Laura Schoenfeld: The most accurate way to do that is to track your intake using something like MyFitnessPal or CRON-O-Meter or FatSecret or any of those apps that you can manually input your intake into the app and see what it comes out with as the carbohydrate amounts. With carbs, it can get a little complicated because, depending on your portion size, depending on how you cook things, depending on even what type of carb you’re using. Different types of rice will have different amounts of carbohydrates in them. Different types of potatoes and sweet potatoes will have different ones. A banana, for example, I’m sure you guys have seen the bananas that are the size of your hand versus the size of your lower arm! They get really big, so just saying I had a banana doesn’t necessarily mean you’re having 30 grams of carbs. It could be 20 or it could be 50. It just really depends on the size. If hitting the targets pretty accurately is important, then weighing and measuring and being really precise about what you’re eating and putting it into an app that’s going to track that for you is really the only way you can do it in a precise manner, and even that is never going to be precise. It’s kind of just a close-enough type of measurement.
If you’re finding that there’s a specific level of carbs you need to get to sleep well, then I would say track for a few days. If you’re noticing that if you go below, let’s just say, 150 grams and you’re not sleeping as well, but if you go up to 300 you’re gaining weight or whatever the issue is from going too high, then you can try to shoot for the midrange, maybe like 180 to 200 as your goal. Then once you’ve been tracking for a few days and once you’ve been eating that way for a few days—or even a couple of weeks; some people need a little bit longer to really get used to eating a different way, especially if you’re changing, like say you’re going from really-low-carb Paleo to a more moderate-carb approach or the other way around, where maybe they’re coming from a Standard American Diet, eating carbs all the time and they’re trying to cut it down, tracking is really the only way to know for sure.
Now, depending on your client, if somebody is way new to Paleo and eating a ton of bread and pasta and all these carbs and sugar and that kind of stuff, being that precise probably isn’t that important, and just talking about portion sizes and generally estimating that a cup of starch has about 40 grams of carbs on average—rice is going to have closer to 50; something like squash is going to have closer to, like, 25 or so—if you’re just aiming for 150 grams a day, if you try to get three cups’ worth of a variety of starch, you should be pretty close. But for anyone who needs more precise measurements, they really need to be measuring and tracking for a while. Then what can happen after you’ve been tracking for a while is you start to get used to what the amount of food looks like. Like I said, if you’re generally finding that you’re eating three cups of starch or, say, a cup of starch at each meal, and then maybe you’re having two pieces of fruit a day, and when you eat that much you’re getting the best sleep, you’re recovering well from your exercise, you feel mentally good—whatever the symptom is that you’re trying to deal with—then just try to play it by ear from there and see how you go. If you’re still having issues, then you can always jump back into the tracking if you’re kind of getting confused or feeling like things are not going as well as they were when you were tracking, but I do think most people are pretty good at estimating portion sizes and getting a sense for what a meal should look like after they’ve done tracking for a while.
This is something that when I work with patients, I give recommendations from a gram level just because I like people to have the option of tracking if they want to or if they want to know what that’s going to look like if you’re trying to aim for about a certain amount of calories. But I also give them general guidelines for meals. This is kind of a learned skill, it takes some time to get good at this, but what I’ll usually do is give them an estimated portion amount for all their macros and say, “OK, if you eat three meals a day, if every meal has four ounces of protein, a cup of starch, one to two cups of non-starchy vegetables, and let’s just say two tablespoons of added fats, that will get you close to 1,800 to 2,000 calories or something.” I usually check it just to make sure. I have a recipe and analyzing app that I use just to make sure, but I find that to be really helpful for people because if they just have a basic meal template that they follow and they’re not really needing to track or being really paranoid about, “Oh, my gosh, I need exactly this many carbs per day or I’m not following the instructions,” for most people, just having a basic guideline is plenty. Then if you have somebody who’s an athlete or if they’re really struggling, let’s say they have a bit of a disordered eating history or maybe they’re having a hard time getting enough or not eating too many carbs, then being a little bit more strict about tracking and making sure things are lining up can be really helpful.
That was a super-long answer, but this is something that I do with most of my clients even if they’re not trying to lose weight or even if they’re not in an HPA axis dysregulation issue. A lot of times certain health issues can get exacerbated by under- or overeating. I tend to work with clients that are undereating just because of the type of people that are attracted to my business. There have been a lot of clients I’ve worked with that were at least exacerbating, if not completely causing, all their health issues from undereating either calories or carbs, so it’s very important. If you have a client that has mysterious symptoms or they’re following all the rules and they’re not getting better, just make sure they’re eating enough because it’s shocking how often that’s a problem.
Dean says, “It’ll be trial and error because levels of activity can change day to day.” Again, it depends on the client because some people are just doing some basic level of activity. I have clients that will go to the gym for, like, 30 or 45 minutes, and they’re like, “What do I need to eat after?” or “What’s my post-workout fuel need to be?” Honestly, for those people, most of the time a post-workout meal or being really concerned about macro tracking is not important, whereas if you have somebody who’s doing CrossFit four times a week and the other three days they’re not really doing much exercise or it’s just walking or something, then maybe on those CrossFit days you give them specific macro targets. That example that I gave before about maybe having three cups of starch for the day, that could be their not-working-out day, and then maybe on their CrossFit day, you say to add in another 50 grams, so another cup of starch or two pieces of fruit or something to make up for the glucose that they used during the high-intensity training.
Again, with diet, it’s weird because you can get really precise as far as recommendations are concerned, but always look at the big picture and think, OK, is this person really going to want to do this level of tracking and attention to detail with their diet? Do they want to weigh all their meat portions and all that? Is there even a benefit to it, because, again, if they’re pretty inactive or they’re not an athlete, they don’t really need to be tracking macros that closely for the most part. If they’re under a lot of stress, that might increase their stress to have to deal with that. If they have a history of disordered eating, that could trigger increased disordered thoughts around food. There’s an art to macro recommendations, and again, like I said, you want to figure out what the return on investment is with any sort of extra attention to macros, and if you think that it’s not really going to make a big difference in their prognosis or their health outcomes, then I wouldn’t recommend doing any sort of intense tracking.