NAT11046002 Student Resource Guide V2 (24-10-23)

11046NAT - CERTIFICATE IV IN NUTRITION

NAT11046002: APPLY THE FUNDAMENTALS OF NUTRITION TO MEET A CLIENT’S DIETARY NEEDS VAST FITNESS ACADEMY RTO #41564 | ACN 607 258 748 | ABN 14 492 461 636 (07) 5443 4072 | ADMIN@VASTFITNESSACADEMY.EDU.AU | 1/84 WISES ROAD, MAROOCHYDORE QLD 4558 VAST FITNESS ACADEMY | NAT11046002: APPLY THE FUNDAMENTALS OF NUTRITION TO MEET A CLIENT’S DIETARY NEEDS | VERSION 1 - 23.01.2023

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TABLE OF CONTENTS Unit INTRODUCTION

8

UNDERSTANDING THE IMPORTANCE AND ROLE OF NUTRITION

9

DEFINING NUTRITION: WHAT IS NUTRITION?

9

THE ROLE OF NUTRITION IN THE BODY

10

THE ROLE OF A NUTRITIONAL COACH

11

UNDERSTANDING THE IMPORTANCE OF CHEMISTRY AND ITS RELEVANCE TO NUTRITION

12

INTRODUCING ATOMS

13

INTRODUCING ELEMENTS

14

ORGANISATION OF ELEMENTS (THE PERIODIC TABLE)

15

PERIODS IN THE PERIODIC TABLE

16

FAMILIES (OR GROUPS) IN THE PERIODIC TABLE

16

INTRODUCING MOLECULES

18

MOLECULAR FORMULA

18

STRUCTURAL FORMULA (FISCHER PROJECTION)

20

SKELETAL STRUCTURE

20

UNDERSTANDING FUNCTIONAL GROUPS/SIDE CHAINS

21

UNDERSTANDING METABOLISM

22

BRINGING IT ALL TOGETHER (RELEVANCE TO NUTRITION)

27

UNDERSTANDING THE IMPORTANCE OF ESSENTIAL NUTRIENTS

28

MICRONUTRIENTS (A QUICK OVERVIEW)

29

MACRONUTRIENTS (A QUICK OVERVIEW)

30

BENEFITS OF KNOWLEDGE OF MACRONUTRIENTS AS A NUTRITIONAL COACH

31

UNDERSTANDING MACRONUTRIENTS: DIETARY PROTEIN

32

WHAT IS DIETARY PROTEIN?

32

THE ROLE OF PROTEIN

33

TISSUE REPAIR AND PRODUCTION

33

HORMONE PRODUCTION

35

ENZYME PRODUCTION

36

IMMUNE FUNCTION

37

ENERGY PRODUCTION

37

THE CHEMICAL MAKEUP OF PROTEIN (UNDERSTANDING AMINO ACIDS)

38

COMPLETE VERSUS INCOMPLETE PROTEINS

41

BRANCHED CHAIN AMINO ACIDS (BCAAS)

43

SOURCES OF PROTEIN

44

DETERMINING THE QUALITY OF PROTEIN

46

DIGESTIBLE INDISPENSABLE AMINO ACID SCORE (DIAAS)

46

PROTEIN DIGESTIBILITY CORRECTED AMINO ACID SCORE (PDCAAS)

47

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PROTEIN EFFICIENCY RATIO (PER)

47

BIOLOGICAL VALUE (BV)

47

NET PROTEIN (NITROGEN) UTILISATION (NPU OR NNU)

48

PROTEIN QUALITY RANKINGS

49

RECOMMENDED DAILY INTAKE FOR PROTEIN

50

BENEFITS OF PROTEIN ABOVE THE RDI

51

COMMON MYTHS ABOUT PROTEIN

52

UNDERSTANDING MACRONUTRIENTS: CARBOHYDRATES

53

WHAT ARE CARBOHYDRATES

53

THE ROLE OF CARBOHYDRATES

54

PROVIDE THE BODY WITH AN IMMEDIATE FUEL SUPPLY

54

PROVIDE THE BODY WITH STORED ENERGY

54

ASSIST WITH DIGESTIVE HEALTH AND DISEASE PREVENTION

54

THE CHEMICAL MAKEUP OF CARBOHYDRATES

55

SIMPLE CARBOHYDRATES

56

COMPLEX CARBOHYDRATES

58

UNDERSTANDING DIETARY FIBRE

61

TYPES OF DIETARY FIBRE

62

UNDERSTANDING THE GLYCAEMIC INDEX OF CARBOHYDRATES

65

GI RANKING

65

GI RATINGS OF COMMON FOODS

67

GLYCAEMIC LOAD

68

CALCULATING THE GLYCAEMIC LOAD

68

SOURCES OF CARBOHYDRATES

69

CARBOHYDRATE RECOMMENDATIONS

70

UNDERSTANDING SUGAR

71

NATURAL SUGARS

71

REFINED SUGARS

71

THE EFFECT OF EXCESSIVE REFINED SUGAR ON THE BODY

73

UPPER LIMIT SUGAR RECOMMENDATIONS

73

EXCESS SUGAR INTAKE

74

EDUCATING CLIENTS ON THE ALTERNATIVES TO REFINED SUGAR

75

COMMON MYTHS ABOUT CARBOHYDRATES

77

UNDERSTANDING MACRONUTRIENTS:

78

FATS (LIPIDS)

78

WHAT ARE DIETARY FATS?

78

THE CHEMICAL MAKEUP OF FATS (UNDERSTANDING FATTY ACIDS)

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FATTY ACIDS

79

CLASSIFICATION 1:

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BY SATURATION

80

CLASSIFICATION 2:

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BY LENGTH

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CLASSIFYING FATTY ACIDS BY DEGREE OF SATURATION

81

SATURATED FAT

81

CLASSIFYING FATS BY THEIR LENGTH

90

THE ROLE OF FATS

92

ENERGY PRODUCTION AND STORAGE

92

NORMAL NERVE FUNCTION

93

VITAMIN STORAGE

93

MAINTAINING HEALTHY CHOLESTEROL LEVELS

93

CELL STRUCTURE

94

BRAIN FUNCTION AND BRAIN DEVELOPMENT

95

ASSIST IN PREVENTING BLOOD CLOTS

95

HUNGER REGULATION

95

REDUCE CARDIOVASCULAR DISEASE RISK

95

INFLAMMATION AND IMMUNE FUNCTION

96

THE PRODUCTION AND REGULATION OF SOME HORMONES

96

IMPROVES BLOOD VESSEL ELASTICITY

97

DECREASES THE RISK OF DEPRESSION AND ANXIETY

97

RECOMMENDED DAILY INTAKE OF DIETARY FATS

98

OMEGA-6 TO OMEGA-3 RATIO

98

RDI FOR POLYUNSATURATED FATS

99

RDI FOR MONOUNSATURATED FATS

99

RDI FOR SATURATED FATS

99

UNDERSTANDING OTHER FACTORS THAT CONTRIBUTE TO ENERGY INTAKE

100

UNDERSTANDING ALCOHOL

100

ENERGY IN ALCOHOL

100

RECOMMENDATION INTAKE FOR ALCOHOL

101

ADVISING CLIENTS ON THE CONSUMPTION OF ALCOHOL

102

RECOGNISING THE IMPORTANCE OF WATER

103

UNDERSTANDING MICRONUTRIENTS

104

INTRODUCING VITAMINS AND MINERALS

104

UNDERSTANDING THE IMPORTANCE OF VITAMINS

106

FAT-SOLUBLE VITAMINS

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WATER-SOLUBLE VITAMINS

109

UNDERSTANDING THE IMPORTANCE OF MINERALS

112

BENEFITS OF ENSURING ADEQUATE MINERAL INTAKE

115

UNDERSTANDING SODIUM (NA)

117

SODIUM RECOMMENDATIONS

119

UNDERSTANDING HOW THE BODY ABSORBS, UTILISES AND PROCESSES NUTRIENTS

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UNDERSTANDING DIGESTION

121

THE ORAL CAVITY (THE MOUTH)

121

THE STOMACH

122

THE SMALL INTESTINE

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UNDERSTANDING ABSORPTION

124

TYPES OF ABSORPTION

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ABSORPTION SITES

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UNDERSTANDING THE ABSORPTION OF MACRONUTRIENTS

127

HOW THE BODY UTILISES FIBRE

128

UNDERSTANDING ENERGY AND ADVISING CLIENTS ON INDIVIDUAL NUTRITIONAL REQUIREMENTS

129

UNDERSTANDING ENERGY

130

UNDERSTANDING BASAL METABOLIC RATE (BMR) AND RESTING METABOLIC RATE (RMR)

131

CALCULATING ESTIMATED ENERGY REQUIREMENTS (EER)

132

STEP 1: CALCULATING THE BMR

132

STEP 2: INCORPORATING THE PHYSICAL ACTIVITY LEVEL (PAL)

133

ESTIMATED PROTEIN REQUIREMENTS (EPR)

134

BENEFITS OF MORE PROTEIN THAN RECOMMENDED DAILY INTAKE AND WHEN TO RECOMMEND

135

UNDERSTANDING MACRONUTRIENT DISTRIBUTION

136

ESTIMATED FLUID REQUIREMENTS (EFR)

138

ESTIMATED FLUID REQUIREMENTS FOR EXERCISE

139

RECOMMENDATIONS FOR ADEQUATE FRUIT INTAKE

140

RECOMMENDATIONS FOR ADEQUATE INTAKE OF FIBROUS VEGETABLES

141

RECOMMENDATIONS FOR ADEQUATE FIBRE INTAKE

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RECOMMENDED INTAKE OF VITAMINS AND MINERALS

143

RECOMMENDED INTAKE FOR DISCRETIONARY ITEMS

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AWARENESS OF PAST AND EMERGING DIETARY TRENDS AND MYTHS IN THE INDUSTRY

146

LOW CARBOHYDRATE DIETS VERSUS LOW-FAT DIETS

147

LOW-FAT DIETS

148

UNDERSTANDING FASTING DIETS

149

IIFYM VS HEALTHY EATING

151

HOW IIFYM WORKS

151

IIFYM THE WRONG WAY

151

IIFYM THE RIGHT WAY

151

UNDERSTANDING DETOX DIETS

152

IS DETOXING NECESSARY?

153

DETOX DIETS AND THE ROLE OF NUTRITIONAL COACHES

153

RECOGNISING FAD DIETS

154

COMMON TRAITS OF A FAD DIET INCLUDE:

154

EDUCATING CLIENTS ON FAD DIETS AND ENCOURAGING HEALTHY ALTERNATIVES

157

EVIDENCE-BASED DIETARY PATTERNS FOR SPECIFIC POPULATION GROUPS:

158

WHY IS FAD DIETING A CONCERN?

159

FAD DIETS AND THE ROLE OF A NUTRITION COACH

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UNDERSTANDING HOW TO READ NUTRITIONAL LABELS

160

NUTRIENTS TO WATCH: TRANS FAT, ADDED SUGARS AND SODIUM

162

WHAT IT ALL MEANS (MARKETING CLAIMS)

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UNDERSTANDING HOW TO READ NUTRITIONAL LABELS

163

RECOGNISING THE EFFECTS OF DIFFERENT COOKING METHODS

163

STEAMING

164

BOILING AND BLANCHING

164

GRILLING/BAKING

165

FRYING

165

KNOWLEDGE OF FOOD SAFETY PRACTICES

167

ENCOURAGING CLIENTS TO ADOPT SAFE FOOD HANDLING PRACTICES

168

COMMON DIET, NUTRITION AND WEIGHT-RELATED CONDITIONS AND COMMON SYMPTOMS

169

FOODS IMPACTING HEART DISEASE

171

INDICATIONS OF CHRONIC HEALTH WHICH REQUIRE REFERRAL TO A HEALTH PROFESSIONAL

172

COMMON FOOD SOURCES TO SUPPORT CLIENT GOALS

174

IMPACTS OF LIFESTYLE, ACTIVITY LEVELS AND PERSONAL CHARACTERISTICS ON RECOMMENDED NUTRITIONAL INTAKE 176 LIFESTYLE FACTORS AND THEIR IMPACT ON NUTRITIONAL HEALTH

177

ACTIVITY LEVELS

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PROVIDING APPROPRIATE EXERCISE ADVICE AS A NUTRITION COACH

181

PERSONAL CHARACTERISTICS AND GENETICS

182

RECOGNISING THE IMPACT OF STRESS ON THE BODY

183

PREVENTION VERSUS TREATMENT RELATED TO NUTRITION, HEALTH AND WELLBEING

184

UNDERSTANDING PREVENTATIVE HEALTH

185

UNDERSTANDING CURATIVE HEALTH (OR HEALTH TREATMENT)

186

RECOGNISING CREDIBLE SOURCES OF PRODUCT, LIFESTYLE AND SELF-CARE INFORMATION

187

INDUSTRY ASSOCIATION

188

NUTRITION COUNCIL AUSTRALIA (NCA)

188

OTHER PEAK INDUSTRY BODIES

189

DIETITIANS AUSTRALIA (DA)

189

NUTRITION SOCIETY OF AUSTRALIA (NSA)

190

THE WORLD HEALTH ORGANISATION (WHO)

190

GOVERNMENT ORGANISATIONS

191

NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL (NHMRC)

191

NUTRITIONAL EDUCATIONAL MATERIALS ONLINE (NEMO)

191

NOT-FOR-PROFIT ORGANISATIONS

192

BREAST CANCER FOUNDATION

192

NUTRITION AUSTRALIA

192

PROFESSIONAL PUBLICATIONS

193

NUTRIENT REFERENCE VALUES

193

AUSTRALIAN DIETARY GUIDELINES

193

THE AUSTRALIAN GUIDE TO HEALTHY EATING

194

ONLINE INDUSTRY AND PROFESSIONAL PUBLICATIONS

195

REPUTABLE HEALTH EDUCATION INTERNET SITES

195

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MANUFACTURER PRODUCT SUPPORT MATERIALS

196

PRODUCT LEAFLETS, BROCHURES AND BOOKLETS

196

MEDICINES DATABASE

197

HEALTH CARE FACT SHEETS

197

PHARMACY MANUALS

197

GLOSSARY

198

REFERENCES

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UNIT INTRODUCTION Welcome to the unit ‘NAT11046002 - Apply the Fundamentals of Nutrition to Meet a Client’s Dietary Needs’. The purpose of this unit is to provide nutrition coaches with the skills and knowledge required to locate and apply nutritional guidance relating to food and products. This unit will allow nutrition coaches to relate this information and inform clients on daily intake requirements for varying goals and needs.

This unit covers the bulk of what nutrition coaches will learn regarding nutrients and nutrition and how to apply that to each client. First, this unit includes the essential foundations of chemistry that are necessary for understanding the basics of food, such as: introducing atoms, elements, and molecules, and informing nutrition coaches on the various ways they can be arranged, thus forming all the different foods. Understanding the basics of chemistry will lead to a thorough understanding of food and its chemical makeup, which is vital for successful nutritional intervention.

This unit also starts at the very beginning in terms of when it comes to nutrients as a whole - explaining the six essential nutrients, what they are, how they can be categorised into macro and micronutrients, where you can find them, how they are processed and utilised within the body, and in what quantities they are recommended. From this, nutrition coaches will clearly understand the various nutrient deficiencies that can arise, their signs and symptoms, and how much they can help these clients without working outside their scope of practice. Graduates will also be able to calculate the individual daily intake of these nutrients for their clients and inform them of the effects cooking has on the nutrientdensity of different foods.

Further, common industry myths and misinformation are explained thoroughly, and useful tips for dealing with diet and weight-related conditions, as well as how to educate clients on other lifestyle factors that could affect their nutrition.

This unit educates nutrition coaches on how to be independent with their research by explaining how to look for and find credible sources and accurately read nutrition labels. This unit is quite comprehensive, but the information held within it is essential for the success of a nutrition coach.

The information within this unit may be applied and utilised in various job roles across the health and fitness industry, including health coaches, sales staff within health and supplement retailers, sports and performance coaches, and fitness professionals. As a result, those within these outlined job roles will have adequate knowledge to ensure their clients’ enquiries are met with safe advice.

This unit will allow a nutrition coach to: Obtain a thorough understanding of the various aspects of nutrition and their role Explain nutritional guidelines relating to recommended dietary intake Describe and apply nutritional information to meet the client’s needs Assist clients in identifying sources of nutritional intake in line with individual requirements and relevant nutritional guidelines.

• • • •

This unit does not provide individuals with the required skills or knowledge to work with: Individuals suffering from chronic health conditions Individuals with medical conditions requiring specialised dietary advice Frail elderly individuals who are at risk of malnutrition The provision of dietary information or advice for infants and toddlers Pregnant or breastfeeding women.

• • • • •

Suppose a nutrition coach faces a client from one of the population groups mentioned above. In that case, they must work collaboratively with allied health professionals by referring clients that fall outside their scope of practice. This ensures that the client and the nutrition coach are safe-guarded should any issues arise.

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UNDERSTANDING THE IMPORTANCE AND ROLE OF NUTRITION DEFINING NUTRITION: WHAT IS NUTRITION? Nutrition is not simply about what is consumed daily. Nutrition is about supplying the body with adequate nutrients from food and other sources and how these nutrients are processed and utilised to ensure optimal health and wellbeing.

The term ‘nutrition’ is derived from the Latin word nutrire, meaning to feed, nurse, support, and preserve.

Nutrition is responsible for the body’s health, growth, and overall functioning. Nutrients enable biochemical and physiological processes to occur and feed the body to fight disease and create enzymes and hormones. Nutrients are pivotal in all human processes and body systems, from the breakdown and absorptive capacity of the digestive system to the efficient and effective nervous system functioning.

Different nutrients are required for different bodily tasks such as growth and development, reproduction, physiological functions, heat production and synthesis of new tissues. Adequate nutrition is crucial for reducing the risk of disease and prolonging the quality and years of an individual’s life.

Adequate nutrition is also about treating disease and other health disorders. Nutritional guidelines and scientific research aim to reduce ill-health risks by outlining the fundamentals of a healthy diet. In doing so, nutrition status identifies how certain conditions or ailments can be avoided or improved.(1) Nutrition coaches play a fundamental role in people’s ongoing health by assisting individuals in making better food choices. It is paramount that nutrition coaches gain and maintains a solid understanding of nutrition, both how it functions inside the body and how to provide the body with the nutrients it requires.

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THE ROLE OF NUTRITION IN THE BODY From energy sources to hormone production, from immunity to hair growth, everything that happens in the body is a direct result of nutrition.

Nutrition encompasses not only the food consumed but the quality of the food itself. Choosing high-quality, nutrientdense foods as often as possible is crucial for gaining and maintaining overall good health. For example, strawberries grown in the sunlight with nutritionally dense soil will yield a much higher vitamin and mineral content than strawberries grown hydroponically and then sprayed with chemicals.

The type of food an individual decides to consume will play a vital role in their overall health and wellbeing, as nutrients directly impact all human processes.

The diagram below provides examples of some of these human processes which nutrition can directly impact:

HAIR AND NAIL GROWTH

MENTAL CLARITY

(GOOD NUTRITION)

DISEASE CAUSATION (POOR NUTRITION)

HORMONE PRODUCTION

OCCURRENCE OF ACNE AND PIMPLES

CELL DIVISION

DISEASE PREVENTION

ENERGY AND LETHARGY NERVE IMPULSES

MUSCLE GROWTH OVERALL GUT HEALTH

DIGESTION

BLOOD CLOTTING

FEELING OF FULLNESS

FEELING OF HUNGER

EMOTIONAL HEALTH

PHYSICAL CAPABILITIES

BOWEL MOTIONS

IMMUNITY

HOMEOSTASIS

REPRODUCTION THERMOREGULATION

CARDIOVASCULAR HEALTH

BONE HEALTH

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THE ROLE OF A NUTRITIONAL COACH Knowledge of the nutritional content of food is essential for nutrition coaches. When consulting with clients, it is important to identify and calculate individual nutrient requirements and understand which nutrients are contained in which foods. Understanding where certain nutrients are found and in what quantity will allow the nutrition coach to create a nutritionally sound plan for a client based on individual nutritional requirements.

For example, it is important to know that while bananas can be a valuable source of carbohydrates, if eaten in excess, especially by someone with high potassium levels, the individual is at risk of creating an electrolyte imbalance, as bananas are extremely high in potassium. High potassium levels can result in symptoms including lethargy, weakness, nausea, vomiting, chest pain, heart palpitations and difficulty breathing.

Another example may be the basic understanding that individuals require a variety of vegetables daily instead of relying on one type of vegetable. It is commonly seen that individuals who want to lose weight will often lean more toward a diet where there is a preference for a certain vegetable, such as broccoli. While broccoli is a great vegetable for any healthy individual, if only broccoli is consumed, the individual is at risk of becoming deficient in vitamin D and vitamin B12, as broccoli contains neither of these. Therefore, a well-balanced variety of vegetables is important and encouraged.

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UNDERSTANDING THE IMPORTANCE OF CHEMISTRY AND ITS RELEVANCE TO NUTRITION Understanding the basics of chemistry will help nutrition coaches to determine which components of foods are needed for the body to function properly. This knowledge enables nutrition coaches to determine what foods are best for overall health.

What would be seen if a scientist looked at food closely under a microscope? The first thing they would see would be the larger structures of proteins, carbohydrates and fats. If they zoomed in closer again, the cells forming the foods’ structures would appear. If they could zoom into the cell, all the molecules that make up the cell could be viewed. And if they could zoom into those with a very powerful microscope, the individual atoms that form the basis of the molecules within could be seen.

Atoms and molecules, and their structure, are the basis of all life. They determine the structure of food, how it smells and tastes, how it reacts when cooked or eaten and even its nutritional value in the body. Understanding the basics of chemistry is key to understanding food and how food works in the human body.

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O O D C He M

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INTRODUCING ATOMS To understand food and nutrition, it is important to understand the chemistry on which it is based. Everything is composed of atoms arranged in a specific way to form molecules, and the science of food chemistry studies these molecules.

MOLECULE Molecules are groups of two or more atoms that function as a unit, tightly bound as a larger structure of atoms forming a stable compound. Molecules will be discussed in more detail later in this unit resource.

An atom is a molecule’s smallest unit of matter (physical substance). Atoms are the building blocks of elements, 118 in total, with 92 found in nature and another 26 human-made.(2)(3) Atoms are attracted to other atoms, and their formation creates matter. It takes trillions of atoms to make something as complex as a human body.

Atoms are incredibly small, and they are made up of even smaller particles: 1. Electrons 2. Protons 3. Neutrons.

Two of the three particles possess an electric charge (protons have a positive charge while electrons have a negative charge). Neutrons, on the other hand, are neutral and have no charge. These particles are attracted to each other and form the structure of an atom.(2) The table below explains each particle in more detail:

TYPE OF PARTICLE

ELECTRONS

DESCRIPTION Negatively charged particles that rotate about the outside of the nucleus of an atom are called electrons. Electrons spin so fast that their position can never be accurately determined; however, scientists can estimate where they should be. If the atom contains the same number of electrons and protons, it is said to have a neutral charge.

It is the positive charge of protons that attracts electrons to the nucleus of the atom.

Electrons are about 1800 times smaller than protons and neutrons!

PROTONS

Protons are positively charged particles forming part of an atom’s nucleus. The number of protons in an atom determines which type of atom, or element, it is. There are 118 known elements. The simplest element has one proton called hydrogen; the largest currently known to science has 118 protons called Oganesson. The elements are grouped in the periodic table of elements.

NEUTRONS

Neutrons get their name from possessing no electrical charge and are, therefore, neutral.

They are found in the nucleus of atoms, except for hydrogen, which only has one proton and one electron and is the smallest atom.

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Bone s

INTRODUCING ELEMENTS

An element is a chemically simple substance made up of a single type of atom, such as hydrogen gas. Elements are the building blocks of all matter, including liquids, solids and gases.

Examples of elements include: Oxygen (O) Nitrogen (N) Iron (Fe) Magnesium (Mg) Sodium (Na) Potassium (K).

• • • • • •

To understand what an element is and the nature of an element, certain factors need to be known: How pure is the element Whether or not the element is reactive If the element can be melted or boiled.

• • •

An element is made of many atoms with the same atomic number, meanings they have the same number of protons in their nucleus. Although an element is composed of the same atoms, they still come in different forms, depending on their temperature. Elements can be solid, liquid or gas, and their form can differ depending on how tightly the atoms are packed.

ATOMIC NUMBER The term atomic number refers to the number of protons in the nucleus of an atom, which is a feature of a chemical element and determines its place in the periodic table. As discussed, each element has a unique atomic number, the number of protons in each atom.

2

ATOMI C N U M B E R OR P R OTO N N U MBE R ( Z )

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E LE ME N TA L SY MBO L

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ATOMI C M AS S IN A M U

For example, hydrogen’s atomic number is 1 because it has one proton in its nucleus, making it the first element. Iron has 26 protons making its atomic number 26, and the 26th element on the periodic table.

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•

ORGANISATION OF ELEMENTS (THE PERIODIC TABLE) Chemical elements are arranged in the periodic table of elements, which displays the various chemical elements. It was devised in 1869 by the Russian chemist Dmitri Mendeleev.(4) The periodic table is organised in a grid, where each element is placed in a specific location based on its atomic structure. As with any grid, the periodic table has horizontal rows (left to right), known as ‘periods’ and columns (up and down), known as ‘groups’. Each period (row) and group (column) has specific characteristics. These characteristics are outlined on the following pages.

PERIODIC TABLE OF ELEMENTS

Nutrition coaches need a sound understanding of the periodic table’s organisation and the chemical symbols. This appreciation assists in understanding the various essential elements required in a healthy diet.

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PERIODS IN THE PERIODIC TABLE The atomic numbers shown in each period increase from left to right. Periods are organised by numbers (1-7), which are located on the table’s left-hand side.(2) Elements in the same period have similar chemical properties. For example, potassium (K) and calcium (Ca) from period four are similar because their electrons are organised with four layers, known as shells. Likewise, magnesium (Mg) and sodium (Na) have three shells in period three.

Another example is in the first two members of period three: sodium (Na) and magnesium (Mg). In reactions, they both tend to lose electrons132 (because they are metals); sodium loses one electron, while magnesium loses two. Chlorine (Cl), a non-metal near the end of the period, tends to gain an electron.

FAMILIES (OR GROUPS) IN THE PERIODIC TABLE When it comes to the organisation of the periodic table, there are also other, less specific, groups of elements, which are referred to as families.

Members of the families (vertical columns) in the periodic table have similar properties(2) and are grouped by their chemical properties.

The families are labelled at the top of the columns in one of two ways:(2) The older method uses Roman numerals and letters. Many chemists prefer and still use this method.

The newer method uses the numbers 1 through 18.

• •

Each group or family react in diverse ways; metals are not like gases as they behave differently, and in addition to this, there are also various types of metals. Some elements are not reactive, while others are reactive. Some are also excellent conductors of electricity (in that they allow electricity to pass through).

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The image below identifies significant families that have been specified with distinct names, and the table below explains each family:

FAMILY NAME

EXPLANATION

‘IA’ FAMILY

This family is made up of the alkali metals, which are elements inclined to drop a single electron in reactions. This family contains some important elements, including sodium (Na) and potassium (K). Sodium and potassium are essential in the body’s chemistry and are commonly found in food.

‘IIA’ FAMILY

This family is made up of the alkaline earth metals. These elements tend to lose two electrons in reactions. An important member of this family is calcium (Ca) which is needed for healthy teeth and bones.

‘VIIA’ FAMILY

This family is made up of halogens. Halogens tend to gain a single electron in reactions.

Important members in this family include chlorine (Cl), which is used in making table salt, and iodine (I), which is needed for healthy thyroid function.

‘VIIIA’ FAMILY

This family is made up of noble gases. These elements are reactive under special conditions. Noble gases were originally called inert gases because they believed these elements would not react at all.

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INTRODUCING MOLECULES Molecules are groups of two or more atoms that function as a unit, tightly bound together as a larger structure of atoms to form a stable compound.

Most elements are unstable by themselves; for instance, pure oxygen atoms are not found in the atmosphere. Instead, two oxygen atoms react to form one oxygen molecule (O2). The same goes for hydrogen, with two hydrogen atoms combining to form stable dihydrogen gas (H2) (‘di’ meaning two).(2) To display the structure of compounds, many methods are used, with the main ones being: Molecular formula The structural formula (Fischer projection) Skeletal formula.

• • •

HYDROGEN

HYDROGEN

H

H

O OXYGEN

WATER MOLECULE

MOLECULAR FORMULA Abbreviations of compounds (molecules) indicate which elements are present in that compound. Each compound will be a different combination of elements attached in different orders and configurations.

Compounds are represented by showing the letter(s) of the elements they are built from and using a small subscript number to indicate how many of this atom is present in the molecule. In a subscript, the number of each atom is

EXAMPLE: WATER The image to the right shows a compound of water that consists of two hydrogen atoms and one oxygen atom, producing the molecular formula H2O. The small subscripted ‘2’ in water refers to the number of hydrogen atoms present. *If only one atom is present of a certain type, no number will be included).

CHEMICAL FORMULAE CHEMICAL FORMULAE

you how many atoms of •Tells each element is in a molecule.

•Example: water • Chemical Formula: tells you how many atoms of each element is in a molecule.

H O

• Example: Water HYD ROG EN

2 ATOMS OF HYD ROG EN

H2O

H

OX YG EN

1 ATOM OF OX YG E N

This naming convention makes writing these chemical formulas easier to understand, and for chemists, these molecular descriptions are essential for identifying the molecules and processes they are studying.

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The table below provides examples of different molecular formulas:

ELEMENTS PRESENT

MOLECULAR FORMULA

WATER

Made up of two hydrogen atoms (H) and one oxygen atom (O).

H2O

ASCORBIC ACID (VITAMIN C)

Made up of six carbon atoms (C), eight hydrogen atoms (H) and six oxygen atoms (O).

C6H8O6

B-CAROTENE (THE COLOUR IN CARROTS)

Made up of 40 carbon atoms (C) and 56 hydrogen atoms (H).

C40H56

LEUCINE (A PROTEIN OR AMINO ACID)

Made up of six carbon atoms (C), 13 hydrogen atoms (H), one nitrogen (N) atom and two oxygen atoms (O).

C6H13NO2

CARBOHYDRATE (GLUCOSE)

Made up of six carbon atoms (C), 12 hydrogen atoms (H) and six oxygen atoms (O).

C6H12O6

FAT (CAPROIC SATURATED FATTY ACID)

Made up of six carbon atoms (C), 12 hydrogen atoms (H) and two oxygen atoms (O).

C6H12O2

TYPE OF MOLECULE

EXAMPLES OF MOLECULAR FORMULAS IN FOOD Different molecules are found in various foods, each of which is a different combination of elements.

To get more acquainted with the concept of molecular formulas, here are some more common food molecules written as a molecular formula: Glucose = C6H12O6 Sucrose (standard sugar) = C12H22O11 Lactose = C12H22O11 Linoleic acid (a fatty acid) = C18H32O2 Baking soda (part of baking powder) = NaHCO3 Starch (part of flour) = (C6H10O5)n (the ‘n’ indicates it can be a long chain of these groups of molecules) Palmitic acid (one of the fatty acids in butter) = C16H32O2 Sodium Chloride (Salt) = NaCl.

• • • • • • • •

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STRUCTURAL FORMULA (FISCHER PROJECTION) This method shows all of the elements connected by lines. Each line represents a linkage or bond. This method is very clear and allows the configuration of the atoms within the compound to be seen. The Fischer projection is the main way compounds are shown in many documents (such as textbooks and this resource).

An example of the structural formula of glucose (C6H12O6) is provided in the image below:

SKELETAL STRUCTURE The skeletal structure is another commonly used method of displaying compounds that are becoming more complicated. It uses a zig-zag line to represent the carbon atoms (known as a carbon backbone) and their linkages, with functional side groups attached to the main structure.

Provided below is an example of the skeletal structural formula of glucose (C6H12O6):

This method adds more information about how the wayside groups are bonded, as seen by the broken lines (hydrogen bond) and thick lines (which represent the direction in space that a side group faces).

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UNDERSTANDING FUNCTIONAL GROUPS/ SIDE CHAINS In organic chemistry (which food falls within), many groups of compounds connect to structures that serve some purpose.

Some important examples include: Amines (NH2) Carboxyl (COOH) Alcohol (OH).

• • •

Each of these groups helps to determine the structure, function and processes a particular molecule will go through in the body to be broken down or turned into another product. For example, amines (NH2) are a functional group in amino acids (proteins). The nitrogen in this compound is important because it can be used to produce energy.

Alcohol groups are important in glucose because it is this group that allows glucose to dissolve. Knowing what groups are present in a molecule will provide information on how it will behave. Likewise, some compounds, like amino acids, are built on a similar base structure but can possess one of many different side chains, resulting in various chemically similar but functionally different proteins, each with a different use in the body.

The image below shows how amino acids possess the same base structure (H3N-CH-COOH) with a different side chain (highlighted in the different colours below) depending on the amino acid:

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UNDERSTANDING METABOLISM Metabolism falls under the science of biochemistry. Nutrition coaches need to understand what metabolism means and how it relates to the study of nutrition.

BIOCHEMISTRY Biochemistry (‘bio’ meaning biological) is the study of chemicals and chemical reactions in the body.

FUEL ENERGY

BIOCHEMISTRY WORK

Metabolism is a set of chemical reactions that release energy for all cellular processes and functions; all living organisms require energy to complete tasks such as walking, eating, sleeping and reproducing.

Hundreds of known metabolic pathways are in the human body, and many remain to be mapped. When food is eaten, it gets broken down and absorbed by the body, and the resulting nutrients get shuttled into the cells of the liver, muscles, and other tissues to be used for energy. The processes that nutrients (from food) go through in the body to produce energy are known as metabolism.(5)

METABOLIC PATHWAY A metabolic pathway refers to a series of processes found in biochemical reactions that help change (or transform) molecules or substrates into different, more readily usable materials.

Energy production occurs in the mitochondria of the cell. The mitochondrion is an organelle (or specialised structure) known as the powerhouse of cells and is where adenosine triphosphate or ATP is produced. ATP, known as the ‘energy currency’ of the body, makes all human processes possible.(6)

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The image below shows a mitochondrion and the pathways within it that each metabolite (glucose, fatty acid or amino acid) must go through for energy to be produced:

ATP FATTY ACIDS C A R NIT

MITOCHONDRION

IN E

FATTY ACIDS

ATP

TCA IP

L

LIP

B COQ10

B

ACETYL COA

CID CA OI B

ETC

B

B

B

O IC ACID

PYRUVATE

PYRUVATE

AMINO ACIDS

B

GLUCOSE

CYTOSOL

The production of energy (ATP) depends upon what is eaten and in what quantity. Carbohydrates are considered the primary metabolite in the human diet because the liver prioritises its processing before the other macronutrients. The only exception to this rule is alcohol, which the liver treats as a poison, prioritising its metabolism out of the body.

The liver is the main site for energy metabolism; therefore, this section will deal with processes as they occur in the liver.(5)

1. CARBOHYDRATES

2. PROTEIN

3. FATS

It is also essential for nutrition coaches to understand metabolism to understand the role each macronutrient (carbohydrate, protein, and fat) plays in energy production.

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The table below describes how each macronutrient is metabolised differently within the body:

HOW MACRONUTRIENTS ARE METABOLISED BY THE BODY PROTEIN METABOLISM Protein is an essential building block of many tissues in the body, and this is achieved through the breakdown of dietary protein into amino acids during digestion.

The main roles of amino acids in the liver are: Production of non-essential amino acids Energy production Ammonia removal and production of urea.

• • •

Protein is broken down in the stomach and small intestine into small proteins and amino acids, releasing energy (for the body to use). These amino acids are absorbed in the small intestine into the bloodstream and then sent to the liver for processing before being transported to where they are needed in the body.

Protein needs are based on activity level, illness and injury status, and age. Any amino acids the body needs are processed and excreted as ammonia and urea. When these by-products are in excess amounts (i.e. as a result of a high protein diet), they increase acid levels and place extra pressure on the kidneys. This is why it is important to maintain a protein intake that meets an individual’s Estimated Protein Requirements (EPR).

During periods of starvation or low energy intake, amino acids can be broken down to produce energy in the process HOWThisMACRONUTRIENTS ARE METABOLISED

BY THEimportant BODYfor many of gluconeogenesis. is not the primary purpose for amino acids since they are extremely other processes, and, as such, fatty acids are the preferred source for gluconeogenesis.

FAT METABOLISM Most dietary fats (excluding phospholipids and sterols) are broken down from triglycerides into free fatty acids and glycerol molecules during digestion, which are then transported to the liver for use.

The two metabolic roles for fats in the liver are: Lipogenesis Lipolysis.

• •

In the aerobic system (where oxygen is present), some fatty acids can enter the mitochondria and be burned directly to produce ATP. Where an excess of energy is available, in the fed state, fatty acids are packaged into triglycerides for storage in adipose (fat) tissue in a process called lipogenesis.

Where energy needs are not met from glucose, such as in the postabsorptive state, stored fats can be broken down by lipolysis into free fatty acids to be used for immediate energy during times of high demand (exercise or fasting).

Lipogenesis

Lipolysis.

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HOW MACRONUTRIENTS ARE METABOLISED BY THE BODY CARBOHYDRATE METABOLISM Beginning in the mouth, longer chains of carbohydrates break down into more simple sugars. Simple sugars and some di and polysaccharides are absorbed into the bloodstream and transported to the liver. The fibre component of carbohydrates remains within the digestive tract.

The liver removes approximately two-thirds of the simple sugars from the circulation for metabolism in the liver. The remaining third is stored as glycogen within the liver.

The metabolism of carbohydrates can occur through seven main pathways, four of which are discussed below: HOW MACRONUTRIENTS ARE METABOLISED BY THE BODY Glycolysis - the breakdown of glucose to produce ATP Gluconeogenesis - production of new glucose from fats or amino acids Glycogenolysis - the breakdown of glycogen into glucose CARBOHYDRATE METABOLISM Glycogenesis - the production of glycogen

• • • •

GLYCOLYSIS The primary energy production in the absorptive or fed state is from carbohydrates, lasting up to 4 hours.

During this time, the cells of the liver, muscles and other tissues prioritise burning glucose for energy until enough energy is present for fat storage to occur. Excess metabolites like glucose and fructose are converted to glycogen (glycogenesis) and triglycerides (lipogenesis) for storage.

For carbohydrate metabolism to occur, many steps must be followed using enzymes to convert glucose into a different molecule at each stage until ATP is produced.

GLYCOGENOLYSIS Once the absorptive state is passed, such as during sleep or fasting, the postabsorptive state is reached.

In this state, glucose is in short supply, so the hormone glucagon is produced, which stimulates the release of glycogen stores through glycolysis.

This enables the release of glucose which can then be metabolised via glycolysis.

GLUCONEOGENESIS Gluconeogenesis occurs in both the fed and postabsorptive states but is much more active in the post-absorptive state.

Gluconeogenesis is demand-driven, meaning that it occurs based on energy needs.

For instance, in a low carbohydrate diet where glucose requirements are not met from the diet, gluconeogenesis will produce new glucose from fats or amino acids to supply the brain with the glucose it requires.

GLYCOGENESIS Glycogenesis occurs in the fed state and is the production of glycogen from glucose for storage.

This process occurs when the cells of the body detect that they have enough energy in the cell and when blood glucose is in excess.

This is most likely to occur during excess energy intake (calorie surplus).

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The image below depicts a visual image that shows the metabolic pathways for these three main macronutrients:

FOODS

STAGE 1 STAGE OF HYDROLYSIS Hydrolysis of macromolecules to their subunits

1

CARBOHYDRATES

PROTEINS

LIPIDS

GLUCOSE

AMINO ACIDS

FATTY ACID & GLYCEROL

ATP

GLYCOLYSIS

+ H+

NADH PYRUVATE

STAGE 2

CO2

PREPARATORY STAGE Converion of subunits to acetyl CoA and production of small amount of energy ATP and NADH

ATP

PDH COMPLEX

2

NADH

+ H+

ATP

CO2

AcetylCoA

KREBS CYCLE NADH

STAGE 3

FADH2

ETC

OXIDATIVE STAGE In precence of O2 acetyl CoA is oxidised to CO2 and H2O by common final pathway TCA cycle.

Considerable ATP is produced in the process

e

3

+ H+

NH3

ATP

e O2

CO2

e H2O WASTE PRODUCTS

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BRINGING IT ALL TOGETHER (RELEVANCE TO NUTRITION) Although this introduction to chemistry does not address more complex structures, it does allow a nutritional advisor to understand the most basic form and, therefore, have a deeper understanding of the foods we eat and how they are formed.

Further, the chemical structure and how elements are arranged and react with one another have determined many of the names we now have for various foods. For example, carbohydrates are made up of carbon (C), hydrogen (H) and oxygen (O); hence their name.

OTHER EXAMPLES INCLUDE WATER: Water is commonly referred to as H2O simply due to its chemical formula, which was discussed previously, as it is made up of two hydrogen atoms and one oxygen atom.

SALT: Likewise, as mentioned above, salt is often referred to as sodium chloride. This is simply due to its chemical formula comprised of equal amounts of sodium and chloride.

OMEGA-3 AND OMEGA-6: These two types of fats receive their name directly from their chemical structure. In an unsaturated fatty acid molecule (this will be discussed later in this unit), one end of the molecule is called the omega; depending on how far along the molecule, a certain type of linkage occurs is what determines whether the fat is a 3 (if it is closer to the omega end) or a 6 (if it is further away).

Vitamin E

Vitamin A

Vitamin C

Vitamin K

Vitamin D

Vitamin C

Vitamin A

A

Mg

Ca

K

Cu

Fe

Ca

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UNDERSTANDING THE IMPORTANCE OF ESSENTIAL NUTRIENTS It is imperative to safely and effectively support clients with their nutritional needs and requirements, among the many roles of a nutrition coach. To do so, nutrition coaches need to understand the importance of and ability to identify essential nutrients required for optimal health and a functioning body.

Essential nutrients are called so because while they are essential for optimal health, the body cannot synthesise them on its own or in large enough quantities. Therefore, essential nutrients must be sourced from the diet. These nutrients are necessary for the body to function properly.

The six essential nutrients include: 1. Protein 2. Fats 3. Carbohydrates 4. Vitamins 5. Minerals 6. Water. *These nutrients can be divided into two major groups: macronutrients and micronutrients. Macronutrients include protein, fat, carbohydrates and water, and micronutrients include vitamins and minerals.

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MICRONUTRIENTS (A QUICK OVERVIEW) Micronutrients refer to elements (vitamins and minerals) required in trace amounts (very small amounts) that enable the body to produce enzymes, hormones and other substances required for normal growth and development. Even though micronutrients are only required in small amounts, depletion of any micronutrient can have devastating effects on the functioning of the human body.

Nutrition coaches need to understand what micronutrients are, the many roles they play in the human body, how they affect an individual’s health when an inadequate amount is consumed (deficiency) or if they are consumed to excess, and how to adapt an individual’s diet to ensure adequate micronutrition on a day-to-day basis.

Vitamins and minerals are required in small amounts to continuously assist with thousands of chemical reactions in the body.

These chemical reactions are responsible for hundreds of roles within the body, including (but not limited to): Improved immunity Bone strength and bone metabolism Blood clotting Nerve function Wound healing Metabolism of macronutrients Night vision Assists with constriction and relaxation of blood vessels pH regulation Regulates body fluid volume Normal function of all cells Glucose metabolism.

• • • • • • • • • • • •

Vitamins and minerals can be obtained from a healthy, varied diet, and consumption is required daily to avoid deficiencies. A healthy and well-varied diet will allow a person to reach all vitamin and mineral requirements without supplementation.

Understanding the importance of micronutrients gives a nutrition coach the ability to assist individuals in ensuring an adequate intake of micronutrients on a day-to-day basis.

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MACRONUTRIENTS (A QUICK OVERVIEW)

Carbs

Pteins

Fats Macronutrients are the foundation of all food sources; every single food and beverage comprises one or a combination of the four macronutrients. Macronutrients are organic compounds found in nature that are required in large portions to sustain vital processes of the human body, such as energy provision to maintain body functions (e.g. digestion of food and breathing) and to carry out daily activities (e.g. working and exercising).

The three macronutrients are explained in the table below:

MACRONUTRIENT

MAJOR FUNCTIONS

FOOD SOURCES

PROTEIN

Involved in every physiological process in the human body and is also important for building muscles and maintaining muscle health.

Meat, eggs, beans, lentils, legumes, tofu and dairy.

FAT

Improves satiety, plays an important role in cardiovascular and brain health, and assists with producing hormones and absorbing certain nutrients.

Visible fat on meat, butter lard and ghee, oils, nuts, seeds, avocados, oily fish and dairy.

CARBOHYDRATES

Provides the body with its preferred energy source and is the main source of dietary fibre to assist with gut health.

Starchy vegetables, fruit, bread, pasta, rice, oats, quinoa, couscous and other grains.

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Carbohydrates, fats and protein are the three macronutrients broken down into smaller structures in the human body and utilised for bodily functions, growth and energy.

Macronutrients provide energy in calories or kilojoules (kJ). Calories and kilojoules are both a measure of energy obtained from food; calories are the unit of measure more commonly used in America, whereas kilojoules are more commonly used in Australia. Throughout this course, all calculations require a final answer in kilojoules.

Proteins = 4 calories/16.7kJ (17kJ) per gram Fats = 9 calories/37.7kJ (38kJ) per gram Carbohydrates = 4 calories/16.7kJ (17kJ) per gra

• • •

BENEFITS OF KNOWLEDGE OF MACRONUTRIENTS AS A NUTRITIONAL COACH Nutrition coaches need a sound understanding of macronutrients’ role in the human body.

When it comes to understanding macronutrients, the key points that a nutrition coach will need to be aware of include: Understanding what macronutrients are and the different types The structure of macronutrients (how they are formed chemically) How much energy is obtained from each macronutrient How macronutrients are digested and utilised by the body The different sources of macronutrients (what food they are primarily found in) Standard dietary recommendations for each macronutrient Common myths and emerging trends regarding macronutrients.

• • • • • • •

This knowledge will allow a nutrition coach to appropriately assess a client’s diet and provide education and reliable recommendations to help their clients achieve optimal health and reach their personal goals.

*Macronutrients will be discussed in more detail later in this resource guide.

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UNDERSTANDING MACRONUTRIENTS: DIETARY PROTEIN WHAT IS DIETARY PROTEIN? The word protein comes from the Greek word ‘proteios’, which means ‘of first rank or importance’.

Protein is a nitrogen-containing macronutrient that is made up of amino acids. Amino acids are the building blocks of proteins, and proteins are often referred to as one of the building blocks of life. The nitrogen component of amino acids differentiates protein from carbohydrates and fats. These nitrogen-containing amino acids serve as the major structural component of muscle and other tissues in the body.

These biological processes include (but are not limited to): Tissue repair and production Hormone production Enzyme production Immune function Energy production Healthy hair, skin and nails.

• • • • • •

The human body is comprised of thousands of proteins, which define what an organism is, what it looks like and how it behaves.(7) The essential knowledge of protein, its roles, structure, sources, quality, intake and myths will be discussed in this section.

EXOGENOUS PROTEIN Exogenous protein is a dietary protein eaten, such as eggs, chicken or beef.

ENDOGENOUS PROTEIN Endogenous protein is a protein within the body, such as muscle tissue. Both protein sources can be used to make new proteins; however, we will focus solely on exogenous protein (dietary protein) within this unit.

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THE ROLE OF PROTEIN Protein has the strongest and longest-lasting satiety effect compared to carbohydrates and fats due to the complexity of its chemical structure, requiring more energy to break down than the other macronutrients, and its effect on satiety/hunger hormones.(8)(9)

As a nutrition coach, it is important to be aware of the role of protein and educate clients on how protein is essential for human health and wellbeing.

Humans require protein in regular, moderate quantities to ensure correct bodily function and overall health. A diet lacking in protein can lead to poor health outcomes, including weakness, fatigue, slowed recovery from exercise and muscle wastage. In extreme cases, a significant lack of protein can lead to protein-energy malnutrition (known as Kwashiorkor); however, this is seen in poverty-stricken regions where there are cases of severe starvation.(10) Protein is an energy-yielding macronutrient containing 17kJ per gram. It also has several other very important roles in the human body.

The primary role of protein relates to the structure, function and regulation of the body’s cells and tissues, which includes: Tissue repair and production (protein synthesis) Hormone production Enzyme production Immune function Energy production.

• • • • •

TISSUE REPAIR AND PRODUCTION Every day the human body builds up and breaks down protein in a constant cycle of protein synthesis (creation) and degradation (breakdown).

PROTEIN SYNTHESIS Protein synthesis is the production of new protein from amino acids, a process that is signalled by physiological needs, such as: Exercise (e.g. resistance training) Injury (e.g. burns) Illness.

• • •

Where protein synthesis (creation of new protein) is greater than protein degradation (breakdown of existing protein), the individual is commonly referred to as an anabolic state. Being in an anabolic state is beneficial for optimal tissue repair and recovery.

ANABOLIC STATE Anabolic state refers to the building or repairing of tissues. In an anabolic state, more proteins are being made than broken down.

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The synthesis of protein takes two steps: 1. Transcription 2. Translation.

STEP ONE: TRANSCRIPTION

STEP TWO: TRANSLATION

Transcription refers to: The transcribing of DNA from within a cell into a message that can be used to make new protein. This stage occurs within the nucleus of a cell. In this stage, an enzyme takes a copy of the information found within DNA and packages it in a message format known as mRNA (the ‘m’ stands for messenger). mRNA exits the cell’s nucleus and takes the message to an organelle within the cell called a ribosome. The role of ribosomes is to make protein, which signals the start of stage two: translation.

Translation refers to: The building of proteins is based on the information copied from the cell’s DNA. This stage takes place in the ribosome of a cell. In this stage, the ribosome holds the mRNA in place and calls upon the delivery of amino acids from tRNA (the ‘t’ stands for transfer).

Here, the mRNA gives instructions (given by the DNA) to the tRNA for which amino acids need to be delivered to match up with the correct codon sequence on the mRNA strand. Codons are explained in more detail in the video below. As tRNA delivers the correct amino acids to the ribosome, they are then bonded together to form a new protein molecule.

*DNA is a molecule of genetic code that contains all the necessary information to create any given structure in the human body. *mRNA is a molecule that carries the genetic information needed to create protein from the DNA to its required destination. *tRNA is a molecule that delivers amino acids to mRNA to create new proteins.

Protein synthesis is a complex process; however, it may be more easily understood by watching the video below:

PROTEIN SYNTHESIS CLICK HERE to watch the video.

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PROTEIN DEGRADATION Protein degradation is the breaking down of protein tissues due to a physiological impact such as: Exercise Injury Illness Lack of energy (for instance, in a calorie deficit).

• • • •

Where protein degradation (breakdown of existing protein) is greater than protein synthesis (creation of new protein), the individual is commonly referred to as a catabolic state. To be in a catabolic state is not optimal for tissue repair and recovery and could indicate the presence of illness, injury or disease.

CATABOLIC STATE The catabolic state refers to breaking down tissues. In a catabolic state, more proteins are broken down than made.

HORMONE PRODUCTION Some hormones are made with cholesterol (fats), while others are made from proteins known as peptides. Peptides are strings of amino acids connected with a special bond to form a protein (the structure of proteins is covered below).

The most common nutrition-related peptide hormones include: Insulin: A peptide hormone that regulates glucose by enabling it to enter the cell.

Leptin: A peptide hormone that regulates hunger by telling the brain the body is full.

Ghrelin: A peptide hormone that regulates hunger by increasing appetite.

• • •

GHRELIN

EAT

LEPTIN

STOP EATING

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ENZYME PRODUCTION Enzymes are molecules made from amino acids that accelerate chemical reactions within the body, speeding up processes like digestion and metabolism.

Enzymes function by reducing the amount of energy required for a reaction to occur, as shown in the image below:

Energy Supplied

WITHOUT ENZYME

WITH ENZYME

ENZYME ACTION Energy Released

REACTANTS GLUCOSE + O2

Activation energy without enzyme

Activation energy with enzyme

Overall energy released during reaction

PRODUCTS:

CO2 + H2O

Adapted from (source): Foundation, C. (2018). How Enzymes Speed Up Chemical Reactions. [online] CK-12 Foundation. Available at: https://www.ck12.org/book/ CBSE_Biology_Book_Class_XI/section/10.15/ [Accessed 18 Sep. 2018].

Each enzyme is designed to fit specifically with a certain type of molecule called a substrate. When an enzyme encounters a substrate, it binds to it and reacts (by joining or breaking bonds or changing acidity) to change the bound substrate in some way. Once the reaction has occurred, the enzyme releases the substrate and is free to react again with another substrate.

Adapted from (source): The Biochemistry Questions Site. (2008). Induced fit model of Enzyme-Substrate interaction. [online] Available at: https:// biochemistryquestions.wordpress.com/2008/07/15/induced-fit-model-of-enzyme-substrate-interaction/ [Accessed 22 Sep. 2018].

Enzymes are substances a living organism produces that act as catalysts to a specific biochemical reaction. Pepsin is the enzyme responsible for breaking down protein from food. Pepsin breaks the protein strands or the bond that attaches amino acids, setting the single amino acids free.(5)

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The following enzymes are all made from amino acids and have different functions: Pepsin and Trypsin break down dietary protein Amylase breaks down dietary carbohydrates Lipase breaks down dietary fats.

• • •

These enzymes all work by breaking the bonds that food particles contain into smaller pieces so they can eventually be absorbed and transported around the body. Enzymes regulate over 5,000 reactions in the body, and the body would not be able to function efficiently without them.(11)

IMMUNE FUNCTION Amino acids help to regulate the body’s defences (immune cells like macrophages and lymphocytes) against bacterial and viral infections. They are used to produce antibodies (cells that detect and help kill foreign bodies) and other substances that circulate in the blood. When a foreign virus or bacteria is detected, the antibodies help fight these infections.

Without adequate amino acids (such as glutamine), the production of immune cells, such as lymphocytes, can be reduced, resulting in a weakened and delayed immune response to viruses and infections. In layman’s terms, the time it takes for the body to react to an infection or virus can be delayed without the appropriate dietary protein intake.

LYMPHOCYTES Lymphocytes are white blood cells that circulate in the lymphatic system and form part of the immune system.

MACROPHAGES Macrophages are white blood cells that engulf and digest viruses, bacteria and dead cells.

ENERGY PRODUCTION Where carbohydrates (glucose) or fats (fatty acids) are not supplying enough energy, protein, or more specifically amino acids, from within the body can be used to produce energy as a backup source. This is known as gluconeogenesis and is most common during fasting, starvation, or intense or extended periods of exercise.

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THE CHEMICAL MAKEUP OF PROTEIN (UNDERSTANDING AMINO ACIDS) Protein is made up of amino acids. An amino acid is an organic compound and is the smallest unit of protein. They are made of carbon (C), hydrogen (H), nitrogen (N), oxygen (O) or sulfur (S) which are combined to form structures within the amino acid, such as amines (NH2) and carboxylic acids (COOH).

The image below shows some examples of amino acids and the chemical elements found within each.

Proteins are like a pearl bracelet - the ‘pearls’ being amino acids and the ‘thread’ being the bonds that attach the amino acids to form a protein.

For the human body to efficiently utilise protein, it must first be broken down into its smaller component, amino acids.

Once digestion breaks down dietary protein, single ‘free’ amino acids are transported to the liver to be repackaged and then sent to other areas of need within the body.

PROTEIN VS AMINO ACIDS: Protein and amino acids are not the same but are closely related. As discussed, amino acids are the smallest unit of a protein and are referred to as the building blocks of protein. Amino acids are strung together with special bonds called peptide bonds. Once existing in a string, these are referred to as peptides. Peptides can be short (2-20 amino acids in length) and are called oligopeptides or long (more than 20 amino acids in length) called polypeptides. Proteins are then the joining of two or more polypeptides.

As a result, proteins have a more defined structure and are more complex molecules, often thousands of amino acids long.

Although amino acids are all structured similarly, each one is chemically different. When linked together to form a new protein, the structures of the individual amino acids determine how they interact and form the shape and function of the new protein. Therefore, the amino acid profile influences how a protein is used in the body.

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Each amino acid has a specific shape and function. The name amino acid describes its structure: a nitrogen-based amine group (-NH2) connected to a carboxylic acid group (COOH). These structures are connected by carbon atoms and contain a side-chain of molecules that differentiates them as a specific amino acid. The nitrogen component of amino acids differentiates them from carbohydrates and fats.

The image below shows how the different amino acids have the same base structure but a different side chain. These differing side chains make each amino acid unique.

LEUCINE (LEU)

SERINE (SER)

CYSTEINE (CYS)

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ESSENTIAL VERSUS NON-ESSENTIAL AMINO ACIDS There are 500 naturally occurring known amino acids; however, only 20 are needed by humans, as they are found in the human body’s genetic code (DNA).

Of the 20 amino acids that are necessary for life: Nine (9) are considered essential, as they cannot be produced in the body and must therefore be obtained from the diet. These essential amino acids are commonly referred to as essential amino acids and abbreviated to EAAs. Six (6) are considered conditionally non-essential, as they can be made in the body; however, they may become essential during stress or nutrient deficiency/depletion.

Five (5) are non-essential and can be made in the body at any time.

• • •

Different foods contain varying amounts and types of amino acids. It is important to consume essential amino acids daily, whereas, for a healthy individual, the non-essential amino acids are not required to be consumed in the diet.

However, protein-rich foods often contain non-essential amino acids, so the body generally receives a supply.

The table below indicates which amino acids are essential and which are non-essential:

ESSENTIAL AMINO ACIDS

CONDITIONALLY NONESSENTIAL AMINO ACIDS

NON-ESSENTIAL AMINO ACIDS

Histidine

Arginine

Alanine

Lysine

Cysteine

Aspartic Acid

Threonine

Glutamine

Asparagine

Isoleucine

Glycine

Glutamic acid

Leucine

Proline

Serine

Methionine

Tyrosine

Phenylalanine Tryptophan Valine

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COMPLETE VERSUS INCOMPLETE PROTEINS Complete proteins are sources of protein that contain all nine essential amino acids, and incomplete proteins refer to proteins that do not contain all nine essential amino acids.

The table below discusses the difference between complete and incomplete proteins in more detail:

COMPLETE PROTEINS

INCOMPLETE PROTEINS

Proteins that encompass all the nine essential amino acids are thought of as complete proteins.

Proteins that do not contain all nine essential amino acids are considered incomplete proteins.

Complete proteins are important because they provide the full range of essential amino acids which cannot be produced in the body. Without a regular supply of these amino acids, muscle tissue will be broken down to supply them, which is not ideal for long-term health.

Plant foods are predominantly incomplete protein sources; however, this does not mean they are lowquality proteins.

These complete proteins mostly come from animal sources, such as: Eggs Chicken Beef Lamb Pork.

• • • • •

Examples of incomplete proteins include: Grains such as rice, pasta and bread (lack/low in threonine, leucine, lysine and histidine) Legumes such as beans, peas and lentils (low in methionine) Starchy vegetables such as potato, pumpkin and sweet potato (low in lysine) Nuts such as walnuts, macadamia and almonds (low in threonine).

• • • •

And some plant sources, such as: Quinoa Buckwheat Soy Quorn (a meat substitute made from a fungus).

• • • •

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COMBINING DIFFERENT FOODS TO FORM ‘COMPLETE’ PROTEINS Simply because a type of protein is incomplete does not make it inferior. Incomplete proteins can be combined to form the full range of essential amino acids to create a complete protein. Someone following a vegetarian or vegan diet should consider doing this to ensure they are consuming all of the essential amino acids in their diet, especially if they are exercising regularly.

A further benefit of combining plant-based foods in the diet (to achieve a complete range of essential amino acids) is the other nutrients accompanying them, including fibre, vitamins and minerals.

Two plant foods with varying amino acid profiles must be combined. Proteins combined to make a complete amino acid profile (containing all the nine essential amino acids) are known as complementary proteins, after which they can be classified as complete proteins.(12) Examples of complementary proteins include (but are not limited to): Spinach salad with almonds Hummus and whole-grain pita bread Navy beans (baked beans) on wholemeal toast Natural peanut butter wholemeal sandwich Black beans with rice (white or brown) Tofu with rice (white or brown) Macaroni and cheese.

• • • • • • •

Complementary proteins do not necessarily need to be eaten together; however, since the body has limited capacity for storing amino acids, they should be eaten throughout the day.(12)

GRAINS

SEEDS

DAIRY PRODUCTS

LEGUMES

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BRANCHED CHAIN AMINO ACIDS (BCAAS) As a nutrition coach, it is important to be familiar with relevant industry terms and language. BCAAs are commonly used in the fitness industry, as BCAAs are well known for their effect on muscle growth and tissue repair. Understanding this will give a nutrition coach an advantage in assisting clients who compete at a professional level (athletes) and the general public who participate in daily physical activity BCAAs refer to the following three essential amino acids: 1. Leucine 2. Isoleucine 3. Valine.

LEUCINE Leucine promotes muscle protein synthesis, while isoleucine and valine may help with energy production during exercise by reducing fatigue and muscle degradation (breakdown of muscle tissue).(13)

These essential amino acids are called branched-chain amino acids, as their side chain contains a secondary branch of three carbon atoms. This differentiation in structure from the other amino acids is the origin of their unique classification and name of BCAAs. In addition to their chemically unique structure, BCAAs also have another unique characteristic; they are metabolised in skeletal muscle. This is why BCAAs are well known for their ability to effectively repair muscle tissue, reduce muscle fatigue and avoid muscle tissue degeneration, and hence why they are popular in the fitness industry.

The necessity of BCAA supplementation is often a topic of debate, especially when BCAAs are already found in whole food sources. While whole food sources are always encouraged as the first approach to take, it is still important to be aware of the benefits of supplementing with BCAAs, and when supplementing with either a pure BCAAs product or a whole protein product (i.e.whey protein) may be appropriate.

BCAAs will be discussed in more detail in the unit NAT11046006 (Advise Clients on the Use of Nutritional Supplements and Ergogenic Aids) unit.

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SOURCES OF PROTEIN Protein is found in animal and plant-based food sources, including meat, fish, eggs, pulses, nuts, seeds and dairy products.

It is important to remember that 100g of food (e.g. 100g of chicken) does not equate to 100g of protein.

For example, 30g of protein is found in approximately 150g of red meat, 100g of white meat, 150g of fish, 5 large eggs or 1L of milk.

Some foods are higher in protein and are more bioavailable. Below is a table of common protein sources and the amount of protein found in a 100g serve. It is imperative to note that the protein content of a food is only a portion of the total serving size, not the entire weight of the food. For example, 100g of baked snapper has 26g of protein; therefore, only 26% of the serving is protein.

BIOAVAILABILITY Protein bioavailability measures how well protein is absorbed and utilised in the body. ‘Bioavailability’ refers to the degree to which a substance can be absorbed and utilised by the body. There is an array of factors that will affect a protein’s bioavailability, such as the type and amount of amino acids that are present in the food, the chemical structure of the protein consumed, the amount and effectiveness of an individual’s protein-digesting enzymes and the type of dietary protein sources consumed.

FOOD

PROTEIN(14)

POULTRY 100g chicken breast (skin off/grilled)

31

100g chicken thigh (skin off/grilled)

25

RED MEAT 100g lean sirloin steak (grilled)

30

100g lean beef mince (raw)

21

100g lean tenderloin steak (raw)

19

PORK 100g lean tenderloin steak (raw)

FOOD

100g bacon (middle rasher, lean, fried)

24

PROTEIN(14) 31

LAMB

FOOD

100g lamb leg (boneless, roasted)

PROTEIN(14) 30

SEAFOOD 100g tuna (in oil, drained)

24

100g snapper (baked)

25

100g salmon (grilled)

24

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FOOD

PROTEIN(14)

EGGS 1 egg (whole, large, hard-boiled)

FOOD

1 egg (white only, large, poached)

6

PROTEIN(14) 3

DAIRY 100g regular cheddar cheese

25

100g cottage cheese (low-fat)

10

100g plain Greek yoghurt (low-fat)

10

250ml milk (low-fat)

FOOD

250ml milk (full cream)

10

PROTEIN(14) 9

NUTS AND SEEDS 100g peanuts (dry roasted, no salt)

24

100g almonds

20

100g sunflower seeds (dry roasted, no salt)

19

100g pumpkin seeds (pepitas, dried)

30

100g cashews (dry roasted, no salt)

15

100g walnuts (raw)

FOOD

100g macadamias (raw)

14

PROTEIN(14) 8

LEGUMES AND GRAINS 100g kidney beans (raw)

7

100g chickpeas (raw)

6

100g soybeans (dry roasted)

40

100g lentils (boiled)

7

100g canned baked beans in tomato sauce

5

100g brown rice (boiled)

FOOD

100g white rice (boiled)

3

PROTEIN(14) 3

SUPPLEMENTS 30g scoop whey protein isolate (WPI) 30g whey protein concentrate (WPC)

FOOD

30g soy protein

26 21

PROTEIN(14) 23

MISCELLANEOUS 100g tofu (firm, hard)

12

250ml coconut milk

1

100g coconut yoghurt

1

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DETERMINING THE QUALITY OF PROTEIN The quality of a protein is vital when considering its nutritional benefits. A protein’s quality is determined by assessing its essential amino acid composition, digestibility and bioavailability of amino acids (the amount absorbed and utilised by the body).(15) The main tests used to determine the quality of a protein are explained below: Digestible Indispensable Amino Acid Score (DIAAS) Protein Digestibility Corrected Amino Acid Score (PDCAAS) Protein Efficiency Ratio (PER) Biological Value (BV) Net Protein Utilisation (NPU) or Net Nitrogen Utilisation (NNU).

• • • • •

DIGESTIBLE INDISPENSABLE AMINO ACID SCORE (DIAAS) The DIAAS is the current gold standard scoring system used to evaluate the quality and digestibility of protein in food that has been adopted by the Food and Agriculture Organisation (FAO) of the United Nations. This measurement method is based on the ileal digestibility of the indispensable amino acids (IAAs) in a source of ingested protein, as entire amino acid absorption occurs in the small intestine.(16) Values for individual amino acids can also be determined using the DIAAS method. The difference between the ingested dietary amino acids and the amino acids in the ileum is calculated and expressed as a percentage which gives a digestibility score. Testing is not done in humans for ethical and logistical reasons, with pigs generally used as the animal model preference over rats. This method is recommended as an appropriate FAO model and still gives a true ileal amino acid digestibility score.(17) The DIAAS calculates amino acid requirements across three age groups, whereas the PDCAAS only measured one age group. The three groups are: Birth to six months Children aged six months to three years A group inclusive of children aged three years through to adolescents and adults.(16)

• • •

Values can then be used to make claims on a food’s protein quality. DIAAS scoring is as follows:

FOOD

DIAAS VALUE

PROTEIN QUALITY CLAIM

>100

Excellent

75-99

Good

<75

Cannot claim

A food must have all the essential amino acids required to be considered a complete or high-quality protein. The food’s amino acid with the least concentration (limiting amino acid) is used to assign the DIAAS value.(16) For example, suppose a food contributes only 36 mg/g of leucine; the requirement is 66mg/g, but it contributes more than the required amounts of other essential amino acids. In that case, the DIAAS is calculated on leucine. In this example the score would be 0.55 (36 / 66 = 0.55).

Animal proteins generally receive a protein quality score of ‘excellent’ as they have DIAAS values >100.(18) Plant proteins, including cereal grains, generally cannot be claimed as high-quality protein food due to DIASS values <75; however, there are some exceptions to this.

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The DIAAS value of soy protein can be between 75 and 100, and oats come in at around 75.(19) Another study found similar values with oats (dehulled) at 77.(20) A 2019 study found a DIAAS value of 43 for hulled oats, concluding that only dehulled oats and not hulled oats could be classed as a good protein source.(21) Based on the research, when high-quality protein cannot be consumed (or consumed in sufficient quantities), a variety of plant and cereal foods as mixed meals (preferably with smaller amounts of animal protein) across the day will help to meet amino acids acid requirements. This strategy will improve the overall DIAAS value of the meal.(16)(22)

PROTEIN DIGESTIBILITY CORRECTED AMINO ACID SCORE (PDCAAS) PDCAAS was the previous gold standard to measure the protein quality of food and has been used for more than 20 years by the U.S. Food & Drug Administration (FDA), the United Nations Food & Agricultural Organization (FAO) and the World Health Organization (WHO) as their preferred method for evaluating food protein.

PDCAAS measured the quality of a protein food based on the amino acid requirements of two to five-year-olds. This is because they are considered the most protein-dependent age group due to their constant growth. The amount of different amino acids in a protein-based food is calculated and compared to the amount of essential amino acids required by a two to five-year-old.

The digestibility of the food is also considered identifying how much of the protein is absorbed by the body. In the case of the PDCAAS, this measurement is taken from faeces. The highest possible PDCAAS is 1.0. A score of 1.0 means that after digestion of the food, it provides 100% or more of the recommended amount of essential amino acids per gram of protein, which is why the DIAAS came in to give the values >100%.

PROTEIN EFFICIENCY RATIO (PER) The protein efficiency ratio (PER) controls a protein’s effectiveness by measuring animal growth. This technique entails feeding rats a test protein and then measuring the weight gain in grams per gram of protein consumed.

This value is then compared to a normal value of 2.7 (which is the standard value of casein protein). Any value that surpasses 2.7 is considered an excellent source of protein. However, while this calculation provides a measure of growth in rats, it does not provide a correlation to the growth needs of humans.

BIOLOGICAL VALUE (BV) Biological value (BV) measures protein quality by calculating the nitrogen used for tissue formation divided by the nitrogen absorbed from food. This product is multiplied by 100 and expressed as a percentage of nitrogen utilised.

The BV provides a measurement of how efficiently the body utilises consumed protein. A protein food with a high BV correlates to a high supply of essential amino acids. Animal sources typically possess a higher BV than plant sources due to plant sources lacking or low in one or more of the essential amino acids.

However, there are some problems with this rating system. The BV measures a protein’s maximal potential quality and not it’s average at required levels. The BV does not consider several key factors influencing protein digestion and interaction with other foods before absorption.

Bioavailability refers to the amount of absorption, and the BV is a test used to measure a protein’s quality; therefore, they are not referring to the same thing.

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NET PROTEIN (NITROGEN) UTILISATION (NPU OR NNU) Net protein utilisation (NPU) is like the BV, except it involves a direct measure of retention of absorbed nitrogen (N).

NPU and BV both measure the same parameter of nitrogen retention; however, the difference lies in that the BV is calculated from nitrogen absorbed, whereas NPU is calculated from nitrogen ingested. In other words, nitrogen quantity is measured when ingested, excreted nitrogen is measured, and finally, a percentage (%) is given to the utilisation (absorption) of the protein.

Bioavailability refers to the amount of absorption, whereas NPU is a test used to measure a protein’s BV. These words can, therefore, not be used interchangeably.

While vegetarians, pescatarians, and vegans may have fewer protein intake options, they can still meet their protein requirements through plant-based protein sources. Individuals who do not consume animal flesh will obtain all their protein and amino acid requirements through plant and marine-based sources such as nuts, seeds, beans, lentils, legumes, fish and eggs.

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PROTEIN QUALITY RANKINGS The table below shows the difference in amino acid scores for various protein powders and high-protein foods using the PER, BV, NPU, DIAAS and PDCAAS and their limiting amino acids. The ideal score for a high-quality protein and optimal digestibility is 1.0 or higher.(16)(20)

PROTEIN SOURCE

PER

BV (%)

NPU PDCAAS (%) SCORE

DIAAS SCORE

CASEIN PROTEIN

2.5

77

76

1.00

1.23

Methionine and Cysteine

WHOLE MILK

2.5

91

82

1.00

1.14

Methionine and Cysteine

EGG (HARDBOILED)

3.9

100

94

1.00

1.13

Histidine

BEEF

2.9

80

73

1.00

1.11

Tryptophan

CHICKEN BREAST

2.7

79

87

1.00

1.08

Tryptophan

WHEY PROTEIN CONCENTRATE

3.6

104

92

1.00

0.97

Histidine

SOY PROTEIN ISOLATE

2.1

74

61

0.98

0.90

Methionine and Cysteine

PEA PROTEIN CONCENTRATE

1.42

65

47

0.89

0.82

Methionine and Cysteine

COOKED PEAS

1.4

57

4454

0.60

0.58

Methionine and Cysteine

TOFU

1.9

74

65

0.56

0.52

Methionine and Cysteine

RICE PROTEIN CONCENTRATE

2.0

59

57

0.42

0.37

Lysine

LIMITING AMINO ACID

Based on the above table, most high-quality proteins come from animal sources. This is primarily due to the ‘completeness’ of protein.

The Digestible Indispensable Amino Acid Score (DIAAS) is the new gold standard that has replaced the previously used gold standard Protein Digestibility-Corrected Amino Acid Score (PDCAAS). The recent recommendation for using the newer updated DIAAS scoring system is due to its greater accuracy in measuring protein digestibility.(23) The main reasons for the change are the flaws in the PDCAAS method, which measures faecal protein digestibility. The true values can be falsely enhanced due to the bacterial metabolism of amino acids in the colon, which returns higher bioavailability/protein quality scores for low-quality proteins.(16) The PDCAAS method was also found to cut off the scoring at a maximum level of 1.0, meaning high-quality proteins with a score >1.0 were not distinguishable as such.(17) Another limitation of the PDCAAS was the assumption that all amino acids had the same level of digestibility.(19) The DIAAS measures ileal digestibility, a more accurate estimate of the amount of proteins that make their way to the end of the small intestine.(24)

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RECOMMENDED DAILY INTAKE FOR PROTEIN Most health organisations recommend a protein intake of ~0.8-1.0g per kg of body weight per day; however, this recommendation can increase depending on physical activity levels, disease states, goals, trauma and stress levels.

Protein is required for cells to grow, repair and function in the body; it is essential for building and maintaining muscle and maintaining a strong immune system. It is important to remember that even sedentary individuals require moderate amounts of protein (at the lower end of the range). Older adults also have increased protein requirements to reduce the effect of ageing-related muscle decline, known as sarcopenia.

Protein requirements are always presented in a range, not one singular number, as consuming within a range of grams is more realistic and achievable. Consuming 20g under or over the calculated range is acceptable, considering there are small amounts of protein in many food items.

Protein requirements increase as physical activity levels increase. This is to aid in muscle maintenance, recovery and synthesis while still consuming adequate protein to support basic functions such as cell repair and immune function. It can sometimes be difficult to decide their physical activity level. Therefore, recommending to consume towards the lower or higher end of their calculated EPR is an easier way to ensure they are consuming appropriate amounts of protein for the amount of exercise they are engaging in.

FOOD

PHYSICAL ACTIVITY

PROTEIN(G)/BODY WEIGHT(KG)/DAY

SEDENTARY (Sedentary job, nil physical activity)

0.8-1.0g per kg body weight per day.

MODERATE-INTENSITY (1-3 days moderate-intensity activity per week)

1.0-1.5g per kg body weight per day.

HIGH-INTENSITY (Four days or more high-intensity activity per week)

1.5-2.0g per kg body weight per day.

EXAMPLE ONE (HIGH INTENSITY) A 90kg male who exercises at a high-intensity >4 times per week would require 1.5-2.0g of protein per kg per day.

1.5 x 90 = 135g 2.0 x 90 = 180g Therefore, this male would require 135-180g of protein per day.

EXAMPLE TWO (SEDENTARY) A sedentary 52kg female would require 0.8-1.0g of protein per kg per day.

0.8 x 52 = 42g 1.0 x 52 = 52g Therefore, this female would require 42-52g of protein per day.

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BENEFITS OF PROTEIN ABOVE THE RDI Studies have looked extensively at the health and performance benefits of increased protein intake and how higher intakes, particularly for very active individuals and athletes, can improve exercise performance, body composition, strength and hormone profiles.(25)(26) Protein recommendations are based on nitrogen balance; a term used to describe the intake and excretion of nitrogen from protein. If you are in a positive nitrogen balance, you are consuming more protein than excreting, so your body is in an anabolic (building) state. If you are in a negative nitrogen balance, you are excreting more protein than you are consuming, and your body is in a catabolic (breaking down) state.(27) Research has found the ideal protein intake for active individuals to maximise performance, control appetite, boost metabolism and increase strength is between 1.4 – 2.0 g/kg of body weight per day. Protein is ideally consumed across the day with every meal and should come from whole food sources containing all the essential amino acids and are rich in leucine, which will be discussed in more detail shortly.(28) It stands to reason that if you are more active, you will require more protein to preserve lean muscle tissue and support the human body’s metabolic processes.

OLDER ADULTS Older adults may have an increased need for protein, with requirements above those for younger adults necessary to stimulate MPS, especially if they exercise. If the same amount of protein were consumed by a 20-year-old and a 60-year-old, the MPS stimulus rate would be lower for the older adult. When higher protein is ingested, especially if it is high in the amino acid leucine, then MPS response may have a negligible difference.(29) Recommendations for older adults to consume protein above the RDI of 0.8 g/kg body weight per day have been suggested by the Academy of Nutrition and Dietetics to be up to 1.6 g/kg of body weight per day to mitigate muscle mass loss.(30) Studies have demonstrated that whilst 20g of protein is enough to stimulate MPS in younger adults, 3040g of high-quality protein would be required to maximise MPS in older adults.(31) 40g of protein has also been observed to be the optimal amount to maximise anabolic potential after resistance training.(32) VAST FITNESS ACADEMY | NAT11046002: APPLY THE FUNDAMENTALS OF NUTRITION TO MEET A CLIENT’S DIETARY NEEDS | VERSION 1 - 23.01.2023

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COMMON MYTHS ABOUT PROTEIN Many myths about protein circulate in the community, especially in health and fitness. Below are some evidence-based answers to common myths:

MYTH

FACT

THE BODY CAN ONLY ABSORB AND USE 25G OF PROTEIN IN ONE MEAL.

The body will absorb all protein from a meal, but how much protein it uses is demand-driven; for instance, a bodybuilder will likely require and use more protein than a sedentary, untrained office worker because the body of the former has a higher requirement for muscle repair and growth.

EXCESS PROTEIN WILL TURN TO FAT IF NOT USED BY THE BODY.

If a client exceeds their EER, excess energy from any macronutrient source (including protein) will be stored as fat.

The human body cannot store excess amino acids. Unneeded amino acids get broken down by the liver and removed by the kidneys.

CONSUMING A HIGH PROTEIN DIET CAN CAUSE KIDNEY DAMAGE.

Diets high in protein increase the production of urea and ammonia, which increases waste processing in the liver and kidneys. Recent scientific reviews of protein dosing and health have confirmed the safety of high protein diets in adults with healthy kidneys and no history of kidney disease.(21) However, there has been very little proven benefit in increasing protein intake above the EPR.(21) Protein needs will vary depending on activity level, gender and age. As such, it is important to remain within the recommended EPR ranges for each individual to meet their goals and avoid compromising intake of other important nutrients.

IT IS BEST TO CONSUME PROTEIN WITHIN 30 MINUTES OF FINISHING A RESISTANCE WORKOUT.

Consuming protein is recommended within 2 hours of resistance training to promote immediate muscle recovery, but protein demand can be elevated for up to 24-48 hours.

So regular dosing of protein every 3-4 hours is recommended.

(21)

CONSUMPTION OF EXCESS PROTEIN WILL RESULT IN MUSCLE GAIN EVEN IF A CLIENT DOES NOT PARTICIPATE IN ANY PHYSICAL ACTIVITY.

PROTEIN IS ONLY NEEDED FOR THOSE WHO EXERCISE REGULARLY OR WANT TO PUT ON MUSCLE MASS.

Without sufficient physical stimulus (e.g. resistance training), the excess protein will be excreted from the body, and muscles will not grow.

Adequate protein is essential for growth, repair, hormone and enzyme production, and overall health throughout the lifespan, regardless of lifestyle; it is needed for all biological processes daily and is essential for optimal health, even in individuals who do not exercise.

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UNDERSTANDING MACRONUTRIENTS: CARBOHYDRATES WHAT ARE CARBOHYDRATES Carbohydrates are organic compounds made up of sugars or starches. The body utilises this macronutrient as an immediate source of energy. Carbohydrates are a major food source and a key form of energy for most organisms. One gram of carbohydrate provides approximately 17kJ of energy or 4 calories of energy.(34) Regardless of origin, all carbohydrates are broken down into a simple sugar, depending on their source and structure.

These are most commonly glucose (honey), fructose (from fruit) and galactose (from dairy).(35)(36) Certain parts of the carbohydrate (such as starch and fibre) slow the release of sugar into the bloodstream, resulting in increased satiety, improved gut flora (by acting as a prebiotic) and regulated bowel motions. While the body breaks down starch into simple sugars, fibre passes through relatively undigested. The fact that fibre is not broken down does not void its importance in the human diet as it dramatically benefits bowel motions, gut flora and satiety.

The Australian Government recommends carbohydrate intake to be approximately 45-65% of the diet, focusing primarily on low GI carbs. It is important to keep in mind the type of client you’re working with, their goals, and their need for carbohydrates when determining where in this range they will sit.(35)(34) As a nutrition coach it is important to understand carbohydrates’ role in the human body to assist with individualised macronutrient recommendations.

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THE ROLE OF CARBOHYDRATES As a nutritional advisor, it is important to understand the essential role carbohydrates play in the human body, as this will assist with individualised macronutrient recommendations and ensure clients’ long-term health.

Carbohydrates have three fundamental roles in the human body: 1. Provide the body with an immediate fuel supply 2. Provide the body with stored energy in the form of glycogen.

3. Assist with digestive health.

PROVIDE THE BODY WITH AN IMMEDIATE FUEL SUPPLY As previously mentioned, carbohydrates are broken down in the body to their simplest form: glucose. Glucose is the body’s preferred fuel source because the brain and red blood cells cannot survive without it.(37) Glucose has fewer biochemical pathways to go through before producing usable energy. Even during starvation, the body will convert noncarbohydrate sources (such as fat and muscle) into glucose for fuel to ensure survival.

Contrary to popular belief, carbohydrates do not always provide the body with immediate energy. Complex sources of carbohydrates (such as starchy vegetables and whole grains) come packaged with dietary fibre, which slows the release of glucose into the bloodstream. This prolongs the release of glucose for more sustained energy. Further, when carbohydrates are consumed in a meal with protein and dietary fat, this too slows the release of glucose into the bloodstream.

For example, if immediate energy is required for individuals partaking in long-distance or high-intensity exercise events, then simple carbohydrate sources can be consumed. This resource will discuss the types of carbohydrates (simple and complex) and their sources in more detail.

PROVIDE THE BODY WITH STORED ENERGY When more carbohydrates are consumed than burned, excess carbohydrates are converted to fatty acids and stored as fat. When fat is required for energy, fat is converted back to glucose through a process known as gluconeogenesis, which is then used for energy. This type of energy can be used at a later stage when there is no immediate supply of glucose in the blood.

ASSIST WITH DIGESTIVE HEALTH AND DISEASE PREVENTION Carbohydrates are essential to maintaining digestive health as they are the primary source of dietary fibre. Without adequate intake of carbohydrates, it is unlikely that an individual will meet their daily fibre intake.

The fibrous components of carbohydrates (discussed later in this resource) have several important roles within the digestive system, such as: Feeding gut bacteria Regulating bowel motions Optimising cholesterol levels Regulating sugar levels, and Decreasing risk of bowel disease.

• • • • •

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THE CHEMICAL MAKEUP OF CARBOHYDRATES Carbohydrates have been given their name because they contain carbon, hydrogen and oxygen at the chemical level.

No matter how big or small, all carbohydrates are composed of carbon, hydrogen and oxygen with the general formula of CH2O. For example, a simple sugar molecule like glucose comprises six carbon atoms, 12 hydrogen atoms, and six oxygen atoms; therefore, the formula for glucose is C6H12O6.

Carbohydrates can be divided into two main categories: simple and complex.

They differ by how many sugar molecules they are made up of and the length of their chains (outlined below): Simple carbohydrates include: Monosaccharides Disaccharides

• •

Complex carbohydrates include: Oligosaccharides Polysaccharides

• •

C6H1206 = GLUCOSE

The below diagram further displays what each category of carbohydrate is comprised of:

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SIMPLE CARBOHYDRATES

Simple carbohydrates refer to carbohydrate-rich foods which are less complex, have minimal/less dietary fibre, and are therefore more rapidly broken down within the body. This results in a quicker release of sugar in the bloodstream and a faster immediate energy supply. Examples of simple carbohydrates are foods that have been processed or refined, such as fruit juice, lollies and sugary cereals.

Simple carbohydrates are quicker to break down in the body than complex carbohydrates because they are shorter in length.

Simple carbohydrates include:(36) Monosaccharides (one sugar molecule in length) Disaccharides (two monosaccharides joined together).

• •

MONOSACCHARIDES ‘Mono’ refers to one, and ‘saccharides’ refers to sugar; therefore, monosaccharides refer to carbohydrates that are one sugar molecule in length. Monosaccharides are the simplest form of carbohydrates, meaning that carbohydrates cannot be broken down any further than into monosaccharides.

There are three monosaccharides: glucose, galactose and fructose. All three of these sugars have the same molecular structure of C6H12O6; however, the carbon, hydrogen and oxygen atoms are arranged differently for each sugar.

GLUCOSE

GALACTOSE

A monosaccharide found widely across most areas of the diet, including vegetables, grains, fruit and dairy.

A monosaccharide found predominantly in dairy products, such as milk, yoghurt and cheese.

FRUCTOSE A monosaccharide found predominantly in fruit and honey.

Within one to two hours of eating, the body will convert all sugars into glucose to be converted into energy and used throughout the body. This conversion to glucose affects an individual’s blood glucose levels.

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DISACCHARIDES ‘Di’ refers to two, and ‘saccharides’ refers to sugar; disaccharides refer to carbohydrates, two sugar molecules in length.

In other words, disaccharides are made of two monosaccharides joined together.

Disaccharides are broken down in the body to their most simple form: monosaccharides. For example, when the disaccharide lactose is broken down, it is broken into the monosaccharides glucose and galactose.

There are three disaccharides: 1. Sucrose 2. Maltose 3. Lactose.

Sucrose, maltose and lactose are broken down in the body to their simplest form of monosaccharides. These are outlined in the table below:

SUCROSE

MALTOSE

LACTOSE

(GLUCOSE + FRUCTOSE)

(GLUCOSE + GLUCOSE)

(GLUCOSE + GALACTOSE)

A disaccharide that is made up of glucose and fructose.

A disaccharide that is made up of two glucose molecules joined together.

A disaccharide that is made up of galactose and glucose.

Sucrose is naturally produced from sugar cane or sugar beets and, when refined, is made into what is commonly referred to as table sugar.

Maltose is created in seeds and other parts of a plant as it breaks down its stored energy to sprout.

Lactose is the natural sugar in dairy products, such as yoghurt, cheese and milk.

Lactase is an enzyme in the small intestine responsible for the breakdown of lactose. Individuals who do not have this particular enzyme, or have only small amounts of this enzyme, may experience bloating, flatulence and abdominal cramping due to lactose maldigestion. This is known as lactose intolerance.

Without sufficient physical Without sufficient physical stimulus (e.g. resistance stimulus (e.g. resistance training), the excess protein will training), the excess protein will be excreted from the body, and be excreted from the body, and muscles will not grow. Amino Sucrose is naturally produced muscles will not grow. Amino acids help repair muscle tissue from sugar cane or sugar beets acids help repair muscle tissue VAST FITNESS ACADEMY | NAT11046002: APPLY THE FUNDAMENTALS OF NUTRITION TO MEET A CLIENT’S DIETARY NEEDS VERSION 1 -increasing 23.01.2023 after |exercise, muscle 57 and, when refined, is made into after exercise, increasing muscle (21) growth.

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COMPLEX CARBOHYDRATES Complex carbohydrates refer to sugar molecules strung together in long, complex chains. Due to the length of the chain and the fibrous and starchy components of the carbohydrate, complex carbohydrates take longer for the body to break down. As a result, complex carbohydrates have a slower release of glucose into the bloodstream. This is beneficial in assisting with satiety, cravings and energy levels.

Complex carbohydrates can be found in whole foods; however, they can also be found in foods that have been minimally processed but are still considered beneficial for health.

Examples of these foods can be seen in the table below:

WHOLE FOOD SOURCE

MINIMALLY PROCESSED SOURCE

Sweet potato, white potato, corn and pumpkin

100% whole wheat pasta

Quinoa

Wholegrain and whole meal bread and wraps

Brown rice and wild rice

Wholegrain cereals (e.g., Weetbix)

Steel cut and rolled oats

Couscous

Beans, peas and legumes (e.g., chickpeas and lentils)

White rice

Buckwheat and barley

Wholegrain crackers

The above foods are a source of carbohydrates that still have their natural dietary fibres (such as the skin, seeds and husk) and starches.

Complex carbohydrates include: Oligosaccharides (three to nine sugar molecules in length) Polysaccharides (>nine sugar molecules in length).

• •

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OLIGOSACCHARIDES ‘Oli’ is a Greek word referring to ‘a few’, and ‘saccharides’ refers to sugar molecules; therefore, oligosaccharides refer to a few (three to nine) sugar molecules linked together. As with disaccharides, the body breaks down oligosaccharides into their simplest form: monosaccharides. However, because the chain for oligosaccharides is longer and more complex, oligosaccharides take longer for the body to break down than disaccharides.

There are two types of oligosaccharides (raffinose and stachyose):

RAFFINOSE

STACHYOSE

MOLECULE STRUCTURE:

MOLECULAR STRUCTURE:

C18H32O16

C24H42O21

Raffinose is an oligosaccharide containing three monosaccharides: fructose, glucose and galactose.

Sources include: Beans Cabbage Brussel sprouts Broccoli Asparagus Avocado Apples Whole grains.

• • • • • • • •

Stachyose is an oligosaccharide containing four monosaccharides: one glucose, one fructose and two galactose molecules.

Sources include: Green beans and other bean varieties Split peas and other pea varieties Human milk

• • •

Fermentation of raffinose in the large intestine can result in extra flatulence. One of the enzymes needed by the body to break down raffinose is called alpha-galactosidase (located in the small intestine).

Individuals who don’t have enough of this enzyme will pass raffinose-containing food into the large intestine as a food source for bacteria. Bacteria will ferment the food and, as a result, form hydrogen, carbon dioxide and sometimes methane as waste products. These waste products are what cause flatulence in individuals. However, this is not a bad thing. The increase in flatulence is only temporary (and perfectly normal) and is no reason to avoid any of these highly nutritious foods.

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POLYSACCHARIDES ‘Poly’ refers to many, and ‘saccharides’ refers to sugar molecules; therefore, polysaccharides incorporate all sugar molecules equal to or greater than ten monosaccharides in length.

As with disaccharides and oligosaccharides, the body breaks down polysaccharides into their most simple form of sugar molecules: monosaccharides. Because polysaccharides are longer and more complex in chemical structure, the body takes longer to break them down than it would a disaccharide or oligosaccharide.

It is interesting to note that the monosaccharides which make up a polysaccharide can either be all the same (e.g. ten glucose molecules all linked together) or a combination of monosaccharides (e.g. four glucose molecules, two fructose molecules and twelve galactose molecules).

Polysaccharides have several different important jobs within the human body, such as: Energy storage Support to cells and tissues Cellular messages.

• • •

There are three major types of polysaccharides: 1. Starch 2. Glycogen (a stored multi-branched polysaccharide of glucose) 3. Cellulose.

STARCH

GLYCOGEN

CELLULOSE

A large polysaccharide manufactured in plants' green leaves from excess glucose produced during photosynthesis serves the plant as a reserve food supply.(38)

A large polysaccharide produced by animals is stored in the liver and muscle tissue as an important fuel reserve. Glycogen is utilised as a fuel reserve for several reasons; it serves as a buffer to maintain blood glucose levels between meals, provides energy for sudden and strenuous activity, and is a source of energy during anaerobic (absence of oxygen) activity (e.g. heavy weight training or sprinting).(39)

A polysaccharide that plays a crucial part in the structural component of a plant’s cell walls and is an invaluable source of dietary fibre. It is often used as a preservative, thickener, additive and emulsifier in commercial products such as sauces, yoghurts and whipped cream.

When cellulose is mixed with water, it forms a gel-like paste.

Starch is broken down in the body to its simplest form of monosaccharides, which then supply energy to the tissues.

Starch is found in all plant sources, most abundantly in potatoes, sweet potatoes, corn and peas.

A polysaccharide can also be referred to as a ‘Glycan’.

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Without sufficient physical

UNDERSTANDING DIETARY FIBRE Dietary fibre is the indigestible part of plant foods that the human body cannot completely break down. It also resists absorption in the small intestine before undergoing complete or partial fermentation in the large intestine. While it remains largely undigested, dietary fibre is essential for obtaining and maintaining optimal health for several reasons.

These reasons include:

• • ADDS BULK TO BOWEL MOTIONS: Insoluble fibre adds bulk to the stool, which encourages the passing of regular bowel motions.

INCREASES SATIETY (FULLNESS): Fibre increases satiety by slowing down digestion and impacting satiety hormone release.

Note: Insoluble fibre will be discussed in more detail below.

ABSORBS WATER INTO BOWEL MOTIONS: • Soluble fibre absorbs water into the bowel motions, making them softer and easier to pass, decreasing the risk of constipation.

•

FOOD SOURCE FOR BENEFICIAL BACTERIA: Beneficial bacteria which reside in the large intestines feed off the fibre. Maintaining a high-fibre diet is important for the optimal health of beneficial bacteria as these bacteria play several indispensable roles that affect every body system.

•

SLOWS THE RELEASE OF GLUCOSE INTO THE BLOODSTREAM: Because fibrous (complex carbohydrates) take longer to break down than simple carbohydrates, glucose is released slower in the bloodstream. In turn, this is beneficial for stabilising energy and hunger levels.

•

ASSISTS IN WEIGHT LOSS: Because dietary fibre increases satiety, controls hunger and energy levels, and slows the release of glucose into the bloodstream, a diet high in fibre is considered very beneficial for weight loss.

PROMOTES HEART HEALTH: • Dietary fibre helps to remove the build-up of unwanted cholesterol in the blood. This is beneficial to the health of the heart.

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TYPES OF DIETARY FIBRE There are two major types of dietary fibre. As the names suggest, soluble fibre is soluble, which means it can be dissolved in water, whereas insoluble fibre cannot be dissolved in water. Regardless, both are vital to include in the diet daily.

TYPE OF DIETARY FIBRE

DESCRIPTION Soluble fibre absorbs water, which helps slow digestion and regulates bowel motion. As a result, this helps one to feel fuller for longer and stabilises blood sugar levels.

Soluble fibre also acts as a prebiotic and provides food for the beneficial bacteria in the gut lining. Sufficient prebiotic fibre assists with the proliferation of beneficial gut bacteria and assists with maintaining adequate gut health.

SOLUBLE FIBRE

Dietary sources of soluble fibre include:(40) Fruit (apple, pear, orange, strawberries, kiwi, banana etc.)

Vegetables (potatoes, beans, peas, asparagus, onion, garlic, leeks etc.)

Oats Barley Psyllium husk Chia seeds Legumes.

• • • • • • •

Insoluble fibre does not dissolve in water and therefore passes through the gut mostly unchanged. Insoluble fibre accelerates the digestive process and adds bulk to the stool.

INSOLUBLE FIBRE

Dietary sources of insoluble fibre include:(40) Nuts (almonds, Brazil nuts, macadamia walnuts) Seeds (pumpkin, sunflower) Wheat bran The skins of fruit and vegetables.

• • • •

RESISTANT STARCH Like the two types of fibre mentioned above, resistant starch cannot be digested, hence the term resistant, as it resists absorption in the upper digestive tract and passes to the large bowel, where it undergoes fermentation.(41) There are four types of resistant starch (RS), and are numbered as: RS1 is found in whole grains and seeds RS2 is found in corn (maize) starch RS3 forms when rice, potatoes or pasta is cooked then cooled RS4, which is manufactured and found added to many food products.

• • • •

Resistant starch functions similarly to soluble, fermentable fibre, helping feed bacteria in the gut and increasing the production of short-chain fatty acids like butyrate.(42) Studies have shown that resistant starch can help with weight loss, benefit heart health, improve blood sugar control, insulin sensitivity, and digestive health, and may help prevent colon cancer.(41)(43)(44) Although there is no formal recommendation for the intake of resistant starch, studies have shown that health benefits at 20 grams per day with an intake of up to 45 grams are considered safe.(44)(45) VAST FITNESS ACADEMY | NAT11046002: APPLY THE FUNDAMENTALS OF NUTRITION TO MEET A CLIENT’S DIETARY NEEDS | VERSION 1 - 23.01.2023

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Below are some foods that contain high amounts of resistant starch: Oats Cooked and cooled rice, quinoa and amaranth Plantains and green bananas (and their flours) Cooked and cooled potatoes (also potato starch) Beans and legumes High-maize starch (corn starch).

• • • • • •

PREBIOTIC FIBRE A type of non-digestible dietary fibre known as prebiotic fibre is especially beneficial for gut health.(46) This fibre feeds the good bacteria in the gastrointestinal tract (GIT), allowing them to proliferate (increase in number).(47) Good bacteria is highly beneficial for improving digestive health; therefore, including prebiotic foods within the diet can be helpful.

Prebiotics are found in fibrous foods, including:(48) Apples Onions, spring onions and shallots Leek Asparagus Garlic Cooked then cooled rice (resistant starch) Oatmeal Banana (unripe or as green banana flour) Jerusalem artichoke Chicory Fennel bulb Green peas.

• • • • • • • • • • • •

RECOMMENDED DAILY INTAKE: FIBRE It is recommended that men consume no less than 30g of fibre each day and women consume no less than 25g each day.(49) When advising clients to increase their fibre intake, there are two (2) important considerations to discuss: 1. With increased fibre intake comes the necessity for increased water intake. As soluble fibre absorbs water into the stool, if water intake is not increased in conjunction with fibre intake, this can lead to or exacerbate constipation.

2. Gas production in the large intestine and colon is necessary for gut bacteria to do their job and comes about due to the fermentation process. With increased fibre intake comes the likelihood of temporarily increased flatulence. If flatulence persists long-term, becomes excessive, or causes any abdominal pain, that is when a nutrition coach will need to refer the client to a GP for a medical clearance.

It has been suggested that early humans consumed approximately 100g of fibre each day.(50) This is 3 - 4 times more than that of Western countries. A hypothesis has been made that this may be the missing link for optimal health and longevity and that increasing dietary fibre may assist with weight management, heart disease, sugar control and gut health.

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SOURCES OF DIETARY FIBRE Fibre is predominantly foods with a husk, skin or seeds, such as fruit, vegetables, nuts, seeds and whole grains. Fibre is found in many sources in the Western diet.

Below is a table showing the amount of fibre in some common foods.

FOOD

SERVE SIZE (G)

FIBRE (G)

APPLE

150g

3.6

AVOCADO

160g

4.5

ORANGE

230g

3.9

WATERMELON

100g

0.6

CARROT

100g

3.9

PEAS

100g

5.5

KIDNEY BEANS

100g

6.5

NUTS

100g

9

BREAD, DARK, RYE

30g (1 slice)

2.1

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UNDERSTANDING THE GLYCAEMIC INDEX OF CARBOHYDRATES The glycaemic index (GI) is a ranking system of carbohydrates that measures how quickly a food will raise blood sugar levels during digestion. Because dietary fibre slows the release of glucose, secondary to taking the body longer to break down, high-fibre foods will generally have what is called a low GI, and low-fibre foods will have what is called a high GI (both low and high GI will be discussed in detail below).

As a nutrition coach, it is important to understand not only the GI of common foods but also the effect different GI levels will have on the body. Understanding the GI of food is useful for understanding how quickly the body will break down a carbohydrate and the impact a carbohydrate will have on the individual.

Understanding this will allow a nutrition coach to appropriately assess a client’s diet and provide beneficial dietary advice.

GI RANKING The GI represents the rise of glucose in an individual’s blood two hours after consuming carbohydrate-containing food.

Carbohydrate-containing foods are compared to glucose as a reference, with a GI rating of 100.

The lower the GI of a food, the better. Carbohydrates that break down rapidly during digestion have a higher GI (>70), and those which take longer to break down are classed as a low GI (<55). Carbohydrates with a GI between 55 and 70 are classed as medium GI.

LOW GI FOODS (<55)

MEDIUM GI FOODS (55 - 70)

HIGH GI FOODS (>70)

Low GI foods (GI rating <55) are called complex carbohydrates and are digested more slowly than medium and high GI foods.

Medium GI foods (GI rating 5670) are between high GI and low GI food sources.

High GI foods (GI rating >70) are referred to as simple sugars (easily digested and quickly absorbed).

Low GI foods, therefore, have a slower release of glucose into the bloodstream and may assist with satiety. Low GI foods are considered to be much healthier than high GI options.

Examples of low GI foods include: Fruit (with the skin on) Legumes Broccoli Full cream dairy.

• • • •

Medium GI foods, while not releasing their glucose into the blood as quickly as high GI food, are still not as beneficial to overall health as lower GI options.

Examples of medium GI foods include: Honey Fruit juice (fresh) Wholemeal bread.

• • •

High GI foods release glucose into the blood quickly and, once absorbed, can leave the individual feeling lethargic and craving more sugar.

Examples of high GI foods include: Lollies White bread Table sugar Watermelon.

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GI RANKING EXPLAINED The image below shows the blood glucose response of a high GI food compared to a low GI food. As indicated, a high GI food releases glucose into the blood very quickly; this glucose is quickly absorbed from the blood into the tissues and results in a quick decline in blood glucose levels.

While the glucose is in the blood, the individual will feel greater amounts of energy; however, when it is absorbed into the tissue and blood glucose levels decrease rapidly, the individual will feel a sudden energy decline. This sudden decline of energy can leave the individual feeling lethargic, and increase cravings for more high GI carbohydrates.

Low GI food, on the other hand, is a slower, flatter and more steady release of glucose into the bloodstream. This results from low GI foods taking longer to break down (secondary to length and complexity of the complex carbohydrate food source). As a result, an individual consuming a low GI food will not have an energy high followed by an energy crash but will rather maintain stable energy levels. This will help decrease lethargy following glucose absorption and may also assist in greater satiety levels.

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GI RATINGS OF COMMON FOODS The table below displays the GI of some common foods.(51)

FOOD

GLYCAEMIC INDEX

GLUCOSE

100

WHITE BREAD

73 - 77

SPECIALITY GRAIN BREAD

51 - 55

CORNFLAKES

75 - 87

PORRIDGE, ROLLED OATS

53 - 57

WATERMELON

72 - 80

APPLE

34 - 38

POTATO, BOILED

74 - 82

CARROTS, BOILED

35 - 43

Nutrition coaches need to understand that the GI of a food is not the only measure of its healthiness; vitamins, minerals, nutrients and palatability need to be taken into account too. For example, while a potato may be ranked as a high GI food, it contains valuable nutrients such as fibre, iron, potassium, vitamin B6 and vitamin C, and is also ranked as the most satiating food in the world.(52) Pairing high GI foods with low GI foods will reduce the overall GI of a meal, resulting in a slower rise in blood glucose levels and increased satiety. Therefore, pairing potatoes (high GI) with carrots (low GI), for example, will result in a slower rise in blood glucose levels and provide the individual with the additional nutritional benefits from both the potato and the carrot.

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GLYCAEMIC LOAD The GI is based on how quickly blood glucose levels rise and fall, given the glucose load of a particular food, whereas the glycaemic load (GL) considers both the quality and quantity of the food when consumed as a whole. Instead of taking into account just the monosaccharide content of a particular food, the GL takes into account the other nutrients too, such as fibre, protein and fat.

The GL, therefore, provides a more accurate picture of the overall effect of the food. For example, oranges have a high GI (when orange juice is consumed alone) but a low GL (when all the orange flesh and fibre are consumed together).

It is optimal to choose foods with a low GL over foods with a higher GL. As with GI, the GL can be categorised into three major groups based on a numerical score, and these three groups are detailed below.(53)

LOW GL A food is classed as a low GL food when it has a GL of < 11

MEDIUM GL

HIGH GL

A food is classed as a medium GL food when it has a GL of 11 - 19

A food is classed as a high GL food when it has a GL of 20

CALCULATING THE GLYCAEMIC LOAD GL is calculated by multiplying the GI of the food by the amount of carbohydrate (in grams) a food contains and then dividing the total by 100.(54) GL = (GI Food x amount (g) of available carbohydrate per serve)/100

EXAMPLE Potatoes have a GI of 78, and 50g of potato has approximately 8g of carbohydrates.

Therefore, to calculate the GL, the GI (78) would be multiplied by the available carbohydrate (8g), and this answer would be divided by 100.

GL = (78 x 8) ÷ 100 GL = 6.24 Therefore, referring to the above table, potatoes have a low GL.

One unit of GL is equivalent toWithout the effect of ingesting one gram of glucose. sufficient physical Starch is found in all plant sources, most abundantly in potatoes, sweet potatoes, corn and peas.

stimulus (e.g. resistance training), the excess protein will be excreted from the body, and muscles will not grow. Amino acids help repair muscle tissue after exercise, increasing muscle growth.(21)

Without sufficient physical stimulus (e.g. resistance training), the excess protein will be excreted from the body, and muscles will not grow. Amino acids help repair muscle tissue after exercise, increasing muscle growth.(21)

Adequate protein is essential for growth, repair, hormone and enzyme production, and overall health throughout the Adequate protein is essential lifespan, regardless of lifestyle; for growth, repair, hormone it is needed for all biological and enzyme production, and processes daily and is essential overall health throughout the for optimal health, even in lifespan, regardless of lifestyle; Adequate protein is essential who| do not exercise. it is needed for all biological VASTindividuals FITNESS ACADEMY NAT11046002: APPLY THE FUNDAMENTALS OF NUTRITION TO MEET A CLIENT’S DIETARY NEEDS | VERSION 1 - 23.01.2023 68 for growth, repair, hormone processes daily and is essential VAST FITNESS ACADEMY | NAT1146002: APPLY THE FUNDAMENTALS OF NUTRITION TO MEET A CLIENT’S DIETARY NEEDS | VERSION 1 24.10.23 68 and enzyme production, and for optimal health, even in

SOURCES OF CARBOHYDRATES Carbohydrate foods can be whole, unprocessed, or processed, and range in their healthiness. Carbohydrates come in many forms, predominantly in fruits, vegetables and grain-based products. It can also be sourced from dairy products and foods formulated with added sugar.

The table below offers a list of common carbohydrate sources with an approximate amount of carbohydrates and sugars per 100g; however, these are a guide only as cooking style, storage and type (e.g. breed of potato or brand of bread) will affect the nutrients contained in a food. It is also important to note that this is not an exhaustive list, as many carbohydrate sources exist.

The weight of carbohydrates is not the weight of the food. For example, 100g of potato only has 11.2g of carbohydrates.

CARBOHYDRATE (PER 100G)

FOOD

SUGARS (PER 100G)

WHITE BREAD

45g

3.5g

WHOLEMEAL BREAD

40g

3g

WHITE RICE

28.8g

<0.1g

BROWN RICE

31.8g

0.3g

WHITE PASTA

68.6g

3g

LENTILS

9.5g

0.5g

LOW-FAT GREEK YOGHURT

4.2g

3.3g

FULL-FAT GREEK YOGHURT

3.9g

2.7g

POTATO

11.2g

1.7g

SWEET POTATO

15.2g

6g

BANANA

19.8g

16.9g

STRAWBERRIES

3.9g

3.8g

MILK CHOCOLATE

56g

54.6g

PLAIN CHIPS

46g

1g

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CARBOHYDRATE RECOMMENDATIONS The Australian Government guidelines recommend carbohydrate intake to be ~45-65% of total daily energy intake, focusing primarily on low GI carbs. When determining where in this range they will sit, it is important to keep in mind the type of client you’re working with, their goals, and their need for carbohydrates.(55) Based on current research and guidelines, nutrition coaches can advise their clients’ daily carbohydrate intake to be anywhere between 20-65% of their total daily energy intake, depending on their goals or preferences. Where a client’s carbohydrate intake is at the lower end of the range, the nutrition coach must ensure that clients consume sufficient fats for adequate energy intake.

It is the responsibility of the nutrition coach to stay up to date with the latest, high-quality research to make bestpractice decisions regarding carbohydrates and general nutritional recommendations.

Carbohydrate recommendations depend on a variety of factors, including: Age Metabolic demands Disease state (e.g. diabetes) Medications (e.g. insulin) Physical activity levels (including intensity, duration and frequency).

• • • • •

For example, a client participating in high-intensity physical activity is likely to require a higher ratio of carbohydrates than an elderly, sedentary client.

It is also important to space the consumption of carbohydrates out over the day. As carbohydrates are broken down into their most simple form of sugar (glucose), having a large intake all at once will cause an influx of glucose to enter the bloodstream. This can result in an energy high; however, as sugar is absorbed from the bloodstream into the cells, this can cause an energy crash where the client may struggle with fatigue, lethargy, mood changes and slowed cognition.

Carbohydrate timing needs to be considered in greater detail for exercise-related goals. This will be discussed in more detail in the unit ‘NAT11046007 Provide nutrition information to clients for exerciserelated goals’.

EMERGING RESEARCH FOR CARBOHYDRATE RECOMMENDATIONS: It is the responsibility of the nutrition coach to stay up to date with the latest, high-quality research to give best practice advice regarding carbohydrates and general nutritional recommendations.

For further research on the recommended daily intake of carbohydrates CLICK HERE.

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UNDERSTANDING SUGAR As previously indicated, all carbohydrates are broken down into their simplest form: monosaccharides. Monosaccharides refer to one sugar molecule and are the simplest form into which the body can break down a carbohydrate. When it comes to sugars, however, there are two common types: natural sugars and refined sugars. Natural and refined sugars will be discussed in greater detail below.

As a nutrition coach, it is of utmost importance to have a solid understanding of the effects carbohydrates will have on the human body and the difference between refined and natural sugars. This knowledge will allow a nutrition coach to appropriately assess an individual’s diet and provide key dietary recommendations to help the individual improve overall health and reach their personal goals

NATURAL SUGARS Natural refers to sugars naturally present in the food that has not been added. Such as the natural sugars in fruit, vegetables, grains and dairy.

REFINED SUGARS Refined sugars are those which are processed and altered from their natural state. Refined sugars are added to food and drinks to improve flavour and extend shelf life.

Refined sugars include table sugar and corn syrup, usually in dextrose, fructose and sugar syrups.(57) Discretionary food items are often high in refined sugars, such as soft drinks, fruit drinks, energy/sports drinks, confectionery, cakes and biscuits.

Fruit juice has a very similar amount of sugar to Coke. Both have 9-10 teaspoons of sugar in 350ml (1 can)!

Low-fat products are often loaded with sugar to improve their taste. One cup of low-fat yoghurt can have 7-8 teaspoons of sugar!

Processed cereals contain approximately 30% sugar. That would mean a 100g serve of cereal would have 33g of sugar, the equivalent of 8 teaspoons.

• •

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NATURAL VERSUS REFINED: A COMPARISON Below is an image indicating the different metabolic effects natural food versus refined food has on the human body. It is noted that a whole orange has the least sugar of all the products (this will all be natural sugar as it is directly from the natural source), plus it has the added benefits of fibre and satiety. As a result of this fibre, sugar will be released into the blood slowly, therefore not causing a rapid rise.

When an orange is juiced, it removes a great deal of fibre, and, as a result, one can consume a lot more of the juice before feeling full, and the sugar will also hit the bloodstream a lot faster as a result of decreased fibre intake. The orange, which was previously classed as a complex carbohydrate, is now classed as a simple carbohydrate due to the juicing process removing much of the beneficial fibre.

Orange soda is an even simpler carbohydrate, with all vitamins and fibre removed and added sugars added. As a result, this will cause a large spike in blood sugars, which in the longer term, could be harmful and lead to various health complications such as diabetes mellitus or insulin resistance.

The final example is a diet orange soda with zero sugar, vitamins or minerals. Diet drinks will use an artificial sweetener, such as aspartame, to add sweetness without the calories or blood sugar spike. While it is beneficial that they do not spike blood sugar levels, diet soft drinks are extremely processed, provide nil health benefits, are full of artificial products, and, in the longer term, are suggested to negatively alter how the body reacts to sugar.

16OZ ORANGE JUICE

MEDIUM ORANGE

16OZ ORANGE SODA

DIET ORANGE SODA

SUGAR

10-13g

FIBRE

++

-

VITAMINS

++

-

-

-

SATIETY

++

-

-

-

EFFECT ON BLOOD SUGAR

Slow, controlled rise in Rapid blood sugar blood sugar spike and fall

48g

58g

0g

-

Rapid blood sugar spike and fall

May alter how body reacts to sugar

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THE EFFECT OF EXCESSIVE REFINED SUGAR ON THE BODY Western diets often contain excessive amounts of refined sugar, with Australians’ average intake of approximately 14 teaspoons per day (2012 data).(55) Excessive refined sugar consumption has been linked to many chronic diseases, such as: Obesity Type 2 diabetes mellitus Cardiovascular disease Certain cancers Tooth decay Non-alcoholic liver disease.

• • • • • •

High sugar consumption resulting in increased insulin levels may increase the risk of cardiovascular disease (CVD).(56) Excess sugar consumption also increases uric acid levels, posing an additional risk for CVD and kidney disease.(57)(58) As such, moderating refined sugar intake is essential in maintaining a healthy diet and avoiding chronic disease.

UPPER LIMIT SUGAR RECOMMENDATIONS The American Heart Association (AHA) recommends a maximum amount of added sugar as:(121) MEN: 150 calories per day (37.5 grams or 9 teaspoons) WOMEN: 100 calories per day (25 grams or 6 teaspoons) Australian dietary guidelines recommend limiting added sugars consumption; however, what defines ‘added sugar’ is still unclear, with no upper limit indicated in Australia due to insufficient evidence for exact recommendations.(63) However, the following international nutrition agencies recommend the following:(63) The World Health Organisation (WHO): <10% (50g or 12 tsp) of total daily energy intake UK Scientific Advisory Committee on Nutrition (SCAN): <5% free sugars (of total daily energy intake) American Dietary Guidelines: limiting sugar to <10% of daily energy intake from free sugars.

• • •

Excess sugars from processed foods account for 81% of Australian free sugar consumption from sources including cordials, sugary breakfast cereals, cakes, muffins, sweet biscuits, chocolate, confectionery, syrups, and sweetened beverages.(63)(64)(65) Australian and New Zealander researchers have analysed sugar consumption across the two countries and found that:(63)(65)(64) 52% of Australian adults exceed the WHO sugar intake recommendations 58% of New Zealand adults exceed the WHO sugar intake recommendations Adolescents and young adults consume the highest amounts of free sugars The primary sources of free sugar intake in Australia and New Zealand come from sweetened beverage consumption, particularly in children’s diets.

• • • •

Until further evidence becomes available, the best advice is to limit added and free sugars consumption to <10% of total daily energy intake.(63) Nutrition coaches should encourage clients to check food labels for sugar content, opting for the lower sugar variety where possible. Checking the amount of sugar per 100g is the best way to compare food items. For example, if one cereal brand contains 8g of sugar per 100g and another 10g per 100g, the first option would be better when trying to reduce or limit sugar intake.

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EXCESS SUGAR INTAKE A 15-year study investigating sugar intake and heart disease showed that people who consumed 25% or more of their daily calories from sugar were more than twice as likely to die from heart disease as those whose diets included less than 10% added sugar.(66) The study concluded that the risk of dying from heart disease correlated with the amount of sugar in the diet, regardless of a person’s age, sex, physical activity level, and weight.

Apart from significantly increasing an individual’s risk of heart disease, consuming excessive amounts of sugar in the diet can have many other negative effects, and these are explained in the table below:

LIVER DAMAGE

The liver can only process fructose; this means that all the fructose ingested by the body is then sent to the liver at once, overloading it and potentially causing damage.

METABOLIC DYSFUNCTION

Fructose fails to stimulate insulin, which in turn fails to suppress the ‘hunger hormone’ ghrelin. As a result, the satiety hormone leptin is not stimulated either, which causes overconsumption.

METABOLIC SYNDROME

A sugar surplus can lead to weight gain, abdominal obesity, increased total cholesterol, elevated blood sugar, elevated triglycerides and high blood pressure. Individuals are diagnosed with metabolic syndrome when they have three or more consequences.

KIDNEY DAMAGE

Excess sugar increases uric acid levels, which can be a risk factor for heart and kidney disease.

TED-ED - HOW SUGAR AFFECTS THE BRAIN CLICK HERE to watch the video.

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EDUCATING CLIENTS ON THE ALTERNATIVES TO REFINED SUGAR Educating clients on alternatives to refined sugars and encouraging more natural sources can be beneficial as a nutritional advisor.

Sugar alternatives refer to carbohydrates that are less processed and present in a more natural form, and therefore contain beneficial properties such as micronutrients, fibre and antibacterial properties.

The table below explores some of the alternatives commonly used to replace refined table sugar:

ALTERNATIVE

HONEY

DESCRIPTION Although not a sugar-free alternative to table sugar, honey is an excellent and nutrientdense alternative. A true natural sweetener, honey has many benefits of being naturally sweet and contains antibacterial and antimicrobial properties. Most honey comprises 80% natural sugars, 18% water and 2% vitamins, minerals, pollen and protein. Fructose and glucose make up ~90% of honey’s natural sugar content.(67) Pure maple syrup derived from the sap of Canadian maple trees (despite being high in sugar) may have some health benefits due to the 54 phenolic plant compounds that have been found that have antioxidant, anti-inflammatory and anti-diabetes properties.(68)(69)

PURE MAPLE SYRUP One unit of GL is equivalent to the effect of ingesting one gram of glucose.

Stevia is a ‘natural’ sweetener because it is a derivative of the leaves of a stevia plant.

However, the available stevia granules are a highly processed version of the stevia plant.

STEVIA

The steviol glycosides in stevia are 250-300 times sweeter than regular table sugar.(70) As such, it is often mixed with large quantities of other sugar polyols so that it can be consumed in similar measures to sugar (ie. one teaspoon of stevia provides similar levels of sweetness to one teaspoon of sugar). When reading the ingredient labels of stevia, it is common to see only 1% stevia and 99% erythritol, for example. Recent research shows that similar to other non-caloric artificial sweeteners such as saccharin, stevia can negatively impact the gut microbiome and potentially cause a decrease in tolerance to glucose.(71) This evidence is still emerging. However, precise recommendations on stevia intake are yet to be determined.

XYLITOL

The alcohol form of xylose, xylitol, is produced by most living things, including trees, fruits, plants and animals. It has 40% fewer calories and 75% fewer carbohydrates than sugar and a GI of seven (low GI). Recent research shows that xylitol can positively affect the gut microbiome by acting like a prebiotic.(72) It is important to note, however, that any polyols (such as xylitol) have an osmotic effect where they draw water into the gastrointestinal tract and, in large doses, can have a laxative effect.(72)

Erythritol is another sugar alcohol found naturally in many foods such as mushrooms, pears, grapes and soy sauce. More commonly, erythritol is produced by fermenting with yeast. It isOFvery low inTOcalories and tastes like table sugar. Due to the 75 VAST FITNESS ACADEMY | NAT11046002:glucose APPLY THE FUNDAMENTALS NUTRITION MEET A CLIENT’S DIETARYalmost NEEDS | VERSION 1 - 23.01.2023 ERYTHRITOL absorption and OF excretion (within 24hrs), it | does not blood sugar 75 VAST FITNESS ACADEMY | NAT1146002: rapid APPLY THE FUNDAMENTALS NUTRITIONof TOerythritol MEET A CLIENT’S DIETARY NEEDS VERSION 1 affect 24.10.23 levels or cause an insulin response. There is no evidence to suggest that erythritol has

This evidence is still emerging. However, precise recommendations on stevia intake are yet to be determined.

ERYTHRITOL

Erythritol is another sugar alcohol found naturally in many foods such as mushrooms, pears, grapes and soy sauce. More commonly, erythritol is produced by fermenting glucose with yeast. It is very low in calories and tastes almost like table sugar. Due to the rapid absorption and excretion of erythritol (within 24hrs), it does not affect blood sugar levels or cause an insulin response. There is no evidence to suggest that erythritol has any positive or negative effect on the gut microbiota.(72) As such, erythritol is classed as safe to consume.

DRIED FRUIT

Dried fruit has more vitamins, minerals and fibre than table sugar. The fibre content will slow digestion and thus decrease the overall GI and GL of the end product when compared to table sugar. If wanting a more nutrient-dense option to table sugar, dried fruit can be a suitable alternative and is considered the most natural alternative to table sugar; however, it is important to note that dried fruit will still contain moderate quantities of glucose and fructose, so is not a ‘sugar-free’ alternative.

Whilst the above sugar alternatives may provide additional benefits, they still contribute to daily energy intake and should be consumed in moderation.

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COMMON MYTHS ABOUT CARBOHYDRATES Several dietary myths encompass carbohydrates, which can confuse the general public. The table below explores common myths and facts about carbohydrates.

MYTH

FACT

It is fine for individuals to consume as much carbohydrate as they please, as long as it comes from an unprocessed food item.

While an unprocessed carbohydrate, such as an apple, is more beneficial to human health than a processed carbohydrate, such as apple juice, the intake of excess (natural) sugar can still adversely affect health, increasing the risk of:(35) High blood pressure Type 2 diabetes Heart diseas

Table sugar alternatives are healthier for the human body and can therefore be consumed without limit.

While alternatives to table sugar, such as dried fruit or natural honey, are healthier due to their increased nutrient profiles (fibre, vitamins, minerals, antibacterial properties), their consumption should still be limited. While they may not spike blood glucose levels compared to refined sugars, they are still high in kilojoules and sugar, which can be detrimental to health.

Only bread and pasta contain carbohydrates.

Carbohydrates are found in several other different dietary sources, such as: Fruit Vegetables Dairy products Oats Beans

Carbohydrates make you gain weight.

• • •

• • • • •

Excess energy intake from any energy-yielding macronutrient (including protein and fat) will cause weight gain – not specifically carbohydrates. If consuming carbohydrates as part of a well-balanced diet that meets energy needs, weight gain will not occur. Where possible, preference should be given for more complex, lower GI and higher fibre sources of carbohydrates, such as whole grains, legumes and starchy vegetables.

These sources have an improved effect on satiety, bowel function and gut health. Excess sugar or highly refined carbohydrates, such as soft drinks, white bread, lollies and chocolate, should be limited to optimise health outcomes.

Carbohydrates are not needed in the diet, as the body creates glucose.

Carbohydrates are essential for a healthy body and should be included in the diet daily. In times of starvation, the body can produce glucose through a process known as gluconeogenesis. However, this can negatively impact the body’s protein and fat stores. Little research supports the use of low carbohydrate diets in the long term, as any weight loss is often regained, and improvement in blood lipids and glucose levels is not maintained.

As with any macronutrient, quality and quantity can impact their usefulness in the body. Preference should be towards high fibre, low GI carbohydrates with small amounts of added sugars.

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UNDERSTANDING MACRONUTRIENTS: FATS (LIPIDS) WHAT ARE DIETARY FATS? Dietary fat, although once portrayed in a negative light, is an essential part of the human diet. Fat provides an energy source for the body and plays an important role in absorbing fat-soluble vitamins, producing hormones, and improving satiety and cognitive function.(36) Dietary fats are a class of macronutrients essential in the human diet. All living tissues contain fat (or lipids as they are scientifically called).

The main types of dietary fats are:(36) Saturated fats Unsaturated fats (monounsaturated and polyunsaturated) Trans fats.

• • •

Dietary fats should not be confused with body fat and the fats used in the body. Once dietary fat is digested, it is broken down into fatty acids and then repackaged into other useful types of fat, such as:(36) Phospholipids (used for cell walls) Cholesterol (used for cell walls, hormone production and fat-soluble vitamin production) Free fatty acids (used to build other fats) Triglycerides (used to store fat in adipose tissue).

• • • •

As a nutrition coach, it is important to be aware of the role of fatty acids and educate clients on how dietary fat is essential for human health and wellbeing. Humans require dietary fats in regular, moderate quantities to ensure correct bodily function and overall health.

Dietary fat is not only an energy-yielding macronutrient, containing 38kJ(34) per gram, but it also plays several other very important roles in the human body.

To understand the roles that fat plays within the body, it is essential to understand the chemical makeup of each type of fat and how their physical characteristics can determine the effect they have on health.

Many people negatively associate the word fat with being physically overweight and will therefore avoid dietary fat. As a nutrition coachal advisor, it is important to create awareness and educate clients that ‘dietary fat’ is a vital part of a healthy diet and is therefore required for optimal health.

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THE CHEMICAL MAKEUP OF FATS (UNDERSTANDING FATTY ACIDS) FATTY ACIDS In the same way that an amino acid is the smallest unit of a protein, a fatty acid is the smallest unit of dietary fat. A fatty acid is a chain of carbon (C) atoms surrounded by hydrogen (H) atoms, with a carboxyl group (COOH) at one end and a methyl group (CH3) at the other end. Most fatty acids are made up of an even number of carbon atoms, with those that contain 18 carbon atoms being the most abundant in the diet. However, fatty acids can also be longer and shorter in length.

The image below shows stearic acid, an example of an 18-carbon fatty acid and a classic example of the chemical makeup of a fatty acid.

For the human body to efficiently utilise dietary fats, they must first be broken down into their smallest component, fatty acids. Once dietary fat is broken down via digestion, individual free fatty acids are transported around the body for use after being absorbed into intestinal cells. If they are not required straight away, fatty acids are re-packaged into triglycerides for storage in the body’s adipose (fat) cells.

TRIGLYCERIDE A triglyceride is a type of fat. The word ‘triglyceride’ means three (tri) fatty acids connected with a glycerol (glyceride) backbone. This means that three fatty acids have been bonded to a glycerol, a type of lipid (fat).

Glycerol (C3H8O3) is a sweet, colourless, non-toxic liquid that can bind the head of a fatty acid. This form of storage is extremely efficient because it does not require water to be bound with it, unlike glycogen, which is stored compactly and more lightly than glycogen.

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The chemical makeup of fatty acids influences the characteristics of food and the effects those foods have on overall health.(5) Nutrition coaches need to understand the differences between the different types of fats and how they act in the body.

There are two ways in which fatty acids can be classified: 1. By their degree of saturation: saturated, unsaturated, trans fatty acids.

2. By their length: short-chain triglycerides, medium-chain triglycerides, long-chain triglycerides.

CLASSIFICATION 1:

BY SATURATION

SATURATED FATTY ACIDS

UNSATURATED FATTY ACIDS

MONOSATURATED

TRANS FATTY ACIDS

CLASSIFICATION 2:

BY LENGTH

SHORT CHAIN FATTY ACIDS

MEDIUM CHAIN FATTY ACIDS

LONG CHAIN FATTY ACIDS

(TRIGLYCERIDES)

(TRIGLYCERIDES)

(TRIGLYCERIDES)

POLYSATURATED

OMEGA-3 FATTY ACIDS

OMEGA-6 FATTY ACIDS

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CLASSIFYING FATTY ACIDS BY DEGREE OF SATURATION As indicated in the above image, fatty acids can be further divided into three classes depending on their degree of saturation: 1. Saturated (essential) 2. Unsaturated (essential) 3. Trans fats (non-essential).

Fats are either saturated, unsaturated or trans fat, depending on the proportions of fatty acids present. For example, butter is described as saturated fat because it has more saturated fatty acids than unsaturated fatty acids. In contrast to this example, olive oil is described as an unsaturated fat because it has more mono and polyunsaturated fatty acids than saturated.

Trans fats (of which there are two types) are mostly man-made fats and, therefore, not essential in the human diet.

Trans fats look similar to saturated fatty acids but have a kink in their structure, making them very hard for the body to process. Trans fats are discussed below, along with the other classifications of fats.

SATURATED FATTY ACIDS Saturated fats get their name from being surrounded, or ‘saturated’, in hydrogen atoms. This means that their chemical structure has hydrogens (H) attached to every carbon (C) in the fatty acid tail, as well as having no double bonds (unlike unsaturated fats, see below). Having no double bonds makes saturated fats more stable for cooking at higher temperatures and means they are solid at room temperature.

The image below displays the biochemical structure of a saturated fatty acid: a structure with no double bonds (a double bond is represented with a double line connecting the carbons (C)) where the carbons (C) are ‘saturated’ (surrounded) with hydrogen (H) atoms.

SATURATED FAT Saturated fats from healthy sources, such as eggs, dairy and some meats, are natural fats and are, therefore, fine to consume as part of a healthy diet. However, saturated fats from processed foods, such as pies and some meats, are not as healthy and should be limited in the diet.

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Saturated fats are typically found in animal products, as well as some plant-based foods, such as: Animal fats (lard, tallow, ghee) Full-fat dairy products (milk, yoghurt, cheese) Coconut products (coconut oil, coconut milk and cream).

• • •

Some examples of the less healthy, highly processed sources of saturated fats include: Processed foods (biscuits, cakes, pastries, pies, chips) Processed meats (sausages, salami) Fast food (hot dogs, burgers, pizza, fried food).

• • •

As a nutrition coach, it is important to promote healthy options for saturated fats because of the effect that they can have on cardiovascular health. Saturated fats, like those found in full-fat dairy products (milk, yoghurt, cheese), are neutral or cardioprotective. This is because saturated fats increase high-density lipoproteins (HDL) as well as low-density lipoproteins (LDL). This means the ratio of total cholesterol to HDL remains the same, so there is no increased risk for cardiovascular disease. Also, fermented dairy products like kefir and yoghurt contain probiotics and can improve the gut microbiota and have preventative health properties.

However, the amount and source of saturated fats are important; processed foods, fatty meats and fast food should be limited within the diet as they can promote an unhealthy ratio of HDL to LDL cholesterol. This is especially important because the combination of these saturated fats with refined and processed carbohydrates can have a negative effect on cholesterol levels.

Saturated fat used to be classed as a ‘bad’ fat following the research findings from Dr Ancel Keys in his Seven Countries Study, released in the 1950s, which suggested that saturated fat intake increased the risk of heart disease.

Since this time, however, it has been found that this particular research had data from 22 countries (as opposed to the initially identified seven countries), and when all 22 countries are considered, it is very difficult to find an association between saturated fat intake and heart disease. Strong evidence supports the claim that saturated fat, while not cardio (heart) protective, is not harmful to human health at an intake of up to 10% of total daily energy intake.(73)

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UNSATURATED FATTY ACIDS In the instance that hydrogen atoms are missing from a fatty acid (this only occurs in pairs), the structure of the fatty acid needs to compensate for this loss so that all carbon atoms maintain four bonds.(5) As such, the two carbon atoms missing a hydrogen would therefore only have three bonds – forming a double bond between one another, creating a fourth bond. This fatty acid is now deemed unsaturated, as it is no longer saturated with hydrogen atoms.

Unsaturated fats are comprised of one or more double bonds in their biochemical structure and are liquid at room temperature. Unsaturated fats are well known to help reduce the build-up of cholesterol in the arteries, thus declining the risk of heart disease and stroke.

Unsaturated fats can also be beneficial for: Improving/reducing inflammation Improving the function of blood vessels Assisting in reducing triglycerides implicated in atherosclerosis (hardening of the arteries) Stabilising heart rhythms Building stronger cell membranes in the body Reducing blood pressure in those with hypertension Assisting those with type 2 diabetes Assisting in the maintenance of body weight.

• • • • • • • •

For this reason, unsaturated fats have often been called ‘good’ fats as they are beneficial in reducing the risk of disease.

However, it is important to note that this does not make saturated fats bad as they have a role to play within the body and often come packaged in nutrient-dense food sources such as meat and dairy.

Because unsaturated fats have a double bond, they are not as stable for cooking at higher temperatures as saturated fats. This means that when unsaturated fats are used for cooking at high temperatures, their biochemical structure can change, making it harmful fat instead of beneficial fat.

There are two major types of unsaturated fat: 1. Monounsaturated 2. Polyunsaturated.

Mono and polyunsaturated fats differ in chemical structure and have slightly different health benefits. As the name suggests, a monounsaturated fat becomes unsaturated due to one double bond (red arrow pointing to the double bond), and polyunsaturated fats become ‘unsaturated’ due to two or more double bonds.

When a fatty acid has one double bond in its chemical structure, it is a monounsaturated fatty acid.

OLEIC ACID-MONOUNSATURATED FATTY ACID

When there are two or more double bonds, this is a polyunsaturated fatty acid.

LINOLEIC ACID-POLYUNSATURATED FATTY ACID

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MONOUNSATURATED FATS Monounsaturated fatty acids, commonly abbreviated as MUFAs, have one double bond in their biochemical structure.

There are many MUFAs, the most common being oleic acid, palmitoleic acid and vaccenic acid.

Mono-unsaturated fats may have some benefits when included in the diet, such as: Reduction in cardiovascular disease risk - thanks to their effect on HDL/LDL cholesterol levels It may help reduce inflammation - this effect was demonstrated in a study where saturated fat was replaced with monounsaturated fat.

• •

Monounsaturated fats can be found in plant-based foods, as well as in meat and animal-based foods. The table below offers a list of food sources high in MUFAs, along with the amount found in (100 grams) of the food source:

FOOD SOURCE

APPROXIMATE AMOUNT OF MUFAS FOUND (PER 100G)

OLIVE OIL

55-83g

EGGS

4g

SUNFLOWER SEEDS

15g

AVOCADOS

10g

ALMONDS

31g

PEANUTS

24g

CASHEWS

24g

PISTACHIOS

25g

PORK

6g

PUMPKIN SEEDS

6g

OLIVES

15g

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POLYUNSATURATED FATS Polyunsaturated fatty acids, commonly abbreviated as PUFAs, have two or more double bonds in their biochemical structure. Polyunsaturated fats are utilised as building blocks in the membranes that encompass all the body’s cells and contribute to the brain’s structure. This type of fat is found mostly in plant-based foods and oils and marine foods such as oily fish.

Evidence suggests that eating foods rich in polyunsaturated fatty acids can: Improve blood cholesterol levels Decrease the risk of heart disease Decrease the risk of type 2 diabetes.

• • •

There are two different groups of polyunsaturated fats: 1. Omega-3 fatty acids (alpha-linolenic acid (ALA), EPA and DHA) 2. Omega-6 fatty acids (linoleic acid and many others).

Omega-3 and omega-6 fatty acids are essential, as the body cannot create them naturally. Therefore, these fats need to be consumed as part of a healthy, varied diet to maintain a healthy functioning body.

Chemists identify polyunsaturated fatty acids by the position of the first double bond closest to the methyl (CH3) end of the carbon chain.(2) The Greek omega symbol denotes this end of the chain: ω The image below shows the skeletal formula for the omega-3 linolenic acid, with each point of the zig-zag lines representing a carbon atom (C). A fatty acid with its first double bond three carbon atoms away from the methyl end is an omega-3 fatty acid.

LINOLENIC ACID (9, 12, 15-OCTADIENOIC)

3 OMEGA-3 FATTY ACIC Omega-6s have their first double bond of six carbons from the omega end of the fatty acid (notice the blue arrows in the picture below):

LINOLENIC ACID (9, 12-OCTADIENOIC)

6 OMEGA-6 FATTY ACIC

Although polyunsaturated fatty acids are often shown linearly for visual ease and understanding, the shape of the fatty acid bends at each double bond.(2)

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The two tables below outline the differences between omega-3 fatty acids and omega-6 fatty acids:

OMEGA-3 FATTY ACIDS

DESCRIPTION

FOOD SOURCES OF OMEGA-3 FATTY ACIDS

TYPES OF OMEGA-3 FATTY ACIDS

Omega-3 fatty acids are essential fatty acids that play a crucial role in: Brain health Vision Joint health Reducing inflammation Promoting heart health.

• • • • • Omega-3 fatty acids can be found in: fish (such as salmon and sardines) • Oily Walnuts • Flaxseeds and sesame seeds • Olive oil • Garlic • Avocados • Whole eggs •

There are three types of omega-3 fatty acids: 1. Alpha-linolenic acid (ALA) - found mainly in plants 2. Eicosapentaenoic acid (EPA) - found mainly in animal products and algae 3. Docosahexaenoic acid (DHA) - found mainly in animal products and algae.

Alpha-linolenic acid (ALA): While ALA may have beneficial effects on the body, it must first be converted into EPA or DHA before it can be used. Research shows that conversion only occurs in small amounts, making its use (especially as a supplement) less effective than animal-derived EPA and DHA. Eicosapentaenoic acid (EPA): EPA appears to provide benefits for brain health by reducing inflammation. It may also help with depression and anxiety, although the mechanism by which it works is not yet known.

BENEFITS

EPA may also help build muscle by being converted to prostaglandins (hormonelike molecules) which play a role in: Maintaining testosterone levels Elevating growth hormone levels Increasing insulin sensitivity Increasing protein synthesis in muscle cells.

• • • •

Docosahexaenoic acid: Inadequate levels of DHA in older adults have shown to result in reduced brain size, which is a sign of accelerated brain ageing. DHA is also a structural factor of the eye and may help slow macular degeneration.

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OMEGA-6 FATTY ACIDS DESCRIPTION

Omega-6 fatty acids are a type of polyunsaturated fat that is cardioprotective (heart healthy), thus decreasing the risk of heart disease. While essential in the diet, these fats are often over-consumed in the Western diet. Overconsumption of omega-6 fatty acids can have an inflammatory effect on the human body.

EXAMPLES

Omega-6 fatty acids can be found in: Dairy (milk, cream, cheese, butter) Nuts and seeds (sunflower seeds, pistachio nuts) Olives and olive oil Evening primrose oil Eggs Vegetable oils (soybean, canola, sunflower) Commercially baked products Deep-fried foods.

• • • • • • • •

There are four types of omega-6 fatty acids: TYPES OF OMEGA-6 FATTY ACIDS

1. Linoleic acid (LA) 2. Gamma-linolenic acid (GLA) 3. Dihomo gamma-linolenic acid (DGLA) 4. Arachidonic acid (AA).

Linoleic acid (LA): Linoleic acid is an essential fatty acid that cannot be produced in the body. Like EPA, LA is found in most human tissues and is used in the production of cell membranes and as a cell signaller, prostaglandins, which help with vessel dilation (opening) and prevent unwanted blood clotting.

Gamma Linolenic acid (GLA): GLA is a non-essential fatty acid; the body can produce it by breaking down linoleic acid. It appears to serve an anti-inflammatory role and is popular as a homeopathic supplement for treating arthritis, eczema, high blood pressure and others; however, there is little evidence to support its use.

BENEFITS Dihomo Gamma-linolenic acid (DGLA): DGLA may again show anti-inflammatory qualities.

Arachidonic acid (AA): AA is a conditionally essential fatty acid (where an LA deficiency occurs) that forms part of cell membranes and acts as a cell signaller. AA is sourced from animal foods (such as meat, poultry and eggs) and may contribute to unwanted inflammation in high quantities.

While omega-6 fatty acids are necessary for the diet, overconsumption can cause inflammation, which may drive long-term poor health conditions like Alzheimer’s disease and arthritis.42,43 Supplementation with omega-6 is unnecessary.

The Western diet is generally high in omega-6 fatty acids because many over-consume processed foods that use cheap vegetable oils (like canola and soybean). Reducing the intake of processed foods and vegetable oils (in favour of olive oil) can help improve the omega-6 to omega-3 in their diet.

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TRANS FATS Nutrition coaches must understand what trans fats are, their origin and their effect on health. Trans fats are found in two sources: Naturally occurring in some animals (cows, sheep, goats and deer) Man-made through industrial processing.

• •

Although trans fats may be found in small quantities in the products derived from some animals, the largest source of trans fats (by far) in the Western diet is processed oils and foods.

Trans fats are an unsaturated fat produced as a byproduct of the processing of unsaturated fats into another product, such as: Hydrogenated margarine Processed baked goods (cakes, biscuits) Processed cooked meat foods (pies, hot dogs, pizza) Foods deep fried in vegetable oils (hot chips, fish).

• • • •

BY-PRODUCT The term by-product refers to an incidental or secondary product made in the manufacture or synthesis of something else.(74)

Unsaturated fatty acids are a less stable structure when compared to saturated fatty acids. This lack of stability means unsaturated fatty acids are more likely to become rancid quicker than saturated fatty acids.

As such, to protect against rancidity and prolong the shelf-life of certain products, some manufacturers put sources of unsaturated fatty acids through a process called hydrogenation.

HYDROGENATION Hydrogenation is the addition of hydrogen atoms to an unsaturated fatty acid to change its structure to be more saturated, thereby increasing its stability and shelf-life.

In the hydrogenation process, adding hydrogen atoms not only changes the chemical structure by making the fatty acid more saturated, but it can also change the position of hydrogen atoms on the carbon chain.

Unsaturated fatty acids usually hold a cis configuration, where the missing hydrogens are from the same side of the carbon chain. As mentioned earlier, this results in bends in the carbon chain where the double bond is. However, during hydrogenation, the hydrogen atoms shift around and change the configuration from cis to trans, where the hydrogen atoms appear on opposite sides of the carbon chain; hence the name trans fatty acids (see below image).

CIS-FAT MOLECULE

TRANS-FAT MOLECULE

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Trans fat, although unsaturated fat, can act more like saturated fat; it is important not to confuse them with other sources of fats that are beneficial for overall health. They became popular in the processed food industry during the twentieth century because of their favourable characteristics in food processing.

These characteristics include: Increase a product’s shelf-life Decrease product refrigeration requirements Less expensive than animal fats like butter and lard Less expensive than semi-solid vegetable oil like palm oil Provide a higher melting point than unsaturated fats (which is ideal for crisper biscuits and crunchier chips).

• • • • •

Trans fats are known to increase the amount of LDL-cholesterol in the blood, a risk factor for heart disease. There is also evidence that trans fats may reduce HDL cholesterol levels in the blood, which is undesirable. Trans fats are not a natural source of dietary fat and are, therefore, not essential in the human diet. The World Health Organization (WHO) recommends limiting energy intake from trans fats to less than 1% of total daily energy intake.

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CLASSIFYING FATS BY THEIR LENGTH Fats can also be classified depending on the length of their biochemical chains. There are three major types of fats when classifying them by their length; these are: 1. Short-chain fatty acids (fewer than 6 carbons) 2. Medium-chain fatty acids (also known as medium-chain triglycerides or MCT) (6 - 10 carbons) 3. Long-chain fatty acids (12-24 carbons).(75)

SHORT-CHAIN FATTY ACIDS Bacteria produce short-chain fatty acids (SCFA) in the gut as they ferment fibre. This provides energy for the microbiome and around 10% of daily energy for the rest of the body.

SCFAs are less than 6 carbon atoms long, and approximately 95% are of 3 main types: 1. Acetate (C2) 2. Propionate (C3) 3. Butyrate (C4) SCFAs are also important for the metabolism of carbohydrates and fats, with propionate being used in the liver for glucose production and acetate and butyrate being used to produce other fatty acids and cholesterol.

A diet rich in fibrous foods like fruits, vegetables and legumes will help increase SCFA production, which may help with the following health concerns: Diarrhoea Colon cancer Inflammatory bowel disease Diabetes mellitus Weight loss

• • • • •

The ‘C’ in brackets following the name of a fatty acid refers to the number of carbon atoms in the fatty acid. For example, acetate (C2) is 2 carbon atoms long, whereas Butyrate (C4) is 4 carbon atoms long.

Foods that feed gut bacteria are often called pre-biotics and include fibrous foods like: Cooked and cooled rice Cooked and cooled potato Onion Garlic Fruit (green bananas, apples, oranges)

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MEDIUM CHAIN FATTY ACIDS Medium chain fatty acids (MCFA), better known as medium chain triglycerides (MCT), are found in foods like coconut oil and full-fat dairy products. Other examples of foods that contain MCTs include: Cheese Butter Milk Yoghurt MCT oil (popular as a supplement).

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MCTs are between 6 and 12 carbon atoms long, and the main four are: Caproic acid (C6) Caprylic acid (C8) Capric acid (C10) Lauric acid (C12)

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MCTs are rapidly broken down in the liver, meaning they can be quickly utilised for energy and because of this, they are less likely to be stored as fat. They are still being heavily researched and may show potential for many benefits, including: Weight management Diabetes mellitus Improved brain function.

• • •

LONG-CHAIN FATTY ACIDS Long-chain fatty acids (LCFA) and very long chain fatty acids (VLCFA) are found in the diet in a range of fat-containing plant and animal foods, including: Avocado Olives and olive oil Legumes, nuts and seeds (peanuts, macadamias, sunflower seeds) Beef and lamb Oily fish (salmon, sardines, mackerel).

• • • • •

LCFAs are between 13 and 21 carbon atoms long and include the important omega-3 and omega-6 fatty acids.

Examples include: Palmitic acid (C16) Stearic acid (C18) Oleic acid (C18) Linoleic acid (C18) EPA (C20) DHA (C22)

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These fatty acids serve many functions in the body: they are used for the production of cell structures and hormones and proper brain function.

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THE ROLE OF FATS As a nutrition coach, it is important to be aware of the role of fatty acids and educate clients on how dietary fat is essential for human health and wellbeing. Humans require dietary fats in regular, moderate quantities to ensure correct bodily function and overall health.(76) Dietary fat is not only an energy-yielding macronutrient, containing 38kJ (9cal) per gram, but it also has many other very important roles in the human body.

The primary role of fat relates to the structure of all cells, as well as: Helps with the regulation of hunger Provides the body with energy and stored energy Critical for normal nerve function Stores some vitamins Maintains healthy cholesterol levels Forms the outer structure of all cells Healthy hair, skin and strong nails Improved brain function and brain development Improves efficiency and effectiveness of blood clotting when/if required Assists in reducing inflammation and increasing immunity Reduces cardiovascular disease risk Improves blood vessel elasticity Decreases the risk of depression and anxiety.

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A diet lacking in a range of dietary fats can lead to poor health outcomes, including: Vitamin deficiency Hormone imbalances Increased hunger Skin problems.

• • • •

In extreme cases, vitamin deficiencies caused by a significant lack of dietary fats can lead to: Weak and brittle bones (vitamin D deficiency) Night blindness (vitamin A deficiency) An inability of blood to clot effectively (vitamin K deficiency).

• • •

ENERGY PRODUCTION AND STORAGE Dietary fat is used for energy production and is stored for use later in adipose (fat) cells. The body can store around 350g of fat in the liver and muscles and an almost unlimited ability to store fat in adipose cells. Depending on energy balance (the amount of energy available in the body) and oxygen demands, the body’s cells determine whether energy production will come from fat or glycogen (stored glucose in the liver and muscles). For example, because energy production from fat requires oxygen, burning fat for energy only occurs in the aerobic system. Fat burning mainly occurs at rest and at low to moderate exertion levels.(6) Energy production from glycogen does not require oxygen and can therefore occur in the anaerobic system, for instance, during intense exercise (sprinting or strength training).

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NORMAL NERVE FUNCTION Nerve cells in the brain have their axon coated in myelin sheath. This coating allows signals to travel down the axon quicker. The myelin sheath (shown in the image to the right) is made from 70-85% lipids, predominantly cholesterol, and 15-30% proteins.(77) These protect the nerve from damage which also helps increase the conduction speed of signals within the brain and the extremities.

If nerve cells become damaged or are not repaired properly, over time, this can lead to neurodegenerative diseases such as Alzheimer’s disease and Parkinson’s disease. Multiple sclerosis is a disease of the myelin sheath that can cause blurred vision, difficulty walking, muscle weakness and tremors (uncontrolled shaking).(78)

VITAMIN STORAGE Vitamins A, D, E and K are fat-soluble, meaning that they can only be absorbed, transported and stored in fats in the body.

Once absorbed from the digestive system, high-density lipoproteins (HDL) carry fat-soluble vitamins to the liver for storage and processing: Vitamin A - is important for immune function and eye health.

Vitamin D - is important for calcium absorption and strong, healthy teeth and bones.

Vitamin E - is important for healthy functions of many organs.

Vitamin K - is important for normal blood clotting.

• • • •

Vitamins C and all B vitamins are water-soluble and therefore are not stored in the body. These vitamins are instead required in small amounts daily (vitamins are discussed later in this resource).

MAINTAINING HEALTHY CHOLESTEROL LEVELS Cholesterol is a form of fat that is produced by the liver and eaten in the diet, which is used for three main roles in the body: Aids in the production of sex hormones Used for the production of human tissues such as cell membranes Used for bile production in the liver.

• • •

Maintaining a healthy cholesterol ratio is important in reducing the risk of cardiovascular disease. Cholesterol is transported in the body by lipoproteins. Lipoproteins are transport molecules that pick up and drop cholesterol wherever needed.

There are many types of lipoprotein; however, the most important ones are: Low-density lipoproteins (LDL) High-density lipoproteins (HDL).

• •

Lipoproteins transport many molecules and nutrients around the body, including: Cholesterol Fat-soluble vitamins (vitamins A, D, E and K) Triglycerides.

• • •

This is important because, without HDL transport, triglycerides can build up in the bloodstream, increasing the risk of atherosclerosis (hardening of the arteries). Without LDL transport, cholesterol would not get transported to tissues that need it.

LIPOPROTEINS Lipoproteins are transport molecules made of protein and fat which carry fats (such as triglycerides) to and from the liver.

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CELL STRUCTURE The human body is composed of cells. Each cell type has an explicit structure and function and contains all the machinery needed to help the body function properly. Cells have walls, called a lipid bilayer, which means that it has two (bi) rows (layer) of fatty acid molecules arranged so that they can keep certain molecules outside or inside the cell (see image below).

The bilayer is composed of a lipid called phospholipids made from saturated and unsaturated fat taken from the diet.

The phospholipids are arranged into the cell membrane and form a hydrophobic layer, meaning that the inner layer repels water. This is important because it prevents unwanted molecules from penetrating the cell, giving it selective permeability, which means the cell has control over what can enter it.(5)

The structure of fat is discussed in more detail throughout the following pages of this resource guide.

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BRAIN FUNCTION AND BRAIN DEVELOPMENT Dietary fat is extremely important for the development and healthy function of the brain. Research shows that polyunsaturated fats (in particular omega-3 fatty acids) are neuroprotective and play an important role in maintaining and augmenting the brain’s health across the lifespan.

For example, polyunsaturated fats are essential for: Foetal brain development in school-aged children Behaviour improvement in those with ADD and ADHD Cognition, memory and mood improvement for teenagers and young adults Improvements to working memory and cognition for older adults.(79)

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The brain is composed of at least 60% fat, particularly a type of omega-3 called DHA. The brain relies on the consumption of sufficient intake from the diet to maintain adequate health and function. A longterm deficiency in omega-3 fatty acids can, in some people, lead to neurodegenerative diseases.(79)(80)

Although nutrition coaches cannot work with children and the elderly, it is still important to acknowledge the indispensable role polyunsaturated fats play in maintaining brain function and development. Sources of polyunsaturated fats will be discussed later in this unit.

ASSIST IN PREVENTING BLOOD CLOTS The polyunsaturated omega-3 fatty acid can help prevent unwanted blood clotting by preventing platelets (small particles of blood that form clots) from clumping together.(81) Omega-6 fatty acids promote blood clotting, so a nutrition coach needs to understand the best ratio of omega-6 to omega-3 in the diet to promote healthy blood clotting, which will be discussed in detail later in this unit.

HUNGER REGULATION The mechanism by which dietary fat helps to regulate hunger is still not completely understood. Many hormones in the body regulate hunger and fullness (satiety). Research has shown that dietary fat and the composition of a meal may be potential factors in achieving increased feelings of fullness and decreased hunger.(82) More research is required to determine the impact of dietary fats on hunger levels.

REDUCE CARDIOVASCULAR DISEASE RISK Some fats are heart-healthy, meaning they can reduce the risk of cardiovascular disease (such as heart attacks, stroke and high blood pressure) when included in a healthy diet.(81) These are polyunsaturated fats, including omega-3 fatty linolenic acid and omega-6 fat linoleic acid.

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INFLAMMATION AND IMMUNE FUNCTION Inflammation is considered to be a normal immune system response to something that might be harmful to the body, such as itchy and red skin because of a bee sting. When the body detects something potentially harmful in the body, special white blood cells called leukocytes rush to the location and attempt to neutralise the threat.

The main immune responses are: Heat Pain Redness Swelling Loss of function.

• • • • •

Low-level, ongoing inflammation has been proposed to be the cause of many diseases, such as: Diabetes mellitus Obesity Cardiovascular disease Arthritis Allergies (asthma, dust allergies).

• • • • •

Some fats, like mono and polyunsaturated fats, help produce prostaglandins (hormone-like substances) which help reduce inflammation. Conversely, some fats like omega-6 fatty acids can increase inflammation when consumed in large quantities in the diet. It is important to learn about these fats, where they come from, and the best ratio to consume them to prevent or reduce inflammation and promote a healthy body for clients.(81)

INFLAMMATION As explained above, inflammation is an immune response to a potential threat. In the case of an allergy, it is an overreaction by the immune system. In the case of arthritis, a high intake of omega-6 fats may be the cause. By analysing a client’s dietary intake, it may be possible to identify the cause of ongoing inflammation and make recommendations to help reduce it.

THE PRODUCTION AND REGULATION OF SOME HORMONES Some hormones, called steroid hormones, are made from fats in the form of cholesterol. Dietary fats are essential for the production of these hormones, and examples include: Testosterone Progesterone Cortisol Aldosterone Vitamin D.

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STEROID HORMONES Steroid hormones refer to sex hormones, including testosterone and progesterone and corticosteroids (which work in the brain), including cortisol (stress hormone) and aldosterone (which regulates water balance).

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IMPROVES BLOOD VESSEL ELASTICITY As individuals age, it is common for their blood vessels to become stiffened, known as the hardening of the arteries.

Consumption of polyunsaturated fats from both oily and lean fish sources have been shown to reduce the hardening of the arteries by reducing plaque accumulation, inflammation, blood clotting and blood vessel constriction.(83)(84)

DECREASES THE RISK OF DEPRESSION AND ANXIETY Intake of polyunsaturated fats has been linked with improvements in mental health in scientific studies. Intake of polyunsaturated fats has been linked with improvements in mental health in scientific studies. The Mediterranean diet may help reduce unwanted symptoms of depression and anxiety. Researchers have proposed that people with depression may not have enough dietary intake of the omega-3 fatty acids EPA and DHA. The results show supplementation with omega-3 reduced depression symptoms in some participants.(85)(86)

Nutrition coaches must remember that clients with depression and anxiety should be encouraged to speak to their GP for assessment and appropriate care.

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RECOMMENDED DAILY INTAKE OF DIETARY FATS The National Health and Medical Research Council (NHMRC) recommends that total fat intake is 20-35% of total daily energy intake, depending on age and physical activity. It further recommends that fats come predominantly from mono and polyunsaturated food sources.(40) A broad dietary fat recommendation of 20-60% may be advisable to allow for variation between client preferences and goals. This will enable the nutrition coach to provide a wider range of intakes for clients who choose to restrict their carbohydrate intake, for example, while still meeting their energy requirements.

The table below provides the recommendations for fat intake for each type of fat.(87)(88)

TYPE OF FAT

TARGET INTAKE

UNSATURATED FAT – Polyunsaturated omega-3 – Polyunsaturated omega-6 – Monounsaturated

per day • 250-1g 4-10% total energy • 15-20% of total energy •

SATURATED FAT

<10% of total energy intake

TRANS FATS

<1% of total energy intake

OMEGA-6 TO OMEGA-3 RATIO Most polyunsaturated fats in commercial vegetable oils are omega-6 linoleic acid, with minimal omega-3 linolenic acid.

Too much omega-6 in the diet creates an imbalance that can interfere with the production of important prostaglandins.

This may result in an increased tendency to form blood clots, inflammation, high blood pressure, irritation of the digestive tract, depressed immune function, sterility, cell proliferation, cancer, arthritis and weight gain.(89)(90) The healthiest ratio of omega-6 to omega-3 is 1:1 to 2:1. In today’s processed food world, dependence on vegetable oil is high, and a lack of fatty fish consumption is common. It is not uncommon for most people to consume an omega-6 to omega-3 ratio of 20:1 (or more), leading to increased obesity risk, weight gain and disease development, including metabolic syndrome, cardiovascular disease, and chronic inflammatory-induced diseases like rheumatoid arthritis, IBD, and cancer.(90)(91) The highest-quality EPA and DHA dietary sources are found in fatty, oily fish like salmon, sardines, mackerel, tuna or fish oils. Adequate amounts are found in eggs, white fish, and shellfish, and smaller amounts in grass-fed butter and grass-fed meats.

Plant-based sources of alpha-linolenic (ALA) are not as easily converted to EPA/DHA. However, the best sources come from flaxseed and walnut oils, ground flaxseeds, raw walnuts, and dried chia seeds that can be converted, though not as sufficient as animal sources.(92) The high dietary consumption of omega-6 fatty acids reduces the conversion of omega-3 to DHA by 40% to 50%, as will high trans fats and saturated fat intake levels.(93) This could pose an issue for people following plant-based diets as they are likely to have a high dietary intake of linoleic acid (omega-6), disrupting the conversion of ALA to EPA and DHA.(92)(94) People following plant-based diets should see a registered nutritionist or an accredited practising dietitian to assess their requirements.

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RDI FOR POLYUNSATURATED FATS The Australian Heart Foundation recommended the intake of omega-3 and omega-6 fatty acids based on population studies by the NHMRC and WHO.(88) Population research demonstrates that dietary intake of omega-6 is very high in Western nations and that this was not the case before the introduction of vegetable oils in the twentieth century.

Some sources recommend consuming a ratio of somewhere between 4:1 to 1:1 of omega-6 to omega-3.(95) Others recommend a ratio of 2:1 to 1:1. Regardless, this means increasing omega-3 sources of food by consuming at least 2-3 serves of oily fish, like salmon, each week or supplementing with high-quality fish oil if necessary.(88) Further, reducing omega-6 intake can be achieved by lowering convenience foods, processed meats and fast food/takeaway food.

Supplementation with omega-6 is unnecessary.

RDI FOR MONOUNSATURATED FATS No specific recommendation for the amount of daily energy from monounsaturated fats exists in Australia.

The American Dietary Guidelines (2015-2020) recommend that 50-65% of daily energy from fat comes from monounsaturated fat sources. This does not mean that 50-65% of an individual’s daily energy should come from monounsaturated fat, but that if someone were to eat 30% of their daily calorie needs from fat, then 15-20% of their total energy should come from monounsaturated fats.

Dietary fat intake is essential for a healthy body. The amount of dietary fat an individual needs in their diet should be based on their energy requirements.

RDI FOR SATURATED FATS The current recommended intake of saturated fats stands at around 10% of total daily energy requirements. Although this is still an area of research, population studies continue to demonstrate that this level of intake reduces the risk of cardiovascular disease.(73) Instead, it is recommended that a person’s total energy from fats should come from MUFA and PUFA sources as part of a plant-based diet, such as the Mediterranean diet.(96)

EMERGING RESEARCH FOR DIETARY FAT RECOMMENDATIONS It is the responsibility of the nutrition coach to stay up to date with the latest, high-quality research to make best practice decisions regarding dietary fats and general nutritional recommendations.

For further research on the recommended daily intake of dietary fats, CLICK HERE.

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UNDERSTANDING OTHER FACTORS THAT CONTRIBUTE TO ENERGY INTAKE UNDERSTANDING ALCOHOL Alcohol is an integral part of Western culture and is a culturally significant aspect of Australian society. As a nutrition coach, it is important to understand the details about alcohol, including: The energy it provides Recommendations on intake How to advise clients on appropriate intake.

• • •

ENERGY IN ALCOHOL Alcohol is said to provide ‘empty calories’ because it contains no other nutrients, such as vitamins and minerals.

Although alcohol is not essential in the diet, it yields energy, providing 29kJ per gram. Because alcohol use is legal and socially acceptable, it can form a regular part of many individuals’ habitual energy intake.

The images below provide some examples of how many kJ’s and standard drinks are in various types (and amounts) of alcohol:

WHAT’S IN MY DRINK? SMALL GLASS (150ml) RED WINE

SMALL GLASS (150ml) WHITE WINE

(13% Alc. Vol) = 1.5 Standard drinks = 490kJ

(11.5% Alc. Vol) = 1.4 Standard drinks = 440kJ

SMALL GLASS (150ml) REDUCED-ALCOHOL WHITE WINE (8-9% Alc Vol)

SMALL GLASS (150ml) CHAMPAGNE

= 1 Standard drinks = 320kJ

1 BOTTLE (375ml) Full-Strength Beer (4.8% Alc. Vol) = 1.4 Standard drinks = 570kJ

(12% Alc. Vol) = 1.4 Standard drinks = 420kJ

SMALL GLASS (150ml) REDUCED-ALCOHOL RED WINE (8-9% Alc. Vol) = 1 Standard drinks = 340kJ

30ML SHOT OF SPIRITS (40% Alc. Vol) with 170ml regular soft drink = 1 Standard drinks = 520kJ

1 BOTTLE (375ml) Light Beer (2.7% Alc. Vol) = 0.8 Standard drinks = 400kJ

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RECOMMENDATION INTAKE FOR ALCOHOL The National Health and Medical Research Council (NHMRC) recommends that adults reduce their alcohol intake.

Pregnant women are advised that there is no safe level of intake. Individuals are also recommended to introduce one or two alcohol-free days a week.

There are two main guidelines to follow. These guidelines ensure alcohol is not consumed in excess and that there are minimal risks of any immediate or lifelong injuries or diseases caused by alcohol.

These guidelines are listed below: (97)(98) 1. To reduce the risk of harm from alcohol-related disease or injury, healthy men and women should drink no more than 10 standard drinks a week and no more than 4 standard drinks on any one day. The less you drink, the lower your risk of harm from alcohol.

2. The Nutrient References Values for Australia and New Zealand state that alcohol should not exceed more than ~5% of daily energy intake on any given day.

WHAT IS CONSIDERED AS A STANDARD DRINK? A ‘standard drink’ is any drink containing 10 grams of alcohol. Some examples are listed in the picture below:(99)

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ADVISING CLIENTS ON THE CONSUMPTION OF ALCOHOL As a nutrition coach, it is important to help guide clients toward moderating their alcohol intake as part of a healthy diet.

Although there is some scientific evidence for the benefit of red wine as part of a healthy diet, reducing alcohol or not drinking at all can benefit many individuals.

Helping clients understand the impact that alcohol can have on their energy intake and long-term health could help them to achieve their goals more quickly, including: Weight loss Blood glucose regulation Improving energy levels Reducing bingeing Reducing the risk of diseases such as cancer, liver and heart disease.

• • • • •

With any changes to a client’s diet, it is important to consider that slow change is always best for long-term adherence to a meal plan. Rather than simply removing all alcohol consumption immediately, it is recommended to reduce intake slowly. This may mean including alcohol in the client’s meal plan. For example, suppose a client regularly consumes 3-4 glasses of wine per night. In that case, a nutrition coach can suggest 2 glasses for the first few weeks, then reduce intake to just one glass before eventually including some alcohol-free days. This approach helps the client not to feel restricted, which can contribute to a healthy relationship with food and the pattern toward sustainable change.

Listed below are just some examples of different approaches that a nutrition coach can take to encourage their clients to moderate their intake of alcohol: Suggest that the client does not keep alcohol in the house.

Encourage the client to buy smaller amounts of alcohol (i.e. a 6-pack instead of a carton) Suggest for the client to drink low or mid-strength beer instead of full strength Suggest the client drinks one glass of wine instead of two Use low-calorie mixers, such as soda water Encourage the client only to drink on social occasions rather than drinking alone.

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RECOGNISING THE IMPORTANCE OF WATER Water is a fundamental part of the human body, making up over two-thirds of total body weight. As a nutrition coachit is imperative to consider and encourage a client to consume water daily and educate them on the importance of water for a healthy, functioning body.

Water plays many roles in the human body, including: Regulating temperature Eliminating waste Aiding in swallowing Lubricating cells Supplying a medium in which the majority of chemical reactions within the body occur.

• • • • •

Even a drop of as little as 2% in body water can trigger signs of dehydration such as:(100) Headaches Increased body temperature Decreased blood pressure Nausea Dizziness Excessive thirst Lethargy Deterioration in concentration/cognitive function.

• • • • • • • •

Dehydration can also often be confused with hunger, causing individuals to overeat. The amount of fluid required is personalised and depends on various factors such as age, weight, climate (e.g. hot and humid or snowing), work environment (e.g. labourer or desk worker) and additional physical activity levels.

The amount of water required would increase for those living in hot and humid environments, who are physically active through their day-to-day lives and for those who participate in regular exercise, where excess fluid may be lost through sweat. On the other hand, fluid requirements may be lower for some individuals, such as those who are sedentary or the elderly, who are less active and may consume more water-based foods such as soups and stews.

Water/fluid can be sourced from the direct consumption of water and other caffeinated and non-caffeinated drinks (e.g. tea/coffee, natural juice, milk and soda water) and through certain foods (e.g. fruits, vegetables, yoghurt and soups).

Water is the ideal source of fluid for hydration and should be recommended as the main source of fluid intake.

Recent systematic reviews have dispelled the myth that caffeine causes dehydration and not contributing to fluid intake. In acute doses of 400mg or less, caffeine does not affect the fluid status and should be included in the total fluid count. There may be a slight diuretic effect on the fluid balance if caffeine is in larger doses (greater than 400mg) or if the body has been deprived of caffeine for a long period.(101) To put that into perspective: coffee contains approximately 80-145mg per cup, and tea contains approximately 20-50mg per cup.(102) Further, caffeine tolerance increases for those that consume caffeine regularly, resulting in NIL effect on fluid status as the body adapts fluid balance with caffeine consumption.(103) Alcohol impacts hydration status and does not contribute to the total fluid count. Milk is approximately 87% water, which must be considered when calculating fluid intake.(104)

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UNDERSTANDING MICRONUTRIENTS INTRODUCING VITAMINS AND MINERALS Micronutrients refer to elements required in trace amounts (very small amounts) that permit the body to yield enzymes, hormones and other substances required for normal growth and development.(105) Micronutrients include vitamins and minerals. Even though they are only required in small amounts, depletion of any micronutrient can have devastating effects on the functioning of the human body.

Nutrition coaches need to understand what micronutrients are, their many roles in the human body, how they can affect an individual’s health when consumption is inadequate or in excess, and how to adapt an individual’s diet to ensure adequate micronutrition on a day-to-day basis.

Vitamins and minerals are required in small amounts to assist with the thousands of chemical reactions occurring in the body. These chemical reactions are responsible for hundreds of roles within the body, including: Improved immunity Bone strength and bone metabolism Blood clotting Nerve function Wound healing Metabolism of macronutrients Night vision Assistance with constriction and relaxation of blood vessels pH regulation Regulates body fluid volume The normal function of all cells Glucose metabolism.

• • • • • • • • • • • •

The difference between vitamins and minerals is that vitamins are organic substances made by plants or animals, whereas minerals are considered inorganic elements that originate from water and soil and are absorbed by plants or eaten by animals.

Vitamins and minerals can be obtained from a balanced, nutrient-dense diet and consumption is required daily to avoid deficiency. Consuming a well-varied diet allows an individual to meet requirements without supplementation.

Supplementation of specific vitamins and minerals may be needed by individuals who are unable to reach their daily requirements, such as: Individuals with higher metabolic demands Individuals struggling with inadequate access to food Individuals with malabsorptive issues or the presence of chronic illness or disease.

• • •

SUPPLEMENTATION Supplementation refers to adding an extra element or amount to something. In other words, when referring to nutrition, supplementation relates to adding micro or macronutrients in the form of a powder, capsule or tablet to supplement the diet to assist individuals in reaching their nutritional requirements.

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Understanding the importance of micronutrients gives nutrition coaches the ability to assist individuals in ensuring an adequate intake of micronutrients daily.

Provided below is an example of a scenario that a nutrition coach may come across in their career:

WORKING WITH A CLIENT WHO IS DEALING WITH FATIGUE A client may come in with complaints of ongoing fatigue, and through the assessment of their nutritional intake, it may be identified that there is an inadequate intake of dietary iron. A nutrition coach would be able to identify the missing micronutrient (e.g. iron), provide education to the client about the effects of deficiency (e.g. fatigue) and work with the client to increase their iron consumption in the diet (e.g. discussion of dietary sources and enhancers/inhibitors of iron absorption).

If it is found that the client is unable to realistically achieve their micronutrient requirements, a supplement may be indicated. In this particular scenario, it would be the responsibility of the nutrition coach to educate and encourage the consumption of whole food sources of iron, and if inadequate intake is suspected longer term, to educate on dietary supplements, which will help the client to reach their micronutrient recommendations.

Suppose a nutrition coach suspects a nutritional deficiency. In that case, it is recommended that a referral is made (or a medical clearance is gained) from a suitable medical professional, as a deficiency could potentially be a sign of an underlying condition.

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UNDERSTANDING THE IMPORTANCE OF VITAMINS Vitamins are organic substances (meaning they contain carbon) made by plants or animals and are essential to sustain life. Vitamins are essential because the body cannot make them; therefore, they must be taken in through dietary measures. While the human body only requires vitamins in small amounts, a deficiency in any vitamin can have negative health impacts on the individual.

Vitamins got their name in the twentieth century from both Latin and English roots. ‘Vita’ means ‘life’ or ‘vital for life’, and ‘amine’ was chosen because vitamins contain nitrogen. An amine is a functional group that contains nitrogen - just as amino acids contain an amine side chain with nitrogen.

Each organism has diverse vitamin requirements. Different vitamins have different roles, and they are needed in different quantities. For example, the human body receives most of its vitamin D from sunlight because it is not available in large enough quantities in food. However, the human body can synthesize it when exposed to sunlight.

There are a total of 13 different vitamins, which can be categorised into two different groups: 1. Fat-soluble vitamins (vitamin A, D, E and K) 2. Water-soluble vitamins (B vitamins and vitamin C).

There are fundamental differences between fat-soluble and water-soluble vitamins, which will be explored in greater detail below.

VITAMINS

WATER SOLUBLE

B

C

FAT SOLUBLE

D

E

K

A

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FAT-SOLUBLE VITAMINS Fat-soluble vitamins refer to vitamins that require dietary fat for their absorption. Fat-soluble vitamins are absorbed along with dietary fats, and excess is stored in the body’s fatty tissue. Because fat-soluble vitamins are stored in the body, excess consumption of them can lead to toxicity. It is therefore important to consume fat-soluble vitamins in small amounts and frequently rather than in large quantities sporadically.(5)

Soluble means able to be dissolved. While for most soluble substances, this refers to the ability to be dissolved in water, a fat-soluble vitamin can only be dissolved by fat. Therefore, a fat-soluble vitamin requires a diet with adequate dietary fats for appropriate absorption.

Fat-soluble vitamins include: Vitamin A (also known as retinol) Vitamin D (also known as cholecalciferol) Vitamin E (also known as tocopherols) Vitamin K.

• • • •

As a nutrition coach, it is important to know that fat-soluble vitamins require fat for absorption. Therefore, it is essential to ensure that clients adequately consume natural dietary fats daily.

Inadequate consumption of dietary fats can lead to the malabsorption of fat-soluble vitamins, consequently leading to their associated deficiencies. For example, individuals following a very low-fat diet for a long period may become deficient in fat-soluble vitamins and may need to increase dietary fat to allow adequate vitamin absorption.

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BENEFITS OF ENSURING ADEQUATE INTAKE OF FAT-SOLUBLE VITAMINS The below table outlines the benefits of fat-soluble vitamins for the human body, including recommended daily amounts and examples of where to find the vitamin in food.

BENEFITS OF FAT-SOLUBLE VITAMINS TYPE OF VITAMIN

VITAMIN A (includes retinoids and carotenoids more predominantly beta-carotene)

VITAMIN D

VITAMIN E

VITAMIN K

BENEFITS Essential for healthy vision, tissues and skin. Aids bone growth. Carotenoids are an important antioxidant that may help lower cancer risk and cataracts.

RECOMMENDED DAILY INTAKE

FOOD SOURCES

(RDI) / ADEQUATE INTAKE (AI)(106)(107)

RDI Men: 900 mcg (3,000 IU).

Women: 700 mcg (2,333 IU).

Retinoids: Beef Liver Eggs Fish Fortified milk Cheddar cheese Swiss cheese.

•• •• •• •

Beta carotene: Sweet potatoes Carrots Pumpkins Squash Spinach Mangoes.

Maintenance of normal blood levels of calcium and phosphorus. Helps the body absorb calcium for strong bones. Also essential for activating the body’s immune response.

AI Men and women: 19-50yrs: 5 mcg (200 IU).

51-70yrs: 10 mcg (400 IU).

71yrs+: 15 mcg (600 IU).

Is an important antioxidant that assists in neutralising free radicals. Protects vitamin A and certain lipids from damage.

AI Men: 10 mg.

Women: 7 mg.

Plays an essential role in forming at least three proteins involved in the blood clotting process. Essential for building strong bones. Also required for the formation of other proteins in plasma, bone and kidney.

AI Men: 70 mcg.

Women: 60 mcg.

•• •• •• liver •• Beef Cheese yolks •• Egg Oily fish (tuna, mackerel and salmon).

green • Leafy vegetables grains •• Whole Nuts • Wheat germ. leafy • Green vegetables (such as kale, and spinach). sprouts •• Brussels Broccoli •• Cauliflower Cabbage •• Fish Liver • Eggs.

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WATER-SOLUBLE VITAMINS Water-soluble vitamins dissolve in water, meaning that water-soluble vitamins require water for their absorption.

Because excess water is constantly flushed out of the body, unused water-soluble vitamins are also flushed out of the body. As a result, all individuals need to consume water-soluble vitamins daily to avoid deficiency.

Water-soluble vitamins include: Vitamin B1 (also known as thiamine) Vitamin B2 (also known as riboflavin) Vitamin B3 (also known as niacin) Vitamin B5 (also known as pantothenic Acid) Vitamin B6 (also known as pyridoxine) Vitamin B9 (also known as folate/folic acid) Vitamin B12 (also known as cyanocobalamin) Biotin Vitamin C (also known as ascorbic acid).

• • • • • • • • •

Although not so common now, diseases caused by nutritional deficiencies include beriberi (vitamin B1thiamine), pellagra (B3-niacin), anaemia (B12-cobalamin), and scurvy (C-ascorbic acid).

It is very difficult to get water-soluble vitamin toxicity (a build-up of water-soluble vitamins) because they are constantly flushed out of the body via the urine.

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BENEFITS FOR ENSURING ADEQUATE INTAKE OF WATERSOLUBLE VITAMINS The table below outlines the benefits of water-soluble vitamins for the human body, including recommended amounts and examples of where to find the vitamin in food.

BENEFITS OF WATER-SOLUBLE VITAMINS TYPE OF VITAMIN

VITAMIN B1 (THIAMINE)

VITAMIN B2 (RIBOFLAVIN)

VITAMIN B3 (NIACIN)

VITAMIN B5 (PANTOTHENIC ACID)

VITAMIN B6

BENEFITS

RECOMMENDED DAILY INTAKE

FOOD SOURCES

(RDI) / ADEQUATE INTAKE (AI)(107)

Assists foods in being converted into energy.

Essential for brain function and healthy skin, hair and muscles.

RDI Men: 1.2 mg Women: 1.1 mg.

Helps foods to be converted into energy. Essential for brain function and healthy skin, hair, and blood.

RDI Men: 19-70yrs: 1.3 mg >70 yrs: 1.6mg Women: 19-70yrs: 1.1 mg >70 yrs: 1.3mg.

Helps foods to be converted into energy. Essential for brain and nervous system function, healthy skin and blood cells.

RDI Men: 16mg Women: 14mg.

Helps foods to be converted into energy. Also helps the body make lipids (fats), neurotransmitters, steroid hormones, and haemoglobin.

AI Men: 6 mg Women: 4 mg.

Helps to lower homocysteine levels and aids the conversion of the neurotransmitter tryptophan into niacin and serotonin.

Aids the production of red blood cells. Essential for cognitive function and immune health.

RDI Men: 19-50yrs: 1.3 mg >50yrs: 1.7mg.

Women: 19-50yrs: 1.3mg >50yrs: 1.5mg

and pork •• Beef Dried milk and seeds •• Nuts Eggs •• Oats Legumes • Peas liver •• Beef Lamb •• Milk Natural yoghurt •• Mushrooms Spinach •• Almonds Sun-dried tomatoes •• Meat Poultry •• Fish Whole grains •• Mushrooms Potatoes. liver •• Chicken Sunflower seeds •• Salmon Whole grains •• Broccoli Mushrooms • Avocados.

•• Fish Potatoes (and other starchy vegetables) fruits •• Non-citrus Beef liver (and other organ meats).

VITAMIN B7 AND B8 (BIOTIN)

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Biotin is also referred to as ‘vitamin H’, and it is one of the B complex vitamins that assist the body in converting food into energy.

VITAMIN B7 AND B8 (BIOTIN)

VITAMIN B9 (FOLIC ACID/ FOLATE)

VITAMIN B12

VITAMIN C

AI Men: 30 mcg Women: 25 mcg.

•• Eggs Kale •• Oats Mushrooms • Pork liver/calf liver.

RDI Men: 400 mcg Women: 400 mcg.

•• Lentils Nuts •• Avocado Dark green vegetables (broccoli,

The term biotin is derived from the ancient Greek term “biotos,” meaning sustenance. Biotin aids in keeping skin, hair, eyes, liver, and the nervous system healthy.

Essential for the synthesis and repair of DNA and RNA. Aids rapid cell division and growth and the production of healthy red blood cells. It may help avoid birth defects of the brain and spine.

spinach, collard or turnip greens, okra, brussels sprouts, asparagus) Citrus fruit

Maintenance of healthy nerve cells and the production of DNA and RNA. Works alongside B9 (folate or folic acid) in helping the body make red blood cells.

Also helps iron to function effectively in the body.

RDI Men: 2.4 mcg Women: 2.4 mcg.

Vital for the growth and repair of tissues in the human body. It assists the body in making collagen (an important protein used to make skin, cartilage, tendons, ligaments and blood vessels). Vitamin C is required to heal wounds and repair and maintain bones and teeth.

RDI Men: 45mg Women: 45mg.

• •• Shellfish Liver •• Fish Crab soy • Fortified products (tofu, soymilk) cereals •• Fortified Red meat •• Cheese Eggs. fruits •• Citrus Red peppers •• Kale Brussels sprouts •• Broccoli Strawberries • Guava.

Please Note: All RDI and AI’s have been derived from the NHMRC (Nutrient Reference Values for Australia and New Zealand).(107)

Water-soluble vitamins are very heat sensitive; therefore, a nutrition coach must understand the solubility of vitamins in food preparation. Vitamins such as B and C will be destroyed if foods containing these vitamins (such as carrots) are cooked for a long period.

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UNDERSTANDING THE IMPORTANCE OF MINERALS Minerals are inorganic substances that are essential as they allow the body to perform functions necessary for life.(5) Minerals are found in the soil and cannot be synthesised by living organisms. In other words, the human body cannot make minerals; for an individual to meet their daily requirements, minerals must be consumed through food.

Plants absorb minerals from the soil, just like the animals that eat plants. This is why plants grown in mineral-deficient soil produce vegetables or fruits that are also mineral-deficient.

Essential minerals are micronutrients that the human body requires in small amounts regularly. There are two major categories of essential minerals: trace and major minerals. Trace minerals are necessary for the human body in smaller amounts than major minerals, although both play fundamental roles in maintaining health.

Essential minerals include calcium, chromium, copper, fluoride, iodine, iron, magnesium, manganese, molybdenum, phosphorus, potassium, selenium, sodium and zinc.(107) These minerals are found across many different foods, including: Organ meats Fish Dairy products Nuts Seeds Legumes Dried fruit Meat (lamb, pork, beef, duck, rabbit, chicken) Table salt Seaweed and seafood.

• • • • • • • • • •

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Essential minerals are divided into two categories: 1. Major minerals (also known as macrominerals) 2. Trace minerals (also known as microminerals)

MAJOR MINERALS

TRACE MINERALS

Major minerals (also known as macrominerals) are minerals that the body requires in larger amounts.

Trace minerals (also known as microminerals) are equally as important as major minerals; however, as they are present in smaller amounts in the body, they are needed in smaller amounts.

Major minerals, while working and functioning alone, also often work together to ensure the healthy functioning of the human body. Therefore, a deficiency of one major mineral can have functional consequences on another major mineral.

Major minerals include: Sodium Calcium Chloride Potassium Phosphorous Magnesium Sulphur.

• • • • • • •

Although only required in smaller amounts, trace minerals have many critical roles in the human body.

Trace minerals include: Iron Zinc Iodine Selenium Copper Manganese Fluoride Chromium Molybdenum.

• • • • • • • • •

Several minerals are required by the human body and are essential for the growth, development and maintenance of health. These essential minerals are used for many functions, such as building strong bones, transmitting nerve impulses and maintaining a regular heartbeat.

As a nutrition coach, it is important to understand the role and sources of essential minerals the human body requires, as a deficiency or toxicity can greatly impact a client’s health. For example, an individual who presents with ongoing fatigue and lethargy, and is a vegetarian who dislikes dark green leafy vegetables, is at increased risk of iron deficiency.

When analysing a client’s diet, it is beneficial to have the confidence and ability to not only identify a mineral imbalance but also to be able to rectify it through dietary measures.

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In addition to the functions mentioned above of essential minerals, there are many other fundamental roles and functions which minerals play in the human body too, including: The structural strength of bones and teeth Balancing electrolytes in the body to prevent dehydration Ensuring the healthy functioning of muscles, the heart and the digestive system Regular functioning of all cells, particularly of bone marrow and nervous and gastrointestinal systems Acting as cofactors for enzymes Stomach acid regulation for optimal digestion and absorption Nerve transmission and muscle contraction Blood clotting Blood pressure regulation Maintaining a healthy immunity.

• • • • • • • • • •

ELECTROLYTES Electrolytes are salts and minerals that conduct electrical impulses in the human body. Electrolytes are fundamental to the healthy functioning of the human body.

Examples of electrolytes include: Magnesium Sodium Chloride Phosphate Calcium.

• • • • •

No Current Flows

Extensive Current Flows

An Electrolyte is a substance that will conduct electricity when dissolved in water or when molten.

All salts and some polar covalent compounds are electrolytes.

Example

Nonelectrolyte Ethanol

Strong Electrolyte Sodium Chloride

All electrolytes are classed as minerals, but not all minerals are classed as electrolytes.

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BENEFITS OF ENSURING ADEQUATE MINERAL INTAKE As a nutrition coach, it is important to know the various functions of the different minerals as well as to be able to identify when a deficiency of a certain mineral may be present. Deficiencies can be identified through various signs and symptoms with which the client may be presenting. In addition to the signs and symptoms of mineral deficiencies, the two tables below outline the benefits, requirements and dietary sources of major and minor minerals.

MAJOR MINERALS (MACRO-MINERALS) TYPE OF MINERAL

BENEFITS

RECOMMENDED INTAKE(106) AI Males/Females: 460 - 920mg UL 2300mg.

FOOD SOURCES

DEFICIENCY

Table salt, anchovies, olives, fetta cheese, bread, stock cubes, and canned fish.

cramps •• Muscle Mental apathy • Loss of appetite.

SODIUM

Sodium is an important electrolyte with an essential role in enzyme operations and muscle contractions.

Sodium is required to maintain a healthy fluid balance in the body too.

CALCIUM

Aids development and DI maintenance of the skeleton. Males: Required for the proper 19 - 70yrs: 1000mg functioning of neuromuscular >71yo: 1300mg and cardiac function.

Females: 19 - 50yrs: 1000mg >51yrs: 1300mg UL Males/Females: 2500mg.

Dairy foods, fish with bones (sardines), tahini, almonds, curly parsley, bok choy, crab, and silverbeet.

CHLORIDE

Essential for a healthy metabolism.

Seaweed, rye, tomatoes, lettuce, celery, and olives.

POTASSIUM

Potassium is an important AI electrolyte that works Males: 3800mg alongside sodium to Females: 2800mg. maintain healthy blood pressure and balance of fluids in the body. Potassium also aids the transmission of electrical pulses for proper nerve and muscle function.

Significant cofactor in more than 300 biochemical reactions, including protein synthesis, muscle and nerve function, blood glucose MAGNESIUM control, and blood pressure regulation. Required for energy production and muscle contraction/ relaxation.

SULPHUR

Makes up vital amino acids required in protein synthesis for cells, tissues, hormones, enzymes, and antibodies.

No Nutrient Reference Values set.

• Osteoporosis; decreased bone

mass, fractures and stooping.

Note: Absorption increased by vitamin D. of appetite •• Loss Muscle weakness • Lethargy

Vegemite, cocoa, Deficiency is unlikely. dried fruit, nuts and Conditioned deficiency seeds, legumes, dairy, may be found with: Kidney disease potatoes, avocados, and Diabetic acidosis bananas.

Excessive vomiting Diarrhoea, or Sweating.

•• •• •

RDI Males 19 - 30yrs: 400mg >31yrs: 225mg Females 19 - 30yrs: 310mg >31yrs: 320mg UL Males/Females: 350mg.

Cocoa, sunflower seeds, Severe deficiency brazil nuts, sesame includes: Tremors seeds, almonds, Muscle spasms peanuts, yoghurt, dried fruit, and dark chocolate.

No Nutrient Reference Values set.

Sesame seeds, sunflower seeds, pork, beef, lamb, nuts, and bread.

••

•• Acne Brittle nails •• Depression Memory loss • Slowed wound healing.

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TRACE MINERALS (MICROMINERALS)(107) TYPE OF MINERAL

IRON

ZINC

IODINE

HOW MUCH IS NECESSARY?

FOOD SOURCES

DEFICIENCY

An essential component of haemoglobin. The substance in red blood cells that carry oxygen throughout the body.

RDI Males: 8mg Females: 19 - 50yrs: 18mg >50yrs: 8mg UL Males/Females: 45mg

Liver and kidneys, red meat, seafood, beans, dark green leafy vegetables, and dried fruit such as raisins and apricots.

Iron deficiency anaemia is characterised by: Tingling of fingers/ toes Breathlessness on exertion Insomnia Dizziness Heart palpitations Fatigue.

metabolism, growth and development.

UL Males/Females: 1100ug.

cheese, green beans, yoghurt, milk, spinach

underactive thyroid and overstimulation of thyroid stimulating hormone (TSH).

Prevention of free radical damage.

RDI Males: 60ug Females: 60ug UL Males/Females: 400ug

Brazil nuts, fish, oysters, egg yolk, cashews, mushrooms, sesame seeds

Assists with the metabolism of iron, part of many enzymes.

AI Males: 1.7mg Females: 1.2mg UL Males/Females: 10mg

Lobster, lamb liver, brazil nuts, sunflower seeds, dark chocolate, dried fruit

BENEFITS

• • •• •• Required for wound RDI Oysters, red meat, growth/ • Slowed healing and the Males: 14mg poultry, legumes, development healthy functioning of Females: 8mg mushrooms, and Delayed sexual • the immune system, fish. maturation UL cell division/growth Impaired immune • Males/Females: and the breakdown of function 40mg. carbohydrates. loss •• Hair Loss of appetite • Diarrhoea.

Found in thyroid hormone, RDI Fish paste, scallops, • Iodine Deficiency it assists in regulating Males/Females: 150ug egg yolk, salmon, Disorder results in an

SELENIUM

COPPER

Essential co-enzyme AI in healthy metabolism.

5.5mg MANGANESE Required for healthy bone Men: Women: 5mg. structure and formation.

FLUORIDE

CHROMIUM

Required for strong tooth enamel and resistance to tooth decay.

Whole grains, macadamias, hazelnuts, tofu

AI Duck, fish paste, Men: 4mg licorice, lettuce, Women: 3mg avocado, drinking water UL Males/Females: 10mg.

Essential for regulating AI blood sugar. Aids insulin in Men: 35mg transporting glucose into Women: 25mg cells. Aids metabolism of fat and protein.

The catalyst for enzymes. RDI Aids the breakdown of Males/Females: 45ug.

MOLYBDENUM certain amino acids.

UL Males/Females: 2000ug

Parsley (curly), olives, spinach, cottage cheese, sultanas, red wine, bread, cheddar cheese Lamb liver, peanut butter, parsley (curly), almonds, coconut, cheddar cheese, and cream.

loss •• Hair Decreased immunity •• Fatigue Brain fog • Hypothyroidism.

•• Anaemia Bone abnormalities immunity •• Decreased Neurological abnormalities • Oedema.

•• Sterility Skeletal abnormalities. susceptibility • Increased to dental cavities.

blood • Elevated glucose.

• Unknown

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UNDERSTANDING SODIUM (Na) Sodium, generally known as table salt, is one of the essential macrominerals and is an important electrolyte required in the human diet for various biochemical processes.

Sodium is a major cation (positively charged ion) of extracellular fluid (the fluid that surrounds cells) which serves many important functions in the human body, such as: Regulates body fluid osmolarity: osmolarity refers to the concentration of a solution; therefore, sodium regulates the concentration of body fluids.

Regulates acid-base balance: acid-base balance refers to the pH levels of the fluids in the body.

Transmission of nerve impulses: communication between nerves in response to various signals and messages from internal and external environments.

Total body fluid volume: secondary to the osmolarity of body fluids, sodium will assist in regulating total body fluid volume.

• • • •

Sodium has long been debated regarding its effects on human health and is suggested to be linked with heart disease, stroke and hypertension (high blood pressure) when individuals consistently consume it in excess over a long period.

Excessive intake has also been linked to potential osteoporosis (brittle and fragile bones), oedema (excess water collecting in tissues of the body such as ankles) and acute (sudden/quick onset) hypertension.

Although rare in Western populations, sodium deficiency is linked to:(108) Insulin resistance (increases risk of diabetes), Elevated triglycerides Muscle cramps Mental exhaustion Loss of appetite and low blood pressure levels.

• • • • •

It is, therefore, important to have the correct balance of sodium in the diet, where it is neither consumed in excess nor avoided. Maintaining an adequate balance of sodium daily is essential for overall health.

Salt in the diet mostly comes from three avenues: 1. Processed foods are either high in salt (such as bacon, salami, chips, frozen meals, snack foods and cheese) or consumed frequently (such as bread and cereal).

2. Added to cooking (such as stock cubes).

3. Added at the table for additional flavour (such as soy sauce or table salt).

With all these additional avenues for sodium intake, it is no surprise that most Western populations are consuming over two times the nutritional recommendations.(109) It is important to be aware that while processed foods contain the most sodium, sodium can also be found naturally in foods such as milk, meat and seafood.

As a nutrition coach, it is important to understand where dietary sources of sodium are found, the role sodium plays in human health and the consequences of both a deficiency and an excess of it. A nutrition coach can help clients to ensure healthier options of salt are selected and that the right quantity is consumed.

2.5 million deaths could be prevented yearly by reducing sodium intake to recommended levels globally.(109)

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DIFFERENT TYPES OF SODIUM Different table salts will have different benefits depending on how the salt has been extracted and refined. As such, a nutrition coach needs to understand the differences to make suitable recommendations.

The four major salts to be aware of are outlined in the table below:

TYPE OF SALT TABLE SALT

IODISED TABLE SALT

HIMALAYAN SALT

CELTIC SEA SALT

DESCRIPTION refined and therefore trace minerals are removed.

• Heavily Made up of 97% or higher sodium chloride.

• Often, anti-caking agents are added to prevent it from clumping together.

• over plain table salt and Himalayan salt because it is an essential • Preferred source of iodine and assists with deficiency. Iodine deficiency is linked with

• •

thyroid and birth disorders.

Some brands are highly refined, and therefore trace minerals are removed; however, iodine is added back in Often, anti-caking agents are added to prevent it from clumping together.

Check labels to ensure these have not been used.

source of trace minerals such as calcium, iron, potassium and • Natural magnesium. levels of iodine.

• Unreliable Mined from compressed (rock-like) state • It may containa dried, higher of heavy metals • It can be purchased inlevels flakes, unground or ground.

• They are less likely to have • Light pink in colour. anti-caking agents or iodine added to them.

• salt with water added to it makes it moister.

• Sea Greyish colour.

• Natural insource of trace minerals, easily accessed by the body • Highest in calcium and magnesium, lowest in sodium • Moderate levels of iodine a natural and bioavailable source • Considered to be the bestbutchoice consumed within a diet • containing iodine-rich foods, suchofassalteggs,whenseafood, sea vegetables (e.g. seaweed varieties), and dairy.

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CHOOSING THE BEST SODIUM FOR CONSUMPTION While there are many other salts on the market, the above table identifies the four major types. If looking at the sodium content alone, all these various types of salt contain 95% or more sodium.

Celtic Sea salt is an excellent choice because it is unrefined and has the highest amounts of beneficial trace minerals and the lowest amount of sodium.(110) However, Celtic Sea salt can be difficult to come by outside of health food stores.

Fortified or not, table salt is refined (processed), has the minerals removed, and may have added anti-caking agents.

With anything in the diet, the closer to its natural state, the better, and it is no different for salt. Therefore, Himalayan salt or Celtic Sea salt is recommended as a preference over refined table salt. Of course, those with an iodine deficiency may benefit from iodine-fortified salt (salt with iodine added to it), and those with heavy metal toxicity may benefit from avoiding sea salt.

Sodium is one of the electrolytes which requires replenishment during and after exercise. During exercise, sodium is lost through sweat. Not replacing sodium can result in increased muscle cramps, imbalanced electrolytes, headaches or light-headedness, and dehydration.

SODIUM RECOMMENDATIONS While WHO recommends no more than 5g (5000mg) salt per day, Australian guidelines recommend an upper limit of 2.3g (2300mg) per day.(109)(110) When reading a nutrition label, it is important to understand how much salt is in a product and if it is considered “very high” or “low” in sodium.

ON A NUTRITION LABEL, IF SODIUM IS:

THE FOOD IS CLASSED AS:

>1000mg/100g

Very high in sodium

500-1000mg/100g

High in sodium

120-500mg/100g

Moderate in sodium

<120mg/100g

Low in sodium (recommended) 100g

3.9

As a nutrition100g coach, it is encouraged that nutrition labels are read and sodium 5.5 levels are kept below 120mg/100g of any product.

100g

6.5

100g

9

30g (1 slice)

2.1

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UNDERSTANDING HOW THE BODY ABSORBS, UTILISES AND PROCESSES NUTRIENTS While a nutrition coach must have a thorough understanding of nutrition and what constitutes the different types of nutrients, it is also vitally important to have a sound understanding of how the body absorbs, utilises and processes the nutrients consumed. Understanding how the body digests and absorbs nutrients will allow a nutrition coach to safely and effectively support the nutritional needs of their clients and, in turn, promote a healthy functioning body.

Digestion involves the chemical and mechanical breakdown of foods ingested from large to small particles and ultimately into their smallest units for absorption. For example, the breakdown of protein into amino acids.

Absorption is the process by which nutrients travel from the digestive system into the blood and lymph system for utilisation by cells or organs. Utilisation refers to the metabolism (breakdown) of nutrients like glucose, amino acids and fatty acids for energy, repair and growth.

Digestion is the process that foods go through to be broken down and used in the body. Digestion commences in the mouth and continues as food travels through the stomach and intestines until waste products are created, stored and finally excreted from the body.

INGESTION

DIGESTION

ABSORPTION

ELIMINATION

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UNDERSTANDING DIGESTION The digestion and absorption of nutrients are quick, with macronutrients often broken down and absorbed within 30 minutes after food has entered the small intestine.

Each macronutrient is broken down into its component nutrients: Proteins are broken down into amino acids Fats are broken down into fatty acids Carbohydrates are broken down into monosaccharides.

• • •

Digestion occurs in three main locations, and these are explained below: The oral cavity (the mouth) The stomach The small intestine.

• • •

The digestion and absorption of macronutrients are discussed in more depth in the unit NAT11046004 (Assist in Establishing Positive Digestive Health).

THE ORAL CAVITY (THE MOUTH) The process of digestion commences within the mouth with mechanical digestion - the action of chewing breaks food into smaller pieces to be swallowed. At the same time, the mouth releases saliva to begin chemical digestion. Enzymes like lingual lipase and salivary amylase work to start chemically breaking down food in the mouth. Amylase breaks down carbohydrates into glucose. This is noticeable when eating white bread, which seems to dissolve even without the action of chewing. This is because saliva contains digestive enzymes. Once food has been chewed enough, a bolus is formed, which is then swallowed.

The image below displays the elements of digestion in the mouth.

Nasal cavity Oral cavity Uvula Lips

Pharynx Tounge

Epiglottis

Jaw

Oesophagus

Larynx

The digestive system is considered external to the body because it is open to the environment at both ends.

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THE STOMACH The bolus travels down the oesophagus and into the stomach. The stomach continues the digestive process by mechanically churning the food into smaller pieces while releasing digestive acids like hydrochloric, sodium chloride and potassium chloride to chemically break down food.

Once the sphincter (a ring of muscle) at the base of the stomach detects that the bolus is digested enough, it allows small amounts to pass through to the small intestine. At this point, the bolus becomes known as chyme.

The image below displays the elements of digestion in the stomach:

Oesophagus Accordion-like folds allow the stomach to expand Sphincters control the flow into and out of the stomach

Food particle

Stomach lining Small intestine

secretes gastric juice (acid, enzyme, molecules, and mucus).

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THE SMALL INTESTINE In the small intestine, bile salts are released from the liver and gallbladder, which help the digestion of fats. Bile is an alkaline fluid that neutralises the stomach acid’s acidity in the chyme.

The surface of the small intestine is lined with a brush border, which is composed of hair-like follicles that protrude from the surface of the small intestine, referred to as villi. Each villus is further lined by more hair-like follicles known as microvilli. The villi and microvilli significantly increase the surface area of the small intestine and thus provide a significantly greater absorptive capacity.

The image below demonstrates the brush border of the small intestine.

Villi Villi

The ‘brush border’ of the small intestine and an organ called the pancreas release more digestive enzymes, which complete the process of digesting the chyme into individual nutrients: Pancreatic amylase: Breaks down carbohydrates into glucose Lactase: Breaks down lactose (from dairy) into glucose and galactose Maltase: Breaks maltose into glucose Sucrase: Breaks sucrose into glucose and fructose Isomaltase: Breaks down starches to help maltase and amylase Lipase: Breaks fats into fatty acids Peptidase and Trypsin: Break proteins into amino acids.

• • • • • • •

Once the chyme has been broken down into its component nutrients, it can be absorbed into the bloodstream and lymphatic system. The image below displays the elements of digestion in the small intestine.

Liver

Bile

Gall bladder

Stomach

Bile Acid chyme

Pancreatic juice Duodenum of small intestine

Pancreas

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UNDERSTANDING ABSORPTION Once food has been digested into individual nutrients, the nutrients can be absorbed and utilised by the body. They move across the border of the small intestine’s microvilli into the gastrointestinal tract’s cells through a process known as absorption. Generally, the majority of absorption of nutrients occurs in the small intestine, specifically the upper portion of the small intestine. Nutrients are absorbed and transported via the bloodstream or lymphatic system to various body parts for utilisation.

ABSORPTION IN SMALL INTESTINE

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TYPES OF ABSORPTION There are various ways in which a molecule, such as a monosaccharide, an amino acid or fatty acid, can be absorbed; the table below identifies and explains the different types of absorption:(111)

DIFFUSION

The passive molecular movement from an area of higher concentration to an area of lower concerntration.

FACILITATED DIFFUSION

The passive molecular movement of a substance across a plasma membrane by means of a protein carrier.

ACTIVE TRANSPORT

The adenosine triphosphate (ATP) dependant absorption or secretion of solute across a plasma membrane.

ENDOCYTOSIS

The movement of relatively large volumes if extracellular material into the cytoplasm via the formation of a membranous vesicle at the cell surface.

Diffusion is dependent on several things: The solubility (water-soluble versus fat-soluble) of the molecule, The electrical gradient (the electrical activity which acts on a molecule forcing it to move in one direction or another) of the molecule, The size of the molecule to be absorbed.

• • •

ABSORPTION SITES As a nutrition coach, it is important to understand how nutrients are absorbed as part of the functioning of the gastrointestinal tract (GIT). Different nutrients are absorbed along different sites of the GIT. Absorption sites include: The stomach The duodenum The jejunum The ileum The large intestine.

• • • • •

Some foods, like fibre, do not get digested in the stomach or small intestine and therefore do not get absorbed. These unabsorbed contents feed the bacteria found in the small intestine or are compacted and add bulk to the stool. If the contents are being compacted to add bulk to the stool, the content is passed out via the ileocecal valve (the valve which connects the small intestine’s final part to the large intestine’s first part) and out through the anus.

BACTERIA Bacteria, also known as gut flora or gut microbiota, refer to the complex community of microorganisms that resides in the digestive tracts of humans. The role of bacteria is to assist in the digestion and absorption of food and nutrients.

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Several bacteria in the small intestine feed on unabsorbed contents; the more common bacterial species include Bacteroides, Enterobacteria, Lactobacilli, Streptococci and Staphylococci. The bacteria are important not only for nutrient absorption but also for overall immunity.

The image below represents the absorptive sites of various nutrients along the GIT.

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UNDERSTANDING THE ABSORPTION OF MACRONUTRIENTS Once food has been digested into nutrients, the processes of absorption begin. Each product of a macronutrient (amino acids, monosaccharides and fatty acids) is absorbed slightly differently. This knowledge is useful in understanding how each nutrient is transported and utilised in the body.

The table below provides a basic outline of how the body absorbs the three common macronutrients: protein, fats and carbohydrates:

PROTEIN (AMINO ACIDS)

FATS (FATTY ACIDS

CARBOHYDRATES (MONOSACCHARIDES)

Once protein is digested into amino acids, it can be absorbed.

Once fats are digested into fatty acids (or free fatty acids), they can be absorbed.

Once carbohydrate foods are digested, simple sugars called monosaccharides are left to be absorbed. This occurs in the cells of the intestinal wall of the jejunum.

Amino acids are absorbed in the border of the small intestine, specifically in the jejunum and ileum.

Absorption is an active process, meaning that it requires energy in the form of Adenosine Triphosphate (ATP) to occur. The amino acids are transported through the intestinal wall cells and into the bloodstream to be transported to the liver and muscles.

Fatty acids are absorbed by the cells of the small intestine, specifically the jejunum.

Once inside the cell, they get converted into triglycerides and packed into a chylomicron for transport. This happens because fatty acids (triglycerides) are hydrophobic, meaning they do not mix with water (e.g. the blood).

Chylomicrons are made from proteins and are hydrophilic on the outside, meaning they can mix with water (i.e. the blood) but hydrophobic on the inside, meaning that the fatty acids (and other hydrophobic molecules) are safe inside them.

The monosaccharides diffuse into the cells by active transport through a sodium channel, meaning sodium (Na+) is used to help transport the monosaccharides.

Because the monosaccharides are small and hydrophilic (can mix with water), they pass out of the cell and into the bloodstream.

The chylomicrons then pass out of the intestinal cells and, because of their large size, enter the lymphatic system for transport into the venous system.

Starch is found in all plant sources, most abundantly in potatoes, sweet potatoes, corn and peas.

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HOW THE BODY UTILISES FIBRE As previously discussed in this resource, fibre is an essential part of many food items. It plays many roles in foods, including: Forms the shape and structure of fruits and vegetables Forms cell walls Stores nutrients (including vitamins and minerals) Protects the external environment (skin, firmness).

• • • •

Fibre, whether soluble or insoluble, does not undergo digestion or absorption but plays a few other major roles in the human body. The fibre in food does not get digested in the same way as the macronutrients (protein, carbohydrate and fat) and passes through the GIT largely intact. While undigested and unabsorbed in the body, fibre aids in the regularity and formation of bowel motions and is also utilised as food for the gut bacteria in the small intestine.

The GIT is packed with many bacteria that help regulate the digestive system.

While the effect that gut bacteria has on the human body is still an area of intense research, there are a number of their functions in the human body that are already well understood, including: Improved immunity defence Acidifying the colonic pH by producing fermentation products such as short-chain fatty acids Enhance faecal bulk production, thereby decreasing transit time and consequently decreasing the time the colon is exposed to toxic substances Promote excretion of toxic substances Production of vitamins and minerals.

• • • • •

Different types of fibre play different roles in the digestive system: Soluble fibre: Slows the passage of food through the GIT, providing the gut bacteria with time to ferment it.

Insoluble fibre: Speeds up the passage of food through the GIT and adds bulk to stools.

Resistant starch: It feeds beneficial bacteria in the colon and reduces the risk of colon cancer when consumed regularly.

• • •

When included as part of a balanced, nutrient-dense diet regularly, fibre will assist with the regularity of bowel motions.

Fibre can also help alleviate diarrhoea and constipation, depending on the type used (fibre supplements can improve diarrhoea by slowing the GIT down).

Gut bacteria are microorganisms that live in the GI tract and help produce vitamins and energy by fermenting fibre as it passes through the intestines. Emerging scientific research highlights the importance of the gut-brain axis, whereby the gut may influence mental health.

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UNDERSTANDING ENERGY AND ADVISING CLIENTS ON INDIVIDUAL NUTRITIONAL REQUIREMENTS Nutrition requirements encompass all the various nutritional needs of a human, which can be identified through various calculations. As a nutrition coach, calculating a client’s nutritional requirements is pivotal in providing appropriate dietary support and recommendations.

A nutrition coach is expected to become familiar with calculating nutritional requirements for a vast array of clientele.

These calculations will include: Estimated Energy Requirements (EER) Estimated Protein Requirements (EPR) Estimated Fluid Requirements (EFR).

• • •

When calculating an individual’s nutritional requirements, a nutrition coach must consider their overall macronutrient ratio distribution. The macronutrient ratio distribution refers to what ratio of the diet comes from each macronutrient: proteins, fats and carbohydrates. This will assist nutrition coaches in ensuring a healthy split of macronutrients and reduce the likelihood of heavy reliance on one specific macronutrient.

Nutrition coaches also need to remember that all individuals have different nutritional requirements. Therefore, factors such as age, weight, gender, health status and activity levels must be considered for calculations.

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UNDERSTANDING ENERGY Calories (Cal) and Kilojoules (kJ) are energy measurement units. All human body functions require energy, from breathing and the heart beating to exercising and laughing. Everything the body does can only be done by using energy.

Calories and kilojoules (kJ) are both measurements for energy obtained from food, where 1 calorie equals 4.184 kilojoules.

(34)

However, in Australia, kilojoule is commonly used on nutrition labels because it is a metric unit and, therefore, easier and more accurate, given the Australian use of the metric system. This is the standard unit of measurement amongst health professionals and is used nationally in Australia.

1 calorie = 1 kilocalorie 1 calorie = 4.184 kilojoules (kJ) 1 megajoule (mJ) = 1,000kJ.(15)

The energy required in the body is obtained through food, more specifically, from macronutrients. When broken down during digestion, each macronutrient produces a specific amount of energy per gram. Some macronutrients are more energy-dense than others. The table below shows how much energy, in kilojoules, is found in each macronutrient per gram.

ENERGY SOURCE (PER GRAM)

CALORIES

KILOJOULES (KJ)

(CAL)

CARBOHYDRATE

17

4

PROTEINS

17

4

FAT

38

9

(Please note: For simplicity, kilojoules have been rounded to the closest whole number)(34)

The body requires a certain amount of energy each day to function optimally. This is referred to as energy intake, the amount of energy consumed through the diet each day. Simultaneously, the body is constantly using energy through the functioning of organs, walking and talking, to physical activity.

Energy balance occurs when an individual’s intake is equivalent to their energy expenditure. If an individual’s intake is higher than the amount they expend, they will gain weight. Likewise, if an individual’s energy intake is less than the amount they expend, they will lose weight.

Each individual’s energy requirements depend on many factors, including height, age, weight, gender, physical activity levels, metabolic demands and pregnancy. Requirements can be calculated and used as a guideline when developing nutritional recommendations or meal plans for clients, but it is important to remember that it is often approximate and desired results will depend on feedback from the client and adjustments to requirements.

Energy requirements are further discussed on the following pages.

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UNDERSTANDING BASAL METABOLIC RATE (BMR) AND RESTING METABOLIC RATE (RMR) As a nutrition coach, understanding the parts that make up an individual’s energy needs is important. This information allows the nutrition coach to determine an individual’s energy requirements based on age, weight, and activity levels.

The two most important parts of the metabolic rate are: Total Daily Energy Expenditure (TDEE) Basal Metabolic Rate (or Resting Metabolic Rate) (BMR/RMR).

• •

TDEE refers to the total amount of energy required for all physical processes and can be broken down into BMR, digestion (known as the thermic effect of food) and physical activity, as shown below:

TOTAL ENERGY EXPENDITURE

=

+ BASAL METABOLISM

+

DIGESTION: THERMIC EFFECT ON FOOD

PHYSICAL ACTIVITY

BMR, which can often be used interchangeably with RMR, refers to the amount of energy expended at rest. The difference between BMR and RMR is how they are measured; however, they both measure the same thing: energy expenditure at rest. RMR tends to be a less strict environment for testing energy expenditure than BMR, and thus BMR is the more accurate reading of the two (although sometimes harder to achieve).

BMR or RMR is the amount of energy expended at rest, including all processes the body carries out with no cognitive input from the person. Examples of this include: Thermoregulation Circulation Respiration (breathing).

• • •

Understanding BMR/RMR is important because it forms the largest part of an individual’s energy needs and is usually shown in most energy equations. Many factors affect BMR, such as age, gender, body size and body composition.

Disease and injury can also have pronounced effects on the BMR, increasing energy demands significantly as the body utilises additional energy.

It is suggested that the BMR or Resting Metabolic Rate (RMR), also known as Resting Energy Expenditure (REE), accounts for 45 - 70% of the total estimated energy expenditure (EER).(65)

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CALCULATING ESTIMATED ENERGY REQUIREMENTS (EER)

While many equations estimate energy requirements, the Harris-Benedict equation is the most commonly used in Australia.

The Harris-Benedict equation estimates an individual’s Basal Metabolic Rate (BMR) and Estimated Energy Requirements (EER) in a two-step process. The equation will estimate how many kilojoules should be included in the client’s diet.

It is unrealistic to meet the same number every day. Consuming as close to the EER as possible is ideal. Within 500kJ on either side of the EER is usually appropriate.

BMR refers to the energy the body utilises to maintain homeostasis and vital functions such as breathing, blinking and temperature control.

STEP 1: CALCULATING THE BMR The first step is an equation used to calculate the BMR. There are different equations to determine the BMR for men and women, based on the assumption that men have a higher percentage of lean body weight than women (which increases BMR in men).(3) MEN

BMR = 278 + (57.5 x W) + (20.93 x H) - (28.35 x A) kJ/day.

WOMEN

BMR = 2741 + (40 x W) + (7.74 x H) - (19.56 x A) kJ/day.

W = Weight in kilograms (kg) H = Height in centimetres (cm) A = Age in years.

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STEP 2: INCORPORATING THE PHYSICAL ACTIVITY LEVEL (PAL) The second step is simply multiplying the BMR by the physical activity level (PAL) to establish the final EER. Multiply the individual’s BMR with their corresponding PAL using the table below.

A working example is provided on the following page.

EER = BMR x PAL

PHYSICAL ACTIVITY LEVEL (PAL)(36) PHYSICAL ACTIVITY LEVEL (PAL)

DESCRIPTION

EXAMPLES OF OCCUPATION

1.2

At rest, exclusively sedentary or lying (chair-bound or bed-bound).

-

1.4 - 1.5

Exclusively sedentary activity/seated work with little or no strenuous leisure activity.

Office employees, precision mechanics.

LIGHT ACTIVE

1.6 - 1.7

Sedentary activity/seated work with some requirement for occasional walking and standing but little or no strenuous leisure activity.

Laboratory assistants, drivers, students, assembly line workers, homemaker/ stay-at-home parent.

MODERATE ACTIVITY

1.8 - 1.9

Predominantly standing or walking work.

Domestic duties, salespersons, waiters, mechanics, traders.

2.0 - 2.4

Heavy occupational work or highly active leisure.

Construction workers, farmers, forest workers, miners, highperformance athletes.

BED REST

VERY SEDENTARY

HEAVY TO VIGOROUS ACTIVITY

If your activity level for work/occupation fits into levels 1.4-1.9 and you exercise strenuously (30-60mins, 4-5 times a week), change your selection to the next highest activity level. For example, James is a waiter with a PAL of 1.8, but he goes to the gym 4 times a week for 30mins. This means he would fall into the next highest category of heavy activity, with a PAL of 2.0. If a client does not participate in regular exercise, they will stay at the level according to their occupation.

A 62-year-old male who is 170cm tall and weighs 82kg, works behind a desk all week and enjoys working at a ‘moderate-intensity’ at the gym 4-5 times per week would have an EER of:

STEP 1: W = 82kg H = 170cm A = 62 BMR = 278 + (57.5 x weight) + (20.93 x height) - (28.35 x age) kJ/day BMR = 278 + (57.5 x 82) + (20.93 x 170) – (28.35 x 62) kJ/day BMR = 278 + (4,715) + (3,558.1) – (1,757.7) kJ/day BMR = 8,551.1 – 1,757.7 kJ/day BMR = 6,793.4 kJ/day STEP 2: PAL = 1.6 EER = BMR x PAL EER = 6,793.4 x 1.6 EER = 10,869.44 kJ/day

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ESTIMATED PROTEIN REQUIREMENTS (EPR) Most health organisations recommend a protein intake of ~0.8-1.0g per kg of body weight per day; however, this recommendation can increase depending on physical activity levels, disease states, goals, trauma and stress levels.

It is important to remember that even sedentary individuals require moderate amounts of protein (at the lower end of the range) to maintain their muscle stores and health. Older adults also require protein in the higher range to reduce the effect of ageing-related muscle decline, known as sarcopenia.

As a nutrition coach, the most influential factor to consider when calculating an EPR for a client is how much exercise they do per week. The table below helps identify protein requirements for various amounts of exercise a client undertakes.

EPR is always presented in a range, not one singular number, as it is unrealistic to recommend an exact amount to hit daily. Consuming within a range of grams is more realistic and achievable. 20g under or over the calculated range is also acceptable, considering there are small amounts of protein in many food items.

Protein requirements increase as activity levels increase. It can sometimes be difficult to decide what exercise level they fall in. Therefore, recommending to consume towards the lower or higher end of their calculated EPR is an easier way to ensure they are consuming appropriate amounts of protein for the amount of exercise they are engaging in. This is to aid in muscle maintenance, recovery and synthesis.

PHYSICAL ACTIVITY

PROTEIN(G)/BODY WEIGHT(KG)/ DAY(112)

SEDENTARY (Sedentary job, nil physical activity)

0.8-1.0g per kg body weight per day.

MODERATE-INTENSITY (One to three days of moderate-intensity activity per week)

1.0-1.5g per kg body weight per day.

HIGH-INTENSITY (Four days or more high-intensity activity per week)

1.5-2.0g per kg body weight per day.

(Please note: For simplicity, kilojoules have been rounded to the closest whole number)(34)

EXAMPLE ONE (HIGH INTENSITY) A 90kg male who exercises at a high intensity >4 times per week would require 1.5-2.0g of protein per kg per day.

1.5 x 90 = 135g 2.0 x 90 = 180g Therefore, this male would require 135-180g of protein per day.

EXAMPLE TWO (SEDENTARY) A sedentary 52kg female would require 0.8-1.0g of protein per kg per day.

0.8 x 52 = 42g 1.0 x 52 = 52g Therefore, this female would require 42-52g of protein per day.

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BENEFITS OF MORE PROTEIN THAN RECOMMENDED DAILY INTAKE AND WHEN TO RECOMMEND There are a plethora of studies that have looked at different health and performance benefits of increased protein intake. Dr Peter Lemon and Mark Tarnopolsky have done extensive research in this area. They looked at protein intake related to performance, body composition, strength and hormone profile.

Their studies revolved around nitrogen balance: a term used to describe the intake and excretion of nitrogen from protein. If an individual is in positive nitrogen balance, they are consuming more protein than they are excreting, so their body is in an anabolic (building) state. If an individual is in a negative nitrogen balance, they are excreting more protein than they are consuming, and therefore their body is in a catabolic (breaking down) state.

Research has found the ideal protein intake for active individuals to maximise performance, control appetite, boost metabolism and increase strength is between 1.6-2.2g/kg/day.(113)(114)(115) It stands to reason that if an individual is more active, they will require more protein to preserve lean muscle tissue and support the human body’s metabolic processes. This is depicted in the image below: However, research is still emerging on the benefits of consuming protein above EPR; in most situations, a higher protein intake is not relevant. As such, it is important to remain within the recommended EPR ranges for each individual to meet their goals and avoid compromising the intake of other important nutrients.

DAILY PROTEIN NEEDS FOR A 90kg Man Types of Training

72g-90g

108g-135g

135g-180g

Sedentary

Moderate Intensity

High Intensity

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UNDERSTANDING MACRONUTRIENT DISTRIBUTION As previously defined, macronutrients refer to protein, carbohydrates, and fat, all of which provide energy to the human body. As the primary energy inputs into the body, the breakdown and ratio of these three inputs can significantly impact overall weight management, general health and overall nutritional status. Alcohol is also considered one of the macronutrients because it provides energy; however, it is not considered essential.

The Nutrient Reference Values (NRVs) for macronutrient distribution, as endorsed by the National Health and Medical Research Council (NHMRC) and the Australian Government, are outlined in the table below.(65) It is encouraged that protein intake is 15-25% of total EER; carbohydrates make up 45 - 65% of total EER, and fat makes up the remaining 20-35% of total EER. As discussed below, nutrition coaches must remember that this ratio does not fit all individuals. Therefore, it is important to work with each client individually to identify which ratio works best for them.

MACRONUTRIENT

RECOMMENDATION

PROTEIN

15 - 25% of total EER.

CARBOHYDRATE

45 - 65% of total EER.

FAT

20 - 35% of total EER. (Please note: For simplicity, kilojoules have been rounded to the closest whole number)(34)

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It is important to understand the current literature and dietary guidelines for macronutrients when educating clients.

Many people choose to follow a low-carbohydrate diet; however, the long-term implications of this dietary choice are not well documented. As nutrition is personal and individualised, what may work well for one client may not work well for another. However, it is not recommended to eliminate or drastically reduce carbohydrates in the diet, as they are an important source of fibre, B vitamins and minerals.

While carbohydrates have been classed by scientific literature as non-essential, almost all foods contain some form of carbohydrates. Therefore, a diet with nil carbohydrates is difficult to obtain (and unlikely to be sustainable).

Nutrient quality and density are important factors to consider when recommending carbohydrate sources; for instance, whole grain, wholemeal grains and starchy vegetables are more nutrient-dense than processed/white varieties and may be a better recommendation to help an individual reach their nutritional recommendations.

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ESTIMATED FLUID REQUIREMENTS (EFR) EFR can differ depending on a client’s activity level, the climate in which they live and disease states which may affect urine output, such as renal disease. Nutrient Reference Values state a simple recommendation for each gender.

GENDER

FLUIDS (INCLUDING PLAIN WATER, MILK AND OTHER DRINKS, NOT INCLUDING ENERGY DRINKS, SOFT DRINKS OR ALCOHOL)

MEN

2.6L/day (about 10 cups)

WOMEN

2.1L/day (about 8 cups)

EXAMPLE ONE A female living in a hot, humid climate and exercising daily would have an EFR of a minimum of 2.1L a day.

Let the client know that her EFR is 2.1L; however, she will likely require more due to the hot environment in which she lives, combined with sweating from her exercise. Encourage her to check the colour of her urine to help determine if she requires more water.

EXAMPLE TWO A male living in very cold conditions and exercising once a week would have an EFR of a minimum of 2.6L a day.

Let the client know that his EFR is 2.6L. It is unlikely that he would require additional hydration considering his climate and activity levels; nevertheless, encourage him to check the colour of his urine as an indication.

A method or approach for checking the hydration levels of a client is by the colour of their urine, where:(116) Pale straw colour (light yellow): suggests that the body is well hydrated Dark yellow colour: suggests that the body is dehydrated Clear colour: suggests that the body is possibly over-hydrated.

• • •

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ESTIMATED FLUID REQUIREMENTS FOR EXERCISE Fluid requirements of those who exercise regularly (>3 - 4 times per week) at a moderate intensity or higher are affected by various factors, including duration, intensity and frequency of training, the climate they are training in, and physical activity levels on non-training days.

Weight loss during exercise is largely due to fluid loss. Sports Dietitians Australia (SDA) recommend that water loss be no more than 2% of body mass during exercise, and weight loss should be no more than 1.4kg. Fluid loss of greater than 2% is linked to a marked decrease in performance and increases the risk of nausea, vomiting, diarrhoea and other acute gastrointestinal issues.(73) The calculations below can be used to estimate losses during training: Total sweat loss (mL) = 1,000 x [PR - PO] + F + SF Fluid loss as a % of body weight = ([PR - PO] / PR) x 100.

• •

Where: PR - Pre-exercise weight in kilograms (kg).

PO - Post-exercise weight in kilograms (kg).

F - Fluid intake in millilitres (mL).

SF - Solid food intake in grams (g).

An individual who weighs 92kg at the start of their training, 91.2kg at the end of their training, consumes 500ml of water and nil food during their training:

Total sweat loss (mL) = 1,000 x [PR - PO] + F + SF Total sweat loss (mL) = 1,000 x [92 - 91.2] + 500 + 0 Total sweat loss (mL) = 1,000 x 0.8 + 500 Total sweat loss (mL) = 1,300mL Therefore, this individual lost 1,300mL (1.3L) of fluid during training.

Fluid loss as a % of body weight = ([PR - PO] / PR) x 100 Fluid loss as a % of body weight = ([92 - 91.2] / 92) x 100 Fluid loss as a % of body weight = (0.8 / 92) x 100 Fluid loss as a % of body weight = 0.00869 x 100 Fluid loss as a % of body weight = 0.87% Therefore, this individual lost 0.87% of their total body weight through sweat losses during training.

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RECOMMENDATIONS FOR ADEQUATE FRUIT INTAKE The Australian Dietary Guidelines recommend consuming 2 serves of fruit a day. It is recommended to include various coloured fruits in your diet, especially orange, red and yellow, as these fruits are high in vitamin A and assist with immune function.(117) As a nutrition coach, it is important to encourage clients to increase their fruit intake. However, some clients will consume very little to no fruit in their diet. Initially, it is unlikely these clients will instantly be able to commit to consuming 2 serves of fruit a day. To increase client adherence, recommend approximately 1 serve of fruit in their diet. Once this becomes a regular process, their fruit intake can be increased further until they meet their 2 serves a day.

Trying to consume as close to the recommendations as possible is ideal, as they are there for a reason. If clients are consuming slightly over the recommended amount of 2 serves per day, this is okay. However, consuming fruit in a large excess of the recommendations is not advised.

Fruit is predominantly carbohydrates, with one serving of fruit providing the body with roughly 5-22g of carbohydrates. Fruit also contains many vitamins, minerals, and phytochemicals essential to the diet.

Most fruits are a particularly good source of vitamin C, vitamin E, folate, potassium and magnesium, which can help reduce the risk of some chronic diseases.(117) Dried fruit should not be consumed regularly due to its high amount of kilojoules and sugar. This can increase the likeliness of tooth decay. It is encouraged to consume fruit in its most natural and whole form, including the fibrous components, which increase satiety.

Fruit juices can be high in kilojoules, low in fibre, and sometimes contain excessive sugar. As learned earlier in this unit, fibre will also help slow the release of sugar in the body. For example, consuming an apple with the skin is better than consuming apple juice.

1 serving of fruit is approximately 150g (350kJ) which is:(33) 1 medium piece of fruit such as an apple, banana, orange, mandarin, peach, grapefruit or pear 2 small fruits such as apricots, kiwi fruits, nectarines or plums 1 cup berries or diced fruit such as mango or pawpaw 1 ½ cups pineapple or watermelon 15-20 grapes 1 cup canned fruit (no added sugar) 30g dried fruit, such as 4 dried apricot halves or 1 ½ tablespoons sultanas 3 ½ whole passionfruit

• • • • • • • •

ONE SERVE OF FRUIT CAN BE:

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RECOMMENDATIONS FOR ADEQUATE INTAKE OF FIBROUS VEGETABLES The Australian Dietary Guidelines recommend that adults consume a minimum of 5 servings of various vegetables and legumes daily.(49) In Australia in 2014-2015, 93% of Australians DID NOT meet this minimum requirement, meaning only 7% of individuals consumed adequate vegetable intake. Vegetables and legumes are high in fibre, phytochemicals, vitamins and minerals, making them indispensable in any diet.

As a nutrition coach, it is important to encourage clients to increase their vegetable intake. However, some clients will consume very little to no vegetables in their diet and initially is unlikely they will instantly be able to commit to consuming 5 serves of vegetables a day. To increase client adherence, suggesting that clients increase their vegetable intake above what they currently consume will still improve their diet. Once this becomes a regular process, their vegetable recommendation can increase until they meet their 5 serves a day.

If clients are consuming slightly over the recommended amount of 5 serves per day, this is okay. However, trying to consume as close to the recommendations as possible is ideal.

1 serve of vegetables is approximately 75g (100-350kJ) which is:(118) ½ cup cooked green or orange vegetables (for example, broccoli, carrots, green beans, capsicum, cauliflower, celery, snow peas, onion or zucchini) ½ cup cooked dried or canned beans, peas or lentils, preferably with no added salt (for example, lima beans, kidney beans or chickpeas) 1 cup green leafy or raw salad vegetables (for example, beetroot, bok-choy, choy sum, cabbage, lettuce or spinach) 1 medium tomato ½ medium avocado ½ cup tinned vegetables ½ cup corn ½ medium potato/ 1 small or other starchy vegetable (for example, sweet potato or pumpkin).

• • • • • • • •

ONE SERVE OF VEGETABLES CAN BE:

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RECOMMENDATIONS FOR ADEQUATE FIBRE INTAKE Dietary fibre relates to the edible parts of plants such as vegetables, fruits, beans and legumes, which are resistant to digestion and absorption in the small intestine, usually with partial or complete fermentation in the large intestine.(36) Dietary fibre is beneficial for satiety, regulating bowel motions, decreasing blood cholesterol levels and modulation of blood glucose levels.

Dietary fibre consists of: Non-starch polysaccharides (a carbohydrate molecule consisting of more than ten monosaccharides), Oligosaccharides (a carbohydrate molecule consisting of three to ten monosaccharides), and Other plant-based components such as lignins, inulin and cellulose (all types of dietary fibre).

• • •

The Adequate Intake (AI) for adult men is 30g per day and for adult women is 25g per day. Fibre AI for adults can be seen below:(111)

AGE (YEARS)

ADEQUATE INTAKE (AI) G/DAY MEN

19 YEARS AND OLDER

30 g/day WOMEN

19 YEARS AND OLDER

25 g/day

Rationale: The AI is set at the median for dietary fibre intake in Australia and New Zealand based on the 1995 National Nutrition Survey of Australia and the 1997 National Nutrition Survey of New Zealand. The value within each gender was set for all ages at the highest median of any of the age groups, plus an allowance of slightly more than 4 g/day for men and slightly less than 3 g/ day for women for the component of RS not included in the food database for dietary fibre used for these surveys, and rounding.

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RECOMMENDED INTAKE OF VITAMINS AND MINERALS Vitamins and minerals have numerous roles in the human body, from assisting with blood clotting, maintaining the structure of bones and teeth, and maintaining healthy vision, sending nerve impulses, maintaining energy levels and ensuring an optimal acid-base balance of bodily fluids. Vitamins and minerals are integral to any healthy diet and are required in small amounts daily. Therefore, an adequate intake of vitamins and minerals must be consumed daily.

The Nutrient Reference Values (NRV) website provides an online calculator to help identify individualised micronutrient requirements.

The calculator adjusts for gender, age and pregnancy/lactation:

The Nutrient Reference Values (NRV) website provides an online calculator to help identify individualised micronutrient requirements. The calculator adjusts for gender, age and pregnancy/lactation.

To go to the NRV website CLICK HERE.

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RECOMMENDED INTAKE FOR DISCRETIONARY ITEMS Discretionary items refer to food and drinks which are not essential in a healthy diet. These items are usually high in kilojoules, sugar and vegetable oils. These contain low levels of essential nutrients and are consequently referred to as energy-dense and nutrient-poor.

The Australian Dietary Guidelines(119) encourage clients to consume less of these foods in much smaller quantities. Eat For Health recommends no more than 2.5 serves per day and emphasises there is only room for them in the diet when individuals have high energy expenditure (taller or highly active) and have met all serves for other food groups.(120) Aim for very minimal discretionary items. If you notice a client consumes excessive amounts, minimise or substitute these items until they are almost completely removed. One serve of discretionary food or drink is the equivalent of approximately 600kJ.(121) The below table identifies what 1 serve of a discretionary item looks like and how many grams of sugar it contains:

SUGAR PER SERVE

ITEM

(ROUNDED TO THE NEAREST WHOLE NUMBER)

1 CAN (375ML) SOFT DRINK

40g

1 TBSP JAM/HONEY

10-21g

2-3 SWEET BISCUITS

5-8g

2 SCOOPS OF REGULAR ICE CREAM

21g

1 DOUGHNUT

6g

1 MUFFIN/ SMALL SLICE OF CAKE

50g

¼ CUP CONDENSED MILK

55g

50-60G (ABOUT 2 SLICES) PROCESSED MEATS, SALAMI, METTWURST

0g

2 THIN HIGHER FAT/SALT SAUSAGES

0g

30G SALTY CRACKERS

0g

5-6 SMALL LOLLIES

28g

½ SMALL CHOCOLATE BAR

15g

2 TBSP CREAM

1g

1 TBSP BUTTER/MARGARINE

0g

60G FRIED HOT CHIPS

1g

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EXAMPLES OF DISCRETIONARY ITEMS HIGH IN REFINED SUGAR

HIGH IN TRANS FAT

HIGH IN TRANS FAT AND REFINED SUGAR

HIGH IN ALCOHOL

Energy drinks

Processed meats

Biscuit

Beer

Fruit juice

Chips

Cake

Liqueur

Sweeteners - maple syrup, honey, agave syrup, coconut sugar

Corn chips and corn products - tacos, nachos, enchiladas

Chocolate

Wine

Jams, marmalades

Commercial pies

Doughnuts

Port

Most condiments (tomato sauce, BBQ sauce)

Commercial pizzas

Ice cream

Sherry

Soft drinks

Some sauces/ dressings

Muesli Bars

Spirits

Confectionary

Deep-fried items

Muffins

Mixed alcohol drinks

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AWARENESS OF PAST AND EMERGING DIETARY TRENDS AND MYTHS IN THE INDUSTRY When it comes to any dietary trend, it is important to understand the scientific evidence on which it is based. Obtaining a sound understanding of the physiological impact of the trend will allow nutrition coaches to make an educated decision to effectively support their clients.

Nutrition coaches, no doubt, will be faced with numerous clients who are following or experimenting with common industry trends relating to nutrition and therefore, it is important to become familiar with the following factors: The implied benefits of the particular trend (if any), Whether or not the benefits outweigh the disadvantages, What the long-term implications may be if a client follows a particular trend for extended periods, and If the trend is sustainable for the particular client’s goals or requirements.

• • • •

As a nutrition coach, it is also fundamental to be aware of common diets individuals may follow to provide the best advice and nutritional recommendations. Also, nutrition is still a young science, so nutrition coaches must stay up to date with the latest research and utilise non-biased evidence to form an opinion.

Listed below are some common diets followed in the twenty-first century; these particular diet trends are discussed in more detail on the following pages.

Low carbohydrate diets Low-fat diets Intermittent fasting Fad diets.

• • • •

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LOW CARBOHYDRATE DIETS VERSUS LOWFAT DIETS Low carbohydrate diets are not a new trend. They have been circulating for many years and tend to go in and out of fashion regularly. While some researchers are adamant that carbohydrates are essential for the human body, others argue that carbohydrates are not essential as the body can make its glucose supply as required.

However, carbohydrates are our only source of fibre and meeting minimum daily fibre requirements is essential for optimal health and digestive function. Carbohydrates may not be essential for providing glucose, as the body can adapt, but in saying that, gluconeogenesis is for when there are insufficient glucose stores. This is not optimal for the functioning of the body consistently. Therefore, when looking at the whole picture, carbohydrate sources are essential.

Low carbohydrate diets refer to diets that have less than 130g of carbohydrates per day. Very low carbohydrate diets, otherwise known as ketogenic diets, refer to diets that have less than 20 - 50g (total carbohydrate minus fibre) of carbohydrates per day. As carbohydrate intake is reduced, the overall fat and protein ratio tends to increase.

While there are many health benefits associated with decreasing carbohydrate intake, it is important to remember as a nutrition coach that there are disadvantages. The table below outlines some of the advantages and disadvantages of a low carbohydrate diet.

IMPLICATIONS OF A LOW CARBOHYDRATE DIET ADVANTAGES Weight loss as a result of: Reduced calorie intake by removing processed and hyper-palatable foods from the diet A decrease in lipogenesis (metabolic formation of fat) and an increase in lipolysis (the breakdown of fats) Greater metabolic efficiency in metabolising fats Increased use of calories secondary to the body creating its glucose from stored body fat, a process known as gluconeogenesis Increased use of calories to digest a higher amount of proteins.

• • • • • Improved blood lipid (fatty acid) profiles, therefore, reducing the risk of heart disease and stroke, including: triglycerides which are found in hydrogenated and trans fat, are known to increase atherosclerosis and • Decreased increase the risk of heart disease and stroke triglycerides due to the removal of refined sugar from the diet • Decreased Increased high-density • cardioprotective qualitieslipoproteins (HDL), which are found in unsaturated fats and are known for their • Decreased total cholesterol.

Improved sugar control for diabetics, including: HbA1C (average glucose reading over a 3-month period) • Improved Decreased glucose • Decreases orfasting eliminates the need for insulin.

• DISADVANTAGES Limitation and avoidance of certain foods such as processed foods, root vegetables and fruits with a high carbohydrate content.

Due to reduced menu choices, it may be difficult to eat out or in a social setting.

Difficulty maintaining adherence long term due to social pressures and the food environment.

Lacking long-term scientific studies to evaluate the sustainability and any long-term disadvantages.

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LOW-FAT DIETS Low-fat diets refer to diets that are restrictive in calories received from fats. Most dietary guidelines in Western populations encourage adherence to a low-fat diet as a result of findings that suggest fat not only makes one gain weight but also increases the risk of heart disease. This is a misconception that has been prominent since 1953 when Dr Ancel Keys presented his findings in the paper Atherosclerosis: A problem in newer public health. The findings show a correlation between cardiovascular disease (CVD) risk and fat consumption in six countries.

It was not until many years later that other researchers identified that when all the countries Keys obtained data from (as opposed to only six) were plotted on the graph, the correlation was far less obvious. Yerushalmy and Hilleboe stated: ‘It is immediately obvious that the inclusion of all the countries greatly reduces the apparent association’. However, by this stage, the low-fat commercialisation, recommendations and adherence to this way of eating were well and truly underway and have continued into the twenty-first century.

WESTERN POPULATIONS When texts refer to a Western population or the Western diet, they refer to advanced, industrialised nations, such as the UK, USA, Europe, Canada and Australia.

While low-fat diets can be beneficial in reducing total caloric intake, the benefits of fat are often overlooked. As a nutrition coach, it is important to remember that fat is an essential nutrient for the human body, and with limited or restricted amounts of fat, the body cannot complete all its processes efficiently or effectively.

Including dietary fat in the diet can have an array of benefits: Improves satiety (fullness) Decreases cravings Improves the flavour of food Reduces cholesterol levels Improves cognitive function Improves moods Reduces risk of heart disease Improves immunity Improves skin health.

• • • • • • • • •

All natural fats, saturated and unsaturated, are classed as essential and, therefore, a necessary part of the human diet. It is only the trans and hydrogenated fats which an individual needs to reduce their intake.(82) Trans fats and hydrogenated fat are undoubtedly linked to an increased risk of CVD. It is generally not recommended to follow a low-fat diet unless clinically indicated. While low-fat diets are often favoured to decrease overall calories per gram, a low-fat diet may place the individual at risk of malabsorption of fat-soluble vitamins (vitamin A, D, E and K) and inadequate synthesis and regulation of hormones (especially in females). In addition, fat plays an important role in brain function, satiety and mood, all of which are affected when a low-fat diet is followed.

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UNDERSTANDING FASTING DIETS Fasting is defined as abstinence from all or some foods and drinks for a specific purpose and timeframe. Humans have used fasting for thousands of years, most commonly observed for religious reasons. Modern forms of fasting, known as intermittent fasting, have become extremely popular in the diet and health community in the past 10 years. Intermittent fasting involves going without food and only consuming water (or calorie-free drinks like black coffee) for a certain period.

The major benefits of intermittent fasting include: Calorie reduction due to reducing the opportunity to eat Normalised blood glucose levels Increased lipolysis (breakdown of fats for energy) Improved relationship with food, Reduced cravings, and Fat loss for improved body composition.

• • • • • •

Many intermittent fasting protocols are popular today and are outlined in the table below:

TYPES OF INTERMITTENT FASTING PROTOCOLS FASTING PROTOCOL

DESCRIPTION

IMPLIED BENEFITS

DANGERS (IF ANY) /LIMITING FACTORS

calorie is recommended that users • Reduced • Itparticipate intake in resistance 16/8 Improve body training and use branched• composition chain amino acids to break (INTERMITTENT Retain muscle mass their fast before training.

FASTING) • while in a calorie 36 HO Potential for muscle loss or • FASTIN deficit. slow progress in muscle gain.

GIT time to get This protocol is advocated by • Rests • Takes comfortable with extended It can help improve Brad Pilon of Eat Stop Eat, who • an individual’s fasting recommends one or two 24relationship with It may not be suitable hour fasts a week, depending on • food for people on certain tolerance.

Creates a large medications • calorie deficit It may not be suitable for Fasting usually begins after dinner • 24 HOUR increase people with eating disorders. on the first night and continues • May autophagy until the next evening. Only water FASTING Martin Berkhan of LeanGains developed this protocol. It advocates using a 16-hour daily fast with an 8-hour feeding window.

and black coffee or tea without milk can be consumed.

(destruction of old, dead, dying cells).

It might interest people seeking to lose body fat, improve health or improve their relationship with food.

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FASTING PROTOCOL

DESCRIPTION Extended fasting protocol whereby fasting begins in the evening on the first night, extends throughout the next day and is broken on the morning of the third day. Only water and black tea/coffee are allowed.

IMPLIED BENEFITS

a significant • Takes time to get • Creates comfortable with extended calorie deficit which

• •

36 HOUR FASTING

• OMAD simply means having one meal a day. It is popular among people who follow a ketogenic or low-carb diet.

ONE MEAL A DAY (OMAD)

This is popular with some type 2 diabetics and wellness seekers who believe it will improve their health and wellbeing.

DANGERS (IF ANY) /LIMITING FACTORS

can help with weight loss Dr Fung advocates 36-72 hour fasts for diabetic management 36-hour fasts have also shown effectiveness in reducing food cravings It may increase autophagy (destruction of old, dead/dying cells).

• • •

fasting It may not be suitable for people on certain medications It may not be suitable for people with eating disorders Extended fasting can be difficult if sedentary.

create a for its sustainability • Helps • Evidence calorie deficit which and effectiveness is limited. can help with weight • Achieving a full day’s nutrition through one meal loss May provide be incredibly hard for • benefits for diabetic would most people.

•

management May increase autophagy (destruction of old, dead, dying cells).

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IIFYM VS HEALTHY EATING IIFYM is an acronym referring to the dietary approach of ‘If It Fits Your Macros’ and is known as ‘flexible dieting’. IIFYM was popularised in the bodybuilding and fitness industry to enable people who were cutting calories for fat loss to use a flexible approach to their diet.

IIFYM is effectively a diet plan whereby an individual is provided with energy and macronutrient goals and can eat flexibly, providing it fits those goals. In other words, an individual does not need to eat ‘healthy foods’ on the proviso that their food intake meets their intended macronutrient breakdown.

HOW IIFYM WORKS By knowing and tracking their energy and macronutrient intake, someone following IIFYM can aim to hit their protein goals for muscle protein synthesis from resistance training and balance their carbohydrate and fat intake from other food sources, including unhealthier foods. It is argued that this approach improves adherence to dieting goals because it breaks up the rigidity and boredom of strict dieting.

IIFYM THE WRONG WAY At some point after its inception, the perception of the diet became that an individual may choose to fill up on fast food and soft drinks, thereby consuming their macronutrient allowance through trans fats, refined sugar and processed protein. However, doing this may result in individuals becoming fatigued, malnourished and unhealthy.

IIFYM THE RIGHT WAY A properly formulated approach enables an individual to fill up on whole, unprocessed foods such as meat, fresh fruit and vegetables, nuts, seeds, avocados and oils with occasional less healthy foods. This individual may see great health benefits such as improved blood sugar levels, increased energy and decreased cholesterol. However, IIFYM stipulates that no matter what food is consumed, if the individual sticks to their energy and macronutrient allowances, they will lose/gain weight depending on their goal.

While IIFYM may help an individual to determine their ideal macronutrient breakdown, it would only be beneficial long term to individuals who maintain the basic nutrition principles of healthy eating and consume a well-balanced and mostly unprocessed diet, including an adequate intake of micronutrients and fibre.

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UNDERSTANDING DETOX DIETS Detoxification is the ‘process of removing toxic substances from both endogenous and exogenous origin’ which may accumulate as a result of:(122)(123)(124) Industrial chemicals Pesticides Heavy metals Xenobiotics Radioactive elements.

• • • • •

Some have carcinogenic, epigenetic, endocrine-disrupting, digestive, and immune-altering actions.(122) The liver, an important organ weighing approximately 1.4kg, is responsible for eliminating toxic materials from the body through mobilisation, biotransformation and conversion into more water-soluble metabolites, which are then excreted via the urine.(125) Benefits of detoxification include: Improved energy Improved pH balance Skin health Weight loss Decreased inflammation.

• • • • •

Detoxification is a two-step process: Phase I: Involves the oxidation, reduction and hydrolysis Phase II: The conjugation of functional groups for elimination.(126)

One way to detox is to make acute and significant changes to the diet. Generally, this would involve dietary changes whereby only unprocessed foods are consumed.

There are various types of detoxification methods. The type of detoxification that may work for one person may not work for another, as it depends on the toxin from which a particular individual is detoxing. Many commercial ‘detoxifications’ are simply a clean eating approach, which a person should be aiming for anyway.

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IS DETOXING NECESSARY? In short, no. The human body has an extremely complex detoxification system built within it to do the detoxification on its own. Detoxification, as described above, is completed by the liver and toxins are excreted through the kidneys and passed out as urine. However, with all the additional toxins polluting food (herbicides, pesticides, heavy metals), the air (pollution) and the chemicals in a standard home (detergents, shampoos, soaps, lotions), there is a potential argument that detoxification once or twice a year can be beneficial.

A detox can be as simple as eating only whole foods for a couple of weeks or as complex as fasting, juicing, supplementation, colonics, chelation and gut support.

Deciding what sort of detox would be beneficial depends on an individual’s lifestyle. For example, someone who consumes only organic fruit and vegetables, grass-fed, organic meat and does not consume processed food may not need to detox, as the liver would be unlikely to be under stress. However, a miner constantly exposed to chemicals in the workplace and is only given processed foods and lots of tuna (mercury) may suffer heavy metal toxicity and therefore benefit from a detoxification program.

Detoxifications are personal, just like nutrition. There is no one-size-fits-all approach. When determining whether someone needs to detoxify, it is important to consider their lifestyle, food intake and household chemical and pollutant exposure.

DETOX DIETS AND THE ROLE OF NUTRITIONAL COACHES As a nutrition coach, it is important to help clients understand the role and indications of a detoxification diet. For most individuals, unless clinically indicated (e.g. an individual with chronic heavy metal toxicity), detoxification is not indicated, and simple strategies to help guide clients towards healthy eating patterns are all that is required. Individuals who may require a detoxification protocol generally have chronic medical conditions and therefore fall outside the scope of a nutrition coach.

While detox diets promote the intake of nutrient-dense foods, like fruit and vegetables, and the removal of energy-dense foods, like fast food and takeaways, this can also be achieved by adopting simple habits and practices, just without the need for extreme measures. Helping clients to improve their relationship with energy-dense foods is as important as improving their relationship with nutrient-dense foods. As a nutrition coach, it is important to educate clients on the benefits of these health strategies and work with them to adopt healthier eating patterns.

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RECOGNISING FAD DIETS A fad diet is a popular dietary pattern that promotes fast weight loss or claims to dramatically improve health without supporting evidence. Often, these diets are not well researched, or the research is biased or misinterpreted.

Fad diets often eliminate key food groups and nutrients, resulting in symptoms such as headaches, dehydration, nausea, weakness and fatigue. They may lack nutrients, such as dietary fibre and carbohydrates, as well as selected vitamins, minerals, and protective phytochemicals. By not receiving the required amounts of these nutrients, an individual is at a higher risk of developing deficiencies or other health problems., including eating disorders.(127) Fad diets do not focus on lifestyle modifications and are not sustainable long-term to support an individual’s overall health. Of the food groups these diets permit, the amounts are either well above or below the recommendations compared to the current guidelines. Regardless of the fad diet, the one thing they have in common is that they all offer a temporary solution.

COMMON TRAITS OF A FAD DIET INCLUDE: a quick fix •• Promises Labels foods as ‘good’ or ‘bad’ use of testimonials •• The Recommendations revolved around selling a program, book, or product one or more of the five food groups •• Eliminates Recommendations based on one study conclusions based on a small number of studies •• Simplified Recommendations based on research without peer review

TYPES OF FAD DIETS NAME

5:2 DIET (AKA ‘THE FAST DIET’)

80/10/10 DIET (AKA ‘811’, ‘811RV’ LFRV ‘LOW-FAT RAW VEGAN’)

DESCRIPTION

IMPLIED BENEFITS

DANGERS AND LIMITING FACTORS

The 5:2 diet involves eating normally for five days of the week and restricting calories to 500 - 600cal (2,092 - 2,510kJ) per day on the remaining two days of the week.

loss from ‘easy’ potential for increased hunger on • Weight • The calorie restriction. days following a fasting day blood sugar potential for low blood sugar in • Improved • The levels due to fasting and people with type 2 diabetes weight loss, designed to recommended for people with • Not not feel restrictive. type 1 diabetes recommended for individuals • Not with a history of disordered eating,

A low-fat, raw, vegan diet proposes that 80% of calories come from carbohydrates and 10% from protein and fats.

to increase • Proposed • longevity (lifespan) loss •• Weight Potential to reduce the risk of some diseases.

•

Based on the idea that humans are not omnivores but herbivores or ‘frugivores’, cooking foods creates harmful substances that damage health.

•• •

pregnant women, children or someone who is underweight.

Requires a large volume of food to be eaten from carbohydrate-containing foods, which can be difficult to manage Low protein and fat intake may result in muscle loss and low vitamin B12 intake Not sustainable over the long term As with any restrictive diet, demonising foods or nutrients as ‘good’ or ‘bad’ can result in a poor relationship with food, restrictive practices and potential for disordered eating Unfairly demonises cooked food, with little evidence to back the claim.

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NAME

ALKALINE DIET

JUICE CLEANSE DIET

BLOOD TYPE DIET

DESCRIPTION Eat fewer acidic and more alkaline foods to ‘alkalise’ the body and improve health.

Success on this diet results from an individual increasing their intake of nutrientdense foods and cutting out some undesirable foods (alcohol, processed foods/meat).

Acidic: Meat, poultry, fish, dairy, eggs, grains and alcohol.

Neutral: Natural fats, starches and sugars.

Alkaline: Fruits, nuts, legumes and vegetables.

A ‘detox’ that promotes the replacement of solid foods with juices for a few days (usually three) or up to a few weeks is called a ‘juice fast’. Meals are replaced with the juice of various fruits, vegetables and herbs/ spices, e.g. the celery juice diet.

This diet is formed on the theory that each blood type represents the genetic traits of our ancestors, including which diet they were designed to thrive on.

Type A: Agrarian/ cultivator. Plants, no red meat.

Type B: Nomad.

Plants and most meats (except chicken and pork), some dairy.

Avoid wheat, corn, lentils and tomatoes.

Type AB: Enigma. A mix between types A and B. Eat seafood, tofu, dairy, beans and grains. Avoid kidney beans, corn, beef and chicken.

Type O: Hunter. Eat high-protein diet of meat, fish, poultry, certain fruits and vegetables. Limit grains, legumes and dairy.

IMPLIED BENEFITS

DANGERS AND LIMITING FACTORS

on the theory that body maintains pH levels within • Based • The a food’s pH can affect how a tight range (7.35 - 7.45pH). It is not it is digested and utilised in the body, and therefore be used to treat or prevent disease, including weight issues.

•

possible to alter pH outside of this range as it would result in urgent medical treatment being required As with any restrictive diet, demonising foods or nutrients as ‘good’ or ‘bad’ can result in a poor relationship with food, restrictive practices and the potential for disordered eating.

to ‘detoxify’ the • Not well studied and little scientific • Proposed liver evidence for its benefits It can cause rapid weight result in increased hunger due to • loss due to creating • May a lack of protein, fat and fibre a calorie deficit while • This can lead to weakness and fatigue increasing nutrient intake. • May result in muscle loss due to low protein intake weight lost during the diet may • The be regained when normal eating practices resume.

fat more efficiently scientific evidence backs the diet.

•• Burn • NoSuccess Increase energy levels is largely dependent on the immune increasing nutrient-dense foods and • Stimulate system removing processed foods/meat, as Promote weight loss and as reducing energy intake • lower the risk of health • well The potential to create a poor problems such as heart relationship with food by implying disease and cancer.

•

that some foods and nutrients are better or worse than others The weight lost during the diet may be regained if normal eating practices resume.

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NAME

DESCRIPTION Emulates the diet of our Paleolithic hunter-gatherer ancestors, whose digestive systems were designed for only whole, unprocessed foods that resemble what they look like in nature.

PALEO DIET

KETOGENIC DIET

ATKINS DIET

IMPLIED BENEFITS

DANGERS AND LIMITING FACTORS

inflammation entire food groups •• Reduce • Restricting Improve gut health can reduce nutrient density and with weight loss opportunities for nutritious foods •• Assist Increase energy Can make eating out more difficult • Assist in clearer/healthier • • As with any restrictive diet, skin.

demonising foods or nutrients as ‘good’ or ‘bad’ can result in a poor relationship with food, restrictive practices and the potential for disordered eating.

Eat only whole, unprocessed foods: meat, fish, eggs, vegetables, fruits, nuts, seeds, herbs, spices, healthy fats and oils.

Avoid processed foods, grains, dairy, legumes, simple sugars and artificial sweeteners.

Limit carbohydrates significantly (approximately 20g net/day) so that the body goes into ketosis (burns fat instead of sugar for energy).

limited carbohydrates • Ketogenic diets result in high • The in this diet put the body electrolyte losses due to reduced in a state of ketosis, which means the body will produce ketones for energy instead of relying on glucose.

glycogen storage. If not replaced regularly, imbalances can result in headaches, dizziness, brain fog and muscle soreness (keto flu) Long-term adherence can be difficult due to the restrictive nature of the diet Adaptation to fat burning can take days to weeks when energy levels may be poor.

• Avoid carbohydrate- This can potentially result in: • hunger rich foods such as •• Reduced Weight loss bread, cereals, rice, pasta, fruit, potatoes, • Improved energy levels (for some) corn and peas. health.

• Improved Limit carbohydrate Weight loss without the weight lost from this diet may be • need for calorie • The intake and eat as counting regained when normal eating resumes much fat and protein improve cholesterol individuals ‘hyper-respond’ to • May • Some as desired. levels in some individuals high-fat intakes resulting in increased Eat meat, eggs, improve symptoms levels of ‘bad’ cholesterol • Itformay cheese, nuts, seeds, coeliac and glutenwith any restrictive diet, • Asdemonising fish, avocados and sensitive individuals. foods or nutrients as vegetables.

Avoid bread, cereals, pasta, sweets and treats, potatoes, corn and fruit.

‘good’ or ‘bad’ can result in a poor relationship with food, restrictive practices and the potential for disordered eating.

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EDUCATING CLIENTS ON FAD DIETS AND ENCOURAGING HEALTHY ALTERNATIVES People embark on fad diets for a variety of reasons, including: Wanting to lose weight quickly Wanting to improve gut health with a new approach Believing in marketing ploys Recommendations from friends who have had success.

• • • •

The ‘dieting industry’ is worth over $640 million annually in Australia alone. Overweight and obesity are responsible for a large burden of health on the Australian health system, and messages to improve health, mixed with people’s desire to adhere to cultural norms of what a healthy body looks like, pushes people and companies to pursue the next magic bullet approach to health and wellness.

Commonly, clever or misleading advertising, celebrity endorsements and social media influencing work to make vulnerable or unsuspecting people believe that they have found a diet type, supplement or product that will result in huge weight loss or dramatic improvements in health, energy, sleep or some other positive outcome.

While fad diets usually work initially, their success is normally short-lived due to difficulty maintaining weight loss. This can be for a variety of reasons including: Hitting goal weight and stopping dieting Not learning sustainable habits during the weight loss process Rapid weight loss due to muscle and or water weight losses Problems adhering due to restrictions imposed by diet rules Knowingly or unknowingly being non-adherent to an energy deficit.

• • • • •

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EVIDENCE-BASED DIETARY PATTERNS FOR SPECIFIC POPULATION GROUPS: DASH (DIETARY APPROACHES TO STOP HYPERTENSION) DIET: The DASH diet has been around for over 20 years, with the diet used to help manage high blood pressure (hypertension).

The diet focuses on consuming low-sodium foods and limits foods high in sugar and saturated fat. The emphasis is on foods that are protein-rich and include plenty of fibre.(128) Foods that are recommended to reduce hypertension include: Fruits Vegetables Lean protein (chicken, fish, and beans).

Page Break Foods to limit or reduce are: Red meat Salt Added sugars Fat

• • • • • • • • •

The DASH diet has demonstrated substantial benefits that help to reduce the risk of heart disease and hypertension due to the blood pressure-lowering effects the diet has. Numerous trials have shown consistent results when following this diet and are well supported by the scientific literature. There is also evidence that the DASH diet may lower the risk of type 2 diabetes, stroke and obesity. This diet is certainly not a fad or trend but a clinically proven dietary intervention to reduce the risk of cardiovascular disease events.(128)

THE LOW FODMAP DIET FODMAPs (Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) are sugars that are not absorbed properly in the gut, triggering symptoms in people with IBS. When FODMAPs reach the small intestine, they move slowly, attracting water. When they pass into the large intestine, FODMAPs are fermented by gut bacteria, producing gas. The extra gas and water cause the intestinal wall to stretch and expand. Because people with IBS have a highly sensitive gut, stretching the intestinal wall causes exaggerated sensations of pain and discomfort. The Low FODMAP Diet was first developed by researchers at Monash University in Melbourne, Australia.(129) A FODMAP diet is intended for people with medically diagnosed IBS. The diet begins with a 2-6 week period of high restriction and then transitions to a more relaxed diet where certain foods are gradually reintroduced. Despite including the word ‘diet’, a low FODMAP approach to eating is not for long-term use or weight loss.(129) Additionally, individuals who are medically diagnosed with IBS fall outside the scope of a nutrition coach.

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WHY IS FAD DIETING A CONCERN? The fad dieting cycle results in repeated attempts at restricting food intake to achieve weight loss.(130) This cycle involves: Restricting food intake Feeling deprived/ cravings Giving into cravings (typically with foods that were classified as ‘forbidden’ or ‘bad’) Feelings of guilt Restricting to compensate for overconsumption/ binging.

• • • • •

START DIET RESTRICTION GUILT

GIVE IN

DEPRIVATION

CRAVE

In your role as a nutrition coach, you will not be required to make a diagnosis of conditions such as binge eating disorder. However, it is important to look for any indication of these behaviours when discussing a client’s diet history to ensure you refer them to the appropriate health professional. Referring this type of client to an accredited practising dietitian will ensure that your client receives the appropriate care.

FAD DIETS AND THE ROLE OF A NUTRITION COACH Nutrition coaches must help their clients navigate the diet and health industry by educating them about fad diets and their benefits, pitfalls and alternatives. For this reason, it is important to keep up with diet trends and scientific research in the nutrition field using reliable information sources. It is also important that nutrition coaches do not recommend fad diets to their clients, as without sufficient evidence for the benefits of a specific diet, they may be putting their clients’ health at risk.

The primary focus is to develop sustainable, long-term, individualised nutrition recommendations. It is important to assist clients in navigating the nutrition and health industry and educate them on fad diets and the associated potential negative outcomes. As these fad diets lack sufficient evidence to support implementation, nutrition coaches are not advised to recommend these to clients.

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UNDERSTANDING HOW TO READ NUTRITIONAL LABELS how to understand food labels

An Australian requirement is to include a nutritional label on all food items besides fresh produce and meat. This makes What to look for… it extremely easy to learn what ingredients are in the food and the nutritional breakdown.

Don’t rely on health claims on labels as your guide. Instead learn a few simple label reading tips to choose healthy foods and drinks, for yourself. You can also use the label to help you lose The image below provides helpful tips on how to best read nutrition labels: weight by limiting foods that are high in energy per serve.

Nutrition Information Total Fat Generally choose foods with less than 10g per 100g.

For milk, yogurt and icecream, choose less than 2g per 100g.

For cheese, choose less than 15g per 100g.

Saturated Fat Aim for the lowest, per 100g.

Less than 3g per 100g is best.

Other names for ingredients high in saturated fat: Animal fat/oil, beef fat, butter, chocolate, milk solids, coconut, coconut oil/milk/cream, copha, cream, ghee, dripping, lard, suet, palm oil, sour cream, vegetable shortening.

Servings per package – 16 Serving size – 30g (2/3 cup)

100g Column and Serving Size

Per serve

Per 100g

Energy

432kJ

1441kJ

Protein

2.8g

9.3g

Total

0.4g

1.2g

Saturated

0.1g

0.3g

Fat

If comparing nutrients in similar food products use the per 100g column.

If calculating how much of a nutrient, or how many kilojoules you will actually eat, use the per serve column. But check whether your portion size is the same as the serve size.

Energy Check how many kJ per serve to decide how much is a serve of a ‘discretionary’ food, which has 600kJ per serve.

Sugars

Carbohydrate

Total

18.9g

62.9g

Sugars

3.5g

11.8g

Fibre

Fibre

6.4g

21.2g

Not all labels include fibre.

Choose breads and cereals with 3g or more per serve

Sodium

65mg

215mg

Ingredients: Cereals (76%) (wheat, oatbran, barley), psyllium husk (11%), sugar, rice, malt extract, honey, salt, vitamins.

Ingredients

Avoiding sugar completely is not necessary, but try to avoid larger amounts of added sugars.

If sugar content per 100g is more than 15g, check that sugar (or alternative names for added sugar) is not listed high on the ingredient list.

Other names for added sugar: Dextrose, fructose, glucose, golden syrup, honey, maple syrup, sucrose, malt, maltose, lactose, brown sugar, caster sugar, maple syrup, raw sugar, sucrose.

Sodium (Salt) Choose lower sodium options among similar foods. Food with less than 400mg per 100g are good, and less than 120mg per 100g is best.

Other names for high salt ingredients: Baking powder, celery salt, garlic salt, meat/yeast extract, monosodium glutamate, (MSG), onion salt, rock salt, sea salt, sodium, sodium ascorbate, sodium bicarbonate, sodium nitrate/nitrite, stock cubes, vegetable salt.

Listed from greatest to smallest by weight. Use this to check the first three ingredients for items high in saturated fat, sodium (salt) or added sugar.

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The table below provides further details on how to effectively read nutrition labels. As a nutrition coach, having this knowledge can prove to be beneficial when educating and providing nutritional support to clients:

ELEMENT

DESCRIPTION This should be noted as the total number of serves in the product, followed by the measurement of the serve in grams. For example, a cereal box may say 10 serves at 50g per serve.

SERVE SIZE

It is important to note that the ‘serve size’ reflects the amount of nutrients an individual consumes. For example, some products may contain two serves in a package, but an individual eats it in one sitting; therefore, they have consumed two serves of that particular product.

PER 100G COLUMN

The per 100g column is important for comparing similar products. For example, suppose an individual was purchasing a box of muesli. In that case, they could compare the sugar and fibre content of two different cereal types and decide which is the better choice. The ‘Per Serve’ column cannot be used to compare items simply because serve sizes are not always the same. For example, one serve of Muesli A may be 30g, whereas Muesli B may have a serve size of 45g.

ENERGY

Energy can be indicated in kilojoules or calories and indicates how much energy is in the product in both one serve and 100g.

DAILY VALUE (% DAILY VALUE)

The daily value is a guide for the nutrients in one serve of a particular food.

For example, if the label says 20% for iron, one serving of that product would give a person 20% of their daily iron requirements.

CARBOHYDRATES

Remember that there are three types of carbohydrates: total carbohydrates, simple sugars and fibre. When reading a nutrition label, it is best to keep the sugar low (<15g/100g) and the fibre high (>7.5g/100g).

SUGARS (AKA SIMPLE CARBOHYDRATES)

Added sugars may come from refined sources such as sucrose (table sugar) or corn syrup. It can be present in foods naturally as fructose (in fruit) or lactose (in milk). While Australia does not have guidelines for added sugar, the World Health Organisation (WHO) recommends keeping calories from added sugars below 5% of total energy intake; this is the equivalent of approximately six teaspoons for the average Australian.

Please note that added sugars include honey, rice malt syrup, soft drinks, cordial, and other sweetened foods. It does not include natural sugars, such as lactose in dairy products.

INGREDIENTS LIST

Products containing more than one ingredient must have an ingredient list on the nutrition label. Ingredients are listed by weight, from largest to smallest.

This is helpful for those with food sensitivities who may need to avoid or limit certain ingredients. This is also helpful for clients to know the main ingredients of the food they are purchasing/consuming.

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NUTRIENTS TO WATCH: TRANS FAT, ADDED SUGARS AND SODIUM Understanding nutritional labels allow a nutrition coach to educate and support clients in making educated decisions when purchasing food. Nutrition coaches should encourage their clients to look out for the sugar, trans fats, sodium and fibre content of the foods they choose to eat and aim to keep sugar and sodium below 15g and 120mg per 100g.

Sugar is well known to be linked with diabetes mellitus, weight gain and inflammation, while excessive sodium intake is believed to increase blood pressure.(62) Trans fats, such as vegetable oils and margarine, are linked with hypercholesterolaemia (elevated cholesterol), inflammation and atherosclerosis.(131)(132)(133)(134) On the other hand, the higher the fibre content, the better. As a general recommendation from nutrition coaches, encourage clients to look at purchasing products with more than 7.5g per 100g of fibre. Fibre is essential for healthy bowel motions, acts as a prebiotic in the gut and increases satiety.

WHAT IT ALL MEANS (MARKETING CLAIMS) When it comes to marketing, big food companies can be very sneaky. It is, therefore, extremely important to understand the marketing claims on food items.

The table below outlines what each marketing claim means when it comes to food labelling:

MARKETING CLAIM

WHAT IT ACTUALLY MEANS

DIET

At least 40% less kJ than the original product

LOW-FAT

Contains <3g fat per 100g.

REDUCED SALT/ FAT

The product is comprised of at least 25% less fat or salt than that brand’s original product (best to avoid reduced fat).

LIGHT/LITE

Used to describe texture, colour and flavour, not necessarily calorie content. The component that makes the food ‘light/lite’ must be stated on the label.

NO ADDED SUGAR

No sugar is added to the product during production(this does not consider the product’s natural sugars). Ensure the labels are still checked for the quantity of sugar.

ALL NATURAL

Indicates no artificial colourings, flavourings or preservatives have been added to the product.

What is an organic claim?(135) An organic claim is any statement that describes a product as organic or the ingredients used to make a product as organic.

For example: ‘100% organic’ ‘made using organic ingredients’, or ‘certified organic’.

•• •

ORGANIC CLAIMS(142)

Products labelled as organic generally attract a premium price compared to those produced using artificial fertiliser, chemicals or pesticides and non-essential food additives or processing aids. Businesses that make organic claims must be able to substantiate those claims.

Organic product standards:(135) There is a voluntary Australian standard for growers and manufacturers who label their products as organic and biodynamic. This standard is a useful reference point when determining whether a product is organic.

Certified products:(135) Many products carry a symbol, logo or another trademark to show that they are certified organic. Various private bodies provide this certification, and the minimum standards required to get certification may vary. A business that labels its product as certified organic must ensure its product is certified. All organic claims, whether they reference a standard or not, should be able to be substantiated. If a business claims to meet a particular standard, it must ensure that this claim is true.

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UNDERSTANDING HOW TO READ NUTRITIONAL LABELS

RECOGNISING THE EFFECTS OF DIFFERENT COOKING METHODS For a nutrition coach to effectively plan, implement and encourage appropriate nutritional habits with their clients, it is important to understand that the nutritional content of food can be altered by how it is cooked or prepared.

Cooking can alter the nutritional content of the food, specifically the antioxidants (a substance that inhibits oxidation, such as vitamin C) and phytochemicals (plant-based compounds with disease-protecting properties) such as polyphenols, carotenoids, glucosinolates. These important substances can be damaged upon heating and therefore have a less beneficial or nil effect on the body.

Food in its natural raw state is often considered to have the highest amount of nutrition; however, it is not always safe to be eaten raw (e.g. chicken). Over the centuries, ancestors have passed down cooking techniques to ensure the food is safe to eat and make it more palatable and easier to digest.

Some of these cooking methods include: Steaming Boiling and blanching Grilling and baking Frying.

• • • •

Palatable has been used in English to refer to palate-pleasing foods since 1619. Palatable comes from the word ‘palate’, a Latin word for the roof of the mouth. The palate was once thought of as the seat of the sense of taste, so the word eventually came to mean ‘sense of taste’ or, broadly, ‘liking’.

Other words with the same meaning include: ‘Savoury’ (dating from the 14th century).

‘Toothsome’ (dating from 1551).

‘Tasty’ (first used in the early 17th century).

‘Appetising’ (since 1653).

•• ••

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STEAMING Steaming refers to heating a food item with minimal water. As the water is heated, it turns to steam and cooks the food.

This is often considered the healthiest way of cooking, as minimal nutrients are lost in the process. This is because the food is exposed to lower temperatures than boiling or baking and only steam, not water, is in contact with the food.

Steaming also preserves the texture of the food better than other cooking methods, such as boiling.

Vegetables such as broccoli, baby carrots and cauliflower are frequently steamed as a fast, effective and healthy way of cooking.

BOILING AND BLANCHING Boiling refers to submerging the food in boiling water for it to cook completely through. While blanching is similar to boiling, blanching food is a process of cooking where food (commonly a vegetable or fruit) is heated in boiling water, removed after a brief, timed period, and plunged into iced water or cold running water to stop the cooking process.

When food is boiled, nutrients can leach out of the food into the water. For example, water-soluble vitamins like vitamin C are heat sensitive and dissolve in water.(136) As the cooking water is often discarded, it ultimately means that certain nutrients are lost in the boiling process. As a result, it is encouraged to not over-boil and to use the water used for boiling if possible.

Interestingly, boiling as a cooking method can better preserve certain antioxidant compounds in various vegetables. For example, carotenoids were preserved in all vegetables, and vitamin C was better preserved in carrots and courgettes.

Boiling also holds the colours of the vegetables when cooking, unlike most other cooking methods. This colour retention can often make it more appealing for consumption through visual sensory receptors.

Both vegetables and meats are commonly boiled. Meats and vegetables may be boiled by themselves, strained and eaten as is, or be turned into a stew or casserole when combined with flavours, herbs and spices.

A sensory receptor is a structure that reacts to a physical stimulus in the environment, whether internal or external. It is a sensory nerve ending that receives information and conducts a process of generating nerve impulses to be transmitted to the brain for interpretation and perception.

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GRILLING/BAKING Grilling or baking refers to placing the food in a hot, dry environment, either inside an oven or under a grill. While a type of fat is sometimes used to keep the food moist and prevent it from drying out, it is not necessary when using this cooking method.

Grilling and baking are well-known for retaining the flavour of food; however, up to 40% of B vitamins can be lost during cooking. While fewer nutrients are lost in grilling or baking than in boiling, nutrients can be damaged, and free radicals can be formed when food is cooked to caramelisation/burning.

For example, when baked, purple and white potatoes lose large amounts of polyphenols and pigments but only lose small amounts when boiled. This effect is especially true for processed meats, with studies showing that grilling can produce large amounts of carcinogenic (cancer-promoting) compounds that can harm health. For this reason, it is best to grill and bake foods, like bacon, at low temperatures, to reduce the production of harmful compounds.

FRYING Frying refers to using a type of fat at high temperatures to cook food, which can be done using a frypan or a deep fryer.

The fat that is used for frying food may be in the form of the following: Oil (e.g. vegetable oil, coconut oil, olive oil) Animal fat (e.g. lard, ghee, duck fat) Animal products (e.g. butter) Unnatural fats (e.g. margarine)

• • • •

Food can also be dry fried, which refers to cooking items over high heat without adding fat.

When frying foods at high temperatures, this can damage the enzymes present in the food and create free radicals when the food is fried to a caramelised/burnt point. As a result, this can lead to inflammation (an unwanted immune response) in the body and increased free radical damage to the body’s cells and DNA. In addition, frying can cause the food to soak up the oil it is cooking. For example, a piece of salmon cooked in harmful sunflower oil would cause the salmon to soak up the sunflower oil and therefore change its fatty acid profile to one of lesser benefit.

Another factor to consider when frying foods is the heat in which the fat is fried. Certain fats can only reach certain temperatures (known as smoke point) before their biochemical structure is altered, becoming harmful and inflammatory.

For example, olive oil is best kept at low heat as when heated past approximately 160 degrees, its biochemical structure changes and becomes an unhealthy and potentially harmful oil for human consumption.

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The figure below displays the smoke point of many common oils.

Source: Reddit. (2018). Smoke Point Chart, Various Cooking Oils. This sub cleared up my misunderstanding about avocado oil, so here’s the rest! : castiron. [online] Available at: https://www.reddit.com/r/castiron/comments/881cks/smoke_point_chart_various_cooking_oils_this_sub/ [Accessed 31 Aug. 2018].

FREE RADICALS Free radicals refer to unpaired electrons. Because electrons like to be in pairs, free radicals will seek out other unpaired electrons, which in effect, will cause damage to cells, proteins and DNA. Free radicals are harmful because they can damage DNA, proteins and lipids in the body, causing oxidative stress, which has been linked to heart disease, high blood pressure and inflammatory diseases like arthritis.(137)

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KNOWLEDGE OF FOOD SAFETY PRACTICES Nutrition coaches may offer services to their clients that involve the direct handling and production of food products, and as such, it is a good practice to be aware of food safety practices. Australian businesses and food handlers are subject to food safety standards, which obligate them to produce safe and suitable food for consumption.

Food Standards Australia and New Zealand (FSANZ) contain health and hygiene obligations that aim to reduce the incidence of foodborne illnesses and include five standards: Interpretation and Application Food Safety Programs Food Safety Practices and General Requirements Food Premises and Equipment Food Safety Programs for Food Service to Vulnerable Persons.

• • • • •

FOOD STANDARDS AUSTRALIA NEW ZEALAND To view the full standards CLICK HERE.

For the purposes of this unit, nutrition coaches should be aware of food handling basics. If a nutrition coach wishes to work in a food handling/production capacity in the course of their business, they may wish to consider obtaining their Food Handling certificate (SITSS00050).

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ENCOURAGING CLIENTS TO ADOPT SAFE FOOD HANDLING PRACTICES It is important that nutrition coaches acquire the skills and understanding of safe food handling and storing so that they can then pass these skills on to their clients where needed. Food handling is not innate, and knowledge of these skills depends on family and cultural practices. It is common for people from different countries and cultures to practice very different food safety practices compared to those used in Australia, and while those practices may be suitable for some foods or some climates, they may not be suitable in the hot climate of many places in Australia.

The four main areas of knowledge required for safe food handling and storage are listed below: 1. Cleanliness 2. Separation 3. Cooking 4. Chilling/refrigeration to grill and bake foods, like bacon, at low temperatures, to reduce the production of harmful compounds.

CLEANLINESS

must be encouraged to wash their hands before handling and preparing food. This • Clients reduces the risk of contaminating food with bacteria that could cause food poisoning. hands thoroughly with warm, soapy water and drying them before and between • Washing handling food is good practice. coaches can also encourage clients to ensure they clean cooking utensils before • Nutrition cooking, including wiping down kitchen surfaces such as benches and hot plates. practices should also be done by handling foods such as raw meat, chicken and fresh • These vegetables to reduce the risk of contaminating food that may be cooked differently (or not cooked), such as salads.

SEPARATION

types of food must be separated for storage and preparation.

•• Different Raw meat, poultry, seafood and eggs should be kept separate from other foods like fruits and vegetables, especially salads that will not be cooked. coaches can encourage clients to ensure that ready-to-eat foods are not placed on • Nutrition surfaces that raw meat, poultry, seafood or eggs have been on. foods need to be cooked to different internal temperatures to ensure that they are • Different fully cooked through and to reduce the risk of bacteria remaining active in them. some meats, like steak, pork and lamb, can be eaten without needing to be fully • While cooked, most meats (i.e. chicken, and ground meats) should be cooked thoroughly before

• • COOKING

eating. Similarly, tuna and salmon can generally be served as rare, but it is safest to ensure that all fish is cooked thoroughly before eating.

Additionally, bacteria grow best and fastest between 5°C and 60°C; thus, food should be warmed to around 70°c for 2 minutes to ensure bacteria are killed before eating, especially when reheating leftovers.

The table below shows different types of food and the internal temperature they need to reach to ensure their safety for consumption.

FOOD

INTERNAL TEMPERATURE

Beef, pork, veal, lamb

63°C

Ground meat

71°C

Ham (uncooked, fresh or smoked)

63°C

Ham (cooked to reheat)

60°C

Poultry

74°C

Egg dishes

71°C

Fish

63°C

Leftovers/casseroles

74°C

With a 3 minute rest.

With a 3 minute rest.

Or, flesh is opaque and separates easily with a fork.

should be set to 4°C and freezers set to -18°C. •• Refrigerators Fresh foods like meat, poultry, eggs, seafood and perishables like fruit and vegetables should be refrigerated within 2 hours of purchase. food should be thawed in the fridge, in cold water or in the microwave, never at room • Frozen CHILLING/ temperature.

REFRIGERATION that are thawed in the microwave should be cooked immediately.

•• Foods Foods that are being marinated should be left in the fridge, not at room temperature. Once the food is cooked, it should be cooled within 2 hours to ensure it chills to below 5°c to reduce the growth of bacteria.

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REFRIGERATION

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COMMON DIET, NUTRITION AND WEIGHT-RELATED CONDITIONS AND COMMON SYMPTOMS The modern Western diet tends to be one of convenience as opposed to nutritional adequacy. Over the decades, the typical diet has shifted from predominantly whole foods such as fruit, vegetables, meat, nuts and seeds to a diet much more processed (including prepackaged meals, takeaway food, and processed food).

Not only this, but fruit and vegetables are being sprayed with chemicals that may impact health (such as Glyphosate), and the farmland for crops and animals is becoming less nutrient-dense due to intensive farming techniques of pesticides and soil erosion.

Whole Fd Diet

Modern Western Diet

This change in dietary intake has resulted in a shift in overall macronutrient and micronutrient distribution. In comparison to a whole food based diet, the Modern Western diet tends to be: Lower in vitamins and minerals Higher in trans fats and lower in natural dietary fats Higher in processed protein sources and lower in natural protein sources Lower in total fibre Higher in sodium Higher in total carbohydrates Higher in refined sugars Higher in preservatives, additives and chemicals Higher in monosodium glutamate (MSG).

• • • • • • • • •

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As a result of this dietary imbalance, individuals may suffer from many symptoms and onset of disease, such as: Lethargy (lack of energy, reducing motivation for exercise and activities of daily living) Compromised immunity (increased susceptibility to illness) Inflammation (joint and muscle aches and pain) Arthritis (pain in the joint and loss of mobility in the joints) Inability to adequately digest/absorb nutrients Vitamin and mineral deficiencies Elevated cholesterol levels (due to processed food intake, but often without overt symptoms) Overweight and obesity (which can make being active more difficult and possibly socially isolating) Heart disease (which reduces exercise tolerance and increases the risk of heart attack or stroke during exercise) Diabetes (which can lead to diabetic neuropathy [pain in the extremities and blindness]) High blood pressure (which can make normal activities of daily living and exercise harder to tolerate) Metabolic Syndrome (at least three of the following conditions: insulin resistance, high blood pressure, obesity and elevated triglycerides, all of which increase the risk of progression to diabetes and cardiovascular disease) Cancer Irritable bowel disease (abdominal pain, bloating and irregular bowel motions as a result of inflammation in the GIT or an imbalance of gut flora secondary to dietary choices, medication use and hereditary factors) Weight gain (increasing weight due to poor dietary choices and inadequate movement daily).

• • • • • • • • • • • • • • •

As a nutrition coach, it is important to educate and assist clients with changing their dietary habits to reflect a nutritionally complete diet that meets their individualised dietary requirements. It is helpful for clients to understand which parts of their nutritional requirements they may not be currently meeting or exceeding and to be provided with practical tips to help them get their nutrition back in balance.

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FOODS IMPACTING HEART DISEASE While it was initially thought that cholesterol and saturated fat-ridden foods cause heart disease, it has come to light over the past decade that foods containing saturated fat and cholesterol are not the culprit.

While many factors may increase an individual’s risk of heart disease, such as stress, physical inactivity and genetics, a nutrition coach needs to understand the role that diet plays in its development.

Trans fats and excessive sugar intake have been shown to contribute to atherosclerosis. If these deposits are not managed or reversed, they can cause a blockage of the artery.

A blockage of the artery can result in one of two things: 1. Inadequate oxygen carried to the brain resulting in a stroke 2. Blood flow is blocked to the heart resulting in a heart attack.

Trans fats and hydrogenated fats are found in food sources such as margarine, vegetable oils and deep-fried foods.

Most cakes, biscuits, pre-made meals, sauces, marinades, crisps, canned soups and other preserved foods contain these trans or hydrogenated types of fat. The relation of sugar to heart disease, on the other hand, refers to the excessive consumption of refined sugar such as cakes, lollies, biscuits and chips, although it can also relate to less refined options such as excessive intake of pasta, bread, rice and cereals.

Individuals with risk factors for heart disease or who have already suffered a heart attack or stroke should evaluate their diet and longer-term nutritional plan. These individuals must seek guidance to reduce the intake of such foods and increase the intake of alternative, healthier, more natural options.

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INDICATIONS OF CHRONIC HEALTH CONCERNS WHICH REQUIRE REFERRAL TO A HEALTH PROFESSIONAL A nutrition coach’s job is to identify when a client would best be referred to a health professional. It is important to understand the scope of practice within which a nutrition coach can practice and when to refer.

A nutrition coach can work with individuals considered healthy and without acute or chronic diseases. It is important to identify if an individual is suffering from some form of disease and requires a referral to a health professional.

If an individual receives clearance from their doctor, the client is welcome to continue consulting with the nutrition coach.

However, once diagnosed with a chronic disease, the client must be referred to a GP, dietitian or another specialised health professional.

Some individuals are unaware of their current health status and may not be aware that they are at an increased risk of various diseases. The nutrition coach’s responsibility is to identify any concerning symptoms and refer on as required.

The table below identifies various chronic diseases’ most common signs and symptoms. If a client presents with one or a multitude of these signs and symptoms, it is encouraged to refer the client to their GP for assessment. A referral to a more specialised health professional is required if diagnosed with a chronic disease.

AFFECTED BODY SYSTEM

RISKS, SIGNS AND SYMPTOMS

•• Bloating Gas •• Diarrhoea Constipation in stools •• Blood/Mucus Abdominal pain DIGESTIVE fog •• Brain Poor memory recall •• Fatigue Lack of motivation cravings •• Sugar Excessive antibiotic use • Furry tongue. high in trans/ • Diet hydrogenated fat low in healthy natural • Diet fats Diet lacking in fibre CARDIOVASCULAR • Deranged lipid readings •• Angina/heartburn •• Atherosclerosis Physical inactivity • Hypertension.

POTENTIAL CHRONIC DISEASE

REFERRAL REQUIRED

bowel practising • Inflammatory • Accredited disease dietitian (APD) colitis •• Ulcerative • General practitioner.

Irritable bowel disease intolerances •• Food Food allergies issues •• Malabsorption Coeliac disease.

practising •• CVD • Accredited Elevated stroke/heart dietitian (APD) attack risk practitioner •• General Exercise physiologist.

• Atherosclerosis.

ENDOCRINE REPRODUCTION INTEGUMENTARY

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thirst mellitus practising •• Excessive •• Diabetes • Accredited Excessive urination Hypo/hyperthyroidism. dietitian (APD) cravings educator •• Sugar • Diabetic Imbalanced energy levels: (diabetes only) fatigue and excessive • General practitioner. energy •• Dizziness ENDOCRINE Headaches fog •• Brain Decreased concentration in peripheries •• Tingling Blurred vision in peripheries •• Numbness Difficulty losing weight. in falling pregnant ovarian practising •• Difficulty • Polycystic • Accredited Decreased egg count syndrome dietitian (APD) (absence of • Amenorrhea •• Infertility • General practitioner (GP). menstrual cycle for over Nutritional deficiencies.

REPRODUCTION three months) menstrual cycle •• Irregular Particularly heavy/ light menstrual cycle. or practising •• Rashes/Bumps • Allergies • Accredited Raised skin follicles sensitivities dietitian (APD) INTEGUMENTARY imbalances •• Flushing •• Hormonal • General practitioner (GP).

Acne Nutritional deficiencies.

• White spots on nail beds bones practising •• Brittle • Nutritional • Accredited Easily broken/ fractured deficiencies dietitian (APD) bones •• Arthritis • General practitioner (GP).

MUSCULOSKELETAL • Rickets Osteoarthritis or aching joints dystrophy •• Sore •• Muscular Decreased flexibility Gout.

• Muscle wastage.

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COMMON FOOD SOURCES TO SUPPORT CLIENT GOALS As a nutrition coach, it is important to build knowledge of the types of food that can help improve health and support client goals. Some foods are more nutritionally dense than others, containing more beneficial vitamins and minerals.

Some of the most nutritionally dense foods earn the title superfood. Some examples include: Dark leafy greens (kale and spinach) Berries (raspberries, strawberries, blackberries, blueberries) Eggs Nuts (almonds, walnuts, cashews, brazil nuts) Seeds (pumpkin, sunflower, chia, flax, hemp) Legumes (lentils, chickpeas, black beans) Turmeric.

• • • • • • •

These foods are all highly nutritious and, when included in the diet, can enhance health in various ways by increasing energy, fibre, vitamin and mineral intake and reducing inflammation. For instance, turmeric is an antioxidant and antiinflammatory source that may help reduce the risk of heart disease, diabetes mellitus and cancer. On the other hand, eggs contain a wide range of vitamins, minerals, antioxidants and protein, making them a valuable source of nutrition.

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The table below provides the details for some superfoods:

FOOD

BLUEBERRIES

WHY IT IS HEALTHY

USES

A fruit native to North America and grown all over the world, blueberries are rich in phytonutrients. Research shows they provide as much antioxidant protection as 1700mg of vitamin E and more than 1200mg of vitamin C.

Blueberries can be eaten fresh, frozen or dried. It could be added to yoghurt or oats.

New research shows blueberries are also beneficial for improving memory and slowing down or postponing the onset of other cognitive problems associated with ageing.(98) It is also possible to freeze blueberries without damaging their antioxidant content. Their low GI means they provide sustained energy.

A leafy green vegetable from the Brassica family is grown in most countries and can be easily sourced. Kale is known for its antioxidants, antiinflammatory nutrients and potential anti-cancer nutrients in glucosinolates.

KALE

Research has shown kale to have 45 different flavonoids, particularly kaempferol and quercetin. It has one of the highest Oxygen Radical Absorption Capacity (ORAC) ratings of any vegetable, making it a potent anti-cancer food. It is also high in carotenoids, another potent antioxidant.

Use raw or steamed in salads, side dishes and in smoothies.

100 calories of kale provide over 350mg of the most basic omega-3 fatty acid, ALA. Raw and steamed kale helps to lower cholesterol by binding its bile acids. Kale is also rich in vitamins, especially vitamins A, K and iron.

A cultured, creamy product similar to yoghurt, containing beneficial yeast and friendly probiotic bacteria. It contains vitamins, minerals and easily-digestible complete proteins; kefir is great for nourishing the gut.

KEFIR

Use as a daily health drink.

Kefir is formed from gelatinous white or yellow particles called ‘grains’, using milk such as cow, goat, sheep, coconut, rice or soy. These grains comprise the bacteria/yeast mixture clumped together with casein (milk proteins) and complex sugars. The grains ferment the milk, including other beneficial organisms, to create the cultured product. The grains are then detached with a strainer (before consumption of the kefir) and added to a new batch of milk.

Kefir helps to create healthy conditions in the digestive tract for the colonisation of friendly bacteria.

CHIA SEEDS FERMENTED VEGETABLES CHIA SEEDS

FERMENTED VEGETABLES

Chia seed is a type of flowering plant identified from the mint family and native to Mexico and Guatemala. When the seeds are soaked, they absorb up to 12 times their weight in liquid. Soaking gives them a mucilaginous gel-like coating.

These seeds are a concentrated source of essential omega-3 fatty acids (ALA). They are also high in B vitamins thiamine, niacin, and a range of dietary minerals, including calcium and zinc. They are an excellent source of carbohydrates and fibre, and their mucilaginous form aids digestion and elimination.

When fermented by lactobacillus bacteria, vegetables become a source of beneficial bacteria and enzymes. The culturing process produces beneficial microbes that help balance intestinal flora and immunity.

Used in baking, salads, stir-fries, smoothies, desserts and beverages.

Use in salads, sandwiches or as a side dish.

This helps with the production of serotonin, essential for a healthy mood.

Fermented foods are also excellent chelators and detox agents, helping to rid the body of toxins and heavy metals.

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IMPACTS OF LIFESTYLE, ACTIVITY LEVELS AND PERSONAL CHARACTERISTICS ON RECOMMENDED NUTRITIONAL INTAKE Lifestyle, activity and genetics all impact the nutritional requirements of individuals differently, which is why a nutrition coach needs to be aware of this to successfully support clients’ nutritional needs. While genetic factors like ethnicity, sex, age, hormones and susceptibility to illness and disease cannot be changed, they can be considered when designing personalised dietary recommendations.

Factors like lifestyle and activity levels can be changed and therefore play a major role in long-term health and how a nutrition coach designs/plans a client’s dietary recommendations. These factors are the most important to address for individuals and the population. Each of these factors is outlined in more detail on the following pages.

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LIFESTYLE FACTORS AND THEIR IMPACT ON NUTRITIONAL HEALTH Lifestyle can be defined as the behaviours, beliefs, mental health, social and environmental factors, and physical activity of an individual within the community in which they live. A complex interaction between these areas influences people’s lifestyles in many ways.

Nutrition coaches need to identify the relevant lifestyle factors that their clients present with to offer tailored nutrition advice.

Examples of some lifestyle factors that can also have an impact on the nutritional health of clients are outlined in the table below.

FOOD

MEANING

NUTRITIONAL IMPLICATION

This can include risk-taking or risk-avoidance behaviour, smoking, drinking alcohol, food intake, motivation levels, hobbies, and interests.

Poor motivation to change will affect whether clients can make dietary changes that may benefit their health.

Beliefs can influence health dramatically - believing that health can be controlled versus not being in control, trust versus no trust in health professionals, and religious beliefs.

Building trust with a client will make them more likely to engage and result in a better outcome.

MENTAL HEALTH

While the individual cannot always control mental health, how someone responds to stressors in their environment or stressful events can determine whether they are resilient and able to respond positively; or lack resilience and respond negatively.

Stress can increase an individual’s drive to eat.

Techniques to reduce emotional eating may help some clients.

SOCIAL FACTORS

Socio-economic status is recognised as the most powerful determinant of health, influencing the likelihood of an individual being overweight or obese, their education level and their long-term health prospects. Other social factors like social support structures, work colleagues, and the influence of other people are important factors in individual health.

Making recommendations on how to cook on a budget may be more appropriate for someone from a low socioeconomic background than someone with a highpaid job.

ENVIRONMENTAL FACTORS

This includes where someone lives and works, what country they live in, the health of the natural and built environment, and access to services, amenities, transport and infrastructure. For instance, it can be expected that living in a developed country like Australia, on the Sunshine Coast, means that an individual is likely to have much better health outcomes than someone living in a poor or developing country.

Advising a weight loss client, who likes fast food, to drive an alternative route home that avoids temptation might be a suitable technique to reduce fast food intake.

Whether an individual drives or walks to work, takes the stairs or the elevator or does a sedentary or active job, all non-exercise factors will affect their energy balance.

An individual who works as a builder will have higher energy requirements than a sedentary office worker. An athlete will have different nutrient requirements than a sedentary retiree.

BEHAVIOURS

BELIEFS

PHYSICAL ACTIVITY

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The lifestyle choices that an individual client makes will affect not only their current food choices and energy intake but also their future choices and willingness to accept suggestions for their diet from nutrition coaches.

This is why nutrition coaches must work collaboratively with clients to provide effective support and service, and as a result, this can work to achieve positive health outcomes. Working prescriptively by setting unrealistic goals and making suggestions for types of foods or ways of eating that do not work for a client will fail to adhere, with a high potential for lack of progress toward goals and likely loss of business.

Provided below are two case studies of two different clients, their lifestyle choices and realistic (collaborative) and unrealistic (prescriptive) suggestions that can be made to support the client:

CLIENT INFORMATION Karen is a 55-year-old retail assistant who wants to lose weight. She is currently sedentary at work and doesn’t enjoy organised exercise.

Karen also drinks a bottle of wine and eats takeaway most nights.

Simon is a 30-year-old full-time builder. Besides his active job, his hobbies include resistance training and triathlon. Simon’s goals are to gain muscle and lose fat.

PRESCRIPTIVE APPROACH a gym •• Join Stop drinking alcohol • Stop buying takeaway

2g/kg of protein •• Eat Increase gym attendance to 5/7 days

COLLABORATIVE APPROACH Karen consider increasing • Would her steps to 10,000 daily during breaks and before/after work?

Karen consider reducing • Would her alcohol intake to meet recommendations?

Karen like help to choose • Would healthier options for takeaway?

Simon increase his daily • Can protein intake to 2g/kg?

Simon afford a personal • Could trainer to maximise his efforts?

Simon use creatine?

•• Does Will triathlon training impact his efforts to gain muscle?

PRESCRIPTIVE APPROACH This approach is based on the thoughts and beliefs of the practitioner who dictates to their client how they should go about doing something. This technique may work for some clients but may alienate others. This approach will likely result in poor adherence.

COLLABORATIVE APPROACH This approach is based on working with a client and their unique circumstances, knowledge and beliefs to develop a way of doing something. This technique requires counselling, education and negotiation skills to help clients to develop their skills and knowledge to achieve their goal(s). This approach will likely result in long-term client adherence.

When considering these factors, it will be possible to adjust calculations of an individual’s energy requirements to provide a personalised approach to energy and macronutrient intake and distributions to help achieve overall good health, weight loss, muscle gain or another goal.

In the example above, it would be best for Simon to increase his protein intake to support his goal and active lifestyle (work life and hobbies included). He would likely have a high PAL factor, and it might be prudent to introduce supplements like creatine and whey protein to support his goals. On the other hand, Karen would be best guided toward reducing energy intake, prioritising protein for satiety and reducing fat and carbohydrate intake.

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ACTIVITY LEVELS

Physical activity refers to any activity that: Gets the body moving Makes breathing faster/quicker Increases heart rate.

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An individual can be physically active in many different ways and at any time of day. Being physically active regularly can promote the following benefits:(138) Reduce the risk of, or help manage type 2 diabetes Reduce the risk of, or help manage cardiovascular disease (CVD) Maintain or improve blood pressure, cholesterol and blood sugar levels Help prevent unhealthy weight gain and assist with weight loss Reduce the risk of, and assist with rehabilitation from some cancers Build strong muscles and bones Help prevent and manage mental health problems Create opportunities for socialising and meeting new people Help develop and maintain overall physical and mental wellbeing.

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For optimal health, all adults must participate in an accumulation of a minimum of 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity per week.(138) Another recommendation is to achieve 10,000 steps daily outside of organised exercise.

MODERATE PHYSICAL ACTIVITY

VIGOROUS PHYSICAL ACTIVITY

Moderate physical activity refers to: Taking some effort, but generally can still talk while participating in the activity.

Vigorous physical activity refers to: Any activity that requires more effort and breathing becomes harder and faster.

Examples include: Brisk walking Recreational swimming Dancing Casual bike riding Social Tennis Golf Household tasks (such as cleaning, gardening, or vacuuming) Pushing a stroller.

Examples include: Jogging Aerobics Fast cycling Organised sports (such as soccer, hockey, AFL etc.)

Resistance exercise High-Intensity Interval Training (HIIT) Tasks that involve lifting, carrying or digging.

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In practice, nutrition coaches need to be aware that not everyone can achieve either moderate or vigorous levels of physical activity for various reasons. Some people may have sedentary jobs or work long or unsociable hours. Some people may have a physical disability that restricts their mobility or ability to exercise. Others may suffer mental health problems that limit their capacity to engage in exercise. For this reason, when supporting clients with their nutritional goals, it is important to understand their lifestyles from a holistic (all-encompassing) viewpoint to tailor nutritional recommendations to their current situation while also being aware of the need to encourage changes to activity levels that suit them.

Provided below are case studies and recommendations that could be made in light of clients’ activity levels:

CLIENT INFORMATION DAVE: Single 40-year-old interstate truck driver. Sedentary and overweight. Currently eats at truck stops (mainly fast food), snacks on confectionary/soft drinks on the road and has no cooking skills.

LISA: Married 35-year-old stay-at-home mum with 4 children. Struggling to lose weight. Enjoys red wine and chocolate every night but does all home cooking.

Sedentary but motivated to change TIM: A 65-year-old retiree who is living on a pension.

Widower. Mainly sedentary and concerned about being a low weight but enjoys going to the lawn bowls club 5 days a week. Poor cooking skills. Not interested in learning to cook.

KELLY: Married, 50-year-old office worker. Busy social life. Goes to the gym 5 days a week and hikes on weekends. Slim but wants to ‘lose the last 5kg’. Lost 30kg in the past 3 years.

RECOMMENDATIONS to reduce energy intake from fast food •• Aim Aim to change to diet soft drinks instead of full sugar versions Dave what healthier fast-food options look • Teach like Dave to prioritise protein at meals to • Encourage reduce hunger between meals • Encourage high-protein snacks for greater satiety. to reduce energy intake from alcohol and • Aim chocolate reduction in alcohol to meet • Encourage recommendations • Encourage exercise. to increase energy intake •• Aim Educate about low-cost convenience foods (ready meals from the supermarket) meals on wheels services •• Explore Educate on portion sizes and energy balance for weight gain.

on energy and protein intake •• Check Discuss physical activity and the need to fuel physical activity and recovery properly • Discuss realistic goals/expectations.

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PROVIDING APPROPRIATE EXERCISE ADVICE AS A NUTRITION COACH A nutrition coach must remember that it is not within their scope of practice to advise clients on specific/detailed exercise programming or requirements. This is because the depth of knowledge and education required to effectively and safely support exercise requirements or design exercise programs for clients is not sufficiently covered in the performance criteria of the Certificate IV in Nutrition.

A nutrition coach can provide general physical activity advice that aligns with their practice scope and the Australia’s Physical Activity and Sedentary Behaviour Guidelines.

To reiterate, it is outside the scope of practice for a nutrition coach to recommend, prescribe or conduct individualised or tailored exercise plans with explicit exercises, timeframes, intensities, or frequency. If a nutrition coach was to develop a tailored exercise plan for a client, it could injure the client.

The appropriate qualifications required for prescribing personalised exercise plans include Vocational Education and Training (VET) qualifications, such as: Certificate III in Fitness - Gym instructor - Group exercise instructor - Aqua exercise instructor Certificate IV in Fitness (personal trainer) Diploma of Fitness Higher education/university degrees, such as - Bachelor of Sport and Exercise Science - Bachelor of Human Movement - Bachelor of Clinical Exercise Science.

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PERSONAL CHARACTERISTICS AND GENETICS Personal characteristics refer to the individual traits and genetic makeup which make an individual unique. A personal characteristic can impact nutritional requirements and therefore needs to be considered when developing a nutritional plan.

Personal characteristics can be passed down (hereditary) or developed through lifestyle. Examples of personal characteristics may include: Ethnicity Gender Height Age Weight Hunger cues Religion/cultural requirements.

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Genetic personal characteristics, such as ethnicity, gender, height and age, need to be considered, as they can greatly affect an individual’s nutrition. Nutritional differences result not only from genetic predisposition but also because of differences in lifestyle and activity levels. For example, a 25-year-old Samoan male will have much greater nutritional demands than a 70-year-old Caucasian female.

The table below explores how some of these characteristics may impact an individual’s nutritional requirements:

PERSONAL CHARACTERISTIC

IMPACT ON NUTRITION

ETHNICITY

The size of the individual will affect nutritional requirements. Different ethnicities have different builds. For example, the Asian population are generally quite smaller framed and petite, while the Islander population are often larger in stature and size.

GENDER

Depending on the type of lifestyle (work (e.g. labour intensive versus sedentary) and leisure activities (e.g. reading versus kayaking)) undertaken will affect an individual’s nutritional requirements. In general, males tend to have a faster metabolic rate than females and, therefore, higher energy demands throughout the day. In addition, females of reproductive age will often require greater iron intake secondary to losses through menstruation.

HEIGHT

The height of an individual will affect total nutritional requirements, with a taller individual generally requiring more energy than a shorter individual. Height is taken into account when calculating EER.

AGE

Age is taken into account when calculating EER. An individual’s age is likely to affect their activity levels and nutritional requirements. Older individuals may have higher or lower micronutrient requirements (such as calcium and iron, respectively) but less EER (secondary to slowing down with age).

WEIGHT

An individual’s weight is no doubt going to be linked to total nutritional requirements, specifically EER. Many factors may affect weight outside the immediate control of an individual, such as hormonal imbalances (weight gain) or chronic illnesses such as cancer (weight loss).

RELIGION/ CULTURAL REQUIREMENTS

Religious and cultural requirements will impact nutritional requirements and the creation of a nutritional plan. For example, some cultures/religions will use fasting sporadically throughout the year for short or extended periods. Other religions will avoid certain types of food, such as pork.

Given the abundance of personal characteristics that may affect an individual’s nutritional requirements, it is beneficial for the nutrition coach to utilise both the Risk Stratification Screening Tool and Health Questionnaire and obtain a detailed personal and family history. Doing so will allow a greater understanding of the nutritional (both macro- and micro-nutritional) requirements of the individual with their various personal characteristics taken into account.

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RECOGNISING THE IMPACT OF STRESS ON THE BODY While stress will not necessarily change an individual’s nutritional requirements, it would impact their ability to carry out recommendations.

It is, therefore, of great importance for a nutrition coach to ensure an individual who is dealing with a high-stress load has: Outside support or strategies to help manage and potentially reduce their stress loads, and Is supported by the nutrition coach to help reach personal nutritional goals. The nutrition coach’s responsibility is to help the individual set realistic goals and make positive dietary changes that will benefit them long term.

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Long-term stress can be linked with comfort eating, leading to overeating and weight gain. The hormone released during stressful periods, known as cortisol, increases insulin levels, consequently decreasing total blood sugar levels. This drop in blood sugar levels can cause cravings for sugary foods to increase energy levels.

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PREVENTION VERSUS TREATMENT RELATED TO NUTRITION, HEALTH AND WELLBEING Nutrition can potentially reduce the risk of disease and improve quality of life. It also has the power to act as medicine and can help treat diseases. As Hippocrates once famously said, ‘let food be thy medicine, and medicine be thy food’.

A diet that is imbalanced or high in processed and unnatural foods may cause all kinds of disturbances inside the body, including but not limited to: Nutritional deficiencies Hormonal imbalances Malabsorption Digestion issues Menstrual irregularities Atherosclerotic build-up Inflammation Buildup of visceral fat Electrolyte disturbances.

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When working in nutrition, two types of clients will be seen: those looking for a cure for their disease and those looking for preventative measures to avoid obtaining any chronic diseases later in life.

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UNDERSTANDING PREVENTATIVE HEALTH Prevention relates to individuals who take the necessary steps in their diet and lifestyle to prevent disease onset.

For example, an individual with a family history of diabetes mellitus may decide to take actionable steps to prevent the development of diabetes. These actionable steps may include discussing their health and wellness with a health professional, making positive changes to their diet, learning to better manage their stress levels or simply increasing the intensity of their physical activity routine.

Prevention is a better strategy for managing health rather than relying on reversing a disease once diagnosed.

Prevention allows an individual to live a healthy and active life, with a better quality of life through ageing.

From a health professional’s perspective, preventative health is achieved by taking proactive measures to prevent the onset of chronic diseases or any ill health conditions. This can be done through health screenings, counselling, maintenance and follow-up checks to prevent future illness and treatment.

PROACTIVE MEASURES Proactive measures refer to creating or controlling a situation rather than just responding to it after it has happened.

Some may argue that taking preventative steps is more expensive; for example, individuals may claim that eating healthy costs more than eating takeaways. The individual making this decision must be aware that spending money on preventative steps, such as fresh fruit and vegetables, will decrease the likelihood of the onset of disease later. Therefore, this will reduce the money spent on future medical bills. In other words, being healthy does not need to be expensive and, in many cases, can be far cheaper than an unhealthy lifestyle, immediately and in the longer term.

The saying goes: ‘if you don’t pay for your health now, you will have to pay for it later’. In saying this, however, health does not need to be expensive. Nutrition coaches need to educate their clients on ways to make their diet healthy, enjoyable, budget-friendly and unrestrictive of the things they enjoy.

Below are just some examples of how a nutrition coach could support and encourage their clients while keeping in mind the costs of ‘being healthy’: Encourage clients to consume regular, wholesome, natural foods and explain that superfoods and supplements are not always essential.

Suggest going for a walk or run or completing their body weight exercise routine at home or in a park instead of buying a gym membership or attending fitness classes.

Encouraging clients to take time out to meditate, stroll on the beach or relax for stress management and suggesting that fancy holidays, expensive counsellors and meditation classes are not always essential.

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UNDERSTANDING CURATIVE HEALTH (OR HEALTH TREATMENT) Cure or treatment refers to individuals who already have a chronic disease or condition and are looking for remedies to reverse or manage their symptoms. Individuals often only realise that their health is in poor form when a diagnosis is made. As a result, most often, clients will be looking to reverse, decrease or manage the symptoms of their disease.

For example, an individual with metabolic syndrome may speak with a health professional to lose weight, decrease blood pressure, better manage sugar levels or improve their lipid profile.

For this particular individual, there may be many health professionals involved, including: Diabetes educator General practitioner Accredited practising dietitian Nutrition coach Personal trainer or exercise physiologist.

• • • • •

The healthcare model in most Western countries is based on a reactive, curative care model rather than a preventative care model. In a preventative health care model, money is spent on preventing (or reducing the chances of) people from becoming ill by promoting behaviours that reduce acute and chronic illness. This results in high costs to the government and the community as people allow their health to worsen in the knowledge that systems exist to manage their health conditions.

REACTIVE MEASURES Reactive measures refer to responding to a situation after it has occurred rather than preventing or controlling it.

A referral must be made to the appropriate health professional for ongoing care if an individual has a chronic disease.

Nutrition is a powerful source of medication when it comes to chronic diseases and has the potential to reverse, manage and decrease the symptoms an individual may experience. As a nutrition coach, knowing what the various chronic health conditions may be and having a basic understanding of what sort of dietary approaches can be taken is important. While often a referral to a dietitian or general practitioner (GP) will be required initially, the client can continue in the nutrition coach’s care afterwards, and thus a base knowledge is essential.

An Ounce of Preventi is Worth a Pnd of Cure - Benjaman Fraklin -

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RECOGNISING CREDIBLE SOURCES OF PRODUCT, LIFESTYLE AND SELF-CARE INFORMATION There are many avenues where a nutrition coach can gain credible information about various products, lifestyles and self-care.

Some of these sources include: Professional publications (Such as The Australian Dietary Guidelines and Nutrient Reference Values for Australia and New Zealand) Manufacturer materials Health care fact sheets Reputable health education internet sites Other Government bodies (Such as the National Health and Medical Research Council [NHMRC]) Other Peak Industry bodies (Such as Dietitians Australia [DA] and The Nutrition Society of Australia [NSA]) Not-for-profit organisations (Such as Nutrition Australia).

• • • • • • •

When obtaining information about various products, be sure to ascertain the validity of the information and ensure the information presented is not biased, misguided or misleading.

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INDUSTRY ASSOCIATION NUTRITION COUNCIL AUSTRALIA (NCA) Nutrition Council Australia (NCA) is an association that recognises the need to support the development of nutrition professionals in the health and wellness sector through nationally recognised and accredited training.

NCA has developed the nationally recognised and accredited 11046NAT – Certificate IV in Nutrition qualification (previously 10763NAT – Certificate IV in Nutrition qualification), the associated Scope of Practice and Risk Stratification Screening Tool. Vast Fitness Academy is the current authorised Registered Training Organisation responsible for delivering this qualification.

NCA provides registration for graduates of the 10763NAT and 11046NAT – Certificate IV in Nutrition who wish to practice as Nationally Recognised Nutritionists.

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OTHER PEAK INDUSTRY BODIES DIETITIANS AUSTRALIA (DA) Dietitians Australia is the peak body (not a governing body) for accredited practising dietitians (APDs) that is committed to supporting its members and advocating for the profession of a dietitian. DA and its members both research and deliver evidence-based information on food and nutrition locally, nationally and internationally. Their advice and support are solid and dependable, based on the latest science and tailored to each person.

Registration with DA is not mandatory unless the dietitian requires the title of an accredited practising dietitian. It is also important to remember that DA does not accredit or develop any VET or Higher Education courses.

To become a member of DA and use the accredited practising dietitian (APD) title, an individual first needs to become a dietitian. This must be achieved through one of the following requirements: An approved undergraduate degree in nutrition and dietetics from an accredited course An approved Bachelor of Science Degree (or equivalent qualification) followed by a postgraduate degree in nutrition and dietetics from an accredited course Completion of the Dietetics Skills Recognition exam for overseas-trained dietitians.

• • •

Membership fees are also required to gain the status of an APD. For more information, CLICK HERE. *Dietitians provide expert nutrition advice for people of all ages and prescribe dietary treatments for many conditions such as diabetes mellitus, food allergies, cancers, gastrointestinal diseases, and overweight and obesity.

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NUTRITION SOCIETY OF AUSTRALIA (NSA) The NSA Register of Nutritionists recognises nutritionists with designated qualifications, who abide by the highest standards of professional conduct and the NSA Code of Ethics, and who are committed to ongoing training and professional development.(101) NSA registration is a voluntary scheme and is not a licence to work. It is also important to remember that NSA does not accredit or develop any VET or Higher Education courses. *Nutritionists may design, coordinate, implement and evaluate a range of population health interventions to improve the wellbeing of individuals, communities and the population as a whole through better food and nutrition.(139)

THE WORLD HEALTH ORGANISATION (WHO) The World Health Organization (WHO) is a specialized agency of the United Nations concerned with international public health.

WHO staff are united in a shared commitment to achieving better health for everyone, everywhere.

The WHO’s guiding principle is based on the fact that “all individuals should enjoy the highest standard of health, regardless of race, religion, political belief, economic or social condition”... This has “guided WHO’s work for the past 70 years since it was first set up as the lead agency for international health in the new United Nations system”.(140) In addition to the above, WHO has brought together the world’s top health professionals and experts to produce international reference materials and make recommendations to bring better health to people worldwide.

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GOVERNMENT ORGANISATIONS Various government organisations provide research across a full spectrum of medical and health research, public health, and disease and nutrition. Two examples of government/non-for-profit organisations are outlined below:

NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL (NHMRC) The National Health and Medical Research Council (NHMRC) is an Australian Government Organisation. It is Australia’s leading expert body that promotes the development and maintenance of public and individual health standards.(141) NHMRC brings together, within a single national organisation, the functions of research funding and advice development. One of its strengths is that it draws upon the resources of all components of the health system, including governments, medical practitioners, nurses and allied health professionals, researchers, teaching and research institutions, public and private program managers, service administrators, community health organisations, social health researchers and consumers.(141)

NUTRITIONAL EDUCATIONAL MATERIALS ONLINE (NEMO) Another example would be Nutritional Educational Materials Online (NEMO). While most commonly utilised by nutrition coaches, nutritionists and dietitians, all members of the public can access this government website which has an abundance of nutrition-based educational resources to assist health professionals in educating clients. As with all organisations, ensure the intentions of the cause are pure, ascertain that there is no bias in outside funding and always utilise evidenced-based publications to cross-check statements if required.

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NOT-FOR-PROFIT ORGANISATIONS Various not-for-profit organisations aim to increase awareness of various diseases, provide education about chronic diseases and raise funds for research to better understand how the disease works. Two examples are listed below:

BREAST CANCER FOUNDATION Most individuals are familiar with the work of the Breast Cancer Foundation, their pink bow and their efforts in raising money through high teas to support and fund research. The Breast Cancer Foundation has a website too, which provides various educational resources for the public.

NUTRITION AUSTRALIA Nutrition Australia is a non-government, non-profit, community-based organisation with offices throughout Australia.

Nutrition Australia is an independent member organisation that aims to promote the health and wellbeing of all Australians. Members of Nutrition Australia include the general public and some of Australia’s most influential food and nutrition experts, together making Nutrition Australia a key nutrition voice in Australia today.(142)

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PROFESSIONAL PUBLICATIONS NUTRIENT REFERENCE VALUES The Nutrient Reference Values (NRVs) website is a government-run nutritional resource available to the public. The NRVs are a set of recommendations for nutritional intake based on currently available scientific knowledge. This website assists health professionals and the public to calculate and determine individual requirements for energy, macronutrients, vitamins, minerals and trace elements. It also provides an abundance of information about the role, uses, interactions, toxicity and deficiency states of nutrients. *This resource is created for the general public; however, it is also a reliable resource for nutrition coaches, nutritionists and dietitians to effectively and safely support the individual nutritional needs of their clients.

AUSTRALIAN DIETARY GUIDELINES The Australian Dietary Guidelines (ADG) (Eat for Health) are government-approved guides that aim to assist individuals in choosing foods that will benefit their overall health and wellbeing. The Australian Dietary Guidelines contain information about the types and amounts of foods, food groups and dietary patterns that aim to promote health and wellbeing; reduce the risk of diet-related conditions, such as high cholesterol, high blood pressure and obesity; and reduce the risk of chronic diseases such as type 2 diabetes, cardiovascular disease and some types of cancers.(40) *This resource is created for the general public; however, it is also used for personal trainers and fitness professionals as a resource for them to stay within their scope of practice. Note: fitness professionals and personal trainers cannot provide any nutrition-related advice if the information is not already provided within this document. *The knowledge obtained by a nutrition coach who has completed the Nationally Accredited 10763NAT and 11046NAT Certificate IV in Nutrition goes beyond the level of a personal trainer or fitness professional.

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THE AUSTRALIAN GUIDE TO HEALTHY EATING The Australian Guide to Healthy Eating is a food selection guide that visually represents the proportion of the five food groups recommended for daily consumption.(119) As outlined earlier, the five food groups refer to vegetables, fruits, grains, meat and dairy. The visual guide helps to determine how much of each of the five food groups is required for optimal health. For example, it is easy to identify that approximately 33% of the diet should be made up of vegetables.

This guide was updated in 2013 and therefore does not consider the research and updates which have come to the surface since. As it can take decades for guidelines to be updated, with a continuous emergence of new nutritional information, it is encouraged that high-quality, evidenced-based information obtained from reputable sources is utilised in addition to the guidelines.

The guidelines are not intended to fit every person but rather act as a guide for the general healthy population.

Therefore, it may be found that certain individuals may benefit from less of one food group and more of another food group.

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ONLINE INDUSTRY AND PROFESSIONAL PUBLICATIONS Industry and professional publications are the best source of information and refer to scientific journals and research articles. Industry and professional publications can be found online through various portals such as Google Scholar or PubMed. As it can take decades for guidelines to be updated, with a continuous emergence of new information, evidence-based information from reputable sources is encouraged to be well analysed and utilised as appropriate.

Identify the authors of the articles, their qualifications, the level of evidence and who funded the research.

REPUTABLE HEALTH EDUCATION INTERNET SITES Reputable health education sites refer to online information from credible sources such as government and not-forprofit organisations. Other sources of generally credible information are from health professionals discussing topics within their industry; however, care is to be taken to ensure adequate referencing and proof for their claims. As websites are often not maintained or updated, it is encouraged that self-research using industry and professional publications is utilised in addition to these online sources.

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MANUFACTURER PRODUCT SUPPORT MATERIALS Large companies will invest a lot of money in marketing their products and providing information about their products to consumers. While this is extremely beneficial to consumers, it is important to remember that the company is essentially trying to sell its product and therefore is more likely to sell its positive attributes and potentially gloss over the negative attributes.

PRODUCT LEAFLETS, BROCHURES AND BOOKLETS Product leaflets, brochures and booklets all prove extremely useful when prescribing a particular product, food or dietary protocol; however, care must be taken to ensure that the information provided is not misguided. As the leaflet has been made with the product’s sale in mind, it is safe to assume that the information will attempt to steer the reader into purchasing the product.

All claims in these sorts of product materials require some form of reference. If the reference is not available on the material, it is encouraged that the nutrition coach calls the company and asks for their list of references. This will hold the company accountable and ensure that the nutrition coach obtains the best quality information to use with their clients.

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MEDICINES DATABASE It is helpful to be aware of and use a medicines database. A medicines database is essentially a database with an extensive medication list, helping the user to identify basic information about the medication, such as active ingredients, indications, contraindications, doses and potential side effects.

CONSUMER MEDICINES INFORMATION (CMI) The Consumer Medicines Information (CMI) is a leaflet that contains information on the safe and effective use of a prescription or specified over-the-counter medicine. A CMI document is written by the pharmaceutical company responsible for the medicine. These documents are important because they provide information to improve health outcomes.

A CMI includes:(143) Name of the medicine Names of the active and inactive ingredients Dosage of the medicine What is the medicine used for, and how it works Warnings and precautions, such as when the medicine should not be taken Interactions the medicine might have with food or other medicines How to use the medicine properly Side effects What to do in the case of an overdose How to store the medicine properly Name and address of the sponsor Date the CMI was last updated.

• • • • • • • • • • • •

THERAPEUTIC GOODS ADMINISTRATION CLICK HERE to view the website.

HEALTH CARE FACT SHEETS Much like product leaflets, brochures and booklets, health care fact sheets can prove extremely beneficial as a quick guide to various products; however, care must be given to ensure it is a reliable source of information. Identify who wrote the fact sheet and what claims are being made, and check the reference list.

PHARMACY MANUALS Pharmacy manuals are guidance documents produced by pharmaceutical manufacturers and governmental or nongovernmental organisations. They are designed to provide healthcare professionals, such as pharmacy assistants, chemists, nurses and doctors, with information on the safe storage, identification, handling, dosing and dispensing of pharmaceutical-grade, controlled substances.

While pharmacy manuals may be available on the internet and provide accurate information on certain aspects of pharmaceutical substances, nutrition coaches should not use them to provide clients with advice. Providing advice on medications is outside the scope of practice for nutrition coaches, and clients should be referred to their treating GP for guidance.

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GLOSSARY TERM

DEFINITION

ANABOLISM/ ANABOLIC STATE

Refers to the synthesis (building up) of complex molecules or substances from simple ones. An aspect of human metabolism and the opposite of catabolism.

ANTIBODIES

A specific protein produced by plasma in the blood and used by the immune system to neutralise pathogens, bacteria, viruses etc., which are recognised as harmful and foreign by the body.

ANTIOXIDANTS

A substance that aims to protect the body from potentially damaging oxidation can come from consuming free radicals.

ATHEROSCLEROSIS

Refers to the deposition of fatty material in the inner walls of arteries, causing an increased risk of cardiovascular disease, heart attacks and stroke.

BIOCHEMICAL

Refers to the chemical structures and processes that take place within an organism.

BLOOD GLUCOSE

Refers to the amount of glucose within the bloodstream. This serves as the body’s main source of energy.

CARDIOPROTECTIVE

Simply means to protect the heart from disease.

CATABOLISM/ CATABOLIC STATE

Refers to the breakdown of large particles into smaller particles.

CHOLESTEROL

A fat type found in, and essential for, all animal cells. The body makes it, so it does not need to be consumed in the diet.

COGNITIVE FUNCTION

Or brain function simply refers to the level of efficiency, productivity, development, learning and understanding; relating to mental processes, memory, perception and reasoning etc.

DEFICIENCY

When insufficient or inadequate amounts of a specific nutrient occur, the body begins showing symptoms of illness.

DEGRADATION

Refers to the breakdown of existing substances.

DETOXIFICATION

The process of eliminating toxins from the body. The liver and kidneys do this naturally; however, some Western diets also aim to do this.

DISACCHARIDES

A type of sugar that is formed by joining two monosaccharide molecules with specific types of linkages.

ELECTROLYTE

Are minerals that enter the plasma of the blood. They are essential for the

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ELECTROLYTE

Are minerals that enter the plasma of the blood. They are essential for the regulation of the body’s fluids.

ENDOGENOUS

Originating internally; internal cause; internal source.

ENERGY-DENSE

Refers to foods that contain more energy than they do nutrients. For example, high carbohydrate foods such as chocolate bars etc. They provide a lot of energy but barely any nutrients.

ENZYMES

These biological molecules either speed up the rate of chemical reactions or are used to bring about certain chemical reactions.

ESSENTIAL

Refers to the need for a nutrient to be consumed through the diet, as it cannot be made in the body.

EXOGENOUS

Originating externally; external cause; external source.

EXTRACELLULAR FLUID

Simply refers to all fluid that is outside of human cells. Plasma and interstitial fluid make up the majority of extracellular fluid.

EXOCRINE GLANDS

Are all glands which secrete substances onto the surface of epithelial tissue.

FERMENTATION

Is the breakdown of sugars and other molecules in the absence of oxygen through the use of bacteria, yeasts and other microorganisms.

FREE RADICALS

Free radicals occur when an oxygen molecule splits into individual atoms and additional electrons. Electrons do not like being alone, so they search the body to find a pair, causing damage to DNA, cells and protein in the process.

GLUCONEOGENESIS

If insufficient glycogen stores are available, it produces new glucose by converting stored fats or amino acids to supply the brain with the glucose it requires.

GLYCEMIC INDEX/ GLYCEMIC LOAD

Is a ranking system that categorises carbohydrates based on their effects on blood sugar. Glycemic load looks at the food before noting its effect on blood sugar.

GLYCOLYSIS

The systematic breakdown of glucose by specific enzymes creates energy in the form of ATP.

HAEMOGLOBIN

Is the protein in red blood cells which contains iron and is responsible for transporting oxygen in the blood.

HAEMATOLOGICAL

Haematology refers to the study of blood - its processes, regulations, diseases, etc.

HOMEOSTASIS

Is the internal regulation of the physiological characteristics and properties of the body to maintain the optimal internal environment.

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HYDROPONICALLY

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HYDROGENATION

The man-made process adds hydrogens to unsaturated fats, turning them into more stable saturated fats. This causes inflammation in the body.

HYDROPONICALLY

Is the process of growing plants in the absence of using soil.

IMMUNITY

The body’s ability to fight off infection through the use of white blood cells and antibodies.

INFLAMMATION

The swelling or reddening of a certain area of the body that produces heat and is caused by infection.

INSOLUBLE

The substance is unable to dissolve in water.

INSULIN

A hormone produced by the pancreas that regulates the amount of glucose in the bloodstream.

IONS

Atoms with an electric charge due to the loss or gain of electrons (which hold a negative charge).

LIPOGENESIS

The process the body uses to convert glucose and other substances to fatty acids or triglycerides.

MACRONUTRIENTS

Refers to carbohydrates, fats, and proteins, which need to be consumed in larger amounts than micronutrients (vitamins and minerals).

MALABSORPTION

Is the abnormal or insufficient absorption of nutrients by the small intestine, which can result in nutrient deficiencies and associated symptoms.

MALNOURISHED

As a result of malabsorption, the wrong diet or not enough food, the body then enters a state of insufficient nutrition.

METABOLISM/ METABOLIC PROCESSES

All the chemical processes undertaken by the body to maintain life are included.

It can involve breaking large particles into smaller ones or synthesising large particles from smaller ones.

MICRONUTRIENTS

The nutrients the body needs in smaller amounts, including vitamins and minerals.

MONOSACCHARIDES

The simplest form of sugar/carbohydrates - includes only one molecule of glucose, fructose or galactose. The remainder of these three molecules forms the remainder of all carbohydrates by linking these single molecules.

NEUROMUSCULAR

Refers to the joining of the nervous and muscular systems. For example, where a nerve connects to a muscle to provide stimulation, that attachment is called the neuromuscular junction.

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OEDEMA

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NEURON NUTRIENT-DENSE OEDEMA

OLIGOSACCHARIDES

The name is given to cells in the nervous system that transmit nerve impulses, allowing the sending of various messages.

Refers to foods that provide more nutrients than they do energy.

A more common term is fluid retention. Oedema is the swelling of body areas due to excess water/fluid.

Is a form of complex carbohydrates which contains between 3 and 10 monosaccharides (single sugar molecules) linked together.

ORGANISM

An individual plant or animal; a living thing; a life form.

OSMOLARITY

Takes into consideration the solutes/particles within a fluid to determine its concentration.

PATHOLOGY

The study of disease. Can also be used to describe the medical measurements and procedures which collect information from the body to determine the state of disease.

PERISTALSIS

The name given to the type of contracting movement found in the oesophagus and the intestine.

PHYTOCHEMICALS

Plant-based compounds that have disease-protecting properties.

POLYSACCHARIDES

Is a form of complex carbohydrates with more than 10 monosaccharides (single sugar molecules) linked together.

RECEPTORS

A specialised area on a cell that receives neurotransmitters, hormones, or other substances as a binding site to facilitate communication.

SATIATION/SATIETY

The feeling of being ‘full’ after consuming certain foods.

SEDENTARY

Remaining inactive or sitting for extended periods; participating in very little physical activity.

SOLUBLE

Substance can be dissolved in any or a specific solution.

SYNERGY/ SYNERGISTIC SYNTHESIS THERMOREGULATION TRACE TRIGLYCERIDES

The ability for various systems, organs, processes, etc., to work together to achieve a common goal.

To produce, create, make.

An aspect of homeostasis, thermoregulation refers to the internal regulation of the body’s temperature.

Small amounts.

A type of fat found in foods - particularly natural fats and oils.

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