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Performance Nutrition

National Archives and Records Administration

RecordsCOllecton

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Terminal Learning Objective

Understand Performance Nutrition and how it relates to Army Physical Readiness Training. In a large group classroom, given a AR 60063, Army Health Promotion, FM 7-22, Army Physical Readiness Training, and Master Fitness Trainer Course (MFTC) Course Management Plan (CMP). Understand performance nutrition and how it relates to Army Physical Readiness IAW AR 600-43 and FM 7-22.

Action:

Conditions:

Standards:

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Enabling Learning Objective A

Identify Army regulatory guidance related to nutrition. In a large group classroom, given this lesson, instructor notes and AR 600-63, Army Health Promotion and Master Fitness Trainer Course (MFTC) Course Management Plan (CMP). Identify Army regulatory guidance related to nutrition IAW AR 600-43.

Action:

Conditions:

Standards:

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AR 600-63
Army Health Promotion
7 May 2007 RAR 7 September 2010

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AR 600-63
56. Nutrition a. Good nutrition. Good nutrition and healthful eating are crucial elements for ensuring Soldier readiness and peak performance. Good nutrition is also important for promoting health and reducing chronic disease. Good health involves balancing proper eating habits with physical fitness and activity from an early age to ensure healthy lifestyle habits are inherently prioritized. The CHPC will recommend, coordinate, and ensure the integration of nutrition education programs for units, Soldiers, Family members, and Army civilians in their area of responsibility. b. Registered dietician. The RD is the consultant and nutrition expert for the MTF commander and the installation commander, and the RD is the food and nutrition expert for healthy lifestyle habits throughout the life cycle. c. Nutrition care specialists. The nutrition care specialist assists in the supervision of medical nutrition care operations to include preparing, cooking, and serving food for regular and modified diets in field and fixed hospitals. Nutrition care specialists work under the supervision of the RD.

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AR 600-63
d. Standards of practice.

(cont)

(1) Military Dietary Reference Intakes (MDRIs) prescribed in AR 40 25 provide guidelines and standards for feeding healthy Soldiers. They are intended for use by personnel involved in menu planning, dietary evaluation, nutrition education and research, and food research and development. (2) The primary care provider will refer Soldiers to a RD for nutrition counseling when appropriate. (3) The CHPC will assess the nutritional needs of Soldiers, their Families, and Army civilians. The council will ensure educational programs are offered to meet communities assessed nutritional health needs, while promoting necessary lifelong behavioral changes to maintain optimal health and wellness. (4) Food advisors and food service managers will comply with the basic nutritional standards for installation dining facilities, in accordance with AR 30 22, which provides guidance for meeting nutrition standards in dinning facilities and ensuring compliance with AR 4025. (5) Commanders will ensure that a RD is an active member of the CHPC.
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Quotes
There are no shortcuts to improvement in nutrition. It is a lifestyle choice. What we look like today is based on the decisions we made in the past. What we look like tomorrow is based on the decisions we make right now. Gordo Byrn
2002 Ultraman Hawaii Champion

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Obesity Trends
Obesity* Trends Among U.S. Adults BRFSS, 1985 (*BMI 30, or ~ 30 lbs overweight for 5 4 person)

No Data
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10%14%
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Obesity Trends
Obesity* Trends Among U.S. Adults BRFSS, 2010 (*BMI 30, or ~ 30 lbs. overweight for 5 4 person)

No Data
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<10%

10%14%

15%19%
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20%

25 %

30%
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Age-Adjusted Estimates of the Percentage of Adults Who Are Physically Inactive

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2008 Physical Activity Guidelines

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2008 DoD Survey of Health Related Behaviors Among Military Personnel

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The Army Nutrition Problem

Main Factor:
Army beneficiaries live in food environments where the easy choice is not necessarily the healthy choice. Many lack the skills, knowledge, motivation and resources to consistently make nutritional choices that support stamina

Main Facts:
Active Duty diagnosis of overweight/obesity has jumped 47% since 2006. Obesity/overweight diagnoses are associated with a shorter length of service. Nearly two thirds of adult family members and retirees are identified as overweight or obese. 86% of retirees are classified as overweight or obese. 18.9% of DoD dependent adolescents are obese. 82% of DoD children eat fast food (15% eat fast food >3 or more times weekly). $1.1 billion estimated annual cost to TRICARE
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The Army Recovery Problem

Main Factors Recovery = Sleep
Lack of individual knowledge, understanding, skills and awareness. Military culture : Suck it Up and Drive On. Lack of Leadership emphasis. Poor sleep health is a national and Army-specific public health issue. Inadequate quantity and quality.

Main Consequences
Soldiers report an average of 5.6 hours of sleep/day (7-9 hours required for Sleep Health). About 1/3 of Soldiers report not getting sufficient sleep in a deployed environment. Soldiers/Leaders underestimate their own impairment due to poor sleep. Contribution of poor sleep to comorbid conditions (mental and physical health). Excessive drowsiness and fatigue due to chronic poor sleep:
Impaired decision making Exacerbates/exacerbated by emotional and physical problems Poor health, BMI, diabetes (Performance Triad) Unethical behavior or misconduct Accidents
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The Solutions
Change the Nutrition Mindset:
Improved nutrition surveillance system and reporting to better inform decision making. Improved military food environments support healthy behaviors. Improved clinical care for prevention and treatment. Increased use of evidencebased nutrition programs. Improved standardization of nutrition education. Unified nutritional messaging.
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Change the Recovery Mindset:

Leaders model and promote Sleep it is as critical as hydration. All understand the impact of poor sleep. All have greater knowledge and skills for healthy sleep. Broadly disseminate current guidance and policies on sleep. IT enablers for sleep monitoring, planning and self-coaching. Screening and treatment.

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Why Does Nutrition Matter?

You are what you eat
Your body metabolizes food to provide the building blocks that allow our bodies to function and repair itself every minute of every day.

In the short-term, poor diet decreases your energy levels, increases your risk for injury and decreases your bodys ability to heal itself. Your body is very good at compensating for a poor diet, but your diet does and will impact your ability to exercise, perform your job as a Soldier and to live a long and healthy life. In the long-term, poor diet increases your risk of obesity, diabetes, heart disease, cancer, and much more. If you want to perform like a race car you need to fuel yourself with high octane food - real food that is nutrient dense.
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Nutrition Today
Over the past 50 years we have emphasized a low-fat diet as a healthy diet. Disadvantage of low fat diet:
increased carbohydrate (sugar and bread) intake which increases blood sugar and increases insulin (the fat storage hormone) which leads to an increase in obesity and diabetes

The trend to increase carbohyrdates has resulted in the number one source of calories in the US being sugar primarily desserts, soda and sweets all empty calories. The Army and performance nutritionists are placing a new emphasis on fresh, nutrient-dense foods with a balance between proteins, fats and carbohydrates. The best carbohydrates are fruits and vegetables.
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Nutrition Trends
Always look at the big picture and strive for a balance, not a specific miracle or bad food. Always ask yourself, are you eating primarily real, fresh food that is being cooked by you from its natural state? Versus processed food. Eat real food and remember that although sugar is a natural food, we need to eat a lot less. Fresh foods include meats, nuts, fruits and vegetables. This requires a larger role for grocery shopping and cooking in performance nutrition:
dont bring the junk food home learn to buy and cook real foods
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Enabling Learning Objective B

Action: Conditions: Describe key elements of a healthy diet. In a large group classroom, given AR 600-63, Army Health Promotion and Master Fitness Trainer Course (MFTC) Course Management Plan (CMP). Describe key elements of a healthy diet IAW AR 600-63.

Standards:

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The Role of Proteins and Amino Acids

Proteins in food are broken down into amino acids Role of amino acids:
Build and repairs all tissues in the body, including muscle Regulate water balance and prevent edema (swelling) by holding fluid in bloodstream Build hormones and enzymes essential for all body functions Form major components of antibodies to fight disease Provide a back-up energy source
Each gram of protein contains 4 calories of energy
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Proteins and Amino Acids

There are 20 amino acids 10 essential and 10 nonessential 10 Essential amino acids:
Our body cannot make them and we can only get them from food Meat, dairy and eggs = complete proteins - contain all 10 essential amino acids Incomplete proteins - only provide some of the amino acids must be combined to provide all amino acids (e.g. rice and beans, peanut butter and wheat) Essential amino acids CANNOT BE stored in the body, so must be consumed daily If even 1 of 10 amino acids is missing the body cannot properly function and muscle is broken down to provide that amino acid (therefore poor diet and extreme exercise or severe illness = muscle wasting)
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Carbohydrates and Sugar

Carbohydrates (CHO) are classified as simple or complex. Simple (fake or processed foods):
sugary, processed foods that should form only a small portion of daily calories. contained in processed foods and often contain added synthetic forms of naturally-occurring nutrients such as added vitamins. examples breads, cereals, cakes, cookies, sugar-filled drinks

Complex (real or whole):

fruits, vegetables, and whole (unprocessed) grains closest to their natural state contain natural forms of vitamins, minerals, digestive enzymes and fiber. examples whole and unprocessed vegetables, and grains such as quinoa, bulgar, Ezekial bread; root vegetables such as sweet and white potatoes.

CHO is an important fuel for physical activity quick starts, short bursts, and long-term endurance.
Stored as glycogen in liver and muscle in limited amounts of 15003000kcal Each gram of CHO provides 4 calories of energy
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Carbohydrates and Sugar

(cont)

Excess carbohydrates are stored in the body as fat. Eating foods that contain sugar and processed carbohydrates leads to increased blood sugar and increased insulin production = sugar high and sugar low. Balancing blood sugar - eating protein, fat and fiber with carbohydrates - helps balance the blood sugar, and decrease hunger and sugar cravings. Most Americans overeat carbohydrates, especially simple processed carbohydrates (cake, candy, breads, soda, sweet tea, energy drinks, etc).
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Fat Basics
Are fats good or bad? It depends on the quality! There are 3 primary types of fats:
Saturated Unsaturated (polyunsaturated and monounsaturated) Hydrogenated (trans) fats.
Found in margarine, shortening (Crisco) and other manmade fats. These are the least healthy and should be avoided.

Fats and essential fatty acids are necessary for good health and survival. Eating healthy fats does not cause obesity
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Fat provides large potential source of energy (fuel) for low intensity, endurance activities if oxygen is readily available to convert the fat into energy.
There are about 120,000kcal of fat in our bodies Each gram of fat has 9 calories

Role of Fats and Essential Fatty Acids

Fats play other important roles in the body:

nervous system: the brain is 50% fat transporting nutrients and absorbs vitamins (A, D) maintains skin health insulates and protects organs primary building blocks of hormones, especially reproductive hormones. Provides structure to cells

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Fat Basics (cont)

Saturated fat: Solid at room temperature, derived from animal sources, except palm oil, coconut oil and cocoa butter Provide fat soluble vitamins such as A and D Unsaturated fat: Usually liquid at room temperature Polyunsaturated (two or more double bonds of hydrogen) and Monounsaturated (single bond of hydrogen) Found in vegetables, fish and poultry Hydrogenated fats or transfats: Processed fat with the hydrogen added in manufacturing to solidify foods such as margarines. Triggers liver into producing extra cholesterol Cholesterol is a steroid, a special kind of waxy fat found in all cells and is necessary for survival High levels can be unhealthy causing plaque to build up in arteries that lead to cardiovascular disease
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Fat Basics (cont)

Healthy fats provide essential fatty acids (ones that we cannot produce and must be obtained from our food) Omega 6 and Omega 3. The ratio of Omega 6 to Omega 3 should be equal or 1:1, but common diet of plant oils (corn, canola, soy, safflower, etc) is very heavy in Omega 6. There is no US standard for omega-3 daily intake, but it can be found in fatty fish (salmon, dark tuna, sardines), walnuts, and flax seed. Three types of omega-3 fatty acids:
docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are found in fish oil. alpha-linolenic acid (ALA) is found in plant foods such as nuts, seeds, and vegetable oils (especially flaxseed oil).
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Fiber
Soluble:
Dissolves in water May help reduce cholesterol levels Found in apples, barley, bananas, carrots, broccoli, peas, sweet potatoes, potatoes, zucchini, and seeds

Insoluble:
Absorbs moisture Aids in elimination of waste by speeding movement of food through the digestive system Side effect of too much is nausea and diarrhea Found in apples, bananas, cabbage, brown rice, cereals, whole grains, strawberries, and green beans.

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Vitamins and Minerals

Vitamins and minerals are organic compounds ingested in food that are essential for normal function and metabolism
Regulate energy production Regulate growth Maintain and repair tissue

Water-soluble vitamins like vitamin C and B are washed out of the body through sweat and urination Fat-soluble vitamins include A, D, and E. They can be stored in the body and therefore can become toxic in large amounts Minerals:
Major minerals:
Potassium, calcium, phosphorus, sodium, sulphur, magnesium

Minor minerals:
Chromium, cobalt, copper, flouride, iodine, manganese, molybdenum, selenium and zinc
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CHECK ON LEARNING
What are the main components of food? How many calories per gram in each component? Give examples of healthy fats Name the soluble and insoluble vitamins What does BMI stand for? What percentage BMI constitutes overweight, and obese? Who are the Armys experts on nutrition issues? Where do they work?
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Enabling Learning Objective C

Describe how diet impacts exercise and performance. In a large group classroom, given FM 7-22, Army Physical Readiness Training, and Master Fitness Trainer Course (MFTC) Course Management Plan (CMP). Describe how diet impacts exercise and performance IAW FM 7-22.

Action:

Conditions:

Standards:

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How Many Calories Do You Need?

Activity Level Light Moderate Heavy Male 17 19 23 Female 16 17 20

Weight in Pounds x Activity Factor

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170 lb male light activity 170 lb male heavy training 140 lb female light activity 140 lb female heavy training
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170 x 17 170 x 23 140 x 16 140 x 20

= 2,890 = 3,900 = 2,240 = 2,800

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Essentials Of Strength Training and Conditioning (2010)

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Eat Often to Maintain Energy

Eat every 3 -5 hours while awake

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Protein & Carb Requirements

Endurance Training
Protein: Carbs: 0.5-0.6 g/pound 2.7 - 5.5 g/pound

Resistance Training
Protein: 0.5-0.8 g/pound
More than 1.0g/pound will not result in performance benefits

Carbs: 2.5 2.7 g/pound

Less than 2.5 g/pound can result in lack of fuel for exercise Excess carbs = increased blood sugar and obesity

MRDA Protein : ~0.4g/pound/day

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Bulking Up
One Pound = 3,500 calories To gain 1 pound per week increase calorie intake by 500-1000 calories per day Consume 3 meals per day with 2-3 snacks If you dont feel hungry think of food as a weight gain medicine that you have to take

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170 Pound Person Exercising for 30 Minutes

Activity
Walk the Dog Clean House Play Basketball Bike Jog

Calories Burned
168 calories 138 calories 230 calories 250 calories 382 calories

Equivalent Food Amount

15 Corn chips 27 Peanuts One packet of M&Ms Dish of ice cream Piece of pie

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Enabling Learning Objective D

Describe the adverse affects of dehydration on physical performance in both deployed and non-deployed settings. In a large group classroom, given FM 7-22, Army Physical Readiness Training, and Master Fitness Trainer Course (MFTC) Course Management Plan (CMP). Describe the adverse affects of dehydration on physical performance in both deployed and non-deployed settings IAW FM 7-22.

Action:

Conditions:

Standards:

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Hydration Basics - Water

Two thirds of the human body is comprised of water
It is the most basic nutrient of all, and is essential for all living matter Maintains homeostasis or thermoregulation Relieves fatigue Improves mental alertness Transports nutrients and wastes to and from cells

Even mild dehydration results in decreased performance and severe dehydration can increase risk of heat injury and can lead to death Over hydration (hyponatremia) is more rare, but also deadly
slow marathon runner who drinks a lot and lowers sodium levels leading to weight gain, swollen fingers, loss of mental alertness, progressing to seizures and death

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Take Time out to Drink

Fluid guidelines: Optimize hydration status while allowing enough time for any excess fluid to be excreted as urine before start of exercise
Drink generous amounts of fluid 24 hours before an exercise session Drink 14-20 oz of fluid 2-3 hours before exercise During exercise - 6 oz every 15-20 minutes After exercise 16 oz cups for every pound lost
ACSM/NATA recommendations

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Impact of Dehydration

9% 8% 7% 6% 5% 4% 3% 2% 1% 0%

>6% 4-6 %

2%

3%
Reduced Muscular Endurance Reduced Strength and Endurance Severe Heat Cramps, Heat Exhaustion, Heat Stroke, Coma

% Weight Loss Wt 125 150 200 2% 2.5lb 3lb 4lb 3% 3.75lb 4.5lb 6lb 6% 7.5lb 9lb 12lb
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Impaired Thermal Regulation

Armstrong MF805010 et al.,1994

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Sweat Rate
Calculating sweat rate to optimize hydration
Weight before minus weight after exercise (lbs) = A Multiply A x 16 to get the amount in ounces Add A to number of ounces consumed during exercise = B B divided by minutes exercised = sweat rate in ounces/minute

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NATA (2000) 41

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Practical Tip

Have your Soldier weigh before and after workouts If they weigh less have them practice drinking more If they weigh more have them drink less
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FLUID NEEDS IN HEAT, COLD CLIMATES AND AT ALTITUDE

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Acclimated Individuals Need More Fluid

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Cold Climate Hydration

Significant fluid loss from warming air you breath

Low rate of fluid ingestion if fluid is cold or cool

Excessive clothing can increase sweat rate Voluntary Fluid Restriction due to difficulty removing layers of clothing to urinate
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Altitude Hydration
Increased Urine Production (~7 Days) Decreased Appetite

High Respiratory Water Losses

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Acute Mountain Sickness?

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Key Points
Heat acclimated individuals
Start sweating earlier Produce greater quantities of sweat Have higher fluid needs

Individuals exercising in the cold are still at risk for dehydration Individuals at altitude need to consume additional fluids to remain hydrated
1 Quart every 3 hours 3 5 Liters per day (6 L/d > 7000 m)
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Why Cant You Eat Anything When Exercising Intensely?

Osmolality:
The density of particles dissolved in a solution Different from concentration of a drink which is the weight, by percent, of one product dissolved in another (carbs in water) Digestion in the gut occurs when osmolality is around 300mOsm/kg If a solution is less than that, digestion slows to allow more electrolytes to be added by the body If its greater than that, the body adds water, again slowing digestion

Hydration:
Dehydration of 4-6% will slow gastric emptying decreases hunger Decreased food intake = decreased electrolyte (sodium and potassium) and glucose intake - vital to functioning of brain, nerves, heart and muscles

Calories:
Foods containing protein and lactose delay absorption High fibers foods, fruits, vegetables, cereals speed digestion Number of calories depends on the type of event

Race Day:
SLOW DOWN to allow blood to absorb the nutrients in your gut Avoid high intensity efforts to prevent lactate accumulation

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Improving Fluid Intake

Cooler drinks
More palatable Can help maintain a lower core temperature

Flavored
Individual preferences should be considered if possible Flavored beverages are consumed at a higher rate than non-flavored

Contain Sodium
Sodium can help maintain the osmotic drive to drink

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After Exercise
How much to drink
More than the amount of sweat lost
150% to 200%

Amount depends on the sodium content of the beverage

Effectiveness of a rehydration drink depends on

Palatability Intake Sodium concentration

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Shirreffs et al., 1996 50

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Practical Tip

Drink 24oz -32oz for every pound lost during exercise

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Additional Thoughts
Plain water can be an effective post exercise rehydration drink IF consumed with food (i.e. banana) If trying to rehydrate in a short amount of time use of a rehydration beverage will be most effective Other non-sports beverages have been found to be acceptable for rehydration
Milk/Chocolate Milk Orange Juice Coconut Water
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Enabling Learning Objective E

Describe the safe use of dietary, herbal and performance supplements. In a large group classroom, given this lesson, instructor notes, AR 600-63, Army Health Promotion, and Master Fitness Trainer Course (MFTC) Course Management Plan (CMP). Describe the safe use of dietary, herbal and performance supplements IAW instructor notes and AR 600-63.

Action:

Conditions:

Standards:

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Carbohydrate Intake During Exercise

General Recommendations
< 1 hour
No CHO needed if athlete has adequate carbohydrate stores Some evidence that a CHO mouth rinse improves all out performance*

>1 hour
30 60g/hr Sports drink of 6 to 8 percent CHO solution
More concentrated solutions can cause GI upset and delay gastric emptying Less concentrated solutions do not provide enough CHO 1 liter of Gatorade provides 60g CHO

>3 hours:
Relatively high rates of intake, up to 90 g/hr, are needed to optimize performance If consuming >60g/hr must use multiple transportable carbohydrates
Multiple transportable carbohydrates = glucose/maltodextrose & fructose combo

Note Train how you plan to perform increase tolerance for calories/food during exercise and also vary it based on intensity
36 hour FTX in extreme heat slow equals eat anything 4 hour marathon ADA/ACSM (2009) IOC (2010) 54

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Oxidation of Glucose and Fructose

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Performance with Glucose and Fructose vs. Glucose Alone

~40K Time Trial after cycling for 2 hrs @ 60% VO2Max

Glu-Fru

8% Improvement

Glucose

10% Improvement

Placebo Time to 50 Complete Trial

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Practical Tip

Mix and match sports products to find the right combination Regular foods can also be good sources of multiple CHOs
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Protein Co-ingestion During Exercise

Current thought: Protein intake during aerobic (cardio) exercise is unlikely to improve performance but may improve protein balance and stimulate protein synthesis in some athletes
Koopman et al., Combined intake of protein and carbohydrate improves protein balance in ultraendurance exercise Beelen et al., Combined intake of carbohydrate and protein hydrolysate stimulates muscle protein synthesis during exercise in young men
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How Much Protein Do You Need?

MRDA = 0.4 g per lb of body weight Recommended intake Sedentary adult PRT 3-5 x per week PRT + strength athlete PRT + endurance athlete PRT + triathlete
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g/lb 0.4 0.5-0.7 0.7-0.8 0.8-0.9 1.0

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Protein Sources
Top choices:
Lean beef (top round, round tip) Chicken and turkey Fish (3 oz cooked = 15-20 g) Egg (1 large = 6g) Peanut butter (natural is best. 2 tbsp = 9 g) Beans (1/2 cup = 7 g)

Tofu (4 oz = 10 g)
Milk and yogurt (1 cup = 8 g)

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Negatives of Excess Protein

Can be high in saturated fat Low fiber Increased calcium loss Dehydration Excess can lead to kidney damage Excess is stored as fat

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Example Post Workout Meals/Snacks

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Turkey Sandwich and Yogurt Low fat chocolate milk and banana Cereal with low-fat milk Low-fat chocolate milk (or UHT boxed Milk) Energy bar & low-fat milk Low-fat fruit yogurt & juice Cottage cheese & fruit salad Baked potato, cottage cheese & salsa Fruit smoothie & protein power
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24-36 hours to go from depleted to loaded

Carbohydrate Timing Take Home Message

Proper timing of CHO intake should be based on the amount of time the athlete has between workout sessions
If given 24 hours to replenish stores, timing becomes less important Less time, the more important it is to consume CHO within 30 minutes and frequently

Timing of CHO intake must be practical

Food availability GI comfort
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Practical Tip

Soldiers do not need a commercial recovery drink Chocolate Milk, Greek Yogurt, Peanut butter & Jelly Sandwich, Smoothies, and Cereal with Milk are all good choices The most important factor in choosing a recovery snack is if the Soldier will eat it
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Timing, Putting It All Together

Ingesting protein immediately before and after strength training (w/in 30 minutes) may result in greater muscle building
Recommended range 15-25g (IOC recommendation)

Consuming CHO immediately after exercise is very important if the Soldier will resume physical activity in 8 or less hours You can wait to consume CHO if you have more time until your next workout
Only working out once per day
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Supplements
Definition:
A dietary supplement is a product taken by mouth that contains a dietary ingredient intended to supplement the diet

Video for after class:

American_Bodybuilding_Supplements_Exposed2.wmv

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Supplements
Types:
Vitamins and minerals Artificial sweeteners Caffeine, pyruvate, melatonin Creatine, carnitine Herbals Tablets, capsules Sports powders, gels, liquids, and bars

Dietary Supplement health and Education Act of 1994 (DSHEA)

Supplement manufacturer is responsible for the safety of the product Cannot make a claim that it treats, cures, or prevents disease Food and Drug Agency takes action against manufacturer once and unsafe product is on the market Government has the burden to prove that the claim is false or misleading Federal Trade Commission regulates advertising:
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Ergogenic aids:
A dietary supplement used to improve physical performance and appearance or to increase stamina, speed, or strength

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Australian Institute of Sport Supplement Categories

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Supplements

Conclusion:
Products are not regulated Can be convenient and portable No magic pill or powder Not a substitute for good diet, exercise and healthy habits (no smoking and moderate alcohol) Information is key Must weigh benefits vs risks (and cost) Can be toxic or create their own imbalances (e.g. calcium interferes with iron, Vit C blocks Vit B) Can interfere with or increase effects of medications Most are poorly absorbed and eliminated in urine Food is always the best source of vitamins and minerals

Recent Warnings:
March 2009: consumers warned about 72 tainted weight loss products May 2009: Hydroxycut products assoicated with liver disease all Hydroxycut products were recalled July 2009: FDA warns consumers to stop using body building products that contain steroids or steroid-like substances

FDA recall:
http://www.fda.gov/Safety/Recalls/de fault.htm

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Enabling Learning Objective F

Describe diseases related to nutrition that may effect Soldier performance.

Action:

Conditions:

Standards:

In a large group classroom, given this lesson, instructor notes, AR 600-63, Army Health Promotion, and Master Fitness Trainer Course (MFTC) Course Management Plan (CMP). Describe diseases related to nutrition that may effect Soldier performance IAW instructor notes and AR 600-63.

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Obesity Trends ~ U.S. Adults

Dramatic rise in obesity in past 25 years (see above) Obesity is a sign of malnourishment excess sugar and a lack of healthy nutrients, including healthy fats, minerals and vitamins

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Obesity BMI Classification

Classification
Underweight Normal weight

BMI (kg/m2)
< 18.5 18.5 24.9

Overweight
Obesity (Class 1) Obesity (Class 2) Extreme/Morbid* Obesity (Class 3)

25 29.9
30 34.9 35 39.9 > 40

* Clinically severe obesity is preferred to morbid obesity

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ACSM Position Paper Physical Activity & Weight Gain

Goal
Prevention of Wt Gain (>3%) Weight Loss

Physical Activity
150-200 min/wk Equal to 1200-2000kcal/wk <150 min/wk (minimal loss) >150 min/wk (2-3kg) >225-420 min/wk (5-7.5 kg) ~200-300 min/wk No adequate studies to determine amount of PA More is better Will result in wt loss if energy restriction is not severe (<kcal/wk than needed to meet RMR)

Wt Loss Maintenance

Physical Activity & Diet

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UNCLASSIFIED Poor perception of self

Disordered Eating
Disordered eating:

Eating Disorders

Missing meals, skipping breakfast, restricting food intake, calories counting, preoccupation with food/weight, rigid food patterns, elimination of food groups, not eating with others Driven by lack of knowledge, time, money, ability to cook, and convenience of fast/snack foods Driven by societys obsession with being thin to gain approval, respect, attraction and value Family style severity of the style
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Eating Disorders: Bulimia and Anorexia

Severe restriction of intake, binge/purge, Use of diuretics/laxatives Compulsive exercise These are used as a coping mechanism for poor selfesteem caused by underlying emotional issues Signs on the PT field:
Fatigue, chronic injury, slower times, secret/extra workouts

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Eating Disorder
Signs off the PT field:

Good perception of self

Healthy Soldier
Treatment may take years:
Intervene openly and early to educate about consequences: food is fuel for your performance. If you want to perform, you have to fuel. Dont expect logic to work. Compassion, caring first. May be resistant to medical avenues and discussion with family Provide support and access to support networks/task forces or sports nutritionist Provide other avenues for release of painful feelings/underlying emotions DO NOT conduct public weighins, body fat testing, skin fold testing or publicly scorn people for being overweight!
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Loss of period, fatigue, decreased concentration, personality changes, bone weakness Very low fat diets Constant weighing Starvation leading to electrolyte imbalance, heart rhythm disturbances and death Anorexia:
Cold, dizzy, loss of fat the muscle, dark circles under eyes, fine hair appearing on face, baggy clothes to hide appearance, boney/skeletal looking

Bulimia:
Swollen cheeks, red eyes, cavities, calluses on knuckles, yellow nails

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Metabolic Syndrome
Majority of Americans are on this track. Used to be in the over 50 year olds, but now being found in pre-school kids Caused by :
Sedentary lifestyle Stress Primarily high carb and high sugar diet Partly genetic

100% preventable Protective Food and Nutrients that reduce inflammation in the joints, skin, blood vessels:
Salmon / food with a balance of omega-6 and omega-3 fatty acids Avocado Garlic Spinach Walnuts Cashews Almonds Dark chocolate Tea Vitamin B6 Vitamin B12 Folate Vitamin E Fruits Vegetables Moderate wine intake (3-4oz) with food

Waist bigger than hips (males and females). More acne, more fatigue, more tired after meals, feel faint with exercise Crave sweets, have a bigger appetite Not feel satisfied after eating sweets Joint pains, tingling feet and numbness Diagnosis consists of 2 of the following:
High cholesterol High blood sugar High blood pressure Obesity Insulin resistance Vitamin and minerals deficiencies Muscle weakness Allergies? More frequent infections

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Type II Diabetes
Incidence:
Develops over many years Familial tendency toward increased risk Starts with high blood sugar and increased insulin due to excess sugar and carbohydrates Expected to double in next 50 years 2x as likely to develop cardiovascular problems Closely related to obesity and physical inactivity

Treatment and Risks

Requires daily blood sugar monitoring Requires diet control, pills, and often insulin injections Results in blindness, loss of sexual function, kidney failure, heart disease and blood vessel disease leading to amputations Type 2 Diabetes - nearly 100% preventable with good diet and exercise

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Food Allergies
1 in 25 people suffers from a food allergy (Academy of Nutrition and Dietetics,
www.eatright.org)

Food allergy vs food intolerance Food allergy anaphylactic reaction vs rash or other reactions Young people often outgrow them Older people may develop allergies later in life 8 foods account for 90% of allergic reactions:
Milk Eggs Peanuts Tree nuts (walnuts, cashews) Fish Shellfish Soy Wheat

Symptoms are due to an immune response to a protein in a food that your body sees as harmful
Runny nose, itchy skin Anaphylactic shock
Swollen throat or swollen areas of the body Wheezing Passing out Chest tightness Trouble breathing Hoarse voice Trouble swallowing Vomiting

Call EMS (At Ft Jackson - 751 9111) Epinephrine pen prescription injection for anaphylactic reactions Should be part of CRM - check Soldiers profiles

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Celiac Disease
Gluten:
A protein found in wheat, barley, spelt, kamut and rye (and some oats) An autoimmune disease triggered by ingesting gluten May be present at birth or develop later in life Approximately 2M people in US have it, most dont know they do Diagnosed with blood test or biopsy Causes the immune system to begin attacking the lining of the small intestine Symptoms include frequent bowel movements, gas, bloating, peripheral neuropathy (numbness in the toes), increased infections, excess weight loss or gain, growth problems in children, and anemia Slows or stops the absorption of nutrients such as iron, calcium and fat Treatment is to avoid eating gluten May also have dairy intolerance At higher risk for thyroid problems and diabetes

Gluten sensitivity:
Can cause gastrointestinal issues after eating products containing gluten. Similar to lactose intolerance. Symptoms might be similar to celiac Lack of energy Abnormal blood counts Fluid and supplementation issues: must find products that are gluten-free or can be tolerated

Celiac Disease:

Performance effects:

http://www.gluten.net/

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Dietary Recall

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Dietary Recall
Goal:
Gain information about your current eating habits

Analysis:
Look for nutrient-dense food versus energy dense foods
Nutrient dense: high in vitamins, minerals, fiber and other nutrients relative to calories - fruits, vegetables, nuts, avocado, fish and lean cuts of meat Energy dense: high in calories relative to their size cheese, whole milk, butter, french fried, sweets, burgers energy bars, soft drinks

Food log:
Document everything you eat and drink for one week At first, record what not how much Add more details as you go time of day, numbers of calories or ounces, bowel movements, sleep hours and sleep quality. Be honest include the snacks, meals and days when you dont eat well Dont forget the BLTs (bites, licks and tastes) they add up

Keep a food log:

Websites: Fitday.com, livestrong.com/thedailyplate, SparkPeople.com, choosemyplate.gov Apps: Loseit, Live Strong, My Fitness Pal, Spark People, Calorie Counter, Plate Maker Handout

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Food Labels Front Panel Ingredients list Nutrition facts

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Dietary Change TTPs

Start gradually:
Dont create a short-term revolution, create long-term habits Choose fresh fruits and vegetables, healthy fats (avocados, olives, olive oil, coconut oil, almonds and walnuts) fish and lean cuts of meat Avoid processed, canned, boxed foods and drinks The time to eat carbs alone is during high intensity training and racing Protein aids carbohydrate metabolism Daily intake: one gram per kilogram of bodyweight (0.45 grams per pound). Some athletes tend to perform best at about 0.80 grams per pound.

Eat real food:

Cook your own food and prepare fresh fruits and veggies Know how to shop around the edge of the store Listen to your body
How well are you digesting what you eat? How is your alimentary canal functioning?

Pay attention to and reduce the serving size:

Use smaller plates and bowls

Eat protein with every meal

Eat more slowly and sitting down Eat at the table and not in front of the TV or in the car if possible Eat breakfast:
Choose low glycemic foods to avoid a spike in insulin and enhance the ability to oxidize fat Avoid quickly-prepared or pre-packaged breakfast substitutes

Serve from the stove, not serving dishes If you are still hungry use the 30 minute rule wait 30 minutes before you have a second portion

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