All about Carbs, Fat, and Protein

Cristin Stokes, RD, LNMUS Wellness June 4th, 2015

“Ask a Nutrition Question” Challenge

What’s the latest

science on eating

carbs, low carb diets,

and avoiding fat?

I’m confused about what oils are heart healthy. Should I be

using only coconut oil or olive

oil?

Is it possible to eat too much protein?

Is there such a thing as a

safe amount of trans fa

t?

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?

Why the confusion?

1950’s – 60’s

1980’s-

2000’s

Present

Early Nutritio

nal Researc

h

Extremes: “No this, no that”

Back to a

healthy balance

Webinar Outline

• Carbs• Fat• Protein• Best ratio of macronutrients

• Hint: Quality over quantity

• Disclaimer: Individual needs vary.

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

Energy!

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

Carbohydrates

• Not all carbs considered equalRefined 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

Limit Balance

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

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

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

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

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

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

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

Protein

• Animal sources: Meat, dairy, eggs, fish, poultry

• Plant sources: Legumes, soy*, nuts, seeds*, whole grains*, vegetables

• Protein shakes/bars/powders/etc.?

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

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

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.

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

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

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

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

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.”

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

Harvard Healthy Eating Plate

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

References1. 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.