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Calories and Energy Balance
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Meal Planning
Calorie Explained
Food Sources
The Macronutrients
Video Review

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OBJECTIVES:
  1. Discuss the role of meal planning in improving eating behavior
  2. Understand how calorie is consumed and spent.
  3. Describe food sources in creating a meal plan.​

Meal Planning

When it comes to meal planning and nutrition, your patient's goals might be to lose weight, gain weight, to lose fat, or to gain muscle, or to simply live a healthy life.  Whatever your goals maybe,  you have to know how to reach those goals and provide what strategies and principles are proven to work.  In order to give a complete and concise introduction into nutrition we have to start with the most abstract principles and work our way to most practical advice later in the course.
 
It is important to understand dieting principles that govern the body composition and will determine whether or not you will reach your goals.  Just like a properly functioning car, it must be based on principles of internal combustions, structural design and computer control, the diet must be based on principles too.  Together they will make up what we call a meal and diet plan and you have to understand each aspect to execute your plan correctly. 

All of this principles play an important role in your diet, but some are a lot more important than others.  Think about it this way, the most important component of the car is the engine.  Without the engine, your car won’t go anywhere, no matter what the other features.  Now the frame and the wheels come and close second, and the control system right behind, but after that the details are much less important.  Even the car with only a steering wheel but not seat or display could get you from point A to point B.
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When applying this frame board to nutrition and dieting, the most important principles are:
  • Calorie Balance
  • Macronutrient amounts
  • Nutrient timing
  • Food composition
  • Supplements
 
As you can see your calorie balance is the most important principle of any diet, and has by far the largest effect in your body composition an weight.  In it’s most basic form it imply that your weight gain is mostly eating more calories and weight loss is a matter of eating less calories.  
 
Determining your optimal calorie intake can be more difficult than you think.  But keep in mind that the calorie is the most important aspect of your diet.  Macronutrients is in second place.  While the calories defines how much you eat, macronutrients define what you eat.  Eating the right amount of protein, carbs and fat makes an important difference in your body composition.  Especially if you want to build muscle or lose fat.  Nutrient timing comes in third on the list and it basically states when you eat.  Food composition is on the fourth place and plays a detailed role of your dieting process.  In general all food composition is important for your overall health.
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The same applies to supplements.  As the name implies supplements and meant to supplement an already effective diet.  No supplement in the world will magically make you overcome deficiency and your calorie balance, macros or timing.  When designing a diet, it must be that you address the bigger picture first.  If you focus on the important things first and come up with a functional diet plan, the right supplements can further improve your diet.  
  • Calorie Balance (=How much you eat)
  • Macronutrient Amounts (=What you eat – Protein, Carbs, Fats)
  • Nutrient Timing (=When you eat)
  • Food composition
  • Supplement
 
The last thing you want to do is invest all your time and energy into small details that have little to no effect on the outcome of your diet.  Like so many others, your patient may quickly lose motivation and give up dieting.  This is not what lifestyle medicine is all about, here we first build a solid foundation and later at the small improvements, that will make an effective diet plan.  
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Calorie Explained

One of the most important variable in determining diet success is calorie balance.  From scientific standpoint, whether you gain weight or lose weight is determined by the first law of thermodynamics which states that energy cannot be created or destroyed, it can only be transformed from one type to another.  But implied to dieting, the first law of thermodynamics states that your body weight is dependent only on the difference on the amount of calories that you consumed versus the amount of calories that you burned, which is known as your calorie balance.  
 
A Calorie is the amount of energy needed to raise temperature of 1 liter of water by 1 degree Celsius.  So that means a calorie is a form of energy measurement.  When you eat your food, you consume the energy that is stored within the food.  Your body then uses this energy to produce movement and keep your organism alive.  Alternatively, when all energy is not used right away, it can also be stored for later use.  Some energy can be stored in the muscles and liver as glycogen but store fill up pretty quickly so your body will then store any additional calories in the form of body fat.
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There are 3 different states of calorie balances and you can only be at one state at a time. 
  • NEGATIVE CALORIE BALANCE.  This occurs when someone burns more calories than he or she consumes.  Here your body needs more calories to produce energy for your daily functions that it gets from your food.  That means it makes up the difference by burning stored energy, meaning you will lose weight.  Because the necessary energy will come from the breakdown of body tissue and negative calorie balance always results on weight loss.
  • NEUTRAL CALORIE BALANCE.  Here a person’s intake of calories is the same as the expenditure of activities and body processes.  This means all the calories you consumed will be used for some form of body process and your weight will remain stable.  Now of course calorie intakes and activities on any given day are not going to be exactly a 100% the same but over the course of weeks and months, a neutral calorie balance is quite possible.  If your weight hasn’t changed in the last few months, your calorie balance is almost always neutral.
  • POSITIVE CALORIE BALANCE.  Here more energy is consumed through food and is being burned to produce body processes and movements.  As I explained before, in this case the extra calories are stored as either glycogen in the muscle and liver or as fat. 
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What you need to understand is that your calorie balance will determine how much muscle you can gain or how much fat you can lose over period of time.  Why? Because literally, calories are the building blocks of body tissue.  If you want to build more muscle you are not only need to train, but you need to provide your body with the necessary raw materials to form muscle cells.  On the other hand, if you want to burn fat, you have to make sure that not enough calories are shuttle into fat cells to keep them the same size.  ​

Food Sources

Food sources refer to the individual foods you eat and what nutrients they have.  Though fitness schools always tell you that it’s super important to eat certain foods and not others, for example you will often hear claim that there are certain weight loss foods that will accelerate the metabolism and make fat loss that much easier.  When it comes to meal planning for fitness, meaning your goals are to lose weight, gain muscle or both.  Our bodies are very intelligent organism that can handle variety of food sources.  That said, when it comes to giving optimal diet and avoiding risk for chronic diseases, a healthy diet means consuming nutrient rich meals rather than calorie dense meals.  

In the study published in many peer-reviewed journals exploring the diet and chronic disease in Chinese population groups, Dr. T. Collin Campbell and his colleagues were able to establish the many different links between various food groups and disease risks and have documented the relevance of diet and nutrition in the initiation and development of disease.  The findings of the world-known study "The China Study" have highlighted the implications of consuming animal and plant-based nutrients and their differences.  The study confirmed the link between fat, fiber and cholesterol to degenerative disease including heart disease, diabetes and even cancer.  ​

The Macronutrients

After the calorie balance, the next important variable of your diet are the macronutrients.  Your body needs each macronutrients in relatively large quantities to function properly.

Carbohydrate, protein, and fat are essential for health maintenance, growth, reproduction, immunity, and healing.  Deficits or excesses of any of these nutrients may compromise these processes, resulting in poor health outcomes, which vary depending on the macronutrient in question and the life stage of the affected person.

In decades past, research on nutrition and disease frequently focused on the problems caused by diets that provided inadequate intakes of protein, calories, or micronutrients.  Concerns that such deficient diets could lead to poor growth and development or might result in weight loss in the hospitalized elderly were appropriate.  Currently, however, an excess of macronutrients is a far greater threat to health and well-being in developed countries and in many developing nations as well.
​DIETARY PROTEIN
 

*Protein supports the maintenance and growth of body tissues.  Th amino acids that make up proteins are used for the synthesis of nucleic acids, cell membranes, hormones, neurotransmitters, and plasma proteins that serve transport functions and exert the colloid osmotic pressure needed to maintain fluid in vascular space.  Protein is also the second-largest energy store, second to adipose tissue because of the large amount of muscle tissue that is a liable source of amino acids for gluconeogenesis, although carbohydrate (in the form of glycogen) is used in between meals as a primary source.

During growth and in various disease states, several other amino acids (arginine, cysteine, glutamine, glycine, proline, tyrosine) are regarded ad conditionally indispensable.  The term conditionally indispensable applies when endogenous synthesis cannot meet metabolic need (eg, under special pathophysiologic circumstances, including prematurity in infants and severe catabolic stress in adults).

Although deficiency in dietary protein is clearly detrimental, many chronic conditions may be caused or exacerbated by an excess of protein, particularly animal protein.  These include osteoporosis, kidney stones, chronic kidney disease, and possibly certain cancers.  Food from plant sources can supply protein in the amount and quality adequate for all ages.

The major difference between diets providing animal protein and those providing plant proteins appears to be that, while plant foods contain all essential amino acids, some are limited in lysine or sulfur-containing amino acids.  The amino acids provided by various plant foods, however, tend to complement each other, and it is not necessary to intentionally combine foods.  The natural combinations of foods in typical vegetarian diets provide more than adequate amounts of complete protein.  Soy products provide protein with a biological value as high as that of animal protein.  Because plant sources are free of cholesterol and low in saturated fat and provide dietary fiber and various phytochemicals, they present advantages over animal protein sources.
 
For body composition purposes, protein is actually the most important dietary macronutrient.  The reason for this is that muscle is literally made out of it.  If muscle is the car then protein is the metal out of which the parts are built.  Protein not only provides the building blocks for muscle growth it also supplies the amino acids needed to reduce muscle breakdown.  So in essence, protein both builds new muscles and saves existing muscles from being lost.  Both functions are very important in maximizing muscle and minimizing fat.
 
About 90% of the protein you eat is broken down into amino acids and becomes part of the amino acid “pool” that the body draws up on when it needs to build or repair a muscle or any other tissue.  Unlike carbohydrates and fat, which the body can store for later use, amino acids have no form of storage in the body so it’s important you have some protein everyday. ​
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How much protein exactly should you consume per day?  This question sounds pretty straight forward, there is no one size fits all here.  Because your ideal protein intake will depend on a variety of factors such as your weight, muscle mass and most importantly your fitness goals.  Your average person will have completely different protein needs than a professional athlete or a 300 pound body builder.  With this in mind, protein need is based on 3 specific cases:
  • To simply live a healthy life
  • To build muscle
  • To lose fat
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Protein requirements are increased in certain conditions.  These include severe acute illness, burn injury, end-stage renal disease and body building.  Protein needs are also influence by life stage.  Protein requirements are highest in the growing years, with infants up to 12 months and children 1 to 3 years of age requiring 1.5 g/kg and 1.1 g/kg, respectively.  Requirements for protein remain high relative to adult needs during the period from growth to puberty (ages 4 to 13 years), at 0.95 g/kg, and are reduced to near-adult levels (0.85 g/kg) from 14 to 18 years of age.  Pregnancy and lactation also increase protein needs, to 1.1 g/kg of maternal prepregnancy weight for the former and 1.3 g/kg for the latter.

For healthy adults, the Estimated Average Requirement (EAR) is considerably lower (0.66 g/kg/day), 47 and 38 grams per day for men and women, respectively.  In addition, the intake of adequate protein-sparing calories allows for maintenance of lean body mass at roughly this level of intake.  More adults in Western countries consume more protein than the recommended EAR and RDA of 0.66 g/kg/day and 0.8 g/kg/day, respectively.  Excessive intakes may contribute to risk for certain chronic disease.  
 
Not what if you want to build muscle.  How much protein should someone consume that is working out and looking to grow muscle mass.  If you ever join a body building or fitness forum then you will notice that this question pops up a lot and it usually triggers a lot of debate.  People usually post values that are way too high or way too specific.  
 
If we look at the present literature on protein intake for anyone looking to build muscle, the ideal daily intake always lies anywhere between 0.8 grams and 1 gram of protein per pound of body weight.  If you are below this range, your body will not build muscle at the optimal rate.  However, if you go above this range, then you will see no increase in protein synthesis which is the rate at which new proteins are produced and therefore no tissue is built. 

​Now what if you want to lose fat instead of building muscle?  Does this range change? The short answer is no, not really.  When losing weight, your primary goal is always maximize fat loss and preserve muscle mass. 
​PROTEIN
  • Should be about 15% of total calorie intake
  • Protein is more important the older you get
  • Rarely needs to be prescribed separately when general diet principles are followed

Broccoli florets (0.105 grams protein/calorie are higher in per calorie protein content than hamburger beef (30 grams for 1/2 breast) in available protein.

​Soybeans (29 grams protein/cup) are comparable to chicken (30 grams for 1/2 breast) in available protein.
DIETARY FATS 
 
Dietary fats are the least-require macronutrient, with only a few grams per day needed for the absorption of fat-soluble vitamins A,D, E and K, among other functions.  Foods contain combinations of saturated and unsaturated fats.  Substantial quantities of saturated fat are found in dairy products, eggs, meats, and tropical oils, while unsaturated fats predominate in liquid fats (eg, vegetable oils).  The latter are subdivided into monounsaturated fats (predominant in olive and canola oils) and polyunsaturated fats (found in nuts, seed oils, and, to a lesser extent, in meats).

Only the polyunsaturated fatty acids (PUFA) are essential to human nutrition, since the boy does not synthesize these.  PUFA have roles as structural components of cell membranes and as signaling molecules (eg, eicosanoids).  The essential fatty acids )EFA) include linoleic acid (an omega-6 fatty acid) and alpha-linolenic acid (an omega-3 fatty acid).  The Institute of Medicine recommends a ratio of dietary linoleic (omega-6) to alpha-linolenic (omega-3) acid intake of 10:1; however this figure is controversial, some suggest a higher intake of omega-3.

The IOM Food and Nutrition Board currently recommends a range of fat intake of 20% to 35% of total energy intake.  This too is controversial, given that good health outcomes have been achieved with considerably lower levels of fat intake.  most individuals can meet their EFA needs by consuming very small amounts of fat per day (14g) although many people are eating far more than this (85 g on average).

This level of excess consumption of fats is problematic because EFA derivatives are raw materials for eicosanoids (ie, prostaglandins, leukotrienes, and thromboxanes), hormone-like chemicals with short-lived but powerful effects.  Eicosanoids play significant roles in immune function, inflammation, thrombosis, proliferation, reproduction, gastroprotection, and hemostasis, in addition to other functions.  The omega-6 and omega-6 PUFA are metabolized to long-chain fatty acids (arachidonic and eicosapentanoic acids, respectively), which are the precursor for the eicosanoids.  These long-chain derivatives are also found in some food products, with arachidonic acid being present in meat, eggs, and dairy products, and eicosapentanoic acid found in fish.  these food sources are not required, however, as eicosanoids are produced in the body.
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In cases when weight gain is the goal in a healthy individual you may consider increasing plant-based unsaturated fat intake above 15 or 20% and that is when you’re bulking.  Bulking is the term used for going into calories surplus to ensure optimal muscle growth.  Skinny people to put on size often had a hard time with this.  When all carbohydrate, fat and protein needs are already met but your daily calories are not yet filled for example, imagine needing 3500 calories to gain weight, but you’ve already met your macro needs at 2500 calories, you have a choice to make.  You can either chose to add protein, carbs or fat or any combination of these three.   

Take in together this points highly support the role of fats as a default calorie buffer.  Now in some cases it can also make sense to consume additional carbs especially when exercising very intensively.  However,  then you need to make sure that this extra carbs come from quality sources such rice or potatoes and not from candies and junk food.  Never allow consumption of too much simple carbs as they will keep the insulin levels up and can lead to prediabetes which is both harmful to muscle gains, fat losses, and general health.
​FAT
  • Should be 15-30% of total calorie intake.  Ancestral and indigent intake in populations with minimal chronic disease is closer to 15%.  USDA recommends 20-35%
  • More commonly prescribed as a "negative" prescription - most people get too much fat.
  • General guidelines around fat intake includes polyunsaturated and mounsaturated fats that are healthful.  Saturated and trans fats are harmful.

Source of Fat
  • Poly-unsaturated
           Omega-3s  - anti-inflammatory: falx seed, chia seed, fish
           Omega-6s  - pro-inflammatory: corn oil, sunflower oil
  • Mono-unsaturated
           Olive oil/olives, avocado oil/avocados
  • Saturated
           Lauric acid: coconut* - neutral
           Stearic acid: dark chocolate - neutral
           Palmitic acid: palm oil, meat - harmful
           Myristic acid: butter - harmful
THE CARBOHYDRATES
 
Carbohydrates are the most misunderstood macronutrients.  Just as with fats and proteins, there are a lot of debates around carbohydrates.    Carbohydrates, in the form of starches and sugars, is the main energy source in the human diet, providing 50% or more of total calories and are found in foods including fruits, vegetables, grains, potatoes and considered the body’s preferred energy source.  More specifically, carbs are sugar molecules that are the union of carbon, hydrogen and oxygen.  Think of carbs as one or more sugar molecules that are bound together and broken down by the body to be used as fuel.  When a person consume high carbs food, the body breaks them down into simple sugar glucose which is then transported throughout the body to provide energy, to fuel important reactions and maintain blood sugar levels.  Any glucose that is not used is stored in your liver and muscles as glycogen or as fat. 

​During high intensity activities such as weight training your body uses glycogen and converts them back to glucose for new fuel.  If glycogen levels are low, hard workouts become increasingly difficult to complete and your performance will suffer.  Next to it’s importance for workouts, carbohydrates have other benefits:  They include:
  • Supplying the nervous system with fuel.  Well maintained blood glucose level will directly benefit the nervous system which not only means better concentration but also better muscle recruitment, more fatigue resistance and even more workout motivation.  Much of the fatigue in long duration training is due to a tired nervous system and not a result of sored muscles.  So providing the nervous system with an adequate source of blood glucose is important for optimizing workout intensity and duration. 
  • Refueling glycogen stores.  In addition to glycogen’s role as provider of energy in high intensity workout, its storage in the muscle plays a role in the regulation of muscle growth.  Low levels of glycogen by themselves have been shown to downregulate muscle growth.  That is just having low muscle glycogen levels irrespective of physical activity level, training intensity and protein intake can affect muscle gains and increase the risk of muscle loss.  This is just another reason why getting enough carbs is a very important factor when wanting to build muscle.
  • Secreting insulin.  The more carbs you eat the more insulin is secreted.  This is important because insulin has a profound effect on muscle growth.  When insulin is secreted into the blood it binds to target receptor on the muscle cell surface and increases muscle growth.  Because of the powerful anabolic effect of insulin, the fact that carbs consumption increased more insulin than the other macronutrients fat and protein, carbohydrate is anabolic to muscle tissue.  This means it helps grow it.

How much carbohydrates we need?
 
In order to optimize your meal plan once protein and fats have been addressed, you also want to look at carbohydrates.  If minimal values are not met especially for extended periods, you will not grow as much muscle as you could.  Now the optimal intake of carbohydrates can be based on a variety of factors.  Fortunately, even without knowing your exact measurements we can still narrow in on a range using only two measures.  Body weight and physical activity/training intensity.
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Can you eat too many carbohydrates?
Keeping in mind the quality sources of carbohydrates, as a general rule for most active people and athletes, there does not seem to be such a thing as an excessive intake of carbohydrates, so long as minimal protein and fat intakes are met.  We know from studies done in endurance runners and vegetarians that diets very high in carbohydrates can be very healthy in a long term.  But this assumes though that you get your carbs from quality sources such as rice, quinoa, oats and potatoes. These are all complex carbs that do not lead to a sudden spike in insulin levels which is the case for simple carbs like candy and sugar.  What this means is that when you exercise a lot and meet the extra energy and you can’t consume large amounts of carbs as long as you get them from complex carbs and you also get your minimum protein and fat needs. 
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Do carbohydrates make you fat?
 
Carbohydrates themselves do not make you fat.  They serve an important function in your body especially if you train in high intensity.  What is true is that many processed food such as candy or fast food are high in sugar and other types of simple carbohydrates.  These foods often lead to cravings and can make it easier to overeat even when you already filled up your daily calories but are still hungry.  That is why many people who follow a diet that is based around these foods will see weight gain overtime.  However, in order to get fat, you always need a calorie surplus which you could also reach with a high protein or high fat diet.  Incorporating quality carbs in the diet is the simple solution.
​CARBOHYDRATES
  • Increase neutral fiber
          -  Tends to be associated with whole foods
          -  The average person doesn't get enough
          -  Goal is 40-45 grams daily
  • Decrease added sugars
          -  Tends to be associated with processed foods
          -  The average person gets too much
          -  Sugars in whole foods, however, tend to be accepted
  • Stay steady on starch
​          -  If it is coming from whole foods, it is usually fine

Micronutrients

Whole foods of a variety of types help to achieve micronutrient balance better than taking supplements.  It is important to keep micronutrient levels balanced.  The body's homeostasis mechanisms maintain micronutrient levels in relatively narrow ranges.  Too much or too little is stressful to the body.  Specific nutrients are not often prescribed but specific foods that contain specific micronutrients can be prescribed.

Micronutrients have many values including the presence of high antioxidants which decreases oxidation, thereby decreasing inflammation and decreased variety of disease states.  ​
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