ACE 6th Edition Chapter 6: Nutrition for Health and Fitness

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Chapter Goals:

• Know the scope of practice for personal trainers in relation to the realm of nutrition.
• Be able to discuss the dietary guidelines for Americans and other patterns of evidence based eating.
• Know the makeup for nutrition labels and be able to find the main categories on the labels. 
• Outline the practical strategies within a trainer’s scope of practice to improve the client’s food literacy. 
• Be able to discuss the proper strategies for fueling and hydration before, during, and after exercise. 
• Talk about nutritional supplementation with clients while keeping within the scope of practice.

Introduction

Trainers will enjoy helping clients with not just exercise but also adopting healthy nutrition habits. 

But with this comes some strict dos and don’ts for the scope of practice for ACE certified personal trainers. 

The trainers should be sure to incorporate the talk of nutrition into their sessions while still abiding by the scope of practice and ACE guidelines. 

ACE Position Statement on Nutrition Scope of Practice for Personal Trainers

Ace declares that their trainers should do their best to share nonmedical nutrition information with their clients, as it is an important part of changing clients. 

The current climate for people shows an epidemic of obesity, lacking nutritional levels, and overall inactivity. Put all of this with the multibillion dollar dieting industry and strong general public interest in improvements for their eating habits and physical activity changes, and we as trainers are well positioned to affect our clients’ journey. 

The ultimate position for the trainer in the realm of nutrition is decided by the policies and regulations of the state or states that they operate in their education and experience with nutrition and the skills and competencies they’ve accumulated. 

The trainers should be ready and able to discuss the following topics to stay within their scope of practice:

• The principles of healthy nutrition and preparation of meals.
• Foods that should be included in a balanced and healthy diet.
• The essential nutrients that the body needs. 
• The actions of nutrients when they are in the body.
• Effects of deficiencies or excess amounts of nutrients. 
• How the requirements for nutrients will vary throughout your life.
• The principles of nutrition and hydration when looking at before, during, and after a workout. 
• Information about the nutrients that are within foods or supplements. 

The trainers that are not completely comfortable with sharing and giving out the information above should ensure that they continue their education and work on developing competency in the realm of nutrition. 

It could be good to develop relationships with registered dieticians. This will give you someone to refer your clients to for information you can’t give or for the information you can give but aren’t informed on. 

Some ACE personal trainers wish to expand the nutrition part of their job with added certifications and things so that they can give you the information that you need. This is important as physical activity and nutrition subjects will often be together. 

The actions regarding nutrition that we consider outside of the scope of practice and see often are:

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• Giving personalized nutrition recommendations and planning meals outside of what is already available for people within the government guidelines and recommendations. 
• Nutritional assessments for determining the needs or nutritional status of clients. 
• Specific programming for nutrient or nutritional intakes, caloric intake, or specialty diets. 
• Nutritional counseling, education, or advice that is aimed at preventing, treating, or curing diseases or conditions. Or really anything in the realm of medical nutrition therapy.
• The development, administration, evaluation, and consultation of the nutrition care standards or the nutritional care process.
• Anything like recommending, selling, or supplying supplements for clients. 
• Promoting or identifying yourself as a nutritionist or a dietician. 

Engaging in these activities will put the client’s health and safety at risk and expose the trainer to litigation and disciplinary action. It is important for trainers to stay current on the legal and regulatory issues regarding the use of supplements and their ingredients. 

Another important thing for trainers to receive is insurance if these legal actions are taken against the trainer. We will discuss this in the last chapter of the book. 

Dietary Reference Intake and Acceptable Macronutrient Distribution Ranges

Dietary reference intake is a generic term we use for four types of reference values:

• The RDA or recommended dietary allowance is the level of intake of nutrients that is adequate enough to meet the needs of almost all healthy people in a population. This is about 97 – 98 percent of people generally. 
• The estimated Average Requirement is also the EAR. This amount is adequate enough to meet the needs of 50% of all people within age and sex specific groups. If someone’s intake is lower than the EAR, they are likely not getting enough of that nutrient. 
• The UL, or the tolerable upper intake level, is the maximal intake that is not likely to have any risk of adverse health effects with it for most people in age and sex specific groups. If someone takes in over this amount, they will likely form negative effects. 
• The AI or adequate intake is the recommended intake of a nutrient that is based on research to be sufficient for good health. This is used when the EAR is unable to be determined. 

Along with the dietary reference intakes, we have established ranges in the form of macronutrient distribution ranges.

These AMDRs represent the percentages of calories that need to come from carbs, protein, and fats for optimal health and reducing chronic disease risks. 

It is important to go over the table in this chapter that goes over the macronutrients and breaks them into subcategories. 

Dietary Guidelines

Every 5 years, a panel of experts from many fields will go through and update the dietary guidelines and review a lot of scientific literature and a series of meetings over the years. 

The dietary guidelines to emphasize our diet have been narrowed down to 5 key guidelines.

Key Guideline 1: Follow a Healthy Eating Pattern Across the Lifespan

All of the choices made in food and beverages matter. Choosing a healthy eating pattern at the right caloric level will help to achieve and keep healthy body weight, support adequate nutrients, and reduce the risks for chronic disease. 

The main parts of a healthy pattern of eating are:

• Variety the vegetables and ensure you get some from each of the five subgroups of dark green, red, and orange, legumes, starches, and others. 
• Fruit items
• Grains, primarily whole grains.
• Fat free and low fat dairy like milk, yogurt, cheese, and fortified soy products. 
• A variety of foods that are rich in protein, like seafood, lean meats and poultry, eggs, legumes, nuts, seeds, and soy products. 
• Limited amounts of saturated fats, trans fats, added sugars, and alcohol.

To teach this well to the clients and give them a tool to utilize, we recommend the MyPlate Food Plan, which is from the USDA and is the recommended way for Americans to eat. This tool breaks down the plate into sections based on how much each food group you should get. This includes proteins, fruits, grains, vegetables, and dairy. 

The recommended number of servings per day is also found here. 

The NIH body weight planner is another thing to utilize when someone is trying to decrease their weight by use of a calorie deficit and tracking those calories. There are around 3,500 calories in one pound of fat, and the recommendation is for there to be a deficit of 500 – 1,000 calories through the decrease in food and the increase in physical activity. This 500 – 1,000 calorie deficit means that you would lose 1 – 2 pounds per week. 

Key Guideline 2: Focus on Variety, Nutrient Density, and Amount

To meet the needs for nutrients and stay within the limits of calories, the goal is to really get nutrient dense foods in all of the recommended food groups in the appropriate amount. 

We put vegetables into 5 categories, and then we want to ensure we receive the nutrients from each of those groups in varied amounts. Skipping out on one could lead to a deficiency. 

Whole and not frozen fruits are better at providing the appropriate nutrients. The goal should be to receive whole fruits, not juices or frozen variants. 

Grains, and more specifically whole grains, are needed from sources like bread, cereals, crackers, and pasta. Grains that are refined are less beneficial than the ones that are whole. 

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Dairy products stay high in some important minerals and vitamins that we don’t find in many other foods. They are not necessary to be healthy, but they do contain many things in high amounts that make reaching the nutrient goals easier. 

Protein foods will include many sources varying from plant to animal and one main thing to consider is the need for seafood due to the body being unable to make omega 3 fatty acids on its own. 

Oils are important. These are fats that have a high amount of monounsaturated and polyunsaturated fats. These are needed for the intake and absorption of certain vitamins. 

Key Guideline 3: Limit Calories from Added Sugars and Saturated Fats and Reduce Sodium Intake

It is important to take in low eating patterns in these three things. They are also three things increasing very quickly in the foods we eat daily. 

The added sugars add to the calories in foods and beverages, and they can come in many forms. Any added sugars we do not burn will turn to fat and store it in the body. 

The most common added sugar foods are sugar beverages, snacks, and sweets. 

The type of fatty acid consumed will have a greater role in health than the amount of actual fat consumed. This high intake of saturated fats will likely increase the levels of LDLs in the body. This is the bad cholesterol and leads to poor health. 

Trans fats are going naturally occurring in meat and dairy products, but the largest amount is going to come from the processed foods. 

Sodium increases with foods as we need to store foods for longer times, which helps with that. Sodium has a role in a person’s blood pressure, so high amounts of sodium usually see people having blood pressure problems. 

Key Guideline 4: Shift to Healthier Food and Beverage Choices

Choose foods that are nutrient dense and beverages across and in all of the food groups in place of less healthy choices. The overall general advice Americans should take to shift their eating pattern is to consume more veggies, fruits, whole grains, and dairy, increase the protein variety, exchange solid fats for oils, and reduce the added sugars, saturated fats, and sodium intake. 

Some examples of things to help implement this are:

• Shift from high-calorie snacks to more nutrient-dense snacks like veggies or fruits.
• Shift from fruits that have sugar added to fruits that are whole.
• Shift from refined grains to whole grains.
• Shift from snacks high in sodium to unsalted ones. 
• Shift from beverages with added sugars to beverages without sugar. 

Key Guideline 5: Support Healthy Eating Patterns for All

Everyone has a role in helping to create and support healthy eating patterns in multiple settings worldwide, from the school to home and to communities. 

Personal trainers can look eat the categories of Food Access, Household food insecurity, and Acculturation to help clients learn about foods. 

We should look at all the locations we go to throughout our days and try to change certain things about them or look for help specific to those locations. 

Food Labels

For people to make healthy decisions, they have first to be able to understand the nutrients that contribute to a diet that is healthy and to know the foods that have those nutrients. 

While many diets are healthy and only use whole and unprocessed foods, many refined and processed foods are still good to consume for a healthy diet. 

There are many health claims to know and go through on the website provided in the text. 

Nutrition Label Parts

• Serving size: is the number of servings within the package and the amount a person usually consumes in one sitting. 
• Calories – this is the number of calories from fat, protein, and carbs. 
• Total Fat – this is the most calories dense macronutrient and it’s important to know how much of the food is made up of it. 
• Saturated Fat is a part of the total fat and plays a role in the rise in blood cholesterol and the risk for heart disease. 
• Trans Fats – this is like saturated fats, but they are actually considered to be worse and people should be aware of their levels in food. 
• Cholesterol – many foods with high cholesterol levels are also high in the saturated fats. 
• Sodium – this again, has a high relation with blood pressure levels and some people really need to control their intake of this nutrient. 
• Total Carbohydrate – these are the main energy source for humans and we have them in many of the foods we eat. 
• Dietary Fiber – there are two kinds included here. The first is soluble and the other is the insoluble fiber. 
• Sugars – This is major as it is a major source of energy and calories in general, so people should watch this one close. 
• Protein – possibly the most valuable source of calories, and 10 – 35% of total daily calories. 
• Vitamins and Minerals – the goal here is going to be to get 100% of the recommendations on each one for every day. 

Practical Consideration for Personal Trainers

Much of the talk around nutrition relates to the individual ingredients or a proportion of calories from specific macronutrients. There is an increasing movement toward whole foods being the main food source. 

In some ways, trainers can work with their clients and guide them to further their support and their client’s knowledge. 

One way is to provide grocery store tours with your client or multiple clients. Grocery shopping can be overwhelming and confusing for many people, so it helps if the trainer is willing to walk through the store and show them what they should think about in person when they go on their own. 

Collaborating with registered dieticians is a way to not only have someone more knowledgeable to refer clients to but also someone you can learn from and enhance your ability to answer the questions your clients bring up. 

Fueling Before, During, and After Exercise

The main goal of fueling before exercise is to do two things: optimize the availability of glucose and stores of glycogen in the body and then provide the fuel needed to support your performance during the exercise. For the more serious athletes that need larger stores for an endurance event, the pre-exercise fueling should start a week before the event. In these times, people will go through the process of carbohydrate loading to enhance the body’s ability to perform. 

During exercise, the goal will be to provide the body with the essential nutrients needed by the muscle cells and keep the blood glucose levels at the appropriate point. 

Post-exercise aims to replenish the glycogen stores in the body and facilitate the best form of muscle repair. 

Fluid and Hydration Before, During, and After Exercise

Maintaining the right fluid balance where the percent of weight lost during exercise is no more than 2% is ideal for us to try to do. 

Drinking too few amounts of liquid will lead to dehydration, and drinking too many liquids will lead to hyponatremia if it is too much of just plain water. 

The goal should also be to replace the lost electrolytes so that exercise continues. 

One of the main things to consider during exercise is replacing the fluid you lose at a ratio of 1:1.

Sports drinks should be utilized when we are working out for over an hour and need to replace some energy and electrolytes that are lost. 

And then when we look at fluid replacement after exercise, where the main goal is going to be like with the food. We want to replace all of the lost fluid back to pre-exercise levels.