Metabolic Efficiency Training

METABOLIC
EFFICIENCY
TRAINING SECOND
EDITION
TEACHING THE BODY TO BURN MORE FAT
Bob Seebohar MS, RD, CSSD, CSCS

METABOLIC
EFFICIENCY
TRAINING
TEACHING THE BODY
TO BURN MORE FAT
SECOND EDITION
Bob Seebohar MS, RD, CSSD, CSCS

This book is intended for educational purposes only. The concepts provided
are meant to serve as a guide to improving health and performance but
should not replace advice from medical and health professionals. It is rec-
ommended that you seek guidance from a registered dietitian and medical
professional before implementing any of the nutrition and exercise training
concepts provided throughout this book.
Bob Seebohar and Fuel4mance®, LLC are not responsible for any conclu-
sions drawn by the reader, nor any losses, injuries or illnesses that result
directly or indirectly from attempting to use the techniques presented
throughout this book. By reading this work and choosing of your own free
will to apply any of the presented concepts, you specifically and completely
accept and assume the risks inherent in undertaking any nutrition and
exercise program.
Copyright © 2014 by Bob Seebohar, M.S., R.D., C.S.S.D., C.S.C.S.
All rights reserved. Except for use in a review, reproduction or utilization of

this work in any form or by any electronic, mechanical means, now known
or hereafter invented is forbidden without the written permission of the
author.
Printed in the United States of America.
ISBN: 978-0-9842759-1-5
Bob Seebohar
Fuel4mance®, LLC
coachbob@fuel4mance.com
www.fuel4mance.com
Design and layout by Kathryn Skiba.

Editing by Dina Griffin
TABLE OF CONTENTS
FOREWARD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix
CHAPTER 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
CHAPTER 2 Health and Vitality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
CHAPTER 3 Metabolic Efficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
CHAPTER 4 Measuring Metabolic Efficiency . . . . . . . . . . . . . . . . . 55
CHAPTER 5 Improving Metabolic Efficiency:

Nutrition and Exercise Strategies . . . . . . . . . . . . . . . . 89
CHAPTER 6 Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131
PARTING THOUGHTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157
REFERENCES AND RECOMMENDED READINGS . . . . . . . . . . . . . . . . . . . . . .163
ABOUT THE AUTHOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .167
iii
Foreword
As a third year professional Ironman triathlete, I know that

what I put in my body dictates what I will get out of it. Fuel
and hydrate right and you give yourself an opportunity to
achieve the end result you imagine. But this logic wasn’t always
so clear to me.
When I started racing triathlon in 2005, I was fresh off of
a collegiate lightweight rowing career that meant I could eat
anything and everything and not gain a pound. And eat I did!
Out of competition I loved the usual foods for someone in their
early 20’s- pizza, candy, pasta, fast food, and lived off of that for
three meals a day. In competition, I stuck to what all the maga-
zines, books and coaches preached and drank sports drinks,
energy gels and bars. And you know what the most problematic
thing was about this approach? I performed well. Sure, I had
gastrointestinal issues at every event, I bonked toward the end
of long course races, I was irritable after big training sessions,
and I was moody around meal time, but I was getting faster and
winning events and didn’t see any reason to change.
And then, a few years ago at the USAT Coaching Cer-
tification in Colorado, Coach Bob walked in to the room and
turned everything I thought I knew upside down. He talked
v
Metabolic Efficiency Training: Teaching the Body to Burn More Fat
about this crazy concept of metabolic efficiency, about using fat

for energy instead of sugars and about eating in a healthy and
sustainable way that I could enjoy and would make me fast at
the same time. I was intrigued.
I brought Bob on as my full time coach in May of 2013.
At this point in my career I was considerably healthier than
I had been nearly a decade before, but I was still struggling
to overcome the traditional approaches to endurance athlet-
ics that relied on carbohydrate heavy foods and sugar for fuel.
But I trusted the Coach, believed in the science and decided
to take all of this wonderful knowledge you now hold in your
hands and put it to the test. We eliminated grains from my
daily nutrition plan and turned to lean protein, fruits and
vegetables and healthy fat to fuel me. Admittedly, the first
week without bread and pasta and all of the things I thought I
loved was tough. But somewhere around 10 days after starting
the Metabolic Efficiency Training (MET) program, I realized
that I was sleeping better, recovering faster and generally feel-
ing “cleaner”. After two or three weeks on the program, I was
training faster and stronger than ever before. Qualitatively and
quantitatively, things looked great. But it remained to be seen
how this shift in my approach to food and fuel would play out
on the race course.
At Ironman South Africa in April of 2013, my last race
pre-Coach Bob, I finished 15th in the pro field with a low
9-hour time on 3,500 very hard fought calories. I choked
down everything I could stomach, fought off bonking with
whatever was sugary and within reach and struggled not to
throw up during the last half of the marathon. Fast forward
four months to Ironman Sweden, with just three months
of MET, where the results were astounding. I had personal
bests in all three disciplines, was 10th in the pro field, did sub
9-hours and all on 750 calories.
vi
Foreword
Metabolic Efficiency Training, quite simply, works. Un-

like the traditional plans that call for more carbs, more calories
and more guesswork, MET is rooted in science and validated
by results. This way of eating has transformed my racing, my
training and my day-to-day life and I know it will do the same
for you.
Thanks Coach!
Greg Close
Professional Ironman Athlete
vii
PREFACE
Since the first edition of this book was published in 2009, I

have received hundreds of testimonials from athletes, recre-
ationally active individuals and non-exercisers who have imple-
mented the concept of metabolic efficiency in their daily lives.
The feedback had a common theme: all of these individuals
praised the life-changing impact the concept of metabolic ef-
ficiency has had.
This second edition will include a more broad emphasis
on health and performance for athletes and fitness enthusiasts.
Updated nutrition and exercise implementation strategies will
be provided so individuals can better adopt the metabolic ef-
ficiency concept into their lifestyle. I want to make it clear that
this book is not only for athletes who train for competitions.
I have chosen to expand the population who can utilize these
cutting edge nutrition and exercise concepts so the benefits can
be more widespread. It doesn’t matter whether you are wanting
to make a dietary and exercise change to improve your lifestyle
and health or are a seasoned athlete, all of the topics in this
book will relate to you and your individual needs.
The concept of metabolic efficiency was first “born” in my
sports nutrition practice in 2006. I wanted to help endurance
ix
athletes who experienced gastrointestinal (GI) distress. The best

method I found to do this was to teach them how to use differ-
ent food combinations to balance blood sugar, and thus ma-
nipulate their internal stores of fat and carbohydrate. Little did
I know the metabolic efficiency concept would turn out to be
so much more! Since then, I have documented positive, almost
life-altering changes for individuals related to decreasing body
fat and body weight. Athletes praise the fact they no longer
need to consume nearly the amount of simple sugars during
training or competition. Because their bodies are more efficient
in using fat at higher exercise intensities, their hourly calorie
needs significantly decrease. But the most powerful health
effects I have noticed with individuals who implement the con-
cept of metabolic efficiency include the following: a reversal of
pre-diabetes, a significant reduction in risk factors for metabolic
syndrome and cardiovascular disease, and the complete discon-
tinuation of medications taken due to disease states. Having
optimal energy levels throughout the day is just the tip of the
iceberg when it comes to the benefits of metabolic efficiency!
Upon the release of the first edition of this book in 2009,
there were many unanswered questions pertaining to the bene-
fits and implementation methods of metabolic efficiency. Since
then, I have helped hundreds of people get healthier, leaner, and
more active. I have made athletes into better athletes. But you
don’t have to just believe one person. There are an increasing
number of health, fitness, nutrition and coaching profession-
als now utilizing the metabolic efficiency concept with great
success among a wide range of individuals. Because the concept
has grown in popularity, I have developed an official metabolic
efficiency certification. Once certified from the Fuel4mance®
team of sport dietitians, these individuals gain official recog-
nition as Metabolic Efficiency Training Specialists (METS)
and can help you succeed in your health, fitness and nutrition
x
Preface
behavior changes. You can search for these qualified METS on

the Fuel4mance® website (www.fuel4mance.com).
In the first edition of this book, I clearly stated there had
been no direct research on the concept of metabolic efficiency
and long-term feeding studies. This is still the case, mostly due
to the large amount of money and resources it takes to fund
feeding studies longer than a month. It is important to realize
there are scientific studies I have used to validate the nutrition
implementation strategies you will see throughout this book.
There are no shortage of these studies. I also use my decades of
experience in behavior modification techniques to ensure your
success when you implement your new nutrition and exercise
strategies. Because of the strong link between improved health
and metabolic efficiency, it is just a matter of time before re-
searchers submit grants to examine the associations between it
and improved health outcomes. Once these studies are funded,
it will not be long until we see the performance effects tested in
laboratory settings. However, keep in mind it is very difficult to
test real-life conditions in a laboratory. Because this is a behav-
ior modification, it requires weeks to months to develop and
fine-tune. Laboratory studies do not usually look at this type
of long-term data but rather, depend on longitudinal data that
compares physiological changes such as blood work, weight and
body composition. Because we know the concept of metabolic
efficiency has been effectively implemented by hundreds of
individuals in real-life with great success, we know it is a valid
strategy to improve health and performance in all types of in-
dividuals. The concept of metabolic efficiency has been molded
from nutrition science, biochemistry and physiology principles
proven from science.
My goal for this second edition of this book is to re-
count the concept of metabolic efficiency and provide more
in-depth information about the steps involved in implement-
xi
ing the specific nutrition and exercise strategies to improve

your health and performance. Enhancements in the second
edition are bountiful and will include more case studies and
testing examples and a step by step guide on how to make this
lifestyle change. Metabolic efficiency is not a diet, for a diet is
temporary without long-lasting results. Rather, this should be
a combination of a nutrition and exercise plan that embraces
a long-term commitment and change. It should be simple and
sustainable, both in the short and long-term.
A quick note about science and the research that is pub-
lished in journals. If you are a student of the trade and peruse
scientific journals on a frequent basis, remember that science
guides us but real life leads us. Science, while useful, is tenta-
tive and is usually a few years behind what athletes have already
been implementing in their daily training and competitions. It
is always debatable in design and methodology. Often times,
the study design is inherently biased based on the type of
journal and the researchers who authored the study. In fact,
you could even argue that researchers cannot measure or detect
the small changes that are worthwhile to athletes in order to
change the outcomes in their real world competitions. As you
will read, research may not detect statistically significant results
in the study findings, but take statistics out of the equation and
there are, in fact, real life, valid changes that could affect an
athlete’s performance in competitions.
Let me provide an example of how a research study may
not find a significant result solely based on statistical analysis
but where real-life clearly shows a notable outcome. There was
a study titled “Effects of Fat Adaptation and Carbohydrate Resto-
ration on Prolonged Endurance Exercise”, published in 2001 that
looked at seven competitive male cyclists. The researchers were
comparing a high versus low carbohydrate diet and its impact
on a 4-hour ride done in the laboratory at 65% of maximum
xii
Preface
exercise intensity, followed by a 1-hour time trial effort. The

cyclists were fed a standard carbohydrate nutrition plan for the
first day which consisted of 9 grams of carbohydrate per kilo-
gram of body weight (g/CHO/kg), 2.2 grams of protein per
kilogram of body weight, and 1.8 grams of fat per kilogram of
body weight. For the next six days they were split into a higher
carbohydrate (11 g/CHO/kg/day), low fat (1 g/kg/FAT/day)
plan or a higher fat (4.6 g/FAT/kg/day), low carbohydrate (2.6
g/CHO/kg/day) plan. On day eight, all cyclists rested and ate
a high carbohydrate nutrition plan that was identical to the
higher carbohydrate intervention from the earlier part of the
study. The cyclists following the higher daily carbohydrate plan
burned more carbohydrate during the exercise while the cyclists
following the higher daily fat plan burned more fat. These were
fairly typical and obvious conclusions. What is most interest-
ing in this study was that the cyclists who followed the lower
carbohydrate and higher fat daily nutrition plan covered an
additional 1.3 miles in the time trial and had a power output of
11% more than the cyclists following the higher carbohydrate,
lower fat daily nutrition plan.
Unfortunately, no statistical significance was found by the
authors, thus they concluded there was no difference in perfor-
mance. I look at this and scoff. How can riding 1.3 miles far-
ther with a higher power output not be significant? Of course,
the answer is this outcome is quite significant in real-life, but
not in the face of statistical analysis and published research. So,
if you put all of your confidence in research to give you all of
the answers, you will be led astray, unless you know how to read
the research and interpret it into real-life application principles.
Maybe there was not a high enough power due to sample
size of the study. Maybe a better statistical analysis method
should have been used. No matter the reasoning, there was
proof that there was real-life significance. How would you like
xiii
to be 1.3 miles ahead of your competitor on a bike? Depend-

ing on your rate of speed, this could mean a two to five minute
advantage, and with a higher power output to boot! Perhaps it
can be said that research studies have not been designed well or
sophisticated enough within a nutrition periodization model in
which some athletes train. It may be that more scientific studies
need to be better developed to mimic training and competition
simulations, but for now, it is safe to say there are limitations
in science. I firmly believe that many athletes are years ahead
of what scientists study. If you understood the process of grant
writing, submitting applications for funding and the length
of this process, you would understand why there is a lag time
between real-life practices and research studies. Not to men-
tion that it usually takes a few years from the inception to the
publication of research. Most individuals I know don’t want to
wait that long for information. For now, remember, we must
use science as a guide in our journey to improving health and
performance. Allow real-life strategies and the proven concept
of metabolic efficiency to lead you.
I hope you enjoy the beginning of your metabolic effi-
ciency journey and throughout your reading, you continually
ask your own questions and become your own experiment. I
will give you the tools throughout the book to accomplish this
and wish you the very best as you begin to utilize the meta-
bolic efficiency concept for years to come. I have manipulated
my personal metabolic efficiency for quite some time and have
been pleasantly shocked at some of the results. My hope is that
you will also.
xiv
Chapter 1
Introduction
I created the metabolic efficiency concept in 2006 out of a

desire to find the piece of the puzzle that was missing from the
sports nutrition services that I provided to athletes. I had been
successfully implementing my nutrition periodization concept
paired with effective behavior change strategies to improve the
performance of athletes, but I knew something was missing.
Throughout my years of college where I studied exercise physi-
ology, nutrition, metabolism, wellness and behavior modifica-
tion principles, I realized I was downplaying the impact of
overall health in my sports nutrition practice. Athletes are
people just like non-athletes but there is not much difference
between the two conceptually when it comes to daily nutrition
habits. I will explain more about this and blood sugar manage-
ment with regard to daily nutrition later in the book. Active
individuals are athletes. Recreational athletes are athletes. Pro-
fessional athletes are athletes. The common thread connecting
all of them is the fact that health must be as optimal as possible
in order to reach individual fitness and nutrition goals.
Since the first edition of this book, I have discovered a
much stronger correlation between improving a person’s meta-
bolic efficiency and certain health markers. There is quite a bit
15
of data that explores how different nutrition strategies affect

disease prevention, body composition and overall well-being. I
will highlight some of these throughout this book. As you read
this second edition, you must realize the need to improve your
health before you can reach any fitness related goals. Optimal
health is the first stepping stone in your metabolic efficiency
journey.
The metabolic efficiency concept has been and continues
to be supported and used by hundreds of individuals: recre-
ational and professional athletes, sport coaches, registered di-
etitians, nutritionists, physical therapists, physiologists, personal
trainers and strength coaches. In the early phases of creating
the concept of metabolic efficiency, I dusted off my exercise
physiology, biochemistry, nutrition and metabolism textbooks,
looking for something that would jump out at me because, at
the time, I really didn’t know what I was looking for. It was a
combination of all four nutrition and exercise science disci-
plines that helped me create the now well-known concept of
metabolic efficiency.
THE THREE AMIGOS

There are three terms and concepts that share scientific simi-
larities: the crossover concept, metabolic flexibility and metabolic
efficiency. I had learned about the crossover concept during my
undergraduate exercise physiology studies. We didn’t spend
much time learning the in-depth nature of the concept, quite
frankly because it really isn’t one of the more complicated
exercise physiology principles. In brief, the crossover concept
explores the exercise intensity in which the body shifts from
fat oxidation (also known as fat burning) to carbohydrate
oxidation, expressed as a percentage of exercise intensity rela-
tive to the maximum volume of oxygen (VO2) consumed. The
16
Introduction
concept taught us that as exercise intensity increases, the body

uses more carbohydrate in contrast to a more rested state and
at lower exercise intensities whereby the body uses more fat.
Or does it? I will of course address this later in this book. The
crossover concept primarily identifies an exercise only interven-
tion to understanding the ideal fat burning “zone” without fac-
toring in the nutrition piece of the puzzle. The crossover con-
cept specifies that the body will burn more fat if you exercise
at less than 63 - 65% of maximal intensity. In some individuals
this may be true. Other individuals can actually burn more fat
at much higher intensities.
Fat
% Substrate Utilization
Carbohydrate
Intensity of exercise
0 5 10 15 20 25 30 35 40 45 50 55 60
Time (minutes)
The Crossover Concept. The solid line indicates the percentage of fat usage
and the dashed line indicates the percentage of carbohydrate usage during
exercise. Note that exercise intensity progresses in magnitude as the graph pro-
gresses from the left to the right indicating carbohydrates are more preferentially
used as the intensity of exercise increases.
The basic message of the crossover concept is that the
17
body prefers to use carbohydrate at increasing intensities while

the reliance on fat significantly decreases. The goal of improv-
ing metabolic efficiency is to extend that crossover (“push” it to
the right) as much as possible by teaching the body to use more
of its internal fat stores at higher exercise intensities. This will
allow more area under the curve where a greater percentage of
fat is being utilized at higher intensities. This has tremendous
benefits for any individual who wants to lose weight, body fat
or improve athletic performance. If you are an athlete, imag-
ine that you can burn more fat at lower intensities of exercise
but also at higher intensities of exercise, close to your lactate
threshold. This is ideal because at the same time you are burn-
ing more fat, you are preserving your very limited carbohydrate
stores until they are really needed at very high exercise intensi-
ties. It’s a win-win situation for everyone!
The next “amigo” is metabolic flexibility. From all that I
have read on this topic, the technical definition is still confus-
ing. Some research defines it as a clear capacity to use fat and
carbohydrate fuels and to transition between them in response
to changes in dietary energy intake or circulating substrate con-
centrations. Yes, a bit confusing to say the least. Other defini-
tions offer that the theory of low carbohydrate diets for athletes
is based on the train on a low carbohydrate daily nutrition plan
and compete on a high carbohydrate nutrition plan to allow the
body to adapt optimally to burning fat. While the definition of
metabolic flexibility may not be easy to find, it is obvious the
concept is based on following a low carbohydrate daily nutrition
plan most of the time before switching to a high carbohydrate
plan before competitions. Unlike the crossover concept, there is
no exercise component, only nutrition recommendations.
Finally, we have the metabolic efficiency concept. This
explains the body’s use of its internal stores of fat and carbohy-
drate at rest and throughout exercise. It is focused on the ma-
18
Introduction
nipulation of the daily nutrition plan and the contribution from

different types of exercise. It blends nutrition and exercise, not
one independently. Research often separates these two to make
it easier and less confusing to study. In real-life, we care about
the combination of both because that is what we have to do
daily. This is not an all or none concept. The following table lists
the benefits of using the metabolic efficiency concept through
the combination of nutrition and exercise. As you can see, there
is a symbiotic relationship between the two in improving many
markers of health, fitness and nutrition.
Benefits Of Improving Metabolic Efficiency
Better fasting blood

Weight loss Body fat loss
sugar levels
Improved
Better fasting Improved
concentration
insulin levels mood states
and focus
Lower calorie needs Ability to follow
Better satiety per hour during a lower sodium
exercise eating plan
Improved blood More sustained Improved
lipid profile energy HbA1c levels
Decreased risk of
Reduced food
Improved sleep chronic disease
cravings
states
I have also created a specific physiological test that as-

sesses metabolic efficiency. This can be used to quantitatively
validate whether or not your daily nutrition and exercise plan is
working. I will describe this in much more detail in Chapter 4,
but keep in mind that while the metabolic efficiency assessment
really should be done in the beginning phases of your metabolic
efficiency journey, you can still be successful without the quan-
titative measurement. However, if you have the means to have
19
your metabolic efficiency measured, the data received will help

streamline your nutrition and exercise planning and shorten
your learning curve.
As I am sure you can tell, I am a huge supporter of base-
line and frequent laboratory testing. This obviously includes
metabolic efficiency assessments but let’s not forget about other
extremely important markers such as a triglycerides, fasting
blood glucose and insulin, LDL and HDL particle size, vitamin
D, iron, testosterone and DHEA, to name a few. Think about
these biological assessments similar to what a mechanic does
when you bring in your car for repair. They run internal diag-
nostics on it to determine issues that need to be fixed. The same
thing applies to your body. By running “diagnostics”, you get a
better idea of what is happening inside your body. Remember,
just because you may look healthy doesn’t necessarily mean that
you are. You could look like the fittest of the fit but maybe you
have high triglycerides or high fasting blood sugar or insulin
which could predispose you to chronic disease states. It is better
to have some initial assessments completed to see what is really
going on inside of your body. Then, you can develop a better nu-
trition and exercise plan that is more customized to your needs.
In addition to helping you understand more about your
health and daily nutrition needs, metabolic efficiency testing
helps you determine your nutrient requirements during training
without having to depend on calorie ranges found in research,
spreadsheets or formulas found floating around the internet.
While these may appear to be helpful, they can grossly under or
overestimate your individual hourly calorie needs. If you are an
athlete, these predicted calorie ranges do not provide a custom-
ized plan for you based on your current fitness level. Metabolic
efficiency testing will.
What really separates metabolic efficiency from any other
concept or nutrition plan is that it is easy, sustainable for a long
20
Introduction
time, non-restrictive, flexible to meet your health and exer-

cise goals, and has the end goal of controlling and optimizing
blood sugar. In fact, there are five different nutrition strategies
that you can use based on your nutrition knowledge, stage of
readiness to make a change and your personality to improve
your metabolic efficiency. There is not a one-size-fits-all ap-
proach. This is not a restrictive diet. It doesn’t matter if you
haven’t exercised in years or if you are a competitive athlete. The
end of the day goal has to do with how best to control blood
sugar. Depending on your exercise or training routine and body
composition goals, there will be different nutrition and exercise
implementation strategies. This is exactly how it should be as
your nutrition and exercise training program should support
the goals of improving health first and performance second. I
will explain these different strategies later in the book and it
should become very clear which one is best for you. As your
behavior change and experience in utilizing metabolic efficien-
cy progresses, you will be able to easily navigate through the
different nutrition and exercise strategies to meet your lifestyle
needs and health, fitness and nutrition goals.
TIME FOR CHANGE

The process of changing your daily nutrition and exercise train-
ing plans would not be successful without you first knowing if
you are ready to do it. I know that may sound a bit strange but
do you know what your readiness to change is? Any time you
want to change your nutrition or exercise training, it is consid-
ered a change in behavior. The scientific literature tells us that
it can take at least 3 weeks to make a change in behavior. I have
noticed that in my real-life practice, it can take an individual
between one month to a year or more. Each individual is differ-
ent and comes into making a change at a different stage. Thus,
21
it is important for you to know more about behavior change

before you take your first step in your metabolic efficiency jour-
ney. You will not be following a “diet” but rather flexible nutri-
tion and exercise plans. The positive health and performance
impacts of metabolic efficiency are profound and are meant to
be a lifestyle change.
To help you understand how to connect the dots behind
the behavior aspects of making a nutrition and exercise change,
I am going to teach you about a model that was developed
in the late 1970’s. This model, termed the Stages of Change
Model (SCM), was developed by James Prochaska and Carlo
DiClemente while studying how smokers tried to end their
addiction. The reasoning behind this model is that behavior
change involves the progression through a series of stages be-
fore a person can fully adopt a behavior. There is no set timeline
in moving through these stages because individuals progress at
different rates. In all of the years I have been assisting active in-
dividuals and athletes in changing their eating behaviors, I have
noticed there is not one single method that is most successful
for everyone. Rather, it must be acknowledged that every indi-
vidual is at a different stage in their life and personalities, social
influence, finances and personal goals will somewhat dictate
not only when an individual will begin making their behavior
change, but how he or she will progress. It is my hope that by
explaining the SCM briefly, you will be able to identify where
you are in your readiness to change in order to adopt your
metabolically efficient plan in a more successful manner.
THE STAGES OF CHANGE MODEL

The SCM is comprised of different stages, each of which has
specific behavioral characteristics that can help you determine
your starting point and logical progression in your quest to be
22
Introduction
more metabolically efficient. You may or may not begin at the

first stage. I know it is a bit counterintuitive not to begin at
stage one but the reason why this model has been so success-
ful for many individuals is because it takes into consideration
where a person is beginning their behavior change. Instead of
rushing through the process, it guides at each person’s comfort-
able pace. I also understand you may have wanted to see all of
your changes yesterday but it is extremely important to not try
to speed the process beyond what is realistic. I will spell out the
steps that you will use to become more metabolically efficient
soon but first, please respect the fact you may need to progress
at a slower or faster rate. If you try to rush change, it may not
happen as you want and you will certainly not be able to sustain
it over a long period of time. I developed the concept of meta-
bolic efficiency as a lifestyle change, which is why you do not
see “diet” in any of my communications. Diets, in my profes-
sional opinion, are short fixes to long-term issues and should
not be followed due to their lack of long-term success.
As I mentioned, it is important to understand you will
progress differently through the stages than someone else but
more importantly, you may begin at a different stage based on
where you are in your life with other factors that may affect
adopting a new behavior. This is why it is so important that
you first determine where you are in your metabolic efficiency
behavior change journey. It will help you adopt and progress
through metabolic efficiency with much more success.
Here are each of the stages. As you read through them, be
sure to acknowledge which stage best characterizes you.
1. Pre-contemplation
This first stage is a bit of an awkward one because you usually
do not acknowledge you actually have to change a behavior and
you certainly do not think seriously about changing. It is a dif-
23
ficult stage for those around you because you want nothing to
do with any of the help or ideas they are trying to provide you.
This is when your family and friends usually keep mentioning
you should do this or that, but you just don’t hear them. All
of the messages go in one ear and out the other. It is certainly
not a bad thing. You are just not ready to think about changing
anything. Having said that, since you are reading this book, I
am pretty certain that you are past this stage!
2. Contemplation
Stage 2 is where you start to make some progress. In this stage,
you will spend time thinking about changing your habit but
you may not be entirely ready to jump in with both feet just yet.
It is purely a cognitive stage where thinking about it is the ex-
tent of your progression. This stage is like riding a teeter-totter.
You go up and down weighing the pros and cons of changing
but never land on solid ground long enough to make a change.
You have heard of all the great benefits of being metabolically
efficient and perhaps have heard from others how simple it is
but you need just a bit more encouragement or push to get the
ball rolling. You will be more open to receiving information
about changing your habit and will use educational methods,
such as reading articles or this book, to reflect on your thoughts
and feelings of making the change.
3. Preparation
And now it begins! You have done your reading, weighed
your pros and cons and have had enough positive encourage-
ment from others that you are now committed to starting your
behavior change. This third stage is where you will focus on
taking small steps towards attaining your goal. You will seek
more educational information regarding the change you want
to make and will strive to improve your knowledge base of the
24
Introduction
change. For example, you are reading this book and absorbing
the information but you have also located additional resources
to improving your success with adopting the metabolic effi-
ciency concept. This could be identifying registered dietitians
in your area who have knowledge of metabolic efficiency or one
of the many certified Metabolic Efficiency Training Specialists
(METS) or locating other educational resources such as the
Fuel4mance “Metabolic Efficiency Recipe Book” or “Smoothie
Book”. The important thing to remember is you are begin-
ning to collect your resources in this stage. However, do not
rush your progress. Consistency and patience are important to
ensure long-term success.
4. Action
As the name of this stage suggests, you are now taking action
in your behavior change journey. You have prepared yourself
and have jumped in with both feet. You are highly motivated
and exhibit high self-confidence to change your behavior and
be successful. A grocery store trip is likely in order so you can
have a kitchen “makeover” with the foods that will support your
progress to become metabolically efficient. The important thing
is that you are now actively involved in the change. Because
this is the stage where you will rely more on your dedication,
it can be volatile and the risk for relapse is high. I typically see
individuals struggle the first 3 - 7 days of their metabolic ef-
ficiency journey because it may be a big nutrition change from
the norm. Don’t lose your focus or your confidence. A good tip
is to develop a positive support system, consisting of individuals
you can depend on in times of need. It will greatly assist you in
progressing to the last and final stage.
25
5. Maintenance
Once you get to this last stage, which can take up to 12
months, you have likely learned and developed the skills to
stay here. Short bouts of relapse may happen but for the most
part, you have done the work to change your behavior and
you are working to maintain it. This stage involves being able
to successfully navigate nutrition temptations (or what I term
“misses”) that you face daily. These can be things like chocolate,
candy, baked goods, refined sugars, sports nutrition products
and the like. One characteristic of this stage is the ability to an-
ticipate situations that may cause a relapse, but you have already
proven coping strategies and solutions ready and waiting. Stand
up tall and be confident for you possess the skills necessary to
continue to be metabolically efficient.
Relapse
While this is not a defined stage in the SCM, it is important to
mention because it is completely normal to take a step back-
wards as you learn about your body’s nutritional needs, likes,
dislikes and emotional eating habits. Some people fade in and
out of relapse frequently while others encounter it only a few
times. It can be discouraging to enter into this stage since you
may think it is negatively associated with your self-confidence,
but this could not be farther from the truth. The fact is that
relapse is part of your journey of developing metabolic effi-
ciency and making any lifestyle change. It is healthy to navigate
through this stage as there is much you can learn about yourself
and your ability to develop effective coping mechanisms that
will get you back on track.
In order for you to continually add skills to your mental
nutrition toolbox, you must learn more about yourself and how
you approach food. Don’t expect this to happen overnight or
even within a few months. You will begin seeing tremendous
26
Introduction
benefits and changes with becoming more metabolically efficient

but it may take a little longer for it to be a normal part of your
daily plan. If you approach this with the idea that there will be
hurdles and obstacles that will prevent you from being success-
ful at times, then you will be more apt to allowing these to come
and go without sending you into a downward spiral. If you slip
on occasion, remember, you are not a bad person and you have
not failed. This should not alter your self-confidence or belief in
yourself that you can make a positive change. You are merely al-
lowing the natural progression of behavior change to take place.
One thing to note about relapse is that when it happens,
try not to not regress to the pre-contemplation or contempla-
tion stages. It is extremely important, if possible, for you to
restart your process at the preparation, action or even better, the
maintenance stage.
Goal Setting
You may or may not have a good grasp on setting goals but
just in case you need a quick reminder or even a full lesson, I
am going to provide additional information that will help you
in your metabolic efficiency journey. Goal setting serves as a
marker of success and increases positive reinforcement through
the immediate feedback it can provide as you are going through
your metabolic efficiency behavior change. The two primary
types of goals are process and outcome.
Process goals are those that you have most control over
and are the ones where most of your emphasis and planning
should be focused. These types of goals provide incremental
markers of progress and success along your journey. They are
conducive to positive behavior change because frequent re-
sults can be seen and used to facilitate positive progression.
For example, a great process goal when first embarking on the
metabolic efficiency journey would be to learn the difference
27
between biological, habitual and emotional hunger, then iden-

tify which hunger you use when you eat throughout the day.
That would help you realize if you are utilizing the concept of
metabolic efficiency successfully and if not, what changes you
could make. The point is that these types of goals become well
defined short-term goals that will help you progress to your
ultimate, long-term goal.
In contrast, outcome goals are those that you have little
control over. Individuals tend to set these goals more in the
idealistic state instead of realistic state of reference. Outcome
goals are beneficial to have but emphasis should not be placed
on the attainment of these goals. Rather, you should focus on
achieving your process goals which will often times lead you to
your outcome goals. For example, your outcome goal may be
to lose weight by adopting the concept of metabolic efficiency.
That would be a great outcome goal but it is a little broad and
without knowing how to implement metabolic efficiency by
setting process goals, it is likely you may not be as successful as
you would had you set process goals first. Your realistic process
goals serve as benchmarks to your progression. The easiest way
to approach setting process goals is to dissect the outcome goal
into different stages. Process goals should provide continued
progress toward the outcome goal without steering off course.
If we use the previous example of wanting to lose weight by
implementing the metabolic efficiency concept, the process
goals could include manipulating the carbohydrate to protein
ratio to balance blood sugar and control hunger levels, sched-
uling a metabolic efficiency assessment and a meeting with a
Registered Dietitian or certified Metabolic Efficiency Training
Specialist. These process goals will lead to a successful outcome
goal attainment because they dissect the one large outcome
goal into more manageable pieces.
Once you begin to adopt and implement the concept of
28
Introduction
metabolic efficiency, you will be more confident in your ap-

proach to food and what it does for your mind and body. Put
yourself first as you begin to change. Some people initiate a
behavior change for someone else but it must be internalized.
You must want to do this for your overall health, exercise per-
formance and well-being. Make time for yourself and provide
a platform that will set you up to succeed such as surrounding
yourself with a positive support system and identifying solu-
tions to potential challenges that will arise. Reward yourself
when you achieve your process goals. Acknowledge and cel-
ebrate your successes.
29
CHAPTER 1 REVIEW
Here is a summary of the main learning objectives of this chapter:
The crossover concept is mainly comprised of exercise changes

while the concept of metabolic flexibility has to do more with
following a low carbohydrate nutrition plan. Metabolic efficiency
eloquently balances both daily nutrition and exercise plans to have
the most robust and long-lasting lifestyle changes.
The benefits of metabolic efficiency span many areas including

health, performance and physical body markers such as weight
and body composition.
When first adopting a new nutrition and exercise plan, it is impor-

tant to identify your current stage of change. By using the Stages
of Change Model, you will be more successful in your metabolic
efficiency journey.
It is important to set goals no matter what you do but under-

standing the difference between process and outcome goals and
implementing both in your metabolic efficiency plan will yield the
greatest benefit.
30
Chapter 2
Health and Vitality
You must be healthy in order to exercise. It’s a frequent phrase

that I find myself repeating to individuals. Let’s face it, some
people let their health take a back seat to their exercise and per-
formance goals. Interestingly, in the first edition of this book,
I did not have much to report in terms of the health benefits
of metabolic efficiency. Since then, I have not only received
a copious amount of testimonials from people who have im-
proved their health through adopting the concept of metabolic
efficiency but have also noted some significant data in research
studies that link the control and optimization of blood sugar to
the improvement of certain health markers. As you recall from
the last chapter, the following benefits can be seen with adopt-
ing the concept of metabolic efficiency:
Benefits of Improving Metabolic Efficiency
Better fasting blood

Weight loss Body fat loss
sugar levels
Improved
Better fasting Improved mood
concentration
insulin levels states
and focus
31
Lower calorie needs Ability to follow

Better satiety per hour during a lower sodium
exercise eating plan
Improved blood More sustained Improved
lipid profile energy HbA1c levels
Decreased risk of
Reduced
Improved sleep chronic disease
food cravings
states
Interestingly, becoming more metabolically efficient with

the goal of controlling blood sugar will reduce the daily calo-
ries you eat. While you will learn that I am not big on calorie
counting, I find it interesting that there is research that links a
longer life span with a reduced calorie intake as we age. Don’t
go out and start counting calories. You don’t have to do this
when you are metabolically efficient because your body will
regulate its hunger based on the successful control of blood
sugar. All you have to do is listen to the signals that your body
is providing you.
As you will learn later in this book, there are a hand-
ful of nutrition and exercise options you can use in your quest
to become more metabolically efficient. I will provide detail
about each one and even let you know who they are best for
at certain times. Keep in mind all of them involve controlling
carbohydrate intake with the primary goal of improving health
through the optimization of blood sugar. Compared to past
dietary recommendations from government sources and so-
called “experts”, we now know that controlling our daily intake
of carbohydrate, in addition to balancing our protein and fat in-
takes, with emphasis on nutrient quality, is absolutely necessary
to achieve better health. Eating too many daily carbohydrates
is linked with many different risk factors for chronic disease
states. Metabolic syndrome is one of these we need to pay at-
32
Health and Vitality
tention to and do everything we can to reduce our risk stratifi-

cation. Why? The simple answer is that you may actually have
some risk factors for metabolic syndrome and not even know
it because five of the metabolic syndrome risk factors are silent.
Here is a list of the metabolic syndrome risk factors along with
the reference ranges for each. If you have three of these, you are
classified as having metabolic syndrome.
Metabolic Syndrome Risk Factors

Risk Factors Values
Triglycerides ≥ 150 mg/dL or receiving drug therapy for
hypertriglyceridemia
HDL-C r NHE-GPSNFO
r NHE-GPSXPNFO
r 0SSFDFJWJOHESVHUIFSBQZGPSSFEVDFE)%-$
Blood pressure ≥ 130/85 mmHg or receiving drug therapy for
hypertension
Fasting glucose ≥ 100 mg/dL or receiving drug therapy for
hyperglycemia
Waist r ŶJODIFTGPSNFO JODIFTGPS"TJBO
circumference Americans)
r ŶJODIFTGPSXPNFO JODIFTGPS"TJBO
Americans)
Metabolic Syndrome Risk Factors. National Heart, Lung, and Blood Institute and the
American Heart Association guidelines.
The obvious first step to knowing your risk for metabolic

syndrome and other chronic diseases is to have blood work
testing done. The current health prevention model includes a
myriad of testing to get a true picture of how healthy your body
really is, from the inside out. Here is a list of the more popular
blood work tests you can get to better understand your current
health state and risk for disease.
33
Blood Work Tests

Lipid Panel Usually includes total cholesterol, HDL, LDL,
triglycerides, and ratios.
Nuclear Magnetic A much more advanced test compared to a
Resonance (NMR) normal blood lipid panel and will measure the
LDL particle number and size as well as HDL
and VLDL subclasses. The LDL particle number
is more important for detecting atherosclerosis,
not the total LDL number by itself.
C-Reactive Protein This is an inflammatory protein that measures
risk of heart disease.
Cortisol This is a stress hormone that stores fat, increases
blood sugar, lowers the immune response and
breaks down muscle.
Fasting blood A high fasting blood glucose level can lead to
glucose diabetes.
Lipid Panel Usually includes total cholesterol, HDL, LDL,
triglycerides, and ratios.
HbA1c This is the average of blood sugar over a
3-month period of time.
Fasting blood This is a hormone that helps glucose enter cells
insulin and stores fat. Insulin resistance is a precursor to
diabetes.
Complete thyroid This measures all of the biomarkers associated
(TSH, free T4, free with thyroid function. Imbalances can cause
T4 update, free T3, fatigue, weight gain or unhealthy weight loss.
reverse T3, thyroid
peroxidase, total T4,
T3 uptake)
Sex hormones All of these are related to testosterone
(DHEA, free deficiency which can affect fat storage, muscle
testosterone, growth, mood and libido.
testosterone,
estradiol, SHBG)
Homocysteine This is a protein that is associated with
increased risk of cardiovascular disease.
34
Health and Vitality
What is extremely interesting is the dietary connection to

many chronic diseases. In regards to metabolic syndrome, daily
carbohydrate consumption is a primary suspect. Following a
higher carbohydrate nutrition plan is directly related to increased
triglycerides and fasting blood glucose, decreased HDL and
weight gain. Even the American Heart Association clearly states
on their website that following a diet higher than 60% of total
calories from carbohydrate can lead to the development of meta-
bolic syndrome. I find that interesting because there are many
people that still follow high carbohydrate nutrition plans, mostly
for athletic performance. Nonetheless, it is clear that in individu-
als who do not exercise somewhat vigorously each day, a daily
nutrition plan high in carbohydrates simply is not necessary.
Each individual has different genetic predispositions to
certain risk factors for diseases and different responses to nutri-
tion and exercise strategies. There is never a “one-size-fits-all”
approach to optimal health and vitality. For example, it is com-
mon that athletes are labelled as being more insulin sensitive
due to their increased activity patterns, but certainly not all ath-
letes fall into this category. Just because you may be an athlete
and train for competitive events for hours upon hours per week,
does not make you immune to metabolic syndrome risk factors.
What happens if an athlete stops training? What if they retire
from athletic competition or they get injured? Chances are they
may turn into being more “normal” and depending on their ge-
netics, their risk for disease may increase due to less frequency
of exercise and different eating habits. Metabolic syndrome has
an alarming correlation with age (the older you get, the higher
the risk for metabolic syndrome).
Take two male athletes as an example. Let’s say they are
both marathon runners and follow the same training program.
All things equal, they manage to perform the same on race
day. So it appears there is no difference, right? Wrong. What
35
we know is that while a training program may provide a very

similar response for two different people, daily nutrition plans
will not. One runner could react very differently while follow-
ing a lower carbohydrate, higher fat daily nutrition plan while
the opposite could be true in his counterpart. This is why you
cannot judge the success of a nutrition intervention strictly
on performance alone. I won’t argue that performing well for
athletes is important, but if that is the only variable that is con-
sidered when structuring a daily nutrition plan, then the person
may not benefit as much as if they would with more nutrition
customization. This will support their exercise energy expendi-
ture needs, genetic predisposition to disease states and sensitiv-
ity to carbohydrate consumption. What if you follow a high
carbohydrate nutrition plan, are able to perform well but you
are clinically diagnosed with metabolic syndrome? It happens
more than you would think. There are research studies that have
done this testing to validate these findings, which proves that
athletes are not resistant to disease or certain risk factors.
The important take-home message is you must pay atten-
tion to the health markers that are measured inside your body
and not simply base the success of your daily nutrition plan on
external markers such as body weight or composition, competi-
tion success, faster speed or greater strength. You never know
what is going on inside your body until you “pop the hood” and
have quantitative measurements of your current health status
which will account for your genetic predisposition to disease.
One of the great outcomes of adopting a metabolic ef-
ficiency lifestyle is that many of the metabolic syndrome risk
factors will be lessened, specifically by controlling blood sugar.
Each risk factor can be tied back to controlling and optimizing
blood sugar, or the effects of it. For example, controlling carbo-
hydrate intake and making sure you are eating enough protein
and fat will lower triglycerides and fasting blood glucose and
36
Health and Vitality
increase HDL. Through associated weight loss often seen with

metabolic efficiency, waist size and blood pressure may also be
reduced.
High triglycerides can increase the risk of becoming insu-
lin resistant. Insulin resistance is a condition where the body’s
pancreas still produces insulin but it is not used properly by the
body’s cells. This leads to the body needing more insulin and
thus it produces more but the pancreas cannot keep up with the
demand, which results in a chronic elevated glucose level in the
blood. This sets the stage for developing diabetes. There is also
evidence in scientific research showing that reduced levels of
fat oxidation are associated with a high rate of weight gain, and
the inability to oxidize fat is a factor in the process of becoming
obese. When it comes to health, the list goes on and on. The
common thread that is known is that we must do a better job at
controlling our blood sugar. How? By adopting the metabolic
efficiency lifestyle!
As you can see, a dietary imbalance of nutrients that does
not support the optimal control of blood sugar can cause prob-
lems from a health perspective and this can have a significant
impact on exercise performance. Your nutritional goal is to fig-
ure out which metabolic efficiency nutrition strategy will work
best for you to support your exercise training while improving
health and performance.
Since we are not getting any younger, I feel that it is
important to highlight some research that has looked at the
biology of aging and the impact on total daily calories. Some
studies have concluded that as we age, calorie needs decrease
and eating less can increase longevity. It is a very interest-
ing concept and one that should be embraced. While there is
certainly a time and place for competitive athletes to consume
enough energy to replenish nutrient stores, feeding the body
calories in excess of what is needed on a daily basis may be a
37
recipe for disaster for health. If you are not competing in sport
but rather exercising for fitness, it is simply not necessary to
think of things like “glycogen replenishment” or “carbohydrate
loading”. Your goal is to focus on eating to support good health
and successful exercise strategies. I mention this because one
of the interesting things about eating metabolically efficient is
that you stay fuller for a longer period of time and do not eat as
many calories throughout the day. Because of the exceptional
control of blood sugar through the combination of protein, fat
and fiber, you will not feel the need to eat every 2 hours but
rather, you will eat when your body is biologically hungry, about
every 3-4 hours. This plays well into the aging equation of eat-
ing less to support better health and body metrics.
CHAPTER 2 REVIEW
Just because you may look fit, it doesn’t mean you are necessarily
healthy. It is important to have blood work assessments done in
order to learn about any risk factors for chronic disease states.
Metabolic syndrome is a set of risk factors for certain chronic diseases.

It is important to have laboratory measurements done to see if you
are at risk for disease states and structure your daily nutrition and
exercise program to support reducing your risk of chronic disease.
Individuals have genetic predispositions to chronic diseases. Blood

work assessments will help you learn about these but so will ask-
ing your parents about their family history of disease and compar-
ing their blood work assessments to yours.
38
Chapter 3
Metabolic Efficiency Training
Efficiency is a term that is frequently used in life. Be efficient

at the tasks you do at work. Be efficient with your time. Be
efficient with your running mechanics. Be efficient with your
weight lifting form. From a nutrition perspective, being effi-
cient means being able to use your fat and carbohydrate stores
better. More specifically, it is about teaching your body to use
more of its almost unlimited fat stores and preserve its ex-
tremely limited carbohydrate stores.
The most important lesson of metabolic efficiency and
daily nutrition centers on the control and optimization of blood
sugar. When blood sugar is controlled through food, specifically
eating sources of protein, fat and fiber at almost every feed-
ing, it minimizes the amount of insulin that is secreted from
the pancreas. One of the roles that insulin has in the body is to
manage high levels of blood sugar. However, when blood sugar
is uncontrolled and insulin is high, it inhibits the process of
lipolysis, the breakdown of fat. Specifically, insulin activates an
enzyme called protein phosphatase 2A which desphosphory-
lates the enzyme hormone sensitive lipase. As you can see, there
are a few biochemistry pathways responsible for this cascade of
events. Therefore, the main goal of combining foods that have
39
protein, fat and fiber is to control the insulin response. Stabi-

lizing blood sugar will lead to lower insulin levels which will
promote a higher degree of fat burning in the body throughout
the day. In addition to inhibiting the fat burning process, insu-
lin also indirectly stimulates the accumulation of fat in adipose
tissue and drives most cells to burn carbohydrate. Collectively,
you can see that the control of blood sugar by eating protein,
fat and fiber rich foods will also control the insulin response
and allow the body to be in a more fat burning versus carbo-
hydrate burning state. Protein, fat and fiber. Remember that
combination.
Metabolic efficiency training is the phrase used to describe
the combination of nutrition and exercise strategies. When you
hear the word “training”, exercise often comes to mind. Based
on the metabolic efficiency assessment protocol that I devel-
oped and continue to use to quantify the metabolic efficiency
status of individuals, I have noticed some interesting points as
it relates to an individual’s goal of becoming more metabolically
efficient. There appears to be a much greater improvement in
metabolic efficiency from daily nutrition changes versus exer-
cise changes. Much of the old physiology research done on the
crossover concept suggested the only way to improve the body’s
ability to burn more fat was through aerobic training, specifi-
cally, exercising at less than 65% of maximum intensity. While
it is true there are cellular changes that will improve the body’s
fat oxidation ability through exercise, it is not the only way. In
fact, the contribution of changing your daily nutrition plan can
account for roughly 75% of your ability to use fat better, with
the other 25% coming from exercise.
Metabolic Efficiency = 3/4 nutrition + 1/4 exercise
40
This is certainly not meant to disregard the impact that ex-

ercise can have on metabolic efficiency or overall cardiovascular
health. We know exercising on a daily basis has positive benefits
but perhaps we have been going about it all wrong. More about
that later. If three-quarters of the metabolic efficiency equation
is due to altering daily nutrition patterns, don’t you think you
should start looking at your daily nutrition plan differently? I’ve
been “in the trenches” to test this in individuals by manipulat-
ing their daily nutrition plans while keeping exercise training
the same and vice versa. The results were astonishing. A higher
rate of metabolic efficiency is achieved when manipulating
nutrition and keeping exercise the same. When individuals have
not changed their nutrition and thus, have not controlled their
blood sugar and only participated in aerobic exercise, the meta-
bolic efficiency changes were far less. Of course, the best of both
worlds is using both nutrition and exercise strategies that will
give you the best opportunity to improve your body’s ability to
burn fat, become healthier, leaner and improve exercise perfor-
mance. Paying attention to both parts of the metabolic efficiency
equation will yield a much higher degree of success.
Metabolic efficiency training (MET) offers specific nutri-
tion and exercise strategies to manipulate cellular processes in
order to improve the body’s ability to utilize both fat and car-
bohydrate. If you are wondering why protein isn’t mentioned, it
is because it is not as important. Protein is not stored as protein
in the body, but rather amino acids. Under normal conditions,
the body does not prefer to use amino acids to supply energy.
However, the role of eating protein in your daily nutrition plan
is very important and will be discussed later in this book.
EXERCISE
To gain a better understanding of the metabolic efficiency
41
concept, it is important to understand a bit of exercise physiol-

ogy since the ME concept is grounded in science. Don’t worry,
I won’t get overly technical but I do think it is important for
you to understand some of the science involved with metabolic
efficiency.
Aerobic exercise training induces changes in the mito-
chondria that improve the body’s efficiency in using macro-
nutrients, specifically fats. Mitochondria, which produce ATP
(adenosine triphosphate - the energy currency of the cell),
increase in size and number as a result of aerobic training. Mi-
tochondrial enzymatic activity also increases with aerobic exer-
cise. More specifically, those enzymes associated with the Krebs
Cycle and respiratory chain (the shuttle system that transfers
protons developed through glycolysis into the mitochondria for
use in the respiratory chain and fatty acid metabolism) increase
in activity. The important take home message is that through
cellular adaptations, aerobic exercise training allows the body to
use more available fats as energy to fuel exercise. I will present
a few different exercise strategies, aerobic and interval based
training, in Chapter 5 that will help you become more meta-
bolically efficient.
The definition of “aerobic” can be quite broad and will

depend on your fitness level. It is typically defined in
scientific research as less than 65% of maximal exercise
intensity. This level of intensity is usually well within
a manageable range for recreational exercisers and is
usually classified as Zone 2 for athletes. It is normally a
level of effort where breathing is not too labored and you
can maintain a conversation during exercise.
Aerobic exercise training also results in cellular adapta-

tions which can increase fat oxidation and decrease sympathetic
42
nervous system activity. These adaptations can improve the abil-

ity of the body to use all of the energy substrates, but overall,
the adaptations will favor more fat than carbohydrate oxidation.
When the intensity of exercise increases, certain biochemical
adaptations contribute to the increased use of carbohydrate.
These adaptations include contraction induced muscle glyco-
genolysis (the breakdown of stored glycogen to glucose so the
body can maintain blood sugar and use glucose for fuel), in-
creased recruitment of more skeletal muscle with a greater pro-
portion of fast twitch fibers, and increased sympathetic nervous
system activity. Norepinephrine (similar to adrenaline which
constricts the blood vessels and increases blood pressure and
blood glucose levels) may stimulate both liver glucose produc-
tion and lipolysis (the breakdown of fat stored in fat cells). Epi-
nephrine (adrenaline) signals the heart to pump harder, opens
the airways in the lungs and increases blood flow to the major
muscles. This intensifies the contraction induced rate of muscle
glycogenolysis which leads to a higher lactate formation. The
acidic effect of lactate and hydrogen ion (H+) development
inhibits free fatty acid transport by inhibiting a key enzyme,
carnitine palmitoyl transferase, which reduces fat uptake into
the mitochondria. Interesting stuff I know, but it is important
to realize that there are some finite processes happening inside
of your body that contribute to you oxidizing more carbohy-
drate or fat as your intensity of exercise changes.
The next step in understanding a bit more about the
physiology involved with metabolic efficiency includes a
short discussion about the metabolic effects that happen af-
ter exercise, termed excess post-exercise oxygen consumption
(EPOC). This is also commonly referred to as “oxygen debt”,
“exercise after-burn” or the increase in volume of oxygen dur-
ing exercise recovery. EPOC was first formulated in the 1920s
as an attempt to link lactic acid metabolism with the oxygen
43
consumption in excess of resting that happens after exercise. It

can take between 15 minutes and up to 2 days to fully recover
metabolically to a fully rested state as a result of an exercise
training session, depending on the intensity and duration of the
session. You can think of EPOC as the body’s way of increas-
ing the amount of oxygen we take in to erase any of the oxygen
debt we have after more intense exercise. When we exercise at
higher intensities, our bodies need more oxygen after exercise,
which leads to taking deeper and more shallow breaths. This is
affectionally known as “catching our breath”. It is also impor-
tant because the amount of calories being burned can be quite
high during this time and the body has to recuperate its inter-
nal calorie stores. The body is efficient in using fat as an energy
source to do this (our ideal scenario) but often times, we sabo-
tage this opportunity. Let me put this into easier language to
understand. After exercise, your body is in a heightened calorie
burning state, the majority from fat. This is a major reason why
some people work out: to burn more fat. However, the sabotage
comes when you eat a high amount of simple sugars immedi-
ately after exercise. This significantly decreases the body’s ability
to burn fat. Feeding more simple sugar carbohydrates after
exercise will increase the body’s carbohydrate burning abilities
and will activate enzymes that inhibit fat burning.
What we want to see happen is that you enjoy a good in-
tense workout then use the time after this workout to continue
your body’s use of calories, consisting predominantly from fat.
What is a person to do then? What about nutrition recovery?
Don’t we have to eat a bunch of sugar after exercise to “recov-
er”? Yes and no. Not many people know you can fully replenish
your glycogen stores within about 12 - 24 hours after exercise
with a normal, blood sugar balancing, daily nutrition plan. I
understand you may not have heard this before and there is a
simple reason for this. It is usually because the media or sports
44
nutrition product companies choose to not disclose this in-

formation. Practicing Sport Dietitians know this because it is
scientifically validated. In fact, we use this all the time to dictate
the type of food and aggressiveness of feeding that athletes do
in between training sessions.
Here is your take-home message: if you workout but do
not have another exercise session for 12 - 24 hours, you may
not need to stuff yourself full of simple carbohydrates immedi-
ately afterwards. Rather, what is more preferred in these cases is
to eat a more macronutrient balanced combination of carbohy-
drate, protein and fat. This will prevent the spike of blood sugar
and insulin and increase your body’s ability to burn fat after you
exercise. Keep your metabolic efficiency nutrition strategies
consistent before and after an exercise training session.
TESTING
The oxidation of fat by the mitochondria is the main source of
energy when exercise intensity is low to moderate. When the
intensity of exercise increases to 65% or more, the body begins
using more carbohydrate and less fat as energy. But, there are a
few flaws in this thinking. The first is that the data pointing op-
timal fat burning to less than 65% of maximal exercise intensity
is old and most of the research that concluded this used young
males riding bikes in a laboratory setting for their studies. The
other flaw is that the research only looked at the influence of
exercise without nutritional interventions. As you read earlier,
daily nutrition manipulations make up approximately 75%
of the body’s ability to use fat. Interestingly, through my own
metabolic efficiency testing of individuals, I have found that
the intensity at which fat can still be utilized in high amounts
can be much greater than 65% of maximal exercise intensity.
On one end of the continuum, I have tested individuals who
45
did not have a metabolic efficiency point, indicating that they

are predominantly sugar burners and very inefficient fat burn-
ers. On the other end, there are those individuals who are so
metabolically efficient that it makes you wonder why scientists
didn’t think of manipulating the daily nutrition plan in some of
their research to study the effects of nutrition. In fact, I tested
a triathlete who, at 89% intensity (Zone 4), was still burning
61% of his total calories as fat. This is an example of someone
who did not reach a metabolic efficiency point due to physical
fatigue, not daily nutritional mistakes. His daily nutrition plan
was very metabolically efficient. What he lacked was the an-
aerobic energy system development to achieve a MEP.
The Metabolic Efficiency Point (MEP) is the point

where carbohydrate and fat burning intersect during
exercise. As the intensity of exercise increases, the con-
tribution of carbohydrate to sustain exercise increases as
fat decreases.
These are three different MET Levels that I will discuss in

the next chapter. Each person will fall into one of these and it is
important for you to know which level you are so you can make
appropriate daily nutrition and exercise changes. The important
thing to remember is that each one of us is different. Genet-
ics, gender, fitness level, exercise choice and daily nutrition
habits all play into your metabolic efficiency state. The great
thing about having your metabolic efficiency tested is that you
will have a snapshot of the current state of your body’s fitness
level, daily nutrition plan and whether they are supporting your
health and exercise performance goals.
How else will you know what is really happening in your
body unless you have it measured? Do you get frequent blood
work done to know and track your blood lipids, iron, vitamin D
46
levels or hormone levels? Do you have any idea how inefficient

your body is at using fat? It’s quite alarming to many individu-
als how much their bodies burn carbohydrate over fat. You will
read much more about the importance of metabolic efficiency
testing and how to use the information in the next chapter but
let me first provide a short primer about its significance.
Not a week goes by that someone doesn’t ask me to pre-
dict their state of metabolic efficiency. Although this metabolic
efficiency “typing” is not impossible, it is extremely difficult
to do and provides no quantitative accuracy. Would you want
someone to guess how well you burn fat then proceed to help
you with your nutrition and exercise plan without really know-
ing if it is right or not? What about having someone guess your
LDL, HDL, triglycerides and fasting blood sugar and insulin
and devising a plan based on guesses? No way! You get my
point. If you want to know how efficient your body is at burn-
ing fat and carbohydrate, the only true way to do this is to have
it measured.
If you are an athlete who competes in endurance events,
you have likely heard of the term lactate threshold (LT). While
I will not get into a full explanation of what LT is, how to use it
and its application in sport, I will provide information relative
to its correlation with metabolic efficiency. The popular ques-
tion I receive from athletes is if the metabolic efficiency point
(MEP) and LT happen at the same time. It’s a great question
and unfortunately, must be answered with the phrase “it de-
pends”. There is research that demonstrates the onset of lactate
accumulation occurs at the same intensity as maximal fat oxida-
tion. However, in real-life physiological testing, the MEP and
LT rarely happen at the same exercise intensity. I have noted
in a few individuals who are very metabolically efficient with a
high fitness level, that the MEP and LT are close but still are
not one of the same intensity. In contrast, those who are more
47
carbohydrate burners with a lower fitness level will see the

MEP and LT very far apart. This could be due to many factors
such as improper training program design and daily nutri-
tion strategies. At this time, it is simply not possible to make a
direct correlation between the MEP and LT for all individuals.
Trying to make an educated guess will only provide inaccurate
training design information. The only true way to see if your
MEP and LT happen at the same intensity is to have them
both measured, independently, on two separate occasions. I will
explain why this is the case in the next chapter.
NUTRITION
Not many people are aware of the quantities of carbohydrate
and fat we have stored in our bodies. You may find it quite
shocking that, depending on gender and size, the average adult
has about 1,300 - 2,000 calories stored as carbohydrate (com-
monly referred to as glycogen stores) in the liver, muscles and
as blood glucose. Glycogen stores can deplete rather quickly,
after about 2 - 3 hours of continuous exercise, at a moderate
intensity. What many people do not realize is that the body
can perform a moderately intense workout of up to 2 - 3 hours
based solely on the use of their internal glycogen stores. What
does this mean? Simply stated, if you have an exercise or train-
ing session that lasts less than 2 - 3 hours, you do not need to
bother feeding extra carbohydrate calories during. Focus on
eating metabolically efficient before and after and you will set
yourself up for fat burning success.
The body has enough carbohydrate stored in it to sup-

port 2 - 3 hours of moderate intense exercise.
Even more interesting is the fact that the risk of gastro-
48
intestinal (GI) distress is higher in individuals who eat during

exercise. You see the story beginning to develop, right? This is
because of what is called the blood shunting response. As you
exercise, especially at higher intensities, the working muscles
require more blood flow to support locomotion and thus less
blood flow is directed to the digestive tract. If you eat or drink
something that contains calories during exercise, the body often
rebels and GI distress rears its ugly head in some way, shape or
form. You may become nauseous, experience bloating, flatulence
or diarrhea. GI distress during exercise usually doesn’t happen
when you don’t consume any calories. In this case, the gut is
“clean” and more importantly, it does not have to compete with
the muscles for blood flow. I am sure you are wondering why
I am discussing GI distress as it relates to metabolic efficiency.
Well, it just so happens that once you develop your body’s
ability to use more fat at higher intensities, thereby preserv-
ing your low amount of glycogen stores, your body requires
fewer calories consumed per hour during exercise. In fact, most
metabolically efficient individuals never experience GI distress
because they do not have to feed their bodies large amounts of
calories per hour during exercise any longer. It’s another win-
win scenario!
And now we come to the fun part of the nutrition piece
of the puzzle: fat. Any guesses on how many calories of fat the
normal adult stores inside their body? Brace yourself because
it can be in excess of 80,000 calories! There is certainly not a
shortage of fat stored in the body. Even lean athletes usually
have between 30,000 - 50,000 calories stored as fat. While this
may seem a bit depressing compared to the very few carbohy-
drate calories that are stored in the body, it actually presents
quite the opportunity. At least, that is the way I saw it years ago
when shuffling through my biochemistry, exercise physiology,
nutrition and metabolism textbooks and research articles.
49
Let me introduce you to eternal optimism. If the body

has approximately 40 times more fat than carbohydrate stores,
then there is a greater opportunity to utilize these fat stores for
energy. It just so happens that doing so will also have a signifi-
cantly positive effect on health and will lead to weight loss and
body composition changes, all of which can improve exercise
performance. What a bonus! I will discuss the different daily
nutrition strategies that you can use to gain the metabolic effi-
ciency benefits in Chapter 5 but please don’t jump ahead. There
is still quite a bit of information that is important for you to
understand before we get to the implementation strategies side
of this concept.
During rest, or shall I say not during exercise, our bodies
usually prefer using fat as the primary energy source. Chang-
ing your daily nutrition plan to optimize blood sugar control
can influence the amount of fat you are burning during rest. In
fact, you can have a more profound effect on your metabolic
efficiency through nutrition alone. Here is how I like to explain
this and how I justify the fact that daily nutrition changes ac-
count for roughly 75% of the improvement of metabolic ef-
ficiency while exercise training only comprises about 25%. An
average person may exercise once a day for 30 - 60 minutes.
Athletes may train 1 - 3 times per day from 45 minutes to 8
hours or more, depending on their sport, level of competitive-
ness and training cycle. What about rest days, days where you
just couldn’t seem to fit in exercise or times of injury, illness or
travel? My point is this. If you exercise or train once a day for
one hour, you only have this one time in the day to induce the
physiological changes that will improve metabolic efficiency
(remember the science lesson I provided earlier). On the other
side of the coin, you may eat 3 - 6 times per day which means
you have 2 - 5 times more opportunity to incorporate fat burn-
ing techniques through the simple regulation of your blood
50
sugar by putting together foods containing protein, fat and

fiber. Again, this is not to discount the contribution of exercise
training in developing metabolic efficiency. Rather, it is to show
you how much your daily nutrition plan can affect metabolic
efficiency, in the times outside of exercise.
What is interesting is that I have conducted hundreds of
resting metabolic rate (RMR) measurements on individuals
and have noted that their respiratory exchange ratio (RER),
sometimes referred to as RQ (respiratory quotient), is heav-
ily influenced by their daily nutrition. While I will not go into
the finite details of the physiological differences between RER
and RQ, for the sake of our conversation and metabolic testing,
we can use both terms for the same meaning. RER is the ratio
between the amount of carbon dioxide produced and oxygen
consumed in one breath. This calculates the contribution of fat
and carbohydrate to overall energy needs.
The physiological range for normal RER values is 0.70
- 1.00. The closer RER is to 0.70, the more fat is being used
as energy. The closer to 1.00, the more carbohydrate. I have
noticed that when individuals are following a higher carbohy-
drate daily nutrition plan with imbalanced protein and fat, their
resting RER is closer to the 0.90 range. This means that they
are teaching their bodies to burn sugar and preserve fat in a
rested state. Quite the opposite effect most of us want because
this can lead us down the road to health issues stemming from
improper blood sugar management and weight gain along with
decreased exercise performance. To contrast this, we see indi-
viduals who are metabolically efficient, controlling blood sugar
through the combination of macronutrients, with resting RER’s
around the range of 0.70 - 0.81. A much better scenario for
everyone and one that will actually help you achieve your goals
instead of hinder the progress.
How about during exercise? Well, that’s where it gets
51
a bit more technical since there are so many additional fac-

tors involved in how much fat or carbohydrate you use during
certain activities, durations or intensities. If we refer back to
our example of someone following a higher carbohydrate daily
nutrition plan, this person will likely not be as metabolically
efficient during exercise in addition to at rest. The two go hand
in hand most of the time. Eat more carbohydrates, burn more
carbohydrates. It’s basic biochemistry. However, those who con-
trol their blood sugar and are metabolically efficient will enjoy
the rewards of being able to use more fat as energy at higher
intensities of exercise.
I get asked quite often if becoming metabolically efficient
is difficult and how long it will take. I will address the first
part later in this book and will provide you multiple strategies
to improve metabolic efficiency but let me talk briefly on the
second question. From the metabolic efficiency testing that I
have conducted, I have noticed that these metabolic changes
can typically happen in as few as one to two weeks with a prop-
erly implemented eating and training program. Of course, this
assumes that the person is in a state of readiness to change and
will implement all of the necessary steps. Keep in mind that
this process may take longer for the “sugar burners”. Those who
follow a high carbohydrate eating plan will require a longer
duration to become metabolically efficient. I usually allow 3 - 4
weeks for these individuals.
SUMMARY
It really doesn’t matter if you exercise for fun or are an athlete
who is training for competitive events throughout the year.
Building metabolic efficiency should be your top priority. For
those individuals who do not compete in sport, you may gravi-
tate into following the same daily nutrition plan from day to
52
day with little fluctuation. There is no harm in doing this since

your energy expenditure from daily exercise may be similar
from day to day. However, for athletes engaging in competition
and following specific training plans and progressing through
different cycles of training, the concept of nutrition periodiza-
tion should be implemented. This means looking at your dif-
ferent training cycles and altering your nutrition program to
support your physical training goals and objectives. Metabolic
efficiency training will complement an athlete’s physiological
goals of improving cardiovascular endurance, strength, power,
speed and flexibility. The important thing to remember is that
your daily nutrition habits may need to be altered from day to
day depending on the focus of your training cycle and daily
training habits.
Lastly, let me conclude this chapter by explaining my
mantra, “eating to train”. When you structure your daily nutri-
tion plan as a factor of supporting your exercise training, you
will better achieve your health and performance related goals.
If, however, you do the opposite and “train to eat”, you will
likely overeat, gain weight and body fat and have lower self-
confidence. If you are in the habit of rewarding yourself with
food because you worked out, you should take the appropri-
ate behavior change steps to change that. It will only lead you
down the wrong path. Instead, look at the exercise training
that you have scheduled and structure your daily nutrition
plan to support it. If you would like more detailed informa-
tion about this topic, refer to my book, “Nutrition Periodiza-
tion for Athletes”.
53
CHAPTER 3 REVIEW
The components of improving metabolic efficiency include nutri-

tion and exercise. In the metabolic efficiency “equation”, daily nutri-
tion improvements account for 75% and exercise changes account
for 25%. It is important to balance these two when adapting your
body to teach it to burn more fat.
Metabolic efficiency testing can be extremely useful in your

journey. If possible, be sure to include this in your plan as well as
getting important blood work done to assess your health status.
The body has enough stores of carbohydrate to provide energy for

IPVSTPGNPEFSBUFJOUFOTFFYFSDJTF0GUFOUJNFT ZPVXJMMOPU
need to consume calories during these durations of exercise train-
ing sessions.
54
Chapter 4
Measuring Metabolic Efficiency
At this time, I would encourage you to take a small break and

review some of the information in the previous chapters to make
sure you have a good understanding of the metabolic efficiency
concept. I am sure I have thoroughly piqued your interest in
the last chapter with my brief discussion of metabolic efficiency
testing. I would like to detail this type of testing in this chapter
to show you, as an individual, how it can benefit you. If you are a
fitness or nutrition professional who conducts metabolic efficien-
cy assessments, you will learn some great information relative
to what data you should pay attention to for interpretation and
how to utilize the data in the most effective way.
Metabolic efficiency testing uses the concept of indirect
calorimetry and is like no other physiological assessment. It
is not a lactate threshold test or a VO2max test. Metabolic effi-
ciency assessments look at different variables and are beneficial
for validating your current nutrition plan in relation to your
health and performance goals. As I will explain, the intensities
in which you exercise throughout this assessment are relatively
easy and most individuals never even make it to a threshold
or hard effort. The actual testing protocol is quite simple but
finding somewhere to have it done may require the most work
55
because a special piece of equipment is needed to conduct the

test and not many individuals or organizations possess it.
The necessary piece of equipment needed to assess meta-
bolic efficiency is called a metabolic cart. This device can be
relatively expensive depending on brand and quality, with the
initial cost ranging from $5,000 to $25,000. As in most situ-
ations, you get what you pay for in terms of metabolic carts.
Because of this somewhat large capital expense, it is more com-
mon to find metabolic carts in performance centers, hospitals
and universities. Once you find a reputable location, the rest is
easy. Well, relatively speaking that is. You just have to exercise a
bit on a treadmill or stationary bike.
One of the great things about metabolic efficiency test-
ing is that it can serve many purposes. It can determine your
efficiency in using your stored fat and carbohydrate, and can
provide information on how to improve your exercise train-
ing and daily nutrition habits. If you are a competitive endur-
ance athlete, it can help you determine a specific competition
nutrition plan that is based on your individual physiology and
current fitness level that will optimize your performance and
eliminate GI distress.
TYPES
There are two types of metabolic assessments that I have devel-
oped: incremental and continuous. An incremental metabolic
efficiency assessment is the most popular and provides infor-
mation regarding at what exercise intensity (power, pace, speed
or heart rate) the body uses fat and carbohydrate and when the
“switch” between the two nutrients takes place. It is this assess-
ment that identifies if you have a metabolic efficiency point
(MEP) or not. The format begins at an almost ridiculously low
intensity (speed on a treadmill or power on a bike) because the
56
primary purpose of the incremental assessment is to identify

the MEP, if it exists. For some individuals, this can happen
at a very low intensity, thus if the intensity is too high in the
beginning of the assessment, the MEP may be missed. While
the starting intensity will differ from person to person based
on fitness level, I normally begin most recreationally active
individuals walking on a treadmill between 3.5 - 4.0 miles per
hour (60 - 100 watts on a bike) while some competitive athletes
may begin at 5.0 - 6.0 miles per hour (100 - 150 watts on a
bike). Less fit and overweight individuals should begin walking
between 1.5 - 2.5 miles per hour (30 - 60 watts on a bike). If
you are conducting this testing, be sure to customize it based on
the individual.
When starting the test at a walking speed, remember

that there will be a significant change in RER once the
individual begins running. Typically, carbohydrate oxi-
dation will increase as a result of greater muscle recruit-
ment and physiological demand for oxygen.
The second assessment, continuous, is utilized more with

endurance athletes who wish to know their specific efficiency
rate at utilizing carbohydrate and fat at specific heart rates,
paces and power outputs. This can be done on the treadmill or
bike or a combination of both. The major difference between
the continuous and incremental assessment options is the
change in intensity. With the continuous, the intensity (pace
or power) is maintained at a certain level throughout the entire
assessment.
It is important to remember that a warm-up of 10 - 15
minutes should be done before either assessment and the test-
ing administrator should closely watch the trend of the biologi-
cal markers such as heart rate, RER and ventilatory rate. This
57
will allow the testing administrator to adjust the intensity as

needed before the first stage of the assessment officially begins.
Be sure that the individual breathes into a mouthpiece or face
mask connected to a metabolic cart during the warm-up.
I discussed the concept of RER during rest in the previous
chapter so now it is time I put it into the context of exercise. As
you recall, RER is the ratio of the volume of carbon dioxide ex-
pired to the volume of oxygen consumed (VCO2/VO2). Let me
provide a quick refresher about the RER. Different amounts
of oxygen are required to metabolize carbohydrates and fats
to carbon dioxide and water. RER typically ranges from
0.70 to 1.0. The lower end (0.70) indicates that fat is being
used as the predominant fuel source and the higher end (1.0)
indicates that carbohydrate is being used as the predominant
fuel source.
Respiratory Exchange Ratio (RER)

RER = VCO2/VO2
Oxidation of one molecule of Carbohydrate

6 O2 + C6H12O6 6CO2 + 6 H2O + 38 ATP
RER = VCO2/VO2 = 6 CO2/6 O2 = 1.0
Oxidation of one molecule of Fat

23 O2 + C16H32O2 16 CO2 + 16 H2O + 129 ATP
RER = VCO2/VO2 = 16 CO2/23 O2 = 0.70
As the intensity of exercise increases, so does the RER.

The MEP is seen at 0.85, reflective of mixed nutrient us-
age (50% carbohydrate, 50% fat). This is the number that the
testing administrator will look for during your assessment to
58
quantify if you have a MEP and where it occurred with regard

to power, pace and heart rate.
INCREMENTAL ME ASSESSMENT
This section will detail the steps it takes for someone to admin-
ister the metabolic efficiency assessment. Individuals should be
responsible for bringing a heart rate monitor, sweat towel, water,
snack (for after) and a bike (if the facility does not provide one).
The pre-assessment protocol requires a 10 - 12 hour fast
before the assessment. No calories or caffeine (or any other
stimulants or herbal supplements) should be consumed. It is
okay for the person to drink non-flavored water and take any
regular medications (as long as they have been doing so consis-
tently for a few months). If an individual is sick and taking an
acute round of antibiotics, they should not participate in test-
ing until they are healthy again. The goal is to try to decrease as
many of the dependent variables that may affect the metabolic
state of the individual. Because of the 10 - 12 hour fast, it is
normally best to do the assessment in the morning.
Upon arriving at the testing facility, the person should try
to go to the bathroom and have a last drink of water if they
prefer. Because they will be wearing a mouthpiece or mask,
there will not be an opportunity to drink water during the as-
sessment. After fitting the person with a mouthpiece and nose
clip or mask (the latter is more comfortable but may produce
more error if a secure fit is not achieved or if a person has facial
hair), familiarize the individual with the exercise machine and
the protocol that will be used. Instruct them, in detail, about
the nature of the assessment and while you would like them
to complete the assessment, they can discontinue at any time
if they feel uncomfortable. Explain that this is a sub-maximal
exercise session of which they may or may not reach threshold
59
intensity, based on what you notice throughout the progression

of the assessment. It is crucial that they understand that this
will be a sub-maximal exercise test since the goal is to find the
MEP, not go to maximal effort. This is not a VO2max test.
After the individual understands the protocol and is con-
figured with the mouthpiece (or mask) and nose clip, conduct a
10 - 15 minute warm-up. This will consist of a very low intensity
relative to their fitness level. I prefer individuals warm-up at a
lower intensity than what the first stage of the assessment will
be. It is very important to keep the intensity low even though the
person may want to go faster. You both know that they can go
faster but that is not the goal. The goal is to try to find the MEP,
if it exists, and low intensity exercise is a necessary starting point.
It is important to realize a couple of things as it relates

to the warm-up. The first is that most individuals usu-
ally do not perform a warm-up before exercise but this
is a requirement for the assessment. The second is that
the individual will likely warm-up at a higher intensity
than what is preferred so it is best that the administrator
control the warm-up speed or power.
Treadmill
To perform a metabolic assessment on a treadmill, begin with
the grade at 1 - 2% to best simulate outdoor conditions. In-
crease speed between 0.2 and 0.5 miles per hour every four or
five minutes.
Four or five minute stages are important because it takes

the body at least two minutes for the heart rate to sta-
bilize when intensity is increased. It may be beneficial
to assign less fit individuals four minute stage increases
and more fit individuals five minute stage increases.
60
Choose either a four or five minute ramp increment and

be consistent with it throughout the assessment. Be sure
to maintain this same protocol for the same individual
each time they have a metabolic efficiency assessment.
The individual’s fitness level will dictate how aggressive to

increase the speed. Refer to the chart below to determine the
speed to increase each stage based on fitness level. Remember,
as I stated earlier, if an individual progresses from a walk to a
run from one stage to the next, there will normally be a tempo-
rary increase in RER due to the physiological and biomechani-
cal differences between walking and running. The administrator
should closely monitor the RER to note the trend. The RER
will usually stabilize after 2 - 3 minutes unless the speed pro-
gression was too aggressive (for example walking at 3.5 miles
per hour and then jumping to 7 miles per hour).
Treadmill Speed Increments

0.2 mph 0.3 mph 0.4 mph 0.5 mph
Beginner Recreational Competitive Elite
Chart indicating the ramp protocol progression of intensity for each stage during an
incremental metabolic efficiency assessment on the treadmill.
Bike
To perform the assessment on a bike, a power measuring device
must be used and workload stage increases can range from
10 - 50 watts, depending on the individual’s level of fitness.
When it doubt, it is better to be more conservative on the speed
or power output stage increase since metabolic efficiency data
at lower intensities is of utmost importance. Refer to the chart
on the next page to determine the power output to increase
each stage for an individual based on fitness level. It is impor-
tant to instruct the individual to maintain their normal cadence
61
(revolutions per minute) and to remain seated throughout the

entire assessment. Standing will recruit different muscles and
will affect the validity of the assessment.
Bike Power Increments

10 watts 20 watts 30 watts 40 watts 50 watts
High
Beginner Recreational Competitive Elite
recreational
Chart indicating the ramp protocol progression of intensity for each stage during an
incremental metabolic efficiency assessment on the bike.
It is very important to remember that once a speed or

power level is chosen, it must be maintained throughout
the assessment. Changing the intensity of each stage will
affect the assessment validity and data interpretation.
DURATION FOR INCREMENTAL ASSESSMENT

The amount of time that the individual should be on the tread-
mill or bike is roughly 30 - 60 minutes, not including warm-
up or cool-down. The best case scenario is to allow 90 - 120
minutes for each assessment appointment. This will allow the
proper progression of the assessment and will give the admin-
istrator time to interpret the data and provide a customized
nutrition and exercise plan to the individual.
COMPLETION OF AN ASSESSMENT
There are many “it depends” when it comes to knowing when
to stop a metabolic efficiency assessment. The first, and most
obvious, stopping point is in the hands of the individual. Basic
exercise testing 101 reminds us that the individual can always
62
discontinue their test at any point if they become uncomfort-

able or feel they need to stop for safety reasons. Of course, we
want to encourage them to continue until we receive the neces-
sary data but remember that this is not a VO2max test so reach-
ing maximal intensities is not important.
The second criteria for ending the assessment is when
the RER reaches 0.91 - 0.92, assuming that the individual
had a MEP. Interestingly, I have found that some athletes who
are inefficient fat burners and do not have a MEP begin with
RER’s around the 0.91 range. What normally happens is that
the RER remains constant for a few stages but then begins to
increase. In this situation, it is this increase in RER from their
baseline that you would identify as the end of the assessment.
The RER upon completion of the assessment, in this case, may
be closer to 0.94 - 0.96.
The third criteria for ending an assessment is to go one
stage beyond the MEP. Since MEP happens at an RER of
0.85, the next stage would have to be greater or equal to an
RER of 0.86. It is best to encourage the individual to con-
tinue the assessment past an RER of 0.86 unless they are
uncomfortable or physically fatigued. It is important to note
that a deconditioned individual may not be able to complete
an assessment as defined above due to lack of fitness. There is
nothing wrong with this. In fact, the administrator can note
the finish point and compare it to the finish point of the next
metabolic efficiency assessment. Trend analysis of test duration,
heart rate and speed or power can be the focal points for these
individuals as it shows positive progress of improving their
metabolic efficiency and more than likely, their daily nutrition
and exercise plans.
The last criteria for ending a metabolic efficiency assess-
ment is physical fatigue in a fit individual. I know that may
sound counterintuitive but if an individual follows a lower
63
carbohydrate, higher fat daily nutrition plan, they will be very

fat adapted. If, however, they are not exercising at higher inten-
sities, their body will not have the physical development and
speed to reach their MEP. Essentially, they are so fat adapted
that they are not able to reach a MEP due to limitations in
their anaerobic energy system. This is the exact opposite from
an individual who does not have a MEP due to daily nutrition
and blood sugar imbalances.
Criteria for ending a metabolic efficiency assessment:

1. Individual stops on their own due to discomfort.
2. RER is between 0.91 - 0.94 (may not happen with
those who have higher RER’s to begin with).
3. One stage beyond the MEP (RER must be greater or
equal to 0.86).
4. Physical fatigue due to limitations in the anaerobic
energy system.
Once the individual is finished, include a 10 - 15 minute

cool-down while still having them breathe into the mask or
mouthpiece connected to the metabolic cart to collect cool-
down RER data. It is best to have the last stage of the assess-
ment and the beginning of cool-down be the first stage in
which they began the assessment. For example, if they began
the assessment at 4.0 miles per hour, after they complete the
assessment, their cool-down intensity will be at 4.0 miles per
hour. This will provide the administrator data regarding how
long it takes for the individual to return to a fat oxidation state.
This information can be used to set proper recovery intervals in
between exercises or sets.
64
CONTINUOUS ME ASSESSMENT
As mentioned previously, the continuous assessment is not used
as much as the incremental. However, the continuous can be a
very beneficial method for athletes to determine their carbohy-
drate and fat oxidation efficiency as well as calories needed per
hour of training at certain heart rates, paces or power zones.
After following the same initial athlete set-up protocol as
discussed for the incremental assessment, instruct the athlete
that the main purpose of this type of assessment is not to find
their MEP but rather to determine specific substrate utilization
at a given intensity or a variety of intensities. The main reason-
ing behind this assessment option is to simulate competition
intensity measured as speed, power, pace or heart rate and
measure specific substrate use during this time. The information
gained from this assessment will provide the athlete a more
customized competition nutrition plan. Depending on the
nature of their competition (short or long duration), the athlete
may be exercising at an intensity higher than the incremental
assessment thus the athlete should be both familiar and com-
fortable with this protocol and the effort.
Most athletes whom I have tested will arrive at the perfor-
mance center knowing their intensity level at which they will
compete, or will have a close approximation of it, thus I don’t
have to do as much background work and calculation as must
be done for the incremental method. For example, an athlete
who trains and competes with power on the bike may come in
and know that their goal power for a certain race is 200 watts. I
would then put them on the bike at 200 watts for the continu-
ous metabolic efficiency assessment.
Because this type of assessment is measuring substrate
usage in a competition simulation setting, it is important the
athlete does not fast as long prior to the assessment compared
to the incremental method. Ask the athlete to follow their same
65
morning nutrition routine as they would prior to a competition,

with the only exception being to arrive in a fasted state lasting
only 2 hours.
The athlete will perform a 10 - 15 minute warm-up on
the treadmill or bike (or both) with the athlete breathing into a
mouthpiece or mask connected to the metabolic cart. Because
finding the MEP is not the primary goal of this assessment, the
athlete should perform their normal pre-competition warm-up
which usually includes some short efforts of higher intensity.
Note the RER changes during this time for comparison when
the assessment begins.
Most runners will choose to do this assessment on the
treadmill and cyclists on the bike. However, triathletes have the
option and in some cases, doing a bike/run combo assessment
may be preferred since it will yield data that they can use in two
out of their three modes of competition. To perform a bike/run
combo assessment, I would recommend that the triathlete do
a 10 minute warm-up on the bike followed by a 5 - 10 minute
warm-up on the treadmill. Then, have the athlete ride for 20 -
30 minutes on the bike at their competition power and/or heart
rate and immediately transition to the treadmill to run for 10
- 20 minutes at their competition pace and/or heart rate. The
intensities should be provided by the athlete.
If the metabolic assessment will be performed on the tread-
mill, maintain the grade at 1 - 2% to best simulate outdoor condi-
tions (this can be altered if the athlete knows the specific profile
of the competition course). The speed should remain consistent
throughout to simulate the athlete’s competition unless the athlete
specifies differing speeds based on their competition plan.
To perform the assessment on a bike, a power measuring
device is needed. Power output and speed should stay relatively
consistent based on the athlete’s predicted competition intensity.
For example, if the athlete predicts she will maintain a power
66
output of 180 watts during competition, 180 watts should be

the intensity that is consistent throughout the assessment. This
would only change if the athlete has differing power output tacti-
cal strategies that she will employ during competition. Once the
athlete is finished, include a 10 - 15 minute cool-down while still
having the athlete breathe into the mask or mouthpiece con-
nected to the metabolic cart to collect post-exercise RER data.
While the incremental assessment can be done at any time
throughout the year, the continuous method is most beneficial
in the 3 - 4 weeks leading up to a competition to dial in the
competition nutrition plan.
DURATION FOR CONTINUOUS ASSESSMENT

This will be different than the incremental assessment because
the athlete may be competing in shorter or longer duration
competitions. Normally, I would recommend a time frame
ranging from 30 - 60 minutes, not including warm-up or
cool-down. Of course, this can be customized to the athlete’s
individual needs but most data can be collected in under 1
hour. The exception would be an ultra endurance athlete. It may
be beneficial for them to spend from 90 - 120 minutes on a
continuous assessment in order to note any heart rate or calorie
expenditure shifts throughout the longer assessment.
Ending a continuous assessment is usually done when
the administrator notes a consistent RER stabilization pattern
from one minute to the next. Because there are no stages or
intensity changes, RER should be relatively stable after about
5 - 10 minutes into the assessment. However, it is important
to remind the athlete to pedal or run at a consistent cadence
without deviating from their normal pattern. If they slow down
or speed up, it could cause the RER to be unstable, thus the as-
sessment may go longer than expected. While an athlete cannot
67
treat all factors in this assessment as they would in real-life, it

is important to remind them to do everything as closely as they
would in competition. Of course, there are the outliers such as
road cyclists who compete in criterium races and do not have
much consistency in their power output. Much of their race is
comprised of attacking and sitting in a pack to draft. I would
encourage the administrator to mimic the athlete’s competition
environment as closely as possible. The great thing about the
continuous assessment is that it can be customized to meet the
athlete’s competition setting.
Once the athlete is finished, include a 5 - 10 minute cool-
down at their self-selected intensity while still connected to the
metabolic cart.
ANALYZING AND INTERPRETING THE INCREMENTAL ASSESSMENT

Now the real fun begins! Once the assessment is complete and
the individual has finished their cool-down, the administra-
tor can begin to analyze the data and “bring it to life”. Many
metabolic cart systems report data in different ways. Some have
pre-set reports and handouts that are printed directly from the
software program while others provide the raw data for the
administrator to use. There are many different variables that can
be reported from one single assessment. I have found that some
metabolic cart systems are limited in their reporting systems
and do not tell the entire story of the metabolic efficiency as-
sessment for the individual. The good news is that the admin-
istrator really only needs the raw data from the assessment to
create as many of the variables as they would like to provide to
the individual in the interpretation process.
Data analysis and interpretation is unlimited. In fact,
when I first devised this metabolic efficiency testing, I really
had no idea the intricate nature of data interpretation that I
68
could offer individuals. Since 2006, I have continually refined

my data interpretation to include the most important pieces
of information that will help an individual achieve their health
and performance goals.
The following represents the more important variables
needed by the administrator to provide a person the appli-
cable information regarding substrate use as it relates to their
metabolic efficiency assessment. Remember, no matter how the
administrator chooses to utilize the data that is collected from
the metabolic cart, the most important thing is to deliver the
most useful data to the individual. Numbers are only numbers
if they cannot be placed into real-life daily nutrition and exer-
cise strategies.
Useful Data
Incremental time and
RER
stage duration
$)0BOE'"5 && LDBMNJO
Heart rate *OUFOTJUZ QBDFQPXFS
702 NMLHNJO RPE
Important variables needed to collect from the metabolic efficiency assessment to
provide proper analysis and interpretation.
Legend:
RER: Respiratory Exchange Ratio RPE: Rating of Perceived Exertion
CHO: Carbohydrate VO2 (ml/kg/min):7PMVNFPG0YZHFO$PO-
EE: Energy Expenditure sumed, reported in milliliters per kilogram of
body weight
As mentioned previously, the goal of the incremental

metabolic assessment is to determine if an individual has a
MEP and, if so, what intensity it occurs. The information
needed from the raw data sheet provided by the metabolic cart
69
to accomplish this include the percent carbohydrate and fat

(%CHO, %FAT). Once you have this information, simply plot
these variables at each four or five-minute incremental stage
to show the MEP, if it exists, and the corresponding heart rate,
power or pace. See the figure below for a visual representation
(note: the example follows a “textbook” metabolic efficiency
point and may not be experienced by all individuals).
Intensity
Low High
Fat
Macronutrient Percentage (%)
65% 60% 65%

60% 55% 55%
50%
45% 50%
35% 40% 45% 40% 35%
Carbohydrate
Minutes 5 10 15 20 25 30 35
Plotting the percentage of fat versus carbohydrate to determine if a MEP exists. Each
percentage indicates a 5-minute stage increase in intensity from left to right.
Once it is determined if the individual has a MEP, the

next step is to deliver a bit more information. The primary data
interpretation for an individual should most certainly include
the following:
R5 65# 5#.52#-.-
R5 ,.5,.65*)1,5),5*5.51"#"5 5"**(
R5
5 2,#-5*,-,#*.#)(5.)5("(5 5B%()1(5-5."5
MEP-D zone)
R5 ).&5&),#-52*(5*,52,#-5-.!
70
R5
5 ).&5&),#-5 ,)'5,)"3,.52*(5*,52,#-5
stage
R5 ).&5&),#-5 ,)'5 .52*(5*,52,#-5-.!
93%
83%
Carbohydrate 73%
64%
52% 51%
48%
49%
36%
Fat 27%
17%
7%
Minutes 5 10 15 20 25 30
Pace 9:14 8:42 8:13 7:47 7:24 7:04
Above is an example of data collected from a metabolic ef-

ficiency assessment done on a female triathlete. As you can see
from the graph, this athlete did not have a metabolic efficiency
point (carbohydrate burning was greater than fat burning at
each stage of the assessment).
The administrator of the assessment will ultimately de-
cide how best to use the information collected in the metabolic
efficiency assessment and make it specific to each individual.
Some of this may be based on the administrator’s knowledge,
philosophy and what type of information their metabolic cart
provides. However, there is a process in the data interpretation
that should be followed. Refer to the following flowchart I have
created to help test administrators interpret the metabolic ef-
ficiency assessment:
71
Metabolic Efficiency Assessment Flowchart
MEP Present
YES /0
Improve fat oxidation Assess readiness to

below MEP change
Move MEP to the right Nutrition intervention to

control blood sugar
Balance aerobic/
Proper exercise
anaerobic exercise
prescription
Manipulate
macronutrient balance
Alter training nutrition
Re-assess every 6 - 12 weeks
As you can see, the first step is identifying the presence

of a MEP or not. From there, a more detailed nutrition and
exercise intervention plan can be created by the administrator
and delivered to the individual. One thing to note regarding the
re-assessment plan is that it is best to perform more frequent
assessments since it can help validate the nutrition and exercise
implementation strategies. However, the re-assessment sched-
ule should be set to fit the needs of each individual, their stage
of change and health and performance goals.
Let me bring this to life with an example. I will use the
same female triathlete I spoke of previously. Here is the initial
data collected from her assessment:
72
Initial Data Of A Female Triathlete

Time (minutes) 5 10 15 20 25 30
Minute/mile 9:14 8:42 8:13 7:47 7:24 7:04
RER 0.86 0.86 0.89 0.92 0.94 0.97
Kcal burned/hr 653 660 729 732 798 863
CHO burned
340 337 467 534 662 837
(kcal/hr)
FAT burned
313 323 262 198 136 26
(kcal/hr)
Heart rate (bpm) 134 138 144 151 155 160
CHO % 52 51 64 73 83 93
FAT % 48 49 36 27 17 7
The next step is to plot the carbohydrate and fat oxidation

percentages in a graph to plot the MEP.
93%
83%
Carbohydrate 73%
64%
52% 51%
48%
49%
36%
Fat 27%
17%
7%
Minutes 5 10 15 20 25 30
Pace 9:14 8:42 8:13 7:47 7:24 7:04
Now that the %CHO and %FAT have been plotted, it

is easy to see where the MEP is located. In this example, the
person did not achieve a MEP, which can be fairly common. I
will discuss the educational strategies for this scenario in the next
section but from a data collection standpoint, this is all of the in-
73
formation that is required to provide a customized daily nutrition

and exercise education plan. While there are many additional,
more advanced variables that can be looked at from the assess-
ment, it is not always necessary to include these. The data pro-
vided to each person should be based on their goals and whether
or not they are training for athletic competitions and need more
advanced interpretation variables. I will not provide an in-depth
explanation of the additional data that can be collected and how
to interpret it in this book because this is a great amount of
detail and not all individuals require it. However, if you would
like more information regarding these advanced techniques,
it is taught in the Fuel4mance® Metabolic Efficiency Training
Specialist Certification. Health, fitness and nutrition profes-
sionals are taught the complex methods of metabolic efficiency,
the testing and interpretation. I will provide more than enough
information in the upcoming pages that will help you organize
the data interpretation or, if you are the individual being tested,
understand the data that was collected from your assessment.
MET LEVELS
Taking this one step further requires looking at the three differ-
ent scenarios that can happen from a metabolic efficiency assess-
ment. I classify these as MET Levels I, II and III. Each scenario
will provide slightly different nutrition and exercise planning
strategies and using the MET Levels will make it much easier
for administrators to communicate these strategies as well as
making it more simple for individuals to understand. Each
MET Level is based on the initial assessment of whether or not
a MEP exists. From there, it is easy to move to the next step.
74
MET Level I
This individual will not have a MEP due to either poor nu-
trition or exercise habits or both. What is typically noted in
these individuals is a daily nutrition plan that consists of high
carbohydrate, low fat and moderate protein and exercising at
too high intensities during each workout. In reality, aside from
the sometimes difficult behavior change component, this is the
easiest person to help change and improve their metabolic effi-
ciency. As you will learn more in the next chapter, there are five
nutrition strategies that can be implemented in an individual’s
nutrition plan: 1) carbohydrate to protein ratio and the Hand
Model, 2) Periodization PlatesTM, 3) carbohydrate unloading, 4)
low carbohydrate, high fat and, 5) fat adaptation, carbohydrate
restoration. It is recommended that a MET Level I individual
utilize the carbohydrate to protein ratio and Hand Model along
with the Periodization PlatesTM nutrition plans to ensure the
most success. Additionally, using the MEP-D zone will be the
primary exercise goal. As you recall, this means keeping the
exercise intensity lower to induce the positive physiological
improvements in fat oxidation.
Interestingly, because some individuals will not have a
MEP, it will be difficult to set a MEP-D zone. The easiest
thing to do is to look at the trend of the carbohydrate and
fat oxidation lines that were plotted. Once the carbohydrate
oxidation line significantly deviates from one stage to the next,
this would imply that the body is using a more significant
amount of carbohydrates as energy. Thus, the MEP-D zone
would be under this deviation. In our example of the female
triathlete, that would mean she would exercise at intensities
of less than 138 beats per minute or run slower than an 8:42
minute per mile (refer to the graph on the following page).
75
MEP-D Zone 93%

83%
73%
Carbohydrate 64%
52% 51%
48%
49%
Fat 36%
27%
17%
7%
Minutes 5 10 15 20 25 30
Pace 9:14 8:42 8:13 7:47 7:24 7:04
These would be training sessions she could do on her more

aerobic training days. It is important to understand that an
individual does not need to train 100% in the MEP-D zone.
As you recall, daily nutrition changes allow for a more robust
(roughly 75%) contribution of metabolic efficiency improve-
ments. Training in the MEP-D zone will assist in these goals
but because the contribution of exercise is less than nutri-
tion (roughly 25%), this lower intensity exercise prescription
should not be the main focus of her implementation strategies.
Improving daily nutrition strategies should be the her main
strategy.
MET Level II
This individual will have a very clear MEP and it may appear
that nothing more could be done to improve their metabolic
efficiency. However, as stated in the MET interpretation flow
chart, the next set of goals for this person will include increas-
ing the amount of fat that is burned at the lower intensity
stages and moving their MEP to the right so that they are
burning fat at higher intensities of exercise. Here is an example
of a MET Level II.
76
Metabolic Efficiency Point (MEP)

Power: 260 watts
Heart Rate: 147 bpm
Fat
68% 69% 74%
64% 65% 60% 64%
59% 53% 57%
40% 41% 47% 43%

32% 31% 36% 35% 36%
Carbohydrate 26%
Minutes 5 10 15 20 25 30 35 40 45 50
Watts 100 125 150 175 200 225 250 275 300 325
As can be seen, this individual’s MEP is at a heart rate of

147 beats per minute and a power output of 260 watts. Because
his MEP is pronounced, the nutrition and exercise strategies
to improve it are different than discussed in the MET Level I
example.
The nutrition plan would include a review of the carbohy-
drate to protein ratio and Hand Model and the Periodization
PlatesTM to ensure the individual was already in compliance
with these. The main nutrition focus would be to implement
a carbohydrate unloading daily nutrition plan and experiment
with a lower carbohydrate, higher fat plan.
Exercise planning should include the MEP-D zone,
which can be quantitatively assigned based on the MEP, as
being less than 147 beats per minute and at a power output of
less than 260 watts (refer to the graph on the following page).
Remember though, MEP-D zone training does not need to
be the main focus of his training. I would recommend that he
respect his MEP-D zone whenever he has aerobic based train-
ing sessions only.
77

Power: 260 watts
MEP-D Zone Heart Rate: 147 bpm
Fat
68% 69% 74%
64% 65% 60% 64%
59% 53% 57%
40% 41% 47% 43%

32% 31% 36% 35% 36%
Carbohydrate 26%
Minutes 5 10 15 20 25 30 35 40 45 50
Watts 100 125 150 175 200 225 250 275 300 325
MET Level III

The individual who falls into this category is usually doing
things correctly when it comes to nutrition and exercise. Most
often, a MEP will not be seen due to physical fatigue, not
nutritional, as in the example of the METS Level I. Stated
more simply, this person is extremely metabolically efficient
and lacks the higher, anaerobic energy system development to
be able to have a MEP. Normally, this person is following a
lower carbohydrate, higher fat daily nutrition plan and exer-
cises regularly.
This athlete is extremely efficient at burning fat at higher
exercise intensities and his RER did not exceed 0.82. In fact, he
was still burning 61% of his calories from fat at a pace of 6:31
minutes per mile and a heart rate of 171 beats per minute!
78

n/a
Physical fatigue before metabolic fatigue due
to lack of anaerobic training
Fat
82% 81% 78% 76% 73% 72% 68% 61%
24% 27% 28% 32% 39%

18% 19% 22%
Carbohydrate
Minutes 5 10 15 20 25 30 35 40
Min/mile 8:27 8:07 7:47 7:30 7:14 6:59 6:44 6:31
Obviously, the goal is to help this person achieve a MEP

and an even higher degree of metabolic efficiency. In order to
do this, the nutrition strategy of a fat adaptation and carbohy-
drate restoration can be implemented so that this person cycles
their higher fat plan with introducing more carbohydrates
into their daily eating patterns when their training calls for it.
As an example, this person would include more carbohydrate
throughout the day before a high intensity training session. This
macronutrient cycling will yield the best of both worlds because
it allows this person to remain in an optimal fat adapted state
but to increase carbohydrate stores to sustain a higher intensity
workout. Remember, it is not nutrition that limits this per-
son from having a MEP but, rather, exercise. Specifically, this
person must place more emphasis on their anaerobic energy
system development by introducing high intensity interval ses-
sions in their training program. This will allow the physiological
adaptation required to reach a MEP.
79
ANALYZING AND INTERPRETING THE CONTINUOUS ASSESSMENT

A continuous metabolic efficiency assessment helps an athlete
create their competition day nutrition plan with more custom-
ization based on their individual fitness level at a given point
in their training program and accounts for the physiological
and nutritional responses that were trained during the previ-
ous months. It allows the athlete to dial in their nutrition more
accurately based on their physiology rather than using the
standard calorie and carbohydrate ranges seen in many sports
nutrition resources.
Because the intensity does not change from stage to stage
as it does in the incremental method, it is quite easy to inter-
pret the continuous assessment. After the RER stabilizes, the
number game can begin. Let’s take this example of a triathlete
who conducted a bike and run continuous metabolic efficiency
assessment.
Bike Data
Minute 5 10 15 20 25 30
Power (watts) 220 220 220 220 220 220
RER 0.81 0.82 0.83 0.84 0.83 0.83
Heart rate
158 160 159 159 159 160
(bpm)
CHO% 36 38 43 47 43 43
FAT% 64 62 57 53 57 57
EE (kcal/min) 9.6 9.9 10.1 10.2 10.1 10.1
Kcal/hour 576 594 606 612 606 606
80
Run Data
Minute 5 10 15 20
Pace
7:00 7:00 7:00 7:00
(minute/mile)
RER 0.85 0.86 0.87 0.86
Heart rate (bpm) 165 167 166 166
CHO% 50 53 56 53
FAT% 50 47 44 47
EE (kcal/min) 11.1 11.3 11.2 11.2
Kcal/hour 666 678 672 672
As can be seen, his data are relatively stable as expected

since it is a continuous metabolic efficiency assessment. From
his data, we can see that he was expending between 576 - 612
calories per hour with a heart rate of 158 - 160 beats per min-
ute at the stable power output of 220 watts. Once transitioned
to the run, he was expending 666 - 678 calories per hour with
a heart rate of 165 - 167 beats per minute at the stable running
pace of 7:00 minute/mile. From this data, you can use the calo-
rie intake efficiency ratio (you will read this in the next section)
of 10 - 30% and provide his hourly calorie needs. For the bike,
this range would be from 58 - 184 calories per hour and for
the run it would be from 67 - 203 (see table). This athlete now
has an accurate hourly calorie prescription for the bike and run
based on his current physiological fitness.
Power/Pace Heart Rate Hourly Calorie Needs

Bike 220 watts 158 - 160 58 - 184
Run 7:00 minute/mile 165 - 167 67 - 203
81
INTAKE VS. EXPENDITURE

The ratio of how many calories a person can consume versus
the amount they expend during exercise is certainly not a one to
one ratio. In fact, I have noticed athletes who compete in longer
duration competitions are lucky to be able to consume 35% of
the calories being burned through exercise without experienc-
ing negative consequences such as GI distress. More realistically,
I have noticed ranges of 10 - 30% as the normal calorie intake
based on calorie expenditure. This is the range that I recommend
most individuals use as their eating during exercise rule.
For example, if you burn 600 calories throughout a train-
ing session or competition, you should safely consume only
60 - 180 total calories (using the 10 - 30% calorie intake ef-
ficiency ratio). What does all of this really mean? Quite simply
it means that you burn more calories than you can eat during
exercise. Think of it as an energy deficit situation. You simply
cannot keep up with the calories that are being used. If you try
to eat more calories than are being expended, it is a recipe for
GI distress. But remember, as you develop better metabolic ef-
ficiency, this becomes less of an issue.
As you have been learning throughout this book, training
your body to use more of its internal stores of fat to supply en-
ergy is your primary goal so you teach your body to need fewer
calories during training or competition. You certainly do not
have to practice feeding an enormous amount of calories to try
to “keep up” with the amount of calories in which you are burn-
ing. It is physiologically impossible and quite frankly, not neces-
sary. Don’t let anyone talk you into trying to overfeed calories
during training so your body is able to absorb more. There are
much better and more effective ways to approach this. In fact,
as you improve your metabolic efficiency, your need for carbo-
hydrates during training and competition will decrease, usually
to the range of 3 - 10% of the amount of calories being burned
82
each hour. This means that you will be using more fat as energy
at higher intensities thus you will be preserving your internal
carbohydrate stores - an even better recipe for athletic success!
As an example as to why it is more important to have this
measured and use the 10 - 30% calorie intake efficiency ratio
rather than relying on ranges published in research, let’s look at
an example. The following energy expenditure table is from an
incremental metabolic efficiency assessment. If we compare the
carbohydrate (CHO) only grams expended per hour at various
intensities to the most updated, standard sports nutrition rec-
ommendations of consuming between 30 - 90 grams of carbo-
hydrate per hour, what we notice is this athlete has the potential
to overeat quite a bit. For example, by looking at the 10:00
minute per mile pace, we notice that she is expending 41 grams
of carbohydrate and 46 grams of fat at that effort.
Energy Expenditure Table

Pace Heart Rate Kcal hour $)0 'BU HSBNT
HSBNT
14:16 103 355 18 32
13:20 128 495 28 42
12:30 137 510 33 43
11:46 143 528 30 46
11:07 145 536 31 46
10:31 153 578 38 48
10:00 160 580 41 46
9:32 165 621 50 47
9:05 171 650 63 44
8:42 173 695 90 38
If this athlete consumed 40 grams of carbohydrate per

hour to try to match her carbohydrate energy losses, she would
likely overfeed herself, risking GI distress. Remember, just
because she is burning 41 grams of carbohydrate, that doesn’t
83
mean this is how much she should eat. Using the 10 - 30% cal-
orie intake efficiency ratio, at a pace of 10:00 minute per mile,
she should consume between 4 - 12 grams of carbohydrate, or
16 - 48 calories per hour.
Most individuals consume more calories per hour during
exercise than they really need. The real issue is that overfeed-
ing excess calories during exercise will predispose individuals
for GI distress. Some people are lucky enough to dodge the
GI distress bullet and eat as many calories as they want during
exercise. For the majority of individuals, however, it is quite the
opposite. Many athletes whom I have worked with complain
of GI distress symptoms during exercise. For these individu-
als, it makes no sense to feed a larger amount of calories during
exercise training.
Teaching your body to use more fat at higher exercise
intensities is the key to having a healthy gut without worries
of vomiting, diarrhea or bloating. Remember, as intensity of
exercise increases, the body’s ability to digest calories decreases.
It makes no sense to try to eat a high amount of calories dur-
ing moderate to higher intensity exercise. Conversely, we see
lower energy expenditure, specifically carbohydrates per hour,
during lower intensity exercise yet individuals are overeating at
these times also. The body may be able to digest calories more
efficiently at lower intensities but the payoff is overfeeding and
possible weight and fat gain. Exercise is not an excuse to over-
eat! All too familiar is the story of new marathon runners who
gain weight during training. This should never happen and is
usually caused by consuming too many calories during training.
Develop your metabolic efficiency first and foremost. As
you do, you will notice that you need fewer calories during both
low and high intensity exercise, will have no GI distress and
will not have to battle weight or body fat fluctuations as you
may have in the past.
84
DIFFERENT STROKES FOR DIFFERENT FOLKS

I have been working with endurance minded individuals for
years pioneering the concept of metabolic efficiency so it is not
uncommon for me to be asked if it is applicable to use in non-
endurance sport settings or even endurance sports with com-
petitions of shorter duration and higher intensity. The concept
of metabolic efficiency has obvious benefits and a tremendous
impact for any endurance athlete competing in events longer
than 3 - 4 hours but would it be beneficial for events lasting less
than this duration? What about for those non-athletes working
out at higher intensities with little aerobic endurance compo-
nent to their exercise program? The easy answer is “yes” but let
me explain the reasoning since it is a bit different than for those
competing in longer duration training and competitions.
During a shorter duration, high intensity exercise session
or competition, carbohydrates become an important energy
source for the body. In general, most people have enough car-
bohydrate stores in their bodies to supply 2 - 3 hours of mod-
erately intense exercise. For individuals participating in higher
intensity exercise sessions throughout the week or for athletes
competing in shorter distance training and competitions, the
two primary nutritional goals include staying hydrated and
consuming enough electrolytes to promote good hydration
balance. Supplying the body with a copious amount of supple-
mental carbohydrates for energy is usually not needed during
short, intense exercise training. Yes, you read that correctly
but before you jump to conclusions, let me explain further. By
reducing the need for consuming a high amount of carbohy-
drates per hour during higher intensity training and competi-
tion, the risk of GI distress decreases significantly. Remember
as I explained before, every opportunity in which your digestive
tract must process calories at higher intensities during exercise,
85
the greater risk of GI distress. Higher intensity exercise alters

the body’s ability to digest nutrients (blood flow that normally
gets delivered to the gut for digestion is shunted to the work-
ing muscles), thus the chances of digesting a high amount of
calories are slim without feeling any form of GI distress. It may
be vomiting, bloating or diarrhea but one thing is for certain,
overfeeding calories during high intensity exercise is a recipe
for disaster.
Thus, by teaching the body to use its internal fat stores
more efficiently, more fat can be used to fuel higher intensity
exercise. This reduces the need for high carbohydrate con-
sumption during short, high intensity exercise sessions. This
does not necessarily mean supplemental carbohydrates are
never needed. Depending on how well fed you are before exer-
cise and how long the intense session lasts, you may need a few
calories here and there but certainly not as many as when you
are more metabolically efficient. Think of it as the less is more
concept: your body will rely more on its fat stores for energy
and less on carbohydrate stores, thus causing a preservation of
your internal carbohydrate stores until they are really needed.
Additionally, remember that the number one nutrition limiter
to exercise and athletic performance is glycogen depletion. As
your internal stores of carbohydrate become less, your body
becomes more fatigued. Metabolic efficiency teaches the body
to conserve your internal carbohydrate stores so that more fat
is being used which delays premature fatigue, otherwise known
as “bonking”.
As I conclude this chapter, the main take-home message is
that you should strive to improve your body’s ability to use fat
at lower and higher intensities for this will benefit you from an
energy standpoint in addition to reducing potential GI distress.
You do not need to overfeed your body carbohydrates in an ef-
fort to train it to absorb more. The body is very smart and will
86
adapt to what you teach it. Hopefully, you choose the method
which makes more sense in terms of health and athletic perfor-
mance: metabolic efficiency.
CHAPTER 4 REVIEW
There are two types of metabolic efficiency assessments: incre-

mental and continuous. Incremental is the most popular and will
identify if an individual has a MEP or not. Nutrition planning and
the MEP-D zone training can then be provided. Continuous is
more suitable for athletes who wish to determine a competition
day nutrition plan based on known race intensities.
There are three MET Levels that individuals will be categorized into
based on their level of metabolic efficiency: Level I, II and III. Each
level offers different nutrition and exercise planning strategies.
The calorie intake efficiency ratios were developed to provide indi-

vidual hourly calorie goals that are based on a person’s individual
fitness and metabolic efficiency. This 10 - 30% calorie range has
been set to provide the right amount of calories necessary to fuel
exercise without risking GI distress.
87
Chapter 5
Improving Metabolic Efficiency:
Nutrition and Exercise Strategies
NUTRITION
There are many “diets” on the market and while they all prom-
ise quick and lasting results, the truth is they are not sustain-
able. Eating to become more metabolically efficient is a lifestyle
adaptation, one that focuses on altering the daily amount of
carbohydrate, protein and fat based on energy demands of exer-
cise and training and to improve overall health.
Over the past few years, I have been using research and
real-life methodology to develop a handful of nutrition strate-
gies which can be used in the journey of metabolic efficiency. I
am excited to offer different nutrition strategies to you because
metabolic efficiency is certainly not a “one-size-fits-all” concept.
It allows changes in nutrition based on your health, exercise and
body weight or body composition goals. The strategies provide
the flexibility to change your nutrition plan based on your indi-
vidual needs and progress in adopting metabolic efficiency. You
will be able to choose which strategy best fits your lifestyle and
goals currently, but you will also have the flexibility to “cycle”
through the different nutrition options as your fitness improves
or health changes. Remember, implementing a metabolically ef-
ficient nutrition plan must account for your activity level, exercise
89
or training goals, body weight, body composition and health

goals. As you read the five nutrition strategies of becoming more
metabolically efficient, remember that you don’t have to commit
to just one method for the rest of your life. That is the beauty of
metabolic efficiency: it is not a set diet that you struggle to follow.
Since each person is genetically different and has different life-
style factors and stressors to consider, it is important to find the
nutrition strategy which can be implemented with the most suc-
cess in your life at this point in time. Will it change? You bet. A
good, metabolically efficient, nutrition plan will continually sup-
port your exercise performance, body and health goals through-
out your lifespan. Here are the five different nutrition strategies
for developing metabolic efficiency along with a full explanation
of how to use them and for whom they would work best.
Metabolic Efficiency Nutrition Strategies Overview

1. Carbohydrate to protein ratios and the Hand Model
2. Periodization PlatesTM
3. Carbohydrate unloading
4. Low carbohydrate, high fat
5. Fat adaptation, carbohydrate restoration
Strategy 1: Carbohydrate to Protein Ratios and

The Hand Model
This is the foundation and first step in learning how to imple-
ment a metabolically efficient daily nutrition plan. It is where
everyone should start their metabolic efficiency journey. Using
these strategies will allow you to learn about the nutrients in
food and help you regulate the volume of food that you eat.
Knowing how much to eat is definitely a complex topic, and
one that does not have an easy, exact answer but the Hand
90
Improving Metabolic Efficiency: Nutrition and Exercise Strategies
Model simplifies it so you will not be handcuffed to calorie

counting or measuring food.
The Hand Model is a simple method for manipulating the
carbohydrate to protein ratio of food. To begin, you must relin-
quish your old knowledge of using the size of the palm of your
hand to equal a serving size. We are using the entire hand, palm
and fingers. Look at both of your open hands then imagine the
food you may eat. Your left hand will be the size and quantity
of protein you should eat. Depending on the size of your hand,
this should equal around 4 - 6 ounces of a protein (such as a
piece of chicken). It is known in satiety and weight loss re-
search that we need between 25 - 35 grams of protein at each
feeding in order to become and stay full. While the protein
content will differ based on its source, normally one ounce of
animal protein contains about 6 - 7 grams. So, if we know your
hand can provide 4 - 6 ounces of animal protein, this means
that you will eat approximately 24 - 42 grams of protein. Do
you need more than 40 grams of protein per feeding? It is bet-
ter to be more consistent in your protein feedings throughout
the day rather than to have a huge protein-rich meal once a day.
Many individuals do not eat sufficient protein throughout
the day. Using the Hand Model is an easy way to ensure you eat
enough of this high satiety nutrient to help keep you full. Now
onto the other hand. Your right hand will serve as the quantity
of the fiber-rich foods you will eat. These include carbohydrate
sources such as fruit, vegetables, nuts, seeds, legumes and whole
grains.
The burning question is whether or not you should eat
whole grains. This is more of an individual decision.
There are many good nutrients found in grains but if you
choose not to include them, remember that you will still
get many of the same beneficial nutrients in foods such
as vegetables, fruit, nuts, legumes and seeds.
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Using the Hand Model to measure out the fiber part of the
protein, fat and fiber “rule” will usually mean that you will eat
1 - 2 servings of the above mentioned fiber-rich foods, depend-
ing on the size of your hand and the volume of the food. There
is usually 3 - 12 grams of fiber in a serving of fiber-rich foods.
That is the extent of the Hand Model. One hand protein, one
hand fiber. Put them together and you have a meal which sup-
ports optimal blood sugar stabilization and metabolic efficiency.
Don’t worry so much about going out of your way to include
fat in this nutrition strategy. Fat is normally included in protein
sources such as beef, chicken, fish, pork, turkey, milk, yogurt,
cheese, nuts and seeds. Be sure to choose protein sources that
are not too lean and do contain some fat. Having fat in protein
rich foods is beneficial for health, satiety and weight loss.
Carbohydrate to Protein Ratios

Are you wondering where the carbohydrate to protein ratio
comes into play? Because each gram of carbohydrate has 4 calo-
ries and each gram of protein has 4 calories, the ratio of one part
carbohydrate to one part protein is 1:1. It is known from diabetes
research that if you can keep your carbohydrate to protein ratio
between 1:1 and 2:1 during meals and snacks throughout the
day, you will control your blood sugar very well. A ratio of 3:1
is okay but not ideal and should not be used often, especially
if you are trying to lose weight. As you learned previously, con-
trolling and optimizing blood sugar is one of the main founda-
tional principles of metabolic efficiency in order to improve your
health, body weight, body composition and exercise performance.
Whenever the carbohydrate to protein ratio exceeds 4:1, it means
you will not be in a state of controlled blood sugar. As a result,
you will significantly decrease your body’s ability to use fat as
energy. Refer to the table on the next page for more information
92
for when to use these ratios.

You can easily use nutrition labels to figure out this easy
math. Simply look at the grams of protein per serving first then
make sure that the grams of carbohydrate are equal to or no
greater than double the amount of protein grams. You can also
refer to this simple table to help you. It incorporates the use of
the carbohydrate to protein ratios and the Hand Model.
Ratio: 1:1 2:1 3:1 4:1

Classification: Ideal Good 0LBZ Pushing it
Application: Use to Use Use after a Minimize
develop before workout that the use of
metabolic or after a is longer than this ratio.
efficiency workout 3 - 4 hours
and at that is or very high
most meals longer intensity
throughout than 2 lasting longer
the day. hours. than 90
minutes
Hand Model:
Combining the carbohydrate to protein ratio with the

Hand Model is the ideal scenario. It makes it easy. No measur-
ing. No counting calories. Just look at your hand and you can
build a 1:1, 2:1 or sometimes a 3:1 ratio of carbohydrate to
protein. It may seem intuitive but I do want to address how to
use this method to ensure you are on the right path in the be-
93
ginning and have minimal “speed bumps” when implementing

it. When using the Hand Model during breakfast, lunch and
dinner, begin by placing 1 hand of carbohydrate with 1 hand of
protein on your plate. If you are still hungry after about 15 - 20
minutes, repeat this step but with 50% less food. This way, you
maintain the ratio and control your blood sugar well without
overeating. Remember though, if the protein source you had
was very lean, you should include an additional fat source to
this meal. For snacks, simply begin with half a handful of
carbohydrate and protein. This will ensure you do not overeat
during snack times.
If you are using the 2:1 or 3:1 ratios at times, follow the
same pattern but if you find yourself still hungry after eating
the first round of food, assess your biological hunger before
loading up your plate again. Because you will be eating more
food with these ratios, you may not be that hungry afterwards.
However, your brain may not get the message that your stom-
ach is full for about 15 - 20 minutes so step away from the table
and do something for a few minutes before you assess the need
for seconds.
The three types of hunger include biological, habitual

and emotional.
1. Biological: when you feel stomach pangs or low
cognitive functioning (you cannot focus too well).
2. Habitual: usually a set time of the day when your body
is used to eating meals or snacks.
3. Emotional: the connection between food and
emotional triggers such as stress, boredom, fatigue,
happiness and sadness.
94
There you have it. Using the carbohydrate to protein ratio

and the Hand Model is the first, most simple step in your meta-
bolic efficiency journey. I’m not saying it will be easy at first but
it really does lessen the need to count calories and measure and
weigh food. This strategy also teaches you more about food and
how it affects your individual hunger cues and satiety signals.
Spend some time experimenting with different foods and you
will soon develop the confidence needed to try some of the other
nutritional strategies of improving your metabolic efficiency.
Strategy 2: Periodization PlatesTM

The second daily nutrition strategy you can use when devel-
oping your metabolic efficiency is the Periodization PlatesTM.
This is a tool I created in response to individuals who wanted
freedom from calorie counting but needed a more visual,
real-time, feedback system. As you will see from the graphics,
this nutrition strategy is based on putting food on a plate in
certain proportions to control and optimize blood sugar. It is
not meant to be a quantitative model so try your best not to
assign percentages to the nutrients when you see the different
graphic options on the following pages. The goal of using the
Periodization PlatesTM is to provide further education on how
foods can be put together at meals and snacks for optimal
blood sugar stabilization. Most individuals adore this model
because they can see the relative portions of foods filling their
plate. It provides immediate feedback and allows you to ma-
nipulate it based on which plate you are trying to emulate.
The plate on the following page is indicative of where
most people start prior to implementing the concept of meta-
bolic efficiency. As you can see, it is high in carbohydrates (pro-
cessed and refined starches/grains, fruits and vegetables) and
fairly low in protein and fat. Misses (indicated by the smaller
circles) are abundant throughout and include foods such as
95
candy, potato chips, pastries, chocolate, alcohol, energy bars, and

sports drinks. This is a classic example of metabolic inefficiency
and it is obvious that something needs to be done to make im-
provements because it does not optimize blood sugar according
to what you have learned thus far.
Metabolic Inefficiency Plate
Typical Individual
Protein
&
Fats
Fruits
&
Vegetables Processed/Refined
Starches &
Grains
= misses
Grains are not created equally and can be divided into

the categories of whole and refined.
Whole grains contain the entire grain kernel which

includes the bran, germ and endosperm. Foods such as
whole-wheat flour, oatmeal (not instant), whole corn-
meal, bulgur, and brown rice can be classified as whole
grains. In contrast, refined grains are milled which is a
process that removes the bran and germ. While this im-
proves the shelf life of products, it removes the benefi-
cial nutrients including fiber, iron and many B-vitamins.
Foods such as white flour, bread and rice are classified as
refined grains. Because these are stripped of some nu-
trients, they are often enriched, which means nutrients
96
such as the B-vitamins thiamin, riboflavin, niacin and

folic acid along with iron are added back into the refined
grain after processing.
This next graphic indicates how a fitness enthusiast would

use the Periodization PlatesTM to progress throughout their
metabolic efficiency journey.
Periodization PlatesTM for Fitness Enthusiasts
Step 1 Step 2 Metabolic Efficiency
Whole
Processed/ Grains
Protein Refined
& Protein
Starches & & Fruits Protein
Fats Grains & &
Fats
Vegetables Fats
Fruits
Fruits &
& Vegetables
Vegetables
As you can see, this is a step by step process and the qualita-
tive model of the Periodization PlatesTM caters to individual
nutritional needs. Because of this, please understand each plate
is simply a starting place for where you should begin. You may
need to adjust quantities based on your exercise training or
health goals. Here’s a great tip to remember: whenever you
change your daily nutrition plan, allow for at least 7 - 14 days
before you decide whether it is meeting your needs. It takes
at least that duration of time for your body to adjust to these
changes.
You should employ progressive steps when beginning a
metabolically efficient daily nutrition plan. The first step is to
note what your normal daily nutrition plan looks like today. I
recommend keeping a photo food log for a few days so you can
get a good snapshot of your baseline daily nutrition patterns. Yes,
97
I did say keep a photo food log as there is no better way for you
to receive immediate feedback. Because the Periodization Plat-
esTM is a visual based teaching tool, the best way to use this op-
tion is by employing a visual feedback loop. With the popularity
of technology, it is quite simple to take photos of your meals and
snacks throughout the day to be able to reference them for step
2. As you can see in step 1 of the Periodization PlatesTM graphic,
this is your beginning phase. The first plate may or may not look
like yours and that is okay. The important part is that you make
progress to step 2 toward metabolic efficiency.
Once you have a few days of photos depicting what your
beginning plates look like for breakfast, lunch, dinner and
snacks, it’s time to get to work. I formed this model to support
the positive behavior change process. Remember, this is a pro-
cess. Don’t feel like you have to implement a complete nutrition
makeover immediately. This is usually too overwhelming and
may not lead you to sustainable success. Rather, take each plate
as a progressive step to learn more about food and its accompa-
nying effects on your body throughout your journey.
Now that you know what your baseline plate looks like, it
is time to take it to the second step. Step 2 is where the work
really begins as it involves making more of a robust change in
your daily eating habits. It shouldn’t be too difficult since you
have already slowly started to change the landscape of your
initial plate. The goals for this step include replacing most of
the processed and refined starches and grains with whole grains
and more importantly, have most of your daily carbohydrate
needs met by vegetables and fruit. Additionally, you should
increase protein and fat a bit more but nothing extreme in
terms of a high protein or high fat diet. Just enough to attain
macronutrient balance for optimal blood sugar control. I would
recommend allowing at least 2 - 3 weeks for this step so you
can really get a hang of it and see how your body will react to it.
98
Most individuals who allow this amount of time in Step 2 find

great long-term success.
The last step is the most impactful. While one specific
plate does not exist to achieve metabolic efficiency, it is known
that focusing on protein, fat and fiber as the predominant
nutrients in one’s daily nutrition plan will provide the best
blood sugar stabilizing results. Many individuals choose to not
include any type of whole grains in their daily eating because
they feel they can receive all of their carbohydrate needs from
vegetables, fruit, nuts, legumes, seeds, dairy and soy products.
This is absolutely true and while I cannot tell you what to do,
I will say you should base your decision of including grains in
your daily nutrition plan on your health goals and your ability
to have strong willpower. For example, some individuals who
lack willpower, and at the same time tell themselves they can-
not have any type of whole grains, will not succeed. They are
setting themselves up for failure. In contrast, those individuals
who are strong-willed can be very successful. It is possible to
be metabolically efficient with including whole grains in your
daily nutrition plan but it takes a bit more work in being able to
control the ratios of carbohydrate and protein.
To be clear, determine what will work best for you con-
sidering your health and exercise goals along with the type of
lifestyle you have. Are whole grains currently a significant part
of your life and something you do not want to try to give up?
Don’t fight it. Take small steps that will yield a higher degree
of success in the beginning of your metabolic efficiency jour-
ney. Remember, you may find yourself cycling back and forth
between plates throughout the year based on life circumstances
and different exercise goals. Remember though, as the Stages
of Change Model suggests, try not to digress back to the first
plate, where you began, since it will take much longer to initiate
the behavior change process again.
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Periodization PlatesTM for Athletes

This next graphic depicts how athletes training for competi-
tions would use the Periodization PlatesTM. Athletes progress
through different training cycles throughout the year and
should adjust their daily nutrition to match their energy needs
for each training cycle accordingly (the concept of nutrition
periodization).
Preparatory Competition Taper Transition

WG
SNP WG WG
FV P/F P/F
P/F P/F FV
FV
FV
Energy
Expenditure
P/F – Protein and Fat

FV – Fruits and Vegetables
WG – Whole Grains
SNP – Sports Nutrition Products
– Misses
As an athlete progresses from their preparatory (base or pre-

season) to their competition season to their transition (off-
season), their energy expenditure fluctuates. This is why the
nutrients change on each of the Periodization PlatesTM - to
accommodate energy demands and energy needs of different
training cycles. One quick note about the taper cycle. Most ath-
letes typically include a taper, lasting between 2 - 28 days, lead-
ing up to their competitions. It is common for athletes to gain
unnecessary weight during this time since the volume of train-
ing is reduced. To prevent weight gain, the nutrients change
and traditional simple sugar based sports nutrition products are
taken out of the daily nutrition plan to account for the lower
training volume.
For the athlete who engages in regular competitions
throughout the year, the Periodization PlatesTM can be utilized
with a different focus, relative to differing training cycles and
100
energy needs and expenditures. The concept of Nutrition Peri-

odization, which means structuring the Periodization PlatesTM
in order to match your daily and weekly energy needs, should
be used to customize daily nutrition needs associated with
varying training loads each day.
Strategy 3: Carbohydrate Unloading

Quite frankly, this strategy is mostly used for individuals who
are highly dependent on carbohydrate rich foods (carbohydrate
addicts). If you fall into this category, it is a good place to begin
your nutrition intervention. How do you know if you are a
carbohydrate addict or not? It’s pretty easy, really. Do you have
constant mood swings throughout the day? Do you experience
an afternoon lull where all you want is caffeine or sugary foods?
Are you gaining weight or not losing weight? Do you crave
sweets? If you answered “yes” to any of these questions you are
most likely a carbohydrate addict.
This nutrition strategy provides what I call a reverse ramp
protocol. Its purpose is to help wean you from a high daily car-
bohydrate nutrition plan to a more manageable one. It’s a pretty
easy concept which includes decreasing your daily carbohydrate
intake by 100 grams per week. Of course, it will depend on how
many grams of carbohydrate you currently eat but most carbo-
hydrate addicts consume upwards of 500 grams per day. I have
to admit, I was there at one point in my life also. It’s what I was
taught in school and was brainwashed into thinking it was the
only way to eat. It’s not. Believe me.
Here is the simple implementation strategy. You will first
have to keep a log of how many grams of carbohydrate you eat
each day. It will be a bit laborious but you only need to do this
for three consecutive days. You can do this by hand and read
labels (just the grams of carbohydrate) or use one of the many
software programs, websites or smartphone apps that exist.
101
As an example, let’s say that you average 500 grams of car-

bohydrate per day over these three days. This is your baseline.
Continue eating this way until next week. Then reduce your
daily consumption to 400 grams of carbohydrate. The following
week, 300 grams, then 200 grams the next week. It is impor-
tant you do not drastically reduce your carbohydrate intake all
in one day or one week. The purpose of this option is to allow
you the proper time to come off of this addiction. Think of it
like carbohydrate rehab. This strategy will be most successful
if you implement it over a 4 week time period. At week 5, you
should be eating between 100 - 200 grams of carbohydrate
per day. If you are recreationally active, you should be closer
to 100 grams per day. If you are an athlete, your range may
be greater depending on the type of training session you have
scheduled. Normally, I recommend athletes hover around the
120 - 200 grams of carbohydrate per day amount. But again, as
I mentioned in the last option, utilize the concept of nutrition
periodization in your daily nutrition plan to allow your carbo-
hydrate intake to fluctuate so that you meet your energy needs
based on training fluctuations. In the off season, athletes may
need less than 100 grams of carbohydrate per day.
Remember to use the concepts I provided in earlier chap-
ters to help reduce your daily carbohydrate consumption. The
best way to do this is to reduce processed starches and grains the
first week, then reduce regular starches, whole grains and fruit
the second week. During week three, consume very minimal
whole grains and starches (if any) and only 1 - 2 servings of fruit
per day. By the fourth week, the majority of your daily carbohy-
drates should come from non-starchy vegetables, nuts, legumes,
seeds, and possibly dairy products (if you are including these).
Remember this is a gradual process so allow time to decrease
your high carbohydrate dependency. If you follow this carbohy-
drate unloading approach, you will not feel the negative effects
102
of reducing your carbohydrate consumption (such as headaches,

mood changes and energy lulls). Be patient, this is a lifestyle
change! Once you graduate from carbohydrate rehab, you can
employ Strategy 1 or 2 or even explore the next two strategies I
will present.
Strategy 4: Low Carbohydrate, High Fat

These next two strategies are a bit more complex so they are
best suited for individuals who know their way around food
and have a good sense of how to utilize the first three strategies
with success.
The low carbohydrate, high fat daily nutrition plan may
seem like it has made a recent introduction to the nutrition
world but in reality, research has been done on this for decades.
Most of the information studied relative to this way of eating
initially focused on health markers related to metabolic syn-
drome, cardiovascular disease and other disease states such as
epilepsy. Then the benefit to athletic performance was studied.
Both had very important results that may impact the way you
view this nutrition strategy for improving metabolic efficiency.
Before I get into the details, it is important to mention there
is no real definition of “low carb” or “high fat”. There are no
exact percentages or grams per day of carbohydrate or fat that
you have to follow with this method of eating, just individu-
als preaching what works for them. Some people strive to be in a
state of nutritional ketosis while others do not. There is much flex-
ibility when it comes to this strategy which makes it a good option.
You have likely heard the term “ketosis” before. It is
popular in regards to low carbohydrate, high fat daily nutrition
plans so let me explain this term before progressing any farther.
Ketosis is a condition when ketone bodies are elevated in the
bloodstream. These ketone bodies are formed when carbohy-
drate stores in the liver become depleted. This becomes impor-
103
tant because if there is no glycogen that can be used for energy,

what fuels the individual following a lower carbohydrate daily
nutrition plan? The answer is the ketone bodies acetoacetate
and beta-hydroxybutyrate. I won’t get too deep into the com-
plex biochemistry and metabolism of ketone bodies but suffice
it to say that when you follow a lower carbohydrate daily nutri-
tion plan, ketone bodies are used as energy to fuel exercise and
brain function. In fact, ketone bodies can cross the blood-brain
barrier and enter the brain where they can be converted into
energy. Now, the important thing to remember is that it takes
eating less than 50 grams of carbohydrate per day to get into
this state, termed nutritional ketosis. It is safe and can provide
great health benefits to individuals but the long-term efficacy
of following this nutrition plan for athletes has not been stud-
ied or validated. What we do know is that most individuals
respond very well to this type of low carbohydrate, high fat
daily nutrition plan. Examples of favorable outcomes include
improvements in blood lipids, decreased disease risk, and body
weight and fat mass decrease in most individuals.
Many people think nutritional ketosis is dangerous, but
that is not the case. The type of ketosis most people associate
with being detrimental is called diabetic ketoacidosis. This hap-
pens when fat metabolism increases because there is a shortage
of insulin. It is primarily associated with those who have Type
1 diabetes. Let me make it clear that nutritional ketosis can be
the outcome of a low carbohydrate, high fat daily nutrition plan,
depending on the total amount of carbohydrates that are con-
sumed. However, this does not happen overnight. Any change in
daily nutrition will require the body to become familiar with it
before fully adapting to it. During the initial stages of nutritional
ketosis, the body will maintain its energy stores through gluco-
neogenesis (the formation of glucose from non-carbohydrate
sources). This can be thought of as a protective mechanism the
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body goes through to ensure blood glucose levels are maintained.

During this time, the brain does not use ketone bodies for
energy. After a few days of nutritional ketosis, the brain finally
begins to use the ketone bodies as energy, fat burning increases
and glucose moves into a preservation state. While the verdict is
still out, most professionals believe it likely requires months to
become fully fat-adapted and accustomed to nutritional ketosis.
The important thing to remember is there is no concrete
definition of low carbohydrate, high fat in the context of this
nutrition strategy. You can eat less than 50 grams of carbohy-
drate per day to induce nutritional ketosis or you can eat more.
The key is to find the right amount of carbohydrate you should
eat each day that will help you achieve your health, perfor-
mance, body weight and body composition goals. I believe for
most individuals engaging in a daily exercise program or for
athletes in training, the ideal daily carbohydrate range is 60 -
150 grams. This range will fluctuate for athletes as they prog-
ress through different training cycles. I worked with a male,
professional long-course triathlete and found that 150 grams
of carbohydrate per day was not enough to satisfy his energy
requirements during his high training load cycle. With him, I
increased his carbohydrate intake close to 200 grams per day
while still practicing metabolic efficiency (the carbohydrate to
protein ratio and the Hand Model) and his body responded
well. Once his season was over, we decreased his daily carbo-
hydrate consumption to under 100 grams. As you can see, this
range allows a great amount of flexibility to align carbohydrate
consumption with exercise and training needs without over-
consuming carbohydrates.
Nutritional ketosis happens when a person eats less

than 50 grams of carbohydrate per day with moderate
protein and high fat intake.
105
Diabetic ketoacidosis happens in situations where fat

burning is increased due to a lack of insulin and happens
in people with Type 1 diabetes.
It is important to note that a low carbohydrate, high fat

nutrition plan is not synonymous with a high protein nutri-
tion plan. If you wish to follow the low carbohydrate, high fat
daily nutrition method of metabolic efficiency, be sure to keep
your protein intake at moderate levels. Many individuals make
the mistake of lowering their daily carbohydrate intake without
increasing their daily fat intake and they become extremely hun-
gry. The key to following this nutrition strategy is to introduce
more fats into your daily nutrition plan while you decrease your
carbohydrates. Both must happen at the same time while pro-
tein stays moderate (usually between 20 - 30% of total calories
or about 80 - 130 grams per day). Refer to my “nutrition teeter-
Nutrition Teeter-Totters
Carbohydrate Fat
Macronutrient balance ➜
Protein
Fat
rate
Low carbohydrate/high fat ➜ Carbohyd
Protein
Carbohydra
te
Fat
Low fat/high carbohydrate ➜
Protein
106
totters” on the previous page as a graphic representation of what

I am referring to.
A low carbohydrate, high fat daily nutrition plan can

represent many different quantitative strategies. More
popular implementation strategies of this method in-
clude eating the following:
Carbohydrate: less than 2.5 grams per kilogram of
body weight per day
Protein: from 1.0 - 1.5 grams per kilogram of body
weight per day
Fat: from 1.5 - 3.0 grams per kilogram of body weight
per day
Let me use a 120 pound (54.5 kilogram) female as an

example. Using the above numbers, she would eat the
following each day:
Carbohydrates: less than 136 grams
Protein: 55 - 82 grams
Fat: 82 - 164 grams
What makes this nutrition strategy even more interest-

ing is, contrary to what the USDA or other institutions report,
there is no clear daily requirement for carbohydrates for adults.
There are ranges for athletes, which typically are defined as
3 - 10 grams of carbohydrate per kilogram of body weight per
day, but these ranges are not individualized and they can be a
very high carbohydrate feeding strategy. The Institute of Medi-
cine recommends Americans consume between 45 - 65% of
their total daily calories as carbohydrates but what is this based
on? It certainly does not account for gender, age, sport, disease
107
risk or body weight and body composition differences among

individuals. There is the supposed fact that the brain needs
between 100 - 130 grams of carbohydrate per day to survive.
What about those individuals who are in nutritional ketosis
on a daily basis? As I described earlier, ketone bodies can cross
the blood-brain barrier so in cases of consuming less than 50
grams of carbohydrate per day, the body increases its fat burn-
ing significantly so that the ketone bodies provide the necessary
energy for the brain to function normally. Interestingly, some
of the onus of the current daily carbohydrate recommendations
are to prevent nutritional ketosis when in fact, many positive
health outcomes of nutritional ketosis have been scientifically
validated in research. Nutritional ketosis is not harmful unless
you have Type 1 diabetes and experience diabetic ketoacidosis.
Have confidence by following this nutrition strategy, you
will improve certain health markers, likely reduce body weight
and body fat, and stabilize your blood sugar extremely well.
Whether you choose to eat fewer than 50 grams of carbohy-
drate per day and induce a state of nutritional ketosis or eat
between 60 - 150 grams of carbohydrate per day, be confident
that both strategies fit into the low carbohydrate, high fat daily
nutrition plan. One important thing to note is that it has been
reported in research that well-trained athletes can become fat
adapted following this nutrition strategy within 36 - 48 hours.
However, most research indicates that the fat adaptation pro-
cess, where it provides most benefit, could take weeks and even
months. Be patient in your implementation of this nutrition
strategy as it is not a quick fix “diet”.
Strategy 5: Fat Adaptation, Carbohydrate Restoration

This option has been quite a popular trend and is usually not
implemented correctly. There is some research that exists on
this nutrition strategy but, as with most research studies, there
108
are limitations. Most of them did not extend past a couple of

weeks which can be problematic. As you learned in the previous
section, it may takes weeks if not months to become fat adapted
on a low carbohydrate, high fat daily nutrition plan. One of
my favorite quotes from a well-respected nutrition researcher
is this: “we currently lack the appropriate tools to accurately mea-
sure exercise/sports performance, in particular, the ability to detect
small changes that are worthwhile to a competitive athlete in order
to change the outcome of real world events” ( John Hawley, RMIT
University in Australia, quoted at the Nestle Sports Nutrition
Conference in Mallorca in 2011).
After scouring the research on high fat nutrition plans, I
found that none concluded a significant improvement in per-
formance. However, you must not look directly at the conclu-
sions in a scientific research publication. The use of statistics in
research can be quite confusing depending on the number of
subjects the study recruited and the statistical method used to
calculate differences. Additionally, the macronutrient composi-
tion for the studies highly vary which supports the fact that
there is no standard definition of a low carbohydrate, high fat
daily nutrition plan. Unfortunately, the research on fat adapta-
tion and low carbohydrate, high fat daily nutrition plans has
not concluded any significant gains in athletic performance.
However, upon reading the studies closely, specifically the
methodology and results sections, I have found that there
are, in fact, significant real-life performance improvements.
How can this be? Statistics. Sometimes data is not found to
be statistically significant thus the conclusion is just that. The
researchers are not lying. They are simply sharing the statistical
conclusions.
There is one study that comes to mind when discussing
this. It was a six day protocol where the researchers compared
a high carbohydrate to a low carbohydrate daily nutrition plan
109
with a carbohydrate restoration day before the exercise testing

protocol. After this time period, the competitive, male cyclists
rode for 4 hours on a stationary bike at 65% of their maximal
intensity followed by a 1-hour time trial. Even though the
group that followed the higher fat and lower carbohydrate daily
nutrition plan leading up to the exercise day showed improved
fat burning (from a statistical standpoint), the conclusions
were that it was not enough to determine a positive effect on
performance. However, when I looked at the detailed results of
this study (not just the conclusions), I noticed the fat adapted
cyclists had 11% higher power outputs and completed 1.3 addi-
tional miles in the time trial. I don’t know about you but I con-
sider this result to be significant in real-life. Refer back to the
quote I presented from the well-known researcher and think
about it. Can research findings be extrapolated to real-life? Not
all of the time and this is where we need to be careful.
There are more studies that compare high fat, low carbo-
hydrate to low fat, high carbohydrate daily nutrition plans with
the conclusions there is no change in performance between
the two nutrition strategies. If this is the case and following a
high fat, low carbohydrate daily nutrition plan does not com-
promise performance and actually shows improved weight loss,
body composition changes and fat burning during exercise, why
wouldn’t you want to do it? There is no data that shows this
strategy is harmful for performance or health. None at all.
But this fat adaptation, carbohydrate restoration strategy
is more than just following a high fat, low carbohydrate daily
nutrition plan as I presented in the last section. This gets a bit
more methodical in nature because there is a carbohydrate
restoration period added to the fat adaptation process. Why do
this? Why not just be fat adapted all of the time? It’s a great
question and unfortunately, the answer is not as simple as you
would expect. If you are an athlete pushing your body to the
110
limits each day, you are accumulating training stress. Add to

that the other stressors of family, social life, career and sleep
disturbances and you can fill up your daily “stress bucket” sig-
nificantly. While some of this stress may be deemed as positive,
it is still stress and your body may not know how to distinguish
it from the negative stress.
I will not go into too much of the detail regarding stress
but suffice to say that stress can wreak havoc on your body.
Adrenal fatigue, overtraining syndrome, sex hormone imbal-
ances, inflammation and sleep disturbances all have ties to un-
controlled stress. So, where does nutrition fit in? Metabolically
efficient individuals are extremely good at balancing their blood
sugar which does regulate hormone balance well in normal
stress states. Add a high amount of uncontrolled stress to the
mix and it could be enough to push the body over the edge to
develop one of the harmful consequences mentioned previously.
Sometimes, this push can be something as benign as altering
your training program. People who are metabolically efficient
are adapted to this state. Their bodies are used to it and func-
tion properly. Add more volume or intensity to the exercise or
training program and the body’s state of homeostasis could be
disrupted. Some individuals can counteract these disturbances
while others cannot. The point is that the fat adaptation and
carbohydrate restoration nutrition strategy can help overcome
these stress disturbances and maintain proper body balance and
functioning.
There is great benefit of this nutrition strategy for ad-
vanced exercisers or athletes. It allows a high daily fat adapted
state while providing the body an opportunity to use more car-
bohydrates in times of need. These times of need can be defined
as before higher intensity exercise or training sessions. Let me
explain this. Fat adapted individuals have a glycogen sparing ef-
fect in exercise intensities up to and just beyond their metabolic
111
efficiency point. This allows a higher fat utilization rate while

the body is preserving its carbohydrate stores for later use dur-
ing high intensity exercise. It is well known that more carbohy-
drates are needed for energy at higher intensities of exercise but
fat adapted athletes may not possess enough of them to attain a
high effort during these workouts.
Here is an example. You are extremely metabolically ef-
ficient and you subscribe to the low carbohydrate, high fat daily
nutrition plan. You have started to introduce high intensity
training in the form of plyometrics and running sprints. While
you could certainly perform the more intense plyometrics and
sprints in a fat adapted state, you may not be able to achieve the
highest intensity to receive the most physiological adaptation
from this type of training. This is where carbohydrate restoration
comes into the picture. Most research on this topic has intro-
duced a 24 - 48 hour restoration period. We know that carbohy-
drate stores can be restored within 24 hours so I like to recom-
mend following carbohydrate restoration no longer than one day.
Do not follow the carbohydrate restoration period lon-

ger than one day. When done correctly, you only need
24 hours of this restoration phase for it to be effective.
Following a one-day carbohydrate restoration will al-

low the body to enter a higher intensity workout with greater
energy stores for that particular workout. It will allow you to
achieve a higher level of effort during the session which means
greater gains in athletic performance and body composition.
One thing I am often asked is whether a carbohydrate restora-
tion protocol should be followed the day before a longer, less
intense training session. Take a runner who will be doing a 20-
mile aerobic run. Because the intensity of this particular session
is lower (and likely below or equal to their metabolic efficiency
112
point), there is no need to restore carbohydrate stores the day

before. If they are metabolically efficient and fat adapted, they
will be able to use fat as a predominant fuel source. Carbohy-
drate stores will be used but not in great quantities, depending
on their degree of metabolic efficiency.
You are probably wondering how to implement this in
real-life. Let me take you through an example of a female ultra
runner whom I used this fat adaptation, carbohydrate resto-
ration protocol on. First, it is important to understand that
we began our nutrition journey with the basics of developing
metabolic efficiency: the carbohydrate to protein ratio and
Hand Model. I then progressed her through the various nutri-
tion strategies as I have described, until we reached the low
carbohydrate, high fat daily nutrition plan. We found great suc-
cess with this strategy but as she began to increase her training
volume and intensity, we found that she wasn’t able to achieve
the effort she needed in her higher intensity training sessions.
This is when I introduced the fat adaptation, carbohydrate
restoration strategy. Her weekly training program consisted
of five runs (aerobic rolling hills, long trail run, aerobic flat,
aerobic with strides, higher intensity interval day), one aqua
run in the pool at higher intensities but short duration, three
strength sessions and one rest day. Most of her runs ranged
between 45 - 90 minutes in duration except for her long trail
run which ranged between 2 - 5 hours. Each day of the week,
she consumed between 40 - 50 grams of carbohydrate and
roughly 60% of her calories from fat, to optimize her metabolic
efficiency. The day before her high intensity interval session,
she consumed between 80 - 90 grams of carbohydrate. This
carbohydrate restoration was just enough to give her the abil-
ity to sustain a higher effort (speed) on her interval day but still
benefit from being in a daily fat adapted state.
You may notice that I doubled her daily amount of carbo-
113
hydrates. There is no set rule for the carbohydrate restoration

protocol in real-life. Research has recommended consuming a
substantial amount of carbohydrate in the restoration period
but the research has not looked at fat adapted athletes who
eat less than 2.5 grams of carbohydrate per kilogram of body
weight per day. Interestingly, she consumed an hourly amount
of calories that was based on her metabolic efficiency assess-
ment during her long run. Because I did not restore her carbo-
hydrates the day before her long run, she used the higher end,
30%, of the calorie intake efficiency ratio as a feeding guide
during her long run. I had her feed at the higher end of the
calorie intake efficiency ratio during the long run while keep-
ing her daily carbohydrate intake low to best utilize her body’s
metabolic efficiency. This allowed her to enter the long run in
a more fat adapted state but reap the benefits of consuming
additional calories to sustain a high level of effort during the
long run.
Female Ultra Runner Training And Dietary Strategies

Mon Tue Wed Thu Fri Sat Sun
Rest Aerobic Interval Aqua Run Long Rolling
Training
run run running with trail hill run

strides run
Strength Strength Strength
Daily CHO intake
40 - 50 80 - 90 40 - 50 40 - 50 40 - 50 40 - 50 40 - 50
grams grams grams grams grams grams grams
CHO: carbohydrate.
While no research provides specific protocols to utilize the

carbohydrate restoration period in these types of fat adapted
114
individuals, we do have real-life implementation strategies that

are being used by people each day. My carbohydrate restora-
tion protocol for most individuals includes not surpassing 150
grams of carbohydrate per day. Obviously, if you are already
consuming this amount of carbohydrates each day, you will not
have a restoration benefit so you would need to consume more.
However, I would warrant against this and instead encourage
you to decrease your daily carbohydrate consumption to allow
your body to become more fat adapted so that you can benefit
from carbohydrate restoration by consuming up to 150 grams
of carbohydrate per day. Again, there are many ways to do this
and each individual’s goals, dietary habits, food preferences and
lifestyle must be considered before implementing this strategy.
In my athlete example, we took months to develop her metabolic
efficiency before introducing the low carbohydrate, high fat daily
nutrition strategy and it was only when her training intensity
called for it that we introduced the carbohydrate restoration day.
While it may seem a bit complex to implement, I firmly
believe the fat adaptation, carbohydrate restoration strategy will
yield the greatest benefits for those engaging in high intensity
exercise or athletes in a high training load cycle. Of course,
there is one more question to answer: What if you train at a
high intensity more than once a week? This is a bit more of a
physical periodization topic but suffice to say, most people will
include some type of intensity, for shorter duration, in more
than one workout per week. The qualifiers are the duration and
intensity of the workout.
Back to my female ultra runner. She has one devoted
interval training run per week. Except for recovery in between
sets, the entire run is performed at a high intensity (threshold
or above). She also has a rolling hill run day where her intensity
will likely increase due to the uphills but because her training
plan does not call for attacking the hills most of the time, her
115
effort is somewhat controlled during these runs. During her

endurance run with strides, she will run at threshold but for
10 - 15 seconds a few times during the run. Again, the quali-
fiers are the duration and intensity of the training session. As
you can see, she does have some intensity planned during other
training sessions but intensity is not the primary focus of these
workouts and she does not need to rely more on her stored car-
bohydrates to complete these since they are shorter in duration.
As I mentioned earlier, most research protocols have used
1 - 2 days of carbohydrate restoration. I would recommend not
exceeding two days per week doing this because it may com-
promise your metabolic efficiency and the long-term health and
performance benefits. I also believe this nutrition strategy will
help individuals in their quest to prevent overtraining and de-
creased immune function and adrenal fatigue. By cycling carbo-
hydrates, you will get the best of both worlds without sacrificing
your fat adapted state. Additionally, I have noticed this nutri-
tion strategy is ideal for more advanced and elite athletes who
are concerned with smaller weight loss goals for performance
enhancement. Most of these athletes cannot sustain a low carbo-
hydrate, high fat daily nutrition plan for lengthy periods of time
thus restoring carbohydrates in a more strategic manner aligned
with training load changes, produces the most robust benefit.
A great example is of a young, professional male triath-
lete with whom I worked. He wanted to lose a few pounds to
improve his run time. He was also approaching his competitive
season and was in a high training load. The last thing I wanted
to do was to compromise the training that his coach gave him
so I used a modified fat adaptation, carbohydrate restoration
protocol with him. The day before his high quality training (for
him it was an entire weekend), we implemented a 2:1 carbo-
hydrate to protein ratio of eating throughout the day and the
morning of his first training session. After the last training
116
session of his first high load day, we went back to a 1:1 carbo-
hydrate to protein ratio. The following morning was a 2:1 ratio
before training and then back to a 1:1 ratio after training. The
rest of the week was centered on following more of the 1:1 ra-
tio with focusing on consuming more vegetables and fat, while
maintaining protein intake, to support his weight loss goals. In
the matter of 6 weeks, he was down 6 pounds and was swim-
ming, biking and running very well. Additionally, he had more
energy levels throughout the day and was not as hungry.
NUTRITION SUMMARY
Keep in mind all five of these nutrition strategies are not diets
but rather possibilities for you to choose the best one that
meets your needs at any given point in time. You may need to
cycle through a couple of them to support your health, weight,
body composition and performance goals throughout the years.
As an example, if you are new to exercise and trying to change
your nutrition, it may be best to start with Strategy 1 because
it will teach you about food and the effect it has on your body.
It is a much more simple method to use and provides a more
gradual introduction to making a nutrition change.
Seasoned athletes may be better using different strategies at
different times since their training will ebb and flow with vol-
ume and intensity throughout a training year. A low carbohy-
drate, high fat approach may be best used during an off-season
while using the carbohydrate to protein ratio and the Hand
Model would be better during training and certain nutrient
timing protocols.
No matter which strategy you use, remember you will not
stick with just one throughout your journey. Metabolic ef-
ficiency is not a strict diet you have to follow but rather, it is a
plan that supports your health, exercise and performance goals.
117
My concept of Nutrition Periodization, allowing your nutrition

to support your exercise energy needs, should be used through-
out this process. In fact, metabolic efficiency is one aspect of
Nutrition Periodization whereby enhanced performance, better
health and improved body composition are the main goals.
EXERCISE
As you read in Chapter 3, the aerobic component of improving
your body’s ability to use fat as energy is important. However,
it is not the only method for improving metabolic efficiency.
For some individuals, namely athletes, training aerobically all of
the time will not contribute to improvements in performance.
The blend of aerobic and anaerobic exercise strategies can and
should be utilized for athletes and recreational exercisers to im-
prove metabolic efficiency, performance, health and meet body
weight and composition goals.
As you read earlier in this book, you can also consider
what happens after exercise as part of the fat burning journey.
As you recall, EPOC is the name given to the post-exercise
timeframe where the body expends calories above its rest-
ing state. The magnitude of this is driven by the duration and
intensity of exercise. Interestingly, some research has concluded
the energy cost of exercise can remain the same but higher
EPOC values will always be seen with higher intensity of ex-
ercise. Of course, it will vary from person to person but EPOC
can be elevated between 15 minutes to 48 hours after exercise.
Again, most of this is dependent upon the intensity of the
exercise session. Does the mode of exercise matter? Again, it
will somewhat depend on individual factors but overall, higher
intensity cardiovascular or strength training exercise will yield
a higher rate of EPOC. This will lead to an extended period
of time after exercise where calories are being burned and fat
118
is being utilized as energy. Of course, we can’t exercise at high

intensities all of the time because this would induce a high
amount of stress on our bodies.
In the following pages, I will provide exercise training
methods you can use throughout your metabolic efficiency
journey. Keep in mind these methods will be general in nature
since every person is different in their fitness level, structural
and muscular imbalances, desire, motivation and skill level.
Scenario #1: The Deconditioned Individual

The most important goal for you is to build your aerobic en-
durance to be able to maintain a continuous 30 - 45 minutes
of exercise. Aerobic, low-intensity exercise such as walking or
cycling are preferred methods for improving aerobic endurance.
If you have had a metabolic efficiency assessment done, be sure
to exercise on the far left of the MEP-D zone. I recommend
following a progressive exercise program for 8 - 12 weeks.
Remember, the mode of exercise does not matter as much as
the duration and intensity. Choose an exercise or two that you
really enjoy and one that will not be too difficult at first. I have
constructed a sample exercise prescription you can follow that
will progress you properly and safely. Please note I prefer you to
use a rating of perceived exertion (RPE) scale to make sure you
are staying in the proper intensity zone during exercise.
On the next page is an RPE chart that you can use to
gauge your intensity. I prefer to use RPE with those just begin-
ning exercise because it is a valuable tool to use without need-
ing high-tech tools such as a heart rate monitor. Additionally,
since RPE is a very subjective method, it will teach you how to
better assess yourself and assign a somewhat qualitative number
to the intensity of your exercise.
119
Rating of Perceived Exertion (RPE) Scale

RPE How I Feel Exertion
1 Resting Very slight
2 Talking is easy Somewhat Slight
3 Talking is easy Slight
I can talk but with a little more
4 Somewhat Moderate
effort
5 I can talk but with more effort Moderate
Breathing is starting to become
6 Getting harder
labored
Breathing is challenging, I do not
7 Moderately hard
want to talk
8 Panting, I cannot talk easily Very hard
9 Panting, I cannot talk easily Very, very hard
Cannot sustain this intensity for
10 Maximal effort
more than about 30 seconds
Here is the sample exercise plan you can follow if you are
just beginning.
Sample Exercise Plan For The Deconditioned Individual.
Exercise Intensity,
Days per Exercise Duration
Week Rating of Perceived
Week Per Session
Exertion (RPE)
Day 1: 2
1 2 15 minutes
Day 2: 3
Day 1: 2
2 2 15 minutes
Day 2: 3
Day 1: 3
3 3 20 minutes Day 2: 4
Day 3: 4
120
Exercise Intensity,
Days per Exercise Duration
Week Rating of Perceived
Week Per Session
Exertion (RPE)
Day 1: 3
Day 3: 4
Day 1: 3
Day 3: 5
Day 1: 3
Day 3: 5
Day 1: 3
Day 2: 4
7 4 30 minutes
Day 3: 5
Day 4: 6
Day 1: 3
Day 2: 4
8 4 35 minutes
Day 3: 5
Day 4: 6
Day 1: 3
Day 2: 4
9 4 35 minutes
Day 3: 5
Day 4: 6 - 7
Day 1: 3
Day 2: 4
10 4 40 minutes
Day 3: 5
Day 4: 6 - 7
Day 1: 3
Day 2: 4
11 4 45 minutes
Day 3: 5
Day 4: 6 - 7
Day 1: 3
Day 2: 4
Day 4: 6
Day 5: 6 - 7
121
Once you have gradually moved from a deconditioned

state to a beginning exerciser state, you are ready to improve
your fitness level even more.
Scenario #2: The Beginning Exerciser

If you fall into this category, you have followed the necessary
steps to improve your aerobic endurance and you should be
able to comfortably exercise at a RPE of 6 or less for at least
45 minutes, five times per week. Now that you are here, you are
ready to provide more of a challenge to your body to improve
not only your fitness level but also your metabolic efficiency.
The main goal for you is to begin adding more intensity into
your exercise program, which should last for about 8 weeks.
Shorter, more high intense exercise sessions (intervals) com-
bined with aerobic exercise will help progress your metabolic
efficiency even more due to the effect of EPOC.
I will use the same RPE chart as I did in the previous ex-
ample but will add more “splashes” of intensity in your exercise
program. Here is the breakdown of the aerobic versus interval
training overall percentage of your exercise plan. Remember,
since each person is different, this should be taken as an exam-
ple. Be sure to customize it to meet your body’s needs.
Aerobic Vs. Interval Training Overall Percentage Of Your Exercise Plan

Week Aerobic Exercise Interval Training
1 80 - 90% 10 - 20%
2 75 - 85% 15 - 25%
3 70 - 80% 20 - 30%
4 70 - 80% 20 - 30%
5 60 - 70% 30 - 40%
6 50 - 60% 40 - 50%
122
Week Aerobic Exercise Interval Training

7 50 - 60% 40 - 50%
8 50 - 60% 40 - 50%
Building upon these percentages that you should spend in

aerobic and interval training, I have provided a guide to putting
all of this together. Below is a sample of an eight-week progres-
sive exercise prescription focusing on aerobic endurance with
more intensity added.
Sample of an Eight-Week Progressive Exercise Prescription

Aerobic Interval
Days per Minutes Exercise Training
Week
week per session (min/session) (min/session)
RPE 2 - 4 RPE 7 - 9
1 3 30 24 - 27 3-6
2 3 35 26 - 30 5-9
3 3 40 28 - 32 8 - 12
4 4 35 25 - 28 7 - 10
5 4 35 21 - 25 10 - 14
6 5 40 20 - 24 16 - 20
7 5 40 20 - 24 16 - 20
8 5 45 23 - 27 18 - 22
I am sure you are wondering how the intervals actually

look in real life. There are many ways to implement interval
training. The easiest for you as a beginning exerciser will be by
using a work to rest ratio of 1:2. What this means is that if you
have six minutes of intervals on a given day, you will do two
sets of 1 minute in your interval training RPE zone followed by
2 minutes in your aerobic RPE zone. For example, if you look
123
at week 3 on the sample exercise prescription chart, you will

notice that you are exercising three days per week for 40 min-
utes per session. Each session has 28 - 32 minutes of aerobic
exercise at an RPE of 2 - 4 with 8 - 12 minutes of intervals
at an RPE of 7 - 9. The easiest way to do this workout is to
do 10 - 15 minutes of aerobic exercise, then 8 - 12 minutes of
intervals done as 1 minute at an RPE of 7 - 9 and 2 minutes
at at RPE of 2 - 4. After the intervals are complete, finish the
workout aerobically at an RPE of 2 - 4.
Example Of Workout 40 Minute Exercise Session
R5 hn575ih5'#(/.-5) 5,)#52,#-5.55h575j
R5 n575gh5'#(/.-5) 5#(.,0&-5.55m575o
The workout could look like this:
R5 gf5'#(/.-5) 5,)#52,#-5.55) 5h575i

R5 5gh5'#(/.-5)(5-5g5'#(/.5.55) 5m575o5(5h5
minutes at RPE of 2 - 4
R5 gf5'#(/.-5) 5,)#52,#-5.55) 5h575i
Each week progresses and may add frequency, duration or

intensity (or a little of all three). Be sure you listen to your body
and not overdo anything that would cause too much muscle
soreness or joint pain.
Scenario #3: The Intermediate to Advanced Exerciser

This is a very interesting stage because your body has been primed
and can handle more exercise intensity. Because of this, we must
respect the body’s need for recovery but still reap the benefits
of the high intensity effects on EPOC in regards to metabolic
efficiency. You will have a new RPE chart (see next page) as it
124
relates more to the terminology that intermediate to advanced

exercisers use.
Intermediate To Advanced Exercisers RPE Chart

Rating of Perceived Exertion
Terminology
(RPE)
1 Resting
2 Normal walking speed
3 Fast walking speed
4 Low aerobic
5 Mid aerobic
6 High aerobic
7 Tempo
8 Threshold
9 High threshold
10 Maximal effort
Your exercise plan will be more diverse and can include

many different options. Because you are more advanced, I will
not provide a detailed exercise prescription but instead provide
guidelines which will maximize the benefits of exercise training,
EPOC and metabolic efficiency.
Exercise training guidelines for the intermediate to

advanced exerciser:
1. Heavy weight training should be included at least

2 times per week. Higher weight, less repetitions and
moderate sets.
2. Plyometric training should be included 1 - 2 times per
week.
125
3. Hiking or walking are great aerobic exercise options

to include a couple times per week in your MEP-D
zone.
Scenario #4: The Athlete

Because there are so many different types of athletes and sports,
it is extremely difficult for me to provide a specific training
program to meet your individual needs. The advice I can offer is
for you to create a balance of aerobic and anaerobic exercise in
your training program and align yourself with a knowledgeable
coach who understands the concept of metabolic efficiency and
how to best periodize your nutrition within your training pro-
gram. Most coaches have teams of professionals, such as sport
dietitians, whom they can utilize to better implement metabolic
efficiency training within an annual training plan.
I will stress that if you are an endurance athlete, do not
be fooled into doing all of your training in an aerobic state or
your MEP-D zone. While this will provide a small benefit to
improving your metabolic efficiency, it will likely not promote
an improvement in your physical performance. A balance of
planned aerobic, MEP-D zone training combined with proper
anaerobic training will be the ideal blend for improving athletic
performance and metabolic efficiency.
Starvation training
I feel the need to discuss this topic because it is so widely mis-
understood. This method of training became popular years ago
when athletes, mostly cyclists, in the United States learned of
this European “fat burning” technique. During the off-season
or early base training, cyclists would complete 3 or more hours
of low intensity, aerobic training in a non-fed, fasted state. Their
goal was to improve their body’s ability to burn fat.
126
Before I developed the concept of metabolic efficiency

and discovered the significant impact that nutrition had on
the body’s ability to burn fat, it was thought that aerobic exer-
cise was the only method of improving the body’s fat burning
capacity. As you have read earlier in this book, aerobic exercise
does contribute to this but as you also learned, daily nutrition
alterations have a much more robust impact on your body’s
ability to use fat as energy.
Starvation training is not normally recommended for most
individuals because it can create a catabolic state in the body.
Done incorrectly and without the replenishment of proper
nutrients, this type of training can increase fatigue, cause a
reduction in muscle mass and suppress the immune system.
But you want to burn more fat, right? I, as well as others, have
testing data that shows that the body can be more metabolically
primed to use fat after eating a metabolically efficient light
meal or snack before exercise versus consuming nothing or
water alone. Why place more stress on the body when you can
simply apply the right combination of nutrients to turn on the
fat burning process prior to exercise? It’s a much safer way to
do it and will yield far better outcomes in the long term.
Use It or Lose It
Of course the question begs, “once I develop metabolic effi-
ciency, can I lose it?”. The easy answer is yes. Similar to physical
exercise, if you stop doing something, you will lose some of the
positive effects. Of course, there are a few “it depends”. Most
individuals on whom I have done metabolic efficiency assess-
ments have shown that metabolic efficiency can be developed
or enhanced in as little as one week. Of course, the same is true
for losing the benefits.
The majority of the change in metabolic efficiency is due
to nutritional “speed bumps”. That is, deviating from your daily,
127
metabolically efficient nutrition plan. While it is not known

exactly how many “speed bumps” an individual can have before
diminishing the effects of metabolic efficiency, what is normally
recommended is to keep these “speed bumps” at manageable
levels. I know that is a bit broad but I like to think of it as
no more than one nutritional “miss” per day. However, as you
learned earlier in the fat adaptation, carbohydrate restoration
nutrition strategy, it is possible to increase daily carbohydrate
intake (while still maintaining good blood sugar control) for
one day and remain metabolically efficient. What you would
want to avoid is having one day full of nutritional “misses” and
letting that spiral into the next day and the next. More than 2
or 3 days of consistent “speed bumps” will surely derail your at-
tempts at improving your metabolic efficiency.
Of course, I do not expect you to be perfect. Nobody is.
What I expect is for you to develop a good relationship with
food and allow your body to have these occasional nutritional
“misses” without them sabotaging your self confidence or meta-
bolic efficiency progress. It is okay to deviate from your plan ev-
ery now and then. Just don’t let it extend more than a couple of
days. Remember, this is a lifestyle change, not a diet. You are in
this for the long haul to see positive health, performance, body
weight and body composition changes over time. While this
may require patience and re-learning your approach to food, it
will yield the best long-term results.
128
CHAPTER 5 REVIEW
There are five nutrition strategies that you can use to improve your
metabolic efficiency: 1) carbohydrate to protein ratios and the
Hand Model, 2) Periodization PlatesTM, 3) carbohydrate unloading,
4) low carbohydrate, high fat and 5) fat adaptation, carbohydrate
restoration. Choose the one that is right for you based on where
you are in your metabolic efficiency journey and remember you
will likely cycle through a couple of these nutrition strategies
throughout your lifespan. These are not diets but rather nutrition
modifications you can make as your health, fitness and athletic
performance goals change.
Exercise can assist in improving your metabolic efficiency but it

does not always have to be aerobic exercise. Depending on your
fitness level, including higher intensity training will benefit your
CPEZTBCJMJUZUPCVSOGBU TQFDJñDBMMZCZXBZPG&10$#FTVSFUP
vary your exercise training program throughout the years and
adjust it accordingly based on your fitness level.
129
Chapter 6
Case Studies
I presented three case studies in my first edition of this book.

Since then, The Fuel4mance® team of Sport Dietitians have
had the opportunity to explore metabolic efficiency in more
detail with a host of different individuals, some athletes, some
not. In this chapter, I will present a more robust collection of
case studies to assist you in your understanding of the real-
life application of metabolic efficiency training. Some of these
case studies were followed very closely with a good amount of
data collection while others consisted only of one metabolic
efficiency assessment with a nutrition intervention. The goal
of this chapter is to show you the methodology of changing
metabolic efficiency in different individuals in their respective
lifestyles.
CASE STUDY #1:

COMPETITIVE MALE IRONMAN ATHLETE
Andrew is a 32 year-old, 6 foot tall, 145 pound, triathlete. He

is a past collegiate runner turned short course triathlete who
switched to training and racing long course triathlons with the
131
goal of qualifying for the Ironman World Championships. An-

drew is a high level athlete, often winning or placing in the top
percentage for his age-group. He is self-coached and had begun
making low end dietary changes in line with metabolic effi-
ciency for a couple months prior to his first metabolic efficiency
assessment. His goal race was Ironman Texas in May of 2013.
He was happy with his body weight and body composition
but wanted to improve his body’s use of fat as close to his Iron-
man predicted race intensity as possible to minimize his need
for a large amount of supplemental carbohydrate. This is fairly
typical for more experienced athletes since they do not want the
burden of eating a copious amount of calories at high frequencies
during training and competitions. This allows the athlete to focus
on executing their physical race strategy instead of worrying
about their nutrition and if GI distress will happen or not.
His initial ME assessment was done on February 8, 2013
at the Fuel4mance® Performance Center in Colorado. As
you can see from the graph below, Andrew did not achieve a
metabolic efficiency point (MEP) and was classified as a MET
Level I. He reported that his goal Ironman power output was
200 watts.

N/A
Carbohydrate 78%
64% 64% 70%

57% 58%
43% 42%
36% 36% 30%
Fat 22%
Minutes 5 10 15 20 25 50
Watts 100 140 160 180 200 220
132
Case Studies
Here is a typical day of what Andrew ate before his ME

intervention:
Before ME Intervention
Breakfast GSVJUTNPPUIJF FTUJNBUFEUPIBWFBSBUJP
of carbohydrate to protein, approximately 60
grams of carbohydrate)
Mid-morning snack fruit with flavored yogurt
Lunch salad with beans, chocolate milk if post-
workout
Mid-afternoon snack nuts and dried fruit with chocolates
Dinner vegetarian protein or fish with vegetables and
an occasional starch such as spaghetti squash
Post-dinner snack sorbet or frozen bananas with nuts and
chocolate syrup
Overall, he followed a higher carbohydrate, lower protein

and lower fat daily nutrition plan. He had a high affinity for
sweets, especially after dinner but this significantly decreased
after his metabolic efficiency intervention.
As mentioned, his important race was Ironman Texas,
about 3.5 months from the time he was tested. He had started
eating better but because of his performance goals, lack of
metabolic efficiency and short timeframe before his race, his
nutrition plan was a bit more aggressive to ensure a high degree
of success.
After his first ME assessment, daily and training nutrition
changes were made and included the following:
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Model on training days where his training duration was
less than two hours for one training session or, if doing
more than one training session for less than 75 minutes
133
each, and training intensity was mostly aerobic (zone

2). His goal carbohydrate to protein ratio for meals and
snacks was set at 1:1 whenever possible and did not
exceed 2:1.
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and incorporate more animal proteins. Breakfast and
lunch were the biggest changes for him as he was not
including sufficient protein with these meals. Snacks
were also changed to include more fiber and protein.
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AcceleradeTM and traditional energy gels to Generation
UCAN®, Osmo Nutrition, First Endurance LiquidShot
and SaltStick® electrolyte capsules. Drink only water
for training sessions less than 90 minutes in duration.
For longer than 90 minute training sessions, consume
75 - 160 calories per hour while cycling and running.
Here is an example of his daily nutrition after his first ME

assessment:
After ME Intervention
Breakfast protein pancakes with almond butter and
agave nectar
Mid-morning snack trail mix
Lunch salmon salad with avocado, green olives,
sunflower seeds, bell peppers, garbanzo beans,
craisins, salad dressing
Mid-afternoon snack trail mix
Dinner Greek salad with chicken
Post-dinner snack Greek yogurt, cashews, agave nectar, added
protein powder
134
Case Studies
Andrew received metabolic efficiency training strategies

from a Fuel4mance® Sport Dietitian to assist his nutrition
changes to improve his metabolic efficiency. The basic goals of
his exercise prescription based on his ME assessment was for
him to train at less than 160 watts only during a couple of his
bike sessions per week to improve his metabolic efficiency. On
the other days that consisted of more quality, higher intensity
training, he was instructed to respect his performance improve-
ment training zones.
After two months of implementing this nutrition plan and
following the training intensity suggestions, Andrew completed
his second ME assessment. As you can see, he achieved a MEP
at 180 watts, which was closer to his goal Ironman power
output. For comparison, let’s take a look at the 200 watt data
point. Here, he went from burning 30% of his energy from fat
in his first ME assessment to 47% in his second ME assess-
ment - a significant increase in such a short period of time.
Keep in mind that he was also increasing his training volume
and intensity and was in the peak part of his Ironman training
during this time. The majority of metabolic efficiency success
that Andrew had was related to nutritional changes.

Power: 180 watts
Heart rate: 128 bpm
Fat
69%
57% 58% 58% 50% 53% 60%
43% 42% 42% 50% 47%

40%
Carbohydrate 31%
Minutes 5 10 15 20 25 30 35
Watts 120 140 160 180 200 220 240
135
Of course, the big news is that Andrew went on to fin-

ish Ironman Texas in a time of 9 hours and 18 minutes, good
enough for a 4th place age-group finish and an Ironman World
Championship invitation.
CASE STUDY #2:

POST-MENOPAUSAL FEMALE TRIATHLETE
Debbie is a 54 year-old post-menopausal female triathlete

with a history of diagnosed adrenal fatigue. Besides wanting to
become more metabolically efficient, she has body composition
goals of reducing her body fat. Her first metabolic efficiency
assessment was done in January as she began her base training
for her September Ironman race. As you can see from her ME
assessment, her MEP was at 95 watts.

Power: 95 watts
Heart rate: 118 bpm
81%
Fat
50% 66%
57% 58%
43% 50%
42%
Carbohydrate 34%
19%
Minutes 5 10 15 20 25
Watts 80 95 110 125 140
While an exact daily nutrition plan was not provided prior

to her first ME assessment, she reported that her daily eating
patterns were erratic and deviated from her normal habits since
it was during the holiday season. She had been eating a higher
carbohydrate daily nutrition plan consisting of sandwiches,
136
Case Studies
crackers, fruits and sweets.

After her first ME assessment, she was given the following
daily nutrition plan goals by a Fuel4mance® Sport Dietitian:
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around training sessions to provide a quality source of
carbohydrate.
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including either a fattier protein source or additional
fats to the meal.
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5 '#.5!,#(-5(5-.,"-5/(&--5.,#(#(!5&)5#-5"#!"85
Include a healthy starch or whole grain to support
training sessions over 3 hours in duration. For her, this
meant including a sweet potato with her evening meal
(prior to the next morning’s training) and including rice
or oats with breakfast on the morning of her training.
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reasons.
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each meal throughout the day.
It was also recommended she monitor her heart rate dur-

ing training sessions and she tailor up to 60% of her total train-
ing time in her MEP-D zone (corresponding to zones 1 - 2).
The other 40% of her training time would be above her MEP,
in zones 3, 4 and 5.
Her second ME assessment (see next page), ten weeks into
her metabolic efficiency intervention, showed a MEP at 135
watts. She had changed her body composition during this 10-
week period (losing 5.75 inches) and reported having extremely
stable energy levels throughout the day. Another success story!
137

Power: 135 watts
Fat Heart rate: 150 bpm
78% 80%
75% 71%
57% 54%
43% 46%
22% 25% 29%
20%
Carbohydrate
Minutes 5 10 15 20 25 30
Watts 80 95 110 125 140 155
CASE STUDY 3:
RUNNER TURNED IRONMAN TRIATHLETE
Dina is a 42 year-old, 5 foot 4 inch, 115 pound, female run-

ner and relatively new long course triathlete. Her goals are to
become more metabolically efficient since she is training for her
first Ironman race. Her first ME assessment at Fuel4mance®
was done prior to making any dietary changes and it was six
weeks after the last important race of her season. As can be
seen on her ME graph, her MEP was at 130 watts.

Power: 130 watts
Heart rate: 137 bpm
Fat
65% 67%
55% 58% 60%
54% 52% 53%
45% 46% 48% 47% 42% 40% 35% 33%

Carbohydrate
Minutes 5 10 15 20 25 30 35 40
Watts 90 105 120 135 150 165 180 195
138
Case Studies
Dina’s daily nutrition plan prior to her metabolic efficien-

cy intervention consisted of approximately 180 - 200 grams of
carbohydrate per day which was about 40% of her daily caloric
intake. Most of her carbohydrates came from fruits, yogurts,
milk and frozen yogurt. She was not eating many grains but
would have an occasional sweet potato and a few misses, usually
in the form of chocolate, during the week.
Interestingly, during this 7.5 week intervention, she did not
do much exercise training as she wanted to enjoy some off-sea-
son time. The first month she performed the following activities:
First Month
4 hours of indoor cycling
2.25 hours of walking or jogging on a treadmill
1.5 hours of strength training
Yes, these are her totals for the entire first month! Al-
though still in off-season, she increased her exercise gradually
during the second month of the metabolic efficiency interven-
tion to consist of the following:
Second Month
8 hours of indoor cycling
3.3 hours of aerobic running
7.5 hours of swimming
2.25 hours of strength training
After her initial metabolic efficiency assessment, her

metabolic efficiency daily nutrition intervention included the
following goals:
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139
grams. Remove fruit and increase vegetables. Remove cow’s

milk and switch to a whole milk based, full-fat yogurt.
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prise 50 - 55% of her daily calories.
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grams at meals and 15 - 20 grams at snacks.
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5 1#."5 ,)'5&(5*,).#(-5.)5#(&/550,#.35) 5*,)-
teins in fat content, such as salami, grass-fed beef/bison,
organic chicken thighs and bacon.
After her 7.5 week metabolic efficiency intervention,

Dina’s results were staggering! She went from having a MEP
at 130 watts to an off the chart MEP, literally! Dina fell into
the category of MET Level III. She did not achieve a MEP
because of physical fatigue. Her daily nutrition plan changes
made her extremely metabolically efficient but because she was
not doing much high intensity exercise training, her body could
not reach a MEP due to physical fatigue. As you can see from
her second ME assessment, there was a significant change in

Physical fatigue before metabolic fatigue
due to lack of anaerobic training
Fat
84% 82%
80% 77% 77%
74% 73% 71% 71% 73%
27% 29% 29% 27%

16% 18% 20% 23% 23% 26%
Carbohydrate
Minutes 5 10 15 20 25 30 35 40 45 50
Watts 90 105 120 135 150 165 180 195 210 225
140
Case Studies
her fat oxidation at all intensities. Additionally, Dina was able

to extend her exercise time during her assessment by 10 min-
utes and increase her power output by 30 watts!
Just as exciting as Dina’s metabolic efficiency changes
were her changes in blood markers that she had measured. As
you can see from the table, Dina had significant changes after
her 7.5 week metabolic efficiency intervention. As I have been
explaining throughout this book, adopting a metabolically ef-
ficient nutrition plan has very significant positive impacts on
health in addition to performance.
Dina’s Blood Markers

November 2012 December 2012 % Change
LDL-p 1165 1167 n/a

LDL-c 150 113 -24.7%
HDL-c 84 90 +7%
Triglycerides 37 27 -27%
Total Cholesterol 241 208 -13.7%
CASE STUDY 4:
MALE ULTRA RUNNER
Wes is a 41 year-old ultra runner and came to the Fuel4mance®

Sport Dietitian team about two weeks prior to competing in
the 2013 Boston marathon in order to find out how fat-adapt-
ed his body was. He had switched to a low carbohydrate daily
nutrition plan about 4 months prior to having his metabolic
efficiency assessment. He normally ate between 20 - 50 grams
of carbohydrate per day, considerably in a state of nutritional
ketosis.
141
Here is an example of his daily nutrition plan:

Daily Nutrition Plan
Breakfast coffee with cream, coconut milk
Lunch 8 ounces of meat, 8 ounces of vegetables, 1
egg, 3 ounces of berries with Greek yogurt,
cottage cheese, green tea
Snack Nuts, dark chocolate
Dinner Same as lunch, occasional 8 ounces of red wine
As you can see, Wes was extremely metabolically efficient

which set him up nicely for his season of racing. Those not fa-
miliar with the concept of metabolic efficiency may argue there
is no way an ultra runner could be a fast marathoner, especially
burning the high fat percentages that Wes was throughout his
ME assessment. As you can see from his ME graph, he began
running at a 10:00 minute per mile pace and stopped at a 6:40
minute per mile pace and is classified as a MET Level III. His
nutrition plan, in this case low carbohydrate, high fat, ketogen-
ic, provided his body the opportunity to burn fat at extremely
fast running paces. To be able to use 70% of energy from fat at

Fat
95%
91% 93% 92% 88%

78% 70%
22% 30%
5% 9% 7% 8% 12%
Carbohydrate
Minutes 5 10 15 20 25 30 35
Pace 10:00 9:14 8:34 8:00 7:30 7:04 6:40
142
84% 84% 84% 84% 84%
84%
Case Studies
a 6:40 minute per mile, as Wes was able to do, has been un-
heard of in the past.
I hope this proves the impact that daily nutrition altera-
tions can have on metabolic efficiency. Are you wondering how
this relates to his Boston marathon finish time? Remember,
he came to the Fuel4mance® Sport Dietitian team two weeks
before his marathon to assess his metabolic efficiency. His goal
was to run under 3 hours for the marathon. He crossed the
line in 2 hours and 52 minutes and set a new personal record.
That was an average pace of 6:35 minute per mile! Interestingly,
during this race, Wes did not consume any calories or water. He
negative split the course by 2 minutes and mentioned, “the last
few miles were some of the fastest of my race because I had plenty of
glycogen stores left for the final twenty minute push.”
Of course, his speed is a direct correlation to his train-
ing program. Nutrition will not make you faster per se, but in
Wes’ words, “this nutrition plan sure did make things a lot easier
and stress-free”. I hear that quite a bit from athletes. If you
improve your metabolic efficiency and rely more on fat as en-
ergy at higher exercise intensities, you will not have to eat as
many calories during a competition and you will not have to
worry about getting GI distress or bonking. Wes confirmed
this by saying, “I was able to take the risks of stomach distress
from trying to digest sugar during the race or bonking out of the
equation.”
I mentioned this in a previous chapter but Wes confirmed
the fact that when on a low carbohydrate, high fat daily nutri-
tion plan, the traditionally recommended amount of carbo-
hydrates after a training session is not required for optimal
recovery. Because the body is better at using fat and preserving
glycogen, it does not need a large amount of carbohydrate in
the window following exercise. This proved true for Wes also as
he stated, “carbs like gluten and sugar seem to really hurt my recov-
143
ery from hard workouts and my sleep quality.”

Wes went on to compete in the Wasatch 100 mile endur-
ance run that year. He was in 86th place at mile 47 and moved
up to 38th place by the finish. He slowed down a lot less than
the rest of the field in the latter stages, the key to performing
well in an ultra running race. To no surprise, based on his high
degree of metabolic efficiency, he only consumed 45 calories
of carbohydrate per hour for his 27 hour and 22 minute effort!
Success yet again!
CASE STUDY #5:

AGE-GROUP FEMALE RECREATIONAL TRIATHLETE
Sarah is a 41 year-old female triathlete who is 5 foot 9 inches

tall and weighs 172 pounds. She is a lacto-ovo vegetarian with
the goals of losing weight and improving her overall daily nu-
trition patterns. Her daily nutrition patterns before visiting the
Fuel4mance® Sport Dietitian team were as follows:

Breakfast Light Greek yogurt, granola
Lunch Frozen meal, rice and beans, sugar-free pudding
Snack Apples, granola, low calorie sport drink
Dinner Veggie pita pizza, wheat bread, peanut butter
Her initial ME assessment was done at the Fuel4mance®

Performance Center in Colorado and, as you can see, she had a
MEP at 168 watts.
144
Case Studies

Power: 168 watts
Macronutrient Percentage (%) Heart rate: 145 bpm
Fat
62% 67% 65% 71%
59% 55% 61%
51% 52% 52%
41% 49% 48% 48% 45%

38% 33% 35% 39% 29%
Carbohydrate
Minutes 5 10 15 20 25 30 35 40 45 50
Watts 85 100 115 130 145 160 175 190 205 220
Prior to her ME assessment, her weekly exercise program

included the following:
Exercise Program Prior to ME Assessment

Swim 2 - 3 times
Bike 3 times for 1 - 1.5 hours and
one long ride of 3 hours or more
Strength training 3 times
No running due to a foot injury
Following her ME assessment, Sarah’s nutrition interven-

tion included the following:
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grams at snacks by including more eggs, tofu, tempeh,
beans, lentils, full-fat cottage cheese, greek yogurt and
protein powders.
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5 )&&)155h9g5,)"3,.5.)5*,).#(5,.#)5B."#-51-5# -
ficult for her given her vegetarian preferences).
145
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R5
5 )5().5.5(35&),#-5/,#(!5.,#(#(!5---#)(-5.".5&-.5
less than 2.5 hours.

Breakfast High protein chocolate shake, mozzarella cheese
Snack Mixed nuts
Lunch Non-fat yogurt, almond butter, honey
Snack Low-fat cottage cheese
Dinner Zucchini lasagna, protein bar
Because Sarah followed a vegetarian daily nutrition plan,

she did have a few challenges with trying to increase her daily
protein without increasing her carbohydrates. She did her best
working with her vegetarian preferences. Additionally, Sarah is
a physician and has a high stress work environment and sched-
ule, often having unpredictable meal times as well as being on-
call. Lastly, she is a single mother of two teenagers. To say that
she did not have a good amount of life and career stress would
be an understatement.
The metabolic efficiency nutrition intervention lasted 6
weeks and, due to her previously mentioned challenges, she was
consistent with her ME nutrition plan for about 4.5 of those
weeks. She visited her Fuel4mance® Sport Dietitian six weeks
later and had her second ME assessment. As you can see, she
improved her metabolic efficiency by just over 20 watts. Great
progress for only six weeks!
146
Case Studies

Power: 190 watts
Heart rate: 147 bpm
Macronutrient Percentage (%) Fat
80% 75%
67%
58% 52% 50% 55% 55%
53%
42% 48% 50% 47% 45% 45%

33%
20% 25%
Carbohydrate
Minutes 5 10 15 20 25 30 35 40 45
Watts 115 130 145 160 175 190 205 220 235
During the six week time period, Sarah lost six pounds.
62% hoped
While she had 62% for more, her blood work indicated an
62%
imbalance in her stress hormones.
62% This is a key
62% 62%factor
62% that62%
many
individuals do not account for with weight loss goals. Not only
must the nutrition and exercise 62% 62% the62%
62% 62% plans be dialed62%in but body’s
62% 62%
stress hormones must be re-balanced in order for the body to
accommodate weight loss goals.
Overall, Sarah saw great success in such a short time. She
proved that she could change her nutrition favorably to have
beneficial responses on her metabolic efficiency and successfully
lose weight.
CASE STUDY 6:
ULTRA RUNNER TURNED SHORT-COURSE TRIATHLETE
Of course, I would be remiss if I did not fully implement these

strategies on myself first and share them in this book. I have
always believed in being my own guinea pig before offering any
nutritional or training strategy to individuals and I am confi-
dent you will see the positive impact that metabolic efficiency
147
has had on both my health and performance.

As a bit of background, I grew up a team sport athlete,
playing competitive soccer. I would definitely classify myself
as an anaerobic athlete. It is a wonder how I fell in love with
endurance sports but, nonetheless, I have compiled an exten-
sive resume of endurance competitions in my 20 plus years of
being an endurance athlete. In the early beginnings of endur-
ance training, I had my sights on triathlon and attempted to
figure out how to race sprint and Olympic distances. Once I
figured that out, I moved up to half-Ironmans and finally the
full Ironman distance. After years of competing at these dis-
tances, I found I was getting bored and needed a new challenge.
Living in Colorado, I had heard many times of the Leadville
endurance races and the challenges they offered to athletes.
So, without much thought, I took a sabbatical from triathlon
for four years and turned my attention to ultra running and
ultra-mountain biking. I was a vegetarian throughout most of
my triathlon training and during the first couple of years of my
ultra running and cycling training. I did eat a few dairy prod-
ucts (cheese and cottage cheese about 2 times per week) and
fish (about 1 time per month) but most of my protein sources
consisted of carbohydrates. My typical daily nutrition plan
included the following:

oatmeal made with milk, blueberries, walnuts
Breakfast
and maple syrup
Mid-morning snack trail mix
salad with beans, nuts, cottage cheese, rice or
Lunch
pasta, fruit
Mid-afternoon
1 - 2 pieces of fruit
snack
148
Case Studies
quinoa or a veggie burger, vegetables, pasta, rice,

Dinner
potato
Post-dinner snack trail mix
As you can see, I followed a pretty high carbohydrate

daily nutrition plan. At that time, I thought it worked just
fine. “Thought” was the key word. Looking back on it, follow-
ing a high carbohydrate daily nutrition plan was probably the
worst thing I could have done for my health and performance.
I was always taught endurance athletes needed to eat as many
carbohydrates as possible and since I was training for 100 mile
running and mountain biking races, I thought this was a fitting
nutrition plan for me.
Unfortunately, it was quite the opposite. I have a family
history of diabetes and cardiovascular disease and as early as
college, when I first started getting blood work done, my HDL
cholesterol was always below the minimum. My total and LDL
cholesterol were always high and my triglycerides were through
the roof. I remember a few of my professors in college being
dumbfounded on how my blood work was so unhealthy for
such a fit individual. I just blamed my genetics. Of course, it
certainly wasn’t my training or nutrition. I was in my twenties
and bulletproof ! How young and naive I was back then.
Growing up playing soccer, I never had experienced GI
distress during training or competition. I didn’t even know what
GI distress was! With soccer being such an anaerobic based
sport, I never had the extended period of running to elicit GI
distress. Not until Ironman training and racing that is. I learned
quickly what GI distress was and in the late 1990’s, it was com-
mon for many Ironman athletes to experience GI distress. It
was almost a “rite of passage” and one that I accepted, painfully.
Unfortunately, this acceptance did not last long because when
149
my body didn’t feel right day after day, I set out to explore the
intricate nature of GI distress. This was the defining moment of
my sports nutrition career. The moment when I began chal-
lenging conventional sports nutrition wisdom. I started experi-
menting with my nutrition, especially when I moved into ultra
running, and found that I could increase or decrease my inci-
dence of GI distress based on what I ate throughout the day.
After years of suffering GI distress and challenging con-
ventional sports nutrition teachings, I created the concept
Nutrition Periodization and utilized it with good success in my
own training and with all of the athletes with whom I worked
with but I still had the occasional instance of GI distress. A
couple years later, I created the concept of Metabolic Efficiency,
which, much to my delight, cured my own GI distress. Then, the
exercise physiologist in me took action. I knew there had to be a
way to assess metabolic efficiency and went back to my exercise
testing background to create the metabolic efficiency assess-
ment. Of course, I had to put myself to the test and depressingly,
I found that I was a very good carbohydrate burner and a very
poor fat burner (see my metabolic efficiency graph below). I
knew I needed to fix this to help my ultra running and cycling
so another individual experiment awaited.
Uncontrolled blood sugar
Carbohydrate
78% 76% 78%

66% 68% 71%
34% 32% 29%

Fat 22% 24% 22%
Minutes 5 10 15 20 25 30
Pace 10:00 9:31 9:05 8:42 8:20 8:00
150
Case Studies
In late September of 2012, I switched from being a

vegetarian to an omnivore in one day’s time. Not necessarily
something I would recommend to individuals but I enjoy using
myself as a test subject. In my mind, I had been a fairly meta-
bolically efficient athlete, even though my ME assessments
proved otherwise. My goals for this 4-week nutrition experi-
ment were to include animal protein in my daily nutrition
plan and be more aggressive in lowering my daily carbohydrate
intake. I did pre- and post-blood work in addition to ME as-
sessments and decided that my daily nutrition plan would fall
into the hands of fate (quantitative data really). Based on the
quantitative data that I would use to compare day 1 to 30, I
would either go back to eating vegetarian or would explore the
omnivore lifestyle.
Here is a sample of what I ate each day during this nutri-
tion intervention.
Nutrition Intervention
omelette with spinach and added fat
Breakfast DPDPOVUPJM PSBDBSCPIZESBUFUPQSPUFJO
ratio smoothie
Mid-morning snack none, wasn’t hungry
turkey, cheese, salami and mayonnaise
Lunch
wrapped in iceberg lettuce
Mid-afternoon snack small handful of raw almonds
Dinner any meat with veggies or a salad
Post-dinner snack none or a cup of herbal tea
I controlled my daily carbohydrates to 60 - 80 grams per

day and increased my fat intake to around 60% of my total
daily calories. The amount of protein I ate increased slightly
but the main difference was the switch to animal based protein
151
sources. What happened throughout the 30-day experiment

was life-changing and quite frankly, rather surprising to me.
Previously, I was on the “eat every 2 hours plan”. During
this nutrition intervention, 3 - 4 hours would elapse in between
meals and I found that I didn’t need any snacks because my
blood sugar was so much better regulated. In the past, I would
be trashed after any type of training session. Lethargic, tired,
sore and needing a nap. During this intervention, I actually had
energy after my training, my muscles were less sore, my sleep
was more restful at night and I recovered extremely fast. I even
lost weight and my body fat decreased. The latter two findings
were never a goal of mine but it was interesting since my swim-
ming, cycling and running times were all improved in this short
amount of time.
Of course, most of these improvements were qualitative
and I couldn’t share this as definitive proof. I knew I needed
quantitative data to be the deciding factor. Numbers don’t lie
and I turned to them to help me quantify my experiment and
my future daily nutrition plan. As you can see from the data, it
was shocking, at least in my mind. How can my blood lipid val-
ues improve on a lower carbohydrate, higher fat daily nutrition
plan? That is certainly contrary to what I learned in my formal
education.
Blood Work Before and After

Month 1 Month 2
205
Total Cholesterol 214
(decrease of 4%)
133
LDL 141
(decrease of 6%)
62
HDL 55
(increase of 13%)
152
Case Studies
Month 1 Month 2
10
VLDL 18
(decrease of 55%)
52
Triglycerides 88
(decrease of 41%)
What about my metabolic efficiency? Did it change in a

mere four weeks time? Was it enough to sway my decision to
continue on this metabolic efficiency nutrition path? Let’s look
at the data for comparison.

Pace: 8:27 minute/mile
Heart rate: 137 beats/minute
Carbohydrate
50% 52% 52% 53% 51% 55% 60%
50% 48% 48% 47% 49% 45% 40%

Fat
Minutes 5 10 15 20 25 30 35
Pace 8:27 8:07 7:47 7:30 7:14 6:59 6:44
This is my metabolic efficiency test done on September 28,

2012, a classic MET Level I. As you can see, I did have a MEP
but it was at the first stage at a relatively slower pace (8:27
minute per mile). After the first stage, my carbohydrate and
fat burning were fairly similar until I reached a 6:59 minute
per mile and carbohydrate burning began to increase while fat
burning began to decrease.
153

Fat
82% 81% 78% 76% 73% 72% 68% 61%
27% 28% 32% 39%

18% 19% 22% 24%
Carbohydrate
Minutes 5 10 15 20 25 30 35 40
Pace 8:27 8:07 7:47 7:30 7:14 6:59 6:44 6:31
This was my second metabolic efficiency test, done four

weeks later after my nutrition intervention. Each of the paces
per stage were identical but as you notice, I was able to run
50% 50% 50% 50% 50% 50% 50% 50%
for an additional five minutes at a faster pace and still did not
achieve a MEP. My nutrition changes supported a very high
change in50% my body’s
50% 50% ability50%
to burn
50%fat but
50% in this
50%case,50%
I was a
classic MET Level III where physical training, more specifical-
ly, lack of anaerobic training, did not allow me to have a MEP.
Since I was not doing any high intensity interval training, I did
not have enough of the anaerobic energy system development
to see where my MEP would be.
Suffice to say, the decision was clear and was not a diffi-
cult one to make. Based on the health and metabolic efficiency
improvements that I had in the 30-day experiment, I real-
ized vegetarianism was not a good fit for my body, health and
athletic performance goals. Currently, I focus on maintaining a
lower carbohydrate, higher fat daily nutrition plan and continue
to explore my athletic boundaries in my new fat adapted state.
154
Case Studies
CHAPTER 6 REVIEW
As you read in this chapter, many people begin their metabolic

efficiency journey in different stages and for different reasons.
Whether your goals center on improving health and reducing risk
of chronic diseases or for athletic performance, it is obvious that
adopting a metabolic efficiency plan will assist you.
155
Parting Thoughts
The concept of metabolic efficiency began years ago as I had

the goal of eliminating GI distress in endurance athletes. I
have to admit that back then, I was fairly close-minded regard-
ing the possibilities that would develop from this one simple
concept. Now, not only are athletes reaping the benefits that I
have described throughout this book but so too are non-ath-
letes, recreational exercisers and even children. No matter your
health, fitness and nutrition goals, it is known that the first step
in improving these is through making your body more meta-
bolically efficient.
It is no secret that my educational knowledge and belief
system got turned upside down when creating this concept and
so will yours. As the field of nutrition changes and more of the
“old school” information is replaced with updated implementa-
tion strategies to improve health and performance, I encourage
you to approach this with an open mind.
There is nothing unsafe about metabolic efficiency. It does
not consist of an unrealistic diet, fast or cleanse. It is merely
a successful concept that has combined exercise physiology,
nutritional biochemistry, metabolism and behavior change
research to create eating patterns and exercise programs that
157
support optimal health and exercise performance. Once you

are ready to become more metabolically efficient, it will hap-
pen. But remember, you are changing the way you eat and your
approach to exercise training. Please do not expect your body to
adapt overnight. These are behavior changes and they will take
weeks to months to implement depending on your readiness to
change.
Be patient with yourself and perhaps start by implement-
ing the strategies at a slower pace instead of rushing into it.
If you think changing your nutrition will be easier than your
exercise plan, then start there and vice versa. The key is that
you begin to make changes when you are ready without forcing
them to happen. You will be rewarded!
It is with great honor to have the following certified Met-
abolic Efficiency Training Specialists (METS) provide glowing
recommendations for the concept of metabolic efficiency.
“As an athlete, ME has brought a new level of confidence to my

training and racing. It takes the guesswork out of nutrition and I
can simply execute my plan knowing that it will work and that I
will feel good consistently. Case in point: I was able to knock out 15
hours of running in extreme heat with just 49 calories/hour-no GI
issues, no bonk. As a coach, ME means that my athletes have one less
thing to worry about when it comes to race day. Both in terms of nu-
trition logistics and the ever-looming GI distress. They go into races
knowing this piece is already handled allowing them to confidently
meet their performance goals.” - Robyn LaLonde, METS
“I work with many endurance athletes including triathletes, run-

ners, ultra runners, cyclists, and swimmers. My clients have em-
braced the concept of Metabolic Efficiency in both their daily lives
and during training and racing. Needless to say, they are reaping all
158
Parting Thoughts
of the benefits – consistent energy levels, less GI distress, improved

body composition, elevated performance and enhanced general
health. Metabolic Efficiency is a game-changer in the most positive
way!” - Brooke Schohl, MS, RD, METS
“I applied the principles of metabolic efficiency initially to see if I

could lose those stubborn extra pounds that were slowing me down
on the track. I lost those pounds easily and in the process discov-
ered the magical key to the simple nutritional lifestyle that I only
dreamed was possible!” - Caroline Kavanagh, METS
“I have been following the concept of metabolic efficiency program

for three months and have lost almost thirty pounds. I have lots of
energy and can cycle for longer periods without the need for refuel-
ing. Metabolic Efficiency Training is working so well for me that
my husband has joined me and is noticing the same changes and has
dropped eighteen pounds.” - Donna Thompson, METS
“The health and performance benefits I have seen in athletes who

implement metabolic efficiency have been life-changing: improve-
ments in lipid profiles, discontinuing (and avoidance of ) diabetes
and cholesterol-related medications, improved sleep patterns, consis-
tent energy levels throughout the day and during training, favorable
changes in body compositions, new personal bests, and completion
of endurance and ultra endurance races with no gastrointestinal
distress. As a sport dietitian, I find it refreshing to have another
set of “tools in the toolbox” to enable my athletes to become healthier
and achieve their performance goals.” - Dina Griffin, MS, RD,
CSSD, METS
159
TAKE-HOME MESSAGES
Nutrition is the most important piece of the metabolic ef-
ficiency puzzle. Adopt a cognitive nutritional paradigm shift
first. Be open to new nutritional ideas, table your “old school”
learnings as I have and become more of an instinctual eater.
Listen to your body and note what different food combinations
have on your hunger and satiety levels. Ask yourself more often
“why” you are eating in hopes to become more in touch with
your emotional connection to food. Give yourself time to ease
into this lifestyle plan to ensure you will be successful. I have
noticed a 3 - 5 day “break-in” period is required followed by a
“honeymoon” phase of 5 - 21 days of learning the methods and
finally, a “relationship” phase that happens at 3 - 4 weeks and
beyond to really allow the new change to take effect.
Phases of Implementing Metabolic Efficiency Training
1. “Break-in”, 3 - 5 days
2. “Honeymoon”, 5 - 21 days
3. “Relationship”, 3 - 4 weeks and beyond
Remember, a good rule of thumb is that at meal or snack

time, first on your plate should be a source of protein and fat,
followed by vegetables and/or fruit. If your health, nutrition
and exercise training goals allow for it, add a few whole grains
and healthier starches. Following this approach will ensure you
are consuming the necessary nutrients and quantities to help
promote metabolic efficiency.
Most importantly, have fun with your nutrition and don’t
make it a chore. Abandon your calorie counting and food
measuring habits. Stop being a slave to the numbers because, as
you learned, achieving your nutrition goals are so much more
160
Parting Thoughts
dependent upon developing a healthy relationship with food

without having the calorie counting handcuffs on all of the
time. Trust your body and your mind. You may overeat at times
and you may undereat. What matters most are the lessons you
are provided from these instances.
Lastly, remember to alter your metabolic efficiency goals
based on your exercise training schedule and goals. If you are
an athlete, use the concept of Nutrition Periodization to guide
your eating patterns and place metabolic efficiency training
within your annual training plan. If you exercise for fun or are
just getting into fitness, remember to always listen to your body
and not feel the urge to use food as fuel. Metabolic efficiency is
the most important first step for you in your journey of im-
proved health and fitness!
161
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166
About the Author
Bob Seebohar (affectionately known

as “Coach Bob”) has worn many hats
throughout his career. Starting out as an
exercise physiologist by studying exercise
and sports science in his undergraduate
work, he turned to the fitness world upon
exiting college but soon found himself ask-
ing more questions than he could answer
so he decided to return to graduate school to expand his knowl-
edge base. He received his first graduate degree in health and
exercise science that had a large emphasis on metabolism and
it was during this time where he was formally introduced to
sports nutrition. Throughout graduate school, Bob worked with
collegiate athletes, assisting them in improving their health and
performance through nutrition and it was then that he realized
that he had discovered his true passion of combining exercise
with nutrition.
This led Bob to staying an extra year in graduate school
to receive a second graduate degree in food science and hu-
man nutrition, mostly to satisfy the qualifications of becoming
a Registered Dietitian (RD). He knew he would require that
167
expertise to continue his work with athletes. After graduate

school, Bob was extremely focused on becoming one of the best
sport dietitians in the country and outlined a specific success
map to attain this goal. Throughout the past 20 years, he has
acquired valuable hands-on experience working with athletes
of all ages and abilities and has fine tuned his approach to
sports nutrition. He has worked in the collegiate sports nutri-
tion setting as a consultant to Colorado State University and
the University of Northern Colorado, has held the position of
Director of Sports Nutrition at the University of Florida and
was a sport dietitian for the US Olympic Committee where he
was fortunate to travel to the 2008 Olympics as the team sport
dietitian.
Bob is known to think outside the box and politely chal-
lenge the “why’s” behind the way things work. These two traits
have brought Bob’s work to the attention of many high caliber
athletes and coaches and fellow health professionals. He is
considered to be a thought provoking sport dietitian who con-
stantly strives for excellence in his work with athletes by always
attempting to leave no stone unturned when it comes to im-
proving performance. Currently, Bob provides sports nutrition
services to all types of athletes including endurance, strength,
power and aesthetic/skills based through his company, Fuel-
4mance® (www.fuel4mance.com).
In addition to his sport nutrition emphasis, Bob is one of
the foremost experts on strength training for endurance ath-
letes and holds the NSCA Certified Strength and Condition-
ing Specialist certification. He is also a USA Triathlon Level
III Elite Coach, having worked with Susan Williams, 2004
Olympic Triathlon Bronze Medalist, as her strength coach and
sport dietitian, as coach and sport dietitian to Sarah Haskins,
2008 Olympian in triathlon, and coach and sport dietitian of
Jasmine Oeinck, 2009 Elite National Champion triathlete. In
168
About the Author
2009, Bob teamed up with Susan Williams to provide endur-

ance athlete coaching through their company, Elite Multi-
sport Coaching (www.teamemc.com), in Littleton, Colorado.
Because of his love of triathlon, Bob also founded the non-
profit organization, Kids that TRI (www.kidsthattri.org). It
is through this endeavor that Bob is able to share his passion
and knowledge of health and sport with young athletes striv-
ing to become better individuals. Kids that TRI inspires youth
to become more physically active and health conscious through
through the sport of triathlon.
Practicing what he preaches, Bob is a competitive athlete
himself. Growing up playing soccer for 18 years, he shifted his
focus to endurance competitions in 1993 off of a dare and has
not looked back since. He has competed in hundreds of multi-
sport races, most notably six Ironman races, the Boston Mara-
thon, the Leadville 100 mile mountain bike race, the Leadville
100 mile trail run and in 2009 he finished the Leadman which
is a series that includes a marathon, 50 mile mountain bike
race, 50 mile trail run, 100 mile mountain bike race, 10 kilome-
ter run and 100 mile run, all in a span of 7 weeks at altitudes
of 10,200 feet and above. Currently, he focuses on short-course
triathlon and cyclocross racing to enhance his anaerobic athlet-
ic abilities. He is truly a “walk the talk” sport dietitian and has
a keen understanding for the physical, mental and nutritional
components that it takes to be a successful athlete.
169
METABOLIC
EFFICIENCY
TRAINING SECOND
EDITION
TEACHING THE BODY TO BURN MORE FAT

Teach your body to burn more fat to improve health and performance.
The concept of Metabolic Efficiency (ME) can be applied to individuals just
beginning exercise, fitness enthusiasts and the seasoned athlete. ME describes
the relationship between the body’s ability to use fat and carbohydrate as energy
sources across a variety of exercise intensities. Being more of a “fat burner” will
allow you to improve your health, reduce risk for chronic disease, lose weight
and body fat, improve athletic performance and eliminate gastrointestinal
(GI) distress.
The second edition of Metabolic Efficiency Training: Teaching the Body to Burn
More Fat has been enhanced to provide more nutrition and exercise prescription
strategies for individuals of all ages, abilities and fitness/sport interests.
This book will provide very specific nutrition and exercise recommendations that
will guide you through each training cycle with the end goal of improving your
ability to use fat as fuel. Gone are the days of needing to consume a high amount
of calories during training and competition. By improving your body’s metabolic
efficiency, it is possible to significantly reduce the amount of calories you need
during exercise. The end result will be improved health and performance with
significantly reduced chances of GI distress.

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METABOLIC

TEACHING THE BODY TO BURN MORE FAT

Bob Seebohar MS, RD, CSSD, CSCS

Bob Seebohar MS, RD, CSSD, CSCS

Copyright © 2014 by Bob Seebohar, M.S., R.D., C.S.S.D., C.S.C.S.

All rights reserved. Except for use in a review, reproduction or utilization of

Printed in the United States of America.

Design and layout by Kathryn Skiba.

CHAPTER 2 Health and Vitality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

CHAPTER 3 Metabolic Efficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

CHAPTER 4 Measuring Metabolic Efficiency . . . . . . . . . . . . . . . . . 55

CHAPTER 5 Improving Metabolic Efficiency:

CHAPTER 6 Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131

PARTING THOUGHTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157

REFERENCES AND RECOMMENDED READINGS . . . . . . . . . . . . . . . . . . . . . .163

ABOUT THE AUTHOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .167

As a third year professional Ironman triathlete, I know that

about this crazy concept of metabolic efficiency, about using fat

Metabolic Efficiency Training, quite simply, works. Un-

Since the first edition of this book was published in 2009, I

athletes who experienced gastrointestinal (GI) distress. The best

behavior changes. You can search for these qualified METS on

ing the specific nutrition and exercise strategies to improve

exercise intensity, followed by a 1-hour time trial effort. The

to be 1.3 miles ahead of your competitor on a bike? Depend-

I created the metabolic efficiency concept in 2006 out of a

of data that explores how different nutrition strategies affect

THE THREE AMIGOS

concept taught us that as exercise intensity increases, the body

The basic message of the crossover concept is that the

body prefers to use carbohydrate at increasing intensities while

nipulation of the daily nutrition plan and the contribution from

Benefits Of Improving Metabolic Efficiency

Better fasting blood

I have also created a specific physiological test that as-

your metabolic efficiency measured, the data received will help

time, non-restrictive, flexible to meet your health and exer-

TIME FOR CHANGE

it is important for you to know more about behavior change

THE STAGES OF CHANGE MODEL

more metabolically efficient. You may or may not begin at the

benefits and changes with becoming more metabolically efficient

between biological, habitual and emotional hunger, then iden-

metabolic efficiency, you will be more confident in your ap-

Here is a summary of the main learning objectives of this chapter:

The crossover concept is mainly comprised of exercise changes

The benefits of metabolic efficiency span many areas including

When first adopting a new nutrition and exercise plan, it is impor-

It is important to set goals no matter what you do but under-

You must be healthy in order to exercise. It’s a frequent phrase

Benefits of Improving Metabolic Efficiency

Better fasting blood

Lower calorie needs Ability to follow

Interestingly, becoming more metabolically efficient with

tention to and do everything we can to reduce our risk stratifi-

Metabolic Syndrome Risk Factors

The obvious first step to knowing your risk for metabolic

Blood Work Tests

What is extremely interesting is the dietary connection to

we know is that while a training program may provide a very

increase HDL. Through associated weight loss often seen with

Here is a summary of the main learning objectives of this chapter:

Metabolic syndrome is a set of risk factors for certain chronic diseases.

Individuals have genetic predispositions to chronic diseases. Blood