Unit 2 -Applying the Principles of Nutrition to a Physical Activity Programme

Question 1

What does a balanced diet require?

Answer 1

Water intake, alongside food chosen in varying amounts from five nutrient groups. These groups are in turn are divided into macronutrients and micronutrients.

Question 2

What are the basic functions of the macronutrients carbohydrate, protein and fat?

Answer 2

Collectively needed in greater amounts.

Used within the body for structure, function and fuel.

Question 3

What are the basic functions of the macronutrients vitamins and minerals?

Answer 3

Needed in smaller amounts.

Also used for structure and function and are necessary to “unlock” the energy contained in the macronutrients.

Question 4

Why does the phrase ‘you are what you eat’ have much truth in it?

Answer 4

Because the food that we eat will become part of the body, as it is used to rebuild or repair vital structures on an ongoing basis. However, we do not digest everything that we eat as some components of our food will be excreted.

Question 5

What happens to food, which is not used for this building up of structural parts of the body?

Answer 5

It will either contribute to the body’s normal chemical functions or be utilised as fuel to sustain life and activity levels.

A continual excess of energy consumed will be stored, mostly in the form of body fat, and will, therefore, also contribute to eventual body mass

Question 6

Also in nutrition, there exists a relationship between both structure and function. What does this mean?

Answer 6

The quality of food within the diet and the specific chemical composition of that food, have a profound effect upon the structure and function of the human body at its most fundamental level.

Question 7

The same basic organisation of structure and function applies to what other systems?

Answer 7

• skeletal system
• muscular system
• nervous system
• digestive system
• respiratory system
• circulatory system
• lymphatic system
• endocrine system
• reproductive system

Question 8

When was the first US national food guide pyramid introduced and to what purpose?

Answer 8

• In 1992
• in an attempt to provide information to the public, in order to promote a healthy diet.
• It serves as a visual guide to ease the confusion that often arises when trying to plan a menu.

Question 9

Who originally devised the US national food guide pyramid?

Answer 9

Originally devised in a joint venture by the Department for Health and Human Services and the US Department of Agriculture (USDA), this basic model and the guidelines it represents has been adopted by many government agencies throughout the developed world.

Question 10

Why was the food guide pyramid of 1992 later revised?

Answer 10

Due to continuing criticism that it did not provide appropriate advice for certain nutrient groups for all sub-groups of the population.

Question 11

When was the 1992 US national food guide pyramid updated?

Answer 11

In 2004, after much debate and deliberation, the Department for Health and Human Services and the US Department of Agriculture released an updated version which was accepted as national policy in 2005.

This has since formed the backbone of all food and nutrition policy throughout the United States

Question 12

What are the main changes in the food guide pyramid, comparing the 1992 version with the 2004 version?

Answer 12

• some fats should be taken in larger amounts as a necessary part of a ‘healthy balanced diet.’
• Certain plant oils, such as olive, soy, sunflower and peanut oil are now set at the base of the pyramid and are advised as an important part of almost every meal.
• The advice on carbohydrates has changed, recognising that refined carbohydrate products such as white bread, white rice and white pasta should be minimised.
• The emphasis is now on wholegrain carbohydrate-rich products which form a large part of the base of the pyramid.

Question 13

What are the advantages and limitations of the food guide pyramid?

Answer 13

Advantages:

• aims to encourage people to think about their diet
• leads to a reduction in pre-made processed food
• encourages the consumption of fruit and vegetables
• encourages portion control
• aims to encourage a wholefood diet
• encourages a moderate alcohol intake

Limitations:

• aimed at populations, not individuals
• assumes a ‘one size fits all’ approach
• criticised for being shaped by food agencies and politics
• insufficient guidance on portion control

Question 14

What is ‘The Eatwell Plate’?

Answer 14

An adaptation of the food guide pyramid in the UK, introduced in 2007, providing an alternative illustration of the similar basic guidelines around food and nutrition found within the US pyramid.

Question 15

‘The Eatwell Plate’ is also supported by 8 specific healthy eating tips as stated by the Foods Standards Agency:

Answer 15

1. Base your meals on starchy foods
2. Eat lots of fruit and vegetables (5 portions per day)
3. Eat more fish ( 2 portions a week, 1 oily)
4. Cut down on saturated fat and sugar
5. Try to eat less salt, no more than 6g a day
6. Get active and try to be a healthy weight
7. Drink plenty of water (6-8 glasses per day)
8. Don’t skip breakfast

Question 16

The specifics of the national food model provide what caloric targets?

Answer 16

Adult males: 2550 calories per day

Adult females: 1950 calories per day

Question 17

How should the total amount of calories be divided across each of the macronutrients?

Answer 17

• minimum of 50% calories from carbohydrates
• maximum of 35% calories from fats
• minimum of 55g of protein per day (9-12% calories)

Question 18

What are the approximate calories per gram for each macronutrient?

Answer 18

• carbohydrates 4 calories per gram
• proteins 4 calories per gram
• fats 9 calories per gram
• alcohol (not a nutrient) 7 calories per gram

Question 19

Some may prefer counting portions than calories. What would be 1 portion of small fruits?

Answer 19

Small fruit – 2 satsumas, 2 plums, 2 kiwi, 7 strawberries, 14 cherries

Question 20

What would be 1 portion of a medium fruit?

Answer 20

1 apple, 1 banana, 1 pear, 1 orange

Question 21

What would be considered a large fruit?

Answer 21

half grapefruit, one 5cm slice of melon, 1 large slice of pineapple

Question 22

What would be a portion of green veg?

Answer 22

2 broccoli spears, 4 heaped table spoons of kale, spinach, or green beans

Question 23

What would be one portion of salad veg?

Answer 23

3 sticks of celery, 5cm piece of cucumber, 1 medium tomato, 7 cherry tomatoes

Question 24

What would be one portion of cereals?

Answer 24

Handful of breakfast cereal

Question 25

How would you measure a portion of lean meat?

Answer 25

Lean meat the size of a deck of cards

Question 26

What is the guideline of maximum intake of food and drinks high in fat or sugar?

Answer 26

Limit these foods to no more than 8% of total intake.

Question 27

The quality of food is very important. What are the key reasons for purchasing organic as to the Soil Association?

Answer 27

• minimal use of additives
• no pesticides, fungicides or herbicides used in production
• no genetically modified foods used
• no routine antibiotic use on animals
• animal welfare is paramount

Question 28

What are commonly occurring, modern-day health complications and diseases that have all been shown to have a root cause or risk factor associated with food and diet?

Answer 28

• obesity
• heart disease
• stroke
• some cancers
• metabolic syndrome
• diabetes
• hypertension
• high cholesterol
• asthma • some types of arthritis
• menstrual irregularities
• infertility
• eczema

Question 29

Does the term ‘Nutritionist’ guarantee to the client any specific level of qualification?

Answer 29

No, the term ‘Nutritionist’ is an unprotected term which anyone who wishes to embark on a business of advising others on what to eat can use to their advantage.

This does not mean that the individual is not skilled at their job.

Question 30

Does the term “Dietician” guarantee the client any specific level of qualification?

Answer 30

Yes, to be a ‘dietician’ requires individuals to be registered with the Health Professions Council as the term is legally protected and requires certain qualifications.

Most dieticians have a Bachelors or Masters degree and are qualified to translate scientific information about food into practical dietary advice.

Question 31

What are registered nutritionists within The British Dietetics Association?

Answer 31

Registered nutritionists are nutrition professionals who have met the criteria to become full members of the Nutrition Society, which requires a degree and a certain amount of evidence supporting professional practice.

Question 32

What are Nutritional Therapists?

Answer 32

The term ‘Nutritional Therapist’ refers to individuals who have trained to cure and prevent ill health through nutrition.

Whilst courses in nutritional therapy are not seen to be in the same depth as dietetics there is still significant effort required to qualify for this title.

The British Association of Applied Nutrition and Nutritional Therapy (BANT) oversee and evaluate nutritional therapists in the UK with the Nutritional Therapy Council regulating the industry

Question 33

Within Level 3, what qualification in nutrition will you obtain, and what does it entail?

Answer 33

It will allow you to use the term ‘Nutritional Advisor’ which clearly defines a role in advising others about healthy eating habits but does not authorise any provision of advice directing others regarding ill health or in the use of dietary supplements to promote health or manage diseases.

It is important that even as a nutritional advisor that it is understood how to evaluate nutritional information and to be able to ensure that advice is given to others based on reliable evidence.

Question 34

Name recognised places to seek nutritional information.

Answer 34

• The British Dietetics Association
• The British Association of Applied Nutrition and Nutritional Therapy (BANT)
• Food Standards Agency
• Committee on Medical Aspects (COMA) of Food and Nutrition
• British Nutrition Foundation
• Institute of Optimal Nutrition
• scientific nutrition journals e.g. British Journal of Nutrition

Question 35

Why is it vital to base ourselves on reliable sources on nutrition?

Answer 35

This is vital as the media and food marketing often report on or make claims regarding certain foods or nutrients and their effects on health.

This will influence the client’s beliefs and opinions regarding nutrition and as professionals, we need to have a reliable source of information to determine the truth and debunk any myths that exist.

We need to be professionals who can provide a grounded and evidence-based approach where knowledge has been proven.

Question 36

What do you do if faced with a client who requires a deeper level of analysis and investigation than qualifications provide?

Answer 36

Then a suitable referral procedure to a Registered Dietician or Nutritional Therapist should be followed so that they may receive the guidance that they need.

Question 37

What types of conditions can be improved through appropriate nutritional guidance and, therefore, should be referred?

Answer 37

• diabetes mellitus
• cardiovascular disease
• elevated cholesterol
• severe obesity
• cancer

Question 38

Of how many amino acid building blocks does protein consist of?

Answer 38

20

Question 39

Why can amino acids be thought of as forming the protein alphabet?

Answer 39

Because they build proteins in a similar way as the various combinations of the 26 letters of the alphabet can be used to create individual words.

Thus one protein will differ from another according to the number and sequence of its constituent amino acids.

Question 40

What are Peptides?

Answer 40

Animal and plant cells join amino acids together to form peptides. This process results in the formation of chains of amino acids of varying lengths, which eventually become proteins.

Question 41

Proteins themselves are formed when the chain of amino acids total how much?

Answer 41

100 or more.

Question 42

Of the 20 amino acids, how many are considered to be essential to the daily diet because the body is unable to produce or synthesise them itself?

What are they?

Answer 42

9

• phenylalanine
• methionine
• tryptophan
• threonine
• lysine
• isoleucine
• leucine
• valine
• histidine

Question 43

What are conditionally essential amino acids?

Which are they?

Answer 43

These are also present in many foods but are not always required to be a part of the daily diet.

• glycine
• alanine
• tyrosine
• serine
• cysteine
• proline
• glutamic acid
• glutamine
• aspartic acid
• asparagine
• arginine

Question 44

What are complete proteins?
What foods are considered to be complete proteins?

Answer 44

These foods contain all nine essential amino acids in sufficient amounts necessary for the liver to synthesise the remaining non-essential amino acids.

• eggs
• meat
• poultry
• dairy
• fish
• soy foods
• buckwheat
• quinoa

Question 45

What are incomplete proteins?

Name a few.

Answer 45

When proteins are of a lower biological value since they are deficient or ‘incomplete’ in one or more of the essential amino acids.

• cereals and grains (wheat, rye, barley, oats, rice)
• cereal products (bread, pasta etc)
• pulses (beans, lentils, peas)
• nuts
• vegetables

Question 46

Why is it advised to vary or combine plant-based protein sources to boost amino acid intake for vegetarians?

Answer 46

This may help to provide a full spectrum of the essential amino acids in the diet.
Whilst these carbohydrate-based foods contain energy in the form of glucose, it is important to remember that they also contain smaller amounts of protein.

Including a variety of unrefined carbohydrate foods is, therefore, particularly important for anyone on a no meat or low meat diet.

Question 47

What would be good variations or combinations of plant-based protein sources to boost amino acid intake for vegetarians?

Answer 47

• rice and pulses
• vegetables and seeds
• nuts and vegetables
• grains and pulses

Question 48

The types of protein within the body can be placed under three headings, along with their corresponding functions.
What are they?

Answer 48

• structural: form the main framework of many components of the body; collagen present in bone and connective tissue, keratin in the skin, and muscle tissue all provide structure. Muscle tissue is also contractile for movement.
• homeostatic: hormones regulate various processes e.g. insulin controls blood sugar, enzymes speed up reactions, and white blood cells fight infection.
• fuel: although not the primary source, protein is a useable source of energy, especially during endurance events or periods of fasting. They can be converted into glucose, fatty acids or ketones to help produce ATP.

Question 49

What is catabolism?

Answer 49

• Catabolism relates to the breaking down of larger structures into smaller ones.
• Protein catabolism occurs to some extent all of the time, as existing proteins from damaged cells are broken down into their amino acids and recycled to build new proteins elsewhere.
• Further muscle catabolism occurs during intensive exercise, as a result of both micro-tear damage and the partial utilisation of key amino acids as fuel.

Question 50

What is anabolism?

Answer 50

Anabolism can be defined as a building up process within the body.

The anabolic phase mostly occurs during rest.

Since proteins form a major component of most cell structures, adequate dietary protein is required to maintain both health and performance.

Question 51

What are our protein requirements?

Answer 51

Although it varies from person to person, it should be a major part of every meal consumed.

A basic starting point is to consider the amount of protein needed dependent on body weight and the intensity of physical activity.

Question 52

How are dietary carbohydrates digested and utilised?

Answer 52

It is ultimately sent to the liver, muscles, or used immediately as a fuel.

Some glucose may enter the adipose tissue (fat tissue), where it is used to help store fat, a process which appears to occur at different rates in different people.

Question 53

All carbohydrates are made up of molecules or units called saccharides.
What are the three basic categories?

Answer 53

• simple carbohydrates also referred to as ‘sugar’
• complex carbohydrates also referred to as ‘starches’
• non-starch polysaccharides (NSP) referred to as ‘fibre’

Question 54

What are simple carbohydrates?

Answer 54

Simple carbohydrates have a very basic structure and usually only contain one or two units of sugar usually made up from a combination of glucose, fructose and galactose.

Question 55

Give three examples of Monosaccharides – single molecules or ‘units’ of sugars

Answer 55

• Glucose
• Fructose
• Galactose

Question 56

Give three examples of Disaccharides – two molecules or ‘units’ of sugars joined together.

Answer 56

• Sucrose = glucose + fructose
• Lactose = glucose + galactose
• Maltose = glucose + glucose

Question 57

What are healthy sources of simple carbohydrate?

Answer 57

Fruits:

• contains fructose and glucose in varying amounts
• contains vitamins and minerals
• contains antioxidants and phytochemicals
• contains high levels of dietary fibre
• contains a trace of amino acids
• cheap, convenient

Question 58

What are less healthy options for sources of simple carbohydrate?

Answer 58

biscuits, cakes, confectionery, soft drinks

• contain excessive sugar – higher than 15g per 100g (FSA)
• contains processed, low-quality fats
• high energy density
• contain no vitamins or minerals
• adversely affects insulin response

Question 59

The energy contained in simple carbohydrates cannot be released without specific vitamins and minerals. Which are particularly important?

Answer 59

• The B vitamins are particularly important since we cannot utilise any carbohydrate without them.
• Fresh fruit provides its own vitamin and mineral requirements for the body

Question 60

What can prolonged use of refined carbohydrates lead to?

Answer 60

Progressive depletion of certain nutrients. This type of food is often referred to as an ‘anti-nutrient’.

Question 61

What are complex carbohydrates?

Answer 61

These foods are often described as starch and consist of many molecules or ‘units’ of glucose all joined together in long complicated branched chains.

These multiple molecules of glucose are called polysaccharides.

Once eaten, these polysaccharides are broken down into glucose, absorbed into the bloodstream and either stored or metabolised accordingly.

Question 62

Name sources of refined carbohydrate.

Answer 62

• white bread
• white pasta
• cakes, biscuits and pastries
• rice cakes
• CHO content of processed foods
• white rice

Question 63

Name the properties of sources of refined carbohydrate.

Answer 63

• contain excessive sugar – higher than 15g per 100g (FSA)
• contains processed, low-quality fats
• high energy density
• contain no vitamins or minerals
• adversely affects insulin response

Question 64

Name sources of unrefined carbohydrate.

Answer 64

• wholemeal or whole grain products
• whole grain rice
• frozen vegetables
• fresh vegetables
• sweet potatoes
• yams
• pulses
• quinoa

Question 65

Name properties of sources of unrefined carbohydrate.

Answer 65

• contains fructose and glucose in varying amounts
• contains vitamins and minerals
• contains antioxidants and phytochemicals
• contains high levels of dietary fibre
• contains trace of amino acids
• cheap, convenient

Question 66

What does fibre consist of and what is it good for?

Answer 66

Non-starch polysaccharide (NSP), indigestible plant material such as

• cellulose
• hemicellulose
• lignin
• pectin
• gums
• mucilages

These are found in fruits, vegetables, grains and beans.

It aids in the transportation of foods through the digestive tract by bulking out the food and faeces for ease of movement.

Question 67

What are the two kinds of fibres?

Answer 67

1. Insoluble: It is normally the outer protective layer of plants. Unrefined wheat, bran, rye, rice and most other grains are primarily composed of insoluble fibre along with fruit and vegetable skins
2. Soluble: It is normally found on the inner part of plants. Found in beans, barley, broccoli, prunes, apples, citrus fruits and oats. This has been proposed to help with the reduction in cholesterol by binding with fats in the digestive tract and carrying them out in the stools.

Question 68

What do fats and oils belong to?

Answer 68

To a family of organic compounds called lipids, and the role they play throughout human physiology makes them an essential component to the diet, and indeed they form one of the recognised macronutrients.

Question 69

What are the key physiological functions of lipids?

Answer 69

• formation of virtually all cell membranes
• formation of myelin sheath within the nervous system
• constitutes majority of the CNS and spinal cord
• synthesis of steroid hormones
• assists in the regulation of enzymes
• insulation through subcutaneous adipose tissue
• protection of internal organs
• transportation, storage and utilisation of fat-soluble vitamins A, D, E, K.
• fuel source during lower-intensity workloads
• storage of energy within the adipose tissue

Question 70

What are lipids at room temperature called?

Answer 70

Oils and those which are solid are called fats.

Question 71

Most dietary lipids consist of chains or rings of carbon atoms joined together along with other atoms, most commonly which?

Answer 71

hydrogen and oxygen

Question 72

The smaller units of fats are called what?

Answer 72

fatty acids

Question 73

What are triglycerides?

Answer 73

Fatty acids naturally occur as triglycerides, where three fatty acids attach to a carbohydrate backbone called glycerol.

During digestion, the fatty acids are broken off and then used in the body as required.

Question 74

What are saturated fats?

Answer 74

These fats comprise of chains of carbon atoms which are ‘saturated’ or full with hydrogen, which gives them distinct properties.

They do not contain any double bonds which means, they have a straight structure.

Saturated fatty acids are straight, which accounts for their solid structure at room temperature since they are able to pack tightly together with little space between them.

Question 75

What are common sources of saturated fat?

Answer 75

Animal

• meat – beef, pork, lamb, venison
• poultry – chicken, duck
• dairy – milk, cheese, yoghurt, cream, butter
• eggs

Non-animal

• palm oil
• coconut oil

Question 76

There are specific needs for saturated fat to be included within the daily diet. What functions do they have?

Answer 76

• enhancement of the immune system
• provision of energy and structural integrity to the cells
• enhancement of liver function and protection against alcohol detoxification
• the ability of coconut oil to act as an antimicrobial and antiviral agent

Question 77

What are unsaturated oils?

Answer 77

These fatty acids are described as unsaturated because some hydrogen atoms are absent from the chain of carbons.

This causes two effects:

• a double bond is formed between one or more of the carbon atoms
• the fatty acid bends at each double bond

Question 79

Unsaturated fats come in two main categories:

Answer 79

• monounsaturated – a single double bond – single bend in molecule
• polyunsaturated – several double bonds – several bends in a molecule

Question 80

What are monounsaturated fatty acids?

Answer 80

these oils contain fatty acids with only one double bond thus the term ‘mono’ or one. This means the molecule has a single bend in it.

Diets high in monounsaturated fats have been shown to lower both LDL cholesterol and plasma triglycerides, and are therefore thought to reduce the risk of CHD

Question 81

What are sources of monounsaturated fatty acids?

Answer 81

• olives or olive oil
• lard
• beef dripping
• peanut oil
• rapeseed oil
• avocados
• nuts
• seeds

Question 82

What are polyunsaturated fatty acids?

Answer 82

These fatty acids are long chains of carbon atoms, again with missing hydrogen but this time they possess more than one double bond.

As with the monounsaturated fatty acids, there is a distinct bend at the point of each double bond, which again means a different shape and a different function.

Question 83

What are essential fatty acids?

Answer 83

These fatty acids are essential to the diet since the human body is unable to synthesise them itself.

They are subdivided into two categories:

• omega 3 fatty acids
• omega 6 fatty acids

Question 84

Give examples of Omega 3 fatty acids.

Answer 84

• oily fish
• flax oil
• walnuts
• pasture reared eggs
  Note: all oils need to be cold-pressed and remain unprocessed

Question 85

Give examples of Omega 6 fatty acids.

Answer 85

• sunflower seeds
• sunflower oil
• safflower oil
• pumpkin seeds
• sesame seeds
  Note: all oils need to be cold-pressed and remain unprocessed

Question 86

What has been shown to reduce the tendency of blood to clot, lower blood triglyceride levels, lower total cholesterol levels and in some individuals to raise HDL cholesterol, all of which are thought to lower the risk of CHD ?

Answer 86

Omega 3 fatty acids found in oily fish.

Question 87

What are hydrogenation and trans fats?

Answer 87

This refers to a process used within the food industry where quantities of unsaturated vegetable oils are manufactured into more solid fats like margarine and shortening.

Question 88

What results from the heating, catalysing and pumping of hydrogen into unsaturated oils?

Answer 88

In the formation of saturated fatty acids, as the original double bonds are broken and replaced with single bonds once again full of hydrogen.

Question 89

What will determine the amount of saturated fatty acids in the end product?

Answer 89

The amount of hydrogen added during the process.

Question 90

The remaining double bonds still contained in vegetable oil after hydrogenation, as it is mostly partial, will have been converted into what?

Answer 90

trans-fatty acids due to the actions of this intense and prolonged process.

Question 91

Name common foods which contain trans fats.

Answer 91

• many margarine’s
• biscuits
• cakes
• crackers
• take away foods
• pies
• pastries
• pre-prepared foods
• many “low fat” processed foods (low in saturated fat but high in trans fat)

Question 92

Consumption of hydrogenated fats is associated with a host of other serious diseases. Which are they?

Answer 92

• cancer
• atherosclerosis
• diabetes
• obesity
• immune system dysfunction low-birth-weight babies
• birth defects
• decreased visual acuity
• sterility
• difficulty in lactation
• problems with bones and tendons

Question 93

Metabolic studies have shown that dietary trans fatty acids have adverse effects on blood lipid levels. What do they promote?

Answer 93

They promote an increase in LDL or ‘bad’ cholesterol and a decrease in healthier HDL cholesterol, and that this effect is double that produced from the ingestion of saturated fat.

Question 94

What is cholesterol?

Answer 94

Cholesterol is a large lipid molecule, which cannot be utilised by the body as energy; effectively it has no calories. However, it is extensively used throughout the tissues for both structure and functions essential to life.

Question 95

Name functions of cholesterol.

Answer 95

• a vital component of cell membranes
• production of steroid hormones
• synthesis of bile acids
• synthesis of vitamin D

Question 96

How much cholesterol is the liver is able to synthesise?

Answer 96

about 75-80% of the body’s own supply.

When dietary cholesterol intake is low, the body increases the synthesis of its own supply, and as dietary intake increases cholesterol production falls.

Question 97

What are lipoproteins?

Answer 97

The body has developed protein-based carriers, called lipoproteins that completely encase lipids for transport in the blood (which is watery)

Question 98

What are the three key lipoproteins?

Answer 98

• very low-density lipoproteins (VLDL). Synthesised by the liver. Contain both cholesterol and triglycerides. Transport triglycerides into adipose tissue.
• low-density lipoproteins (LDL). Formed from VLDL’s once they have unloaded most of their triglycerides. Transport the remaining cholesterol to cells throughout the body that are in need.
• high-density lipoproteins (HDL). Synthesised by the liver. Transport excess cholesterol from the tissues and blood back to the liver.

Question 99

How can a higher risk for heart and circulatory problems be identified considering cholesterol?

Answer 99

Particularly elevated levels of total triglycerides, elevated LDL cholesterol and lower than 25% HDL cholesterol has been identified as increasing the risk of heart and circulatory problems.

Question 100

At approximately what reading will the medical profession initiate to intervene with lifestyle changes and in many cases medications such as statins to lower plasma cholesterol?

Answer 100

Levels above 5.2mmol/dL.

Question 101

What category do vitamins fall under?

Answer 101

Under the category of micronutrients and they consist of a group of organic compounds (all containing carbon), which are required for normal growth and metabolism

Question 102

All vitamins are synthesised by what?

Answer 102

plants

Question 103

Give examples on B vitamins that we can synthesise ourselves.

Answer 103

e.g. biotin and riboflavin, and vitamin K ourselves, from the action of bacteria found within our GI tract

Question 104

What are precursos on vitamins?

Answer 104

Pro-vitamins, often referred to as ‘inactive vitamins’.

For example, beta-carotene is a pro-vitamin found in yellow and dark green vegetables from which our bodies in the right circumstances may synthesise vitamin A.

However, it should be noted that this is a difficult process for the body to undertake and an individual will not get anywhere near their daily vitamin A requirements by relying on the conversion of betacarotene.

Question 105

What are fat-soluble vitamins?

Answer 105

Vitamins A, D, E, and K are termed as fat-soluble, meaning that they can only be absorbed, transported and utilised in the presence of fat.

A diet that is low in fat will lead to a severe deficiency in the fat-soluble vitamins, which will lead to ill health.

Question 106

Any deficiency in vitamin A will affect what?

Answer 106

the bodies’ capacity to produce necessary hormones like testosterone, oestrogen and cortisol.

Question 107

What are water-soluble vitamins?

Answer 107

The B group of vitamins and vitamin C are all water-soluble and are absorbed, transported and utilised within the water.

These vitamins cannot be stored within the body in any great quantity and therefore, we need to include them daily in our diet if we are to avoid an eventual deficiency resulting in ill health.

A diet high in refined simple carbohydrates containing an excess of sucrose will eventually lead to such a deficiency.

Question 108

What are the minerals necessary for?

Answer 108

Minerals are necessary for structure and for the normal regulation of metabolic, hormonal and nervous interactions within the body.

Question 109

Minerals form approximately how much of our body mass?

Answer 109

4%, mostly within the skeletal system.

Question 110

What are the seven macrominerals that are required in greater amounts?

Answer 110

• Calcium
• Chloride
• Magnesium
• Phosphorus
• Potassium
• Sodium
• Sulphur

Question 111

What are trace minerals?

Answer 111

Minerals that are needed for a healthy functioning body, but are required in much smaller amounts. There are over 20 minerals that have been acknowledged as essential for human health.

Question 112

Give examples for trace minerals.

Answer 112

• copper
• manganese
• iodine
• boron
• iron
• nickel
• selenium
• zinc
• cobalt
• chromium
• molybdenum
• silicon

Question 113

What are phytochemicals?

Answer 113

These are chemicals synthesised by plants, which appear to have an important effect on human health.

A few of the main categories include:

• carotenes
• flavonoids
• isoflavones
• phytosterols

These types of plant nutrients have been found to benefit the human body in many different ways from cancer prevention, cholesterol management and in preventing oxidation and damage of structures.

Question 114

What are enzymes?

Answer 114

For every physiological change in the body, a specialised protein molecule known as an enzyme provides the stimulus.

Its job is to catalyse or speed up chemical reactions within the cells so that the physiological changes that support life can take place more quickly.

The rate at which these reactions take place is totally dependent upon the enzyme, often increasing them by one hundred thousand to one million times.

Question 115

How does an enzyme work?

Answer 115

1. The substrate binds to active site of enzyme
2. Enzyme and substrate usually change their shape to fit each other perfectly, thus forming an enzyme-substrate complex.
3. The reaction occurs, forming products that are then released.
4. The enzyme is free to bind to other substrate molecules.

Question 116

What are antioxidants?

Answer 116

• Antioxidants are molecules that fight free radicals in your body. (Defence in order to limit the damage that can occur as a result of oxygen-based reactions)
• Free radicals are compounds that can cause harm if their levels become too high in your body. They’re linked to multiple illnesses, including diabetes, heart disease, and cancer.
• Your body has its own antioxidant defences to keep free radicals in check.
• Dietary antioxidants can also be acquired from the food that we eat
• the body’s antioxidant enzymes require nutrients such as vitamins A, C, E and minerals including zinc, selenium, copper and manganese in order to function properly.
• Research suggests that regular exercisers do have a much higher level of their natural antioxidant enzymes to help protect them

Question 117

Name sources of antioxidant nutrients.

Answer 117

• vitamin C – citrus fruits, green veg, peppers, tomatoes, potatoes
• vitamin E – unrefined veg oils, egg yolks, whole grains, almonds, nuts, green leafy veg
• zinc – oysters, ginger root, lamb, nuts, grains, eggs, peas
• selenium – grains, meats, fish, brazil nuts, tuna, shellfish, dairy

Question 118

Why is it important to stress that those engaging in regular and especially intense exercise, need to ensure that their diet is better than the average to ensure high nutrient densities?

Answer 118

Because exercise increases oxidative stress through increased oxygen consumption.

Also as we get older, we lose the battle against environmental damage from radiation, pollution and increasingly poor diets.

Question 119

How do we ensure that the body can function nearer its optimal level?

Answer 119

With a variety of vitamins and minerals from many different sources.

This should help limit any damage caused by exercise, including injuries, and to help promote recovery caused by myofibril damage (DOMS).

Question 120

What are the Dietary Reference Values (DRV’s)?

Answer 120

Nutrient reference tables used to provide guidance on the levels of vitamins and minerals required by the body.

Question 121

What to the DRV’s provide?

Answer 121

The DRV’s basically provide estimated guidelines for the energy and nutrient needs of healthy people in the population, though they do not take into account exercise needs.

Question 122

Why is it questionable as to how relevant the values of DRV’s provided actually are?

Answer 122

The British Nutrition Foundation states that ‘DRV’s are estimates of the requirements for groups of people and are not recommendations or goals for individuals.

They are also only estimates based on 4 systems of estimated or average values of nutrients.

Trainers and clients need to understand that these values are not going to provide any individualised nutrient guidance and will not ensure that they will be taking in adequate nutrition to support the growth, repair and energy expenditure during exercise as this has not been factored into any of the nutrient guidance.

Question 123

What is the current system used to provide minimum nutrient requirements?

Answer 123

The Recommended Daily Intake (RDI).

Question 124

What specific population groups may be more likely to experience nutritional deficiency and should be investigated more closely to ensure they are receiving enough nutrition for the needs?

Answer 124

These groups include but are not limited to:

• children
• elderly
• pregnant and lactating women
• those with chronic disease conditions

Due to the increased demand on the body for growth, the wear and tear of life or the additional stress on the body caused by each of these circumstances the nutritional requirements may actually be much different than the typical recommended daily intakes.

Question 125

Give a general overview of vitamins supplements. Such as, which vitamins are best ingested through food, etc.

Answer 125

• Fat-soluble vitamins A, D, E and K are best sourced from natural sources where they are present in fats, oils or oil capsules, rather than in tablets or pills.
• Vitamin B-complex supplements only contain only 8-12 of the different types of B vitamins - you do not get all of them through a tablet.
• Almost all vitamin C in supplements are made in a laboratory and are usually pharmaceutical grade ascorbic acid
• vitamin C in natural foods comes as part of a complex including minerals; something called rutin and other analogs which help buffer the vitamin and increase bioavailability
• When taking calcium, but only if the tables uses a natural food extract it is called calcium hydroxyapatite.
• Multivitamin supplements are clearly lacking many of the natural types of nutrients such as all of the B, D, E and K vitamins

Question 126

What is a key point to understand about supplements?

Answer 126

A key point to understand is that supplements are only designed to support a nutrient-rich diet, they are not a quick fix solution for a poor quality diet.

However, carefully evaluated, high-quality nutritional supplements can provide good support to health when taken in correct dosages under the direction of a suitably qualified registered nutritionist or dietician.

Question 127

The digestive system.

Answer 127

• can be seen as the body’s own food-processing factory
• It provides two critical functions: digestion and absorption of nutrients.
• large food molecules are broken down into smaller more manageable units before they can be assimilated through chemical and mechanical digestion.
• Many of the components of the digestive system secrete special substances called enzymes
• each enzyme will only work on specific nutrients
• takes place within the gastrointestinal tract (GI tract) (a hollow tube that runs from the mouth to the anus)

Question 128

What organs make up the GI tract?

Answer 128

• mouth
• pharynx
• oesophagus
• stomach
• small/large intestines
• anus

Question 129

In the digestive system, what is the role of the mouth?

Answer 129

Mastication – mechanical chewing

Saliva – moistens food, protects teeth against decay, contains an enzyme

Salivary amylase – begins to break down larger carbohydrate molecules

Question 130

In the digestive system, what is the role of the oesophagus?

Answer 130

Peristalsis travels food down to the stomach.

Question 131

In the digestive system, what is the role of the stomach?

Answer 131

Gastric juices contain acid and enzymes

Hydrochloric acid – kills bacteria

Pepsin – breaks proteins into shorter chain peptides

Question 133

In the digestive system, what is the role of the pancreas?

Answer 133

Pancreatic juices contain enzymes

Lipase – breaks fat into fatty acids

Amylase – CHO into glucose

Trypsin – proteins into amino acids

Question 134

In the digestive system, what is the role of the liver?

Answer 134

Food doesn’t pass through the liver

Produces bile acids – emulsifies fats, or mixes fats with water

Question 135

In the digestive system, what is the role of the gall bladder?

Answer 135

A storage reservoir for bile acids

Question 136

In the digestive system, what is the role of the small intestine?

Answer 136

The main site of digestion and absorption

Pancreas and gall bladder empty into 1st section –

duodenum villi absorbs nutrients into the blood

Question 137

In the digestive system, what is the role of the large intestine?

Answer 137

The colon absorbs any remaining water, vitamins and minerals

Bacteria – produce some vitamins and fight infection in the intestine

Rectum stores faeces

Question 138

In the digestive system, what is the role of the anus?

Answer 138

Opening for the elimination of waste

Question 139

What do food labels have to identify by law?

Answer 139

• macronutrient and calorie values
• Ingredients are listed in descending weight order
• manufacturers details
• a total volume or weight
• a date mark or best before date
• storage instructions
• potential allergens in the product

Question 140

What was the surprising result of a study conducted in 2005 about food labelling?

Answer 140

• that out of 70 products tested for 570 nutrients only 7% actually matched the stated values, and
• almost 1/5 contained levels outside of the generous 20% margin of error

Question 141

What is the FSA and what is its role?

Answer 141

The Food Standards Agency set up on 3rd April 2000 is responsible for governing the control and sale of food in the UK.

They are an independent body that helps in protecting public interests with regard to our food, and serve in an advisory role to promote food legislation.

The FSA were responsible for the food model that guides both corporate and consumer alike, ‘The Eatwell Plate.’

Question 142

Marketing terminology
Many terminologies are being used misleadingly.

Name some terms how the food regulations state they should be used.

Answer 142

• fresh – ‘to differentiate food sold a short time after harvest’
• pure – ‘single ingredient foods…or to highlight the quality of ingredients of a food’
• natural – ‘comprised of natural ingredients, not the work of man’ • authentic – ‘remains unchanged…originates from the area implied by its name’
• home-made – ‘made in the home, or of domestic manufacture’
• traditional – ‘a method of preparation that has existed for a significant period’
• farmhouse – ‘other than bread, it should refer to that produced on a farm’
• original – ‘a method of preparation that has remained essentially unchanged overtime’

Question 143

Are there are no specific guidelines for using the terms ‘light, low, reduced or high’?

Answer 143

No, but they should not mislead

Question 144

The food labelling ‘reduced or low fat’ - what does that have to mean?

Answer 144

that it must be at least 25% lower in fat, but often calories are maintained by adding other ingredients

Question 145

The food labelling ‘low calorie’ - what does that have to mean?

Answer 145

must have lower calories than the original, but no set level

Question 146

The food labelling ‘sugar-free’ - what does that have to mean?

Answer 146

sugar has not been added, but almost always an artificial sweetener has been used for taste

Question 147

Refined sugars In many cases, these sweetening compounds are mildly addictive, contain empty calories and help to increase sales. Commonly added sugars and caloric sweeteners are:

Answer 147

• sugar
• dextrose
• glucose syrup
• glucose-fructose syrup
• inverted sugar syrup
• high fructose corn starch
• mannitol
• xylitol
• sorbitol
• maltodextrin

Question 148

What is Monosodium glutamate (MSG)?

Answer 148

• An isolated amino acid that acts as a flavour enhancer
• has been found to have addictive qualities.
• has been linked with obesity due to its effects on the hypothalamic region of the brain and the net resulting influence on appetite.
• MSG (E621) is only required by law to be included on the ingredients list if it is added in its pure form.

Question 149

What ingredients will indicate the presence of monosodium glutamate?

Answer 149

• yeast extract
• hydrolysed protein
• whey protein isolate
• soy protein isolate
• carrageenan
• most ‘natural’ flavourings

Question 150

What are all the major sweeteners used in the food industry are categorised by some experts?

Answer 150

As ‘excitotoxins’ that stimulate the sensory areas of the brain and potentially craving sensations and appetite.

It is clearly an advantage to manufacturing companies to increase the sweetness of a product and add a mildly addictive compound that will lead, in the long run, to more being ingested and ultimately purchased

Question 151

What can you say about Aspartame (E951)?

Answer 151

• sold under other brand names such as NutraSweet, Equal and Spoonful
• The American Food and Drug Administration has received more complaints about aspartame than any other additive in history
• Aspartame has been linked with a number of health conditions such as high blood pressure, seizures, depression, numbness, aching muscles and dizziness.

Question 153

What can you say about Sucralose (E955)?

Answer 153

• sold under the brand name Splenda.
• Scientific tests have linked high intakes to shrinking of the thymus gland and enlargement of the liver and kidneys, reduced growth, decreased red blood cell count and diarrhoea.

Question 154

What can you say about Acesulfame K (E950)?

Answer 154

• stimulates insulin which causes hypoglycaemia when a response higher than is needed follows a low-calorie intake

Question 155

What can you say about Saccharin (E954)?

Answer 155

• has had a shaky history of approved and condemned status.
• It is currently listed as an ‘anticipated human carcinogen’ which in sensitive individuals may cause irritability, insomnia, headaches, itching or diarrhoea.

Question 156

Aerobic training requires fuel, which can be provided by what?

Answer 156

• fat
• carbohydrate
• protein

Question 157

Working at lower intensities, a greater percentage of what will be utilised for energy?

Answer 157

Fat

Question 158

With the rising intensity of exercise a progressively higher amount of what will be drawn into the fuel equation?

Answer 158

carbohydrate

Question 159

The choices for the serious exerciser or the dedicated athlete can be narrowed down to the following:

Answer 159

• the use of food alone
• the sole reliance on sports drinks and/or protein shakes
• a combination of food plus sports drinks
• a combination of food plus protein shakes
• a combination of food plus water

Question 160

What do the aerobic system and the anaerobic (lactate) system utilise to fuel activity?

Answer 160

• the aerobic system is able to utilise both fats and carbohydrates
• the anaerobic (lactate) system uses only carbohydrate.

Question 161

What scientific research exists to the key question whether the idea of high-intensity exercise being purely anaerobic is correct?

Answer 161

• Bulbulian, 1986, research into an elite 5-mile cross country run: anaerobic work contributed to 58% of total work
• Medbo, 1989, short term exhaustive cycling: aerobic system contributed 40% energy during a 30-second sprint, 50% of a 1-minute sprint and 65% of a 2-minute sprint.
• Duffield, 2004 study on 100m and 200m sprinting:

100m → Male → 21% aer. → 79% an.

Female → 25% aer. → 75% an.

200m → Male → 28% aer. → 72% an.

Female → 33% aer. → 69% an.

It is clear from these three studies that both aerobic and anaerobic energy systems contribute to exercise regardless of the intensity, although it does appear to change the longer the duration

Question 162

Pre-exercise meal - high or low glycaemic index?

Answer 162

The majority of studies show that there may be slightly more favourable metabolic conditions with regards to insulin levels during exercise associated with low GI foods than with high GI alternatives.

The conclusion is that athletes probably perform the same on both pre-race meals.

More important is the fuel during exercise.

Athletes should consume adequate amounts of carbohydrate drinks during endurance exercise and may feel free to choose their pre-exercise meal according to their personal preferences

Question 164

What have different studies indicated about ingesting carbohydrates being acceptable?

Answer 164

• if the session is longer than an hour
• if the match or race is longer than 90 minutes
• if a pre-exercise meal is not possible (such as early morning intensive training)

Question 165

Why may isotonic drinks during exercise be effective?

Answer 165

• delay the onset of fatigue and to improve performance in endurance athletes
• One study found that ingesting an isotonic drink during endurance training is as effective as a pre-training carbohydrate meal.
• The replacement of fluid provided by the isotonic drink is also a direct advantage.

Question 166

After intensive exercise, the muscles are more sensitive to the effects of insulin thus enabling a more efficient replacement of lost glycogen. This process is particularly evident during the first two hours following the training session.

By what is the rapid synthesis of muscle glycogen stores aided?

Answer 166

By the immediate intake of high GI carbohydrate.

Question 167

Why high glycaemic index CHO post-exercise?

Answer 167

• increased glucose availability
• increased insulin
• increased glucose uptake
• increased glycogen synthesis

Question 168

Some studies have advised what guidelines on the glycaemic index?

Answer 168

• post-training: 1 gram CHO (high carbohydrate) per kilogram body mass every two hours (50 grams per meal)
• first intake within 15 min post-training
• intake over 24 hours: 7 –10 grams CHO per kilogram (500 –700 grams of CHO per day)

Question 169

What are the guidelines for people undertaking lower intensities of training, where a greater amount of fat will be utilised with some possible loss of glycogen?

Answer 169

• aim to stay within energy balance
• create an energy deficit of 250 kcal if trying to lose body fat
• fulfil CHO needs, chose from moderate to low GI foods
• try to provide energy that can be metabolised, don’t mix high CHO with high fat
• smaller portions and regular meals favour the oxidation of nutrients
• micronutrients should be high
• fibre should be adequate
• include adequate protein
• EFA’s should be eaten in balance

Question 170

What is an isotonic drink?

Answer 170

They serve two main roles, notably the replacement of fluid and the provision of fuel in the form of carbohydrate.

Isotonic drinks have a similar balance of dissolved solids to the blood. This helps provide a faster rate of absorption of fuel whilst maintaining reasonable hydration. They also contain the necessary electrolytes or salts lost through increased sweating during intensive exertion.

Question 171

Many of the commercial sports drinks have other additives which are less desirable. It is not uncommon to find isotonic drinks that have sweeteners and colourings in them.

Aspartame and acesulfame K are common sweeteners (see food additives chapter) and have undesirable side effects.

Another option is to make your own equivalent of a sports drink.

Name 2 options.

Answer 171

• dissolve 60g glucose into 1 litre of water and add 1/5 teaspoon of natural unprocessed salt
• mix 500ml of unsweetened fruit juice with 500ml of water and add 1/5 teaspoon of natural unprocessed salt (paralympics.org.uk)

Question 172

The sugar, salt, caffeine and alcohol levels will all influence fluid balance in some way. Even food contributes somewhat to overall cellular hydration levels.

What may additional factors that may change the levels of water needed?

Answer 172

• environmental temperature
• amount of lean muscle mass
• frequency, intensity and type of exercise

Question 173

Several different health professionals recommend that water intake should be guided by drinking how much?

Answer 173

half of the body weight in pounds in fluid ounces of water e.g. a 150lb person should drink 75 fluid ounces of water

75kg person 2.30 litres.

Question 174

Name positive facts about Protein shakes.

Answer 174

• Whey protein is found in milk, which averages about 6.5% protein, of which about 20% is whey protein.
• In its natural state, it has the highest biological value to the body of any protein, due to its high concentration of essential and branched-chain amino acids.
• useful to the body in many ways, one of which is in the repair and growth of muscle tissues

Question 175

Name important considerations about protein shakes.

Answer 175

• whey is a waste liquid by-product from cheese manufacture.
• often dried at high temperatures for speed of manufacture – above 60ºC these fragile proteins become denatured, which destroys their ability to function
• manufacturers use sugars, sweeteners, colours and flavours to improve palatability
• often very low in fat – proteins need fat for proper metabolism and use.
• often backed up by self-funded research, if any – this does not provide an independent, objective view
• prices now are highly inflated due to market demand generated by clever advertising

Question 176

It is important to recognise that protein shakes were only intended to supplement, not replace good food.

The body is designed to absorb and metabolise real, untainted food and protein sources.

If a supplement is required then what points should be considered before purchasing?

Answer 176

• to seek cold-processed protein powders, manufactured below 50 ºC
• no added sugars, sweeteners, colours or flavours
• mix with whole organic milk, as fats are necessary for protein metabolism

Question 177

What is the goal of weight management?

Answer 177

• To prevent the accumulation of excess body fat and
• for those who are already overweight, to reduce body fat to an acceptably safe level in order to prevent the health risks associated with obesity

Question 178

What is the ultimate answer to successfully managing weight?

Answer 178

Eating according to one’s metabolism.

Question 179

It would be beneficial to overview the main approaches prior to embarking on a discussion of the main concerns surrounding weight management.

What will help the client make an informed decision about choosing a diet?

Answer 179

Empathetic, accurate and clear communication.

Question 180

Give the reasoning and the problems associated with the dietary method “fasting”.

Answer 180

Reasoning:

• helps to detoxify many systems of the body
• creates negative energy balance – weight loss
• rests the digestive system

Problems:

• risk of dehydration
• lack of essential nutrients
• lack of energy
• increased headaches, aches and pains, allergies and bad breath

Question 181

Give the reasoning and the problems associated with the dietary method “very low calorie “.

Answer 181

Reasoning:

• the doctor supervised replacement shakes and bars
• often only 800 kcal/day
• fortified with daily requirements of vitamins and minerals
• designed for the obese to achieve rapid weight loss

Problems:

• fatigue, constipation, nausea or diarrhoea
• possible gall stone formation
• low bioavailability of many of fortified nutrients
• only a short term approach

Question 182

Give the reasoning and the problems associated with the dietary method “Calorie counting groups”.

Answer 182

Reasoning:

• group involvement creates accountability
• calorie intake controlled
• guidance of foods to eat provided

Problems:

• tends to be a short term fix
• ‘yoyo’ dieting cycle common
• nutrient intake may be compromised

Question 183

Give the reasoning and the problems associated with the dietary method “Meal replacement”.

Answer 183

Reasoning:

• control the intake of food with calorie counted meals and shakes
• usually 1200-1500 kcal
• removes the complexity of calorie counting for consumer

Problems:

• boredom and taste fatigue
• lack of energy
• low bioavailability of many of fortified nutrients
• low adherence

Question 184

Give the reasoning and the problems associated with the dietary method “Food combining”.

Answer 184

Reasoning:

• CHO digest better in alkali environment
• proteins digest better in an acidic environment
• foods should be separated and eaten at different times

Problems:

• erratic blood sugar responses from high CHO to no CHO
• very restrictive meals
• may lack vitamin A, D, B12, zinc and calcium due to low animal intake

Question 185

Give the reasoning and the problems associated with the dietary method “Fat-burning supplements”.

Answer 185

Reasoning:

• create a thermogenic effect in the body
• boost the metabolism to burn body fat

Problems:

• may cause illness – even heart attack, seizures and stroke
• may cause arrhythmia
• may cause depression, nervousness or insomnia

Question 186

What is adipose tissue?

Answer 186

Adipose tissue, or fat, is an anatomical term for loose connective tissue composed of adipocytes. Its main role is to store energy in the form of fat, although it also cushions and insulates the body.

Question 187

What do the adipocytes do?

Answer 187

store excess dietary fat and energy in the form of triglycerides.

Circulating lipoproteins serve as transport vehicles for lipids within the bloodstream.

Lipoprotein lipase (LPL) acts on lipid-containing lipoproteins sent out to the adipose tissue from the liver, causing them to unload triglycerides into adipocytes.

Question 188

Adipose tissue is also capable of storing excess energy from overconsumption of carbohydrate.

If excess carbohydrate is consumed over several consecutive days leading to a positive energy balance, what is the result?

Answer 188

An increase in body fat (Acheson et al, 1988).

Glucose enters the adipose tissue where under the influence of insulin, it is synthesised into fat and stored as triglycerides.

It is more likely when insulin levels are elevated.

Question 189

Adipocytes may either increase in size or under certain environmental conditions, increase in number. Either change will lead to a net increase in the amount of body fat on an individuals frame.

Some scientists have theorised that overfeeding during childhood, especially puberty, may stimulate what?

Answer 189

(Malina and Bouchard 1991): it may stimulate an increase in the number of total fat cells.

Perhaps genetics do play a role in the total number of fat cells, but it is unlikely that this factor will predestine an individual to become obese. Environmental factors at any age will influence the fat-storing capacity of those adipocytes.

Question 190

What is the difference between males and females when it comes to the distribution of body fat?

Answer 190

• An excess of central or abdominal fat is more common in males and may be referred to as an ‘android’ or ‘apple’ body shape.
• Peripherally distributed fatness is more common with females and may be referred to as a ‘gynoid’ or ‘pear’ body shape

Question 191

There are several different methods commonly used and established in good practice for assessing body composition and determining health risks associated with both total weight and body shape.

Name 3.

Answer 191

• Body Mass Index (BMI)
• Abdominal Circumference
• Hip to Waist Ratio

Question 192

What information does BMI provide?

Answer 192

on the amount of body weight found within each square metre of the body and is measured using kg/m2.

It is calculated by dividing body weight in kg by height in metres squared.

Question 193

Fat stored in the abdominal region (as opposed to legs, hips and arms) is considered to be a greater risk factor for diseases of what?

Answer 193

the cardiovascular system. Health risk increases in line with increasing waist: hip ratio. The measure of the waist is simply divided by the measure around the widest point of the hips.

Question 194

Explain the starvation response.

Answer 194

• As fat cells increase in size they produce more leptin, and the levels of leptin are directly proportional to the levels of body fat or adipose tissue
• Fat loss will reduce leptin levels, whilst fat gain will cause a corresponding increase
• If a reduction in body fat happens too quickly some studies have postulated that it may initiate the starvation response

Question 195

Where is the starvation response thought to be originated from?

Answer 195

The starvation response is thought to have originated from our hunter-gatherer evolutionary ancestors.

As the body often went for long periods without food when meat was scarce, it developed a way of preserving its most valuable energy store, body fat, in order to assure longer survival.

It also reduced daily calorie needs by reducing the volume of ‘energy-hungry’ muscle tissue, thereby lowering metabolism.

Question 196

Explain Set point vs. settling point.

Answer 196

set point theory: we possess a genetically determined level of body fat and that any attempt to alter this level will cause metabolic adjustments designed to regain the previous “set point”.

Settling point theory: suggests that the human body is influenced by many environmental factors. The body will respond to these factors and find a point at which to ‘settle’ into a state of equilibrium. These influencing factors may include genetics, weather, eating habits, exercise and daily lifestyle. Settling point theory implies that we can affect an individuals’ long term body composition by altering the environmental factors associated with weight gain.

Question 197

What is Basal Metabolic Rate (BMR)?

Answer 197

This is the sum total of all the reactions that occur in the body when at complete rest and no digestion is occurring.

This is usually expressed as the number of calories needed to sustain those reactions.

Question 198

What is Thermal Effect of Food (TEF)?

Answer 198

Refers to the amount of energy expended by the body through the ingestion, digestion, absorption, utilisation and storage of food.

The TEF accounts for between 6-10% of daily energy expenditure for men and between 6-7% for women

Question 199

What is Thermal Effect of Activity (TEA)?

Answer 199

The thermal effect of activity includes planned and unplanned levels of physical activity and the amount of energy required in support.

Since research clearly indicates that low levels of activity are heavily implicated in the development of obesity, it follows that increasing levels of activity must play a major role in reversing this process.

TEA is the most variable component of energy expenditure and accounts for approximately 20% - 40% of total energy expenditure.

Question 200

What is the Total Daily Energy Expenditure (TDEE)?

Answer 200

TDEE is the amount of calories we need on a daily basis to fuel all the functions, exercise and activity of the body.

Question 201

If one begins a new exercise regime at the same time as starting a calorie-controlled diet, this new exercise routine and increased energy expenditure will need to be supported if the adaptations and growth in fitness are to happen.

In order to reduce the possibility of starvation response, any calorie deficit should be pitched no higher than what?

Answer 201

no higher than 250 calories less than the TDEE.

Question 202

What happens when you to establish a negative energy balance to reduce body fat?

Answer 202

Research indicates that if the energy deficit is too great then body fat is more likely to return, possibly to an even greater level.

Question 203

What is a priority for an effective weight management programme?

Answer 203

to lose body fat, whilst retaining as much FFM or lean mass as possible thereby minimising the fall in metabolic rate.

The American College of Sports Medicine (ACSM) have suggested that to achieve this, a weight loss of - 1lb per week (ideally from body fat) is recommended.

Question 204

The 1lb per week reduction in body weight may be achieved through several different strategies. Which are they?

Answer 204

• diet restriction alone: reduce dietary intake by 500 kcal per day
• exercise intervention alone: increase exercise/activity by 500 kcal per day
• exercise and dietary restriction combined: increase exercise/activity by 250 kcal and reduce dietary intake by 250 kcal
• some other combination of dietary restriction and exercise-related energy expenditure accounting for 500kcal deficit

Question 205

What factors need to be considered in the weight loss diet to provide sufficient nutrients required for health and normal functioning?

Answer 205

• frequency of meals
• effects of insulin
• biochemical individuality
• macronutrient balance

Question 206

What impact does the frequency of meals have?

Answer 206

in order to minimise the loss of FFM and to avoid the subsequent fall in metabolism, regular meals throughout the day seem the most appropriate approach.

A minimum of 3 meals a day is advised

Question 207

What are the influences of blood glucose and insulin on dieting?

Answer 207

Higher insulin levels will encourage a faster rate of glucose converted and stored in adipose tissue.

High glycaemic index foods and refined carbohydrates tend to cause insulin levels to ‘spike’ in an attempt to control rocketing blood glucose levels.

This will favour fat storage and suppress the burning of fat as fuel. Spiking often results in a subsequent crash in blood glucose, which creates tiredness and hunger and may, in turn, lead to overeating.

Question 208

What is Biochemical individuality?

Answer 208

Biochemical individuality is the concept that the nutritional and chemical make-up of each person is unique and that dietary and other needs therefore vary from person to person. People have unique biochemical profiles based upon their own genetic structure, nutrition, and environment.

Question 209

What does Macronutrient balance mean?

Answer 209

That the intake of each macronutrient is equal to its needs within the body. This means that we have to be able to metabolise and utilise the protein, carbohydrates and fats that we ingest.

Question 210

What happens to a macronutrient ingested in excess of our ability to utilise it?

Answer 210

It will be either stored or excreted.

Question 211

Is only excess fat stored as fat in the body?

Answer 211

No. Excess protein, excess carbohydrates and excess fat can also contribute to increased body fat.

Question 212

The increased intake or decreased intake of any one macronutrient will cause a change in the way the other two macronutrients may be metabolised by the body to meet energy or nutritional requirements.
What are the combinations in nature between protein and fat - carbohydrate and fats?

Answer 212

In nature, most foods that contain a significant source of protein also house a significant portion of fats. This is due to the necessary role that fats and fat-soluble nutrients play in metabolising proteins.

In nature also, it is often found that high carbohydrate foods have smaller proportions of fats and proteins

Question 213

What could a possible guideline be in trying to meet a suitable macronutrient balance?

Answer 213

An inverse relationship between carbohydrates and fats/proteins.

Question 214

Modern systems for weight management

Whole food carbohydrate diet

What does the research say?

Answer 214

high carbohydrate, lower fat diets still constitute the mainstream approach:

• diets consisting of unrefined low glycaemic index carbohydrates alongside sufficient levels of monounsaturated fat have been shown to produce prolonged satiety. Therefore, they provide an effective method for reducing calorie intake and achieving long-term weight control (Ball et al, 2003)
• maintaining a carbohydrate-based diet, but substituting saturated fat for greater amounts of monounsaturated fat, has been implicated with a reduced risk of CHD in overweight insulin-resistant individuals (Connor and Connor, 1997)

Question 215

Modern systems for weight management

Whole food carbohydrate diet

What are the dietary guidelines?

Answer 215

• cut out processed foods to reduce trans fatty acids
• reduce refined high glycaemic index carbohydrates
• reduce saturated fat and emphasise the monounsaturated fat intake
• include oily fish or flax oil for omega 3 fatty acids
• maintain a ratio of 2:1 or 1:1 of omega 6 to omega 3 fatty acids
• include plenty of fresh fruit and vegetables
• include plenty of unrefined low to moderate glycaemic carbohydrates

Question 216

Modern systems for weight management

Ketogenic diets

What is the principle?

Answer 216

high-fat

moderate protein

low carbohydrate

The reduction in carbohydrate reduces blood glucose causing the body to undergo metabolic changes.

The body responds by relying more on ingested fats for energy.

Research has also shown a rise in the use of fatty acids from reserves within the adipose tissue.

These fatty acids circulate to the liver where they are converted into smaller fragments and released back into circulation. These fragments are called keto acids or ketone bodies and are easily utilised by various tissues as fuel.

The individual is said to be in a ketogenic state under these environmental conditions.

Question 217

Modern systems for weight management

Ketogenic diets

What does the research say?

Answer 217

• higher protein/fat diets with reduced carbohydrate intake appear to improve blood lipid profiles in some individuals (Wolfe, 1995)
• replacing carbohydrate with protein/fat from meat, poultry, and dairy foods, produced beneficial metabolic effects and no detectable effects on markers of bone turnover or calcium secretion (Farnsworth et al, 2003)
• researchers found that low carbohydrate diets appeared to be effective for short-term weight loss in overweight adolescents, and did not harm the lipid profiles (Sondike et al, 2003).
• Caution with such diets was still advised

Question 218

Modern systems for weight management

Ketogenic diets

What are the guidelines?

Answer 218

• the classic ketogenic diet contains a 4:1 ratio of fat by weight to combined protein and carbohydrates
• protein intake is usually targeted at 1g per kg body weight per day
• the Atkins diet typically had a higher protein intake than the classic ketogenic approach
• reduction in starchy carbohydrates including some fruits and vegetables, bread, rice, pasta, grains and sugar
• the initiation phase may limit carbohydrates to as low as 20g per day which increases once moving into the ongoing maintenance phase by 5g of carbohydrates more per day across each week until an optimal level is found
• increase sources of fats like butter, cream, olive oil and particularly coconut oil

Question 219

Modern systems for weight management

Ketogenic diets

Is the ketogenic diet suitable for everyone?

Answer 219

Whilst some individuals may thrive on these ketogenic diets, they are by no means suitable for everyone, and are associated with some inherent risk factors.

Concerns include increased fat intake and CHD risk, protein turnover and kidney function and blood acidity and calcium reduction in bones.

They may well suit a proportion of individuals, providing improvements in fat loss, insulin resistance and blood lipid profiles. They may equally be less suited to others, especially people with a history of kidney function problems

Question 220

Modern systems for weight management

Palaeolithic diet

What is the concept?

Answer 220

The basic argument centres on the fact that 99.9% of our genes were formed 10,000 years ago by the beginning of the Neolithic or agricultural era. By logical argument proponents of this argument suggest that we are better suited to the Palaeolithic (over 10,000 years ago) diet, since this is what we evolved with.

Question 222

Modern systems for weight management

Palaeolithic diet

What are the dietary guidelines?

Answer 222

• approximately 30% protein intake, varied according to season. Protein should come from wild game meat such as venison, bison, rabbit and fowl (Eaton and Konner, 1983)
• an ideal ratio of 1:1 up to possibly 1:4 omega 6 to omega 3 fatty acids
• a greater percentage of monounsaturated fat and less saturated fat
• carbohydrates are limited to seasonal fruit, wild vegetables, roots, legumes and nuts
• the hunter-gatherer lifestyle was very physically active, an important component relating to this diet

Question 223

The basis of the Palaeolithic diet is a return to the foods that would have been available to us in a Stone Age setting, whilst avoiding the modern mass agricultural foods available today that would not likely have been present.

What foods should be avoided according to this diet?

Answer 223

• all grains e.g. wheat, rye, barley, oats etc.
• all-grain products e.g. bread and pasta
• all processed food
• milk and dairy products
• all pulses e.g. beans of any kind, including string beans, peas,
• cashews
• potatoes and sweet potatoes
• sugar

Question 224

The basis of the Palaeolithic diet is a return to the foods that would have been available to us in a Stone Age setting, whilst avoiding the modern mass agricultural foods available today that would not likely have been present.

What foods should be included according to this diet?

Answer 224

• a variety of organic meat, poultry
• organic organ meats e.g. liver and kidneys
• organic free-range eggs
• plenty of fruits (strawberries, raspberries, blueberries etc)
• plenty of root vegetables (carrots, turnips, parsnips, swedes, radishes etc)
• plenty of broad green-leafed vegetables (lettuce and spinach leaves, kale etc)
• bulbs (onions, garlic)
• nuts and seeds

Question 225

What are the considerations with the Palaeolithic diet?

Answer 225

• not suitable for everyone
• restrictive and some may find it hard to adhere to
• the lack of dairy products may result in poor calcium intake although dark green leafy vegetables are a plant source of calcium and magnesium
• the exclusion of processed food is an improvement for everyone
• recognise the importance of increased fruit and vegetables and an improved ratio of omega 3 to omega 6 essential fats
• increased intake of saturated fat
• a significant percentage of fat within most red meat is in fact monounsaturated, which experts have identified as being beneficial to health
• The amount of saturated fat within domesticated livestock tends to be higher than within the original Palaeolithic wild game.

Question 226

What are anorexia and bulimia nervosa?

Answer 226

Eating disorders that lead to underweight

Question 227

What are usually root causes to anorexia and bulimia nervosa?

Answer 227

Psychological in nature.

Question 228

Will nutritional advice be sufficient when one is suffering from anorexia and bulimia?

Answer 228

No, appropriate professional help should be sought if or when dealing with individuals suspected of suffering from one of these challenging conditions.

Question 229

Prior to collecting a client’s personal information on health and diet, it is vital for the health professional to obtain what?

Answer 229

That the health professional has obtained a written and signed ‘informed consent’ form.

Question 230

Who does a written consent protect and against what?

Answer 230

This will protect both the trainer and client and ensure that sensitive information remains confidential and that the client doesn’t receive any unexpected surprises with the type or level of service as they have been ‘informed’ prior to the nutrition service beginning.

Question 231

Name methods on how to collect client details.

Answer 231

• questionnaires e.g. lifestyle, PAR-Q, medical, nutritional
• completed food diary
• interviewing / consulting
• short and long term observation e.g. body language, long term behaviours, habits, reactions, emotions, health
• nutritional testing / assessing

Question 232

Why is it very important that a sufficient amount of accurate information is gathered by any nutrition or health and fitness professional prior to offering advice and direction?

Answer 232

This will help in more fully understanding the clients’ current situation in relation to where they really need to be. This will also serve as the foundation to determine the correct, individualised stages of change to ease and guide a client through a series of adjustments to their current lifestyle and food habits.

Question 233

What is do be considered when gathering information through interviewing?

Answer 233

• communicate clearly and effectively to be sure knowledge shared is understood by both the trainer and the client
• generate enthusiasm and motivation for change
• be aware of the effect of their personal attitudes and beliefs and avoid being too judgemental
• understand the constraints on an individuals’ health and nutrition behaviour, including family, employment, cultural and religious considerations
• foresee any obstacles that may reduce adherence to nutritional change and investigate tactfully using appropriate questioning
• determine a variety of options suitable to the clients’ lifestyle that will move them towards their goals

Question 234

Why is good communication important for single consultations and longer programmes?

Answer 234

• communication is essential to a professional relationship.
• the trainer must determine what style or method of communication best suits the client and then adapt their style to match
• communication is a primary skill needed to convey knowledge to other people
• communication is a vital key to retaining or losing clients. Once a trainer starts to communicate effectively they can build rapport, relate, empathise, explain, understand, motivate, question and laugh with a client
• good communicators build good relationships. This is because they can convey what they want or need in a form the other person understands. However, they are also able to understand what the other person is feeling and needs.

Question 235

Conditions which promote effective consultation / interview

Answer 235

The room:

• comfortable, bright, airy, warm or cool (as appropriate)
• no barriers e.g. a desk between people
• comfortable chairs, not opposite each other but angled to allow for eye contact, but also to enable client to break eye contact easily whilst they think about their responses
• no loud noises or distractions, professional privacy to be maintained
• no prominent clocks

The consultant:

• genuine, a person of integrity, open-minded
• having unconditional regard for the client
• posture and body language should be welcoming

Question 236

The clients’ PAR-Q, lifestyle, medical and nutrition questionnaire can serve as a basis for which to follow a stream of viable questioning and it will help to identify potential barriers and solutions such as:

Answer 236

• time available to purchase food, and prepare meals
• family commitments that may hinder efforts
• employment commitments and degree of priority
• potential support network
• social habits and activities that support or hinder
• health problems that may require more specialist care

Question 237

Nutrition questionnaires may not be answered truthfully. How can the personal trainer get a better inside of the nutrition of their clients?

Answer 237

With the help of a food diary.

Question 238

What needs to be considered when using a food diary?

Answer 238

• complete diary after each meal, not at the end of the day
• record accurately what was eaten
• identify amounts eaten
• identify food brands and quality of food where possible
• note the time of intake
• specify any fluid intake e.g. water, coffee, soft drinks
• note when activity or exercise was done
• assess energy, mood, and mental clarity 1-2 hours after food was eaten

Question 239

What are basic things to consider when interpreting a food diary?

Answer 239

• amount of carbohydrate in the daily diet
• level of refinement of carbohydrate foods
• energy, mood and mental response to high carbohydrate intake
• varied fruit and vegetable intake
• amount of protein in the daily diet
• inclusion of protein in each meal
• quality of the sources of protein
• energy, mood and mental response to high protein intake
• amount of fat in the daily diet
• types of fat included
• quality of the sources of fat in the diet
• sources of omega 6 to omega 3 and the current ratio
• timing of meals generally throughout the day
• how food fits in around the working day and family commitments
• food intake around activity, exercise and other key stressors
• regularly eaten foods that may form part of the subconscious, addictive pattern
• fluid intake and how this measures up to guidelines and additional exercise needs
• alcohol habits and intake
• additives that are ingested regularly and the potential side effects
• ‘go-to’ foods that serve to satisfy when quick and convenient options are a must
• look for repetitive eating patterns with little variety

Question 240

After analyzing the food diary, it is important to be able to provide both positive feedback and highlight areas of attention that need to be improved upon. The health professional should not determine the goals beforehand and arrive at the feedback session with a set of goals to impose upon the client.

Some clients may have many areas that need to be worked upon that could prove to be too vast for a client to get to grips with in one go.

How do you go about this?

Answer 240

The areas of needed change should be prioritised by considering which are most nutritionally important, but also which would be the easiest changes to make.

Question 241

Having gained a new perspective on the issues and concerns, it becomes possible for the client to identify goals and ways in which these might be achieved.

The important thing about this stage is that the client is allowed time to talk through the potential areas of change by considering the likely consequences of change, both positive and negative.

By discussing the possible options, what will the trainer discover?

Answer 241

The trainer will discover much more about the client’s attitude and beliefs and the way in which they think about the different dietary habits and behaviours they have.

This will also aid the client in developing ownership of agreed goals and the strategy that is decided upon.

Question 242

What may be the client’s objectives when it comes to nutrition?

Answer 242

• body fat reduction or weight loss
• muscular development
• eating to achieve optimal health
• fuelling exercise and/or sport

Question 243

Explain the SMART goal principle.

Answer 243

S - specific statement of the objective

M - measurable in order to provide comparative progress

A - agreed by the client involved

R - realistic whilst still providing a challenge

T - time framed to focus effort and attention

Question 244

Explain The performance equation (G. Tim Gallwey).

Answer 244

Clients who are able to remain focused on their potential, act in accordance with their objectives and take 100% responsibility for their outcome are rarely distracted by interference.

Some sabotage their potential through their own psychological interference, particularly through lack of motivation and the perpetuation of their own limiting beliefs and opinions about themselves or the methods being used to make change occur.

Question 245

Why is it important to investigate concerns and identify barriers?

Answer 245

It’s a tool that will aid the trainer to assess where a client is in relation to their efforts to alter their lifestyle. Given this understanding, suitable behavioural change strategies can then be implemented.

Question 246

When a person prepares to make changes, he or she needs to take account of things he or she liked about the old lifestyle. They need to accept that the reasons for the old behaviour will still be around and will sometimes seem to be more important than the reasons for changing. It will be important to develop strategies for handling such ‘temptation’.

What may be examples of the kind of barriers that may be faced?

Answer 246

• client enjoyed the taste of less healthy food
• comfort eating to improve feelings and emotions during stressful times
• financial concerns over cost of better quality food
• family members, spouse or partner may not want to change
• time constraints may support low quality, convenience eating
• they have become accustomed to certain habits and routines that are difficult to break

Question 247

There are many ways and tools which a nutritional advisor or personal trainer can use to support the client whilst they strive to keep their focus on the objectives at hand.
Name a few.

Answer 247

• Self monitoring
• Reinforcement
• Behavioural contracts
• Provide praise
• Encourage paired or group participation
• Recruit supportive ‘other’
• Periodic testing for positive reinforcement
• Use behavioural change strategies
• Charting progress
• Reward systems

Question 248

For the nutritional success of the client, a network of professionals may be needed.

Which professionals could it include?

Answer 248

• Doctor
• Spouse
• Employer
• Fitness Instructor
• Psychologist
• Friends
• Personal Trainer
• Dietician

Question 249

In regards to Data Protection, nutritionists or trainers must satisfy which two obligations?

Answer 249

First obligation, adhere to the following:

• information is fairly and lawfully processed
• the information is used for the limited purposes intended and known by the client
• there is adequate information for the required purpose
• the information held is all relevant and not beyond the purpose or needs
• all information is accurate and current
• information should only be stored or held on file for the required time period
• information is stored in fire-proof lockable filing cabinets, or under password protection on a computer
• information should not breach an individual’s rights
• information should not be passed on to others without the individual’s permission, and should not be used outside the EC unless adequate protection for the individual is in place

Second obligation:
Inform the information commissioner. A form can be completed online at www.dpr.gov.uk

Question 250

Explain the pros and cons of the Harris Benedict Formula.

Answer 250

Uses factors of height, weight, age, and sex to determine basal metabolic rate (BMR). This makes it more accurate than determining calorie needs based on total bodyweight alone.

The only variable it does not take into consideration is the amount of lean body mass. Therefore, the equation will be very accurate in all but the extremely muscular (it will underestimate caloric needs) and the extremely over fat (it will over estimate caloric needs).

Question 251

The Harris Benedict Formula

What is the formula for male and female?

Answer 251

Men: BMR = 66 + (13.7 x weight in kg) + (5 x height in cm) – (6.8 x age)
Women: BMR = 655 + (9.6 x weight in kg) + (1.8 x height in cm) – (4.7 x age)

Question 252

After calculating your basal metabolic rate, what are the multiplications for different lifestyles?

Answer 252

Activity Multiplier

• Sedentary BMR x 1.2 (little or no exercise, desk job)
• Lightly active BMR x 1.375 (light exercise/sports 1-3 days/week)
• Mod.Active BMR x 1.55 (moderate exercise/sports 3-5 days/week)
• Very Active BMR x 1.725 (hard exercise/sports 6-7 days/week)
• Extra Active BMR x 1.9 (hard daily exercise/sports and physical job)