Whether we find it cliche or not, the New Year and January specifically, tends to be a time in which individuals are in search for PT’s/Coaches to turn the tide on post Christmas overindulgence.
Nutrition is a topic that on the surface appears to be simple, as social media influencers and PT’s/Coaches fresh out of qualification seem to be constantly suggesting. Yet it has a huge amount of depth and complexity to actually meet the requirements needed for the individual client in question.
When it comes to discussions around nutrition, we all know what we should/shouldn’t consume. Yet we often fall short in assisting clients/ourselves because we miss the component of this that isn’t quite as simple. We aren’t a machine, changing inputs and outputs, we’re attempting to change behaviours and relationships to food that began even as far back as our time in our mothers womb.
As part of the on boarding process for new clients as well as a reconfirmation for current clients looking to fine tune nutrition post Christmas, over the past month the whiteboard below has been up in the office as our guide to both educating and develop our individual approach to nutrition.
The goal of this insight is to walk through as we would with a new client, to show both the complexities, debunk a few myths as well as the simple steps we can take to make a start.
We begin with the first law of thermodynamics, the conservation of energy. Energy can neither be created or destroyed, but is simply transformed from one type to another. In the case of nutrition, this is the age-old Energy (kcal) In vs Energy (kcal) Out. We of course can debate whether this applies to complex biological systems such as ourselves, but fundamentally it gives us a place to start.
From the Energy In equation we have the following considerations…
- Total Calories Consumed
- Food Quality
- Protein Intake
- Carbohydrate Intake
- Fat Intake
- Micronutrient Intake
Across these basic measures we’re simply building a picture of what our energy in/food consumption looks like on a day to day. It gives us a platform to begin.
With any introductory client, we’re aiming to initially be the watcher of our current behaviours. Are they consistent with caloric intake, does it vary in terms of macro split day to day or is there a significant food group that offers specific micronutrients that is missing. There should be no pressure on the client to alter behaviour (though inevitably it does – the whole “don’t think of a elephant” scenario), let’s just establish where they are now.
To overview briefly our Energy Out equation, we have the following components.
- Basal Metabolic Rate (BMR): How much energy do you use at complete rest to simply “stay alive” and keep things functioning.
- Thermic Effect of Food (TEF): Whilst we can argue the actual realities of the 1st law of thermodynamics, different food sources require different degrees of energy usage to break them down. In this scenario, WHAT you eat also matters, not necessarily just how much.
- Non-Exercise Activity Thermogenesis (NEAT): The activity you do that ISN’T structured exercise. Think walking to and from work, climbing stairs, playing with children etc…
- Exercise Activity Thermogenesis (EAT): Structured exercise; gym, classes, running, cycling etc…
The combination of these four factors build into what’s called our Total Daily Energy Expenditure (TDEE).
The first goal is to roughly establish what an individual’s TDEE is, and we mean this literally, at it’s purely an estimation. No two days are going to be the same. No two meals are the same. Soils are different depending on where produce is from, providing different macro and micronutrient breakdowns. We ourselves are variable creatures in constant flux.
However the statement “What gets measured, gets managed” still will always apply to some degree.
There are mathematical equations to establish an estimation of BMR such as Harris-Benedict, Mifflin St Jeor and the Katch-McArdle.
We can make an estimation of TEF and the type of nutritional strategy someone is CURRENTLY using, depending on whether we have a high protein (above 2.3g/kg or 25% of total kcal), high carbohydrate (above 45% total kcal) or high fat (above 50% total kcal).
It’s simple to gauge an understanding of daily NEAT through the use of activity tracking devices (pedometers, FitBit, Apple Watch), and we can assess EAT through the use of heart rate monitoring during sessions to establish an estimate of kcal burning, all of which we provide at IFT.
We now have a starting point for both sides of the equation, energy in and energy out.
- As a very brief side note here, we have to factor in what we know about humans and dietary recall adherence from the research into nutritional behaviour. This shows that even with qualified nutritionists, they underestimate their caloric intake by 20-25% on recall, thats anywhere between 400-600kcal on an average day, that’s 3000+ kcal a week… This is a cohort of people who work in this field day and day, they’re specialists, yet they still under recall. In general population cohorts it’s often likely to be more around the 40% kcal under reporting. Something to consider when looking at dietary recalls in clients hitting kcal and macro goals but not seeing body composition changes.
With this is mind, we need to have a measure of current body composition.
At IFT we combine BIA (Bioelectrical Impedance Analysis) and Skinfold Calliper measures, where appropriate, to gauge a starting point on measures like body fat percentage, lean body mass, muscle mass, % water weight and so on. Whilst this isn’t necessarily the gold standard, such as you’d find in a University or hospital setting, it’s vastly more accurate and applicable than simply measuring scale weight.
Moving back to our Energy In portion of the equation, with general population clients we have initial buffers that we like to take into consideration as a basic starting point in regards to total kcal, protein intake and fat consumption when it comes to weight loss.
- Total Calories – A deficit of 250-500kcal MAX, aiming for continuous manageable body composition changes over time. (*I’ll caveat this with two key points, 1) we know that individuals under report so even with a 500kcal deficit they may only be getting 100-200kcal as an actual deficit, 2) In specific circumstances in which energy in is significant over, we may choose to create a short term deficit with a more aggressive restriction)
- Protein – around 1.2-1.4g/kg lean mass. Protein is satiating, it makes us fill fuller for longer. Regardless of whether you’re a meat eater or not, these are barriers that are achievable to support resistance training with general population clients. In athletic populations, or those with a mass gain target, this number will of course be higher based on specific body composition goals.
- Fat – 0.8g/kg total mass. We need some degree of fat within the diet, simple as that. There is 9kcals in every 1g of fat consumed, if we want to build calorie surpluses or deficits this is an easy variable to control.
To demonstrate how this may look, take a look at the example below. We will keep the numbers nice and rounded to avoid confusion. (All estimates….)
- 90kg Male – 30% BF = 27kg Fat Mass + 63kg Lean Mass
- TDEE = 2400kcal
- Total Kcal Intake = 3000kcal
- Target Kcal Intake = 2100kcal
- Target Protein Intake (1.4g/kg Lean) = 88g (x4kcal per gram) = 352kcal
- Target Fat Intake (0.8g/kg) = 72g (x 9kcal per gram) = 648kcal
- Remaining Kcals for Carbohyrdates = 1000kcals (1000kcal/4) = 250g of Carbohydrates
So a nutritional starting point with the above individual for energy in, could look something like this…
- 88g of Protein (352kcal)
- 72g of Fat (648kcal)
- 250g of Carbohydrates (1000kcal)
Based on these figures we may choose to alter the ratio between fat and carbohydrates depending on the training undertaken however this gives a clear picture of how we build totals.
If we went no deeper nutrition with this client, we’ve got basic measures in place to creating a body composition change purely from a thermodynamic perspective without expecting to see loss of functional mass (i.e. muscle).
If we move back to our energy out equation, based on the research we can apply the following expectations across each of our 4 variables;
- BMR = 60-70% of TDEE
- TEF = 8-15% of TDEE
- NEAT = 15-50% of TDEE
- EAT = 15-30% of TDEE
Using the same fictitious example above, lets say we have something along the lines of the following energy out…
- BMR = 1600kcal
- TEF = 210kcal (High fat/carbohydrates diet – heavily processed, little protein)
- NEAT = 350kcal (sedentary individual – 5000 steps per day etc…)
- EAT = 60kcal – (Park Run once a week – 250-300kcal (280/7 = 40kcal a day…))
- TDEE = 2400kcal
So if we ignore the nutritional aspect for one moment, what contributes to each of these variables.
Basal Metabolic Rate
- Fetal Environment (Genetics)
- Muscle Mass
- Aerobic vs Anaerobic Exercise
- Food Consumption
Do we have the capacity to influence variables within BMR? To some degree yes we do. Do we know how much of influence each component will have on BMR? Simply, no.
Thermic Effect of Food
By changing our macronutrient emphasis we have the capacity to alter our TEF marginally. An alteration in the degree of processed vs whole foods consumed will also see a change in TEF. As mentioned above, TEF accounts for between 8-15% of TDEE, whilst small changes do matter, this is still not going to provide a big impetus in changing our thermodynamic equation.
Non Exercise Activity Thermogenesis
This can account for between 15 and 50% of potential TDEE. The scope for change within this contributor is HUGE!
At IFT we will try to band an individual within one of the following groups (Assuming a 2200-2400kcal TDEE as a guide)
- Extremely Inactive (Full Bed Rest ) = 13% of TDEE – Around 300kcal
- Sedentary (Seated Profession etc…) = 17% of TDEE – Around 400kcal
- Moderately Active (Roughly 8-10000 steps per day) = 22% TDEE – Around 500kcal
- Highly Active (10-12000 steps) = 26% of TDEE – Around 600kcal
- Extremely Active (Upwards of 12000 steps) = 30% of TDEE – Around 700kcal
Completely ignoring any change we make in terms of nutrition, by moving someone from sedentary to hitting 8-10000 steps per day, we can create around a 200-300kcal deficit without a single change to nutrition (*assuming all else is equal).
Exercise Activity Thermogenesis
This includes what we do within the gym, classes, runs and so on, this may contribute 15-30% of TDEE.
When it comes to a body composition change one of the first things individuals tend to do is heavily hit EAT with 3-5 sessions a week of High Intensity Interval Training thinking it will give them their desired outcomes.
The issue? 4-6 weeks later they’re injured, under recovered, progress has stalled or some combination of all the above.
When it comes to a new general population client, the minimum effective dose we are looking for from a resistance training standpoint is 2-3x 1hr session per week to see both muscle mass and strength gains. If we ensure progressive overload, monitor intensity and stay on top of recovery this will suffice for most individuals. Once we get past the initial “newbie gains” in which pretty much any stimulus will initiate a positive response, we may need to be a bit more specific.
However, now faced with all the previous information from both the energy in and energy out equations, where do we begin, what do we address first to ensure we see longevity in weight loss or body composition changes?
- Know the starting point
Whether you’re choosing to use scales, BIA, Skinfold Calipers, Hydrostatic Weighing, DEXA or some combination, get a baseline to begin. This doesn’t mean simply one measurement and hope for the best.
(* Our key caveat here is can you be the “watcher” of a monitoring tool. Behaviour shouldn’t be guided reactively to an individual measure or moment in time)
If it scales, use a starting measure in the AM, for the first week measure on a daily basis at the same time and see if you fluctuate highly. If so, whats the average? We may in this case need to either look deeper at the cause of fluctuation or be more reliant on weekly averages as opposed to single measurements.
If its BIA, ensure validity of the device. Measure the individual 2-3x within a 8-10min window. Are the results the same time after time. Yes? reliability seems good. If not, are you sure its measuring what you think it is accurately as you certainly haven’t lost/gained in that time period.
Skinfolds? Same as above, can your provider accurately measure you with reliability in back to back assessments in a short window. With proper training the deliverer should have been assessed for reliability and validity. Always ask…
Hydrostatic Weighing and DEXA, if you’ve got these available, 100% use them. They’re considered the goal standards for body composition assessment.
- What side of the equation do you want to influence?
Is this a health or performance related client, because this matters…
If you’re simply looking to improve health, fitness and wellbeing, we can potentially use a combination of dialling in nutrition to an acceptable maintenance or slight deficit and by using either/or an increase in NEAT and EAT to create a deficit.
In a performance based client who are likely to have much higher NEAT and EAT than a sedentary individual by nature of there day-to-day living, can we afford to put them into a deficit nutritionally and run the risk of reducing macronutrients that may contribute to performance?
Is body composition actually effecting performance negatively?
Is there a better time in their calendar year in terms of competition to make this alteration?
From a personal opinion, the goal should always be to get a person to eat more and move more regardless of the desired outcome, whether its a 500kcal surplus or 500kcal deficit. If you want to grow, you have to eat, simple as that, as a result food quality may have to take a hit. If you’ve got a 3500kcal target for growth, thats more green beans, broccoli and sweet potato than any normal human would care to consume in a day. Context matters.
Equally if we want a negative net change in body composition and don’t want an individual to experience the detrimental bio-psycho-social aspects, we need to clean up food quality to make sure they’re still eating a considerable amount of food whilst still hitting total kcal and macro targets.
Simple put, are we targeting one side of the equation or both? What are the consequences if we do?
- Monitor, Assess and Adapt
Are there measures in place to track what is going on. By this I don’t mean simply a paper sheet that’s recording weight on a week by week basis. This is biological, psychological and social.
Yes we want to see changes in body composition if that’s the goal, but how is it impacting on all physiological processes? If the caloric restriction imposed has altered the sleep quantity/quality negatively of a client, are we really creating a healthier individual? If the dramatic increase in fibre has caused upset to the digestive system that we are no longer absorbing what we’re taking in, are we helping overall?
There will be occasions in which clients may not lose or even gain weight in significant caloric restrictions. Do we understand why? Do we understand that water retention through stress, increases in carbohydrates or during menstruation may hide body composition changes. Metabolic adaptation may occur as TDEE changes over time. Muscle mass increases may hide weight loss when scales are the only measures of body composition
Not only physically, but how is it impacting psychologically? Can they regulate mood during the day? Do they feel better or worse subjectively? Lethargic and tired regardless of time asleep? Hard to motivate themselves for tasks that usually are performed without effort?
Finally how has this impacted them socially, have you indirectly created disordered eating by asking a client to track every single thing that goes in their mouths? Have you reignited an eating disorder in a client from a younger age? Do they turn down opportunities to socialise for fear they don’t have the calories to eat/drink when they’re out?
Consider the person as a whole.
Do we need to apply cognitive oversight to illicit a change by tracking and monitoring or do we need to make a change to the individuals environment itself?
If we see an impact negatively, are you able to adapt your approach. Can we be flexible in recommendations for clients or are we simply limited to what the ideal scenario should be.
There will be situation in which we see where our laws of thermodynamics don’t apply. We are the most complex organism that has walked the planet. Simply limiting ourselves to just calories in vs calories out may work for some clients, for others it really won’t.
Once we know where we are, we have a multitude of approaches to begin from. This is a whole other conversation however to provide a very brief overview…
- Ad libitum Diets: Think any diet that simply asks you to NOT eat a certain food component (sugar, carbs, fats etc…)
* Whilst we can argue the efficacy of these types of strategies, the truth is that we cannot deny they often create dramatic results for people in the short term. However, unless there is a specific need for such strategies there should always be an intention to return to a more holistic approach to food intake in the longer term.
- Total Kcal with a Protein target and Meal Plan: Can you hit kcal and protein targets. Individuals will then flip-flop on a day to day as to how they split Fat and Carbohydrates.
- Total Kcal tracking with Macros and Meal Plan: Can you cover the big basics. Set PRO, CHO and FAT targets with a specific purpose in mind
* Note – By meal plan, in no way do we mean a written diet in the formal sense of the word. For example we may set a kcal or macro target for each meal and allow the client to fill in with whatever food source they prefer. If you’re hoping for a pre-written plan with every ingredient and quantity already listed, you’re severely missing the point of this insight. That’s not behaviour change between a client and coach, thats a dictatorship.
Between the two approaches above should be most, if not all, general population clients. Structured flexibility to enable a client to fill in the gaps with preferred food without creating unmanageable long term habits. If we need to address food quality, it can be done within the context of each individuals food preferences.
- Total Kcal with Macros and Food Weighing: If you have a significant body composition goal in mind, physique athlete, body builder, sport with a weight cut-off, this is likely going to be the strategy that most individuals undertake. If its part of your life as a profession athlete most clients will be within the realm already.
Regardless of the strategy we still have to apply the same protocol of monitor, assess and adapt, consider all components of the biological, psychological and social.
When a new client arrives or a current client looks for a body composition goal, we can begin with the assumption of understanding Energy In vs Energy Out, it starts the ball rolling. We can also recognise that not all food is the same on its impact internally within our bodies. But what we can’t afford fail to do, is recognise the complexity of each individual, the small adaptions we have to make on a client by client basis.
So what looks like a simple whiteboard with 30-40 words, becomes a 3000 word training insight and more often than not a 60-90min consultation with ongoing monitoring, assessment and adaptation.
Nutrition is more than a plug and play with MyFitnessPal. It’s more than Kcals In vs Kcals Out. It’s more than “…if it fits my macro’s”, it’s the fuel that drives the only body you will ever have.
Respect that fact and we can see some unbelievably positive changes in body composition and relationships with food. Don’t, and you’ll create disordered eating, unwanted weight gain, poor social relationships, inevitably a failure to hit goals, or if you’re a coach/PT, the loss of a client in need of your help.