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Should Health Coaches and Nutritionists Interpret Lab Tests?

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

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

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

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

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

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

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

What Is a Health Coach?

Health coaches are behavior change specialists. They support people in discovering their own strategies and motivation for change, overcoming obstacles, and implementing protocols that have either been prescribed by a clinician or nutritionist/dietitian or that the client has chosen to implement on their own.

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

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

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

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

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

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

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

What Are Dietitians and Nutritionists?

Dietitians and nutritionists are different than health coaches. Whereas a health coach focuses on behavior change, dietitians and nutritionists are experts that assess, diagnose, and treat dietary and nutritional problems at both an individual and a wider public health level.

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

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

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

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

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

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

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

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

Should Health Coaches Interpret Blood Tests?

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

I believe that health coaches should not interpret blood tests. By “interpret,” I mean “explain the meaning of” the results to the client, which gets very close to (and in some cases may be indistinguishable from) diagnosing a condition or disease.

There are two reasons for this:

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

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

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

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

What about Recognizing “Red Flags” on Blood Tests?

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

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

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

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

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

Reviewing lab test results that relate to nutrition or nutrient levels could be considered nutrition education, which health coaches are permitted to do in some states. However, interpreting blood tests and making diagnoses and treatment recommendations would be considered the practice of medicine in all states and is explicitly prohibited.

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

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

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

A Caveat: Health Coaches with Other Licenses or Credentials

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

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

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

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

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

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

Should Dietitians and Nutritionists Interpret Blood Tests?

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

According to the CDC: (4)

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

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

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

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

So, it’s clear to me that both RDs and certified nutrition professionals with adequate training should be able to interpret blood test results. This is why we have accepted both RDs and certified nutritional professionals in our ADAPT Practitioner Training Program since its inception in 2016.

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

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

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

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

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

Recognizing “Red Flags” and Risk Factors for Chronic Disease

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

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

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

What about Other Types of Lab Testing?

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

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

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

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

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

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

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

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

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

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

It Takes a Village to Reverse Chronic Disease

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

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

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

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

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

Instead, I am a passionate advocate for what I call a “collaborative practice model.” This model links many different providers—clinicians, nurses, dietitians and nutritionists, health coaches, physical therapists, counselors, psychologists, etc.—into an integrated care team that can provide the highest possible level of support to patients.

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

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

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

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

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

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

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

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

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

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Calories in vs. calories out? Hormones? The debate is finally over. Here’s who won.

When it comes to body change, there’s no topic more polarizing than “calories in vs. calories out.” Some argue it’s the be-all and end-all of weight loss. Others say it’s oversimplified and misguided. In this article, we explore every angle of the debate from “eat less, move more,” to hormonal issues, to diets that offer a “metabolic advantage.” In doing so, we answer—once and for all—how important calories in vs. calories out really is. And discuss what it means for you and your clients.  

+++

“You’re either with me, or you’re against me.”

Everyone’s heard this one. But did you know the health and fitness industry has its own version of the saying? It goes: “You’re either with me, or you’re stupid.”

I kid, of course!

But this kind of binary mindset does fuel plenty of heated debates. Especially when it comes to one topic in particular: “calories in vs. calories out,” or CICO.

CICO is an easy way of saying:

• When you take in more energy than you burn, you gain weight.
• When you take in less energy than you burn, you lose weight.

This is a fundamental concept in body weight regulation, and about as close to scientific fact as we can get.

Then why is CICO the source of so much disagreement?

It’s all about the extremes.

At one end of the debate there’s a group who believes CICO is straightforward. If you aren’t losing weight, the reason is simple: You’re either eating too many calories, or not moving enough, or both. Just eat less and move more.

At the other end is a group who believes CICO is broken (or even a complete myth). These critics say it doesn’t account for hormone imbalances, insulin resistance, polycystic ovary syndrome (PCOS), and other health problems that affect metabolism. They often claim certain diets and foods provide a “metabolic advantage,” helping you lose weight without worrying about CICO.

Neither viewpoint is completely wrong.

But neither is completely right, either.

Whether you’re a health and fitness coach tasked with helping clients manage their weight—or you’re trying to learn how to do that for yourself—adopting an extreme position on this topic is problematic; it prevents you from seeing the bigger picture.

This article will add some nuance to the debate.

I’ll start by clearing up some misconceptions about CICO. And then explore several real-world examples showing how far-right or far-left views can hold folks back.

Rethinking common misconceptions.

Much of the CICO debate—as with many other debates—stems from misconceptions, oversimplifications, and a failure (by both sides) to find a shared understanding of concepts. So let’s start by getting everyone on the same page for a change.

CICO goes beyond food and exercise.

There’s an important distinction to be made between CICO and “eat less, move more.” But people, especially some CICO advocates, tend to conflate the two.

“Eat less, move more” only takes into account the calories you eat and the calories you burn through exercise and other daily movement. But CICO is really an informal way of expressing the Energy Balance Equation, which is far more involved.

The Energy Balance Equation—and therefore CICO—includes all the complex inner workings of the body, as well as the external factors that ultimately impact “calories in” and “calories out.”

Imperative to this, and often overlooked, is your brain. It’s constantly monitoring and controlling CICO. Think of it as mission control, sending and receiving messages that involve your gut, hormones, organs, muscles, bones, fat cells, external stimuli (and more), to help balance “energy in” and “energy out.”

It’s one hell of a complicated—and beautiful—system.

Yet the Energy Balance Equation itself looks really simple. Here it is:

• [Energy in] – [Energy out] = Changes in body stores*

*Body stores refers to all the tissues available for breakdown, such as fat, muscle, organ, and bone. I purposely haven’t used “change in body weight” here because I want to exclude water weight, which can change body weight independent of energy balance. In other words, water is a confusing, confounding variable that tricks people into thinking energy balance is broken when it’s not.

With this equation, “energy in” and “energy out” aren’t just calories from food and exercise. As you can see in the illustration below, all kinds of factors influence these two variables.

When you view CICO through through this lens—by zooming out for a wider perspective—you can see boiling it down to “eat less, move more” is a significant oversimplification.

Calorie calculators and CICO aren’t the same.

Many people use calorie calculators to estimate their energy needs, and to  approximate how many calories they’ve eaten. But sometimes these tools don’t seem to work. As a result, these individuals start to question whether CICO is broken. (Or whether they’re broken).

The key words here are “estimate” and “approximate.”

That’s because calorie calculators aren’t necessarily accurate.

For starters, they provide an output based on averages, and can be off by as much as 20-30 percent in normal, young, healthy people. They may vary even more in older, clinical, or obese populations.

And that’s just on the “energy out” side.

The number of calories you eat—or your “energy in”—is also just an estimate.

For example, the FDA allows inaccuracies of up to 20% on label calorie counts, and research shows restaurant nutrition information can be off by 100-300 calories per food item.

What’s more, even if you were able to accurately weigh and measure every morsel you eat, you still wouldn’t have an exact “calories in” number. That’s because there are other confounding factors, such as:

• We don’t absorb all of the calories we consume. And absorption rates vary across food types. (Example: We absorb more calories than estimated from fiber-rich foods, and less calories than estimated from nuts and seeds.)

• We all absorb calories uniquely based on our individual gut bacteria.

• Cooking, blending, or chopping food generally makes more calories available for absorption than may appear on a nutrition label.

Of course, this doesn’t mean CICO doesn’t work. It only means the tools we have to estimate “calories in” and “calories out” are limited.

To be crystal clear: Calorie calculators can still be very helpful for some people. But it’s important to be aware of their limitations. If you’re going to use one, do so as a rough starting point, not a definitive “answer.”

CICO doesn’t require calorie counting.

At Precision Nutrition, sometimes we use calorie counting to help clients improve their food intake. Other times we use hand portions. And other times we use more intuitive approaches.

For example, let’s say a client wants to lose weight, but they’re not seeing the results they want. If they’re counting calories or using hand portions, we might use those numbers as a reference to further reduce the amount of food they’re eating. But we also might encourage them to use other techniques instead. Like eating slowly, or until they’re 80 percent full.

In every case—whether we’re talking numbers or not — we’re manipulating “energy in.” Sometimes directly; sometimes indirectly. So make no mistake: Even when we’re not “counting calories,” CICO still applies.

CICO might sound simple, but it’s not.

There’s no getting around it: If you (or a client) aren’t losing weight, you either need to decrease “energy in” or increase “energy out.” But as you’ve seen, that may involve far more than just pushing away your plate or spending more time at the gym.

For instance, it may require you to:

• Get more high-quality sleep to better regulate hunger hormones, improve recovery, and increase metabolic output

• Try stress resilience techniques like meditation, deep breathing, and spending time in nature

• Increase your daily non-exercise movement by parking the car a few blocks away from your destination, taking the stairs, and/or standing while you work

• Trade some high-intensity exercise for lower-intensity activities, in order to aid recovery and reduce systemic stress

• Improve the quality of what you’re eating, as opposed to reducing the quantity. This can allow you to eat more food with fewer total calories

• Tinker with the macronutrient makeup of what you eat. For example: eating more protein and fiber, or increasing carbs and lowering fats, or vice versa

• Experiment with the frequency and timing of your meals and snacks, based on personal preferences and appetite cues

• Consider temporarily tracking your food intake—via hand portions or weighing/measuring—to ensure you’re eating what you think you’re eating (as closely as reasonably possible)

• Evaluate and correct nutritional deficiencies, for more energy during workouts (and in everyday life)

• Consult with your physician or specialists if consistent lifestyle changes aren’t moving the needle

Sometimes the solutions are obvious; sometimes they aren’t. But with CICO, the answers are there, if you keep your mind open and examine every factor.

Imagine yourself a “calorie conductor” who oversees and fine-tunes many actions to create metabolic harmony. You’re looking for anything that could be out of sync.

This takes lots of practice.

So, to help, here are 5 common energy balance dilemmas. In each case, it might be tempting to assume CICO doesn’t apply. But look a little a deeper, and you’ll see the principles of CICO are always present.

5 common energy balance dilemmas.

Dilemma #1: “I’ve been eating the same way forever, but suddenly I started gaining weight.”

Can you guess what happened?

More than likely, “energy in” or “energy out” did change, but in a way that felt out of control or unnoticeable.

The culprit could be:

• Slight increases in food intake, due to changes in mood, hunger, or stress

• An increase in the amount of energy absorbed—caused by new medication, an unknown medical condition, or a history of chronic dieting

• Physiological changes that resulted in fewer calories burned during exercise and at rest

• The onset of chronic pain, provoking a dramatic decrease in non-exercise activity thermogenesis (NEAT)

• Significant changes to sleep quality and/or quantity, impacting metabolic output and/or food consumed

In all of these cases, CICO is still valid. Energy balance just shifted in subtle ways, due to lifestyle and health status changes, making it hard to recognize.

Dilemma #2: “My hormones are wreaking havoc on my metabolism, and I can’t stop gaining weight. Help!”

Hormones seem like a logical scapegoat for weight changes.

And while they’re probably not to blame as often as people think, hormones are intricately entwined with energy balance.

But even so, they don’t operate independently of energy balance.

In other words, people don’t gain weight because “hormones.”

They gain weight because their hormones are impacting their energy balance.

This often happens during menopause or when thyroid hormone levels decline.

Take, for example, triiodothyronine (T3) and thyroxine (T4), two thyroid hormones that are incredibly important for metabolic function. If levels of these hormones diminish, weight gain may occur. But this doesn’t negate CICO: Your hormones are simply influencing “energy out.”

This may seem a bit like splitting hairs, but it’s an important connection to make, whether we’re talking about menopause or thyroid problems or insulin resistance or other hormonal issues.

By understanding CICO is the true determinant of weight loss, you’ll have many more tools for achieving the outcome you want.

Suppose you’re working from the false premise hormones are the only thing that matters. This can lead to increasingly unhelpful decisions, like spending a large sum of money on unnecessary supplements, or adhering to an overly restrictive diet that backfires in the long run.

Instead, you know results are dependent on the fact that “energy in” or “energy out” has changed. Now, this change can be due to hormones, and if so, you’ll have to make adjustments to your eating, exercise, and/or lifestyle habits to account for it. (This could include taking medication prescribed by your doctor, if appropriate.)

Research suggests people with mild (10-15% of the population) to moderate hypothyroidism (2-3%) may experience a metabolic slow down of 140 to 360 calories a day.

That can be enough to lead to weight gain, or make it harder to lose weight. (One caveat: Mild hypothyroidism can be so mild many people don’t experience a significant shift in metabolic activity, making it a non-issue.)

What’s more, women suffering from polycystic ovary syndrome, or PCOS (about 5-10%), and those going through menopause, may also experience hormonal changes that disrupt energy balance.

So, it’s important to understand your (or your client’s) health status, as that will provide valuable information about the unique challenges involved and how you should proceed.

Dilemma #3: “I’m only eating 1,000 calories a day and I’m still not losing weight!”

So what gives?

The conclusion most people jump to: Their metabolism is broken. They’re broken. And CICO is broken.

But here’s the deal: Metabolic damage isn’t really a thing. Even though it may seem that way.

Now, their energy balance challenge could be related to a hormonal issue, as discussed above. However, when someone’s eating 1,000 calories a day but not losing weight, it’s usually due to one of the two reasons that follow.

(No matter how simple they sound, this is what we’ve seen over and over again in our coaching program, with over 100,000 clients.)

Reason #1: People often underestimate their calorie intake.

It’s easy to miscalculate how much you’re eating, as it’s usually unintentional. The most typical ways people do it:

• They underestimate portions. (For example, without precisely measuring “one tablespoon of peanut butter,” it might actually be two, which adds 90 calories each time you do it)

• They don’t track bites, licks, and tastes of calorie-dense foods. (For example, your kid’s leftover mac and cheese could easily add 100 calories)

• They don’t record everything in the moment and forget to log it later on

• They “forget” to count foods they’d wished they hadn’t eaten

Don’t believe this can be a big issue?

A landmark study, and repeated follow up studies, found people often underestimate how much they eat over the course of a day, sometimes by more than 1,000 calories.

I’m not bringing this research up to suggest it’s impossible to be realistic about portion sizes. But if you (or your clients) aren’t seeing results on a low-calorie diet, it’s worth considering that underestimation may be the problem.

Reason #2: People overeat on the weekends.

Work weeks can be stressful and when Friday night rolls around, people put their guard down and let loose.

(You probably can’t relate, but just try, okay?)

Here’s how it goes: Let’s say a person is eating 1,500 calories a day on weekdays, which would give them an approximate 500-calorie deficit.

But on the weekends, they deviate from their plan just a little.

• Drinks with friends and a few slices of late night pizza on Friday
• An extra big lunch after their workout on Saturday
• Brunch on Sunday (“Hey, it’s breakfast and lunch, so I can eat double!)

The final tally: An extra 4,000 calories consumed between Friday night and Sunday afternoon. They’ve effectively canceled out their deficit, bumping their average daily calories to 2,071.

The upshot: If you (or your client) have slashed your calories dramatically, but you aren’t seeing the expected results, look for the small slips. It’s like being a metabolic detective who’s following—perhaps literally—the bread crumbs.

By the way, if downtime is problem for you (or a client), we have just the remedy: 5 surprising strategies to ditch weekend overeating.

Dilemma #4: “I’m eating as much as I want and still losing weight, so this diet is better than all the others!”

This might be the top reason some people reject CICO.

Say someone switches from a diet of mostly processed foods to one made up of mostly whole, plant-based foods. They might find they can eat as much food as they want, yet the pounds still melt away.

People often believe this is due to the “power of plants.”

Yes, plants are great, but this doesn’t disprove energy balance.

Because plant foods have a very-low energy density, you can eat a lot of them and still be in a calorie deficit. Especially if your previous intake was filled with lots of processed, hyperpalatable “indulgent foods.”

It feels like you’re eating much more food than ever before—and you really might be.

On top of that, you might also feel more satiated because of the volume, fiber, and water content of the plants.

All of which is great. Truly. But it doesn’t negate CICO.

Or take the ketogenic diet, for example.

Here, someone might have a similar experience of “eating as much as they want” and still losing weight, but instead of plant foods, they’re eating meat, cheese, and eggs. Those aren’t low-calorie foods, and they don’t have much fiber, either.

As a result, plenty of low-carb advocates claim keto offers a “metabolic advantage” over other diets.

Here’s what’s most likely happening:

• Greater intake of protein increases satiety and reduces appetite

• Limited food choices have cut out hundreds of highly-processed calories they might have eaten otherwise (Pasta! Chips! Cookies!)

• Reduced food options can also lead to “sensory-specific satiety.” Meaning, when you eat the same foods all the time, they may become less appealing, so you’re not driven to eat as much

• Liquid calories—soda, juice, even milk—are generally off limits, so a greater proportion of calories are consumed from solid foods, which are more filling

• Higher blood levels of ketones—which rise when carbs are restricted—seem to suppress appetite

For these reasons, people tend to eat fewer calories and feel less hungry.

Although it might seem magical, the keto diet results in weight loss by regulating “energy in” through a variety of ways.

You might ask: If plant-based and keto diets work so well, why should anyone care if it’s because of CICO, or for some other reason?

Because depending on the person—food preferences, lifestyle, activity level, and so on—many diets, including plant-based and keto, aren’t sustainable long-term. This is particularly true of the more restrictive approaches.

And if you (or your client) believe there’s only one “best diet,” you may become frustrated if you aren’t able to stick to it. You may view yourself as a failure and decide you lack the discipline to lose weight. You may even think you should stop trying.

None of which are true.

Your results aren’t diet dependent. They’re behavior dependent.

Maintaining a healthy body (including a healthy body weight) is about developing consistent, sustainable daily habits that help you positively impact “energy in” and “energy out.”

This might be accomplished while enjoying the foods you love, by:

• Eating until you’re 80% full
• Eating slowly and mindfully
• Eating more minimally processed foods
• Getting more high quality sleep
• Taking steps to reduce stress and build resilience

It’s about viewing CICO from 30,000 feet and figuring out what approach feels sane—and achievable—for you.

Sure, that might include a plant-based or a keto diet, but it absolutely might not, too. And you know what?

You can get great results either way.  

Dilemma #5: “I want to gain weight, but no matter how much I eat, I can’t seem to.”

The CICO conversation doesn’t always revolve around weight loss.

Some people struggle to gain weight.

Especially younger athletes and people who are very, very active at work. (Think: jobs that involve manual labor.)

It also happens with those who are trying to regain lost weight after an illness.

When someone intentionally eats more food but can’t pack on the pounds, it may seem like CICO is invalidated. (Surprise.)

They often feel like they’re stuffing themselves—“I’m eating everything in sight!”—and it’s just not working. But here’s what our coaches have found:

People tend to remember extremes.

Someone might have had six meals in one day, eating as much as they felt like they could stand.

But the following day, they only ate two meals because they were still so full. Maybe they were really busy, too, so they didn’t even think much about it.

The first day—the one where they stuffed themselves—would likely stand out a lot more than the day they ate in accordance with their hunger levels. That’s just human nature.

It’s easy to see how CICO is involved here. It’s lack of consistency on the “energy in” part of the equation.

One solution: Instead of stuffing yourself with 3,000 calories one day, and then eating 1,500 the next, aim for a calorie intake just above the middle you can stick with, and increase it in small amounts over time, if needed.

People often increase activity when they increase calories.

When some people suddenly have more available energy—from eating more food—they’re more likely to do things that increase their energy out. Like taking the stairs, pacing while on the phone, and fidgeting in their seats.

They might even push harder during a workout than they would normally.

This can be both subconscious and subtle.

And though it might sound weird, our coaches have identified this as a legitimate problem for “hardgainers.”

Your charge: Take notice of all your activity.

If you can’t curtail some of it, you may have to compensate by eating even more food. Nutrient- and calorie-dense foods like nut butters, whole grains, and oils can help, especially if you’re challenged by your lack of appetite.

3 strategies to game the system.

Once you accept that CICO is both complex and inescapable, you may find yourself up against one very common challenge.

Namely: “I can’t eat any less than I am now!”

This is one of the top reasons people abandon their weight loss efforts or go searching in vain for a miracle diet.

But here are three simple strategies you (or your clients) can use to create a caloric deficit, even if it seems impossible. It’s all about figuring out which one works best for you.

Maximize protein and fiber.

Consuming higher amounts of protein increases satiety, helping you feel more satisfied between meals. And consuming higher amounts of fiber increases satiation, helping you feel more satisfied during meals.

These are both proven in research and practice to help you feel more satisfied overall while eating fewer calories, leading to easier fat loss.

This advice can sound trite, I know. In fact, someday when there are nutrition coach robots, “eat more protein and fiber” will probably be the first thing they’re programmed to say.

But the truth is, most people trying to lose weight still aren’t focused on getting plenty of these two nutrients.

And you know what? It’s not their fault.

When it comes to diets, almost everyone has been told to subtract. Take away the “bad” stuff, and only eat the “good” stuff.

But there’s another approach: Just start by adding.

If you make a concerted effort to increase protein (especially lean protein) and fiber intake (especially from vegetables), you’ll feel more satisfied.

You’ll also be less tempted by all the foods you think you should be avoiding. This helps to automatically “crowd out” ultra-processed foods.

Which leads to another big benefit: By eating more whole foods and fewer of the processed kind, you’re actually retraining your brain to desire those indulgent, ultra-processed foods less.

That’s when a cool thing happens: You start eating fewer calories without actively trying to—rather than purposely restricting because you have to.

That makes weight loss easier.

Starting is simple: For protein, add one palm of relatively lean protein—chicken, fish, tempeh—to one meal. This is beyond what you would have had otherwise. Or have a Super Shake as a meal or snack.

For fiber, add one serving of high-fiber food—in particular vegetables, fruit, lentils and beans—to your regular intake. This might mean having an apple for a snack, including a fistful of roasted carrots at dinner, or tossing in a handful of spinach in your Super Shake.

Try this for two weeks, and then add another palm of lean protein, and one more serving of high-fiber foods.

Besides all the upside we’ve discussed so far, there’s also this:

Coming to the table with a mindset of abundance—rather than scarcity—can help you avoid those anxious, frustrated feelings that often come with being deprived of the foods you love.

So instead of saying, “Ugh, I really don’t think I can give up my nightly wine and chocolate habit,” you might say, “Hey, look at all this delicious, healthy food I can feed my body!”

(And by the way, you don’t actually have to give up your wine and chocolate habit, at least not to initiate progress.)

Shift your perspective.

Imagine you’re on vacation. You slept in and missed breakfast.

Of course, you don’t really mind because you’re relaxed and having a great time. And there’s no reason to panic: Lunch will happen.

But since you’ve removed a meal, you end up eating a few hundred calories less than normal for the day, effectively creating a deficit.

Given you’re in an environment where you feel calm and happy, you hardly even notice.

Now suppose you wake up on a regular day, and you’re actively trying to lose weight. (To get ready for vacation!)

You might think: “I only get to have my 400-calorie breakfast, and it’s not enough food. This is the worst. I’m going to be so hungry all day!”

So you head to work feeling stressed, counting down the minutes to your next snack or meal. Maybe you even start to feel deprived and miserable.

Here’s the thing: You were in a calorie deficit both days, but your subjective experience of each was completely different.

What if you could adjust your thinking to be more like the first scenario rather then the second?

Of course, I’m not suggesting you skip breakfast everyday (unless that’s your preference).

But if you can manage to see eating less as something you happen to be doing— rather than something you must do—it may end up feeling a lot less terrible.

Add activity rather than subtracting calories.

Are you a person who doesn’t want to eat less, but would happily move more? If so, you might be able to take advantage of something I’ve called G-Flux.

G-Flux, also known as “energy flux,” is the total amount of energy that flows in and out of a system.

As an example, say you want to create a 500-calorie deficit. That could like this:

• Energy in: 2,000 calories
• Energy out: 2,500 calories
• Deficit: 500 calories

But it could also look like this:

• Energy in: 3,000 calories
• Energy out: 3,500 calories
• Deficit: 500 calories

In both scenarios, you’ve achieved a 500-calorie deficit, but the second allows you to eat a lot more food.

That’s one benefit of a greater G-Flux.

But there’s also another: Research suggests if you’re eating food from high-quality sources and doing a variety of workouts—strength training, conditioning, and recovery work—eating more calories can help you carry more lean mass and less fat.

That’s because the increased exercise doesn’t just serve to boost your “energy out.” It also changes nutrient partitioning, sending more calories toward muscle growth and fewer to your fat cells.

Plus, since you’re eating more food, you have more opportunity to get the quantities of vitamins, minerals, and phytonutrients you need in order to feel your best.

Win. Win. Win.

To be clear, this is a somewhat advanced method. And because metabolism and energy balance are dynamic in nature, the effectiveness of this method may vary from person to person.

Plus, not everyone has the ability or the desire to spend more time exercising. And that’s okay.

But by being flexible with your thinking—and willing to experiment with different ways of influencing CICO—you can find your own personal strategy for tipping energy balance in your (or your clients’) favor.

If you’re a coach, or you want to be…

Learning how to coach clients, patients, friends, or family members through healthy eating and lifestyle changes—in a way that optimizes energy balance for each unique body, personality, and lifestyle—is both an art and a science.

If you’d like to learn more about both, consider the Precision Nutrition Level 1 Certification. The next group kicks off shortly.

What’s it all about?

The Precision Nutrition Level 1 Certification is the world’s most respected nutrition education program. It gives you the knowledge, systems, and tools you need to really understand how food influences a person’s health and fitness. Plus the ability to turn that knowledge into a thriving coaching practice.

Developed over 15 years, and proven with over 100,000 clients and patients, 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 health and fitness coaches in the world.]

Interested? Add your name to the presale list. You’ll save up to 33% and secure your spot 24 hours before everyone else.

We’ll be opening up spots in our next Precision Nutrition Level 1 Certification on Wednesday, April 3rd, 2019.

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 discount of up to 33% off the general price 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 for a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results… this is your chance to see what the world’s top professional nutrition coaching system can do for you.

The post Calories in vs. calories out? Hormones? The debate is finally over. Here’s who won. appeared first on Precision Nutrition.

from Blog – Precision Nutrition https://www.precisionnutrition.com/calories-in-calories-out
via Holistic Clients

Imagine If: A session of talks in partnership with the U.S. Air Force

Curator Bryn Freedman invites the audience to imagine a world we all want to live in, as she kicks off the TED Salon: Imagine If, presented in partnership with the U.S. Air Force. (Photo: Ryan Lash / TED)

The event: TED Salon: Imagine If, curated by Bryn Freedman and Amanda Miller, TED Institute

The partner: U.S. Air Force

When and where: Thursday, February 21, 2019, at the TED World Theater in New York City

Music: Rapper Alia Sharrief, performing her songs “My Girls Rock” and “Girl Like Me”

The big idea: Imagination is a superpower — it allows us to push beyond perceived limits, to think beyond the ordinary and to discover a new world of possibilities.

New idea (to us anyway): We may be able to vaccinate against PTSD and other mental illnesses.

Good to be reminded: Leaders shouldn’t simply follow the pack. They need to embrace sustainability, equality, accountability — not just the whims of the market.

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The talks in brief:

Brenda Cartier, Director of Operations at Headquarters Air Force Special Operations Command (AFSOC) and the first female Air Commando selected for the rank of general

• Big idea: “Precision-guided masculinity” allows us to maintain a killer instinct without discarding the empathetic, “feminine” traits that mitigate the “collateral damage” of toxic masculinity.
• How? Viewing gender as a spectrum of femininities and masculinities allows us to select traits as they fit each situation, without tying our identities to them. As we learn to balance our personalities, we become well-rounded human beings and create more just societies.
• Quote of the talk: “This new narrative breaks us out of a one-size-fits-all approach to gender, where we link male bodies and masculinity and female bodies and femininity. ‘Precision-guided masculinity’ begs us to ask the question: ‘Who is it that is employing those masculine traits to protect and defend?'”

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Could we put a stop to mental illnesses like depression and PTSD before they develop? Rebecca Brachman explores the potential of a new class of drugs called “resilience enhancers.” (Photo: Dian Lofton / TED)

Rebecca Brachman, neuroscientist, TED Fellow and pioneer in the emerging field of preventative psychopharmacology

• Big idea: Brachman and her team have discovered a new class of drugs called “resilience enhancers” that could change the way we treat mental illness like depression and PTSD. These drugs wouldn’t just treat symptoms of the diseases, she says — they could prevent them from developing in the first place.
• How? Brachman’s research applies the fundamental principle of vaccination to mental illness, building up a person’s ability to recover and grow after stress. For example, imagine a Red Cross volunteer going into an earthquake zone. In addition to the typhoid vaccine, she could take a resilience enhancer before she leaves to protect her against PTSD. The same applies to soldiers, firefighters, ER doctors, cancer patients, refugees — anyone exposed to trauma or major life stress. The drugs have worked in preliminary tests with mice. Next up, humans.
• Quote of the talk: “This is a paradigm shift in psychiatry. It’s a whole new field: preventative psychopharmacology.”

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Michele Wucker, finance and policy strategist, founder and CEO of Gray Rhino & Company

• Big idea: Catastrophic events (like the 2008 financial crisis) might surprise us, but too often we invite crises to barrel right into our lives despite countless, blaring warning signs. What keeps us from facing the reality of a situation head-on?
• How? Semantics, semantics, semantics — and a healthy dose of honesty. Wucker urges us to replace the myth of the “black swan” — that rare, unforeseeable, unavoidable event — with the reality of the “gray rhino,” the common obvious catastrophes, like the bursting of a financial bubble or the end of a tempestuous relationship, that are predictable and preventable. She breaks down the factors that determine whether we run from problems or tackle them, and lays out some warning signs that you may be ignoring one of those charging rhinos right now.
• Quote of the talk: “Think about the obvious challenges in your own life and how you deal with them. Do you stick your head in the ground like an ostrich and ignore the problems entirely? Do you freak out like Chicken Little over all the tiny things, but miss the big giant wolf coming at you? Or do you manage things when they’re small to keep them from going out of control?”

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Curator Bryn Freedman interviews executive (and former candidate for president of Iceland) Halla Tómasdóttir about how we can transform corporate leaders and businesses for a better world. (Photo: Ryan Lash / TED)

Halla Tómasdóttir, CEO of Richard Branson’s B Team and former Icelandic presidential candidate, interviewed by curator Bryn Freedman

• Big idea: Corporate leaders — and the businesses they run — are in a crisis of conformity that favors not rocking the boat and ignores big issues like climate change and inequality. We need new leadership to get us out of this crisis.
• How? It’s not enough for corporate leaders to simply follow the pack and narrowly define the missions of their organizations. If CEOs want to avoid the pitchforks of the masses, they must also ensure that their businesses are global citizens that embrace sustainability, equality, accountability — not just the markets.
• Quote of the talk: “At the end of the day, we need to ask ourselves who are we holding ourselves accountable for — and if that isn’t the next generation, I don’t know who.”

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Sarah T. Stewart, planetary scientist at the University of California, Davis, and 2018 McArthur “Genius” fellow

• Big idea: How did the Moon form? Despite its proximity, we don’t actually know! Adding to the mystery: the Earth and Moon are composed of the same stuff, a rarity we’ve found nowhere else in the universe. In trying to solve the mystery, Sarah T. Stewart discovered an entirely new not-quite-planet.
• How? Stewart and her team smash planets together in computer simulations to learn more about how they were created. While trying to uncover the Moon’s origin, they discovered that the early Earth may have been involved in a massive collision with a Mars-sized planet, which then created a “synestia:” a super-heated doughnut of molten material previously unknown to science, out of which the Moon was born.
• Quote of the talk: “I discovered a new type of astronomical object. It’s not a planet; it’s made from planets.”

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Why do teens seem to make so many bad decisions? Kashfia Rahman searches for an answer in psychological effects of risk-taking. (Photo: Ryan Lash / TED)

Kashfia Rahman, Intel International Science and Engineering Fair winner and Harvard freshman

• Big idea: Teenagers aren’t necessarily chasing thrills when they make bad decisions. Rather, repeated exposure to risk actually numbs how they make choices.
• How? After wondering why her peers were constantly making silly and irresponsible decisions, Kashfia Rahman decided to conduct an experiment testing how her fellow high school students responded to risk. She found that habituation to risk — or “getting used to it” — impacts how teenagers make choices beyond their cognitive control. With this insight, she believes we can create policies that more holistically tackle high-risk behavior among teenagers.
• Quote of the talk: “Unforeseen opportunities often come from risk-taking — not the hazardous negative risk-taking I studied, but the good ones, the positive risks,” she says. “The more risks I took, the more I felt capable.”

from TED Blog https://blog.ted.com/imagine-if-a-session-of-talks-in-partnership-with-the-u-s-air-force/
via Sol Danmeri

Strawberry Banana Smoothie with Peanut Butter

Want to take your classic strawberry banana smoothie recipe up a notch? Add a few tablespoons of peanut butter for an epic twist on a breakfast smoothie. If you’re a smoothie lover like us, then our strawberry banana smoothie with peanut butter is a must! With strawberry banana smoothies being ...

The post Strawberry Banana Smoothie with Peanut Butter appeared first on Fit Foodie Finds.

from Fit Foodie Finds https://fitfoodiefinds.com/strawberry-banana-smoothie-recipe/
via Holistic Clients