MF805010 Perf Nutri (20130116)

Performance Nutrition 805P-MF805010 / Version 2 Effective Date Not Assigned SECTION I.
ADMINISTRATIVE DATA
All Courses Including This Lesson Course Number Version Course Title
None
Task Number Task Title
Task(s) Taught(*) or Supported
None
Task Number Task Title
Reinforced Task(s)
None
Knowledge Knowledge Id Title Taught Required
None
Skill Skill Id Title Taught Required
None
Administrative/ Academic Hours
The administrative/academic hours required to teach this lesson are as follows:

Academic Resident Hours / Methods
Yes 2 hrs 0 mins Practical Exercise (Hands-On) Yes 3 hrs 0 mins Conference/Discussion Yes 0 hrs 0 mins Test Review Yes 0 hrs 0 mins Test ________________________________________________________________________ Total Hours: 5 hrs 0 mins
Test Lesson Number Hours Lesson Number
None
Prerequisite Lesson(s) Lesson Number Lesson Title
None
Training Material Classification Foreign Disclosure Restrictions
Security Level: This course/lesson will present information that has a Security Classification of: U - Unclassified. FD1. The materials contained in this training event/course have been reviewed by the developers in coordination with the Physical Readiness Div, TSSD, DCG-IMT, Ft Jackson FD authority. This training event/course is releasable to students from all requesting foreign countries without restrictions.
Number Title Date Additional Information
References
AR 600-63 FM 7-22
Army Health Promotion (RAR - 07 Sep 2010) Army Physical Readiness Training
1
07 May 2007 26 Oct 2012
Student Study Assignment

- As instructed by MFTC Instructor prior to and following this lesson.
Instructor Requirements
- Be thoroughly familiar with this lesson and FM 7-22 prior to conducting training.
- Ensure all handouts, slides, and lesson for Visitors Book are prepared and on-hand.
- Ensure classroom is prepared and all required equipment and training aides are on-hand for training and in proper working order.
- Ensure Assistant Instructor (AI) is identified, briefed, and is aware of any requirements involving his/her interaction. The AI also needs to ensure he/she can teach the is lesson if the Primary Instructor (PI) is not present.
- Identify corrections, inconsistencies, or errors in training material. These need to be addressed with the PRD Training Specialist after the scheduled training.
- Complete an end-of-day AAR with students.
Additional Support Personnel Requirements
Name
Student Ratio
Qty
Man Hours
None
ID - Name Student Ratio Instructor Ratio
Equipment Required for Instruction
Spt
Qty
Exp
5836-01-408-4665 0:0 PROJECTOR, VIDEO (INFOCUS LITEPRO 550) 6515-01-509-2908 - DEPLOY 0:0 PAC,AED 6545-00-116-1410 - FIRST AID 1:40 KIT,GENERAL PURPOSE 6665-01-103-8547 - WET 1:40 GLOBE TEMPERATURE KIT 6730-00-577-4813 - Screen, 0:0 Projection 7010-01-454-5951 - Computer 0:0 System, Digital, Desk Top 7520-00-T82-3256 - LASER, 0:0 POINTER (PEN SIZE) 7520-01-351-9148 - Pointer, 0:0 Instructional (Note: Asterisk before ID indicates a TADSS.)
1:40 1:40 0:0 0:0 1:40 1:40 1:40 1:40
No No No No No No No No
0 0 0 0 0 0 0 0
No No No No No No No No
Materials Required
Instructor Materials:
- This lesson and any SME notes
- Updated composite risk worksheet
- Student Handouts
Student Materials:
- Uniform as designated by instructors
- Pen/Pencil
- Paper
- Required regulations
- Student handout
Classroom, Training Area, and Range Requirements
ID - Name
Quantity
Student Ratio
Setup Mins
Cleanup Mins
17120-T-1680-50 Classroom, Traditional, 1680 Square Feet, 50 Students
1:40
Ammunition Requirements
DODIC - Name
Exp
Student Ratio
Instruct Ratio
Spt Qty
None
Instructional Guidance
NOTE: Before presenting this lesson, instructors must thoroughly prepare by studying this lesson and identified reference material.
- Instructor must adhere to the guidelines established by this lesson, the Master Fitness Trainer Course (MFTC) Program of Instruction (POI); and unit/installation policies, Standard Operating Procedures (SOPs), and guidelines of the training unit.
Proponent Lesson Plan Approvals
Name
Rank
Position
Date
None
NO DATA
SECTION II. INTRODUCTION Method of Instruction: Instr Type(I:S Ratio/Qty): Time of Instruction: Instructional Strategy:
Motivator
NOTE: SHOW SLIDE 1: Performance Nutrition (Title Slide)
Conference/Discussion Contracted Instructor (1:10/0), Instructor (1:40/0) 5 mins Large Group Instruction
Slide 1
As MFTs you need to understand the importance of foods and fluids used to fuel the performance and recovery of a broad spectrum of Soldiers participating in PRT and other mission-specific physical activity. You need to know the basic components of foods, the caloric and nutritional loads of each and how to calculate the caloric and hydration needs of Soldiers in various environments and activities. You will also become familiar with safe supplement options and medical issues associated with nutrition.
NOTE: SHOW SLIDE 2: Terminal Learning Objective (TLO) and Brief Soldiers on the objectives of this lesson.
Slide 2
Terminal Learning Objective
NOTE. Inform the students of the following Terminal Learning Objective requirements.
At the completion of this lesson, you [the student] will:
Action: Conditions:
Understand performance nutrition and how it relates to Army Physical Readiness Training. In a large group classroom, given a AR 600-63, Army Health Promotion, FM 7-22, Army Physical Readiness Training, and Master Fitness Trainer Course (MFTC) Course Management Plan (CMP).
Standards:
Understand performance nutrition and how it relates to Army Physical Readiness IAW AR 600-63 and FM 7-22.
Safety Requirements
1. Safety is a major consideration when planning and evaluating PRT programs. Commanders should use the composite risk management process for all PRT activities to ensure they do not place their Soldiers at undue risk for injury or accident. The commander should address:
- Environmental conditions - Emergency procedures - Facilities - Differences in age - Gender - Level of conditioning of each Soldier in the unit
2. Safety Requirements in a Classroom Setting:
Safety is of the utmost importance in any training environment. During the training process, Commanders will utilize the 5-Step Composite Risk Management process to determine the safest and most complete method to train. Every precaution will be taken during the conduct of training.
Safety is everyones responsibility to recognize, mitigate, and report hazardous conditions.
3. In a training environment, lead Instructors must perform a risk assessment in accordance with FM 5-19, Composite Risk Management. Leaders will complete a DA Form 7566 COMPOSITE RISK MANAGEMENT WORKSHEET during the planning and completion of each task and sub-task by assessing mission, enemy, terrain and weather, troops and support available-time available and civil considerations, (METT-TC).
NOTE: During MOPP training, leaders must ensure personnel are monitored for potential environmental injury. Local policies and procedures must be followed during times of increased heat category or freeze warning in order to avoid injury. Consider the MOPP work/rest cycles and water replacement guidelines IAW FM 3-11.4, NBC Protection, FM 311.5, CBRN Decontamination.
Risk Assessment Level
Low Conduct Classroom Instruction
Assessment: - Tripping over extension cords, electrocution, mishandle equipment. - Dehydration - Stress - Overheating - Fire Controls: - Tape or cover cords on the floor, educate on operation of equipment, develop emergency evacuation procedures. - Drink water or comparable beverage during breaks - Relaxation and preparedness for class
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- Proper hydration, climate control - Emergency evacuation plan Contact to emergency services Use of sprinkler-fire ext Leader Actions: - MFTIs will brief classroom safety at the beginning of every class. - MFTIs will encourage all MFTs to drink water. - MFTIs will brief the location of a water fountains and the latrine. - MFTIs will assign student reading the day prior. - MFTIs will brief the MFT break area. - MFTs will be in the prescribed uniform. - MFTs will drink water when needed. - MFTIs will brief the fire evacuation plan in the beginning of every class. - MFTIs will control MFTs in the event of a fire drill. - MFTs and cadre will form up at the designated formation area. - MFTIs will ensure the wet bulb is operational and checked every hour to keep up with the correct heat category for the event. - All hot weather injuries will be followed up with an LCIR to the Chain of Command. - MFTIs will ensure adequate time will be given to eat all meals and drink fluids. - MFTIs will adhere to work/rest cycles of continuous high heat categories for each training event.
Environmental Considerations
NOTE: Instructor should conduct a Risk Assessment to include Environmental Considerations IAW FM 3-34.5, Environmental Considerations {MCRP 4-11B}, and ensure students are briefed on hazards and control measures.
Individuals instructing this task must ensure they are familiar with FM 7-22, Appendix D, pages D-1 thru D-5,
Environmental Considerations prior to training this task.
Evaluation
NOTE: Describe how the student will demonstrate accomplishment of the TLO throughout the course, during Practical Exercises (PEs), and on any performance assessment. Refer student to the Student Evaluation Plan.
Instructional Lead-in
The purpose of this period of instruction is to familiarize you with the concept of performance nutrition and its relevance and practical application for Soldiers. This class will complement an analysis of your own personal eating habits which will be conducted in the dietary recall practical exercise following this class.
SECTION III. PRESENTATION NOTE: A. Inform the students of the Enabling Learning Objective requirements. ENABLING LEARNING OBJECTIVE ACTION: CONDITIONS: 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). STANDARDS: Identify Army regulatory guidance related to nutrition IAW AR 600-63. Learning Step / Activity ELO A - LSA 1. Army regulatory guidance related to nutrition Conference/Discussion Contracted Instructor(1:10/0)* / Instructor(1:40/0)* 0 hrs 20 mins Large Group Instruction PowerPoint Presentation This course/lesson will present information that has a Security Classification of: U - Unclassified. Note: Marked as (*) is derived from the parent learning object
ELO A - LSA 1.
Method of Instruction: Instr Type(I:S Ratio/Qty): Time of Instruction: Instructional Strategy: Media Type: Security Classification:
NOTE: SHOW SLIDE 3: Enabling Learning Objective (ELO) A: (Inform the students of the Enabling Learning Objective requirements)
Slide 3
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NOTE: SHOW SLIDE 4: AR 600-63
Slide 4
a. Use the supplied printed reference and the next two slides for this slide to review Ch 5 Para 6. The Community Health Promotion Council mentioned here may have changed to some other newer version (IET Healthcare Committee, or Army Wellness Center) depending on the location. Have students make notes in their copies on page 24.
b. The main point to remember is that the Registered Dietician (RD) is the first person that MFTs go to for all nutrition-related issues that you have with Soldiers.
QUESTION: Who is the RD on your installation? ANSWER: _________________________________
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NOTE: Students will need to know this for the final weeks PE developing the MFT toolkit.
NOTE: SHOW SLIDE 5: AR 600-63 (cont)
c. Have the students read selected paragraphs in the next two slides
Slide 5
NOTE: SHOW SLIDE 6: AR 600-63 (cont)
d. Have the students read selected paragraphs in the next two slides
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Slide 6
NOTE: SHOW SLIDE 7: QUOTE
e. Have the students read selected quote:
Slide 7
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f. 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
g. As Gordo Byrn said, what we look like right now is based on the decisions we made in the past. So what do we look like right now from a nutritional point of view? The following slides will illustrate this. h. Gordo Byrn: (1) Previously very fat stockbroker, began mountain climbing in his late 20s, transitioned to triathlon and used the wealth he accumulated from his previous career to fund his search for athletic excellence. (2) Won Ultraman Hawaii in 2002 and continued to perform as a professional at Ironman races around the world. (3) Has written Going Long now in 2nd edition, which has become the must-read for anyone contemplating endurance sport achievement. (4) His coaching and blogging websites are endurancecorner.com and coachgordo.posterous.com.
NOTE: SHOW SLIDE 8: OBESITY TRENDS
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Slide 8
i. So how do we look? Obesity trends are perhaps the most obvious way to illustrate the nutritional challenge we face in the US. In 1985, blue and white states are good either Body Mass Index (BMI) was low no obesity, or there were no data.
j. Behavioral Risk Factor Surveillance System (BRFSS)
NOTE: SHOW SLIDE 9: OBESITY TRENDS
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Slide 9
k. BMI over 25% is overweight, over 30% is obese. l. Body Mass Index (BMI): A measure of an adults weight in relation to his or her height, specifically the adults weight in kilograms divided by the square of his or her height in meters.
NOTE: BMI calculators can be found and used online for free.
NOTE: SHOW SLIDE 10: AGE ADJUSTED ESTIMATES OF THE PERCENTAGE OF ADULTS WHO ARE PHYSICALLY INACTIVE
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Slide 10
m. Some facts for you:

(1) Less than half (48%) of all adults met the 2008 Physical Activity Guidelines (see next slide).
(2) Less than 3 in 10 high school students get at least 60 minutes of physical activity every day.
(3) Physical activity can improve health.
(4) People who are physically active tend to live longer and have lower risk for heart disease, stroke, type 2 diabetes, depression, and some cancers.
(5) Physical activity can also help with weight control, and may improve academic achievement in students.
(6) Inactive adults have a higher risk for early death, heart disease, stroke, type 2 diabetes, depression, and some cancers.
(7) Rates of activity and inactivity vary across states and regions
(8) Americans living in the South are more likely to be less physically active than Americans living in the West, Northeast and Midwest regions of the country.
NOTE: SHOW SLIDE 11: 2008 PHYSICAL ACTIVITY GUIDELINES
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Slide 11
n. This is background information supporting the previous slide about physical activity these were the standards in 2008 that were not met by 52% of adults in the U.S.
NOTE: SHOW SLIDE 12: 2008 DoD SURVEY OF HEALTH RELATED BEHAVIORS AMONG MILITARY PERSONNEL
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Slide 12
o. So lets focus a little more narrowly on the Military services to see how we were doing at the same time.
(1) In 2008, 61% of the Army was overweight, including 12.4% who were obese.
(2) Coastguard was the most overweight Service.
(3) The leanest was the Marine Corps, but even the majority of them were overweight (BMI of greater than 25%).
NOTE: SHOW SLIDE 13: THE ARMY NUTRITION PROBLEM
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Slide 13
p. Main Factor: (1) Army beneficiaries live in food environments where the easy choice is not necessarily the healthy choice.
(2) Many lack the skills, knowledge, motivation and resources to consistently make nutritional choices that support stamina
q. Main Facts:
(1) Active Duty diagnosis of overweight/obesity has jumped 47% since 2006.
(2) Obesity/overweight diagnoses are associated with a shorter length of service.
(3) Nearly two thirds of adult family members and retirees are identified as overweight or obese.
(4) 86% of retirees are classified as overweight or obese.
(5) 18.9% of DoD dependent adolescents are obese.
(6) 82% of DoD children eat fast food (15% eat fast food >3 or more times weekly).
(7) $1.1 billion estimated annual cost to TRICARE
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NOTE: SHOW SLIDE 14: THE ARMY RECOVERY PROBLEM
Slide 14
r. Main Factor: Recovery or sleep is affected by these factors and has these consequences.
(1) Recovery = Sleep
(a) Lack of individual knowledge, understanding, skills and awareness.
(b) Military culture : Suck it Up and Drive On.
(c) Lack of Leadership emphasis.
(d) Poor sleep health is a national and Army-specific public health issue.
(e) Inadequate quantity and quality.
s. Main Facts:
(1) Soldiers report an average of 5.6 hours of sleep/day (7-9 hours required for Sleep Health).
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(2) About 1/3 of Soldiers report not getting sufficient sleep in a deployed environment.
(3) Soldiers/Leaders underestimate their own impairment due to poor sleep.
(4) Contribution of poor sleep to co-morbid conditions (mental and physical health).
(5) Excessive drowsiness and fatigue due to chronic poor sleep:
(a) Impaired decision making
(b) Exacerbates/exacerbated by emotional and physical problems
(c) Poor health, BMI, diabetes (Performance Triad)
(d) Unethical behavior or misconduct
(e) Accidents
NOTE: SHOW SLIDE 15: THE SOLUTIONS
Slide 15
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t. MEDCOMs proposals for changing course on Recovery (sleep) and Nutrition. Read the bullets as they stand alone.
u. Change the nutrition mindset:
(1) Improved nutrition surveillance system and reporting to better inform decision making.
(2) Improved military food environments support healthy behaviors.
(3) Improved clinical care for prevention and treatment.
(4) Increased use of evidence- based nutrition programs.
(5) Improved standardization of nutrition education.
(6) Unified nutritional messaging.
v. Change the recovery mindset:
(1) Leaders model and promote Sleep it is as critical as hydration.
(2) All understand the impact of poor sleep.
(3) All have greater knowledge and skills for healthy sleep.
(4) Broadly disseminate current guidance and policies on sleep.
(5) IT enablers for sleep monitoring, planning and self-coaching.
(6) Screening and treatment.
NOTE: SHOW SLIDE 16: WHY DOES NUTRITION MATTER?
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Slide 16
w. In the next few slides we will discuss the so what of nutrition
(1) Why does what you eat matter and how does it affect how you perform?
(2) What are the short-term and long-term effects?
(3) What are you performance goals?
(4) What are the basic elements that make up all foods and how does the body use them to fuel your exercise?
(5) Why does the average American diet have a negative effect on performance?
(6) What can you eat?
(7) The body is ~70% water are you getting enough?
(8) Why is it so confusing? The research changes does it, or does it matter how it is reported? Believe half of what you hear. Always look at the big picture.
(9) What do we mean when we say real food (whole vs. processed food).
(10) Striving for balance the 90/10 rule do you want an A grade nutrition plan or not?
(11) What is the role of shopping and cooking in nutrition? What happens if everyone in your family all
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eat the same portions?
x. Why does nutrition matter?
(1) You are what you eat
(a) Your body metabolizes food to provide the building blocks that allow our bodies to function and repair itself every minute of every day.
(2) In the short-term, poor diet decreases your energy levels, increases your risk for injury and decreases your bodys ability to heal itself.
(3) 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.
(4) In the long-term, poor diet increases your risk of obesity, diabetes, heart disease, cancer, and much more.
(5) If you want to perform like a race car you need to fuel yourself with high octane food - real food that is nutrient dense.
NOTE: SHOW SLIDE 17: NUTRITION TODAY
Slide 17
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y. Over the past 50 years we have emphasized a low-fat diet as a healthy diet.
z. Disadvantage of low fat diet:
(1) Increased carbohydrate (sugar and bread) intake
(2) which increases blood sugar
(3) and increases insulin (the fat storage hormone)
(4) which leads to an increase in obesity and diabetes
aa. 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.
bb. The Army and performance nutritionists are placing a new emphasis on fresh, nutrient-dense foods with a balance between proteins, fats and carbohydrates.
cc. The best carbohydrates are fruits and vegetables.
NOTE: SHOW SLIDE 18: NUTRITION TRENDS
Slide 18
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dd. Always look at the big picture and strive for a balance, not a specific miracle or bad food.
ee. Always ask yourself, are you eating primarily real, fresh food that is being cooked by you from its natural state? Versus processed food.
ff. Eat real food and remember that although sugar is a natural food, we need to eat a lot less.
gg. Fresh foods include meats, nuts, fruits and vegetables.
hh. This requires a larger role for grocery shopping and cooking in performance nutrition:
(1) Dont bring the junk food home
(2) Learn to buy and cook real foods
ii. Conclude with:
(1) A discussion about the ways that we can shop and cook in ways that improve our diet.
(2) Ideas might including shopping around the outside of the store, concentrating on the produce, fresh meats and fish sections.
(3) Use online meal idea sites.
(4) Prepare the day ahead for the next days food instead of planning on the fly or the same day which leads to unhealthy snacking, fast food, and more expensive dining out.
(5) Think about blending products for quick breakfasts, and using a slow cooker to have meals ready when you arrive home.
(6) Write down a weekly meal plan that has simple-to-prepare foods that you enjoy.
(7) Divide responsibility for purchase, prep, and clean-up of meals.
(8) What other ideas do you have or use?
Check on Learning:
Determine if the students have learned the material presented by soliciting student questions and explanations. Ask the students questions and correct misunderstandings.
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Review Summary:
Conduct a review and solicit feedback from students on the administrative/support function offered in this Learning Step Activity.
CHECK ON LEARNING (ELO A):
QUESTION: What Army Regulation would a Master Fitness Trainer reference when seeking guidance on nutrition? ANSWER: AR 600-63, Army Health Promotion
QUESTION: Who must a unit MFT coordinate with in order to receive nutrition education for his unit? ANSWER:
REVIEW SUMMARY(ELO A):
The Community Health Promtion Counsil
Conduct a review and solicit feedback from students on the administrative/support function offered in this Enabling Learning Objective (ELO).
B.
ENABLING LEARNING OBJECTIVE 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). STANDARDS: Describe key elements of a healthy diet IAW AR 600-63. Learning Step / Activity ELO B - LSA 1. Key elements of a healthy diet Conference/Discussion Contracted Instructor(1:10/0)* / Instructor(1:40/0)* 0 hrs 30 mins Large Group Instruction PowerPoint Presentation This course/lesson will present information that has a Security Classification of: U - Unclassified. Note: Marked as (*) is derived from the parent learning object
ELO B - LSA 1.
NOTE: SHOW SLIDE 19: Enabling Learning Objective (ELO) B: (Inform the students of the Enabling Learning Objective requirements)
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Slide 19
NOTE: SHOW SLIDE 20: THE ROLE OF PROTEINS AND AMINO ACIDS
Slide 20
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a.
The next few slides cover the components of food and their roles proteins, carbohydrates, fats, fiber,
vitamins and minerals.
b. Proteins in food are broken down into amino acids.
c. Role of amino acids:
(1) Build and repairs all tissues in the body, including muscle.
(2) Regulate water balance and prevent edema (swelling) by holding fluid in bloodstream.
(3) Build hormones and enzymes essential for all body functions.
(4) Form major components of antibodies to fight disease.
(5) Provide a back-up energy source:
(a) Each gram of protein contains 4 calories of energy
NOTE: SHOW SLIDE 21: PROTEINS AND AMINO ACIDS
Slide 21
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d. The number of essential amino acids is still debated in scientific circles and the number cited varies from reference to reference as a result, but generally 10 essential amino acids and 10 non-essential is an acceptable standard number. Source: Univ of Arizona Biology Project as cited on webpage hyperphysics.phy.astr.gsu.edu e. There are 20 amino acids 10 essential and 10 non-essential f. 10 Essential amino acids: (1) Our body cannot make them and we can only get them from food (2) Meat, dairy and eggs = complete proteins - contain all 10 essential amino acids (3) 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) (4) Essential amino acids CANNOT BE stored in the body, so must be consumed daily (5) 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
NOTE: SHOW SLIDE 22: CARBOHYDRATES AND SUGAR
Slide 22
g. Carbohydrates (CHO) are classified as simple or complex.
h. Simple (fake or processed foods):
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(1) sugary, processed foods that should form only a small portion of daily calories.
(2) contained in processed foods and often contain added synthetic forms of naturally-occurring nutrients such as added vitamins.
(3) examples breads, cereals, cakes, cookies, sugar-filled drinks
i. Complex (real or whole):
(1) fruits, vegetables, and whole (unprocessed) grains closest to their natural state
(2) contain natural forms of vitamins, minerals, digestive enzymes and fiber.
(3) examples whole and unprocessed vegetables, and grains such as quinoa, bulgar, Ezekial bread; root vegetables such as sweet and white potatoes.
j. CHO is an important fuel for physical activity quick starts, short bursts, and long-term endurance.
(1) Stored as glycogen in liver and muscle in limited amounts of 1500-3000kcal.
(2) Each gram of CHO provides 4 calories of energy.
NOTE: SHOW SLIDE 23: CARBOHYDRATES AND SUGAR (CONT)
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Slide 23
k. Excess carbohydrates are stored in the body as fat.
l. Eating foods that contain sugar and processed carbohydrates leads to increased blood sugar and increased insulin production = sugar high and sugar low.
m. Balancing blood sugar - eating protein, fat and fiber with carbohydrates - helps balance the blood sugar, and decrease hunger and sugar cravings.
n. Most Americans overeat carbohydrates, especially simple processed carbohydrates (cake, candy, breads, soda, sweet tea, energy drinks, etc).
NOTE: SHOW SLIDE 24: FAT BASICS
Slide 24
o. Are fats good or bad? It depends on the quality!
p. There are 3 primary types of fats:
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(1) Saturated.
(2) Unsaturated (polyunsaturated and monounsaturated).
(3) Hydrogenated (trans) fats.
(a) Found in margarine, shortening (Crisco) and other man-made fats.
(b) These are the least healthy and should be avoided.
q. Fats and essential fatty acids are necessary for good health and survival.
r. Eating healthy fats does not cause obesity.
NOTE: SHOW SLIDE 25: ROLE OF FATS AND ESSENTIAL FATTY ACIDS
Slide 25
s. Fatprovides large potential source of energy (fuel) for low intensity, endurance activities if oxygen is readily available to convert the fat into energy.
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(1) There are about 120,000kcal of fat in our bodies.
(2) Each gram of fat has 9 calories.
t. Fats play other important roles in the body:
(1) nervous system: the brain is 50% fat.
(2) transporting nutrients and absorbs vitamins (A, D).
(3) maintains skin health.
(4) insulates and protects organs.
(5) primary building blocks of hormones, especially reproductive hormones.
(6) Provides structure to cells.
NOTE: SHOW SLIDE 26: FAT BASICS (CONT)
Slide 26
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u. Saturated fat:
(1) Solid at room temperature, derived from animal sources, except palm oil, coconut oil and cocoa butter.
(2) Provide fat soluble vitamins such as A and D.
v. Unsaturated fat:
(1) Usually liquid at room temperature.
(2) Polyunsaturated (two or more double bonds of hydrogen) and Monounsaturated (single bond of hydrogen).
(a) Found in vegetables, fish and poultry.
w. Hydrogenated fats or transfats:
(1) Processed fat with the hydrogen added in manufacturing to solidify foods such as margarines.
(2) Triggers liver into producing extra cholesterol.
(3) Cholesterol is a steroid, a special kind of waxy fat found in all cells and is necessary for survival.
(a) High levels can be unhealthy causing plaque to build up in arteries that lead to cardiovascular disease.
NOTE: SHOW SLIDE 27: FAT BASICS (CONT)
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Slide 27
x. Healthyfats provide essential fatty acids (ones that we cannot produce and must be obtained from our food) Omega 6 and Omega 3.
y. 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.
z. 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.
aa. Three types of omega-3 fatty acids:
(1) docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are found in fish oil.
(2) alpha-linolenic acid (ALA) is found in plant foods such as nuts, seeds, and vegetable oils (especially flaxseed oil).
NOTE:
Omega-6 is high in Arachidonic acid an inflammatory agent causes inflammation. Western diet
ration of omega-6 to omega-3 may be as high as 15:1. (Farooqui A, Horrocks L, Farooqui T. (2007). Modulation of inflammation in brain: A matter of fat. J Neurochem. May 25, 2007;101(3):577599.)
Walnuts and flex seed it should be noted only have about one half of one percent of the long-chain omega-3 fatty acids that are the best for us. So, the cold water wild fish are the best source of high-quality omega-3.
The American Heart Association recommends eating two servings of fish per week, , which is equivalent to
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250 to 500 mg of EPA and DHA per day. Eating two servings of fish per week is also the recommendation in the US dietary Guidelines although they do not specify an "amount."
The AHA are the best to date: "The American Heart Association recommends that people without documented coronary heart disease (CHD) eat a variety of fish, preferably oily fish (salmon, tuna, mackerel, herring and trout), at least twice a week.
People with documented CHD are advised to consume about one gram of EPA and DHA (eicosapentaenoic and docosahexaenoic acids, EPA and DHA) per day, preferably from oily fish, although EPA+DHA supplements could be considered in consultation with a physician. People who have elevated triglycerides may need two to four grams of EPA and DHA per day provided as capsules under a physicians care.
The general scientific community believes that the intake should be no less than 500 mg. (Patricia Deuster, PhD, MPH, FACSM, Professor and Scientific Director, Consortium for Health and Military Performance Department of Military and Emergency Medicine, C1050 Uniformed Services University).
An omega-3 fatty acid dose of 4 grams per day (800mg of DHA) has been shown to increased vigor, reduce anger and anxiety, and reduce reaction time in sustained attention tests.8 It is prudent to suggest that this amount be set as a goal currently for neuroprotection since it has demonstrated positive potential to improve brain performance and health. As further research is conducted with omega-3s and TBIs that amount might change. The goal of 4 grams of omega-3s per day might be challenging for many athletes since it equates to about 12 ounces of halibut or 9.6 ounces of anchovies.9 Therefore, a dietary supplement might be needed to reach the 4g/d goal either as a standalone strategy or in combination with a high Omega-3 fatty acid diet. No serious side-effects were reported with omega-3 supplementation use in multiple studies10 and omega-3 supplement intake has been shown to increase omega-3 fatty acid intake without increasing mercury intake.11 Warriors need to ensure they make purchases through a reputable source and that the product contains at least 800mg of DHA in a 4 gram serving. (Nick Barringer MS, RD, CSSD, CSCS; William Conkright MS, RD, CSCS, Omega-3 Fatty Acid Ingestion as a TBI Prophylactic, Journal of Special Operations Medicine Volume 12, Edition 3/Fall 2012.)
NOTE: SHOW SLIDE 28: FIBER
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Slide 28
bb. Soluble:
(1) Dissolves in water.
(2) May help reduce cholesterol levels.
(3) Found in apples, barley, bananas, carrots, broccoli, peas, sweet potatoes, potatoes, zucchini, and seeds.
cc. Insoluble:
(1) Absorbs moisture.
(2) Aids in elimination of waste by speeding movement of food through the digestive system.
(3) Side effect of too much is nausea and diarrhea.
(4) Found in apples, bananas, cabbage, brown rice, cereals, whole grains, strawberries, and green beans.
NOTE: SHOW SLIDE 29: VITAMINS AND MINERALS
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Slide 29
dd. Vitamins and minerals are organic compounds ingested in food that are essential for normal function and metabolism
(1) Regulate energy production
(2) Regulate growth
(3) Maintain and repair tissue
ee. Water-soluble vitamins like vitamin C and B are washed out of the body through sweat and urination.
ff. Fat-soluble vitamins include A, D, and E. They can be stored in the body and therefore can become toxic in large amounts.
gg. Minerals:
(1) Major minerals:
(a) Potassium
(b) Calcium
(c) Phosphorus
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(d) Sodium
(e) Sulphur
(f) Magnesium
(2) Minor minerals:
(a) Chromium
(b) Cobalt
(c) Copper
(d) Flouride
(e) Iodine
(f) Manganese
(g) Molybdenum
(h) Selenium
(i) Zinc
Check on Learning:
Review Summary:
CHECK ON LEARNING (ELO B):
NOTE: SHOW SLIDE 30: CHECK ON LEARNING
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Slide 30
QUESTION: What are the main components of food?
ANSWER:
Proteins, Carbohydrates, Fats, Vitamins and Minerals
QUESTION: How many calories per gram in each component?
ANSWER:
Proteins = 4, Carbohydrates = 4, Fats = 9, Vitamins = , Minerals =
QUESTION: Give examples of healthy fats
ANSWER:
Omega-6 (plant oils such as corn, canola, soy, safflower) and Omega-3 (fatty
fish such as salmon, dark tuna, sardines, and in walnuts, flax seeds)
QUESTION: Name the water-soluble and fat-soluble vitamins.
ANSWER:
Water-soluble = C and B; Fat-soluble = A, D, and E
QUESTION: What does BMI stand for?
ANSWER:
Body Mass Index
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QUESTION: What percentage BMI constitutes overweight, and obese?
ANSWER:
over 25% = overweight; over 30% = obese
QUESTION: Who are the Armys experts on nutrition issues?
ANSWER:
Registered dieticians
QUESTION: Where do they work?
ANSWER:
Everywhere
REVIEW SUMMARY(ELO B):
C.
ENABLING LEARNING OBJECTIVE ACTION: CONDITIONS: 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). STANDARDS: Describe how diet impacts exercise and performance IAW FM 7-22.
ELO C - LSA 1. Learning Step / Activity ELO C - LSA 1. How diet impacts exercise and performance Method of Instruction: Instr Type(I:S Ratio/Qty): Time of Instruction: Instructional Strategy: Media Type: Security Classification: Conference/Discussion Contracted Instructor(1:10/0)* / Instructor(1:40/0)* 0 hrs 20 mins Large Group Instruction PowerPoint Presentation This course/lesson will present information that has a Security Classification of: U - Unclassified. Note: Marked as (*) is derived from the parent learning object
NOTE: SHOW SLIDE 31: Enabling Learning Objective (ELO) C: (Inform the students of the Enabling Learning Objective requirements)
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Slide 31
NOTE: SHOW SLIDE 32: HOW MANY CALORIES DO YOU NEED?
Slide 32
43
a. This slide gives a simple formula to calculate approximate caloric demands of various activity levels. Using the gender-specific activity factor in the right hand columns for males and females, you can multiply those by the persons weight to get their daily caloric requirement.
b. Light Activity Level: (I usually relate this to CQ duty) walking on a level surface at 2.5 to 3.0 miles per hour, house cleaning etc.
c. Moderate Activity Level: Doing Toughening Phase PRT 3x/week, walking 3.5 to 4.0 miles per hour, cycling, skiing, tennis, dancing.
d. Heavy Activity Level: Sustaining Phase PRT x 5 per week, start of a field problem, Air Assault training, walking uphill with a load, heavy manual digging, soccer, basketball (full court).
ACTIVITY: Give the students an example to calculate and then have the students complete their own assessment using the table shown on slide 32. Go around the group to make sure that everyone has it, and to illustrate how smaller students will have much lower demands than larger ones. What happens when you increase the activity level?
NOTE: SHOW SLIDE 33: EAT OFTEN TO MAINTAIN ENERGY
Slide 33
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e. This graphic illustrates the sugar high and low phenomenon energy consistency. Ideally we would stay in the range of our optimal energy levels, but that is difficult to do when we overload calories with fewer meals per day. As this graphic says eat every 3-5 hours while awake spread out your caloric intake throughout the day.
NOTE: SHOW SLIDE 34: PROTEIN AND CARB REQUIREMENTS
Slide 34
f. MRDA Minimal Recommended Daily Allowance.
g. Oreos and milk which is the carb and which is the protein? Is that an optimal snack? NO!! it turns you into a small, wooden doll with a cubed head.
NOTE: SHOW SLIDE 35: BULKING UP
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Slide 35
h. One Pound = 3,500 calories.
i. To gain 1 pound per week increase calorie intake by 500-1000 calories per day.
j. Consume 3 meals per day with 2-3 snacks.
k. If you dont feel hungry, think of food as a weight gain medicine that you have to take.
ACTIVITY: Weight Gain: Ask the students for their ideas of healthy snack ideas, or ask them what do you think of when I say healthy snacks? They will probably list a bunch of low kcal snacks. Talk about healthy snacks for weight gain being high in calories. If someone wants to bulk up, they cant do it if they are filling up on bulky low kcal snacks. Also talk about drink options, calorie containing beverages are better for the hard gainers (super skinny folks who have a hard time gaining weight). Remind them of the role of
carbohydrates and protein. If you dont have adequate carb intake more of your protein will be used for energy preventing them from achieving optimal performance. Make sure those wanting to bulk up intake at least 2.5g of carbs per # body weight.
NOTE: SHOW SLIDE 36: 170 POUND PERSON EXERCISING FOR 30 MINUTES
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Slide 36
NOTE: Relate the activities with the calories burned and what those calories may be compared to.
Check on Learning:
Review Summary:
CHECK ON LEARNING (ELO C):

QUESTION:
How many calories do a 184 lb SSG in the 5-21st Infantry need to meet his
daily caloric requirement? (See slide 32 and slide notes)
ANSWER:
4232
QUESTION:
It is advised a Soldier should spread out his/her caloric intake and eat every
________ while awake.
47
ANSWER:
3-5 hours
QUESTION:
In order to gain __________ per week, a Soldier would need to increase their
caloric intake by 500-1000 calories per day.
ANSWER:
1 pound
REVIEW SUMMARY(ELO C):
D.
ENABLING LEARNING OBJECTIVE ACTION: CONDITIONS: 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). STANDARDS: Describe the adverse affects of dehydration on physical performance in both deployed and non-deployed settings IAW FM 7-22. ELO D - LSA 1. Learning Step / Activity ELO D - LSA 1. The adverse affects of dehydration on physical performance in both deployed and non-deployed settings Method of Instruction: Instr Type(I:S Ratio/Qty): Time of Instruction: Instructional Strategy: Media Type: Security Classification: Conference/Discussion Contracted Instructor(1:10/0)* / Instructor(1:40/0)* 0 hrs 25 mins Large Group Instruction PowerPoint Presentation This course/lesson will present information that has a Security Classification of: U - Unclassified. Note: Marked as (*) is derived from the parent learning object
NOTE: SHOW SLIDE 37: Enabling Learning Objective (ELO) D: (Inform the students of the Enabling Learning Objective requirements)
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Slide 37
NOTE: SHOW SLIDE 38: HYDRATION BASICS - WATER
Slide 38
49
QUESTION: What is homeostasis? ANSWER: the physiological process and state of equilibrium in the body in respect
to various functions and to the chemical compositions of fluids and tissues.
a. Although it provides no calories, water is the most important nutrient for the body. Every thing that happens in the body happens in the medium of water. An important rule for every soldier to remember is to drink water before, during, and after exercise constantly. The body has huge amounts of energy storage but water exists in finite amounts. Even slight dehydration can have massive effects on the way soldiers perform their mission. Developing the habit of drinking water, the best sports drink, is very important. The use of sports drinks is not an adequate replacement in all cases. Mild dehydration (2% of BW) affects performance, mood, and desire to eat. More severe increases risk of heat injury or illness. b. RDA = 8 x 8 oz glasses per day; not enough for active soldiers. c. Thirst is not a good indicator. Frequent trips to bathroom (every 2 hours) with lighter (pale yellow) urine means drinking enough. Dark, smelly concentrated urine means body is not getting enough water. d. Plain cool (40 degrees F) best because empties from stomach and absorbs quickly. Any beverage contributes to daily total except caffeinated and alcohol. Some beverages contain empty calories (soda, Kool Aid). e. Two thirds of the human body is comprised of water. (1) It is the most basic nutrient of all, and is essential for all living matter. (2) Maintains homeostasis or thermoregulation. (3) Relieves fatigue. (4) Improves mental alertness. (5) Transports nutrients and wastes to and from cells. f. Even mild dehydration results in decreased performance and severe dehydration can increase risk of heat injury and can lead to death. g. Over hydration (hyponatremia) is more rare, but also deadly. (1) slow marathon runner who drinks a lot and lowers sodium levels leading to
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weight gain, swollen fingers, loss of mental alertness, progressing to seizures and death.
NOTE: SHOW SLIDE 39: TAKE TIME TO DRINK
Slide 39
h. Fluid guidelines: (1) Optimize hydration status while allowing enough time for any excess fluid to be excreted as urine before start of exercise. (a) Drink generous amounts of fluid 24 hours before an exercise session. (b) Drink 14-20 oz of fluid 2-3 hours before exercise. (c) During exercise - 6 oz every 15-20 minutes. (d) After exercise 16 oz cups for every pound lost.
NOTE: ACSM/NATA recommendations

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NOTE: SHOW SLIDE 40: IMPACT OF DEHYDRATION
Slide 40
i. 3-5% decrease: primary cause of heat exhaustion (Armstrong et al, Urine Indices of hydration status; IJSN, 1994). j. Thirst drive is not stimulated until 1-2% water loss---therefore, athletes probably train in a state of hypo-hydration most times.
NOTE: SHOW SLIDE 41: SWEAT RATE
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Slide 41
k. Calculating sweat rate to optimize hydration. (1) Weight before minus weight after exercise (lbs) = A. (2) Multiply A x 16 to get the amount in ounces. (3) Add A to number of ounces consumed during exercise = B. (4) B divided by minutes exercised = sweat rate in ounces/minute.
NOTE: SHOW SLIDE 42: PRACTICAL TIP
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Slide 42
TIP 1: Have your Soldier weigh before and after workouts. TIP 2: If they weigh less have them practice drinking more. TIP 3: If they weigh more have them drink less.
NOTE: SHOW SLIDE 43: FLUID NEEDS IN HEAT, COLD CLIMATES, AND AT ALTITUDE
54
Slide 43
l. For someone relaxing in a hot, humid environment, the normal 2-L daily fluid requirement doubles or even triples from evaporative fluid loss. Relative humidity exerts the greatest impact on the effectiveness of evaporative heat loss. Relative humidity refers to the percentage of water in ambient air at a particular temperature compared with the total quantity of moisture that the air could carry.
m. The bodys thermoregulatory mechanisms primarily protect against overheating.
(1) Radiation:
(a) Objects emit electromagnetic heat waves.
(b) Body temperature is warmer than the environment.
(c) Radiant heat energy leaves the body through air to solid cooler objects around us.
(d) The body absorbs radiant heat energy when the temperature of objects in the environment exceeds skin temperature.
(2) Conduction:
(a) Transfers heat directly through a liquid, solid, or gas from one molecule to another.
(b) The circulation transports most of the body heat to the shell.
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(c) A small amount continually moves by conduction directly through the deep tissues to the cooler surface.
(d) Conductive heat loss then involves the warming of air molecules and cooler surfaces in contact with the skin.
(3) Convection:
(a) Air movement.
(b) Warm air next to the skin acts as a zone of insulation.
(c) If cool air continuously replaces the warmer air surrounding the body, heat loss increases.
(d) For example, air currents at 4 miles per hour cool twice as effectively as air moving at 1 mile per hour.
(4) Evaporation:
(a) Major physiologic defense against overheating.
(b) Water vaporization from the respiratory passages and skin surface continually transfers heat to the environment.
(c) In response to heat stress, 2-4 million sweat (eccrine) glands secrete large quantities of hypotonic saline solution.
(d) Cooling occurs when sweat evaporates from the skin surface. Along with heat loss through sweating, approximately 350 mL of water seeps through the skin (called insensible perspiration) each day and evaporates to the environment. Also, approximately 300 mL of water vaporizes daily from the respiratory passages moist mucous membranes.
NOTE: SHOW SLIDE 44: ACCLIMATED INDIVIDUALS NEED MORE FLUID
56
Slide 44
n. Average rectal temperature, heart rate, and sweat loss during 100 minutes of daily heat-exercise exposure for 9 consecutive days. o. After 10 days of heat exposure, sweating capacity nearly doubles, and sweat becomes dilute (less salt lost) and more evenly distributed on the skin surface. Optimal acclimatization necessitates adequate hydration. p. Acclimatized Individuals: (1) Sweat earlier. (2) Have less sodium in their sweat.
NOTE: SHOW SLIDE 45: COLD CLIMATE HYDRATION
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Slide 45
- Significant fluid loss from warming air you breath. - Voluntary Fluid Restriction due to difficulty removing layers of clothing to urinate. - Low rate of fluid ingestion if fluid is cold or cool. - Excessive clothing can increase sweat rate. q. Risk of dehydration is greater in hot environments. r. Dehydration is not uncommon in cold weather. s. Factors that increase the potential for dehydration during cold-weather exercise. Factors: (1) Respiratory fluid losses. (2) Sweat losses that may be high if insulated clothing is worn during intense exercise. (3) Low rates of fluid ingestion. (4) Voluntary limiting of fluid intake due to difficulty of removing multiple layers of clothing to urinate.
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NOTE: SHOW SLIDE 46: ALTITUDE HYDRATION
Slide 46
t. ALTITUDE: Exposure to altitudes higher than 2,500 m (8,200 ft) may result in fluid losses beyond those associated with any exercise that might be performed. These losses are the result of mandatory diuresis and high respiratory water losses, accompanied by decreased appetite, which lead to an increased need for fluid intake. w. Losses due to: (1) Increased Urine Production (for ~ 7 days). (a) May indicate successful acclimatization. (b) Might be minimized by adequate kcal intake and maintenance of body weight. (2) High respiratory water losses. (a) May be as high as 1,900mL per day in men and 850mL in women. (3) Decreased appetite.
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(a) Decreased food intake = Decreased Fluid Intake. (4) Vomiting/Diarreha. x. The diuresis is considered by some to be an indication of successful acclimatization (105), although others (106) have suggested that at least part of the diuresis can be minimized by adequate energy intake and maintenance of body weight. y. Under circumstances of weight maintenance, this diuresis is of a magnitude of about 500 mL per day and lasts for about 7 days (106). z. Respiratory water losses may be as high as 1,900 mL per day in men (107) and 850 mL in women (108). Thus, fluid intake at high altitude should be increased to as much as 3 to 4 L per day to assure optimal kidney function.
NOTE: SHOW SLIDE 47: KEY POINTS
Slide 47
aa. Heat acclimated individuals.
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(1) Start sweating earlier. (2) Produce greater quantities of sweat. (3) Have higher fluid needs. bb. Individuals exercising in the cold are still at risk for dehydration. cc. Individuals at altitude need to consume additional fluids to remain hydrated. (1) 1 Quart every 3 hours. (2) 3 5 Liters per day (6 L/d > 7000 m).
NOTE: SHOW SLIDE 48: WHY CAN'T YOU EAT ANYTHING WHEN EXERCISING INTENSELY?
Slide 48
dd. Osmolality: (1) The density of particles dissolved in a solution.

61
(2) Different from concentration of a drink which is the weight, by percent, of one product dissolved in another (carbs in water). (3) Digestion in the gut occurs when osmolality is around 300mOsm/kg. (4) If a solution is less than that, digestion slows to allow more electrolytes to be added by the body. (5) If its greater than that, the body adds water, again slowing digestion. ee. Hydration: (1) Dehydration of 4-6% will slow gastric emptying decreases hunger. (2) Decreased food intake = decreased electrolyte (sodium and potassium) and glucose intake - vital to functioning of brain, nerves, heart and muscles. ff. Calories: (1) Foods containing protein and lactose delay absorption. (2) High fibers foods, fruits, vegetables, cereals speed digestion. (3) Number of calories depends on the type of event. gg. Race Day: (1) SLOW DOWN to allow blood to absorb the nutrients in your gut. (2) Avoid high intensity efforts to prevent lactate accumulation.
NOTE: SHOW SLIDE 49: IMPROVING FLUID INTAKE
62
Slide 49
hh. Cooler drinks: (1) More palatable. (2) Can help maintain a lower core temperature. ii. Flavored: (1) Individual preferences should be considered if possible. (2) Flavored beverages are consumed at a higher rate than non-flavored. jj. Contain Sodium: (1) Sodium can help maintain the osmotic drive to drink. mm. To increase voluntary fluid intake Fluids should be coolnot cold. Sodium in the drink (.5-.7 g/L) will stimulate the thirst response. Thirst is triggered by a decrease in plasma volume and an increase in plasma sodium. Consumption of plain water may remove the osmotic drive to drink. Studies show that sports drinks are consumed at 2 times the rate of water. kk. Sodium does not enhance fluid absorption because the amount in the beverage is miniscule compared to the amount of Na in the bloodstream. Plasma Na freely diffuses into the gut following fluid intake.
63
ll. Plasma Na is 138-142, sweat is 25-75 mmol/L.
NOTE: SHOW SLIDE 50: AFTER EXERCISE
Slide 50
mm. How much to drink? (1) More than the amount of sweat lost. (a) 150% to 200%. (2) Amount depends on the sodium content of the beverage. nn. Effectiveness of a rehydration drink depends on: (1) Palatability. (2) Intake. (3) Sodium concentration.
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NOTE: You will NOT achieve euhydration by drinking the exact amount that you lost during exercise.
NOTE: SHOW SLIDE 51: PRACTICAL TIP
Slide 51
TIP 4: Drink 24oz -32oz for every pound lost during exercise.
NOTE: SHOW SLIDE 52: ADDITIONAL THOUGHTS
65
Slide 52
oo. Plain water can be an effective post exercise rehydration drink IF consumed with food (i.e. banana). pp. If trying to rehydrate in a short amount of time use of a rehydration beverage will be most effective. qq. Other non-sports beverages have been found to be acceptable for rehydration: (1) Milk/Chocolate Milk: Milk, as long as they can consume a large enough volume it is a good rehydration drink due to the electrolyte content and the delayed gastric emptying that can help reduce dieresis. (2) Orange Juice. (3) Coconut Water.
Check on Learning:
Review Summary:
66
CHECK ON LEARNING (ELO D):

QUESTION: Over hydration is also known as ______________.
ANSWER:
Hyponatremia
QUESTION: During exercise, water should be consumed at a rate of ______________________.
ANSWER:
6 ounces every 15-20 minutes
QUESTION: A Soldier weighs 184 lbs before exercising and weighs in at 182 lbs after the mornings scheduled PRT session. How much water should the Solder consume?
ANSWER: lost).
The Soldier should drink 32 ounces of water (based on 16 ounces for every lb
QUESTION: What are the bodys thermoregulatory mechanisms?
ANSWER:
Radiation, Convection, Conduction, Evaporation
QUESTION: What are the factors that increase to potential for dehydration during cold weather exercise?
ANSWER:
(1) Respiratory fluid loss
(2) Sweat losses that may be higher if insulated clothing is worn during intense exercise
(3) Low rates of fluid ingestion
(4) Voluntary limiting fluid intake due to difficulty of removing multiple layers of clothing to urinate.
REVIEW SUMMARY(ELO D):
Conduct a review and solicit feedback from students on the administrative/support function
67
offered in this Enabling Learning Objective (ELO).
E.
ENABLING LEARNING OBJECTIVE ACTION: CONDITIONS: 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). STANDARDS: Describe the safe use of dietary, herbal and performance supplements IAW instructor notes and AR 600-63. ELO E - LSA 1. Learning Step / Activity ELO E - LSA 1. The safe use of dietary, herbal and performance supplements Conference/Discussion Contracted Instructor(1:10/0)* / Instructor(1:40/0)* 0 hrs 25 mins Large Group Instruction PowerPoint Presentation This course/lesson will present information that has a Security Classification of: U - Unclassified. Note: Marked as (*) is derived from the parent learning object
NOTE: SHOW SLIDE 53: Enabling Learning Objective (ELO) E: (Inform the students of the Enabling Learning Objective requirements)
Slide 53
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NOTE: SHOW SLIDE 54: Carbohydrate Intake During Exercise
Slide 54
a. General Recommendations
(1) < 1 hour.
(a) No CHO needed if athlete has adequate carbohydrate stores.
(b) Some evidence that a CHO mouth rinse improves all out performance*.
(2) >1 hour.
(a) 30 60g/hr.
(b) 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.
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1 liter of Gatorade provides 60g CHO.
(3) >3 hours:
(a) Relatively high rates of intake, up to 90 g/hr, are needed to optimize performance.
(b) If consuming >60g/hr must use multiple transportable carbohydrates.
- Multiple transportable carbohydrates = glucose/maltodextrose & fructose combo.
(4) Note Train how you plan to perform increase tolerance for calories/food during exercise and also vary it based on intensity.
(a) 36 hour FTX in extreme heat slow equals eat anything.
(b) 4 hour marathon.
NOTE: SHOW SLIDE 55: Oxidation of Glucose and Fructose
Slide 55
70
b. When fed a very large amount of glucose (1.8 g/min) you get almost an identical oxidation rate as 1.2g/min. They both peak around 0.8g/min.
c. Mixture of glucose and fructose, because of the carbon labeling of glucose and fructose you can see the different oxidation rates, with 1.2g/min of glucose being oxidized at a rate of around 08.g/min and fructose being oxidized around 0.4g/min.
d. The glucose plus fructose went up to a peak of 1.26g/min (first time that the cho oxidation went above 1.0g/min) this indicated that the absorption is the limiting factor in cho oxidation.
(1) One drink with 1.2 g/minute (enough to saturate glucose transporter).
(2) Second drink with 1.8g/minute (if saturation is a prob you would not see a dif between drinks).
(3) Third drink with 1.2g/min glucose and 0.6g/min fructose (used carbon labels to look at oxidation).
(4) Fourth drink with 1.8 g/min with added sodium.
NOTE: SHOW SLIDE 56: Performance with Glucose and Fructose vs. Glucose Alone
Slide 56
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e. 2hr of cycling at 60% VO2 max followed by a 40K time trial.
f. First time that a study showed performance was improved by multiple cho (1.5g/min).
g. Subjects then cycled for 2 h at an intensity of 55% Wmax, with the cycle ergometer set in cadenceindependent mode. Immediately on completion of the steady-state period, the cycle ergometer was set to linear mode (workload increases as the pedaling rate increases). Subjects were asked to perform a certain amount of work (equal to about 60 min of cycling at 75% Wmax) as fast as possible. The total amount of work was based on the maximal workload (Wmax) (19), and the total amount of work to be performed was calculated according to the formula:
(1) Total amount of work = Total amount of work = 0.75 Wmax x 3600 kJ
NOTE: SHOW SLIDE 57: Practical Tip
Slide 57
TIP 5: Mix and match sports products to find the right combination. Regular foods can
also be good sources of multiple CHOs.
(1) Bread and honey sandwiches and bananas are examples of transportable carb foods.
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(2) Mix and match gels, bars, (sport foods) with water or a sports drink.
NOTE: SHOW SLIDE 58: Protein Co-ingestion During Exercise
Slide 58
h. 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.
(1) Koopman et al., Combined intake of protein and carbohydrate improves protein balance in ultraendurance exercise.
(2) Beelen et al., Combined intake of carbohydrate and protein hydrolysate stimulates muscle protein synthesis during exercise in young men.
i. Carb and carb plus:
(1) Mixed muscle synthesis was increase compared with pre-exercise levels, and with the addition of protein mixed muscle synthesis was stimulated.
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(2) This might allow the reconditioning process to occur during exercise.
NOTE: SHOW SLIDE 59: How Much Protein Do You Need?
Slide 59
j. MRDA = 0.4 g per lb of body weight.
Recommended intakeg/lb Sedentary adult 0.4
PRT 3-5 x per week
0.5 - 0.7
PRT + strength athlete
0.7 - 0.8
PRT + endurance athlete
0.8 - 0.9
PRT + triathlete
1.0
k. Muscle is 80% H2O, 20% P, 8% F.
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l. P metabolism changes during intense endurance and weight lifting activities. Have a net loss of skeletal protein, muscle breakdown (catabolism), and reduction in P synthesis.
m. The average 165-pound male can only metabolize 40 grams of protein every five hours, so anything above that is stored as fat or used for energy in the absence of carbohydrate calories.
NOTE: SHOW SLIDE 60: Protein Sources
Slide 60
n. Top choices:
(1) Lean beef (top round, round tip)
(2) Chicken and turkey
(3) Fish (3 oz cooked = 15-20 g)
(4) Egg (1 large = 6g)
(5) Peanut butter (natural is best. 2 tbsp = 9 g)
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(6) Beans (1/2 cup = 7 g)
(7) Tofu (4 oz = 10 g)
(8) Milk and yogurt (1 cup = 8 g)
o. Many protein sources are also high in fat. Listed above are some of the top protein food choices.
(1) Lean beef (3 oz) = 25 g P, 15 g F
(2) Chicken (3.5 oz) boneless, skinless = 30 g P, 8 g F
(3) Fish (3 oz) = 15-20 g P
p. Complete:
(1) Eggs
(2) Milk
(3) Dairy
(4) Meat
(5) Fish
q. Partial:
(1) Beans
(2) Tofu
(3) Nuts
r. Incomplete:
(1) Fruits
(2) Vegetables
(3) Rice
(4) Pasta
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NOTE: SHOW SLIDE 61: Negatives of Excess Protein
Slide 61
s. Negatives of Excess Protein:
(1) Can be high in saturated fat: High protein diets from animal sources are typically high in fat and saturated fat and cholesterol.
(2) Low fiber: High protein diets are also low in fiber due to low intake of fruits and vegetables. Diets low in fiber can cause constipation, diverticulosis, and other intestinal disorders.
(3) Increased calcium loss: High protein diets also flush calcium from the body, leading to excessive loss of Ca in the urine.
(4) Dehydration: High protein diets are also dehydrating. Within the first week of a high protein diet, you can lose a lot of weight, depending on your initial weight and body fat percentage. But, most of the weight loss is water, which can lead to dehydration.
(5) Excess can lead to kidney damage: Excess dietary protein can be rough on the kidneys. The kidneys
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process the nitrogen wastes (urea) generated by protein metabolism. A system overloaded with protein interferes with the kidneys ability to properly eliminated these wastes, increasing the risk for developing kidney disease.
(6) Excess is stored as fat: Any excess protein calories (above the bodys energy requirements) is stored by the body as fat.
NOTE: SHOW SLIDE 62: Example Post Workout Meals/Snacks
Slide 62
t. Post Workout Meals/Snacks.
(1) Turkey Sandwich and Yogurt.
(2) Low fat chocolate milk and banana.
(3) Cereal with low-fat milk.
(4) Low-fat chocolate milk (or UHT boxed Milk).
(5) Energy bar & low-fat milk.
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(6) Low-fat fruit yogurt & juice.
(7) Cottage cheese & fruit salad.
(8) Baked potato, cottage cheese & salsa.
(9) Fruit smoothie & protein power.
NOTE: SHOW SLIDE 63: Carbohydrate Timing Take Home Message
Slide 63
u. 24-36 hours to go from depleted to loaded.
v. Proper timing of CHO intake should be based on the amount of time the athlete has between workout sessions.
(1) If given 24 hours to replenish stores, timing becomes less important.
(2) Less time, the more important it is to consume CHO within 30 minutes and frequently.
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w. Timing of CHO intake must be practical.
(1) Food availability.
(2) GI comfort.
x. Glycogen Depletion occurs in:
(1) Endurance Exercise:
(a) After 2-3 h of continuous exercise performed at 60-80% VO2max.
(b) Cycling, running.
(2) Short Duration-High Intensity.
(a) After 15-60 minutes of exercise performed intermittently at 90-130% VO2 max.
(b) Tennis, basketball, soccer, swimming.
NOTE: SHOW SLIDE 64: Practical Tip
Slide 64
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TIP 6: Soldiers do not need a commercial recovery drink.

factor in choosing a recovery snack is if the Soldier will eat it.
Chocolate Milk, Greek Yogurt,
Peanut butter & Jelly Sandwich, Smoothies, and Cereal with Milk are all good choices. The most important
NOTE: SHOW SLIDE 65: Timing, Putting It All Together
Slide 65
y. Ingesting protein immediately before and after strength training (w/in 30 minutes) may result in greater muscle building.
(1) Recommended range 15-25g (IOC recommendation)
z. Consuming CHO immediately after exercise is very important if the Soldier will resume physical activity in 8 or less hours.
aa. You can wait to consume CHO if you have more time until your next workout.
(1) Only working out once per day
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QUESTION: What do you tell your athlete?
ANSWER:
It depends. If they are very interested in hypertrophy/muscle synthesis then Id have them try
to eat within 30 minutes and intake both carbs and protein. If protein synthesis is not a big issue then they can wait, as long as they have adequate CHO and PRO throughout their day.
bb. Carb intake recommendations for rapid glycogen replenishment 1.01.5 g CHO/kg bw w/in 30 min and every 2h for 46h.
NOTE: SHOW SLIDE 66: Supplements
Slide 66
cc. Definition: A dietary supplement is a product taken by mouth that contains a dietary ingredient intended to supplement the diet.
dd. Video for after class: American Bodybuilding Supplements Exposed2.wmv
NOTE: SHOW SLIDE 67: Supplements (continued)
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Slide 67
ee.
Types:
(1) Vitamins and minerals.
(2) Artificial sweeteners.
(3) Caffeine, pyruvate, melatonin.
(4) Creatine, carnitine.
(5) Herbals.
(6) Tablets, capsules.
(7) Sports powders, gels, liquids, and bars.
ff. Ergogenic aids:
(1) A dietary supplement used to improve physical performance and appearance or to increase stamina, speed, or strength.
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gg. Dietary Supplement health and Education Act of 1994 (DSHEA).
(1) Supplement manufacturer is responsible for the safety of the product.
(2) Cannot make a claim that it treats, cures, or prevents disease.
(3) Food and Drug Agency takes action against manufacturer once and unsafe product is on the market.
(4) Government has the burden to prove that the claim is false or misleading.
(5) Federal Trade Commission regulates advertising.
NOTE: SHOW SLIDE 68: Australian Institute of Sport Supplement Categories and Explain/Discuss with Students
Slide 68
NOTE: SHOW SLIDE 69: Supplements
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Slide 69
hh. Conclusion:
(1) Products are not regulated
(2) Can be convenient and portable
(3) No magic pill or powder
(4) Not a substitute for good diet, exercise and healthy habits (no smoking and moderate alcohol)
(5) Information is key
(6) Must weigh benefits vs risks (and cost)
(7) Can be toxic or create their own imbalances (e.g. calcium interferes with iron, Vit C blocks Vit B)
(8) Can interfere with or increase effects of medications
(9) Most are poorly absorbed and eliminated in urine
(10) Food is always the best source of vitamins and minerals
ii. Recent Warnings:
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(1) March 2009: consumers warned about 72 tainted weight loss products
(2) May 2009: Hydroxycut products assoicated with liver disease all Hydroxycut products were recalled
(3) July 2009: FDA warns consumers to stop using body building products that contain steroids or steroidlike substances
jj. FDA recall:
http://www.fda.gov/Safety/Recalls/default.htm
kk. Food supplementation is a multimillion-dollar business. There are thousands of supplements on the market, most of which are easily accessible to soldiers. Supplements were traditionally defined as any product made of one or more of the essential nutrients such as vitamins or protein. That definition has been broadened to include any product intended for ingestion as a supplement to the diet. Supplements include vitamins, minerals, herbs, amino acids, botanicals, as well as concentrates, metabolites, constituents, and extracts of these substances. Supplement product labels must include the words dietary supplement. Most products that meet this definition are not strictly regulated and are therefore not subject to any tight standards on makeup or claims. Soldiers primary goal should be to always strive to obtain the nutrients they need from the foods in their diet. Eating a variety of foods on a regular basis is the most important step toward this goal. Supplement powders and bars can be a convenient and portable method for busy soldiers to ensure they are consuming adequate supplies of the essential nutrients. Variety is still important because bars and powders are not always low fat, inexpensive, or easily digested by all. Supplementation should be part of a larger plan for an optimal performance diet not a replacement for poor habits and choices. Nor are supplements a substitute for regular, precise PRT. There is no one magic pill or powder that soldiers can take that will make them stronger, skinnier, or give them more energy. Soldiers considering supplements must weigh the purported benefits against the potential risks (and cost) before deciding to use any product. Information is key. If a product makes claims that sound too good to be true, the claims probably are too good to be true.
Check on Learning:
Review Summary:
CHECK ON LEARNING (ELO E):

QUESTION: How much protein does the 184 lb SSG in the 5-21st Infantry need to consume to meet his minimum recommended daily allowance? (See slide 59)
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ANSWER:
92-128.8g (based on a rate of 0.5 0.7 g per lb body weight)
QUESTION: Present two negative aspects of too much protein.
ANSWER:
(1) Can be high in saturated fat
(2) Low fiber
(3) Increased calcium loss
(4) Dehydration
(5) Excess can lead to kidney damage
(6) Excess is stored as fat
QUESTION:
What are great recommended replacements to commercial recovery drinks?
ANSWER:
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)
REVIEW SUMMARY(ELO E):
F.
ENABLING LEARNING OBJECTIVE ACTION: CONDITIONS: Describe diseases related to nutrition that may effect Soldier performance. 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). STANDARDS: Describe diseases related to nutrition that may effect Soldier performance IAW instructor notes and AR 600-63. ELO F - LSA 1. Learning Step / Activity ELO F - LSA 1. Diseases related to nutrition that may effect Soldier performance Conference/Discussion Contracted Instructor(1:10/0)* / Instructor(1:40/0)* 0 hrs 20 mins Large Group Instruction
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Method of Instruction: Instr Type(I:S Ratio/Qty): Time of Instruction: Instructional Strategy:
Media Type: PowerPoint Presentation Security Classification: This course/lesson will present information that has a Security Classification of: U - Unclassified. Note: Marked as (*) is derived from the parent learning object
NOTE: SHOW SLIDE 70: Enabling Learning Objective (ELO) F: (Inform the students of the Enabling Learning Objective requirements)
Slide 70
NOTE: SHOW SLIDE 71: Obesity Trends - U.S. Adults
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Slide 71
a. Dramatic rise in obesity in past 25 years (see above):
(1) Obesity rates have soared from 15% to 33% in adults.
(2) Start with 1991 because at this point all states have information in about their obesity rates.
b. Obesity is a sign of malnourishment excess sugar and a lack of healthy nutrients, including healthy fats, minerals and vitamins.
NOTE: SHOW SLIDE 72: Obesity BMI Classification
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Slide 72
CLASSIFICATION Underweight Normal Weight Overweight Obesity (Class 1) Obesity (Class 2) Extreme/Morbid* Obesity (Class 3)
BMI (kg/M) <18.5 18.5 - 24.9 25 - 29.9 30 - 34.9 35 - 39.9 40
* "Clinically severe obesity" is preferred to morbid obesity
NOTE: SHOW SLIDE 73: American College of Sports Medicine (ACSM) Position Paper Physical Activity and Weight Gain
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Slide 73
c. Moderate exercise: working hard enough to raise heart rate and break a sweats, yet being able to carry on a conversation.
d. About 60-75% of max heart rate.
GOAL
PHYSICAL ACTIVITY
Prevention of Weight Gain (>3%)
150 - 200 min/wk Equal to 1200 - 2000 kcal/wk
Weight Loss
<150 min/wk >150 min/wk
(Minimal Loss) (2-3 kg)
>225-420 min/wk (5-7.5 kg)
Weight Loss Maintenance
200-300 min/wk No adequate studies to determine amount of PA More is better
Physical Activity & Diet
Will result in weight loss if energy restriciton is not severe (,kcal/wk than needed to meet RMR)
NOTE: SHOW SLIDE 74: Relation of Disordered Eating to Eating Disorders (w/ Poor Perception of Self)
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Slide 74
e. Disordered eating:
(1) Missing meals, skipping breakfast, restricting food intake, calories counting, preoccupation with food/weight, rigid food patterns, elimination of food groups, not eating with others.
(2) Driven by lack of knowledge, time, money, ability to cook, and convenience of fast/snack foods.
(3) Driven by societys obsession with being thin to gain approval, respect, attraction and value.
(4) Family style severity of the style.
f. Eating Disorders: Bulimia and Anorexia:
(1) Severe restriction of intake, binge/purge.
(2) Use of diuretics/laxatives.
(3) Compulsive exercise.
(4) These are used as a coping mechanism for poor self-esteem caused by underlying emotional issues.
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(5) Signs on the PT field:
(a) Fatigue, chronic injury, slower times, secret/extra workouts.
NOTE: SHOW SLIDE 75: Relation of Eating Disorders to Healthy Soldier (w/Good Perception of Self)
Slide 75
g. Signs off the PT field:
(1) Loss of period, fatigue, decreased concentration, personality changes, bone weakness.
(2) Very low fat diets.
(3) Constant weighing.
(4) Starvation leading to electrolyte imbalance, heart rhythm disturbances and death.
(5) Anorexia:
(a) Cold, dizzy, loss of fat the muscle, dark circles under eyes, fine hair appearing on face, baggy
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clothes to hide appearance, boney/skeletal looking.
(6) Bulimia:
(b) Swollen cheeks, red eyes, cavities, calluses on knuckles, yellow nails.
h. Treatment may take years:
(1) Intervene openly and early to educate about consequences: food is fuel for your performance. If you want to perform, you have to fuel.
(2) Dont expect logic to work. Compassion, caring first.
(3) May be resistant to medical avenues and discussion with family.
(4) Provide support and access to support networks/task forces or sports nutritionist.
(5) Provide other avenues for release of painful feelings/underlying emotions.
(6) DO NOT conduct public weigh-ins, body fat testing, skin fold testing or publicly scorn people for being overweight!
NOTE: SHOW SLIDE 76: Metabolic Syndrome
Slide 76
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i. Metabolic Syndrome:
(1) Majority of Americans are on this track.
(2) Used to be in the over 50 year olds, but now being found in pre-school kids.
(3) Caused by:
(a) Sedentary lifestyle.
(b) Stress.
(c) Primarily high carb and high sugar diet.
(d) Partly genetic.
(4) Waist bigger than hips (males and females).
(5) More acne, more fatigue, more tired after meals, feel faint with exercise.
(6) Crave sweets, have a bigger appetite.
(7) Not feel satisfied after eating sweets.
(8) Joint pains, tingling feet and numbness.
(9) Diagnosis consists of 2 of the following:
(a) High cholesterol.
(b) High blood sugar.
(c) High blood pressure.
(d) Obesity.
(e) Insulin resistance.
(f) Vitamin and minerals deficiencies.
(g) Muscle weakness.
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(h) Allergies?
(i) More frequent infections.
(10) 100% preventable.
(11) Protective Food and Nutrients that reduce inflammation in the joints, skin, blood vessels:
(a) Salmon / food with a balance of omega-6 and omega-3 fatty acids.
(b) Avocado.
(c) Garlic.
(d) Spinach.
(e) Walnuts.
(f) Cashews.
(g) Almonds.
(h) Dark chocolate.
(i) Tea.
(j) Vitamin B6.
(k) Vitamin B12.
(l) Folate.
(m) Vitamin E.
(n) Fruits.
(o) Vegetables.
(p) Moderate wine intake (3-4oz) with food.
NOTE: SHOW SLIDE 77: Type II Diabetes
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Slide 77
j. Type II Diabetes:
(1) Incidence:
(a) Develops over many years.
(b) Familial tendency toward increased risk.
(c) Starts with high blood sugar and increased insulin due to excess sugar and carbohydrates.
(d) Expected to double in next 50 years.
(e) 2x as likely to develop cardiovascular problems.
(f) Closely related to obesity and physical inactivity.
(2) Treatment and Risks.
(a) Requires daily blood sugar monitoring.
(b) Requires diet control, pills, and often insulin injections.
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(c) Results in blindness, loss of sexual function, kidney failure, heart disease and blood vessel disease leading to amputations.
(d) Type 2 Diabetes - nearly 100% preventable with good diet and exercise.
NOTE: SHOW SLIDE 78 Food Allergies
Slide 78
k. Food Allergies:
(1) 1 in 25 people suffers from a food allergy (Academy of Nutrition and Dietetics, www.eatright.org).
(2) Food allergy vs food intolerance.
(3) Food allergy anaphylactic reaction vs rash or other reactions.
(4) Young people often outgrow them.
(5) Older people may develop allergies later in life.
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(6) 8 foods account for 90% of allergic reactions: . (a) Milk.
(b) Eggs.
(c) Peanuts.
(d) Tree nuts (walnuts, cashews).
(e) Fish.
(f) Shellfish.
(h) Soy.
(i) Wheat.
(7) Symptoms are due to an immune response to a protein in a food that your body sees as harmful.
(a) Runny nose, itchy skin.
(b) Anaphylactic shock.
- Swollen throat or swollen areas of the body.
- Wheezing.
- Passing out.
- Chest tightness.
- Trouble breathing.
- Hoarse voice.
- Trouble swallowing.
- Vomiting.
(c) Call EMS (At Ft Jackson - 751 9111).
(d) Epinephrine pen prescription injection for anaphylactic reactions.
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(e) Should be part of CRM - check Soldiers profiles.
QUESTION: (If this course is NOT being conducted at Fort Jackson) What is the EMS number at the installation conducting this course?
ANSWER:
______________________
NOTE: 1 in 25 people suffers from a food allergy (Academy of Nutrition and Dietetics, www.eatright.org)
NOTE: SHOW SLIDE 79: Celiac Disease
Slide 79
l. Celiac Disease: (1) Gluten: (a) A protein found in wheat, barley, spelt, kamut and rye (and some oats)
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(2) Celiac Disease: (a) An autoimmune disease triggered by ingesting gluten

(b) May be present at birth or develop later in life
(c) Approximately 2M people in US have it, most dont know they do
(d) Diagnosed with blood test or biopsy
(e) Causes the immune system to begin attacking the lining of the small intestine
(f) 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
(g) Slows or stops the absorption of nutrients such as iron, calcium and fat
(h) Treatment is to avoid eating gluten
(i) May also have dairy intolerance
(j) At higher risk for thyroid problems and diabetes
(2) Gluten sensitivity:
(a) Can cause gastrointestinal issues after eating products containing gluten. Similar to lactose intolerance.
(b) Symptoms might be similar to celiac
(3) Performance effects:
(a) Lack of energy
(b) Abnormal blood counts
(c) Fluid and supplementation issues: must find products that are gluten-free or can be tolerate
(d) http://www.gluten.net/
NOTE: Approximately 2M people in the United States have it; most don't know they do (RubioTapa, Am J Gastro, July 31, 2012)
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NOTE: SHOW SLIDE 80: Dietary Recall
m. Hand out and brief the students on the dietary recall sheet (See Appendix D, Student Handout)
<graphic=1080>
NOTE: SHOW SLIDE 81: Dietary Recall (continued)
Slide 81
n. Goal:
(1) Gain information about your current eating habits.
o. Food log:
(1) Document everything you eat and drink for one week.
(2) At first, record what not how much.
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(3) Add more details as you go time of day, numbers of calories or ounces, bowel movements, sleep hours and sleep quality.
(4) Be honest include the snacks, meals and days when you dont eat well.
(5) Dont forget the BLTs (bites, licks and tastes) they add up.
p. Analysis:
(1) Look for nutrient-dense food versus energy dense foods.
(a) Nutrient dense: high in vitamins, minerals, fiber and other nutrients relative to calories - fruits, vegetables, nuts, avocado, fish and lean cuts of meat.
(b) Energy dense: high in calories relative to their size cheese, whole milk, butter, french fried, sweets, burgers energy bars, soft drinks.
q. Keep a food log:
(1) Websites: Fitday.com, livestrong.com/thedailyplate, SparkPeople.com, choosemyplate.gov.
(2) Apps: Loseit, Live Strong, My Fitness Pal, Spark People, Calorie Counter, Plate Maker.
(3) Handout.
NOTE: SHOW SLIDE 82: Food Labels
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Slide 82
r. Food Labels.
(1) Front Panel.
(2) Ingredients list.
(3) Nutrition facts.
s. Look at the ingredients list on a Monster Drink.
t. Food labels have three parts = front panel, ingredients list, nutrition facts.
u. Front panel tells what ingredients have been added.
v. Ingredients list tells whats in food in order of decreasing amount.
w. Nutrition facts is best source of nutrient information for comparison of similar foods.
CHO 13 g x 4 cal/g = 52 cal
P 3 g x 4 cal/g = 12 cal
F 3 g x 9 cal/g = 27 cal (rounded to 30)
Total 91 cal (rounded to 90)
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% P = 12 cal P / 91 total
cal = 0.132 x 100% = 13.2%
NOTE: SHOW SLIDE 83: Dietary Change (TTPs)
Slide 83
x. Dietary Change TTPs:

(1) Start gradually:
(a) Dont create a short-term revolution, create long-term habits.
(2) Eat real food:
(a) Choose fresh fruits and vegetables, healthy fats (avocados, olives, olive oil, coconut oil, almonds and walnuts) fish and lean cuts of meat.
(b) Avoid processed, canned, boxed foods and drinks.
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(3) Eat protein with every meal.
(a) The time to eat carbs alone is during high intensity training and racing.
(b) Protein aids carbohydrate metabolism.
(c) 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.
(4) Cook your own food and prepare fresh fruits and veggies.
(5) Know how to shop around the edge of the store.
(6) Listen to your body.
(a) How well are you digesting what you eat?
(b) How is your alimentary canal functioning?
(7) Pay attention to and reduce the serving size:
(a) Use smaller plates and bowls.
(8) Eat more slowly and sitting down.
(9) Eat at the table and not in front of the TV or in the car if possible.
(10) Eat breakfast:
(a) Choose low glycemic foods to avoid a spike in insulin and enhance the ability to oxidize fat.
(b) Avoid quickly-prepared or pre-packaged breakfast substitutes.
(11) Serve from the stove, not serving dishes.
(12) If you are still hungry use the 30 minute rule wait 30 minutes before you have a second portion.
Check on Learning:
Review Summary:
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CHECK ON LEARNING (ELO F):

Determineif the students have learned the material presented by soliciting student questions and explanations. Ask the students questions and correct misunderstandings.
QUESTION:
______________ is a sign of malnourishment.
ANSWER:
Obesity
QUESTION: List the following as either an eating disorder (ED) or disordered eating (DE)
Missing meals = _____
Use of laxitives = _____
Compulsive exercising = _____
Skipping breakfast = _____
Elimination of food groups = _____
Binge/Purge = _____
ANSWER:
Missing meals = __DE___
Use of laxitives = _ED____
Compulsive exercising = __ED___
Skipping breakfast = __DE__
Elimination of food groups = __DE__
Binge/Purge = __ED__
QUESTION: What are two causes of Metabolic Syndrome?
ANSWER:
- Stress
- Sedentary Lifestyle
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- Primarily a high carb and high sugar diet
- Partly genetic
QUESTION: List 4 symptoms of Anaphylactic Shock.
ANSWER:
- Swollen throat or swollen areas of the body
- Wheezing
- Passing out
- Chest tightness
- Trouble breathing
- Hoarse voice
- Trouble swallowing
- Vomiting
REVIEW SUMMARY(ELO F):
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SECTION IV. SUMMARY Method of Instruction: Instr Type(I:S Ratio/Qty): Time of Instruction: Instructional Strategy:
Check on Learning
Conference/Discussion Contracted Instructor(1:10/0), Instructor(1:40/0) 5 mins Large Group Instruction
QUESTION: Based on the 2008 Physical Activities Guidelines, what is ONE option an adult has to meet these guidelines?
ANSWER:
(1) 2.5 hours (150 minutes) of moderate-intensity aerobic activity AND 2 or more days of muscle-
strengthening activities.
(2) 1.25 hours (75 minutes) of vigorous-intensity aerobic activity AND 2 or more days of musclestrengthening activities.
(3) An equivalent mix of moderate- and vigorous-intensity aerobic activity AND 2 or more days of musclestrengthening activities.
QUESTION:
What are the best sources of carbohydrates?
ANSWER:
Fruits and vegetables
QUESTION: What is the MFTs reference when seeking information on nutrition?
ANSWER:
AR 600-63
QUESTION: What organic compound Build and repairs all tissues in the body, including muscle and regulates water balance and prevents edema (swelling) by holding fluid in the bloodstream?
ANSWER:
Amino Acids
QUESTION: TRUE or FALSE: Our body can produce most of the 10 essential amino acids.
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ANSWER:
FALSE. Our body cannot make them; we can only get them from food.
QUESTION:
____________ is stored as glycogen in the liver and muscles in limited amounts of 1500 3000kcal
ANSWER:
Carbohydrate (CHO)
QUESTION:
What are the two classifications of carbohydrates?
ANSWER:
Simple and Complex
QUESTION:
Excess carbohydrates are stored as ______.
ANSWER:
Fat
QUESTION: What are the three primary types of fat?
ANSWER:
Saturated, Unsaturated, Hydrogenated
QUESTION: What are two types of healthy fats?
ANSWER:
Omega-3 and Omega-6
QUESTION: There is no U.S standard for ___________ intake, but it can be found in fatty fish (salmon, dark tuna, sardines), walnuts, and flax seed.
ANSWER:
Omega-3
QUESTION: What type of fiber can be found in barley, carrots, broccoli, peas, sweet potatoes, zucchini, and seeds?
ANSWER:
Soluble
QUESTION: One Pound = ________ calories
ANSWER:
3,500
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QUESTION: What is homeostasis?
ANSWER:
The physiological process and state of equilibrium in the body in respect to various functions and to the
chemical compositions of fluids and tissues.
QUESTION: After exercising, water should be consumed at a rate of ___________________________.
ANSWER:
16 ounces cups for every pound lost during exercise.
QUESTION: A Soldier being wrapped in an ice sheet to reduce his/her core body temperature is an example of what type of thermoregulatory mechanism?
ANSWER:
Conduction
QUESTION: List three of the top sources of protein.
ANSWER:
(1) Lean beef (top round, round tip)
(2) Chicken and turkey
(3) Fish (3 oz cooked = 15-20 g)
(4) Egg (1 large = 6g)
(5) Peanut butter (natural is best. 2 tbsp = 9 g)
(6) Beans (1/2 cup = 7 g)
(7) Tofu (4 oz = 10 g)
(8) Milk and yogurt (1 cup = 8 g)
QUESTION: Celiac Disease is an autoimmune disease triggered by ingesting ____________.
a. Protein
b. Gluten
c. Amino Acids
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d. Carbohydrates
ANSWER:
b. Gluten
Review/ Summary
Conduct a review and solicit feedback from students on the administrative/support functions offered in the various Learning Step Activities of this lesson.
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SECTION V. STUDENT EVALUATION

Testing Requirements
NOTE: Describe how the student will demonstrate accomplishment of the TLO throughout the course, during Practical Exercises (PEs), and on any performance assessment. Refer student to the Student Evaluation Plan.
Feedback Requirements
Following the Master Fitness Trainer Course, a Student End-of-Course Critique will be issued, taken, and collected. These critiques are required to be reviewed by the Chief, Physical Readiness Division (PRD).
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Appendix A - Viewgraph Masters Performance Nutrition 805P-MF805010 / Version 2 Sequence 0 Media Name MF805010: Performance Nutrition Slides Media Type PPTX
A-1
Appendix B - Test(s) and Test Solution(s)
B-1
Appendix C - Practical Exercises and Solutions PRACTICAL EXERCISE(S)/SOLUTION(S) FOR LESSON 805P-MF805010 Version 2 PRACTICAL EXERCISE SHEET 805P-MF805010 PE1
Title Lesson Number/Title Security Classification Introduction
Dietary Recall Practical Exercise

805P-MF805010 Version 2 / Performance Nutrition Unclassified This Practical Exercise (PE), Dietary Recall, complements the classroom instruction and will be completed in two parts. Dietary Recall is an analysis of your own personal eating habits.
Motivator
Dont create a short-term revolution ... create long-term habits!
Terminal Learning Objective
NOTE. Inform the students of the following Terminal Learning Objective requirements.
At the completion of this lesson, you [the student] will:
Action: Conditions:
Understand performance nutrition and how it relates to Army Physical Readiness Training. In a large group classroom, given a AR 600-63, Army Health Promotion, FM 7-22, Army Physical Readiness Training, and Master Fitness Trainer Course (MFTC) Course Management Plan (CMP).
Standards:
Safety Requirements
1. Safety is a major consideration when planning and evaluating PRT programs. Commanders should use the composite risk management process for all PRT activities to ensure they do not place their Soldiers at undue risk for injury or accident. The commander should address:
- Environmental conditions - Emergency procedures - Facilities - Differences in age - Gender - Level of conditioning of each Soldier in the unit
2. Safety Requirements in a Classroom Setting:
Safety is of the utmost importance in any training environment. During the training process, Commanders will utilize the 5-Step Composite Risk Management process to determine the safest and most complete method to train. Every
C-1
precaution will be taken during the conduct of training.
Safety is everyones responsibility to recognize, mitigate, and report hazardous conditions.
3. In a training environment, lead Instructors must perform a risk assessment in accordance with FM 5-19, Composite Risk Management. Leaders will complete a DA Form 7566 COMPOSITE RISK MANAGEMENT WORKSHEET during the planning and completion of each task and sub-task by assessing mission, enemy, terrain and weather, troops and support available-time available and civil considerations, (METT-TC).
NOTE: During MOPP training, leaders must ensure personnel are monitored for potential environmental injury. Local policies and procedures must be followed during times of increased heat category or freeze warning in order to avoid injury. Consider the MOPP work/rest cycles and water replacement guidelines IAW FM 3-11.4, NBC Protection, FM 311.5, CBRN Decontamination.
Risk Assessment Level Environmental Considerations
None
NOTE: Instructor should conduct a Risk Assessment to include Environmental Considerations IAW FM 3-100.4, Environmental Considerations in Military Operations, Appendix G, and ensure students are briefed on hazards and control measures.
Individuals instructing this task must ensure they are familiar with FM 7-22, Appendix D, pages D-1 thru D-5, Environmental Considerations prior to training this task.
Evaluation
NOTE: Describe how the student will demonstrate accomplishment of this lessons TLO throughout the course, during Practical Exercises (PEs), and on any performance assessment.
Instructional Lead-in
The Dietary Recall Practical Exercise (PE) is broken into two parts. First is an explaination of student responsibilities for Part I. Second is an analysis of your dietary intake as recorded on the Dietary Recall Student Handout.
Resource Requirements
Instructor Materials:
- This lesson
- The Dietary Recall Handout
- Class schedule (in order to notify the students when Part I and Part II of the PE are scheduled)
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Student Materials:
- The Dietary Recall Handout.
- Class schedule (in order to know when Part I and Part II of the PE are scheduled)
- Pen/Pencil to record nutritional intake
NOTE: More than one sheet may be required in order to record all nutritional intake.
Special Instructions
1. Ensure students use the Dietary Recall Handout located in Appendix D of this lesson and in the lesson Toolkit.
2. 1.0 hour of this Practical Exercise will be completed during the MF805010 class in Week 2.
3. The remaining 1.0 hour of this practical exercise will be completed as directed by the MFTC Instructors during week 4 of this course.
Procedures
NOTE: SHOW SLIDE 80: Dietary Recall Handout. (Make sure all students have a least one handout)
Slide 80
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NOTE: SHOW SLIDE 81: Dietary Recall.
Slide 81
a. Dietary Recall Guidelines:

(1) Goal: Gain information about your current eating habits.
(2) Food log:
(a) Document everything you eat and drink for one week.
(b) At first, record what not how much.
(c) Add more details as you go time of day, numbers of calories or ounces, bowel movements, sleep hours and sleep quality.
(d) Be honest include the snacks, meals and days when you dont eat well.
(e) Dont forget the BLTs (bites, licks and tastes) they add up.
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(3) Analysis:
(a) 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
(4) Keep a food log:
(a) Websites: Fitday.com, livestrong.com/thedailyplate, SparkPeople.com, choosemyplate.gov
(b) Apps: Loseit, Live Strong, My Fitness Pal, Spark People, Calorie Counter, Plate Maker
(c) Handout (See Appendix D, Student Handout)
NOTE: SHOW SLIDE 82: Food Labels. (Discuss and provide guidance on how to read a food label)
Slide 82
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b. Look at the ingredients list on a Monster Drink
c. Food labels have three parts = front panel, ingredients list, nutrition facts
(1) Front panel tells what ingredients have been added
(2) Ingredients list tells whats in food in order of decreasing amount
(3) Nutrition facts is best source of nutrient information for comparison of similar foods
(a) CHO 13 g x 4 cal/g = 52 cal
(b) P 3 g x 4 cal/g = 12 cal
(c) F 3 g x 9 cal/g = 27 cal (rounded to 30)
(d) Total 91 cal (rounded to 90)
(e) % P = 12 cal P / 91 total
(f) cal = 0.132 x 100% = 13.2%
NOTE: SHOW SLIDE 83: Dietary Recall TTPs.
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Slide 83
b. Dietary Recall TTPs:

(1) Start gradually:
(a) Dont create a short-term revolution, create long-term habits.
(2) Eat real food:
(a) Choose fresh fruits and vegetables, healthy fats (avocados, olives, olive oil, coconut oil, almonds and walnuts) fish and lean cuts of meat.
(b) Avoid processed, canned, boxed foods and drinks.
(3) Eat protein with every meal.
(a) The time to eat carbs alone is during high intensity training and racing.
(b) Protein aids carbohydrate metabolism.
(c) 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.
(4) Cook your own food and prepare fresh fruits and veggies.
(5) Know how to shop around the edge of the store.
(6) Listen to your body.
(a) How well are you digesting what you eat?
(b) How is your alimentary canal functioning?
(7) Pay attention to and reduce the serving size:
(a) Use smaller plates and bowls.
(8) Eat more slowly and sitting down.
(9) Eat at the table and not in front of the TV or in the car if possible.
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(10) Eat breakfast:
(a) Choose low glycemic foods to avoid a spike in insulin and enhance the ability to oxidize fat.
(b) Avoid quickly-prepared or pre-packaged breakfast substitutes.
(11) Serve from the stove, not serving dishes.
(12) If you are still hungry use the 30 minute rule wait 30 minutes before you have a second portion.
Feedback Requirements
Following the Master Fitness Trainer Course, a Student End-of-Course Critique will be issued, taken, and collected. These critiques are required to be reviewed by the Chief, Physical Readiness Division (PRD).
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SOLUTION FOR PRACTICAL EXERCISE 805P-MF805010 PE1

NOTE: There is no "one solution" since the goal to this Practical Exercise (PE) is to "Gain information about your current eating habits."
1. MFTC Instructors will break down students into mentor groups.
2. Each group will analysis their data recorded over the past week.
3. Patterns of each student's diet will be identified in order to demonstrate how to identify potential nutrition intake issue requiring the attention of a dietician.
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Appendix D - Student Handouts Performance Nutrition 805P-MF805010 / Version 2 Sequence 0 Media Name MF805010: Dietary Recall Handout Media Type DOCX
D-1
Appendix E - TRAINER'S LESSON OUTLINE
Performance Nutrition 805P-MF805010 / Version 2 DRAFT
1. The importance of this lesson: (Why)
Understand performance nutrition and how it relates to Army Physical Readiness Training.
2. What we want our Soldiers to Achieve: (Outcomes/Standard)
Outcomes Possess a knowledge of Basic Anatomy, Physiology, and Exercise Science
Possess a knowledge of the Armys Physical Readiness Training System
- History of Army fitness - Differences between PRT and other programs
Possess knowledge of Human Performance Optimization/Injury Prevention (HPOIP)
- Understand HPOIP at the macro and micro levels
Possess a knowledge of Army doctrine relating to and impacting PRT
Skills (Be):
Teach (correct, mentor)
Communicate (coordinate, collaborate)
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Move (athleticism)
Lead (direct, inspire, exemplify)
Liaise (advise)
Assess (comply)
Abilities (DO):
PRT Leader
Special Staff Advisor on Physical Readiness Training
Special Conditioning Program Advisor
Train other leaders
Liaison to other SMEs (medical personnel) and other MFTs
Design, lead, execute, and evaluate PRT Programs
3. Tasks to be taught
Task Number
Task Title
Task Type
None
Additional Non-Standard Tasks
None 4. References:
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Reference Number
Reference Title
Date
AR 600-63 FM 7-22
Army Health Promotion (RAR - 07 Sep 2010) Army Physical Readiness Training
07 May 2007 26 Oct 2012
Additional Non-Standard References
None 5. Resources
TIME: Time of Instruction (Time not specified)
LAND: Classroom, Training Area, and Range Requirements

Id Name
17120-T-1680-50
Classroom, Traditional, 1680 Square Feet, 50 Students
AMMO: Ammunition Requirements

DODIC Name
None
MISC: Materiel Items and TADSS Requirements

Id Name
5836-01-408-4665 6515-01-509-2908 6545-00-116-1410 6665-01-103-8547 6730-00-577-4813 7010-01-454-5951 7520-00-T82-3256 7520-01-351-9148 (Note: Asterisk before ID indicates a TADSS.)
PROJECTOR, VIDEO (INFOCUS LITEPRO 550) DEPLOY PAC,AED FIRST AID KIT,GENERAL PURPOSE WET GLOBE TEMPERATURE KIT Screen, Projection Computer System, Digital, Desk Top LASER, POINTER (PEN SIZE) Pointer, Instructional
Additional Non-Standard Resources
None 6. A possible technique to achieve the outcome:

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Outcome (Measures of Effectiveness) Knowledge (Know): Possess a knowledge of Basic Anatomy, Physiology, and Exercise Science (MF805002 thru MF805014)
Possess a knowledge of the Armys Physical Readiness Training System (MF805018, MF805019; MF805024 thru MF805026; MF805029)
- History of Army fitness
- Differences between PRT and other programs
Possess knowledge of Human Performance Optimization/Injury Prevention (HPOIP) (MF805020 thru MF805022)
- Understand HPOIP at the macro and micro levels
Possess a knowledge of Army doctrine relating to and impacting PRT (MF805015 thru MF805017)
Skills (Be):
Teach (correct, mentor) (MF805062 and MF805065)
Communicate (coordinate, collaborate) (MF805062 and MF805065)
Move (athleticism) (MF805031 thru MF805058)
Lead (direct, inspire, exemplify) (MF805062 and MF805065)
Liaise (advise) (MF805062 and MF805065)
Assess (comply) (MF805057, MF805058, MF805061, MF805063)
Abilities (DO):
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PRT Leader (MF805031 thru MF805062)
Special Staff Advisor on Physical Readiness Training (MF805002 thru MF805065)
Special Conditioning Program Advisor (MF805019 thru MF805022)
Train other leaders (MF805062)
Liaison to other SMEs (medical personnel) and other MFTs (MF805065)
Design, lead, execute and evaluate PRT Programs (MF805018, MF805019; MF805024 thru MF805026; MF805029)
7. Conduct AAR with Soldier and Cadre.
a. Conduct end of training day AAR. (1) Begin the AAR. Review training events of the day. (2) Discuss strengths and weaknesses of each event or critical activity. (3) Decide what to do differently next time; how to improve. (4) Summarize key training points and events of the AAR. (5) Allow students two ask questions and/or address any of the cadre members. (6) Quickly review the next days training and inform students of any schedule updates or changes.
NOTE: Before presenting this lesson, Instructors must be thoroughly prepared by studying the appropriate lesson plan and identified reference material.
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Performance Nutrition 805P-MF805010 / Version 2 Effective Date Not Assigned SECTION I.

Task(s) Taught(*) or Supported

The administrative/academic hours required to teach this lesson are as follows:

07 May 2007 26 Oct 2012

Student Study Assignment

- Complete an end-of-day AAR with students.

Additional Support Personnel Requirements

Equipment Required for Instruction

1:40 1:40 0:0 0:0 1:40 1:40 1:40 1:40

- This lesson and any SME notes

- Updated composite risk worksheet

- Uniform as designated by instructors

Classroom, Training Area, and Range Requirements

17120-T-1680-50 Classroom, Traditional, 1680 Square Feet, 50 Students

Proponent Lesson Plan Approvals

Terminal Learning Objective

2. Safety Requirements in a Classroom Setting:

Safety is everyones responsibility to recognize, mitigate, and report hazardous conditions.

Risk Assessment Level

Low Conduct Classroom Instruction

Environmental Considerations prior to training this task.

NOTE: SHOW SLIDE 4: AR 600-63

QUESTION: Who is the RD on your installation? ANSWER: _________________________________

NOTE: SHOW SLIDE 5: AR 600-63 (cont)

NOTE: SHOW SLIDE 6: AR 600-63 (cont)

NOTE: SHOW SLIDE 7: QUOTE

e. Have the students read selected quote:

NOTE: SHOW SLIDE 8: OBESITY TRENDS

j. Behavioral Risk Factor Surveillance System (BRFSS)

NOTE: SHOW SLIDE 9: OBESITY TRENDS

m. Some facts for you:

(3) Physical activity can improve health.

NOTE: SHOW SLIDE 11: 2008 PHYSICAL ACTIVITY GUIDELINES

(2) Coastguard was the most overweight Service.

NOTE: SHOW SLIDE 13: THE ARMY NUTRITION PROBLEM

(2) Obesity/overweight diagnoses are associated with a shorter length of service.

(4) 86% of retirees are classified as overweight or obese.

(5) 18.9% of DoD dependent adolescents are obese.

(7) $1.1 billion estimated annual cost to TRICARE

NOTE: SHOW SLIDE 14: THE ARMY RECOVERY PROBLEM

(1) Recovery = Sleep

(a) Lack of individual knowledge, understanding, skills and awareness.

(b) Military culture : Suck it Up and Drive On.

(c) Lack of Leadership emphasis.

(e) Inadequate quantity and quality.

(3) Soldiers/Leaders underestimate their own impairment due to poor sleep.

(5) Excessive drowsiness and fatigue due to chronic poor sleep:

(a) Impaired decision making

(b) Exacerbates/exacerbated by emotional and physical problems

(c) Poor health, BMI, diabetes (Performance Triad)

(d) Unethical behavior or misconduct

NOTE: SHOW SLIDE 15: THE SOLUTIONS

u. Change the nutrition mindset:

(2) Improved military food environments support healthy behaviors.

(3) Improved clinical care for prevention and treatment.

(4) Increased use of evidence- based nutrition programs.

(5) Improved standardization of nutrition education.

(6) Unified nutritional messaging.

v. Change the recovery mindset:

(1) Leaders model and promote Sleep it is as critical as hydration.

(2) All understand the impact of poor sleep.

(4) Broadly disseminate current guidance and policies on sleep.

(5) IT enablers for sleep monitoring, planning and self-coaching.