17. METABOLISM

Question 1

What is the ‘First Law of Thermodynamics’?

Answer 1

Energy cannot be created or destroyed, but it can be transformed from one form into another.

Question 2

Explain the concept of ‘energy balance’. What would ‘negative’ or ‘positive’ energy balance entail?

Answer 2

Energy balance = energy intake
(+ energy stores) – energy expenditure.

If the intake and expenditure are not equal:
- Negative energy balance (utilisation of body’s energy stores: glycogen, fat, protein).
- Positive energy balance (an increase in body energy stores, primarily as fat).

Question 3

Name two forms in which energy consumed in the form of food and drinks can be stored in the body.

Answer 3

• Glycogen in the liver and muscles.
• Fat (accounting for the majority of energy storage).

Question 4

When energy is in short supply, where can the body source energy from?

Answer 4

• Glycogen in the liver and muscles.
• Fat
• Protein (a last resort in cases of starvation
  or malnutrition – amino acids are liberated from tissues such as skeletal muscle).

Question 5

What is the ‘Second Law of Thermodynamics’ as it applies to the body?

Answer 5

All energy used by the body degenerates as heat

Whenever energy is transferred or transformed (e.g. during cellular metabolic reactions) there is a loss of energy in the form of heat. This means that there is a portion of thermal energy that is no longer available for chemical, mechanical or electrical work inside the body.

Question 6

The heat-generating potential of a food can be measured and expressed as energy units known as …………………

Answer 6

‘calories’

Question 7

Calculate the energy provided by a snack consisting of 10 grams of fat, 20 grams of protein and 10 grams of fibre – show your working.

Answer 7

10 x 9Kcal (fat) – 90kcal
20 x 4kcal (protein) – 80kcal
10 x 2kcal (fibre) – 20kcal
Total = 190kcal

Question 8

List FOUR key nutrients needed for mitochondria to generate ATP, through Acetyl CoA formation, the Krebs Cycle and the Electron Transport Chain.

Answer 8

• Magnesium
• Manganese
• Iron
• Sulphur
• CoQ10
• Copper
• Vitamins B1, B2, B3, B5
• Alpha-lipoic acid.

Question 9

List THREE things that could impair mitochondrial function and interfere with energy production

Answer 9

Nutrient deficiencies, toxins (including poor liver detoxification and elimination pathways) and heavy metals (e.g. Mercury, Arsenic & Aluminium)

Question 10

There are many factors that affect an individual’s ability to produce energy. Discuss FIVE factors that contribute to ATP production, impairment of which can result in deficiency (e.g. fatigue).

Answer 10

• Sufficient nutrient intake (fuel): Nutrient intake is crucial for cell respiration (i.e. for the Krebs cycle etc.) – so ensure good nutrition.
• Digestion & absorption: Digestion is crucial for the liberation of nutrients from food. Good GI health is also vital for nutrient absorption.
• Respiratory health: Oxygen intake. Consider lung diseases, smoking, chronic hyperventilation.
• Heart health & circulation: Key in nutrient (‘fuel’) delivery to cells.
• Mitochondrial health: Requires nutrients for ATP production, including antioxidants to protect against mitochondrial damage, as well as a minimal toxic load.
• Thyroid health: Upregulates metabolism.
• Adrenal health: Adrenaline and Noradrenaline increase energy delivery (stimulate glycolysis, increase HR and BP, dilating airways).
• Healthy Detoxification: To prevent mitochondrial damage, optimise liver detoxification and routes of elimination (bowel, kidneys, skin, lungs) and minimise toxic exposure.
• Sleep hygiene: Adequate sleep promotes melatonin production (a potent antioxidant).

Question 11

On which three variable factors does a person’s daily total energy expenditure depend?

Answer 11

• Basal Metabolic Rate (BMR)
• Physical Activity
• The Thermic Effect of Food.

Question 12

Define ‘Basal Metabolic Rate’?

Answer 12

The Basal Metabolic Rate (BMR) is the minimum level of energy required to sustain life; i.e. the energy used to maintain basic physiological functions such as the cardiac contractions, ventilation and cell growth.

Question 13

What proportion of total energy expenditure does BMR account for?
a) 10 - 25%
b) 35 - 50%
c) 60 - 75%

Answer 13

c) 60 - 75%

Question 14

Which factors can affect BMR?

Answer 14

• BMR varies between individuals, mostly due to differences in body/muscle mass.
• Physical activity can also impact BMR: exercise can elevate metabolic rate for up to 48 hours and can also increase the FFM which further elevates BMR.
• Other factors that can affect BMR include stress, caffeine, nicotine, medications, fever, injury, genetics, thyroid hormones, etc.

Question 15

Recap:

Which nutrients are are especially important for T3 and T4 production?

Answer 15

Iodine
tyrosine
zinc
selenium
iron

Question 16

What is subclinical hypothyroidism? How does it present and what underlying factors should be considered?

Answer 16

Subclinical hypothyroidism is categorised as TSH levels above range but with normal levels of T4 & T3. It is found in 8-10% of the population (60% are unaware) and is more common in women.

It can present as low energy, reduced appetite, weight gain, feeling cold, dry skin, thinning hair, constipation, irregular periods and depression.

Underlying factors to consider may include nutrient deficiencies (especially iodine, selenium, zinc, vitamin D), autoimmunity, fluoride, mercury and exposure to endocrine disruptors such as BPA.

Question 17

How could disease or trauma affect an individual’s metabolism?

Answer 17

• Infection and fever raises one’s metabolic rate.
• Energy requirements increase to recover
  after surgery or an injury.
• The BMR of a patient with severe burns
  can more than double during recovery.
• Anorexia Nervosa patients need energy
  intake up to 2.5 times their BMR during re-feeding.
• Cancer patients’ energy requirements may reach 145% of BMR.

Question 18

What is the ‘Thermic Effect of Food’ (TEF)?

Answer 18

The Thermic Effect of Food (TEF) is the amount of energy required to digest and process the food you eat.

Question 19

What are the Thermic Effects of:
- Fats?
- Carbohydrates?
- Proteins?

Answer 19

• Fats = 0-3%
• Carbohydrates = 5-10%
• Proteins = 20-30%

Question 20

Why can protein be considered helpful to weight loss programmes?

Answer 20

• The 20-30% thermic effect of Protein can be helpful in weight loss programmes.
• Protein increases satiety and has a much lesser effect on insulin levels when compared to carbohydrates.

Question 21

Different macronutrients provide different amounts of energy. How much energy (kcal) does 1 gram of the following yield:
a) Carbohydrate
b) Protein
c) Fat
d) Alcohol
e) Fibre

Answer 21

a) Carbohydrate = 4kcal
b) Protein = 4kcal
c) Fat = 9kcal
d) Alcohol = 7kcal
e) Fibre = 2kcal*

* yielded from bacterial fermentation in the gut

Question 22

When considering the Thermic Effect of Food (TEF), what is problematic about highly processed foods?

Answer 22

The thermic effect of highly processed food is substantially less than their whole- food counterparts.
It also has a low satiety effect and a high reward effect, which can contribute to overeating.

Question 23

Instead of blindly following government guidelines for energy requirements, which factors need to be taken into account when trying to establish the energy needs of an individual?

Answer 23

Caloric requirements vary between individuals.
Government guidance does not take into account many important factors such as:
- one’s body size
- muscle mass
- current state of metabolic health
- sedentary vs. active lifestyle

Question 24

What is de novo lipogenesis (DNL)?

Answer 24

It is the metabolic pathway that synthesises fatty acids from excess carbohydrates.
Converting CHOs into body fat (DNL) is a costly process requiring up to 30% of the CHO energy to do so.

Question 25

TRUE OR FALSE:

Up to 30% of the energy from all excess carbohydrates is used for its conversion into body fat through the process of de novo Lipogenesis (DNL).

Answer 25

FALSE.
Fructose is the carbohydrate exception regarding DNL since the liver easily converts fructose into fatty acids (without the high energy cost).
High amounts of fructose result in high levels of de novo lipogenesis.

Question 26

Explain why chronic calorie restriction can be counterproductive when trying to lose weight.

Answer 26

Although consuming fewer calories than needed to meet energy requirements (i.e. a negative energy balance) forces the body to use stored fat for energy (weight loss), chronic calorie restriction may lead to a slowing down of one’s metabolism (as well as micronutrient deficiencies).
This can make it more difficult to continue losing weight. A person may need to eat more food (but the right types – i.e. nutrient dense) to help re-establish a healthy metabolism for weight loss to continue.

Question 27

When considering the maintenance of energy balance, which would be more important:
Macronutrient status OR Food quality?

Answer 27

In naturopathic nutrition, the specific amounts of macronutrients that an individual should aim to consume, are not as important as food quality in maintaining energy balance.

Question 28

Recap:

What are the average macronutrient percentages in a ketogenic diet of:
- Fat
- Carbohydrates?

Answer 28

Ketogenic Diet ratios:
- Fats = 65-75%
- Carbohydrates = 5-10%

Question 29

Known for almost 100 years to be effective in preventing epileptic seizures, in what other conditions could ketogenic diets be adjunctively used?

Answer 29

• Obesity
• Metabolic syndrome
• Type 2 diabetes
• Alzheimer’s
• Parkinson’s
• Certain cancers such as malignant brain tumours.

Question 30

A 50-year old lady who requires 2,017 kcal per day is interested in eating for healthier ageing.
Using the blue zones as a guide (Carbs 65%, Proteins 15%, Fats 20%), calculate the calories (kcals) and grams per day for each macronutrient.

Answer 30

• Carbs: 1311kcal; 328g
• Proteins: 302kcal; 75.5g
• Fats: 403kcal; 44.5g

Question 31

What effect was seen in public health since governments started recommending low fat diets after Harvard University research pointed the blame for rising obesity rates at fat intake?

Answer 31

Low Fat diet advice coincided with the biggest rise in obesity and cardiovascular disease in human history.

Question 32

Which hormone, made by the stomach, increases with food deprivation and may trigger hunger?

Answer 32

Ghrelin

Question 33

Which neurotransmitter is a potent stimulant of food intake?

Answer 33

Neuropeptide Y (NPY)

Question 34

Which adipokine hormone (made by fat cells) promotes satiety and stops feeding behaviour?

Answer 34

Leptin

Question 35

Which hormone, secreted in response to the presence of food in the duodenum, promotes satiety?

Answer 35

Cholecystokinin (CCK)

Question 36

Outline the working of Cholecystokinin (CCK)

Answer 36

• CCK stimulates the gall bladder to release bile.
• It stimulates the pancreas to release
  pancreatic juice (digestive enzymes).
• It delays gastric emptying.
• It acts on CCK receptors throughout the central nervous system (CNS) and in the satiety centres in the brain stem.

[Meals rich in protein and fat stimulate CCK more than meals that just contain carbohydrates].

Question 37

What triggers the release of insulin from the beta-cells of the pancreas and what is its main role?

Answer 37

• Insulin is released by the beta-cells of the pancreas in response to elevated blood glucose.
• Its role is to lower blood glucose by facilitating its storage predominantly in muscle tissue and the liver as glycogen.
• It is also responsible for controlling the storage and the release of fatty acids in and out of adipose tissue. In fact, fat cannot be stored without insulin.

This is achieved via:
1. The regulation of several lipase enzymes.
2. The activation of glucose transport into the fat cells via recruitment of glucose-transport protein 4 (GLUT4)

Question 38

List FOUR Metabolic Actions of Insulin

Answer 38

Insulin:
- Stimulates synthesis of triglycerides from free fatty acids.
- Inhibits release of free fatty acids from triglycerides.
- Increases synthesis of liver glycogen, thereby increasing glucose uptake and storage.
- Inhibits gluconeogenesis.
- Stimulates glucose uptake in skeletal muscle.
- Reduces hunger via the hypothalamus

Question 39

Outline the genesis of ‘Insulin Resistance’

Answer 39

• Chronic excess energy intake (combined with a sedentary lifestyle) leads to the body producing excessive amounts of insulin.
• Increased insulin levels inhibit lipolysis – the breakdown of fat from adipose tissue.
• With insulin resistance, lipolysis is not inhibited leading to visceral fat deposition (also referred as “Central Adiposity”).
• As visceral fat increases, adiponectin production decreases.

Adiponectin = an adipose-specific protein hormone that increases the oxidation of fatty acids, promotes the clearance of excess fat in tissues, and improves insulin sensitivity.

Question 40

What is is a typical feature of insulin resistance?

Answer 40

```
Central adiposity
(excessive belly fat)
~~~

Question 41

Outline why central adiposity (excessive belly fat) is problematic.

Answer 41

• This type of adipose tissue acts as an ‘endocrine organ’ and can produce inflammatory cytokines including TNF-α and interleukin-6, raising the levels of systemic inflammation. This promotes further hormone resistance, obesity and chronic diseases.
• Visceral fat supplies a constant source of excess free fatty acids (FFA) because lipolysis is not working properly.
• The additional FFAs pass into the blood and to the liver.

Question 42

Why is Insulin Resistance a major feature in Non-Alcoholic Fatty Liver Disease (NAFLD)?

Answer 42

Normally, insulin sends two signals to the liver:
1. Stop making glucose – i.e. inhibit gluconeogenesis.
2. Store the available blood glucose as glycogen – i.e. glycogenesis.

However, in insulin resistance both of these processes respond poorly to the insulin signal, putting patients at risk of chronically elevated glucose levels.

Question 43

Why is high dietary intake of fructose problematic and what conditions can it lead to?

Answer 43

• The liver metabolises fructose differently than glucose - when glycogen stores are full, fructose is converted directly to liver fat.
• Excess fructose intake is associated with NAFLD, obesity, hypertension, excess uric acid levels (associated with gout), and elevated Advanced Glycation End products (AGEs) linked with accelerated ageing and diabetes complications.

Question 44

How is dysregulated sleep, elevated cortisol levels and exercise connected to weight loss or lack thereof?

Answer 44

Dysregulated sleep and elevated cortisol levels are associated with increased ghrelin secretion; whereas exercise has been shown to decrease ghrelin concentrations.

Ghrelin = hunger stimulating hormone

Question 45

Explain why the following equation does not always function in practice:
Increased adiposity = Increased leptin = Suppressed appetite

Answer 45

Leptin is an adipokine produced by white adipose cells in proportion to overall body fat (Adiposity).

However, whilst leptin levels are often elevated in overweight people, obesity promotes a number of inflammatory cellular processes that weaken leptin signalling leading to leptin resistance and its failure to suppress appetite.

Question 46

Outline how the vicious cycle of leptin resistance play out.

Answer 46

• Excess Leptin can modify insulin sensitivity, tissue metabolism, stress responses, and reproductive function, all mediated via the hypothalamic-pituitary-adrenal axis.
• Over time, these changes in metabolism produce abdominal weight gain in both men and women, as well as thigh and hip weight gain in females, chronic fatigue, sleep problems, cardiovascular distress, and a host of other changes.
• Additional adipose tissue then contributes further to leptin resistance (becoming a vicious cycle).

Question 47

A client is trying to lose weight and you suspect leptin resistance. Give FOUR recommendations to enhance leptin sensitivity and support them on their weight loss journey.

Answer 47

Go Gluten-Free
Wheat gluten has been shown to stop leptin binding to the leptin receptor.

Reduce sugar consumption
Especially fructose as this has been shown to induce leptin resistance.

Support gut flora with prebiotics
Some evidence to show that prebiotics can improve leptin sensitivity.

Reduce Inflammation
Following an anti-inflammatory diet can contribute to restoring leptin sensitivity.

Regular exercise
Shown to increase leptin sensitivity.

Sleep hygiene
Poor sleep can adversely affect leptin sensitivity.

Question 48

How does gut microflora composition impact on body fat composition and vice versa?

Answer 48

• Overweight individuals have different gut microflora compositions to lean individuals (e.g. reduced Bifidobacterium).
• There is evidence that a higher ratio of Firmicutes v. Bacteroidetes phyla may be implicated in obesity.
• Scientists have shown that transferring the gut flora from obese mice to lean mice causes the lean mice to gain weight and vice versa.
• What we eat affects which species of bacteria proliferate in the gut.
• A high-fat diet causes increased levels of gram-negative bacteria and reduced levels of bifidobacteria.

Question 49

Explain why intestinal permeability is a risk factor for obesity.

Answer 49

Intestinal permeability is associated with
‘metabolic endotoxemia’ (a persistent, sub-clinical low-grade inflammatory response due to circulating endotoxins, which is a risk factor in obesity) characterised by:
- Enhanced lipopolysaccharide (LPS) absorption.
- Low grade chronic inflammation.
- Insulin resistance.

Question 50

Explain the role of pre- and pro-biotics as part of an effective weight management and metabolic health protocol.

Answer 50

Pre- and pro-biotics can be used for the modification of gut flora.
Studies using prebiotics have been shown to:
- Promote satiety.
- Reduce hunger.
- Reduce food ingestion.
- Suppress ghrelin.
- Increase peptide YY (inhibits feeding stimuli after a meal) and GLP-1.

Trials using probiotics have also shown success in metabolic syndrome:
* One trial found a combination of diet and probiotic supplements (Lactobacilli and Bifidobacteria) was significantly more effective at lowering blood glucose levels and improving insulin sensitivity compared to dietary measures alone.
* In another trial 4 weeks of L. acidophilus supplementation preserved insulin sensitivity, whereas it decreased in the placebo group.

GLP-1 = Glucagon-like peptide 1 (Promotes satiety).

Question 51

Define:
a) Appetite
b) Hunger

Answer 51

a) Appetite: a psychological reaction that stimulates a physiological response such as salivation; i.e. a conditioned response to food.

b) Hunger: a physical reaction that includes chemical changes in the body from a prolonged period without eating; i.e. the need for food.

Question 52

How are dopamine receptors implicated in overeating?

Answer 52

• Foods with a high fat or sugar content offered a survival advantage to our hunter-gatherer ancestors.
• Consequently these foods strongly stimulate the dopamine reward system.
• Obese people have been shown to have reduced numbers of dopamine receptors in their brains and get less of a reward response from palatable foods.
• More repeated intake of palatable food
  results in down regulation of dopamine receptors.
• This can increase the risk of over eating.

Question 53

List two factors affecting food intake for each of the following categories:
a) Cultural/Social
b) Sensory
c) Emotional

Answer 53

a) Cultural/Social:
* Religious traditions.
* Celebrations.
* Meal patterns.
* Family traditions.
* Work lunches / dinners.
* Attitudes to leaving food on the plate.
* Education

b) Sensory:
* Appearance/smell of food.
* Taste and palatability of food.
* Addiction (sugar, cigarettes and coffee)
* Packaging, advertising.
* Surroundings and ambience.
* Learned likes and dislikes.
* Flavour fatigue.

c) Emotional:
* Comfort eating.
* Stress.
* Insomnia.
* Loneliness.
* Sadness.

Question 54

Outline why and how to keep blood glucose levels even as a strategy to regulate food intake

Answer 54

Studies show that sharp spikes in blood glucose are followed by sharp drops which increase activity in the ‘nucleus accumbens’, an area of the brain that produces a desire to eat, often manifesting as sugar cravings.

To maintain stable blood sugar:
- Include protein with every meal.
- Avoid refined carbs/sugar and include complex carbs / low GI/GL foods; e.g. beans, wholegrains, vegetables, etc.
- Choose organic/whole foods for optimum nutrition.
- Chew well, eat mindfully, don’t overeat, 3 meals-a-day.

Question 55

How could keeping track of food eaten be utilised as a strategy to regulate food intake as part of a weight loss plan?

Answer 55

Keeping track of what we eat leads to more conscious food choices and can reduce mindless eating.
- Be clear on portion sizes.
- Monitor changes in weight, body fat and waist circumference.
- Food diaries can help to regulate food intake.

Question 56

You recommend ‘mindful eating’ as part of your client’s nutritional plan. Outline some ways in which this can be implemented.

Answer 56

Mindful Eating = the process of paying attention to your eating experience without judgement to help you become aware of the reasons behind your hunger. Some ways in which this can be implemented:
- Prepare – take in the sights, sounds and smells as you prepare/wait for the food.
- Put away electronics – hold space for one thing… eating.
- Sit down – take a deep breath, centre yourself and enjoy the food in front of you.
- Be Still – dedicate at least part of the meal to the silent enjoyment of food.
- Connect – to your mind & body.
- Take in the food with your senses – the visual appeal, the texture, try to identify the tastes as you chew slowly.
- Listen to your body – Honour the internal cue for when you’ve had enough.

Question 57

When making dietary recommendations, why would you focus on “adding in” rather than “taking away”?

Answer 57

• By adding in more “nutrient dense” foods (e.g. colourful vegetables, fruit, pulses & wholegrains)
  that are high in fibre, water,
  phyto- and micronutrients…
• We displace the “energy dense” foods that have high amounts of fat, sugar and starch and less water, fibre and micronutrients, such as processed foods, oils and confectionery.

“Eating is a zero-sum game: The more you eat of one food, the less you eat of another.”

Question 58

People tend to consume a certain volume of food regardless of the calories it contains.
How can you use this knowledge in your recommendations to help them regulate food intake?

Answer 58

• Filling your client’s menu plan with lots of plants can help them to feel full, increasing nutrition whilst reducing calorie intake.
• A plant-based diet can equate to between 400 to 800 fewer calories a day without a conscious restriction of the amount of food they’re eating.

Question 59

List FIVE factors that could hinder weight loss.

Answer 59

• Over-eating and junk food too many calories from energy-dense, nutrient-poor foods.
• Sedentary lifestyle not enough movement.
• High blood sugar often associated with high
  intake of refined carbohydrates and ‘Insulin resistance’.
• Chronic stress cortisol→↑ blood sugar, ↑ abdominal fat.
• Poor sleep is linked to ↑ waist circumference, ↑ fat mass.
• Underactive thyroid function.
• Gut flora imbalances which can influence metabolism.

Question 60

Stress reduction is an important part of a weight loss plan. Outline to your client how they could achieve this.

Answer 60

• Identify and address the root cause of stress.
• Diaphragmatic breathing exercises to stimulate the Vagus nerve (and parasympathetic activity).
• Eat to balance blood sugar (low blood sugar increases cortisol).
• Use ‘adaptogenic’ and ‘nervine’ (relaxing) herbs such as ashwagandha, chamomile and passionflower.
• Reduce reliance on stimulants (e.g. coffee, energy drinks) and alcohol.
• Eat a diet high in Magnesium, B-vitamins and Vitamin C.
• Epsom Salt baths (500g of salts – add 10 drops of lavender oil).

Question 61

Outline to your client how they could achieve good ‘sleep hygiene’.

Answer 61

Good Sleep Hygiene:
- Avoid coffee (a stimulant) and products containing caffeine. Also avoid alcohol (a sedative that leads to a less restorative sleep).
- Plan for 8 1⁄2 to 9 hours in bed – lights out before 11pm.
- Aim to go to sleep and wake up at the same time each day.
- Ensure the bedroom is dark, cool and well ventilated.

3 hours before bed:
- Finish all eating and complete any aerobic exercise.

1-2 hours before bed:
- Minimise exposure to bright lights.
- Switch off devices (e.g. mobile, tablets, television).

Question 62

What is Alternate Day Fasting (ADF) and what are some of the benefits?

Answer 62

Alternate Day Fasting (ADF) is a type of Intermittent Fasting (IF) whereby you alternate between periods of normal eating and periods of fasting or significant caloric restriction. It works by lowering insulin levels, thereby training your body to get better at using fat for fuel. IF also increases Growth Hormone which is associated with lower body fat.
Benefits include reduction in fat mass (particularly trunk fat), LDL cholesterol and Triglycerides (TG).

Question 63

What is ‘Time Restricted Feeding’ and how can it be implemented?

Answer 63

Time Restricted Feeding (TRF) is a type of Intermittent Fasting (IF) where all of one’s eating is limited to a certain number of hours each day.
- The eating window varies depending on a person’s preference, usually between 6 to 12 hours per day; e.g. 16:8 (10am-6pm).
- More extreme TRF can be 20:4 or 23:1 i.e. one-meal-a-day (OMAD).

TRF studies demonstrate results in weight loss and reduced caloric intake without counting calories.

Question 64

What are the health benefits of a Low Carb/High-Fat (LCHF) diet and list THREE therapeutic uses

Answer 64

The health benefits of LCHF diets such as the ketogenic diet, apart from reduced body fat, include a lower inflammatory and oxidative burden than when running on glucose.

Therapeutic uses include:
- type 2 diabetes
- cardiovascular disease
- cancer
- Alzheimer’s
- PCOS
- Parkinson’s
- epilepsy

Question 65

In the ketogenic diet, which percentage of total energy intake is from fat:
a) 35-45%
b) 50-70%
c) 65-75%

Answer 65

c) 65-75%

Question 66

What type of exercise would you recommend as part of a weight loss plan and why?

Answer 66

High-Intensity Interval Training (HIIT):
HIIT creates an oxygen debt which is repaid via EPOC (Excess Post-exercise Oxygen Consumption) whereby oxygen intake increases post-exercise.
Short bursts of intensive exercise alternated with low-intensity recovery, typically only performed for 10-30 minutes.
For example, cycling hard on a stationary bike at high resistance for 20 secs and resting for 40 secs before repeating, for a total of 20 minutes.

Health benefits:
- increases metabolic rate (<36 hours post-exercise),
- lowers body fat, fasting blood sugar, blood pressure and resting heart rate
- another benefit: less time spent exercising.

Question 67

List six factors to evaluate when creating a nutritional weight loss plan.

Answer 67

1. Does the plan address behavioural triggers or eating?
2. Does the plan provide all necessary micronutrients and macromolecules?
3. Is it a diet or a lifestyle change?
4. What is the motivation?
5. Does the plan offer education and support?
6. Does the plan include exercise?