Carbs, Protein and Fat: How much?

buffet-variations-1321243“What percentage of my diet should be carbs? What about fat? and how much protein do I need?” I get this question all the time and usually give the same answer: do you really want to think about that every day?  The point is, even as a dietitian who is somewhat good in math I would never want to calculate these figures on a daily basis. Even using an app. But many people are confused about this, they hear things at the gym, their marathon running friends are carb loading, or maybe they saw a magazine headline at the grocery store check out. Not to mention goals of losing weight, which usually are part of the motivation to find the best combo of macronutrients that could be the magic answer.

As far as recommendations that would provide a “balanced” diet here is the general guide:

Carbs: 45-65%          Fat: 20-35%               Protein: 10-35%

Many are surprised that our diets should be at least half carbohydrates, with all the low carb diets out there, it may not make sense. Remember, everyone is different and it is important to consider your own health history, metabolism and body. There are some patients I have worked with who respond differently to carbohydrates (such as those with PCOS or polycystic ovarian syndrome) and balancing carbs with protein is important to prevent increases in insulin. And for the average person who wants to maintain a certain level of blood glucose, including protein in a meal definitely helps. It is more about balance and less about avoidance or restricting.

But what if you really did want to figure out what percentage of your diet is protein for example? I do know people who eat a lot of protein thinking it will help them build muscle (just yesterday at lunch a young twenty-something year old teacher had two bunless cheeseburgers on his plate….nothing else). You first would need to know the total amount of calories you ate in a day (nothing I would ever recommend doing, but just to demonstrate how ridiculous and irritating it would be), let’s use 2000 calories as an example.Then 10% of this would be 200 calories. That means 200 calories as a minimum should come from protein. Since protein has 4 calories per gram, that means 200 divided by 4 is 50. So the answer is 50 grams of protein is 10 percent of calories from protein in a 2000 calorie diet. An ounce of meat has 7 grams of protein, so 7 ounces of meat would just about meet the 50 grams. But protein also comes from other foods, even cereals and grains, dairy, beans, nuts and pasta have some protein. See why it would not be too fun to try to figure out? Even for one day, pretty irritating. So what should you do if you want to eat a healthy balanced diet?

I did do a brief review of the research regarding macronutrients and health as well as weight. To put it simply, I could not find any new breaking news regarding macronutrients and weight. Low glycemic index diets do not result in more weight loss as far as current research (that means low carb). The one macronutrient mentioned as affecting both health and weight was fiber. There were several studies that suggested a high fiber diet was beneficial for both health and weight. This means more fruits, veggies and whole grains. Now that is not exactly a newsflash, but does reinforce a “health” approach to eating verses a “weight loss” approach or trying to limit a certain food group. That is why the government came up with the simple “My Plate” illustrating half the plate as “colors”, or fruits and vegetables, a quarter of the plate whole grains and a quarter of the plate protein food, as well as dairy on the side. The message I like to send is variety, not restriction. I don’t think it is “dieting” to try to add more fruits and vegetables to your meals. If you throw strawberries in your salad or an apple in your lunch bag, it makes sense because you enjoy them. This kind of move toward healthier eating does not seem stressful to me. It does not take too much thinking (too much thinking about eating is not health promoting, and tends to add stress which is NOT good for health). If you don’t take the My Plate idea too far (you don’t have to have the perfect plate every meal), then it is a good general and simple guide.

If you are interested in more specifics regarding dietary recommendations, see Dietary Reference Intakes however please keep in mind we all have different needs, and not everyone eats or needs exactly the same amount of a nutrient. These are general recommendations.

The Academy of Nutrition and Dietetics also has a position paper (2002) on the topic called Total Diet Approach. Although it mentions the outdated Food Pyramid it also describes a way of eating where “all foods can fit” and again, stresses the importance of focusing on health without trying to be perfect. If you like a food, any food, you need to fit it in. It is the average intake of nutrients over an entire week for instance that matters. So even if you eat twinkies for all three meals one day, it does not matter….over time.

Bottom line: keep it simple. Learn from listening to your own body. Good old boring common sense…….

 

 

 

 

Should You Care About Your BMI?

hips-don-t-lie-1324351Friday morning as I was having my coffee, doing my usual multi-tasking, kind of listening to the news from my bedroom, something I heard made me stop what I was doing and run to the TV. “Indiana Teen refuses to calculate BMI”. What? I am a huge anti-fan of BMI. I was dying to hear this story. In case you have not heard, this young eighth grade athlete has received national attention after her Facebook Post about refusing to calculate her BMI in a class at school. She had been shamed in the past when she was told she was “obese” according to her BMI. Although she says she knows she is a bigger girl, it never had bothered her before but after that incident she felt bad and so the next time, she refused. Instead she wrote an essay about why BMI should not be used to determine health, especially in a middle school where girls are already super body conscious and insecure. Check out just one article  Indiana Teen Refuses to Calculate BMI to read more. She went to her doctor who did a complete physical with labs and let her know she was fit and healthy. Her message is simple yet powerful: BMI has nothing to do with health.

An eighth grade kid understands perfectly, yet unfortunately, the medical community still does not get it. Besides falsely labeling larger sized people as unhealthy, people who are very ill but have a “healthy BMI” fall through the cracks. I have story after story of eating disorder patients I have worked with in the past who have been starving themselves, purging in all kinds of dangerous ways, yet when they go for their yearly check up, the doctor responds: “You look great! You lost weight!” Which leaves the poor patient who is suffering in a confused and sometimes angry state. Most of the time the health care provider never asks how the weight was lost. It seems assumptions are made that the weight loss was a result of some healthy eating and exercise, but in these situations it is not the case. As long as that number is where it should be, it seems it does not matter.

The reality is that having a healthy  body  is not a simple task. Eating a perfect diet or having the correct BMI does not result in a healthy body, and does not negate unhealthy behaviors such as smoking or starving yourself or being stressed out. Genetics play a gigantic role (we all joke about the old man who smokes a pack a day and drinks whiskey and lives to 100). How it is that we have come to rely on some number based on a calculation using height and weight to tell us anything about someone’s health is beyond me. I believe part of the reason could be because it saves time. It is so much quicker to get a height and weight measurement and calculate BMI than it is to ask someone about all of the details of their lifestyle. Most health care practitioners don’t have time for this. In the hospital where I worked as an outpatient dietitian, we moved into a “productivity” based practice, so instead of an hour with a new patient, I was now expected to assess and counsel a patient and family in 30 minutes. If they were 10 minutes late, I was in trouble. It was heartbreaking to me. How could I even start to help a family with so little time to even find out about who they were? I left that job because of it, but I imagine that office is not unlike many others. Time is money.

So, it you ask me, you definitely should NOT worry about your BMI. Instead, you should worry if your health care providers give you advice without ever asking you about your lifestyle. Oh boy, does it make my blood boil when I hear stories from both friends and patients alike about the assumptions made based on weight or body size. It is prejudice, plain and simple, and it is wrong.

Forget the numbers, and keep it simple. How do you feel? What things run in your family that you need to be aware of? Look at all aspects of your life, both physical and mental (which is why I left that job, the stress was affecting my health). What you eat does matter but just to a degree. For instance, if you don’t drink enough to stay hydrated, you just won’t feel good and it can hurt you, especially in hot weather. If you live on sweets, you will likely not feel good either. If you don’t consume any calcium your bones may eventually be at risk. If you don’t eat any fruits or veggies, you may experience constipation which is not fun. So yes, nutrition matters, over time. You can eat brown foods for a week with no repercussions. You can eat sugar every day and have no ill effects. It is all in the big picture, with all aspects of your life having an impact on your health. Food, sleep, stress, movement, fun, family, friends, all of it.

So when someone brings up your BMI, tell them you want to talk about your health, not some dumb number that is meaningless.