L1 Resources – Chapter FAQs and Supplemental Reading

We provide the recommended “learning plan” in the first activity of each chapter. However the best way is the way that works best for you.

For most students, that means watching the video to get a feel for key concepts, studying the chapter, answering the study guide questions, completing the case studies, and taking the chapter exam.

Remember, you’re the boss. Just show up and do something. Use outcome-based decision making. And focus on the fundamentals of learning, not memorizing the text or feeling like you need to “know it all” right now.

The Review Checklist for each chapter is at the start of each chapter exam.

This checklist exercise will help you practice reviewing all your learning steps before taking the chapter exam, to ensure your greatest chance of success with each exam.

Yes.

Having “beginner’s mind” means that no matter what you already know, or how much experience you have, you “show up” with an open mind, pretending that you don’t know anything.

This kind of growth mindset is what allows you to learn, see connections between things, ask better questions, and gain deeper understanding.

You don’t have to know all the answers or solve all the problems yourself when working with clients for the first time. (Or, frankly, ever. We strongly recommend you try to keep “beginner’s mind” forever.)

Yes, we do. It’s an important part of your coaching growth.

This approach will allow you to use proven systems until you start to gain the confidence and experience to begin to modify those systems.

Then, as you begin to master the art of coaching, you can start to make your own recipes.

Scope of practice depends on your qualifications, the work you want to provide, and where you live and work.

For more on scope of practice in the United States, check out these resources:

• Center for Nutrition Advocacy
• State Matters, Eat Right
• Summary of State Statutes, Eat Right

When in doubt, ask a local lawyer who can provide you with guidance on the laws of your location.

Check out these resources:

• Academy of Nutrition and Dietetics (US)
• Sports, Cardiovascular, and Wellness Nutrition (US)
• PN Certified Professionals

Many. Here are a few good ones to get you started:

• How to Win Friends and Influence People
• Crucial Conversations
• Saying What’s Real: Seven Keys to Authentic Communication and Relationship Success
• Thanks for the Feedback: The Science and Art of Receiving Feedback Well

In our experience:

• 90% or more of your clients will be at Level 1.
• Fewer than 10% will be Level 2.
• Fewer than 1% will be Level 3, unless you coach in a niche that is specific to Level 2 or 3 populations (e.g. elite athletes, physique athletes).

Yes. It works.

Teaching about healthy food choices is a great start! And, at the same time, we have to help people do those choices consistently (plus, hopefully feel good about those choices). That’s where behavior change comes in.

In fact, in terms of improving our clients’ day-to-day habits, and helping them maintain those habits for life, the psychology of change is often more important than the food itself!

We coached over 100,000 clients, and incorporating more behavioral coaching techniques has transformed the outcomes of our clients, moving them from “just” superficial (and often short-lived) change to improving their long-term performance, physique, and “deep health”.

Good for you for knowing what your clients are seeking, and how they might be thinking about their goals.

The more you listen, assess, and try to understand your clients, the more you can speak to your clients’ needs, wants, and concerns in language and terms they can understand. And, the more effective you’ll be as a coach.

Of course, many people will have short-term goals that may not feel completely compatible with the bigger ideas of good nutrition (such as sustainability, or food quality). They may have deadlines (such as a wedding or competition), and not be particularly concerned about the finer points of “deep health”.

That’s OK. Because YOU can care, and YOU can work those elements into their nutritional programs anyway.

As a coach, you can:

• Talk to your clients about the trade-offs they’re willing to make in the service of their goals. (We recommend using the “Want, Willing, Won’t” or “Ready, Willing, Able” worksheets you’ll find in your Resource Center.) Explore with clients what might be involved in the short- and long term, given the choices they’re making.
• Suggest possibilities they hadn’t considered. Many clients aren’t aware that there are other options besides “quick fixes”.

When we encourage them to focus on the journey itself, there are no shortcuts.

Coaching people to deep health is about helping them in the short- AND long-term, with an emphasis on the long-term.

Short-term weight loss / gain solutions aren’t a problem. Most North Americans have mastered the yo-yo diet act. But long-term body composition solutions are difficult, and few people ever really have success here without quality coaching.

Yes, we truly believe in being a dietary or nutritional agnostic.

Consider the question — many people, with varying ways of eating, have asked it. They’ve all found great success with a specific way of eating. And yet, the styles have likely all been different.

This is because all quality dietary approaches share most of the same fundamental principles of health and good nutrition. Check out our article that dives deep into the topic: Paleo, vegan, intermittent fasting… Here’s how to choose the absolute best diet for you.

Well, the body is quite complex. Calories do matter.

However, there are many factors that come into play here, and we cover a lot of them in these articles: Calories in vs. out?, Can you gain weight from eating too little?, Can eating too little actually damage your metabolism?.

The good news is this: While the body is quite complex, we currently know enough about nutrition and human physiology to make food choices that lead to optimal health and body composition.

Don’t overcomplicate it.

Clinical research in controlled settings and our experience suggest that metabolic rate is often right where we would expect it to be for most people… but often, lower than we’d prefer for easily staying lean.

Modern life for most people doesn’t create a high metabolic demand (even for folks who eat a generally healthy diet and exercise a few times per week).

Most people:

• don’t have physically demanding jobs.
• live in climate-controlled environments.
• consume many processed foods that don’t require much effort to digest.
• don’t eat when physiologically hungry.
• don’t stop eating when physiologically satisfied.
• are on fad/restrictive diets.
• have disrupted sleep cycles due to stress and exposure to artificial light.
• are indoors rather than outdoors.
• use escalators and elevators instead of walking and climbing stairs.
• use body products (e.g., lotion, shampoo, etc) and OTC medications that contain ingredients that might have negative outcomes on regular body processes.
• experience regular loneliness and a lack of deep social ties.

And so forth….

We have constructed a modern lifestyle that involves a low metabolic demand. Obviously there are pros and cons to this new way of living.

We find that metabolic rate often gets back into more of an expected range after someone re-adjusts various components of how they live their life.

This can include:

• Doing physical activity every day (e.g., chores, walking, stairs, biking, exercise, sports, etc.)
• Regular sleep patterns with appropriate sleep hygiene.
• Eating in response to hunger/fullness cues and avoiding fad/restrictive diets.
• Choosing mostly minimally processed foods.
• Not relying on climate controlled environments, and letting the body adjust to warmer and colder temperatures.
• Getting involved in jobs, hobbies, or volunteer opportunities that are physical.
• Getting outside every day.
• Getting connected socially with family and friends.
• Limiting body products and OTC medications to minimal amounts and only when necessary.
• Choosing body products with less ingredients when possible.

The solutions to our metabolic problems don’t lie in a capsule or lab test, but rather, just creating a life that is more in balance overall.

So, is it possible to “break” your metabolism?

In our experience, some type of pathological physiological damage to metabolic rate is much less likely than simple behavioral or lifestyle changes that affect metabolic activity and energy flux.

In other words, when we improve our behaviors and lifestyle choices consistently, we often find that our body composition and health “magically” improve too.

No. Keep in mind what we said in the preface: Focus on major concepts instead of minor details.

And remember, your end-of-chapter exam is open book. Just like coaching people will be.

In real life you don’t have to memorize everything you’ve ever learned. You just need to know where to find the information you need when you need it.

Of course you are! Check out this video for an overview: Membranes & Transport: Crash Course.

Glucose-6-phosphatase (G6P) deficiency, or Type 1 Glycogen Storage Disease is a great example.

Note: This condition is genetic.

G6P is an enzyme necessary for breaking down glycogen to glucose. Without its activity, we lose our ability to properly regulate blood glucose.

If that happens, one can experience low blood sugar, hunger, fatigue, and even seizures.

Further, since the liver isn’t regularly breaking down glycogen, the liver can swell and even develop tumors.

For more, see here: Type 1 Glycogen Storage Disease

It’s estimated that 3-7% of children and about 2% of adults suffer from a food allergy.

It is also estimated that about 5-20% (some research even suggests possibly up to 75%) of people have some type of food intolerance.

Since food intolerances and sensitivities can happen through many physiological mechanisms, responding to many types of foods, and changing throughout the lifespan (for instance, as we age), you can expect that many of your clients will somehow be sensitive to at least one food or food type.

Not really. Pancreatic juice contains the digestive enzymes, as well as bicarbonate. It is not an enzyme itself.

Soluble fiber binds to bile salts in the GI tract, causing them to be excreted as part of our fecal matter, rather than being re-absorbed by the colon as they usually are.

Since blood cholesterol is needed to make bile, the body must pull more cholesterol out of our blood to make more bile to replace what was lost.

This then lowers the amount of cholesterol in our bloodstream.

The ATP-PCr system needs nutrients to be able to have PCr stores, so it definitely requires food and nutrients over the long term.

Without adequate intake, your PCr stores will be lower, reducing the effectiveness of your ATP-PCr system.

On an immediate level, no, nutrient intake is not really important for this system. The ATP-PCr system is only able to really operate, 10 seconds at most. So food doesn’t matter that quickly.

However, research suggests that ongoing, consistent creatine supplementation may provide greater levels of PCr over time, to allow the ATP-PCr system to last for a few extra seconds.

Well, there are many factors involved.

But here’s the main idea: No matter what, recently consumed nutrients floating around the bloodstream won’t fuel exercise for very long. This is why the body generally prefers to pull from stored nutrients.

Think of it like the “first in, first out” approach when stocking inventory. Same idea.

First, your working muscles will use the glycogen (carbs) and fat it has stored within them, because those fuels are immediately available.

Then, muscles will look for what’s floating around in the blood (it’s a little more complicated in that your muscle will be pulling in energy from your blood while using its stored energy).

If someone just ate carbohydrates, which broke down through digestion into simple sugars floating through the bloodstream, our bodies will use that sugar, because it’s immediately available.

If someone just ate fat, and have fatty acids floating through their bloodstream, they’ll use that instead — again, because it’s immediately available.

Now, beyond the very short term perspective, let’s say you’re working with an athlete who’s consistently consuming carbs, and refilling carb stores. The body adapts to this, and will start to do a better job burning carbs during exercise.

The same goes for fat. If someone is consistently consuming fats, and refilling fat stores, the body seems to do a better job burning fats during exercise.

The body adapts to what it’s given. People can train their body to prioritize different fuels.
Now, obviously this is hard to translate to the “real world” since most people are eating a mixed diet. But in a controlled lab setting, this is what you’ll see.

High sugar diets do increase fatty acid synthesis. A process known as de novo lipogenesis (the conversion of carbohydrate into fatty acids and then, if required, triglycerides for storage). This is most pronounced when fat intake is low (relatively speaking, <30% of kcal).

This is because de novo lipogenesis increases to meet the fatty acid demands of the body. But it doesn’t necessarily mean that we’ll store more fat in the long term.

This is an important point to keep in mind.

Increased fatty acid synthesis does not equal increased fat storage. It only increases fat storage if/when we’re consistently taking in more energy than we’re expending. Otherwise, the fatty acids oxidized equal or outweigh the fatty acids created/stored.

You could eat a very high sugar diet, greatly increase fatty acid synthesis, and still lose body fat if you eat fewer calories than you need, because fatty acid oxidation would outpace synthesis and storage.

Yes, check these videos:

Metabolism & Nutrition, Part 1
Cellular Respiration 1 – Overview
ATP & Respiration: Crash Course

Yes, check this out: Cellular Respiration 2 – Glycolysis

Yes, check this out: Cellular Respiration 3 – TCA Cycle (Krebs Cycle)

Yes, check this out: Cellular Respiration 4 – Beta-Oxidation

Yes, check this out: Cellular Respiration 5 – Oxidative Phosphorylation

Deamination and transamination are two separate processes.

Deamination is the removal of the amine group from an amino acid. This leaves just carbon and hydrogen, which can be converted into energy.

Transamination is the transfer of the amine group to a keto acid. The keto acid now becomes an amino acid, and the amino acid now becomes a keto acid.

Check out this series on food labeling: Food labels series

And these infographics on the problem with calorie counting:

• The surprising problem with calorie counting, part 1 [Infographic]
• The surprising problem with calorie counting, part 2 [Infographic]

Keep in mind that equations simply estimate, or guess at, energy requirements. The margin of error can be quite large based on various factors (some of these factors we know, some of them we don’t know).

So, be cautious with how much of this information you share with the people you coach. If you do show them how to use equations to calculate metabolic rate, explain that there’s a significant margin of error, and that any number you get is just a broad estimate, not a precise (or unchanging) target.

Calorie equations can sometimes squeeze out common sense, good judgement, and intuition.

Someone in an energy deficit (in other words, using more energy than they’re taking in through food) will use their protein differently than someone in calorie balance.

If someone is purposefully limiting their energy intake by eating less, not all protein consumed will be available for protein synthesis since some of it will be oxidized to meet energy needs. This means that if we’re eating less (for instance, to lose body fat) then we need to make sure our protein intake is sufficient.

About a day or two. The body responds rapidly to help ensure homeostasis.

But it really depends on the person. Some people (who tend to be hardgainers) will see a big change in RMR when overfed. People who gain weight easily will have a minimal change in RMR when overfed.

Kind of. 🙂

Humans do not defy the laws of thermodynamics. At the same time, energy out isn’t some static number. It’s affected by the foods you eat to provide that energy, along with other factors such as:

• Hormonal status (thyroid, sex hormones, even insulin)
• macronutrient profile (protein intake, fiber intake)
• micronutrient intake (nutrient deficiencies)
• phytonutrient (impacting cellular health, recovery)
• etc.

So over the long term eating 2000 kcal per day of candy is not equivalent to eating 2000 kcal per day of lean protein, vegetables, high-fiber carbohydrates, and healthy fats.

Over time, that second type of eating pattern will lead to better results because:

• those types of foods help us manage our hunger and fullness, eating the right amount for our bodies’ needs;
• it provides adequate protein for muscle retention, thermogenesis, satiety, and recovery;
• it provides more fiber, so more calories end up being excreted than absorbed.

This article explores the question further: Can eating too little actually damage your metabolism?

Well, there are many factors involved.

But here’s the main idea: No matter what, recently consumed nutrients floating around the bloodstream won’t fuel exercise for very long. This is why the body generally prefers to pull from stored nutrients.

Think of it like the “first in, first out” approach when stocking inventory. Same idea.

First, your working muscles will use the glycogen (carbs) and fat it has stored within them, because those fuels are immediately available.

Then, muscles will look for what’s floating around in the blood (it’s a little more complicated in that your muscle will be pulling in energy from your blood while using its stored energy).

If someone just ate carbohydrates, which broke down through digestion into simple sugars floating through the bloodstream, our bodies will use that sugar, because it’s immediately available

If someone just ate fat, and have fatty acids floating through their bloodstream, they’ll use that instead — again, because it’s immediately available.

Now, beyond the very short-term perspective, let’s say you’re working with an athlete who’s consistently consuming carbs, and refilling carb stores. The body adapts to this, and will start to do a better job burning carbs during exercise.

Same goes for fat. If someone is consistently consuming fats, and refilling fat stores, the body seems to do a better job burning fats during exercise.

The body adapts to what it’s given. People can train their body to prioritize different fuels.

Now, obviously this is hard to translate to the “real world” since most people are eating a mixed diet. But in a controlled lab setting, this is what you’ll see.

Yes, fructose can provide energy for everyday activity.

While the liver does prefer fructose to fill its own glycogen stores, it also converts most of the fructose to glucose. Much of this enters circulation and is oxidized or stored as glycogen in muscle tissue.

And on a separate note, the liver can and will use glucose to fill its glycogen stores too.

Great question. We actually wrote an entire article dedicated to this exact topic:
Carb controversy: Why low-carb diets have got it all wrong

In humans protein is rarely stored as fat. While possible, it is not at all common in otherwise healthy individuals. If excess protein and calories are consumed, then less of the fat you eat gets oxidized, and instead gets stored.

Fat is the easiest macronutrient to store since no conversion is needed. In most cases of a hypercaloric intake, it is the fat you eat that is stored as bodyfat, while the body oxidizes the excess protein and/or carbs you consumed.

If you consume excess protein but your overall calorie intake meets your needs, then no extra protein, carbs or fat will be stored as fat. Instead you will oxidize a bit more protein, and convert some of the extra protein to glucose and other things the body needs.

By consuming a few thumbs of each of the different types of fatty acids per day — saturated fatty acids (butter, coconut, dark chocolate, animal foods in general), monounsaturated fatty acids (nuts and nut butters, olives and olive oil, avocados and guacamole), and polyunsaturated fatty acids (flax and chia seeds, walnuts and pecans, fish and fish oil).

For many reasons. First, whole foods are composed of far more than just amino acids — they contain vitamins, minerals, fatty acids, zoochemicals, phytochemicals and more.

Second, they contain a far larger complement of amino acids, which are used for many other important functions than just muscle protein synthesis.

Third, it requires more than just protein or BCAAs to build muscle — you need to be consuming more calories than you need. And whole foods contain far more calories than BCAA supplements.

Newer research has found EAA and whey protein powder more effective for muscle protein synthesis:

BCAAs are falling out of favor in the strength/muscle/sport communities. (This is why PN has been recommending essential amino acids, whole protein supplements, or whole food proteins over BCAAs for a while now).

Consuming just BCAAs on their own without other EAAs, intact protein or other macronutrients, increases the stimulation of mTORC1 activity and myofibrillar-MPS following exercise in resistance-trained young men…

Yet BCAA ingestion alone does not maximally stimulate myofibrillar-MPS following exercise despite stimulation of translation initiation pathways.

The lack of sufficient EAA appears to limit the response of myofibrillar-MPS following exercise.

Thus, whereas our data clearly show that BCAA ingestion activates cell-signaling pathways that result in increased myofibrillar-MPS, ingestion of BCAAs alone may not be the optimal nutritional regimen to stimulate a maximal MPS response to resistance exercise training.

Yes, some of them. There are two types of cofactors:

• inorganic ions (e.g., zinc or copper ions); and
• organic molecules known as coenzymes. Most coenzymes are vitamins or are derived from vitamins.

So some cofactors are co-enzymes (organic molecules such as most vitamins or vitamin derviatives).

No, certainly not. You should pay attention to the key words and the chapter summary. And you should familiarize yourself with the vitamins and minerals.

But you don’t have to memorize this list in detail. Instead, simply try to become comfortable with each micronutrient, and use this section as a resource for people who present with deficiency or toxicity symptoms.

Probably not, assuming the people you work with are consuming a mixed and varied diet, with a nice blend of proteins, veggies, healthy fats, whole grains and other quality carbs.

Avoiding a food because of its anti-nutrient is missing the bigger picture — foods are a complex matrix of hundreds and thousands of compounds. And there are anti-nutrients in nearly every food.

For example:

• healthy foods such as spinach, Swiss chard, many berries and dark chocolate are sources of oxalates, an anti-nutrient that inhibits calcium absorption.
• Green tea and red wine contain tannins, another anti-nutrient that inhibits zinc and iron absorption.

In fact, many of these anti-nutrients may actually have health benefits.

For example tannins may have anticancer properties, and phytic acid may play a role in decreasing risk of cancer, diabetes and cardiovascular disease.

As with many things, these anti-nutrients may have a U-shaped curve of benefits (like most nutrients). Consuming a little to no consumption might be inconsequential, consuming some may be beneficial, and consuming a lot is harmful.

They are quite common, even in industrialized countries. Most research on the subject has found people to have at least one deficiency, some people have had more than a dozen deficiencies. Our How to fix a broken diet article covers this in detail.

About 30% of people are suspected to have insufficient iodine intake. This is mostly outside of North America. Still, data indicates that pregnant women in the U.S. are also at risk for being mildly iodine deficient.

This can be rectified by using iodized salt, taking a multivitamin with iodine, and/or consuming foods rich in iodine (sea vegetables, shellfish and other seafood that don’t contain contaminants, dairy, eggs, etc.).

In general, most people should consume a simple multivitamin / multimineral. Multivitamin / multiminerals can help make sure that people don’t have deficiencies of any essential nutrients.

However, a multi should likely not be used to treat a known deficiency — treatment should be prescribed by a physician. While multis are helpful, they should not replace food, since food contains countless beneficial compounds that a multi can never match. Check out Precision Nutritions’s recommended supplements for more.

Check this out: Fruits and vegetables. [Infographic]

Check this out: 10 ways to get the most nutrients from your food

Check out this template for “peak week” nutrition and training guidelines.

BIA tends to have a wide margin of error when it comes to measuring body fat levels. For better accuracy, rather than single frequency BIA (such as a scale that you stand on, which sends current only through your feet), we’d recommend:

• skinfolds
• Bod Pod
• DEXA
• underwater weighing, and/or
• ultrasound.

Multi-frequency BIA requires standardization between tests that include room temperature, placement of electrodes, preparation of the skin, and hydration status (which can be affected by factors such as sodium levels or menstrual cycle).

Try adding a half of a lemon. Or some cucumber water. Or green tea.

For clients who are transitioning away from soda, you might start with flavored low-calorie soda water as an intermediate step. (See the next point.)

Remember that with clients, we’re always looking to meet them where they’re at.

For clients who are transitioning away from soda, you might start with diet soda or flavored low-calorie soda waters as an intermediate step. Is it “ideal”? Probably not, but you have to start somewhere.

Over time, we can encourage our clients to choose a variety of options, including plain water.

If everything we eat and drink is sweet, then our taste buds become conditioned to expect sweetness all the time. This may mean clients avoid non-sweets, such as vegetables, or expect other foods to be sweeter than needed (e.g. coffee with lots of sugar, sweetened oatmeal, etc.).

So, help your clients:

• choose an increasingly wide range of foods;
• expand their repertoire of tastes and textures as much as possible; and, over time
• rely less on highly sweetened tastes.

Within the context of a varied and otherwise nutrient-rich diet, occasional artificial sweeteners for the clients who choose them aren’t that big a deal.

Level 2 and 3 clients may wish to transition away from artificial sweeteners completely… or, artificially sweetened waters may be one of the few sweet-tasting things that Level 2/3 clients enjoy within a fairly regimented dietary plan. As always, it depends.

Yes. Check out this infographic: Workout nutrition illustrated: What to eat before, during, and after exercise.

Yes, we have a great article that goes deeper into good and bad stress Good stress, bad stress: Finding your sweet spot

Here’s a great video series about stress and the physiological response to stress.

Here’s a great tutorial on the autonomic nervous system

While many people will benefit from going slow, others will want or even need to go faster.

There’s no “one size fits all” approach to coaching.

The first steps of building a coaching relationship are assessment and understanding. This will include learning more about your client’s needs, goals, readiness, and capacity for change.

You can learn more about your client by using the tools and worksheets we offer in this program. (And, of course, by asking good questions and listening carefully.)

See the “Assessment Forms & Coaching Resources” section of the Resource Center for more.

Yes. It works.

Teaching about healthy food choices is a great start! And, at the same time, we have to help people do those choices consistently (plus, hopefully feel good about those choices). That’s where behavior change (and specific techniques such as motivational interviewing) comes in.

In fact, in terms of improving our clients’ day-to-day habits, and helping them maintain those habits for life, the psychology of change is often more important than the food itself!

We’ve coached over 100,000 clients, and incorporating more behavioral coaching techniques has transformed the outcomes of our clients, moving them from “just” superficial (and often short-lived) changes to improving their long-term performance, physique, and “deep health”.

Just like your clients, do only one thing at a time.

Set aside a bit of time to go through the forms package slowly and carefully yourself, to see what’s available.

You’ll see that although there are many options and questionnaires available, you don’t have to use all of them, now or ever.

You may also find it helpful to annotate the forms, group them, or pull out the ones you like most so that you have them handy.

We suggest you start with the “PN Initial Assessment and Triage” form for new clients, and then use other worksheets or questionnaires only as needed, adding them one by one, slowly, over the course of your coaching relationship.

Check out the “Coaching Process Checklist” and “Form Flowchart” in the Assessment Forms & Coaching Resources section of the Resource Center for more guidance.

For now, please use the forms provided as is (i.e., with the PN logo) to handout.

When you graduate from this course, we’ll provide you with a way to swap your own logo in.

Yes, refer to the “Nutritional Level Assessment Worksheet” in the Assessment Forms & Coaching Resources section of the Resource Center

Yes, refer to the “Coaching Process Checklist” in the Assessment Forms & Coaching Resources section of the Resource Center for more guidance.

We suggest:

• Conscious Coaching by Brett Bartholomew
• Motivational Interviewing in Nutrition and Fitness by Dawn Clifford and Laura Curtis
• Crucial Conversations by Kerry Patterson, Joseph Grenny, Ron McMillan, and Al Switzler.
• Atomic Habits by James Clear
• Nudge: Improving Decisions about Health, Wealth, and Happiness by Richard H. Thaler and Cass Sunstein
• Thanks for the Feedback: The Science and Art of Receiving Feedback Well by Douglas Stone and Sheila Heen

Maybe. It’s hard to say. Have they been consistent with all of the foundational nutrition, exercise, and recovery habits? If so (and you know this for sure), then the medication could be altering how the body is able to mobilize fat stores (or something else related to food intake, hunger cues, etc.).

Here is a resource on the PN blog covering how some medications might influence the body: Prescriptions, fitness, & body fat

First, make sure you carefully measure, monitor, and assess your client’s nutrition, exercise, and recovery practices. If you’ve exhausted this with the client or patient, and you are still stumped, and suspect a medication might be playing a role, you could call, write, or email their physician and discuss your concerns about the medication.

Remember, medications are outside of your scope of practice, so, unless you are a licensed physician, don’t tell individuals they should/shouldn’t take a certain medication.

Each client is different. How often you meet or stay in touch will depend on your clients’ needs, goals, and preferences.

At first, you’ll probably find that it works best to meet in person, do a video call, or somehow connect with your client every 1-2 weeks.

Over time, you may want to meet less often, or connect differently (e.g. email check-ins rather than an in-person or video chat session).

As you go along, monitor the results you’re getting, and discuss contact / meeting frequency with your clients to ensure what you’re doing is working best for them.

Using body weight as a way to monitor or motivate can fail, especially in Level 1 clients, or anyone with a history of yo-yo dieting.

If the scale is higher, the client feels distress. Their anxiety about the higher number may lead to overeating. Or, the higher number might lead to restrictive eating and dieting, thereby setting the stage for the inevitable binge.

If the number is lower, the dietary deprivation can end, so it’s easy justification to eat. Time for a reward. Further, weight loss can stir up thoughts about losing more weight, leading to dietary restriction, and another binge.

Until someone has made a fundamental shift in their relationship with food, be careful with how you guide them in using the scale (or any other measure for that matter).

As you go along, monitor the results you’re getting, how your client is feeling, and discuss measurement methods with your clients to ensure what you’re doing is working best for them.

You may want to use non-weight-based modes of tracking, such as:

• how clothing fits
• how clients feel mentally and physically
• energy levels
• sleep quality and duration
• pain and/or mobility
• consistency and ease with dietary changes
• physical performance (e.g. getting stronger)
• etc.

In our experience:

• 90% or more of your clients will be at Level 1.
• Fewer than 10% will be at Level 2.
• Fewer than 1% will be at Level 3, unless you coach in a niche that’s specific to Level 2 or 3 populations (e.g. elite athletes, physique athletes).

It’s hard to say. You’ll have to use your professional judgement.

Food records help us improve our awareness as both coaches and clients. Instead of going through meals on autopilot, clients are asked to think, consciously observe, and potentially measure what they are eating.

This can be powerful at first (or at least on occasion). But if a person has repeatedly used food logs, and awareness isn’t an issue for them, it might not be that useful any longer.

Plus, it’s always important to consider how individuals use food records. Do they use it to record only “good” days so they can impress you with their choices? If so, that’s not useful over the long haul. You want to get an honest idea about what they are eating each day.

In our assessment forms package, we include several different types of food journals that go beyond the usual tracking, and look at aspects such as:

• hunger and fullness
• athletic performance and recovery
• potential food intolerances
• emotional eating

If a standard food journal doesn’t seem like a good fit for a specific client, but the client still wants to track something (or you think tracking would be useful, and the client agrees), consider using one of these other journals, which you can find in the Resource Center.

Hand portions are nearly as precise as weighing and measuring your food to track macros. In our experience, hand-size portions are about 95-100% as precise, while being much easier for clients to use consistently.

In other words, hand-size portions are simpler but nearly as accurate — a win-win for most clients.

As with all coaching tools and techniques, there’s no “one-size-fits-all”. Hand-size portions work for most clients who don’t need or want extra precision, and/or who can’t or won’t consistently measure their food.

However, for physique-oriented Level 2s, or folks who really enjoy and are empowered by the precision and tracking (e.g. number-oriented folks like accountants and engineers), weighing and measuring food to track macros is often the better option.

As always, find the option that your client would benefit from, enjoy following, and implement consistently to reach their goals.

And remember that for most Level 1 clients in particular, the long-term plan should lean towards building the skill of self-regulation (i.e. recognizing and properly responding to physiological hunger and fullness cues), and away from diligent food tracking of any kind.

Yes. Refer to the “Hand-Sized Portion Guide” in the Assessment Forms & Coaching Resources section of the Resource Center

Yes. It works.

Teaching about healthy food choices is a great start! And, at the same time, we have to help people do those choices consistently (plus, hopefully feel good about those choices). That’s where behavior change (and specific techniques such as motivational interviewing) comes in.

In fact, in terms of improving our clients’ day-to-day habits, and helping them maintain those habits for life, the psychology of change is often more important than the food itself!

We’ve coached over 100,000 clients, and incorporating more behavioral coaching techniques has transformed the outcomes of our clients, moving them from “just” superficial (and often short-lived) changes to improving their long-term performance, physique, and “deep health”.

In our experience, fewer than 10% of your clients will be at Level 2, unless you coach in a niche that is specific to that population (e.g. elite athletes).

It’s hard to say. You’ll have to use your professional judgement.

Food records help us improve our awareness as both coaches and clients. Instead of going through meals on autopilot, clients are asked to think, consciously observe, and potentially measure what they are eating.

This can be powerful at first (or at least on occasion). But if a person has repeatedly used food logs, and awareness isn’t an issue for them, it might not be that useful any longer.

Plus, it’s always important to consider how individuals use food records. Do they use it to record only “good” days so they can impress you with their choices? If so, that’s not useful over the long haul. You want to get an honest idea about what they are eating each day.

In our assessment forms package, we include several different types of food journals that go beyond the usual tracking, and look at aspects such as:

• hunger and fullness
• athletic performance and recovery
• potential food intolerances
• emotional eating

If a standard food journal doesn’t seem like a good fit for a specific client, but the client still wants to track something (or you think tracking would be useful, and the client agrees), consider using one of these other journals, which you can find in the Resource Center.

Remember, Level 2 clients are those who have mastered Level 1 strategies, have progressed as far as they can, need a bit more individualization, and are emotionally mature enough to try more advanced strategies.

You can find it here.

You can find it here.

There is no best way. The calorie calculation model of our Weight Loss Calculator or Nutrition Calculator is more accurate than the Daily Calorie estimator in Table 17.5. However, they are both providing an educated starting point. From there you would help your client make adjustments to their intake using outcome-based decision making.

You can find the list of “Precision Nutrition Approved” supplements here.

Hand portions are nearly as precise as weighing and measuring your food to track macros. In our experience, hand-size portions are about 95-100% as precise, while being much easier for clients to use consistently.

In other words, hand-size portions are simpler but nearly as accurate — a win-win for most clients.

As with all coaching tools and techniques, there’s no “one-size-fits-all”. Hand-size portions work for most clients who don’t need or want extra precision, and/or who can’t or won’t consistently measure their food.

However, for physique-oriented Level 2s, or folks who really enjoy and are empowered by the precision and tracking (e.g. number-oriented folks like accountants and engineers), weighing and measuring food to track macros is often the better option.

As always, find the option that your client would benefit from, enjoy following, and implement consistently to reach their goals.

In our experience, fewer than 1% of your clients will be at Level 3, unless you coach in a niche that is specific to that population (e.g. physique athletes).

You can find it here.

You can find it here.

There is no single best way. The calorie calculation model of our Weight Loss Calculator or Nutrition Calculator is more accurate than the Daily Calorie estimator in Table 17.5. However, they are both providing an educated starting point. From there you would help your client make adjustments to their intake using outcome-based decision making.

You can find the list of “Precision Nutrition Approved” supplements here.

Here is a step-by-step guide on how to calculate calories, macronutrients during cycling for fat loss (Option 3 from pages 171-172 using the example given).

Our sample client has a total body weight (in pounds) of 125 lb.

Step 1: Calculate calories
i) Menu 1 Baseline: Multiply body weight (in pounds) by the factor 8 (page 172 first sentence). e.g, for someone who is 125 lb their calorie estimate is: 125 lb x 8 = 1000 kcal

ii) Menu 2 Higher carbohydrate: Multiply body weight (in pounds) by the factor 10 (page 172 first sentence) e.g, for someone who is 125 lb their calorie estimate is: 125 lb x 10 = 1250 kcal

iii) Menu 3 Higher carbs and calorie & Menu 4 Higher calorie: Multiply body weight (in pounds) by the factor 12 (page 172 first sentence – should be 8-12 kcal/lb). e.g, for someone who is 125 lb their calorie estimate is: 125 lb x 12 = 1500 kcal

Step 2: Macro breakdown for Baseline
i) Protein intake between 1.35 and 1.5 grams of protein per pound of body weight.

In this example, 1.35 g / lb body weight.

So, 1.35g/ lb x 125 lb = 168.75 grams of protein per day. We rounded this to 170 grams for easier math.

Or, in terms of calories = 170 g x 4 kcal / g = 680 kcal.

ii) Carbohydrates: Very low carb-diets should have carbs between 10-15% of intake (page 170).

So, calories from carbs = Total calories x 10-15% = 1000 kcal x 10% = 1000 kcal x 0.10 = 100 kcal = 1000 kcal x 15% = 1000 kcal x 0.15 = 150 kcal

This gives us a daily range of 100 to 150 kcal of carbohydrates per day.

In terms of grams of carbohydrates:

• 100 kcals of carbs / 4 g per kcal = 25 grams
• 150 kcals of carbs / 4 g per kcal = 37.5 grams.

This gives us a daily range of 25-37.5 grams of carbohydrates per day.

In our example we chose 25 g of carbs, which = 100 kcal

iii) Fats:

Calories from fat = Baseline calories per day (from Step 1 part A) – Calories from protein (from Step 2 part A) – Calories from carbs (from Step 2 part B).

In our example:

• Calories from fat = Baseline calories per day – Calories from protein – Calories from carbs
• 1000 kcal – 680 kcal – 100 kcal = 220 kcal Convert to grams = 220 kcal / 9 kcal per gram of fat = 24.44 g or rounded to 25 g for simpler math

Step 3: Macro breakdown for Menu 2 – Higher carbohydrate
Only calories and carbs go up. Protein and fat stay the same as baseline.

Add the additional calories for the day by adding carbs.

So in our example:

• Menu 2 = 1250 kcal, which is 250 kcal above baseline from Step 1 part A (1250 kcal – 1000 kcal).
• Convert to grams = 250 kcal / 4 g/kcal = 62.5 g.

Remember you already had carbs in the baseline menu 1, so the total carbs for the day are 25 g of carbs (from Menu 1) plus 62.5 g.

Total carbs for menu 2 are 90 g (rounded up from 87.5 g, but you could round up to 88 g, since a gram or two isn’t going to matter).

Step 4: Macro breakdown for Menu 3 – Higher carb and calorie
Protein stays the same as baseline. Calories, carbs, and fat go up.

So, we have already calculated calories above (Step 1 part C) as 1500 kcal.

i) Carbs: 30-35% of daily calories, or in terms of calories = 1500 kcal x 30-35% = 450 to 525 kcal or in terms of grams = 450 to 525 kcal / 4 kcal per gram = 113 to 131 g In our example: 120 grams of carbs or 480 kcal

ii) Fats: Calories from Fat = Menu 3 Calories per day (from Step 1 part C) – Calories from Protein (from Step 2 part A) – Calories from Carbs (from Step 4 part A). Calories from fat = 1500 kcal – 680 kcal – 480 kcal = 340 kcal Convert to grams = 37.8 grams (rounded up to 40 grams for ease).

Step 5: Macro breakdown fro Menu 4 – Higher Calorie
Protein and carbs stay the same as baseline. Calories and fat go up.

So, we have already calculated calories above (Step 1 part C) as 1500 kcal.

Menu 4 = 1500 kcal, which is 500 kcal above baseline from Step 1 part A (1500 kcal – 1000 kcal).

So we need to add 500 kcal of fat.

Convert to grams = 500 kcal / 9 g/kcal = 55.5 g of fat

Remember you already had fat in the baseline Menu 1, so that means the total fat for the day is 25 g of fat (from Menu 1) plus 55.5 g

Total fat for menu 4 is 80 g (rounded down from 80.5 g, but you could round up to 81 g, one gram isn’t going to matter).

While there aren’t statistics on disordered eating (which covers a wide range of eating behaviors that negatively impact deep health in some way), there are statistics on diagnosable eating disorders (which cover a much more narrow range of dysregulated eating behaviors).

Diagnosed eating disorders are considered a mental illness marked by an obsession with food and/or body shape, usually combined with one or more of:

• restriction and/or rigid control of food;
• repeated over-eating and/or binge eating (a loss of control over eating);
• compensation and/or purging (e.g. laxatives, vomiting, excessive exercise); and/or
• persistent and compulsive urges to engage in these behaviors despite harm.

In the US alone at least 30 million people of all ages and genders suffer from an eating disorder. And eating disorders have the highest mortality rate of any mental illness.

In our experience with over 100,000 clients, disordered eating affects a majority of people in some way. Disordered eating is a complicated, multi-faceted biopsychosocial challenge with many interlocking causes and social, familial, and genetic links.

However, bear in mind that the type of rigid and restrictive eating that is required for Level 3 clients may actively contribute to long-term disordered eating pattens. Refer to Chapter 19 in your text for more guidance on coaching clients through disordered eating, or referring out to a specialist as appropriate (especially for diagnosed eating disorders).

Diagnosed eating disorders are considered a mental illness marked by an obsession with food and/or body shape, usually combined with one or more of:

• restriction and/or rigid control of food;
• repeated over-eating and/or binge eating (a loss of control over eating);
• compensation and/or purging (e.g. laxatives, vomiting, excessive exercise); and/or
• persistent and compulsive urges to engage in these behaviors despite harm.

In the US alone at least 30 million people of all ages and genders suffer from an eating disorder. And eating disorders have the highest mortality rate of any mental illness.

In our experience with over 100,000 clients, disordered eating affects a majority of people in some way. Disordered eating is a complicated, multi-faceted biopsychosocial challenge with many interlocking causes and social, familial, and genetic links.

However, bear in mind that the type of rigid and restrictive eating that is required for Level 3 clients may actively contribute to long-term disordered eating pattens. Refer to Chapter 19 in your text for more guidance on coaching clients through disordered eating, or referring out to a specialist as appropriate (especially for diagnosed eating disorders).

Check this out: Becoming a vegetarian without giving up meat.

Yes, please see the “Yale Food Addiction Scale” in the Assessment Forms & Coaching Resources section of the Resource Center.

We have some articles on the blog that address these exact topics: Exercise when sick and Eating when sick.

And here are the corresponding infographics: Should you exercise when sick [Infographic] and What should you eat when sick [Infographic]

Yes, check out: Living well with fibromyalgia.

UNITED STATES
Registered dietitians: www.eatright.org
Registered dietitians with sports focus: www.scandpg.org
Sports specific nutritionists: www.theissn.org

CANADA
Registered dietitians: www.dietitians.ca/Your-Health/Find-a-Dietitian.aspx

UK
Registered dietitians: https://www.bda.uk.com/improvinghealth/yourhealth/finddietitian

AUSTRALIA
Registered dietitians: https://daa.asn.au/for-the-public/find-an-apd/

WORLDWIDE
To search for fellow PN Certified Professionals all over the world, go to www.precisionnutrition.com/directory

Yes, first check out the Bonus reading for this chapter.

Then consider:

• The Appetite Awareness Workbook by Linda Craighead
• Intuitive Eating by Elyse Resch and Evelyn Tribole
• Eat what you love, love what you eat by Michelle May
• Secrets from the Eating Lab by Traci Mann
• Why Me Want Eat by Krista Scott-Dixon
• The Hungry Brain by Stephan Guyenet
• The End of Overeating by David Kessler

Then consider:

• Change Maker: Turn Your Passion for Health and Fitness into a Powerful Purpose and a Wildly Successful Career by John Berardi
• The Business and Practice of Coaching by Wendy Allen and Lynn Grodzki
• Never Eat Alone by Keith Ferrazzi
• The Wealthy Fit Pros Guide to Starting Your Career by Jon Goodman

This will be different based on where you live. We have dietitians on the PN staff in the United States who use Pro Liability. We have no financial ties to this company. It’s just one we’ve used.

Another company to consider is Stevenson & Hunt.

We are constantly updating and adjusting our thinking related to nutrition and coaching. It’s a never-ending process… an an essential one. If you are on our email list, you’ll always be notified when we have updated materials and blogs.