nutrient dense diabetic friendly vegan foods

  • Eating plant-based foods can be a great way to improve nutrient density and reduce the amount of highly insulinogenic processed carbohydrates in your diet.
  • This article looks at how we can make a plant-based diet even more nutrient dense as well as more diabetic friendly by reducing insulin load.
  • Finally, we will look at whether adding additional food groups such as seafood, dairy or eggs would diminish or improve the nutrient density of a plant based approach.

nutrient density

A nutrient dense diet is key to maximizing health and satiety with a minimum of calories.  Maximising nutrient density enables our mitochondria to do more with less.  If our world is full of beneficial nutrients our body realises that there is no longer an energy crisis and is more likely to stop searching for more nutrients and lets go of our stored body fat and decrease appetite.

As detailed in the ‘Building a Better Nutrient Density Index’ article, quantifying nutrient density enables us to prioritise foods that contain the highest amount of essential nutrients that are harder to obtain.[1]

The chart below (click to enlarge) shows the percentage of the recommended daily intake of various essential nutrients provided by:

  • all 7000+ foods in the USDA foods database,
  • plant based foods, and
  • the most nutrient dense plant based foods.

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Restricting ourselves to ‘plant based’ foods will improve the vitamin and mineral content of the foods we eat.  However, focusing on the most nutrient dense plant based foods allows us to improve nutrient density even more.

most nutrient dense plant based foods

Listed below is a summary of the most nutrient dense plant based foods sorted by their nutrient density score.

The nutrient density score (ND) is shown for each of the foods.

As you can see from the plot below from Nutrition Data, celery, which has a very high nutrient density score (ND), will provide you with a range of vitamins and minerals equivalent to 81% of your recommended daily intake with 1000 calories and 52% of your protein intake with 1000 calories.  Keep in mind though that you would need to eat 100 stalks of celery to get that 1000 calories (and many of these calories will be spent digesting it!).

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The fact that celery has a low energy density may be a benefit if you are trying to lose weight, but perhaps would not be so helpful if you are fueling for an Ironman Triathlon.

Also shown in the tables below is the net carbohydrates and calories per 100g for each of the foods listed.

The great thing about most of these foods is that they will provide you with heaps of nutrients while having a low energy density which will make it hard to over consume them to a point that they will spike your blood glucose levels.

In the second half of this article we will look at how we can choose foods that will be more gentle on blood glucose levels for those of us that are more insulin resistant.

 

vegetables

food ND % insulinogenic insulin load (g/100g) calories/100g
celery 1.44 48% 2 17
broccoli 0.52 54% 6 42
winter squash 0.39 68% 7 39
seaweed (kelp) 0.39 77% 10 50
okra 0.34 64% 6 37
kale 0.33 74% 10 56
bell peppers 0.33 72% 8 43
turnip greens 0.31 45% 4 37
summer squash 0.30 47% 2 19
radishes 0.27 49% 2 19
mung beans 0.24 77% 5 26
parsnip 0.21 68% 13 76
rhubarb 0.21 57% 3 21
artichokes 0.20 47% 6 54
lettuce 0.20 54% 2 17
white mushrooms 0.16 51% 4 34
sweet corn 0.15 77% 21 111
snap green beans 0.14 61% 6 40
peas 0.14 57% 7 51
jalapeno peppers 0.10 54% 5 35
collards 0.10 50% 5 40
Brussels sprouts 0.08 54% 7 52
asparagus 0.08 48% 3 27
sweet potato 0.06 84% 18 87
pinto beans 0.06 61% 22 142
leek 0.06 77% 7 36
cabbage 0.04 49% 4 30
pumpkin 0.03 73% 4 23
cucumber 0.03 74% 3 18
turnips 0.01 61% 4 24
Chinese cabbage 0.01 49% 2 17
bamboo shoots 0.01 69% 5 28
cassava 0.01 89% 36 160
mustard greens 0.00 50% 4 30
eggplant (cooked) 0.00 67% 7 41
chives 0.00 40% 4 37
potato -0.03 89% 21 95
seaweed (spirulina) -0.03 53% 52 395
onions -0.03 77% 8 41
banana pepper -0.04 47% 5 39
carrots -0.04 50% 5 39
lentils (sprouted) -0.04 90% 29 129
parsley -0.04 49% 5 44
beets -0.07 74% 9 48
soybeans (cooked) -0.08 36% 14 151
arugula -0.09 47% 4 31
shallots -0.09 77% 15 78
edamame -0.10 35% 11 124
portabella mushrooms -0.15 48% 4 32
shiitake mushrooms (cooked) -0.15 82% 13 66
carrots (raw) -0.15 66% 7 44
chicory greens -0.29 27% 2 28
shiitake mushrooms (raw) -0.31 55% 6 41
cilantro -0.41 36% 3 28
alfalfa (sprouted) -0.41 32% 2 31
spinach -0.41 41% 3 29

nuts and seeds

food ND % insulinogenic insulin load (g/100g) calories/100g
coconut water 0.60 66% 3 20
tahini 0.04 19% 30 633
sunflower seeds 0.02 27% 33 491
pistachio nuts 0.02 23% 35 602
pine nuts 0.02 7% 11 647
pecans 0.00 5% 10 762
pumpkin seeds 0.00 33% 64 777
sesame seeds 0.00 16% 25 603
cashew nuts 0.00 25% 38 609
macadamia nuts 0.00 5% 10 769
walnuts -0.01 15% 25 683
almonds -0.01 12% 19 652
hazel nuts -0.01 12% 20 692
chia seeds -0.01 16% 20 511
brazil nuts -0.01 9% 15 704
coconut meat -0.02 4% 8 703
flaxseed -0.02 11% 16 568

cereals and grains

food ND % insulinogenic insulin load (g/100g) calories/100g
teff 0.29 80% 20 101
spelt 0.23 79% 27 135
quinoa 0.05 70% 21 120
millet 0.05 83% 24 118
tapioca 0.01 98% 87 356
spaghetti 0.01 94% 87 371
buck wheat -0.01 79% 74 371
brown rice -0.01 83% 23 111
oats -0.02 70% 69 395
wheat flour -0.03 87% 77 353
rye flour -0.03 78% 70 359
corn-starch -0.03 99% 91 367
rice flour -0.04 84% 76 360
egg noodles -0.04 80% 28 137
macaroni -0.05 95% 38 161

fruit

food ND % insulinogenic insulin load (g/100g) calories/100g
cherries 0.26 79% 11 54
grapes 0.19 92% 18 77
litchis 0.13 82% 15 73
figs 0.10 82% 17 82
apples 0.08 87% 12 53
mandarin oranges 0.04 82% 12 59
dates 0.03 90% 69 308
raisins 0.02 92% 77 336
honeydew melon 0.01 88% 9 40
blueberries 0.01 88% 20 91
passion fruit -0.01 52% 14 109
oranges -0.01 79% 11 55
mango -0.01 84% 14 67
prunes -0.01 97% 91 378
raisins -0.03 89% 73 329
raspberries -0.03 42% 6 58
pear -0.04 78% 13 64
nectarines -0.06 67% 8 49
kiwifruit -0.06 78% 13 67
plantains -0.06 89% 30 136
plum -0.06 75% 10 51
pineapple -0.07 88% 13 57
olives -0.07 18% 4 90
avocado -0.07 11% 3 131

legumes

food ND % insulinogenic insulin load (g/100g) calories/100g
lima beans 0.14 68% 22 129
lentils 0.09 63% 18 118
hummus 0.07 32% 14 175
navy beans 0.07 57% 20 143
peanuts 0.02 19% 28 605
tofu 0.01 29% 8 112
kidney beans -0.01 87% 58 266
peanut butter -0.02 19% 31 630
soybeans (cooked) -0.02 35% 16 187
tempeh -0.03 37% 20 213
miso -0.04 53% 28 207
natto -0.05 33% 19 227
chickpeas -0.05 73% 26 145
split peas -0.07 57% 17 119

diabetic friendly nutrient dense vegan foods

While the foods listed above would represent a significant dietary improvement for most people, those who are insulin resistant may struggle to keep their blood glucose levels stable if they eat too much non-fibre carbohydrate that can be found in plant based foods (e.g. bread, sweet potato, quinoa, rice, beans or spaghetti).

It is hard to get too many calories and / or spike your glucose levels if you restrict yourself to vegetables like celery, broccoli and spinach.  The problem with this approach comes if you are still hungry after you have eaten your fill of non-starchy veggies and are not wanting to lose more weight.  People using a plant based approach may end up filling up on energy dense higher carbohydrate foods which are more likely to raise their blood glucose and insulin levels.

As shown in the chart below, our insulin response to food is only partially explained by the quantity of carbohydrates in our food.

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The analysis of the food insulin index data indicates that our insulin response is also influenced by the fibre and the protein in the foods we eat.

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We can use the formula below to estimate the amount of insulin that our food will require as shown by the formula below.  Foods with a lower insulin load will enable your pancreas to keep up with demand and maintain normal blood glucose levels without the ‘blood glucose roller coaster’.

insulin load (g)=carbohydrates (g)-fiber (g) + 0.56*protein (g)

 

The higher fat foods actually have a lower nutrient density than the most nutrient dense vegetarian foods listed above.  Ideally in time someone with insulin resistance would be able to restore their insulin sensitivity through eating nutrient dense, low insulin load foods along with perhaps intermittent fasting and exercise.  However, in the meantime the lower insulin load foods will enable you to maintain normal blood glucose levels.

diabetic friendly plant based foods

The list of foods below is prioritised by both nutrient density and the proportion of insulinogenic calories.  These foods will provide high levels of nutrition while also being gentle on your blood glucose levels with lower levels of insulin required.

vegetables

The vegetables in this list have a lower percentage of insulinogenic calories, lower amounts of net carbohydrates and a low energy density and therefore will have a minimal impact on blood glucose levels.   While the percentage of insulinogenic calories is often high, the net carbohydrates is low so the effect on blood glucose will be minimal.

food ND % insulinogenic insulin load (g/100g) calories/100g
celery 1.71 48% 2 17
turnip greens 0.32 45% 4 37
broccoli 0.50 54% 6 42
summer squash 0.28 47% 2 19
artichokes 0.23 47% 6 54
radishes 0.26 49% 2 19
soybeans (cooked) -0.10 36% 14 151
edamame -0.12 35% 11 124
chives -0.04 40% 4 37
chicory greens -0.34 27% 2 28
collards 0.11 50% 5 40
white mushrooms 0.09 51% 4 34
okra 0.36 64% 6 37
asparagus 0.00 48% 3 27
mustard greens 0.00 50% 4 30
cabbage -0.04 49% 4 30
banana pepper -0.09 47% 5 39
arugula -0.10 47% 4 31
lettuce 0.06 54% 2 17
parsley -0.04 49% 5 44
endive -0.56 24% 1 20
rhubarb 0.10 57% 3 21
winter squash 0.34 68% 7 39
peas 0.10 57% 7 51
carrots -0.06 50% 5 39
bell peppers 0.39 72% 8 43
jalapeno peppers 0.01 54% 5 35
kale 0.41 74% 10 56
Chinese cabbage -0.12 49% 2 17
alfalfa (sprouted) -0.49 32% 2 31
Brussels sprouts -0.03 54% 7 52
portabella mushrooms -0.15 48% 4 32
seaweed (kelp) 0.42 77% 10 50
snap green beans 0.09 61% 6 40
parsnip 0.19 68% 13 76
cilantro -0.49 36% 3 28
asparagus -0.57 34% 2 23
turnips -0.07 61% 4 24
mung beans 0.26 77% 5 26
spinach -0.49 41% 3 29
cauliflower -0.54 41% 3 28
eggplant (cooked) -0.06 67% 7 41
leek 0.12 77% 7 36

nuts and seeds

Nuts and seeds have a lower proportion of insulinogenic calories as well as being lower in net carbs which makes them diabetic friendly.  They do have a considerably higher energy density and hence, unlike the veggies, it is possible to overeat nuts and seeds if you’re keeping an eye on your weight.

food ND % insulinogenic insulin load (g/100g) calories/100g
coconut meat -0.02 4% 8 703
macadamia nuts -0.01 5% 10 769
pecans 0.00 5% 10 762
pine nuts 0.02 7% 11 647
brazil nuts -0.02 9% 15 704
coconut milk -0.06 8% 5 246
flaxseed -0.02 11% 16 568
coconut water 0.76 66% 3 20

fruits

The list of diabetic friendly fruits with a lower proportion of insulinogenic calories ends up being quite short.

food ND % insulinogenic insulin load (g/100g) calories/100g
avocado -0.09 11% 3 131
olives -0.11 18% 4 90
raspberries -0.04 42% 6 58
passion fruit -0.03 52% 14 109
blackberries -0.26 45% 5 48
guava -0.19 54% 10 76
cherries 0.26 79% 11 54
nectarines -0.10 67% 8 49
currants -0.24 66% 10 63
limes -0.17 71% 8 47
plum -0.10 75% 10 51
strawberries -0.27 67% 6 36
kiwifruit -0.07 78% 13 67

legumes

These legumes have a lower proportion of insulinogenic calories and lower carbohydrates, however there may still be some impact on blood glucose with the moderate levels of carbohydrates, so you may want to keep an eye on your blood glucose levels when you try these foods to see how you react to them.

food ND % insulinogenic net carbs/100g calories/100g
peanuts 0.03 24% 7 605
hummus 0.08 46% 8 175
tofu 0.02 29% 2 112
peanut butter -0.01 23% 18 630
tempeh -0.00 37% 9 213
soybeans (cooked) -0.01 48% 4 187
natto -0.03 43% 9 227

what about pescetarian, lacto, ovo options?

In the development of this article I spoke with Barry Erdman who runs the Vegetarian Low Carb Diabetic Healthy Diet Society Facebook group.

Barry has been a strict vegetarian since 1970 and was diagnosed with Type 1 Diabetes nine years ago.  Barry maintained a nutrient dense plant based diet after his diagnosis, however found that he needed to incorporate dairy, eggs and some oils (e.g. MCT, coconut) into his vegetarian diet in order to achieve acceptable blood glucose control.  Barry told me that when he lost 30 lbs when he switched from a vegetarian diet to a LCHF keto lacto ovo vegetarian diet eliminating all grains, bad oils and fruit (except berries).

Barry also came to the conclusion that he would need to incorporate some fish oil into his diet in order to provide adequate levels of essential fatty acids which are not available in significant quantities in plant based products.

Barry asked me to have a look at how a lacto, ovo, pescitarian diet would stack up against the straight vegan approach.  So listed below are the most nutrient dense lacto (dairy), ovo (eggs), and pescetarian (seafood) diabetic friendly foods.

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For those who are interested in adding eggs or seafood I have listed them based on their nutrient density and proportion of insulinogenic calories.

eggs and dairy

food ND % insulinogenic net carbs/100g insulin load (g/100g) calories/100g
butter 0.00 0% 0 1 734
egg yolk 0.04 19% 4 15 317
cream cheese 0.01 10% 4 8 348
sour cream 0.00 9% 3 4 197
goat cheese 0.03 22% 2 25 451
limburger cheese 0.02 18% 0 15 327
blue cheese 0.02 20% 2 18 354
gruyere cheese 0.02 21% 0 22 412
edam cheese 0.02 22% 1 20 356
cream -0.01 5% 4 5 431
cheddar cheese 0.02 20% 1 20 403
camembert cheese 0.02 20% 0 15 299
muenster cheese 0.02 20% 1 18 368
Monterey 0.02 20% 1 19 373
gouda cheese 0.02 23% 2 20 356
Colby 0.02 20% 3 20 394
feta cheese 0.02 22% 4 14 265
provolone 0.02 24% 2 21 350
brie cheese 0.01 19% 0 16 334
Swiss cheese 0.02 26% 5 25 379
parmesan cheese 0.03 30% 3 31 411
mozzarella 0.01 23% 2 18 318
whole egg 0.03 29% 1 10 138
ricotta cheese -0.02 25% 3 11 174
Greek Yogurt -0.05 27% 6 9 130
cottage cheese -0.06 39% 3 9 93

seafood

food ND % insulinogenic insulin load (g/100g) calories/100g
caviar 0.09 32% 22 276
anchovy 0.10 42% 21 203
herring 0.07 34% 18 210
sardine 0.05 36% 18 202
trout 0.08 43% 17 162
mackerel 0.07 45% 17 149
oyster 0.11 57% 14 98
tuna 0.08 50% 17 137
salmon 0.07 50% 15 122
sturgeon 0.06 47% 15 129
squid 0.02 50% 21 170
halibut 0.06 63% 16 105
mussel 0.05 61% 25 165
shrimp 0.07 66% 19 113
lobster 0.08 69% 14 84
Pollock 0.06 66% 17 105
whitefish 0.06 67% 17 102
octopus 0.06 69% 27 156
snapper 0.05 64% 15 94
crab 0.07 69% 13 78
whiting 0.03 63% 17 109
haddock 0.04 67% 18 110
crayfish 0.03 64% 12 78
perch 0.01 59% 13 91
haddock 0.02 69% 15 85
clam 0.03 71% 24 135
cod 0.01 67% 17 99
abalone 0.03 76% 19 99

comparison of essential micronutrients

The charts below show the level of vitamins, minerals and amino acids for each of the approaches including for the most nutrient dense foods (without the plant based constraint).  All of the reduced insulin load (IL) approaches do well compared to the average of all the foods in the USDA database.

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The plot below shows the amino acids and essential fatty acids of the various approaches.  This analysis indicates that you can achieve the daily recommended intake of protein from a nutrient dense plant based approach.  The area that suffers when it comes to an exclusively plant based approach is the essential fatty acids EPA and DHA which many vegetarians choose to supplement with.

However, with the high levels of omega 3s in seafood it appears that you could probably obtain adequate essential fatty acids from around 200 calories of nutrient dense seafood (or around 10% of your energy intake).

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In an effort to simplify things, the chart below shows a comparison of the average of the nutrient density provided by the various lower insulin load diabetic friendly approaches.

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When we look at the average (blue bars) the pescetarian approach (i.e. plant based plus seafood, no eggs, no dairy) wins out.

A more useful way to identify the approach that will maximise the nutrient density of all the nutrients is to look at the average minus the standard deviation (orange bars).  When we look at it from this perspective the pescetarian approach (i.e. plant based plus seafood without eggs or dairy) wins out again.

So it appears that the optimal approach from a nutrient density perspective is to focus on nutrient dense plant foods with some seafood.

summary

So in summary, there are some great nutrient dense options for people with diabetes who choose to follow a plant based dietary approach.  Supplementing a plant based diet with some seafood will provide essential fatty acids and boost protein levels.

more information

If you’re interested in learning more about the nutrient density ranking system check out:

 

Dominic D’Agostino’s breakfast – sardines, oysters, eggs and broccoli

At first it sounds like a bizarre food combination, but when the smartest guy in the room says that he has sardines, oysters, eggs and broccoli as his regular breakfast I wasn’t surprised to find that it scored highly in the nutritional analysis.

Before he started saving the world by progressing Warburg’s mitochondrial theory of cancer and oxygen toxicity seizures for DARPA Dominic D’Agostino studied nutrition and is rumoured to have done some bodybuilding.

Both physical and mental performance are undoubtedly critical to Dom, so it’s not surprising that he is very intentional about what he puts in his mouth to start each day.

As you can see in the plot from Nutrition Data below Dom’s breakfast scores a very high 93 in the vitamins and minerals score and a very solid 139 in the protein score.

You could say this meal was high protein (44%), low carb (10%) and moderate fat (46%), although his fatty coffee and high fat deserts would boost the fat content to make it more “ketogenic”.

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Dom’s breakfast scores well against the 250 meals analysed to date in the meal rankings for different goals coming in at:

  • therapeutic ketosis – 176
  • diabetes and nutritional ketosis – 87
  • nutrient density – 9
  • weight loss – 16

I’ve heard Dom say that he aims for a ‘modified Atkins’ approach with higher protein levels rather than a classical therapeutic ketogenic diet which is harder to stick to and might be used for people with epilepsy, cancer, dementia etc.  It was intriguing to see that Dom’s standard breakfast ranks the highest in nutrient density rather than therapeutic or nutritional ketosis.

Image result for tim ferriss dom d'agostino

Dom first mentioned his favourite breakfast concoction in his first interview with Tim Ferriss (check out the excellent three hour podcast here).   You can hear the shock and slight repulsion in Tim’s voice in the sound check as he responds with

“Do you blend that up in the Vitamix?”

But now Tim, rather than following his own slow carb approach, has made sardines and oysters a regular breakfast staple and mentions it as one of the top 25 great things he learned from podcasts guests in 2015.

The stats for a 500 calorie serve of Dom’s breakfast are shown in the table below.

net carbs

insulin load carb insulin fat protein fibre
6g 38g 18% 46% 44%

6g

oyster20at20ettas

I was aware that broccoli, eggs and sardines are nutritionally amazing, but then the oysters fill out the vitamin and mineral score to take it a little bit higher.  Dom obviously understands the importance of Omega 3s which are hard to get in significant quantities from anything other than seafood.

I was surprised to see that oysters can be ‘carby’ (at 23% carbs) which is apparently due to their glucose pouch which varies in size depending when they’re harvested.

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If you wanted to skip the oysters due to taste or cost considerations, the combination of sardines, egg and broccoli still does pretty well.  This option gives less carbs, a slight decrease in the vitamin and mineral score with an slight increase in the amino acid score.

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The ranking for the sans-oyster option is:

  • therapeutic ketosis –  159
  • diabetes and nutritional ketosis –  67
  • nutrient density –  11
  • weight loss – 20

The stats for a 500 calorie serving are:

net carbs

insulin load carb insulin fat protein fibre
3g 30g 10% 48% 44%

6g

The combination of nutrient dense seafood with nutrient dense vegetables is hard to beat.  The chart below shows my comparison of the nutrients in the various food groups in terms the proportion of the Daily Recommended Intake (DRI) from 2000 calories (click to enlarge).

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I couldn’t get any photos of Dom’s breakfast, but I did get a photo of my current go to lunch.   Each weekend I get a bunch of good quality celery and chop it up into tubs to take to work each day.  I have cans of mackerel and sardines in my drawer at work.

Celery does really well in terms of nutrient density per calorie and sardines and mackerel are high on the nutrient density lists without being outrageously expensive (e.g. caviar, anchovy, swordfish, trout).

mackerel and celery

When I feel hungry I might start munching on the celery which is pretty filling and hard to binge on.  Then if I’m still hungry I’ll have as many cans of mackerel or sardines as it takes to fill me up (which is usually 2 to 4).

At around 2pm this is my first meal of the day (other than espresso shots with cream) at around 2pm.  If I start to feel hungry before then I might check my blood glucose to see if I really need to refuel or if I think I’m hungry because I’m bored.   I’ll then go home and have an early dinner with the family around 6pm.

I’ve been known to indulge in some peanut butter with, cream, Greek yogurt or even butter if I’m still hungry (e.g. if I’ve ridden to work) but I try to not overdo it as I’m not as shredded as Dom yet.

The simple combination of celery and mackerel also does pretty well in the ranking of 250 meals and aligns well with my current goal of maximising nutrient density and ongoing weight loss now that I’ve been able to stabilise my blood glucose levels.

  • therapeutic ketosis – 137
  • diabetes and nutritional ketosis – 36
  • nutrient density – 16
  • weight loss – 8

net carbs

insulin load carb insulin fat protein fibre
8g 33g 25% 51% 35%

6g

 

 

 

 

how to make endogenous ketones at home

I’ve spent some time lately analysing these 1100 ketone vs glucose data points looking for the secret to achieving optimal ketone values for weight loss and health.

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As you can see from this chart, there is a relationship between ketones and glucose.  As your blood glucose levels decrease your blood ketones rise to compensate.

Different glucose : ketone relationships for different people

It seems that each person has a unique relationship between their blood glucose and ketone values that gives us an insight to understand their insulin resistance status and metabolic health.

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Characterisation of different metabolic states

Similar to Dr Kraft’s insulin curves, we can characterise different levels of insulin resistance metabolic health using the relationship between glucose and ketones.

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If you want to know why hyperinsulinemia is the “unifying theory of chronic disease” it’s worth taking the time to read up on it to provide some more context for the discussion later in this article. [1] [2] [3] [4] [5]

Type 2 Diabetes

If you have type 2 diabetes and your blood glucose levels are consistently high, you are not metabolising carbohydrates well, and will likely benefit from a lower insulin load dietary approach.

When you go a long time between meals, your ketones don’t kick in because of high insulin levels and / or your mitochondria are not functioning optimally.  You feel tired and hangry.

Particularly in the early stages when someone is still insulin resistant, a lower insulin load dietary approach will help with satiety and carb cravings while keeping blood glucose levels under control.

Hyperinsulinemia and metabolic disorders

If your blood glucose levels are very low and ketone levels are also very low, you may have an infection or a metabolic disorder that is stopping you from producing enough energy.

The yellow line in the chart above is based on an actual person who is suffering from a range of metabolic related issues including obesity, PCOS, depression, etc.  For these people, EXOGENOUS ketones may help to relieve the debilitating symptoms of acute Hyperinsulinemia.

Exciting research is currently underway looking at the use of EXOGENOUS ketones as an adjunct treatment for cancer or to provide energy directly to the mitochondria for people with epilepsy, dementia, Alzheimer’s and the like.[6]  [7]  

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Patrick Arnold, who worked with Dr Dominic D’Agostino to develop the first ketone esters and BHB salts, has noted that exogenous ketones may help alleviate the symptoms of the ‘keto flu’ during the transition from a high carb to a low carb dietary approach.


However, as noted by Robb Wolf, once you have successfully transitioned to a lower carb eating style you would need to reduce or eliminate the exogenous ketones to enable your body to fully up-regulate lipolysis (fat burning), maximise ENDOGENOUS ketone production and access your ENDOGENOUS FAT stores.

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Insulin resistant

Someone with diabetes who persists with a nutrient dense low insulin load dietary approach may be able to successfully normalise their blood glucose and insulin levels.  When this happens your body will be able to more easily release ENDOGENOUS ketones which will help improve satiety between meals, and decrease appetite which will in turn lead to weight loss.  Exercising to train your body to do more with less is also helpful.

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If you are insulin resistant you are probably not able to metabolise carbohydrates, protein or fats very well.  The light blue “mild insulin resistance” line is based on my ketone and glucose values when I started trying to wrap my head around this ketosis thing.

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I enthusiastically started adding unrestricted amounts of fat from all the yummy stuff (cheese, butter, cream, peanut butter, BPC etc) in the hope of achieving higher ketone levels and therefore weight loss, but I just got fatter and more inflamed as you can see in the photo on the left.  My blood tests suggested I was developing fatty liver in my mid 30s!  And I thought I was doing it right with the bacon and BPC?!?!?

The photo on the right is after I worked out how to decrease the insulin load of my diet and learning about intermittent fasting from Jason Fung.  I realised that ENDOGENOUS ketosis and weight loss is caused by a lower dietary insulin load, not more EXOGENOUS fat on your plate or in your coffee cup.

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I recently had my HbA1c tested at 4.9%.  It’s getting there.  But knowing what I know now about the importance of glucose control,  I would love to lose a bit more weight and see my HbA1c even lower.

I recently purchased a couple of bottles of KetoCaNa from the USA after hearing a number of podcast interviews with Dominic D’Agostino and Patrick Arnold.[8] [9]

This metabolic jet fuel is definitely fascinating stuff!  My experience is that it gives me the buzz like a BPC, but also has an acute diuretic effect (meaning I need to stay close to a toilet and long drives to work in slow traffic were sometimes humiliating).

I had hoped it would have a weight loss effect like some people seemed to be saying it would.

2016-08-10

I did find it had an amazing impact on my appetite.  While it was in my system I didn’t care as much about food.  However once the ketones were used up my appetite came flooding back.  It was like I had ‘bonked’ all of a sudden and needed LOTS OF FOOD NOW!

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Unfortunately my hunger and subsequent binge eating seemed to offset the short term appetite suppression.  And it was not going to be financially viable for me to maintain a constant level of artificially elevated ketone levels.

I asked around to see if anyone had come across studies demonstrating long term weight loss effects of exogenous ketones.[11]   It was a VERY enlightening discussion if you want to check it out here.  Wow!

image30

The Pruvit FAQ says that one of the benefits of Keto//OS is weight loss, however no reference to the research studies was provided to Pruve this claim.

AVPageView 11082016 13036 PM.bmp.jpg

Also, the studies that were referenced in the Pruvit FAQ all appear to relate to the benefits of ENDOGENOUS or nutritional ketosis rather than EXOGENOUS ketone supplementation.

Princess_Bride_That_Word

According to a Pruvit tele-seminar the EXOGENOUS ketone salts were not designed to be a weight loss product and hence have not been studied for weight loss.

The only studies that we could find that mentioned EXOGENOUS ketone supplementation and weight loss were on rats an they found that there was no long term effect on weight loss.[12]   

So in spite of my hopeful $250 outlay it seems that exogenous ketones ARE just a fuel source after all.

image06

Even the experts don’t seem to think exogenous ketones help with fat loss.

image25

 

image28

image16 [13]

Confused yet?  I don’t blame you.

Metabolically healthy

The “metabolically healthy” line in the chart above is based on RD Dike man’s ketone and glucose data when he recently did a 21 day fast.

image32

Due to his hard earned metabolic health and improved insulin resistance he has developed the ability to fairly easily release ketones when goes longer periods between meals.

2016-08-10 (2).png

RD has achieved a spectacular HbA1c of 4.4%.  Perhaps a two or three day water only fast testing blood glucose and ketones with no exercise would be a useful test of your insulin status?  You could use RD’s line as the gold standard.

image04

In spite of his improvement in insulin resistance and blood glucose control, he still says the “siren” of hunger is incredibility difficult to resist and mastering appetite is more challenging than particle physics.  As a Chief Scientist at Lockheed Martin, he would know.

RD also told me that when he is not fasting and is eating his regular nutrient dense higher protein meals his ketone levels are not particularly high. While RD fairly easily produces ketones, it seems they are also quickly metabolised so they do not build up in his bloodstream.

I know Luis Villasenor of Ketogains finds the same thing.

image10

Total energy = ketones + glucose

Where this gets even more interesting is when we look at the glucose and ketone data in terms of TOTAL ENERGY.  That is, from both glucose and ketones.

2016-08-12 (11)

The average TOTAL ENERGY of the 1100 data points from these 26 fairly healthy people working hard to achieve nutritional ketosis is 6.1mmol/L. It seems the body works to maintain homeostasis around this level.

When the TOTAL ENERGY in our bloodstream increases outside of the normal range it appears the body raises insulin to store the excess energy.  That is, unless you have untreated Type 1 Diabetes, in which case you end up in diabetic ketoacidosis with high blood glucose and high ketones.

Regardless of whether your energy takes the form of glucose, ketones or free fatty acids they all contribute to acetyl-coA which is oxidized to produce energy.  Forcing excess unused energy to build up in the bloodstream is typically not desirable and can lead to long term issues (gyration, oxidized LDL etc).

I’m not sure if ketones can be converted to glucose or body fat, but it makes sense that excess glucose would be converted to body fat via de novo lip genesis to decrease the TOTAL ENERGY in the blood stream to normal levels.

A number of studies seem to support this view including Roger Unger’s 1964 paper the Hypoglycemic Action of Ketones.  Evidence for a Stimulatory Feedback of Ketones on the Pancreatic Beta Cells.[14]

Ketone bodies have effects on insulin and glucagon secretions that potentially contribute to the control of the rate of their own formation because of antilipolytic and lipolytic hormones, respectively.  Ketones also have a direct inhibitory effect on lipolysis in adipose tissue.[15]

This guy seems to agree too.  But what would he know? [16]  [17] [18]

image26

Looking at the glucose and ketones together in terms of TOTAL ENERGY was a bit of an ‘ah ha’ moment for me.  It helped me to understand why people like Seyfried and D’Agostino always talk about the therapeutic benefits and the insulin lowering effects of a calorie restricted ketogenic diet. [19] [20] [21] [22]

Dealing with high ketones and high glucose typically a concern fro the body because it just doesn’t happen in nature with real whole foods.  But now we have refined grains, HFCS, processed fats and exogenous ketones to ‘bio-hack’ our metabolism and send it into overdrive.

While fat doesn’t normally trigger an insulin response, it seems that excess unused energy in the blood stream, regardless of the source, will trigger an increase in insulin to reduce the TOTAL ENERGY in the blood stream.

I am concerned that if people continue to enthusiastically zealously focus on pursuing higher blood ketones “through whatever means you can”[24] in an  effort to amplify fat loss they will promote excess energy in the bloodstream which will lead to insulin resistance and hyperinsulinemia.

Using multi-level marketing tactics to distribute therapeutic supplements to the uneducated masses who are desperate to lose weight with a ‘more is better’ approach also troubles me deeply.

My heart sank when I saw this video.

MORE investigation required?

There are anecdotal reports that use of exogenous ketones provide mental clarity, enhanced focus and athletic performance benefits.  At the same time there are also people who have been taking these products for a while that don’t appear to be doing so well.

A July 2016 study Ketone Bodies and Exercise Performance: The Next Magic Bullet or Merely Hype? didn’t find that EXOGENOUS ketones were very exciting.

Recently, ketone body supplements (ketone salts and esters) have emerged and may be used to rapidly increase ketone body availability, without the need to first adapt to a ketogenic diet. However, the extent to which ketone bodies regulate skeletal muscle bioenergetics and substrate metabolism during prolonged endurance-type exercise of varying intensity and duration remains unknown. Therefore, at present there are no data available to suggest that ingestion of ketone bodies during exercise improves athletes’ performance under conditions where evidence-based nutritional strategies are applied appropriately.

Another study by Veech et al (who is trying to bring his own ketone ester to market) from August 2016 Nutritional Ketosis Alters Fuel Preference and Thereby Endurance Performance in Athletes found in favour of ketones.

Ketosis decreased muscle glycolysis and plasma lactate concentrations, while providing an alternative substrate for oxidative phosphorylation. Ketosis increased intramuscular triacylglycerol oxidation during exercise, even in the presence of normal muscle glycogen, co-ingested carbohydrate and elevated insulin. These findings may hold clues to greater human potential and a better understanding of fuel metabolism in health and disease.

I can understand how exogenous ketones could be beneficial for someone who is metabolically healthy and consuming a disciplined hypo-caloric nutrient dense diet.  They would likely be able to auto regulate their appetite to easily offset the energy from the EXOGENOUS ketones with less food intake.

While it seems that EXOGENOUS ketones assist in relieving the symptoms of metabolic disorders I’m yet to be convinced that a someone who is obese and / or has Type 2 Diabetes would do as well in the long term, especially if they were hammering MOAR fat and MORE exogenous ketones (along with maybe some sneaky processed carbs on the side) in an effort to get their blood ketones as higher in the hope of losing body fat.

Some questions that I couldn’t find addressed in the Pruvit FAQ that I think would be interesting to study in a long term controlled environment in the in the future are:

  1. What is the a safe dose limit of EXOGENOUS ketones for a young child?  How would you adjust their maximum intake based on age and weight?
  2. IF EXOGENOUS ketones do have a long term weight loss effect what is the upper limit  of intake of EXOGENOUS ketones to avoid stunting a child’s growth?
  3. Is there a difference in the way EXOGENOUS ketones are processed in someone is metabolically healthy versus someone who is very insulin resistant?
  4. Does the affect on appetite continue beyond the point that the ketones are out of your system?
  5. Do you need to take EXOGENOUS ketones continuously to maintain appetite suppression?  Does the effect of ENDOGENOUS wear off as your own ENDOGENOUS ketone production down regulates?  Do you need to keep taking more and more EXOGENOUS ketones to maintain healthy appetite control?
  6. How should someone with Type 2 Diabetes adjust their medication and insulin dose based on their dose of EXOGENOUS ketones?  Should they be under medical supervision during this period?
  7. Is there a difference in health outcome if you are taking EXOGENOUS ketones in the context of a hypo-caloric ketogenic diet versus a hyper-caloric ketogenic diet?  What about a diet high in processed carbs?
  8. Is there a minimum effective dose to achieve optimal long term benefits to your metabolic health or is MORE better?
  9. Are the long term health benefits of EXOGENOUS ketones equivalent to a calorie restricted ketogenic diet?

Unfortunately, I think we will find the answers to these questions sooner rather than later with the large scale experiment that now seems to be well underway.

Perhaps the burden of proof is actually on Pruvit to prove it rather getting their Pruvers to demonstrate that within 59 minutes they are successfully peeing out the product they’ve just paid some serious money for!

The lower the better?

Alessandro Ferretti recently made the observation that metabolically healthy people tend to have lower TOTAL ENERGY levels at rest (and hence have a lower HbA1c), but are able to quickly mobilise glycogen and fat easily when required (e.g. when fasting or a sprint). They are metabolically flexible[25] and metabolically efficient.[26]   

These people would have been able to both conserve energy during a famine and run away from a tiger and live to become our ancestors, while the ones who couldn’t didn’t.

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Similar to RD Dikeman, John Halloran is an interesting case.  Recently he has been putting a lot of effort into eating nutrient dense foods, intermittent fasting and high intensity exercise.

image13

He is also committed to improving his metabolic fitness to be more competitive in ice hockey.  His resting heart rate is now a spectacular 45 bpm!

image08

And he’s been able to lose 10kg (22lb) during July 2016!

image12

At 5.2mmol/L (i.e. glucose of 4.0mmol/L plus ketones of 1.2mmol/L) John’s TOTAL ENERGY is lower than the average of the 26 people shown in the glucose + ketone chart above.  Looking good John!

It seems excellent metabolic health is actually characterised by lower TOTAL ENERGY.

MORE is not necessarily BETTER when it comes to health.

Fast well, feed well

To clean up the data a little I removed the ketones vs glucose data points for a couple of people who I thought might be suffering from pancreatic beta cell burnout and one person that was taking exogenous ketones during their fast that had a higher TOTAL ENERGY.  I also removed the top 30% of points that I thought were likely high due to measuring after high fat meals.

So now the chart below represents the glucose and ketone values for a group of reasonably metabolically healthy people following a strict ketogenic dietary approach, excluding for the effect of high fat meals, BPC, fat bombs and the like.

image22

The average ketone value for this group of healthy people trying to live a ketogenic lifestyle is 0.7mmol/L. Their average glucose is 4.8mmol/L (or 87mg/dL). The average TOTAL ENERGY is 5.5mmol/L or 99mg/dL.

ketones (mmol/L)

blood glucose (mmol/L)

total energy (mmol/L)

average

0.7

4.8

5.5

30th percentile

0.4

4.6

5.2

70th percentile

0.9

5.1

5.8

The table below shows this in US units (mg/dL).

ketones
(mmol/L)

blood
glucose (mg/dL)

total
energy (mg/dL)

average

0.7

86

99

30th percentile

0.4

83

94

70th percentile

0.9

92

104

It seems we may not necessarily see really high ketone levels in our blood even if we follow a strict ketogenic diet, particularly if we are metabolically healthy and our body is using to ketones efficiently.

The real ketone magic

When we deplete glucose we train our body to produce ketones.

This is where autophagy, increased NAD+ and SIRT1 kicks in to trigger mitochondrial biogenesis and ENDOGENOUS ketone production (i.e. the free ones).[27]   The REAL magic of ketosis happens when all these things happen and ketones are release as a byproduct.  I do not believe that simply adding EXOGENOUS ketones will have nearly as much benefit to your mitochondria, metabolism and insulin resistance as training your body to produce ENDOGENOUS ketones in a low energy state.

image33

Everything improves when we train our bodies to do more with less (e.g. fasting, high intensity exercise, or even better fasted HIIT).  Resistance to insulin will improve as your insulin receptors are no longer drowning in insulin caused by high TOTAL ENERGY building up in your bloodstream.

image01

Driving up ketones artificially through EXOGENOUS inputs (treating the symptom) does NOT lead to increased metabolic health and mitochondrial biogenesis (cure) particularly if you are driving them higher than normal levels and not using them up with activity.

You may be able to artificially mimic the buzz that you would get when the body produces ketones ENDOGENOUSLY, however it seems you may just be driving insulin resistance and hyperinsulinemia if you follow a “MORE is better” approach.

Simply managing symptoms with patented products for profit without addressing the underlying cause often doesn’t end well.

Just like having low blood glucose is not necessarily good if it is primarily caused by high levels of EXOGENOUS insulin couple with a poor diet, or having lower cholesterol due to statins, having high blood ketone values is not necessarily a good thing if it is achieved it by driving up the TOTAL ENERGY in your blood stream with high levels of purified fat and EXOGENOUS ketones.

Nutrient density

When we feed our body with quality nutrients we maximise ATP production which will make us feel energised and satisfied.  Nutrient dense foods will nourish our mitochondria and reduce our drive to keep on seeking out nutrients from more food.  Greater metabolic efficiency will lead to higher satiety, which leads to less food intake, which leads to a lower TOTAL ENERGY, greater mitochondrial biogenesis, improved insulin sensitivity and lower blood glucose levels.

Prioritising nutrient dense real food is even more important in a ketogenic context.[28]  While we can always take supplements, separating nutrients from our energy source is never a great idea, whether it be soda, processed grains, sugar, glucose gels, HFCS, protein powders, processed oils or exogenous ketones.

Based on my analysis of nutrient density I don’t think you should be trying to avoid protein and carbohydrates in the pursuit of higher ketone levels unless you have a legitimate medical reason for perusing therapeutic ketosis (e.g. cancer, Alzheimer’s, epilepsy, dementia etc).

image09

I believe the best approach is to maximise nutrient density as much as possible while working within the limits of your metabolic health and your pancreas’ ability to maintain normal blood glucose levels.

image14

Intermittent fasting

If your goal is metabolic health, weight loss and improving your ability to produce ENDOGENOUS ketones, then developing a practice of FEASTING and FASTING is important.

To start out, experiment by extending your fasting periods until your TOTAL ENERGY is decreasing over time.  This will cause your circulating insulin levels to decrease which will force your body to produce ENDOGENOUS ketones from your ENDOGENOUS fat stores.

image03

Check out the how to use your glucose meter as a fuel gauge article or Jason Fung’s Intensive Dietary Management blog for some more ideas on how to get started with fasting.   Rebecca Skvorc Latham has also developed a fasting protocol using weight to guide your eating schedule if your primary goal is weight loss rather than blood glucose control.

image24

If you really want to measure something, see how low you can get your glucose levels before your next meal.  Then when you do eat, make sure you choose the most nutrient dense foods you possibly can to build your metabolic machinery and give your mitochondria the best chance of supporting a vibrant, active and happy life.

As my wise friend Raymund Edwards keeps reminding me, FAST WELL, FEED WELL.

 

 

Epilogue

Like most people dabbling in this low carb thing, I’m still on a journey.

I’d love to be able to share shirtless photos like Ted and Dom but I’m still working to overcome my own genetic propensity for diabetes, obesity, Alzheimer’s and Parkinson’s.  I’m still learning and working out how to apply these things in my own life.

Although I do sometimes check blood glucose levels before meals to see how I’m tracking I haven’t been testing ketones much for a year or so after I realised chasing high ketones with more dietary fat wasn’t helping me lose weight.

However after writing this article using other peoples’ data, I was intrigued to see how my ketones were travelling.

This was mid-morning after a kettlebell session.

I was able to get my heart rate up to 190 bpm which is my highest ever!  My daughter joined me today so there was some downtime between sets.  Usually I do an exercise until my heart rate gets up to at least 170 bpm.  I then stop and wait until it drops back down to 140 bpm and then go again.

My aim is to train my mitochondria to pump out more power with less energy (i.e. fasted) to improve insulin sensitivity as well as mitochondrial efficiency and drive  mitochondrial bio-genesis.

You can get a lot of work done in an intense 25 to 30-minute session with these weapons of torture that I keep downstairs in my garage (although I don’t think it really matters what you do as long as you push your body to do more with less).

My appetite today was great so I didn’t feel the need to eat until I had dinner with my family.

Previously I would have not been happy with these ketone readings and would have wanted to drive my ketones higher to get into the ‘optimal ketone zone’.  I would have wondered “Maybe I should have eaten some MORE butter or had a BPC to drive ketones higher to facilitate fat loss?”

But given I’d still like to lose some more body fat I’m pretty happy with these numbers.

  • My total energy is low (4.5mmol/L and 5.1mmol/L).  Check.
  • Ketones are present but not too high which means I’m able to mobilise fat but not building it up in my bloodstream.  Check.
  • Blood glucose is low.  Check.

All good!  Feeling crisp, happy and vibrant thanks to ENDOGENOUS ketones!

(Sorry.   I can’t sell you mine.  You’ll have to make your own.)

 

references

[1] http://www.thefatemperor.com/blog/2015/5/6/the-incredible-dr-joseph-kraft-his-work-on-type-2-diabetes-insulin-reigns-disease

[2] http://www.thefatemperor.com/blog/2015/5/10/lchf-the-genius-of-dr-joseph-r-kraft-exposing-the-true-extent-of-diabetes

[3] https://profgrant.com/2013/08/16/joseph-kraft-why-hyperinsulinemia-matters/

[4] https://www.amazon.com/Diabetes-Epidemic-You-Joseph-Kraft/dp/1425168094

[5] https://www.youtube.com/watch?v=193BP6aORwY

[6] http://fourhourworkweek.com/2016/07/06/dom-dagostino-part-2/

[7] http://www.thelivinlowcarbshow.com/shownotes/10568/848-dr-dominic-dagostino-keto-clarity-expert-interview/

[8] http://superhumanradio.com/579-shr-exclusive-patrick-arnold-back-in-the-supplement-business.html

[9] http://superhumanradio.com/shr-1330-best-practices-for-using-ketone-salts-for-dieting-performance-and-therapeutic-purposes.html

[10] http://docmuscles.shopketo.com/

[11] https://www.facebook.com/groups/optimisingnutrition/permalink/1574631349504574/

[12] https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-016-0069-y

[13] https://www.facebook.com/groups/optimisingnutrition/permalink/1574631349504574/

[14] https://www.dropbox.com/s/287bftreipfpf29/jcinvest00459-0078.pdf?dl=0

[15] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2129159/

[16] https://www.facebook.com/BurnFatNotSugar/

[17] http://www.dietdoctor.com/obesity-caused-much-insulin

[18] http://www.lowcarbcruiseinfo.com/2016/2016-presentations/Hyperinsulinemia.pptx

[19] http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0115147

[20] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1819381/

[21] http://healthimpactnews.com/2013/ketogenic-diet-in-combination-with-calorie-restriction-and-hyperbaric-treatment-offer-new-hope-in-quest-for-non-toxic-cancer-treatment/

[22] https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjK8Jvku7DOAhUJspQKHS5-DkwQFggbMAA&url=http%3A%2F%2Fwww.rsg1foundation.com%2Fdocs%2Fpatient-resources%2FThe%2520Restricted%2520Ketogenic%2520Diet%2520An%2520Alternative.pdf&usg=AFQjCNFuTA7xmWX1pFr6wBTV_hsS7C5j_w&sig2=pcBN_f_kCLSgFKYUy–uug&bvm=bv.129391328,d.dGo

[23] https://www.facebook.com/DocMuscles/videos/10210426555960535/?comment_id=10210431467003308&comment_tracking=%7B%22tn%22%3A%22R9%22%7D&pnref=story&hc_location=ufi

[24] https://www.facebook.com/DocMuscles/videos/10210426555960535/?comment_id=10210431467003308&comment_tracking=%7B%22tn%22%3A%22R4%22%7D&hc_location=ufi

[25] http://guruperformance.com/episode-3-metabolic-flexibility-with-mike-t-nelson-phd/

[26] http://guruperformance.com/tag/metabolic-efficiency/

[27] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852209/

[28] http://ketotalk.com/2016/06/23-responding-to-the-paleo-mom-dr-sarah-ballantynes-claims-against-the-ketogenic-diet/

breakfast of champions

My Facebook feed has been flooded lately with stories about Tour de France cyclists going low carb.[1]

image05[1]

Or is it high protein?[2]

image10[1]

Whatever is going on, it seems helps them run well too![3]

image09[1]

While I’m not sure you can say that these elite cyclists have eschewed all carbohydrate-containing foods,  the trend away from processed carbs to whole foods is intriguing.

So if they’re going low carb does it mean they’re now butter, cream, MCT oil after starting the day with BPC?

Dr. James Morton, head of nutrition at Team Sky and an associate professor in the Faculty of Science at Liverpool John Moores University explains:[4] [5] [6] [7] [8]

We promote a natural approach to food.  Our riders eat food that grows in the ground or on a tree and protein from natural sources.

They need energy, but they also have to stay lean and healthy with a strong immune system. A natural diet is the best way to achieve this.

Fat is important for everything from energy release and muscle health to immunity, but by eating the right food the fat takes care of itself.  The riders eat eggs, milk, Greek yogurt, nuts, olive oil, avocados and some red meat for a natural mix of saturated and unsaturated fats.”

To achieve optimal weight Dr Morton asks the riders to “periodise” their carb intake by eating more when they train hard and cutting back when they’re less active.

They routinely train in the morning after eating a protein-rich omelette, instead of carbohydrate-dense bread, to encourage their bodies to burn fat for fuel.[9]

image03[1]

So how does low carb real food thing work?

According to Dr Terry Wahls it seems that nutrient density is a key part of maximising energy output.

To produce ATP efficiently, the mitochondria need particular things.  Glucose or ketone bodies from fat and oxygen are primary.  

Your mitochondria can limp along, producing a few ATP on only these three things, but to really do the job right and produce the most ATP, your mitochondria also need thiamine (vitamin B1), riboflavin (vitamin B2), niacinamide (vitamin B3), pantothenic acid (vitamin B5), minerals (especially sulfur, zinc, magnesium, iron and manganese) and antioxidants.  Mitochondria also need plenty of L-carnitine, alpha-lipoic acid, creatine, and ubiquinone (also called coenzyme Q) for peak efficiency.  

If you don’t get all these nutrients or if you are exposed to too many toxins, your ATP production will become less efficient, which leads to two problems:

Your body will produce less energy so they may not be able to do everything they need to do.

Your cells will generate more waste than necessary in the form of free radicals.

Without the right nutrient sources to fuel the ATP production in the mitochondria – which in turn produce energy for the cellular processes required to sustain life – your mitochondria can become starved.  The cells then can’t do their job as effectively.[10] 

So let’s look at the macro and micronutrient analysis of Chris Froome’s “rest day breakfast” (pictured above).   The analysis indicates that it does very well in both the vitamins and minerals score as well as the amino acids score.

image12[1]

If we throw in some spinach Froomey would improve the vitamin and mineral score of his breakfast even further.  The addition of spinach increases the nutrient balance score from 57 to 77 while the amino acid score stays high.

image14[1]

Froome’s wife says eating more protein has been one of the keys to losing weight and building muscle leading up to the tour.[11]  Getting a quarter of your calories from protein is more than the 16% most people consume, however with 65% of the energy coming from fat you could also call this meal low carb, high fat, or even “ketogenic” depending on which camp you’re in.

image01[1]

This simple but effective meal would be a pretty good option for just about anyone.  Froome’s breakfast ranks well regardless of your goals.  Based on the ranking system of meals for different goals it comes in at:

  • #10 (with spinach) and #31 (without spinach) out of 245 meals analysed for the low carb diabetes ranking,
  • #18 and 52 on the therapeutic ketosis ranking, and
  • #26 and 64 on the overall nutrient density ranking.

image00[1]

It seems it’s not just the low carbers, “ketonians”[12] and people battling diabetes who are training their bodies to burn fat more efficiently.  Maximising your ability to burn fat is critical even if you are extremely metabolically healthy.

The chart below shows comparison of the fat oxidation rate of well trained athletes (WT) versus recreationally (RT) athletes (who are not necessarily following a low carb diet).[13]  The well trained athletes are clearly oxidising more fat, which enables them to put out a lot more power (measured in terms of their VO2max).   It seems that you ability to efficiently burn fat for fuel it a key component of what sets the elite apart from the amateurs whether you call yourself vegan, ketogenic or a fruitarian.[14]

image07[1]

While carbohydrates help to produce maximal explosive power, it seems that the glucose turbocharger works best when it sits on a big power fat fueled motor.  According to Peter Defty (who spent the last couple of years helping 2016 Tour de France second place getter Romain Bardet refine his ability as a fat adapted athlete using his Optimised Fat Metabolism protocol), fat can yield more energy more efficiently with less oxidative stress which requires less recovery time.[15]

Dr Morton also understand the importance of keeping carbohydrates low to maximise mitochondrial biogenesis and to access fat stores.  If you want to learn more about his thinking on the use of diet to drive mitochondrial biogenesis you might be interested in checking out his array of published papers on the topic.[16] [17] [18] [19] [20] [21] [22]   On the topic of carbohydrate intake Morton says:

Amateur riders are taught the importance of carbohydrates for training and racing, perhaps too much actually.

From our research at Liverpool John Moores University, we now know that deliberately restricting carbs around carefully chosen training sessions can actually enhance training adaptations.

But then of course we must ensure higher carbohydrate intakes for key training sessions and hard stages in racing.

I believe this concept of periodising daily carbohydrate intake is the most exciting part of sports nutrition in the last decade and our challenge now is to address how best we do this practically.

Essentially, exercising your mitochondria in a low insulin and low glucose state forces your body to adapt to using fat for fuel and to use glucose and oxygen efficiently and effectively.[23] [24]

image06[1]

Not only is this useful for endurance athletes and people battling diabetes, training your body to use fat and oxygen more effectively is also claimed to be important to minimise anaerobic fermentation which is said to increase your risk of cancer.[25] [26] [27]

Many of us struggle trying to cope in an environment of excess energy from low nutrient density highly insulinogenic food.  If we can’t obtain the necessary nutrients from our food to efficiently produce energy our bodies seek out more and more food in the hope of finding the required nutrients and enough energy to feel OK.

image13[1]

Our bodies do their best to use the energy that we give them, but they are working overtime to pump out insulin to store the excess energy that is not used.  Over time our bodies adapt by becoming resistant to insulin in order to stop the excess energy being stored in our liver, pancreas and eyes when our fat stores on our muscles and belly can’t take any more.[28]  Then to overcome the insulin resistance the body has to pump out more insulin which makes even less of the energy we eat available for use.

image04[1]

When we call on our mitochondria to produce intensive bursts of energy with minimal fuel (i.e. fasting) or glucose (i.e. low carb) we force our bodies to more efficiently the limited carbohydrate.  Suddenly our bodies become insulin sensitive.

Recent studies indicate that people who are fat adapted are able to mobilise higher rates of fat at higher excercise intensities.[29]

image08[2]

With a higher reliance on fat they are able to conserve the precious glucose for explosive efforts.

image02[1]

Then, when they really need the power they have both fuel tanks available to cross the  line first… and second!

image11[1]

 

references

[1] http://realmealrevolution.com/real-thinking/great-news-for-lchf-first-and-second-place-riders-of-the-tour-de-france-are

[2] http://www.businessinsider.com.au/chris-froome-weight-loss-tour-de-france-2016-7?r=US&IR=T

[3] https://www.youtube.com/watch?v=UPqxUA70ulo

[4] http://www.telegraph.co.uk/men/recreational-cycling/how-to-eat-like-a-tour-de-france-cyclist/

[5] http://www.teamsky.com/teamsky/home/article/68342#CpWWiwr2TyE0EA2P.97

[6] https://www.ljmu.ac.uk/about-us/staff-profiles/faculty-of-science/sport-and-exercise-sciences/james-morton

[7] http://www.ncbi.nlm.nih.gov/pubmed/23364526

[8] http://www.ncbi.nlm.nih.gov/pubmed/23263742

[9] http://realmealrevolution.com/real-thinking/great-news-for-lchf-first-and-second-place-riders-of-the-tour-de-france-are

[10] https://www.amazon.com/Wahls-Protocol-Autoimmune-Conditions-Principles/dp/1583335544

[11]

[12] http://ketotalk.com/2016/04/19-inflammatory-keto-foods-build-muscle-on-moderate-protein-baby-boomer-ketonians/

[13] http://m.bmjopensem.bmj.com/content/1/1/e000047.full

[14] http://www.30bananasaday.com/profile/durianrider

[15] http://www.vespapower.com/mighty-mitochondria/

[16] https://www.ljmu.ac.uk/about-us/staff-profiles/faculty-of-science/sport-and-exercise-sciences/james-morton

[17] http://ajpregu.physiology.org/content/304/6/R450

[18] http://www.ncbi.nlm.nih.gov/pubmed/23263742

[19] http://www.ncbi.nlm.nih.gov/pubmed/19265068

[20] http://journals.lww.com/acsm-msse/pages/articleviewer.aspx?year=9000&issue=00000&article=97464&type=abstract

[21] http://www.sciencedirect.com/science/article/pii/S0891584916000307

[22] http://www.tandfonline.com/doi/abs/10.1080/17461391.2014.920926

[23] https://www.fightaging.org/archives/2011/04/calorie-restriction-increases-mitochondrial-biogenesis/

[24] http://www.marksdailyapple.com/managing-your-mitochondria/#axzz4G2D39DgB

[25] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4493566/

[26] https://www.amazon.com/Tripping-Over-Truth-Metabolic-Illuminates/dp/1500600318

[27] https://www.youtube.com/watch?v=PuG5XZSR4vs

[28] http://www.ncbi.nlm.nih.gov/pubmed/25515001

[29] http://www.vespapower.com/the-emerging-science-on-fat-adaptation/

the avoid list… the most insulinogenic low nutrient density foods

Over the last year I have used the  food ranking system to identify a range of foods to suit different goals, including:

Even the list of insulinogenic but nutrient dense foods didn’t look that scary for targeted use by someone who is metabolically healthy.

It can be more useful to tell people what they need to focus on rather than what they shouldn’t do.  It’s like the proverbial hot plate or ‘wet paint’ sign.  You can’t unsee it and you just want to touch it!

If you are busy focusing on the good stuff then you just won’t have any space left for the bad stuff, especially once you start feeling the benefits.

But when it comes down to it, what are the foods that everyone should avoid?

what’s so bad about sugar anyway?

For the past four decades mainstream food recommendations have been dominated by a fear of fat, particularly saturated fat and cholesterol, which if taken to the extreme can lead us to avoid nutrient dense foods and towards insuilnogenic nutrient poor processed low fat foods.

More recently, a growing number of people are advising that we should eat less sugar, from Sarah Wilson’s I Quit Sugar, to Robert Lustig’s Sugar: The Bitter Truth and Damon Gameau’s That Sugar Film.  Gary Taubes seems to be softening his stance against carbohydrates in general and is about to release his new book The Case against Sugar.

The World Health Organisation are imploring people to reduce their sugar intake.[1]   Investment bank Credit Suisse is predicting a turn away from sugar and and back towards fat, effectively advising people to ‘short sugar’.[2]

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But what is it about sugar that makes it uniquely bad?  It just the ‘evaporated cane juice’ that we should avoid?  What about whole foods than contain some sugar, should we avoid them too?

While added sugars are not good, they’re also an easy target that everyone can get behind.  It’s easy to swing from demonising one thing to another, from fat to carbs, to sugar.

I think we need to avoid are foods that quickly boost our insulin and blood glucose levels without providing any substantial nutrition in return.

Foods that should be considered universally bad are foods that are:

  • highly insulinogenic,
  • have a low nutrient density,
  • have a high energy density, and
  • have negligible fibre.

If you want to maximise the nutritional value of your food, give your pancreas a break so it can keep up, you should AVOID THESE FOODS.

Included in the tables below are:

  • Nutrient density (ND) is a relative score based on nutrients per calorie (zero is average, less than zero is worse than average).
  • Percentage of insulinogenic calories is the proportion of the energy that will require insulin to metabolise.
  • Net carbs is the amount of non-fibre carbohydrate per 100g of food.
  • Energy density is the amount of calories per 100g of food.

The ranking of these foods is based on a multi criteria scoring process using all of these factors.  I hav taken the ranking criteria for foods to help people manage their diabetes and blood glucose levels and reveresed it.

Without further ado, here is the avoid list.

drinks

Soft drinks provide very little nutritional value, are very insulinogenic and have no fibre so will raise your blood sugar and insulin levels quickly.

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food ND % insulinogenic net carbs / 100g calories / 100g
creaming soda -0.30 100% 13.3 53
ginger ale -0.50 100% 8.8 35
cola -0.40 100% 10.6 42
Gatorade -0.71 100% 6.4 26
root beer -0.40 100% 10.6 42
sweetened iced tea -0.44 100% 9.8 39
energy drink -0.24 100% 13.0 52
Powerade -0.54 99% 7.8 32
orange juice -0.24 99% 13.3 54

sweets

Sweets provide minimal nutrition while being very energy dense and highly insulinogenic.  Sugar tops the list of badness, however there are a bunch of other sweets not far behind.

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food ND % insulinogenic net carbs / 100g calories / 100g
sugar 0.05 100% 100 400
candies 0.05 100% 99 394
HFCS 0.04 100% 76 304
marshmallows 0.05 99% 81 334
maple syrup 0.09 99% 91 366
molasses 0.15 100% 75 300
jams and preserves 0.05 97% 67 278
honey 0.16 100% 82 331

fruits and fruit juices

Fruit in its natural state provides fibre, nutrients with a lower energy density.  However fruit juice and dried fruit has a much lower nutritional value and is much more insulinogenic.

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food ND % insulinogenic net carbs / 100g calories / 100g
mango nectar -0.18 98% 13.0 53
apple juice -0.20 95% 11.1 47
canned peaches -0.13 93% 17.6 77
grape juice -0.06 92% 14.0 62
blueberry syrup -0.05 92% 21.2 94
currants -0.21 83% 12.2 63

breakfast cereals

Commercial breakfast cereals are not a good way to start the day.

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food ND % insulinogenic net carbs / 100g calories / 100g
rice krispies 0.06 97% 87.9 383
frosted flakes 0.06 96% 85.8 375
corn flakes 0.07 97% 85.9 375
puffed wheat 0.07 94% 78.9 388
honey smacks 0.07 93% 87.5 398
grape nuts 0.07 91% 78.8 387
Wheaties 0.07 92% 80.3 384
puffed millet 0.07 90% 79.6 403
honey nut shredded wheat 0.08 90% 82.0 394
cocoa pebbles 0.07 88% 85.4 400
fruity pebbles 0.05 87% 84.1 398
froot loops 0.09 89% 83.9 397
raisin bran 0.08 89% 72.0 345

grains and pasta

Processed grains are cheap and have a long shelf life, however the processing removes most of the fibre and most of the nutrients which means they are highly insulinogenic and energy dense.

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food ND % insulinogenic net carbs / 100g calories / 100g
corn-starch 0.05 97% 88.7 367
rice flour 0.05 88% 75.3 360
macaroni 0.03 95% 31.7 161
white flour 0.08 95% 77.3 358
corn meal 0.08 92% 73.5 348
wheat flour 0.07 88% 70.7 353
rye flour 0.07 84% 68.9 359
spaghetti 0.05 90% 30.1 155

baked products

Similar to grains and pasta, processed baked products can be low in nutritional value, energy dense and highly insulinogenic.

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food ND % insulinogenic net carbs / 100g calories / 100g
snackwells 0.06 95% 73.7 327
crackers 0.06 94% 78.6 368
ice cream cones 0.06 89% 83.1 402
bagels 0.04 90% 52.1 270
muffins 0.04 89% 47.0 240
bread 0.04 85% 49.1 267

 

references

[1] http://www.who.int/mediacentre/news/releases/2015/sugar-guideline/en/

[2] https://www.credit-suisse.com/us/en/articles/articles/news-and-expertise/2013/09/en/is-sugar-turning-the-economy-sour.html

Jimmy Moore’s keto eggs

During his yearlong n=1 ketosis experiment Jimmy Moore in 2012 didn’t give too much away about exactly what he was eating which made me a little frustrated but inquisitive.  

What was he doing to keep his blood glucose consistently low and ketones high?  Could this help me lose some weight or perhaps my type 1 diabetic wife normalise her blood glucose levels

Jimmy did  publish a list of healthy high fat foods (i.e. avocados, butter, whole eggs, coconut oil, bacon, sour cream, 70% ground beef, full fat cheddar cheese and coconut) on the Carb Smart blog but he didn’t give away much more detail.

I suppose it’s part of what drove me to dig into the food insulin index to create a ranking of all foods.

One meal he did blog as one of his favourites was his “keto eggs” which he included in Keto Clarity and on his blog here.  He says it helps him “rock the ketones”.  This was often his meal for the day with intermittent fasting.  The recipe is shown below:

  • 4-5 pastured eggs
  • 2-3 oz grass-fed butter and/or coconut oil
  • sea salt
  • parsley (or your favorite spice)
  • 2 oz full-fat cheese (optional)
  • 2 Tbs Sweet Chili Sauce
  • 3 Tbs sour cream
  • 1 whole avocado

The nutritional analysis for the recipe below shows that it’s certainly ketogenic with 83% fat, 13% protein and 4% carbs.  This recipe provides a solid protein score though the vitamins and minerals aren’t as high as some of the other meals.  However if your primary aim is therapeutic ketosis then this meal will likely be great for you.

2016-07-18 (2)

The ranking for the keto eggs recipe, compared to the 241 other meals that have been analysed so far,  for each of the approaches is:

  • therapeutic ketosis – 18 / 242
  • diabetes – 54 / 242
  • weight loss – 175 / 242
  • nutrient dense (maintenance)  – 159 / 242

net carbs

insulin load carb insulin fat protein

fibre

6g 31g 21% 83% 13%

3g

the most insulinogenic nutrient dense foods

  • As well as identifying nutrient dense diabetic friendly foods we can also use the food insulin index to highlight insulinogenic nutrient dense foods for targeted use by athletes.
  • This article highlights more insulinogenic nutrient dense foods that can be used by metabolically healthy people to strategically “carb up” before events or to intentionally trigger insulin spikes (e.g. Carb Back-Loading, Alt Shift Diet or the targeted ketogenic diet).

insulin load, a refresher

Many people with diabetes will try to reduce the insulin load of their diet to normalise blood glucose levels.  It’s the non-fibre carbohydrates, and to a lesser extent protein, that drive insulin and blood glucose, particularly for someone who is insulin resistant.

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Managing the insulin load of your diet is an effective way to get off the blood glucose roller coaster and stabilise your blood glucose levels.

We can calculate the insulin load of our diet based on the carbohydrates, fibre and protein using the formula shown below.

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We can also calculate the percentage of insulinogenic calories to identify the foods that will affect our blood glucose levels the least, or the most.

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why would you want to spike your glucose levels?

Much of the nutrition and diabetes world is focused on helping people who are struggling with insulin resistance and trying to normalise blood glucose.  However, there are others who are blessed to be metabolically healthy who may want to strategically refill their glycogen tanks or spike insulin.

  • Some follow a targeted ketogenic diet and strategically replenish glucose around workouts by eating higher carbohydrate foods.
  • Some bodybuilders use a cyclical ketogenic diet where they deplete glucose and then replenish glucose periodically.
  • Some fat adapted endurance athletes will look to ‘carb up’ before an event so that they have both glucose and fat based fuel sources (a.k.a. train low, race high).

  • Others find success with dietary approaches such as the AltShift Diet, Carb Back-Loading which alternating periods of extreme high and low carb dietary approaches (not always with the most nutritious high carb foods).

the mission…

Recently Dr Tommy Wood approached me to design a high insulin load and a low insulin load diet regimen that he could try for a month of each to see how his body responded.  The constraint was that both the high and low insulin food selections would be nutrient dense whole foods so as to be a fair comparison of the effect of insulin load.  The idea was to also find someone who is more insulin resistant and less metabolically fortunate to see how they fair on one month of each of the approaches.

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Tommy generally eats fairly low carb nutrient dense foods, however I think he would still do pretty well on a higher insulin load nutrient dense approach.  My hypothesis is that someone who is insulin resistant would do better on a lower insulin load nutrient dense approach than the high insulin load nutrient dense foods that would enable them to normalise their blood glucose levels.   Maybe one day we’ll get to run the experiment and see.

It was an interesting test for the food ranking system, which was designed to help people with diabetes manage blood glucose levels by minimising insulin load, to identify nutrient dense foods that would intentionally raise insulin and blood glucose while at the same time maximising nutrient density.

While these foods might not be ideal for someone with diabetes, they actually look like a pretty healthy list of foods compared to the “food like products” that you’d find in the isles of the supermarket.

The table below shows a comparison of the highest ranking foods two ranking approaches.  Both lists of food have a similar amount of fibre and protein, it’s just the fat and carbs that are reversed.

goal fibre (g)  % protein % net carbs % fat % insulinogenic
low insulin load 27 23% 7% 64% 20%
high insulin load 24 23% 64% 9% 77%
average all foods 26 26% 38% 31% 53%

This list is sorted by both nutrient density (i.e. nutrients per calorie) and the proportion of insulinogenic calories using a multi criteria analysis.  Only the foods that have a nutrient density score of greater than zero have been included.

Also shown are the insulin load and energy density per 100g.  An athlete looking to refuel quickly would chose more energy dense foods while someone looking to lose weight would chose nutrient dense foods with a lower energy density.

 

most insulinogenic nutrient dense foods

vegetables

food ND % insulinogenic insulin load (g/100g) calories/100g
celery 1.10 48% 2 17
winter squash 0.49 68% 7 39
broccoli 0.47 54% 6 42
summer squash 0.45 47% 2 19
okra 0.39 64% 6 37
seaweed (kelp) 0.29 77% 10 50
radishes 0.34 49% 2 19
kale 0.26 74% 10 56
bell peppers 0.26 72% 8 43
artichokes 0.31 47% 6 54
parsnip 0.25 68% 13 76
turnip greens 0.30 45% 4 37
snap green beans 0.26 61% 6 40
peas 0.23 57% 7 51
jalapeno peppers 0.23 54% 5 35
rhubarb 0.22 57% 3 21
onions 0.16 77% 8 41
sweet corn 0.14 77% 21 111
cabbage 0.20 49% 4 30
cucumber 0.14 74% 3 18
mung beans 0.12 77% 5 26
collards 0.17 50% 5 40
sweet potato 0.08 84% 18 87
white mushrooms 0.15 51% 4 34
lettuce 0.13 54% 2 17
asparagus 0.14 48% 3 27
pinto beans 0.09 61% 22 142
eggplant (cooked) 0.08 67% 7 41
bamboo shoots 0.06 69% 5 28
Chinese cabbage 0.11 49% 2 17
potato 0.01 89% 21 95
cassava 0.01 89% 36 160
mustard greens 0.08 50% 4 30
beets 0.02 74% 9 48
banana pepper 0.08 47% 5 39
Brussels sprouts 0.06 54% 7 52
carrots 0.04 50% 5 39

animal products

7450703_orig

food ND % insulinogenic insulin load (g/100g) calories/100g
beef liver 0.13 58% 24 169
chicken liver 0.11 48% 20 165
turkey breast 0.05 70% 22 127
ham 0.06 55% 20 146
veal (leg) 0.06 56% 25 174
pork 0.06 54% 21 154
chuck steak 0.06 50% 25 197
chicken breast 0.04 56% 25 178
turkey heart 0.05 39% 13 130
veal (sirloin) 0.04 38% 19 195

seafood

food ND % insulinogenic insulin load (g/100g) calories/100g
oyster 0.16 57% 14 98
lobster 0.13 69% 14 84
pollock 0.12 66% 17 105
tuna 0.15 50% 17 137
crab 0.11 69% 13 78
whitefish 0.10 67% 17 102
snapper 0.11 64% 15 94
shrimp 0.10 66% 19 113
abalone 0.08 76% 19 99
mackerel 0.14 45% 17 149
octopus 0.08 69% 27 156
anchovy 0.14 42% 21 203
trout 0.13 43% 17 162
salmon 0.11 50% 15 122
haddock 0.08 67% 18 110
swordfish 0.12 41% 17 165
halibut 0.08 63% 16 105
mussel 0.08 61% 25 165
clam 0.06 71% 24 135
whiting 0.08 63% 17 109
crayfish 0.08 64% 12 78
haddock 0.06 69% 15 85
caviar 0.13 32% 22 276
cod 0.05 67% 17 99
herring 0.12 34% 18 210
perch 0.06 59% 13 91
sturgeon 0.07 47% 15 129
sardine 0.09 36% 18 202

fruits

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food ND % insulinogenic insulin load (g/100g) calories/100g
cherries 0.29 79% 11 54
grapes 0.14 92% 18 77
apples 0.15 87% 12 53
honeydew melon 0.10 88% 9 40
figs 0.09 82% 17 82
raisins 0.04 92% 77 336
mandarin oranges 0.07 82% 12 59
oranges 0.06 79% 11 55
dates 0.02 90% 69 308
litchis 0.03 82% 15 73
pear 0.03 78% 13 64
blueberries 0.01 88% 20 91
watermelon 0.00 88% 7 34
passion fruit 0.07 52% 14 109

legumes

food ND % insulinogenic insulin load (g/100g) calories/100g
lima beans 0.15 68% 22 129
navy beans 0.12 57% 20 143
lentils 0.11 63% 18 118
kidney beans 0.01 87% 58 266

bread and pasta

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food ND % insulinogenic insulin load (g/100g) calories/100g
oatmeal 0.26 77% 13 67
teff 0.25 80% 20 101
spelt 0.19 79% 27 135
oat bran 0.11 72% 48 264
quinoa 0.10 70% 21 120
wheat bran 0.07 79% 51 257
rye bread 0.06 78% 55 282
millet 0.05 83% 24 118
spaghetti 0.01 94% 87 371
brown rice 0.03 83% 23 111

 

what about my cheesecake?

toffee-chocolate-cheesecake

The table below shows foods popularly used to ‘carb up’, ‘bulk’ or ‘refuel’ which didn’t make the list due to their lower nutrient density score.

food ND % insulinogenic insulin load (g/100g) calories/100g
Powerade -0.36 68% 5 32
cola -0.28 57% 6 42
doughnuts -0.01 47% 53 452
cheesecake -0.04 36% 29 327

Regardless of their macro nutrient split, it seems nutrient dense foods are typically unprocessed and don’t have a have spectacularly high  energy density or insulin load which makes it harder to overdo real whole foods found in nature.

 

Dr Rhonda Patrick’s Ultimate Micronutrient Smoothie versus Zero Carb Gregg

I recently ran the numbers on Dr Rhonda Patrick’s Ultimate Micronutrient Smoothie that she says she and her husband have this for breakfast every day.   

I’ve been enjoying Rhonda’s podcasts as well as her mentor Bruce Ames’ great work on nutrient density.   I was pretty hopeful that Rhonda’s daily breakfast would knock it out of the park.  

So far I’ve run 235 meals though a system that ranks meals in terms of nutrient density, protein score, energy density, fibre and insulin load.  A score of 100 in the Nutrition Data analysis means that you would achieve all your daily requirements with 1000 calories (notwithstanding the limitations of bio-availability, anti-nutrients, fat soluble vitamins etc etc etc).  

So here is how Dr Rhonda’s morning smoothie scores in the nutritional analysis.  

rhonda's smoothie

In terms of vitamins and minerals it did pretty well ranking at number 40 of 235 meals analysed to date. Liberal doses of kale and spinach always tend to boost the vitamin and mineral score.  These green leafies contain heaps of vitamins A, C, K, B and folate as well as solid amounts of the minerals magnesium, phosphorus, copper and manganese.   

If you’re interested, the meal that ranks the highest in terms of vitamins and minerals score is Terry Wahls’ lamb skillet meal.  While you might think that a vegetarian meal might win in the vitamins and minerals category, Dr Wahls’ combination of broccoli, garlic, and spinach along with lamb and coconut oil actually does even better with a score of 94 compared to the green smoothie which has a score of 75.   

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The good thing about blending everything into a smoothie though is that you will be able to get more green leafy veggies down the hatch.  The downside is that you might lose a little bit of the effect of the fibre.  The same thing can be said for cooking.  

In terms of amino acids though, the micro-nutrient smoothie was a bit disappointing coming in at 196 of 235. Some people will argue that low protein isn’t a big deal and that 9% protein is adequate.  Others think protein is really important. 

The answer for you probably depends on whether you want to be really big and strong or whether you have some muscle that you don’t mind donating in the name of nutrition and weight loss.  

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The 57g of fibre was pretty good from all those leafy greens, ranking at 75 of 235 in terms of fibre. Energy density was also pretty good ranking at 100 of 235 meaning that the smoothie will be quite filling and not easy to binge on.   

The insulin load was where things got a bit disappointing.  At 50% carbs the smoothie mixture came in just above the porridge with blueberries.  This may not be a problem if you’re insulin sensitive but I think people who are struggling with diabetes might suffer a bit with the apple and banana which don’t add a lot in terms of nutrient density (other than sweetness and palatability).  Maybe drinking fruit is not such a great idea?  

Minus the apple and banana

Just for interest I dropped out the apple and banana and the ranking improved in terms of vitamins and minerals, though it didn’t change the protein score.   The insulin load ranking improved marginally from 228 of 235 to 206 of 235.  

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Overall, this may not be a bad option for breakfast if you’re not diabetic and get some additional protein later in the day, especially if you’re looking to maintain / build lean muscle.

And now for something completely different… zero carb Gregg

After releasing the ketogenic fibre article a while back in October 2015 I got into a discussion about zero carb and ended up running the numbers on Gregg’s typical daily diet which largely consists of meat, butter and cream.

Not surprisingly the protein score of Gregg’s daily diet is high though the vitamin and mineral scores are not so great (214 of 235).

The insulin load of Gregg’s typical daily diet is pretty good coming in at #50. 

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[Just for interest Bulletproof Coffee comes in at #1 on the insulin ranking but comes in last on the vitamins and minerals and second last on the protein.]

Many people find that they do really well with a zero carb approach, particularly if they have had major digestive issues.  People who are fans of zero carb often speak highly of Fibre Menace by Kanstantin Monastrysky.  It seems that people with major digestive issues can get much needed relief from their inability to digest FODMAPS using a zero carb approach.  

Overall I’m a fan of fibre and wonder if people might benefit from the slow reintroduction of some fibre for the sake of their digestion and well rounded nutrition once their gut has settled.  

It’s also it’s interesting that the the protein level is only 22% in the zero carbohydrate (with 76% calories from fat) because of the solid amount of fat from the beef and the added fat from the butter and cream.  You can see how this might work really well for people who are insulin resistant.  

Can you get enough vitamins and minerals from a zero carb diet?

Lots of people who use a zero carb approach say that they can get all the vitamins and minerals they could even need from animal products, so I threw in some sardines and liver to see how high we could get the vitamins and minerals score without any green stuff.  

As you can see below, the protein score improves with the fish and liver (I’m not vouching for the palatability though).  This meal now ranks at #1 for protein score with a massive score of 159 on the amino acid score!  The vitamins and minerals take a significant jump to #142 of 235.

So it seems that there are some benefits of a zero carb dietary approach, but perhaps still some limitations when it comes to the vitamin and mineral side of the equation.  

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Combining forces

But then I thought, “what if Rhonda made Gregg breakfast and Gregg made dinner for Rhonda?”

As you can see from the analysis below combining the green smoothie (no fruit) with the zero carb approach (with sardines and liver) went really well in both the vitamins and minerals ranking (#20) and amino acid score (#41).  Not a bad balance overall!  

On the weight loss ranking this meal combination would come in at #26 of 235, on the athlete ranking it comes in at #10, on the diabetes and nutritional ketosis ranking it comes in at #23, and for therapeutic ketosis ranking it comes in at #67.  

Overall, not a bad balance of the extremes?

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What to make of all this?

Lots of people get hung up on a particular magic nutrient and spend a lot of money to supplement just that one missing ingredient.  However perhaps it would be optimal (and cheaper?) to get a high quantity of a broad range of nutrients from natural sources.

Real foods that were recently alive are going to be a better bet than relying on supplements as there are probably a bunch of other things that are good for us that we haven’t isolated and quantified yet.  

Should you eat more plant foods, more protein, or more fat?  

The answer will depend on your situation, your goals and your preferences.

As always, optimal lies somewhere between the extremes.  

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Further reading

what about saturated fat?

  • The topic of saturated fat continues to be contentious.
  • While most people agree these days that minimising sugar and processed carbohydrates is a good, thing many still struggle with the idea of eating fat, particularly saturated fat.  At the other extreme there are some people who have heard the message to ‘not fear the fat’ loud and clear and seem to be making up for lost time by eating copious amounts of processed fat.
  • This article looks at what happens to nutrient density when we swing to the extremes of either very low or very high levels of saturated fat intake in our diet.  As per usual, optimal lies somewhere between the extremes.
  • If we focus on nutrient dense whole foods issues like dietary saturated fat and cholesterol tend to look after themselves.

saturated fat in various food approaches

There are plenty of different views on fat and saturated fat and very little agreement between the extremes.

If you spend much time trying to research the issue you will likely come away confused after trying to understand the implications of the epidemiological and rodent studies.

People are also very passionate on both sides of this argument.  It can be hard to know which guru to believe.

Is saturated fat the greatest dietary villain or saviour leading us from the wilderness of the low fat dark ages?

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You may be aware that the USDA Dietary Advisory Committee recently changed position on dietary cholesterol and removed their upper limit on fat.[1]  They did however retain their recommended upper limit on saturated fat (10% in the USA and 11% in the UK).

As noted by Dr Frank Hu in the video below, the upper limit is not based on any specific research that higher levels of saturated fat are dangerous, but rather the fact that what they consider to be healthy diets (e.g. Mediterranean, Ornish etc) were within these upper limits.

Over the last four decades massive industries have developed around the concept of lowering cholesterol in your blood through diet or drugs in order to reduce your risk of heart disease, so there is going to be a high degree of inertia that will make any change in thinking happen slowly at best.

With all the concern and confusion about saturated fat I thought it would be interesting to check the saturated fat content of the highest ranking foods identified by the food ranking system to see how they compare with the upper limits.

The table below shows that none of the food lists exceed the recommended upper limit for saturated fatty acids.  Even the diabetic friendly low insulin load approach with half the energy coming from fat has a saturated fat level less than 11%.

approach SFA fat protein insulinogenic
most nutrient dense 5.6% 22% 30% 52%
low energy density 6.9% 17% 37% 55%
low insulin load 9.7% 49% 20% 30%

So it seems that focus on nutrient dense whole foods we end with moderate, but not excessive, levels of saturated fat.[2]  

what happens if we get rid of all saturated fat?

It’s always useful to test a theory by looking at what happens at the extremes.

I starting wondering about the relationship between saturated fat and nutrient density.

“What would happen to nutrient density if you removed ALL saturated fat?”

“Does avoiding saturated fat affect nutrient density for the better or worse?”

The chart below (click to enlarge) shows the essential nutrients for foods that have no saturated fatty acids (SFA) compared to vegetables, seafood and the most nutrient dense foods.

This analysis indicates that if you eliminate saturated fatty acids the nutrient density plummets!  As you can see from the little red bars on the graph, you might be able to obtain solid levels of Vitamin C and Vitamin A from a diet with no saturated fat but everything else is abysmal!

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how does SFA influence nutrient density?

So eliminating saturated fat completely doesn’t appear to be such a great idea.   But what does the other extreme look like?

I sorted the 7000+ foods in the USDA database by their saturated fat content and divided them into four equal “quartiles”.  The table below shows the SFA as a percentage of calories for the different quartiles.  Interestingly, only the highest quartile exceeds the arbitrary limit for saturated fat (i.e. 13% compared to the 10% arbitrary upper limit in USA or 11% in the UK).

quartile SFA fat protein insulinogenic
first 0.05% 18% 15% 72%
second 1.1% 20% 28% 63%
third 4.5% 32% 38% 52%
fourth 13% 50% 22% 38%

I think the most interesting observation here is in the right hand column.  The more you try to avoid saturated fat the more insulinogenic your diet ends up being.  That is, in the avoidance of saturated fat you may end up exacerbating any genetic propensity that you may have towards insulin resistance and diabetes by eating foods that require your pancreas to produce high levels of insulin to keep up!

One of the challenges with the low fat approach is that the avoidance of fat can often lead to increased consumption of highly processed, highly insulinogenic foods which tend to be a problem for people who are insulin resistant.

In the 70s when they started to encourage people to eat less saturated fat (which was associated with fried junk food) people didn’t eat more vegetables as they’d hoped.  Instead people ate more processed foods that now had to be sweetened with sugar to make sure it didn’t taste like cardboard.  Some would argue that this increase in low nutrient density carbohydrates has been a major contributor to the current obesity epidemic.

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“Replacement of saturated fat by carbohydrates, particularly refined carbohydrates and added sugars, increases levels of triglyceride and small LDL particles and reduces high-density lipoprotein, cholesterol, effects that are of particular concern in the context of the increased prevalence of obesity and insulin resistance.”[3]

The chart below (click to enlarge) shows the nutrient density for the various nutrients for each of the saturated fat quartiles.  While it’s hard to digest all the detail on this chart it appears that, the third quartile (i.e. more saturated fat than average) tends to have the highest nutrient density on average however the second quartile is more consistently high (i.e. less highs and low).

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The chart below shows the average of the nutrient density across the quartiles of saturated fat.  The lowest quartile has the lowest amount of nutrients both in terms of average and being consistently high.  The foods that are the highest in saturated fat have more nutrition than the foods low in saturated fat.  However the second and third quartiles have the most.

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what’s the latest on saturated fat?

In this video from Dr Frank Hu points out that when you’re talking about whether saturated fat is good or bad it’s important to consider what you are exchanging it with.  For example, saturated fat is good if it’s replacing processed carbohydrates, but not so good if you are replacing your vegetables with processed saturated fat.

The most interesting paper I have found on the topic is Saturated fat and cardiometabolic risk factors, coronary heart disease, stroke, and diabetes: a fresh look at the evidence by Dariush Mozaffarin[4] which indicates that, while total cholesterol in the blood may increase with increased dietary saturated fat, the changes in HDL and total cholesterol : HDL ratio are positive.

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When we look in more detail it seems that saturated fats such as 14:0 and 16:0 (typically found in dairy) have positive effects on HDL and insulin sensitivity.

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So in the end it seems the case for or against saturated fat is confusing at best (see the Good Fats, Bad Fats article for more detail).

More recently there has been a more thorough analysis of the data from the Minnesota Coronary Experiment (1968 to 1973) on which the diet-heart hypothesis was based and which has driven the avoidance of fat in the western diet.[5] [6] [7]   The understanding based on this original research headed up by Ancel Keys, was that increased fat raises ‘bad cholesterol’ which leads to heart attacks.

Does the more rigorous analysis of the full data still support this hypothesis?    To quote from Professor Grant Schofield:[8]

The diet-heart hypothesis says that saturated fat raises cholesterol and thus causes heart disease.  Widespread acceptance of this idea has shaped the way we look and how we eat more than anything else in the history of health and medicine.

It’s still the cornerstone of conventional wisdom and dietary guidelines in virtually every country. It’s still the reason the conventional experts can’t take the biologically obvious leap to embracing low carb healthy fat diets for important treatments like weight loss and diabetes.

So, 40+ years on. Here it is in all its glory, published in the BMJ no less. What did they find?

“Available evidence from randomized controlled trials shows that replacement of saturated fat in the diet with linoleic acid effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease or all causes.

“Findings from the Minnesota Coronary Experiment add to growing evidence that incomplete publication has contributed to overestimation of the benefits of replacing saturated fat with vegetable oils rich in linoleic acid.”

That’s right, there was no support for their hypothesis in a randomised trial of more than 9500. Replacing saturated fat with Omega 6 fat did reduce cholesterol, but as we’d predict had no effect on heart disease.

The one effect they did see was that older subjects who lowered their cholesterol had higher overall mortality.  Yes, cholesterol lowering in older adults caused more death. This is an effect already seen in some population studies.

So it seems that the diet–heart hypothesis that tells us to avoid fat, particularly saturated fat, is on shaky ground these days.

so what now?

So, should we avoid fat at all costs?

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Or, after all these years of being told to avoid saturated fat should we rebel and make up for lost time?

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As with most things, optimal lies somewhere between the extremes.

Perhaps if we focus on nutrient dense whole foods then issues like dietary fat and cholesterol will look after themselves?

 

references

[1] http://www.hsph.harvard.edu/news/features/assessing-the-new-u-s-dietary-guidelines/

[2] http://daa.asn.au/for-the-public/smart-eating-for-you/nutrition-a-z/nutrient-reference-values-nrvs/

[3] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943062/

[4] http://www.ncbi.nlm.nih.gov/pubmed/20354806

[5] http://www.pubfacts.com/detail/27071971/Re-evaluation-of-the-traditional-diet-heart-hypothesis-analysis-of-recovered-data-from-Minnesota-Cor

[6] http://whatthefatbook.com/prof-grant-on-minnesota-coronary-experiment/

[7] http://www.cbc.ca/news/health/the-case-of-the-missing-data-1.1412420

[8] http://whatthefatbook.com/prof-grant-on-minnesota-coronary-experiment/

garlic prawns, spinach, pine nuts

This “diet” food is so hard to take!   And with a great blood glucose response to boot!

Fresh prawns from the markets with spinach, pine nuts, shiitake mushrooms, butter and garlic.

Super high on the vitamins and minerals as well as aminos with the pine nuts and spinach.

Prawns are a nice way to get your DHA in as well.
10347807_10152594899515544_1456969411669851549_n

net carbs

insulin load carb insulin fat protein

fibre

11g 35g 31% 50% 36%

6g

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