RHR: Unanswered Questions About SIBO

In this episode we will discuss:

• Is lactulose breath testing an accurate way to diagnose SIBO?
• Is SIBO always pathological?
• Are our treatments effective?
• Is SIBO always the underlying cause?
• Should probiotics and prebiotics be avoided during treatment?
• Does a long-term low-FODMAP diet help prevent recurrence?

[smart_track_player url="http://traffic.libsyn.com/thehealthyskeptic/RHR_-_Unanswered_Questions_About_SIBO.mp3" title="RHR: Unanswered Questions About SIBO" artist="Chris Kresser" ] Hey, everybody, it’s Chris Kresser. Welcome to another episode of Revolution Health Radio. This week we're going to do something a little bit different. Rather than answer one specific question that was sent in, I'm going to answer a bunch of different questions that I get all the time regarding a very popular topic, which is SIBO. As a matter of fact, I have many questions about SIBO myself, and that's actually how I want to frame this podcast. I get more questions about SIBO than probably any other health topic. I've been treating it now for many years, and I've learned a lot about it in that time, and yet it seems like the more I learn, the more questions I have. Certainly, if you look on internet forums and blog comments, you look at summits and podcasts in our entire field, you can see that there's still a lot of questions about SIBO and misunderstanding and things that we really need to figure out in order to be able to appropriately diagnose and treat this condition. I think the best way to dive into this is just to say that I've started to doubt many of the standard assumptions or beliefs around SIBO that many of you are probably already aware of. I just want to go through five or six of these assumptions and tell you what my current thinking about them is, and this might be a little bit of a frustrating podcast to listen to because I'm not necessarily going to give you answers. I'm just going to tell you what the questions are, where my doubts are, and what further research or exploration or investigation I think we need to do.

Question #1: Is lactulose breath testing an accurate way to diagnose SIBO?

Let's start with assumption number one, which is that lactulose breath testing is an accurate way of diagnosing SIBO. As many of you know, the standard way of diagnosing SIBO in an outpatient setting is using lactulose breath testing. There is another way, which is an endoscopy, where they put a tube down your throat and take a sample of bacteria from your small intestine, but that's never used in outpatient settings because it's invasive and expensive. It's just not done. There are actually a lot of problems with that method as well, which leads us to probably the biggest issue of all from a 30,000-foot-view perspective with SIBO, is that in order for a test to be accurate, it needs to be validated against something that's a gold standard, and we have no gold standard way of diagnosing SIBO. The endoscopy, which I just mentioned, has been used as the gold standard test against which breath testing is validated. But what if the gold standard test itself is not accurate? That obviously creates some pretty big problems in terms of developing another test like breath testing and then validating it against a test that itself is not very valid. That's the biggest issue.

The problems with SIBO diagnosis and treatment

I'm not going to go into all the nitty-gritty details on why breath testing isn't necessarily as accurate as some people may believe. But in this context, I'll just say that—and this is a guess, I haven't done any rigorous study—but I would estimate that over 90 percent of the patients we test for SIBO test positive. Now this is using the former criteria and I'll come back to this in a second, but if you just use the machine-generated criteria that are printed on any of the SIBO breath testing labs, I would say over 90 percent of our patients test positive. Now, that alone should be a red flag. When more than 90 percent of your patients test positive for a condition, that should raise some eyebrows. Certainly SIBO is common, but do we really expect that 90 percent of patients, even people who are sick and dealing with chronic health issues have SIBO? I've never seen any research suggesting that over 90 percent of people with any particular conditions also have SIBO. The exception might be acne rosacea. I think I saw one study of 42 patients where 100 percent of patients with acne rosacea had SIBO [Correction: study I was referring to found that SIBO was 17 times more prevalent in patients with rosacea than in controls.] This doesn't mean for sure that the test is inaccurate, but it definitely raises my eyebrows. It makes me wonder whether we're over-diagnosing SIBO. Changes in criteria Now I mentioned the criteria, so up until pretty recently the idea was that if you see an increase in 20 parts per million or more of hydrogen in the first 120 minutes of the test, that would indicate a positive result, and the criteria were an increase in 12 parts per million for methane, but those criteria recently changed; there was a consensus statement issued in the spring. A bunch of SIBO experts got together and talked about how to update the breath-testing criteria to make it more accurate and ensure that the criteria were modified to, on the one hand with hydrogen, the changes would lead to fewer diagnoses, less overdiagnosis of hydrogen-predominant SIBO. But in the case of methane, they're going to lead to a greater number of diagnoses because those criteria, instead of becoming more strict, became more liberal. The new hydrogen criteria are increasing 20 parts per million within the first 90 minutes, and then with methane, it's any value over 10 parts per million at any point during the test, including during the third hour. That’s a pretty big difference, and that's going to lead to a lot more positive results for methane. It’s also worth pointing out that there are a lot of different studies that are critical of lactulose breath testing that suggest that there is a very high potential for false positives, especially using lactulose instead of glucose. With glucose breath testing, the opposite problem is true. There's a high potential for false negatives. If there is a positive, it should be positive. But if there's a negative, you can't rule out that SIBO might be present. Again, I'm not going to go into great detail here, but let's just say that there is a lot of uncertainty about breath testing as a way of diagnosing SIBO.

Question #2: Is SIBO always pathological?

The second assumption is that SIBO is always pathological. The idea is that if SIBO is present, it's always causing the patient's problems, whatever they are, but that's not sound thinking, of course, because we know that correlation is not causation. It's possible that SIBO could be present, but it's not actually driving whatever the patient's symptoms are. We know that early studies suggested that up to 20 to 30 percent of healthy controls have SIBO but don't have symptoms. Of course, I have to offer a side note here, which is, I don't know where these studies are finding these so-called “very healthy controls with no symptoms.” I haven't met that many of those people, but let's assume that that's true. That could mean that 20 to 30 percent of the population has SIBO, but it's not causing any problems for them. In many cases, we treat SIBO, and the numbers improve, so the patient goes from being breath-test positive to breath-test negative, but their symptoms don't necessarily improve. That would suggest that maybe SIBO was present, but it wasn't causing their symptoms. It's possible that the testing is accurate as far as what it's measuring, but what we call SIBO as a condition is not always pathological. It's also possible that SIBO might be present in a patient and might be causing some issues, maybe a mild nutrient deficiency or something like that, but it's not causing the main complaints. The reason I bring this up is that I see some patients just getting hyperfocused, almost obsessed about SIBO, at the expense of everything else. And clinicians—there is that saying, “If you've got a hammer, everything looks like a nail”—I see both clinicians and patients becoming over-focused, I think, on SIBO, and the risk there is that you actually miss other pathologies or underlying mechanisms that are really actually driving the condition in those cases if we're just myopically focused on SIBO.

Question #3: Are our treatments effective?

The third assumption is that our current treatments are effective and optimal. The typical treatments for SIBO are antimicrobials. Initially, there were prescription medications. Rifaximin is the most commonly used, especially for hydrogen-predominant SIBO, and neomycin is also added at times when methane is present. Metronidazole is another medication, or Flagyl is used in some cases for treating SIBO, as well as other antibiotics, but rifaximin certainly has become the drug of choice. But then there have been some studies recently that have found that botanicals, herbs, are as effective as rifaximin treatment or even more effective and cause fewer side effects. In general, the approach is if SIBO is there, then you use antimicrobials to reduce the growth of bacteria in the small intestine. The problem with this approach is that the efficacy is often quite low. I've seen some studies that we use rifaximin individually that show as low as 40 percent efficacy. Of course, there are other studies that show higher efficacy, and then if you combine other agents in the treatment, you can make it more effective. There was one treatment where the researchers speculated that using partially hydrolyzed guar gum would improve the efficacy of rifaximin, and in fact it did. It increased it significantly. In our clinic we use a combination protocol that uses a bunch of different things together, all of which are designed to maximize the efficacy. It also depends whether it's just hydrogen alone that's high, or methane alone that's high, or both hydrogen and methane, and each of those scenarios requires a different approach. But the problem remains that efficacy is much lower than I certainly would like to see it. Not only that, in some cases, not only do patients not get better, they actually get worse after treatment. They might get worse right away or they might improve initially, but then the symptoms return and when they come back, they come back even worse. I've seen this actually happen in multiple cycles, meaning with each treatment and each return of symptoms, the symptoms get worse after each cycle, which is obviously problematic. Then there's the very high rates of recurrence for SIBO, which is related to what I just said. One study, I think, found a recurrence rate of 45 percent in patients who had been treated by rifaximin. In our practice, despite using all of the evidence-based methods and combining several different methods, we still see recurrence rates a lot higher than optimal, than I think is acceptable. That's one of the main things that has led me to question many of these beliefs and assumptions because when the treatments are not that effective and the recurrence rates are very high, then I think that something is definitely wrong.

Question #4: Is SIBO always the underlying cause?

The fourth assumption is that SIBO was always the underlying cause of a particular condition. This is somewhat related to what I mentioned earlier, but a little bit different. In functional medicine, we're always trying to get to the root of the problem, but sometimes that's easier said than done, and it can be like peeling layers of an onion back to keep going deeper to find the deepest underlying issue. If a patient has SIBO, for example, and we treat their SIBO and it doesn't go away, or maybe it does go away and it comes back, and we do that two or three times, then of course I start wondering, “All right. Well, is there some other deeper condition that is causing the SIBO?” In this case SIBO is not necessarily a cause itself, but almost a symptom of a deeper underlying problem. In my experience, those problems can be things like:

• mold or chronic inflammatory response syndrome
• chronic infections like tick-borne illnesses
• viral reactivation
• other gut infections that have escaped detection
• heavy metal toxicity
• other types of toxicity
• mitochondrial deficiency

And a range of other problems. But the point being that in those cases, those problems are the real thing that's driving SIBO and then whatever symptoms the SIBO is causing. It’s like layers, and so you have to keep going deeper in order to identify and address those conditions, otherwise that patient is never going to get over SIBO. We’ll just keep treating it, it might improve a little bit or not, and then it just keeps coming back. Even though rifaximin and the botanicals are relatively safe compared to other antimicrobials, they're still antimicrobials, and we still want to minimize our use of them.

Question #5: Should probiotics and prebiotics be avoided during treatment?

Assumption number five is that probiotics and prebiotics should always be avoided when a patient has SIBO and shouldn't be included in treatment. I think I've discussed this before and I'm not totally sure where this belief or assumption came from. It's pretty prevalent within the mainstream SIBO community, if you want to call it that. But all of the studies that I've seen, I think, without exception, have found that when you use probiotics, either along with antibiotics or as separate distinct treatment for SIBO, they are effective. They're either effective as solo treatment, or they increase the efficacy of SIBO [treatment protocols]. Even the studies that have used probiotics have shown positive results, which might be a little counterintuitive because you would expect probiotics to feed the bacteria that are present in the small intestine. I think there are still quite a few questions here. Certainly, I have seen probiotics, and probiotics make patients with SIBO worse, but in other cases, I've seen them make patients with SIBO significantly better. We do include very specific types of probiotics and even prebiotics in our SIBO treatment protocol. We've done that for many years because of the research I've seen on this, and I do think it is effective in most cases. This sort of points to another question or concept, which historically a lot of SIBO authorities have claimed that SIBO is just really kind of a small intestine, it's not really related to the health of the large intestine or the overall gut microbiome. That doesn't make sense to me. There is a sphincter that separates the small and large intestine, but one of the prevailing theories about how SIBO got started in the first place is it’s an inappropriate transfer of bacteria from the large intestine to the small intestine. It's entirely possible, and even likely, in my opinion, that one of the predisposing factors that can lead to that translocation of bacteria from the large intestine to the small intestine is an unhealthy large intestine. It may be that that’s one of the reasons that prebiotics and probiotics work in terms of treating and even preventing recurrence of SIBO is that they help to improve the gut microbiome. That, in turn, has a sort of upstream effect on the small intestine. Really, still a lot of unanswered questions here related to probiotics and probiotics, but I've seen enough now to convince me that the dominant idea that they should always be avoided is not true.

Question #6: Does a long-term low-FODMAP diet help prevent recurrence?

Then finally, the last assumption, number six, is that a long-term low-FODMAP diet is always a good idea in order to prevent recurrence. I have discussed this and written about this before, so I'm just going to mention it briefly. But studies have shown that a long-term low-FODMAP diet can reduce the diversity and quality of beneficial bacteria in the large intestine, and for the reasons that I just mentioned, I think that that can be problematic. Even though the low-FODMAP diet can reduce symptoms, it may be setting patients up for recurrence if it's leading to undesirable changes in the beneficial bacteria in the colon. Also, there was a recent study that just came out that found that patients with IBS are often able to reintroduce certain FODMAPs without any adverse effects. This study didn't consider SIBO, but as you probably know, many patients with IBS do have SIBO. My guess is that they would have found a similar effect if they had done the study in patients that only had SIBO. It seems that even in patients who do have SIBO or IBS that reintroducing some FODMAPs not only could be potentially beneficial, but doesn't actually lead to a return of symptoms. That's what I've always encouraged my patients to do is reintroduce as many FODMAPs as they can without significant discomfort. I think that's a wise approach because we want to keep our diet as diverse as possible, and especially when it comes to fermentable fiber, it can support our beneficial gut bacteria. Okay. I'm going to stop there. As you can see again, this is a little frustrating maybe to listen to. I'll tell you that it's super frustrating for me as a clinician. This is again something I've been paying very close attention to for a long period of time, and I feel quite frustrated with the lack of answers around many of these questions. Certainly, not for lack of looking, experimenting, and exploring, but my commitment to you is that I will continue to do that. I think it's a very important starting place to just admit when we don't know the answers to these questions at least, and to lay those questions out so we can start exploring what the answers might be, and of course that is the process of science. It's not that we always have the answers and we always know what and we stop looking. Once we think we know the answers, we always question our assumptions and we continually re-evaluate them, especially in the face of evidence that contradicts our previous assumptions or beliefs. That's the true application of the scientific method in the case of healthcare. I hope that was helpful in some way. If you're a patient out there and you're frustrated with your lack of progress with SIBO, you're definitely not alone. If you're a clinician out there and you're frustrated with your lack of progress with SIBO in terms of treating patients, you're definitely not alone. I think we should ... we need to get these questions out there more so that we can all work together to answer them. Okay, that's it for now. Please continue to send your questions in at chriskresser.com/podcastquestion, and I'll talk to you next time. Take care, everybody.

from Chris Kresser https://chriskresser.com/unanswered-questions-about-sibo/
via Holistic Clients

Manifestos and destinies: Notes from Session 8 of TEDGlobal 2017

Ameenah Gurib-Fakim became the sixth president of Mauritius in 2015 (slightly to her surprise). Now, she’s using her platform to build capacity and highlight the biodiversity of her home country. She was interviewed onstage by Stephanie Busari of CNN at TEDGlobal 2017: Builders. Truth-Tellers. Catalysts., on Wednesday, August 30, 2017, in Arusha, Tanzania. Photo: Ryan Lash / TED

It’s the last session, can you believe it? This is the part where we declare our intent to take all we have learned and proceed with purpose to change the world. But first, a few big statements from inspiring speakers to wind us up — the kind of statements that will send us out in fighting shape, ready to take on any challenge.

Ladies and gentlemen, boys and girls, poodles and labradors … this is the last session of TEDGlobal 2017, in Arusha, Tanzania.

And since we’re already in party mode, Sauti Sol open the session with three of their hottest numbers back to back — “Live and Die in Africa,” “Sura Yako,” and “Kuliko Jana.”

The impossibly wonderful East African superstars Sauti Sol play at TEDGlobal 2017. Photo: Bret Hartman / TED

This kicks us into a few minutes of audience feedback, with a lineup for the mic and 60 seconds each on the clock — including a solid shout-out to Ghada Wali, a report from the flooding in Houston, Texas, and a stirring manifesto from Ory Okolloh. An excerpt:

We are called upon to decolonise our spaces, our education and our minds.
We are called upon to resist
We are called upon to be courageous
We are called upon to own our culture (and by own I mean get paid). Nigerian music is leading the way — hi, Sauti Sol!
We are called upon to make democracy work. Development is not inconsistent with freedom.

In the final session of TEDGlobal 2017, another president graces the stage — this time, here in person. Maritius’ president, Ameenah Gurib-Fakim, is the only woman president on the continent, and the only Muslim female head of state currently in office. But this is hardly her only remarkable achievement. Gurib-Fakim is also a biodiversity scientist; in fact, well before she imagined she might be tapped to be president, she gave a TED Talk in 2014 about her five favorite plants. We will save the full details of her interview with CNN’s Stephanie Busari for a separate post, but we can tell you that save for one or two deflections, the president acquitted herself well. Not bad for someone who, three years ago, did not even aspire to sit in the president’s house.

In the past 50 years, 37 languages from sub-Saharan Africa have become extinct, and 315 languages across Africa are currently listed as endangered by UNESCO. Yvonne Chioma Mbanefo recollects how as a child she would get into trouble in school for speaking in her native tongue, Igbo — and says that “in many schools across Africa today, children are still being punished for speaking their indigenous languages.” For parents who realise the importance of preserving identity by teaching their children their native language (since many kids in Africa are taught English or French in school, not their local language), teacher-quality learning materials are scarce. It’s why Chioma Mbanefo has created micro-language lessons and illustrated dictionaries to help children learn the Igbo language. Next stop: more languages.

Yvonne Chioma Mbanefo created language lessons to teach her kids — and the world’s kids — her own native language, Igbo — to preserve it for generations to come. Photo: Ryan Lash / TED

University professor Clapperton Chakanetsa Mavhunga is training thinker-doers and problem solvers. This will require an entirely new curriculum, he says. “The curriculum we are designing shifts attention from merely meeting the needs of foreign industry towards producing visionaries, critical thinkers, makers, and designers, to imagine and create new industry that meets the needs of society.” Clapperton’s is the first of several talks in this session to turn into a good old-fashioned full-throated manifesto — a cry for African students and teachers to run toward problems, not away from them, and claim the creativity and riches of Africa for the people who live there.

Clapperton Mavhunga asks us to lean toward problems. Photo: Bret Hartman / TED

Dayo Ogunyemi believes in the transformative power of film — and his talk uses strong images from Nigerian film as a springboard to examine Africa’s self-image. He leads us through a thought exercise called the 100-year leap: Imagine stepping back in time to 1917. Now imagine that same world but with semiconductors, modern medicines, jets. Dayo suggests that Africa’s untapped innovation could lead to just as big a jump — a century’s worth of progress — if it can only be unleashed. In a moment that brings the point home, he asks the audience to imagine having only 3 hours of electric power per day, or unpredictably losing internet for 10 or 16 hours at a time. (Reader, I have no need to imagine this.) Methodically moving forward to fill the infrastructure and services gaps, to bring stable power, water and connectivity to African nations, is key to pushing the continent forward.

Dayo Ogunyemi speaks in front of a still from Rungano Nyoni’s film “I Am Not a Witch,” a story of Zambia that brought a challenging new vision to the Cannes Film Festival this year. But what matters, Dayo suggests, is not so much the international festival crowd, but what Africans think of their own creators. Photo: Bret Hartman / TED

Kisilu Musya quit his job in the city to become a farmer. But for years, he struggled. Failed crops made it difficult to put food on the table and send his children to school. When he consulted the other farmers who lived near him, he discovered that his situation wasn’t unique. His thirst for a solution drove him to enroll in agricultural courses, where he learned how climate change had shifted the realities of growing crops. He would need to change his methods to turn his farming fortunes around. Realising that it would take a village, Musya took his newly acquired knowledge back to his community. He reports that the techniques they would execute together, beginning from a small-scale irrigation pilot, saw them achieve three times the yield they were accustomed to seeing when harvest time came. He kinda got carried away towards the end, and host Emeka stepped onstage to help him wind up his talk with a hug and a smile. The audience loved him anyway, and he stayed onstage, sandwiched between hosts Chris, Emeka, Lolo and Kelo, as they said their last thanks and sent us out into the world.

Kisilu Musya found his voice as a farmer, a community leader and a filmmaker, telling the story of a community effort to grow food and face climate change. Photo: Bret Hartman / TED

The conference has ended, but we’ve still got a lot of great content — features and, very soon, video — to share with you in coming days and weeks. In the meantime, check out all the TEDGlobal 2017 coverage, as well as all the conference photos on Flickr.

Emeka Okafor, Lolo Madikgetla, Kisilu Musya, Chris Anderson, and Kelo Kubu wave good-bye to TEDGlobal 2017: Builders. Truth-Tellers. Catalysts. Photo: Ryan Lash / TED

from TED Blog http://blog.ted.com/manifestos-and-destinies-notes-from-session-8-of-tedglobal-2017/
via Sol Danmeri

Great shorts: All the short films and video played at TEDGlobal 2017

How does TED complement a program of speakers sharing bold ideas, tough truths and jaw-dropping creative visions at TEDGlobal 2017 in Arusha? With interstitials: the beautiful, funny, inspiring, silly, short video breaks screened in between speakers.

Pulling from a global pool of creativity, talent and thoughtfulness, this year’s TEDGlobal interstitial lineup boasts many films directed, produced, written or prominently featuring African and diaspora artists. Enjoy the seventeen interstitials shown at TEDGlobal 2017 that got our creative juices flowing, our dancing shoes tapping and our hearts beaming.

Title: “We are KOKOKO!”

The short: Meet KOKOKO!: The energetic and explosive musical group creating new sounds with instruments they make, inspiring a thriving alternative dance in Kinshasa, D.R.Congo. (We edited it down for the TED stage.)
Creator: La Belle Kinoise

Title: “Ethiopia!”

The short: A mouth-watering (and toe-tapping) look into the making of injera, False Banana and Coffee Arabica and other staples of Ethiopian coffee.

Creators: Directed and Edited by Daniel Klein and Mirra Fine

Title: “Herencia de Un Pueblo (Inheriting a Legacy)” (trailer)

The short: Set in the vibrant Peruvian town of El Carmen, this film highlights the people, town and dance legacy of African descendants of the diaspora.

Creator: Directed by Carmen Román

Title: “A Small Escape”

The short: An animated film about a pair of scissors trying to escape a kitchen that will leave you cheering for your craft supplies!

Creator: Directed by David Sandell

Title: ”WoodSwimmer”

The short: Practically hypnotic, “Woodsimmer” is a music video made entirely of cross-sectional photographic scans of pieces of hardwood, burls and branches.

Creator: Directed by Brett Foxwell

Title: Sons of Kemet, “In the Castle of My Skin”

The short: An imaginative dance video with fun choreography to match an upbeat tune.

Creator: Directed by Lebogang Rasethaba. Production Company: Arcade Content

Title: ASA, “A Call to Dance in Senegal”

The short: The beautiful and haunting dance film featuring the incredibly talented Senagalese dancers Khoudia Toure and Pierre Belleka, otherwise known as Dexter.

Creator: Directed by Diane Fardoun

Title: “Salvation”

The short: A quick and mesmerizing journey through time from the birth of a planet to the growth of the human race, all created from a multitude of found objects salvaged from car-boot sales and flea markets around London!

Creators: Directed by Noah Harris & Andy Biddle. Production Company: Blinkink.

Title: “The Tale of Ikiré Jones”

The short: Clothing company Ikiré Jones is the brainchild of two first-generation children from Nigeria and Cambodia, Walé Oyéjidé, a TEDGlobal Fellow, and Samuel Hubler, creating an Afro-futurist take on the modern suit.

Creator: Directed by J.M. Harper

Title: “Mapping Zanzibar Using Low-Cost Drones”

The short: The inspiring story of how the Zanzibar mapping initiative is creating a high-resolution map of the islands of Zanzibar and Pemba, using low-cost drones instead of satellite images or manned planes to assist with better planning, land tenure and environmental monitoring.

Creator: World Bank Africa

Title: 2016 AICP Sponsor Reel

The short: This colorful video remix of Major Lazer’s “Light It Up” is a celebration of global creativity and some truly epic dance moves.

Creators: Concept, Design and Direction by Method Studios. Directed by Rupert Burton. Creative Director, Jon Noorlander. Music: Major Lazer “Light It Up” (Remix)

Title: “Shanty-Megastructures”

The short: An artistic, visual conversation on how slums are frequently viewed as unsightly eyesores to be bulldozed, leaving their inhabitants completely displaced.

Creator: Directed by Olalekan Jeyifous

Title: “Gift”

The short: A poetic film teaching us about perception from the vantage of a young child who dances to the sounds of his fears to find his freedom to re-imagine his life.

Creator: Directed by: Dan Mace

Title: “Blooms”

The short: A spellbinding look at Blooms, 3-D printed sculptures designed to animate as a single self-contained sculpture when spun under a strobe light .

Creators: John Edmark, Artist. Cinematography and editing by Charlie Nordstrom

Title: “Words”

The short: An exploration of the expression of words and their creation of the visual world around us, with an eye on “the fundamentals of natural laws and laws of nature themselves.”

Creators: Concept/Design/Animation by Enle Li & Liz Xiong

Title: “Woodoo”

The short: A fun and quirky stop-motion study of wood that brings its shape and consistency to life.

Creator: Directed by Andre Maat

from TED Blog http://blog.ted.com/great-shorts-all-the-short-films-and-video-played-at-tedglobal-2017/
via Sol Danmeri

Level 1: The Precision Nutrition Formula: Build your coaching practice. Make more money. Get better results for the people you want to help.

How would the PN Formula change your career?

Once you’re Precision Nutrition Level 1 Certified, you can use the Precision Nutrition Formula — world-class curriculum, expert coaching, innovative software — to help improve the nutrition, fitness, and health of the people who turn to you for advice. It’s your springboard to a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results.

The post Level 1: The Precision Nutrition Formula: Build your coaching practice. Make more money. Get better results for the people you want to help. appeared first on Precision Nutrition.

from Blog – Precision Nutrition http://www.precisionnutrition.com/precision-nutrition-formula-for-coaching-and-business-level-1-blog
via Holistic Clients

7 proven + profitable models for adding nutrition coaching to a health and fitness business. Help more people and build a thriving practice with these expert tips.

Learning more about nutrition is one thing; turning that knowledge into results (and a thriving practice) is another. That’s why, in this article, I share seven proven business models from top health and fitness experts. Use them to grow your existing practice — or to get a new one off the ground.

++++

The fitness industry is evolving. And with it, coaching is evolving too.

People aren’t just looking for ‘personal trainers’ or ‘nutritionists’ anymore — they’re looking for well-rounded coaches who can help them look, feel, and live better, in a way that lasts.

A big part of that, of course, is eating better.

That’s why modern health and fitness pros are learning more about nutrition than ever before; they’re reading books, taking courses, and getting certified.

But getting the knowledge is one thing; turning it into results (and a thriving practice) it is quite another.

That’s why, when we recently updated and re-opened our Precision Nutrition Level 1 Certification, we added an entire chapter on business, advertising, and marketing (click here to see the table of contents for the course).

It’s also why we put together this article.

In it you’ll learn 7 proven models for adding nutrition coaching to your practice. (Or, if you’re just beginning, how to offer it right from the start). These come from some of the industry’s top experts, including: Alwyn Cosgrove, Jonathan Goodman, Sean Greeley, Pat Rigsby, and yours truly.

Here’s a snapshot of what we’ll discuss:

Which model is best for you?

All of the strategies here are proven and expert-vetted — so you really can’t go wrong with any of them. Still, they all have pros and cons. One model might be a lot more effective for, or better suited to, you (and the people you help) right now.

Feel free to read them all from top to bottom, or just jump to the section most relevant to you by clicking one of the links below.

• Individual model
• Small group model
• Transformation contest model
• Corporate model
• Online coaching model
• Partnership model
• ProCoach model

Individual model

Suggested by John Berardi, Precision Nutrition

For many coaches, working one-on-one with clients is a good start. In the individual model, you present yourself to clients as a well-rounded lifestyle coach — and deliver on that promise.

One of the best ways to do this is to simply build nutrition coaching into your standard package of services.

Step 1: Get a commitment

Ask for the commitment you need to get real, sustainable change. That’s probably at least six months… maybe 12.

Establish an agreement for this duration and bill per unit of time (weekly, monthly, quarterly) instead of per session.

Then, begin your nutrition coaching practice (simply adding it to the training, therapy, or other services you’re offering if you’re already in business).

Step 2: Decide how to work nutrition into your one-on-one sessions.

There are two options here.

Option 1: Offer a dedicated, regularly scheduled nutrition session every 1-2 weeks.

Value that session equal to what you’d value a training/workout session if you currently provide that. For example, if you charge $100/session for fitness training, you’ll charge $100/session for nutrition coaching.

Option 2: If you’re adding nutrition to an existing business, tack on 15 minutes to each client training session.

Do this ideally at the start of the session, before your client is tired.

Meet in a quiet place. Don’t do this while your client is foam rolling or warming up.

Factor this extra time into your price per session. For example, if you charge $100 per session, consider charging $125 for a session that includes nutrition assessment and consultation.

At this point, you’re probably asking: “With a higher price point and a longer commitment, won’t that mean fewer clients?”

Probably not. As current (and prospective) clients see the tremendous value this sort of holistic coaching provides — and begin to see you as an elite-level, well-rounded coach — they’ll be more eager than ever to work with you.

However, even if you did lose a few clients at first (which isn’t likely), you’ll begin attracting clients who are really ready for change, and willing to commit. Of course, that means you’ll get better results, and a better shot at establishing a great reputation, not to mention the income that reflects what you’re really worth.

Step 3: Develop your nutrition coaching format.

Here’s an example of what an hour of nutrition coaching might look like, based on the methods we teach in the Precision Nutrition Level 1 Certification:

1. Start with an assessment (if warranted) — check out the ones we use at Precision Nutrition for guidance.

This would involve tracking the things important to your client. It could be objective things like weight, girths, skinfolds, photos and food intake. Or subjective things like mood and perceived health.

2. Review check-in questions.

During the prior week or two, you should have assigned new habits or practices for your clients to work on. Review how they’ve done with those practices, celebrate all successes, and talk through any challenges around those habits.

3. Look back, look ahead.

Most clients tend to focus on how far their goals are ahead of them, and how much time, effort, and work still remains. Change their focus by looking backwards and reframing the future as a set of opportunities.

Review what they’ve accomplished and what they’re currently excited about or looking forward to:

Looking back over the last xx days, what are you most proud of?

Today, what are you most excited about?

Looking forward, what are you most confident about for the next xx days?

4. Establish the next practice to work on.

Together with your client, collaborate on what to do next. As part of your decision-making process, consider your client’s progress, their changing goals, current sticking points, and what feels most important and/or urgent to them.

Once you agree on next actions, ask: How confident are you that you can follow this for the next xx days? Adjust as necessary until you come up with something you think will make a difference and they think they can actually do.

5. Create a plan/discuss next steps that will set them up for success.

Based on what we decided to practice over the next xx weeks…

What advantages do you have that’ll make this easy?

What surprises or challenges may come up and get in the way?

What sort of things might you do to overcome these challenges?

Top benefits of the individual model:

Easy to get started. If you have training clients,, you have potential nutrition clients too.

Keeps the scale small and manageable. This is a great place to start if you don’t feel ready for large-scale coaching, or if you’re simply happier coaching people one-on-one.

Simple integration with existing services. You’ll still be leaps and bounds ahead of the run-of-the-mill trainers out there because you’ll be coaching people to better, lasting change. You’ll have real results to show for your efforts — and you’ll be able to charge for it.

Small group model

Suggested by Alwyn Cosgrove, Results Fitness University

Unlike the individual model, the small group model lets you coach several people simultaneously in the same session. The sessions are held at a regular, recurring time, and everyone works together. Usually, there’s also a finite end point (such as an 8-week or 12-week program).

This is also a nice way to make the most of your time. You’re spending an hour (or whatever) regardless; 10 people paying $20 each will yield twice the revenue of 1 client paying $100 for that same hour. Clients may also prefer to trade off one-on-one attention for a cheaper price — or simply like the idea that they’re sharing the journey with others.

Step 1: Add nutrition classes to your existing fitness business.

If you have existing training clients, you can suggest that for an additional fee, they join your small group nutrition class.

Step 2: Consider “front-loading” nutrition for new clients.

Encourage uptake of the nutrition program by offering a free “entry level” nutrition starter class or kit when a client signs up with the gym, if you work in one.

For example, at Results Fitness, every new client gets a “Phase 1” nutrition program that includes some initial habit-based coaching with bonus tools (like a food journal). From there, Cosgrove estimates that 90% of clients upgrade to the 8-week small group program.

Feel free to experiment and discover the “winning formula” that works for your own coaching style and client base.

Step 3: Develop your nutrition class.

What should the classes look like?

Class size can vary depending on your client base and comfort level. However, generally 5-25 clients per nutrition class is ideal.

The class structure could look something like this:

• 30 minutes lecture on a given topic
• 15 minute Q & A
• 15 minute check-in and accountability session

Step 4: Find a good system for tracking compliance.

Accountability generally involves reviewing whether the client has met their stated goals from the last session; and identifying what the client will commit to work on for the next period of time.

The coach can assign the same habit to everyone, or allow each client to choose their own habit for the week, based on what they’re learning and their progress in the program. (Perhaps take a certain supplement each day or practice eating slowly at dinner time.)

Straightforward ways to track compliance include:

Have clients sign a visibly placed whiteboard. By doing so, they’re committing to the week’s habit.

Keep a “compliance grid”. Throughout the program, track each individual’s consistency: If they miss a habit, they get an X; if they do the habit, they get the checkmark.

Assign “accountability buddies”. This allows people to partner up so they may check in with each other about their progress.

Top benefits of the small group model:

Return on investment: You maximize your profitability without investing more time. Serving more people at once, even at a lower rate than an individual hourly model, will allow you to increase profits per unit of time spent.

Accountability: For many people, the biggest barrier to success isn’t knowledge, it’s consistency. And consistency can be helped tremendously by accountability — something that naturally flows from having other people check in on your progress week after week.

Social support: We also know clients are more likely to stick with the program if they have peers, friends or family with similar habits. A group model can provide a community feel and give clients a sense of support. They’ll keep coming back (and re-subscribing to your program) because they want to remain a part of the community.

Transformation contest model

Suggested by Pat Rigsby, patrigsby.com

In a transformation contest model, you provide coaching within a limited time frame (about 4 to 6 weeks), with a very clear goal. The contest offers a prize for a particular achievement, such as:

• body composition changes
• visual transformation
• habit transformation
• athletic accomplishment
• etc.

Step 1: Develop and advertise the contest.

Decide on the criteria and find an enticing prize to draw people in. (Note: You will likely need a sponsor for this prize, especially if you’re not part of a gym.)

Set a registration fee you’re comfortable with. $225 is a typical starting point.

Now, of course, to make a good contest, you need plenty of people. While you can have as many people as you like, to make it sporting I recommend about 20 people as a minimum.

Step 2: Offer ongoing coaching and accountability.

Throughout the pre-specified time frame of the program, you’ll deliver a combination of email coaching and in-person (or online) educational workshops. For example, you might send out a new email every Monday with that week’s program (i.e. workouts and nutritional habits), plus follow-up emails throughout the week.

In addition, you might host weekly in-person workshops or webinars throughout the program that discuss nutritional habits in more detail.

You may also choose to set up an online group, such as a private Facebook group, where you can send a daily reminder or “check-in” asking people to confirm they did their daily habit. This helps to build accountability into the program.

Step 3: Objectively measure results.

For instance:

• If the goal is physical transformation, set times for in-person measurements throughout the program.
• If the goal is athletic achievement, set times for group workouts or “fitness tests”.

Make sure criteria and measurements are clear and transparent. You don’t want people feeling misled or shortchanged.

While the program is short, it enables you to offer a lot of value in a short period.

Top benefits of the transformation contest model:

Creates urgency: The short time frame with specific set dates encourage people to make a commitment.

Highly motivating; keeps people focused: People can see real change within a short time frame, with a set endpoint. They can go “all in”, with an intense and focused effort.

Immediate cash influx and long-term financial benefit: You’re both enhancing the value of existing clients by getting them to pay for a new service, and bringing in new clients who may sign up for other programs/training with you.

Enables you to deliver nutrition coaching and fitness coaching together in a structured way. This may be a good model if you want to incorporate some nutrition coaching into your work but aren’t ready to transfer it to your standard programs/training models.

Corporate model

Suggested by Sean Greeley, Net Profit Explosion

In the corporate training model, you’ll provide nutrition coaching to a workplace (either a whole company or a specific department).

Corporate demand is increasing. It’s a great way to scale up your business and sell your services at a higher corporate rate.

It’s also mutually beneficial: Employees appreciate getting access to quality nutrition coaching and employers love the corporate culture and team-building benefits while improving the health of their employees.

Step 1: Get comfortable coaching large groups of people.

Get some experience with the group setting by starting with the small group or transformation contest model.

Step 2: Decide on the format of your nutrition coaching program.

For corporate clients, you’ll need to make a few amendments to your existing model, but you can borrow many of the same practices of either the small group program or the transformation contest program, depending on company size.

Top benefits of the corporate model:

High profits: Corporate coaching programs usually come with a higher price tag. Just be sure you can deliver on your promises. They will expect good service.

Less investment of time and administration: Corporate programs don’t need the marketing or sponsorship of free-standing transformation contests. This makes things more efficient (and potentially more profitable) for you. Transformation contests can be a bit heavy on logistics. Within a company environment, they become much more straightforward.

Broader audience: A corporate program can give you access to a large group of people (e.g. 100+), allowing you to sell/upgrade more clients after the program is complete. (This assumes you have your clients’ permission to do so.)

Online coaching model

Suggested by Jonathan Goodman, The Personal Trainer Development Center

Online coaching typically involves weekly programming (by email or a software service), which may include written, photo and/or video content. It will require a degree of one-on-one time from you to provide accountability or answer questions, but that time should be structured and limited, as described below.

Step 1: Choose how many clients you want.

Your goal number of clients should depend on what you are trying to accomplish. Are you starting an online-only business? Is this supplemental to other projects, or will it be your full-time work?

If it’s supplemental, or you’re just getting started, you may choose to begin with a small group (e.g. 10 to 20) and a small price point ($100/month).

Up to around 30 or 40 people seems to be manageable without special software. Beyond that point, you may wish to use a special software system to help manage clients and content delivery.

Step 2: Choose your specialty or “niche”.

Efficient online nutrition coaching requires you to focus and establish templates for client “type”. Pick no more than 3 types of clients you want to include in your online program.

For example:

• 25-30-year-old males looking for muscle
• Women in their 30s who recently had a baby.
• 18-25-year-old male college athletes
• etc.

Step 3: Assess your prospects in advance.

Ask potential clients to fill out a questionnaire. You can set up a simple survey online using a system such as Survey Monkey.

This will not only help you vet clients to make sure they fit your area of specialty, but also to anticipate needs and problems in advance. (For example, if they have a shoulder injury, you will need to adjust their workouts accordingly.)

Step 4: Create 3-4 phases of programming for each client type.

Each client in the same category will receive a similar program, tailored slightly for them, based on their questionnaire answers.

Step 5: Set appointed times for compliance check-ins.

For example, at the end of the week, the client can send you their food journal, or their update on what habits they kept, etc. You can schedule a time to review your email and check off your client’s’ compliance using your favorite method (e.g. a whiteboard or spreadsheet).

Schedule your time carefully. Set up regular appointments for yourself for when you will send materials to clients, when you will check email or conduct accountability check-ins, schedule follow-ups, etc.

Step 6: Consider software.

Once you get a broader scope of clients, you may look at buying software to help you deliver nutrition coaching materials to clients.

Unfortunately not all software services support nutrition coaching. If you’re going the software route, be sure to speak with a representative about nutrition coaching in advance to make sure it has the functionality you need.

[Editor’s note: Precision Nutrition’s ProCoach is just this type of nutrition coaching software. It allows health and fitness pros to leverage our proven methods with their own clients.]

Top benefits of the online coaching model:

It can save you time and money… if you do it right. Remember, online training doesn’t have to be a big business; it can be a great adjunct to an existing in-person training business. For example, if you are training at a gym and want to try combining nutrition coaching with fitness, this can be a good way to do that on the side.

Client adherence can actually be better. Think about it: At a big box gym, the client buys “training”. Not the trainer. The gym usually picks the trainer for them. The client and trainer may or may not be a good fit — and the client feels no sense of agency in the decision. On the other hand, when you’re an online trainer, the client picks you. Not a gym. You. (Of course, this applies if you’re an independent trainer, too. In this case, online training is a way of broadening your reach.)

You reach the people who need you. Online training is a great way to reach people who need the help, such as people who can’t afford gym memberships or personal training, or who are intimidated by gyms. It’s more accessible for many people.

More flexibility. Online training can give you more freedom for how and when you train, allowing you to block off time according to your own schedule and use your preferred ways of working.

Just remember, in order to save you time, you must work efficiently and systematically. If you’re redesigning your programs for each and every person, and answering email all day long, you’re probably not going to get the results or profit you hoped for.

Partnership model

Suggested by John Berardi, Precision Nutrition

What if you’re not quite ready to provide nutrition coaching within your business?

No problem. You can outsource it.

The truth is, some coaches who are qualified to dispense nutrition advice (including Precision Nutrition Certified pros) decide that now isn’t the right time to formally incorporate practice-based nutrition coaching into their business.

That’s a fair decision. After all, it takes time to make any kind of addition or change to your business. It takes time to put all this nutrition stuff into practice, let alone become an expert at it. And it takes time to settle into your sweet spot of expertise, wherever you find it.

Meanwhile, you want the best for your clients. You don’t want them getting lost in diet fads or repeating harmful patterns. You want them to feel good and succeed, in and out of the gym.

So let’s say you decide that, at least for the time being, you’d like some help delivering nutrition coaching. This is where a partnership model can be useful.

Step 1: Start by picking your partner.

This may be a local nutritionist or dietitian who you trust and respect. Or it may be a reputable online coaching company, like us. (Obviously, at Precision Nutrition, we believe we’re the best in the world at what we do. So perhaps you want to partner with us? If so, drop us a line and let us know.)

Step 2: Decide on your partnership arrangement.

If you’re teaming up with a local nutrition pro, figure out what works best for the both of you: Will you exchange referrals? Go with affiliate-type commissions? Come up with a barter system?

There are lots of options, although my experience suggests that affiliate/referral commissions work best. With affiliate commissions, you determine a commission rate. Your affiliate partner pays you that rate for each person you refer to them. (And vice versa if they’re referring clients to you.)

This type of revenue sharing model is commonly used in the digital/online world but there’s no reason it can’t be done offline too. Obviously, you can negotiate whatever you agree is fair, but a commission of 10 to 20 percent on each coaching package sold is standard.

For example, let’s say you decide you want to partner with us. As a Precision Nutrition Certification student or graduate you can become a referral partner of ours. You contact us, sign up for our affiliate program, and you’re given a special link to share with clients for them to learn more about Precision Nutrition Coaching.

For each client you think is a good candidate, you share that link with them. And if they go on to sign up for coaching, you get paid a generous percentage of the sale.

This is just an example, of course. You could set up a similar relationship with any other nutrition coach or nutrition company you choose, as long as they’re amenable.

The key is to make sure they’re giving advice you actually believe in, so that your clients aren’t receiving mixed messages and getting confused.

Step 3: Stay in touch with the client about their nutrition coaching.

For example, you might schedule regular check-ins to see how it’s going, what habits they’re working on, etc.

Just stay informed so you have a sense of their progress and so you can make sure your programming dovetails with what’s happening on the nutrition side.

Top benefits of the partnership model:

You can take care of your clients. If you aren’t ready or able to offer nutrition coaching right now, you’ll know they’re getting quality support in this area. Part of being a great coach is knowing when to call in extra resources to help your client succeed. Not everything needs to come from you.

You buy yourself some time. Keep working in the areas where you’re already a superstar. Meanwhile, keep learning and practicing in areas you want to grow. Remember, you don’t have to do everything all at once.

You keep it simple. Like your business the way it is now? Not excited about adding or changing things? Outsourcing is an easy solution.

You make a bit of money, and/or find some new clients. Partnership can open up new opportunities and it can even make you some cash, with very little investment on your part.

Precision Nutrition’s ProCoach

As an addition, or alternative, to the models above, you may consider using Precision Nutrition’s ProCoach software, which offers Precision Nutrition Certification students and graduates an easy way to deliver the practice-based nutrition coaching we teach in our program.

In this model, ProCoach delivers the Precision Nutrition Coaching curriculum to your clients, while keeping you in the driver’s seat as the coach.

You sign up your clients, and ProCoach runs automatically for each person.

Each of your clients will get 12 months of lessons, habits and progress check-ins, delivered to them automatically on your behalf. Meanwhile, ProCoach gives you a platform to track their progress.

While ProCoach delivers the programming, you are the coach. That means you can help your clients through the curriculum in whatever way you choose — whether that’s in person, entirely online, in a group setting in the gym, a corporate setting, and so on.

Here’s an idea of how this works.

Step 1: Get started on (or complete) your Precision Nutrition Certification.

Again, ProCoach is only available to Precision Nutrition Certified pros.

Step 2: Sign up for ProCoach.

We’ll be making more spots available to certified pros soon. Click here to check out our next launch date.

Step 3: Register your client(s) for the program.

This takes less than 30 seconds per client. The program immediately kicks off and gives your client access to their personal dashboard, from any device.

Step 4: Review the client’s assessment answers.

The program begins with an initial screening and assessment questionnaire. You can then review your client’s responses to get to know more about them and understand their goals.

Step 5: Let the program run.

At this point, the program runs like clockwork. Clients get daily emails with short reviews and lessons about what they should be working on that day. Every two weeks they will practice a different habit, supported by daily guidance in the form of written, audio, and visual content.

Step 6: Review client progress.

Every week or two, clients are asked to report markers of progress such as body weight and photos. Through your ProCoach dashboard you will be able to review client progress. You can easily track all of your clients at a glance, and deep dive into each client’s individual progress as you wish.

Step 7: Check in and provide feedback.

If you want to be more involved, you can check in, provide feedback, and give high fives through the ProCoach communication system. Depending on your coaching style, you can also add your own personal elements to this — such as in-person coaching, group meetups, webinars, etc.

Top benefits of the ProCoach model:

Provide a reliable nutrition coaching experience. You’ll deliver the same high quality nutrition coaching experience to every single client regardless of what else is going on… in your life or your client’s.  ProCoach offers our “road-tested”, evidence-based, real-world-proven system and experience for clients. We’ve put some serious mileage on it so we know it works.

Scale up. (The sky’s the limit.) You’ll be able to coach 5 clients, 50 clients, or 500 clients easily — because ProCoach makes it simple. We’ve already coached more nearly 100,000 clients using this very system. Think you can handle that many clients? Go for it. The system will work, whether you have 10 clients or 10,000.

Automation makes it easy. You’ll be able to deliver nutrition habits, lessons, and assignments on time and on track, no matter what else you’re doing. Whether you’re sleeping, busy, out of town, in bed with the flu, stuck in traffic or on a plane somewhere above the Pacific ocean… it doesn’t matter. You don’t have to be there all the time, or married to your laptop, always wondering and worrying. The system will take care of your clients, and make sure they get what they need. Daily, weekly, and monthly check-ins and progress tracking are also automated.

What to do next:
Some tips from Precision Nutrition

Whether you’re already in the middle of your coaching career or you’re just starting out, getting a top-notch nutrition education is the most important (and first) step.

Then you’ll need smart tools and systems for using that knowledge to get the best results for your clients — and for your business.

In this article, we’ve offered lots of ideas for adding nutrition coaching to your practice. It can sometimes feel overwhelming. But starting with these steps will help you stay focused.

1. Know your stuff.

The business models we’ve laid out in this piece only work if you truly know your stuff. For example: If you’re going to coach nutrition, make sure you understand the fundamentals.

And just like nutrition, business is an ongoing learning process, too. Do you know the essentials of sales and marketing and buying psychology? Can you express what you do with clarity and passion? Do you know how to demonstrate authority and build a top-notch reputation for yourself? These may be areas where more study is needed to raise your game.

Take an honest assessment of where you are now as a coach and a business person. Where are your gaps?

Of course, if you don’t have the fundamental nutrition knowledge yet, maybe it’s time to get your Precision Nutrition Level 1 Certification. It’ll boost your credentials and up your game. Plus, once certified, you can use ProCoach.

2. Value your time and your services.

It may be tempting to give your nutrition knowledge away for free. Clients (and friends and family) may ask you to do so, without giving it much consideration.

But if you want to make a living as a trainer or coach, you need to put a price on your nutrition coaching services — whether that’s an increased hourly rate or a special program.

You also need to value your own time. The adage “time is money” is particularly true for fitness and health professionals. Be clear and specific about when you’re available to clients, and how the time will be used.

You can also apply my ‘1-minute rule’. If you can answer the question in less than one minute, go for it. If you’ll need more than that, it falls under the umbrella of coaching — and that means you charge for it.

3. Use a system.

Nutrition coaching really isn’t something you can wing. The best, most effective, way to use your knowledge — for the good of your clients and your business — is to have a system in place.

As you consider which business model to use, consider your goals and preferred way of working.

Do you feel most inspired when interacting with clients one-on-one? Do you love the group setting because of your passion for public speaking? Are you pressed for time, making the online option most practical for you? Do you need to work with a partner or other third party for now, while you refine your nutrition knowledge and coaching skills?

All of these options have their own pros and cons; there is no single “right” way to do things.

It may take some experimentation before you find what works best for you. Start by picking one system, and giving it a try. As you go, you’ll learn from your mistakes, discover what works best, and adapt accordingly.

4. Get some support, if you need it.

You don’t have to do everything all by yourself, or all at once. If you’re not quite ready to provide nutrition coaching to your clients, you may consider a partnership model.

Or, if you want to provide nutrition coaching but want an easy and reliable delivery method and a tried-and-tested curriculum, explore Precision Nutrition’s ProCoach.

If you’re not sure which way to go right now, you can always reach out to us at Precision Nutrition — we’re happy to help.

5. Above all else, fulfill your promise.

Remember why you’re doing this in the first place — you’re passionate about fitness and nutrition, and you want to use that passion to help people.

Your success fundamentally depends on the value you deliver. If people hire you because they want to live better, healthier lives, it’ll be your job to help them do that.

That’s the biggest reason nutrition coaching belongs in a fitness business. It’s also why you have the potential to be immensely successful in this industry. Because if you deliver on the promise to help people live and feel better, you will stand out, and you will be successful.

Passionate about fitness and nutrition?

If so, and you’d like to learn more about it, consider the Precision Nutrition Level 1 Certification. Our next group kicks off shortly.

What’s it all about?

The Precision Nutrition Level 1 Certification is the industry’s most respected education program. It gives you the knowledge, systems, and tools you need to really understand how nutrition influences a person’s health and fitness.

Developed over 15 years, and proven with nearly 100,000 clients, the Level 1 curriculum stands alone as the authority on the science of nutrition and the art of coaching.

Whether you’re already mid-career, or just starting out, the Level 1 Certification is your springboard to a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results.

[Of course, if you’re already a student or graduate of the Level 1 Certification, check out our Level 2 Certification Master Class. It’s an exclusive, year-long mentorship designed for elite professionals looking to master the art of coaching and be part of the top 1% of nutrition and fitness pros in the world.]

Interested? Add your name to the presale list. You’ll save $200 and secure your spot 24 hours before everyone else.

We’ll be opening up spots in our next Precision Nutrition Level 1 Certification on .

If you want to find out more, we’ve set up the following presale list, which gives you two advantages.

• Pay less than everyone else. We like to reward people who are eager to boost their credentials and are ready to commit to getting the education they need. So we’re offering a $200 discount when you sign up for the presale list.

• Sign up 24 hours before the general public and increase your chances of getting a spot. We only open the certification program twice per year. Due to high demand, spots in the program are limited and have historically sold out in a matter of hours. But when you sign up for the presale list, we’ll give you the opportunity to register a full 24 hours before anyone else.

If you’re ready to boost your education, and take your nutrition game to the next level, let’s go down the rabbit hole together.

The post 7 proven + profitable models for adding nutrition coaching to a health and fitness business. Help more people and build a thriving practice with these expert tips. appeared first on Precision Nutrition.

from Blog – Precision Nutrition http://www.precisionnutrition.com/adding-nutrition-coaching-to-business
via Holistic Clients

Level 2: How top-earning health and fitness coaches save time, increase their effectiveness, and work + live on their own terms.

Everyone in health and fitness eventually hits the same wall: Time. Specifically, they run out of it. They start feeling like there aren’t enough hours to coach clients, manage their businesses, and keep an eye on growth.

How do top coaches save time, increase their effectiveness, and work on their own terms? With very specific strategies. In this article, I’ll cover those strategies. I’ll also share the training and tools that are helping thousands of coaches change the game in terms of time management and work flexibility.

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Today’s article is really exciting because I’m going to cover something that every single person working in health and fitness (or who wants to work in health and fitness) needs to know.

I’ll cover how to:

• Take stock of what you spend time on in your business.

• Weed out low-value, annoying activities.

• Increase the time you spend on lucrative and fulfilling tasks.

And, in doing so, I’ll show you how you can coach more clients, more effectively; make more money; and have more time off.

Before digging in, however, I wanted to let you know that the most effective, practical, and elite coach development program in the world — the Precision Nutrition Level 2 Certification — is opening very soon.

Our highest rated (and most revered) program, the Precision Nutrition Level 2 Certification gives exclusive training, mentorship, and coaching practice under the guidance of the Precision Nutrition team — resulting in a more rewarding, sustainable, and profitable business for you.

The Level 2 Certification gives you strategies for solving complex coaching challenges so you can do your job with confidence, grow your business while working fewer hours, get the best results, and live life on your own terms.

What’s more, our research shows that while our Level 1 Certification graduates emerge as industry leaders, the average Level 2 graduate:

• gets more clients than the average Level 1 coach,
• retains more clients than the average Level 1 coach,
• gets better results with those clients, and
• reports more fun and enjoyment in their coaching practice.

Indeed, as amazing as our Level 1 certified coaches are, recent ProCoach data with nearly 100,000 coaching clients shows that Level 2 certified coaches have 10 times(!) the retention vs. Level 1 coaches.

To learn more about the Level 2 program, check out this video.

Precision Nutrition co-founder Dr. John Berardi gives you a sneak peek at the Level 2 Certification
(Plus, industry leaders share their thoughts on the program).