Chapter 20 and 21: Helping Clients Navigate the Real World/Navigating Diets

Question 1

Long chains of amino acids that serve many essential functional roles in the body.

Answer 1

Protein

Question 2

Organic compounds of carbon, hydrogen, and oxygen, which includes starches, cellulose, and sugars, and are an important source of energy.

Answer 2

Carbohydrates

Question 3

A source of energy, stored by the body.

Answer 3

Fat

Question 4

How to choose a healthy meal at a restaurant:

Answer 4

1. Pick a protein:

Is it lean? If not, is there a leaner version that is cooked differently? (Is it grilled or poached versus fried?) Is it an appropriate portion size? If not, can you request a smaller portion or save a portion for later?
Is there adequate protein? If not, can you request a slightly larger portion?

2. Pick at least two vegetables:

Are vegetables available with the lunch option? Are they included in the meal? Can you request additional vegetables either on the side or to be added to the meal? How are the vegetables prepared? Are they raw or cooked? If cooked, are they prepared in a healthy manner: grilled or roasted versus fried?
Are the vegetables breaded or covered in a sauce? Can you request sauce on the side?

3. Pick a healthy, high-fiber starch:

What are the starch options available for the meal?
If grain-based, is it a whole grain or a refined grain?
How much starch does the meal provide?
Is it an appropriate portion? If in excess, can you request a smaller portion or save some for a later time? Is starch prepared in a healthy manner? Does it contain added fat (oil, butter, or cheese)?

4. Pick a healthy fat:

Is fat included in the preparation of the meal?
Is a healthy fat part of the meal?
If not, what options are available–olive oil, avocado, nuts, seeds? Is the amount a healthy portion? If not, can you request less or request it on the side?

Question 5

The amount of nutrients provided by a food or meal relative to the total calories in the meal.

Answer 5

Nutrient Density

Question 6

Refers to the amount and variety of nutrients provided in a food or meal.

Answer 6

Nutrient Quality

Question 7

The collective reasons that drive a person to take action.

Answer 7

Motivation

Question 8

The skill and knowledge to be able to perform an action/accomplish a feat.

Answer 8

Ability

Question 9

The idea of snacking should never be written off and can help your client curb cravings that may lead to unhealthy food choices. However, if your client’s calorie needs range from 1,500-1,800 who likes to eat 3 meals a day with 1-2 snacks should limit the calories pers snack to what?

Answer 9

150-200 calories each

Question 10

What does batch prep mean?

Answer 10

Preparing ingredients used in multiple recipes at the same time

Question 11

When meal prepping, it is recommended that clients limit themselves to how many new recipes to avoid making the process too complicated?

Answer 11

Two or three

Question 12

The nutrient quality of a meal refers to which of the following?

Answer 12

The amount and variety of nutrients provided in a food or meal

Question 13

Negative Effects of Low-Calorie Dieting and Rapid Weight Loss

Answer 13

Increased risk of lean body mass loss, particularly in those who are already relatively lean

Decreased athletic performance

Lowered ability to recover from exercise

Increased hunger versus more moderate calorie reduction (although not always the case)

Decreased food options

Difficulty in consuming sufficient amount of micronutrients

Question 14

Should be followed only under the supervision of a medical professional. It is beyond the scope of practice for Nutrition Coaches to recommend or oversee the implementation of ____ for clients. A ____ is a doctor-supervised diet that typically uses commercially prepared formulas, such as liquid shakes or bars, to promote rapid weight loss in patients who are obese. ____ formulas are not the same as the meal replacements sold at grocery stores or pharmacies, which are meant to substitute for one or two meals a day.

Answer 14

Very-low-energy diets (VLED)

Question 15

Potential Negative Impacts of Extremely Low-Fat Intakes

Answer 15

Can limit inclusion of foods with positive health impacts (e.g., nuts, seeds, olive oil, etc.)

Can make the diet more difficult to adhere to due to food restrictions

May lead to decreases in sex hormones such as testosterone (Hämäläinen et al., 1983)

Can lead to increases in triglyceride levels in the blood in the short-term (Lichtenstein & Van Horn, 1998)

Theoretically, can increase the risk of an essential fatty acid deficiency at consistent extremely low-fat intakes (<10% of total calories)

Question 16

A type of scientific study/trial where participants are randomly assigned into different groups – one or more will be the intervention to be tested and one will be the control group. Groups are randomized and a control is used in an attempt to reduce potential bias in the trial.

Answer 16

Randomized Control Trial (RCT)

Question 17

Positive Impacts of Dietary Fat

Answer 17

Humans cannot make essential fatty acids, so they must be obtained via the diet.

Fat allows us to absorb fat-soluble vitamins: A, D, E, and K.

Cell walls contain fat.

Fats are involved in hormone production.

Helps avoid problems with low-fat diets

Question 18

A study where participants are kept in a ward where they can be closely monitored at all times – this allows for precise measurements of metrics like energy expenditure or precise recording of food intake. These studies are extremely high-quality, well-controlled studies.

Answer 18

Metabolic Ward Study

Question 19

Foods that are ultra-processed and made to be highly appealing to our senses.

Answer 19

Hyperpalatable

Question 20

This describes energy production systems/pathways in the body in which oxygen is not present. Activity that leads to energy production via the anaerobic system will cause an accumulation in hydrogen ions and lactic acid.

Answer 20

Anaerobic System

Question 21

A metabolic state where the liver is producing ketones (or ketone bodies) from fatty acids – there are three ketones produced in the human body: acetoacetate, beta-hydroxybutyrate, and acetone. These ketones are an alternative fuel (substrate) that the body can use during the time of low glucose availability brought on by starvation, very low-calorie intake, and/or carbohydrate restriction (or in clinical disorders).

Answer 21

Ketosis

Question 22

The ketogenic diet has been around since the 1920s as a diet plan to reduce seizures for patients with epilepsy. It involves consuming a large percentage of calories from fat, moderate percentage of protein, and very little carbohydrate. It is a combination that leads to the physiological state of (nutritional) ketosis.

Ketosis is a natural metabolic state that occurs when the body starts producing ketones (ketone bodies) from fat. The body can use these ketones as a fuel (substrate) source to generate energy in place of glucose (which is now scarce).

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Starvation ketosis occurs in response to a lack of incoming energy (insufficient caloric consumption). Nutritional ketosis can be achieved without extremely low-caloric intake through the restriction of carbohydrates, although this can still occur within the context of a calorie deficit.

A ketogenic diet typically requires carbohydrates to be restricted to less than 50 grams per day (or 5% of total calories), protein intake to be moderate (20 to 30% of calories), and the remaining calories to be made up from dietary fat (usually 65 to 75% of calories).

Long-term ketogenic diets are capable of leading to greater weight loss than traditional low-fat diets or other control diets. However, when calories and protein are matched between diets, a ketogenic diet does not lead to more fat loss than a non-ketogenic or higher-carbohydrate diet. While it is entirely possible to increase muscle mass on a ketogenic diet, the increases in muscle may be inferior to a higher-carbohydrate diet.

Answer 22

Ketogenic diet

Question 23

A hormone that stimulates appetite and creates a drive for food intake.

Answer 23

Ghrelin

Question 24

High-protein diet

Answer 24

typically defined as one containing more than 25% of total calories from protein or above 1.2 grams of protein per kilogram of body weight (g/kg) or 0.54 g/lb. The recommended daily allowance (RDA) for protein is currently set at 0.8 g/kg (0.36 g/lb). However, there is strong evidence showing multiple health and body composition benefits to consuming higher amounts, especially in the range of 1.2 to 1.6 g/kg (0.54 to 0.73 g/lb).

Question 25

The amount of energy (calories) expended to digest and metabolize food.

Answer 25

Thermic Effect of Feeding (TEF)

Question 26

The edible seeds of plants from the legume family that include dry beans, dry peas, cow peas, pigeon peas, lupins, lentils, fava beans, and chickpeas.

Answer 26

Pulses

Question 27

originally conceived based on observations of the good health experienced by populations living by the Mediterranean (predominantly Greece, Italy, and Spain). Plant foods such as fresh vegetables, fruit, grains, and nuts make up the basis of the diet in addition to liberal use of olive oil. Fish, poultry, and dairy like cheese and yogurt are included in moderate amounts while red meat consumption is low. However, the Mediterranean diet extends beyond food choices as it also accounts for social and cultural aspects such as communal mealtimes, resting after eating, and regular physical activity.

The Mediterranean diet approach has evidence supporting its role in reducing the risk of several chronic diseases. When adherence to the diet is sufficiently high, it is also associated with decreased mortality. A meta-analysis of trials looking at the diet’s effect on weight loss found that the Mediterranean diet did better than control diets. Current evidence strongly supports the Mediterranean diet as a health-promoting diet. Because of the food emphasized in the diet, it will likely positively impact cardiovascular disease markers (e.g., triglycerides, cholesterol, and blood glucose).

Answer 27

The Mediterranean diet

Question 28

No animal products at all in the diet.

Answer 28

Vegan diet

Question 29

No animal products except dairy

Answer 29

Lacto-vegetarian diet

Question 30

Lacto-Ovo-Vegetarian diet

Answer 30

No animal products except dairy and eggs.

Question 31

Pescatarian diet

Answer 31

Dairy, eggs, and fish allowed. No meat.

Question 32

Flexitarian (or semi-vegetarian)

Answer 32

Primarily vegetarian with occasional inclusion of meat or fish.

Question 33

Where there is net-positive protein balance (i.e., there is more protein synthesis than there is protein breakdown) – there is a net building of protein.

Answer 33

Anabolic response

Question 34

Some pitfalls with vegetarian diets

Answer 34

Protein Intake – Due to the absence of meat, fish, eggs, and dairy in the vegan diet, an individual may struggle to eat optimal amounts of protein, especially if their goals are to increase/maintain muscle mass and/or recover from exercise. Therefore, attention should be paid to plant sources of protein in the diet and, if necessary, a vegan-friendly protein supplement (e.g., pea protein powder) can be used.

Protein Quality – When it comes to maximizing the muscle protein synthesis (repair/growth) response to a meal, plant-based proteins are inferior to animal-based protein sources due to their poorer amino acid profile (van Vliet, Burd & van Loon, 2015). Therefore, to maximize the anabolic response to feeding, one may consider increasing the protein dose from plant-based sources, supplementing with additional amino acids such as leucine, or using a combination of plant-based sources in a meal to provide a more favorable amino acid profile for maximizing muscle protein synthesis.

Vitamin B12 – The absence of meat in the diet also puts the individual at risk for suboptimal vitamin B12 intake and/or outright deficiency. Therefore, it is advisable to supplement with vitamin B12.

Omega 3 Fatty Acids – The essential omega-3 fat is called alpha-linoleic acid (ALA), which can be converted into eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in the body. It is EPA and DHA that have the most potent health benefits. These are the omega-3 fatty acids that are present in fatty fish like salmon and mackerel. Omega-3 fatty acids in plant foods (e.g., hemp seeds, walnuts, and chia seeds) are in the ALA form. And while ALA can be converted into EPA and DHA, this conversion is poor in humans. Therefore, in diets that do not include fatty fish, it may be advisable to supplement with an EPA + DHA supplement. Vegan-friendly EPA/DHA supplements are available with the fats extracted from microalgae.

Calcium – In diets that do not contain dairy, a common source of dietary calcium is absent. Therefore, special attention should be paid to food sources to ensure sufficient calcium is consumed. Vegans can obtain calcium from several sources with leafy green vegetables being a particularly good source.

Iron – The absence of meat in the diet removes a good source of iron. In addition, the iron found in plant-based foods is non-heme iron as opposed to the heme iron found in animal products. Non-heme iron has a much lower bioavailability than heme iron, meaning vegan clients may require even higher iron intakes to maintain adequate iron status. The Institute of Medicine recommends an intake of 1.8 times that of non-vegetarians.

Creatine – Red meat, poultry, and fish are the best sources of creatine within the diet. Therefore, vegan and vegetarian clients may tend to have lower muscle creatine stores. Creatine has demonstrated clear and consistent benefits for exercise performance and emerging research has suggested it can have benefits on health, including mitigating age-related loss of muscle mass and strength and reducing risk of neurological disorders such as traumatic brain injury and Parkinson’s disease.

Question 35

a dietary approach that focuses on selecting foods that proponents of the diet claim humans were exposed to for most of our evolutionary history: meat, fish, vegetables, fruit, nuts, and seeds. In its strictest form, it calls for the avoidance of grains, legumes, dairy products, and most conventionally processed foods. However, this commonly represented list of foods is not in concordance with the current evidence of what our ancestors likely consumed.

Answer 35

Paleo Diet (Paleolithic Diet)

Question 36

Containing a high amount of calories relative to the volume or weight of the food.

Answer 36

Energy dense

Question 37

A collection of proteins found in grains – in wheat, gluten covers two related proteins: gliadin and glutenin.

Answer 37

Gluten

Question 38

An autoimmune disorder where the protein gluten causes the body to mount an immune response, which leads to damage to the small intestine.

Answer 38

Celiac Disease

Question 39

A clinical condition induced by the ingestion of gluten leading to intestinal and/or extraintestinal symptoms that improve once the gluten-containing foodstuff is removed from the diet and celiac disease and wheat allergy have been excluded.

Answer 39

Non-Celiac Gluten Sensitivity (NCGS)

Question 40

MyPlate recommendations

Answer 40

The MyPlate recommendations are based on four primary goals (What is MyPlate?, 2018):

Focus on variety, amount, and nutrition.
Choose foods and beverages with less saturated fat, sodium, and added sugars.
Start with small changes to build healthier eating styles.
Support healthy eating for everyone.

Question 41

Eating vegetables, fruits, and whole grains

Including fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils

Limiting foods that are high in saturated fat such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils

Limiting sugar-sweetened beverages and sweets

Answer 41

DASH (Dietary Approaches to Stop Hypertension) Diet

Question 42

Translates to “as desired” and refers to eating or drinking as you are normally driven to (i.e., not purposely overeating or undereating).

Answer 42

Ad Libitum

Question 43

Fasting and Time-Restricted Feeding

Answer 43

Fasting is achieved by consuming zero to minimal amounts of calories (via food and caloric beverages) for periods that can range from 12 hours to 3 weeks (Longo & Mattson, 2014).

There are various distinct iterations of a dietary approach based on intermittent fasting:

Alternate Day Fasting, 5:2 Diet, Time-Restricted Feeding (TRF), Prolonged Fast (several days of fasting done every several months)

Question 44

Alternate Day Fasting

Answer 44

the individual alternates between a day of fasting and a day of feeding (typically ad libitum dieting). While the fasting day can indeed be a complete fast, it often allows a small amount of calories such as 25% of normal maintenance intake or 500 kcal. Not only is a large calorie deficit created on fasting days, but trials seem to indicate that although as much can be consumed on feast days as desired, the amount eaten is not large enough to negate the large caloric deficit created the day before while fasting, thus, leading to significant fat loss. However, this seems to also depend on the individual, as big eaters (an ability to overeat or eat large amounts of food) may eat enough on feeding days to prevent weight loss.

Question 45

5:2 Diet

Answer 45

derives its name from a description of the protocol: 2 fasting days and 5 feeding days per week. Calories can be consumed on the fasting days with a maximum of typically 500 kcal set for women and 600 kcal for men. The diet has been shown to be capable of inducing fat loss, despite only 2 of every 7 days being purposely hypocaloric. This can be explained by considering the impact on energy balance across the 7-day period. If the 2 fasting days create a significant caloric deficit and there is not a large overcompensation for this on feeding days to completely mitigate the large deficit created on the 2 fasting days, over the 7-day period there is a net caloric deficit and, thus, weight loss.

Question 46

Time-restricted feeding is a term that has appeared in research to describe an eating approach where there are specific eating and fasting windows across the day. As an example, a common variant of intermittent fasting is a 16:8 fasting:feeding approach. As the name suggests, in such a set-up the individual would fast for 16 hours in every 24-hour period, leaving a feeding window of eight hours (e.g., eating the first meal of the day at 1 p.m., having the final meal at 9 p.m., and then fasting until 1 p.m. the next day). Recent research has suggested such a 16:8 time-restricted feeding pattern may improve health markers and decrease body fat.

However, it is worth noting that the time-restricted feeding group ate fewer calories in the study. Indeed, time-restricted feeding may help people achieve a calorie deficit without counting/tracking calories or food intake

Answer 46

Time-Restricted Feeding

Question 47

What is orthorexia?

Answer 47

A fixation on only eating healthy food.

Question 48

An extremely low intake of what nutrient, on a consistent basis, may increase the risk of low testosterone?

Answer 48

Fat

Question 49

In research, a low-energy diet (LED) most commonly describes a diet of approximately how many daily calories?

Answer 49

800 to 1,200 kcal/day

Question 50

A ketogenic diet comprised of a high-fat intake can lead to what potential negative impact in genetically susceptible individuals?

Answer 50

Increased LDL-C (low-density lipoprotein cholesterol)

Question 51

Which of the following grains is naturally gluten-free?

Answer 51

Corn (not Wheat, or Barley, or Rye)

Question 52

According to global estimates, what is the prevalence of gluten-related disorders?

Answer 52

5%

Question 53

What does the body do during ketosis?

Answer 53

Produces ketones (ketone bodies) from fat

Question 54

According to research, how much daily protein intake will maximize the muscle gain that occurs in response to resistance training?

Answer 54

1.6 g/kg