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800.892.4772 • Nutrition : The Complete Guide Second Edition International Sports Sciences Association

Nutrition: The Complete Guide

Second Edition

International Sports Sciences Association CERTIFICATION COURSES

John Berardi, PhD, CSCS Ryan Andrews, MS, MA, RD Brian St. Pierre, MS, RD, CSCS Krista Scott-Dixon, PhD Helen Kollias, PhD, CSCS Camille DePutter

John Berardi, PhD, CSCS Ryan Andrews, MS, MA, RD Brian St. Pierre, MS, RD, CSCS
John Berardi, PhD, CSCS
Ryan Andrews, MS, MA, RD
Brian St. Pierre, MS, RD, CSCS
Krista Scott-Dixon, PhD
Helen Kollias, PhD, CSCS
Camille DePutter
The Complete Guide
Nutrition: The Complete Guide (Edition 2) Official course text for: International Sports Sciences Association’s

Nutrition: The Complete Guide (Edition 2)

Official course text for: International Sports Sciences Association’s Certified Nutrition Specialist program

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Copyright © 2018 International Sports Sciences Association.

Published by the International Sports Sciences Association, Carpinteria, CA 93013.

All rights reserved. No part of this work may be reproduced or transmitted in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including xerography, photocopying, and recording, or in any information storage and retrieval system without the written permission of the publisher.

Direct copyright, permissions, reproduction, and publishing inquiries to:

International Sports Sciences Association, 1015 Mark Avenue, Carpinteria, CA 93013 1.800.892.4772 • 1.805.745.8111 (international)


This text is informational only. The data and information contained herein are based upon information from various published and unpublished sources that represents training, health, and nutrition literature and practice summarized by the author and publisher. The publisher of this text makes no warranties, expressed or implied, regarding the currency, completeness, or scientific accuracy of this information, nor does it warrant the fitness of the information for any particular purpose. The information is not intended for use in connection with the sale of any product. Any claims or presentations regarding any specific products or brand names are strictly the responsibility of the product owners or manufacturers. This summary of information from unpublished sources, books, research journals, and articles is not intended to replace the advice or attention of health care professionals. It is not intended to direct their behavior or replace their independent professional judgment. If you have a problem or concern with your health, or before you embark on any health, fitness, or sports training programs, seek clearance and guidance from a qualified health care professional.

About the Authors | iii

About the Authors

Dr. Berardi has been recognized as one of the top exercise nutrition experts in the world. He earned a PhD in Exercise Physiology and Nutrient Biochemistry at the University of Western Ontario, Canada. His work has been published in numerous textbooks, peer-reviewed academic journals, and countless popular exercise and nu- trition books and magazines.

As an elite nutrition coach and exercise physiologist, Dr. Berardi has worked with over 50,000 clients in over 100 countries, including Olympic gold medalists, world champion UFC fighters, and professional sports teams. He is also an advisor to Apple, Equinox, Nike, and Titleist.

He is also an advisor to Apple, Equinox, Nike, and Titleist. Dr. Berardi was recently selected

Dr. Berardi was recently selected as one of the 20 smartest coaches in the world and one of the 100 most influential people in fitness.

With a PhD from York University in Toronto and 10 years of university teaching, Krista Scott-Dixon has over 20 years of experience in research, adult education, cur- riculum design, and coaching and counseling. In addition, she has spent over 20 years pursuing self-education in health and fitness.

Through writing, coaching, speaking, teaching, and curriculum development, Krista has galvanized thousands of clients to transform their health and fitness for the better, and is guiding a new generation of fitness professionals to a higher level of success and satisfaction.

professionals to a higher level of success and satisfaction. Krista is the author of several books,

Krista is the author of several books, dozens of popular articles, and many academic publications. She also inspires readers at her groundbreaking women’s weight training website,

Ryan Andrews is a world-leading educator in the fields of exercise science and nutrition.

Ryan is a Registered Dietitian with two master’s degrees. He completed his education

in exercise and nutrition at the University of Northern Colorado, Kent State Universi-

ty, and Johns Hopkins Medicine.

A highly respected coach who has been a part of the Precision Nutrition team since

2007, Ryan’s body of work includes an impressive number of articles, presentations, books, and certification manuals on the topics of eating, exercise and health.

manuals on the topics of eating, exercise and health. A nationally ranked competitive bodybuilder from 1996-2001,

A nationally ranked competitive bodybuilder from 1996-2001, and now a certified

yoga instructor, Ryan is also an active volunteer with non-profit organizations to help promote a sustainable future.

iv |

iv | Brian St. Pierre is a renowned expert in performance nutrition. Brian is a Registered

Brian St. Pierre is a renowned expert in performance nutrition.

Brian is a Registered Dietitian with a Masters in Food Science and Human Nutrition from the University of Maine. He is also a certified strength and conditioning spe- cialist, a certified sports nutritionist, and the author of five books including the High Performance Handbook Nutrition Guide.

As Precision Nutrition’s Director of Performance Nutrition, Brian contributes to ground-breaking research, education and curriculum development at PN, where he is also an esteemed coach.

Brian shares his expertise on a global scale by presenting at conferences around the world, serving as a nutrition consultant for pro sports teams such as the San Antonio Spurs, Brooklyn Nets, and Cleveland Browns, coaching professional and Olympic athletes, and writing for popular publications including Precision Nutrition.

for popular publications including Precision Nutrition. Camille DePutter is an author, speaker, and communications

Camille DePutter is an author, speaker, and communications consultant with a rich portfolio of experience in marketing, public relations, and storytelling.

Camille received her HBA in English from the University of Toronto and trained at the Humber School for Writers. An advisor to Precision Nutrition, Camille lends her communication expertise to Precision Nutrition publications, course materials and marketing content.

As a consultant, Camille has helped dozens of top brands and business leaders refine their messaging and improve their customer relationships. Her work has been pub- lished extensively in popular websites, magazines and newspapers.

Camille writes for the Precision Nutrition Encyclopedia of Food and is a frequent con- tributor to the Precision Nutrition blog. She is also the author of the workbook Share Your Story, and self-publishes at

Share Your Story, and self-publishes at Dr. Helen Kollias is a researcher and L1 Certification

Dr. Helen Kollias is a researcher and L1 Certification advisor at PN. She is also a regular content contributor to the blog, where she uses her witty and articulate writing style to make complex science accessible and entertaining.

Helen holds a PhD in Molecular Biology from York University, specializing in the area of muscle development and regeneration, and a Master’s degree in Exercise Physiology and Biochemistry from the University of Waterloo. She has also held research posi- tions at some of the most prestigious institutions in the world, including John Hop- kins University and Toronto’s Hospital for Sick Children.

Outside the lab, Helen has played and coached varsity soccer, and has been involved in fitness and weight training for almost two decades. She also has two daughters with whom she wants to share her joy of inquiry and experimentation, but above all, she wants to teach them resilience, bravery, and grit.

How to Use This Text | v

How to Use This Text

When faced with new information, students usually wonder one thing:

“Will I ever need to know this in the real world?”

Whether it’s the cosine of an angle, Kepler’s laws of planetary motion, or the enzyme responsible for forming citrate, students’ most common questions about what they’re learning are:

“Will this be on the test?”

“Will I ever need to know this again in my life?”

We, the authors, know these questions well. We’ve asked them ourselves, most often during our own high school, undergraduate, and graduate studies.

So now, as instructors living in the “real world”, we’d like to level with you: Probably not.

Unless you become an engineer, you probably won’t need the cosine stuff. Unless you go to work for NASA, you can probably forget Kepler. And the Krebs cycle? Well, you won’t need that unless you teach biochemistry.

So why learn all this information?

Well, most of us don’t know what we want to be when we grow up. Work (and life) is full of surprises.

You never know what career path you’ll follow, or what hobbies you’ll take up.

Be prepared for anything. Learn as much foundational knowledge as possible. Now you have options.

But there’s another, more inspiring, reason for learning this stuff.

It’s actually kinda interesting. It helps explain your world. And makes you super-fun at parties.

In fact, when you really dig into this knowledge, you might just change what you want to do for a living because of it.

What this means

In this program, we’ll provide a lot of foundational knowledge.

We give you more details below.

This foundational knowledge — about stuff like cells, digestion, metabolism and whatnot — can feel a little heavy at times. Especially if you’re new to this material. Or you’re a practical, hands-on kind of person who would rather spend more time doing than reading.

Hang in there.

vi |

The payoff comes in the second section, where that foundational information gets applied.

We’ll give you case studies. Strategies for working with real-world clients. Question- naires and assessments to use with your clients. Psychological strategies for getting clients excited about working with you. And all kinds of other fun things.

Even if you’ll never use the more theoretical material we teach you, you’ll still need to know the science to apply it under “test conditions” — in other words, when you’re sitting across from a client.

By the end of this course, we expect you to understand:

• how the body works;

• how to apply that knowledge to working with clients;

• how to assess, monitor, and revise client programs;

• how to communicate your knowledge effectively; and

• how to get your clients on board with your nutrition plans and programs — hopeful- ly feeling just as inspired as you about making progress and changing their nutrition habits.

How the program is organized

This course is split up into two units.

Section 1: Nutrition science

In Section 1, we’ll go through all the nutrition information you’ll need to know, such as:

• How and why your cells work the way they do

• How carbohydrates, fats, vitamins, minerals, and other nutrients interact with your cells

• How food becomes energy for maintenance functions, physical work, and repair

• How your body balances out the food you eat with the work it does

• How exercise affects nutritional needs and how nutrition affects exercise

Section 2: Nutritional practice

In Section 2, we’ll introduce you to how to coach, including:

• What it means to be a good coach

• How to prepare for clients

• How to interact with different clients

• How to assess clients

• How to know which approaches are best for which clients

• How to meet clients where they are (not where you want them to be)

• How to keep clients progressing from day one until they reach their goals

How to Use This Text | vii

Other learning tools

Throughout the textbook, look for things like:

Unit objectives

Each unit contains clear objectives at the beginning. This will tell you what to focus on, and give you goals before you even start reading.

Unit summaries

At the end of each unit, we’ll summarize the most important points from that unit. These will confirm that you’ve learned what really matters, and give you another handy tool for review.

Key terms

The first time a key term appears in the text, it is highlighted and a definition provided in the margin. Familiarize yourself with each key term.

Case studies

Most units end with relevant case studies. These give you “real-life” examples of ap- plied nutrition.

Each story describes a client’s nutrition challenges, then provides practical solutions to work through these challenges.


We’ll provide a comprehensive list of references used to create this course. If you’re interested in learning more about nutrition and health, you can look up and read more of this primary source literature.

How to focus your learning

Just like coaching or training, learning should be focused and systematic, with a clear purpose.

Here are some ways to stay on track and on target with your Level 1 journey.

Learn what you need to learn

You know your own learning style. (And if you don’t, now’s a great time to discover it.) Help yourself succeed by building a system that suits you.

Use as many ways of processing the material as possible: reading, writing, thinking and reflecting, listening, watching, talking about the material, drawing maps and flowcharts of ideas, etc.

We suggest…

viii |

1. Read the unit. (textbook)

2. Watch the video. (online)

3. Answer the workbook questions. (study guide)

4. Take the quiz. (online)

Set up a weekly self-study schedule so you get into a routine. Consistency and struc- ture will help you move forward steadily and confidently.

Focus on key concepts

As the scientists working on the 1999 Mars lander mission found out when their precious spacecraft wandered off into oblivion because they mixed up imperial and metric measurements, details are important.

But details usually aren’t the most important things in this program. You don’t have to memorize entire units, nor usually recall minute details (such as the exact body density equation by Jackson & Pollock).

As long as you learn the concepts and study as we recommend, you have a great chance of doing well on the quizzes.

Plus, you’ll always have your text available for reference. If you get stumped during a quiz or a client interaction, you can always look things up.

It’s more important to know how to think. How to learn. How to connect ideas.

And to understand why things are important (and how they relate to one another) than to recall specific details. (Unless detail memorization is your thing. Then go for it.)

What to look forward to

If you show up consistently, ready to learn and grow, and if you engage with this materi-

al using all the learning methods that work best for you, then this course will make you

a better coach.

Seek to master both the basic science (Section 1) and the applied art of coaching (Section 2).

If you do, you’ll finish this program as a highly trained professional with the knowl- edge to support your recommendations; the ability to communicate them effectively and well; and a foolproof system for delivering outstanding, reproducible results.

Let’s get started.

Acknowledgements | ix


It’s really important to us that everyone who helped bring this major project to com- pletion is recognized for their work. Because, as we all know, nothing worth doing can be done alone.

To this end we’d like to thank Paul Bradbury, Rachael Bell, Phil Caravaggio, Al Cimi- no, Alwyn Cosgrove, Alison Dungey PhD, Georgie Fear MS RD, Carmelo Galati RGD, Jonathan Goodman, Sean Greeley, Mariane Heroux PhD, Timothy Jones, Bedros Keuilian, Helen Kollias PhD, Sarah Maughan MS, Bob Moesta, John Nadalin, Spencer Nadolsky DO, Tom Nikkola BA, Eric Noreen PhD, Prasanna Paul, Alex Picot-Annand MS, Pat Rigsby, Francisca Ruff, m.c. schraefel PhD, Chris Spiek, Bryan Walsh ND, and Erin Weiss-Trainor.


Introduction — Nutrition: The big picture, p2

What is food?, p3

What is good nutrition?, p6

What’s the best diet?, p11

The cycle of food, p15

What is nutrition coaching?, p16

What this program will cover, p20

Summary, p20

Section 1: Nutritional science, p22

1 Cells, p23

Cell structure and function, p24

How the body is organized, p25

Nutrition and cellular interaction, p28

Parts of cells, p31

Body function, p39

Cell types, p42

Summary, p44

2 Through the GI Tract, p45

Controlling the digestive process, p65

How do we absorb our food?, p70

Summary, p76

3 Energy Transformation and Metabolism,


Energy intake, storage, and transfer, p78

How are nutrients metabolized?, p87

Summary , p111

4 Energy Balance in the Body, p112

Energy value of food, p113

Estimating energy needs and energy intake,


Energy balance and imbalance, p124

Achieving energy balance… naturally, p133

Summary, p136

5 Aerobic and Anaerobic Metabolism, p137

How metabolism changes , p138

How exercise affects metabolism, p139

Muscle and metabolism, p140

Energy demands of muscle, p143

Oxygen consumption, p144

Anaerobic versus aerobic exercise, p146

How we adapt to exercise, p148

Summary, p154

6 Macronutrients, p155

Macronutrients, p156

Summary, p195

7 Micronutrients, p197

Micronutrients, p198

Vitamins, p199

Minerals, p201

Getting vitamins and minerals right, p203

Vitamin and mineral overview, p205

Phytonutrients and myconutrients, p226

Summary, p229

8 Water and Fluid Balance, p230

The big picture, p233

Body water imbalances, p235

Body water regulation, p241

Hydration strategies, p245

Summary, p251

Section 2: Nutritional practice, p252

9 What It Means To Be a Good Coach, p253

Why talk about coaching?, p254

What’s your story?, p255

What do great coaches do?, p259

Understanding clients, p262

Mental skills, p264

Communication skills, p267

Summary, p269

10 The ISSA Nutrition Coaching Methodology , p270

The process of change, p271

The 6 steps of coaching, p272

The early stages of the change process,


Assessment and triage, p279

Identifying and clarifying values, priorities, and goals, p283

Choosing a direction for coaching and building an early action plan, p287

Working through normal client ambivalence, p290

How to communicate effectively, p295

Putting it into practice: What’s ahead, p296

Summary, p299

11 Nutritional Levels , p300

Working with nutritional levels, p301

Summary, p316

12 Working with Level 1 Clients, p317

Level 1: Where it all begins, p318

Level 1 clients and your coaching process,


Level 1 limiting factors and coaching strategies, p327

Troubleshooting Level 1, p353

Summary, p359

13 Working with Level 2 Clients, p360

Level 2: An introduction, p361

Level 2 strategies, p370

Troubleshooting Level 2, p393

Summary, p397

14 Working with Level 3 Clients, p398

Level 3: Special situation nutrition, p399

Level 3 strategies, p404

Troubleshooting Level 3, p424

Summary, p429

15 Special Scenarios, p431

Start with the basics, p432

Disordered eating, p433

Food addiction , p442

Alcohol , p446

Nutrition and immunity, p447

Injuries / inflammation, p452

Sex and gender , p454

Ethnicity, heritage and genetics, p461

Life stages and aging, p462

Food sensitivities, p469

Plant-based eating, p471

How we fit into the food system, p473

Summary, p478

16 Business 101 for Fitness and Nutrition Pros, p479

What’s next for your coaching practice?,


Smart business strategies for nutrition coaching, p481

How to attract clients: Frequently asked questions about sales and marketing, p488

Making it work: Avoid common mistakes,


Summary, p492

17 Continuing Ed for the Coach, p493

Keeping up to date, p494

Taking it further, p495

Staying on top of research, p496

Developing your coaching practice, p497

Summary, p499

References, p500

Index, p522

INTRODUCTION Nutrition: The Big Picture
Nutrition: The Big Picture

Nutrition: The Big Picture | 3

Unit Outline

1. Objectives

5. The cycle of food

2. What is food?

6. What is nutrition coaching?

3. What is good nutrition?

7. What this program will cover

4. What’s the best diet?

8. Case Study

9. Summary


This unit will introduce you to the big picture of good nutrition.

• why good nutrition matters for personal health, as well as community and global health

You’ll learn:

• how to answer the often-asked question: “What’s the best diet?”

• how we define and think about food

• how we define and think about good nutrition

• some of the things to think about when you sit down to eat a meal

What is food?

Seems like a dumb question with an obvious answer. Food is stuff we eat that fuels our body. Right?

Well, that’s one way to think about it. Food contains energy. Or, more correct- ly, “chemical bonds that, when broken, are used to create ATP, the fuel for our cells.” (More on that in a later unit.)

But food also includes micronutrients, phytochemicals, zoochemicals, fiber, water, and perhaps even organic molecules that we haven’t yet discovered. All of these substances play crucial roles in our body, even though they don’t necessari- ly “fuel” it directly.

Micronutrients: Vitamins and minerals

We need vitamins and minerals in our diet. Without them, our body breaks down.

For example:

Vitamin C (also known as ascorbic acid) is a powerful antioxidant that can help control inflammation and cellular damage.

The mineral magnesium plays a role in more than 300 enzyme systems and helps with protein synthesis, muscle and nerve function, blood sugar control, blood

Zoochemicals: Components found in animal food sources

Organic: Obtained from living things

Vitamins: Organic compounds required by an organism as a vital nutrient in limited amounts

Minerals: Naturally occurring, inorganic substances

Inflammation: The reaction of a tissue to injury or infection, characterized by heat, redness, swelling, and pain

4 | Introduction

pressure regulation, energy production, and transport of other minerals.

The list could go on and on. You’ll learn more about these and other nutrients in later chapters.

While none of these nutrients provide “fuel”, we still need them to live and thrive.

When you’re missing key vitamins and minerals, your body doesn’t work properly. You feel rotten. And you get sick. That’s true no matter how much fuel is in the tank.

Phyto- and zoochemicals

Phytochemicals (whose name comes from the ancient Greek phuto, or plant) are nutrients that only occur in plants. Phytochemicals are one of the main reasons that eating fruits and vegetables is good for us.

For instance, phytochemicals have been shown to:

• offer DNA protection against free radicals;

• protect against cancer;

• decrease the risk of heart disease; and

• reduce overall mortality.

Zoochemicals (from the Greek zoion, or animal) are nutrients found only in animal products, such as CLA (a fatty acid), creatine, and carnosine.

Zoochemicals have been shown to:

• reduce inflammation and blood clotting;

• protect against heart disease;

• suppress cancer cell development; and

• inhibit complications from diabetes.

Phyto- and zoochemicals don’t provide “fuel.” Which means that the “food as fuel” story leaves them out too.

Food is so much more than fuel.

Living organisms are not machines.

They’re incredibly complex, self-regulating, and dynami- cally responsive — almost magical — systems.

Machines have precise inputs and outputs. For instance,

when you fill your car’s tank with gas, you know more or less how far you can drive.

But if you’ve spent any time doing “calorie math”, you’ll know that trying to calculate precise inputs and outputs for a human body is frustrating.

• Maybe you ate more calories than you thought you should… but got leaner.

• Or you ate fewer calories than you thought you should… and gained weight.

• Or you started eating breakfast instead of skipping

it…or vice versa your waistline.

and dropped a couple of inches off

According to the simplistic “food as fuel” view, none of this should be possible. Yet it happens all the time.

Human bodies aren’t combustion engines.

They’re complex, dynamic, organic, and infinitely sensi- tive systems.

For example: Research now shows that all food isn’t creat- ed equal, and what we eat isn’t necessarily what we absorb or use. Dozens — maybe even hundreds — of factors affect how we digest, process, and utilize the food we eat.

This means that the fuel, or calorie, value of food outside the body isn’t necessarily the same as the value inside the body.

Plus, our body has its own priorities.

For instance, the body will extract nutrients to keep you alive by any means necessary, often making tough com- promises along the way. This would be sort of like your car suddenly driving itself to the gas station and holding up the cashier until it gets what it needs, or cannibaliz- ing its own headlights for fuel.

What’s more…

Your body isn’t even completely “human.”

The trillions of microbial critters living in and on us do much of our digestion and nutrient extraction. Analysis

Nutrition: The Big Picture | 5

of our bacterial environments shows that each of us has an individual gut flora “microbiome”, like a fingerprint.

Changing our microbiome changes our digestion and absorption, and hence our body composition and health.

Microbiome: The genetic content of all the microorganisms that inhabit the GI tract

We’re incredibly complicated, self-organizing, agenda-driven, only-sorta-human systems. Frankly, the machines should be jealous. So, if the “food as fuel” idea doesn’t give us the whole story, what is food?

Food is — in part — information.

When we eat, we’re delivering messages to our body.

• Do this.

• Don’t do this.

• Release this hormone.

• Don’t release that one.

• Express this protein.

• Don’t express that one.

Food (and the act of eating) sends instructions that kick off a chemical chain letter. Each molecule of food contributes to a beautiful cascade of events, sending all kinds of signals throughout our body.

Make hormones! Trigger immune cells! Switch genes on and off! Tell the work crew to clean up and the builders to get on standby! Lights! Camera! Action!

It’s like the biggest, busiest movie set you can imagine. And somehow — unlike many film sets — it runs almost perfectly.

Our body processes millions of calories and (let’s be scientific about this) zillions of chemical compounds a year, with nearly 100% efficiency. (Just for comparison, gas-powered engines, like our car, would be happy to hit 30% efficiency.)

Even cooler: Our thoughts, feelings, and environment can affect these process- es. If we smell a tasty meal, have a positive or negative thought about food (or anything else), are happy and relaxed or worried and rushing…it affects nutrient processing.

Food is smart. And so is your body.

Thinking about food only as fuel reduces food to gasoline, your body to a dumb machine, and you to a calorie accountant. You’re more than that.

Food and your body deserve a lot more recognition and honor.

The more we learn, research, and work with clients, the more we’re amazed at the power of food.

6 | Introduction

Food is packed with meaning, information, and communication.

Every food decision we make sends a message to our body.

Every food choice is an opportunity to direct, shape, and remake our health. Our body composition. Our perfor- mance. Our wellbeing.

Food tells a story.

Many of us in this field are physiologists and biochem- ists. Sure, we look at food through a science lens. But that’s not our only perspective.

We know, too, that sharing food is a fundamental hu- man act. Breaking bread (or whatever other food is on the table) is part of our history. Our culture. Our legacy as humans.

Food isn’t just a chemical story. It’s a story about people.

How we eat, where we eat, and what we eat (or don’t) tells a story. Food helps us communicate about who we are, what we think about, and what’s important to us.

For instance:

• I’m sophisticated. I’m a “foodie.”

• I’m a thoughtful consumer. I’m a regular at the farm- ers’ market.

• I’m from Mexico / Italy / Nigeria / Laos / [insert region / origin / ethnicity] and proud.

• I’m the social hub for my big family. Come on over this Sunday for dinner!

• I’m adventurous. I’ll eat anything once. Once, when I was traveling, I ate…

• I’m careful with my choices. I avoid processed food.

• I’m low maintenance; my fridge is empty. Let’s grab something on the go.

• I’m a bon vivant. I love eating at fancy restaurants.

• I’m a caregiver. I love you. So I cook for you.

And so on.

These stories are essential information about ourselves, about our family and friends, and about our clients.

For a nutrition coach, knowing these stories is relevant. Crucial. Powerful, life-shaping knowledge.

Take a few minutes and consider these questions:

What is food?

What is food… for you?

For your clients?


it fuel? Is it information? Is it personal freedom? Is it

shame? Is it self-esteem? Is it comfort?

Then consider these questions:

• What would you like food to be?

• What do you imagine it could be?

We encourage you to think big. Get imaginative. Learn a little more about physiology. Learn a little more about humanity. Discover what makes food one of the greatest stories ever told.

A story of the wonder of evolution and biology. A

collective grand epic of our humanity. A chemical story written in molecules, not words. It’s a story that shapes your daily life, your health, and your function.

Food is fuel? No. It’s so much more than that.

What is good nutrition?

If food is more complicated than just fuel, then good

nutrition is probably more complicated than “following the rules.”

Take a minute to answer this question for yourself: What is good nutrition?

We’ve given this question a lot of thought over the years. As of today, here’s how we answer it:

Good nutrition controls energy balance.

As we’ve seen, food is more than fuel… but it does give us energy.

Without enough energy coming into the body, we just don’t work right. Our body starts to shut down processes that we don’t absolutely need to survive, such as reproduc- tion, some aspects of metabolism, and brain function.

Nutrition: The Big Picture | 7

Too much energy coming into the body also causes problems. We can become resistant to important hormones (such as insulin or leptin). Inflammation may increase. Plaques can form on vessels and blood pressure can go up. We risk getting many chronic diseases.

Good nutrition helps control energy balance. We don’t eat too much or too little. We can stay healthy, fit and strong. We feel good, and our body shows it.

Chronic diseases: A long-acting disease that does not quickly resolve, e.g., cardiovascular disease, cancers, chronic respiratory diseases and diabetes

Good nutrition gives us nutrients.

Each food has a certain nutrient density, or nutrients per amount of food. Since we want to eat the right amount of food for our needs, we want to make sure that that food is loaded with nutrients.

Imagine several plates, each one full of one type of food:

• a plate of kale

• a plate of lentils

• a plate of cookies

• a plate of salmon

• a plate of berries

• a plate of saltine crackers

Now, per plate of food, ask:

• How many calories are in each plate?

• How many nutrients are in each plate?

In some cases, like the cookies, there are lots of calories but few nutrients. That’s called low nutrient density.

On the other hand, with the kale, there are lots of nutrients but few calories. That’s called high nutrient density.

We need nutrients to live, and to thrive. Nutrients help us be as healthy as possi- ble, perform at our best, and live long, active and vibrant lives.

Good nutrition helps us balance energy intake and getting enough of these valuable, essential nutrients.

Table I.1: High- versus low-nutrient-density foods

Higher nutrient density

Lower Nutrient Density

Bright or deeply colored vegetables

Potato chips

Bright or deeply colored fruits

Soda and fruit juices

Beans, meats, eggs

Hot dogs, deli meats

Whole grains

Refined grains/flours, pastries

8 | Introduction

Good nutrition helps us look, feel, and perform our best.

Good nutrition — and good nutrition coaching — helps our clients do what is most important to them, without other things getting out of balance.

An athletic client might be focused mostly on perfor-

mance. You can also help them stay healthy and strong

as they train. Or to be the right weight (or body fat percentage) for their sport.

An older client might want to simply live healthier and better. You can also help them keep the bone and muscle that will keep them active and mobile.

A client who dreams of looking good at the beach or at a

big event (such as a wedding) might want to lose weight. You can also help them prevent chronic diseases.

Good nutrition is about helping people look better. Feel better. Perform better. Live better. And just be better overall.

As a nutrition coach, take a holistic approach. Help your clients balance specific goals with general benefits — perhaps even benefits they didn’t realize were possible.

Good nutrition is outcome-based.

Every nutrition choice you make will lead to an out- come. Those outcomes can be measured. And they’re a great mirror of reality.

That’s why we love the question “How’s that working for you?”

Whenever someone tells us they eat really “healthy” — which is just a concept in their head — the best fol- low-up is “Great! How’s that working for you?”

We use this question because it tests perception against reality. If someone thinks they’re eating really “healthy”, but they just don’t have the body, health,

or performance that could be expected, maybe that

person’s idea of “healthy” doesn’t match reality. Maybe

they’re not making outcome-based decisions.

Indeed, lots of people in North America think they have a really healthy and balanced diet.

Yet, for example:

Performance Health Body Composition Figure I.1 Good nutrition resides in the intersection between health, performance,
Body Composition
Figure I.1 Good nutrition resides in the intersection between
health, performance, and body composition.


study of Canadians found that over 60% of the cal-

ories they eat come from highly processed foods.

In the US, just over 11% of calories come from fast food.

That “5 servings a day of fruit and vegetables” habit? Data show that only 30% of people in the UK are do- ing it… and only 8% of Australians. (And often, those vegetable servings are potatoes.)

Over 90% of clients report eating at least one meal in

cafeteria or restaurant a day. While some people are undoubtedly making healthy, less-processed choices when they eat out, many folks are probably not.


That’s why good nutrition includes using outcomes (data and reality) to inform future decisions.

Good nutrition is sustainable for both us and the planet.

Can we keep eating and producing food the way we are now? For how long?

Research suggests that we waste between 30 and 50% of all food produced.

Nutrition: The Big Picture | 9

Food often travels thousands of miles between the farm and our dinner plate.

While global food production has gone up, hunger and malnutrition are still big problems worldwide. And more crops than ever before are being grown to feed livestock (not people).

With a planet that isn’t growing and a population that is, our food decisions need to be more sustainable and environmentally considerate than ever before.

Luckily, what helps the planet usually helps our body and health as well. That’s why good nutrition is about finding a diet that is sustainable for us and the planet.

Good nutrition is about removing limiting factors.

If you can help your clients identify their limiting factors — the things that stand between them and reaching their goals — you’ll become a great nutrition coach.

While you’re building up your expertise, here’s a quick list of possible limiting factors to look for. (We’ll share more examples later on.)

Genetics and epigenetics

Genetics (the blueprints of our body) and epigenetics (factors that control how our genes are expressed) can affect how your clients respond to nutrition.

For example:

• Few clients will have the genetic makeup to reach the upper limits of human performance.

Epigenetics: The study of changes in organisms caused by modification of gene expression rather than alteration of the genetic code itself

• Some clients will have genetic factors that can make losing weight, gaining muscle, completely avoiding chronic diseases, or other physical outcomes easier or harder.

• Some clients will be genetically more or less able to metabolize certain foods or chemicals, such as caffeine or particular amino acids.

Genes are not destiny. Epigenetic factors — such as nutrition, stress, or a healthy environment — can strongly affect genetic expression. So you might carry sev- eral of the known gene variants for obesity… but you can also choose what to eat for dinner, or put on running shoes and get outside.

Almost everyone can make daily choices that will keep them as healthy, fit, and vibrant as possible, for their individual body.


Activity changes how our body uses nutrients. Active and fit people can eat more, use nutrients more efficiently and effectively, and keep their metabolisms healthier than sedentary and unfit people.

So exercise (or lack thereof) can be an important limiting factor.

Amino acids: The building blocks of protein. Organic compounds containing both COOH and NH 2

Gene variants: Diversity in gene sequence within a population or among populations that are most commonly due to single nucleotide polymorphisms (SNPs) or copy number variants (CNVs)

10 | Introduction

At the same time, exercise alone isn’t enough to keep your clients healthy or lean. (Which is one reason that your work as a nutrition coach is so important.)


If you’ve ever had a serious metabolic or hormonal problem, or an imbalance of

neurotransmitters, you’ll know: Physiology is powerful.

Work with, rather than against, your clients’ unique physiological makeup, and help them understand what’s realistic. (But stay hopeful.)

Take an integrated approach: Collaborate with your clients’ health care provid- ers, if needed, to work together as a team.


Every action starts with a thought. Thoughts become things.

Negative, sabotaging or inaccurate thoughts, self-talk and beliefs can hold your clients back. Not only do negative mental dynamics affect clients’ behavior, they also have physiological effects: Our brain and body treat these like any other stressor, and respond accordingly.

Luckily, as a nutrition coach you can help replace negative mindsets with things like positive self-talk or better information.

Notice how your clients think, and the stories they tell themselves. Consider how you can also improve those thoughts and beliefs as part of your nutrition coach- ing. (We’ll look more at this in Section 2.)

Also consider how you can help your clients move from knowing information to taking action.

A winning mindset plus a great nutrition action plan… that’s a recipe for success.


What’s around your clients?

Who is on their team? (Besides you.) How are their relationships at work, home, school, or elsewhere?

What’s their schedule like?

What’s their physical environment like? Are healthy choices close and convenient?

Most of our daily decisions are unconscious. We don’t think about them. We just make them. So our environment strongly shapes what we do, eat, and think about.

Even if your clients really want to make better choices, they’ll probably also need

to adjust their environment to do so.

Nutrition: The Big Picture | 11

Good nutrition looks for strengths and wins.

Good nutrition isn’t about “following the rules” or “being strict.” It’s about en- abling happier, healthier, fuller lives.

As a nutrition coach, you’re looking for limiting factors, but also for your clients’ advantages, strengths, and opportunities for success.

How can you take what’s already working, and improve on it?

Now, of course, if you’re looking for strengths and wins, you’ll probably wonder

What’s the best diet?

As a fitness professional, one question you will often get asked is which “nutri- tion camp” you fall into. Are you into Paleo? What about vegan? Intermittent fasting? Detoxing? Or any number of other “flavors of the month” (so to speak)?

And clients will want to know:

“What’s the best diet?”

The secret:

There isn’t one.

Here’s why.

Clients are diverse.

Here are just a few ways that your clients can differ:

Paleo: A diet built upon foods presumed to have been eaten by early humans

intermittent fasting: A diet that cycles between periods of eating and not eating

Body type: Some clients are tall and thin; others short and stocky. Or every- thing in between.

Fitness level and body composition: Some clients are active, strong, lean, and dense. Some clients have been sedentary for the last 50 years and may be frail, without a lot of muscle.

Dietary preferences and exclusions: Whether kosher, halal or Jainist; plant-based or carnivore; scavenger or “picky eater”; iron stomach or “allergic to everything”, clients have a vast range of food preferences and many reasons for them.

Budget: Your client might be a broke student, a middle-class family trying to make ends meet, or a highly paid executive — perhaps even a pro athlete.

Organic / conventional: Some clients live on boxed and packaged foods. Some clients try to read labels, sometimes. Some clients may choose only kale that has been lovingly grown by a sect of Californian monks who hand-pluck the bugs off.

12 | Introduction

Nutrition knowledge and diet history: Some clients will be devout followers of a certain dietary practice, or a history of trying different diets. Others have very little nutrition knowledge at all.

Time: Some clients have an open schedule, ready for any kind of health and fitness project. Others have a crowded daily schedule and countless conflicting priorities.

Ethnic background and heritage: Our coaches practice all over the world. Our clients live, and come from, all over the world. A meal or cuisine that suits an Anglo family may not suit their Hispanic, Somali, or Punjabi neighbors. A client from a northern Euro- pean ethnic group may digest dairy easily, while the client of Japanese heritage next to them may not.

Age: As we age, our metabolisms change, our food tolerances and appetites change, and our digestive abilities change.

You get the picture.

As a nutrition coach, your job is to help your clients — as unique people — get to their goals. To do what matters to them, in the way that’s best for them.

The best coaches don’t have a single nutrition philosophy.

You might have the approach you like, or one that worked for you. Great. That’s a solid start.

But good coaches take a flexible approach. They borrow the best ideas from everywhere and everyone, and are always looking for new insights or tools. They don’t get stuck in dogma.

The best coaches use data and evidence to make decisions.

Throughout this course, we’ll encourage you to wear your scientist hat and gather data for outcome-based decision making.

Good coaches look at the evidence. This can include:

• peer-reviewed clinical and scientific research;

• understanding the basis of how and why things work (or don’t); and

• “real-life” testing and client experience.

Good coaches stay skeptical, think critically, and take a broad perspective.

Indeed, here’s one crucial piece of evidence:

The healthiest people in the world don’t have a single nutrition philosophy.

Physiologically, the human body can do well under all kinds of different nutritional conditions.

We can see this clearly if we look at the traditional diets of indigenous groups and ethnic groups throughout the world.

• For example, the Arctic Inuit and African Masai eat traditional diets that are high in fat and animal prod- ucts, with few vegetables.

• Conversely, Kitavans in the South Pacific, the Hadza of East Africa, and many groups in the Amazon basin (such as the Tsimane of Bolivia) eat traditional diets that are low in fat but high in vegetables and starchy carbohydrates.

• The !Kung of Africa eat traditional diets that are made up of mostly nuts and seeds.

This is also true if we look at the world’s Blue Zones, areas where people live exceptionally long and healthy lives.

You probably wouldn’t mistake Okinawan cuisine for the Mediterranean cuisine of Sardinia, Italy or Ikaria, Greece. Or the Central American cuisine of Costa Rica’s Nicoya peninsula.

These cuisines and dietary patterns differ.

Yet people eating these ancestral or traditional diets have much fewer of the chronic “diseases of affluence” (such as cardiovascular disease, stroke, diabetes, obesity, etc.) considered normal in industrialized areas.

The human body adapts amazingly well to many different ways of eating.

You can be healthy and fit whether you eat mostly meat

Nutrition: The Big Picture | 13

or mostly veggies, mostly fat or mostly carbohydrates, many times a day or just a few times, and so on.

Carbohydrates: A group of compounds including sugars, starch, and cellulose

Which means that, as a nutrition coach, you shouldn’t really belong to any spe- cific nutrition camp at all.

When you work with actual human beings, you must be a nutrition agnostic:

• Explore and try anything and everything that could work.

• Be willing to test new methods, even if they fly in the face of current beliefs or practices.

• Be humble and open-minded enough to let yourself be wrong, even if you really like being right. (Which we do.)

Don’t focus on the food itself. Or on making sure everyone follows your “nutri- tion rules.”

Focus instead on your clients. What do they need to be their best?

Good nutrition is more similar than different.

You might be wondering: How can such varied diets all keep people fit and healthy? Well, despite their disparities, most effective nutrition programs are more alike than different.

1. Good nutrition asks people to care about their food

and eating.

Research shows that your actual choices are probably less important than simply paying better attention to what you eat.

When you really care about what you eat, and make mindful, deliberate choices, you almost inevitably eat better.

2. Good nutrition focuses on food quality.

Almost no decent diet plan asks you to eat more processed, nutrient-depleted pseudo-food.

Instead, pretty much every camp recommends eating whole, minimally pro- cessed, nutrient-rich foods — foods with which our body has a longstanding relationship.

Regardless of the macronutrient breakdowns or specific choices, just eating bet- ter quality food will improve most people’s health significantly.

3. Good nutrition helps eliminate nutrient deficiencies.

When we care about what we eat, choose foods mindfully, and try to get the best-quality foods we can afford, we usually get lots of valuable nutrients along for the ride.

Often, when people start a certain diet program, they just start eating better

14 | Introduction

overall. They get more nutrients. They may get more variety. Or fresher foods. Or less-processed foods. Or foods they chose mindfully.

Because of these factors, they feel better. And that’s one reason they start making wild claims about the rejuvenating power of their new diet.

They didn’t do anything special, really. They often just started getting what their bodies needed.

Hyper-palatable: Foods that are exceptionally pleasing to the sense of taste.

4. Good nutrition helps control appetite and food intake.

For most people, “it’s hard to eat just one” of the hyper-palatable deliciousness bombs of processed foods. We often keep eating and eating them, but don’t feel satisfied.

We may also eat them on the go, when we’re rushed and busy. So not only are we eating foods that encourage us to eat more of them, we’re not even really paying attention to the experience at all.

Conversely, when we’re more aware of what we’re eating; choose a variety of more satisfying, higher-quality foods; and eliminate nutrient deficiencies, we almost always end up eating less food overall.

We feel more satisfied — both physiologically and psychologically. We lose fat, gain muscle, and perform better.

Notice that you don’t need calorie counting here. Focusing on food awareness and food quality is usually enough for people to tune into their own hunger and appetite. That means calorie control without the annoying calorie math.

It also means that your clients can stick with this, since almost nobody can count calories (or wants to) forever.

5. Good nutrition promotes regular exercise.

When people start paying attention to their eating, they usually start thinking about physical activity too. Or vice versa: If you take up an activity you love, eventually you start wondering if your nutrition could help you do that activity better.

Good nutrition fits with regular activity like a key into a lock.

And most nutrition programs suggest that people exercise along with eating well.

What this means for you as a nutrition coach

Stay open-minded and flexible. Question everything.

Learn more about global nutrition and eating habits. Broaden your focus. Expand your world. (If possible, travel and actually experience different foods, cuisines, and food philosophies.)

Test your theories and programs. See how they work on actual clients with real lives and real bodies in the real world. Look for evidence. Gather data and mea- sure outcomes.

Nutrition: The Big Picture | 15

Remember to ask our favorite question: “How’s that working for you?”

And where possible, look for underlying themes that make all good nutrition programs “work.”

One key feature about successful diet plans — especial- ly in the Blue Zones — is that good nutrition connects people to the food itself.

So now that you’ve thought about what food is, and what good nutrition involves, let’s think about where food comes from. Or where it goes.

The cycle of food

Check your fridge and pull out a fruit or vegetable.

• Where was it grown?

• How was it grown?

• Who picked it for you?

• How did it get to you?

• What steps did it take?

• How far did it have to travel?

• What factors ensure you can get more of that fruit or vegetable?

• Do you think that people could still be eating that fruit or vegetable in 100 years? What about 500? Why?

In the world of nutrition for health, performance, and body transformation, we don’t talk much about where food comes from. Or where it ends up if we discard it.

where food comes from. Or where it ends up if we discard it. Figure I.2 The

Figure I.2 The food life cycle

Sure, we might check a few labels for the word “organic.” But beyond that… well, many folks think that chicken is just “protein” that comes in rectangular plastic packages.

(Wait… a chicken is a bird? That has feet, and feathers, and stuff?)

Food as information about the world

Just as food is information for your body, food is also information about ecosystems and the environment.

Food is information about how things get produced, processed and sold all over the world.

Someone had to grow that fruit or vegetable from your fridge. Other people picked it, and packed it, and trans- ported it, and sold it.

Obviously, a full discussion of the social, political, eco- nomic, and environmental issues involved in agriculture

is beyond the scope of this text. We’ll touch on it briefly,

to help you understand a few more parts of the bigger picture of food. If you’d like to learn more about these issues, check out the agriculture resources in Unit 17.


Something sustainable is something that you can do for a long time. That could be a well-planned nutrition program, of course. Or in this case, a way of growing and producing food.

Sustainable agriculture is agriculture that we can do for

a long time. It involves things like:

• preserving and replenishing soil with nutrients;

• preserving and replenishing water reserves, especial- ly clean fresh water;

• growing a wide range of diverse crops that are prop- erly adapted for their surroundings;

• making the best use of valuable farmland;

• making animal welfare a priority;

• understanding the interaction of living organisms as a complex ecosystem rather than as a food factory;

• making sure that people involved (such as growers or pickers) are safe and fairly treated;

• ensuring food safety and public health; and

• minimizing waste and pollution.

16 | Introduction

At its most basic level, sustainable agriculture is about ensuring that we can produce safe, high-quality food for everyone, for a long time to come.

Sustainability in agriculture isn’t just a nice thing to have. It’s what will ensure we can keep eating the things we want and need to eat.

We’ll talk more about sustainability and organic versus conventional foods in a later unit.

Food as a set of choices

We’ve suggested that food is information, and a way of telling a story.

Here’s another thing to think about: Food and eating is a set of choices.

As a nutrition coach, one of your jobs is to make your clients more aware of what they’re doing. Indeed, aware- ness itself can often change people’s behavior. (We’ll talk about this more in Section 2.)

As we’ve stressed, nutrition coaching isn’t about getting people to follow “the rules.” It’s about helping them make more conscious choices. Choices that align with their values, priorities, and goals.

We (and our clients) think about lots of things before we buy and eat a food, such as:

• what’s convenient;

• what it costs;

• what’s healthy (or not);

• what we’ve done before (and in that case, we don’t really “think” about it);

• what’s available;

• what might taste good;

• what might feel good, distract us, or change our emotional state; and

• what is better for the environment, or more sustainable.

Each client has their own decision-making process and priorities.

Your role as a nutrition coach is to help your clients

become more aware of these processes and priorities — to help them see that choices are at the end of a pathway.

And, if needed, you can help them change those path- ways to change their choices.

As you look to deepen your own practice and increase your awareness, think about food within a larger web.

We’ll talk more about how to implement small, manage- able habits later in the course.

For now, just get the general idea:

Think about the big picture of nutrition, food, and eating. Notice how adding some context helps expand your understanding of what nutrition, food, and eating are all about.

Think about what might be most important for both you and your clients. Notice how there are lots of options for diverse clients. (Don’t worry, we’ll help you sort things and focus later.)

Think about how you might work towards those values and priorities as part of nutrition coaching. We know it’s a long-term project. Just start with today… and keep reading.

What is nutrition coaching?

We’ve started to give you some ideas about what nutri- tion coaching is.

Let’s look more closely now at what the role of nutrition coach involves.

First, congratulations.

Being a nutrition coach is an important job.

You’re often the first person a client sees when they want to look, feel, and / or perform better.

They might not go to their doctor or another health care provider. Instead, they might come to see you.

You’re part of your client’s social support system.

Many clients don’t have family or friends who are willing

Nutrition: The Big Picture | 17

to help and support them as they improve their exercise and nutrition choices. In fact, sometimes those family and friends can actively sabotage your client’s efforts.

In the beginning, you may be the only team member a client has.

You have the power to change lives.

If food and eating is information and a story, we can offer new information and revise that story.

You can help change your clients’ bodies. You can also help change their mindset about who they are and what they can do. You can help change their ability to make choices and try new things — to fully experience the world around them.

By helping prevent chronic diseases or nutrition-related disabilities, or helping them change their relationships with food, you might even save their lives sometimes.

What does a good nutrition coach do?

Fundamentally, a nutrition coach is a guide for change. We’ll talk about this more in Section 2.

Here are some things that all good nutrition coaches should do.

Be client-centered.

This means you’re an advocate and ally of the client. You want to help them do what matters most to them… not what matters most to you.

You listen to them. Try to understand their needs. Try to understand their lives.

You see them as unique individuals, and try to match your nutrition programming to what’s best for them.

Help clients take action.

Knowledge and information are great, but they’re not enough. Your clients need to do stuff.

Good nutrition coaches create clear, goal-driven, evi- dence-based nutrition plans that clients can immediately start putting into action.

Keep learning. Stay up to date.

Your clients want reliable, current, practical information they can understand and use.

This means that you should have a process of ongoing learning, information gathering and filtering, and shar- ing that knowledge.


Being a nutrition coach is a big and important job. But you don’t work alone.

Good nutrition coaches build and maintain a profession- al network with other health care professionals such as:

• doctors

• registered dietitians

• nurses

• physical therapists

• naturopaths

Think collaboration rather than competition. You’re all working together on your client’s team.

We also suggest you build a professional network to sup- port your own practice. Look for people such as:

• business coaches

• accountants

• marketers

• web designers

Have good boundaries. Know your scope of practice.

You’re not a therapist, medical doctor, or general fixit person. Good nutrition coaches understand clearly what they can and can’t do.

We’ll look more at client assessment and scope of prac- tice in Section 2, but here’s a general overview.

What’s your scope of practice?

You’re probably here because you’d like to be able to talk about nutrition with your clients, and to help them

18 | Introduction

improve their food and eating habits. But it’s not always clear what you can and can’t talk about with clients.

Here are the guidelines.

You can talk about nutrition with your clients… if you’re qualified to do so.

In most jurisdictions, certified personal trainers or other licensed health care professionals who have fundamental nutrition knowledge can answer questions or address concerns that their clients may have about nutrition.

Notice we emphasize the “fundamental knowledge” part. With specific training, such as that provided in this course, you’ll have that fundamental knowledge and be able to discuss nutrition with clients.

Know your options where you live.

Each state, province, and country has different rules for dispensing nutrition advice.

We’ve given you some resources below, and on our web- site, for learning more.

Offer general nutrition advice, not medical nutrition therapy.

(Unless you’re qualified to do so, of course.)

With this ISSA credential, you’re able to make general nutrition suggestions in most jurisdictions. You can also share nutrition education using materials from a public or well-known entity such as the American Heart Asso- ciation, the Centers for Disease Control and Prevention, and the Academy of Nutrition and Dietetics. (And of course, ISSA.)

But unless you’re licensed or otherwise certified to do so, you can’t offer specific advice in the form of medical nutrition therapy.

This means you can’t prescribe nutrition for specific health conditions and illnesses, such as:

• post-surgical nutrition

• diabetic nutrition

• cancer therapy nutrition

• nutrition to treat liver disease or kidney stones

• nutrition for clinical eating disorders such as anorexia

Of course, the general advice you give your clients will probably improve their health and lower their disease risk.

You just can’t offer directed advice that could reason- ably be considered part of medical therapy. You can’t use words like “diagnose”, “treat”, “cure” or “prescribe.” (And unlike a lot of kooks on the Internet, you can’t claim to magically eliminate all human suffering with your wondrous diet plans.)

It’s not always completely clear where the boundaries are, so when in doubt:

Collaborate with your professional network of other health care providers.

It’s 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, you’ll not only be able to expand your business network, you’ll have experts to turn to when you don’t know the answers to certain questions.

Learn the rules and regulations of your area.

The Center for Nutrition Advocacy provides a comprehensive guide to statue laws. Visit www. to fully understand your states statutes.

Nutrition: The Big Picture | 19

Case Study

Many clients come to us with “diet experience.”

Some have done lower-carbohydrate diets, like the At- kins Diet. Others have done low-fat diets, like the Ornish Diet. And others have done more “balanced” plans, like the Zone Diet.

One client followed all three plans at one point or an- other, along with exercise.

In each case, the process and results were the same:

• He followed the diet.

• He lost about the same amount of weight.

• He gained it all back… and usually more.

• He tried another diet.

No matter what diet he tried — despite how “differ- ent” these diets were from each other — the same stuff happened.

How can this be?

Well, instead of focusing on what makes diet plans dif- ferent, let’s look at what makes them similar.

The client got the same results with different diets because all three plans forced him to follow a key rule of good nutrition:

All three plans, together with his exercise plan, forced him to control his energy balance.

To lose weight, we need a negative energy balance. In other words, we need to take in less energy (in the form of food) than we expend (in the form of metabolism and activity).

If someone loses weight, they’ve somehow managed to get into negative energy balance.

In this case, that’s what did the trick — not the lack of

carbohydrates. Or reducing fat. Or a specific macronu- trient ratio.

All three plans create a negative energy balance in three ways:

1. When clients follow a “weight loss plan”, they usual- ly eat less. This decreases “energy in.”

2. Exercise increases “energy out.”

3. Both Atkins and Ornish ask dieters to restrict either dietary carbohydrate or dietary fat. The Zone plan asks dieters to eat a specific ratio of macronutri- ents — which usually means that people eat less of whatever they were eating “too much” of. Is it any wonder that by asking dieters to avoid eating some- thing, they’ll end up eating less?

It wasn’t some magical macronutrient mix that made the client lose weight. It was plain old energy deficit. (You’ll learn more about energy balance in an upcoming unit.)

However, all three experiments ultimately failed.

Each time, the client rebounded. He gained more weight after losing it. After giving up, he got off track, stopped exercising, and started eating poorly again.

However, it wasn’t the food that caused this rebound. It was many other lifestyle factors. The problem wasn’t what he was eating necessarily… but how he was eating and living.

Only when we started to address these key factors did the client change his fundamental habits… and lose his excess body fat for good.

In this program, you’ll learn that both the what (i.e., the food itself) and the how (i.e., how we eat and live) are crucial elements in change.

20 | Introduction

What this program will cover

Here’s what we’ll do in the rest of this textbook and this course.

• Dispel common myths and fallacies associated with nutrition.

• Give you the foundational knowledge you’ll need to make general nutritional recommendations to a variety of clients.

• Provide and explain nutrition theory and science.

• Give you a clear process and walk you through the steps of preparing for, assessing, evaluating, and making recommendations for clients.

• Give you a set of resources that you can use almost immediately in your coaching practice (if you have one already).

You should finish this course with both a better under- standing of exercise nutrition and the tools used to deliv- er nutritional recommendations.

Important note

Completing this course will not qualify you as a registered dietitian, licensed dietitian, or licensed nutritionist. Check with the licensing bodies in your area if you are hoping to get licensed.

Nor will this course allow you to provide medical nutrition therapy.

Instead, this course will provide you with continuing education in the field of nutrition.

It will enhance your credibility, your confidence, and your skill set.

And it will help you overcome the biggest limiting factor your clients face every day: poor nutrition.


Food is fuel, but it’s so much more than that. Food gives us important substances such as micronutrients, phyto- and zoochemicals. We need all of these nutrients to live and thrive.

Living organisms are not machines. Human bodies aren’t combustion engines. They’re more complex than simple inputs and outputs.

Food is information and a story. Physiologically, socially, and even environmentally, food and eating gives us important information about things like:

• chemical interactions in our body;

• how we relate to ourselves and one another socially and culturally;

• how we make choices about what to eat (or not); and

• how larger forces shape how food is produced and consumed.

Good nutrition plans:

• control energy balance;

• give us nutrients;

• help us look, feel, and perform our best;

• are outcome-based;

• are sustainable for both us and the planet;

• are about removing limiting factors; and

• look for strengths and wins.

What’s the best diet? Trick question! There isn’t one. The best coaches don’t have a single nutrition philosophy, and use data and evidence to make decisions.

Clients are diverse. The human body adapts amazingly well to many different ways of eating. You can be healthy and perform well on many diets.

Good nutrition is more similar than different. It:

• asks people to care about their food and eating;

• focuses on food quality;

• helps eliminate nutrient deficiencies;

Nutrition: The Big Picture | 21

• helps control appetite and food intake; and

• promotes regular exercise.

Being a nutrition coach is an important job. You’re often the first person a client sees when they want to look, feel, and / or perform better. You’re part of your client’s social support system. You have the power to change lives.

A good nutrition coach will:

• be client-centered;

• help clients take action;

• keep learning; stay up to date;

• collaborate; and

• have good boundaries; know your scope of practice.

What’s your scope of practice?

• You can talk about nutrition with your clients… if you’re qualified to do so.

• Know your options where you live.

• Offer general nutrition advice, not medical nutrition therapy.

• Collaborate with your professional network of other health care providers.

• Learn the rules and regulations of your area.

This program will:

• help to dispel common myths and fallacies

• give you the foundational knowledge you’ll need to make general nutritional recommendations to a variety of clients

• provide and explain nutrition theory and science

• give you a clear process for preparing, assessing, evaluating, and making recommendations for clients

• give you resources that you can use almost immediately

• give you a better understanding of exercise nu- trition and the tools used in delivering nutritional recommendations

SECTION ONE NUTRITION SCIENCE 1 Cells, p23 2 Through the GI Tract, p45
1 Cells, p23
Through the GI Tract, p45
3 Energy Transformation and Metabolism, p77 4 Energy Balance in the Body, p112 5 6
Energy Transformation
and Metabolism, p77
Energy Balance in the Body, p112
Macronutrients, p155
Micronutrients, p197
Water and Fluid Balance, p230

Aerobic and Anaerobic Metabolism, p137

UNIT 1 Cells

24 | Unit 1

Unit Outline


5. Parts of cells

1. Objectives

6. Body function

2. Cell structure and function


7. Cell types

3. How the body is organized

8. Summary

4. Nutrition and cellular interaction


In this unit, you’ll learn how your body’s cells:

You should be able to recognize:

• get nutrients from the food that we eat, and

• the main cell organelles;

• what each organelle does; and

• use these nutrients for the raw materials and fuel to keep us alive.

At the end of this unit, you should have a working knowl- edge of how humans are organized, from the organismal level all the way down to the atomic level.

• how each organelle interacts with organic molecules to do its most important jobs in the body.

You’ll start to build the foundation of physiological knowl- edge that you’ll need to make and apply nutrition plans.

Cell structure and function

The cell is the most basic structural and functional unit of all living things. All living tissues are built from ells.

In terms of nutrition, our cells have two basic roles:

• to get nutrients from the food that we eat, and

• to use these nutrients for the raw materials and fuel to keep us alive.

How your body works depends on how each cell works.

Adult humans have trillions of cells. All work together to keep us alive.

metabolism: Sum of reactions that take place to build up and break down the body

To do these basic jobs, cells must:

• grow, mature, and die;

• exchange gases like oxygen and carbon dioxide (i.e., respiration);

• absorb and digest nutrients;

• circulate blood and other fluids;

• get rid of waste; and

• reproduce.

Together, these cellular tasks are known as metabolism.

Cells | 25

F. Organ Tissues combine to form organs. Example: heart. E. Tissue Cells form tissue. Example:
F. Organ
Tissues combine
to form organs.
Example: heart.
E. Tissue
Cells form tissue.
Example: cardiac
muscle tissue.
D. Cell
Organelles work together
to form cells. Example:
cardiomyocytes (cardiac
muscle cells).
C. Organelle
Molecules and atoms combine
to form organelles.
Example: nucleus.
B. Molecule
Atoms combine to form a molecule.
Example: deoxyribonucleic acid
A. Atom
Chemicals, such as carbon,
hydrogen and oxygen, are
the basic units of matter.
Example: carbon.
G. Organ System
Organs work together to form
organ systems.
Example: circulatory system.
H. Complex Organism
Organ systems sustain
complex organisms.
Example: you.

Figure 1.1. Organization of the human body. Atoms combine to form molecules. Molecules and atoms combine to form organelles. Organelles work together to form cells. Similar types of cells form tissue, and tissues join to make up the various bodily organs. Groups of organs that work closely together form organ systems, and it is these organ systems that ultimately sustain an organism.

We need proper nutrition for our cells to work proper- ly. This means getting the right nutrients in the right amounts.

When we eat well, our cells function well. When we don’t eat well, problems happen.

Healthy cells means healthy metabolism. Unhealthy cells means unhealthy metabolism.

How the body is organized

Cells — and by extension, the body — is organized into systems, each system nested into another. See Figure 1.1.

And the body lives within even larger systems.


Our body lives within ecosystems — dynamic, interac- tive, interconnected networks of living things.

Some scientists even think that given how many bacteria are on us and in us, humans aren’t even really “separate” bodies at all!


The organism is, well, you.

An organism is a definably self-contained living system.

26 | Unit 1

For the purpose of this program, we can say that you as a human are a distinct organism. (Bacterial buddies notwithstanding.)

homeostasis: The body’s ability to maintain a stable and constant internal condition

As an organism, the human body can reproduce, replace, and repair itself, all to stay alive and to maintain homeostasis: the state of balanced function in the body.

Organ systems

Complex organisms, such as humans, are made up of organ systems.

Integumentary system: This system protects the body from external damage. It includes your skin, hair, nails, sweat glands, and other external structures.

Skeletal system: This system gives the body a rigid structure so that it can move and hold itself up. It includes your bones, tendons, ligaments, and other structures.

Muscular system: This system moves us, whether it’s to move you across the room, to move your blood through blood vessels, or to move food through your intestines. This system includes your skeletal muscles, cardiac muscles (in your heart), and smooth muscles (part of arteries and veins, bladder, gastroin- testinal tract, respiratory tract, uterus, and more).

Nervous system: This system sends electrochemical signals that trigger thoughts, emotions, and movement as well as involuntary activity (such as breathing). It includes your brain as well as a vast network of nerves and sup- porting structures.

Endocrine system: This is your cellular communication system. It includes your hormonal organs and glands, including the hypothalamus, pineal gland, pituitary gland, thyroid gland, liver, pancreas, kidney, adrenal glands, testes, ovaries, and more.

enzyme: Substance that helps catalyze chemical reactions

Circulatory system: This system transports hormones, enzymes, nutrients, and other chemicals throughout the body. It includes your heart, blood, and blood vessels.

Immune system: This system protects against pathogens, tumor cells, and other foreign invaders. It includes your thymus, lymph nodes, spleen, tonsils, and other similar organs.

Respiratory system: This system brings in oxygen and excretes carbon dioxide. It includes your nasal cavity, trachea, lungs, and other airways and gas exchange organs.

Digestive system: This system breaks down and absorbs nutrients from food and drink. It includes your oral cavity, esophagus, stomach, intestines, and the other organs associated with digestion including the liver, gallbladder, pancre- as, and bile duct.

Urinary system: This system produces, stores, and eliminates urine. It in- cludes your kidneys, ureters, bladder, urethra, and related organs and glands.

Reproductive system: This system controls reproduction as well as sexual development. It includes your sex organs and glands.

Cells | 27

While these organ systems have distinct jobs, they also work closely together. This is important for nutrition coaching.

For instance, if something is out of order in the gastrointestinal tract (say, with a client who often gets an upset stomach), it’s probably out of order elsewhere (for instance, in the endocrine system or nervous system). We’ll talk more about this in later units.


Organ systems are made up of individual organs. Each organ has at least one spe- cific job, and often several.


Collectively, our tissues make up our organs.

Epithelial tissues make up our skin.

Connective tissues make up structures such as our joints and fascia.

Muscle tissues make up our skeletal muscles and heart, and are part of sever- al other organ systems

Nervous tissues make up our brain, nerves, and associated structures.

Our tissues do many things, such as:

• form protective barriers against outside invaders (epithelial tissues);

• hold us together (connective tissues);

• move the body around (skeletal muscle tissues); or

• communicate between cells (nervous tissues).


Tissues are made up of large groups of cells.

Cells range in size from about 7 to 300 micrometers. To give you some perspec- tive, the dot over this letter “i” is about 100 micrometers.

Cells show us how living matter is wonderfully unique in its diversity. For ex- ample, immune cells can engulf pathogens and destroy them, while muscle cells have sliding filaments that cause muscle contraction and relaxation. (Fun factoid! The axon of a motor neuron in the spinal cord can be up to 1 meter long.)


Each cell is like a tiny city. Within each cell are organelles, collections of mole- cules / chemicals that have particular jobs, much like different utilities (such as power production or waste disposal) within a city.

organelle: Component of the cell that is responsible for a spe- cific task

There are over 24 known organelles. We’ll talk about the most important ones — such as the endoplasmic reticulum (ER), Golgi apparatus, and mitochondria — in this textbook.

These organelles do their jobs in a semi-fluid matrix called the cytosol.

cytosol: Internal fluid portion of the cell

28 | Unit 1

atom: Basic unit of a chemical element

molecule: Group of atoms bonded together

macromolecules: A large molecule


Fundamentally, we are a soup of chemicals.

Chemicals are built from structures of varying sizes, from atoms (smallest), to molecules, to macromolecules (largest).

Macromolecules are made up of groupings of molecules. Molecules are made up of tiny particles called atoms. And these atoms, which are invisible to the naked eye, make up all material things of the universe.

So if you think about it, nutrition coaching is really about harnessing the funda- mental particles of everything that exists.

As astronomer Carl Sagan famously said, “The cosmos is also within us. We’re made of star stuff.”

Our body can only do what it does if our cells, and the organelles within them, can do what they do: send and receive messages, create proteins, etc. Indeed, nearly everything that happens in the body is based on making proteins, and what those proteins do.

Think of the body as a manufacturing plant — that also manufactures itself. The proteins we make not only break down and rebuild the plant itself, they break down and rebuild the machines, the workers, the messengers, and lots of other stuff.

We’ll get more into this idea as the unit progresses. For now, just remember that every level of human organization depends on the health of important subunits — our cells — and the proteins they make.

Nutrition and cellular interaction

macronutrient: Nutrient the body requires in large amounts (i.E., Protein, fat, carbohydrates)

micronutrient: Organic com- pound the body requires in very small amounts (i.E., Vitamins and minerals)

compounds: Consisting of two or more substances

potential energy: Energy stored within a physical system

co-factor: Non-protein com- pound that interacts with another substance to facilitate a transformation

hormone: Compound created by one cell that travels to and stimu- lates another cell

In general, the macronutrients (proteins, carbohydrates, and fats), micronutri- ents (vitamins and minerals), phytochemicals, and zoochemicals we eat are bro- ken down through the digestive process into smaller compounds such as amino acids, glucose, fatty acids, etc.

These digested and absorbed compounds then travel through our bloodstream to interact with our cells. Our cells use those compounds in many ways, such as:

1. To provide potential energy that’s later released by breaking the chemical bonds between the macronutrients.

2. To provide raw materials that can then be incorporated into our body structures, including tissues and organs.

3. To act as co-factors for chemical reactions in the body. All of the chemical reactions that take place in the body require the help of particular proteins called enzymes. These enzymes often use nutrients gathered from the food we eat to do their job.

4. To stimulate the release of hormones, which act as chemical messengers, directing overall body function with their unique messages.

Cells | 29

Cell nucleus contains chromosomes. DNA provides cellular instruction for making proteins. Chromosomes contain DNA.
Cell nucleus contains chromosomes.
DNA provides cellular instruction
for making proteins.
Chromosomes contain DNA.

Figure 1.2. DNA inside the nucleus. Wrapped up in chromosomes, our DNA, or genetic code, dictates which proteins are formed in the body. The nucleus of each cell contains this genetic code. Each person has a unique genetic code that influences how we respond to ingested foods.

Because of these various and important roles that nutrients have, the food we eat can fundamentally change how our body works. No wonder nutrition is so critical!

Nutritional individuality

In the previous unit, we looked at why there is no one “best diet.”

One reason is that not everyone responds the same way to the digestion and absorption of particular foods — or to the uptake of particular nutrients into the cell. Research suggests that although the basic mechanics are the same, there are important and intriguing individual differences, which are likely due to our unique genetic makeups.

Each cell in our body houses our genetic code, a series of nucleic acids called DNA, in an organelle called the nucleus. This code, which is unique to each of us, provides cellular instructions for making proteins we need for our structure and function.

As we all have slightly different genetic profiles, the proteins we make may also differ. These variations are responsible for our individual responses to the food we eat. See Figure 1.2.

genetics: Specific, inherited DNA of an organism, which influences what they become, although environment also plays a key role in the expression of an organism’s genetic code

DNA: Nucleic acids that contain instructions for heredity

nucleus: Organelle where ge- netic material is housed

In general, these differences are quite small. All humans share over 99.9% of

30 | Unit 1

gene: A particular sequence in DNA or RNA that controls the expression of a protein, and, by extension, influences the charac- teristics of an organism

evolutionarily conserved:

Something that’s remained es- sentially unchanged throughout evolution

the same genes. You may have even heard that humans and chimpanzees share between 95% and 98% similarity in their DNA, which is also true.

In addition, many important genes have been evolutionarily conserved. This means that those genes appeared very early in our evolutionary history, perhaps even back in the days of single-celled bacteria.

For instance, much of what we know about the health effects of fasting comes from research on a tiny, primitive flatworm known as Caenorhabditis elegans. C. elegans has nearly 200 known genes that respond to dietary restriction. These genes are involved in things like knowing when metabolism is disrupted; looking for and repairing DNA damage; and hunting for cancer-type overgrowths. We share 45 of those genes.

Thus, we are much more alike than we are different.

genetic polymorphism:

Variation in the form of one or a sequence of genes

However, these small genetic differences, called genetic polymorphisms, explain why some people respond slightly differently to various types of foods. These differences may also explain why many research studies seem to have confusing or conflicting conclusions.

Differences in nutrient processing

For example, we all have a gene in our liver for making a particular enzyme that breaks down caffeine. However, due to these small genetic differences, some of us have the enzyme that breaks down caffeine quickly. Others have the enzyme that breaks down caffeine slowly.

• In people with the fast enzyme, caffeine is processed and removed quickly, while the antioxidants found in coffee can help protect against free radicals.

• However, in people with the slow enzyme, the caffeine hangs around longer, causing health problems.

So imagine a study that asks: “Is 1-3 cups of coffee a day healthy or unhealthy?”

bioactive: Having a biological effect

The answer would be: “For whom?”

Differences caused by nutrients themselves

Not only are there individual differences in response to the same foods, different foods have particular nutrients and other bioactive components that can actually change the message expressed by our unique genes.

For example, isothiocyanates found in broccoli can switch on a gene in the liver that detoxifies cancer-causing chemicals and other toxins.

upregulated: An increase of a cellular component

Without the broccoli, this gene stays inactive. Our body looks for other detoxifi- ers. With the broccoli, this gene is upregulated and participates more actively in the detoxification process.

Some of us have this gene, and some don’t. If we don’t have the gene, broccoli can’t help us fight cancer in this particular way. (Of course, broccoli does other good things.)

Another example is cooked tomatoes, which contain compounds (lycopenes)

Cells | 31

that switch off growth-promoting genes in the prostate. With cooked tomatoes in the diet, prostate cancer risk decreases; without the tomatoes, risk increases.

Fish oil is yet another example. Fish oil (specifically DHA — a fatty acid found in fish, other marine animals, and fish / algae oil supplements) might signal genes in the brain to produce a chemical that preserves brain function with age. People who consume more omega-3 fats tend to have better cognitive function as they age, compared with those who consume less.

Thus, nutrition can strongly influence our gene expression. And our genes, in turn, affect how we respond (or don’t) to a given nutrition plan. This genetic di- versity and its relationship with nutrition is an emerging area of research called nutrigenomics.

DHA: Docosahexaenoic acid, an omega-3 fatty acid

nutrigenomics: Study of how genes respond to nutritional intake

Needless to say, there is an important relationship between what we eat and how our cells function. Throughout this course, this interaction will become clearer.

By the end of this course, you should have a better grasp of how to optimize health, body composition, and performance by controlling nutrient intake. However, before we talk more about food, let’s discuss the cell in depth, and in particular, the main cellular components and organelles.

Parts of cells

To better understand how the food we eat interacts with our body, it’s important to learn about the structures, chemicals, and organelles within each of our cells. In this unit, we’ll review the following organelles:

Plasma membrane

Golgi apparatus





Endoplasmic reticulum

These organelles and approximately 17 others (there are about 24 or so in total) give our cells their structure and function, which are in turn often shaped by our nutrient intake.

Plasma membrane

Around the edge of each cell is a boundary, known as the plasma membrane, which separates the cell from its neighbors and from the rest of our body. The plasma membrane’s bilayer (double layer) acts like a protective wall, keeping important chemicals in while keeping harmful chemicals out.

The plasma membrane is made up of lipids, proteins, cholesterols, and other chemicals. It has an interesting nature: while it forms a structural boundary between the cell and the rest of the body, this boundary is flexible and fluid-like. Membranous organelles — specialized sacs and canals — can float around with- in the plasma membrane, rather like icebergs floating around in the ocean.

This fluid-like boundary is made up mostly of phospholipids, molecules with phosphate “heads” and fatty acid “tails.” The phosphate “heads” of the lipid molecules that form the bilayer are hydrophilic (water-loving) and therefore can

plasma membrane: Lipid bi- layer that is permeable to certain compounds that contains the cell

lipids: Any class of organic com- pounds that are fatty acids or their derivatives

cholesterol: Synthesized in the liver; precursor of bile acids and steroid hormones

phospholipids: A type of lipid with a hydrophilic phosphate group “head” and hydrophobic fatty acid “tail” that forms cell membranes

hydrophilic: Strong affinity for water

32 | Unit 1

Extracellular space Hydrophilic region Phospholipid Hydrophobic region Hydrophilic region Intracellular space
Extracellular space
Intracellular space
Figure 1.3. Plasma membrane. The plasma membrane is composed of lipids, proteins, cholesterol and other chemicals. The lipid
bilayer has water-loving (hydrophilic) heads and water-fearing (hydrophobic) tails. Substances generally pass through the plasma
membrane via a transmembrane protein.

hydrophobic: Lack of affinity for water

bond to water-based molecules. On the other hand, the fatty acid “tails” of the lipid molecules that form the bilayer are hydrophobic (water-fearing) and bond best with fat-based molecules.

This dual-purpose membrane creates a boundary that regulates what gets into and out of cells. See Figure 1.3.

The cell needs to be choosy about what can enter and exit. Thus, most molecules must enter the cell through one of several membrane proteins. These proteins are like gates in a fence, allowing only particular molecules to pass through. We’ll talk more about these cellular proteins later in this unit.

Because of this lipid structure, the types of fats we eat can change how fluid or flexible the cell membrane can be.

• Too much saturated fat may cause the membrane to be too rigid.

• Too much polyunsaturated fat may cause the membrane to be too fluid.

Cells | 33

Because most people eat too many saturated and trans fats, we often need to balance that with getting enough mono- and polyunsaturated fats. We’ll look

at this more later on. For now, just remember that fat balance affects how the cell

works in important ways.


The interior space of the cell is composed of a gel-like solution called cytosol. Many organelles, enzymes, salts and other organic molecules, including stored carbohydrates and fats, are suspended and maintained by the cytosol. The body

carries out many of its chemical reactions in this gel-like matrix, including most

of its enzymatic reactions. Cytosol, together with all the organelles, except the

nucleus, are called cytoplasm.

The cytosol is rich in stored carbohydrates that can be broken down quickly and used to transfer energy. This process is controlled by cytosolic enzymes.

saturated fat: A fat with no dou- ble bonds between the individual carbon atoms of the fatty acid chain

trans fat: Fat derived from the partial hydrogenation of vegeta- ble oils

monounsaturated fat: A fat with one double bond between the carbons in the fatty acid chain

polyunsaturated fat: A fat with two or more double bonds between the carbons in the fatty acid chain

cytoplasm: The protoplasm within a cell, excluding the nucleus

Exercise and other physical activity creates a demand for more energy. The cell responds by making more of these enzymes along with storing more carbo- hydrate and fat for future use. The cell also gets better at breaking down these

carbohydrates for energy. This is especially true in skeletal muscle cells, since this

is where active people need most of their energy.

A key point here for nutrition coaching is that regular exercise and other activity

can powerfully affect cellular makeup, metabolism and function. Activity can fun- damentally change how the body uses, processes, and stores nutrients. Active bod- ies will thus respond differently than inactive bodies to the same nutrition plan.


Mitochondria (plural of mitochondrion) convert nutrients into energy.

Just like you can’t eat an egg until you crack open its shell (well, at least we don’t recommend it), you can’t use the energy stored in carbohydrates, proteins, and fats until you break their chemical bonds. Mitochondria convert the energy released from this process into adenosine triphosphate (or ATP), the energy currency of the cell.

mitochondria: Organelles that supply the cells’ energy / ATP (singular: mitochondrion)

adenosine triphosphate: ATP, source of energy for physiological reactions

Mitochondria produce most of the body’s energy — about 95% of it. The rest is produced in other parts of the cell. If mitochondria don’t work well, we don’t work well. (Or at all.)

Mitochondria make ATP in their inner mitochondrial membranes. The outer membrane of the mitochondrion is porous, while the inner membrane is the main barrier between it and the rest of the cell. The inner membrane contains folds called cristae, which are studded with the enzymes and structures that help make ATP.

mitochondrial membrane:

The double biomembrane sur- rounding the mitochondrion

Since the mitochondria generate power for the cell, more mitochondria means more energy, and more active cells. Conversely, the more active we are, the more mitochondria we likely have (and since your heart is beating all day, every day, it also has plenty of mitochondria to keep pace). More mitochondria means more total energy production for a muscle.

34 | Unit 1

circadian: Any biological process that recurs naturally on a day- night cycle

Nutrition in practice

Your skin color, body size, hair type, and risk of specific illnesses all depend on how your genes interact with your environment.

For instance, your genes may suggest that you’ll grow to somewhere between 5’5” and 5’8.” But your actual height is an interaction between genes and envi- ronment. If you grow up malnourished, you won’t ever reach 5’8.”

What we eat early in life (and what our moms eat while they’re pregnant) can affect our genes and regulate our traits — including the development of diseas- es, even decades later.

For example, data from the WWII Dutch Famine show that children of under- nourished mothers had higher risk for cardiovascular disease, obesity, and breast cancer later in life. (In fact, this “famine memory” can persist for generations, “remembered” by descendants’ genes.)

Our genes can be influenced by all kinds of things, such as:

• nutrient deficiencies or excesses (especially at crucial developmental stages);

• dietary components (e.g., omega-3 fats, phytoestrogens, cruciferous vegetables, lycopene, folate, carotenoids, and so forth);

• sunlight and vitamin D;

• toxins (such as industrial chemicals, pesticides, heavy metals);

• bacteria and viruses;

• exercise and activity;

• alcohol and other drugs;

• stress, trauma, and mood;

circadian rhythms (such as sleep, shift work, light-dark cycles, and travel across time zones); and

• a host of other factors we probably don’t even know about yet.

If that sounds a little scary, consider it from the opposite perspective: While we can’t control our genes themselves, we can affect their expression — whether they’re likely to get “switched on” or off.

Our genetic expression is strongly shaped by our environment… over which we do have some power. So, if we know more about our genetic variants, we might be able to adjust our lifestyle or environment in order to prevent some illnesses or become healthier.

Cells | 35

For example, certain gene variants can tell us:

• how food is metabolized;

• whether carcinogens in cooked meats will influence the development of colon and prostate cancers; or

• our inflammatory response and efficiency of DNA repair / replication.

If we know more about our own unique risk factors, we might be more likely to make healthier choices — choices that could improve our genetic expression.

Genetic screening may show us the way to individualized nutrition and exercise prescriptions. But we’re not quite there yet. Here’s what we know right now.

One size doesn’t fit all.

Genetic subgroups might respond differently to different foods and activity types. In theory, genetic screening might help us customize food (and supple- ment) intake and exercise prescriptions for each person’s unique needs.

The details are kinda hazy.

In practice, it’s not as clear how genetic diversity might play out or how much it even matters. After all, we also choose food and exercise based on other things like taste, preference, convenience, price, and cultural norms.

Gene expression isn’t a destiny. It’s a set of possibilities.

What if your genes show you’re all slow-twitch endurance athlete but you think fast-twitch sprint events are more fun? How closely should you stick to your “blueprint”? How much can you affect your genetic expression through envi- ronment and habitual choices?

We don’t have all the answers yet.

Measuring nutrient-gene interactions takes time and effort. Genetic mapping is complicated, sometimes expensive, and error-prone. And for any of this to mat- ter, gene testing has to tell us what to actually do with that information. Genetic testing is interesting. Provocative. Complex. And let’s be honest, kinda cool. But for now, it raises more questions than it answers.

Stay tuned.

When genetic screening companies are able to more cost-effectively test the entire genome (again, most only test a part of it) we should have a greater understanding of gene sequencing and its use in nutrition. Most experts predict that’ll happen within a few years, as the cost of sequencing the entire genome drops from $10,000 to $500.

36 | Unit 1

Matrix Cristae Outer membrane Inner membrane Figure 1.4. Mitochondria. Inside the mitochondria is where energy
Outer membrane
Inner membrane
Figure 1.4. Mitochondria. Inside the mitochondria is where energy converts to ATP. The number of mitochondria in a cell is directly
related to the activity of the cell.

Elite athletes usually have a high mitochondrial density. This means they not only build more total mitochondria with training, they also build more mitochondria per unit of muscle mass. This gives them the ATP they need for high-level performance. Once again, we can see how regular movement and activity can change the funda- mental structure and function of cells.

Having a lot of mitochondria is good, but we also want them to be effective. In other words, we want mitochon- drial quality as well as quantity. In order to understand this, let’s look at a little bit of biochemistry.

When we make ATP for energy, our cells consume oxygen, and produce reactive oxygen species (ROS) as a byproduct. Just as with nutrient processing, not every- one does this at the same rate.

Different people may make ATP at different rates. They may use different amounts of oxygen to do this; they may need different amounts of food energy to do this; and they may produce different amounts of ROS in the process.

In general, although ROS are a natural part of this reac- tion, we don’t want to make too many at once, or have them hanging around too long. ROS can cause cellular damage, including damaging our DNA.

Scientists used to think that the more oxygen we con- sumed, the more ROS we’d make. However, we now be- lieve that mitochondrial efficiency changes this equation.

• People with less-efficient mitochondria make more ROS with every unit of ATP they produce.

• People with more-efficient mitochondria make fewer ROS for the same amount of ATP.

So if your mitochondria are efficient, you make lots of energy with fewer damaging waste products. You feel great, you perform well, and you live longer.

While there is a genetic component to mitochondrial function, it’s strongly affected by how we live, what we eat, and what we do.

See Figure 1.4 for more.

Cells | 37

Nutrition in practice

Nutrient deficiencies can affect our mitochondrial function. Statin drugs, de- pression, fibromyalgia, or Parkinson’s disease are all associated with low levels of co-enzyme Q10 (CoQ10). We need this compound for energy production in the mitochondria.

Another compound, an amino acid called L-carnitine, is also involved in energy production in the mitochondria. L-carnitine is found mainly in animal foods. While our body can make L-carnitine, clients who eat a mostly or entirely plant- based diet might find supplementation helpful.


The nucleus, usually found in the central part of the cell, is the largest organelle. Most cells have only one nucleus, though muscle cells have more than one. The nucleus is Mission Control, home of our DNA, also known as the genetic code.

Wrapped up in chromosomes, our DNA dictates which proteins are formed in the body. This ultimately determines everything from how the body develops, to how it repairs itself, to how it transports and / or metabolizes every chemical introduced into circulation. In many ways, our DNA also determines how mus- cular we can get.

As we’ve discussed, there is an important link between our DNA, our food intake, and our health. In fact, much of what we eat interacts directly with our DNA or causes hormonal cascades that influence our DNA.

These relationships begin in our nucleus: Chemicals can bond with our DNA to begin making cellular proteins, processes called transcription and translation.

ER and Golgi apparatus

The endoplasmic reticulum, or ER, is a “circulatory” network found inside the cytosol, near the nucleus.

When our DNA sends out a signal to make proteins, the ER and Golgi apparatus receive this genetic message. They then make and transport the proteins.

There are two types of ER: smooth and rough.

Rough ER is lined with ribosomes, which give it a “rough” appearance. Ribo- somes are the protein factories of the cell.

Smooth ER doesn’t have ribosomes, so it doesn’t make proteins. Instead, it builds lipids, steroid hormones, and carbohydrates to use in glycoproteins.

chromosomes: Located in the nucleus, contain genetic information

transcription: The synthesis of RNA using a DNA template

translation: Forming a protein molecule based on the informa- tion contained in the mrna

endoplasmic reticulum:

Cytoplasmic membrane that translates proteins

Golgi apparatus: Cytoplasmic organelle necessary for the modi- fication and transport of proteins

ribosomes: A complex rich in RNA and protein found in cells

steroid hormones: Hormones possessing steroid ring system, including androgens, estrogens, and adrenocortical hormones

glycoproteins: Protein that contains a carbohydrate group, involved in membrane integrity

38 | Unit 1

Rough endoplasmic reticulum (ER) Nucleus Transport vesicle Cis (C) face: from ER receives transport vesicles
Rough endoplasmic
reticulum (ER)
Transport vesicle
Cis (C) face:
receives transport
vesicles from ER
Golgi apparatus
Trans (T) face: produces
vesicles for cellular
use or for excretion
Transport vesicle
from Golgi apparatus
Figure 1.5. Endoplasmic reticulum and Golgi apparatus

protein synthesis:

Manufacturing of proteins from amino acids; guided by DNA

ribonucleic acids (RNA):

Various nucleic acids on a single strand containing ribose and uracil, necessary for the control of cell activities

cisterna: Flattened membrane disc of Golgi apparatus (plural:


vesicles: Fluid filled pouch/ sac that can transport and store compounds

lysosome: Organelle containing hydrolytic enzymes

microorganism: Organism of microscopic size

peroxisome: Cytoplasmic orga- nelle with enzymes that help with the breakdown of fatty acids and other macromolecules

Making proteins, or protein synthesis, takes place using ribonucleic acids (RNA).

Once these proteins are synthesized in the ribosomes of the rough ER, they move towards the Golgi apparatus. This organelle prepares the newly formed protein molecules that will leave the cell.

The Golgi apparatus contains cisternae (tiny disc-like “holding tanks”, similar to the word “cistern”) that are stacked on one another and small, circular vesicles. These vesicles (small sacs) act like little chaperones, engulfing the protein mole- cules and transporting them to the cell membranes, where they’ll either be sent elsewhere into the body, or incorporated into the membrane itself. See Figure 1.5.

Proteins are thus always being built up and broken down within our cells. This takes energy and protein for raw materials. If we don’t eat enough, or don’t eat enough protein, our cells can’t do their jobs of synthesizing and transporting the proteins we need. Over time, this can lead to problems such as hormonal imbalances, depressed immune function, or poor recovery from exercise (per- haps even injuries).

Lysosomes and peroxisomes

Lysosomes are the “garbage disposal units” of our cells. They are vesicles, con- taining more than 50 different enzymes, which can break down cellular com- ponents and protect cells. If a large molecule, such as an old cellular structure or a microorganism, enters the cell, the lysosome will engulf it then digest and dispose of it. By keeping the cells clear of waste and debris, lysosomes help renew and protect the cell.

Peroxisomes are similar to lysosomes: they are small membranous sacs

Cells | 39

containing enzymes (catalase and oxidase), which also detoxify harmful sub- stances that enter cells. Found commonly in liver and kidney cells, peroxisomes are also important in cholesterol synthesis, bile acid synthesis, ß-oxidation, and prostaglandin metabolism.

Like mitochondria, peroxisomes are able to break down fats for energy. However, when they do this, they produce 30-40% more energy as heat but 30% less energy as ATP.

Since dietary omega-3s increase fat breakdown through peroxisomes, more fat is burned to do the same daily activities when omega-3 intake is high. Unfor- tunately, omega-3 supplementation is not a magic fat loss method: The overall impact is minor.

Body function

Let’s look now at how these cellular components, and the chemicals they make and use, work together within the body.

detoxify: To remove a poison or toxin from the body

cholesterol: Synthesized in the liver of humans and other animals. A precursor of bile acids and ster- oid hormones

bile: A yellow or orange fluid pro- duced by the liver, concentrated and stored in the gallbladder, and released into the small intestine for fat digestion

ß: Beta, the second letter of greek alphabet

prostaglandin: Class of physi- ologically active fatty acid com- pounds present in various tissues; can have hormone-like effects


Enzymes make up the largest group of proteins in the body. You can often spot enzymes by their names, which typically end in “-ase”, such as:

• lipase (enzymes that break down lipids);

• protease (enzymes that break down proteins); or

• amylase (enzymes that break down carbohydrates).

Enzymes are important biological catalysts, substances that jump-start and speed up nearly every chemical reaction that occurs in the body.

Enzymes work by exposing their own “active sites” to connect with particular molecules. Once the
Enzymes work by exposing their own “active sites” to connect with particular
molecules. Once the enzyme can hold these molecules in place, reactions can
occur. One model of this process is the lock-and-key model. In this model, the
substrate bonds
active site

catalyst: A substance that accel- erates a chemical reaction

lock-and-key model: Model that explains enzyme specificity

Figure 1.6. Enzymes. Enzymes expose their own “active sites,” connecting with spe- cific molecules. Holding these molecules in place, they allow reactions to occur, which allows for product formation.

40 | Unit 1

induced fit model: Model that suggests enzymes are rather flex- ible structures

enzyme and its chemical partner fit together tightly and carry out their reaction. In another model, the induced fit model, the enzyme and chemical partner undergo structural changes when close to one another, eventually fitting together properly and starting the reaction. You can think of this like puzzle pieces that change their shape when they are near each other.

No matter what model you apply, the key idea is that enzymes must somehow fit and connect with their chemical partners. Lipase can only work with lipids; it can’t work with proteins.

See Figure 1.6.

Many environmental, genetic, and nutritional factors — including temperature, pH, substrate concentration, and vitamin and mineral status — influence how en- zymes work. Thus, nutrition plays an important role in most enzymatic reactions.

co-enzyme: Non-protein com- pound that forms the active por- tion of an enzyme system

catalyze: Initiate or increase the rate of a chemical reaction


Just like a co-pilot works with a pilot, co-enzymes work with enzymes. Coen- zymes are non-protein molecules, made up wholly or partly of vitamins. We need them for enzyme-catalyzed reactions.

For instance, pyridoxal phosphate, the active form of vitamin B 6 , acts as a co-en- zyme in all transamination reactions, a particular kind of chemical reaction involving amino acids. We’ll talk about these types of chemical reactions later in the text.

And you may already have heard of co-enzyme Q10, which we mentioned earlier, and which is involved in cellular respiration reactions.

Protein receptors

Protein receptors are found both in the plasma membrane and inside the cell. As we’ve discussed, cell membranes help control what gets in and out of our cells. They do this, in part, with membrane protein receptors that act like little chemical gates.

signal transduction:

Conversion of one signal to an- other by a cell

receptor-ligand binding com- plex: A complex formed between a receptor and a substance to allow for further cellular activity

ligand: An ion or molecule that binds to another molecule or metal atom

second messenger: Substance that mediates intracellular activity by relaying a signal from an extra- cellular molecule

Cells get information about their outside world by signal transduction. The process is a little bit like the telephone game you played as a kid.

A receptor on a cell binds to what is known as a ligand, forming a receptor-ligand binding complex. A ligand attaches to its specific receptor and no other. The ligand activates its receptor, which then activates a second messenger inside the cell. Then the second messenger activates another second messenger, and so on until the last second messenger goes into the nucleus and triggers changes in gene expression that leads to some sort of cellular response.

An example of this process is our cellular response to insulin.

• After we eat, insulin is released from our pancreas and travels through the bloodstream.

• From there, it can bind to specific, insulin-friendly protein receptors on the membrane of our cells.

Cells | 41

Once bound, this connection signals to proteins inside the cells — usually called second messengers — to get more channels to the membrane and accept glucose more readily.

As we’ve stressed already, physical activity changes how our cells respond to nutrients. Repeated muscular contractions (for instance, 30 minutes of pumping our legs on a bike) tell the cell to move more protein receptors to the cell mem- brane. This helps glucose get into the cell more efficiently and effectively to help refill the fuel tank.

What we eat can also influence second messengers. For instance, caffeine in coffee / tea, theobromine in cacao, and theophylline in tea / cacao can all inhibit phophodiesterase, an enzyme that breaks down second messengers in cells. So, in the case of caffeine, this means stronger / faster heart muscle contractions, greater blood vessel constriction, and enhanced stomach acid secretions.

Transport proteins

Transport proteins are also involved in cellular communication. These live in cell membranes and let molecules pass between spaces inside the cells and spaces outside of cells.

This movement across the plasma membrane can take place via one of two mechanisms:

• passive transport (which doesn’t need energy), or

• active transport (which needs energy).

Active transport allows vitamins, minerals, glucose, and amino acids into cells. See Figure 1.7

In the next unit, we’ll look at how some of these chemical processes and cellular
In the next unit, we’ll look at how some of these chemical processes and cellular
structures and tasks are involved in digestion.
Extracellular space
Intracellular space

Figure 1.7. Transport proteins. Transport proteins specifically allow the passage of water-soluble molecules between the spaces inside the cells and the spaces outside the cells. Movement across the plasma membrane can take place via one of two mechanisms:

facilitated diffusion or active transport. Cellular transport allows things like vitamins, minerals, glucose and amino acids into cells.

42 | Unit 1

Nutrition in practice

Salivary amylase is an enzyme in saliva that starts the digestion of starch. It helps to improve our “mouth experience” while eating (e.g., enhanced taste of certain foods). We’ve known about it for over 100 years.

Just recently, researchers found a correlation between obesity and a person’s ability to make amylase. People with fewer AMY1 genes — thanks to genetic polymorphisms — might not tolerate carbohydrates as well. People whose ancestors traditionally ate diets higher in starch seem to have more AMY1. This is another example of the interaction between our environment, culture, genes, and optimal dietary choices.

Cell types

In the next unit, you’ll meet some different cell types.

You’ll notice that many types end in the suffix “cyte.” This suffix will tell you that something is a cell. (For more on this, see the “Language matters” sidebar.)

Each cell’s structure can tell you about its job. For instance:

• Enterocytes, which line the intestine, are shaped like little brushes. This increas- es their surface area and helps them absorb nutrients.

columnar epithelial cells:

Pillar-shaped cells that line many surfaces of the body

goblet cells: Mucus-secreting epithelial cell that distends, taking on the form of a goblet; found often in respiratory and intestinal tracts

• Much of the gastrointestinal tract is lined with columnar epithelial cells. These are tall skinny cells.

• If their job is to absorb nutrients, there’s only one layer of them.

• If their job is to secrete things (like saliva), they’re stacked on top of each other like cases of beer. Stacked cells are known as stratified cells.

• Some columnar epithelial cells are known as goblet cells because of their shape.

• Cuboidal, or cube-shaped cells, are found in the salivary glands and the lining of the mouth. Because of their shape, they tend to be a little stronger and tougher, so they’re often used as structural cells.

• Squamous cells are flat cells that look a bit like layers of fish scales. They line the esophagus and help protect it from stomach acid. They’re easily sloughed off and replaced.

• The structure of myocytes, or muscle cells, allows them to produce force in order to move our body around.

There are many types of cells within the human body. You won’t learn them all.

Just get the general idea: Cells are not only diverse inside, they’re diverse outside too. Each unique cell type and structure is adapted for a specific job.

Cells | 43

Language matters

Many of our English medical terms come from ancient Greek or Latin, or even older sources. You’ll notice we often mention where these terms come from.

Obviously, you don’t have to brush up on the classics to become a nutrition coach.

But you may find it helpful to understand where words come from, so that you can guess at what an unfamiliar word might mean.

For instance:

“Entero” comes from the Greek enteron, or intestine.

“Hepatic” comes from the Greek hepatikos, or liver.

“Gastric” comes from the Greek gaster, or stomach.

“Cyte” comes from the ancient Greek kyto, which refers to a hollow or empty container. We now use it to refer to cells.

“Epi” comes from the even more ancient Proto-Indo-European epi, meaning near, at, or against.

So any time you see a form of these words, you’ll know what you’re dealing with.

For instance, enterocytes are intestinal cells. Hepatocytes are liver cells. Epithelial cells are cells that are the top layer of something, such as the innermost layer of the esophagus.

This study of where words come from is known as etymology. This can give us clues about what those words mean. It can also help you if English is not your first language.

If you’re having trouble recalling a particular term in this course, try Googling “etymology” and that term. You might learn a little factoid or two about that term that helps it stick with you.

Get to know the language of your field and where it comes from, and you’ll probably find that your understanding and comfort with the terminology im- proves. (And you’ll remember it better when tested!)

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The trillions of cells of the human body work together to form tissues, organs, and organ systems. The total of all of the activities taking place in these systems is what most people refer to as “metabolism.”

There are many levels of organization in the body, from microscopic atoms up to fully functional organisms (and beyond, to ecosystems). These systems are interconnect- ed, and all must work properly for organisms to thrive.

Our cells have many jobs, including:

• converting nutrients into energy (particularly ATP)

• making proteins (under the direction of our DNA)

• moving those proteins, nutrients and other substanc- es around (including in and out of the cell across the membrane) and

• clearing waste and debris from the cell.

Our cells use specialized structures and molecules (such

as enzymes and co-enzymes, or protein receptors) to begin and carry out chemical reactions; to send cell signals; and / or to transport other molecules.

The food we eat interacts with the small chemical reac- tions and processes taking place in our cells.

Food thus affects our health in five ways. It:

1. provides energy

2. provides molecules involved in chemical reactions

3. is incorporated into body structures

4. influences chemicals such as hormones and neurotransmitters

5. affects genetic protein-making signals as well as the quality of the proteins that are made