabolism magnesium in foods
with carrier proteins; found
DNA and protein sy nlhesi s High intakes of zinc, fiber and prote in can mainly in plant food s

Ac ti ve transpo rt of ions across cell decrease magnesium absorpti on, putting

membranes individuals at risk for defic ien cy, In ad dition,
those with gastrointestinal diso rders, kidney
Phosphorylation of second messengers
disorders, and alcoholism are at risk.
Cell migration and wo und heali ng
EXCE SS/TOXICIT Y SYMPTOMS
Magnesium is found prima rily in the
skeleton, but also in skelet al muscle and • None identifi ed from food s
inside/outside of cells, Ne arly 300 essential
metabolic reactions rely on magnesium.

MANGANESE
DIETARY SOU RCES

Manganese is found in pineapple, whole wheat, oals, peca ns, brown rice, spinach, almonds,
peanuts, sweet potatoes, beans, green and black teas , rye, tempeh, raspberries, and cloves,

Phytates fo und in many foods can decrease mangan ese absorption, as can iron , magnesium,
and calcium supplementation.

FUNCTIONS DEFICIENCY SYMPTOMS

Assists the antioxidant enzymes of the • Not typically observed in humans

mitochondria
EXCESSfTOX ICITY SYMP TOMS
Wo rks enzymatically to assist
carbohydrate, ami no acid , and • Gene ral ly from industr ial exposu re on ly
cholesterol metabolism
Assists in the synthesis of protog lycans

MOLYBDENUM
DIET ARY SOURC ES

Molybdenum is found in beans , lent ils, peas, whole grains and nuts, Some fruits , vegetables
and meats have small amounts.

FU NCTIONS DE FICIENCY SYMPTOMS

Acts as a co~f ac tor for enzymes involved • Very rare

with carbon, nitrogen and sulfur cycles
EXCESS/ TOXIC ITY SYMPTOMS
as well as nucleotide breakdown and the
metabolism of dr ugs/to xi ns • Gout in rare ci rcumstances
182 UNIT 1 Chapter 7 ( ,I ' l ' Ut ' U l ll e w '

o adenine

I
-0- P - 0 - P - 0 - P -O-CH 2
I I I
o 0 0
ribose

Adenosine (ribose + adenine)

Adenosine monophosphate (AMP)

Adenosine diphosphate (ADP)

Adenosine triphosphate (ATP)

FIGURE 7.3 PHOSPHORUS

PHOSPHORUS AND ATP
DI ETARY SOURCES

Phosphorus is found in whole grains , brazil nuts, eggs , chickpeas, pumpkin seeds , berries,
bananas, toma toes, al monds, lentils, salmon, halibu t, and dairy foods.

FUNCTIONS DEFIC I ENCY SYMPTOMS

Forms the structu re of bones • Symptoms are very rare

Energy trans fe r (phospho ryla tion is Popu lations at risk include prem atu re
essential) infants, th ose who use antacids, those with
Hormo ne production alcoholism and tho se with unco ntroll ed
Enzyme production diabetes me liit us . In these ind iv idua ls,
symptoms include mu scle weakness,
Cell signaling
fatigue, and tooth decay.
Buffering acidity
Bind ing site activity for hemoglobin EXCESSfTOX ICITY SYMPTOMS

Every cell in the body requi res phosphorus Very rar e; may result in soft tissue
for normal func ti on. calci ficat io n
UNIT 1 Chapter 7 " II - :J t ll~ -,:
183

POTASS IUM
DIETARY SOURCES

Potassium is found in swiss chard, lima beans, yams, squash, potatoes, prunes , raisins,
bananas, artichoke s, spinac h, tomato juice, molasses , tomatoes, sunflower seeds, organ
meats, almonds, avocado, soybeans, pi nto beans, le nt ils and papaya .

Consuming foods high in potassium may balance out the intake of sodi um- rich foods , which
may help regulat e blood press ure .

FUNC TI ONS Potassium deficiencies are typically not a

Maintains an electroche mical grad ie nt resu lt of insufficient dietary in take. Ins tead,
across cell membranes (membrane t hey' re usually caused by protein wasti ng
potentiail; t ig ht reg ulation of this conditions. Som e diuretics ca n also cause DIURETICS
excess ive loss es of potassium in the urine. A pharmaceutical that
gradient is imperative for nerve impulse
eleva tes the rate of urination
transmiss ion, ca rdiac function and
EXCESS/TOXIC ITY SYM PTOMS
muscle contraction
Tingling of extrem iti es
Assists in enzyme activity (ATPase and
pyruva te kinase) Muscl e weakness
Nausea
Potass ium is the pr inc ipal cation (positively CATION
cha rged ion) of the in tra cellular flu id . Vomit ing Positively charged ions
Diarrhea
DE FIC IENCY SYMP TOMS
Toxicity occurs when the intake of
• Cardiac arrest potassium exce eds the capacity of the
kidneys for elim in at io n. This is fo und
with kidney fail ure and potas sium sparing
diuretics . Oral doses grea ter than 18 grams
of potassium can also lead to toxic ity.

SELENIUM
DI ETARY SOURCES

Selenium is found in brazil nuts , sea food, brown ri ce, qui noa , whole wheat, walnuts, milk,
mushrooms and barley.
Note foods vary III thelf setenlum content as plants: do not reqUire selenium to fun ction.

FUNC TI ONS DEFICIENCY SYMPTO MS

Acts in concert with selenoproteins, Limited glutathione activity

selenium-dependent enzymes Juve nile cardiomyopathy
Assists gluta th ione pe roxi da se in Chondrodystrophy
reducing rea ctive oxygen species
EXCESS;TOX ICITY SYMPT OMS
In te racts with nutrients inv olv ed in the
antioxidant balance of the cell Dermatologic lesions
De iod inat ion of T4 Hair and nail br ittleness
Gastrointe st in al disturbances
Skin rash
Fat igue
Nervous system abnormalities
184 UN IT 1 Chapter 7 W·Ct 0:1l, tll er t5

FIGURE 7 4
DIETARY SODIUM SOURCES

Naturally occurring
(12%)

- --\--- At the table

Food processing (6%)
(7 7 %)

If--- - Durin g cooking

(5%)

SODIUM
DIE TARY SOU RCES

Sodium is found in whole grains, whofe fruits, vegetabtes, lean meats, legumes and nuts!
seeds. In additi on, foods with salt as a fla vor enh ancer pro vide higher am ounts of sodium .
Howeve r, these foods, such as potato chips, boxed pasta, soup, pretzels, deli meats, pickles,
etc. aren't recommended. Note, a majority of the sodium and chloride in the diet comes from
salt. Consuming a diet based around whole , unprocessed foods usua lly results in a lower
sodium in take.

FU NCT IONS DEFICI ENCY SYMPTOMS

Assists in the abso rption of chloride, Nausea

amino acids, glucose, and wa ter Vomiting
Regula tes extracellular flui d status , blood Headache
vo lume, and blood pressure Cramps
Main tai ns the ele ctro chem ical gradie nt Fa tigue
across cell membranes; tight regulation
Disorien tation
of this gradient is imperative for nerve
impulse transmission, cardiac funct ion Sodium deficiency doesn 't typically result from
and muscle contraction low dietary intake. Low blood sodium is usu ally
a consequence of increased fluid retention.
Sodiu m is the principal ca ti on (positively
charged ion) of the extracell ular flui d. EXCESSITOXIC IT Y SYMPTOMS
Sodium levels in the body are reg ulated
Increased fluid volume and edema
tightly by the renin-angiotensin- al dos teron e
system and an tidiuretic hormone (arginine Nausea
vasopressin). Vomiting
Diarrhea
Abdominal cram ps

High blood sod ium usually results from

excessive water loss.
UNIT 1 Chapter 7 M .r:r Ot' lI lrl{'f'I !S 185

ZINC
DI ETARY SOURCES

Zinc is fo und in sesame seeds, pumpkin seeds, wild game, crab, poultry, beans . cashews,
chickpeas, almonds, peas, yogurt, mushrooms, oysters . and shrimp.

Zinc bioavailabilily seems to be higher from animal foocs due to the absence of inhibi tory
compounds. The amino acids cysteine and met hionin e can improve zinc absorption. Excessive
dietary folate, supplemental iron, dietary calcium, and dietary phytates can impair zinc absorption.

FUNCTIONS DEFICIENCY SYM PT OMS

Assists in growth, development, Growth retardation

neurol ogical function, re production and Lowered immune status
immune function
Skeletal abnorma lities
Acts as a critical component of apoptosis
Delayed sexual maturation
(cell death)
Po or wound healing
Acts as a catalyst: for enzymes to
catalyze chemical reac tion s. zinc must Tas te changes
be present Night blindness
Suppor ts ce ll structure: Th e st ructure Hai r loss
of proteins and cell membranes Note those at Ilsk for deficiency include the etderty,
depend upon zinc, when zinc is lost those with alcoholism, those w ith malabsOIPtlon
diseases, vegans , and those w llh sevele diarrhea
from t hese struct ures , vulnerability to
ox idative damage and deteriorating
EXCESSfTO XI ClTY SYMP TOMS
function may occur
Abdominal pain
Helps with regulation of gene
Diarrhea
exp ressions , cellu lar signaling. hormone
rele ase, and nerve impulse t ransmiss ion Na usea
Vomiting

Long~ t erm consumption of exc essive zinc

can result in copper deficiency.
186

Defic ie nc ies by body part

IF YOU HAVE.. YOU MAY BE OR HAVE ..

Ankles Swo llen ankles Over-hydrated

Brain Memory problems, Niacin (83), vitamin 812, or thiam ine (81) deficiency
disorientation or demen ti a

Eyes Puffy, swollen eyes Over-hydrated

Sunken, dull or dry eyes Vitamin A or zinc deficiency; under-hydra tion

Dry eyes with gray spots Vitamin A deficiency

Red or difficult-to-control eyes Riboflavin (82), pyridoxine (86) , thiamine (81)

or phosphorus deficiency

Face Acne Vi tamin C deficiency

Feet Tingling feet Pyridoxine (86) or vitamin 812 deficiency

Gums Sore and spongy or red and swollen Vitamin C deficiency

Hands Tingling hands Pyridoxine (86) or vitamin 812 deficiency

Lips Cracked lips Riboflavin (B2), niacin (83), or pyndoxine

(86) defiC Ie ncy

Lungs Shortness of breath Over-hydrated

Mouth and mucous Dry mucous membranes Under- hyd rated

membranes

Sore mouth Pyridoxine (86) or vitamin B 12 deficiency

Muscles Muscle spasms Calcium. magnesium or vitamin 0 deficiency

Nails Brittle, th in nai ls Iron deficiency

Saliva Sticky sa liva I dry mouth Under-hydrated

Skin Moist skin Over-hydrated

Dry, scaly. pale or bruises easily Iron, vi tamin A, C, K, zinc, essential fatty ac id
or protein deficiency

Red spots under your skin's surface Vitamin C deficiency

Coo l, pale, clammy skin Under- hydrated

Sca ly, grea sy sk in Vitamin A, zinc or ri boflavin (82) deficiency

Tongue Purple, white, or smooth Riboflavin (B2), ni ac in (83), pyridoxine (86), folic acid
and slick; painful (89), B12, zinc or iron deficiency

Sore tongue Pyridoxine ( 86 ) or Vitamin 812 defiC Iency

Urine light-colored urine Over-hydrated

Dark colored uri ne Under-hydra ted

187

Who's at risk?

HEALTH CO NDITI ON DEF ICIENCY RI SK

AIDS Vitamin 8 12

Alcoholism Th iamine (81), ribofl avi n (82), niac in (83). pa ntothen ic

ac id (85 ), pyridoxine (86), bioti n, fo lic ac id (89)

Blood loss Iron

erahn's disease Vitamin A

Diabetes mellitus Riboflavi n (82 )

Dia rrhea Selenium

Exce ssi ve consumption of goitrogenic foods Iod ine

(cassava , cabbage, rutabagas , turnips, among ot hers)

Gastric bypass Vitamin 812

Gastritis Vit ami n B12

Gluten intolerance (un t reat ed) Vitamin A

Gut flora irritation/ alteration Vitam in A

Hyperparathyroidism Py rid ox ine (86)

Hyperthyroidism (overact ive thyroid ) Vita min C

Hypothyroidism (underactive t hyro id) Riboflavin (B2)

Increased energy needs

(illne ss, intense train in g, injury rehabilitation, etc.) Vitamin A

Inflammatory bowel disease Pa nto then IC acid (85)

Lactation Vitam in C

Living in endemic areas with un- supplemented Iodine

food supplies

Menstruation (heavy or lengthy periods) Iron

Pregnancy Vitamin C, iron

Raw egg white consumption (excessive amounts) Biotin

Rheumato id arthritis Zinc

Sickle cell anemia Zinc

Smoking Vitam in C

Stress (excess ive amounts) Iod ine

Sun exposure (insufficient amou nts) Vitamin 0

Vegan diet Vi tamin B12

188 UNIT 1 Chapter 7 MIC'onutnenlS

Medication use

MEDICATION DEFICIENCY

Aminosalicylic acid Vitamin 812

Amitryptyline Riboflav in
Anticoagulant th erapy Vitami n K
Anticonvu lsants Vitamin D, fo lic aCid , vitam in B12
Anti-t hyro id therapy (methimazo le, propyl th iouracil) Iod ine
Barbitura tes Vitamin C
Carbamazepme 8iotm
Cholestyramlne Vitamin 0
Colchiclnes Vitamin 812
Colestipol Vitamin 0
Corticosteroids Vitamin 0
Cycloserine Pyridoxine, folic acid
Dlethylenetriamine Zm c
Diuretics Zmc
D-penicillamine Zmc
EPO use Iron
Estrogen/oral contracep ti ves Vitamin C, folic acid
Ethionam ide Pyridoxi ne
Hydralazine Py r idox me
Imipramine Riboflavin
Iron mega doses Copper
Isoniazid Vitamin D. niacin, PYridoxine
Metformm Vitamin 812
Methotrexate Folic acid
Neomycin Vitamin 812
Nitrous oxide Vitamin 812
Non-stero idal anti-Inflammatory drugs (NSAIDS) Iron
Omeprazole Vitamin 812
Penicillamine Pyridoxine
Pentamidine Folic acid
Phenothlazines Rlboflavm
Phenytoin Biotin
Primidone Biotin
Probenecid Riboflavm
Pyrazinamide Pyridoxine
Pyrimethamine Folic acid
Salicylates Vitamm C, Iron
Sulfasalazlne Folic acid
Tetracycline Vitamin C
Tnamterene FoliC aCid
Tri cyc li c antidepressants Riboflavin
Trlmethoprim Folic acid
Valproare Zinc
Vitamin A megadoses Vitamin K
Vitamin E megadoses Vitamin K
Zinc megadoses Copper
UNIT 1 Chapter 7 MICI onul l lenls 189

This chapter has presented a brief overv iew of each of the most Importan t dietary micronutnen ts,
food sou rces, functi ons, deficie ncy symptoms and toxicity symptoms . This overview is by no
means exhaust ive. A thorough trea tmen t of micro nutr ient absorption, transpor t, metabolism,
and excreti on, as well as deficiency symptoms and toxici ties, is beyond the scope of this
manual. For more advanced information abou t the micronut rie nts, Caroly n 8erdanie r' s
Advan ced Nutrition: Micronutrient s and Groff and Gropper's Advanced Nutrition and Human
Meta bolism are exc ellent re sources. Please se e the re ference li st at the end of this text for
more information .

A 51 -year-old obese female client follOWing a snacks to meet her calorie needs. This led us
hypocaloric diet for approximately 5 months to a sec ond hypothesis : that the cli ent was not
visited us for a follow - up appointment to discuss co nsumi ng enough vitami n B12 an d her limited
her nutrition and exercise plan. During th is stores were becoming exhausted , A deficiency of
appoin tment, sh e comp lai ned of low energy as vitamin B12 can result in neurological chan ges
well as " tingling" sensati ons in he r fingers and and a tingl ing sensat ion in the hands and feet.
toes _At first, these sensations wou ld come and go This can take time to develop, as the liver only
sporadically: recently, however, such episodes had has a limi ted supply,
become longer and more frequent.
Advancing age and synerg istic decreases of
After cons idering the description of her symptoms , intri ns ic factor in the stomach can precipitate
we began to explore causes for them. First, a vitamin B12 def iciency as well. Si nce people
we want ed to rule out excessive vitamin 86 produce less intrinsic factor as they get older,
supp lementation . An excessive intake of vitam in a subl i ngua l B12 supplement is usua lly better
86 can result in neuro logical damage and similar absorbed. After the nutritional fo llow-up
"tingling " symptoms in the extrem ities . Ho wever, appointment with us, she checked with her
a diet history revealed that the client was not doctor, who agreed that the symptoms were
using any vitamin or mineral supp lements likely due to a vitamin B12 deficien cy. The
besides a calc ium supplement. cl ient immediately began taking a vitami n B12
supplement, consu ming 100 mcg da ily, Quickly,
The diet hi story also showed a low overall intake
her "tingli ng" sympt oms disa ppeared , and she
of food (because she wanted to lose weight), and
began to feel more energy.
a re li ance upon processed calor ie-controlled
190 UN IT 1 Chapter 7 ~1" cro n ~ J t ' r· ~ j s

1. Vitamins are organic compounds (chemical compounds whose molecules contain

carbon) that the body needs in trace amounts, They have several regu lato ry
functions and do not act as a direct energy/fuel source,
2, Most minerals are considered essential and comprise a vast set of micronutrients,
They can take on different formations, like ions, in the body.
3. Phytochemicals are non-nutritive chemicals found in plants. Researc h indicates
that many of these chemicals can help to protect humans from disease,
4. Vitamins are generally categorized as either fat soluble or water soluble because
they dissolve well in either lipids or water, respectively. Vitamins A, D, E, and K
are fat-soluble. The B vitamins and vitamin C are water-soluble.
5, Vitamins have a diverse set of functio ns, from supplying a portion of co-enzymes
(such as hydrogen carriers) that cannot be synthesized by the body, to scavenging
free radicals.
6. Vitamin/mineral deficiencies and toxicities usually manifest as one or more
symptoms. Awareness of how these physical symptoms are presented is vital.
7. Minerals support biochemical processes and act as electrolytes in maintain ing the
electrochemical gradient among cells of the body. Other minerals can act as co-
factors and enzymes.
8. Micronutrient needs are highly ind iv id ualized.
9. There are many foods which contain a variety of micronutrients. The most
nutrient-dense foods have a high nutrient to calorie ratio and will improve health.
CHAPTER 8

WATER
& FLU ID
BALANC E
Chapter objectives
Key terms
The importance of body water
Fluid balance
Body water imbalances
Body water regulation
Hydration strategies
Chapter 8 Summary
KEY TERMS
bioelectrical impedance
analysis (BIA)
intracellular fluid (ICF!
extracellular fluid (ECF!
solvent
fluid balance
dehydration
insensible water losses
solute load
hyponatremia
hypotonic
electrolytes
plasma volume
cardiac output
osmolarity
hypothalamus
osmoreceptors
antidiuretic hormone (ADH)
hypovolemic
euvolemic
hypervolemic
cerebral edema
aldosterone
osmolytes
osmosis
renin-angiotensin system
angiotensin /I
angiotensin I
angiotensin converting
enzyme (ACE)
edema
193

The importance of body water

All of our cells soak in water Water makes up nearly 60 percent of total bodyweight.
Therefore, a 100 Ib woman actually carries around 60 Ib of water; a 200 Ib man carries
about 120 Ib of water And you thought came ls had a large fluid storage capacity! The
amount of water we carry is based on how much body fat and muscle mass we have as
well as our transient hydration status. Our water content depends on body composition
because different cells contain different amounts of water. For example, bone contains 22%
water, ad ipose tissues conta in about 25% water, muscle cells contain 75% water, and blood
BIOE LECTR I CA L
contains nearly 83% water.
IMPEDA NCE ANA LYS IS (B IA)
The se water ratios in the different cells of your body are cr itical to the measurement of body Method of body composition
fat us ing bioelectrical impedance analysis (BIA). You've probab ly seen the scales tha t measurement; estimates
total body water by
estimate your body fat percentage along with your we ight. These scales are based on the
determining the opposition
BIA method, which sends an imperceptible electrical current through the body. That current to flow of an electrical
travels di fferently through water or other cellular materials. If someone has a high amount current
of muscle mass (which contains a high water and electro lyte content), then the BIA device 's
electrica l current is conducted ve ry well. Conversely, a high amount of adipose tissue (which
contains a low water and electrolyte content), will impede the electrical current. After passing
the current through your body and estimating the speed at which it travels, the BIA device
performs a series of mathematical calculations to determ in e how much water weight you INTRACEL LULAR
FLUID II CF)
have as well as how much Jean mass and fat mass you carry.
Fluid inside of cells
Water in our bodies can be divided into intracellular fluid (lCF) and extracellular fluid (ECF).
EXT RAC EL LU LAR
All this water in the body has many important jobs. It acts as a solvent, as a transporter, as a
FLUID (ECF)
catalyst, as a lubrican t, as a temperature regulator, and as a mineral source. It also assists in Fluid outside of cells
anabolic processes.
SO LVE NT
WATER AS A SOLVENT AND TRANSPORTER A liquid or gas that
A solvent is a liquid that can dissolve other solids, liquids, or gases and carry/transport these dissolves a solid, liquid
dissolved chem icals in a variety of ways. In the body, water acts as a solvent to dissolve or gaseous solute

Intracellular and extracellular fluid

INTRACEL LU LAR fl UID (leF) EXTRACE LLU LAR FLU ID (EeF)

Found Enclosed w ithin cell membranes Outside of cell membranes

25% within vascu lar system, makes up plasma
porti on of blood volume
75% known as interstitia l fluid, wh ich surrounds
cells and connective t issues

Makes up About 2/3 of the body's water About 113 of body water

Higher in Potassium and magnesium Sodium and chloride

Lowe r in Sodium and ch loride Potassium and magnesium

194 UNIT 1 Chapter 8 Wa te' & FI I. IC Ba ance

Solids & Fat

28L (40%)
ECF
14L (20%)

Water
42L (60%)

FIGURE 8.1 proteins (including enzymes , DNA, etc.) and transfer them throughout the body. Water also
BODY COMPOSITION OF 70 transports nutrients to cells and carr ies waste products away from the cells.
KG LEAN ADULT MALE AS
PERCENT OF BODYWEIGHT
WATER'S ROLE IN GROWTH
AND AS VOLUME
As water can dissolve both organic and inorganic nutrients and transport them into our
cells or away from our cel ls , water is important in the synthesis of proteins, glycogen, and
other macromolecules.

WATER AS A CATALYST
As disso lved chemicals spend much of their time surrounded by water, water serves as the
medium for a large number of intracellular met abolic react ions. Indeed, in the presence of
water, chemical reactions can proceed when they might otherwise be im poss ibl e. Thus water
acts as a catalyst that speeds up enzymatic interactions with other chemicals.

WATER AS A LUBRICANT
Water lubricates joi nts and even acts as a shock absorber for the eyes and spina l cord.
Amniot ic fluid, which surrounds the growing fetus and is composed mainly of water, prot ec ts
the fetus from mechanical forces transferred through the mother's body.

WATER AS A TEMPERATURE REGULATOR

Body water content and fluid exchange regulate body temperature. When body temperature
in creases , we begin to sweat. As this sweat pools on the skin, its evaporation cools the body,
lowering body temperature.

WATER AS A MINERAL SOURCE

Drinking water is an important dietary source of several minerals, including fluor ide .
As dr inking water is processed and pollutants are removed, li me or limestone is used to
re-mineralize this water. Th is re-mineralization adds minerals suc h as calcium, magnesium,
etc. Since the min era l composition of limestone varies depending on the quarry location , the
mineral conte nt of our dr in king water also varies.
UN IT 1 Cha pter 8 'Nat e' t-. r lu, r 8a a'v, 195

100%
-----:
-
,--
80%
-
-'"
Q;

-;;:
0
g>"
60%

-'"'"
c::
~
40%
- ,--
'"
a.
20%

0% n FIGURE 8.2
WATER CONTENT OF
VARIOUS FOODS

Fluid balance
Th e idea of fluid balance is similar to energy balance, in tha t th e relationship between FLUID BALANCE
When ffuid output
fluid in (through food and drink) and fluid out (through excretion ) determines net balanc e.
matches fluid input
Avo iding flu id imbalances is impe rtan t for ove ra ll healt h.

We excrete water via urine, fe ces , sweat, and expired air. We take in water from th e food we
ea t and the beve rages we drink. On average , huma ns get about 1 L (4 cups) of water from th e
food we eat. Of course, this amount depends on our food selections. For examp le, fru its and
vegetables in their raw form hav e the highest percen tage of water. "Wet " carbohydrates like
coo ked who le grains and legumes have a fa ir amount as well. Foods higher in fat, on the othe r
han d, typica ll y have a very low water content (e .g ., nu ts, seeds, oi ls, butter, and lard).

FLUID INTAKE NEEDS

In addition to our food in take, a large percentage of ou r daily flu id in take comes from the
beverages we drink. Several factors can affect how much we drink, including clima te ,
physical act ivi ty dema nds, how much we've swea ted, overall body size, etc. Fo r example,
we get thirstier when it's warmer, and/or when we've been swe ating a lot. Thi s mechanism
is obviously in pla ce to help prevent dehydration . However, thirst is actu ally a poor indic ator DEH YDRATION
of hydra tion status . In fac t, th irst us ually isn't pe rceived until 1-2% of bodyweight is lost. At Loss of water and salts
necessary for normal
that peint, if you ' re exercising, performance decrea se s will al ready have occurred . Even if
body functioning
you're no t exerci sing, mental focus an d cla rity may drop off.

Because body wa ter ba lan ce an d th irst don't ma tch up, it's im portan t fo r most healthy
individuals to determ ine their fl uid requir em ents in advance and strive to ingest the right
amount of wa te r, rega rdless of thi rs t. There are two co mmon ways to do th is.

EST IMATE FLUID NEEDS BY METABOLIC RATE

With this method, for every 100 kcal of metabo lic rate , yo u ingest 80-110 mL of water. So,
for example, if you 've got a BMR of 2000 kcals, you requi re a daily intake of 1. 6 - 2.2 L of
water per day.
196 UN IT 1 Cha pter 8 \"'/<I te' & fl uid So lance

EST I MAT IN G FLUID NEEDS BY BO DYW EIGH T

With this method, for every kilogram of bodywe ig ht, you'd ingest 30 - 40 mL of water. So,
for example, if you weigh 50 kg (! 10 Ib), you'd require 1.5 - 2 L of water per day. And if
you're 100 kg (220 Ib), you'd require 3 - 4 L of water per day.

Accord ing to most of the literature , a safe general recommend atio n for daily fluid in take
is about 3 L of fluid (or 12 cups) each da y. Since 1 L (4 cups) comes from our food, this
means that 2 L (8 cups) comes from purposeful fluid intake (in other words, drinking).

As with the perception of thirst, several fa ctors affect actua l fluid needs. For instance, body
size is impo rtant La rger people will likely require more water, smaller people like ly require
less. More exercise and warmer clima tes can increase water requirem en ts too . If the weather
is warm, total fluid needs might increase by an additional 500 mL (2 cups) per day ev en
with no add iti onal activity, if exercise is performed, flu id needs might double, resulting in a
requirement of 6 L (24 cups) per day. Reme mber, of course, that your daily water intake can
come from both food and drink.

Interestingly, 200 to 300 mL of usable water is actually formed each day through metabolic
processes in the body. During periods of growth, this amount can be elevated. However, this
amount of water is just a small contributor toward body water balance in humans. In some
desert animals, on the other hand, this metabolic water production can be significant. This is
a very important adaptation to the low water conditions of th e desert.

FLUID LOSS
Our daily fluid loss balances our fluid in take. Healthy adults lose wate r in several ways,
INSENSIBLE WATER LOSSES In sensible water losses (losses you can't see or feel) occur via expired air in ventilation!
Loss of water via skin. respiration and evaporation from the skin. This constitutes about 0.4 to 0.5 mUhr!
evaporation and the kg bodyweight or about 650 to 850 mU24 hrs in an ave rage 70 kg adull. This can be
respiratory tract
increased during a fever.
Losses through sweating. During non-exercise conditions, water loss due to sweating
and evaporative cooling is minimal. However, during intense exercise , especially in hot
climates, sweat loss can be quite pronounced. The hi ghest recorded sweat rate during
exercise was 3.7 L - 8 pounds' - per hour, recorded by Alberto Salazar, while preparing
for the 1984 Summer Olympics . Interestingly, even higher rates (up to 5 L per hour -
and 11 Ib of bodywe ig ht) have been recorded in hot enviro nment s wi th no exercise. This

Percentage of body water loss and consequences

0.5 % 1% 3% 4% 5% 6% 10-20 %
Increased Reduced Reduced Reduced Heat Physical Death
strain on aerobic musc ular muscle exhau stion, exh austion,
the heart endurance endurance strength, cramping. heatstroke,
reduced motor fatigue, reduced com a
skills, heat mental
cramps capacity
UNI T I Cha pter 8 Water & Flu k1 Sa arc c 197

Losses through sweati ng

(min imal with no exe rcise) - - -- - - - - - " .
- 100 ml

Losses through fe ces - - - - -- - , . .

- 100 mL

Losses through uri ne

(assuming no excess intake) --+-----_
- 500 mL

Tot al : - 1500 mL

seem s puzz li ng at first , but scientists suggest t hat more wate r can actually be lost wh en FIGURE 8.3
skin blood flow can achieve maximum rates in th e absence of exerci se . DAILY WATER LOSSES

Losses through feces and urine. An ave rage adul t with normal kidney function requ ires 400 to
500 mL of wa ter to excrete the dai ly solute load in maximally conce ntrated urine. This is an SO LUTE LOAD
absolute mi nimum . Only with severe diarrhea and/or vom iti ng are GI water losses significant. Load that a substance
presents to the kidney
Remember, as li ttle as a 1-2 % reduction in bodyweight due to water loss can lead to
performan ce decrements during activity. Add itiona l losses can lead to ill ness and death.

Body water imbalances

The two most common body wate r imbalances are dehydration (too little wate r relative to
othe r so lutes) and hyponatremia (too much water relative to body sodium concentratio ns). HYPONATREMIA
Eac h of these can have profo undly negative consequences for the body. Low levels of blood sodium

DEHYDRATION
Dehyd ration is caused by a negative wate r balan ce in which water losses exceed water
intake. Under normal , non-exercise cond iti ons, dehydratio n ca n occ ur from inadeq uate
daily wate r intake, altho ugh this type of dehydrat ion is often mild. On the other hand , larger
physio logical problems can cause more severe dehydratio n, including,

vomiting burns diabetes mellitus with

diarrhea trauma ketoacidosis

fever and sweat ing kid ney failure hypoaldosteronism

dia lysis d iu ret ics

198 UNIT 1 Chapter 8 \\-'.I t" (\ t /.J 'O 8aI31'(E'

HYPOTONIC Because sweating causes a loss of both water and salts from the body, swea ting-ind uced
Osmotic pressure fower than dehydrat io n is a major co nc ern fo r athletes and exercisers. However, since sweat is a
that of a solution in wh ich It
hypoton ic so lution, the loss of water from the body is disproportionately grea ter than
is compared
the simultaneous loss of sodium and chloride. Therefore no t only do athletes lose body
water, but their electrolytes become im ba lanced. Even small amounts of water lost during
ELECTRO LYTE S
exercise can impact performance. With endurance exercise , this occurs due to a reduction
Compound that when
placed in solu tion becomes
in plasma volume. Since the plasma has a high volume of water, swea t loss will decrease
an ion; regulates flow in and blood volume . The heart must work harder to pump blood through the body and heart rate
out of celfs must go up to deliver the same cardiac output.

The body does have mechanisms in place to help prevent this dehydration effect during
PLAS MA VO LUM E
exercise. For example, as water is lost in greater proportion to sodium, sodium concentra tions
Amount of plasma in
circulation in the extracellular fluid increase. This change in blood osmolarity signals receptors in the
hypothalamus (called osmoreceptor s), which trigger the thirst mechanisms. However, as
CAROIAC OUTPU T
we've noted, this th irst is n't usually perceived unti l 1-2 % of body water is lost. At this point,
Volume of blood pumped by performance has already started to dec lin e. Thus, at hletes should plan th eir fluid intake
the heart rather than relying so lely on th irst as a guide.

Beyond performance impairment, many othe r symptoms can appear at various stages
OS MOLARI TY
Concentration of osmolicaffy
of dehydration. These include headache, fatig ue, low blood pressure , dizziness, fainting,
active particles in a solution nau sea , thirst, flushing, rap id heart rate, and constipation. As fluid continues to be lost,
symptoms can intensify until becoming potentially fatal. Some of these symptoms may
HY POTHA LAM US sound like those of a hangover, with good reason, Hig h alcohol in take can suppress
A major regulator of the certain hormones that control thirst and body water regulation. This can cause mild
body, located deep in dehydration and the resultant "hangover", charac terized by heada ches, fatigu e, thirst,
the brain, that controls and dizziness.
basic functions such as
hunger. thirst, and sexual Unlike many biological stimuli, the body doesn't "adapt" to dehydration. When
reproduction dehydrated, it's important to stop any ongoing fluid loss and begin rehydration therapy as
soon as possible . Flu id loss must be corrected th ro ug h exogenous (aka outside) means
OSMOREC EPT ORS - in other words, you must drink enough to meet you r needs, and should not wait un til
Sensory receptor that you're thirsty to drink.
detects changes in osmotic
pressure
HYPONATREM IA
Hyponatremia is almost the opposite of dehydration. We say almost opposite because
hyponatremia doesn't Just describe having too much water in the body. It also means having
too much water relative to sodium conten t. Thus , hyponatremia also describes inadequate
plasma sodium concentrations. Normal blood sodium concentrations (which are main tained
in a narrow range) typica lly fall between 136 to 145mEq/L. Hyponatremia occurs when the
plasma sodium concentration drops below 135 mEq/L. There are three common causes for
this decline in sodium, low blood volume, high blood volume, and normal blood volume.

LOW BLOOD VOLUM E

Hyponatremia can occur when both blood vo lume and tota l body water decrease yet the re's
a relatively greater decrease in sodium concent ra tion. This type of hypovolemic (low blood
HYPOVOLEMIC
Low blood volume volume) hypona tremia can be caused by vomiting, diarrhea , panc reatiti s, periton itis, burns,
rhabdomyol ysis, diuretics, osmotic diuresis, mineralocorticoid defic ie ncy and salt-losi ng
kidney diseases.
UNIT I Ch ap te r 8 \"/d ler & Hu t! Bc l,;; n:; e 199

FIGU RE 8.4
10% EFFECTS OF
DEHYDRATION ON
PHYSICAL PERFORMANCE
8%
.,
~ .,""'"
"E
'" .,c.~
-3., -.,,.,""
~ 6%
~
0
-~.<=

.-
;: 4%
"0
0
~

2'%

Impai red Reduced muscular

endu ra nce time
0%

Effect s of water loss

NORMA L BLOOD VOLUME

Hyponatremia can also occu r when both blood vo lume and total body wa ter inc rease yet EUVOLEMIC
sodium concentrati ons remain normal. Th is type of euvolemic (normal blood volume) Normal blood vo lume
hyponatremia can be caused by diuretic use, hypothy roidism, glucocorticoid deficien cy,
in creased anti·diuretic hormone (ADH) and excess ive thirst.
ANT IDIURETIC
HORMONE tADH )
HIGH BLOOD VOLUME
Hormone secreted by the
Hypona tre mia can also occur when blood volume, to tal body water, and sodium pituitary gland that helps to
control body water
concent ration s all increase yet sod ium doesn't increase in prop or ti on to body water. This
type of hypervDlemie (high blood vol ume) hypo nat remia can be caused by co ngest ive heart
fail ure, liver cir rhos is, and va rious kidney disord ers. HYPERVOLEMIC
High blood volume
Ini tia l symptom s of hyponatrem ia in clude gastrointestinal discomfort, nause a, vomiting,
headache, swollen hands and feet , co nfusion , and restlessness . In advanced stages,
hypona trem ia is a very seri ous and life th reaten ing condition because it can produce cerebral CEREBRA L EDEMA
edema , an inc rease in bra in ce ll water that results in brain swelling an d potent ially death. Excessive fluid in the brain

Thu s, al though it's important to drin k enough water to replac e flu ids and prev ent
dehyd ration, athletes should not drink overzeal ously, especia l ly during enduran ce exe rcise.
Experts re commend more bal anced intakes of fluid and electrolytes (su ch as spor ts
drinks) . While athle tes are at higher risk becau se by de libera tely re hydrating as part of
th eir exercise regime the y may inad vertently ove rc ompen sate for their fluid losses, this
also applies to non-e xercisers. In deed, within th e las t fe w years, seve ral individuals have
di ed from hyponatremi a afte r drinking too much water. This ha s occu rred in cond itions
that either disrupted thi rst re gulation or ove rr ode the body 's na tural co ntro l mechanisms.
Notable examp les incl ude th e following ,

The university student who died from drinking too much sodium -fr ee water du ri ng a
fraternity hazing .
The woma n who died from drinking too much sodium-fr ee wate r during a water·
dri nk ing con test.
200 UNIT 1 Ch apte r a \ '!,w ' 6. FlU j 8. I ~r

Relationship between blood volume, body water, and sodium concentrations

BLOOD VOLU ME TOTAL BODY WATER NA + CO NCENTRATIONS CO MMON CAUSES

Low blood vo lu me Vomiting, diarrhea ,

(hy povolemic) pancr ea titis, peritonitis,
bu rns . rhabd omYOlysis,
diuretics . osmotic diures Is,
minera locort icoid
deficiency, salt·losing
kidney diseases
Normal blood volume No change Diure tic use,
(euvo lem ic) hypothyroidism,
glucocort icOid deficiency,
inc reased ADH and
excessive thirst
High blood volum e Congestive heart failure,
(hypervo lem ic) liver cirrhosis, and va ri OUS
kidn ey disorders

Several people who died from drinking too much water after taking the drug Ecstasy,
whi ch affects thirst, body fluid balance , and sodium balance .

Body water regulation

Body water and electrolyte levels are regulated by the balance between water intake
and water excretion through the kidneys . Both thi rst and ki dney excreti on are , in turn ,
ALDO STERONE influenced by pituitary ho rmones such as ADH , adrenal hormones such as aldosterone , and
Water- and efectrolyte - con cen tra tions of blood osmolytes (soluble substances that can affect osmO Sis , such as ion s,
regulatin g hormone released
proteins, or other molecules). These mechanisms signa l thi rst when body water volume is
by the adrenal cortex
low (or solu te concentrations are high). They also signal urin ary excretion when body water
vo lume is high (or so lute co ncentrati ons are low). They ope rat e in several ways to encourage
OSMOLYTES
Organic compounds that fl uid in take and decrea se fl ui d output.
affect osmosis
ANTI·DIURETIC HORMONE (ADH )
OSMOSIS
First, an increase in blood con cenlration of so dium (for example, from a sa lty meal) ,
Movement of substances
from an area of high
stim ulates os morecept ors in the hypothalamus. These osmoreceptors then sti mulate thirst
concentration to an area of while also st im ulat in g the release of AD H. As ADH red uces fl uid output thro ugh the kidneys ,
low concentration across a the osmoreceptors both increase the amo unt of fluid coming in whi le preventing the amou nt
semi -perme able membrane of fluid going out.

AD H, also refe rred to as argin ine vasopress in or AVP, is a powerfu l co ntroll er of water and sa lt
leve ls in th e body. In add ition to being stimulated by high concen trat ions of pla sma sodium,
thi s hormone is also stimulated by water loss th rough sweat and low water intake . Indeed ,
any condition that reduces body water or increases relativ e so dium content can stimulate
ADH rel ease in order to sti mula te fluid intake while in hib iti ng the kidney 's production of urin e
(o r diures is, as the name suggests ), and thus dec reasin g fluid loss thro ugh urin ati on.
UNIT 1 Chapter 8 w ) ter 6. Fid d B3 I J n ~ 201

RENIN-ANGIOTEN SIN SY STEM

Decreased sodium de livery to the distal tubules of the kidney (tha nks to ADH reducing Ilow
through the kidneys) then activates the renin-angiotensin system . (Note, renin, with one n, REN IN- ANG IOTENS IN

should not be confused with rennin, the enzyme in rennet, a substance derived from cow SYSTEM
Hormone system that
stomachs that is used in the production of cheese.) Re nin is secreted by the kidneys. (To
regulates blood pressure
hetp remember these terms and their functions, think of their roots, the prefix "ren" comes
and fl wd balance
from from ren, the Latin word for "kidney". "Angio", derived from the Greek word for "vesset",
typically refers to the circutatory system.) When reteased, re nin then stimulates the re lease of
ANG I OTENSIN II
the hormone angiotensin II, which constricts blood vessels (aka vasoconstrict ion) and thus Hormone that stimulates
increases blood pressure. Angiotensin II can also interact with the central nervous system to aldosterone release and
stimulate thirst and to reduce fluid excretion. constric ts blood vessels ;
helps to regulate blood
Here's an interesting side note: Because angiotensin II raises blood pressure in response vol ume and pressure
to high sodium concentrations, you may have heard that people with high blood pressure
are often advised to [ower their sodium intake. This IS one possible method of keeping
angiotension [[ under control. Drugs are another method of lowering blood pressure . One of
the medications that lowers blood pressure does so by inhibiting the format ion of angiotensin
[I. Angiotensin [[ is formed from angiotensin I when angiotensin converting enzyme (ACE) ANGIOT ENS IN I
acts on it. Drugs known as ACE inhibitors can thus prevent ang iotensin [[ lormation by Hormone converted to
blocking the action of ACE that's required to convert angiotension [ to [I. Since angiotensin angiotensin /I

[[ helps to preserve water in the body, i nc luding maintaining plasma volume, preventing the
formation of angiotensin [[ reduces this fluid retention, getting rid of body water and plasma
ANGIOTENSIN CONVERTING
volume, and thus reduces blood pressure.
ENZYM E (AC E)
Aldosterone, which is also part of the ren in-angiotens in system, is a hormone secreted by Enzyme that catalyz es the
the cortex of the adrenal glands (wh ich si t atop the kidneys) in response to a high potassium converSion of angiotensin I
to angiotensin If
concentration in extraceliu[ar I[u id, [ow blood volume, and/o r [ow blood pressure. Each of
these conditions indicate that more fluid is needed in the body. For example, when the body
pe rceiv es high sodium [eve[s, it may stimulate the release of potass iu m, which then signals a
need for aldosterone. A[dosterone is also generated in re sponse to high levels of angiote nsin [I.
A[dosterone helps the body retain sodium by in creasi ng sod ium reabsorption by the kidneys.
Since sodium pulls water in the direction it's headed , aldosterone helps to conserve body water.

As you can see, most of the wate r regulating processes of the body are in place to control
and prevent dehydration . On the other hand, when fluid intake is high and concentrations
of AD H, angiotensin II , and aldosterone are suppressed, fluid losses are high . [n essence,
without these urinary "brakes " on , the healthy body can remove extra fluid at a rate that
matches lIuid intake. It's only when kidney problems exist that excess fluid accumulation,
or edema , can occur. ED EMA
Swelling from
fluid accumulation
MACRONUTRIENTS
Dietary carbohydrate and protein also affect fluid bala nc e. Ca rbohy drate storage increases
water storage in the body, for every gram of sto red carbohydrate, 3 to 4 grams of water
are also sto red. Thus higher-carbohydrate diets can lead to increased fluid storage whi le
[ow er-carbohydrate diets can lead to decreased fluid storage. Higher protein intakes tend to
stimulate small additional flu id losses because the body must increase its removal of urinary
urea (a bi-product of protein/amino ac id deam ina tion - see Chapter 3 for more on protein
metabolism). Sw itch ing to a high-protein, [ow-c arbohydra te diet triggers very rapid water
weight loss, at [ea st in the short term, from decreased stored carbohydrate and inc reased
urinary urea production. Fortunate[y these losses stabi lize after the firs t few days on the diet.
202 UN IT 1 Chapter 8 Wa ter & F,l Jl d Balance

Low water and/or high sweat

triggers the posterior
pituitary to produce ADH .

.......
·····ADH

Aldosterone
High blood potassium,
low bl ood volume, and
fow bl ood pressure
'. stimul ate the adrenal
gla nd to sec re te Ki dney conserves
aldos tero ne. and reabsorbs wa ter.

ELECTROLYTES
FIGURE 8 .5
MECHANISMS OF BODY In addition to macronutrient intake, certa in mineral intakes can affect fluid balance.
WATER CONSERVATION For example, a high dietary sodium intake encourages water storage. just as a high -
carbohydrate intake does. Fortunately, when t he kidneys are healthy, sodium and fluid
excretion can match intake. However, if kidney function is not adequate, edema may result
from overconsumption of sodium.

Electro lytes are minerals such as sodium, potassium, chloride, ca lcium and magnesium
that carry an electrical charge (positive or nega t ive) when disso lved in water. These charged
ions conduct electrical currents that enab le fluid to pass th rough cellular membranes -
essentially. they 'r e electrical transporters. As these electrolytes are so important in the
body. maintaining a proper electrolyte balance is cr iti cal for normal physiological funct ion.
And just as wi th f lu id balance. electrolyte balance is determined by the difference between
electrolyte intake and electro lyte losses.

Electrolytes can be lost as water is lost in the urine or sweat; however, this loss doesn't occu r
in the same proportions found in the blood. Sweat is a hypotonic solution, meaning that
more waler is lost than electrolytes. However. electrolyte loss can st i ll be substanti al with
high rates of water loss - for instance. when sweating from long-duration training in the heat.
Urinary losses of electro lytes are determ ined by dietary intake, Higher electrolyte consumption
leads to higher losses; while lower electrolyte consump t ion leads to lower losses.

During exercise, it's critica l to replace both fluid and electrolytes as they are lost t hrough
respiration and sweat. Although norma l dietary sodium intake can support short exerc i se
bouts, ath letes performing longer endurance exercise sessions should consider replacing
their electrolytes during and after these bou ts. Research suggests that a diluted carbohydrate
drink that also contains electrolytes is an ideal form of fl uid replacement. Note tha t
concentrations of both carbohydrate and electro lytes should be low, as the more concentrated
the rehydration solu tion is, the slower it wi ll leave the stomach. Anything greater than a 10%
concentration can hinder absorption and create GI distress and discomfort. (Not someth in g
you wan t during a hard training session or competition!) Carbohydrates can improve the
UNIT 1 Chapter 8 Wa te r & Fluid Bala<) ce 203

1 2 3 4 5 6 7 8 The Urine Color Chart shown

here will assess you r hyd rati on
sta tus (level 01dehydration) in
.c extreme environ men ts.

B .~ C C
II the urine sample

I
~ "0 "0 matches # 1, #2 , or #3 on the
~-
~ 2
~~
0
';i; "0 "0 "0 ~
e e~ ch art , you are well hydrated. If
o >-
>-
•'" "0 '"
~ "' "' your urine colo r is #7 or darker,
oE '"~ '"
0. '" ~
"0
"0
"0 l'
g
i!
-8
you are dehydrated and should
u .2'l
-;;; '" consume fluids.

rate of fluid absorption and enhance endurance, increase blood glucose, decrease the FIGURE 8.6
stress response to training, improve immu ne fun ction, decrease inflammatory damage after URINE COLOR AND
HYDRATION STATUS
tra in ing, enhance whole body hydrat ion, and improve muscle and liver glycogen synthesis.

Hydration strategies
It's fairly easy to stay adeq uately hydrated when you aren 't exercising. Meeting your basic
fluid demands simply req uire s matching your in take with your expenditure. For most
people, approximately 2 L of water per day in addition to food related fl ui d inta ke should
be su ffici ent. As we've me ntioned, a diet high in water-co ntaining whole foods - namely,
fru its and vege tables - makes it sim ple to ingest plen ty of flui d from food. You can deter mine
whether you're adequ ate ly hydrated by using simple color char ts.

However, people performing intense exercise should use additional stra tegies for fluid
replacement , suc h as the following.

BEFORE AND DURING EXERCISE

Many peop le th ink of rep laci ng lost wa ter only afte r they have begu n sweati ng heavily, or
afte r complet in g their worko ut. Ye t it's also im portan t to begin the hydra ti on process before
wa ter is lost. Th is "p re-h ydratio n" ens ures that the athlete sta rts the physica l activity we ll -
hydrated (o r euhydrated) and with normal plasma electro lyte leve ls. Th us, athletes should
consume about 500 mL of fluid ab out 30 minu te s before exercise.

During exercise , fluid and electrolyte replacement is the goal. This prevents excessive
dehyd rati on and electrolyte changes that might decrease performance . Ath letes should co nsume
approxima tely 250 mL every 15 mi nutes durin g exercise. (Remember tha t this amount will
depend on body size, ambie nt temperature of the workout en vironment , and the inten sity of the
tra ining.) As men ti oned above , these beverages should con tain a low concen tration (6-8%) of
carbo hydrates and electrolytes . To figure out how concentra ted a fluid replacement drink should
be, compare solute amounts to fluid amounts. For example, in a 500 mL solution:

TO GET .. USE . .. TO CALCULATE TH IS..

6% solu tes 30 g of carbohyd ra te + electrolyte ( 500 mL x 0.0 6 = 30 g)

8% sol utes 40 g of carbo hydra te + elec trolyte (500 mL x 0.08 = 40 g)

AFTER EXERCISE
After exe rcise , fluid intake is required to assist in recovery. If athletes don't sufficiently
replace fluid, the sodium and carbohydrate losses that they 've in currec th rough exercise will
204 UNIT 1 Chapter 8 Wa le! & FI\, ld Aa a 1'lc~

prevent them from returning to a hydrateo stilte , stimulate excessive urine production, and delay
recovery. Typically, a more concentra teo solution of 10-12% can be ingesteo at th is time, prov iding
approximate ly 0.8 g carbohyd rate per kg of bodyweight in approximate ly 500 rn l - 1 L of water.

For example, to get a 10% solut io n,

AN ATHLETE OF
TH IS BODYWEIGHT.. . NEEDS .. TO CALCULATE THIS ..

50 kg 40 g of carbohydrate in 400 mL of water 150 kg x O.B gl / 0.1 mL

100 kg BO g of ca rb ohydrate in BOO mL of water (1 00 kg x O.B g)/ 0. 1 mL

Of course, most commercial sport drinks con tain electrolytes as wel l as carbohydrates.
However, since this isn't always the case, an additional ,/, - 1 tsp of sodium can be added
to ensu re adequate electrolyte replacement.

RAPID REHYDRATION
Individuals who need rap id and comple te recovery from excess ive dehydra tion can dr in k
up to about 1.5 L of fluid per hour un til body wa ter and weigh t is replenished. This is the
maximal rate of fluid absorpt ion, assum ing that their sodium and carbo hyd rate intake is
also adequate. This type of rapid rehydration would be necessary between events dur in g
a weekend tournamen t, after weigh- in s in weight class sports such as wrestling, or after
extreme exercise bouts in hot environments.

ADDING PROTEIN
In ad dit ion to ingesti ng fl Ui d, carbo hyd rate, and el ectrolytes, research suggests th at ad ding protein
to drin ks consumeo during and aft er workou ts can hel p enhance muscle protein syn thes is, imp rove
recovery, reouce muscle so reness, dec rease protein brea kdown, enhance glycogen resynthesis ,
enhance immune function, and increase the use of body fat du ring subsequent training. Thus, we
include protein in both during and post-exercise rehydration and recovery beverages.

As a baseline, we recommend tha t athletes consume a solution of 30 g carbohyd rate and

15 g protein (a long wi th electrolytes) disso lveo in 600 mL wate r for each hour of tra ining. Th us,

IF THE ATHLET E
TRAINS FOR .. . THE Y SHOULD DRINK .. FOR A TOTAL OF. .

1 hour 30 g carb + 15 g protein in 600 mL water 30 g carb + 15 g prote in

in 600 mL wate r

2 hours First hou r: 30 g ca rb + 15 g pro tei n 60 g carb + 30 g protein

in 600 mL wa ter in 1200 mL wate r

Seco nd hou r: 30 g carb + 15 g protei n

in 600 mL wate r

To minimize GI upset, athletes sho uld sip this gradu ally ra ther t han attempting to drink it all
at once. Once the workout is done, consuming a whole food meal wi thin an hour or two of
tra ining wi ll help to rep le nish fluid and micronutrients wh ile stimulating fur ther recovery.

Remember that exe rcise in tensity and duration both determine hyd ration st rategies. Moderate
intensity recreational exercise doesn 't req uire the same aggress ive hydrat ion and recovery
st ra tegies disc ussed above. These strategies are designed for optima l results in mo re extreme
situations of fl uid loss and exerc ise in tensity. Therefore if high sweat rates and subseque nt
fluid losses aren't apparent , ath letes can probably meet t heir fluid and electrolyte needs with
normal daily in takes or slightly more.
UNIT 1 Chapter 8 vV ale l & Flu lc Ba ,anee 205

Bodybuilders, fitness athletes, and weight 2 . Decrease your carbohydrate intake. For most
classed athletes are masterful manipulators people, this means eating around 50-100 g
of fluid balance in the body. In the case of of carbohydrate per day. By doing th i s, you 'll
physique athletes, water manipulation enhances begin to lose muscle glycogen as well as
the appearance of muscularity. By reducing 3-4 g of wate r per gram of glycogen lost.
extracellular fluids, less water rests between 3. Increase sodium intake by actively salting
skeletal muscles and the skin; the muscles appear your meals and/or even adding small amounts
more prominent and the body appears leaner. of sa lt to your dr inki ng water. By doing this,
In the case of weight classed athletes such as you'll trigger your system to start actively
powerlifters or grapplers, size offers a distinct excreting lots of both sa lt and water.
advantage; thus approaching a competition about
4. Continue until two days out from the contest.
10- 15 Ib above the upper limit of the weight
class is a common strategy. If athletes can drop 2 DAYS BEFORE THE CONTEST
10-15 Ib of water in time to successfully "make
1. Drop your water intake down fourfold . For
we ight" , and then replenish this water weight
example, if you're now taking in 8 L per day,
quickly before competing, they can enter the
drop back to 2 L. Si nce the body has grown
contest heavier and, presumably, stronger.
accustomed to excreting large amounts of
While some water manipulation practices these flu id, and ad j ustments take a few days to
athletes have adopted are dangerous and life-
catch up, th is sudden drop means a negat ive
threatening, the most successful ones are based
water balance. In essence, you 'll be temporarily
on fluid balance physiology. By manipulati ng
dehydrating the body by forci ng it to lose more
fluid , carbohydrate, and sodium intake for short
water than it takes in.
peri ods of time, athletes can drop water weight
quickly and effectively for competition. In fact, 2. Increase your carbohydrate intake. For most
many of our clients have used such a system peop le, this means eating two to four times
to win powerlitting championships, physique what they've been eating for the last few
contests, and mixed martial arts titles. Although days. So , if you've been eating 50-100 g of
each athlete is different and requires slightly carbohydrate per day, increase your intake
different manipulations, the general gUidelines to 200-400 g. By doing this, your body w ill
below - laid out for physique competitors - can supercompensate muscle glycogen stores,
be used for all sorts of water manipulation , based filling out the muscles with stored glycogen
on the athlete's particular goals. as well as drawing some water into the
intracellular spaces . This means that you'll look
8 DAYS BEFORE THE CONTEST more muscular and leaner at the same time .
1. Double you r water intake. For example, if 3 . Finally, decrease sodium intake by avoiding
you're drinking 2 L per day, start drinking 4 L all sodium. Cut all extra sa lt out of your
per day. This process of increased water intake diet and avoid foods higher in sodium . Just
leads to an increase in urinary fluid losses. like with the water manipulation above, the
Sure , they' re matched by the increased water body has become accustomed to excreting
intake , so net water balance remains fairly large amounts of sodium. It will temporarily
constant. But that'll be addressed later. continue this, even in the face of low salt
2 . Continue this until six days before the contest. intakes . For a brief pe riod, more sodium will
leave the body than enter it; as it goes , this
6 DAYS BEFORE THE CONTEST sodium will draw additional water from the body.
1. Double your water intake again. Now you'll
4 . Continue until one day out from the contest
drink four ti mes your normal water intake. If you
(i .e., about 24 hours).
started with 2 L per day, you'll now dri nk 8 L.
Again, you're stimu lating increased water losses.
206 UN IT 1 Chapter 8 Wa ter & Flu id Ba lance

1 DAY BEFORE THE CONTEST 2. Decrease your carbohydrate intake. For most
1. Drop your water intake aga in by 50%. For people, this means eating around 50-100 g
exampl e, if you're now drinki ng 2 L per day, of carbohyd rate per day. By do i ng this, you'll
drop down to 1 L per day. This second drop begin to l ose muscle glycogen as well as 3·4
g of water per gram of glycogen lost.
will ensure that additional water is lost from
the body as excretion rates should still be high. 3 . Increase sodium intake by actively salting
your mea ls and / or even adding small amounts
2 . Maintain your increased carbohydrate
of salt to your drinking water. By doing th is,
intake, further filling up muscle glycogen and
you ' ll trigger your system to start actively
drawing any remaining extracellular fluid into
excreting lots of bo th sa lt and water.
your intracellu lar spaces .
4. Continue until three days out from the contest.
3. Keep your sodium l ow. Th is will contin ue to
draw sodium and additional extracellular fluid
out of the body.
3 DAYS BEFORE THE CONTEST
1. Drop your water intake down fourfold . For
4 . Continue for about 24 hours, until the
example, if you ' re now taking in 8 L per day,
contest day.
drop back to 2 L. Since the body has grown
accustomed to excreting large amounts of
CONTEST DAY
fluid, and adjustments take a few days to
1. Avoid water until the contest. catch up, this sudden drop means a negative
2. Keep carbohydrate intake high . water balance. In essence, you 'll be temporari ly
3 . Cont inue to keep sodium intake low. dehydrating the body by forcing it to lose
more water than it takes in.
For weight class athletes, who often weigh in 2. Maintain your low carbohydrate intake.
and compete on different days , or at different 3 . Finally, decrease sod i um intake by avoiding
ti mes (e.g .. weigh-in early morning. compete in all sodium. Cut all extra salt out of your di et
afternoon), the process would be a bit different. and avoid foods higher in sodium. Just like
Below is an example program for an athlete, with the water manipulation above, the body
such as an MMA athlete, who needs to weigh has become accustomed to excreting large
in 24 hou rs before the ir competition . amounts of sodium . It wi ll temporarily continue
this, even in the face of low salt intakes . For
8 DAYS BEFORE THE CONTEST a brief period , more sodium will leave the body
1. Double your water intake. For example, if than enter it; as it goes, this sodium will draw
you're drinking 2 L per day, start drinking 4 L additional water from the body.
per day. This process of increased water intake 4. Cont inue for 24 hours.
leads to an increase in urinary fluid losses.
Sure, they ' re matched by the increased water 2 DAYS BEFORE THE CONTEST
intake , so net water balance remains fairly 1. Drop your water in take again by 50% . For
constant. But that'll be addressed later. example, if you ' re now drinking 2 L per day,
2. Continue this until six days out fro m the contest. drop down to 1 L per day. This second drop
will ensure that additional water is lost from the
6 DAYS BEFORE THE CONTEST body as excretion rates should still be hig h.
1. Double your water intake again. At this point, 2. Maintain your decreased carbohydrate in take.
you'll be drinking four times your normal 3. Keep your sodium low. This will continue to
water intake. If you started with 2 L per day, draw sodium and additional extracellular fluid
you 'll now be drinking 8 L. Again , you ' re out of the body.
stimulating increased water losses. 4. Continue until weigh-in.
UN!T 1 Chapter 8 Wale' & Fluid Ba lanc e 207

AFTER WEIGH-IN 3. Continue until bodyweight is back up

1. Begin a program of rehydration to normal .

2. As described in this chapter, aim for

1.5 L of fluid reh ydration per hour (u si ng
carbohydrate, electrolytes, and protein)

Perplexed . That's how my fellow staff members a poor source of electrolytes, particularly sodium.
and I felt after working with a patient admitted This combination of a low sa lt and protein intake
to the medical center. He was diagnosed with can result in the reduced excretion of ur inary
hyponatremia and muscle wasting. However, after solutes. Restricted excretion of so lutes then limits
receiving the standard medical tests and labs, the body's ability to excrete fr ee water. And if free
nothi ng made sense. We cou ldn't quite figure out water is staying in th e body, blood sodium will be
the how this patient's hyponatremia originated . dilute. In essence, the body falls behind on free
water excretion when con suming high volumes of
With limited options left, we probed the patient
hypo-osmolar beer. And he was consuming about
with further questions about his nutritional
2 L a night. The result? Hyponatremia.
history. What was he eating? What suppl ements
or medicat io ns was he tak ing? What was Than kfull y, we averted disaster, immed iate ly
he drinking? Etc . After about 20 minutes of treat i ng t he patient with an IV solution of
dialogue, he mentioned that he consumed iso tonic sodium chloride. Thi s raised his sodium
an occasional alcoholic beverage. Hmmm. concentrat ion s to normal leve ls and triggered
We asked him to define "occasional." Well, the normal, healthy cleara nce of bo th water and
"occ asional " wasn't so occasional. He was solute. However, that was a temporary fix. To
basically drinking a six-pack of beer eve ry night. prevent this in the future, we suggested he scale
That's about 2 L of beer every night. back on the beer intake while increasing hi s
intake of healthy foods , especially protein s and
We left his room and immediately went to the
micronutrient-dense offerings. Fortunately, he took
med ica l library, where we began to re sea rch
our advice.
the effects of alcohol/beer on bl ood solutes and
plasma volume. La and behold , we discovered a If, instead of taking our advice, he had co ntinued
potential cause for his mystery condition: severe with his current pattern , we would hav e had to
hyponatrem ia secondary to beer potomania, or come up with some sort of sub-optimal , quick fix .
the regular co nsumption of high volumes of beer. For example, we m ig ht have re commended that
when he was drinking bee r, he also ea t so meth ing
Th is situation is produced by two fa ctors. First,
like beef jerky, wh ich is h ig h in bo th protein
most people who regular ly engage in excessive
and so dium that wou ld help avert the on set of
alcohol in ta ke have poor diets. They ' re usually
hypo natremia . Of course , this isn't the hea lthiest
deficien t in vi tam ins and mine ral s as we ll as
of recommendations . Howeve r, it's enough to
protein intake. Second , beer (an d most alcohol) is
prevent hyponatrem ia and brain edema .
208 UNIT 1 Chapter a Wa \t.'r & Fl. mj Ba l ~ rc l.;

l. Water makes up nearly 60 % of bodyweight. Different tissues contain higher or

lower fluid percentages based on chemical composition.
2. About 2/3 of total body water is intracellular fluid while about 1/3 of total body
water is extracellu l ar fluid.
3. Water acts as a so lvent, catalyst, lubricant, temperature regu lator, mineral source
and regulator of growth .
4. Water intake comes through food ingestion and beverage consumption . On
average, between 2 and 3 L of tota l fluid intake is required per day to balance out
water losses.
5. Fluid is lost through resp iration, sweat, urine, and feces.
6. Dehydration refers to losses in total body water wh ile hyponatremia refers to
reductions in plasma sodium concentrations (relative to total water volume).
7. The body has mechanisms to correct fluid imba lance. When fluid volumes are
low (or solute concentrations high), these mechanisms stimulate thirst and water
conservation . On the other hand, when fluid intake is high , these mechanisms
attempt to match flu id l osses w ith fluid intake.
8. Electrolytes are electrically charged ions of minerals such as sodium , potassium,
chloride, calcium and magnesium that help conduct fluid passage through cellular
membranes.
9. Adequate hydration requires attention to both daily fluid intake as well as intake
around exercise.
10. Fluids ingested before , during, and after exercise may be required in more extreme
situations of fluid losses and during extreme exercise conditions. In such cases ,
carbohydrates , proteins, and electrolytes may be required for optimal hydration
and recovery.
CHAPTER 9

SP ECIA L
NEEDS
Chapter objectives
Key terms
Sports nutrition
Nutrition for injury and rehabilitation
Nutrient needs during injury and
reha bi litation
Plant-based diets
Disordered eating
Nutrition and diabetes
Nutrition and cardiovascular di sease
Nutrition and pregnancy
Chapter 9 Summary
KEY TERMS
immuno-compromise
URT/(s)
nutritional antigens
macrophage
nutrient partitioning
meal spacin g
nutritional periodizatlOn
cardiac output
the RICE method
hyperpermeable
vasodilation
fibroblast
scar tissue
COX enzyme activity
plant-based diets
vegans
greenhouse gases
rebound intake
anorexia nervosa
amenorrhea
bulimia
binge eating
anorexia athletica
Type I diabetes
Type /I diabetes
glycation
diabetic retmopathy
lifestyle-related disea se
Western diet
hemoglobin Ale
atherosclerosis
metabolic syndrome
statin drugs
soluble fiber
neural tube defects
pre-eclampsia
UNIT 1 Chapl er 9 Spec ial NE-cds 211

Sports nutrition
While the basic nutritional needs of competitive athletes are surprisingly similar to those of
the recreational exerciser, there are a few important differences.

• Competitive athletes typically train with a high volume of exerc ise. This requires a large
calorie intake - enough to support the extreme energy demands of this type of training.

• Competitive athletes face regular immuno-compromise and must take special steps IMMUNO -COMPROM ISE
to bolster their own immune system. If athletes don't pay attention to immune system Diminished immune
recovery, they're more likely to miss train ing weeks and competitions. response due to
medications, illness,
• Competitive athletes train to force positive physiologicat adapta tion. These adaptations can age, etc.
only occur in the presence of the righ t blend of macronutrients and micronutrients.

• Competitive athletes often have to maintain their bodyweights and body fat percentages
within a narrow range if they hope to be compe titive in their sport. This means trai ning
and eating appropriately to achieve and maintain an ideal bodyweight.

• Competitive athletes must prioritize fluid and electrolyte balance. tf dehydration sets in,
performance is acutely and quickly diminished.

FUEL FOR ATHLETES

The use of energy during exercise activity is quite high in both athletes and non-athletes
alike. This means that quite a few kcals are necessary to fuel exercise activity, For example,
for a l50-pound person, even walking at 4 mph can burn about 5-6 kcat per minute, or
about 340 kcal per hour. This represents about a four-fo ld increase in energy demand vs.
rest. And that's just during a fas t-paced walk. Now imagine putting in three to six hours of
high-intensity training per day. Under these conditions el it e competitive athletes can expend
anywhere from 1000 to 2500 kcat per day as a direct result of their accumulated dai ly
activity. Add to this their basal energy expenditure (anywh ere from 1500 to 2500 kca l) and
we have a steadily growing dai ly energy need - as much as 2500 kcal per day (or more) for
smaller fema le athletes and up to 5000 kca l per day (or more) for larger male athletes.

With these high energy demands, athletes must be especially vigilant when it comes to
fueling for ac ti vity. This can be quite a challenge for a few reasons. First , athletes are
usua ll y brought up eat ing three meals per day. To ingest 3000 to 5000 kcal over three
meals is difficult. Second, the average person becomes sated at about 4 Ib of food per day.
When eating a diet that is high in fruits and vege tables, lean protein, good fats, and whole
gra ins, 3000 to 5000 kc al often requires up to 8-10 Ib of food per day, ma king an athlete
feel "stuffed." Finally, athletes who are concerned about maintaining an appropriate body
composition and bodyweight are often fearfu l of eating much more than other people. They
assume that this high volume of food will lead to weight and fat gain. Female athletes in
body-conscious spor ts such as gymnasti cs and swimming are often particularly concerned ,
as are athletes in weight-classed sports such as wrestling.

Despite these fears, athletes should be encouraged and supported throughout the process of
Increasing th eir food in take. Whil e undereating can be sustained for short period s of th e year,
in the long run it can cause several problems. As discussed in Chapter 4, when exercise
expenditure exceeds calorie intake, it creates a negative energy balance that leads to a host
of metabolic , hormonal , and adaptive challenges in th e athlete. Micronu tr ient needs can go
unmet , which can lead to clinical or sub -clinical vitamin and minera l deficiencies. Eventually,
212 UNIT 1 Ch apt er 9 Special Needs

athletes may experience immune system compro mise and illness; inc reased injury poten tial;
rapid over-reaching and overtraining; decreased metabolic rate; depression and low tra ining
motivation; premature fatigue; loss of muscle mass or inability to improve muscle size and/
or quality; and dramatic decreases in performance. Luckily, simple nutritional modifications
along wi th the establishment of sustainable habits can improve tra ini ng , decrease stress ,
im prove immune function , decrease excessive in flammation, and assist in glycogen and
protein synthesis.

IMMUNE FUNCTION
Immune syste m hea lth is of particular concern to competitive athletes. Intense bouts of
training and com petition actua ll y lead to immuno-compromise, a reduction in immune
system function, at least acutely. Indeed , the risk of infection and illness is greatly increased
immediately after training and competition.

For example, after a marathon, 50-70% of runners report symptoms of upper respiratory
URTI tract infections (URTls) and the common co ld. Consider why th is is the case: First, the
Illness caused by an acute marathon itself creates a large amount of st ress on the body. Second, before, during, and
infection, which manifests in
after the marathon, thousands of people congregate in a common loca t ion, sharing their
the upper respiratory tract
germs. Th is combination of reduced immune system activity and increased exposure leads to
an unusually high rate of sic kness.

Beyond acute exerc ise, chronic exerc i se tra ining impacts imm une function in different ways
depending on the intensity and volume of the training. If you don't exercise enough, the
immune system is weak. Likewise, if exercise volume is very high, the immune system
is also weak. Somewhe re in t he middle, with appropriately challenging yet well-managed
volu mes of exercise , imm une funct ion is optimal. This relationsh ip is known as a J-shaped
curve and is seen be low .

In addition to training, nutrition can affect immune integrity in both positive and nega t ive
ways . The ingestion of carbohydrates and amino acids/protei ns during and/or after exerc ise
and competition (generally in so-cal led "recovery drinks") can improve athletes' immuno-
competence during t he acute phase of post -exercise immu ne com promise. Ath letes who use
these types of recovery drinks enjoy a lower incidence of URTls than athletes who don't.

fiGURE 9.1,
RELATIONSHIP BETW EEN
EXERCISE VOLUME Above average
AND INFECTION

'0 Ave r age

Below average

Sedenta ry Moderate Very high

Exe rci se intensi ty

UNIT 1 Chapter 9 Spe clill Need s 213

On the other hand, eating particular foods to which we're intolerant can increase our
levels of physio logical and immune stress. In athleles, the cumulalive stress of training and
nutritional intolerance can lead to an increased ra te of infect ions when compared to an
individual training recrea tionally yet also exposed to nutritional antigens (in other words, NUTR ITIONAL ANTIGENS
foods that stimu late an inflammatory response - see Chapter 2 for more on this). This is Nutritional substan ce that
causes the immune system
another reason why athletes may experience more frequent illness than
to respond
recreational exercisers.

Even if nutritional antigens are n't present, if the body lacks key vitamins and minerals that
support Ihe function of the imm une system, ath letes may be at risk for frequen t infectio n.
Vitamins and minerals are involved in several key functions:

Building and supporting immu ne syste m lissue, such as :

• epithelia (or the linings of tissues such as the nasal passages)
• lymphoid tissue (such as the lymph and thymus glands)
Ensuring adequate amoun ts of white blood cells (leukocytes) , such as:
• lymphocytes (including B cells, which bind to fore ign invade rs; and T-cells that
coordinate the immune response and help to kill pathogens)
• phagocytes or macrophages (which clean up cellular debris once the threat MACROPHAGE
is inactivated) Type of white blood cell that
fights inflammation
Helping to produce cytokines , other substances that act as chemical messengers
Protecting ce ll s from oxidative damage

A deficiency in any of the vi tamins and minera ls iden tified below can lead to a poor immune
response and inadequ ate immune defense from foreign invaders. Here 's a Jist of the key
vitamins and minerals that may he lp support healthy immune systems.

Deficiency depresses phagocyte functions and T-cell proliferation.

TH IAM IN

Deficiency reduces thymic weight , antibody response, and lymphocyte pro lifera tion.

VITAM IN C

Th e ant ioxidant function of vi tamin C protecls phagocytes from auto-oxidalion (chemical

breakdown in Ihe presence of oxygen) . Deficiency lowers phagocyte activ ity and ability to
repair wounds.
214 UNIT 1 Chapter 9 Snec 31Need~

VITAM IN D

Stimulates monocyte and macrophage development and phagocytosis (the cleanup

of debris).

VITAMIN E

Increases lymphocyte proliferation, antibody levels and phagocytosis. Deficiency reduces

lymphocyte proliferation and phagocyte functions .

COPPER

Deficiency reduces antibody production, phagocytic activity, T-cell proliferation, and

B-cell numbers.

IRON

Deficiency reduces cytotoxic activity of phagocytes and proliferation of T-helper I ce lls.

MAGNE SIUM

Deficiency reduces thym ic cellulari ty, var ious cytokines, acute phase proteins (which help
control inflammation) and complement.

SELEN IUM

Def iciency reduces antibody production, cytokine synthesis, cell-mediated cy totoxic ity, and
lymphocyte proliferation.

ZINC

Deficiency reduces T-cell development and function .

CELLULAR ADAPTATION IN ATHLETES

Regular bouts of both aerobi c and anaerobic train in g lead to protein breakdown, which
includes both the breakdown of ce ll ula r enzymes and structural componen ts as well as
contrac tile proteins. While th is process of protein turnove r (breakdown plus synt hesis) seems
like a problem, it's actually integ ral to the manufacture of new protei ns, which leads to more
functi onally adapted tissues. For example,

After strength training, tissues that are tempora rily damaged are then recycled into bigger,
stronger contractile protei ns that are ready for increased strength challenges in the future.

After anaerobic tr ain in g, tissues accumulate higher concentration s of highly effi cien t
anaerob ic enzymes that assist in future anaerobic ATP generation.

After aerobic tra in ing , some con tra cti le proteins are lost to facilitate future aerobic
economy; however, we eventually accumulate higher concentrations of highly efficient
aerobic enzymes that assist in fut ure aerobic ATP generation.

Ye t these positive adaptations are not guaranteed just because we're capa ble of them.
Nutr ition is vital to each process. During pe ri ods of negative ene rgy balance, the body has
fewer raw materials to assist in the adaptat ion process. Optimal adaptation requires
adequate kcals.

In addition , the periods before , during , and after exercise provide critical "windows" of
opportunity to take advantage of increased nutrient sensitivity. For example, pre·exercise
UNIT 1 Chapter 9 Spe Ci al Nt' r.;J s 215

FIGURE 9 .2
MUSCLE GLYCOGEN
SYNTHESIS WITH
SUPPLEMENTATION

",-;:0
' in :E. *
'" '"
.c
~
-u
c:: '"
,.,=>
'" E
~~
01)-
00
u '"
,.,0
- u
01),.,
",blJ
<3-
'" 0
=> E
:;;:.:::;.

Placebo Carb only Carb + protein

amino acid consumption (alone or with carbohydrate) ca n reduce the amount of muscle
t issue used as a fuel source . Furthe r, consuming carbohydrates and am ino acids during and
after workouts can shift the body into a positive protein sta t us quickly after exercise, also
mak ing additional glycogen available for subsequent trai ning sessions .

BODY COMPOSITION MANAGEMENT IN ATHLETES

Many athletes must maintain their bodyweight and body composition in a narrow range
for ath letic success . This, of course, is more important in some sports than ot hers. For
example, the top 20 Olympic female cross country skiers tend to average 11 % body fat
with a tight spread of 10-12% while the top 20 male skiers tend to average 5% body fat
with a tight spread of 4-6%. This is quite a narrow range necessary in order to succeed. In
weight classed sports, athletes are expected and required to be within specific weight
ranges to compete.

Since most elite athletes are putting in roughly the same amount of training time (and
thus, unlike sedentary people, energy output through activity can't reasonably increase very
NUTRIENT PARTITIONING
much), nutrit ion is the most critical factor in managing and/or improving body composition
Allocation of nutflents to
for athletes. Adding extra "cardia" work in an attempt to create a larger caloric deficit is often
a particular destination
a mistake, especially when an athlete is following a well-designed, well-periodized training based on the body's
plan. This inappropriate use of extra training sessions could compromise performance. perceIVed reqUirements
Lucki[y there are many nutritional strategies that athletes can use , including nutrient
partitioning, improving meal spacing, adjusting macronutrient intake based on body type, MEAL SPACING
nutritional periodization ; and water manipulation strategies . We' ll discuss most of these Amount of time
strategies further in Unit 2. between feedings

It can be difficult to find the ideal balance between body compos ition management, peak
NUTRITIONAL
performance, and energy balance, thus, nu tritional periodization that matches intake to PERIODIZATION
output (i.e., training) is critical. During the off-season, when athletes are training at lower Continuous nutntlOn plan
volumes, they can prioritize faVweight loss, and thus ente r into their pre-season already in that is manipulated to
shape. When energy demands increase with added training loads, athletes ca n then eat accommodate more or les s
aggressive nutrition goals
appropriately to manage their we igh t and fue l their performance.
216 UNIT I Chapter 9 Spec la, Needs

If athletes and coaches don 't period ize their training and nutrition properly, physica l and
emotional ailments may emerge. In both anaerobic and aerobic athletes , these ai lm ents
might include poor sleep, muscle soreness, appetite and GI disturbance, anxiety, irr itability,
depression , lowered libido, regular infections, flu-like symptoms, and no motivation to train.
Each of these is associated wi th some form of over-reaching or overtraining. Although proper
nutrition alone can't stave off the effects of over-reaching or over training, it can go a long
way toward doing so. Keep in mind, though, that once severe over-reaChing or ear ly over
training sets in , rest is the only thing that can help.

FLUID NEEDS IN ATHL ET ES

As discussed in Chapter 8 , proper fluid balance is necessary for health and performance.
During exercise we lose large amounts of body water via sweating and resp iratio n.
When this water is lost without being replaced, blood and cellular water is diminished.
Since diminished blood volume decreases cardiac output and body temperature
CARD IAC OUTPUT regulation, sma ll i nc rement s of dehydration can lead to big pe rfo rm ance decrements
Volume of blood pumped as the body attempts to protect the heart from working too hard and the brain from
by the heart
gett ing too hot. Thus , body water (and the electrolytes it contains) must be replaced to
ensure ove rall hea lth and performance. Both anaerob ic and aerobic athletes should be
conscious of this during both training and competi tion, espec ially in hot climates.
Sports drinks contain ing a low concen trati on of carbohydrate, electrolytes and amino
acids can help to delay fatigue and maintain hydration. Refer to Chapter 8 for specific
rehydration guidelines.

Nutrition for injury and rehabilitation

The immediate prescription for any type of sports injury is res t, ice, compression and
THE RICE METHOD elevation (the RICE methodl. However, physical therapists and physicians often
Rest, ice, compress ion, neglect or ignore the role of nutrition in the recovery process , both during the acute
elevation; used to control
phases of early recovery and later during the rehabili tation process. In order to apply
the inflammatory response
nutrit iona l mod ifications to injured peop le, it is important to understand the process
of an acute injury
of injury repa ir.

Although most of us co nsider injury messy and disorganized, there are actually three orde rly
stages in the injury repair process for soft tissue injuries.

STAGE 1: INFLAMMATION
(Approx imately 0 to 4 days post-injury)

Re gardless of the injury type, muscle, bone , and vasc ular damage likely occur, all of
which deprive injured ti ssues of their normal flow of oxygen and nu trient-rich blood.
This red uc tion in blood fl ow, as well as the actual physical damage suffered, leads to
cell dea th. In an attempt to clear out the dam aged/dead cells and help lay down new
cells, the body initiates the in flamma tory process. Inflammation itself is stimulated by
the increased movemen t of inflammatory/immune chemicals in to the injured areas.
These chemica ls take care of the ce llu lar deb ri s and att ract plasma (fluid from the blood)
and blood proteins to the site of injury. As a resul t of this biochem ica l process, injured
tissues are removed and the process of repair is init iated. The inflamma tor y process is
characterized by three main features,
UNIT 1 Cha pter 9 Spec ial Needs 217

PA IN

Pain is believed to be a function of two things. First, certain chemicals involved in injury
repair (substance P, calcitonin , histamines, cytokines) may interact with local pain receptors
to cause the pain associated with inflammation. As inflammation proceeds, pain may also
result from the swelling/pressure placed on the nerve endings.

SWEL LI NG / ED EMA

Swelling, or edema, results from fluid seeping through damaged and now hyperpermeable
vessels into the injured tissues . These vessels can be damaged by the initial trauma . Further,
HYPERPERMEAB LE
they can be altered chemically during the Inflamma tory process.
Increased penetration

REDNESS AND HEAT through a membrane

Additiona l blood is shunted to the are a of injury, which generates increased heat from
vasodilat ion up-stream of the in jury and constriction downstream . The upstream vasodilation
is thought to be related to nitric oxide activity. VASOD ILAT ION
Widening of blood ve ssels
Alt hough painful and irritating, Ihe inflammatory process is necessary for repair. Without
inflamma tio n, injuries would not hea l. Any attempt to elim inate inflamma tio n is a mistake,
especially in acu te injury.

However, chronic injury and pain is differen t from acute injury. Excessive inflammation,
especially if it's prolonged, can le ad to other problems including excessive macrophage
activity at the sile of inflammation and continued tissue destruction. This is why
FIGURE 9 .3
inflammation management is an important concep t in long-term injury recovery and why THE BO~Y'S RESPONSE
anti-inflammatory agents are often prescribed by physicians during chronic pai n. TO STRESS

_ - - -. .~ Modulation by eNS
1. Pa in
2. Anx iety
3. Hypot he rm ia
4 . Hyperthermia

Afferent arc Efferent arc

Local wound

1. Cytokines ) • Endocrine response

1. Catecholamines
2. Oxygen radica ls p ro ducts 2. Gl ucagon
3. Neutrophil p ro ducts Syste mic inflammation 3 . Corti so l
4, Pros tano ids 4. HGH
Med iators

t
Systemic response

1. Increased ox yge n co ns umption

2. Increase d metabolic rate
3. Increa sed temp erature
4. Protein ca tabolism, loss of lean mass
5. Blood flow maldist ri bution l ea ding to ischemia
218 UNI T 1 Chapter 9 Sp ecial Needs

STAGE 2: THE PROLIFERATIVE PHASE

(Approximately 4 to 21 days)

FIBROBLAST Once the initial inflammation begins to subside, most of the damaged tissues will have been
A cell that makes the removed from the site of injury and new vasculature will have developed. This restorat ion of
structural fibers and
oxygen and nutrient flow to the damaged area allows for the proliferation and multiplication
ground substance of
of cells known as fibroblasts , which prov ide the structure of connective tissues. Once
connective tissue
this occurs, glycoproteins such as collagen and fibronect in are laid down, forming what is
SCAR TISSUE commonly called "scar tissue ." Importantly, scar tissue will lay down in alignment with
Fibrous tissue form ed as a the forces be ing placed on the area, and this scar tissue will con t racVshorten as it matures
result of wound heating to reduce the size of the inj ury.

STAGE 3: REMODELING PHASE OF INJURY

(Approximately 21 days to 2 years)

Eventually, the scar t issue formed above (typically made up of type II collagen) will be
degraded and type I collagen (much stronger) will be laid down in its place. Although
th is new tissue will never likely be 100% normal, it can become up to 80% as strong as
uninj ured tissue. Further, as this tissue is aligned along tension lines , it's important that the
tissue be used in normal functional activity throughout t he recovery process. This will help
maintain the lengt h of the scar ti ssue as well as help arrange the tissue in an organized
pattern in line with adjacent soft tissue fibers.

Bo ne healing undergoes a sim il ar yet unique regeneration process when compared to the
one described for soft tissues.

STAGE 1: REACTIVE PHASE INFLAMMATION

(Up to 2 to 3 weeks post-injury)

Bleeding from t he f ractured bone and surrounding tissue causes the frac t ured area to swell.
This phase is similar to the inflammation phase experienced in soft tissue in ju ry. Th is attracts
plasma and inflammatory cells to Ihe site of injury, which help clear out the damaged tissue
and bring in new vascular tissue .

STAGE 2: SOFT CALLUS

(From about 2-3 weeks post-injury to about 4-8 weeks post-injury)

At this point, the pain and swelling will decrease. After Stage 1 inflammation occurs , other
cells pro liferate and differentiate , forming new tissue (c artilage and woven bone). This ends
up forming the ca llus. The site of the fracture w il l st iffen, with new bone forming. The new
bone is weaker and incomplete and therefore cannot be seen on x-rays.

STAGE 3: HARD CALLUS

(From about 4-8 weeks post-injury to about 8-12 weeks post-injury)

As with soft tissue injury, the early tissue is eventually replaced . During this ph ase, new bone
begins to bridge t he fracture, cove ring the soft cailus. The cartilage and woven bone forms
lame llar bone and this occurs after a collagen matr ix becomes mineralized.
This bony bridge can be seen on X-rays.
UN IT 1 Chapter 9 Spec ial Nee ds 219

STAGE 4 : BONE REMODELING

(From about 8-12 weeks post-injury to several years)

The fracture site remodels itself, correcting any deformities that may remain as a res ult of the
injury, Lame llar bone becomes trabecu lar bone, which is nearly a strong as the original bone.
During the last phase, th is trabecular bone is resorbed and compact bone takes its place.
This compact bone closely duplicates the original bone's shape and strength. This final stage
of fracture healing can last up to several years.

Nutrient needs during injury and rehabilitation

CALORIE NEEDS
As we've already learned, increased activity results in greater energy needs, yet some athletes
intent ionally (to lose bodyweight) or unintentionally (due to improper nutrition education)
under-eat. Under-eating can lead to an increased incidence of stress fractures, ligamentous
injury, and so forth. Thus inadequ ate food intake, even in a healthy at hlete, can lead to injury.

Once an injury ha s been sustained, not consuming enough calories can also prevent an
individual from recove ring. Energy needs increase during acute injury. In fact, BMR may
increase by 15 to 50% depending on the severity of the trauma. For example , sperts inj ury
and minor surgery may increase BMR by 15-20%, while major surgery and burn injury may
lead to a 50% increase in BMR. The increased metabolic rate comes from the work that the
body must do to repair itself.

When trying to dete rmine energy needs during recovery from injury, it's important to consider
this increase in energy requirement. Of course, comparatively speaking, a recreational
exerciser or athlete will have to eat less during injury recov ery than during high- vo lume
training and competition. Yet if they return to their baseline in take, they may be under-eating.

Let's take the example of a young male athlete who is 14 years old, 5'6", and 140 lb. Based
on the mean of the three predictive equations for calculating basal metabolic rate (which you
learned in Chapter 4), we would estimate his BMR to be around 1611 kcal/day. Here's how
his energy needs would differ based on his activity and injury status:

As you can see, although energy intake should decrease (relative to training and competition)
during periods of injury repair, returning to baseline intake will lead to underfeeding . Not only
is this an important clinical note, it's an important pract ical one. Reduced physical activity

Calcu la ti ng energy needs

WHEN HE IS.. HIS ENERGY NEEDS ARE. . BASED ON ..

Sedentary 1933 kea l per day Ac t ivity factor of 1.2. or lightly active

Training and/or competing dally 2739 kcal pe r day Activity factor of 1.7

Inj ured and recovering 23 19 keal per day Activity factor of 1 ,2 and a 20% increase
in metabolism due to injury
220 UNIT 1 Cha pt er 9 SpeCia l Need s

leads to reduced appetite . Therefore if a client is eating based on hunger only, it's quite likely
that he or she may under-eat du rln g recovery, which leads to losses of lean mass, poor
healing and slow progress. Thus , while it's important for injured individuals to reduce energy
intake during periods of injury, they should still be just as cognizant of their intake as they
are during periods of high-volume train ing. This includes frequent feedings, sufficient prote in
intake, adequa te macro nutrient intake, etc .

MACRONUTRIENT NEEDS
PROTE IN

Along with calories, it's also important to consider the macronutrients ingested during per iods
of injury, In particular, increased dietary protein is recommended for injury repair. However,
athletes who are already consuming a relatively higher protein intake may not need to adjust
their eating patterns much when injured. Clinica l recommendations for in jury nutrition are
based on increasing in take from the usual O.8g1kg baseline to 1.5-2.0glkg. Since many
active individuals with a good nutrition program will already be hitting this 1.5-2.0glkg mark,
their needs should be covered. Regardless, protein intake is essential if a rapid return to
normal function is desired . Injured individuals should strive for 1 g of protein per pound of
bodyweight as a minimum .

Supplemental am ino acids have al so been shown to exert powerful effects on injury healing,
When the body is under stress, argin ine and glutamine become conditionally essent ial am ino
acids lin other words, amino ac ids that are normally not essential) . These two amino acids,
as well as ornithine and HMB, have been shown to speed up healing process in the body, We
advise our ath letes who are recovering from injury to take 14 g arginine, 3 g HMB, and 14 g
glutamine in two divided doses (two doses of 7 g arginine, 1.5 g HMB, 7 g glutamine) per day,

FAT

A diet high in trans-fats, omega -6 rich vege table oils, and saturated fat will have pro-
in flammatory effects lin other words , it will increase inflammation), while a diet high in
monounsaturated fats and omega -3 fats will have anti-inflammatory effects. As we saw in
Chapte r 6, the ratio of omega-6 to omega-3 in the diet is an important determinant of overall
inflammation in the body, and it's especially significant during normal periods of hea lthy
living when we definitely wan t to keep inflammation under control (in other words, when we
do not need the inflamma tory cascade to start the hea li ng process), In these circumstances,
the omega-6 to omega -3 ratio should be anywhere from 3: 1 to L I, which should lead to
a balanced inflammatory profile . Overall fat ba lance is also important. A good balance of
saturated, monounsaturated, and polyunsa turated fats (abou t 1/3 of total fat intake each) will
he lp to regu late the body's inflammatory profile in healthy people .

However, during acute injury, athletes shou ld inten tiona ll y decrease their omega -6 intake
and increase their omega-3 i ntake, especially in the form of fish oil. Studies have shown that
high omega-6:3 ratios (in other words , high intakes of omega-6 re lative to omega-3) reduce
collagen production , while conversely, a balanced 6:3 ratio supports healing, We recommend
supplementing with anywhere from 3-9 grams of fish oil (salmon oil, sardine oil, menhaden
oil, krill oil, etc.) per day during injury and we would extend these recommendations to
normal healthy conditions as wel l.

In addition to the omega-6:3 ratio, research has shown that increased nut and seed
consumption, as well as olive oil consumption, can mildly reduce inflammatory biomarkers
(although not as significantly as fish oil), Nuts, seeds , and olive oi l likely share a common
UN IT 1 Chapter 9 Spec ial Needs 221

mechanism, as the monounsaturated fats found in all three contain compounds can mild ly co x ENZYME ACTIV ITY
reduce COX enzyme activity (someth ing that these foods share with ibuprofen). Be aware, Either of two related
however, tha t too high a dose of any anti-inflammatory may reduce acute hea ling . enzymes that control the
production of biological
CARBOHYDRATES mediators from
arachidOniC acid
While we need glucose for injury healing, no specific carbohydrate recommendations have
been established for inju ry periods . However, dietary carbohydrate (specifically, unprocessed
carbohydrates) should likely be included in sufficient amounts to ensure adeq uate
micronutrient intake and keep insulin concentrations stable (as an anabolic hormone ,
insulin may affect wound healing). A high intake of processed carbohydrates (including
sugars), however, should be avoided as these carbohydra tes may trigger further inflammatory
processes in the body.

Of special note, a specific sub-class of carbohydrates, glycosamingens (of wh ich, the

supplement glucosamine is an example), may be helpful in the treatment of osteoarthrit is,
as this group may possess anti-inflammatory ac tivity and prevent cartilage damage. However
the use of glycosamingens during acute injury has not been shown to improve recovery.

VITAMINS AND MINERALS

In Chapter 7, we looked at vitamins and minerals in detail. Several vitamins and minerals,
including vitamins A, 8, C, and 0; and calcium, copper, iron, magnesium , manganese, and
zinc can all play important roles. Interest ingly, oral vitamin E supplementation may slow
healing so it's recommended to avoid vitamin E supp lem ents during injury.

However, the role that each vitamin and mineral plays is not well un derstood. Until further
research con firms these roles , it's unclear whether we should simply prevent deficiencies in
these key micronutrients, or whether additional supplementa tion of vitamins and minerals
provides extra benefits . It's likely that most micronutrients have some role, even tangentially,
in injury recovery, but here are the ones that appear to requ ire additional supp leme ntation.
Note that this kind of supplemen tation should only be used for brief periods following in j ury
or trauma; sustained higher doses of many of these micronutrients ca n be toxic (as in the
case of vitamin A), or in terfere with the actions of other micronutrients (as in the case of
zinc and copper) .

VITAM IN A

Vitamin A enhances and supports early in fl ammation during injury, reverses post~ i njury
immune suppression, and assists in collagen formation by modula ting the effects of
co llage nase , an enzyme that is active in the process of collagen breakdown. Collagen, a
protein that forms part of the str ucture of tissues (espeCially connec tive tissues such as
ligame nts and tendons, but also bones, skin, and blood vessels), is organized into fib ers that
are then "cross- linked" into a sturdy matrix. Stud ies have shown that collagen cross- lin kage
is stronger with vitamin A supplementation and re pair is quicker. Typica lly, 25,000 IU da ily
is recommended during short periods of time following serious trauma and surgery. With
sports injuries, supplementation with 10,000 IU daily for the first 1-2 weeks post- inju ry is
likely a safe approach. However, th is period of supplementa tio n should be brief, as vitamin
A can accumu late in the body. Assuming dietary vitamin A in take is sufficien t, post-injury
supplementation should stop after the acute phase of injury in order to avoid potential
vitamin A toxicity.
222 UN IT 1 Chapter 9 Spec lCl Neeo s

VITAM IN C

Vitamin C enhances the activity of neutrophils (white blood cells that are involved in f ighting
bacteria l infect ion) and lymphocytes during phase 1 of acute injury. It plays a key role in
collagen synthesis, as it assists in the formation of bonds between strands of collagen fibers .
In the presence of vitamin C deficiencies, collagen f ibers are formed abnormally and fibrous
tissue is weak with poor adhes ion. As vitamin C acts as a powerfu l antioxidant and immune
system modulalor, it's an important supplement for injury repair. Indeed , research suggests that
supplemental vitamin C can be beneficial in subjects recovering from surgery, injury, and ulcers.
Vitamin C supplementation of 1-2 wday is recommended during periods of injury repair.

CO PPER

Copper ass ists in the formation of red blood cells and acts in conce rt with vitamin C to form
elastin (another protein in connective tissue) and to strengthen connect ive tissue. 2-4 mwday
is recommended during the f irst few weeks of injury repair.

ZINC

Zinc is required for over 300 enzymes in the body and plays roles in DNA synthesis, cell
division, and protein synthesis. These are all necessa ry for t issue regeneration and repair.
Zinc deficiency has been associated with poor wound healing and as zinc deficiency is one
of the most common micronutrient deficiencies, supplementation of 15-30 mg per day is
recommended, especially during the initial stages of heal ing.

CA LCI UM AND IRON

Like zinc def iciencies, calcium and iron deficiencies are quite common. Because of their roles
in bone health, deficiencies in these two minerals can inc rease the fisk of stress fractures
in athletes. While these two minerals may not play direct roles in injury healing, they playa
large ro le in prevention. Healthy people should ensure that their intake of these two minerals
(preferably from food sources) is adequate.

DIETARY HERBS
In addition to the macro- and micronutrients, dietary herbs can help manage inflammation.

TURMER IC

Turmeric (a flowering plant in the ginger family) has long been used as an anti-inflammatory
agent and in wound hea li ng . It may also have anti-vira l and anti-bacterial properties. Current
research suggests that the act ive ingredient, curcumin, is responsible for some of these benefits.

GAR LI C

Biologically active compounds in garlic, such as allicin and other organic sulfur compounds,
appear to inhibit the activity of t he inflammatory enzymes cyclooxygenase and lipoxygenase
as well as impac t macrophage function . While eating additional garlic during injury is li ke ly a
good strategy, garlic extracts may be required for more measurable anti-inflammatory effects.

BROME LAIN

Brome lain, an enzyme derived from pineapple, is best known for its digest ive properties, but
it is also an excellent anti -inflammatory and analgesic compound. However, its mechanism
of action is still poorly understood.
UNIT 1 Chap ter 9 SpeCia l Needs 223

BOSWELLIA

Boswellia is a type of t ree that produces resin with an ti -in fl amma tory uses. It appears to
inhibit the action of 5-lipoxygenase and potentia ll y other inflammatory cyto kines .

FLAVONO I DS

Flavonoids are a group of plant chemicals that often function as plant pigmenls (for example,
in dark colo red fruits such as berries). Several flavonoids appear to offer health benefits ,
although it is not yet clear whelher these compounds exert direcl effects in the body, or
whether their benefits derive from secondary processes, such as the body 's attempt to expel
th em (which then generates the production of other useful chemicals).

Consum ing more flavo noid-containing foeds (such as deeply colored fr uits and vegetables or
raw cocoa) is probably a good strategy follow ing acute injury. Adding flavonoid supplements
such as bl ueberry or grape extracts, green tea extracts, citrus extracts (hesperedin, nar ingin,
etc.), quercetin/dihydrocuercetin , and rutin may lead to mo re markec ant i-inflammatory effects.

As with any nutrient that has anti-inflammatory effects, caut ion is warranted as who lesale
suppression of the inflamm atory respo nse in the body is contra indicated during the acute
phases of injury. The idea here is to prevent inflammalion from getting oul of control , not
stop it from happening.

Plant-based diets
Plant-based diets are basically vegetarian meal plans. So why not just stick with the term PLAN T· BASED DI ETS

"vegetarian diets"? Well, the concept of "vegetarianism" has taken on a life of its own. It Diet that incfudes primarily
foods of plant Of/gin
implies certa in moral and/or philosophica l motivations that may not be shared by every
person avo iding meat. People may feel that avoid ing meat is sim ply healthier, or that it's
better for the environment. Others make this choice as a result of religious or an ima l rights
beliefs. Thus we call it a plant-based diet and not vegetarian ism. The term "plant-based diet"
doesn't carry the same kind of cultural baggage. More impo rt ant ly, it emphasizes that the diet
is based on eating mostly/only foods that come fr om plants.

Because the decision to eat a plant-based diet can be based on ethical , environmental,
religious, hea l th, or economic concerns, there are several types of plant-based diets. Some
plant-based eaters still eat meat, they just eat much less than average, or may choose to
VEGANS
avoid red meat. Other plant-based eaters avoid meat, however they eat fish, dairy products,
Incfudes only foods from
and eggs . Other plant-based eate rs avoid all meat and fish, eating on ly dairy and eggs. the plantJfungi kingdom s,
And finally, vegans eat only foods from the plant kingdom, avoiding all animal products, devoid of all an imal
including dairy, honey, and/or eggs . derived ingredients

Current ly, about 2% of the population follows a plant-based diet (with I % followi ng a
vegan lifestyle). Because of the recent exp losion of media exposure, the plant-basec diel
is gaining momentum. You ' ll likely work with more and more people foll ow ing th is type
of diet as time goes on.

Why are so many people trying plant-based diets? Well, for sta rters, ea ting more
plant-basec food can improve our health. We kn ow that almost 70% of Americans suffer
from ailments associated with dietary intake, wh ich ca n be im proved when follow ing a
diet high in plant foods. Planl -based diets provide highe r amounts of certain vitamins,
minerals, phytonutrients, antioxidants, essential fatty acids, and more. By eating more
224 UNIT 1 Chapter 9 Special Needs

plant-based food, peop le end up disp lacing foods high in sugar and fat from t he diet. Of
course , people don't have to forgo an imal products entirely to ach ieve thi s goa l, they
simply have to eat mo re plan t foods.

500
FIGURE 9.4
RELATIONSHIP Sweden Ireland
BETWEEN ANIMAL FAT UK Aust ria
CON SUM PTION AND DEATH Denmark
Germany
FROM HEART DISEASE Finland
USA
Norw ay , ....Belgium
Czechoslo vakia ....Switzerlan d
Australia Netherlands
300
Ita ly ,
Bu lgaria ". New Zea land
Yugosla vi a .... .... Po land
So. Africa Fr ance
"t Zimbabwe Israel Urugua~ .... .;
m 200
Argenti na
I
Portugal .......
"
*"
'C
'" I 100
Egypt
Trinidad ......... Greece
Spain...- Cuba
,,
~ Philippines ... .rapan
Sri Lanka Pa raguay
Singapore
Hong Kong Bahamas
.... "'Peru Equator
'" Bolivia
o ~M~o~z~a~m~b~i~u~
e ____________________________________________________________
a 60 80 100 120
Animal fat grams/person per day

FI GU RE 9 .5
RELATIONSHIP
16
BETW EEN A NIM AL FAT
Canada Denmark,..
CO N SUM PTION AND DEATH
FROM CANCERS
'"~ UK USA New Zealand ,..'"
,
:;; Australia Finlan d
"- France ,
o ,.. -1rela nd
8 12
So. Afri ca Bel gium
c5
o
~
,
Poland ......
~
Switzerland
,
... .... Sweden Netherlands
o'" Israel
ID
Germany
8 Japan
", ... Italy
Spain
Hong Kong Norway Hungary
" Czec hoslovakia

*
Gree ce
"
'C
ro
4 India Cbi l€
,.. "Panama
Roma nia
Yugosla vi a
.u Venezula
:it , , Mexico
Njgeiia
, , Thailand Columbia
a Sri lanka
a 40 60 80 100 120

Anima l fat grams/ perso n per day

UNIT 1 Chapler 9 Special Needs 225

Beyond personal health, many believe that eating fewer animal products is good for the
environment and for the world's population, because of the role that raising animals for
food plays in greenhouse gas generation , waste production, water consumption, and GREENHOUSE GASES
world-wide hunger. Gases that absorb the heat
released by the surface of
While there are hundreds of ways that peop le can persona l ly help to reduce greenhouse the earth and cause global
gases, dietary choices may be an important one. A report released by the United Nations warming (carbon dioxide ,
in 2006 suggested that raising animals for food generates more greenhouse gases nitrous oxide, methane.
water vapor)
than all the cars and trucks in the world combined. Further, research published in the
Lancet recommends that people in developed countries should limit their meat-eating to
approximately three ounces per person per day to help stave off global warming.

The waste production and resource consumption of meat production is a significant concern
for many plant-based eate rs, especially given its potential impact on humans. Livestock
produce an estimated 13 billion tons of waste worldwide every year. In addition, recent
statistics suggest that producing one pound of beef uses approximate ly 2500 gallons of
water; thus some estimate that the standard omnivorous diet in the U.S. requires about
1300 gallons of water inpu t per day. A plant-based diet , on the other hand , requires only
520 ga llons of water per day. Animal producers use nearly 75% of the annual grain harvest
to feed farm animals. With nearly 1 bi l lion people going hungry wor ld-wide, many believe
we ' re unjustly prioritizing feeding the animals that feed us over feed ing .. us. Of course, we
can also choose to eat free-range, grass fed meat , which helps manage this latter problem
without requiring us to avoid meat.

There are several reasons for following a plan t- based diet and many of them are based on
a sound hea lth and/or environmental platform. However, whi le each of these reasons can
be compelling, it's important to consider all of your health options as well as env ironmenta l
strateg ies before choosing complete animal product avo idance .

Regardless of the reasons for following a plan t- based diet, it 's important to understand that
plant-based eating carries important physiological implications. Many individuals who choose
a plant-based diet only plan their intake based on what they're elim inating, which is animal
products. However, this approach doesn't give them any indication or instruction about
how to properly plan the rest of the ir dietary intake . When avoiding or minimizing animal
products, it's more difficult to get adequate amounts of certain dietary ingredients, including
dietary prote in and/or a host of other vitamins and minerals . Thus , most people following a
plant-based diet should consult with a nut ri tion profess ional before undertaking such a plan.

Of course, common nutrient deficiencies ca n be made up with supp lements and/or careful
planning. Here 's a list of the nutrients often low or miss ing in plant-based diets, and our
recommendations for supplementation.

Vitamin B12 is a product of bacterial fermentation and on ly found in reliable amounts

in an imal foods. Therefore supp lementation with this vitamin is essential for those
avoiding animal products. Plant-based eaters can get vitamin B12 from fortified products
(such as grains and non -dairy milks) and nutritional yeasts. Aim for 3-5 mcg/day from food
or 10-100 mcg/day from supplements .

Calcium is found in green leafy vegetables, ca lcium set tofu , fortified non-dairy beverages,
legumes and nuts. However, some compou nds, eaten in large amounts when following a
plant-based diet, wi ll hinder its absorption. Therefore, if the regular consumption of high
calc ium foods is sporadiC , incorporating a supplemen t can be helpful. Aim for 1000 mg per day.
226 UN IT 1 Chapter 9 SpeCIa l Need s

Because many plan t -based diets rely on soy foods for protein, it's important to note that a
large intake of soy-based foods can compromise thyroid function, especia lly when iodine
intake is inadequate. Kelp and other sea vegetables, asparagus, green leafy vegetables,
iodized salt or a re liable sea-based salt are all good sources. Without consumption of these
foods, then supplementation cou ld be critical. Plant-b ased eaters should consume about 75-
100 mcg every few days.

Omega-3 fat concentrations in the blood of non -meat eaters are lower than in omnivores.
Therefore emphasiz ing the plant-based omega -3 rich fats, which are typically high in
alpha-linolenic acids (ALA), such as flax, hemp, walnuts, canola, seaweed , perilla, salba,
etc., along with a marine-based supplement, which is typically high in docosahexanoic
acid (DHA) and eicosapentanoic acid (EPA), such as one that is algae based (or kr ill-b ased,
for plant-based eaters t hat consume seafood) is important to prevent chronic disease and
ass ist in body composition man agement. Plant-based eaters should consume at least 2 g of
added ALA per day, and add a DHNEPA supplement if possib le since ALA is only converted
inefficiently to DHNEPA in the body.

Vitamin D is found in very few foods. On ly foods fortified with vitamin D (such as many
dairy products) wil l provide any vitamin D for those eating an exclusively plant-based diet.
Plan t-based eaters should also be aware that there are mul ti ple forms of vitamin D, D2 is
animal-free, while D3 is animal-derived. Noonday sunlight on the skin is t he best source of
vitamin D. Supplementati on is imperative for those not getting sunlight, especially during
the winter months. Plant-based eaters should aim fo r 1000 IU (25 mcg) on days they
don't get any sun.

Before we move on, it's important to reiterate that it's not necessary to avoid meat to achieve
all the health benefits of a plant-based diet. Rather, these benefits can be achieved by simply
eating mo re vegetables, legumes, nuts, seeds, and fruits than the standard North American
diet typically includes. For instance , as the American Institute of Cancer Research indicates,
increasing the proportion of plant foods and decreasi ng one's intake of animal proteins can
assist in cancer prevention.

FIGURE 9.6
HOW TO STRUCTURE
OUR PLATES 'l3 (or more)
vegetables,
fruits ,
whole grains,
and beans

,
/3 (or less)
animal protein
UNIT 1 Cha pter 9 Spe cld, Nee cs 227

Disordered eating
Disorde red eating comes in many forms that range from avoid ing food altogether, to
consuming a highly restricted and regimented diet, to regular or sporadic bingeing, to various
forms of purging (such as intentional vomiting or the use of laxatives). Most often, disordered
eating presents as a combination of two or more of these behaviours. People suffering from
eating disorders typically need the help of a qua li fied professional with specific training in
this fie ld. While most untra ined individ ua ls think that eating disorders are solved by "talking
it out" or by "changing your thinking," there is no single so lut ion . This is because there is
no single cause or standard type of disordered eat ing. Disordered eating is a multifaceted
problem with various interlocking causes and social, familial, and genet ic links. As with
the term "plant-based diets", which we've chosen because of the im plied meaning of
"vegetarianism", we're using the term "disordered eating " to refer to a range of complex ,
multifactorial behaviours instead of "eating disorders", which im ply an identity (such as
"anorexic") or a na rrow ly defined patholog ical state.

People with disordered eating aren't just ha ving problems with food. They typically have
problems with their body image , have ineffective nutri tiona l coping strategies, have low
self-esteem, have no feeling of personal ident ity, and have a lack of perceived contro l. In
most cases, food is a symptom - disordered food behaviours are manifestations of deeper
problems. For instance, here are some of the potential causes of or associat ions with
disordered eating:

Low self-esteem
Feelings of inadequacy
Lack of control in life
Depression, anger, anxiety, loneliness
Troubled relationships (family/personal)
Trouble expressing emot ions
History of being teased about weight
History of physical/sexual abuse
Cultural pressures
Narrow definitions of a "good body"
Cultural norms

When you work with clients who have a suspected eating disorder, it 's imperative to be
caut ious with words and not provide reinforcement or further ideas . Without training, you
simply can't know what's wrong. Don't try to play counselor if you are not professionally
qualified to do so.

While eating disorders can ma nifest in many ways , and in response to a host of thoughts and
feelings, two critical factors often initiate disordered behavior: stric t dieting and the inability
to adjust to environmen tal stressors. The res tric tion of food tha t characterizes strict dieting
can cause preoccupation with food and a "reboun d" in take. Any strict dieters can attest to REB OUND INTAKE
this. Because particular foods , especially those higher in fat and sugar, stimulate "fee l-good" A high intake of food after
hormones and responses in the brain that help to buffer negative emotions, they can also a period of restriction
become "drug-like" for those struggling to cope with stress.

Since doctors have no requ irement to report eating disorders to health agenc ies, and many
people suffering may never seek treatment, it's hard to know how many people are affected
228 UNIT 1 Chap ter 9 Spec 3 1 Needs

FIGURE 9 .7
Restrictive type Binge- purge type
MAN IFESTATION OF
EATI NG DIS ORDER S
Over- evaluation of ea tin g, Ove r-evaluat ion of eating ,
shape , and we ight con t rol shape, and weight co nt ro l

Stric t weig ht-c ontrol behaviou r: ...-t~ St r ic t weig ht -control be havio ur:
dieting, purg in g, exercise, etc. di et in g, purging, exercise , etc.

Low body weig ht '" "

Binge ea ting Lo w body weight

~t ~
Eff ects of starvation Purging Effects of
starvatio n

with disordered eating. In addition, clinical pract itioners generall y only see people with quite
ANOREXIA NERVOSA extreme symptoms. such as full-blown, advanced anorexia nervosa ; we do n't know how
1) Use of excessive exer cise many people have mild to moderate manifestation s. Howeve r, based on cu rr ent repo rts,
to control bodywe ight
about 1% of fema le adolescents have anorexia nervosa , while near ly 4% of college -aged
2) Self- induced st arvation
women have bu li mia. We quote female statistics as the risk of developing an eating diso rd er
is abo ut th ree times highe r in women than men . Although these pe rcen tages may seem
low, remember that they are based on the entire popu lation , and rep resen t only those cases
known to medical profess iona ls. Indeed , according to the Nat ional Ass ociat ion of Anorexia
Nervosa and Associated Disorders, about 8 mill ion people in the U.S. have anorexia ne rvosa ,
bulimia, and related eating disorders . Inter esting ly, new data suggest that a large por tion of
thi s 8 million is made up of female athletes, and that almost a third of female athle tes may
strugg le with ea ting disorders. This latte r statistic is not only ala rm ing, it's highly re levant to
all coa ches and fitness professionals. After all, a large percentage of people with whom you
work will be physically active or will have been at some point in their lives .

ANOREXIA NERVOSA
Anorexia nervosa is the most commonly discu ssed eating disorder and is characterized by a
dist urbed sense of body image, a morbid fear of obe sity, a refusal to ma inta in a minima ll y
AMENORRHEA normal bodyweight, and, in women, amenorrhea (which is secondary to food restriction).
Abnormal suppression or Ano re xics rest rict food seve rely, whi ch ca uses extreme we ight loss , depressed metabolism ,
abse nce of menstruation and fatigue . Anorexia nervosa has many, like ly in ter-re la ted ca uses tha t may be biolog ical
(e .g., geneti c or neurolog ica l feat ures), psychological (emotiona l and psyc hological makeup ),
andl or soc iocu ltura l (soc ietal pressures to be lea n, muscu la r, etc). Unfortunately, anorexia
nervosa has the highest death rate of any mental illness. Others problems include anem ia,
lun g problems, bone loss and fractures , abnormal hear t rhythms, heart failure , amenorrhea,
hypogonadism, constipation, na usea, electrolyte abnormalitie s, and kidney prob lems.
UNIT 1 Chapter 9 5pf'c al Neeos 229

BULIMIA NERVOSA
Bulimia nervosa is another well-characterized eating disorder, associated with recurr ing (at BULIMIA
least twice a week) episodes of binge eating during which the individual consumes large Uncontrolled episodes of
overeating followed by some
amounts of food and feels unable to stop eating. After bingeing, the individual will use
form of purging
inappropriate compensatory efforts to avoid weight ga in, such as self-induced vomiting,
laxat ive or diuretic abuse, vigorous exercise , or fasting. There can be many causes of bulimia. BINGE EATING
Typically, bulimics are of normal bodyweight but steadily and overly apprehensive about Uncontrollable consumption
body shape and weight. Other characteristics include being college-educated; experiencing of excessive amounts of
food in a very short period
loneliness, irritability, passiVity, sadness , and suicidal behavior ; having overweight mothers
of time
who taught the m to eat as a stress coping mechanism; have domineering mothers with high
expectations of the ir ch i ldren.

Most physical complications come from purging . During purging, the stomach can rupture
or the esophagus can tear, frequent ly with fatal results. The chron ic vomiting that many
bulimics induce can lead to erosion of dental enamel and saliva ry gland enlargement. Fluid
and electrolyte disturbances can occur (notably hypokalemia, or low potassium!. Repeated
binge episodes inc rease gastric capacity, which delays emptying, blunts the release of
cholestocystekin in (CCK, a hormone secreted in the small intestine) and impairs the satiety
response. Dry mouth, mucosal trauma, receding gums, and dental caries can also resul t
from the presence of stomach acids in the mouth .

BINGE EATING
Binge eating is similar to bulimia nervosa in that it is characterized by recurring large meals
with a lack of control over the eating episodes; however, unlike bulimia it is not usual ly
followed by compensatory behaviours such as fasting or purging. Episodes can involve eating
more rapid ly th an normal, eating until uncomfortable, eating when not phys ically hungry,
eating foods despite the foods being less appealing (e.g ., while still frozen, or left over on
someone else 's plate), and/o r eating foods and then feeling disgusted/guilty/depressed .
Chronic dieting may predispose individuals to binge eating . Depression is also a common
precedent. More than one quarter of patients in we ight control programs binge at least twice
per month. Many have a history of mood disorders; parental abuse; alcoho l abuse, or other
traumatic events such as years of unusual stress. Binge eating contributes to excessive
calorie intake and is most common in obese people. Depression can also resul t, since many
are concurrently trying to reduce bodyweight. Lifelong weight cyc ling and psychological
distress are typical when the disorder goes uncontrolled .

ANOREXIA ATHLETICA
This condition occurs when an individual no longer chooses to exerc ise, but feels compelled
to do so. Individuals suffering from anorexia athletica struggle with extreme guilt and/ ANOREX IA ATHLETICA
or anxiety if they do not exercise. Anorexia athletica goes beyond a love for exercise; it's a Use of excessive exercise
to control bodyweight
compulsive behaviour in which many individuals engage in an attempt to gain more control
over their lives. It can be provoked by dieting at an early age, comments abou t body shape
by a professional/coach, and spor t-specific training. Anorexia athletica is associated with
dry hair, dry skin , hair loss, digestive difficulties, slowed heart rate, low blood pressure,
dehydrat ion, kidney problems, insomnia, joint weakness, suppressed immune funct ion,
micronutrient deficiencies and some cancers .
230 UNIT 1 Chapter 9 SJX! Ci i'J1 Nn'c<;

TREATMENT
Treatment varies depending on the severity and du rati on of th e disordered eat ing in
ques tion. With anorex ia, it generally has two phases, first, a short-term in tervention to
restore bodyweight and prevent death, seco nd, long-term therapy to improve psychological
functioning and prevent re lapse . A team approach that invo lves a physician, nurse, dietitian
and psyc hiat"st is often used . Bulim ia is typ ically treated with psychotherapy and/or
antidepressants. Sessions can be done over a six month period and the antidepressants can
be helpful for lo ng -term res ults. Th ere is no standard trea tment for binge ea ting and anorexia
athletica. Often, th e patient determines the treatment method, and co nv enti onal weight
management programs or professional cou nse lin g may be involved.

Once again, if you do not have professional qu alific atio ns and specialized training, you
should not counsel your clien ts wi th suspected eat ing disorders. You r best course of action
is to re fe r these people to an eating disorder specialist.

Nu t rit ion and diabetes

Commonly known as diabetes, diabetes me llit us (DM) is actual ly a group of metabolic
diseases characterized by chronically high concentrations of high blood suga r. This chronic
elevation of blood sugar can result fr om physiological defects in insulin secre ti on, defects
TYPE I DI AB ETE S in insulin action, or both. Type I diabetes is categorized as an absolute insulin deficiency
An auto-immune disease in which the pancr eas does not produce adequate insulin. As a res ult, blood suga r remains
that destroys pancreatic high and unco ntroll ed.
cells; results in little to no
insulin production In Type II diabete s, blood sugar remains high because of insulin resistance. In this case, an
individual has Irouble eftectively using the in sulin Ihey do produce (which may be relatively
TYPE II DIABETES normal compa red to Type I diabetes), bec ause their cells are resistant to insul in's eftect s.
When the body has become Glucose can not be properly transported into cells, and it remains in circulation. As the body
resistant to insulin, or does perceives an excess of gl ucose, it attempts to produce more insuli n in order to ma nage high
not produce it any more;
glucose levels. Th us, insul in resistan t people end up with both high circulating glucose and
this IS the more common
form of diabetes mellitus insulin, which can then also result in a poor blood li pid profile (s uch as eleva ted triglyce ri des
and LDL , or "bad cholesterol", wi th decreased HDL, or "good choles terol").

In both cases, uncontrolled blood suga r leve ls can eventually lead to the glycalion of
proteins in the body (essent ia lly the protei ns get "gummed up" with sugar and fail to
GLYCATI DN function properly) , to organ damage and eventu ally, to orga n failure. Among peop le with
Binding of a sugar molecule diabetes the risk of premature dea th is about twice that of peopl e without diabetes of sim ila r
without the controlling age. Hi gh blood sugar levels eventually degenerate the eyes, leading to so methin g ca lled
action of an enzyme
diabetic retinopathy , indeed, diabetes is the leading cause of new cases of bli ndness among
adults aged 20 to 74 years. And at least 65% of peop le with diabetes die of some form of
DI AB ET IC RE TIND PAT HY cardiovascular disease.
Damage to small blood
vessels of the eyes, due to Pote ntial complications associated with diabetes incl ude,
glycation of the retina
Growth impairment Eye disease Amputatio ns
Obesity Kidn ey disease Stroke
Ketoacidosis Non-function al Cardiovascular diseases
Greater in fant mortality intestines High blood pressure
(gestational diabetes) Nervous system
diso rd ers
UN IT 1 Chapter 9 SpeCia l Needs 231

HEALTHY DIABETIC

FIGURE 9.8
DIABETES' EFFECTS
ON THE KIDNEY
HEALTHY NEPHRON DAMAGED NEPHRON

Although Type I diabetes is typically genetic in nature (with some speculating that it
represents a type of auto- immune diso rder) and requires insulin injections to control blood
sugar, Type II diabetes is a lifestyle-related disease. 80% of those diagnosed with Type LIFESTYLE-REL AT ED
II diabetes are overfat or obese, have sedentary lifestyles and consume a diet high in DISEASE
carbohydrates, particularly refined carbohydrates and simp le sugars. Fortunately, however, Diseases that are caused
and/or affected by the way we
most Type II diabet ics can manage their condition through a comb i nat ion of exercise ,
live (e.g. amount of exercise.
nutrition, and we ight loss, which diminishes the use of prescription medications and the risk quality at nutrition, smoking.
of further disease and med ical comp lications. str ess, etc .)
232 UN IT 1 Chapt er 9 Spec ial Needs

Many simp le behaviour and li festy le mod ifications can reduce the risk of developi ng
diabetes , inc luding:

Ma intain a healthy body fat percentage (under 15% for men and under 22% for women).
Space meals evenly (every 3-4 hours is ideal) .
Avoid or minimize alcohol intake (fewe r than 5 drinks per week).
Eat one to two servings of vegetables or fruit with every meal (about 5-10 ser vings
per day).
Eat at least 25 grams of fiber per day f rom a variety of food sources.
Eat lean protein at most (if not all) meals (about 20-30 g per mea l for women and
40-60 g for me n).
Avo id trans fat consumption (shoot for 0 trans fats per day).
Exercise at least 3-5 hours per week, using a combi nat ion of resista nce exe rcise and
aerob ic exerc ise.
Minimize ref ined and high-sugar carbohydrates (except after exercise).
EaUsupp lement with foods con taining omega-3 fats, includ i ng fish oil supp lements .

As you can see from the list above, exerc ise and nutrition have an enormous in fluence on
the mani festat ion of Type II diabetes. In fact, accord ing to data from the Diabetes Prevention
Program, lifesty le interventions are even more powerful than medication when it comes
to Type II diabetes. Traditional indigenous diets based on who le, unprocessed foods with
a balanced fatty acid profile and low in refined ca rbohydra tes (in conjunction wi th ample
physical activity) can all but prevent Type II diabetes. Conversely, cultura l obse rvations have
WESTERN DIET demonstrated tha t the modern Western diet that is high in processed foods. sugar, and
Dietary pattern followed an imal fat, combined and a sedentary lifestyle, is responsible for the high incidence of Type II
by those in much ofthe
di abetes in many societ ies . Despite these suggestive findings, be careful of profess ionals who
Western world: consists of
processed and fast foods
make blanket sta t ements about " Iow-carb" or "low-fat" diets being best for diabetics . These
with high-caforie density claims are unsubstan tiated . Many different dietary strategies have been shown to work as
and fow -nutflent density long as they adhere to the general prin ciples above.

Nu tritional mod ifications for diabetes shou ld be tailo red to your clients ' treatment goals and
outcomes . Typically, t hese inc lude:

ma intaining near normal blood sugar levels (80-120 mwdL fasting),

HEMOGLOB IN Ale keeping hemoglobin Alc be low 7% ,
Gfycated hemoglobin;
reflects average blood
achieving norma l se rum lipid leve l s;
gl ucose level over the achieving norma l, hea lt hy blood pressure , and
past three months
weig ht loss.

In fact, weight loss alone often drastically improves glucose tole rance and blood sugar.

When working with diabe tic clients , it's important to recognize the signs/symptoms of high
and low blood sugar levels . Signs and symptoms of high blood sugar i nclude :

excessive hunger weight loss urinary ketones

excessive thirst weakness blurred vision
excessive urin ation infections cramps
UNIT 1 Chapter 9 Soec lai Needs 233

Signs and symptoms of low blood sugar include:

shaky weakness tingling
confused irri tab il ity nausea
hunger headache double vision

Likely ali of yo ur Type I diabetic clients and some of you r Type II diabetic clients may be
on insulin therapy, so it's important to recognize the co nnect ion between exercise, ins ulin,
and blood sugar. The effect diabetes has on an exercise session depends on seve ral factors
includ in g the type and timing of medication, blood sugar levels prior to exercise , previous
food intake , and type of exercise. Exercise is a cornerstone of diabetes ca re. It imp roves
blood sugars and in su li n sens it ivity, reduces bod y fat, improves cardiovasc ular funct io n,
and reduces stress. However, be awa re tha t it can impact insulin demands. Here are some
genera l guid elines for regulatin g blood sugar response to exerci se:

Metabolic control before exerci se: Avoid exercise if fasting sugar levels are greater th an 250
mwd L and ke tos is is present, and use cau tion if sugar levels are greater than 300 mwdL and
no ketosis is prese nt.

Before , during, and after exercise : Monitor blood sugar. In gest added ca rbohydr ate if
sugar levels are le ss than 100 mWdL. Ident ify when chan ges in in sulin or food intake are
necessary. Lea rn the blood sugar respon se to different exercise conditions.

Food intake: Consume added ca rbo hyd rates , as ne eded, to avo id low blood sugar. Have
carbohydr ate -based foods readi ly available during and afte r exercise.

Too much insulin can cause extremely low blo od sugar and death. Be sure to note ins ulin
so urces , speed of absorption, peak times of effect, and duration of effect. Reading this , yo u
probably feel as th ough this is beyo nd your scope of ex pert ise , and you're probab ly right.
That's why, without proper training, you shouldn 't be practici ng Medical Nutrition Therapy.
If you're working with a diabetic on a hos t of blood sugar medications, be sure to cali in an
expe rt to consult. (See the Introduction for more on guidelines of practice.)

Nutrition and cardiovascular disease

Cardiovascular disease (eVD) is a general category that encompasses coronary hear t disease ,
hypertension, and rhe umatic heart disease. Of ali the diseases prevalen t in Nort h Amer ic a,
eVD is the most commo n cause of death , kil ling more peo ple tha n the next six leading
causes of death com bined . Nearly 2,400 Ameri cans die of eVD each day - an average of
one death every 37 sec onds. To say that eVD is a problem of epid emic proportions would be
an unde rst atement.

eVD is la rg ely the prod uct of atheroscierosis, the progressive accre ti on of plaq ue (fatty AT HE ROSC LE ROSIS
deposits) on blood vessel wa ll s. As the blood vessels become caked with these plaques, t he Development of plaque in
the lumen (In tenor spac e)
vessels beco me increasingly narrow and blood flow con tinues to decrease . This can lead
of blood vessels
to increa sed blood pressure (hypertensio n) and poor oxygen delivery to the lissues of the
body. As athe rosclerosi s worsens and vessels narrow, blood clots can become lodged in th e
constr icted spaces. If this occurs, blood flow in the affected vessel can be stopped co mp letely
and the tiss ues downstream can die. When this takes place in a hea rt vessel, it's calied a
heart attack. Wh en it takes place in the bra in, it's called a stroke.
234 UNIT 1 Chapt er 9 Soec iol Needs

Sequences in the Progres sion of Atherosclero sis

CL INI CAL
COR REL AT ION: clinicall y Silent I Ir------;;;d" "y''."'ile;;;''-;;'';-;~;;;.;;-
ini"''''"' , -------,

MA IN GROWT H
Srowth mainly by IiPle! a(i(hhoo
MECHANISM:

EARtiES T ONSET:

NOMENCLAT URE AND IOitiallesion lesion lesion

MAIN HISTOLOGY: • n,S! cl ogtca l "nor mll" • nalnly Int race llul ar • In lf3ce ll ull ' li P'<! I,pill
' I n t r~ c e llul ar · s.ngle or m ul t l ~l\! • surla,e d~!~~t
• miKropMage . 1 1 ~'d .cc"m u l ~ t <>1 ~,cum u l al*, aceu"'u l. t,:>:> II PiC cO<u • herma toma
Ir.!l ltrat ,cr\ • 'rmlli ex\'iee ilui a' 'ccreoleX«acel1 ul ar 'l ' ~rn!lclcalc llt c lal'ers l>emo"h~ge
' lS<l~te<l loam ce li S Io CIO poets "~Id • Throm bOsIS

- -- - -- -- ENO OTHELIAL OYSFU NC TION - - -- - - - -- - - - - -- _

FIGURE 9.9 Interestingly, in recent years , fewer people have died from CVD and heart attacks . However,
ATHEROSCLEROSIS it's not due to changes in lifestyle, such as improved diet and exercise. Rather, it's due to
improvements in med ical care and treatment. The prevalence of CVD is not improving nor is
Ihe rate of heart attac ks themselves (for example, as shown by hospital admi ssion datal. We're
just developing better ways of dealing with the problems of plaque bu ild-up, heart attack, and
stroke once they occu r. Th is is unfortunate , si nce CVDs are quite preventab le in a majority of
the populat ion. As wi th diabetes, CVD is lifesty le related. Thus, improv ing diet, exercise, and
lifestyle can prevent CVD from occurring and even reverse its de lete rious effects.
M ETA BOLIC SYNDR OME
A blend of conditions The presence of what's called the metabolic syndrome pred icts CVD more strongly than any
that often occur togeth er, other individual risk factors do, including diet or genetics. Metabolic syndrome is defin ed
consisting of obesity, high
as the combination of abdominal obesi ty, high blood pressure, high blood glucose, and
blood sugar. high blood
pressure, decreased HDL
elevated tr iglycerides. Indeed, CVDs and diabetes go hand in han d. The same lifestyle hab its
and high trig/yeef/des and phys ica l cha racte ristics that cause one lead to the ot he r. (I ndeed, some argue that we
should not even conce ptua lize CVD and diabetes as separate co nditions, but rather separate
man ifestatio ns of the same underlying loundation.) Here are some of the major physiological
correlates of th e melabolic syndrom e and CVD.

HIGH BLOOD PRESSURE

High blood pressure is dangerous because the pressure wi thin blood vessels can create
vascu lar in jury. This type of in jury to the blood vesse ls ca n initiate the plaque-form ing
process and an ultima te corona ry event. Controling blood pre ssure could prevent nearly
40% of coronary events in men and 55% in women. Diets rich in fruits, vegetab les , and
whole grains, and low in sodium , can help to control blood pressure. Limiting alcohol and
exercising regularly can als o help to control blood pressure. So can weigh t lo ss.
STATIN DRU GS
Pharmaceutical agents HIGH LDL CHOLESTEROL
that decrease cholesterol Low-density li poprotein (LDU cholesterol can easily attach itsel f to artery walls, creati ng
production within the body
ath erosc lerotic plaque. Dietary modifications can red uce LD L levels by up to 30% , a rate of
via downregufation of
HMG-CoA reductase reduction that is very similar to statin drugs (a class of drugs that are prescribed to lower
UN IT 1 Chapt er 9 Spe cial N ee ds 235

cholesterol leve ls). This makes dietary interve ntions as effec tive as medications . Diets high in SOL UBLE FIBER
saturated fat and refined carbohydrates/sugars can increase blood leve ls of LDL cholesterol. Relatively mdlgestlble .
water-soluble
On the other hand, soluble fiber (especially the soluble fiber found in oats, barley and beans)
poly saccharides found
is particularly effective at reducing LDL cholesterol levels. in plants (e.g, psyllium.
pectin) that undergo
HIGH TRIG LYCERIDES metabolic processing to
High blood triglyceride levels may be a risk factor for heart disease by themselves, even enhance bowel health

when cholesterol levels are normal, as they may make the blood more likely to clot. In
addition, high blood tr iglycer ides are typically associated with low levels of the "good" high-
density lipoprotein (HDL) cholesterol. Just as with LDL cholesterol, triglyceride levels in the
blood are strongly in fluenced by diet. Satu rated fat and refined carbohyd rates can increase
blood tr iglycerides. Soluble fiber found in legumes and whole grains is extremely effective at
reducing them. Soy food consumption may also help to reduce blood lipids, as can
omega-3 fatty acids .

OBESITY
Al though obesity is also a consequence of the same lifestyle that can lead to eVDs, it's also
an independent risk factor, especially abdominal obesity (which typically indicates hig her
levels of visceral fat, around the internal organs) . It's believed that visceral adipose tissue
IS a highly produc t ive chemical "factory" that genera tes inflammatory proteins such as

interleukin-6, e-reactive protein and fibrinogen . Inflammation appears to playa cent ral role
in the development of eVD, research suggests that inflammation can damage blood vessel
walls, lead ing to both a build-up of atherosclerolic plaques as well as an increased risk of
blood clotting and stroke/ hear t attack.

DIABETES MELLITUS
Uncontrolled blood sugar can damage blood vessel wal ls and, again, initiate atherosclerosis .
Type II diabetes, which results in elevated blood glucose concentrations , thus increases
coronary risk.

INACTIVITY
Physical activ ity does not need to be strenuous to achieve health and cardiovascular benefits,
Al though health benefits increase with the amount of physical activity (up to a point), people
who are inactive can improve the ir health by becoming even moderately active for 3-5 hours
per week. In someone with established eVD, the exercise goals and outcomes may include
relief of anginal symptoms, increased maximal oxygen consumption, decreased body fat,
decreased blood press ure, increased good cholesterol, and protection against another hear t
attack triggered by increased work intensities. Moderate to vigorous physical activity is
extremely beneficial for ca rdiovasc ular health. 30 minutes per day of this form of activity is
the minimum amount recommended .

UNMANAGED STRESS
The stress response can create a hormonal cascade that aggravates the cardiovascular
system, which can lead to high blood pressure and plaque build-up. Yoga, meditation,
breathing, exercise, manag ing finances and healthy relationships can all contribute to
healthy stress levels.
236 UNIT 1 Chapter 9 Spe cial Ne€ds

HEREDITY
If someone's parents have CVD, they are more likely to develop it. People of African
descent have higher blood pressure than those of white European descent, which can lead
to early onset of CVD. While one cannot control heredity, they can control many of the
other risk factors.

As mentioned above, dietary strategies often play an important role in the prevention and
resolution of CVDs. These stra tegies typical ly center on fat intake, fruit and vegetable intake,
carbohydrate intake, and fiber intake. However, following the same strategies that improve
diabetes prognosis is also a good idea for improv ing CVD risk.

FAT INTAKE
There was a sharp decline in CVD during World War II; th is is thought to be due to the
scarcity of high-fat meats, butter, sugar and eggs, as well as calories in general. As gasoline
was rationed, more people traveled by foot. This meant people exe rcised more , were leaner,
ate less sugar, and ate less saturated fat - all factors associated with lower CVD risk. Along
with keeping saturated fat and sugar intake in check, CVD risk can be cut with an increased
intake of monounsaturated and polyunsaturated fats. In addition, ensuring an adequate
intake of the omega-3 fats is also important, as these fats have anti-inflammatory effects and
preven t blood clotting. Beyond preventing CVDs, omega-3 fats have actually been shown to
increase survival ra tes aft er su ff ering a heart attack.

FRUIT AND VEGETABLE INTAKE

Plan t -based diets have been successful at arresting CVD and even reversing it. This may
be due to the high amounts of fiber and phytonutrients, and low amounts of sa turated and
trans fat, associated with this type of diet. Pl ant-based diets are often lower in calories and
enhance satiety, which can lead to a lower bodyweight and less body fat, another important
factor. Consuming high amounts of fru its and veget ables can improve vessel elasticity. Even
the regular consumption of whole-grain foods has been shown to improve heart health.
Also, the incorpora tion of soy produc ts into the diet may lower bad cholesterol levels,
homocysteine, and blood pressure. Of course, the avoidance of meat isn't necessary here
- especially if this means meats such as fish and wild game , along with othe r lean meats.
What's important is the increase in the intake of plant foods.

FIBER AND CARBOHYDRATE INTAKE

Fi ber can bind to bile acids, which are heavily comprised of cholesterol. This binding
increases their elimination. Whole -food sources of complex, unprocessed carbohydrate,
such as who le grains, legumes, vegetables and fruits all contain ample amounts of fiber.
Nuts and seeds can also provide enough fiber to help lower CVD risk. In contrast, refined
carbohydrates are low in fiber; because of their effects on blood sugar, they also have an
unfavorab le influence on blood lipid levels.

Nutrition and pregnancy

Most people recognize tha t during pregnancy, the mother's habits can affect the health of
her offspring . Thus it's important tha t clien ts know what to ea t and what to avoid when
pregnant. To begin with , pregnancy is a period of anabolism, or growth. Women should eat
more when pregnant than they typically do , and recogni ze that the resul ting weight gain is a
critical part of a healthy pregnancy. Studies show that low gestational weight gain (in other
UNIT 1 Chapter 9 Sp ec lJ I Need s 237

words, not gaining enough weight when pregnant) often results in infants with low birth
weights, who may expe rience delayed development. The mother's weight determines fetal
weight. if she does not gain enough weight, the fe tus may rema in small simply to protect Ihe
mothe r 's bodyweight. Here are some guidelines for weigh t gain during preg nancy,

Underweight women shou ld gain between 25 and 35 Ib

Overweight women should gain no more than 15 to 25 Ib
Women 5'2" or shorter should gain between 10 and 25 Ib

To achieve this we ight gain, women should ingest an additional 300-500 kc als per day,
and closer to 500 if exe rcisi ng regularly. This means total inta ke could climb to 2500
or 3000 kcal pe r day during pregnancy. Of course, if the food choices are sound during
this increased intake, the pregnant wom an will also benefit from an increase in vitamins,
minerals, and phytonutrients . This is also critical to the mot her's health as well as the health
of the developing fetus. Without this adequate calorie and micronutrient in tak e, the rapidly
developing fetus can be subject to a host of birth defects . Inadequate nu tritional status du ri ng
development can also have consequences for the chi ld's later life, even as an adult. poo r
nutrition dur ing fetal development can lead to eventual ca rdiovascula r di sease, hypertension,
and Type II diabetes yea rs lat er.

FIGURE 9 . 10
EMBRYO AND
FETAL GROWTH

15 weeks

11 weeks

9 weeks
Ov um
7 '12 weeks
Blastocyst

1'T' J;'k
6 ,,2 wee ks

l~'~ ,-~
~
Y

24da

Fertilization age
1 2 3 • 5 6 7 8 9 10 11 12 13
" 15 16

0 1 2 3
0
•
~
5 6 7 8
~
9 10 11 12 13 ,. 15 16 17 18
Menstrual age in weeks
"2 0
0

-~
•• 0
~
"a;
~
.":t~
0

·
@";:
0 '5 1j ~ ~ '-

E~
t;
•
>
0 0.
E
~
'E•
••
.
.-::: .~
E"
~

·
;;:
~.
or
0
u
•
'"
238 UNIT 1 Chapter 9 Special Needs

During pregnancy, women should avoid the following,

Alcohol and caffeine (more than 300 mglday); high intakes of alcohol and caffeine can
lead to birth defects and spontaneous abortion
Tobacco
Cured/ de li meats, raw eggs, and raw seafood, all of which can carry harmful bacteria
Artificial sweeteners
More than 6 ounces of fish per week, because of potential heavy metal contamination. In
particular, women should avoid shark, swordfish, king mackere l, and tilefish, which are
known to be high in mercury.
Empty calories (i.e., junk food containing processed ingredients, sugar, and little nutrition)

The following nutrients should be incl uded and/ or increased during pregnancy,

VITAMIN 8 12

Vitamin 812 is an important nutrient in cell development. Since 812 is abundant in animal
foods, B12 int ake may be adequate with an omnivorous diet. However, if one is limiting their
intake of animal foods, a supplement will be essential.

FOLAT E

NEURAL TUBE DEFECTS Folate (vitamin 89) is essential to prevent neural tube defects. Intake is most critical within
Birth defects of the brain the first few weeks of pregnancy. Dark green leafy vegetables and legumes are good sources.
and spina! cord
Many other breads and cereal are fo rtified. Those of child bearing age should include ample
folate and typica lly, a folic ac id supplement is recommended by many doctors.

VITAM IN D

A deficiency in vitamin D can lead to minimal calcium absorption and a low infant birth
weight. Vitam in D is found in small amounts in many foods as well as in several fo rtified
foods. Sun exposure (20-30 minutes, 2-3 times per week) is the ideal source for vitamin D.

CALC IUM
PRE· ECLAMPSIA
Calcium intake can be important for the prevention of a condition known as pre·eclampsia .
A condition in pregnancy
Pre-eclampsia leads to hypertension and protein in the urine of pregnant women . Calcium
characterized by high blood
pressure, protein in the
needs are increased dUfing pregnancy. Good sources include dark green leafy vegetab les,
urine. and swelling bok choy, to fu, legumes, figs, seeds, nuts, fortified milks and fortified cereals.

IRON

Iron is essential for many processes, especially during pregnancy. Legumes , dark green
vege tab les, dried fruits, molasses, nuts, seeds, whole grains and an imal fo ods contain iron.
When one consumes vitamin C with iro n-containing foods, absorption is enhanced.

ZINC

Zinc is important not only for athletes but pregnant women. Its ro le in growth and
developmen t is critical in the developing fetus. Legumes, nuts, whole grains, cereals and
animal foods are good sources of zinc. Deficiency can lead to congenital malformatio ns.
UN IT 1 Chapter 9 Sp ecial Neeos 239

PROTE IN

Overall protein intake should be increased by at least 25 grams during the second and third
trimesters . This can be obtained by increased overall energy in take via whole foods or by
ingesting natural, unsweetened protein supplements. This protein becomes pa rt of the fetus'
structura t development, as approximately 2.2 Ib (l kg) of protein are incorporated mto the
development of the fet us and the placenta ,

FATTY AC IDS

Since most women are advised to limit intake of la rge fish (e.g., tuna) due to potential
environmental pollutants, toxins , and contaminants dur ing pregnancy, pregnan t women
should get an ample amount of omega -3 fatty acids from other foods including flax, walnuts,
canola oil , hemp, small fish (e .g., herring), algae, green leafy vegetables and seaweed.
Supplementation with omega-3 fish oil rich in EPA an d DHA has also been shown to be
beneficia l for both mother and child . Supplementation improves infant brain developmen t
during pregnancy and can reduce the incidence of post-partum depression in the mother
after giving birth. It's important, though, to avoid oil tha t comes from the liver of the fish,
such as cod liver oil, as this is high in potentially toxic vi tamins A and D.

Several macronutrients and micronutrients are critica l for ens uring the health of both the
pregnant mothe r and her child. Indeed, nearly 35% of major feta l cardiac defects could
be prevented by maternal use of vitamin and minera l supp lements rich in folate before
concept ion and during the pos t-conceptual perio d. In add ition to proactively seeking out the
best foods, foods high in the vi tamins and minera ls listed above, it's a good idea to take a
multivitamin/multimineral supplement (especia ll y one designed spec ifically for pregnancy).

FOOD CRAVINGS
Food cravings and aversions to certain foods are commo n during pregnancy. While there 's no
harm in satisfying food cravings, we urge caution . Many women use these cravings to justify
overeating and eating poor-quality foods, which can be detrimental to both mother and fe tus.
Pregnan t wome n shou ld be advised to eat a wide variety of nutritionally dense foods while
avoiding high-calorie, nutritionally "empty" opt ions . Following the guidelines estab li shed in
this manual is the best prescription for nutrition during pregnancy.
240 UN IT 1 Chapter 9 Special Needs

A 58-year-old male approached us for a We set the following four rudimentary goa ls,
nutritional consultation after be ing informed by which we call "Levell" goals. We'll learn more
his doctor that his blood pressure and blood sugar about the differences between client levels 1, 2 ,
were in the "dangerous" range . His fasting blood and 3 in Unit 2 .
sugar was 123 mgldL and his blood pressure
was 138/ 89. These results put him very close GOA L # 1 - BR EA KFAST

to being considered d ia betic and hypertensive. Switch from Frosted Flakes to Shredded Wheat.
One is considered diabetic when their blood
Instead of sausage, have fruit.
sugar is above 125 mgldL. And one is considered
hypertensive when thei r blood pressure is above GOAL #2 - DINNER
140/ 90 . As you can see , he was knocki ng on the Replace half of the fatty animal protein with veggies.
door of both.
GOAL #3 - MOS T DAYS
Since this man was at high risk for these lifestyle
diseases , the doctor, a rare one that preferred Instead of four alcoholic drinks , have one.
lifestyle change to medication, referred this GOAL # 4 - MOST DAYS
patient to us. He told the patient that he had
Do something physically active for at least 20
three months to shape up. If he didn't change his
minutes (his favorites were cycling and walking).
health behaviours in that tim e, he'd have to go on
diabetes and blood pressure medications. With these simple, achievable goals in mind, our
new client got excited. His first comment was, "If
After the initial news, our client started to
this is all I have to do, I' ve got it made!" He got
read about the subject of nutrition and health.
started the next day. Of course, with these simple
However, he got nowhere. He ended up feeling
goals he had no problem implementing the small
confused and overwhelmed , suffering from
changes. And after two weeks, he came back
nutr ition "informa tion overload ,lI Fin ally, when he
to us reporting that he felt much belter - both
was at his wit's end, he took his doctor's advice
physically and emotionally.
and gave us a call.
We had him keep at it - mainta ining the
Afte r a few conversations it became clear that
attitude that if he was feeling belter, why make
this client didn't want lessons in physiology,
it complicated? However, he became worried
biochemistry, etc. Clients rarely do. Th is client
after two months . He felt like he wasn ' t doing
just wanted simple direction. He wanted to know
enough. He thought he'd have to work harder.
what he needed to do to improve his hea lth via
He thought he shOUld be suffering. After talking
nutrition and lifestyle habits - he wasn 't ready for
him into sticking with what he was doing
the "why" part just yet. The "why" was just too
for one mo re month, we scheduled his next
confusing and, to him, not necessary. His mantra
doctor's appointment.
was this: "Tell me what to do!"
Amazingly to both him and his doctor, his blood
Thus we kept our approach very simple. We
pressure was down to 125/ 85 and his fasting
started with very basic, da ily life modifications.
UNIT 1 Chapter 9 Special Ne ed s 241

blood sugar was at 102 mg'dL. On top of that, he overloaded him with nutritional points systems,
had dropped 10 Ib of body fat' Not bad for a few specific diet plans to follow, and $200 per month
tiny changes! Now, even more motivated then ever, of supplements? The outcome would likely have
he wanted more, so we added a few new - but been the same as above. He would have probably
small - changes to his exercise and nutrition plan. bailed, thinking this was all too difficult, and
Once again, we recommended simple, manageable ended up on the medications anyway.
adjustments similar to the ones above. After
Here's the lesson, Don't overload your clients with
another three months' time, his weight was down
all sorts of information that's not necessary to
even further and his blood values in the healthy
get them started in the direction of better health
range. His blood pressure fell to 120/80 and his
and body composition. Most times, a complete
blood sugar was sitting at 83 mg'dL.
lifestyle overhaul isn't necessary to improve
Amazing, isn't it? Just getting rid of some of health. Nor does a crazy nutritional system full
the sugars and high-fat foods while doing a bit of dietary exchanges, meal planning, and total
more physical activity took this guy from almost abstinence from sugar, alcohol, and fat benefit or
diabetic and hypertensive to healthy. Consider interest the average person. Instead, Simple, basic
what would have happened had he not given us nutrition and exercise changes are often enough
a call! He'd probably be on medications for life. to get people moving in the right direction without
His health problems would be barely managed scaring them off.
and he'd continually get unhealthier. But what
if he had called us and we had immediately
242 UNIT 1 Chapter 9 SpeCi al Need"

1. In general, food choices and nutrient timing of competitive athletes and

recreational exercisers are similar. However, they differ in several important
ways: athletes face extreme energy demands and increased food requirements;
immune system challenges; forced physiological adaptation; tight management of
bodyweight and fat; and particular fluid and electrolyte needs.
2. If sport/exercise nutrition is neglected, consequences such as prolonged muscle
soreness, fatigue, limited performance, overtraining symptoms, loss or minimal
gain of muscle mass and impaired metabolism with unfavorable body composition
changes may occur. The period of time around workouts seems to be critical
for nutrient partitioning and tissue adaptation; thus appropriate protein and
carbohydrate intake during this period is essential.
3. Macronutrient interventions, micronutrient interventions, and nutritional
supplement additions can speed up injury repair and support return to function.
These strategies emphasize inflammation management and tissue synthesis.
4. Plant-based diets provide a host of benefits. However, people consuming less meat
must be more diligent about getting enough protein, B-vitamins, and several other
vitamins and minerals.
5. Disordered eating is a complex problem that goes beyond just food
choices and may be linked to genetics, family dynamics, and social pressures.
If you suspect disordered eating with a client, you should refer out to an
experienced professional.
6. Diabetes is actually a group of metabolic diseases characterized by high blood
sugar that results from defects in insulin secretion, insulin action, or both. Lifestyle
is the most powerful way to improve diabetes outcomes, and both exercise and
nutritional strategies play an important role .
7 . Cardiovascu lar diseases are most often characterized by atherosclerotic build up
in the arteries and eventual heart attack and stroke. As with diabetes, exercise and
nutritional strategies play an important role in disease prevention and potentially
reversal.
8. During pregnancy, nutritional intake is critical : specific foods should be eaten while
others avoided . A good mU ltivitamin supplement can help reduce the risk of birth
defects, although striving for an improved nutrient intake and ensuring adeq uate
calories is most important.
UNIT 2

Nutritiona I
Practice
CHAPTER 10

ST EP 1·
PREPARING
FOR YO UR
CLIENT
Chapter objectives
Key terms
Step 1: Preparing for your client
What it means to be a good coach
Understandi ng your clients
Readiness for change
Overcoming client objections
What should you know? What
should your clients know?
Chapter 10 Summary
KEY TERMS
coach
archetype
commitment to change
outcome goals
behavior goals
client objections
information dump
UNIT 2 Chapter 10 Ste;; 1 Pr8;J cll lng for Yo ur Cli ell t 247

Step 1: Preparing for your client

The nutritional consultation process begins with you. Before ever meeting with a clien t to COACH
discuss nutrition, you must be prepared to tackle the human side of lifestyle change. Before Someone who is involved
with the direction, teaching,
you can ever hope to help clients with the food aspect of their nu tritional programs, you must and training of an individual
understa nd some fundamentals of teaching, coaching , psychology, and goal-setling. All the
food discussion in the world won't make you a good coach . If you are committed to helping
your clie nts make a change, you need to learn about people.

WHAT IT MEANS TO BE A GOOD COACH

A great coach is the cornerstone of any great exercise and nu trition program. As a persona l
trainer, it's your responsibility to consistently strive to improve your abilities as a coac h.
Ask yourself,

Is becoming a great coach a priority for me?

Do I constantly seek ways to be a better coach and mentor to my clients'
Do I read coaching books, talk to successful coaches, and seek out ways to improve my
own coaching abilities?

If you answered yes to these questions, you're on the right track. If not, you're in trouble.
You ' ll soon learn that all the anatomy and physiology knowledge in the world won't help
a cli ent lose fat or gain muscle if you can't coach them to do a squat properly or motivate
them to do a set of 10 proper squa ts when they only feel like doing three. The same is true
for nutrition. Knowing exactly which foods you r clients should be eating for optimal body
composition, hea lth, and performance is essential. Bu t if you can't coach them on where to
find those foods in the grocery store, how to prepare them properly, how to ensure they're
available when they need them , and how to deal with situations where healthy eating isn't
supported by other people, they won't see any progress.

Table 10.1 ou tlines 12 principles that you should follow to become the best coach you can
be . Each principle is defined, described, and pu t into con text with a nut rition or exercise
example. If you comm it to fol lowing each of these simple principles, and developing your
skills in these areas, your ability to help your clients make significant change will
improve immeasurably.

Before you meet with a client for the first time, review the principles to remind yourself how a
great coach would treat the situation. At first, yo u'll have to do this del iberately. Practice. And
keep working on your skills by commun icating wi th and/or readi ng books by great coaches .
Eventua lly, these principles will become second nature .
248 UNIT 2 Chapter 10 Steo 1 PrepaT .ng lor YO t,r CI·cn l

Twelve princip le s of coaching excellence

PR INCIPLE DESCRIPTIO N N UTRITION AND EXE RCISE EXAMPLES

1. Know, do , and coach . The best coaches know what To teach someone how to lose fal ,
they're coachin g, do (or have you should know how to lose fat,
done) wha t they're coaching, and you should have lost fa t yourself,
have successfully coached what and you should have a histor y in
they're coaching. helping others lose fat. Without
knowledge, experience, and success
in helping others, It'S difficult to
teach fat loss to a client.

2 . Teach and communicate. The best coaches are sk ill ed A great coach will have di ffe rent
teachers. No t only do they have ways of demonstrating, desc flb ing,
the patience to teach a subject and supervising exercise instructi on;
they know well to others, they each method is designed to reach a
also have the wisdom to know different type of learner.
that not everyone tearns the same
For example , you might show
way. Strategies that work for a
clients how to perform a squat. then
20-year-old male might not work
describe how to perform it, and
for a 55-yea r-old female. Strategies
fin al ly supervise th ei r performance
that work for a kinesthetic learner
of the squat. With each technique ,
might not work for a verbal learner.
you use coaching cues that will
To teactl each client effectively, a
enhance the clients' learning.
coach must have a wide range of
communication styles.

3. Control information transfer. Good co aches teach skills to the ir When teaching a client how to better
clients as they're ne eded, th ereby control blood suga r and manage
control ling the flow of information. hunge r, a great coach will sta rt by
On the other hand, poor coaches giving clear, practical instructions,
dump information on the ir clienls. such as telling the client how
Informa t ion dump happens when frequently to eat and exac tl y which
coaches are trying to impress; slow-digesting foods to eat. Poor
trying to help the client understand coaches tend to launch into a
th e "whys"; and/or so excited about physiology and biochemistry lesson
their own learning that they feel on gut transfer time, pancreat ic
they wan t to teach what they know in sulin secretion, and glucose
to everyone. to lerance. This latter information is
what the coach needs to know, not
Regardless of the reason, at first
what the cl ien t needs to know.
clients should only be exposed to
a minimal amount of theory while
getting a lot of practical information.
What the coac h needs to know
(theory) and what th e client needs
to know (practical applications) are
often two different things.
UNIT 2 Chapter 10 Step I Pr eoa ll'lg for Yo:,; r e lent 249

Twelv e pri nci ples of co aching exc ell en ce

PR I NC IPLE DESCR IPTION NU TRIT I ON AND EXERC I SE EXAMP L ES

4. Unlock. The ability to motivate is an When discussing good nutrition with a

importan t quality that all coaches clien t. it's important to find ou t exactly
mu st develop. To become an wh y they want to improve their diet.
effe ctive mo tivator, it' s critical to
Ar e they mo tivated positively (toward
understand the "type" of client
some source of pleasu re) or negatively
you're working with.
(away from some source of pain)? For
Ty pically, cl ie nts fa ll into one of a Instance, are they moti va ted most by
few categories (archetypes} tha t the prospect of looking hot in a pair
rep re sen t the sum total of their of Jeans (positive) or by avoiding a
in ner desires and motivations. By lifestyle disease that took one of their
un derstand i ng their archetype, you pare nts (negative)?
can stimulate and maintain th eir
Good coaches understand
interest in progress.
these motivations and tap into
the m w hen the c lie nt is feeling
u ni nspi red or wea k.

5. Ask good questions. Individual differences in learning If a client is having a hard time
sty le, personal motivat io ns, and lea rn i ng a spe cific exercise , thei r
emo tional trigger s will di rect your di ff iculty may be physical or
coac hing style and help you unlock emotional. They may simply not
client archetypes. To pick up on have op timal rec rui tment patterning
these cu es. you must as k the right or flexibility to perfo rm it pro perl y. In
questions and be a good listener thiS case you have to improve thei r
while they' re being answered. firing or flexibility.

Or, they may Sim pl y not know how to

make their body move in that speci fic
way. In this case you have to learn
whether ve rbal, visual, or written
Instruct ion best hel ps them learn .

Or, they may be afraid of a particular

exe rcise because of prior expe rience.
In t his case , you have to help them
overc ome th ese fears, star ting slo w
an d bu ilding con fidence in th e
movement. You may have to choose
a differe nt move ment altogethe r.

6. Lead by example . Cl ients don't respond favorab ly to There's no thing worse than a broke
"do as I say, not as I do" messages . banker, a real tor Without a house,
Lead by exa mple . You r actio ns an overw eigh t and un fit trai ner, or
spe ak volumes. a nutritionist wi th a li festyle-related
disease. To lead by example, gel into
sh ape yoursel f.
250 UNIT 2 Chapter 10 Slep 1 Prepa r. ng for YOL. r Clie n ~

Twelve princ ip les of coaching excellence

PRINCIPLE DESCR I PTION NUTR IT ION AND EXERCISE EXAMP LE S

7. Display commitment. If you're random, disorganized , To bnng out the best in your clients,
and uncommitted in your li fe, your be sure that you display a high
clients will pick up on it. Even level of organization, preparat ion ,
worse, they' ll think It'S accep tab le to and commitment when worki ng
be th e same way when it comes to with them. Always be prepared for
working with you. And this means meetings and sessions and convey
missed appointments, poor effort, a sense of authority and control.
and lack of atten!lon to detail. Always be on time for sessions and
don't tolerate lateness. Demonstrate
that you also follow your exercise
and nutrition p lan, even when it's
challenging, you don't feel like domg
it, or you're busy yourself.

8 . Coach excellence. If your coaching style is oriented Instead of focusing your clients on
toward specific outcomes such as specific outcomes (Iosmg 20 Ib of
winning or attaining a specific goal, fat, bench pressing their bodyvve lght,
you'll breed cl ients who become etc) , focus th em on the process
goal-obsessive without being of excellent execut ion. If II'S their
committed to excellence. Therefore nut rition plan, make sure their
the best coaches focus th e cl ient' s compliance to their program is 90-
attention on excellence in execution. 100% and reward that. If it's their
If a client learns how to execute exercise plan, make sure you reward
with excellence, success will be a excellent form, excellent effort, and
pleasant "side effect." excellent adherence to the plan. If
excellence is bred In your clients,
they'll have no choice bu lla succeed .

9. Credit success. Everyone wants to feel like they've There are personal and public
accomplished big goals, regardless ways of crediting your client's
of the size of their accomplishment. successes. If they achieve a specific
Yet not everyone has someone In body composition, health, or
their lives who he lps them recognize per formance goal, you can reward
and ce lebrate their successes. Thus, th em fmancial ly with a free sess ion
it's impor ta nt to "make a big deal" or two. Or you could reward them
out of your client's successes. Set by posting theIr profile to your "client
up milestones for them and when of the month" bulletin board. You
they achieve them, have some sort cou ld also have a year's end party
of reward or celebra tion. This will in which you invite all of your clients
empower them and make them feel out for dinner and give out awards
like a hero. to each fO( their successes. The
mode of celebration should be based
on the client's personality type
but regardless of the mode, these
celebrations should occur.
UN IT 2 Chapter 10 Step 1 Prepa 'l fl g tor Yo w Cli ent 251

Twelve principles of coaching excellence

PRIN CI PLE DESC RIP TI ON NUTR ITI ON AND EX ERC I SE EXAMP LE S

10. Take responsibility. If a client is unsuccessful, there 's If a client has struggled or had
no use In blam ing them for failure; difficu lty in los in g weight or adhering
blame gets them no closer to then to their nutritio n plan , have an
goa l and it can even create a ri ft earnest t alk with t hem . TeJl them tha t
between the coach and th e cli ent. alth ough they need to acc ept some
Instead of blaming the client, accept of the respons ibil ity for not finding
perso nal responsibi lity yourse lf. If sol ut ions to their challenges, yo u
you always assume you could be accept most of the respons ibi li ty,
doing a bette r job as a teacher, as you're the one they hired to help
coach, and mentor, you'll constantly them get great results. Convey to
be loo king for ways to improve. Th is them that you 'll work harde r in
means perpetual growth and a very your mission to help th em im prove
high client success rate. their lives and layout the specific
strategies th at you' ll teach, share,
and implement to ensure progress.

11. Challenge the process. In most coaching situations, if If your gym has a rule aga inst givi ng
common problems continue to nutrition advice to your clients, rat her
arise , poor coaches tend to blame than complain ing abou t "the system,"
the system. They look for reasons simply come up with another solut io n.
why things don't wo rk, while staYing In th iS sit uation, some tramers w il l
within their current system. The best start a side consulting business out
coaches, however, challenge the of the ir homes in which they prOVide
system by coming up wi th unique, general nutrition strategies fo r healthy
innovat ive, and creative ways to solve individuals privately and outside of
client and admin istrative problems . the gym. Then, co nven iently, all their
customers end up be ing t heir own
clients. By challengi ng the process,
they've created a way to earn some
additional money wh ile support ing
their clients in the way they need to
be supported.

12. Inspire a shared vision. The best coaches pass ionately It you have a big vision for eac h of
believe that they can and w ill make yo ur clients and you be lieve you ca n
a diffe ren ce. They beli eve t hey truly help them, let th em know it.
can shape the fut ure. If the be lief Let them know how you've helped
is strong enough and the coach others like them in the past. Let
expresses this to clients, eve ryone them know th at you plan to help
in volved in the coaching process them. And let them know what your
becomes enltsted in this dream. ti me lines and expectat ions are for
Wh en there's a bigger dream at t he m. Differen t clients will likely
stake, everyone involved wi ll exceed resp on d differently to this, so be
their own pe rceived limits in mak ing careful about how forcef ul you are
that dream a reality. wi th yo ur vision . Re gard less of your
deliver y, be sure to sha re the vision.
252 UNIT 2 Chapter 10 Step I Preparing for YO :J [ e lent

Understanding your clients

COACHING NEEDS
To help your clients succeed, you need to understand them as individuals. Each one will
have a unique temperament, personality, problem-solving ability, or discipline. Thus,
each one wil l need a differen t coaching style. Luckily, you don't have to come up with a
completely new approach each time - most people's coaching needs can be sor ted into
four general categories depending on two criteria ' mo tivation and skill, as Figure 10 .1 and
Table 10.2 show.

FIGURE 10.1
SKILL AND
MOTIVATION MATRIX

.High-motivation; . . High-~~ii\til~ion, > .

high-Skill . ' lowcSkilL '

,••.•.......•••....••........
' , ..

Low-motivation,
high-skill
UNIT 2 Ch apter 10 S~e p 1 Preparrng fo r You r e ,ren l 253

Four types of clients and how to approach them

CLIENT TYPE COACH ING STYLE OESCR I PTION

High-motivation, Delegate High-motivat ion, high-skill cl ien ts are typically people who are good at
high-skill everything and motivated to get better.

Keep these clients constantly invo lved and in tune with your process by
making them active drive rs 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 t he most successful clients is their ability to learn, understand, and
become sensiti ve 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, Inspire To be good at something but lose zeal for it is often the result of
high-skill overwhe lming internal or external pressure. These characteristics
describe the low-motivation, high-skill client .

Clients with this temperamen t do not respond wel l 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 .

To coach 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.

For this type of client you need to take the pressure off and find ways to
ease them back into the coaching process through subtle inspirat ion.

High -motiva tion, Direct "More enthusiasm than sklll" describes this type of client, who often
low-skill suffers from too much motivation rather than too litt le.
Th is 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 both be dangerous and limit potent ial long-term success.

You wi ll need to guide them through well-staged and progressive steps

so that they get it, but don't le t them try to get it all at once!

Low -motivation, Gu i de This type of client is typically quiet, shy, and introverted. Respect that
low-sk ill persona l ity, and don't become the ir 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 deve lop
a re lationship 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.

(A dapted fro m Grasso 2007)

254 UNIT 2 Chapter 10 Steo 1 Preoar· ng for Your CI!en t

As you work with client s, took for t he qualities outlined in Table 10.2 and note which
category corresponds to eac h client. Then, find the approach that suits each person best ,
avoiding strateg ies that will cause more harm than good .

READINESS FOR CHAN GE

Before you choose your coaching style, you should do an even simpler assessment that
COM MI TMEN T TO CHANGE determines your client's desire and commitment to change . Begin by looking for two things,
The level of change to
which a client is dedicated; 1. How badly do they wanl to change'
dictates the type of be/Javior 2. Are they ready to make a change'
changes they're
ready to implement Ju st because a client walks into your office or signs up for training sessions doesn't mean
that they 're committed to making changes. Nor does it mean that they're ready for change.
Indeed , the fact t ha t they're in front of you may mean the opposite' They may be looking for
someone upon whom they can foist t he respo ns ibility of their weight gain, poor health, and
poor pe rforma nce. By hiring yo u, they can blame you, instead of themselves, for their lack
of progress.

Th us, before meeting new clients, prepare an assessment plan to help you determine both
commitment and read iness for change. To assist you, the next chapter will provide you
with a Readiness for Nutritional Change Questionna ire that will demonstrate whether the
client is actually ready to make some changes, or whether they're just toying with the idea
of change. It will also help you separate cl ients by nutritional level (Level 1-31 based on
their goals and experience.

Most beginner clients (Level II , clients intimidated by change, and clients who do
belter with slow, step-by-step approaches to change are more likely to score Iowan the
Readiness for Nutritiona l Change Questionnaire. With these clients, you'll need to introduce
exercise and nutritional strategies more slow ly. Rather than attempt a complete lifestyle
overhaul, you may need to take one step at a time, focusing on sma ll objectives that are
introduced one by one, such as adding vege tables and frui ts in to their diet , adding an extra
meal per day, red ucing soft drink consumption while replaCing those drinks with water,
eat in g breakfast every day, and so on. In the book The Power of Less, author Leo Babauta
emphasizes th is point in stating,

The only way you ' ll form long-lasting habits is by applying the Power of Less, focus on
one habit at a time, one month at a time, so that you'll be able to focus all your energy
on creating that one habit.
I. Select one habit ... only one habit per month . You can choose any habit -
whatever you think will have the biggest impact on your life.
2. Write down your plan . You will need to specifically state what your goal will be
each day, when you'll do it, what your "trigger" will be, who you wil l report to ...
3. Post your goal publicly. Te ll as many people as possib le that you are trying to form
your new habit. I suggest an on line forum, but yo u cou ld email it to coworkers
and family and friends or otherwise get the word out to a large group.
4. Report on your progress da ily. Each day, tell the same group of people whether or
not you succeeded at your goal.
UNIT 2 Chapter 10 Step : Prepat lng for VOl. r Clien t 255

According to Babauta, when only one habit is adopted per month, success rates can be
as high as 80%. However, when people get 100 ambitious and attempt to adopt two habits
sim ultaneously, their success rate drops to below 20% for either habit. In other words,
for most people, sticking to one habit at a time means t he difference between progressive
success and absolute failure in adopting a new habit.

Of course, some clients will be able to tackle several changes simultaneously and these
clients will likely see results more quickly. However, clients who require a slower pace
may find their success rate is higher in the long run, as each change may become better
Ingrained in their lifestyle. Either way, as their trainer you have to clearly indicate that
there's a consistent rela tionship between the adoption of nutrition principles and the rate of
body change . If a client wants to take a slower approach, thei r goals will have to be more
modest at first.

Beyond identifying w hether a client is ready for change and how quickly you can introduce
new habits, it's important to determine how much your clients want to change . To do so, no
advanced questionnaires are required . Rather, you can simply look for specific commitment
words during your initial conversations with them. Figure 10.2 shows a "commitment
continuum" that will help you understand this better.

Low Commitment High Commitment

Try

When a client uses words to t he far left of the scale, they're demonstrating a low level of FIGURE 10.2
commi tment to change. When they use words to the far right , they're demonstrating a high THE CO MMITMENT

level of comm itment to cha nge. Your objectives are to keep "high commitment" people CONTINUUM

motivated and committed, while moving "low commitment" people up the ranks from
wishing and hoping to wanting and committing.

Setting goals
Once you know a client's readiness for change and level of commitment, you have to learn
about their goals. In other words, what do they want to do' Although you may think this part
is up to the client, this area also requires your work and skill , even before you meet with
the client. Most of the clients you'll meet will have poorly defined go als, if they have any
goals at all. They might say they want to "lose weight," "tone up," "bulk up," and so on. Or
they might simply be unhappy with their bodies and wa nt to change them, but they have
not articulated exactly what that means. How far do you think these clients will get without
knowing exactly where they want to go or how they're going to get there' Not very far. It's
your job to help them along.
256 UNIT 2 Chapter 10 S:cn 1 P'coa(ll'lg for YOur Clienl

All goals must ha ve the follow ing chara cter istics,

J. Goals are put down in writing. If it's not written down and re co rded , it's not a goal; it's
a wish or a dream . Although wishes and dreams are ni ce, th ey usually don't come true
without a written pla n of action.
2. Goals are specific and measurable. Ton ing up, bulking up, and getting healthier are
vague notions, not goals. Losing 4 Ib of fat, building 4 Ib of muscle, and dropping your
cholesterol by 40. points are goals . If you can't measure it or be specific about what it is
that you want, it's not a goal.
3. Goals have a specific timeline. Specific, measurable goals are a good start, but until
they have a time line on them, they're still lacking. Timelines make goals more real.
Without timelines, you're still wishing and hoping that you r spec ific. measurable
objective comes true sometime in yo ur life. With a timeline, you know exactly when it's
go ing to happen. Talk about losing 4 Ib of fat in 10. weeks time versus ju st foc usi ng
on the 4 lb.
4. Goals are realistic. o.f course, you can set a goa l to gain 5 Ib of muscle in a week ,
but that's not likely. (5 Ib of muscle would take anywhere from one to six months
based on commitment level and level of exper ience. ) Goa ls should ref lect an accurate
unde rsta nding of how long it actua lly takes to attain suc h a goal.

A truly successfu l goal has a fifth quality as well. significance. Before someone can get
really motivated to accomplish a given goal, they must aspire to accomplish something
that's personally meaningful. Without some deeper value attached to their goal. it's unlikely
to take shape.

Fo r example, dropp ing 5 Ib of fat while maintaining bodyweight over the co urse of the next
12 weeks is a specific, measurable, and rea li stic goal. But if a client is just setting this goal
because they're bored and have nothing better to do , they won't likel y be ins pired to do
wh atever it takes to accomplish th e goal (unless , of course , boredom ins pires th em). On
the other hand. if it's the ir job to achieve a ce rta in level of leann ess to pre pare for a movie
role , photo shoot, or fitness competit io n, more is at stake (suc h as ca reer advancement or
financ ial gain). They 're more likely to be ins pired to accomplish that goa l.

As a tr ainer, help yo ur clients establish writte n, spec if ic, measurable, rea listic goals that have
clear timelines. And help them find personal meaning in these goals so tha t they' ll stick to
t he goals even when th e going gets tough. This is where the art of goal-setting comes in to
play. In early interviews with the client you might discover that they 're mo tivated by the fa ct
that their mother died of heart disease and they don't want to suffer th e same fat e. You might
learn that they have a de sire to do a professional photo shoot at age 40.. You might discover
that they want to run a marathon or do a triathlon . Or you might learn that they've en tered
into a competition at work where th e person with the best results wins $1,0.0.0.. The re are
no rig ht or wrong motivations. It's your j ob to help your clients find th eir motivations, atta ch
perso nal meaning to them, and stay motivated. If they don 't have any inherent motivations
of th eir own, you ca n always help them crea te new on es. How about holding you r own
body transfo rmati on ch alle nge? We do this in our Lea n Ea ting Coaching Program . offe rin g
$10,0.0.0. in pr ize money to the winner.
UNI T 2 Chapter 10 St ep 1 P' CPJ ll ng fo r YOLir Cller t 257

OUTCOME VERSUS BEHAVIOR GOALS

Understanding and co nsistently app lying these req uirements wi ll he lp your clien ts' success,
bu t there's even more to goal-setting than th is basic approach . Success coach Jeff Smith
adds another dimensio n to goal-setting by distinguishing between outcome goals and OUTCO ME GOALS
behavior goals , a distinction that he argues is essent ial to success. Intended result that will
occur from carrying out
OUTCOME GOALS a behaVior; a long-term
measure of strategic
An outcome go al is the main outcome or objective that one hopes to accomplish . For example, effectiveness
"I want to lose 10 Ib in 10 weeks" is an outcome goa l. Another outcome goal is: "I want to
have $200,000 in investments five years from now." One of the key characteris tics of an BE HAVIOR GO AL S
outcome goal is the fact that you can't directly control the accomplishment of the goal. It's the Goals framed around
end resu lt of a series of other things you have to do. activities of the client that
are under complete control
BEHAVIOR GOALS of the individual

Behavior goals are the steps you have to take to accomplish your outcome. For example,
when the outcome goal is "I want to lose 10 Ib in 10 weeks," related behavior goals might
be: "I will exercise five days a week for the next 10 wee ks " or: "I will reduce my total
calorie intake by 500 calories a day for the next 10 weeks." One of the key characteristics
of a behav ior goa l is that you can directly control the goal; it's an action you can choose to
do every day.

Why list the differences between outcome and behavior goals' Well, there's a fundamental
problem with setting outcome goa ls alone: outcomes are often beyond one's control. Your
clients can't control their fat cells and their rate of fat mobilization, They can't command the
financ ial world to bestow wealth upon them, or control the fluctuations of world markets. But
they can control the ac tions that lead to a leaner body or a bigger bank account. Thus, they
should focus on the behavior goals tha t' ll help them reach their outcome goals.

This gives you, the trainer, some important jobs . Yo u have to help shape your cl ients'
outcome goa ls. You have to tap into their mo ti vations for accomp lishing t hose goals. And
you have to presenl them with a list of the behaviors that will help them reach these
outcomes . Your clients may know how much fat they want to lose and in what time frame.
But they won't know which behaviors are necessary to produce that fat loss . Thus , you
must present these behaviors in advance and in doing so, help Ihem fo rm behav ior goals
such as the following :

"I commit to exercising for a total of five hours per week, three of those hours wi th my
personal trainer, for the next 12 weeks ."
"I commit to missing no more than 10% of my scheduled exercise sessions for the next
12 weeks. "
"I commit to eat ing breakfast every day for the next 12 weeks ."
"I commi t to reducing my total calorie intake by 500 per day for the next 12 weeks."
"I commit to only ea ting 'junk food' during one scheduled 'free meal' each week."

As a trainer, if you show up to a first meeting or session with a cl ient prepared to discuss
your client's readiness for change and their goals and actua lly walk them through the
process of establ ishing behavior goals, you'll eas il y set yourself apar t. You'll notice that
your new clien ts wil l put their trust in you. And you'll deserve this trust: you'll start to get
co nsistent results fast.
258 UNIT 2 Chapl er 10 S l e~ j Prepa ri ng :01 You Cller t

Overcoming client objections

CLIENT OBJECT I ONS One additional skill you'll need to develop is the ab ility to overcome client objections, I'm
Barriers percei ved by clients sure you know what I'm talking about here: "I can't do X, Y, or Z because of X, Y, or Z." Of
in changing behaviors; these course, some client objections represent real problems that need real solutions. But most of
are critical points
the time, the objec tions you 'll face are mer e excuses that are poorly conceIved, vague, and
of counseling and
illogical. This latter type of objection typically results as a response to change - either it's
Intervention for the health
profe ss ional a knee -je rk reaction to simply being asked to change, or signifies deeper anx ieties over the
larger prospect of change altogether.

Regardless of whether or not the objections are valid, your job is to help your client
overcome them . There are two key strategies that trainers can use to manage objections:
fe-framing and responding.

RE -FRAM ING

Our perceptions and ideas about our lives make up a "fram e" that constrains what we
think we can do , Clients may object 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 cl ient 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, So don't get
frustra te d with them, Rather, understand that th e ideas and perceptions that make up their
current frame prevent them from seeing the solutions to the ir problems, Help them "re -
frame" their situation.

Re -framing involve s three components:

1. Acknowledge the client's concerns ra ther than dism issing them outright. Brushing off the
concerns will probably entre nch t he client's resistance further, while recognition builds
empathy t ha t is necessary to achieve client trust. To a client, these obstacles feel real,
even if they don't seem that way to you,
2, Move from focusing on the obstacles that hinder t heir progress to the advan tages that
each client may already have, such as existing fitness knowledge, an enjoyment of
cooking, or a flexible work schedule .
3. Work Wi th t he clien t to solve perceived prob lems and develop strategies to get around
the obstactes, This also helps t he client feel like an active participant in the process,

For example, if a client objects to your suggestion to eat every few hours, telling you it's
absolutely impossible with the ir job/lifestyle/etc., you might re-frame their objection by
saying "I know it's difficult for you to get this do ne, Heck , it may even be impossible.
However, with no restrictions, what sort of conditions would have to be in place to make
this work?" Notice t hat in this case, the re-framing includes an acknowledgement of the
client's concerns before moving rapidly to discuss solutions. Then, by discussing "what if"
scenarios that allow t he client to explore possibilities, you may be able to help them unlock
their brain and open it up to new solutions.

Simply put, as success coach Anthony Robbins teaches, if you think you can or you think
you can't, you' re right. If your clie nts think they can, they'll find a way. If they think they
can't, they won't find a way even if it's right in fron t of them, Help the m find the way.
UN IT 2 Chapter 10 St':p 1 PreiJai l" iS f'Jr YO. II C It'lt 259

Common objections from clients and potent ia l responses to them

OBJECTION POTENTIAL RESPONSE

"1 can't eat five times a "Eating fi ve times a day is simpler than you think. After all, you don't have to cook f ive
day; I do X (insert any big meals every day. What if you were to eat breakfast, lunch, and dinner li ke you do
and every job here). " now and then ha ve two easy-to-make liquid snacks or energy bars In between meals?
Let's start with that."

"I heard on the news that "The latest information on body transformation shows that you need at least five hours
I shouldn't exe rcise for a week of physical activity to improve body composition. Even the U .S . government
longer than 30 minutes agrees; they recommend at least 60 minutes of physica l activity every single day -
at a time , so I don't want or 7 hours a week - to stimulate weight l oss.
to do these long X-minute
"Wi th my help, you'll be able to get great results with about five hours a week. So, let's
(insert any and every time
figure out how we can schedule your week to accommodate these five ho urs."
frame here) workouts ."

"I don't like the taste of "You have a wide variety of food chOices, and I guarantee that we can f in d some
X (insert any and every varieties of X that you do li ke .
food here)."
" Let's try some other ways to have X. I'd also like to teach you some new ways to
prepare X so that it is still healthy but tastes better to you."

"Lifting weights ma k es "U nless yo u want to compete in enduran ce spo rt s, It'S important to spend mo re than
me bulky and muscular hal f of your gym time doing higher-intens i ty activities li ke inter va l exerc ise and res istance
really fast, so let's stick exercise. But don't worry, I'll design your lifting program in suc h a way th at you won't
with cardia, " bulk up; yo u'll just get stronger and leaner."

"I can't do X (insert any "Don't worry; I'm going to teach you a way to pe rform t hiS exerc ise. and a numbe r of
and every exercise here); it others, that work th e same muscle group. Not on ly wi ll th is app roach avoid pai n In Y.
hurts my Y (insert any and i t'l l act ua ll y st rengthen th iS area. Eventually you m ay be pa lO -free In th iS area."
every body part here) ."

"[ can' t give up X (insert "Oh, yo u won' t have to ! While you might have to eat less of X, we' II bU ild it In to your
any and every food here)." 'f ree meals.' After all, you 'll get abou t four of th em a week ."

"It's too much of a pain "Th ere are a number of wa ys to accumulate five hours of exerCise a w eek. Not all five
to exercise (after work! hours ha ve to be done at the gym , you kno w. Let's look at your weekly schedule ; we'll
before work/during my build your exercise schedu le around it so that you can get your fi ve hours comfortably."
lunch hour),"

"I can't afford to "I know it seems like it i s, but I ca n tea ch yo u some strateg ie s f or buying ~ l ea lth y food
eat healthy; it's too that will help you save a lot of mo ney, In fact, when I'm done with you , you' ll like ly be
expensive". spe nding le ss money on grocer ies , not m ore ."
260 UNI T 2 Chapter 10 Step I , Prepari ng for You r Clien l

Common object ions fro m clients and potential responses to t hem

OBJECTION PO TE NTIAL RESPO N SE

"1 don 't have anyone to "Well, during your training sessions, you've got me. And for the other workou ts like
exercise with ." cardio, intervals, and so on, I can either hook you up wi th one of my other cli ents so
you can motivate each other. Or you can just bring your MP3 player and let you r mus ic
keep you comp any during the workouts."

"A friend of mine at work "I don 't really know you r friend 's situation, but since you brough t It up, your friend may
is in great shape and he/ not ha ve to eat this way for a few reasons: First. you r friend may have a muc h faster
she doe sn't ha ve to eat metabolism, allowing for a less-strict nutrition plan. Second , thi s person may do a lot
this way." more physical activity th an you . Finally, although you r friend may not be following the
same plan as yours, the y may be following anot her good nu tri tion plan tha t has yielded
these results ."

RESPONDING

Wh il e, as we 've emp hasized , each clien t is un ique , man y of their objections are sim il ar.
Thus, it's helpful to have a "chea t sheet" of responses to the most co mmon objecti ons,
so that whenever a cli en t points out a see ming ly ins urmoun table obstac le, you can provide
a so lut ion quickly and easily. If you address their concerns as easily manageable, as if
you've helped people overcome these specific objectio ns a million times before, you'll put
your clients at ease while establishing and reinforcing your authOrity. Note that t he tone here
should not be dismissive, as we've suggested above , but rather convey the impress ion that
the client is not alone in the ir worr ies, and tha t many ot he r peop le wi th similar challenges
have ove rcome them.

Of course, on ly experienc e can help yo u come up with solut ions to all the objecti ons you ' ll
face during you r career as a trainer. However, table 10.3 has a list of the most common
on es, as well as some potential respo nses for each .

This is just a small samp le of the common objections you'll fac e and some response s for
dea ling wi th them. You'll undou btedly fa ce ma ny more than these over the course of your
ca reer. Develop responses for the most common ones you hear so that you'll be able to easi ly
address the m and help clien ts ove rcome them. Keep ing an objecti on table like the one above
mi ght prove to be a good learni ng experience for you.
UN IT 2 Chapter 10 Step 1: Pr epar ing fo r Your Client 261

What should you know?

What should your clients know?
One of the most important things you'll need to realize as a trainer is that there 's a big
difference between what you should know as a practitioner and what you should be
communicating to clients as you work with them. What you know and what your clients
need to know are two different things. Here's an examp le.

As a trainer you need to know that most beginner and intermediate cl ients will have troub le
squatting. Very likely, their knees wi ll adduct (buckle in) when any appreciable amount of
weight is used. This knee and hip adduction can be counteracted by firing the powerful
muscles involved in the ex terna l ro tation of the hips (most notably the glutes) , especially
when coming up from the bottom position of the squa t. This strategy wi ll help clients not
only lift more weight, but also keep their knees and hips in a hea lthy, biomechanica ll y
sound position .

But do your clients need to know that the glutes are power ful hip rotators and that the
length-tension relationship between the adductors and external hip rotators is what contro ls
wh ich direction the knees go during the squat' Probab ly not' It's your job to understand
these things , not theirs.

However, you have to come up with some simple, practical suggestions and brief, easily
understood verbal cues (including imagery) that will he lp your clients keep those knees ou t.
Here are three that wo rk particularly well ,

1. "Wide stance with feet pointed out." First, you need to tell your clients to take a wlder-
than-shou lder-width stance with their toes pOinting sli ghtly outwa rds .
2. " Spread the floor." Use the image of "spreading" the floor with their feet, pushing hard
against the sides of their shoes and keep ing the path of knee trave l in the same direct ion
the feet are painted .
3. "Si t back and down ." Finally, tel l them to sit back and down as they squat , focusing on
dipping down in between their thighs, which they should keep spread wide apart.

These three simple cues will teach your clients how to activate their hip rotators without a
bunch of hard-to-comprehend scient ific jargon that they don' t need to know anyway.

The same approach applies to nutritional adv ice. In this course you'll learn both techn ical
informat ion and practical strategies. As you're learn ing it, remember that none of the
technical informa tion is important to your clients . You clients shouldn 't have to learn about
the biochemistry of proteins, carbs, and fats to lose we ight or ga in muscle. They shouldn't
have to know that ca lories are metabolically converted into energy in the mitochondria to
boost sports performance. They shouldn't have to know how choles tero l levels in the blood
are regulated to improve their health. All your clients have to know is what to do in order to
reach their goals.
262 UNIT 2 Chapter 10 S!<:,p 1 Pr,maw :g (O ( VOl ( C I I ~ · ' t

Translating technical messages for you r client

TE CHN ICAL MESSAGE (WHAT YOU SHOULD KNOW) TRANSLATION (WHAT YOUR CLIENT SHOULD KNOW)

24·hour energy expenditure, blood sugar control, and Eat every 2-4 hours during the day. This means 5 or 6
the anabolic/catabolic hormonal profile can all be smal ler meals a day versus 2 or 3 bigger meals.
Improved by increased feeding frequency,
Doing this wil l help improve your body composition,
energy levels, and health.

To optimize protein turnover, protein synthesis, thermic Eat 1-2 servings of lean , complete protein per meal.
effect of feeding, and mu scle recovery, most clients should Protein foods include low -fat dair y, lean meats, soy
be getti ng around 19 of protein per Ib of boclyweight. products , eggs, and protein supplements.

This w ill help you reach your da ily protei n goals ,

improve you r energy levels, and he lp you keep your
metabolism high.

To control insulin levels and keep blood glucose levels Stock your house with unprocessed , whole-gra in
constant th roughout the day, low-glycemic-index/load ca rb ohyd rates such as whole oats, whole-grain breads,
carbohydrates should be eaten instead of high-glycemic- wi ld rice, and quinoa.
indeX/load carbohydrates.
Keep processed carbohydrates such as white bread,
bagel s, white pasta, whit e rice, ch i ps , crackers, sugary
desserts, and the like out of the house.

The closer the carbohydrate to its natural state , the

better it is for your health and body composit ion.

To opt imize t he dietary fat profile , you r cl ients should Add good fats into your diet every day. Th is means
be gett ing 1/ 3 of t heir dietary fa t from polyun sa tu ra tes, including foods like ground flax seeds, oli ve oil, flax oil,
1/3 from monounsaturates, and 1/3 from sa t urate s. This avocados, and ra w mixed nuts.
balance helps c re ate a favorable hormona l envi ronmen t
Also, one of the best th ings you can do is to include fish
in the body, helps to manage infl ammat ion , and helps
or algae oil supplements (in all or capsule form) each day.
support healthy immune function.
To optimi ze health and red uce appetite, most clients should
be getting 10-15 servings of vegetables and fruit per day.

The phytonutrients present in these fruits and veggies With every meal or snack, eat 1-2 servings of veggies. A
have been show n to reduce cancer, heart disease, and se rving is around 1fz cup.
diabetes risk.
Some fruit can also be included, but be cautious, fr uit is
more energy dense than vegetables.

Different body types requ ire different macronutrient If you're na turally slim, you should eat mo re healthy
intakes to maxim i ze fat loss due to differing degrees of carbohydrates and less dietary fa t each day.
glucose tolera nce and carbohydra te/fat oxidation.
If you ' re naturally fatte r, you should eat fewer
This is due to differences in hormonal profiles between carbohydra tes and more protein and fa t each day.
ectomorphs, mesomorphs, and endomorphs.
UNIT 2 Chapte r 10 Sk u 1 P'E' I= <! II "' g fOr Y:l.JI CI ;'Ill 263

Table lOA contains some basic technical messages that you should know along with some
practical, teachable, take-home messages your clients should know.

Notice how the more com plicated, theoretical information can be transformed in to ve ry
usable, practical infor mati on that your clients can understand and imple me nt immediately.
Next tim e you meet with a client to talk about training and nutrition, try to remember to focus
on the practical and usable over the theoretical.

Of course, I unde rstand why trainers sometime s make the mistak e of getting too techn ical
with the ir cl ients. In their en thusiasm for knowledge and their excitement to share the new
things they're learn ing, trainers can have the tendency to do an "informalion dump" - to INFORMATION OUMP
overwhe lm family, friends, and clients with all this new information. Don't fall victim to th is Providmg unwa{[anted
tendenc y. It's great to be excited about lea rning. But not everyone around you may be as amounts of knowledge
to a new client
exci ted as you are to learn th is stuff. (I t's too bad , I know.) Sh are only wh at's req ui red and
leave the rest for chats with oth er fit ness profess ionals. In fact , you could even make a game
of it: Every time you learn some new pi ece of technical information, challenge yourself to
translate it in to something practica l that your cli en ts can do immediately.

At this point, many tra iners ask: What shou ld they do with those clien ts who do want to
know th e sc ie nce or the biomechanics of what they're doing? In such cases , is it okay to
te ll them? Sure it is. But here 's the caveat: Don 't waste val uabl e gym or cons ulta tion time
teac hing sc ie nce lessons. Instead, print off some resources for th em to review at home, gi ve
them a list of web resources to browse, and/o r give them a couple of book titles to read. Gym
and consulting tim e are exclusively for hard work and sharing practical strategies - not for
theory or book learning . If they spend too much t ime talking about theory, you r clients may
get so distra cted by trying to learn the whys that they forget to learn the whats.
264 UNIT 2 Chapter 10 S: ep I Prepar ng lor You r CI en!

In this chapter we discussed how important it knowledge and application . She had an extensive
is to differentiate between what you need to fitness library at home. She had read every single
know as a coach and what your clients need to article and book I'd ever written. And she was
know as you work together. Many clie nts can familiar with most of the popular strength training
get so wrapped up in learning about fitness and and nutrit ion theories of th e time. In her mind,
nutrition that th ey never get around to applying this made her an advanced athlete. Never mind
what they're learning. Acquiring knowl edge and that she was obese and unable to perform basic
applying that knowledge are two separate skill movement patterns. She felt that the possession
sets. As a coach, you want to help your clients of knowledge alone made her advanced.
excel at the latter.
How does this apply to your clients? Well, just as
A few years ago , I wor ked with a client w ho wi th this individua l, there are several things to
epitomized the importance of this dis tinction. The look out for when coaching your clients.
client called me to inquire about my coaching
First, your more intelli gent and cerebral
services. As per the initial assessment guidelines
cli ents will more likely have difficulty with the
we set out in this chapter, I did a pre liminary
application of knowled ge. For exampl e, the client
screening over the phone , asking a few quest ions
in this example was a PhD student who always
to see if we were a good match . So far, so good.
excelled in school, and had been in school her
The client was proud to admit that she had been
entire life, but had never had a non-academ ic
working out for about 10 years, had read every
job or played a sport. Her entire existence was
article and bo ok I'd ever written, an d was fairly
cognitive (thinking and reasoning) so it was a
advanced. She simply wanted to take her fit ness
real challenge for her to be kinesthetic (moving
to the next level. Impressive. So we scheduled her
and physically experiencing) .
first appointment.
Secondly, your clients who insist they want
When this client walked in the front door of my
to know the "w hys" w ill likely have difficulty
fac ility, I was su re there was a mistake. She
distinguishi ng between w hat they ' re learning
was at least 50 Ib overweight and appeared
and what they should be doing. Thi s client
as if she had never been to the gym in her
always wanted to know why we were dOing
life! Now, there 's nothing wrong with being
something before we actually did it. This can
overweight or being new to fitness . I wo rk with
become a real cha lleng e.
clients like this all the time . However, problems
arise when someone is this out of shape yet Over time, I achieved quite a bit of success
still be li eves they're advanced and just need a with this client in the gym and in the kitchen
few small adjustments to their program. This by getting close enough to demonstrate exactly
client truly believed that she was advanced - where she was not applyi ng what she already
even after preliminary fitness testing re vealed knew. I realized that she had quite a bit of book
that she was over 35% body fat, had multiple learning, so during our educa tion sessions I'd ask
muscle imbalances, and couldn't properly what she thought she should be doing for training
perform a squat. and nutrition. Then we'd discuss. This helped her
feel engaged and recognized her prior learning.
Ho w could there be such a difference between
However, I would go one step further, pointing
her perception and reality? Well, it's easy.
out where she wasn't actually applying her
She simply didn't see the difference between
UNIT 2 Chapter 10 Sl(;p I Pr epar ing 1m Ycu r Client 265

knowledge, and providing strategies that would mon itoring sheets, and education sessions are
make it easier for her to do so. designed with practical outcomes in mind, the
nature of what you'll be communicating to your
Fortunately, the system outlined in this unit
clients is application based.
will help you better manage all your clients,
including those like the one described above. By Remember that helping your clients improve
having education sessions separate from training is only part physiology. The other part is
sessions, you can make a clear distinction psychology. You have to understand that clients
between learning and application. During training will come to you with their own unique mental
sess ions, keep the focus on training . And during and physical challenges. It's your job to ensure
educa tion sessions, keep the focus on education . that you have a system in place for dealing with
Plus , since many of the assessments , adherence any cha llenge that arises .
266 UN IT 2 Chapter 10 Steo: Prep a ri ng fQr Yo ur Ci le'l t

1. Before ever meeting with a client you need to know how to get the most out of
that client. To do that, you first have to know how to be a coach.
2. Great coaches possess certain qualiti es and characteristi cs that set them apart.
To be a successfu l trainer, focus on developing these qua lities and followi ng
some key principles.
3 . Immediately determ ine each client's motivation and readiness for change. Listen
for the comm itment words presented in this chapter and admin ister the Readiness
for Change Questionnaire in the next chapter.
4. Once you know a cl ient 's comm itment l evel, determine w hat they're committing
to, and help your clients create specific , measurable, time-sensitive, rea listic, and
inspiring outcome goa ls. Then translate these outcome goals into behavior goals.
5. When presenting behavior goals to your clients, you 'll often encounter resistance
and objections . These are likely instinctive responses to change and ca n be
overcome by us i ng re framing and respondi ng strat egies .
6. Create a pre-establ ished list of responses to com mon objections. Th is wil l help you
qu ickly and effectively overcome objections and move forward.
7. What you know and what you need to teach your clients are two different things.
You need to know the fo un dational techn ical and practical information; your
cli ents on ly need to know how to put that information into practice. Craft your
messages accord ingly.
8 . Being the best coach you can be requires ongoing learning, including masteri ng
the strategies in th is chapter. Strive to constantly improve your skill in these areas
so that every initial cl ient meeting w i ll go mo re smoothly than the last.
CHAPTER 11

STEP 2:
COLLECTING
PRELIMINARY
CLIENT
INFORMATION
Chapter objectives
Key terms
Important questionnaires for new clients
Important measurement tools for new
clients
Physical Activity Readiness Questionnaire
Medical History and Present Medical
Condition Questionnaire
Comprehensive Client Information Sheet
Three-Day Dietary Record
Readiness for Change Questionnaire
Kitchen Makeover Questionnaire
Social Support Questionnaire
Initial Body Composition Assessment
(Men)
Initial Body Composition Assessment
(Women)
Baseline Stress/Recovery Assessment
Initial Performance Assessment
Baseline blood chemistry assessment
Baseline visual assessment
Chapter 11 Summary
UNIT 2 Chapter 1 1 Step 2 Coll ectlllg Pre lim in ary Client Info rmation 269

Whether you're a trainer or a nutritionist, the prelimin ary information you ga ther when
working with a first-time client will be a valuab le tool in your decision-maki ng proces s. For
example, as a trainer, you shou ld know whether your clients have any problems that can
affect the ir program, such as orthopedic issues, previous in jur ies, jOint or muscle pain,
ca rdiovascular conditions, muscular imbalances, and so on. By know in g th ese thi ngs right
away, you can avoid activ ities that will aggravate cur re nt or previous problem s and plan
activities that will help with rehabilitation and muscular balance. You won't know eve ryth ing
at the outset. Indeed , you ' ll discover many things over time as you work with the client.
But don't wait until your client is squatting to discover th eir previous knee in jury, or until
they're doing high-intensity interva ls to discove r that previous heart attack. You should have
some idea of what to expect up front. To collect th is informati on, you should ask al l new
clients cer tain quest ions systematica ll y. You should also pe rform postu ra l and movement
assessme nts des igned to give you some addi tion al information about th e client that they
might not even know themsel ves .

The sam e is tru e for nutrition . You should know, up front, if your cli ents suffer from any
life styl e-related diseases (Type II diabetes, obesity, and so on) or have any sign ifi can t risk
fac tors (high choleste ro l, high blood pre ssure, poor blood sugar managemen t, and so on).
Yo u shou ld know someth in g about the ir body composi ti on , includ ing thei r skinfold measures
and body fat pe rcent age . And finally, before eve r maki ng a nut rit iona l suggest ion , yo u shoul d
ha ve some objective info rmation abou t yo ur clients ' daily schedules and cu rre nt dietary
habi ts. Only when you know these th ings can you proper ly add ress your client's nutriti onal
needs, wh ether you're doing so as a trainer presenting di etary options to support a client's
healthy lifestyle, or as a nutritionist making a dietary prescription.

Th is chapter presents a number of commonly used questi on naires and assessmen t strategies,
as well as some new ones designed specifical ly fo r this course. Each of the question naires
and assessme nts ha s val ue, especially if yo u inte nd to cover both exe rcise and nut ritio n with
your clients. They are as follows,

Important quest ionnaires for new clients

Instr uct clie nts to fill these out at home and return du ri ng you r firs t appoin tmen t together,

Phys ical Activ ity Readi ness Quest io nnaire (PA R-Q)
Medical His tory and Present Medical Condition Quest ionnaire
Comprehensive Clien t Information Sheet
Three -Da y Di et ary Reco rd
Readi ness for Change Questionnaire
Kitc he n Ove rhaul Question na ire
Social Support Qu est io nnaire
270 UNIT 2 Chapter 11 St ep 2 Co llec ti ng Prellm ll1 ary Client Inform ation

Important measurement tools for new clients

Fill ou t these assess ments during you r first apPo intment with the clien t:

Ini ti al Body Composition Assessmen t

Baseline Stress/ Recovery Assessmen t
Initial Performance Assessment
Baseline blood chemistry assessment
Baseli ne visua l assessment

As yo u read through this chapter, go t hrough each questionnaire and assessment too l closely
and think about the best way to integrate each one into your daily coaching environment. To
ensure that each questionnaire is completed and that t his infor mation is usefu l as you plan
your coaching st rategy, do the following,

1. Hand your new clients these questionnaires when they first sign up to work with you.
even before your first appointment. Instruct them to fill out the questionnaires and bring
them in during your assessment meeting.
2. Dur in g the assessment me et ing, review the questionnai res to ens ure they're complete,
gather any additional details you feel may be missing, and perform th e assessments
detailed in this chapter. Once this is complete. schedule an initial consultation meeting.
3. Once you've privately reviewed all the information co llecte d in the questionnaires and
assessments and you've established yo ur coaching priorities and program objectives , meet
with yo ur client (in itial consultation) to disc uss goals, scheduling, and programming.

Alt hough t his series of steps may not be exactly how you do business right now , rest assured
that it is the best way to start off on the right foot with a client. Col lecting this inform atio n will ,

hel p you give clients an objective appraisal of how well (o r poorly) they're dOing;
help you exclude individuals who ha ve health issues that may increa se their ris ks for
illness and / or injury;
provide you with vi ta! in forma tion on what a client's limiting factors may be; and
provide information t ha t ser ve s as a baseline for comparison when monitori ng progress in
the future.
UNIT 2 Chapter 11 St ep 2 Co llec ti ng Prelimi na ry Client InformatIO n 271

Physical Activity Readiness Questionnaire (PAR-Q)

Name' ___________________________ Da te, ___________________

A Questionnaire for People Aged 15 to 69

Reg ula r physical activity is fun and healthy, and more peop le are star ting to become more
active every day. Being more active is very safe for most people. However, some people
should check with their doctor before they start becoming much more physically active.

If you are planning to become much more physically act ive than you are now, start by
answering the seven questions in the box below. If you are between the ages of 15 and 69,
the PAR-Q will tell you if you should check with your doctor before you start. If you are over
69 years of age and you are not used to being very active, check with your doctor.

Common sense is your best guide when you answer these questions. Please read the
questions care fully and answer each one honestly, check YES or NO.

YES NO

o o 1. Has your doctor ever said that you have a he art condition and that you should only do physical
activity recommended by a doctor?
o o 2. Do you feel pain in your chest when you do physical activity?
o o 3. In the past month, have you had chest pain when you were not doing physical activity?
o o 4 . Do you lose your balance because of dizziness, or do you ever lose consciousness?

o o 5. Do you have a bone or joint problem (for example , bac k, knee or hip) that could be made worse
by a change in your physical activity?
o o 6, Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or
heart condition?
o o 7. Do you know of any other reason why you should not do physical activity?

If you answered YES to one or more questions

Talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you
have a fitness appraisal. Tell your doctor about t he PAR·Q and to which q uestions you answered YES.

o You may be able to do any activity you want - as long as you start slowly and bui ld up gradually. Or, you may need
to restrict your activities to those that are safe for you. Talk with your doctor about t he kinds of activities you wish to
participate in and follow hIs/her ad vice.

o Find out which community programs are safe and helpful for you.
If you answered NO to all of the questions )
DELAY BECOMING MUCH MORE
If you answered NO honestly to all PAR-Q questions, you can be reasonably ACTIVE,
sure that you can:
o If you are not feeling well because
o Start becoming much more physically active - begin slow ly and build up of a tempora ry illness such as a
gradually. This is the safest and easiest way to go. cold or a fever - wait until you
o Take part in a fitness appraisal- this is an excellent way to determine feel better; or
your basic fitness so that you can plan the best way for you to o If you are or may be pregnant
live actively. It is also highly recommended that you have your blood - talk to your doctor before you
pressure evaluated. If your reading is over 144/94, talk with your doctor start becoming more active
before you start becoming much more physically active.

PLEASE NOTE,
If your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional.
Ask whether you should change you r physical activity plan.
272 UNIT 2 Chapter 11 Step 2· Collec ting Prelim ina ry Client Inform ation

Medical History and Present Medical Condition

Questionn aire
Name' ___________________________ Date, __________________

In order for you to gain the most benefit from th is program , we encourage you to answer all
of the following questions. If you are uncomfortab le with answering a particular question, feel
free to leave it blank . Please explain all YES answers at the end of this questionnaire.

PERSONAL MEDICAL HISTORY

Have you have ever had any of the following condition s?

YES NO YES NO YES NO

o 0 1. Allergies o o II. Ulcer o 0 22. Epilepsy

o 0 2 . Loss of hearing o 0 12. Heart attack o 0 23. Convulsions/seizures
o 0 3. Asthma o 0 13. Heart murmur o 0 24. Stroke
o 0 4. Kidney disease o 0 14. Positive stress test o 0 25. Diabetes
o 0 5. Prostatitis o 0 15. Heart valve abnormality o 0 26 . Thyroid trouble
o 0 6. Colitis o 0 16.
Angma o 0 27. Anemia
o 0 7. Hepatitis o 0 Heart fai lure
17. o 0 28. Eczema
o 0 8. Liver disease o 0 18.
High cholesterol o 0 29. Cancer (includmg skin cancer)
o 0 9. Elevated Jlver enzyme test o 0 19.
High blood pressure o 0 30. Sleep apnea
o 0 10. Pancreati tis o 0 20 . Arthritis/rheumatism
o 0 21 . Loss of consciousness

REV IEW OF CON DIT IONS

Do you currently have or have you recently had any of the following?
EYES , EARS , NOSE , THROAT PULMONARY GEN 1TO- URINARY
YES NO YES NO YES NO

o 0 31 Difficulty with night vi sion o 0 40, Shortness of breath o 0 45 . Bladder trouble

o 0 32. Change in vision o 0 41. Chronic ortrequent cough o 0 46 , B lo od in urine
o 0 33. Blurred or double Vision o 0 42 . Brown/blood-tinged sputum o 0 47. Irregu lar vaginal bleeding
o 0 34. Bleeding gums o 0 43. Chest tightness o 0 48. Currently pregnant
o 0 35. Frequent nosebleeds o 0 44. Wheezing o 0 49. Difficulty starting/stopping
o 0 36. Frequent sinus trouble urination
o 0 37. Recent hoarseness o 0 50. Uri nating 3 times per night
o 0 38 , Ring ing/buzzing ears o 0 51. Frequent or painful urination
o 0 39. Earaches o 0 52 . Problems with sexual function

GASTR OINTE ST I NA L CENTRAL NERVOUS SYSTEM HEARTNASCULAR

YES NO YES NO YES NO

o 0 53. Vomited blood o 0 63. Fainting spe ll s o 0 71 . Palp itation (irregular

o 0 54. Persistent diarrhea o 0 64. Recu rrent dizziness heartbeat)
o o 55. Persistent constipation 0 o 65 . Frequent headaches o o 72. Pain or discomfort in chest
o o 56. Frequen t abdominal pain 0 o 66. Tremors o o 73 . High cholesterol
o o 57. Frequent nausea 0 o 67. Memory loss o o 74. Swelling of feet
o o 58 . Frequent indigestlon/heartburrl 0 o 68. Loss of coordination o o 75 . Leg pain while walking
o o 59 . Black/bloody bowel movement 0 o 69. Difficu lty concentrating o o 76. Painful varicose veins
o o 60 . Hemorrhoids 0 o 70. Numbness/tingling extremities
o o 61 . Trouble swallowing
o o 62. Hernia
UN IT 2 Chapter 11 Step 2 Collect i ng Pre liminary Client (nformatlon 273

PERSONAL MEDICAL HISTORY

MUSCU LOS KELE TAL MISC ELLA NEOU S

YES NO YES NO YES NO

0 077. Back trouble/pain 0 o 8l. Bleeding/bruising eas rly 0 086. Night sweats
0 078. Neck trouble/pain 0 082. Enlarged glands 0 087 . Undesrred werght loss
0 079 . Joint injury/pain/swell ing 0 083. Rashes 0 088 . Snoring
0 080. Carpal tunnel syndrome 0 084. Unexplained lumps 0 089. Difficulty sleepmg
0 085. Chronic fatigue 0 090. Low blood sugar

ADDITIONAL HEALTH AND LI FESTYL E QUESTIONS

Please answer the following questions honestly:

YES NO

o 0 91 Are you experiencing any stresses, mood problems, relationshrp dlfficultles, or substance-related problems for which you
would like resource or re ferral information on a confidential baSIS?

D 0 92. Do you occasionally use or are you currently taking any prescriptron or over-the-counter medications? List name, dosage,
and t he reason the medlcation IS used on the next page.

D 0 93. Have you had any surgical operations In the last 10 years?

o 0 94. Has anyone in your immedIate family developed heart disease before the age of 60?

D 0 95. Do any diseases run in your fami ly?

o 0 96. Do you currently have a co ld/Cough, or have you had any in the last two weeks?

D D 97 . Have you ever been hospital ized? If yes, list date, length of stay, and reason on the nex t page.

D 0 98 . Are you currently under a doctor's care? If yes, JiSt what you are being treated for on the next page.

D D 100. Have you had a change In the size or color of a mole, or a sore that would not heal in the past year?

o 0 101. 00 you have any special concerns rega rding you r health that you would like to di scuss with the doctor?

o 0 102. Are you a current cIgare tte smoker?

A. How many packs of cigarettes do you smoke a day?
B. How long h ave you been smoking?

o 0 103. Are you an ex-smoker?

A. How many years did you smoke?
B. How many packs a day?
C. When did you quit?

D 0 104. Have you used chewing tobacco or smoked cigarS/pipe in the last 15 years?
105.1 dnnk _ _ _ _ __ beers; _ _ _ _ __ ounces of hard liquor; _ _ ounces of wine per week.

106. When were your most recent immunizations?

Tet anus _ _ _ _ _ __ Flu shot _ _ _ __ Pneumovax _ _ _ _ _ __

107. When were you mos t recent health maintenance screenmg tests?
Cholesterol _ _ _ __ Results? _ _ _ __ PSA (Prostate) _ _ _ __ Results? _ _ _ __

Mammogram _ _ _ __ Results? _ _ _ _ __ Slgmoidoscopy _ _ _ __ Results? _ _ _ __

Pap smear _ _ _ _ __ Results? _ _ _ __

108. Descnbe any hobbies or recreational actlv lties that have exposed you to noise, chemicals, or dust:

109. Please describe typical weekly exerClse or physlca l actiVities including any exercise at work:

110. My current diet could be best characterized as (check all that apply):

o Low-fat o Low-carb o High-protem o VegetarianNegan D No speC ial d ie t

274 UNIT 2 Chapter 11 St ep 2 . Co llect in g Prellln ll1a ry Client Informa tion

Please explain all YES answers here. List the question number, and add details.

PERSONAL MEDICAL HISTORY

QUE ST I ON NUMBE R DETA IL S

UNIT 2 Chapter 11 St ep 2 Collec ti ng Pre lwlIna ry Clie nlln rorma llon 275

Comprehensive Client Information Sheet

Name: _________ Date:

INSTRUCT IONS
This is your comprehensive client information sheet, in which we will ask you to provide
some relevant personal informati on. The ans wers to these questions are essential in order
to allow us to design an optimized individual fitness program for yo u. Please answer all
questions in the most accurate manner possible while being as concise as poss ible.

DISCLA I MER
Please recognize Ihe fact that it is your responsibility to work directly with your physic ian
before, during, and after seeking fitness consu ltation. As such, any informa tion provided
is not to be followed without th e prior app roval of your physi cia n. If yo u choose to use thi s
information wi t hout the prior consent of your physician, you are agreeing to accept fu ll
responsibility ror your decis ion.

COMPREHENSIVE CLIENT INFORMATION SHEET

PA RT 1: BAS IC I NFORM AT ION

Name _ _ __ _ _ _ _ _ _ _ _ Gender _ __ _ Age _____ _ _ _ __

Date or birth (mon th/day/year) _ _ _ _ _ __ Heigh t _ _ _ _ _ _ Weight (as of thi s morning) _ _ __

Body fat pe rcentage (h ave thi s t aken before submltt mg t his sheet) _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ __

PAR T 2: BODY COMPOSIT ION

Please provide the follOWing sklnfold measures (In mm), Please provide the follOWin g girth measurements (In ches or centime tres):

Abdominal _ _ _ __ Subscapu l ar _ _ Neck _ _ __ _ __ Chest _ __ _ _ __ _

Triceps _ __ _ __ Suprailiac _ _ Shoulder _ _ _ _ __ BIceps _ _ _ _ __ _ _

Chest _ __ _ __ Th igh _ __ _ _ _ __ Wai st _ __ HIps _ _ _ _ _ _ _ __

Mid -ax illary _ _ _ __ Thigh _ __ _ __ _ Calf _ _ _ _ _

PA RT 3: GOALS

Given the following goals, please ra nk them In order of Importance, With 1 bemg most important and 8 bemg least important.
Improved heal th _ __ Improved endurance _ _ _ Increased stren gt h _ _ _ Sport-spec lfic * _ _ __ _ _

In creased muscle mass _ Fat loss _ _ __ _ __ In creased power _ __ Weig ht gain _ _ _

*Please provide the sport or athletic even t for which you are traini ng:
276 UNIT 2 Chapter 11 Slep 2 Co llectmg Prellm ma ry Client In'ormatlon

COMP REHEN SIVE CLIENT INFOR MATION SHEET

Do you have a specific tlme)me for achieving a speci fic goa l? If so, please specify·

Ci rcle which type of progress IS more Important to you:

Imm edia te pr ogress that's l ess easi ly mamtained Maintaina ble pro gress tha t may not be as rapid

Please explain below:

PART 4: EX ERCISE INFORMATI ON

Rale your abil i ty In the fo llowing exercises (check the box th at correspond s wi th your ability):

EXERCISES : ADVANC ED INTER MEDIATE NOV IC E UNFAM ILI AR

Barbell squ ats

Barbell deadlift

Barbell bench press

Bent-ov er barbell row

Barbell shoulder press

Pull-up

Barbell hack squat

Olymp ic movements

~~:a~:~- -----------------f ------------------1------------------j-------------------1- --------------------

Are you cu rre ntly exercising regu la r ly (at least 3x per week)?

DYes 0 No

If yo u answered YES , continue on to the followi ng section.

If you answered NO , skip ahead to the sec tion marked "Not currently exercising"

Comple te thi s section" you ARE currently exercising reg ular ly

How long have you been consis te ntly exerCISing without a break?

On the followmg chart, fi ll In which type 01 exercise you normally perform each day: resistance tralnmg (RT); interval cardia bouts (INT);
low-mtensity cardia bouts (LIC); sport-specific work (SSW) .
UN IT 2 Chapter 11 Step 2 Co llect ing Prelimina ry Cli en t Infor mation 277

COMPREHENSIVE CLIENT INFORMATION SHEET

On t he following chart, hll 10 your approx imate workout dUration for each day (in minutes)

~~~ - ~ _____1_ -- ~-~~~~~ -- -1- --~~~~~~~ ---l- ~:~_N_E_S?_A_Y_ -l- _T_H_~~~~~~ - -l- --~~~~~Y- - - -1- -~~~~~~~~ -- j--~~~?~~- ----
Duration I I I
Please submit your current exercise regimen along w ith th is form (type it up or write it out fo r us).

Complete this sectIOn if you ARE NOT currently exercismg regularly

If you are not currently exercising regularly, have you ever been on a consistent exercise plan (at least 3x per week)?

DYes 0 No

If you have exercised on a consistent basis previously, how long ago was this and how long did it last? _ _ _ _ _ _ _ _ _ __

PART 5: M EDICAL AND HEALTH IN FORMATION

If you have any diagnosed health problems, hst the condition(s). _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

If you are on any medications, please list them. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

What additional therapies or interventions are being undertaken for the given health problem(s)?

If you have any injuries, please list t hem.

What additional therapies or interventions are being undertaken for the given mjury(s)?

PAR T 6: LIFESTYLE I NFO RMATION

What do you do for a livmg? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

What is the actiV ity level at your Job?

o None (seated work only) o Modera te (hght acti vity such as walking) o High (h eavy la bor, very active)
Does your job mvolve shift work?

DYes 0 No

If you follow a more regular schedule, do you work days, afternoons or night s? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __

Are you a primary caregiver for children, individuals wi t h a disability, or an elder relative?

DYes 0 No

How often do you t ravel?

o Rarel y o A few times a year o A few t imes a month o Weekly

Please lis t t he physical activities that you partiCipate in outside of t he gym and outS ide of work.
278 UNIT 2 Chapter 11 Step 2 Collecting PrellrnIl13'y' Client Information

COMPREHEN SIVE CLIENT INF ORMATION SHEET

Please fill ou t the fonowmg timetable with your most normal dally schedule listing the time you wake up, work and have breaks, work
ou t and go to sleep.

A.M , P.M .

Exactly how much money do you spend on groceries per month (provide amounts from your las t two grocery bills)? _ _ _ _ _ __

How many times per week do you shop for groceries? _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ __

How many meals do you eat in resta uran ts and/or fast food places per week? _ _ __ _ _ _ _ _ _ _ __ _ _ _ _ _ __

Exactly how much money do you spend on supplements per month? _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ __

If you have any known food anergies, please list them below.

Are there any other foods to which you're particularly senSitive (i.e., which cause excessive gas, bloating, stuffiness, or congestion)?
UNIT 2 Chapter 11 Step 2 Collecting Pre llin mary Client Inform at ion 279

COMPREHENSIVE CLIENT INFORMATION SHEET

If you're currently using any nutritional supplements, please list them (as well as the doses you ' re taking) below.

Please provide a three-day dietary record (attached). Be sure that these records are representative of the last few months of your dietary
intake. In other words, If you just decided to get in shape two weeks ago and changed your diet dramatically, you should give us an
indica ti on of how you ha d been eating habitually prior to the recent change.

How long have you been eating in the manner recorded on your dietary record? (If your answer is less than one month, please fi ll out
your record according to your prior intake bef ore this recent month.)

M I SCE LLANEOUS INFORMATION

If there is any other information you think might be relevant to your program design , please share it wi th us below.

Please share your most frequent health, nutr ition, or physique complaints and/or dissatisfactions with us.

You have now completed our clien t inform atIOn sheet. Please bring this, along with your current workout schedu le (if applicable) and
th ree-day diet record, to your fi rst appointment.
280 UN IT 2 Chapter 11 Step 2 Collecting Prelimina ry Client Information

Three-Day Dietary Record

Na me: ___________________________ Da te: __________ _ __

It is impo rta nt that this rec ord be both acc urate and representative of your no rma l dietary inta ke.
Thus it is essential that you do not alter yo ur nor mal eating habits in any way and that you record as
precisely as possible every single item th at you consume (this includes water, vita mins, condiments,
etc .). To do so , you must follow a few simple instructions (listed below). The purpose here is to
correctly record and quantify your normal intake, not to judge it. If you change your eating habi ts in
any way, then we cannot accurately analyze your Iypica l diet. The procedure may seem som ewhat
cumbersome , but remember, it is on ly three days.

INSTRUCTIONS
Ke ep a pen and paper With you at all times to record Record combination foods separa tely (e g., hot dog, bun,
your Inlake Including food l1em, Quantity, and notes . and condimen ts ) and include bland names of food items
This IS Imperative as snacks are typically consumed (list contents of homemade Item S)lI'Ihenever possi b le .
unpredic ta bly and, as a result . IllS Impossible to record
For pa ckaged Items, use labels to determine quantities.
th em accura tely unless your reco rding forms are nea rby.
Recor d three days that are representative of your normal
Use a small food scale If you have one , or use standard
Intake There fore if your weekdays ale dlHerent from your
measuring devices (e g" measuring cups . measuring
wee kend s, pick t\vo weekdays and one weekend . Like wise,
spoon s) to record the Quanti ties consumed as accu rately
If yo ur M, W, and Fare diHerent from your T and Th and all
as possible. If yo<J do not ea t all of the Item (for Instance
these da ys are di Heren t from your Sat and Su n, you should
a portion of an apparen tly deliCIOUS has tily prepared
pick one day to represent each u nique sc hedule.
casse role of lef tovers t hat turn ed out to be not so deliCIO US),
re-m ea su re what's left and record th e differe nce .

EXAMPLE: DIETARY RECORD : DAY 1

FOOD IT EM QUANTITY NOTE S

Breakfast

2 pieces of toast 2 pc

Margarine 1T

Ora nge JUi ce 6 oz

Lunch

Small pilla 400g Pepperoni. mush ro om, cheese

Dinner

Chic ke n 6 oz

Baked potato 6 oz

Mixed vegetables 1c Peas. ca rro ts, com

UNIT 2 Chapter 11 Step 2 Col lec ting Prehm lna ry Chen t Informa tion 281

DIETARY RECORD: DAY 1

FOOD ITE M QUANTITY NOTES

(Include brand names) Ig. mL lablesnoons In (Inc lude in gredien ts & amo unts of homemade Items)
teaspoons [II. cups le I. etc)

10.

11.

12.

13.

15.

16.

lB.

19 .

20.

21.
282 UN IT 2 Cha pter 11 Slep 2 : Coli e<:: llllg Preli minary Client Info rm at ion

DIETARY RECORD, DAY 2

FOOD ITEM QUANTI TY NOTE S

i l,l (: ude OrClrl(1 names) If,. rn L tablespoo ns I TI (Inc lu de Ingred e lts & amounts of homelnade It ems)
te as poo ns Il l. C UD S (c1. etc I

10.

11.

12.

14.

15.

16.

17 .

18.

19.

20 .

21.
UNtT 2 Chapter 11 Step 2 Collectong Preilmma ty Cli en ll nforrT1 <1 tlo n 283

DIETAR Y RECORD : DAY 3

FOOD IT EM QUA NTITY NOTES

i l tlC IJde ::> I ~nd ' la ' ne~ l (15 ml !abl espc<lns iT ' Ih';ctJoe l '1greQ lenls & a rr O J1 t ~ of hor ,e ll'ade , t f'm~
teasooo ns It L c Lp s d etc I

10.

11.

12.

13.

15.

16.

17.

18.

19.

20.

21.
28 4 UNIT 2 Chapter 11 Step 2: Collectmg Prellmmary Client Inf or ma t ion

Readiness for Change Questionnaire

Name' ___________________________ Date, ___________________

One of the most important things you can do to change your lifestyle for the better is
understand your readiness for change. In other words, although you might want to be
in great shape, there's a difference between wanting it and being ready to do the work
necessary to accomplish it In this questionnaire we'll find out if you're really ready to make
Ihe changes necessary to improve your body composition, health , and physical performance.

Simply answer the questions below by select ing the response most appropriate to your
situa tio n. Once you 've completed all the questions, your score will be calculated. And
remember, be honest You're doing this exercise to find out if you're really ready to make a
lifestyle change. So don't lie to yourself.

READINESS FOR CHANGE QUESTIONNAIRE

QUESTIONS: RESPONSES AND SCORING

1. Do you look in the mirror and feel frustrated , upset, a) Yes (+ 3)

or humiliated because of how your body looks? b) I'm not sure (0)
c) No (- 3)

2. When yo u feel run down and tired , what do you think a) Getting older (- 1)
is the source of these feelings? b) My lifestyle chO ices (+ 3 )
c) Someth ing else altogether (- 3)

3. Are you taking any medicati ons for heart disease, high a) Yes , I'm on two or more of these medications (+3)
blood pressure, or type II diabetes that you didn't have b) Yes, I'm on only one of these medicat ions (+ 1)
to take when you were younger? c) No, I'm not on any of these medications (- 3)

4. How do you explam the fact that you 're in worse shape a) I th ink It's my family history (-1)
than when you were younger but haven't changed b) I think it's that I'm less active (+3)
your habits at all? c) I think it's a natural consequence of agmg (- 1)
dl I don't know why it's happenmg (OJ

5. If you don't have anyone to exercise with regularly, a) Yes (+5)

are you willing to look for a phYSical act ivity partner? b) No (-5)

6. Are you willing to join a gym toda y? a) Yes ( + 3)

b) No (- 3)

7. If someone told you that you'd need to throwaway all a) Yes (+5)
the foods m your cupboards today and go shopping for b) No (- 5)
different foods that are more appropriate to your goal,
would you do It?

8. If an expe rt presen ts some mformation on diet and a) Keep an open mind and give it a try (+3)
exercise that contradicts what you currently believe, b) Ask a friend (0)
what approach will you take? c) Ignore the advi ce (- 3)

9. Are you willing to have a meeting With your friends and a) Yes, right away (+5)
loved ones and share your beha Viour goals and desired b) Yes, but not Just ye t (-3)

outcomes With them? c) No (- 5)

UNIT 2 Chapter 11 Step 2 Collecting Pre liminary Cl ient Inl or ma tlon 285

READINESS FOR CHANGE QUESTIONNAIRE

QUEST IONS : RESPONSES AND SCORING

10. If your work environment presents significant barriers to a) Yes (+5)

you exercising and eating well, would you consider speaking b) No (- 5)
to your employer about changing some of the se conditions or
are you willing to find new employment?

11. Are you ready to spend less time with people who offer little a) Yes ( + 5)

or no social support for your goals while spending more time b) No (-5)

with those who do offer support?

12. Can you accept res ponsibility for the way your body is today a} Yes (+ 5)
and und erstand that, while your old habits don't make you b) No (- 5)
a bad person, they still need to be changed?

13. If a friend or loved one suggests that you don't have what It a) I can do It (+ 2)
takes to get into great shape because you've failed before b) I know I've got to make some changes but I'll take it
or for some other reas on, what will be your response? one day at a time (+ 5)
c) Maybe I can't do It (-5)

14. Are you willing to wake up In t he morning a bit earlier and a} Yes (+5)

stay up at night a bit later to accomplish your goals? b) No (- 5)

15. Are you Willing to do at le ast five hours of phYS ical ac ti vity a) Yes (+5)
each week? b) No (-5)

YOUR SCORE AND WHAT IT MEANS

21 to 63:
It's clear that changing the way you look, feel, and perform have become very Impor ta nt to you and you rea lize that the way you're
dOing things right now simply isn't cutting it. You're tired of not ge tll ng resu lts, and you're tired of your growmg waisllme, your
sluggish metabohsm, and you r lack of energy. And not only are you tired of it, you're committed to domg something about it - today.
Congratulations! Getting to this point takes a lot of work. Now, let's do something about it

-20 t o + 20:
If you scored in thiS range, II'S important for you to stop thlOklng and start doing. You're probably frustrated wi th the way thin gs are , but
you're afra id that changing the way you do thmgs Will cause yo u more hassle and difficulty than just Sitting back, doing nothing, and
con tinuing to look and fee ! the way you do today. In fact, you 're no t atone. ThiS IS most people's greatest fear: that a new exercise and
nu trition program will cause more pain than th e palO they feel right now.

If this is you , step outside of your shell and seek ou t some people who are ex ercising, eatmg well, getting resu lts, and having fun doing
it. Clearly, miJfions of people ou t t here are f ollOWing a healthy lifestyle and lOVing every minute of it. But thinking that they never had
difficul t ies to overcome like you do is a mistake. At some point in time each and everyone of them had some old se t of unproductive
ha bits to discard . Once this was ac complished, they could eaSi ly ge t Into the zone . And you can, too. What are you waiting for?

-6 1 to - 21:
From the results of your questionnaire, it doesn't look like you rea lly want to change. Is thiS t rue? Are you Simply toying with the Idea of
improving your phYS ical activity habits and eating habits? If so, you're not really ready to make a change. With each passing year that
you avoid good activity a nd nutrition habits yo ur risk for disease increases. Not on ly that, you'll progressively gain fat. lose muscle, and
look much older than your ac tu at age. These are the consequences of remalOing indifferent to the medications you're on, the weigh t
yo u've gained, and the environment wi th which you've surrounded yourself.

Are you ready to deal with these t hmgs? Don't stay indifferent any longer. Take an honest look at how you've ch anged (on the Inside and
out) and admi t t ha t you could use a tune· up.
286 UNIT 2 Chapter 11 Step 2 Co llect ing Prelim inary Client Information

Kitchen Makeover Questionnaire

Name, ____________________________ Date, ___________

There's a fundamenta l law of human nutrit ion that goes like this,

If a food ;s in your possession or located in your residence, you will eventually eat it.
(Whether you plan to or not, whether you want to or not, you'll eventua ll y eat it ' Trust us.)
Therefore, according to this impor tant law of human nutri tion, if you wish to be healthy and
lean, you must remo ve all foods that aren't part of your hea lthy eating program and replace
them with a variety of better, health ier cho ices.

How do you know which foods have got to go and which foods can stay' Simply answer the
questions below by selecting the response most appropriate to your situation. Once you 've
completed all the questions, your score will be calcula ted. And remember, be honest. You ' re
do ing this exercise to find out whether your ki tchen is in good shape.

KITCHEN MAKEOVER QUESTIONNAIRE

QUESTIO NS: RESPO NSES AND SCOR ING

1. Do you have the fo llowing it ems in your kitchen?

* Good set of pots and pans * Sca le for weighmg foods al I have all of them. (-5)
* Good set of knives * Sealable containers for carrying mea ls b) I have more than half of them . (- 2)
* Spat ula * Small cooler fo r takmg mea ls to work c) I have Jes s than half of them . ( +2)
* Bl ender * Shaker bo tt le for drinks and shakes dl I don't have any of them . ( +5 )
* Tea kettle * Food processor

2 . Do you have the fo llowing items in your pa ntry?

* Whole oats * Extra virgin olive oil a) ! have all of them . (- 5)

* Qu i noa * Vinegar b) r have more than half of them. (- 2)
* Whole-grain pas ta * Green tea c) I have less than half of them. ( +2)
* Natura l peanut butter * Pro tein supplements d)! don' t have any of them . ( +5)
* Mixed nuts * Fish oil supplements
* Canned or bagged beans * Green foods supplemen ts

3. Do you have the follow in g items in your fridge or freezer?

* Extra-lea n beef * At least fou r varieti es of fru it a) I have all of them. (- 5)

* Chicken breasts * At least five varieties of vege tables b) I have more than half of them. (- 2)
* Salmon * Flax seed oi[ c) I have less th an ha lf of them. (+2)
* Omega-3 eggs * Water fi lter d) I don't have any of them. ( +5)
* Packaged egg whites * Sweet potat oe s
* Real cheese

4. Do you have the fol low mg items in your pantry'

* Potato or corn chi ps * Chocolates or candy a) [h ave aU of them . ( + 5)

* Fru it or g ran ola bars * Salt drinks b) I have more than half of them. (+2)
* Regular or low-fat cookies * Regu lar peanut butter c) I have [ess than halt of them . (- 2)
* Crackers * At least four types of alcohol d) r don't have any of them. (- 5)
* Instant foods li ke cake mixes and mash ed potatoes
* Bre ad crumbs, croutons, and other dried bread produc ts
UN IT 2 Chapter 11 St ep 2 Co llecting Pre liminar y Cl ient Information 287

KITCHEN MAKEOVER QUESTIONNAIRE

QUEST I ONS : RESPONSES AND SCORING

5. Do you have the followmg Jtems in your fridge or freezer?

* At least four types of sauces * Baked goods a) 1 have all of them. ( + 5)

* Juicy steaks or sausage * Frozen dmners b) I have more than half of them. (+2)

* Margarine * At least two types of bread or bagel c) I have less than ha lf of them. (- 2)

* Fruit jUice * Take-out or restaurant leftovers d) I don't have any of them. (- 5)

* Soft dri nks * Big bowl of mashed potatoes or pasta

6. Do you have bowls of candy, chips, crackers, or other snacks sitting a) Yes (+5)

around at home? b) No (- 5)

7, When yo u have parties or dinner guests, do you se rve the m what you a) What I think IS healthy (- 3)

th ink they' ll want or what you think is healthy? b) What I th ink they want (+3)

S. When food shopping, do you buy economy-sized bags, or do you buy a) More than half of the time I buy

smaller portions? economy-sized bags. ( + 3)

b) Mo re than half of the time I buy

smaller portions, (- 3)

9, How often do you shop for groceries? a) Fewer than three times a month (+5)

b) About once a week (- 1)

c) More t han once a week (- 5)

10. Do yo u keep food in plain view around the house? a) Yes (+ 3)

b) No (-3)

1 1. Do you think healthy eat ing means low- fat eati ng? a) Yes (+2)
b) No (- 2)

12, If someone were to point to a food 10 your k itch en, would you know a) Yes (- 2)

whether It was composed of mostly carbohydrate, protem, or fat? b) No (+2)

13 , When you prepare mea ls from recipe books, do you use those a) Most of the time (- 5)

that contain hea lthy recipes? b) About half of the time (0)
c) Almost neve r (+5 )

14. Do you prepare meals In advance to take wi th you to work, a} Yes, always (- 5)

on day trrps, or on vacations? b) More than half t he time (- 2)

c) Less than half the time ( + 2)

d) Almost never ( +5)

15. Are you heSItan t to throw out unhealthy leftovers or gift foods a) Yes , I hate throwing food out (+5 )

that don't fit into your nutritional plan? b) No, more than half the ti me I throw
thiS stuff out (0 )
c) No, I always throw this stuff out (- 5)
288 UNIT 2 Chapter 11 St ep 2 Co llecting Preliminary Client Info rm at ion

KITCHE N MA KEO VER QUE STIONNAIRE

YOUR SCORE AND W H AT IT MEANS

32 to 63 poi nts

You've scored high on the kitchen overhaul questionnaire. But thiS high score means you're not dOing so well in the kitchen department.
In tact. If your kitchen stays in this cond ition you'll have better luck winning the lottery than getting grea t body composi ti on, health, a nd
performance results. Since you're in need of an Extreme Makeover - The Ki t chen Ed ition, he re's wh at to do:

Step L Go grab an ext ra-large shoppmg bag

Step 2 : Without t hmklng about It , open t ha t bag up a nd with your forearm, sweep every offenSive food Item f rom your
fridge, freezer, and cupboards right in . These Include all items from Quest i ons 4 and 5 above.

Step 3: Wave goodbye as this food rolls away on the back of a garbage tru ck.

Step 4: Ge t to t he grocery store immediately, and pick up the foods lis ted in Questions 2 and 3 above .

o to 31 points
Your ki tchen's not the worst I've seen , bu t could certamly use some Improvemen t here and there. Take a look at t he inventory above
and make sure you 've got all the items listed In quest io ns 1 through 3 and fewer of t he items from questions 4 and 5. Begin shopping
more frequent ly, eat ing fresher items, and bemg more aware of t he foods that you're eat ing and when . Only then Wi ll you be eqwpped
for success .

-31 to -1 points

Nice Job; you're dOing pretty well in t he kitchen department . In fact , with a few minor tweaks , your kitchen will be 100% ready to go .
Revisit the Questions above and figure out exactly wha t It'[1 take to get croser to a perfec t score of - 63 .

- 32 to - 63 paints

Don't let the negative scores fool you~ Negative sco res on the ki tchen ove rhaul questionnaire mean tha t you don't need much of a
ma keover. And that's great ! Congratulations on your ki tchen set-up. With your kitch en full of these good foods ([ike those li sted m
questi ons 2 and 3 ab ove) and the right app li ances, you' ll be the envy of all your fitness- and nutrition-conSCIOUS friends.
UN IT 2 Chapter 11 ;'\10',) 2 Col ec tl " i; P'clin r ary Cllen ll rl lurmallo' 289

Social Support Questionnaire

Name' ___________________________ Date, __________________

Social support is defined as having a network of people that support your endeavors, contribute
positively to your decision-making processes, and are there for you when you need help. Scientists
have suggested that people with this kind of network around them can transcend even the worst
environments and accomplish great things. Unfortunately, people who don't have this type of
network have a harder time accomplishing even modest goals . Remember this, who you are today
and who you become in the future has a lot to do with whom you choose to spend your time.
The following questions are designed to assess your level of social support, which strongly
influences how well you follow any nutrition or exercise program. Simply answer the questions
below by selecting the response most appropriate to your situation. Once you've completed
all the questions , your score will be calculated. And remember, be honest. You're doing this
exercise to find Ihe areas of your life that might present challenges to your progress.
A word of caution, once you recognize your challenges it's easy to blame them for your
outcomes . Don 't do this. Outside factors can affect you - If you let them. But you're in
contro l. You have the power to place yoursel f in the righ t env ironment, so use it!

SOCIAL SUPP ORT QUE STION NA IRE

QU ESTI ONS: RESPONSES AND SCOR ING

1. Do the people with whom you spend each day (at work or at home) a) Yes, most of them do. (+3)

follow healthy lifestyle habits such as exercising regularly, watching b) About half do and half don't. (0)

what they eat, and taking nutritional supplements? c) No, most of them don't, (- 3)

2. Does your spouse or partner follow healthy lifestyle habits such as a) Yes, my spouse/partner does. (+5)
exe rcIsing regularly, watching what sJhe eats, and taking b) No, my spouse/partner doesn't. (- 5)

nutrrtlonal supplements? c) I don't have a spouse or partner. (0)

3. When you want to perform some physical ac tivity such as going for a) Yes, it's easy to find a partner. (+2)

a workout or takmg a hi ke, is it easy for you to find a partner b) Yes, but very infrequently. (0)

to go wi th you? c) No , they never do. (-4)

4. At your workplace, do your coworkers regularly bring in treats a) Yes, they oft en do. (-4)

like cookies, donuts, and ot her snacks? b) Yes, but I typically don't indulge (0)
c) No, they don't (+ 5)

5. If you go out to eat more than once per week, do the people you a) Yes, they always do. (+2)

dme With order healthy selections? b) Only about half of the time. (0)
c) No, they never do. (- 2)

6. Do you belong to any clubs, groups, or teams that meet at least a) Yes , I've been a member for years. ( + 5)

twice per week and do some physical exercIse (thiS does not include b) Yes, I've just started. (+2)
a health club membership)? c) No, I don't. (0)

7. Do you belong to a health club and attend, on average, a) Yes, I've been doing this for at least 1 year. (+2)

at leas t three tim es per week? b) Yes, I've just joined. (+ 1)

c) No, I don't. (0)
290 UNIT 2 Chapter 11 St ep 2 Collecting Preliminary Client Information

SOCIAL SUPPORT QUESTIONNAIRE

QUES TI ONS: RESPO NSES AND SCOR ING

8. When discussing your nutrit ion and exercise goals with fnends. a) They're very interested. (+2)
do they seem interested In getting on board, or do lhey think you're crazy? b) They're no t interested. (0)
c) They think I'm crazy. (-2)

9. Do the people you lIVe w ith bring home foods that aren't considered a) Always (-5)

healthy or good for you? b) Sometimes (- 3)

c) Never (0)

10. Do the people you live wiLh bring home foods that are cons idered a) Always (+5)
healthy or good f or you? b) Sometimes (0)
c) Never (-5)

1 1. Do t he people you live with or work with schedule actiVit ies for you a) Always; t hey don't respect my time. (-3)
that interfere with your pre-established exercise time? b) Sometimes; they don't th ink about it. (- ll
c) Never; they respect this time. (+3)

12. Do those around you bring nutrition, exerCise, or supplement information a) Always (+5)
to your attention so that you can stay Informed abo ut these tOPICS? b) Sometimes ( + 2)
c) Never (0)

YOU R SCORE AN D WHAT IT MEANS

28 to 38 total points:
Congra tulat ions! You 've got a great support ne twork around you. Of co urse, that's not all you'll need to succeed with a good nutrition and
exercise program, but it's a great start . Even though you may have scored rela tively high on this questio nnaire, remember that social support
works bolh ways : in order to make sure you keep this great group of people around you, you'll have to offer support to them as well.

5 to 19 total points:
It looks like you've got some SOC ia l support around yo u but there are obviously a few areas of your life that Will present ch allenges. Be
aware of workplace challenges, at-home cha llenges, and re lationship challenges that might st and In your way. Make sure to review the
potent ial probl ems above and come up With cre at ive ways to im prove the social enVIronment aro und you.

4 to - 14 total points:
Your social support is lacking and needs a makeover. While some of your env ironment Isn't condUCIVe to your goa ls, there are some areas that
yo u can begin to exp lore. Identify whic h areas are deficient above, then take ste ps to fix them. Joi n a health club, dine with friends committed
to health, spend time dOing nonfood-related thmgs with your other friends, and aVOid the donut tray at work. And remember, although It'S
easy to blame those around you for not being as supportive as you'd like, choosmg new exercise and nutrit ion goals is your own choice, not
necessarily theirs. Instead of blammg them, simply come up w ith creative and non-an ta gonistic ways to enlist their support.

-15 to - 31 total points:

ThiS score JS qUite low and therefore signals some real problems In your work and at-home enVIronments, as well as In your
relati onships. Of course , some people have been known to succeed in reach ing the ir goals by gOing it al one. But succeed i ng with a "lone
ranger" mentality IS too difficult for most to accomplish. Without some serious changes , your environment will al most cer ta inly cause
your old hab it s to surfa ce. Important changes may Include: hav i ng a serious ta lk with your friends and fami ly in order to express to them
how important th iS IS to you, gO ing out Immediately and JOJOing a club or group that meets for regul ar exerCise, or finding a workout
partner that IS as motivated as you are . And remember, alt hough It'S easy to blame those around you for not being as supportive as
you'd like, Instead of blaming t hem, simply come up With creative and non-antagoni st ic ways to enlist their support. Of course, If It
comes down to it, pick some new friends. Your social group IS one of the most Important variables in your success.
UN IT 2 Chapter 11 Sl ep 2 Co l le ct i ng Pr el lm ma ry Client Information 291

Name, _____ Date, _

INITIAL BODY COMPOSITION ASSESSMENT (MEN)

MEASUREMEN T MEASUREMENT MEASUREMEN T MEAN OF 3

SITE #1 #2 #3 MEASUREMEN TS
---- -- ----- --- --- - --- -- -- ------- ---- -- -- -- - --- -- -- -------- - ---- - ----- -- ------- -- ---------- - ---

Abdom inal
ski nfold (mm)

Triceps
skinfold (mm)

Chest
skin fo ld (mm)
--- ----- -------- -- - ---- ------ - --- ------ -- - --------- ---- - ---- --- --- - --- -- ----- ------------- - --- ------

Subscapular
skinfold (mm)

Supra ili ac
skinfold (mm)

Thigh
skinfold (mm)

Sum of me an sk ln folds (mm) =

Body fat % (S ee Appendix A for calculatIOns) =
292 UNIT 2 Chapter 11 Steo 2. Collecting Prelim inary Client Information

INITIAL BODY COMPOSIT ION ASS ESSMENT (MEN)

MEASUREMEN T MEASUREMEN T MEASUREMEN T MEAN OF 3

SITE #2 #3 M EA SU RE MEN TS

Neck girth (em)

Shoulder girth (em)

Chest girth (em)

Upper -arm girth (em )

Waist girth (em)

Hip girth (em)

Thigh girth (em)

Call girth (e m)
UNIT 2 Chapter 11 Step 2 Collec lmg Preilnlll".ar ',' Client Inlo' 1T' 3tlon 293

Date, _ _ _ __ _ _ _ __

INITIAL BODY COMPOSITION ASSESSMENT (WOMEN)

MEAS UREMENT M EAS UREMENT MEAS U RE MEN T MEAN OF 3

SI TE #1 #2 #3 MEASUREMEN TS

Abdom i nal
skinfold (mm)

Triceps
skin fold (mm)
. --- - ------
~ ~ ~~~ ~~ ~~. ~ ~ ~ . ~ ~ ~ ~. ~ ~ _. -- ---- - --- -- ~ ~ - --
~ ~ ~ ~ ~. ~ .. ~ ~. ~ -' ---- ---- -- --- _. _.. -_........ - -----

Chest
skinfold (mm)

Mid-axillary
skinfold (mm)

Subscapu lar
sk infold (mm)

Supra ili ac
sk infold (mm)

Thigh
skinfold (mm)

Sum of mea n sk lnfoJds (mm) =

Body fat % (See Appendix A for calculati ons) =
294 UNIT 2 Chapter 11 Sl ep 2. Co lt ec tlng Pre limi nary Cl ien t Informallon

INITIAL BODY COMPOSITION ASSESSMENT (WOMEN)

MEASUREMENT MEASUREMENT MEASUREMENT MEAN OF 3

SITE #1 #2 #3 MEASUREMENTS

Neck girth (e m)

Shou lder girth (em)

Ches t girth (em)

Upper-arm girth (em)

Wais t girth (em)

Hip gi rth (em )

Thigh gi rth (em)

Calf gi rth (em)

UNI T 2 Chapter 11 Step 2 Co llect i ng Prellm ll1a ry Cli ent In form at ion 295

Name' ________ Date, _

BASELINE STRESS/ RECOVERY ASSESSMENT

Rate the following mood qualities on a scale of 0 to 5 as folJows:

MOOD QUALITY RATING (0-5)

Appetite
o = No appeti te: 5 = Very hungry

Sleep quality
o= Poor slee p: 5 = Very good sleep

Tiredness
o= No tiredness ; 5 = Very tired

Willingness to train
o= No wi llingn ess; 5 = Ve ry excited to train

Record you r resting heart rate (taken first thing in the morning w hile seated, not s ta nding) below. Place your IIldex and middle

fi nger on either your carotid ar te ry (neck) or yo ur radial artery (InSide of your wnst) and count the number of beats yo u feel III

60 seconds.

Resting morning heart rate (beats/minu te ):

296 UNIT 2 Chapter 11 5110 1.2 C,) I €'c "n~ P ' el l" w la ,) Cllt! !l l Info' ' ) .31,0 11

Initial Performance Assessment

Name' ___________________________ Date , ___________________

Regardless of whether you're tracking performance in the gym or on the playing field, many
different measures ca n be used to assess progress. These include maximal strength tests,
power tests, strength endurance tests, and endurance capacity tests . Each of these tests will
be affected by the quality of the traini ng and nutrition programs you are following, so test them
periodically to ensure that they're improving. Collect baseline measures for each of the tests
that are relevant to your particular goals, in order to provide a basis for future compa ri son.

INITIAL PERFORMANCE ASSESSMENT

MAXIM AL STRENGTH TE STS

One great way to assess max ima l strength is to perform 1RM (1 repe titIOn maximum) or 3RM (3 repetitIOn maximum) tests in the major
lifts - bench press , squa t, and deadlift - as these lifts are most ind icative of whole -body strength.

No te: if you afe relatively new to th es e movements, use 3RM tests.

MAJOR LIFT REPETITIONS LOAO

Bench press lRM or 3RM

Squat lRM or 3RM

Deadlifl I RM or 3RM

POWE R TE STS

If i ncreased powe r is an important goal for you, you may choose to perform l RM tests in the explosive Olympic li ft s: cleans and
snatches . You may also want to test your vertica l jump for lower body power, and overhead medicine ball toss for upper body power.

Note: these exercises are technique-driven and therefo re you should spend ample time practicmg before testing Lhese l ifts.

POWER TEST REPETITIONS LOAO

Barbell clean lRM

Barbell sna tch lRM

POWER TEST REPETITIONS LOAO

Vertical jump 1 jump

Overhead medicine ball toss 1 toss

UNIT 2 Chapter 11 St ep 2 - CO llecl l11g Preli mi nary Cl len ll nf orm atl on 297

INITI AL PERFOR MANC E ASS ESSM ENT

ST RE NGTH-ENDURAN CE

Another valuable test that can demonstrate progress in strength·endurance IS a percent of 1RM test In this type of test, you select a
weight that's 75% of your lRM and pe rf orm as many reps as you can.

Note; choose the same weight f or your baseline testing as you do for your follow-up testing. For example, don't sel ect 75% of your new
1 RM when you re t est Choose 75% of your angina l 1RM. In other words, If you use 225 Ib for this first assessment, make su re that
each follow -up test is pe rformed with 225 lb. This will help you accura tely gauge progress over time.

MAJOR LIFT MAX % OF MAX LOAD REPET ITION S

Bench press

Squat

Deadlill

ENDU RANCE CAPACITY

While VOl ..... testing and aerobic/anaerobic threshold tes ting are popular measures of endurance capacity, a simple in·gym treadmill
procedure can be used to measure endurance progress. Here's how It'S done;

1. Start by running on the treadmill at a speed between 7.5 and 8.5 mph and a 0% elevation.

2. Increase the elevation by 1% every mlOute.

3. Continue until exhaustion .

4. Record the highest ac hi eved elevation.

This number is Vc .., (maximum ve locity). Most young, active people can last until they reach between 8% and 12% elevation.

Over li me, you can retest your V....... for a good index of yo ur aerob iC capac ity. You 'll know you've improved If you can last longer and
achieve a higher locline. II you wan t to go one step further, here's another good tes t:

1. After a day off from the gym, begin by setting the treadmill at the same speed and grade as your V"""

2. Ru n on the treadmill at Vrr~ until fatigue .

3. Record you r maximum time at V-. This duration is called T...., (maximum time).

Most athletes can last between 200 and 300 seconds. As with V.,. n' you can retest T_ over time as another good index of endurance
capacity.

Note: choose the same V", ", for pretesting and follow -up te stin g. In other words, if you can last for 200 seconds at 10% eleva tion and
8.5 mph during the pretest, make sure that you use 10% eleva tion and 8.5 mph during your second test. This will help you accurately
gauge progress over time.

TE ST SPEED ElEVATION

V~ .

TE ST
298 UNIT 2 Chapter 11 Step 2 Co llec ting Prell mmary Client Information

Baseline Blood Chemistry Assessment

Name' ___________________________ Date, ___________________

A complete blood profile test, perform ed by your doctor, wil l assess your overall blood and
cellular health as well as your susceptibility to disease. We recommend the following tests.
Please bring this list to your physician and inquire about having these tests done. Once this
information is collected, i nc lude this information in your file for comparative data over ti me.

BASELINE BLOOD CHEMISTRY ASSESSMENT

GENERAL TESTS CARD IOVASC ULAR RISK PROF IL E HORMONES

Total cholesterol Testosterone

TYPically called SMAC-20, SMA-20, or
LDL Free testosterone
Chem-20, this basic t est looks at 20
HDL IGF·l
different parts of the blood incl udi ng
Triglycerides Growth hormone
blood levels of certain mmerals, proteins,
C·reactive protem DHENDHEAs
etc. This test [s standard and should be
Homocysteine Estradiol
done although it's not very te lhng of your
SHBG
overall health profil e.

PROSTATE TESTS CARBO HYDRATE TOLERA NCE

PSA Fasted insu lin

Fasted glucose

LIVER FUNC TI ON TESTS KID NEY FUNCTIO N TESTS THYROID PANE L

Alkaline phosphatase Creatinine TSH

GGT BUN 13
SGOT Creatinine/BUN ra tio T4
SGPT ,13
Bilirubin
UN IT 2 Chapter 11 Slep 2 Co llec tll1 g Pre llmll1 ar y Cli ent Information 299

Baseline Visual Assessment

You can use severa l markers to measu re healt h, body composition, and performance.
A[ [ of these marke rs have a place, depending on clients' current goals, priorities, leve[ of
commitment, and so forth. We've already recorded body composition markers (weight,
sk info[d measures , and girths) , hea lth markers (b [ood work), and performa nce markers
(gym performa nce) , yet we saved what's perhaps one of the most impo rtant ones for last
visual inspection.
Peop le exercise and improve their eating so that they can improve the way their bodies [oak
and feel. Yet they often don't compare the way they [oak when they start their new program
and the way they [oak 4, 6, 12, or 24 weeks later. Sure , they may spend time looking in the
mi rr or and searching for changes. However, no one notices prog ress th is way. The on ly real
way to document visual progress is to take before , during, and after pictures .
He re's how to take them,
1. Have your client stand aga inst a bare wa ll , wearing a sm all pa ir of shorts (men) or a
swimsuit (women) .
2. Set up your camera about five to seven fee t away from your cli ent so that it can capture
their who le body from head to toe.
3. Make sure the room is well [it. You may need to use the flash when taking your photo.
However, make su re the re isn't a [at of overhead light; yo u don't want to cast shadows .
4. Wr ite down exact ly how yo u took the before pictures (camera setti ngs , lig hting cond itions,
how far away the camera was , etc .). This wi ll he lp you duplicate the same cond itions in
the future .
5. Take four ful[-body photog raphs, one of the client's front, one of the [eft side, one of the
right side, an d one of the back .
6. [f posti ng pictures in a public fo rum, block ou t your client's head and face for anonymity
unless they expl icitly reques t otherwise .
300 UNIT 2 Ch apte r 11 St ep 2 Collect in g Prellmma ry Cl ient Infor mat ion

Here are a few examp les of what your progress photos shou ld loo k like:

Female progress photo, front and ba ck Fema le prog ress photo, each side

Male progress photo , front and back Male progress photo, each side
UNIT 2 Chapter 11 St ep 2 Collecting Preliminary Client Info rm ati on 301

I'm comfortable ad mitting that earlier in my career testosterone leve ls. Normally, the "healthy range " for
I made qui te a few mistakes - both generally and blood testosterone is between 300 nwdL and
with particula r clients. One of the biggest mistakes 1100 nWdL. Many weight lift ers and strength ath letes
I made was not prioritizing comprehensive client have testosterone co ncentrations in t he mid- to high
assessments. Looking back, I realize that if I had range. Unfortunately, this client had a testosterone
taken the time to learn more about my cl ients up- conce ntration of 150 ngidL. Th is is considered
front, I wou ld have had far more success. In some cl in ica ll y low (in medicine, it 's cal led hypogonad ism )
cases , I would have ensured they got results faster. In and usually wa r ra nts testosterone replacement
other cases, I would have been able to retain clients therapy. My client's doctor (presumab ly now
who left frustrated . (Yes, t his happened. And in many co ntrite) provided hi m with prescrip ti on testosterone
cases, needlessly.) replacement and worked wit h him to he lp bring his
testosterone levels into the norma l ran ge.
In one case , I began working wi th a 34-year-old male
with a history of being very thin . He wanted to gain After begin ning testosterone therapy, although we
we ight. At 6'2" he we ighed in at 160 Ib (7% body kept my client's tra ining and nutrition progra m the
fat) despite strength tra ining 4-5 ti mes per week with same, his gym intensity skyrocket ed, his strength
a personal trainer and, he claimed , "eating a lot. " went up dramatically, and in eight short weeks his
body responded by packing on 15 Ib of lea n body
After he described what he'd been dOing , I changed
mass! Wi th the first 16 weeks of hard tra ining and
his training program and recommended much more
eati ng a ton of food , he 'd only ga i ned 5 Ib of lean
food , including a host of higher-calorie SuperShakes
body mass . Add in therapeutic testostero ne and half
that he could drink between meals to boost his total
the time produced t hree times the res ults. He also
ca lorie int ake . I assumed that he simply had a fast
descri bed feeling a he ightened sense of well -being,
metabolism, was tra ining incorrectly for his body
more focus and concentration, and an improved
type, and wasn't eating eno ugh to compensate for h is
libido. He called it a miracle and was ecstatic.
speedy metabolic rate.
I, on the other hand, did not feel a heightened
Eve ry two weeks we recorded his bodyweight and
sense of well-bei ng; I fel t terrib le for not notici ng
skinfold numbers. Although he was moving in the
th is until fo ur months into hi s progra m. Instead
right direction, after 16 weeks, he still had on ly
of adequately as sess ing my cl ien t and looking fo r
gained about 8 tota l pounds (5 of it being lean
l imiti ng factors, I made a host of assu mptions
mass), despite reporting perfect adherence t o the
and provided a sub-standard service. After th is
pl an. Knowing my advice was so und, I started to
experience, I reso lved to ask more questions and
wonder if there was someth ing else preve nting his
take more assessments with new cl ients. I didn 't
progress. I knew he was training hard and eating
want to leave any sto ne unt urned .
well , so what could it be?
Not every client who wants to ga in m uscle m ass and
I sent him in to have his blood taken and analyzed ,
strength needs t estosterone rep lace ment therapy.
provid ing a list of what shou ld be eva luated,
That's not the lesson here. Indeed , for cl ients wit hin
including a host of hormones and unconventional
t he normal ra nge for testosterone , medica l therapy
measures. At first , his doctor protested the hormone
probably won 't improve performance or muscle m ass
tests. He claimed that since this cl ient was 34 years
at all. Only clients who are hypogonadal will benefit.
old and healthy, there was no reason to suspect
hormonal ab norma lit ies. But my client i ns isted and The real lesson is that you must adeq uately assess
got the tests do ne. your clients from the outset to gather sufficient
information; to set appropriate expectations; and to
Interestingly, everything came back in the normal ,
design the ideal program for their needs . Without
healthy range except for one th i ng : my client's blood
adeq uate assessme nt , you're j us t gue ssing.
302 UNIT 2 Chapter 11 Step 2 · Collec ting Prelimula ry Clien t InformatIOn

1. Prel iminary client assessments are requ ired for a few reasons :
a. They help establish exclusion criteria, telling you who can and can't begi n a
ri goro us exercise program.
b. They help establish whether you can offer the client nutritional
recommendations or whether you should refer out to other health care
prov id ers.
c. If you r client is healthy an d able to begi n a new program , these assessments
he lp shape the direction of you r advic e.
d. As you beg in a new program , yo ur client w il l start off w ith objective baseline
data that they can refer back to over t i me to demonstrate progress (o r lack
thereof) .
e. They provide your client with an objective picture of how well or how poorly
they've been doing before working with you. Just the simple act of measuring
and recording forces people to be honest about the areas in which they need
to improve.
2. There are hundreds, if not thousands, of measures you can collect when beginning
with a new cl ient. The most important criter ion for whether a measure makes
the c ut is this: does it inform your decision maki ng? If it does, as many of the
assessments in this chapter do, keep it. If it doesn't, it's optional.
3 . In the next chapter you' ll learn how each of the measu res collected in this unit can
give you so me va luab le information about how to design a client's program . Not
only will this help justify the us e of each assessment, it'll help you create better
programs right from the start.
4 . En su ri ng that you're thorough in your assessments will set you apart from other
trainers and hea lth care providers, creating the highest demand for your services.
CHAPTER 12

STEP 3:
INTER-
PRETING
CLIENT
INFORMATION
Chapter objectives
Key terms
Physical Activity Readiness
Questionnaire (PAR-Q)
Medical History and Present Medical
Condition Questionnaire
Comprehensive Client Information
Sheet
Three-Day Dietary Record
Readiness for Change, Kitchen
Overhaul, and Social Support
\
Questionnaires
Assessments (body composition,
stress/recovery, performance , blood
chemistry)
Determining your client's level
Communicating results with clients
Chapter 12 Summary
UN IT 2 Chapter 12 Slep 3 In:e rve t>ns C li e l ~ t II'IO 'IlBllol' 305

In the last chapter, we provided several assessment tools used to gather base line information
about new cl ients - from descriptive data such as age, he ight, weight, and body composi tion ,
to lifestyle data such as occupat ion, tra vel schedule, current exercise program, and curre nt
nutritional intake. These tools provide you with al l the information you need to design an
in itia l program that's well su ited to each client's un ique physiology and lifestyle needs,

Col lect i ng adequate information is important - even essential. But don't get carr ied away
during the initial assessment period . You could eas il y collect hundreds, if not tho usa nds,
of additional measures from a new client. Howeve r, not all of them are useful. Collect
on ly the measures that you need to make decis ions. If a measure affects your initial
recommendations or future plans , then collect it. If not , then it's optional. In this chapter,
we'll walk you through each questionnaire and assessment provided in the previous chapter,
and demonstra te how each one shapes your decision making (and why).

Physical Activity Readiness Qu estionnaire (PAR-Q)

The PAR-Q is straightforward, it's an exclusion test that screens out those who shou ldn't be
exercising without their doctor 's consent and instruction. If a client answers "no" to all the
questions, they can get started. If the client answe rs "yes" to one or more questions, they need
to see their doctor first and get further instruction about how to proceed. Therefore , this test
determines whether your client is ready to begin an exercise and nutrition program with you.

Medical History and Present Medical Condition

Quest ionnaire
Th is medica l history quest ionnaire he lps you iso late med ica l conditions and/or symptoms
that may interact with your exercise or nutrition advice. Although you may not be qual ified
to make recommendations based on a positive test for any of the diseases and symptoms
discussed in this quest ionnaire , adm inisteri ng it will alert you to the ir presence. This may
lead you to make a referral that you might not have otherwise kno wn you needed to make.
Even if a reported med ical problem doesn 't req uire a referral , you might discuss issues such
as low blood sugar, poor sleep quality, the use of specific prescription medications, and so on
with your client's physician or a phys ician in your own professional health ca re network.

This emphasizes the importance of having your ow n hea lth care network (discussed in
the Introd uct ion to th is course ) that can serve as an impo rtant link fo r cross-referrals, and
provlde you with ski ll ed experts to whom you can turn when spec ific issues arise that are
outs ide of your expertise as a trainer.

Comprehensive Client Information Sheet

The Comprehensive Client Information Sheet covers quite a few different areas. Let's examine
these one by one, including what's asked , why, and how th is information will guide your
approach with a new client.

PART 1: GENDER, HEIGHT, WEIGHT, AND AGE

The first section of the Client Information Sheet asks for clients' gender, he ight, weight, and age,

Ge nder is an important facto r for seve ral reasons. Li ke height, it probably won't change, but
it may affect some of your exercise and nutrition suggest ions . First, although there are many
306 UNIT 2 Chapter 12 Steo 3 I l\ terpretl-1g Client Infor m at ion

important physical similarities between males and females when it comes to training and
nut rition, there are also many important hormonal and morphological differences. For example,
men and women tend to respond different ly to carbohydrate intakes, men 's higher average
testosterone levels enable them to put on muscle more easily although the hormone also
predisposes them to put on fat around their midsection (which etevates their risk of metabolic
syndrome), women's menstrual cycles affect the ir appeti te and jO int laxity, and so for th,

Seco nd, because of socialization, men and women may have differen t goals (men may want
to get bigger, while women may want to be smaller) and may prefer di ffe ren t coaching styles,

Third, because women still carry much of the responsibility for caregiving and food
preparation in ho useho lds, they may differ in the ir approach to meal planning, or in how
much time they feel they have available to them (particularly if they have children!.

Id eal heighVweight ratios for men and women

IDEA L W EIGHT FOR HEIGHT I N MEN (l S) I DEAL WEIGH T FO R HEI GH T IN WOM EN (LS)
------ ------ - -------- - --- ---- ---- ----- - -- -- ----- ---- -- - ---- - ---- - .- ------ ----- ---------- -- -- --------
HEIGHT (in feet & inche s) FRAME SIZE FRAME SIZE
----- -- -- ----- --- ---- -- --- ----- ------ -- ---- ----- - ---- -- - ----- -- ---- ------- --- --- --- -- --------- -- ---
SM ALL MED IUM LARGE SMALL MEDI UM LARG E
---- --- -- -- ----- ---- - ------- ---- -- ----- -- -- -- -------- ------- - --- ------ --- ---------
4'10" 102-111 109-121 118-131
4'11" 103-113 111-123 120-134
5'0" 104-115 113-126 122-137
5'1" 106-11 8 115-129 125-140

5'2" 128-134 131-141 138-150 108-121 118-132 128 -143

5'3" 130-136 133-143 140-153 111-124 121-135 131-147
5'4" 132-138 135-145 142-156 114-127 124-138 134-151
5'5" 134-140 137-148 144 -160 117-130 127-141 137-155
5'6" 136-142 139-151 146-164 120-133 130-144 140-159

5'7" 138-145 142-154 149-168 123-136 133-147 143-163

5'8" 140-148 145-157 152-172 126-139 136-150 146-167
5'9" 142-151 148-160 155-176 129-1 42 139-153 149-170
5'10" 144-1 54 151-163 158-180 132-145 142 -1 56 152-173
5'11 " 146-15 7 154-166 161-184 135-148 145-159 155-176
6'0" 149-160 157-170 164-188 138-151 148-16 2 158-179
6' 1" 152- 164 160-174 168-192
6'2" 155-168 164 -1 78 172-197
6'3" 158-172 167- 182 176-202
6'4" 162-176 171-187 181-207
UN IT 2 Chapter 12 Step 3 I n ~ e r p rd , n g Client Informallon 307

Although of course there is a great deal of individual variation among the genders , and
each person should be approached as a unique case, gender will probab ly affect your
recommendations to some degree.

He ight and weight information allows you to determine your client's baseline weight and
establish the goal of progressing towards a healthy (or lean) weigh t if needed . A heightJ
weight table can act as a start ing point (see table 12.1).

Before drawing any conc lusions from this table, you must understand what the height and
weight numbers represent. The "idea l" weights for each height range are based on the lowest
calculated mortality rates for peop le from the ages 25 to 59. This means that those in these
weight ranges are less likely to suffer from all-cause mortality (i .e., premature death from all
diseases) than those who were heavier or lighter. Of course, these numbers aren't directly
corre lated wi th health, nor do they make any distinction between individuals of different
body compositions, nor do they establish idea l weights for sport performance. However, for
relatively Inactive populations considering a lifestyle change, these numbers can be a good
starting paint in the process of setting bodyweight goa ls.

A client's age can also aHect nut rition recommendations . As individua ls get older, nutrient
tolerance, digestion, and metabolic rate change . Past the ages of 30 to 35, lifestyle-re lated
dec reases in voluntary physical activity (purposeful exercise) and incidental physical activity
(lifesty le-related movement) may lead to decreases in overall metabolic rate as we ll as in
carbohydrate tolerance. In plain English , as fo lks age they lose metabolic power and their
ability to handle a higher-carbohydrate diet dim inishes . With clients over 35 (or even some
clients over 30), focus on boosting the metabo li c rate through higher-vo lume exercise training.
Suggest a diet lower in tota l calories and carbohydrate to he lp combat age -associated we ight
gain. And as panc reatic enzyme re lease diminishes with age , individua ls over the age of 35
with digestive complaints may benefit from the inclusion of a digestive enzyme supplement.

PART 2: BODY COMPOSITION

SKINFOLDS

The next section of the Client Information Sheet records sk infold thickness (in milli metres),
total body lean mass, total body fat mass , and body fat percentage. Although there are
several methods for calculating body composit ion, each with advantages and disadvantages,
the sk infold method is usually the most pract ical for trainers.

While some traine rs use skinfold measures simply to calculate body fat percentage , you
should use the actual skinfold measures as an independent variable for two reasons: First ,
skinfo ld measu res provide a more direct way of assessing changes in your clients. Since the
skinfo ld method all ows you to directly measure the thickness of the skin in severa l areas of
the body, it enab les you to t ra ck regional changes in body fat. Rather than just allowing you
to compare a client's initial body fat to their body fat three months la ter, this method allows
you to see specifica ll y where the fat loss originates, and in what proport ions.

This leads to the second advantage of using skinfolds: the locat ion of changes in skinfo ld
measurements can provide clues about a client's hormonal environment. If a client is
losing fat from the th igh s but not from the abdomen, it may indicate an excess of the stress
hormone cort iso l. Alternatively, if a cli ent is los ing fat from the abdomina l region but not
from the subscapular or suprai li ac areas, it may indicate a prob lem with carbohydrate
tolerance . Finally, if a client is losing fat from the abdom ina l and suprailiac areas but not in
308 UNIT 2 Chapter 12 Steo 3 Interp reting: Chent In/Ofr.l d!IOn

the thighs and triceps , this may indica te an excess of the hormone est roge n, Table 12.2
outli nes some poten ti al correla ti ons between skinfo ld measures and spec ific hormones in
the body, While research in this area is in its infancy, several coaches have provided some
convincing observationa l da ta suggesting that these correlations exist. In fa ct, Charles
Po liquin's BioSignature Modulation program offers the most comp rehensive treatment of
this topic. For more , visit www.charlespoliquin.com.

Please note that if body fat is universally high, these correla tions are relatively meaningless.
After all, if every skinfold site is high , leading to a high percentage of body fat , this indica tes
a poor diet, lack of exercise, and a total energy im ba lance (where ca lories in exceed calories
out) . However, these co rr elations do become meaningful when a client is lean in other areas
of the body but not the specific target area; or if fat lo ss is occurring in areas but not in the
specific target area.

Although skinfolds can be reveal i ng , measures of total body fat percentage, fat mass, and
lean mass are still impor ta nt; thus you should record them as pa rt of yo ur in iti al assessment.
Doing so will he lp you determine where you r clien t is now and how their body composition

Potential co rrelatio ns between skinfold measures and hormones

SKI NFO LD SIT E PHYSIOLOGICAL CORRELATES INTERVENTION PO T EN TI AL STRATEGY

High abdominal skinfold High cortisol Cor ti sol suppression Frequent protein meals

High stress Stress control Adequate sleep

SCMs
Stress- reduction techniques

High supra iliac skinfold large insulin release w/meals Control carb intake Reduce carbohydrate
intake

Nutrient timing strategies

High subscapular skinfold Poor insulin sensitivity Boost insulin sensitivity Add fish oi Is

Add R-ALA

High chest skinfold Low testos terone Support testosterone levels Adequate calorie intake

Adequate die tary fat

Hig h triceps skinfold High estrogen Reduce estrogen levels Increase exercise volume

High thigh skinJold Add cruciferous veggies

Discuss prescription
estrogens with doctor
UN IT 2 Chapter 12 Step 3 Inler p' et lng CI,ent InfOf'llJ tl" ') 309

Body fat percentages for various age ranges

MEN WOMEN

AGE 20 -30 30 ·40 40-5 0 5 0+ 20 · 30 30 · 40 40-50 50+

Very low fat < 9% <11% <12% <13% <17% <18% <20 % <21 %
Low fat 9-12% 11-l3% 12-1 5% 13-16% 17-20% 18-21% 20-23 % 21-24%
Average fat 13-16% 14-17% 16-20% 17-21% 21-23% 23-25% 24-27 % 26-28%
Very high fat 17-19% 18-22% 21-25% 22-27% 24-27% 25-29% 28-31 % 31-35%
Overfat 20+ 23+ 26+ 28+ 28+ 30+ 32+ 36+

needs to change to fall in a more optima l range. To help establish this range , Table 12 .3
presents some normat ive information on body fat percentages for different age ranges, wh ich
can help you and your clients set outcome goals for desired body fallevels.

GIR TH MEASURES

Girth measurements provide another me thod to track changes over time . If a client's goa l
is to gain muscle mass and , for example, to build up Ihe legs and biceps, regular girth
measures taken in these areas can indicate positive changes in their outcome measures .
Likewise, if a clien t 's goal is to lose fat and reduce waist size, regular girth measures can
help demonstra te reduc tions in waist size.

Of course, while increa ses or decreases in girth can give some information about whether
a body part is getting bigger or sma ller, you shou ld always evaluate girth in conjunction
with skinfold measurements. For example, if a particular body part's gi rth increases, yet the
skinfo ld meas urement decreases, it is a pretty good indication that the client gained some lean
mass but lost some fat mass. On the other hand , if a par ticular body part's girth increa ses
while the skin fold also increases, it means that the client has ga ined some fat mass.

PART 3: CLIENT GOALS

By asking clien ts to rank their goals and discuss their des ired time li nes for achieving them, you'll
learn a few things, first, where clients think their fitness priorities lie; second, whe ther they're
patient ; and third , how realistic they are when starting their program.

For examp le, if a client comes in, states that fat loss is a priority and explains that they wan t
to accomplish this very quickly, you'll know that the client is anxious, perhaps even impatient.
However if they also suggest that they want to lose 15 Ib of fat in four weeks while only exercising
an hour per week, you'll know that they are comp letely unrealistic in their expectations. In order
to keep them on tra ck , some readjustment of either their leve l of comm itment or their set of
expectations has to be made .

On the other hand, if a client prioritizes athletic perform ance goa ls and fat loss , yet is
comfor table wi th the process taking some tim e, you'll know that they're in this for the long
haul and wil l be comfortable focus ing on each goal independent ly. Prioritizing fat loss during
310 UNIT 2 Cha pter 1 2 Str.P 3 l'lleq:;retlng Cli ent In (\,..-m allOl1

the off- season and performance support during the compe ti tive season is the best and most
realisti c way of accom plis hing the ir goa ls. Their patience wi ll li kely be rewarded by a leane r
body and better per formance.

In ad dition to in formi ng you, these goal ques tion s will also get your clients thinking about their
goals and t imelines. Once they become cogni zant of these thin gs and start working through
them in the ir own mind, their goal awa reness will increase. And once this has happened,
it's much easier to discuss th e importance of wr itten , spec if ic, measurable goals as well as
outcome and behav ior goals with th em.

PART 4: EXERCI SE INFORMATION

The next sec ti on of the Client Information She€t has your clients record their exercise
competence, mode of exercise, and total weekly volume.

SK ILL LEVE L AND EXERCISE CO MPETENC E

As a tra iner, you certai nly wan t to kn ow how well your new clien t can perform the bas ic
exerc ises listed in th is section. As these exe rcises should form the cornerstone of you r exe rcise
prescript ion, if a clien t is un fami li ar wit h more than a few of them, start slowly in the we ight
room and focus on exercise skill development. Thi s app ro ach, while sound, does have one
drawback: when you spend time focused on form and execution , exercise energy expendi ture,
muscle building, and strength developme nt will have to take a back seat temporarily. This
directly affects your clie nt's diet: If you must spend time on skill development, their initia l
calorie intake mu st be lower, as the total metaboli c cos t of a weight ro om instructional/practice
session is much lower th an a full -out li fting bout. However, if your clie nt is compete nt in the
basics, th en the nutritional plan will include additional energy inta ke to compensa te for the
increased meta bolic cos t of the workout.

PR EVIOUS EXERC ISE HABITS

The re are two reasons to unde rstand how much and what type of exercise your clie nt was
previously doi ng: First, it wil l help exp lain the measurements you've al ready collected. For
example, if a clie nt is ove rfat and reports doi ng no prior exercise, then it shou ld be clea r why
they're Qve rfa t; if a clien t is very lean and repo rts a high vo lum e of exe rcise, the con nect ion
will also be clear. Second, this info rmation will he lp shape you r advice. If you r ove rfat,
sede ntar y client wants to get into better shape , you'll likely begin by incorporating a mixed-
exercise pro gram as well as some sound nutritional principles. Even with a mode rate exercise
volume and a few general nutritional sugge stions, it's very like ly that they'll experience
so me fat loss. But what if a client is over fat and reports doing fou r hours of low-intensity
cardiovascular ac tiv ity (such as treadmill walki ng) per week? In this case , the approach would
be different. You 'd li kely remove some of the low-i ntensity cardia and replace it with strength
exercises and interval/anaerobic energy system work, without substan tially increasing their
exercise volume. And yo u'd defi ni tely spend more time focusing on their food intake.

The scenarios yo u'll face are seemingly end less, but li nking your clie nt's cu rrent habits with
the ir cu rre nt body can help exp la in why they are where they are. Use this informat io n to help
plan your app roac h. Rece nt resea rch has show n t ha t, assuming an adequate diet, ind ividuals
improve their body com posi tion most whe n they do five or more ho urs of phys ical activity
per week, with at least 5D% of thi s exercise from higher-intensity ac tivities. The refore, if you
des ign your exercise programs in a way that helps your clients accumulate five hours of tota l
physical activity per week (and please note, thi s does not all have to be done in the gym; it
can inc l ude sport, re creational play, and the like) and that consists of at least 2.5 hours of
UNI T 2 Chapter 12 S:ep 3 Interpret ing Cher t Inforrr atiol 311

strength exercise and/ or hig h in tensity interva l/anaerobic exercise , you're much more likely
to see positive changes in every client. Of cou rse , this again assumes tha t your clients are
following a sound nutritional plan t hat considers the right amount, type, and timing of food,

The following activity chart in table 12,4 should help you determine which exercises have
the highest metabolic cost as well as provide a number of ideas for activities that you can
prescribe to your clients, Always remember that lifting weights and walking on the treadmill
are merely two of a hundred different exercise modalities your clients can use to get in better
shape, improve their body composition, and build strengt h.

PART 5: MEDICAL AND HEALTH INFORMATION

Al t hough the PAR-Q and Medica l History Questionnaires assess objective health measures,
Ihe Client Info rmation Sheet gathers some additional informa ti on, including curren t
medications, curren t injuries, and current therapies . Knowing th is information is critica l and
will likely affect yo ur exercise, nutrition, and supp lement recomme ndations. Of course, as
discussed earl ier in this unit, wh ile you may not know how certa in medications wi ll in t eract
with your exercise and nutrition recommendations, your health care network shou ld include
individuals whom you can contac t to discuss these issues. In doi ng so, you may learn a
numbe r of useful things such as :

Side effects of antidepressant medications frequently include weight gain and/or

reduced rate of weight loss . You may want to recommend that clients on antidepressants
supp lemen t with green tea extract and CLA. This combination has been show n to
improve weight loss profiles in those on antidepressants. Fur t her, to help stim ulate body
compos ition progress, you mig ht recommend that your client spe ak to their doctor about
find in g ways to manage depression without presc ri pt ion antidepressants.
Ce rtain birth control medications either increase body fat or reduce the rate of fat loss ,
spec ifi cally in the lower body and triceps areas. If you have a fema le client on birth
control medications and she's having difficulty with body fat, you might recommend she
speak to her physician about switch in g prescriptions in order to find a more physique-
friend ly birth co ntrol treatment.
Clients diag nosed with hypothyroidism and who are on thyroid medications are likely
to have a reduced metabolic rate and slower fa t loss resul ts. If you have a client on
thyroid medication and t hey are having difficulty with fat loss, they may require more
total exercise volume as well as a more controlled calor ie intake. Further, they may need
to discuss their thyroid bala nce with their physician , and explain their fat loss goa l. The
physician may then alter their prescription to help suppo rt your nutrition and exe rcise
suggestions .
Cl ients with a recent injury will benefit from a specific nutritional program . The injury
repair process can be enhanced by supplementi ng wi th vitamin A, vitamin C, copper,
zinc , argin ine, HMB, and glutamine, as well as by ma nipu lating calorie in take, dietary
protein intake, and dietary fat inta ke. (See Chapter 9 fo r mo re on this .)
These are just a few common scenarios you may encounter when assessing a client's
medica l history and/or their prescript ion med ications. Aga in, you ' re certainly not expected
to know how every prescr iption med ication and/or injury can interact with nutritional
intake and exercise prescription. However, you do need to know when a client is on certain
prescript ions or has certain medical issues. Th is way you can seek help from the medical
experts in you r network.
312 UNIT 2 Chapter 12 St ep 3 I )~ e rp e~ I1 fS Cli en t Inf :.:rrr il t lCI

Calories burned for various activities, by sample bodyweights

BODYWEIGHT (LBS) 80DYWEIGHT (LBS)

ACT IVITY (1 HOUR) 130 155 190 AC TI VITY (1 HOUR) 130 155 190

Aerobics, general 354 422 518 Canoeing, rowing, light effort 177 211 259

Aerobics, high-impact 413 493 604 Canoe ing, rowing, moderate effort 413 493 604

Aerob ics, low-impact 295 352 431 Carpent ry, general 207 246 302
Archery (non-hunting) 207 246 302 Ca r ry ing heavy loads, such as bricks 472 563 690
Au tomobile repair 177 211 259 Ch ild care: sitting'kneeling-dressi ng, feeding 177 211 259

Backpacking, general 413 493 604 Ch ild care: standing-dressing, feeding 207 246 302
Badminton. competitive 413 493 604 Ci rCUlt traini ng , general 472 563 690
Badminton , socia l, general 256 317 388 Cleaning, heavy, VJgorous effort 266 317 388
Basketball, game 472 563 690 Cleaning, house, general 207 246 302
Baske tball, nongame, general 354 422 518 Cleaning, light, moderate effort 148 176 216
Basketball, officiating 413 493 604 Coaching: footba ll, soccer, basketball , etc. 236 281 345
Basketball , shooting baskets 266 317 388 Construction, outside, remodeli ng 325 387 474
Basketball, wheelchair 384 457 561 Cooking or food preparation 148 176 216
Bicycling, <10 mph, lel sure 236 281 345 Cricket (batting, bowling) 295 352 431
Blcyclmg, >20 mph, racing 944 1126 1380 Croquet 148 176 216
Bi cyc li ng, 10 - 11.9 mph, light effort 354 422 518 Cu rling 236 281 345
Bicycling, 12 -13,9 mph, moderate eftort 472 563 690 Dancing, aerobiC, ballet or modern, tw ist 354 422 518
Bicycling, 14 - 15.9 mph, vigorous effort 590 704 863
Dancing, ballroom, fast 325 387 474
Bicycling, 15-19 mph, very fast, rac ing 708 844 1035
Dancing, ballroom , slow 177 211 259
Bicycling, BMX or mountain 502 598 733
DanC ing, general 266 317 388
Bicycling, stationary, general 295 352 431
Darts, wa H or lawn 148 176 216
Bicycling, stationary, light effort 325 387 474
Divi ng, sp ringboard or platform 177 211 259
Bicycling, stationary, moderate eHort 413 493 604
Electrical work, plumbing 207 246 302
Bicycling, stationary, very light effort 177 211 259
Farming, ba ling hay, cleaning barn 472 563 690
Bicycling, stationary, very vigorous effort 738 880 1078
Farming, milking by hand 177 211 259
Bicycling , stationary, vigorous effort 620 739 906
Fa rming, shoveling grain 325 387 474
Billiards 148 176 216
Fenc ing 354 422 518
Bowl ing 177 211 259
Fishing from boat, sitting 148 176 216
Boxing, In ring, general 708 844 1035
Fishing from river bank, standing 207 246 302
Boxing, punching bag 354 422 518
Fishing In stream, in waders 354 422 518
Boxing, sparring 531 633 776
Fishing, general 236 281 345
Broombal l 413 493 604
Fishing, ice, sittmg 118 141 173
Calisthenics (push-ups, sit-ups), 472 563 690
vigorous effort Football or basebal l, playing catch 148 176 216

Ca li stheniCS, home, lighVmoderate effort 266 317 388 Football , competitive 531 633 776

Canoeing, on camping triP 236 281 345 Football, touch, nag, general 472 563 690

Canoeing, rowing, >6 mph , vigorous effort 708 844 1035 Frisbee playi ng , general 177 211 259

Canoeing, rowing, crewing, competiti on 708 844 1035 Fri sbee , ultimate 207 246 302
UNIT 2 Chapte r 12 Slep 3 Inlerpret ln g Cli ent In lorn latlon 313

Calo ries burned fo r various activities, by sample bodyweights

BODVWEIGHT (lBS) BOOVWEIGHT (LBS)

ACTIVITY (l HOURI 130 155 190 ACTIVITY (1 HOUR) 130 155 190

Gardening, general 295 352 431 MUSIC plaY ing, guitar, classical, folk (sitting) 118 141 173

Golf, carrying clubs 325 387 474 Music playing, guitar, rock/ro ll band (standing) 177 211 259

Golf, general 236 281 345 MUSIC playing, piano, organ, violin, tru mpet 148 176 216

Paddleboat 236 281 345

GOlf, miniature or driving range 177 211 259
Painting, papering, plastering, scrapmg 266 317 388
GOlf, pulling clubs 295 352 431
Polo 472 563 690
Golf, using power cart 207 246 302
Pushing or pull ing stroller with ch ild 148 176 216
Gymnastics, general 236 281 345
Rac e wa lkmg 384 457 561
Hacky Sack 236 281 345
Racquetball, casual, general 413 493 604
Ha ndba ll , general 708 844 1035
Racque tball, competitive 590 704 863
Handball , team 472 563 690
Raking lawn 236 281 345
Health club exercise, general 325 387 474
Rock clim bing , ascend ing rock 649 774 949
Hiking, cross country 354 422 518
Rock climbing, repelling 472 563 690
Hockey. field 472 563 690
Rope jumping, fast 708 844 1035
Hockey, ice 472 563 690
Rope jumping, moderat e, general 590 704 863
Horse grooming 354 422 518
Rope jumping, slow 472 563 690
Horse racing, galloping 472 563 690
Rowing , stationary, light effort 561 669 819
Horseback riding, general 236 281 345
Rowing , stationary, moderate effor t 413 493 604
Horseback riding, trotting 384 457 561
Row i ng, stationary, very vigorous eHor t 708 844 1035
Horseback riding, walking 148 176 216
ROWin g, stationary, vigorous eff ort 502 598 733
Hu nt ing , genera l 295 352 43 1
Rugby 590 704 863
Jai alai 708 844 1035
Runn i ng, 10 mph (6 min mile) 944 1126 1380
Joggi ng, general 41 3 493 604
Running, 10.9 mph (5,5 min mile) 1062 1267 1553
Judo. karate . klckboxing, taekwondo 590 704 863
Run ni ng , 5 mph (12 min mile) 472 563 690
Kayaking 295 352 431
Running , 5.2 mph (1l.5 min mile) 53 1 633 776
Kickba ll 413 493 604
Ru nning, 6 mph (10 min mi lel 590 704 863
lac ro sse 472 563 690
Runn ing, 6.7 mph (9 min mi le ) 649 774 949
March ing band, playing inst rume nt (walking) 236 281 345
Runmng, 7 mph (8.5 min mi l e) 679 809 992
Marching. rapidly, mil itary 384 457 56 1
Running, 7.5mph (8 min mile) 738 880 1078
Motocross 236 281 345
Running, 8 mph (7.5 min mile) 797 950 1165
MOVing furniture, household 354 422 518
Running, 8.6 mph (7 min mile) 826 985 1208
Moving household items, boxes, upsta i rs 53 1 633 776
Running, 9 mph (6.5 min mile) 885 1056 1294
Moving household items, carrying boxes 413 493 604
Runni ng , cross country 531 633 776
Mowing lawn, general 325 387 474
Running, general 472 563 690
MOW ing lawn, rldmg mower 148 176 216
Ru nni ng , In pl ace 472 563 690
MUS IC playing, cello, fl ute . horn , woodwmd 118 141 173
Ru nm ng , on a track, team practice 590 704 863
MUS IC playing, drums 236 281 345
Ru nnmg, stairs, up 885 1056 1294
314 UNIT 2 Chapter 12 Steo 3 Inlcrplct.ng Clie rli InforrnaMr

Ca lories burned for various activit ies, by sample bodyweights

BODYWE IGHT (lB S) BODYWE IGHT ( LBS )

.. .. _---- -... -- --- - -- -- -----.----.--------- -------- --- ------ ------ --------------- ---- -------------- --
AC TI VITY (l HO UR) 13 0 155 190 AC TI VITY (1 HOUR ) 130 15 5 190
-- --- - ----- --- -- --- ----------------------- ----- ---- - ---------- ---------- ----- -- -- -- -- -- -- ------ -_ . _--
Running, training, push ing wh eelchair 472 563 690 Snor keling 295 352 431
Runn ing, wheeling, general 177 2 11 259 Snow shoeing 4 72 563 690
Sai ling, boat/board, windsurfing, genera) 177 211 259 Snowmobil ing 207 245 302
Sailmg, in compe tition 295 352 431 Soccer, casu al, gen era l 413 493 504
Scrubbing floors , on hands and knees 325 387 474 Soccer, competitive 590 704 863
Shoveling snow, by hand 354 422 518 Softball or baseball, fas t Of slo w pitch 295 352 431
Shuffleboard, lawn bowling 177 211 259 Softball , officiating 354 422 518
Silting· plaYing with chlld(ren)-lIght 148 175 216 Squash 70 8 844 1035
Skateboarding 295 352 43 1 Stair- treadm ill ergometer, general 354 422 518
Skat ing, Ice, 9 mph or less 325 387 474 Standlng-packmg/unpacking boxes 207 246 302
Skatlllg, ice, general 413 493 604 Stre tching, ha th a yoga 236 281 345
Ska ting, ice, rapidly, > 9 mph 531 533 775 Surfing, body or board 177 211 259
Ska tmg, ice, speed, co mpetitive 885 1055 1294 Sweeping ga rage, sid ewalk 235 28 1 345
Skating, roller 413 493 504 Sw imming laps, freesty le, fast. vigorous effort 590 704 853
Skl/umping (climb up carrying skiS) 413 493 504 SWim ming laps, freesty le, ligh Vmoderate effort 47 2 553 590
Ski machine, general 551 559 819 SW imming, backstroke, genera l 472 553 590
Skiing, cross-countr y, >8.0 mph , rac ing 825 985 1208 SWimming, breaststroke, general 590 704 853
SkII ng, cross -country, moderate effort 472 563 590 SWimming, bu tterfly, general 649 774 949
Ski ing , cross-coun try, slow or l igh t effort 413 493 504 Swimming, leisurely, genera l 354 422 518
Skiing, cross -country. uphill , maximum effort 974 1161 1423 Swimming, sides troke, general 472 553 690
Ski ing, cross -country, vigorous effort 531 633 775 SW imming, synch ronized 472 553 690
Ski ing, downhill, light effort 295 352 431 Swimmi ng, treadmg water, fasVvigorous 590 704 863
Skii ng. downhi ll , moderate effort 354 422 518 Swimming, treading water, moderate effort 236 281 345
Skiing. downhill . vigo rous effort, racing 472 553 590 Table tenniS, ping pong 235 28 1 345
Sk iing, snow, gene ra l 413 493 504 Tai chi 235 281 345
Ski ing, water 354 422 518 Teac hing aerobics cla ss 354 4 22 518
Skimobiling, water 413 493 504 Tenn i S, doubles 354 422 518
Skin diving, scuba diving, gene ral 413 493 504 Te nnis, general 413 493 504
Sledding, tobogganing, bobsle dd in g, Juge 413 493 504 TenniS, Singles 472 563 590
UNI T 2 Chapter 12 Slep 3 h~ e r pre l l')g Cllcnl l ;- l rY ' fl (J l>0' 1 315

Calories burned for various activities, by sample bodyweights

BODYWEIGHT (LB S) BODYW EIGHT (LBS)

--- ------- - - --- ------ --- ------- -- -- ---------- --- --- -------- -- -- ------ ----- ---------- --- -- -- ------- -
ACTIV ITY (1 HOUR) 130 155 190 ACTIV ITY (1 HOUR) 130 155 190
---------------------------------------------------- - - - - - -- -------------- ----- -- -- ---- -------- -- --- --
Unicyclmg 295 352 431 Walking, grass track 295 352 431
Volleyball, beach 4 72 563 690 Walking, upsta irs 472 563 690
Volleybal l, competitive, in gymnasium 236 281 345 Walking, using crutches 236 281 345
Volleyba ll , noncompetitive; 6-9 member team 177 211 259
Wally ball, general 413 493 604
Walk/run playing with ch ild(ren), moderate 236 281 345
Water aerobiCS, water calisthenics 236 281 345
Walk/run playing wit h chlld(ren), vigorous 295 352 431
Water polo 590 704 863
Walking. 2 .0 mph, slow pace 148 176 216
Water volleyball 177 211 259
Walking, 3 .0 mph, mod . pace, walking dog 207 246 302
Walking, 3 .5 mph, uphil l 354 422 518 WelghtliftingibodybUilding, vigorous effort 354 422 518

Walking, 4.0 mph, very brisk pace 236 281 345 Weightlifting, light or moderate effort 177 211 259
Walking, carrymg Infant or 15- lb load 207 246 302 Wh it ewater rafting, kayaklnglcanoelng 295 352 43 1

PART 6 : LIFESTYLE INFORMATION

OCCUPATION AND TRAVE L SC HEDULE

The information you gather in this section will give you some insight in to your client's
lifesty le, work schedule, sleep schedule, and poten t ia l st ressors, which can also help guide
your exercise and nutri t ional recommendat ions . For example, if you have a client with a
ste ady 9- to-5 job, it's more likely that they have consistent eating patterns, sleep patterns,
and exercise patterns . Shift workers and those with more irregular work schedules have more
difficulty wi th this. Further, if you have a client who travels often, it's more likely that their
eating and exercise sched ules are also more erra t ic. These individuals may work out and
eat we ll when at home, but when traveling they may miss workouts and make poor food
selections. Beyond this information describing a clien t's current sched ule, it may highlight
potential difficulties they may have in fo llowing your recommendations.

Once you understand the patlerns your clients have formed and the challenges t hey face,
create exercise and nu trition strategies that integrate well with your clients' schedules in order
to help adherence. For example:

If they travel frequently , provide strategies for eating we ll at home and making healthy
choices wh ile on the road. If they experience jet lag, poor sleeping patterns, and hi gher
amounts of stress when traveling, you can also suggest spec if ic nutrients (e.g., zinc and
magnesium to promote more restful sleep) and/or a more moderate exercise schedule to
maximize recovery and minimize stress .
If your client is a shift worker, make recommendat ions for varying shi ft s, as scheduling
meals can become difficu lt when working even ings and nights. Changing shifts
affect sleep duration and quality, so adjust the exercise demands placed on the clien t
accordingly. Finally, stress hormone leve ls are higher in shift workers, which depresses
316 UN IT 2 Chapter 12 Ste p 3 Interpretmg Client Inform ation

immune function while increasing t he risk of poor health, catabol ic hormone dominance,
and abdomina l fat storage . Incorporate stress-reduction exercise strategies and cort isol-
lowering nutritional strategies to he lp improve immunity, red uce catabolic hormone leve ls,
and decrease the risk for accumulating central adipos ity (abdominal fat) .
If your client has a low-activity job , they ' ll likely need more physical activity outside of
work and fewer total ca lories . On the othe r hand , if they have a high-ac tivity job , they' ll
likely need less phys ical act ivity outside of work and more total calories.
If your client is a primary caregi ver for chi ldren, people with disabilities, or elder
relatives, the amount of time they have available for exercise and food preparati on
may be dramatically reduced. Further, their stress leve ls and incidental physical
demands can be higher. So ad justing exe rcise volumes, food prepa ration requirements ,
and nutritiona l supplement suggestions may be necessary. They may also need your
ass istance with learn i ng sa fe lifting tec hniques.

Remember, what a clie nt does outside the gym - includ ing physical activity, work, beha vio rs
that increase or reduce stress levels - affects overa ll exercise and nutrient tolerance as well
as potential adherence to an exercise or nutrition plan . Therefore , as their trainer, you should
always consider a client's lifestyle before putting their program togethe r.

GROCE RY SHOPPING AN D DINING HAB ITS

Asking a few simple questions about yo ur clie nts' grocery shopping patterns , grocery costs,
and restaurant habits wil l reveal qu ite a lot abou t their nu tritional intake. If they shop
infrequently, they likely eat out a lot, buy few nat ura l foods (most of wh ich have short-term
expira ti on dates) and/or are inconsistent with their intake. If they eat at restaurants often,
it's likely that they are no t very good cooks, that their mea l patterning isn 't consistent, and
that they're making poor choices.

As yo u can guess , this information can he lp yo u expla in why your cl ients may be
having health, body composition , or pe rfo rmance issues. It can also help you guide
the ir nutrition al intake - from grocery store to ki tchen to meal ti me. If your cli ents shop
infrequently and eat out at resta urants often, deve lop strategies and identify resources to
he lp them in crease their grocery store and kitc he n comfort levels, as well as to prepare
meals more efficiently and improve their cooking ski ll s.

FOOD ALLERGIES AND INTOLERANCES

Food allergies and intolerances are ve ry common . Most clients you work with will
have at least one food allergy or intolerance . Fort unately, you aren 't limited to a sma ll
list of food cho i ces; your clients can in clude a wide va ri ety of good foods in their diet.
It's cri t ica l to di scover wh ich foods should abso lutely be left off the menu (a ll erg i es)
as wel l as wh ich foods cause excessive gas , bloa tl ng , stuffiness or congestion
( in tolerances) and should be avo ided. The following chart lists common food allergies
and intolerances .

Th ree-Day Dietary Record

The Three -Day Dietary Record is a common assessment tool des igned to give you an
overvi ew of your cli ent's eating habits for three represen tat ive days of the week .
Nut rit ion ists and diet itians wi ll often input these three-day records in to dieta ry ana lys is
software (such as ESHA Food Processor, Nutrition ist Pro , or EatRight NutriGen ie) that
UNIT 2 Chapter 12 Step 3 Irll erpre!tng Cli ent Information 317

Common food allergies and intolerances

Common food allergies Common food into lerances

IN ADULTS IN CHILDREN IN ADULTS AND CHILDREN

Eggs Eggs
Gluten
Milk Milk
Da iry
Fish Wheat
Fructose
Nuts Nuts
Yeast
Corn Soy

generates a complete overview of a client's calorie, protein, carbohydrate, fat, vitamin,

and mineral intake for the three recorded days. By performing this analysis, they can
pinpoint areas of the diet that need improvement. For example, many women's diets are
low in protein and in iron .

The nutrition analysis would point this out, th ereby leading a nutritionist or dietitian to
suggest more high-quality proteins and more iron-containing foods in the diet. This needs
analysis allows both the client and the practitioner to get a clear picture of the diet's quality,
and it allows the practitioner to suggest ways to eliminate any deficiencies.

However, you may not need to do a full analysis of each cli en t's diet, especially since it's
pretty time -consumi ng to enter al l the data. A quick review of the dietary records should
demonstrate whether your clients are eating the rig ht foods at the righ t times in the right
amoun ts . For examp le, if you see they're eating a lot of processed or simple carbohydrates
such as bagels, sugary cereals, white bread, white rice, white pasta, fruit juice, carbonated
sof t drinks, and so on , you don't need a dietary analysis to know that they should be
replacing these with higher-quality, unprocessed carbohydrates such as whole grains, fruits,
vegetables, and so on. Also, if you notice a conspic uous absence of fruits and vegetables
(yo ur clients should be ge tt ing at least seven servi ngs of these per day), proteins (coming
from comp lete sources such as animal proteins or comp let e vege tarian proteins), and/or good
fats (flax, olive oil, nuts, avocados, fish oil, etc.) yo u don't need a software program to know
that they simply need to eat more of th e missing food sources.

However, if you do decide to analyze the diets of your clients, remember that the goal of
good nutrition isn't to encourage clients to keep up their curre nt dieta ry intake (espec ially
if they're in li ne with th e typical North American diet) while simply eli mina ting dietary
deficienc ies. Ra the r, he lp them improve their diet so that they ' re eating the righ t things in
the right amou nts at the righ t times . And while a dietary ana lysis desc ri bes how they' re
doing, it doesn't teach you how to create an oplimal diet based on the principles discussed.
Since , for most clients, noth ing short of a complete dietary overhaul will need to take
place , make recommend at ions that work towards achieving this optimization, rather than
recommendations designed to work within the confines of a clien t's current limitations.
318 UNIT 2 Cha pler 12 Steo 3 Inwrpret l'1g Cl letV l'1 formatIOl1

Readiness for Change, Kitchen Overhaul , and Social

Support Questionnaires
These self-scoring inventories will prove indispensable, They are designed to pinpoint whether
your clients are prepared fo r and ready to execute the nutritional changes you're hop ing to
institute, Thes e questionnaires will show you where to direct your efforts to promote change,

If, for example, a clie nt' s readiness for change is low, provide motivation and support along
with small, incrementa l suggestions for change, As disc ussed in Chapter la, this may mean
asking them to make one change at a time, such as eating breakfast every day; once they've
implemenled that change and It's become a habit, perhaps asking them to add two servings
of fruils and vegetables a day; and so on, Rather than overwhelm clients who have a low
read iness for change, ease them into Ihe changes while supporting and encouraging them
along the way,

Even if a cti ent is men tally ready for change, they may be hindered if they don't have the
fo ods andlor appliances they need for conSistently preparing the right meals, Eliminate this
limiting facto r with a complete kitchen makeover; Go to their home and help th em make ove r
their kitchen; throwaway the foods that do not support the ir goals; and take them shopping
to replace these items with foods that do, You can do th is yourself or you can refer them to
someone who specializes in kitchen makeovers. Either way. if your client scores poorly on
the Kitchen Makeover Questionnaire, no amount of food education will help them improve
their 'nutrition, Only a kitchen over haul will do,

Finally, even if a client is ready for change and has a great kitchen environment, their Soc ial
Support Questionnaire may show that they are surrounded by people and environments
that do not support or share their desire to be healthier, to be leaner, and to feel better, This
will be an important limiting factor to address. Although most people want to believe they
can overcome this adversity, very few actually can, In fact, although most people assume
that a person's success or fail ure is determined largely by socioeconom ic level or pe rhaps
inte llige nce, res earc h shows that the real determ ining facto r is the ir social network.

If you hang out with people who drink a lot , yo u'll likely drink more, If yo u surround yourself
with people who eat j unk food and don't exercise, you'll likely do the same. Sure, your social
group might not make you become an alcoholic or give up entirely on you r goals, But your
social group will likely alter your behavior. This is why social support is such an important
factor; social groups help us make both good and bad choices. Unfortunately, thi s is the
most difficult limiting factor to overcome, as people hate to be told that they may need to
move away from unsupportive friendS and environme nts. They often believe that they can
accomplish their goals independent of those around them. Some may be right; th e rare
individual can go it alone. But most can't.

Assessments (body composition, stress/ recovery,

performance , blood chemistry)
While the questionnaires are all designed to he lp you plan the in it ial program yo u put
together for clien ts , the specific assessments discussed he re have a slightly different purpose;
to collect basel ine information that enables comparison in the fut ur e. In other words, these
assessments are done so that you can repeat them later and see what's changed.
UNI T 2 Chapter 12 Sleo 3 Interp ret i ng Cllent Inforrnatlo') 319

This approach is important for two main reasons. First , it will he lp you know if your program
is actua ll y produc ing the desired result improvements in health, body composition, and
performance. If it is, keep going . tf it isn't, make some changes to stimutate progress,
based on the assessments you've ma de. As a lack of progress can be a resu lt of poor client
adherence , poor programming, or some combination of t he two, you'JI have to determine
whether to change your coaching style and/ or t he program. This is where adherence/
comptiance monitoring (discussed tater in the course) wil t come in handy. tf a cl rent has a
high teve l of adherence to the program, it's the program that needs adj ustment. If a cli ent's
adherence is low, i t's t he client or the coaching that needs adjust ment.

Along with us ing these assessments to inform your coach in g style or programming
decisions, use t hem to demonstrate to your clien ts that the program is working. One uniq ue
character is tic that alm ost al l clients share is that in foc using on what they want to achieve,
they are blind to what they have ach ieved. In fact, it's not uncommon for clients who've
lost 10 , 15, or 20 pounds in a f ew months to become impatient because they want to los e
weight faster. Even more commo n is the client who has gained 12 pounds of lean mass
while losing 10 pounds of fat being disapP ointed because they've ga ined 2 pounds. You 'll
atso have cl ients who have impro ved in every major lift as well as radically altered their
blood profile , yet who feel as though their time in the gym is was ted beca use they haven 't
accompl ished every major physi que goal. Thus, help clients look for progress "outside the
box." By meas uri ng a number of pr imary progress indicators up front, yo u can prevent your
clients from putting a box around one outcome (weight loss, for example) and usin g it as t he
on ly measure of prog ress .

Determining your client's level

One of the easiest ways to select the appropria te coaching style for a new client is to do a
preliminary ranking of the clien t' s nutrition level. The questionnaires and assessments wi ll give
you a ve ry good idea of who the client is. You' ll have gathered information about their medica l
situat ion, their lifestyle, their occupation, thei r goals, their eating habi ts, their exerc i se hab its,
and mo re. All of this should suggest what their limiting factor(s) are and what approach you
should take to help them improve their heatth, body composit ion, and performance.

Yet rather than lea ve this process a subjective one, he re 's a simple and objective way to
characterize your clients: place them into one of t he t hree categor ies listed in Table 12.6. This
will show you the best approach when ini t ia ti ng the coaching process. The table should make
it easy for you to categorize your clients and estab lis h a ge neral coaching plan for them (the
next chapter will provide the specifics). Obviously, not every client will fit neat ly in to one of
these three categories and as you proceed with your coaching , you may have to alter you r sty le.
However, the tab le shou ld get you started in the right direction from the very first meeting.

Communicating results with clients

So far, the coachi ng process has invotved preparing for your clien t, collecting preliminary
client information, and evaluating this in formation in order to categor ize yo ur client and
establish your app roach to coac hing. Much of t his work is done up front without much one-
on -one discussion. Preparing for the client in th is way will help you :

develop an understanding of the coaching process:

understand you r clients' min dsets;
320 UNIT 2 Chapter 12 Step 3· Intcrpretl!1g Client Informallorl

establish a process for goal-setting and goa l-ori ented discussion;

prepa re for clien t objec ti ons; and
understand how and what to co mm unicate with clien ts.
To collect prelimina ry client information , ha ve you r cli ent fi ll ou t th e following questionnaires
at home, in your absence,

Physi cal Activ ity Read ine ss Questionnaire (PAR-Q)

Medical History and Present Med ical Condition Questionn aire
Comp reh ens iv e Cli en t Informa ti on Sheet
Three -D ay Diel ary RecorQ
Rea diness for Change Questionnaire
Kitche n Overhau l Ques ti onnaire
Social Support Questio nnaire

Your first meeting with your clien t, therefore , will be the assessme nt meet in g that enables you
to re vi ew the ques tion naires , get any clarification you ma y requ ire , and reco rd the fo ll owing,

Initi al Body Composi tion Assessmen t

Ba seline Stres s/ Recove ry As sessment
In i tial Performance Assessme nt
Baseline Bl ood Chemistry Assessment
Baseline Visual Asses sment

Until this point, your only interactions with your cl ient will have been in formation gathering.
No cl ient education will li ke ly have taken place. Howeve r, during your second meeting, the
in i ti al consultat ion meet ing, you will need to spend some additional time with your clie nt so
tha t you can communicate the res ults of your questionnaires and assessm en ts in simple and
clear te rms . For examp le,

If you r client is overfa t, ex plain what this means in te rms of disease risk (i ncreased ri sk for
diabetes , cardiovascu lar dise ase, etc.).
If your client's err ati c work and travel schedule will present eating ch allenges, briefl y
discuss them and highli ght them as a lim i ting factor.
If your client does not do enough exe rcise, br iefly discuss the minimum amo unt that may
be required for a great body and dete rm ine whether they' re willing 10 put in this amount
of time.
If your client's skinfold measures demonstrate established patterns, briefl y exp lai n the
relat ionships between hormones, lifestyle , and sk infolds .
If the cl ie nt 's read iness for ch ange, kitchen setup, or social env ironment show limiting
factors , let Ihem know what Ihe scores of the ir quest ionnaires mean and what may need
to change to rem ove these limit in g fac tors .
If your cli ent demonstrate s unw arran ted haste , disc uss thi s and tel l them you' ll hel p to
establish more rea li st ic time lines for accomplishme nt.
UNI T 2 Chapter 12 Slep 3 IIVerj:l t?: mg C len: Int;: ' ') :'0" 321

Nutritional levels, character isti cs , and recommended approaches

LEVEL 1: PEOPLE WHO ARE COMPLETELY NEW TO EATING WELL

ASSESS MENT TOOL SHOWS .. AP PRO ACH AND STRATE GIES

Body Composition High body fat % Th is type of client requires a slow coaching
Assess ment Over 18% for men approach fo cused on bas Ic food educa tion and
Over 25% for women basic habit development, suc h as basIc fo od
selection lessons, grocery shopping strat egies, and
Kitchen Questionnaire Poor kitchen setup
better meal planning and preparation.
Client Information Sheet Poor grocery shopping habits
Begin by making some general food suggestions
3-Day Dietary Record Reveals little knowledge of correct while teaching the cl ien t the strategies required to
food type , timing, and amount support heal thy eating.

LEVEL 2 : PEOPLE WHO DEMONSTRATE SO M E UNDERSTANDING OF GOOD NUTRITI ON YET

NEED GUIDANCE, PLANNING , AND DIRECTION

ASSESSM ENT TOOL SHOWS .. AP PROAC H AND STRATEGI ES

Body Composition Mod erate body fat % This type of cli ent usua(Jy has th e basics down
Assessment 12·18% for men in terms of food selection. They may do we ll at
20-25% for women the grocery store and may have no i ss ues with
food preparation.
Kitchen Questionnaire Avera ge kitchen se tup
However, this type of client typically needs to learn
Client Information Sheet Average grocery shopping habits
more about moderating overall calorie intake,
Three-Day Dietary Record Above-average knowledge of estab li sh ing correct po rtion sizes for their body
co rrect food type but average type, and eating the right foods at th e right times
to below average knowledge of the day.
01 food amount or timing
General strategies may work well here although
more specific ideas may also have to be introd uced.

LEVEL 3: PEO P LE WHO EAT THE RIGHT FOODS IN THE RIGHT AMOUNTS AT THE RIGHT TI M ES

ASSESSMENT TOOL SHOWS .. . APPR OAC H AND STRATEG IES

Body Composition Low body fat % These individuals are typi ca lly already lea n
Assessment Le ss th an 12% fo r men yet want to optimize and further refine th eir
Les s than 20% for women nutritiona l strategies .

Kitchen QUestionnai re Excellent kitchen setup They may also have excellent shopping and
preparation strategies. However, they may need very
Client Information Sheet Excellent grocery shopping habits
deta iled calorie and macronutrient information.
Three -Cay Dietary Record Above-average knowledge of correct
Beyond establishing a baseline diet, they'll also
food type, amount, and timing
need specific strategies for making outcome-based
dietary decisions.

Note: All levels can apply to both sedentary people as well as people wi th exercise experience. Levels are differentiated by nutritional experti se that is concretely
demonstrated through behaV Ior, lifesty le, and physical characteristics (rather than SI mply knOW ing the In for mation) .
322 UN IT 2 Chapter 12 Step 3 l r1te rp rel lng Cl ient In formJt lo n

Beyond this review of the client quest ionnaires and assessments, you'll also want to
comm unicate your coaching plan . Touch on the following items:

1. How often you will meet to discuss nutrition. Remember, the best coaches meet
pr ivately to discuss nutrition and avoid discussing nutrition during workouts . Thus, outline
your approach for meeting outside of your training sessions to talk about nutrition. Also
out li ne what's going to happen at these meetings. Your clie nt should know what to expect
coming into eac h one, inc luding what to bring with them . We' ll look at this more in
subsequent chapters.
2. How you're going to establish goals. Help the cli ent develop a written set of outcome
goals , maki ng sure they're specific, measurab le, and reasonably timed. Als o look for
perso nally meaningful things about these goals that'll get t he client excited and motivated.
Then establish a set of beha vior goals that wil l be necessary for the client to achieve the
desired outcomes. Emphasize that while you will develop these st rategies together, they
must mon itor their own adherence to these behaviors. We ' ll provide some monitoring
tools in forthcoming chapters.
3. How you 'll approach the coaching process. After you spend some time discuss ing
goals, you should outline how you're going to guide their nutfltional education. Will you
start slowly wi th a discussion of general nutrition and lifestyle habi ts (Levell)? Or will
you jump right in and establish strategies for optimizing ca lorie in take and macronutrient
in take (Level 3)' Your decision here will be based on the client's level and your limiting-
factor ana lysis . Therefore, different clients wil l require different coaching approaches.
4. Finally, based on how much time is left, you may actually beg in to discuss the first one
or two nutritional steps (t he se will be discussed in depth in the next chapters) . If the
client's kitchen is their limiting factor, yo u may want to start by shar ing strategies for
kitche n improvement. You may even schedule an appointment to go to their home and
help them revamp their kitche n. If their grocery strategies need work, you may provide a
grocery shopping agenda or even take them to the grocery store. And if they simply need
to learn about mak ing better food choices, you may begin by sharing the basic nutrition
outlines discussed in the next chapter. As stated in the Introd uct ion, all the best coaches
do one thing very well: t hey find limiting factors, and they eliminate them. So, if there's
time at the end of your in itial consultation , this would be a grea t opportunity to begin
this process. And if th ere's not enough time, you can begin during the next scheduled
appointment, a nutrition education and check-up session.
323

In this chapter, we discussed how to inte rpret Knowing that these two sites are closely correlated
and use the info rm ation you'll collect with your with the body's ability to tolerate carbohydrates
quest ions and assessments . Of course, your and insu lin, I re-evaluated his train ing and
interpretat ion of the answers and metrics is as nutritional intake. He was doing a mix of low
important as co llecting the information in the first in tensity cardio, interval work, and weights. That
place. Th is interpretation will help you decide the wouldn't be the problem. At th is po int he was also
best course of action with any given client. eati ng mostly high-fibe r, unprocessed carbs. That
wouldn't be the prob lem either. Indeed , there
Here's an example of how interpreting a client's
must be something else going on.
informat io n can alert you to things that you'd
otherwise miss. A few years back I started I scheduled a meeting with him to ask some
working with a client who wanted to become questions. I wanted to see if he was taking any
a competitive bodybuilder. He started with an muscle building supplements or drugs that might
excellent foundati on: 5'11" , over 300 Ib, and otherwise impact his insulin sensitivity. For
about 18% body fat. He was quite strong. examp le, I knew that growth hormone and insulin
Howeve r, his diet was awful. He was eating (both popular bodybuilding drugs) can cause
over 10 000 kcal per day of highly processed, insulin resistance in the body. This , among other
high-sugar, low-nutrient-density foods. And his things, could explain this apparent inability to
health profile reflected it. He had high cholesterol , imp rove his insulin-specific skinfold sites.
triglyceri des, bl ood pressure, and insulin. To get
During this meeting he was candid, admitting
him hea lthy as well as drop his body fat down to
to exper imenting with both growth hormone
that of a competitive bodybuilder, we'd have to
and insulin, starting about the same time that
make quite a few changes to his diet.
his suprailiac and subscapular skinfo lds went
We elimin ated some of the junk food, added high- up. Fortunately, h is doctor was monit or i ng his
fiber foods and some fruits and vegetables, and use of these drugs . Unfortunately, they were
prescribed some ca rdio work. This kick-started the preventing him from getting leaner in these two
fat loss process. In the first eight weeks he lost areas . I recommended to his doctor that he
about 20 Ib of fat while preserving his lean body either discont inue the drugs or introduce a few
mass and improving his blood profile. We were off compounds known to improve insulin sensitivity
to a great start. However, something puzzled me. in diabetics and in those with insulin resistance:
supplements such as r-ALA and chromium; or
Every two weeks we measured his skinfolds,
drugs such as metformin or troglitazone. After
and every two weeks most of those skinfolds
eight more weeks of applying strategies designed
went down , reflecting his overall weight loss.
to improve his insulin sensitivity, he was able to
However, not all the skinfolds changed in th is
drop a significant amount of additional body fat,
way. The suprailiac and subscapular reg ions
most of it com ing from these two areas.
were increas in g while the other skinfolds were
going down. Figuring that these must be his Although this is an extreme exampl e, it
"trouble spots" and that within a few weeks, illustrates an important point: Think through
they'd eventually decrease, I waited another two the implications of your assessment measures.
measurement periods to see if these spots would Most trainers and nutrition coaches overlook
improve. They didn't. They stayed the same the details that can help their clients improve
even as he lost 6 more pounds of body fat. the most. Don't be one of them.
324 UN IT 2 Chapter 12 Step 3 lnlefprel lng Clien t Inform ation

1. We've designed each questionnaire and assessment presented in the last chapter
to provide you with all the information you need to develop both an initial
coaching strategy and a program well suited to your clients' unique physiology and
Iifestyle needs.
2. In this chapter, we've explained how to interpret data on your client's baseline
measures, overall health, current mindset, current lifestyle, and potential limiting
factors. This information includes the results of the following questionnaires
and assessments:
a. The PAR-Q
b. Medical History Questionnaire
c. Comprehensive Client Information Sheet
d. Readiness, Kitchen Makeover, and Social Support Questionnaires
e. Body Composition, Performance, Recovery, Blood, and Visual assessments
3. Before any initial meetings take place with a new client, begin by having them fill
out the questionnaires provided.
4 . Your first meeting is an assessment meeting at which you should check the
questionnaire data for completeness, gather any clarifications necessary, and
perform the relevant assessments.
5. Once yo u' ve col lected this information , interpreted it, and have prepared a pla n of
action, you and your client shou ld get together for a second meeti ng: an
initial consultation.
6. During this consultation, you'll discuss the results of your questionnaires and
assessments with your clients, and how you will proceed to help them improve
their nutritional intake.
7. Finally, if time permits, you may even begin to provide them with strategies
that can help them overcome the limiting factors identified during the screening
process. (These will be discussed in the next chapter.)
CHAPTER 13

STEP 4:
PROVIDING
A NUTRITION
PLAN
Chapter objectives
Key terms
USDA Food Pyramid
Habit- and superfood-based nutrition
Individualization
Special dietary strategies
Pre-, during-, and post-workout
nutrition
Competition days
When to discuss nutrition
Chapter 13 Summary
KEY TERMS
American Dietetic Association
USDA Food Pyramid
pasteurized milk
lactose intolerance
osteoporosis
nutrient timing
5 Habits
feeding opportunities
complete lean protein
alkaline load
controlled carbohydrate
carbohydrate-dependent sports
glycemic index
5 Habits Cheat Sheet
Super/oods Checklist
Levell ciJents
Level 2 clients
Level 3 clients
body types
ectomorph
mesomorph
endomorph
eeto-mesomorph
endo-mesomorph
somatotype
carbohydrate tolerance
very low-calorie diets (VLCDs)
neutral energy balance
green food product
very low-carbohydrate diet
calorie cycling
carbohydrate cycling
very high -carbohydrate diets
periworkout nutrition
P+ C drinks
UNIT 2 Ch apter 13 Slep <1 Prov·dmg a Nut fl \ lon Plan 327

After you have comp leted the assessments described in Chapter 11 as well as the analysis
and initial meetings described in Chapter 12, you and your client should be ready to discuss
prope r nutrition. To do this, you will need to have a syste m for eHectively communicating
to your client which foods are appropriate , in what amounts, and at what times. Will you
write them up a list of "good " and "bad" foods' Wi ll you give them a copy of the USDA Food
Py ra mid? Will you photocopy a menu from the American Di eteti c Association 's website? AMER I CAN DIE TETIC
Will you print out a few "healthy eating tips" from a trusted webs ite' Make it up as you go ASSOC I AT I ON
Largest organization of food
along' These are all option s, of course. But if you realty want to ste er your clients in the right
and nutrition professionals
direction, develop a predefined operating system. This chapter will present you with a few in the United States;
common nutrition education systems and discuss the ir relative merits. You will learn how to composed pnmafily of
apply these systems to your practice immedia tely, making adopting a new nutrition education registered dietitians
style a simple and painless procedure.

Many nutrition education programs have been developed ove r the years, such as:

The United States Department of Agriculture (USDA) Food Pyram id

Weight Watchers' "points" system
The American Dietetic Assoc iation's dietary "exchange" system
Canada 's Food Guide produced by Heatth Canada

In th is chap ter, we'll even introduce two add ition al methods that are uniq ue to this cou rse.
All of these systems are aimed at teaching people to improve the ir nutrition intake without
counting calories, macronutrient grams, and so on. Each has it s rela tive merits and
drawbacks. Rath er than discuss each system exhaustively, however, this chapter pre sen ts
the methods I believe to be most effective for imp roving the health, body composition , and
performance of your clien ts.

USDA Food Pyramid

The iconic USDA Food Pyramid (Figure 13.1) is perhaps the most widely recogniz ed US DA FOOD PYRAMID
nutritional educa tio n resource in the world. Designed in 1992 , the recommendations A graphical display of a
presented in the earliest Food Pyra mid were widely adopted and became the gold standard healthy diet centered on
food groupings: created by
for nutri t ional advice. Based on presen ti ng a graph ica l depiction of six "food groups", this
the USDA in 1992
py ramid summed up the USDA's dietary adv ice in one simp le picture. It included,

grains (recom mended 6-11 se rvings/day)

vegetables (3-5 servings/d ay)
fruit (2 -4 servings/da y)
meat/beans/nuts (recommended 2-3 servings/d ay )
dairy (2-3 servings per day)
fats/oil s/sweets (use sparingly)

Because of its ease of use, it was widely adopted, distributed , and taugh t to everyone from
children at schools to adults seeking nutrition counseling.

The original Food Pyramid had one problem, the advice contained in th is simple picture was
flawed. For examp le, the clear message presented in th is ea rly model is that carbohydrates
are good (represented by the base of the pyramid be ing fill ed wi th pasta, bread, and other
carbohydrates) and that fats are bad (represented by the message to avoid or use sparingly).
Yet research being do ne at the time of the Food Pyramid 's development (researc h that has
328 UNIT 2 Chapter 13 S'."! ~ Pro~<:JI1'\7 a Nu\rl:lon P dr'

FIGURE 13 1
1992 USDA FOOD PYRAMID
Fats, Oils & Swe ets KEY
USE SPARINGLY
C Fat (natura lly occ urri ng and added)
g Suga rs (added)

Milk, Yogurt & Meat, Pou ltry, Fi sh, Dry Bea ns,
Cheese Group Eggs & Nuts Group
2·3 SERVINGS 2·3 SERVINGS

Frui t Group
2·4 SERVINGS

Bread , Ce rea l,
Rice & Pasta
Grou p
6·11
I

FIGU RE 13.2
2005 USDA FOOD PYRAMID vlJ'I~mid
•
UNIT 2 Chap t er 13 S\f"P J Pro viding a Nut fltlon Plan 329

gain ed strong support more recently) show ed that carb ohydra tes (even the "complex" kind)
aren't universally good for you and that fat isn't unive rsa lly bad , As a result of thi s resear ch ,
the model was rev ised in 2005 (figu re 13,2),

Bas ed on mounting evidence that the dietary advic e presented in the 1992 Food Pyramid
was inadequate at best and inco rr ect at worst, the USDA made thr ee important and positive
modificat io ns, First, the Pyramid was changed (and im proved) to reflect a more moderate
intake of grains (4 servings per day), a higher fruit and vege table intake (5 cups per da y), a
moderate dairy intake (3 cups per day), a hi ghe r meat and bean intake (6,5 oz per day), and
the inclusion of some healthy fatS/oils (7 teaspoon s per day). Second, the new Food Pyra mid
included ac tua l vo lume and weigh t serving sizes. This also im proves the adv ice: it's much
easier to measure a cu p of vegetables and 6,5 oz of meat th an a "serving" , as few people
actual ly know what a "serving" is, Finally, th e Pyramid was accompanied by a stronger
focus on physical activity vi a instr uctions to exerc ise , an oth er positive addition to this new
approach, For more informati on on the evo lu tion of th e US DA Food Pyramid, visit th e US DA
website, www,mypyramid,gov, and visi t the section "for professionals",

In recogn izing the need for a higher intake of healthy fats , the need for a reduction of grain
in take, in including actual portio n siz es , and in offeri ng exe rcise recommenda ti ons, the
new Pyramid subst antially improve d the general dietary advice given to th e North American
popul ation, One further enhan cemen t is now available on the USDA' s website: individualized
recommendations that are produced whe n a user in puts age, he igh t, weight, ge nd er, and
physical activ ity levels, This allows a more customi zed approach to the food pyramid, As
you can see in Table 13 ,1 below , men and women at different ages may requir e diffe rent
amounts of ene rgy intake, leading to alterations in th e amo un t of each food group suggested,

Example recommendations based on USDA Food Pyramid

DAILY RECOMMENDED INTAKE

25 ·YEAR · OLO MALE 25 ·YEAR · OLD FEMALE 55 ·YEAR · OLD MALE 55-YEAR · OLD FEMA LE
FO OD GROUP (6'0 ", 180 LB ) (5 '6", 135 LB) (6 '0 ", 180 LB) (5 '6", 135 LB )
. . . - - - - - ------ - - - - - - ------ -- - - - - -- --- - - - - - - -- --- - - -- - --- ---- --- - -- -- - - - - --. - - - - ---.- -- _ .... . . --
Gra ins 10 ounces 6 ounces 8 ounces 6 ounces
Vegetables 3,5 cups 2,5 cu ps 3 cups 2,5 cups
Fru its 2.5 cups 2 cups 2 cu ps 1. 5 cups
Milk 3 cup s 3 cups 3 cups 3 cups
Meat & bea ns 7 ounce s 5,5 ounces 6.5 ounce s 5 ounc es

Oils 8 teaspoons 6 te aspoons 7 teaspoon s 5 tea spoons

Assumed
physical activity < 30 min per day < 30 min per day < 30 min per day < 30 min per da y

Calories 2,800 2,000 2,400 1,800

330 UNIT 2 Chapter 13 Slep ~ Pray .dmg a NulnllO n P'dn

With th is init ia tive, th e USDA has provided some excellent dietary plann ing resou rces for you
and your clients, including:

An easy-to-understand system for designing a client's nutrition plan based on a healthy,

well-ba lanced approach including a diverse diet rich in fruits and veggies.
An individualized set of daily food group goals which, if met , would help a client achieve
weekly calorie and nutrient needs.
An in teractive website for producing educa t ion and mo ni toring tools, wh ich you can prin t
off and hand to your cl ients with the blessing of the USDA.

However, there are some disadvantages.

The macronutrient gu idelines may work well for large popula ti ons making the switch
from the typ ica l North American diet, but t hey aren 't id eal for eve ry individual with whom
you'll cons ult, nor are they ideal for every set of goals. The USDA system recommends an
avera ge diet consis ting of 15 to 20% protein, 50 to 55% carbohydra te , and 25 to 30%
fat. Yet not all body types respon d well to this type of macronutrient rat io. For example,
some will need lowe r carbohydrate recommendat ions whi le some will need higher
carbohydrate recomm enda t ions. These differenc es wi ll be based on hormonal status,
activity levels, and more.
The protein in take recommended by t he Food Pyramid may be too low for ce rt ain highly
active individuals, especially exe rcise rs and at hletes following low-calorie, fat-loss diets.
PASTEUR IZED M ILK The USDA may reco mmend too much milk and dairy, according to many expe rts. As
Milk that's been exposed calcium is eas ily obtai ned from other food sources (such as green leafy vegetable s) an d
to high temperatures a high intake of pasteurized milk has been shown to increase cer tain disease ris ks,
Inan effort to destroy
the US DA fo cus on dairy and milk might be overstat ed . The work of Walter Willett at
microorganisms
the Harvard Sc hool of Public Health has highlighted several risks assoc iated with mi lk
LACTOSE INTOLERANCE
drinking (i ncluding hormona l exposure from dairy ind ustry milk, lactose intolerance ,
Inability of the body to potential inc reased risk of certain cancers, and more) as well as the fact t ha t milk drin kin g
break down lacto se. usuaffy does not even seem to offer prot ec ti on against osteoporosis (although frui t and vegetable
seconda ry to lactase consumption do es ).
enzyme deficiency
The system offers limited in form at ion about food selection. With t he set of
re commendations given, your clients would have to learn which foods fit into which
OST EOP OROS IS
A decrease in the mass
categories. Fo r example, t hey would have to learn the differences between high ly
and density of bone with processed grains (less desirable) and whole grains (more desirable). They would also
enlargement of bone have to learn t hat fatty meats are less desirable than lean meats. Fu rt her, t hey would have
spaces, creating porosity to learn tha t omega- 3-rich and monounsa turated oi ls may be healthier than om ega-6-rich
oils . None of thi s information is inheren t in the Food Pyramid recommend ati ons.
NUTRI EN T T IM I NG
The Food Pyramid doesn't offer nutrient timing suggest ions or exercise nutrition
Sports nutrition concept
that manipulates meal recommendations. While this is fine for a sedentary population in need of baS IC nu tr ition
chronology to enhance strategies , yo ur typica l clientele wi ll need more in formation on these two important topics.
recovery from trainmg and Finally, t he value of nutri ti onal supplements, which are im portan t when whole food intake
body compositIOn
is limit ed or lacking, isn't addressed.

The USDA has improved its Food Pyr am id substan ti ally over the last few years, it offers an
individualization compon ent, and th e die tary recom mend ati ons are based on more current
resea rc h. This has led to an excellen t system for teaching good nutri tion to th ose relatively
new to optimal food in take. Therefore, for Levell clients, you may want to begin with t he
USDA approach to nutrition education. For a rela t ively seden tary individual ea ti ng the typ ical
North American diet, th is app roach wou ld likely lead to very effective outcomes. However,
UN IT 2 Chapter 13 Step 4 PrCVllJ ln b a N ut ri tlOfl Pial 331

the USDA system does have its li mitations, especially for highly active populations,
To address some of t hese tim itations, the strategies t ha t follow are he[pfu l.

Habit- and superfood-based nutrition

As an adjunct and/or al ternative approach to the USDA Food Pyramid sys tem, we have
found the fol lowing set of strateg ies us eful for providing nutri tion education to clients.
These strategies can be u sed for Leve[ 1 and Leve [ 2 clients and are based on teach ing your
ctients five simple habits as well as providing them with superfood recommendations that ,
if followed, will naturally lead to an improvement in ca lorie controt, nutrient timing, and
food selection. Let's begin wit h the 5 Habits . 5 HABI TS
Simple habits that wh en
followed will naturalfy lead
HABIT 1: EAT EVERY 2 TO 4 HOURS
to an Impro'le ment in calori e
Most North Americans eat somewhere around three mea ls a day wit h a "see -food" snacking control, nutnent tlmmg. and
pattern between mea ls (if they see food, they snack on ill . This is an inadequate way to food selectIOn
feed the body, especially if an individuat is physica [l y active , as research has demonstrated
that eatin g every two to four hours is one of the most important strategies for improving
health and body composition. Regu[ar feed ing intervals st imulate the metabo li sm, balance
blood sugar, and help maintain le an mass while giving the body a reason to burn off ex tra
fat mass. This strategy atso ensures that physically active people (who need more ca lo ries
than sedentary individuals) get enough food to meet their ca lorie needs without eating very
ca lorie-dense foods that are more [i kety to promote fat storage.

A[though this guideli ne is basic, you may have some questions about how to implement it.

QUEST[ON 1, How many meals per day should a client be eating?

That's easy, just divide the time a client is awa ke (say, 15 hours) by 3. So if they're up
for 15 hours a day, they can shoot for about f ive meals a day. Some clients may need
to eat more meals than this. For example, if the goal is weight ga in and they have a fast
metabolism, they'[1 likely need to eat more frequently. However, for now, don't get too
wrapped up in trying to figure out the perfect number of meals for your client. Five meals is
an easy ru le of thumb . Yo u can make adjustments la ter based on your client's res ults.

QUEST tON 2 , When should a client eat in relation to activity?

For example, should they eat before bed or before exercise' For this one, keep the 2- to -4 -
hou r rul e in mi n d. [f it's bed time and it's time to eat, then eat ' Regardless of what you've
heard befo re about ea ting prior to bed, if it's time to have a meal, your ctient should have a mea l,

The same goes for exercise. Yo u may often hear that it's important to eat before exercise
because this helps a client mai ntain energy levels throughout the enti re exercise session. But,
as yo u'll le arn later, your clients are al ready going to be feeding during t he exercise session.
Th us, with this st rategy there's no need to eat just before exercise, beca us e they' ll be getting
those nutrients and that energy thro ughout the entire session . 1D0n't worry, these are liquid
feedings so you won't to have to recommend carrying some carrots and chicken in a gym
bag.) Just have your clients eat every two to four hours and let exercise, bed time, and so on
happen when they may. Don't make it any more difficult than this .
332 UN IT 2 Cha pter 13 Step 4 Provldmg a Nut fl tlon Plan

QUESTION 3, How big should the meals be?

Everyone's mea l sizes will differ based on sex, body size, body fat percentage, physical
act ivity levels, calorie needs for the day, and more. Yet it might not be necessary to start
measuring portion sizes and calories immediately, especially with Levelland 2 clients. For
now, stick to the 5 Habits, and meal sizes will often fall right into place. If they don't, you
can follow the strategies outl ined fo r Level 3 clients , which we describe later in this chapter.
FEEDING OPPORTUNITIES
An opportunity to eat QUEST ION 4, Does this mean three meals and two or three snacks a day?

Don't differentiate between "meals" and "snacks"; instead, think in t erms of feeding
opportunities. In other words, every time a client eats , they have the oppor tunity to make
their body better or make it worse. If they focus on the 5 Habits, they 're guaran teed to make
it better. Sure, some meals may be smaller than others, but the poi nt is that each meal should
conform to the four additional habits that follow.

QUEST ION 5, What happens if a client has to miss a meal?

Obviously, according to the rules of nutrient timing, it's best to not miss a meal. As the course
progresses, you'll learn some strategies to share with your clients that can he lp improve the ir
planning and can help ensure that they've got what the y need when they need il. However,
from time to t ime , your clients may have to miss a meal. Tell them not to sweat il. Have
them just get right back on track as soon as they can.

Aim to have yo ur clients do their best to stick to Habit 1 - eat ing every two to four hours -
without making it a source of frustration and confusion. Next, use the remaining four Habits
to ensure that they make the most of each of t hese feeding opportunities.

HABIT 2, EAT COMPLETE, LEAN PROTEIN WITH EACH FEEDING OPPORTUNITY

This area is somewha t controversial. Some experts will have you believe that addit io na l
protein is somehow harmful or un necessary. However, the research is pretty clear: in healthy
individuals, a highe r-protein diet is comple tely sa fe. And not only is it safe, it may actually
COMP LETE, LEAN PROTEIN
Protein source th at be important for achieving the best hea lth, body composition, and performance. The truth is,
contains all of the essential it's hard to achieve al l three of these with a suboptimal protein intake. Your clients may be
amino acids able to reach protein optimization without eating complete, lean protein with each feeding.
But most clients find this very hard to do because they have to eat large portions during
the actual protein-containing meals. So, make it easy on your clients and recommend they
follow this habit in order to meet their protein needs . Here's what they should keep in mind
(summarized in Table 13.2L

A portion size of protein is visually about the size of the palm of you r hand,
between 20 and 30 g. Women should get one portion of protein per meal (20-30
g), and men should get two portions per meal (40-60 g).

Reinforce this lesson with your clients, protein is not limited to just breakfast, lunch, and dinner.
Every feeding opportunity, every two to four hours, should contain complete, lean protein. By
following this advice, your clients will not only ensure an adequate in take of prote in , they'll also
stimulate their metabolism, improve their muscle mass and recovery, and reduce their body fat.

HABIT 3, EAT VEGETABLES WITH EACH FEEDING OPPORTUNITY

This is some thing your client's mothers and grandmothers have been harping on for years, so
it's about time scientists final ly caught up. Science has demonstrated that in addition to the
micron utrients (vitamins and minerals) packed into vegetables , there are also important plant
UNIT 2 Chapter 13 SteP <l Pl ovld ,ng a Nutr ition Plan 333

Prot ei n Chart

Food type lean , complete pro tein sources

Food timing Eaten with each feeding opportun ity

Food amount 1 serving for women (size of palm)

2 servmgs for men (size of two palms)
Example s • Lean meats such as ground beef, chicken, turkey, bison, venison
• Fish such as sa lmon, tuna, cod, roughy
• Eggs (egg whites, occaSional whole eggs)
• low·fat dai ry such as skim milk, cottage cheese, yogurt, part skim cheese,
string cheese, etc.
• Vegetarian choices such as tofu, tempeh, seitan, etc.

• Protein supplements
• mi lk·b ased: whey, casein, milk protein blen ds
• non·dairy/vegan: hemp , brown rice, soy, or other plant· based bl ends

chemicals (phytochemicals) that are essen tial for optimal physiological functioning. Even
more interesting is that vegetables (and fruits) provide an alkaline load to the blood. Since ALKALINE LOAD
both proteins and grains present acid loads to the blood, it's important to balance these acids A food int ake that genera tes
a slightly higher pH value in
with alkaline-rich vegetables and fruits. Too much acid and not enough alkalin ity means the
the body; base forming
loss of bone strength and muscle mass. Make sure your clients stay balanced' Here's how to
ensure that your clients are getting enough vegetables,

Remind your clients to include at leas t two servings of fruits andlor vegetables per meal.
Teach them that one medium-sized fruit , 1/2 cup raw chopped fruit or vegetables, and
1 cup of raw, lea fy vege ta bles each equal one serving.
Given that each client should slrive to eat five meals a day, they should get about 10
servings of fruits and veggies a day.

While it's possible to get enough fruits and vegetables each day without following the two-
to-four-hou r rule, it's difficult, getting 10 serv ings in two or three meals wo uld require you r
clients to eat three to five servings of fruits and veggies per meal. It's un likely that they'll do
th is. By developing the habit of eating vegetables at each meal, your clients will be much
more likely to get their ful l 10 servings of cancer-fighting, free-radi ca l-destroying, acid-
neutralizing, and micronu trient-rich power per day. Looking at things from this perspective,
this is one hab it with which no one can argue!

HAB IT 4: FOR FAT LOSS , EAT "O THER CARBOHYDRATES"

ONLY AFTER EXERCISE
Another way of saying this is, If a client's got fat to lose, they've gOllo earn those higher-
carbohydrate meals by exercising firsl! Do your clients want to eat bread, pasta, rice, sugary
foods, and the like' They can eat them, as long as they do two things,
334 UNIT 2 Chapter 13 SIE'D <l PrOV iding a NutntlO!1 Pla n

1. Focus more on whole-grain, unprocessed varie t ies.

2. Save them until within 1-2 hours after exercise .

Som e clients may resist this recom me ndat ion . For starters, some will think this makes your
recommendations "low -carbohydrate. " Others say that thi s approach do esn't necessarily
distinguish betwee n "good", high-fiber, low -glycemic -index carbo hydrates and "bad ", high-
sugar, empty-calor ie carbohydra tes . Others will simply object because they want to eat
carbohydrates when they want them and don't want to be told not to. So be prepared for the
objection s with th e followin g.

Carbohydrate cha rt for fat loss and muscle gain

SIMPLE SUGARS AND WHO LE-GRAIN,

EX ERC ISE HIGH LY PROCESSED STARCHY FRU ITS ANO
FOOD TYPE RECOVERV DR INK STARCHES CARBOHYDRATES VEGETABLES

FOOD TIMING
For muscle gain During and Immediately after Eat soon (within Eaten with each
after exercise exercise (if at allF 3 hou rs ) after feeding
exerc ise3

FOOD TIMING
For fat loss During exercise Minimize intake Eat soon (within Eaten with each
only' 1·2 hours) after feeding (with
exercise emphaSIS on
veggles)

Ex amples Sugary, protein-rich Sugary sp orts Bread (preferably Sp inach

recovery drinks dnnks whole grai n)
Carrots
such as Biotest
Breakfast cereals Pasta (preferably
Surge. Endurox R4 Tomatoes
whole grai n or flax)
Soda
Broc coli
Rice (prefera bly
Fruit jUice
whole grain , Cauliflower
Table sugar unprocessed) Apples
Sugary desser ts Po tatoes (pre ferably Oranges
Ice cream sweet potato es or
Avocad os
yams)
Muffins
Be rries
Oats (preferably
Bagels
whole oa1s)
Other ca rbohydrate-
Cerea l grains
ri ch snacks
(wheat, rye, et c.)

Noles:
1. If yo ur client tolerates carbohydrates we ll, you can incl ude such a drink dUring exercise. If your client doesn't you should prObably
stICk With wa ter Of a bran ched-chain ammo acid workout dnnk (to be discussed la te r in the coursel.
2. These food choIces should be minimIzed yet are permisSible after ex.erci se for those with good carbohydrate tolerance and the
goal of weight gain.
3. If a client has good carbohydrate toleran ce and a hard time gammg weight. you can mclude these foods throughout the rest of
the day as well.
UNIT 2 Chapter 13 Step 4 Prov ding a Nutrition Plan 335

This is not a low-carbohydr at e die t. Rat her, it's a controlled-carbohydrate die t. CONTROLLED

Your clients interested in fat loss will be getting most of the ir carbohydra te s from CARBOHYDRATE
Eating ca rbohydrate s in the
vegetables and fru its with a smal l amount of additional carbohydrates from sugary
forms and at the times that
sources during exercise and a sma ll amount of starchy sources post-exercise. Yes, it the body can best tolerate
may be lower carbohydrate, bu t most Norlh Americans ea t too many carbohydrates as it is,
Consuming fewer carbohydrates will take them right into a healthy range,
For clie nt s competing in carbohydrate-dependent sports and for those interested CAR BOHYDRATE -
DEPENDENT SPORTS
in musc le gain, they ca n and li kely should include more carbohydrates than j ust
Sports that exhaust high
recommended. However, as this subpopulation of clients will li ke ly be smaller than yo ur amounts of muscle glycogen
fat-loss clients, we' ll discuss these individua ls later in t he course.
Wh ile th is strategy doesn't discuss glycemic index, it does distinguish between carbohydrate GLYCEM IC I NDEX
Measure of the rate at which an
sources in a more meaningful way. Tab le 13.3 can he!p you and cl ients make the dist inctio n
mge sted food causes the level
between different carbohydrates and when to consume them depending on the of glucose in the blood to ri se
two goals of fat loss and muscle gain,
Th is carbohydrate timin g strategy works very, very well in those with stubborn and hard -to-remove
body fat stores; and for minimizing fa t gain in those interested in gaining musc!e. Keep it simp!e:

If you r client wants to lose fat, have them eat carbohydra tes only when they earn them ,
No exercise, no carbohydrates (other than fruits and veggies , of course).
If your cli en t wants to gain muscle or support carbohydrate-dependent activities, use the
carbohydrate timing prinCiples out li ned in the charts,

One caveat before moving on: Just li ke grammar, there may be exceptions to the rules in cer tain
situat ions. However, don't worry about these in the beginn ing. The exceptions are advanced
Ind ividualiza t ion princ iples that are only necessary to follow when working with a Level 3 client.

HABIT 5: EAT HEALTHY FATS DAILY

About 30% of the diet shou ld come from fat, although the optimal in take for each client
can range between 20 and 40%. !n some ext reme cases where very spec ific goa ls have to
be achieved with individuals of a specific body type, it could even be as low as 15% (when
carbohydrate Intake is much higher) or as high as 60% (whe n carbohydrate intake is much
lower). These scenarios would on ly occur in Leve! 3 clients and will be discussed later in the
course , For now, us ing 30% is the best strategy for ensur ing a hea lt hy fa t distribution,

More important than tota l fa t intake, however, is the balance between saturated,
monounsaturated , and polyunsaturated fats; we recommend a ratio of one -third each from
saturated, monounsaturated, and polyunsaturated fat Health, body compOSition, and
performance can be optimized by balancing fat intake in th is way,

The ratios and percentages mentioned might seem in timidating at first. Rather than focusing
on them, focus on adding healthy monounsa t ura ted fats (from extra virgin olive oil, some
nuts, and avocados) and po lyunsaturated fats (from some nuts, some vegetable oils, and fis h
oil supp le ments) to the diet By adding these to a diet of fruits and veggies, carbohydrates
when earned, and lean prote ins, you r clients' dietary fat intakes should ba la nce right out

You should have some sort of easy-to-reference "cheat sheet" for sharing the hab i ts With your 5 HABITS CHEAT SHEET
clients, This way they can keep them handy and quickly refe rence t hem both for meals at Simple habits that wh en
home or meals on the road, The follow ing 5 Habits Cheat Sheet is a great resource for you to fol/owed will naturally lead
share with your clie nts. to an improvement in calone
control, nutrient liming, and
At this point, clrents may need an additional resou rce or two for helping them make good food food selection
choices, The charts provided should help steer t hem in the right direction ,
336 UNIT 2 Chapter 13 Step 4 Prov iding a Nutn[lon Plan

Fat chart

FOOD TYPE SATURATED FAT MONOUNSATURATED FAT PO LYUNSATURATE D FAT

Food t imi ng No specific tlmmg: No specific timingl No speci fic limin g]

Food amount 1/3 of Intake 1/3 of intake 1/3 of in take

Exampl es Animal fats (in eggs, dair y, Olive oil Flax seeds and oil
meats. butter, cheeses. etc.) Nuts and nut butters Fish oil
Coconut all Avocado Nuts and nut butters

Palm all Vege table oils

As discussed ea rl ie r In the text, meals h lgll er in ca rb ohydrate shou ld likely be lowe r In f at. and vi ce versa Th erefore jf eat ing a higher-
ca rbo hyd rate post-e xercise meal. fa t intake would be lower. Converse ly, with a higher- fat meal outs ide of the "workout window", th e
ca rbohydrate portion should be relatively smaller

Along wi th the Habits, we also use a list of "s upe rf oods", These 21 supe rf oods are foods
that are pa rti cularly rich in macronutrients, micronutrients, and phyton utr ients . Ma ny are
relativ ely lower in calories and higher in fib er as wel l. We encourage clients to build their
diets around th e superfood s for three reaso ns.

it provides a handy list for grocery shopping and can easily be posted on a client's fr idge
to guide their food se lections;
when used in conjunction w it h the 5 Ha bits it generally ensures th at clients' ea ting
habits (food type, amoun t, and timing) are sign ific antl y i mproved without ever bothe ring
to count calories; and
it offers th e psychological benefit of an "affirma tive" nutriti on plan - one that is bas ed
aro und what clien ts should consume, rat her than what they shouldn't,

Recommend that your clients try to get between three and five se rvings of each of these
foods, barr in g allergies or intolerances, every week. The checklist in Tab le 13.6 wi ll help
the m keep track of their progress.

Note. Don't assume thes e are the only foods recommended' Rath er, th ese are important
foods that should be included , Once cli ent s meet their recomme nd ed minimum in tak e of
the superfoods they can easily round ou t thei r nutritional in t ake with mo re of th e same
foods , or with additional food choices - as lo ng as th ey comply with the 5 Habits discussed
previously. If your client is a vegeta ria n, you can substitute vege tarian proteins (includ ing
legumes) for th e mea t sources inc lu ded in Tab le 13,5. Fur th er, if yo ur cli ent has allergies or
intolerances to any of the foods listed he re, substitutions should be made.

SUPER FOO DS CH ECK LI ST This dual sys tem of 5 Habits and the Superloods Checklist has a few key ad vantages.
Foods that are very nutrient
dense and energy controlled Together, th ey help guide foo d se lection, am ount , and tim in g without the need to cou nt
calories, This leads to th e next benefit.
By not req uiring calorie-cou nting, the strategy prese nts a simple-to -understa nd and easy-to-
apply method of gua ra nteeing a well-balanced diet spec ifically ta rgeted to active ind ividua ls.
FOLD HER E FOLD HERE
c
0
:;:::; 0 ~
ui
~
<f)
(J) on :is
:::J c CO
~
(J) 0- I
~ ..c:
E L!)
<f)
0
U U OJ
C CO u
« (J) CO
..c:
~
CUT ALO NG LINE
UNIT 2 Chapter 13 Step 4 Pro viding il Nu\r lt,on Plan 337
CUT ALONG LINE
FOLD HE RE FO LD HER E
w w

'"
W
I
'"wI
o
~
o
2 2

w
Z

C)
z
S
1. When did you 3. Where are the se rving of fruits and veggies '"=>
~

instead. If yo u have just worked u

last eat? veggies? out, a mix of carb so urces is fine.

If it's been longer than 2·4 Are you abo ut to ea t at least 2

hours, it's time to eat. servings of veggies? Prepare them 5, Where are your
any way yo u li ke, but eat them
c
fats coming from?
'"
~
c 2, Where is the
wi th eve ry meal or snac k. (One
¥ servi ng is about 1/2· 1 cu p and Today you need some fat from
'5 complete protein?
z your target is 5·10 cups per day). anima l fo ods, from olive oil, from
ro
~ mixed nuts, and from flaxseeds!
Are yo u abou t to eat at least 1
"i5 se rving (20·30 g) of co mplete 4, Where are the flaxseed oil or fish oil. Spread
0:
., protein? If not, find some
them th roughout the day but
~ carbs? make sure to add th em in.
~
prot ein . Women ge t 1 serving
-
~

.!i
~
and men gel 2. If you have fat to lose but haven't
ju st wo rked out, put dow n th e
•
~
u pasta, bread , ri ce, and othe r
N
~ starchy carbs. Opt for a double
Z
~ w
z
"
C)
z
S
'"=>
~

w w
'"w
I
'"
W
I
0 0
co ~
0 <5
M ~ ~
M
UNIT 2 Chapter 13 Slep..j Provdlrlg a Nutrition Plan 339

21 SUPERFOO DS REFER EN CE GUIDE

PROTEINS 1, Lean red meat (93% le an. top round, sirlom)

2, Salmon

3. Dmega-3 eggs

4. Low-fat, plain yogurt (lactose -free if yo u

can fin d i t)

5. Protem supplements (mi lk protein Isolat es. whey prote in Isola te s,

or vegan protem source s)

VEGETABLES AND FRUITS 6. Spinach

7. Tomatoes

8. Crucl ferous ve getables (broccoli, cabbage, cauliflower)

9. Mixed berries

10. Oranges

OTHER CARBOHYDRATES 11. Mixed bea ns

1 2. Quinoa

13. Whole oa ts

GOOD FATS 14. Mixed nuts

15. Avocados
16. Extra vi rgin olive oil
17. Fish all

18. Flax seeds (ground)

DRINKS / OTHER 19. Green tea

20. liqu id exe rCise drinks (quick ly digested ca rba ll yd ra te and protein )

21. Gree ns- ' (vegetab le concentrate supplement)

Note:
Do not select foods th at you are aller giC to or intolerant of
340 UNIT 2 Chapter 13 Step,j Pr oviding a Nutri tion Plan

21 SUPERFOODS CHECKLI ST

FOOD TYPE FOOD CATEGO RY # OF SE RVI NGS

1. Lean red meat (93% lean, top round, sirloin) Protein - Lean meat

2. Salmon Protein - Fish

3. Omega-3 eggs Protein - Dairy

4, Low-fat plain yogurt (lactose-free if you can find it) Protein - Dairy
5. Supplemental protein (milk protein isolates, whey protein Protein - Powder
isola tes , or vegan protein sources)

6. Spinach earb - Vegetable

7. Tomatoes Carb - Vegetab le

8. Cruc iferous vege tables (broccoli, cabbage, cau liflower) Carb - Vege tab le

9. M ixed berries (strawberries, blueberries, raspberries, etc.) Garb - Fru it

10. Oranges Carb - Fruit

11. Mixed beans (kidney, navy, white, etc .) Carb - Legume

12. Quinoa Carb - Gra in

13. Whole oa ts (large flake) Carb - Cereal

14. Mixed nuts (a variety of different types of nuts including Fat - Seeds and nu ts
pecans, walnuts, cashews, brazil nuts, etc.)

15. Avocados Fat - Fruit

16. Olive oil (extra virgi n) Fat - Oils

17. Fish oil (salmon , anchovy, menhaden, krill) Fat - Oi ls

18. Flax seeds (ground) Fa t - Seeds and nuts

19. Green tea Teas

20. greens + J: or compa rable bra nd Vegetab le concen trate

supplement

21. Liquid exercise drinks (quickly digested carbohydrate and protein) Recovery drinks

Note:
Do not select foods thaI yo u are a ll ergIC to or mtolerant of
UNIT 2 Chapter 13 Step 4 Pr ovldmg a Nu\ nliOn Pia") 341

The Cheat Sheet , Protein, Carb and Fat Charts, and the Superfoods Checklisl can all be
posted on the fridge or in anolher easily visible place as ongo in g teaching tools.
The strategy can help establish rules for each meal, thus directing meal·by · meal
nutritional choices and intake. The Cheat Sheet provides your clients with guidance even
when you're not there.

Like any other system, however, this strategy has some limitations.

This strategy doesn't provide prescriptive nutrition or tailor calorie intake specifically to
the client. Rather, it relies on optimal timing and food selection to regulate hunger and
overall intake.
As with the USDA system, the recommendations don't provide specific guidelines for
different body types. Not every body type will respond optimally to the recommendations
outlined in these first two systems.
Without specific guidance, the intake of carbohydrate may be too low for some
individuals. In try ing to follow the hab its exact ly, clien ts may become overzealous in their
carbohydrate avoidance. If they are very physically active or compe te in carbohydrate·
dependent spo rts, this may be problematic as their energy intakes and carbohydrate
intakes might be too low.

Nevertheless. this strategy presents a viable alternative to the USDA Food Pyramid for
educating Levell clients and likely represents a superior strategy for Level 2 clients who are
also very physically active.

However, before moving on, it's important to reite rat e one lesson that was taught earlier in
this course. good nutrition goes beyond theory of nutrition. Good nutrit ion equals results.
Even if your clients comply perfectly with the strategies presented , you must monitor their
progress and alter food quantiti es based on their response. For example, if they're interested
in weight loss and their progress stalls, you may want to recommend that they reduce their
food intake (assuming they're already exercis ing at the optim um level of approx imately five
hours per week for weight loss) . On the other hand , if th ey're interested in we igh t gain and
their progress stalls, you may want to recommend that they increase their food in take . Th is
type of ou tcome· based nutrition is critical, because as the body changes its needs also
change. As a client loses or gains weight, the ir physiology will change . With this change may
come a new set of calorie demands. This makes good nutrition, like a good train ing program,
an iterative process.

Individualization
In the Precision Nutrition System , we divide clients into three levels, and tailor our
recommendations appropri ate ly to each level.

LEVEL 1 - BAS IC NUTRITIONAL PROGRAMMING

This level is ideal for nutritional beg in ners. Clients can be advanced in the gym or on the
play ing field and still be nutritional beginners. It's also ideal for th ose with more modest
goa ls, such as moderate body composition improvements, or feeling better every day. This
leve l requires simple, basic instructio ns and steps.

LEVEL 2 - INDIVIDUALIZED NUTRITIONAL PROGRAMMING

This level is appropriate for recreational exercisers and high·performance athletes who
342 UNIT 2 Chapter 13 S:cp L Pro vldlrg a NutnliOIl Plan

already have a high·quality basic diet and wan t to pursue very specific performance and!
or body transformalion goals. It's also good for Ihose clients who really want and need to
know the details of their intake. At this level , clients can handle activity- and goal ·based
calorie calc ulat ions, body type-specific macronutrient breakdowns and nutrient sensitivity·
based timing strat egies.
LEVEl 1 Cll ENTS
Oescfibes people who LEVEL 3 - SPECIAL SITUATION NUTRITIONAL PROGRAMMING
are not yet In the habits This level is for nutritionally experienced people with specific, aggressive goals such as
of eating healthy foods , at competing in a physique contes t, dropping body fat percentage into the mid·single digits
the right time, in the right
(men) or close to Single digits (women) or optimizing competitlOn·day nutrition. Leve l 3
amounts
is for people who want to accompli sh lofty physique and performance goals and have the
LEV EL 2 CLI EN TS
discip li ne to follow 95% adherence or highe r, rigorously tra ck intake, count ca lories, vary
Describes people who have macro nut rient s systematically and so forth. Unless you specialize in, for example, coaching
an idea of portion sizes, upper·level physique athletes, very few of your clients will probably be in th is group.
body awareness and food
choices but need help For Levell and Level 2 clients, th e nutrition educal ion strategies discussed previou sly shou ld
with food timing, nutrient go a long way toward improving their intake. However, Level 3 clients, those who already
partitIoning, and food intake understand the principles of nutrient timing, portion control, and food selection, may need
rela tive to need/goa ls a substantial ly more individualized approach. Th is section will present a step·by·step guide
to individualization based on activity levels, goals, and body type. Befo re presenting this
LEV EL 3 CLI ENTS strategy, however, it's important to note that the following strategies are hi gh- level nutritional
Describes people who have
interventions. They require more rigorous adherence. They require calorie calculation and a
a good gra sp of Level 2
strategies but their high
thoro ugh understanding of the macronutrients. The y requ ire a strong commi tment to physical
performance goals demand and lifestyle change. In other words, your average client will not likely have the knowledge,
more specialized strategies discipline, or will power to follow them. Use the in formation gathe red in the quest ion naires
and supplementation to and assessments to decide whether a client is tru ly ready for this level of indi vidualizati on, or
precisely address food
whether you shou ld use the strategi es presented earlier in this cha pter.
mto/erances/allergies,
body fat distribution, gene
profiles, and other highly
INDIVIDUALIZATION STEP 1: DETERMINE CALORIE NEEDS
specific nutritional goats To determine a client's calorie needs, simply ma tch their activity levels and goals in Tabl e 13.7.
This will lead you to Ihe right equation for your clien t. Once you 've found this equalion , multiply
their bodyweight in pounds by t he given multiplier. This will yield th eir daily calorie estimate.

Calorie estimator

CLIENT GO AL

WE IGH T LO SS WEIGH T MAI NTENANCE WEIGHT GA IN

MULTIPLY BODYWE IGHT IN PO UNDS BY

Sedentary (minimal exercise) 10-12 12-14 16-18

Moderately active (3-4 times/wk) 12-14 14-16 18-20

Very active ( 5·7 times/wk) 14-1 6 16-18 20-22

UN IT 2 Chapter 13 Steo .1 Provld lr,g a N u tn tlor Plan 343

To demonstrate how th is works in pract ice, let's work though a coup le of examples.

Examp le L A 140 Ib, moderately active woman intere sted in fat loss would begin
by tak ing in between 1680 (140 Ib x 12) and 1960 (140 Ib x 14) keal/day.

Example 2, A 190 Ib, moderate ly act ive man in terested in muscle mass ga in would
begin by taking in between 3420 1190 Ib x 18) and 3800 (190 Ib x 20) keal/day.

BODY TYPES
IND IVIDUALIZATION STEP 2: MACRONUTRIENT SPLIT
Also known as
Once you have determ ined the proper calorie in take , use Tab le 13.8 to determine the id ea l somatotypes; general
starting macronutrient percentages for different body types. To use this table, simply choose categories of body structure
the cli ent's body type and general goals. Then calculate the recomme nde d percen tage of as weff as muscle and
protein, carbohydrate, and fat. fat storage and distribution

Body type and macronutrient estimates

SUGGESTED AVERAGE STARTING

PERCENTAGES (APPROXI MAT E)

SOMATOTYPE AND PHYSICAL

ACTIV ITY PREFERENCE CH ARACTER I ST I CS TYPICAL GOALS PROTEIN CARBOHYDRATE FAT

Ectomorphic Thyroid dominant Gain muscle strength and 25% 55% 20%
size, especially in limbs
(Naturally thin Fast metabolic rate
with skinny limbs) Ma intain bodyweight
High sympathetic
and strength during
Endurance exercise nervous system activity
h igh-vo!ume/endu rance
Higher carbohydrate exercise
tolerance

Mesomorphic Tes to ste ro ne and growth Continue to build muscle 30% 40% 30%
hormone dominant mass while ma in taining
(Natura fly muscular
low body fat percentage
& athletic) Moderate to high
sympathetic nervous Support ath letic
Bodybuilding and/
system activity performance
or relative strength
exercise Moderate carbohydrate
tolerance

Endomorphic In sulin dominant l ose body fat, especia lly 35% 25% 40%
in centra! reg ion
(Naturally broad Slow metabolic rate
(abdomina!, lower back)
and thick)
Low sym patheti c
Absolute strength nervous system activity
exercise
low carbohydrate
tolerance
344 UNIT 2 Chapter 13 St ep 4 Prov iding a Nutr,tlon PICHi

FIGURE 134
SOMATYPE S

J )

Ectomorph Endomorph Mesomorph

ECTOMORPH Some individuals, particu larly elite athletes who usua lly self-select for given spor ts, can easily
Body type characterized by be classified as a specific body type. For instance, marathon runners are likely ectomorphs ;
long and thin muscles and competitive bodybuilders usually mesomorphs ; and heavyweight powerlifters endomorphs.
limbs with lower fat storage;
Other individuals are hard to classify as they naturally fall between categories . It's possible
generalfy slim
for a client to be a genetic ecto -mesomorph (athletic looking yet still on the thin side,
MESOMORPH especially in the limbs) or genetic endo -mesomorph (heavily muscled yet carry ing extra
Body type charactef/Zed by body fat around the midsection)_ A client's lifestyle can also alter their natural somatotype to
larger bones. a sofid tors o. produce a hybrid type. For examp le, your client could be a genetic ectomorph or endomorph
wide shoulders, t!lm waist.
that has exercised and eaten well for years and now resembles a mesomorph. On t he other
controfled body fat levels
side of the spectrum, your clien t might be an ectomorph or a mesomorph that has developed
ENDO MORPH poor insulin sensitivity and carbohydrate tolerance due to years of inactivity and poor food
Body type characterized by choices, and now resembles a mixt ure of t heir original type and the endomorphic type.
increased fat storage, wider
waist, large bone structure Don't get too bogged down trying to figure out every client's exact class ification. It doesn't
matter all that much! In this context, th is classification is merely a tool to determine a cl ient's
ECTO - MESOMORPH idea l starting macronutrient composition. If you're having a hard time determining a client's
A blend between ectomorph exact body type, skip that part and go righ t to their ideal goa l set
and mesomorph body
types: athletic looking Do they need to prioritize muscle gain' If so , begin with the ectomorphic
yet still on the thin side, recommendations. Then, using outcome-based dec ision making, adjust the program to
especiaffy in the limbs promote continual progress.
Do they need to prioritize fat loss' If so, begin with the endomorphic recommendations . Then,
ENDO - MESOMORPH
A blend between
using outcome-based decision making, adjust the program to promote continual prog ress.
endomorph and Do they need to priorit ize endurance performance' If so, begin with the ectomorph ic
mesomorph; heavily recommendations. Then, us ing outcome-based decision making, ad just the program to
muscled yet carrymg extra
promo te contin ual progress.
body fat around
the midsection Do they need to prioritize strength/power performance' If so, beg in with the
mesomorphic recommendations . Then, using outcome-based decision making, adjust the
program to promote continual progress.
UNI T 2 Chapte r 13 Step L1 Providing a N ut rition Plan 345

Before movin g on, it's important to note that you will need to use both the ca lorie char t SOMATOTYPE
and the macro nu t rient percen tage chart to ensure t hat you're recommend ing the right Also known as body
types; general categorie s
amount of calories, the right macro nutrient breakdown, and the right macronutrient amounts,
of body structure as well
The calorie chart te l ls you how many calories a client should be eating and t he macronutrient
as mus cle and fat storage
chart tells you how ma ny calories should come from eac h macron utrient As you may recall and di stributIOn
from Unit 1, each gram of prote in and carbohydrate contains 4 kcal and each gram of fat
con tain s 9 kc aL Th us it's easy to conv ert macro nu t rien t ratios to grams . Using our two
previous examples (t he 140 Ib woman and 190 Ib ma n ), let's wor k through two CARBOHY OR ATE TOL ERANC E
A person's ability to
sample calculations .
handle higher dietary
carbohydrate loads
EXAM PL E 1: 140 LB MODERATE LY ACT IVE WOMAN

Step 1: Determine somatotype and goals. We know this woman wants to lose fa t, and
we've discovered that she is an endomorph.

Step 2, Calculate her specific dietary needs by starting with the calorie chart (Table
13.7) . Based on her calorie needs and goals, she sho u ld be ea ting between 1,680 and
1,960 kca l per day (12 to 14 times bodyweight) .

Step 3, Identify macronutrient ratios from macro nutrient chart (Table 13.8). Based on t he
macron ut rien t chart, her macronu trient brea kdown would be as follows: 35% protein, 25%
carbohydra tes, a nd 40% fa t.

Step 4 : Combine calorie and macronutrient ratio recommendations to find calories from
each macro nutrient, then convert to grams. Fixing her dietary intake at 1,750 kcal, th is
means tha t:

about 6 12 kcal (1750 x 0 .35) should come f rom protein;

about 4 37 kcal (1750 x 0 .25) should come f rom carbohydrates ; and
about 700 kcal (1750 x 0040) should come from fat.

Translated into grams, this me ans your client wrll be eating 153 g of protein (61 2/4 ), 109 g
of carbohydrate (437/ 4), and 77 g of fat (700 /9) .

EXA MPLE 2 : 190 LB MODERATELY ACT IVE MAN

Step 1, Determine somatotype and goals. This man is an ectomorph who is interested in
gaining muscle mass.

Step 2: Calculate his specific dietary needs with the calorie chart (Table 13.7). His
prescribed calorie intake is between 3 ,4 20 (190 Ib x 18) and 3,800 (190 Ib x 20).

Step 3 , Identify macronutrient ratios from macronutrient chart (Table 13.8). His
macronutrient breakdown should be 25% protein, 55% carbohyd rates, and 20% f at.

Step 4: Combine calorie and macronutrient ratio recommendations to find calories from
each macronutrient, then convert to grams. Fixing his dietary inta ke at 3700 kcal,
this means that:

about 925 kcal (3700 x 0.25) should come f rom pro tein;
about 2035 kca l (3700 x 0 .55) should com e from carbo hydrates; and
about 740 kcal (3700 x 0.20) should come from fat.

Transla te d into grams, he will be eating 23 1 g of protein (925/4 ), 508 g of carbohydrate

(2,035 /4), and 82 g of fat (7 40/9) .
346 UNIT 2 Chapter 13 Step 4 PrOV ld ng a Nutl lt,(},) Pia"

Carbohydrate timing table

CARBOH YDR ATE TYPICA L ACT IVITY

TOLERANCE TYPICAL GOA L TYP I CA L BODY TYPE IF AN ATHLETE CARBO HY DRATE TIMING RULES

Exce llent Gain muscle or Ectomo r ph Endurance activity Shou ld include sugary
improve endu rance carbs during/after each
performance exercise sess ion.
Some starchy, whole-grain,
unprocessed carbs can be eaten
at every other meal.

Vegg les and fruits

(3: 1 serving ratio) should be
eaten at each meal.

Mode rate Gain muscle Mesomorph Intermittent Can include sugary carbs only
sport athlete during/after exercise.
Lose fat or improve
sport performance Starchy, whole-grain,
unprocessed carbs can also be
eaten at breakfast and after
exercise. They can be used
in moderation during the res t of
the day.

Veggies and f ru i ts
(4:1 servi ng ratio) should be
eaten at each mea l.

Poo r Lose fat Endomorph Strength and All starchy/sugary carbs should
power athlete be incl uded on ly during/after
exerc ise.

Veggies and fruits (5 : 1 serving

rat io) should be ea t en at each
additional meal.

INDIVIDUALIZATION STEP 3: NUTRIENT TIMING

Nutrient timing is based on the idea that nutrients are ha ndted differentty during various
periods of t he day (which does not necessarity mean "ctock time", but usuatty an association
with activity, such as a tr aining session). For examp le, carbohydrate tolerance is much
improved after exercise; therefore dietary carbohydrates are better utilized during th is period
than at any other time of the day. Table 13.9 outl ines how the principles of nutrient timing
can be used to organ ize carbohydrate intake fo r each body type.
UN IT 2 Chapter 13 Steo J PrOJ ,d ng a Nutl ltlcn Pial 347

These nutrient tim ing rule s help to both regul ate carbohydrate intake based on body
type as we ll as tailor nutrient intake to each body type's hormonal profile. These r ul es, of
course, come into play once the calorie and macronutr ient in format ion above has been
estab li shed and the specific meal layout is being considered . Let's con tinue with ou r
example clients from earl ier.

Example 1: Your 140 Ib, moderately active, endomorphic female client interested
in weight loss wo uld be eating about 1750 kca l per day com ing from 153 g of
protein, 109 g of carbohydrate, and 77 g of fat. And since she's both endomorphic
and trying to lo se fat, you can assume she has poor ca rbohydra te tolerance.
Therefore any starchy andlor sugary carbohydrates she eats sho uld be cons umed
only during the post-exercise per io d. The rest of t he day will include proteins,
healt hy fats , and a vegetable to fru it ra tio of 5: 1.

Example 2: Your 190 Ib, moderately active, ectomorphic male client

interested in weight gain would be eating about 3700 kcal per day coming
from 231 g of protein, 508 g of carbohydrate, and 82 g of fat. And sin ce he's
both ectomorphic and trying to gain muscle, you can assume he has excellent
carbohydrate tolerance. Therefore, his diet shou ld include sugary carbohydrates
during/after each exe rc ise sess ion (more detai l on this to come), some whole-g rain,
unprocessed carbohydrates with eve ry other meal, and a vegetable to
fruit ratio of 3 : 1.

Of course, both clients wi ll also follow the 5 Habits, including eating every two to four hours,
eating protein wit h each meal, eat ing vegetables with each meal, and including good fats
each day.

INDIVIDUALIZATION STEP 4: FROM CALORIES AND PERCENTAGES

TO MENU
After going through all of the specific ca lorie, macronutrient. and nutrient timing charts
prov ided, you may need some practice at generating nutritional suggestions th is way. For
star ters , it requires quite a bit of mat h. And beyond that, it takes some planning to go from
the ca lcula tions to an actua l food-based menu.

Think about our two examples from earlier. Even though we know our client s' weights , body
types, goa ls, calorie intakes , macronutrient breakdowns, and Ideal nutrient timing, and
though we know they will (or shou ld be) following the 5 Habits, it's not always easy to create
proposed menus unless you have some familiarity with the specific calorie and macronutrient
breakdowns of different foods. Without th is familiarity, you'll have to use a USDA -derived
nutrition database, figure out t he calorie and macronutrient breakdowns of the foods you
intend to build into the plan, and ba lance out the meal plan based on the parameters
calcu lated ear lie r.

So let's say, for example, your 140 Ib female client has been assigned to eat 1750 kca l
per day com ing from 153 g of protein , 109 g of ca rbohydrate, and 77 g of fat. With f ive
meals per day (eating every two to four hours), and only one carbohydrate- rich meal (post-
exercise), Table 13.10 provides an example of how th is breaks down .

From here, using the Superfoods Checklist and the USDA nutrient database to determi ne the
calorie and macronutrient intakes of each food choice, you can plan wh ich foods will fit into
each set of meal guidelines above. See Table 13.11 for what t his might lo ok li ke.
348 UN IT 2 Chapter 13 Step 4 Prov iding a Nut ri tion Plan

Suggested nutrient breakdown by meal, 1750 calories daily

MEAL CALORIE INTAKE PROTEIN INTAKE CARBOHYDRATE I NTAKE FAT INTAKE

Breakfast -350 kcal 30 g protein 12 g carbohydrate 20 g fat

Snack - 350 kcal 30 g protein 12 g carbohydrate 20 g fat
Lunch -350 kca J 30 g protein 12 g carbohydrate 20 g fat
Post-exercise snack - 350 kcal 30 g protein 60 g carbohydrate o g fat
Dinner -350 kcal 30 g protein 12 g carbohydrate 20 g fat

Totals -1, 750 kcal 150 g protein 108 g carbohydrate 80 g fat

As you can see, the process is a fairly straightforward step-by-step one, although you'll
likely need to familiarize yourse lf with some software-based nutrition tools or the USDA
nutrient database.

Suggested meal pl an, 1750 calories daily

MEAL CALOR IE AND MACRON UTRIEN T GOALS ACTUAL FOO D INTAKE

Breakfast 350 kca l 3 egg whites

30 g protein 2 whole eggs
12 g carbohydra te 1 piece of cheese
20 g fa t 2 slices of t urkey bacon
2 cups veggies
Snack 350 kcal 2 oz lean turkey
30 g protein 1 piece string cheese
12 g carbohydrate 2 cups veggi es
20 g fat 1 oz mix ed nuts
Lunch 350 kca l 4 oz chicken breast
30 g protein 2 cups veggies
12 g carbohydrate 1 tsp fish oi I
20 g fat 1/2 avocado
Post-exercise snack 350 kcal Post-exercise drink
30 g protein OR
60 g carbohydrate 2 s li ces whole-grain bread
o g fat 1 t bsp honey
1.5 scoops of protein powder in 1 cup skim milk
Dinner 350 kcal 4 oz extra lean meat
30 g protein 2 cups salad
12 g carbohydrate 1 tbsp olive oil dressi ng
20 g fat
UNIT 2 Cha pl er 13 Step 4 Providing a Nut ri t IOn Plan 349

Two great on line resources for this are available here:

The USDA Food Database, www.nal.usda.gov/ fnic/f oodcomp/ searc h
Nutrition Data: www .nutritiondata.com

While th is individualization strategy is more complicated t han most others, it will definitely
help you plan and communicate the precise nutritional intakes of your Level 3 clients who
want to go from good nutrition to great nutrition . However, if at any pO int you feel this
strategy is beyond your ability, you might want to ou tsource the nutriti onal plans of you r
Leve l 3 clients to a sports nutritionist whose nutrition programs will account for food type,
tim ing, and amount for different activity levels and body types . While you'll certa inly be able
to help clients with this level of fine-tuning, and this chapter should help clarify just how
to do so, it's okay if you either don't w ant to get this involved or you feel like this level of
individualization should only be done by the profess ionals. Just decide your comfort level
and outsource the res t.

Special dietary strategies

The three nutritional education strategies mentioned above wi ll all help your clients
improve their overall nutri tional intake. Th e majority of your clients will benefit
tremendously from these strategies and never need to go any deeper into nutritional
manipulation. However, in the course of your career, you may end up working wi th a few
individuals who want to accomplish very lofty physique and/or performance goals. They
may want to step on the competitive bodybuilding or fitn ess stage. They may want to win
an Olympic medal. They may want to win the Boston Marathon . Not only do they want to
accomplish these goals, they're committed to doing so . In these situations, the following
dietary strategies may be usefu l. But remembe r, just as you would guide a training client
slowly through more difficult programming choices, you should guide your nutrition clients
gradually through more complex nutrition behaviors. Trying to teach a brand new exerciser
to perfo rm an Olympic-style clean and jerk on the ir first day in the gym is not only foolish,
it's dangerous. Likewise, applying these strategies to nutritional beginners will likely do
more to lead them ast ray than help t hem achieve their goals. Only use these strategies in
Leve l 3 exercisers who have demonstrated the readiness, aptitude, and commitment to
refi ne their intake patterns furt her.

SPECIAL STRATEGY 1: VERY LOW-CALORIE DIETS VERY LOW -CALORIE

As discussed in the Introduction. very low-calorie diets (VLCDs) can, if used long-terrn, DIETS (VLCDS )
A short-term strategy for
lead to nutrient deficiencies, metabolism reduction, muscle loss , and bone loss. Very
body composition alteration
low-calorie diets followed for long periods of time are not ideal for long-terrn body fat and
bodyweight losses. However, during certain times of the year, certain individuals with
specific goa ls may choose to follow an intelligently designed low-calorie diet for a brief
period of time. These situations a re discussed next.

Weight loss and fat loss ultimately result frorn ac hieving a negative energy balance. Simply put,
a negative energy balance is the result of total calorie expenditure exceed i ng tota l calorie intake .
To ensure that your clien t is in a negative energy balance, you can increase energy expenditure
while keeping calories the same. Alternatively, you can decrease calorie in take while keep ing
energy expenditure the same. For some individuals, however, both strategies have to be
appl ie d. And fo r some individuals pursuing single-digit body fat, both strategies rnay have to be
applied aggressively, leading to very high energy expendit ures 17-10 hours of physica l activity
per week, someti mes more) and very low energy intakes (10 kcal/lb, sometimes less) .
350 UNIT 2 Chapter 13 S!f'P": PIOV ld1f1g a N li tio cr Pla n

Of course, not everyone who wants to get lean has to do what some might call excess
exercise or extreme calorie restriction. In fact, most don't. However, you may have to employ
these strategies for those pursuing extreme leanness who seem to plateau before reaching
their ultimate goals. To determine if a client is one of these individuals, you ' ll have to use
outcome-based strategies, starting with the calorie intakes discussed in the charts in the
previous section and making changes based on your client's response.

Step 1: If a client is not losing fat consistently and plateaus for more than 3 or 4 weeks,
yo u shou ld first be sure that they're exercis in g for 5 to 7 or more hours per week and
adhering to their nutri tion plan. If not, increase their exercise andlor help them with
stra tegies to improve adherence.

Step 2: If they are meeting these two objectives and progress stagnates, decrease calorie intake.

Step 3: If they've done this and progress stagnates again, increase exercise volume again.

Step 4: If they've done this and progress stagnates again, decrease calories again.

Continue to increase exercise and decrease calories until a client's body responds in the
way they want. However, don't follow this approach wi th clients for longer than three or
four months at a time. If cl ients follow this approach for too long, they may lose lean mass
and suHer metabolic decline, making it very hard to accomplish their goals. If they haven't
accomplished their goals within three or four months, make sure that you bring them to
NEUTRAL ENERGY BA LANCE a more neutral energy balance (either decrease exercise or increase food intake). After
When energy intake another three or four months of balancing things out , you can shoot for anothe r lower-calorie
(from food) matches
phase . Further, make sure th at if their ca lor ies do drop below 10 kcal/lb th ey consc ien tiously
energy output (from basal
supplement their diet. Here are some best~practice guidelines;
metabolism and activity)
You may have to decrease feeding frequency to 3 or 4 meals/day as the meals may start
getting too sma ll to manage hunger.
Make sure their vegetab le intake is high.
Get at least 19l1b of dietary protein.
Take a multivitamin.
GRE EN FOO D PRODUCT Use a green food product.
Dietary supplement
Sip a branched-chain amino acid (BCAM drink during exercise and perhaps even
composed of green foods
{hat are rich in nutrients
between meals.
If they have difficulty sleeping, which is common on low-calorie diets, try the following:
Supplement with a zinc-magnesium (ZMA) product before bed.
Add in 300-600 mg of phospha tidylseri ne at dinner and bedtime.
If necessary, add in 200-400 mg of valerian before bed.

Finall y, if a client is considering following a very low-calorie diet, make sure that you use
some of the strategies outlined in the calorie and carbohydrate cycling section that follows.
Cycling both calories and carbohydra tes are important strategies for ensuring fewer negative
effects and more consistent progress while following a very low-calorie diet.

VERY lOW· CARBOHYDRATE SPECIA L STRAT EGY 2: VERY LOW-CARBOH YD RATE DI ETS
DI ET As discussed in the Introduction, very low-carbohydrate diets can, if used long-term, lead to
A short-term strategy for
carbohydrate depletion and poor performance (both physical and mental) . Thus, very low-
body composition afteration
carbohydrate diets followed for long periods of time are not ideal when trying to look, feel, and
perform better. However, during certain times of the year, certa in individuals with specific goals
may choose to follow an intelligently designed low-carbohydrate diet fo r a brief period of time.
UN IT 2 Ch apter 13 Step -1 PrOV ldrm: a Nut' tlO"1 Pial' 351

These situations are discussed next.

There is a critical link between carbohydrate intake, body fat conten t, and blood
concentrations of the hormone insulin. Some carbohydrates are necessary (even for
endomorphs w Ith poor carbohydrate tolerance) and insulin is required for many
physiological functions. However, if carbohydrate intake goes unchecked (espec ially if
these carbohydrates come from high sugar and high starch foods), insulin concentratio ns
in the blood can become chronica lly elevated, w hich leads to increased fat gain and
decreased fat loss. Carbohyd rates are not "evi l", but as a genera l rule, very high dietary
carbohydrate intake and high blood in sulin concentrations frequently hinder body
composition progress.

Indeed, som e individuals h ave fo und that to achieve high leve ls of lean ness, t hey must
dramatically limit their dietary ca rbo h yd rate (and t hus tightly control blood insulin), w hich
can cause the body to effectively shift in to "fat burni ng mode." Th is may lead to rapid body
fat loss and achieving a high level of leanness in short periods of time .

Before discussing how to design a lower-carbohydrate diet intelligently, here's a caveat about
low carbohydrate diets, when it comes to very low -calorie diets, very low-carbohydrate diets,
and very high -carbohyd rate diets, it is essential to keep t he duration short These diets
are essentially imbalanced, and imba lances can lead to physiologica l problems . If you're
conSidering recommending such a diet to a cl ient, you must set a deadline and tra nsition
to more ba lanced eating after this timeline has expi red. If your client is an elite athlete, they
should avoid very low-carbohydrate diets during periods of heavy trai ning and/or competition,
as these diets are not at all suitable to high t raining volumes or intensities . The on ly time
elite athletes shou ld consider very low-carbohydrate diets is during off-season periods of low
training intensity when fat loss is a priority.

Ca l or ie int a ke by bo d ywei g h t

CALOR IE INTAKE", BODYWEIG HT (I N LB ) X 9- 11 KCA L

Bodyweight l 100 LB 150 LB 200 LB 250 LB 300 LB

Calorie intake -1000 kGal -1500 kGal -2000 kGa l -2500 kGal -3000 kGai
(900-11001 (1350-1650) 11800-2200) (2250-2750) (2700-3300)

Note:

1. It a clrent is between these weights, you can simply calculate their needs by multiplying bodyweight by 9-1 1.

Here's how you might put together a very low-carbohydrate diet, beginning with determ ining
calorie intake by bodyweight:

On such a diet, protein sho uld make up between 30 and 35% of daily intake and all of it
should come from whole food sources. Carbohydrates sho uld make up 10 to 15% of intake
and all of it should come from fresh vegetab le sou rces (preferably organic) such as spinach,
broccol i, green beans, asparagus, zu cchini, cauliflower, different colored peppers, carrots,
and tomatoes. Finally, fats should make up 55 to 6 0 % of in ta ke, With a fairly even mixture of
352 UNIT 2 Chapler 13 Step <l Pr ollld in g a Nutli lion Plan

Calorie to macronutrient gram conversion

BOOYWEIGHP CALORIE INTAKE PROTEIN INTAKE CARBOHYDRATE INTAKE FAT INTAKE

100 Ib - 1000 kc, l 75 g 25 g 66 g

150 Ib -1500 kc,l 113 g 38 g 100 g
200lb -2000 kc,l 150 g 50 g 132 g
250lb -2500 kc,l 188 g 63 g 167 g
300lb -3000 kc,l 226 g 76 g 200 g

saturates, po ly unsaturates, and monounsaturates (this means about 33% of total fat coming
from each). Table 13.13 shows how to translate these percentages into grams.

Per-meal totals of calories and macronutrients

BODYWE IGHT I CALORIE INTAKE PROTEIN I NTAKE CARBOHYDRATE INTAKE FAT INTAKE

100Ib 250 kc,l 19 g 7g 17 g

150lb 375 kcal 28 g 109 25 g
200lb 500 kc,l 38g 13 g 33 g
250lb 625 kcal 47 g 16 g 42 g
300lb 750 kc, l 57 g 19 g 50 g

Note :

1. If a clien t is betwee n these weights, simply calculate these numbers based on th e las t chart.

Once calorie, protein, carbohydrate, and fat goals have been established, plan the meal
breakdown. Since calorie intake is low, your client may drop down to four whole-food
meals each day (with calories evenly split), Simply divide the numbers above by four
to get per-meal totals.

Now, does each meal need to be exactly 1/4 of the daily total? No. Just make sure that
you 're splitting food intake up re latively even ly throughout the da y.

This type of dietary strategy is fairly drastic and would only be used in extreme situations
where fat loss is a major priori ty, such as an upcoming physique competition or photo
shoot. Always remember the rules of following such a diet, and repeat them to your client.
UNIT 2 Chapter 13 Step ': PfQv ,dlng a Nuffl (lor: Plan 353

Don't follow the plan for longer than three to four months. Set a nutrition plan
expiry date in advance.
Make sure to use outcome-based nutritional decision making.
Calone balance is still paramount, so if a client is not losing fat, either increase
exercise expenditure or decrease calorie intake.
If a client is considering following a very low-carbohydrate diet, make sure that
you use some of the strateg ies outlined in the carb and calorie cycli ng se ction
(specia l strategy 31 . Ca lor ie and carbohydrate cycling are important strategi es for
ensuring fewer negative effect s and more consistent progress whi le foll owing a very
low-carbohydra te diet.

SPECIAL STRATEGY 3: CARBOHYDRATE AND CALOR IE CYCLING FOR FAT LOSS

When a dieter is following either a low-carbohydrate or a low-calorie diet. these low intakes
of both total energy and carbohydrate energy can reduce metabolic rate, thyroid hormone
output, sympathetic nervous system activity, spontaneous physical activity, reproductive
hormone output (testosterone and estrogen), and more. In other words, following a low-
carbohydrate or low-calorie diet for too long means the fat loss will plateau. Your body is
simply too smart to allow you to diet yourself to death. In an effort 10 keep you alive, it slows
down all processes not required for life.

Then what's a dieter to do if he or she can't out-diet that eve r-persiste nt scient ific
phenomenon of homeostasi s' Fo r starters, he or she can t rick the body by giVing it hi gher
calo rie and ca rbohydrate inta kes frequently eno ugh so that it wo n't ever get to o close CA LORI E CYCLING
Altermg high and low levels
to starvation mode, but infrequ ent ly enough so Ihat fat loss can co nti nue on. That' s
of calorre Intake. which
what calorie and carbohydrate cycling can do during periods of low-energy and low- doesn·t allow the body to
carbohydrate intake. fmd homeostasis

There are many ways to use calorie and carbohydrate cycling to your client's advantage. CARBOHYDRATE CYCLING
Here's a quick overview of some of these strategies: Altering high and low levels
of carbohydrate intake,
INFR EQUENT, BIG RE - FE EDS which doesn't allovi the body
to fmd homeostasis
ThiS type of re-feed usually occurs everyone or two weeks dUring a low-calorie or low-
carbohydrate phase and consists of a single day of eating significantly more carbohydrates
and calories than a client would during their other diet days.

This is the right type of strategy for a client if he or she has fantastic dietary discipline, can
maintain a cons iste nt rate of weig ht loss without pla teau for one or two week s, and can
men tally handle low-carbo hydrate or low-calorie diets w ithout Sign ifican t prob lems. He re are
some tips for structuring this type of re-feed:

Pick out re-feed days for the entire diet period in advance. Schedule them on a calendar
and be sure your client remains committed to their strict plan, knowing there's light at the
end of the tunnel every 7 to 14 days.
Until Ihe re-feed days come, reinforce that your clients must stay the course and follow
the plan with no deviations. After 6 to 13 days in a row of dietary discipline, they will
have earned the re -feed.
On the 7th or 14th day, your client will eat high-calorie foods that they'd never usually eat
while on a low-calorie or low-carbohydrate diet. Even taboo foods like pi zz a, burgers, ice
cream are fair game.
354 UN IT 2 Chapter 13 Step ~ Provldlfl g a N U\II\IOP Plan

Of course, this isn't a license to go hog-wild. In fact, to keep thi ngs in check, here's a
simple rule of thumb . Restrict ca lories to abo ut 3 or 3.5 times t heir daily low-calorie or
low-carbohydrate guideline. Therefore, if they're ea ting 1000 kcal a day, don't allow t hem
to go above 3000-3500 kcal. If they're eating 2000 kcal a day, don't allow
them to go above 6000-7000 kcal. ThiS wil l also help to prevent GI distress that can
occ ur in a dieter not accustomed to la rg er portions or richer foods.
Make sure your clie nt exercises on this day so that all that extra energy will go
toward muscle bu ilding and recovery.
Make sure to use outcome -based decision making. If these re- feeds are wor king,
keep go ing. If not, Iry a different re-feed strategy, such as the ones that follow:

FREQU ENT, MODERATE RE- FEEDS

This type of re-feed usu ally occu rs every three or four days during a low-calorie or
low-carbohydrate phase and consisls of a si ngle day of eating a few more carbohydrales
and calories than your client would eat during their other diet days. Th is is the right
type of strategy for a client if they have fairly poor mental tolerance for low-carbohydrate
or low-calorie diets, stagnate on these types of diels quite quickly, and are ve ry physica lly
active. Here are some tips for structuring this type of re-feed:

Schedule a re-feed every three to four days during a client's low-calorie or

low-carbohydr ate phase.
On these re -feed days, have your client eat a simi lar diet to what they'd normally eat
wh ile adding some high-quality carbohydrates to each meal.
A client's food choices on such a plan will be unli ke those in the previous example.
Their foods during these days should be high-quality, low-glycemic-index high-
carbohydrate foods such as whole grains, fru its, or beans/legumes. Their goal is to
simply get more high-quality food.
A cli ent's total ca lorie intake on these days should be roughly 1. 5 times what Ihey're
eating on their low-calorie or low-carbohydrate plan. Therefore, if they're eating 1000
kcal a day, don't let them go above 1500 kcal. If they're eating 2000 kcal a day, don'llel
them go above 3000 kcal.
Make sure your client exercises on these higher-calor ie and -carbohydrate days so that a ll
that extra energy will go toward muscle bu ilding and recover y.
Make sure to use ou tc ome-based decisio n mak ing . If these re -f eeds are working, keep
gOing. If not, try a different re-feed strategy.
You can use random re -feeds or scheduled ones, based on your knowledge of the c li ent's
body. If they're just slarting out, simply sched ule them every 3 or 4 days and be done
with it. If you know their body we ll, wait un ti l they rea lly need a re-feed . They'll know, as
their body w ill start to flatten out. This means tha t they will feel very low in energy and
will begin to lose muscle fullness.

STRATEG IC CALOR IE CY CLI NG AND CARBOHYD RATE CYC LI NG

These types of re- feeds involve sepa rate ca lorie and carbohydrate re-feeds. You create three
or fo ur different menu plans and the clien t ro tates through them. Table 13.15 shows an
example of what the four menu plans might look like for a relative ly lean, highly dedicated
woman weighing about 125 Ib and interested in rapid fa t loss.
UN IT 2 Chapter 13 S:e;; ~ ::Ir o\ J' n2 J Nut' 111C' rl Plan 355

Sample calorie and ca rbo hyd rate cycling menus for fat loss '

MENU 1 - BASELINE MENU 2 - HIGHER CARBOHYDRATE MENU 3 - HIGHER CARB AND CALORIE MENU 4 - HIGHER CALOR IE

-1000 keal -1250 keal -1500 keal - 1500 keal

150 g protein 150 g protein 150 g protein 150 g protein
33 g carbs 95 g carbs 125 g carbs 33 g carbs
30 g fat 30 g fat 45 g fat 85 g fat

Notes:

1. These recommendations are primari ly for a 125 Ib female interest ed in f at loss. Macronutrient changes from baseline (Menu 1) are
shown in bold and Ita lIcs.

And here 's how these menus might be distributed during the week,

Sample weekly menu distribut ion

MONDAY TUES DAY WEDNESOAY THURSDAY FRIDAY SATURDAY SUNDAY

Menu 1 Menu 1 Menu 4 Menu 2 Menu 1 Menu 1 Menu 3

You' ll notice that this woman's calorie intake fluctuates between 8 and 11 kcal/lb of
bodywe ight. Thus, it's a low-ca lorie, low-carbohydrate diet. However, you ' ll also notice
Ihat the ca lories and carbohydrate intakes vary throughoul the week to keep the body from
adapt ing to too Iowan intake and slowing down the metabol ism. On Monday and Tuesday,
the calor ies and ca rbohydrates are very low. Wednesday brings a much higher-ca lorie menu,
although t he carbohyd rates are still low (the extra calories come from dietary fat). Th is helps
to keep the body in fat-burning mode while preventing starva tion mode. Thu rsday sees a
more modera te calorie in tak e, but carbohydrates are added whi le fats are kept low to signal
certain systems of the body to keep metabo lic ra te high. Next, on Friday and Saturday
we're back to low-calorie and low-carbohydrate intakes . Sunday sees a high-calorie, high-
carbohydrate intake .

Of co urse, this is the most demanding strategy, but it works qu ite we ll for ind ividua ls who
are already fairly lean and in whom the body will fight every las t bit of fat loss. This strategy
keeps the body guess ing with fluctuating calorie and carbohydra te intakes that are fairly
unpredictable. Here are some tips for structu ring th is type of cyc li ng,

Plan at least three types of menus, low-calorie, low -carbohyd ra te days; high -ca lorie,
low -carbohydrate days; high-calorie, high-carbohydra te days; and mid -ca lorie; mid-
carbohydrate days
356 UNIT 2 Ch apter 13 Step 4 Pr ov ldm g a NU \ fl tlon Plan

Cycle these menus depending on how much fat loss is required. The more fat loss is
required, the more lowe r-calorie days are needed. The less fat loss required, the fewer
lower-calorie days are required.
Be sure to cyc le both the calories and the carbohydrates to prevent quick adaptation and
stagnation.
Structure the menu so that the highest-intensity training days correspond with the
highest-calor ie and carbohydrate days.
Make sure to use outcome-based decision making . Judge your strategy by your resul ts.

SPECIAL STRATEGY 4: CARBOHYDRATE AND CALORIE CYCLING FOR

MUSCLE GAIN
The calorie and carbohydrate cyc ling strategies described earl ier can also be used for
muscle gain situations to optimize the muscle:fat gain ratio (i.e. , greater increases in muscle
gain relative to fat gain during overfeeding/muscle building phases). This process is quite
simple and is based on the previously presented charts detailing total calor ie needs and
macronutrient needs for different body types.

To deSign a calorie/carbohydrate cycling strategy for muscle gain , choose your client's activity
level and their musc le gain goal. From there you'll know how many calories your client needs
to eat (16-22 kcal/lb). Next, decide which body type they are and calculate their required
macronutrient split. Finally, develop three menus , one with a lower-carbohydrate intake
(80% of sugges ted), one with the required carbo hyd rate intake (100% of suggested I, and
one wi th a higher-carbohydrate in take (120% of sugges ted).

Let's take, for example, a moderately act ive mesomorphic male weighing 180 Ib who wants
to gain muscle mass. He should begin by determining his calorie intake; in th is case it
would be about 18-20 kcal/lb or 3200-3600 kcal/day. From here he'd use a 30% protein,
40% carbohydrate, 30% fat diet. Assuming he eats 3500 kcal, Ihat's 262 g prote in, 350 g
carbohydrate, and 116 g fat.

Using those numbers, here's what his three menus wou ld look like. Notice how the
carbohydra te cycling also dicta tes calorie cycling. As his carbohydrates fluctuate, so do his
calories. He'd simply rotate through th is menu with menu 1 on day 1, menu 2 on day 2,
menu 3 on day 3, and so on.

Samp le calorie and carbohydrate cyc ling menus for muscle mass ga in'

MENU 1 MENU 2 MENU 3

3,212 kcal 3,500 kcal 3,772 kcal

262 g protein 262 g protein 262 g protein
280 g carbohydrate 350 g carbohydrate 420 g carbohydrate
116 g fat 116g fat 116 g fat

Note :
1. These recommendations ar e for a 180 Ib, moderately act ive mesomorphiC male interested in building muscle mass
UNIT 2 Chapter 13 Step .:l Prov iding a Nut rition Pla n 357

SPECIAL STRATEGY 5: VERY HIGH-CARBOHYDRATE DIETS VERY HIGH-CARBO HYDRATE

DIETS
As discussed in the tnt roduction, very high-carbohydrate diets can, if used tong- term,
A short-term dietary strategy
tead to higher body fat pe rce ntages, chronically high ins utin teve [s, and even poor insulin to be used by athletes in
sens iti vity if high-sugar, high-starch , high-gtycemic-index foods are consumed. Thus , very ca r boh ydrate -depe n den t
high-carbohydrate diets followed for lo ng per iods of t ime are idea l when trying to loo k, sp orts or for body
feel, and perform better. However, during certain times of the year, certa in individuals with composition change

specific goals may choose to fo[ low an inte [[igently designed high-carbohydrate diet for a brief
period of time. These si t uations are discussed next.

Research has demonst ra ted that high [eve ls of muscle and li ver glycoge n (carbohyd rate)
can lead to bette r athletic performance in long-duration endurance compe tit ions (for
examp le, marathon duration or greater). These studies show that long-dur ation ath letes
who increase their dietary carbohydra te intakes leadi ng up to a competition can
supercompensate the ir body carbohydrate supp lies and this extra stored carbo hyd rate
provides a readi ly ava ilable source of musc le energy and blood glucose. This mea ns a
better ab ility to main tain submaxima l exerc ise intensity. [t also prevents the at hlete
from " bo nking. "

Th us, very high-carbohydrate inta kes may be useful for ectomorphic body types who
are training for an impending [ong -duration athletic competition. We define very high-
carbo hyd rate diets here as co ntaining 3.5-5 g of carbohydrate/[b or 70% or more of dietary
energy . For a 150 [b person, th is means 525-750 g of carbohyd rate.

However, this does not mean that very high -carbohydrate diets are good year-rou nd, even
for the ectomorphic endura nce athlete. Indeed, as discussed, to ach ieve this amoun t
of carbohydrate intake, athletes will often need to use high-sugar or highly processed
carbohydrate foods, which can lead to excess fat ga in, a difficu lty in losing fat , poor
carbohydrate tolerance, denta l prob lems, and long- te rm prob lems with in su lin sensitivity.
Fur t her, current research shows that the strategic use of higher-carbohydrate feedings du ri ng
and post -exercise combined with mo re moderate carbohydrate feedings throughout the
rest of the day, can help to increase fat burning while preserving carbohydra te stores, thus
maintaining muscle and liver glycogen concentrations even during intense training periods .
This means that fewer daily carbchydrates can be consumed (closer to 2-3 g carbohydrate/[b

Calorie and macro nu trient intakes for endura nce athletes

During high -vo lum e endurance training periods

CALORIE INTAKE CARBOHYDRATE INTAKE PROTEIN IN TA KE FAT INTAKE

Bodyweight x 20-22 55% of to tal calories 25% of total calories 20% of total calories

3-4 days prior to competition

CALOR IES CARBOHYDRATE INTAKE PROTEIN I NTAKE FAT INTAKE

Bodyweight x 20-22 70% of t otal calories 15% of total calories 15% of total ca lories
358 UNIT 2 Chapter 13 SH ..1 Pr 1 (1 & ,1 N.lf" IICI Pld!1

or 55% of dietary in take), more protein and good fats can be consumed, and the athlete
can achieve better carbohyd rat e, insulin, and body composition management, while sti ll
supporting training.

Higher-carbohydrate intakes of th is nature should thus only be assigned for the 3 or 4 days
leading up to the compe tition. Also recommend that your clients choose more whole-grain,
nutrient-rich, unprocessed carbohydrates rather than sugary, processed selections during
these periods.

And remember, if your clients are not long-distance endurance athletes, despite what you've
heard, this strategy is not for them. In fact, if a client's event is shorter in duration than 90
minutes, the excess muscle glycogen and accompanying water gain (the body holds about
2-3 g of water for every 1 g of glycogen) cou ld harm the ir performance.

Pre-, during-, and post-workout nutrition

Workout nutrition has become a hot topic of late. Substantial data coming out of re searc h
labs all over the wor ld suggest that th e right combination of amino acids, quickly digested
proteins, and/or quickly digested carbohydrates can improve performance, stimulate better
recovery, reduce muscle soreness, improve immune function, increase protein synthesis,
and reduce fat mass.

PERI WO RK OUT NUT RI TION Of course, the precise application of periworkout nutrition depends heavily on a client's
Nutritional choices before. act ivity (duration and intensity), goals, and body type, along with th eir individual tolerance for
during and after workouts specific feedings. Even the goals of their workout nutrition wi ll differ based on the stra tegy they
choose. For example, when training or competing as an athlete, even in strength and power
sports, blood sugar levels can dictate how well an athlete feels during the session. If blood
sugar drops, they'll feel low in energy. If it stays constant, they'll feel like they have adequate
energy. The re for e, the goal of every wo rkout, whether it's in the gym, on the field, or on the
road , is to prevent blood suga r from dropping. There are two strategies for this: the high-
carbohydrate diet. and eati ng ca rb ohydra tes when they 're needed.

High-carbohydrate diet. You can ensure th at a client's muscle and liver glycogen stores
are always topped off by recommending a chronic higher-carbohydrate diet. If you do
this, they'll have so much saved up carbo hydrate that even during long-duration or high-
intensity sessions they'll be able to maintain muscle energy and blood glucose (via the
liver's unique ability to slowly distribute glucose to the blood).
Carbohydrates when they're needed. You can ensure blood sugar management by
recommending dietary carbo hydrate immedia tely before and during exercise to ensure
adequate blood glucose. Rather than using liver stores to provide blood glucose, a
carbohydrate-containing drink sipped during exercise would provide it. With this strategy,
the athlete will be giving the body the carbohydra tes it needs when they're needed, rather
than load ing up on them when they're not.
It's probably no su rprise that many modern nutr ition coaches prefer the second. As
discussed, while chronic high-carbohydrate diets do keep glycogen stores high, excess
fat gain and poo r carbohydrate handling may result in the long run. So , why load up on
carbohydrates all the time, especia ll y when they're not needed, just so that you can have
a few grams of blood sugar available during training and competition? Why not simply eat
a balance of carbohydrates, proteins, and fats (based on body type) outside of the training'
competition period and sip carbohydrate-containing beverages when they're needed?
UNIT 2 Chapter 13 Slep':: Pro'J ,dmg a Nulli llOl'l Plan 359

Eit he r strategy can work , but the question is: Whic h will work better for your clients,
providing all the benefit without the risks' Perhaps only exper imentation will determine that.
However, current evidence from research and coaching practice suggests that you start with
the second strategy and work from there. To make things easier, the following table will help
you decide which strategy is right for your clients to start off with.

Workout-related nutrient ti ming by body type and goal

BODY TYP E GE NERAL GOAL PRE·WORKOU T DURING WO RKOUT POS T·WORKOUT

Ectomorph Muscle gain or 1 P+C drink 1 P+C drink during 1 P+C drink or solid
endurance support immediately before l food meal immediately
after

Mesomorph Physique optimization Eat normally 1-2 1 P+C drink during 1 P+C drink or solid
or intermittent hours prior food meal immediately
sport support after

Endomorph Fat loss or strength Eat normally 1-2 1 P+C drink or BCAA Eat normally 1-2
sport support hours prior drink during hours after

Note: See nellt chapter for a discussion of P+C drinks .

Remember, you can experiment with these strategies. None of them is absolutely set in
stone. Rather, they're guidelines from which to begin.

Competition days
By fa r, t he number one question you'll get from at hletes is t his one: "What do [ eat on
competition day?" Unfortuna te ly, if an athlete waits until a precompetition situa ti on to
decide to follow the best practices of sport nutrition, they've waited too long. Good nutrition
is tra ining nutrition - the food an athlete ea ts day in and day out while preparing for
competition day. On the competition day, they only should have three goals:

1. Do what they' ve practiced. Ath[etes should practice and rehearse their competition-day
routine. Warming up at 10 a.m. and compe ting at 12' Then they should do a trial ru n well
before the competi tion day. Wake at th e same time, eat the same foods, and perform the
same athletic feat. [f they haven't practiced, they're leaving things up to chance. That's a
mistake. On competition day, they need to show up and do what they've practiced.
2. Supply the body with energy for competition . During competition days, an athlete's
primary goal should be to ensure that the nervous system is stimula ted for perfo rmance
and that they have a constant supply of blood glucose to prevent them from bonking.
360 UN IT 2 Chapter 13 Step 4 Prov ldlllg a Nu t ri tion Plan

P+C DRINKS Therefore, the competition feeding strategy IS simple, Eat small , easily digested foods
Drinks composed of protein frequent ly througho ut t he day. Snacking is t he best policy. Ensure snacks contain some
and carbohydrates that can
protein, fats , and most importantly, qua lity carbohydrates. Also , t he ath lete should eat
be used before. during or
fami liar foods - the foo ds that they've been eat ing all along to get them to competitton day.
after tramlng/exercise
Ce rtain sport supplements (even caffeine) can help with nervo us system st imu la tion and
others can help wit h the provision of carbohydrate ene rgy. In fact , liquid nutrition is very
useful fo r sipp ing between events if an athlete is going to have several heats during the
day. Liquid protein + carbohydrate (P+C) drinks best assist in fluid rep lenishment, are
often betier tolerated, and can provide rapidly digested prote in and carbohydrates for
better between - race recovery.

3. Avoid foods that make them uncomfortable. As many ath letes a re hyperstim ulated on
compet ition day, they find it more difficu lt to tolerate large meals or slow ly d igested foods.
They should eat foods that make them feel good , that don't aggravate their slomachs,
and , for most athletes, thai make them fee l "light." During the praclice run suggested,
experiment with d ifferent foods unt il yo u find a ro utine that works wel l for them. Even
foods that aren't part of a "good nu tr ition " plan are acceptable here as long as blood sugar
is managed and t he athlete feels comfor table.

When to discuss nutrition

You may wonder when you shou ld start discussing nutrition w it h your clients. Th is sll ould
usually occur at the end of the initial consu ltat ion appointment (if the re's time) or during a
th i rd sess ion devoted to nutrition education and a c hec k-up . Here's what your appointment
sched u le should look li ke t hus far,

MEETING 1: ASSESSMENT
After a cl ient signs up to work w ith you , give them the necessary forms (described in
Chapter 11) and schedule an assessment meeting. During this meeting, rev iew the
questionnaires to ensure they're complete, gather any additional details you feel may be
missing, and perform the assessments detai led earlier. Once this IS complete, schedule an
initial co ns ultation meeting.

MEETING 2 : INITIAL CONSULTATION

Once you've privately re viewed a ll the information collected In the que st ionnaires and
assessments, identify your client's li miting factors, establish you r coaching priorities , an d
outline yo ur nutritional program objectives (use Chapter 12 to help yo u). During the second
appointment with yo ur client (t he initial consultati on), establish their goals (based on t he
nutritiona l program objectives you outline), sc hedule, and program. If there's time at the end
of this session, you can delve in to nutrition and supp le ment education. If not, save this for
the next sess ion (nutntion education and check-up) .

MEETING 3: NUTRITION EDUCATION AND CHECK-UP

After the assessment and init ia l consultation sessions, each additional session (nut ri tion
educat ion and check-ups) will be designed with three goals in m ind,

1. To share nutrition and supplement educatio n strategies

2. To perform follow-up assessments (see Chapter 15 for details)
3. To consider program design changes
UNIT 2 Chapter 13 Ste p 4 Pro viding a Nut rl \lon Plan 361

At these meetin gs yo u will per form the foll ow- up ass essments (out lined in Ch apter 15 ),
Th ese assessments w il l provide fee dback a nd relev an t metri cs th at should en able you to
make any necess ary progra m adjust me nts (see Chapte r 16 for deta ils). Al so, during t he se
me et i ngs , yo u'll work tho ug h the provided client lesso ns (see Ch apter 1 n

In this chapter l we discussed components of an milk? Well, for starters, he loves the stuff. He'd
optimal nutrit iona l plan that is tailored to client's rather "bu lk up " on th is than any other food. Also,
un ique nutrit ional level. However, we didn't talk a he finds it easier to drink his ca l or i es this way
lot about what's permissible. In other words, once than to try to eat more ca l or i es .
t he nutritional bases are covered , is there any
Most importantly, the strat egy works. When
room left for foods that aren't on the Superfoods
he adds these additiona l 2400 kcal (72 g fat,
list - foods that aren't considered "healthy?" The
360 g carbohydrate, and 96 g protein), this
answer, of course, is: "It depends."
athlete lYpically adds an add itional 5-10 Ib of body
If a person wants rap id fat loss then the diet mass , which he l ps him enter the next competitive
should remain fa irly clean. That's often the best season bigger and stronger than he was during
way to keep calorie intake in check. However, if a the previous competitive season . He monitors his
person needs to gain weight or needs to support health closely, and thus we know that this strategy
high-volume tra ining, then some "discretionary has not yet negatively affected his blood work.
ca lori es" might be warranted . As we teach our
There's another advantage with this approach:
athletes, there are certa in nutritional targets we
If he wants to lose weight or body fat, all he has
need to hit. We want them to get enough dietary
to do is slowly drop the chocolate milk from his
protein, fru its and veggies, fiber, vitamins and
plan. Th is is as simple a weight reduction pl an as
minerals, and healthy fats. Once these dietary
ex ists today. By dropping 1 L from his plan every
goals are met, if they still need more kcal, they
two or three weeks , he can achieve a da ily kca l
can eat what they want. It's all fa ir game as long
reduction of about 800 kcal.
as their blood profi le stays in check and so does
body composition . Of course, the moral of this story isn 't that
choco late milk is the perfect weight gain food.
For example, one of our bobsleigh athletes is
It's that when an individual is training hard and
a 6'4", 245 Ib strength and power machi ne.
meeting their nutritional objectives, addit iona l
He eats six so li d, clean meals a day year-
discretionary ca lories can be included in their
round, in addition to taking a few select dietary
plan, chocolate milk, pizza, cheeseburgers , etc.
supplements, includi ng workout recovery drinks.
Many folks assume that health-consci ous people
This intake helps him support his tra ining and
and hard-training athletes should always avoid
maintain his large muscle mass. However, during
these types of food since they're "unhealthy."
certa in times of the year, he sets the goal of
However, if health and body composition are
ga ining bodyweight, muscle size, and muscle
monitored and the inclusion of these foods has no
strength. During this time, he adds half a litre of
negative i mpact on either, then they can't exact ly
chocolate milk to every meal, thus drinki ng a tota l
be unhea lthy, can they?
of 3 L of chocolate milk every day. W hy chocolate
362 UN IT 2 Chapter 13 Stf:' D i Pro" ldlng a Nl,tfl llcl'1 PI¥ 1

1. There are many ways to ass ist clients in the developmen t of a nu t rition plan
includ ing the USDA Food Pyram id, a Habit-based and Su perfoods approach ,
and a highly individua l ized plan based on body type and nutrient timing.
2. Each method has advantages and disadvantages, and shou ld be applied
appropriately to each client.
a. Levell clients need a simple re -education approach. Keep it basic an d
use either the USDA approach or the Habit-based approach . In some
clients yo u may even have to take it slower, starti ng with si mple strategies,
del ivered one at a tim e.
b. Leve l 2 clients need more specific information on food amount , type, and
timing, so the Habit-based approach may be best for this group .
c. Leve l 3 clients need an even more special ize d approach w ith a h igh level of
individua lization. For this type of clie nt, you can either use the suggesti ons
in this chapter or yo u can re f er the cl ient out to a competent sport
nutritionist. If you fee l that this is beyond your knowledge base , refer the
client to someone who knows exactly what they're doi ng.
3 . Wh ile the three approaches mentioned wil l prod uce great results in most of yo ur
cl ients, a few cl ients will want to achieve lofty physiq ue or competition go al s that
requ ire add itional strat eg i es, such as those discussed in the spec ial strat egies
section of this chapter. You can hand le this yourself; or, if yo u don't understand
these strategi es wel l enough, re fer the cl ient ou t.
4. Never get overzealous in pus hing cl ients to w hat yo u bel ieve is the "next level" of
nutritiona l intake. Just as you wou ld not ask a beg inner to perform the cl ean and
jerk on their first day at the gy m, yo u shouldn't load your clients up w ith advanced
strategies when they bare ly eve n understa nd the bas ics of food prepa ration,
shopping, and food selection.
CHAPTER 14

STEP 5:
NUTRITIONAL
SUPPLEMENT-
ATION
Chapter objectives
Key terms
When to suggest supplements
Essential nutrients
Nonessential nutrients
Supplements in sport
Supplement risks versus rewards
Five staple supplements
Nonessential nutrient supplements
Chapter 14 Summary
KEY TERMS
supplement needs analysis
creatine
beta alanine
peer-reviewed
www.pubmed.com
essential nutrients
nonessential nutrients
part-time supplement user
glutamine
caffeine
tyrosine
green tea extra ct
carnosine
central nervous system (CNS)
International Olympic
Committee (lOC)
nutrient-dense food
Food and Drug
Administration (FDA)
Natural Health Produc ts
Directorate (NHPD)
good manufacturing
practices (GMPs)
UNIT 2 Chapter 14 Slep 5 NU\II \'onal Sup pl ern enia t lOn 365

The topic of nutritional supplements is controversial , to say the [east. Strong nutritional
supplemenl propone nls believe Ihal n ulr ilional supplemenls are necessary for a hea llhy,
energetic life; strong opponents believe that nutritional supplements have little to no value
and are simply promoted In order to make the supplement companies rich. Both views are
overly simplislic. Sure. Ihey make answering supplemenl queslions easy, bullhey prevenl
critical thinking. As a health care practitioner, it's your job to evaluate the evidence and
decide whal is besl for your clients.

When to su ggest suppl ements

Your approach 10 supplemenls should be pragmallc and evidence-based, If you recommend SUPPLEMENT
a nulritional supplement to your clients, it should be based on a strict supplement NEEDS ANALYS IS
Determmatlon of specifIc
needs analysis . Ask yourself the fol lowing questions before choosing to use a nutritional
dIetary supplements needs
supplement.
based on a client's
What are the chan ces that my client's diet is deficient in the essen tial nutrients I current situation

think they should supplement'

If recommending a multivitamin/multiminera[, you should determine whether or not your

client is getting the nutrition they need , such as enough total calories, dietary diversity, and
fruits and vegetables. If they are, you may not need to recommend a vitamin supplement.
If they aren't, you may need to suggest they start supplementing with a multivitamin. The
same goes for prote in supplements, fish oil supplements, greens supp lements, and so on. If
a client's diet lacks Ihese things, fi rst help them improve their base line nutritional plan (see
Chapter 13 for more on this) . Then they won't need the supplement. Yet if they consistently
fail 10 meet certain dieta ry minimums , then you might need to recommend a supplement.

This doesn'l have 10 be an all-or-nothing choice. If a client does well with their diet some
days but not so well on other days, perhaps they can be a part-time supplemenl user. For
example, they mighl take a protein supplement on days Ihal their protein inlake from whole
foods is low; on higher-inlake days, th ey can skip the protein supplement.

Which physiological system do I hope to target with this nutritional supplement'

Does my client need to target that system'

If you're going to recommend a client take creatine , beta alanine , or any other supplement CRE ATI NE
that's not in the essential nutrient category (mo re on th is next), you should know which Nitrogenous substance.
derived from arginIne.
system you hope to affect. For example, creatine targets the ATP-PCr energy syslem and
glycine and methlonme,
ca n also help to increase lean bo dy mass by improvi ng the body 's work capacity. If a client
found m muscle tissue
doesn't need to targel 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 BETA ALANINE
lean mass, and performs high-intensity, ATP-PCr-dependent exercise bouts , creatine may Rate-limltmg precursor of
carnosine which can help to
be a useful supplement for them. If you can'l answer both questions, you likely shouldn't
decrease muscular fatigue
recommend the supplement!

Is there appropriate. peer-reviewed research demonstrating that this supplement

does what manufa cturers claim it can do, without cau sing harm?

Choosing nutritional supplements is laugh. There's so much information available, and

most of it is from parties who may be biased in one direction or another. Therefore, ii's
best to igno re marketing messages and turn to an appropriate body of knowledge to decide
whe ther a supplement is useful and/or safe. This knowledge can include scientific reviews,
366 UNIT 2 Chapler 14 Ste .' 5 N Uir l\I(}I'a S cl p~ I ( rn ' 111101

P EE R·REV IEWED sc hola rly textbooks , and acade mic journals, which are monitored by other rese archers in
Scrutinized and examined by the field (aka peer· re vi ewed ) for accuracy and scientific rigor. You should not depend on
other professionals working
mainst ream magazine or newspaper articles, books published in the popular press, websites,
In a simJlar field or relevant
or anecdotal evide nce (in other words , someo ne else's opinion on "w hat worked for them"),
research area
as the quality of these is not controlled.

WWW. PUBMED . CO M Using the previous creatine example, there are many research reviews on the safety and
World's largest freely efficacy of creatine supplements for certain goals. In fact. one paper indexed at www.
available medical database pubmed .co m (the world's largesl fr eely available medic al database) reviews over 500
research st udies evalua t mg the effects of creatine supplements on muscle physio logy
and/or exercise capacity in healthy, tramed, and various diseased popula ti ons. It also
discusses the 300 studies that have evalua ted the pote ntial performance value of
creatine supplementation. Interestingly about 70% of these studies show statistically
significant positive res ults with creatine supplem entation while 30% show no performance
improvements. Further, safety reviews show that creatine is safe and well tolerated in the
vast majority of the individuals st udied.

In the light of this huge body of literature with overwhelmingly positive re sults for ce rt ain
outcomes (and minimal risk) , it appears fairly safe to assume that crea tine has some value
in certain Situations and poses little to no risk. Unfort unately, not all supplements have
been as well researc hed as creatine , bu t hopefully the point has been made, use objec t ive
means to assess whether a supplement is safe and effective rather than li sten to the un- or
underinformed opinions of media sources, magazines, colleagues, and even some health
care practitioners. These individuals may either offer unequ ivoca l sup port or unequivocal
rejection of supplementa ti on based on an incomplete review of th e available data.

Re t urn ing to the crea t ine examp le, the media have communicated a clear anti-creatine
message for years. Many of t he physic ia ns you enco unter will suggest creatine is ineffecti ve
and harmful Without having read any of the scie nt ific literature on the subject. This is a
problem. The on ly way to combat it is to do your own read ing and educate yourself.

Of course, reviewi ng the scienti fic literatu re may be hard er to do if you're not train ed in
research methods. In this case, you can start by fam iliarizing yourself with using www.
pubmed.com to search for nutritional supp lement studies and reviews. And if you ever get
to the point where you fee l li ke you' re in ove r your head, turn to an in for med and t rusted
practitioner in yo ur health care network who specia lizes in the area in question (in othe r
words, a nutritionist can help you interpret a study on vitamin D; a biomechanicist can help
you interpret a study on compressive forces during the squat, etc.). This individual may be
able to help you eva lua te the research. Yel, in the end, you have to be responsible for your
ESSE NTIAL NUTR I ENTS own clients and the recommendations you give them.
Nutrients present in food
that are needed for normal There are two major catego r ies of nutritional supplements: essential nutrients and
physiological functioning none ssential nutrient s. They are each discussed next.

NONESSE NTI AL NUTR IE NTS Essential nutrients

Nutrients that either the
body can make itself. Esse nt ial nulrients are nu tri enls, present in food , that we need for normal physiological
assummg adequate
functioning. Th e defining characterislic of the essential nutrient category is that t hese
nutritional intake, or
nutrients that aren't
nutrients must be ingested, since the body doesn't have the capacity to make them itse lf.
needed for normal Essent ial nutrients include proteins/amino acids, essen ti al fatty acids, vitamins, and
physIOlogical functioning minerals. Ph ytochemicals/phytonu tri en ts may also fall in to this ca tegory as these plant-based
UNIT 2 Chapter 14 Step 5 N,w .t on al Supp eme l'ta llor 367

nutrients playa host of important physiological roles in optimizing physiological function and
reducing disease risk.

Since essential nutrients are present in food, essential nutrient supplemen ts are not
technically "needed." However, many individuals do fall short with their in take of protein,
essential fatty acids, vitam in s, minerals, and phytonutrients. For example, 50% of
hospitalized patients in urban areas show signs of malnutrition. Further, other studies
have shown that 42% of patients rece iving hip replacements and between 40 and 85% of
nurs in g home residents are malnourished. In addition to these special populations of elderly
and hospita li zed pa tients, marginal vitamin and mineral intakes as weI ! as clinical signs of
malnutrition are also present in healthy active and athletic populations. Indeed, although
many believe that malnutrition has been eliminated in North America, a significant portion of
the population suffers from low intake of essential nutrients.

In the case of clients low in essential nutrients, your priority should be to help them improve
their whole-food intake of these nut ri en ts, and the 5 Habits outlined in Chapter 13 should
help with this. Yet in some cases your clien ts may stil l fall short. For example, despite your
urging, some clients, due to food aversions, may eat too little protein, too fe w fruits and
vegetables, or too litt le fat. Other clients who travel often may have difficulty finding nutrient-
dense, whole-food choices when on th e road. In these cases, essen tial supplements may
help. Regardless of whether a client travels often, has dietary aversions, restricts calories
due to a specific body composition goal , fails to plan th eir intake properly, or has a hectic
sc hedule and forge ts to eat/skips meals, essentia l nutrient deficiencies can develop in
otherwise healthy popu lations. And although the clien t might not "need" essential nutrient
suppl emen ts (i.e., they can ge t all the nutrients they need fr om food), if they're falling short
with their food in tak e, practically speaking, they do "need" essential nutrient supplements.
Begin by spending some ti me with them to develop better food selection and/or preparation
strategies. If this doesn't work, you might refer them out to a trusted nutritionist in your
network. If neither strategy works , it may be time to introduce essential nutrient supplemen ts.
PAR T-TIME
Essential nutrients don't ha ve to be an all-or-noth ing consider at ion. If yo ur clients do SUP PLEMENT USER
Someone who uses dietary
well 80% of the time, perhaps they'll only need essential nutrient supplements the other
supplements on certain
20% of t he time. And if they do well only 20% of the tim e, they' ll need essential nutrient
days when they might
supplements the other 80% of t he time. Clients with on ly part-time needs can keep some not be meeting minimal
supplemental prote in, some supplemental greens, a multivitamin/multimineral, and an requirements from food
essential fatty acid supplement around in the cupboa rd for hectic days, Iravel days, or other
days when nutritional inta ke may be poor. GLUTA MI NE
Condi tion ally essen tial
amino acid that is abundant
In musc le tissue
Nonessential nutrients
CA FFEI NE
Nonessential nutrients are food-based nutnents that either the body can make itself,
A xanthine deflvatlve that
assuming adequate nutritional intake, or nutrients th at aren't needed fo r normal physiological can stimulate the central
functioning. Because of this broad definition, there are far more nutritional supplements that nervous system
fit into this category than the essen tial nutrient category.
TYROS INE
When it comes to supplement at ion, these types of nonessential nutr ients, such as crea tine, A non-essential amino aCid
glutamine, beta alanine, caffeine, tyrosine , and green t ea extract and ot he r fat burners, are
GREEN TEA EXT RAC T
much lower on the nutritional priority list. So why are they so popu lar' Well , first, beca use
Derived from green tea {eaves ,
the supplement industry does a good job of marketing them. And second, because some
contains high levels of EGCG .
of them produce positive benefits when used specifically to target a physiological system in a compound that may playa
need of enhancement. role in disease pre ven tion
368 UNIT 2 Chapter 14 Step 5 Nutri tiona l Supplementation

For example:

Creatine IS useful when the ATP-PCr syslem IS regula r ly being challenged through high-
intensity exerCise. By helping to replenish stores of phosphocreatine, this system can support
a higher work ou tput during high-intensity training, leading to a 5upeHraining effect. New
research is also showing that enhanced PCr stores in the brain can help improve cognitive
function by providing the brain with enhanced substrate for AT P-PCr energy generation.
These are all important be nefits. However. if there's no reason 10 target the ATP - PCr system
in a part icular client, creatine may not be an approp riate supplement for t he m.

CARNOSINE Beta alanine increases cellular carnosine levels. Carnosine targets intracellular buffering
Dipeptide found primarily mechanisms, reducing acid accumulatton during exercise. Therefore, if your client engages in
In muscle that can help to
exercise that causes slgmficant alterations in cellular pH and high amounts of lactate in the blood,
decrease muscular fatigue
beta alanine may improve performance and therefore lead to increased training adaptations.

CENTRAL NERVOUS Caffeine provides another useful example as, in the right dose, it increases alertness and
SYSTEM (C NS) enhances react ion ti me. Therefore, if a client need s to improve central nervous system
The portion of the nervous
(CNS) function for a specific sport task or activity, caffeine may be a useful supplement.
system made up of the bralfl
and spmal cord This section won't discuss every nutritional supplement on the market and its value in your
practice. That would take a whole book, if not several additional volumes. Instead, the goal is
to highlight the fact that nonessential nutritional supplemenls promise consume rs all sorts of
benefits. Rather than focusing on these benefits, investigate the mechanisms by which Ihese
supplements work. By understanding these, you can better determine whether your clients
actually need to target the specific systems on wh ich the proposed supplements act. If so,
perhaps you can give the supplement a try (assuming it's got an accep tab le sa fety profile). If
not, then the supplement should likely be left alone.

Supplements in sport
INTERNAT IONAL OLYMPIC As some of your cl ients may be compe titive at hlete s, It'S Important to di sc uss t he implications
COMMITTEE (lOC) of supp leme nt use for spor t. In 2003, t he tnternational Olympic Committee (I0C) re leased
A group. based in
a position paper discussing sports nutrition as well as supplements in sport (available at
SwItZerland. that organizes
www.olympic.org), in which they conclude the followinw
the modern OlympIC games
The amount, composition and t iming of food intake can profoundly affect sporls
performance. Good nutritional practice will help athletes train hard, recov er quickly
and adapt more effectively with less risk of illness and injury.

Th e righl diet will hel p ath letes achieve an optimum body size and body
composition to achieve greater success in their sport.

Fu rther, when il comes to supplements, they state,

Athletes are cautioned against the indiscrimina te use of dietary supplements.

Supplements that provide essenlial nutrients may be of help where food intake or
food choices are restr icted, but this approach to achieving adequate nutrient intake is
normally on ly a sho rt-te rm option ... Athletes contemplati ng the use of supp lements
and sports foods should consider their efficacy, their cost, the risk to hea lth and
performance, and the potential for a positive doping ou tcome .

Even the highly conservati ve IOC is clear that the right nutritional intake can improve body
size and composition. training, recovery, and adaptation, as well as reduce the risk of illness
UN IT 2 Chapter 14 St<: r:: 5 NJt' I:lo rt al SuoplemEfl latlO'1 369

and injury. And they also contend that if an athlete doesn't have access to an adequate and NUTRIENT· DENSE FOOD
nutrient-dense food supply (due to travel, poor preparation, food aversions, etc), essential Foods that provide
nu trient supplements may be helpful. substantial amounts of
nutnen(s with only the
necessary calori es

Supplement risks versus rewards

As the previous example may suggest, while many consumers believe that if a product is FOOD AND DRUG
on the mar ket, it must be okay to use, that isn't always the case . With supplements, for ADMIN I STRATION (FDA)

example, it's important to know that the Food and Drug Administration (FDA) does not test United States government
agency that enforces laws
the effectiveness, safety, or purity of nutritional supplements in the United States. Indeed,
on the manufacturmg,
here's a quote from their website (www. fda.gov), testing, and use of drugs
and medical devices;
The FDA does not analyze supplement products before they are sold to consumers.
does not regulate dietary
The manufacturer is responsible for ensuring that the ingredient list is accurate and
supplements
that the ingredients are safe. They are also required to make sure that the content
matches the amount declared on the label. FDA does not have adequate resources
to analyze dietary products sent by consumers who want to know their content.
Instead , consumers may contact t he manufact urer or a commercial laboratory.

In the United States, there is no consumer advocate group making sure that nutritional
supplements are pure, safe, and effective. As stated above, the FDA leaves this in the hands
of the ma nu facturer. In other words, 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.

On the other hand , in other countries like Canada, stricter regulations are in place. Before NATURAL HEALTH
any supplement is producec/marketed, this product has to be cleared by the Natural Health PRODUCTS DIRECTORAT E
(NHPD)
Products Directorate (NHPD). The NHPD ensures that each supplement company and
A diVIsion of the Health
manufactu rer has a proper license, that each manufacturer follows good manufacturing
Products and Food
practices (GMPs), that there is thorough adverse event reporting, that clinical trials support branch of Heafth Canada
claims and safety, and that standard labeling conventions are used. This means that that is responsibfe for
supplements coming out of Canada are more likely to be labeled properly, safe, and effective. implementation of the
(Although when it comes to athletes, it doesn't necessari ly ensure that supplemen ts are natura' health product
regulations, including good
free of banned substances. After all, some IOC -banned substances are perfectly legal in
manufacturing practices,
nonathlete populations.)
for natural health produc ts
Thus, if one of your clients needs/wan ts to supplement with either essential nutrients missing fo r sale in Canada

from their d iet or nonessential nutrients designed to target a specific physiological system, it 's
best to follow t hese strateg ies to improve the reward / risk profile, GOOD MANUFACTURING
PRACTICES (GMPs)
If you're working with an athlete, be sure that the supplement you're recommending isn't on A recognized term used
a bannec substance list. ThiS list can be found at www.wada-ama.org. worldwide regarding the
control and management of
Be sure that the supplements/foods you recommend don't have any interactions with manufacturing and quality
any medicat ions/drugs your client is tak ing. The pharmaceutical company Merck has a control testing of foods,
comprehensive listing of dietary supplement- and food-drug interact ions in their online Merck pharmaceutical products.
Manual of Medical Information (Home Edition) (w.w.w .merck.com/mmhe). and medical devices

Choose a larger company t hat's bee n doing business for quite some time, that provides
certificates of analysis, and that is cert ified by a t hird party. The NSF, located at www.
nsf.org, has begun a third -party certification / test ing program, yet as of 2009 , it's still in
its infancy and very few supplements have been tested. Another organiza t ion, HFL Sport
370 UNIT 2 Chapter 14 Step 5 Nufl lliOq a! Su pp:em en ta tlon

Sc ience, is also conducting testi ng out of the UK and, although their standards aren 't qUite
as rigid as the NSF standards, they ha ve a much larger database of tested supplements.
They can be found at www.hfl.co.uk. Anothe r option is to visit www.consumerlab.com.
This comprehensive website is devoted to reviewing purity and label claims for a variety of
nutritional supp lements on the market today.

Choose supplements that only have a few ingredients. If you're look ing 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.

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 dea l with the
manufacturing company. Th is way you can get exactly what you want for your clients/
athletes and you can red uce your ri sks of being exposed to a banned substan ce or impure
product. (Note, howeve r, that manufacturing companies will not work with yo u unl ess you're
coming with a very la rge order. So don't go to them for 50 Ib of protein; they won 't eve n ta lk
to you unless you come with an ord er of 500 lb.)

As you can see, supplementation offers some rea l risks and challenges. Thus before making
wholesale supplemen t recommendations, you need to be educated. If you're not interested in
doing all this homework, that's fine. After all , as we note, supp lements are often unnecessary
if t he diet is appropriately developed and a client's adherence to It is good. Yet if you believe
your clien t is falling short and/or would benefit from targeted supplementation, you may want
to refer to someone in your health care network.

Five staple supplements

Although no supplements are absolutely essentia l, borderline-low in takes of calories,
macronutrien ts, and mi cronu trients are more common than yo u th ink - even in your hea lthy,
active cl ients. In such cases, your first line of defense will be to help the client im prove their fooc
in take , or in difficult cases, to refer your cl ients ou t to a nut rition ist who has more experience in
this area . In eithe r situation , conside r suggesting some essential nut rient supplement options .
Again, using essential nu trient supplements isn't an al l-or-nothing quest io n. Your clien ts will
have "good" and "bad" nutrition days. And on "gooc" nutrition days, the cl ient may sk ip the
supplements while on "ba d" nutrition days they might add a few in . To ensure that this option
is always available, a great essential nutrient strategy would be to have a client pick up the five
staple supplements and keep them on hand for the "bad days" (see Table 14.1).

Nonessential nutrient supplements

Beyond the supp lements just discussed, there are a host of nonessentia l nu tr ient
supplements that may benefit you r clients in certain situations. Again, before recom mending
these particular nutrients , remember you r pr ior ities: First . ensure that the cli ent's exercise
and eating plans are well des igned and that thei r adherence is high. Next, ensure that
any supplement suggestions you offer are based on understanding the systems you wish
to target. Table 14.2 offers a short list of supp le ments that may be usefu l, assum ing the
conditions discussed here are in place. Some of the competition-specific supplements are
only signif ica ntly effective for com petitive athletes at high levels of sport. They are unlikely to
make a difference for recreational exercisers .
371

Essential nutrient supplements for reg ular and occasional use

SUPP LEMENT TYPE AND DES CRIPTION FOOD EQU IVALENT NOTES ON USE

Protein supplement Any complete prote in Use w he n a w hole-food prote in cho ice is
source includi ng lea n recommended but inaccessible.
Preferab ly a milk prote in blend;
meat. lean dairy, egg
although egg, ric e, or so y pro te in Freque nc y depends on w ho le food protein intake:
w hi tes , etc.
supplements wi ll work if prote in needs are met w i th whole food protein ,
supp lement use will be In frequent; if protein needs
are no t met, supplement use wil l be mo re f requen t.

Fish oil supplement Fa tty fish such as Much of the ava ilable whole-food f ish supply
salmon , anc hovy, or contains environmental pollutants. As a resu lt, fis h al l
High omega -3 content; shou ld
sa rdine supp lements should likely be taken every day whi le
conta in at least 30% EPA and
you r Clients red uce the ir fis h intake to "occas ion al. "
OHA
Take wi th meals, daily; recommended dose is 2-3 g of
total omega-3 ri ch fish oil pe r day. Clients can take in
liqUid or capsu le format.

Greens supplement Vegeta bles, f rui ts Use whe n a vegetable or fruit choice is recommended
but Inaccessible.
Green food blend high in
antioxida nts, strongly alkal ine, Freque ncy depends on fru it and vegetable in take: if
and vitamin/ minera i rich vegetable and fruit intake is high (up to 10 servings!
day), supplement use will be in frequent ; If vegetable
and fr Ui t Intake is low, sup plement use will be more
frequent.

Multivitamin and multimineral Varied diet As many North Ame ric ans are margina lly deficient
in severa l mic ro nutr lents, unless a Client is very
conscientious about their diet, mul tivitami ns and
mu ltimlnera ls shou ld be taken every day.

Take with meals, da il y, on days whe re dietary intake

IS poor.

Protein-carbohydrate (P + C) drink Any prote ln - and To be used dU ri ng all high-inte nsity exerc ise sess io ns
ca rbo hydrate-rich food when muscle stre ngth inc re ases and size increases,
Shou ld contain a mixture of quic kly
as we ll as athlet ic pe rfor ma nce in creases, are desired .
digested, we ll -tole rate d pro te in
and carbohyd rat e In a ratio of 2:1 Use during wo rkouts on ly.
or 3: 1 carbs :proteln

Branched·chain amino acids Any prote in-rich food DU ri ng al l high-intensity exercise sess ions when f at
(BCAAs) loss and muscle/performance preservation is desi red .

Shou ld contain the 3 BCAAs Use dUring workouts on ly.

le ucine, isole uc ine, and va lin e
372 UNIT 2 Chapter 14 Sl ep 5 Nut ri tional Supplem en tation

Non-essential nutrient supplements for regular and occasional use

FREQU ENCY
PURPOSE SUPPLEMENT AND TIM ING DOSE NOTES

To improve insulin sens itivity r-Alpha lipoIc acid Da lly 100 mg Be sure to choose the "r"
and red uce insul in response form as non-r forms are
to meals in those with poor 3 times per day less effec tiv e.
carbohydrate tolerance and
fat loss goals

To help reduce eNS fatigue Tyrosine and Daily durmg hlgh- 2,000- These can be taken before
and/or symptoms of phosphatidylcho lm€ volume training 3,000 mg trammg to enhance neural
sympathetic nervous sys tem phases tyrosine drive as well, bu t do not
overreaching dU ring high- exceed the recomme nd ed
intensity and/or high-volume Ta ke n post-exercise 1,000 mg dose.
exe rcise phases choline

To improve eNS output Caffeine Prior to athletic 250-500 mg Some athletes do not
prior to competiti on events only tolerate caffeine well,
SO a trial run outside
Within 60 min of competit ion should
before competition be conduc ted to assess
tolerance.

To buffer hydrogen ions Sodium bicarbonate, 60·90 minutes 20-30 g Some athletes do not
and acidity during hlgh- sodium citrate pnor to events Ihat In I L water tolerate either supplement
laclate activity produce high tactate well. so a trial run outside
concentrations of competition should
be conducted to assess
tolerance.

To buffer hydrogen Ions Beta alanine Daily during periods 1,000 mg At thi S dose . beta alan in e
and acidity dUring high- of high lactate may cause "flushing"
lacta te acttvity traming (tIngling) of the skin . This
is not harmful.
3 times per day

To help regenerate ATP Creat ine Daily during periods 5.000 mg Load ing doses higher
during ATP-PCr-dependenl of high-intensity than 5 g daily are not
strength and power activity st rength/power necessary.
training

To stimulate the metabolism Green tea extract Daily during fat loss 400 mg Ensure the green
during weight loss phases periods tea extract IS high In

EGCG. the most active

1 to 2 times daily component.

To st i mula te the me tabol ism , CLA Daily du ri ng fat loss 2.5-5 g Can be taken in a sin gle
mduce apoptosis of fat cells, periods dose or diVided doses.
and down-regulate leptin
during weight loss phases
UNIT 2 I Chapter 14 Step 5 NUlJ ll lonal Supplemenlahon 373

In this chapter we discussed the use of nutritional Added to the well-known menopausal-related sleep
supplements in two possible scenarios: if you believe disturbances, th is means poor quality sleep and
a client may be missing out on ce rtain essential a downward stress spiral. Less sleep means more
nutrients; and/or if you believe a client might need stress, And more stress means less sleep.
to target a specific physiological system to improve
In this context, weight gain appears. When folks
their health or performance , Do a needs analysis to
don't sleep properly, they end up eating more
determi ne whether either of these is the case.
during the day, particularly more processed/sugary
A great example of this principle in action came carbohydrates. During stressful periods, folks typically
up when a 58-year-old woman approached me to miss out on meals because they're busy and because
he lp her lose weight. She was 5'6" and 180 Ib at their hormonal status blunts hunger. However,
30% body fat. She wanted to get into better shape unfortunate ly, because they skip meals during the
while reducing her hot flashes (a sy mptom of the day, they end up binge ing at night - again, on high -
menopausal per iod), sugar/ processed foods .

After a comprehensive assessment , I determ ined Although exercise and good nutritional choices
that she was a Leve ll client. She'd never been generally im prove sleep quality and hunger, when
involved in purposeful exercise and never followed there's a strong negative energy balance and a host
anything but the typi cal North American diet. of other stressors, sleep problems and poor eat ing
Based on the ideas shared so far in this unit, we habits can arise.
started her out slowly, building up her exercise
Many factors are involved in sleep, Not every client
tolerance and reshaping her food choices. Over
who isn't sleeping properly is necessarily stressed
time, she made some fantastic improvements and
out and high in cortisol. I only treat a sleep problem
lost nearly 30 Ib, while controlling her hot flashes
like a cortisol problem if the evidence strongly paints
and improving nearly every blood mea sure.
to cortisol as the cause , or if the client has a 24-h
Eager to improve even furthe r, she wanted to increase cortisol test or an evening salivary cortiso l test that
her exercise volume , reduc e her ca lories , and get comes back high. If I feel that high cortisol levels are
even leaner. She had a friend who had sta rted indeed causing problems, I address it as follows:
competing in figure contests and she wonde red if she
Include parasympathetic activities such as
could do the same, So we slowly added exercise and
meditation, meditative yoga, low-intensity
reduced calories. Although she was progressing well,
cardio activity, etc. These reduce heart rate,
during this time she decided to change careers. With
cortisol, and epinephr ine and norepinephrine
the intense exercise program, strict diet, and lifestyle
concentrations in the body. They also decrease
stress associated with her career choices, she began
feelings of being "stressed out",
to have problems sleeping and was bare ly able to get
three or four hours of restless sleep per night. At this Supplement with phosphatidylserine, a targeted
point she started gaining weight back . nutritional supplement that reduces evening cortisol.
This helps high cortisol folks get to sleep. It also
After a few weeks of this, I guessed that she might
helps cut down on bin ges and carb cravings,
be experiencing high levels of the stress hormone
cortisol. During periods of negati ve energy balance, Make sure they 're eating a healthy mea l every three
cortisol tends to rise. Add in lifesty le stressors such to four hours , which red uces bingei ng behaviors .
as a cha nge in career and it can rise to the pOint that
When my client started fo ll owing these steps, she
it disrupts normal functioning. Indeed, high evening
started sleeping better and her body composition
cortisol levels can reduce sleep quality and duration .
improved. However, because she was still in a
374

negative energy balance, she still wasn't back to This case study provides an example of how
normal. It was only once we reduced the negat ive nutritiona l supp leme nts can and should be used.
energy balance that she was able t o get eight full Rather than ju st throw in g the m into a person's diet
hours of restful slee p eve ry night. because you heard they'd help, you should on ly
use t hem when it's clear that they're needed.

1. Supp le ment use is a controversial topic with ve hement proponents and opponents.
As a practitioner, you should never become too pro- or anti-supplement since
different supplements have different uses and merits. Keep an open, critical mind .
2. When considering reco mme nd ing a supplement to a client, you shou ld ask
yourself the following questions, wh ich will inform your decisio n about whether to
recommend a giv en nutritional supp lement:
• What are the chances that my client's diet is deficient in the essential nutrients
I think t hey should supplement?
• Wh ic h physiological syst em do I hope to ta rget with th is nutritional
supplement? An d does my cl ien t need that ?
• What objective, peer- re viewed researc h demonstra tes that this supplement
does w hat manu facturers say it ca n do - wit hout causing harm?
3. Supplements can be split into two categories: essentia l nutrients and nonessen tial
nutrients. Essential nutrient supplements should be taken when food intake, for
whatever reason, is lim ited or un availab le . Nonessent ia l nutrient supplements may be
taken if there is a specif ic physiological syst em that needs to be targeted/optimized.
4. Various supplements present specific risks, from the possibility of a banned test for
athletes, to a lack of stan dard iza tion or quality in manufacturing. Be cautious wit h
your reco mmendations, and suggest only reputable companies.
5. The re are fi ve stap le essen ti al nutrient supplements that your cli ents may wish to
keep on hand in case they' re missi ng specific nutrients: Protei n, Fis h oil, Greens,
Mu ltiv itam in/ multimi ne ral, Workout d ri nks (P+C or BCAA)
6. Additiona l non essenti al nutrients can playa specific ro le in certa in situations
although focus on th ese supplements may shift a client's focus away from what's
most important: consistent, intell igent exerc ise and consistent, optimal nutrition.
CHAPTER 15

ST EP 6:
SETTING
BEHAVIOR
GOALS &
MON ITORI NG
Chapter objectives
Key terms
Set goals and manage expectations
Establishing behavior goals
Compliance and adherence
The assessments
Bi -weekly Client Report
Follow-up progress assessments
Chapter 15 Summary
KEY TERMS
goal-setting
expectation management
outcome goals
behavior goals
limiting factors
compliance/adherence
monitoring
adherence chart
bi-weekly client report
UN IT 2 I Chapter 15 Step 6 Settmg Be haV iour Goals & Monltofl ng 377

At this point in t he coaching process, you shou ld have accomplished the following,

Collecte d preliminary client information

Evaluated this information and exp lained Ihe res ulls to your client
Developed a coaching stra tegy
Established what your cl ient's limiting factors are
Developed a nutrition and supptement plan specific to your client's needs

Fo r some nutrition coaches, this is the end of the road. They simply hand their clien ts a
food plan and that's it. However in this course, the food plan represents the beginning of t he
relationship, not the end. Once you've considered the nutrition and supplement strategies
necessary for your client , you stil l have some work to do: Now it's time to establish realistic GOAL-SETT ING
goal sets with your clients so that when they leave t he initial cons ullation meeting they Pro cess of coach and clie nt
understand where they're headed, and what steps they need to take to get to this desti na tion. deciding on objecti ve

Of course, along with goal-setting comes expectation management. Your clients have to
know what your expectations of them should be and vice versa. They also have to know EXPECTATION
MANAGEMENT
what kind of progress to expect. And once you 've determined realistic expectations, you must
Clients' accurate anticipation
establish monitoring st ra tegies and follow- up meetings. Think of these as "check-ups". We and understanding of
recommend that these check-ups occur every two weeks throughout the coach ing process. realistiC progress, as well as
Therefore, your schedule up to this point and beyond will likely look like this, their coa c h's expectations
of them

7 days 7 days 7 days 7 days

~
Appointment 1 ~'m'" 2~r:A:-P-",c'-;"'-'m-'-C"'-:~:--'
Initial assessment Initial co nsultation Check·up # 1
/-A-pp-, c'int--m-,,-,-' -+---
Check·up #2+
Day 7: Time Ih O~J IA: 11m" Itl Day 21, Time 1h Day 28. Tim e Ih
Client brings in Client infOl'm3tion Follow-up Follow-up
questionnaires and e~plaiMd, goal~ ~~t, assessments, assessmenls,
initial assessments initial behavIours nutrition lesSOlls, lessons, and
are collected pre~~nt~d and troubleshooting troubleshooting

--------~~================>
This chapter di sc usses goal-setting and fo llow-up assessment. At the end, you'll walk away FIGURE 15 .1
with specific assessments to perform throughout t he coaching process. TYPICAL CLIENT SCHEDULE

Set goals and manage expectations

Most clients will come to you with goals. Yet , as we describe in Chapter 10, these goals are
often ill-formed. Fo r examp le, a client who just says, "1 want to lose weight" without adding
anything more specific is more likely to fail tha n to succeed. You need to help your clients
establis h more concrete, directional goals. The goa ls that you and your clients generate
should be all of the following:

Written down
Specific and measurable
On a deadline
Rea li stic
Inspiring and personally significant
3 78 UN IT 2 Cha pter 15 StfP 6 S(': l ng Beil aV IGlJ' Goa ls & Mc n l~ o r h l g

DEFINING GOALS AND EXPECTATIONS: A SAMPLE SCRIPT

To prod uce t hese goals, here are a few open-ended questions and statements that you can use
to discuss objectives with your cl ient during the in it ia l consultation session. In this case, we'll
use the example of a client interested in weight loss, because it is the most common outcome
goal you'll address. However, you can have very similar discussions relative to increasing
muscl e mass, improving hea lth markers, and any other possible goal. Hopefully this dialogue
will help your clients get focused and will help you direct their goals and expectations.

"What is your main outcome goal' In other words, what do you wish to accomplish
with your exercise and nutrition program?"

"Let's get more specific. To achieve your 'dream goal ', what exactly do you want to
lose and how much of it?"

"I 'd like to break that down a bit further. A 40 pound (or other number of pounds)
fat loss would take about one to two years (or however long) to accomplish. So ,
knowing this, we can expect that if you're really dedicated, you'll lose eight pounds
in the next eight weeks. Does this work for you'"

"Keep in mind that you might not lose eight pounds of scale weight. In this case,
we're discussing fat weight here. As this new program will likely bui ld lean weigh t
(muscle st reng th, bone st reng t h), you may gain some lean weight while losing fat
we ight. Th is means your weight on the bathroom scale might not change in the way
you assume . I just wanted to explain t his that so that you know what to expect."

"Finally, I' d li ke to ask you one more thing. How motivated by this goal are you' In
other words, during events like summer barbecues, birthdays . weddings, and other
social outings, you'll be tempted by foods not on your healthy eating menu. Also,
when you get busy at work or with your family you'll be tempted to skip workouts.
If losing eight pounds in eight weeks isn't important to you, you'll break your plan.
So, what can you think of that really gets you motivated to lose the first eight
pounds of fat in eight weeks'"

"OK, now that you've found your motivation, let's write down your goal and keep it
in your file."

"At this point [putting written goal away], you should forget about this goal. Put
it ou t of your mind. You see , from now on, I'll be the one who focuses on this
ou tcome and accepts responsibility for you accomplishing it. After all, you can't
think your way to an eight-pound fat loss in eight weeks . You need a good exercise
and nutrition plan. Those things are my responsib ility now."

"Your responsib ility now is to focus on the behavior goals we're about to establish.
These are things you do have control over. If you follow the behavior goals we
establish (and my programs are good) we can be confident that you'll reach the
ou tcomes we just talked about."

As you can see, these questions and statements are in place to direct a client from t he vague
"weight loss" goal to more specific goals that are measurable and also t ime sensitive. Further,
these questions and statements help manage expectations, set timelines, and establish
motivation. As a result, you and your clients will end up with concrete, well-formed outcome
goals that carry with them a much higher probability of success.

You've also taken the opportunity to shift your client's focus toward behavior strategies and
UNIT 2 Chapter 15 S ~ t' P 6 Sett nQ B e l ' a\ 'lo ~ . r Goa':' &. 1/0 1' 110 ' r ,: 379

away from obsessing abou t their we ight or th eir body fat. Your cli ents shouldn't wo rry about
every flu ctuation in scale we ight and ski nfol d th ickness (the ou tcome). This often le ads
to impatience, discontentment, and, in the wors t cases, eating and body image disorders.
Rather, they should be spendi ng the ir energy implementing and adhering to the plan (the
behavio r). If they're accomplishi ng this and sticki ng to the plan, t hat's all they pe rs onally
can do . The rest is up to yo ur adv ice. In ot he r wo rds, if t he client is doing exact ly wha t yo u
recommend (following thei r behavior goa ls) and not gett ing results (achievi ng t heir outcome
goals), then it's your adv ice t hat's the problem. Accept th is responsibility. Yo u focus on the
outcomes, and place the re sponsibility for ad he ren ce on your clients.

OUTCOME GOALS VERSUS BEHAVIOR GOALS

Now the second aspect of goal-setting becomes important. Since your clien ts won't know OU TCOME GOA LS
which behaviors are necessary to prod uce t he fat loss t hey'd like to achieve in the prescribed Intended result that will occur
time frame, you need to discuss behavior goa ls. In Ch apter 10, we ident ified the difference from carrying out a behavior;
a long-term measure of
between outcome goals and behavior goals. Outcome goals are the ma in outcomes or
strategic effectiveness
object ives th at one hopes to accompl ish. For example, "I wan t to lose eight pou nds in eigh t
weeks" is an outcome goal. Other outcome goa ls are things like "I want to have $2 00,000 in
investmen ts five years from now." You can't directly con t rol the accomplishment of an outcome
goal. It's the end res ult of a series of other t hings you have to do.

Behavior goals represent the steps you have to take to accomplish your outcome . Fo r BEHAV I OR GOALS
example, when the outcome goal is "I want to lose eig ht pounds in eigh t weeks," the Goals framed around
be havio r goals would likely be "I will exercise five days a week for the next eight weeks" or "I actIVIties of the client that
are under complete control
wil l red uce my to tal calo ri e inta ke by 500 calories a day for the next eight wee ks." You ca n
of the indiVidual
directly control a behavior goa l. It's an act ion you can choos e to take (o r not ). Ma jor behavior
goals for an 8-week fat loss program mig ht include the followi ng,

"I commit to exercising for a total of f ive hours pe r week , three of those hours with my
persona l trainer, for t he next eight weeks."

"I commit to miss ing no more than 10% of my schedu led exercise sessions fo r the next
eigh t weeks."

"I comm it to eating breakfast every day for the next eig ht wee ks. "

"I commit to reducing my total calorie intake by 500 kca l per day for the next eight weeks ."

"I commit to only eating 'junk food' during one schedu led 'f ree meal' each week,"

"I commit to eating five meals per day for t he next eight weeks ."

And majo r behavior goals for an eight-week mu scle-building program might include the
following,

"I commit to eating every two to three hou rs, whether I'm hungry or not, for the next
eight weeks ."

"I commit to miss ing no more than 10% of my schedu led exercise sessions for the next
eight weeks."

"If my we igh t gain stagnates , I comm it to inc reasi ng my daily ca lorie in take each week
until I start to gain again ."

"I comm it to increasing my weekly exercise intensity by progressively increas ing the
weights I can lift."
380 UNIT 2 \ Chapter 15 Step 6 , Setting Behaviour Goals & MOnlto rmg

"I commit to using P+C workout drinks during every weight lifting session ."

Establishing behavior goals is fairly straightforward. These goals are the most important
behaviors to wh ich a client can commit right now that will immediately affect whether they
atta in their outcome goals. The exerc ise outlined in the next section will help you think
th rough the process of establishing behavior go als.

Estab lish ing behavior goals

This tool high li ghts areas that need improvement and direct goal-se~ing acti vi ties. By
follow ing these steps, your clients will end up with an initial set of behavior goa ls designed
to guide their actions. Ideally you should do this exercise before meeting with your client to
discuss nutrition. Then, after discussing food and establ ishing outcome goals, discuss the
beh avio rs you 've iden tified be low as necessary for your client to see progress .

STEP 1
Look over the results of the Soci al Support Questionnaire, Kitc h en Makeover Questionnaire,
and Readiness for Cha n ge Qu estionnai re. Also, think about you r client's cu rrent eating and
exercise behaviors. Once you've got these in mind , think about the areas that need immediate
improvement. Are their limiting factors social ones, environmental ones, or men tal ones?

STEP 2
LIMITING FACTORS Write down th e three or four most sig nificant limiting factors you ident ify in your rev iew of
Anything t!Jat makes it the client's initial assessment.
more di fficult (or a chent to
achieve optimal results Limiting factor L

Limiting factor 2:

Lim iting factor 3:

Lim iting fa ctor 4:

STEP 3
Consider the strategies required to overcome these limiting factors. This might include:

Big-picture lilestyle goals like improving their kitchen contents (while removing the not-so-
good contents) or recruiting a workout partner on the days they're not exercising
with you.

Food-related goals such as eating breakfast every day or eating protein with each meal.

Commitment goals such as simply making it to a ll their scheduled train ing and nutrition
sessio ns . Again, th e goals you establish Wi ll be based on your client's current limiting
factors so be sure to review th eir questionnaires and assessments thoroughly. Generic
suggestions won't work here.

STEP 4
Develop t hree or fo ur behavior goa ls that can most immediately help your clients
overcome the limiting factors you iden tified.
UN IT 2 ! Chapter 15 Step 6 : Setting Be hav iour Goals & MonitO ri ng 381

Behavior goal 1,

Behavior goa l 2.

Behavior goal 3,

Be havior goal 4,

STEP 5
When you meet with you r clien t, after discussing their quest ionnaires and assessments and
eslab lishing ou tcome goals, prese nt t hem wi th the be havior goals you estab li shed.

STEP 6
Instr uct your clients to write down these behavior goa ls and carry them around with t hem as
a reminder of what it will take to achieve the des ired outcomes.

STEP 7
Throughout the consul t ing process, co nt inue to perform this limi ti ng factor analysis and establish
new behavior goals based on new limiting factors. As mentioned qui te a few times already, tackle
on ly one or a select few lim iting factors at a time . Ot herwise, you'll overwhelm your clients.
Address the biggest ones first. Eventually, you can add ress the others.

Compliance and adherence

COMPLIANCE/ADHERENCE
Once you and yo ur clients have discussed their outcome and behavior goals and tal ked about
MONITORING
the nutritiona l changes they need to make, establish a program of compliance/adherence
Tra cking, recording. and
monitoring. You need two things to get great results, First, you have to design a great overseeing adherence to
program. Next, your client has to follow that program. Without both laking place, there is a given nutritional and/o r
no progress. Many tra iners fe el help less because they ca n only co n trol what the ir clients are exercise plan
doing in the gym. Yet yo u can and wil l have an influence oulside the gym if you monitor your
client's adhe rence to your plan.
ADHERENCE CHART
Table 15 .1 is a sample adherence chart. Here's how the adherence chart works ,
A spreadsheet that can be
Each time a cli ent eats a compliant meal (for examp le, following the 5 Habits and from the used to record and measure
Superfoods list in Chapter 13), they put an x in the appropriate box. compliance to a set of goals
and behaviors
Each t ime the client misses a meal, they put a 0 in the box.

Each time t he clien t eats a noncomplian t meal, they put a * in the box .

If a meal isn't applicable, the client simply puts N/A in the box .

To help give you a better picture of wha t th is compliance cha rt w il l look li ke after one week,
Table 15.2 provides an example.

In revieWing a client's compliance chart, Simply tall y up t he total meals sc heduled for the
week (46 in this case) and sub tract the boxes that either con tai n a 0 or contain a * (7 in this
case). Once you have these numbers, give your client a percentage ~ based adherence score .
For example, as this client missed four meals and "cheated" at three mea ls, they've achieved
abou t 85% (39/46) ad here nce.

A score of 85% isn't bad. It's better than most folks would do. And it will likely lead to
improvemen ts in health, body composition, and performa nce. Howeve r, the level of
382 UNIT 2 Chapter 15 SteJ b Setl lng 8 €h iN IOl r G Ga l ~ &. M r> n to' ng

acceptab ility of a comp liance sheet is n't based on an absolute percentage rating. Ra t her, the
level of acceptab il ity is based on your pre-established behavior goa ls. If you've establ ished that
a particu lar client should be 90% compliant (which , incidentally, is recommended for optimal
progress), then your cl ient wou ld have to do betler. However, if your cl ient's goals are more
modest and you establ ished a lower compliance standard at the outset, 85% or less might do.

THE WEST POINT METHOD

Often, when clients are be ing assessed for specific be haviors, they have a tendency to
"explain away" lack of compliance, For example, if you ask whether or not they 've taken
the ir f ish oil, and they haven't, many clients, in stead of sayrng "no" , will begin to justify why
they didn't. This process of justifying negative behav iors must be short-circuite d because
if it's allowed to continue, clients can actually start to talk themselves into further lack of
compliance in t he futu re. To this end, what's been called "The West Point Method" has been
proven very effective as a way to prevent th is type of justification .

Bi-Weekly Adherence Chart

WEEK MEAL 1 MEAL 2 M EAL 3 MEAL4 M EAL 5 MEAL 6 (WORKOU T

ADHERENCE DR INK)

Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Day 10

Day 11

Day 12

Day 13

Day 14
3 83

Example Adherence Chart

WEEK 1 MEAL 1 MEAL 2 MEAL 3 MEA L4 MEAL 5 MEAL 6 (WORKOU T

ADHERENC E DR INK)

Day 1
Tra ining Day x x x x x x
Day 2
Non-training day x D x D x x N/A
Day 3
Traini ng day x x x x x x x
Day 4
Non-train ing day x x x o x x N/A
Day 5
Training day x x x x x x x
Day 6
Training day x x x o x x
Day 7
Non-train ing day x x x x x N/A

Wi th the West Point Method, clients are only permitted to respond to habit-based ques tions
with one of t hree responses:

Yes
No
I don't know

For example, if you ask a client whether or not they've taken their fish oil, you aren't
inlerested in hearing anyth ing beyond whether they did take it or whether they didn't.
Any additional informat ion is counterproductive, So, jf clients try to respond with more
information, remind them that the only su itable answers are yes, no, and I don't know.

THE CLEAN SLATE POLICY

Now, here's the important part, your response. If they answer yes, then congratulate them
and offer praise. This will reinforce compliance in the future. However, if they answer no, the
key is to avoid jUdgment, to hide any disappointment, and to offer them a clean slate. Here
at Precision Nutrition, everyone of our clients is familiar with our "Clean Slate Policy" which
states the fo llowing,

"Changing your habits - and your body - is hard. So keep things ve ry simple,
and remember:

Everyone slips up from time to time .

384 UNIT 2 Chapter 15 Step 6 Sett ing Be ha viour Goa ls & Monl tollng

In our experience, people are far too hard on themselves. We make it easy. If
you slip up or miss a day, remember the PN Clean Slate Policy, you have our
permission to wipe the slate clean at any time. Put the past behind you and focus
on today. We'll do the same."

Once you've made it clear that yesterday is behind them, focus on strategies for helping them
do better next time.

Create an environment where clients know it's okay to be honest about their habits and their
compliance; where they're rewa rd ed for pos itive changes; and where they're given a clean
slate when they slip up.

MONITORING STRATEGIES AND ASSESSMENTS

Without measurement there can be no knowledge of improvement. It's always amazing to
see personal trainers take their clients through workouts week after week with nary a body
composition or performance measure recorded. Or a nutritionist meet with clients week after
week without measuring anything tangible and results related. Or a chiropractor perform
an adjustment yet not perform some assessment of function. What's the point of all this
exercise, counseling, or manipulation if not to improve something?

In Step 2 (Chapter II), you should have collected preliminary client information in order
to guide your nutrition and exercise decisions as well as provide a baseline for future
comparison. While these baseline measures are important, as an outcome-based practitioner
you must monitor cfients regularly and use the results of your assessments to shape your
future exe rcise and nutrition decisions. Implement a regular program of measurement and
assessment as you coach your clients to better health, better performance, and better
body composition.

This program of monitoring can have several parts.

Daily

Clients record adherence , recovery, and bodyweight , and submit togs every two weeks.

Every two weeks

Measure skinfolds and body girths.

Every 4- 6 weeks

Assess gym performance via a number of simple strength an d end urance-rela ted tasks; for
athletes , these may be sport-specific tasks.

Take physique photographs.

Every few months to once a year

Work with your client's physician to regularly monitor blood profiles and health markers . Start
out taking these every few months. Once you've come up wi th a great program and you know
it works (based on this evidence) , you may take these measures only once per year.

Of course, there are a few situations where you might not wan t to measure all of these
variables. First, some clients will have more modest goals. In this case keeping a keen eye on
how your client feels and looks in the mirror may be sUitable. After all, why spend all that time
measuring if your client is simply in maintenance mode or wants to have more daily energy?
UNI T 2 Chapt er 15 Step 6 · Se lt lng Behaviour Goals & Monlto rmg 385

Summary of regu lar measu rements

DA I LY MEASURES BI ·WEEK LY MEAS URES MONTHLY MEAS URES ANNUAL MEASURES

Subjective Skinfolds Stre ngth, end urance, Blood work

recovery or sport performance

Objec tive recovery Body girths Photograp hs

Bodywe ight Bodyweight (if not daily or we ekly)

Second, if regular measureme nt provokes distress, skip the da ily assessments . For 90%
of your clients, this likely isn't a problem . They 'll learn (with your encouragement) to
be objective about these numbers and know that both positive results (moving in the
right direction) and negative results (moving in the wrong direction) can both be positive
outcomes. After all , any measurement result shows what's working and what isn't, which
makes it easy to change their program when necessary. Yet you will likely have clients who
literally fear the scale and have near-breakdowns when confronted with body composition
measurements . In these cases, you have two choices: Ei ther avoid these measu res as they
may do more harm than good. Or collect them but keep them a secret from your client,
providing assurances that eve rything is movin g in the right direction.

The assessments
The preferred follow-up assessment st rategies bu ild on the in itial measures you col lected in
Step 2 (Chapter 11) of this co urse . As in Step 2, your clients will fi ll out a bi-weekly version
of the Comprehensive Cli ent Information Sheet, called the Bi-weekly Clien t Report. This
report tracks daily bodyweight, recove ry, and dietary adherence. During their first nutrition
education/check-up appointment, give your clients their bi-weekly client report form with BI -WEEKLY CLI ENT REPOR T
instructions to fill it ou t at home and retur n it to you at the next check -up , two weeks later. Bi -weekly version of the
Every two weeks , give your clie nts a new Bi -weekly Client Repo rt form to complete and return. Comprehensive Client
Information sheet
There are severa l additional follow -up measu rement tools available, incl uding body
composit ion assessments , performance assessments, visual assessments, and blood
chemistry assessments . Per form each assessment and record the resul ts during each
check -up pe ri od as expla ined below.

Bi -weekly Client Report includes,

Da ll y bodywe igh t records

Dally recovery records
Da il y adherence tracking
386 UNIT 2 Chapter 15 Step 5 Se ttlllg Behav iour Goa ls & Mor lloflng

Follow-up measurement tools

Fo llow-up body composition assessment (every 2 weeks)

Follow-up performance assessment (every 4 weeks)

Follow- up visual assessment (every 4 weeks)

Follow-up blood chemistry assessment (yearly)

Follow-up progress assessments

BODY COMPOSITION MEASUREMENTS

During each check-up, perform skinfold testi ng and co llect girth measures. Use th e same
methods and cha rts out lin ed in Chapter 11, and record yo ur measurements. Be su re to
wr ite down the date each time you take measurements. The Bi-weekly Results Tracker in
Appendix B can help you q uickly and easily compare body composition measures from one
visit to the next.
UNIT 2 Chapter 15 S: r.p 6 Sct t' J'g 8e ll avlour Goa ls & ~~cJl) t: :JII lg 387

Bi-weekly Client Report

Date, _ __ _ _ _ __ _ _

INSTRUCTIONS
In order to provide the best possible service, it is important that you fill out all the information
be low. Keep a daily record of bodyweight and recovery measures. Please bring this report
to your next check-up meeting. I'll collect your skinfold measures and girths during this
meeting, so you can leave those sections blank.

DISCLAI M ER
It is your responsibility to work directly with your physician before, during, and after seeking
fitness consultation. As suc h, any information provided is not to be fol lowed without the prior
approval of your physician. If you choose to use this information without the prior consent of
your physician, you agree to accept full responsib il ity for your decision.

BI-WEEKLY CLIENT REPORT

Body com pos it ion m eas ur es

1. Bodyweight (in Ib)
WE EK 1 WE IGH T WEEK 2 WE IGHT

Monday Monday

Tuesday Tuesday

Wednesday Wedn esday

Thursday Thursday

Fnday Frrday

Saturday Saturday

Sunday Sunday

2. What is your body fat percentage (have this taken before submitting this sheet)? _ _ _ _ _ _ _ _ _ __

3. Please provide the following skinfold measures 4. Please provide the following girth measurements
(in mm) *. (inches or cm)*.

Abs Subscapularis Neck Waist

Triceps Suprailiac Shoulder Hips

Chest Thigh Chest Th igh

Mid-axillary Upper-arm Cal f

* No te: These Will be collected and recorded dur ing your next appomtment
388 UNIT 2 . Chapter 15 Step 6 Se ttmg Beha viour Goals & M OOl tQ(l ng

BI-WEEKLY CLIENT REPORT

Goals
1. To ensure that your goals and our approach are still on the same track, please reevaluate and rank your goals
at this current time . Rank these goals according to importance, with 1 being the most important and 8 being the
leas t impo rtant.

GOAL RANK GOAL RANK

Improve hea lth Increase muscle mass

Improve endurance Fa t loss
Inc rease strength Inc rease po wer
Sport -specific* Weigh t gain

*1 1~ sport - specif i c " was selected, please provide the spor t I at hletic even t for w hich you are trai ni ng:

2 . Is there a specific timeline for achieving your goals? If so , please describe in detail.

3. What' s more important to YOu:

o a. Immediate progress that's less easily maintai ned OR 0 b. Maintainable progress that may not be as rapid
Please explain below:

Subjecti ve recovery measures

Plea se rate (daily) each of the follow ing variables on a scale of 0 • 5 as follows:

Appetite : 0 """ No appe tite; 5 = Ver y hu ngry Tiredness : 0 = No ti red ness; 5 = Very tired
Sleep quality: 0 = Poo r slee p; 5 = Ve ry good sleep Willingness to train : 0 = No wi lli ngness; 5 = Ve ry exci ted
to train

WEEK 1 MO NDAY TUESDAY W ED NESDAY THURSDAY FRIDAY SAT URDAY SUNDAY

Appet ite

Slee p qual i ty

Tiredness

Willi ngness to trai n

WEEK 2 MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SU NDAY

Appe t ite

Sleep quality

Ti red ness

Willingness to tra in
UN lT 2 : Chapter 15 Step 6 Seiling Behaviour Go als & M on ito ri ng 389

BI-WEEKLY CLIENT REPORT

Object ive recovery measures

Please record your morning resting pulse for each day while seated, immediately upon waking. Take your radial pulse
(at the wrist) for 15 seconds and multiply by 4 to get a minute value. Record this minute value (beats per minute) here:

~~~~~ ;~~~)- - - - - - - - - - - -[- MON_DAY ___ f TUESDAY_ - -f ",ED NESDAY r H UR: DAY - r ~I DA_Y - - - -f ~~:U RD AY _ - f _SUNDAY - - - --

Perceived appearance
What changes in your appearance do you see when you look in the mirror? Please describe them in your own word s.
(For example, are you getting tighte r, more muscu lar, or more vascu lar?)

Gym performance
Subjective appraisal

How are your workouts going? Are you getting stronger, more powerful, or improving your anaerobic tolerance? let
us know what changes you feel when working out. Please describe them in your own words. You can also use this
section to highlight " problems" or concerns you may have about the workout.

Genera l nutrition perceptions

How is your nutritional program go ing? Are you having difficulty following it or is it easy to eat this way? How
successfully have you avoided unhealthy choices and made more positive eating decisions?
390

BI-WEEKLY CLIENT REPORT

Adhe rence to nutrition plan

Please place an "X" only in squares corresponding to the day and meal w here you followed the nutrition plan , as
prescribed , 100% . Please input a uN/ A" in boxes that don't apply to you (for example, if you are only required to eat 5
meals per day, put N/A in the 6, 7 and 8 columns). The order of your meals isn't important. As long as you've managed
to get the meal in, it counts as 100% adherence for that meal (for instance if you ended up switching meals 1 and 5
around to fit your schedule better, you' d still place an X for each meal).

W EEK 1 W EEK 2

MEAL 2 3 4 5 6 7 8 2 3 4 5 6 7 8

Monday

Tuesday

Wed nesday

Thursday

Friday

Saturday

Sunday

Are you having any problems with adherence, or does it seem easy? Please elaborate below.

With an increase in protein intake, some people may experience abdominal bloating, gas, or constipation. Are you
experiencing any negative gastrointestinal symptoms? Please describe.

How much are you now spending on groceries per week (please list grocery bill totals for both weeks)?

How much money are you now spending on supplements per month (total for the month)?

How often have you eaten out in restaurants per week?

Genera l well-being
Have any of your previous health, nutrition, or physique complaints decreased?

Please provide any general comments not covered above that you think we should or would like to know. Positive and
negative feedback is welcome.
UNIT 2 Ch apte r 15 Slep 6 Se: l l "lg Be haV IOl,. 1 Goa $ & MO 'lr tow·.g 391

Follow-up progress assessments

BODY COMPOSITION MEASUREMENTS

During each check-up, perform skinfold testing and collect girth measures. Use the same
methods and charts outlined in Chapter 11, and record your client's measurements. Be sure
to write down the date each time you take measurements. The Bi -weekly Resu lts Tracker in
Appendix B can help you quickly and easily compare body composition measures f rom one
visit to the nex t.

FOLLOW-UP VISUAL ASSESSMENTS

Visual assessments are important measures of progress th at serve two important roles:

1. Visual assessments help your clients to see visual changes in a more objective way .
Because clients see themselves every day, it can be difficult for them to appreciate the
progress that has taken place over tim e. In most cases, their transformation is slow.
Fro m one day to the next there are no dramatic changes. Fur th er, most clients are
impatient . They visualize a certain lean body look and, even though their body is getting
better, it's still not their "ideal." So they interp re t this as "no progress." When you take
photographs eve ry four to six weeks, then put these pictures side-by-sid e, a client's
progress becomes obvious.
2 . Visual assessments allow you to demonstrate the effectiveness of your program
to potential clients. The mo st successful trainers and coac hes have clear and
consistent evidence demonstrating the succe ss of their system. Grea t pro coaches have
championship ri ngs . Great Olympic coaches can show their athletes' world championship
and Olympic medals. So , what's the best way fo r a trainer to demonstrate success' By
having a collection of successful body transformation images. In fact. one successful
coach in California has a cotlection of over 500 amazing sets of progress photos. Every
client gets the" picture taken before beginning the program with him and every month
t herea ft er. Not only does this benefit th e client by providing objective evidence of their
change, it benefits the tra iner by allowing him to demonstrate the success of his program.
You should already have initial client photos. Here's how to take follow-up photos,

1. Dressed in a sma ll pair of shorts (men) or a swimsuit (women), ha ve you r client stand
against the same bare wall against wh ich they stood for their initial picture.
2. Using t he information you have already writlen down (camera settings, lighting conditions,
how far away t he camera was, and so on), sn ap another set of progress photos.
3. Just as you did for the first session, take four photographs, front sid e, left side, right side,
and back side. If your photos are digital, name the files with the da tes the photos were
taken. If hard copies, w rite t he date on the back.
4. tf necessary, block ou t your client's head and face for anonymity.

FOLLOW-UP PERFORMANCE ASSESSMENT

During your initial testing appointment, you likely measured one or more of the fo llowing
performance variables. Now that you have these ba se li ne data, you can follow up with
monthly assessments of the changes that have taken place In order to demonst rat e progress
(both to your current client and to potential clients). Every four to six weeks , schedule a
workout or two for testing. Collect measures that are releva nt to your client 's particular goals.

If you chose a 3 RM test during initial testing, have your clients work up to a 3 RM again.
392 UNIT 2 Ch ap ter 15 Step 6 Sett ing Beh avIOur Goal~ & Momto rlng

(T he same goes for I RM testing if applicable). Here is a sample assessment table for the
first three months,

SESSION 1 (BASELINE) SESSION 2 SESSION 3

MAJOR LIFT REPS WEIGHT REPS WEIGHT REP S WEIGHT

Bench press
Squat
Deadlift

I L::: _ _ :-_:: --: ~_:~~ION1:]S~'~!:: j ~~ION :2

Barbell snatch
: t: J~:~~~ON 3::: ~EIG"-T :::
GHT ::
f
-::

I DISTAN CE ~ HEIGHT I DI STAN CE ~ HEIGHT I DISTANCE

- --- --~ - -. _ .. . ... . . _. . --- ---HEIGHT
_ . . ............. ------- _ ... . . . . ..... --_.- _. - - - - -. - - -. -. --- ------ - - - - ----
Vertical jump
- ----- - - - _. -. -- -- .--- - - - - -- - -. - - ...... - . . . . .. -- - - - - . ...... -- - -- - - - - - - - - -- - - -- - -- ---- - -- - - - - - - - - - - - --

Overhead medicine ball toss

STRENGTH ENDURANC E TEST

During pretesting, you selected a weight that was 75% of your client's I RM and had them
perform as many reps as they could. Choose the same load and repeat the test to failure.
Record the number of reps they can now perform . Here's a sample table,

SESSION 1 (BASE LI NE) SESS ION 2 (FOL LOW-UP)

MAJ OR LI FT lR M LOAD % OF MA X LOAD REPS lRM LOAD % OF MAX LOAD REPS

Bench press

Squa t

Dead li ft
UNIT 2 Ch ap te r 15 Slep 6 Setting BehavIour Goals & Monllorlng 393

END URANCE CAPAC ITY, VM"

You ca n find instructions for V ",~ testing in Chapter 11 . He re is a sample table for recording,

SESSION 1 (BASE LI NE) SESS ION 2 SESS ION 3

FINAL SPEED FINAL ELE VATION FINAL SPEED FINAL ELEVATION FINAL SPEED FINAL ELE VATION

ENDURANCE CAPACITY: TMAX

There are two ways to do follow-up T ~, testing (see Chapter 11 for more on Tm)

METHOD L T M" COMPARAT IVE TESTI NG

After a day off from the gym , set the treadmi ll at the same speed and grade as their initial V,~,.

Have them run on the treadmill at the in itial V "la ~ until fatigue.

Record their maximum time at the initial V "IA~'

This duration is called Trna . (maximum time).

This comparison allows your cl ients to know how much longer they can last at the same
intensity they used during initial testing .

M ETH OD 2 : N EW T M" CHALLENGE

• After a day off from the gym, set the treadmill at the same speed and grade as their new V~ .

Have them run on the t readmill at t he new V,,,. until fatigue.

Record their max imum time at the new V"'B"

This duration is also called Tm~ x (maximum time).

This comparison allows your clients to know how wel l they perform at the ir new Vrn~ "

SESS ION 1 (BASE LI NE ) j SESSION 2 j SESSION 3

:~~:_ ~~ ~~ i~ i ~~~!,~.. ___ _. ___ . __ . _. _._ ...... _. _. ___ ________ . __. _. __ .. ____ ..... ..... _. __. __ . _________ ___ _
Time at new v ,~.,
--- _ .. _ .. ---------- _ .. - _ .. _. -- _ ...... - ------- --- ----- _ .. _..... - --- - _ . ... ------- _
. -- _ .... _ .. -_ .. --_ ... .
394 UNIT 2 Ch apt er 15 S: e,J 0 Sett ing Be l13vloU Gca ls & Mor lto' II'g

FOLLOW-UP BLOOD CHEMISTRY ASSESSMENT

Your client's doctor shou ld do a comp lete blood profile to assess the ir overall blood and
ce llular hea lth as well as t heir susceptibility to disease . We recommend specific tes ts in
Chapter 11 for t he initia l assessment. Repeat the same tests annually. Ask your client
to bring a copy of all test resu lts, and include this inform ation in your client's file for
comparative data over time .
UNI T 2 Chapter 15 Steo 6 Y.:: lml! R2 !l ilvlC(. f Gr.l<l l ~ & 1
....'01 I tO lI 1g 395

Most of your clients come to you to look better mass. Not a bad start, but he was frustrated .
and feel better. While these are legitimate Despite the numbers changing , he was convinced
concerns, they' re hard to measure, especially that his body hadn't changed at all. As a re su lt,
for the cl ie nt themse lv es . They often compare he doubted the program.
the way they look to some ideal. It could be a
I showed him the skinfold information a nd
real celebrity photo from a magazine. Or it could
explained what that meant in terms of fat loss
be an imagined ideal they have in their head .
an d muscle gain. However, he was unimp ressed .
Even as their body ch anges they can often grow
When looking in the mirror, he felt no different.
frustrated, thinking nothing is happening because
An d he w as getting desperate.
th ey still feel very fa r from the ideal.
As a last resort, I turn ed to th e phot os we'd been
In the case of one ma le clien t of mine , th is
ta king every two weeks. By now we had four
ex perience was particularly noteworthy. Starting
sets of them. I put the se photos si de by side and
out at about 6'3 ", 170 Ib, and 20% body fat,
asked him to take a look. Only then was it clea r
he was what we'd typically call "skinny-fat", His
to him that his body was changing. His stomach
body fat was high and his muscle mass was low.
was flatter from the side. H is arms and legs had
He wa nted to look better, so he hired me to hel p
more shape. And his waist was cle arly wider in
him los e fat and ga in muscle.
the in itial pictures than the more recent pictures
Knowing tha t someone with his body type when viewed both from the front and fro m the
typically has poor nutrient partitioning due to th eir back . After going through t he photos, instead
high fat percentage, I decided we should conquer of feeling like he was wasting his time , he felt
his body fat first and then, once his body fat was like he had really accomplished something. This
lower and his nutrient partitioning improved , help renewed his trust in the process .
him build muscle. We put him on a prog ram of
Without having this visual documen tat ion , it
heavy strength trai ning (three d ays per week)
wou ld have been difficu lt to keep him fo cused
along with two days a week of low-intensity
on the plan . He might ha ve eve n given into
ca rdia and two da ys of h ig h-intensity intervals.
frustration . It's hard to bl am e a cl ient for this. It's
I assessed him as a Levell eater, so we focused
very difficult to see the smal l changes that take
on the basics: eating more regularly, eating more
place day in and day out when you're following a
protein, eating fewer processed fo ods , etc.
stre nuous exercise plan and new way of ea ting.
During t he first two months he got much stron ger Howeve r, when you can demonstrate that good
and had a lot more energy. Plus, he dropped things are indeed happenin g, c li en t s will be much
about 2% body fat while gaining 2 Ib of lean more like ly to stick with you for the long run .
396 UNIT 2 Chapter 15 Slep 6 Setting Behaviour Goals & Monltormg

l. Nutritional recommendatio ns are only the beginning of the client relationship.

Once your client has a set of strategies and suggestions, address goal-setting and
expectation management.
2. Establish well-formed outcome goals and action-oriented behavior goals with your
clients. Once these are formed, it's your responsibility to look after the outcomes
and your client's responsibility to look after the behaviors.
3. Use objective measures, such as the compliance sheet provided in this section , to
assess whether your clients are adhering to their behavior goals.
4. We have provided a number of follow-up questionnaires and assessments in this
chapter to assist you in the outcome-based development of successful coaching
and body transformation strategies. Perform these questionnaires at various
intervals (daily, bi-weekly, monthly, annually) in order to assess your clients'
current status, whether they're improving, and whether you need to modify their
adherence or your programming.
5. Your program of cl ient consultation should now be clear:
• After a client signs up: meet with them for an initial assessment meeting.
• End of week 1: meet again for an initial consultation.
• End of week 2: meet for a nutrition education/check- up.
• Every two weeks after that: meet for additional education/check-up sessions.
6. If you intend to become a great coach and trainer (rather than a mere repetition
counter) treat these sessions as if they're as important as your one-on-one training
sessions. If you view them as less important (or allow clients to do the same), your
effectiveness as a trainer will suffer.
CHAPTER 16

STEP 7:
MAKING
NUTRITIONAL
ADJ USTM ENTS
Chapter objectives
Key terms
The outcome-based coach
Judging your client's progress
Improve client adherence
Making program changes
Improve your troubleshooting skills
More advanced troubleshooting scenarios
Chapter 16 Summary
KEY TERMS
outcome-based
decision making
the Sunday ritual
the breakfast ritual
greens + •
Gourmet Nutrition
Spellatino
Super Shake
Majoring in the minor
body type recommendations
USDA Nutrient Database
periodiled program
plateau
vegetarian
molecularly distilled
enteric coated
postpartum depression
micronized
black cohosh
ZMA
valerian
phosphatidylserine
andropause
fibromyalgia
CoOlO
statin drugs
niacin (inositol
hexanicotinate)
pol/cosanol
folic acid
food allergies
food intolerances
CLA
UN IT 2 Chapter 16 Ste p 7 ~' a " ng r-- l ,\ril lorH I Ad Jl <;t rn (' n ~s 399

After you have followed t he steps described in Chapters 10- 15, your clients should have
rea listic expectations and the co nf iden ce that th ey've got t he bes t nutritional st rategies at their
disposal. Fu rt her, you should have a comp rehensive initial da ta set as well as a lis t of metrics
that you'll use to quan ti fy ongoing progress. The next step in the coa ching process is to make
nutritional ad justments based on the results of these metrics, whi ch will come d uring your
bl-weekly check-up appoi ntment s.

The outcome-based coach

Good n ut rition al coachi ng has several component s. We've already id en ti fied t hree of them:

Good nutrition coaches focus on optimizmg body composition, health, and performance.
Good nutrition coaches use programs spec ific to each client.
Good nu trition coaches use discrete systems for teaching clients how much to eat (portion
and calorie cont ro l), what to ea t (food selection), and when to eat (food timing).

In t his chapter we'll examine a fo urt h element t hat makes a good nutrition coach: good
nutrition coac hes prod uce resu lts.

Even if you th ink you r clients are eating well enough, if they don't have t he results to show
for it, th en their food intake isn't what it needs to be. Even if your clients swea r t ha t their food
amounts, selection s, and tim ing are perfect , if their body isn't getting better, th en they need
some nutritional ad justments. Only resu lts tell you whether a client is truly eating well. This
brings us to a discussion of outco me-based decision making.

Can it be poss ib le that someone eats rea lly we ll , has a "perfect" diet yet is overweight, low
in energy, and riddled with li fes t yle -related diseases' Sure, it's possible, bu t it's not likely . In
ot her words, most people who believe they're "doing a good job" but don 't have the physique
or the health profi les to show for it . . simply aren'\. They either have a good plan that they're
not executing properly, or their plan isn't very good .

This highl ights one major advantage of this coaching system, By taki ng regular
measurements of you r clie nts' progress, you can rou ti ne ly assess the resu lts or outcomes
of yo ur combined effo rts. By regular ly track ing bodyweight, body composition, recovery,
per formance, and/or vi sua l measureme n ts, you receive feedback tell ing you whether you r OUTCOME-BASED

client h as moved in the direction of their goa ls, stayed the same, or moved in the wrong DECIS I ON MAK ING
Intended result that
direction . Every two weeks you' ll recei ve objective information either reinfo rc ing the fact that
will occur from carrying
yo ur program is working or suggesting that you n eed to make some changes. Th is is the
out a behavior; a
basis of outcome~based decision making: measure key progress indicators regularly, and long-term measure of
make programmi ng decisions based on t he results of these measures. strategic effectiveness

Judging your client's progress

Every two weeks, look for one th in g: progress. If a client has advanced toward their goals,
th en your decision is simple: keep followi ng the current program w ithout change . In other
words, if it ain't bro ke, don't fix it. This is true even if progress is slow. Un less there is a
particular n eed to speed the process up (e.g., an upcoming competition or event) then you
may make some subt le changes (outlined next!. However, before allow ing you rself to be
press ured by artificial time constraints or impatien t clients, make sure you know what slow
progress is .
400 UNIT 2 Chapter 16 Step 7 Ma kmg Nut ri tional Adjustments

It's alw ays amaz ing when a clienl or tra iner who has lost 3% of fat in three months or 6 Ib
in eight weeks complain abou t "slow progress". Or they may complain of "only" gaining 1 Ib
of lean mass every three or four weeks. This is not slow progress. If you're working with a
woman at 30 % fat and she's losi ng 1 % fat a month, by the end of a year she' ll be at 18%,
which is def ined as "athletic". Your clie nt has gon e from obese to athletic in one year. And
if a client gains 1 Ib of lean mass every four weeks , that client can expect a 12 Ib weight
gain (of quality lean body mass) over a year. Of course, when waiting for th ese changes to
happen, progress may seem slow and nonexistent. Ye t over the long haul , both outcomes
represent amazing progress. Before givi ng in to client pressure or trying to speed up what
is already great progress, you must understand what reasonable progress is. Tabl e 16.1
prov ides a general guide.

Assessing " rea sonable progress"

PROGRESS FAT lOSS MUSCLE GAIN

Excellent losing 0.5 to 1% body fa t eve ry Gaining 1 to 2 Ib of lean mass

2 to 4 weeks every 2 to 4 weeks

Average Los ing 0 .5% of body fat every Ga ining 1 Ib of fean mass
4 weeks every 4 weeks

Slow Losing less than 0.5% of body fat Gaining less than 1 Ib of lean mass
in 4 weeks in 4 weeks

Not e: these numbers are based on averages and do not represent the maximum range or acceptable results. For example, some clients
may gain substantially more lean mass or tose substantially more fat mass than the ~excellent range" above However, don't force the
Issue. Results m the ranges above are accep table and sust ainable .n the long run

If a client's progress f it s into the ranges above, keep do ing what you're doing. Howeve r, if a
cli ent isn't mak ing progress, is pro gressing too slowly, or is movi ng in the wrong direction,
make some changes.

Improve client adherence

Before making broad-based nutritional alterations, figure out why clients are not making
positive progress . Th ere are t hree possibilities,

Poor adherence , Ihey're not following the plan you set out for them, and you know this
beca use thei r adherence sheets demo nstrate it.
Poor adherence, t hey're not fo llowing t he plan you set out for them, but you don 't know it
because t hey're fudging the ir adherence sheets.
Poor programming, t hey're foll ow ing t he plan, as evidenc ed by their adherence sheets,
but it's not worki ng.

Be open to all three possibili ties. Ye s, many times the fau lt lies with th e client, whether
they admit it or not. In many cases th ey may not be doing what it takes to ge t the best
results . Howeve r, rather th an simply assum in g the blame lies with th em , make sure th at you
thoroughly evaluate thei r adhe rence sheets and discuss their adherence.
UNIT 2 Chapter 16 Step 7 Mak ing Nutritiona l Ad lustm en ts 401

If their adherence sheets and their feedback show poor dietary discipline, then explore the
lim iting factors associated with this poor adherence. By dOing this yo u may discove r that the
client spends a lot of time in res tau rants and simply doesn't know how to order a compliant
meal when dining out. Or yo u may dis cover that t he client still hasn 't stocked their kitchen
with the foods on their plan. Or you may discover that the client hasn't done a kitc hen purge
to get rid of the junk food in the ir house. All three of these problems can be solved easily. You
simply have to stick with the client, figure out why they aren't adhering to the plan, and help
them find strategies to remove the ir limiting factors.

Table 16.2 includes a few examples of client limiting factors and how they might come to
light during your bi-weekly check-ups.

Sample limiting factors and what they really mean

PROBLEM PERCE IVED LIM ITING OB JECT IVE ACTUA L LIM ITING STRAT EGY
FACTOR INFORMATI ON FACTOR

Not gaining "My client simply Upon inspection of The limiti ng factor he re Assis t them with
muscle mass won 't eat more!" your client's fridge, isn't appetite and isn't shopping habits (use
yo u f in d that it's likely re lat ed to problems the Superfoods list
frequently empty. with meal size. The elsewhere in this
prob lem is grocery manua l) and encourage
shopping habits. The them to priorit ize
client either doesn't know shOPP i ng.
how to properly shop,
doesn't prio ri tize shOPP ing,
or doesn't plan regular
shopping trips.

Not losi ng "My client goes out Your chent The limi ti ng factor here Encou rage th em to
body fat to party twice per has made the isn't the beer and pizza. enlist better social
week and drinks commitment to It's either th e client's support ci rcl es and!
too much beer tra in with you so prioritization (they or discuss th eir priority
and eats too they are interested priori tize social interaction structure . Offer strategies
much pizza. " in change. over physical change) or for managing social
it's social support (their situations where
However, when
social pressure is too "prob lem food s" are
they're not with you
great to say no to the avai lab le.
they have problems .
pizza and beer).

Poor recovery "My client just won't After do in g repeated The client may not kn ow Prov ide the client wi th
from exercise In c rease their protem diet assessments, how to increase protein prote in lists and good
intake." yo u no ti ce your intake or add more prote in cooking strategies for
client doesn't ch oose to their daily menu. incorporati ng more
from all t he pro te in protem in everyday
options at their meals and snacks.
disposal.
402 UNIT 2 Chapter 16 S:ep 7 rvtak ng Nutflilo nai Ad justmen ts

Of course, th is all assumes that a client is being honest with their adherence forms and during
the check-ups. If they're not. things can get tough. You may assume that they are doing a
good job and that your program needs adjustment when in fact they' re Just fudg ing the form.
However, in real ity, you may never have a client do this in your career. Indeed, it's quite rare
for a person who's hired you to help them to lie both in person and in documented forms .
Bending the truth when talking to you is easy becau se there is social pressure involved.
They don't want to look stupid or be embarrassed by their answers when talking fa ce to face.
However, when keeping records on their own, people don 't feel the same pressures and
therefore are more willing to record accurate ly.

But wh at ca n you do if you suspect someone is f udging the ir forms? Here are two tricks I've
used successful ly for years.

TRICK 1: GROCERY RECEIPT SUBMISSION

If yo u suspect a client isn't adhering properly yet is reporting great adherence, simply as k
them to save their grocery receipts In a liploc baggie and to bring the receipts to you at
each bi-weekly check-up. This will give you a good ind ication of what they're buying at the
grocery store. It will also offer you a great opportunity to coach them on mak ing better grocery
shopping decisions, if necessary.

TRICK 2: MEAL PHOTOS

If the grocery receipt strategy doesn't uncover anything, the next step is to instruct them to
carry their digital camera with t hem for a few days each week, snapping photos of each meal
that t hey ea t. Again, have them bring the camera or the photo file to you during bi -weekly
check-up appo intments. Th is gives you an opportuni ty to see exactly wh at they're doing
without having to take thei r word for it.

There are many reasons why a client's adhe rence might be poor. However, rather than try to
fix every li ttle issue that arises, target the f actors that are really causing the pro gress blockage.
Think of you r clients' behaviors and habits like a string of Christmas ligh ts. If you plug in a
string of Christmas lights and it doesn't work, what do you do' You look for the one sing le
bulb in the string that's preventing al l the others from shining and replace it. Just because the
entire string is ou t doesn't mean that every bu lb is broken. By finding the specific bu lb - or
limiting factor - that's not worki ng and replacing it , you're more likely to see eventual success .

Here are some of the most common ad herence hurd les for clients . By helping your clie nts
eliminate these problems up front, you'll elimin ate most of the major barr iers preventing them
from following your advice .

HURDLE 1: EATING OUT FREQUENTLY

Perhaps due to occupation, trave l habits, or personal preference , some of your clients wi ll
eat a large percentage of the ir meals in re stauran ts. While there's noth ing wrong with th is,
ma ny clients have di fficulty making the right choices when eating out. Here are some
strategies to help them.

CHOO SE CUSTO M M EA LS

Restaurants design their meals based on typical customer expectations. However, your clients
will hopefu lly avo id the trap of eating "typical" meals. Instead of ca rbohydrate heavy, sauce-
laden, or no-vegetable fare, they should look for meals that are co mpliant with their meal
plan. Most restaurants nowadays offer such meals.
403

Let clients know that they can order items that aren't exact ly on the menu . Most clients will
need to increase t heir protein portion, reduce the carbohydrate portion, and bump up the
vegetables. Typically this means asking for extra meat, no starchy carbohydrate, and double
the vegetables. Help clients learn to improvise if a restaurant doesn't have any stock offerings
compliant with their meal plan ,

Finally, it's important for clients to ask their server exact ly what they 're getting. Many me als
will conlain unexpected breading, sauces, and/or high-sugar additives. These can real ly drive
up the calorie cost of a meal. However, inquiring in advance and asking for the questionable
i tems to be removed or substituted out is a great way to avoid restaurant sabotage .

USE THE 5 HABITS

While your clients may not be able to access the exact meals they typically eat at home when
dining out, they are stil l encouraged to use the 5 Habits to choose their meals. In asking
the questions prov ided in the 5 Habits Chea t Sheet (Chapter 13), your client will be able to
direct their meal choices in a way that guarantees success ,

CHOOSE CO MPLIANT RESTAURAN TS

If a client ea ts out often in a part icular part of town, encourage them to pick four restaurants
in their immediate area (two fast-food places, one medium -priced restaurant, and one
higher-priced restaurant) that prepare meals in a way that conforms to thei r nutritional plan.
For example, Dave Thomas' Wendy 's makes a couple of tasty chicken salads and a chi li that
your clients can ea t when on the go. Even McDonald's is offering healthier meal selections
nowadays. In this way your clients can choose hea lth ier fast-food meals that conform to
the ir meal plan when they don't have much time or much money for a meal. They can al so
choose a medium-priced restaurant such as TGI Fridays for a better quality menu. Finally,
your client can choose higher-priced rest aurants if a roman t ic evening or a business lunch
is scheduled.

HURDLE 2: BUSY LIFE; LITTLE FOOD - PREP TIME

Ever wake up late for work and have to rush off without even a shower, not to mention eati ng
breakfast' Ever have to work through lunch and sk ip hitting the local restaurant where you
get your dai ly chicken salads' Ever get invited to lunch by your boss and consider it rude to
skip the invitation in favor of microwaved lean ground beef and quinoa? If you've experienced
this, it's likely that your clients have, too.

Each of t hese unexpected scenarios presents a unique nutrit ional challenge. How your
c1ienl s respond to this challenge will determine the ir results. Your clients should plan for the
unplanned. This means always having mea ls and snacks pre pared in advance, j ust in case.
The following strategies will help .

THE SUNDAY RIT UAL

The Sunday ritual means setting aside three hours or so every Sunday (any day of the week THE SUNDAY RITUAL
will do, but Su nday is easiest for most) to write out a men u for the week, shop fo r t he week, Settmg aSide three hours or
and prepare meals for the week. The ritua l day should proceed as follows, so every Sunday (any day of
the week will do but Sunday
1. The cl ient sits down and comes up with the ir meal plan for the week. IS easiest for most) to wrile
out a menu for the week.
2. Once the meal plan is laid out, the clien t ca lculates exactl y how much of each food they 'll shop for the week. and
need over the seven days, and genera tes a shopping list. prepare meals for the week
404 UNIT 2 Chapter 16 Step 7 : Making Nutri tion al Ad justments

3. The client goes to the groce ry store and uses the shopping list.

4. Once they've got all those groceries home, it's time to start cooking for the week. Some
people choose to prepare a[ [ their meals for the week on Sundays (exc [uding shakes).
Others prefer to figure out wh ich meals will be easy to cook just prior to meal time and
save them for later, preparing on ly the meals that will need to be ea ten du ri ng work hours
or during busy times of the day when food prep becomes difficult. For example , some
people ca n eas ily prepare breakfast mea ls and dinner meals on demand by setting as ide a
few minutes each day for meal preparat ion. Some people have a sig nificant other who can
prepa re these meals for them. Either way, these meals can probably wait until they are
needed. How ever the lunches, two or three dayti me snacks, and workout shakes usually
present a problem for the unprepared, so they should be made in advance. Sunday is a
good time for most to do thi s preparation. [f it suits your clien t's lifestyle, they can use the
Sunday ri tual to get the se meals ready for the week .

5. Cook all the mea t, chop all the vege tables, and distribute all the supp lements lif th ey're
necessary). Encou rage your clients to have them ready and set aside so that they can grab
them in the morning and bring them to work regardless of their day or what their boss has
in store for them.

TH E BREAK FAST R[TUAL

Rather than prepare all the ir food for the week on a single day, some people prefer to do a
THE BREAKFAST RITUAL little food preparat ion each day. That's what the breakfast ritual is fo r. Cli ents simply perform
Pr oce ss of preparing food for all their cooking for the day each morn ing. Si nce they have to prepare breakfast anyway,
the day during breakfast th ey can get a couple of meals going while breakfast is being prepared. As with the Sunday
ritual, your clients should think about what their day will hold under both the best conditions
(e.g., horne from work early and a relaxing evening ah ead) and the worst (e.g., unexpected
UNIT 2 Chapter 16 Slep 7 Makmg Nutrr llo nal AO Jus tments 405

deadline, all-nighter at work, long day at work and soccer practice for the kids) and ac t like a
Boy Scout Be prepared.

One great strategy for being prepared is to bring both the meals they expect to eat as well
as some backup options, just in case. Even if they expect to grab lunch at TGI Fridays and
have dinner at home, have them bring both a lunch alternative and a dinner alternative, just
in case something else comes up. If they don't need the meals, that's fine, they can just eat
them another day. But if they do need them, they can chow down without skipping a meal or
choosing a poor alternative.

PRE-COOKING PROTEIN

Another great way to save time in the kitchen is to have clients pre-cook their protein for the
week. A ba rbecue or countertop gri ll is great for this, but cl ients can also roast or oven-b roil
a big batch of protein, such as chicken breasts, turkey sausage, or burgers, on shopping
day (perhaps while they're chopping vege t ables) and refri gerate them until they need them.
Heati ng pre-cooked protein in a pan or in the microwave mak es food prep a snap . Think
of those pre-cooked frozen chicken breasts. That's what they're shooting for here , except
they'll save time as their pre-cooked ch icken breasts won't need to be defrosted. (Of course,
they may also use alterna ti ve protein sources such as dairy products, soy products, or
supp lemen tal prote in.)

PRE -CHOPPING VEGETABLES

It's li kely best to chop vegetables soon before ea ting them. Th ey retain the mo st nutrients
that way. How ever, if your clients are pressed for time and find that they simply don't
get enough vegetables this way, their next best st rategy is to chop up half of their weekly
vegetable purchase as soon as they get home from grocery shopping and chop up the rest
when they' re done eat ing the first half, three or fou r days la ter.
406 UNIT 2 Ch apter 16 Sler 7 MJ~ I ')g "'l u:r ' (l'1 (l 1A:J us[ mrnts

To use this la tter method, have t hem buy some large zip-top freezer bags and separate their
vegetables by tyW green peppers in one bag, red peppers in another, onions in another,
spinach in another, carrots in anoth er, and so on. This one strategy will cut down their food
prep time sign ificantly, and they'll increase th eir vegetable in take. Each t ime they want a
salad, a vegetable omelet, or a stir-fry, either right away or for later at work, a wide variety
of pre -cut vegetab les is just a bag away. Fruits work the same way: pineapples, mangos,
peaches, nec tarines, oranges, strawberries - all can be pre-cut. Clients can also buy froze n
fruits and vegetabl es . Some vegetab le st rategies are better than others, but regardless of
which strategy you r clients choose, make sure they get t hose 10 or so servings per day !

LIQUID NUTR ITION

SU PER SHAKE Although nothing replaces a deliciously creamy and cold blended Super Shake , if your
A recipe base for a cli ents don't have a blender se t up at wor k th ey 've got three choices:
nutrition shake
Have blende rs both at home and at work (smaller, portable handheld blenders or the
Magic Bullet ' can be good fo r this, and they 're less of a spectacle in the workplace).
Pre-blend shakes at home and store them in the fridge at work.
Pre-c hop all dry ingredients (mixed nuts, flax, oats, etc.) and store them in zip-top bags
(as with the fruits and vegetables). Put all the dry Super Shake ing redients in a shaker
bottle and add the wet ingredien ts (water, ju ice, milk, etc.) when it's time for a shake .

This will help your clients get a quick meal when they're on the go .

HURDLE 3: LOTS OF TRAVEL

Clients who travel a lot will also need special nutritional strategies for when they're on the go.
Here are a few you can share with them to increase their adherence.

CHOOSE THE BEST LOCAT ION

Whether your clients hit the road for sport or for business , their first priority is to ensu re that
everything they need is in close proxim ity to where t hey will be work in g or playing. Just as
in real estate, loc ation is key. For example, let's say they're gOing to a week-long con fere nce
at a conv entio n cen te r. Have th em first get on th e Internet and find all the hotels nearest the
convention center. Next, have them give these hotels a call to find out where th e nearest
grocery stores, restaurants and gyms are loc ated. Ha ve t hem pick the hotel with the best
comb in ation of nearby resources. Another option is to begin with t he gyms or stores, and
work backwards. Google Maps (map s. google.com) allows users to search by items of interest
(e .g., "grocery sto re "), and then find other thin gs nearby (e.g., "h ote l") This way, even if your
clients' don't get a rental car, they can easily walk or tak e a cab to the ir fit ness and nutritional
ha ve ns. Without resou rces close by, clie nts have excuses to skip workouts , miss meals, and
make poor food se lections while on the road.

CHOOS E A ROOM WI TH A KITCHENETTE

Whi le your road warrior cl ients don't necessarily have to stay at a five -star hotel or choose the
penthouse suite, they can choose a hote l ch ain (such as Exte nded Stay) t ha t offers roomS/
suites with fridges (at least) or even a full ki tche nette. On the way from th e airpo rt , they
can just have their cabbi e drop them at the grocery store (or wa lk to the store once the y've
deposited t heir luggage, since t hey'll have made sure to choose a hotel with a store nearby).
Once they get to their hotel room, they 'll be able to eat as well as when they' re at home.
UNIT 2 Ch apter 16 Slep 7 V ?h. ng Nl Ir 1·()I'lal A. oll.S! "'e n l ~ 407

Even if your client can't find or afford a hotel that has a kitchen or kitchenette, as long as
they've got a refrigerator, they can stock their room with good snacks. They can store and
snack on fresh fruits and vegetables, bottled water, cottage cheese, plain yogurt, roasted
chickpeas, regular cheese, natural peanut butter, whole-grain breads, sliced chicken or
turkey, milk, and mixed nuts. Canned fish can round ou t the protein options.

SH IP SOME [TEMS BEFOREHAND

Instead of going shopping when th ey get into town, some of your clients may actually ship
their food and/or supple men ts via expedited ca rrier. Protein powders, fruits and vegetables,
mixed nuts , legumes, meat, eggs, cottage cheese, yogurt, cooking pans , utensils, shaker
bottles and non-stick cooking sprays can be shipped (some pa cked in dry ice or frozen) to a
hotel before teav ing home. By doing this, your clients need not worry about where grocery
stores and restaurants are located. As soon as they arrive in town, they 're good to go. at least
nutrit ion ally. And although the shipping option may seem a bit pricey, they'll end up saving
money on restaurants and the price may work out in the end.

CARRY A BIG COOLER

Your clients might even consider purchasing a big cooler with an extendible handle and
wheets (much like the wheeled luggage so popu tar nowadays), put a li tt[e partition down th e
middle, and carry this combined cooler/suitcase when traveling.

OBTA[N RESTAURANT MENUS IN ADVANCE

[f your clients intend to eat out, make sure they find out where the restaura nts nearest their
hotel are located. Many restaurants have menus that can be downloaded from their websites;
if downloadable menus aren't available, clients can ask the re sta urant to send menus to
the hotel for when they arrive. By having the restaurant menus in advance, your clients will
know exactly w hat types of food they have access to at all times. Also, when dining with a
group, they'[1 be able to suggest places that conform to their nutritional requirements.

BR[NG PRO TE[N SUPPLEMENTS

Using some combination of the strategies already mentioned , your clients should be able to
ensure that good meal options are always around the corner. But sometimes when they're on
the road it's impossible to slip back to their room or to get to a restau ran t. For times like this,
they'll need to consider a few supplement options. Protein choices are both hard to come by
and more expensive than other options. Increasing their dietary energy with protein powders
is a good fall-back option when on th e road.
GREENS +
BRI NG POWDERED VEGETABLES
A brand of green food
Normally, at home, clients should be getting around 10 servings of fruits and vegetables per product that is used as a
dietary supplemen t
day. But when on the road, that amount is usually reduced to somew here around two to four
un less they're conscious of their intake. To make up for this redu ction in micronutrient intake,
clien ts can use a powdered vegetable supplement such as green s+ ' .

BR ING HOMEMA DE BARS

GOURMET NUTRITION
Clients can also bring some homemade snacks wi th t hem. There are a number of great A cookbook released
fitness-friendly recipe books (such as Gourmet Nutrition , available at www.gourmetnutrition. by Precision Nuff/tion
with vaT/OUS recipes. food
com) that offer fantastic alternatives to the mostly low -qu a[ity, store-bought protein bars on
preparation tips and
the market. food timmg ideas
408 UNIT 2 Cha pt er 16 Slep 7 Making Nuln\lo nal Adj ustments

HURD LE 4 : BUSY SOCIAL SCHEDULE

For those clients who have busy entertaining or social schedules, their limiting factors may
include too much finger food or too-frequent dinners eaten in uncontrolled environm ents.
Some strategies for them follow.

EAT BE FORE DINNER

Mom always told you not to eat before dinner because you'd spoil your appetite. In this
case, it's a good option. When invited to eat out at a noncompliant restaurant or at a friend's
home, clients can "pre-eat" a healthy selection of protein, qua lily vegetables, and good fats.
Once they get to dinner they won' t be very hungry and can choose to eat a small po rt io n of
noncompliant food versus a full meal.

BR ING SOM E FOOD

When dining at a friend's house, clienls can offer to bring food that fits into t hei r meal plan.
Th is way, if there aren't healthy opti ons for them, they can snack on or eat the en t rees
they've provided.

BECOME THE HOS T

If your clients typ ically find themselves at social gather ings with folks that aren't invested in
a good nutritional li festyle, they might begin to host t hese events instead of simply atte nding.
By hosting these events , they can control the foods and the portion sizes.

HURDLE 5: NUTRITIONAL BOREDOM

The rea lity is that your clie nt s are go ing to have to eat ce rtain foods on a regular basis.
There 's no way to get around it. To suc ceed in the long term , they' ll have to keep the
nutritional staples constanl. Yet how do they keep from getting bored? Well, they can keep
the slaples consta nt while co nstantly changing their meals, Th ere are dozens of ways to
prepare lean meat, eggs , vegetables, and olher healt hy foods, so if a client is getting bored
with healthful eating, it's time for them to learn to cook.

Now, they don't need to enroll in a culinary school or subscribe to the cooking channel.
However, they should learn a bit about flavoring and preparing fo od, Here are a few strategi es;

Have your cl ients get some cooki ng tips from someone they know (their mother, grandmother,
spouse , etc). Even t hough thei r staple recipes may not necessari ly be "h ealthy fare" , thei r
season ing and preparation strategies can be used wi th your client's preferred food choices.
Send your client to t he local bookstore for a few basic coo kbooks . Most meals can be
modified to fit the plan by removing or substitu ti ng ingredients; knowing Ihe difference
between rosema ry and thyme will help clie nts decide wh ich to add. Agai n, Gourmet
Nutrition (www.gourmetnutrition.com). would be a fantastic start.
Have your clien ts read a few online articles about healthy cooking. A general web search
will yield hundreds of articles about healthy meal preparation.
Ha ve your clients stop by the newsstand and pick up a food magaz ine or, better yet, get a
subscription. The reg ular arrival of new ide as will remind them that boredom isn't a valid
SPEZZA TINO excuse. The food magazine Spezzatino is an excellent choice (www.spezzatino.com).
A food maga zine that
supports the Healthy If you're a good cook yourself, hold occasional food preparation les sons for yo ur clien ts as
Food Bank part of th is program. Ju st as you'd take them to the grocery sto re to show them where the
best foods are located, yo u can show th em how to prepare these foods in the kitchen.
UNIT 2 Cha pter 16 Slep 7 Ma kmg Nutritiona l Ad l ust ments 409

Making program changes

As we've suggested, there are circumstances In which your client's adherence isn't
their major limiting factor. Th is is where you, as a trainer, need to be objective about
yo ur own programming and exerc i se/ nutritional sugges tions. Most trai ners assume that
responsibility for poor results lies wi th the client. Often th is isn't the case. The problem
may very well be your original prescription, you r te aching method, and/ or the fac t th at
your original prescription was suffic ient but t he clien t's body has changed, leading to a
progress plateau.

If the client's adherence is good , yo u'll need to ma ke nutritional adjustments in the

fol lowing situations,

Poor initial progress

Good initial progress followed by plateau
Old goals have been achieved and new goa ls set
Alterations in the tra ining program

Let's look at each one of these in more depth.

POOR INITIAL PROGRESS

There are a few things that can explain poor initial progress . First, although your prescription
may be correct and the client's adherence may be great, you and the client may not be
communicating prope rly. If this happens, there cou ld be something "lost in translat ion" and
Ihe client could be following the wrong advice . To ensure tha t the message you intend to
pass on ge ts communicated properly, avo id the fo llow ing pitfalls,

PROB LEM), BEING VAGUE

If you are vague in your nutritiona l commun ication, your clien t may misinterpret your
suggestions, lead ing to a fa lse sense of adherence. For example, tell ing your client to eat
more pro tein isn't the same as telling them to eat one portion with each of five daily meals
(one portion is the size of their palm). As you can see, "eat more protein" is subje ct to
interpreta tio n; specific protein suggestions aren' t. The same is true for your vegetable and
fruit, carbohydrate, and healthy fat suggestions. The more spec if ic you are, the better yo ur
communica tion will be. Therefore it's important to be very clear as to what you want your
cl ients to do .

However, remember, Teach to your client's level. If your client is a very basic Level I,
too much detail may be in timidating. You may need to begin by emphasizing that they
eat breakfast da ily and drin k five glasses of water a day. To be more specific in these
recommendations, yo u recommend that they eat breakfast every morning wi thin 30 minutes
of waking and that they drink a cup of water with every meal and snack. These goals are
speci fic without being overwhelming.
MAJORING IN THE MINOR
PROBLEM 2, " MAJORING IN THE MINOR " Teaching that overemphasizes
minor points while
If your teaching overemphasizes minor points (such as precise ratio of carbohydrate to underemphasizing major
protein in post-workou t drinks) while underemphasizing major points (such as getting points; dilutes client focus
enough protein), your clients may spend too much time II ma joring in the minor " and and does not permit them
not enough time working on eliminating their biggest limiting factors. For example, if a to eliminate their biggest
limiting fa c tors
client is looking to lose fat and is simply overeating, rather than emphasizing a specific
410 UNIT 2 Chapter 16 5 1'?!) 7 M a kl11Q NI, t fl tlonal A:J JI.St' Tl f" 1tS

macronutrient split based on their body type, you may want to begin by emphasizing calorie
and portion control. Once they've taken care of the "major" problem, you can foc us on more
"minor" issues like macronutrient split. Here are a few things to remember:

Calorie inta ke contro ls weight gain or loss. Even if your clients choose better foods, it's still
possible to over- or undereat for their goals. In fact, this is a very common mistake. Clients
think that just because they're eating "hea lthy", they can eat all they want while still being
lean and fi t. Keep an eye on all three important nutritional factors; food type, food amount,
and food timing.

For Levell cl ients w ho are ju st starting to bu il d up good habits, you m ay just stick with one
habit at a time, proceeding to the next only when clients h av e adopted the previous habi t.
Begin with food type. Once th is is mastered, then foc us on food amount. Then food tim ing.
For th is type of cli ent, this habiHo rm ing behavior is more critical than direct results up
front. Late r on, you will have to work on control!ing ca lories if progress is too slow. Be sure
to keep an eye on each important nutritio nal var iable regardless of the client's leve l.

PROBLEM 3 : NOT EAT I NG RIGHT FOR BODY TYPE

BODY TYPE Body type recommendations are important (see Chapter 13). While the factors discussed
RECOMMENDATIONS above are the "major" factors assoc iated with client progress, for more advanced clients,
Dietary planning that even if their intake is based on calorie control and good food selection, if they don't eat right
depends on body somatotype:
for their bo dy type, their results may still seem suboptimal. If they're Levell, you may wait
for more advanced clients'
limiting factors unt il their early habits are formed before adding in body type recommendations . However,
you should st i ll be aware of this and keep it in mind for fut ure program alterations.

The simplest and most important strategy for helping a client see bi-weekly body
composition change is to manipulate energy balance. This is the key to body transformation.
Simply pu l:

If a client wants to lose fat and isn 't seeing bi~weekly progres.s in this direction, exercise
volume must increase or calorie intake must decrea se.

These are both simple to accomplish. We recommend the following processes.

For a client who wants to lose fat:

For a client who wants to ga in lean mass:

PERIODIZED PROGRAM
A cycled approach to exerc ise A pre re quisite for increasing muscle mass is we[[~planned and intense strength training.
that al10ws for a specific focus
Ensure that your clients are training ha rd enough and have a periodized program
on a component of fitness
that emphasizes a diversity of training modalities such as maximal strength work ()-5
repetitions), power work (explosive exercise), and more conventional body~bui ldi ng type
traimng (8- 12 repetitions).
Increase daily calorie intake by about 250 calories. Rather than counting calories, simply
have them eat a bit more with each meal. Using a program like the free USDA Nutrient
Da tabase (www.nutritiondata .com) makes it easy for you to know how many calories
eac h food contains and how much to add to each mea l.
411

These initial steps are li ke ly to pro duce rapid improvements in body composition and
health markers.

GOOD INITIAL PROGRESS FOLLOWED BY A PLATEAU

Once you've found what works with you r clients, keep their nutritional program consistent
until they reach a plateau . Plateaus typically occur when the body changes but the PLATEAU
program doesn't. A perrod of time when
results are sta lled
As your cl ient's body changes , so does the ir physiology. For example, whe n a client loses
weigh I, the cost of each of their daily activities goes down. This is because they're lighter,
t hei r metabolism has likely slowed down a bit (due to a red uction in energy intake), and they
simply burn less energy wilh every single activity - both those that req uire movement and
those that don't Therefo re, the same program that helped a client lose weight initially might
not he lp them con tinue to lose weight. The client may have to progressively do more exercise
or eat progressive ly less food to continue making progress. Likewise, cl ients who want to
ga in lean mass will slowly increase their bodyweight and their tota l metabolic rate (due to an
increase in energy intake), They 'l l burn more energy with every single activi ty and may need
more food to continue making progress.

Thus, the same program that promotes weight loss or gain at the beginning may not
perpetually produce the same resu lt Clients often reach a plateau because the physical
changes tha t ha ve taken place have altered their need for energy inlake or energy
expenditure. He re are some suggestions for adjusting their exercise and training program:

For a client who wants to lose fat

Make sure your client exercises for a total of five to seven hours per week, either with you
or outside of their tra ining sessions.
Decrease daily calorie intake by about 250 calories. Rather than counting calories, simply
have them eat a bit less with each meal. Us ing a program like t he free USDA Nutrient
Database makes it easy for you to know how many calories each food conlains and how
much to eliminate from each meal.
If fat loss stagnates aga in, increase total weekly exercise volume to seven to nine hours
per week. Use a mix of interva ls, weigh ts, and longer-duration, moderate-intensity cardia.
If fat loss again stagnates, decrease calorie intake by another 250 calories.
Keep exercise volume high (although more than 10 hours a week might be too much for
nonathletes) and keep ca lorie intake controlled with regular decreases (250 calories per
day) until a client's specific goals are met.

For a client who wants to gain lean mas s:

A prerequisite for increasing muscle mass is well-planned and intense strength training. Ensure
that your clients are training hard eno ugh and have a periodized program that emphas izes a
diversity of training modalities such as maxim al strength work (1-5 repetitions), power work
(explosive exercise), and more conventional body-building type training (8- 12 repetitions).
Increase daily ca lo rie intake by about 250 calories. Rather than counting calories, simply
have Ihem eat a bit more with each meal. Using a program like the free USDA Nutrient
Database makes it easy fo r you to know how many calories each food conla ins and how
much to add to each meal.
412 UNIT 2 Cha pte r 16 Ste p 7 · Making Nutri tional Adjustments

If progress stagnates, increase calories by 250 calories per day. With the goal of gaining
muscle mass, 250-caJorie increases every two weeks may be required until bodyweight
increases. However, keep an eye on their body composit ion measurements to ensure that
they are not gaining excessive body fat.

In both of the previous scenarios, client body type is an importa nt determinant of exercise
volume and food intake. The strategies described above wil l work regardless . However, if
you're following a more aggressive troubleshooting approach, ensure that your client is eating
according to their body type in add ition to manipulating their exercise and food volume.

Remember, basic lifestyle changes and subtle calorie and exercise manipulations are the
most important changes for Levelland 2 clients. Only the Level 3 clients need the more
advanced troubleshooting. Use the individualized approach from Chapter 13 plus the
manipulations discussed here for these clients.

CHANGING GOALS
If a client accomplishes their outcome goals and wants to change their body in some other way,
their program must reflect this. For example, a client may have wan ted to lose body fat but has
now reached their outcome goals. They might want to follow up their fat loss with a muscle-
building period. Conversely, a client who successfully gained as much lean mass as they
wanted might want to follow up their muscle gain with a per iod devoted to fat loss . Monitoring
a client's outcome goals and their progress regularly will help you figure out whether you need
to change their program (or not) based on their goals and the ir physical changes.

Make the transition to new goals gradually. After aggressively pursing a particular set of goals
your client will have formed habits associated with these goals. Rather than simply thrusting
a new set of habi ts upon clients, move slowly, one step at a time.

There is another, more practical, reason to proceed slowly. If, for example, a fat- lo ss client
has been doing about nine hours of physical activity and eating 10 calories per pound and
wants to start building muscle mass, you don't want to throw 16-18 calories per Ib at them
all at once. This wil l likely overwhelm their appetite and their digestive system. Th is may
lead to discomfort and potentially excess fa t gain. Rather than move from 10 calories per Ib
to 16-18 calories per Ib in a single week, slowly increase by 1-2 calories per Ib every 1-2
weeks. So, during week one they might eat 11 calories per Ib , week two they might eat 12
calories per Ib, and so on. This will ensu re a better transition to a hig her calorie intake as
well as less fat gain while building muscle.

In this situation it's also prudent to slowly decrease exercise activity. Rather than go from
nine hours to five hours of activity in a single week, you might want to decrease by one hour
every week or two. Thus, during week one they might do eight hours of exercise; during
week two they might do seven hours, and so on . This will help control energy ba lance and
reprogram the metabolism after the goal set has changed.

The opposite is also true if a client wants to sw itch from a goal of gaining muscle to a goal of
losing fat. Instead of going from 18 calories per Ib and five hours of exercise per week to 10
calories per Ib and nine hours per week, it's important to follow the strategies outlined earlier.
Begin slowly, decreasing calorie in take by 1-2 ca lories per Ib every 1-2 weeks while also
Increasing exercise volume slowly. This wi ll help your client reduce body fat without leading
to losses in lean mass.
UNIT 2 Chapt er 16 Sl ep 7 Making Nuln lton al Ad l us tments 413

TRAINING CHANGES
If a client's tra ining program changes - perhaps due to Iheir athletic schedu le, a periodized
exercise plan, planned periods of rest, and/or unplanned periods of injury - the program may
need adjustment. For example, the preseason calorie needs of athletes may be higher than
their off-season needs. Further, if a client's exercise program includes more (or less) endurance-
specific exercise, they may require a higher (or lower) carbohydrate intake. A nutritional
program that's produced great results may lose efficacy when a client's training program
changes. Alter a client's nutritiona l intake if their training changes and thei r resulls stagna te.

As with body composition changes, calorie balance is cntical. Any program changes that
will alter energy balance shou ld be counterbalanced by your nutr ition al recommendations.
For example , if a client is injured and energy expendi ture decreases, it's important to also
recommend decreases in energy intake to ensure fat gain is kept to a minimum . likewise, if
a client increases phySical activity levels due to an increased practice demand (alhletes, for
example), energy intake should be increased to ensure adequate recovery.

Improve your troubleshooting skills

Just as with client adherence, there are coun tl ess situations in which your nutritional
recommendat ions may need to change. Whe ther these changes are based on your educati ona l
style, a client's unique interpretat ion of your message, a lack of client results, or client plateaus,
none of these scenarios indicate that you're a bad coach . After all, even if you were a highly
trai ned sports dietitian (which requires about four to five years of higher education), you still
wouldn't likely know the exact prescription for every client in every situation. That's the beauty
of this system, By regu larly moni toring cli ent results, you'll have an ongoing measure of your
program 's success. If your program is producing resu lts, that's great. Keep at it. If it isn 't, that's
okay too. In two weeks very little "damage" can occur, if any. Using this method of regular
assessment ensures that you'll be able to catch programs that are in need of change before
they actually lead to body composi tion or performance problems .

THE DECISION -MAKING CHART

The flowchart in Figure 16.1 will he lp you visualize the oulcome-based coaching approach
you should be uSing with your clients. Fo llow a clear plan and measure changes at each
step. If there are positive changes, proceed with the program as before. If not, develop and
move on to the next plan.

Have follow-up plans prepared before you need them . In other words, w hen sta rting "Plan
A" you should anticipate "Pl an B" and "Plan C". This may mean preplanning changes
in exercise or calorie recommendat ions; strategies for addressing known limiting factors;
mod ify ing another habit, etc. Whether you put this backup plan into action is irreleva nt. You
should simply be ready for the possibility that a program w il l stop working. Rat he r Ihan panic
at this point , you'll know exactly what 10 do.

More advanced troubleshooting scenarios

The adheren ce and programming strategies we've discussed thus far shou ld address the
needs of most of your clients, including exercise goals, body compOSitio n changes, and
improvem en ts in a client's overall health profile. However, from time to time other questions
or problems may arise.
414 UNIT 2 Chap ter 16 Step 7 Ma"I'lg Nuill;lonal AOJu~tJll\-JlIS

B
c
FIGURE 16.1 For example, a client may experience digestive problems. Or a client may com plain of fatigue
THE DECISION ·MA KING or, conversely, nighttime restlessness. As discussed in the Introduction, these probl ems
CHART
are likely outside of your scope of pra ctice. If they aris e it's best to refer your clien ts to an
appropriate health care practitioner within your network, one who can help work with you to
troubleshoot specific clie nt health concerns.

Alternatively, a client may wonder about menopau se, nutrition for children, or vege ta rianism.
Here are a few notes on speci fic conc erns that clien ts may have and how to begin a di alogue
about them.

CHILDREN
Som e clienls have children and wonder, Can they eat this way? The meals , snacks, bars,
and Super Shakes discussed in this course are rich in vitamins, mineral s, phytonu trients,
antioxidants, and quality proteins, carbohydrates, and fats. They're also low in sugars and
processed ingredienls. The prepa ration strategies we've described can also he lp parents plan
and implement good nutrition, regar dless of the ine vi table surprises and controlled chaos
that characte rize most busy families' schedu les. Kids can also get involved in food prep and
shopping, suc h as helping to put chopped vegetables in bags, or choosing thei r favor ite fruits
and vege tab les at the grocery store, which helps teach and practice healthy habits. Both in
con tent and st ructure, this way of eati ng is abso lute ly perfect fo r the who le fam ilyl

But here's a quick note about youth nutrition, Active kid s need mo re ca lories per pound than
even adults need - about 15 to 25% mo re. Rem emb er, though, th is is per pound. They
certainly don't need as many cal ories as a fully grown adul t. To help you understa nd just how
many ca lories acti ve young boys and girls may need , see Table 16.3.
UN IT 2 Cha pt er 16 Stej:: 7 rv aklng N ul 11110nal AeJ.lstmcr' l<:, 41 5

Estimated energy needs for physically active boys and girls aged 8 to 15 years

CA LOR IE NEEDS FOR HIGH LY AC TI VE CH I LD REN

AGE BOY S GI RLS

8 2,300-2,400 2,100-2,200

9 2,400-2,500 2,300-2,400

10 2,500-2 ,600 2,400-2,500

11 2.700-2,800 2,500-2,600

12 2,800-2,900 2,600 -2.700

13 3,000-3,100 2,700-2,800

14 3,200-3,300 2,800-2,900

15 3,500-3 ,600 2,900-3,000

These data are based on average helght/we lghl statlsllC S (Center for Nationa l Hea lth Statistics, 2000 ) and the Ch il dren 's Energy Needs
Ca lculator (NCRC at the Baylor Co llege of Med iCine)

Note that even though the calor ie recommendations in Tab le 16.3 are a good baseline,
children stil l can overeat a nd accumu late excess body fat, especially if they remain
sedentary. Indeed, physical activity is crilical during the early years, perhaps even
more than during any other time dur in g the life cycle. Since children requi re more total
nutrition 10 fuel Iheir physical and men tal growth and development, they need a higher
calorie intake with a diversily of micronutrients and phytochemicals. Yet if these children
are sedentary, thi s increased calorie and nutrien t in t ake can lead to accumulation of
body fat and potential obesi ty. Making sure kids are getting daily physical activity will
ensure that all those g re at foods they're be ing fed wi ll go to good use.

VEGETARIAN CLIENTS
Some vegetarian clients wonder, Is this type of plan fo r me' All of the rul es outlined VEGETARIAN
in this course can certainly be appl i ed to vegelarians. Whi le we recommend ge tting One who eats mainly
plant-based foods
le an protein at every mea l and include l ea n beef as a Superfood, there are plenty of
protein-containing foods that are vegetarian and vegan -friend ly. Table 16.4 sugges ts
some options.

PREG NANCY
Some pregnant clients may wonder, Do I need to alter the plan for pregnancy' All of the
strategies outlined in this course are useful for pregnant women if we assume that the goal
of pregnancy is to gain weight. The m eals , snacks, bars , and Super Shakes discussed are
rich in vitamins, mi ne ra ls , phyton utrients, anti ox idants, an d quality protei ns, carbohydrates,
and fats. They're also low in suga rs and processed ingredients. Thus, they're perfect for
nourishing both a pregnanl mother a nd her baby through the duration of her pregnancy.
416 UNIT 2 Chapter 16 Step 7 Ma king Nulntlonal Ad lustm en ts

Non-meat protein sources

VEGETAR IAN VEGAN

Eggs and liqu id egg whites Ferme nted soy products: tempeh, natto. and mise

Cottage cheese ' Non -fer mented soy products?: tofu. soy milk, etc,

Lo w-fat yogurt Vegetable-based protein powde rs: brown rice, hemp. soy',
pea and blends such as Vega
Low-fat cheese
Nuts and nu t butters l
Low-fat milk
Whole tradition al grains such as Quinoa , amaranth, left,
Mi lk·based protein powders: whey an d casein and buckwheat

Egg-based protein powder s Legumes: lentils, black beans, pinto beans, etc.

Notes:
1 Be aware that some clients may have Into lerances 10 dairy
2. Consume In moderati on, rev iew pro duct ingredients carefu lly, and ensure a so urce of dietary Iod ine to ensure thyro id hea lth
3. Be awa re that these are ca lorie-d ense

Pregnant clients should choose whole-food opti ons ins tead of suppl ements where
possible. Onl y ve ry bas ic supplements without many artificial ingredients, fi llers or
MOLECU LARLY DISTILLED prese rvatives should be used (if at all ). Ensure that your clients discuss all sup pl emen t
A process that rids the recommendations with their physic ia n and lo r pharmacist before th ey take th em.
product of harmful chemicals Examples incl ud e th e foll owing:

Molecularly distilled, enteric coated fis h oi l is pe rf ect dur ing pregnancy. In fac t, studies
ENTERIC COATED
PIli or capsule coated with a
show that it might he lp enhance brain developmen t while helping to prevent postpartum
material that permits tranSit depression . Women co nsuming fis h for omega-3s sh ould choose smaller fish such as
through the stomach to the herring, mackere l, and sardines, as these are fart her down the fo od cha in and less likely
sma ll intestine before its than large fis h (such as salmon and tuna) to accumu la te environmen tal chemicals and
contents are released
toxins such as heavy metals and PCBs.
Protein supplements co nt ai ning minimal artificial ingredients are good fo r wome n who
POSTPARTUM DEPRESSION
ha ve difficulty gett in g enough protein from whole foods.
A form of depression
exp erienced immediately Women using crea tine prior to pregnancy may cont inue to take it during pregnancy,
after giving birth simply choos ing a plain crea tine monohydrate (micronized ), If not. they should avo id it.

MICRONIZED While the majority of your female clien ts are li kel y interested in fat loss, preg nant cl ients
Proces s of reducing the sho uld fo cus on healt hy weight gain. Stud ies show that low gestat ional we ight gai n (i.e.,
average diameter of a solid when th e mothe r does not ga in enough weight while pregnant) oft en resu lts in low-birth-
material's particles wei ght infan ts, who ma y expe rience dela yed development. Here, the mothe r's weight is the
prio rity : if she's not ga in ing enough, the fetus may remain small simply to prot ect the mo ther.
On the other hand, pregnancy should not be an excuse to go on the "see-food" diet and eat
unrestricted am ounts of food rega rd less of quality.
UNIT 2 Chapter 16 Step 7 Wa k'r:g Nutritional Ad lu st rnen ~s 417

Here are some gUidelines:

Underweight women should gain between 25 and 35 lb.

Overweight women should gain no more than 15 to 25 lb.
Women 5'2" or shorter should gain between 10 and 25 lb.

To achieve this weight gain, women should ingest an add it iona l 300-500 kcals per day,
close r to 500 if exercising regularly.

Nursi ng mothers can follow the same recommendation s as above. Alth ough many women tr y
to lose their "baby weight" after delivery by decreasing calories and increasing exerc ise vo lume,
nursing mothers should continue to eat a nutrient-rich diet, as these nutrients are passed along
to their child via their breast milk. In addition, many women find that during the first few months
after de livery, their appetite remains high with the metabolic demands of manufacturing breast
milk and they are fat igued and time-stressed from managing a new baby. As a trainer, you shou ld
set realis ti c expectations for activity and nutrition during this time. Focusi ng on nutrient quality,
regular exe rcise (with options for fitting activity into a hectic schedule), and simply managing day-
to-day tasks of food preparation and shopping may be sufficient.

MENOPAUSE
Most menopausal women suffer symptoms such as hot flashes, sleep disruption, depression, and
increased osteoporosis risk. What can be done to manage these symptoms? To begin with , regular
exercise is essential for treati ng all of these symptoms, particularly a balance of moderate high-
impact activity, balance exercise, and resistance tra ining that loads bones along their length; this
helps improve mood and sleep quality, and reduces the risk of fractures and fa lling.

To reduce hot flashes (which occur in about 75% of all women). women should reduce
coffee intake, add flax seeds to the diet, and practice deep , paced breath ing or other
relaxation techniques wh en hot flashes begin. Black cohosh (40 mg per day) has been
shown to reduce hot flas h incidence.
BLACK COHOSH
To improve sleep quality , reduce caffe in e intake at night and eat a small meal befo re bed Herb generally used to
(protein + fat). A single dose of ZMA (zinc-magnesium), a pre-bed dose of valerian (400 treat hot flashes and
mg). and phosphatidylserine (200-400 mg at dinner and before bed) ma y help. menopausal symptoms

To reduce depression and improve sleep quality, add fish oil (6-10 g per day) to the diet. ZMA

To reduce osteoporosis risk and improve acid-base balance of the diet (wi th a higher fruit A dietary supplement
composed of linc
and vegetab le in take), ingest a protein-carbohydrate supp leme nt during exercise.
monamethianine aspartate
It can be a bit more of a challenge to manage menopause-related weight gain. Ens ure that and magnesium aspartate;
generally used far sleep and
your calorie and nutri en t recommendation s take age and menopausal statu s in to account:
recavery by athletes
as women age, their basal metabo li c rate declines and they lose muscle. In some cases,
presc ription medications (su ch as hormones andlor antidepressants) can interfere with VALERIAN
weight loss efforts. This is why it's best to have an exerCise-friendly doc. So, if your clients Herb generally used as
don't have one, recommend tha t they do find one! a sleeping aid

Women should check wi th their physicians and pharmacists to ensure that supplements PHOSPHATIDY LSERINE
do not interact negattvely with other medications (e.g., black co hosh and HRTl. Also, as A phospholipid that
hormonal balance sh ifts, women's risk of metabolic syndrome and cardiovascular diseases plays a functional role
(e.g., heart attacks and strokes) increases significantly. You may need to monitor blood profile in membrane-related
indicators more closely, and be aware that fat depOSit io n patterns may ch ange (typically processes in the brain

migrating to the mIdsection as estradiol levels decrease).

41 8 UNIT 2 Ch apter 16 Slep 7 l\Aak. ng Nutri ti on al Ad lustments

ANDROPAUSE ANDROPAUSE
Reduct ion In en doge nous
We don' t want to leave th e boys out , so this sect ion is devoted to discussing the decl ines in
testosterone as a male
advances into older age testosterone leve ls (some times referred to as andropause ) th at men may experience as they age.
Th ese lower levels are associa ted wi th inc reasec prostate cancer risk (although it is still hotly
debated); decreased libido, mood, and overall energy; and even an inc reased heart disease risk
(again, another cont roversial area) . Unfortunately there's litl le to be done nutritionally to increase
androgen levels. How eve r, nutrition can playa role in min imizing the damage.

For example , excess body fat ca n increase the conversion of testosterone to es trog en, which
can lead to an unfavorable testo sterone- to -estrogen ratio. Ma le clients who are signifi can tly
overfat can experience sleep disruptions and poorer sleep quality, which is also assoc ialed
with lower tes tost erone levels. Th us, it's important to manage body f at. Also , lower-ca lorie,
lower-fa t, and high-sugar diets tend to decrease testosteron e levels. Make sure that your
clie nts get enough die tary protein and fat while minimizing th eir sugar intake.

TYPE II DIABETES
Wh ile man y peop le think type II diabetes is one of th ose disea ses thei r grandma gets, ve ry
few rea li ze just how prevalent th is metabo lically and physically destru ct ive disease is. First of
all, type II diabetes affects app roxima te ly 18,2 million people in the Un ited States, or 6.3%
of the populat io n. That's either an impossible number of grandmas or it's just a big por ti on
of the non-grandma population. In fact, wh ile type II diabetes used to be called "adu lt ons et
diabetes " because diabetes risk and occurrence increase after the age of 45, more and mo re
young people are now diagnosed with this condition . At least 2% of 20- to 39-year-olds have
type II diabetes; over 200 ,000 new cases are diagnosed each year. Thus, type II diabetes is
something peopl e shou ld be aware of at any age.

While th e management of type II diabe tes is abso lu tely outside of the scope of your practice,
you can certainly con trib ute to preventing it and complem enting medical the rap ies wi th nu tr ition
and exercise. Indeed, as a stud y in the New England Journal of Medicine tha t followed nearly
85,000 women for 16 years conc ludes, "the major ity of cases of type II dia betes could be
prevented by the adoption of a healthier lifesty le" and tha t "excess body fat is the single most
impor tan t determinant of type II diabetes. " All of th e strategies outlined in th is course (especi ally
the 5 Habits ) can help manage blood sugar, decrease body fat, and reduce diabetes risk.

FIBROMYALGIA
FI BROMYALG IA Fibromyalgia is a ch ron ic di sorde r characterized by widespread mus cu lo skeletal pain,
Disorder that affects fatigue, and multiple tend er points that occur in precise , loca lized areas, particularly in
muscles and th e;r
the neck, spine , shoulders, and hips. It may also cause sleep disturban ces , mornin g
attachments to bone; results
stiffness, irritab le bow el syndrome, anxiety, and other symptoms. Unfortunately th e cause of
in Increased muscu/oskefetal
pain and fatigue fibromyalgia is still unknown.

As far as nutrition goes, most experts recommend fibromy algia suffe rers foc us on reducing
stress and the stress hormone corti so l, reducing exposure to dietary tox ins, and restoring
vi tami n/ mineral stat us. Th is usua ll y means li miti ng sugar, caffe i ne, and alcohol , and
embracing many of the strategies out lined in this cou rse . It's also beneficia l to consu me anti-
inflam matory foods , including,

Cur ry powder/turmeric Cocoa Ginger

Ga rlic Tea Fatty fish
Pineapple Blueberries
UNIT 2 Chapter 16 Step 7 Mah lr'& Nul rl tlonal ACj ustmento, 419

CARDIOVASCULAR PROBLE MS
Cardiovascular disease (CVD), which includes atherosclerosis, hea rt attacks, and strokes,
has been the leadi ng or second le ad ing cause of death in Western societ ies for decades.
Whi le the treatment of CVD and its risk fac tors can be complicated, there are several dietary
strategies that we know can have an impact:

Avoiding trans fats

Incre as ing fish oil intake
Increasing dietary fiber intake
Decreasing dietary sugar in take
Balanc ing dietary fal intake wilh additional monounsaturates and po lyunsa turates

These are all strategies presented in th is course. In addition to these nutrit ional st rategies,
certa in nutritional supplements have been shown to help, CoQ l O
An antIO xidant produced by
CoQ1D depletion is likely in those taking statin drugs so it should be supplemented if a the human body; necessary
client is on these drugs . for ceffular function
Niacin (inositol hexan ic otinate) can increase HD l while lowerin g lDl, total cholesterol ,
and trlglycerides .
STATIN DRUGS
Policosanol can he lp reduce cholesterol. Pharmaceuticaf agents
Folic acid can help reduce homocysteine. that decrease cholesterol
production within the
Dietary calc ium and potassium along with garlic can help reduce blood pressure. body via downregu/ation
of HMG-CoA reductase
Of course, let's not forgel exercise in all of this. Exerc ise may be the biggest heart proteclor
of all' Yet, again, the management of heart disease is absolutely outside of the scope of your
pract ice, so be sure to discuss your client's exercise and nutrition program with their doctor. NIAC IN
A form of no-flush vitamin
ALLERGIES AND INTOLERANCES 83 that can help to improve
one 's lipid profile
If your client has a food allergy, they'll probably already know, they 've likely been rushed to
the ER at some point in their lives because of it. However, symptoms of food intolerances
POLICOSANO L
and general poor gut health are much more subtle, and inc lude gas, bloating, stuffy nose,
A dietary supplement
and general abdomina l discomfort. Some food intolerances don't have overt signs, but qu ie tly
derived from sugar cane or
increa se catabolic hormones in the body and produce a physical stress reaction . Here are the beeswax that can help to
most common food allergens and intolerances: control blood cholesterol

In adu lts, In children,

FOLIC ACID
Da iry Eggs
A B Vitamin that is essential
Seafood/shellfish Dairy for synthesis of DNA and the
Peanuts growth and division of cells
Peanuts
Tree nuts Soy
FOOD ALLERGY
Eggs Wheat
An immune response in
which the body creates
Some protein supp lements can also cause negative gastroin testinal responses although
antibodies in reaction to a
experimenting with different brands and types (rice vs. soy vs. milk) can help. If a client is
food that was consumed
suffer ing from gastro in testinal symptoms and can't locate specific foods ca using the prob lem,
there are two approaches that typically prove effective,
FOOD IN TOL ERANC E
Start a gut heal th protocol. Begin by adding probiotics, which introduce hea lthy bacteria Adverse reaction
into the gut. Next. add digestive enzymes . induced by food
420 UNIT 2 Chapter 16 Step 7 Makmg Nutritional Adj ustments

Begin a rota t ion diet. This entails removing all of the most common allergens for six to
eigh t weeks. Th is simple per iod of removal alone may help you rid your clien t of potent ial
in tolerances, after six to eight weeks of absence, they may be ab le to tolerate the trigger
foods. Once you 've removed these foods from your client's plan, introduce them back in,
one at a time, and they may pose no additional problems. If problems re·appear, you will
know to exclude the offending food fo r good.

These are safe general sol utions. Before taking any dramatic steps, discuss the plan with
your client's doctor. Again, medical nutrit io n is outside of the scope of your practice.

ANTIDEPRESSANT USE
Many people gain body fat when starting on antidepressant and/or antipsychotic medications
if they're not following a good exercise and nutrition program. And even if Ihey are following
a good exercise and nutrition program, they tend to have a hard time losing fat. The following
strategies may prove useful:

Encourage physicians and the ir patients to try different prescriptions. Not all medications
have the same impact on fat gain/preven ti on of fat loss . Some drugs may work with a
patient's metabolic physiology better than another.

Redu ce medication dose. Of course, this is only done in conjunction with a physician and an
emotional support sys tem in place.

CLA Include a green lea + CLA supplement. Recent rese arch has shown that when used in
CLA. short for conjunction with anlidepressant meds, a green tea + CLA supplement can slimulale body
conjugated linoleic acids,
fat loss.
are a type of unsaturated
fatty acid found largely These special circumstances discussed above are likely outside Ihe scope of your practice as
in meat and dairy from
a trai ner. You may feel comfortable discussing some of these issues wilh your clients. If so,
ruminants such as cows
go for it. However, before mak in g specific recommendations, it's importanl to discuss them
and sheep.
with you r clien t and their physician.

Once you've implemented an initial program , World Championships. These two athletes tra in ed
refining its features (or correcting them when together and shared an apartment. They were
they're not ideal) is both art and science . looking to fine·tune their nutritional intake so that
It requires both a strong understanding of they could achieve an ideal body composition
physiology and a good help ing of experience . As for the ir sport while ach ieving top race form and
you strive to acq uire both , the troub leshoot ing qua lifying for the Olym pics .
pr inciples and strategies presented in this chapter
Th e first of the two at hl etes, defini tel y the more
should help you along t he way.
outgo i ng of the two, contacted me every we ek or
Le ading up to the 2006 Winter Games , I was two, filling me in on wha t she was dOing training-
working with two female athletes, both top junior wise, and how her nutriti on ptan was going. Th e
co mpetitors who had done well at the Ju nior other athlete, a bit more shy and reserved , was
UN IT 2 . Chapter 16 STep 7 Making Nutlltlonal Ad lustrn ents 421

content to simply follow along with the advice carbohydrates , moderate in protein , and lower in fa t,
I gave, despite my urgings to keep me updated she deviated from this plan, follow in g her roommate's
with progress reports should she need slightly plan instead. She figured that if her roommate was
different modifications to accom plish her goals. succee ding on the plan, she would too.

As the season progressed, the first ath lete seemed Another problem was that the second athlete
to be pulling ahead of the second. She was doing stopped eating red meat duri ng the season
very well on the j unior circui t, so much so that withou t men tioning it to me . When red mea t was
she ad vanced to the World Cup Circu it. Even on the menu at home, inst ead of replacin g it with
mo re exciting, wi th about two months to go chicken or fish, she simply skipped t he protein.
before the Olympics, she qualified to co mpete at Thi s resulted in a nutritional deficiency of ca lories
the Games. Her teammat e, unfortunately, was and iron , even when she did substitute chi cken
only invited to one World Cup event while never or fish for the red meat her roommate was eating,
actually qualifying for the Olympics that year. because she lacked that nutrient source and had
no strategy fo r adding in other foods that would
After th e season , which was a very successful one
prov ide an appropriate substitute. Her food
for t he f irst athlete, ye t a disappointing one for the
preferences set her up for under-eating and what I
second , we had a meeting to discuss what went
now suspect was borderl ine anemia.
right a nd what went wrong.
If this ath lete had be en providing me with
The first ath lete was on top of the world. She
feedback during the season, I could have figured
was ecstatic with her training and nutrition
th is out and helped her troub leshoot her low
and couldn't wait till next season to take both
energy intake, fr equent co lds , and minor injuries .
to the next level. The secon d athlete had quite
However, by keeping me in the dark and simply
the opposite perspective. She claimed that her
following what seemed to work for her roommate,
training was off and that my nutrition advice
her en t ire season was negatively affected.
made her worse. She beli eve d that my nutritional
suggestions left her t oo low in ene rgy to perform This case study shoul d present an import an t
at the World Cup level. She also believed that it lesson in working with clients. Not on ly do you
made her more suscepti ble to illn ess and injury. need to give them a soli d ini tia l presc ript ion,
you also need to get regu lar feedba ck and
At thi s point you might be wond eri ng how two
troubleshoot based on th is fee dback . Make sure
athletes who lived together, trained together, and ate
you stay on top of your clients and at hletes about
together had had such a different experience. Well ,
this. I certainly could have done a better job with
after furt he r questioning, the answer was clear.
the client in this case study. However, at the tim e
For starters the two athletes started off with different r used the excu se that since these were distance·

body types. The fi rst had more of a mesomorphic based clients , th ere wasn 't much more I could
body type. So, as I coached her through the process , do. I also believed that since she wasn't checking
I kept her protein intake, fat intake, an d carb in t ake in, things must have been go i ng well for her. In
fairly balanced as outlined in Chapter 13. Since she retrospect, I now realize I could have done more
kept in touch with regular feedback and rep orting, to pr even t this problem. These days, if a client
we tweaked her plan so that it fit her perfectly and wants to work with me to achieve big goals, I
she continued to excel. The second athlete, on require them to give me bi-weekly fee dback. If
the oth er hand, had more of an ectomorphic body they' re unwill ing to do so, I recommend t ha t th ey
type. Although I advised he r to ea t a diet higher in wor k wit h a di ffe ren t fitness profess iona l.
422 UNIT 2 Chapter 16 Slep 7 'lIal',Ing N l. III \lonal AO J .J sl rlen t~

1. Nutritional adjustments are often required in the following situations:

• Poor initial progress
• Good initial progress followed by plateau
• When goals change
• When trai ning programs change
2. Use outcome-based nutritional strategies to determine whether a client's program
should stay the same or whether it should change. If the client is seeing positive
progress, it should remain the same. If not, the program should change.
3. Poor client progress could be due to one of two things:
• Poor adherence
• Poor programming
4. Regu lar assessments of client adherence should indicate whether adherence is a
problem. If it is, find the major limiting factors in each client's situation and work
with the client to eliminate them.
5. If a client's adherence isn't a problem, yet pro gress is poor, the client's nutritional
intake needs adjustment.
6. If working with a Levell or 2 client, simple intake increases or decreases may be
enough to stimulate progress. If working with a Level 3 client, you may need to
consider more precise calculations.
7. If clients have other complaints (digestive, mood, sleep, and so on), it is
likely most prudent to refer them out to a qualified health care professional or
sports dietitian.
CHAPTER 17

STEP 8:
PROVIDING
CONTINUING
EDUCATION
& SUPPORT
Chapter objectives
Key terms
Challenges to long-term success
Continuing education lessons
Lesson plan 1: Grocery
shopping tour
Lesson plan 2: Kitchen makeover
Lesson plan 3: The sugar lesson
Lesson plan 4: The fruit and
vegetable lesson
Lesson plan 5: The fat lesson
Lesson plan 6: From North
American to nutritious
Lesson plan 7 : Eating on the go
Lesson plan 8: Understand
energy balance
Chapter 17 Summary
KEY TERMS
continuing education
new normal
social support network
written praise
tangible rewards
public recognition
nutrition label
glycation
negative energy balance
modeling success
UNIT 2 Chapter 17 Ste p 8 Prov iding Con tinu ing Edu cation & Suppor t 425

Your clients wil l benefit most f rom the coa ching process if you provide Ihem with ongoing CONTINUING EDUCATION
continuing education and support. Although about half the duration of each bi -weekly ProvIsion of up- to -date

check-up appointment should be devoted to meas urement and troubleshooting, the other and relevant knowledge
to clients
ha lf of these check-ups should prov ide continuing education in the form of highly practica l
food lessons , lifestyle lessons, kitchen lessons, grocery lessons, and more .

Challenges to long-term success

Your clienls are subjec ted to the same nutritional press ures as the resl of the popu lat ion.
Therefore they likely have bu il t up a li fet ime of poor hab its, includi ng the fol lowin g,

Eating only two or three meals per day

Skipp ing breakfast
Skipping meals to try to lose weight
Dr in king too many calories in the form of sugar
Ea t in g too many convenience/processed calories every day
Eat ing too few fruits and vegetables
Eat ing too little protein

Because they 've been conditioned by these habits, cl ients may have a difficult time
adopt ing a new nutrition program based on the habits you teach them . In the face of
new challenges, it's human nature to regress to what's comfortable or seems "normal."
Therefore, when new, "abnormal" behaviors appear, clients may do fine at first. Yet
if these behav io rs aren't constantly reinforced , clients are more like ly to revert back to
NEW NORMAL
their "normal" old habits . By providing continuing education, you help to break this The process of internalizmg
pattern. Throughout the educational process. clients will begin to adjust to a new habits to create a
" new normal" while you continually reinforce a future full of more appropriate food new Idestyle
cho ices and amounts.

Beyond a client's hab its, during the course of your coaching process, clients will
undoubtedly be bombarded by the often incomplete and/or erroneous messages of friends,
family, and/or media outlets. There are hundreds of books, magazine articles, and news
segments devoted to discussing exe rc ise, nutrition, and supplementation. Controversy
ensures media attention; therefore, experts worldwide do their best to stir up a little
controversy and get noticed (hoping for an appearance on a best-seller list!. They fill our
heads with contradictions and confusion, trying to debunk what was once thought of
as true (and still may be true) .

The net resu lt of all this expert positioning and eventua l media noise is a con f used,
undereducated, and frustra ted clien t who has no nutritional direction. By prov iding your
clients with continuing education, you ca n help them filter ou t the media noise and stay the
course even in the face of confusing, contradictory info rmat ion.

Fina lly, your clients' families, friends, coworkers, teammates, and so on may be an tagonistic
toward the ir goa ls. You'll know this based on the results of the soc ial support quest ionn aires
your clien ts will fi ll out for you. If your client has a grea t sociat support network, then you're SOCIAL SUPPORT
NETWORK
one step ahead of the game. If not, your work is cut out for you . After all, you might be the
Group of people with
only individual provid in g social suppo rt. In suc h a case, focus both on continuing education whom a person surrounds
and on providing positive re inforcement for your client's efforts and for their behaviors. themselves . e.g., fflends,
Follow ing are some usefu l strateg ies . family, co -workers
426 UNIT 2 Cha pter 17 Step 8 Pr ov ld n ~ CQ n:'n cl ln" Educ al lo r & SL pp ort

REMIND CLIEN TS OF THE BIG PICTURE

One of the most common complaints from friends and fam il y is the fact that this new
devot ion to exercise and eating well "takes aw ay" from their relationships. In other words,
all t his time at the gym is taking away from soc ial time. Clients may begin to be swayed by
th is negat ive fee db ack . Howeve r, if you emphasize their big goals of look ing better, th inking
better, and fee ling better as well as t hei r personally meaningful motivations for work in g with
you, they 'll be more likely to focus on all the posi t ive things that their program is he lping
them accomplish.

CELEBRATE CLI ENT SUCCESSES

Set milestones along the way that can be celebrated. For example, if a client has been
strugg li ng with adherence and fin ally achieves 90% compliance, ce lebrate. If a client loses a
certain pre -established amount of body fat, or gains a pre-established amount of lean mass,
W RITT EN PRAIS E celebrate. These ce lebrations can come in the form of written praise, in the form of tangible
A congratulatory e-mail. an
rewards , or in t he form of public recognition . Examples include the fol lowing,
award certificate, a post
card, a greeting card, etc. Written praise, A congratulatory e-mai l, an award certificate, a postcard, a greeting card, etc.

TANG IBLE REWARDS Tangible rewards, A gift certi f icate (grocery store, supplement store, clothing store), a
A concrete form of certi ficate for a f ree training session or free week of training, an exercise- and/or nutrition-
recognition
specific gift (blender, weight scale, X-ves t, etc.), and/or a special T-shirt that you only give to
those clients who've achieved a specific milestone.

PUB LI C RECOG NI TION Public recognition , A milestone board posted at the gym for your clients, asking successful
Something a coach does clie nts to share tips (and or body transformation photos) with new clients, making special
for a client that allows them announcements in a newsletter or at the gym, and/or recognizing success at client-only
to be acknowledged in the
social/awards events.
public eye

CREATE NEW SOC IAL SUPPORT CIRCLES

Another grea t way to motivate and inspire your clients is to create socia! support events. You
can do t his by scheduling social activities (healthy dinners and cocktail parties) and physical
activity events (sports days, physical challenges, group workouts) for them. By drawing
together a strong network of individuals working toward common goals, your clients can get
to know one another and, in doing so, forge relationships. This may lead to these clients
exercising together, sharing recipes, sharing eat ing tips, and providing encouragement and
motivation . This external support can go a long way toward keeping your clients surrounded
by posit ive influences while eliminating some of the social support burden placed on you. In
addition, with you as the center of these ne tworking activit ies, you're guaranteed both repeat
bus iness and referrals,

Continu i ng education lessons

In the face of past habits and current pressures, it's hard for clients to stick with a new
nutrition plan without a social support and education system. As a trainer, it's your job to
counterattack old habits, f lawed ideas, and downward social pressure. You can do this with
the following,

Grocery store, kitchen, and restaurant lessons

Food education
Regular positive feedback and messaging
UNIT 2 Chapter 17 Slep 8 PrO'j ,d I'g COIl II'IL I')>; Eu ucat 0 '1 &. 5',r r'I" t 427

Bui[ding up t rus t and authority

Leading by example
Providing lifestyle mentorship

These strategies are easy to accomplish with the bi-week ly structure outlined in this course.
[f a client is working with you for 16 weeks, you'll have the opportunity to make an impact
during eight weekly one-hour sessions. If you ' re also training w ith them three to five times a
week, these lesso ns ca n be rei nforced multip le times each week. Prov ide them w ith take -
home materials and you can influence them even when they're not w ith you. Finally, if you
can create social support circles, you r clients may support each other.

Most of these lessons need not take longer tha n 30 minu tes, although some (such as grocery
shopping or a kitc hen makeoverl w i ll take [anger. However, if you pre-establ ish lesson plans,
the time spent will be minim i zed and the return on this time spent will be high. This chapter
outlines eight lesson plans that cover 16 weeks of nutritional coaching .

Each of these lesson plans is designed to be very practical. Your clients don't n eed theo re tica l
or academic nutritional information; they need coping and implementation strategies.
Remember, too, that to deliver the best and most cred ible messages, you'll need to know
these strategies and do them yourself. As discussed in Chapter 10, the best coaches are
those who know, those who do, and those w ho have coached others to success. Spend some
time on yourself before working on your clients .

Lesson plan 1: Grocery shopping tour

[n this [esson, you'l l actually take cl ients to the grocery store to give them a crash course on
healthy shopping habits . You can do the tour one-an-one or in small groups of th ree or four
to save time.

TOPIC 1: THE GROCERY LIST

Before heading to the grocery store, work with your clients to prepare a comprehensive
weekly shOPPing list. This will provide clear direction for your shopping outing. During this
trip, your client should leave w ith everything on their list and nothing more.

TOPIC 2: THE SHOPPING PATHWAY

Teach clients to shop mostly around the perimeter of the grocery store. Th is is where they' ll
find the following:

Fruits and vegetables

Lean meats
Whole grains
Dairy

Brief trips into t he center aisles are acceptable for specific items on the grocery list. However,
these trips can le ad to the selection of [ower-quality food items so caution your clients agai nst
impu lse purchases.

TOPIC 3: LOCATING SUPERFOODS AND NONTRADITIONAL ITEMS

While the items on your clients' Superfoods list may be commonplace to you, to some clients
these items are nontraditional and you'll need to direct them to the aisles that contain these
428 UNIT 2 Cha p te r 17 Slep 8 Prov iding Co ntinUi ng Ed uc ati on & Suppo rt

foods (and even, possibly, show them w hat t hese foods actual ly look like) . These foods may
include the follow ing,

Flax seeds
W hole oats
Healthy oils (olive oil, fish oil, etc.)
Whole grai ns
Bulk nutrition

Be sure your cli ents know how to recogn ize better select ions and know where to find them.

TOPIC 4 : READING THE LABELS

Very few of your clients will know what to look for when checking food labels. Help them
pr ioritize their search.

Teach them to look for and avoid foods with,

trans fats
long ingred ient li sts containing lots of artifici al Ingredients and added chemicals
oth erwise healthy products that contai n unhealthy additional sugars added (sucrose,
glucose, sugar, maltodextrin, corn syrup, etc.)

Also instruct them to be skeptica l of foods making health claims on the package. ThIS
can include:

"added vitam ins and minera ls"

"who lesome" or "healthy"

"no added sugar"

"contains rea l fruit"
"natural"
"fat-free"; "Iow-carb"; "high-protein"

Explain to them that if a food needs to make health claims on the label, there is a good
chance that it is not actually good for them.

TOPIC 5 : BARGAIN HUNTING

Teach your clients to be discriminating shoppers and choose the best foods at the
lowest prices. Some "healthier selections" can be quite pricey so it's important to find
t he lowest-cost healthy selection. Typically, brand names are more expensive so when
two products have the same ingredient list, choose the less expensive one. Suggest t ha t
clients explore farmers' markets, butchers, and indepe ndent supermarkets as well as
"big-box" chains.

Lesson plan 2: Kitchen makeove r

In th is lesson, you'll actually go to your client's home to survey their kitchen setup. Look for
the presence of high-qua lity and low-quality foods: and for time-saving food prep appl iances
and storage systems. Help clients get rid of foods that aren't beneficial, replacing them with
foods that are.
UNIT 2 l Chapter 17 Step 8 . Pro viding Conlin Ulng Education & Suppo rt 429

TOPIC 1: GET RID OF LOW -QUALITY FOODS

Do an inventory of your client's kitchen, looking at how many low-qualily foods, canned
goods, highly processed items , sauces, dressing, snacks, additives, etc, are present.

Tell your clients why certain foods shouldn't be in their kitchen, working from the nutrition NUTR ITION LA BE L
labels for reference. Talk about the problematic ingredients that have been added (e,g., trans A label on packaged
fals, sugars, artificial ingredients) and the beneficial ingredients that have been removed food products thai fists
nutfitlO n fact s
(e.g., fiber, phytonutrients).

Show clients how to differentiale whole from processed foods, and explain that the less
processed the better.

Highlight the fact that while no foods are absolutely off limils , having low-quality foods in the
house leads to eating more of them than is desirable,

Bring garbage bags or boxes and deposit the low -quality foods into them , Take them with you
when you go, Compost items if possib le and recycle the packaging if you can , Donate those
Ihat are not truly damaging (j,e" that may be inappropriate for your client, but not entirely
unfit for consumption) to a local food bank or home less shelter, Discard the remainder.

TOP IC 2: APPLIANCE AND STORAGE INVENTORY

As your clients will have to get better at food prep and food storage, it's importanl to be sure
that they have the right items in their kitchen.

Make sure they have the following:

A good set of pots and pans A cooler for carry ing pre-made meals
A good set of knives A food weight scale
A blender or comparable device Measuring cups and spoons
A tea pot for green tea Indoor grill and/or gas barbecue grill
Shaker bottles for drinks on the go Aluminum foi l and plastic wrap
Food storage co ntainers of diffe ren t Zip-top bags
sizes, some for food storage and some
for food transport

If your client is miSSing any of these items , explain why each item is useful and encourage
them to purchase the item(s) as soon as possible,

TOP IC 3: RESTOCK THEIR KITCHEN

By now, your client's kitchen may be getting empty, Help them restock their kitchen with
higher-quality foods. Lesson 1 will come in handy here.

You can either shop before this lesson or after. Either way, don't leave your clients with an
empty kitchen, (That's a good excuse for a client to phone for pizza .)

Get the good foods into the kitchen and help your clienls organize them, By keeping a tidy
fridge and freezer as well as keeping foods and appliances organized in the pantry, food
prep will be much easier and quicker, and your client will be more likely to follow your
nutrition advice.
430 UN IT 2 Chapter 17 S:t'J) 8 P-Gli IOl'1 g CO nl lnu' I1 R Ed.J(:d llon & Support

TOPIC 4: BASIC COOKING

Whil e nei ther you no r your clients have to be a 5-star chef, you shou ld possess some basic
cooking ski lls . Go over the following with you r clients:

Making Super Shakes

Chopp ing vegetables for th e week
Gri lling and prepar in g (in cludi ng seasoning) protein selections for the week
Making homemade protein/en ergy bars
The breakfast ritual
The Sunday ritual

Lesson plan 3: The sugar lesson

This lesson can lak e place at the gym during a regu lar bi -weekly chec k-up appointment, and
informs clients about the dangers of eating too much sugar, as well as how to avoid eating a
diet high in sugar.

TOPIC 1: OANGERS OF A CHRONIC HIGH-SUGAR DIET

Key points to sha re with client s:

Chronic higher suga r intake ca n redu ce the bod y's ability to han dle carboh ydrates .
This redu ce s insulin sen sitivity.
This increases insulin response to meals.
This leads to excess fat gain due to chronic high insulin levels (espec ially around the
"love handle" and upper back areas) .
The even tual co nseq uen ce of poor carbohydrate tole ran ce is borderline or full -
blown diabetes.
High amounls of suga r in the blood, caused by chroni c high-sugar intake, can cause the
GLYCATI ON binding of sugar molec ules 10 blood proteins. Th is is called glycalion .
Bmding of a s/Jgar molec ule Gl ycation of proteins causes decreased biological activity of prote in s and has been lin ked
without the controlling
to the following (and more):
action of an en zym e
Prem ature aging
Cancer
Altered vision, ca tara cts, retinopathy
Alzheimer' s
Vascular disease
Erectile dysfunction
Kidney disease
Joint pa in and arthrit is
UNIT 2 Chapter 17 Slep 8 P' ovld ,n g Cr: n:1I1 u.r g E ~ ] u calio r, & SJppo n 431

TOPIC 2: THE PREVALENCE OF ADDED SUGAR

Encourage your clients to avoid adding sugar du ring food preparations.

Teach your clients these synonyms for sugaL

sucrose hydrolyzed sta rch agave necta r
fructose invert suga r sugar beets
glucose corn syrup high -fructose
ma lto se honey corn sweetener

dextrose cane sugar maple sugar

maltodextrin molasses

Foods that contain less than 5 g of sugar per 100 g of food are conside red "low-sugar",
although your clients should look for foods with as close to a g of sugar as possible.

Food manufacturers add sugar to many foods you'd never expect (f rozen fruit, bread,
dressings, sauces, and more). Instr uct cli ents to read food labels critically and carefully. Be
aware that sometimes fruit concen trates and purees are also used as sweeteners.

TOPIC 3: THE SUGAR CONTENT OF CO MMON FOODS

Show your clien ts how much sugar common foods contain. Tab le 17.1 provides a
helpful sta rt.

Share some typica l North Amer ican sugar intake information.

The typical North American consumes 34 tea spoons (136 gl of sugar per day.

Su gar content of common foods

FOOD SUGAR CONTEN T

2 slices of white bread 3 teaspoons

1 bowl of cereal 4-5 teaspoo ns

1 bage l 4 -5 teaspoons

112 cup of dri ed fruit 4 teaspoons

1/2 cup fruit ju ice 3-4 teaspoons

1 can of soft drink 9 teaspoons

1 cup of chocolate milk 6 teaspoons

1 bowl of ice cream 23 teaspoons

432 UNIT 2 Chapter 17 Slep 8 Prov id ing Co ntin u ing Ed ucallon & Support

Tab le 17 .2 shows one sam ple day

Suga r inta ke in an av erage day of the North America n diet

MEAL FOO DS EATEN SUGAR CONTEN T

(t ea spoons )

Breakfast 1.5 cups cereal, 1 cup orange Juice , 1 cup milk 10

Snack 2 toaster pastries and 1 can of soft dnnk 15

Lunch 1 sandwich. 1 granola bar, 1 cup apple jUice 7

Snack 1 ser ving applesa uce, 1 cup Ga torade 7

Dinner Salad with dreSSing, 1 pota to, pork chops. 2 coo ki es 6

Tota l intake for the day 45 tsp (180 g)

Go through your client's food record and determine how much sugar they were eating per
meal and over the course of each day.

Set sugar intake goals and limits for cl ients.

The USDA recomme nds no more tha n 10 teaspoons (40 g) per day.

If your clients are trying to lose fat, they may need even fewer.

TOPIC 4: SUGAR DURING AND AFTER EXERCISE

Discuss sugar intake in the form of spo rts drinks during/after exercise.

Fo r clients interested in fat loss, even th is sugar should be minimized.

Clie nts interested in muscle gain or clients look ing to sup po rt trai ning and sports
pe rforman ce can inc lude these sugars.

Car bohydrate tolerance is much improved during and immediately after exercise and
t he refor e sugars are handled differently t ha n during other times of the day.

As long as sugars are min im ized du ring othe r meals, th is sma ll daily amount of sugar can be
beneficial.

For more detail on sports dr inks , see Chapter 13 .

UNIT 2 Chapter 17 Step 8 Prov iding Continuing Ed uca l lOf"l & Support 433

Lesson plan 4: The fruit and vegetable lesson

This lesson can take place at the gym during a regular bi-weekly check-up appoinlment, and
informs clients about the bene fits of eati ng enough fruits and vegetables as well as how to
ensure an adequate fruit and vegetable intake.

TOPIC 1: BENEFITS OF VEGETABLES AND FRUITS

Higher intakes of vegetables and fruits are necessary and important.

Higher vitamin and mineral intake preve n ts malnutrit io n and nu trien t deficiencies.

Higher intake of phytonutrients reduces the risk of many cancers , diabetes, and heart disease.

Higher intake of antioxidants reduces free -radical damage.

Sirong alkaline potential balances out dielary acids (coming from proteins and grainsl and
reduces osteoporosis risk .

Higher intake of f iber improves blood sugar contro l; reduces appetite; and increases
digestive health.

TOPIC 2: SERVING SIZES AND DAILY RECOMMENDATIONS

Recommend that clients get be tween 8-12 servings of vegetables and fruits each day.

A serving is equa l to :
1 medium-sized fruit
1/2 cup raw chopped fruit or vegelables
1 cup of raw leafy vegetables
Each client shou ld include at least 2 servings of vegetables and/or fr uits wilh each meal.
Give clients examples of what 10 daily servings looks like:
1 app le
1/2 cup pineapple
1 cup frozen berries
1 cup spinach
1 tomato
1 avocado
Put this intake into the con text of a da ily menu or sample meal(sL
1/2 cup green peppers, 1/2 cup red peppers, 1/2 cup onions, and 1/2 cup mushrooms
with breakfast omelet
1/2 cup pineapple with morning snack
1 cup spinach, 1 tomato, 1/2 avocado with lunch salad
1 cup berries mixed in afternoon Supe rShake
1/2 avocado with dinner

Fo r clients interested in fat loss , eat more vege tables than fruit as vegetables are less calorie
dense . The typical ratio in this scenario would be five vegetables for everyone fruit.
For cli ents interested in performance enhancement and/or muscle gain, t his ratio of
vegetables to fruit can be closer to three vegetables for everyone fr uit.
434 UNIT 2 Chapter 17 STe p 8 P'ov lOing Contlo1U1n i; Ed ucat io n & Sup port

TOPIC 3: PREPARATION STRATEGIES

Many clients avoid vegetables because they claim not to like them. Usually this is because
they have little experience with the variety of vegetables and preparation methods available.

In troduce different vegetable varieties.

Suggest various preparation methods, such as :

raw and/o r in salads stir-fried or sauteed
steamed juiced with a juicer
baked or roasted

Discuss using t hem as snacks vs. using them in ma in courses.

With experimentation even the worst vegetable opponent will come around.

Some clients will not be able to tolerate raw vegetables . They may get gassy and bloated
when eating them. In this case . simply steaming the vegetables will make a big difference.

TOPIC 4: VEGETABLE ALTERNATIVES

As discussed in Chapter 14, during times where vegetable select ion and/or intake is limited,
vege table supplements may provide a useful alternative.

Vegetable suppleme nts are equivalent to prote in supplements, in that they're powdered
extracts of specific fruits and vegetables .

These supplements should not serve as a long-term solut io n to low fruit and vege table intake
but rather a short-term solu t ion in specific situations.

Lesson plan 5: The fat lesson

Th is lesson can take place at the gym during a regular bi-weekly check-up appointment, and
informs clients about the benefits of balancing out the ir dietary fats as well as how to get a
variety of healthy fats each day.

TOPIC 1: TYPES OF FAT AND FAT BALANCE

Your clients many not be aware of the different types of fats:

Sat ura ted fats

Monounsaturated fats
Polyunsaturated fats

The fat charts presented in Chapter 13 will help your clients know which foods provide
wh ich types of fats.

Explain to your clients that each type of fat should be present in the diet and that an even
balance of the three types is likely best for overall health.

Fa t balance is important for:

hor monal regulation, including female menstruation and male testosterone production
a healthy immune system
a healthy inflammatory balance in the body

The easiest way to balance out the three types of fat is to add healthy fats to a client's daily diet.
UN IT 2 Chapter 17 Sten 8 P' OVI(l I"'b COJ' tI11LJ lJ' g Ec uc alic: 1l & SUOJpa rt 435

You r client will be getting some satura ted fat from their protein selections .

Monounsaturates and po lyunsatura tes should come from these sources:

avocado flax oil hemp
nu ts flax seeds fish oi l
olive oil

TOPIC 2: OMEGA FATS

Total fa t balance plays a role in hea l th. So does the ba lance of omega -3 and omega -6 fats.

Most dietary polyunsaturated fals come from Ihe omega-6 category, so it's importanl to
inc lude omega-3 rich foods and supp lements such as,
fish oil flax oil chia seeds
flax seeds hemp seeds algae oil
By adding these omega -3-rich foods da il y, the omega-6 to omega-3 ratio will improve,
leading to a better hea lt h and inflammation profile.

TOPIC 3: FISH OIL

Alt hough the beneficia l omega-3 fa ts EPA and DHA are prevalent in fis h, comme rcia l fish
may be co ntam inated with env ironmenta l toxins in varying amounts. Thus, it's best to keep
fish in take to a minimum wh il e supplementing with EPA- and DHA-rich fish oi l.

To optimize heal th, co nsume about 900 mg of EPA and DHA per day (eq uivalent to about
3 g of to tal fish oil) although higher intakes (up to 3 g of EPA + DHA or 10 g of fish oil per
day) ha ve shown additiona l benefit.

Fish oil has been show n to do the follow ing,

Decrease the risks for hea rt disease , diabetes , and certai n cancers
In crease metabolic rate
He lp reduce fat mass and increase lea n mass
Reduce inflammation in the body
Reduce pa in associa ted with inflammatory disorders such as arthritis, chronic fatigue , etc.
Improve mood whi le decreas ing symptoms of depress ion

Lesson plan 6 : From North American to nutritious

Th is lesson can take place at the gym during a regular bi -weekly check-up appointment. The
pu rpose of this tesson is to discuss typical North Amer ican eat ing patlerns and highlight how
each pattern can be improved With a few simp le tips .

TOPIC 1: TYPICAL MEAL PATTERNING

Cri tica ll y review a typ ical day of North Amer ican eat ing with your cli ent. Have thern
critique this eating pattern as best they can , bas ed on the informa tion you've shared
with them. Supp lement the ir input with additional explanat ion of what's wrong with this
inta ke as needed .
436 UNIT 2 : Chapter 17 Step 8 Providing Co ntin uing Education & Su ppor t

BR EAKFAST Cereal, ora nge juice, bagel, and/or toas t

Sk ip breakfast altogether
SN AC K Granola bar, c ra ckers, ca nd y, and/or fruit
Skip snack altogether
LUN CH Sandwich and juice or soft drink
SNACK Sam e as earl ier
DINNER Meat, vegetab les , starchy carbohyd rate
SNA CK More snack food, popcorn, and/or ice cream
Sample criticisms:

Not enough protein and/or nutrients through the morning hours; breakfast is Ihe most
impertan t meal of t he day
Too many processed/sugary carbohydrates
Little to no healthy fat intake
Fru it and vegetable intake is fa r below the reco mmendati on
Too many calories later in t he day when client is more sedentary
Too little water

TOPIC 2: IMPROVING TYP ICAL MEAL PATTERNS

Encourage your clients to follow the 5 Ha bits, and exp lain the rationale for each:

Habit 1: Eat every 2 to 4 hours

For improved health profile, metabolism and bod y co mposition

Leads to more frequent feeding
Leads to a better ability to reac h total ca lo rie intake needs

Habit 2: Eat lean, complete protein with each feeding

Easiest way to suppert da ily protein needs

May improve metabolism, body composition, and pe rformance

Habit 3: Eat vegetables with each feeding

Easiest way to achieve daily vegetable needs

Improved micronutrient and phytochemical intake
Improves acid/base status of th e body

Habil 4: Save high-slarch meals until after exercise

Eas iest way to control carb intake

Hel ps with nutrient liming

Habil 5 : Eal good fats da ily

Easiest way to balan ce fat intake

Improved inflammation, hormonal profile, and meta bo li sm
UNIT 2 i Chapter 17 Step 8 Provldmg Con tin Ui ng Education & Su pport 437

Provide sample meals and snacks for clients who follow the 5 Habits. This will help
them visualize how to incorporate the habits into their regular day_

TOPIC 3: CRITIQUING EXAMPLE DIETS AND MAKING SUGGESTIONS

FOR IMPROVEMENT
One great way to get your clients thinking about improving their intake is to perform a
meal replacement exercise.

Provide your c lient with a few sample menus collected from new client diet records.

Have t he c li ent provide a written critique of each meal based on the 5 Habit s.

Have the clien t provide an alternative meal based on the 5 Habits .

Tab le 17.3 provides an example of what this sheet might look like.

5 Ha bits com patibi lity te st

MEAL FOO DS HAB IT UA LLY COMPATI BLE W IT H WHY OR WHY NOT? ALTER NAT IVE MEAL
EATE N 5 HAB ITS? BASED ON HAB ITS

Breakfast Bowl of cereal

(with milk)
Orange juice
Coffee, cream
and sugar

Snack Bagel wit h cream

cheese
Coffee, cream, and
sugar

Lunch Sandwich with 2

slices wheat bread
and tuna salad
Cu p of soup
Diet soda

Snack Hand ful of mixed

nuts or candy at
the office
Soda

Exercise

Dinner Steak, mashed

potat oes, asparagus
Glass of wine

Snack Small bowl of

ice cream
Hot tea
438 UNIT 2 Chapter 17 St('p 8 Prov ld, ng COnl u'lI nr EC LI calto') & Supoon

Lesson plan 7: Eating on the go

This lesson can take place at the gym during a regular bi-week ly check-up appointment,
and provides clients with strategies for eating on the go.

TOPIC 1: STRATEGIES FOR CLIENTS WITH BUSY SCHEDULES

Near ly all of your clients will be "busy" and some will complain of having no time to
prepare meals. For th ese cl ien ts, the fol low ing strategies (outlined in Chapter 16 )
will help:

The Sunday rit ual

The breakfast ritual
Pre-cooking prote in
Pre-chopping vegetables
Li quid nutrition

TOPIC 2: RESTAURANT EATERS

Some of your clients will hate cooking or, due to specific lifestyle choices, frequently
eat out at restaurants. For these clients, the following strategies (outlined in Chapter 16)
will help:

Choose custom meals

Use the 5 Habits
Choose compliant restaurants

TOPIC 3: FREQUENT FLIERS AND TRAVELERS

Some of your clients will travel frequently and have to eat away from home. For these clients,
the following strategies (outlined in Chapte r 16) will he lp :

Choose the best location (where everything they need is in close prox imity)
Choose a room with a kitchenette
Ship some items beforehand
Carry a big coo ler
Restaurant menus
Bring protein supplements
Bring powdered vegetables
Bring homemade bars

Lesson plan 8: Understand energy balance

This lesson can take place at the gym during a regular bi-weekly check-up appointment.
The purpose of this lesson is to help clients understand how and why seemingly different
nutriti on plans can all produce a posit ive re sult. The foundation of this message is the cont rol
of energy ba la nce.
UN IT 2 Chapter 17 Step 8 P' 8vld mg Con tln'J lllg Ed uca l lo" & SU8por l 439

TOPIC 1: THE COMMON DENOMINATOR

Energy status in the body is the relationsh ip between energy intake and expenditure.

If energy intake is greater than expenditure , weight is gained.

If energy in take is less than expenditure, weight is lost.

If energy intake is equal to expenditure, weight is maintained.

This is the most i mportan t determining factor of a client's progress.

The common denomi nator between all successfu l we ight loss plans, whether it's the Atkins
Diet (low carb/high fat) or the Orn i sh Plan (high carb/ low fat), a high -vo lume endurance
exercise program or a high -volume strength training plan, is that a negative energy balance
is established.

Following any nu trit ion plan typically leads to calorie co ntrol.

Increasing exercise vo lume typically leads to calorie control.

Restricting intake of any macronutrient leads to calorie control.

Therefore your clients must understand the following,

NEGATIVE
If they want to lose weigh t they must establish a negative energy balance. ENERGY BALANCE
If Ihey want to gain weight they must establish a positive energy balance . When energy flow out of the
body exceeds energy in
TOPIC 2: NEGATIVE ENERGY BALANCE THE RIGHT WAY
There are many ways to estab li sh a negative energy ba lance,

Restrict a macronut rient

Eat sma ll er meals
Skip meals
Exercise more
Fast
Wire jaw shut
Develop an eating disorder
Be born with a ve ry fast metabolic rate

Obviously not all of these ways are desirable.

The best way to estab l ish a negative energy balance is to increase exercise vo lume to five
to seven hours per week.

This allows a client to main tain a fairly high energy intake. full of health-promoting nutrients,
while st ill ealing fewer calories that they're expending .

The strategies outlined in this course are designed specifically to help you master energy balance
while also maxim izing nutrient intake, health profile, and da il y or athletic performance.
440 UN IT 2 Chapter 17 Slep 8 Provldlll g Co nl lnulIlg Ed uca tion & Support

TOP IC 3 : MODELING SUCCESS

Many lifestyle variables con tribute to a betler control of energy ba l ance. Not on ly do calorie
intake and purposeful exercise play i nto energy ba lance, so do:

Macronut ri ent type

Macronutrient tim i ng
Type of purposeful physical activity
MOOELING SUCCESS
Seeking out those Spontaneous physical activity
individuals who are
Nonexercise activity
successful with nutrition
and exercise. and then Those successful in body transformation Iypica lly have established the right lifestyle hab its
modeling their behavior and therefore should be mode led . Not only shou ld their diet and gym workouts be copied,
but so shou ld their ot her activities.

Instead of cl ients fol lowing the media, book authors , or unsuccessful friends!fami ly!
coworkers, encourage them to find a mentor who has been successful and copy that person's
habits, patterns, and behaviors.
UNIT 2 Chapter 17 St ep 8 P(O\lId lng Con tl numg Ed ucat ion & SU PPOf t 441

As discussed in this unit, individuals' behavioral enjoy the process because they have like-minded
choices are strongly affected by the social support indivi duals wi th whom to share th is progress .
that's available to them. Studies repeatedly show
One particular client we worked with had yo-yo
that what a person accomplishes in life is directly
dieted for years, losing and regaining the same
correlated with the people around them. Thi s is
10-15 lb. After we provided her with a long-
particularly true with fitness. That's why even
term education and support program, she lost
those nutrition programs that don 't provide sound
32 Ib in 24 weeks and, as of this printing, has
nutritional advice, but do provide group meetings
successfully maintained this weight loss. Duri ng
and social support, can help people lose weight
follow-up discussions, she commented that in
and improve their health. The best recipe for
the past, friends, family, and co-workers would
body transforma tion is a combination of sound
always sabotage her once her body changes had
nutritional advice, approp ri ate exe rcise training,
beco me noticeable . However, during the coach in g
and social support.
program, she developed friendships with a group
Several exce llent online coaching programs of supportive individuals who helped her through
provide such a service (e.g. , Precision Nutrition's the tough times , including those situations in
Lean Eating Coaching Program). These programs which those close to her were unsupportive.
provide nutrition and exerc ise advice as well
These stories are quite common and we've all
as the critical element of social support. They
heard them repeated ly. In the past, little resear ch
accomplish this by crea ti ng online discussion
addressed this top ic. However, science now
groups in which coaching members can discuss
clearly demons trates a powerful li nk between
what they're doing, why they' re doing it , and how
body transformation and social support. Fitness
they feel about it. In addition, this format allows
programs that don't include some element
their coaches to help shape group discussions. In
of social support are missing a key element
this context, participants are more likely to stick
necessary for success.
to the program , achieve their initial goals, and
442 UNIT 2 Chapter 17 Sleo 8 Prov ld, ng Contin uing Ed Jcatlon & Support

1. Because of past habits, media pressure, and la ck of social support, many cl ients
will require continuing education and support to successfully change their
nutritiona l attitudes and behaviors.
2. To reinforce client success, you should do the following:
• Keep clients focused on the big picture;
• Ce lebrate client success; and
• Create social support circ les.
3 . To fu rther keep cl ien ts on track as they attempt to create a "new normal" you
shou ld also provide the following:
• Grocery store, kitchen, and restaurant lessons;
• Food education;
• Regular positive feedback and messaging;
• Trust and authority;
• Positive examples; and
• Lifestyle mentorship.
4. To be a great role model for clients, you' ll need to know, do, and teach. Follow the
lessons you plan to teach you r clients .
5. The eight-lesson curri cu lum provi ded in this chapter provides highly practica l
lessons for cooking, shopping, and ordering mea ls. It also provides basic lessons
on sugar, fat, fruits and vegetables.
6. Each lesson should be built into one of your bi-weekly check-up appointments and
given after the week's assessments.
443

GLOSSARY OF KEY TERMS

a- ketoacid Anor ex ia athl etica

Unit 1 An organic acid co nt aining a fu nc t IOna l Use of excessive exercise to cont ro l
ke tone g r oup and a carb oxyli c a cid b odywelgf lt
A Alpha linolenic acid (ALA) Anorexia nervosa
Acetyl -CoA Unsaturated omega-3 fatty acid Self-induced starvation
Co-enzyme that plays a role in Am enorrhea Antioxi da nt prote ction
intermediary metabolism; can enter the Abnormal suppression or absence of A compound capable of preventlngl
Krebs cycle to produce energy and be menstruation slowing oxidation
used for fatty acid synthesis
Amine Apolipopro te in
Actin One of a group of organic nitrogen Lipid binding protem that is part of a
Thin fibrous muscle protein that is necessary compounds lipoprotein
for cell shape and can bind to myosin
Am ino groups Atherosclerosis
Active transport Functional group (abbreviated as NH) Development of plaque m the lumen
Movement of particles from an area of that contains a nitrogen atom (interior space) of blood vessels
low concentration to an area of high
concentratIOn; requires energy and enzym es Ammonia ATP / PCr system
Also known as NH ,j' a very basic end Composed of ATP and phosphocreatine.
Ad enos ine diphosphate (ADP) this system rep lenishes oxygen rapidly
produc t of pro tein metaboli sm
Nuc leotide produce d in livmg ce lls ; made wi thout the use of oxygen
up of adenosine and two phosphate group s, Amyl ase

reversibly renewed to ATP for energy tran sfe r Of pancreatic and salivary orig in. this Avidin
enzyme ca talyzes the hydrolysis (spli tting) A compound found in raw egg album en
Adenosine triphosphate ( ATP) of starch Into smaller compound s that inactivates biotin
Adenosine molecule with three phosphate
Amylopectin
8fOUps that supplies energy for the cell
A component of starch characterized by its B
Antidiuretic hormone (ACH) highly branched structure and fast digestion Basal metabo lic ra te (BMR )
Hormone secreted by the pituitary gland
Am ylo se Level of energy required to sustain the
that helps to control body Vlater
A component of starch characterized by body's vital functIOns in the waking state
Ad i po cyt e straight chams of glucose units Beta oxi dation
Fat cell
Anaerobic Breakdown of fatty acids that takes place
Ad ipose ti ss ue Without oxygen present in the mitochondria and peroxlsomes
Fat tissue
Anaerobic threshold Bicarbon ate
Adrenal medull a The po i nt at which la ctic acid begins to Organic sa lt (HCO,) tflat can neu tr alize
Central part of the a dr enal gtand that accumu late in the bl oodstr ea m a ci ds
secret es epinep hr ine, norepin ephrine and
Angiot ensin converting enzyme (ACE) Bile
dopamine
Enzyme that catalyzes the conver sion of FlUid produced by the li ver and stored
Aerobic angiotensin I to angiotensin II in the gallbladder. ultimately secret ed
With oxygen present into the small intestine to atka/mize and
Angi oten si n I
emulsify foodstuffs
Aldosterone Hormone converted to angiotensin 1/
Water- and electrolyte-regulating hormone Binge ea t ing
released by the adrenal cort ex Angi oten si n II
Uncontrollable consumptIOn of excessive
Hormone that stimulates aldosterone
a -ce ll s amounts of food in a very short period
release and constricts blood vessels; helps
Endocrine cells of the pancreas that of time
to regulate blood volume and pressure
secrete glucagon
GLOSSARY Or KEY TERM S
444

Bi oelectrical impeda nce ana lysis (B IA) Cardiac output Cori cycle
Method of body compo sition measurement. Volume of blood pumped by the heart Use of lactate produced in the muscles by
estimates to tal body water by determining the th e liver for the produ ction of glucos e
Catalyze
opposition to flow of an ele ctrical current
Initi ate or increase the rate of a chemic al Counter -regulatory hormone
Blood·brain barrier rea ction Hormone that opposes the action of
Natural barrier formed by bram capillaries Insullfl
Cation
that prevents substances from lea ving the
Po sitively charged Ions cox enzyme activity
blood and entenng brain tissue
Either of two related enzymes that control
Cerebral edema
Body composition the production of biological mediators
Excessive flUid in the brain
Relative relationship between lean body from arachidonic aCid
mass (which Includes bone mass, body Cholecalcifero l
Creatine
water. muscle mass, and organ mass) and Vitamin 03
Nitrogenous substance. derived from
fat mass (which Iflcfudes adipose tissue Cholesterol argmine, glycine and meth ionine, found in
and mtra-tissue fat deposits) Lipid/s terol contained in the body's cells muscle tissue
Bolus and fluids that ac ts as a precursor to
Creatine kinase
A form ed mass of soft. partially chewed food horm ones and bodily structures
Isoenzyme found in muscle and brain
Bomb ca lo rimeter Chromosome tis sue tha t ca talyzes the formation of ATP:
A rigid vessel used for measurlllg heat Organized structure of DNA, found within higher after ti ssue injury
of combu stion ce lls, that contains the genes of an organrsm
Cristae
Branched chain amino Chylomicron Internal compartments of the
acid (BCAA) A lipoprotein that transports cholesterol mitochondria
Amino acid with aliphatic side cham that and tnglyceride from the small inte stines
Cross - bridges
is non-linear to tissues of the body
Formed when the head of myos in
Bulimia nervosa Chyme temporarily attach es to actin
Uncontrolled episodes of overeating Partly digested foo d formed as a semi -
Cross-referral system
followed by some form of purging fluid mass
System in which two health and fitness
Cisterna
c Flattened membrane disc of Goigi
apparatu s (pluraf. cisternae)
professionals (su ch as a physiCian
personal tramer) actively recommend
or

Calciferol each other's complementary servic es to

Vitamin D Co-enzyme thelf own clients and patients
Non-protein compound that form s the Cytochrome
Calorie
active portion of an enzyme system Protein found in mitochondria (inner
Amount of energy reqUired to rais e the
temp era ture of one kilogram of water by 1 Co-factor membrane) that transports efectrons
degree Celsius; equal to 4184 Joule s No n-protein compound that interacts Cytoplasm
with another sub stance to faCilitate a Fluid medium in side of the cell. but
calorie
tran sformation out side of the nucle us, that surrounds
Amount of energy required to raise the
temperatur e of one gram of water by 1 Colonocyte organelles
degree Celsius Cell of the colon Cytosol
Calorie density Complete protein Internal fluid portion of the cell
Energy provided per unit of food: high calonc Protein source that contains all of the
density foods proVide many ca lories in
small portion while low calonc density foods
a es sential amino acids o
Concentration gradient Deamination
provide fewer calories in a large portion
Difference in the conce ntration of solutes Removal of an am ine group from a
Capillarization in a solution between two areas compound
Development of a capillary network
Conditionally essential amino acids Dehydration
Carbon skeleton Amino acids that are not normally Loss of water and salts necessary for
Chains, branches or rings of ca rb on atoms esse ntial, but in certain physiologic normal body fun c ti oning
tha t form organic molecules conditions mu st be p ro vided exogenously
Desaturation
Carcinogen Connective ti ss ue Removal of hydrogen atom(s) to form a
Cancer-causing substance Supportive tissue, such as ligament s, double bond
tendons, and fascia . formed from a
Detoxify
fibrous matrix
To remove a pO is on or tox in from the body
GLOSS ARY OF KE Y TERM S
445

DHA (doc osahexaenoic acid) Endocrine Excess post-exercise oxygen consumption

An omega- 3, polyunsaturated fatty aCid, Secret ion, such as a hormone, distributed (EPOe)
found mainly in fish and algae; can be in the body by the bloodstream Increased r ate of oxygen update follOWing
formed from ALA strenuous activity
Endoplasmic reticulum
Diabetic retinopathy Cytoplasmic m em brane that translates Exercise activity
Damage to small blood vessels of the proteins Physical movement p erformed in
eyes, due to glycatlon of the retma structured exe fCIs e sess ions
Energy balance
Diglycer ide Relationship betw ee n al/ sources of Exocrine
A glycerol with two fatty acid chains energy intake and energy output ; an Secretio n, such as saliva or bile, releas ed
organism IS said to be in energy balance ou rs ide Its source by a duct
Direct calorimetry
when energy flow into the body a nd out Extracellular fluid (ECF)
Direct m eas urement of hea t output by
of the body is equal; often evidenced by Fluid outside of c ells
th e body; used as an index of energy
a stable bod ywe ight
ex penditure

Diuretics
Energy imbalance F
When the amount of energy intake
A pharmac eutical that elevates the rate Facilitated diffusion
doesn't meet. or exc eeds, the amount of
of urination Transp ort that requires a carner molecule,
energy output
occurs when diffusion of a substance on
Diurnal
Energy transfer its ow n IS not possible
Daily cyc le, e,g of hormone release
Movement of ATP from one compound to
FAD+
DNA an other so that it can be used Riboflavin -derIVed hydroge n acc ep tor In
Nucleic acids that contain in structions
Enterocyte the Krebs cycle
for heredity
Absorptive cell of the intes tine FADH2
Dysmenorrhea
Enterohepatic circulation Th e reduc ed form of FAD +
Painful menstru ation
Circulation of blood between the Intestine Fast-twi tch muscle fibers
and the liver
E Muscle fibers, characterized by fewer
mitoc hondria and capillaries, which contract
Enzyme
Edema Substance that helps catalyze chemical quickly and With relatively more force yet
Swelling from flu id acc umulation fatigue more qUickly than slow-twitch muscle
rea ctions
fibe rs; includes three subgroups
Eicosanoids
EPA (eicosapentaenoic acid)
Signaling molecules of the body that Fat adaptation
An omega-3, polyunsaturated fatty acid,
control many systems A higher capacity to oxidize fa t
found mainly in fish and algae
Electrochemical gradient Fat soluble
Epiglottis
Diffusion gradie nt of an ion; repre sents Able to be dissolved in fat
Lid-like cartilaginous structure suspended
the potential energy of an ion across a
over the entrance of the larynx; swallowing Fatty acid
membrane and its tendency to move
closes the opening to the trachea by Cha in of carbon atoms with a carboxylic
based on that membrane potential
pla cing the laryn x against the epiglottis aCid and aliphatiC tail
Electrolyte Fatty acid synthase system
Epinephrine
Comp ou nd that when placed in solution Hormone and neurotransmitter; also System of enzymes Involved In the
becomes an ion; regulates flow in and out known as adrenaline sy nthes is of fatty acids
of cells
Epithelial tissue Feces
Electron transport cha in Tissue composed of ce llular layers that Waste di sc harged from the body through
Set of co mpounds that transfe rs electrons protect ou te r surfaces of the human body the anus
to a donor that creates energy such as skin, mucosa, and intestinal lining
Fibroblast
Elongation Ergogenic A cell that makes the stru ct ural fibers and
Addition of carbons on a fatty acid chain Physical or mental performance- ground substance of connective ti ssue
Emesis enhancing strategies
First pass metabolism
Vomiting Essential amino acid When a substance is swallowed and
Emulsification Ammo acid that must be included in the diet ab su rbed, It first travels th ro ugh the
To disperse, convert and suspend one hepatic portal system fo r metaboli sm by
Euvolemic
the liver; thiS "first pass" can reduce the
liquid as droplets into another Normal blood volume
availability of the substance to the body
446

Flavinuria Genetics Glycolysis

An in ten se yel/ow color of the urine d ue to Study of how living organisms vary in Series of reactions in the cytosol tl la t
a high do se of supplemental riboflavin their heredity converts glucose mto pyruvic acid and
ultimately ATP
Fluid balance Glucagon
When fluid output matches ffvid input Hormone secreted by the pancreas to Glycoly tic system
increase blood glucose levels Process of breaking down glucose for
Folic acid
energy: can be fast or sloV!
Vitamin 89 Gluconeogenesis
Conversion of non-carbohydrate Glycoprotein
Food intolerance
compounds (i.e. amino aC ids, pyru vate. Protem tha t con ta ms a car bohydrate
Adverse re action induced by food
glycerol) to glu cos e group, involved m mem brane integflty
Free radica l
Glucoregulatory hormone Golgi apparatus
Reactive atom with one or more electrons
Hormone that balances blood glucose Cytoplasmic organelle necessary for the
Fructose modification and transport of protems
levels. such as glucagon or insulin
A monosaccharide that 15 very sweet:
Greenhouse gases
possesses a ketone rather than an Glucose
Gases that absorb the heat released by
aldehyde. which distinguishes it from A monosaccharide found In foods and
the surface of the ear th and cause global
glucose blood: the end p ro duct of carbohydrate
wa rm ing (carb on dioxide, nitrous oxide,
metabolism an d the major source of
methane. water vapor)
G energy for human s
Growth hormone
Glucose 6-phosphate
Galactose Anabolic hormone that causes growth
Phosphorylated form of glucose that won't
A monosaccharide: less soluble and sweet and cell reproduction; also known as
than glucose diffuse out of a cell
somatotropin
Gallbladder GLUT family

Muscular sac where bile IS stored Group of mem brane proteins that
H
transport glucose from the blood Into cells
Gastric hydroch loric acid HDL cholesterol
Produced by parietal cells in the stomach, Glycation A lipoprotein that transports fatty aCids
this aCid liquid is necessary for digeslton Binding of a sugar molecule without the and cholesterol from the body tissues to
controlling action of an enzyme the liver
Gastroesophagea l reflux
Condition in which acidiC stomach Glycem ic index (GI) H ea lth
con tents flow back up into the esophagus Measure of the rate of which an ingested State of phYSical well-being and optimum
food causes the level of glucose in the function t hat should be assessed
Gastrointestinal (GI) tract
blood to rise thr ough medical te st s, In cl ud ing blood
The long tu be thro ugh the body composed
Glycemic load assessment s, card iovascu lar tests, and
of stomach and Intestines
Equal to the glycemic index of a other screenmg mod alities
Gene food times the number of grams of Healthy fats
A particular sequence in DNA or RNA that carbohydrates m the serving Fats that have been shown to improve
controls the expression of a protein. and
overall health
by extension Influences the characteristics Glycerol

of an organism Sugar alcohol that IS the backbone of a Hem e iron

triglyceride Form of iron bound with ca rrier pro teins
General circulation fo und In anima l products
The flow of blood throughout the entire Glycogen
Chief source of stored glucose in selected Hemoglobin Ale
body
tissues Glycated hemoglobin; reflects average
Genetic polymorphi sm blood glucose level over the past 3
Variation in the form of one or a sequence Glycogen phosphorylase
months
Enzyme necessary for glycogenolysis,
of genes
breaks glycogen into glucose units Hepat ic portal system
Genetics Veins that carry blood from the capillaries
Specific. Inherited DNA of an organism. Glycogen synthase
of the stomach, intestine, pancreas, and
which influences what they become, Enzyme necessary for the conversion of
spleen to the live r
although envi ronment also plays a ke y excess glucose into stored gl ycogen
Hepatocyte
role In the expression of an organism 's Glycogenesis
Liver cell
genetic code Synthesis of glycogen
Hiata l hernia
Glycogenolysis Protrusion of the stomach through the
Breakdown of stored glycogen to glucose esophageal hiatus of the diaphragm
447

Homeostasis Incomplete protein

The body's ability to maintain a stable and A protein source that contams a lower
K
constant internal conditIOn amount of an essential amino acid kcal

Hormone Used to express food energy. represents

Indirect calorimetry
Compound created by one cef( that travels a Calone
Estimation of energy expendil ure via the
to and stimulates another cell measurement of oxygen consumption and Ketone body
Hormone sensitive lipase carbon dioxide production Either acetoacetic acid, acetone or beta-
Enzyme of the cytoso! that frees fatty hydroxybutyric acid with a carbonyl group
Induced fit model
acids and glycerol attached to two carbon atoms
Model that suggests enzymes are rather
Hydrocarbons flexible structures Kinetic energy
Organic compounds that contain only Energy generated by motion
Industrial exposure
carbon and hydrogen Exposure to something in the workplace Krebs cycle
Hydrochloric ac id A major metabolic pathway that involves a
Inflammatory bowel disease
Solution of hydrogen chloride in water; series of enzymatic reactions that convert
Inflammation-based disorder of the
found in gastric juice pyruvic acid from food to acetyl-GoA for
Intestinal tract, such as Crohn's disease or
energy
Hydrogen ion ulceratIVe colitis
The cation of acids; consists of a hydrogen
alom whose electron has been transferred
Insensible water losses
Loss of water Via skin, evaporation and the
L
to the anion of the acid Lactic acid
respiratory tract
Hydrophilic An organic byproduct of anaerobic
Insolu ble fiber
Strong affinity for water metabolism derived from pyruvic acid.· can
Indigestible. non-water-soluble
be used as an energy source for cells
Hydrophobic polysaccharides found in plants (e.g.
Lack of affinity for water wheat bran, nuts); mcrease stool bulk and Laws of thermodynamics
enhance transit time Principles that govern energy exchange,
Hyperpermeable
including heat exct1ange and the
Increased penetration through a Insulin
performance of work
membrane Protein hormone released from the pancreas;
necessary for the metabolism of nutrients LDL cholesterol
Hypervitaminosi s
A lipoprotein that transports triglyceride and
Vitamin toxicity Insu l in index (II)
cholesterol from the liver to body tissues
Hypervolemic Measure of the rate of which an ingested food
causes the level of msulin in the blood to rise Lecithin-cholesterol acyltransferase (LCAT)
High blood volume
An enzyme that is used to convert cholesterol
Hyponatremia In su lin resistance
to a transportable form for lipoproteins
Low levels of blood sodium Condition in which normal amounts of
the hormone insulin are inadequate to Lifestyle·related disease
Hypothalamus
produce a normal response from fat, Diseases that are caused and/or affected
Portion of the brain that controls body by the way we live (e.g. amount of exercise,
muscle, and liver cells
temperature, hunger and thirst
quality of nutrition. smoking. stress. etc.)
Interstitial fluid
Hypotonic
Fluid that surrounds cells; component of Limiting amino acid
Osmotic pressure lower than that of a
extracellular fluid The essential amino acid found in the
solu tion in which it is compared
smallest quantity in the food
Intesti nal brush border
Hypovolemic
All of the villi that form a brush -like border Limiting factor
Low blood volume
inside the intestine Anything that makes it more difficult for a
client to achieve optimal results
Intracellular fluid (lCF)
F/uid inside of cells Linoleic acid (LA)
Ileocecal valve Unsaturated omega-6 fatty acid
A valve between the large intestine Ionic state
A given ion's charge: positive, negative or Lipase
(cecum) and the small intestine (ileum)
neutral Catalyzes the splitting of fats Into glycerol
Immuno·comprom ise and fatty acids
Dimintshed immune response due to
medications. illness. age, etc.
J Lipid
Organic substance that is insoluble in
Joule
water; prOVides structure. storage, and
Unit of energy; 4 Joules equal 1 calorie
messenger functions in the body
448 GLOSSAR Y OF KEY' TERMS

Lipid mobilization Metabolic equivalent (MET) Muscle glycogen

Using lipids as a fuel source Oxygen cos t of energy expenditure Ma in sto rage form of carbohydrates In
measured at rest. equal to 3.5 mL of oxygen muscle cells
Lipogenic enzyme
per kilogram of bodywelght per mmute
Enzyme involved with the synthesis of fat Muscle hype rtr ophy
Metabolic rate Increase In the sIZe of muscle cells
Lipolys is
Amount of energy expended in a given
Breakdown of lflg/reef/des mto fatty acids Muscle tissue
and glycerol
time frame; usually described as the Tissue consistmg of bundles of cells that
amount of calories burned In a 24 hour contract when stimula te d
Lipoprotein pef/od
A class of proteins with hydrophobic Myocyte
Metabolic syndrome
core of triglycendes or cholesterol Muscle eelf
A blend of conditions that often occur
surrounded by hydrophilic phospholipids.
together. consistmg of obesity, high blood Myofibrillar hypertrophy
apolipoprotems and cholesterol
sugar. high blood pressure. decreased Enlargement of a muscle fiber as it gams
Lipoprotein lipase HOL and high trig/ycef/des myofibn/s
An enzyme found in endothelial cells
Metabolic testing Myosin
fming the capillanes; hydrolyzes lipids into
Tests that measure metabolic functions Thick fibrous muscle pro tein that can split
fatty acids and glycerol
(e.g . diges tion and energy production) A TP and bind with actin
Lock and key model
Metabolism
Model that explains enzyme speedicdy
Sum of reactIOns that take place to build
N
Lower esophageal sphincter up and break down the body NA D+
Also known as the cardiac sphincter. a thick, Co-enzyme of dehydrogenases: plays a
Microminerals
muscular ring surrounding the opening role m intermediary metabolism as an
Mmerafs required In amounts less than
bel¥teen the esophagus and stomach oxidizing agent or reducmg agent for
15 mg/day
Lysosome metabolites
Micronutrient
Organelle containing hydrolytic enzymes NADH
Organic compound the body requires in very
Reduced form of NAD; us ed to transfer
small amounts (I.e. vitaminS and mmerals)
M electrons
M icroorganism
Macrominerals Negative energy balance
Organism of microscopIc size
Minerals required in amounts of 100 mg/ When energy flow out of the body exceeds
day or more Microvilli energy flow mto the body, often evidenced
Microscopic hair structures that increase by a decreasing bodyweight
Macronutrient
the surface area of cells; many are found
Nut rie nt the body requires in large Nervous tissue
in the GI tract (sing ular: microvillus)
amounts (I . e p ro tem, fat. carbohydrates ) Ti ssue capable of con ducting impu lses
Mitochondria that help to connect a nd communica te
Macrophage
Organelles that supplies the cells ' energy/ Signals to other parts of the body
Type of white blood cell that fights ATP (smgular: mitochondrion)
Inflammation Net negative protein balance
Mitochondrial density Nitrogen output that exceeds nitrogen
Malabsorption syndromes
Quantity of mitochondria per Ulllt volume Intake
Medical condition that results when
the intes tines cannot absorb nutrients Mitochondrial quality Neural tube defects
from food Specific attributes of mdochondf/a Birth defec ts of the bram a nd spinal cord

Mastication Monoglyceride Neuromuscular junction

To grind. crush and chew food A glycerol with one fatty acid chain Junction of an efferent nerve fiber and the
Monosaccharide muscle fiber cell membrane
Meal spaci ng
Amount of time between feedmgs The Simplest form of carbohydrate Neurotransm i tter
Monounsaturated fat Substance that transmits nerve Impulses
Medical nutrition therapy (MNT)
Fatty aCid containing one double or tf/ple across a synapse
Nutritional adVi ce intended to treat a variety
of conditions and illnesses , the pro vis ion of bond betwee n carbo ns Nicotinic acid
which is the exclusive domain of tramed and Monounsaturated fatty acid Vitamin 83
licensed nutf/tlon professionals A smgle double bond in the fatty aCid cham Non-essential amino acid
Muscle acidity Ammo acid that does not need to be
An acidic environment created when the included in the diet
pH level of muscle cells falls below 7
GL OSS ARY or K[ Y TERM S 449

Non-exercise activity thermogenesis (NEAT) Osmolarity Pepsin

Spontaneous physical activity, such as Concentration of osmoticafly acti ve Digestive protease released in the
tapping feet and moving hands particles In a solutIOn stomach to degrade food proteins to
peptides
Non-heme iron Osmoreceptor
Form of iron not bound with camer Sensory receptor that detects changes in Peptic ulcer
proteins; found mainly in plant foods osmotic pressure Found on the wall of the duodenum or
stomach. this ulcer results when gastric
Norepinephrine Outcome-based
juic es and H. pylori combine
Hormone and neurotransmitter; also Use of specific, measurable outcomes and
known as noradrenaline evidence to make deCisIOns, rather than Peptide chain
nebulous or dogmatic definitions of what's Short polymer formed from linking amino
Nucleus
"good" or "correct" acids
Organelle where genetic material is
housed Oxaloacetate Performance
Intermediate that couples with acetyl Co -A Function, action, or operation. whether
Nutrient density
to form citrate athletically or in daily life
Foods that provide substantial amounts of
nutrients with only the necessary calories Oxidation Peristalsis
Increase of positive charges on an atom or Waves of involuntary muscle contraction
Nutrient partitioning
the loss of negative charges; the opposite movmg the contents of the GI tract
Fate of the energy we ingest: storage in lean
reaction is reduction forward
tissues or fat tissues, conversIOn to energy,
release as heat, or excretion as waste Oxidative phosphorylation Peroxisome
The phosphorylation of ATP coupled to the Cytoplasmic organelle with enzymes for
Nutrigenomics
electron transport system production and breakdown of hydrogen
Study of how genes respond to nutritional
peroxide
intake Oxidize
\ Nutritional antigens
To combine with oxygen pH
Measure of acidity and alkalinity; lower
Nutritional substance that causes the Oxygen debt
numbers are more acidic, higher numbers
immune system to respond Extra oxygen required above basal needs
are more alkalme; 7 is neutral
after a period of intense exercise
Nutritional periodization Pharynx
Continuous nutrition plan that is Oxygen deficit
Throat
manipulated to accommodate more less Difference between oxygen uptake of the
body during early exercise and during a Phosphocreatine (Per)
aggressive nutrition goals
similar duration of steady state exercise Compound of creatine (Cr) and

o p
phosphoric acid (P) found in muscle

Phytochemical
Oligosaccharide
Chemical substance obtained from plants
Saccharide composed of a smafl number Pancreas
that is biologically active but non-nutritive
of monosaccharides Large gland behind the stomach that
secretes digestive enzymes and the Plant- based diet
Omega -3 hormones insulin and glucagon Diet that includes primarily foods of plant
Family of unsaturated fatty acids origin
Pancreatic amylase
characterized by a carbon-carbon double
Enzyme found in pancreatic juice that Plasma
bond three spaces in from the methyl end
catalyzes the hydrolysis of starch Liquid component of blood that suspends
Omega -6 blood cells; contains water, glucose,
Pancreatic lipase
Family of unsaturated fatty acids proteins and hormones
Enzyme secreted from the pancreas that
characterized by a carbon -ca rbon double
hydrolyzes fat Plasma membrane
bond six spaces in from the methyl end
Parasympathetic nervous system Lipid bilayer that is permeable to certain
Omega-6 /omega -3 ratio compounds that contains the cefl
Part of the autonomic nervous system that
Balance of dietary fat intake; cntical to
controls secretions and the tone of smooth Plasma pool of amino acids
overall health
mu scle. along with cardiac muscle activity Reserve of amino acids found in blood
Organelle plasma
Pathogen
Component of the cell that is responsible
Disease-causing agent; usually bacteria, Plasma volume
for a specific task virus, or fungi Amount of plasma in circulation
Organic molecule
Polysaccharide
Relating to or contaming carbon compounds
More than about 10 linked
monosaccharides that form a polymer
450

Polyunsaturated fatty acid Pyloric sph incter Sarcomere

A fatty aCid with multiple double bonds in Thick, muscular ring of mucous Repeating structural Units of stflated
the chain membrane surrounding the opening mus cle fibers
between the stomach and the duodenum
Positive energy balance Sarcoplasm
When energy flow into the body exceeds Pyruvate Cytoplasm of muscle fibers
energy flow out of the body, often Salt of pyruvIc aCid; the end product of
Sarcoplasmic hypertrophy
evidenced by an increa smg bodyweight glycolysis
In crea se In the volume of the
Potential energy sarcoplasmic fluid in the muscle cell with
Energy stored within a phy sical system R no concurrent mcrease in strength

Prebiotic Reactive oxygen species (ROS) Sarcoplasmic reticulum

Compound that is not digested but rather Vario us substances formed as a byprodu ct Endoplasmic reticulum of muscle that
fermented by microflora and stimulates of metabolism that are highly reactive due appropriates calcium
growth of healthy bacteria in the GI tract to the unpaired electron sheff
Satiety
Pre-eclampsia Rebound intake The state of being satisfactorily full
A conditIOn In pregnancy characterized by A high intake of food after a period of
Saturated fatty acid
high blood pressure, protein in the urine, restriction
A fatty acid wlfh no double txJnds in the challl
and swelling Receptor-ligand binding complex
Scar tis sue
Probiotics A complex formed between a receptor and a
Fibrous tissue formed as a result of wound
Live microorganisms that help to res tore substance to allow for further cellular activity
healing
beneficial bacteria In the GI tract Renin-angiotensin system
Second messenger
Proenzyme Hormone system that regulates blood
Substance that mediates intracellular
Inactive enzyme precursor that requires a pressure and fluid balance
activity by relaying a signal from an
biochemic al change to become active Respiratory quotient (RQ) extracellular molecule
Prohormone Ratio of the volume of carbon dioxide
Secondary. tertiary, and quaternary structures
Precursor to a hormone(s) expired to the volume of oxygen
Shape/formation that a protein takes
consumed in a given period of time,
Protein depending on its biological function
indicative of the substrates being used
Large and complex molecule consisting of Short chain fatty acid
amino acids (which contain nitrogen) that Resting metabolic rate (RMR)
Fatty acid with fewer than eight carbons
are essential for living cells Level of energy required to sustain the
that are taken up directly through the
body's vital functions at rest
Protein breakdown portal vein, and are produced as fiber is
Degradation of proteins Retinol fermented in the colon
Animal-def/ved form of vitamin A
Protein digestibility corrected amino acid Signal transduction
score (PCDAAS) Ribonucleic acid (RNA) Conversion of one signal to another by a
A method based on the amino acid Various nucleic acids on a single strand ce fl
requirements of young children that takes containing ribos e and uracil, necessary for
Simple diffusion
into consideration digestibility of the protein; the control of ceft activities
Spontaneous movement of particles from
a re ce ntly developed and preferred measure Ribosome an area of high concentration to an area
for determining the quality of protein A complex rich in RNA and protein found of low concentration
Protein synthesis in cefts
Slow twitch muscle fibers
(Re)buildlng of protems RICE method Muscle fibers, rich in mitochondria and
Protein turnover Re st, ice, compressIon, elevation; used to dense with capillaries, which are able to
Balance between protein synthesis and control the Inflammatory response of an repeatedly contract for ex tended perio ds
breakdown acute injury of time

Social support
Proteolytic enzyme
Enzyme that hydrolyzes (breaks down) s Network of individuals that provides positive
protein or peptides Salivary amylase feedback, constructive criticism, and
Enzyme fo und in sa liva that catalyzes the encouragement for one's lifestyle choices
Proton
Partic le with a positive charge, usually hydrolysis of starch Soluble
regarded as a hydrogen ion; wh en the Sarcolemma Disposed to being dissolved
proton gradie nt shifts If) the el ectron Plasma membrane of a muscle fiber
transport chain, energy conversion occurs
451

Soluble fiber Thermogenesis Urea

Relatively indigestible, water-sofuble The process of heat production in the Water-soluble fmal nitrogenous excretion
polysaccharides found in pfants (e.g body product sy nthesized from ammonia and
psyffium, pectm) that undergo metabofic Thyroid hormone
carbon dioxide, found in urrne
processing to enhance bowel health One of a group of metabolically active Urea cycle
Solute load hormones stored in the thyroid gland Cycle that ta kes place in the liver and creates
Load that a substance presents to the kidney Tocopherols urea from ammonia and carbon dioxide

Solvent Fat soluble alcohols with vitamin £ URTI(s)

A liquid or gas that dissolves a solid, liquid Tocotrienols IfIness caused by an acute infection;
or gaseous solute Vitamin £ compounds manifests m the upper respiratory tra ct
Statin drugs
Pharmaceutical agents that decrease
Trans fats
Unsaturated fat with a trans- is omer fatty v
cholesterol production within the body via acid; created through hydrogenation Vascular water
downregulalion of HMG- CoA reductase
Transamination Fluid contained in the vessels
Steady-state The transfer of an amino group from an
Vasodilation
A leve! of metabolism during exerCise when ammo acid to an alpha-keto acid
Widening of blood vessels
oxygen consumption matches energy
Transcription
expenditure Vegans
Construction of mRNA from a DNA molecule
Includes only foods from the plant/fungi
Subclinical deficiencies
Translation kingdoms, deVOid of all animal derived
Nutrient deficiencies that don't manifest
Forming a protein molecule based on the ingredients
as a clinical health problem
information contained in the mRNA
Very low density lipoprotein particles
Substrate
Transport protein (VLDL)
\ Substance acted upon by an enzyme

Sympathetic nervous system

Protein that moves compounds across a Particles used in lipid transport;
membrane assembled in the liver by chofesterol and
A division of the autonomic nervous apolipoproteins, converted to LDL
system that is always active and proVides Transverse tubule (T-tubule)
sympathetic tone; its activity increases Inward-folded crevice of the sarcolemma Vesicle
during times of bodily stress on muscle that forms tubular portions; Fluid filled pouch/sac that can transport
T-tubule depolarization triggers calcium and store compounds
Systemic circulation
release and muscle contraction
When blood travels from the heart to Villi
the arteries and capilfaries, exchanging Triglyceride Small projections (singular: villus) covering
oxygen for carbon dioxide and returning Compound with three molecules of fatty the surface of the mucous membrane
via the veins to the heart for pulmonary acids bound with one molecule of glycerol; lining the small intestine, through which
circulation the storage form of fat in humans nutrients and fluids are absorbed

T
Type I diabetes
An auto-immune disea se that destroys w
The intersection pancreatic cells; results in little to no Water soluble
Center of three interfockmg go a ls: msulin production Able to be dis so lved in water
improved performance, improved health,
Type II diabetes Western diet
and improved body composition
When the l.xxJy has become resistant to Dietary pattern folfowed by those in
Insulin, or does not produce it any more; this much of the Western world; consists of
is the more common form of diabetes mellitus processed and fast foods with high calorie
Type I fibers dens ity and low nutrient density
Slow-twitch mu scle fibers

Type II fibers
z
A class of fast-twitch muscle fibers Z-discs
Region of the sarcomere mto which actin
u is inserted

Unsaturated fatty acid

Doubfe bonds between carbons in fatty
acid chain
452 GLOSSARY or K(Y IERMS

Unit 2 Buffering hydrogen ions

Can reduce acid accumulation during
Controlled carbohydrate
Eating carbohydrates in the forms and at
exercise the times that the body can best tolerate
A
Adherence chart c CoQ10
An antioxidant produced by the human
A spreadsheet that can be used to record Caffeine body; necessary for ceffular function
and measure compliance to a set of goals A xanthme derivative that can stimulate
and behaviors the central nervous system E
Alkaline load Calorie cycling Eeto-mesomorph
A food intake that generates a slightly Altering high and low levels of calorie A blend between ectomorph and
higher pH value In the body; base forming intake, whicf1 doesn't allow the body to mesomorph body types; athletiC lookmg yet
find homeostasis still on the thin side, especially in the limbs
Amer ic an Dietetic Association
Largest organization of food and nutrition Carb cycl ing Ectomorph
professionals in the United States; Altering high and low levels of Body type characterized by long and th in
composed primaflfy of registered dietitians carbohydrate intake. which doesn't allow muscles and limbs with lower fat storage,
the body to find homeostasis generally slim
Andropause
Reduction in endogenous testosterone as Carb-dependent sports Endo- mesomorph
a mare advances mto older age Sports that exhaust high amounts of A blend between endomorph and
muscle glycogen mesomorph; Ileavily muscled yel carrying
Apoptosis
extra body fat around the midsection
Programmed cell death Carbohydrate tolerance
Endomorph
Archetypes A person's ability to iJandle higher dietary
carbohydrate loads Body type characterized by increased fat
A particular style or characterization storage, wider waist, large bone structure
forming an archetype for potential clients Carnosine
can help to better relate to tfJem Enteric coated
Dipeptide found primarily in muscle that
Pill or capsule coated with a material that
can Ilelp to decrea se muscular fatigue
permits transit through the stomach to the
B Client objections small intestme before its contents are relea sed
Behavior go als Barriers perceived by clients in changing
Epigallocatechin gallate (EGCG)
Goals framed around actIVities of the behaviors; these are critical points of
A type of catechin; most a bundant in tea
client that are under complete co"trolof counseling and intervention for the healtf1
tfle individual professional Essential nutrients
Nutrients present in food that are needed
Beta alanine CNS fatigue
far normal p/lysiolagical functioning
Rate-limiting precursor of carnosine which A state of neurotransmitter depletion
can help to decrease mu scular fatigue which can dimmish the body's ability to Expectation management
recruit muscles Clients ' accurate anticipation and
Bi-weekly client report
understanding rea/;stic progress, as well
Bi-weekly version of the Comprehensive Coach
as their coach's expectations of them
Client Information sheet Someone who is involved with the direction,
teaching, and training of an individual
Black cohosh F
Herb generally used to treat hot flashes Commitment to change
The level of change to which a clien t is Fe eding opportunitie s
and menopausal symptoms
dedicated: dictates the type of behavior An opportunity to eat
Bo dy type recommendations
changes they're ready to implement Fibromyalgia
Dietary planning that depends on body
Complete protein Disorder that affects muscles and their
somatotype; for more advanced clients
Protein source that contains all of the attachments to bone; results in mcreased
Body type s musculoskeletal pain and fatigue
essential ammo acids
Also known as somatotypes; general
Conjugated linoleic acid (CLA) 5 Habits
categori es of body structure as well as
muscle and fal storage and distribution Isomer of the linoleiC fatty acid; found in Simple habits that when followed will
meat and dairy of ruminant animals such naturally lead to an improvement in
Breakfast ritual calorie control, nutrient timing, and food
as cows and sheep
Process of preparing food for the day selection
during breakfast Conti nuing education
Provision of up-to-date and relevant
knowledge to clients
GLOSSARY OF KEY It RMS
453

5 Habits cheat sheet

A concise form thai helps to check
L N
accuracy of the five nutritional habits Lactose intolerance Natural Health Products Directorate
Inability of the body to break down (NHPD)
Folic acid
lactose, usually secondary to lactase A dIVision of the Health Products and
A B vitamin that is essential for synthesis of
enzyme defidency Food branch of Health Canada that is
DNA and the growth and division of cells responsible for implementation of the
Leptin
Food allergies natural health product regulations,
Hormone with a central role in fat
including good manufacturing practices,
An immune response in whIch the body
metabolism ; released by fat cells,
creates antibodies in reaction to a food for natural health products for sale in
influences the hypothalamus
that was consumed Canada
Level 1 clients
Food and Drug Administration (FDA) N ew normal
Describes people wlJO are not yet in the
United States government agency that The process of Internalizing new habits to
habIts of eating healthy foods. at the right
enforces laws on the manufacturing, testing, create a new lifestyle
time, in the right amounts
and use of drugs and medical deVIces; does Niacin (inositol hexanicotinat e)
not regulate dietary supplements Leve l 2 clients
A form of no-flush vitamin 83 that can
Describes people who have an idea of
help to improve one's lipid profile
portion sizes, body awareness and food
G choices but need help with food timing, Non-essential nutrients
Glutamine nutrient partitioning, and food intake Nutrients that either the body can make
Conditionally essential amino acid that is relative to need/goals itself, assuming adequate nutritional
abundant in muscle tissue intake, or nutrients that aren't needed for
Level 3 clients
normal physiological functioning
Goal-setting Descflbes people who have a good
Process of coach and client deciding on grasp of Level 2 stra tegies but their Nutrient timing
objectives high performance goals demand Sports nutrition concept that manipulates
more specialized strategies and meal chronology to enhance recovery from
Good manufacturing practices (GMPs)
supplementation to precisely address training and body composition
A recognized term used worldwide
food intolerances/allergies, body fat
regarding the control and management of Nutrition label
distribution, gene profiles, and other
manufacturing and quality control testing A label on packaged food products that
highly specific nutritional goals
of foods, pharmaceutical products, and lists nutrition facts
medical devices
M o
Gourmet Nutrition
A cookbook released by Precision Majoring in the minor
Osteoporosis
Nu trition with various recipe s, food Teachmg that overemphasizes minor points
wl1J1e underemphasizing major points; dilutes
A decrease in the mass and denSity of
preparation tips and food timing ideas bone with enlargement of bone spaces,
client focus and does not permit them to
Green food product eliminate their biggest limiting factors creating porosity
Dietary supplement composed of green Outcome goals
Mesomorph
foods that are rich in nutrients Intended result that wifJ occur from
Body type characterized by larger bones,
Green tea extract a solid torso, wide shoulders, trim waist, carrying out a behavior; a long- term
Deflved from green tea leaves, contains controlled body fat levels measure of strategic effectiveness
high levels of EGCG, a compound that
may playa role in disease prevention
Micronized p
Process of reducing the average diameter
greens+ . of a solid material's particles P+ C drinks
A brand of green food product that is used Drinks composed of protein and
Modeling success
as a dietary supplement carbohydrates that can be used before,
Seeking out those individuals who are
during or after training/exercise
successful with nutrition and exercise. and
then modeling their behavior Part-time supplement use r
Information dump Someone who uses dietary supplemen ts
Molecularly distilled
Providing unwarranted amoun ts of on certain days when they might not be
A process that rids the product of harmful
knowledge to a new client meeting minimal requirements
chemicals
Internation al Olympic Committee (lOC) Pasteurized milk
Milk that's been exposed to high
A group, based in Switzerland, that
temperatures in an effort to destroy
organizes the modem Olympic games
microorganisms
454 G.fJ SS,\fIY or KEY ~[Rr.~ .•

Periodized program
A cycled approach to exercise that allows for
Super Shake
A recipe base for a nutf/lion shake
w
a speCific focus on a component of fitness Written praise
Superfoods checklist
A congratulatory e ~ mail, an award
Periworkout nutrition Foods that are very nutrient dense and
certificate, a post ca rd. a greeting card, etc_
Nutritional choices before, during and energy con trolfed
after workouts www.pubmed.com
Supplement needs analysis
World's largest freely available medical
Pho sp hatidyl se rin e Determination of specific dietary
database
A phosphOlipid that plays a funclionat role supplements needs based on a client's
If]

brain
membrane-related processes in the current situa ti on

Sympathetic nervous system overreaching

z
Plateau Repeated high amounts ZMA
A period of time when results are stalled of physical exer tion that fatigue the A dietary supplement composed of
sympathetic nervous system zinc monomethionine aspartate and
Policosanol
A dietary supplement derived from sugar magnesium aspartate; generaJ/y used for

cane or beeswax that can help to control T sleep and recovery by athletes

blood cholesterol
Tangible r ewa rds
Poor carbohydrate tolerance A concrete form of recognition, e.g. a gift
When an individual has a d iminished certificate, a certificate for a free training
ability to handle higher carbohydrate session or free week of training, an exercise-
loads; often distinguished by rapid energy and/or nutrition-specific gift, and/or a special
fluctuations and changes in body fat i-shirt tha t you only give to th ose clients
Po stpartum depression wh o've achieved a specific milestone
A form of depression immediately after
Tyrosine
giving birth
A non-essential amino acid
Public recognition
Something a coach does for a client that
a llows them to be acknowledged in the
u
USDA food pyramid
public eye: could be a milestone board,
newsletter story or social event A graphical display of a healthy diet
centered on fo od groupings; created by

s the USDA in 1992

USDA nutrient dat abase

Social support network
Provides a full nutrient profile for
Group of people with whom a person
thousands of foods
surrounds themselves. e.g friends, family,
co-worker s, etc.

Somatotypes
v
Also known as body types; general Valerian

categories of body structure as well as Herb generally used as a sleeping aid

muscle and fat storage and distribution Vegetarian

Spezzatino One who ea ts m ai nly plant-based foods

A fo od magazine th at supports the Very high-carbohydrate diet
Healthy A shorHerm dietary s trategy to be used
Food Bank by athletes in carbohydrate-depen dent
Statin drugs sports or for body composition changes
Pharmaceutical agents that decrease Very low -carbOhydrate diet
cholesterol production within the body via A short- term strategy for body composition
downregulation of HMG-CoA reductase alteration
Sunday ritual Very low-calorie diets (VlCD s)
Setting aside three hours or so every Used for extreme body composition
Sunday (any day of the week will do bu t alteration; around 10 kcaJ/fb of
Sunday is easiest for most) to write out bodyweight or less
a menu for the week, shop for the week,
and prepare meals for th e week
APP[NDIX
455

APPENDIX A:

BODY FAT CALCULATIONS

FOR MEN AND WOMEN

Men

SUM OF 7
SKINFOlDS !MM) ( SUM7 ) BODY DENSITY BODY FAT % FAT MASS LEAN MASS

FORMULAS FOR MEN

Body density (D b) 1.112 - {O.00043499 x SUM?} + 10.00000055 x SUM7' } -
10.00028826 x AGE}

Percent body fat [1 457/ Db} - 4.14 21 x 100

Fat mass l ib or kg} [Total bodyweighl Ilbs or kg} x body fat %1/ 100

Lean mass l ib or kg} Total bodyweight IIbs or kg} - fat mass Ilbs or kg)

Note, SUM7' refers to the sum of 7 skinfolds, squared.

APPE ND IX
456

Women

SU M OF 7
SK1NFO LDS (MM ) (SUM7 ) BODY DENS ITY BODY FAT % FAT MAS S LE AN MA SS

FORMULAS FOR WOMEN

Body density (0,) 1.097 - (0.00046971 x SUM?) + (0.00000056 x SUM7 ' ) -

(0.000 12828 x AGE)

Percent body tat [(4.57/0,,1- 41421 x 100

Fat mass (Ib or kg) [Total bodyweight (Ibs or kg) x body fat %1/100

Lean ma ss (Ib or kg) Total bodywe ight (Ibs or kg) - fat mass (Ibs or kg)

Note : SUM7' refers to the sum of 7 skinfolds, squared.

The Results Tracker '''' , availab le at www.precisionnutrition.com/members. is a grea t online

tool for measuring, recording, and track in g ski nfold data, body density, fat mass, lea n ma ss,
and body fat percentage. Here you can pick up an inexpensive pair of skin fold ca lipers, learn
how to perform skinfold measurements in an accurate and repeatable way, and rec ord body
composilion data for mu lti ple clients over tim e. Track your clien ts ' changes throughout their
entire coac hing process and provide the m with professional spreadsheets of their progress
along the way.
APPEN DIX
457

APPENDIX B:

Bi-weekl y Res ults Trac ker

WEEK OF PROGRAM

DATE OF MEASUREMENT

MEAN BODYWEIG HT

Skinfolds Mean abdominal

sklnlold (mm)

Mean tri ceps

skinfotd (mm)

Mean chest
skinfold (mm)

Mean midaxillary
skin fold (mm)

Mean subscapu lar

skinlold (mOl)

Mean supra iliac

skinfold (mm)

Mean thigh
skinfold (mm)

Sum of mean
skinfolds (mm)

Gir ths Mean neck

girth (em)

Mean sho uld er

girth lem)

Mean chest
girth (em)

Mean right arm

girth (em)

Mean waist
girth (em)

Mean hfp
girth (em)

Mean right thigh

girth (em)

Mean ri ght calf

girth (em)

Body composition Body fat %

Fat mass lib)

lean mass (Ib)

458 APPE ND IX

APPENDIX C:

RECOMMENDED NUTRITION
COACHING SCHEDULE
Use Ihe foll owing steps, each comprehe nsively outlined in Ih is cou rse gui de, w he n directing
Ihe nu trili on al inlake of you r clien t s.
Step 1 Prep are for yo ur clien t (C hapter 10) Step 5 Nut riti onal suppleme nt ati on
Slep 2 Collecl preli mina ry cli ent (Chapter 14)
information (C hapte r 1 1) Step 6 Set behaviou r goa ls and mo ni to r
Step 3 Interp re t client information prog ress (C hapter 15)
(Chapter 12) Ste p 7 Make nut rit io nal adjustments
Step 4 Provide a nutr ition plan (Cha pt er 16)
(C hapte r 13) St ep 8 Provi de con tin uing ed uca tio n and
suppo rt (Chapte r 17)
Develop a coa ching and meeting sc hed ul e to accomplish each of these steps . We recommend th at
th is schedul e be co nducted as a seri es of chec k-ups Ihat occ ur every two wee ks or so . To ma ke it
simp le fo r yo u, here's an exam pl e sched ule you may choose to use when meet in g wit h your cl ients.

DATE MEETING TYPE TI ME ALLOTMENT TASKS

Day 0 Client en rol lment 15 minutes Client pays for thei r coac hing program. You give
them their initial client questionnaires to 1111 ou l.

End of Week I Initial assessment 60 minutes Client brings in questionnaires.

You perform initial assessments.

End of Week 2 Ini tial consultation 60 minutes You explai n th e results of you r questionnaires and
assessments to your client, you and your clien t se t
goals, and yo u beg in to ma ke initia l suggestions
fo r improv ement.

End of Wee k 3 Ch eck-up #1 60 minutes You pe rform foll ow-up assess m en ts, use ou tcome-
based decision maki ng to modify your client's
program , and deliver thei r initial nutrition lesson,*

End of Wee k 4 Check-ups #2-8 60 minutes eac h You perform follow-up assessments, use outcome-
End of Week 6 based decision maki ng to adjust your client's
End of Week 8 program, and del iver thei r follow-up nutrit ion
End of Week 10 lessons.'"
End of Week 12
End of Week 14
End of Week 16

*Each of the lessons is ou tlined in Chapter 17. Al th ough they can be pe rf ormed in any order, we recommend you del ive r the most prac tica l
l essons ea rly In th e coac hing process .
A PPE ND IX
459

APPENDIX D:

RECOMMENDED PRINT
AND VIDEO RESOURCES
They say that the difference between you today and you five years from now will be found
in the quality of the books you've read . If you hope to grow as a practitioner, you'd better
be reading. I think every health and fitness practitioner should have at least the following
resources in the ir library.

COACHING
Babauta, Leo. The Power of Less.

Gavin, James. Lifestyle Fitness Coaching.

Grasso, Brian. The Art of Coaching.

Martins, Rainer. Successful Coaching.

Miller, William and Rollnick, Stephen. Motivational Interviewing.

Sommer, Robert. Inspiring Others to Win.

Wooden, John. Wooden.

NUTRITION AND SUPPLEMENTS

Antonio, Jose and Jeff Stout. Supplements for Strength and Power Athletes.

Benardot, Da n. Nutrition for Serious Athletes.

Berardi, John. Precision Nutrition.

Hargreaves, Mark and Lawrence Spriet. Exercise Metabolism.

Ivy, John and Robert Portman. Nutrient Timing.

McArdle, Wi ll iam, Frank Katch, and Victor Katch. Exercise Nutrition.

Pollan, Michael. The Omnivore's Dilemma.

Pollan, Michael. In Defense of Food.

APPLIED STRENGTH TRAINING

Baechle, Thomas R. and Roger W. Earle, eds. Essentials of Strength Training and
Conditioning.

McGill, Stuart. Ultimate Back Fitness and Performance.

Thibaudeau, Christian. The Black Book of Training Secrets.

Thibaudeau, Christian. Theory and Application of Modern Strength and Power Methods.

Siff, Mel and Yuri Verkhoshanksy. Supertraining.

Zatsiorsky, Vladimir. Science and Practice of Strength Training.

460 APPE ND IX

TRAINING PROGRAM DESIGN

Boy le, Mike. Designing Strength Training Programs and Facilities.

Cosgrove, Alwyn. Professional Fitness Coach Program Design Manual.

Robertson, Mike and Bill Hartmann. Inside Out Upper Body DVD.

Robe rtson, Mike and Eric Cressey. Magnificent Mobility Lower Body DVD.

Waterbu ry, Chad. Muscle Revolution.

POPULAR TRAINING AND NUTRITION PROGRAMS FOR SPECIFIC GOALS

Berardi, John. The Metabolism Advantage.

Berardi, Jo hn and Mike Mejia. Scrawny to Brawny.

Cosgrove , Alwyn. Afterburn Fat Loss Training Manual.

Mohr, Chris and Alwyn Cosgrove . Human Inferno.

Sta ley, Charles. Es ca lating Density Training.

Zinczen ko, David. The Abs Diet.

APPENDIX E:

RECOMMENDED NUTRITION
AND RESEARCH-BASED WEB
RESOURCES

PRECISION NUTRITION
www.precis ionnu trition .com

Dr. Be rardi's own comp rehensive nutrition program and free online nu tr ition know ledge base.
This site is geared toward hea lt h and fitness professi onals , athletes, and recreationally ac tive
exercisers.

HEALTHY KITCHENS
www.healthyki tchensrnakeover.com

Amanda Graydon 's Hea lt hy Kitchens websi te provides prod ucts and services designed to
edu cate prac titioners and cons um ers abo ut creati ng a healt hy kitche n, making smart groce ry
decisions, and creating physique-friendly meal preparation hab its.

THE U.S. DEPARTMENT OF AGRICULTURE LIBRARY

www.nal.usda.gov/fnic

The USDA's food and nutrition information center provides resourc es for nutrition and health
professionals.
APPE NDIX
461

THE U.S. DEPARTMENT OF AGRICULTURE 'S FOOD PYRAMID

www.mypyramid .gov

This site hosts the USDA's revised food pyramid as well as a variety of olher nulrilion resources.

AMERICAN DIETETIC ASSOCIATION

www.eatr ighLorg

The ADA is the la rgest U.S. organization of food and nutrition profess ionals and their website
provides a myriad of nutrit ion resources.

SPORTS , CARDIOVASCULAR, AND WELLNESS NUTRITION ISTS

www.scandpg.org

Dne of the largest ADA pract ice groups, SCAN focuses on sports pe rfo rmance, card iovascular
health, we li ness and weight management, and disordered eat ing prevent ion and treatment.

NUTRITION DATA
www .nutrit iondata.com

Nutrition Data provides comp lete nutritional information for thousands of foods and rec ipes.

MEDLINE
www.pubmed.com

PubMed is a se rvice of the U.S. National Libra ry of Medicine . It's a resea rch database and
per iodical index that inc ludes over 17 mi llion citations from MEOLINE and other life science
j ourna ls fo r biomedical articles back to the 1950s.

WORLD ANTI·DOPING AGENCY

wwwwada -ama.org

WADA is the international independent organ ization created in 1999 to promote, coordinate,
and mon i tor the fight against doping in sport in all its forms.

MERCK
www.merck.com/rnmhe

Merck is a global research-driven pharmaceut ical company and their website contains some
va luable physicia n and patient resources, including the Merck Manuals.

NSF INTERNATIONAL
www.nsf.org

The NSF certifies products and writes standards for food , water, and consumer goods .

CONSUMER LAB
www.consumerlab.com

Consumer Lab iden tifies the best quality health and nutrition products through
independent testing.
REFE RE ~jC E S
462

REFERENCES

Unit 1
Abelow BJ, Holford TR, Insogna TL Cr oss -cu ltu ra l association between dietary animal p ro tein and hip frac tu re: a
hypothesIs. Ca lcl f Tissue ln t 1992 : 50 : 14

Agre n MS, Fra nzen L Influence of zinc deficiency on br ea king strength of 3-week -old skin InC ISi ons In the rat Acta Ch ir
Scand 1990:156:667

Albina J E. el aL Arginine metabolism In wounds . Am J Phys ioI 1988 :254(4 PI 1) :E459

Al l M, Thomson M, Afza l M. Ga rl iC and on ions: thei r effec t on ei cosa noid meta boli sm an d Its clmrca l relevance
Prosta glandi ns Leu kol Essen! Fatly AC ids 2000:62:55

Alva rez OM. Gilb re ath RL Effe ct of dietary thiam ine on in te rmo lecu lar collagen cross-linking durin g wound repa i r: a
mechan ica l and biochemi ca l assessmen t. J Trau ma 1 982 :22 :20

American Dietet ic Associ ation POS ition of th e Ame ri ca n D ietetic ASSO Cia tion : Vegetarian Die ts J Am Diet Assoc
2009; 109 : 1266 - 1282

Ammon HP Bosweilic acids In chronic Infla mma tory diseases . Planta Med 2006;72 , 1 100 .

Anth ony TG, et al Feed ing meals conta ining soy or whey protein after exercise stimul ates protein syn lhesls and
tr anslat ion Initiation In the skeletal muscle of ma le rats J N utr 20 07;137 :35 7 .

Ap rahamlan M , et al Effects of supplemental pan to t hen ic acid on wound healing: experimental s tu dy In ra bbit. Am J
Clin Nutr 1985 ;4 1:578

Arnold M , Barbul A Nutrition and Wound Healing Plast Reconslr Su rg 2006: 1 17 {Su pp1 1.42S.

Augustsson K, et a t. A prospecti ve sludy of intake of fi sh and ma ri ne fatty aCids and prosta te ca ncer. Cancer Epidem iol
Bioma rke rs Prev 2003:12 : 64 .

Axe n K. Axe n KY Illus tr ated Princ iples of ExerC ise Ph ysiolo gy, 1st Edition NJ Prentice Hall; 2001

Ba iley JL, M itch WE. Mecha nisms of protem degrad a ti on: what do th e rat stu die s te ll u s? j Ne ph ro l 2000; 13 :8 9 .

Ba iley J L. MetaboliC aCIdOS IS and protein catabol ism : mecha nisms and clinica l Imp li cations . M iner Electrolyte Metab
1998;24 13

Baech le TR , Ea rle RW. Essen tials of Stren gt h Tr aining and Condit ion ing. Na ti ona l S tr ength Tr alnmg ASSOC iation, 2nd ed
2000 . Hum an Kinetics

Barnard NO , We issenger R, Jaster B. Ka ha n S, eels Nutrition Guide for CliniCians. 1st ed. peR M . 2007

Beaucha mp GK, et al Ibupro fe n -like activ ity in extra-VIrg in oli ve 01 1 Na ture 2005;43 7 : 45

Beers MH , Berkow R, eds Th e Merck Ma nual, 17 th Ed ition . Merck Research Laboratories, 1 999

Bemben MG, Lamon t HS. Cr eatme supplementa ti on and exerCISe performa nc e: rec en t f indings. Sports Med
2005;35 10 7

Bemelmans WJ, et al. Change In saturated fat Intake IS associated With p ro gressio n of caro ti d and fem oral mtlma-media
th ickness , and With levels of sol ub le interce llu lar adheSion m olecule- } AtherosclerOS IS 2002: 1 63 1 13

Berkow SE . Barnard N. Vegetaflan diets and weight status Nu tr Re v 2006;6 4:17 5

Bern mg J and Steen S Nu trition for Spo rt and ExerCISe , 2nd Ed ition . Co lorado: Aspen Pu bl ica tions, 1 998

Berthoud HR M ultiple neu ral syslem s cont ro lling food Intake and body weigll !. Neurosci Biobehav Rev 20 0 2;2 6 :393 .
RE tE RE "j CES 463

Blolo G. et a l. Inc reased rates of musc le p ro tein turnover and am mo aCi d transpor t after res is tance exe rcise in humans
Am J PhysloI 19 95 ;268 :E5 14 .

Blankson H, et al Co njuga ted Imo lelc aC id reduces body fat mass In overwe ight and obese humans J Nutr
2000. 130 :2943 .

Blom PC. et al . Effe ct of different post-exe rCis e suga r diets on the rate of musc le glycogen synthes Is M ed SC I Spo rts
Exerc 1 987 : 19 491

8 10m WA. et al. EHect of a high-protein break fas t on th e pos tprandial ghrelln response . Am J Clln Nutr 2006.83 ' 21 1

Boe lens PG. et al Glutam ine allmenta\ion In cataboliC stale. J Nutr 2 001; 13 1(9 Supp l):2569S .

Bore r KT. Exe rcise Endocr inolog y, 2nd Ed ilion. 2003 Huma n Kineti CS

Borshe lm E. et al Essent ial amino aCids and musc le protem recove ry from res istance exerc ise . Am J Physiol Endocrmol
Meta b 20 0 2 :283 :E648

Bnen S. et al Bromelain as a treatmen t for osteoarth ri tis a rev iew of clmlcal st udies . EV ld Base d Comp lement Altemat
M ed 2 004 ; 1. 25 1.

Brou we r IA. et a l. Effe ct of fi sh all on ventncu lar tac harrhythmia and dea th In pa ti ents with Implan table ca rd lov erter
defi br illators . The study on omega-3 fatty acids an d ve nt ri cular arrhythmia (SOFA) random ized tria l. JAM A
2006 : 295;26 13 .

Brown EC. et al Soy versus whey protein ba rs. effects on exe rcise tra in ing impact all lea n bo dy ma ss and antioxid ant
st atus. Nutr J 2004 ;3 ,22

Brown L, et al Cholesterol-lowe ri ng effects of diet ary fi ber a meta-analys Is. Am J Clln Nutr 1999 ,69 .30

Brungger M. Hu ller HN , Kra pf R. Effect of chrontc me ta bo liC aC idOS IS on the growth hormone/IGF- 1 endOC ri ne aX Is new
ca use of growth hormone Insensit iv ity In humans Kidney In t 1 997 :5 1:216

Bu chholz AC . Schoeller DA. Is a ca lorie a ca lorie? Am J Clln Nutr 2004;79 :899S .

8uc lt n T. et al. Diet aC ids and alkal iS In fl uence ca lCium retenti on In bone Os teopo ro s Inl 2001 12.493 .

Bu lus N. e[ al PI1YS Iologic importance of glutamme. Metab oli sm 1 989 ;38 : 1

Cersosimo E. et al. Ro le of glutam ine In adaptations In mtrogen metabolism dUfi ng fastmg. Am J Physiol 1986 .
250 · E622

Chand ler RM , et al. Dietary su pp lemen ts affect the anabolic hormones after weight-training exerc ise . J App l Phys iol
199 4 ;76:839

Cho SY, et al Qu erce tin supp res ses proinflammatory cyt okilles produ ct ion through MAP ki na ses and NF-kappa8
pathway in lipopolysaccha ri de- st i mu lated macrophage . Mol Ce li Blochem 2003 ;243 : 153 .

Ch un OK, Kim DO , Lee CY Superoxide rad ical scavenging actiVity of U1 e ma jor polyphenols In fres h plums. J Agric Food
Chem 2003;51:8067

Co he n DB, et al Indomet ha Cin and cel ecoxib Inhibit rotator cuff te ndon-to-bone hea ling Am J Spo rts Med
2006;3 4 :362

Carl CF. The fate of sugar In the ammal body. I. The rate of ab so rption of he xoses and pen toses fr om th e mtes tlna l tract.
J Bioi Che m 1925 :66691

Coudray-Luca s G, et al Or nlthme alpha-ketoglu ta ra te Improves woun d hea ling In severe burn patients a prospec tive
randomized double-blind t ri al versus Isoni\rogenous controls. Gri t Care Med 2000 ,28: 1 772

Crawford MA. The ro le of dietary fatty aC ids In biology : their plac e in the ev olution of the huma n braill . Nutr Rev
1992.503

Cross CE oet al Oxygen ra dica ls and human disease . An n Intern Med 198 7 ; 107 :526 .

DaV IS B, Me lm a V. Becom ing Vega n· The Comp lete GUi de to Ad opl lng a Hea lthy Plant- Based Diet Book Publlsh mg
Com pany; 2000

DaV IS BC. Kris-Etherton PM . AchieV ing optima l essential fatty aCid status m vege ta ri ans : cu rr en t knowledge and
prac li ca l lmp llcatlons Am J Cltn Nutr 2003 :78 (s uppl) ·640S
464 RE fE RENCES

DavIs JM, et at Curcumln effects on inflamm ation and performance recovery followmg eCCenlflC exerCise-Induced
muscle damage . Am J PhYSlol Regullntegr Comp Physiol 2007.292 R2168

Dawson-Hughes B, Ha ms 5S. Cegtia L. Alkaline diets favor lea n tissue m ass In older adults. Am J elin Nutr
200S,SH62

Oe larue J, et at Effects of fish oil on metabolic responses \0 oral fructose and glucose loads m heal thy humans . Am J
Physlo 11996:270 (2 PI 1):E353

Dem lgne C, et al. Protect ive effec ts of high die ta ry potass ium nutritiona l and me tabo lic aspects. j Nulr
2004 ;134 :2903 .

Demll ng RH The ro le of anabolic hormones fo r wound hea ling In calabolic stales J Bu rn s Wo und s 2005:4 ' e2

Donati L, et al. Nutritiona l and clinical efficacy of ornl th me alpha-ke toglu ta rate In severe burn patients Clm Nutr
1999;18307 .

Dreyer HC, et al Resistance exercise increases AM PK activity and reduces 4E-BPI phosphorylation and protein
syn th es is m human skeletal muscle. J PhysioI2006;576:613.

Durstlne Jl. Moore GE ACSM's Exercise Management for Persons With ChroniC Diseases and Disabilities. 2nd ed.
Champaign, IL: Human Kinetics. 2003.

Eato n SB, Kanner M Paleoli lhlc nUIIll lon. a consideration of its nat ure and cu rr ent Implications. N Engl J Med
1985,31 2:283

Ehrlich HP, Ta rver H. Hunt TK , Effects 01 vitamin A and glucocortico ld s upon In fla mmation and collagen synthesIs. Ann
Surg 1973;177 :222

Ehr lich HP, Tarver H, Hu nt TK. Inhibitory eff ects of vitam in E on col lagen synthesIs and wound repair Ann Surg
1972;175235

Eld er CL, Dahners LE. Weinhol d PS. A cyClooxygenase-2 Inh ibitor Impa irs ligament healing in the rat. Am J Spo rt s Med
2001 ;29:801

Em ery PW MetaboliC changes in malnutrrtlon Eye 2005; 19: 1029.

Escott-Slump S. Nutntlon and Diagnosis-Related Care. 5th Edition Philadelphia, PA: Lippincott Williams and Wilkms;
2002.

Eshel G an d Marlin PA. Diet. energy. and global warming Earth Inter aclrons 2006;10:1.

[sselstyn CB Jr. Updating a 12-year experience With allest and reversa l therapy l or coronary heart disease (an overdue
requiem lor palliative cardiology). Am J Cardiol 1999;84:339.A8

Esse n- Gustavsson B, Tesch PA. Glycogen and triglycerrdes utiliz ation in relat ion to muscle me tabolic characteristICS in
men performing heavy resistance exercise. fur J Appl PhysloI1990;6l:5.

Feingo ld D. Harne SL. Fem ale athle le tr iad and stress fractu res . Ort hop Cli n North Am 2006 ,37:575.

Fernandez-Mad rid F. Prasad AS, Oberleas D. Eff ect of Zinc defi Cienc y on nucleiC aCids. col lage n, an d non co llagenous
pr ote in of the connective ti ssue J Lab ClIO Med 1973;82 :95 1.

Flatt JP The bioche mis try of energy expenditure . In : Bray GA ed Recent advance s in obeS ity research. Londo n:
Newman, 1978:21 1

Food and Agriculture Organization of the United Nations (FAO) . FAOSTAT online stat istical serVice (FAO. Rome. 2004).
Available online at. http://faosratfao.OIglsitel291/default .a spx. Accessed 8/1/2008

Forbes GB . Body fa t content rnfluences the body composition response to nu t ri tion and exercise. Ann N Y Acad Sci
2000,904 359.

Frankenfield D Energy expenditure and prO tem requi re ments after traumatic injUry Nutr Clin Pract 2006:21 430

Frassetto L. Morns RC Jr, Sebastian A Potassium bicarbonate red uces urinary nitrogen excretion In postmenopausal
wo men. Clin Endocrrnol Me ta b 1997;82 254

Frassetto L, et al. WorldWide InCidence of hip fracture In elderly women' relalion to consumpliOn of animal and
ve getab le foods . J Gero nto l A Bioi Sc I Med SC I 200Q ,55 :M585.
REF ERENC ES 465

Fre und-LevI Y. et al n-3 fatty acid treatment in 174 patients with mild to moderate Alzheimer diseas e OmegAD study:
a rand omized double-b li nd tflol. A rc h Neurol 2006;63 - 14 02

Furst P, Steh le P What are the essential elemen ts needed for the determmatlon of ammo aCid reqUi rements in humons?
J Nulr 200 4,1 34( 6 Su pp l) · 1558S .

Ganong WF. Endocn ne fun ctions of th e pa ncreas and regulation of ca rbohyd ra te metabolism In . Review of Medica l
Phy si ology. New York: M cGraw-Hili: 2001:322 -343

Geelen A, et al. Fish consump\lon, n- 3 fatty <K ids , and colorectal cancer: a meta-analysIs of p ros pecti ve cohort studies
Am J Epidem loI 2007;166 : 111 6 .

Greene , J Cost-conSC IOus pre scrlbmg of nonsteroida l anti -inf lamm ato ry drugs for adults Wi th arthntlS Arch ives of
Interna l M ed iCine 1992; 15 2 : 1995

Greenwood M, et al. Creatine supplementati on during co llege foo tball training does not increa se the InC idence of
c ra mpmg or inju ry Mol Ce ll Biochem 2003 ;2 44 ,83

Griffenberg L, et al The effect of dietary fi ber on bowel functi on fo llOWing rad ica l hysterectomy· a ran dom ized tnal.
Gy necol Oncol 1997 ,66 .4 17

Groff JL, Gropper SS . Advanced Nutn\lon and Human Metabolism , 3rd Ed it ion 1999 De lmar Publishers, Jnc

Gross RL. The effect of ascorba te on wou nd heal ing. In t Ophthalmol Clin 2000;40 :51.

Guyton AC , Hal l JE. In su lm, glucagon, and diabetes mellitus. In· Te xtbook of Medical PhYS iology. Phi lad elph ia: W. B.
Sau nde rs : 2000:884 -898

Hankenson KD , et al Omega-3 fatty aC ids enhance ligament fi broblast col lagen formation 111 associa\lon With changes
In Interlell kln-6 prod ll C\lon . Proceed ings of the Society for Experi m en ta l Biology and Medicine 2000; 223 :88 .

Harm on AH, Ge rald BL. Position of th e Americ an Dietetic Associ ation: Food and nutntlon profe SS ionals can implement
pra cti ce s to conserve na tu ral resources and support ecol og ica l sustamabil lty. J Am Diet Assoc 2007 ; 107 . 1033

H av lik RJ Vitamm E and wo und heali ng Plas ti c Surge ry Edu ca ti onal Fou ndation DATA Committee. Plas t Reconstr Surg
1997 ; 100 . 1901.

He K, et al. Accumu lated eV idence on fis h consumption and coronary heart disease morta li ty : a meta·analysls of co hort
studies. Circulation 2004 :1 09:2705 .

Heljnen CG, et al. Flavonoids as pe ro xynltrlte sca ve ngers: the role of the h yd ro xy l grou ps . Toxicolln Vitro 2 001; 15 :3 .

Higdon, J. An EVidence-Based Approach to Vitamins and Minerals. Linus Pauling Institute; 2003 .

Howard LV, West 0, Ossip-Klein OJ. ChroniC constipation man age ment for Institutionalized o ld er adu lts. Geriatr Nurs
2000,2L78

Howley ET and Franks BD Heal t h Fit ne ss Inst ru ctor's Handbook , 4th ed. Champai gn , IL : Human Kinetics; 2003 .

Hu FB, et 0 1. Diet, lifestyle, and the f iSk of type 2 d iabet es mellit us In wom en . NEJM 200 1 ;345 :790 .

Hughes MS, et al Enha nced fr acture and soft-llssue hea ling by means of anabol iC dietary supplementation . J Bone
Joint Surg Am 2006 :88 :2 386 .

Ivy JL, et al. Muscle glycogen syntheS IS after ex ercise : Effect of tim e of carbohydrate ingestion. J App l Physiol
1988: 64 . 14 80 .

Ivy JL Muscle glycogen syntheSIS be fore and after exe rci se . Sports Med 1977: 11 :6 .

Jenk ins OJ, et al Effect s of a dietary portfolio of cholestero l-I owerrng foo ds vs lovastatrn on serum lipids and C-react ive
pro te m. JAMA 2003 ;290 : 502 - 510.
r
Je nkins OJ , et al. Low-glycem iC diet In hyperlipidem ia: u se of traditiona l sta rchy foods . Am J Clrn Nut r 1 98 7: 46 :66 .

Jentjens R, Jeukendrup A Determinan ts of post-exerCise glycogen syntheSIS dUfing short te rm recov er y, Sports M ed
2003;33 , 11 7

Jequ ier E Lep t in Signaling, ad iposity, and en er gy balance. Ann NY Acad SC I 2 002 :967 379 .
466 REFEflENCES

Jiang R, el al Nul and seed consumption an d Inflammatory markers In the mu ltl -ethnr c study of atherosclerosIs Am J
Ep ldem lol 2006;163222

Jon es PJH and Kubow S, LIPids , ste rols, and their metaboli tes In : Sh il s M E. Olson JA, Shike M, Ross AC , eds Modern
Nutrition In Hea lth and Disease 9 th cd Balt im ore , MD Wil liams and Wilkins; 19996 7

Ka l ma n 0 , el al Effect of protein source and res istance trammg on body co m position and sex hormones . JI SSN
2007; 4 :4

Ki rk SJ, Ba rbu l A Role ofa rglil ine In traum a, sepSIS, and Immun ity. J Parenter Enteral Nulr 1990 , 14 (5 Su ppl) 226 S

Kishmo Y, Mo nguch l S, Nutritio na l factors and cellu lar Imm un e resp onses Nulr Hea lth 1992 :8:133 .

Ko opm an R, el al. In crease In S6Kl phosphorylati on in hum an sk ele ta l muscle follOWi ng res istance exerc ise occurs
mainly In typ e II musc le fi bers Am J Phys lo l Endoc nnol M eta b 2006,29 0 12 45 .

Kns-Etherton PM , Ha ms WS , Appel LJ . AHA SC ientific Statem en t: Fish consumption , fish all, omega-3 fatty aC ids, and
card iovascular disease . Circu lation 2002: 1 06 :27 47

Kns-Etherton PM. et al Polyu nsatu ra ted fatty acids in the food cha in In the United States Am J Clln Nutr 2000 : 7] (1
Suppll: S179 .

La granha CJ, et a l. The e ff ect of glutamme supplementation and phys ica l exe rc ise on neutrophil fu nct ion, Am mo AC ids
2008 ,34 :337

La ine L. The gast ro intestina l effects of nonselect ive NSAlOs and CO X-2-se lectlve inhibitors Se mln Arthri tis Rheum
2002:32(3S uppl 1)25

Latner JD, Schw ar tz M . The effects of a high-ca rboh ydrate. high -pro te in or ba lan ced lunch on later food intake and
hunger ratin gs . Appetite 1 999:33 , 1 19

Lemon PW, N ag le FJ , Effec ts of exe rcise on p ro tem and amino aCid metabolism Med Sc i Sports Ex erc 198 1: 13 141 .

Lem on PW, et al. Protem reqU iremen ts and musc le mass/strength changes durmg intenS ive tr aining In novice
bodybui lders J Appl Phys io I 19 92; 73 . 767 .

Leve n ha gen OK. et al. Pos texe rcise nutrient Int ake tlmmg m humans IS cntlca l to recovery of leg gl ucose and protein
homeostas Is Am J Physiol Endocri nol Met ab 2001, 280 :E982 .

Lo GH . et al. Intra-articular h ya luro niC aCi d in treatm ent of knee osteoarthntls' a meta-analysis. JAMA 2003: 29 0: 3 1 15 .

Lock K, et al The globa l bu rden of d isease att ri butable to low consumption of f rU it and ve getab les Imp lications fo r the
globa l strategy on diet Bu ll Worl d H ea llh Orga n 2005:83:100 .

Lo mbardo YB, Ch leco AG . Effe cts of d ie ta ry polyunsaturated n-3 fatty acids on dyslipidemia , and Insu lin res istance In
roden ts and humans. A revi ew J Nulr Blochem 2006; 17 : 1

Long CL , et al Metab olic response to Injur y and Illness: esllmatlon of energy and protei n needs from Ind irect
ca lOri metry and nitrogen balance J Pa re nter En teral Nulr 1979 :3 .4 52

Ludwig OS , Eckel RH . The glycem iC Index at 20 yea rs. Am J Clin Nutr 2002 .7 6 264S

Ludw ig DS Dietary glyce miC Index and obe si ty. J Nutr 2 000; 130:2805 .

MacDonald 1M, et a l. Eff ect of docosa hexaenoic ac id supp le mentation on retin al funct ion in a pa ti en t w ith auto som al
dominan t Sta rgardl-I lke retinal dystrophy. Sr j Ophthalmol 2004 ,88 .305

MacDou ga ll JO, et al The t ime cou rse for elevated muscle protein syn theSIS foll OW ing hea vy re sistan ce exerCise Can J
Appl Phys iol 199 5;20:480

M acDougall JD, et al Substrate ut il ization dUrin g we lgl1 tll fting Med SC I Sp or ts Exe rc 19 88;20: 566

M ac rae F Whea t bran fi ber and development of adenomatous polyps: eV idence fr om ra ndom ized , cont ro ll ed clin ica l
trials . Am J Med 1999 ;10 6 :38S

Maes M, et a l. Lowered ome ga 3 polyunsa tu rated fatty acids in ser um ph os phol ipids and cholesle ry l es lers of
depressed pa llents. Psychiat ry Res 1999: 85 : 27 5

Mahan LK. Esc ott-St ump S Food . Nutrition and Diet Therap y, 11th Ed i ti on. Ph iladelph ia: Sau nders: 200 4 .
RE""ERENCE S 467

Marchlo li R, et al. Earl y protection aga ins t sudden death by n-3 polyu nsa tura ted fatty aCids aft er myoc ard ial Infa rc ti on :
Ti me-co u rs e analys Is of the resu lts of the Gruppo Italia no per 10 Stu dio del la Sop ravv ivenza ne ll·l nlarto Ml oca rdlCO
(GISS I)· PrevenZi one. Circula tIOn 2002105,18 97.

Ma rcos A. Nova E. Mon t ero A Changes m th e Immu ne sys tem are cond iti oned by nutriti on . Eur J e lln Nutr 2003 ·57
Suppl 1;S66

Ma rtinez ME. et al Assoc iat IOn of diet and colorecta l adenoma to us pol yps d ie tary fi ber, ca lcium , and tot al fat
Ep idem iology 1996 .7:264

Marti nez ME. et al A ca se -con t ro l stu dy of dieta ry Intake and other lifes ty le fisk fa cto rs for hype rplastic po lyps
Gas tr oent ero logy 1997: 1 13 ·4 23

M asse y LK Dieta ry ani ma l and plant pr ote in and human bone hea lth · a w ho le foods approach . J Nutr
200 3 :13 3862S .

Mau rer HR. Bromelaln: biochem ist ry. pharm acology and medica l use . Ce ll Mo l Life SCI 200 1; 58 1234

McA lmdon TE. et al Glucosam i ne and chond ro l tm fo r trea tment of osteoar th ri ti s: a sys tematic quali ty assessment and
meta-an alys Is. JA MA 20 00;283 1 46 9

Mc Keow n-Eys se n GE. et al. A rand om ized tr ial of a low fa t high fibre d iet In the rec u rre nce of colorecta l po lyps. Toro n to
Po lyp Prev ention Gro up. J Cli n Ep ldem loI 199 4 ;47 .5 25

McMichael AJ. et al. Food . live sto ck production. energy, cli ma te cha nge, and hea lth Lancet 2 007; 370 : 1253.

Meha llo CJ , Dr ez ner JA, Bylomskl JR. Practica l management. non sterO idal anti-Inflammatory drug (NS AIO) use 111
athletic injuri es . Cli n J Sports Med 2006 , 16 : 170

Mi llwa rd OJ Opl lmal intakes of protel11 In t he human d iet. Proc Nutr Soc 1999.58403

M I1lIc h OM , Blan d JS AC id-alkaline ba lance ' role in chron iC disease and detox ification. Alt ern Ther Hea lth Med
2 007;1 3 :6 2.

Moms MC Do cosahexaenoic aC id and Alzheimer disease Arc h Neurol 2006 ;63 1527 .

Nationa l Diab et es Info rmation Clea rn lll g House. Diabetes Sta tisti cs 2007 Avai lable on ll11e at: htlp:!/diabetes niddk nih
gov/ dm/pubs/s tatl sticsl Accessed 8/7/ 2 008

Nationa l Eati ng Disorders - Statistics. Available on line at http://www. nali ona lea tingdiso rde rs.org/. Accessed 8/ 7/ 08

Ne mets B, Stahl Z, Be lmaker RH Ad dition of omega -3 [a tly aC id to mal11ten ance med ica tion treatment for rec u rren t
Uni pola r depre ssi ve diso rd er. Am J Psy ch iat ry 2002 ;1 59 477

New SA Intake of [r Lil t and vege tab les: impl ica tions for bo ne hea lth Proe Nutr Soc 200 3:62 ·88 9

New SA . Nutll \lon So ciety Meda l lec ture. The ro le of the skelet on in aCid-base homeostasIs Pro c Nu tr Soc
2002 :6 1. 15 1.

News holme EA , Crab tr ee B. Ar dawi MS . T he ro le of high rate s of glyc olYSIS and glutam ine ut il izati on III rap idly dividing
cells Bio sc i Rep 198 5 :5:39 3.

NllIll kos kl J. Kivisaa n J. VIIJan to J Loca l hy pera limentatlon of ex peri men ta l gran ulation \Is sue Ac ta Chlr Scand
1977;14320 1

Norat T. et al. Meat , fi sh, and co lorecta l ca ncer IIs k t he European p ro spective inve sti ga tion mto ca ncer and nutntl on J
Nail Cancer Inst 2005 ;97 -906 .

No rton LE and Laym an OK . Leuc11le re gulates translati on initiati on of pro te in sy nthesiS In skelet al muscle after exerCise
J Nutr 2006 ;1 36 ·533S

O'Lea ry KA. et al Effec t of flavonOids and vitamin E on cycl oo xyg enase-2 (COX - 21 tr an sc ri ption. Mutat Res
200 4 ;551 : 245

Ogl11 o A, et al Eva luation envi ronm ental Impacts of the Japa nese bee f cow-ca lf sys tem by [\l e li fe cyc le assess ment
method. J An lm SCI 2 00 4:82 : 11 15

Or1ll sh D, et al. \n te nSlve lifes ty le chang es for reve rsal of coronary hea rt diseas e JAM A 1998 :2802001
468 REFER ENCES

Park Y, et al . Dietar y fiber mtake and fi sk of co lorecta l cancer : a poo led analysIs of prospective co hort stu dies , JAMA
2005,2942849

Peel M. Horrob ln OF. Dose -rangmg study of the effects of et hyl- €Icosapentaenoate in pat ients with ongoi ng depression
despite apparently ad eq ua te treatm en t with standard dru gs. Arch Ge n Psych iatry 2002;59:913 .

Peters U, et al. Dietar y fibre and co lore ct al adeno ma In a co lorectal cance r ear ly detection prog ramme. Lancet
2003;361 ,1491

Ph ill ips SM . e1 al M ixed musc le pr ote in synthesIs and b re akdown after res istance exe rcise in humans. Am J Ph ysiol
1997,273E99

Pitkanen H, et al. Free ami no acid po ol and mu sc le pro tem ba lance after resistance ex ercise . Med Sci Sports Exe rc
2003;35.784

Pr entice A, Jebb S. Ene rgy in take /physical activity InteractIOns In the homeostas is of body weight re gu lation. Nutr Rev
2004 ,62,S98

Rampone AJ, Reyno lds PJ . Obe sity : thermodynam ic princip les In perspective . Life Sc i 1988;43:93 .

Reeds PJ . Di spensab le and indispensable am ino ac ids for huma ns J Nutr 2000;130: 1835S

Remer T, Dim ltri ou T, Manz F Dietary potent ial rena l acid load and rena l net acid excret ion in hea lthy, free-l ivi ng
children and ado les cents . Am J Cl in Nulr 2003;77 :1255 .

Remer T. Manz F Po tential ren al aCid load of foods and its in flu ence on pH. J Am Di et Assoc 1995 ;95 791

Rennie MJ , Tip to n KD . Prote in and ammo aC id meta bolism dUri ng and afte r exerC ise and the effec ts of nutrition. Annu
Rev Nutr 2000 ;20:457

Robergs RA. et al Musc le glycogenol ysis duri ng di ff erent in tens ities of we igh t resistance exercise J Appl Physiol
1991:70:1700.

Rose ll MS , et al. Long -cham n-3 polyunsa tur ated fa tty aC ids In p la sma in Br itish mea t- eatmg, vegeta ri an, and vegan
men . Am J Clin Nutr 2005 ;82 :327 .

Rolslein NP. et al. Protect ive effect of docosahexaeno lc acid on OX idative stress-induced apoptosls of retma
photoreceptors . Invest Op th almol Vis SCI 2003 ;44 :22 52.

Roy BO, Tarnop ol sky MA . Infl uen ce of di ffe r ing mac ronutrrent Intakes on muscle glycogen resyn thesis after resistance
exe rcise . J App l Phys io l 1998;84:890 .

Rucker RB , el al. Coppe r Iy sy l OX idase, and ext ra ce llular matrix pro tem cross-linking. Am J Clin Nutr 1998;67(5
suppl) :996S.

Sa ka ta K, et al. Inh ibition of inducible isoforms of cyclooxygenase and nitriC ox ide syn thase by flavonoid hesperidin In
mouse ma crophage ce ll li ne . Can cer Le tt 2003; 199:139 .

Satoska r RR, Shah SJ, Shenoy SG. Eva luation of anti-Inflammatory proper ty of curcumm (d lf eru loy l met ha ne) in
patients with postop erati ve Inflam ma tion . In t J Clin Phar maco l Ther To xlco I 1986;24:651.

Schaefer EJ, et al. Plasma phosphatidy lchollne docosahexaenO lc acid content and risk of dementia and Alzheimer
disease . the Fram ingham heart study. Ar ch Ne urol 2006;63: 1545.

Sch illing BK, et al. Creat ine supplementat io n and hea lth variables. a ret ros pect ive st udy. Med Sci Sports Exerc
2001;33 .183

Scho ll 0, Lang kamp-Henken B Nut ri ent reco mmenda tions fo r wo und hea ling. J Intrav en Nu rs 2001: 24 :124 .

Schwa rtz MW, Kah n SE . Insu lin resista nce and obesity Na tu re 1999:402:860.

SeiHe r E, et al. In fluence of vitam in A on wound healing in rats With femoral fracture. Ann Su rg 1975 ; 181 ,836.

Se llmeyer DE, et al. A high rat iO of dieta ry anima l to vegetable prote in i ncreases th e ra te of bo ne loss and the fis k of
fracture In postmenopausa l wo men. Study of Osteo poroti c Fractures Research Group. Am J Clln Nu tr 2001,73 .118.

Shl HP, et al. Effe ct of suppleme ntal orn ithine on wou nd hea lmg . J Surg Res 2002 ; 106:299 .
REFERENCES 469

$lmOpoulos AP The Imporlan ce of the rallO of omega -6/omega-3 essential fatty aCids Bl amed Pharacother
2002,56,365 .

Soeters PB. et al. Amino aCids adequacy In pathophysiological state s J Nutr 2004 ; 13A(6 Suppl) .1 57 5S

Stein feld . H et al Llves!ock·s Long Shadow : Environ me nta l Issues and Opt ions Rom e. Food an d Ag ri culture
Organiza tion of the United Nahons (FAD): 2006 Available online at Itp li ftp.faoorgldocrep/ faoJOlO /a0701 el
a070 leOO pdf. Accessed 8/7/2008

Siorey Ml. For shee RA. Anderson PA Beve rage consum pt ion In the uS population J Am Die t Asso c 2006; 106: 1992

Su KP. et al. Omega -3 fatty aCids If) maj or depressive disorder A prelim inary do uble-blind. placebo -contro lled trial Eur
Neu roPsych opha rmacol2003:13 267

Talanlan JL. et al. Two weeks of hlgh·lf)tenslty aerobic mte rval training increases the capaCity for fat oXidation during
exerCise If) women J Appl PhysioI 2007:102:1439

Tangney CC. et al. A review wh ich dietary plan IS best for your pat ients seeki ng we ight loss and sustamed weigh t
management' Dis Mon 2005 .5 1; 284 .

Tappy L Therm iC effect of food and sympa thetic nervous system activity In humans Repred Nutr Dev 1996.36:391

Tarnopolsky MA. et al Evaluation of prO!em reqUIrements for trained si rength at hletes J Appl PhYSlo11992.73 1986.

Tarnopolsky MA. et al. Whole body leuc ine metabo lism during and after res istance ex.e rClse 10 fed humans Med SC I
Sports Exerc 1991;2 3326·333 .

Tamopolsky MA. et al Creatme -dextrose and pro tein -dextr ose induce SImilar stlength gains during traming. Med SCI
Sports Exerc 2001 :33.2044

Tenaud I. eL al. Wound healmg m rats with blolin, PYridOXin . or riboflav in defic iencies Proc Soc Exp 8101 Med
194M74 18 .

Tesch PA. Colliander EB. KaIser P. Muscle metabolism durmg intense. heavy resistance ex.ercise. Eur J Appl Physiol
1986,55,362

Thibodeau GA. Palton KT Anatomy and Physiology. 4th Ed i tI on. 1999. Mosby. Inc.

Tipton KD . et al Timin g of ami no acid -ca rbohyd rate Ingesti on alte rs anabolic response of musc le to res istance exerc ise .
Am J Physiol Endocrinol Metab 2001;281:E197.

Todd KS. Butterfield GE. Calloway DH Nitrogen balance In men with adequate and deficient energy Intake at three
levels of work. J Nutr 1984.114 2107.

Tre mblay A. et al . Effect of Intensity of physical acti Vity on body fatness an d fat dist rib ution Am J Cl in Nutr
1990,5 U53

Tremblay A. Simoneau JA, Bouch ard C. Impact of exercise intenSity on body fatness and skelet al muscle metabolism
Metabolism 1994;43814.

Tse PW. et al. Dietary fibre Inta ke and constipa tion in child re n With seve re developm en tal disabiliti es . J Paedl8tr Child
Hea lth 2000;36 ·236

Van Den Bergh AJ. et al. Muscle glycogen recovery after exe rcise dutlng glucose and fructose mtake momtored by
13C-NMR J App! Ph ysioI1996;81:1495.

Van Loon U. et al. Ingestion of pro tein hydrolysate and amin o acid...carbohy drale mi xtu res Increases postexercise
pl asma Insul in res ponses in men . J Nutr 2000:130:2508

Van Loon U. et al. Maximlzmg postexercise muscle glycogen syntheSIS: carbohydrate supplemen tation and th e
applica tion of am ino aCid or protein hydrolysate mixtures. Am J ClIO Nutr 2000;72:106.

Van l oon U , et al. IngesliOn of protem hydrolysate and ammo aCld·carbohydra te mixtures mcr eases postexerCise
plasma Insulin res ponses in men J Nutr 2000.130 ·2508 .

Va n Marken Ll chtenbelt WD. Men slnk RP. Wes terterp KR . The eff ect of fa t composition of 1t1e diet on ener gy
metabolism Z Ernahrungswlss 1997;36303

Venn BJ. Mann JI Cereal grains. legumes. and diabetes. Eur J Chn Nutr 2004;58:1443.
470 REFERENCES

Va lek. J Chap ter 2 Nutnt lO n and th e strength a th lete . In Ratzm. CG , ed eRe Press , 2001.

Watkins SA, Xu H, Tu rek JJ Llnolea te Impa irs co llagen synth es Is In prim ary cul tures of aV ia n chondrocytes . Pr oe Soc
Exp 810 1Med 1996;21 2 :1 53.

We i bou rn e T, Clav ille W, Langford M . An oral glutam ine load en ha n ce s rena l acid secretion and fu nction. Am J Clin
Nulr 1998; 6766 0

We lbourne T In creased plasm a bicarbonate and grow th hormone aft er an ora l glutam ine load Am J Clin Nut r
1995,61:1058

W heaton DH, et al Biological sa fe ty assessmen t of docosahexaenoic acid supp lementation In a random ized clini ca l tria l
lor X-linked re tin itis plgrnen tosa Arch Opthalm o12003 , 12 1 1269 .

W high am L D. Watras AC. Schoeller DA . Eff icac y of conj ugated linoleic acid for reducmg fat mass: a meta·analys is III
hu mans Am J Cll n Nutr 2007:85 : 1203 .

Wiederkehr M , Krapf R Metabo lic and endocrine effects of m et abolic aC idosIs In humans. SW ISS Med Wkly
20 01:131 127

Wi llia ms JZ , Abumrad N , Barbu l A Effect of a specialized ammo aCid mixtu re on human collag en depOS ition Ann Su rg
20 02:236 . 369

Wo rl dWatch Institu le. Meat Ava ilable on line at ' http ,//www.worldwat ch.orglnodel 1 495 . Accessed 811 108 .

Wu G. et al GlutaHlione metabolism and Its Im plications for health J Nutr 2004 ; 134:489

Wu H. et al. Dietar y' fiber and progression of athe rosclerOSIS the Los Angeles Atherosclerosis Study Am J e lm Nut r
2003)8 1085

Wylie-Rose ll J, Seg a l- Isaacson CJ, Se gal- Isaacson A, Carbohydrates and Increases in obeS ity does lhe typ e of
ca rb ohydr ate make a difference? Obes Res 2004;12 Su pp1 2 : 124S

Xi ZP, Wang JY. Effec t o f d ie tary n-3 fatty aCids on th e composition of long-and ver y-long-cham polyen oic fatty aCid in
ra t retina . J N utr SC I Wa mm ol (Tok yo ) 2003:49 : 210

Yos ~ l l oka M, et al Impact of high -In te nsi ty exercise on energy expend iture, lipid oxidation and body fat ness Int JObes

Relat Metab Dlsord 200 1 ;25 : 33 2

Zhang X, et al Soy food co nsum pti on IS aSSOC ia ted With lower ri sk of co ro nary hea rt disease In Chi ne se women J Nut r
2003,1332874

Unit 2
Alaswad K, O' Ke efe JH J r, Moe RM. Combi na tion drug therapy fo r dys llp ldemia . Curr Atherosc ler Rep. 1999 :1 ; 1.

America n Diabetes Associa ti on wwwd labetes .org, Accessed 20 08

America n Hearl ASSOCIa tion, www .amen ca nheart org Acc essed 2008 .

Andr esa RH , et al Fun cti ons and effec ts of creatine in th e cen tral nervous sys tem . Brain Res Bu ll July 2008;76 :4.

Bar- Or O. Nu lritlon for child and adolescent ath letes . Gator ad e Spor ts Sc ien ce Institute SSE # 77 2000; 13:2

Barrett-Co nnor, et al The association of testosteron e level s with ove rall sleep qua li ty , sleep architectu re, and sle ep-
disordered breathing, J Clin EndOC ri nol Melab 93 : 7

Bena rd ot D Tim ing o f energy and fl uid Intake. New con cepts fo r weight control and hyd rat ion. ACSM Heallh and
Fitness Journa l Ju lyl Augu st 2007: 11 :4 .

Benardot D, et al. Between -mea l ellergy Intake effects on body composition, performance and total ca lOriC consumptIOn
in athl etes_ Med SCI Sports Exe rc M ay 2005 ; 37 .5 (Supplement)

Berard i J The Metabolism Adva ntage. PA Rodale, 2006.

B er ard i J The PreCiSion Nu tri tion System V3 2 008

Berard i J, An drews R Til e be lter to heal you Wi th . Tra ining and Cond ition ing MagaZi ne March 2008
'i EFERENCES 471

Ber ardi J, Noree n EE, Lemo n PWR Po st exercise mu sc le glycogen re syntheSIS enhanced w ith a carboh ydrale-prolem
supplement Med SCI Sports Exerc. June 20 06 ;38:6

Bera rdi J, Rouse ll, M . Beta alani ne supp lementati on and sports perfo rm ance Agro Food Industry HI-Tec h 2007

Bit ar A. et al long itudi nal changes In body compositi on , ph ysi cal capaci ti es and energy ex pend iture In boy s an d gi rls
dUring the ons et of puberty Eu r J N ul r Sept 2000 .39 4 .

Britten P, Ha ven J, Da vis C. Consum er rese a rch fo r dev elopment of educat ional message s for th e My Pyr am ld Food
GU idance System . J Nutr Ed Be hav. November/ December 200 6 ;3 8 .65

Britten P, et a l. MyPyram id food Intake pattern modeling for t he Dietary GUidelines Advisory Comm itt ee J Nutr Ed
Behav 20 06;3 8 :65.

Britt en P. et al. Development of food Intake patterns for t he MyPyram ld Food GUidance Sys tem J Nutr Ed 8 ehav.
Novembe r/ Dece m be r 2006;3 8: 65

Camp be ll B, et al. Interna\lona l Soc ie ty of Spo rts Nutrition pos iti on stand p rote m and exerC ise J In t Soc Spor ts NutL
Sep tember 2007 :4 :8

Ce tm I, Ko letz ko B Long-chain omega-3 fa tty aCi d supply in pre gn ancy and lactation. Curr Op ln Clln Nutr M et ab Ca re.
May 2008;1 1,3

Cha ll a S, et al. Asso cia tion of reSident, faCil ity. and geographic char acte ri sti cs wilh chroniC undernutnllon In a nationa lly
rep re sented samp le of older re sidents In U.S nursing homes. J Nutr Health Ag ing Mar-Apr 20 0 7 ,1 1,2

Consumer Lab . w ww.co nsum er lab .com. Accessed 2008

Demling, R. H Eff ec t at a hypoca lorlc diet. In creased protein intake and resistance tr ammg on lea n mass gains and fat
ma ss loss m overweigh t pol ice office rs. An n Nutr Metab. 2000 ;44

Em erton V. Foo d Allergy and In tolera nce. Cambridge, UK- RSC Pub lishin g; 20 02

Fletcher R. Fai rfield K Vitam ins for ch ro niC disea se prevent io n In adults. JAM A June 2002;287 23

Fogteloo AJ, et al. Impac t of m ea l time a nd freq uency on th e twenty -four-hou r leptin rhythm . Harm Res. 200 4 ;62 .

Foo d and Drug Ad mmlstral lon http . // www . cf sa n Jda . g o v/~d ms/ su p p l m n l . h tm l . Accessed 2008

Frenchl , et al Design ing My Py ram id fo r kids: Materi als to help chi ldren eat right. exerCISe , have fun. J Nulr Ed Behav
20 06 ;38 :6 .

Gales loo t TE, Tmbergen 8J, eds Milk Prote i ns '84 ' Pro ceed ings of t he Internationa l Congress on Milk Proteins,
Luxem bo urg, 7-11 M ay 1 984 . Wage nlngen, The Netherlands Pudoc , 19 85.

Geller SE. Studee L. Bolanlcal and dietary supplemenls f or me nopausal symptoms: wha t works. wh at does not J
Wome ns Health . Sep 20 0 5; 14 :7

Geyer H. et al. An alYSi s of non -hormonal nutritIOn al su pplements for ana bo lic-and ro gen ic sterOids ' An mternatlonal
st udy. In t J Spo rts Med Feb 20 04; 25 .2

Gr asso B. Complete Ath lete Deve lopment System Audio and Vid eo seri es . 2 007

Ha ms RC, et a l. The absorption of orally su pp lied l3-a lani ne and ItS effect on m uscle ca rn osille sy ntheS IS In human
vastus latera lis Amin o ACids 20 06 ;3 0:3

Harris, AM , Jensen MD. LeV ine JA Wee kly changes In basa l met ab olic rate With eight weeks of overfeedmg Obesity
20 06 : 14

Ha ven J, et al. Developlllg t he consumer m te rfa ce for the MyPyram ld Food GUidance System J Nulr Ed Behav
2006,386

Haven J, et a l. MyPy ra mid.gov Pro Vides Cons umers With Pr actical Nutrition In for ma tion at their Fi ngertips. J Nutr Ed
Behav. 2006 ;38 :6 .

Hea llh Canada Canada's Ph YS ical Activity GUide to Healthy Ac tive liV ing Ottaw a· H ea lth Canada; 199 8 .

Hea lth Canada Drugs and Hea lth Produ cts Information. http -//www hc -sc gC.ca /d hp-mpsip ro dnatur/ lndex -eng php
472 REFERENCES

Accessed 2008.

Hellh ammer J, et al Effects of soy leci thi n ptl Qs phatld lc acid and phospll atld y lserine co mp lex (PAS) on th e en dOC ri ne
and psycho logi ca l re sponses to me ntal st ress . Stres s Ju ne 2004;7 :2.

Higgins A, Hall L The Na ti ona l Coac hi ng In st itute of Ca nada Leve l 4/5 Cer ti ficatio n 2007 . Course mate ri al hando uts

Hom ann G, Berard i J Long ha ul training Article p ub lished at www.Joh n be rar di. com. 2004 .

Hu. Fran k, et al Di et, lif esty le. and the risk of type 2 diab etes me llit us In wo m en . NEJM Sep t 13 200 1: 345 11

In ternationa l Olymp Ic Co mmitte e Con sens us Statem en t on Spo rts N utrition . www. olymp lc. org. 2003 .

Ivy JL, et al £Heet of a carb ohydra te-pro te in supp lement on endu rance pe rformance dUri ng exe rcise of varying intenSi ty
In tJ Sport Nu tr Exe rc Meta b. Sep 2003 ;13 :3.

Iwao S, Marl K, Sa to Y Effe cts of mea l freque ncy on body co mpO SItIOn dU ri ng we ight cont ro l In boxe rs Scand J Med
SC I Spor ts . Oct 1996;6 :5 .

Jaklcic, J, Otto . A Treatment and preventIOn of obes lly ' What IS the ro le of exe rC ise? Nutr Rev Feb 2006;64 :2

Jen kins OJ et al Ni bb ling ver su s gorgmg : Metabol ic ad va ntages of Increased mea l fr equency. NE JM. Oct
1989.321 ' 14

Jones PJ, et al. Short-term administra tion of tall oil phytos terols Imp ro ves plasma lipid profiles in subjec ts with differen t
choles tero l leve ls. Melabollsm. Ju ne 1998:47:6 .

Juan WY, Gerr ior S. H lza H. GEM No . 427 MyPyrami d Tra cke r assesses foo d consumption, act ivity, an d ene rgy
balance status Interac tive ly. J Nu tr Ed Behav. Novembe r 20 06 ;38 ,6 .

Katz man M, et al. Weight ga m and ps ychla t fl c treat ment Is there a role for green tea and co njugated linoleiC aCid ?
Lipids Hea llh DIS. M ay 2007; 6: 14 .

Kre ide r RB . Eff ect s of creatine supplementation on performance and tralnmg ada ptat ions. Mo l Ce ll Bloche m. Fe b
2003 ; 24 4 :1-2.

Leibe l RL, Rose nbaum M. Hirsch J. Chan ges in ene rgy expend iture resu lti ng from altered bod y weight. NEJM. Mar 9
1995,332:10 .

Lem on PW R, Be rar di JM, Noreen EE . Th e role of protein and am ino aCid su ppl eme nts In the athlete's diet: Does type or
timi ng of in gest ion matte r? Cur r Spo rts Me<! Rep Aug 2002 ; 1·4

LIU, RH . Hea lth be nefits of fruil an d vegetab les ar e from add itive and synergist iC combinat ions of phyto c he mlca ls. Am J
Clin Nutr Sep 2003;78 ,3

Mallnow MR, el al. Reduction of p la sma hom ocystei ne levels by b reak fas t ce rea l fortified With fo liC aCid in pa tients With
co ro na ry he art disease . NEJM Ap fl l 9 1998;338: 15.

Marcoe K, et al Deve lopment of food gro up com pOSite and nutrient pro fi les for MyPy ram ld Food GUid ance Sys tem
Nulr Ed an d Behav. Nov - Dec 2006;38 :6

Mar co ff L. Thompson PO The ro le of coenzy me QI O in st atin -asso clated myopat hy : a systematic revi ew J Am Co li
Cardio l. Jun e 2007; 49 :23

McA rd le W, Ka tch F. Katch V ExerC ise Ph ySiology, 4 1h Ed ition Phi lade l ph ia. PA : LI PPincott Wil liams and Wi lkins;
1996

Meo he AL, et al Ora l non presc nptlon t re atm ent fo r II1 so ml1l a: an eva luation of products With lim ite d eVidence J CIII1
Sleep M ed April 2 005 ; 1: 2.

NS F Cer tif ica tion GUide lme 306 Cert ified For Sport. http ://www.nsf. or gi Cert ified/BannedS ub/Llstings.asp . Ac cessed
2008 .

Ottoboni A, Oltobo ni F Th e Fe od Gu ide Py ram id. Wi li l he defect s be corrected? JAm Phys Surg. Win ter 2004 ;9 4.

Pe rs eg hm G. et al In creased glucose tr ansport- pho sp hory la tion and muscle gl yco gen synt heSIS after exerCise trall1 lng 111
insul in- res ista nt subjec ts . NEJM. Oct 31 1996 ;335 18.

PoliqUin C. Bios ignatu re Modu lati on Ce rti fica tion . Live Ir al nll1g cou rse . 2008
REFEREN CES 473

Porter RS, et ai, eds Merck Manua l of Med ical Info rmation Onli ne ed iti on http-J/www merc kcom/mmhe Acc essed
200 8

Pruthl S, et al Pilot evaluation of flax.seed for the management of hoi fl ash es J Soc Integr Oneol. Summer 2007,53

Raschka, C. Schwelzl Sportsmed, 1993 (German)

Re mer T, Manz F Potential renal aCId load of foods and Its influence on pH. J Am Diet Assoc. July 1995;95 7

Robbins A Personal Power II - 30th Anniv ersary Edition. 1996 Gunt hy-Renker Co rporatio n. Audio se ries

Smith J. The St l ess Free Success Coach ing Program 2008 . In ternet-based .

Society of Actua ries and ASSOCiation of Ufe Insurance Med ical Directors of Am eric a. 1979 Burl d Study Metropolitan Life
Insurance Company: 1980.

Sokmen B, el al. Caffeine use m spOIls. conSiderations for the athlete J Strength Gond Res. May 2008;22 3.

Price lB, et al. Human muscle glycogen resynthesis after exercise: insulin·dependenl and -indep enden t phases. J Appl
Ph~'Slo l. Jan 1994: 76: 1.

Tarnopolsky MA et ai , Ev aluation of pro tein requi remen ts fo r trained strength athletes J Appl Physio l, Nov 1992: 73:5.

The Arthr itiS Society. www.ar thntls .c a Accessed 2008

Tipton KD, et al. Tlmmg of ammo acid-ca rbohydrate ingestion alters ana bolic response of muscle to reslsta nce exerCise.
Am J Ph ysiol Endocrinol Metab. Aug 2001 ;281 :2 ,

USDA Food Pyramid. 2005 Available at www.mypyramid goy.

USDA Center for Nutrition Policy and Promotion Food GUide Pyramid Booklet 1992.

WADA Bann ed Substances List www.wada-ama .o rg Accessed 2008 .

Will ett W, Skerrett P Eat Drink and Be Healthy New York: Simon and Schu ster: 1995

Yamiml S, et al. Impac t of usmg updated food consumptlOn and composition data on selected MyPyramld food group
nu tri ent profiles J Nulr Ed Behav. Nov- Dec 2006.38 6
Precision Nutrition Pn '~:n Gou rmet Nutrition
; ::~ ~

'..••
' .. .:
.. ..
.... ;". g
.2
REC IPES. COOKIN G TiP S & SFlATE GI ES FOR A \'IlNN l flG BODY

...•••
....
.......
.....

The Precision Nutrition System .

THE COMPREHENSIVE DIET GUIDE FOR YOUR CLIENTS.

Now that you've learned the right way to teach nutrition, make sure you have the right textbook
Gourmet Nutrition, Diet Gu ide for your clients: The Precisio n Nutrition System.
Volume 1 Measurement Guide
Success Gu ide Each part of Precision Nutrition directly supports the lessons yo u've learned in th is
Ind ividualization Guide
course. So [strongly recommend that you have each of your clients pick up a copy of
Quick Start Guide Plant-based Diet Guide
Precision Nutrition, because to truly infl uence them, you need to remforce the lessons you
Super Shake Guide Maintenance Guide
teach every way you can - both in and out of the gym.
Five-Minute Meal Guide Support Gu ide

To find out more, and to order the PN system, vis it

us online at: www.precisionnutrition.com/system Precision Nutrition

Nutritional Practice 243: Unit 2
100% (1)
Nutritional Practice 243: Unit 2
20 pages
Precision Nutrition Certification Textbook Table of Contents and Introduction
86% (22)
Precision Nutrition Certification Textbook Table of Contents and Introduction
20 pages
Precision Nutrition Certificaiton Textbook Table of Contents, Introduction and Chapter 1
57% (7)
Precision Nutrition Certificaiton Textbook Table of Contents, Introduction and Chapter 1
38 pages
Precision Nutrition Manual
No ratings yet
Precision Nutrition Manual
5 pages
Chapter 1 PDF
100% (1)
Chapter 1 PDF
33 pages
Nutritionist
100% (1)
Nutritionist
538 pages
PN L1 Chapter 5 What Is Good Nutrition
No ratings yet
PN L1 Chapter 5 What Is Good Nutrition
4 pages
ISSA Certified Nutritionist Main Course Textbook
89% (9)
ISSA Certified Nutritionist Main Course Textbook
538 pages
Issa Certified Nutrition Specialist Chapter Preview
90% (10)
Issa Certified Nutrition Specialist Chapter Preview
55 pages
PDF (Original PDF) Nutrition From Science To You (4th Edition) Download
100% (1)
PDF (Original PDF) Nutrition From Science To You (4th Edition) Download
55 pages
PN L1 Intro Chapter 1
No ratings yet
PN L1 Intro Chapter 1
3 pages
(Original PDF) Nutrition From Science To You (4th Edition) Full Digital Chapters
No ratings yet
(Original PDF) Nutrition From Science To You (4th Edition) Full Digital Chapters
110 pages
PN Level 1 Inside Look
No ratings yet
PN Level 1 Inside Look
45 pages
Nutrition Diet Therapy 9th Edition Linda K. Debruyne 2025 Full Version
No ratings yet
Nutrition Diet Therapy 9th Edition Linda K. Debruyne 2025 Full Version
96 pages
Nutrition Catalog
100% (2)
Nutrition Catalog
24 pages
Flexible Dieting PDF
No ratings yet
Flexible Dieting PDF
144 pages
Nutrition Is Not A Simple Science - Nutritional Insight
No ratings yet
Nutrition Is Not A Simple Science - Nutritional Insight
2 pages
ISSA Fitness Nutrition Certification Chapter Preview
60% (10)
ISSA Fitness Nutrition Certification Chapter Preview
25 pages
The Fertility Diet Groundbreaking Research Reveals Natural Ways To Boost Ovulation and Improve Your Chances of Getting 1st Edition Jorge Chavarro Download Full Chapters
100% (1)
The Fertility Diet Groundbreaking Research Reveals Natural Ways To Boost Ovulation and Improve Your Chances of Getting 1st Edition Jorge Chavarro Download Full Chapters
121 pages
ISSA Certified Nutritionist Certification Main Course Textbook
100% (8)
ISSA Certified Nutritionist Certification Main Course Textbook
466 pages
Nutrition Diet Therapy 10th Edition Ruth A. Roth Digital Download
100% (2)
Nutrition Diet Therapy 10th Edition Ruth A. Roth Digital Download
164 pages
Basic Nutrition and Diet Therapy (Sue Rodwell Williams)
100% (4)
Basic Nutrition and Diet Therapy (Sue Rodwell Williams)
1,231 pages
Food Secrets That Change Lives Lesson 1
No ratings yet
Food Secrets That Change Lives Lesson 1
40 pages
Retrieve Conquer The Fat Loss Code (Includes Complete Success Planner, All New Delicious Recipes, and The Secret To Exercising Less For Better Results!) 1st Edition Full-Resolution Download
No ratings yet
Retrieve Conquer The Fat Loss Code (Includes Complete Success Planner, All New Delicious Recipes, and The Secret To Exercising Less For Better Results!) 1st Edition Full-Resolution Download
15 pages
Module 3 PE Health
No ratings yet
Module 3 PE Health
15 pages
(Ebook PDF) Fit To Be Well 5Th Edition Install Download
No ratings yet
(Ebook PDF) Fit To Be Well 5Th Edition Install Download
55 pages
Managing Energy Balance
No ratings yet
Managing Energy Balance
8 pages
Sigassfoundations
No ratings yet
Sigassfoundations
8 pages
(Ebook PDF) Nutrition: Science and Applications, 4th Edition by Lori A. Smolin Instant Access 2025
No ratings yet
(Ebook PDF) Nutrition: Science and Applications, 4th Edition by Lori A. Smolin Instant Access 2025
166 pages
K11 Human Performance Nutrition (HPN) Course Counseling Presentation - 10.6.25
No ratings yet
K11 Human Performance Nutrition (HPN) Course Counseling Presentation - 10.6.25
42 pages
Nutritionist Course Work
100% (2)
Nutritionist Course Work
7 pages
Diploma Nutrition Training Manula 2018
100% (1)
Diploma Nutrition Training Manula 2018
126 pages
NUTRITION
No ratings yet
NUTRITION
31 pages
MNU Module Descriptions Lecture Updated Design
No ratings yet
MNU Module Descriptions Lecture Updated Design
17 pages
N101 Unit 01 Intro To Health and Nutrition V2
No ratings yet
N101 Unit 01 Intro To Health and Nutrition V2
21 pages
Fitness Goals and Dance Goal
No ratings yet
Fitness Goals and Dance Goal
21 pages
Physical Fitness & Nutrition Guide
No ratings yet
Physical Fitness & Nutrition Guide
26 pages
The 7 Step Process of Nutrition Coaching
100% (1)
The 7 Step Process of Nutrition Coaching
25 pages
Nutrition & You. ISBN 0135196221, 978-0135196229
100% (18)
Nutrition & You. ISBN 0135196221, 978-0135196229
23 pages
ISSA FastTrack Nutrition
100% (1)
ISSA FastTrack Nutrition
7 pages
Pnchapter1 PDF
No ratings yet
Pnchapter1 PDF
17 pages
Precision Nutrition Level 1 Intro
100% (1)
Precision Nutrition Level 1 Intro
19 pages
Mapeh: Music Arts Physical Education Health
No ratings yet
Mapeh: Music Arts Physical Education Health
15 pages
Science of Exercise Coursera
No ratings yet
Science of Exercise Coursera
1 page
L1N Information Packet Revised Nov 2024
No ratings yet
L1N Information Packet Revised Nov 2024
15 pages
NFNA Institution Profile
No ratings yet
NFNA Institution Profile
13 pages
Flexible Dieting A Science Based, Reality Tested Method For Achieving and Maintaining Your Optima L Physique, Performance & Health
100% (11)
Flexible Dieting A Science Based, Reality Tested Method For Achieving and Maintaining Your Optima L Physique, Performance & Health
14 pages
NF StarterGuide v1
No ratings yet
NF StarterGuide v1
28 pages
Nutrition Now, 8TH Edition Judith E. Brown Ready To Read
No ratings yet
Nutrition Now, 8TH Edition Judith E. Brown Ready To Read
167 pages
(Ebook PDF) Nutrition: Science and Applications, 4th Edition by Lori A. Smolin Instant Download
100% (5)
(Ebook PDF) Nutrition: Science and Applications, 4th Edition by Lori A. Smolin Instant Download
58 pages
Basic Nutrition Coaching
No ratings yet
Basic Nutrition Coaching
6 pages
HCES-Nutrition Weight Management Module 7
No ratings yet
HCES-Nutrition Weight Management Module 7
38 pages
Energy PTC March 2019
No ratings yet
Energy PTC March 2019
111 pages
Nutrition For Sport and Exercise, 4th Edition J. Andrew Doyle Instant Download
No ratings yet
Nutrition For Sport and Exercise, 4th Edition J. Andrew Doyle Instant Download
171 pages
Pure Bodybuilding Phase 2 - Hypertrophy Handbook
82% (11)
Pure Bodybuilding Phase 2 - Hypertrophy Handbook
53 pages
12 Week Shred
88% (162)
12 Week Shred
70 pages
Squat Bible
97% (35)
Squat Bible
177 pages
Jay Cutler's High Volume Training
90% (62)
Jay Cutler's High Volume Training
65 pages
100 No Equipment Workouts 2014 by Neilarey
100% (42)
100 No Equipment Workouts 2014 by Neilarey
210 pages
Mobility
100% (34)
Mobility
937 pages
The Body Transformation Blueprint 271 Pages - Sean Nalewanyj
93% (44)
The Body Transformation Blueprint 271 Pages - Sean Nalewanyj
271 pages
Thibaudeau's Guide To Hypertrophy-Clean Health Fitness Institute
100% (20)
Thibaudeau's Guide To Hypertrophy-Clean Health Fitness Institute
219 pages
Vshred Workout Log
91% (33)
Vshred Workout Log
13 pages
ISSA Strength and Conditioning Performance Psychology Main Course Textbook
100% (11)
ISSA Strength and Conditioning Performance Psychology Main Course Textbook
586 pages
The Body Mechanic
98% (40)
The Body Mechanic
66 pages
The Pure Bodybuilding Program - PPL
100% (7)
The Pure Bodybuilding Program - PPL
85 pages
Knee Ability Zero Now Complete As A Picture Book 4 PDF Free
94% (70)
Knee Ability Zero Now Complete As A Picture Book 4 PDF Free
49 pages
The Pure Bodybuilding Program - Full Body
100% (12)
The Pure Bodybuilding Program - Full Body
55 pages
ISSA Sports Nutrition Certification Main Course Textbook
95% (21)
ISSA Sports Nutrition Certification Main Course Textbook
644 pages
John Rusin FHT Functional Hypertrophy Training Level 1 PDF
93% (14)
John Rusin FHT Functional Hypertrophy Training Level 1 PDF
121 pages
Jim Stoppani Shortcut To Size PDF
87% (15)
Jim Stoppani Shortcut To Size PDF
43 pages
The Muscle Ladder - Ebook - 07 - 10.11.24
94% (16)
The Muscle Ladder - Ebook - 07 - 10.11.24
23 pages
The Hypertrophy Handbook
100% (10)
The Hypertrophy Handbook
53 pages
Old Man Strength
95% (42)
Old Man Strength
122 pages
Tactical Barbell Green Protocol - K Black
100% (11)
Tactical Barbell Green Protocol - K Black
252 pages
The Kettlebell Solution
90% (10)
The Kettlebell Solution
87 pages
Stretching Scientifically - A Guide To Flexibility Training
97% (34)
Stretching Scientifically - A Guide To Flexibility Training
220 pages
10-Week Muscle Building Training Program by Jeffrey Ortiz
90% (30)
10-Week Muscle Building Training Program by Jeffrey Ortiz
54 pages
The Calisthenics Bible
86% (7)
The Calisthenics Bible
137 pages
Hardcore Bodybuilding - A Scientific Approach - Frederick Hatfield
100% (11)
Hardcore Bodybuilding - A Scientific Approach - Frederick Hatfield
503 pages
100 PLANKS - The Plank Encyclopedia For Back Health - Bodyweight Training - and Ultimate Core Strength PDF
95% (21)
100 PLANKS - The Plank Encyclopedia For Back Health - Bodyweight Training - and Ultimate Core Strength PDF
409 pages
Kris Gethins 12 Week Muscle Builder Ebook
100% (18)
Kris Gethins 12 Week Muscle Builder Ebook
45 pages
FBB Lookgoodmovewellguide
87% (15)
FBB Lookgoodmovewellguide
45 pages
Matt Schifferle - Overcoming Isometrics Isometric Exercises For Building Muscle and Strength
100% (17)
Matt Schifferle - Overcoming Isometrics Isometric Exercises For Building Muscle and Strength
153 pages
ACSM's Resources For The Personal Trainer 6e 927-953
0% (1)
ACSM's Resources For The Personal Trainer 6e 927-953
27 pages
Course
No ratings yet
Course
76 pages
Rep Windown
No ratings yet
Rep Windown
3 pages
Creating The Foundation With Abdominal Bracing
No ratings yet
Creating The Foundation With Abdominal Bracing
3 pages
Pregnant: Athlete
100% (1)
Pregnant: Athlete
273 pages
Strength Quality Intensity Reps Time Under Tension Relative Strength Functional Hypertrophy Hypertrophy Strength Endurance
No ratings yet
Strength Quality Intensity Reps Time Under Tension Relative Strength Functional Hypertrophy Hypertrophy Strength Endurance
1 page
PT Commission
No ratings yet
PT Commission
1 page
Pt Check - In: Skyfitness Cầu Diễn Hotline: 091 8883 558 - Reception: 0983 580 665
No ratings yet
Pt Check - In: Skyfitness Cầu Diễn Hotline: 091 8883 558 - Reception: 0983 580 665
2 pages
PT Commission
No ratings yet
PT Commission
2 pages
Member Checkin
No ratings yet
Member Checkin
2 pages
Boring But Strong Challenge
50% (4)
Boring But Strong Challenge
5 pages
PT Schedule: Name Contact No. MON TUE WED THU FRI SAT SUN
No ratings yet
PT Schedule: Name Contact No. MON TUE WED THU FRI SAT SUN
1 page
3ZK23N - Group 3 - Laboratory Report - Experiment 2
0% (1)
3ZK23N - Group 3 - Laboratory Report - Experiment 2
11 pages
ZUNDRIVE-SI100 Manual Updated 180305
No ratings yet
ZUNDRIVE-SI100 Manual Updated 180305
170 pages
FACTS - Flexible AC Transmission System - Controllers & Devices
No ratings yet
FACTS - Flexible AC Transmission System - Controllers & Devices
21 pages
Limits
100% (1)
Limits
6 pages
UPQ-Technical Description - UPQ-Power Sales - GR - PSL
No ratings yet
UPQ-Technical Description - UPQ-Power Sales - GR - PSL
22 pages
CRICKET P 14 - Web
No ratings yet
CRICKET P 14 - Web
2 pages
Subject Code: 17529 SUMMER - 15 EXAMINATION Model Answer
No ratings yet
Subject Code: 17529 SUMMER - 15 EXAMINATION Model Answer
19 pages
The Miraculous Phenomenon of LIFE RESPONSE by Roy Posner
100% (1)
The Miraculous Phenomenon of LIFE RESPONSE by Roy Posner
298 pages
An Introduction To Mechanical Engineering (4Th Ed.) 4Th Edition Jonathan Wickert - Ebook PDF Install Download
No ratings yet
An Introduction To Mechanical Engineering (4Th Ed.) 4Th Edition Jonathan Wickert - Ebook PDF Install Download
84 pages
Huasun HJT PV Module Installation Manual
No ratings yet
Huasun HJT PV Module Installation Manual
14 pages
Curva de Desempeño - Folleto - Power Flo - LX
No ratings yet
Curva de Desempeño - Folleto - Power Flo - LX
1 page
Harduaganj Thermal Power Station Extension-II (1x660 MW) : Epc Package
No ratings yet
Harduaganj Thermal Power Station Extension-II (1x660 MW) : Epc Package
4 pages
GE Motors Product Line
No ratings yet
GE Motors Product Line
8 pages
A IIT Bombay Suraj Paper
No ratings yet
A IIT Bombay Suraj Paper
10 pages
Esoteric Traditions of The Old Inca Empire - Peter Liefhebber PDF
No ratings yet
Esoteric Traditions of The Old Inca Empire - Peter Liefhebber PDF
4 pages
Equipment Guide: Construction, Power and Lighting
No ratings yet
Equipment Guide: Construction, Power and Lighting
52 pages
Iek Training Calendar
No ratings yet
Iek Training Calendar
2 pages
How To Make New Orgone Devices
100% (1)
How To Make New Orgone Devices
59 pages
J1171 Ignition Proof Standard
100% (1)
J1171 Ignition Proof Standard
2 pages
Energy Science and Engineering Koe043
No ratings yet
Energy Science and Engineering Koe043
1 page
Petroleum Engineering Course Name: Malak Ahmad Abu Radaha REG - Number:31715019045
No ratings yet
Petroleum Engineering Course Name: Malak Ahmad Abu Radaha REG - Number:31715019045
4 pages
Efficient Transformer-less DVR
No ratings yet
Efficient Transformer-less DVR
8 pages
Doha Gas Conf
No ratings yet
Doha Gas Conf
16 pages
Daikin Sa Inv2014
No ratings yet
Daikin Sa Inv2014
30 pages
DLP - Math 9 Co2
No ratings yet
DLP - Math 9 Co2
11 pages
Lecture 1 To 9
No ratings yet
Lecture 1 To 9
90 pages
Xpower Inverter 1500: Owner'S Guide
No ratings yet
Xpower Inverter 1500: Owner'S Guide
32 pages
Untitled
No ratings yet
Untitled
11 pages
Quantum Powers Session 2 - Quantum Power #1 - The Power of Your Quantum Self - Transcript
100% (1)
Quantum Powers Session 2 - Quantum Power #1 - The Power of Your Quantum Self - Transcript
28 pages
First Law of Thermodynamics Guide
No ratings yet
First Law of Thermodynamics Guide
4 pages