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Adjusted Values for Macronutrients, Electrolytes, and Water
By Gary F. Zeolla
This article is continued from Adjusted Levels for Macronutrients, Electrolytes, and Water: Part One. The “adjusted’ refers to adjusting the RDAs (called PDAs in my DietPower software program) to levels I have found to be more beneficial for me.
I have long found a moderate carb diet works best for me. The reason why this is so was explained when I was diagnosed with reactive hypoglycemia back in 2007 (see Hypoglycemia, Diabetes, and the Glycemic Index). Eating a high carb diet would play havoc with my blood sugar. I first thought of this potential blood sugar problem with high carb diets back in college, when I was majoring in Nutrition Science (Penn State; ‘83).
We were studying diabetes, and I remember clearly the professor saying, “We used to put diabetics on low carb, high fat diets, but they were dropping like flies from heart disease.” So now she was saying the recommendation was for a high complex carb diet.
I remember thinking, “If diabetics have a problem with carbs, then why put them on a high carb diet?” I just wished I had spoken up and asked the professor that question back then. It made no sense to me then and still does not today. But I’m not recommending a low carb diet for those with blood sugar problems. The reason such a diet caused people to “drop like flies” was probably because it was high in saturated fats. A moderate carb diet with an emphasis on unsaturated fats will work just as well at controlling blood sugar but with a decreased not elevated heart disease risk, as discussed in Part One. It is also nowhere near as restrictive as a low carb diet.
Also, consider the following:
New research adds clarity to the connection between a high fat diet and type 2 diabetes. The study finds that saturated fatty acids but not the unsaturated type can activate immune cells to produce an inflammatory protein, called interleukin-1beta (Link between high-fat diet and type 2 diabetes clarified).
The most recent position statement on nutrition from the American Diabetes Association recommends an individualized approach to nutrition that is based on the nutritional assessment and desired outcomes of each patient and that takes into consideration patient preferences and control of hyperglycemia and dyslipidemia. To achieve these nutritional goals, either low-saturated-fat, high-carbohydrate diets or high-monounsaturated-fat diets can be advised. A meta-analysis of various studies comparing these two approaches to diet therapy in patients with type 2 diabetes revealed that high-monounsaturated-fat diets improve lipoprotein profiles as well as glycemic control (High-monounsaturated-fat diets for patients with diabetes mellitus: a meta-analysis).
Based on these data, we tested the efficacy of diets with various protein : carbohydrate : fat ratios for 5 weeks on blood glucose control in people with untreated type 2 diabetes. The results were compared to those obtained in the same subjects after 5 weeks on a control diet with a protein : carbohydrate : fat ratio of 15:55:30. A 30:40:30 ratio diet resulted in a moderate but significant decrease in 24-hour integrated glucose area and % total glycohemoglobin (%tGHb). A 30:20:50 ratio diet resulted in a 38% decrease in 24-hour glucose area, a reduction in fasting glucose to near normal and a decrease in %tGHb from 9.8% to 7.6%. The response to a 30:30:40 ratio diet was similar (Control of blood glucose in type 2 diabetes without weight loss by modification of diet composition).
Personally, I have found 40–45% of calories from carbs to be best for blood sugar control, provided the bulk of the carbs come from minimally processed and low glycemic carbs. More than 45% carbs plays havoc with my blood sugar levels, leaving me hungry and dragging an hour or two after eating. But less than 40% does not give me significantly better blood sugar control. Moreover, I have found going to less than 40% carbs to be excessively restrictive and hard to follow.
In addition, if I get less than 40%, my energy levels suffer. But if I get more than 45%, it doesn’t give me more energy. As such, 40–45% carbs is the ideal level for sufficient energy for my workouts and otherwise.
Another issue to consider is blood triglycerides. It is known that, “When the content of dietary carbohydrate is elevated above the level typically consumed (>55% of energy), blood concentrations of triglycerides rise” (Parks). So the 60% RDA is above the normally consumed range and the level at which triglycerides will rise. But my 40-45% range works well at keeping triglycerides low. In my recent blood test, my triglycerides were a mere 40, while normal is anything under 150 (Mayo Clinic: Cholesterol levels: What numbers should you aim for?).
Given all of this, I adjusted the percentage of carbs from calories from 60% to 43% to be in the middle of my preferred range of 40-45%. That is about 2 grams of carbs per pound of bodyweight.
Almost all of the sugars in my diet are from naturally occurring sugars, especially from fruit and yogurt. The only foods I regularly consume with added sugars are my Natural Whey and Natural Casein protein powders and my pre-workout cold cereal. These are also the only highly processed foods I eat regularly, but I do so as I have found them beneficial for specific purposes. The protein powders will be discussed shortly, and a detailed discussion on cold cereal can be found at Cold Cereal: Healthy or Unhealthy?
But here, the protein powders only have about 3 grams of sugar per serving, and the cereal is always low sugar cereal, with only a few grams of sugar per serving. With one or two servings of protein powder and one of cereal a day, my average daily intake of added sugar from these foods is probably less than 15 grams a day, or 60 calories; that’s less than 3% of calories and far less than the recommended top limit of 150 calories from added sugar by the American Heart Association. That’s for men; the recommended top limit for women is 100 calories (Added Sugar).
However, DietPower does not make a distinction between naturally occurring sugars and added sugars, but it should. Added sugars, as with all processed carbs, are problematic in regards to heart disease risk, as discussed in Part One, and added sugars are empty calories, while naturally occurring sugars like in fruit and dairy come with a wealth of nutrients. This is why it is being proposed for the next revision of the “Nutrition Facts” labels on foods to have a separate line for added sugars (FDA: Proposed Changes to the Nutrition Facts Label).
Also, consider the following quotes:
Even if people have not been diagnosed with triglycerides outside the normal range, if they eat too many simple sugars (refined grains, added sugars and alcohol) their triglycerides will increase (American Heart Association: Triglycerides: Frequently Asked Questions).
According to the study published in JAMA: Internal Medicine, those who got 17 to 21 percent of calories from added sugar had a 38 percent high risk of dying from cardiovascular disease compared to those who consumed 8 percent of their calories from added sugar. The risk was more than double for those who consumed 21 percent or more of their calories from added sugar (Added Sugars Add to Your Risk of Dying from Heart Disease).
Despite what food marketers might lead you to believe, there are only 2 forms of natural sugars – the kind found in milk (lactose) and the kind found in fruit (fructose) [This is not totally correct; glucose and sucrose are also found in these foods, but these foods are the main sources of naturally occurring sugars]. These types of sugar are also purely carbohydrates but from a nutritional standpoint, the food sources in which they are found have a lot more to offer. Milk and fruit provide other important nutrients like protein, vitamin D, calcium, vitamin A, vitamin C and fiber – you’ll be hard pressed to find any of these nutrients in candy, cookies and soft drinks. As an additional bonus, fiber and protein take longer to digest, causing a less dramatic spike in blood sugar. They also make you feel fuller for longer, providing a greater satiety value (Ask the Dietician; Added vs. Natural Sugar).
The type of carbohydrate consumed can affect blood lipid profiles. … the consumption of lower-GI [glycemic index] foods has been associated with lower triglycerides and higher HDL cholesterol. Substituting low-GI foods for high-GI foods may lower triglyceride concentrations by 15% to 25%. There is also considerable evidence that high intake of added sugars , and fructose in particular, adversely affects all components of atherogenic dyslipidemia. Most recently, an evaluation of data from 6113 adults participating in the National Health and Nutrition Examination Survey (NHANES) showed a positive correlation between added sugars and dyslipidemia  (Siri-Tarino, Saturated Fatty acids).
[Note: Atherogenic dyslipidemia is defined as low HDL-C plus elevated triglycerides (Michel P Hermans, et.al).]
In any case, by reducing the percent of calories from carbs from 60% to 43%, if I left the default of 20% of carbs from sugars, then the gram allotment would be significantly reduced. So to counter these problems, I increased the percentage of carbs from sugar to 30%. Thus my total sugar intake in terms of percentage of total calories is only slightly higher than DietPower’s PDA.
I adjusted the PDA for fiber from 30 to 40 grams for two reasons. First, I have long had a problem with constipation, so the extra fiber helps me to move my bowels. Second, fiber is very beneficial otherwise for health reasons.
… an increment of 10 g/day of dietary fiber was associated with a 27% decreased risk of death from coronary heart disease. This suggests that replacing saturated fat with the equivalent energy from fiber-rich carbohydrate would likely be associated with a significantly reduced risk of death from coronary heart disease. This suggestion is supported by a different meta-analysis which found that an increment of about 2 servings a day of whole grains was associated with a 22% decreased risk of death from cardiovascular disease (Clearing Up The Confusion Surrounding Saturated Fat).
I have always believed strength training increases protein needs. I can even remember giving an oral presentation back in college on this subject. I put forth the hypothesis that strength athletes need about 1.0 gram of protein per pound of bodyweight. This is far greater than the RDA of 0.36 grams, and at that time most authorities denied that strength athletes had higher protein requirements than others. I thought the professor would object to my hypothesis, but surprisingly, she did not, and I got an “A” on that presentation.
As part of that presentation, I stated that it was possible to attain that level of protein without the use of protein powders, thus I never used them. I remember displaying a chart ranking various high-protein foods on a cost per gram of protein basis. Protein powders was the most expensive source, while non-fat dried milk was the least expensive, eggs the second least expensive, with meat, chicken, and fish in the middle.
But that was when I was in college back in the early 80s, when the only protein powders available were soy-derived and tasted like chalk. When I started powerlifting again in my 40s (2003), protein powders were much improved, now being made with whey, casein, or egg white, and thus were much better tasting, less expensive, and have a higher biological value, so I have always made use of them. And with doing so, my protein intake has ranged from 1.2 to 1.5 grams/ pound.
But there have been times when I have thought back to that college presentation and debated if I really need that much protein and thus the protein powders. I even tried Googling "protein requirements for strength athletes." I found many pages on the subject. The consensus was that strength athletes require more protein than sedentary individuals and even more than endurance athletes. That is an improvement. But the exact recommendations varied:
While protein needs of both endurance and power athletes are greater than that of non-athletes, they’re not as high as commonly perceived. The Academy of Nutrition and Dietetics, Dietitians of Canada and the American College of Sports Medicine recommend the following for power and endurance athletes, based on body weight:
•Power athletes (strength or speed): 1.2 to 1.7 grams/kilogram a day
•Endurance athletes: 1.2 to 1.4 grams/kilogram a day (Protein and the Athlete – How Much Do You Need?)
The average adult needs 0.8 grams per kilogram (2.2lbs) of body weight per day.
• Strength training athletes need about 1.4 to 1.8 grams per kilogram (2.2lbs)
of body weight per day
• Endurance athletes need about 1.2 to 1.4 grams per kilogram (2.2lbs) of body weight per day (Sports Nutrition - Protein Needs for Athletes)
Consequently, growing evidence indicates that strength athletes should ingest quantities of protein at the upper end of the range of 1.5 to 2.0 g/kg per day, as well as ingest protein or amino acids either before, during, or after exercise (or at more than one of these times) in order to optimize training adaptations (Campbell et al. 2007; Kerksick et al. 2008; Lemon 2001; Protein intake in relation to performance).
The range for strength athletes is 1.2-2.0 grams of protein per kilogram of bodyweight. That works out to 0.55-0.94g/ pound, less than even the 1.0 grams I consumed in college.
Given this evidence, on several occasions I experimented by substituting a cup of milk for each of my servings of protein powder. A cup of milk contains 8 grams of protein, while one serving of protein powder contains 24 grams, so that would reduce my protein intake by 16 grams per serving and my average daily intake down to about the 1.0 grams/ pound I consumed in college. But each time I tried this experiment, I ran into problems.
I would usually start to feel very sore, like I was not recovering from my workouts; my training would stagnate, and one time I even experienced a flare-up of my stiff person syndrome (SPS) and was paralyzed for the next 48 hours. But each time, about a week after going back to the protein powders, I would no longer feel sore and would start to make good progress again.
These experiments could prove that I need the extra protein the powders provide, or something else could be at work. I use a 50/ 50 mixture of whey and casein. This gives me 12 grams of whey protein. Milk is composed of 20% whey and 80% casein, so one cup only provides 1.6 grams of whey protein. That is a big difference, so maybe there is “something” about whey protein that helps to reduce workout soreness. That something could be the high glutamine content of whey, as I know that supplementing with glutamine helps with workout soreness (see Glutamine).
Also, glutamine has a role in SPS. In fact, I first started supplementing with glutamine when an alternative doctor suggested I do so to aid my recovery from SPS. Or it could be some other factor in whey. Incidentally, “Human and bovine milk differ substantially in the ratio of whey to casein protein (≈ 60:40 in human milk and ≈ 20:80 in bovine milk)” (American Journal of Clinical Nutrition). Thus my 50/50 mixture might be even more natural than cow’s milk.
Another possibility could be timing. Although I might be getting sufficient protein without the protein powders by the end of the day, I might not be at the two critical times I use the powders: breakfast and pre-workout. With milk having a third of the protein of the protein powders, maybe when I substituted it for the powders that amount of protein was not enough to break the fast in the morning or to prevent muscle breakdown during the workout and to begin the recovery process afterwards. The latter time is mentioned in the last quote above as being especially important for a high protein intake.
But whatever the case, I will stick with the protein powders and thus the adjusted value of 25% of calories from protein. That percentage gives me the at least 1.2 grams/ pound that by experience I know I need. Moreover, a recent blood test showed that my liver enzymes are fine, and my blood protein levels are within normal, so my high protein intake is not adversely affecting me. This all fits with the following:
• We don’t know how much protein is required to optimize all of the potential pathways important to athletes.
• We know that a protein intake of 1.4 g/lb (3.0 g/kg) isn’t harmful and may have benefits that are too small to be measured in research
• As long as eating lots of protein doesn’t keep an athlete from eating too few of the other nutrients (carbs/fats), there’s no reason to not eat a lot. And there may be benefits. (Protein Requirements for Strength and Power Athletes).
But I should mention there is some evidence that a very high protein intake reduces testosterone levels, but that is for an intake of 44% of calories, much higher than my 25%.
Also, the source from which the protein is derived may influence T concentrations. Raben et al. compared the effects of two diets differing only in the source of protein in male athletes. Results showed a reduced resting and post-exercise increase in T concentrations in athletes consuming protein derived mainly from vegetable sources compared with a diet with protein derived mainly from animal sources (Volek, et.al.).
This is another possible reason (along with little or no cholesterol intake) why vegetarians tend to have lower testosterone levels than omnivores, and why it was while following a vegan diet that I developed clinically low testosterone levels, as discussed in Part One. This all could also be related to soy intake, as soy has a propensity to lower testosterone levels (see Soy: Health Food or Food to Avoid?). But now, the bulk of the protein in my diet is from animal sources, so my current high protein intake is probably not a problem in regard to testosterone levels.
Electrolytes and Water
The RDA/ PDA for sodium is 1,300 mg. But, “The Institute of Medicine recommends 1500 mg of sodium per day as the Adequate Intake level for most Americans and advises everyone to limit sodium intake to less than 2300 mg per day, the Tolerable Upper Limit” (CDC: Americans Consume Too Much Sodium). So 1,300 mg is too low; staying below 2,300 mg is all most people need to be concerned about.
But even 2,300 mg might be too low. What matters most is the ratio of sodium to potassium. A less than 1:1 ratio of sodium to potassium is considered protective against heart disease (Sodium/Potassium Ratio Important for Health). As such, maybe the best approach would be to determine potassium intake, and then to consume less sodium than that.
The RDA/ PDA for potassium is 4,700 mg. I consume a lot of fruits and vegetables (the best sources of potassium) and mostly unrefined foods (which all contain at least some potassium), but my levels still tend to be borderline. But this could be because food labels do not always include potassium, so when I add a food to DietPower, I am not able to include its potassium levels, so I do not get “credit” for potassium when eating that food. As such, I am probably consuming more than the PDA for potassium.
The PDA/ RDA for water is 125 fluid ounces. But, “The Institute of Medicine determined that an adequate intake (AI) for men is roughly 3 liters (about 13 cups) of total beverages a day. The AI for women is 2.2 liters (about 9 cups) of total beverages a day” (Mayo Clinic: Water: How much should you drink every day?). Doing the math, the AI for men is 104 fluid ounces and 72 for women.
Also, such blanket recommendations do not take into account individual differences. A more logical recommendation would be based on bodyweight, activity level, and environmental temperature. Taking those factors into account, my recommended intake would be just 86 ounces (see Human Water Requirement Calculator). But that calculator has a maximum of 60 minutes of exercise a day, while I average a little more than that, so another 10 ounces might be needed.
In addition, my doctor had been telling me for years to consume more sodium and less water. The reason for this is I had chronically low sodium blood levels. But by increasing my sodium intake and decreasing my water intake, my sodium levels were within the normal range for my most recent blood test in October 2014, but just barely. Plus, my blood pressure was only 104/ 64 at my last doctor's appointment on October 31, 2014.
Given all of these points, I had increased the PDA for sodium up to 2,300 mg and decreased water to 96 ounces. They were at these levels for the above tests. But in late March 2015, I increased the PDA for sodium to 3,000 mg, but I kept potassium at 4,700 mg. These levels will keep my sodium to potassium ratio to well less than 1:1 and thus shouldn’t be a problem blood pressure wise, but they should keep my blood sodium level from dropping too low again and hopefully get it into the middle of the normal range.
But with consuming more sodium, I have been thirstier and thus have been drinking more water. I wasn’t actually keeping track of my water intake but was just inputting enough water (36 ounces) to keep DietPower from lowering my “Nutrient Quotient” (its “grade” for my diet) due to low fluid intake. But starting in late March 2015, I began to keep track of it so as to keep tabs on drinking too much and thus offsetting the benefits of increased sodium intake.
These benefits include experiencing a reduction in my fibromyalgia fatigue and improved sleep. The latter makes sense given that a recent study found, “Very short sleepers showed less dietary variation, and they had the lowest total calorie intake, consumed less protein and carbohydrates, and were more likely to be on a low-sodium diet” (Don't Snooze on Nutrition: See How Foods Affect Sleep, italics added).
However, I will need to keep a watch on my blood pressure. I am checking it with a home blood pressure monitor. On March 22 when I started the increased salt intake it was 117/ 70. On April 1 it was 115/ 73, and on May 12 it was 118/ 65. So there's been no significant change after almost two months of increased salt intake. But I will continue to check it periodically, and it will of course be checked at my next doctor’s appointment.
On October 2, 2015 I had my annual physical exam, including getting my blood pressure taken. It was 119/ 74. Thus the systolic went up 19 points and the diastolic 10 points in the past year and since I started consuming more salt. However, it is still below normal, and I am feeling much better with the increased salt intake. In fact, the previously somewhat low blood pressure might have contributed to my ill-feeling, so I will stick with my current salt intake level of about 3,000 mg/ day. But this shows the above is wrong--increased salt intake does in fact increase blood pressure, at least for me. For further details, see Annual Physical Exam - 2015.
Eggs and Salt are Good
During the weeks in which I was researching, writing, and publishing this two-part article, I made two significant changes and one minor change to my eating plan and thus to DietPower’s PDAs. The first was to double my egg intake from an average of one to two per day and thus to double my allotted cholesterol level. This was because of the research cited in Part One. As a result, I updated that section with mention that since doing so it seems like my testosterone levels have increased and I have been sleeping better. Helping somewhat in the first regard is I also increased my saturated fat level to 30% of total fat and thus to the recommended 10% of total calories limit. But more significant is the increased sodium intake, for the reasons and with the results noted above.
Of course, the US government has been advising its citizens for 50 years, basically my entire life, to decrease cholesterol and sodium intakes. That is why I had always limited my egg intake and followed a low sodium diet. But I should have realized the government was in wrong in these regards when I wrote my God-given Foods Eating Plan book back in 2007. In that book, I quote Jesus as saying eggs are a “good gift” and that “salt is good” (Luke 11:12; 14:34), but I did not take those statements to their logical conclusions.
Update on BP/ Salt Intake:
On June 14 my BP was 131/ 80, and on June 24 it was 135/ 78. Thus after three months of the increased salt intake my BP had gone up some, both the systolic and diastolic numbers. It still was not high, but it had me a little concerned , so for the next week I reduced my salt intake, thus decreasing my average sodium intake from the 2,609 mg it had been the previous quarter to 1768 mg. During that week, my fatigue got worse, and I struggled through my workouts. My blood pressure on June 30 was then 123/ 84. Thus the systolic number went down some, but the diastolic actually went up. I have no idea what that means. It could just be the normal variability of blood pressure. But since I was feeling more fatigued and my BP at the highest still was not really high, I went back to the higher salt intake. I will just keep tabs on my BP with my home monitor and see what happens at my next yearly physical this fall. But to be sure, I will drop the sodium allowance to 3,000 mg, which is about what I've been consuming, as I don't think it would be good to consume more than that.
On July 22, my BP was 117/ 68 after three weeks of the re-increased salt intake. That is about what it had been for years. Maybe the initial higher numbers were due to my body adjusting to increased sodium, or maybe something else was up. But as of now, the higher salt intake only appears to be helping not hurting me, as my fatigue has improved and my training has been going very well. I will thus stick with the 3,000 mg level.
This article has detailed what I have found works best for me. I am not saying my intake of macronutrients, electrolytes, and water is best for everyone as everyone is different. That is the problem with the RDAs for these nutrients as they do not take those individual differences into account. So experiment and see what works best for you. But it is my hope and prayer that this article will give you some direction in your experimentation. For how all of this works out in practice, see my Diet Evaluation Logs – 2015. For an update to this article, see Annual Physical Exam - 2015.
Adjusted Values for Macronutrients, Electrolytes, and Water - Part Two. Copyright © 2015 by Gary F. Zeolla.
The above article was first published in the free
FitTips for One and All newsletter.
It was posted on this site March 4, 2015 and last updated October 9, 2015.
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