Macro-Managing Meals

Food Balance

Societal shift in carbohydrate, fat and protein intake behind overfat epidemic.

Among the many problems with the diet trend of the past 50 years is that it has dulled our senses about what we should eat. Calories, most believe, are the enemy, and since fat has twice the calories of carbohydrates, it must be “bad,” too.

Obviously, this is untrue, but it has led to many millions of people becoming overfat and unhealthy. Unfortunately, marketing is often more powerful than science.

We have become obsessed with calories in particular, despite the fact that the long-term success of calorie-counting diets have been shown to be a dismal failure. Studies show people who follow them for three to five years actually gain weight.

Since 1960, the U.S. National Health and Nutrition Examination Survey (NHANES) has analyzed the food intakes of large numbers of people. The overfat epidemic has been growing steadily during this same period, and since the mid-1970s it took a sudden turn for the worse. Along with the growth in the overfat epidemic, rates of obesity also paralleled other conditions of poor health, including diabetes and other problems that are now part of the metabolic syndrome. This includes many physical injuries, aches and pains associated with inflammation in joints, ligaments and muscles.

During these epidemics, the NHANES study found that caloric intake has increased, and that these increases have been due almost entirely to people eating more refined carbohydrates.

The food we eat plays a more important role in overall health than does fitness and exercise. Another unhealthy trend is the misinformation — promoted by companies selling refined carbohydrates and governments influenced by lobbyists — that the overfat epidemic is due to reduced levels of activity, and that it’s OK to eat junk food as long as you exercise. As we now know, we can’t run away from a bad diet.

Studies show that physical activity levels have basically changed little during this period of the overfat epidemic. What has changed is fitness. While athletic performance records continue to be broken by a handful of individuals, average race times today, for example, are slower. The American Heart Association has shown that many children can’t run as far or fast as their parents did. In fact, in a one-mile run, today’s children are about a minute and a half slower than their peers 30 years ago with average changes similar between boys and girls, younger and older kids. This serious problem may also reflect increased carbohydrate intake.

While low-fat foods sometimes appear to make sense to prevent higher levels of body fat, it’s actually metabolically illogical. That’s because low-fat meals usually mean increased consumption of refined carbohydrates, which produce the proverbial three-strikes and you’re out: Up to half of these carbs turn to fat and go into storage. They also reduce our ability to burn body fat for energy, and they impair aerobic fitness. These effects are immediate.

The NHANES study found that the increased consumption of carbohydrates from 1974 to 2000 was significant. In men, it rose from about 40 percent to almost 50 percent of total calories, and in women, carbohydrate intake rose from 45 percent to 52 percent. Fat intake actually decreased for men during this period, and slightly increased for women, despite women being more prone to go on low-cal/low-fat diets.

This data was also confirmed in a 2013 study by the USDA.

During my years in private practice, within the NHANES study period noted above, I performed at least one dietary analysis on virtually all patients. The same trend was evident. By 1981 I found myself recommending a diet that was no more than a moderate 40 percent natural carbohydrates like fruits, vegetables, legumes and whole grains, and avoiding avoiding all refined carbs such as breads and pasta, which gave me the reputation as the “low-carb guy.” However, this level was obviously low only in relation to those consuming 50, 60, 70 percent or more of their food as carbohydrate, most of which was refined. For older individuals who tend to become more carbohydrate intolerant, less was recommended, as low as 20 percent (and sometimes less to stimulate ketosis in appropriate patients). But what is “low” or “high” carbohydrate?

The developing consensus, without adjusting for an individual’s specific needs, is listed below. I can agree with this, however, if the amount of carbohydrate is based on natural forms and not refined.


  • High carb diet: >45 percent (this would leave about 30 percent for fat and 25 percent for protein).
  • Moderate carb diet: 26-45 percent (leaving roughly 35 percent fat and 30 percent protein).
  • Low carb diet: 25 percent (leaving about 45 percent fat and 30 percent protein).
  • Very low carb (ketogenic) diet: 10 percent (leaving about 65 percent fat and 25 percent protein).

Two important points:

  • There is no minimum daily requirement for carbohydrates (unlike fat and protein).
  • For very low-carb/ketogenic diet, most individuals require between 30-50 grams of carbs and may have to reduce protein to 20 percent.

Since government agencies won’t make the necessary recommendations to reverse the overconsumption of carbohydrates that have caused an overfat epidemic, along with rising disease states, individuals will have to take responsibility for their own health by making these important adjustments and implement healthy eating.

Dr. Phil Maffetone


  • Alexandra says:

    Hello – I’ve been quite good at reducing my carbohydrate intake and eating along the lines of the MAF method (we do still eat chickpeas and brown rice twice a week though…) – but yesterday I ended up doing the ’emotional eating’ thing after work (I used to do this regularly several years ago and am obviously out of practise…). I didn’t feel guilty about what I’d eaten, but felt physically ill afterwards (I ate a whole block of milk chocolate in one go before eating dinner (which seemed to be the other extreme – avocado and tomato with a beautiful sheep’s cheese). I also ended up with a headache – still have it – and slept badly. I know part of the headache and bad sleep is stress related, but given how ill I felt after the ‘binge’ have you got any suggestions of how to feel better after doing that?

    Today I feel like eating chocolate again (I have none at my desk at work but ate a stack of white bread with lunch which I usually avoid) and am now having trouble concentrating. I think I am on top of what the stressors were from yesterday and have a plan in my head for how to deal with them in the short and long term.

    Of course I will ride my bike/go for a walk today – but any other short term methods of countering this ill feeling?

    I don’t normally feel ill from food – or get sick that often!!!! So I am a bit ???? about what to do….

    I can’t believe I used to do this to myself every day, at time even more than once.

    Your website is about long term changes – and I appreciate that asking for a ‘quick fix’ isn’t part of the method – but I am feeling awful right now.

    Any tips for feeling better now, dealing with ‘next time’ or what to do to avoid this happening again (other than telling myself – remember how sick you felt on Tuesday?)

    Many thanks,


    • Alexandra:

      What I usually do is eat large amounts of fresh veggies (in the form of salad and juice), as well as probiotics (tempeh, miso, sauerkraut, kimchi—sometimes all four) to help ease my digestion, It’s my “reset,” and in fact that’s how I usually eat every Sunday.

      The first thing that I’d recommend is to find or create a ritual that helps you “reset.” For me it’s showering and 20 minutes of contemplative meditation where I basically explore my body with small movements and muscle contractions. It helps me move away completely from the very mental type of work stress and into a very different state of mind.

  • Sarah Wells says:

    I’m so pleased to have found Dr Phil and his work via endurance planet, everything he says makes total sense to me. My question is (and I’m sorry if this has already been covered), I am a triathlete who is working towards doing their first ironman, what is the recommended macro split for optimum performance and not for not interfering with using fat for fuel? I have just started using a 20% carb, 30% protein 50% fat ratio, and am finding I am never hungry, but lacking a bit of oomph in my training. Do I need to stick with it or do need to up carbs slightly?

    • Sarah:

      Your macro ratios look very much how they should for an average, hypothetical, endurance athlete.

      That said, the answer to your question is that it very much depends. Endurance athletes in particular should stick to “train low, compete high” when it comes to levels of muscle glycogen (which is highly influenced by dietary carbohydrates). You should know that even when you’re training more slowly due to low levels of glycogen, the physiology that you’re developing in that environment becomes much more powerful than a physiology that trains primarily with high levels of glycogen (hence the above quote). For that reason, your training speeds may not reflect your racing speeds at the same heart rate—which is why Dr. Maffetone suggests pacing by heart rate, rather than by target pace, unless you have previously correlated your heart rate with your intended race pace.

      I recommend 2 things: play around more with your diet, and tailor it to the kind of training that you’re doing. For example, the day before strength/power training, it’s a good idea to emphasize low-glycemic carbohydrates in your diet, in order to be more fueled with glycogen, which is necessary to produce low-end torque (power). Conversely, emphasize fats the day before your longer runs and bike rides, in order to bring down insulin levels and increase leptin levels. That way, your long runs become dedicated fat-burning training events.

      Does this help?

  • Kat says:

    When I cut down on carbs I lose weight quickly so how can I eat well while maintaining an adequate weight. I realize this is not the norm but it is rarely addressed in health circled

  • Miguel says:

    Hi, one week ago start the two week test. I’m vegetarian so had less choices to eat, specially in the case of proteins.
    Is possible to incorporate toffu in the test.
    Do you have any advice or suggestions in the case of vegetarians?.
    Thank you!

  • Theresa says:

    I love your work and writing. My comment is requesting clarification related to the chart. The labels appear incorrect and I want to confirm that the first bar is not low carbohydrate, as labeled.

    Thank you!!!

  • Miguel says:

    Hi, I’m planning to star the two week test. I’m vegetarian so is possible to replace meet and fish with tofu and ceitan?.
    Thank you!

      • Kay says:

        Seitan is made of wheat gluten. Doesn’t seem like that would be good for the two week test. (?)

        • Kay:

          Tough answer. I’d like to be militant about what is allowed and not allowed, but I can’t really do it because some people don’t eat animal products, and they would have a very difficult time meeting the requirements of the TWT as well as their protein needs.

          The main idea of the Two-Week Test (TWT) is to test for carbohydrate intolerance. This generally means no sugars and no starches. Since gluten is a protein, seitan passes, in principle. While typically doing the TWT de facto means that you are eliminating gluten, as a side-effect of eliminating most grains, I’ve needed to make some allowances for vegetarians.

          The jury’s out on whether gluten itself is a problem or whether it should just be avoided by people with trigger-happy immune systems. So, for people that need a protein source, I let it pass.

          For example, I tend to tell people to avoid tempeh because of the slightly higher starch content.

  • Antonio says:

    Hi Doc!
    Are the values of the table expressed in grams or on calories?

    Thanks in advance.


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