is there a relationship between macronutrients and diet quality?

Q:  To achieve optimal health, diabetes control and longevity should you:

  • Eat more fat to burn your body fat.
  • Follow a Protein Sparing Modified Fast (PSMF).
  • Eat more protein and lift heavy.
  • Fast more.
  • Use Bulletproof Intermittent Fasting.
  • Decrease protein and eat more fat bombs.
  • Take exogenous ketones and / or drink butter and MCT oil to boost your blood ketones.
  • All of the above.
  • None of the above.
  • I give up! All you ‘diet gurus’ can’t agree.  I’m going back to Maccas where things are simple!

Although many of these answers are contradictory, all are ‘correct’ depending on which low carb / keto groups you belong to.  It can be confusing out there on the interwebs!

For a couple of years I’ve been working to refine our ability to quantitatively optimise our food quality (a.k.a. nutrient density).   At the start of 2017, I developed the Nutrient Optimiser and have since then run detailed macronutrient and micronutrients analyses for more than forty people, all starting from different situations and with different goals.

With all the conflicting advice and my personal quest to manage diabetes while maximising nutrient density, I wondered what my nutrient analysis tools might be able to tell us about the relationship between macronutrients and micronutrients to provide some clarity to the circular debates that I see so often online.

I’m never sure where these articles will end up when I start them.  And this one is certainly interesting!

The analysis suggests that a nutrient dense diet is not necessarily low in protein.  However just focusing on increasing protein won’t necessarily lead to a nutrient dense outcome.

The best way to maximise nutrient density is to not focus primarily on macronutrients.  We get a much better outcome when we focus on the harder-to-find micronutrients (i.e. vitamins, minerals and essential fatty acids, not the amino acids) and then tweak to suit our goals (e.g. weight loss, diabetes control, muscle gain, athletic performance or therapeutic ketosis).

Nutrient density

First let’s look at what we mean by ‘nutrient density’ and how we can quantify it.

Nutrient density of all foods available

The chart below shows the nutrients provided by the 8,000 foods in the USDA database in terms of the percentage of the Daily Recommended Intake (DRI) if you ate just a little bit of all the foods available.

It’s easy to meet the recommended minimum intake of various micronutrients shown at the bottom of the chart (e.g. vitamin B12 and most of the amino acids), at least if you are eating animal products.

However, you really have to go out of your way to get adequate amounts of the nutrients at the top of the chart (e.g. essential fatty acids, vitamin D, choline, vitamin E, calcium, manganese and magnesium).

The most nutrient dense foods

The chart below shows the micronutrients provided by the most nutrient dense foods.

When we focus on foods that contain more of the harder-to-find nutrients we can get a massive boost in all the micronutrients.

If we ate these foods we could get sufficient quantities of all but one of the 34 essential micronutrients.

Why should we pursue a nutrient dense diet?

With adequate amounts of nutrients being provided by the food we eat there is a good chance we will be able to satisfy our cravings with less energy.

Obtaining adequate levels of all the micronutrients will ensure that we have what we need to drive our mitochondria at full power rather than limping along.  We will feel energised and may find that our appetite turns off sooner and we will be less likely to overeat and get fat.[1] [2]  [3] [4] [5] [6] [7] [8] [9] [10] [11]

The chart below shows a comparison of the most nutrient dense 10% of the foods available compared to all the foods in the USDA database.  It seems we can get a significant improvement in the quality of the food we eat by prioritising the more nutrient dense foods.

Which nutrients do we need to worry about?

After a ton of trial and error and systems refinement, I finally figured out that maximising nutrient density works best when we focus on the nutrients that are harder to obtain.

Listed below are the nutrients that tend to be harder to get in adequate quantities from the western food system (i.e. all the foods in the USDA database):

  • Alpha-linolenic acid
  • EPA + DHA
  • Choline
  • Vitamin D
  • Vitamin E
  • Calcium
  • Magnesium
  • Potassium
  • Phosphorus
  • Zinc
  • Thiamine
  • Pantothenic acid
  • Niacin
  • Manganese
  • Folate
  • Selenium

Which nutrients are easier to find?

Listed below are the micronutrients that we don’t need to prioritise because they are fairly easy to get enough of from our western food system (i.e. the foods in the USDA database):

  • Leucine
  • Valine
  • Sodium
  • Methionine
  • Isoleucine
  • Tyrosine
  • Riboflavin
  • Lysine
  • Vitamin B-6
  • Histidine
  • Threonine
  • Phenylalanine
  • Tryptophan
  • Iron
  • Vitamin C
  • Copper
  • Vitamin A
  • Vitamin B-12
  • Vitamin K

I have intentionally left out all the amino acids (i.e. protein) because, as you will see below, it’s easy to get enough protein if we focus on the vitamins, minerals and essential fatty acids.

Can you get too much of a good thing?

As a general rule it’s hard to get excess micronutrients from real food, but it is possible.

  • While we can get more than thirty times the DRI for vitamin K from a nutrient dense diet there is no upper toxicity level of toxicity for vitamin K[12] [13], only menadione which is used as a vitamin K supplement.[14] [15]
  • We can get eighteen times the DRI for vitamin B12 from a nutrient dense diet, however again, there is no upper limit established for B12.[16] [17]
  • We can get seventeen times the DRI for Vitamin A from a nutrient dense diet. It is possible to get vitamin A toxicity, though this typically occurs from supplementation.[18] [19]  There are some reports of Hypervitaminosis A from explorers gorging on polar bear liver which is not likely to be a common occurrence.[20] [21]
  • We can get around twelve times the DRI from copper from a nutrient dense diet which is around the upper limit. This is unlikely to occur without very high liver consumption.
  • A nutrient dense diet can provide around fifteen times the DRI for vitamin C however the upper limit is more than 20 times the DRI.[22] [23] Excessive vitamin C supplementation usually causes diarrhea so it’s largely a self limiting situation.
  • A nutrient dense diet will provide around ten times the DRI for iron while the upper limit is set at around six times the DRI. Many women are iron deficient while many men have hemochromatosis which is excess iron storage.  Liver, mushroom, seaweed and spices are the highest sources of iron.  It’s useful to understand your current iron status to know whether you need more or less iron or should be considering donating blood.
  • It is quite easy to get more than the DRI for amino acids. While high protein diets do not cause kidney disease in healthy people there is no need to chase excess super high levels of protein.[24]   And just like liver, most people will struggle to eat excessive amounts.

So yes, it is possible to get excessive levels of some micronutrients, though generally not a concern unless you are eating a LOT of liver or over supplementing with synthetic nutrients.  Excess levels of micronutrients is not a common problem.

As an example, the chart below shows the nutrient profile of Amy who is following a zero carb diet with a lot of organ meats.  While she is generally getting high levels of most nutrients, she is still not meeting the DRI for a number of vitamins and minerals that are typically found in plant foods (e.g. vitamin K1, vitamin C, calcium, manganese, vitamin E, magnesium and potassium).

At the other extreme we have David who is eating a plant based diet that has plenty of vitamins and minerals but less amino acids.  He knows he needs to supplement with vitamin B12 and vitamin D which are hard to get from a purely plant based diet.

When it comes to nutrient density I often see arguments around whether or not the daily recommended intake levels are correct and whether they might vary for different people with different dietary approaches and whether or not nutrients from plant or animal based food are more bioavailable.  While I think these are definitely under researched areas I think these discussions are not so relevant when we’re orders of magnitude above or below the DRI value.  We need to identify the full range of foods, from whatever source, that will provide the nutrients that we’re not getting enough.  We can then choose from within those to suit our tastes and preferences.

There is plenty of discussion about excess protein or excess calories.  While it’s true that excess is typically not good, I think it’s more valuable to focus on eating foods that contain more of the nutrients that we are currently not getting enough of.   When we’re eating nutrient dense whole foods we’re less likely to need to consciously worry about calories, protein, fat, carbs, sugar, fibre or whatever.

Is there any relationship between macronutrients and nutrient density?

While I don’t see a lot of discussion about nutrient density or food quality, there is seemingly endless debate in social media in low carb and keto circles around macronutrients.  People are often very passionate about eating more or less protein, carbs, fat and fibre.

Perhaps this is because macronutrients are reasonably easy to track and understand.  Or maybe it is because the previous approach hasn’t worked, so they swing to the other extreme.

We’ve been told for so long that fat is bad and now people are realising that it’s not as bad as they were told, so they swing to the other extreme.  Now fat can do no wrong.

Meanwhile, there are plenty of people who stick to fat being bad and wanting to avoid it.

Different people have different perspectives on the multifaceted topic of nutrition.

But is there really any value gained by focusing on macronutrients?  Will they materially improve our food quality or the adequacy of the various essential micronutrients?

To understand whether there is any useful relationship between the various macros and micronutrient adequacy I have plotted the various macronutrients versus the nutrient density score for the 8,000 foods in the USDA foods database.

Note: In this analysis a high nutrient density score means that a particular food has a relatively large amount of the harder-to-find nutrients listed above.  

Protein versus nutrients density

There is a lot of debate at the moment around protein and whether we should be getting more or less of it.

The chart below shows the nutrient density score for the harder-to-find vitamins, minerals and essential fatty acids vs protein (%).

Although amino acids are not included in the nutrient density score it appears that the more nutrient dense foods have more protein.  Conversely, foods with less protein have less of the nutrients that are harder to find.

This analysis indicates that if we avoid protein we will end up with less nutrients overall.  While if we focus on getting the nutrients that are harder to find we will get more than enough protein.

However, as they say, correlation does not equal causation.  There is a lot of scatter in this chart.  In this case the correlation (R2) of this relationship is 0.32.

Makes me wonder if the studies that suggest benefits from increased protein are not at least in part from increased levels of other micronutrients that often come along with protein.

What I think we can conclude from this is that high levels of nutrition do not correlate with avoidance of protein.

Fat versus nutrient density

The chart below shows the nutrient density score versus the percentage of calories from fat.

The first thing to point out here is that there is a massive amount of scatter and a low degree of correlation between fat and micronutrients (R2 = 0.069).

However, it does seem that very high fat foods contain less of the harder-to-find nutrients.

Meanwhile at the other extreme very low fat foods can either be nutrient poor (e.g. sugar and processed grains which would be at the bottom left of this chart) or very nutrient dense (e.g. non-starchy vegetables which would be at the top right of this chart).

If we run a trend line through all these foods we see that the highest nutrient density occurs at around 30% calories from fat.

The reality is that not many people live primarily on high nutrient density low fat foods at the top right of the chart.  People avoiding fat will often slip into the bottom left of this chart and resort to the low fat processed grains and sugars to get enough energy to get through the day.  Meanwhile others who are not afraid of fat will often include 50 or 60% of their energy from fat to get enough energy for maintenance while still getting a high quality diet.

Sugar versus nutrient density

There is currently a lot of focus on sugar as the primary culprit for our poor health.  Gary Taubes and Damon Gameau are down on sugar while Robert Lustig is leading the charge against fructose or fruit sugar.

This analysis suggests that foods with more sugar have a poorer nutrient density, though it’s hard to make sense of this unless we differentiate between added refined sugar and naturally occurring sugar in plant based foods that come with a ton of other nutrients.  However, low sugar content does not necessarily guarantee excellent nutrient density.

Energy density versus nutrient density

Energy density is the amount of energy we get per gram of food.

Minimally processed foods contain more water and fibre and thus have a lower energy density but also tend to have a higher nutrient density.

Meanwhile, processed foods that are shelf stable and easy to transport typically have less water and fibre and more preservatives.

While lower energy density foods have a higher nutrient density, in the end most people won’t survive long on a diet of only lettuce, broccoli and celery, so they will need some more energy dense foods to survive.

However, if you are looking to lose weight in a hurry while still getting the nutrients you need, focusing on lower energy density foods might not be a bad place to start.

Most people believe that eating more veggies will be better for their health, but the unfortunate reality is that it takes some time and money to prepare the food yourself rather than reaching for a quick and cheap energy hit with minimal effort.

Net carbs versus nutrient density

Foods with more digestible carbohydrates typically have a lower nutrient density.

However, simply going low carb doesn’t guarantee that we maximise nutrient density as there is a range of high and low nutrient density foods at the low carb end.

Whether your carbs are nutrient dense will likely depend more on whether they are highly processed or in their natural form, and will likely make a bigger contribution to their nutrient density than the quantity of carbs.

Fibre

Higher fibre foods contain more nutrients.  However, we can’t just add fibre supplements to maximise nutrient density.  It’s the plant based whole foods that also happen to have heaps of fibre that provide us with more higher levels of nutrition.

Insulinogenic calories

The proportion of insulinogenic calories is the proportion of the food we eat that requires insulin to metabolise.

On the right hand side of the chart, highly processed foods with minimal protein and fat typically don’t provide a lot of the harder-to-find nutrients.

Meanwhile on the left hand side of the chart, foods with minimal fibre, carbs and protein are also less nutritious.

If we plot a trendline it appears that the maximum nutrient density occurs at around 50% insulinogenic calories.

If you are already insulin resistant you may want to steer your dietary ship to the left with a lower insulin load diet to the point that your pancreas can keep up and maintain normal blood sugars.

Meanwhile if you’re fit and insulin sensitive you will be able to have more leeway when it comes to macros and insulin load.

Summary

So what to make of all this?  Which of these parameters has the best correlation with food quality or nutrient density?

The table below shows the various parameters sorted by their correlation (R2) with their nutrient density score.

parameter correlation comment
protein 0.32 Foods with more of the harder to find micronutrients tend to have more protein.
energy density 0.15 Lower energy density foods are typically more nutrient dense.
net carbs 0.12 Foods with more net carbs are typically less nutritious.
insulinogenic 0.11 Nutrient density peaks at around 50% insulinogenic calories.  Extremes extreme is not optimal.
fibre 0.08 High fibre foods are often more nutritious.
fat 0.07 Nutrient density peaks at around 30% fat.
sugar 0.04 High sugar content correlates with low nutrient density

It seems that if we want to optimise the quality of our diet we should:

  1. Focus on the foods that contain the harder-to-find nutrients.
  2. Not actively avoid protein.
  3. Chose lower energy density foods when we can.
  4. Avoid foods that are largely digestible carbs with minimal fibre (e.g. processed grains and sugars).
  5. Chose moderately insulinogenic foods without swinging to either extreme (though we should err on the less insulinogenic side if we already have diabetes).

Meanwhile, sugar, fat and fibre, aren’t spectacular predictors of nutrition.

chasing nutrients vs chasing macros

So, if protein is good, more is better, right?   Bring me the bulk tub of protein powder!

Not so fast.  It is important to understand the difference between emphasising:

  • all nutrients,
  • protein,
  • less insulinogenic foods, and
  • harder-to-find nutrients.

Maximise all nutrients

The chart below shows what happens to the micronutrient profile when we simply maximise all nutrients.

The amino acids are through the roof (69% protein) because aminos are easy to find in our food system, but we’re still lacking in many of the harder to get nutrients.

Maximise protein

If nutrient density correlates with protein then it makes some sense to prioritise protein.    Doesn’t it?

The chart below shows what happens to the nutrient profile if we sort the USDA foods database by % protein.  It seems that if we simply focus on protein we get a very poor vitamin and mineral profile.

Minimising protein and maximising fat

Minimising protein and carbs while maximising fat is all the rage in the keto scene.  Unfortunately, a very low insulin load diet is not a high nutrient density approach as we can see from the chart below.  While we get adequate protein (15%), the vitamin and mineral profile is poor.   With 80% of our energy coming from fat we are deficient in about half the micronutrients.

Perhaps a very high fat therapeutic ketogenic approach should be reserved for special circumstances and extra attention needs to be given to the nutrients you won’t be able to get from your food?

Prioritising the harder to find nutrients

The chart below shows the outcome when we focus the harder to find nutrients (excluding amino acids).  We get adequate quantities of all the micronutrients and still plenty of protein.

Learnings from the Nutrient Optimiser analysis

It’s one thing to look theoretically in a database of individual foods.  But it’s another to look at what people are eating in real life.

Next, I want to share what I’ve learned from analysing more than forty different people’s food logs in the Nutrient Optimiser.

The nutrient density score

But first, I need to introduce you to the Nutrient Density Score.

The chart below shows Rhonda Patrick’s nutrient analysis based on a couple of day’s worth of her typical meals.  Rhonda’s diet is not particularly extreme in anything other than nutrients.

Rhonda is meeting the Daily Recommended Intake levels for everything other than Vitamin D.

Rhonda would score 100% if she could achieve 200% of the DRI for the hardest to hardest to find lower half of the nutrients.  However, because she doesn’t achieve 200% with all of the lesser scoring half of the nutrients she only gets a Nutrient Density Score of 81.3%.

For reference, if we add a little bit of all the foods in in the USDA database we would get a nutrient density score of 63% .  The most nutrient dense 10% of the foods in the USDA database will give us a nutrient density score of 93%.  Even Rhonda has some room for improvement.

By contrast, the chart below shows Patrick’s nutrient density score which comes in at only 21%. He is following a very high fat keto approach even though his blood sugars are great and he doesn’t appear to be insulin resistant.

Patrick will need to eat a lot more of his current diet to meet the daily recommended intake for most of the nutrients.

There is a good chance that that Patrick will be craving more food to obtain the nutrients that he needs to get through the day.  Even though he is trying to lose weight, he might end up overeating more calories using his current diet than if he spent a week eating with Rhonda.

The table below shows the nutrient density score for more than forty Nutrient Optimiser analyses that I’ve run to date along with:

  • protein (g/kg LBM),
  • protein (%)
  • fat (%)
  • fibre (%)
  • net carbs (%).

I encourage you to click on each of the names below to review their nutrient analysis to see what they are and aren’t eating to get these scores.

Name score protein (g/kg LBM) protein fat fibre (%) net carbs (%)
Rhonda Patrick 82% 2.5 17% 57% 10% 15%
Briana Theroux-Hulsey 79% 3.5 29% 21% 15% 35%
David Houghton 77% 0.6 17% 2% 21% 60%
Andy Mant v3 77% 4.4 27% 53% 5% 15%
Alber Van Zyl 75% 1.0 15% 77% 2% 6%
Alma Fuente 75% 5.3 27% 60% 7% 6%
Mike Berta 74% 2.1 31% 58% 4% 7%
Alex Leaf 74% 3.3 33% 26% 10% 32%
Alex Ferrari 74% 2.0 17% 54% 6% 24%
Deb Pinsky Lambert v2 72% 1.2 31% 61% 3% 6%
Luis Villasenor 72% 2.4 43% 48% 3% 5%
Gayle Louise 71% 2.4 40% 49% 4% 7%
Andy Mant v2 70% 3.0 26% 54% 6% 15%
Robin Reyes v3 69% 1.6 18% 67% 6% 8%
Ruth Jamieson v2 66% 1.6 18% 67% 6% 8%
Amy 65% 3.3 41% 57% 0 1%
Ingunn Lovik 62% 1.5 21% 70% 1% 8%
Sophia Thom 62% 1.1 24% 65% 4% 7%
Franziska Spritzler 61% 2.3 27% 55% 10% 8%
Sarah Koenck 58% 2.2 14% 77% 4% 6%
Ruth Jamieson v1 57% 1.4 19% 65% 7% 9%
Maria Fornaciari 52% 1.6 30% 61% 3% 6%
Matija Mlakar 50% 2.1 23% 49% 11% 17%
Nicole Jacobi 48% 2.8 32% 60% 3% 6%
Graeme Monteith 48% 2.6 18% 67% 5% 10%
Dave Knowles 46% 2.4 31% 63% 2% 3%
John Robertson 46% 1.4 16% 59% 4% 21%
Leah Williamson 44% 1.8 19% 75% 2% 3%
Balin Jones 43% 5.0 26% 66% 3% 5%
Andy Mant v1 34% 3.7 35% 54% 2% 9%
George 34% 0.8 9% 69% 9% 12%
Robin Reyes v2 32% 1.6 21% 59% 4% 15%
Lorraine Ayre 30% 1.3 19% 64% 5% 12%
Terry Palmer 29% 1.5 25% 62% 5% 8%
Paul Stansel 28% 1.5 18% 77% 2% 3%
Gigi Giodani 26% 1.6 15% 81% 1% 2%
John Kerr 25% 0.7 11% 84% 2% 3%
Robin Reyes v1 23% 1.1 13% 50% 2% 35%
Patrick Butts v1 21% 0.8 18% 73% 4% 5%
Patrick Butts v2 20% 1.4 26% 66% 3% 6%
Harry Nguyen 20% 2.3 20% 72% 4% 4%

In the charts below we’ll quickly look at the relationship between the macros and their nutrient score.

Protein

This chart shows the relationship between protein intake and each person’s nutrient density score.

The average protein intake is 2.1g/kg LBM or 23% of energy.

On the top left corner of the chart we have David who is following a plant based diet and intentionally getting lower levels of protein but also maximising vitamins and minerals from plant based foods.

On the bottom left we have a number of people following a therapeutic ketogenic diet targeting low protein and high fat.

As long as you are not trying to target low protein and high fat to generate higher blood ketones then it doesn’t seem to matter what your protein intake is.  Most people get enough protein to support their activity levels.

The chart below shows the nutrient density score versus protein (%).  Again, it seems that it’s hard to get high levels of nutrients if you are targeting minimal protein levels.

% insulinogenic

The story is similar with insulin load.  Reducing the insulin load of your diet to the point that your blood sugars normalise is a great idea, but less is not necessarily better.  We want to avoid really high insulin levels but not drive it so low that we don’t have enough nutrients to repair our muscles and organs.

Fat

High levels of fat do not guarantee high levels of nutrition.

Net carbs

It’s good to reduce the carbohydrate load of your diet to normalise your blood glucose levels, but minimising is not necessarily the best idea and may be unnecessary if you are not managing diabetes.

Higher carbs isn’t necessarily bad either when it comes to nutrient density.  On the top right of the chart we have David who is striving for a nutrient dense plant based diet with about 35% net carbs while for contrast we have Robin’s baseline junk food diet which also has about 35% net carbs which has about the same nutrient density score as the very high fat therapeutic keto dietary approaches on the bottom left of the chart.

Fibre

Higher levels of fibre typically correlate with more nutrition (although you theoretically can get heaps of nutrients from shellfish and organ meats).

Summary

  • A nutrient dense diet is not low in protein; however focusing on protein won’t necessarily guarantee great nutrition.
  • Foods with a lower energy density are often more nutrient dense. To maintain our body weight and growth we will need to add more energy dense foods (i.e. more non-fibre carb and / or fat).  Meanwhile, dialling back the energy density and forcing your body to use your stored body fat can be a good strategy for weight loss.
  • Reducing carb or the insulin load of your diet can be useful if you are managing diabetes or insulin resistance to normalise blood sugar and insulin levels. However less is not necessarily better.
  • For the most part ensuring you are getting the harder-to-find micronutrients will ensure that you are not going to extremes with any of the macronutrients while maximising your diet quality.

references

[1] https://www.youtube.com/watch?v=rYXF0l18ciI

[2] https://www.youtube.com/watch?v=ncVJfZZ7bTM

[3] https://www.youtube.com/watch?v=ZjUgX91VZpk

[4] http://perfecthealthdiet.com/2011/02/perfect-health-diet-weight-loss-version/

[5] https://www.ncbi.nlm.nih.gov/pubmed/18469287

[6] https://www.ncbi.nlm.nih.gov/pubmed/19785688

[7] http://www.tandfonline.com/doi/abs/10.1080/13590840220143062?journalCode=ijne20&

[8] https://www.ncbi.nlm.nih.gov/pubmed/19263591

[9] http://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2007.00465.x/abstract

[10] https://www.ncbi.nlm.nih.gov/pubmed/20142823

[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988700/

[12] http://www.consumerlab.com/RDAs/#VitaminK

[13] http://www.consumerlab.com/RDAs/#VitaminK

[14] https://en.wikipedia.org/wiki/Menadione

[15] https://www.amazon.com/Nutrient-Bible-Henry-Osiecki/dp/1875239545

[16] http://www.consumerlab.com/RDAs/#B12

[17] https://www.amazon.com/Nutrient-Bible-Henry-Osiecki/dp/1875239545

[18] http://www.mayoclinic.org/drugs-supplements/vitamin-a/safety/hrb-20060201

[19] http://www.consumerlab.com/RDAs/

[20] https://www.121dietitian.com/never-eat-a-polar-bears-liver/

[21] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1257872/

[22] http://www.consumerlab.com/RDAs/#VitaminC

[23] https://www.amazon.com/Nutrient-Bible-Henry-Osiecki/dp/1875239545

[24] https://chriskresser.com/do-high-protein-diets-cause-kidney-disease-and-cancer/

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personalised nutrition… how to tweak the moving parts

There are a number of moving parts when it comes to optimising nutrition to suit your personal situation and goals.

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General nutritional recommendations are standardised for simplicity.    However simple and standard doesn’t always work for everyone, particularly if you aren’t average, or don’t want to be average.

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Just like people come in different shapes and sizes, their nutritional requirements vary widely depending on our situation and goals.

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The Nutrient Optimiser is a moderately sophisticated tool to optimise food choices to suit different people with different goals.  However, I don’t want it to be a black box. Ideally I would like people to understand the inputs and how best to refine their nutrition to suit their goals.

The problem is black boxes is you get what you put in.  If you understand the inputs you’ll have a better chance of getting the output you’re after.

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This article discusses the various parameters that the Nutrient Optimiser manages.    Even if you’re not a user, it may be of interest to see how you can truly personalise your nutrition.  If you are already using the Nutrient Optimiser this article will help you understand how the algorithm uses various parameters to determine the optimal foods for you.

Multicriteria analysis

The first thing to understanding is the parameters used in the multi criteria analysis which is at the heart of the Nutrient Optimiser algorithm.  The image below illustrates the three main dials that you can adjust in the algorithm:

  • insulin load,
  • nutrient density, and
  • energy density.

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A multi criteria analysis is a way to combine a number of priorities.

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You do it all the time.  You want to have money in the bank but you also want to wear clothes and live under a roof.  So you balance these priorities depending on your goals.  You like to look and feel good but you also like to eat treats “occasionally”.  So you balance these priorities.

You want to have the proverbial cake and eat it too.  We make compromises all the time in life.  Living at the extremes is not always healthy or optimal.

I have written at length on the blog about the three key parameters of the system.  The pros and cons of having the various parameters at either extreme are highlighted in the table below.

Parameter Too high Too low
Insulin load Very high insulinogenic processed junk food that drives a blood glucose roller coaster. Super high fat therapeutic ketogenic foods do not provide high levels of the broad range of various essential vitamins and minerals.
Nutrient density Very high nutrient per calorie foods are also very low energy density.  For someone who is active and not looking to lose weight the most nutrient dense foods may not contain enough energy to provide satiety and prevent excessive fat loss. Low nutrient density processed junk food leads to a lack of satiety (nutrient hunger), overeating and a whole host of other health issues.
Energy density Energy dense foods are ideal for someone who is very active and looking to replenish energy, though not necessarily for someone who is less active or looking to lose weight. Low energy density foods are very bulky and hard to get enough energy  to maintain weight if you’re very active.

 

As you can see, these three parameters are important to different people to different degrees for different people.  The table below shows the ‘pre-set values’ in the system that have been found to work well for different goals.  More experienced users of the Nutrient Optimiser may want to tweak these values to refine the results to further suit their preferences.

approach insulin load nutrient density energy density total (absolute)
bulking -20% 60% -20% 100%
nutrient dense maintenance 20% 70% 10% 100%
weight loss (insulin resistant) 5% 70% 25% 100%
weight loss (insulin sensitive) 0 85% 15% 100%
therapeutic ketosis 15% 85% 0% 100%
diabetes and nutritional ketosis 10% 90% 0% 100%

You may have noticed that some of the parameters are negative (e.g. insulin load and energy density for the bulking approach).

While many people are eating too much, some athletes want to bulk up and / or get more energy “down the pie hole” to support their amazing feats of endurance.

Someone who is insulin resistant will want to minimise the insulin load of their diet, bodybuilders often want food to spike insulin around workouts to promote growth.  If you turn the nutrient density parameter negative you’ll get a list of processed junk food that you see in the supermarket aisles.

Adapting the system as you progress

People would ideally use these value as a starting point and refine them to suit your goals as you see fit and as you get fit.

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Someone who starts out with  diabetes, is on three medications and hundreds of units of insulin may need to start on the high fat therapeutic keto approach to reduce the insulin load of their diet.

Someone like this who is looking to progressively refine their diet would come back and re-run the Nutrient Optimiser every two to four weeks to see their new dietary recommendations and refinements.  Through continual, gentle, non-judgemental and anonymous guidance (with the support of the Nutrient Optimiser Facebook group community as required) they would be able to progressively refine their diet.

In time, their blood glucose would come down with lower insulin load foods.  But then they still might want to lose weight so they would start to prioritise lower energy density foods rather than low insulin foods so much.  Then as their weight came closer to optimal and they were more active they might swing back to some focus on insulin load to enable them to have a more nutrient dense suit of foods.

Where do I start?

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While there are a lot of parameters you can use, your average glucose levels and waist : height ratio is a pretty good starting place as shown in the table below.

A higher fat / ketogenic / low carb approach typically works really well for people who have elevated blood glucose and elevated insulin levels.  However, as blood glucose control and improved insulin sensitivity kicks in but you still need to lose weight energy density and nutrient density become more important.

The table below will give you a guide on which approach might be most appropriate based on your current weight blood glucose levels and body fat levels.

approach average glucose waist : height
(mg/dL) (mmol/L)
therapeutic ketosis > 140 > 7.8  
diabetes and nutritional ketosis 108 to 140 6.0 to 7.8  
weight loss (insulin resistant) 100 to 108 5.4 to 6.0 > 0.5
weight loss (insulin sensitive) < 97 < 5.4 > 0.5
bulking < 97 < 5.4 < 0.5
nutrient dense maintenance < 97 < 5.4 < 0.5

 

Food preferences

There are a plethora of different approaches to choosing foods.  Some of these are based around avoiding allergens (autoimmune, lactose intolerant, nut allergy etc) or digestive issues (zero carb, low fodmap).  Some are based on religious belief systems (e.g. vegetarian).

Although the ideal approach is going to be to prioritise the most nutrient dense foods available, we have also created options to suit your preferences.

The recommended foods list will be based on the remaining top 10% foods.   Noting your preferences up front will save you sifting through a long list of foods that you may not want to eat.

option details
most nutrient dense No limitations
zero carb Eliminates vegetables, fruit, grains and any non-animal based sources of carbohydrate.
vegan / plant based No animal products or animal derived products such as dairy or eggs.
vegetarian No animal products but includes eggs and
paleo No grains, dairy or processed foods.
pescatarian Vegetarian plus seafood
gluten intolerant No grain products
nut allergy Excludes nuts
no salicylates  
no organ meats Excludes organ meats.
no offall  

Should I log my supplements?

No!

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But why not?

The goal of the Nutrient Optimiser is to identify nutrient deficiencies and whole foods to fill them.  If you don’t manage to fill the gaps, then you will know which nutrient you might need to supplement.

There is a credible line of thinking that the reason that many processed foods are fortified with B vitamins and the like is that we would find these foods unpalatable and lose our appetite without the fortification.[1] [2] [3] [4] [5]  With fortification, we associate these otherwise nutrient devoid processed foods with essential vitamins and hence we are happy to keep eating them.  Unfortunately, they don’t also contain the full range range of beneficial nutrients that whole foods possess (i.e. essential, non-essential and the ones that we haven’t discovered yet) so fortified foods are unlikely to lead to optimal health.

If you are taking a ton of supplements then you may be able to continue to happily eat large quantities of nutrient poor processed food that you would otherwise lose your taste for.  If you cut back to foods that don’t need to be fortified or flavoured to make up for their nutritional deficiencies you will be able to hear your appetite again and let it guide you to whole foods that contain the nutrients you need at a particular point in time.

Regardless of whether this narrative is correct I think it’s safer to get your nutrients from real food.  Supplements supplement.  They shouldn’t be the foundation.

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If you still can’t quite cover off on the nutrients you need from real food, you can supplement in a targeted manner once you’ve got the foundation of whole foods in place.

Micronutrients

The Nutrient Optimiser compares the nutrients you are getting to the recommended daily allowance (RDA) or daily recommended intake (DRI).  Different RDA / DRIs are commonly given for different situations including  whether you are male or female and if you are pregnant or breastfeeding.

Recommended micronutrient levels for men are typically greater than those for women (other than iron, which is greater for women).  Levels of micronutrients during pregnancy and breastfeeding are greater for obvious reasons.  These values (for adults) are included in the Nutrient Optimiser.

You may have blood tests that indicate you are deficient or sufficient in particular nutrients.  You may also be able to use tools like the Organic Acids Test or the NutrEval test to identify any nutrient deficiencies that you need to prioritise.

If you have this data you can override the recommendations from your food log to focus the nutrients you know you are low in.  For example you may have blood tests that you are getting a lot of vitamin D from the sun so you could decrease your dietary targets or you may have blood tests that suggest you are low in iron due to poor absorption so you can increase your dietary targets.

The daily recommended intake levels for vitamins, minerals and essential fatty acids are shown in the table below.  Keep in mind that these are the recommended minimum levels to prevent the diseases of malnutrition.  There is generally no harm in being above these levels in a particular nutrient if you are getting it from real food.  However if a certain nutrient is super high there is a chance that you are neglecting other nutrients.

Vitamin men women pregnant breastfeeding
B1 (Thiamine) (mg) 1.2 1.1 1.4 1.4
B12 (Cobalamin) (µg) 2.4 2.4 2.6 2.8
B2 (Riboflavin) (mg) 1.3 1 1.4 1.6
B3 (Niacin) (mg) 16 14 18 17
B5 (Pantothenic Acid) (mg) 5 5 6 6
B6 (Pyridoxine) (mg) 1.3 1.2 1.9 2
Folate (µg) 400 400 600 500
Vitamin A (IU) 3000 3000 3000 3000
Vitamin C (mg) 90 75 85 120
Vitamin D (IU) 600 600 600 600
Vitamin E (mg) 15 15 15 19
Vitamin K (µg) 120 90 90 90
Calcium (mg) 1000 1300 1000 1000
Copper (mg) 0.8 0.8 1 1
Iron (mg) 8 18 27 10
Magnesium (mg) 400 310 350 310
Manganese (mg) 5.5 5 5 5
Phosphorus (mg) 1000 1000 1000 1000
Potassium (mg) 3800 2800 2800 3200
Selenium (µg) 55 55 60 70
Sodium (mg) 460 460 460 460
Zinc (mg) 11 9 11 12
Omega-3 (g) 1.6 1.1 1.4 1.3

Amino acids

There is a lot of passion around the topic of optimal protein levels.

I think the long and short of it is that if you focus on getting the harder to find nutrients you won’t need to worry too much protein.  However if you focus on getting particularly high or low levels of protein you will risk missing out on getting adequate vitamins and minerals.

However, unless you’re actively trying to avoid protein you will likely be getting enough.  Conversely, unless you’re trying to hammer down to get extra protein with powders, you will find it hard to get too much protein whole foods.

As long as you’re not living exclusively off hyperpalatable processed foods I think you can generally trust your appetite to make sure you’re getting enough protein.  People who are active and working out will need more protein to support muscle growth and recover.  People who are sedentary will need less protein (as well as fat and carbs).

The Nutrient Optimiser takes your weight and LBM into account to tell you how you’re positioned against normal healthy protein intake levels which are noted in the table below.

Scenario % calories g/kg LBM
minimum (starvation) 6% 0.4
RDI/sedentary 11% 0.8
typical 16% 1.2
strength athlete 24% 1.8
maximum 35% 2.7

To take things another step further, the Nutrient Optimiser also looks at the adequacy of the individual amino acids.  If you’re following a lower carb or paleo approach these are likely to be adequate.  If you’re vegan, fasting or aiming for therapeutic ketosis, the Nutrient Optimiser may encourage you to seek our more of specific amino acids if you’re not getting enough.  Although typically most people get enough of the amino acids unless they are actively trying to avoid protein.

The table below shows the minimum daily requirement of the various essential amino acids in terms of milligrams per kilogram of body weight as well as for someone who is 70kg and 100kg.  These target levels have been included in the Nutrient Optimiser based on your total body weight.  If you are deficient in any of these individual amino acids the Nutrient Optimiser will highlight foods that will fill the gaps.  The Nutrient Optimiser also checks to make sure you’re getting enough protein overall based on your lean body mass.

Amino acid(s) mg per kg body weight mg per 70 kg mg per 100 kg
Histidine 10 700 1000
Isoleucine 20 1400 2000
Leucine 39 2730 3900
Lysine 30 2100 3000
Methionine

Cysteine

10.4 + 4.1 (15 total) 1050 1500
Phenylalanine

+ Tyrosine

25 (total) 1750 2500
Threonine 15 1050 1500
Tryptophan 4 280 400
Valine 26 1820 2600

Common micronutrient deficiencies

Managing micronutrients is a bit of a moving feast.  You could run a reasonable argument that the various daily recommended intakes (DRI) are based on limited knowledge and understanding.  Realistically in the early stages of understanding nutrients and how they work in our body.

For this reason, the Nutrient Optimiser doesn’t try to hit the DRI for every single nutrient.  That would be unrealistic with real food (chemical concoctions like Soylent or other meal replacement products, might get closer, but who knows what you’ll be missing out on if you only get what we currently understand to be the essential nutrients).  Instead we want to highlight the nutrients that you are currently getting in smaller quantities and help you focus on the foods that contain more of those harder to find nutrients.

The chart below shows common micronutrient deficiencies.  The majority of people are not getting adequate amounts of vitamin D, vitamin E, magnesium, calcium, vitamin A and zinc.  However your situation will be unique.

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The Nutrient Optimiser will progressively train you to incorporate new foods and rebalance your diet to fill your nutritional gaps.  When you get to the point that most of your nutrient requirements meet the minimum from real food you might just find your appetite and cravings for particular nutrients start to diminish.

If you’re interested in checking out how the Nutrient Optimiser has worked for a number of other people check out the Nutrient Optimiser Facebook Page or the Nutrient Optimiser site for more details on the tool and how to be involved.

2017-05-23

 

references

[1] http://freetheanimal.com/2015/10/fortification-obesity-refinements.html

[2] http://freetheanimal.com/2015/06/enrichment-theory-everything.html

[3] http://freetheanimal.com/2016/05/enrichment-promotes-everything.html

[4] http://www.audible.com.au/pd/Health-Personal-Development/The-Dorito-Effect-Audiobook/B00WVLVT0Q

[5] https://www.amazon.com/Dorito-Effect-Surprising-Truth-Flavor/dp/1476724237

are ketones insulinogenic and does it matter?

There has been a lot of chatter around the interwebs lately about exogenous ketones and whether they are health promoting, particularly for people with conditions that relate to excess insulin such as diabetes, traumatic brain injury, Alzheimer’s, cancer, epilepsy, obesity etc.

exogenous ketone are trendy
exogenous ketones, Pruvit and Keto//OS are becoming trendy.

Exogenous ketones are becoming trendy, particularly in the low carb scene!

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A couple of people recently asked me whether I thought exogenous ketones are insulinogenic.  Roger Unger’s 1964 paper the Hypoglycemic Action of Ketones.  Evidence for a Stimulatory Feedback of Ketones on the Pancreatic Beta Cells[1] indicates that ketone levels are controlled by insulin and that ketones suppress lipolysis:

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.[2]

It seems that exogenous ketones are insulinogenic to some degree.  But how do we test this hypothesis to find out whether they are just slightly insulinogenic like fats or more insulinogenic like carbohydrates?

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how to test the insulin response to exogenous ketones in someone with Type 1 Diabetes

If someone with Type 1 Diabetes stops taking their insulin both their blood glucose levels and blood ketones spiral out of control as they slip into ketoacidosis[3] which can be dangerous and fatal before very long without exogenous insulin injection.[4]   In metabolically healthy people,  high levels of ketones suppress mobilisation of body fat (lipolysis).[5]

In someone with Type 1 Diabetes, taking exogenous insulin brings both ketones and blood glucose under control.  So, based on what we see in people with Type 1 Diabetes, it seems logical that exogenous ketones would provoke an insulin response to keep ketones and glucose under control.

One way to test whether exogenous ketones are insulinogenic would be to have an Type 1 Diabetic to take a significant amount of exogenous ketones and monitor how much additional insulin they would need to keep the continuous blood glucose stable with the same amount of calories in glucose.

I initially became interested in exogenous ketones after hearing a number of podcasts with Patrick Arnold and Dominic D’Agostino thinking that it may be a useful alternative source of energy that does not rely on insulin for my wife, who has Type 1 Diabetes.  However the one time she tried it resulted in such bad gut distress she never touched it again.  So scratch that n = 1.

food insulin index testing with exogenous ketones

Another way to test whether exogenous ketones are insulinogenic would be to run a food insulin index test[6] [7] using ketones rather than food.  This would involve giving 1000kJ of exogenous BHB (e.g. 48g of KetoCaNa) and measuring the insulin response over two or three hours.

The chart below compares the results of previous food insulin index tests undertaken for different foods.[8]   Comparing the area under the curve insulin response for the exogenous ketones to the insulin area under the curve for glucose would give you the insulin index for exogenous beta hydroxybutyrate.  I’m surprised that the companies marketing exogenous ketones to people with metabolic issues, as part of their due diligence, haven’t already done this testing to understand to what degree exogenous ketones are insulinogenic.

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but wait, the food insulin index testing with exogenous ketones has already been done!

Then I came across this figure in a paper, Nutritional Ketosis Alters Fuel Preference and Thereby Endurance Performance in Athletes (Cox et al, 2016)[9],  where they have effectively done the food insulin index testing with exogenous ketones.

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Thirty-nine athletes took an isocaloric dose of ketone esters, carbs and fat in three different sessions. In the chart on the right (G) we can see that the ketones provoked about half the insulin response compared to the carbohydrate drink.  This test is different to normal food insulin index testing in that the participants started to exercise ten minutes after taking the drinks (i.e. at T = 0) at which point insulin and glucose start to rapidly decline.

updated insulin load formula, including exogenous ketones

The chart below shows the relationship between the food we eat and our insulin response based on the previous food insulin index testing.

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In lieu of more thorough food insulin index testing, I think we can update the insulin load calculation formula to:

insulin load = carbohydrate – fibre + 0.56 * protein – 0.725 * fructose + 0.5 * exogenous ketones

It appears that exogenous ketones provide about half the insulinogenic impact of carbohydrates (i.e. about the same as protein).


So, if you’re avoiding protein because of its impact on insulin, should you also consider exogenous ketones for the same reason?  Mike Julian added:

Exogenous ketones stimulate insulin, but BHB also inhibits lipolysis directly via the nicotinic acid receptor PUMA-G in adipose.[10]

While exogenous ketones may be equally as insulinogenic as protein, they’ll also be a counterproductive use of insulin.

Whereas the insulin response to protein is a positive use of insulin to build and repair muscle, with exogenous ketones, insulin simply reduces oxidation of other fuels to allow ketones to be burned.

Exogenous ketones displace the burning of other substrates.  You know what else displaces the burning of other substrates?  Glucose. Carbs reduce the amount of fat you burn. Similarly, exogenous ketones displace both fat and carbs/glucose.

That’s a double whammy in the wrong direction! Substrate competition is key.

total energy = glucose + ketones

In a healthy metabolism, endogenous ketones are generated as fat stores are mobilised to compensate for a decreased energy availability from glucose.  When glucose is not available, ketones come to the rescue to ensure survival.

If you’re insulin resistant, you might have trouble releasing free fatty acids due to the high levels of insulin circulating in your blood stream.  This inability to access your own fat stores will reduce your ability to create ketones and likely lead you to be more hungry and eat more than you otherwise would if you were insulin sensitive.  If you are insulin sensitive you can more easily access your own body fat stores.

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This chart demonstrates the concept of total energy (i.e. glucose + ketones) using more than a thousand combined ketone and glucose readings from people following a low carb / keto lifestyle.  Other than in the extremes of extended fasts or major feasting, the body seems to use insulin to maintain a homeostasis of around 5 to 6 mmol/L of total energy in the blood.

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On the left hand side of the chart, when our blood glucose levels drop, we get a rise in ketones, but an increase in autophagy and all the good stuff that comes with fasting and ketosis.

On the right hand side of the chart, when we drive our total energy high with excess energy (be it from processed carbs, Bulletproof Coffee, or exogenous ketones) the body releases insulin to bring the energy out of our blood stream and back into our liver.

People with the highest levels of metabolic health tend to walk around with a lower total energy in their bloodstream.  It seems you don’t need to buffer lots of energy in the blood if you can easily mobilise body fat and glycogen stores quickly when required.  Further, having high levels of energy sitting around in the blood stream is far from ideal and leads to glycation in the case of high blood glucose levels and oxidation in the case of free fatty acids.

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The total energy concept also seems to hold up with laboratory testing in rat pancreas islet cells, where exogenous ketone bodies promoted insulin secretion when there was greater than 5.0 mmol/L of glucose.[11]

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It appears that if your blood glucose levels are greater than 5.0 mmol/L (or 90 mg/dL), then exogenous ketones will be insulinogenic (at least if you’re a rat, but we have no reason to believe this wouldn’t occur in humans as well).

So if your blood glucose levels are greater than 5.0mmol/L (or 90 mg/dL),  then those expensive exogenous ketones may just be working as quick burning insulinogenic fuel, just like a dose of simple carbs.

do exogenous ketones “help” with fasting?

Mike Julian again:

If exogenous ketones raise insulin and reduce blood glucose, then where does the glucose go?  It gets stuffed back into the liver. 

Think about all of these people who fast with the intent of depleting liver glycogen but drinking Keto/OS. They’re literally preserving glycogen stores! No wonder we were seeing whacky glucose and ketone response to fasting with exogenous ketones.

Instead of the normal trajectory of a fast that would result in depleted liver glycogen we see exogenous ketones keeps this from happening, so you would get purges of glucose out of the liver throughout the fast when people were fasting using exogenous ketones.”

Let’s take a quick look at what Mike means by “the normal trajectory of glucose”.    In the chart below, we can see that blood glucose levels drop and ketone increase in four people.

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Where things get interesting is when you step look at the longer-term glucose and ketone trajectory of the fourth person who was taking exogenous ketones during the fast.

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What’s causing this anomaly in glucose and ketone response?   Is it a unique level of insulin resistance, or could this simply be explained by the use of exogenous ketones which are down regulating release of free fatty acids and endogenous ketone production?

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One theory is that exogenous ketones are switching off lipolysis, which drives the liver to release more glucose and ramp up gluconeogenesis to fuel the system during fasting?

The glucose : ketone index is the measure that Dr Seyfried encourages cancer patients to use during a fast to measure its therapeutic effect.  The lower the better.  For most people the GKI continues to drop during extended fasting, but in this case the GKI dropped and then starts to rise over time when taking exogenous ketones.

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I would like to see some more thorough studies to understand if this is typical in people taking exogenous ketones during extended fasting.  It’s not conclusive, but n = 1s are useful to build a hypothesis that can be tested in a more controlled environment.

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oxidative priority

Ray Cronise and David Sinclair recently published an intriguing article, Oxidative Priority, Meal Frequency, and the Energy Economy of Food and Activity: Implications for Longevity, Obesity, and Cardiometabolic Disease (2016)[12] where they detailed the basis for the oxidative priority of different fuel substrates.

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  1. Alcohol will be burned first because the body has limited storage capacity for it. It sees it as a toxin that needs to be cleared.
  2. Protein will be burned second because you can only store a few hundred calories worth of amino acids in the bloodstream (though I think most people struggle to overeat protein when from whole food sources).
  3. Carbohydrate will then be burned before we can access our virtually unlimited stores of body fat.

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So, I think it would be logical that exogenous ketones would be first in line (before or just after alcohol) to be burned off because the body has no way of storing the exogenous ketones other than circulating in the blood stream.

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So, it seems that exogenous ketones neither lower insulin nor promote fat burning.  They’re just another fuel that will be burned before the fat on your bum and your belly.

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do exogenous ketones boost exercise performance?

Exogenous ketones in sports performance is an interesting area of research.  Rumour has it the Tour de France cyclists and British Olympic rowers are using ketone ester drinks (though it’s worth noting that the people spreading these rumours are selling the ketone esters).[13]

Some people use exogenous ketones as a preworkout, like caffeine, to give them a cognitive boost.  Research by Richard Veech and Kieren Clarke suggests that there may be a small athletic boost if you provide both exogenous ketones and exogenous glucose at the same time to provide a “dual fuel”.[14] [15]  This situation provides a fuel oversupply that would force the body to burn off the excess fuel quickly.  However other people like Dr Mike T Nelson suggest that driving a chronic energy surplus from high ketones and high glucose might be problematic in the long term as there is no precedent in nature for this condition.[16]

I have dabbled with exogenous ketones (i.e. KetoCaNa, Pruvit and the Ketone Aid ketone ester).  The chart below shows  how my blood ketones rose to 3.5mmol/L and then back down to normal levels after about 3 hours.  Note how my body tries to remove the excess energy from the blood stream and bring the total energy back down to around 5.0mmol/L.

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I didn’t find a massive boost in performance in my workouts with any of the ketone products.  My best performance is when I was fasted without supplementation and it seems I could easily access my fat stores and breath more effortlessly.

I’m far from a high level athlete, but when I perform at my best cycling or in my kettlebell workouts, my breathing seems effortless and my time to exhaustion increases.   When we are insulin sensitive and / or don’t have excess glucose in our system and burn more fat for fuel we use less oxygen than when we burn glucose for energy.[17]  That reduction in oxygen usage is critical to make sure you don’t get out of breath and fatigue.  It seems that too much exogenous ketones or glucose in the system will mean that we’re less reliant on burning our own body fat.

I think the future of exogenous ketones in athletic performance will revolve around finding the right dose to boost ketones enough to get a performance benefit, without switching off lipolysis, which is where the real performance powerhouse lies.   If you put in so much fuel in line in front of your virtually unlimited fat stores, then you may risk gassing out because you can’t access your fat stores as easily.

Perhaps someone who is a normal carb burner might benefit from having ketones raised to the 3 or 4 mmol/L range, while someone who is more fat adapted might benefit more with ketones in the 1 to 2 mmol/L range so as to get a dual fuel boost without switching off fat burning?

It’s still early days.  Time and more experimentation will tell.

does it matter?

If you’re metabolically healthy and you enjoy the brain buzz of exogenous ketones more than alcohol or caffeine and want to use exogenous ketones as a pre-workout, then I say go your hardest if you can afford it.

However, if you are looking for improvements in your metabolic health or magical weight, I think you should be cautious.

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Companies like Ketopia are marketing exogenous ketones as a “bridge” through the keto flu, which I think is a more ethical approach (although many people say you can eliminate the ‘keto flu’ with good mineral supplementation).

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But you probably haven’t heard of Ketopia, because selling seven days’ worth of exogenous ketones isn’t a great business model in comparison to getting people to sign up for an ongoing subscription as a distributor buying thousands of dollars of ‘inventory’ up front so they can take it… Every.  Single.  Day.

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If you’re using exogenous ketones with the hope of reducing insulin levels or reversing metabolic disease (e.g. Type 2, cancer, Alzheimer’s, obesity), then maybe think again.  Exogenous ketones may alleviate your symptoms while they’re in your system (about 2 hours), but I fear they might worsen the conditions that people are using them for in the hope of improved metabolic health.

Mike Sheridan’s article in T-Nation makes a number of excellent points:

Ketones may be depressing dieters’ hunger and giving them a hit of energy and cognitive enhancement, but it’s INHIBITING their ability to burn fat, providing zero nourishment, and doing nothing for their metabolic health. There’s an assortment of evidence suggesting that it’s probably making things worse.

Think of exogenous ketones kind of like alcohol. When they’re consumed, everything is stored and nothing else is burned. So any lipolysis (fat burning) that would be taking place is halted; any glucose and fatty acids in your blood that were circulating are stored; and the ingested ketones are burned until there aren’t any left.

But suggesting individuals already fasting, restricting calories, or cutting carbs will get anything other than a brain buzz is misleading. And to serve up exogenous ketones to an obese, insulin-resistant general population with promises of fat-burning and disease prevention is potentially damaging.

Sure, it might suppress hunger and give a damaged brain a useable fuel source, but what happens when pre-diabetic Pete starts adding ketones to his glucose-rich blood? Or anaerobic Andy continues reloading with the same amount of carbs post-workout even though the liver glycogen he normally burns during his sessions is now suppressed?[18]

Sure, exogenous ketones might provide energy to the muscles or brain cells of someone with Type 2 or Alzheimer’s who can’t use glucose well because of decades of hyperinsulinemia.  But, if someone already has super high glucose and insulin levels, will they worsen the condition by chasing high ketone levels with large doses of insulinogenic exogenous ketones?

If someone is trying to shrink their brain tumour by reducing growth stimulating insulin, will ingesting large amounts of exogenous insulinogenic ketones accelerate growth in the brain tumors?  Recent studies suggest that this may in fact be the case.[19]

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At the current rate, it looks like we will be able to confirm the long term effects of exogenous ketones sooner rather than later.


But by then, the people running the MLMs will have driven off into the sunset and be on to another scheme.

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good news… endogenous ketones for free!

The good news is that all the benefits of endogenous ketosis is freely available risk free!

It’s not easy, but you can get the benefits of ketosis (e.g. autophagy, apoptosis, increased NAD+, mitogenesis etc) by keeping the insulin load of your normal diet down to the point that you can maintain normal blood glucose and insulin levels, then occasionally you can push the time between meals than usual in order to derive some extra benefits (i.e. intermittent fasting).

references

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

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC441933/

[3] http://www.webmd.com/diabetes/type-1-diabetes-guide/ketoacidosis

[4] http://www.webmd.com/diabetes/tc/diabetic-ketoacidosis-dka-topic-overview#1

[5] https://www.dropbox.com/s/hnycwc6b5pw37hr/Inhibition%20of%20Ketogenesis%20by%20Ketone%20Bodies%20in%20Fasting%20Humans.pdf?dl=0

[6] http://ajcn.nutrition.org/content/66/5/1264.abstract

[7] http://ses.library.usyd.edu.au/handle/2123/11945

[8] http://ajcn.nutrition.org/content/90/4/986.short

[9] https://www.ncbi.nlm.nih.gov/pubmed/27475046

[10] https://www.dropbox.com/s/j66y3osyasvq3b3/KETONES%20and%20NICOTINIC%20ACID%20receptor.pdf?dl=0

[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1152056/

[12] https://www.ncbi.nlm.nih.gov/pubmed/27869525

[13] http://www.nutraingredients.com/Markets-and-Trends/Ketones-get-rough-ride-at-Tour-de-France

[14] http://journals.lww.com/acsm-msse/Abstract/publishahead/A_Ketone_Ester_Drink_Increases_Postexercise_Muscle.97232.aspx

[15] http://www.nourishbalancethrive.com/blog/2016/10/10/instant-ketosis-04-62mm-30-minutes/

[16] http://www.nourishbalancethrive.com/podcasts/nourish-balance-thrive/high-ketones-and-carbs-same-time-great-performance/

[17] http://www.freemocean.com/2017/02/22/oxygen-and-your-dna/

[18] https://www.t-nation.com/diet-fat-loss/avoid-this-ketogenic-rip-off

[19] https://link.springer.com/article/10.1186/s40170-017-0166-z

chocolate orange smoothie

This recipe is from Carrie Brown’s Eat Smarter! Smoothies and Sides.  While not particularly low carb due to the orange, it packs a solid amount of nutrients.

ingredients

  • 1 cup / 8 fl oz. unsweetened coconut
  • milk ⅔ cup / 2 oz. / 55g powdered egg white
  • 1 oz. / 30 g unsweetened cocoa powder
  • 2 oranges, take zest from one orange before peeling
  • ½ tsp. sea salt
  • ½ tsp. orange essence
  • 1 head Romaine lettuce
  • Xylitol as needed to sweeten
  • ½ tsp. guar gum

directions

  1. Place ingredients in the blender in the order listed, except guar gum.
  2. Blend on high until completely smooth.
  3. Tap the guar gum through the hole in the blender lid while the blender is still running and blend for 5 seconds.

15174403_1287439231297830_814297128_n

The micronutrient breakdown is shown below indicating that it does quite well in terms of vitamins, minerals and protein.

2016-11-19-20

The table below shows the nutritional data per 500 calorie serving.

net carbs insulin load carb insulin fat protein fibre
27g 56g 48% 16% 53g 26g

high nutrient density, high energy density foods for athletes

If you’re an athlete, the “problem” with nutrient dense foods like non starchy vegetables and organ meats is that it can be hard to get enough fuel to support your activity.

Foods designed for athletes are energy dense but are not nutrient dense but rather are fast burning foods that don’t contain a lot of essential nutrients.  These foods may provide fuel for the short term, but they can lead to gut distress in the short term and as well as inflammation and insulin resistance in the long term.

To overcome these problems, this list of foods has been designed to be both nutrient dense and energy dense to ensure someone who is very active can get enough fuel while maximising nutrient density as much as possible.

energy density

The energy density of the foods listed below comes out at 367 calories per 100g compared to 231 calories per 100g for all foods in the USDA foods database.  They will contain enough energy to fuel an active life without spending all day chewing or overfilling your stomach.

macronutrients

From a macronutrient perspective these foods will provide you with:

  • more protein for muscle recovery,
  • more fat to provide energy,
  • more fibre due to the lower level of processing, and
  • less non-fibre carbohydrates which will normalise blood blood glucose levels while still providing some glucose for explosive power.

micronutrients

The chart below shows that these foods are quite nutrient dense, with all of the nutrients achieving greater than the daily recommended intake.

nutrient dense, energy dense foods for athletes

Listed below are the top 10% of the foods using this ranking including:

  • nutrient density score (ND)
  • energy density (calories/100g) and
  • their multi criteria analysis score (MCA).

vegetables

While the vegetables and spices in this list aren’t particularly energy dense they will ensure that you get the vitamins and minerals you need to perform at your best.  The lower energy density vegetables have been removed because they won’t be that helpful fueling for race day.

food ND calories/100g MCA
spinach 17 23 1.6
yeast extract spread 11 185 1.4
seaweed (wakame) 13 45 1.3
portabella mushrooms 13 29 1.2
shiitake mushrooms 7 296 1.1
broccoli (sulforaphane) 11 35 1.0
shiitake mushroom 11 39 1.0
seaweed (kelp) 10 43 0.8
cauliflower 9 25 0.7

seafood

Seafood packs some nutrient density and energy density at the same time.

food ND calories/100g MCA
cod 13 290 1.9
crab 14 83 1.4
anchovy 10 210 1.3
salmon 11 156 1.3
lobster 13 89 1.3
fish roe 11 143 1.3
caviar 8 264 1.2
halibut 11 111 1.2
trout 10 168 1.2
sturgeon 10 135 1.1
crayfish 11 82 1.1
pollock 10 111 1.0
oyster 10 102 1.0
shrimp 10 119 1.0
haddock 9 116 0.9
rockfish 9 109 0.9
sardine 7 208 0.9
octopus 8 164 0.9
flounder 9 86 0.8
white fish 9 108 0.8
perch 8 96 0.8
mackerel 4 305 0.7
whiting 7 116 0.7
herring 5 217 0.7
tuna 6 184 0.7
clam 6 142 0.6
scallop 7 111 0.6

eggs and dairy

Eggs are nutritionally excellent.  Butter has plenty of energy.

food ND calories/100g MCA
egg yolk 6 275 0.9
butter -5 718 0.7
whole egg 5 143 0.5

fats and oils

Fats and oils don’t contain a broad range of micronutrients, but they’re a great way to fuel without excessively raising your blood glucose or insulin too.  From an inflammatory perspective they’re going to be better than process grains and glucose for fueling as well as keeping insulin levels low to enable you to access your fat stores during endurance activities.

food ND calories/100g MCA
grapeseed oil -4 884 1.3
peanut oil -5 884 1.1
olive oil -6 884 1.1
soybean oil -6 884 1.1
beef tallow -6 902 1.1
duck fat -6 882 1.1
soy oil -6 884 1.1
lard -6 902 1.1
coconut oil -7 892 1.0
walnut oil -7 884 1.0
palm kernel oil -6 862 1.0
mayonnaise -4 717 0.8

grains and cereals

The more nutrient dense bran component of wheat makes the cut, however the more processed and more popular grains don’t make the list. Many people find use the “train low, race high” approach to be useful to ensure you are fat adapted through fasted or low glycogen training but have some glucose in the system for explosive bursts on race day.

food ND calories/100g MCA
wheat bran 10 216 1.3
baker’s yeast 12 105 1.2
oat bran 5 246 0.8

legumes

Legumes are moderately nutrient dense and have a higher energy density than most vegetables.  Properly prepared legumes can be a cost effective way of getting energy and nutrients, though not everyone’s gut handles them well.

food ND calories/100g MCA
peanut butter 1 593 1.1
soybeans 2 446 0.9
peanuts -1 599 0.9
cowpeas 2 336 0.6
black beans 1 341 0.5
broad beans 1 341 0.5

nuts and seeds

Nuts and seeds are a great way to get some energy in, though they’re not as high in the harder to find nutrients.

food ND calories/100g MCA
sunflower seeds 4 546 1.4
pumpkin seeds 1 559 1.1
almond butter 0 614 1.1
almonds 0 607 1.0
pine nuts -2 673 1.0
walnuts -1 619 1.0
brazil nuts -2 659 1.0
flax seed 1 534 1.0
sesame seeds -2 631 0.9
sesame butter -1 586 0.9
hazelnuts -2 629 0.9
macadamia nuts -4 718 0.8
pecans -4 691 0.8
cashews -2 580 0.7
pistachio nuts -2 569 0.7

animal products

Organ meats also do well in terms of nutrient density.  Fattier cuts of meat will pack some more energy.

food ND calories/100g MCA
lamb liver 12 168 1.4
veal liver 10 192 1.2
ham (lean only) 11 113 1.2
lamb kidney 11 112 1.2
beef liver 9 175 1.1
chicken liver 9 172 1.1
turkey liver 9 189 1.0
pork chop 8 172 0.9
chicken breast 8 148 0.9
pork liver 7 165 0.8
beef kidney 7 157 0.8
pork shoulder 7 162 0.7
veal 7 151 0.7
leg ham 6 165 0.7
ground pork 6 185 0.7
lean beef 7 149 0.7
sirloin steak 5 177 0.6

micronutrients at macronutrient extremes

In the previous article, Which Nutrients is YOUR Diet Missing?, we looked at the micronutrients that you might be lacking when following popular dietary strategies such as vegan, Paleo, keto, or zero carb.

As a follow-up, I thought it would be interesting to look at the effect on essential micronutrients if we define our dietary approach in terms of macronutrient extremes such as low carb, high fat, high protein, high carb, or low protein.

Humans tend to think in extreme terms.  It’s easy to follow a binary approach to nutrition, but which, if any, of these are the most useful in terms of maximising the nutrition provided by our diet?

For most of my life, best practice nutrition has been defined by a fear of fat which spawned the low-fat processed food era.

And because protein is necessary for muscle growth, more must be better?

But protein is also insulinogenic, so less protein must be good.  Right?

And then of course there is low carb, which has been popular since the appearance of the Atkins diet appeared in the early 1970s.

atkins.jpg

But then there are a good number of people who still define their diet as being high carb.

Banana-girl-.jpg

All of them seem to be similarly zealous about their all-or-nothing approach.

But are any of these macronutrient extreme approaches beneficial?  And if so, which one leads us to the optimal selection of nutritious foods that will lead to health, happiness, optimal weight, and longevity?

why bother with nutrient density?

The premise of nutrient density is that we want to maximise the quantity of essential micronutrients that we need to support our bodily functions while not overdoing energy intake.

Micronutrient dense foods allow us to obtain adequate nutrition with fewer calories.  Then, with our nutrients accounted for, higher micronutrient density might just lead to higher satiety levels, reduced appetite, reduced food intake and optimal body fat levels.

At the other extreme, if we consume fewer foods with a lower nutrient density, we will likely end up needing to consume more food to obtain the nutrients we need to survive and thrive.  If our appetite drives us to keep on eating until we obtain the nutrients we need, we may end up having to consume too much energy and and end up storing unwanted energy as fat.

macronutrient comparison

In this post, we’ll look at the micronutrients provided by the highest-ranking foods when we sort the eight thousand foods in the USDA database by the most and least fat, protein, and carbs.

Approach % protein % fat % net carbs % fibre
high fat 14% 82% 3% 1%
low net carbs 33% 67% 0% 0%
most nutrient dense 49% 19% 20% 12%
high protein 77% 22% 1% 0%
least nutrient dense 7% 32% 59% 2%
low protein 1% 27% 68% 3%
low fat 8% 1% 84% 7%
high net carbs 3% 2% 92% 2%

This chart shows the macronutrient split for these extreme approaches.

fat

While low carb is still in the lead in terms of internet searches (as shown in the Google Trends data below), the ketogenic diet is becoming pretty popular these days.

The chart below shows the nutrients provided by 2000 calories of the fattiest foods.  Nutrients are expressed in terms of the percentage of the daily recommended intake (DRI), for each nutrient, per 2000 calories (i.e. a typical daily intake).

While we achieve adequate amounts of about half of the essential micronutrients with a therapeutic ketogenic diet, we may need to consider supplementing some of the harder to obtain nutrients such as vitamin C[1], vitamin D, potassium, choline, vitamin K, and magnesium.

Looking at things from the other extreme, a low-fat diet will give you a ton of vitamin C, sodium, manganese, and iron.  However, it will be harder to obtain adequate quantities of the twenty-one essential nutrients, particularly essential fatty acids.

saturated fat

These days, the US Dietary Guidelines have lifted their limit on fat and cholesterol but retained their limitation on saturated fat.  Saturated fat and trans fats remain the two nutrients that we are advised to avoid.

The chart below shows the outcome when we avoid saturated fat.  The top 10% of foods with the lowest saturated fat are lacking (i.e. < 100% DRI) in nineteen essential nutrients.

At the other extreme, foods with the most saturated fat are slightly better with seventeen essential micronutrients lacking.

As discussed in the ‘What about Saturated Fat?’ article, I think saturated fat is neither a concern nor a priority.  Saturated fat a great clean-burning fuel, but there’s no need for us to make up for the last four decades of avoidance by suddenly binging on it.

The chart below shows a comparison of the nutrient density of the quartiles of saturated fat in terms of percentage of energy.  It seems that the foods with moderate levels of saturated fat that are the most nutrient dense.

protein

Once you move past the fear of fat, the next hot topic is optimal protein levels.

The ‘high protein bros’ recommend more protein for muscle growth and satiety, while many in the low carb/keto community target lower protein levels for longevity and ketosis through minimising insulin and mTOR signalling.[2]

As shown in the chart below, when rank foods to minimise protein, we end up with only four essential nutrients meeting the recommended daily guidelines to prevent malnutrition.

At the other extreme, if we prioritise protein we end up with ten nutrients that we fall short of.  The other twenty-six essential nutrients meet the minimum recommended levels.

Not only does protein contain essential amino acids, this analysis indicates that higher protein foods generally come bundled with high amounts of vitamins and minerals, such as vitamin B-12, selenium, vitamin B-6, riboflavin and copper.

It’s one thing to talk about targeting the minimum daily protein that you can get away with if you are looking to preserve muscle in fasting or extreme calorie deprivation during long term weight loss.  It’s a whole different discussion if you’re looking to minimise protein while making up the rest of your daily energy intake with fats or carbs!

carbohydrates

The chart below shows the nutrients we obtain if we maximise energy from non-fibre digestible carbohydrates (i.e. net carbs).  This high carb approach provides adequate amounts of twelve of the essential nutrients, while still being inadequate in twenty-four essential nutrients.

The chart below shows that low carb performs better than high carb, only falling short in sixteen essential micronutrients.

One of the benefits of a low carb approach, is that it often forces the elimination of many processed foods that fill the supermarket shelves to satisfy the demand for low fat foods driven by the admonition by the for the last four decades by the ruling dietary establishment to minimise fat.

A nutrient dense diet contains less non-fibre carb than the typical diet, but some people will do better, at least for a while, on a carb restricted diet.  Another major benefit of low carb is for insulin resistant people when they can lower their blood glucose and insulin levels on a carb restricted diet.  Many people find it easier to lose excess body fat once they have restored their insulin sensitivity.

nutrient density

You’re probably wondering where all these analyses are headed.

With all of these extreme approaches being so deficient in many micronutrients, you must be thinking “I hope there is a happy ending to this story, and soon.”

The good news is that we can manipulate our food selection to maximise micronutrients.  But first, here’s something to scare you even more.

The chart below shows the outcome when we minimise the harder-to-find nutrients.  This low nutrient density approach ends up being adequate in only three essential nutrients: sodium, vitamin C and iron.

The good news is shown in the chart below, which quantifies the nutrients provided by the most nutrient dense foods when we prioritise for the harder to find nutrients.  Alpha linolenic acid (found mainly in nuts and seeds) is hard to come by in adequate quantities, however we can obtain the daily recommended intake of all the other nutrients when we prioritise the harder to find micronutrients.

comparison of nutrients adequate

It’s a little hard to present and digest this analysis clearly.  There is no agreed protocol to compare the nutrient density foods.  So I’ve tried to summarise it in a number of different ways to allow you to draw your own conclusions.

Firstly, the chart below shows the number of nutrients that each macronutrient extreme is adequate in, from the most nutrient dense at the top to the least nutrient dense at the bottom.

The chart below shows a stacked bar chart of the various nutrients in terms of % DRI.  It’s like we have added up all the above charts for each nutrient and stacked them on top of each other.  This chart demonstrates that there is a is a massive difference between the most nutrient dense and least nutrient dense approaches.  If you’re foods that have a lower nutrient density you might just be hungrier compared to if you are eating the same number of calorie of the most nutrient dense foods which will much more effectively provide you with your essential micronutrients.

But  we needn’t be too concerned about the micronutrients that are easy to obtain.  What we really care about is the nutrients that are harder to obtain.  The chart below shows the sum of the eighteen nutrients that are harder to obtain for each extreme approach.

application

It seems that thinking in terms of macronutrient extremes has some usefulness.  However, focusing on micronutrient density seems to provide an order of magnitude improvement in the level of actual nutrients provided by our food.

Maybe it’s time for a new trend?

The ‘problem’ with nutrient dense foods is that that they are so lean and contain so much fibre that it can be hard to consume enough calories to maintain weight.  You’ll just be too full!

If you are insulin sensitive and not looking to lose weight, then you could consider adding some more ‘Paleo friendly’ carbs such as beets, squash, yams, and sweet potatoes, and/or some fattier cuts of meat to fuel your activity.  If you are insulin resistant, you may need to add some fattier (but still relatively nutrient dense) foods to maintain your weight while also keeping your blood glucose and insulin levels in check.

Perhaps micronutrient density is the most important parameter to pursue in our diet.  Then with that cornerstone in place we can personalise our nutritional approach to suit our goals (e.g. weight loss, ketosis, athletic performance or healthy maintenance).

The various food lists in the table below are designed with micronutrient density as the main priority, but also consider insulin load and energy density to suit different goals.

approach average glucose waist : height
(mg/dL) (mmol/L)
therapeutic ketosis > 140 > 7.8
diabetes and nutritional ketosis 108 to 140 6.0 to 7.8
weight loss (insulin resistant) 100 to 108 5.4 to 6.0 > 0.5
weight loss (insulin sensitive) < 97 < 5.4 > 0.5
bulking < 97 < 5.4 < 0.5
nutrient dense maintenance < 97 < 5.4 < 0.5

personalisation

In the end, no one sticks to an optimal list of foods that perfectly balances their diet 100% of the time.

I’ve been working on a system that will give you feedback on YOUR current diet, identify which nutrients you are currently lacking, and which supplements or real whole foods you may need to add or subtract to optimise your nutrition.  Most people don’t eat perfectly all the time, but we could all use some help moving forward towards optimal.

Check out the Nutrient Optimiser page for more details.

 

notes

[1] There is a strong case for the idea that the DRI for vitamin C could be relaxed for a diet with lower glucose.  See http://breaknutrition.com/ketogenic-diet-vitamin-c-101/ and http://orthomolecular.org/library/jom/2005/pdf/2005-v20n03-p179.pdf

[2] Check out this video by Ron Rosedale for an overview of the topic of protein, mTOR signalling and longevity.  https://www.youtube.com/watch?v=xtZ0LqUBySQ

which nutrients is YOUR diet missing?  

I recently took a look at which nutrients might be missing from various popular dietary approaches in preparation for a recent on nutrient density.  At a population level, the chart below shows the proportion of the US population that are deficient in various micronutrients.  Many people are not getting enough vitamin D, vitamin E, magnesium, calcium, etc.

While your body hasn’t read the World Health Organisation’s reports on the Daily Recommended Intake of the various essential nutrients,[1] it’s likely that your appetite will drive you to seek out the nutrients that are lacking.  If we are deficient in something that is required the body kicks in “nutrient hunger” and cravings that will make sure it gets what it needs.[2] [3] [4]

If you work hard to restrict your food intake to a certain dietary approach, but the body doesn’t receive the nutrients it needs, it may slow down and not function at full capacity.   By contrast, adequate nutrition, without too much energy, slows many of the modern diseases of aging such as diabetes, Alzheimer’s and cancer and improves your chance of living healthfully to a ripe old age.[5]

USDA foods database

The chart below shows the nutrients that are both easiest and hardest to obtain from the eight thousand foods in the USDA foods database.  At the bottom of this plot we have iron, various amino acids, and vitamin C, all of which are easy to obtain in adequate quantities.

However, at the top of the chart, we can see that it is much harder to obtain adequate quantities of six essential nutrients (omega 3 fatty acids, vitamin D, choline, vitamin E, and potassium).  We would obtain sufficient quantities of all the other essential nutrients if we ate just a little of each of the foods in the USDA food database.

If we want to maximise nutrient density, it makes sense to prioritise foods that contain more of the harder-to-obtain nutrients.  The chart below shows the nutrients for the top 10% of the 8000 foods in the USDA database (blue bars) when we prioritise for those.  Not only do we get an increase in the more difficult to obtain nutrients, we also get a massive boost in all nutrients.  Rather than being inadequate in six nutrients, we are now lacking only one (alpha-Linolenic acid, an Omega 3 fatty acid).

Limiting our food selection to the most nutrient dense foods makes it easier for us to consume the required nutrients without excessive energy, which is ideal if we are trying to lose fat or reduce calorie intake to slow the diseases of ageing.[6] [7]  Nutrient density becomes even more important if you’re fasting or restricting calories to achieve long term weight loss.

Optimising nutrient density

If you’re reading this, then you’re likely aware that there is a wide variety of dietary approaches that people follow to optimise their health depending on their preferences and beliefs.

I’ve tried to turn many of these beliefs about nutrition into a quantitative algorithm that we can use to evaluate and compare these approaches, and make sure we’re getting the outcome we want (e.g. low insulin, blood glucose control, nutrient density, or low/high energy density).

After testing a number of options, the three quantitative parameters that I have found the three parameters that are most useful are:

  • insulin load,
  • nutrient density, and
  • energy density.

My aim in this post is to show how considering nutrient density can improve various dietary approaches, from therapeutic ketogenic, vegan, paleo, and low fat.   This post highlights which nutrients you will most likely be lacking with each of the different nutritional approaches, which foods you can use to fill these nutritional gaps, and perhaps which supplements you may need if you are still looking for some added nutritional insurance.

There’s been a lot of talk lately by Taubes[8] and Lustig[9] about how bad sugar and fructose are, but I think these nutritive sweeteners are just extreme examples of nutrient poor foods that are highly insulinogenic and energy dense.  At the other end of the spectrum, we have foods like liver, broccoli, and spinach.  Everything else is somewhere in the middle and will support or work against your goals, whatever they may be, to different degrees.

My aim here is to help you see where each of these foods sits on that continuum and use this information to help you refine your food choices to reach your personal goals.

Therapeutic ketogenic diet

Let’s start with the therapeutic ketogenic dietary approach.   I have previously noted that a number of the issues and concerns with the ketogenic diet seem to relate to being able to obtain essential nutrients rather than consuming excessive levels of fat.[10] [11] [12]  On one hand, I’m excited that the concepts of insulin load and percentage of insulinogenic calories have been helpful for people with chronic conditions such as epilepsy, cancer, dementia, Alzheimer’s etc.  However, I think there is a risk their ultra-high fat diet will not contain the nutrients which are critically important for mitochondrial function and energy production.

The chart below shows the vitamins and minerals provided by a therapeutic ketogenic dietary approach if we simply prioritise for low insulin load (red bars)[13] in comparison to the average of all foods in the USDA database (orange bars).  If you don’t pay attention to nutrient density a therapeutic ketogenic diet can provide lower levels of nutrition.

As shown in the chart below if we ate a little of all the foods in the USDA database, we would be deficient in six essential nutrients, whereas if we follow a therapeutic ketogenic diet, we will likely be lacking in ten essential nutrients.

The chart below shows the effect of how thinking in terms of nutrient density can improve the therapeutic ketogenic dietary approach (blue bars) compared to prioritising for insulin load only (red bars).  All nutrients are boosted, particularly the harder to obtain ones.

While lots of people find that higher fat whole foods are hard to overeat, there are still some hyper palatable high fat foods that go down easily.  We talk about eating “fat to satiety”, but what happens when nutrient hunger kicks in and your body is craving more potassium, magnesium, calcium, or one of the other nutrients that are harder to obtain in a very high fat dietary approach?  If you keep on consuming large amounts of processed fats that don’t contain the nutrients you require, your appetite may not automatically turn off before you’ve consumed a lot of excess energy!

Low carb

The chart below shows the boost in nutrients when we consider nutrient density combined with a low carbohydrate approach.  It appears that, based on this analysis, that without a focus on nutrient density, a low carbohydrate diet is likely to be deficient in folate, vitamin D, choline, potassium, magnesium, pantothenic acid, calcium, vitamin E and manganese.  With a focus on nutrient dense foods, a low carb diet provides adequate amounts of the majority of nutrients.

Weight loss (insulin sensitive)

The weight loss approach is intended for people who are insulin sensitive but still have excess body fat to lose.  Foods with a lower energy density (e.g. spinach, broccoli cucumber, celery, lettuce etc) typically are harder to overeat because they are bulky.

This approach doesn’t pay any attention to insulin load because it is assumed that people using this approach are not insulin resistant and are able to maintain good blood glucose levels.  Practically, it’s also difficult to achieve a really high insulin load with these foods because they do not contain a large amount of processed carbs and are hard to overeat.

Without consideration of nutrient density, the essential fatty acids tend to be low along with vitamin B-12, choline, and tyrosine.  However, once we factor in nutrient density all these nutrients dramatically improve.

This approach may not be viable for long term maintenance due to the extremely low energy density which would make it hard to get in enough energy.  However, in the short term, it may be appropriate for a period of substantial energy restriction, and will provide maximum nutrition with a minimum amount of energy.

Zero carb

Getting adequate protein on a zero-carb approach is not a problem.  However, unless there is a major focus on organ meats, there are a large number of vitamins and minerals, such as   vitamin K, manganese, vitamin C, vitamin E, vitamin D, potassium, magnesium and calcium that may be worth supplementing.

Vegan

At the other extreme, the chart shows the nutritional analysis of the vegan diet.  The main deficiencies in a vegan approach are omega 3s and vitamin B-12, which are hard to obtain without animal products.  It may be prudent for vegans to consider fish oil supplementation and B-12 injections, or alternatively adding some seafood occasionally.

While it appears possible to obtain the recommended levels of protein, it’s hard to get very high levels of it.    If you are insulin resistant, the fat levels can be increased using added coconut products and nuts.

Higher insulin load foods for bulking

The bulking approach is designed for people who are looking to gain strength and size by combining nutrient density with more calories and insulin load.  Without consideration of nutrient density, a high insulin load means very low nutrient density foods.  However, once we factor in nutrient density, we get a range of highly nutritious foods that may be helpful if you want to gain size and strength, while still maximising health and nutrition.

Paleo

The chart below shows the nutrients provided by the Paleo approach (i.e. no processed foods, dairy or grains) both with and without consideration of nutrient density.  While ‘going Paleo’ eliminates many of the nutrient-poor processed food, it appears to be beneficial to also consider nutrient density as well in addition.

What does this all mean?

So, how do we decide which approach is best?  Unfortunately, it’s not straightforward so I’ll look at this a number of ways.

What we ideally want is to identify the foods that will provide us with high amounts of all of the nutrients.   The blue bars in the chart below represents the average of the % daily recommended intake of all the nutrients in the various approaches evaluated above, without considering nutrient density.  The orange bars represent the average minus 0.5 x the standard deviation which is a measure of reliability.  The higher the reliability the more consistent and high are the nutrients over all.

This chart shows that, in comparison to the other approaches, Paleo foods have a high and consistent level of nutrients; while the vegan and low energy density weight loss foods have high levels of some individual nutrients, but low levels of some others.  Without consideration of nutrient density, the high insulin, low carb and zero carb approaches are a bit lacking in nutrients.

Things become a little more interesting once we factor in nutrient density.  The vegan, therapeutic keto, low carb and zero carb approaches do poorly against the paleo, higher insulin load, most nutrient dense of all foods, and the lower energy density weight loss foods.

Many people will benefit on a high fat therapeutic ketogenic dietary approach, at least until their blood glucose and insulin levels normalise.  However, in time, it may be beneficial to transition to more nutrient dense foods to continue their journey towards optimal health.

As detailed in the ‘how to optimise your diet for insulin resistance’ article, I think you should eat the most nutrient dense foods your pancreas can keep up with while maintaining good blood glucose levels.  In time, someone who is highly insulin resistant may be able to progress to a more nutrient dense and more moderate fat approach if your ultimate goal is to normalise blood glucose levels and lose weight.

Food lists

If you identify with any of these goals, you may be interested in following these food lists.   If blood glucose levels are sky high or you are managing a chronic condition such as epilepsy, cancer, Alzheimer’s or dementia, you may benefit from a higher fat therapeutic keto dietary approach, for a period.  As your glucose levels come under control, you can transition to more nutrient dense foods that will also help you to achieve your weight goals.

approach average glucose waist : height

(mg/dL)

(mmol/L)
therapeutic ketosis

> 140

> 7.8
diabetes and nutritional ketosis

108 to 140

6.0 to 7.8
weight loss (insulin resistant)

100 to 108

5.4 to 6.0

> 0.5

weight loss (insulin sensitive)

< 97

< 5.4

> 0.5

bulking

< 97

< 5.4

< 0.5

nutrient dense maintenance

< 97

< 5.4

< 0.5

Getting even more personal

As you can see, nutrients are provided at different levels depending on the approach.  However, most people don’t follow any dietary approach strictly, so the nutrients in your diet will be different depending on your personal habits and preferences.

Rather than trying to pick up someone else’s nutrition plan, or live by a strict list, I think it’s better to refine your current habits, emphasising the good foods, minimising the bad, and progressively trying new foods that may be beneficial.

To this end, I’ve been developing a Nutrient Optimizer algorithm that can help you refine your food choices to suit your goals.  By identifying the foods you are currently eating that align most with your current goals, which ones don’t, and which new foods perhaps you should consider.

Most current nutritional advice is driven by the avoidance of fat, particularly saturated fat, and therefore ends up being next to useless.  Calorie counting apps like MyFitnessPal does nothing but count calories, which is also of limited use.  Cron-o-meter tracks your micronutrients and can recommend foods to boost a single nutrient.  However, there doesn’t seem to be anything available that will tell you which foods will help you actually correct multiple deficiencies and  achieve a diet that is truly balanced in micronutrients.

The Nutrient Optimiser also allows you to tailor the approach to your goals, such as:  therapeutic ketosis, diabetes management, weight loss or just nutrient dense maintenance.  Food preferences like vegan, pescetarian, autoimmune, or paleo can be factored in to the recommended food lists.

At the moment, the process involves manually exporting food intake data from Cron-o-meter, then analysing it in a spreadsheet to manually generate a personalised report.  I am eager to do this as a proof-of-concept for a range of people with various goals (particularly therapeutic ketosis, vegetarian, zero carb, fruitarian) to demonstrate how it works.  So, if you’re happy to have your report shared publicly, and have a couple of weeks of Cron-o-meter data, feel free to send it to me and  have your data analysed.

In time, the plan is to automate the process via an online interface and then ideally an independent mobile app.    To keep up-to-date with progress, watch this space and check out the various analysed examples on the Marty Kendall’s Nutrient Optimiser Facebook page.

Epilogue…  limitations

For completeness, I thought it would be worth mentioning a few limitations relating to calculating nutrient density…

  1. Measuring foods in terms of calories has its own limitations as different macronutrients provide different amounts of energy (ATP) in different people. Some smart friends of mine are working on calculating ATP yield for different foods based on their macronutrient content.  I’ll happily update this analysis in terms of nutrients per ATP as soon as that data is available.  Initial indications are that people who are fat-adapted are able to use fat more efficiently (i.e. less entropy/losses in metabolism) and hence require less calories to yield the same amount of energy in the body (i.e. ATP).  Hence, it appears that it is even more important for someone following a low carb or ketogenic approach to maximise nutrient density in terms of nutrients per calorie.
  2. The official dietary reference values are based on limited research.[14] Typically, they relate to the minimum amount of a nutrient to avoid disease rather than the amount required for optimal function.  They may also vary by person (e.g. someone who is more active may need more protein) and by their diet type (e.g. someone who is on a low carb diet may need less vitamin C to process the limited amount of glucose).  Hence, I think the DRI values should be seen as a minimum.  Ideally, we want to get more than the minimum while not having to ingest too much energy.  I also don’t think nutrients are meant to come as individual vitamins and minerals in a bottle.  The nutrients required to metabolise a certain food typically come packaged in whole foods, and often work synergistically.  Taking supplements or fortifying foods will always be inferior to obtaining nutrients from whole foods.
  3. Species-specific bioavailability and anti-nutrients are contentious topics. Zero carbers will tell you that nutrients in animal based foods are more bioavailable than plant based foods, while the vegans will tell you the opposite.  To date, I haven’t been able to find useful data that would enable me to quantitatively refine the nutrient data in the USDA database regarding bioavailability.  All we currently have is a measure of the nutrients contained in the food– rather than the nutrients that make it into your body after digestion.  Again, if this data ever comes to hand, I’ll eagerly update the analysis.

Overall, I don’t think these limitations make a difference in the outcomes of the analysis.  This is not an exact science and the body doesn’t operation like a rigid machine.  Calculation of nutrient density is just a way to identify the foods that contain the most raw materials with the least amount of calories that your body can work with.

referecnes

[1] http://www.who.int/nutrition/publications/nutrient/en/

[2] https://books.google.com.au/books?id=gtQyAgAAQBAJ&pg=PA185&lpg=PA185&dq=%22nutrient+hunger%22&source=bl&ots=VMRQ8EbvHx&sig=l_xJEksBS538UX3QwQNxVJBXTLw&hl=en&sa=X&ved=0ahUKEwjRj6mSs5DSAhWKyLwKHXBQAjEQ6AEIKDAC#v=onepage&q=%22nutrient%20hunger%22&f=false

[3] https://www.amazon.com/Perfect-Health-Diet-Regain-Weight/dp/1451699158

[4] https://www.amazon.com/Dorito-Effect-Surprising-Truth-Flavor/dp/1476724237

[5] https://optimisingnutrition.com/2016/03/21/wanna-live-forever/

[6] http://ajcn.nutrition.org/content/78/3/361.full

[7] http://www.nature.com/articles/ncomms14063

[8] https://www.amazon.com/Case-Against-Sugar-Gary-Taubes/dp/0307701646

[9] https://www.youtube.com/watch?v=dBnniua6-oM

[10] https://www.thepaleomom.com/adverse-reactions-to-ketogenic-diets-caution-advised/

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

[12] http://www.thelivinlowcarbshow.com/shownotes/10888/868-dr-sarah-ballantyne-challenges-the-wisdom-of-low-carb-diets-for-women-2/

[13] In terms of macronutrients this high fat dietary approach comes out at 80% fat, 15% protein, 2% fibre and 3% net carbs.

[14] http://www.who.int/nutrition/publications/nutrient/en/

superfood salad with liver, seaweed and saurkraut

This superfood salad is from Kate Johnson of Eat, Recycle, Repeat and was published as guest blog on Sarah Ballantyne’s Paleo Mom (see recipe here).

It’s the chicken liver and the seaweed along with the sauerkraut, mustard and coconut oil that make this salad so super with a spectacular score in both the vitamins and minerals score as well as the protein quality score.

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The details per 500 calorie serving are listed below.

net carbs

insulin load carb insulin fat protein

fibre

12g

36g 32% 52% 35% 5g

analysis of what a nutritionist eats and hospital food

An article in Business Insider, A Nutritionist Shares Pictures of Everything She Eats in a Day, caught my eye recently.  I thought it would be interesting to run the numbers to see how the food diary logged by this nutritionist compared to the four hundred or so meals that I’ve analysed.

Check out the original article if you want to see the daily food log chronicled in photos by the popular and published “Registered Dietician”, who claims to specialise in diabetes and is “passionate about being a good role model.”[1]

The quantities and foods that I analysed in the recipe builder at SELFNutritionData are shown below.  Besides the fact that the only green things she ate during the day were M&M’s, the food log is not particularly divergent from mainstream dietary advice (i.e. no full-strength Coke or McDonald’s).  The nutritional analysis would be much worse if it was a diet full of junk food, which is pretty common for a lot of people these days in this fast-paced convenience-loving world.

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This dietician is a national media spokesperson for the Academy of Nutrition and Dietetics.  She has published books and written for several magazines.[2]  Like most nutritionists, she argues for less fat and more whole grains.[3]

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So, let’s see how her daily diet stacks up.  The analysis below shows that, when we compare this daily diet against mainstream dietary advice that nutritionists prescribe, it ticks the following boxes:

  1. avoids trans fats,
  2. is low in fat, and
  3. is low in cholesterol.

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However, even though the diet is fairly low in fat, it has 29g of saturated fat which is greater than the Heart Association’s recommendation for a maximum of 16g of saturated fat per day.[4]   Unfortunately, the recommended limit of saturated fat is actually quite hard to achieve without relying on low fat highly processed foods.

Ironically, due to the focus on avoiding fat and trying to incorporate more “heart healthy whole grains”, the food recommended by nutritionists ironically tends to be lacking in nutrients.  It makes no sense!

The registered nutritionist’s daily food log also contains more than 400 grams of carbohydrates which will be a massive challenge to someone who is insulin resistant, would likely generate insulin resistance and eventually diabetes in someone who isn’t there yet.

For comparison, check out the analysis shown below of one of my regular meals (stir-fry veggies with some butter and sardines) which has a much higher vitamin and mineral score (94 compared to 55) and better protein score (139 compared to 66).

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When it comes to nutrient density and being diabetic friendly, this nutritionist’s daily food log ends up at the bottom of the pile of the four hundred meals that I’ve analysed!

It’s sad that this myopic one-size-fits-all dietary advice is forced on anyone who asks what they should be eating, or anyone whose food is influenced by government nutritional guidelines (e.g. hospitals, schools, jails, nursing homes etc).

Then we are told that dieticians are the only ones that are qualified to give dietary advice, even though the dietary advice that they give revolves around avoidance of saturated fat and more “heart healthy whole grains” and does not actually lead to high levels of micronutrition.

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Where it gets even sadder is that this sort of short sighted advice is also given to the people who are the most vulnerable.  The photo below is of Lucy Smith in hospital after being diagnosed with Type 1 Diabetes.  The diet given to her, as a newly diagnosed Type 1 Diabetic, is Weet-Bix, low fat milk, bananas, low fat toast, orange juice, and peaches.

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The analysis for Lucy’s hospital-provided breakfast is shown below.

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This single meal contains more than 200 grams of carbohydrates (82% of calories).  This breakfast would require a ton of insulin to be injected into her little body, and she would be on a blood glucose / insulin rollercoaster for days to come.

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When it comes to nutrient density, this meal has an even lower score than the day in the life of the nutritionist’s own diet discussed above!  Ironically, this hospital prescribed meal ranks at the very bottom of the list of four hundred meals when ranked to identify the best recipes for people with diabetes!

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Unfortunately, things don’t seem to have changed much from thirty years ago when my wife Monica was diagnosed with Type 1 Diabetes.  In hospital, after diagnosis, she was given so many carbs that she hid the food in pot plants in her hospital ward room because she just couldn’t eat anymore!  Twenty-five years later, she learned about the low carb dietary approach and she was finally able to reduce the high levels of insulin required to cover her food.

I’ve witnessed firsthand the massive improvements in quality of life (body composition, inflammation, energy levels, dental health etc) when someone comes off the blood glucose/insulin roller coaster!

Monica has been able to halve her daily insulin dose since no longer ascribing to the dietary advice she has been given by the dieticians and diabetes educators.  Her blood glucose levels are now better than ever and when she goes to the dentist, podiatrist and optometrist they tell her she’s doing great and they wouldn’t even know she’s diabetic.  And I get to have my wife around for an extra decade or two!

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By the way, Lucy is doing well now too.  Her parents are some of the most knowledgeable people I know when it comes to optimal foods for diabetics and monitoring blood glucose (as shown in this video from her father Paul).

My friend, Troy Stapleton, is another example of someone living with Type 1 Diabetes who has benefited immensely from a low carbohydrate dietary approach that aligns with his metabolic health.  His story and approach has been an inspiration to me.  You can also check out the Standing on the Shoulders of Giants article for a few more encouraging stories of people with Type 1 who got their life back after going against nutritionists orders.

As detailed in the article How to optimise your diet for your insulin resistance, if you have the luxury of being more metabolically healthy (i.e. not diabetic) you can focus on more nutrient dense foods or lower energy density if you’re looking to lose some weight.

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It amazes me that dieticians can be so militant and belligerent when they are largely passing on the recommendations of the US Department of AGRICULTURE (i.e. the USDA, also known as “Big Ag”), whose mission it is to promote the economic opportunity and production of AGRICULTURE[5] (i.e. grains and seed oils).  Talk about putting the fox in charge of the hen house!

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Speaking of conflicts of interest, it’s worth noting that major nutritionist organisations funding ‘partners’ are big food manufacturers.[6]  Does this influence the recommendations they give?  They claim not.

It’s hard to believe their published research or dietary recommendations could be impartial when so heavily sponsored by the food industry.

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Despite these conflicts of interest and a poor track record of success over the past four decades, I don’t think we should be gagging the Accredited Dietitians from publishing poor nutritional advice.  Everyone should be entitled to their freedom of speech and freedom to choose what they eat.

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What I do find ironic is that dieticians can bring spurious cases of malpractice against doctors to their governing bodies when they are acting in line with latest research and their personal, professional and clinical observations (e.g. Tim Noakes in South Africa and Gary Fettke in Australia).  At the same time, the Registered Dieticians have no governing body to report to, only their board of directors[7] and their ‘partners’.

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While they purport to be protecting the public interest, one could be excused for thinking that the dieticians’ associations are another marketing arm for big food companies and are protecting commercial interest rather than acting on behalf of public health.

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Is it just a coincidence that Nestle’s Milo, which is half sugar, is prescribed by hospital dieticians for pregnant and breastfeeding mothers with diabetes?

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Unfortunately, the situation isn’t that much different with the diabetes associations.[8]  Why would these institutions ever make recommendations to their members that reduced the amount of medications they needed or reduce the amount of processed food when their financial partners are pharmaceutical companies who manufacture insulin and drugs for diabetes?

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What would happen to this financial structure if a significant amount of people started eating whole unprocessed food without a bar code?  The share price of these massive medical and pharmaceutical companies would tank!

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After battling cancer himself and studying the role of nutrition in metabolic and mitochondrial disease in depth, Gary Fettke now spends his days as an orthopaedic surgeon amputating limbs mainly due to the complications of diabetes.

No, it’s not pretty, but unfortunately it’s very very real.

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Each year Gary volunteers as an orthopaedic surgeon in Vanuatu.[9] [10]  The contrast between the native people living in their natural environment, eating their native foods, and their relatives in town, eating processed foods, is stark.

I took this photo in a traditional village during our holiday in Vanuatu a couple of years ago.  These people eat lots of coconuts (which contains plenty of saturated fat, one of the remaining nutrients that Registered Dieticians still say we should avoid) and fish. These Vanuatu natives are some of the most beautiful, healthiest and happiest people I have ever seen!

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Unfortunately, in the capital Port Vila, it’s not so pretty.  The diabetes rates are the third highest in the world.  One in fifty Vanuatu natives have had an amputation!

It is such a big problem. Their diet has changed quite rapidly over the years, so instead of eating their island’s food, they now eat very large quantities of white rice and of course all the liquid sugar, like Coca-Cola and Fanta, and it’s literally killing them.[11]

After seeing the impact of diet, Gary has been outspoken in Australia, bringing attention to the quality of food that people are eating, especially in hospitals.[12]

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Gary and his Nutrition for Life Centre also worked with Chef Pete Evans on the “Saving Australia Diet” on national TV with great results achieved.[13]

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Then, in return for his efforts, Gary has been reported by the certified dieticians to the Australian Health Practitioner Regulation Agency; and he has been told he can no longer tell his patients to limit sugar even if they have just had their leg amputated due to the complications of diabetes.

Similarly, Tim Noakes has developed a massive following after realising that he needed to go against his own previous publications and advice, when he found he was developing diabetes. The recipe book that he helped write, The Real Meal Revolution, is filled with nutrient dense low carb meals that help people with diabetes achieve normal blood glucose levels, has been massively popular.

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Despite his impressive track record of real results, which goes against the general trend of the explosion of diabetes and obesity in western society, Professor Noakes has been reported to the Health Professionals Council of South Africa (HPCSA) and charged with unprofessional conduct, after suggesting that a mother wean her baby on to whole foods rather than processed “baby food”.

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This has led to a long and expensive court case which really appears to be more about maintaining the status quo on the supermarket shelves rather than public health.[14]

I think most nutritionists believe that they are doing the right thing by advising their clients to prioritise the avoidance of fat, cholesterol and saturated fat, and eat “heart healthy whole grains”.  However, the foundation of this advice seems to be crumbling from underneath them with the most recent updates to the US Dietary Guidelines that now remove the upper limit on fat and removing cholesterol a nutrient of concern.[15] [16]

However, if we have to rely on Big Food to provide processed food products to achieve the reduced saturated fat aspirations of the dietary guidelines (and in so doing produce very otherwise nutrient poor foods), then perhaps we need to declare them broken and look for new ones?

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Makes you wonder how we survived (let alone thrived) with the food that were available to us before the highly-processed foods and the low fat dietary guidelines that came to dominate our food choices in the 1970s.

Unfortunately though, fear of saturated fat still dominates the majority of mainstream dietary recommendations out there and leads to nonsensical food rankings that only suit the grain based food industry.[17] [18]

For example, the simplistic Australian Health Star Rating is based on the energy, saturated fat, sodium, sugar content along with the amount of fruits and vegetables in a product.[19]  This avoidance-based process gives little consideration for the amount of essential nutrients in a product, regardless of where they came from, and hence often returns nonsensical results.

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It’s hard to tell whether the attacks on people like Fettke and Noakes are motivated by:

  1. Well-meaning nutritionists who earnestly believe that higher levels of fat and a lack of “heart healthy whole grains” is going to harm people,
  2. Nutritional institutions sensing that they are becoming irrelevant and making a last-ditch attack at their adversaries in an effort to hold onto their jobs,
  3. Processed food manufacturers (i.e. big food) using their “partner organisations” to attack these outspoken thought leaders so they can maintain their strangle hold on nutritional advice that suits them and sells more of their product (i.e. it’s not a conspiracy, it’s just business), or
  4. Some combination of each of these options.

To cut through the confusion and conflicts of interest, wouldn’t it be great if there was an unbiased quantitative way to judge whether a particular food or meal was optimal based its nutrient density?  Perhaps we could even tailor food choices based on blood glucose and metabolic health (i.e. using insulin load), or by manipulating energy density of someone who is insulin sensitive but just needs to lose weight.

If you’ve been following this blog, you may have seen the optimal food lists tailored to specific goals.  To this end, I have devised a system to identify foods for different goals and situations. The table below will help you choose your ideal dietary approach and optimal foods based on your blood glucose levels and waist to height ratio.

approach average glucose waist : height
(mg/dL) (mmol/L)
therapeutic ketosis > 140 > 7.8
diabetes and nutritional ketosis 108 to 140 6.0 to 7.8
weight loss (insulin resistant) 100 to 108 5.4 to 6.0 > 0.5
weight loss (insulin sensitive) < 97 < 5.4 > 0.5
nutrient dense maintenance < 97 < 5.4 < 0.5

The first step in improving your nutrition is to minimize processed food that is laced with sugar.  These food lists can help you further optimise your food choices to suit your goals whether they be blood glucose management, weight loss or just maintaining optimal health.

Once you normalise your blood glucose levels, you can then start to focus more on nutrient density.  If you still have weight to lose, then you can focus on foods with a lower energy density to force more energy to come from your body while still maximising nutrition.   You can also find the highest ranking of the four hundred meals that I have analysed listed here.

Several people recently have suggested that I turn the nutrient density ranking system into a mobile app for easy implementation of the ideas and theories outlined on the blog in the real word.

So, my current project is to develop a Nutrient Optimiser that would rank the foods you have eaten based on your current goals (e.g. therapeutic ketosis, diabetes management, weight loss or maximising nutrient density) and recommend new foods to try.  The Nutrient Optimiser would progressively retrain your eating patterns towards ideal by helping you to maximise the more optimal foods, and progressively eliminate the foods that don’t align with your goals.   Whether you are trying to eat less Maccas, or you are practicing Calorie Restriction with Optimal Nutrition (CRON) and trying to live to 120, the Nutrient Optimiser would push you forward to truly optimise your nutrition.

The idea is not to simply create another calorie counting app.  There are plenty of those out there already.  Rather, the Nutrient Optimiser will help you to maximise nutrient density as much as you can, while catering to your other goals.

Rather than being centred on outdated “science” and avoiding boogeymen such as cholesterol, fat and saturated fat, or serving the interest of “financial partners” (e.g. BigFood and BigPharma), the Nutrient Optimiser uses a quantitative algorithm that will help you maximise the nutritional value of the food you eat.

The Nutrient Optimiser, based on the foods logged in the past few weeks, helps you to identify foods that would provide the nutrients that you haven’t been getting as much of.  Rather than just tracking calories, the app will continually adapt to what you eat, ensure that you are getting a broad range of foods that contain the nutrients you need, and ensure you don’t get stuck in a nutritional rut.

For people just starting out, it will help them gently move forward, without the judgement of someone looking over their shoulder.  It will suggest foods they should buy more of, new foods to try, and maybe which foods they should bin and never buy again.

For people who are truly wanting optimal nutrition, it will hopefully be the ultimate tool to continue to refine their food choices to maximise nutrient density while optimising blood glucose, insulin and body fat levels.

As you continue to log your weight, blood glucose levels and whatever other metrics you want to track, the app will progressively prompt you to “level up” to a more optimal nutritional approach.  Then, with your nutritional deficiencies filled, the cravings will dissipate and you will naturally be satisfied with less food.[20] [21]

If something like this is of interest to you and you want to be an early adopter or just check it out the nutritional analysis of other people food logs that have been done so far then then take a look at the Nutrient Optimiser Facebook page and to stay posted as things develop.

references

[1] https://www.amazon.com/Ruth-Frechman/e/B007HDN5IW

[2] http://www.ruthfrechman.com/Meet_Ruth.html

[3] https://www.youtube.com/watch?v=LAugDpr16Jg

[4] http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Know-Your-Fats_UCM_305628_Article.jsp#

[5] https://www.usda.gov/documents/usda-strategic-plan-fy-2014-2018.pdf

[6] http://daa.asn.au/advertising-corporate-partners/program-partners/

[7] http://daa.asn.au/?page_id=136

[8] https://www.diabetesaustralia.com.au/corporate-partners

[9] http://www.hopeforhealthvanuatu.com/volunteers/

[10] https://www.facebook.com/permalink.php?story_fbid=857965770964542&id=393958287365295

[11] http://www.radionz.co.nz/international/programmes/datelinepacific/audio/201818486/hope-given-to-amputees-in-vanuatu

[12] http://www.nofructose.com/2014/12/19/hospital-food-is-crap-and-its-killing-my-patients-and-what-to-do-about-it/

[13] https://au.news.yahoo.com/sunday-night/features/a/31538041/the-saving-australia-diet/#page1

[14] http://foodmed.net/tag/tim-noakes/

[15] http://time.com/3705734/cholesterol-dietary-guidelines/

[16] https://therussells.crossfit.com/2017/01/05/big-food-vs-tim-noakes-the-final-crusade/

[17] http://healthstarrating.gov.au/internet/healthstarrating/publishing.nsf/Content/How-to-use-health-stars

[18] http://www.nuval.com/

[19] http://healthstarrating.gov.au/internet/healthstarrating/publishing.nsf/Content/excel-calculator

[20] http://sydney.edu.au/news/84.html?newsstoryid=12632

[21] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988700/

steak, eggs, spinach, brazil nuts and hallouimi

This is another one of my dad’s nutrient dense moderate protein meals.  He’s in a bit of a groove with the diced steak ready to do with the eggs, spinach and halloumi in the pan as the first meal of the day at between 1.00-2.00pm.

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Add some avocado, cucumber brazil nuts, broccoli sprouts and dulse flakes, salt & pepper and he’s good to go.

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Again, the nutrient density is great and we still get a keto / LCHF / diabetes friendly 70% fat without actually adding too much fat.

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The table below shows the nutritional data per 500 calorie serving.

net carbs Insulin load carb insulin fat protein fibre
4g 19g 13% 72% 29g 5g
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nutrient density optimised for diabetes, ketosis, weight loss, longevity and performance

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