Nutrition LEARN - INSPIRE - SUCCEED · • Flavour ~ fat in food gives ﬂavour and improves...

LEARN - INSPIRE - SUCCEED

Level 3 Certificate in Personal Training:Nutrition

Performance Training Academy 2

Contents

Nutrition ………………………………………. Page 3

• Principles of Nutrition ………………………………………. Page 4

• Fats ………………………………………. Page 5

• Protein ………………………………………. Page 12

• Carbohydrates ………………………………………. 0

• Micronutrients ………………………………………. Page 28

• Fluids and Hydration ………………………………………. Page 37

• The Digestive System ………………………………………. Page 43

• Healthy Eating Guidelines ………………………………………. Page 47

• Energy Needs of the Human Body ………………………………………. Page 60

• Nutrition and Health ………………………………………. Page 64

• Weight Management ………………………………………. Page 72

• Effective Weight Loss Strategies ………………………………………. Page 81

• Nutrition for Exercise and Sport ………………………………………. Page 100

• Dietary Practices ………………………………………. Page 115

• Reading Food Labels and Recipe Modification …………………………………… Page 118

• Client Consultation ………………………………………. Page 125

Introduction

Our understanding of the relationship between nutrition and its impact on health has dramatically improved due to a wealth of research and scientific studies.

This manual is designed to provide you with clear, accurate facts on the relationship between nutrition and health, sport, exercise performance and weight management. The knowledge you gain will enable you to evaluate dietary information, make recommendations in line with healthy eating guidelines and assist individuals to develop behavioural strategies to achieve a 'balanced diet’.


Applying Nutrition to Physical Activity

Principles of nutrition

In order to promote and maintain health, your diet (the food and fluid you routinely consume) must contain adequate amounts of all of the essential nutrients. These are:

Macronutrients (needed in larger amounts)

• Proteins

• Fats

• Carbohydrates (and fibre)

• Water

Micronutrients (needed in small amounts)

• Vitamins

• Minerals

In addition, fibre (sometimes referred to as non-starch polysaccharide) is essential for a healthy diet. The term 'healthy/balanced diet‘ describes a diet that provides the recommended types and amounts of food to promote and improve health. Fibre is not strictly a nutrient as it is not fully digested in the gut, absorbed by the body or utilised for energy. However, it is needed to ensure efficient gut function and for the effective digestion and absorption of other nutrients. This also applies to water; although it does not provide you with energy or essential vitamins or minerals, it is essential for survival and is a recommendation covered in the ‘Healthy Eating Guidelines‘.

Alcohol can be utilised by most tissues of the body to release energy, but despite recent claims about the benefits of moderate consumption, no qualified health professional would include it on a list of essential nutrients.

The following chapters will examine the essential nutrients by considering the following:

• Structure

• Function

• Metabolism

• Sources

• Energy value

• Characteristics

• Current recommendations

• Overconsumption

• Deficiency


Fats

Objectives

By the end of this section, you should be able to:

• Identify the dietary role of fat

• Identify the structure of fat

• Identify foods that provide a rich source of fat

• Describe the different classifications of fat

• Describe the characteristics of fat

• Identify the potential energy value of fat in kcal per gram

• Briefly describe the metabolism of fat

• Describe the current dietary recommendations for fat in relation to total energy

• Identify the health risks associated with over-consumption of fat

• Identify the health risks associated with under-consumption of fat

• Identify good sources of essential fatty acids and their health benefits.


Functions of fat

Dietary fat continues to be a subject of debate and concern. Many people believe that fat is bad for you. However, not all fats are ‘bad’ and some are absolutely essential for the following reasons:

• Protection of internal organs.

• Thermoregulation (temperature control) - subcutaneous fat provides insulation.

• Insulation of nerve cells - each nerve cell in the body is wrapped in a layer of fat called the myelin sheath. This enables the nerves to conduct electrical messages efficiently.

• Uptake and storage of fat - insufficient fat in the diet may lead to dietary deficiencies by compromising the efficient use of soluble vitamins.

• Provide energy - 1g of fat will provide 9kcals of energy. You can easily carry 15-25kg (30-50lbs) of fat whilst still appearing slim. Because the body is not 100% efficient, each kilogram of fat provides approximately 7700 kcals (1lb provides approximately 3500 kcals).

• Growth, development and repair of body tissues - the cell membrane surrounding all body cells consists of a double layer of fat and protein. Fats in the skin are responsible for radiant complexions and also keep the hair looking sleek and glossy. One of the first signs of a diet low in fat is dull, dry skin.

• In women, storage and modification of reproductive hormones, particularly oestrogen, takes place in adipose tissue. if the percentage of body fat drops too low, reproductive function will be compromised.

• Oestrogen is also responsible for stimulating the activity of bone-making cells (osteoblasts) that are responsible for bone growth. In the absence of oestrogen, rates of bone breakdown exceed rates of bone growth, leading to an increased risk of osteoporosis.

• Flavour ~ fat in food gives flavour and improves ’mouth feel’. Fat also provides food with a high ’satiety value’ as it takes a long time to digest.

• Provide essential fatty acids - Omega 3 and Omega 6.

Classification and characteristics of fats

Saturated fats

Mainly come from animal sources (with the exception of palm oil and coconut oil) and tend to be solid at room temperature, eg, butter, lard, fat in meat and meat products.

Polyunsaturated fats

These are mainly from non-animal sources and tend to be liquid at room temperature, eg, sunflower oil and fish oil.

Monounsaturated fats


Primarily from a non-animal source and are liquid at room temperature. On cooling, these oils will become more viscous eg, olive oil and avocado oil.

Of the total amount of fat consumed, no more than 11% (of total calories) should be saturated fat and approximately 13% from mono and 6.5% polyunsaturated fats (DH, 1991, 1994).

A diet high in saturated fat has been linked to linked to plaque formation on the artery walls and increased levels of low density lipoprotein (LDL) (this will be discussed later in the Nutrition and health section), total cholesterol in the blood, and in turn cardiovascular disease. There is an enormous amount of research concerning the relative merits of different types of unsaturated fat (eg, polyunsaturated versus monounsaturated) that is beyond the scope of this course. However, the advice to eat predominantly unsaturated fat is widely accepted.

Essential fatty acids

There are certain types of polyunsaturated fats that are essential to the human body. The term ‘essential’ means that they cannot be manufactured in the body from other fats; they have to be provided in the diet. Essential fatty acids (EFA) are precursors for an extremely important class of chemicals - prostaglandins. These essential fats are Omega 3 and Omega 6 fatty acids, or n—3 and n-6 fats. They should make up approximately 2% of daily energy intake (DH, 1991; SACN, 2004).

The roles of EFAs include:

• Protection against heart disease (control of blood pressure)

• Prevention of blood clots

• Beneficial effect on blood lipid profiles

• Reduction of inflammation in arthritis and asthma

• Enhanced transport of oxygen by red blood cells

• Enhance immune responsiveness

• Maintenance of the quality of cell membranes and therefore may present some protection against the ageing process.

The n-6 fats (linoleic acid) are found in a number of plant sources, such as: evening primrose oil, nuts, seeds, soya bean and corn oil. N-3 fats (linolenic acid) are less common. One of the best sources of n-3 fats is fish oil. This is why it is advisable to eat fish regularly, particularly fatty fish like salmon, mackerel, herring, tuna, trout and sardines. The recommended intake of omega 3 fats is 1.0-1 .5g per day. This can be achieved by eating two portions of fish per week; one should be oily fish. (SANC, 2004).

This of course is a problem for anyone following a vegetarian diet, or indeed anyone who doesn't like fish. Fortunately, omega 3 fatty acids are also present in smaller amounts in vegetable oils such as flax seed oil, rapeseed oil, canola oil and walnut oil. Food manufacturers also offer a number of foods fortified with omega 3 such as wholemeal bread and 'columbus’ eggs.

Omega 9 does not fall into the category of an essential fatty acid as it can be manufactured by the body.


Hydrogenated (trans) fats

An unsaturated liquid fat can be treated to become more solid in consistency. This process, hydrogenation, adds hydrogen atoms to the unsaturated double bonds on a fatty acid chain, which then takes on the appearance and characteristics of a solid ‘saturated fat’.

Hydrogenated fats are thought to be even worse than naturally occurring saturated fats in terms of health risk. So whilst you might think you are taking the healthy option by eating margarine as opposed to butter, this may not be the case. Look for the more expensive brands of margarine that state the specific types and amounts of fats used in their manufacture. Highly processed foods, such as microwave ready meals, should also be used sparingly in a healthy diet.

Hydrogenated fats are listed on many ingredients labels, particularly margarines, baked products and many processed meals. They are used in food manufacturing because they are inexpensive compared to a more naturally occurring solid fat. For example, a biscuit could be made using pure butter (expensive) or using hydrogenated vegetable fat (inexpensive).


Classification Characteristics Sources

Saturated fats Mainly from animal sources and solid at room temperature (with the exception of palm oil and coconut oil).

Meat and eggs

Meat products

Butter and cream

Polyunsaturated fats Naturally occurring fats.

Mainly from non-animal sources and liquid at room temperature.

Vegetable and plant oil

Corn oil, nuts and seeds

Oily fish

Monounsaturated fats Naturally occurring fats.

Liquid at room temperature.

Will slightly solidify at cool temperatures.

Avocado

Many nuts and seeds

Olive oil and rapeseed

Flaxseed and almond oil

Essential fatty acids

Omega 3 and 6

Unsaturated fats.

Omega 3 found in far fewer foods than omega 6.

Oily fish

Seeds and oils, flaxseed, pumpkin seeds and walnuts

Rape seed

Soya beans

Dark green leafy vegetables

Vegetables and plant oils

Trans fatty acids

(hydrogenated)

Although a smaller amount of trans fat occur naturally, the majority of trans fats consumed are produced by a process called hydrogenation.

This process converts a liquid fat to a solid fat.

Cakes and biscuits

Some margarines

Many manufactured products

Fast foods


Recommendations for fat intake

The healthy eating guidelines for fat are as follows:

• Fat intake for the majority of the population should be no more than 35% of total kcal intake.

• Saturated fats should contribute approximately 11% of total kcal intake.

• Monounsaturated fats should contribute approximately 13% of total kcal intake.

• Polyunsaturated fats should contribute approximately 6.5% of total kcal intake.

• Include foods that will provide you with a supply of essential fatty acids - current recommendations are a minimum of two portions of fish per week (one should be oily). A few tablespoons of seeds or a small handful of nuts would also go towards meeting your recommendations.

Health risks of a high fat diet

When considering health risks, it is important to consider both ’quality' and ‘quantity’ of fat in the diet. Too many total kcals from fat can lead to weight gain and obesity. Quality and quantity of fat in the diet may also contribute to the development of coronary heart disease (CHD).

Health risks associated with low fat diets

There is considerable health risks associated with lowering your dietary intake of fat much below 30% for an extended period of time. Although some people can manage perfectly well on diets lower than this, it is highly advisable to have a week at regular intervals where a few high fat foods are added. A diet that is permanently less than 25% fat would not be healthy. Some of the earlier signs of deficiency would be that skin and hair condition would deteriorate.

It is also possible that intakes of fat-soluble vitamins (A, D, E and K) would be compromised. If total fat intake is low, deficiencies in essential fat may occur, which can result in hormone imbalances, impaired immunity and skin conditions. It is vitally important to note that fat is an essential part of a healthy diet.

Main points

• Fat in the diet is essential for health.

• Fat has many functions: these are outlined on page 12.

• No more than 35% of your energy should be provided by fat.

• Fat provides 9kcals per gram.

• Saturated fats mainly come from animal sources and are solid at room temperature.

• Unsaturated fats are from non-animal sources and are liquid at room temperature.

• Unsaturated fats have the best health giving properties.

• Trans fats are produced by a process called ’hydrogenation' and have the worst properties in relation to health.


• The essential fatty acids are Omega 3 and 6. These must be provided in the diet.

• The primary health risks associated with too much fat in the diet are obesity and CHD. -

• Insufficient fat in the diet can lead to deficiencies of fat-soluble vitamins and essential fatty acids. It can also affect normal hormone balance and production in both males and females.


Protein

Objectives


• Describe the dietary role of protein

• Identify the structure of protein as combinations of amino acids

• Identify the two main categories of protein

• Explain the significance of essential and non-essential amino acids

• Identify the potential energy content of protein in kcals per gram

• Briefly describe the metabolism of protein

• Identify sources of protein and discuss the quality of these sources based on their amino acid content

• Describe current recommendations for protein intakes in relation to total energy

• Describe when protein requirements may be increased

• Identify what happens if you over-consume protein

• Identify what happens if you under-consume protein

• Identify considerations for individuals following a vegetarian/vegan diet

• Describe safety, effectiveness and contraindications relating to protein supplementation.


Function of protein

Protein is essential for the growth, maintenance and repair of body tissue. Protein is a part of every living cell and predominantly makes up some tissues, like skin, muscle, tendons, ligaments, hair and the core of bones and teeth. However, in addition to this structural role, proteins perform an enormous variety of physiological functions inside the body:

• All enzymes are proteins. Enzymes control both the rate and the pattern of all chemical reactions that take place in the body, including the digestion of food and the extraction of energy from it.

• Some hormones are made up of protein. These are chemical messengers that regulate activity of cells within the body and cover a wide range of functions. For example, insulin is a hormone that controls blood glucose (sugar) levels.

• Antibodies are proteins. These are produced by white blood cells and move directly into the bloodstream to fight infection.

• Although not a primary source of energy, protein does provide 4kcals per gram.

It may seem logical that because of the importance of protein in the body, you would need to consume a lot of it on a daily basis. Before looking at this in more detail, it is necessary to look at what proteins are made of.

Structure of protein

Proteins are made up of amino acids. There are 20 different amino acids that routinely take part in protein structure. Eight of these are essential or primary amino acids. These amino acids must be provided in the diet, as the body is unable to manufacture them. The remaining 12 are called the non-essential or secondary amino acids because, if they are in short supply, the body can easily make them. Proteins are made up of long chains of amino acids all linked firmly together and usually wrapped around each other to form a tangled ball.

Metabolism of protein

This long-chain protein structure is broken down during digestion into amino acids. The amino acids are then transported to the liver and muscle cells to produce energy, and used to build and repair body tissue, or to build enzymes, hormones and antibodies.


When the body needs to synthesise a new protein, it looks around for the right amounts of each of the component amino acids. One major source is old proteins that are no longer in use. These are simply recycled to make new ones. When a nonessential amino acid is in short supply, the cell will simply make what it needs. However, when an essential amino acid is missing, the protein cannot be re-constituted until a new source is supplied.

So although it is necessary to eat protein on a daily basis to keep the cells topped up with all amino acids, you need to pay particular attention to sources of the essential ones. This will be no problem for people who regularly eat complete proteins such as meat or animal produce like eggs, milk and cheese. Soya bean products also contain the full complement of amino acids.

Most plant proteins are incomplete proteins, ie, they have one or more of the essential amino acids missing. However, different plant proteins lack different amino acids and so combining plant protein sources can easily solve the problem. Combinations of cereals or rice with legumes (beans and peas), or nuts will usually supply adequate amounts of the required amino acids. If following a vegetarian diet, it is essential to have a good mixed diet of pulses, grains, cereals and nuts to ensure you obtain a full complement of all the essential amino acids.

20 different amino acids

8 essential or primary(cannot be made in the body)

12 non-essential or secondary(can be made in the body)

• Isoleucine• Leucine• Lysine• Methionine• Phenylalanine• Threonine• Tryptophan• Valine

• Alanine• Arginine• Asparagine• Aspartic acid• Cysteine• Glutamic acid• Glutamine• Glycine• Histidine• Proline• Serine• Tyrosine

Cereal grains Legumes Combinations

Bread Nuts Toast and peanut butter

Rice Pulses Vegetable chilli and rice

Bread Beans Beans on toast

Barley Lentils Lentil soup


Sources of protein

Protein is plentiful in the British diet. Meat and dairy products will provide a good supply of protein; a significant amount will also come from nuts, grains, cereal and pulses. The quality of protein is determined by two factors: protein digestibility and amino acid content.

Protein content of some common foods

Animal proteins Non-animal proteins

Meat Tofu

Meat products Pulses

Fish Nuts

Poultry Grains

Dairy products Soya

Eggs Cereals

Textured vegetable protein (TVP)

Meat and fish Portion size Protein (g)

Beef 100g 28g

Salmon 150g - 1 steak 30g

Tuna 100g - 1/2 tin 24g

Mackeral 150g - 1 fillet 31g

Dairy

Skimmed milk 200ml 7g

Cheese 40g - 1 thick slice 10g

Cottage cheese 100g 12g

Low fat plain yogurt 150g 8g

Low fat fruit yoghurt 150g 6g

Nuts, seeds and pulses

Baked beans 200g - 1/2 tin 10g

Kidney beans 200g - 1/2 tin 20g

Peanut butter 20g - on 1 slice of bread 5g

Chick peas 200g - 1/2 tin 20g

Brazil nuts 50g - 1 handful 7g


Protein requirements

Unless there are insufficient carbohydrate stores, protein will not be used for energy production. Add to this the fact that protein turnover within the body is continual and that there is usually a large pool of amino acids available for protein synthesis, and you can see that the daily needs of dietary protein are really quite small.

Daily protein needs = 0.8g per kg body weight per day, This is equivalent to approximately 10-15% of total calories. This guideline is an estimate for a healthy, sedentary adult and would be sufficient for the majority of the UK adult population. (Ref: DH1991, 1994)

For example, a 60kg individual would require 60 x 0.8 = 48g per day

Roasted peanuts 50g - 1 handful 12g

Walnuts 50g - 1 handful 7g

Sesame seeds 25g - 2 tbsp 4g

Sunflower seeds 30g - 2 tbsp 6g

Soya bean and TVP

Tofu 100g 8g

Soya milk 200ml 6g

Quorn mince 100g 12g

Tofu burger 50g - 1 burger 4g

Cereal and grains

Wholemeal bread 30g - 1 slice 3g

White bread 30g - 1 slice 3g

Wholemeal pasta 100g 3g

White pasta 100g 3g

Brown rice 100g 3g

White rice 100g 3g

Quinoa 100g 13g

Couscous 100g 5g

Miscellaneous

Eggs 1 medium 8g

Protein bar 60g 22g

Protein shake 150ml 24g

Meat and fish Portion size Protein (g)


As protein from most food sources comes in a much-hydrated form, it would be necessary to eat something weighing about 240g in order to get 60g of pure protein. However, this does mean that if you have something on your plate a few times per day that is recognisably protein, then you are probably over-consuming.

This requirement applies to people who maintain a desirable body weight and composition. individuals who have a relatively high amount of body fat need to work out their needs based on their desirable weight, as research has shown that fat tissue has a lower rate of protein synthesis than lean tissue. Because of this, strength training athletes who have a large amount of muscle mass and a low percentage of body fat may have higher requirements. The consensus from various research studies would estimate this to be about:

Protein needs of the endurance athlete/trainer

Protein requirements for endurance trainers increase for two reasons. First, an increased intake will compensate for the breakdown of muscle tissue due to depleted glycogen stores. This will normally take place at around 60-90 minutes of moderately hard endurance training. This process of converting muscle protein to glucose is called ’gluconeogenesis'.

Gluconeogenesis is the body's way of maintaining blood glucose levels when muscle and liver glycogen have become depleted during exercise or at times where there is a low energy intake. This will be discussed later in the manual when low calorie dieting is studied. Also, due to an increased demand on the muscles, a higher protein intake will be of benefit for repair and recovery.

Protein needs of the strength athlete/trainer

Protein requirements for strength and power athletes are greater than endurance athletes due to a higher rate of muscle synthesis and increased demands placed on the body for repair and recovery. For effective muscle growth, the body should be in a state of positive nitrogen balance (the nitrogen input is greater than loss), therefore there is a greater protein pool in the body for building.

One important point to remember with strength training is that an increase in protein intake will not automatically produce an increase in lean muscle tissue. For effective muscle hypertrophy, an increased protein intake must be accompanied by the appropriate workload on the muscles to promote increases in muscle bulk.

Do athletes need protein supplementation?

Type of training Daily protein requirement

Endurance training 1.2-1.4g per kg of bodyweight

Strength training 1.4-1.8g per kg of bodyweight

Intakes of over 2g per kg bodyweight have shown to provide no significant improvements.


Most sources clearly state that a normal balanced diet provides adequate protein for most athletes, even body builders, and that the widespread use of protein/amino acid supplements is a complete waste of time and money, and may compromise health status. Protein-based supplements are not a substitute for a poorly planned diet. However, there are certain circumstances when they prove useful:

• Strength- and power-based athletes with a large build, or those on very heavy training schedules (a strength athlete weighing 80kg may need as much as 144g of protein a day).

• An athlete on a calorie-restricted or fat loss programme, if they simply cannot consume enough protein from food alone with their calorie allowance.

• Vegetarian athletes - a well-planned vegetarian diet may still meet the protein requirements of athletes, though this may be harder to achieve; low fat dairy products are relatively rich in protein but plant sources are generally lower in protein so it is essential to eat the right combination of plant-based proteins.

Many protein-based supplements are engineered to be meal replacements for athletes so may actually contain a better nutritional combination than a protein only supplement.

Health risks of excessive protein intakes

There are no health or performance benefits in taking in more protein than actually needed. Many studies have been performed in this area, but as yet the evidence is not conclusive as to the damage caused by high protein intakes.

The body will use its required amount of protein in relation to the demands put on it. The remainder can then do one of the following:

• The nitrogen-containing element of protein is converted to urea in the liver and excreted in the urine.

• High protein intakes have been shown to be dangerous for individuals with kidney and liver disease and may lead to problems following long term overconsumption.

• A high protein intake can potentially lead to the accumulation of ammonia in the blood that is toxic, particularly to brain cells.

• Excess protein (if it contributes to more energy than the body needs) is stored in the body as fat and this can lead to obesity.

• A high protein intake from animal products is associated with high intakes of saturated fat and therefore, potentially increasing cholesterol and circulating LDL levels. in turn, this may lead to the development of CHD.

If you like eating meat there is no need to worry if your protein consumption is a little higher than needed every now and again. However, if you consistently consume considerably more than 10-15% of your total calorie intake as protein, you could increase your health risks.

Health risks of a low protein intake


In the UK and most developed countries protein deficiency is very rare. Deficiencies in protein, or of one or more of the essential amino acids, will lead to a reduction of growth in children or muscle loss in adults. Susceptibility to disease will be increased and in extreme cases may result in death.

Main points

• The main function of protein is the growth and repair of body tissue.

• The building blocks of protein are amino acids, of which there are 20.

• There are 8 essential and 12 nonessential amino acids.

• All animal protein provides a full complement of all the essential amino acids.

• To obtain a full complement of essential amino acids from non~animal protein a diet must include a combination of non-animal proteins.

• 10-15% of daily energy should come from protein.

• The protein requirement for a relatively inactive, healthy individual is 0.8g per kg body weight - this is sufficient for the majority of the adult UK population.

• Endurance training requires approximately 1.2-1.4g per kg body weight.

• Strength training requires approximately 1.4-1 .8g per kg body weight.

• Protein provides 4kcals per gram.

• Health risks associated with high protein intakes include: accumulation of ammonia, kidney and liver damage (in already established damage), increased body fat and ketosis (when linked to low carbohydrate intake).


Carbohydrates

Objectives


• Describe the dietary role of carbohydrate

• State current recommendations for carbohydrate in relation to total energy

• State the potential energy content of carbohydrate in calories per gram

• List good sources of carbohydrate and fibre

• Describe the characteristics of simple and complex carbohydrates

• Describe the characteristics of soluble and insoluble fibre

• Explain the concept of the glycaemic index (gi) and glycaemic load (gl) of carbohydrates

• Discuss the health consequences of a diet high in high gi/gl foods

• Give example of low, medium and high gi and gl foods

• Identify any health risks associated with under and over—consumption of carbohydrate.


Function of carbohydrates

The main function of carbohydrates is to provide energy. Most cells in the body can use a mixture of fat and carbohydrate (and protein when carbohydrate is limited) for energy. Muscle cells rely on carbohydrate for contraction when the exercise intensity is high. Some forms of indigestible carbohydrates (fibre) are also very important in ensuring efficient gut function and in prevention of gastrointestinal illness.

Guidelines for carbohydrate intake

If 10-15% of dietary intake should be protein and no more than 35% fat, that leaves the bulk of the diet - 50% - to be provided by carbohydrates. As with protein and fat, it is recognised that some people will need a higher percentage of their energy to come from carbohydrates and some people will need lower. The amount of carbohydrate an individual needs is determined by their energy expenditure. For the majority of the population the figure of 50% is sufficient. There are however a small proportion of individuals who have very high energy expenditure (some athletes for example require up to 70%). Very inactive people may need fewer carbohydrates, approximately 40-45% of total energy.

No matter in which form carbohydrate enters the body, it is always converted to glucose before it is utilised by the cells. The stored form of glucose is called glycogen. Glycogen can be stored in both the muscles and the liver. When stores of glycogen become depleted through prolonged activity, starvation or a calorie restricted diet, the body can manufacture usable carbohydrate through a process called gluconeogenesis (this will be discussed in more detail in the Weight management section).

Classification of carbohydrate

Simple (sugars) Mix of both Complex (starches and fibres)

Table sugar (sucrose) Biscuits Wheat (bread, pasta)

Fruit (fructose) Cakes Oats

Sweets Sugary breakfast cereals Corn

Jam Starchy fruit (banana) Barley

Marmalade Pastries Potatoes

Honey Rice

Energy drinks (glucose) Beans

Soft drinks Peas

Milk (lactose) Lentils

Chick peas

Vegetables


Structure of carbohydrates

Simple sugarsMonosaccharides - single sugar molecules

Glucose Fructose Galactose

Disaccharides - two sugar molecules

Maltose Lactose Sucrose

Complex carbohydratesPolysaccharides - long chain sugar molecules

When it comes purely to satisfying the carbohydrate needs of the body, there is no difference between simple or complex sugars and there is also no difference in the energy they provide. Carbohydrate, in the form of either sugar or starch carries 4kcals per gram. In that respect, sugar is no more fattening than a potato. The difference of course is the nutrient density.

A potato will fill you up, whereas a few spoonful's of sugar will leave you empty and wanting more. This is because most sources of complex carbohydrate provide dietary bulk or fibre in addition to the nutrient starch, which leaves you feeling more satisfied.

The glycaemic index (GI)

The glycaemic index is a ranking given to carbohydrate foods based on their effect on blood glucose levels. Carbohydrates that break down very quickly during digestion have a high Gl. The Performance Training Academy 22

blood glucose level raises very ‘high and fast’ following digestion of these carbohydrates. Carbohydrates that break down slowly release glucose gradually into the blood stream and have a low Gl. Compared to fast releasing carbohydrates the rise in blood sugar from low Gl carbohydrates is ‘low and slow’.

The glycaemic index of food is based on the effect 50g of carbohydrate from a given food. It is a ranking of carbohydrate foods in relation to the immediate effect on your blood sugar levels. The glycaemic index concept was first developed in 1981 by Dr David Jenkins. These original studies were to determine which foods were best for people with diabetes. According to the glycaemic index scale, foods are given a rating of low, medium or high.

According to the glycaemic index scale, foods are given a rating of low, medium or high.

Low = 55 or less

Medium = 56-69

High = 70 or more

There are many factors that determine the glycaemic index of food. Manufacturing advances over the years have produced finer and softer flours for baking. This process removes most of the fibre from the grain and reduces the particle size; the end result is very fine flour which produces soft, light bread and cakes, etc. The downfall, however, is that it is of very low nutritive value — it will provide you with calories but very few other nutrients. It will also be of a high glycaemic index.

There are two types of starch in food - amylose and amylopectin. it has been found that foods with a higher proportion of amylose are harder to digest and therefore produce a lower GI; this is why some types of rice such as basmati rice, have a lower Gl than long grain rice.

When foods are cooked, eg, potatoes, their particle size swells and can burst. When this happens the starch can leak out and is very easily digested, producing a high GI.

From the above points, it seems difficult to determine the GI of the foods being consumed.

The most important factor to consider when making food choices is the physical form of a carbohydrate. Nature has packaged foods with a low GI; advances in food processing have had a huge effect on the Gl value. When choosing carbohydrate foods, choose wholegrain products and pulses where the grain is intact eg, high fibre, wholegrain breads and cereals and brown or wild rice. Also try a variety of grains such as barley, quinoa and spelt as opposed to wheat-based products such as bread, pasta and couscous. It is worthwhile taking time to see what supermarkets and health food shops offer as alternatives.

The presence of fibre has an effect of reducing the glycaemic index of food; where possible consume fruit and vegetables with the skin on. Adding protein or fat or mixing high and low Gl foods will also lower the glycaemic index.

Glycaemic load (GL)

The glycaemic load is another method used to determine how rapidly a carbohydrate food releases its energy into the blood. This method, however, does not consider 50g of carbohydrate from a given food; the glycaemic load is determined by the available carbohydrate in one serving. Performance Training Academy 23

GL = (Gl x the amount of carbohydrate) divided by 100.

The glycaemic load of carbohydrates is also given a rating of low, medium or high.

Low = 10

Medium = 11-19

High = 20 or more

High Gl or low Gl

• Low Gl causes a smaller rise in blood sugar level after a meal.

• Low GI diets have benefits for weight control as they can help control appetite, delay hunger and do not promote fat storage caused by a high insulin response.

• Low Gl diets show benefits for individuals with type 1 and type 2 diabetes as they can improve the body's sensitivity to insulin.

• Low GI diets can prolong physical endurance.

• High Gl foods provide a quick supply of glucose and can be beneficial for fuelling during prolonged exercise.

• High Gl foods provide an instant supply of glucose if consumed shortly before commencement of exercise.

• High GI foods help refuel carbohydrate stores after exercise.

• High GI diets present peaks and troughs in energy levels which can lead to poor concentration and lethargy.

• High GI foods promote fat storage due to the high insulin response following a high GI meal.

For health, it is recommended that one’s diet should be based on low GI foods in order to prevent the most common diseases of affluence, such as CHD, diabetes and obesity.


Glycaemic index and glycaemic load ranges

Gl and GL table Note: GL is bracketed


Type of food Low GI 55 or less Medium GI 56-69 High GI 70 or more

Bread Wholegrain or mined grain bread eg, rye or linseed(5-11)

Wholemeal bread (some brands may be higher than others)

Fruit bread(7-13)

Baguette (12-15)

Bagel (25)

Breakfast cereal Oat-based food eg, porridgeHigh bran cereals(9-11)

Cereal barMuesli(12-16)

Refined maize or wheat based cereal(23)

Pasta Pasta and noodles(20-26)

Pasta and noodles (depending on variety)

Rice Basmati rice (15-18) Easy cook basmati (28) White rice (19-25)Brown rice (22-29)

Beans and pulses Beans (5-9)Lentils (5)Nuts (3)

Potatoes Boiled new potatoes in their skins (15)

Baked potato with skin (19)Instant mashed potato (17)

Fruit Most fresh fruit if not over-ripe - apple, pear, citrus fruit, plums and grapes (6-10)

Dried fruit (8-15)Banana (12)Pineapple (6)

Watermelon (5)Lychee (9)Fruit juice (10-12)

Vegetables All green vegetablesCarrots (2)Plantain (9) (GI increases when cooked)

Beetroot (4)Sweet corn (10)Sweet potato (10-16)

Parsnip (4)Pumpkin (3)

Dairy foods Milk (4)Plain and flavoured yoghurt (2-10)

Sugars Fructose (2) Honey (10)Sucrose (6)Cola (15)

Glucose (10)Lucozade (40)

Dietary fibre

Fibre is simply the ’skeleton' of plants. It is mainly found in the outer walls of plants and seeds and is therefore more abundant in unrefined foods. Although there are two main types of fibre - soluble and insoluble - there are many different versions of each type, all with slightly different beneficial effects, eg, cellulose, pectin and lignin. It is therefore best to get your daily intake from eating a wide variety of foods rather than adding just one sort eg, ’All Bran’.

Insoluble fibre

Found in wheat bran, whole grain breads and cereals and a wide range of fruit and vegetables, insoluble fibre holds water in the digestive tract, thus increasing bulk. This stimulates the muscles of the tract to contract, so that they retain their strength and tone. A healthy digestive system may help to prevent conditions such as constipation, haemorrhoids and diverticulitis. It may also play a part in helping to prevent the development of colon cancer.

Soluble fibre

Found in oats, beans and other legumes, in addition to fruit and vegetables, soluble fibre may play a role in helping to lower blood cholesterol levels. Although the exact mechanism by which this occurs is not known, it seems that soluble fibre can be partially digested by the bacteria in the gut. Some of the products of this digestive process enter the blood, causing the cholesterol lowering effect.

Dietary fibre may also assist in weight management as it can delay gastric emptying and lower the glycaemic index of high/moderate glycaemic index foods. This may make you feel fuller for longer and present a slow steady release of glucose into the bloodstream.

Over-consumption of fibre

As with most nutrients, it is possible to consume too much fibre. One of the problems is that fibre (in particular soluble fibre) increases transit times through the gut and may therefore limit the time available for the absorption of essential nutrients. Some forms of fibre can actually bind to much-needed minerals such as calcium and zinc and prevent their absorption. The current recommendation is that people should try to consume around 18 grams of fibre per day (DH, 1991).

Health risks associated with over and under-consumption of carbohydrate

Complex carbohydrates, especially in their unrefined forms, provide the diet with fibre, protein, vitamins and minerals, all of which are not present in sugar. This is why sugar is said to provide ’empty calories’. If carbohydrates are consumed in their complex unrefined form, it is quite difficult for people to over-consume them. The fibre content will make you feel full long before this occurs.

An over-consumption of total calories from any nutrient will lead to weight gain and obesity. If the diet mainly consists of unrefined or simple sugars, an over consumption of calories is more likely. A diet high in simple sugars also presents a risk of dental cavities. Performance Training Academy 26

A low carbohydrate diet can lead to low fibre intakes as discussed above and low blood glucose levels, the consequence of which will be discussed in the Weight management section of the manual.

Main points

• 50% of energy should be provided by carbohydrates.

• The main function of carbohydrate is to provide energy.

• Both simple and complex carbohydrates provide 4kcals per gram.

• The glycaemic index and glycaemic load of carbohydrates relates to how its energy is released into the bloodstream,

• For health, people should aim to consume a diet rich in low glycaemic index carbohydrates.

• Fibre is essential in the diet to ensure efficient gut functioning.

• Over consumption of carbohydrates can lead to obesity.


Vitamins and minerals

Objectives


• Define vitamins and minerals

• Identify which vitamins are fat-soluble and which are water-soluble

• Describe the main function of the vitamins and minerals listed

• Describe antioxidants, free radicals and phytochemicals and their effect on body functions

• Identify macro and trace minerals, their functions, and food sources that provide them

• Identify effective ways of ensuring you have enough vitamins and minerals in your diet

• Identify the advantages and disadvantages of supplementation.


Vitamins

Vitamins are chemicals found naturally in food. With the exception of Vitamin D, which can be manufactured through the action of sunlight on the skin, vitamins cannot be made by the body and must be provided by the diet. They are needed in minute amounts to perform specific functions and fall into two different classes:

Water-soluble: B(group) and C

Fat-soluble A, D, E and K

The water-soluble vitamins are essential co-factors or helpers for enzymes. Without these vitamins, enzymes cannot function properly. They control all of the chemical processes that take place in the body, including the extraction of energy from food and the growth of new body tissues. The fat-soluble vitamins have a more varied range of functions but are equally important:

• Vitamin A is needed for vision

• Vitamin D is essential for bone growth and development and helps to regulate calcium levels in the body

• Vitamin E protects the body's tissues against chemical damage, mainly from a very unstable form of oxygen atom called a ‘free radical’

• Vitamin K is important in blood clotting.

Although some of these vitamins, particularly the fat-soluble ones, can be obtained from animal sources, the best way to ensure an adequate intake is to eat a wide range of fruit (2-4 portions) and vegetables (3-5 portions) on a daily basis.

Vitamin deficiency in developed countries is quite rare, although some recent studies suggest that it is becoming more prevalent, particularly among young children and weight conscious teenagers on restricted calorie intakes.

Vitamin pills are commonly consumed to ensure sufficiency, but for the vast majority of people this is a waste of time and money. It is much better to address any perceived problem by trying to eat more natural sources of vitamins, as this is also likely to supply other needed nutrients. An excess of water-soluble vitamins is no real problem as this will simply result in vitamin-enriched urine.

However, an excess of fat-soluble vitamins may be toxic as they are stored, mainly in liver, and can interfere with normal liver function. Vitamin A toxicity can occur at levels just five times higher than the Recommended Daily Allowance (RDA).


Vitamin Source Role Deficiency

A

Retinol (animal_

Carotenoids - Beta carotene (non-animal_

(Beta carotene can be converted to retinol in the body - 6mg beta carotene converts to 1mg retinol)

Dairy products, dark green leafy vegetables, orange coloured fruit and veg, fish oils and liver.

Some vitamins are also fortified with vitamin A.

Growth and repair of body tissue.

Essential to normal structure and function of cell membranes.

Normal vision.

Antioxidant.

Poor vision in dim light (can lead to blindness).

Stunted growth.

C

Ascorbic acid

Main sources are from plant sources - fruits and vegetables are a rich source. Milk and liver contain small amounts.

Normal structure and function of connective tissue.

Helps absorption of iron.

Antioxidant - protects from free-radical damage.

Scurvy.

D

Cholecalciferol

Fish oils.Dairy products.Fortification of foods.

Healthy bones and teeth.

Absorption of calcium.

Rickets.

Osteomalacia.

E

Tocopherols

Tocotrienols

Dairy products.Dark green leafy vegetables.Nuts.

Antioxidant.

Protects fat-soluble vitamins and red blood cells.

Accelerated ageing, loss of skin elasticity, wrinkles in skin.

K

Phylloquinone

Dark, green leafy vegetables.Fish.Liver. Fruit.Produced by bacteria in the gut.

Aids blood clotting. Vary rare in adults.

Haemorrhages.

B1

Thiamin

Whole grains, meaat, flour and breakfast cereals (may be fortified).

Normal functioning of nervous system and heart.

Beri-beri - disorder of the nervous system.

B2

Riboflavin

Milk, eggs, green vegetables, fortification of some foods.

Release energy from food.Metabolism of iron.Normal structure and function of mucous membrane.

Dry, cracked skin around the mouth and nose.


Vitamin Source Role Deficiency

Niacin Found in most foods.

Meat is a rich source.

Release energy from food.Normal functioning of nervous system.Normal structure and function of mucous membrane.

B6 Beef, fish and poultry are the richest sources.Eggs, whole grains and some vegetables.

Maintain normal homocysteine levels.

Homocysteine is a risk factor of CVD.

B12 Predominantly from animal sources - milk, meat and eggs.

Can be produced by some algae and bacteria.

Normal cell division and blood formation and function.

Normal structure and function of nerves.

Deficiency is rare but may be found in vegans.

Anaemia.

Folate Liver, yeast extract, green leafy vegetables.Some foods may be fortified.

Normal cell division, formation of blood cells, normal structure of nervous system, especially the neural tube.

Anaemia.

Recommended pre-conception and during first weeks of pregnancy to prevent neural tube defects.


Minerals

Minerals also fall into two groups. The terms are derived from the amounts in which they are required, trace (micro) elements are required in minute quantities invisible to the naked eye (less than 100mg), whereas macro elements are required in larger quantities eg, half a teaspoon.

Macro elements : Sodium, Potassium, Calcium

Trace elements: Copper, Zinc, Iron

The list of trace elements is extensive and includes metals that perform specialised functions. For example, chromium is needed for the optimal activity of insulin, but that is its only function in the body and therefore it is needed in minute amounts. The small quantities of trace elements required make deficiencies in these nutrients extremely rare. It is important to remember that just because a tiny amount is essential, it doesn't mean that a lot is great. More than enough will not improve health.

Iron

Iron is an important component of the protein haemoglobin that transports oxygen around the body. It is also involved in the final stages of the extraction of energy from food to make ATP (a high-energy compound used to produce muscle contractions - see the Energy systems section). This is why iron deficiency can lead to lethargy and fatigue. There is some indication that iron intake may be inadequate in a large proportion of pre-menopausal women, although not at the levels that would cause clinical problems. It is certainly the most common micronutrient deficiency worldwide.

The RDA for iron for menstruating females is approximately 50% greater than for men (iron is the only example where the RDA for women is greater than that for men). Although this is possible to achieve on a normal healthy diet, the source of iron may have to be taken into consideration as there are enormous variations in the availability of different sources of iron.

Iron comes in two forms, ferrous (haern) and ferric (non—haem), the ferrous form being easier to absorb. Iron from meat and other animal products is in the ferrous form, and is therefore much more easily absorbed than iron from pulses, whole grains, dried fruits and nuts, which are in the ferric form. Vitamin C can help iron absorption considerably, as vitamin C converts ferric iron from plant sources into ferrous form. Fortunately, vegetarian diets are naturally high in vitamin C so this should not pose any problems.

Zinc

Zinc helps an enormous range of enzymes to do theirjob; particularly enzymes involved in growth and development of nerves. Zinc is also necessary for blood clotting, wound healing and thyroid function. Zinc deficiency has been linked to male infertility, because zinc is necessary for sperm maturation.

Fortunately, zinc is widely available in foods but, like iron, its bio availability varies enormously. In particular, high phytate (fibre) diets inhibit absorption. Yeast in bread counteracts this but it still remains a problem where flat bread is a routine part of the diet. Performance Training Academy 32

Sodium

Sodium is unique amongst vitamins and minerals because people routinely eat too much of it, rather than struggling to obtain enough.

Sodium has many functions in the body, particularly regulation of water balance. The problem with sodium is that it dissolves easily in blood. The dissolved sodium makes blood a lot more concentrated than the fluid inside cells. As a consequence, water is pulled out of cells and into the bloodstream, raising the amount of blood the heart has to pump around and therefore raising blood pressure (BP).

There are a growing number of research studies that show that this link between raised BP, stroke and salt intake only seems to occur in some people with a genetic susceptibility or salt intolerance. Unfortunately, it is not possible to know who those people are and because cutting down on salt doesn't carry any danger, it is recommended that everyone does so.

The RDA for sodium is about 3g per day; however it has been estimated that people consume on a regularly basis around three or four times more than this. Because of this, government healthy eating targets are now advising to reduce intake to around 6g per day. However, cutting down doesn't simply mean banning salt from the dining table. There are many hidden sources of salt. For example; bread, baked beans, most tinned vegetables, processed foods, cooked meats (particularly continental varieties), sauces, crisps, pickles, takeaway meals, etc. People generally get more than enough salt without adding it to meals.

Calcium

Calcium is needed for a range of functions in the human body such as muscle contraction (including cardiac muscle), the secretion of hormones and nerve transmission. It is also one of the main components of strong, healthy bones.

Bone acts as the body's reservoir of calcium, and when levels in blood drop, then calcium will be taken from the bones to fulfil its many other functions. Blood concentrations must therefore be kept at a constant high level so that calcium availability for these important functions is not compromised.

Calcium is present in many foods, the richest sources being dairy products such as yoghurt, milk, cheese and cream. As most people associate these foods with a high fat intake, consumption has fallen in recent years. So success in getting one dietary message across may have compromised another. It is worth remembering that low fat versions of all these foods have the same calcium content, or in some cases an even higher one than their high fat counterparts.

Obtaining sufficient calcium from a vegan diet (where dairy products are not eaten) may again be a problem as calcium in most plant sources is not absorbable. This is because many plants contain high levels of compounds called phytates and oxalate that impair absorption of calcium. High protein intakes also inhibit calcium absorption. In fact, taking any of the minerals as single supplements has considerable knock-on effects on the role of other minerals eg, calcium inhibits magnesium uptake.

Vitamin D is also important for helping the absorption of calcium from the gut. Performance Training Academy 33

Potassium

Potassium is essential for water and electrolyte balance and the proper functioning of cells including nerve cells. it is present in a variety of fruits and vegetables such as bananas, dried fruit and berries.

Selenium

Selenium plays a similar role as the antioxidant vitamins by protecting against the damage caused by oxygen free radicals. Good sources of selenium include brazil nuts, cereals, fish and eggs. To source the most up—to-date RDA information visit www.doh.gov.uk or www.SACN.

Maximising vitamin and mineral intake

There are many simple measures that can be taken to ensure that adequate vitamins and minerals are obtained from the diet, without resorting to supplementation. Here are some guidelines:

• Eat a wide variety of foods.

• Include plenty of fresh fruit and vegetables on a daily basis.

• The nutrient value of fruit and vegetables starts to deteriorate as soon as it is harvested.

• The fresher the produce, the higher the vitamin and mineral content.

• Choose local produce of known origin. Food supply is a truly international business today. It is quite possible for ‘fresh’ produce to have travelled halfway around the globe from grower, to processor, to packager, to wholesaler and to retailer, losing nutrient value all along the route before it finally gets to you.

• Frozen vegetables often retain a higher nutrient content than fresh ones because of the speed with which they are frozen and packaged immediately after being picked.

• Store foods correctly; many foods are degraded by heat and sunlight and require a cool, dark place. A refrigerator is ideal.

• Intensive farming methods may reduce the nutrient content of soil, in turn reducing the nutrient content of the food grown.

• Cooking destroys vitamin and mineral content. Eating fruit and vegetables in the raw state overcomes this problem, although this is not always advisable or palatable.

• Choose a cooking method such as steaming or microwaving rather than boiling. Boiling leaches much of the nutrient content from vegetables.

• Choose whole and unprocessed foods rather than very refined foods that have lost much of their nutrient content during manufacture.


http://www.doh.gov.uk/

Vitamin and mineral supplements

There has always been considerable controversy on the need for supplementation with the micronutrients. Supplementation is widespread and the subject arouses passionate debate with devotees of the practice extolling the merits of their particular daily pills. It is important to note that it is not your job to recommend supplementation with vitamins and minerals to individuals. You should always base your advice on healthy eating guidelines. if you are presented with an individual who has or suspects they have a vitamin or mineral deficiency you must refer them to their doctor or a dietician.

Antioxidants, free radicals and phytochemicals

Evidence suggests that there are some vitamins that may be needed in amounts in excess of the RDA for very active people. These are the antioxidant vitamins A, C, and E. The mineral selenium and other nutrients also have antioxidant properties.

These vitamins help fight against the damaging effect of free radicals that build up in the body as a result of normal metabolic activity. Free radicals are essentially damaged oxygen molecules and have an extremely unstable atomic structure. They damage fats and proteins all over the body, but particularly those in membranes that line blood vessels or those in skin and other connective tissues.

As research has shown that vitamin A can be toxic in relatively small doses, it may not be best to rely on food sources of this particular antioxidant nutrient and focus on supplementing with vitamins C and, particularly, E.

The net effect of this over a period of many years can be extensive external and internal tissue damage. It is visible in the loss of elasticity and appearance of wrinkles in skin as people get older. Internal damage to blood vessels may make it more likely that plasma lipoproteins will stick to the damage site, precipitating atherosclerosis.

Anything you do that raises your metabolic rate, like exercise, will also accelerate the production of free radicals. For moderate levels of exercise, the benefits undoubtedly far outweigh the costs, but it may well be that one of the negative effects of too much exercise is that it can lead to premature ageing.

This is obviously a problem for people who earn their living from teaching exercise. The best way to combat free radicals is to eat a healthy diet containing lots of fruit and vegetables, particularly brightly coloured ones eg, deep green leafy vegetables such as broccoli and spinach, as well as yellow, orange and red fruits and vegetables like red and yellow peppers, carrots, butternut squash and apricots. Seed oils, nuts, whole grain, and beans and pulses will also provide a good supply of antioxidants. However, athletes and other very active people may choose to supplement this intake - just in case.

Phytochemicals

Phytochemicals or (phytonutrients) are plant compounds what have specific health benefits. These compounds include plant pigments and hormones. Some of the classification of phytochemicals include; carotenoids, flavonoids and isoflavones.


These compounds have a similar role to antioxidant nutrients and are also thought to play an important role in the following processes:

• fighting cancer

• helping combat the effects of free radicals

• lowering cholesterol and reducing the risk of CHD

• supporting and boosting the immune system

• increasing the number of gut bacteria

• protecting against harmful bacteria and viruses.

In order to ensure you are getting a good supply of phytochemicals, it is essential to at least meet the recommendation of five portions of fruit and vegetables per day. As many of the phytochemicals are found in plant pigments, it is essential to consume a variety of different coloured fruit and vegetables, as each colour will provide a different phytonutrient with a different health-giving property. As well as consuming a wide variety of brightly coloured fruits and vegetables, consuming a diet rich in grains, beans, pulses and soya products will also ensure a good supply of phytochemicals.

Cooking methods to retain nutritive value

It is important to remember that the nutrient value of the fruit and vegetables starts to deteriorate as soon as it leaves the plant. The best advice would therefore be to store them in a cool dark place - a refrigerator is ideal. Prepare fruit and vegetables immediately before use if possible and cook them for as short a time as possible in as little water as possible. Steaming and quick stir frying are considered to be the best methods of cooking to retain the nutritive value of vegetables.

Main points

• Vitamins are chemicals naturally found in food.

• The fat-soluble vitamins are A, D, E and K.

• The water-soluble vitamins are B and C.

• All vitamins have specific functions but work in synergy.

• The antioxidant vitamins are A, C and E.

• The function of the antioxidant vitamins is to combat the effects of oxygen free radicals.

• To ensure a good supply of A, C and E vitamins, you should consume a variety of brightly coloured fruits, vegetables and green leafy vegetables.

• Iron is essential for the formation of haemoglobin.

• Calcium is essential for strong healthy bones and teeth.

• Sodium is required for fluid balance.

• Too much sodium may lead to high blood pressure in some individuals.

• It is not your job to recommend supplements to individuals.

• To ensure the nutrient content of fruits and vegetables is retained the most efficient cooking method is steaming.


Fluids and hydration

Objectives


• List the main reasons why water is vital to survival

• List the main function of water

• Describe different ways in which fluid is lost from the body

• State how much water is needed in a day

• Describe the potential consequences of dehydration

• Discuss the diuretic effect of caffeine and alcohol

• Describe how to assess hydration levels

• Evaluate the effectiveness of different drinks as hydrators

• List effective ways of ensuring maximum hydration during day-to-day activity and exercise

• Identify the uses of various sports drinks

• Describe the composition of hypertonic, hypotonic and isotonic drinks

• Describe the recommendations for safe intakes of alcohol.


Function of water

Water is arguably the most important of all the nutrients the body needs, not least because around 60-70% of the body is water. It serves many other vital functions in the body:

• Water (as the base fluid of the blood) provides the transportation system of the body. •• It moves everything, like nutrients, oxygen, vitamins and minerals to where they are needed

and takes waste products to the excretory organs •• Water plays a vital role in temperature regulation. At a simple level, it distributes heat around

the body from sites where it is produced, such as exercising muscles, to cooler places like the skin’s surface

•• Water is the environment in which every single chemical reaction that occurs in the body takes

place. The water content of each individual cell, and indeed the whole body, needs to be kept constant between very narrow limits, so that metabolism and all other body functions remain efficient eg, digestion.

Daily water needs

To assess how much water the body needs on a daily basis, an estimate of output and input is required:

Output Water is lost from the body continually throughout the day, by breathing, sweating and excretion of waste.

Input Input is much more variable and difficult to estimate. Some water intake will come from the food eaten. Fruit and vegetables, for example, have very high water content in addition to their other attributes. It has been estimated that a well-balanced diet can probably provide as much as 1-1.5 litres of water. This still leaves a water shortfall that needs to be made up on a daily basis.

A typical mixed diet in the UK that is low on fruit and vegetables, provides only about 0.3 litres. Water is also generated as a result of normal metabolism but this probably contributes only about another 0.3 litres. Water consumption therefore needs to be at least 1-2 litres per day for normal sedentary adults.

Water output Volume (l/day)

Urine 1.20

Faeces 0.75

Skin evaporation 0.40

Respiration 0.15

Total 2.50


Activity, even walking, will increase this water loss. An hour of exercise could be responsible for a further 1-2 litres of water loss, depending on intensity and weather conditions. Very active people in hot humid climates may have water needs as high as five litres per day.

By far the best fluid to drink is water itself. It is free and almost as good as very expensive sports drinks for hydration purposes. There are no advantages of bottled water as opposed to tap water, although some individuals claim superior taste, purity etc. for certain mineral and spring waters.

Is it possible to drink too much water?

Too much water is rarely a problem as the body simply excretes any excess. For someone running a marathon, the toilet stop would certainly be an inconvenience, but not a threat to health. Large volumes of water in the stomach can make the individual feel bloated and nauseous, so it is preferable to consume little and often.

Although very uncommon, it is possible to drink too much water. The result is a condition called hyponatremia. Drinking a high volume of water over a short period of time (before the kidneys have time to filter out the excess) means the sodium concentration in the blood can become very low. This condition may manifest itself in individuals performing endurance events, consuming large amounts of water and not replacing electrolytes, namely sodium. In this instance the following symptoms may occur: headache, confusion, muscle spasms, weakness and nausea. In very severe cases, water can enter the cells causing them to swell. Most cells can cope with some degree of swelling. If swelling occurs in the brain cells - cerebral oedema - this can be fatal.

Consequences of dehydration

The consequences of not having enough fluid can be serious. Fluid loss is measured as a percentage of body weight.

For example, if an 80kg person is 2% dehydrated they will have lost: 80 x 2% = 1.6kg of water. One litre of water weighs approximately 1kg. Hence, l.6kg of water is equivalent to 1.6 litres.

• A loss of 3% of body fluids results in a reduction in blood volume and blood flow, inefficient kidney function, a measurable reduction in exercise performance, and symptoms such as dry mouth, headache, etc.

• At a 4% loss, the capacity for hard muscular work declines by some 20-30%.

• At 5%, heat exhaustion will result, requiring medical attention.

• At 7%, dehydration, whereby physical and mental function becomes severely affected and the individual will begin to hallucinate.

• At 10%, dehydration will lead to heat stroke, circulatory collapse and death.

Clearly, the importance of water replacement cannot be over stated.

How to assess hydration levels

Unfortunately, thirst cannot be used as an accurate indicator of fluid status. This is because thirst is a response to dehydration; the body cannot predict what will happen to its water content in the Performance Training Academy 39

immediate future. Hence, by the time you feel thirsty you are already dehydrated, perhaps sufficiently to affect performance, and it is too late.

It is also likely that when you drink, your thirst will feel satisfied long before you have fully rehydrated. Water takes time to be absorbed and transported to where it is needed.

Urine colour is a reliable indicator of hydration. There are certain substances in the diet that may alter the colour of the urine temporarily, such as B vitamins (bright yellow) or beetroot (reddish) and complicate assessment. However, if these factors are minimised, then the lighter the urine, the better hydrated the body.

Urine colour hydration level

Clear: Hydrated

Very pale yellow (straw): Hydrated

Pale yellow: Hydrated

Yellow: Mild dehydration

Dark yellow: Dehydration

Sports drinks

Sports drinks fall into three main categories:

• Hypertonic

• Isotonic

• Hypotonic

The categories are based mainly on the quantity of glucose and mineral salts each drink contains. This is sometimes referred to as the osmolality of the drink. A drink with high osmolality (hypertonic) contains more glucose and mineral salt particles per 100ml than a low osmolality (hypotonic) drink. if a high osmolality drink is consumed then water moves into the gut to dilute the particles sufficiently before they can be absorbed.

Conversely, a low osmolality drink speeds emptying of water from the gut. This is the basis of most sports drinks.

Hypertonic

Hypertonic drinks contain more glucose than body fluids; typically more than 8g per 100m|. Absorption from the gut is slowed compared to plain water. Most fruit juices and cans of fizzy drink fall into this category. Slower rehydration will result. However, useful glucose is supplied to fuel continued exercise. in this respect, a hypertonic drink is more of an energy replacement drink rather than a fluid replacement drink. Performance Training Academy 40

Many hypertonic energy replacement drinks contain glucose polymers. These are carbohydrate molecules artificially manufactured from cornstarch. in size they are in between simple sugars and starches, containing chains of 4-24 glucose molecules. They are usually present on the ingredients list as maltodextrin.

From a general health point of view, the high sugar content of any hypertonic drink is undesirable because it increases risk of dental caries (tooth decay).

Isotonic

Isotonic drinks contain the same amount of glucose as body fluids, typically between 4-8g/100ml. Absorption from the gut is faster than plain water and therefore faster rehydration will result. Also, glucose is supplied to fuel continued exercise.

Hypotonic

Hypotonic drinks contain less glucose than body fluids, typically less than 4g/100ml. Absorption from the gut is faster than plain water and therefore faster rehydration will result. Also, glucose is supplied to fuel continued exercise, but not as much as an isotonic drink.

Making your own sports drink

Sports drinks can definitely improve performance by improving hydration or glucose replacement. Many studies have been carried out to show this. However, commercial drinks are very expensive. Fortunately it is easy to make your own. For example, most fruit juices contain around 10-12g/100ml of glucose. Simply diluting it in half with water results in an isotonic drink. Alternatively, take some neat orange squash, and measure out enough to contain 60g sugar (use the nutrition label and a measuring jug to achieve this). Then simply dilute it in 1 litre of plain water to obtain an isotonic drink. Adding a pinch of salt may help the palatability of the resulting drink and so encourage you to drink more.

Diuretics

A diuretic is a substance that encourages net water loss from the body. The most common examples are drinks containing caffeine, such as coffee, tea, cola etc. and drinks containing alcohol.

Caffeine is a stimulant, affecting the central nervous system. It can increase endurance, concentration, mental alertness and fat burning. As such, it is a reasonably effective ergogenic aid. However, it does stimulate the kidneys to excrete more water than they otherwise would. Hence, too much caffeine can lead to dehydration. Having said this, it does depend on how much fluid is taken in along with the caffeine. For example, a large cup of relatively weak coffee (ie, lots of water) could actually result in a net fluid gain, whereas a small cup of extra strong espresso (very little water) would lead to a net fluid loss. Two or three cups of coffee, tea and cola etc. per day are probably fine. Anything over this could cause problems.


Alcohol is a depressant that also affects the central nervous system. Most people are familiar with its effects. It is also a diuretic and will stimulate net fluid loss. Many of the symptoms of a hangover (headache, dry mouth, nausea) are purely symptoms of dehydration. Drinking water and soft drink mixers along with alcohol will help to replace some of the lost fluid. It is also worth mentioning here that alcohol is very calorie dense (7kcal/g). Drinking beer, wine and spirits on a regular basis can be a major contribution to calorie intake and therefore fat gain.

Recommended guidelines for safe alcohol consumption (Department of Health - Safe limits of alcohol consumption per day)

Males - 21 units per week, 3-4 units per day

Females - 14 units per week, 2-3 units per day

You should not ‘save up’ your recommended units and consume them in one day.

What is a unit?

• 1/2 pint beer/lager at 3.5% alcohol

• 25mls spirits at 40% alcohol

• 125mls wine at 9% alcohol

Main points

• Water is essential to health.

• Signs of dehydration are fatigue, headache, impaired performance and, at worst, death.

• To ensure hydration, sip water at regular intervals throughout the day.

• A weight loss of 1kg is equivalent to the loss of 1 litre of water.

• Fluid requirements are related to activity levels.

• Fluids with a high sugar concentration (higher than the concentration of the blood) are termed ’hypertonic’

• Fluids with sugar content the same as the blood are termed ‘isotonic’.

• Fluids with sugar content lower than the blood are termed ’hypotonic’.

• Diuretics such as caffeine, sugar and alcohol can cause dehydration.


The digestive system

Objectives


• Explain the journey of food from the mouth through to the gut, etc.

• Name and describe the main functions of each section of the alimentary canal:

• Mouth

• Oesophagus

• Stomach

• Small intestine

• Large intestine

• Describe how fats, proteins and carbohydrates are digested and absorbed, and the main enzymes involved

• Discuss the role of dietary fibre in the maintenance of gut function

• Discuss the role of the liver and pancreas in assisting digestion

• Define digestive disorders and recognise your own level of competence when dealing with special needs

• Identify the time scales of digesting foods

• Explain the importance of fluid within the digestive system

• When food has been eaten it must be broken down within the body so that the nutrients it contains can be absorbed - a process called ‘digestion’.


The digestive system

Digestion occurs through physical (mechanical) and chemical actions that take place in the digestive system or alimentary canal. The process takes many hours, starting at the mouth and finishing at the anus.

The ultimate aim of digestion is to break down the food eaten, to extract the nutrients the body requires. Complex structures of protein, fat and carbohydrates are broken down to their simplest form. Water is absorbed to aid hydration and vitamins and minerals are extracted from food in order to perform their vital functions. What is left following the complex process of hydration is waste products and fibre.

Both mechanical and chemical digestion occurs throughout the digestive system. The diagram below outlines the process of digestion at different stages of the alimentary canal.

The mouth

Here food is chopped and torn by the teeth - mastication. It is moistened with saliva, and with the aid of the tongue, rolled into small balls that are easy to swallow. The tongue also allows you to experience taste as this is where the taste buds are. Saliva contains the digestive enzyme, salivary amylase, which starts a chemical breakdown of starchy carbohydrate into simpler sugars. There is no chemical breakdown of fat or protein in the mouth.

The oesophagus

From the mouth, the food is pushed into the oesophagus to travel to the stomach by a process called ‘peristalsis’. Peristalsis is rhythmical waves of muscle contractions which help push food towards the stomach. There is no physical or chemical breakdown at this stage.


The stomach

An empty human stomach is only about 15-30cm long with an internal volume of just 50ml. In this state its internal surface is thrown into deep muscular folds. However, its capacity for stretching is enormous and it can fill to hold up to four litres of partially digested food. lts smooth muscle fibres are orientated in three different layers so that it can really get to work at breaking up remaining food chunks into a thick liquid called chyme (pronounced 'kyme'). The stomach wall contains different kinds of cells, each with their specific job to do.

It is in the stomach where the breakdown of some protein and fat takes place. Pepsin breaks the protein into smaller amino acid chains. Peptides and gastric lipase will also be released to break down short chain triglycerides (mainly found in milk) into fatty acids and monoglycerides. The stomach contents are mixed by powerful muscular contractions. These enzymes can only work in very acidic conditions and therefore other cells pump hydrochloric acid into the cavity. This acid is so strong that it can dissolve metal. It can therefore very easily dissolve the stomach lining too. Fortunately, other cells produce thick mucus that coats the inside of the stomach and prevents the acid from causing any damage.

Acid secretion is controlled by nerve impulses and by the hormone gastrin, which is produced by yet another type of gastric cell in response to nerve impulses. Those nerves are partially stimulated into action when you simply think about food, or savour the aroma of a meal being prepared. Because of this high degree of nervous control, it makes sense that digestive processes are affected by emotional state. in individuals who produce either too much acid or not enough mucus, the acid can cause ulcers in the stomach wall.

Very little absorption actually occurs through the stomach. Alcohol can cross the lining of the stomach and therefore gets into the blood stream very quickly after drinking. Some drugs, such as aspirin, can also be absorbed here. Taking large amounts of aspirin can cause irritation and bleeding of the stomach.

The process of churning and digestion in the stomach can take up to five hours. Chyme from the stomach is then spurted in small amounts through a small opening called a sphincter, into the next part of the tract, the small intestine.

The small intestine

The small intestine is divided into three parts, the duodenum, the jejunum and the ilium, and is the major site for digestion and absorption of nutrients. The name ’small intestine’ is misleading, as it is actually about seven metres (25ft) long. The small intestine’s role is to break down the complex structure of nutrients into their usable components.

The liver plays a part in digestion by secreting bile. Bile emulsifies fat and provides the correct environment for the breakdown and absorption of fats. As the partially digested food enters the small intestine, it will also be mixed with pancreatic enzymes that break down carbohydrates, protein and fat.

It is the small intestine’s role to transport nutrients into the bloodstream. To do this, the surface of the small intestine is covered with millions of tiny villi. These villi present a large surface area and are covered with blood capillaries for the absorption of nutrients. At the centre of the villi is the lacteal, which connects to the lymphatic system.


The small intestine is also the major site where water absorption occurs. The small amount that is not absorbed in the small intestine is passed to the large intestine and absorbed there. Only a very small amount will be excreted in the faeces.

The large intestine

The final stage of digestion takes place in the large intestine with the partial breakdown of cellulose (soluble fibre). The large intestine’s role is to reabsorb the remaining water from undigested food. The undigested food and fibre ends up as faeces where it is passed to the colon and then expelled from the body via the anal canal (rectum).

Main points

• Digestion is the process by which complex structures of the food eaten are broken down to their simplest building blocks to be absorbed.

• Protein, fats and carbohydrates are broken down and absorbed at different stages of digestion.

• Carbohydrates start to be broken down in the mouth by salivary amylase.

• Protein and fats take longer to be broken down and are absorbed further down the digestive system.

• The main absorption of nutrients occurs in the small intestine.

• The large intestine removes water and forms faeces.

• Food and waste passes through the digestive system by muscular contractions called peristalsis.

• Fibre adds bulk to food and waste and assists with the passage of food through the digestive system.


Healthy eating guidelines

Objectives


• Identify professionals and professional bodies associated with nutrition

• Identify dietary targets to achieve a ‘healthy diet’ for the majority of the uk population

• Understand some individuals may need more or less than the guidelines suggest

• Explain dietary reference values (DRVs) and their use

• Identify the advantages and disadvantages of using drvs

• Explain guideline daily amounts (GDA) and their use

• Describe how dietary trends have developed in the uk and their impact on health

• Describe current levels of activity of individuals in the uk and describe their impact on health.


This section will examine the current UK guidelines to promote a 'healthy diet’. It also describes the range of professionals and professional bodies in the field of nutrition and their role in setting and using these guidelines. You will also understand your roles and limitations as a fitness professional/personal trainer when using these guidelines with clients.

Professionals and professional bodies involved in the area of nutrition

The scope of this qualification will allow you (the instructor/personal trainer) to provide ’healthy eating’ advice to your client in line with nationally recognised guidelines. These guidelines are suitable for the majority of people within the UK population. It is acknowledged however that some people may require more, or less than the 'healthy eating guidelines‘.

The role of a Dietician or Nutritionist

Referral to a doctor, dietician or nutritionist would be appropriate if you are presented with an individual who has a condition, or suspect they have a condition, which may be affected by their diet - remember it is not your job to diagnose and treat a diet~related (or any) medical condition. Also, if an individual requires more complex dietary analysis other than healthy eating guidelines they should also be referred to an appropriately qualified professional. Below is a statement taken from the British Dietetic Association website, outlining a description of the role of a dietician and the role of a nutritionist.

’Registered Dieticians (RDs) are the only qualified health professionals that assess, diagnose and treat diet and nutrition problems at an individual and wider public health level. Uniquely, dieticians use the most up to date public health and scientific research on food, health and disease, which they translate into practical guidance to enable people to make appropriate lifestyle and food choices.

Dieticians are the only nutrition professionals to be statutorily regulated, and governed by an ethical code, to ensure that they always work to the highest standard. Dieticians work in the NHS, private practice, industry, education, research, sport, media, public relations, publishing, NGOS and government. Their advice influences food and health policy across the spectrum from government, local communities and individuals. The title dietician can only be used by those appropriately trained professionals who have registered with the Health Professions Council.’

Similarly, a nutritionist can assist individuals who have specific dietary requirements eg, weight gain or loss, dietary modifications to treat food allergies and dietary assessment and prescription for health. A nutritionist should hold a nutrition related qualification to at least degree level and be registered with a governing body eg, The Nutrition Society. However, this is not governed bylaw and some individuals practice and call themselves a 'nutritionist' without any formal training and education in the field.

Dietary reference values (DRVs)

In 1991 an expert working group set up by the Committee on Medical Aspects of Food Policy reviewed the then current RDAs and recommended daily intakes (RDls). What the group devised was a more comprehensive set of values called dietary reference values (DRVs).


The values set are intended as guidelines and not recommendations. By using these guidelines the intention is to promote the concept of health and not just avoidance of disease. Guidelines are provided for energy, fats (saturated, mono and polyunsaturated), protein, carbohydrates (sugars, starches and non-starch polysaccharides NSP - fibre), vitamins and minerals.

These DRVs provide the scientific basis for the following practical guidelines and development of a healthy balanced diet:

• Increase consumption of fibre-rich complex carbohydrate foods

• Increase consumption of fruit and vegetables

• Reduce consumption of saturated fats and replace with unsaturated (mono and polyunsaturated) fats

• Decrease salt intake.

Although less commonly referred to, DRVs can still be found on some food labels and therefore it is useful to have an understanding of what the values represent.

Definitions of DRVs

Recommended daily intakes (RDI) - the amount sufficient, or more than sufficient for the nutritional needs of practically all healthy people in the UK.

Recommended daily amounts (RDA) - the average amount of a nutrient that should be provided if the needs of all members of the group have to be met.

Estimated average requirements (EAR) - the estimated average requirement of a group, for a particular nutrient.

Safe intakes - The amount judged to be enough for almost everyone, but below a level that could have undesirable effects.

The group responsible for revision and guidance on these recommendations is the Scientific Advisory Committee for Nutrition (SACN). SACN is an advisory committee of independent experts who provide advice to the Department of Health as well as other government agencies. Their remit includes advice on the nutritional content of food and guidelines and advice on diet and the nutritional status of the population.

Guideline daily amounts (GDAs)

It is recognised that individual requirements vary within a population. Guideline daily amounts should therefore not be used as a target, but as a useful indicator for a ‘healthy diet’.

More commonly, you will find guideline daily amounts (GDAs) on pre-packaged food labels. GDAs are a guide to the total amount of energy and nutrients that a healthy adult should be eating per day.

The GDAs for fats and saturates are derived from the DRVs of these nutrients as published by the Department of Health (1991) and, for salt, the GDA is based on the 6g per day as recommended by


Committee on Medical Aspects of Food Policy (COMA) (1994) and then confirmed by Scientific Advisory Committee for Nutrition (SACN) (2003).

Summary of DRVs for Energy, Carbohydrates, Fats and Protein for UK adults (19-60 years)

It is important to understand that these values are intended to provide ‘guidelines’ for the UK population rather than ‘recommendations’ for all individuals within the population and that some people may require more or less than the above guidelines, for example:

• Individuals who lead very active lifestyles may require a higher percentage of carbohydrate (approx. 70%).

• Individuals aiming for weight loss/weight management may benefit from slightly higher protein intakes (20%).

• Pregnant/lactating mothers may require more energy and nutrients to support the developing baby and while breastfeeding.

• Older adults may require less energy if they are inactive and more specific nutrients (eg, calcium) to maintain bone health.

Main points

• The scope of this qualification will allow you (the instructor/personal trainer) to provide ’healthy eating’ advice to your client in line with nationally recognised guidelines.

• Guidelines are provided for energy, fats (saturated, mono and polyunsaturated), protein, carbohydrates (sugars, starches and non-starch polysaccharides NSP - fibre), vitamins and minerals. By using these guidelines the intention is to promote the concept of health and not just avoidance of disease.

• It is important to understand that these values are intended to provide ‘guidelines’ for the UK population rather than ‘recommendations’ for all individuals within the population and that some people may require more or less than the above guidelines.

Male Female

Energy 2500kcals per day 2000kcals per day

Carbohydrate 50% of daily intake 50% of daily intake

Total fats Not more than 35% Not more than 35%

Saturated fats Not more than 11% Not more than 11%

Polyunsaturated fats 6.5% 6.5%

Monounsaturated fats 13% 13%

Protein 10-15% 10-15%


The UK national food guide

Objectives


• Describe the key features of the national food guide (’eatwell guide‘) and healthy eating guidelines and explain how they are used

• Identify the different food groups included in the ’eatwell guide’ and the nutrients they contribute

• With reference to ‘quantity’ and ‘quality’, give advice to promote a diet representative of healthy eating recommendations

• Analyse your own eating habits in relation to the ’eatwell guide’

• Identify ways to make eating habits more closely resemble the ’eatwell guide’ and healthy eating guidelines

• Explain how to access reliable sources of nutritional information when advising individuals on healthy eating

• Explain how to interpret available information

• Distinguish between evidence-based knowledge and unsubstantiated marketing claims.


Healthy eating guidelines

From the information covered in this section it is possible to construct some healthy eating guidelines. These are as follows:

1. Eat at least 5 portions of a variety of fruit and vegetables every day 2. Consume less 'free sugars’* and more dietary fibre 3. Continue to derive approximately 50% of total dietary energy from starchy carbohydrates,

choosing wholegrain or higher fibre versions with less added fat, salt and sugar 4. Have some dairy or dairy alternatives; choose lower fat and lower sugar options 5. Eat more beans and pulses and 2 portions of sustainably sourced fish a week, one of which is

oily 6. Eat less red and processed meat 7. Choose unsaturated oils and spreads and eat in small amounts 8. If consuming foods and drinks high in fat, salt or sugar have these less often and in small

amounts 9. Drink 6-8 cups/glasses of fluid a day - water, lower fat milk, sugar-free drinks including teas

and coffee all count. Limit fruit juice and/or smoothies to a total of 150ml a day 10. Recommended daily energy requirements for men are 25OOKcal and for women 2000Kcal

*’Free sugars’ are those added to foods plus those naturally present in fruit juices, syrups and honey. it does not include the sugars naturally present in intact fruit and vegetables or dairy products.

The UK national food guide - ‘The eat well plate’


Most people in the UK eat and drink too many calories, consume too much fat, sugar and salt, and not enough fruit, vegetables, oily fish or fibre. The Eatwell Guide defines the government's advice on a healthy balanced diet to support people to make healthy choices. It provides a visual representation of the food groups and the proportion of each food group that should make up your overall diet. It gives examples of different foods that can contribute towards a healthy balanced diet.

To achieve a healthy, balanced diet, people should try to choose a variety of different foods from the five main food groups.

Whilst there will be variations in energy and nutrient requirements between individuals, the national guideline for males is 2500Kcal per day and for women it is 2000Kcal per day. Various factors, such as age and gender, play a part in individual requirements for energy and nutrients, for example:

• The RNI for vitamin C for a child aged 1 year and under is 25mg/d, and for an adult is 40mg/d

• Adolescents have higher calcium requirements to cover their bone growth

• The RNI for iron in women aged 19-50 years is 14.8mg/d, which is higher than for men (8.7 mg/d) to cover menstrual losses

• The RNI for vitamin D in women that are pregnant or breastfeeding is 10 ug/d, whereas there is no RNI set for women of childbearing age who are not pregnant or breastfeeding

• Energy requirements for pregnant women increase by 0.8 MJ/day or 200 kcal/day, but only in the final three months of pregnancy

• Protein requirements increase in pregnancy (an additional 6g/d) and lactation (an additional Hg/d O»6m and 8g 6+ months).

It is also recognised that some sections of the population will require varying proportions in relation to those represented by the 'Eatwell Guide’ eg, the proportion of the carbohydrates food group may be less for some individuals or the proportion of protein foods may be higher. This could be influenced by the presence of certain medical conditions or the specific nutritional goals of an elite performer for example.

If you consider the above in relation to the Eatwell Guide, those individuals who require more energy, will require more food throughout the day, but the proportions of the food groups will stay the same.

It is important to note that children under two have different requirements, but children over the age of two should be working towards a diet resembling the Eatwell Guide.

Using the Eatwell Guide

The guide is split into five food groups:

• Potatoes, bread, rice, pasta and other starchy carbohydrates

• Fruit and vegetables

• Beans, pulses, fish, eggs, meat and other proteins


• Dairy and alternatives

• Oil and spreads

The guide encourages the choice of different foods from the first four groups every day, to help ensure the population obtains a wide range of nutrients needed to remain healthy. Choosing a variety of foods from within each group will add to the range of nutrients consumed. Notice that foods and drinks high in fat, salt or sugar are not included since the recommendation is to consume this type of food and drink less often and in small amounts.

The size of the segments for each of the food groups is consistent with Government recommendations for a diet that would provide all the nutrients required for health.

The Eatwell Guide is not meant to represent the balance required in any one specific meal or over a particular timescale, rather, it represents the overall balance of a healthy diet.

‘Quality’ of food

Potatoes, bread, rice, pasta and other starchy carbohydrates should make up just over a third of the food you eat, and you should choose wholegrain or higher fibre versions with less added fat, salt and sugar.

(N.B. the recommendation for 50% of total dietary energy refers to total carbohydrate consumption as a proportion of overall diet which includes ALL starch, sugars and dietary fibre).

This food group occupies a large section of the food plate, indicating that people should be obtaining a high percentage of energy from this food group. This does not mean you can eat any amount of food from this group; it is crucial to note that there are 'good’ carbohydrate choices (high nutritional quality and value) and ’bad’ carbohydrate choices (poor nutritional quality and value).

People should be aiming to consume a variety of high ‘quality’ foods in this group and notjust the usual bread, pasta and rice; consider the sources of carbohydrates. When making food choices in this food group try following these approaches:

• Choose unrefined carbohydrates - wholegrains and fibre-rich

• Include starchy vegetables as an alternative to potatoes/pasta etc, eg sweet potato, yarns, butternut squash and pumpkin

• Avoid overconsumption of refined carbohydrates - eg white bread and products made from refined flour, pasta, white rice and refined breakfast cereals

• Add variety to your diet by including grains such as barley, millet, spelt, quinoa, brown rice and wholegrain/brown rice pasta

• Include predominantly low GI/GL carbohydrates

It is now recommended that the dietary reference value for the average population intake of dietary fibre should be increased as follows:

30g a day - aged 16 and over


25g for 11 to 15 year-olds

20g for 5 to 11 year-olds

15g for 2 to 5 year olds

Fibre encompasses all carbohydrates that are naturally integrated components of foods and that are neither digested nor absorbed in the small intestine.

Fruit and vegetables - you should eat at least five portions of a variety of fruit and vegetables every day accounting for just over a third of the food you eat.

This food group also occupies a large section of the food plate. In fact, it indicates that this food group should be consumed in the same proportion as the starchy carbohydrates group.

A general guideline for this food group is that people should be consuming at least five portions of fruit and vegetables per day. One adult portion of fruit or vegetables is 80g. For children, a portion equates roughly to the amount they can fit in the palm of their hand.

This food group is essential to provide a rich supply of vitamins, minerals and fibre. If you are consuming over this recommendation of five portions per day, this should not be seen as a problem, unless you are consuming a high volume of fruit and vegetables and not a lot from other food groups. This can lead to a deficiency in energy and other essential nutrients (namely protein and fat).

When making choices in this food group consider the following:

• Limit consumption of fruit/vegetable juices and smoothies to a combined total of 150ml a day

• Include a variety of fruits and vegetables

• Include brightly coloured fruits and vegetables

• Include green leafy vegetables

Portion sizes:

• For small fruit, one portion is two or more small fruit, for example two plums, two satsumas, two kiwi fruit, three apricots, six lychees, seven strawberries or 14 cherries

• For medium sized fruit, one portion is one piece of fruit, such as one apple, banana, pear, orange or nectarine

• For large fruit, one portion is half a grapefruit, one slice of papaya, one slice of melon (5cm slice), one large slice of pineapple or two slices of mango (5cm slices).

• A portion of dried fruit is around 30g however, dried fruit can be high in sugar and can be bad for your teeth. To reduce the risk of tooth decay, dried fruit is best enjoyed as part of a meal, as dessert for example, not as a snack between meals

• Green vegetables - two broccoli spears or four heaped tablespoons of cooked kale, spinach, spring greens or green beans count as one portion

• Cooked vegetables - one portion is three heaped tablespoons of cooked vegetables, such as carrots, peas or sweetcorn, or eight cauliflower florets count as one portion


• Salad vegetables - three sticks of celery, a 5cm piece of cucumber, one medium tomato or seven cherry tomatoes count as one portion

• Tinned and frozen vegetables - roughly the same quantity as you would eat for a fresh portion. For tinned, choose those canned in water, with no added salt or sugar.

Beans, pulses, fish, eggs, meat and other proteins - Aim for at least two portions of fish every week, one of which should be oily, such as salmon or mackerel.

This food group occupies a smaller section of the food plate compared to the fruit and vegetable group and the starchy carbohydrates group. This group provides energy and protein as well as essential vitamins, minerals and fats.

As with all the food groups there are good and poor choices in relation to the ’quality' of the food. Good choices will ensure a good supply of essential fatty acids, amino acids, vitamins and minerals. Bad choices will provide a high percentage of saturated fats.

When making food choices in this group consider the following:

• Include more foods from non»anima| sources such as pulses (all beans/peas/lentils), nuts and seeds

• Eat 2 portions of sustainably sourced fish per week, one of which is oily (this helps to increase omega-3 intake)

• Try not to consume your entire protein intake from meat or animal products

• Eat less red and processed meat (bacon, ham, sausages etc).

Dairy products — have some dairy or dairy alternatives (such as soya drinks and yoghurts). Choose lower—fat and lower—sugar options.

As with the previous group, this group is required in a smaller proportion than fruit and vegetables or the carbohydrates group. lt will provide energy, protein, fats, vitamins and minerals.

When making food choices in this group consider the following:

• Choose lower fat and lower sugar options

• Some lower fat alternatives may be beneficial for some people (although it is important to read the food label as some lower fat options are high in sugar)

• Be aware of portion sizes as these foods can be high in energy as well as fat

• Individuals who do not consume dairy products can increase their intake of foods from other groups to obtain the essential nutrients they may be missing out on, eg, nuts, seeds, pulses, Whole grains. brightly coloured and green leafy vegetables.

Oils and spreads — choose unsaturated options and use in small amounts.


The small size of the purple section reflects the fact that oils and spreads are high fat and contain a lot of calories, so these should only be consumed in small amounts. As part of a healthy diet, we should try to cut down on foods and drinks high in saturated fats and trans fats and replace some of them with unsaturated fats.

When considering fat intake and selecting which oils/spreads to use consider the following:

• Although saturated fat should not be eliminated from the diet, be aware of how much saturated fat you consume/use butter, ghee, palm oil etc

• Be aware that some vegetable oil spreads/margarines may be high in trans fats, therefore limit consumption of them

• Remember that all types of fat are high in energy. A gram of fat, whether saturated or unsaturated, provides 9kcal (37kJ) of energy compared with 4kcal (l7kJ) for carbohydrate and protein

• The average man should aim to have no more than 30g of saturated fat a day

• The average woman should aim to have no more than 20g of saturated fat a day

• Children should have less

• Found primarily in oils from plants, unsaturated fats can be either polyunsaturated or monounsaturated. Monounsaturated fats help protect our hearts by maintaining levels of HDL cholesterol while reducing levels of LDL cholesterol. Monounsaturated fats are found in olive oil, rapeseed oil and their spreads, avocados, and some nuts such as almonds, brazil nuts and peanuts.

Foods containing fats and/or sugar — less often and in small amounts.

Foods high in fats and/or added ’free sugars’ such as crisps, confectionary, cakes, biscuits, pastry, cheeses, butter, preserves/sweet spreads and sugary drinks (including tea and coffee with added sugar), should be consumed less often and in small amounts.

Free sugars should account for no more than 5% of daily dietary energy intake equivalent to:

• 19g, 5 sugar cubes, or 3-5 teaspoons for children aged 4 to 6

• 24g, 6 sugar cubes, or 4-6 teaspoons for children aged 7 to 10

• 30g, 7 sugar cubes, or 5-7 teaspoons for 11 years and over, based on average population diets

High levels of sugar consumption are associated with a greater risk oftooth decay and the higher the 3 proportion of sugar in the diet, the greater the risk of excessive energy intake.

Hydration guidance - 6-8 glasses a day.

Keeping hydrated is part of a healthy diet and so the Eatwell Guide reinforces fluid intake recommendations and the best drinks to choose. The guide advises a fluid intake of 6-8 glasses a day. Water, lower fat milk, sugar~free drinks including teas and coffee all count. Fruit juice and/or smoothies should be limited to a total of 150ml a day.


The consumption of sugar-sweetened beverages (e.g. fizzy drinks, soft drinks and squash) should be minimised by both children and adults because:

• Drinking high sugar beverages results in weight gain and increases in BMI in teenagers and children

• Consuming too many high-sugar beverages increases the risk of developing type 2 diabetes.

Guideline daily amounts for energy

UK estimated average requirements for adults are based on the average energy required for people of a healthy weight who are moderately active.

(British Nutrition Foundation 2015)

Main points

The ’Eatwell Guide’ is the UK national food guide. it provides a pictorial representation of the healthy eating guidelines.

• The ’Eatwell Guide’ encourages healthy eating choices from the different food groups to help ensure the population obtains a wide range of nutrients needed for good health.

• The size of the segments for each of the food groups is consistent with government recommendations for a diet that would provide all the nutrients required for a healthy diet (for those over the age of two).

• The ’Eatwell Guide‘ is not meant to represent the balance required in any one specific meal or over a particular timescale, rather it represents the overall balance of a healthy diet.

• It is essential to consider both quantity and quality of foods represented by the national food guide.

• People should aim to consume more fruit and vegetables, more dietary fibre and wholegrains whilst reducing their intake of refined carbohydrates and fatty/sugary/salty foods and drinks.

Males Females

Age (yrs) MJ/d Kcal/d MJ/d Kcal/d

19-24 11.6 2772 9.1 2175

25-34 11.5 2749 9.1 2175

35-44 11.0 2629 8.8 2103

45-54 10.8 2581 8.8 2103

55-64 10.8 2581 8.7 20179

65-74 9.8 2342 7.7 1912

75+ 9.6 2294 9.7 1840


• Aim to drink 6-8 cups/glasses of fluid a day and limit fruit juice and/or smoothies to a total of 150ml a day.

• Recommended daily energy requirements for men are 25OOKcal and for women 2000Kcal, but these energy requirements will differ according to a variety of factors.


Energy needs of the human body

Objectives


• Describe the factors affecting energy requirements

• Demonstrate the ability to evaluate energy requirements

• Calculate individual energy requirements

• Calculate how much carbohydrate, fat and protein are required in grams to meet your daily requirements

• Provide guidelines to achieve these requirements.


Factors affecting energy requirements

The following factors will have an influence on an individual's energy requirements:

• Activity levels

• Exercise

• Occupation

• Lifestyle

• Age

• Gender

• Body mass

• Body composition

• Environmental temperature

• Diet

• BMR - Basal Metabolic Rate

• Thermal Effect of Food - TEF (the energy used during the process of digestion)

Basal (or basic) metabolic rate (BMR)

BMR is an individual's basic requirement of energy at rest. This energy will be adequate to maintain the body's basic function without any movement. One of the main influences on BMR is body composition - even at rest, a muscle cell is metabolically more active than a fat cell.

Calculating BMR

There are many methods and equations used by clinicians and physiologists to estimate individual energy requirements. The most accurate method of measuring energy requirements is a process called calorimetry.

These methods analyse heat production, oxygen consumption and carbon dioxide production to determine energy expenditure and are generally performed under laboratory conditions. Unfortunately, such conditions are not available to the fitness professional/personal trainer and so you must therefore rely on other methods to estimate energy requirements.

From numerous studies carried out to investigate energy expenditure, various calculations have been formulated to provide an estimate of energy requirements. Some of the commonly used calculations are the Schofield calculation (1985) and the Henry calculation (2005).

These calculations use the variables of gender, age, height and weight to calculate an individual's BMR. A factor is then applied based on their activity levels. This factor may be described as a PAL - Physical Activity Level, or PAF - Physical Activity Factor.

Calculations that factor in lean body mass will be most accurate when calculating BMR, as lean tissue is more metabolically active than fat. The Schofield calculation will be sufficiently accurate


for most people with the exception of those with a very high muscle mass (underestimate kcal needs) or a very high fat mass (overestimate kcal needs).

The Schofield Calculation

Key: W = Body weight in kilograms SEE = Standard error of estimation

The SEE value means the calculated BMR could be this number of calories out, in other words either too many or too little. As an example, if you are very muscular and possess more lean weight than an average person of the same height and weight, then you may have to add the SEE value to the BMR calculated. The simple reason is more lean weight means more calories needed.

In addition to calculating BMR you have to apply a factor that will account for an individual's physical activity level (PAL), or (PAF) physical activity factor:

BMR x 1.4 inactive men and women (this applies to most people in the UK)

BMR x 1.6 moderately active women

BMR x 1.7 moderately active men

BMR x 1.8 very active women

BMR x1.9 very active men

As discussed, formulas that take into account an individual's lean body mass are more accurate than formulas which take into account only one factor eg, weight.

Resources that Convey the message of healthy eating

In order to Convey the message of healthy eating to your clients there are various reliable sources of information. Below are just a few examples of websites and organisations that you could use to obtain leaflets, information, booklets etc. It is important to understand what your client wants to achieve and what type of information would benefit them. This will be discussed further in the Client consultation section. Performance Training Academy 62

Males

10-17 years BMR = 17.7 x W + 657 SEE =105

18-29 years BMR = 15.1 x W + 692 SEE = 156

30-59 years BMR = 11.5 x W = 873 SEE = 167

Females

10-17 years BMR = 13.4 x W + 692 SEE = 112

18-29 years BMR = 14.8 x W + 487 SEE = 120

30-59 years BMR = 8.3 x W = 846 SEE = 112

NHS Choices - www.nhs.uk/livewell British Heart Foundation - www.bhf.org.uk Weight Concern - www.weightconcern.com Change 4 Life Department of Health Campaign - www.nhs.uk/change4life Diabetes UK - www.diabetes.org.uk The Nutrition Foundation - www.nutrition.org.uk

Evidence-based knowledge

It can sometimes be difficult to distinguish between evidence-based knowledge and unsubstantiated marketing claims. Researching a subject will give you a broader understanding and keep you up to date with what is happening in a particular field. When researching and using information, it is important to follow some basic rules:

• Use information that has been concluded from a valid research study.

• Use information from reliable sources (as outlined above).

• Be aware of your limitations. It is not yourjob to 'prescribe’ dietary advice, even if the advice comes from a reputable source.

• Your role is to advise on well documented ‘healthy eating guidelines’.

• The guidelines, information and references provided throughout this manual are obtained from reliable sources of information.

Main points

• BMR is an individual’s basic requirement of energy at rest.

• In order to calculate energy requirements, use the variables of gender, age, height and weight to calculate an individual's BMR. A factor is then applied based on their activity levels. This factor may be described as a PAL - Physical Activity Level, or PAF - Physical Activity Factor.


http://www.nhs.uk/livewell

http://www.bhf.org.uk/

http://www.weightconcern.com/

http://www.nhs.uk/change4life

http://www.diabetes.org.uk/

Nutrition and health

Objectives


• Describe the relationship between nutrition, physical activity, body composition and health

• Understand classifications of obesity

• Describe the health risks associated with excess body fat.


This section examines how nutritional status can affect health, and contribute to the development of certain dietary related conditions.

Levels of obesity both in the UK and worldwide

Levels of obesity both in the UK and worldwide, have increased dramatically in recent years. So much so, that the World Health Organisation (WHO) have declared it a ’global epidemic’.

• In 2009, 24% of adults (aged 16 or over) in England were classified as obese BMI 30 (kg/m2) and 38% were classified as overweight BMI 25 to less than 30 (kg/m2) (Health Survey for England 2009. NHS IC 2011).

The WHO claims 'over a billion people worldwide are overweight and at least 300 million obese’ (WHO 2003). The UK population has grown steadily fatter - 23% of the UK population is now obese, a threefold increase since 1980 (Lister 2005). Obesity is both a major cause of chronic ill health and 'considered a disease in its own right’ (WHO 2003).

It is becoming clear that causes of obesity are complex and multifactorial. However the bottom line is that body weight (or more accurately body fat), increases when energy consumption is greater than energy expenditure for a sustained length of time. Fat is twice as dense in calories as either proteins or carbohydrates at 9kcals per gram. This means that a diet high in fat is likely to lead to a diet that is also high in calories. These extra calories will be stored as fat, mainly underneath the skin.

It is certainly not possible to say that high fat intakes cause obesity. In fact it would be possible to have a diet very high in fat and be slim or lose weight as long as the total calories consumed were still less than the total being expended (hypocalorific). However, all health organisations agree that this would not be a healthy approach to long-term weight management.

Healthy ranges of body fat percentage

What these figures mean is that the percentage body fat of the vast majority of people would fall between these two values. When percentage body fat falls outside of this range people may be considered to be carrying too much body fat or too little for health. However, it is also important to consider how much weight a person is carrying in relation to their whole body size. So another useful indicator of obesity is the Body Mass Index or BMI.

To calculate BMI, divide body weight in kilograms by height in metres squared:

BMI = Body weight (kgs) / Height m2

Age Male Female

16-29 14-18% 22-25%

30-49 19-24% 25-29%

50+ 24-27% 29-32%


The following table shows guidelines for classifying BMI. Waist circumference also gives further useful information about level of disease risk.

Dieticians and health professionals recognise different classes of obesity based on a variety of measurements. Research indicates that the more excess weight being carried, the greater the health risk from a variety of conditions. It is therefore undoubtedly desirable to develop weight loss strategies to assist people at the upper levels of these normal ranges and above. However, it is perhaps unrealistic to set a target that everyone should try to attain regardless of their starting point or genetic makeup. Beware of using labels based on a limited range of measurements and visual judgements.

BMI measurements provide a simple measurement of obesity and are widely used by health care professionals. It is also important to consider the regional distribution of excess body fat as it increases the risk of developing other diseases, such as coronary heart disease (CHD) and non-insulin dependent diabetes mellitus (NIDDM).

Fat that is distributed around the abdomen is close to the internal organs; individuals of these types will have both a high BMI and a high waist circumference. This type of obesity is termed ’central obesity’; individuals who have central obesity have also been found to present an increased risk of CHD and NIDDM.

Disease risk relative to normal weight and waist circumference

BMI Men: waist less than 102cmWomen: waist less than 88cm

Men: waist more than 102cmWomen: waist more than 88cm

Underweight Less than 18.5 No additional risk No additional risk

Normal 18.5-24.9 No additional risk No additional risk

Overweight 25.0-29.9 Increased High

Obesity class:

I 30.0-34.9 High Very high

II 35.0-39.9 Very high Very high

III More than 40.0 Extremely high Extremely high

Waist circumference cm (in)

Risk category Females Males

Very low Less than 70cm (28.5 in) Less than 80cm (31.5 in)

Low 70-89CM (28.5-35.0 in) 80-99 (31.5-39.0 in)

High 90-109cm (35.5-43.0 in) 100-120cm (39.5-47.0 in)

Very high More than 110cm (43.5 in) More than 120cm (47.0)


Individuals who have fat predominantly around the hips and thighs, and below the navel may have a high BMI but a low waist-to-hip ratio. Individuals with this type of fat distribution may carry less risk of CHD, but still carry a significant risk of obesity.

Diabetes

All cells need glucose to function properly and for energy. When people eat and digest carbohydrate, glucose is transported into the cells by the hormone insulin. People who have diabetes do not produce enough insulin or the insulin they do produce does not work efficiently (insulin resistance).

There are two main types of diabetes:

• Type 1 diabetes

• Type 2 diabetes

Type 1 diabetes

Type 1 diabetes usually appears before the age of 40 and especially in childhood. With this type of diabetes the insulin-secreting cells become damaged and do not produce sufficient amounts of insulin to move the glucose from the blood into the cells. Blood glucose levels remain excessively high. It is treated with insulin either by injection or pump, a healthy diet and regular physical activity.

Type 2 diabetes

Type 2 diabetes develops when the body doesn't produce enough insulin or the insulin that is produced doesn't work properly. Usually it appears in people aged over 40, though in South Asian, African and Afro-Caribbean people it can appear from the age of 25. it is becoming more common in children and young people of all ethnicities.

Type 2 diabetes is treated with a healthy diet and regular physical activity, but medication and/or insulin is often required.

It has been found that individuals with high body fat levels, especially those individuals who present with central obesity, have a greater risk of developing type 2 diabetes.

The following are identified as risk factors by 'Diabetes UK’:

• Having a close family member (parent or brother or sister) with type 2 diabetes

• Being overweight or having a waist measurement of 31.5 inches or over for women, 35 inches or over for Asian men and 37 inches or over for white and black men

• Having high blood pressure or having had a heart attack or a stroke

• Having polycystic ovary syndrome and being overweight

• Having impaired glucose tolerance or impaired fasting glycaemia

• Having had gestational diabetes Performance Training Academy 67

• Having severe mental health problems

The more risk factors that apply, the greater the risk of having diabetes.

Not all people with diabetes are overweight but the statistics show that over 80% of people diagnosed with type 2 diabetes are overweight. The more overweight and the more inactive people are, the greater the risk.

Coronary heart disease (CHD)

Many studies have shown an association between high fat intakes and high levels of CHD. Many sources of fat, particularly those from animals, may cause an increase in the levels of cholesterol circulating in the blood. Chemically speaking cholesterol is not strictly a fat, although it is very like one.

Cholesterol is essential to the human body. It has three very important functions:

• Along with fats, it is a major component of the membranes that surround all the cells and is therefore needed to maintain cellular integrity

• It is used in the liver to make bile salts, which are essential for the digestion and absorption of dietary fats

• All steroid hormones - which are responsible for regulating an enormous range of body functions - are derived from cholesterol.

Cholesterol is so important to the human body that you do not need to rely on it being provided in the diet; the human body can make all the cholesterol it needs. Surprisingly, dietary cholesterol does not affect blood cholesterol levels, although a high total fat intake, particularly of saturated fat, may.

Fat metabolism

Fats in the diet mainly come in the form of triglycerides (TGs). Dietary fats are broken down (by digestion) to fatty acids and glycerol, reconstituted back to TGs and then transported to where they are needed in the body. In order to transport TGs and cholesterol, they need to be solubilised (as they are insoluble in water). This is achieved by packaging them up with proteins into small particles called plasma lipoproteins (PLPs).

Some fats may be oxidised for energy or if there is no immediate use for them, stored as subcutaneous fat. Others will be used as structural molecules (cell membranes) or used to synthesise other essential substances (hormones).

Plasma lipoproteins

There are several different types of PLPs floating around in the bloodstream. They are classified according to their weight or density. The low density lipoproteins, or LDLs are considered to be detrimental to health. These transport mainly cholesterol but also TGs to all the cells in the body. The more fat there is in the diet, particularly from animal sources, the more LDLs there will be in


the blood. Cells take up LDLs from the blood to obtain the needed nutrients. When they have enough, they simply stop removing them from the blood. If fat intake remains high, then LDLs will gradually accumulate in the bloodstream where they can easily settle on artery walls.

When this happens, LDLs become chemically altered into compounds that can damage the lining of the blood vessels. Scar tissue forms, leading to the development of a fatty fibrous plaque embedded in the artery wall. This makes it more likely that more LDLs will stick to the damaged areas and so the process continues.

Atherosclerosis

Over a fairly lengthy period of time, the fatty plaque can build up to such an extent that it may slow down or disrupt the blood flow, depriving tissues beyond the blockage of much needed nutrients and oxygen. Some of the smaller arteries in the body are highly likely to become completely blocked during the course of a lifetime. Some of the smallest arteries in the human body are the ones that supply the heart muscle (myocardium) with blood. Furring of these coronary arteries with fatty plaques is called atherosclerosis.

The myocardium, in particular, is very sensitive to disruptions in its blood supply as it is totally dependent upon oxygen to produce the energy it needs to contract. A heart muscle cell deprived of oxygen will simply stop working and die. Only 5% of the coronary arteries need to become blocked before serious problems arise when even minor exertion is attempted. Sometimes this can result, quite suddenly and with very little warning, in a fatal heart attack. With luck, pain will be felt beforehand as a warning sign that something is wrong. This pain is termed angina.

At this stage, CHD can be controlled with drugs and lifestyle changes to prevent the condition getting any worse. Currently cancer and CHD are the biggest killers in the Western world. Although there are many factors that contribute to their development, dietary fat intake may be a contributing factor. When the small arteries providing the brain with blood become blocked with fatty deposits, bursting and haemorrhaging of the vessels can lead to strokes.

However, that is not the whole story in relation to PLPs. There is another class of them that actually help in the fight against CHD. These are the high density lipoproteins or HDLs. HDLs are made by the liver and then circulate in and around the bloodstream. Their role is to scavenge free cholesterol in the bloodstream and return it safely to the liver where it is converted to bile and excreted. So a high level of HDLs, particularly in relation to the level of LDLs, can help to protect against CHD.

Blood lipid profiles are routinely carried out in hospital laboratories to estimate someone’s risk of developing CHD. Although absolute levels of TGS or cholesterol are important, what really matters is the relative ratio of LDL to HDL. Normally this is about 3:1 (LDL:HDL) — you are considered at risk if that ratio rises to twice that level, ie, 5/6:1.

The good news is that exercise has a beneficial effect on the LDL:HDL ratio. In an exercising body, the ratio can be as good as 1:1. This is because an active body is a more efficient fat burner and would therefore pull more LDLs out of the blood, in turn lowering their concentration.

Classification of blood cholesterol levels


Cholesterol levels are measured by taking a blood sample after a period of fasting. In order to get an accurate cholesterol measurement it is beneficial to obtain a ratio of HDL:LDL as well as total cholesterol.

The British Heart Foundation recommends people aim for the following:

• A total cholesterol of under 5mmol/l

• An LDL level of under 3mmol/l

• An HDL level of above lmmol/l

• A triglyceride level of under l.7mmol/l

Practical guidelines to reduce your cholesterol level

The average cholesterol level of adults living in the UK is around 5mmol/l. As a high cholesterol level is one of the major risk factors to CHD, it is important to make lifestyle changes in order to have a positive effect on cholesterol levels by doing the following:

• Perform regular physical activity

• Maintain weight at a healthy level

• Decrease the intake of saturated fats and replace them with moderate amounts of unsaturated fats

• Ensure the diet provides a good supply of omega 3 fatty acids

Other risk factors for coronary heart disease are:

• Smoking

• Having high blood pressure

• Being physically inactive

• Being overweight or obese

• Having diabetes

• A family history of chd.

Your overall risk of a heart attack doubles if you have high cholesterol plus one of the above risk factors (British Heart Foundation).

Practical guidelines to reduce fat intake

• Try steaming or grilling food as opposed to frying.

• If frying, use oil sparingly or use an oil spray.

• Eliminate the butter from sandwiches as the taste is often lost with the filling.

• Avoid or limit the use of thick, creamy sauces; opt for tomato-based sauces instead.

• When making your own white sauce, add cornflour to skimmed milk, not flour and margarine.

• Use skimmed milk instead of full fat or semi-skimmed as much as possible. Performance Training Academy 70

• In some recipes full fat cream and milk can be substituted for half fat.

• In cake recipes, try swapping butter or fat for pureed fruit, or try half and half (this will have a similar effect).

• Instead of mayonnaise in recipes, try low fat yoghurt.

• Cut the visible fat and skin off meat, as this is where most of the fat is usually found.

Main points

• People who have diabetes do not produce enough insulin or the insulin they do produce does not work efficiently (insulin resistance).

• There are two main types of diabetes: Type 1 diabetes and Type 2 diabetes.

• Many studies have shown an association between high fat intakes and high levels of coronary heart disease.

• High intakes of saturated fat may cause an increase in the levels of cholesterol circulating in the blood.

• Cholesterol is essential to the human body.

• Along with fats, cholesterol is a major component of the membranes that surround all cells and is therefore needed to maintain cellular integrity.

• Cholesterol is used in the liver to make bile salts, which are essential for the digestion and absorption of dietary fats.

• All steroid hormones - which are responsible for regulating an enormous range of body functions - are derived from cholesterol.

• Fats in the diet mainly come in the form of triglycerides (TGS).

• In order to transport TGs and cholesterol, they need to be solubilised (as they are insoluble in water). This is achieved by packaging them up with proteins into small particles called plasma lipoproteins (PLPS).

• ’Furring’ of the coronary arteries with fatty plaques is called atherosclerosis.

• HDLs and LDLs are produced by the liver and have a specific function in the transport of fats and cholesterol.


Weight management

Objectives


• Describe the energy balance equation

• Explain the role of diets and context of diets in contemporary society, exploring the significance of the media, broad cultural factors, health concerns and commercialism

• Describe the contraindications to very low calorie diets

• Explain why dieting is an ineffective long-term weight loss strategy

• Describe some of the current misconceptions, eg, spot reduction, rapid weight loss, fad diets

• Describe the typical thought processes of a yo-yo dieter

• Discuss the physiological consequences of low calorie diets

• Describe barriers to improving eating behaviour

• Devise strategies for effective weight management

• Consider an individual's lifestyle and devise nutrition plans, exercise routines and activities to help them achieve their goal

• Explain the importance of communicating health risks associated with weight loss fads and popular weight loss diets.


This section examines the impact of weight loss fads on the ability to achieve and maintain a healthy weight. It also considers your role as a personal trainer/instructor in communicating the health risks associated with popular diets, alternative methods of weight loss and weight loss fads. This will allow you to develop effective weight loss strategies with your clients.

The energy balance equations

An adequate balance of nutrients is important, but so is total energy in relation to energy expenditure. Put simply, if energy intake exceeds requirements, the result is weight gain. If intake is less than requirements, the result is weight loss. If intake and expenditure are balanced, the result is weight maintenance.

• Energy in more than Energy out = weight gain

• Energy in less than Energy out = weight loss

• Energy in equals Energy out = weight maintenance

Physiology and psychology of dieting

The role of the media

Acquiring an increased knowledge about food and its effect on the body is an important step in developing eating behaviours that maintain a high health status. Unfortunately, when it comes to actually making choices about what to eat and when, knowledge is only one part of the influence and usually a very minor part at that.

Far more important is the cultural and sociological environment and the resultant pressures to conform to norms established and forcefully maintained by that culture through media images, advertising and marketing. To put it bluntly, we live in a society and time where ’thin' is valued and seen as attractive and desirable, while ’fat’ is perceived as the opposite. Developing from this is an inherent prejudice against overweight people leading to discrimination in all aspects of daily life.

Food inevitably dominates our lives; humans need to eat in order to survive. However, the pressures to get thin and stay thin are enormous and have led to the use and abuse of food as a controllable factor in an otherwise uncontrollable life.

Individuals eat (or don't eat) as a response to a whole range of life events, and to deal with the subsequent emotions and feelings. If the eating behaviour results in overeating and therefore a gain in weight, then the eating behaviour comes to be seen as the cause, rather than the symptom, of psychological distress. This is often translated into ’If only I could get my eating under control and get thin then I would be happy and everything would be all right’.

There are plenty of seemingly glamorous role models provided by the media in the form of ultra-slim, usually tall models, who are used to advertise designer clothes and an enormous range of other products. The clothes are specifically designed to look good on their particular frame, so it is hardly surprising that when we go to our high street stores to try on a copy (or even the real thing), they somehow never look anywhere near as good. But of course, if only we could lose weight to Performance Training Academy 73

look just like the supermodels, then we would look good and feel good too. All we need is to lose a stone or two, particularly from our stomachs and thighs.

Whilst it is unarguably true that most of the pressure to conform to an ideal body image is aimed at females, men also experience role model imagery in the media. However, most male role models tend to be athletes or film screen heroes. Whilst it may be just as unrealistic for most males to get to look like a top athlete as it is for females to try to look like a supermodel.

Ask any exercise teacher what is the most common question they get asked and the answer will be ‘How can l make my bottom/tummy/thighs/hips smaller?’ or ‘How can I bulk up my chest and arms?’ In other words, it is about the desire to change body shape and look different.

The ability to change body shape

There has been considerable research around the question of what determines how fat people are and how easy or difficult it is to lose that body fat. Some research has arrived at astonishing findings that will inevitably have major implications on programme planning for weight loss and fat loss. Our overall shape, or somatotype, is genetically determined and falls in to one of three main patterns:

• Ectomorphs have long limbs relative to their bodies. They are usually tall and thin. •• Mesomorphs have limb length relative to the body. They are lean and athletic. •• Endomorphs are rounded with relatively short limbs compared to the rest of their body.

There is nothing people can do to change their basic body shape. The body they have can look bigger or smaller, it can get fitter and healthier, but it will still be proportioned the same and look the same shape overall. If you lose weight you don't get to look like someone else, you just look like a thinner version of yourself.

Fat cells

It has been known for some time that the number of fat cells in the body, and where those fat cells are, is predominantly determined by genetic makeup.

The most obvious confirmation of this are the very different patterns of fat distribution between men and women. Fatter people don't necessarily have more fat cells than thinner people, it’s just that the fat cells they do have contain more fat.

In addition, how resistant those fat cells are to losing that fat seems to be strongly genetically determined. One common frustration of dieting with the aim of making a specific part of the body smaller, is that the weight comes off everywhere else, but not from the desired area, making it look even bigger in relation to the rest of the body.

Fat cells have the ability to increase in both size and number. When fat cells increase in size it is called hypertrophy. If energy intake is greater than required, the excess energy will be stored in fat cells causing them to increase in size.


Fat cell hyperplasia is the laying down of more fat cells and will normally only occur during certain periods in life:

• Year 1-2 as a child (during the period of rapid growth)

• Puberty (again during a growth spurt)

• If fat cells become so full they cannot take any more

Once these fat cells have developed they are there for life. The average number of fat cells in the majority of individuals is 30-50 billion. An adult who has developed obesity by fat cell hyperplasia may have 70-100 billion fat cells. Hyperplastic adiposity is considered to be a more ‘permanent’ form of obesity than hypertrophic adiposity due to the increased number of fat cells.

The role of leptin and the set point theory

So what does control how fat people are? Undeniably, behaviour plays a vital part, but it seems that there is also a physiological mechanism residing in the fat cells that under normal circumstances keeps body weight and body fat fairly close to a genetic set point.

This mechanism can easily cope with day-to-day fluctuations in eating habits, very quickly restoring the balance after a weekend of overindulgence or a day of semi-starvation.

It has been discovered that fat cells produce a hormone called leptin. Leptin seems to have two main effects. Together with other hormones it helps to regulate metabolic rate by speeding it up. It also seems to control appetite by acting as a suppressant. So when fat cells are exactly as full as they are genetically set to be, and therefore they are producing exactly the right amount of leptin, metabolic rate and appetite will be normal.

When the amount of fat in the fat cells increases they produce more leptin, which leads to an increase in metabolic rate, a decrease in appetite and, very quickly, a restoration of normal ie, genetically pre-set levels, of body fat. Conversely, when one loses a little weight, even after a day of not eating very much, the amount of fat in the fat cells decreases. They produce less leptin, which leads to a decrease in metabolic rate, an increase in appetite and, again, a return to normal.

It seems that this mechanism works well when we listen to our bodies and only eat when we feel hungry. However, it is not that easy. People have behavioural control over their eating habits and can easily over ride physiological signals; people eat for all sorts of reasons that have nothing to do with biological necessity.

When someone over eats over an extended period of time the body will continually overproduce leptin. Remember that its purpose is to decrease appetite and speed up metabolic rate; if the leptin is ignored then the body will soon stop responding to its signals and settle down at its new larger size.

What this means is that in order to restore normal/desirable body weight it is necessary to do far more than just eat less. We have to:

• Address any underlying psychological problems that led to eating becoming a comfort or control mechanism

• Re-establish healthy diet and lifestyle patterns that are sustainable for life


• Learn to listen to the body's natural signals and messages.

Seen as bullet points, it all looks easy, but of course it is not. it demands determination, commitment, help and support, both short and long term.

Many people with the desire to change are very unsure how to go about getting the help they need. It is very easy at this point to be swayed by magazines, advertisements or recommendations from friends about the latest wonder diet or product that will make the pounds drop off overnight with very little pain or effort. Nearly all diets are based on calorie restriction, no matter how they are dressed up, and indeed there is no mystique or magic.

As stated before, in order to lose weight, calorie expenditure must be greater than calorie input. The problem is that many diets advise quite extreme calorie restriction in order to guarantee short-term success and it is this 'too much, too soon’ approach that instead guarantees long-term failure.

The role of ghrelin

Recent studies have discovered ghrelin, a hormone product in the stomach that stimulates us to eat. If functioning normally ghrelin levels are high, therefore stimulating hunger (via the hypothalamus) and eating. After a meal, ghrelin levels fall, therefore the stimulus to eat is no longer there and you feel satisfied. Studies in the area of obesity treatment are continuing to investigate a possible link between ghrelin, satiety and obesity.

Fat loss case study

To examine the effects of low calorie diets let's consider the following case study:

Profile

• Female

• Age: 35yrs

• Height: 1.6m (5ft 4ins)

• Weight: 70kg (1 1st)

This 35 year old female wishes to ‘go on a diet’ to lose some weight. A magazine advises that a 1000kcal per day diet will lead to a weight loss of 6-8lbs in one week.

Step 1- Work out how many kcals she needs to meet her basic requirement using the Schofield calculation:

BMR = 8.3 x 70 + 846 = 1427kcals

Step 2 - Apply a PAL factor for activity 1427 x 1.4 (inactive) = 1998kcals

Total energy requirement for the day to sustain current weight at her current energy expenditure = l998kcals

Analysis of 1000kcal diet in relation to her needs:


• Suggested calorie intake is 50% of needs

• More importantly, intake is below BMR

• Body perceives this as starvation

• Body switches to survival mode

Physiological adaptation following the first few days of the diet

Survival mode is a fundamental physiological response to a life-threatening situation. It is designed to ensure, at all costs, the continuation of life. Several changes occur so that whatever energy is available will last longer and major organs (eg, the brain) will be protected. Remember that the brain can only utilise carbohydrate for energy and can only access the glycogen stored in the liver; it does not have any stores of its own. All of this would be utilised on the first day of the diet in addition to consumed calories. Any glycogen in muscle would also be used up.

Assume that this total amount of glycogen in both the muscle and liver amounts to a total of about 250g. Glycogen is stored in the body in a much hydrated form (3g of water for every ‘lg of glycogen) and this weight of water would be lost too.

Total weight loss =

250g glycogen + 3 x 250g water = 1,000g = 1kg (2.2lbs)

Because the body is not being given the number of calories it needs it slows everything down to try to manage, ie, the BMR drops; this can be by as much as 20% and can occur within 24hrs, although it usually takes a little longer.

Physiological adaptations to reduce the requirements of energy

Normal BMR calculation = 1427kcals

During times of low energy intake = 1427 - 20% = (1427 —-285) = 1142kcals

Producing energy via gluconeogenesis

Glucose can be made quite easily by the body, but only by starting with amino acids. When a dietary intake of protein is so low, the body will obtain the amino acids it needs by breaking down its own stores. These are held in skeletal muscle. Muscle protein is also bound up with lots of water; there are 4g of water for every 1g of protein. Even a small protein breakdown of 100g will mean a loss of lean body tissue amounting to five times this, ie, 500g or 1.1lb in weight.

Weight loss so far: lkg glycogen + 0.5kg lean tissue lost already in two days.

Total weight loss = l.5kg (3lb)

Even though weight loss on the scales shows a reduction of 1.5kg, the loss is from water, glycogen and lean muscle tissue.

What will happen if the diet continues?


The body cannot sustain the continued loss of these amounts of lean tissue (which is one of the reasons it slows everything down), but protein breakdown is fairly extensive in the early weeks of a low calorie diet, until the brain adapts to using other sources of energy rather than unavailable glucose.

Almost certainly, weight loss in the first week would be predominantly from lean body tissue, water, glycogen and some fat stores. Throughout this period, although fat stores are plentiful, they cannot be mobilised efficiently and used by the body through normal metabolic processes. There are several reasons for this:

Because fat is stored in a very dehydrated form you would need to create a calorie deficit of 500kcals a day every day for one week, or 3,500kcal per week, to lose 0.5kg (1 lb) of fat per week.

Remember that fat from body stores cannot make up the entire deficit created because a significant proportion of the calorie needs are for carbohydrate calories, not fat calories. Therefore, to lose just half a kilogram (one pound) of fat per week you would have to create a calorie deficit of around 750kcals per day; a restriction of intake that, as you have already seen, would take most people below their BMR and into physiological starvation. During starvation, the body will attempt to hold on to its reserves and would respond by:

• Inhibiting the activity of enzymes that release and burn fat

• Increasing the activity of fat storage

Remember that the efficiency of fat burning decreases when carbohydrate is not abundantly available.

Producing energy via ketosis

The brain demands a supply of glucose for efficient functioning and fuel. Ketosis can occur when individuals are following a low carbohydrate or low energy diet. When carbohydrate intakes are insufficient to maintain blood sugar levels and fuel the brain, ketone bodies are formed from the breakdown of stored fats.

Ketone bodies can mask natural appetite and stimulus for feeding, even though the brain is demanding carbohydrate. Ketone bodies are very acidic substances and produce abnormally acidic blood pH.

Ketosis can become harmful if ketone bodies become excessively high - ketoacidosis. Signs and symptoms of ketoacidosis are feeling of tiredness and fatigue, headaches, excessive thirst and increased urination. Late stage ketoacidosis presents the following symptoms: nausea, increased breathing rate, fruit smelling breath, fever and finally unconsciousness. If the diet continues to involve low intakes of carbohydrate and energy, the body will also revert to using lean muscle tissue as energy, as described above.

As the diet proceeds, weight loss per week will decrease, partly to protect vital lean tissue but also because of the physiological changes that occur as a result of starvation. It may well be that several weeks into the diet no further weight loss will occur. A plateau will have been reached which means that the body has learned to adapt to the new situation, albeit at the very high price of dramatically decreased efficiency and therefore potential health risks.


There are a few possible responses to this situation. One is to think that if weight loss has slowed down so much on l000kcals, then maybe dropping down to 750 will ’kick start’ everything again. This will create a new deficit and weight loss will indeed pick up. Once again the body will have to learn to adapt, as indeed it will. Fairly soon, weight loss will stop even on 750kcals per day. Now what? 500kcals? Then 300kcals, after the next round of adaptation?

Fortunately, when 'plateauing’ does occur, the most likely response is to start eating normally again. However, because of the dramatic increase in calorie intake, the body perceives it as a binge. Because of the physiological changes that occur during the dieting phase, what the body sees as extra calories will be very easily stored as fat. Unfortunately, the weight that was lost whilst dieting was a mixture of fat and lean muscle tissue. When the weight goes back on again (this can take from a few months to a few years) it will be as stored fat.

Yo-yo dieting

How would you feel if you had tried to lose weight, succeeded to some extent, though not as much as you wanted; but then, over the next several months, had put it all back on again, probably plus a little bit more?

Psychology of dieting

There are probably a few more words you could add to this list but they all add up to the same thing - extremely low self-esteem.

What would you do? Give yourself a good ‘pull yourself together’ talking to and determinedly embark on another diet? So begins the merry-go-round of yo-yo dieting.

The net result of all this is that several years down the line and several diets later, the dieter could well be two or three stone (15-20kg) heavier than they were when they started with 5-6% more body fat; although their perception is that they have always been on a diet.

It is this well-documented sequence of events which leads health professionals working in the field of weight management to estimate that 95% of all ‘diets’ (fad diets) simply do not work. Performance Training Academy 79

Yo-YoDieting

Negative feelings about self

Desire for better body

Negative feelings about self

Rigid dieting

Loss of control

Binge

Main points

• An overconsumption of calories results in fat call hypertrophy.

• Fat cell hyperplasia naturally occurs during the first growth periods in childhood and puberty.

• Fat cell hyperplasia also occurs when the cells become so full that they cannot take in any more fat.

• When following a very low calorie diet, weight loss in the first few days will be mainly from water, glycogen depletion and lean muscle tissue.

• Lean muscle tissue losses will continue if calorie intake continues to be low.

• A daily calorie intake that is less than the minimum daily requirements will result in physiological changes to cope with such a low intake. There will be a reduction in metabolic rate.

• The body will adapt to cope with a low energy intake.

• The bodys main priority is survival, and it will switch to mechanisms of survival such as gluconeogenesis and ketosis, in order to manufacture energy.

• To lose 1lb of body fat requires a deficit of 3500kcals per week.


Effective weight loss strategies

Objectives


• Identify the role of activity and exercise when devising effective weight loss strategies

• Understand that different activities provide an opportunity to expend varying amounts of energy

• Describe the benefits of cardiovascular training in a weight management programme

• Describe the benefits of resistance training in a weight management programme

• Identify guidelines for an effective weight management programme.


The role of activity and exercise

Success in achieving and maintaining a healthy body weight is very strongly associated with an active lifestyle in which consistent exercise plays a part. Although this may not come as a big surprise to people already involved in the fitness industry, it remains true that the vast majority of people do not take part in exercise and have very sedentary lifestyles. This course is concerned primarily with nutrition; therefore this is not an appropriate place for developing a detailed exercise prescription for fat loss.

Here are some simple guidelines that can be adopted by most people:

• Become more active on a daily basis to burn calories. Rather than just focusing on sport. exercise or the gym, focus instead on an active living approach, such as using stairs, walking or cycling to work, gardening, taking a walk in the park on Sunday, etc.

• Perform cardiovascular exercise on a regular basis to burn calories. The frequency, intensity, duration and type of exercise should suit the individual's fitness level and time available. Try to build to three sessions of vigorous cardiovascular exercise a week, of 20-30mins, as a minimum.

• Perform resistance exercises. Whilst these will not directly burn many calories, they will stimulate lean tissue (muscle) growth and maintenance better than any other type of training. The more lean tissue present, the higher the BMR, hence using up calories in the long term. This is especially important on a fat loss programme, because resistance training helps to keep lean skeletal muscle that might otherwise be lost. A general guide is to complete a whole body workout twice a week, performing 8-12 repetitions to reach overload on each exercise.

Individual lifestyles

Everyone follows different lifestyles, which have to be considered when devising weight loss plans. Occupation, activity levels and living environment will all have an influence on food intake. Take for example someone who is married with children, has a busy work schedule and very little time for food preparation. What would you have to consider for this person?

Consider and treat the cause of why people are overweight

Education and awareness are very powerful tools when devising weight loss strategies. Providing people with information on why they have become overweight allows them to understand what they have to do to reverse the trend of weight gain.

Include a balance of all food groups and nutrients

Eliminating whole food groups from the diet not only presents the possibility of deficiency, but also, by forbidding foods or labelling them as being ‘bad’, makes people want them more. Moderation and balance are crucial.

Activity and lifestyle


From the studies that have been carried out to date, it seems that success lies not in dieting but in bringing about a whole series of lifestyle changes. The move to a healthy (calorie adequate) diet is only one factor. In particular success in achieving and maintaining a healthy bodyweight is very strongly associated with an active lifestyle in which consistent, regular exercise/activity plays a big part.

Guidelines

Along with other research institutions, the American College of Sports Medicine (ACSM) carried out studies on how to increase participation in an exercise programme. Exercise prescription for improving fitness in all components has traditionally involved working out three times per week, ensuring that the heart rate is elevated to around 70-75% of maximum heart rate for a period of 20-30 minutes. The ACSM studies discovered that for most people, this simply represents too big a commitment in terms of time, effort and degree of change needed. Many who were following the standard exercise prescription and had been doing so for some time experienced no further improvements in fitness after initial gains. Neither had they achieved success in weight management, or in bringing about significant alterations to body shape or composition.

Several conclusions can be drawn from these studies:

• The intensity, duration and type of exercise must initially be within the boundaries that people believe are manageable within the constraints of their own lives.

• For long-term help in weight management, any exercise programme must be sustainable for life. It must address fat loss, not just weight loss, and attempt to enhance lean muscle tissue for a healthier body. This means exercise must become an integral part of that life and not an ‘add on’ chore to be endured a few times per week. Exercise must also not be seen as legitimising an unhealthy lifestyle the rest of the time; ’lt’s ok for me to eat what I like, drink alcohol whenever i want and put my feet up most of the time because l do three step classes a week.’ Three hours of exercise per week cannot compensate for a slothful lifestyle during the other 165 hours.

• For long-term success in achieving goals, any exercise programme must be progressive until those goals are achieved. This, of course, depends on the goals set being realistic ones. It means that some element of the programme must be made more demanding after a suitable time to keep on providing a challenge big enough to evoke beneficial adaptive changes.

In keeping with these findings, it is possible to arrive at some new guidelines that may help to encourage and motivate a lot more people to adopt a healthier lifestyle.

First of all, it is necessary to use far more user friendly words than ’exercise’ and ’prescription’. The idea of 'activity’ instead of ‘exercise’ seems to be far less threatening to people and encompasses a much wider scope of possibilities. ACSM research, as well as other studies, has discovered that significant gains in health-related fitness could be achieved by analysing current daily patterns of activity and finding a wide variety of ways to add to that activity.

This might include things like:

• Always taking the stairs instead of lifts and escalators •• Leaving the car at home for very short journeys (eg, a quick trip to the newsagents for the

morning papers) Performance Training Academy 83

•• Walking to work instead of using public transport. If this is not possible, getting off the bus a

stop or two earlier and walking the rest of the way •• With desk-bound jobs make sure lunch breaks are spent taking a walk in the park or around

the shops •• Take up an active leisure time hobby like dance classes •• Every time you do have to walk anywhere, no matter for how short a time, make it brisk.

This is by no means an exhaustive list. The range of possible activities is as extensive as the range of individual lifestyles.

ACSM's position stand on physical activity and weight loss (ACSM 2011)

The ACSM reports that 150-250 minutes of moderate intensity physical activity per week is associated with moderate weight loss (between 8-12kg in 12 weeks). Performing more than 250 minutes of moderate intensity physical activity per week is associated with clinically significant weight loss and will prevent regain of weight after weight loss.

Start active, stay active

To further highlight the importance of activity in conjunctions with healthy eating, the CMO (Chief Medical Officer) and DH (Department of Health) published a report named 'Start Active, Stay Active‘, which outlines the guidelines for physical activity for health, for the various age ranges. They are as follows:

• Under-fives - 180 minutes each day once the child is able to walk.

• Children and young people (5-18 year olds) - from 60 minutes and up to several hours even! day of moderate to vigorous intensity physical activity. Vigorous activity that strengthens muscles and bones should be included three days per week.

• Adults (19-64 year old) and older people (65+) - 150 mites each week of moderate to vigorous intensity physical activity (adults should do some physical activity every day). Muscle strengthening activity should also be included twice a week.

Energy expenditure from different activities

This extra activity will of course need extra energy in the form of calories and some of those calories will be provided by fat stored on the body. Even though these extra calories might not seem significant on a daily basis, burning just 100 more calories per day will lead to half a kilogram or one pound of fat loss every five weeks or in the long term, 4.5kg (10lbs) of fat per year. Suddenly, the very small amount of extra effort and the insignificant calorie deficit becomes significant.

The real benefit of these changes is that they are an integral part of day-to-day life. Within a very short time, they become automatic and therefore sustainable forever.


Although these lifestyle changes in daily activity would undoubtedly lead to improvements in both weight management and overall health-related fitness, the gains may be, for a lot of people, too little over too long a period. However, once a good base of enhanced activity has been established it is easier to place more structured exercise on top, so that greater gains can be achieved in a shorter time.

For relatively unfit people, the type of exercise needed to produce a calorie deficit at the end of the day is aerobic exercise, sustained for gradually increasing time periods. Remember that for untrained people the maximum amount of fat used for energy, even at exercise intensities within aerobic capacities, is probably around 40-50%, with the remainder coming from carbohydrate.

The key to maximising fat burning at these early stages is to control intensity at the optimal level so that the muscles work aerobically. For a variety of reasons, many class structures do not easily lend themselves to maintaining this level of consistent workload. It is easier to do so within classes specifically aimed at this fitness level, where the participants are all equally matched.

Because of the need for controllability at an individual level, cardiovascular gym equipment may be an extremely useful option and will also allow the opportunity for cross training. Because of the variety involved, motivation can be as good as that provided by an aerobics class. For individuals who are highly resistant to the idea of entering a gym, a progressive walking programme may be an option. It is also worth bearing in mind that these ideas are not exclusive. A combination of different exercise strategies may work very well.

Energy expenditure of different activities

Adapted from: Manore, M. and Thompson, J.L, (2002) Sports Nutrition for Health and Performance. Human Kinetics Europe Ltd.

Activity Kcal/min (based on a 65kg individual)

Leisurely cycling 6.5

Race cycling 13.0

Indoor stationary cycling (low/mod intensity) 6.0

Indoor stationary cycling (high intensity) 11.0

Weight lifting (low/mod intensity) 3.25

Power lifting 6.5

Hatha yoga 4.25

High intensity aerobics 7.5

Brisk walking 6.0

Light jogging 8.5

Running 10.5


Cardiovascular activity

There are few rules, only guidelines. Stay aerobic at as high an intensity as possible for as long as possible and, more importantly, maintain motivation, enthusiasm and commitment. It is very little use designing a programme that no one likes, even if it is very effective.

Aerobic exercise/activity is necessary for relatively unfit people in order to burn fat. However, for long-term improvements in fat burning, other strategies are necessary.

To enhance fat burning, several physiological and anatomical changes need to occur:

• The cardiovascular system needs to become more efficient at processing oxygen and supplying it to the working muscles.

• The amount of muscle tissue needs to be improved to increase work capacity so that higher intensities can be sustained for longer periods of time.

• The ability of the muscles to utilise oxygen to burn fat needs to be improved.

As fitness levels improve, it is important to include activities that are performed at a higher intensity. This will ensure that improvements in fitness levels are maintained and the net calorie loss at the end of the session will be higher. In turn, the calorie deficit and overall fat loss will be potentially greater.

For individuals of a lower fitness level, working at a higher fitness level can be introduced gradually by performing interval training. Interval training need not be at a ’sprint’ pace; it just has to be at a fast enough pace to move people out of their comfortable aerobic training zone. For example, introducing higher intensity work, such as, including short brisk uphill walks into a walking training programme.

A sustained programme of aerobic activity will improve VO2 max by increasing left ventricular stroke volume. For the second and third parts of the ‘fat attack’, individual muscles need to be targeted.

When designing a cardiovascular training programme for fat loss there is no one 'magic' programme. It is important to consider the fitness level of the individual and ensure the programme is progressive and varied.

Resistance training

To acquire greater amounts of the contractile proteins inside muscle, a strength training programme should be followed. This demands that each targeted muscle should be asked to lift a very high resistance and should reach overload in relatively few repetitions so that the contractile power of the muscle - its ’pulling power’ will be fully exhausted. One of the main misconceptions about strength training is that getting in to a gym and lifting any weights, as long as it feels quite difficult, will do the trick. However, the resistance needs to be sufficient to ensure that almost all of the motor units in the muscle are fully engaged so that there is no reserve.

A muscle that can always do everything it is asked to do, with a little left over, will have no incentive to get better. During the recovery phase from exhaustive exercise, muscle tissue will be broken down, then repaired and improved by the addition of just a little more of the contractile proteins. Performance Training Academy 86

It is important to reach overload quickly to avoid other fatigue mechanisms in the muscle, in particular, lactic acid build up, causing the muscle to stop working.

Another misconception concerning strength training, particularly with women, is that ’l’ll bulk up and look big and muscular if I start lifting weights’. The capacity of the female body to build muscle is very low compared to the male body because of the lack of the anabolic steroid hormone, testosterone. Amounts of new muscle acquired will certainly lead to a firmer, more toned body, without any possibility of looking muscle-bound. The real benefit is that even small increases in muscle tissue lead to large increases in work capacity and equally big increases in fat burning ability.

Strength training does, of course, demand high levels of body awareness and good technique to avoid injury and achieve maximum effectiveness; it is therefore a more advanced technique. Fortunately, in the early stages of an exercise programme, for some muscles, bodyweight alone may provide adequate overload. However, the human body will quickly adapt to these demands; after all, muscles are genetically designed to move the body through space and they should easily be able to reach that goal. For continued improvement; a resistance greater than body weight must be applied on a progressive basis. it is not enough just to improve muscle mass. Gains will predominantly be in fast twitch, type II muscle fibres. It is also important to improve the fat burning ability of muscles by encouraging physiological adaptations.

For increased fat burning, blood supply into the muscle via the capillary network needs to increase, the ability of the muscle to extract oxygen from the blood needs to improve, and the ability of muscle cells to carry out aerobic production of ATP needs to develop.

All of these adaptations can be achieved in response, once again, to resistance training. This time the ability of the muscle to contract repeatedly without the build-up of lactic acid is the goal. Aerobic metabolism generates carbon dioxide and water as its end products and exercise can thus be sustained for longer.

Paradoxically, in order for a muscle to get better at generating ATP without lactate build up, the muscle needs to be worked until exactly that happens. In other words, it is necessary to deliberately create lactate build up. In order to do that, relatively low or moderate resistance is needed for a sufficient number of repetitions to build up lactate to the point of fatigue (though not pain).

In the recovery phase of endurance exercise, the capillaries in the muscle multiply, the muscle cells make more myoglobin (the protein that transfers oxygen from haemoglobin into a muscle cell), and the number of mitochondria inside a muscle cell increase. Remember that it is only inside mitochondria that fat burning can take place. There are also biochemical alterations in the enzymes responsible for using fat for energy.

The net result is that the next time the muscle is asked to do the same number of repetitions less lactic acid will build up and it is possible do one or two more repetitions before fatigue sets in. In other words the endurance properties of the muscle have been improved.

Again, it is not enough to do a large number of repetitions of exercise, eg, 20 reps, and assume that these adaptations will occur. For endurance as well as for strength training overload must occur, although the mechanism of overload is different in each case.


Floor-based work in an aerobics class may be sufficient initially to cause overload, but quite quickly a point Will be reached where within the time and resource limitations of most class situations it may not be possible to achieve overload. increasing resistance above bodyweight is then necessary.

Resistance training has a few more major advantages. First is the process ie, the actual time spent doing it can be aerobic and therefore fat burning. Although muscles being strength trained do need rest, it is only the specific muscle being exercised that needs rest, not the body or the person. Secondly, another very important adaptation to resistance training is improved bone mass and protection from osteoporosis.

Given the importance of controlled cardiovascular work and resistance training in a weight/fat loss programme, getting used to a gym environment and becoming familiar with exercise equipment and techniques could help to break down barriers and establish a more holistic approach to exercise and activity for health and weight management.

Guidelines for effective weight management

• Be patient

• Make gradual changes to eating plans and lifestyle

• Eat a well-balanced diet

• Do not go hungry or skip meals

• Consider a variety of tools to measure progress, not just weighing scales

• Be prepared for obstacles

• Get active.

Any diet to reduce weight must provide fewer calories than needed, but at the same time not invoke a starvation response. Here are some guidelines for safe and effective weight loss:

• Keep a food diary (see the Client consultation’ section). This does take some time and effort, but it is essential to obtain an accurate picture of what is being eaten. Many overweight clients under report calories taken in.

• Set a realistic goal. A good guideline is 0.5kg of fat per week. This equates to a calorie deficit of about 3500kcal per week, or 500kcal per day. This is not enough to invoke any major starvation response. Whilst it is possible to lose weight much more quickly than this, it will not all be fat.

• Aim to achieve a 500kcal deficit by decreasing input (food) and increasing output (activity).

• Never consume fewer calories than your BMR, because this is guaranteed to create starvation mode.

• Trim out the ‘bad’ saturated and hydrogenated fats (butter, cream, mayonnaise, visible fat on meat etc.). This is a simple way to create a calorie deficit, whilst also working towards healthier eating.

• Eat little and often. The process of digestion and absorption in itself uses up calories. Also it helps to keep blood sugar levels and blood fats more constant, avoiding hunger.

• Choose low Gl carbohydrates. These help to improve appetite regulation, delaying hunger between meals. They also produce a smaller insulin response.


• Choose high fibre, low Gl carbohydrates. These tend to fill the stomach whilst being relatively low in calories for their bulk.

• Monitor progress effectively. Weighing scales do not give a complete and accurate picture; use tape measure readings and body fat percentage if possible.

• Increase activity and exercise. This is the other side of the energy balance equation, and its importance cannot be over stated.

Developing good eating habits and changing one's basic diet is the only way to achieve a healthy body weight in the long term.

Main points

• When designing effective weight management programmes pay careful consideration to individual lifestyles.

• Make realistic short and long-term goals.

• Include diet, lifestyle activities and exercise.

• Consider individual fitness levels when prescribing activity and exercise.

• Include both cardiovascular and resistance training in the programme.


Weight loss fads and popular diets

Objectives


• Discuss the impact of the diet industry on the health of the population

• Evaluate popular weight loss diets and other methods of weight control

• Discuss the advantages and disadvantages of these diets

• Describe the importance of communicating health risks associated with weight loss fads and popular diets.


The diet industry

Over the last 40-50 years the diet industry has grown with the promise of miracle weight loss solutions. When you consider the growth of the diet industry and the growth of the incidence of obesity, it is easy to see just how ineffective the diet industry has been in achieving what it promises.

What has been seen in the diet industry is the regurgitation of the same diet again and again under a different name. Take, for example, the high protein diet. This type of diet has been around since the 19705 with the introduction of the original Atkins diet. Over the years this type of eating plan has been introduced under different names, all following the same concept of limiting carbohydrate intake. Initially, these diets produce weight loss, but this has proven to be unsustainable.

Popular weight loss diets

Low carbohydrate/high protein diets

Dr. Atkins’ ‘New Diet Revolution’ is a well-known low carbohydrate diet.

In essence, the diet allows unlimited amounts of protein and fatty foods (including meats, eggs, cheese, cream, etc.) but severely cuts back on foods rich in carbohydrates. Dr. Atkins (himself a cardiologist) states that by following this diet, an individual can change their metabolism and lose weight quickly and easily. Too many carbohydrates, he says, causes over production of insulin, leading to increased hunger and weight gain. Carbohydrates are therefore severely limited in the diet, while protein and fat are allowed in unlimited amounts.

There is certainly some truth in what he says, and those who had previously tried an opposite diet (ie, low fat, high carbohydrate) without success found the Atkins diet highly effective and rated it as very easy to follow as there are no complicated meal plans. They enjoyed the fact that normally ’banned' foods were allowed.

Some research suggests that low carbohydrate diets could help certain individuals to maximise body fat loss. Insulin is a hormone that increases the activity of lipoprotein lipase, an enzyme that promotes fat storage in muscle and adipose tissue. Research has shown that there was nearly half as much insulin in the blood of a group of participants consuming a low carbohydrate diet compared to a high carbohydrate diet. Low carbohydrate/high protein diets may lead to reduced fasting insulin levels.

Low carbohydrate diets lead to a reduction in glycogen storage. Because glycogen is stored together with 3-4 times its weight in water, much of the rapid weight loss experienced may merely be fluid loss. The digestion of protein requires far more energy (dietary thermogenesis) than that of carbohydrates, so increasing energy expenditure and contributing to fat loss.

However, there are many questionable aspects of the diet when long-term healthy eating is considered. For example:

• The diet is deficient in certain vitamins and minerals (a supplement is now recommended).

• The diet is deficient in fibre.

• The diet is deficient in many antioxidant phytochemicals found in whole grains and fruit. Performance Training Academy 91

• The diet is very difficult to implement for a vegetarian.

• The diet can be high in saturated fat (although research in this area has found that this does not necessarily lead to an increase in cholesterol).

• If adopted universally, it would be impossible to feed large concentrated populations. People rely on carbohydrate cereal crops as a staple diet.

• The Atkins diet is not suitable for the regular exerciser. High carbohydrate diets have consistently been shown to be beneficial for athletes. For regular exercisers, ketosis (breakdown of fats because of too little carbohydrate) is a risk, together with muscle wasting, leading to a drop in BMR.

• Finally, it is worth mentioning that cutting out carbohydrates severely restricts the range of foods that may be eaten.

The Zone diet

The Zone diet meal plan is very specific, designed to include 40% of its calories from carbohydrates, 30% from protein and 30% from fat. it is therefore a high protein, low carbohydrate diet, although not as extreme as the Atkins diet. This is a mass-marketed diet with meal plans, based upon one’s gender, activity level and current percentage of body fat. All meals and snacks follow this calorie ratio, causing the body to work within its peak performance ‘zone’ for maximum energy and weight loss.

Adherents to the diet can purchase the pre-processed and packaged meals. The diet claims to change the body's insulin/glucagon ratio, which in turn promotes fat usage rather than storage. it also claims to increase eicosanoid production, which will dilate blood vessels and increase blood flow to muscles. However, research has found no evidence to back up either of these claims.

Blood group diet

This diet is based on the idea that each blood group (A, B, AB, and O) has a unique antigen marker, which reacts badly to certain kinds of food. it is therefore claimed that by following a diet based on your blood group, your digestion will improve and this will encourage weight loss.

Scientists have theorised that the different blood types evolved overtime. For example, they say: type O first appeared when man was a big meat-eating hunter; those with type A appeared when people began farming; and types B and AB descended from nomadic people who ate a bit of everything. Each individual has different levels of digestive enzymes and stomach acidities closely related to blood group. Each of the four blood types therefore has a list of foods that should, in theory, be avoided.

Despite the popularity of the diet, there is no evidence at all that blood group affects the foods people can eat, and whether those calories will be stored as fat. Instead, there is mounting genetic evidence that blood groups are strongly linked to natural immunity to endemic diseases such as malaria and cholera, not to food.

The diet is certainly an interesting idea. It is ’novel’ and ’different’ and therefore attractive to habitual dieters. But it has not been shown to affect body weight or fat deposition, unless of course, it is hypocalorific.


There are strict guidelines to be followed, such as what to eat/not to eat, and when. This regimented approach appeals to some. It is less practical, however, if one or more people in a household have different blood types, causing each of them to follow a very different diet. Finally, following the diet strictly leads to some foods being completely missed, which can result in nutrient deficiency.

Food combining diets

There are several diets based on this theme. The theory is that combining foods inappropriately means that they cannot be absorbed into the intestinal tract and that weight gain is a result of eating patterns not excess calorie intake. The main two food groups that should not be eaten together are starchy carbohydrates and proteins.

This is because starchy foods require lower stomach acidity for digestion compared to protein foods. Eating them separately at different meals allows full digestion; eating them together means only partial breakdown, poor absorption, and hence a number of health problems. Therefore, combinations such as steak and chips, spaghetti bolognese or a ham sandwich, are banned. Dairy products are often prohibited as well. Food combining makes it difficult to eat out.

There is no scientific evidence to support the validity of this dietary approach. Millions of people eat mixed meals all the time with no ill effect. Mixed meals are universally consumed in all cultures and at all socioeconomic levels.

Participants claim that food combining diets are very effective if followed closely, with weight loss noticeably occurring. However, this is more to do with restricted calorie intake, rather than maximising the body's digestive powers. Weight loss occurs rapidly due to the limits on food types allowed.

Most of the foods allowed are fruit and vegetables, the rest consisting of one or two servings of starch (such as rice or pasta) and minimal amounts of animal protein. Whilst eating more fruit and vegetables is widely encouraged by most health authorities, drastically restricting other food groups is not. Unfortunately, the diet is deficient in many nutrients including protein, calcium zinc and vitamins D and B12, and cannot be recommended for this reason.

Meal replacement

Meal replacement products usually come in the form of shakes or nutrition bars, which the person eats in place of a normal meal. They are usually full of all the necessary vitamins and minerals, proteins and carbohydrates, whilst being low in fat and low in calories (170-220kcal each). Hence they can aid in weight loss. One of the best known brands of meal replacements claim that their products are ‘an easy, nutritious, convenient, economical, great tasting, simple and flexible method for weight loss and weight maintenance’.

The basic plan uses two meal replacement shakes, three snacks and one sensible meal each day. This should result in weight loss of 0.5-1.0kg per week. The calorie intake is approximately 1200-1500kcal per day, and in addition, daily exercise of 30-60 minutes and lifestyle changes to promote long-lasting weight maintenance are encouraged.


Meal replacement products can be a useful approach to weight loss for some people. Their main strength is convenience: the dieter need only take two shakes or nutrition bars to work with them, and then cook a meal in the evening. They are assured of a reasonable micronutrient intake. There are several possible drawbacks:

• The products are expensive.

• Not everyone can tolerate the taste on a repetitive basis.

• The diet is very restricted in calories for anyone with a large build.

• Relying on highly processed shakes and nutrition bars does not promote long-term healthy eating.

Diet clubs

The primary feature of diet clubs is group support. People who are interested in losing weight meet on a regular basis to check on their progress. The diet itself is based on strict programming including a food plan, an activity plan and behaviour modification.

The food plan uses a points system, where every food is assigned a number of points based on its fat, fibre and calorie content. Each person is allowed a set number of points per day.

If exercise and activity is done then points are accrued on the other side of the balance, allowing the person to make quicker progress, or alternatively, to eat a little more on that day without any negative consequences. This approach has several advantages:

• Dietary advice is based on sound scientific principles of healthy eating and calorie restriction, rather than a fad.

• Many find the group support very helpful.

• Long-term weight loss is encouraged, rather than a quick fix.

• Exercise and activity is advocated.

• A wide variety of foods can be eaten.

• The dieter chooses what they eat themselves, so long as they stick to their allotted points.

• Dieters can ‘save’ points on some days and carry them over for a particular occasion, such as eating out.

Possible drawbacks are:

• Dieters may regress quickly without group support.

• Not everyone likes the atmosphere of a group, being weighed in front of other people, and cheered if they have lost some weight, and so on.

• Traditionally, diet clubs have been almost exclusively for women. This is changing as obesity in men is being recognised as a major problem, but it will take time to shed the all-female image.

Very low calorie diets


Very low-calorie diets are generally based on a daily energy intake of around 1000kcals per day. This low energy intake will result in fast weight loss as it is not enough energy to sustain most people's minimum requirements. Much of the weight loss will be from lean muscle tissue and water as seen from the weight loss case study.

In terms of health, no one should be following a diet that provides 1000kcals or less, unless they are under medical supervision, as they will definitely be omitting essential nutrients from their diet.

Why diets don't work

All of the above diets fail to consider one important factor; why people have put weight on in the first place. Most diets treat the effects of poor lifestyles and not the cause. Being ’on a diet’ suggests that at some point you are going to come off of it.

Evaluating diets

When evaluating diets consider the following:

• Do they take into consideration individual lifestyles?

• Do they set long-term plans for both diet and activity?

• Do they include exercise?

• Do they provide enough energy to meet minimum requirements?

• Do they include all the food groups?

If you can answer no to any of the above points, reject it as a balanced eating plan.

Over the counter weight loss pills

Because over the counter weight loss pills are easier to obtain than prescription only pharmaceuticals, they can pose additional risks for dieters, especially teenage dieters, who may be tempted to view these weight loss pills as the answer to their bad diet habits. Teenagers with weight problems should avoid these weight loss products; instead, they should focus on improving their diet and exercise habits.

Fat burners and fat burning weight loss supplements

When the word ’fat burner’ is used to describe a diet pill or weight loss supplement, the product may contain an amphetamine-like compound with potentially lethal effects on the central nervous system and heart. 'Fat burners’ or ’fat burning’ weight loss supplements do not burn or reduce fat in a healthy way.

Side effects of ‘fat burners’ may include:

• Rapid or irregular heartbeats (heart arrhythmias)

• Raised blood pressure


• Depression

• Nervousness

• Insomnia

• Heart attack or stroke.

The US Food and Drug Administration (FDA) continue to issue warnings to consumers of diet products and supplements containing these dangerous compounds.

Appetite suppressant chewing gum

Originally developed in the late 1990s, appetite suppressant diet chewing gum is usually sugar free and contains a chromium compound which, according to certain research, is an effective aid for weight loss and regulates fat deposition. This claim remains unproven. In fact, appetite suppressant diet gum includes artificial sweeteners which may slow down the digestive process and increase appetite. Such sweeteners may also increase a sweet tooth. Chewing stimulates the pancreas to make digestive enzymes and can increase feelings of hunger, which might lead people to eat more than needed. Whether or not chromium is linked to weight loss, appetite suppressant gum is not the answer to weight problems; successful weight loss requires long-term diet modification. Besides, appetite is a natural bodily function. It should be properly satisfied, not suppressed by chewing gum.

Eating disorders

Any discussion about weight loss would be incomplete without some reference to eating disorders. Occasionally people develop underlying psychological problems with their weight and body image and obsession with food can set in. It is important to have an awareness of these disorders and recognise the signs and symptoms of these in order to act accordingly.

This is a very sensitive subject and must be approached with caution. Never attempt to understand what the person is going through, unless you have been through it yourself, and don't be tempted provide quick fix solutions, as these are serious conditions that can prove to be fatal.

Eating disorders affect thousands of people and seem to be increasing over recent years. Many blame the pressure to be thin from the media as one of the main causes. This may be related, but it is still not clear exactly what the causes are. Psychological state is often considered a main trigger. Recently, social and cultural factors have been considered more important.

Eating disorders are more common in female athletes than male, and studies in the US have suggested that 62% of athletes suffer from some kind of disordered eating. Much emphasis in sport is placed on being the correct weight, aesthetic qualities and comparison to others, more than proper health and fitness. Studies have shown that many athletes have a higher level of body dissatisfaction, more disordered patterns of eating and greater preoccupation with body shape and weight, than the general population.

Characteristics associated with development of an eating disorder include being a perfectionist, being obsessive, being competitive and having high self~motivation. This is often true in anorexics who train obsessively, whilst eating little.


There are three main eating disorders, which are all serious, and should be dealt with by qualified professionals. These are:

• Disordered eating

• Anorexia nervosa

• Bulimia nervosa

Disordered eating

This is a relatively newly recognised condition where sufferers have unstable eating patterns and may fluctuate from very low calorie diets to bingeing. The binges are often only a regular meal but the person may feel guilty. Such people may have distorted body images and have a fear of gaining weight or getting fat. Weight is usually average or below average and food and exercise are preoccupations The effects are a reduction in energy, aerobic capacity and an increased risk of injury, as the body attempts to stabilise itself with the erratic eating.

Anorexia affects mainly females and typical sufferers are aged 15-25, well-educated and possess good nutritional knowledge. It affects men too, and is becoming more prevalent in all races, cultures and age groups. The following table highlights the major characteristics, warning signs and health consequences associated with anorexia:

Characteristics Warning sign Health consequences

Severe weight loss Extreme thinness Reduced physical performance

Self-induced starvation Extreme weight loss Decreased aerobic capacity

Obsessive fear of weight gain Claiming to be fat when thin Increased susceptibility to infection

Low self-esteem Eating very little Slow recovery from injury

Fear of fatness Great interest in food and calories Electrolyte imbalances

Distorted body image Arguments about food Amenorrhoea

Perfectionism Cold and bluish extremities Depression

Obsessive Anxiety about food Cardiac arrhythmias

High need for approval Restlessness Shrinkage of heart muscle

Social withdrawal Obsessive weighing Increased risk of bone loss and early osteoporosis

Obsessive exercise Sleeping very little Hypotension

Hypothermia

Gastrointestinal problems


Bulimia nervosa

This is characterised by recurrent bouts of binge eating, followed by self-induced vomiting, or exercising intensely to compensate for the food intake. In some cases, laxatives are taken to encourage purging. Sufferers usually have a normal weight. They are usually secretive about their behaviour because they feel guilty. Preoccupation with food and weight and a fear of becoming fat is also common. The following table highlights the major characteristics, warning signs and health consequences associated with bulimia.

Managing users with suspected eating disorders

Many fitness instructors and personal trainers will be working in health clubs; this means they have a duty of care towards the members using the facility. With reference to the ISRM information note no.352: Managing Users with Suspected Health Problems: Eating Disorders - ’If a member is clearly not well, club managers have a legal obligation to make sure they do everything in their power to ensure they minimise the potential damage they can cause themselves.’

There are numerous warning signs of an eating disorder (as outlined above); if suspected, it is the fitness instructor/personal trainer's responsibility to inform the club manager.

Health consequences of an eating disorder eg, cardiovascular complications, heart conditions and dehydration can be further exacerbated by exercise; therefore it is the club's (manager and staff) responsibility to ensure they do not do further damage to their health while exercising in their facility.

Characteristics Warning sign Health consequences

Bingeing large amounts of food (up to 5000kcal)

Tooth decay and enamel erosion

Menstrual irregularities

Guilt and remorse after bingeing Puffy face Enamel erosion and gum disease

Purging - vomiting or laxative abuse

Weight fluxuations Bowel problems

Starvation Frequent weighing Electrolyte imbalance

Low self-esteem Disappearing after meals to get rid of food

Dehydration

Impulsiveness Hiding food Cardiovascular complications

Anger and anxiety Secretive eating Depression

Body dissatisfaction and image distortion

Menstrual disturbances Hypotension

High needs for approval Gastrointestinal problems

Excessive exercise

Obsession with food and weight


What to do:

• Do not be afraid to approach someone you suspect has an eating disorder; it is for their own benefit.

• Do not use aggressive language.

• Do not try to make them see that they are too thin.

• Do not comment on their weight or appearance.

• Do reinforce their self-worth.

• Make it known that you are there to support them.

• Do not try to take on the role of therapist or counsellor; that is not your job.

• If the individual is in serious danger, it may be permissible to suspend their membership and only return it with a doctor's approval.

• Encourage them to contact their GP or the following organisation: www.anorexiabulimiacare.co.uk

If you are not qualified to deal with this issue, you may also find it useful to Contact the above organisation or the organisation referenced below.

Main points

• Fad diets do not work. This has been shown again and again as various types of diet have been around for many years and have had no effect on long-term weight loss for those who follow them.

• These diets generally follow a very low-calorie eating plan to achieve results.

• When evaluating diets investigate the research behind the theories.

• Use the points above to evaluate their effectiveness in relation to health.

• Weight loss is not always synonymous with fat loss.

• To lose 0.5kg/1 lb of body fat requires an energy deficit of 3500kcal.


http://www.anorexiabulimiacare.co.uk/

Nutrition for sport and exercise

Objectives


• Identify the three energy systems

• Explain the characteristics of each energy system

• Identify the muscle fibre types of each energy system

• Identify the fuels for each energy system

• List the waste products associated with each energy system

• Match the predominant energy system to examples of activities/sports

• Identify the need for eating a variety of foods for energy.


This section examines the role of nutrition in sporting and exercise performance. By examining the needs of active individuals and athletes you can develop strategies to meet the nutritional demands of these individuals.

Energy systems

It is widely acknowledged that nutrition has a profound effect on sports performance.

In essence. the same basic principles that promote health and well—being in the general population are equally appropriate for athletes. However, there are some specific recommendations for very active people and high performers that are vital to meet the energy demands of their sport.

Before we start to look at the input side of the equation, we need to look at output. What exactly does energy mean to a working muscle and what are the processes that take place inside a working muscle that lead to movement?

ATP - the energy currency

In order for muscles to contract, they need a supply of the chemical ATP - Adenosine Triphosphate. This is a very high energy compound and when it is broken down inside the muscle cell to a lower energy version (Adenosine Diphosphate or ADP), this releases energy. This enables the protein filaments (myosin and actin) inside the cell to slide over each other, bringing about the shortening or contraction of the whole muscle.

Unfortunately, because of its high energy status, ATP cannot be stored in muscle and needs to be made fresh, on demand, and in the right amounts. ADP and phosphate (P) can be stored inside muscle cells because of their relative stability and can join together to form ATP as long as there is fuel in the form of food to drive their synthesis.

Fuel

To fuel the production of ATP, the source can be either carbohydrate or a mixture of carbohydrate and fat under different conditions. Remember that protein is not usually used for energy except in fairly long endurance events or when following a very low calorie/carbohydrate diet.

In addition to a food source, there is another compound present in small amounts inside the muscle that can also be used to generate ATP. This compound is called creatine phosphate (CP). Although CP is not a food, the body must use energy from foods to synthesise it. Whether CP, fat, carbohydrate or protein is used depends on the duration and intensity of the exercise. in order to understand the nutritional requirements for exercise it is important to understand these relationships.

Creatine phosphate (CP)

Creatine phosphate is used to make ATP only under conditions that require 100% effort for very short periods of time, ie, less than 10 seconds. An Olympic athlete will use this energy system to run the 100m. Although most people have just enough CP to last for about five seconds of activity, the amount of stored CP can be enhanced by sprint training to last for up to 10 seconds. This system is often referred to as the phosphocreatine system (PC).


Fat and carbohydrate

Fat and carbohydrate used for ATP synthesis comes from stored food. Carbohydrate is stored in the form of glycogen - long branched chains of glucose - in the liver and muscles. Although there is a very small amount of fat inside a muscle cell, most of the fat used during exercise comes from fat stored all over the body underneath the skin and needs to be transported to muscles by the blood.

Carbohydrate and fat are rarely utilised alone. The relative ratio of use varies depending on the exercise. High intensity, anaerobic exercise of fairly short duration will predominantly rely on carbohydrate, as fat cannot be used in the absence of oxygen. However, aerobic exercise will use different mixtures of fat and carbohydrate depending on the intensity. As a rule, the higher the intensity, the lower the fat consumption, even if the exercise remains aerobic. This fact has significant implications for weight loss, or rather, fat loss programmes.

An important fact is that no matter how intense or aerobic the exercise, the human body cannot efficiently burn fat alone. Fat can only be utilised efficiently for energy alongside carbohydrates. Fat is utilised for energy in the absence of carbohydrates; this may occur during fasting, starvation, when on a low carbohydrate diet or when diabetes mellitus is poorly controlled. During this process, ketone bodies are produced. As ketone bodies accumulate above normal levels they produce a very unfavourable and acidic environment. This condition is known as ketosis. Prolonged ketosis can lead to ketoacidosis which results in an abnormally low blood pH.

Fat or carbohydrate?

For most people, even under steady state aerobic conditions, the ratio of fat to carbohydrate used will probably be about 50:50. This does improve with training, so fitter people will use proportionally more fat at any particular work rate compared to unfit people.

Consider the following:

Subject 1 - Low fitness level, inexperienced runner using a treadmill.

Subject 2 - High fitness level, experienced runner uses the treadmill as part of their training programme, in particular when performing interval training.

If you start both people off at a slow walking pace on the treadmill and gradually increase the pace to a light jog at the same rate, the fuel mix of subject 2 will result in a higher proportion of fat utilisation with the ability to spare the stores of carbohydrate. With subject 1, their ability to utilise fat will be less efficient and will use readily available carbohydrates very quickly.

When muscles are carrying the body around during the day outside of an exercising situation they will predominantly be using fat, but also a good deal of carbohydrate.

The efficient utilisation of fat depends on maintaining adequate glycogen stores, which in turn depends on maintaining an adequate daily intake of carbohydrate, as the ability to store carbohydrate is severely limited. In addition, exercise performance depends on carbohydrate availability, as this is the only fuel that can drive high level surges of activity.

Even during events traditionally considered as endurance, and therefore aerobic activities, the amount of time during which the anaerobic energy system is brought into play can be considerable. For example, breaking away from other athletes, maintaining pace whilst running uphill or sprinting for the finish line all depend on having enough glycogen reserves available. Performance Training Academy 102

Main points

• ATP is the high energy compound used to produce muscle contractions.

• It cannot be stored, and must be made on demand.

• Creatine phosphate, lactic acid and aerobic energy systems drive the production of ATP at different intensities.

• Creatine fuels the CP system.

• Glycogen stored in the muscles fuels the lactic acid system.

• Fats and carbohydrates fuel the aerobic system.

• Duration and intensity of activity determines which system predominates.

• Fitness level has an effect on how long these systems have the potential to last.

• Training can enhance these systems.

System Fuel Duration Intensity Considerations

CP or PC Creatine stored in muscle

Seconds Maximum The potential duration of this system is dependent on the individuals fitness level and training.

Lactic acid Glycogen stored in muscle

Minutes High to moderate As above. Through training it is possible to increase the capacity of this system. This enables individuals to work at a higher intensity for longer and extend the duration of this system.

Aerobic Predominantly fat with the assistance of carbohydrate

On-going Moderate to low Fitness level and effective fuelling will affect an individuals aerobic capacity.


Eating for energy

Objectives


• Explain how exercise intensity and duration may affect the fuel mixture

• Describe where carbohydrate and fat are stored on the body and in what quantities

• List ways in which an active person can ensure they maintain adequate levels of glycogen in their muscles

• Provide effective guidelines to ensure effective fuelling and refuelling for exercise.


Energy stores of the human body

In Contrast to carbohydrate, the body's capacity for fat storage is very high.

Stores of fat

Body weight = 60kg (female)

% body fat = 20%

Weight of fat = 12kg or 12,000g

Fat kcal 12,000 x 9 (9 kcals per gram of fat)

Total = 108,000kcals

Whilst it is difficult to give an exact figure for the number of calories used during any particular exercise situation, a normal, moderate intensity exercise class to music may use around 400kcals.

So there are plentiful fat stores available for exercise and for getting around during a busy day.

Stores of carbohydrate (glycogen)

The following figures represent the potential amount of glycogen a person could store if their nutritional status was adequate.

Liver stores = 60-100g (240-400kcals)

Muscle stores = 200-400g (800-1600kcals)

There are various factors that influence the amount of glycogen that can be stored in muscle. These include time of day, training, levels of lean muscle tissue and diet. Trained athletes will be more efficient at utilising and storing glycogen than untrained individuals. For the majority of untrained individuals, their total glycogen stores would reach approximately 1500kcals.

A total of l,500kcals would seem to be sufficient to cover all but the most arduous exercise situations. However, the true amount of available glycogen for muscle activity during the day is actually much lower than this. This is because the glycogen stores in each muscle cell is for the sole exclusive use of that muscle cell and it cannot be transferred to another cell.

Liver glycogen

The glycogen stores in the liver are not primarily intended for muscular use, but for maintaining blood glucose. Glucose is steadily released into the blood from the liver. The brain can extract this glucose which is its preferred energy source as it does not have the capacity to store its own supply.

Active muscles will pull glucose from the blood to use for energy when glycogen stores are depleted. However, this simply lowers blood glucose, making it much harder for the brain to get the supplies it needs.


As blood glucose levels fall, your brain stimulates you to feel hungry so that blood glucose levels can be replenished. Ignoring those hunger pangs means that both your brain and your muscles will not have enough energy to keep going. In order to get the precious glucose that you are not providing, your body has to make it. This manufacturing process takes place predominantly in the liver, and needs some starting material. Unfortunately, fats cannot provide this source of energy, although they can be used to produce ketones. Only amino acids can be converted to glucose. These amino acids would come from the breakdown of your own muscle protein; in other words you would cannibalise your own muscles.

If the body ever has to exercise when glycogen stores are low, the results will be lowered efficiency of fat burning, very poor sports performance and a breakdown of lean body tissue, ie, muscle. This process is called 'gluconeogenesis’.

How long can stores last?

During moderately hard activity, stores of muscle glycogen will last approximately 60-90 minutes; however, this will vary from individual to individual. During normal day-to-day activity, stores can last approximately four to five hours. Again, this will vary between individuals. Low blood sugar levels will stimulate hunger and produce the urge to eat.

There is a strong argument that if people wait until they feel hungry it might well be too late, ie, glycogen stores will already be depleted. Eating three meals a day with a large time gap between them is not really the way to ensure adequate glycogen stores. Another problem is that if you wait until you are very hungry, you could end up over-consuming calories of the wrong sort.

Eating large amounts at once could also mean that you will saturate the absorptive processes and the food will remain in your digestive system for a long time, making you feel full and sluggish. The secret of successful eating is to snack on small amounts of food at regular intervals, eg, every two hours or so. It is vital to make sure that these snacks are the right sort, ie, complex carbohydrates and low Gl.

Remember that 50% of the total calories in the diet should be carbohydrate. It is necessary, therefore, to work out the number of total calories needed over the day and ensure they are mostly consumed when the individual is at their most active.

Rules for fuelling and refuelling

Pre training

• Ensure you top up your carbohydrate stores every four to five hours.

• Eat small, regular meals to reflect your activity levels throughout the day.

• Aim to consume most of your kcal when you are more active.

• Do not go for long periods of time without eating; if you are very hungry you tend to consume the wrong type of food.

• Do not exercise on an empty stomach, eg, first thing in the morning.

• Aim to consume a light meal up to two hours prior to training or a larger meal two to four hours prior to training.

• Aim to consume low GI foods throughout the day to ensure a steady supply of carbohydrate energy.


• High Gl foods may be beneficial immediately prior to activity to provide an immediate supply of energy.

During activity

• If your activity/training session lasts more than 90 minutes ensure you consume carbohydrates during the session.

• Aim to consume approximately 20g of carbohydrates every 30 minutes.

Post activity

• After exercise consume enough carbohydrates to get your stores back up.

• Consume them as soon as possible after your training session has finished.

• The window of opportunity to refuel after exercise lasts up to 2 hours.

• Research suggests that 15 minutes post—exercise is the optimal time to refuel.

• Females aim to refuel with 40-50g of carbohydrates.

• Males aim to refuel with 60-80g of carbohydrates.

• Be realistic with the duration and intensity of the training session. If your session is low intensity and of short duration your refuelling requirements will be lower.

Main points

• Body fat is stored under the skin and is available in unlimited supplies.

• Glycogen is stored in the muscles and the liver and is available in limited supplies.

• To ensure efficient use of fat there has to be a supply of carbohydrates available.

• Stores of carbohydrate are dependent on training, diet, lean muscle tissue and time of day.

• At low intensity activity (day-to-day activity) glycogen stores potentially last four to five hours.

• At moderately high activity, stores have the potential to last 60-90 seconds.

• Follow guidelines on fuelling and refuelling to ensure stores are adequate.


Nutritional guidelines for active individuals

Objectives


• Identify specific nutritional needs for lean muscle tissue gains

• Outline the nutritional guidelines for active individuals

• Construct exercise and activity plans to meet specific activity goals.


Lean muscle tissue gains

Not everyone you will be working with will have a goal of weight loss. What about people whose goal is weight gain? When we say ‘weight gain’ we generally mean an increase in lean muscle tissue.

In order to increase levels of lean muscle tissue you must combine an effective strength training programme with optimum nutrition. It is essential that the volume of training is adequately supplemented with enough calories. An increase in training must be matched by an increased energy intake. If your energy intake is not enough to sustain the level of training, the result will be a loss in lean muscle tissue.

Weight gain at the start of a programme tends to be faster and then can lead to a plateau and a slowdown of any gains. To ensure continued gains are made, the programme must be progressive and specific to the individual’s needs. Achievable lean muscle tissue gains are approximately 0.5-1kg per month, if following an effective strength training programme.

As well as an effective training programme for weight gain, there are other physiological factors that will determine the amount of weight gain achievable. These are:

• Genetics

• Somatotype

• Hormone levels

Genetic makeup will determine muscle fibre physiology and body type, which will play a huge part in determining how the body will lay down lean muscle tissue. If someone’s genetics do not favour lean muscle tissue gains, all the training in the world will not reverse this.

The male sex hormone, testosterone, also has a huge part to play. Individuals who have naturally higher levels of this hormone will lay down more lean muscle tissue in response to training. This is why females will find it difficult to lay down lean muscle tissue even in response to strength training; they just don't have the genetic makeup.

Dietary consideration

An increased volume of training will require an increased energy intake. However, excess calories to your requirements will result in weight gain in the form of fat.

An increase of approximately 500kcals per day will allow for the increased needs for activity. It is important to ensure adequate carbohydrates are consumed to provide energy for training. if the volume of strength training is high, protein intake may need to be increased as a result.

Endurance training

Endurance training requires an increase in energy intake due to the volume of training being done. Individuals training for an endurance event, eg, a marathon or triathlon, must ensure their nutritional intake, especially carbohydrates, will provide the fuel required for training and recovery.


Guidelines for nutritional intake:

• Spread intake throughout the day.

• Aim to consume a light meal two hours before training or a large meal four hours before training.

• Refuel effectively after training. Aim to consume 1g of carbohydrates per kilogram of bodyweight.

• Prior to the event follow a carbohydrate loading programme.

The importance of carbohydrate intake

You have seen in the preceding section that carbohydrates are essential for performance in any exercise or sport. How can the active person make sure their intake is sufficient?

Eating only three meals 3 day. with a large time gap in between, is not the best way to ensure adequate glycogen stores; blood sugar levels will inevitably fall between meals, and glycogen replenishment will not be possible.

When glycogen stores are depleted, active muscles will use glucose from the blood for energy. This simply lowers blood glucose further, making it much harder for the brain to get the supplies it needs. This will lead to feelings of lethargy, light headedness, lack of concentration and psychological effects on mood such as depression and bad temper.

The body will respond to low blood sugar levels by causing feelings of hunger, prompting the person to eat. if they do not eat, the body will then set about making glucose in the liver. It does this by breaking down precious lean muscle to yield the amino acids necessary to make the glucose (this is a process known as gluconeogenesis).

Unfortunately, stored fats cannot be used to fuel this process. If the body ever has to exercise when glycogen stores are low, the results will be lowered efficiency of fat burning, very poor sports performance and a breakdown of lean muscle. This is the case when an individual decides to train early in the morning on an empty stomach. They are unlikely to be achieving the enhanced fat burning effect they desire.

The way to successful eating for sports performance, or even just getting through a very hectic day, is to eat smaller amounts of food at regular intervals (every two hours or so). Of course it is vital to make sure that each meal is well balanced, with the correct proportions of fats and proteins as well as being high in carbohydrates.

Remember that around 50% of total calories in the diet should be complex carbohydrates on a routine basis. Earlier, you explored how to calculate an individual’s energy requirements on a daily basis. Using that formula, the following table predicts approximately how many grams of carbohydrate should be eaten per day if the needs of exercise are to be met.


Use the table above to predict your own carbohydrate requirement or work it out based on the Schofield calculation. Use the food tables in the appendix in conjunction with your food diary, to estimate your actual daily intake. Do you find that you are eating sufficient quantities of carbohydrate? If not, what effect might it have on training, mood and general well-being?

For elite athletes there may well be times when the training schedule is so demanding that carbohydrate consumption at 70% of total calories may be advisable. Glycogen depletion can easily occur over several days of repeated training if adequate carbohydrate intake is not maintained. Under these circumstances, fat consumption should be dropped to 20% of total calories. This would be sustainable without detrimental effects for a few weeks or so. After this time, a normal fat intake would need to be resumed. Often, eating at these high levels of calorie and carbohydrate intake becomes very difficult to fit into a very busy life; eating becomes a time management problem as much as anything else. The athlete needs to utilise every spare slot in the time schedule to eat, following the principles of, little and often, wherever possible.

Usually, the beginning and end of most days are a good time to replenish stores. Breakfast should be seen by athletes and indeed by everybody, as a vital opportunity to stock up on vital carbohydrates.

When athletes are finding it difficult to physically eat enough food to get in the required nutrients, the use of a high carbohydrate supplement may be warranted. However, it is important to remember that supplements should never replace food, but just help out when needed.

Carbohydrate intake before, during and after exercise

One of the prime objectives for any athlete is the maintenance of glycogen stores. As previously discussed, this means eating a high-carbohydrate diet virtually all of the time. However, there are also certain guidelines to follow immediately before, during and after a training session or competition if performance is to be maximised.

Carbohydrate loading

Body weight (kg) Daily carbohydrate need (g)

50 284-340

55 293-351

60 302-363

65 312-373

70 321-385

75 330-396

80 339-407

85 349-418

90 358-430


Carbohydrate loading ensures muscle glycogen stores are efficiently topped up prior to an event to limit the effect of glycogen depletion and fatigue. In simple terms, carbohydrate loading involves the following:

• In the week running up to the event the volume of training should decrease

• During this period a high carbohydrate diet should still be consumed

• Aim to consume 7-12g of carbohydrate per kilogram of body weight

• The amount of carbohydrate to be consumed will depend on the duration of the event.

Example of a carbohydrate loading diet for a 70kg triathlete

Breakfast 3 portions cereal1 banana250mls juice

SnackMuffin and honey500ml sport drink

Lunch2 sandwiches (4 slices bread)200g yoghurt375ml soft drink

SnackSmoothieCereal bar

Dinner 1 portion pasta sauce 3 portions pasta 2 slices garlic bread2 glasses juice

Late snack

Muffin and jam 500ml sport drink

The carbohydrates consumed should be of a wide variety, with different digestion and absorption rates so there are no surges in blood glucose levels and there is a continual sustained release throughout the time period leading up to the event. Immediately before training or competing it may be beneficial to consume high GI carbohydrates that are more quickly absorbed. At other times this would not be advised because they might cause an over secretion of insulin, followed by low blood sugar (reactive hypoglycaemia).

However, as training approaches, the exercise hormones, adrenaline, noradrenaline and cortisol are released in the body. Their function is to release food from energy stores and to increase cardiac output. They also suppress insulin activity. It is possible to consume high GI carbohydrates, maybe


in the form of a drink, in the 15 minutes or so just before the start without danger of insulin over-response.

During exercise

For short duration events, intake of carbohydrate during exercise has a limited benefit on performance. However, for events lasting longer than 90 minutes, performance will be considerably enhanced if 25-30g of carbohydrate is taken in every 15-30 minutes (beginning at 90 minutes). High GI carbohydrates are recommended because blood sugar and glycogen are being used immediately. The obvious way to achieve carbohydrate intake during exercise is to combine it with fluid replenishment. Many energy drinks are now available on the market or they can be made at home quite simply.

After exercise

Timing here is all important. This is because the enzyme responsible for the synthesis of glycogen, glycogen synthetase, is at its most active immediately following exercise. Enzyme levels stay high for just a few hours and then gradually return to normal. Aim to replenish glycogen stores as soon as possible after exercise. For example 50g of carbohydrate can be consumed immediately, either as a drink (eg, 750ml of isotonic sports drink), or as a snack, such as dried fruit, rice cakes, etc. Then a larger meal can be eaten within the next two hours.

It is advantageous here to choose carbohydrate sources with a high Gl so that carbohydrate is delivered to the empty muscle and liver cells as quickly as possible.

Even with optimal replenishment techniques, glycogen stores are restocked at the rate of about 5-7% per hour. In the best of circumstances it will take 17-20 hours to re-establish glycogen stores after a bout of glycogen depleting exercise. This is why it is essential to continue with high carbohydrate eating, even on rest days.

Low carbohydrate diets therefore do not provide suitable carbohydrate levels for athletes. A diet low in carbohydrates aims to keep insulin levels as low as possible because frequent surges of insulin cause the body to convert food into fat rather than burning it off. (Glucagon, on the other hand, initiates fat and carbohydrate oxidation.) There is not enough evidence to support this because there is not going to be a big enough rise in glucagon levels to affect fat burning.

Common beliefs about nutrition and exercise

Strength trainers and extra protein

Whilst it is true that protein is responsible for laying down the basic building blocks of muscles, poor muscle building is unlikely to be due to any deficiency. A typical diet is more than adequate to supply needs. Since muscle itself only consists of 22% protein, to put on 4kg of muscle per year requires less than 1kg of protein ie, 2.4g extra per day. Remember that a strength trainer will be eating more total calories anyway, so a daily intake of 10-15% of those calories will automatically increase protein intake.

Protein supplements may be beneficial for athletes with a large build who are on heavy resistance training schedules. This makes protein requirements very high and difficult to meet from normal eating alone (eg, a strength training athlete weighing 100kg may require as much as 150-180g protein per day). Protein supplements may also be beneficial for athletes on a weight loss plan Performance Training Academy 113

(they seem to help conserve lean tissue), or for vegetarian athletes to account for the incomplete digestion of the plant sources of protein they consume.

Carbohydrates are the only fuel used for exercise

Fat is actually a major store of energy in the body and it is used mainly with carbohydrates in low intensity, longer duration exercise. At higher intensity and in anaerobic activities, carbohydrate in the form of glycogen will be used as the fuel since fat has low water solubility and cannot be metabolised quickly enough to keep up with the demand.

Through training, the body will become better at using fat as its energy source since the cause of fatigue or ‘hitting the wall’ is depleted glycogen stores. If both glycogen and fat stores are low, the body will call upon its protein stores to provide energy, hence diminishing protein stores in the muscles.

Hydration before, during and after training sessions or endurance events

To ensure peak performance it is essential to start completely hydrated. Sipping water throughout the day will ensure you maintain hydration levels. This may not sound practical for everyone but carrying a bottle of water, or having one sitting on your desk can prompt you to drink regularly.

Pre exercise or event

Aim to drink 500ml of water in the two hours leading up your session. This will allow for adequate hydration and urination.

During the event

To ensure adequate hydration, aim to drink 120-l80ml every 15 minutes. This is equivalent to a few gulps.

Post exercise or event

Aim to replace the fluid you have lost during the session plus half again to account for the thermal effect of exercise.

Main points

• Achievable lean muscle tissue gains are approximately 0.5-1kg per month, if following an effective strength training programme.

• An increased volume of training will require an increased energy intake. However, excess calories to your requirements will result in weight gain in the form of fat.

• Gluconeogenesis is the process whereby the body will manufacture glucose (from protein - muscle) when carbohydrate stores are depleted.

• Carbohydrate loading ensures muscle glycogen stores are efficiently topped up prior to an event to limit the effect of glycogen depletion and fatigue.


Dietary practices

Objectives


• Discuss how religious practices can influence nutritional intake

• Identify how increased availability of different foods and food outlets influence patterns of consumption

• Identify the impact of changes in family and working practices on nutritional behaviour.


This section examines social, cultural and religious influences to enable you to advise individuals on obtaining a healthy, balanced diet. It also looks at food labels. By examining food labels, food choices and methods of food preparation you will be more equipped to offer nutritional advice that considers these patterns of food consumption.

The impact of cultural, social and practices on dietary intake and advice

Many religions adopt specific dietary practices eg, abstinence, fasting, food restriction or rules on food preparation that will influence an individual’s food choice. Below are some examples and the dietary practices they follow.

Islam

Muslims only consume Halal meat (meat that has been slaughtered in a prescribed way according to lslamic practices). They do not consume pork and during the religious festival of Ramadan, they fast between sunrise and sunset.

Hindu

Hindus generally follow a vegetarian or vegan diet. A vegetarian is an individual who (for ethical, moral or other personal reasons) chooses not to eat meat, fish, poultry or animal products. Vegetarians do eat eggs and dairy products. A vegan follows a vegetarian diet and in addition does not eat dairy products and eggs.

Buddhist

Buddhists generally follow a vegetarian or vegan diet.

When offering dietary advice about healthy eating, these factors would have to be considered. it would involve considering the latest government nutritional guidelines and discussing what foods can be incorporated. Although fasting is not generally recommended for a prolonged period of time, if the religion dictates this, you can still offer advice on healthy eating during the times the fast can be broken.

Societal changes on eating habits

In our ever changing and developing society, dietary practices have changed due to many influences. These changes have not all been for the best in terms of the effect they have on health.

Family

There are a higher percentage of families where both parents are working. This has an impact on the type of food consumed and patterns of food consumption within the family. More families are now resorting to convenience foods, which can be high in fat and refined sugars and of low nutrient density, as time for food preparation is limited.

Families are spending less time eating together. Members of the same family will 'grab something quick’ and eat in front of the television. As a result, parents have less control over the quantity and quality of food their children are eating and the food tends to be of low nutritive value.


A television or computer provides a distraction when eating, therefore it is easier to over-consume food as they are not thinking about what they are eating.

Food availability

If you walk down any high street you will notice a high proportion of fast food outlets. This presents individuals with a quick, tasty, although not necessarily nutritious, option. When faced with such an abundance of choice, it is very tempting to go for the quick and easy option. School kids may opt for fast food as they walk home from school or at lunchtime. It can also be very tempting for people who have just finished work and don't have the time or the inclination to cook a meal from scratch.

Supermarkets continually offer deals to encourage people to purchase the ‘large’ size of a product. it may look like value for money but in reality do they need it? Or are they just going to consume more food than they actually need? As Britain and many other societies around the world battle with the ’obesity epidemic’ it is clear that changing dietary practices have a major impact.

Main points

• Many religions adopt specific dietary practices eg, abstinence, fasting, food restriction or rules on food preparation, which will influence an individual’s food choice.

• In our ever-changing and developing society, dietary practices have changed due to many influences. These changes have not all been for the best in terms of how they affect health.


Reading food labels and recipe modification

Objectives


• Interpret and understand the relevance of information given on a food label

• Discuss food label claims in the context of healthy eating

• Discuss the advantages and disadvantages of the above in providing consumers with clear information and guidelines, which will help them achieve a healthy, balanced diet

• Calculate the percentage of calories in a food coming from fat, protein and carbohydrates

• Demonstrate an ability to make informed choices when eating out or shopping and cooking at home

• Identify and define organically produced food.


What the label tells you

EU Food Information for Consumers Regulation (FIR) 2011 provides EU rules on general and nutrition labelling. These regulations replace current UK law. Most requirements do not apply until 2014 and nutrition labelling will become mandatory by 2016. The Food information for Consumer Regulation (FIR), designed to make food labelling easier to understand for consumers, has been published by the European Union.

The main points of the regulations are as follows:

• Country of origin - subject to further discussion, the introduction of mandatory origin information for most fresh and frozen meat. For example, it will be possible for ‘Scotland’, ‘England’, ‘Wales’ and ‘Northern Ireland‘ to be used on food labels, without mentioning ‘UK’ under new provenance rules. Also, the origin of main ingredients will have to be given if different from where the final product is made.

• Nutrition labelling will be required for most foods. Simplified information may be provided voluntarily on the front of the pack.

• Labelling clarity - a minimum font size has been set for all mandatory information on most food labels.

• Allergen information will have to be provided on all food (whether sold pre-packed or loose). For pre-packed foods, the allergens will have to be highlighted on the ingredient list.

• Drinks with high caffeine content will have to be additionally labelled as ’not recommended for children, or pregnant and breastfeeding women’, with the actual caffeine content quoted.

• Meat and fish products that look like a cut, joint or slice and contain more than 5% added water will have to show this in the name of the food.

• The types of vegetable oil used in food, such as palm oil, must be stated.

The EU has also agreed:

• to make it easier for alcoholic drinks companies to voluntarily include calorie information on product labels

• to enable voluntary provision of calorie information in out-of-home settings

• to continue to permit selling by numbers - such as a dozen bread rolls or eggs.

In 2004 the genetically modified (GM) labelling rules came into force. The presence of foods of genetically modified organisms (GMOs) or ingredients produced from GMOs must be indicated on the label eg, bread made from GM flour. Foods produced using GM technology, eg, cheese produced using GM enzymes or meat milk or eggs from animals fed on GM animal feed, need not be labelled.

Traffic light labelling

Many food manufacturers and supermarkets have adopted the traffic light labelling system. This system is devised to offer consumers a simple, visual representation of the proportions of nutrients in a food product.


Red = high

Amber = medium

Green = Low

It is designed to help consumers make healthier food choices when shopping. Everyone knows they should be cutting down on fats, especially saturated fats; if at a glance you see on the food label that the fat content is labelled ‘green’ you know it is low in fat. It is important to note that foods that appear red under the traffic light system do not have to be avoided completely; they can still be included in moderation.

This system may cause confusion with some foods, eg, nuts and fruitjuice. Nuts would be labelled red for fat as they are very high in fat. As mentioned above, it is not necessary to ‘avoid all foods high in fat’, just be aware of how much you are consuming. It is not advisable to eat a large bag of nuts in one day because ‘they are good for you’; they are still very high in energy and should only be consumed in small amounts. Fruit juice is another example; you should not consume a whole carton of fruit juice as it is very high in sugar, but it is good in small amounts.

Trans fatty acids

These are usually ‘healthier’ vegetable or fish oils that have been artificially hardened by hydrogenation. Trans fats are just as bad if not worse than saturated fats. They increase LDL cholesterol and lower HDL cholesterol. They are often found in cakes, biscuits, pastries and margarines. For years margarines were considered healthier than butter until it was discovered that hydrogenation actually changes the chemical structure of the vegetable oils and makes them just as bad for health as butter. It is important to read the labels and look for hydrogenated oils. However, by a strange quirk of the law, it is not a legal requirement to declare how many trans fatty acids are in a food unless a ‘low in trans fatty acids’ claim is made on the packaging. Trans fats are widely used by food manufactures because they are cheap to produce and have a long shelf life.

Organic

Foods stated to be ’organic' must be grown/produced in accordance with EU laws on organic production. These laws require food sold as ’organic' to come from growers, processors and importers who are registered and approved by organic certification bodies, which are in turn registered by the Department for Environment, Food and Rural Affairs (DEFRA) or a similar control body elsewhere in the EU.

Labels on food sold as ‘organic’ must indicate the organic certification body that the processor or packer is registered with, eg, the Soil Association. The labels must, at the minimum, include a code number that denotes the approved inspection body. The name or trademark (logo) of the certification body may also be shown.

It is not always possible to make products entirely from organic ingredients, since not all ingredients are available in organic form. Manufacturers of organic food are permitted to use specific non-organic ingredients provided that organic ingredients make up at least 95% of the food.


If the product contains between 70% and 95% organic ingredients, organic ingredients can be mentioned only in the ingredients list, and a clear statement must be given on the front of the label showing the total percentage of the ingredients that are organic.

Nutritional claims - fat and sugar

EU legislation on nutrition and health claims made on food (2006) specifies that health claims should only be made after a scientific assessment of the highest possible standard is carried out by the European Food Safety Authority (EFSA). Health claims are a way of providing health or functional benefits to the consumer in order that they can make informed choices in a healthy diet. Health claims should be fully substantiated and should not mislead the consumer.

Keep in mind that claims on food labels are often deceiving and hard to understand unless you know what you are looking for. Therefore, it is important that you are able to read food labels. Knowing the fat percentage allows you to determine which foods are truly low in fat. Low fat foods are below 30% fat and can be eaten routinely. Medium fat foods are between 30-40% and should be eaten somewhat less frequently. High fat foods are anything over 45%. You don't have to eliminate high fat foods from your diet Just eat them less often than the lower fat foods.

How to work out the percentage of calories from fat

Look at the nutrient label:

Multiply the grams of fat by 9 (9kcal per gram) to get the amount in calories:

3 x 9kcal = 27kcal

Divide this number by the number of calories per serving / 100grams:

27 divided by 70 = .385

Multiply this number by 100 to get the percentage = 38.5%

Don't assume that ‘reduced fat’ or other such products are always the best choice. Often the regular brands are lower in fat. You can use this information to make a decision about a product. You may want to compare it with another brand to see if it is lower or higher in fat. However, just because this food is almost 39% fat doesn't mean that you have to eliminate it from your diet. Remember you are merely trying to keep your daily/weekly average of 30% fat.

Energy 291Kj/70kcal

Protein 3g

Carbohydrate 8g

Fat 3g


The ingredients list

The ingredients list provides information on what the product contains. The ingredients appear in descending order of weight; therefore you can identify the ingredients of the highest proportions.

Recipe modification

If reducing the fat content of your diet is your aim, here are some practical suggestions on reducing the fat content of meals. The ingredients and methods used to cook food have a direct impact on the fat content of the final product. To keep the fat content low it is important to use low fat cooking methods such as baking, grilling, microwaving and steaming as much as possible. The following are some healthier alternative options:

• Roasted potatoes can be prepared to be low in fat by first pre-boiling cut potatoes until partially done. Next, put them in a bowl and drizzle a teaspoon or two of oil over the top. Mix so that all potatoes are coated lightly with oil. Place in a pan that has just -been wiped with oil. Cook on the top shelf of a very hot oven. Oven chips can also be made in this way.

• If the recipe calls for sauteing, try sautéing in broth, wine or water rather than oil. Alternatively, put oil in a spray bottle and dispense it that way, use no more than ltsp of Oil in the Pan, or use a non-stick spray on the pan.

• Steam vegetables or cook in a microwave without fat.

• If the recipe calls for whole eggs or egg yolks, substitute 1‘/2 egg whites for each whole egg.

• If the recipe calls for butter, lard or shortening, use vegetable margarine.

• If baking a cake try replacing half or all of the fat with a pureed fruit such as stewed prunes or applesauce. If you do this you can also decrease the sugar used.

• If the recipe calls for whole milk or cream, use canned evaporated, skimmed or low fat milk.

• If the recipe calls for sour cream or double cream use plain low fat yoghurt.

• If it is to be heated, mix in one tablespoon of flour for each 240g used, to avoid separation.

• If the recipe calls for cream cheese use half the amount called for or substitute it for a lower fat cheese. Try ‘quark’ cheese instead of cream cheese.

• If the recipe calls for nuts, use sparingly - limit to 1/4 or 1/2 cup per person.

• If the recipe calls for mayonnaise try using half the amount called for or less.

• If the recipe calls for flour, substitute half as whole wheat (wholemeal) flour. NB: this is not recommended in delicate items such as sponges.

• If the recipe calls for salt, use half the amount called for or less.

• If the recipe calls for sugar, try using 1/4 or 1/2 the amount called for.

• If making gravy or soups, refrigerate the stock and skim the fat off the top. Use stock cubes and thicken with flour or cornflour.

• If making a white sauce, thicken skimmed milk with cornflour instead of margarine and flour.


Eating out

An increasing number of meals and snacks are eaten outside the home. in today's society most people have to ‘eat on the run’ at some point or another. It is therefore important to understand how to make healthy choices when dining out.

Although it's ideal to try and follow the principle of healthy eating while out, remember it is not unacceptable to make a high fat food selection once in a while. First, consider the reason for eating out. ls this a one-off occasion such as an anniversary or birthday or just a quick snack? Although a special occasion it should not signal that it's time to 'pig out’, it is important to keep things in perspective. Remember eating is often a very sociable event and this shouldn't be compromised in order to eat healthily. When eating a balanced, low fat diet the majority of the time, there is still room for the luxuries such as a big meal out.

Fast food and take away facts

• Burgers tend to be lower in fat than deep fried chicken/fish sandwiches.

• Order burgers without special sauces and mayonnaise.

• Adding cheese to sandwiches/salads increases the fat content significantly.

• Try a side salad instead of chips.

• Vegetarian pizza (without cheese) can be a good choice.

• Salad bars may not be a good choice as they are full of mayonnaise, salad dressings and lots of cheese.

• Fish and chips are probably among the highest fat food choices.

• At Chinese restaurants avoid deep fried items such as spring rolls, fried noodles, crispy meats. sweet and sour items, etc. duck, goose and other poultry with skin are all high in fat, as are foods made with nuts. Try ordering boiled rather than fried options.

• At Indian restaurants avoid items described as korma, creamy sauces, coconut, fried or dipped in batter. Items such as tikka tandoori, pilau rice and naan bread without butter on it are lower fat choices.

Main points

• EU Food information for Consumers Regulation (FIR) 2011 provides EU rules on general and nutrition labelling.

• The traffic light system is devised to offer consumers a simple, visual representation of the proportions of nutrients in a food product.

• Health claims are a way of informing the consumer of health or functional benefits in order that they can make informed choices in a healthy diet. Health claims should be fully substantiated and not mislead the consumer.

• By using the example calculation you can determine the percentage of energy contributed by fats, carbohydrates and protein.

• The ingredients list on food packaging presents ingredients in descending order of weight. Performance Training Academy 123

• It is not essential to eliminate high fat foods from the diet. As long as they are included with a balance of low-fat, high-carbohydrate foods.

• Trans fats can appear on labels as 'hydrogenated vegetable oils’.

• Processed and fast foods may contain high proportions of fat, simple sugars and salt to add flavour.

• Fast and processed foods should be kept to a minimum in the diet as their nutritive value may be low.


Client consultation

Objectives


• List the benefits of carrying out an initial client consultation

• Describe the information that needs to be collected when offering nutritional advice to clients

• Explain the legal and ethical implications of collecting nutritional information

• Describe different formats for collecting and presenting information

• List the advantages and disadvantages of the above methods

• Describe the different stages in the prochaska and diclemente model for change

• Suggest ways to move a client forwards onto the next stage in the model for change

• Develop 'smart’ nutrition and exercise goals

• Analyse information contained in a food diary

• Explain how to translate nutritional goals into basic healthy eating advice that reflects current nutritional guidelines

• Demonstrate the use of credible sources of information when providing healthy eating advice

• Identify potential barriers to achieving goals and suggest suitable motivational strategies to overcome those barriers

• Choose appropriate methods to measure progress towards goals

• Explain the need for reappraisal of a client's body composition and other relevant health parameters at agreed stages of the programme.


This section examines the process of client consultation which includes: gathering information, assessing client's readiness to change, goal setting, analysing information, developing nutrition and exercise/activity programmes, measuring progress, identifying barriers and developing strategies for success.

Benefits of a client consultation

There are a number of good reasons for carrying out consultations with clients prior to advising any changes to their nutrition or lifestyle. Often it is the best chance you will get to make a good first impression and establish a good working relationship with them in a neutral environment. It is also a great opportunity to ’sell’ yourself and the merits of having a healthier lifestyle.

Some of the benefits of the consultation include:

• Building rapport with your client to put them at ease and gain their trust

• Making the client feel more valued as a customer

• Finding out about their lifestyle, which can give you a better idea about what interests they have, time constraints or barriers

• Giving an insight into their current health and fitness levels and identify areas for improvement

• Finding out what they would like to achieve from a new healthier lifestyle, and give you a chance to promote the benefits to them

• Allaying any fears or worries regarding a change to their lifestyle and answering any questions

• Agreeing a plan of action, including coming to an agreement about times, costs, the expected effects and what changes they will have to make to achieve their goals

• Identifying any clients who may need medical clearance to participate in a new nutrition programme

• Assessing the client's readiness to change and helping them set ‘smart’ goals.

The consultation will also be a chance to set a benchmark that you can reassess at regular intervals to see how their goals have changed, how they have improved or progressed since the first assessment and deal with any problems they may have encountered.

Fitness instructors and personal trainers should establish and maintain proper standards of ethical and professional conduct when providing services to clients. Information gathered during any consultation is strictly confidential, and clients should be informed of this fact. It is unprofessional to discuss any client details with a colleague. If it is necessary to divulge information to a third person, such as a medical professional, then permission from the client must be sought first.

Information gathered should be recorded. Any nutrition adviser who consults with many clients will develop standard forms for this purpose. These should be kept safely in a locked filing cabinet. Any electronic files should be password protected, and practitioners should register with the appropriate authority to conform to the Data Protection Act.


Gathering information

During the consultation(s) it is essential that you gather enough relevant information in order to build a profile of your client's current state and understand what they want to achieve.

Collecting information such as gender, age, weight, height, health status occupation lifestyle including hobbies and pastimes, etc. will give you a profile of your client and a basis to work out their current activity levels and calorific requirements. Food diaries will provide information on their current dietary habits.

Assessing readiness for change

Stages of change model

Changing any behaviour, whether it is giving up smoking, changing eating habits, beginning to exercise or handling stress, is difficult and requires a great deal of determination, commitment and effort. Whether you want to change yourself or help others to change, it can be very useful to gain insight into how change actually happens.

Prochaska and DiClemente (1983) studied huge numbers of people going through the change process. These included those who were giving up smoking, drinking, drugs, trying to lose weight, etc. They began to see a general pattern emerge and decided that there were some definite stages of change that everybody goes through when trying to alter their behaviour. They then designed a ’Stages of change model’ also referred to as the ’Transtheoretical model of change’.

They suggest that there are seven stages of change: pre-contemplation, contemplation, preparation, action, maintenance, relapse and termination. It is possible that you will encounter clients at any of the stages of change model but it is most likely to be in the contemplation or preparation stage.

The instructor’s objective is to assist clients through the change process.

Pre-contemplation

At this stage people are not seriously considering the possibility of change. This may be because they are unaware of the problem or because they cannot confront it. These people are unlikely to seek any help or advice. They may be ignorant of their situation or have their ’head in the sand’. If they are taking action, it will be because of the persuasion of others. People who have had many attempts before may also just see it as pointless.

Pre-contemplation also includes people who view admitting to a problem as a weakness which would threaten their self-confidence. An example of a person in this stage may be someone who is overweight but does not have any real desire to reduce his or her body fat.

Strategies - appropriate interventions:

• Education via media • Raise general awareness • Raise the issue • Encourage the client to contemplate the change for themselves.


The instructor must be neutral in the provision of information. Any attempt to get the client to change will be seen as a threat to their freedom. The goal is to get them onto the next stage, not into complete change.

Contemplation

This is the stage where people become aware of or acknowledge the existence of a problem. They are seriously considering the possibility of change but need to weigh up the pros and cons as to whether they take any action or not. Most people get stuck at this stage in terms of weight loss. Although they may feel that they would like to change their body composition they often feel that there are a lot of barriers in their way, eg, they have to eat out a lot because of work, or they feel that it would be too difficult as the rest of their family would not want to change their eating habits. Many people remain in this stage of contemplation for years. You may be able to think of a few people you know who are always talking about making a change but never actually get round to it.

Although it may be tempting, one of the worst things you can do as a fitness professional is to try to persuade the individual to change by telling them all the reasons why they should. This will either totally ’turn that person off’ the idea of change as they naturally feel that they should resist the pressure that you are putting on them, or they will say that they are willing to change when they really are not. This often leads to the scenario where you feel like you are pulling teeth every time you deal with that client. You cannot make anyone change unless they whole heartedly want to. Therefore, the best course of action when dealing with a person who is clearly in contemplation is to allow them to use you as a sounding board.

You may want to ask open questions to encourage them to talk about all the pros and cons of making that change. Often, the client finds that by hearing themselves vocalise their indecision they are able to decide on the way forward.


• Build client confidence in their ability to make a change. • Encourage them to think about the pros and cons of changing and the implications of staying

in their current situation.

The instructor should assist the client in carefully tipping the balance in favour of change, not forgetting to show the positive results it could bring.

Preparation

Prochaska and DiClemente state that most people in this stage will make a change within the next three months. However, they are still in the decision»making process and don’t like to be hurried into action. They have progressed from the contemplation stage by finding out what steps they will need to take to start the change process. This stage may involve finding out about local weight management groups, reading up on nutrition, or buying a diet book.


• Develop the client's skills to help them change. • Help them set ’SMART' goals. Performance Training Academy 128

The role of the instructor is to help the client explore the options for change and to choose the best course of action. Try to strengthen their commitment and confidence for change and develop a SMART plan - Specific, Measureable, Achievable, Realistic and Time-framed. Try to help the client build their self-efficacy.

Action

This is the stage when people actually start to make changes. These changes could be any form of coping that will result in a long-term change in behaviour. Examples could be trying new recipes. recording eating habits in a journal or buying different types of food on the weekly shopping trip.


• Help the client to reassess their goals regularly and keep their plan on track. • Give encouragement. • Help the client learn to cope with difficult situations or potential problems. • Help them to maintain a positive environment and possibly help them to build a ‘support

network’ of friends and family.

The emphasis now shifts towards the behavioural processes of keeping the client on track. The client needs lots of reassurance about their decision to change to increase their self-efficacy; they may be looking for quick results and may become disappointed.

Stimulus control involves changing the environment to reduce the number of prompts to return to the old behaviour.

Counter-conditioning is learning to respond differently to the stimulus eg, have plans in place such as deciding to eat at a specific restaurant, practicing relaxation techniques when stressed rather than reaching for something to eat or varying the exercise routine when it becomes boring.

Reinforcement management aims to increase the frequency of the desired behaviour as a result of increasing positive experiences and limiting negative experiences. This would include the client seeing progress, positive comments from others and praise from the personal trainer.

Maintenance

This is the stage where people attempt to continue with or sustain the progress that they achieved during the action stage. People in maintenance are often very anxious about avoiding slips or relapses to less desirable behaviour. These people may have a heightened awareness of their eating habits. They may still have to think carefully about choosing the foods that they eat.

Individuals are likely to stay in maintenance for 6-12 months and then relapse or hopefully maintain a stable, safer lifestyle. They may be happy to remain here and not pursue any further challenges. Pressure to pursue further challenges may decrease the client's likelihood of adherence. If the client wishes to progress, then support this and help to set appropriate goals.


• Help the client to see warning signs and prevent relapse before it happens. Performance Training Academy 129

• Re-evaluate and set new goals. • Review positive aspects of new behaviour. • Help the client to recognise high risk situations that may threaten their chances of reaching a

stable, safer lifestyle and make changes accordingly.

Relapse

This is when people revert back to their previous behaviour or fail to stick to their plan of action. This can happen for any number of reasons.

As fitness professionals, it is important to be aware that people rarely change their behaviourj ust because they know that they should. Other factors come into the equation that usually causes the individual to fall back into old habits; this is a relapse in the change process. For example, a person who is attempting to eat healthily may find that on their birthday or at the weekends their eating habits take a nosedive. It is important that they allow for these relapses and pick themselves up and start again instead of throwing their hands up in the air and shouting 'l've failed’. in fact, if people acknowledge that these relapses will occur, and that they are vital to any successful change process, then they are much more likely to eventually succeed.

Although it is important to try to avoid relapsing into old behaviour, it should be emphasised that you can learn a great deal about how to permanently change a client's behaviour from their relapses. This is done by asking why the person relapsed in the first place. For example, a client may report eating and drinking far too much on Saturday night. It would then be logical to examine the reason why. ‘because we were invited to a restaurant that we hadn't been to before by some friends of ours. I wasn't used to the menu and I also drank a couple of glasses of wine before we ordered, once I'd done this i found that l had a lot less willpower than usual when ordering my meal.’

Now that the client is aware of why the relapse occurred they are 'forewarned’ for next time the situation arises, and can devise strategies to make sure they do not find themselves in the same situation again. For example, they may call the restaurant and ask for details of the menu so that they can decide on their order well in advance. They may also try to make sure that they only drink an alcoholic drink after the first course. It is these sorts of small adjustments to everyday behaviour patterns that can eventually lead to long-term success.

Relapse is very common and often leads back to contemplation stage. It can be an intended relapse such as a holiday or unintended through illness, etc. It is important to remember that client’s may feel guilty or annoyed with themselves about relapsing.


• Help client to understand why it happened. • Explain that relapse is quite normal. • Encourage client to learn from their mistakes and start again.

Termination

Once the individual is at this stage, they no longer consciously worry about the change process and carry on their new behaviour automatically. in other words they have broken their old habits and formed new ones. This may mean that new patterns of eating are established, or simply that Performance Training Academy 130

the individual finds that they no longer have to think so carefully about their food choices as they naturally select foods that help achieve their goals, ie, weight loss or healthy eating.

Whenever a simplistic model illustrates major concepts there are always flaws and disadvantages. However, as a fitness professional, you can learn a lot from studies such as those of Prochaska and DiClemente. A possible major conclusion that can be drawn from their work is that no one can ’make' anyone else change. You can only facilitate, guide and encourage. It is very important that you bear this in mind if you are faced with a potential client who is very obviously in contemplation or even pre-contemplation. You need to listen impartially to their reasons for and against changing, and simply provide information if it is requested. Trying to persuade the individual to change is often futile, as in the long term, the individual will only change when ready.

The model also emphasises the importance of client responsibility. It seems it is no longer sufficient to adopt a ’white coat’ approach towards clients, issuing strict programmes and guidelines and expecting them to follow them. instead, you need to adopt a flexible approach that fits around the individual’s likes, dislikes, time commitments and work. In other words the programme must be realistically achievable for the given individual. Healthy eating recommendations apply to everyone and are fairly general and unchanging. However, advice on methods to change eating patterns to comply with the recommendations must be tailored specifically to the individual if a successful change is to be effected.

Helping people change

Consider the following when helping people change:

• Build rapport. It is essential that there is a degree of empathy between you and your client if a good working relationship is to be established. Trying to place yourself in the client's shoes, ie, gaining a good understanding of their current lifestyle is very important if an effective l programme is to be established.

• Find out what the client wants and their motivations.

• Listen to previous history.

• Confirm readiness to change.

• Present options for change.

• Discuss barriers to change.

• Help client create a plan for change (SMART).

• Monitor progress and re-evaluate where necessary.

It is vital that you are aware of your limitations when dealing with clients or potential clients. Unless you are a qualified dietician, ie, have undergone a four~year university course, a qualified counsellor (or possibly both), it is unlikely that you are qualified to deal with people with eating disorders or medical problems. For this reason, it is important to develop a strong support network of professional, qualified practitioners. You can then refer clients if you feel that their needs are beyond your capabilities. Referring clients should not be seen as a weakness, but rather as a strength that signifies your professionalism.


Goal setting

The Stages of Change model needs to be applied with suitable, relevant SMART goals. Without sufficient goal setting and client ‘ownership’ of their goals, lapses are more likely; clients need their own reasons to change. Goal setting is a valuable tool for measuring achievement, identifying new strategies to help clients and giving them the ownership and control over the changes they implement. Generally, research shows that goal setting enhances self-confidence, motivation and performance more than just ‘doing your best’. Goal setting can help to maintain a challenging environment for the client.

Goals should be relevant to a client's personality, lifestyle, aims and objectives at all times. There are two main types of goals:

Performance goals

These focus on the processes to be followed to reach the desired end result. These are generally more positive types of goals because the person can set short and mid-term goals to help maintain self-control and determination.

Outcome goals

These focus on the end result only and are perhaps not the most effective method of goal setting because the client does not have direct control over whether the goal is met. These types of goals may ‘decrease confidence and lead to anxiousness' (Burton, 1989) if a person does not achieve this goal.

Goals need to be:

• Flexible - to allow for alterations as and when needed. • Organised and clearly structured. • Followed up - re-assessed at regular intervals.

Try to make sure your goals are 'SMART’

Specific to the individual (eg, rather than just wanting to lose weight ask them to specify how much weight)

Measurable - ensure you establish evaluative methods (eg, instead of trying to gauge if a client is 'more toned’ try measuring lean body mass / body fat).

Achievable/Agreed - to/with client - Does it fit in with their lifestyle? Is it what they want to achieve?

Realistic - attainable (but challenging) for the individual (eg, don't forget that healthy weight loss is only l-2lb a week for the average person so do not mislead them if this is one of their goals. Also does their goal take into account any barriers they may have to combat?).

Time-Framed - a time limit to increase motivation combined with short-, mid« and long term goals. When are they next going to be reassessed? When is their next ‘weigh day’? etc.


Measuring progress

In order to monitor and evaluate your client’s progress towards their long~term goal(s), it is essential to choose the most appropriate method of measurement. This will be determined by your client's motivation and appropriateness of the method to show realistic success.

When deciding on the most appropriate method of measurement it is also essential to consider when and how often you will take measurements. De»motivation can occur if measurements do not show if the client is progressing towards their goal(s). Consider the following when choosing what method of measurement to use with your clients.

To weigh or not to weigh

You can record actual weight loss by using a pair of bathroom scales. However there are problems with scales. Firstly they are not always accurate. Secondly they do not show whether weight loss is from fat, water or muscle. Thirdly, a person may actually look better, but not have lost weight due to muscle gain. In addition to these issues, weight fluctuates, so to get consistent readings, weight must be taken at the same time, wearing the same clothes with the same conditions. Many people weigh themselves daily, and this is not advisable; once a week or every two weeks should be the maximum frequency.

Body fat measurement is very useful as fat loss is more important than weight loss. For those who are exercising, it is likely that some muscle will be built and muscle is denser than fat. If an individual builds some muscle and reduces fat, there may be no difference in their weight, or even a slight increase. This can be a major setback to those who have designed a weight loss goal.

Ultimately, the reason for losing weight is usually to look better or for medical reasons, so if this is the case, body fat loss would be more effective. Body fat takes up more room than muscle, so by changing the balance individuals can improve their bodies.

Skin fold callipers

Skin fold callipers can be a much more accurate method of measuring actual fat loss than the scales as they can determine between fat and lean muscle tissue. They are easy to carry and can be very useful with certain clients. However, the measurements do need to be taken by someone experienced with the callipers to ensure accuracy. Callipers can also be quite intrusive, especially if a client feels self-conscious, as they involve the subject having to be measured around the torso and arms. The callipers themselves also vary in accuracy; cheap callipers often result in less accurate readings, while the more accurate callipers can be very expensive.

Body mass index

Body mass index (BMI) can be used to identify a suitable weight, as previously discussed, but this has limitations because it does not account for body composition. It focuses on body weight rather than measurements or body fat.

Tape measures


These should ideally be used in conjunction with other body fat measurements. They are cheap, accessible and easy to use. It is important that a note is made of exactly where the measurements were taken. Ideally, the same person should do the measuring. It is not recommended that the measurements be taken at less than six week intervals.

Food diaries and journals

These can be very useful as a method of gaining insight into how people are currently eating. However, as with all methods these have their drawbacks. People often forget to fill them in at the time of eating. When they remember to record the information, several hours may have passed and they may forget something they ate, or fail to record it as accurately as they might have done. Some people may also feel self-conscious about what is written and tend to be economical with the truth; this can all have an effect on the accuracy of the diary. Nevertheless, it can be a very valuable tool and it also helps raise the person's awareness of what and when they are actually eating.

The client should record all food and drink consumed within a set period, which can then be analysed. it is important to ensure that people carry logs around with them, as it is easy to forget to record something, or think something didn't matter when it may be of great relevance. In order to obtain a realistic record of food intake and activity levels a diary should be kept for at least three to seven days, and include the weekend.

Food diaries can give you a whole range of information, including:

• Likes and dislikes

• Eating habits - snacks/rituals/times/mood, etc.

• Social life - restaurant/pub/takeaways, etc.

• Total calorie intake

• 'Ouantity' of carbohydrate, protein and fat

• 'Quality' and types of carbohydrate, protein and fat

• Portion sizes of different food groups

• Fluid intake

• Alcohol intake - habits, units, etc.

• Variations at weekends or during a holiday, etc.

However, there can also be problems with food diaries:

• Clients may lie

• Clients may forget

• Recording intake is time consuming

• Accuracy of intake is hard to judge

• Analysis is not always easy.

Analysis of food diaries can be done manually or using inexpensive computer software. An example layout for a food diary is shown on the next page, followed by a table that helps to


analyse intake in terms of different food groups. This can then be compared to the ’eatwell guide’ discussed previously.

Bio-electrical impedance(89. Bodystat)

With this method small, electrodes are placed on the feet and hands and a very mild electrical current is passed from one to the other. An analysis is then done based on the speed of the current. This can be a quick, convenient and unobtrusive method. However, its accuracy can vary; often if an individual is dehydrated the reading can be misleading.

Other methods are available such as waist to hip ratios, food surveys and so on. However, it is important to think carefully about what you are trying to measure and why. Very often it can be just as useful for a client to measure their progress against how their clothes fit or how they feel. Do they have more energy, feel more positive, etc?

It is also important to be aware that if only one particular method of measurement is chosen eg, body fat, this can be detrimental to the client's programme. The client can end up only focusing on the reduction of their body fat and not acknowledge all the other benefits they may be experiencing such as reduced blood pressure, increased energy, stronger muscles, better posture and so on. It is much more advisable to encourage your clients to take a holistic view of the benefits they are getting from their programme.

Analysing information and providing healthy eating advice

The process of analysing information on your client's current eating habits and lifestyle against what they want to achieve will enable you to provide healthy eating and exercise advice to help them reach their goal(s).

Daily food and activity diary sample layout

Time Food Amount Outlines of exercise and activity

Recommendation


• Time - at what time they consumed the food. • Food - description of the food eaten. • Amount - how much food they consumed (weights, portions or approximate sizes). • Activity - what activity they have done over the day(eg, walking to the bus stop, structured

exercise; number of hours spent sedentary sitting at desk) • Recommendations - use this space to write comments in relation to their food choices

To analyse a client's diet in relation to the ’eatwell guide‘ it is useful to know how much food they are consuming from each of the food groups. Their diet should be proportionally representative of the food groups but they may have too much food on their plate. By using a combination of guidelines - the 'eatwell guide’ and Guideline Daily Amounts (GDA) you can analyse their diet in terms of 'quantity' (how much food they are actually consuming) and ‘quality’ (foods of a high/low nutritive value). The following example ’daily portion tally sheet’ will help to explain this.

Daily portion tally sheet

In order to identify how much food and fluid (’quantity') clients are consuming, you can use the following table to identify how many portions from the food groups are consumed (a description of portions can be found in the appendix). This information can then be used to advise clients if they are consuming too much food from a certain food group.

Day Fats, oils and sweets

Dairy produce

Meat, fish and alternatives

Fruit and vegetables

Grains, cereals and pulses

Water (l)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Average

Recommendations


Methods on analysing ‘quantity’ and ‘quality’ of food choices

Consider your client's food choices in relation to the healthy eating guidelines discussed in this manual so far. For example: is there a high proportion of refined carbohydrates? If so what alternatives do you recommend? Does the meat, fish and alternatives group include a lot of animal proteins? If so, what alternatives do you recommend?

Example of a completed food diary

As you are analysing your clients food diary art is useful to write notes in the recommendations section in relation to the ‘quality’ of their food choices as outlined above.

When you have collected enough information covering 3-7 days you can then analyse the information in relation to the food groups outlined on the healthy eating food plate.

Time Food Amount Outlines of exercise and activity

Recommendation

7.30am CornflakesSemi skimmed milk1/2 banana

Medium bowl - 50gApprox 100ml

Opt for low GI breakfast, eg porridge, muesli.

Opt for fruit and a few nuts.

Opt for wholegrain with a large portion of salad. Reduce amount of mayo.Opt for water or diluted juice.

Opt for fruit or oat biscuits.

Opt for small glasses of wine or spritzers.

Ensure you consume a small portion of rice and a larger portion of vegetables.

10.30am Glass of waterBlueberry muffin

-1 small

12pm BagelTuna and mayonnaiseDiet Coke

1 large1/2 tin + 1 tblspn1 can

3pm 2 x chocolate covered biscuits1 tea

2 x small biscuits

Mug

6pm 2 glasses of white wine1 packet of crisps

2 large glasses

8pm Green chicken curryJasmine riceVeg in curry - baby corn, mange tout, green beans and carrotsCoconut milk

1 ch. breast2 table spoons3 tablespoons in total

1/2 tin.


Example daily portion tally sheet

* To find the average, add up all the portions and divide the result by the number of days. When you have an average consumption, you can compare it to how much is actually recommended according to their energy requirement and identify if they are consuming ‘too much’ or ‘too little’ from certain food groups.

Barriers to achieving goals

It is inevitable that a client will have some barriers or obstacles standing in the way of their success. You can help them find strategies to overcome these barriers and help to keep them on track towards achieving their goals. Barriers will be a very individual thing, specific to the individual, so get as much information about them and help your client to allow for these and (if possible) use them to their advantage.

Potential barriers could include:

• Time - Does your client work? Do they have family or children? What are their hobbies? What time could they put towards a healthier lifestyle?

• Money - Do they perceive a healthy lifestyle as being more expensive (eg, healthier foods or taking part in exercise)?

Day Fats, oils and sweets

Dairy produce

Meat, fish and alternatives

Fruit and vegetables

Grains, cereals and pulses

Water (l)

Monday 1 1 3 6.5 7.5 2

Tuesday 2 2 4 5 7 3

Wednesday 2 1 3 5 6 1

Thursday 1 2 4 7 6 2

Friday 2 2 3 5 6.5 1

Saturday

Sunday

Average 1.6 1.6 3.4 5.7 6.6 1.8

Recommendations


• Children - This is often a time constraint for clients but there are also other costs involved eg, Do the kids make them buy ‘bad’ foods or do they pick at the children‘s leftovers, or skip dinner themselves because they are too busy?

• Motivation - Why is your client's lifestyle unhealthy? Why have previous attempts at diets failed? How could you help them to change this?

• Lack of education - Does your client know enough about a healthier lifestyle or the benefits of a healthy diet? Do they know what foods they should or should not be eating for a healthy and balanced diet? Now is your chance to promote this to them.

Developing strategies

Just as barriers are specific to each individual, so too are the strategies you develop with your client to assist them. For example, if time for cooking is a barrier, you may help your client develop a weekly plan of quick, easy, nutritious meals that they can cook. You may also work with them to develop a list of ’store cupboard essentials’ so that when they come home from work there will be ‘healthy options’ available.

Some clients may benefit from information about healthy eating. Your role is to educate and advise; there are also numerous resources available that you can use with your client to convey the message of healthy eating.

Main points

• It is important to develop strategies to assist individuals through various stages of change.

• Recognising at what stage individuals are at is important to devised the correct strategies.

• Follow the ‘Stages of change model’ to ensure you go through the process effectively.


Nutrition LEARN - INSPIRE - SUCCEED · • Flavour ~ fat in food gives ﬂavour and improves...

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