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Specialist in

Fitness Nutrition
John Berardi, PhD

Ryan Andrews, MS/MA, RD

Specialist in Fitness Nutrition

(First Edition)
Official course text for: International Sports Sciences Associations Specialist in Fitness Nutrition program
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Copyright 2010 International Sports Sciences Association.
Published by the International Sports Sciences Association, Carpinteria, CA 93013.
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John Berardi, PhD
Dr. John Berardi made his mark as a leading researcher
in the field of exercise and nutritional science, and as a
widely read author, coach, and trainer who has helped
thousands of men and women achieve their health, fitness and performance goals. Through his highly
acclaimed nutrition education and solutions company,
Precision Nutrition, John has reached nearly 40,000
clients in 87 countries.
Dr. Berardi earned a doctorate in Exercise and Nutritional Biochemistry from
the University of Western Ontario and currently serves as an adjunct assistant
professor of Exercise Science at the University of Texas. He provides nutrition
consultation services for athletes and sports teams including a number of
Canadian Olympic programs, the University of Texas Longhorns, and numerous individual professional football, hockey, and baseball players.
Dr. Berardi has written and contributed to many books and has published
more than 300 articles in major health and fitness magazines, including Mens
Health, Mens Fitness, Womens Health, Oxygen, and more. You can learn more
about Dr. Berardi and his visionary approach to fitness and nutrition at

Ryan Andrews, MS/MA, RD

After earning his BS in Exercise Science from the
University of Northern Colorado and two Masters
Degrees from Kent State in Exercise Physiology and
Nutrition, Ryan Andrews completed a Medical Center
Dietetic Internship at Johns Hopkinsone of the most
recognized and awarded research institutions in the
world. Ryan has applied his comprehensive education
and enthusiasm for helping others to his work as a dietitian, strength and conditioning specialist, and invaluable contributor to various non-profit organizations.
Ryan has presented on topics related to fitness and nutrition to numerous
groups and has written hundreds of articles about nutrition, exercise, and
health. He currently serves as Director of Education for Precision Nutrition.
For more on Ryan, visit www.precisionnutrition.com.


Preface: How to Use This Text, viii

Section I: Nutritional Science

Introduction: What Is Good

Nutrition?, 1

Cell Structure and Function, 19

Nutrition as a Limiting Factor, 2

The Cell, 21

Good Nutrition Defined, 4

Organism, 21

How You Can Help Clients Improve Their

Nutrition, 11

Nutrition and Cellular Interaction, 26

Your Scope of Practice, 12

Cellular Proteins, 35

Applying Nutrition Technologies, 15

Summary, 38

Summary, 18

Cellular Components, 28

Food Intake, Digestion and

Absorption, 39
Food Versus Nutrients, 41
Digestive System Structure and Function, 44
Controlling the Digestive Process, 53
Nutrient Absorption, 58
Fate of Nutrients after Absorption, 63
Nutrient Delivery, 65
Summary, 68

Energy Transformation and

Metabolism, 69
Energy Intake, Storage, and Transfer, 71
Energy Transfer Process, 72
Pathways for Nutrient Metabolism, 79
Summary, 104

Energy Balance in the Body, 105

The Micronutrients, 177

Energy Value of Food, 106

Vitamins, Minerals, and Phytochemicals, 178

The Bodys Need for Energy, 109

Water-Soluble Vitamins, 183

Estimation of Energy Needs and Energy

Intake, 111

Fat-Soluble Vitamins, 189

Consequences of Energy Imbalances, 115

Summary, 206

Roles of Vitamins and Minerals in Energy

Balance, 124

Water and Fluid Balance, 207

Summary, 126

All About Body Water, 208

Aerobic and Anaerobic

Metabolism, 127
How Exercise Impacts Metabolism, 128
Muscle Structure and Function, 130
Muscle Energy Requirements, 133
Physiology of Anaerobic Exercise, 136

Minerals, 193

Fluid Balance, 211

Body Water Imbalances, 214
Body Water Regulation, 218
Electrolytes, 220
Hydration Strategies, 220
Summary, 224

Physiology of Aerobic Exercise, 138

Special Needs, 225

Adaptation to Exercise, 139

Sport Nutrition, 227

Summary, 146

Nutrition for Injury and Rehabilitation, 232

The Macronutrients, 147

Plant-Based Diets, 239

Carbohydrate Structure, 149

Carbohydrate Digestion, Absorption,
Metabolism, and Transport, 150

Eating Disorders, 243

Nutrition and Diabetes, 246
Nutrition and Cardiovascular Disease, 250

Carbohydrates in the Diet, 155

Nutrition and Pregnancy, 257

Fat Structure, 157

Summary, 260

Fat Digestion, Absorption, Metabolism, and

Transport, 158
Fat in the Diet, 158
Protein Structure, 166
Protein Digestion, Absorption, Metabolism,
and Transport, 168
Protein in the Diet, 171
Summary, 175

Section II: Nutritional Practice

Step 1:
Preparing For Your Client, 261
What It Means to Be a Good Coach, 266
Understanding the Potential Clients
Mindset, 270

Step 3: Evaluating Client

Information and Explaining
What It Means, 307
Physical Activity Readiness Questionnaire, 308

Understanding Your Clients Goals, 272

Medical History and Present Medical

Condition Questionnaire, 309

Overcoming Client Objections, 276

Comprehensive Client Information Sheet, 309

What You Should Know and What Your

Clients Should Know, 278

Three-Day Dietary Record, 322

Summary, 280

Step 2: Collecting Preliminary

Client Information, 277
Physical Activity Readiness Questionnaire, 280
Medical History and Present Medical
Condition Questionnaire, 281

Readiness for Change, Kitchen Makeover, and

Social Support Questionnaires, 323
Assessments, 324
Determining Your Clients Level, 325
Communicating Results with Clients, 326
Summary, 328

Three-Day Dietary Record, 287

Step 4: Offering Nutritional

Suggestions and Providing a
Nutrition Plan, 329

Readiness for Change Questionnaire, 291

USDA Food Pyramid, 331

Kitchen Makeover Questionnaire, 293

Habit- and Superfood-Based Nutrition, 335

Social Support Questionnaire, 295

Individualization, 346

Initial Body Composition Assessment, 297

Special Dietary Strategies, 351

Initial Recovery Assessment, 299

Pre-, During-, and Post-Workout Nutrition, 360

Initial Performance Assessment, 301

Competition Days, 361

Baseline Blood Chemistry Assessment, 302

When to Discuss Nutrition, 362

Baseline Visual Assessment, 302

Summary, 364

Comprehensive Client Information Sheet, 284

Summary, 306

Step 5: Offering Nutritional

Supplement Suggestions, 365

Step 8: Providing Continuing

Education and Support, 433

When to Suggest Supplements, 366

The Big Picture, 435

Supplement Categories, 369

Celebrating Client Successes, 435

Supplements in Sport, 371

Creating New Social Support Circles, 436

Supplement Risks Versus Rewards, 373

Lesson Plan 1: Grocery Shopping Tour, 439

Five Staple Supplements, 374

Lesson Plan 2: Kitchen Makeover, 441

Nonessential Nutrient Supplements, 374

Lesson Plan 3: The Sugar Lesson, 443

Summary, 380

Lesson Plan 4: The Fruit and

Veggie Lesson, 446

Step 6: Setting Behavior Goals and

Creating Monitoring Strategies, 381

Lesson Plan 5: The Fat Lesson, 449

Goal-Setting and Managing Expectations, 383

Lesson Plan 6: From North American

to Nutritious, 451

Compliance and Adherence, 389

Lesson Plan 7: Eating on the Go, 453

Monitoring Strategies and Assessments, 390

The Assessments, 391

Lesson Plan 8:
Understanding Energy Balance, 454

Follow-Up Body Composition Assessments, 395

Summary, 456

Follow-Up Visual Assessments, 395

Appendixes, 457

Follow-Up Performance Assessment, 396

Follow-Up Blood Chemistry Assessment, 396

Glossary, 465

Summary, 400

References, 479

Step 7: Making Nutritional

Adjustments, 401
The Outcome-Based Coach, 402
Judging Your Clients Progress, 403
Improving Client Adherence, 404
Making Program Changes, 414
Improving Your Troubleshooting Skills, 420
The Decision-Making Chart, 414
More Advanced Troubleshooting Scenarios, 420
Summary, 432

Introduction at a Glance
Nutrition as a Limiting Factor; page 2
Good Nutrition Defined; page 4
How You Can Help Clients Improve Their
Nutrition; page 11
Your Scope of Practice; page 12
Applying Nutrition Technologies; page 15
Summary; page 18

What Youll Learn

In this unit, youll learn how important a
good nutritional intake is to overall physiological function as well as to the body transformation process. Specifically, through
understanding the definition of good nutrition, youll not only be able to better help
your clients improve their daily food intake,
youll be better able to help them improve
their lives. In addition to being better able to
define good nutrition, by the end of this unit,
youll better understand your scope of practice
when it comes to making nutritional recommendations. In understanding what you can
and cannot recommend, you can shape your
coaching strategy to include both sound training advice and the systematic application of
nutrition technologies.


International Sports Sciences Association

Key Terms
limiting factor

positive energy balance


negative energy balance

energy balance

calorie density

nutrient density




body composition

social-support system


cross-referral system


Medical Nutrition Therapy

laws of thermodynamics


limiting factor: A limiting
factor is anything that makes it
more difficult for a client to
achieve optimal results.

To really achieve great results with a client, you only need to master one crucial skill: the ability to find your clients limiting factors and remove them.
That one skill will take you from being a good coach to being a great coach.
From a student to a master. That one skill alone will generate more business
than you can handle and produce better results than you ever thought possible. Find their weakness. Find whats holding them back. Find whats keeping
them from succeeding. And fix THAT.
Now, when it comes to specific limiting factors, there can be a lot of them.
More, in fact, than we could likely cover individually in this manual. After all,
there are lots of people out there with lots of different genotypes, lots of different lifestyles, and lots of different ideas about whats good for them and
whats not. However, if you look at peoples limiting factors in terms of their
ability to be healthy, to lose fat, and to gain muscle, there are really only three
big picture limits: 1) their genetic makeup, 2) their physical activity patterns,
and 3) their nutritional habits. Everything else really just falls into one of these
three categories, doesnt it?

genetics: The specific, inherited genetic code of an organism. An organisms genetics

influence what they become.
However, environment plays a
key role in the expression of
an organisms genetic code.

So lets begin by talking geneticsspecifically, is your clients limiting factor

genetics? Well, to be honest, I seriously doubt it. Out of the thousands of people Ive worked with over the years, I cant remember a single one that couldnt
improve in some very significant ways, despite their genetics. Lets face it; few
people will ever come close to realizing their genetic potential when it comes
to health and fitness. So its a huge mistake to assume that your clients are
standing on the brink of their upper limit, genetically.
Sure, weve got to be realistic here. Each of us has certain limitations, indeed.
For instance, some of your clients may not be equipped to play quarterback for


the Patriots, play center for the Lakers, or win the
Tour de France. In other words, they may not have
the genetic makeup to reach the upper limits of
human performance. But, with the right advice, and
despite their genetics, they can improve their health,
lose fat, and/or gain muscle. In ten years of working
with people of all stripes, from office managers to
elite athletes, Ive yet to see a single case where we
couldnt make significant body composition changes.
And with these changes almost always come
improvements in health profile and performance.
Lets now turn to exercisespecifically, is your
clients limiting factor their physical activity pattern?
Well, maybe, especially if an individual is completely
sedentary. Indeed, if their daily activity involves
nothing more than moving from one piece of furniture to another, their exercise habits (or lack thereof)
probably represent one of their limiting factors.
Getting more fit, getting leaner, improving health,
and looking good naked all require both an active
lifestyle as well as a commitment to engaging in purposeful, intense exercise. Make no mistake about it
if a client sits at a desk all day and then goes home to
sit some more, theyre probably on the fast track to
metabolic decline, fat gain, muscle loss, and lifestylerelated disease. They just dont take enough steps in
a single day. Indeed, when the number of steps people take per day is measured, those taking under
5,000 steps are considered sedentary and at higher
risk for early death, disease, and being overweight.
On the other hand, those taking 10,000 steps are
considered active and have lower body weights, body
fat, and improved health. Further, when people
bump up their level of this type of basic physical
movement, in conjunction with doing at least three
hours of purposeful, high-intensity exercise per
week, the magic starts to happen.
However, dont get the wrong idea. Exercise isnt
usually enough. As Ive seen time and time again
with clients, and as research at major universities is
starting to prove, even with the best exercise program, many clients lag behind because of a different
limiting factor. To drive home this point, Id like to
share with you the results from a recent study. In
this study, overweight participants were either
assigned to a control group for 16 weeks (where

they didnt exercise at all) or an exercise group for

16 weeks (where they exercised for three hours per
week performing strength exercise with an Olympic
weightlifting coach, and spent two hours per week
performing circuit training with a group exercise
instructor). During this time, body composition and
a host of other measures were collected. So, what
were the results?
Well, as you might have expected, the exercise group
did get better results than the control group; but
these results were embarrassingly unimpressive.
Check it out:
Control Group: gained 1 pound of lean
mass, lost 0.5 pound of fat, and lost 0.5%
body fat
Exercise Group: gained 3 pounds of lean
mass, lost 2 pounds of fat, and lost 1.5%
body fat

Again, its obvious that the exercise group did better

and that the exercise helped a bit. However, if I were
your client, and I had paid $4000-$8000 for 80 training sessions (5 sessions per week for 16 weeks), and I
left having lost only two pounds of fat after four
months, Id probably demand my money back and
your head on a platter. Seriously, is this what we
expect our clients to put up with? They come to us
overweight and unhealthy, and after months of time,
effort, and large amounts of money, they leave only
slightly less overweight and unhealthy. If I were in
the clients position, I would have rather: a) sat at
home on my arse, b) read more books, c) learned to
play the guitar, d) learned to speak French, or done
any number of other things rather than waste my 80
hours and 4-8K on two measly pounds of fat loss!
OK, Ill be honest; Im exaggerating my indignation
here . . . but just a little . . . and only so I can drive
home the point. And the point is that purposeful
exercise alone, while marginally better than nothing,
never seems to produce the results that purposeful
exercise plus increased general physical activity (i.e.,
more steps) plus nutritional control can produce.
That leads us to the next, and biggest, limiting factor
your clients face . . . their nutritional habits.
People who are overweight and unhealthy, with too
little muscle and too much fat, usually have a few

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problems. They probably move too little and eat too much (or at least, too
much of the wrong stuff). As discussed above, you should absolutely get them
moving more; thats a prerequisite. But, as also discussed, getting them to
move more for three, four, or five hours per week isnt usually enough. If this
is true (and it is), their real limiting factor must lie beyond their exercise. Its
not their genes. Its not their training program. Its what theyre eatingand
sometimes more importantly, what theyre not eating. Their limiting factor is
their nutritional habits.
energy balance: The relationship between all sources of
energy intake and energy output. An organism is said to be
in energy balance when energy flow into the body and out
of the body is equal. This is
often evidenced by a stable
body weight.

Whether your client wants to gain muscle, lose fat, live healthily, or even compete at the highest levels of sport, the limiting factor is almost always nutrition.
Poor nutrition is what holds clients back. And good nutrition is what will move
them forward. Good nutrition is what will feed muscle and shed fat. Its what
will improve nearly every measurable health marker. Its what will drastically
improve recovery and mood so they can exercisewhether its purposeful or
just part of their daily lifestyleharder, longer, and more frequently. Good
nutrition is what will get them the body they never thought they could have.

nutrient density: Foods that

provide substantial amounts of
nutrients with only the necessary calories.


health: Health can and

should be assessed through a
number of medical tests,
including blood assessments,
cardiovascular tests, and other
screening modalities.
body composition: Body
composition is the relative relationship between lean body
mass (which includes bone
mass, body water, muscle
mass, and organ mass) and fat
mass (which includes adipose
tissue and intra-tissue fat
performance: Performance
means functioning or operating; high performance means
functioning or operating on a
high level. Each of us is asked
to perform on a daily basis,
regardless of whether were an
athlete or not.
outcome-based: Basing
nutritional decisions on specific, measurable outcomes
rather than nebulous definitions of whats good or

At this point I hope youre convinced of the importance of good nutrition

since this entire course is devoted to teaching you exactly what good nutrition
is and how to help your clients eliminate poor nutrition as a limiting factor. Of
course, to begin with, its important to have a working definition of the concept of good nutrition. This phrase may mean different things to different
people, and if you ask a hundred different people what good or healthy
eating means, youll likely get a hundred different answers! Some think good
nutrition means eating fewer sugary desserts. Others think it means eating
more fruits and vegetables. Others think it means eating less meat. Others
think it means eating fewer carbs. And then theres the often cited and common sensical idea of the balanced diet. Sure, most of the definitions youll
hear are simple and easy to remember. Yet most of them will be incomplete,
and some of them will be flat-out wrong.
So, in this course, its our goal to help reprogram your brain when it comes to
nutrition. Its our goal to help you dump out all the ridiculous, oversimplified,
often erroneous media mythology youve been exposed to in order to make
some room for the right info. Its our goal to help you understand how to
judge the goodness of a nutrition plan. And, to begin, well start with four
important criteria that all good nutrition plans must meet.
1. Good nutrition properly controls energy balance
2. Good nutrition provides nutrient density
3. Good nutrition achieves health, body composition, and performance goals
4. Good nutrition is honest and outcome-based

Lets now discuss each of these more specifically.




The phrase energy balance represents the relationship between energy in
(food calories taken into the body through food and drink) and energy out
(calories being used in the body for our daily energy requirements). Its this
relationship, defined by the laws of thermodynamics, that dictates whether
weight is lost, gained, or remains the same.
However, theres a lot more to energy balance than its physical manifestation
in weight change. Energy balance also has a lot to do with whats going on in
your cells. As you continue reading this manual, youll learn more about
whats happening in your body on the cellular level. And youll see that both
when youre in a positive energy balance (more in than out) and when youre
in a negative energy balance (more out than in), everything from your
metabolism, to your hormonal balance, to your mood is impacted. Indeed, in
a study looking at military recruits, severe negative energy balance led to massive metabolic decline, reductions in thyroid hormone production, reductions
in testosterone levels, an inability to concentrate, and a huge reduction in
physical performance. The same is true of anorexics. They lose physical fitness,
metabolic fitness, mental fitness, bone mass, and muscle mass.
Doesnt a negative energy balance lead to weight loss? Of course! An intense
negative energy balance leads does lead to weight loss. But so does getting
thrown in a prison camp or living in an impoverished village without adequate
food. And thats exactly what our body perceives when we impose a large negative energy balance. It thinks its starving, so it slows down or shuts down all

laws of thermodynamics:
The laws of thermodynamics
describe the specific principles
that govern energy exchange
including heat exchange and
the performance of work.

positive energy balance:

An organism is in positive
energy balance when energy
flow into the body exceeds
energy flow out of the body.
This is often evidenced by an
increasing body weight.
negative energy balance:
An organism is in negative
energy balance when energy
flow out of the body exceeds
energy flow into the body.
This is often evidenced by a
decreasing body weight.

International Sports Sciences Association

Figure I.1 Stable weight requires a balanced relationship between energy in and energy out, in the form of calories.

non-survival functions including reproductive function, metabolic function, brain function, and more.
Of course, on the other hand, weve got positive
energy balance and its consequences. Overfeeding
(and/or under exercising) has its own host of repercussions not only in terms of weight gain but in
terms of health and cellular fitness. With too much
overfeeding, plaques can build up in our arteries,
blood pressure can increase, blood cholesterol can
increase, we can become insulin resistant and begin
to suffer from diabetes, we can increase our risk for
certain cancers, and the list goes on.
So, in the end, the take home point here is that good

nutrition programs help to properly control energy

balance. When properly controlled, excessive swings
in either direction (positive or negative) are prevented and the body can either lose fat or gain lean mass
in a healthy way.


Another criterion for a good nutrition plan is that it
provides a high level of nutrient density. Nutrient
density is defined as the ratio of nutrients (vitamins,
minerals, fiber, etc.) relative to the total calorie content in a food. Therefore, a food with a high nutrient


density contains a large amount of key nutrients (i.e., protein, iron, zinc, Bvitamins, etc.) per 100 calories of food. Examples of foods with a high nutrient density include: a) bright or deeply colored vegetables, b) bright or deeply
colored fruits, c) high fiber, unprocessed grains, and d) lean meats. Examples
of foods with a low nutrient density include: a) table sugar, b) soda, c) white
flour, and d) ice cream.
In contrast to nutrient density, we have calorie density. Calorie density is
defined as the ratio of calories (which are merely units of potential energy in
food) to the actual weight of a food. Therefore a food with high calorie density would have a lot of calories per 100 grams of food, while a food with low
calorie density would have few calories per 100 grams of food. Examples of
foods with a high calorie density include: a) cookies, b) crackers, c) butter, and
d) bacon. Examples of foods with a low calorie density include: a) fresh vegetables, b) broth based soups, c) fresh fruits, and d) chicken breast.

calorie density: The ratio of

calories to the actual weight of

As you might imagine, the best combination of nutrient and calorie density for
improving health and promoting fat loss is a diet high in nutrient dense foods
(a lot of nutrients per calorie) and low in calorie dense foods (few calories per
gram of food weight). Such a diet would promote the following benefits:
Easily controlled calorie intake (without calorie counting)
Longer periods of satiation after meals

satiation: Pleasantly fed to


Difficulty overeating
A higher total essential nutrient intake
More essential nutrients per volume food

Also note that if someone is interested in weight or muscle gain, the recommendation above might be altered in favor of high nutrient dense, high calorie
dense foods. This would allow for increases in both nutrient intake and calorie
intake, both essential for gains in lean mass and total body weight.

Table I.1
Key nutrients found per 100 calories of sample foods.
The higher the nutrient value per 100 calories, the more nutrient dense the food. The lower the nutrient
value, the less nutrient dense the food.



















Lean Beef


















Low Fat Milk












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As I hinted above, good nutrition is about more than weight loss or gain.
Weight loss and gain are just transient indicators of energy balance since energy balance and weight can change from one day to the next. Therefore, finding
a long-term set of dietary habits should be based on the intersection of the following three goals:
1. Improved body composition
2. Improved health
3. Improved performance

Yes, a large majority of your clients are working out with aesthetics in mind.
They want to lose fat, gain muscle, achieve a flat stomach, and generally look
great naked. Often, as a result of these strong motivators, they can easily be
lured into a world of powerful drugs, invasive and risky surgeries, and ridiculous crash diets. Yet these strategies, while sometimes improving the way your
clients look in the mirror temporarily, can sacrifice the clients health and well-being in the
long run. So rather than focusing soley on body
composition as an outcome, its incumbent on
you to also focus on improving a clients health
and performance as well. Therefore, the strategies you employ should be those that also act to
reduce blood lipids, increase insulin sensitivity,
reduce diabetes risk, increase good cholesterol,
reduce body fat percentage, and increase lean
body mass. In addition to boosting health and
body composition, recommendations should
also be in place to help your clients improve performance, regardless of
whether theyre elite athletes or people who only watch such athletes on TV.
This means targeting everything from improved energy levels, stamina, and
the like to working toward improvements in athletic performance at the elite,
world-class level; it all depends on your clients goals and activities.

ergogenic: Physical or mental performance-enhancing


While there is a lot of overlap herefor example, if someone begins to look

better, they should also begin to feel better and perform betterthe overlap
isnt all-inclusive. As mentioned above, some plans help folks lose weight in a
hurry while sacrificing their health and performance. Similarly, there are a lot
of programs out there that cater to the I just want to be healthy market.
And while some of these approaches (calorie restriction, the avoidance of certain foods, and high doses of certain vitamins, for instance) can improve one
or two indicators of health, many actually degrade a host of other health
markers. Finally, there are a lot of programs out there designed to improve
performance but that include such components as powerful ergogenic (performance-enhancing) drugs, crash dieting, diuretics to shed weight for competition, unresearched nutritional supplements, and more. And while these
approaches might improve performance acutely, they often lead to a degrada-





Body Composition

Figure I.2 Good nutrition resides in the intersection between health, performance, and body composition.

tion of health, something counterproductive to

long-term performance.
In the end, I hope you can see that a strict focus on
any one of the goals above, to the exclusion of the
others, can lead to problems. In other words, an
excessively single-minded focus on performance or
weight loss or health might, in some cases, actually produce negative, long-term consequences. And
its your job to prevent this type of coaching gone
bad. Your focus should be on a nutrition plan that
improves the way your clients look, improves the
way they feel, and improves the way they perform.
To ensure you stay on track, a host of metrics (questionnaires and assessments) are provided later on in
this manual. These metrics will help you keep an eye
on each of these three important variables, making
sure that each area is looked after properly.


While we know that good nutrition controls energy
balance, boosts nutrient intake, and targets health
goals, body composition goals, and performance
goals, we must also be honest about whether or not
it hits the mark. After all, how many times have you
heard the following:
I eat really well, but . . . Im still 20
pounds overweight.
My diet is perfect, but . . . I often feel
sluggish and have a low level of energy.
I make good nutritional choices, but . . .
Ive got high blood pressure, high cholesterol, and type II diabetes.

International Sports Sciences Association

Table I.2
Food Group Servings: Perceived, Average Daily Consumed, and Recommended by Age Group

Females 19-24
Females 25-50
Females 51+
Males 19-24
Males 25-50
Males 51+






Meat, etc.





































(fats, oils, sweets)

* Recommended servings based on energy RDA for gender/age groups.


Is it possible that someone can eat really well and

have a perfect diet yet be overweight, low in energy,
and have a host of lifestyle-related diseases? Sure, its
possible, but its not likely. In other words, most people who believe theyre doing a good job, yet dont
have the physique or the health profiles to show for
it, simply arent. They either have a good plan that
theyre not executing. Or their plan isnt very good.
Of course, as someone committed to finding limiting
factors and removing them, its your job to help your
clients improve both their plan and their execution.
So make sure that you help your clients remain honest and outcome-based in their approach.
Table I.2 is a great example of how, psychologically,

we can be dishonest with ourselves, whether we

intend to be so or not. In the table, a research study
is described in which researchers compared how
many servings of each of the major food groups
study participants thought they had eaten each day
(perceived) and how many servings of the major
food groups they actually ate (consumed). Notice
how people in every age group erroneously reported
their intake. Indeed, their perceptions did not always
reflect reality.
In reviewing these data, its clear that in all age categories, both men and women ate more grains, fats,
oils, and sweets than they thought they had eaten.
They also ate less fruits, veggies, milk, and meat than


they thought they had eaten. In other words, they ate more carbs, fat, and junk
food than they thought, while eating less protein, fruits, and vegetables than
they thought.
Now, I doubt these people were trying to be dishonest with their food records.
Rather, I believe this study points out a common phenomenon. People simply
dont have a good idea of what their dietary intake really looks like unless they
take the steps to record it accurately. And, for you, the personal trainer, this
points to an important lesson. If youre going to help a client improve their
nutrition, you have to provide them with the right tools that force them to be
accurate and honest in their nutritional assessment. (These tools will be provided in Section II).
In addition to honesty, good nutrition also requires results, plain and simple.
If one of your clients think hes doing a good job yet has no results to show for
his efforts, how effective is the job hes doing? Not very. And this is where we
see the significance of outcome-based nutrition. The effectiveness of a clients
nutrition plan is judged by evaluating what happens when your client follows
it. So, in an outcome-based world, theory is meaningless, and results are everything. Your client shouldnt believe hes doing a good job based on what he has
read in the papers, what he has read in magazines, what he has seen on TV,
etc. He can only judge his plan based on the results his diet consistently produces. To this end, good nutrition equals results.


Now that you know what good nutrition is, its important to also know that
youll likely be asked to help clients make nutritional changes. After all, as a
trainer, you occupy an important space within the health care industry and,
accordingly, have a large set of responsibilities.
For starters, youre likely the primary health, body composition, and performance access point for your clients. In other words, they may not regularly see a
physician or other health care provider to get information on these subjects.
Or, if they do, this health care provider may not be equipped to dispense practical advice for preventative health measures, body composition change, or performance improvement. As a result, your client will turn to you for answers in
each of these domains. If youre prepared for this, thats great. If not, your client
may seek help elsewhere, and both a client and an opportunity may be lost.
In addition, you may also become your clients social-support system. Many
new, or even long-term, clients wont have friends and family committed to
helping them improve their exercise and nutrition choices. In fact, those
around them may be either uninterested or antagonistic to their lifestyle
changes. And as a result, again, theyll be turning to you for support. Although
this places a large amount of responsibility on you to act as a trainer, an educator, and a friend/mentor, it also provides you with a real opportunity to help

social-support system: A
network of individuals that
provides positive feedback,
constructive criticism, and
encouragement toward our
lifestyle choices.


International Sports Sciences Association

your clients in a big way. In gaining a clients trust this way, the advice and
support you give can quite literally change their life. Here are two things that
will help you prepare for this responsibility:
1. Keep Up-To-Date. Its incumbent upon you as a trainer to be prepared for servicing your clients needs by keeping up-to-date on reliable information pertaining to exercise, nutrition, supplements, and
health in general. Of course, its impossible to have a high level of
specialty knowledge in each area. However, thats not required; a
working knowledge should be sufficient.

cross-referral system: A system in which two health and

fitness professionals actively
recommend each others synergistic services to their own
clients and patients. For example, a physician and a personal
trainer would have just cause
in setting up a cross-referral
system since each possesses an
exclusive knowledge set.

2. Establish a Network. Its important to establish relationships with

other health care professionals, such as registered dietitians, nurses,
physical therapists, chiropractors, and physicians. By networking and
creating a cross-referral system, youll not only be able to
expand your business network, youll have experts to turn to when
you dont know the answers to certain questions.


Trainers are often asked by their clients to talk about exercise, nutrition, supplements, and more, yet theyre often unsure of what they should and shouldnt talk about. As a qualified trainer, you likely possess a fundamental
knowledge of human anatomy and physiology. And given your choice of profession, youve likely committed yourself to doing what you can to help clients
improve their health, body composition, and performance. Your experience
tells you that nutrition and training go hand-in-hand and that results come
only when both are improved. So I have no doubt that you want to talk about
both areas with your clients. However, its possible that employers, dietitians,
and other health-care practitioners have discouraged you from discussing
nutrition as it relates to your clients goals. Perhaps youve even been told that
its illegal to talk about nutrition with clients. Well, thats not exactly the case.
Although each state and province in North America has different rules for dispensing nutrition advice, in most states its well within the scope of practice
for personal trainers who possess fundamental nutrition knowledge to address
questions and concerns their clients may have. Notice I emphasize the fundamental knowledge part. With specific training, such as that provided in this
course, youll possess that knowledge and be better able to discuss nutrition
with clients.

Medical Nutrition Therapy:

Nutritional advice with the
purpose of treating a variety of
conditions and illnesses.
Providing MNT is the exclusive
domain of trained and licenses
nutrition professionals.

Of course, it is true that the domain of the personal trainer is limited with
respect to nutrition. Technically, in many North American states and
provinces, anyone can make general nutritional suggestions. However offering
Medical Nutrition Therapy (i.e., prescribing nutrition for a variety of health
conditions and illnesses) is another story.
For example, certain states have statutes that include an explicitly defined
scope of practice. In these states, performance of the profession (Medical
Nutrition Therapy) is illegal without first obtaining the dietitian credential



Many states have regulations that govern nutritional counseling. Familiarize yourself with the statutes in your state.

and then applying for a license from the state. These

states include: Alabama, Alaska, Arkansas, California,
District of Columbia, Florida, Georgia, Idaho,
Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine,
Maryland, Massachusetts, Minnesota, Mississippi,
Montana, Nebraska, New Hampshire, New Mexico,
North Carolina, North Dakota, Ohio, Oklahoma,
Pennsylvania, Rhode Island, South Dakota,
Tennessee, Texas, and West Virginia.
It should be noted that in these states its perfectly
legal for you to make nutritional suggestions for
healthy, active individuals. Its also legal for anyone
to share nutrition education through materials that
originate from a public or well-know entity such as
the American Heart Association, the Centers for
Disease Control and Prevention, the American
College of Nutrition, the ISSA, etc. Its only illegal to
prescribe nutrition for medical conditions unless
youre a licensed dietitian.

Others states have statutes that limit the use of titles

such as licensed dietitian, certified dietitian, or
certified nutritionist. Yet these states do not necessarily limit the practice of making nutritional prescriptions. These states include: Connecticut,
Deleware, Hawaii, Indiana, Nevada, New York,
Oregon, Utah, Vermont, Virginia, Washington, and
Wisconsin. In these states the laws are more liberal,
allowing for those without dietetics licensure to
offer specific nutrition recommendations as long as
theyre certified in nutrition and registered with the
state as certified.
In analyzing these definitions, the differences
between general nutritional suggestions and
Medical Nutrition Therapy arent always apparent.
After all, whats the difference between a co-worker
giving some general tips on weight loss for cholesterol reduction and a personal trainer giving the
same tips in between sets of squats? And whats the


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difference between recommending certain breakfast
foods for general good health in a type II diabetic
and recommending the same breakfast foods for
controlling blood sugar? Well, in the case of gray
areas, the decision is made by the state, so its best to
check your states laws, rules, and regulations regarding nutritional recommendations.
Now, in plain language, Ill be completely candid
here. The likelihood of a trainers getting in trouble
for making general nutritional suggestions to otherwise healthy clients is low. And this is why the best
trainers, those with nutrition continuing education
credits such as those obtained in this course, often
make suggestions related to optimal rest, hydration,
and food intake. Such topics directly relate to gym
performance and usually include recommendations
for adequate sleep (7 to 9 hours per night), adequate
hydration (6 to 12, eight-ounce cups per day), preworkout nutrition (a light meal within an hour or so
of training), and post-workout nutrition (usually
some protein and carbohydrate nutrition). Further,
trainers often make suggestions to support in-thegym weight loss and muscle-gain efforts, providing
ideas or education on the following topics:
1. Calorie management strategies such as eating less, eating more filling foods, avoiding
calorie-dense drinks and snacks, etc.
2. Good food selection strategies such as
choosing whole grains over processed
carbs, choosing complete protein sources,
choosing water over pop, etc.
3. Good food timing strategies such as eating
in and around the workout, eating breakfast, not eating a large meal right before
bed, etc.
4. Suppplement suggestions/information such
as which vitamins, minerals, and other
essential nutrients (protein, fat, etc.) may
be useful
5. Healthy lifestyle choices such as meal
options for breakfast, lunch, and dinner,
alternative snack suggestions, and planning for upcoming social events

Again, in most cases giving general advice on these

topics is acceptable. However, its also important to
recognize that there are many nutritional issues that
fall outside the scope of practice. For example, giving
nutrition advice for health problems such as diabetes,
heart disease, liver dysfunction, kidney stones, etc., is
definitely the domain of registered dietitians and
medical practitioners, as is giving advice for eating
disorders such as anorexia and bulimia.
Giving this type of adviceagain, Medical Nutrition
Therapyis well beyond the scope of the personal
trainers practice (and likely expertise) and certainly
goes against the regulations of many states. This is
why every trainer should know when to refer, whom
to refer to, and how to refer. I suggest developing a
relationship with a qualified local nutrition partner
(a dietitian who is also certified in sport nutrition)
to refer clients to when necessary.
In the end, your level of nutritional discussion with
clients will likely be based on the following:
1. Your particular state or provinces
Most states do allow you to address client
questions and concerns with respect to
nutritional advice although different states
have different regulations.
2. Your clients likelihood of working
with both you and a nutritionist
If your client has the means to work with
both you and a dietitian also trained in
sports nutrition*, this is likely your best bet
as long as you trust the dietitians advice. If
not, you may want to talk about nutrition
with your clients as long as you stay within
your scope of practice.
3. Your clients health
If your client has health problems or specific nutrition-related diseases, its best to
refer them to a licensed dietitian also
trained in sports nutrition* as long as you
trust the dietitians advice. There should
never be a time when you, as a personal
trainer, offer Medical Nutrition Therapy.

* To find a Registered Dietitian in your area, visit www.eatright.org. To

find a Sports Dietitian in your area, visit www.scandpg.org. And to find
a Sports Specific Nutritionist, go to www.theissn.org.




Although most trainers that dispense nutrition suggestions do so in and
around workout sessions, this is never the ideal time to talk about nutrition.
Can you imagine trying to listen to, process, and absorb new information
before, during, or after a tough workout? This is definitely not the best learning environment, is it? Yet even good trainers often make the mistake of trying
to deliver important nutritional information in this context.
A better model for making nutritional suggestions is the one nutrition professionals use, the one youll learn more about in this course. This systematic
coaching process is all about talking nutrition when clients are most receptive
to learning, during separate nutrition sessions, which, of course, you can bill
for as if they were regular training sessions. Its during these sessions that the
client will be ready to share and receive nutritional information.

The 8 Steps to Effective Nutrition Coaching

Step 1: Prepare for the client
Step 2: Collect preliminary client information
Step 3: Evaluate client information and explain what it means
Step 4: Offer nutritional suggestions and provide nutrition plan
Step 5: Offer nutritional supplement suggestions
Step 6: Set behavior goals and create monitoring strategies
Step 7: Make nutritional adjustments based on client results
Step 8: Provide continuing education and support

The eight steps outlined above represent a logical system of interacting with
clientsfrom preparation for the first meeting to continuing education and
support. They help systematize the coaching process so that every client gets
the attention, education, and support they deserve. During this course youll
learn about each step and be provided with tools that ensure a successful
coaching environment.


So what can you hope to get out of this course? Well, first, the course is
designed to help you dispel common myths and fallacies associated with
nutrition. Its designed to prepare you for talking about nutrition with your
clients by establishing the knowledge base necessary make general nutritional
recommendations, recommendations that support healthy eating behaviors in


International Sports Sciences Association

your clients. Finally, it is designed to teach you the practical, step-by-step
approach sports nutritionists use to get optimal results.
To this end, in addition to a descriptive treatment of nutrition, well walk you
through the actual steps sports nutrition practitioners use to prepare for, evaluate, and make recommendations for clients. As you work your way through
the course, youll find that each step is accompanied by the sub-steps, descriptions, tables, and summary charts required to implement each step. And in the
end, you should walk away from this course with both a better understanding
of exercise nutrition and with a complete understanding of the tools used in
systematically delivering detailed nutritional recommendations.
It is important, though, to note that successful completion of the course examination will not qualify you as a registered dietitian, licensed dietitian, or
licensed nutritionist. (Each state has individual rules and regulations about
nutrition licensure; check with your particular state to ensure you are following legal protocol.) Nor will this course allow you to provide nutrition therapy. Instead, this course will provide you with continuing education in the field
of nutrition. It will enhance your credibility and your skill set. And it will help
you overcome the biggest limiting factor your clients face day-in and dayoutpoor nutrition.

Food for Thought

In my years of coaching clients, Ive had a host of
them enter my practice with diet experience. Some
have followed low-carb diets (similar to The Atkins Diet).
Others have followed low-fat diets (similar to the Ornish
Diet). And others have followed more balanced plans
(similar to the Zone Diet). Even more interestingly, I had
one client follow all three plans at one point or another
and, in conjunction with exercise, achieve similar weight
loss results with each of the three plans! Unfortunately,
despite the divergent diet philosophies and consistent
weight loss, his end result was always the same; he
regained the weight (and then some) before trying the
next diet.
So, weve got three wildly different plans and successful
weight loss with each one. Some would ask the question,
How can this be? I would ask the question, Are these
plans so different after all? You see, instead of focusing on
the differences between three strategies that achieve the



same result, I think its more important to focus on the similarities. Indeed, perhaps the differences arent all that
important, and the results lie in the similarities.
So, what are the similarities? Well, the biggest one, the reason why my client got results with a low carb diet, a low
fat diet, and a balanced macronutrient diet, is the fact that
all three plans forced him to follow the first rule of good
nutrition. All three plans, in conjunction with his exercise
plan, forced him to control his energy balance. You might
recall that it takes a negative energy balance to achieve
weight loss. And if someone achieves successful weight loss
with each of these plans discussed here, it must be due to
the negative energy balance, not the lack of carbs or the
reduction of fat or a specific macronutrient ratio. So how
do all three create a negative energy balance? Heres how:
1. The very process of following a weight loss plan
tends to reduce calorie intake, helping decrease
energy in and helping to shift the body toward a
more negative energy balance.
2. Exercise programs also help to contribute to the
negative energy balance by helping to increase
energy out.
3. The Atkins and Ornish plans require dieters to
restrict their intake of either dietary carbohydrate or
dietary fat. And the Zone plan requires creating specific ratios of these macronutrientsratios which
lead to eating less total food.
I hope its now evident why my client had weight-loss success with the Atkins, Ornish, and Zone plans. It was the
negative energy balance that led to his short-term results,
not some magical, mythical macronutrient mix. However,
its also important to remember that all three experiments
ultimately failed; this guy had rebound weight gain each
time. And this weight gain was a result of several nonfood-related limiting factors. After giving up, he got offtrack, stopped exercising, and started eating poorly again.
However, it wasnt the food that caused thisit was a host
of lifestyle problems that triggered the relapse. Indeed, it
was only when, working with my team, he addressed these
factors that he changed his fundamental habits, and he
lost his excess body fat for good.


International Sports Sciences Association


1. The best trainers are set apart by their unique ability to find
limiting factors in their clients progress and eliminate them.
2. Frequently, nutritional intake is the limiting factor for clients.
3. To help a client improve their nutrition, its important to
understand that good nutrition is based on: a) controlling
energy balance, b) improving nutrient density, c) finding the
intersection of good health, performance, and body composition, and c) honesty and outcome-based evaluation.
4. As a front-line health service provider, you may have to fulfill
many roles for your clients including the role of trainer, health
information provider, and social support network. With this
comes great responsibility but also a great opportunity to
change your clients lives.
5. The trainers scope of practice does not include dispensing
nutritional prescription, especially Medial Nutrition Therapy,
yet nearly all trainers are expected to help with their clients
eating plan. Its up to you and your State/Provincial regulatory
board to decide just how much information you can provide.
6. Trainers should establish partnerships with high-quality, local
nutrition partners (dietitians also certified in sport nutrition) to
refer clients to when necessary. Further, its essential to make
sure these partners follow a systematic nutrition approach,
such as the one outlined in this course.
7. When using nutrition technologies, a specific process should
be followed, one that is based on a logical workflow and timeline. This process will be taught in this course.
8. Upon completion of this course, you will not be a registered/licensed dietitian or nutritionist; but, you will be prepared to address many of the nutritional concerns your
healthy clients have.