Lessons From The Precision Nutrition Level 1 Certification

PN Certified Coach Level 1

Back in October 2014 I did two big things:

  1. I started Integrative Osteopathy
  2. I signed up for the Precision Nutrition Level 1 Certification

Since then, only one of them had been getting the attention required to make it a success.

Until recently.

A couple of months back, I decided it was time to do the work and learn something, to benefit both myself and my patients and clients.

So a couple of months ago I started knuckling down, and this week I finally completed the Precision Nutrition Level 1 Certification.

For those of you who are unfamiliar with PN, it is a coaching and education company based in Toronto, Canada.

Founded by John Berardi, PhD., and his business partner Phil, who does the tech side of things, they are industry leaders in nutritional coaching and education for health and fitness professionals.

The level 1 course is broken up into two sections:

  1. Nutritional science
  2. Nutritional coaching

Having studied nutrition for a semester at university, along with physiology and biochemistry, I was more interested in the coaching side of things, but brushing up on the basics is never a bad thing.

I was hoping to learn how to become a better coach, and then apply that knowledge to my practice as an osteopath, in order to be able to better serve my patients.

Here are some of the major lessons I learnt:

1. Knowledge Is Key

Even though I had studied nutrition before, covering the ground again reinforced and enhance my knowledge on the topic.

It might be tedious, especially when starting out, but understanding what is happening at a cellular/biochemical level separates great nutritional coaches from the “Instagram macro coach” crowd.

If you understand what’s happening, then you can modify things for an individual when things don’t go to plan.

You can also experiment intelligently to get that “extra edge”, once the basics have been implemented.

As an osteopath, it has never been enough for me to just “know” that my patients get better.

Firstly, some don’t, but secondly, I wanted to know why this was the case.

Why do some people get better, whilst some don’t?

And, what can I do so that more people fall into the former, rather than the latter category?

2. Define The Goal

Defining a goal means understanding the “why” behind the “what”, and to be honest, it takes skill and experience to be able to elicit this from someone in a way that feels “natural”.

This was probably the biggest mistake I made in my first year of practice as an osteopath.

I would see someone, and not clarify their goals, their reasons for seeing me in the first place.

I made assumptions, and as a result, I’d often do too much or too little for someone, meaning they didn’t get the outcome they were looking for.

Once the why is clear, to both patient and practitioner, the what becomes easy.

3. Assess, Intervene, Reassess, Modify

What gets measured, gets managed. – Michael Drucker

If a person is asking for help to change, then it is important to know exactly where they are at, so you can map out the path for them to get to where they want.

The beginning of any coaching relationship should be all about information gathering.

A coach needs to know what a client needs, but also how to gauge progress.

In practice, I have intermittently used objective measures of assessment along with more subjective measures.

The problem is, there is no clear way to gauge progress, or lack thereof.

Now, pain being what it is (invisible and complex), it is hard to measure it directly, but we can strive to measure function and disability in an objective manner.

To do so, I have taken courses by the Functional Movement Group, and will undertake further study with Functional Movement Systems.

In addition to these movement based assessments, I will systematically use outcome measures more regularly.

4. Behaviours, Not Outcomes

One thing PN is huge on, is that we are all human, our lives are varied and whilst we may have different goals, it is what we do that gets us to our goals.

If you set a goal of having $500,000 of investments in 10 years time, then how much of that is in your control?

Realistically, you can’t control the global markets or economy.

What you can control is your income (to an extent) and how much of that you save and invest.

Nutrition and health coaching is similar.

Whilst you may want to lose weight, feel better or get stronger, you can’t control when or by how much.

What you can control, are you behaviours.

If your behaviours are in line with becoming leaner, healthier etc., then you undoubtedly will. It might happen sooner or it might happen later, but it will happen.

5. Judge on Results

At the end of the day, people hire me for an outcome.

That usually means they want to feel better (less pain), improve their quality of life (less disability) or improve their performance (move better).

I can write the best blogs, produce the most popular social media content and follow the “best practice guidelines to a T”, but if I don’t get the results people want, they won’t come back or refer people to me, and I will go out of business.

Getting good results is a culmination of the above points:

  1. Clearly defining a patient’s goal.
  2. Knowing what they need to do to achieve it.
  3. Translating that into behaviours.
  4. Reassessing and modifying along the way.

Summary

We are entering a new age in healthcare.

It is no longer the practitioner on one side of the table with all the power and information.

Now, patient and practitioner sit side by side, with access to more information than ever before.

It is not information that separates the best from the average, but the appropriate delivery and application of information.

When it comes to the body, things are always changing. A year from now you will be different. Thus, your needs will be different.

For a long time, healthcare has been moving towards “standardised care”.

The way I see things, that is just the beginning.

Standardised care, or best practice, is simply the foundation from which to achieve outstanding results.

Outstanding results, will be achieved with the help of outstanding coaching.

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 



Effective Nutrition for Injury and Rehabilitation

Fresh Food

An often overlooked aspect of recovering from an injury is nutritional intake.

This post will look at nutritional needs for injury from a broad perspective including:

  • Energy needs during reocvery from injury
  • Macronutrient needs during recovery
  • Micronutrient needs during recovery

A future post will explore effective supplementation for pain and injury, but as always, it’s important to start with the “big rocks” first.

Before we go into further details, you need to understand the difference between pain and injury.

Injury occurs when tissues are stressed beyond their tolerance, resulting in damage as either a partial or full rupture of the tissue. Injuries usually fall into one of two categories: acute/traumatic, chronic/overuse. Whether soft or hard tissue is involved, each injury undergoes an acute inflammatory phase followed by a rebuilding phase. Both the inflammatory and rebuilding phases can benefit from targeted nutritional approaches.

Pain is the unpleasant feeling we experience, often, but not always, in response to an injury. We can also experience pain without injury, so just having pain is not an indicator you need to modify your nutrition.

To know whether you are suffering from pain resulting from and injury, or simply “non-specific” pain, you can ask yourself a couple of simple questions:

  1. Was there a traumatic incident that could have caused the injury, and did the pain start after this?
  2. Is this a new pain? (recurring pain is typically non-specific, or less associated with injury)
  3. Are there obvious signs of inflammation – redness, swelling, heat?

Answering yes to one or more of these questions could indicate an injury. If you are unsure, it’s best to seek out a medical professional for a diagnosis.

Energy Needs During Injury

As you can imagine, an injury results in an increase to our energy needs, as the body increases metabolic activity to repair the damaged tissues.

Most textbooks calculate an increase of approximately 20% on top of your energy needs, if you are sedentary and eating at maintenance (not gaining or losing weight).

If you are already highly active, you will actually end up eating less than normal, as being highly active would require eating greater than 20% above maintenance intake.

You don’t have to track your intake exactly, but rather be mindful that if sedentary, you will need to increase your energy intake during an injury, whereas if you are highly active, you will need to decrease it, but not all the way to your baseline maintenance intake.

Macronutrient Needs During Injury

Macronutrients are the three different constituents of food: protein, fat and carbohydrate (alcohol is also considered a macronutrient, but it should be obvious that it isn’t good for injuries or recovery).

Depending on your current diet, you may benefit from changing the macronutrient ratio of your diet.

Protein

For someone eating a fairly average diet, when injured, an increase in protein intake is beneficial. The recommended protein intake is 0.8 g/kg of body weight, whilst the recommended intake for an injury is 1.5-2.0 g/kg, double the baseline. If you are already consuming a high protein diet (as is common among athletes), you don’t have to change anything.

Fat

The amount of fat you consume in response to an injury isn’t as important as the types of fat you consume.

Recall that after injury there is an inflammatory phase. This is when the body increases blood flow to the effected area, breaking down the damaged tissue to prepare it for rebuilding.

If the inflammatory phase is prolonged and/or too extreme, healing can be delayed. This is the reasoning behind applying ice and compression to acute injuries.

Different kinds of fats can be either pro or anti-inflammatory. Thus it makes sense to limit your intake of pro-inflammatory fats during an injury.

There are 3 kinds of fats: saturated , monounsaturated and polyunsaturated. Dieticians generally recommend your total fat intake is evenly divided amongst the 3.

Certain types of polyunsatured fats, omega-6 fats, are pro-inflammatory. Typical western diets are already high in omega-6 fats, so they should generally be reduced, even more so during an injury. Common sources of omega=6 fats are flax seeds, hemp, canola, safflower (and their oils), commercial dressings and many nuts.

At the other end of the scale, omega-3 fats have an anti-inflammatory effect, and can be increased during injury. The best sources of omega-3 fats are marine oils (fish oils) and algae. Many people do not eat adequate amounts of  fish to get enough omega-3 fats, so it is commonplace to supplement. However, the quality of fish oil supplements varies highly, with many brands using low quality sources, along with poor transport and storage methods, which mean that it is unlikely that you are getting what you pay for. In fact, if the oils have already oxidised, then you are actually taking something that is likely causing your health harm*.

It is important to understand that whilst reducing inflammation slightly can accelerate healing, reducing inflammation too much (or eliminating it) can impair healing, thus, you want to eat adequate, not surplus amounts of omega-3, especially if you are also taking non steroidal anti inflammatory drugs (NSAIDs) like aspirin, ibuprofen (Nurofen) or diclofenac (Voltaren).

Carbohydrates

There are no specific dietary guidelines for carbohydrate intake and injury.

Understanding the injury process leads us to two conclusions regarding carbohydrate intake:

  1. We need some form of carbohydrate in our diet, as glucose is required for repair.
  2. Ideally, these carbohydrates come primarily from fruits and vegetables and whole grain sources, as excessive processed carbohydrate intake can be inflammatory.

So while very low carbohydrate diets are currently popular for weight loss/management, during a time of injury it is advisable to consume adequate amounts of carbohydrate.

Micronutrient Needs During Injury

Micronutrients are vitamins and minerals found in foods. As to be expected, the needs for certain micronutrients increases with injury.

One important thing to understand, at this stage, it is not clear whether simply having adequate amounts in your diet is optimal, or whether there is benefit to be had from “megadosing” certain micronutrients during time of injury.

Here is a list of micronutrients that play important roles in recovery from injury:

  • Vitamin A: supports early inflammation, reverse post injury immune suppression and assists in collagen formation. A dosage of 10,000 IU daily for 1-2 weeks post injury is likely safe, but be aware that Vitamin A accumulates in the body and can become toxic if taken in excess. Remember to consider all dietary sources.
  • Vitamin C: enhances white blood cells the help fight infection as well as improving collagen formation during repair. It also is a powerful anti-oxidant and immune booster. Recommended dosage: 1-2 g/day during injury repair.
  • Copper: helps the formation of red blood cells and acts with Vitamin C to form elastin – part of our connective tissue. Recommended dosage: 2-4 mg/day for the first few weeks after injury.
  • Zinc: is required for over 300 different chemical reactions in the body. It also helps with DNA synthesis, cell division and protein synthesis – all necessary for tissue regeneration/repair. Recommended dosage: 15-30 mg/day during initial stages of healing.
  • Calcium and Iron: more in the preventative category, as deficiency in either or both minerals are quite common, leading to increased risk of stress fractures.

It is important to remember that these recommendations are guidelines only. For specifics, it is best to speak to a qualified practitioner well versed in nutrition (or a dietician) to tailor a diet and supplement plan specific to your injury needs. Some of the above if taken continuously can lead to toxicity, whilst others can cause interactions with other nutrients if taken in excess.

Conclusions

The main key to managing your recovery from injury with nutrition is to ensure you are getting adequate amounts of everything you need.

If you already eat a healthy diet and your weight is in the healthy range, it is likely you don’t have any excesses or deficiencies (it is still possible), so continuing to do what you already are is probably your best course of action, with perhaps a modification of total intake up or down as needed.

There are certain supplements that can help with injury and pain resulting from certain conditions, and we will explore those in a future post, however, in terms of this article, the majority of your nutrient needs should be met with food. If you feel you might require specific supplementation, it is best to speak to a qualified health professional (in Australia, go with an AHPRA registered professional as your starting point).

 

This blog post was written by Dr Nick Efthimiou (Osteopath), founder of Integrative Osteopathy.

This blog post is meant as an educational tool only. It is not a replacement for medical advice from a qualified and registered health professional.

 

References

(1) Berardi, J., Andrews, R., The Essentials of Sport and Exercise Nutrition, 2nd Edition, Precision Nutrition, ON

(2) Foods high in omega-6: http://nutritiondata.self.com/foods-000141000000000000000-1w.html?

*The two brands of fish oil we recommend in Australia are BioCeuticals and Metagenics. These are “practitioner only” ranges (we can order them), though you can often source them from health shops with a naturopath on staff.