http://chriskresser.com/

There are now a few companies that are offering this type of training to health coaches, and I suspect that we’re going to see more of them in the future. So, I wanted to take the opportunity in this article to share my position and explain the reasoning behind it.

But before I do that, I want to start by saying that everyone reading this article has a crucial role to play in reversing the chronic disease epidemic, whether you are a medical doctor, a chiropractor, a nutritionist or dietitian, a health coach, a personal trainer, or even what I’ve called a “citizen activist.”

The scale of the challenge we face is enormous, and we need to work together as a community of professionals and advocates to solve it. I spent at least a third of my recent book, Unconventional Medicine, making this argument, and I haven’t stopped believing it. In fact, I feel more strongly about it than ever.

Let’s begin by clarifying some of the roles that are relevant to this discussion because I think there is still a lot of confusion about them. Frankly, I didn’t fully understand the distinctions between these roles myself until just a few years ago.

Should health coaches interpret lab tests for their clients? What about nutritionists? Check out this article for my take on a contentious issue. #changeagent #functionalmedicine #chriskresser

We Need Both Health Coaches and Nutritionists/Dietitians—But They Are Not the Same

The terms “health coach,” “nutritionist,” and “dietitian” are often used interchangeably, but they are not the same.

What Is a Health Coach?

This is a critical role since we know that over 85 percent of chronic disease is driven by our behavior and environment—not our genes—and that only 6 percent of Americans consistently engage in the top five health behaviors identified by the Centers for Disease Control: maintaining a healthy weight, not smoking, not drinking excessively, getting enough exercise, and getting enough sleep. (1, 2) (I would also add eating a healthy diet to this list.)

We desperately need properly trained health coaches because information is not enough to change behavior. If it were, 100 percent of Americans would engage in the top health behaviors all the time. Most people know that getting enough exercise and sleep, eating well, and avoiding smoking and drinking excessively are healthy behaviors. But as the statistics show, they still don’t do these things.

And this isn’t just true in the general population. Even in my own Functional Medicine practice with highly motivated patients, some people struggle to implement the changes I suggest. And I know from training thousands of healthcare professionals of all types that lack of compliance is an extremely common problem.

Health coaches fill a critical void in both conventional and Functional Medicine by offering more intensive, patient-centered care. When properly trained, they are skilled in evidence-based methods of supporting change, including:

• Motivational interviewing, which helps people to discover their own motivation and strategies for change
• Positive psychology, which teaches people to build on what’s working, rather than fixing what’s broken
• Understanding the stages of change, which allows health coaches to offer the appropriate type of support at each stage of change
• Habit formation and reversal, which supports people to create new, healthy habits and reverse unhealthy ones
• Accountability and goal setting, which helps people to stay on track and achieve their goals

All of the knowledge and expertise in the world doesn’t matter unless someone can apply it in their own life. The support of a health coach can make the difference between success and failure in implementing long-term diet, lifestyle, and behavior changes. So, there’s no question in my mind that health coaches will play a crucial role in reversing the chronic disease epidemic. (For more on the importance of health coaches in combating chronic disease, see this article.)

All of that said, health coaches do not typically have training in health and medical sciences (unless they also have another healthcare license or credential). They don’t need this expertise to be successful in supporting behavior change, which is their primary purpose and role.

What Are Dietitians and Nutritionists?

Generally speaking, the term “registered dietitian” (RD) is more tightly regulated than the term “nutritionist,” but this doesn’t necessarily mean that a dietitian has more training than a nutritionist.

For example, a certified nutrition specialist (CNS) is a highly qualified nutrition professional with both a bachelor’s and a graduate degree (master’s or doctorate) in nutrition, plus 1,000 hours of a supervised internship and a passing score on a rigorous exam.

Registered dietitians are also highly qualified. They have typically attended an accredited bachelor’s program as well as a 1,200-hour supervised internship, and they may have additional licenses or credentials in specific areas of study.

Both dietitians and certified nutrition professionals have had extensive training in health and medical sciences, such as:

• Organic chemistry
• Biochemistry
• Anatomy
• Physiology
• Genetics
• Microbiology
• Pharmacology
• Statistics
• Nutrient metabolism

There are many different degrees, credentials, and qualifications within the nutrition field. Some are regulated and protected, and others are not. For this reason, the range of training that someone using the term “nutritionist” has had can vary wildly, from being self-taught, to a 40-hour course, to hundreds or even thousands of hours of academic and clinical education and experience.

It is beyond the scope of this article to explain all the different career paths that a nutrition professional might pursue, but if you’d like to learn more I’d suggest the following two resources:

• Description of Nutrition Professional Degrees/Credentials on the American Nutrition Association website
• What Is The Difference Between A Nutritionist And A Dietitian?

Should Health Coaches Interpret Blood Tests?

Let’s begin by discussing blood testing since it is the most common type of testing offered in medicine today.

There are two reasons for this:

1. Safety and ethics. Many health coaches have not had in-depth training in health and medical sciences that would prepare them to interpret blood work, unless they also hold another license or credential that included that training  (e.g., a nurse, dietitian, occupational therapist, etc.). If a health coach reads a blood panel and misses something important on the results and/or makes an unsuitable recommendation, the client could be harmed.
2. Legal and regulatory concerns. In many states, a health coach would be infringing on the scope of practice of other practitioners (including dietitians and medical doctors) by interpreting blood tests, and they might be subject to legal action.

It’s important to understand these two reasons separately because even when one does not apply, the other still does.

For example, in some states, the law does not explicitly prohibit a health coach from reviewing blood test results—which is different than interpreting them and making a diagnosis and treatment suggestions. (I’ll explain this distinction further below.) But that does not mean that it is safe or ethical for a health coach without adequate training to do it.

On the other hand, a health coach may have a background in health or medical sciences that would provide a foundation for understanding blood work, but without a credential or license that permits this, she would still be at legal risk.

What about Recognizing “Red Flags” on Blood Tests?

There is one caveat here. Although I don’t think that a health coach should interpret blood tests, I do think that they should be able to recognize “red flags” and risk factors for chronic disease and then make a referral to an appropriate healthcare professional.

The National Board of Medical Examiners (NBME) recently teamed up with the International Consortium of Health & Wellness Coaches (ICHWC) to create an internationally recognized credential for health coaches called the National Board Certified Health & Wellness Coach (NBC-HWC). Section 3 of the Health & Wellness Coach Certifying Exam Content Outline states: (3)

By definition, health and wellness coaches are not content experts in health or disease; they do not diagnose or prescribe, unless a coach has credentials in another profession that allow expert advice to be given. However, it is important for coaches to have a solid working familiarity of current evidence-based recommendations provided by public health groups such as the Centers for Disease Control and National Institutes of Health.

Relevant guidelines and recommendations fall in the areas of health promotion, disease prevention, and lifestyle medicine. The coach should be able to identify risk factors for chronic disease, commonly used biometric measures, and current lifestyle recommendations for optimizing health. An important focus for the coach is to recognize potential imminent danger and medical red flags and to know when and how to refer to another health care professional. [Emphasis added]

There is a crucial difference between interpreting a blood test result and making a diagnosis and treatment recommendations (including nutrition and diet suggestions) based on the result, and recognizing a potential red flag and referring to medical professional for further investigation.

This distinction is well recognized in other healthcare professions. For example, a nurse working in a hospital might notice and report signs and symptoms of redness, pain, and swelling at an incisional site but would not diagnose an infection or prescribe treatment for it. Instead, she would bring the issue to the attention of a physician, who could then diagnose and treat the problem.

While “reviewing” lab tests to recognize red flags and risk factors and “interpreting” them to diagnose and treat disease are not the same thing, they are often confused and and there’s a fine line between them that health coaches could easily cross.

This is why we train our ADAPT health coaches to avoid interpretation of lab tests entirely, and take a conservative approach to reviewing them if they live in a state that might permit it. If they live in a state that doesn’t, they must avoid even reviewing lab test results.

A Caveat: Health Coaches with Other Licenses or Credentials

Some certified health coaches also have licenses or credentials in other healthcare fields. For example, we have several licensed professionals in our ADAPT Health Coach Training Program, including medical doctors, physical and occupational therapists, and registered dietitians.

In these cases, the health coach does have the training and credentials that would allow them to interpret blood tests. However, most attorneys that I’ve consulted have advised that health coaches that have a license should only interpret labs if they are clearly operating under the scope of practice of their license.

Let’s say you’re a nurse practitioner (NP) and a health coach. If you advertise yourself as a nurse practitioner (that may also incorporate health coaching) and you onboard your patient using the same methods that you would use for any of your patients, you may interpret labs and do all of the other things that your scope of practice as an NP allows you to do.

However, if you advertise yourself as a health coach and onboard the client with only that understanding, then you should operate within the scope of practice of a health coach—not a nurse practitioner.

For this reason, in our ADAPT program we recommend that “dual professionals”—health coaches that are also licensed healthcare providers—advertise and operate within the scope of practice of their licensed profession if they want to be able to incorporate lab testing into their practice.

They can still use health coaching skills and competencies with their patients or clients because, in most cases, the scope of practice of licensed providers (like MDs, NPs, PTs, RDs, etc.) doesn’t preclude them from using these skills along with whatever other activities their licensure enables them to perform.

Should Dietitians and Nutritionists Interpret Blood Tests?

As I mentioned above, registered dietitians (RDs) and certified nutrition professionals often have hundreds or thousands of hours of academic and clinical training in health and medical sciences. This qualifies them to interpret blood test results related to nutrition status.

According to the CDC: (4)

RDNs in clinical practice: Recommend, perform, and/or interpret test results related to nutrition status: blood pressure, anthropometrics (e.g., height and weight, skinfold thickness, waist circumference, calculation of body mass index with classification for malnutrition and obesity), indirect calorimetry, laboratory tests, and waived point-of-care laboratory testing (e.g., blood glucose and cholesterol).

This is also true in a Functional Medicine context. According to the American Dietetic Association: (5)

IFMNT practitioners use a range of assessment tools in practice. These include a nutrition-focused physical exam and conventional laboratory data along with functional tests to assess the integrity of the metabolic networks and core imbalances that may be present.

Certified nutrition professionals with adequate training, such as certified nutrition specialists (CNSs), are also able to interpret blood tests. Section 3cii of the Examination Content Outline for Certified Nutrition Specialists states that a CNS should be able to “[i]nterpret laboratory data as it applies to nutrition-related conditions and systemic imbalances.” (6)

What If You’re a Nutritionist without a Nationally or Conventionally Recognized Credential or License?

There are many different career paths and training options for nutritionists, and they can vary significantly in terms of the prerequisites, curriculum, practical supervision (e.g., internship, practicum, etc.), length of study, and other factors.

Moreover, the term “nutritionist” is not regulated or protected. This means that someone could take be self-taught, or take a short course in nutrition (say, 30 to 40 hours) and then refer to themselves as a nutritionist. In these cases, I believe that the individual wouldn’t have the necessary training in health and medical sciences to prepare them to interpret blood testing.

This leads to both ethical and safety concerns and legal and regulatory risk—just as it does with health coaches. A nutritionist without adequate academic and clinical education in health and medical sciences could harm a client if she does not interpret a blood test correctly, and if the client pursued legal action, it’s likely that the nutritionist would not be protected.

It is beyond the scope of this article to address the scope of practice of nutritionists that do not have a nationally or conventionally recognized license or credential. If you fall into this category, please refer to your educational institution or an organization like the National Association of Nutrition Professionals for more information.

Recognizing “Red Flags” and Risk Factors for Chronic Disease

As I mentioned above, although interpreting blood tests is not within the scope of practice of a health coach, the NBME suggests that a health coach should be able to recognize red flags and risk factors of chronic disease, including commonly used biometric tests (i.e., blood tests, blood pressure, etc.).

While I’m not aware of a general scope of practice that covers nutritionists without nationally recognized credentials or licenses, I think it’s also important that these providers are able to recognize red flags and risk factors and make referrals to appropriate healthcare professionals, at least in states that permit review of blood test results by unlicensed providers.

Again, there is significant risk here of the line between review and interpretation blurring, so caution is warranted.

What about Other Types of Lab Testing?

So far in this article, I have focused on the interpretation of blood testing. But what about the interpretation of other types of testing like the stool, saliva, and urine labs that are often used in a Functional or Integrative Medicine context?

This is more of a gray area from both a safety/ethics and legal/regulatory perspective. In general, I believe that registered dietitians and certified nutrition professionals should be able to interpret the results of these types of tests, provided they have been specifically trained in these Functional Medicine diagnostics.

The answer is much less clear in the case of health coaches and nutritionists that do not possess a nationally recognized credential or license, and/or have not had adequate training in health and medical sciences.

Using the results of a stool test from uBiome or a functional lab to make recommendations like eating more fiber or consuming probiotics is very different than interpreting the results of a comprehensive blood panel. The stakes are much higher with blood work, since the results can indicate serious and potentially life-threatening conditions like cancer, hemochromatosis, or Wilson disease.

At the same time, although saliva, stool, and urine testing don’t typically reveal serious conditions, some of the treatments that providers recommend based on these results can be dangerous when prescribed incorrectly.

For example, I know of one case from a few years back when an unlicensed health coach recommended a high dose of DHEA, a hormone, to a client based on the results of that client’s saliva hormone test. What the coach failed to recognize is that a high dose of DHEA could exacerbate the client’s preexisting Graves’ disease, a hyperthyroid condition. After taking the DHEA, the patient experienced tachycardia, palpitations, high blood pressure, and elevated body temperature and had to be taken to the emergency room.

The client hired an attorney and sued the health coach—and also the program that trained the coach to interpret the lab results and prescribe treatment based on them.

So, as you can see, the question of whether a health coach or non-credentialed or non-certified nutritionist should be able to order and interpret saliva, stool, and urine tests is nuanced and complex. In some cases, it may be fine provided that they have adequate training to interpret the specific test in question. In others, I see potential issues from both a safety/ethics and legal/regulatory perspective.

The legal and regulatory landscape is not well defined in the case of Functional Medicine diagnostics because it’s relatively new and until recently has not been on the radar of the organizations that are responsible for creating the laws and regulations that govern who can order and interpret laboratory testing.

I suspect we’ll see more developments in this area over the coming years. Until then, the safest approach is likely to apply the same principles that determine which healthcare providers can interpret blood tests to other Functional Medicine diagnostic tools like saliva, stool, and urine tests.

It Takes a Village to Reverse Chronic Disease

The fact that I don’t believe that health coaches and nutritionists without nationally-recognized credentials or training in health and medical sciences should interpret most lab test results does not in any way mean that I don’t value these vital health professionals.

I know of many skilled and competent nutritionists that are neither RDs nor certified nutritional professionals yet have helped hundreds of people transform their diet and lifestyle, reverse chronic disease, and dramatically improve their quality of life.

Likewise, I’m such a believer in the power of health coaching that I launched a 12-month health coach certification called the ADAPT Health Coach Training Program in 2018. Health coaches have a critical role to play in healthcare because they are working on the front lines to help people change their behavior—and that is arguably the single most important thing we can do to prevent and reverse chronic disease.

So, this article is not about creating a hierarchy in which the providers that can order and interpret lab testing and prescribe treatment are higher up and the providers that focus on behavior change and providing guidance on diet and nutrition are lower down.

That mentality is an artifact of the conventional medical paradigm that values information more than transformation, expertise more than support, and managing and suppressing symptoms more than changing diet, lifestyle, and behavior. It’s exactly the model that got us into this mess in the first place.

It recognizes the inherent and equal value of each type of provider and seeks to maximize his or her skill, training, and scope of practice in service of the patient. For example:

• Medical doctors and other clinicians focus on the diagnosis and treatment of disease
• Nutritionists and dietitians focus on creating individualized nutrition protocols
• Health coaches focus on supporting people in implementing the protocols prescribed by nutritionists/dietitians and clinicians and in making successful and lasting behavior change

While each of these providers can have a major impact working independently, I believe that they are even more effective when working together in a collaborative fashion:

• A doctor can prescribe a brilliant treatment protocol, but without a nutritionist or dietitian to customize the diet prescription and a health coach to help the patient to implement it, the chances of success are much lower.
• A health coach can have a powerful impact on supporting people to make diet, lifestyle, and behavior changes, but if his client is struggling with a significant chronic health problem, working in collaboration with a clinician that can perform the full scope of lab testing and prescribe treatments will lead to better results.
• A nutritionist or dietitian can create a perfectly tailored nutrition prescription for her client, with meal plans and recipes, but if the client doesn’t follow it, all of this work will be for naught. This is where a health coach can be so helpful.

It truly does take a village to address this growing problem of chronic disease. If you’re reading this, it means that you’re already playing a role—however big or small—in this healthcare revolution, and I am so grateful for your efforts!

As this article indicates, there are still many gray areas and quite a lot of confusion, even amongst legal and medical professionals that have closely studied these issues. What’s more, the landscape is changing quickly, as professions like health coaching and nutritionists become more common and better recognized.

I will continue to study this topic, consult with healthcare attorneys, and gather feedback from the professional community. I’ll update this article with any new, relevant information.

I’d love to hear your feedback, questions, or concerns in the comments.

The post Should Health Coaches and Nutritionists Interpret Lab Tests? appeared first on Chris Kresser.

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Knee discomfort is something that many of us experience during a workout or when performing specific exercises or activities, including squatting, lunging, or running. This experience has prompted many of my clients to ask me what exercises they can do for their “bad” knees.

While there is no clinical diagnosis or specific exercise prescriptions to help “bad” knees, understanding why you might have knee discomfort can help you:

• Identify some strategies to address it.
• Reduce pain during activity
• Know when you should go to a medical professional for diagnosis and treatment.

Knee Anatomy

To understand why you might have sore knees, it helps to know a little bit about knee anatomy. Your knee is what is sometimes called a modified hinge joint. It is made up of three bones and is where the bottom of the thigh bone (femur) and the shin bone (tibia) meet. The kneecap (patella) is a small triangular bone that articulates with the thigh bone and helps protect and cover the front of the knee joint.

Within the knee are two cartilage-based pads called menisci (singular, meniscus). These pads reduce friction within the joint when the thigh bone and shin bone articulate relative to one another. On the inside, outside, and within the knee are ligaments, which stabilize the joint and prevent the thigh bone and shin bone from sliding too far backward or forward.

Behind the knee is a small fluid filled sack called a bursa, which cushions the knee and helps the tendons and ligaments glide at the joint. The knee is also supported by tendons, which are attached to muscles, to bend and straighten the knee. These actions are also referred to as knee flexion and extension.

Potential Causes of Knee Soreness

While the knee primarily flexes and extends, it also does small amounts of internal and external rotation. Also, because it is located between the hip and the ankle, it is heavily influenced by how well the joints above and below it move.

For many people, these nuanced rotations within the knee joint, combined with limited mobility or a lack of control in the hip and ankle, can contribute to knee soreness, even if there isn’t anything wrong with the knee itself.

Sometimes there is an underlying condition that is contributing to knee pain. Some of these conditions include arthritis, bursitis, or a ligament tear. If you experience an ongoing sense of instability around the knee, an inability to control how your knee straightens and bends, or ongoing pain and grinding, then it is recommended that you consult your medical provider for diagnosis and treatment.

That said, as mentioned above, it is possible to experience mild to moderate knee discomfort without a knee injury. In these instances, the soreness is often caused by a movement compensation due to limited mobility or a lack of control in the hip and ankle. This happens because much of the sitting and footwear required by modern daily life doesn’t set us up to use our hips and ankles in their fullest ranges of motion or as optimally as we could.

While this isn’t a crisis, it can contribute to inefficient movement patterns and knee stiffness and discomfort during exercise. However, taking time to strengthen and mobilize the hips and ankles can often reduce soreness and promote better movement patterns during activity and daily life.

Additionally, sometimes a person will have knee discomfort because of how they are executing a specific movement. For example, their knees will feel fine, except when they lunge, because they are driving their knee forward, creating additional pressure on the knee. However, if they hinged the hips slightly back and then performed the lunge, it could lessen the pressure in the front of the knee and in turn reduce discomfort.

In this case, sometimes making some small adjustments to how you practice an exercise can resolve the issue. If you are unsure of how to make these adjustments, you may want to consult a physical therapist or fitness professional who is trained to evaluate exercise form.

Strategies to Address Knee Soreness

There is no one-size-fits-all solution or exercise sequence for addressing knee soreness and if you experience ongoing pain or discomfort, you may want to consult a medical provider to make sure there isn’t an underlying issue that needs to be diagnosed and treated. Still, many of us can benefit from movement and self-care approaches to address low-grade discomfort.

Foam Rolling, Massage, and Soft Tissue Release Work

While foam rolling, massage, and soft tissue release work won’t create permanent changes to the tissues, they can temporarily reduce soreness around the joint and increase the range of motion in the hips and ankles. This can promote better movement patterns during exercise, which over time could contribute to less discomfort.

In the case of knee pain, it can be beneficial to address the muscles and tissues above and below the joint. This could include rolling the inner thighs, hamstrings, quadriceps, calves, and the portion of the IT band located just above the knee.

Once you have rolled or performed soft tissue release to this area, it can be beneficial to also perform mobility, stability, or strength exercises to teach your body how to use this new range of motion, which can create longer-lasting changes.

Stretching

Similar to foam rolling and soft tissue release work, stretching can sometimes reduce knee discomfort and temporarily increase the range of motion at the hips and ankles. As mentioned above, in this case, it can be helpful to gently stretch the muscles above and below the knee, paying specific attention to the hamstrings, calves, inner thighs, and hip flexors.

The exception to this is if you suspect that you have an acute injury to the structure of the knee, such as a ligament tear or if you are hypermobile and have found that stretching makes your knees feel worse. If you experience swelling at the joint or suspect that you an underlying knee injury, you should consult a medical provider.

Again, because stretching can create similar results as foam rolling, if you follow up stretching with some sort of movement work to improve stability, mobility, and strength, you may experience better results.

Hip Mobility, Stability, and Strength Exercises

Addressing hip mobility, stability, and strength can promote better knee health, because the muscles of the outer hip and inner thigh play a large role in knee alignment and controlling the impact on the knee during movements, including walking, running, squatting, and lunging.

While everyone is different, most of us will benefit from practicing exercises that allow us to move and strengthen our hips in multiple directions. Some examples of this include leg circles, quadruped rocking, bird dogs, monster walks, and bridging with a yoga block between the knees.

Additionally, for some people, exercises that activate the hamstrings and quadriceps and integrate VMO activation can reduce knee soreness. The VMO (vastus medialis oblique) is a part of the quadriceps located to the inside of the leg, just above the knee that plays a role in kneecap tracking when the knee straightens.

Ankle Mobility and Strength Exercises

Sometimes stiff or unstable ankles can create movement compensations that affect the knee. For example, limited ankle dorsiflexion, which is when the front of the ankle creases, can cause the feet to turn out and collapse in when squatting or walking. This can create additional pressure or discomfort at the knee.

Additionally, weakness in ankle plantar flexion, which is when the foot points down away from the shin, can create additional impact or movement compensation around the knee when walking or running.

In both scenarios, ankle mobility and strength drills can be beneficial for indirectly addressing knee soreness. Some examples of ankle drills include calf raises with an emphasis on keeping equal weight across all ten toes and ankle circles.

Strength Training

Did you know that strength training exercises such as squats can reduce knee discomfort and even promote better knee health? This is because strength training can increase your tolerance to movement in your joints and the added lower body strength can help you control the forces through the knees when walking and running.

The key thing is to find a way to practice strength training exercises in a way that doesn’t create more knee pain in the moment. This might mean modifying your set up for the exercise or picking a different exercise entirely. For example, some people who experience knee pain during squats might find that taking a wider stance and hinging their hips back allows them to squat without pain. For others, a band around the thighs or elevating the heels may also help.

Again, there isn’t a single solution. Nevertheless, thoughtful exploration or working with an appropriately trained professional can help.

In Conclusion

Knee soreness can stem from a variety of underlying causes and there isn’t a single solution. However, knee pain doesn’t mean that you have “bad” knees. Oftentimes, you just need to find an individualized approach and in some cases seek medical treatment to understand and address the discomfort.

Read also: Why You Need Better Ankle Mobility

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“Steve, how many calories should I eat every day? I got goals, son!”

Great question!

Knowledge is power, so today, we are going to make you more powerful.

First off, we’ll discuss your Basal Metabolic Rate (BMR) and your Total Daily Energy Expenditure (TDEE), which are fancy terms for how many calories you require on a daily basis to exist.

I’ll even give you two calculator options below – to determine your personal BMR and TDEE – plus I’ll show you how to use this information.

We’ll end today’s article by giving some practical advice on calorie requirements and weight loss, including a step-by-step plan, because I’m nice like that.

Let’s do this!

THE NERD FITNESS TOTAL DAILY ENERGY EXPENDITURE CALCULATOR

We’re going to start off by doing some math.

Don’t worry though, our robot calculator (beep boop boop) will do all the hard stuff for you.

We will need to know your height in inches, your weight in pounds, and an idea on your activity level (Use the metric system? I wish we did too here in the States! Click right here for our Metric calculator).

Although you can adjust it, I want you to set your “Activity Level” as “Sedentary,”  (I’ll explain why in a minute):

Nerd Fitness Total Daily Energy Expenditure Calculator

(Note: we have used the The Mifflin-St Jeor Equation to create this calculator! ^[1])

Hooray! You now know your BMR and TDEE!

You may be thinking, “Ah, Steve, what do either of these mean?”

I got you boo. Make sure you write down your two numbers.

WHAT IS BASAL METABOLIC RATE (BMR)?

Basal Metabolic Rate (BMR) is the total amount of calories needed to keep you alive.

Breathing, cell production, pumping blood, and keeping your body temperature up all require calories to function.

When you sit perfectly still, you use plenty of calories keeping your body in good working order.

“Basal” more or less means “basic,” so you can think of BMR as the number of calories needed for basic daily functions.

Your sex, weight, and height will all affect the number of calories you need, which is why they are variables in our equation above.

The taller you are, or the more you weigh, the higher your BMR will be. There is simply more of you that needs calories. More blood to pump, more cells to produce, etc.

Roughly two-thirds of the calories you need each day go into keeping your body running.

The other third?

That goes into powering your motion. Because going from one place to another requires calories from your body. So does lifting stuff.

Let’s talk about Total Daily Energy Expenditure (TDEE) next.

WHAT IS TOTAL DAILY ENERGY EXPENDITURE (TDEE)?

Total Daily Energy Expenditure (TDEE) is an estimate of how many total calories you burn in a day.

Since your BMR calculates the calories you need for a state of rest, we need to factor in movement and exercise to get an idea of how many calories you burn each day.

To do this, we’ll take your BMR and multiply it by an “Activity Level” factor.^[2]

Activity Levels can be thought of as the following:

Sedentary. You get up to tell Netflix you are still watching.  You don’t intentionally exercise at all.

Sedentary = BMR x 1.2

Lightly Active. You casually stroll through your neighborhood a few times a week. On average, you walk for exercise about 30 minutes a day. Another way to think about this would be 15 minutes per day of vigorous exercise like jogging or lifting weights.  

Light Active = BMR x 1.375

Moderately Active. If we called the gym on a weeknight looking for you, they’d find you. This averages out to about one hour and 45 minutes of walking (for exercise, not going around your house) a day, or 50 minutes of vigorous exercise.

Moderately Active = BMR x 1.55

Very Active. You work in construction during the day and you’re on the company softball team. This averages out to about four hours and 15 minutes of walking (again, for intentional exercise) a day, or two hours of vigorous exercise.

Very Active = BMR x 1.725

If you’re following along at home, you may notice that different Activity Levels can make a big difference for the calories burned.

Let’s use some numbers:

Suppose you’re male, 35 years old, weigh 200 pounds and are six foot even (72 inches).

You’re also wearing a Nerd Fitness Shield Tee and it looks great on you. It really brings out your eyes.

Awesome shirt or no awesome shirt, we know your BMR comes in at 1,882 calories given the variables we identified. Which means you’ll need roughly 1,900 calories for basic bodily functions.

This is where things get interesting.

If you’re Sedentary, we’ll multiply 1,882 (BMR) by 1.2 to get a TDEE of 2,258. Which means you’ll need 2,258 calories to support bodily functions and to walk around your house, to go from your car to your office, from your office back home, etc.

Let’s imagine a scenario where you are not Sedentary. Instead, we’ll calculate that you are Lightly Active, meaning you walk around your neighborhood a few times a week.

We take your BMR of 1,882 and multiply it by 1.375 to get a TDEE of 2,588.

The difference between Lightly Active and Sedentary is 230 calories, about what you’d find in a glazed donut.

Let’s keep going.

Let’s say you hit your local gym a few times a week for strength training practice. And on your off days, you do a little yoga and take walks. This will push you into the “Moderately Active” category.

We take your BMR of 1,882 and multiply it by 1.55 to get a TDEE of 2,917.

The difference between Sedentary and Moderately Active would be 659 calories.

That’s an extra meal’s worth of calories! Here are some examples of things that are roughly 650 calories:

A whole meal’s worth of Sicilian fish with sweet potatoes:

Or, one Big Mac® with Bacon:

Or, one large Orange Dream Machine® from Jamba Juice:

People often UNDERestimate how many calories they consume, and then OVERestimate how much exercise they’re doing.

This is why Activity Level could be a “trap” when doing TDEE calculations!

WHAT SHOULD MY ESTIMATED ACTIVITY LEVEL BE?

We people are notoriously bad at estimating our Activity Level.

We’re also terrible at tracking calories accurately and almost always underestimate (often by as much as 30-50%+ percent).

Study after study demonstrates that people evaluate their movement and exercise greater than what it actually is.^[3]

We think we’re working out “intensely” for 60 minutes. However, when researchers look at stuff like heart rate, VO2 max, and calories burned, they determine that we actually only exercised “moderately.”

What’s this mean for you? If your goal is weight loss, pick an Activity Level below your initial guess.

Take our predisposition to overestimate Activity Level and grab the one beneath it.

Instead of “Moderately Active” pick “Lightly Active.”

This will give you a more accurate estimate of your caloric needs, and give you a larger margin for error when trying to lose weight!

The other thing to consider would be strength training.

As we mention in our “Lose Weight and Build Muscle” article, strength training requires a lot of calories out of your body, not only for the exercise itself, but also for rebuilding your muscle too.

In general, consider strength training to be “vigorous exercise,” which we highlighted above. If it takes 30 mins of walking a day to be “Lightly Active,” 15 minutes of daily strength training would roughly be equivalent.

If estimating your Activity Level and TDEE is starting to freak you out:

Trying to pick and calculate the right amount of calories to consume can be stressful. Especially if you’ve had trouble losing weight in the past. And that’s just the math part – we haven’t even got to the psychological part about how delicious pizza and ice cream are.

It’s actually the reason we created our uber-popular 1-on-1 Coaching Program. We sought to take all the guesswork out of getting in shape, by creating a program to tell you exactly what to do.

If you’re trying to lose weight, adjust your diet, or start a strength training practice, we can help! We work with busy people just like you level up their lives in a permanent and sustainable fashion. If you’d like to learn more about it, click on the big image below:

USING BMR AND TDEE FOR WEIGHT LOSS

If you’ve read this far into the article, I imagine you are interested in learning your Total Daily Energy Expenditure for weight loss.

I also imagine you support my belief that The Shawshank Redemption is the best movie ever made:

I started this article by stating that if you are having trouble losing weight, it’s because you are eating too many calories.

The TDEE we calculated above will give us a good estimate of calories you require each day – if your scale is staying constant: congrats! You found your ‘calorie equilibrium.’ This means your body burns just as many calories as you consume each day.

However, I’m going to guess you’re here because your goal is to see the scale go down!

To really be able to utilize this number, we also need to have an idea on the number of calories we are consuming. Without knowing this, the TDEE is really just an arbitrary number.

Many would say the easiest way to assess and track calories consumed is with an app. We live in the future. Use a smartphone and download one of the following:

• My Fitness Pal. The gold standard of calorie counting apps. It’s also the most popular, supporting the largest food database in the game. Plus it can download recipes from the internet and provide an estimate of calories.
• FatSecret. Basic, simple, and free, FatSecret is a great calorie tracker. It’ll allow you to connect with other users, plus it’s got a barcode scanner for caloric content from labels.  Super nifty.
• Lose it! Another free calorie counting app, focusing more on goal setting. Additionally, the Snap It™ feature lets you use pictures for data input. Double nifty.

You don’t have to use the app forever. A solid week’s worth of data will help you get a sense of the food you are consuming, especially if you eat roughly the same food each day. You can then compare this to your TDEE.

If you’re trying to lose weight, you need to have your calories consumed less than your TDEE on average.

Here are some numbers to think about: 3,500 calories equals roughly one pound of fat. There are seven days in a week. If you want to lose one pound of body fat in a week (a sustainable goal for some), you need to create a caloric deficit of 500 calories a day: either through consuming 500 fewer calories, burning 500 more calories, or a combination of the two.

Let’s imagine that your TDEE is 2,500. This would mean you’d have to consume around 2,000 calories a day to lose around a pound per week.

As we discuss to great detail in our “Why Can’t I Lose Weight” guide, sustained weight loss is largely a result of controlling the first half of the equation: “calories in.”

If you’ll remember, your BMR is about two-thirds of the total calories used, independent of movement. And most people overestimate exercise and underestimate consumption.

So controlling calories in is the most effective way to sustain weight loss.

Said another way, it’s much more difficult to increase your Activity Level than it is to reduce the calories you consume.

What’s the easiest way to eat fewer calories consistently? By eating REAL food.

Why? Because real foods are more likely to fill you up and satisfy your hunger while also keeping you under your calorie intake goal for the day!

MOVING TOWARDS A HEALTHIER WAY OF EATING

The Nerd Fitness philosophy on diet can be written in three words: Eat REAL food.

I lay it all out in our Beginner’s Guide to Healthy Eating, but you’re smart – you know what real food is:

Food that grew in the ground, on a tree, ran on the land, swam in the sea, or flew through the air.  Meat, fish, eggs, vegetables, fruits, nuts are all great examples of REAL food.

This is what you should be eating more of.

The fine folks at WiseGEEK did an awesome post where they took pictures of what 200 calories of a certain food looks like.

200 calories of broccoli gets you enough broccoli to fill up an entire plate:

Or half a Snickers bar:

Yeah…

What I’m saying is by eating REAL food, you have a MUCH higher margin for error to stay under your calorie goal for the day.

If you “accidentally overeat Broccoli,” you might accidentally eat an additional 50 calories. If you accidentally overeat candy or soda or processed foods, you can consume an extra 500+ calories without feeling satiated or content.

If you want to create a caloric deficit consistently, REAL food is the answer. Before you get all huffy, I know a Snickers bar is way more delicious than broccoli – it was designed in a lab by scientists to be AMAZING!

I’m not gonna tell you to never eat a Snickers ever again either. Instead, you need to start being proactive about your food choices. If you’re gonna eat a Snickers, just plan for it (or adjust after) by reducing your calorie intake elsewhere.

If the scale isn’t budging  – you’re still eating too much!

SHOULD I DO KETO OR PALEO FOR WEIGHT LOSS? WHAT’S THE BEST DIET

Should you do the Mediterranean Diet? Keto? Vegan? Paleo?

Maybe.

They all follow the same premise: by changing the foods you eat, you’re more likely than not to eat a caloric deficit without a struggle. Certain people respond better to certain diets than others.

So yes, any of those diets can help you lose weight – but you need to stick with the changes permanently to make the results stick permanently!

I personally follow a mental model diet, that focuses on real food all the time, and occasionally includes some junk food :

Minimize processed food – they’re designed for you to overeat them. Take a look again at that Snickers bar. Do you really think you’d only eat half of one to stick to 200 calories? Of course not. This argument is more or less the rationale for following a paleo diet.

Eat veggies. Vegetables are nutrient dense and light on calories. Because of all the fiber, they are also tough to overeat. Imagine eating all that broccoli. Are you going for seconds? Probably not. So eat your veggies to help keep you full. Hate vegetables? I once was like you. Read how I turned it around here.

Be wary of liquid calories. Cut back on soda, juices, smoothies, and any beverage with calories. Even most coffee orders (with sugar, cream, etc.) will have a ton of hidden calories. All these drinks are sugar bombs since there is no fiber to balance out all the carbs you are consuming. Stick to water, and unsweetened tea or coffee. Here are our thoughts on diet soda.

Prioritize protein. When your body heals itself, like after exercise, your body uses protein as the building block of muscle rebuilding. Outside of repairing your body, protein will also work to keep you full and satiated: 400 calories of chicken will leave you wayyy more full than 400 calories worth of Gatorade.^[4] If you prioritize protein on your plate, you’ll be doing a lot of the heavy lifting on proper nutrition. Some great sources of protein include chicken, eggs, beef, pork, fish, nuts, legumes, quinoa, and most dairy products.

These four points will help you on your journey to create a caloric deficit.

Disclaimer: this is all easier said than done. After all, 70% of the country is overweight. Don’t worry though, because most of them don’t read Nerd Fitness. You do. This is like a strategy guide for life.

If you’re struggling with portion control and challenges, jump fully into the NF community. We cover human behavior and psychology to help you improve your environment, fix your habit building, and how to surround yourself with people that make you better (including our free message board community).

We’ve helped thousands of people like you here at NF, and we really focus on nutrition.

Like we said, it’s 90% of the battle!

It’s why we created our 10-level nutritional system. Each level gets a bit more challenging and healthier, but you can progress at your own speed to make your changes stick!

The name of the game here at Nerd Fitness is “consistency.”

You can download our 10-Level Nutrition Guide when you sign up in the box right here:

HERE’S WHAT TO DO TO LOSE WEIGHT WITH YOUR TDEE

Let’s recap this whole article for you, with some actionable steps:

• Determine your BMR and TDEE. This will be critical for computing your caloric deficit.  They’re good numbers to keep in mind during the whole experiment. Calculate your TDEE here.
• Track everything, as is, for one week. Log everything you eat. No judgment. If you eat five slices of pizza in a night, count every slice. This step alone has helped many rebels turn their lives around. Consider a food tracking app or online tracker to educate yourself!
• Compare numbers. Where is your current caloric intake at? How does this compare against your TDEE? If your intake is higher than your TDEE, you’re likely gaining body fat. We want to flip the equation.
• Create a caloric deficit. The easiest and most sustainable way to do this is to eat REAL food. Sorry. Steve is going to tough love you on this one. And remember, a 500 calorie deficit a day could help you lose one pound of body fat in a week. REAL food is the easiest way to achieve this.
• Track progress. Continue to track caloric intake to ensure you expend more calories than you consume.  

That’s it.

You can do this. I know you can because many of our readers have done it themselves.

However, I won’t lie to you, it’s not easy. Human biology is working against you.

But again, it is totally doable.

As I started this article off, knowledge is power. I hope you calculate your calorie requirements today and use this information to make actionable changes.

Knowing your caloric requirements is a great first step for a weight loss journey. You’re on the right track.

For the Rebellion!

-Steve

PS: If you want any help on the way, I’ll remind you of the Nerd Fitness Coaching Program. We can help you calculate your Total Daily Energy Expenditure and create a workable plan to keep your calories under it.

If you want to learn more, schedule a free call with our team to see if we are a good fit for each other, by clicking the image below:

PPS: Seriously, how great is The Shawshank Redemption? I could quote that movie all day long.

If you don’t agree…

###

All photo citations can be found right here.^[5]

Originally Posted At: https://breakingmuscle.com/feed/rss

In November of 2017 my wife, Neely, and I nervously attended orientation at an adoption agency. We filed into our seats and attentively followed the day’s program, brimming with all the obvious questions:

“How long does it take?”

“How are we matched?”

“How often do matches fail?

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My primal story all started while hiking one day back in 2009. Hiking has always been more than exercise for me. It has always been a place to clear my thoughts and think of new ideas. On a late summer day when hiking one of my favorite trails, I asked myself the question. “What would I eat if I lived out here?” I took a mental inventory: pine nuts, rabbits, chipmunks, some berries, and a deer if I was lucky. I started thinking that nothing out in the wild really represented anything I would find at my local store. I would have a hard time finding rabbit and chipmunks at the Mega-Mart, if you know what I mean.

This idea sparked my interest so much I went home and started searching everything online I could find on wild human diets etc. and eventually landed on Mark’s Daily Apple. I was hooked from the first words I read. (I eventually read all of Mark’s books too). I was all in from that day forward. I told my wife I finally figured it out, she said “what” I said “everything” and I told everyone. It all became so clear to me. Not just the diet but the lifestyle in general. It seemed the Primal Blueprint answered all of the problems of modern living.

I started cleaning out the pantry, went grocery shopping, and the next day and started my new life. It was really that easy to be honest. I had a bit of a headache and a few cravings here and there, but after that it was smooth sailing.

At the time I weighed 210 lbs on a large 6’1” frame and thought I was in good health. I hit 185 lbs after the first six months of my life altering experience, and maintained 175 to 185 it for 3 years. I was down 25 lbs, and never felt better. I was hiking about 40 miles a week things were great. All my blood markers were good, my blood pressure was low, and resting heart rate was under 50 bpm. I felt on top of the world, I was invincible.

I maintained the Grok lifestyle until 2012, and then things took a turn. I changed jobs, and moved to Hawaii. Don’t get me wrong—Hawaii was great, but the stress of being so far from family, and the hustle and bustle of a million people on one little island started taking its toll. All the great new foods didn’t help either. Who can’t resist a piece of Haupia Pie now and then? I still followed the primal eating principles for the most part probably 75/25. However things were changing for sure. I started drinking more beer and eating less than ideal (this is not the best way to handle stress). I gained most of the weight back and then some over the next three years.

While living in Hawaii we had a few deaths in the family (this was the breaking point really). So my wife and I decided to move back to the Mainland. The job search was on and I ended up taking a position for a company in the same town we lived before. Sounded great, ended up the worst decision I ever made. The job was a terrible fit, high stress, and I never took so many trips to the HR office in my entire life. To compensate for the stress, I started drinking more (if that was even possible), and eating polar opposite of the Primal Diet—SAD. I also quit hiking. Life was going downhill fast.

I finally hit rock bottom (so I thought). It was late 2015. I had fell off the Primal Wagon and bounced three times. I started having issue with heart palpitations to the point where I would almost pass out. I went to the doctor to get things checked out. The diagnosis was not good. I was up to 233 lbs, had too much bad cholesterol, triglycerides sitting at 180, borderline hypertensive, and well on my way to being a type II diabetic. The good thing through all of this, I was never prescribed any medications, and my echocardiogram looked good.

In the spring of 2016 after a year and a half of pure hell, I quit that horrifying job without notice. The good news, the heart palpitations went away almost the next day, and I slept better than I have for a few years. I started hiking again off and on but I would get a lot of pain in my legs and hips. The bad news, I was drinking even more beer.

Unemployment was not treating me well and I was in a really dark place. Death was not out of the question and an option for me. After 6 months of beer drinking and unemployment I blimped out to 245 POUNDS. I was fat, had leg and joint pain and just wasn’t there mentally. I was afraid to go to the doctor and get things checked out. I really thought the end was near. Then the end of 2016 I interviewed for a great job at a good company and got it. The position started in January 2017. I’m just grateful a good company took a chance on a fat unemployed alcoholic.

I have to admit from 2015 through 2016 had a tremendous negative effect on my family. I don’t wish it on anyone. My wife and kids stood by my side however and supported me, I love them. If not for their support, understanding, and love the difficult times would have been unsurmountable.

2017 was a big year of change, I turned 50, and started getting my head back on straight. I fell off the top of the mountain and needed to start climbing back up. I knew that I needed to make some big lifestyle changes to make the summit. I wanted to be there for my wife, kids, myself, and future grandkids well into my 80s. The first thing I did was quit drinking, cold turkey August 1st 2017. After 25 years of drinking this was one of the most difficult things I have ever undertaken. After I went through that, I figure I can make it through anything!!

After I beating the drinking problem, wanted to start back down the Primal Path. It was difficult at first. I attempted and failed a few times through 2018. Slowly but surely I got back on track. January 7th 2019 I was full on following the Primal Blueprint again. I started with The Keto Reset for the first month and it worked great. I now practice intermittent fasting a few times per week as well. I keep my carb intake around 50 grams per day now. I started at 244 lbs and now I’m down to 220 as of February 18th 2019. My target weight is probably 175 to 180 (this is where I feel best). I’m back on track to hardcore hiking too.

My first grandchild will be born this year and I can’t wait to teach him or her how to live like a Grok Child (payback for my daughter’s teen years). I have also enrolled in the Primal Health Coach Institute, I’m just over 30% complete. I plan on coaching, and helping people for the next 25 years or more. I first need to pass the comprehensive and challenging course however. The Primal Blueprint was great for me the first time. The second time is personal, and I never plan on looking back. I am looking forward to living a happy healthy life well into the future.

The readers featured in our success stories share their experiences in their own words. The Primal Blueprint and Keto Reset diets are not intended as medical intervention or diagnosis. Nor are they replacements for working with a qualified healthcare practitioner. It’s important to speak with your doctor before beginning any new dietary or lifestyle program, and please consult your physician before making any changes to medication or treatment protocols. Each individual’s results may vary.

The post Falling Off the Mountain and Climbing Back Up appeared first on Mark’s Daily Apple.

http://www.marksdailyapple.com/

Last week I announced that the bees and are looking to share your stories of success in changing habits, losing weight, reclaiming your health, and enjoying more vitality with the help of Primal and/or Primal-keto living—and that I’m offering a giveaway to sweeten the pot: a $200 gift certificate  to PrimalKitchen.com for one lucky winner, plus a 5-book Primal library for two additional winners—all three randomly chosen among those who send in their success stories and photos by March 8th, 2019—as well as a 20% off discount to either PrimalBlueprint.com or PrimalKitchen.com for everyone who sends in a story and photos at any time.

Remember, anyone in the world can enter. Additionally, everyone who has submitted a Success Story to Mark’s Daily Apple in the past is free to submit an updated story and new photos.

Just submit your story along with pictures you feel are indicative of your journey and your current Primal life and success. Please use the subject heading “My Primal Story.” Otherwise, there’s a good chance we might miss it.

For more info on success story guidelines and giveaway rules, check out the previous post, and for inspiration to write your own story, you can read past Success Stories here.

I’ve got another amazing success story coming up this morning, so stay tuned.

The post Reminder: Success Story Giveaway Closes March 8th! appeared first on Mark’s Daily Apple.

http://www.thealternativedaily.com/

It is likely that you are familiar with the term keto. How many of your family members and friends are following a ketogenic diet? Perhaps you are as well. Unlike other diets, keto is not a fad and has some pretty solid science behind why so many people are successful following it. About the keto […]

Originally Posted At: https://breakingmuscle.com/feed/rss

She doesn’t like your dinner so you make her mac and cheese. He doesn’t like crusts, so you cut them off. Your nine and 12-year-old won’t wake themselves up, pack a lunch, or make breakfast, so these responsibilities fall to you. She doesn’t like the kids at her bus stop so you sit through a car line so long and tedious that you begin to yearn for a day at the DMV. He forgot his homework. Better skip your exercise class and bring it up to him. She wants to play volleyball.

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Fudge…the creamy, rich squares of pure decadence we might associate with the holidays (or with trips to grandmother’s house). A little sure went a long way, but still…. With versions that typically call for everything from three cups of sugar to marshmallow fluff to sweetened condensed milk, fudge isn’t exactly a realistic Primal option. In fact, however much we may have loved it as kids, most of us have tastes too far adapted from this level of sweetness for it to hold the same temptation anymore. (Does anyone’s teeth hurt right about now?)

But that was then. This is now—with a whole different, Primal take on this classic. We happen to think this recipe is what fudge was always meant to be—all the rich texture and creamy feel (from healthy fats)…with a fraction of the carbs. Enjoy!

Ingredients:

• 1 packet of Primal Kitchen® Collagen Peptides (optional for nutrition benefit)
• 1/2 c organic tahini
• 3/4 c organic coconut butter
• 1/4 c SunButter (no sugar added)
• 1/2 fresh vanilla bean
• 3 tbsp maple syrup
• 1/2 bar of unsweetened chocolate
• Sea salt flakes to top

Instructions:

Melt and mix everything (except the chocolate and salt) in a double-broiler. Let cool to room temp.

Chop the chocolate into chips and stir into fudge mixture.

Pour into a silicon cube tray, sprinkle with salt flakes and let chill in the fridge until super firm.

*Store covered in the fridge.

Nutritional Information (per serving):

• Calories—312
• Carbs—9 grams
• Fat—27.5 grams
• Protein—7 grams

The post Tahini Fudge appeared first on Mark’s Daily Apple.

http://www.thealternativedaily.com/

Pushups have long been a standard measurement for strength. While this is true, a new study that tested middle-aged male firefighters has found that pushups are also an indicator of heart health. New study finds a  connection between pushups and heart health The study found that firefighters who could do more than 40 pushups in […]