This is a follow-up to our "Everything you always wanted to know about Nutrition but were afraid to ask" webinar. We received many questions about the role of macronutrients (carbs, proteins, and fats) in our diet--how much, what kind, what balance, etc. So we're dedicating an entire webinar to this subject! With Cristin Stokes, RD, LN of MUS Wellness.

1. All about Carbs, Fat,
and Protein
Cristin Stokes, RD, LN
MUS Wellness
June 4th, 2015

2. “Ask a Nutrition Question”
Challenge
What are some good sources
of non-animal protein?
How many carbs should I
eat in a day?
What is the best ratio of
protein, fats, and carbs?

3. Why the confusion?
1950’s – 60’s
1980’s-
2000’s
Present
Early
Nutritional
Research
Extremes:
“No this,
no that”
Back to a
healthy
balance

4. Webinar Outline
• Carbs
• Fat
• Protein
• Best ratio of macronutrients
• Hint: Quality over quantity
• Disclaimer: Individual needs vary.

5. Carbohydrates
• Preferred energy source for the body
• Converted to glucose in the body
• Stored as glycogen in liver & muscles
• Provide structure to plants (fibers)
• Food sources: Starches & sugars
• Grains (bread, cereal, baked goods, pasta), fruit, vegetables,
sweets, dairy

6. Carbohydrates
• IOM recommended intake: 45-65% of total calories
• 200-290g for 1800 calorie diet
• 1 slice of bread = 15g
• 12 oz can of Coca-Cola = 40g
• Low carbohydrate intake (<80-130g/day)
• Fatigue/lethargy
• Inadequate fiber?
• Protein converted into glucose; fat  ketones
• Excessive carbohydrate intake
• Raises triglycerides
• Blood sugar instability & increased insulin

7. Carbohydrates
• Not all carbs considered equal
Refined Whole
White bread, rice, pasta, bagels Vegetables
Soda Fruit
Cookies, candy, pie, cake Whole grains (i.e. quinoa, brown
rice, whole wheat, oats)
Chips, crackers, processed snack
foods
Legumes
Sugar (in all its various forms) Dairy
Calories, not much else Vitamins, minerals, antioxidants, fiber

8. Carbohydrates
• Blood sugar/insulin response
• Focus on unrefined carbohydrates. Quality matters.
• 3rd Nutritional Tenet (Whole foods over processed)
• Choose vegetables, whole fruit, and whole grains

9. Fat
• Benefits: Energy, cell membranes, absorption of
nutrients, healthy skin & hair, insulation
• Certain types of fats are essential
• IOM recommendations
• 20-35% of total calories
• 40g-70g on an 1800 calorie diet
• 1 tablespoon of salad dressing: 5g
• Big Mac: 29g

10. Fat
• Classified according to chemical structure
• Chemical structure affects form & function
• Differing effects on cholesterol levels, inflammation
• Major types:
• Trans
• Saturated
• Monounsaturated
• Polyunsaturated
• Omega-3s & omega-6s

11. Fat
• Trans
• Commercially produced to make vegetable oils more stable
• ↑ LDL, ↓ HDL, promotes inflammation
• Sources: Stick margarine, commercial baked goods/snack
foods/processed foods, fried foods

12. Fat
• Saturated
• Sources: Whole fat dairy, cheese, red meat, butter, bacon
• Annals of Internal
Medicine meta-
analysis, 20141
• “…contains multiple
errors and
omissions, and the
conclusions are
seriously
misleading…” –
Walter Willet,
Harvard School of
Public Health

13. Fat
• Monounsaturated
• Sources: Olive oil, canola oil, peanut oil, avocados, nuts
• Primary source of fat in Mediterranean diet
• ↓ LDL, ↑ HDL
• Polyunsaturated
• Omega-3: salmon, mackerel, sardines, trout, ground flaxseeds,
walnuts
• Beneficial for heart & brain health
• Omega-6: Corn oil, soybean oil, sunflower oil, safflower oil, typical
vegetable/cooking oil
• n-6:n-3 ratio
• Type of fat matters, focus on unsaturated fats

14. Protein
• Large, complex molecules, composed of amino acids
• Structural component of all cells in the body (bones, muscles, skin, etc.)
• Builds & repairs body tissues
• Forms immune system antibodies, hormones, enzymes

15. Protein
• Animal sources: Meat, dairy, eggs, fish,
poultry
• Plant sources: Legumes, soy*, nuts, seeds*,
whole grains*, vegetables
• Protein shakes/bars/powders/etc.?

16. Protein
• Recommended intake
• IOM: 0.8 g/kg minimum
• 160lb person = 58g
• 10-35% of total calories
• 45g – 158g protein
• 3oz chicken = 26g protein
• Most Americans get ~15% of calories from protein
• 1g/lb body weight = approx. 30% of calories

17. Protein
•Inadequate intake
• Kwashiorkor very rare in U.S.
• Adequate vs optimal
• Excessive intake
• Potential lack of fiber
• Certain medical conditions
• Osteoporosis?
• Protein calories are still calories

18. Protein
• Benefits
• Takes longer to digest than carbohydrates
• Increases satiety hormones
• Does not raise blood sugar or cause insulin response
• May boost metabolism
• Consider the “protein package”
• Sodium, nitrates, trans/saturated fat?
• Fiber, phytochemicals
• Processed meats – bacon, hot dogs, cold cuts, sausage, etc.

19. Balance of Macronutrients
• What’s the best ratio of carbs/fats/proteins?
• We’re not quite there yet
• Depends
• More research is warranted
• Keep in mind:
• Studying diets long term is tough
• 20-40% dropout rate in most diet studies
• Definition of “low-carb” or “low-fat” varies
• Differences in quality of proteins, fats, carbs

20. Balance of Macronutrients
• High Protein diet studies
• Short-term (3-6 months)
• High-protein, low carb more effective for weight loss and
improved heart risk factors 6, 10, 11
• Most low-carb were not calorie restricted
• Longer-term (12 months+)
• Meta-analysis of 32 studies, published 20142
• Higher protein diet resulted in more weight loss & fat loss,
lower TGs, and lower fasting insulin
• Effect was small; dependent upon compliance

21. Balance of Macronutrients
• High Protein diet studies
• Cell Metabolism retrospective study (March 2014)5
• 50-65 year old men & women, >20% of calories from animal protein
• 4x more likely to die of cancer or diabetes, 2x more likely to die of any
cause
• Correlations were significantly reduced or completely erased if
protein was primarily plant-based
• Additional epidemiological data show low-carb, high-protein diets increase
all-cause mortality
• Low fiber? Low fruits/vegetables? Type of protein?
• Blue Zones

22. Balance of Macronutrients
• All macronutrients are important
• Replacing some carbohydrates, particularly refined,
with protein or fat can be beneficial
• OmniHeart trial9
• ↓ Blood pressure, ↓ LDL
• Nurses Health Study data3,4
• ↓ risk of heart disease, ↓ risk of diabetes

23. Balance of Macronutrients
• 2-year studies
• DIRECT trial8
• Low-carb & Mediterranean-style diets were better than low-fat for weight
loss & maintenance
• POUNDS LOST trial7
• 4 diets of varying levels of macronutrients
• Worked equally well in the long run; no speed advantage for one diet over
another
• “Reduced calorie diets result in weight loss regardless of which
macronutrients they emphasize”
• “The best diet for weight loss is the one that you’ll stick with.”

24. Conclusions
• Cristin’s recommendations:
• Aim for lower end of carbohydrate recommendations
(45%-55%)
• Include protein with all meals & snacks
• Emphasis on lean & plant-based proteins
• Don’t be afraid of fat
• Moderate intake of a variety of unsaturated fats
•Quality over quantity
• Types of carbohydrates, fat, and protein more important
than exact ratio

25. Harvard Healthy Eating Plate

26. Cristin’s 6 Nutritional Tenets
•1. 80/20 rule of moderation
•2. Eat more plants
•3. Choose whole foods over processed
•4. There’s no hidden secret to weight loss
•5. Take advantage of local MT food
•6. Enjoy your food

27. References
1. Chowdhury, R., Warnakula, S., Kunutsor, S., Crowe, F., Ward, H. et al. (2014) Association of Dietary, Circulating, and Supplement Fatty Acids with
Coronary Risk: A Systemic Review and Meta-analysis. Annals of Internal Medicine, 160(6). 398-406.
2. Clifton, P.M., Condo, D., Keogh, J.B. (2014). Long term weight maintenance after advice to consume low carbohydrate, higher protein diets – A
systematic review and meta analysis. Nutrition, Metabolism & Cardiovascular Diseases, 24. 224-235.
3. Halton, T.L., Liu, S., Manson, J.E., Hu, F.B. (2008). Low-carbohydrate-diet score and risk of type 2 diabetes in women. American Journal of Clinical
Nutrition, (87). 339-346.
4. Halton, T.L., Willet, W.C., Liu, S. (2006). Low-carbohydrate-diet score and risk of coronoary heart disease in women. The New England Journal of
Medicine, (355). 1991-2002.
5. Levine, M.E., Suarez, J.A., Brandhorst, S., Balasubramanian, P., Cheng, C., Madia, F., ... Longo, V.D. (2014). Low Protein Intake is Associated with a
Major Reduction in IGF-1, Cancer, and Overall Mortality in the 65 and Younger but Not Older Population. Cell Metabolism, 19. 407-417.
6. Nickols-Richardson, S.M., Coleman, M.D., Volpe, J.J., Hospig, K.W. (2005). Perceived hunger is lower and weight loss is greater in overweight
premenopausal women consuming a low-carbohydrate/high-protein vs high-carbohydrate/low-fat diet. Journal of the American Dietetic Association, 105 (9).
1433-1437.
7. Sacks, F. M., Bray, G.A., Carey, V.J., Smith, S.R., Ryan, D.H., Anton, S.D., ...Williamson, D.A. (2009). Comparison of Weight-Loss Diets with
Different Compositions of Fat, Protein, and Carbohydrates. The New England Journal of Medicine, 360. 859-873.
8. Shai, I., Schwarzfuchs, D., Henkin, Y., Shahar, D.R., Witkow, S., Greenberg, I., … Katorza, E. (2008). Weight loss with a low-carbohydrate,
Mediterranean, or low-fat diet. The New England Journal of Medicine, 359(3). 229-241.
9. Swain, J.F., McCarron, P.B., Hamilton, E.F., Sacks, F.M., Appel, L.J. (2008). Characteristics of the Diet Patterns Tested in the Optimal Macronutrient
Intake Trial to Prevent Heart Disease (OmniHeart): Options for a Heart-Healthy Diet. Journal of the American Dietetic Association, 108(2). 257-265.
10. Volek, J.S., Sharman, M.J., Gomez, A.L., Judelson, D.A., Rubin, M.R., Watson, G., …Kraemer, W.J. (2004). Comparison of energy-restricted very low
carbohydrate and low-fat diets on weight loss and body composition in overweight men and women. Nutrition & Metabolism (London), 1. 13.
11. Yancy, W.S., Olsen, M.K., Guyton, J.R., Bakst, R.P., Westman, E.C. (2004). A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity
and hyperlipidemia. Annals of Internal Medicine, 140 (10). 769-777.