NAT11046006 Student Resource Guide V2 (12-10-23)

CERTIFICATE IV IN NUTRITION

NAT11046006: ADVISE CUSTOMERS ON THE USE OF NUTRITIONAL SUPPLEMENTS AND ERGOGENIC AIDS 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 | NAT11046006: ADVISE CUSTOMERS ON THE USE OF NUTRITIONAL SUPPLEMENTS AND ERGOGENIC AIDS | VERSION 1 - 18.01.2024

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TABLE OF CONTENTS TABLE OF CONTENTS

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UNIT INTRODUCTION

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UNDERSTANDING ERGOGENIC AIDS AND NUTRITIONAL SUPPLEMENTATION

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UNDERSTANDING AND DEFINING ERGOGENIC AIDS

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DEFINING AND IDENTIFYING THE CONCEPT OF NUTRITIONAL SUPPLEMENTS

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THE REGULATION OF NUTRITIONAL SUPPLEMENTATION IN AUSTRALIA

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RECOGNISING THE USE OF SUPPLEMENTATION

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RECOGNISING THE VARIOUS BENEFITS OF SUPPLEMENTATION

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IDENTIFYING THE VARIOUS CATEGORIES OF NUTRITIONAL SUPPLEMENTS ON THE MARKET

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IDENTIFYING COMMON TYPES OF VITAMINS AND MINERALS ON THE MARKET

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IDENTIFYING COMMON TYPES OF SPECIALITY SUPPLEMENTS ON THE MARKET

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IDENTIFYING COMMON TYPES OF HERBAL AND BOTANICAL SUPPLEMENTS ON THE MARKET

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IDENTIFYING COMMON TYPES OF SPORTS AND WEIGHT MANAGEMENT SUPPLEMENTS ON THE MARKET 26 RECOGNISING THE FUNDAMENTALS OF GOOD NUTRITION

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UNDERSTANDING THE IMPORTANCE OF ESSENTIAL NUTRIENTS

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SUPPLEMENTING WITH ESSENTIAL NUTRIENTS

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

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IDENTIFYING CONCERNS AND CONDITIONS THAT FALL WITHIN AND OUTSIDE OF A NUTRITION COACH’S SCOPE OF PRACTICE 51 UNDERSTANDING LIFESTYLE FACTORS THAT INFLUENCE BODY COMPOSITION, NUTRITIONAL GOALS, AGEING AND SUPPLEMENTATION NEEDS 52 IDENTIFYING LIFESTYLE FACTORS THAT CAN INFLUENCE A CLIENT’S NEED FOR NUTRITIONAL SUPPLEMENTATION

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UNDERSTANDING THE IMPORTANCE OF ADEQUATE NUTRIENT INTAKE IN SUPPORT OF THE AGEING PROCESS 60

RECOGNISING INDUSTRY TRENDS, MYTHS AND MISCONCEPTIONS RELATING TO SUPPLEMENTATION

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IDENTIFYING AND EVALUATING THE QUALITY OF PRODUCTS ON THE MARKET AGAINST HYPE

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UNDERSTANDING HOW TO IDENTIFY QUALITY INGREDIENTS AND PRODUCTS ON THE MARKET

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RECOGNISING MISLEADING MARKETING CLAIMS

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THE MYTH OF MEAL REPLACEMENT PROGRAMS AND COMMON TRENDS

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RECOGNISING DANGEROUS, BANNED AND ILLEGAL SUBSTANCES AND THE ROLE OF A NUTRITION COACH

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UNDERSTANDING THE BIOAVAILABILITY OF MICRONUTRIENTS IN FOODS AND THE RELEVANCE OF SUPPLEMENTATION

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UNDERSTANDING VITAMIN AND MINERAL ABSORPTION

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UNDERSTANDING VITAMIN AND MINERAL WASTAGE

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RECOGNISING VITAMIN AND MINERAL INTERACTIONS WITHIN THE BODY

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KNOWLEDGE OF TOXICITY AND IMPLICATIONS OF EXCESSIVE VITAMIN AND MINERAL INTAKE

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UNDERSTANDING FOOD FORTIFICATION WITH VITAMINS AND MINERALS

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KNOWLEDGE OF DRUG AND MEDICATION INTERACTIONS

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RECOGNISING INDICATORS OF WEIGHT-RELATED CONDITIONS

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BODY MASS INDEX

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WAIST CIRCUMFERENCE MEASUREMENT

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WAIST TO HIP RATIO (WHR)

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UNDERSTANDING AND DESIGNING SUPPLEMENT PROTOCOLS FOR HEALTHY CLIENTS

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DESIGNING SUPPLEMENT PROTOCOLS: CASE STUDIES

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KNOWLEDGE OF SCOPE OF PRACTICE FOR SUPPLYING DIET, NUTRITION AND WEIGHT MANAGEMENT SUPPLEMENTS SCOPE OF PRACTICE AS A NUTRITION COACH

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INDICATIONS FOR RECOMMENDING SUPPLEMENTS

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IDENTIFYING CONTRAINDICATIONS FOR RECOMMENDING SUPPLEMENTS TO CLIENTS

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DUTY OF CARE FOR NUTRITION COACHES

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REPORTING IDENTIFIED PROBLEMS AS A NUTRITION COACH

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RECOGNISING CREDIBLE SOURCES AND FORMATS OF PRODUCT INFORMATION

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INDUSTRY ASSOCIATIONS

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OTHER PEAK INDUSTRY BODIES

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GOVERNMENT ORGANISATIONS

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PROFESSIONAL PUBLICATIONS

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ONLINE INDUSTRY AND PROFESSIONAL PUBLICATIONS

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MANUFACTURER PRODUCT SUPPORT MATERIALS

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MAKING INFORMED DECISIONS AND EVALUATING INFORMATION

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GLOSSARY

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REFERENCES

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UNIT INTRODUCTION Welcome to the unit NAT11046006 - Advise customers on the use of nutritional supplements and ergogenic aids. This unit describes the performance outcomes, skills and knowledge required by nutrition coaches to advise clients on the use of nutritional supplements and ergogenic aids for weight management, nutritional support or energy level management within their scope of practice. It also requires the ability to determine whether or not a supplement or ergogenic aid is safe and useful to a client’s condition and goals.

This unit covers all aspects of supplementation and begins by explaining the difference between the terms ‘nutritional supplementation’ and ‘ergogenic aids to provide nutrition coaches with a clear understanding from the very beginning.

This unit then outlines the regulation of nutritional supplementation within Australia, the uses and benefits of supplementation, when supplementation is necessary, and the various types of nutritional supplements on the market.

Once the foundation of this concept is laid, this unit teaches nutrition coaches to identify common diet, nutrition and weight-related conditions, as well as other lifestyle factors, which can influence nutritional goals and could result in a client seeking nutritional supplementation. However, in order to provide safe and evidence-based recommendations, the nutrition coach must first revisit knowledge of essential nutrients and identify the various industry trends, myths and misconceptions relating to supplementation, and determine reliable sources of information.

This unit then educates nutrition coaches on when to incorporate supplementation and how to do so appropriately.

Nutrition coaches will gain the skills and knowledge to identify the bioavailability of micronutrients in food sources, in order to determine the need and appropriate use of nutritional supplements, in situations where the diet is nutritionally inadequate.

In addition, nutrition coaches will learn about the interactions of various drugs/medications with supplement prescriptions and other indications or contraindications. This knowledge is fundamental in providing safe recommendations to clients who may already have existing health conditions, or are taking certain medications.

This unit is applicable to health coaches and advisors, health and fitness professionals, and customer service staff working within supplement stores and health food retailers. These individuals work independently, without supervision from pharmacists or medical professionals; however, they work in partnership with allied health or medical professionals to refer clients who are outside their scope of practice.

This unit does not provide nutrition coaches with the required skills or knowledge to work with: Clients suffering from chronic health conditions Clients 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.

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Suppose a nutrition coach is presented with any of the aforementioned population groups, that fall outside of their scope of practice, they are required to refer on and work collaboratively with allied health or medical professionals. It will ensure that the client and the nutrition coach are safeguarded if any issues arise.

This unit will allow a nutrition coach to: Research and evaluate information relating to nutrition-related conditions and products Identify the client’s needs and suitability for nutritional supplementation Provide nutritional products and lifestyle information to the client.

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UNDERSTANDING ERGOGENIC AIDS AND NUTRITIONAL SUPPLEMENTATION UNDERSTANDING AND DEFINING ERGOGENIC AIDS Ergogenic aids can be broadly defined as ‘a technique or substance used for the purpose of enhancing performance.(1) Ergogenic aids can refer to any training technique, physiological technique, mechanical device or substance (nutritional or pharmacological) used to enhance performance.(2) As a nutrition coach, it is essential to understand exactly what ergogenic aids are, their indications and contraindications for use, and both harmful and beneficial interactions with other supplements/medications. This knowledge will assist nutrition coaches in providing accurate, professional and beneficial advice to a wide range of clients.

Ergogenic aids have been utilised in the professional sporting industry for many decades; however, this is not the only industry that benefits from them. While many ergogenic aids are safe, some have harmful side effects, and some have been banned in professional sports.(3) Ergogenic aids can be broken down into the following categories: Mechanical Physiological Mental.

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CATEGORY MECHANICAL AIDS

PHYSIOLOGICAL AIDS

DESCRIPTION Clothing, footwear and sporting equipment that reduce friction, improve aerodynamics and are made of better-quality materials for a particular sport. For example, cyclists often use lycra clothing and lightweight bikes made of carbon fibre to enhance their performance.

Substances that improve the circulation, efficiency and effectiveness of the human body on a physiological level. Examples may include: Bicarbonates Carbohydrates Phosphates Nutritional supplements Pharmacological aids.

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Physiological aids can be ingested or applied topically, depending on the chosen aid.

MENTAL AIDS

Support from professional and personal relationships to enhance mental health and wellbeing. Examples may include counselling, psychological support and personal support (family and friends).

For the purpose of this unit, the primary type of ergogenic aids most applicable to a nutrition coach are physiological ergogenic aids, more specifically, nutritional supplementation. As such, nutritional supplementation will be discussed in more detail throughout this unit.

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DEFINING AND IDENTIFYING THE CONCEPT OF NUTRITIONAL SUPPLEMENTS SUPPLEMENT The term ‘supplement’ refers to adding one thing to another to benefit it or make it more complete.

Nutritional supplementation, therefore, refers to adding macro or micronutrients to the diet to better reach specific dietary guidelines and recommendations.

Nutritional supplements (also known as dietary supplements) are a type of ergogenic aid which are intended to supplement the diet; however, they are not considered a complete food source and should not replace a balanced and adequate diet.

More specifically, nutritional supplements are products that: Contain one or more dietary ingredient(s) such as vitamins, minerals, herbs and amino acids Are intended to be taken orally Are labelled as a nutritional supplement on the packaging.

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There are many different definitions of the term supplement. The table below outlines how the various governing bodies and reputable organisations within the health and fitness industry define the term supplement.

Nutritional supplements come in many forms, including capsules, powders, tablets, energy bars and liquids. These products are generally available in chemists, supermarkets or supplement stores and, in more recent years, have become available on the internet.

Nutritional supplements are generally labelled as ‘dietary supplements’ and are not solely specific to enhancing sporting performance in athletes. An increasing number of individuals are utilising nutritional supplementation for general health and wellness benefits.

In Australia, nutritional supplements can be found in supermarkets, pharmacies, health food shops and supplement stores and include (but are not limited to): Vitamin and mineral products Protein powders Herbal or botanical products Amino acid products Enzyme supplements.

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CATEGORY

DESCRIPTION

US FOOD AND DRUG ADMINISTRATION (FDA)

The US Food and Drug Administration (FDA) defines dietary supplements as products taken by mouth that contain a “dietary ingredient”. Dietary ingredients include vitamins, minerals, amino acids, herbs or botanicals, and other substances that can be used to supplement the diet’.(4)

DIETITIANS AUSTRALIA (DA)

SDietitians Australia (DA) defines nutritional supplements as products that contain an ingredient or a combination of ingredients, typically in higher concentrations than found naturally in dietary sources.(5) Nutritional supplements may be used for sports-related nutrition (e.g. whey protein, caffeine and creatinine) or general health and wellbeing (e.g. vitamin D, iron or a multivitamin), intended to add additional nutritional value to the diet.

DIETARY SUPPLEMENT HEALTH AND EDUCATION ACT (DSHEA)

According to the Dietary Supplement Health and Education Act (DSHEA), a dietary supplement (other than tobacco) is a product which:(6)(7) Is intended to supplement the diet Contains one or more dietary ingredients (including vitamins, minerals, herbs or other botanicals, amino acids, and certain other substances) or their constituents Is intended to be taken orally, in forms such as a tablet, capsule, powder, soft gel, gel capsule, or liquid Is labelled as a dietary supplement.

INTERNATIONAL JOURNAL OF SPORTS NUTRITION AND EXERCISE METABOLISM

The Journal of Sports Nutrition and Exercise Metabolism defines a dietary supplement as ‘a food, food component, nutrient, or non-food compound that is purposefully ingested in addition to the habitually-consumed diet, with the aim of achieving specific health and/or performance benefits’.

In addition to this, they recognise that dietary supplements come in many forms, including:(8) Functional foods which are enriched with increased nutrients or elements outside their distinctive nutrient composition (for example, vitamin- and mineral-fortified foods).

Formulated foods and sports foods for general nutrition support, such as products that provide energy and/or nutrients in a more suitable/appropriate form as opposed to normal forms of food (e.g. liquid meal replacements) or for specific use around exercise (e.g. sports drinks, gels, protein bars).

Other components of foods, herbs or single nutrients and products that are provided in forms that are concentrated or isolated.

Products containing multiple ingredients with various blends/mixtures of other products target similar outcomes.

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Products containing ingredients such as herbs, vitamins, minerals, nutritional supplements, homeopathic and certain aromatherapy preparations are referred to as ‘complementary medicines’ in Australia and are regulated as medicines under the Therapeutic Goods Act 1989 (the Act).(9)

THERAPEUTIC GOODS ADMINISTRATION (TGA)

A ‘complementary medicine’ is defined in the Therapeutic Goods Regulations (1990) as a therapeutic good consisting principally of one or more designated active ingredient(s) (listed below), each of which has a clearly established identity and traditional use:(9) 1. An amino acid 2. Charcoal 3. A choline salt 4. An essential oil 5. Plant or herbal material (or a synthetically produced substitute), including plant fibres, enzymes, algae, fungi, cellulose and derivatives of cellulose and chlorophyll 6. A homeopathic preparation 7. A microorganism, whole or extracted (except a vaccine) 8. A mineral, including mineral salts and naturally occurring minerals 9. A mucopolysaccharide 10.Non-human animal material (or a synthetically produced substitute) including dried material, bone and cartilage, fats and oils and other extracts or concentrates 11. A lipid, including essential fatty acids or phospholipids 12. A substance produced by or obtained from bees, including royal jelly, bee pollen and propolis 13. A sugar, polysaccharide or carbohydrate 14.A vitamin or provitamin.

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THE REGULATION OF NUTRITIONAL SUPPLEMENTATION IN AUSTRALIA In Australia, all high-risk medicines and some lower-risk supplements designed for human use must be registered with the Therapeutic Goods Administration (TGA) under the Therapeutic Goods Act (1989).

The TGA regulates the supply, import/export, manufacturing and advertising of therapeutic goods, including: Medicines Vitamins Minerals Herbal and traditional medicines.

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Nutrition coaches need to be aware of the TGA and its regulation, especially since many products do not require registration with the TGA, leaving the public vulnerable to purchasing and using products that may not have been scrutinised to perform as claimed.(9)

THE ROLE OF THE TGA - INFORMATION FOR CONSUMERS CLICK HERE to watch the video.

ADDITIONAL LINKS

home page • TGA TGA information • Aboutsafety the TGA • TGA - Information for industry •

TGA

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HOW COMPLEMENTARY MEDICINES ARE REGULATED IN AUSTRALIA Australia uses a risk-based approach to regulating all medicines, including complementary medicines. The approach uses a two-tiered system of regulation: 1. Lower-risk medicines can be listed on the Australian Register of Therapeutic Goods (ARTG).

2. Higher-risk medicines must be registered on the ARTG.(10) Listed products carry a lower risk than registered medicines. Examples of listed products include lower risk medicines such as: Vitamins Minerals Sunscreens Herbal, complementary medicines.

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Listed products can be listed on the ARTG provided that: They meet certain conditions and claims made about a product’s effectiveness Labelling and packaging standards have been met The product contains only approved ingredients The manufacturer has complied with Good Manufacturing Practice (GMP) standards.

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Unlike registered medicines, the TGA does not individually evaluate lower-risk ‘listed’ medicines before they are released to the public. As such, many products are available to the public which have not been scrutinised and may not achieve the claims made by their manufacturer.

If these products fail to achieve their claims, health professionals should report them to the TGA for further investigation.

Products, including some homeopathic medicines, are exempt from the requirement to be listed on the ARTG. The Australian Regulatory Guidelines for Complementary Medicines (ARGCM) provide further detail on complementary medicine regulations.

ADVERTISING OF COMPLEMENTARY MEDICINES Therapeutic goods in Australia are subject to the advertising requirements of the Therapeutic Goods Advertising Code (TGAC) and the Trade Practices Act 1975, which requires marketing and advertising to be conducted in a manner that: Promotes quality use of a product Is socially responsible Does not mislead or deceive the consumer.(11)

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Complaints about the advertising of a therapeutic good can be made to the TGA directly and confidentially, to protect consumers.

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TGA POST-MARKET REGULATORY ACTIVITY OF COMPLEMENTARY MEDICINES The TGA undertakes a number of regulatory activities once products have been released to the market, including: Product monitoring Risk management reviews Manufacturing inspections Listed complementary medicine compliance reviews Product recalls.

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One of the roles the TGA undertakes includes monitoring the safety, quality and efficacy of Registered, Listed, and Therapeutic Goods once released onto the commercial market. The TGA uses a regulatory framework to ensure products comply with risk management requirements. The TGA’s ‘Manufacturing Quality Branch’ inspects product manufacturers for compliance with good manufacturing practices on an ongoing basis.(12) In addition to the above, the TGA also reviews the compliance of listed complementary medicine to ensure that listed products align with the regulations. The TGA is also involved in the recall of therapeutic goods for reasons related to quality (for example, packaging or labelling errors), efficacy or safety (for example, contamination issues or unexpected side effects).

ADVERSE EVENTS RELATED TO COMPLEMENTARY MEDICINES As part of its ongoing regulation of ‘Listed’, ‘Registered’, and ‘Therapeutic Goods’, the TGA operates a ‘pharmacovigilance program’ whereby it investigates adverse events related to complementary medicines, as reported by consumers, health professionals, the pharmaceutical industry stakeholders or international medicine regulators, or by medical and scientific experts on TGA advisory committees. (13)

Adverse events should be reported to a suitably qualified medical professional such as a doctor, especially if medical treatment is required. The adverse event should then be reported to the TGA for further investigation.

PURCHASING COMPLEMENTARY MEDICINES OVER THE INTERNET The TGA does not regulate products available on international websites; therefore, the protection of the TGA is not applied. The TGA advises consumers not to purchase medicines, nutritional supplements or herbal preparations over the internet unless consumers know exactly what is in the product. Consumers also need to be aware of the legal requirements of importing therapeutic goods, as some products or their ingredients may be illegal in Australia.

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RECOGNISING THE USE OF SUPPLEMENTATION According to the Australian Bureau of Statistics, 29% of Australians take at least one type of supplement daily.(14)

The use of supplementation is increasing in popularity with each passing year, as an increasing number of individuals become familiar and comfortable with implementing it into their everyday lives. However, when supplementation was first introduced to the public, it was advertised and promoted predominantly for the use of:(15) Deficiency diseases Periods of stress associated with pregnancy Lactation Convalescence (recovery from illness or medical treatment) Bone and dentition promotion General growth in children Loss of appetite A possible application in tuberculosis Other wasting diseases Infantile diarrhoea Other therapeutic applications.

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As research has progressed and an appreciation for the importance of adequate nutrition has been gained, the use of supplementation has increased within the general population for both treatment and preventative health measures.

Many clients assume that nutritional supplements are only utilised to improve athletic performance.

However, they can also be used for various reasons, mostly linked to general health and wellbeing.

Some clients utilise nutritional supplements to compensate for the lack of quality diet, medical conditions, or eating patterns/habits which limit the intake of essential nutrients. It is also common for clients to utilise supplements to boost energy levels or improve sleep quality. In addition, specialised dietary supplements are used by postmenopausal women to help counteract a sudden drop in oestrogen levels.

Supplementation should never replace a healthy diet. Supplements should only ever be used to supplement a diet. Supplementation should be considered if the client cannot obtain all essential vitamins, minerals, fatty acids and amino acids. Nutrition coaches are required to encourage a nutritionally complete diet for all clients before supplementation is considered and recommended.

Supplementation should only be a short-term solution, and supplementation should be ceased as soon as the client can meet, absorb, and utilise all nutritional requirements through food alone.

As a nutrition coach, it is essential to be aware that clients can buy supplements over the counter at a local pharmacy, supplement stores or online, which they can self-administer or utilise at their discretion, without professional advice.

Hence, nutrition coaches need to become familiar with readily-available and common types of supplements available on the market.

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RECOGNISING THE VARIOUS BENEFITS OF SUPPLEMENTATION The human body requires relatively small amounts of vitamins and minerals daily, and it is reasonable to achieve this intake through diet alone. However, for those who cannot achieve this through diet alone, be it because of poor dietary choice, malabsorption issues or other reasons, vitamin and/or mineral supplements can be highly beneficial.

Incorporating a nutritional supplement into the diet can provide several benefits to clients, providing the supplement is indicated and has no negative interactions with other supplementation or medication.

INDICATED Indicated refers to when something is advisable or necessary. For example, iron supplementation may be indicated for a young vegan female with menorrhagia (heavy menstrual cycle) because: • She is unable to obtain adequate iron in her regular diet • She loses a lot of iron on a monthly basis • She is unwilling to make dietary changes to obtain better sources of iron (such as red meat) • She is chronically iron deficient.

It is becoming increasingly common that clients are malnourished, despite abundant access to nutrient-dense food sources. The reason for this is the combination of decreasing nutrient levels in the soil and increasing exposure to a sedentary lifestyle and excessive stress. As such, supplementation may be indicated.

Listed below are just some of the many beneficial effects of supplementation.

Meeting recommended daily intakes (RDIs) which a client may otherwise be incapable of meeting (due to time constraints, food insecurity, finance, stress, mental illness, abuse or another non-dietary related reason) Weight management, including weight loss, weight gain and weight stabilisation Enhanced physical capabilities Decreased appetite secondary to improved satiation Healthy snack options Immunity booster Improved regulation of bowel motions Management/treatment of chronic diseases Improved joint health Improved cognitive health Increased effect of insulin in the body Promotion of tissue growth and repair Increased baseline and immediate energy levels.

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In addition to the list previously provided, the following table provides an example/scenario of how supplementation may benefit a particular client:

BENEFITS

Meeting RDIs that a client may otherwise be incapable of meeting

EXAMPLE/SCENARIO A business owner may be so preoccupied with their own business that they do not take the time to prepare nutritionally dense meals but instead rely on fast food takeaways.

As a result, they develop a deficiency over time and may require supplementation to ensure adequate nutrition until a nutrient-rich diet can be obtained again.

It is important to remember that supplementation should never replace a healthy diet and that a healthy, well-balanced diet is always the first recommendation and overarching goal.

Weight management, including weight loss, weight gain and weight stabilisation

A client may struggle to maintain their weight secondary to a decreased appetite and lack of interest in food. As a result, they may take vitamin, mineral and oil supplements to ensure micronutrients and fat recommendations are being met and may also consider some calorie-rich smoothies or protein powders.

Enhanced physical capabilities

A weight lifter may use caffeine during a heavy weight-training session for its metabolic, cardiovascular and central nervous system effects.

Decreased appetite secondary to improved satiation

An obese client with an elevated appetite looking to lose weight may consider making use of whole food, fibre-rich supplement, such as chia seeds, to improve satiety, or may consider high-quality meal replacements.

Healthy snack options

A client who is out for the day and eating on the road may take a high-quality bar or shake with them for a quick and convenient snack.

Immunity booster

A client with compromised immunity or who has been on antibiotics may consider probiotic and prebiotic supplementation such as sauerkraut, kombucha or capsules, and may also look into antioxidant-rich supplementation such as Vitamin C.

Improved regulation of bowel motions

Irregular bowel motions can be caused by malabsorption, food intolerances or inadequate fibre. As a result, a client who suffers from irregular bowel motions may benefit from gut support supplements such as probiotics and prebiotics, soluble and insoluble fibre supplementation or digestive enzymes.

Management/treatment for chronic diseases

A client with dyslipidaemia (abnormal blood lipid profile) may benefit from highquality fish oil supplementation to improve the overall blood lipid profile.

Improved joint health

A client with arthritis may benefit from fish oil supplementation to assist with the movement of their joints.

Improved cognitive health

A student may benefit from fish oil supplementation in the lead-up to and the duration of their exam period in an effort to improve cognitive function.

Increased effect of insulin in the body

A client with uncontrolled sugar levels may benefit from chromium supplementation to improve their insulin response.

Promotion of tissue growth and repair

A weightlifter who trains several days in a row may benefit from various protein and amino acid supplements to improve muscle recovery and stimulate further muscle synthesis.

Increased baseline and immediate energy levels

A recreational endurance athlete may use gels or bars for training and completing big events such as ultramarathons.

These bars and gels provide an immediate source of glucose to the body, which are quickly absorbed into the bloodstream and utilised for energy.

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IDENTIFYING THE VARIOUS CATEGORIES OF NUTRITIONAL SUPPLEMENTS ON THE MARKET There is an abundance of supplements now widely available on the market. It is predicted that as much as a third of men and half of women in Australia use some form of supplementation on a daily basis, in the hope of promoting good health.(16) While there are thousands of supplements available on the market, they can be simplified into the following four main categories: 1. Vitamin and mineral supplements 2. Speciality supplements 3. Herbal and botanical supplements 4. Sports supplementation and weight management supplements.

SUPPLEMENT CATEGORY

DESCRIPTION Vitamin and mineral supplements are products formulated to provide a physiological benefit to bodily systems by improving levels of vitamins or minerals, which may be deficient or at risk of deficiency.

VITAMINS AND MINERALS

Vitamins (such as vitamin B12, C and D) and minerals (such as iron, magnesium and zinc) are essential for: Energy production Hormone production Immune function Healthy hair, skin, nails and vision Many other aspects of health.

• • • • •

Supplementation to avoid deficiencies, correctly diagnosed deficiencies and improve overall health is a multimillion-dollar industry in Australia. However, it must be remembered that it is possible to obtain sufficient amounts of vitamins and minerals from diet alone.

Using a vitamin or mineral supplement to fill nutrient gaps in an energy-dense, nutrient-poor diet is not considered optimal for long-term health; following a nutrient-dense and minimally processed diet is always preferred.(17) Speciality supplements are products formulated to provide physiological benefits such as improving joint health (glucosamine), bowel function (fibre supplements), gut health (probiotics and prebiotics) and reducing inflammation (omega-3).

SPECIALITY SUPPLEMENTS

Speciality supplements are not categorised as vitamins and minerals as they are not considered essential nutrients and are not major sources of energy like sports and weight supplements. The use of specialty supplements is common in Australia, as messages promoting preventive healthcare become more popular in the media and community.(17)

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Herbal medicine has been used for centuries by many indigenous cultures worldwide for its therapeutic properties.(18) Herbal supplements are products that contain herbal substances as their primary active ingredient. Examples include: Herbs and botanicals (such as echinacea and ginseng) Homeopathic remedies Flower preparations/essences

• • •

The main active ingredients (herbal substances) are usually preparations of fungi, algae and yeasts but also include extracts from the roots, stems, leaves, flowers or bark of various plants, often without specified chemical composition.(19) HERBAL AND BOTANICAL Throughout the world, herbal medicine, or ‘complimentary medicine’ is widely used and is often integrated into primary health care. Herbs are usually rigorously tested for quality and efficacy for safety reasons. In Australia, the TGA provides compositional guidelines for herbal use in ‘listed medicines’, such as supplements.(20) (21)

AUSTRALIAN REGULATORY GUIDELINES FOR COMPLEMENTARY CLICK HERE to view the link.

Sports supplementation refers to a convenient and practical means of meeting nutrient requirements known to optimise daily training or competition performance,17 as well as other components that claim to directly enhance sports performance or maintain/restore health and immune function (scientifically supported), when consumed in the correct amounts.(22)

SPORTS SUPPLEMENTATION AND WEIGHT MANAGEMENT

Sports supplements can include (but are not limited to): Pre-workout aids (both single ingredient products or combination ingredient products) Protein powders and bars Amino acids (i.e. glutamine and creatine) Hydration supplements Energy supplements (such as glucose gels and carbohydrate bars) Caffeine and other stimulants Other liquid meal supplements and sports drinks.

• • • • • • •

Weight management products usually include meal replacement powders, snacks, and fat-burning products. The weight loss food industry was worth around $280 million in 2013-2014, with continued annual growth expected as more individuals look toward preventive health to reduce weight and improve long-term health.(23) The four main categories of supplements can be further broken down by the functions they are intended for, which include: Stimulating tissue growth and repair Weight loss and fat loss Increasing energy supply and delaying fatigue Improving immunity Central nervous system (CNS) optimisation Promoting joint health Promoting recovery post training and competition Meeting RDIs and essential nutrient requirements.

• • • • • • • •

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The nutrition coach’s responsibility is to become familiar with the various supplements on the market.

It is encouraged that all nutrition coaches spend some time reading supplement labels and becoming familiar with the different brands that are readily available.

It is also important to remember that ingredients, doses and brands will change frequently, and therefore products and product guides should be checked regularly. Often, ingredients are almost identical, but the branding is different, and products can therefore peak in price.

Tips for nutrition coaches: Become familiar with the various brands of supplements and alternative products which can be utilised Speak with the sales representatives, pharmacists and pharmacy assistants about various supplements.

Utilise information on the supplement brand’s website for indications and contraindications Most importantly, make thorough use of scientific journal articles to identify when and how much of a supplement to recommend.

• • • •

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IDENTIFYING COMMON TYPES OF VITAMINS AND MINERALS ON THE MARKET Having the ability to identify types of vitamins and minerals available on the market, their role, and their recommended daily intake (RDI) allows a nutritional advisor to educate clients and make appropriate recommendations to avoid/treat deficiencies.

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).

VITAMINS WATER SOLUBLE

FAT SOLUBLE

B

D

C

Remember fat soluble vitamins by visualising a BIG deck of cards (DEKA)

E

K

A

The adapted table below lists common vitamins found on the market as well as their role in the body and recommended RDI:19

VITAMINS (FAT-SOLUBLE) ESSENTIAL NUTRIENT

VITAMIN A (RETINOL)

VITAMIN D (CHOLECALCIFEROL)

VITAMIN E (TOCOPHEROL)

VITAMIN K

ROLE for normal growth and development • Essential Maintenance • Night vision of epithelial tissues • Normal bone development • Normal tooth formation • Antioxidant • Immune response • Toxic in large doses.

• for normal growth and development • Essential Healthy development and maintenance of bones and • teeth absorption and digestion of phosphorus and • Influences calcium. antioxidant • Strong red blood cells from haemolysis • Protects Prostaglandin synthesis.

• with normal blood clotting responses • Assists Involved in bone metabolism.

•

RDI Males: 900μg.

Females: 700μg.

AI Males 19-50yrs: 5μg.

Males 51-70yrs: 10μg.

Males >70yrs: 15μg.

Females 19-50yrs: 5μg.

Females 51-70yrs: 10μg.

Females >70yrs: 15μg.

AI Males: 10mg.

Females: 7mg.

AI Males: 70μg.

Females: 60μg.

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VITAMINS (WATER-SOLUBLE) ESSENTIAL NUTRIENT

VITAMIN B1 (THIAMIN)

VITAMIN B2 (RIBOFLAVIN)

VITAMIN B3 (NIACIN)

VITAMIN B6 (PYRIDOXINE)

VITAMIN B12 (CYANOCOBALAMIN)

FOLATE/FOLIC ACID

PANTOTHENIC ACID

BIOTIN

VITAMIN C (ASCORBIC ACID)

ROLE for growth, normal appetite and • Essential digestion for healthy nerves and muscles • Essential Involved in metabolism.

• for growth • Essential Enzymatic in tissue respiration • Involved in role energy metabolism.

• in the metabolism of amino acids and • Aids carbohydrates in fat synthesis, tissue respiration and • Involved glycolysis. the synthesis and breakdown of amino • Supports acids in the synthesis of unsaturated fatty acids • Aids from essential fatty acids for the conversion of tryptophan into • Essential niacin • Essential for normal growth. in metabolism and growth • Involved Involved in the metabolism of nervous tissue • Involved with folate metabolism • Activates folate/folic acid.

• for normal maturing of red blood cells • Essential as a coenzyme • Functions Essential for the biosynthesis of nucleic acids • (especially early foetal development) in the synthesis and breakdown of many • Assists vital body compounds in the intermediary metabolism of • Essential carbohydrates, fats and protein. amino acids and fatty acid synthesis/ • Supports breakdown • Acts as an essential factor in enzymes. collagen with preservation of capillary • Maintains integrity • Immunity healing • Wound Important in allergic responses • Increases absorption of non-haem iron.

•

RDI Males: 1.2mg.

Females: 1.1mg.

Males <70yrs: 1.3mg.

Males >70yrs: 1.6mg.

Females <70yrs: 1.1mg.

Females >70yrs: 1.3mg.

Males: 16mg.

Females: 14mg.

Males <50yrs: 1.3mg.

Males >50yrs: 1.7mg.

Females <50yrs: 1.3mg.

Females >50yrs: 1.5mg.

Males: 2.4μg (micrograms).

Females: 2.4μg.

Males: 400μg.

Females: 400μg.

Pregnant: 600μg.

AI Males: 6.0mg.

Females: 4.0mg.

AI Male: 30μg.

Female: 25μg.

Males: 45mg.

Females: 45mg.

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The adapted table below lists common minerals found on the market as well as their role in the body and recommended RDI:(19)

MINERALS ESSENTIAL NUTRIENT

CALCIUM (CA)

PHOSPHORUS (P)

MAGNESIUM (MG)

SODIUM (NA) CHLORIDE (CL)

POTASSIUM (K)

IRON (FE) ZINC (ZN) COPPER (CU) IODINE (I) FLUORIDE (FL)

COBALT (CO)

ROLE with constriction and relaxation of blood vessels •• Assists Assists with nerve impulse transmission contraction •• Muscle Secretion of hormones, including insulin structural strength of teeth and bones •• The Assists with blood clotting. found in the organic portion of bones and teeth •• 80% Component of every cell • pH regulation.

50% in bone, the other 50% almost • Approximately entirely inside body cells of many enzymes, influencing almost all body • Activator processes. regulate hormones and neurotransmitters • Helps associated with sleep, relaxation and stress. in bones •• 30-45% Regulates body fluid and pH. in combination with sodium •• Functions A component of gastric hydrochloric acid (HCl). pH and osmolarity •• Regulates Regulates cardiac function for metabolism of proteins and carbohydrates •• Required Functions in cell membrane transfer.

70% of haemoglobin •• Approximately Approximately 26% in the liver, spleen and bone • Important in oxygen transfer. in nucleic acid metabolism •• Important Found in most tissues and bones.

• It may be an important component of DNA and RNA. in hormone synthesis by the thyroid gland •• Aids Actions involving cellular energy. in bone and teeth •• Present Reduces dental caries and bone loss. for the normal function of all cells, especially • Essential bone marrow, nervous system and gastrointestinal

RDI Males 19-70yrs: 1,000mg.

Males >70yrs: 1,300mg.

Females 19-50yrs: 1,000mg.

Females >51yrs: 1,300mg.

Males: 1,000mg.

Females: 1,000mg.

Males 19-30yrs: 400mg.

Males >31yrs: 420mg.

Females 19-30yrs: 310mg.

Females >31yrs: 320mg.

AI Males: 460-920mg.

Females: 460-920mg.

No RDI or any nutrient reference values set.

AI Males: 3,800mg.

Females: 2,800mg.

Males: 8mg.

Females 19-50yrs: 18mg.

Females >50yrs: 8mg.

Males: 14mg.

Females: 8mg.

AI Males: 1.7mg.

Females: 1.2mg.

Males: 150μg.

Females: 150μg.

AI Males: 4mg.

Females: 3mg.

No RDI or any nutrient reference values are set.

system.

SELENIUM (SE) CHROMIUM (CR)

in fat metabolism •• Involved Involved with antioxidant functions. in maintaining glucose homeostasis by • Assists enhancing the activity of insulin.

Males: 70μg.

Females: 60μg.

AI Males: 35μg.

Females: 25μg.

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IDENTIFYING COMMON TYPES OF SPECIALITY SUPPLEMENTS ON THE MARKET Speciality supplements are products formulated to provide physiological benefits such as improving joint health or bowel function. These supplements are increasingly popular as the media and community encourage preventative healthcare. However, they are not considered essential and are not major sources of energy for the body.

Identifying types of supplements and their effective uses (or lack of effect) can help nutrition coaches provide their clients with effective supplementation strategies that target their goals and nutritional needs.

The following table highlights some of the most common specialty supplements on the market and lists their common uses:

PRODUCT

GLUCOSAMINE

DESCRIPTION A naturally occurring amino sugar found in the human body, primarily used for the building and maintenance of cartilage.

Glucosamine sulphate is often considered the most effective form.

USE Used to treat and prevent joint disorders such as: Osteoarthritis Rheumatoid arthritis Osteoporosis.

•• •

Glucosamine may assist in reducing inflammation in the body.(20) Essential fatty acids EPA and DHA are polyunsaturated fats extracted from food sources, including fish, nuts and seeds, and are encapsulated in capsule form.

OMEGA-3

FIBRE SUPPLEMENTS

Fibre supplements provide additional dietary fibre where diet alone is not providing enough. It can be categorised into two groups (soluble and insoluble fibre).

Soluble fibre: Absorbs water in the intestine, slowing down digestion.

Insoluble fibre: Does not absorb water and therefore speeds up the movement of food through the digestive tract.

triglycerides: May be useful for • Elevated helping to lower triglyceride (fat) levels in the blood. arthritis: May help to reduce • Rheumatoid joint pain and stiffness by reducing inflammation. and dementia: Thought to be • Alzheimer’s effective for protecting brain health.

May be beneficial in reducing • Depression: depression. bowel function •• Improving Preventing constipation satiety (fullness) •• Improving Reducing cholesterol.

Adequate water consumption is advised when taking a fibre supplement to avoid constipation.

• •

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Involved in bone metabolism.

Females: 60μg.

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Microorganisms, including live bacteria and yeasts that colonise within the digestive tract and perform various functions.

PROBIOTICS

The non-digestible fibre found in foods that feed gut bacteria (the microbiome).

PREBIOTICS

to supplement a client’s existing gut • Used microbiome to increase diversity after a round of antibiotics (which • Used kill both good and bad bacteria) to restore balance help improve gut motility •• May May help reduce diarrhoea help with illnesses of the bowel • May (i.e. irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) assist with weight loss •• May Reducing cholesterol • Improving immune function.

Used to feed the gut microbiome and support a healthy gut.

Examples include: Legumes/beans/peas Green bananas Oats Berries Asparagus Garlic Leek Onions.

Supplements include: Psyllium husks Inulin Guar gum (PHGG) Galactooligosaccharides (GOS) Fructooligosaccharides Transgalactosylated oligosaccharides (TOS)

•• •• •• • • •• •• ••

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IDENTIFYING COMMON TYPES OF HERBAL AND BOTANICAL SUPPLEMENTS ON THE MARKET Herbal supplements (often referred to as ‘botanicals’) have been used in many different cultures for many centuries.(21) They involve the medicinal use of either whole plants or parts of plants for both curative and preventative health. These days, most pharmaceutical products are derived from plants; however, herbal supplements use these plants in their purest form, and their use is becoming increasingly popular, despite their controversy in the past.(14) The following table outlines common herbal/botanical supplements, their use and possible adverse effects:

SUPPLEMENT

CHAMOMILE

DESCRIPTION A flowering herb of the Asteraceae plant family.

Commonly made into naturally decaffeinated tea, high in antioxidants.

(23)

POSSIBLE ADVERSE EFFECTS

USE

sleep quality • Improved • Allergies Promotes digestive irritation (applied • health • Skin topically). relieve anxiety and • May depression improve heart • May health.

(23)

*Nil research into dosing for children, pregnant/nursing women, and those with liver/ kidney disease.

(23)

ECHINACEA

A group of wildflowers, with three being used for herbal preparations (echinacea purpurea, echinacea angustifolia, echinacea pallida.(24)

the immune • Stimulates system to treat boils, fever • Used and herpes reduce anxiety • May May help treat some • skin conditions. nausea and • Treat stomach upset caused

• Fatigue • Dizziness • Headache • GI upset.

(24)

(24)

GINGER

PAPAIN

Plant native to Asia, also grown in Australia. The root is used in traditional medicine as an antiinflammatory and antinausea treatment.(24) Found in papaya, papain works with other proteases (enzymes) to break down protein.(25)

by motion sickness, surgery, medicines Relieves gas Diarrhoea Improve appetite.(24)

• • • reduce pain, • May inflammation and • •

swelling May assist with digestion May assist with infections, diarrhoea and allergies.(25)

heartburn • Mild Mild • Mild diarrhoea • stomach discomfort.

(24)

throat and • Severe stomach damage (large

• •

doses) Skin irritation and blisters Allergies.(25)

May help reduce •symptoms associated with osteoarthritis A protein-digesting Can be used as a Diarrhoea enzyme found in digestive enzyme Nausea pineapple. One of the BROMELAIN May help reduce Vomiting strongest and most clot formation and Heavier than normal tested enzymes used for cardiovascular events menstrual bleeding.(26) VAST FITNESS ACADEMY | NAT11046006: ADVISE CUSTOMERS ON THE USE OF NUTRITIONAL SUPPLEMENTS AND ERGOGENIC AIDS | (26) various treatments.

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• •

• • • •

22 22

SUPPLEMENT

BROMELAIN

DESCRIPTION A protein-digesting enzyme found in pineapple. One of the strongest and most tested enzymes used for various treatments.(26)

A spice used in traditional Indian cooking. The active ingredient, ‘curcumin’ has been heavily researched for its potential health effects.(24)

help reduce • May symptoms associated

• •

with osteoarthritis Can be used as a digestive enzyme May help reduce clot formation and cardiovascular events related to stroke, heart attack and high blood pressure.(26)

anti• Possesses inflammatory properties bodily • Increases antioxidant capacity improve brain • May function and lower the

ADVERSE EFFECTS

• Diarrhoea • Nausea • Vomiting than normal • Heavier menstrual bleeding.

(26)

stomach • Upset • Diarrhoea • Nausea • Dizziness.

(24)

risk of brain disease May lower risk of heart disease May help treat Alzheimer’s disease May reduce cancer risk Used to treat arthritis.

Beneficial for digestive and liver health.(24)

TURMERIC

MILK THISTLE

A prickly plant that contains an active ingredient called ‘silymarin’ which is thought to have medicinal properties.(27)

GINSENG

Ginseng has been used in traditional Chinese medicine for hundreds of years. It contains two active ingredients: ginsenosides and gintonin, which have a complementary effect.(24)

LICORICE ROOT

A traditional cure-all substance derived from the root of the Glycyrrhiza glabra plant.

Contains the active ingredient ‘glycyrrhizin’ and can be taken as deglycyrrhizinated licorice (DGL) if recommended long-term.(24)

HYPERICUM (COMMONLY KNOWN AS ST JOHN’S WORT)

USE

Asteraceae

• • • • • help reduce liver • May inflammation and

damage in those with liver disease Can increase breast milk production.(24)

• Diarrhoea • Nausea • Bloating

(24)

(In 1%of respondents)(27)

• blood pressure reduce the • Reduces • May effectiveness of Nervous system • adaptogen anticoagulant drugs cholesterol Not recommended for • Reduces • with recovery children or pregnant or • Assist from illness. breastfeeding women.

(24)

enhance repair of Excessive intake may cause: • May the stomach after illness Low potassium • (ulcers, heartburn, food (hypokalaemia) poisoning) • Swelling Nervous system heartbeat • adaptogen • Irregular High blood pressure.

• improve respiratory • May health.

(24)

(24)

• May

• May

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SUPPLEMENT

HYPERICUM (COMMONLY KNOWN AS ST JOHN’S WORT)

DESCRIPTION A flowering plant from the hypericaceae family with a primary phytochemical called ‘hyperforin’.(24)

USE

ADVERSE EFFECTS

depression • Reduces • Vomiting Healing wounds, bruises, • burns and sores.

• Dizziness • Anxiety attacks • Panic Aggression • Amnesia • Possible drug • interactions. mental Nausea • Improves • alertness • Diarrhoea Reduces oxidative stress upset • Reduces inflammation • Stomach Dizziness • May assist with weight • Headache • loss • Withdrawal symptoms • (long-term/high doses assist in reducing • May use) fatty liver reduce cancer risk. side effects • May • Serious May help lower blood include irregular • sugar. heartbeat, mood (24)

(24)

GREEN TEA

Green tea comes from the Camellia Sinensis plant with dried leaves brewed into tea or dried and encapsulated as an extract. Contains the active ingredients ‘catechins’ and ‘caffeine’.

(28)

(28)

changes, tremors, seizures, and liver toxicity (uncontrolled vomiting, stomach pain, dark urine, yellow eyes).(28) A yellow flowering plant native to North America containing gammalinolenic acid (GLA), an omega-6 fatty acid.(29)

EVENING PRIMROSE

Traditionally used to treat: Haemorrhoids Rheumatoid arthritis Bruises Digestive issues Can help alleviate Premenstrual syndrome (PMS) symptoms, including breast pain.

• • • • •

stomach • Upset Stomach • Headachespain • Soft stools • Nausea • Dizziness • Allergic reaction (rare).

•

(29)

May also assist with: Acne Eczema and other skin conditions High blood pressure Pain.(29)

TRIBULUS TERRESTRIS

A flowering plant used in Chinese and Ayurvedic medicine with apoptogenic properties that may offer protection from oxidative stress and promote cardiovascular and urogenital health.(24)

• • • • oxidative stress side effects and • Reduces • Minimal (liver and kidneys) no safety concerns libido (sex uncommon side effects • Enhances drive) include minor stomach Boosts testosterone cramps or reflux.

• (minimal evidence) reduce blood sugar • May levels.

(24)

(24)

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SPECIAL CONSIDERATIONS FOR HERBAL SUPPLEMENTS Herbal supplements are often considered completely safe for consumption because they are natural products; however, this is not always the case. Harm can occur if supplements are taken unnecessarily, against directions or with other medicines where interactions are possible. Potential harm is more likely as many herbal and botanical supplements are not tested to the same standards as prescription medicines and products.

Herbal supplements contain one or more active ingredient(s), and many of these are unknown or understudied. Like prescription medications, herbal supplements should always be prescribed by a qualified and registered practitioner. medicines can interact with other medications, so caution must be exercised in their use.

• Herbal Herbal medications and supplements can interact harmfully with over-the-counter or prescription • medicines. herbal supplements may reduce the effectiveness of other drugs or may increase the • Taking negative side effects. is always best to speak with an experienced dietitian, naturopath or GP about specific herbal • Itsupplements before considering recommending them to clients or talking about them, especially if other medicines are already being taken.

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IDENTIFYING COMMON TYPES OF SPORTS AND WEIGHT MANAGEMENT SUPPLEMENTS ON THE MARKET There are countless products on the market that fall under the category of ‘sports supplementation/weight management, and as a nutritional advisor, it is important to become familiar with these products. The sports supplement category is particularly important to nutritional advisors as it will be a popular point of discussion among clients within the fitness/sporting setting.

This section will focus on particular ingredients/products that fall under the sports supplement category, including: Sports specific supplementation Weight management supplementation Stimulants and energy enhancers (non-prescription versus prescription only).

• • •

IDENTIFYING VARIOUS SPORTS SUPPLEMENTS Sports supplementation is much like nutritional supplementation in that it is designed to assist clients in reaching their nutritional requirements, which they may not otherwise be able to achieve. However, instead of simply optimising health, clients utilise sports supplementation to improve their: Physical performance Recovery Muscle growth Body composition Endurance Overall physical stamina.(3)

• • • • • •

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The following table summarises some common sports supplements, their benefits, adverse effects and approximate dosing, based on research. Nutrition coaches should always check the product information when establishing dosing information for their clients.

PRODUCT

WHEY PROTEIN POWDER

DESCRIPTION A refined protein supplement derived from cow’s milk is used to increase protein intake in a pure and convenient form.

Many forms exist. However, whey protein is considered the best. Typically used in isolate, concentrate and hydrolysate forms.(30)

BENEFITS TO SPORTING PERFORMANCE

exercise • Enhance recovery muscle • Increase protein synthesis (MPS).(30)

•

per meal, to achieve from 1.6g/kg/day to 2.2g/kg/ day.

High protein diets and supplements do not negatively affect kidney or liver health in healthy adults but can exacerbate those with pre-existing kidney damage.(31)

(30)

nausea in high doses.(32)

in higher doses during a ‘loading phase’ to enable maximal saturation of muscle stores. The same effect can be achieved over a longer period (around 30 days) through daily supplementation of 5g.(32) A conditionally essential amino acid found in dairy, meat and eggs. Used as a supplement for wound recovery and sports supplementation.

GLUTAMINE

dosing for MPS • Optimal appears to be 0.4g/kg

performance phase: 0.3g/kg •• Increase • Loading Enhance exercise for 5-7 days.

Maintenance phase: 5g recovery • Increase explosive daily (up to 10g for non• energy responders, those with Reduce fatigue high muscle mass or high • activity levels). cause stomach • May cramps, diarrhoea and Creatine is often recommended Naturally occurring compound found in meat, eggs and fish. Used in muscle tissue to convert ADP to ATP for energy production. Many forms exist, however, monohydrate is considered the best form.

CREATINE MONOHYDRATE

APPROXIMATE DOSES AND ADVERSE EFFECTS

Glutamine is a building block of protein as well as playing an important role in intestinal health and immunity.(33)

exercise daily and not exceeding • Enhance • 5g0.75g/kg recovery dosing due May improve muscle to increased • recovery for vegans/ production. ammonia (33)

• •

vegetarians or dairy avoiders Enhance wound healing (burns, puncture wounds, muscle wasting diseases) Improve immunity and intestinal health.

(33)

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Essential amino acids Leucine, Isoleucine and Valine extracted from food sources such as meat and eggs.(34)

exercise • Enhance recovery for fasted • Popular exercise.

(35)

lower dose of up to • A255mg per kg of body weight per day has shown to be more effective than higher doses.(34) 20g of combined BCAAS.

• is • Supplementation unnecessary for those with

BRANCHEDCHAIN AMINO ACIDS (BCAAS)

(35)

a sufficiently high protein intake 1-1.5g/kg.(35)

D-ASPARTIC ACID

L-ARGININE

An amino acid that triggers hormone release in the brain.

Thought to help increase testosterone levels, which confer a performance benefit.(36)

boost • May testosterone production in untrained men May boost fertility.(36)

• A conditionally essential amino • May increase blood acid that is important for blood flow and improve

dosing: 2,000• Standard 3,000mg daily. considered safe, • Generally with no side effects from normal dosing.(36)

pre-workout • Standard dosing: 3-6g daily. athletic performance, dosing: 15-18g in 3 • Daily however, little evidence doses. to support this. over 10g at a time • Dosing may cause stomach upset

flow and nitric oxide levels.

L-arginine is poorly absorbed and L-citrulline may be a better supplement option.(37)

(37)

(37)

and diarrhoea.(37)

MAGNESIUM

An essential mineral, the second most abundant electrolyte in the body and the most common mineral deficiency.(38)

exercise • Enhance performance exercise • Enhance recovery reduce muscle • May cramps.

(38)

L-carnitine and its related compound acetyl-L-carnitine (ALCAR) are compounds involved in metabolism.

L-CARNITINE

Research suggests these products have the potential to fight the effects of ageing and disease on mitochondria (the energy powerhouse of the cell).

ALCAR is used to boost cognition by increasing alertness and reducing neurological decline, whereas L-carnitine may assist conversion of fat for energy and is therefore popular with dieters/exercisers.(40)

exercise • Enhance performance

••

(resistance training, endurance and high-intensity cardiovascular exercise) Improved cognition Enhance insulin sensitivity.(39)

• Male: 19-30: 400 mg > 31: 420 mg

• Female: 19-30: 310 mg > 31: 320 mg(39)

dosing: 500• Standard 2,000mg daily. dosing: 630• ALCAR 2,500mg daily (39)

(39)

*Use as a fat burner is not supported by scientific evidence.

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NITRIC OXIDE

A signalling molecule formed from nitrogen and oxygen (NO) which plays a role in blood pressure regulation, inflammatory response and immune response.

exercise 3,000• Increase • L-citrulline: performance 8,000mg before exercise. the perception • Reduce of fatigue L-carnitine: 500-2,000mg • Reduce muscle • soreness (citrulline • daily L-arginine: 3-6g daily. malate).

(42)

(39)

(37)

(37)

NO is taken as a supplement and is boosted through the use of supplements like L-citrulline, L-carnitine and L-arginine.(41)(37)

BETA-ALANINE

An amino acid modified from alanine. Metabolised in the body to form carnosine, which buffers acidity and offers protection from exerciseinduced lactic acid production.

(43)

exercise dose: 4-6g daily • Increase •• Typical performance Although used premuscular workout, supplementation • Increase endurance is not timing-dependent, Reduce the perception so best taken when it suits • of fatigue. the user. cause paraesthesia • May (tingling). exercise daily.

• Increase •• 500-2,000mg performance May cause vomiting, the perception nausea, liver pain, • Reduce of fatigue. headache and stomach

(43)

(43)

(43)

An organic amino acid found in the body which acts as a membrane/lipid stabiliser and assists antioxidant defences.

TAURINE

(44)

(44)

pain.(44) Taurine may have multiple cardiovascular and physiological health benefits beyond sports performance.(44) exercise Dosing should be tailored to • Increase performance the client: Improve physical No more than • strength • Adults: 400mg per day, exercise maximum 200g in a single • Improve endurance serving.

Reduce the perception supplementer: • of fatigue.

• New (TIP: One cup of coffee 100mg dose. typically contains between 80burning: 200mg dose •• Fat 145mg of caffeine, depending Acute dose range: 4-6mg/ on the type of coffee). kg body weight.

The active, stimulatory ingredient found in coffee beans and tea. Consumed in coffee or added to pre-workout supplements and energy drinks.

(47)

(46)

CAFFEINE

(45)

(45)

(45)

Important note: Depending on the individual, caffeine can maintain effects for 1.5-9.5hrs.

(48)

It may also disrupt sleep quality in some individuals when taken later in the day.(49)

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GLUCOSE GELS

Made from dextrose, glucose or maltodextrin and water.

Usually used by athletes during long-distance aerobic activity (cycling, marathon, ironman) to provide fast-digesting and absorbing energy. Also used by diabetics to counteract hypoglycaemic events (low blood sugar).(50)

L-CITRULLINE

An amino acid that is converted to L-arginine by the kidneys. Best supplemented in the form of citrulline malate.(42)

LEUCINE

An essential amino acid found primarily in animal products, most concentrated in dairy (whey). Leucine efficiently triggers muscle protein synthesis and, combined with sufficient training, can boost muscle growth as part of a wellformulated training and diet program.

D-RIBOSE

Supplementation may help improve recovery after prolonged exercise by increasing ATP production and glycogen stores. It may also be beneficial for those with cardiac health issues.(52)

HMB (hydroxymethylbutyrate or betahydroxy betamethylbutyrate)

ZMA

WAXY MAIZE STARCH

HMB is a product of the breakdown of the amino acid leucine and appears to have anti-catabolic effects on muscle tissue.(53) A supplement containing zinc, magnesium aspartate and vitamin B6. It has been claimed that ZMA can help boost testosterone; however, there is limited evidence for this effect, and the International Society of Sports Nutrition has declared ZMA’s effect on muscle building as ‘not clear’.(54) A fast digesting carbohydrate supplement made from refined maize, which resembles the composition of wax. Contains the branched chain starch amylopectin. (54)

the risk of dosing: 60g/ • Reduce • Standard hypoglycaemic events hr for exercise duration exercise beyond 1 hour, and 90g/hr • Improve performance for exercise duration over 2 Improve exercise hours.

• endurance. dosing: 15g dose at • Initial the start of exercise.

(50)

(50)

fatigue •• Reduce Improve exercise endurance.

sports performance: • For 6,000-8,000mg citrulline malate 60 minutes before exercise.(42)

muscular for maximal muscle • Enhance • 1-3g recovery from exercise protein synthesis.

• Enhance muscle growth.

(51)

recovery after per day • Enhance •• 5-15g Mild diarrhoea, slight exercise glycogen nausea and stomach • Faster repletion. discomfort.

(52)

reduce exercise• May induced muscle breakdown.

1-3g 30-45 • Dosing: minutes before exercise. be harmful to the • Could kidneys in large doses studies on • Nohealthlong-term effects exist. typically contains: • ZMA 30mg of zinc, 450mg of

(53)

improve sleep • May quality improve muscle magnesium and 10-11mg • May strength, size and of B6. These forms may recovery. vary. benefits Since no confirmed • Nofromconfirmed • controlled studies. benefits exist, follow the (55)

(55)

commercial supplement dosing guide.

improve exercise the commercial • May • Follow performance supplement dosing guide. improve muscle • May glycogen repletion after exercise.(54)

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IDENTIFYING VARIOUS TYPES OF PROTEIN SUPPLEMENTS There are many types of protein supplements and their nutritional value is determined by their unique amino acid profile. Research has demonstrated that whey protein, with its high biological value (BV), is more effective than other proteins as it contains a full range of essential amino acids (EAAs) and is also quickly digested and absorbed. Whey protein contains a substantial dose of the amino acid leucine, which efficiently stimulates muscle protein synthesis and may improve muscle recovery and growth as part of a resistance training exercise program.

Plant protein sources are usually incomplete proteins, meaning they do not naturally contain the full range of EAAs, or the individual EAAs are found in low levels, which demote them to an incomplete protein source. As a result, blending of two or more incomplete protein sources is common (e.g. pea and rice are often combined) to produce a product that contains the full range of EAAs (complete protein).(56) The hierarchy of supplemental proteins (by EAA profile) is provided in the list below: 1. Whey protein isolate (WPI) 2. Whey protein concentrate (WPC) 3. Whey protein hydrolysate 4. Casein protein 5. Soy protein 6. Egg albumen 7. Beef protein 8. Hemp protein 9. Rice protein 10.Pea protein 11. Collagen protein.

DECIDING WHICH PROTEIN TO RECOMMEND TO CLIENTS: As a nutrition coach, deciding which protein is suitable for a client requires consideration of several factors, including: Price Digestibility and risk of allergens Level of physical activity Dietary preferences.

•• • • Examples include: cow’s milk-based whey or casein protein would be unsuitable for a vegan, who would be better • Asuited to choosing soy protein. with a milk protein or egg allergy would be better suited to a dairy and egg-free protein such • Aasclient beef, soy or mixed plant protein. who wants a competitive advantage for training recovery and muscle growth might be • Anmoreathlete suited to whey protein.

However, it must be remembered that it is possible (and preferable) to achieve a sufficient protein intake without supplementation, even with higher protein requirements. Supplements should be used to complement a varied, protein-rich diet and to enhance intake by providing fast digesting, high-quality protein after a workout or by complementing a client’s lifestyle e.g. using protein to fortify meals such as porridge, to increase protein intake at key meal times.

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supplements are very popular in the sports/fitness industry and with gym goers; however, • Protein protein supplementation can be extremely beneficial to other clients and is not solely used for sporting performance. adults require a higher protein intake per kg of body weight than younger adults, and where • Older appetite is poor, a protein shake can be an effective way to increase intake without having to eat whole foods. requirements also increase for hospitalised patients who have illnesses and injuries that • Protein require higher protein intake for recovery. protein supplements are also commonly recommended during weight loss programs in the • Finally, form of low-calorie meal replacements, providing essential proteins and micronutrients without the extra calories associated with fats and carbohydrates.

The table below identifies and describes the various types of protein available on the market:

TYPE OF PROTEIN SUPPLEMENT

DESCRIPTION Whey protein is derived from the process of creating cheese and forms about 20% of the protein found in cow’s milk. After the casein curd separates from the milk, the remaining watery liquid is called whey. It is a high biological value (HBV) protein and contains high levels of branched-chain amino acids (BCAA), especially leucine. BCAAs stimulate muscle growth (synthesis) and possibly reduce muscle breakdown; therefore, they are extremely beneficial for clients looking to maximise muscular strength and size or reduce muscle breakdown (catabolism). (57) Whey protein is usually taken immediately before or after a workout and can be used to fortify various foods (such as cereals, smoothies and baked items).

WHEY PROTEIN

There are three types of whey protein: 1. Whey protein concentrate (WPC): WPC is 75-80% protein by weight and contains small amounts of carbohydrate (in the form of lactose) and fat. It is naturally rich in amino acids, particularly BCAAs and glutamine, which ensure optimal muscle growth. WPC is one of the most popular and affordable forms of whey protein.

(57)(58)

2. Whey protein isolate (WPI): WPI is purer than WPC, containing ~85-90% protein by weight and negligible amounts of lactose and fat. As with WPC, it is naturally rich in amino acids, particularly BCAAs and glutamine, but because of the extra processing and higher purity, WPI is the most expensive form of whey protein, however, there is little evidence to suggest that WPI provides any additional benefits over WPC.(57)(58) 3. Whey protein hydrolysate (WPH):

WPH or ‘hydrolysed whey’ has been partially broken down due to the protein being exposed to heat, acid or enzymes. As such, the chains of amino acids (which make up the proteins) are reduced in size; and the proteins are therefore suggested to be more rapidly digested.(57) This hydrolysis process makes the powder bitter tasting and more expensive.(59)(58)

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Casein is the primary protein found in cow’s milk (around 80% of total protein), and has a HBV. Casein is slowly digested and usually taken before going to bed. This is because it offers a slower release of amino acids than most other types of protein, which allows for continued muscle recovery and synthesis, and a reduction of muscle protein breakdown, especially in times of fasting (sleep). This earns casein the title of being an ‘anti-catabolic’ and a ‘time release’ protein.(59)

CASEIN PROTEIN

The two main forms of casein supplement are: 1. Micellar casein: Micellar casein is produced by filtration and is the most popular form.

2. Casein hydrolysate:

Casein hydrolysate is processed to be faster digested than micellar casein.

Casein contains the amino acids glutamine and leucine, which are important for the synthesis of muscle tissue. However, casein may not be suitable for everyone, as some clients have a dairy protein sensitivity or allergy, which can make the digestion of casein difficult and/or uncomfortable. If digestive issues occur (bloating, excessive flatulence, pain, diarrhoea or constipation), then its use should be discontinued.(60) Soy is considered a HBV protein that is rapidly digested. As the name suggests, it is produced from the processing of soybeans. Soy protein is available as both a soy concentrate and soy isolate and contains the full range of essential amino acids.

SOY PROTEIN

Soy protein is an ideal source of protein for those who are vegetarian/vegan or who have food intolerances or allergies to other types of supplemental protein.

All soy products are known to contain isoflavones, a type of phyto-oestrogen.

As oestrogen is referred to as the ‘female hormone’, ongoing research is required to better understand if there are any long-term complications of ongoing soy protein supplementation (such as hormone disruption). As the science currently stands, there is no harm from supplementing with soy protein in typical doses.(61) Egg albumen protein powder is made from dehydrated and powdered egg whites and is a high-quality source of protein. It contains all of the EAAs and has a HBV. Egg protein also has the highest protein digestibility-corrected amino acid score (PDCAAS) of all supplemental proteins, meaning it is the most easily digested.

EGG ALBUMEN PROTEIN

Egg albumen protein has a very low carbohydrate and fat content and contains both non-essential and all nine essential amino acids required for tissue growth and repair. Egg protein contains the second highest level of the amino acid leucine (after whey protein), making it an excellent choice for resistance training clients. Because it does not contain dairy (casein, whey, lactose), it is an ideal substitute for those intolerant/allergic to dairy.

HEMP PROTEIN

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A newcomer to the protein market, hemp protein is derived from hemp seeds and, unlike many vegetable-based proteins, contains highly digestible proteins.

Hemp protein is a great vegan protein option and includes all nine essential amino acids with a similar profile to egg and soy protein, however, it contains less protein per serve than alternatives, providing around 50% protein.

HEMP PROTEIN

Hemp protein also contains fibre and essential fatty acids. Essential fatty acids are the fats that can only be obtained from the diet, as the body does not synthesise them itself. Having a source of essential fatty acids in protein powder can therefore be extremely beneficial for those who consume inadequate dietary fat (e.g. avocados, olive oil, nuts, seeds, animal fat).

Hemp protein also contains many antioxidants and minerals to support health, including iron, zinc, magnesium, calcium, copper and phosphorus.

RICE PROTEIN

When made from the whole grain, rice protein is a highly digestible and allergen-free (hypoallergenic) protein source. Rice protein contains the full range of EAAs but is low in the essential amino acid lysine and is therefore considered an incomplete protein. As such, it is often combined with pea protein powder to achieve a superior amino acid profile (complete protein).

Rice protein is suitable for vegetarians and vegans, consisting of approximately 80% protein and approximately 13% carbohydrates (depending on the product). (62) Pea protein is another hypoallergenic protein with a lighter texture than most other protein powders. It is made by milling peas into a powder and extracting the carbohydrate, leaving the protein behind. Pea protein has an amino acid profile comparable to that of soy, making it a suitable choice for vegetarians and vegans. Manufacturers often combine pea and rice protein to produce a product with a full range of essential amino acids (complete protein).

PEA PROTEIN

Pea protein is also less allergenic in comparison to soy and is ideal for those who react to dairy, egg and soy. Pea protein has a high fibre content and has no allergenic ingredients, making it more easily digested compared to whey protein.

Pea protein is a slow digesting protein and is, therefore, more satiating than faster-digesting proteins. It is also suitable for baking/cooking as it withstands heating without clumping.

Another newcomer to the protein market, beef protein isolate is made by dehydrating and processing beef to produce a protein with a HBV and complete amino acid profile.

BEEF PROTEIN

Beef protein isolate is approximately 98% protein and considered hypoallergenic, meaning it may be suitable for those with allergies to dairy, egg or other supplemental protein sources. However, beef protein can have a saltier taste compared to other proteins and may be an acquired taste for some consumers, requiring masking with strong flavours.

There is little research yet to back the use of beef protein isolate over higher quality proteins like whey, casein and soy protein. Care should be taken when VAST FITNESS ACADEMY | NAT11046006: ADVISE CUSTOMERS ON a THE USE protein OF NUTRITIONAL SUPPLEMENTS selecting beef product, however,AND asERGOGENIC productsAIDS can| include collagen or 34 VERSION 1 - 18.01.2024 VAST FITNESS ACADEMY | NAT11046006: ADVISE CUSTOMERS THE USEwhich OF NUTRITIONAL SUPPLEMENTS AIDS | VERSION 2 20.11.23 34 gelatinON protein are of lower qualityAND andERGOGENIC poorer amino acid profiles.

Another newcomer to the protein market, beef protein isolate is made by dehydrating and processing beef to produce a protein with a HBV and complete amino acid profile.

BEEF PROTEIN

Beef protein isolate is approximately 98% protein and considered hypoallergenic, meaning it may be suitable for those with allergies to dairy, egg or other supplemental protein sources. However, beef protein can have a saltier taste compared to other proteins and may be an acquired taste for some consumers, requiring masking with strong flavours.

There is little research yet to back the use of beef protein isolate over higher quality proteins like whey, casein and soy protein. Care should be taken when selecting a beef protein product, however, as products can include collagen or gelatin protein which are of lower quality and poorer amino acid profiles.

A relative newcomer to the supplemental protein market and has become popular due to recent health claims.

COLLAGEN PROTEIN

Collagen is the most abundant protein found in the human body, found in hair, skin, nails, organs, ligaments and tendons. It is made from the remnants of animal products (fish, poultry or meat bones) to produce a flavourless protein that contains a range of amino acids but is not a complete protein (it lacks the essential amino acid tryptophan).

Manufacturers have claimed that collagen supplementation can improve skin elasticity and reduce wrinkles and cellulite; however, this is not backed by a large volume of evidence. There is some evidence for the benefit to older adults with arthritis as collagen is important in joint structure. Collagen protein is not as digestible as many other proteins and is often hydrolysed to make it more digestible.(63)

Some health professionals class protein supplements as a ‘food source’ rather than as a supplement; since most protein supplements are substantially altered from their original food form (e.g., removal of carbohydrates, fats, fibre, vitamins and minerals), they should be considered a supplement.

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SAFETY OF SPORTS SUPPLEMENTATION While there is an abundance of sports supplementation available to the public, there is a poor understanding of associated safety risks and scientific evidence. As a result, the Australian Institute of Sports (AIS) uses the ABCD Classification System to differentiate between sports supplements. This makes it easier to identify which supplements are safe and recommended and which are unsafe and/or illegal.

In the ABCD system, sports supplementation and foods are broken into four groups (ABCD) based on scientific evidence (where category A has the most scientific evidence to support its use, and category D has the least amount of evidence or is banned from use) and other practical considerations, which determine if the product is safe, legal and effective in improving sports performance.(64)

CATEGORY A (Approved and/or recommended).

Sports drinks, sports gels, sports confectionary, liquid meals, whey protein, sports bars, electrolytes, calcium, iron, vitamin D, probiotics, creatine, bicarbonate, caffeine, beta-alanine, beetroot juice.

CATEGORY B (Research protocol only/ further research required).

Tart cherry, exotic berries, curcumin, antioxidants A and C, carnitine, HMB, glutamine, fish oils, glucosamine.

CATEGORY C (No proof of benefit).

Ribose, lactaway, coenzyme Q10, ginseng, chromium, MCT oils, ZMA, Inosine, pyruvate.

CATEGORY D (Harmful and/or Illegal).

The stimulants ephedrine and methylhexanamine, the prohormones DHEA, androstenedione, tribulus terrestris and glycerol.

IDENTIFYING WEIGHT MANAGEMENT SUPPLEMENTATION Weight management supplements refer to a range of products that claim to help enhance weight loss through various mechanisms such as boosting metabolism and increasing fat burning. Although many weight management supplements do not work as they claim, it is still important for a nutritional advisor to be aware of the various products that are popular in the supplementation/weight loss industry, to help to advise, educate and inform clients about which products actually work compared to their claims.

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The table below provides information on popular weight management supplements, their benefits to weight loss, approximate doses based on research and adverse side effects:

PRODUCT

GREEN TEA EXTRACT

KETONES

CLA

DESCRIPTION

BENEFITS TO SPORTING PERFORMANCE

Green tea extract contains the active compounds of caffeine and epigallocatechin gallate (EGCG), which may boost metabolism. Commonly included in popular ‘teatox’ products.

May help to achieve calorie deficit by encouraging behaviour change (e.g. replacing previously consumed high caloric beverages such as soft drinks, or being more physically active).

Supplemental ketones (betahydroxybutyrate, acetone, acetoacetate) are used to increase blood ketone levels, which can assist the body’s transition from glucose metabolism to ketone production and metabolism.

Available as salts (powdered) or esters (liquid).

May help to achieve a calorie deficit due to the natural appetite suppressing effect of ketones.

Conjugated Linoleic Acid (CLA) is a fatty acid found in meat and dairy foods. CLA has been shown to boost the fat-burning effect in animal models, but little evidence exists for its use in humans.

May help to achieve calorie deficit by encouraging behaviour change (e.g. replacing previously consumed high caloric beverages such as soft drinks, or being more physically active).

Side effects can include stomach upset, diarrhoea, nausea and fatigue.(67) Caffeine is well known to mildly boost metabolism and exercise performance.

CAFFEINE

May cause side effects such as jitters, restlessness, alertness and stomach upset.

May help to achieve calorie deficit by increasing calorie expenditure through increased exercise performance and non-exercise activity thermogenesis (NEAT).

(68)

GREEN COFFEE BEAN EXTRACT

Popularised by Dr Oz in 2012, Green Coffee Bean Extract may help boost metabolism due to its high caffeine content, however, its effectiveness has yet to be proven.

May help to achieve calorie deficit by boosting activity levels or by changing previous behaviours (e.g. replacing caloric beverages, increasing exercise).

APPROXIMATE DOSES AND ADVERSE EFFECTS a fat-burning effect: • For 400-500mg EGCG equivalent per day.(65)

supplements contain • Most 8-12g of ketones per serving.(66)

dose exists; • Nodosesstandard of between 3-6g are suggested in the scientific literature.

doses mimic coffee’s • Safe caffeine content (100-

•

200mg); however, a daily intake up to 400mg from all sources appears safe.

Clients sensitive to caffeine should exercise caution when using caffeine supplements.

dosage • Supplementation varies within research.

It may cause common caffeine-related side effects.(68)

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IDENTIFYING STIMULANTS AND ENERGY ENHANCERS Energy is predominantly derived from the food and nutrients that a client consumes, and therefore, the quality of energy is dependent on the quality of food. Clients often utilise other substances to further drive energy levels, and there are numerous types of energy enhancers on the market that work to enhance performance and/or concentration.

A ‘stimulant’ (often referred to as an energy enhancer) is any substance (or drug) that is used to excite a bodily function, usually the brain or central nervous system.

Energy enhances/stimulants can be further broken down into the following categories: 1. Natural/ ‘non-prescription’ stimulants (within scope of practice) 2. ‘Prescription only’ stimulants (outside scope of practice).

This section will assist nutritional advisors in identifying the difference between each type of stimulant/energy enhancer and whether or not they fall within their scope of practice.

UNDERSTANDING THE IMPLICATIONS AND RISKS OF CONSUMING STIMULANTS/ENERGY ENHANCERS Before identifying which supplements or substances are within or outside a nutrition coach’s scope of practice, it is important to remember that there are potential risks with using energy-enhancing supplements/substances. Some enhancers carry higher risks than others, therefore being assigned a ‘prescription only’ or ‘illegal’ status and require high regulation. Conversely, other non-prescription products or naturally occurring substances may pose little to no risk and require lower regulation.

The list provided below outlines some of the common side effects that can be experienced after consuming energy-enhancing substances (whether they be natural, non-prescription or prescription only): Heart palpitations Elevated blood pressure Nausea and vomiting Insomnia Nervousness Restlessness Muscle tremors Caffeine overdose may result in extraordinary elevated blood pressure, convulsions and, in severe cases, death Poor dental health as a lot of energy enhancers come in the form of an energy drink high in sugar Reliance on energy enhancers to improve energy Obesity Not knowing when to stop/wanting to stop using the supplements.

•• •• •• •• •• ••

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RECOGNISING NATURAL AND NON-PRESCRIPTION STIMULANTS AND ENERGY ENHANCERS (WITHIN SCOPE OF PRACTICE) First and foremost, it is important to remember that a client’s health is of utmost importance. As such, before a nutritional advisor recommends any type of energy enhancer to a client, it is important to ensure that the following considerations are taken into account: The client is already consuming a well-balanced diet that is nutritionally adequate The client is getting enough sleep on a regular basis The client is exercising regularly or to the best of their ability.

• • •

For many clients, however, the factors listed above are not always possible; In this case, there are specific supplements/ products that may help to boost their energy when they need it the most. Some products are more suitable for enhancing energy levels before or during exercise/sporting events, while others may be best taken when a client requires a quick boost of energy (often referred to as a quick ‘pick-me-up’).

Regardless of the reasons a client wishes to use energy enhancers, it is still best practice for nutritional advisors to encourage a client to check with their GP or a dietitian to determine if the supplements are safe for the client to use and if the client has any further questions.

If a client follows a healthy, well-balanced diet, then there is no need for stimulants/energy enhancers.

Energy enhancers are predominantly utilised by those in the professional sporting arena; however, recreational athletes often make use of their benefits.

It is the responsibility of the nutrition coach to advise a client if they require an energy enhancement or not. It is sensible first to ensure the diet is nutritionally complete and pre and post-workout nutrition is adequate before identifying the need for recommending energy enhancers.

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The table below lists some examples of popular non-prescription stimulants and energy enhancers that a nutritional advisor can advise and educate their clients on the use and implementation of:

NON-PRESCRIPTION STIMULANTS/ENERGY ENHANCERS TYPE OF STIMULANT

DESCRIPTION The most commonly utilised form of energy enhancement, which comes in the form of coffee, energy drinks or shots (small 3050ml liquid shots of concentrated caffeine).

CAFFEINE

Where a standard cup of coffee can contain 60-100mg of caffeine, a large energy drink can have anywhere between 300 and 500mg of caffeine: the equivalent of 4-6 coffees!

TAURINE

An amino acid naturally found in the human body that has earned the title of ‘wonder molecule’. It may have a broad range of applications for both sporting performance and disease risk reduction.

Rather than boosting energy, taurine appears to reduce the perception of fatigue.

NOOTROPICS

Nootropics are natural or synthetic cognitive enhancers designed to increase motivation, alertness and cognitive ability. Nootropics are becoming more popular; however, research is limited on the efficacy and longterm safety of some compounds.

A naturally occurring compound that assists with the production of ATP, the energy source of cells. Supplementation can provide increased energy during exercise.

CREATINE

CITRULLINE

TYROSINE

A compound that increases nitric oxide in the blood which acts as a vasodilator, increasing blood flow. This may help improve energy levels by improving oxygenation and nutrient delivery to the body.

Tyrosine is an amino acid produced from the breakdown of phenylalanine. It produces serotonin, thyroid hormones and adrenaline/noradrenaline and may help boost memory, alertness and focus.

•• • •• • •• • • • • •

FOUND IN (EXAMPLES)

APPROXIMATE DOSES BASED ON RESEARCH

Coffee Energy drinks (such as RedBull™, V™, Mother™, Monster™, Rockstar™) Other types of energy enhancers, which may include guarana, vitamin B12, Ginseng and Coenzyme Q10.

Safe doses mimic coffee’s caffeine content (100200mg); however, daily intake up to 400mg from all sources appears safe.

Clients who are sensitive to caffeine should be cautious when using caffeine supplements.

Energy drinks Single supplement (pill or powder).

Doses in the range of 5003,000mg per day have been shown to be safe.(69)

Common examples include combinations of L-theanine, caffeine phenylpiracetam, noopept, ashwagandha, ALCAR.(70),(71)

Use as directed by the specified product.

Red meat Fish Single supplement (creatine monohydrate, pre-workout) in pill or powder form.

5g per day.(32)

Found in some plant foods (first isolated from watermelon) Supplements (single supplement, pre-workout).

Found naturally in meat and dairy products Supplements (single or preworkout).

•• • • •

3-6g/day L-citrulline, or Approximately 8g/day citrulline-malate.(42)

500-2,000mg per day (usually before exercise) as L-tyrosine Large doses may cause stomach upset Tyrosine can interact with other drugs.(3)

Nootropics are synthetic compounds that have become popular for their ability to enhance motivation, concentration and cognitive ability, earning the nickname ‘smart drugs’. Unlike medicines which are designed to make sick clients better, nootropics are designed to enhance the functioning of healthy clients.

Many compounds can be classed as nootropics, including well-known compounds like caffeine, nicotine and creatine. However, nootropic products combine or stack compounds to produce specific effects. For instance, combining caffeine and L-theanine is said to produce the focused high of caffeine without the jitters that caffeine can have in large doses. Nootropics have become popular with students, bodybuilders, people working in creative industries and with those looking for neuroprotective benefits (often known as biohackers).

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KNOWLEDGE OF PRESCRIPTION-ONLY STIMULANTS AND ENERGY ENHANCERS (OUTSIDE SCOPE OF PRACTICE) Prescription stimulants increase alertness, attention and energy. In addition to this, they can also increase heart rate and blood pressure.(72) Various prescription stimulants are available on the market, such as amphetamine and methylphenidate.

Historically, prescribed stimulants were used to treat a variety of conditions, including obesity, asthma, depression and nervous system disorders. However, due to their addictive properties and frequent misuse, doctors now only prescribe stimulants for a small number of health conditions.(72) It is important to be aware that these prescriptions are outside the scope of practice for a nutrition coach.

Stimulants have similar chemical structures to certain key brain neurotransmitters, including dopamine and norepinephrine. As a result, stimulants boost the effects of these chemicals in the brain and body, producing increased alertness, attention and energy.(72) When such stimulants are prescribed, doctors begin with a very low dose and slowly increase so as to monitor the client and their personal responses. However, when these stimulants are misused, such as taking excessive quantities or in ways other than orally (e.g. injecting), dopamine in the brain is increased at an extremely rapid rate. As a result, the brain neurotransmitters do not communicate normally, resulting in a ‘high’ and increasing the risk for dangerous side effects.

(72) This misuse can lead to addiction and is one of the many reasons why the following products (described in the table below) fall outside the scope of nutrition coaches.

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The table below describes some examples of either illegal or prescription-only stimulants, drugs and energy enhancers that fall outside of a nutritional advisor’s scope of practice:

PRESCRIPTION ONLY STIMULANTS/ENERGY ENHANCERS PRESCRIPTION STIMULANT

DESCRIPTION Designed to be used for a short-term (three months) period of rapid weight loss. Contains the active ingredient ‘phentermine,’ which is chemically similar to amphetamines.

Duromine® works as an appetite suppressant and energy booster.

PHENTERMINE (AS DUROMINE®, METERMINE®)

Side effects may include: Dry mouth Disrupted sleep Elevated heart rate Increased blood pressure Restlessness Tremors Headaches Dizziness and nausea Vomiting Diarrhoea/constipation Stomach cramps.

• • • • • • • • • • •

*More serious side effects are possible but uncommon.(73)

Designed to be used for an extended period, with evidence for safety extending beyond 12 months. Contains the active ingredient ‘liraglutide,’ which mimics the effect of the hormone GLP-1 and acts to suppress appetite. Not currently available on the Australian Pharmaceutical Benefits Scheme (PBS), therefore expensive.

LIRAGLUTIDE (AS SAXENDA®)

Side effects include: Nausea Vomiting Headache Constipation Diarrhoea Stomach pain Dizziness Tiredness.

• • • • • • • •

*More serious side effects are also possible.(74),(75)

Prescription amphetamine is used to treat attention deficit hyperactivity disorder (ADHD). It works by acting as a stimulant, which can improve concentration and focus.

AMPHETAMINE (DEXEDRINE®, ADDERALL®)

Side effects include:(76),(77) Dry mouth Loss of appetite Weight loss Nervousness, Difficulty sleeping Dizziness Headaches Vomiting Diarrhoea.

• • • • • • • • •

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Commonly known as Ritalin®, methylphenidate is a prescription amphetamine used to treat the effects of ADHD. It works by acting as a stimulant, which can improve concentration and focus.

METHYLPHENIDATE (AS RITALIN®)

MODAFINIL (AS MODAVIGIL®, PROVIGIL®)

Common side effects include: Difficulty sleeping Nervousness Loss of appetite Weight loss Dizziness Nausea Vomiting Headaches.(78)

• • • • • • • •

Available on the Australian PBS to treat the effects of fatigue due to sleeping disorders.

However, also available illegally via direct sales websites.

Commonly referred to as a ‘smart drug’ or nootropic because of its effects on alertness, cognition and energy levels.(79)

SCOPE OF PRACTICE FOR NUTRITION COACHES: As nutritional advisors are not medically trained, it is outside their scope of practice to recommend drugs, such as those described above, to their clients - only GPs can prescribe these drugs. nutritional advisors are qualified to assist their clients with weight loss through dietary and behavioural changes. They must refer clients on to a suitably qualified medical professional for further assessment, where standard nutritional therapy is not successful.

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RECOGNISING THE FUNDAMENTALS OF GOOD NUTRITION It should be well recognised by now that good nutrition is fundamental to optimal physical and mental health, which is best achieved through the use of a balanced diet that provides sufficient macro- and micronutrients from a variety of sources. It is the role of the nutrition coach to help clients design a nutritional plan based on whole food nutrition that suits their unique lifestyle, preferences and goals.

Supplementation should only be considered where whole-food nutrition alone cannot achieve those goals and in accordance with a nutrition coach’s scope of practice. For instance, a nutrition coach could suggest nutritional supplementation if the client falls within their scope of practice (examples are listed below): If the client has specific food preferences (dislikes) If the client has dietary beliefs (vegetarian, vegan) If the client is an older adult who is deemed ‘healthy’ through the RSST and requires higher levels of micronutrients Clients with allergies/intolerances (who have medical clearance to work with a nutrition coach) Clients who exercise for health or competition Athletes who are looking to improve their nutrition for performance or body composition.

• • • • • •

Some examples above may require restricted diets, which could prevent clients from achieving nutritional adequacy. For instance, it would be acceptable to recommend that a vegan take iron, vitamin B12 and calcium supplements (although a blood test would be required to monitor deficiencies) as these nutrients are found most readily in animal products.

Likewise, an adult with an irrational dislike of all vegetables could be recommended to take a daily multivitamin if they refuse to improve their diet quality and want a strategy to ensure they are achieving micronutrient adequacy, if they refuse to change their eating habits.

For these reasons, nutrition coaches need to be able to determine which nutrients their clients are likely to be lacking in their diet, so to advise them on ways to improve their dietary intake and offer strategies to obtain the missing nutrients from supplementation, where diet alone is not sufficient.

Additional reasons for utilising nutritional supplementation are listed below; however, the following could also fall outside the scope of practice of a nutrition coach upon completing an RSST, in which instance a referral or medical clearance may be required: Known medical conditions (such as Crohn’s disease, cancer, IBS) Age (frail elderly individuals who are at risk of malnutrition requiring higher levels of micronutrients) Illness (requiring higher nutritional requirements) Disability (requiring different delivery of nutrients).

• • • •

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UNDERSTANDING THE IMPORTANCE OF ESSENTIAL NUTRIENTS To educate clients on nutritional supplements and their many benefits/contraindications, nutritional advisors must first have an understanding of what micronutrients actually are.

Although micronutrients have been discussed in previous units of this course, it is important to revisit and continuously develop knowledge of essential nutrients and the following information: The many roles they play in the human body How they affect a client’s health when an inadequate amount is consumed or if they are consumed to excess How to adapt a client’s diet to ensure adequate micronutrition on a day-to-day basis.

• • •

MICRONUTRIENTS Micronutrients refer to elements (vitamins and minerals) required in trace amounts (very small amounts) which enable the body to produce enzymes, hormones and other substances required for normal growth and development.

Essential nutrients refer to the nutrients required for human survival, which the body cannot synthesise itself; and therefore, relies on the nutrient being consumed via food. Even though micronutrients are only required in small amounts, a depletion of any micronutrient can have devastating effects on the functioning of the human body.

Vitamins and minerals are required in small amounts to assist with the thousands of chemical reactions occurring in the body on a continuous basis. 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 Assisting with constriction and relaxation of blood vessels pH regulation Regulating 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 on a regular, daily basis to avoid any deficiency. Consuming a healthy and well-varied diet will allow a client to reach all vitamin and mineral requirements without the need for supplementation.

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SUPPLEMENTING WITH ESSENTIAL NUTRIENTS Supplementation of certain vitamins and minerals may be required by clients who are unable to reach their daily requirements, such as those: With higher metabolic demands Struggling with inadequate access to food With malabsorptive issues Following restrictive diets.

•• ••

Understanding the importance of micronutrients gives a nutritional advisor the ability to assist clients in achieving an adequate intake of micronutrients on a day-to-day basis.

Provided below is a scenario that a nutritional advisor may encounter:

CASE STUDY A strict vegan client may come in with complaints of ongoing weakness and fatigue. Through the assessment of their nutritional intake, it is identified that there is inadequate intake of vitamin B12.

A nutrition coach would be able to identify the missing micronutrient, such as referring back to their GP to test Iron studies (B12, Iron, and Folate) and provide education to the client about the limitations of a vegan diet and the effects of deficiency (e.g. weakness/ fatigue).

If the test result comes back with a deficiency (e.g., B12), after a medical clearance, the nutrition coach can work with the client to increase their B12 consumption in their diet. However, a supplement may be indicated as there are no vegan sources of B12. It would be the responsibility of the nutrition coach to educate and encourage the consumption of whole food sources first; however, in this case, a supplement would be required.

Supplements provide the body with the essential nutrients that it would otherwise miss out on, which can be detrimental to long-term health. Below is an adapted table revisiting essential nutrients and the role they play in the human body.(19)

MACRONUTRIENTS ESSENTIAL NUTRIENT

ROLE

RDI

0.8-2.0g/kg/body weight/day (depending function and regulation of the • Structure, body’s tissues (e.g. muscles) and organs on physical activity levels, weight and the and repairing body tissues client’s goal).

• Building Control of blood sugars through the hormone, • insulin PROTEIN defence • Immunity Satiety • Fuel source (energy) for the body.

• regulation 35-60% of total EER, including: • Hormonal Satiety from polyunsaturated fat • Different types of fat either increase or • 4-10% from monounsaturated fat • decrease the risk of heart disease by • 50-65% FAT Approximately 10% from saturated fats • Omega-6: omega-3 increasing or decreasing cholesterol ratio should be • approximately 4:1.

• Fuel source for the body.

Fuel source for the body (immediate source of 20-60% of total EER. CARBOHYDRATES • energy).

(80),(81)

(82)

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IDENTIFYING COMMON DIET, NUTRITION AND WEIGHT-RELATED CONDITIONS, SYMPTOMS AND CONCERNS Before a nutrition coach can provide adequate advice and recommendations for the use of vitamins, minerals and other nutritional supplements, it is fundamental to recognise common diet, nutrition and weight-related conditions, as doing so will enable nutrition coaches to: Identify clients within their scope of practice Identify clients who may require referral to another medical or health professional for treatment Identify functional deficiencies that can be addressed through adequate nutrition.

• • •

While weight-related conditions such as underweight, overweight and obesity are easy to identify visually with the use of a body mass index (BMI) calculation and through identifying a client’s waist to hip ratio, diet and nutritionrelated conditions are harder to identify. Identifying the relationship between poor dietary choices and nutrition-related conditions is possible. For example, a client who consumes excessive amounts of refined carbohydrates and inadequate fibre may later be diagnosed with diabetes mellitus; a client who restricts their calorie intake to extreme levels may later be diagnosed with an eating disorder.

A nutritionally inadequate or nutritionally compromised diet can result in poor health outcomes if left long-term without intervention. It is a nutrition coach’s role to be able to identify nutritional gaps in the diet by making a comparison between the client’s current dietary intake and their individualised dietary recommendations.

Diet and nutrition-related conditions not only stem from inadequate nutritional intake but also from excessive intake of macro and micronutrients and a general imbalance within the overall dietary intake (for example: consuming too much protein and not enough natural fat).

As Hippocrates once said, ‘Let food be thy medicine, and medicine be thy food’.

The food a client chooses to nourish their body can either be beneficial to the human body or chronically damaging.

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There are a multitude of conditions related to inadequate nutritional intake, some of which are described in the table below:

CONDITIONS AND CONCERNS RELATING TO NUTRITION (179).

CONDITION

ANAEMIA

DYSLIPIDAEMIA (DERANGED BLOOD LIPIDS)

SIGNS/SYMPTOMS

• Fatigue iron levels • Low • Dizziness skin • Pale Muscle cramps • Headaches • Shortness of breath.

• have no signs other than a • Can deranged pathology result. have no signs other than an • Can elevated pathology result.

HYPERCHOLESTEROLAEMIA (ELEVATED BLOOD CHOLESTEROL)

• Can be asymptomatic.

HYPERTENSION (ELEVATED BLOOD PRESSURE)

CARDIOVASCULAR DISEASE

LIVER DISEASE

RENAL DISEASE

• Hypercholesterolaemia • Hypertension risk of stroke and heart attack • AtShortness • Tighteningofofbreath • Angina (chest chest pain).

• • Nausea • Vomiting • Jaundice pain • Abdominal Bleeding/bruising easily.

• • Fatigue cold • Feeling Shortness • Brain fog of breath • Itching • Swelling in hands/feet.

• ooth discolouration • Enamel • Weakenedbreakdown • Holes in teethtooth structure • Halitosis (bad breath).

• T

TOOTH DECAY

CAN BE SUPPLEMENTED WITH iron • Haem Non-haem • Vitamin C. iron •

fish oil supplements • High-quality Cod liver oil • Flaxseed oil.

• fish oil supplements • High-quality Magnesium • Vitamin B3 • Vitamin C • Fibre • CoQ10 • Tocotrienols.

• • Magnesium • Bioflavonoids • Histidine C • Vitamin CoQ10.

• fish oil supplements • High-quality Magnesium • Beta-carotene • Bioflavonoids • Resveratrol • Hawthorn berry • Carnitine.

• • Glutathione Thistle • Milk Selenium.

•

• Iron C • Vitamin Vitamin D • B group vitamins • Calcium.

• • Calcium • Phosphorus • Magnesium A, D, E and K • Vitamins Zinc.

•

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TOOTH DECAY

POLYCYSTIC OVARIAN SYNDROME (PCOS)

METABOLIC SYNDROME

OVERWEIGHT AND OBESITY

DIABETES MELLITUS

discolouration • Tooth Enamel • Weakenedbreakdown • Holes in teethtooth structure • Halitosis (bad breath).

• on the ovaries • Cysts menstrual cycle • Irregular Alopecia (hair loss) • Genetic predisposition • Hirsutism (darkening of hair and • male hair patterns) • Acne • Insulin resistance.

• Overweight/obese • Hypertension • Dyslipidaemia • Insulin resistance.

BMI • Elevated • Elevated waist-to-hip ratio. resistance • Insulin Inadequate insulin production • Elevated glucose • and post-meal) levels (fasting gain • Weight Fatigue • Excessive thirst • Excessive urination.

• iver disease • Cancer the liver • Physicalofdependence alcohol • Withdrawal symptomsonsuch • as anxiety, confusion, tremors, L

ALCOHOLISM

racing heart, nausea and sleeplessness. cancers can be • Some asymptomatic (show no

SOME FORMS OF CANCER

• • • • •

symptoms, confirmed with test results) Weight loss Fatigue Decreased energy levels Physical growth on or inside the body Tumours.

• Calcium • Phosphorus • Magnesium A, D, E and K • Vitamins Zinc.

• fish oil supplements • High-quality • Iodine • Chromium • Magnesium B6 • Vitamin • Collagen • Fibre. fish oil supplements • High-quality MCT oil • Chromium • Magnesium • Zinc • Fibre.

• • Fibre oil • MCT Carnitine • Deficient vitamins and minerals.

• • Fibre • Cinnamon • Biotin D • Vitamin Chromium.

• • Glutathione • Omega-3 vitamins • B-group Vitamin C • Vitamin D • Magnesium.

• vitamins • B-group fish oil supplements • High-quality Selenium • Resveratrol • Vitamin C. •

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RICKETS

SCURVY (VITAMIN C DEFICIENCY)

CHRONIC FATIGUE SYNDROME (CFS)

stature • Short Bone fractures • Muscle cramps • Skeletal deformities (e.g. bowed • legs) deformities (e.g.

• Teeth abscesses, enamel breakdown).

• Fatigue of appetite • Loss Nausea • Diarrhoea • Fever • Painful joints • Loose teeth • Bulging eyes • Slow wound healing.

• • Fatigue of concentration • Lack Sleep disturbances • Forgetfulness • Anxiety • Depression • Muscle weakness • Sore throat.

•

A • Vitamin Magnesium • Phosphate • Calcium • Vitamin D. •

• Vitamin C.

fish oil supplements • High-quality CoQ10 • Acetyl-l-carnitine • Magnesium • Probiotics • Amino acids.

•

It is important to always be aware of and to practice within the scope of practice for nutrition coaches.

It is essential that only clients within a nutrition coach’s scope of practice are seen, and that any who fall outside the scope of practice are referred on to an appropriate health professional efficiently and effectively.

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IDENTIFYING CONCERNS AND CONDITIONS THAT FALL WITHIN AND OUTSIDE OF A NUTRITION COACH’S SCOPE OF PRACTICE As previously explained, nutrition coaches need to identify which clients fall within their scope of practice, and those that fall outside of their scope. This is a legal requirement as nutrition coaches are trained and insured to work only with those clients listed in the scope of practice documentation. Those falling outside of scope should be referred on to a suitably qualified health professional, such as a GP or dietitian, for further care.

The table below provides examples of various scenarios and identifies which clients are within a nutrition coach’s scope of practice, and which clients fall outside their scope:

SCENARIO Individual has metabolic syndrome and is taking medication

Individual has bulimia nervosa.

Client is slightly overweight and has recently been cleared by their GP to work with a nutritional advisor.

Client has nil health concerns but would like to improve their diet.

Individual recently diagnosed with cancer who would like to improve their diet.

Client is training for a marathon or sporting event and has nil health concerns.

Client has nil health concerns but doesn’t eat enough protein. The client would like help identifying a protein supplement as a convenient way to increase protein intake.

Client has been cleared from their GP with regards to their wheat allergy. The client would like help identifying gaps in their nutrition and the possibility to add vitamins and minerals, so their diet is more nutritionally sound.

SYMPTOMS

•• Overweight/obese Hypertension •• Dyslipidaemia Insulin resistance. post meals •• Purging Underweight aversions •• Food Hair loss nails •• Broken Absence of menstruation.

•• Overweight nutritional inadequacy. weight •• Healthy Nil health concerns • Nil medications. loss •• Weight Hair loss with radiation therapy appetite •• Decreased Recent food aversions. weight •• Healthy Nil health concerns • Nil medications. weight •• Healthy Nil health concerns • Nil medications.

weight •• Healthy Nil health concerns allergy (medically • Wheat cleared from GP) • Nil medications.

WITHIN SCOPE OF PRACTICE NO

NO

REFERRAL TO practitioner •• General Accredited Practising Dietitian. eating • Specialised disorder dietitian practitioner •• General Psychologist • Counsellor.

YES

• Nil required.

YES

Nil required.

NO

practitioner •• General Accredited Practising Dietitian.

YES

Nil required.

YES

Nil required.

YES

Nil required.

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UNDERSTANDING LIFESTYLE FACTORS THAT INFLUENCE BODY COMPOSITION, NUTRITIONAL GOALS, AGEING AND SUPPLEMENTATION NEEDS IDENTIFYING LIFESTYLE FACTORS THAT CAN INFLUENCE A CLIENT’S NEED FOR NUTRITIONAL SUPPLEMENTATION LIFESTYLE FACTORS Lifestyle factors can be referred to as the modifiable habits and ways of life that can greatly influence overall health and wellbeing.(83)

Lifestyle factors play a pivotal role in achieving and maintaining a healthy body and a well-balanced, enjoyable life.

The way a client lives and the behaviours they maintain both play a part in determining long-term and short-term health (whether that be positive or negative).

It is important to understand that not only do lifestyle factors play a crucial role in improving a client’s quality of life and their ability to meet nutritional goals, but certain lifestyle factors can also: Affect the ageing process Reduce chronic disease risk Reduce mental health risks.

• • •

Furthermore, lifestyle factors can influence a client’s need for nutritional supplementation at various points throughout their lifespan by influencing nutritional requirements (positively or negatively).

There are a number of lifestyle factors that a nutrition coach will need to recognise, which can influence body composition, the need for supplementation and the achievement of personalised nutritional goals. These factors include, but are not limited to: Food choices and adequate nutrition for quality of life Food security and food access Regular physical activity Substance overuse/abuse Stress levels Living environment Social support network Health beliefs.

• • • • • • • •

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RECOGNISING THE IMPORTANCE OF ADEQUATE NUTRITION FOR IMPROVED QUALITY OF LIFE For the body to be healthy, adequate nutrition is essential. Where a client does not maintain adequate macronutrient and micronutrient nutrition, this will impact their long-term health and, ultimately, their quality of life. This is true across the lifespan, as nutritional needs change from childhood into adulthood and into older adulthood, where enhancing quality of life becomes the goal.

In Western nations, lifespan has been steadily increasing with advances in modern medicine; however, with increases in chronic diseases (often related to poor nutrition), quality of life in older age has not maintained.

Ensuring adequate nutrition throughout the lifespan is therefore an essential factor in maintaining the quality of life.

A diet that is too high or too low in certain vitamins, minerals or overall food groups can negatively affect the overall health and wellbeing of a client, reducing the quality of life. For this reason, supplementation may be beneficial for those who are unable to maintain adequate nutrition leading to deficiencies, such as someone who follows a restrictive diet or someone who has limited access to nutritious foods.

EXAMPLE

1. A fussy eater may not consume adequate vegetables and may, therefore, be at risk of inadequate fibre and deficiencies of essential vitamins and minerals on a regular basis.

2. A client may not have been taught how to cook for themselves, resulting in frequent eating

out and takeaways. This may consequently result in the client being diagnosed with obesity, hypercholesterolaemia or metabolic syndrome.

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IDENTIFYING THE IMPACTS OF FOOD SECURITY AND ACCESS TO FOOD AND HOW THIS CAN IMPACT QUALITY OF LIFE Food security is defined as the physical and economic access to food across four areas: Availability (of sufficient nutrients or range of foods) Accessibility (being able to afford to pay for food and proximity to buy it) Utilisation (having the skills to store, prepare, cook and keep food safely) Stability (of supply).(84)

• • • •

Food security is often an issue for developing nations or war-torn countries; however, it also affects Australians on a daily basis, including: Indigenous Australians living in remote areas Homeless people Students Elderly people Unemployed and under-employed people.

• • • • •

Nutrition coaches must be sensitive to the socio-economic situation of their clients, as food security can affect clients differently at different times in their lives and is not limited to those in low socio-economic areas. Food security problems can result in: Nutrient deficiencies Missed meals Unintended weight loss Loss of energy and motivation Mental health problems Social isolation.

• • • • • •

Nutrition coaches can assist those at risk of food security issues by: Helping with budget planning Suggesting cheap, nutritious food options Connecting at-risk clients with food services (e.g. meals on wheels, food banks and charities).

• • •

It is also essential for nutrition coaches to be aware that in many cases where food security and access to food is low, clients are usually unable to include nutritional supplements into their daily regime. This could be due to accessibility – not being able to afford supplements or access to particular products within their area.

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RECOGNISING THE IMPORTANCE OF REGULAR PHYSICAL ACTIVITY FOR IMPROVED QUALITY OF LIFE Regular physical activity is recognised as one of the most powerful factors in maintaining or improving the quality of life for a client. Lack of regular exercise puts a client at higher risk of weight gain, depression, high cholesterol (hypercholesterolaemia), muscle wastage and reduced functional capacity.

By exercising regularly, clients can reduce their risk of developing chronic lifestyle diseases such as obesity, diabetes mellitus, cardiovascular disease and poor mental health, which place a burden on health systems worldwide. For this reason, guidelines such as the Australian Guidelines for Physical Activity have been developed to encourage all Australians to participate in regular exercise to reduce long-term negative health outcomes and improve quality of life.

IMPORTANCE OF PHYSICAL ACTIVITY EXAMPLE: An overweight client may not exercise as a result of sore joints, but unless the diet is changed drastically, this may result in further weight gain and worsening joint pain, creating a vicious cycle of poor health.

It is important that regular physical activity is supported with the use of a nutritious diet that provides enough energy for performance and sufficient nutrients for recovery and adaptation to exercise, especially where performance or body composition goals are desired.

Nutrition coaches must be aware of the physical activity level of their clients so that they can take into account their increased energy requirements when calculating macronutrient needs and developing meal plans, and with an awareness of supplementation that may be beneficial for their client’s situation. For example, it would be appropriate for a nutrition coach to recommend that their resistance training client should supplement their diet with creatine monohydrate to assist their performance and recovery while training. It would also be appropriate to advise a recreational cyclist (training for a long-distance bike ride) on nutrition for their event, including supplementation strategies such as using glucose gels.

EXERCISE ADVICE FROM AN ACCREDITED NUTRITION COACH /NATIONALLY RECOGNISED NUTRITIONIST It is important to remember that it is not within a nutrition coach’s scope of practice to advise clients on specific/detailed exercise programming or requirements. This is due to the depth of knowledge and education required to effectively and safely support exercise requirements for clients is not covered in the performance criteria of the Certificate IV in Nutrition.

A nutrition coach can, however, provide general physical activity advice and general guidelines for physical activity that align with their scope of practice and the Australia’s Physical Activity and Sedentary Behaviour Guidelines.

The appropriate qualifications required for prescribing personalised exercise plans include Vocational Education and Training (VET) qualifications and higher education programs, 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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UNDERSTANDING THE IMPACTS OF SUBSTANCE OVERUSE/ ABUSE ON A CLIENT’S LIFESTYLE Clients use and abuse both legal and illegal substances for a number of reasons and this can have a number of impacts on their lifestyle and nutritional status. It is important for nutrition coaches to understand how substance use can affect a client’s food choices, nutritional status and health, and understand ways to encourage behaviour change. On a nutritional level, legal substances such as alcohol and tobacco can result in altered eating behaviours, while long-term use can result in illnesses that affect the gastrointestinal tract, resulting in nutrient deficiencies that ultimately reduce health and quality of life.(83) Substances, such as recreational drugs and alcohol, can impact a client’s ability to achieve their nutritional goals and overall health for a number of reasons, including: Addictiveness Poor dietary choices Nutrient deficiencies Erratic sleep patterns Lack of routine eating patterns Impacted appetite (poor and excessive) Impact on budget (ability to afford food) Calorie intake (inadequate or excessive) Decreased motivation and self-control. For example, consuming more than ten standard drinks a week is considered excessive from both a health risk and an energy intake perspective.

• • • • • • • • •

EXAMPLE: A client who remains sober through the week and uses substances over the weekend to relax may very easily and quickly undo all their efforts towards their goals. This can be extremely demotivating and may set the client back by a few weeks/months or may even cause them to give up on their goals altogether.

Excessive consumption of alcohol is also associated with vitamin and mineral deficiencies due to reduced appetite and food intake, as well as impaired absorption, metabolism and utilisation of these nutrients.

For example, alcohol reduces fat absorption and therefore affects the absorption of fat soluble vitamins A,D and E, which can result in nutrient deficiencies and associated effects, such as night blindness and weakening of the bones.

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UNDERSTANDING THE IMPACTS OF UNCONTROLLED CHRONIC STRESS ON A CLIENT’S NUTRITION-RELATED HEALTH OUTCOMES Chronic stress can be defined as ongoing stress that causes the sufferer anxiety for a prolonged period of time. While stress is a normal part of daily life and is usually acute in nature (with a defined cause and end), chronic stress is perceived as long-lasting and being outside of the sufferer’s control. It is important for nutrition coaches to understand how chronic stress can impact a client’s dietary choices and nutrition-related health outcomes.

Chronic stress and high cortisol levels cause oxidative damage within the body, which can result in accelerated biological ageing – antioxidant supplements such as vitamin C can help to reduce the amount of oxidative damage and can help to prevent early apoptosis (cell death).(85) Chronic stress may result in a client eating more, eating less or turning to substance use (such as nicotine, alcohol or illegal drugs) as a coping method. This is not an optimal outcome since all three can result in under or over-nutrition and related negative health outcomes (nutrient deficiencies, weight loss, malnutrition, obesity, chronic disease).

Stress creates an imbalance of various hormones in the body, one of them being cortisol (stress hormone). When cortisol levels rise, insulin levels also rise, which depletes glucose from the bloodstream and ultimately results in greater sugar cravings. This can result in overeating and, if constantly raised, can make overeating and binge eating a habit.

Where chronic stress impacts a client’s eating habits, resulting in deficiencies such as low iron, vitamin B12 or compromised immune function, supplementation may be required to help improve health and rectify the deficiency until normal diet can be resumed.

Supplementing with magnesium may improve symptoms of stress and anxiety as magnesium is thought to act on the hypothalamus in the brain, helping to regulate neurotransmitters as well as the pituitary and adrenal glands.(38) B vitamin supplementation has also shown promise in helping to reduce symptoms of anxiety, stress and depression by supporting brain function, even where deficiency does not exist.(86)

EXAMPLE: A client going through a divorce and having to move out of their family home is likely to have extremely high levels of stress and cortisol, which, as explained above, can result in poor dietary choices and bingeing. This is done in an effort to raise glucose levels which appears to dampen the stress response.

For a client attempting to reach nutrition and health goals, this can make it much harder to stick to healthy options and stay on track. A client such as this may benefit from supplementing with magnesium in the evenings to aid sleep and stress, and B complex vitamin supplementation in the mornings to help regulate stress and energy levels.

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UNDERSTANDING THE IMPACTS OF A CLIENT’S LIVING ENVIRONMENT ON THEIR QUALITY OF LIFE Many factors influence food choices in the living environment: Proximity to food outlets Opening hours of food outlets (24-hour access) Ease of access (e.g. car, delivery services) Advertising.

• • • •

The environment that clients live in greatly influences their food choices and, as a result, their nutritional status and long-term health. Studies show that fast food outlets are concentrated in low socio-economic areas, resulting in a higher likelihood that clients in those areas will consume poorer quality, energy-dense foods and suffer greater rates of obesity and cardiovascular disease. Constant food advertising (billboards, television adverts, social media posts, webpage banners and in-app adverts) and ease of access (close proximity or food delivery) encourages clients to make poor dietary choices based on low prices, reduced motivation to cook food from fresh and instant gratification.

Nutrition coaches need to be aware of their client’s relationship with food and their food environment to help counsel them to make better choices. Encouraging behaviour change by changing the way a client drives home (to avoid a favoured fast food outlet), deleting food apps and learning new cooking skills is invaluable for life-long nutrition and health, especially where clients fail to achieve adequate intakes of nutrient-dense foods like fruits and vegetables, which put them at risk of nutrient deficiencies.

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RECOGNISING A CLIENT’S SOCIAL SUPPORT NETWORK Lack of adequate social support can also place clients at risk of poor nutrition and nutrient deficiencies. For example: Where cooking skills have not been learned from family or friends Where clients do not have help/support to afford nutritious food Where peer influences encourage poor dietary choices (skipping meals, eating fast food regularly) Where others encourage substance misuse (e.g. binge drinking).

• • • •

Nutrition coaches should do their best to understand their client’s psycho-social situation in order to evaluate and address social issues that impact food choices.

HEALTH BELIEFS It is very common for clients to develop health beliefs that impact their food choices. For example, previous health problems in the past may have been self-treated with food avoidances which now impact current nutritional status.

Unsubstantiated beliefs about the healthfulness of certain foods (like meat, dairy or gluten) may result in a client avoiding foods that they have no need to avoid, which can reduce their overall diet quality and expose them to a greater risk of deficiency.

It is the responsibility of the nutrition coach to help re-educate clients about their nutritional health beliefs; however, this must be done tactfully and only once a good rapport is established so as not to offend a client who may have strong reasons for their beliefs. Nutrition coaches also need to be able to identify nutritional gaps in their clients’ diets and to find ways to ensure that nutritional adequacy is achieved, despite self-imposed restrictions. In these situations, shortterm supplementation may be appropriate for a client who agrees to try this intervention.

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UNDERSTANDING THE IMPORTANCE OF ADEQUATE NUTRIENT INTAKE IN SUPPORT OF THE AGEING PROCESS It is important for nutrition coaches to be aware of how ageing affects older adults and their ability to provide themselves with adequate nutrition.

The ageing process affects all major systems of the human body, resulting in physical/functional decline over time and impacts on quality of life. This can impact the nutritional status of older adults, as the digestive system becomes less efficient at digesting and absorbing nutrients and responds less effectively to protein as compared to younger adults.

The ageing process is influenced by how well a client has managed factors such as nutrition, physical activity and stress over their lifetime, as well as their genetic traits. As a result, supplementation may be an effective tool to manage nutrition and avoid deficiencies for older adults.

When understanding the importance of adequate nutrient intake and how this can support the effects of ageing, a nutrition coach is required to have knowledge of: Physiological and psychological stress and how these factors impact the ageing process Energy and nutrient needs of older adults Nutrient-related concerns of older adults.

• • •

KNOWLEDGE OF PHYSIOLOGICAL AND PSYCHOLOGICAL STRESS AND THE AGEING PROCESS Both physiological and psychological stress can promote the early onset of ageing-related diseases. Stress prompts a physical response that is hormonally driven (flight-or-flight response), which readies the body’s defences in anticipation of an external stimulus or event. Prolonged stress can result in the body’s defences being overworked and vulnerable to illness, and as clients age, the ability to adapt to internal and external stressors weakens. This can result in greater susceptibility to illness, disease and a greater risk of poor health outcomes or death.

The physiological changes that ageing brings can result in the declining function of various body parts and include changes in: Body weight Body composition Immune system Gastrointestinal tract Dental health Sensory perception Appetite.

• • • • • • •

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The table below explains how each of these physiological factors change with age:

PHYSIOLOGICAL FACTOR

CHANGE Increase due to overnutrition.

Decrease due to undernutrition. of lean muscle • Loss mass in body fat • Increase mass in bone • Reduction density.

in the • Reduction effectiveness of the IMMUNE SYSTEM

THE GASTROINTESTINAL TRACT

Reduction in physical activity/increasing sedentary behaviour, with no change in dietary intake or increasing intake of energy-dense food, can lead to a marked increase in weight for some older adults.

However, for older adults, carrying a little extra weight is actually protective of health, with a BMI of 24-31kg/m2 demonstrating the lowest mortality risk. This is because it provides fat mass that the body can use for energy during illness, with improved chances for recovery.(87)

BODY WEIGHT

BODY COMPOSITION

EXPLANATION

immune system Increased susceptibility to illness and disease.

Appetite tends to decline with age, resulting in reduced energy intake and a decrease in body mass, which can increase the risk of malnutrition and poor health outcomes.

Loss of lean muscle mass with ageing, known as ‘sarcopenia’, can result in a dramatic muscle loss in older age. This is partly due to variations in hormone signalling and increasing sedentary behaviour.

Bone density also diminishes with age due to: Inactivity Hormonal changes (especially after menopause in women) Reduced calcium intake Medication usage.

• • • •

As a client ages, their immune system responds more slowly to threats, and antibodies become less effective.

In addition to this, the body also becomes less effective at detecting and correcting cell abnormalities.

• stomach acid A condition called atrophic gastritis can result in • Reduced production inflammation of the stomach lining, resulting in small intestine reduced stomach acid production and reduced nutrient • Impaired nutrient absorption absorption in the small intestine, especially iron, Slowed GIT motility vitamin B12, biotin, folate, calcium and zinc.

• Reduced saliva • production The lining of the GIT also weakens with age, resulting Difficulty swallowing. in slowed gastric motility and changes in hormone • production. This can cause: appetite and energy intake • Reduced Weight loss • Increase the risk of constipation.

• Difficulties with swallowing, known as dysphagia, can occur as a result of changes in saliva production, functional capacity and illness (such as stroke) and require specialist management (speech pathology), which can impact dietary intake.

•• ••

Fatigue

•• •

Iron

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RENAL DISEASE

Brain fog

Vitamin D

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LIVER DISEASE

DENTAL HEALTH

SENSORY PERCEPTION

• Nausea • Glutathione Vomiting Thistle • Jaundice • Milk • Abdominal pain • Selenium.

• Bleeding/bruising easily.

• ability Gum disease and tooth loss make chewing difficult • Reduced/impacted or painful, and dentures are less effective for eating to eat some foods susceptibility to than healthy teeth. This can result in reduced • Increased oral hygiene issues. dietary intake or the avoidance of nutritious foods taste and smell • Reduced perception vision and • Impacted hearing functional • Reduced capacity to prepare meals and self-feed.

of ageing (the • Anorexia decline of appetite with

APPETITE

•

ageing) Appetite changes related to taste perception changes.

that are difficult to eat (tough meat, crunchy foods), which may lead to an increased risk of nutrient deficiencies and unintended weight loss.

There are many ways that ageing affects sensory perception and, therefore food intake. Taste and smell changes can result in changes in food acceptance, with an increased preference for sweet foods.

A reduction in physical capacity can result in difficulties preparing meals or self-feeding and increased risk of nutrient deficiencies and unintended weight loss.

Loss of appetite with ageing is common and occurs as a result of: Changes in hormones GIT function Metabolic rate Increasing sedentary behaviour.

• • • •

Taste and smell changes may also reduce appetite as food acceptance becomes impacted.

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KNOWLEDGE OF ENERGY AND NUTRIENT NEEDS OF OLDER ADULTS As adults age, their nutritional requirements for total energy, macro- and micronutrients change. Research into older adult energy requirements has led to the development of two sets of age-based guidelines: 1. A set for those aged 51-70 years old 2. A set for those over 70 years old.

While overall energy requirements for older adults tend to reduce, the need for specific nutrients varies due to a lifetime of varied dietary habits, genetic factors and activity levels.

A reduction in physical activity, hunger levels and body mass associated with ageing dictates that dietary intake be reduced to avoid unintended weight gain; however, as discussed above, unintended weight loss due to physiological changes can be equally negative for quality of life and health outcomes.(88) While requirements for energy intake may reduce macronutrient requirements (i.e. protein) and micronutrient requirements (i.e. vitamin B12), can increase because of the effect of ageing. For these reasons, supplementation of lacking nutrients becomes a more suitable solution to meeting the nutritional needs of those at risk of deficiency, especially as appetite declines, protein utilisation becomes blunted, and outdoor activities are reduced.(89) To support older clients, nutrition coaches must learn about the main nutrition requirements that change with ageing, which include: Water Energy and macronutrients Vitamins and minerals Supplementation needs.

• • • •

Knowing these changes and how to address them will enable the nutritional advisor to provide effective dietary care for their older clients; To ensure nutritional adequacy and reduce the need for supplementation (or supplement effectively where necessary).(88)

WATER FOR OLDER ADULTS Older adults are at greater risk of dehydration than younger adults because thirst signals become less effective, and total body water levels reduce with age as the kidneys become less effective at retaining water. Other reasons for failure to hydrate properly include not wanting to bother carers for water and reluctance to drink because of bladder incontinence, and difficulties mobilising to get to the toilet.

As with younger adults, older adults should aim to consume 30-35ml of water per kg of body weight per day, meaning that a 70kg male would require between 2.1 and 2.5 litres of water a day.(90)

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ENERGY AND MACRONUTRIENTS FOR OLDER ADULTS Although overall energy requirements for older adults decrease with age, it is important to consider that macronutrient needs may increase.

Protein requirements for older adults increase as the effects of sarcopenia reduce the body’s ability to respond to protein effectively (known as protein blunting), resulting in muscle wasting. This can result in loss of functional capacity and reduced quality of life.

PROTEIN

The best sources of protein include meat, chicken, fish, eggs and dairy, and older adults can safely consume 1-1.5g of protein per kg of body weight in order to help reduce the effect of sarcopenia and protein blunting. This means that a 70kg older adult could aim to consume 70-100g of protein a day, preferably distributed evenly between meals. In order to overcome the effect of protein blunting, it is recommended that older adults aim for a minimum of 20g of protein per main meal.(91) For some older adults, being able to eat sufficient protein from whole food sources may be difficult for a number of reasons. These include (but are not limited to): Difficulty chewing Preparing food Low appetite.

• • •

Supplementation with protein-based drinks may be a suitable way to achieve adequate protein intake.

Fats are crucial for health as research into the Mediterranean diet and full cream dairy products show promise for healthy ageing. Quality of fats in the diet are key, with mono and polyunsaturated fats, especially omega- 3, being beneficial for long-term health.

FATS

For some older adults, supplementing with fish oil can be beneficial for reducing inflammatory disorders, improving joint health, managing arthritis and supporting healthy brain function, especially where diet alone does not achieve the required intake of essential fatty acids.(17) Carbohydrates provide many vitamins, minerals and fibre that are essential for health and healthy ageing.

CARBOHYDRATES AND FIBRE

Aiming to remove processed foods and including fruits, vegetables, and whole grains can help older adults meet their energy and micronutrient needs while reducing their risk of unintended weight gain. As with younger adults, older adults should aim to consume around 25-30g of fibre daily to reduce the risk of constipation and support gut health.(92) When an older adult cannot meet their fibre needs from diet alone, supplements such as Metamucil can be an easy way to achieve recommendations without having to eat larger volumes of food. Always ensure that they have adequate amounts of water with fibre supplements. It is important to remember that dehydration may cause constipation.

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VITAMINS AND MINERALS FOR OLDER ADULTS While it is possible to receive adequate vitamin and mineral intakes from diet alone, older adults are at greater risk of micronutrient deficiencies. This is due to some older adults excluding fruit and/or vegetables, reduced dietary intake of nutrient-dense foods in favour of energy-dense foods, and, in some cases, changes in the body’s capability to digest and absorb nutrients.

Knowing which nutrients are at-risk for older adults will enable nutrition coaches to identify trends in their clients’ dietary habits and help steer them toward improving diet quality to address potential deficiencies.

The table below explains how and why the following four important nutrients are impacted by ageing, including: Calcium Vitamin D Iron Vitamin B12.

• • • •

Men over the age of 51 years old are recommended to consume 1,000mg of calcium a day, increasing to 1,300mg per day for those over 71 years.(93)

CALCIUM

Women are recommended to consume 1,300mg of calcium per day from the age of 51 years onwards to fight the effect of aging-related osteoporosis. However, calcium intake in older adults tends to be below these recommendations. This may be due to reduced intake of milk or dairy products related to digestive issues or taste changes.

To address this, older adults may use calcium-fortified products, add milk powder to their cooking or take calcium supplements where a deficiency exists.

Vitamin D deficiency is prevalent for clients across the lifespan, but especially in older adults as they become more sedentary and spend less time outside in the sun.

VITAMIN D

The body’s ability to convert sunlight to vitamin D also becomes less effective with age, and requirements also increase to improve muscle and bone strength.

Adults aged 51-70 years old require 10μg a day, and older adults over 70 years require 15μg a day. Where sun exposure and diet alone are not enough, supplementation may be necessary, especially for those living in residential care.(94) Adults over the age of 51 years old are recommended to consume 8mg of iron per day.(95) This is the same for both men and women, as female iron needs reduce once menstruation ceases i.e post-menopause.

IRON

Deficiency is still common among older adults as digestive issues, illness and medications result in reduced absorption of dietary iron; intake may also be reduced due to dietary changes or reduced ability to prepare or chew iron-rich foods.

Supplementation may be recommended where a deficiency exists. This should be combined with advice to optimise iron absorption, such as combining iron sources with vitamin C containing foods and the avoidance of inhibitors such as tannins (tea, red wine) and calcium around meals/supplementations.(96)

VITAMIN B12

All adults, regardless of age, are recommended to aim for 2.4μg of vitamin B12 a day from the diet.(97) B12 is important for the production of fatty acids as well as blood and brain function. However, as adults age, intrinsic factor production in the stomach declines, reducing the body’s ability to absorb vitamin B12. Therefore, some older adults may require supplementation with B12 to achieve their daily requirements.(89)

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NUTRITIONAL SUPPLEMENTATION AND AGEING As observed from the previous table, the risk of nutritional deficiencies increases with age and it is therefore likely that supplementation becomes a viable strategy for ensuring that nutrient needs are met. Supplementation becomes especially important where food preferences, medications and the ability to prepare and eat foods are impacted by age or health problems.

The following table highlights common nutrients that nutrition coaches need to be aware of as points of concern/ deficiency for their older clients.

TYPE OF NUTRIENT

EFFECT OF THE AGEING PROCESS

EXPLANATION

Reduced intake due to reduced thirst signalling and lower total body water make dehydration more likely.

Mild dehydration is common and can cause confusion. Adequate intake is essential for older adults who are at greater risk for dehydration due to reduced body mass and poor heat tolerance.(17)

Increased requirement for women over 51 years and men over 71 years to fight osteoporosis.

Women are at greater risk of osteoporosis after menopause and men over the age of 71 years.

Dairy intake often declines with age due to digestive discomfort/taste changes.(91)

Increased requirement due to reduced skin synthesis and less sun exposure.

Older adults become less active and spend less time outside in the sun, resulting in an increased risk of deficiency. Conversion of cholecalciferol to vitamin D3 becomes less effective.(98)

FIBRE

Fibre intake declines due to reduced hunger and/or changes in dietary intake and increased risk of constipation due to slowed gut motility.

Changes to the palate, food preferences, ability to prepare foods and dentition result in lower intake and potentially increasing constipation as a result.(17)

VITAMIN B12

Increased requirement due to atrophic gastritis (inflammation of the stomach) and reduced production of intrinsic factor.

Reduced production of intrinsic factor may lead to vitamin B12 malabsorption and the need for supplementation.(17)

Increased requirement to combat the effects of sarcopenia.

Poor appetite results in lower intake and reduced ability to maintain existing muscle mass. Muscle protein synthesis response to dietary protein reduces, resulting in ‘protein blunting’, requiring higher intakes to get the same effect as a younger adult.(3)

No change in requirement for older adults unless a blood test confirms deficiency.

Absorption may become less efficient due to changes in digestion and reduced intake of ironrich food sources.(17)

Decreased requirement.

Less physical activity (both activities of daily living and planned exercise).

WATER

CALCIUM

VITAMIN D

PROTEIN

IRON

ENERGY

More sedentary behaviour and activities result in reduced energy requirements as body mass declines.(17)

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NUTRIENT-RELATED CONCERNS OF OLDER ADULTS Nutrition plays an important role in preventing many ageing-related changes that were once thought to be unavoidable. Good nutrition may be able to reduce the effect of some common age-related issues, such as: Inflammation Vision Arthritis/osteoarthritis Nutrient deficiencies and the ageing brain.

•• ••

INFLAMMATION

Ageing appears to be associated with chronic low-level inflammation known as ‘inflammaging’, which is a significant risk for morbidity and mortality. This is because many diseases share the same inflammatory response, such as arthritis, osteoporosis, hypertension, diabetes mellitus and cancer.(99) Ensuring that older adults eat a healthy diet, exercise appropriately and include pre and probiotic foods in their diet may help reduce the effect of inflammation.

VISION

Ageing-related vision diseases, such as cataracts and macular degeneration, can result in poor health outcomes and reduced longevity. Maintaining healthy vision is therefore important for quality and length of life.

Good nutrition that includes the fatty acid omega-3 and vitamins C and E, sourced from fruits and vegetables, can help protect against ageing-related eye diseases.(100) Rheumatoid arthritis, osteoarthritis and gout affect over 4.5 million Australians and New Zealanders.

Rheumatoid arthritis occurs when the immune system mistakenly attacks bone tissue, resulting in pain and inflammation of the joints.

Osteoarthritis is characterised by the progressive deterioration of the cartilage found in the joints and appears to be ageing-related.

ARTHRITIS/ OSTEOARTHRITIS

Gout occurs as a result of uric acid crystals being deposited in joints causing pain, inflammation and swelling.

Treatment for all three conditions is aimed at reducing the symptoms of the diseases, such as pain relief and reducing inflammation.

Supplements such as glucosamine (RDI of 1,500mg per day) and chondroitin (RDI of 800-1,000mg per day) appear to improve symptoms of osteoarthritis while removing uric acid promoting foods (alcohol, seafood and meat) appears to alleviate the symptoms of gout.(101) As the brain ages, it becomes prone to degradation and nutrient deficiencies can exacerbate this. Many functions of the brain are affected by ageing, including: Short-term memory Mental health Problem-solving Vision Neurotransmitter synthesis Cognition.(102)

•• •• ••

The table below highlights which nutrients are most likely to assist with the preservation of good brain health:

NUTRIENT DEFICIENCIES AND THE AGEING BRAIN

BRAIN FUNCTION

DEPENDANT ON ADEQUATE INTAKE OF

SHORT-TERM MEMORY

Vitamin B12, vitamin C and vitamin E, magnesium, ginko biloba.(24)

MENTAL HEALTH

Thiamin (B1), niacin (B3), zinc, folate.

PROBLEM-SOLVING

Riboflavin (B2), folate, vitamin B12, and vitamin C.

VISION

Essential fatty acids, vitamin A.

NEUROTRANSMITTER SYNTHESIS

Tyrosine, tryptophan, choline.

COGNITION

Folate, vitamin B6, vitamin B12, iron, vitamin E, acetyl-lcarnitine.

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RECOGNISING INDUSTRY TRENDS, MYTHS AND MISCONCEPTIONS RELATING TO SUPPLEMENTATION Regarding supplementation, it is important to understand exactly what the client will benefit from taking instead of recommending a concoction of various supplements based on current dietary trends and/or myths.

With the clever and persuasive marketing strategies utilised nowadays, clients can read a supplement’s label and mistakenly believe that they need to add that particular supplement to their current supplementation plan.

It is the responsibility of the nutrition coach to accurately decipher which dietary supplements may be required and which are contraindicated, unnecessary or potentially dangerous. It is important to remember that in most cases if the body does not require additional nutrition, it will either store excess nutrients as fat, cause toxicity or pass them out as urine: all of which are unpleasant and wasteful outcomes of the client’s time and money.

CONTRAINDICATED ‘Contraindicated’ is when something is indicated to be unsafe or unnecessary to use; for example, a protein powder is contraindicated in a client who easily meets their protein requirements through diet alone.

There are many common trends and myths relating to the use of supplementation and ergogenic aids. As a nutrition coach, it is important to keep up to date with these common trends and make prog and educated decisions on whether or not to believe these industry trends and health claims. Critical thinking and common sense are also important requirements in order to educate and share the correct information with clients.

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The following table provides a list of common myths and misconceptions relating to nutritional supplementation and ergogenic aids:

MYTH/ MISCONCEPTION All clients need to take supplements.

Taking more supplementation is always better.

Supplements never interact with drugs.

FACT Sufficient nutrition can be gained from a healthy, balanced diet. Companies spend millions of dollars on marketing supplements to convince the public that they absolutely need supplements in order to increase sales.

Depending on the supplement, the result of overnutrition can result in excess energy intake, increased production of waste products (e.g. excretion of water-soluble vitamins via urination) or damage to healthy organs (e.g. the liver).

Supplementation should only be considered when a deficiency has been identified and where food alone is unable to address the deficiency.

While many do not, some nutritional supplements can interact with drugs that can reduce their effectiveness, amplify their effect or cause harm. For this reason, clients must speak with their GP or pharmacist about possible drug-nutrient or drugsupplement interactions.(79) The TGA governs the regulation of medicinal products in Australia under two categories: ‘Registered Goods’ and ‘Listed Goods’.

The Therapeutic Goods Administration (TGA) approves all dietary supplements in Australia.

Higher-risk medicines are classed as ‘Registered Goods’ and receive an individual assessment before being released for sale.

‘Listed Goods’ are lower risk and do not undergo individual assessment, with as few as 2% being assessed for compliance with TGA requirements.

Supplements always do what they claim.

Supplements are not as tightly regulated as medicines and often make false claims.

An example is detox teas that claim to aid weight loss and liver cleansing; however, they have never shown proven results in clinical trials.

Companies are able to make claims as they do not fall into the category of ‘Registered Goods’ under the TGA.

All multivitamins are the same.

The quality and quantity of individual compounds in various multivitamins differ between manufacturers. While some manufacturers formulate and test their products using high-quality compounds (such as magnesium chloride or glycinate), others opt for cheaper and poorer quality compounds (like magnesium-oxide).

This affects the product’s absorption, so nutritional advisors must understand which brands and compounds are best for their clients.

Ingredients and quantities that are listed on the supplement label are always accurate.

Calcium is calcium.

Investigations into some vitamin supplements have found that the claimed amount of ingredients listed on the label has been incorrect.

Nutritional advisors should be aware of which manufacturers produce the best quality supplements for their clients.

There are many forms of calcium, and the body better absorbs some than others.

Calcium citrate and carbonate are the most readily absorbed forms. Calcium is also absorbed best with vitamin D, which is why some manufacturers combine the two minerals into one supplement.

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‘Studies have shown’ indicates that clinical research supports whatever statement follows.

Sadly, many products make health claims based on weak or no evidence. Scientific research performed by private companies does not have to be released to the public but is often used to promote products with no firm evidence.

Nutritional advisors should research the claims made about products by using reliable sources of information such as Pubmed, Web of Science and Scopus, which archive scientific literature.

Supplementing with protein powder will make anyone put on muscle despite not exercising.

For muscles to grow larger, sufficient stimulus through exercise is required. If a client who does not exercise regularly consumes more protein than their body requires, it will either be excreted or used for energy production.

Males/females need different types of protein powder. If a female consumes protein for ‘males’, she risks growing excessive amounts of muscle which will make her look ‘manly’.

There is no such thing as gender-specific protein. Men and women both require protein for health and recovery from exercise. Protein requirements are weight, activity and goal dependent; however, both men and women can safely consume 0.8-2.2g/kg of protein depending on their needs.

Taking a multivitamin can make up for a poor diet and prevent disease.

A multivitamin is no substitute for a varied, healthy diet. Vitamins and minerals in foods are better absorbed than in supplemental form and should always be the first aim of a well-formulated diet.

All nutritional supplements are safe because they are natural.

It’s not possible to overdose on vitamins.

Vitamins, minerals and other supplements should only be taken on an empty stomach.

Whey protein makes clients fat.

Nutritional supplements are a waste of money.

Sadly, just because a nutritional supplement is made from natural ingredients, this does not automatically make it safe for consumption. Some herbal supplements have caused serious adverse effects and even death, although this is uncommon. (103) Therefore, it is important to research supplements and only recommend those with scientific data to back their effectiveness and safety.

Overdosing on water-soluble vitamins is virtually impossible as excess is excreted via the kidneys in urine. However, it is possible to overdose on fat-soluble vitamins (A, D, E and K) because instead of being excreted from the body, excess vitamins are stored, which can cause toxicity in the liver and other organs.

Vitamins and supplements should always be taken as directed on the instructions’/ label. Some minerals, like magnesium, can cause stomach upset (stomach cramps) and should be taken with food, whereas iron is best taken on an empty stomach to improve absorption.

Failure to follow directions may affect the digestion, absorption and effectiveness of micronutrient supplements.

Excess calorie intake in general results in energy storage as adipose (fat) tissue, not specifically protein, fats or carbohydrates.

As some supplements make false claims, they can be considered a waste of money as they do not do what they claim, however, not all nutritional supplements are a waste of money.

Nutritional supplements that do as they claim can provide many health benefits and are therefore worth their cost.

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A well-balanced diet is a good place to start; however, it does not mean that all the body’s nutritional needs are being met.

A well-balanced diet doesn’t require supplementation.

Individual nutrient requirements can vary and fluctuate due to age, health, environment, stress and intense training. Consider supplements as an insurance policy, one that fills in the gaps in nutrition. For example, the elderly and clients living in the northern hemisphere may benefit from taking vitamin D due to reduced sunlight exposure.

All supplements are the same quality.

Not all supplements are created equal: some manufacturers formulate and test their products to a higher standard than others and contain better quality ingredients.

Nutritional advisors should research which companies and products are the best for their clients.

Creatine is a steroid.

Creatine is a naturally occurring compound found in humans and animals and is not scientifically classified as a steroid. It is one of the most widely researched and effective supplements in the health and fitness industry, with benefits for sporting performance, energy production and brain health.(103)

Sports supplements improve a client’s strength and muscle mass even if they do not train.

Strength and muscle mass can only be increased through the application of progressive overload through resistance training. In other words, a client cannot increase strength and muscle mass without the appropriate stimulus (physical activity).

Supplements may augment the effect by improving exercise performance or enhancing recovery.

Creatine causes kidney damage.

Creatine will not cause kidney damage in healthy clients, and there is limited evidence of damage caused to those with pre-existing kidney issues.(81)

Everyone will experience the same benefits from using the same supplement.

Results may vary from client to client. Some clients find noticeable benefits from supplementation, while others do not. This does not mean that the product isn’t working. Instead, some clients respond more effectively to medications/supplements (hyper-responders) than those who do not respond (non-responders).

High protein diets are unhealthy and put unwanted stress on the kidneys.

Athletes do not need extra protein.

Strong evidence suggests that high protein diets (1.6-2.2g/kg/BW) are not detrimental to long-term health or kidney function.

Multiple studies have shown that protein intake up to 3.3g/kg of body weight does not negatively affect kidney health; however, caution must be taken for those with pre-existing kidney health problems or those with a family history of kidney issues. (3) Depending on their sport and level of exercise, athletes will require extra protein for growth, repair and maintenance of their muscle mass, especially compared to an untrained client.

The body cannot produce omega-3 and omega-6 fatty acids, so both must be obtained from the diet or by supplementation.

The body produces enough omega-3 fatty acids on its own, so there is never any need for supplementing with fish oils.

Omega-3 and omega-6 are found in: Oily fish Nuts/seeds Oils Some vegetables like avocado.

• • • •

Where diet alone, or dietary preferences, cannot provide enough omega-3, supplementation with high-quality fish oil is a suitable alternative.

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Some supplements (like chromium and creatine) have shown benefits in managing diabetes; however, they are unlikely to prevent disease onset.

Supplements can help prevent or manage conditions like type 2 diabetes or heart disease.

The best supplements are those labelled ‘all natural’.

Men need more supplementation than women.

Chronic lifestyle diseases such as type 2 diabetes mellitus and heart disease are best prevented and managed with lifestyle changes, such as: Regular exercise Eating a healthy diet Maintaining a healthy weight Reducing alcohol intake Quitting smoking.

• • • • •

The term ‘all natural’ is a marketing claim implying that a supplement’s ingredients are somehow better or purer than another brand. Still, the term does not indicate quality. This is why it is important for nutritional advisors to research a product’s ingredients and quantities of compounds and be wary of marketing claims.

Men may require more nutrition than women, generally due to having a larger body and muscle mass than women, but are unlikely to require more supplementation than women.

In some cases, women may actually require more supplementation than men. For example, having a higher iron requirement due to menstruation and greater nutrient needs while pregnant, which may not be met by diet alone.

The Australian Sports Anti-Doping Authority (ASADA) has conducted research confirming that some supplements contain substances on the banned list.

Supplements have steroids mixed in them.

Caffeine doesn’t cause side effects.

While it would be extremely rare for steroids to be added to supplements, it is best to use trusted brands and research companies and products before using or recommending them. And while some supplements contain banned substances, the banned substance may not be a steroid but rather a substance that has been deemed unsafe or unfair for use by humans or competitive athletes. (104) Caffeine may produce side effects for some clients, including: Increased heart rate Jitters Elevated mood Increased urge to defecate Inability to concentrate correctly.

• • • • •

However, these side effects are usually dose-dependent and short-term.

Caffeine has been shown to be an effective and safe supplement for sporting application.(104)(46)

Pre-workout supplements for sporting purposes are always safe as they only contain caffeine to boost energy.

Most pre-workout supplements contain a mixture of substances that are designed to boost performance, commonly included are: Taurine Beta-alanine Caffeine Creatine L-Citrulline Carbohydrates.

• • • • • •

Individuals react to supplements differently. For this reason, it is important to research products and assess their side effects prior to taking them.

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Protein shakes (i.e. whey protein) are the only source of protein that should be consumed after a workout.

The term ‘supplement’ refers only to sports supplements (i.e. only athletes should take supplements).

Supplementing with protein powder is only for athletes.

Non-athletes should never use protein powder.

The best protein to consume after a workout is whole food protein sources, as they bring additional benefits for digestion and health, such as vitamins, minerals and fibre.

However, protein supplements are convenient and fast digesting, which may benefit some clients, such as bodybuilders and athletes.

The term ‘supplement’ refers to anything that is added to complete or enhance something else.

This includes vitamins, minerals, herbal preparations, medicines and food products such as protein supplements, which anyone can use. For example, older adults, not just athletes, are regular users of supplements.

Supplementing with protein powder, while not essential for health or muscle building, can be an effective and convenient way to achieve a client’s goals, even if they are not a competitive athlete.

In addition to industry myths and misconceptions relating to supplements and ergogenic aids, it is also important as a nutritional advisor to attain the skills and knowledge for: Identifying and evaluating the quality of new products on the market against hype Being able to recognise clever marketing claims Dispelling the myths surrounding meal replacement programs and common dietary trends.

• • •

[The above factors are discussed in more detail on the following pages].

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IDENTIFYING AND EVALUATING THE QUALITY OF PRODUCTS ON THE MARKET AGAINST HYPE Nutrition coaches must stay up to date with supplements available on the market, as many new products and variants are released yearly. Evaluating the quality of a product’s ingredients will also enable a nutrition coach to identify whether the product will live up to the manufacturer’s claims or whether the claims are in fact, ‘advertising puff’.(105)

Advertising puff (or puffery) is a legal term first used in 1892 to describe a form of advertising in which a product or service is praised as being superior without any evidence to support the claim. This ‘puffery’ is to attract buyers who might not otherwise give the product or service any attention. (105)

All companies and brands will market their products in such a way as to look as appealing as possible to potential consumers. Certain catchphrases are often used on the packages of supplements to draw consumers in, such as ‘weight loss!’, ‘gluten-free’, or ‘natural’. It is the nutrition coach’s responsibility to educate the client on ignoring hyped-up catchphrases and rather focusing on the quality of the contents.

In an effort to best educate clients on the quality of products versus the hype, nutrition coaches should ensure they encourage clients to:

Read the label of the bottle/product carefully to identify indications of use (e.g. nutritionally deficient or muscle cramps) and contraindications (e.g. the supplement may react with certain blood pressure medications).

Check the supplement’s ingredient list carefully and ensure ingredients are non-harmful, with a preference for natural or organically sourced ingredients.

Note: It is important to continuously check ingredient lists of frequently-used products, as ingredients often change, which can include the addition of potential allergens or food sensitivity ingredients.

Check the nutritional label for amounts of each ingredient.

Note: It is important to continuously check ingredient quantities, even if frequently used, as the quantities are prone to change, which can cause toxicity or inadequacy of the supplement.

Identify the possible side effects of taking the supplement so that the client can be prepared should the effects arise. Nutrition coaches should also encourage the client to seek medical advice if side effects persist.

Identify any allergens in the supplement and ensure the client is not at risk.

If the client is purchasing their supplement directly, encourage them to follow the above steps to ensure the chosen supplement is safe for them. Also, clients should be encouraged to speak with the pharmacist, GPs and other qualified individuals before commencing any new supplements to identify any potential medication interactions (e.g. magnesium taken with antihypertensives (blood pressure medication) may cause hypotension (low blood pressure).

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Below is an image of a standard supplement label from a supplement with the important components circled in red. It is important for a nutrition coach to be confident in reading a nutrition label and ensuring that a particular product is suitable for the client.

2

Supplement Facts Serving Size: 2 Level Caps

3

Servings Per Container 30

Amount Per Serving

% Daily Value*

Amount Per Serving

Calories Calories from Fat

6 5

Selenium

200mcg

Total Fat

1g 1g

1%† <1%†

Tocotrienols

17mg

15000 IU

300%

Total Carbohydrate Vitamin A

(Caromin as beta carotene and alpha carotene) 1mg alpha carotene 132mcg

...

200mg

333%

Vitamin E

100IU

333%

(as calcium ascorbate)

(as d-alpha tocopherol and mixed tocopherols) Natural Mixed tocopherols 167.25mg ... d-alpha tocopherol 67mg ... d-beta tocopherol 2.25mg ...

80mg d-gamma tocopherol

5 9

...

Vitamin C

gamma carotene

8

(as selenium yeast)

d-delta tocopherol

18mg

...

% Daily Value*

(Tocomin Palm Tocotrienol Complex) d-alpha tocotrienol d-beta tocotrienol 15000 IU d-gamma tocotrienol d-delta

(algae extract)

286%

300%

750mcg

... ...

5mg

...

300mcg

...

CoQ10 (ubiquinone) Astaxanthin

1

30mg

Lutein

4

(as Floraglo marigold extract)

Zeaxanthin

(as Floraglo marigold extract)

†Percent Daily Values are based on a 2,000 calorie diet. **Daily Value not established

Other ingredients: Vegetable cellulous, Vegetable stearate, Lecithin, Medium chain triglycerides, Palm oil.

Directions: Take 2 liquid filled vegetarian capsules daily with meals.

Note: If you are pregnant or lactating, consult a health care professional beore using this product. Keep out of reach of children. Store in a cool, dry please.

Do not use this product is safety seal on the bottle is broken or missing.

LOT 809067 EXP 0909 Manufactured By: Specialised Nutrition 40 Best Quality Street, Queensland, Australia 3487 For more information please visit us at: www.specialisednutrition.com

6 7 10 11

1. PERCENTAGE DAILY VALUES (% DV):

The % DV identifies what percent of the recommended daily value a particular nutrient supplies. For example, if the % DV for vitamin C is ‘33%’, this would indicate that this product contains 33% of total daily Vitamin C requirements per serve.

2. SERVING SIZE:

The serving size indicates the amount required to be consumed to reach the corresponding % DV. Never advise clients to consume more than the recommended serving size, unless directed by a suitably qualified health professional, e.g. GP.

3. UNITS OF MEASURE:

Each nutrient will identify its unit of measure, such as international units (IU), milligrams (mg), grams (g), millilitres (ml) and micrograms (μg). These amounts can be compared to the recommended daily intake for a specific nutrient.

4. DOUBLE ASTERISK (**):

Double asterisk in place of a % DV reading indicates that % DV has not been confirmed for that particular nutrient.

5. OTHER INGREDIENTS:

Other ingredients refer to ingredients which are not considered nutrients, but rather add to the integrity and shelf life of the product. For example, tablets are bulked up using fillers such as starch, calcium, salts and sugars.

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6. EXPIRY (EXP):

Expiry refers to the date on which the product expires and should not be consumed. Vitamins lose potency over time depending on how they are packaged and stored, and should be discarded after their expiry.

7. LOT NUMBER:

Lot number identifies the specific manufacturing lot of the product. This can be beneficial if there is a recall of the product, or the consumer wishes to request information about the integrity of and ingredients used for a specific lot.

8. DIRECTIONS:

Directions provide information on how and when to take the product in a safe and effective manner. Supplements should always be taken as directed; otherwise their digestion, absorption or effect may not occur as intended.

9. NOTES:

Notes are important messages from the manufacturers to the consumer regarding specific contraindications or special precautions. This may include drug-nutrient interactions and possible allergen risks which should always be noted.

10. MANUFACTURER’S INFORMATION:

Manufacturer’s information provides information about who made the product and their location. This information can be used to assess the reputability of the company manufacturing the product.

11. FOR MORE INFORMATION:

A website, email or phone number is usually provided should the consumer have the need to get in touch, or to report the manufacturer to the TGA.

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UNDERSTANDING HOW TO IDENTIFY QUALITY INGREDIENTS AND PRODUCTS ON THE MARKET Understanding how to identify the quality of a nutritional supplement on the market is imperative for a nutrition coach.

This essential knowledge not only provides nutrition coaches with the ability to promote quality products to assist clients in reaching their nutritional goals, but it also allows nutrition coaches to educate their clients on how to identify the quality of supplements for themselves.

Educating the client is a very powerful tool for nutrition coaches as it helps the client to become more aware of products that are filled with unnecessary ingredients or products that are just ‘hype’ and gives the client the ability to make wellinformed decisions about choosing nutritional supplements.

Being able to identify the quality of a supplement is essential, especially with regards to enhancing the health and wellbeing of a client, as bioavailability and effect of some micronutrients can vary, resulting in more or less effective supplementation.

To identify quality ingredients and products, nutrition coaches must be able to: Identify common ingredients used in various supplements Recognise ways to identify a quality protein powder Recognise effective strategies for identifying a quality fish oil supplement Recognise effective strategies for identifying a quality multivitamin Identify the benefits of single-ingredient supplements vs. combination supplements Recognise which supplements will perform as they claim Recognise which supplements might perform as they claim Recognise which supplements do not perform as they claim.

• • • • • • • •

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IDENTIFYING COMMON INGREDIENTS USED IN VARIOUS SUPPLEMENTS As a nutrition coach, it is imperative to be aware that various products on the market do not just contain ingredients for what the product is intended - many products include additional ingredients. For example, a product might be advertised as a ‘protein powder’ - giving the impression that ‘protein’ is the only ingredient used to create a product; however, many consumers do not realise that there may be other ingredients in the product, such as creatine or fillers (cheap carbohydrates like maltodextrin).

Having the knowledge to identify both good and poor quality ingredients allows a nutrition coach to adequately promote and educate their clients on which products to use.

The Dietary Supplement Health and Education Act uses the term ‘ingredient’ to refer to the compounds used in the manufacture of a dietary supplement. For instance, when calcium carbonate is used to provide calcium, calcium carbonate is classed as an ‘ingredient’ and calcium as a ‘dietary ingredient’.

The term ‘ingredient’ also refers to substances such as binders, colours, excipients, fillers, flavours, and sweeteners. (106) The following table highlights common nutrients found in various supplements with their best and poor quality forms:

NUTRIENTS

BEST QUALITY FORM

POOR QUALITY FORM

COMMENTS Zinc picolinate is best absorbed.

ZINC

Zinc gluconate and zinc picolinate. (107)

Zinc oxide. (107)

MAGNESIUM

Magnesium citrate and Magnesium gluconate. (107)

Magnesium oxide/oxalate (best for constipation). (107)

Citrate and gluconate are best absorbed. (107)

CALCIUM

Calcium orotate. (107)

Calcium carbonate. (107)

Ororate is best absorbed. (107)

Cholecalciferol (D3). (107)

Ergocalciferol (D2). (107)

D3 comes from animal sources and is better metabolised by the liver. (107)

D-alpha-tocopherol. (107)

DL-alpha-tocopherol. (107)

D-form is natural, DL-form is synthetic and poorly utilised by the body. (107)

(107)

VITAMIN D

VITAMIN E

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The following table highlights common ingredients found in various supplements and their safety level:

OTHER INGREDIENTS ARTIFICIAL COLOURS

SAFETY LEVEL (SAFE/UNSAFE)

COMMENTS

Not enough data at this current time to be deemed safe/unsafe.

Some clients may have allergies to certain food dyes, and some children appear more sensitive to them, resulting in hyperactivity. However, for most clients, artificial colours are safe for consumption. (108)

Potentially unsafe.

Partially hydrogenated oils have been heated beyond a point that denatures the oils’ molecular structure, causing them to change from a liquid to a solid (e.g. margarine).

These can contain trans fats which can negatively impact HDL and LDL cholesterol levels, and no safe consumption exists, therefore should be avoided. (108)

Safe.

Palm oil is an edible vegetable oil that is acquired from the fruit of oil palms. It has a high saturated fat content and is heavily used in processed foods as a cheap additive.

PARTIALLY HYDROGENATED OILS

Palm oil production has a negative impact on the environment due to deforestation and habitat destruction for crops.

VEGETABLE OIL (PALM)

Palm oil is considered safe for human consumption with some conflicting evidence for heart health. (109) LEAD, MERCURY, AND POLYCHLORINATED BIPHENYL (PCBS)

Unsafe.

Lead, mercury and PCBs are toxic, and their consumption over time can result in liver toxicity and death.(110)

Potentially unsafe.

Talc or magnesium silicate is commonly used as a filler or anti-caking agent,(111) magnesium silicate has been implicated in the development of cancers in clients exposed to inhaled talc.

TALC OR MAGNESIUM SILICATE (553)

Its use as a food additive appears to be banned in Australia. (112) Potentially unsafe.,(113)

Titanium dioxide has been used as a white food and product colouring for decades; however, recent studies have highlighted concerns about its effects on health when administered orally. (114)

Mostly safe. (115)(116)

Xanthan gum is a type of vegetable gum that is made from microbial fermentation and used in gluten-free baked goods to replace gluten.

TITANIUM DIOXIDE (171)

XANTHAN GUM

Some side effects of xanthan gum can include bloating and gas. (115)(116)

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Safe. (117)

Guar gum is a type of fibre extracted from the guar gum plant.

Guar gum has many clinical uses (treatment of diarrhoea, high cholesterol, IBS, weight loss, small intestinal bacterial overgrowth).

GUAR GUM (EXTRACTED FROM GUAR BEAN)

Guar Gum is used as a thickening, suspending, binding and stabilising agent in food manufacturing and is generally considered safe.(117) Always ensure that clients drink adequate water with fibre supplements.

Safe. (118) LOCUST BEAN GUM (FROM CAROB TREE) (E410)

Locust bean gum is a type of vegetable gum that has been used since ancient Egyptian times.

Considered safe, and research has shown it to be safe as a formula thickening agent for infants. (118)

Safe. (119) PECTIN (FROM APPLES OR CITRUS FRUIT)

Pectin is a type of carbohydrate found in fruit. Pectin is used to make jams and as a fibre supplement.

It is known to be safe, but large doses could cause stomach cramps, nausea and diarrhoea. (119)

Mostly safe. (120) CELLULOSE GUM

Cellulose gum is a thickening agent made from various plant sources and used for various food and non-food products.

Considered safe for human consumption and adverse reactions are rare. (120)

COLLAGEN AND GELATIN (FROM ANIMAL COLLAGEN) AGAR (FROM ALGAE) (E406)

Safe. (121)

Food-grade collagen and gelatin are safe for human consumption and have been used in the food industry for decades. (121)

Safe. (122)

Agar is a type of thickening agent made from seaweed.

Recent analysis has shown that Agar is safe for human consumption. (122)

Potentially unsafe. (123)

Carrageenan is a type of thickener derived from red seaweed and used to prevent separation in dairy products and ice cream.

CARRAGEENAN (407)

Carrageenan can cause gastrointestinal upset in some clients. (123) TETRASODIUM PYROPHOSPHATE LECITHIN/SOY LECITHIN (E322)

Not enough data. (124)

Tetrasodium is an emulsifier used in common foods such as canned fish and instant pudding. Has been implicated in causing kidney damage in some clients. (124)

Safe. (125)

Lecithin is an emulsifier found in egg yolk, soybeans, legumes and corn. Lecithin is considered safe for human consumption. (125)

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Safe. (126)

Monoglycerides and diglycerides are stabilisers found naturally in many seed oils and used as an emulsifier in food products. Recent reviews have found that their use is safe. (126)

Unsafe. (127)

DMAA has been used in sports supplements; however, it is considered toxic and was banned by the TGA in 2012. (128)

Unsafe. (129)

Depea is an analogue of methamphetamine found in some commercial sports supplements. Not safe for human consumption. (129)

Unsafe. (130)

DMBA is a legal analogue of the compound DMAA, which is banned in Australia. DMBA is banned for use in sport by ASADA, and the TGA is considering banning its use as a food additive. (130)

Unsafe. (131)

Oxilofrine is a stimulant that has been used in sports supplements. Currently banned by ASADA and the World Anti-Doping Authority (WADA). (131)

Unsafe. (132)

Vinpocetine is banned in Australia due to potential potent nootropic effects. Used in supplements as a vasodilator to improve blood flow. (132)

Unsafe. (133)

Tianeptine is currently due for rescheduling as a controlled substance in Australia.

MONO- AND DIGLYCERIDES (E471)

1,3-DIMETHYLAMYLAMINE (DMAA)

DEPEA

DMBA

OXILOFRINE/ METHYLSYNEPHRINE VINPOCETINE (PIRACETAM)

TIANEPTINE

GREEN TEA EXTRACT POWDER

Tianeptine has shown promise as an antidepressant medication; however, it can be addictive and its use in supplements could be problematic. (133) Safe. (134)

Green tea extract powder is extracted from green tea. This additive is used for a variety of dieting and sports products.

Its use is considered safe in standard doses. (134)

Potentially unsafe. (135)

Yohimbe is a herbal supplement made from the bark of a tree and is popular for enhancing fat loss. Yohimbe can cause unwanted side effects and should be used with caution. (135)

Safe. (136)

Acesulfame potassium is an artificial sweetener used in soft drinks. Implicated as a carcinogen; however, extensive reviews have deemed it safe for human use. (136)

Not enough data. (137)

Sucralose is an artificial sweetener used as a sugar alternative. Considered safe for human use, but controversies over safety exist. (137)

YOHIMBE

ACESULFAME POTASSIUM (ACESULFAME-K) SUCRALOSE

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Safe. (138)

Lactase is a naturally occurring enzyme produced by humans and animals that enables the breakdown of lactose sugars found in dairy products.

LACTASE Supplemental lactase is available for those with lactose intolerance to enable them to digest lactose-containing foods. (138) Safe. (139)

Papain is an enzyme found naturally in papaya and is used as a meat tenderiser. Papain is considered safe for human consumption. (139)

Safe. (139)

Bromelain is an enzyme found within pineapple juice. It is used therapeutically as a digestive enzyme. (139)

Safe. (140)

Lactoglobulin is a major whey protein found in sheep and cow’s milk extracted for commercial whey protein supplements.

PAPAIN

BROMELAIN

LACTOGLOBULIN Lactoglobulin is often the cause of cow’s milk protein allergy. Considered safe for human consumption where an allergy does not exist. (140) Safe. (141)

Lactoferrin is a protein found in cow’s milk used in meat and dairy processing to kill bacteria. Safe for consumption except in the case of allergy. (141)

Safe. (142)

Cocoa powder is refined from cocoa beans and is commonly used in chocolate production. Cocoa powder is safe for consumption and has many health benefits. (142)

Safe.(139)

Sodium and chloride are some of the most abundant electrolytes in the human body, essential for fluid balance, nerve conduction and cellular function.(139)

Safe. (143)

Acidifier is produced from citrus fruits and used as a flavour enhancer or preservative. Citric acid is one of the most commonly used food additives and is safe for human consumption. (143)

Not enough data. (144)

Forskolin is a natural plant compound used as an additive in some weight loss products. It can cause side effects, and caution should be exercised in using it. (144)

Safe. (145)

Olive leaf extract contains active compounds that can be beneficial for health. It is considered safe for human consumption. (145)

LACTOFERRIN

COCOA POWDER

SODIUM CHLORIDE (SALT)

ACIDIFIER (CITRIC ACID ANHYDROUS) (E330)

FORSKOLIN

OLIVE LEAF EXTRACT

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GLUCOMANNAN FIBRE (KONJAC ROOT)

Safe. (146)

Glucomannan is used as supplemental fibre for a number of health conditions and is considered safe for human use; however, it is not effective as a weight loss aid. (146)

Not enough data. (147)

Alpha-lipoic acid shows promise as a supplement for managing a number of health conditions (diabetes mellitus, vascular disease, hypertension). Likely safe for consumption, but further research is required. (147)

Safe. (24)

Fenugreek is used as a supplement to boost testosterone and can help with diabetes management. Fenugreek has been used for centuries. Safe for human use, side effects are rare. (24)

Safe. (148)

Maltodextrin is a highly refined food additive made from corn, rice, potato or wheat. It is used as a thickener, filler and preservative in processed foods like desserts, sauces and sports supplements.

Maltodextrin is included in the carbohydrate count of a product. While maltodextrin is safe for human consumption, it is high GI, meaning it is not ideal for those with diabetes. (148)

Safe. (149)

Aspartame is an artificial sweetener commonly used to substitute sugar in diet or zero-calorie soft drinks.

ALPHA-LIPOIC ACID

FENUGREEK

MALTODEXTRIN

ASPARTAME

It is highly controversial due to fears over adverse effects causing headaches, cancer and gut health issues. However, at safe, normal doses, Aspartame is not linked to negative health outcomes. (149) For those who experience negative effects from aspartame, other non-nutritive sweeteners like stevia or xylitol are a better choice.

PLEASE NOTE: The items listed in the table above are not exhaustive and nutritional advisors should research ingredients they are unfamiliar with to assess whether they are suitable for their clients.

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RECOGNISING EFFECTIVE STRATEGIES FOR IDENTIFYING A QUALITY PROTEIN POWDER The protein powder industry was worth $389 million in 2014 and continues to grow. With so many products on the market, it can be challenging to decipher which brands offer quality products and which products are best avwoided. It is therefore essential that nutrition coaches recognise effective strategies for identifying quality protein powder to provide their clients with the best possible advice on what to look for in protein supplements.

There are a number of strategies to consider when identifying the quality of protein powders, including: Identifying the type of protein (whey, soy, pea, beef, hemp) Identifying the form of protein (isolate, concentrate, hydrolysates) Comparing the serving size/scoop size Recognising the ingredients Knowledge of the manufacturer’s reputation Knowledge of the manufacturing quality assurance Locating product reviews.

• • • • • • •

[The factors in the list above are further outlined in the following table.]

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STRATEGIES FOR IDENTIFYING QUALITY PROTEIN POWDERS STRATEGY

DESCRIPTION

IDENTIFYING THE TYPE OF PROTEIN

Whey protein is considered the highest quality protein available because of its high digestibility and leucine content. This is followed by casein, egg, pea and hemp proteins, respectively, which all provide a full range of essential amino acids.(22)

IDENTIFYING THE FORM OF PROTEIN

The three main forms of protein are isolate, concentrate and hydrolysates. Isolates are the purest form of protein, filtered to remove fat and carbohydrate to leave 90-95% pure protein.

Concentrates are filtered to leave around 80-85% protein, while hydrolysates are treated with acids or enzymes to make the amino acids easier to digest.(22) The scoop size is an essential factor to consider, as most containers of protein powder will typically come with a scoop and a nutritional label that indicates suggested serving sizes.

Typically, a serving size of protein is one scoop; however, scoop size and weight can differ drastically between various brands/products, and they may not always comprise of the same amount of protein.

In other words, a 30g scoop of protein powder (or one serve) does not necessarily provide 30g of actual protein. It is very rare to find a protein product where the serving size or scoop is 100% protein.

COMPARING THE SERVING SIZE/SCOOP SIZE

For example, a product label may indicate that the scoop size is 40g (approximately 1 level scoop). However, the nutritional information panel on the back of the product may specify that the quantity of protein per serving is only 20g. This indicates that the scoop (or serve) of that product only contains 50% of actual protein, which would be considered a ‘low quality’ protein. In this instance, to meet a client’s recommended protein intake, they may need to consume additional servings of the product (which could be costly for the client).

Nutritional advisors should look for and recommend products that yield at least 80-90% protein per serve as a ‘higher quality’ product. Whey protein isolates and concentrates from reputable products typically offer this level of protein.

It is also important for nutritional advisors to be aware that the standard serve or scoop size provided by a protein powder manufacturer is not suitable as a one-size-fits-all serving, as daily protein requirements are dependent on the client’s weight, physical activity level and goal(s). (51)

RECOGNISING THE INGREDIENTS

Cheaper and poorer quality protein powders can contain added fillers to bulk out the powder, including sugars like dextrose and maltodextrin, fibres like psyllium or cheap amino acids like asparagine, glycine and taurine (known as ‘amino spiking’).(150)

KNOWLEDGE OF THE MANUFACTURER’S REPUTATION

There are many protein powder manufacturers in Australia and worldwide. The popularity of a manufacturer and the length of time the manufacturer has been operating for can be a good indication of the quality of their products.(22)

KNOWLEDGE OF THE MANUFACTURING QUALITY ASSURANCE

A high-quality protein powder will have undergone processing that complies with a comprehensive quality management system like ISO 9001 to ensure that consumers receive consistent, high-quality products. (151)

Using a combination of the strategies discussed above will provide the nutrition coach with the information required to determine the quality of protein powder and whether it is worth buying or recommending to their clients.

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RECOGNISING EFFECTIVE STRATEGIES FOR IDENTIFYING A QUALITY FISH OIL SUPPLEMENT Fish oil is one of Australia’s most commonly consumed nutritional supplements, with consumers spending over $200 on fish oil supplements each year.(152) Fish oil is produced from the tissues of oily fish such as tuna, anchovies, mackerel and herring, or from fish liver, such as cod liver oil.

Fish oils contain the essential fatty acid omega-3, which humans cannot synthesise and must derive from their diet.

While it is recommended that people consume 1-2 portions of oily fish each week, which is not achieved, taking an appropriate supplement can provide the same benefit.

The types of omega-3 found in fish oil are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are the active forms of the fatty acid. While many plant foods contain omega-3 (such as walnuts, flax seeds and avocado), they only contain alpha-linolenic acid (ALA), which must be converted to its active forms in the body. Humans are poor converters of ALA, therefore consuming fish or fish oil is preferable.(17)

Fish oil also contains other types of fats and vitamins A, D and E, which are also beneficial for health and wellbeing.

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Nutrition coaches therefore need to be aware of the reasons for and benefits of fish oil, which include: Supporting heart health Supporting brain health Supporting eye health May reduce inflammation Supports healthy skin.(17)

• • • • •

SUPPORTING HEART HEALTH

The regular consumption of fish or fish oil may help reduce the incidence of heart disease. Omega-3 fatty acids may help to support heart health by: Increasing HDL cholesterol and reducing LDL cholesterol Lowering triglycerides Improving blood pressure Preventing the build-up of arterial plaques (atherosclerosis).(17)

• • • •

The brain is composed of nearly 60% fat, the majority of which is omega-3 fatty acids, making Omega-3 essential for normal brain function and supporting brain health.

SUPPORTING BRAIN HEALTH Consuming fish or fish oil supplements regularly may prevent the onset or improve the symptoms of some mental disorders, such as Alzheimer’s disease, depression, anxiety and bipolar disorder.(153) SUPPORTING EYE HEALTH

REDUCING INFLAMMATION

Like the brain, the eyes also rely on omega-3 fats for health. Regular intake of fish or fish oil may reduce the risk of aging-related macular degeneration in old age.(153) Omega-3 fatty acids contain anti-inflammatory properties, which can help reduce inflammation associated with chronic conditions such as diabetes, obesity, heart disease and depression.

Fish oil can also mobilise and reduce joint stiffness associated with arthritis, potentially reducing pain and medication usage.(153)

SUPPORTING HEALTH SKIN

Fish oil supplements contain both omega-3 and vitamin A, which work to keep skin healthy. Omega-3 has been shown to improve dermatitis and psoriasis.

(154) Vitamin A can help promote skin cell production and reduce skin dryness.(155)

In addition to the above, nutrition coaches may recommend their clients to use a fish oil supplement for a number of reasons, including (but not limited to): To supplement low fish intake (e.g. due to dislike of fish or inability to afford fish) To support vitamin A status To support vitamin D status, and To assist with disease prevention (e.g. slowed mental decline, improved cognition).

• • • •

Encouraging dietary intake and helping clients understand the benefits of fish intake should be a nutrition coach’s priority. However, if a client does not like, cannot afford or is unable to access fish for some reason, then supplementation may prove convenient and beneficial.

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CHOOSING A QUALITY FISH OIL SUPPLEMENT FOR CLIENTS As there is a vast array of fish oil supplements available on the market, it is important for nutrition coaches to be able to identify and choose quality fish oil products and educate their clients on how to do this for themselves.

There are a number of strategies that a nutrition coach can utilise in order to choose a good quality fish oil supplement, including: Identify the dose Identify the form Quality Freshness Sustainability.

• • • • •

Not all fish oil supplements are created equal, and it is important to recommend a supplement that provides a sufficient dose of EPA and DHA. The recommended intake of combined EPA and DHA is between 250-500mg a day for healthy adults(156) and varies for people with specific health conditions, with a maximum dose of 3,000-5,000mg a day shown to be safe. (157)

IDENTIFY THE DOSE

A fish oil supplement may provide a dose of 1000mg of fish oil; however, not all of this 1000mg will be from EPA and DHA, as other oils are present in fish oil, as well as vitamins D and E. Nutritional advisors should check the amount of EPA and DHA in a product by looking at the nutrition information panel. Recommending a product that provides the highest amounts of EPA and DHA per serve may provide better value for money for clients.

For example, a product that contains 1000mg of fish oil may contain 200mg of EPA and 120mg of DHA, whereas another may provide 300mg of EPA and 200mg of DHA. In this case, the second product will represent better value for money by providing a more concentrated dose of omega-3 oils.

Many fish oil products can also be formulated differently, such as using ethyl esters (EE), free fatty acids (FFA), phospholipids (PL), triglycerides (TG) or reformed triglycerides (rTG).

IDENTIFY THE FORM

Ethyl esters are a form of supplement that are synthesised from fatty acids and ethanol. They are less bioavailable in the body compared to natural fish oil supplements, therefore, are not well absorbed by the body. They also have a reduced stability, therefore, these factors make them more cost-effective.(158)

IDENTIFY THE QUALITY

Look for fish oil that has been subjected to rigorous quality testing and filtration, such as Norwegian-caught fish that has been filtered from heavy metals, such as mercury and micro-plastics.

FRESHNESS

Omega-3 fatty acids can go rancid when exposed to light and should also have a production or use-by date. Look for fish oil with natural preservatives, such as vitamin E (antioxidant). It is best to store fish oil in the fridge and avoid using a product that has passed its use-by date or smells rancid.

SUSTAINABILITY

Like most food products, fish oil is subject to sustainability issues. Choosing products that adhere to Marine Stewardship Council (MSC) requirements for sustainability helps to ensure that nutritional advisors are recommending highquality products with the lowest environmental impact.

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RECOGNISING EFFECTIVE STRATEGIES FOR IDENTIFYING A QUALITY MULTIVITAMIN Multivitamins are extremely popular supplements among the Australian population and form part of a growing industry of health products marketed for various health benefits. Multivitamins are a combination product that combines various vitamins and minerals to fill potential nutritional gaps in a client’s diet. There is no accepted definition of what constitutes a multivitamin, meaning that multivitamin products vary in composition and quality between manufacturers.(159) Choosing a multivitamin can be fraught with difficulties as many factors need to be considered, including age, gender and stage of life of the client, their ability to afford supplements, their lifestyle and likelihood to adhere to supplementation being just a few. In most cases, nutrition coaches should always aim to help their clients obtain adequate micronutrient intakes using a ‘food-first’ approach by encouraging a broad intake of fruit, vegetables and nutrient-dense animal products (such as eggs and organ meats) and use supplementation as a back up to fill nutritional gaps and reduce the risk of deficiencies.(17) Nutrition coaches may wish to recommend a multivitamin to their clients to help reduce their risk of developing nutritional deficiencies for many reasons, including: Clients following strict vegan diets Clients with food dislikes Clients with allergies or intolerances to some foods (who have obtained a medical clearance) Older adults (provided they fall within the scope of practice for nutritional advisors).

• • • •

Multivitamins come in many forms, including capsules, tablets, powders, liquids and chewable gummies, and are available from supermarkets, pharmacies, health food shops, sports nutrition retailers and online retailers(17).

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CHOOSING A QUALITY MULTIVITAMIN SUPPLEMENT FOR CLIENTS Due to their popularity, there is a vast range of multivitamin supplements on the market, and it is important for nutrition coaches to be able to identify and choose quality multivitamin products and educate their clients on how to do this for themselves.

There are a number of strategies that a nutrition coach can utilise in order to choose a good quality multivitamin supplement, including: Identifying common ingredients Identifying the quantities of ingredients Identifying the quality of ingredients.

• • •

A quality multivitamin product should include the following ingredients: Vitamin A Vitamin C Vitamin D Vitamin E Vitamin K Vitamin B1 Vitamin B6 Vitamin B12 Calcium Magnesium Iodine Zinc.

•• •• •• •• •• ••

IDENTIFYING COMMON INGREDIENTS

In addition to these common ingredients, many manufacturers include ingredients from other sources (i.e. root or fruit extracts, fillers, preservatives and colourings) to enhance shelf-life, flavour and to push a point of difference about their product.

Adding these additional ingredients is all in an effort to harness the ‘health halo’ effect, by making a product sound better than it may actually be. Many additional ingredients, like ginkgo, green tea extract and milk thistle, are unlikely to provide any benefit, especially in the very small doses they are included.

The term ‘health halo’ is a marketing term that refers to claims about a product that are designed to enhance a product’s healthfulness in the eyes of a consumer.

Terms like ‘all natural’, ‘low fat’, ‘low calorie’ or ‘organic’ are terms that attempt to make a product sound healthier to entice customers to buy them as they may provide an additional benefit for health or wellbeing. These claims are often unsupported by scientific evidence, and consumers should beware of clever marketing.

Not all multivitamin supplements are created equal and it is important to recommend a supplement that contains sufficient doses of nutrients/ingredients.

IDENTIFYING THE QUANTITY OF INGREDIENTS

A good quality multivitamin should contain 100% of the consumer’s RDI for vitamins A, B12, C, D, E and K and the minerals zinc, magnesium, folate and calcium. For all other vitamins/ minerals, they should be meeting RDI or AI, where a recommended intake exists.

Nutritional advisors should check the quantities of each nutrient by looking at the nutrition information panel. In comparing the nutrition information panels of multivitamin products, clients can determine which product provides the highest amount of each nutrient and is therefore, the best value for money.

It is important, however, for nutritional advisors to advise clients that excessive intakes of certain nutrients can cause toxicity, and more isn’t always better.

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The quality of individual ingredients in various multivitamins differs between manufacturers.

While some manufacturers formulate and test their products using high-quality ingredients, others opt for cheaper and poorer quality compounds. As such, the quality of ingredients can vary, and it is important for nutritional advisors to be aware of this and only recommend multivitamins that contain the best quality ingredients.

For example, magnesium glycinate and chloride are well absorbed by the gut, whereas magnesium oxide is not well absorbed, yet magnesium oxide is commonly used in multivitamins. This is because magnesium oxide is cheap to produce and shelf-stable, making it better value for manufacturers.

For vitamin A, beta-carotene (the precursor to active vitamin A) is commonly used in multivitamins due to being cheap; however, many individuals are poor converters of betacarotene to the active form retinol, meaning that it is less useful as a supplement.

The table below shows commonly included ingredients/nutrients within a multivitamin with their poor and best quality forms:

NUTRIENTS

IDENTIFYING THE QUALITY OF INGREDIENTS

POOR QUALITY FORM

BEST QUALITY FORM

VITAMIN A

Beta-carotene.

Retinol.

VITAMIN B1 (THIAMIN)

Benfotiamine.

Thiamin hydrochloride.

VITAMIN B2 (RIBOFLAVIN)

Riboflavin 5’-phosphate or FMN.

Riboflavin.

VITAMIN B3 (NIACIN)

Not applicable.

Nicotinamide or nicotinic acid.

VITAMIN B6 (PYRIDOXINE)

Not applicable.

Pyridoxine hydrochloride or Pyridoxal-5-phosphate.

VITAMIN B12 (COBALAMIN)

Not applicable.

Methylcobalamin (natural) or cyanocobalamin (synthetic).

VITAMIN C (ASCORBIC ACID)

Not applicable.

Ascorbic acid or calcium ascorbate.

VITAMIN D

Ergocalciferol (vitamin D2)

Cholecalciferol (vitamin D3).

VITAMIN E

DL-alpha-tocopherol (synthetic).

D-alpha-tocopherol (natural).

MAGNESIUM

Magnesium oxide.

Magnesium glycinate, citrate or chloride.

IRON

Ferrous gluconate.

Ferrous fumarate or ferrous sulfate.

ZINC

Zinc oxide.

Chelated zinc or zinc picolinate.

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IDENTIFY THE BENEFITS OF SINGLE INGREDIENT SUPPLEMENTS OR COMBINATION SUPPLEMENTS Single ingredient supplements are those supplements which contain only one main or active ingredient.

Common examples include: Creatine monohydrate Caffeine tablets Isolated amino acids (glutamine) Isolated vitamins and minerals.

• • • •

Combination supplements are those supplements which contain multiple main or active ingredients in one product.

Common examples include: Pre-workout supplements Protein powders with added vitamins and minerals Multivitamins Mineral supplements with added vitamins.

• • • •

Choosing which type of supplement to recommend or take will depend on a number of factors, including the client’s goals, their health and their budget. For example, creatine monohydrate is commonly purchased as a single supplement as it is very cheap, whereas a combination supplement that contains both creatine and another substance will be more expensive to purchase. Conversely, mineral supplements are often recommended in combination form because of the beneficial effects that some vitamin/mineral combinations can have on digestion and absorption, such as iron and vitamin C.

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RECOGNISING NUTRITIONAL SUPPLEMENTS THAT PERFORM AS THEY CLAIM Nutrition coaches need to be able to recognise nutritional supplements that perform as they claim, especially due to the lack of oversight and regulation that many ‘Listed Products’ receive from the TGA. Of the many types of supplements that are brought to the retail market each year, there are only a few well-researched supplements that perform as claimed, including: Caffeine Creatine Sodium Bicarbonate Beta-alanine.

• • • •

Caffeine has been shown to enhance endurance and short-term high-intensity exercise performance due to its stimulatory effects on alertness and reduction in perception of fatigue.

CAFFEINE

Caffeine is a popular pre-workout supplement but can cause gastrointestinal upset, nervousness, physical jitters, irritability, headaches and diarrhoea in some clients.

Low to moderate dosing of 3-6mg/kg of body weight is considered effective, with no improvement in performance seen at levels exceeding 9mg/kg.(46) Creatine is one of the most widely researched supplements in the world and has shown benefits for short-term high-intensity exercise such as sprinting and weight lifting, exercise recovery and injury prevention, and has many promising applications in medicine.

CREATINE

Creatine works by boosting and replenishing the body’s natural creatine stores to enable creatine phosphate to be produced more effectively during exercise, resulting in more explosive power and faster recovery between bouts of exercise. Its dosing and long-term safety have been proven in studies of both healthy and diseased populations, including children and the elderly, at dosages ranging from 0.3 to 0.8g/kg of body weight per day. The preferred form is creatine monohydrate, which shows the best absorption and bioavailability, and recommended dosing is 0.3g/kg/day for 5-7 days, followed by 3-5g daily after that.(160) Sodium bicarbonate supplementation has been shown to be an effective way to reduce acidity in the blood and muscle during short-term high-intensity exercise. It works by providing the body with more bicarbonate, which is used to rid the body of acid (hydrogen) and carbon dioxide (CO2), the waste products of energy production.

SODIUM BICARBONATE

Studies have shown benefits for athletes performing exercise lasting one to three minutes in duration, such as sprinting, swimming and cycling. Recommended dosing of 200 mg per kg of body weight (BW) ingested 1-2 hours before exercise has been found to improve performance. Dosages <100 mg/kg of BW does not see performance results. The optimal dosage for athletes is 300 mg/kg of BW; however, this should be the maximum where athletes are not likely to suffer gastrointestinal (GI) upset. >300 mg/kg BW can result in (GI) issues such as bloating, diarrhea and abdominal discomfort.(3) Beta-alanine is a non-essential amino acid that has shown benefits for short-term highintensity exercises such as weight lifting and sprinting. It works by buffering acidity in skeletal muscle, enhancing muscular performance and reducing fatigue.

BETA-ALANINE Dosing requires a loading phase of 4-6g a day (in doses of 2g or less) for four weeks to increase carnosine levels. Beta-alanine has been shown to be safe, with the only side effect reported being temporary paraesthesia (tingling) of the skin.(43) VAST FITNESS ACADEMY | NAT11046006: ADVISE CUSTOMERS ON THE USE OF NUTRITIONAL SUPPLEMENTS AND ERGOGENIC AIDS | VERSION 1 - 18.01.2024 VAST FITNESS ACADEMY | NAT11046006: ADVISE CUSTOMERS ON THE USE OF NUTRITIONAL SUPPLEMENTS AND ERGOGENIC AIDS | VERSION 2

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RECOGNISING NUTRITIONAL SUPPLEMENTS THAT ‘MIGHT’ FUNCTION AS THEY ‘CLAIM’ Nutrition coaches should be able to recognise products that may perform as claimed. There are a number of supplements that may perform as they claim, though evidence for their use is extremely limited, including: Beta-hydroxymethylbutyrate (HMB) Ribose.

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HMB is a product from the breakdown of the amino acid Leucine, which is well known for its effects on muscle protein synthesis. HMB appears to be anti-catabolic, meaning it may help preserve muscle mass and avoid break down during exercise. It is proposed that this may assist with the recovery and growth of muscle in resistance training clients; however, minimal benefit has been confirmed in the scientific literature.(161) Ribose (or D-Ribose) is a type of carbohydrate that is produced by the body from the conversion of dietary carbohydrates. It is proposed that supplementing with Ribose may improve athletic performance and have applications in the management of some chronic diseases. There is sufficient evidence to promote the use of Ribose as an effective supplement for improved athletic performance.(162)

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RECOGNISING NUTRITIONAL SUPPLEMENTS THAT ‘DO NOT’ PERFORM AS THEY CLAIM Although the following products/supplements have been discussed in previous pages of this resource, they have also been listed below as they often do not perform as claimed. Nutrition coaches need to be aware of these products to help improve knowledge around supplement use within the health/wellness and fitness industries, as well as educate their clients.

Examples of these products include (but are not limited to): Carnitine Chromium picolinate Fat burners.

• • •

Carnitine (or L-carnitine) is a naturally occurring amino acid that has been promoted as a ‘fat burner’ because of its effects on fatty acid transport and energy production in the cell’s mitochondria. It is found naturally in foods such as dairy, meat and fish and can be produced in the body from other amino acids.

CARNITINE

Supplementation may be beneficial for vegans or clients with a genetic abnormality resulting in a lack of carnitine production; however, most clients are able to receive enough from diet alone, making supplementation unnecessary.

Studies have shown that supplementing with carnitine does not significantly increase carnitine concentration in skeletal muscle or significantly enhance exercise performance. Long-term supplementation with carnitine may also be harmful to health with nausea, stomach discomfort and increased atherosclerosis (hardening of the arteries) risks reported.(40) Chromium is a mineral that is found naturally in small amounts in some plants. It affects carbohydrate metabolism and has been researched for potential benefits in diabetes management, weight loss and muscle growth.

CHROMIUM PICOLINATE

Although it has shown promise for managing diabetes by enhancing the action of insulin, it shows little benefit for muscle building and weight loss. Its safety over long-term use is unknown, with potential for the production of free radicals (which damage cells in the body) and interaction with some medications.(163) Many fat-burning products claim to increase the metabolism of fats and carbohydrates which can aid weight loss. They usually contain a mixture of active ingredients such as caffeine, B vitamins, herbs and superfoods.

FAT BURNERS However, products like this always carry disclaimers that state that they are to be used as part of a calorie-controlled diet and exercise program, and therefore, any weight loss is unlikely to be as a result of these products and should be avoided.(164) Detox products claim to help cleanse the liver to remove toxins, improve skin, and help burn energy more efficiently. They usually contain superfoods, fad ingredients or herbs, which at best may promote liver health, or, at worst add to liver toxicity due to their volume or unexpected intolerance by the user.(165) DETOX PRODUCTS (OR SIMILAR)

It is impossible to detoxify the body via external sources; the liver, kidneys, lungs and blood are constantly working to maintain this naturally. It is possible to support the liver to remove toxins by: Drinking plenty of water Avoiding alcohol Eating a nutritious diet Exercising regularly Managing stress Ensuring adequate sleep.

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RECOGNISING MISLEADING MARKETING CLAIMS Supplementation manufacturers and companies will do everything possible to enhance their sales, including marketing campaigns, some of which can be misleading and misguiding. As a nutrition coach, it is important to be able to identify a company’s marketing campaign and whether this campaign is exaggerated or misleading for clients.

There are a number of different types of marketing strategies that companies use in order to best sell their products, such as: Catchphrases Visual Appeal Testimonies Social Media.

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Catchphrases refer to words that tend to catch a client’s attention. Examples of catchphrases include ‘Weight loss!’, ‘Organic’ or ‘Sugar Free’.

CATCHPHRASES

It is important for nutritional advisors to educate their clients on the way that a product is marketed, as labels and marketing can often be misleading. For example: ‘Weight loss’ may be referring to clients who use the product in combination with a very low calorie diet (VLCD) for more than eight weeks ‘Organic’ may refer to only a few selected ingredients ‘Sugar Free’ may be referring only to refined sugars as opposed to natural sugars or total carbohydrate load.

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A lot of money is spent on the visual appeal of a product and encompasses both the product itself and the perceived emotion/look/feeling when taking the product. A classic example is the marketing for major soft drink brands, where life is dull and boring, but when the drink is opened, friends appear, a party starts, and the consumer is much happier.

VISUAL APPEAL

This is an extremely clever marketing campaign as it misleads clients into thinking that if they use a particular product, they will have more fun, make more friends or be more liked.

The visual appeal of a supplement is just as important; supplement packaging which looks professional and clean and has correct spelling will sell quicker than other, less visually appealing supplements.

Some companies will have a section of their social media or website dedicated to testimonies.

TESTIMONIES

It is important to remember that while some testimonies are legitimate, many of them can be paid for. This refers to a sum of money (or other forms of payment) being exchanged for the writing of positive testimonies.

It is also important to remember that each client is different. Just because someone may have a positive view or experience of the supplement, this does not mean that their results were because of the supplement alone and results always vary between clients.

Companies can use social media to market their products and run various marketing campaigns for various products, encouraging consumers to share, like, comment and tag pictures/statuses. This is often in return for a free product (e.g. when a client shares a post and tags five friends, they go into the draw to win one kg of protein powder).

SOCIAL MEDIA Companies also pay ‘social media influencers’ (users who have a substantial number of followers on platforms like Instagram), to spruik a particular product in their posts. This form of advertising is more influential than regular advertising as influencers are seen as trusted sources of information.

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THE MYTH OF MEAL REPLACEMENT PROGRAMS AND COMMON TRENDS

Meal replacements refer to drinks and/or foods that provide 100% of nutritional needs and are considered a sole source of nutrition (i.e. if someone were to only consume meal replacements, they should not become deficient in any nutrients). However, a variety of portion-controlled shakes, bars, smoothies and soups are falsely being sold as ‘meal replacements’ when in fact they do not provide adequate micronutrition.(166) Meal replacements are a popular weight loss strategy often used in conjunction with a very low calorie diet (VLCD) and advice from a health professional.

As a nutrition coach, it is important to educate clients on the pros and cons of meal replacement programs and to also be aware that not all health professionals are well-versed or educated in the study of nutrition (i.e. pharmacists, GPs).

There are several important factors to consider when it comes to deciphering the benefits and recommending meal replacement programs to clients. These factors include: Understanding the pros and cons of meal replacement programs or products Supplementation during meal replacement programs Identifying ingredients of meal replacement programs/products Duration of the meal replacement strategy/program Meal replacement guidelines for nutritional advisors.

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[These factors are discussed in more detail on the following pages.]

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RECOGNISING THE PROS AND CONS OF MEAL REPLACEMENTS It is important to discuss the pros and cons of meal replacements with clients prior to the implementation of any type of meal replacement product. The table below outlines some pros and cons of meal replacements:

PROS

CONS

A quick and easy alternative for those short on time.

Does not substitute a healthy diet as it is not nutritionally complete.

Highly palatable secondary to the artificial sweeteners and flavours.

Lack of fibre will cause sugar spikes and decreased satiety and increase the risk of constipation.

Portion controlled.

Contain harmful ingredients, including artificial sweeteners, vegetable oils and refined sugars.

Easily transportable.

Not a sustainable method for ongoing weight loss.

Difficulty in attending social events where food is involved.

Not recommended for long-term use.

SUPPLEMENTATION WITH MEAL REPLACEMENT PROGRAMS The vast majority of meal replacements are not nutritionally complete, so it is important to recommend a trusted brand of vitamin and mineral supplement for the duration of the meal replacement program. It is important to study the label of the meal replacement and identify which particular nutrients are missing, and then use this as a guide when recommending vitamin and mineral supplements.

Many meal replacement programs will recommend the consumer to consume a proper meal once or twice a day. If this is the case, the client should be recommended to ensure that their proper meal includes a full serving of protein, 2-3 serves of vegetables and a serving of healthy fats to ensure nutritional adequacy.

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IDENTIFYING INGREDIENTS OF MEAL REPLACEMENT PROGRAMS/PRODUCTS Ingredients of each product will depend on the brand and type of meal replacement. As the majority of meal replacements are used for enhancing weight loss, they are often portion controlled and average approximately 800kJ per serve (generally moderate protein, low fat and moderate to high carbohydrates).

Meal replacements often lack essential vitamins and minerals, and therefore supplementation is of paramount importance for the continued health of the client. Many meal replacements also lack fibre, which is important for regulating sugar levels and improving satiety; the replacements may therefore not be satiating and cause spikes in blood glucose levels (BGLs).

In addition to inadequate micronutrients, meal replacements often contain potentially harmful ingredients which may not be consumed in a standard healthy diet, for example: Vegetable oils Refined sugars (e.g. fructose, dextrose) Artificial colours and sweeteners (e.g. aspartame).

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DURATION OF MEAL REPLACEMENT PRODUCTS Nutrition coaches need to be aware of the recommended time frames or the duration of a meal replacement program or product. This is because some meal replacements are used to replace one meal per day, whereas others are intended to replace all meals for a set period of time, after which whole foods can be gradually reintroduced back into the diet.

Some programs recommend the client to replace one meal a day with a shake, for example, at breakfast time. The benefit of this type of program is moderate calorie restriction without restricting overall food intake, with the hope of improving adherence to the program. This may benefit clients looking for a convenient option for one meal a day (e.g. those who don’t have any time to prepare a full breakfast or who want something easy for lunch). This style of program will result in slower weight loss in comparison to a two-shake program, which may be more desirable for some clients.

Other programs recommend replacing two meals a day with shakes. The benefit of this type of program is a larger calorie restriction, which may induce faster weight loss. This can help improve adherence to a weight loss protocol in the short term for clients who are motivated by seeing fast results. It may also be convenient for those who are time-poor or who do not know what to eat to lose weight.

Meal replacement programs can also act as a way of breaking old dietary habits for a period of time before introducing new healthy eating practices. However, a program like this can be hard to maintain for an extended period of time as meal fatigue can occur, whereby the client becomes bored of the shakes and begins to stop using them or adds in ‘cheat’ foods to supplement the shakes. For this reason, it is important that nutrition coaches follow product guidelines and do not recommend these products for longer than three months.

Meal replacement products have only proved to be successful for short-term use due to the occurrence of meal fatigue that many clients experience in attempting to use meal replacement shakes over a long period of time. (167) To improve adherence, clients should be offered regular contact with a nutrition coach who can offer support and encouragement while preparing the client for healthy behaviour changes and eating habits that support weight loss maintenance once meal replacements are ceased.

When weighing up the pros and cons of meal replacements, it may become evident that clients do not wish to remain following this type of diet or program for an extended period of time. The sooner a client recommences a whole food diet, the better.

A whole food diet is superior to meal replacements for a number of reasons, including: Enhanced satiety Nutritionally complete Adequate fibre More socially accepted Enhanced sustainability.

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MEAL REPLACEMENT GUIDELINES FOR NUTRITION COACHES It is important for a nutrition coach to be well educated in regards to which meal replacements are useful and which brands should be completely avoided. It is also important to remember that supplements, even if labelled as ‘meal replacement’ products, are designed to ‘complement’ a diet where there is a clear indication for their use (such as where a nutrient deficiency exists) and should never completely replace whole food nutrition.

Meal replacement shakes can be a good option for some clients and show promise as a means to elicit rapid and medically valuable weight loss for conditions such as diabetes, high blood pressure and high cholesterol. However, for nutrition coaches, a ‘food first’ or ‘whole food’ approach is always preferred as a means of producing healthy and sustainable weight loss.

As a guide, when selecting or educating clients about meal replacement, products should ideally contain: 20-30g of protein per serve, to ensure satiety (fullness) Fortification with a third of daily vitamins and minerals in order to assist with nutritional adequacy >6g of fibre per 100g, to assist with daily requirements and reduce constipation risk <10g of sugars per 100g, to reduce energy intake and blood sugar spikes No vegetable oils or harmful artificial sweeteners, as these can cause gastrointestinal upset and increase inflammation.

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FOOD FORTIFICATION Food fortification is ‘the practice of deliberately increasing the content of an essential micronutrient i.e. vitamins and minerals (including trace elements) within a food, irrespective of whether the nutrients were originally in the food source.

The concept of food fortification is to improve the nutritional quality of the food supply and to provide a public health benefit with minimal risk to health.(168)

Nutrition coaches must also remember that the success of a ‘meal replacement program’ relies on the support provided during its use. If clients do not learn new dietary habits, then they are likely to regain weight when returning to past behaviours that led to weight gain initially. Nutrition coaches can work with their clients to create new habits and behavioural change that suits their preferences, lifestyle and psychological needs for permanent weight loss.

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RECOGNISING DANGEROUS, BANNED AND ILLEGAL SUBSTANCES AND THE ROLE OF A NUTRITION COACH Some supplements are dangerous, banned and illegal for human use, and nutrition coaches can help to educate their clients on the possible implications and dangers of illegal substance use. If a client requires more information regarding any illegal substance, they should be referred to a specialised physician or GP as it is outside of a nutrition coach’s scope of practice to provide any advice on or recommend a client to use any type of banned substance.

Examples of illegal/banned supplements include (this is not an exhaustive list): Anabolic steroids DHEA and androstenedione Human growth hormone (hGH) Clenbuterol.

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Anabolic steroids are derived from testosterone and promote muscle growth beyond normal physiological potential. They are used heavily in the bodybuilding world as well as in competitive sports, such as the Olympics, where they offer competitors an advantage.

ANABOLIC STEROIDS

Steroid use can produce dangerous side effects, including: Aggression and hostility Heart disease Liver damage Hormone deficiency.

•• • •

For these reasons, steroids are banned for use in competitive sports and illegal for use in most countries, except under medical supervision.(169) DHEA and androstenedione are prohormones (hormone precursors) produced in the adrenal glands that act as precursors for testosterone production. While promoted for benefits including fat loss, muscle gain and slowing ageing, there is little evidence to support these claims.(170) DHEA AND ANDROSTENEDIONE

Much like anabolic steroids, their use can produce unwanted side effects, including: Aggressive behaviour Liver enlargement Testicular shrinkage Acne.

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DHEA and other prohormones are controlled substances in Australia, meaning their use is illegal.(171) Many fat-burning products claim to increase the metabolism of fats and carbohydrates which can aid weight loss. They usually contain a mixture of active ingredients such as caffeine, B vitamins, herbs and superfoods.

FAT BURNERS However, products like this always carry disclaimers that state that they are to be used as part of a calorie-controlled diet and exercise program, and therefore, any weight loss is unlikely to be as a result of these products and should be avoided.(164) Detox products claim to help cleanse the liver to remove toxins, improve skin, and help burn VAST FITNESS ACADEMY | NAT11046006: ADVISE CUSTOMERS ON THE USEThey OF NUTRITIONAL SUPPLEMENTS AND ERGOGENIC AIDS | or herbs, which energy more efficiently. usually contain superfoods, fad ingredients VERSION 1 - 18.01.2024 at best may promote liver health, or, at worst add to liver toxicity due their volume or VAST FITNESS ACADEMY | NAT11046006: ADVISE CUSTOMERS ON THE USE OF NUTRITIONAL SUPPLEMENTS AND ERGOGENIC AIDSto | VERSION 2 20.11.23

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HUMAN GROWTH HORMONE (hGH)

Human growth hormone (hGH) became popular due to the belief that it is safer than anabolic steroids, with fewer side effects. However, hGH causes not only the muscles to grow but also internal organs and bones, resulting in many potential negative side effects, including: Diabetes mellitus Thyroid cancer Heart disease Reduced sex drive Menstrual irregularities Shortened lifespan.

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hGH is banned in Australia for the above reasons.(172) Clenbuterol is a compound of drugs known as a beta2-antagonist. It works by increasing the dilation of the bronchioles in the lungs and is used as a prescription medicine for the treatment of asthma and chronic obstructive pulmonary disease (COPD). It became popular with bodybuilders due to its effect on metabolism and is used as a fat burner. However, limited evidence exists to support its claims for muscle growth or strength, and it is on the banned list under the Olympic World Anti-Doping Code.

CLENBUTEROL

Side effects may include:(173) Headaches Tremors Cramps Restlessness Anxiety Insomnia Nausea Palpitations Hypertension Increased appetite.

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Nutritional advisors are reminded to refer back to their scope of practice (SoP) developed by the Nutrition Council Australia (NCA, 2018) as a continuous reference guide, in order to stay within their scope of practice.

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UNDERSTANDING THE BIOAVAILABILITY OF MICRONUTRIENTS IN FOODS AND THE RELEVANCE OF SUPPLEMENTATION

BIOAVAILABILITY ‘Bioavailability’ refers to the proportion of a nutrient that is absorbed from the diet and used for normal body functions.(174)

While supplementation has the ability to add vital nutrients to supplement a diet, the amount which is absorbed (absorptive capacity) and the amount that actually enters the blood’s circulation and is utilised by the human body (bioavailability) needs to be taken into consideration. For example, only 90% of a nutrient may be absorbed, and from that 90%, only 80% may actually enter the bloodstream and be utilised by the body. Therefore, even though a client may be taking adequate supplementation to reach recommended dietary intakes, their body may only be utilising a fraction of this amount.(175)

There are a number of different types of nutrients; some of these enter the body in a ‘ready to use’ or active state, and others require synthesis (connection of other molecules/compounds) in order to make them active.

The human body is only able to absorb and/or utilise active ingredients, and therefore ensuring that the nutrients are bioavailable is essential to optimising the function of the chosen dietary supplement. For example, many vitamin D supplements come in the form of vitamin D3 (cholecalciferol), which is synthesised and activated in the skin by exposure to sunlight (UV radiation). This nutrient can then be utilised as opposed to supplementing with vitamin D2 (ergocalciferol), which is less effective at raising circulating vitamin D levels.

The bioavailability of macronutrients (carbohydrates, proteins, fats) is usually very high at more than 90% of the amount ingested.

The bioavailability of micronutrients (vitamins and minerals) on the other hand, can vary, resulting in wide variations in the extent to which they are absorbed and utilised, even between two types of the same mineral or vitamin.

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A vitamin supplement that is not well absorbed may cause toxicity or wastage, and it will be passed out of the body in the urine or stool. Therefore, it is important to be aware of factors that can enhance the bioavailability of various compounds, such as combining nutrients to increase absorption and those that can inhibit their bioavailability, such as foods that compete with nutrients for absorption.

ENHANCERS AND INHIBITORS OF NUTRIENT BIOAVAILABILITY (IN RELATION TO SUPPLEMENTS AND VITAMINS) ENHANCERS

INHIBITORS

‘Enhancer’ refers to: Intensifying, increasing, or further improving the quality, value, or extent of something.(176)

‘Inhibitor’ refers to: A substance that slows down or prevents a particular chemical reaction or other process, which reduces the activity of a particular reactant, catalyst, or enzyme.(179)

Enhancers improve nutrient absorption by increasing solubility or protecting the nutrient from an inhibitor. For example, carotenoids, which are found in brightly coloured plant foods, are fat soluble and are better absorbed in meals containing at least 3-5g of fat or oil.(177)

Inhibitors may reduce nutrient bioavailability by: 1. Binding the nutrient in a form that is not recognised by the binding site on the surface of intestinal cells and is therefore excreted. For example, phytic acid is abundant in some plant foods (e.g. pulses, whole-grain cereals, seeds, nuts) and strongly binds to minerals (e.g. calcium, iron and zinc).(180) 2. Making the nutrient insoluble and therefore unavailable for absorption 3. Competing for the same binding site on the surface of intestinal cells, blocking the vitamin/mineral’s transport into the cells.

Iron, an essential mineral, is better absorbed with the addition of vitamin C, which increases absorption by 20-30%. So, consuming vitamin C-rich vegetables, like capsicum, with iron-rich foods, like steak, can help increase iron absorption from a meal.(178)

The inhibitory effect of food components can also be used beneficially, for example, phytosterols. Phytosterols are extracted from certain plant foods and added in higher doses (about 2g per portion) to other foods (e.g. fermented milk drinks and enriched spreads) to lower cholesterol absorption. (181)

Therefore, when educating clients and recommending supplements, the following factors need to be considered: Vitamin and mineral absorption Vitamin and mineral wastage Any possible vitamin and mineral interactions within the body Knowledge of drug and medication interactions.

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UNDERSTANDING VITAMIN AND MINERAL ABSORPTION Fat-soluble vitamins, vitamins A, D, E and K, require fat for optimal absorption. If the diet contains inadequate fat, for example, a low-fat diet, the body will have difficulties in absorbing fat-soluble vitamins. Fat-soluble vitamins are not required on a daily basis as the body is able to store them. Excess fat-soluble vitamins may result in toxicity.(182) On the other hand, water-soluble vitamins are required daily as they are otherwise passed out in the urine if excess is consumed. Taking large doses of water-soluble vitamins (B- group vitamins and vitamin C) does not mean that the body will absorb it all. The body will simply absorb what it requires and then excrete the rest of it out.(183)

Minerals are required from the diet in small doses. Minerals are absorbed in the small intestine either by passive or active transport. Some minerals, such as iron, require a co-transporter in order to be absorbed. In contrast, electrolytes such as sodium, potassium and chloride are able to travel freely through the cells of the intestine and into the blood. Excess minerals may result in toxicity.(17)

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UNDERSTANDING VITAMIN AND MINERAL WASTAGE Vitamins, when not well-absorbed well or in excess, are essentially wasted as they are excreted out of the body without being utilised. Unlike fat-soluble vitamins, water-soluble vitamins require replenishment on a daily basis as they are not stored in the body. If a large dose is taken, the body will utilise what it needs and excrete the rest via the urine.

As with vitamins, minerals consumed in excess will either be excreted or stored. The kidneys control sodium, potassium and chloride storage and excretion.

Where intake is lacking, however, excretion will be reduced, as mineral electrolytes are extremely important in the body and the kidneys for normal bodily functions. Deficiency and excess are therefore rare due to constant bodily regulation and easy availability in the diet.

Trace minerals such as iron, zinc and copper are required in small amounts, and excessive intake can result in toxicity to the body, much like fat-soluble vitamins.

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RECOGNISING VITAMIN AND MINERAL INTERACTIONS WITHIN THE BODY As a nutrition coach, it is important to consider the synergistic relationship that vitamins and minerals may have. In this context, synergistic refers to the interaction of two or more nutrients that produce a combined effect greater than the sum of their separate effects. Nutrients do not always work alone in the body but rather work with other nutrients to enhance or inhibit their effect.

When recommending supplementation, a nutrition coach must consider all possible interactions of the supplements, ensuring there are no negative side effects and that the recommended supplementation is safe, given individual requirements and health status.

Some common examples of nutrient interactions may include: Vitamin C increases iron absorption Calcium decreases iron absorption Vitamin D increases the bioavailability and absorption of calcium Calcium and magnesium reduce the absorption of each other Zinc reduces copper absorption Phytic acid reduces zinc absorption.

• • • • • •

MICRONUTRIENT

VITAMIN/MINERAL INTERACTION WITH Vitamin C.

EXPLANATION Vitamin C increases the absorption of iron, especially non-haem iron (plant-based iron sources) in the small intestine.(107) This can be beneficial for those who struggle with iron deficiency anaemia, or for vegetarians/vegans, as it will help to boost iron stores, however, it can be dangerous for those with excess iron storage (haemochromatosis).

Vitamin A.

Similar to the effect of vitamin C, vitamin A increases the absorption of iron, especially nonhaem iron (plant-based iron sources) in the small intestine.(107)

IRON This could be useful for vegans or vegetarians who do not consume the more readily absorbed haem iron sources (meat, fish, dairy), but again, it can be dangerous for clients with haemochromatosis.

Calcium.

Calcium may decrease iron absorption in the small intestine, although this exact mechanism is poorly understood.(107) For this reason, nutritional advisors should advise their clients to avoid consuming large quantities of dairy with iron-rich foods or supplements, to ensure optimal iron absorption (especially if iron stores are low).

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MICRONUTRIENT

VITAMIN/MINERAL INTERACTION WITH Vitamin D.

EXPLANATION Vitamin D increases the absorption of calcium by increasing the number of calcium transport channels on the intestinal lumen, enabling more calcium to be absorbed and pumped into the bloodstream more quickly.(107) Since calcium is the most abundant mineral in the body, improved absorption ensures that plenty is available for use. It also counteracts the action of phytates (found in grains) and oxalates (found in some vegetables), which inhibit the absorption of other important nutrients such as zinc.

CALCIUM Magnesium.

Calcium and magnesium reduce the absorption of each other (e.g. calcium reduces the absorption of magnesium, and magnesium reduces the absorption of calcium). Therefore, a client with low magnesium should avoid taking calcium simultaneously as magnesium as this would hinder the magnesium’s absorption.

Sodium.

When sodium intake is high, this can interact with calcium levels as both calcium and sodium are then excreted.(107)

Zinc.

Zinc reduces the absorption of copper. For those with copper toxicity, this can be extremely helpful, as it will reduce the absorption of copper, reducing a client’s copper levels to normal.

COPPER However, clients with inadequate copper levels would need to ensure zinc is not taken at the same time as copper to avoid this interaction and potential copper deficiency.(107) Phytic acid.

Phytates found in nuts, grains and vegetables like beans can impair zinc absorption by binding with it, resulting in excretion instead of absorption.(180) Ensuring that grains and seeds are soaked and sprouted, or that foods are processed to reduce phytic acid can help ensure that zinc absorption is not impaired, which is especially important for those following a vegetarian or vegan diet.

ZINC

Calcium, Copper and Iron.

These minerals reduce zinc absorption in the small intestine.(107)

Vitamin B12.

Increases zinc absorption in the small intestine.(107)

Vitamin B6.

Vitamin B6 increases magnesium absorption.(107)

Calcium.

Calcium reduces magnesium absorption.(107)

Phosphorus.

Magnesium absorption is reduced when phosphorus intake is high as it binds to the magnesium in the digestive tract.(107)

MAGNESIUM

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MICRONUTRIENT

VITAMIN/MINERAL INTERACTION WITH

EXPLANATION

Vitamin C and E.

Vitamin C and E reduce the oxidation of vitamin A, meaning that it is able to protect the body more efficiently.(107)

Zinc.

Zinc assists with the metabolism of vitamin A into its active form.(107)

Vitamin B6.

Vitamin B6 slows vitamin B1’s transformation into its active form.(107)

Vitamin B12.

Vitamin B12 promotes the breakdown of vitamin B1.(107)

Vitamin B12.

Vitamin B12 promotes the breakdown of vitamin B6.(107)

Zinc.

Zinc decreases the absorption of vitamin B9.(107)

Vitamin C.

Vitamin C promotes the retention of vitamin B9 in tissues.(107)

Vitamin B1 and C, Copper and Iron.

All turn vitamin B12 into useless analogues (versions).

Vitamin C.

Vitamin C repairs oxidised vitamin E.(107)

Selenium.

Selenium enhances the antioxidant effect of vitamin E (and vice versa).(107)

VITAMIN A

VITAMIN B1

VITAMIN B6

VITAMIN B9

VITAMIN B12

VITAMIN E

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KNOWLEDGE OF TOXICITY AND IMPLICATIONS OF EXCESSIVE VITAMIN AND MINERAL INTAKE TOXICITY Toxicity is the degree to which a particular quantity or mixture of substances (or a chemical substance) can damage or impair an organism. Toxicity can refer to the effect on a whole organism (i.e. the human body) as well as the effect on a substructure of the organism (such as a cell or an organ such as the liver).(184)

Supplements contain active ingredients that can strongly affect the body if misused.(185) It is important to remember that more is not always best, as nutrients can cause toxicity or are wasted. As with prescription medication, it is essential to ensure supplements are not recommended in excess of the client’s nutritional requirements.

While excess water-soluble vitamins are excreted out of the body on a daily basis, excess fat-soluble vitamins, such as vitamins A, D, E and K, are stored in the body. Therefore, high doses of fat-soluble vitamins can become toxic. In saying this, however, toxicity can still occur if a client were to consume extremely high doses of water-soluble vitamins within a short period. For example, vitamin C is a water-soluble vitamin, and therefore excess is usually excreted out of the body via the urine; however, if a large dose is taken in a short amount of time, this toxicity can result in diarrhoea and nausea.(186) As with vitamins, minerals are also known to cause toxicity in the body. For example, magnesium toxicity can result in low blood pressure, nausea, vomiting, facial flushing, lethargy, muscle weakness, irregular heartbeat and shortness of breath.(186) Additionally, some common vitamin and mineral toxicities are provided below: (187) Vitamin A toxicity can result in birth defects, as well as many disorders of the liver, bone, central nervous system and skin.

Excess magnesium can result in diarrhoea.

Very large doses of fish oil supplementation can affect the body’s ability to clot blood.

Fluoride, taken excessively, can stain and weaken teeth.

Iron, even with minor toxicity, can result in stomach upset, nausea, constipation and black bowel motions. Severe iron toxicity can result in a coma or death.

• • • • •

It is also important to remind clients that certain vitamins and minerals are also added (fortified) to cereals, milk, bread and various other household food items. For example, Food Standards Australia New Zealand (FSANZ) legalised the mandatory addition of folic acid and iodine into non-organic bread-making flour, to decrease the prevalence of neural tube defects.(188) To avoid nutritional toxicity, the addition of vitamins and minerals to various household food and items needs to be taken into account when recommending supplementation.

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RECOGNISING DEFICIENCIES AND TOXICITIES OF VARIOUS NUTRIENTS When a client is deficient in various nutrients, this can be evident through a variety of signs and symptoms. For example, a client who is deficient in iron may present with fatigue, pale skin, light headedness and lack of motivation. Toxicities can also present signs and symptoms; however, some may be asymptomatic.

It is a common belief that “more is better” when it comes to nutrition; however, it is important to remember that if nutrients are taken in excess over a period of time, this has the potential to lead to toxicity. Excessive amounts of vitamins/minerals can cause changes in the blood, hormones, bones, muscles, blood vessels and nearly all tissues in the human body.

The table below outlines the possible signs and symptoms of various nutrient (mineral) deficiencies and toxicities:

MINERALS NUTRIENT

CALCIUM

PHOSPHORUS

POTASSIUM

DEFICIENCY SIGNS/ SYMPTOMS

• Osteoporosis • Rickets growth • Diminished Poor teeth and • formation. bone teeth and bone • Poor formation • Weakness • Anorexia • General malaise. weakness • Muscle Confusion • Abnormal heartbeat.

•

TOXICITY SIGNS/SYMPTOMS

• Hypercalcaemia bones • Weakened Kidney stones • Impaired brain and heart • function.

Toxicity is rare, but can include: Diarrhoea Hardening of organs and soft tissues Impacts the use of other minerals.

• • • fatal, irregular • Potentially heartbeat.

FOOD SOURCES

• Salmon • Sardines products • Dairy Dark green • vegetables.leafy • Milk • Cheese • Fish • Poultry • Nuts • Legumes.

(107)

(107)

• Banana • Orange fruit • Dried • Meat • Legumes • Milk. salt • Table • Cheese • Milk • Seafood. salt • Table Seafood • Milk • Eggs.

• (107)

SODIUM

CHLORIDE

• Nausea • Exhaustion • Muscle cramps. in gastric • Imbalance acidity blood pH • Irregular • Nausea • Exhaustion.

blood pressure • Elevated • Oedema.

(107)

is rare, but can • Toxicity include hyperchloremic acidosis.

(107)

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cramping • Muscle Emotional • disorders. and mental MAGNESIUM

• Anaemia.

IRON

• Diarrhoea blood pressure • Low Nausea and vomiting • Facial flushing • Lethargy and muscle • weakness retention • Urine • Cardiac arrest. liver • Injure Can be fatal • May contribute • disease. to heart

green leafy • Dark vegetables • Avocados • Nuts • Banana.

(107)

meat • Red Shellfish.

• Liver • Dried fruits • Dark green leafy • vegetables.

• Seafood • Liver • Eggs • Milk • Legumes.

• Seafood • Kidney • Liver meat • Red • Grains.

• Legumes • Shellfish • Liver • Nuts • Wholegrains.

• Meat • Nuts • Yeast.(107 (107)

ZINC

of appetite • Loss Skin changes • Impaired wound healing • Decreased taste • Dwarfism.

• • Muscle weakness.

SELENIUM

and vomiting • Nausea Stomach • Diarrhoeapain • Taste changes • Flu-like symptoms • Blood lipid changes.

• • Vomiting of hair and nails • Loss Skin lesions.

•

(107)

(107)

COPPER

• Anaemia disease • Bone growth and • Disturbed metabolism.

• Vomiting • Diarrhoea

(107)

CHROMIUM

of glucose • Disturbance metabolism.

is rare (usually • Toxicity environmental, not dietary).

)

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The table below outlines the possible signs and symptoms of various nutrient (vitamins) deficiencies and toxicities:

VITAMINS DEFICIENCY SIGNS/ SYMPTOMS

NUTRIENT

TOXICITY SIGNS/SYMPTOMS

blindness defects • Night • Birth Respiratory infections Bone pain • Decreased bone growth. • Enlargement of the liver.

• • VITAMIN A

FOOD SOURCES

• Liver • Butter • Cream liver oil • Cod Dark green leafy • vegetables coloured fruit and • Deep vegetables.

• Salmon • Sunlight • Eggs • Mushrooms.

(107)

VITAMIN D

VITAMIN E

VITAMIN K

stones • Rickets • Kidney Osteomalacia Calcification of soft tissues.

• Osteoporosis • • Muscle spasms • Poorly developed teeth • and bones. of red blood is rare, but may • Destruction • Toxicity cells. cause: thinning • Blood • Increased inflammation. blood with • Prolonged • Interferes clotting anticoagulants.

• Haemorrhage.

(107)

green vegetables • Leafy Nuts • Oils.

• • Liver • Milk green vegetables • Leafy Broccoli • Brussel sprouts.

• • Beef • Pork • Liver • Eggs • Fish • Legumes.

• Liver • Kidney • Heart • Cheese • Leafy green vegetables.

• Milk • Eggs • Fish • Poultry.

(107)

(107)

tract, • Gastrointestinal nervous system and THIAMIN (VITAMIN B1)

RIBOFLAVIN (VITAMIN B2)

•

cardiovascular problems Beriberi (thiamin deficiency leading to illness and death).

sensitivity • Eye Dermatitis, • Glossitis.

•

• Nervousness • Oedema of breath • Shortness of heat • Sensation Sweating • Tachycardia • Tremors.

• (high red • Polycythaemia blood cell concentration that makes blooded thicker and contributes to sluggish blood flow).

(107)

(107)

NIACIN (VITAMIN B3)

• Dermatitis • Dementia • Diarrhoea.

• Itching flush • Facial Stomach • Nausea pain • Vomiting • Diarrhoea • Low blood pressure • Difficulty breathing.

•

(107)

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PYRIDOXINE (VITAMIN B6)

COBALAMIN (VITAMIN B12)

FOLATE (VITAMIN B9)

• Dermatitis • Confusion • Depression • Irritability.

• Depression • Nerve damage.

• Pork • Fish • Poultry • Eggs • Legumes.

• Seafood • Poultry • Cheese • Milk • Eggs.

• Liver green vegetables • Leafy • Legumes • Seeds • Broccoli • Fruit.

• Milk • Liver • Kidney yolks • Egg Legumes • Fruit.

• • Eggs • Liver • Salmon • Poultry • Mushrooms • Cauliflower. fruit • Citrus Broccoli • Melons • Strawberries • Capsicum • Cabbage • Tomatoes.

• (107)

anaemia • Pernicious • Nil. Sore mouth and tongue • Anorexia • Neurological disorders.

• risk of cobalamin • Anaemia • Increased Glossitis. deficiency.

•

(107)

(107)

BIOTIN (VITAMIN B7)

PANTOTHENIC ACID (VITAMIN B5)

• Dermatitis • Nausea • Anorexia • Depression • Hair loss. feet syndrome • Burning Fatigue • Vomiting.

•

• Nil.

(107)

in histamine • Increase Sensitivity in joints.

•

(107)

ASCORBIC ACID (VITAMIN C)

• Scurvy cramps • Muscle Ulcerated gums.

•

uric acid levels • Raised Kidney • Reboundstones scurvy.

•

(107)

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UNDERSTANDING FOOD FORTIFICATION WITH VITAMINS AND MINERALS Many clients cannot achieve the recommended intake of certain nutrients due to their dietary habits or choices. To prevent widespread deficiencies from occurring, the government mandates that some foods be fortified with nutrients to prevent deficiencies and reduce the cost of deficiency-related disease on the public health system. One of the most wellknown mandatory fortifications is folic acid and iodine added to bread to reduce the incidence of neural tube defects in unborn children, and to reduce the incidence of iodine deficiency which was becoming more common in the population.

(188)

WHAT IS FORTIFICATION? Fortification is the process of adding extra nutrients, usually vitamins and minerals, to a food during production to increase its nutritional value. This commonly occurs within breakfast cereals and cow’s milk alternatives. This means that clients using an alternative form of a food will obtain the same benefits as using the commonly consumed form, e.g. soy milk with added calcium to match the nutrient levels found in cow’s milk.

Fortification can be mandatory, meaning that food manufacturers are legally required to add the prescribed nutrients in specific doses to their food products, meeting government-set regulations.(188) Mandatory fortification is present within: Cereals and cereal products (bread, breakfast cereals) Edible spreads (margarine).

• •

Another type of fortification is voluntary fortification, meaning that food manufacturers can fortify their products if they wish to; however, they are not legally required to do so. This can be appealing to some food manufacturers as it can give their product additional benefits and a competitive edge over other products on the market, which may improve sales.(189) Such products include: Bottled water and sports drinks Caffeinated beverages Salt Chewing gum.

• • • •

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The table below identifies examples of mandatory and voluntary fortification of popular food items in Australia: (189)

MANDATORY FORTIFICATION ITEM EDIBLE OIL SPREADS (E.G. MARGARINE)

WHEAT-BASED BREAD

FORTIFIED WITH

AMOUNT OF FORTIFICATION

Vitamin D.

No less than 55μg/kg.

Folic acid.

2-3mg/kg.

Thiamine.

6.4mg/kg.

Iodine (using iodised salt).

46μg/100g.

VOLUNTARY FORTIFICATION ITEM BOTTLED WATER

FORTIFIED WITH

AMOUNT OF FORTIFICATION

Fluoride.

0.6-10.0mg/L.

Sodium.

No less than 10mmol/L.

Dextrose, fructose, glucose syrup, maltodextrin, sucrose.

50-100g/L combined.

Fructose.

No more than 50g/L.

Calcium phosphates, potassium phosphates, calcium citrates, potassium citrates, sodium citrates, potassium carbonates, potassium chloride, calcium chloride, sodium chloride, calcium lactate, magnesium lactate, magnesium sulphate.

Nil quantities available.

CAFFEINATED BEVERAGES

Caffeine.

145-320mg/L.

SALT AND SALT PRODUCTS

Iodine.

25-65mg/kg.

CHEWING GUM

Calcium.

80-200mg/serving.

SPORTS DRINKS

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KNOWLEDGE OF DRUG AND MEDICATION INTERACTIONS Some medications (both prescription and non-prescription) can interact with other drugs or nutrients in the diet, known as a ‘drug-nutrient interaction’. For example, grapefruit juice can affect the breakdown and absorption of many drugs, potentially causing them to be more or less effective than intended. Nutrition coaches must be aware of some common interactions and the risks involved to prevent an interaction from occurring.

Drug-nutrient interactions can occur as a result of inappropriate dosage, type of administration (intravenous versus oral), absorption site (e.g. small intestine, mouth) and the physical form of drug/nutrient (e.g. liquid, capsule, powder).

Examples of common drug/medication interactions are provided below:

MEDICATION ANTACIDS

ANTIBIOTICS (PENICILLINS)

USE

INTERACTION

Used to reduce stomach acid for those who suffer from reflux or heartburn.

Decrease absorption of vitamin B12. Vitamin B12 supplementation is encouraged for clients on this medication to avoid vitamin B12 deficiency.(190)

Used to treat bacterial infections, where the immune system requires assistance.

Inhibits the growth of and destroys both harmful and beneficial microorganisms and can negatively affect the gut microbiome.

Prevent blood clotting by thinning the blood.

Anticoagulants can interfere with vitamin K levels.

A high-quality probiotic may be required (taken 2-4 hours after the antibiotic).(191)

Care should be taken to ensure vitamin K levels remain consistent for any client taking anticoagulants.(192)

ANTICOAGULANTS (ASPIRIN, HEPARIN, CLOPIDOGREL, WARFARIN)

Anticoagulants can interfere with iron levels.(193) Grapefruit juice can interfere with warfarin (a commonly prescribed anticoagulant).

Alcohol can impact the effectiveness of anticoagulants.

Fish oil has a weak anticoagulant effect on blood; therefore, it can interfere with other anticoagulant medications.(194)

ANTICONVULSANTS (CARBAMAZEPINE, CLONAZEPAM, PHENOBARBITONE, DIAZEPAM, PRIMIDONE)

Prevent/reduce epileptic seizures.

Can cause vitamin D deficiency in long-term use.

Can cause vitamin B12 deficiency.

Can affect calcium and magnesium levels.

Alcohol can impact the effectiveness of anticoagulants.

Reduce blood pressure.

ANTIHYPERTENSIVES (RAMIPRIL, PERINDOPRIL, LOSARTAN, IRBESARTAN, METOPROLOL ETC.)

Can affect the body’s mineral levels, such as potassium and magnesium.

Care should be taken prior to supplementation.

Some antihypertensives can affect vitamin B12 and iron levels.

Grapefruit juice can affect some antihypertensives.

LIPID LOWERING MEDICATIONS (STATINS, COLESTIPOL, CHOLESTYRAMINE, NIACIN, GEMFIBROZIL ETC.)

Lower lipid (fat) levels, especially LDL cholesterol.

Can affect the storage of fat-soluble vitamins (A, D, E, K).

Grapefruit juice can increase the concentration of some statins, making side effects more likely.

PLEASE NOTE: It is always encouraged that supplements’ ingredients, indications and contraindications are checked thoroughly before recommending them to clients. It is helpful and encouraged to discuss with Doctors and Pharmacists about potential adverse interactions and to ensure that the client is within the nutritional advisor’s scope of practice or to refer on as required.

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RECOGNISING INDICATORS OF WEIGHTRELATED CONDITIONS Helping clients improve their health is the primary role of the nutrition coach. The medical model of health care utilises a number of metrics to determine health status and stratify future risk of disease, including: Body mass index (BMI) Waist circumference (WC) Waist-to-hip ratio (WHR).

• • •

These tools can be useful to determine whether a client is at risk of future poor health outcomes and can be a good starting point for reference as a client progresses through their journey with a nutrition coach. As clients’ bodies change, for instance, due to fat loss or muscle gain, their BMI, WC and WHR may change, putting them into a new or lower category of risk for disease.

BODY MASS INDEX Body mass index (BMI) uses weight and height measurements to determine if an adult is within the healthy weight range, underweight, overweight or obese. It establishes an estimate of total body fat and the potential risk of developing weight-related diseases.

‘BMI scores can be written simply as the number (e.g. BMI = 25), or with the equation attached (e.g.

BMI = 25kg/m2), which is the more formal approach and is recommended when writing to other health professionals. (17)

If a client is overweight (with a BMI over 25kg/m2) and physically inactive, they are at increased risk of: Cardiovascular disease (CVD) Gallbladder disease High blood pressure (hypertension) Diabetes mellitus Osteoarthritis Fatty liver disease Sleep apnoea Kidney disease Gout Certain types of cancer, such as breast cancer or colon cancer Depression and other mental health disorders.

• • • • • • • • • • •

If a client is underweight (BMI less than 18.5kg/m2), they may be malnourished and at increased risk of: Compromised immune function Respiratory disease Digestive diseases Cancer Fertility issues Osteoporosis.

• • • • • •

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CALCULATING BMI BMI is an approximate measure of the ideal weight for health. To calculate BMI, the following information is required: Weight in kilograms (kg) Height in centimetres (cm).

••

To calculate BMI, divide the client’s body weight in KG by their height (in metres) squared (BMI = kg/m2).

EXAMPLE: For a person that is 175cm tall with a weight of 70kg: = 70kg / (1.75m)2 = 70 ÷ 3 (1.75 x 1.75) = 70 ÷ 3.063 BMI = 22.86kg/m2

HOW TO CALCULATE BMI: BMI = Kg / (Height [m])2

BMI CALCULATORS There are also many online calculators that can be used to determine BMI, including: ‘Health Direct’ BMI Calculator Australian Government Department of Health BMI Calculator The Heart Foundation BMI Calculator NSW Government Health BMI Calculator The National Institute of Health BMI Calculator.

• • • • •

IDENTIFYING BMI RANGES Once BMI has been calculated, it can then be identified if the client is classed as underweight, healthy weight, overweight or obese using the BMI ranges below. The ranges are based on associations between chronic diseases (comorbidities) and mortality risk, and have been adopted for use internationally by the World Health Organisation (WHO).(195) BMI ranges for weight classification in adults are as follows:

BMI RANGES: WEIGHT CLASSIFICATION

BMI RANGE

RISK OF COMORBIDITIES

UNDERWEIGHT

<18.5

Low (but the risk of other clinical problems increased).

HEALTHY WEIGHT/NORMAL

18.5–24.9

Average.

OVERWEIGHT/ PRE-OBESE

25.0–29.9

Increased.

OBESITY (LEVEL 1)

30.0–34.9

Moderate.

OBESITY (LEVEL 2)

35.0–39.9

Severe.

OBESITY (LEVEL 3)

≥40.0

Very severe.

For older Australians, overall health status may be more important than BMI or being mildly overweight. While BMI recommendations for the Australian elderly vary slightly from state to state, it is generally suggested that a BMI range of 24-30kg/m2 is considered within the healthy weight range for those over the age of 70 years.(196) It is important to note that BMI is not considered the best measurement of weight and potential health risk since it does not distinguish between fat and fat-free mass (bones, muscles, fluid etc.).

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BODY MASS INDEX (BMI) CHART FOR ADULTS Weight

Obese (>30)

Overweight (25-20) Normal (18.5-25) Height in feet/inches and centimeters

Underweight (<18.5)

4’8”

5’1”

5’2”

5’3”

5’4”

5’5”

5’6”

5’7”

5’8”

5’9” 5’10” 5’11” 6’0”

6’1”

6’2” 6’3” 6’4”

6’5”

4’9” 4’10” 4’11” 5’0”

lbs

(kg)

142cm

147

150

152

155

157

160

163

165

168

170

173

175

178

180

183

185

188

191

191

196

260

(117.9)

58

56

54

53

51

49

48

46

45

43

42

41

40

38

37

36

35

34

33

32

32

31

255

(115.7)

57

55

53

51

50

48

47

45

44

42

41

40

39

38

37

36

35

34

33

32

31

30

250

(113.4)

56

54

52

50

49

47

46

44

43

42

40

39

38

37

36

35

34

33

32

31

30

30

245

(111.1)

55

53

51

49

48

46

45

43

42

41

40

38

37

36

35

34

33

32

31

31

30

29

240

(108.9)

54

52

50

48

47

45

44

43

41

40

39

38

36

35

34

33

33

32

31

30

29

28

235

(106.6)

53

51

49

47

46

44

43

42

40

39

38

37

36

35

34

33

32

31

30

29

29

28

230

(104.3)

52

50

48

46

45

43

42

41

39

38

37

36

35

34

33

32

31

30

30

29

28

27

225

(102.1)

50

49

47

45

44

43

41

40

39

37

36

35

34

33

32

31

31

30

29

28

27

27

220

(99.8)

49

48

46

44

43

42

40

39

38

37

36

34

33

32

32

31

30

29

28

27

27

26

215

(97.5)

48

47

45

43

42

41

39

38

37

36

35

34

33

32

31

30

29

28

28

27

26

25

210

(95.3)

47

45

44

42

41

40

38

37

36

35

34

33

32

31

30

29

29

28

27

26

26

25

205

(93.0)

46

44

43

41

40

39

37

36

35

34

33

32

31

30

29

29

28

27

26

26

25

24

200

(90.7)

45

43

42

40

39

38

37

35

34

33

32

31

30

30

29

28

27

26

26

25

24

24

195

(88.5)

44

42

41

39

38

37

36

35

33

32

31

31

30

29

28

27

26

26

25

24

24

23

190

(86.2)

43

41

40

38

37

36

35

34

33

32

31

30

29

28

27

26

26

25

24

24

23

23

185

(83.9)

41

40

39

37

36

35

34

33

32

31

30

29

28

27

27

26

25

24

24

23

23

22

180

(81.6)

40

39

38

36

35

34

33

42

31

30

29

28

27

27

26

25

24

24

23

22

22

21

175

(79.4)

39

38

37

35

34

33

32

31

30

29

28

27

27

26

25

24

24

23

22

22

21

21

170

(77.1)

38

37

36

34

33

32

31

30

29

28

27

27

26

25

24

24

23

22

22

21

21

20

165

(74.8)

37

36

34

33

32

31

30

29

28

27

27

26

25

24

24

23

22

22

21

21

20

20

160

(72.6)

36

35

33

32

31

30

29

28

27

27

26

25

24

24

23

22

22

21

21

20

19

19

155

(70.3)

35

34

32

31

30

29

28

27

27

26

25

24

24

23

22

22

21

20

20

19

19

18

150

(68.0)

34

32

31

30

29

28

27

27

26

25

24

23

23

22

22

21

20

20

19

19

18

18

145

(65.8)

33

31

30

29

28

27

27

26

25

24

23

23

22

21

21

20

20

19

19

18

18

17

140

(63.5)

31

30

29

28

27

26

26

25

24

23

23

22

21

21

20

20

19

18

18

17

17

17

135

(61.2)

30

29

28

27

26

26

25

24

23

22

22

21

21

20

19

19

18

18

17

17

16

16

130

(59.0)

29

28

27

26

25

25

24

23

22

22

21

20

20

19

19

18

18

17

17

16

16

15

125

(56.7)

28

27

26

25

24

24

23

22

21

21

20

20

19

18

18

17

17

16

16

16

15

15

120

(54.4)

27

26

25

24

23

23

22

21

21

20

19

19

18

17

17

17

16

16

15

15

15

14

115

(52.2)

26

25

24

23

22

22

21

20

20

19

19

18

17

17

16

16

16

15

15

14

14

14

110

(49.9)

25

24

23

22

21

21

20

19

19

18

18

17

17

16

16

15

15

15

14

14

13

13

105

(47.6)

24

23

22

21

21

20

19

19

18

17

17

16

16

16

15

15

14

14

13

13

13

12

100

(45.4)

22

22

21

20

20

19

18

18

17

17

16

16

15

15

14

14

14

13

13

12

12

12

95

(43.1)

21

21

20

19

19

18

17

17

16

16

15

15

14

14

14

13

13

13

12

12

12

11

90

(40.8)

20

19

19

18

18

17

16

16

15

15

15

14

14

13

13

13

12

12

12

11

11

11

85

(38.6)

19

18

18

17

17

16

16

15

15

14

14

13

13

13

12

12

12

11

11

11

10

10

80

(36.3)

18

17

17

16

16

15

15

14

14

13

13

13

12

12

11

11

11

11

10

10

10

9

Note: BMI Values rounded to the nearest whole number. BMI categories based on CDC (Centers for disease control and prevention) criteria.

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EXCEPTIONS TO THE BMI RULE BMI does not differentiate between body fat and fat-free mass (muscle), meaning that there are a number of exceptions to the BMI rule, including: High Muscle Mass Low Muscle Mass/Muscle Wastage Height Ethnicity.(197)

• • • •

HIGH MUSCLE MASS

Clients with a higher than average muscle mass percentage are not appropriate for BMI calculation as the BMI does not differentiate between fat and muscle mass. In this case, BMI would simply identify the person as being overweight or obese.

For example, Olympic weightlifters are often classified as overweight or obese according to their BMI.

LOW MUSCLE MASS/ MUSCLE WASTAGE

HEIGHT

In contrast to the above, BMI underestimates the amount of total fat mass for those with low muscle mass or with muscle wastage. Groups particularly susceptible to low muscle mass or muscle wastage include the elderly, those with eating disorders and those with a physical disability.

BMI provides a calculation for the average height of a human. Unfortunately, this means that those who are unusually tall or unusually short will have their BMI underestimated or overestimated.

As a general guide, BMI should not be calculated on clients shorter than 150cm or taller than 190cm.

As each ethnic group has varying muscle-to-fat mass ratios, it is inappropriate to use the same BMI reference ranges for all ethnic groups.

ETHNICITY

For example, Asian and Indian clients tend to have a higher fat mass than clients of European descent and therefore may require lower BMI reference ranges. On the other hand, clients of Torres Strait Islander and Maori descent are known to maintain a heavier build without increased health risk and can, therefore, have higher BMI reference ranges.

The link between being overweight or obese and the risk of illness/disease is not well defined. Research is ongoing, although statistically, there is a greater chance of developing some diseases when overweight or obese. For example, the risk of death increases by approximately 20 to 30% as BMI increases from 25kg/m2 to 27kg/m2. Additionally, as BMI increases above 27kg/m2, the risk of death increases more steeply, by approximately 60%.(198)

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BMI AND CHILDREN Although working with children falls outside of the scope of practice of a nutrition coach, it is still important to understand BMI ranges and how they can differ among children.

Children are continuously growing and developing, which makes it difficult to establish set values for BMI cut-offs. For many adults where the growing process has stopped, an increase in BMI is usually caused by an increase in body fat.

However, as children grow, their fat, muscle and bone mass changes, as does their BMI. For example, BMI generally decreases during preschool years and then increases during adolescence into adulthood.(199) For this reason, BMI calculations for children or adolescents are interpreted differently, and it is important to take into account the age and sex of the child or adolescent.

It’s worth asking a few trusted people in your life what they think of when they first see the business name or if it clearly depicts your business. As they are not personally invested in the name, they may point out something that you hadn’t yet considered.

ADVANCING KNOWLEDGE RELATED TO BMI As with any source of information or guideline, there will always be ongoing research and debate on the topic’s pros, cons and longevity.

While the pros and cons of the BMI have been explored above, it is encouraged that nutrition coaches complete additional learning on this topic, to extend their knowledge of the BMI calculation, and enhance confidence in using the BMI calculation by itself or with the addition of other anthropometric measurements.

Body Mass Index (BMI) on the Rise (The Health Report). CLICK HERE to view the link.

• PODCAST: Rethinking BMI & Mortality (The Health Report). CLICK HERE to view the link.

• PODCAST: Association With Overweight & Obesity Using BMI Categories: A Systematic Review and • Meta-analysisof Mortality (Journal Article). CLICK HERE to view the link.

Healthy Body Fat An Approach for Developing Guidelines Based on BMI (Journal Article).

• CLICK HERE to viewRanges: the link.

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WAIST CIRCUMFERENCE MEASUREMENT Waist circumference (WC) reflects subcutaneous abdominal fat storage and, according to the World Health Organisation (WHO), has been shown to indicate a health risk.

A client’s waist circumference is a better predictor of health risk than BMI. Stored fat around the abdomen (known as abdominal adiposity or central obesity), regardless of body size, indicates a greater risk of developing obesity-related health conditions such as:(3) Cardiovascular disease (CVD) High blood pressure High cholesterol Diabetes.

•• ••

This increased risk is due to increased fat around vital organs within the abdominal area. Men, for example, often store weight in the waist/stomach region and therefore have an increased risk of obesity-related disease. Comparatively, fat that is predominantly deposited (or stored) around the hips and buttocks (seen typically in females) doesn’t appear to have the same health risk.

Generally, the link between health risks and body fat distribution is as follows: Lowest risk (slim/evenly distributed body fat) Moderate risk (overweight with no abdominal adiposity) Moderate to high risk (slim with abdominal adiposity) High risk (overweight with excess abdominal adiposity).

•• ••

Waist circumference can also be used as an indication of a client’s health risk for chronic diseases (outlined in the following table).(3)

WAIST CIRCUMFERENCE GUIDELINES GENDER

NOT AT RISK

INCREASED RISK

SUBSTANTIALLY INCREASED RISK

MALE

Less than 94cm.

94cm or more.

120cm or more.

FEMALE

Less than 80cm.

80cm or more.

88cm or more.

HOW TO MEASURE A CLIENT’S WAIST CIRCUMFERENCE To identify a client’s health risk, it is important to measure their waist circumference accurately by following the steps below:

STEP 1

Place the tape measure directly around the client, preferably over no more than one layer of light clothing.

STEP 2

Ensure correct placement of the tape measure, halfway between the lowest rib and the top of the hip bone (generally in line with the belly button).

STEP 3 STEP 4

Ask the client to breathe out normally and take the measurement.

Make sure the tape is pulled tight, without squeezing the skin.

Before a nutrition coach takes any sort of circumference measurement, it is essential that the client is aware of the process and provides consent, as taking a circumference measurement requires close contact between the client and the nutrition coach, which may make the client feel uneasy if they are not prepared. Simply explaining to the client what the process involves and asking for their consent to take the measurement is essential.

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WAIST TO HIP RATIO (WHR) Waist-to-hip ratio (WHR) is used frequently by health professionals (on adult clients only) to identify a client’s weight status (healthy or overweight) and health risk. The WHR is a simple calculation that determines the ratio between the waist circumference (previously discussed) and the hip circumference (HC) (explained below).

This calculation provides a greater indication of how much excess fat is stored in the abdominal region and health risks, such as high blood pressure and high cholesterol. (3)

HOW TO MEASURE A CLIENT’S HIP CIRCUMFERENCE: With the client standing tall, legs slightly apart and breathing normally, place the tape measure around the widest part of their body (this will be over the greatest protrusion of the clients gluteal (buttocks) muscles).

Ensure that the tape measure is straight, has no twists and is firm against the body.

CALCULATING A CLIENT’S WHR The steps for calculating a client’s WHR are as follows:

STEP 1

Measure waist circumference Ask the client to stand straight and breathe normally. Use a tape measure to identify the circumference around their waist (the smallest part of their body, generally just above their belly button).

STEP 2

Measure hip circumference Ask the client to remain standing tall. Use a tape measure to identify the circumference around their hips (the widest part of their body, generally around their buttocks).

STEP 3

Calculate a client’s WHR Divide their waist circumference (in cm) by their hip circumference (in cm) to get their WHR (WHR = WC ÷ HC).

EXAMPLE: Female with a WC of 75cm and an HC of 80cm WHR = WC ÷ HC = 75cm ÷ 80cm Therefore, WHR = 0.93 (which is more than 0.85, therefore high risk for poor health outcomes).

The table below can be used to identify if the client’s health is at an increased risk based on their WHR:

WAIST-TO-HIP RATIO WOMEN

MEN

LOW RISK

0.8 or below.

0.95 or below.

MODERATE RISK

0.81-0.85.

0.96-1.0.

HIGH RISK

0.85 or more.

1.0 or more.

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UNDERSTANDING AND DESIGNING SUPPLEMENT PROTOCOLS FOR HEALTHY CLIENTS When designing a supplement protocol/program for a client, nutrition coaches need to take a number of factors into consideration, which are outlined in the steps below: 1. Conduct the RSST to ensure the client is within the scope of practice 2. Conduct a ‘client questionnaire’ and diet history to collect additional information about the client (such as getting them to fill out a food diary) 3. Identify potential signs and symptoms associated with nutrient deficiencies 4. Conduct a risk assessment of potentially beneficial supplements, understanding their side effects, toxicity, interactions and contraindications 5. ‘Recommend’ potentially beneficial supplements if diet alone cannot address nutritional gaps (tailoring doses depending on the product) 6. Consider appropriate timing for when to (or when not to) include supplements across the day 7. Consider whether the client will benefit from the use of a combination of supplements 8. Provide clear instructions for all clients 9. Consider legal considerations and medical disclaimers 10.Fine tune and review supplement programs over time.

The table below provides more information about the factors above:

CONSIDERATIONS/STEPS FOR DESIGNING A SUPPLEMENT PROGRAM 1

PRE-SCREENING CLIENTS USING RSST (CONFIRMING THE CLIENTS HEALTH STATUS)

2

CLIENT QUESTIONNAIRE (COLLECTING ADDITIONAL INFORMATION ON CURRENT NUTRIENT INTAKE)

3

IDENTIFYING POTENTIAL NUTRIENT DEFICIENCIES (RECOGNISE SIGNS AND SYMPTOMS ASSOCIATED WITH DEFICIENCIES)

Using the Industry Endorsed Risk Stratification Screening Tool (RSST) tool will help the nutritional advisor to establish whether a potential client is/is not suitable for consultation or requires medical clearance. ‘client questionnaire’ is not a mandatory requirement for nutritional • Aadvisors.

However, it is an essential tool for building rapport and

•

establishing their likes/dislikes, food preferences, goals and motives.

Conducting the ‘client questionnaire’ can also assist the nutritional advisor in determining which approach to take with a client that will best support their goals.

advisors have learned how to conduct a full nutritional • Nutritional assessment and identify gaps in nutritional adequacy. advisors have learned to recognise the common signs and • Nutritional symptoms of various nutrient deficiencies. the information gathered from clients in their screening process • Using and the ‘client questionnaire’ will help the nutritional advisor to identify the possibility of a nutrient deficiency (in combination with signs and symptoms).

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4

RISK ASSESSMENT OF POTENTIALLY BENEFICIAL SUPPLEMENTS (UNDERSTANDING THE SIDE EFFECTS, TOXICITY, INTERACTIONS AND CONTRAINDICATIONS OF VITAMINS, MINERALS AND SPECIFIC SUPPLEMENTS)

5

‘RECOMMEND’ POTENTIALLY BENEFICIAL SUPPLEMENTS ( AND TAILORING DOSAGES OF VARIOUS PRODUCTS)

is the duty of care for nutritional advisors to understand the risks • Itassociated with specific supplemental advice, especially around the side

• •

effects, toxicity, interactions and contraindications of using supplements with clients.

This information is provided within this resource as well as supplement information leaflets, from pharmacists and from reliable internet resources.

This unit has provided information on the safe levels/dosages of various vitamins and minerals and the potential outcomes of toxicity. When in doubt, nutritional advisors should conduct further research to increase their knowledge of the risks of supplementation.

should come with clear usage and dosing guidelines • Allthatsupplements should be read and understood before implementing in a client’s

•

supplementation program.

While some supplements are simply a single pill/tablet or set dose (e.g. 5g), others will be more complex and may be based on client weight. Where a supplement requires weight-based dosing, the nutritional advisor will need to calculate the required dose for the client. For example: creatine loading phase = 0.3g/kg body weight, therefore a 70kg male x 0.3g = 21g dose.

supplements, like creatine and beta-alanine, are not required to • Some be taken at specific times. Clients should be encouraged to take these

6

ENSURING APPROPRIATE TIMING FOR VARIOUS SUPPLEMENTS

•

supplements when convenient to establish a good supplement-taking routine to ensure the best effect.

Other supplements are timing-dependent and usually offer the most benefit when timed with exercise ( i.e. pre-workout, L-citrulline, caffeine etc.) or food (i.e. protein, vitamins/minerals etc.). In these situations, nutritional advisors should educate clients on the need to take supplements at specific times, to establish a consistent supplement-taking routine, and to ensure the best effect.

some clients may benefit from one or two supplements to help them • While reach their goals, others may benefit from including more. In this case,

• 7

CONSIDERING WHEN TO COMBINE SUPPLEMENTS

•

nutritional advisors need to know which supplements are safe to combine, which to separate and which supplements represent the best combination for their clients.

Single supplements (like creatine monohydrate) are cheaper to purchase in bulk and should be kept as a single product, as it requires consistent, habitual dosing for the best effect. Other products, such as those used preworkout (i.e. caffeine, carnitine, citrulline), can be purchased as combination products which may offer better value for money and convenience for clients.

The main supplement types which require more awareness are vitamins and minerals. Minerals such as iron are best absorbed on an empty stomach (where digestive issues are not present) and best taken in small doses across the day to maximise absorption. Additionally, due to the many inhibitors and promoters of absorption, clients need to be educated on foods to include or avoid when taking supplements.

advisors need to ensure all instructions are clear and be able to • Nutritional communicate at a suitable level for all clients: from the young to the old, from those with low literacy to those with high educational attainment and for those for whom English may be a second language.

The ability to explain a concept or information in many ways can be helpful to increase understanding and reduce the potential for confusion and PROVIDING CLEAR INSTRUCTIONS FOR ALL 8 mismanagement of supplements, which in turn, reduces risks for the client CLIENTS and advisor.

Nutritional advisors need to establish whether their client understands the VAST FITNESS ACADEMY | NAT11046006: ADVISE CUSTOMERS ON THE USE provided OF NUTRITIONAL ANDwill ERGOGENIC AIDS | supplementation 127 information andSUPPLEMENTS whether they follow their VERSION 1 - 18.01.2024 VAST FITNESS ACADEMY | NAT11046006: ADVISE CUSTOMERS ON THE USE OF NUTRITIONAL SUPPLEMENTS AND ERGOGENIC AIDS | VERSION 2 20.11.23 program as directed.

127 Nutritional advisors should always ask clients if they understand the

• •

advisors need to ensure all instructions are clear and be able to • Nutritional communicate at a suitable level for all clients: from the young to the old,

8

9

PROVIDING CLEAR INSTRUCTIONS FOR ALL CLIENTS

LEGAL CONSIDERATIONS, DOCUMENTATION AND MEDICAL DISCLAIMERS

• •

from those with low literacy to those with high educational attainment and for those for whom English may be a second language.

The ability to explain a concept or information in many ways can be helpful to increase understanding and reduce the potential for confusion and mismanagement of supplements, which in turn, reduces risks for the client and coach.

Nutritional advisors need to establish whether their client understands the information provided and whether they will follow their supplementation program as directed.

Nutritional advisors should always ask clients if they understand the information provided and provide clarifications where necessary.

• advisors are legally accountable for the advice they provide and, • Nutritional as such, they must be aware of the risks that some supplements carry. advisors must keep a professional paper trail of their • Nutritional consultations for auditing purposes. this reason, medical disclaimers can be used to help protect nutritional • For advisors who are following their duty of care to provide the correct information to clients, where harm from a supplement program arises as a result of client negligence.

10

MONITORING AND MODIFYING SUPPLEMENT PROTOCOLS (FINE TUNING SUPPLEMENT PROGRAMS OVER TIME)

As clients progress with their diet and supplementation programs, nutritional advisors need to fine-tune the supplements and products being used.

This is important for many reasons: Supplementation should only be a short-term solution to fill nutritional gaps and should be managed in combination with improving dietary intake so that supplementation becomes unnecessary over time.

Supplementation can be expensive for some clients Long-term reliance on supplements inhibits clients from making appropriate dietary and behavioural changes to improve health.

Supplement needs will change and evolve over time based on a client’s lifestyle, diet and stage of life.

• • • •

By considering the above factors when developing a supplement protocol/program, nutrition coaches will be able to ensure that their clients are taking supplements in such a way that: Provides a benefit Is safe Minimises risk to client and practitioner Is clear and easy to understand Is reviewed and ended when appropriate.

•• •• •

In addition, applying the above considerations in day-to-day practice helps ensure that nutrition coaches practice ethically and in accordance with their duty of care and scope of practice.

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PROVIDING INSTRUCTIONS TO CLIENTS ON RECOMMENDED SUPPLEMENT PROTOCOLS When developing supplement protocols for clients, it is important to provide adequate information and to ensure that the protocol is clear and easy to understand. Generally, a supplement protocol should provide information on: Recommended dosing Recommended number of doses to be taken each day (timing) Whether the product is to be taken on an empty or full stomach Inhibitors/promoters Safety information.

•• •• •

It is important to provide clients with their supplement protocol in written form as it is easy to forget information. This will not only protect the client from misuse but will also protect the nutrition coach by ensuring that duty of care is followed.

There are many different methods for presenting a supplement protocol and conveying information for clients to follow.

For example, nutrition coaches can utilise: Set templates, such as supplement diaries or spreadsheets Hand-written notes Step-by-step instructions

•• •

Providing clients with a supplement diary is a beneficial method to ensure that clear instructions are outlined, and clients can tick off when they have taken supplements to maintain a consistent supplement routine (see example below):

SUPPLEMENT TYPE MAGNESIUM SULPHATE VITAMIN B12

PROMOTERS/ SAFETY/ INHIBITORS COMMENTS M T W T F S S

DOSE

TIMING

150mg 1 tablet)

Evening, after food

Avoid dairy around supplementation

Discontinue if you experience diarrhoea

2,000μg (1 tablet)

Evening, after food

Nil

Nil (very safe supplement)

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DESIGNING SUPPLEMENT PROTOCOLS: CASE STUDIES The case studies below provide examples of various types of clients and their potential supplementation needs; however, in real-life practice, client needs are extremely varied and require an assessment of their unique circumstances before a supplementation protocol is suggested, designed and implemented.

CASE STUDY ONE: LISA Lisa is a busy 40-year-old mum of three children (youngest being two years old and not breastfeeding).

She complains of always feeling tired, not having time to prepare fresh meals and not getting enough sleep or having broken sleep as she is always ‘on the go’ and cannot relax at night. Her current diet is low in essential fatty acids (as the family do not like seafood) and vegetables (as Lisa buys a lot of pasta and rice-based meals because they are what her children prefer).

Lisa has explained that trying to get her children to eat more vegetables is very stressful, and she just wants to fill the gaps in her diet with a supplement.

EVALUATION: Recommended supplements: 1. Fish oil tablets 2. Multivitamin 3. Magnesium

JUSTIFICATION:

counselling Lisa on the importance of establishing consistent routines and modelling positive • After eating behaviours to help improve her children’s and her own diet quality, some supplements could

• • •

be beneficial.

Fish oil tablets will help Lisa achieve her daily requirement for essential fatty acids (around 1,000mg a day).

The multivitamin can help to address potential nutrient gaps from inadequate vegetable intake.

Magnesium is a supplement that may help Lisa relax in the evening and fall asleep easier, as she has mentioned that she struggles to switch off at night.

CASE STUDY TWO: MENA Mena is a 23-year-old university student on a tight budget who would like to lose weight. She is vegan, eats a lot of processed food and has been complaining of being tired and having poor energy levels, possibly due to the stress of university, her job and partying with friends.

EVALUATION: Recommended supplements: 1. B complex vitamins 2. Calcium 3. Iron.

JUSTIFICATION:

presents classic symptoms of a nutritional deficiency - most likely iron and B vitamins, due to • Mena following a vegan diet. B vitamins and iron supplementation may therefore help improve her energy

• • •

levels.

Calcium can help supplement a diet lacking in dairy and vegetable intake.

Calcium and iron/vitamin B supplements should not be taken at the same time, however due to interaction.

Finally, it would be a good idea to recommend that Mena see her GP for a full blood test to see whether she is in fact deficient in any nutrients to track improvements.

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CASE STUDY THREE: JOHN John is an amateur bodybuilder who supplements with amino acids and eats four to five times a day (usually rice, chicken/beef and broccoli). He is looking for a way to increase his energy and explosive power for his workouts but does not want to consume any additional calories as he is already so full from all the food he is eating and wishes to maintain a lean physique.

EVALUATION: Recommended supplements: 1. Pre-workout supplement (that includes caffeine, beta-alanine and L-citrulline), 2. Creatine 3. Multivitamin.

JUSTIFICATION:

addressing John’s sleep routine and recovery/training volume, it looks as though • After supplementing with a high-quality pre-workout supplement may help him get the boost he is

•

looking for without adding to the volume of food he is eating. This is also a suitable supplement for John as it is low in calories, and the natural alternative would be sugary carbohydrates for extra energy (however, he does not want to consume more food or additional calories). This supplement should be consumed approximately 30 minutes prior to a workout, and John should be wary of the time he trains, as a pre-workout supplement may keep him awake at night due to the high caffeine content. Supplementing with creatine may help with exercise performance, power and recovery between exercises, specifically for resistance training.

A multivitamin can help address potential nutritional gaps that John may have due to his increased nutrient requirements from his high training volume. A good quality multivitamin will contain 100% of the RDI for vitamins A, B12, C, D, E and K and the minerals zinc, magnesium, folate and calcium.

While taking a multivitamin is not timing-dependent, if the multivitamin contains zinc, it is wise to take it with or directly after food to avoid stomach upset. John is best to take his supplements at a time that suits his routine best, either with breakfast or lunch, to ensure he is consistent with his supplementation routine.

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KNOWLEDGE OF SCOPE OF PRACTICE FOR SUPPLYING DIET, NUTRITION AND WEIGHT MANAGEMENT SUPPLEMENTS SCOPE OF PRACTICE AS A NUTRITION COACH

Many supplements contain ingredients that have strong biological effects, and such products may not be safe for all clients. If a nutrition coach were to recommend a client (who has certain health conditions) to take these products, this could potentially put the client at risk.

The table below is adapted from the FDA and lists important factors that a nutrition coach must consider when recommending supplements to clients:(4)

Supplements are not intended to treat, diagnose, cure, or alleviate the effects of diseases.

Nutritional supplements cannot completely prevent diseases. However, some supplements are useful in reducing the risk of certain diseases and are authorised to make label claims about these uses. For example, folic acid supplements may make a claim about reducing the risk of birth defects in the brain and spinal cord or the use of calcium in preventing osteoporosis.

Using supplements improperly can be harmful.

Taking a combination of supplements, using these products together with prescribed medicines, or substituting them in place of prescribed medicines could lead to harmful or even life-threatening results.

Some supplements can have unwanted effects before, during, or after surgery.

For example, thinned blood and bleeding are potential side effects of garlic, fish oil, ginkgo biloba, ginseng, and vitamin E. In addition to this, fish oil can increase the effects of other medications used during surgery.

Prior to surgery or medical procedures, a client should inform their health professional about the supplements they use.

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WHAT A NUTRITION COACH CAN/CAN NOT RECOMMEND A nutrition coach’s role is to help mitigate the risk of incorrect supplemental advice (a serious and common concern in the supplement, health and fitness industry). Mitigating risk is achieved by creating awareness of nutritional supplements and educating clients on how to identify quality products on the market and recognise unsafe/harmful ingredients.

Nutrition coaches must remember that prescribing nutritional supplementation for the purpose of treating, curing or alleviating the effects of disease falls outside their scope of practice - failing to abide by the scope of practice can lead to serious legal implications and put their clients at risk.

Nutrition coaches can not prescribe dietary supplements or expect their clients to follow mandatory supplement protocols. Instead, nutrition coaches should only ‘recommend’ supplement protocols to help support a healthy diet. It is then ultimately up to the discretion of the client to adhere to a nutrition coach’s recommendations. Nutrition coaches must always be clear and explain to their clients that any recommendation for the use of supplementation is just that - a ‘recommendation’ - which the client has no obligation to follow.

In addition to this, nutrition coaches are advised to ‘recommend’ nutritional supplements that are ‘Australian compliant products’, which are listed on the Australian Register of Therapeutic Goods, or supplements that comply with the Food Standards Code.

CLICK HERE to go to the Australian Register of Therapeutic Goods (ARTG).

Examples of supplements that may be compliant with the Food Standard code include: Caffeinated beverages (pre-workouts) Formulated supplementary sports foods (protein products or BCAA products).

• •

Utilising the ARTG or Food Standards Code ensures that nutrition coaches are recommending products that are receiving regulatory oversight from a recognised body, further reducing risk to client and coach. However, nutrition coaches may also recommend supplements that fall outside of TGA regulation, provided they follow the directions of use for a specific supplement and apply evidence-based research for the development of recommendations for clients. Nutrition coaches will need to be able to provide a justification for their supplement recommendations to clients and to the NCA should auditing or legal investigation be requested by clients or another authority (e.g. GP, insurance investigator etc.).(200)

What is the difference between ‘prescribing’ and ‘recommending’?

The term ‘prescribe’ means: to state authoritatively or as a rule that (an action or procedure) should be carried out; or to authorise the use of (a medicine or treatment) for someone, especially in writing.

While the term ‘recommend’ refers to advising or suggesting (something) as a course of action.

Nutritional advisors are reminded to refer back to their scope of practice (SoP) developed by Nutrition Council Australia, (NCA, 2018) as a continuous reference guide, in order to stay within their scope of practice.

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ENCOURAGING CLIENTS TO DISCUSS DIETARY SUPPLEMENTATION WITH ADVANCED HEALTH PROFESSIONALS Nutrition coaches are expected to build and maintain a high level of supplementation knowledge. As well as selfdirected learning, it can be hugely beneficial for nutrition coaches to speak with pharmacists, doctors, naturopaths, and experienced dietitians or registered clinical nutritionists about supplementation.

Nutrition coaches should also encourage their clients to seek medical advice prior to commencing a new supplement, as this can affect their current health status or medication regime, which is relevant information for their GP. Clients should also be encouraged to disclose any other vitamins, minerals or supplements they currently use which they have not previously disclosed to their GP. However, it is important to note that due to the large variety of new dietary supplements available, some GPs are still learning about their uses, risks and potential benefits. Therefore, it is important that both clients and nutrition coaches gather accurate information about the dietary supplements they wish to use and then approach their GP with this information to assess whether it will be suitable for their circumstances.

Finding out whether a supplement can be used alongside prescribed medications can help determine whether a supplement is safe to use and whether it will provide additional benefits.

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INDICATIONS FOR RECOMMENDING SUPPLEMENTS As a nutrition coach, it is possible to recommend supplements that may be of benefit to some clients, for example, to prevent nutrient deficiencies or improve gut health, especially where diet alone is unable to address potential deficiencies.

Recommending supplements would also be suitable where clients describe recognisable symptoms of nutrient deficiencies. For example, a client who follows a vegetarian diet and complains of low energy, weakness and lethargy is likely describing the symptoms of iron deficiency. Combined with the knowledge of their dietary intake, it is likely that they are iron deficient and can be educated about iron supplements (benefits, negatives, how to use foods that promote absorption) and advised that a supplement may be beneficial due to their unique circumstances. It is imperative that nutrition coaches only consider supplements after the initial assessment and nutritional assessment have been completed.

To date, supplementation is indicated for a variety of ailments and preventative strategies, including (but not limited to): Failure to meet nutritional requirements To boost levels of nutrients after clinical testing (blood testing) To improve athletic performance To prevent illness (e.g. coughs and colds) To improve body composition To support conception, pregnancy and breastfeeding To support those suffering from eating disorders or mental health conditions.

•• •• •• •

INDICATED ‘Indicated’ refers to something that is advisable or necessary.

It is imperative that nutrition coaches only consider supplements after the initial assessment and nutritional assessment have been completed and ensure that clients fall within their scope of practice. For example, although supplementation may be indicated for a pregnant (or breastfeeding) woman, this type of client would fall outside a nutrition coach’s scope of practice. The same goes for clients who present with complex mental health conditions or eating disorders.

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The table below provides examples of scenarios where incorporating nutritional supplementation may be indicated (advisable) and whether or not the situation or scenario falls under the scope of practice of a nutrition coach:

SCENARIO WHERE SUPPLEMENTATION MAY BE INDICATED

WITHIN THE SCOPE OF PRACTICE FOR NUTRITIONA COACHES

Clients who simply do not meet nutritional requirements on a day-to-day basis for various reasons.

YES.

Individuals who use recreational drugs habitually and/or excessively.

NO (This client should be encouraged to seek assistance with their substance use).

Endurance athletes.

YES.

Bodybuilders, weight-lifters and those looking to build muscle who do not have the time and/or ability to use whole foods pre- and post-training.

YES.

Adults who do not enjoy the taste of particular foods and therefore require a supplement substitute (e.g., omega-3 from fish).

YES.

Individuals receiving long-term enteral nutrition (where essential nutrients are delivered straight into the stomach or intestine via a nasogastric tube).

NO. (Referral to dietitian required).

Women who experience heavy menstrual cycles.

YES (Nutritional advisor can recommend that the client visits their GP for an assessment of iron status).

Crash and fad dieters who limit daily calorie intake to a point where they are no longer able to meet nutritional requirements.

YES (nutritional advisor to monitor for signs of eating disorder and refer on if necessary).

Individuals with thyroid disease

NO.

Women intending to get pregnant.

YES. (Once pregnant, referral to dietitian required).

Pregnant or breastfeeding women.

NO (Referral to dietitian required).

Clients who cannot cook and/or shop for themselves.

YES.

Individuals with eating disorders such as anorexia nervosa or bulimia nervosa.

NO (Referral to dietitian required).

Clients who live in rural areas where food security is of concern.

YES.

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Vegetarians and vegans who may be missing essential nutrients from their diet.

YES.

Children who are fussy eaters and may not be consuming adequate nutrition such as fruit or vegetables.

NO (Referral to dietitian required).

Clients who struggle with food intolerances or allergies.

YES (Only after the nutritional advisor has gained medical clearance and instruction from a dietitian or GP).

Clients with mild absorption issues (e.g. diarrhoea, constipation).

YES.

Individuals with a chronic illness or who have been identified ‘at risk’ during screening processes (Crohn’s disease, diabetes mellitus).

NO. (Referral to dietitian required).

Clients who participate in a lot of physical activity and cannot meet their higher nutritional requirements using whole foods.

YES.

Clients who are short on time and therefore lack proper nutrition on a day-to-day basis.

YES.

Individuals who have undergone bariatric surgery.

NO. (Referral to dietitian required).

Clients who do not meet their nutritional requirements through dietary measures may benefit from supplementation to ensure adequate intake of essential nutrients. While supplementing a diet with various vitamins, minerals and macronutrients may be suitable under some circumstances, it is important to educate the client and make them aware that supplements should never replace a healthy diet.

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IDENTIFYING CONTRAINDICATIONS FOR RECOMMENDING SUPPLEMENTS TO CLIENTS Contraindication refers to when a treatment or intervention is not indicated due to undesirable effects. All clients do not require supplementation, and many clients are unable to safely take supplements for a multitude of reasons and contraindications.

CONTRAINDICATION Contraindication refers to a sign that someone should not commence or continue with a particular medicine or treatment because it is or might be harmful.(201)

Below is a list of some of the occasions where supplementation is contraindicated in a client: The client is reaching nutrition requirements, and this is unlikely to change in the future The client is sensitive or allergic to certain ingredients in a supplement The client has a disease that may contraindicate certain ingredients. For example, a client with excess iron (haemochromatosis) should not be recommended an iron supplement The client is in nutritional toxicity The client is at risk of refeeding syndrome (dangerous electrolyte imbalances following a period of starvation) The client is taking medication, which may react to certain supplements. It is encouraged to check medication interactions with the Pharmacist/prescribing Doctor prior to recommending a supplement The supplement produces side effects that can be damaging to the health or wellbeing of a client The supplement is an illegal or banned substance.

• • • • • • • •

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DUTY OF CARE FOR NUTRITION COACHES Like any professional field where health advice is provided to a client, there are legal and ethical considerations which need to be considered. Incorrect nutrition or dietary supplementation advice can have direct and serious implications for a client’s physical and mental health. As such, it is of utmost importance that nutrition coach understands their duty of care and scope of practice.

Consequences to clients if a nutrition coach practises outside of their scope may include: Negative impact on a client’s pre-existing health conditions Sub-optimal or dangerous nutrient imbalances, interactions, toxicities and deficiencies Negative interactions between nutrients and drugs.

• • •

As a result of practising outside of their scope, nutrition coaches are at risk of: Potential legal proceedings and investigation for harm caused to the client, which could incur considerable financial costs and lost time.

Potential loss of professional reputation.

• •

It is important to have a sound understanding of the duty of care and responsible practice requirements inherent to all health professionals. In Australia, the provision of health and fitness information is generally not governed under a single legislation, act or code but is instead governed under codes of conduct for membership groups, peak bodies or industry authorities. However, any individual who provides professional health advice holds a duty of care to clients, which can be further defined as ‘the legal obligation to safeguard others from harm while they are in the health professional’s care, using their services, or exposed to their activities’. (201) As such, any nutrition coach who has provided incorrect nutritional advice supplied or recommended products that had a negative impact on a client’s health or indirectly contributed to a client’s injury or illness through incorrect, outdated or inappropriate nutritional support services may be in breach of their duty of care.

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REPORTING IDENTIFIED PROBLEMS AS A NUTRITION COACH REPORT PROBLEMS TO TGA Nutrition coaches are recommended to report health-related reactions, illnesses or suspected adverse reactions to a supplement to the TGA so that the product can be investigated.(202) Serious reactions or illnesses could include: Itching, rash/hives, throat/lip/tongue swelling, wheezing Low blood pressure, fainting, shortness of breath, palpitations, irregular heartbeat, chest pain Stomach cramps, abdominal pain, severe persistent nausea, vomiting, diarrhoea Difficulty urinating or decreased urination Loss of appetite, fatigue, yellowing skin/eyes, itching, dark urine Severe joint/muscle pain Slurred speech, one-sided weakness of the face, arm, leg, vision (stroke) Abnormal bleeding from gums or nose Blood in urine, sputum, stool or vomit Marked mood, behavioural or cognitive changes, suicidal ideation Attendance in emergency services or hospitalisation.

• • • • • • • • • • •

Clients who experience a suspected adverse reaction or illness to a dietary supplement should immediately stop taking the supplement and contact their GP for medical attention where required. The GP will then log a report with the TGA for further investigation. Nutrition coaches can also report suspicions to the TGA and are encouraged to do so, even if only reporting a suspicion and not an overt reaction.

Reports help the TGA to determine the safety of a product as part of its safety monitoring program. The TGA uses scientific and clinical expertise to assist decision-making and to ensure that product benefits outweigh potential risks to consumers.

Nutrition coaches are encouraged to report as much detail as possible, including: Contact details of the reporter (name, address, phone number) Client identification (initials, date of birth or age, but not full name) Details of the product Details of the suspected adverse event The provision of all information relevant to a specific adverse event, which can help the TGA to assess the role of the product in causing the adverse event.(203)

• • • • •

The TGA cannot accept anonymous reports and asks for contact details from reporters/clients so that it can seek further information about suspected adverse events. Providing complete and accurate information can reduce the need for the TGA to follow up.(203) All information that identifies a reporter or client is kept confidential.

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RECOGNISING CREDIBLE SOURCES AND FORMATS OF PRODUCT INFORMATION There are a number of different avenues where a nutrition coach can gain credible sources of information about various products, lifestyles and self-care.

Some of these sources include: Other Peak Industry bodies (Such as Dietitians Australia [DA] and The Nutrition Society of Australia [NSA]) Other Government bodies (Such as the National Health and Medical Research Council [NHMRC]) Professional publications (Such as The Australian Dietary Guidelines, Nutrient Reference Values for Australia and New Zealand) Manufacturer materials Health care fact sheets Reputable health education internet sites.

• • • • • •

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. For more information about how to obtain reputable information, please refer back to the unit ‘NAT11046001 Promote the Concepts of Health and Wellbeing’.

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INDUSTRY ASSOCIATIONS 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 (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. *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. (204)

DA MEMBERSHIP To become a member of DA and to use the title of an Accredited Practising Dietitian (APD), 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.(204)

• • •

Membership fees are also required to gain the status of an APD. For more information, head over to Dietitians Australia: CLICK HERE to view the link.

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. (205) 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.(205)

THE NUTRITION SOCIETY OF AUSTRALIA CLICK HERE to view the link.

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GOVERNMENT ORGANISATIONS There are various government organisations which 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 promoting the development and maintenance of public and individual health standards.(206) NHMRC brings together, within a single national organisation, the functions of research funding and development of advice. 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.(206)

NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL (NHMRC) WEBSITE CLICK HERE to view the link.

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 are able to 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.

NUTRITIONAL EDUCATIONAL MATERIALS ONLINE (NEMO) WEBSITE CLICK HERE to view the link.

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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 in calculating 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.

NUTRIENT REFERENCE VALUES (NRVS) WEBSITE CLICK HERE to view the link.

AUSTRALIAN DIETARY GUIDELINES The Australian Dietary Guidelines (Eat for Health) are Government approved guidelines that aim to assist clients in choosing foods that will benefit their overall health and wellbeing. The Australian Dietary Guidelines have 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. (207) *This resource is created for the general public; however, it is also used by personal trainers and fitness professionals as a resource in order 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 nutritional advisor who has completed the Nationally Accredited Certificate IV in Nutrition goes beyond the level of a personal trainer or fitness professional.

AUSTRALIAN DIETARY GUIDELINES CLICK HERE to view the link.

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THE AUSTRALIAN GUIDE TO HEALTHY EATING The Australian Guide to Healthy Eating is a food selection guide which visually represents the proportions of the five food groups recommended for consumption each day.(208) 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 take into account 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 from another food group.

AUSTRALIAN GUIDE TO HEALTHY EATING CLICK HERE to view the link.

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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. Identify the authors of the articles, their qualifications, the level of evidence, and who funded the research. As it can take decades for guidelines to be updated, with a continuous emergence of new information, it is encouraged that evidence-based information from reputable sources is always well analysed and utilised as appropriate.

REPUTABLE HEALTH EDUCATION INTERNET SITES Reputable health education internet sites refer to online information obtained from credible sources such as government and not-for-profit 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 the positive attributes associated with it and potentially gloss over the negative attributes.

MEDICINES DATABASE It is helpful to be aware of and make use of 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 aimed at bringing about better health outcomes.

A CMI includes:(209) Name of the medicine Names of the active and inactive ingredients Dosage of the medicine What the medicine is used for and how it works Warnings and precautions, such as when the medicine should not be taken How to use the medicine properly Interactions the medicine might have with food or other medicines Side effects What to do in the case of an overdose How to store the medicine properly Name and address of the sponsor The date the CMI was last updated

• • • • • • • • • • • •

THERAPEUTIC GOODS ADMINISTRATION CLICK HERE to view the link.

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PHARMACY MANUALS Pharmacy manuals are guidance documents produced by pharmaceutical manufacturers and governmental or nongovernmental organisations. They are designed to provide information to health 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 may provide accurate information on certain aspects of pharmaceutical substances, they should not be used by nutrition coaches 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.

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 sale of the product 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 is obtaining the best quality information to pass forward to their clients.

HEALTH CARE FACT SHEETS Much like the product leaflets, brochures and booklets, health care fact sheets can prove extremely beneficial as a quick guide to various products. nutrition coaches should, however, ensure that health care fact sheets are a reliable source of information. This can be achieved by identifying who published the fact sheet/s, what claims are being made, and by checking the reference list.

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MAKING INFORMED DECISIONS AND EVALUATING INFORMATION Clients regularly seek out information regarding health and dietary supplements that they are considering using in order to make an informed decision. As discovered throughout this unit, many supplements can provide benefits, while some products may be unnecessary for health or may carry unexpected risks. Given a large amount of often conflicting information available to the public, identifying reliable sources of information is important.

Listed below are tips and resources that can assist nutrition coaches in becoming better informed about the use of supplements:

CONSIDER A CLIENT’S ‘TOTAL DIET’.

Nutritional advisors need to consider a client’s overall diet and preferences to determine whether a supplement is really necessary. While being deficient in a nutrient can cause problems, too much of some nutrients can also be problematic.

SHOULD A CLIENT SEEK ASSISTANCE FROM THEIR GP ABOUT SUPPLEMENTS?

Nutritional advisors should encourage their clients to consult with their GP when considering commencing a new supplement or supplement program. However, if a client decides not to consult their GP, this is their responsibility, not the nutritional advisor’s.

SOME SUPPLEMENTS HAVE THE POTENTIAL TO INTERACT WITH OVER-THE-COUNTER AND PRESCRIPTION MEDICINES.

Nutritional advisors need to ensure that they are aware of potential nutrient/nutrient and drug/nutrient interactions. Ensuring that clients provide complete information, as well as outlining the risks and benefits of supplements, is a duty of the nutritional advisor so that clients can make informed decisions.

RESPONSIBILITY FOR SUPPLEMENT SAFETY.

Manufacturers of supplements are responsible for ensuring that their products are safe before they go to market. They are also responsible for accurate labelling and are liable for action when products fail to perform as claimed. The TGA regulates these activities.

IS A CLAIM TOO GOOD TO BE TRUE?

Are the claims made about a product exaggerated or unrealistic? Is the product supported by evidence? Is anecdotal evidence being presented as scientific evidence? Does the website use testimonials or reviews? These can often be paid for or false. Learning to identify hype from evidencebased information is important.

DO NOT FALL FOR THE LATEST FAD.

Good health advice is based on a large body of quality evidence, not a single study. Be aware of products that promote a quick fix or new evidence that is unsubstantiated. If a product provides research links, read and critique the research study. Do not trust the promotion of new studies or products through social media or television channels.

CONTACT PRODUCT MANUFACTURERS FOR MORE INFORMATION.

It is good practice to contact manufacturers and distributors of products for more information about them. A good quality manufacturer will be able to provide high-quality information about their products and links to the science that supports their products or claims. Information regarding quality control systems and adverse events should also be available.

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RECOMMENDATIONS FOR SEARCHING ONLINE FOR INFORMATION ON DIETARY SUPPLEMENTS Being able to identify good quality products and retailers on the internet is important to ensure that the best possible products are being recommended to clients.

The table below provides recommendations for what nutrition coaches should look for when using online resources:

WHO RUNS/OWNS THE WEBSITE?

WHAT IS THE PURPOSE OF THE WEBSITE?

WHAT/WHO IS THE SOURCE OF INFORMATION?

Commercial websites, such as retail sites and blogs, are usually run for profit, and the accuracy of their information should be checked against independent or government websites (e.g. check health claims on products against independent research).

Reliable sources of information include: Government websites Independent research bodies (like CSIRO and Nutrition Australia) Universities and medical/health associations ( Cancer Council, DA, NSA).

• • • whether a website is designed to educate the public objectively • Determine or to sell a product. nutritional advisors should always be wary of websites •

• information should be presented with references that can be • Unbiased used to verify the author’s claims. evidence-based website will also present both sides of an argument or • Anproposition and use evidence to present a conclusion.

Websites like Healthline and Livestrong are evidence-based sites • that aim to useWebMD, research to back articles; however, the reader still needs to •

IS THE INFORMATION CURRENT?

IS THE INTERNET A RELIABLE SOURCE OF INFORMATION?

that provide information while also promoting specific products.

Commercial websites should distinguish adverts from scientific information or provide a label to identify whether an article is sponsored or promotional.

Most non-profit websites contain no advertising and provide access to materials for free.

be aware of individual contributors’ potential biases.

High-quality websites like www.theconversation.com.au and research papers (on sites like PUBMED, Scopus, and Web of Science) will provide information about an author’s credentials and sources of bias.

when an article or webpage was produced can provide • Checking information about the currency and reliability of the information. the article or site is over five years old, it is likely to be outdated, as • Ifscience, research, and technology are constantly being updated.

Websites should be updated regularly.

• general, the internet can be a reliable source of information. Searching • Inresearch databases can provide the nutritional advisor with up-to-date

• •

information that can be very reliable, especially when utilising ‘systematic reviews’ and ‘meta-analyses’ which collate and review the available data on a specific area of health or nutrition.

The next best form of information usually comes from government and not-for-profit websites, followed by ‘grey literature’, which includes independent sites that generate income from advertising (like WebMD, Healthline and Livestrong).

Blog posts from individuals are highly unreliable sources of information unless the owner’s funding, occupation and biases are made clear.

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GLOSSARY TERM

DEFINITION

ANABOLISM/ ANABOLIC STATE

Refers to the synthesis 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 has the purpose of protecting the body from potentially damaging oxidation, which can come from the consumption of ‘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 (sugar received from food) within the bloodstream. This serves as the body’s main source of energy.

CARDIOPROTECTIVE

Simply means to protect the heart from disease.

CATABOLISM

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, and the body begins showing symptoms of illness.

DEGRADATION

Refers to the breakdown of existing substances.

DETOXIFICATION

The process of eliminating toxins from the body. This is usually done by the liver and kidneys; however, some Western diets also aim to do this.

DISACCHARIDES

Type of sugar which is formed by the joining of two monosaccharide molecules with specific types of linkages.

ELECTROLYTE

Are minerals which enter the blood plasma and are essential for regulating the body’s fluids.

ENDOGENOUS

Originating internally; internal cause; internal source.

ENERGY-DENSE

Refers to foods which 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.

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ENZYMES

Are biological molecules which either speed up the rate of chemical reactions, or are used to bring about specific 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 by themselves, so they will search the body to find a pair, while causing damage to DNA, cells and protein in the process.

GLUCONEOGENESIS

The term given to the process through which the kidneys use stored glycogen to create ready-to-use glucose.

GLYCEMIC INDEX/ GLYCEMIC LOAD

Is a ranking system which categorises carbohydrates based on their effects on blood sugar. Glycaemic load looks at the food as a whole before noting its effect on blood sugar.

GLYCOLYSIS

The systematic breakdown of glucose by specific enzymes, to create 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.

HYDROGENATION

The man-made process which adds hydrogens to unsaturated fats in order to turn them into more stable saturated fats. This causes inflammation in the body.

HYDROPONICALLY

Is the process of growing plants in the absence of 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, which produces heat and is caused by infection.

INSOLUBLE

The substance is unable to dissolve.

INSULIN

A hormone produced by the pancreas which controls/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).

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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

Includes all the chemical processes undertaken by the body in order to maintain life. It can involve the breakdown of large particles into smaller ones or the synthesis of large particles from smaller ones.

MICRONUTRIENTS

Are the nutrients that the body needs in smaller amounts and include vitamins and minerals.

MONOSACCHARIDES

The simplest form of sugar/carbohydrates - includes only one molecule of glucose, fructose or galactose. From these three molecules, the remainder of all carbohydrates is formed by the linking together of 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.

NEURON

The name given to cells in the nervous system, which are used to transmit nerve impulses, allowing the sending of various messages.

NUTRIENT-DENSE

Refers to foods which provide more nutrients than they do energy.

OEDEMA

A more common term is fluid retention. Oedema refers to the swelling of body areas due to excess water/fluid.

OLIGOSACCHARIDES

It is a form of ‘complex’ carbohydrates which contain between three 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. It 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 which have disease-protecting properties.

POLYSACCHARIDES

Is a form of ‘complex’ carbohydrates which contain more than 10 monosaccharides (single sugar molecules) linked together.

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POLYMERS

Another name for the joining of single sugar molecules (which are also known as monomers).

POLYMERISATION

The process by which single sugar molecules or monomers join together to form more complex forms of carbohydrates.

RECEPTORS

A specialised area on a cell which receives neurotransmitters, hormones, or other substances as a binding site to facilitate communication.

SATIATION/SATIETY

The feeling of being ‘full’ after consuming certain types of foods.

SEDENTARY

Remaining inactive or sitting for extended periods of time; participating in very little physical activity.

SOLUBLE

Able to be dissolved in any or a specific solution.

SYNERGY/ SYNERGISTIC

The ability of various systems, organs, processes, etc., to work together to achieve a common goal.

SYNTHESIS

To produce, create, make.

THERMOREGULATION

An aspect of homeostasis, thermoregulation, refers to the internal regulation of the body’s temperature.

TRACE

Small amounts.

TRIGLYCERIDES

A type of fat found in foods - particularly natural fats and oils.

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