The Wheat Foods Council recently hosted an industry-presented webinar entitled: Nutrition for Performance: Theory and Effective Practice Guidelines for Fitness Professionals. The webinar is also available for two (2) CECs via ACSMceOnline.

View the webinar for free on YouTube without CECs. 

Several questions were asked by attendees during the webinar and the answers are below.

Viewpoints presented in this blog reflect opinions of the authors and Wheat Foods Council and do not necessarily reflect positions or policies of ACSM.

Q. How do you guide a client in balancing carbohydrates and proteins if they are trying to decrease percent body fat while gaining muscle mass?

Protein needs are based on body weight. A person who is cutting calories needs to be sure to consume 1.5 - 2.4 g protein per kg (adjusted) body weight. While it's hard to build muscle when in energy deficit, some research suggests it is possible with a high protein intake + resistance exercise + a small calorie deficit.

By dividing the required amount of protein into even-sized meals and snacks, the person can consume the balance of calories as carbs and fat, staying within the calorie allotment. Creating a calorie deficit by knocking off any kind of calories, be they from carbs, protein or fat. is what triggers fat loss.

Q. How would one approach a client who is not gluten-intolerant but who is avoiding gluten because he is afraid that gluten is bad? What would you tell that client in order for him to have a balanced diet?

I would approach the client like this: "I'm curious. What seems right about eliminating gluten?" and learn the client's perspective. And then I would ask if he or she wanted to know my opinion. If yes, I would share the research done by Dana Lis comparing athletes (without celiac disease) who went on a gluten-free diet vs athletes who consumed gluten. Both had similar levels of inflammation, with no health or performance differences between the two groups.

Q: Do you have a meal plan for vegans?

I do not have a standard meal plan specifically for vegans. When counseling vegan clients, I work together with them to create a meal plan that appeals to that individual. For one of my clients, the sample day looked something like this:
• Breakfast: oatmeal + almonds + raisins + soy milk
• Lunch: bread + peanut butter + banana (sandwich) + carrots + hummus
• Snack: trail mix (nuts, dried fruit, granola) + soy yogurt
• Dinner: Burrito with beans + rice + salsa + avocado + soy cheese.

Q. Are there any repercussions for too much protein in an athlete's diet?

Of course. There are repercussions of too much of anything (even water overconsumption can cause a toxic condition known as hyponatremia!). The current position stand supports daily protein intake for healthy active individuals at 1.2-2.0 grams per kilogram of body weight per day. MOST of the available evidence from multiple laboratories supports this range. We are aware of other research recently published that advocate for slightly higher recommendations, especially during times of energy restriction, but these recommendations are not universally accepted at this time. Some researchers have expressed concerns that as protein intake increases (beyond 2.0g/kg) that diet quality and variety may suffer. These potential repercussions could have negative effects beyond athletic performance and body composition outcomes.

Q. Can you touch on scope of practice for fitness/nutrition professionals without an RD?

Excellent question. There was a recent article published on this topic (free):

Kruskall, Laura J.; Manore, Melinda M.; Eickhoff-Shemek, JoAnn M.; Ehrman, Jonathan K. DRAWING THE LINE: Understanding the Scope of Practice Among Registered Dietitian Nutritionists and Exercise Professionals.
ACSM's Health & Fitness Journal. 21(1):23-32, January/February 2017

Q. Dr. Thomas, in one of your slides pertaining to "training low" you had mentioned how this method of reducing carbohydrates before an intense bout of physical activity does reduce reliance of carbs but does not enhance fat loss. If there is a lower reserve of carbs, in the form of glycogen, wouldn't fat oxidation serve as the next available fuel/energy source?

Excellent question. In the lab you will see an increase in fat oxidation (at sub-max intensities) following a "train-low" protocol. This is due to an increase expression of proteins involved in the lipid oxidation pathway. While this is a neat finding that is still being studied, there are two big limitations. First, marginal increases in fat oxidation do not usually translate into chronic fat mass loss. In chronic studies, the key player in promoting fat loss appears to be creating a calorie deficit with a combination of exercise and calorie restriction. The second limitation is that athletes are probably already "maxing out" on any benefit of increased fat oxidation related to inadvertently 
"training low" by simply not refueling after every training session or training early in the morning without breakfast. Additional train low strategies would likely compromise performance by limiting muscular adaptations associated with high intensity training fueled by high carbohydrate availability.

Q. What are your thoughts on keto? Everyone I talk to seems to be on the hype that they should be doing keto. Are there any new studies showing that a ketogenic diet is or is not helpful to stay on long term?

The keto diet has been around for a long time, originally to treat epilepsy. Medical interest in the diet faded once it was recognized that the diet was not sustainable and medications were more effective.

Athletes: Research does not support a performance advantage of Keto diets. Many benefits of exercise come from being able to train well (and enjoy) high-intensity work. Keto diets do not support this.

Non-athletes/Recreational Athletes: Optimizing adherence to any diet is the most important factor for weight loss success, and this is enhanced by regular professional contact with a Registered Dietitian and supportive behavioral change programs. Although the American Diabetes Association (ADA) suggests that low CHO diets can improve glycemic control (Tay (2015), the ADA recommends that macronutrient distribution should be individualized and advocate for a variety of eating patterns that do not include the ketogenic diet.

A key point raised in the presentation is "self-monitoring" dietary intake. Non-athletes need less energy intake and carbohydrate, but carbohydrate based healthy foods should remain in the diet to improve diet quality and support physical activity.

Keep in mind that ketogenic diets, in particular, are often high in saturated fat. This runs counter to position stands by the ADA and American Heart Association (AHA). Both the ADA and AHA recommend following the dietary patterns presented in the 2015-2020 Dietary Guidelines for Americans (i.e. DASH and Mediterranean).

Q. What are your thoughts on intermittent fasting for recreational athletes?

Seems to be a gimmick strategy to reduce total calorie intake. Research is lacking in this area, especially in controlled conditions compared head-to-head with other strategies proven to be effective. Keep in mind that the most important factors governing weight loss are: adherence to diet and promoting an energy deficit…the key is how to do this in a healthy way to promote disease prevention, longevity, and performance!

Q. What are the preventative measures to take in terms of dietary needs to prevent the female athlete triad? When do we become concerned regarding loss of menses/bone loss?

Many strategies can be implemented. Healthy conversations about food and fueling for performance in the form of workshops, training table demonstrations, and peer-led discussions are good first steps. Educating coaches and trainers about the limitations of body composition measurement techniques, that body composition outcomes should never be used for athlete selection and "body comp percentages" are poor predictors of athletic success are key points to understand.

A Registered Dietitian should complete a comprehensive dietary assessment that includes an assessment of energy expenditures and attitudes/beliefs about nutrition. This will allow for the assessment of low EA and the etiology of low EA.

Athletes experiencing fatigue, weight loss, performance decrements, and a history of stress fracture should certainly receive medical evaluation that include an evaluation of bone mineral density. Any history of abnormal menses should be discussed with a primary care provider.

Q. If I eat a balanced nutrition meal an hour prior to a resistance training exercise do I need to replenish protein intake, whether via food or supplementation?

I presume you mean post-exercise? If so, the provision of protein immediately post-exercise is less important in this scenario. Muscle protein synthesis is amplified for up to 24-hours following an RT bout. Focus on a balanced spread of protein throughout the day.

Travis Thomas, PhD, RDN, CSSD

Dr. Thomas is an Associate Professor of Clinical & Sports Nutrition in the College of Health Sciences and Director of the Undergraduate Certificate Program in Nutrition for Human Performance at the University of Kentucky. Dr. Thomas is board certified as a specialist in sports dietetics (CSSD) and a Fellow of the Academy of Nutrition and Dietetics.

Nancy Clark, MS, RDN, CSSD

Nancy Clark is an internationally respected sports nutritionist, weight coach, nutrition author, and workshop leader. She is board certified as a specialist in sports dietietics (CSSD) and a certified WellCoach. She is also a Fellow of the Academy of Nutrition and Dietetics and the American College of Sports Medicine. Nancy completed her undergraduate degree in nutrition from Simmons College, her dietetic internship at Massachusetts General Hospital, and her graduate degree in nutrition with a focus on exercise physiology from Boston University.