ADAPT Week Five: Macronutrient Ratios

As week five comes to a close, I find myself questioning my approach to this ADAPT Journal. My original intent was to give an insider’s view of the structure and quality of the course while consolidating for myself information as I absorb it. I think what I’ve posted so far has served both of those aims.

I’m feeling though that these posts are becoming redundant. There’s only so much one can say about the structure of the curriculum. And in terms of consolidating information, I’m feeling that a lot of the functional health summaries I’m putting into these posts could be better packaged as stand alone content on my main blog where they can reach a more general audience.

This week I will continue with a journal post as planned. And next week I will do a post looking back on the first six weeks — a kind of overview of the course thus far. After that I will limit ADAPT Journal posts to once a month. I’ll post at the end of August, then September, and so forth.

It’s a natural time for such a transition as I’m leaving Mauritius next week (July 26th) for Singapore, where I will be based for the duration of the course. Look for new content to start popping up on my main blog in August — I’ve got a long list of topics awaiting my pen — and then an August report here at the end of the month.

Now about week five.

The Spirit of Motivational Interviewing

Probably the most impressive thing about the ADAPT course is how strong the coaching track is. Functional health aside, if someone wanted to just become an effective life coach, the Art & Practice of Coaching track alone would probably suffice. There are three pillars to the ADAPT coaching framework. They are motivational interviewing, positive psychology, and the transtheoretical model/stages of change. With this week’s content, as in weeks past, we continued unpacking the principles of motivational interviewing.

The highlight was a live question and answer session with Ken Kraybill, the lead motivational interviewing instructor. For ninety minutes he fielded questions and took his time with well-considered answers. As I’ve stressed in past journal entries, this coaching stuff is just empty technique unless there is genuine connection taking place, unless the client really feels accepted and heard, unless the coach embodies what is referred to in the industry as the spirit of MI.

I found Ken to be a tremendous model of MI spirit. I look forward to seeing more of him as the curriculum unfolds.

Macronutrient Ratios

In week three of the Functional Health track, we studied macronutrients. This week we took the consideration a little further with a look at macronutrient ratios in paleo-style diets. Chris Kresser outlined for us four different approaches to macronutrient ratios — high carb, moderate carb, low carb, and very low carb (ketogenic). In doing so, he stressed the importance of customization — in finding the most suitable approach to each person based on their metabolic health, activity levels, and a host of other factors.

Following is a rough sketch of what we learned:

A high carb diet (greater than 30% of total calories from carbohydrates) is most suitable for athletes and highly active people, people trying to gain muscle, people with fast metabolisms, and pregnant or breastfeeding women.

A moderate carb diet (15 to 30% of total calories) is the optimal approach for people who are generally healthy and of normal weight. It can also be the best approach for specific conditions, such as adrenal fatigue, hypothyroidism, and familial hypercholesterolemia. A moderate carb diet is what studies have found to be most common among hunter-gatherer populations.

A low carb diet (10 to 15% of total calories) is often the best approach for weight loss, blood sugar regulation, and digestive problems. It’s a good diet for reversing pre-diabetes and may be the optimal approach for someone newly diagnosed with type-2 diabetes.

A very low carb diet, or ketogenic diet, (fewer than 10% of total calories) can be a powerful intervention for people suffering neurological issues, such as epilepsy or Alzheimer’s. And also for severe blood sugar problems. Despite its mainstream popularity, doing it right can be difficult for the average person and is often problematic for highly active people.

Protein

Generally healthy people do well with 10 to 20% of total calories from protein. People wanting to lose weight, or gain muscle, and people with blood sugar issues, usually do better by upping their protein ratio as high as 20 to 35%.

Fat

Once carbohydrate and protein ratios are determined, the percentage of calories from fat falls into place. Fat could be as high as 80 to 85% on a low carb/low protein diet or as low as 10 to 15% on a high carb/high protein diet. On a typical moderate carb diet, fat will usually be about 60% of total calories. A high fat diet is no problem as long as one is getting adequate protein.  More problems result from eating too little fat, as fat-derived cholesterol forms the building blocks for hormones (a topic for another time). The most important thing is that ones consumes “healthy fats” (mostly saturated and monounsaturated), which is a near certainty if one is following a paleo template.

A Few Key Points:

1. These ratios are general guidelines. Most people will want to track their ratios and experiment with what works best for them. Again, the importance of customization.

2. Macronutrient ratios can change from day to day. For instance, someone may eat a very low carb diet on most days and do a carb re-feed (a moderate-to-high carb day) once or twice a week.

3. There is a common misconception that a keto diet should be high fat and moderate-to-low protein. This can be true for people using keto as an intervention for neurological conditions. But those with weight to lose would do better upping protein at the expense of fat. In which case, one “eats” the fat stored on one’s own body. Yum!

4. Chris Kresser says that in his clinical experience, many patients come to him thinking that they are eating moderate carb diets when in fact they are eating very low carb diets. He says its a common mistake with people who convert to paleo and that when such patients balance out their carb intake a lot of other things tend to fall into place. He cites this as an example of how minor adjustments in some cases can make a world of difference. Hence the importance of learning how to measure and track one’s macronutrient ratios — at least for a while — to avoid the the potential pitfalls of being highly active and too low carb.

5. The business of determining optimal macronutrient ratios is not an exact science. There is a lot of nuance involved. I’ve barely scratched the surface here. At some point, I’ll write up a more in-depth consideration on my main blog.

Your questions and comments are always welcome. Thanks for reading.