Nutrition for Physical

Activity Manual
Level 2 Award in Nutrition for Healthy Living

Learning Outcomes:
By the end of this unit the learner will be able to

demonstrate knowledge of nutrition for health and fitness in nutrient groups and
substrate oxidation, diets, weight management, pre and post exercise nutrition
collect, analyse information and agree short, medium and long-term goals with
your clients (SMARTER) to include: healthy eating, weight loss, weight gain and
improved sporting performance
identify when your clients need referral to another professional
identify barriers to your clients achieving nutritional goals

Introduction to Nutrition
The human body requires energy to maintain life and health. It must have the means
to grow from childhood through to adulthood, and to repair itself on a daily basis
throughout life. In order to achieve this feat, oxygen, food and water is required. This
course will examine the importance played by food and water in order to promote
both good health, and effective training outcomes.
Nutrient Groups
A balanced diet requires adequate water intake, alongside food chosen in varying
amounts from five nutrient groups. These in turn are divided into macronutrients
and micronutrients.
Macronutrients

Basic functions
Collectively needed in greater amounts.
Used within the body for structure,
function and fuel. Note: alcohol also
provides fuel, but is not classed as a
nutrient.

carbohydrate
protein
fat

Micronutrients

Basic functions
Needed in smaller amounts. Also used
for structure and function and are
necessary to unlock the energy
contained in the macronutrients.

vitamins
minerals

During subsequent chapters, the various nutrient groups and their individual and
collective effects upon the body will be examined. The purpose of this chapter is,
however, to introduce the relationship between the quality of the food in the diet, and
the overall health of the individual.
The food on the plate will, for the most part, become part of the body, as it is used to
rebuild or repair vital structures on an ongoing basis. Food, which is not used for this
purpose, will either contribute to the bodys normal chemical functions, or be utilised
as fuel to sustain life and activity levels. An excess of energy consumed will
eventually be stored, mostly in the form of body fat, and will therefore, also contribute
to eventual body mass.
The Organisation of Life
Throughout the human body, a relationship exists between both structure and
function, indeed it can be said that structure dictates function. This point remains
central even to nutrition, whereby the quality of food within the diet and the specific
chemical composition of that food, have a profound effect upon the structure and
function of the human body at its most fundamental level.

To understand this point, it is necessary to examine the basic organisation of the

human body, and an example using protein.
Chemicals

Proteins

Cells

Actin

Tissue

Fibres

Organs

Muscles

Systems

Muscular
System

The
Human body

The
Human body

Other systems to which this same organisation applies are:

the skeletal system

muscular system
nervous system
the digestive system
the respiratory system
the circulatory system
the lymphatic system
the endocrine system
the reproductive system

The 1992 National Food Guide

The national food guide is an attempt to provide information to the public, in order to
promote a healthy diet. It serves as a visual guide to ease the confusion that often
arises when trying to plan a menu. Originally devised by the US Department of
Agriculture (USDA), this basic model has been adopted by many government
agencies throughout the developed world.
Now widely accepted, the USDA pyramid does have its critics (McCullough et al,
2000), however, it still serves to encourage people to think more carefully about the
food they choose within their diet.
The food guide has been revised due to continuing criticism that it did not provide
appropriate advice for certain nutrient groups. In 2004, after much debate and
research by many large nutritional companies, the USDA released their updated
version.

The 2004 National Food Guide

The revised pyramid takes into account that not all fats are the same, and that they
actually have some significant health benefits. Certain plant oils are now set at the
base of the pyramid and are advised as a part of almost every meal. The advice on
carbohydrates has also changed, recognising that refined carbohydrate products
should be minimised, whilst the emphasis is on wholegrain products.

The Food Pyramid

Advantages

Limitations

aims to encourage people to think

about their diet
leads to a reduction in pre-made
processed food
encourages consumption of fruit and
vegetables
encourages portion control
aims to encourage a wholefood diet
encourages a moderate alcohol
intake

aimed at populations not individuals

assumes a one size fits all approach
criticised for being shaped by food
agencies and politics
not much advice on portion control

In the UK we have adapted the original food pyramid and follow a healthy eating
balance plate instead. It provides an alternative illustration of the same basic
guidelines.

Bread

Bread

Butter
Milk

Food Quality
It must be recognised that while encouraging the eating of whole foods as identified
above, there are still factors that affect the quality of even fresh produce.
The cycle of food quality helps to identify some of these issues:

Nutrients from
soil help grow
healthy plants

Healthy plants
eaten by
animals

Cycle of
Food Quality

Plants and
animals eaten
by man

Man naturally
enriches soil

The organic farming movement began in the 1940s and has grown and developed
into a highly marketable force. Organic produce is governed by strict regulations that
help to maintain a higher standard of farming. In 85% of cases organic produce has
been shown to have an equal or higher nutrient content than commercial food stuffs
(Worthington, 1999). The Soil Association checks approximately 70% of all organic
producers in the UK are meeting the requirements laid down by European law. The
Soil Association states that some of the key reasons for purchasing organic are:

no additives
no pesticides, fungicides or herbicides
no genetically modified foods
no routine antibiotic use on animals
animal welfare is paramount

In order to understand the effect which nutrition exerts upon health and performance,
it is necessary to examine the nutrient groups in turn, and to determine the varying
ways in which they interact, both within the population and within the individual
themselves.
References
McCullough M.J., Feskanich D., Stampfer M. J., Rosner B.A., Hu F. B., Hunter D.J.,
Variyam N.J., Colditz G.A., Willett W.C., (2000). Adherence to the Dietary Guidelines
for Americans and the risk of major chronic disease in women. Vol. 72 No. 5, 12141222.
Worthington, (1999). Is Organically Grown Food Nutritious?, Price-Pottenger
Nutrition Foundation

Protein
Proteins belong to a family of organic compounds, which serve many functions within
the body. All proteins are made from building blocks called amino acids, which
number 20 in total. These amino acids can be thought of as forming the protein
alphabet, since they build proteins in a similar way as the various combinations of the
26 letters of the alphabet can be used to create individual words. Thus one protein
will differ from another according to the number and sequence of its constituent
amino acids.
Peptides
Animal and plant cells join amino acids together to form peptides. This process
results in the formation of chains of amino acids of varying lengths, which eventually
become proteins.
Peptides
Two amino acids

Dipeptide

Di meaning two

Three amino acids

Tripeptide

Tri meaning three

4-9 amino acids

Oligopeptide

Oligo meaning few

10 or more amino acids

Polypeptide

Poly meaning many

Proteins themselves are formed when the chain of amino acids total 100 or
more, or when two or more polypeptide chains combine and repeatedly fold
together to form specific three-dimensional shapes. The shape or structure of
a protein will dictate its function within the body.
Essential amino acids
Of the twenty amino acids, nine are considered to be essential to the daily diet
because the body is unable to produce or synthesise them itself. Only when sufficient
quantities have been ingested, are we able to synthesise the remaining non-essential
amino acids.
Essential amino acids
Phenylalanine
Methionine
Tryptophan
Threonine
Lysine

Isoleucine
Leucine
Valine
Histamine

Non-essential amino acids

These are also present in many foods, but are not essential to the daily diet. So long
as we successfully absorb sufficient amounts of the nine essential amino acids, the
liver is able to synthesise the remaining eleven non-essential amino acids listed
below.
Non-essential amino acids

glycine
alanine
tyrosine
serine
cystein
proline

glutamic acid
glutamine
aspartic acid
asparagine
arginine

Note: some authors now consider that due to the close relationship that exists
between some of the essential and non-essential amino acids, that the latter are
more accurately described as conditionally essential amino acids (Laidlaw and
Kopple, 1987).
Complete protein
These foods contain all nine essential amino acids in sufficient amounts necessary
for the liver to synthesise the remaining non-essential amino acids.

Complete proteins
Animal sources
eggs
meat
poultry
dairy
fish

Non-animal sources
soy foods
tofu
soy milk

Below is a graph that represents the complete amino acid content in chicken.

Chicken
Incomplete proteins

Plants contain many nutrients, including protein. However, with the exception of soya
based foods, these proteins are of an inferior nature, since they are deficent or
incomplete in one or more of the essential amino acids.
Incomplete proteins

cereals and grains (wheat, rye, barley,

oats, rice)
cereal products (bread, pasta etc)
pulses (beans, lentils, peas)
nuts
vegetables

Complementary proteins
In order to gain sufficient protein from plant sources, we need to combine a variety of
incomplete proteins together, either in the same meal or during the course of the
same day.

Wheat

Pulses (beans)

10

Whilst these carbohydrate based foods contain energy in the form of glucose, it is
important to remember that they also contain smaller amounts of protein. Including a
variety of unrefined carbohydrate foods is, therefore, particularly important for anyone
on a no meat or low meat diet. Good combinations include:
rice and pulses
vegetables and seeds
nuts and vegetables
grains and pulses
Quality of Protein Foods

Pulses are beans

Before we even purchase them at the supermarket, farmers and manufacturers can
have a huge influence on the quality of protein-based foods. The treatment of the
animals and their level of health are paramount to producing good meat. If any level
of the cycle of food quality is not maintained at a high standard then quality will
diminish. Factory processing can further damage and destroy animal produce by
adding water, bulking agents, additives and preservatives, therefore increasing the
potential for profit.
The current legal guidelines state that meat can be composed of up to 25%
connective tissue. The following minimum requirement of meat in certain food
products gives a further indication as to their quality.

economy burgers 41 50%

luncheon meat 55 67%
meat pies 12.5%
pasties/sausage rolls 6%
sausages 26 32%

The total amount of meat used can be alarming enough, but often the meat used in
these types of products are lower grade off cuts and machine reclaimed meat
collected at the end of the day.
Functions of Protein

The types of protein within the body can be placed under three headings, along with
their corresponding functions:

structural: form the main framework of many components of the body; collagen
present in bone and connective tissue, keratin in the skin, and muscle tissue all
provide structure. Muscle tissue is also contractile for movement

homeostatic: hormones regulate various processes, eg insulin controls blood

sugar, enzymes speed up reactions, and white blood cells fight infection

fuel: although not the primary source, protein is a useable source of energy,
especially during endurance events or periods of fasting. They can be converted
into glucose, fatty acids or ketones to help produce ATP

11

Breaking
damage cells

Catabolism
Catabolism relates to the breaking down of larger structures into smaller ones.
Protein catabolism occurs to some extent all of the time, as existing proteins from
damaged cells are broken down into their amino acids and recycled to build new
proteins elsewhere. Further muscle catabolism occurs during intensive exercise, as a
result of both micro-tear damage and the partial utilisation of key amino acids as fuel.
Building up
muscles using
protein

Anabolism
Anabolism can be defined as a building up process within the body. The anabolic
phase mostly occurs during rest. Since proteins form a major component of most cell
structures, adequate dietary protein is required to maintain both health and
performance.
Protein Requirements
The amount of protein needed for effective function will vary significantly from person
to person. It is very difficult to get it exactly right with a simple calculation. It will take
some trial and error and fine tuning to find what works best for an individual. In the
UK, it is very common to find the general public lacking in this vital nutritent.
Commonly, the only decent amount of protein is eaten at an evening meal. It should
be a major part of every meal consumed. A good starting point is to consider the
amount of protein needed dependent on body weight and the intensity of physical
activity.
Daily protein requirements: grams of protein per kilogram body mass

sedentary adult

0.8

recreational adult exerciser

0.8-1.5

adult endurance athlete

1.2-1.6

growing teenage athlete

1.5-2.0

adult building muscle mass

1.5-1.7

** athlete restricting calories

1.8-2.0

estimated upper limit; adults

2.0

Data taken from American Collage of Sports Medicine, American Dietetic

Association, and Dieticians of Canada Joint Position Statement. Nutrition and Athletic
Performance. Medicine and Science in Sports and Exercise 32 (12): 2130 2145,
2000.
** Athletes attempting to lose body fat via the use of an energy restricted diet, will
convert much of their dietary protein into glucose which is then burned as energy.
This leaves less protein available for muscle repair, requiring the athlete to increase
their protein intake.
12

Excess Protein
Protein is best utilised when ingested in smaller, more regular meals. If a
protein surplus is ingested the amino acids are taken to the liver, where a
process called deamination occurs.
What is deamination?
Amino

Amino
Acid

Ammonia

Acid

Acid remnants
used as fuel

Urea
excreted via
the kidneys

Excess
suppresses fat
burning may
cause increased
fat storage

Food Recommendations

Avoid
low quality meats
processed, reformed meats
battery farmed eggs
roasted nuts
UHT or processed dairy products
meat pies, pre-packed meals
cheap tinned beans or pulses
overcooking meats

Advise
fresh, quality meat, ideally organic
organ meats liver, kidney
organic free range eggs
raw nuts
fresh, whole non-homogenised milk
organic tinned beans or pulses in just
water
slow cook at lower temperatures

Why do we need to avoid roasted nuts? Is it simple avoiding pre processed nuts?
What is considered over cooked? E.g cooking with pressure cooker vs Slow cook

Same amount of protein digested regularly through out the day versus bigger
amount less time a day

13

Key learning points

1. Proteins are made from amino acids
there are 20 protein amino acids
there are nine essential amino acids because we can not synthesise
them ourselves
there are 11 non essential amino acids that the liver can synthesise so
long as we have sufficient essential amino acids in our diet
2.

Proteins are made from chains of amino acids

shorter chains are called peptides
proteins are chains of 100 or more amino acids
large proteins are two polypeptide chains joined together an folded into
specific shapes

3. Complete proteins are foods, which contain large amounts of all 9

essential amino acids. Examples are:
meat
poultry
fish
dairy
eggs
soy products
(Key learning points continued)
4. Incomplete proteins are foods, which are deficient in two or more
essential amino acids. Examples:
grains
cereals
nuts
seeds
vegetables
5. Complementary proteins occur when a variety of incomplete proteins
are eaten which will provide all eight essential amino acids. They need
not be eaten with the same meal, but need to be eaten on the same day.
6. Catabolism
the breaking down of structures within the body
exercise is catabolic on muscle tissue
7. Anabolism
the building up of a structure
rest and feeding after exercise is anabolic

8. Excess dietary protein is disposed of via two pathways:

the nitrogen is excreted in urine via the kidneys

the protein remnants are burnt by the tissue as fuel

Excess protein can suppress the use of fat as fuel, potentially causing an
increase in body fat
14

References
Laidlaw S A, Kopple JD. (1987). Newer concepts of the indispensable amino acids.
Am J Clin Nutr 46:593-605.
Food standards agency, (2003). Labelling and composition of meat products

15

Carbohydrates, Fibre and the

Glycaemic Index
Dietary carbohydrate (CHO) is digested and utilised in the body in a variety of ways.
It is ultimately sent to the liver, muscles, or used immediately as a fuel. Some
glucose may enter the adipose tissue, where it is converted into fat, a process which
appears to occur at different rates in different people (McDevitt, 2001).
Dietary glucose

Glucose enters the blood

Insulin released from pancreas

Glucose may now enter

Liver

Muscles

(Stored as
glycogen)

(Stored as
glycogen)

Used as
fuel by the
tissues

Adipose Tissue
(Converted
into fat)

Some glucose remains in the

blood to provide fuel for the brain

Structure of Carbohydrates
All carbohydrates are made up of molecules or units called saccharides. There are
three basic categories:

simple carbohydrates also referred to as sugar

complex carbohydrates also referred to as starches
non starch polysaccharides (NSP) referred to as fibre

16

Monosaccharides single molecules or units of sugars e.g.

Glucose
Fructose
Galactose
Disaccharides two molecules or units of sugars joined together e.g.

Sucrose = glucose + fructose

Lactose = glucose + galactose
Maltose = glucose + glucose
Sources of simple carbohydrate
Fruit: a healthy choice
contains fructose and glucose in
varying amounts
contains vitamins and minerals
contains antioxidants and
phytochemicals
contains high levels of dietary fibre
contains trace of amino acids
cheap, convenient

Less healthy options: biscuits,

cakes, confectionery, soft drinks
contain excessive sugar
contain excessive fat
high energy density
encourage an increase in body fat
contain no vitamins or minerals
adverse effect on insulin levels

The energy contained in these foods cannot be released without specific vitamins
and minerals, the B vitamins are particularly important, since we cannot utilise any
carbohydrate without them. Fresh fruit provides its own vitamin and mineral
requirements for the body. Heavily refined and processed foods still provide us with
energy but without needed vitamins. Prolonged use of refined carbohydrates can
lead to a progressive depletion of certain nutrients. This type of food is often referred
to as an anti-nutrient.

17

Complex Carbohydrate
These foods are often described as starch and consist of many molecules or units of
glucose all joined together in long complicated branched chains. These multiple
molecules of glucose are called polysaccharides.

Once eaten, these polysaccharides are broken down into glucose, absorbed into the
bloodstream and either stored or metabolised accordingly. All such carbohydrates
will provide energy. However, their real dietary value centres on whether they are
refined or unrefined.

Sources
of
refined
carbohydrate
white bread
white pasta
cakes, biscuits and pastries
rice cakes
CHO content of processed foods
white rice

Properties

Sources
of
unrefined
carbohydrate
wholemeal or whole grain products
whole grain rice
frozen vegetables
fresh vegetables
sweet potatoes
yams
pulses
quinoa
Properties

source of energy
deficient in dietary fibre
largely stripped of their vitamin and
mineral content
produces faster insulin response

source of energy
good source of dietary fibre
good source of vitamins and
minerals
slower, sustained insulin response

18

What is Fibre?
Fibre consists of non-starch polysaccharide (NSP), indigestible plant material such
as cellulose, hemicellulose, lignin, pectin, gums and mucilages. These are found in
fruits, vegetables, grains and beans. Fibre doesnt provide any energy, yet is vital for
a healthy body. There are two kinds:
Insoluble:
It is normally the outer protective layer of plants. Unrefined wheat, rye, rice and
most other grains are primarily composed of insoluble fibre along with fruit and
vegetable skins (Englyst, 1982).
Soluble:
It is normally found on the inner part of plants. Found in beans, barley, broccoli,
prunes, apples, citrus fruits and oats.
What are the benefits of a high fibre diet?
Reduced damage to the colon:
Low stool weight, dehydration and lack of exercise all contribute towards
constipation. The long term effects of constipation can give rise to diverticular
disease:

increased pressure against the colon wall causes weakness and damage
results in the accumulation of bulges called diverticuli in the walls of the colon
if they become blocked by faecal material, they can inflame into a condition
known as diverticulitis which may require surgery

High fibre diets, along with drinking plenty of water:

help to provide greater bulk to the stools and aid peristalsis

reduces both the pressure and the resultant damage to the colon

Colon

Diverticuli

2. Reduced heart disease

19

Reduces risk of CHD:

Foods rich in soluble fibre such as, oat bran, barley and pulses, taken alongside
insoluble fibre, are reported to lower blood cholesterol, and reduce the risk of CHD
(Kromhout et al, 1982).
The following effects have been reported (Marlett et al, 1994):
soluble fibre binds to bile
bile is necessary for the effective absorption of dietary fat and cholesterol
less bile is available
less cholesterol and fat are absorbed
lower blood cholesterol levels are associated with a reduced risk of CHD
Regulates blood glucose levels:
Fibre delays gastric emptying, and also collects within the small intestines, both of
which delay the absorption of blood glucose.

Absorption of nutrients only occurs once

the food has emptied from the stomach,
and enters the intestines. Therefore, no
absorption of glucose can take place
within the stomach. The presence of
fibre in a meal will delay gastric
emptying, and thus slow down the
release of glucose into the blood.
Fibre slows down the process of food going to the
intestine, therefore there it takes more time for the
glucose to reach the intestine and release the glucose.

Weight management:
High fibre diets can help with weight management and fat loss in the following ways:

it takes longer to eat. The hypothalamus in the brain receives various signals
from within the body, which eventually signal satiety (the point of being full or
sustained)
the completion of these signals takes around 20 minutes; therefore, taking longer
to eat meals can help to prevent over eating, and assist with weight management
(Ludwig, 2000)
soluble and insoluble fibre delays the release of glucose into the blood, resulting
in lower levels of insulin. One of insulins actions is to turn excess CHO into fat
high fibre foods tend to be less processed and contain less fat.

The Glycaemic Index

The glycaemic index (GI) was devised to give a ranking system to show how
quickly a given carbohydrate can feed glucose into the blood. It was originally
devised to help diabetics to manage their blood glucose levels (Jenkins et al,
1981), but has since become of increasing value to people engaged in weight
management and regular training. Foods are compared to the rate at which the
standard food (pure glucose) is delivered into the blood and then given a
relative rating. The indices were categorised as follows:

20

Coronary
Heart Disease

Glycaemic index range

High

Above 85

Moderate

60 - 85

Low

Below 60

Glycaemic index and research:

long term consumption of a diet with a high glycaemic load, has been shown to
be a significant independent predictor of the risk of developing Type II diabetes
(Salmeron et al, 1997), and cardiovascular disease (Liu et al, 2000)
recent studies have shown that diets with a low glycaemic index may help protect
against the development of obesity (Ludwig 2000) and colorectal cancer
(Franceschi 2001)
diets with a predominance of low glycaemic foods have been shown to be more
satiating than high glycaemic diets, and can help in the treatment of obesity
(Ludwig 2000)
Main factors influencing the speed of entry of CHO into the blood:

amount of CHO eaten

the presence of fat in the meal. Fat is the strongest inhibitor of gastric emptying
the presence of protein in the meal. Protein is also a gastric inhibitor
the presence of fibre in the meal delays gastric emptying
the presence of soluble fibre slows the absorption of glucose into the blood
cooking methods. The longer the time of cooking, the more saccharides are
broken down and thus the faster they are absorbed
the ripeness of fruit. As a banana ripens, enzymes become active and begin to
break down the polysaccharides into smaller saccharide units
food preparation bread has a higher GI than pasta, even though they are both
derived from wheat

21

FOOD

SCORE

Sugars
Glucose
Maltose
Honey
Sucrose (sugar)
Fructose

Fruit
Watermelon
Pineapple
Melon
Raisins
Banana
Kiwi Fruit
Grapes
Orange
Apple
Plum
Pear
Grapefruit
Cherries

100
100
87
59
20

72
66
65
64
62
52
46
40
39
38
38
25
25

Cereals

FOOD

SCORE

Grains & Grain Products

French Baguette
White Rice
Bagel
White Bread
Wholemeal Bread

95
72
72
70
69

Ryvita
Crumpet
Brown Rice
Pastry
Basmati Rice
White Spaghetti
Instant Noodles
Wholegrain Wheat Bread
Wholemeal Spaghetti
Wholegrain Rye Bread

69
69
66
59
58
50
46
46
42
41

Pulses
Baked Beans
Butter Beans
Chick Peas
Blackeye Beans
Haricot Beans

48
36
36
33
31

Puffed Rice
Cornflakes
Museli
Kelloggs Special K
Kelloggs All Bran
Porridge Oats

80
67
66
54
52
49

Kidney Beans
Lentils
Soya Beans

29
29
15

Dairy
Products
Ice Cream
Yoghurt
Whole Milk
Skimmed Milk

Vegetables
Parsnips (cooked)
Potato (baked)
French Fries

97
85
75

50
36
34
32

Potato (new)
Beetroot (cooked)
Sweetcorn
Sweet Potato
Peas
Carrot

70
64
59
54
51
49

Food Recommendations

Avoid
white sugar, syrups
white flour, rice
white bread, pastries, cakes, biscuits
CHO content in pre-packed meals
sweets and confectionery
soft drinks, cordial, cheap fruit juices
processed fruit or vegetables

22

Advise
wholegrain products
brown rice
fresh, whole fruit and vegetables
home baking know ingredients
mainly drink water

Key learning points - CHO

1. When glucose enters the blood, insulin is released. Glucose may
enter:
the liver to be stored as glycogen
the muscles to be stored as glycogen
the tissues where it is burnt as fuel
the adipose tissue where it is converted to fat
2. CHO is made up of units called saccharides
monosaccharides are single units of CHO, often called
sugars
disaccharides are two units of CHO, often called sugars
polysaccharides are many units of CHO joined together
often called starch
3. Unrefined CHO offers the best nutritional benefits
good source of dietary fibre
good source of vitamins and minerals
reduced insulin response

Key learning points - Fibre

1. Fibre is indigestible plant material and helps:
regulate blood glucose
aid in weight management
delays absorption of blood glucose
adds bulk
aids peristalsis
helps protect the colon
lowers blood cholesterol
2. Insoluble fibre is found in:
whole wheat
rye
whole grain rice
most other unrefined grains
3. Soluble fibre is found in:
oats
barley
broccoli
apples
citrus fruits

23

Key learning points Glycaemic Index

1. The glycaemic index (GI) represents the speed at which CHO
foods deliver glucose into the blood.
2. Glycaemic index range:
high = above 85
moderate = 60 85
low = below 60
3. High glycaemic diets associated with increased risk of diabetes
type two and cardiovascular disease.
4. Low glycaemic diets promote satiety and help with weight
management.
5. Main factors effecting the glycemic index:
presence of fat
presence of protein
presence of fibre
cooking methods and time

References
McDevitt, Regina M et al. (2001). De novo lipogenesis during controlled overfeeding
with sucrose or glucose in lean and obese women. Am J Clin Nutr; 74:737 46.
Englyst H, Wiggins HS, Cummings JH. (1982). Determination of the non-starch
polysaccharides in plant foods by gas-liquid chromatography of constituent
sugars as alditol acetates. Analyst. 107:307-318.
Kromhout D, Bosschieter EB, de Lezenne Coulander C. (1982). Dietary fibre and 10year mortality from coronary heart disease, cancer and all causes: The Zutphen
Study. Lancet. 1: 518-522.
Ludwig D. (2000). Dietary glycemic index and obesity. J. Nutr. 130: 280S-3S.
24

Marlett JA, Hosig KB, Vollendorf NW , Shinnick FL, HaakVS, Story JA. (1994).
Mechanism of serum cholesterol reduction by oat bran. Hepatology.20:1450-1457.
Southgate DA, Hudson GI, Englyst H. (1978). The analysis of dietary fibre: the
choices for the analyst. J Sci Food Agric. 29:979-998.
Stephen A. (1991). Starch and dietary fibre: their physiological and epidemiological
interrelationships. Cancer J Physiol. 69: 116-120.
FAO/WHO Expert Consultation. Carbohydrates in human nutrition: report of a joint
FAO/WHO Expert Consultation, Rome, 14-18 April, 1997. Rome: Food and
Agriculture Organisation, 1998. (FAO Food and Nutrition paper 66).
Franceschi S, Dal ML, Augustin L, et al. (2001). Dietary glycemic load and colorectal
cancer risk. Ann Oncol. 12: 173-178.
Frost G, Leeds A, Trew G, Margara R, Dornhorst A. (1998). Insulin sensitivity in
women at risk of coronary heart disease and the effect of a low glycemic diet.
Metabolism. 47: 1245-1251.
Jenkins D, Wolever T, Taylor, et al. (1981). Glycemic index of foods: a physiological
basis for carbohydrate exchange. Am J Clin Nut. 34:362-366.
Liu S, Willett W, Stampfer M, et al. (2000). A prospective study of dietary glycemic
load, carbohydrate intake, and risk of coronary heart disease in US women. Am j Clin
Nut. 71: 1455-1461.
Ludwig D. (2000). Dietary glycemic index and obesity. J. Nutr. 130: 280S-3S.
Salmeron J, Manson J, Stampfer M, Colditz G, Wing A, Willett W. (1997). Dietary
fibre, glycemic load, and risk of non-insulin dependant diabetes mellitus in women.
JAMA. 277: 472-477.

25

Lipids
Fats and oils belong to a family of organic compounds called lipids, and the role they
play throughout human physiology makes them an essential component to the diet,
and indeed they form one of the recognised macronutrients.
The aim of this chapter is to classify the most common dietary lipids, and to give an
overview of their structure and function, and thereby provide a firm foundation for
further reading. At present dietary recommendations for lipids, and their subsequent
effect on human health is the subject of great debate. Clearly, the role played by
lipids within the body cannot be under estimated.
Key physiological functions of lipids

formation of virtually all cell membranes

formation of myelin sheath within the nervous system
constitutes majority of the CNS and spinal cord
synthesis of steroid hormones
assists in the regulation of enzymes
insulation through subcutaneous adipose tissue
protection of internal organs
transportation, storage and utilisation of fat soluble vitamins
A, D, E, K.
fuel source during lower intensity work loads
storage of energy within the adipose tissue

The Structure of Lipids

At room temperature lipids which are liquid are called oils, and those which are solid
are called fats.
Most dietary lipids consist of chains or rings of carbon atoms joined together along
with other atoms, most commonly hydrogen and oxygen. There are many different
kinds of fats that vary mainly due to their structure. The smaller units of fats are
called fatty acids. These are seen in differing molecular lengths and with the
presence of double strength bonds between some carbon atoms. The double bonds
change the shape of the molecule and enable lipids to become very versatile. A
different shape means a different function in the body.
Both short chain and medium chain fatty acids such as those commonly found in
butter are small enough to be absorbed quickly into the blood, thus they provide a
faster source of energy than the long chain fatty acids. For this reason they are less
likely to cause weight gain (Portillo et al, 1998).

26

Triglycerides
Fatty acids naturally occur as triglycerides, where three fatty acids attach to a
carbohydrate backbone called glycerol. During digestion the fatty acids are broken off
and then used in the body as required.

G
L
Y
C
E
R
O
L

SATURATED FATTY ACID

SATURATED FATTY ACID

SATURATED FATTY ACID

Saturated Fat
These fats comprise of chains of carbon atoms which are saturated or full with
hydrogen, which gives them distinct properties .They do not contain any double
bonds which means they have a straight structure. The shape of fatty acids is highly
significant in understanding both their resultant properties and the way they function
within the body. Saturated fatty acids are straight which, accounts for their solid
structure at room temperature, since they are able to pack tightly together with little
space between them.

Saturated fatty acid

Saturated fatty acid

Saturated fatty acid

Saturated fatty acid

Saturated fatty acid

Saturated fatty acid

Saturated fatty acid

Common sources of saturated fat

Animal
meat beef, pork,
lamb, venison

poultry chicken,
duck
dairy milk, cheese,
yoghurt,
cream,
butter
eggs
27

Non animal
palm oil
coconut oil

Health Implications
Some studies strongly suggest that much of the original research and subsequent
follow up work relating to saturated fat and its effect on health have been subjected
to both misinterpretation and misrepresentation (Enig, 1993; Ravnskov, 1995).
Further to this, an increasing number of researchers have failed to find a correlation
between saturated fat intake and the development of clogged arteries, more
commonly termed as atherosclerosis (Ravnskov, 1998). In fact, an evaluation of the
fat found within the arterial walls as a result of CHD, reveals that only 26% is
saturated, the rest is unsaturated or plant-based fats (Felton, 1994).

Research reveals there is a need for saturated fat to be included within the daily diet.
Functions include:

enhancement of the immune system (Cohen, 1986)

provision of energy and structural integrity to the cells (Mead et al, 1986)
enhancement of liver function (Nanji et al, 1995; Cha and Sachan, 1994)
the ability of coconut oil to act as an antimicrobal and antiviral agent (Projan et al,
1994;Hornung et al, 1994)

It should be remembered that diets too high in any kind of fat are also very energy
dense, which may lead to a positive energy balance and thereby promote an
increase in body fat. An excess of body fat is inherently damaging to our health and
is closely linked to the development of disease, including coronary heart disease,
diabetes and cancer.
Unsaturated Oils
These fatty acids are described as unsaturated because some hydrogen atoms are
absent from the chain of carbons. This causes two effects:

a double bond is formed between one or more of the carbon atoms

the fatty acid bends at each double bond

UNSATURATED FATTY ACID

Remember a different shape means a different function within the body. Unsaturated
fats come in two main categories:

monounsaturated a single double bond single bend in molecule

polyunsaturated several double bonds several bends in molecule

28

Monounsaturated fatty acids:

These oils contain fatty acids with only one double bond thus the term mono or one.
This means the molecule has a single bend in it. The body is able to recognise the
distinct shape and length of the various monounsaturated fatty acids, and utilise them
accordingly. Diets high in monounsaturated fats have been shown to lower both LDL
cholesterol and plasma triglycerides, and are therefore thought to reduce the risk of
CHD (Kris-Etherton et al, 1999). The bodys tissues are also able to synthesise
monounsaturated fatty acids from saturated fatty acids where necessary.

Sources of monounsaturated fatty acids

olives
olive oil
beef
peanut oil

rapeseed oil
avocados
nuts
seeds

Polyunsaturated fatty acids:

These fatty acids are long chains of carbon atoms, again with missing hydrogen but
this time they posses more than one double bond. As with the monounsaturated fatty
acids, there is a distinct bend at the point of each double bond, which again means a
different shape and a different function.
Polyunsaturates have 2 sub-divisions which are considered essential to the daily diet.

essential fatty acids

These fatty acids are essential to the diet since the human body is unable to
synthesise them itself. They are important because they act as precursors to local
hormone like substances called prostaglandins, which act as potent regulators of
metabolism within the cells. The combined effects of these prostaglandins are far
reaching within the body, and a deficiency in these particular fatty acids can lead to ill
health. They are sub-divided into two categories.

Omega 3 fatty acids

Omega 6 fatty acids

One end of the fatty acid chain is referred to as the omega end, omega being the last
letter of the Greek alphabet. The omega number refers to the position of the first
double bond from the omega end of the fatty acid. These fatty acids are very specific
to the functioning of the cell, and must be eaten in the required amounts to promote
good health.

29

Omega 6 fatty acids

Omega 3 fatty acids

oily fish
flax oil
unrefined canola oil
unrefined soybean oil
walnuts

Note: all oils need to be cold pressed

and remain unprocessed

sunflower seeds
sunflower oil
safflower oil
pumpkin seeds
sesame seeds

Note: all oils need to be cold pressed

and remain unprocessed.

Omega 3 fatty acids such as those found in oily fish are particularly beneficial. They
have been shown to reduce the tendency of blood to clot, lower blood triglyceride
levels, lower total cholesterol levels and in some individuals to raise HDL cholesterol,
all of which are thought to lower the risk of CHD (Harris, 1989).

The ratio of omega 3 to omega 6 essential fatty acids

The balance between omega 3 and 6 fatty acids found in the diet is of special
importance. Our evolutionary diet provided a ratio close to 1:1, whilst the
modern Western diet is between 1: 15-16 in favour of omega 6. Excessive
amounts of omega 6 polyunsaturated fatty acids and a very high omega 6 to
omega 3 ratio, have been shown to promote the development of cardiovascular
disease and cancer, as well as inflammatory and autoimmune diseases
(Simopoulos, 2002).
An ideal ratio of omega 6 to 3 fatty acids is 2:1-1:1 (Okuyama et al,1997).
Fatty Acid Isomers
Unsaturated fatty acids are found in two isomers or shapes:

cis unsaturated double bonds

trans unsaturated double bonds
30

Cis unsaturated double bonds:

Most unsaturated fatty acids are naturally found with a cis configuration, where the
two hydrogen atoms by the double bond are the same side. This produces the
natural bend in the molecule. The body easily recognises this shape and uses these
fatty acids for their appropriate purposes.
Trans unsaturated double bonds:
Although these fatty acids occur naturally in small amounts within the diet, they are
mostly produced through the mass processing of unsaturated oils within the food
industry. The double bond remains but due to a disruption of the molecule it has an
unnatural, unsaturated, straight fatty acid chain.
The body no longer recognises these fatty acids, as their shape combined with their
length is now entirely foreign, and as a result they become very damaging to the
structure and function of the tissue. These are the bad fats, which are increasingly
associated with a variety of diseases, including CHD.
UNSATURATED TRANS FATTY ACID

It is completely unnatural to have a straight long chain fatty acid with a double bond.
Some experts believe that trans fats are closer in structure to plastic than fat.

hydrogenation and the formation of trans fats

This refers to a process used within the food industry where quantities of
unsaturated vegetable oils are placed into a large vat and:

heated to extremely high temperatures

subjected to high pressure
mixed with a nickel catalyst (to increase the
reaction rate)
subjected to the forced application of hydrogen

The addition of the hydrogen during this process, results in the formation of saturated
fatty acids, as the original double bonds are broken and replaced with single bonds
once again full of hydrogen. The amount of hydrogen added during the process will
determine the amount of saturated fatty acids in the end product. The consistency of
the final product will also be determined by the degree of hydrogenation. Fully
hydrogenated vegetable oil would result in a very hard waxy substance. Most
hydrogenation is partial, leaving varying amounts of the vegetable oil still containing
unsaturated double bonds. Many of these double bonds however, will have been
converted into trans fatty acids due to the actions of this intense and prolonged
process.

31

Common foods which contain trans fats

many margarines
biscuits
cakes
crackers
take away foods

pies
pastries
pre-prepared foods
many low fat processed foods
(low in saturated fat but high in
trans fat)

trans fatty acids and health risks

Metabolic studies have shown that dietary trans fatty acids have adverse effects on
blood lipid levels, promoting an increase in LDL or bad cholesterol, and a decrease
in healthier HDL cholesterol, and that this effect is double that produced from the
ingestion of saturated fat (Mensink and Katan, 1990).
Based on available metabolic studies, one report estimated that approximately
30,000 premature coronary heart disease deaths annually could be attributed to the
consumption of trans fatty acids (Willett and Ascherio, 1994).
Cholesterol
Cholesterol is a large lipid molecule, which cannot be utilised by the body as
energy; effectively it has no calories. However, it is extensively used
throughout the tissues for both structure and function and is essential to life.
The functions of cholesterol include:

a vital component of cell membranes - cell membranes, or walls, are

predominantly made up of lipids. Cholesterol is also incorporated within cell
membranes where, along with saturated fatty acids, it helps to provide structure
and rigidity. Membranes which contain greater amounts of polyunsaturated fatty
acids, due to eating too much vegetable oil and processed food, become floppy
and require more cholesterol to make them rigid (Jones, 1997).
production of steroid hormones - many hormones are proteins synthesised
from amino acids. The steroid hormones however, including the sex hormones
such as testosterone and oestrogen and adrenal hormones such as cortisol, are
synthesised from cholesterol.
synthesis of bile acids - the liver produces bile in order to digest dietary fat.
synthesis of vitamin D - cholesterol within the skin produces a precursor to
vitamin D, when exposed to sunlight.
Sources of dietary cholesterol
meat
poultry
egg yolks

fish
seafood
dairy produce

Dietary cholesterol only plays a relatively minor role in meeting our daily
needs. Cholesterol is so essential to life that the liver is able to synthesise its
own supply. When dietary cholesterol intake is low, the body increases the

32

synthesis of its own supply, and as dietary intake increases cholesterol

production falls.
Lipoproteins:
Cholesterol is a lipid, which means that it does not mix with the watery medium
of blood. The body has developed protein based carriers, called lipoproteins
that completely encase lipids for transport in the blood.
Three key lipoproteins are:

very low density lipoproteins (VLDL). Synthesised by the liver. Contain both
cholesterol and triglycerides. Transport triglycerides into adipose tissue.
low density lipoproteins (LDL). Formed from VLDLs once they have unloaded
most of their triglycerides. Transport the remaining cholesterol to cells
throughout the body that are in need.
high density lipoproteins (HDL). Synthesised by the liver. Transport excess
cholesterol from the tissues and blood back to the liver.

Liver packages VLDLs

VLDLs
VLDLs unload triglycerides into
adipose tissue and become
LDLs

HDLs transport
excess cholesterol
back to liver

LDLs

LDLs unload cholesterol into body

tissues

Table 6.10 Review of cholesterol research

33

Lipids and plasma cholesterol (Grundy 1997)

Saturated fatty acids

palmitic, myristic and luric acid raise plasma cholesterol
increased plasma cholesterol is linked with increased risk of CHD
these fatty acids make up approximately 2/3 of dietary saturated fat
stearic acid does not raise cholesterol, and has been linked to being
antiathrogenic (anti-artery clogging)
moderate intake of dietary saturated fat

Monounsaturated fatty acids

antiatherogenic (anti-artery clogging)
lowers LDL cholesterol and fasting plasma triglycerides
higher levels should be included in the diet

Polyunsaturated fatty acids

lower total and LDL cholesterol
should consist of omega 3 and omega 6 in balance
high intakes linked with increased cancer risk
high intakes lead to increased oxidation of LDL cholesterol
increased LDL oxidation enables cholesterol to, enter the arterial
walls, and thus increase CHD risk
Trans fatty acids

raise LDL cholesterol

lower HDL cholesterol
increase risk of CHD

High carbohydrate diets

raise plasma triglycerides
raise VLDL cholesterol
lower HDL cholesterol

Recommended % of total calorie intake (Grundy, 1997)

animal fats and trans fats

polyunsaturated fats
monounsaturated fats

7-8%
no more than 7%
remaining 15-16%

*Note: Although many researchers link both cholesterol and animal fats to the
development of CHD, others now challenge this concept, and question its very validity
(Stehbens, 2001).
Genetic factors may well play a role in establishing ideal dietary fat guidelines (Mistry
et al, 1981).

34

Food Recommendations

Avoid
margarines
hydrogenated or partially
hydrogenated fats
fats in cheap meats
skimmed or low fat dairy products
artificially lower fat products

Advise
organic butter, olive oil, and coconut
oil
organic full fat dairy products
organic quality meats
oily fish
organic seeds linseed, pumpkin
balance EFAs 1:1-2

Key learning points

1. Functions of lipids include:
cell membranes
myelin sheath
synthesis of steroid hormones
insulation
protection
transportation of fat soluble vitamins A, D, E, K
energy
2. Fatty acids occur in three lengths:
short chain
medium chain
long chain
3. Saturated fat:
found in animal products
found in palm oil and coconut oil
some fatty acids are considered to be atherogenic
saturated fats found in coconut oil considered to have health benefits
controversy over effects of saturated fat and health
4. Monounsaturated fat:
found in olive oil, peanut oil, avocados, red meat
linked with a reduced risk of heart disease
should be used in preference to saturated fat
5. Polyunsaturated fat:
omega 3 found in, oily fish, flax oil
omega 6 found in vegetable, pumpkin and sesame seeds
modern diet too high in omega 6
ideal ratio 2:1 or 1:1

35

Key learning points (continued)

6. Trans fatty acids:
damaging to the structure and function of tissue
caused by over heating and hydrogenation
found in processed food
increased risk of heart disease
the most damaging dietary fat
7. Cholesterol is an important substance, functions include:
component of cell membrane
production of steroid hormones
synthesis of bile acid
synthesis of vitamin D
found in animal produce
8. Cholesterol and triglycerides are transported in lipoproteins:
VLDLs unload triglycerides into adipose tissue
LDLs transport cholesterol from the liver to the tissues
HDLs transport cholesterol from the tissues and the blood, back to the
liver
9. Some studies indicate risk factors for CHD include:
elevated VLDL cholesterol
elevated LDL cholesterol
reduced HDL cholesterol
other studies question the link between cholesterol and CHD

References
Cha YS, Sachan DS, (1994). Opposite effects of dietary saturated and unsaturated
fatty acids on ethanol-pharmacokinetics, triglycerides and carnitines. J Am Coll
Nutr;13:338-343.
Cohen LA, Thompson DO, Maeura Y, Choi K, Blank M, Rose DP, (1986). Dietary fat
and mammary cancer. I. Promoting effects of different dietary fats on Nnitrosomethylurea-induced rat mammary tumorigenesis. Journal of the National
Cancer Institute;77:33.
Enig, M.G. (1993). Research review: trans fatty acids an update. Nutrition Quarterly
17(4): 79-95.
Felton CV, Crook D, Davies MJ, Oliver MF, (1994). Dietary polyunsaturated fatty
acids and composition of human aortic plaques. Lancet; 344:1195-1196.
Frank B Hu., Meir J., Stampfer J., Manson J E., et al (1999). Dietary saturated fats
and their food sources in relation to the risk of coronary heart disease in women. Am
J Clin Nutr 70:1001-1008.

36

Grundy, S.M., (1997). What is the desirable ratio of saturated, polyunsaturated, and
monounsaturated fatty acids in the diet? Am J Clin Nutr. 66(S) : 988S-990S.
Harris, W.S. (1989). Fish oils and plasma lipid and lipoprotein metabolism in humans:
a critical review. J. Lipid Res. 30:785-807.
Hornung, B,. Amtmann, E,. Sauer, G,. (1994). Lauric acid inhibits the maturation of
vesicular stomatitis virus. Journal of General Virology. 75:353-361.
Kris-Etherton, P.M, Pearson, T.A, Wan, Y. Hargrove, R.L, Moriatry, k, Fishell, V,
Etherton, T.C. (1999). High monounsaturated fatty acid diets lower both plasma
cholesterol and triglycerol concentrations. Am J Clin Nutr. 70: 1009-1015.
Mead, J, F, et al, (1986). Lipids: Chemistry, Biochemistry and Nutrition, Plenum
Press, New York.
Mensink, R.P.M, Katan, M.B. (1990). Effect of dietary trans fatty acids on highdensity and low-density lipoprotein cholesterol levels in healthy subjects. N Engl J
Med. 323: 439-445.
Mistry, F,. et al, (1981). Individual variation in the effects of dietary cholesterol on
plasma lipoproteins and cellular hoeostasis in man. J Clin Invest, vol. 67, 493-502.
Nanji AA, Sadrzadeh SM, Yang EK, Fogt F, Maydani M, Dannenberg AJ, (1995).
Dietary saturated fatty acids: a novel treatment for alcoholic liver disease.
Gastroenterology;109:547-554.
Okuyama, H, Kobayashi, T, Wantanabe, S. (1997). Dietary fatty acids: the omega 6
and omega 3 balance and chronic elderly diseases. Lipid Res. 35(4): 409-497.
Portillo, M, P,. et al ,(1998). Int J Obes Relat Metab Disord, 22(10): 947-949.
Projan, S, J,. Brown-Skrobot, Schlievert, P, M,. Vandenesch, F,. Norvick, R, P,.
(1994). Glycerol monolaurate inhibits the production of beta-lactamase, toxic shock
toxin-1. And other staphylococcas exoproteins by interfering with signal transduction.
Journal of Bacteriology. 176:4202-4209.
Ravnskov, U. (1995). Quotation bias in reviews of the diet-heart idea. J Clin Epid. 48:
713-719.
Ravnskov, U (1998) J Clin Epidemiol, 51(6):443-460.
Simon J, A,. Hodgkins M,L,. Browner W,S,. Neuhaus J,M,. Bernert J,T, Jr,. Hulley
S,B,. 1995. Serum fatty acids and the risk of coronary heart disease. Am J of
Epidemiol , Vol 142, Issue 5; 469-476.
Simopoulos, A,P,. (2002). The importance of the ratio of omega 6 to omega 3
essential fatty acids. Biomed Pharmacother. 56 (8) : 365-379.
Stehbens, W, E,. (2001). Coronary heart disease, hypercholesterolaemia, and
atherosclerosis.1 False premises and 2 Misrepresented data. Experimental and
Molecular Pathology, 70, 103-119 and 120-139.
Willett, W.C, Ascherio, A. (1994). Trans fatty acids: are there effects marginal? Am J
Public Health. 84: 722-724.

37

Vitamins, Minerals and Free Radicals

Vitamins and minerals form the micronutrients in the diet. Although we need these
substances in much smaller amounts than the macronutrients (CHO, protein and
fats), they remain a vital part of our diet if we are to maintain our health.
Minerals
Minerals are necessary for structure and for the normal regulation of metabolic,
hormonal and nervous interactions within the body. In simple terms, they enable our
bodies to function correctly on a daily basis. They do not provide energy themselves
but may allow our bodies to unlock the energy contained within our diet. Minerals
form approximately 4% of our body mass, mostly within the skeletal system. Plants
extract the minerals from the soil, which enables us in turn to ingest them, assuming
we have a varied diet. Although most minerals are important to the body, the four
macrominerals are required in greater amounts.
Calcium

Magnesium

Sodium

Potassium

Purposes:
bone growth
muscular
contraction

Purposes:
heart rhythm
immune
system

Purposes:
fluid balance
nerve function

Purposes:
fluid balance
nerve function

sardines
salmon
peanuts
walnuts
sunflower
seeds
dried beans
green leafy
vegetables

nuts
green leafy
vegetables
peas
beetroot
egg yolk
whole grains

shellfish
vegetables
carrots
artichokes
kidney
bacon

citrus fruits
watercress
green leafy
vegetables
mint leaves
sunflower
seeds
bananas
potatoes

Other minerals are needed for a healthy functioning body, but are required in much
smaller amounts. These are referred to as the trace minerals:
Some Trace Minerals

copper
manganese
iodine
boron
fluoride

38

aluminium
selenium
zinc
cobalt
chromium

Vitamins
Vitamins also come under the category of micronutrients and consist of a group of
organic compounds (all containing carbon), which are required for normal growth and
metabolism. All vitamins are synthesised by plants and can be obtained in the diet by
either eating the appropriate plants themselves or by eating animal products that
have derived their vitamin content from plants. We
are capable of synthesising some of the B
vitamins, i.e. biotin and riboflavin, and vitamin K
ourselves, from the action of bacteria found within
our GI tract. Our bodies are also capable of
assembling certain vitamins from precursors called
pro-vitamins often referred to as inactive vitamins.
For example, beta-carotene is a pro-vitamin found
in yellow and dark green vegetables from which
our bodies synthesise vitamin A.
Fat soluble vitamins:
Vitamins A, D, E, and K are termed as fat soluble,
meaning that they can only be absorbed,
transported and utilised in the presence of fat.
Their main function is to have a protective effect
on our cell membranes (cell walls). These
membranes are important because they enable
our cells to breathe and to receive the nutrients
necessary to maintain our health and normal
functioning. A diet too low in fat will lead to a
severe deficiency in the fat-soluble vitamins,
which will lead to ill health.
Water soluble vitamins:
The B group of vitamins and vitamin C are all water-soluble and are absorbed,
transported and utilised within water. They are all absorbed along the length of the
digestive tract and tend to have an effect within the cells themselves. These vitamins
cannot be stored within the body in any great quantity and therefore, we need to
include them daily in our diet if we are to avoid an eventual deficiency resulting in ill
health. A diet rich in refined simple carbohydrates containing an excess of sucrose
will eventually lead to such a deficiency.
Phytochemicals
These are chemicals synthesised by plants, which appear to have an important effect
upon human health. One important phytochemical found in tomatoes and other
brightly coloured fruit and vegetables, is lycopene, an effective antioxidant.
Key components of 1
cup of cherry tomatoes

vitamin C
vitamin E
vitamin A
folic acid

39

potassium
iron
lycopene
31 calories

Enzymes
For every physiological change in the body a specialised protein molecule known as
an enzyme provides the stimulus. Its job is to catalyse or speed up chemical
reactions within the cells so that the physiological changes that support life can take
place more quickly. The rate at which these reactions take place is totally dependent
upon the enzyme, often increasing them by one hundred thousand to one million
times.
How does an enzyme work?
An enzyme has a precise three-dimensional structure. By adjusting or altering the
structure of the enzyme the body can use it as a switch to turn on and off the reaction
that it catalyses or other reactants involved in the process. These reactants that bind
to the enzyme are known as substrates, and the point on which the substrate binds
onto the enzyme itself is known as the active site. The two fit together almost like a
lock and key and therefore, only an appropriately fitting substrate can bind to the
specific enzyme. Once this binding process has taken place it can now promote the
desired reaction and cause the eventual outcome.

Each enzyme is specific for only one substrate. There is a one lock and one key
principle where the active site of the enzyme also has a unique fit for one specific
substrate and no other.
Since this whole process relies on a unique fit between the substrate and the active
site in the enzyme it often requires assistance, which almost customises the
substrate in order to achieve a perfect fit. This assistance comes from either coenzymes, which are derivatives of vitamins, or co-factors, which are minerals.
Therefore, vitamins and minerals play a vital role in helping enzymes to function
appropriately and sustain life.
Free Radicals
Research has linked exercise with increased production of damaging chemicals
called free radicals, which cause a variety of diseases such as cancers,
cardiovascular disease, autoimmune disorders and even the aging process itself
(Pullen, 2002).

40

What is a free radical?

A free radical is strictly defined as an entity with one or several unpaired electrons in
the outer electron orbit of an atom or molecule (Karlsson, 1997).
This explanation may sound a little confusing but is in essence fairly simple. Atoms
have within them small particles called electrons and protons which play a role in
creating the attraction to form a chemical bond. Generally, atoms or molecules have
equal numbers of protons and electrons to remain balanced and stable. In a chemical
reaction, this balance may be changed and leave an unpaired electron. With unequal
numbers of protons and electrons the atom is unbalanced and must achieve stability.
The unbalanced free radical is highly reactive and quickly seeks out a spare
electron. If one cant be found it quickly steals an electron from an intact molecule
causing damage in the process. This may initiate a chain reaction that continues for
several days (Colgan, 1993).
Free radicals are produced in the body in a number of ways but a big contributor
especially for regular exercisers is oxygen. Most energy is produced within the body
via an aerobic process, which requires the break down of the food we eat along side
the use of oxygen. 95% of energy is produced through controlled oxidation, resulting
in clean reactions, which cause no free radical damage. However, the remaining
5% of energy production, results in the formation of a mass of free radicals, each
capable of causing damage within the body (Colgan, 2002).

5% of energy reactions create

unstable free radicals

Food

+
WATER

Oxygen
(oxidation)

Energy
(ATP)

C
O2

95% of energy reactions produce clean

fuel without free radicals

Examples of the damaging effect of oxygen or oxidation include the rusting of

untreated metal, the browning of a cut apple and the rotting of meat. Inside the body
the radicals can attack cell membranes leading to wrinkles, and skin diseases such
as eczema and psoriasis. Arterial walls become damaged, leading to the beginning
41

of blocked arteries or atherosclerosis. Double bonds found in unsaturated fats and in

DNA, are attacked leading to an increased risk of cancer and arthritis (Golan, 1995).
The damage caused by free radicals is also the major source of delayed muscle
soreness, or DOMS felt for several days after intense exercise (Gerutti et al, 1988).
Further, links have also been made between free radicals and Alzheimers disease,
diabetes, hypertension, rheumatoid arthritis, mental Illness and macular degeneration
of the eye (Patrick Holford, 1997). On a positive note, free radicals are utilised by
some cells within the immune system in order to kill harmful microbes.
Exercise can create a 10-15 fold increase in oxygen consumption and along with it
increased free radical damage (Pullen, 2002).
Defence mechanisms antioxidants:
As the human body evolved to utilise oxygen, it has also evolved elaborate defences
in order to limit free radical damage. These come in the form of antioxidant enzymes,
which the body produces naturally within the cells, such as superoxide dismutase.
Dietary antioxidants can also be acquired from the food that we eat. People with poor
diets depleted of nutrients may be at greater risk, as the bodys antioxidant enzymes
require nutrients such as vitamins A, C, E and minerals including zinc, selenium,
copper and manganese in order to function properly.
Antioxidants are substances that slow oxidation by neutralising free radicals (Mayo
Clinic, 2003) and work by being able to donate or receive electrons. Both the
enzymes and the nutrients play a role in breaking the damaging chain reactions.
Research suggests that regular exercisers do have a much higher level of their
natural antioxidant enzymes to help protect them (Cardwell, 1999).
Sources of antioxidant nutrients

vit C citrus fruits, green

veg, peppers, tomatoes,
potatoes
vit E veg oils, egg yolks,
whole grains, almonds,
nuts, green leafy veg

zinc oysters, ginger root,

lamb, nuts, grains, eggs,
peas
selenium grains, meats,
fish, brazil nuts, tuna,
shellfish, dairy

As we get older we lose the battle against environmental damage from radiation,
pollution and increasingly poor diets. Exercise also increases oxidative stress
through increased oxygen consumption, so it is important to stress that those
engaging in regular and especially intense exercise need to ensure that their diet is
better than the average to ensure high nutrient densities. A variety of vitamins and
minerals from many different sources will ensure that the body can function nearer its
optimal level. This should help limit any damage caused by exercise, including
injuries, and to help promote recovery caused by myofibril damage (DOMS).
Although not all the research with supplementation is favourable, one thing is agreed
among scientists. Consumption of a diet rich in fruit and vegetables is recommended
as a protection against the risks of developing a number of degenerative diseases
associated with age, including cardiovascular diseases and cancer (Food Standards
Agency, 2001).

42

Food Recommendations

Avoid
limiting food choices
fresh produce from overseas
fortified foods lack quality
processed fruit and vegetables
cooking at high temperatures

Advise
eat variety of fresh fruit, vegetables,
and animal produce
eat seasonal, local produce - freshest
eat raw fruit and veg where possible
broaden tastes try new foods

Key learning points

1. Minerals are necessary for:
structure
the regulation of metabolism
act as co-factors to assist enzymes
many act as antioxidants
2. Vitamins:
water soluble = B, C
fat soluble = A,D,E,K
act as co-enzymes to assist enzymes
many act as antioxidants
3. Phytochemicals:
important chemicals synthesised by plants

4. Enzymes:
a protein molecule that acts as a catalyst for the bodys reactions
they speed up chemical reactions without entering the reaction itself
they activate by the presence of a substrate binding with the active
site - Work in conjunction with co-enzymes and co-factors

5. A free radical is a molecule which is:

unbalanced and unstable
highly reactive
they are mostly formed by 5% rogue oxygen
6. Free radicals cause damage to:
cell membranes
DNA in the nucleus of the cells
arteries
LDL cholesterol
7. Diseases linked with free radicals:
coronary arterial disease
cancer
arthritis
alzheimers disease
diabetes
macular degeneration of the eye

43

References
Ames, BN. (1983). Science: 221:1256
Cardwell, G. (1999). Antioxidants and sport, from ptonthenet.com.
Colgan, M. (1993). Optimum sports nutrition, Advanced Research Press.
Colgan, M. (1995). The new nutrition. Apple Publishing.
Colgan, M. (2002). Sports nutrition guide, Apple Publishing Company Ltd.
Food Standards Agency, (2001). Antioxidants in food. Crown Copyright.
Gerutti, A. et al. (1988). Oxy-radicals in molecular biology and pathology, New York:
AR Liss.
Giovannucci, E., Rimm, E.B., Liu, Y., Stanpfer, M.J., Willett, W.C., (2002). A
prospective study of tomato products, lycopene, and prostate cancer risk. Journal of
the National Cancer Institute, Vol. 94, No. 5: 391-398.
Harman, D. (1956). Aging: A theory based on free radical and radiation chemistry. J
Gerontol, 1956: 11: 298-300.
Hirayama, T. (1985). A large-scale cohort study on cancer risks by diet- with special
reference to the risk reducing effects of green-yellow vegetable consumption.
Princess Takamatsu Symp, (USA), vol 16, 41-53.
Holford, P. (1997). The Optimum nutrition bible, Judy Piatkus (publishers) Ltd.
Karlsson, J. (1997). Antioxidants and exercise, Human Kinetics.
Kawai, Y. Shimomitsu, T. Takanami, Y. et al. Vitamin E level changes in serum and
red blood cells due to acute exhaustive exercise in collegiate women. J Nut Sci
Vitaminol (Tokyo), Jun: 46(3): 119-24.
Mayo Clinic information, (2003). MayoClinic.com
Meydani, M. Evans, WJ. Handelman, G. et al. (1993). Protective effect of Vitamin E
on exercise induced oxidative damage in young and older adults. Am J Physiol May:
264
Pryor, WA. (1986). Ann Rev Physiol, 48:657-667.
Pullen, S. (2002). Exercise; free radicals and antioxidants, from ptonthenet.com.
Quintanilha, A. (1989). Handbook of free radicals and antioxidants. CRC Press.
Singh, A. Failla, ML. Deuster, PA. (1994). Exercise induced changes in immune
function: effects of zinc supplementation. J Appl Physiol Jun: 76(6): 2298-303.
Thompson, D. Williams, C. McGregor, SJ. et al. (2001). Prolonged vitamin C
supplementation and recovery from demanding exercise. Int J Sport Nut Exer Metab
Dec: 11(4): 466-81.

44

Exercise Nutrition
The best nutritional recommendations to accompany an exercise regime will vary
according to the physiological demands placed upon the body, and therefore must be
relevant to specific training programmes.
Aerobic training requires fuel, which can be provided by fat, carbohydrate and even
protein. Whilst working at lower intensities, a greater percentage of fat will be utilised
for energy, but with rising intensity of exercise a progressively higher amount of
carbohydrate will be drawn into the fuel equation.
The serious exerciser or the dedicated athlete is faced with an array of information
and possible options to best suit their needs. These choices can be narrowed down
to the following:

the use of food alone

the sole reliance on sports drinks and/or protein shakes
a combination of food plus sports drinks
a combination of food plus protein shakes
a combination of food plus water

Pre-exercise Meal - High or Low Glycaemic Index?

It has often been quoted that a pre exercise meal is best chosen from low GI foods.
The rationale for this belief is that, if a high GI carbohydrate meal is taken before
training or competing, the relatively rapid rise in blood glucose will cause
corresponding release of insulin.
The feared effects of high GI CHO were:

an increased rate of early glucose oxidation

a rebound hypoglycaemia effect where the increased insulin causes a rapid fall
in glucose levels possibly even before the session has begun

The original research reported that cyclists given a low GI meal consisting of lentils
eaten one hour before intensive exercise, performed for longer before fatiguing,
when compared to those fed on a high GI meal (Thomas et al, 1991). The
researchers suggested that glycogen sparing may have occurred with the low
glycaemic trial, thus promoting better performance. However, post training glycogen
levels were never measured, and subsequent studies have failed to prove any clear
benefit from pre-feeding on a low glycaemic meal, including repeated work from Dr
Thomas team.
The majority of studies show that there may be slightly more favourable metabolic
conditions with regards to insulin levels during exercise associated with low GI foods
than with high GI alternatives. But these differences are small and short lived. The
conclusion is that athletes probably perform the same on both pre-race meals.
As will be discussed later, the real difference in performance appears to be related to
carbohydrate feeding during exercise, which seems to over ride any metabolic or
performance effects arising from the type of pre-event meal. Athletes should
consume adequate amounts of carbohydrate drinks during endurance exercise, and

45

may feel free to choose their pre-exercise meal according to their personal
preferences (Burke et al 1998).
Carbohydrate taken during exercise or competition
Different studies have indicated that ingesting carbohydrates is acceptable:

if the session is longer than an hour

if the match or race is longer than 90 minutes
if a pre-exercise meal is not possible (such as early morning intensive training)

The consumption of isotonic drinks during exercise has been shown to delay the
onset of fatigue and to improve performance in endurance athletes (Tsintzas et al
1995). Many athletes find it difficult to consume even a light meal before exercise
without causing gastrointestinal discomfort, or they simply may not have time to eat
before their planned training session. Often people have to train early in the morning,
making a pre-exercise meal impossible. One study found that ingesting an isotonic
drink during endurance training is as effective as a pre training carbohydrate meal
(Chryssanthopoulos et al, 1994). The replacement of fluid provided by the isotonic
drink is also a direct advantage.
Post-Exercise Meal Guidelines
After intensive exercise, the muscles are more sensitive to the effects of insulin thus
enabling a more efficient replacement of lost glycogen. This process is particularly
evident during the first two hours following the training session. The rapid synthesis
of muscle glycogen stores is aided by the immediate intake of high GI carbohydrate.

Why high glycaemic index CHO post-exercise?

increased glucose availability

increased insulin
increased glucose uptake
increased glycogen synthesis

Some studies have advised the following guidelines

post training: 1 gram CHO per kilogram body mass every two hours
(50 grams per meal)
first intake within 30 min post-training
intake over 24 hours: 7 10 grams CHO per kilogram
(500 700 grams of CHO per day)
(Burke et al, 2000)

46

The frequency of carbohydrate meals post-training does not appear to exert an effect
on glycogen replenishment. Small regular intakes or three larger meals appear to
gain the same results.
General Exercise
This category refers to people under taking lower intensities of training, where a
greater amount of fat will be utilised with some possible loss of glycogen. These
guidelines are somewhat similar to normal guidelines for eating, except that it should
be timed appropriately around the exercise session.
Guidelines for general exercise

aim to stay within energy balance

create energy deficit of 250 kcal if trying to lose body fat
fulfil CHO needs, chose from moderate to low GI foods
try to provide energy that can be metabolised, dont mix high CHO with high fat
smaller portions and regular meals favour the oxidation of nutrients
micronutrients should be high
fibre should be adequate
include adequate protein
EFAs should be eaten in balance

What is an Isotonic Drink?

Sports drinks are now widely used in order to
improve performance and recovery. They
serve two main roles, notably the replacement
of fluid and the provision of fuel in the form of
carbohydrate. Isotonic drinks have a similar
balance of dissolved solids to the blood. This
helps provide a faster rate of absorption of fuel
whilst maintaining reasonable hydration. They
also contain the necessary electrolytes or salts
lost through increased sweating during
intensive exertion.
As previously stated there are several studies showing that the use of sports drinks
has been beneficial in prolonging activity and has particularly helped as fuel
replacement during exercise. However, it should be noted that many of the
commercial sports drinks have other additives which are less desirable. It is not
uncommon to find isotonic drinks that have sweeteners and colourings in them.
Aspartame and acesulfame K are common sweeteners (see food additives chapter)
and have undesirable side effects.
Another option is to make your own equivalent of a sports drink. Below are 2 options:

dissolve 60g glucose into a litre of water and add a fifth teaspoon of natural
unprocessed salt
mix 500ml of unsweetened fruit juice with 500ml of water and add a fifth
teaspoon of natural unprocessed salt (paralympics.org.uk)

47

Protein Shakes
Protein shakes have become a popular training supplement in
the last 20 years, partially due to the increased profile of
bodybuilding, but also because of the significant investment in
advertising in mens magazines and the internet. The appeal is
a quick, easy to use supplement that enables individuals
seeking hypertrophy to achieve their increased protein needs.
Much of the advertising implies that their supplement is the
answer and is a highly advanced or precision engineered
muscle building formula. So how much is marketing and how
much is truth?
Whey protein is found in milk, which averages about 6.5%
protein, of which about 20% is whey protein. In its natural state
it has the highest biological value to the body of any protein,
due to its high concentration of essential and branched chain amino acids. This
makes it useful to the body in many ways, one of which is in the repair and growth of
muscle tissues (Kadey, 2005). However, by the time a tub of whey powder is
purchased it is often vastly different from the original product. Consider the following
points:

whey is a waste liquid by-product from cheese manufacture. Traditionally it was

disposed of by farmers into animal feeds (Fallon, 2003)
often dried at high temperatures for speed of manufacture above 60C these
fragile proteins become denatured, which destroys their ability to function (Fallon,
2003)
manufacturers use sugars, sweeteners, colours and flavours to improve
palatability
often very low in fat proteins need fat for proper metabolism and use. Some
studies indicate that skimmed milk can lead to increased body fat storage
compared to whole milk (westonaprice.org)
often backed up by self-funded research, if any this does not provide an
independent, objective view
prices now are highly inflated due to market demand generated by clever
advertising

It is important to recognise that protein shakes were only intended to supplement, not
replace good food. The body is designed to absorb and metabolise real, untainted
food and protein sources. If a supplement is required then consider the following
points before purchasing:

seek cold processed protein powders, manufactured below 50 C

no added sugars, sweeteners, colours or flavours
mix with whole organic milk, as fats are necessary for protein metabolism

48

Key learning points

1. Pre-exercise feeding:
traditional thought was to use low glycaemic CHO two hours before
session or event
now appears that the glycaemic index of CHO before training or an
event makes little difference
CHO of personal preference can be eaten some time prior to training
isotonic sports drink can be taken within 15 min before session
consider home made isotonic drinks
fuelling during session or event is important for sessions or events
longer than an hour
2. Post exercise feeding should take advantage of active glycogen storing
enzymes:
increased glucose availability
increased insulin
increased glucose uptake by muscles
increased glycogen synthesis
3. Isotonic drinks
same concentration as blood
offer fast absorption of CHO
contains important electrolytes/salts
4. Protein shakes are driven by advertising
often processed at high temperatures, and have many additives
should only be used as a supplement to natural, quality food

References
Burke LM, Claassen A, Hawley JA, Noakes TD. (1998). No effect of glycemic index
of pre-exercise meals with carbohydrate intake during exercise. Med Sci Sports
Eexerc 30, S82: 471.
Chryssanthopoulos C, Williams C, Wilson W, Asher I, Hearne I. (1994). Comparison
between carbohydrate feeding before and during exercise on running performance
during a 30 km treadmill time trial. International Journal of Sports Nutrition. 4: 374386.
Murray R, Paul GL, Seifert JG, Eddy DE, Halaby GA. (1989). The effects of glucose,
fructose, and sucrose ingestion during exercise. Med Sci Sports Eexerc. 21:275-282.
Thomas D.E, Brotherhood J.R, Brand J.C. (1991). Carbohydrate feeding before
exercise: effect of glycemic index. Int J Sports Med. 12: 180-186.
Tsintzas O.K, Williams C, Boobis L, Greenhaff P. (1995). Influence of carbohydrate
supplementation early in exercise on endurance running capacity. Carbohydrate
ingestion and glycogen utilisation in different muscle types in man. Journal of
Physiology. 489: 243-250.
Tsintzas O.K, Williams C, Singh R, Wilson W, Burrin J. (1995). Influence of
carbohydrate-electrolyte drinks on marathon running performance. 70: 154-160.
49

Kadey M. (2005) Whey Protein: Not just for Bodybuilders. Ptonthenet.com

Fallon S, Enig M. (2003). Hyperbole meets high tech: Slick sales talk and modern
Energy Bars. Westonaprice.org

50

Digestion
The digestive system can be seen as the bodys own food-processing factory. It
provides two critical functions: digestion and absorption of nutrients. The body is
unable to absorb or use large food molecules and therefore has to break them down
into smaller and more manageable units before they can be assimilated. This is the
job of the digestive system and it fulfils this role through the combined efforts of
chemical and mechanical digestion.
Many of the components of the digestive system secrete special substances called
enzymes. Enzymes are chemical catalysts and speed up the digestive process by
breaking down the large, unabsorbable macronutrient molecules into smaller,
absorbable ones. The enzymes themselves are not changed in these reactions and
just like a lock and key, each enzyme will only work on specific nutrients.
Digestion and absorption of all nutrients takes place within the gastrointestinal tract
(GI tract). The GI tract is a hollow tube that runs from the mouth to the anus. The
organs that make up the GI tract are the mouth, pharynx, oesophagus, stomach,
small/large intestines and the anus. Each of these components fulfils a precise
function.
Location
Mouth
Stomach
Small Intestine
Small Intestine
Small Intestine

Enzyme
Salivary amylase
Pepsin
Lipase
Pancreatic amylase
Trypsin

Macronutrient
Carbohydrates
Proteins
Fats

Nutrient
Carbohydrates
Proteins
Fats
Carbohydrates
Proteins

End Product
Glucose
Amino acids
Free fatty acids, glycerol

51

Mouth:
Mastication mechanical chewing
Saliva moistens food, protects
teeth against decay, contains an
enzyme
Salivary amylase begins to break
down larger carbohydrate molecules
Oesophagus:
Peristalsis travels food down to the
stomach
Stomach:
Gastric juices contain acid and
enzymes
Hydrochloric acid kills bacteria
Pepsin breaks proteins into shorter
chain peptides
Pancreas:
Pancreatic juices contain enzymes
Lipase breaks fat into fatty acids
Amylase CHO into glucose
Trypsin proteins into amino acids
Liver:
Food doesnt pass through liver
Produces bile acids emulsifies fats,
or mixes fats with water
Gall Bladder:
A storage reservoir for bile acids
Small Intestine:
Main site of digestion and absorption
Pancreas and gall bladder empty
into 1st section duodenum
Villi absorbs nutrients into blood
Large Intestine:
Colon absorbs any remaining water,
vitamins and minerals
Bacteria produce some vitamins
and fight infection in intestine
Rectum stores faeces
Anus:
Opening for elimination of waste

52

Weight Management and Eating

Behaviours
The goal of weight management is to
prevent the accumulation of excess body fat
and for those who are already overweight, to
reduce body fat to an acceptably safe level
in order to prevent the health risks
associated with obesity (Robinson et al,
1995). The ultimate answer to successfully
managing your weight is eating according to
your metabolism. Metabolism is dependent
on many factors and variables which need to
be understood in order to eat accordingly.
Energy balance, insulin response, leptin
control, activity levels, body size and
genetics are some of the major factors
involved in managing weight. Understanding how and why the body accumulates
body fat helps in providing measures on body fat reduction or maintenance.
Adipose Tissue
Adipose tissue consists of individual fat cells or adipocytes, which function to store
excess dietary fat and energy in the form of triglycerides. Circulating lipoproteins
serve as transport vehicles for lipids within the bloodstream. Lipoprotein lipase (LPL)
acts on lipid containing lipoproteins sent out to the adipose tissue from the liver,
causing them to unload excess triglycerides into adipocytes.
Adipose tissue is also capable of storing excess energy from an over consumption of
carbohydrate. If excess carbohydrate is consumed over several consecutive days
leading to a positive energy balance, the result will be an increase in body fat
(Acheson et al, 1988). Glucose enters the adipose tissue where under the influence
of insulin, it is synthesised into fat and stored as triglycerides. It is more likely when
insulin levels are elevated.

Excess glucose enters

adipose tissue and is
converted into fat

GLUCOSE

Most glucose is taken

into the tissues to be
used as fuel

ADIPOSE
TISSUE

An increase in the size of adipocytes is usually what occurs when body fat is stored.
Although an individuals overall number of adipocytes is genetically predetermined,

53

environmental factors can also exert an effect. Appetite is subject to a number of

complex hormonal and nervous signals as well as behavioural responses and
parental influence. Overfeeding during childhood stimulates an increase in the
number of fat cells. This is especially the case during puberty (Malina and Bouchard
1991) and is of concern, since these fat cells remain for life and may exert a longterm influence on appetite. The goal therefore of effective weight management is to
progressively reduce the size of the existing fat cells.
Distribution of Body Fat
The distribution of adipose tissue also has significance
and is heavily influenced by genetics and gender. An
excess of central or abdominal fat is more common within
males and gives rise to an android or apple shape.
Central obesity is associated with insulin resistance
(Helmrich et al 1991), and with an increased risk of
disease including coronary heart disease (Seidell et al
89). Peripherally distributed fatness is more common
within females and gives rise to a gynoid or pear shape,
and represents less of a risk factor.
The Release of Signalling Hormones
Adipose tissue has been found to produce several signalling proteins or hormones,
which appear to have far reaching effects on metabolism. One such protein produced
by the ob (obese) gene within fat cells is leptin, which is known to:

reduce appetite
increase energy expenditure

As fat cells increase in size they produce more leptin, and the levels of leptin are
directly proportional to the levels of body fat or adipose tissue (Woods et al 1998).
Fat loss will reduce leptin levels, whilst fat gain will cause a corresponding increase
(Kolaczynski et al, 1996; Weigle et al, 1997).

1. Decreased
BMR
2. Increased
hunger
3. Increased
LPL activity
Rapid fat loss
causes severe
reduction in leptin

Drop in leptin detected

by hypothalamus
Starvation response
initiated

Response remains
until leptin and body
fat return to previous
levels

Proponents of the set point theory claim that we possess a genetically determined
level of body fat and that any attempt to alter this level will cause metabolic

54

adjustments designed to regain the previous set point. Lipoprotein lipase (LPL) is
the enzyme responsible for storing triglycerides into adipocytes. Increased activity
will increase the size of those fat cells. This starvation response is thought to have
originated from our hunter gatherer evolutionary ancestors. As the body often went
for long periods without food when meat was scarce, it developed a way of
preserving its most valuable energy store, body fat, in order to assure longer survival.
It also reduced daily calorie needs by burning up energy hungry muscle tissue,
thereby lowering BMR.
Typical dieting alone will likely bring about this response and often leads to
weight cycling up and down, which has been linked with poor nutritional levels
of health. Understanding this response can help so that we do not restrict
calories too severely and bring about a fat storing environment. To reset your
bodys fat thermostat requires a slower more sustainable rate of weight loss,
accompanied by a gradual increase in physical activity.
Total Daily Energy Expenditure (TDEE)
TDEE is the amount of calories we need on a daily basis to fuel all the functions and
activity of the body. Knowing how many calories we need a day can give us a starting
point if calorie restriction is being used as part of weight management. In order to
offset the starvation response any restriction should not exceed 250 calories.
See Appendix Part 2 The Harris-Benedict Formula
Energy and Metabolism
The components of energy expenditure are as follows:

Basal Metabolic Rate (BMR)

Thermal Effect of Food (TEF)
Thermal Effect of Activity (TEA)

Each of these components must be taken into account when considering energy
balance.
Basal Metabolic Rate (BMR):
We have identified that if the energy deficit is too great, this will cause a lowering of
the BMR due to a fall in leptin levels and a reduction in muscle mass or fat free mass
(FFM). To minimise this effect, any intervention must therefore, incorporate a more
modest energy deficit.
Thermal Effect of Food (TEF):
The thermal effect of food refers to the amount of energy expended by the body
through the ingestion, digestion, absorption, utilisation and storage of food. The TEF
accounts for between 6-10% of daily energy expenditure for men and between 6-7%
for women (Poehlman, 1989).

a very high fat diet, may promote an increase in body fat for the simple
reason that more energy is ingested (Stubbs et al, 1995).
high intakes of heavily refined carbohydrates, which are rapidly absorbed and
produce elevated levels of insulin, should be avoided. Increased levels of insulin
suppress the release and burning of stored body fat (Giovannucci, 1995;
McKeown-Eyssen, 1994).

55

Thermal Effect of Activity (TEA):

The thermal effect of activity covers planned and unplanned levels of physical
activity. Since research clearly indicates that low levels of activity are heavily
implicated in the development of obesity, it follows that increasing levels of activity
must play a major role in reversing this process. TEA is the most variable component
of energy expenditure, and accounts for approximately 20% - 40% of total energy
expenditure.
Genes
As well as the environmental factors of dietary intake and activity levels,
genetic influences clearly play a role. Genetic factors form part of the
increasing epidemic of obesity, but it can not be seen to be the sole cause
since the advance of the condition has occurred too quickly to be traced back
to the gene pool alone. An individuals genetic make up may predispose them
to obesity, but the environmental factors of over-feeding and reduced activity
also contribute to the extent of the eventual problem. In an environment
conducive to producing obesity, people genetically prone to obesity will gain
weight (Bouchard, 1997).
Creating an Energy Deficit
In order to lose body fat, a negative energy balance has to be established. Research
concludes that if the energy deficit is too great, the body fat is more likely to return,
possibly at an even higher rate. A priority for an effective weight management
programme is to lose body fat, whilst retaining as much FFM as possible thereby
minimising the fall in metabolic rate (US Dept of Agriculture, 1995). To achieve this,
a weight loss of - 1lb per week (ideally from body fat) is recommended.
Creating an energy deficit
Create a 500 kcal deficit per day
500 kcal deficit seven days a week
= 3500 kcal, = slightly less than 1lb (0.45kg)

Available methods to achieve negative energy balance:

diet restriction alone: Reduce dietary intake by 500 kcal per day
exercise intervention alone: Increase TEA by 500 kcal per day through planned
exercise
exercise and dietary restriction combined: Increase TEA by 250 kcal and reduce
dietary intake by 250 kcal

Each of these methods can achieve a negative energy balance necessary for the
desired goal. However, the figures are approximate and the rate of fat loss will vary
slightly from week-to-week and between different individuals.

out of the above-mentioned interventions, the combination of exercise coupled

with a modest dietary restriction has been proven from numerous studies to be
the most effective method for achieving the desired negative energy balance,

56

when compared with exercise and diet alone (Miller, 1991; Rachette et al, 1995;
Wilmore, 1996).
exercise increases the long term success of weight management programmes in
relation to the maintenance of fat loss, as opposed to diet restriction alone
(Brownell et al, 1986; Pavlou et al, 1989).
exercise and dietary restraint combined, has been shown to stimulate fat loss
whilst minimising the loss of FFM and subsequent fall in metabolic rate (Ross,
Pedwell, Rissanen, 1995).

Effective Dietary Interventions

If exercise interventions are most effective when correctly designed, implemented
and evaluated, then the same must be true for any dietary interventions. The weight
loss diet should contribute towards the desired energy deficit, whilst also providing
sufficient nutrients required for health and normal functioning. Factors to consider
include:

frequency of meals
insulin
macronutrient balance
biochemical individuality

Frequency of meals:
Advice to eat little and often is freely given so is there any rationale behind such
advice? The answer is yes. Although the TEF over 24 hours is the same for several
smaller meals totalling 1500 kcal as for one single meal totalling 1500 kcal, the
physiological effects on the metabolism do differ. One study consisted of feeding two
trial groups a total of 800 kcal per day. The first group had one meal per day, whilst
the second consumed their 800 kcal from several smaller feeds. The group which
consumed one meal a day experienced more hunger and a greater loss of FFM
(Garrow, 1981). Both of these effects are detrimental to long term weight
management. These results show that in order to minimise the loss of FFM and to
avoid the subsequent fall in metabolism, regular meals throughout the day seems the
most appropriate approach. A minimum of 3 meals a day is advised.
Large meals often contain too much energy to be metabolised at one time. Since
carbohydrate and protein in large amounts both suppress the oxidation of dietary fat,
larger meals increase the probability of energy being stored as fat, unless the
macronutrients are in a favourable balance.
Blood Glucose and Insulin:
Insulin plays a significant role in the storage of energy, and is a major contributing
factor towards obesity. The following graph helps to illustrate the hormonal response
in relation to high or low blood glucose levels:

57

Insulin drives glucose in the blood into the cells of the body for use. It primarily sends
glucose to the muscles and liver where it is stored as glycogen. Glycogen is a large
complex chain of glucose molecules and is better for storage. Glucose will be driven
to other cells throughout the body. It will also send glucose into the adipose tissues.
Higher insulin levels mean more glucose converted and stored in adipose tissue. It is
important when striving to manage weight and body fat stores that insulin levels are
kept reasonably constant. High glycaemic index foods and refined carbohydrates
tend to cause insulin levels to spike in an attempt to control rocketing blood glucose
levels. This will favour fat storage and suppress the burning of fat as a fuel. Spiking
often results in a subsequent crash in blood glucose, which creates tiredness and
hunger and may lead to overeating.
A high carbohydrate diet cannot be said to be the only cause of insulin resistance,
but it can compound the problem. Insulin resistance is closely linked with becoming
over fat through an excessive intake of energy, be it from carbohydrate, protein, fat or
more commonly from a combination of all three. A high fat diet is just as likely to
promote insulin resistance since its high energy density can lead to overfeeding and
the development of obesity.
It is important to realise that insulin resistance is not just associated with increased
body fat, but also with low levels of activity. Regular moderate intensity aerobic
exercise incorporating large muscle groups has been shown to reduce insulin
resistance by increasing insulin sensitivity particularly within the muscle tissue
(Eriksson, 1999).

58

The actions of insulin include

uptake of glucose into cells

promotion of glycogen synthesis
uptake of amino acids into cells
promotion of protein synthesis
the suppression of fat breakdown and release from the adipose tissue
increased uptake of glucose into adipose tissue
increased synthesis of fat from glucose during positive energy balance
stimulation of lipoprotein lipase (LPL), enabling the storage of fatty acids
within the adipose tissue.

Macronutrient balance:
Macronutrient balance means that the intake of each macronutrient is equal to
its oxidation or use as fuel. Simply put this means that we have to be able to
metabolise the food we eat by utilising it as energy or heat. Any macronutrient,
which is ingested in excess of our ability to oxidise it, will be stored as energy
most commonly as fat within the adipose tissue. The key here is to understand
the hierarchy, which exists with regards to the oxidation of each of these
nutrients. The order is as follows:

alcohol
protein
carbohydrate
fat

Research has shown that intakes of carbohydrate, protein and alcohol are met
by corresponding increases in their rates of oxidation and that under normal
circumstances they are not easily converted to fat (Swinburn and Ravussin,
1993). However, an increase in dietary fat is not matched by an increase in the
rate of its oxidation (Abbot et al, 1998). Protein, carbohydrate and alcohol will
suppress the burning of dietary fat. It has been suggested that many people
who gain weight on high carbohydrate diets do so due to a failure to oxidise
the fat in their diet, causing them to store it instead (Jebb et al, 1996).
Balance of macronutrients. Factors to consider

why high CHO along with low fat?

why high protein along with low

CHO?

59

glucose suppresses the use of

fat as fuel

increased protein intake leads to

an increased fat content within
the diet. If too much CHO is also
added to the fuel mix, the glucose
will suppress the burning of the
dietary fat, and promote fat
storage

Biochemical individuality:
Whilst we share many similarities, we are each an individual biological entity in
our own right, shaped by our genetic makeup and our environment. Our function is
related to our structure. This is reflected from the whole body right down to the
individual organs. For example, the size and shape of individual stomachs differ
widely and in return exert an influence on our ability to digest and handle protein.
In dietary terms, what suits one person may not suit another. Hence there are those
who may thrive on large amounts of dietary carbohydrate, whilst others may thrive on
a high protein, ketogenic diet. Yet others favour less heavy carbohydrates in favour
of more protein and large amounts of nutrient dense raw vegetables, nuts and seeds,
such as our Palaeolithic ancestors would have eaten. In the words of the Roman
philosopher One mans food is another mans poison (Lucretious, 200 BC).
So what are the options?
Carbohydrate Diet
The research:
High carbohydrate, low fat diets still constitute the mainstream approach. Research
tells us they can be effective:
diets consisting of unrefined low glycaemic index carbohydrates alongside sufficient
levels of monounsaturated fat have been shown to produce prolonged satiety (the
state of being satisfactorily full). Therefore, they provide an effective method for
reducing calorie intake and achieving long-term weight control (Ball et al, 2003)
maintaining a carbohydrate based diet, but substituting saturated fat for greater
amounts of monounsaturated, has been implicated with a reduced risk of CHD in
overweight insulin resistant individuals (Connor and Connor, 1997)
The aims:
create favourable fuel mix
create energy deficit
prescribe an appropriate exercise programme
minimise insulin levels
provide wide spectrum of nutrients
provide ample dietary fibre
The guidelines:
cut out processed foods to reduce trans fats
reduce refined high glycaemic index carbohydrates
moderate saturated fat intake (minimise competition for fuel)
include monounsaturated fat (helps maintain HDL cholesterol)
include oily fish or flax oil for omega 3 fatty acids
maintain a ratio of 2:1 or 1:1 of omega 6 to omega 3 fatty acids
include plenty of fresh fruit and vegetables
include plenty of unrefined low to moderate glycaemic carbohydrates such as
wholemeal bread and pasta
Ketogenic Diets
The principle:
A high protein, low carbohydrate diet permits a much higher intake of protein
than a more standard diet. When carbohydrate is removed from the diet causing a

60

dramatic shortage of available glucose, the body is forced to undergo metabolic

changes. The body responds by releasing more fatty acids from its reserves within
the adipose tissue. These fatty acids circulate to the liver where they are converted
into smaller fragments and released back into circulation. These fragments are called
keto acids or ketone bodies, and can be easily utilised by tissue as fuel. The
individual is said to be in a ketogenic state.
The research:
higher protein diets with reduced carbohydrate intake appear to improve blood
lipid profiles in some individuals. (Wolfe, 1995)
replacing carbohydrate with protein from meat, poultry, and dairy foods, produced
beneficial metabolic effects and no detectable effects on markers of bone
turnover or calcium secretion (Farnsworth et al, 2003)
researchers found that low carbohydrate diets appeared to be effective for shortterm weight loss in overweight adolescents, and did not harm the lipid profiles
(Sondike et al, 2003). Caution with such diets was still advised
The risk factors:
possible kidney damage
possible risk of osteoporosis. The ketone bodies cause the kidneys to become
more acidic, forcing the body to respond by releasing more calcium from the
bones in order to act as a chemical buffer to control acid levels
lack of unrefined carbohydrate can lead to micronutrient and dietary fibre
deficiency
The conclusion:
Whilst some individuals may thrive on these ketogenic diets, they are by no means
suitable for everyone, and are associated with some inherent risk factors.
These diets are very extreme and restrictive, but may well suit a proportion of
individuals, providing improvements in fat loss, insulin resistance and blood lipid
profiles. However, they may equally be less suited to others, especially people with a
history of kidney function problems. The ability to handle these diets may be down to
biochemical individuality and genetics.
The Palaeolithic Diet
The concept:
The concept of the diet is well researched, and brings many
scientific disciplines together. The basic argument centres on the
fact that 99.9% of our genes were formed 10,000 years ago by
the beginning of the Neolithic or agricultural era. This indicates
we are better suited to the Palaeolithic or Stone Age diet, since
this is what we evolved with. Only after the beginnings of an
agricultural era did we extend the variety and percentages of
carbohydrates within the human diet. The Neolithic diet came
about as the result of the diminishing availability of wild game in
relation to an expanding population, not out of an increased need for carbohydrate.
Key facts:
early man consumed approximately 30% protein; which would vary
according to season and geographic location. The protein would have

61

come from wild game meat such as deer, bison and antelope (Eaton and
Konner, 1983)
wild game would have had a more ideal ratio of 1:1 up to possibly 1:4
omega 6 to omega 3 fatty acids
game meat had a greater percentage of monounsaturated fat, and less
saturated fat
most of early human carbohydrate came from quantities of fruit, wild
vegetables, roots, legumes and nuts. These would have been high in
soluble fibre and micronutrients, and much lower in anti-nutrients such as
phytic acid which adversely affects mineral absorption
the diet helps to control insulin levels
the hunter gatherer life style was very physically active, an important
component relating to this diet

The basis of the diet is a return to the foods that would have been available to us in a
Stone Age setting, whilst avoiding the modern mass agricultural foods available
today that would not likely have been present.
Avoid the following Neolithic foods

all grains i.e. wheat, rye, barley, oats etc.

all grain products i.e. bread and pasta
all processed food
milk and dairy products
all pulses i.e. beans of any kind, including string beans, peas,
cashews
potatoes and sweet potatoes
sugar
Include the following Palaeolithic foods

a variety of organic meat, poultry

organic organ meats i.e. liver and kidneys
organic free range eggs
plenty of fruits (strawberries, raspberries, blueberries etc)
plenty of root vegetables (carrots, turnips, parsnips, swedes, radishes etc.
plenty of broad green leafed vegetables (lettuce and spinach leaves, kale etc)
bulbs (onions, garlic)
seeds (sunflower seeds, pine seeds, flax seeds, sesame seeds, prickly pear
seeds etc)
a variety of nuts
A balanced view:
Many debates continue within the field of nutrition, and the benefits of the Palaeolithic
diet are no exception. This diet may not be the solution for everyone; yet again others
may thrive on it. Critics argue that it is restrictive and some may find it hard to adhere
to. Others express concern that the lack of dairy produce may promote poor calcium
intake, although dark green leafed vegetables are themselves a good source of
calcium and magnesium.

62

Nutritionists agree that the Palaeolithic diet does have some favourable points. The
exclusion of processed food has to be an improvement for everyone, reducing both
sugar and the heavily refined carbohydrates within the diet. Most sides in nutrition
recognise the importance of increased fruit and vegetables in the diet, which provide
soluble fibre, micronutrients, antioxidants and phytochemicals. A more favourable
lipid content is also beneficial, with a dramatic reduction in trans fatty acids, and an
improved ratio of omega 3 to omega 6 essential fats.
Concerns still exist within some quarters over the increased intake of saturated fat.
Although a large percentage of fat within meat is in fact monounsaturated, which we
know to be good, the amount of saturated fat within domesticated livestock is higher
than within the original Palaeolithic wild game.
Anorexia and Bulimia Nervosa
Occasionally in dealing with weight management
clients may present with significant eating
disorders like anorexia or bulimia. These are
difficult issues to deal with for anyone. It should be
recognised that while the outward symptoms are
not eating enough food or vomiting food after
meals, the root cause of the problems are
psychological in nature. Sufferers are often in
denial about the problem so nutritional advice
does not normally have much influence.
Appropriate professional help should be sought if or when dealing with individuals
suspected of suffering from one of these mentally challenging conditions.
Eating Disorders Association
www.edauk.com
Telephone helpline: 0845 634 1414
Key learning points
1. Functions of adipose tissue include:
to store triglycerides for energy
to convert excess glucose to tryglycerides
to synthesise and release hormones
one such hormone is leptin
2. The enzyme lipoprotein lipase( LPL ):
unloads fatty acids into fat cells
is stimulated by insulin
increased LPL activity promotes fat storage
3. Distribution of adipose tissue:
android refers to centrally stored fat
centrally stored fat carries a greater risk factor for disease
gynoid refers to peripherally stored fat
peripherally stored fat carries less of a risk factor for disease
4.

Leptin is a hormone released by adipose tissue:

the level of leptin is proportional to fat mass
leptin will affect appetite and energy expenditure

63

5. Research indicates that obesity is associated with:

excessive dietary intake
reduced levels of physical activity
it is acknowledged that genetics play a role
6. The set point theory:
states that we have a genetically determined level of body fat
remains a theory, but may explain why body fat is often regained
the hormone leptin plays a key role
mechanism may make fat loss more difficult, but not impossible
7. Energy expenditure involves:
BMR, TEF, and TEA
the following is recommended to lose body fat:
the approx. loss of 1lb (0.5kg) per week
an energy deficit of 500 kcal per day
250 kcal dietary restriction
250 kcal increase from exercise
8. Exercise is essential for effective and long term fat loss:
exercise increases energy expenditure
reduces loss of FFM during energy restriction
increases long term success
9. Frequent meals:
at least three meals per day
helps ease hunger, and prevent over-feeding later in the day
helps to minimise loss of FFM during energy restriction
better enables the body to metabolise energy contained in each meal
10. Effects of elevated insulin:
suppresses the release and oxidation of fat
increases uptake of glucose into adipose tissue
increases synthesis of fat from glucose
exercise helps to increase insulin sensitivity (reduce insulin resistance)
low GI CHO helps to reduce insulin levels
refined high GI CHO should be avoided

64

References
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Glycogen storage capacity and de novo lipogenesis during massive carbohydrate
overfeeding in man. Am J Clin Nutr. 48:240-7.
Bouchard, C., et al, (1997). Human variation in body mass: evidence for role of
genes. Nutr. Rev 55:S21.
Brownell, K., and Rodin., (1994). Medical, metabolic, and psychological effects of
weight cycling. Archives of Internal Medicine. 154: 1325-30.
Garrow, J., S., Webster, J., D., (1989). Effects of weight and metabolic rate of obese
women of a 3.4 MJ (800 kcal) diet. Lancet I: 1429-1431.
Helmrich, S, P,. Ragland, D, R,. Leung, R, W,. Paffenbarger, R, S,. (1991). Physical
activity and reduced occurance of non-insulin-dependant diabetes mellitus. New
England Journal of Medicine 325: 147-152.
Malina, R., and Bouchard, C. (1991). Growth, maturation, and physical activity.
Champaign, IL:: Human Kinetics.
Seidell J, C., Hautvast J, G., Deurenberg P. (1989) Overweight: fat distribution and
health risks. Epidemiological observations. A review. Infusiontherapie. 16:276-81
Stubbs R. J., Harbron C. G., Murgatroyd P. R., Prentice A. M.,. (1995) Convert
manipulation of dietary fat and energy density: effect on substrate flux and food
intake in men eating ad libitum. American Journal of Clinical Nutrition. 62:316-329.
Woods, S. C., Seeley, R. J., Porte, D., and Schwartz, M. W. (1998) Signals that
regulate food intake and energy homeostasis. Science. 280:1378-1383.
Abbott WGH, Howard B, Christian L, et al. (1988). Short-term energy balance:
relationship with protein, carbohydrate, and fat balances. Am J Physiol; 255:E332-7.
Ball, S.D., Keller, K. R., Moyer-Miller, L. J., et al (2003). Prolongation of satiety after
low versus moderately high glycemic index meals in obese adolescents. Pediatrics
111(3): 488-494.
Conner, W. E., Conner, S. L., (1997). Should a low fat, high carbohydrate diet be
recommended for everyone? The case for a low fat, high carbohydrate diet. New
England Journal of Medicine 337:562-563.
Eaton, S. B., Konner, m., (1983). Palaeolithic nutrition: a consideration of its nature
and current implications. New England Journal of Medicine, 312:283-289.
Eriksson, J.,G., (1999). Exercise and the treatment of type II Diabetes Mellitus. An
update. Sports Medicine, 27(6):318-391.
Farnsworth, E., Luscombe, M. D., Noakes, M., Wittert, G., Argyiou, E., Clifton, P. M.,
(2003). Effect of high protein, energy restricted diet on body composition, glycemic
control, and lipid concentrations in overweight and obese hyperinsulemic men and
women. Am.J. Clin. Nutr, 78(1):31-39.
Giovannucci E. (1995). Insulin and colon cancer. Cancer Causes and Control 6:164179.
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Jebb SA, Prentice AM, Goldburg GR, Murgatroyed PR, Black AE, Coward WA.
(1996). Changes in macronutrient balance during over-and underfeeding assessed
by 13-d continuous whole-body calorimetry. Am J Clin Nutr; 64:259-66.
McKeown-Eyssen G. (1994). Epidemiology of colorectal cancer revisited are serum
triglycerides and / or plasma glucose associated with risk. Cancer Epidemiology
Biomarkers and Prevention 3:687 695.
Miller, W.C., Diet composition, energy intake, and nutritional status in relation to
obesity in men and women. Med. Sci. Sports Exercise, 234:280.
Milton, K., (1993). Diet and primitive evolution. Scientific America, 269:86-93.
Pavlou, K.,N., (1989). Exercise as an adjustment to weight loss and maintenance in
moderately obese subjects. Am. J. Clin. Nutr. 49:1115.
Poehlman, E.T., (1989). A review: exercise and its influence on resting energy
metabolism in man. Med. Sci. Sport. Exerc. 21:515-525.
Rachette, S. B., et al, (1995). Effects of aerobic exercise and dietary carbohydrate on
energy expenditure and body composition during weight reduction in obese women.
Am. J. Clin. Nutr. 61:486.
Robinson, J.I., Hoeer, S.L., Petersmarck, K.A., Anderson,J.V., (1995). Redefining
success in obesity intervention: the new paradigm. Am. J. Diet. Assoc. 4;422-423. J.
Am. Diet. Assoc, 96:342.
Ross, R., Pedwell, H., Rissanen, J., (1995). Effects of energy restriction and exercise
on skeletal muscle and adipose tissue in women as measured by magnetic
resonance imaging. Am. J. Clin. Nutr. 61:1179-1185.
Sondike, S. B., Copperman, N., Jacobson, M. S., (2003). Low carbohydrate diet
helps overweight adolescents lose weight safely. The Journal of Pediatrics,
142(3):253-258.
Staten, M., A., (1991). The effect of exercise on food intake in men and women. Am.
J. Clin Nutr. 53:27.
Swimburn B, Ravussin E. (1993). Energy balance or fat balance? Am J Clin Nutr; 57
(suppl): 766S 71S.
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(1995). Nutrition and your health: dietary guidelines for Americans. 4th ed. Home and
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Wilmore, J. H., (1996). Increasing physical activity: alterations in body mass and
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Collect, Analyse Information, and

Agree Goals
There are many ways in which to gather information from a client in an effort to guide
and advise on nutrition. These methods may include:

interviewing / consulting
questionnaires
a completed food diary
through observation

When gathering information through interviewing the consultant should:

help clients to develop their motivation for change

be aware of the effect of their own attitudes and beliefs
understand the constraints on an individuals health behaviour

Conditions which Promote Effective Consultation / Interview

The room:
comfortable, bright, airy, warm or cool (as
appropriate)
no barriers, e.g. a desk between people
comfortable chairs, not opposite each other
but facing at an angle
no loud noises or distractions, private with
no likelihood of interruptions
no prominent clocks to stare at
The consultant:
genuine, a person of integrity, open-minded
having unconditional regard for the client
posture and body language should be welcoming
It is necessary to establish a climate in which a client can open up. Warmth,
openness, genuineness, empathy and unconditional positive regard can achieve this.
Through giving their full attention, actively listening, encouraging the client to talk and
by asking questions, the consultant begins to establish trust and to encourage the
client to explore relevant issues.
Using questionnaires
The clients PAR-Q and lifestyle questionnaire can provide valuable information when
trying to encourage change and reform. It will help to identify potential barriers and
solutions such as:

time available to purchase food, and prepare meals

family commitments that may hinder efforts
potential support from others
social habits and activities

67

Effectively Using a Food Diary

Ensuring the correct use of a food diary is paramount to collecting accurate
information about the clients eating habits. Time should be taken to ensure the client
fully understands what information you want recorded and when you want it done.
Consider these points when using a diary:

complete diary after each meal, not at the end of the day
record accurately what was eaten
identify amounts eaten
note the time of intake
specify any fluid intake
note when activity or exercise was done
identify energy, moods, and mental clarity 1-2 hours after food was eaten

Help the Client to Set Goals and Identify Options

Having gained a new perspective on the issues and concerns, it becomes possible
for the client to identify goals and ways in which these might be achieved. The
important thing about this stage is that the client is allowed time to talk through the
issues:

weighing up the pros and cons

considering the likely consequences of change
deciding which is the best option

The client may have a number of different goals in mind when it comes to nutrition

body fat reduction or weight loss

muscular hypertrophy
eating to achieve optimal health
to improve sporting performance

Whatever the goals mat be, it is essential to work with the client to set appropriate
goals that fall in line with the SMARTER principle:
S
M
A
R
T
E
R

- specific in its objectives

- measurable in order to show progress
- agreed by the person concerned
- realistic
- time framed to promote motivation
- enjoyable
- recorded

Having made a decision, the client now needs to think about turning that decision into
action. The client might need to identify coping strategies and sources of support.
Once an action plan has been agreed, it must be recognised that there will be a need
to regularly monitor progress.
Investigate Concerns and Identifying Barriers
Sometimes people want to change but are afraid of the consequences or concerned
how they would cope. It may help the client just to have an opportunity to air these

68

concerns to a sympathetic listener. Often the health professional will be able to

contribute information that will allay fears or be able to offer suggestions about how
these concerns could be taken into account in the action plan. It is important not to
appear to be dismissing concerns as trivial or irrelevant.
When a person prepares to make changes, he or she needs to take account of things
he or she liked about the old lifestyle. They need to accept that the reasons for the
old behaviour will still be around and will sometimes seem to be more important than
the reasons for changing. It will be important to develop strategies for handling such
temptation. Examples of the kind of barriers that may be faced are:

client enjoyed less healthy food

comfort eating during stressful times
financial concerns over cost of better food
family members may not want to change
time constraints support convenience eating
it will affect routine of daily life

Helping to Provide Possible Solutions

The health and fitness professional can spend useful
time in helping a client plan how to make the desired
changes. A comprehensive action plan is helpful to a
client who is ready to make changes and to the
professional supporting the process because:

a clear plan can provide motivation

difficulties or possible problems will be identified in
advance and may be anticipated
monitoring and revision is easier if the plan is clearly thought out to begin with

Action Plan for Behavioural Change and Motivational Strategies

Self Monitoring:
recording of thoughts, feelings and situations before, during and after the target
behaviour. Strategies can then be developed to cope with barriers and make
good use of support
Reinforcement:
positive rewards necessary
monitoring of progress
social support
Behavioural contracts:
should include clear, realistic objectives and deadlines
tailored to the individual and re-evaluated regularly during the maintenance stage
Provide positive, behaviourally specific feedback:
praise specific examples of good behaviours
Encourage group participation and support:
for social reinforcement, camaraderie and commitment
regular re-enforcement and support via the phone

69

Recruit supportive other:

it is important that whoever the other person is, that they are supportive in a
positive and not a negative way.
Develop a flexible routine with a variety of options:
examples might include classes at different times, outside activities if fine, lunchhour walks, games, etc
Periodic testing for positive reinforcement:
to give information about progress towards goals and opportunity to provide
positive reinforcement
Use behavioural change strategies:
examples might include participants self-goal setting, past experience influence,
self motivation positive statements, self-efficacy, short-term achievable goals
decision balance sheets
performance profiling to identify patterns and methods of individual motivation
Chart progress:
both trainer and client to note and record progress (including psychological) on a
regular basis to give positive feedback
Recognise goal achievement:
newsletters, bulletin boards an individuals effort increases when the effort is
identifiable
Reward systems:
for example, attend a specific number of gym sessions and receive a free gift
such as a T shirt or water bottle
Data Protection
It must be remembered that when information is gathered in any context from an
individual that we must conform to the regulations of the Data Protection Act. As
nutritionists or personal trainers we must consider each of the following points:

information is fairly and lawfully processed

the information is used for the limited purposes intended and known by the client
there is adequate information for the required purpose
the information held is all relevant and not beyond the scope or purpose for which
it was intended
all information is accurate and current
information should only be stored or held on file for the required time period
information is stored in fire-proof lockable filing cabinets, or under password
protection on a computer
information should not breach an individuals rights
information should not be passed on to others without the individuals permission,
and should not be used outside the EC unless adequate protection for the
individual is in place

70

Food Labelling and Additives

Learning to understand and grasp the basics of how to interpret food labels is an
essential tool for anyone keen to improve their nutrition. In todays world food
manufacturers are required to place a lot of very useful information on their labels.
This information is particularly helpful in making consumer shopping choices.
Nutrition Label Basics
There are certain elements that must by law be placed on a food products label. The
following illustration from a chicken soup tin identifies each area:
Supermarket brand chicken soup

Identifies
macronutrient and
calorie values

Ingredients are
listed in
descending
weight order

(www.sainsburys.co.uk)
They must also include:
manufacturers details
a total volume or weight
a date mark or best before date
storage instructions
potential allergens in the product

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The nutritional information table provides average amounts of each macronutrient

expected to be found in the product. However, a recent survey reported that out of 70
products tested for 570 nutrients only 7% actually matched the stated values, and
almost one fifth contained levels outside of the generous 20% margin of error (BBC
news, 2005). Although these tables do provide information, it is not guaranteed
accurate and can be misleading.
Currently foods sold loose or cooked in house are not subject to many of the food
labelling laws.
Food Standards
The Food Standards Agency (FSA) set up in 2000 is responsible for governing the
control and sale of food in the UK. They are an independent body that helps in
protecting public interests with regard to our food, and serve in an advisory role to
promote food legislation. Current food production, labelling, and manufacture is
governed by the Food Safety Act, 1990.
Marketing Terminology
Food manufacturers use many different terms in their pursuit of selling their products
to the public. This has almost certainly been brought about by the fierce competition
in the food sales market. The FSA has provided many guidelines and legal
requirements in the use of these terms so that they are not misleading to the public.
However, once again research has found some manufacturers to be misusing certain
terms to boost sales. The Foods Advisory Committee reported that up to 75% of
consumers found terms like fresh, pure, and natural to be misleading (Llewelyn et
al, 2001). Below is a list of terms and how the food regulations state they should be
used:

fresh to differentiate food sold a short time after harvest

pure single ingredient foods...or to highlight the quality of ingredients of a food
natural comprised of natural ingredients, not the work of man
authentic remains unchanged...originates from the area implied by its name
home made made in the home, or of domestic manufacture
traditional a method of preparation that has existed for a significant period
farmhouse other than bread, it should refer to that produced on a farm
original a method of preparation that has remained essentially unchanged over
time

With an increasingly health conscious public many foods are targeted at this market
and so the terminology used on packaging reflects this. But again this can be
misleading if the public dont understand the legal implications.

light, low, reduced or high there are no specific

guidelines for these terms, but they should not
mislead
reduced or low fat must be at least 25% lower
in fat, but often calories are maintained by adding
other ingredients
low calorie must have lower calories than the
original, but no set level

72

sugar free sugar has not been added, but almost always an artificial
sweetener has been used for taste

Food Additives and Labelling

Food manufacturers are required to list a large number of allowable food additives by
either identifying its E number or by its proper name. It is very common today to find
manufacturers favour the use of technical names that the general public are ignorant
of, rather than the use of E numbers, which the health conscious strive to avoid. It is
important to start to take time to become familiar with the more common terms used
so more informed decisions can be made when choosing food.
Refined sugars are in many cases mildly addictive, contain empty calories and help
to increase sales. Common sugars are:

sugar
dextrose
glucose syrup
glucose-fructose syrup
inverted sugar syrup
high fructose corn starch
mannitol
xylitol
sorbitol
maltodextrin

Monosodium glutamate (see chicken soup ingredients) is an

isolated amino acid that acts as a flavour enhancer and is also
addictive. It has been linked with obesity due to its effects on
the brain and influence on appetite. Any of the following
ingredients will indicate its presence:

yeast extract
hydrolysed protein
whey protein isolate
soy protein isolate
carrageenan
most natural flavourings

Artificial sweeteners are all excitotoxins that stimulate the sensory areas of the
brain and create a desire for more, almost all of which have potentially harmful side
effects:

aspartame (also branded as NutraSweet, Equal, Spoonful or anything that states

it is a source of phenylalanine). The American Food and Drug Administration
have received more complaints about aspartame than any other additive in
history. It is currently present in over 6000 food products available to the
consumer
sucralose (branded as Splenda) - initial tests have uncovered a shrinking of the
thymus and enlargement of the liver and kidneys as a result in ingesting
sucralose
acesulfame K stimulates insulin which causes hypoglycaemia

73

saccharin anticipated human carcinogen which in sensitive individuals may

cause irritability, insomnia, headaches, itching or diarrhoea

E numbers may well be used on ingredients lists, but as previously stated that is
less common now:

E102 tartrazine
E123 amaranth
E252 potassium nitrite
E330 citric acid
E621 monosodium glutamate
E951 aspartame
E954 - saccharin

Flavourings can be either artificial or natural, both of which often have a large
number of chemicals hidden behind the simple words. The flavouring industry is one
of the worlds largest industries, but is generally hidden in secrecy. It is not required
for the chemical concoctions to be listed in the ingredients.
Food manufacturers play with your perception of what given words mean and they
know that if they can label an additive as natural, the health conscious, label reading
consumer is much more likely to purchase it, yet just because something is natural,
doesnt mean its better for you. After all, alcohol, tobacco, marijuana, and cocaine
are all natural, but none of them are good for you!
To show what is being hidden from us and is right under our nose (literally!), consider
these ingredients used in a Burger King strawberry milk shake, but not disclosed
because labelling laws do not require it:
Amyl acetate, amyl butyrate, amyl valerate, anethol, anisyl formate, benzyl acetate,
benzyl isobutyrate, butyric acid cinnamyl isobutyrate, cinnamyl valerate cognac
essential oil diacetyl dipropyl ketone, ethyl butyrate, ethyl cinnamate, ethyl
heptanoate ethyl lactate ethyl methylphenylglycidate ethyl Nitrate, ethyl propionate,
ethyl valerbate, -ionone, aheliotropin, hydroxyphreny I-2butanone (10% solution in
alcohol), isobutyl anthranilate, isobutyl butrate, lemon essential oil, maltol, 4methylacetophenone, methyl anthranilate, methyl benzoate, methyl cinnamate,
methyl heptine carbonate, methyl naphthyl ketone, methyl salicylate, mint essential
oil, neroli essential oil, nerolin, neryl isobutyrate, orris butter, phenethyl alcohol, rose,
rum ether, g-undecalactone, vanilla, and solvent!
To make this even more alarming, the ingredients listed here are only for the
strawberry flavouring in a Burger King milk shake, this doesnt include the ice
cream or anything else in the shake! (Schlosser, 2001)
Not all food additives need to be disclosed on the label. There are many substances
whether naturally or artificially sourced that are Generally Recommended As Safe
(GRAS) for long term use. If a product was used in food manufacture before 1958 it
is identified as Prior Sanctioned and again does not need to be listed. Neither of
these categories guarantees the safety of the additives used, but generally means
they have not gathered evidence to show they are harmful.

74

Additive Categories
E100s are colourings
E200s are mostly preservatives
E300s are antioxidants, acidity regulators,
and anti-caking agents
E400s are emulsifiers, thickeners, stabilisers,
and gelling agents
E900s are generally waxes, sugars, and
sweeteners
Other E numbers anti-foaming agents, carrier solvents, bulking agents, firming
agents, flavour enhancers, flour treatment agents, glazing agents, modified starches,
or raising agents.
Additive Safety
The majority of additives on the officially accepted lists have been shown to be safe
when kept within accepted limits:

150 additives have had concerns raised about them due to some signs of
adverse reaction in testing
70 additives are known to cause allergic reactions and intolerance in some
people
30 additives are known to be harmful (Millstone and Lang, 2004)

It is important to recognise that while food manufacturers may keep within the safe
and accepted limits for the additives they use, some additives are prevalent in many
products. This may mean that during the day or week we may consume more than is
desirable due to the cumulative effect of ingesting many foods containing these
additives. Aspartame, monosodium glutamate and saccharin are some of those
additives that are rampant in the current food market.
Additives are a relatively new addition to the food chain, and ultimately should not be
in our food, even if they have been found to be beneficial to the manufacture and
sale of the product. We should try to minimise their presence in our diet. The
guidelines are as follows:
Food Recommendations

Avoid
processed food in general
fast foods
confectionery
soft drinks and cordials
pre-packaged meals
refined baked goods
low fat foods or healthy options
cheap sausages, burgers, pies

75

Advise
buy organic additives used
minimally
use whole, fresh produce
home baking you choose
ingredients
always read food ingredients lists

References
www.sainsburys.co.uk
www.news.bbc.co.uk.,(March 2005). Many labels on food misleading
Llewelyn et al., (2001). FAC Review of the use of the terms Fresh, Pure, Natural etc.
in Food Labelling
www.foodlaw.rdg.ac.uk/additives
Millstone and Lang, (2004). The Atlas of Food: Who Eats What, Where and Why,
Earthscan
www.food.gov.uk
Schlosser E, 2001. Fast Food Nation, Houghton Mifflin.

76

Appendix 1
Food Composition Table
The following table provides an alphabetical list of details of the energy (kcal),
Protein (g),
Carbohydrate (g) and Fat (g) for 100g of various foods.
Food (100g)

Energy(kcal) Protein(g)

Fat(g)

Carbo(g)

All Bran

250

13

2.5

46

Almonds

560

17

54

Alpen

368.2

11.5

6.2

66.6

Apples

35

0.2

Apricots

30

0.6

Apricots, dried, raw

180

43

Artichokes
Jerusalem boiled

20

1.5

Asparagus boiled

8.8

1.7

0.5

Aubergine raw

15

0.7

Avocados

220

20

Fat(g)

Carbo(g)

Food (100g)

Energy(kcal) Protein(g)

Bacon collar joint

boiled

330

20

27

Bacon gammon
grilled

230

30

12

Bacon gammon joint

boiled

270

25

19

Bacon rashers
streaky fried

500

23

45

Bacon rashers
streaky grilled

400

25

36

Baked Beans Heinz

74

0.3

12.7

Baked beans Weight Watchers

53

4.8

0.3

8.8

Bananas

80

0.3

20

Barcelona nuts

640

11

64

Barley pearl boiled

120

2.7

0.5

28

Bean sprouts
canned

10

1.6

0.8

Beans broad boiled

50

0.6

Beans butter boiled

100

0.3

17

Beans haricot boiled

90

6.6

0.5

17

Beans mung cooked

100

11

Beans runner boiled

20

0.2

77

Beef brisket boiled

320

27

24

98.14

9.87

3.37

7.17

Beef corned canned

216

26

12

Beef minced stewed

230

23

15

Beef rump steak

fried

250

29

15

Beef rump steak

grilled

220

27

12

Beef silverside
salted

240

29

14

Beef sirloin roast

280

24

21

Beef steak stewing

stewed

220

30

11

Beef topside roast

200

27

12

Beer bitter

30

Beer larger

30

1.5

Beer stout

40

Beetroot boiled

45

1.8

10

Beetroot raw

30

1.3

Bilberries

60

0.5

14

Biscuit - Custard
Cream

483

23.8

65

Biscuit - mini
cheddars

529

9.8

29.1

54.2

Biscuits - morning
coffee

444

6.9

14.5

75.4

Biscuits - Rich Tea

440

6.9

15.7

71.5

Biscuits Chocolate
covered

520

27

67

Biscuits digestive
chocolate

490

24

66

Biscuits digestive
plain

477

6.5

22

67

Biscuits shortbread

500

26

65.5

Biscuits wafers filled

540

30

66

Black currents

30

Black pudding fried

300

13

22

15

Blackberries

30

1.5

Bran Flakes

329

9.3

71.5

Bran wheat

200

14

5.5

27

Brazil Nuts

600

12

60

Beef Casserole Crock-pot

78

Bread brown

220

2.2

45

Bread malt

250

49

Bread rolls white

300

10

54

Bread white

235

7.8

1.6

46.2

Bread white toasted

300

9.6

1.7

65

Bread whole meal

220

8.8

2.7

42

Breadcrumbs white

350

12

77

Broccoli tops boiled

20

1.6

Brussels sprouts
boiled

20

1.7

Buns current

300

55

Butter

750

0.5

82

Food (100g)

Energy(kcal) Protein(g) Fat(g) Carbo(g)

Cabbage savoy boiled

10

1.3

Cabbage savoy raw

25

Cabbage spring boiled

Cabbage winter boiled

15

1.7

2.3

Cake fruit

330

11

58

Cake Madeira

400

17

58

Cake sponge with fat

460

6.5

27

53

Cake sponge without fat

300

10

54

Cakes fancy

400

15

69

Carrots boiled

20

0.6

Carrots raw

25

0.7

Cauliflower boiled

10

1.5

0.8

Cauliflower cheese

116

Celery boiled

0.6

0.7

Celery raw

10

1.3

Cheese camembert

300

23

23

Cheese cheddar

400

26

34

Cheese cottage

66.5

14

0.5

1.5

Cheese cream

440

47

Cheese Danish blue

360

23

29

Cheese edam

300

24

23

Cheese parmesan

400

35

30

Cheese processed

300

22

25

Cherries

40

0.5

10

Cherries glace

224

56

Cheese stilton

460

26

40

Chestnuts

170

2.7

37

79

Chicken Kiev

328

24.4

21.6

10

Chicken roast boned

150

25

Chicken roast meat

159

22

7.5

Chocolate Break (mug of)

107

3.1

2.4

19.4

Chocolate milk

530

30

59

Chocolate plain

530

29

65

Christmas Pudding

300

12

48

Cider dry

35

Cider sweet

40

Cocoa powder

300

19

22

12

Coconut

350

36

Coconut desiccated

600

62

Cod fillet baked

100

21

1.2

Cod fillet fried

170

21

Cod fillet fried in batter

200

20

10

Cod fillet grilled

100

21

1.3

Cod fillet poached

90

21

Cod fillet steamed

80

19

Coffee instant

155

0.7

35.5

Coffee instant & milk

36.96

3.27

0.12

6.14

Coke diet

0.48

0.12

Cola

48.8

12.2

Coleslaw

163

1.1

14.8

6.7

Cornflakes

350

0.5

82

Corn flour

350

0.6

0.7

92

Cornish pastie

330

20

31

Crab boiled

130

20

Crab canned

80

18

Cracker Bread

375

10.9

4.1

73.7

Cranberries

18

0.5

Cream crackers Crawford

390

7.7

12.8

64.9

Cream double

450

1.5

48

Cream single

200

2.4

21.2

Cream sterilised canned

230

2.6

23

Cream whipping

330

1.9

35

2.5

Crisp bread rye

320

9.5

71

Crisp bread wheat

390

45

7.5

37

Croissant

230

4.3

12.2

27.3

Cucumber

10

0.6

80

Currents dried

240

63

Custard egg

120

11

Custard powder

120

17

Food (100g)

Energy(kcal) Protein(g) Fat(g) Carbo(g)

Damsons

35

0.4

Dates dried

210

55

Drinking chocolate

370

77

Dripping

900

100

Duck roast

190

25

10

Dumpling

200

12

25

Food (100g)

Energy(kcal) Protein(g) Fat(g) Carbo(g)

Egg dried whole

560

43.6

43.3

Egg scrambled

250

10

23

Egg whole raw

150

12.3

10.9

Egg yolk

340

16.1

30.5

Egg white

35

Food (100g)

Energy(kcal) Protein(g) Fat(g) Carbo(g)

Fish fingers fried

230

13.5

13

17

Flour brown

330

13

69

Flour white

340

11

1.2

75

Flour white self raising

340

1.2

77.5

Flour whole meal

320

13

66

Fruit gums

170

45

Fruit juice sweetened

40

10

Fruit juice unsweetened

30

Fruit pie

370

16

56

101.2

0.3

25

Fruit salad canned

Food (100g)

Energy(kcal) Protein(g) Fat(g) Carbo(g)

Goose roast meat

320

29

22

Gooseberries

16

Grape nuts cereal

360

11

76

Grapefruit - Tin

36

0.3

Grapefruit peeled

20

0.5

Grapes black

50

0.5

13

Grapes white

60

0.6

15

25.71

1.21

0.53

4.18

Green Bean Mix

Food (100g)

Energy(kcal) Protein(g) Fat(g) Carbo(g)

Haggis boiled

300

11

22

19

Halibut steamed

130

24

81

Ham

120

18

Ham cooked

269

24.7

18.9

Hamburgers fried

260

20

17

Hare stewed with bones

140

22

Heart roast

240

26

15

Heart stewed

180

31

Herring grilled

200

20

13

Honey

290

76

Food (100g)

Energy(kcal) Protein(g) Fat(g) Carbo(g)

Ice cream dairy

170

25

Ice cream non dairy

170

21

Food (100g)

Energy(kcal) Protein(g) Fat(g) Carbo(g)

Jams

260

0.5

60

Jelly packet

58

14

Food (100g)

Energy(kcal) Protein(g) Fat(g) Carbo(g)

Kidney fried

150

25

Kidney stewed

170

26

Kipper baked

200

26

11

Food (100g)

Energy(kcal) Protein(g) Fat(g) Carbo(g)

Lamb breast roast

400

19

37

Lamb chops loin grilled

350

24

29

Lamb cutlets grilled

370

23

31

Lamb leg roast

270

26

18

Lamb scrag and neck

stewed

290

26

21

Lamb shoulder roast

320

20

26

Lard

900

100

Leeks boiled

25

1.8

Lemon curd

280

63

Lemon sole fried in

breadcrumb

200

16

13

Lemon sole steamed

90

21

Lemonade bottled

24

Lemons

15

Lentils boiled

100

0.5

17

Liver fried

250

27

13

Liver stewed

200

25

10

Lobster boiled

120

22

3.5

Luncheon meat

300

13

27

Lettuce

82

Food (100g)

Energy(kcal) Protein(g) Fat(g) Carbo(g)

Macaroni boiled

120

0.6

25

Macaroni cheese - Tin

97

3.6

4.8

10.5

Mackerel fried

190

22

11

Mandarin Oranges - can

57

0.6

14.7

Mango Chutney

230

0.5

0.4

59.8

Mangoes

60

0.5

15

Macaroni cheese

170

10

15

Margarine

730

81

Margarine low fat spread

370

40

Marmalade

260

69

Mars bar

440

19

67

Marzipan

440

25

49

Mayonnaise

720

79

Melon

22

0.5

Milk

65

3.3

3.8

4.7

Milk condensed skimmed

270

9.9

0.3

60

Milk condensed whole

sweetened

320

8.3

55.5

Milk evaporated whole

160

8.6

11.3

Milk skimmed

33

3.4

0.1

92.34

8.79

4.04

5.33

Mincemeat

284

62

Muesli

370

13

7.5

66

Mushrooms fried

210

2.2

22

Mushrooms raw

13.4

0.6

10

1.5

Mince and Spaghetti

Mustard and cress

Food (100g)
Nectarines
Food (100g)

Energy(kcal) Protein(g) Fat(g) Carbo(g)

50

11

Energy(kcal) Protein(g) Fat(g) Carbo(g)

Oil vegetable

900

100

Omelette

200

11

16

Onions fried

350

33

10

Onions raw

25

Onions spring

35

8.5

Orange juice

40

0.6

Orange peeled

40

Oxo cube

16

1.5

0.3

1.8

Food (100g)
Pancakes

Energy(kcal) Protein(g) Fat(g) Carbo(g)

300

83

16

36

Parsnips - boiled

60

1.3

13.5

Pasta

365

13.2

77

Pastry flaky cooked

560

40

47

Pastry Puff

385

5.4

25

37

Pastry short crust cooked

530

32

56

Peach Slices - tin

49

0.5

12.3

Peaches canned

49

0.5

12.3

Peaches fresh

34

0.5

Peanuts fresh

570

24

50

Peanuts roasted and

salted

570

24

50

Pears

30

0.2

Peas boiled

41

5.4

0.4

4.3

Peas canned

50

0.3

Peppers green raw

15

0.4

Philadelphia cheese light

196

12

15

Pickle Branston

150

0.7

0.2

34.5

Pilchards canned

130

19

0.7

Pineapple canned

63

0.4

0.2

16

Pineapple fresh

50

0.5

12

Plaice fried in butter

280

16

18

14

Plaice steamed

90

19

Plums cooking

26

0.5

Plums dessert

40

0.5

10

Popcorn

415

1.6

12.8

78.2

Pork chops grilled

330

29

24

Pork leg roast

290

27

20

Porridge Oats with Bran

332

10.6

6.7

60

Potato chips

250

11

37

Potato crisps

526

7.3

35.2

48.4

Potatoes baked with skin

85

20

Potatoes boiled - King

Edwards

82

1.4

0.1

19.7

Prawns

100

23

Prunes - Tin

88

22

Prunes stewed

84

20

Puffed wheat cereal

325

14

1.3

68.5

Food (100g)
Quiche Lorraine
Food (100g)

Energy(kcal) Protein(g) Fat(g) Carbo(g)

400

15

28

20

Energy(kcal) Protein(g) Fat(g) Carbo(g)

84

Rabbit stewed

90

14

Radish

15

Raisins

250

65

Raspberries

28

Red Currents

20

Rhubarb raw

0.5

Rhubarb stewed with

sugar

45

0.5

10

Rice Brown Boiled

182

3.4

1.4

40.7

Rice Krispies cereal

350

0.7

88

Rice pudding canned

72

3.7

1.2

12.4

Rice white boiled

119

2.6

0.1

28

Food (100g)

Energy(kcal) Protein(g) Fat(g) Carbo(g)

Salad Cream

300

27

15

Salad Cream Weight

Watchers

145

1.2

8.2

17.4

Salmon steamed

200

20

13

Sardines canned in oil

220

24

14

Sardines canned tomato

sauce

180

18

12

0.5

Satsuma peeled

35

Sauce brown

100

25

Sausages beef grilled

270

13

17

15

Sausages pork grilled

320

13

25

12

Scampi fried in
breadcrumbs

320

12

18

29

Scones

370

7.5

15

56

Sherry dry

115

1.4

Sherry sweet

140

Shredded wheat cereal

320

10.5

68

Sorbet Blackcurrant

118

0.3

30.7

Spaghetti boiled

120

0.3

26

Spaghetti canned tomato

sauce

51

1.7

0.2

10.5

Spaghetti tin, weight

watchers

51

1.7

0.2

10.5

Spirits - whisky, Gin etc

220

Sponge pudding

340

16

46

Spring greens boiled

10

1.7

Squash undiluted

122

0.1

0.1

32.2

0.1

1.2

Squash Undiluted - sugar

free

85

Steak stewed canned

180

15

13

Strawberries fresh

25

0.5

Sugar

390

100

Sugar puffs cereal

350

0.8

84

Sultanas

250

65

Swede boiled

20

Sweetcorn

124

4.1

2.3

22.8

Sweets boiled

330

87

Food (100g)

Energy(kcal) Protein(g) Fat(g) Carbo(g)

Tangerines peeled

36

Toffees

430

17

71

Tomato juice

12

Tomato Ketchup

97

24.9

Tomato Puree

89

5.6

0.4

16.4

Tomatoes canned

23

Tomatoes raw

15

Trout steamed

140

24

4.5

Tuna canned in oil

100

25

0.1

Turkey roast

140

29

Turnips boiled

10.8

0.7

Food (100g)

Energy(kcal) Protein(g) Fat(g) Carbo(g)

Veal fillet roast

230

32

12

Venison roast

200

35

Food (100g)

Energy(kcal) Protein(g) Fat(g) Carbo(g)

Walnuts

530

11

52

Watercress

14

0.7

Weetabix cereal

340

11.5

3.5

70

Wine red

70

Wine white dry

65

0.6

Wine white sweet

10

Food (100g)
Yoghurt flavored - low fat

Energy(kcal) Protein(g) Fat(g) Carbo(g)

41.6

4.6

0.1

5.5

Yoghurt natural

55

5.9

1.2

5.6

Yorkshire puddings

222

10

26

86

Appendix 2
The Harris Benedict Formula
This is a calorie formula using the factors of height, weight, age, and sex to
determine basal metabolic rate (BMR). This makes it more accurate than determining
calorie needs based on total bodyweight alone. The only variable it does not take into
consideration is the amount of lean body mass. Therefore the equation will be very
accurate in all but the extremely muscular (it will underestimate caloric needs) and
the extremely over fat (it will over estimate caloric needs).
Men: BMR = 66 + (13.7 x weight in kg) + (5 x height in cm) (6.8 x age)
Women: BMR = 655 + (9.6 x weight in kg) + (1.8 x height in cm) (4.7 x age)
Note: 1 inch = 2.54 cm
1 kg = 2.2 lbs
1 stone = 14 lbs
Example:
You are female
You are 30 yrs old
You are 5 6 tall (167.6 cm)
You weigh 8 stone 8 lbs (54.5 kg)
Your BMR = 655 + 523 + 302 141 = 1339 calories/day
Now that you know your BMR, you can calculate Total Daily Energy Expenditure
(TDEE) by multiplying your BMR by your activity multiplier from the chart below:
Activity Multiplier
Sedentary
Lightly active
Mod. Active
Very Active
Extra Active

BMR x 1.2
BMR x 1.375
BMR x 1.55
BMR x 1.725
BMR x 1.9

(little or no exercise, desk job)

(light exercise/sports 1-3 days/week)
(moderate exercise/sports 3-5 days/week)
(hard exercise/sports 6-7 days/week)
(hard daily exercise/sports & physical job)

Example:
As above BMR is 1339 calories/day
Your activity level is moderately active (work out 3 4 times a week)
Your activity factor is 1.55
Your TDEE = 1.55 x 1339 = 2075 calories/day

87

Appendix 3
Food and Mood Diary
Day

6 10am

10 2pm

2 - 5pm

5 - 9pm

9 - 12pm

Monday

Rate 1-2 hours

after food

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

!#

Tuesday

Rate 1-2 hours

after food

!#

Wednesday

Rate 1-2 hours

after food

!#

Thursday

Rate 1-2 hours

after food

!#
Friday

Rate 1-2 hours

after food

!#

88

Food and Mood Diary

Day

6 10am

10 2pm

2 - 5pm

5 - 9pm

9 - 12pm

Monday

Rate 1-2 hours

after food

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

!#
Tuesday

Rate 1-2 hours

after food

!#

Wednesday

Rate 1-2 hours

after food

!#
Thursday

Rate 1-2 hours

after food

!#
Friday

Rate 1-2 hours

after food

!#

89

Food and Mood Diary

Day

6 10am

10 2pm

2 - 5pm

5 - 9pm

9 - 12pm

Monday

Rate 1-2 hours

after food

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

Mood

Energy

!#

Tuesday

Rate 1-2 hours

after food

!#
Wednesday

Rate 1-2 hours

after food

!#

Thursday

Rate 1-2 hours

after food

!#
Friday

Rate 1-2 hours

after food

!#

90

Further Reading
The Cholesterol Myths by Uffe Ravnskov, MD, PhD
Excitotoxins: The Taste that Kills by Russell Blaylock, MD
KNOW YOUR FATS: The Complete Primer for Understanding the Nutrition of Fats,
Oils, and Cholesterol by Mary Enig, PhD
Milk, Money, and Madness by Naomi Baumslag, MD, MPH, and Dia L. Michels
Nourishing Traditions by Sally Fallon with Mary G Enig, PhD
Nutrition and Physical Degeneration by Weston A. Price, DDS
Sugar Blues by William Dufty
Not on the Label by Felicity Lawrence
Shopped by Joanna Blythman
Fast Food Nation by Eric Schlosser
www.westonaprice.org
www.mercola.com

91