BALANCING MACRONUTRIENT INTAKE
When looking at nutrients, the two main groups that rightfully get the most attention are MACRO-nutrients and MICRO-nutrients. So what are macronutrients? They are the “big” nutrients found in all natural beverages and foods. There are 5 functional macronutrient categories…
Soluble & insoluble fiber. Often classed as a carbohydrate but acts very differently than a carb in the body.
Includes the 20 protein-building amino acids.
Includes saturated & unsaturated fatty acids, including 2 essential fatty acids (EFAs).
Cholesterol, a sterol, can also be classed here.
Includes simple carbs (sugars) and complex carbs (starches). Alcohol is often classed in its own category, but since it acts like a simple carb in many ways I place it here.
CALORIE COUNTING = OVERLY SIMPLIFIED NUTRITION
Starting in the latter part of the 1800s, some members of the scientific community sought to understand the energy values (or energy potential) of the macronutrients found in foods. The unit of measurement they chose to measure this energy potential is called a calorie- more specifically, a large calorie. Technically defined, a large calorie (or kcal) is the amount of energy needed to heat 1 kilogram of water 1 degree (Celsius) at a pressure of 1 atmosphere (helpful, right?). The word calorie comes from the Latin calor meaning “to heat.” [46-47]
Since that time the 5 macronutrients above came to have caloric values assigned to them as follows…
* Water: 0 calories per gram
* Fiber: 2 calories per gram (used by most countries; the U.S. still generally assigns 4 cal/g for fiber)
* Protein: 4 calories per gram
* Fats: 9 calories per gram
* Carbs: 4 calories per gram
Note that alcohol (not listed above) is often assigned 7 calories per gram, and sugar alcohols (which I’m not discussing in this article) are assigned 2.5 calories per gram. I generally treat alcohol like other carbohydrates (simple carbs and complex carbs/starches) due to some of its primary effects on the body. [48-50]
I can only assume that the general motive of many researchers in this area has been to gain a better understanding of how foods function in the body. And I applaud that motive. However, the result of some of this research (and erroneous conclusions drawn from it) has had a largely negative impact on public health for one very simple reason- the human body uses each macronutrient in very different ways.
For instance, fiber is, on-the-whole, only fractionally digested (if at all) and instead is used primarily as either food for gut flora (i.e. prebiotic fiber) or as an intestinal bulking agent (i.e. functional fiber), aiding in more complete elimination of waste materials.
Proteins are primarily used for cellular and tissue building and repair, immune system functioning, enzyme creation and as a third-tier energy source.
Fats are primarily used for neurological system functioning, for hormone production, for skin health, as a transport for fat-soluble vitamins (A, D, E and K) and as a second-tier energy source.
Carbs (simple and complex) are broken down into glucose (or stored as glycogen) and are primarily used as a first-tier energy source. [51-52]
Trying to treat each macronutrient as merely a “unit of energy” is inadequate in that it fails to recognize the unique physiological effects each macronutrient has on the body. It’s this kind of erroneous thinking that eventually led to the demonization of fats and government-backed low fat (and low cholesterol) dietary guidelines in the late 1970s and early 1980s. Forty years later, the 4 decades-worth of wide-spread excess carbohydrate intake and fatty acid deficiencies have played a large role in obesity rates doubling among adults and tripling among children. This kind of eating has also played a primary role in our diabetes mortality rates QUADRUPLING since 1980. [53-59]
It is for these reasons that using “calorie counting” as a health and weight loss approach is marginally effective at best, and at worst can result in macronutrient (and micronutrient) imbalances and deficiencies, leading to degenerative disease. So what approach am I recommending instead? An approach called “macronutrient balancing”, which is a nutritional strategy that seeks to supply each person with the amount (and ratio) of macronutrients that will have the greatest health benefit.
BALANCING MACROS & LOWERING CARB INTAKE (WHICH MAY INCLUDE “KETO”) FOR FAT LOSS, BLOOD SUGAR/INSULIN BALANCING & INFLAMMATION REDUCTION
While each adult will benefit most from a truly personalized nutrition plan, because many U.S. adults are dealing with excess body weight, blood sugar and insulin issues, gut dysbiosis and chronic inflammation, there are similarities in what a healthy macronutrient intake will look like. In my experience (and based off findings from clinical data), this often looks like…
* For fiber, 25-50g a day 
* For protein, up to 1g per pound of ideal weight, per day (for example, a small framed 5’0” woman with a goal weight of 100lbs would aim for up to 100g of protein a day, and a medium to large framed 6’4” man with a goal weight of 200lbs would aim for up to 200g of protein a day) [61-66]
* For dietary fat, 0.5 to 0.8g per pound of ideal weight, per day (for example, that same woman would aim for 50-80g of dietary fat a day while that same man would aim for 100-160g of fat a day) [67-73]
* And for net carbs (that’s total carbs minus fiber), 25-150g a day. [74-78]
This is a significantly lower carbohydrate approach compared to what most government health agencies suggest, as the Institute of Medicine’s RDA (suggested minimum amount needed for adults) is 130g/day and the USDA guidelines suggest intake of 200-400g/day (or more), which is based off of getting 45-65% of daily calories from carbohydrates.
Most independent researchers agree that ketosis (the state where the body is primarily burning fat for fuel instead of glucose) is reached and maintained when daily net carbohydrate intake stays below 50-60g a day. [79-80]
USING INTERMITTENT FASTING TO IMPROVE HEALTH
Technically-speaking, a fast is abstaining from caloric intake for at least 8 hours.
Over the last few years, “intermittent fasting” has become a health buzz phrase, and usually indicates a habit of abstaining from caloric intake for anywhere from 12-24 hours. Some of the more popular forms of intermittent fasting or I.F. include the 16:8 approach, where you fast for 16 hours of the day and have an 8 hour eating window, the 23:1 approach or one meal a day (called OMAD for short) and alternate day fasting (or ADF) where you eat every other day. In addition to intermittent fasting, the practice of fasting for more than 24 hours, often called extended or prolonged fasting, has also grown in popularity.
A VERY BRIEF HISTORY OF FASTING
While fasting may be trending it’s hardly new. People have been fasting for millennia, for physical, spiritual… even financial and vocational reasons. Around 3500 years ago the Israelite leader Moses famously fasted for 40 days on 2 separate occasions (see Deut. 9). Some 800 years after Moses, the Israelite prophet Isaiah prophetically spoke to the people of Israel, explaining what a righteous fast before God looked like, and the promises of healing that would come from such a fast.
The ancient Greek philosopher Plato and Greek physician Hippocrates (who’s often called the Father of Modern Medicine) both extolled fasting's many benefits in the 5th and 4th centuries before Christ. Plato famously said that he fasted for “greater physical and mental efficiency.” Around 500 years ago, the Swiss physician Paracelsus, often called the Father of Toxicology, famously proclaimed that, “Fasting is the greatest remedy, the physician within.” Over 200 years ago, founding father Benjamin Franklin stated that “the best of all medicines is resting and fasting.” And more than 100 years ago, American writer and humorist Mark Twain also touted the benefits of fasting, as he himself would regularly fast for 1-2 days when battling colds or fevers, with reportedly excellent results.
THE SCIENCE OF FASTING
Today, modern science is reaffirming the veracity of smart fasting practices, a 2010 study from the journal Autophagy found that fasting-induced autophagy “has been recognized as a crucial defense mechanism against cancer, infection and neurodegenerative diseases.” Infection here would include conditions like pneumonia, influenza, COVID and the common cold, and neurodegenerative diseases would of course include conditions like Alzheimer’s, dementia and Parkinson’s. 
A 2014 study from the journal Cell Metabolism found that fasting “helps reduce obesity, hypertension, asthma and rheumatoid arthritis”, and that fasting “has the potential to delay aging.” 
And finally a 2017 study from Ageing Research Reviews found fasting effective for weight loss, insulin resistance, cardiovascular disease and diabetes, and reported promising results in using intermittent fasting to combat multiple sclerosis and cancer. 
Regarding weight loss, a 2015 systematic review of 40 studies found intermittent fasting effective for weight loss, with a typical loss of around 10 pounds over 10 weeks. Obese individuals will often lose significantly more than this, with a 2-3 pounds a week weight loss a common occurrence. 
Heart disease, hypertension, cancer, asthma, Alzheimer’s, dementia, multiple sclerosis, Parkinson’s, diabetes, insulin resistance, pneumonia, influenza, common cold, obesity, weight loss, arthritis and aging. These diseases and conditions make up the vast majority of the disease burden in the United States, and here we have scientific evidence that smart fasting practices can improve ALL of them!
HOW FASTING WORKS
Modern science and clinical research are also helping us understand more precisely how fasting exerts its therapeutic effects on the body, which includes…
• changes to gene expression (including DNA repair)
• cellular repair and regeneration (including positive changes to the mitochondria, to stem-cell regeneration, and with autophagy, a process where cells digest and remove old and dysfunctional intracellular proteins)
• hormonal optimization (including boosts to Human Growth Hormone and lowered insulin levels)
• and positive changes to general metabolism (including regulating glucose and glycogen levels, as well as triggering ketogenesis, where body fat and triglycerides are broken down into ketones and free fatty acids, to be used by the cells for fuel)
DAILY ACTION STEPS/SOLUTIONS
To get the most out of balancing macronutrients and utilizing meal timing strategies (including intermittent fasting) I suggest a few essential action steps…
Step 1: Get a basic understanding of what foods are high in what macronutrient. With my clients I use a Venn Diagram image called “Do You Know Your Healthy Macros?” as a resource to help with this.
Step 2: Choose some of your favorite foods from each macronutrient category (low calorie, high protein, high fat, high simple carb, high complex carb and combination).
Step 3: Create a few meals and snacks using these foods, placing an emphasis on low calorie, high protein and high fat foods. This might be 2 breakfasts, 2 lunches, 2 dinners and 2-3 snacks.
Step 4: For homemade meals and snacks, check out websites like All Recipes, Eating Well and Food Network for recipe ideas.
Step 5: Decide if you’re going to utilize a prepared meal service (great for those who don’t particularly enjoy cooking or who are crunched for time). Three of my favorites here are Freshly, The Good Kitchen and Factor 75.
Step 6: Decide if you’re going to be eating out at all, and plan for those meals as well. Some of my favorites here include Chipotle, Jason’s Deli and Zoe’s Kitchen/Cava.
Step 7: Decide if you’re going to do any form of intermittent fasting. A 16 hour fasting window followed by an 8 hour eating window is a common starting place for many people. This might look like an eating window of 11am to 7pm.
Step 8: Decide how many meals/snacks a day you’re doing to have on most days and create a rough schedule for those meals/snacks. For example, if you decided on 3 meals (and the occasional snack) along with a 16:8 I.F. habit, your meals might be scheduled for 11am, 2pm and 6:30pm.
Step 9: Download a nutrition tracking app (ex. MyFitnessPal) and start tracking your nutritional habits.
Once you’ve settled on a solid nutritional plan, one of the biggest keys to successful execution is consistently making time for food prep. And unless you already possess some serious culinary skills, I suggest keeping your recipes on the simple side. I’ve often said that a sustainable diet is one that’s Healthy, Tasty, Convenient and Affordable. Building a dietary habit that checks all 4 of those boxes isn’t easy but is definitely worth it!
60 www.cnpp.usda.gov/sites/default/files/nutrition_insights_uploads/Insight36.pdf (info on dietary fiber)
81 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3106288/ (2010 study on fasting)
82 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946160/ (2014 study on fasting)
83 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5411330/ (2017 study on fasting)
84 https://www.sciencedirect.com/science/article/abs/pii/S0303720715300800 (2015 study on fasting)