Is the acetone:glucose ratio the Holy Grail of tracking optimal ketosis?

Key points

  • The real magic of ketosis seems to occur in a lower energy state.
  • High levels of beta-hydroxybutyrate ketones (BHB) can be a good sign, particularly with less glucose.
  • Unfortunately, forcing in extra energy in the pursuit of higher BHB levels (e.g. exogenous ketones or refined fat) has the potential to drive higher insulin and insulin resistance.
  • As we lose weight, improve our metabolic health and stop over fueling, many people start to see lower levels of BHB.
  • While it can be used as an alternative to glucose in the brain, BHB needs to be converted to acetoacetate to be used by the body.
  • If you are making and using ketones without consuming excessive energy you will likely see lower blood glucose, higher breath acetone and lower BHB levels.
  • The ratio between breath acetone and glucose can be a useful indicator of genuine nutritional ketosis and a healthy metabolism.

Introduction

In previous articles we’ve looked at why chasing higher blood ketones with more dietary fat or exogenous ketones might not be smart.[1] [2]

We also looked briefly at the glucose:ketone ratio as a useful parameter to track therapeutic ketosis.[3] [4]

This article looks at the ratio between acetone (a form of ketones that can be measured on your breath) and your blood glucose.

It appears that this ratio may be helpful if you require therapeutic ketosis (e.g. to manage cancer, epilepsy, Parkinson, Alzheimers, dementia etc) or to optimise your metabolic health for weight loss, general health or longevity.

We crunch the numbers to see how you can use breath acetone to help you optimise your metabolic health.

[TL;DR…  Higher breath acetone with lower blood glucose seems to be a good place to be.  Breath acetone is potentially more useful than monitoring BHB in the blood.]

What is ketosis?

Ketosis is trending hard at the moment.  But what is it?  And do you really need more of it?

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Some people think that we need to be “in ketosis” to burn fat.  Hence, many people think that more ketosis is better, especially if you have body fat you want to burn.

While this message helps sell keto-related products, it’s technically not correct.

Ketosis is an alternative metabolic pathway that our body uses when there is not enough oxaloacetate in our diet (from carbs or protein) to burn fat via the Krebs cycle.  When this occurs, the fat that can’t be oxidised in the Krebs cycle is oxidised via ketosis.

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This is a “sliding scale” sort of thing.  People following a typical western diet will have lower levels of blood ketones (e.g. 0.1 or 0.2 mmol/L).[5]

The fact that we can use this backup metabolic pathway has helped us survive many a famine to procreate another day.

Ketosis is a critical component of our metabolism and our survival as a species.

But are ketones magical?

Our understanding ketones and ketosis is evolving fast.

Some people believe that ketones have unique and special signalling properties.[6] [7]  While others feel that these beneficial properties of ketosis are limited to endogenous ketosis (i.e. when we predominantly burn stored body fat).[8]

When our energy levels are low, we also see an upregulation of mitochondrial biogenesis, sirtuins, autophagy and NAD+ which are also highly beneficial.

But perhaps it’s actually all of these things working together that causes the benefits that many people associate with “being in ketosis”, not just the ketones themselves.

When energy levels are low, our body goes into repair mode to ensure survival and we switch over to burn body fat.  Our blood ketones rise significantly after a few days without food.

The chart below shows about three thousand data points from people following a low carbohydrate or ketogenic diet measuring blood ketones and blood glucose at the same time.  Blood ketones (shown in blue) are not necessarily high for most people while they are eating normally, even if blood sugar levels are low (shown as orange).

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We can drive high blood ketones by taking exogenous ketones and/or lots of refined fat (the right-hand end of this chart).  But, unless you’re about to do some explosive exercise to burn off all this energy, this over fueling may not be optimal.

Oxidative priority

Our appetite does an excellent job of making sure we get the fuel if it’s available.  Our bodies are pretty good at balancing the different fuel sources based on inputs and demand.

While our bodies are adapted to deal with a range of fuel sources, it struggles to deal with too much energy for a long time.

The chart below (from a paper by Ray Cronise, David Sinclair and Andrew Bremer, with the addition of exogenous ketones courtesy of Craig Emmerich) shows the order that we generally prioritise the use of different fuel sources.

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  1. Alcohol will be burned off first because it’s effectively a poison that the body can’t store.  (Alcoholics can have really low HbA1c levels because insulin rises to shut off the release of glucose into the bloodstream while the alcohol is burned off.[9])
  2. Similar to alcohol, ketones are used up as a priority because we can’t channel them back into storage in the body.  Ketones are acidic and high levels of ketones in the blood lead to diabetic ketoacidosis.  (note: As discussed below, Beta-hydroxybutyrate (BHB) can be thought of as the storage form of ketones.  While BHB can be used directly by the brain, it needs to be converted back to acetoacetate to be used by the rest of the body.)
  3. Protein is not a great fuel, so we can’t store much of it in the blood.  It’s hard for the body to convert protein to energy so it’s hard to overeat.[10]
  4. Carbohydrates can be a useful source of fuel for explosive efforts.   But glucose can be toxic in large quantities (it leads to glycation) so the body tries to limit the amount in the bloodstream.
  5. If glucose levels are high, the body won’t burn off the fat from our diet.  Fat is last in line to be burned because it’s such an effective way of storing energy.
  6. Similarly, if the level of fat in our diet is high we won’t burn off the fat on our body effectively.  (High levels of fat in the bloodstream can lead to oxidised LDL, so the body wants to keep it moving rather than building up high levels.)

Your body increases insulin to hold back the release of stored energy until the energy in the blood decreases.  As you burn through all these fuel sources the body decreases your insulin levels to eventually allow the release of your stored fuel for use to make up the difference.

When you look at it from this perspective you see that nutrition is essentially a process of optimising our food choices to ensure we get the nutrients and fuel we need without stacking up too much energy in front of our body fat stores.[11] [12]

Low carb and weight loss

More stable blood glucose levels help people normalise appetite.  People often eat less when they are no longer on the blood glucose roller coaster.  For people with diabetes, weight loss is often a spontaneous response to reducing carbohydrates as demonstrated by the recently released Virta one year trial results.[13]

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However, while high blood ketones (BHB) is often targeted as evidence of being “in ketosis”, BHB levels often typically taper off over time, especially if you are lean, active, metabolically healthy and weight stable.

It seems that as our fat stores become ‘less full’ we don’t store as much energy in the bloodstream.   And, as we will see later, once our NAD+: NADH ratio increases, less acetoacetate is pushed off to into storage as BHB.

One of the most fascinating outcomes of the one-year Virta study was that over the period of a year, participants’ BHB levels went from 0.17 mmol/L to an average of 0.54 mmol/L after 10 weeks and then settled back to 0.3 mmol/L after a year.[14]

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I found it ironic that in this study of treating diabetes with a ‘ketogenic diet’ that, on average, these people only temporarily dipped into “nutritional ketosis” (defined as having BHB > 0.5 mmol/L).  Then in the long term, they settled back to much lower levels of BHB.

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Even under the supervision of the doctors and dietitians who are the world experts in ketosis and wrote the book on the topic, at no time did they go near “optimal ketosis” (as defined as having BHB between 1.0 mmol/L and 3.0 mmol/L[15]).

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Blood sugar and HbA1c

While the science around ketosis is still controversial, we do know that a lower HbA1c and lower blood sugar levels can be beneficial in terms of long-term health and avoiding many common killers (e.g.  diabetes, heart disease, cancer, stroke etc).

The chart below shows that a HbA1c of 4.5% (i.e. a proxy for your average blood sugar level) gives the lowest hazard ratio (i.e. lowest risk of mortality from all causes).[16] [17]

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As shown below, a lower HbA1c is beneficial in terms of reducing your risk of stroke, heart disease, cardiovascular disease and many of the modern diseases.

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The risk  of focusing on beta-hydroxybutyrate as your measure of ketosis

However, if at first, you don’t succeed in achieving “optimal ketone levels” many people resort to the following to raise their blook ketone levels:

  • load up on high levels of refined fat such as Bulletproof Coffee with butter and MCT oil,

[warning: These foods are typically more energy dense and less satiating, so many people find them easy to overeat.  While most people don’t need to avoid dietary fat, simply eating ‘fat to satiety’ doesn’t lead to long-term weight loss for many people.]

  • eat less protein to reduce oxaloacetate and force more fat to be burned via ketosis rather than the Krebs Cycle,

[warning: Replacing energy from protein and carbohydrates with fat can lead to a less nutrient dense selection of foods as evidenced by many of the lower ranking people in the Nutrient Optimiser Leaderboard.  In this recent article Volek and Phinney suggested that protein intake is between 1.5 and 2.0 g/kg reference weight and that while reducing protein will help to increase ketosis you should not drop below 1.2 g/kg BW.[18]],

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  • eat a more acidic diet with less electrolytes to ensure that the keto acids are not able to be balanced with alkaline minerals such as magnesium, potassium and calcium), or

[warning: This approach may lead to the keto flu in the short term and insulin resistance[19] and metabolic acidosis in the longer term.[20]]

  • eat a diet that contains less B vitamins to decrease your NAD+:NADH ratio to force more acetoacetate to be stored and converted to BHB.

[warning: B vitamins are important for efficient and effective energy production].

The glucose:BHB index

So we do know that lower glucose levels are a good thing and high blood ketones are not necessarily bad.  They can actually nourish the brain if we are insulin resistant and aren’t using glucose well and this is helpful where therapeutic ketosis is required (i.e. Alzheimer’s, epilepsy, Parkinson’s, cancer etc).

But high ketones are not great if they are also accompanied by high blood glucose levels and/or free fatty acids.

So, the way to make sure we are not overloading our system in our pursuit of ketosis is to ensure that our higher ketone levels are also accompanied by lower glucose levels.

Enter the glucose: ketone index which was developed by Professor Thomas Seyfried of Boston College[21] [22] to help optimise the metabolism of cancer patients.

Seyfried subscribes to the Warburg hypothesis of cancer which says that cancer cells ferment glucose and, hence, reducing the glucose supply to cancer cells can help them slow proliferation.

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To help understand what this looks like in practice I have plotted more than 1200 blood glucose versus ketone values in the chart below and divided them up into five groups based on their GKI value.  The average GKI values of these groups of data points are shown on the charts (i.e. GKI = 1.5, 2.8, 4.5, 7.5 and 20).

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The worst metabolic health is the GKI = 20 population (green dots at the bottom of the chart) with high blood glucose levels and low ketones.  This means that glucose values are twenty times that of the ketone values.

Meanwhile, the people with the lower glucose and the higher ketone are likely to be in a better place metabolically.  They will be more likely to experience the positive therapeutic benefits associated with “being in ketosis”.

Before you go chasing a super low GKI value, be aware that most people are not going to get GKI values under than 2.0 until they fast for a few days, even if they are following a ketogenic diet.  The chart below shows what you could expect if you fasted for seven days.

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The glucose : acetone index

Both Michel Lundell from Ketonix and Dave Korsunsky from Heads of Health recently told me that, building on the GKI concept, a number of people are tracking the ratio between their breath acetone readings and their glucose levels.

In order to better understand the relationship between breath acetone and ketones, I have plotted about two and a half thousand glucose and breath ketone readings taken at the same time in the chart below.

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You can see from this chart that there is a similar relationship between glucose and breath ketones as with blood ketones.  However, there is less scatter compared to the previous chart.  It seems that blood glucose and breath acetone are more closely correlated than blood ketones.

It’s hard to have high breath acetone with high blood glucose levels.   You can’t ‘game the system’ in the same way you can with BHB by forcing in exogenous fat or ketones.

As your energy and insulin levels start to rise, more of your acetoacetate will be shunted off to storage as BHB.  So, while some refer to BHB as ‘the gold standard”, it’s hard to know whether high blood ketone values are due to a low energy state or if your bloodstream is full of energy so you need to store more as BHB.

I think the optimal situation to be in is to have lower blood glucose levels with a solid amount of breath acetone in your system which suggests you are producing ketones without driving excess energy.

If you have good metabolic health, you’ll probably be in the purple or green area on this chart.  If you are achieving a therapeutic level of ketosis or fasting for longer periods, you will ideally be in the upper left corner of this chart (green or light blue) with low glucose and high breath ketones.

The chart above shows breath acetone (BrAce on the Ketonix scale of 0 to 100) and the blood glucose in mmol/L.  To calculate your BrAce:BG ratio you can divide your Ketonix reading by your blood glucose level.

The chart below shows glucose vs breath acetone with glucose in mg/dL (American units).  If you have Ketonix and blood glucose meter you can test and see how you compare.

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Are breath ketones a better measure of health than BHB?

If you’re really interested in this topic, I recommend you watch this video from Chris Masterjohn that explains in detail how ketones are made and used.

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In summary:

  • Acetoacetate is the first ketone body made in the liver. Unfortunately, it’s hard to measure.
  • If your NAD+:NADH ratio is low, more acetoacetate will be converted to BHB, which can be measured in the blood.
  • While the brain can use BHB directly, BHB needs to be converted back to acetoacetate to be used in the rest of the body.
  • When the level of energy in your bloodstream decreases, your NAD+:NADH ratio increases and insulin levels decrease. You will then be able to shuttle the ketones stored as BHB back to acetoacetate to be used for energy in the rest of the body.

Acetone is like a vapour that is released from acetoacetate, similar to nail polish fumes.  If you are releasing a high level of breath acetone, then people might say you have a ‘fruity’ smell on your breath or you will experience a different, metallic taste in your mouth.

It’s not easy to measure acetate in the blood, but devices like the Ketonix are becoming more popular to measure acetone in your breath.  Acetone on your breath is not a direct measure of the quantity of acetoacetate in your system but it’s a useful proxy.  Imagine the difference in smell if you have a small thimble versus a massive drum of nail polish.  You’re going to get more fumes coming off a large amount of acetone.

The take-home point here is that if our NAD+:NADH ratio is high, and our overall energy levels are low then not as much acetoacetate will be converted to BHB, and hence more acetoacetate will be available in the blood and more acetone will be measured on the breath.

Meanwhile, if you have excess energy in your system, you will have high levels of ketones in their “storage form” available for use only by the brain.  Conversely, if you have a lower energy state that is more conducive to burning body fat, you may have less BHB and more acetoacetate.

So, breath acetone is more of a measure of ketones ready to be used by your body while BHB is more of a measure of ketones being stored for later use.

Why does the balance of acetone vs BHB vs BrAce matter?

NAD+ is a metabolite that declines with age.[23]  A lot of the anti-aging research at the moment is focusing on how we can boost NAD+ levels.[24] [25] [26] [27] [28]   IV NAD+ treatments are being used for drug addiction, anti-ageing and quick recovery from a really big night.[29] [30] [31]

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The secret here is that, while you can take supplements and injections to boost NAD+, most people can get plenty from B vitamins (particularly vitamin B3 (niacin) which is dirt cheap).[32]

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NAD is also made from tryptophan in the diet.

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NADH builds up when we become over-fueled and is typically higher in conditions such as diabetes.[33]  When we eat and get energy from food, a hydrogen ion (H+) and two electrons (2e-) attaches to NAD+ and we get NADH.  When we use the energy and go without foods the reverse reaction occurs.  NADH decreases and NAD+ builds up.

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Too much energy in our system drives high NADH levels.  Just like in a car engine, we can drown our mitochondria in fuel and they choke.

When we have lots of fuel in our system NADH rises but then if we don’t have enough NAD+ we can’t use it.  So we’re drowning in fuel but we can’t use it!

Bringing this back to measuring ketones… if we have a higher NAD+:NADH ratio we will see higher breath acetone, lower blood glucose and lower levels of BHB (which is a good thing).

Tell me what to do!!!

So ideally we want to see:

  • higher breath acetone,
  • lower blood glucose levels, and
  • blood ketone values of maybe greater than 0.2 mmol/L (they’re not really a big deal unless you specifically require high levels of blood ketones to feed your brain in conditions such as epilepsy, Alzheimer’s or Parkinson’s).

How to get higher NAD+ levels and higher acetoacetate

Boosting your NAD+ levels can be achieved by:

  1. Eating nutrient dense foods with plenty of B vitamins (which are a precursor to NAD+),
  2. Not avoiding protein (particularly tryptophan),
  3. Supplementing with niacin.

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If you find your breath acetone is on the lower end you can try supplementing with Niacin.  When I supplement with Niacel or Niacin my BHB levels drop and my breath acetone rises substantially.

Be warned, you can get a flushing reaction so make sure you start slowly.  There is no need to take super high levels, particularly if you’re keto-adapted.

You can supplement to the point that you start to see higher Ketonix readings.  Or, if you don’t have a Ketonix, to the point that you get a funky metallic taste in your mouth.

You might want to start with 25 mg or 50 mg of Nicotinic Acid and build up to 100 mg or even 200 mg if you don’t see any flushing or a rise in your breath acetone.

  • If you’re wanting to start gently, the Carson Lab niacin is the only one I’ve been able to find in 50 mg in Australia via iHerb.
  • The 100 mg Nicotinic Acid is actually a lot cheaper (only 5 c per tab).
  • Nicotinamide Riboside can be useful for people who can’t as easily convert niacin to NAD+, but it’s more expensive.

However, rather than supplementing, nutrient dense minimally processed whole foods are ideal, at least as a starting point before you start adding supplements.  The Nutrient Optimiser has been designed to help you find the most nutritious whole foods to balance your macro and micronutrients.

If you require therapeutic ketosis the Nutrient Optimiser free report will give you a suggested macro range that will also help you avoid excessive energy.  It will also give you a short list of nutrient dense meals and foods that will help boost your mitochondrial function.

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If you’re interested, the Nutrient Optimiser full report will give you a longer list of foods and meals.  You also have the option to upload your Cronometer data to progressively fine-tune your diet to achieve your goals.

How to get lower blood glucose levels

The key to achieving lower blood glucose levels is:

  1. Avoid processed, and nutrient-poor high carbohydrate foods (e.g. processed grains, cereals and sugars),
  2. Eat less often / fast / avoid snacking,
  3. Eat less overall.

If you do these things, you will see your blood glucose levels decrease, your NAD+ levels increase, and your breath acetone levels increase.

You can stabilise your blood glucose levels by eating a diet with more fat and less carbohydrates, but to really shift your NAD+:NADH ratio in a favourable direction, you may need to reduce your body fat to more optimal levels.

The article How to use your blood glucose meter as a fuel gauge can guide you through how to use a glucose meter to re-calibrate your eating routine based on when you really need to eat.

The Nutrient Optimiser will suggest macronutrient ranges and nutritious foods that will help you stabilise your blood sugars.

 

 

Thanks

Special thanks to:

  • Robert Miller for sharing his unique insights into biochemistry.
  • Michel Lundell from Ketonix for supplying all the data!
  • Craig Emmerich. Mike Julian, Ben McDonald, Robin Reyes, Alex Leaf and Helen Kendall for their review and editing.

 

References

[1] https://optimisingnutrition.com/2016/08/08/how-to-make-endogenous-ketones-at-home/

[2] https://optimisingnutrition.com/2017/04/30/are-ketones-insulinogenic-and-does-it-matter/

[3] https://optimisingnutrition.com/2015/07/20/the-glucose-ketone-relationship/

[4] https://optimisingnutrition.com/2018/02/03/is-too-much-protein-on-keto-a-thing/

[5] https://link.springer.com/article/10.1007%2Fs13300-018-0373-9

[6] https://www.ncbi.nlm.nih.gov/pubmed/25686106?dopt=Abstract

[7] https://www.ncbi.nlm.nih.gov/pubmed/23223453?dopt=Abstract

[8] https://optimisingnutrition.com/2016/08/08/how-to-make-endogenous-ketones-at-home/

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5125693/

[10] https://www.dropbox.com/s/zej4razn4dn993y/protein%20leverage%20hypothesis%20-%20simpson2005.pdf?dl=0

[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5326984/

[12] https://www.amazon.com/Keto-Complete-Ketogenic-including-Simplified/dp/1628602821

[13] http://doi.org/10.1007/s13300-018-0373-9

[14] http://doi.org/10.1007/s13300-018-0373-9

[15] https://www.amazon.com.au/Art-Science-Low-Carbohydrate-Living/dp/0983490708

[16] http://circoutcomes.ahajournals.org/content/3/6/661

[17] This chart is interesting because it shows that very low blood glucose levels can be association with issues such as autoimmune issues or alcoholism which can cause blood sugars to go very low while the body burns through the alcohol.

[18] https://blog.virtahealth.com/how-much-protein-on-keto/

[19] https://optimisingnutrition.com/2017/10/21/redesigning-nutrition-from-first-principles/

[20] https://optimisingnutrition.com/2016/11/19/the-alkaline-diet-vs-acidic-ketones/

[21] https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-015-0009-2

[22] https://www.bc.edu/bc-web/schools/mcas/departments/biology/people/faculty-directory/thomas-seyfried.html

[23] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852209/

[24] http://www.lifeextension.com/Magazine/2018/2/Anti-Aging-Effects-Of-NAD/Page-01

[25] https://www.sciencedaily.com/releases/2017/03/170323141340.htm

[26] http://www.iflscience.com/health-and-medicine/preliminary-results-early-human-trials-anti-aging-formulas-reveal-no-adverse/

[27] https://bengreenfieldfitness.com/podcast/anti-aging-podcasts/what-is-nad/

[28] http://longevityfacts.com/nmn-nad-nicotinamide-mononucleotide-david-sinclair-interview-anti-aging-drug-trials-nicotinamide-adenine-dinucleotide-sirtuins/

[29] https://www.nadtreatmentcenter.com/6-major-benefits-of-nad-iv-therapy

[30] https://www.vice.com/en_us/article/bn3vmq/nad-plus-brain-reboot-infusion-injection

[31] https://bengreenfieldfitness.com/podcast/anti-aging-podcasts/what-is-nad/

[32] https://openi.nlm.nih.gov/detailedresult.php?img=PMC4588049_cells-04-00520-g001&query=&req=4&npos=-1

[33] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869616/

is ‘too much protein’ on keto really a thing?

  • There is a lot of confusion in keto land about ‘excess protein’.
  • Insulin and protein are used to build and repair your muscles, organs and the other important parts of your body.  This is an important and beneficial use of protein and insulin.
  • Foods that contain the harder to find nutrients (e.g. potassium, magnesium, choline, vitamin D) typically contain plenty of protein.
  • Actively avoiding protein and can lead to a less nutritious diet.
  • Unless you require therapeutic ketosis for the treatment of cancer, epilepsy, Alzheimers, Parkinson or dementia, you should be chasing vitality, health and nutrition along with stable blood sugar levels rather than some arbitrary ketone level.
  • There are a range of different ways to quantify protein intake.  Thinking in terms of percentages can be more confusing than helpful.
  • It’s hard to over-consume protein because it is highly satiating.  However, if you avoid protein your body may drive you to consume more calories until you get the protein it needs.
  • If you follow your appetite and focus on foods that contain the vitamins and minerals you need you will probably get enough protein.

Virta Facebook Live Q&A

I recently had the opportunity to pose some questions about protein intake to the Godfather of Keto, Dr Stephen Phinney in a recent Facebook live Q&A.

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Dr Phinney’s response to my question is shown below, including his recommended protein intake levels of 1.2 to 1.75 g per kg reference body weight of protein.

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While I largely agree with Dr Phinney’s response, I think it’s worth elaborating on some of the issues that are causing so much confusion at the moment.

Will too much protein kick me out of ketosis?

If you’ve read previous posts on Optimising Nutrition you’ve probably seen my analysis of the food insulin index data that shows that our carbohydrate intake alone doesn’t explain our insulin response to food.

The food insulin index data shows that our insulin response to food is more accurately predicted when we consider the fibre and protein content of our food, not just the carbohydrate.

However, I fear that many people have used the insulin load concept as a reason to avoid protein.  I now understand that this is far from optimal within the broader context of good nutrition for health, weight loss and vitality.

If you are interested in learning more the implications of the insulin index data I recommend you check out the following articles:

Effect on blood sugar and insulin

While trading your calories from butter for steak will increase your requirement for insulin, the food insulin index data suggests that as a general rule, getting more of your energy from protein will reduce your insulin requirements as it forces out processed carbohydrates as shown in the chart below.

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Getting more energy from protein tends to decrease our glucose response as it forces out nutrient-poor refined high carb foods.  Your body can convert protein to glucose (i.e. gluconeogenesis) if it really needs to but it’s a lot of work, so it would much rather get energy from carbs or fat.

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Protein is also very satiating.  Once we have enough protein, our body tends to crave more fatty and carby foods for energy.[10] 

While it is both financially and metabolically expensive, protein is the most important component of your diet.  Different people will need different amounts of protein depending on their life stage and activity levels.

While you probably don’t need to be going out of your way to binge on more protein than you can comfortably consume, actively avoiding protein containing foods is a recipe for nutritional disaster.  If you are exercising or lifting heavy then you will naturally crave more protein.

If you actually need higher levels of blood ketones for therapeutic ketosis, it may be a good strategy to consciously restrict protein.  However, I don’t’ think the vast majority of people chasing ketones are looking for therapeutic keto for the management of cancer, Alzheimer’s, epilepsy, dementia or Parkinson’s but rather fat loss or diabetes control.

Protein number crunching

The numbers around protein can be confusing due to the units used.

  • Dr Phinney uses ‘reference body weight’ (RW) (which he says is ‘the weight you were when you were in college’).
  • The mainstream nutrition world talks in terms of total body weight (BW).
  • Meanwhile, the sports nutrition community talk in terms of lean body mass (LBM).

In order to understand what this means in practice, let’s look at an example of a woman who is currently 40% body fat but was 25% in college (i.e. her reference weight).  For argument’s sake let’s say she was 70 kg in college but she is currently 87 kg or 193 lb.  The images below will give you an idea of what these level of body fat levels look like.

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In the table below I have calculated what Dr Phinney’s recommended protein intake looks like for this person in terms of:

  • reference body weight (RW),
  • lean body mass (LBM), and
  • body weight (BW).

Based on Dr Phinney’s guidance, this person should be eating between 84 and 123 g of protein per day.

  body fat weight (kg) weight (lbs) lower limit upper limit
reference weight 25% 70 154 1.2 g/kg RW 1.75 g/kg RW
lean body mass 0% 52.5 116 1.6 g/kg LBM 2.3 g/kg LBM
body weight 40% 87.5 193 1.0 g/kg BW 1.4 g/kg BW
protein (g/day)       84 123

On a practical note, there is nothing low about 2.3 g/kg LBM protein.  While I do track my intake I find it hard to get above 2.2 g/kg LBM even when trying to maximise protein.  At the same time, the lower limit is well above the official Recommended Daily Intake of 0.84 g/kg for men and 0.75 g/kg for women which are set to maintain nitrogen balance and prevent disease (i.e. not achieve optimal health and vitality).

What about percentages?

Talking about protein in terms of percentages of energy intake can be confusing as it depends on your activity levels or whether you are dieting.   Theoretical energy intake requirements are based on your lean body mass and activity levels.

The table below shows what Dr Phinney’s protein recommendation of 1.2 to 1.75 g/kg RW (or 1.6 to 2.3 g/kg LBM) look like for our hypothetical woman above in terms of percentage of energy intake for different energy intakes depending if she was trying to lose weight, maintain weight or was more active.

scenario calories lower upper
30% deficit 1158 29% 42%
sedentary 1654 20% 30%
lightly active 1852 18% 27%
moderately active 2084 16% 24%
vigorously active 2431 14% 20%
protein (g)   84 123

Protein intake in terms of percentage energy intake can vary widely to the point that it’s practically useless.  It’s generally much more useful to talk in terms of protein intake in grams per weight lean body mass rather than percentages.

Protein and nutrient density

Since stumbling across the insulin index, one thing I have found consistently is that nutrient-dense foods are not low in protein.

If you are focusing on the foods that contain the harder to find nutrients (e.g. magnesium, magnesium, choline, vitamin D etc) you will be getting plenty of protein.

Conversely, the only way to really get the ultra-low protein intakes being recommended by many people without an energy deficit is to avoid most solid foods and prioritise macadamia nuts, butter and oils.  It should not be a surprise that it will be hard to get a broad spectrum of essential nutrients with this sort of dietary approach.

As shown in the chart below, nutrient density tends to increase up to about 50% of energy intake.   If you’re eating more than 50% protein you’re likely relying on processed foods and supplements.[11]

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The chart below shows the nutrient profile of the most nutritious foods in the USDA database.  If you could stick to these foods you would easily be getting a lot of the essential nutrients without having to consume too much energy.

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The problem with these foods is that they can be very satiating which makes it hard to get enough energy in if you are active.  However, if you are trying to lose weight these foods may help to ensure that you are getting the nutrients you need with less energy without being hungry.

It’s interesting to see many people who have been experimenting with the Nutrient Optimiser have commented on how little food they can get away with while experiencing minimal levels of hunger.   Nutrient dense foods tend to be hard to overeat and also provide you with the nutrients to prevent cravings and hence reduce appetite.

For comparison, the chart below shows the nutrient profile of the ketogenic diet foods.  That is, the foods that have the lowest percentage insulinogenic calories.   These foods are 80% fat, 15% protein and 3% net carbs).  Ironically, an individual consuming these foods will be meeting the minimum levels of protein but they will be missing out on a large number of other vitamins and minerals.

I find that it’s often the people who are trying to actively avoid protein that find themselves at the bottom of the Nutrient Optimiser Leaderboard with a very poor nutrient profile.

The chart below shows the nutrient profile that we get when we actively avoid protein.  The only nturients that we get enough of in this scenarios is sodium and vitamin C!

Unless you are chasing therapeutic ketosis for the treatment of cancer, epilepsy, Alzheimers or dementia I think your focus should be on building health and maximising nutrition rather than higher ketone values.

If you are getting the micronutrients you need to thrive you will be getting plenty of protein and won’t need to worry too much about getting adequate protein intake.  Conversely, if you are actively avoiding protein you will be unnecessarily sacrificing your other micronutrients (especially if you are replacing your calories from protein and carbs with refined fat).

But will too much protein kick me out of ketosis?

As I write this I have been experimenting with adequate protein with less fat and carbs and maximal nutrients on the Ketogains Bootcamp.  A typical daily Cronometer summary is shown below.

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My protein is sitting at about 2.2g/kg LBM for me given that I’ve been spending a lot of time in the gym lifting heavy during this time.  I’ve also been able to hit many of the nutrients targets while maintaining a significant calorie deficit.

Leading up to this period my blood glucose levels were sitting in the mid 5s (approx 100 mg/dL).  However, once I introduced the energy deficit my glucose levels plummet to the mid 4s (approx 80 mg/dL).

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And although I don’t worry much about ketones, they seem to be sitting at around 0.7 mmol/L, which I’m pretty happy with.

I know if I keep my blood glucose around this level I will continue to lose weight and continue to improve my glucose control and HbA1c.

I also get plenty of breath acetone from endogenous ketones as shown on my Ketonix below.

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Don’t forget the basal insulin!

While there has been a lot of focus on what we can do to not have too much insulin, we need to remember that insulin has a number of important roles including:

  1. to help us get glucose into cells to be used by our mitochondria,
  2. to help build and repair our muscles, and
  3. to control the release of glucose from our liver while the energy in our bloodstream is used up.

People with type 1 diabetes demonstrate happens if we don’t have enough insulin.  Not only would we not be able to store the energy we eat as fat and muscle, the brake comes off the liver and all the stored energy in our body comes flowing out in the form of excess glucose and ketones (i.e. diabetic ketoacidosis).

The image below is the same child, “J.L.”, in the 1920s before and after receiving insulin therapy.  In a healthy person, insulin suppresses the fuel flow from the liver to healthy levels.

In someone on a standard western diet, basal insulin represents about 30% of the today daily dose.  Basal insulin drops to about 50% for someone on a low carb or keto diet.  But you can never drop your insulin requirements to zero.  You always need this basal to stop the uncontrolled flow of fuel from your liver into your bloodstream.

We focus so much on the effect of the food we eat but we forget that it’s also the excess fuel on your body and floating around in our bloodstream that also plays a massive role in the insulin demand on our pancreas.

Whenever there are high levels of energy sitting in our bloodstream (from glucose, ketones or fat) the pancreas has to ramp up basal insulin production until the fuel in our bloodstream is used up.  The more fat there is on our body the harder our pancreas has to work to hold back the pressure of excess fat on our body from being released into our bloodstream.

So, you may believe that your mug of Bulletproof coffee or the fat bomb may not be raising your insulin levels because it does not contain glucose or protein.  However, your pancreas is still working overtime to produce more insulin to hold the fat on your bum and until the energy coming in via your mouth is used up.

You may be able to ramp up your energy expenditure for a while by shivering and fidgeting, more but after a time of overdriving energy you’ll likely end up fat and insulin resistant.

If you really want to reduce your insulin levels you need to work on reducing the excess level of energy floating around in your bloodstream (from any source, including fat, carbs, protein or exogenous ketones) so your pancreas will decrease its production of insulin to allow body fat to be used.

Focusing on obtaining the nutrients you need without too much energy seems like common sense to me.

Therapeutic ketosis

Someone targeting therapeutic ketosis to assist with the management of chronic conditions such as cancer, epilepsy, dementia or Alzheimer’s may benefit from higher levels of ketosis and less reliance on glucose.  But I don’t think the vast majority of people who are Googling “keto” at the moment are looking for a therapeutic treatment.

therapeutic keto

Understanding how to quantify the insulin load of our food enables us to accurately tailor or food choices to suit our goals.  When it comes to insulin load we need to keep it low enough to get the results we need without compromising the nutritional value of the food we eat too much.

The chart below shows that nutrient density peaks at around 40% insulinogenic calories.

  • If you are insulin resistant it would be prudent to have less than 40% insulinogenic calories.
  • Someone on a low carb diet might have less than 25% insulinogenic calories.
  • Someone targeting therapeutic keto will likely need to have less than 15% insulinogenic calories to see therapeutic levels of ketones.

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Unless you really require therapeutic keto then I don’t think there is a need to worry too much about the impact of protein on your blood ketone levels.  Actively avoiding protein tends to lead to compromising nutrient density unnecessarily which may lead to nutrient cravings or deficiencies in the long term.

The glucose : ketone index

People who require therapeutic ketosis should also ensure that they are not driving the total energy in their system too high.  To do this they can track their glucose as well as ketones.  The glucose:ketone ratio (GKI) which was developed by Dr Thomas Seyfried to measure the degree of therapeutic ketosis.[12]

If you’re interested, your GKI can be calculated by dividing your glucose (in mmol/L) by your ketone values.  For example, if your blood glucose is 108 mg/dL and your blood ketones are 0.5mmol/L, GKI = blood glucose / ketone = (108 mg/dL / 18) / 0.5 mmol/L = 6 mmol/L / 0.5mmol/L = 12.

People who are chasing therapeutic ketosis typically do not need to worry about ingesting too much energy.   Driving a hypercaloric state with refined fats is not a major concern for someone trying to keep weight on (e.g. cancer cachexia).  However, ensuring that they are achieving lower glucose levels will ensure that they are not driving insulin resistance.

For reference, the table below shows the relationship between HbA1c, average glucose, ketones and GKI for different scenarios showing how your GKI and ketones correlate with HbA1c and blood glucose.

 metabolic health HbA1c average blood glucose blood ketones GKI
 (%)  (mmol/L)  (mg/dL)  (mmol/L)  
low  4.1 3.9 70 > 0.3 < 4
optimal 4.5 4.6 83 > 0.3 < 15
excellent < 5.0 < 5.4 < 97 > 0.3 < 20
good < 5.4 < 6 < 108 < 0.3 < 40
danger > 6.5 7.8 > 140 < 0.3 > 40

Really low GKI values (i.e. very high ketones and very low glucose) are typically seen in extended fasting when glucose levels to drop and ketones from body fat increase in a low insulin state.

The chart below shows my blood ketone and glucose levels during a seven day fast.  Amazingly, as my blood glucose levels dropped below 4.0 mmol/L my ketones drifted up to 8 mmol/L.  During more recent, however, I haven’t been able to achieve such high ketone levels.

While we can get these high ketone levels during fasting, we typically don’t see them in the fed state.  To give you an idea of what to expect, the chart below shows GKI values over time during fasting for RD Dikeman (from Type 1 Grit), Jimmy Moore, Simon Saunders (Keto Island) and myself.   As a rule of thumb, you might expect to see a GKI value less than 2 after two or three days of water fasting.

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Nutrient density analysis

Being a big fan of Dr Phinney and the Art and Science books, I couldn’t help running his recommended diet through the Nutrient Optimiser.  I entered all the meals in the Art and Science of Low Carb Living into Cronometer and ran it through the Nutrient Optimiser.

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If you’re interested, you can see the full report here and where these meals rank on the leaderboard here.

So what should you do with all this information?

So, to summarise:

  1. If you have great blood sugars and just want to lose weight then you should focus on maximising nutrient density while reducing the energy levels in your bloodstream.  There is no need to worry about “being in ketosis”.  You will produce ketones if you are successfully achieving an energy deficit and burning your own body fat stores.
  2. If you are insulin resistant then you will want to limit your insulin load to a maximum of 2.9 g/kg LBM.  This will restrict carbohydrates in your diet so your blood sugars stabilise.
  3. If you are trying to manage diabetes then you want to keep your insulin load under 1.8 g/kg LBM.  This will restrict carbohydrates and may reduce your protein intake a little.
  4. If you require therapeutic keto then you will want to keep your insulin load less than 1.1 g/kg LBM and may need to consider limiting protein.

The recommended values for protein and insulin load are shown in the table below.

approach

min protein

(g/kg LBM)

max insulin load

(g/kg LBM)

therapeutic ketosis 0.8 1.1
diabetes / nutritional ketosis 1.8 1.8
weight loss (insulin resistant) 1.8 2.9
weight loss (insulin sensitive) 1.8

Can run the numbers for me?

I realise all this data can be confusing if nutrition is not your hobby.

Over the last few months, I’ve been working with a very talented programmer, Alex Zotov, to develop some handy software to help people navigate all this information and put it into practice.

The first instalment of the Nutrient Optmiser is a free calculator that will help you identify the ideal macronutrient ranges to suit your goals as well as a shortlist of optimal foods and meals.  The table below shows how we can determine the optimal approach for you based on your metabolic health, waist to height ratio and goals.

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We’d love you to check it out the Nutrient Optimiser.  We’d love to hear what you think and how we can refine it to suit your goals.

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We hope it will be really helpful for a LOT of people on their journey towards health through optimal nutrition

 

references

[1]https://www.amazon.com.au/Keto-Clarity-Definitive-Benefits-Low-Carb/dp/1628600071

[2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737348/

[3]http://assets.virtahealth.com/docs/Virta_Clinic_10-week_outcomes.pdf

[4]http://www.ncl.ac.uk/press/articles/archive/2017/09/type2diabetesisreversible/

[5]https://www.ncbi.nlm.nih.gov/pubmed/25515001

[6]https://cardiab.biomedcentral.com/articles/10.1186/1475-2840-12-164

[7]http://circoutcomes.ahajournals.org/content/3/6/661

[8]https://www.perfectketo.com/how-too-much-protein-is-bad-for-ketosis/

[9]https://nutritionfacts.org/video/the-great-protein-fiasco/

[10]https://digitalcommons.wku.edu/ijes/vol10/iss8/16/

[11]https://optimisingnutrition.com/2017/10/30/nutrition-how-to-get-the-minimum-effective-dose/

[12]https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-015-0009-2

keto… do you want some more?

key points

  • “Keto” is booming!   But there is still a lot of confusion about what exactly constitutes “optimal ketosis”.
  • Most of the magic of ketosis occurs when you burn your own body fat rather than eat more dietary fat or consume exogenous ketones.
  • If your goal is weight loss or diabetes management, chase lower blood glucose levels, not higher ketone levels.
  • Our bodies switch to burning more fat via ketogenesis when we eat less digestible carbohydrates and protein available.
  • While many people get caught up chasing ‘optimal ketosis’, anything above 0.2 mmol/L with lower blood sugar levels is a sign that your insulin sensitivity and metabolic health is improving.
  • Eating ‘fat to satiety’ on a low carb or ketogenic diet can help you achieve ‘non-diabetic’ blood sugar levels.   However, some degree of self-discipline may still be required to achieve optimal health and desirable body fat levels.

Keto is so hot right now!

Every woman and her cat seem to be getting on the keto bandwagon.

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Whether it be cookbooks, Facebook groups or forums, keto is booming!

If everyone else is getting on the keto train then surely you need some?

And more must be better?

Right?

If you’re not doing it yet then maybe you’re missing out?

Or like every exponential trend, is there a crash just over the horizon?

Like tulip bulbs in the 1630s?

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Or perhaps Bitcoin right now?

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My keto journey

Personally, I’ve had a keen interest in ketosis for a while.

I was into keto before it was cool.

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I followed Dave Asprey’s Bulletproof coffcoffeeze.  I even bought a bunch of his expensive mycotoxin free beans.

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I eagerly followed Jimmy Moore’s updates during his n=1 ketosis experiment during 2012.

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I was so eager to follow in his footsteps as soon as I could!

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I got hold of Keto Clarity as soon as it was released.  I started adding butter and MCT oil to my coffee and eating liberal amounts of cheese, cream and coconut products in an effort to get my ketone values into what I understood to be the “optimal ketone zone”.[1]

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I spent a good chunk of money on strips to test my blood ketones regularly to see if I was achieving ‘optimal ketosis’.

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Calories and energy balance didn’t matter.

I had faith.

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But unfortunately, I wasn’t one of the blessed that could ‘eat fat to satiety’ and be as lean and healthy as I’d hoped.

The picture below is my work profile shot a year or so after chasing higher ketones with more refined dietary fat.

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I was as heavy as I’d ever been, had early signs of fatty liver and prediabetes.

I realise now that I had been trying to drive exogenous ketosis with lots of extra dietary fat.

What I really needed was to learn how to achieve endogenous ketosis to burn off my unwanted body fat.

My quest to understand what went wrong has taken me on a fascinating journey in an effort to manage my own health as well as to understand how to assist my wife Monica better manage her type 1 diabetes.

In this post, I hope to share some of my learnings and insights to help people get what they really need from their keto journey and avoid the common pitfalls.

Virta Facebook Live Q&A

I recently had the opportunity to pose some of my most pressing questions about optimal ketone levels and protein intake to the Godfather of Keto, Dr Stephen Phinney in a recent Facebook live Q&A.

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Dr Phinney addressed one of my questions in the live broadcast as well as responding in writing in writing on the Virta blog.

I have included my question on optimal ketone levels and Dr Phinney’s response below along with my own additional thoughts.

But first, I think it’s important to understand what ketosis actually is.

What is ketosis?

Ketosis occurs when there is a lack of Oxaloacetate from non-fibre digestible carbohydrates and protein to enable fat to be oxidised in the Krebs cycle.    When Oxaloacetate availability reduces, the body produces Acetoacetyl CoA and Acetoacetate (AcAc) via ketosis.

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You can also think of this in terms of insulin load.  That is, when the net carbs and protein in the diet are reduced we switch to burn more of our fat via ketogenesis rather than in the Krebs cycle.

I used to think that we were only burning fat when via ketosis, but I now understand that’s not correct.  Ketosis is just how we burn fat when the Kreb cycle can’t operate normally.  Ketosis is an important biochemical process that allowed us to survive through times when food was scarce.

As described by Dr David Sinclair in this video, lots of good things happen during periods of low energy availability (e.g. increased autophagy, AND+ and SIRT1).  Our bodies go into emergency repair mode to increase our chances of being around to procreate in future times of plenty.

Energy restriction is the only thing that has conclusively been proved to promote longevity in humans.  But it’s hard, so it’s not very popular.  When food is available, left to our own devices, our bodies tend to store up a little extra fat for the winter.  Unfortunately, in our modern environment, winter never comes.

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If your NAD+ levels are lower, more Acetoacetate (AcAc) will be converted to Beta-hydroxybutyrate (BHB) in the blood.  If your NADH+:NADH ratio is high there will be more Acetoacetate in circulation.  Acetone can be thought of as the vapour that is released from Acetoacetate.   So, if less Acetoacetate is being converted to BHB, you will register higher breath ketones.  Chris Masterjohn explains this in more detail in this video.

Reduced NAD+ levels are associated with ageing, and increased NADH levels are associated with over fueling and diabetes.  Thus, high levels of BHB and low levels of breath acetone are not a good sign.

You may be interested to know that fat loss from the body is better correlated with higher breath acetone levels rather than ketones in the blood.[2]

Personally, I find when I take Niacin supplements (vitamin B3 increases NAD+) my BHB plummets and my breath acetone skyrockets.

In summary, the amount of beta-hydroxybutyrate in your bloodstream at any point in time is influenced by the amount of fat ingested, your NAD+:NADH ratio as well as the rate at which they are using BHB.

What are normal ketone levels?

We all like to compare others to others to understand if we are normal.

I thought it would be interesting to crowdsource some data to understand what normal ketone levels are in people following a low carb or ketogenic diet.  I wanted to understand if everyone was struggling to reach the ‘optimal ketone zone’ like I was.

The chart below shows the compilation of more than three thousand blood ketone and glucose data points crowdsourced from people following a low carb or ketogenic diet (with particular thanks to Michel from Ketonix for the anonymous data).  Ketone values are shown in blue on the bottom and glucose is in orange on top.

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Diabetic ketoacidosis

Someone with uncontrolled type 1 diabetes will have a very low NAD+:NADH ratio and hence very high levels of BHB (i.e. greater than 8 mmol/L).  This is termed “ketoacidosis” and is accompanied by very high blood glucose levels.  Someone with uncontrolled type 1 diabetes would be off the chart to the right.

High levels of BHB are dangerous because they are acidic.  However, people who do not have Type 1 diabetes typically have blood ketone values less than 4.0mmol/L.  People with a functioning pancreas do not need to fear acidic ketones, particularly if they are sitting to the left of this chart with lower levels of energy floating around in their blood.

The bloodstream, our metabolic highway

You can think of our bloodstream as our metabolic highway that helps get the energy to the cells that need it.  We want enough energy in the blood to fuel the body, but not so much that a traffic jam occurs.

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Really high levels of glucose in the bloodstream lead to glycation.  Similarly, high levels of free fatty acids lead to oxidised LDL which increases your risk of heart disease.

If your bloodstream is full like syrup with excess glucose, ketones and fatty acids then the energy and nutrients can’t get where they need to go.  Your kidneys will be working overtime clearing out the nutrients from the blood that your body does not require.

Your body raises insulin in an effort to stop energy flowing out of storage while you are still using up the energy in your blood.

When your bloodstream is clogged with energy there will be no opportunity for the body to cleanse and undertake autophagy.  Detoxification won’t be able to occur as effectively, and your fat stores will continue to build up toxins.

Exogenous vs endogenous ketosis

I now realise where I went wrong in my early keto journey was that I didn’t understand the difference between exogenous and endogenous ketosis.

I now realise that I was trying to address my pre-diabetes and obesity with a classical or therapeutic ketogenic diet which is intended to be used for epilepsy, cancer, Alzheimer’s, Parkinson’s and dementia.

All this excess energy was just exacerbating the situation I was trying to solve.

Exogenous ketosis

The chart below shows the blood glucose and ketone levels during exogenous ketosis.  While glucose may not be high, but we have high levels of ketones and likely higher levels of triglycerides in the bloodstream largely from external sources.

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This may be helpful in a situation such as epilepsy, Alzheimer’s, Parkinson’s or dementia where glucose is not being processed efficiently by the brain.  Excess glucose is thought to fuel the growth of some cancers, so reducing glucose and increasing ketones enables us to fuel the brain while not feeding the cancer cells.

Endogenous ketosis

The chart below shows what happens in endogenous ketosis.  In fasting or energy restriction your blood sugar will decrease.

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As you can see from this chart, your blood ketones may not be as high due to your high NAD+:NADH ratio and the fact that you are not pushing in large amounts of external fat.  Ketones will also be used for energy rather than building up in the bloodstream.

In this lower energy state, your body will be pulling fat from your belly and bum to offset the deficit of energy from glucose and ketones in the bloodstream.

Your blood will no longer be a congested and the toxins will be able to flow out of your fat stores.  Your kidneys will cleanse your bloodstream, and you will excrete the waste that was stored in your fat.

You will increase autophagy as you old proteins, and pre-cancerous cells are cleansed and eaten up by your body.  Your insulin levels will also decrease, and your fat stores will become insulin sensitive again.

Without constant incoming energy, the fat in your pancreas, liver, heart, brain, eyes etc will then be used for energy.  You will feel younger and lighter and start to think more clearly!   You will effectively be slowing the aging process!

Ketosis vs diabetes and obesity

Someone managing diabetes and/or seeking weight loss should ideally target a lower overall level of energy in their bloodstream.  Having less energy in the blood, whether in the form of glucose, ketones or free fatty acids, forces the body to supply more energy from body fat.

The chart below shows the levels of blood ketones that relate to higher and lower levels of glucose and ‘total energy’ from glucose and ketones.

The three thousand blood ketone and glucose levels have been divided into five ‘bins’ based on their total energy content.  The smallest is shown on the left with the largest total energy shown on the right.

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This data suggests that good metabolic health is characterised by not having excessive levels of energy floating around in the bloodstream.  Lower glucose levels tend to correlate with lower blood ketones.  The lowest blood glucose levels are associated with a blood ketone level of about 0.3 to 0.7mmol/L.

Virta ketone data

When I recently re-read the paper detailing the results of the first ten weeks of the Virta trial I was intrigued to see that, even though they were targeting ‘nutritional ketosis’  the average BHB level achieved was only just above the cut off for nutritional ketosis.  The average BHB was 0.6mmol/L with a standard deviation of 0.6 mmol/L.

To better understand what this means, the chart below, many people had ketone levels below the cut off for nutritional ketosis of 0.5 mmol/L.  The largest ‘bin’ of ketone values as 0.1 to 0.3 mmol/L.[3]  The second largest grouping was 0.3 to 0.5 mmol/L.

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It struck me that these blood ketone levels aligned reasonably closely with the values shown in my crowdsourced data.  My question to Virta and Dr Phinney’s response is shown below:

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Dr Phinney’s comment that it was the people with the higher ketone levels that experienced better results in the long term made me think of the relationship between ketones and blood glucose which is also based on the crowdsourced data.

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In fasting, people who are more insulin sensitive can more easily produce ketones when there is no food, while people with high levels of insulin have high blood sugar levels and tend to have lower levels of ketones as shown in the chart below.

So perhaps the people who did the best were the ones that were already more insulin sensitive and thus were able to go longer periods between food, especially once the insulin load of their diet was reduced and their blood sugar and insulin levels came down closer normal levels?

What does all this mean in practice?

At this point, you’re probably confused.  Is it even worth testing ketones?  And if I do, what values should I be targeting?

My conclusion, after doing a lot of self-testing as well as analysis of a lot of other people’s data is that, unless you require ketosis for therapeutic purposes your blood ketone levels probably don’t matter that much.

Some level of blood ketones is good to have (say 0.2 mmol/L or more), but more is not necessarily better.

And for goodness sake, don’t go chasing higher blood ketones with more dietary fat if your goal is fat loss from your body!

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For people trying to manage obesity and/or diabetes, ketosis is a fascinating side effect of a lower energy state when you have less carbohydrate and protein to burn.  But it is not the end goal.  Ketosis is part of the process that occurs as we burn out own body fat.

So how do I optimise my blood sugars?

A diet with a lower insulin load (i.e. less non-fibre carbohydrates and less insulinogenic protein) will enable someone with diabetes to stabilise their blood glucose levels.  They will require less insulin so their pancreas can more easily keep up to maintain healthy blood glucose levels.

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Stable blood sugars and removal of processed carbohydrates often helps to normalise appetite and spontaneous weight loss.

As body fat stores become less full your adipose tissue will become more insulin sensitive and can then absorb the day to day energy flux without needing to spill excess energy into the bloodstream.  Because your body fat is doing the job properly, you won’t see high levels of blood sugar in your blood.

Your body is always rebalancing your fuel system (i.e. glucose, ketones and free fatty acids) depending on your needs and dietary energy sources.

We can store a little bit of glucose in our bloodstream and liver, but the major fuel tank is our fat stores.  When our adipose tissue is full and can’t take anymore everything else backs up and overflows.

How to stay below your “Personal Fat Threshold”

Fascinating recent work by Professor Roy Taylor at Newcastle University in the UK has shown that reducing fat from the vital organs like the pancreas can actually reverse diabetes.[4]

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Professor Taylor coined the term ‘Personal Fat Threshold’ which is the point at which your adipose tissue can no longer easily absorb the extra energy from the food we eat and starts to send more of it to other places in our body.  It’s like our fat storage balloon is full.[5]

Once we exceed our personal fat threshold any extra is energy shuttled off to the bloodstream in the form of high glucose, high free fatty acids and higher ketones) as well as the other parts of the body that are more insulin sensitive than our adipose tissue such as our liver, pancreas, heart, eyes, kidney, brain and heart).

The problem however with Professor Taylor’s approach was that it was an 800 calorie per day short-term intervention based on Optifast meal replacement shakes. The ideal approach would be to design a nutritious set of foods that would provide the nutrients you need without excessive energy. 

Many people find that a low carb diet will help stabilise blood sugar levels.  However, many, if not most, people find that they need to restrict energy intake and/or increase the nutrient:energy ratio of their diet in order to achieve the blood glucose control and body fat levels that are associated with optimal longevity.  This can be achieved through intermittent fasting, time restricted feeding, meal skipping,  ‘clean eating’, calorie counting or whatever works for you.

Regardless of how you feel about any of these concepts, you need to do whatever it takes to reduce the inputs to the point that you see the energy in your bloodstream decrease.  How much discipline and deprivation you want to enforce on yourself depends on how close you want to get to optimal.

While it’s good to see your body fat levels reducing, measuring your blood sugar is probably the most effective way to get a cost-effective and immediate understanding of whether you actually need to eat (see How to use your glucose meter as a fuel gauge for more details on this concept).

The figures below show the relationship between HbA1c to various symptoms of metabolic disease such as diabetes, heart disease and stroke.[6]

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All-cause mortality is lowest with an HbA1c of somewhere between 4.5 and 5.0%.[7]image13.jpg

Can we achieve optimal in our modern environment?

This Australian Aboriginal hunter from more than 100 years ago is my favourite example of optimal metabolic health.

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Everything he could find to eat would have been filled with nutrients.  He wouldn’t have overeaten because he had to hunt or gather everything, and that took a lot of effort.

Every year or so he would have had a period of externally enforced fasting when food wasn’t so plentiful.  And if he was the fattest and slowest in his tribe he might have been prey to wild animals.

Today we like to reminisce about paleo and ancestral times.  However, I don’t think we can ever go back to mimic how this guy lived, even if we wanted to.

While we can get unprocessed organic fairly nutrient dense foods, we will probably never achieve the food scarcity context that he had.

Today food is fairly cheap and easy to get hold of.  And whenever when we eat ‘to satiety’ we are programmed by evolution to prepare for a famine on a long boat ride where only the people who could store energy survived.

Food is pleasure.

Food is entertainment.

Food is social connection.

Food is emotional.

People like to rail against the idea that we might need to limit our energy intake.  However, in today’s context, I think we need to work out how to recreate the useful elements of ‘the good old days’ in a modern context.

Unless we’re prepared to live in the desert and leave our credit cards behind, perhaps things like periods of fasting to reduce our blood glucose levels, gyms to build strength, energy tracking apps like Cronometer to ensure we are eating nutritious food (and not too much of it) all play a role in our modern context?

It’s not going to be a popular concept, but some level of deprivation or self-control may be necessary if you want to achieve optimal health and delay the diseases of aging.

It’s OK if you don’t want to go all in and invest everything it takes to achieve optimal health, but it’s still useful to understand how to get even part of the way there.

Introducing, our new toy!   The Nutrient Optimiser

It can be confusing to know how much of each macronutrient you should be eating.  Everyone has different goals and circumstances.

Over the last few months, I’ve been working with a very talented programmer, Alex Zotov, to develop some handy software called the Nutrient Optimiser to help people navigate all this information and help people put it into practice.

The table below shows how we how we segregate people based on their different goals based on your blood sugar levels, HbA1c, waist:height ratio and trigliceride:HDL ratio.  From there we can target the most nutrient dense foods and meals while also keeping your blood sugars stable, fueling your activity or help you to lose body fat.

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If you do have diabetes, then a low carb/keto diet will help stabilise your blood sugars and will often help to stabilise your appetite.  But then, as you improve your health you can continue to refine your food choices to and increase the nutrient density of your diet even more.

Meanwhile, if you’ve got great blood sugars but want to lose body fat there’s no reason to be eating a super high fat therapeutic ketogenic diet designed to control epileptic seizures.

The first instalment of the Nutrient Optmiser is a free calculator that will help you identify the ideal macronutrient ranges, energy intake and as well as a shortlist of optimal foods and meals to suit your goals.  We’d love you to check it and let us know what you think.   We hope it will help a lot of people avoid the confusion of keto and move forward towards optimal.

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references

[1]https://www.amazon.com.au/Keto-Clarity-Definitive-Benefits-Low-Carb/dp/1628600071

[2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737348/

[3]http://assets.virtahealth.com/docs/Virta_Clinic_10-week_outcomes.pdf

[4]http://www.ncl.ac.uk/press/articles/archive/2017/09/type2diabetesisreversible/

[5] https://www.ncbi.nlm.nih.gov/pubmed/25515001

[6]https://cardiab.biomedcentral.com/articles/10.1186/1475-2840-12-164

[7]http://circoutcomes.ahajournals.org/content/3/6/661

[8]https://www.perfectketo.com/how-too-much-protein-is-bad-for-ketosis/

[9]https://nutritionfacts.org/video/the-great-protein-fiasco/

[10]https://digitalcommons.wku.edu/ijes/vol10/iss8/16/

[11]https://optimisingnutrition.com/2017/10/30/nutrition-how-to-get-the-minimum-effective-dose/

[12]https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-015-0009-2

micros > macros?

Most of the time, when it comes to nutrition, we like to think in terms of macronutrients.

  • Carbs.
  • Fat.
  • Protein.
  • Fibre.

Simple!

But maybe too simple?

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In the good old days, before your food was grown in nutrient depleted soil and the creation of nutrient-poor processed frankenfood, we just ate food.  We didn’t have to worry about micronutrients.  Pretty much everything we ate was full of them!

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These days micronutrients are harder to come by.  In a number of previous articles, I have suggested that maximising micronutrients as your first priority (before calories or macronutrients) will likely to be a more useful guide to help us genuinely optimise our nutrition.

Unfortunately, it’s hard to think in terms of micronutrients.  With thirty-four essential nutrients and many more conditionally-essential and beneficial nutrients and compounds in the food we eat, there are just too many moving parts to keep in our working memory.

Before the creation of hyper-palatable flavoured and coloured foods, our appetite was a useful to help us seek out the nutrients we need.  Over the years it had come to be the perfect nutrient optimiser, prioritising the foods we needed at any point in time.  Unfortunately, in our modern food environment, our paleolithic instincts are no match for modern food chemistry.

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Today, we need a little extra help to discern fake foods from the real foods that actually contain the nutrients we need to thrive.

This article outlines how we can utilise macronutrients to assist us, like training wheels, to help us get pretty close ot ideal nutrition.  We can then focus on eating nutrient-dense foods that will help us thrive and to enable us to look, feel and perform at our best.

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Macronutrient wars

Many diet communities built around a specific macronutrient profile that they believe is optimal.

Different people believe in a wide range of macronutrient philosophies as the cornerstone of their nutritional approach.  One of the many variations is IIFYM.

If It Fits Your Macros (IIFYM) or Flexible Dieting was a trend in the bodybuilding community based on the idea that you could eat pretty much anything you wanted as long as you hit your macro targets.[1] [2] [3]

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IIFYM blossomed as a response to the ‘clean eating’ trend that grew around the Paleo diet[4] trend which emphasised food quality and was largely ‘macro agnostic’.

With IIFYM:

  • protein is set based on your lean body mass (LBM) and activity levels (typically 1.8g/kg LBM),
  • energy intake is calculated and then tweaked based on your desired rate of loss/gain,
  • fat is generally set at 25%, and
  • the remainder of your energy requirement is filled with carbs.[5]

IIFYM… the good

There are some good things about IIFYM / flexible including:

  1. It’s simple.
  2. It avoids macronutrient extremes which often drive micronutrient deficiencies.[6]
  3. A consistent energy deficit will work for most people, particularly the young fitness enthusiast who does not have diabetes.

IIFYM… the bad

However, there are a number of downsides to the IIFYM / Flexible Dieting approach, such as:

  1. No consideration of micronutrients.  Food quality becomes critical when restricting quantity over the long term to avoid deficiencies and cravings.[7]
  2. Little emphasis is placed on food quality.  While they might fit your macros, low nutrient density foods can be hyper-palatable and lead to overeating.  Foods with a higher nutrient density are more likely to be satiating, have a lower energy density and be harder to overeat.   Someone can get all their food from processed packaged foods and still comply with the IIFYM approach.
  3. Doesn’t cater well to people who are insulin resistant/diabetic.
  4. Recent research does not support the minimisation of dietary fat.  While too much refined fat is not optimal, the fat that comes with nutritious whole food should not be a concern for most people.
  5. Tracking specific macros and calories replaces a neurosis about micromanaging food quality with an obsession with hitting particular macro targets.
  6. It may be hard to hit exact macronutrient targets with whole foods.

The minimum effective dose of macros

In reality, there is a range of macronutrient that will give you a substantial level of essential micronutrients.

The article Nutrition… How to Get the Minimum Effective Dose outlined the macronutrient ranges that give us the best chance of getting a reasonable micronutrient profile.

The vertical axis in the charts below shows the Nutrient Density Score which is a measure of the amount of micronutrients in a range of foods.

As shown in the example below, if we could get three times the recommended daily intake of all the thirty-four essential nutrients, we would get a perfect nutrient score of 100%.   There is probably limited benefit in getting more than three times the recommended daily intake of a particular nutrient.  At that point, you’ll likely benefit by focusing on foods that contain the nutrients you are not getting as much of.

I have calculated the nutrient density score for a range of dietary approaches to understand the relationship between micronutrient adequacy and macronutrients.  Check out the detail in this post if you’re interested.

Protein

Of all the nutrients, protein has the highest correlation with nutrient density.

If we assume a nutrient density score of 70% as our minimum effective dose of nutrition (as denoted by the red line on the chart below), we can get a reasonable nutritional outcome when our protein intake is at least 19% of our energy intake.

Nutrient density seems to peak when we get around 45% of our energy from protein.  .

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If you have ever tried to more protein and track your intake, you will appreciate how hard it actually is to hit 45% of your energy intake from protein!   As you increase protein intake to more than 45% of calories, you would need to depend more and more on processed foods, so the overall nutrient density decreases.

The minimum effective dose level of 19% of energy happens to align reasonably well with 1.8g/kg LBM protein which aligns IIFYM recommendation for protein.  This is also aligns with the point at which strength gains start to plateau for strength athletes as shown in the chart from Lemon below.

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Protein even more important when we are trying to lose weight.  Recent research suggests that our need for protein increases if we want to prevent loss of lean muscle mass in a significant energy deficit.

If we are active and/or doing resistance training, then our requirement for protein is even higher.  As shown in the chart below from a recent review paper by Stuart Phillips,[8] lean muscle mass is best preserved when we have at least 2.6g/kg total body weight (BW) protein if we are targeting an aggressive deficit (e.g. 35%).  If we are chasing a less aggressive energy deficit, then 1.5 g/kg BW protein seems to be adequate.image38.png

So, unless you require a therapeutic ketogenic diet (i.e. as an adjunct treatment for cancer, epilepsy, Alzheimer’s, Parkinson’s, etc.), it appears prudent to think of 1.8g/kg LBM as a minimum protein intake.  Higher intakes will likely be beneficial if your goal is to maximise nutrient density or lose fat without losing muscle.

As an aside, you needn’t worry about ‘too much protein kicking you out of ketosis’   The images below are from my recent Ketogains Bootcamp where I was eating plenty of protein, had low blood glucose levels and plenty of endogenous blood and breath ketones from my own body fat. 

As detailed in the Optimal ketone and blood sugar levels for ketosis article, if you are trying to lose weight or manage diabetes you really want to drive a low energy state in your bloodstream  If you are burning body fat and/or are decreasing your blood sugar levels then ketones will come along for the ride.  You don’t need to active chase them or track them.

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The chart below shows the nutrient profile we get when we minimise protein.

There is a concerning trend of people trying to minimise protein to minimise insulin and mTOR.  While these things are not good in excess, neither is missing out on essential nutrients of having consumed excessive amounts of energy to get the nutrients you need.

Given that not consuming an excessive amount of energy is the only thing that has been proved to extend lifespan in human it makes a lot more sense to me to increase your nutrient : energy ratio so you don’t have to eat as much to get the nutrients you need.

Carbohydrates

While the optimum intake of non-fibre carbohydrate is about 30%, it seems that the minimum effective dose of non-fibre carbohydrates is effectively zero.

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Although we can get lots of vitamins and minerals from non-starchy veggies, people who do not feel the need to consume plants in their diet can get a substantial amount of nutrition from organ meats, shellfish and the like with minimal carbs.

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The chart below shows the nutrient profile you could acheive if you focused on the most nutrient dense animal based foods.

If you are metabolically healthy, there’s nothing wrong with consuming up to 65% carbohydrates, particularly if they are from unprocessed sources.  However, nutrient density starts to fall off beyond 65% as processed grains and sugars begin to dominate your diet.

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The chart below shows the nutrient profile that you could achieve if you focused on the most nutrient dense plant-based foods.

Regardless of your dietary preferences, ethical position or religious beliefs, quantifying nutrient density is an exciting tool to help you optimise your food choices and find optimal nutrition within the wide range of reasonable carbohydrate intake levels.

Fat

Although fat doesn’t correlate well with nutrient density,[9] it seems we struggle to get a good nutritional profile with less than about 10% dietary fat (or about 0.4g/kg LBM dietary fat).

At the other extreme, we could consume up to around 65% of our energy from fat without having a detrimental impact on our nutritional profile.    Similar to carbohydrates, it starts to get harder to get a broad range of essential micronutrients if we are getting more than 65% of our energy intake from fat.

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The proportion of insulinogenic calories

The percentage of insulinogenic calories is a measure of the insulin we require to metabolise our food due to non-fibre carbohydrates and protein it contains.[10] [11] For someone who is metabolically healthy, insulin load does not need to be a major concern.

Optimal nutrient density seems to occur around 40% insulinogenic calories.   Diets with more than 65% insulinogenic calories tend to be very low fat, very low in protein or very high in processed carbohydrates.   Similarly, our nutritional profile with a very high fat very low insulin load diet is not so flash either.

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I have drawn three windows on the chart of % insulinogenic vs nutrient density score to show suggested target ranges for:

  1. someone who is insulin resistant has prediabetes or knows they have a family history of diabetes,
  2. someone with diabetes who needs to follow a low carb or nutritional ketogenic approach to manage their blood sugar, and
  3. therapeutic ketosis.

If you are insulin resistant or have a family history of diabetes, then keeping your insulin load below 50% is likely a good idea.

If you already have diabetes, then lowering your insulin load to less than 25% of your energy requirement will help stabilise blood sugar and insulin levels.  You also need to keep an eye on nutrient density so you can build health with the food you are eating.  The chart below shows the nutrient profile you can acheive with a nutrient dense low carb approach.  

Meanwhile, someone who requires therapeutic ketosis (for the treatment of cancer, epilepsy, Alzheimer’s, Parkinson’s etc.) typically requires an insulin load less than 15% of their energy requirement to see therapeutic benefits.  The chart below shows the nutrient profile that you can achieve with a high-fat ketogenic diet if you focus on maximising nutrient density.

However, keep in mind that driving your insulin load unnecessarily low can lead to a poor nutritional outcome.   The chart below shows the nutrinet profile of the most ketogenic foods without consdieration of nutrient density.

Personally, I think you need to find the balance between insulin load and nutrient density that works for you.  Ideally, a therapeutic ketogenic approach would only a short-term undertaking until the condition stabilises and you can transition to a nutrient dense low carb approach for maintenance.

Minimum effective dose + nutrient density for the win!

The table below shows the guidelines for the minimum effective dose of protein, fat and insulin load for different goals in terms of your lean body mass (LBM).

  • In all but the therapeutic ketosis scenario, we should aim to hit our 1.8g/kg LBM of protein.
  • We may need a lower protein intake to achieve therapeutic levels of ketosis.
  • In the therapeutic ketosis, diabetes and insulin resistant scenarios we limit insulin load to 1.1, 1.8 and 2.9g/kg LBM respectively to enable the pancreas to keep up and maintain healthy blood sugar levels. This will mean you need to reduce carbohydrates, and to a lesser extent protein.
approach min protein

(g/kg LBM)

min fat

(g/kg LBM)

max insulin load

(g/kg LBM)

therapeutic ketosis 0.8 0.4 1.1
diabetes / nutritional ketosis 1.8 0.4 1.8
weight loss (insulin resistant) 1.8 0.4 2.9
weight loss (insulin sensitive) 1.8 0.4
most nutrient dense 1.8 0.4
nutrient dense maintenance 1.8 0.4
bodybuilder (bulking) 1.8 0.4
endurance athlete 1.8 0.4

Once we have the protein, fat and insulin load ranges set, we are free, unencumbered by concerns about meeting theoretical macronutrient targets, to fill the rest of our diet with foods and meals that are most suited to our goals.

These macronutrient windows function a bit like bumper rails for a child at a bowling alley.  As long as you stick within those ranges, you have a good chance of getting a reasonable nutritional outcome.

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Once you learn to focus on nutrient dense foods, you will no longer need the bumper rails.

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The table below shows how the parameters of insulin load, energy density and nutrient density are used to optimise our food choices to suit our goals.  In some cases (i.e. weight gain or loss) we may intentionally focus on managing energy intake.  For most people, focusing on more nutrient-dense foods will get you most of the way.

approach insulin load energy density nutrient density target calories
therapeutic ketogenic very low lower
diabetes / nutritional ketosis low lower adequate
weight loss (insulin resistant) low low good lower
weight loss (insulin sensitive) lowest maximum very low
most nutrient dense maximum
nutrient dense maintenance high high
bodybuilder (bulking) high good higher
endurance athlete very high high

How to set your target energy intake

If you are trying to lose weight and going to the effort of tracking, it is useful to have an upper limit energy intake that you make sure you don’t exceed.

While there are many inaccuracies involved in our energy in and energy out calculations, tracking your food in an app like Cronometer can be a useful self-education tool to understand the quantity and quality of your diet.

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Most macro calculators calculate your Basal Metabolic Rate (BMR) based on your lean body mass (LBM) and activity levels.  From this, you can estimate the amount of energy you might need to gain weight or the amount you will need to limit to lose weight.

These formulas, while a useful starting point, are only indicative, and should be used as a starting point.  I’ve run the Nutrient Optimiser analysis for plenty of people who are lean but eating a lot more calories than you might expect.  Conversely, many people who are obese seem to be eating much less than you might think they would be.  This may be in part due to measurement error or optimism bias, but everybody’s metabolism seems to be unique due to a wide range of factors.

The best way to determine your actual energy requirement is to track your intake and reduce or increase from there to ensure you are gaining or losing as required.  This is an iterative process based on your long-term trend.

Maximum rate of fat loss

The maximum rate of fat loss you can sustain without significant muscle loss is influenced by your current body fat levels.  Someone with a lot more body fat might be able to maintain a larger energy deficit than someone who is already lean.

The paper A limit on the energy transfer rate from the human fat store in hypophagia (Alpert, 2005) proposed that this maximum rate of fat loss is 31 calories per pound of body fat.[12]  According to Alex Ritson, in a recent Sigma Nutrition podcasts, this was later revised down to a maximum rate of fat loss of 21 calories per pound of body fat without losing significant muscle mass.[13]

While you may not want to target this maximum rate deficit every day, it is useful to be aware of this number.  If you don’t feel hungry, there is no need to keep eating to hit some arbitrary energy intake above this.

The table below shows an example of what this might look like in practice.

  obese lean
weight (kg) 110 70
weight (lb) 242 154
LBM (lbs) 157 135
% BF 35% 12%
BF (lbs) 85 18
BMR 2106 1871
max deficit (cals) 1,785 378
max deficit (%) 85% 20%

The obese person can nearly meet their entire maintenance energy intake from body fat while the lean person could only mobilise enough body fat to provide about a fifth their energy requirements.

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While out might have enough body fat to survive an extended famine, I wouldn’t recommend fasting for extended periods without paying attention to periods of nutrient-dense refeeding.

Research into the Protein Sparing Modified Fast suggests that nitrogen balance is maintained with a minimum of 1.4g/kg of ideal body weight for men and 1.2g/kg of ideal body weight for women.[14] [15]

Once we account for body fat, 1.4 g/kg IBW ends up pretty close to the 1.8g/kg LBM minimum effective dose level discussed above).

So it seems reasonable to use 1.8g/kg LBM protein plus 0.4g/kg LBM fat as an absolute minimum energy intake to make sure you can get the nutrients you need.

Should I keep eating until I hit my calorie target if I’m not hungry?

Many people find their appetite stabilises once they take out refined carbohydrates from their diet and stabilise their blood sugar levels.  Others find that focusing on nutrient-dense foods decrease their appetite and lead to spontaneous satiety.[16]  Meanwhile, others just find it tough to keep within their calorie limits.[17]  The bottom line here is, if you have obtained your minimum protein intake to preserve your lean muscle mass, there is no real need to keep eating if you don’t feel hungry.

Rather than some specific target, I think it is much more useful to think in terms of a range of energy intake that will enable you to reach your goals.  If you’re hungry there is no harm eating up to your upper limit calorie intake.  However, if you are trying to lose weight, then there is no point eating more than you need to to get the nutrients you need.

The daily thought process for someone following this process would be…

  1. Have I met my minimum calorie target?  If not, keep eating nutrient-dense foods.
  2. Have I met my minimum protein intake?  If not, keep eating nutrient-dense foods.
  3. Do I feel hungry?  If no, don’t eat.  If yes, eat nutrient dense foods that align with your goals until you hit your absolute minimum energy target.
  4. Do you still feel hungry?  If yes, then eat nutrient dense foods until you hit your maximum calorie intake.
  5. Have I exceeded my maximum energy intake?  If yes, then stop eating.

Summary

So in summary:

  • Focusing on specific macronutrient targets takes the focus off food quality and micronutrients and can be counterproductive.
  • There is a range of macronutrients within which you can get a reasonable nutritional outcome that aligns with your goals. Within these limits, your focus should be on getting all the micronutrients you need.
  • If you are are insulin resistant or have diabetes then it’s prudent to focus on less insulinogenic foods.  However, there is no point driving your insulin load to the point that you compromise nutrient density unnecessarily.

How to calculate your target macronutrient range

I know all these numbers can be confusing!

To help make this process easier we have developed a free report at NutrientOptimiser.com.

Simply enter your goals, preferences, weight and estimated body fat % and the Nutrient Optimiser will spit out a free report with your recommended macronutrient ranges as well as a shortlist of suggested foods and meals that will help you optimise your nutrition that will align with your goals.

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To get your free report you go to NutrientOptimiser.com, tell us what you’re interested in and enter your email address.

As your situation changes (e.g. you lose weight or your blood sugars stabilise) you will be able to come back and update your details and get new macro targets as well as optimal meals and foods.

We think this is unique and exciting.  We hope it will help a lot of people cut through the dietary confusion.  We would love you to test it and give us some feedback.

 

I have included some worked examples of that the macronutrient ranges would look like in practice in the appendix below.  But the best way to understand how it works is just to go have a play and see what the Nutrient Optimiser would recommend for you!

 

Example macronutrient ranges

So let’s look at how this will look in practice with some worked examples.

Let’s take the example of Paul, who currently weighs 90 kg and has 19% body fat.  He’s done the Nutrient Optimiser analysis but wants to know what targets to put in Cronometer.

We will look at how he could use this approach to setting macronutrient ranges in the following scenarios:

  1. therapeutic ketosis,
  2. low carb / nutritional ketosis,
  3. insulin resistant weight loss, and
  4. weight gain / athletic performance.

Therapeutic ketosis

Paul is interested in the ketogenic diet and recommends it to many of his clients.

The table below shows the range of protein, fat, carbohydrates (in grams) if Paul was aiming for therapeutic ketosis along with the basis for the upper and lower limits.

  lower upper comment
protein (g) 58 80 Minimum protein based on 0.8g/kg LBM.

The upper limit is based on 15% insulinogenic calories assuming no carbs.

fat (g) 180 212 Minimum based on weight maintenance with minimum protein and carbs.

Maximum based on weight maintenance with minimum protein and carbs.

carbs (g) 0 48 The upper limit corresponds to minimum protein and 15% insulinogenic calories.
energy (calories) Calories are not limited on a therapeutic ketogenic diet.  Many people using chasing therapeutic ketosis are looking to keep weight on, so very high levels of dietary fat intake is not a concern.

The chart below shows the resultant macronutrient ranges for the therapeutic ketogenic dietary approach in terms of percentage of energy intake.    As you can see, regardless of the scenario, Paul’s energy would largely come from fat.

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The foods listed below would give Paul the best chance of achieving therapeutic levels of ketosis while maximising high micronutrients as much as possible.

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The chart below shows the nutrient profile of the foods listed above.  The nutrients coloured yellow typically harder to obtain on a therapeutic ketogenic diet and have been emphasised in the foods listed above.

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If you’re following a therapeutic ketogenic diet as an adjunct therapy for cancer, epilepsy, Alzheimer’s or dementia, then you’ll likely also be tracking glucose and ketone levels.

If you are following a disciplined high fat ketogenic diet, you should expect to see lower blood sugars and higher ketone levels.

If you want to get serious, you can track your Glucose Ketone Index (GKI) which was developed by ketogenic cancer researcher Dr Thomas Seyfried.[18]  Through fasting, higher fat and a lower insulin load many people who require therapeutic ketosis aim for a GKI value of less than 1.0 which means your ketone values are higher than your glucose levels.  If you are just looking to manage diabetes then having a GKI less than 10 is a healthy place to be on a day to day basis when not fasting.

Therapeutic ketosis takes a lot of dedication and discipline.  Many people find that their condition resolves after a period and they can transition to a low carb / nutritional ketosis approach without triggering adverse symptoms.

Diabetes / low carb / nutritional ketosis

A diet for management of diabetes is not as restrictive as a therapeutic ketogenic diet and provides a higher level of nutrition.  The table below shows the low carb style macronutrient range that would keep Paul in nutritional ketosis.

  lower upper comment
protein (g) 131 239 Minimum protein is based 1.8g/kg LBM.

Upper limit based on maximum insulin load of 1.8g/kg LBM with zero carbs.

fat (g) 131 178 Lower limit is based on weight maintenance with maximum protein and carbs.

The upper limit is based on weight maintenance with minimum protein and minimum carbs.

carbs (g) 0 60 The upper limit corresponds to minimum protein (1.8g/kg LBM) and a maximum 1.8g/kg LBM insulin load.
energy (cals) Calories are not necessarily controlled on a low carbohydrate diet.  The initial focus should be on stabilising blood sugars and appetite.  From there we can force an energy deficit if necessary.

The figure below shows the range of macronutrients that will fit within the guidelines of a low carbohydrate diet to stabilise blood sugar or achieve nutritional ketosis.

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This food list will enable you to maximise your micronutrients on a low carbohydrate diet.

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Compared to a therapeutic ketogenic diet, the low carbohydrate diet provides a significantly high level of nutrient density.  The nutrients shown in yellow that are harder to find on a low carbohydrate dietary approach that have been emphasised.

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If you are following a low carbohydrate dietary approach, you will likely be tracking your blood sugars on a regular basis.  Once you are able to stabilise your blood sugars to non-diabetic levels using a low carb diet, we can then start to focus on reducing energy to lose weight (i.e. if your waist : height ratio is greater than 0.5 or you have a higher than desirable level of body fat).  From there you can start to focus on an energy deficit if you do not find you are achieving your desired level of weight loss with a low carb diet alone.

average blood sugar  

hbA1c (%)

 

trig:HDL ratio

mg/dL mmol/L
diabetes > 140 > 7.8 > 6.5% > 3.0
pre-diabetes 108 – 140 6.0 – 7.8 5.4 – 6.5% 2.0 – 3.0
insulin resistant 100 – 108 5.4 – 6.0 5.0 – 5.4% 1.0 – 2.0
insulin sensitive < 97 < 5.4 < 5.0% < 1.0

Many people find that they actually need to drop their body fat levels further before they are able to achieve truly optimal blood glucose levels.

Aggressive weight loss

Paul actually wants to lose weight fairly aggressively, but without compromising his hard-earned lean muscle mass.

If we take 21 calories per pound of fat as the maximum rate of fat loss without significant loss of muscle, then Paul could theoretically cut up to 790 calories from his typical energy intake without significantly compromising his lean muscle mass.  This deficit would leave him with 1349 calories.  He will still be able to get his minimum protein and fat intake levels at this energy level.

Paul is eager to lose fat fast, so he wants to target an aggressive deficit of at least 20%.  However, if he’s not hungry, there’s no real point in consuming beyond 1349 calories per day (i.e. a 37% deficit).  Paul is also still mindful of his blood sugars and insulin resistance, so we will also ensure his insulin load remains under 2.9 g/kg LBM.

  lower upper comment
protein (g) 131 214 Minimum protein is based on 1.8g/kg LBM which is fine if he is only targeting a 20% deficit.

The upper limit is based on 2.9g/kg LBM insulin load.

fat (g) 29 132 Maximum fat is based on 20% energy deficit with min protein and carbs.
carbs (g) 0 231 Maximum carbs is based on target energy deficit with minimum protein and fat.
energy (cals) 1349 1711 Lower energy intake is based on BMR -21 cal/lb fat mass.  The maximum is based on 20% deficit against BMR.

The screenshot below from Paul’s Cronometer showing how he can enter his target protein range.  Simply click on the bar for energy, protein, carbs and fat to enter the target range.

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The figure below shows the macro split including the energy from body fat (shown in yellow).

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This figure shows the food proportion of protein, fat and carbs when we only look at the food intake.  When we consider the food intake alone, between 30 and 55% of energy is intake will be from.

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The foods below will maximise nutrition to align with this aggressive fat loss approach.

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The chart below shows the high level of nutrients provided by the foods listed above.  These foods also have a very low energy density meaning that they will be hard to overeat.

image11.png

If your goal is aggressive fat loss, then you will likely be tracking your energy intake and body weight and fat on a regular basis to make sure you are achieving your desired results.

There is little value in regularly tracking blood sugars or ketones with this style of approach as they will likely be excellent if you are maintaining a significant energy deficit.

Paul’s focus with should be on making sure he gets adequate protein and nutrient dense foods while keeping under his energy target.

As an aside, Paul is doing well and sitting at #2 on the Nutrient Optimiser Leaderboard.  You can see Paul’s detailed Nutrient Optimiser report here.

Maximum fat loss

The table below shows the macronutrient ranges if Paul was to target maximum energy restriction while minimising the risk of muscle loss.  This is based on the maximum energy deficit of 21 calories per pound of body fat.

  lower upper comment
protein (g) 234 241 Minimum protein is based on 2.6g/kg BW in view of the aggressive deficit.

The upper limit is based on maximum 2.9g/kg LBM insulin load.

fat (g) 29 150 Max fat is based on 37% energy deficit with min protein and carbs.
carbs (g) 0 108 Max carbs is based on target energy deficit with minimum protein and fat.

We also want to limit Paul’s insulin load to less than 40% of his maintenance energy intake

energy (als) 1348

 

A maximum deficit of 21 calories per pound of body fat (i.e. 37% deficit)

Even though the protein levels are very high and he has some history of insulin resistance, I do not think Paul is likely to see elevated blood sugar levels with such a massive deficit.

Some protein may be converted to glucose via GNG, however, there will already be such a dramatic energy deficit that he would likely be seeing very low blood sugar levels.

The chart below shows the macronutrient split, including body fat.

image10.png

This chart shows the macronutrient split of this approach when we consider the food only.  These foods contain between 56 and 72% protein which starts to make this style of approach difficult without significant reliance on protein powders.  Achieving a strict Protein Sparing Modified Fast is actually quite difficult in practice because attaining such a high level of protein intake with such an aggressive deficit is quite hard.

image22.png

The foods below will give you the best chance of minimising energy intake while getting adequate protein and nutrients.

image3.png

The chart below shows the nutrient profile of these foods with the harder to find nutrients emphasised.

image23.png

Weight gain

If Paul was wanting to gain weight, he could target a 20% energy surplus and choose nutrient dense and energy dense foods so he could achieve this.

  lower upper comment
protein (g) 131 289 Minimum protein is based on 1.8g/kg LBM.

The upper limit is based on 50% of energy from protein.

fat (g) 29 185 Maximum fat is based on 20% energy surplus with minimum protein and carbs.
carbs (g) 0 348 Maximum carbohydrates is based on target energy surplus with min protein and fat.
energy (als) 2567 The maximum is based on a 20% energy surplus against BMR.

The list of nutrient dense and energy dense foods below would help Paul to maximise nutrient density in an energy surplus.

image27.png

The chart below shows the nutrients provided by these energy-dense foods.

image19.png

You should make a calculator for that!

To get your optimal macronutrient ranges please check out the new calculator at NutrientOptimiser.com.

image9.png

We hope you love it!  Let us know how we can make it more useful to help you achieve your goals.

 

 

references

[1] https://www.iifym.com/

[2] https://www.bodybuilding.com/fun/your-complete-guide-to-iifym

[3] https://www.avatarnutrition.com/

[4] Incidentally, paleo has been in decline since January 2014 while IIFYM peaked in mid 2016.  Currently keto and vegan are the hot new diet trends.

[5] https://healthyeater.com/flexible-dieting-calculator

[6] https://optimisingnutrition.com/2017/03/19/micronutrients-at-macronutrient-extremes/

[7] https://optimisingnutrition.com/2017/06/17/psmf/

[8] https://www.ncbi.nlm.nih.gov/pubmed/29182451/

[9] https://optimisingnutrition.com/2017/10/30/nutrition-how-to-get-the-minimum-effective-dose/

[10] https://optimisingnutrition.com/2015/03/30/food_insulin_index/

[11] https://optimisingnutrition.com/2015/03/23/most-ketogenic-diet-foods/

[12] https://www.ncbi.nlm.nih.gov/pubmed/15615615

[13] https://sigmanutrition.com/episode207/

[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1646394/

[15] http://www.ketotic.org/2014/01/how-much-protein-is-enough.html

[16] https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-9-51

[17] https://ketogains.com/tag/tyler-cartwright/

[18] https://www.researchgate.net/publication/274011072_The_glucose_ketone_index_calculator_A_simple_tool_to_monitor_therapeutic_efficacy_for_metabolic_management_of_brain_cancer

Dr Greger’s How Not to Die Cookbook (review)

To celebrate the release of the How Not to Die Cookbook I thought it would be interesting review some of Dr Greger’s recipes to see how they stack up nutritionally.

Well presented

Firstly, I’ve got to give kudos on the layout.  Rather than wait for a hard copy to ship to Australia, I bought my copy on Apple iBooks and was impressed at how you could interactively explode the ingredients list to full screen on my phone.

This feature would be invaluable when actually using the book in the kitchen, especially on a phone where showing a full page of small text on a screen is impractical, and all you want to see is the ingredients from a distance.

Whole food

The recipes in the How Not to Die Cookbook are full of nutritious minimally processed whole food, which is a win for me.

image21.png

There are heaps of colour on the pages, which is indicative of the range of vitamins and minerals present in these minimally processed foods.

In the introduction, Dr Greger makes the critical distinction between a vegetarian diet (which could be filled with highly processed grains and sugars) and minimally processed plant-based whole foods.

Most of the issues with nutrition come when we overly process our food and make it shelf stable for increased profit margins.  Some of the recipes in the How Not To Die Cookbook call for some whole wheat bread, pasta, date sugar and the like, but generlaly, the recipes rely on minimally processed whole foods.

If you want quick and easy, this may not be the book for you.  Although there are headings of ‘easy’ and ‘moderate’ on the recipes, most of the recipes have a significant number of ingredients, including a range of herbs and spices.

You may have to gear up your kitchen with a range of new ingredients if you are not already following this way of eating.  However, for the experienced WFPB enthusiast who wants to add some flair and variety to their diet and dinner parties, this book is ideal.

Plant-based

In spite of being the Director of Public Health and Animal Agriculture for the Humane Society by day, Dr Greger doesn’t overtly focus on being vegan or vegetarian in the book.

image20.png

Unlike many others in this field, he doesn’t lead with animal welfare as the primary basis for his dietary appraoch.  In the introduction to the cookbook, he talks about his personal experience of seeing his grandmother’s life turned around by this way, under the guidance of Nathan Pritikin (pictured below).

image15.png

Greger is a self-confessed “nutrition nerd” who appears to find genuine excitement in unpacking the research to find links between different aspects of diet and their impact on health.  His Nutrition Facts YouTube channel has become viral and has become the primary resource for pre-processed nutritional inspiration for many.

Frame of reference

Nutrition is still an emerging science.  We seem to still be fumbling trying to understand the mechanisms, the cause and effect relationships of the food we eat on our health, well-being and longevity.

To deal with complexities of a topic like nutrition, we adopt a simplified frame of reference to help us navigate our reality without our mind exploding.  These simplified frames of reference are never perfect.  It’s also hard one frame of reference that explains everything perfectly.  Over time we strive to create new and more useful frames of reference that suits use best.[1]

Some example of different frames of references for nutrition are:

  • The Paleo frame of reference says we should eat foods that we evolved with.
  • The vegan frame of reference says we should eat foods that don’t harm other sentient life forms.
  • The hedonistic frame of references says, “if it tastes good, eat it.”
  • The cost frame of reference optimises for the lowest cost per calorie with minimal consideration of nutrition.
  • The Heart Association frame of reference believes that minimising fat, especially saturated fat, will help us avoid heart disease.
  • The conservationist frame of reference tries to eat in a way that we should eat in a way the minimise our impact on the environment.
  • The Seventh Day Adventist Church (who have a large influence through their food companies and medical evangelism) believe that they should eat plants and herbs (and not meat) because that’s how it was in the Garden of Eden.
  • The low carb/keto frame of reference suggests that minimising carbohydrates and maximising fat will lead to optimum health for most people.

As a doctor, Dr Greger relies on the medical research frame of reference.  He draws associations between different food properties and health outcomes and tries to develop a system that avoids the qualities of food that he believes to be dangerous.

While some people suggest that Greger cherry picks the studies and interprets the data to fit his plant-based perspective,[2][3][4] the research-based frame of reference is at least a refreshing contrast to the fear-based frame of reference in more militant vegan presentations (e.g. What the Health and Cowspiracy).

The Optimising Nutrition framework

Nutrient density

While I don’t call myself a Nutritarian, my frame of reference has a lot in common with Dr Joel Fuhrman’s focus on nutrient density.

Rather than focusing on foods to avoid I think we need to focus on foods that contain the nutrients we need.  By focusing on the things we need we automatically eliminate the things that aren’t good for us in excess.  Ultimately, I think we should focus on eating the foods that give us the nutrients without having to ingest too much energy to get those nutrients.

Dr Mat Lalonde’s take on nutrient density has also been a major inspiration.  Lalonde took Fuhrman’s ANDI and re-ran the analysis to consider only essential vitamins, vitamins, amino acids and essential fatty acids for which there are widely available data and some consensus on the minimum nutrient intakes.

The problem with Lalonde’s approach, though, is that amino acids are very easy to find in our food system, so the system ends up optimising for very high protein foods at the expensive of vitamins and minerals which can be harder to obtain in our food system.

Dr Greger is also a big fan of nutrient density as shown in this NutritionFacts.org video.

Rather than emphasising all nutrients, the Nutrient Optimiser algorithm identifies the nutrients that you are not getting in large quantities and identifies foods that will boost those nutrients.

cropped-2017-04-22-2.png

If you want to follow a particular dietary template (e.g. vegan, paleo, ketogenic, low carb, whole food plant based, pescetarian, vegetarian, bivalve vegan etc) the Nutrient Optimiser algorithm can work within those parameters to identify the most nutrient-dense foods.  However, the optimal nutritional outcome tends to be to simply focus on the most nutrient-dense foods available.

Insulin load

As the husband of someone who has had type 1 diabetes for three decades, I also see the importance of eating food that doesn’t require massive amounts of insulin to maintain normal healthy blood sugar levels.

There is value in managing dietary insulin load to make sure you don’t need massive levels of insulin to stabilise your blood sugar.  The food insulin index data shows us that our glucose response is proportional to the carbohydrate we eat.[5][6]image10.png

While our insulin response is related to the non-fibre carbohydrates minus about half the fibre.

image3.png

Energy density

And lastly, energy density can be a useful tool to help you moderate your food intake.

image5.png

This is another area where the WFPB approach shines in contrast to the low carb or ketogenic approaches, which can be energy dense and make it possible to overeat.

Without the use of added oils or a significant amount of processed grains and sugars, it will be practically impossible to overeat using only the meals set out in the How Not to Die Cookbook.

image26.png

Meals analysed

I chose representative meals from the various sections of the book.   If you click on the recipes listed below, you will see the meal entries in Cronometer.  If you want the photos and directions, you’ll have to buy the book).

●     portabellas and greens on toast
●     curried cauliflower soup
●     skillet sweet potato bake
●     white bean soup
●     spinach and mushroom black bean burritos
●     summertime oatmeal
●     whole wheat pasta with lentil bolognese
●     superfood breakfast bites
●     chocolate-cherry-banana soft-serve
●     morning oatmeal bowls
●     chocolate oatmeal

micronutrient profile

The figure below shows the nutrient profile of Dr Greger’s recipes in terms of nutrients provided as a proportion of the recommended daily intake.

image8.png

As you might expect, we get a ton of vitamin K1, vitamin A and vitamin C.  However, at the top of the chart, we’re not meeting the DRI levels of vitamin D and vitamin B12.

Nutrient score

The Nutrient Score is a relative comparison of the quantity of essential nutrients in our food.

If your diet provides twice the minimum level of nutrients, then we would achieve a perfect score of 100%.  This approach doesn’t reward massive amount of a small number of nutrients, but rather leads people to rebalance their diet so they can obtain a substantial intake of all the essential nutrients.

In his Perfect Health Diet, Paul Jaminet notes that “a nourishing, balanced diet that provides all the required nutrients in the right proportions is the key to eliminating hunger and minimising appetite and eliminating hunger at minimal caloric intake.”[7]  Similarly, studies by Dr Joel Fuhrman indicate that a nutrient dense diet will reduce cravings and provide satiety with a lower energy intake.[8]

Overall, the recipes from the How Not to Die Cookbook get a respectable Nutrient Density Score of a score of 79%.   For comparison, the lowest Nutrient Density score is 20% while the highest score to date has been 92%.

Macronutrients

The macronutrient split of the recipes is shown in the chart below.     While these foods are 70% carbohydrates, there are only 54% non-fibre carbohydrates once we subtract the fibre.

image24.png

Carbohydrates

As shown in the chart below of nutrient density score vs non-fibre carbohydrates (see this article for more detail), we can get a reasonable amount of nutrition with net carbs anywhere in the range of 0 to around 60%.  So, while not optimal, this level of non-carbohydrates in Dr Greger’s meals is not excessive for most people.  However if you already have diabetes it will likely not provide optimal blood sugar control.

image17.png

Fat

Similarly with fat at 14%, we’re still within an acceptable macronutrient range, although optimal nutrient density seems to align with around 40% fat.

image4.png

Protein

For the sake of analysis, I have run the Nutrient Optimiser report for a male who is 80 kg (176 lbs) with 15% body fat to achieve a maintenance energy intake of 2000 calories per day.  Dr Greger’s recipes provide on average 84 g of protein per day which equates to 1.2 g/kg lean body mass (LBM) or 1.05 g/kg total body mass per day.

Optimal protein is a contentious topic. However, we can say that the intake level provided by Dr Gregor’s meals would exceed the Adequate Intake level of 0.86 g/kg and is about equivalent to the recommended daily intake.[9]

Where things get murky is when we talk about the bioavailability of plant-based protein versus animal protein; however, Dr Gregor generally appears more concerned about not getting too much “animal protein” for longevity considerations.

I’m not aware of any research in humans that demonstrates that we live longer by reducing protein intake.  There is research in yeast and worm that shows that energy restriction and protein restriction causes slower growth and overall longevity, though the quality of life may be compromised.[10]

What appears clear is that having more lean muscle mass and lower levels of body fat is a good thing.[11]

To optimise your health and longevity you need to find the balance between excess growth and obesity versus being too frail and weak to be resilient as we age.

NF-Sarcopenia[1].jpg

As shown in the chart below, there is an optimal balance between growth and wasting.[12] Too much insulin and you grow to the point that you get complications of metabolic disease.  Too little growth and you become frail, lose your muscle and bone strength then you may fall, break your hip and never get up again.

image25.png

If you are lifting heavy and trying to build muscle, you may benefit from consuming at least 1.8g/kg total body weight.[13]

image1.png

And if you are dieting and trying to lose body fat, then it seems to be beneficial to have anywhere between 1.4g/kg total body weight (for a moderate energy deficit) and up to 2.6g/kg body weight (for a very aggressive energy deficit) if you want to preserve your lean muscle mass.[14][15]image7.png

Insulin load

Insulin load is the amount of the food in your diet that will require insulin to process due to the non-fibre carbs and protein.  This video from Dr Greger was one of the things that got me thinking about insulin load there three years ago and trying to put the pieces to.

While having plenty of vitamins and minerals (particularly potassium, calcium, magnesium and sodium) from whole foods helps to improve blood sugar control by improving insulin sensitivity, so does lower levels of processed carbohydrates that tend to raise blood sugar levels.

Dr Greger’s diet would provide an insulin load of around 341g per day with 67% insulinogenic calories.   For those of you that are used to thinking in terms of carbohydrates, this is 294g per day of non-fibre carbohydrates.

Insulin load is actually quite closely correlated with nutrient density.[16]  While 67% insulinogenic calories is just inside the nutrient density envelope, such a high insulin load would be a problem for someone like my wife Monica who has Type 1 diabetes.

As discussed in the vegan vs keto for diabetes article, a whole food diet can provide benefits in terms of higher levels of beneficial nutrients to help with insulin sensitivity and generally means people eat less due to a lower energy density of fruit and vegetables, it seems to be the people on a reduced carbohydrate higher protein approach that has the best diabetes control.[17][18]

image9.png

Optimal nutrient density appears to align with an around 40% insulinogenic calories.  People who are already insulin resistant or who have diabetes should work to reduce the insulin load of their diet to the point that they can achieve stable blood sugar levels.

It is harder for someone not consuming any animal products or seafood to reduce their insulin load.  However, we will look at how someone following a WFPB diet can minimise their insulin load as much as possible.

Potential Renal Acid load (PRAL)

It’s also worth noting that Dr Greger’s recipes have a solid amount of alkalising minerals, notably:

  • calcium (207% of the DRI),
  • potassium (210%),
  • magnesium (269%), and
  • sodium (234%).

While I’m a proponent of getting adequate protein, I also think getting adequate minerals is critical to metabolic health, as well as muscle building.[19][20][21][22][23][24]

Some believe that avoidance of animal products is the most important parameter.  However, I think one of the major benefits of a WFPB approach over a grain-based diet (or even a typical ketogenic or low carb diet managing diabetes) is the fact that it gives you plenty of alkalising minerals, which serves to reverse metabolic acidosis which leads to diabetes.

Nutrient balance ratios

The table below shows the nutrient balance ratios of Dr Greger’s recipes.

  • It seems there are lower levels of zinc and higher levels of copper, which is a concern.
  • The potassium : sodium ratio is above 2 which is great.  However, I would have expected this to be higher given that Dr Greger actively avoids salt.
  • The iron : copper ratio is high due to higher levels of copper from the plant-based diet.
  • The calcium : phosphorus ratio is low due to the lower levels of calcium and higher levels of phosphorous.
ratios ratio target recommendation
Omega 6 : Omega 3 2.1 < 4 Omega 6 : Omega 3 ratio is good.
Zinc : Copper 3 8 – 12 Zinc : Copper ratio is outside limits.
Potassium : Sodium 2.3 > 2 potassium : sodium ratio is good
Calcium : Magnesium 1.8  < 2 calcium : magnesium ratio is good.
Iron : Copper 8 10 – 15 iron : copper ratio is within range.
Calcium : Phosphorus 0.9 > 1.3 calcium : phosphorus ratio is low.

Nutrients to prioritise

The aim of the Nutrient Optimiser is to help you rebalance your nutrients at a micronutrient level by identifying foods that will provide more of the nutrients that you are currently not getting in large quantities.

image19.png

The table below lists the nutrients that someone following Dr Greger’s diet would be getting less of relative to the other nutrients.  The right-hand column indicates whether we want to prioritise these nutrients.

While six of the thirteen less-available nutrients are amino acids, we will only prioritise the vitamins and minerals, given that Dr Greger has a range of videos warning of the perils of “excess” animal protein.[25]

nutrient % DRI prioritise
Vitamin D 17% yes
Cobalamin (B12) 26% yes
Leucine 101% no
Zinc 124% yes
Methionine 124% no
Lysine 157% no
Pantothenic Acid (B5) 174% Yes
Selenium 188% yes
Valine 192% no
Isoleucine 197% no
Tyrosine 199% no
Calcium 207% yes
Potassium 207% yes

Optimal foods – nutrient dense plant-based

The image below shows the plant-based foods that would provide the nutrients that are not being provided in large quantities by Dr Greger’s meals.  The food shaded in light green are vegetables, the foods in dark green are spices, brown ad nuts and seeds, grey are oils and pink are fruits.

image11-1.png

Optimal foods – most nutrient dense

Meanwhile, the image below shows the foods that would provide the harder to find nutrients without the plant-based constraint.  In this table, the cells shaded green are seafood, red is offal, blue is dairy.

image14.png

What I find fascinating here is that even though we did not prioritise any amino acids or essential fatty acids, the Nutrient Optimiser algorithm seems to rebalance the diet with more protein (50%), more fat (35%) and less non-fibre carbs (3%).

Optimal foods – diabetes-friendly plant based

Meanwhile, if we were trying to manage diabetes and insulin resistance, these are the foods that the Nutrient Optimiser algorithm would recommend to manage insulin load while also being nutrient dense and filling in the nutrient gaps in Dr Greger’s meal while also remaining plant-based.

image6.png

If we weren’t trying to avoid animal products, the foods listed below would provide the harder to find nutrients required with a lower insulin load.   It’s interesting that the system prioritised butter, cream and cheese to help reduce insulin load and rebalance micronutrients in Dr Greger’s recipes.

Most of the time when I have run the analysis for people following a low carb diet the system recommends much more nutrient-packed green veggies that are often neglected by people following a low carb or keto diet.  It’s interesting to see that for someone follow Dr Greger’s recipies it would recommend the opposite.

Screenshot-2017-12-07-06.04.26.png

Optimal meals

Where this gets really cool is when we use the same process to identify meals to boost the harder to find micronutrients.   The list below shows a selection of meals identified by the Nutrient Optimiser algorithm to fill the micronutrient gaps in Dr Greger’s meal plan.

●     Bootcamp Omelette
●     eggs, sardines, oysters and broccoli
●     spinach, mussels, sardines, eggs, sauerkraut
●     spinach, egg and oysters breakfast bowl
●     mussels, spinach, egg and sauerkraut
●     sardines, spinach and egg breakfast bowl
●     spinach, mackerel, peanuts and cheese
●     anchovies, spinach and egg breakfast bowl
●     oysters and salmon
●     Rhonda Patrick smoothie 1
●     mackerel, spinach, egg breakfast bowl
●     nutritional omelette 2
●     nutrient omelette 1
●     high cruciferous juice
●     cauliflower cream soup
●     green juice
●     lift day omelette

The chart below shows the nutrients provided by these meals.  Compared to the 78% provided by the meals from the How Not to Die Cookbook, these meals from the Nutrient Optimiser would provide an almost perfect score of 99%!

image23.png

The higher nutrient density provided by these meals will mean that you would need to consume less energy to get the nutrients you need, while also improving insulin resistance, mitochondrial function and overall energy levels with the higher levels of essential and nonessential nutrients from whole foods.

image28.png

If you’re interested, you can read Dr Greger’s full Nutrient Optimiser report here.

Summary

  • The recipes in the How Not to Die Cookbook are nutritious while remaining whole food plant based.
  • The protein content meets the recommended minimum intake levels. However, higher protein levels may be required to maximise muscle protein synthesis for someone who is active or wanting to maintain lean muscle mass while losing body fat.
  • The meals are relatively low fat but relatively high in non-fibre carbohydrate. While this level of carbohydrate is not excessive for someone who is metabolically healthy, someone who has diabetes may benefit from foods with a lower insulin load while also still maximising the nutrients that are provided by non-starchy vegetables.
  • We can use the Nutrient Optimiser algorithm to identify foods that contain more of these harder to find nutrients regardless of our preferred nutritional constraints.

 

references

[1]https://www.amazon.com/Win-Bigly-Persuasion-World-Matter/dp/0735219710

[2]https://deniseminger.com/2017/05/22/critical-review-of-michael-gregers-how-not-to-die/

[3]http://www.nourishbalancethrive.com/blog/2016/06/09/foodloose-recap-transcript/

[4]https://robbwolf.com/2017/07/03/what-the-health-a-wolfs-eye-review/

[5]https://optimisingnutrition.com/2017/10/21/redesigning-nutrition-from-first-principles/

[6]https://optimisingnutrition.com/food-insulin-index/

[7]http://perfecthealthdiet.com/

[8]https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-9-51

[9]https://www.nrv.gov.au/nutrients/protein

[10]https://optimisingnutrition.com/2017/10/15/high-protein-vs-low-protein/

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

[12]http://press.endocrine.org/doi/full/10.1210/jc.2011-1377

[13]https://www.ncbi.nlm.nih.gov/pubmed/29182451/

[14]https://www.ncbi.nlm.nih.gov/pubmed/29182451/

[15]https://www.dropbox.com/s/1if7n957u66htiy/10.1123%40ijsnem.2017-0273.pdf?dl=0

[16]https://optimisingnutrition.com/2017/10/30/nutrition-how-to-get-the-minimum-effective-dose/

[17]https://optimisingnutrition.com/2017/07/25/vegan-vs-keto-for-diabetes-which-is-optimal/

[18]https://optimisingnutrition.com/2015/08/02/standing-on-the-shoulders-of-giants/

[19]https://optimisingnutrition.com/2016/11/19/the-alkaline-diet-vs-acidic-ketones/

[20]http://suppversity.blogspot.com.au/2013/04/science-round-up-seconds-macro-mineral.html

[21]https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/diet-induced-acidosis-is-it-real-and-clinically-relevant/D7F03DFEF497996E90BB6DA487C777B8/core-reader

[22]https://www.ncbi.nlm.nih.gov/pubmed/21481501

[23]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4935236/

[24]https://www.ncbi.nlm.nih.gov/pubmed/16736444

[25]https://nutritionfacts.org/topics/animal-protein/

optimal meals and foods for fat loss and muscle building

Ever wondered what foods and meals are optimal for fat loss and muscle building?

Ketogains’ Luis Villasenor recently put a call out for recipes for their upcoming Ketogains Boot Camp, so I thought it would be interesting to see what the Nutrient Optimiser had to say about optimal foods and meals that align with the Ketogains approach.

luis villasenor

The essence of the Ketogains approach is to:

  1. consume adequate protein,
  2. limit carbohydrates, and
  3. use ‘fat as a lever’.[1]

This article unpacks each aspect of the Ketogains system.

image34.png

Protein as a goal

The Ketogains macro calculator recommends a minimum protein intake of 0.8g per pound of lean body mass (LBM) (i.e. 1.8g/kg LBM), increasing to 1.0g/lb LBM (or 2.2g/kg LBM) on lifting days.

This protein intake level is more than would be recommended in a therapeutic ketogenic approach or even the average protein intake for the general population.[2] [3] It does, however, align with Steve Phinney’s recommended protein intake level for athletes and performance and represents a more optimal protein intake for active people.[4] [5] [6]

From a sports nutrition standpoint, more than 2.2 gram per kilogram of total body weight is regarded as “high protein”.[7]  This could be as high as 3.0g/kg LBM when fat mass is taken into account.  So, while the Ketogains protein recommendations might be considered high in therapeutic keto and vegan circles, the Ketogains recommendations would be ‘moderate’ in a sports nutrition and bodybuilding circles.[8]

This chart above (from Lemon, 1998[9]) shows that, for a strength athlete, muscle protein synthesis is maximised when they consume at least 1.8g/kg BW of protein.

image53.png

Protein intake even more important when you are trying to lose weight.  The higher the energy deficit, the greater is our need for protein to prevent loss of lean muscle mass.  If we are active and/or doing resistance training, then our requirement for protein is even higher again.  As shown in the chart below from a recent review paper by Stuart Phillips, muscle mass is best preserved best when we have higher levels of protein, particularly if you are targeting an aggressive deficit.[10] [11]  If you are targetting a moderate energy deficit (e.g. 10%) then a protein intake of around 1.5g/kg BW is appropriate.  However, if we are targetting a very aggressive energy deficit then higher levels, up to 2.6g/kg BW will be beneficial to prevent loss of lean muscle mass.  If we are active then we will also need more (dashed line) while we need less if we are sedentary (dotted line).

image37.png

While it’s actually difficult to consume such high levels of protein due to the satiety effect, more protein won’t turn to chocolate cake.  [12]

image16.png

Protein contributes to your energy intake.  So if your goal is fat loss, then you want to target the minimum effective dose of macronutrients and micronutrients.

As a general rule, a higher protein intake tends to lead to a better nutritional profile[13] and increased satiety.[14] [15]  Very high protein diets (i.e. above than 80% energy from protein) will likely rely on supplements and may minimise other foods that provide more vitamins and minerals.  As you can see on the far left of this chart, actively targeting a low protein intake can lead to a poor nutritional outcome.[16]

protein (%) vs nutrient density score [click to enlarge]
[note: If your goal is therapeutic ketosis for the management of epilepsy, dementia, cancer, Parkinson’s or Alzheimer’s you will need to pay particular attention to ensure you get your share of micronutrients.]

Carbs as a limit

As you can see in the chart below,[17] you can get a reasonable level of nutrition if you consume anywhere between 0 and 60% of your energy from non-fibre carbs.[18]  However, with an exploding diabetes epidemic,[19] [20] [21] it’s probably fair to say that the majority of people would do better if they reduced their consumption of refined grains and sugars.

carbohydrates (%) vs nutrient density score [click to enlarge]
If you have already developed insulin resistance or diabetes, then reducing your carbohydrate intake to the point you achieve normal blood glucose levels is a good idea,[22] both in terms of overall health and controlling appetite that can be driven by excessive blood sugar swings.

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The fact that much of the population is already insulin resistant is likely part of the reason the Ketogains approach, with its limit on carbs, has been so successful.

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Low carbers are fond of saying “there is no such thing as an essential carbohydrate”.  However, unless you are focusing on getting lots of organ meat, shellfish, or fresh meat, you may benefit from consuming some non-starchy veggies to get your essential vitamins and minerals.

Twenty or thirty grams of non-fibre carbs doesn’t sound like much in the context of grains or sugars, but it can feel like a LOT of food to consume if it’s from non-starchy veggies.[23]

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Fat as a lever

So to recap before we get into discussing fat:

  1. Adequate protein is critical to support muscle growth and repair.
  2. Non-starchy veggies (which contain a small amount of non-fibre carbohydrates) provide vitamins and minerals (unless of course, you are eating heaps of shellfish, organ meat or drinking blood like the Maasai).

Recently, many people are swinging back from their fear of fat to embrace dietary fat again.  Carbohydrate is a more explosive fuel source for emergencies, while fat is a slower burning and more efficient fuel source.

While there are essential fats, we don’t require much to meet our minimum requirements of essential fats.[24]  Beyond this, where you get your energy doesn’t matter that much.

Many people do fine on a diet that obtains a lot of the energy from carbs while other do well on a diet that get the majority of energy from fat.  However, where things seem to go wrong is when people consume diet that is high in energy dense nutrient poor fat and carbs with minimal amounts of protein.

fat vs carbs.jpg

As you can see from the chart below, we can achieve a respectable nutritional outcome with a fat intake of between 10 and 65%.   More fat is not necessarily better, but very low-fat levels are not great either as they tend to have minimal amounts of protein and other essential nutrients.

fat (%) vs nutrient density score [click to enlarge]
If you are trying to reduce body fat, then maximising the nutrient density and reducing the energy density of your food is a worthy goal.  A protein sparing modified fast, an extreme version of this, provides adequate protein while limiting both fat and carbohydrates.

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If you are looking to gain weight, add muscle or perform extended feats of endurance exercise on a regular basis, it may be beneficial to load up on more energy dense foods.  However, conversely, if are not an endurance athlete but trying to use your body fat for fuel (like most of us these days living in a sedentary environment full of hyperpalatable food), you may want to wind your dietary fat intake back.

Micronutrients

Once you’ve worked out your macros using the Ketogains calculator and got the hang of using fat as a lever to manage energy intake, the next step is to ensure you are getting your share of micronutrients.

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Focusing purely on macros (e.g. Flexible Dieting, IIFYM, etc.) is short-sighted because it fails to consider micronutrients.  Chronic energy restriction without attention to micronutrients can lead to chronic nutrient deficiencies,[25] a lack of energy, increased hunger,[26] rebound bingeing due to cravings and even death.[27]

You’re likely aware that the branched-chain amino acids (BCAAs) trigger muscle protein synthesis and ensure you use the rest of the amino acids to build and repair your muscles.[28]  However, recent research has found that the amino acids arginine and lysine trigger satiety and hence we find foods that contain these amino acids more filling.[29] [30]

The chart below shows what your micronutrient profile would look like if you focused on branched chain amino acids (valine, isoleucine, and leucine) and the satiety-related amino acids (lysine and arginine) while also keeping carbohydrates low.

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While we get plenty of protein with this approach, we would not obtain the recommended minimum levels of a large number of the essential vitamins, minerals, and essential fatty acids.

As much as we like to focus on macronutrients (i.e. fat, protein, carbohydrates, fibre, ketones), micronutrients are arguably a more useful to assist us in our nutritional decision making.

Getting adequate minerals is especially important for:

  • avoiding the symptoms of the keto flu,[31]
  • reversing insulin resistance and minimising the amount of basal insulin circulating in your body,[32] [33] [34] and
  • maximising athletic performance.[35]

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The chart below shows what happens to our micronutrient profile when, in addition to BCAAs, we also prioritise foods that contain the harder to find micronutrients.  The purple bars represent the nutrients contained in the average of all foods in the USDA foods database while the blue bars represent the nutrients contained in the shortlist of foods.

nutrients - weight loss insulin resistant vs all foods.PNG

Optimal foods

In case you were wondering which foods will give you the most micronutrients while also having a lower energy density and fewer carbs, I have listed them below.

vegetables

  • endive
  • alfalfa
  • chicory greens
  • escarole
  • coriander
  • pumpkin leaves
  • asparagus
  • spinach
  • Chinese cabbage
  • lettuce
  • parsley
  • okra
  • zucchini
  • beet greens
  • watercress
  • arugula
  • portabella mushrooms
  • chives
  • chard
  • white mushroom
  • turnip greens
  • cauliflower
  • mustard greens
  • banana pepper
  • cucumber
  • pickles
  • sauerkraut
  • yeast extract spread
  • summer squash
  • radishes
  • broccoli
  • collards
  • shiitake mushroom
  • celery
  • artichokes
  • eggplant
  • cabbage
  • snap beans
  • turnips
  • red peppers

spices

  • basil
  • dill (fresh)
  • sage
  • marjoram
  • curry powder
  • thyme
  • caraway seed
  • mustard seed
  • dill seed
  • cloves

fruit

  • blackberries
  • avocado
  • raspberries
  • olives

seafood

  • salmon
  • sturgeon
  • halibut
  • fish roe
  • anchovy
  • crab
  • trout
  • caviar
  • crayfish
  • flounder
  • mackerel
  • sardine
  • oysters
  • mussel
  • rockfish
  • pollock
  • lobster
  • herring
  • haddock
  • perch
  • whiting
  • tuna
  • shrimp
  • white fish
  • cod
  • octopus

offal

  • liver
  • kidney
  • heart
  • brains
  • headcheese
  • brains

animal products

  • pork chops
  • pork shoulder
  • lamb
  • roast pork
  • pork loin
  • ground pork
  • pork ribs
  • roast ham
  • leg ham
  • sirloin steak
  • ground beef
  • chicken drumstick
  • chicken breast
  • veal
  • bratwurst
  • chuck steak
  • roast beef
  • ham
  • ground turkey
  • turkey
  • beef roast
  • lamb
  • ribeye fillet
  • bison
  • beef loin
  • ground beef

dairy & egg

  • whole egg
  • egg yolk
  • whey protein powder

You should ideally focus on the foods closer to the top of these lists.  But once you’ve eaten as much endive, alfalfa, liver and caviar as you can, feel free to move down the list to more energy dense foods or ones that you might enjoy eating more.

Supplements

If you can’t get enough nutrient-dense foods, it may be beneficial to use supplements.[36]  Keep in mind though, the nutrients from whole foods are likely to be better absorbed.

Too many minerals at once will ‘give you a dose of the salts’ and all your expensive supplements will end up in the toilet.  Whole foods are also more likely to contain other beneficial non-essential nutrients that come along with nutrient-dense foods.

What to track

“What gets measured gets managed”.[37]

But we can only manage a handful of things at a time.

“If everything is a priority, nothing is a priority.”

Rather than trying to track everything all at once you need to identify a few things to track to ensure you are moving towards your goals.

In the context of losing fat and gaining muscle the best things to track appear to be:

  1. weight/body fat,
  2. macros/calories, and
  3. performance (e.g. weight on the bar).

weight / body fat

Most people want to have more energy and look good naked.  While it’s much easier to track body weight, this ultiamte goal really about losing body fat.

There are a ton of different ways to measure body fat (e.g. DEXA, comparison photos, bioimpedance scales, Skulpt, the Navy Method, etc.).  They are all inaccurate to some degree.

You can do your head in focusing on the fluctuations on the scale or body fat from day to day.  But, you want to see your overall weight and body fat reducing toward your target levels.  People who successfully lose weight and keep it off manage their food intake, measure their weight regularly and are active![38] [39]

If you’re a fitness model you might want to measure yourself daily.  If you’re just starting to focus on eating well and lifting, then you might just want to weigh yourself weekly or monthly.[40]

If you are not moving towards your goals over the long term, something needs to change.

body fat chart.png

But first, you need to set some realistic goals.  Take the time to determine your current and target body weight, fat (in kg and %) and lean body mass (LBM).

  current target
body weight (kg)
body fat (%)
body fat (kg)
LBM (kg)

If you are disciplined, it is possible to lose 1% of your mass per week, but 0.5% is a more realistic and less aggressive target.  If you are already lean, then it will be harder to lose fat without losing muscle so you may need a less aggressive deficit.[41]

It’s not all about the weight on the scale.  You can be losing fat and gaining muscle, the weight on the scale probably is the most reliable indicator that you’ve got your inputs right.  If you’re getting enough protein and working out, incrased muscle mass should be looking after itself, and any loss should be mainly fat.[42]

Keep in mind that body weight is a lagging measurement that tells you whether you’re on the right track.  Tracking inputs (e.g. food intake and exercise) will be much more useful.

macros / calories

Personally, I don’t enjoy tracking my food, so I’ve designed a range of food lists and meals that will help most people improve from where they currently are.  It will be pretty hard to get/stay morbidly obese if you eat only the foods and meals listed above.

But eating to satiety won’t guarantee you will lose weight.  If you want to look like a fitness model, or you are not getting your desired results from ‘eating ad libitum’ you will likely need to track your food to overcome your inbuilt impulse to maintain a higher body weight and prepare for a possible famine ahead.

Tracking your food in an app like Cronometer can be a useful educational experience.

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The Ketogains calculator will give you a starting point in terms of calorie intake based on your current weight and activity levels.  If, after a few weeks, you are not seeing the progress you were hoping for you will need to adjust your inputs.

Performance/weight on the bar

Building muscle or achieving a performance goal is probably more important than weight loss, particularly if you are not trying to get down to a very low level of body fat.

The great thing about using a performance goal is that it is both a leading and lagging measure.  By going harder, faster and heavier you are providing a greater stimulus for growth.  And by measuring your performance outputs, you are ensuring that you are getting fitter/faster/healthier.

While being strong doesn’t guarantee weight loss, being stronger will improve your metabolic health, insulin sensitivity and ability to burn fat more effectively than nearly anything else.

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Having more lean muscle mass will ensure you burn both glucose and fat more efficiently.  Lean muscle mass is a key predictor of longevity.[43]

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The Ketogains boot camp uses a 5×5 strength progression.  The Stronglifts 5×5 or Starting Strength uses a similar progressive overload approach.  These programs involve compound lifts (squat, deadlift, bench press, overhead press, row etc.) and progressive overload meaning that you add weight to the bar each time and continue to get stronger.   By doing this, you train your body to produce energy more efficiently.

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Don’t be surprised if your appetite ramps up during the first few months of intensive lifting as your body goes into anabolic overdrive to recover and build new muscle.  This should settle down though after a while, and you can then focus on dialling your diet in if you want to gain strength as well as lose body fat.[44]  You have a unique window of ‘newb gains’ during initial whne you can get stronger at in a way that you may never achieve again.  You can focus on getting to single digit body fat later.

Other stuff that you could track

There are other things that you might like to track, but they will be less useful than the things mentioned above.  Most people have limited time and don’t really want to live a completely quantified life.  Unless this is your only hobby or you are a professional athlete or fitness model, you may quickly hit ‘analysis paralysis’ and give up.

quantified self.png

There is no guarantee that technology will help you reach your goals.  In fact, it seems that you are more likely to gain weight if you use wearables like a Fitbit.[45]  It’s hard to know whether this is due to the EMF or perhaps the wearer is always allowing themselves to consume the extra calories that their technology told them that they just burned with exercise.

So, coming from a biohacker nerd….  don’t try to track too many things at once!  OK?

Heart Rate Variability

Heart Rate Variability (HRV) is a measure of the variability between your heart beats.  If you are stressed and/or exhausted your heart will be more rhythmically as well as more rapidly.   If you are relaxed and well rested your heart will be more to stresses and quickly return to rest.

HRV.png

Measuring your Heart Rate Variability (HRV) can tell you if you’re pushing too hard and need to rest recover or you’re not pushing hard enough and should be working harder to maximise your progress.  Training when you are burning out can be counterproductive and lead to injury or under recovery.

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HRV tells you whether your sympathetic and parasympathetic nervous system is balanced.

  • If you are “parasympathetic nervous system dominant” you might be overstressed from too much activity, not enough sleep, too much caffeine or work stress.
  • If you are “sympathetic nervous system dominant”, then it probably means your body wants to rest. You’ll probably do better if you listen to it and let it recover.
  • If your overall HRV is dropping, it means you are burning out and should consider slowing down.

After 1.5 years of measuring my HRV each morning, it’s uncanny how many times I will see my HRV fall a few days before you get the flu or hit the wall.  I don’t like to stay still long enough to meditate, so tracking each day with Elite HRV is part of my relaxation, breathing and focus at the start of each day.

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Blood sugar

Your blood sugar and glucose control is a powerful indicator of metabolic health.  But blood sugar readings can vary depending, not just due to the food you eat or your metabolic health, but also exercise and stress.

blood sugar ketones.png

If you have diabetes, then refining your food choices to normalise your blood sugars is critical. However, regular blood sugar tracking is likely a waste of time and money for most people who are following a Ketogains style approach (i.e. tracking their food to ensure they are moving towards an optimal weight, getting adequate protein and lifting regularly) is unnecessary.

Blood ketones

Unless you require therapeutic ketosis to help manage epilepsy, cancer, Alzheimer’s or Parkinson’s measuring your blood ketones is also largely an irrelevant distraction.

Lots of people get caught up chasing ‘optimal ketosis’ by eating more dietary fat and less protein.  However, this is exactly the opposite of what you need to gain strength and lose body fat.

Blood ketones do increase when we don’t eat. But high ketone levels don’t mean you are burning your own body fat.  It could just be the three Bulletproof coffees and exogenous ketones you just had to get that are driving your high ketone levels.

Some people, especially those who are physically fit and/or have been practising a low carb diet for a long time, seem to have lower blood ketone levels, even if they are eating a ‘ketogenic’ diet.  It’s hard to know whether this is due to the more efficient use of ketones or the fact they are burning more fat through non-ketogenic pathways.

image29.jpg
Ketones are just one of a number of ways that we burn fat (chart from Dave Feldman)

Someone who is not so metabolically healthy can load up on exogenous ketones, butter and MCT oil and get a high blood ketone reading on their meter.  But this may just mean that they have eaten a lot of fat that they are not burning (because of their lack of activity and/or poor metabolic health) and the fat is backing up in their bloodstream.

A healthy metabolism seems to keep the total energy circulating in the bloodstream fairly low (i.e. from glucose, ketones or free fatty acids).  If you are metabolically healthy, you can easily access your fat stores so you don’t need to build up high energy stores in the blood.  By contrast, someone with a less healthy metabolism seems to maintain higher energy stores in the blood (i.e. glucose, ketones, free fatty acids) as well as on their body.[46]

image26.png
This chart shows more than 3000 data points of blood glucose and ketones together from a range of people following a low carb and ketogenic diet.  Having high blood ketones and high blood sugar at the same time is not good!  Healthy people tend to have lower blood sugar and moderate level ketones.

Most people don’t need to worry about their blood glucose and ketone levels consciously.  If you focus on nutrient dense food to optimise your mitochondrial function and strength building to keep pushing your mitochondria to produce energy at peak efficiency, then your body will probably look after the rest.

[At the risk of getting too technical, it’s worth pointing out that blood ketones rise because there is a lack of Oxaloacetate (from protein and carbs) available to burn Acetyl CoA from fat in the Krebs cycle, so the body defaults to a starvation protocol to produce ketones (AcetoAcetate). 

image54.png
Figure from Amy Berger showing how fat can be burned in the Krebs cycle or via ketosis when there is not enough Oxaloacetate from protein and carbs turn the Krebs cycle.

If your NAD+ is low, AcetoAcetate will not be converted to Acetone so there will be lots of beta-hydroxybutyrate left in the blood to be measured on your meter.  So, other than fasting and/or exercising to deplete your liver glycogen levels, one ‘hack’ to achieve high blood ketone is to avoid protein and eat a nutrient-poor diet low in niacin and other B vitamins (which produce NAD+).  But don’t try this at home.  It’s not a recipe for optimal health, just high blood ketone levels.]  

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Ketogains’ Tyler Cartwright has lost nearly three hundred pounds without exceeding 0.4mmol/L blood ketones on his ketone metre (other than that time he ate nothing but lard for two weeks as an experiment and got to 0.5mmol/L).[47]

tyer cartwright.png

Breath ketones

Breath ketones are an interesting indication of your metabolic health.  But again, they’re not necessary if you are already focusing on a nutrient-dense diet without too much energy and plenty of activity.

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Waist measurement

BMI is often used to assess whether or not someone is at a healthy weight.

image33.png

However, BMI is notoriously problematic for people with more muscle.

image42.png

Waist to height ratio is a much better predictor of the years of life that you will lose due to your poor health.[48]

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Micronutrients and nutrient score

Focusing on the nutrient-dense whole foods above and the meals below will get you most of the way to optimal nutrition.  However, you can also track your macronutrients in Cronometer to help you identify the nutrients you are not getting from your diet.

image18.png

But then, once you’ve tracked your food in Cronometer, you are left wondering what foods and meals you should eat.  and if need to supplement, how much of each supplement do you require and how much?

The Nutrient Score is a measure of the micronutrient quality of your diet.  If you were able to get two times the recommended daily intake of all the essential micronutrients, you would get a perfect score of 100%.

To demonstrate what this looks like in practice, Ted Naiman’s diet got a very respectable nutrient score of 70%.

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Luis’ got 72%.

luis nutrition.png

Nutrition nerd Alex Leaf (and regular reviewer of my blog posts… thanks so much Alex!!!!) scored an impressive 74%.

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Mike Berta also scored 74%.

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Brianna Theroux’s scored a very healthy 79%.

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And sitting at the top of the leaderboard is Dr Rhonda Patrick with a score of 82%.

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But the coolest competition is against yourself.  Andy Mant managed to seriously up his nutritional game…

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… by eating a LOT of nutrient-dense seafood…

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… in preparation for his Paris wedding.

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By following the recommendations of the Nutrient Optimiser analysis, Robin was able to improve her nutrient score to 32% (junk food diet) to 68% over a number of iterations (see report 1, report 2 and report 3).

In the process, she was able to significantly improve her blood glucose levels, dropping her HBA1c from 10.6% to 6.4%.  Robin was also able to progress from taking hundreds of units of insulin per day to only needing occasional correcting doses to fine tune her blood sugars.  She also managed to lose 2.6lbs per week!

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And after a couple of rounds of following the Nutrient Optimiser recommendations and a couple of Ketogains boot camps the Matt Standridge (aka The Ketodontist) has stepped up from a nutrient score of 48% to 73%.  He says he is feeling great and continues to gain muscle and lose fat.

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The Nutrient Optimiser

While there are common themes, each person’s micronutrient fingerprint is unique.  The optimal foods and meals that will balance your micronutrient profile are unique to you.  The Nutrient Optimiser is the only tool that will tell you what foods are ideal to balance your diet while also aligning with your goals.

Currently, the Nutrient Optimiser is a manual report that will help you optimise your nutrition from the micronutrients based on your food log in Cronometer.  We’re working hard to develop an automated system that will use your goals and whatever data you have to help you refine your nutrition to achieve your goals.

If you don’t want to track your food, the system will tell you what meals and foods will align with your goals.  But if you want to step up your game and provide other data we can work with that to further refine your nutritional prescription to fill in your micronutrient gaps.  The system will also adapt with you to improve your nutrition, ideally from diabetic to weight loss to achieving your performance goals.

nutrient optimiser.png

It might just be your secret weapon to help you blitz #transormationtuesday.

Summary

  • The Ketogains protocol involves getting adequate protein (to support muscle growth and recovery) and adequate carbs to get essential vitamins and minerals. Fat is used as a level to manipulate energy intake to suit your goals.
  • If you are limiting your energy intake, maximising your nutrient : energy ratio is critical!
  • The Nutrient Optimiser can help you identify foods and meals that align with your goals and fill in your micronutrient deficiencies.
  • Chose what you track wisely. Trying to manage too many things can lead to ‘analysis paralysis’.  If you manage the most important inputs, results should naturally follow.

 

 

Meals

I’ve been building a database of to help identify the meals that provide you with the nutrients you need more of and align with your goals.

If you are tracking in Cronometer, you can sign up for a Nutrient Optimiser analysis and report here to find out which foods and meals will help you move forward.  I’ve also been working with Alex from Nutrient Hero for the past few months building a massive database of recipes we can use to optimise your nutrition.

It feels like it’s been a long time coming, but it won’t be too long before it’s all automated and online.  If you want to be the first to trial the beta version then make sure you enter your email in the pop on this page or head over to NutrientOptimiser.com now to learn more.

The recipes below are some of the highest ranking when we prioritise some of the harder to find vitamins and minerals (potassium, magnesium, calcium, zinc, vitamin D, thiamine and choline) as well as higher protein and a lower energy density.

I have included the link to the Cronometer entry as well as the nutritional profile and a list of foods that will help you balance the nutritional profile of the recipe.

Bootcamp omelette

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Gayle Louise created this simple omelette recipe for her Ketogains boot camp workout days.   Nutritional yeast has a fantastic nutritional profile and adds a cheesy taste without the calories, minimising fat and maximising nutrient density.

ingredients

method

  • cook the spinach first with ghee or butter.
  • whisk 4 eggs with salt and pepper and add too cooked spinach
  • sprinkle with nutritional yeast, cover and cook until firm.

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Cronometer analysis

https://nutrienthero.com/recipe-analysis/boot-camp-omelette

 

Potassium salted caramel coffee

potassium caramel coffee.png

Everyone loves coffee, and most people find potassium harder to get in their diet than sodium.  So why not potassium coffee?!?!  The milk and caramel syrup are not essential, but they give you that indulgent salted caramel taste.

Getting adequate minerals is critical to ensuring insulin sensitivity, nutrient partitioning, muscle building and recover and avoiding diabetes.

While most people don’t need to worry about getting too much salt, having a potassium : sodium ratio greater than two is hard to achieve for most people, even if they do eat a lot of greens.

My friend Raymund Edwards of Optimal Ketogenic Living has been doing a LOT of research into the wide-ranging benefits of alkalising electrolytes, in particular, potassium.  This recipe was inspired by Raymund after hearing that he was adding potassium to his coffee.

Raymund said, “A potassium enriched coffee in the morning really wakes the muscles.  It’s better than any warm up.  Loose and alive we can feel the difference as they soak up actively the potassium especially after the night fast (where muscles have been releasing potassium).  And  the coffee in my view tastes so much better too.”

It’s hard to get a significant amount of potassium from tablets as they are limited to 99 mg which is only a fraction of the 3,800 mg of potassium that we need each day (you would need to take forty tablets to get the DRI for potassium!).

potassium.png

You can also add the potassium citrate powder to your drinking water, coffee or pre-workout mix.  You would need more than 10g of the citrate powder to get your recommended daily intake of potassium, but, like all things, start slowly. However, in time, it might just make you feel amazing!

ingredients

method

  • Pour coffee shot from fresh grounds
  • Add potassium citrate powder
  • Add caramel syrup (optional)
  • Add a dash of full cream milk to taste (optimal)
  • Add hot water to taste (depending on how you like your coffee)

Cronometer analysis

nutritional analysis

 

Greens + eggs + seafood

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Dom D’Agostino infamously told Tim Ferriss in his sound check that his breakfast was sardines, oysters, eggs and broccoli.  It might sound bizarre, but it packs a nutritional punch.

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Most days my breakfast is some variant on frozen greens (spinach, broccoli, kale) + eggs + seafood (sardines, mackerel, oysters, mussels, anchovies) + nutritional yeast.

If you’re not focusing on losing body fat you can add cheese or peanuts for some extra indulgent taste, but leaving these out will help you increase your protein : energy and nutrient : energy ratio which is ideal if you are trying to lose body fat (and will make Ted Naiman and Luis Villasenor proud).

You could take more time to fry these ingredients up and plate them up nicely, but most of the time breakfast only needs to be time efficient and doesn’t need to look good.  If you can start the day with a high protein nutrient dense breakfast, you’ll be less likely to succumb to other cravings later in the day.

ingredients:

  • 250g frozen veggies. Spinach is always best, but broccoli or kale work too.
  • Three eggs. Consider removing the yolks if you are focussed on lower fat higher protein fat loss phase, though this will decrease the overall nutrient profile.  The yolk is where all the vitamins and minerals are!
  • 1 can of seafood (e.g. mackerel, sardines, oysters, mussels or anchovies).
  • 1 teaspoon of nutritional yeast
  • Peanuts (optional, only if not looking to lean out)
  • 1 oz mozzarella cheese (optional, only if not looking to lean out)
  • Salt (No Salt, Celtic Sea or Redmond Real Salt) & pepper to taste.

method

  • Defrost greens in bowl for five minutes in the microwave.
  • Add eggs and cook for a further minute or until done. (I often find that the eggs need a bit more cooking but stir everything in at around three minutes and then cook for another two minutes).
  • Add other ingredients
  • Salt liberally to taste.

Nutritional analysis

Cronometer entry

Photos of other variants (hey, they ain’t pretty, but they work).

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Bacon, egg, spinach and mushroom

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This is a variant on the common bacon and eggs recipe. The spinach mushroom and tomato round out the nutritional profile of the stock standard bacon and eggs.

The spinach provides a wide range of vitamins and minerals, particularly vitamin K and vitamin A.  Most people think kale is the ultimate nutrient-dense green vegetable.  However, kale just has a lot of Vitamin K1 and not so as much of everything else.  Spinach has a much better nutritional profile across the board.

If you are focusing on reducing body fat and maximising nutrient density, consider eliminating the cream, draining the bacon fat and keeping the butter to a minimum for cooking.  If your goal is bulking and recover, then you can be more liberal with the cream and cheese to taste.  Remember, fat is a lever.

ingredients:

  • 3 large eggs
  • 200g fresh spinach
  • 2 mushrooms
  • 30g cream (optional)
  • 30g mozzarella cheese (optional)
  • butter
  • Salt (No Salt, Celtic Sea or Redmond Real Salt) & pepper to taste.

method

  • Fry bacon separately. If your priority is reducing body fat then you can let the bacon rest on a paper towel to drain the fat.  Alternatively, bacon grease can be used to fry the spinach, mushroom and eggs.
  • Fry eggs separately.
  • Add cream and cheese if not looking to lean out.
  • Salt to taste.

Nutritional analysis

Cronometer entry

 

Steak, egg, tomato, avo spinach and lettuce

image32.png

This is a fairly standard Sunday night family dinner at our place.  A solid piece of steak on the BBQ with salad.

ingredients:

method

  • Grill BBQ steak
  • Cook spinach with some butter or coconut on BBQ plate when grilling the steak.
  • Serve with boiled egg (or fried on the BBQ) along with salad (avocado, tomato and lettuce shown here).
  • Salt (No Salt, Celtic Sea or REdmond Real Salt) & pepper to taste.

Facebook

Nutritional profile

Cronometer

 

Be sure to check out the more than 300 meals on the Nutrient Optimiser Facebook Group.  You might even want to add some of your own.

 

 

 

references

[1] https://ketogains.com/2017/06/energy-balance-macros-nutrient-density/

[2] https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htm

[3] http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32252-3/abstract

[4] http://www.artandscienceoflowcarb.com/the-art-and-science-of-low-carbohydrate-performance/

[5] https://www.amazon.com/Art-Science-Low-Carbohydrate-Performance/dp/0983490716

[6] https://www.youtube.com/watch?v=GkQYZ6FbsmI

[7] https://optimisingnutrition.com/2017/10/15/high-protein-vs-low-protein/

[8] https://jissn.biomedcentral.com/articles/10.1186/s12970-017-0201-z

[9] https://www.ncbi.nlm.nih.gov/pubmed/9841962

[10] https://www.ncbi.nlm.nih.gov/pubmed/29182451/

[11] https://l.facebook.com/l.php?u=https%3A%2F%2Fwww.dropbox.com%2Fs%2F1if7n957u66htiy%2F10.1123%2540ijsnem.2017-0273.pdf%3Fdl%3D0&h=ATNppfskJJ6fMuIVoJrC0rX_8H9KCT2SeryF0MeRrAnJz6X9p_3FPhPYUK3RGSOE-kDTeOLxKdw26vel3zBWDbOlaCQzxkxpDU8CjFs9Moo51fC9NByHYvs83uU7PvjFolOxvqx3Pw

[12] https://optimisingnutrition.com/2017/06/03/why-do-my-blood-sugars-rise-after-a-high-protein-meal/

[13] https://optimisingnutrition.com/2017/10/30/nutrition-how-to-get-the-minimum-effective-dose/

[14] https://www.ncbi.nlm.nih.gov/pubmed/15836464

[15] https://www.ncbi.nlm.nih.gov/pubmed/24588967

[16] https://optimisingnutrition.com/2017/10/30/nutrition-how-to-get-the-minimum-effective-dose/

[17] https://optimisingnutrition.com/2017/10/30/nutrition-how-to-get-the-minimum-effective-dose/

[18] https://optimisingnutrition.com/2017/10/30/nutrition-how-to-get-the-minimum-effective-dose/

[19] https://www.reuters.com/article/us-health-diabetes/cost-of-diabetes-epidemic-reaches-850-billion-a-year-idUSKBN1DD2SW

[20] http://www.diabetesincontrol.com/the-true-cost-of-diabetes-and-preventing-it/

[21] http://www.diabetes.co.uk/cost-of-diabetes.html

[22] https://optimisingnutrition.com/tag/insulin-load/

[23] https://www.dietdoctor.com/low-carb/20-50-how-much

[24] https://www.nrv.gov.au/nutrients/fats-total-fat-fatty-acids

[25] https://www.ncbi.nlm.nih.gov/pubmed/17593855

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

[27] https://optimisingnutrition.com/2017/06/17/psmf/

[28] https://metabolicnutrition.com/branched-chain-amino-acids-bcaas-benefits-for-muscle-growth/

[29] https://www.sciencedaily.com/releases/2017/09/170927093254.htm

[30] http://suppversity.blogspot.com.au/2013/09/the-satiating-secret-of-arginine-lysine.html

[31] https://ketogains.com/2017/06/keto-flu-electrolyte-imbalances/

[32] https://www.ncbi.nlm.nih.gov/m/pubmed/21036373/

[33] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC301822/

[34] https://diabetesmealplans.com/6285/magnesium-and-diabetes-type-2/

[35] https://www.ncbi.nlm.nih.gov/pubmed/22150427

[36] https://ketogains.com/2016/08/ketogains-seven-must-supplements/

[37] https://athinkingperson.com/2012/12/02/who-said-what-gets-measured-gets-managed/

[38] https://www.ncbi.nlm.nih.gov/pubmed/24355667

[39] https://en.wikipedia.org/wiki/National_Weight_Control_Registry

[40] http://www.nourishbalancethrive.com/podcasts/nourish-balance-thrive/keto-masterclass-robb-wolf/

[41] https://www.ncbi.nlm.nih.gov/pubmed/15615615

[42] https://www.bodyrecomposition.com/muscle-gain/calorie-partitioning-part-1.html/

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

[44] https://startingstrength.com/articles/clarification_rippetoe.pdf

[45] https://jamanetwork.com/journals/jama/fullarticle/2553448

[46] https://optimisingnutrition.com/2015/07/20/the-glucose-ketone-relationship/

[47] https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwjpo5y5qu_XAhWHFpQKHV8VAXgQFggvMAE&url=http%3A%2F%2Fketogeek.libsyn.com%2F14-tyler-cartright&usg=AOvVaw04xLzYxE3tS8oa8LWvLkZk

[48] http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0103483

how to get the minimum effective dose of nutrition

The goal of Optimising Nutrition is to help you design the minimum effective dose of nutrition to support your goals (e.g. performance, weight loss, diabetes management, therapeutic ketosis, bodybuilding, etc.).

When we break it down, we require food that:

  • provides adequate micronutrients,
  • with enough energy (but not too much), that
  • enables you to maintain healthy hormone levels.

In nutrition, we talk about parameters such as:

  • macronutrients (protein, carbs, fat, and fibre),
  • carnivore vs plant-based,
  • energy density, and
  • insulin load.

Unfortunately, talking about “high”, “low” or “adequate” often leads to unproductive circular arguments due to a lack of definition.

Optimal typically lies somewhere between the extremes.

A ‘Goldilocks zone’ of not too little.  Not too much.

A ‘minimum effective dose’ if you will.

image32

If we want to design the minimum effective dose (MED), we need to understand which parameters have the most significant impact on the quality of our nutrition.

With all the discussion about ‘high,’ ‘low’ and ‘not too much’ we need to understand the acceptable range for each of the key parameters to ensure we don’t stray too far from optimum.

What is the ‘minimum effective dose’?

The ‘minimum effective dose’ (MED) is the smallest dose that will produce the desired effect.

In terms of medication, the MED is the minimum amount that will give the desired effect for most people.  Too much of a drug can be expensive and harmful.  Too little won’t have the enough of an effect.

image30

In fitness, the minimum effective dose is the point beyond which any additional stress would be redundant or even counterproductive to strength and fitness goals.

image7

In biohacking, the MED is about getting the desired outcome with the minimum investment of time, money or effort.

image19

What does MED mean regarding nutrition?

There are a handful of interacting factors that help us determine the minimum effective dose of nutrition.  Unfortunately, it’s not possible to optimise all parameters at once.  We need to decide which ones we want to prioritise and which ones we are prepared to sacrifice based on our context and goals.

image29

Before we get into the details of how we determine the MED of nutrition, let’s set the context with a review of some parameters.

Nutrients

The body needs a range of essential nutrients and benefits from an even more extensive range of non-essential nutrients.

Recommended Dietary Intake (RDIs) or are given as the minimum amount to prevent diseases of malnutrition for most people (i.e. not necessarily optimal health and longevity).

Nutritional requirements vary due to a wide range of factors.  Men need more than women (unless they are pregnant or breastfeeding).[1]

Many nutrients are easy to obtain, but we need to pay particular attention to getting adequate quantities of others.

If we are obtaining the recommended minimum levels for the majority of the essential nutrients, we are likely to significantly exceed the Recommended Daily Intake[2] for a number of these nutrients.

We tend to get a better nutritional outcome when we prioritise the foods that contain the harder-to-find nutrients, and the other nutrients tend to look after themselves.

The upper limit (UL) for most nutrients is difficult, if not impossible, to exceed without supplementations (except for those Arctic explorers that gorged on polar bear liver and felt ill due to hypervitaminosis[3]).

If you are an athlete, you will need more nutrients.  However, you will be able to consume a lot more energy, thus letting you achieve the minimum intake level for most nutrients rather easily.

At the other extreme, if you are restricting energy to lose weight, it may be hard to get enough nutrients from the food you eat.  Focusing on foods with a high nutrient : energy ratio will be critical.

In his Perfect Health Diet,[4] Paul Jaminet notes that:

a nourishing, balanced diet that provides all the required nutrients in the right proportions is the key to eliminating hunger and minimising appetite and eliminating hunger at minimal caloric intake.

Bruce Ames’s Triage Theory[5] warns that the body will prioritize available nutrients for short-term functions and at the expense of longevity where nutrients are limited.

image12.png

Francis Pottenger demonstrated that poor nutrition has generational impacts with his cats that progressively became more deranged to the point that they couldn’t procreate after three generations.[6]

image17.png

There is also a growing body of fascinating research suggesting that different nutrient deficiencies are related to specific conditions and boosting these nutrients (ideally with whole foods) will improve these chronic diseases.[7] [8]

image16

Maximising the nutrient content of our diet with the minimum amount of energy seems to be central to our short-term and our long-term health!

We crave nutrients like salt and protein and go out of our way to make sure we get them.[9] [10] [11]

The Protein Leverage Hypothesis shows that we keep eating until we get enough protein.[12]

A pregnant woman will crave weird foods and obscure flavours to ensure she’s getting the nutrients to grow a healthy baby.

image23

As you will see below, nutrition and protein are tightly interrelated.  Rather than the ‘Protein Leverage Hypothesis’, I think it’s reasonable to think that there is a ‘Nutrient Leverage’ effect such that we seek out more food until we get the nutrients we need.

It’s not unreasonable to think that getting adequate nutrients from the food we eat is a critical component of our satiety mechanism and managing our appetite.  If we don’t obtain sufficient nutrients from our food, we will be more likely to seek out more food in search of nutrients, and thus end up over-consuming energy and become obese and/or diabetic.

With our modern trend towards processed foods that are optimised for bliss point[13] and profit margin rather than nutrient content, it’s not surprising that we have an epidemic of malnourished obese people.[14] [15]

image24

Adequate energy

While we have developed our appetite to seek out foods that contain the nutrients we need, our drive for energy is even stronger.

Adapted biologically to scarcity, we tend to consume a little more energy than we need in preparation for leaner times.  However, today in our modern processed food environment with fossil fuels, chemical fertilisers, and artificial flavourings, winter never comes.[16]

Before the advent of processed foods, energy always came packaged with adequate nutrients.  However, this is no longer always the case.

image9

To thrive in our modern world with primal instincts, we need to find a way to reverse-engineer our food environment to ensure that we prioritise foods with the nutrients we require without too much energy.

Perhaps we need a shortlist of optimal foods and meals that will provide the minimum effective dose of nutrients that we require without having to consume excess energy.

Insulin load

Insulin is arguably the most important metabolic hormone that helps us build muscle, use glucose and keep stored energy locked away for a later day.

Adequate levels of insulin are critical to survival.  People with Type 1 diabetes die without insulin.  However, today’s processed foods tend to drive our insulin levels too high for too long, thus leading to insulin resistance and the majority of modern disease.[17]

Low carb and ketogenic diets help us bring insulin and blood sugar levels under control.  At the same time foods with an extremely low insulin load are tend to be mostly fat and do not contain the vitamins and minerals that we need.

We need to balance the reduction in insulin load that will help us stabilise blood sugars and insulin levels in our body without excessively and unnecessarily compromising nutrient density.

The official “Acceptable Macronutrient Distribution Range”

The table below shows the Acceptable Macronutrient Distribution Range for macronutrients to reduce chronic disease risk whilst still ensuring adequate micronutrient status along with the currently typical macronutrient” according to the Institutes of Medicine (IOM) [18][19].

macronutrient lower upper
protein 15% 35%
fat 20% 35%
carbohydrates 45% 65%

The Australian Ministry of Health notes that only 10% of energy is required from protein to cover physiological needs.  However, this level is insufficient to provide adequate micronutrients levels.  Active communities have much higher protein intake levels with no apparent adverse health effects.[20]

The chart below shows that our carbohydrate intake is trending up while fat has trended down as we have followed the official guidance to avoid fat to avoid heart disease over the past four decades.[21]

image13

The table below shows the typical macronutrient intake for the US, UK and eighteen non-Asian countries from the PURE study.

parameter protein fat carbs
United States (NHANES, 2000)[22] 15% 33% 52%
United Kingdom 16% 35% 50
non-Asia (PURE) 17% 28% 55%
Asia (PURE) 15% 21% 65%

A number of people such as Gary Taubes[23] and Nina Teicholz[24] have argued that the unnecessary fear of fat and retreat to processed carbohydrates has contributed to the obesity epidemic.

image27

One of the main goals of this article is to consider whether the ‘Acceptable Macronutrient Ranges’ set by the Institute of Medicine actually allows us to optimise nutrient density.

The data analysis

I’ve previously discussed the relationship between macronutrients and the nutrient density of individual foods (see Micronutrients at Macronutrient Extremes and Which Nutrients is YOUR Diet Missing?).  However, I thought it would be interesting to look at things in terms of the nutrient score for each nutritional approach.

To understand the relationship between nutrition and various food parameters I updated the analysis for a wide range of nutritional approaches as shown in the table below (sorted in descending order for nutrient density).  The table below shows the nutrients provided by 43 different nutritional approaches along with the shortlist of foods associated with each goal.  (This took me a LOT of time to re-run, so I’d love you to check it out).

approach score foods pdf nutrients
most nutrient dense 96% foods pdf nutrients
adrenal fatigue 96% foods pdf nutrients
weight loss (insulin resistant) 96% foods pdf nutrients
pregnancy 96% foods pdf nutrients
alkaline 96% foods pdf nutrients
asthma 96% foods pdf nutrients
testosterone 96% foods pdf nutrients
nutrient dense paleo 96% foods pdf nutrients
weight loss (insulin sensitive) 96% foods pdf nutrients
hypertension 96% foods pdf nutrients
excess estrogen 96% foods pdf nutrients
autism 96% foods pdf nutrients
hypothyroidism 95% foods pdf nutrients
pescetarian 95% foods pdf nutrients
breastfeeding 95% foods pdf nutrients
female fertility 95% foods pdf nutrients
sleep and insomnia 95% foods pdf nutrients
nutrient dense maintenance 94% foods pdf nutrients
depression 94% foods pdf nutrients
mitochondrial health 94% foods pdf nutrients
autoimmune friendly 94% foods pdf nutrients
bodybuilder 92% foods pdf nutrients
nutrient dense athlete 91% foods pdf nutrients
nutrient dense low carb 91% foods pdf nutrients
nutrient dense paleo (low carb) 90% foods pdf nutrients
mitochondrial health (low carb) 89% foods pdf nutrients
gestational diabetes 89% foods pdf nutrients
bivalve vegan 87% foods pdf nutrients
autoimmune (low carb) 84% foods pdf nutrients
nutrient dense plant based 81% foods pdf nutrients
nutrient dense carnivore 80% foods pdf nutrients
lowest energy density 77% nutrients
plant based (low carb) 76% foods pdf nutrients
highest protein 70% nutrients
well formulated ketogenic 63% foods pdf nutrients
lowest carb 56% nutrients
most ketogenic 44% nutrients
highest fat 43% nutrients
lowest fat 35% nutrients
highest carb 26% nutrients
highest energy density 22% nutrients
lowest protein 16% nutrients
most insulinogenic 3% nutrients

This table shows the macronutrient split of each of these approaches.  To make sense of all this data, I have plotted each these parameters against nutrient density and included some discussion on what I think this means in the following sections.

approach score protein fat net carbs fibre density
most nutrient dense 96% 40% 16% 29% 16% 104
adrenal fatigue 96% 47% 18% 23% 13% 107
weight loss (insulin resistant) 96% 42% 24% 18% 15% 101
pregnancy 96% 41% 18% 27% 15% 113
alkaline 96% 33% 20% 28% 18% 112
asthma 96% 41% 16% 27% 16% 102
testosterone 96% 40% 17% 28% 15% 115
nutrient dense paleo 96% 47% 17% 22% 14% 92
weight loss (insulin sensitive) 96% 51% 18% 19% 12% 85
hypertension 96% 42% 16% 27% 15% 105
excess estrogen 96% 50% 19% 19% 12% 109
autism 96% 48% 17% 22% 13% 103
hypothyroidism 95% 52% 18% 9% 9% 122
pescetarian 95% 37% 16% 31% 16% 108
breastfeeding 95% 42% 17% 26% 15% 101
female fertility 95% 55% 20% 16% 9% 110
sleep and insomnia 95% 44% 16% 28% 12% 134
nutrient dense maintenance 94% 42% 23% 26% 9% 240
depression 94% 59% 21% 12% 8% 114
mitochondrial health 94% 34% 14% 35% 17% 126
autoimmune friendly 94% 53% 21% 17% 10% 102
bodybuilder 92% 64% 23% 8% 5% 120
nutrient dense athlete 91% 39% 40% 15% 5% 366
nutrient dense low carb 91% 28% 50% 10% 12% 222
nutrient dense paleo (low carb) 90% 26% 53% 10% 11% 260
mitochondrial health (low carb) 89% 25% 47% 13% 14% 211
gestational diabetes 89% 27% 56% 8% 9% 257
bivalve vegan 87% 21% 14% 45% 20% 129
autoimmune (low carb) 84% 26% 58% 8% 8% 285
nutrient dense plant based 81% 20% 16% 45% 20% 151
nutrient dense carnivore 80% 65% 30% 5% 0% 143
lowest energy density 77% 20% 10% 52% 18% 30
plant based (low carb) 76% 17% 29% 35% 19% 241
highest protein 70% 77% 22% 1% 0% 132
well formulated ketogenic 63% 16% 73% 4% 6% 423
lowest carb 56% 30% 70% 0% 0% 361
most ketogenic 44% 15% 80% 3% 2% 466
highest fat 43% 14% 81% 3% 1% 470
lowest fat 35% 8% 1% 84% 7% 143
highest carb 26% 3% 1% 90% 6% 141
highest energy density 22% 6% 64% 28% 2% 599
lowest protein 16% 1% 27% 68% 3% 308
most insulinogenic 3% 6% 2% 90% 2% 190

The table below shows the correlation coefficient between nutrient density and each of the parameters along with the P value indicating that there is a reasonable degree of statistical significance.

parameter R2 P
protein 0.89 < 0.0001
% insulinogenic 0.66 < 0.001
carbs 0.62 < 0.0001
net carbs 0.60 < 0.0001
fibre 0.47 < 0.0001
fat 0.41 < 0.0001
density 0.32 0.004

Protein vs nutrient density

Given that protein has the highest correlation with nutrient density score (R2 = 0.89) let’s start by looking at the relationship between protein and nutrient density.

The chart below shows the relationship between the nutrient density score and the percentage of energy from protein.   It seems that nutrient density peaks in around 45% of calories from protein.

If we were to use a nutrient density score of 70% as our cut off for our minimum effective dose of nutrition we would have a lower limit of 19% protein and an upper limit of 78% energy from protein.

This optimal level is significantly above the typical protein intake of around 16% of energy and even greater than the upper end of the official Acceptable Macronutrient Distribution Range of 15 to 35%.

The chart below shows the micronutrients provided by the most nutrient-dense foods.  That is, the highest ranking 10% of foods in the eight thousand foods in the USDA food database when we boost the harder to find nutrients (shown in yellow).[25]    These foods provide the best balance of micronutrients to meet the Recommended Daily Intake Levels.

What’s worth noting here is that this shortlist of nutrient-dense foods are NOT identified by prioritising any of the amino acids.  We just happen to get plenty of protein from foods that contain more of the harder-to-find nutrients (i.e. omega 3, choline, vitamin D, calcium magnesium potassium, zinc and thiamine).

The nutrient score in this analysis is calculated based on the proportion of the area between 0 and 300% of the RDI for the various nutrients.  If we could find a group of foods that provided 300% of the recommended daily intake (RDI) of all nutrients we would get a perfect score.

If your goal was just to maintain weight or fuel your endurance activities you could argue that such high a high level of nutrient density is excessive.  You may end up fueling up with some more energy dense fat or refined carbs.  However, maximising the nutrient : energy ratio of your diet would be very useful if you were trying to reduce your energy intake to lose weight.

According to Bruce Ames’ Triage Theory,[26] maximising nutrient density enables us to maximise both our short-term and long-term health and vitality.

Perhaps with a higher nutrient : energy ratio, the body would be happier with a lower energy intake for longer without overwhelming cravings that may derail our weight loss efforts?

On the far right of the plot of protein vs nutrient density above we have the highest protein foods.  Prioritising amino acids alone gives us a massive 77% of energy from protein!  However, as you can see from the chart below, we will miss out on a number of essential vitamins and minerals (e.g. vitamin A, vitamin K, folate, manganese, vitamin D, calcium etc.).

Just prioritising high protein foods doesn’t achieve optimal outcomes.  We need to prioritise nutrients!

At the other extreme, the nutrient profile of the lowest protein foods is shown below.  If we actively avoid protein, we end up with an inferior nutritional outcome.

image25

If there is such as thing as ‘too much protein’ we could say that it occur when we are getting more than half our energy intake from protein (which is hard to do!).

image6

Lately, a lot of people are concerned about reducing protein to minimise insulin and mTOR.[27] [28]  While chronically high overall energy intake is indeed a problem, I am concerned that an intentionally low protein dietary approach will have a very poor nutrient outcome.  We then risk being driven to overeat in an effort to find nutrients that we are not getting from our low protein diet.

As suggested by Ames’ Triage Theory, if we miss out on nutrients by prioritising low protein foods, our body diverts our nutrients to short-term survival rather than longevity.  Pottenger’s cats suggest that our descendants will develop degenerative diseases, become lazy and eventually not be able to procreate due to our poor nutritional status.  The most logical solution seems to be to increase our nutrient intake without overdoing energy intake.

The ‘problem’ however with really high nutrient foods is that they, ironically, provide you with too much nutrition.  It’s hard to overeat highly nutrient-dense foods.  Your appetite switches off and you will lose body fat.  As shown in the chart below, it seems we have the lowest ad libitum energy intake when 40 to 50% of our energy comes from protein.[29]  This seems to align with the highest nutrient density foods shown above.

image2

Excessively high levels of protein is not a good idea from an evolutionary perspective because protein is very satiating.  We need the more energy-dense fat and carbs to fuel us to chase our food down and help us get in enough energy to store body fat to make it through the winter.

However, forcing ‘rabbit starvation’ may be a useful hack if you have body fat to lose.  For someone wanting to lose weight, a higher percentage of protein with a lower overall energy intake might be optimal.

image31

So is 40 to 50% protein optimal for everyone?

Not necessarily!  It depends on who you are and your goals.

For most people, consuming a nutrient-dense diet will increase the proportion of energy from protein beyond the typical 16% intake.  At the other extreme, it seems that increasing protein beyond 50% of energy intake would dilute nutrient density as well as be too satiating!

When it comes to protein, the minimum effective dose is whatever comes with more nutrient-dense foods, but not so much that satiety kicks in so hard that you can’t maintain your body weight.

The minimum effective dose appears to be around 19% of energy from protein with higher levels providing more overall nutrition.

If you are active and need to consume a lot of energy, then the optimal 45% protein will be impractical.  However, if you are aggressively cutting calories and eating a very nutrient-dense energy-restricted diet with a high nutrient : energy ratio then closer to 45% may be optimal.

Insulin load

After protein, the parameter that is most correlated with nutrient density is insulin load.  Insulin load is a proxy for the amount of insulin that our pancreas will need to produce and is proportional to the carbohydrates, minus fibre plus about half the protein.

If you have diabetes, you need to invest your available insulin wisely.  Consuming highly insulinogenic foods will make insulin dosing hard to calculate if you have Type 1 diabetes.  People with Type 2 won’t have enough insulin to keep up to overcome their insulin resistance and maintain excellent blood sugars.

Someone who already has diabetes will benefit by reducing the insulin load of their diet to help normalise their blood sugars, particularly if they have been overloading their pancreas with processed carbs and sugars.

A typical western diet has about 60% or more insulinogenic calories.  The chart below shows that we get the minimum effective dose (i.e. a nutrient density score of 70%) with an insulin load of 19%, optimal at around 41% of energy and an upper limit of 65%.  Overall nutrient density starts to suffer outside these limits and we would have to pay more particular attention to our nutrition.

image14

The current typical macro intake suggests that we are 65% insulinogenic calories on average in non-Asian countries and 73% in Asian countries.  And if this is typical it is likely that many people are consuming much more than this.

Perhaps highly insulinogenic low nutrient density processed foods could be playing a role in the epidemic of diabesity?

Carbohydrates vs nutrient density

This chart shows the relationship between nutrient density and total carbohydrates…

… and nutrient density vs net carbohydrates.

It seems the minimum effective dose of net carbs is 0% and 8% in terms of total carbs with an optimal nutritional outcome at around 30% net carbs or 35% total carbs.  The upper limit is 60% net carbs or 65% total carbs.

This upper limit aligns with the official “Acceptable Macronutrient Distribution Range” for carbohydrates of 65%.  What is worth noting here is that the typical intake is 55% which is greater than the optimal nutrient intake.  The lower limit of the official AMDR is 45% which appears to be unnecessarily high, especially for someone who is not active or is already developing metabolic syndrome.

Many people in low carb circles are fond of point out that ‘there is no such thing as an essential carbohydrate’.  However, foods that contain essential vitamins and minerals also often come packaged with carbohydrates.  At the same time, you can also get plenty of vitamins and minerals from organ meats and shellfish if green leafy veggies aren’t your thing.

If you already have diabetes you should lower your carbohydrate intake to the level that lets you achieve excellent blood sugar control.  In order to control your blood sugars, you will need to reduce your carbohydrates to a level less than the typical level of 55% and most likely less than the optimal level of 30%.

You can continue to refine your approach and ‘eat to your meter’ until you get the blood sugars you are chasing.  However, unless you require therapeutic ketosis (i.e. to manage chronic conditions such as cancer, epilepsy, dementia or Alzheimers), there is probably no need to drive carbohydrate intake much lower than 8% as you may struggle to obtain the broad range of essential nutrients.

Fat vs nutrient density

While there is a lot of talk about “high fat” or “low fat”, fat is actually a relatively poor predictor of nutrient density (R2 = 0.41).  The minimum effective dose seems to set at around 10% of energy intake with an upper limit of 65% fat.   Outside this window, it tends to be harder to get excellent nutrition.

The average intake of fat in western diets is around 28%.   Most people would benefit from consuming more than, particularly if they are not trying to lose weight.  However, there might not be any benefit in going over 65% of energy from fat, particularly if your primary goal is to lose body fat.  If your goal is to control your blood sugar and insulin levels then increasing fat is probably a better option than increasing energy from carbs if you can’t fit any more protein in.

Overall, I don’t think we need to target a specific fat or carb intake.  In the days before we had refrigerators, we would naturally cycle our intakes seasonally between more carbs in summer and more fat in the winter.  However, these days our macronutrient intake seems to be driven more by profit margins and shelf lives (i.e. less protein and more refined fats and sugars) which keeps us in a higher carb summer-like phase.

Fibre

Foods with more fibre tend to be more nutritious and less process.  I don’t think this is necessarily due to the fibre (i.e. you may not benefit by loading up on fibre supplements), but rather because plant-based foods often have nutrients that are harder to find in animal-based foods.

image20

Some people seem to thrive on a zero carb diet, especially when switching from a processed high carb diet which can cause gut dysbiosis.  However, it can be challenging to get as much of the essential vitamins and minerals from a diet with no fibre (although if you are eating nose to tail including minerals from blood this may be another matter).

Energy density

Energy density has the lowest correlation with nutrient density (R2 = 0.32).  However, as a general rule, less energy-dense foods tend to more nutritious.

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Energy density can be a useful tool to help us identify foods that are more filling with less energy if we are looking to lose weight.  Alternatively, we can look for higher energy-dense food that is still nutritious if we are looking to fuel high levels of activity.

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Carnivore vs plant based

Another nutritional battle that seems to be raging is the plant-based versus carnivorous diets (i.e. no plants).  The good thing about either extreme here is that they both generally eliminate highly processed foods.

A whole food plant based dietary approach will remove processed junk foods and leave low energy density high fibre foods that will make it hard to lose weight.  As you can see it is hard to get omega 3 or vitamin B12 on a plant-based diet there are a number of amino acids that are harder to get due to the amount in the plant-based foods and the bioavailability of plant-based proteins.  If you are consuming a diet that is predominantly plant-based you should look out for symptoms of deficiencies associated with omega 3, vitamin B12 and even protein and consider supplementing accordingly.

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The chart below shows the micronutrient profile of a nutrient-dense carnivore diet.  As you can see, there are a number of nutrients that are harder to obtain with this approach.  However, there is some evidence to suggest that you may not need as much of some nutrients if you are not consuming as much glucose.  Again, understanding which nutrients you are not getting in large quantities may be useful to help you identify supplements or look out for symptoms.

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Suggested updates to the Acceptable Macronutrient Range

The table below shows suggested minimum effective dose, optimal and upper limit macronutrient splits along with the current intake levels for comparison.

parameter protein fat total carbs insulin load
minimum effective dose 19% 10% 8% 19%
optimal* 45% 36% 35% 41%
upper limit 78% 65% 65% 65%
current (NHANES, 2000) 15% 33% 52% 60%
United Kingdom 16% 35% 50% 59%
non-Asia (PURE) 17% 28% 55% 65%
Asia (PURE) 15% 21% 65% 73%

It seems that to improve their nutrition, most people would benefit from:

  • more protein,
  • more fat,
  • less carbs, and
  • a lower insulin load.

However, food doesn’t come in neat packages of carbs, fats and protein.  Trying to increase protein by adding protein powder or fat by increasing butter or cream may not lead to an optimal nutritional outcome.  But if you focus on meeting your micronutrient requirements with real food the macronutrients will typically look after themselves.

* If you are astute you might notice that the optimal macros actually sum up to 116%.  This is to be expected given that it is not a closed system.  In reality, most people will struggle to consume “optimal” protein levels.  As a general rule of thumb starting with a three-way split of protein, fat and carbs is a reasonable starting point if you insist in thinking in terms of macros.  You can then make refinements from there to suit your goals (e.g. diabetes control, therapeutic keto, weight loss, athlete etc) and preferences (e.g. low carb, high carb, paleo, vegan etc).

Suggested minimum effective dose levels

In the end, nutrition is about getting enough nutrients without too much energy.  Percentages also don’t mean that much for a real person wanting to know what to eat.

The table below shows you the minimum amount of each macronutrient you might need to also provide a solid level of nutrition in terms of your current lean body mass (i.e. total weight minus your fat) and grammes per kilo and grams per pound of LBM.

LBM (kg) LBM (lbs) minimum effective dose (g)
protein fat  net carbs total carbs insulin load
40 88 72 17 0 30 72
45 99 79 18 0 33 79
50 110 85 20 0 36 85
55 121 91 21 0 38 91
60 132 97 23 0 41 97
65 143 104 24 0 44 104
70 154 110 26 0 46 110
75 165 116 27 0 49 116
80 176 123 29 0 52 123
85 187 129 30 0 54 129
90 198 135 32 0 57 135
95 209 142 33 0 60 142
100 220 148 35 0 62 148
g/kg LBM 1.8 0.4 0 0.75 1.8
g/lb LBM 0.8 0.2 0 0.3 0.8

These minimum levels will leave you with a shortfall of energy that you will have to make up from your body fat or other dietary inputs.  There is endless debate about which diet is optimal and leads to longevity.  However, the one thing that nearly everyone seems to agree on is that taking in too much energy is a problem.  So erring on the side of less rather than more is going to be a good thing.

Optimal intake levels

This table shows you the levels that you would need to hit the optimal nutritional outcome for each of these parameters.  In practice, most people will find such high levels of protein difficult to consume and may end up making up any energy shortfall from body fat, dietary fat or dietary carbs.  Nutrient density is important, however, it’s not the only thing.  Most people will end up diluting their nutrient density somewhat in order to get in energy from higher fat or higher carb foods.

LBM (kg) LBM (lbs) optimal intake (g)
protein fat  net carbs total carbs insulin load
40 88 171 61 114 133 156
45 99 186 66 124 145 169
50 110 201 71 134 156 183
55 121 216 77 144 168 197
60 132 231 82 154 180 210
65 143 246 87 164 191 224
70 154 261 93 174 203 238
75 165 276 98 184 215 251
80 176 291 103 194 226 265
85 187 306 109 204 238 279
90 198 321 114 214 249 292
95 209 336 119 224 261 306
100 220 351 125 234 273 319
g/kg LBM 4.3 1.5 2.9 3.3 3.9
g/lb LBM 1.9 0.7 1.3 1.5 1.8

I could show the upper limit of each nutrient too, however, don’t think there’s much practical use precisely quantifying these amounts.  If you are active then your appetite will increase to encourage you to get more food.  If you are gaining unwanted weight then you probably need to back off the intake.

Food lists

I encourage you to make use of the food lists in the table below.  Click on the ‘foods’ hyperlink to open the food list as an image or the ‘pdf’ to download to print.  You can also check out the nutrient profile to see what nutrients these food lists contain and which nutrients have been profiled.  Once you reduce the nutrient-poor foods, you will be able to trust your appetite to guide you to the foods that contain the nutrients you need.

approach score foods pdf nutrients
most nutrient dense 96% foods pdf nutrients
adrenal fatigue 96% foods pdf nutrients
weight loss (insulin resistant) 96% foods pdf nutrients
pregnancy 96% foods pdf nutrients
alkaline 96% foods pdf nutrients
asthma 96% foods pdf nutrients
testosterone 96% foods pdf nutrients
nutrient dense paleo 96% foods pdf nutrients
weight loss (insulin sensitive) 96% foods pdf nutrients
hypertension 96% foods pdf nutrients
excess estrogen 96% foods pdf nutrients
autism 96% foods pdf nutrients
hypothyroidism 95% foods pdf nutrients
pescetarian 95% foods pdf nutrients
breastfeeding 95% foods pdf nutrients
female fertility 95% foods pdf nutrients
sleep and insomnia 95% foods pdf nutrients
nutrient dense maintenance 94% foods pdf nutrients
depression 94% foods pdf nutrients
mitochondrial health 94% foods pdf nutrients
autoimmune friendly 94% foods pdf nutrients
bodybuilder 92% foods pdf nutrients
nutrient dense athlete 91% foods pdf nutrients
nutrient dense low carb 91% foods pdf nutrients
nutrient dense paleo (low carb) 90% foods pdf nutrients
mitochondrial health (low carb) 89% foods pdf nutrients
gestational diabetes 89% foods pdf nutrients
bivalve vegan 87% foods pdf nutrients
autoimmune (low carb) 84% foods pdf nutrients
nutrient dense plant based 81% foods pdf nutrients
nutrient dense carnivore 80% foods pdf nutrients
plant based (low carb) 76% foods pdf nutrients
well formulated ketogenic 63% foods pdf nutrients

Once you feel you have got the hang of eating mostly nutrient dense foods, you may wish to use the Nutrient Optimiser to identify the nutrient gaps as the foods and meals that will help you optimise your nutrition.

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references

[1] https://optimisingnutrition.com/2017/05/23/personalised-nutrition/

[2] https://www.nhmrc.gov.au/guidelines-publications/n35-n36-n37

[3] https://en.wikipedia.org/wiki/Hypervitaminosis_A

[4] https://www.amazon.com.au/Perfect-Health-Diet-Regain-Weight-ebook/dp/B007USA6MM

[5] https://www.bruceames.org/Triage.pdf

[6] https://en.wikipedia.org/wiki/Francis_M._Pottenger_Jr.

[7] https://www.dropbox.com/s/to3f84z77sckvjx/Interactive-Library-Nutrient_Correlation_Wheels-2.pdf?dl=0

[8] https://www.amazon.com/Nutrient-Bible-Henry-Osiecki/dp/1875239545/ref=tmm_pap_title_0?_encoding=UTF8&qid=&sr=

[9] https://www.ncbi.nlm.nih.gov/pubmed/28121382

[10] https://www.dropbox.com/s/zej4razn4dn993y/protein%20leverage%20hypothesis%20-%20simpson2005.pdf?dl=0

[11] https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=5&cad=rja&uact=8&ved=0ahUKEwigtuWKl_7WAhUIQLwKHeDdC74QFghFMAQ&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS2212877817305379&usg=AOvVaw3NNHJwsTp33sDHvoOVdpAA

[12] https://www.ncbi.nlm.nih.gov/pubmed/15836464

[13] https://en.wikipedia.org/wiki/Bliss_point_(food)

[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3313629/

[15] https://www.ncbi.nlm.nih.gov/pubmed/16332298

[16] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4209489/

[17] https://optimisingnutrition.com/2015/03/22/diabetes-102/

[18] https://www.ncbi.nlm.nih.gov/pubmed/16004827

[19] https://www.nrv.gov.au/chronic-disease/summary

[20] https://www.nrv.gov.au/chronic-disease/summary

[21] https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htm

[22] http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32252-3/abstract

[23] http://garytaubes.com/

[24] https://thebigfatsurprise.com/

[25] Note: we have not prioritised using Vitamin E and Pantothenic Acid due to the fact that the DRI targets are based on population averages rather than deficiency studies.

[26] https://www.bruceames.org/Triage.pdf

[27] http://www.meandmydiabetes.com/2010/05/07/ron-rosedale-protein-the-good-the-bad-and-the-ugly/

[28] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4209489/

[29] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3192127/

redesigning nutrition from first principles

In a sea of nutritional gurus, theories and conflicting opinions, have you ever wondered,

“What should I eat to optimise my blood sugars, weight and health to feel great and thrive?”

If your answer is “yes,” you’re in luck!

This article sets out a bold proposal and methodology to redesign nutrition from the ground up using first principles.

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It also gives you a peek under the hood of the Nutrient Optimiser, an exciting new tool to help you identify optimal foods to incorporate into your diet to achieve your goals.

Overview

But before you dive in, let me give you an overview of where we’re going.

  • Humans require food that contains:
    • adequate nutrients,
    • energy (but not too much), and
    • the ability to maintain healthy hormone levels.
  • The Nutrient Optimiser algorithm considers insulin load, nutrient density and energy density to identify optimal foods to suit different people with different goals.
  • People with diabetes or some degree of metabolic syndrome are on a blood sugar/insulin rollercoaster which drives appetite and fat storage.
  • Stabilising blood sugars and insulin levels using a lower insulin load dietary approach can help to normalise appetite and improve energy levels and often leads to a degree of spontaneous weight loss.
  • Being able to accurately quantify the insulin load of our food enables us to ensure we invest it wisely on protein and other nutrient-dense foods while still maintaining excellent blood sugar levels.
  • The foods that require the least insulin are typically high-fat foods which may not contain adequate amounts of vitamins and minerals.  We need to find the balance between a lower insulin load and adequate nutrient density.
  • Some nutrients are easier to obtain than others. The nutrient density index embedded in the Nutrient Optimiser algorithm prioritises foods that contain more of the harder to find nutrients.
  • People on a low carb or ketogenic diet often miss out on a number of nutrients, particularly electrolytes (e.g. potassium, magnesium, calcium and sodium) and our pancreas will increase insulin levels to enable our kidneys to hold on to these nutrients if we are not getting enough of them from our diet, and thus drive insulin resistance.
  • We can use energy density to manage how filling our food is to suit our goals.  For example, someone wanting to lose weight by eating less by decreasing their energy density or someone wanting to eat more by increasing energy density.
  • The Nutrient Optimiser considers what you are currently eating and identifies nutrient-dense whole foods that will provide the nutrients that you are not getting enough of while also managing your blood sugars and weight goals.
  • The Nutrient Optimiser can help retrain people to make progressively better food choices and reduce nutrient-poor processed foods using a quantitative algorithm that eliminates the emotion, belief and conflicts of interest that often derail our best nutritional ntentions.

My why

My name is Marty Kendall, and my journey into nutrition started fifteen years ago when this happened…

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…and we started thinking about having these.

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My wife Monica has Type 1 Diabetes.  Not too long after we got married we started researching how we could optimise her blood glucose control to minimise the risks associated with a diabetic pregnancy.

And personally, I have a family history and my own struggles with prediabetes and obesity (as you can see from the “before and after” below).

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By day I’m an engineer.  I like to use data to optimise things quantitatively.

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I even spent a period of time developing trading systems.  In this environment, it is critical to eliminate emotion, belief and confirmation bias.

As they say, necessity is the mother of invention.  I got frustrated with the lack of useful information for people with diabetes and decided to take matters into my own hands to create the optimal nutritional solution for my family.

The key components of optimal nutrition

You may have noticed that there is a lot of argument and conjecture about what is the best diet.  Unfortunately, decades of expensive epidemiological studies don’t seem to have provided any clarity.

Paleo, vegan, low carb, fruitarian, pescetarian, Mediterranean, vegetarian, plant-based, ketogenic, the list of nutritional camps goes on and on.

But when you peel away the dogmatic belief and conflicts of interest I think what we really need from our food is:

  • adequate nutrients,
  • enough energy (but not too much), and
  • the ability to maintain healthy hormone levels (e.g. insulin, ghrelin, leptin, mTOR etc.).

After experimenting with a range of parameters to optimise nutrition, the three that I have found to be most useful are:

While not as useful by themselves, we can combine these parameters using a multi-criteria analysis and apply different weightings to each parameter to optimise food choices to suit different people with different goals.

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Given that the diabetes epidemic is exploding, let me start by discussing how we can quantify the insulin load of the food we eat to optimise our blood sugar control.

The blood sugar rollercoaster

Someone with diabetes is on a constant rollercoaster of treating blood sugars with insulin.

You eat, and your blood sugars go up.  You dose with insulin, and eventually, your blood sugars start to come down.  Then you find your blood sugars have dropped too low so you feel compelled to eat again.  Maybe something sweet or a glucose tablet that you wouldn’t have otherwise eaten.  This cycle continues night and day.

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The blood sugar – insulin roller coaster leaves you feeling fatigued and hangry, often gaining weight due to fat storage effects of excess insulin.

When the inputs of food and insulin are both large, it’s impossible to match the right amount of insulin to the food you eat.  There is always a massive error!  And the blood sugar swings are like a bad theme park ride.

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So logically, the goal for someone wanting to manage their blood sugars is to reduce the dietary inputs that need insulin.[1]   But then, the next question is:

“What exactly is it in our food that raises blood glucose and requires insulin, and then how can we accurately quantify it so we can more effectively manage it?” 

The food insulin index data

A couple of years back, I stumbled across a motherload of Food Insulin Index data in a University of Sydney thesis[2] that I thought might hold some clues about how we could more accurately manage insulin.

So I exported the data into a spreadsheet and started tinkering with it to better understand the relationship between the food we eat, our glucose response and the insulin we need.

Our blood sugar response to glucose

It’s not a great surprise for most people to see that our blood glucose response is correlated with the carbohydrate we eat.

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However, things get more interesting when we look at the insulin response to the food we eat.

Measuring our insulin response to food relative to glucose

The Food Insulin Index quantifies the area ‘under the curve’ insulin response to a range of foods.  Pure glucose is assigned a score of 100%, and everything else is measured relative to that.

The food insulin index is a little bit like the Glycemic Index.  However, rather than just measuring the maximum rise in blood glucose, the food insulin index measures the insulin response to the food we eat over time.

Understanding our insulin response to the food we eat is much more useful for someone who cannot keep their blood sugars at normal levels due to insulin resistance (type 2 diabetes) or not being able to produce enough insulin (type 1 diabetes).

Carbohydrates versus insulin response

When we plot carbohydrates against the Food Insulin Index, we find that, while high-fat foods such as bacon and avocado have a small insulin response, high protein foods (e.g. steak and fish) have a significant insulin response even though they don’t contain any carbs.

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People with Type 1 diabetes find that they need insulin to cover the protein they eat.  However, the details of why and how much are often not well understood which leads to poor blood sugar control.

Fats versus insulin response

Higher fat foods have a smaller insulin response, while low-fat foods (which are typically processed grain products) have a high insulin response.

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[Note: There are a couple of situations where fat will require insulin.  The glycerol backbone that holds fat molecules together can be converted to glucose via gluconeogenesis which will need insulin to metabolise.  Also, when we consume more energy than we require over the long term, regardless of macronutrient source, the pancreas secretes insulin to keep energy stored in the liver while the energy coming in from our diet is used up.   However, the changes in insulin levels due to dietary fat are negligible in the short term compared to the carbohydrates and protein.]

The insulin response to dietary protein

Although protein needs some insulin to help us build and repair our muscles and organs, higher protein foods tend to have a lower insulin response because they force out refined carbohydrates from our diet.

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Does protein turn into chocolate cake?

When I first started looking into this issue, I thought the reason that protein requires insulin was because the glucogenic amino acids in protein were being converted to glucose which needs insulin.[3]

But I have since come to understand that it’s not quite that simple.  Protein does not turn to chocolate cake in our bloodstream.

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I feel partially responsible for propagating that misunderstanding with my early posts on the food insulin index.[4] [5]  Many people are avoiding protein to minimise insulin, and I’ve been trying to set the record straight.[6]

Insulin has many critical roles in our body.

  • Most people are aware that insulin helps the body take glucose into the cells to be used for energy.[7]
  • Bodybuilders are well aware that insulin is an anabolic hormone that helps us use the protein we eat to build and repair muscle and organs.[8] [9] [10]
  • The third, lesser-known function of insulin, is that it works to hold glucose in the liver (i.e. glycogen) for later use when we’re not eating.[11]

Type 2 diabetes occurs when we become resistant to the effects of insulin, and stored glucose leaches out into our bloodstream.  Similarly, Type 1 diabetes occurs when the pancreas can’t produce enough insulin to keep glycogen stored in the liver, and we see our blood sugars rise.  Effective and efficient use of insulin in our body is critical to our metabolic health.

Most of the amino acids that make up protein can be converted to glucose via gluconeogenesis, but converting protein to ATP it’s really difficult compared to just using fat and/or carbs. for energy[12]  It takes a lot of energy to convert protein to glucose (we use 6 ATP to yield only 2 ATP of energy!).  So the body tends to look for other energy sources once you’ve consumed enough protein.

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That’s why you can quickly become full-on lean protein, but we always have a “dessert stomach” with enough room for carbs and fat which are much easier for the body to use for energy.

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Let me clarify this with a real-life example that is close to home.

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Pictured above is my wife Monica’s blood glucose response measured with a continuous glucose meter) to this meal of steak and veggies shown below.

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Over the first few hours after finishing the meal the carbohydrates in the veggies digest and raise her blood sugars.  Then the insulin that she injected with the meal kicks in and brings the blood sugars down.

But then over a period of about ten hours, we can see that she is slowly metabolising the steak which requires insulin for the anabolic process of muscle repair.  While the insulin is going to work on the protein, Monica doesn’t have enough insulin to stop the glucose being released into the bloodstream.

You could be forgiven for thinking that protein is being converted to sugar.  But it’s actually the glycogen in the liver leaching into the blood due to a lack of insulin.  Monica actually needs more insulin here to enable her to build and repair her muscles as well as keep glucose in storage in the liver at the same time!

Most people see their blood sugar decrease after a high protein meal due to the effect of insulin (the insulin released to metabolise the protein also brings the blood sugars down and keeps the glycogen shut in the liver).  If you find that your blood sugars rise significantly after a high protein meal, it might be a sign that you actually need more insulin to ensure you are effectively using the protein you are eating.

According to the Protein Leverage Hypothesis, (Simpson, 2005) rather than minimising protein, someone with diabetes eating less carbohydrate may actually require more protein.

“One source of protein loss is hepatic gluconeogenesis, whereby amino acids are used to produce glucose. This is inhibited by insulin, as is the breakdown of muscle proteins to release amino acids, and therefore occurs mainly during periods of fasting.

“However, inhibition of gluconeogenesis and protein catabolism is impaired when insulin release is abnormal, insulin resistance occurs, or when circulating levels of free fatty acids in the blood are high.

“These are interdependent conditions that are associated with overweight and obesity and are especially pronounced in type 2 diabetes. It might be predicted that the result of higher rates of hepatic gluconeogenesis will be an increased requirement for protein in the diet.”  [13] 

Type 1 Diabetes guru Richard Bernstein says he found it hard to build and maintain muscle before he understood the importance of matching insulin with protein.

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However, after matching adequate protein with the right amount of insulin this is no longer a problem, even after more than seven decades of living with Type 1 Diabetes.

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At the same time though, there’s no point choking down more protein beyond what you have an appetite for.   Regardless of the macronutrient source, there’s no use consuming more energy than you need, particularly as the errors in matching food with insulin can exacerbate the glucose/insulin rollercoaster.

Anyone who is somewhere on the spectrum of metabolic disease needs to invest their limited supply of insulin wisely (e.g. to metabolise protein to build and maintain muscle and metabolise limited glucose from nutrient dense green leafy veggies) rather than squander it (on refined grains and sugars).

I hope this interlude into protein metabolism gives you an insight into why a good understanding of our insulin response to protein is important.   While there are a wide range of other hormones that drive our metabolism (e.g. mTOR, leptin, ghrelin and PPK) most of these fall in line if we optimise insulin and blood glucose levels.

Fibre

As a general rule, indigestible fibre does not require insulin and does not raise blood sugar levels.  High fibre foods such as All Bran and navy beans tend to have a lower insulin response due to their high indigestible fibre content.  Hence, it appears that a ‘net carbs’ approach makes sense, at least for whole foods.[14]

[Note:  Many people with Type 1 find that they do require insulin or have a blood sugar response to sugar alcohols and other fibres used in manufactured foods so it may be prudent to adopt a total carbs approach when dealing with foods that come in a packet and claims to have low ‘net carbs’.]

Fructose

Fructose (a.k.a. fruit sugar) is processed in the liver without requiring insulin.  However, some of it is converted to glucose via gluconeogenesis.[15]   Analysis of the food insulin index data suggests that 25% of the fructose we eat requires insulin.   However, this is typically such a small component and difficult to calculate, so it’s generally not worth worrying about.

The solution

After playing around with the Food Insulin Index data for a while, I found we can more accurately predict our insulin response to the food we eat when, in addition to carbohydrate, we also consider the effect of indigestible fibre and protein.

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[If you want to dig into this data a little more you can check out these charts in an interactive Tableau format here.]

With this improved understanding, we can then develop these formulas to calculate the insulin load and the percentage of insulinogenic calories.

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Understanding the insulin load of our food helps us to more accurately calculate the insulin people with diabetes would need to inject, including for protein.   Or conversely, it can help them make better food choices so their pancreas can keep up and maintain healthy blood sugar levels.

Being able to calculate the proportion of insulinogenic calories allows us to identify the most ketogenic foods that will elicit the smallest insulin response in our pancreas.  Understanding the percentage of insulinogenic calories can be beneficial for people who require therapeutic ketosis to help with the management of cancer, epilepsy, Alzheimer’s or dementia.

With better food choices that require smaller inputs of insulin, we are able to smooth out the blood sugar-insulin roller coaster.

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This is a big deal for someone with Type 1 diabetes.  However, the same principles apply to anyone on the spectrum of metabolic disease (which is a growing portion of the population).

I believe our first priority should be to normalise blood sugar and insulin swings.  Often satiety and weight loss will naturally follow as we are able to access our own body fat more efficiently and are not driven to eat by fluctuations in blood glucose and insulin.

Lack of nutrients in fattiest foods

However, after looking at the foods that elicit the smallest insulin response, I realised we may have another problem.  The least insulinogenic foods tend to be mainly fat!

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While an unnecessary fear of fat has driven the unfortunate low-fat processed food saga that has been in place for most of my lifetime, I think we also need to acknowledge that the highest fat foods typically do not contain a lot of the essential vitamins and minerals.

This chart shows the nutrients contained in the fattiest foods as a percentage of the recommended daily intake for each of the essential nutrients.  The nutrients are then sorted to identify which nutrients these foods fail to provide in adequate quantities.

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So if you ate a little bit of the eight hundred fattiest foods of the eight thousand foods in the USDA database you would not be getting the DRI for the following micronutrients:

  1. Vitamin D
  2. Folate
  3. Potassium
  4. Choline
  5. Manganese
  6. Vitamin C
  7. Magnesium
  8. Calcium
  9. Pantothenic acid
  10. Vitamin K
  11. Riboflavin
  12. Vitamin B6
  13. Vitamin A
  14. Vitamin E

Nutrients lacking in the most ketogenic foods

Rather than sorting by percentage fat, this chart shows the nutrients contained in the most ketogenic foods using the percentage insulinogenic calories formula shown above.

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While these foods (refer summary below) are an improvement on the nutritional profile of the fattiest foods, they still do not provide the recommended daily intake for about a third of the essential nutrients.

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So the next question is, what can we do to maintain low insulin levels and while still getting the micronutrients we need?

Enter nutrient density.

Nutrient density

Building on the work of the likes of Dr Mat Lalonde and Dr Joel Fuhrman I developed a nutrient density index to identify foods that contain more of the nutrients that are harder to find.

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Dr Lalonde’s nutrient density system considered all the essential nutrients in terms of nutrients per weight of foods and ended up with a very protein heavy (e.g. 60 to 70% of energy) array of foods.

Dr Fuhrman’s Aggregate Nutrient Density Index considered vitamins and minerals (but not amino acids or essential fatty acids) along with a range of other factors as noted below.

The following nutrients were included in the evaluation: fiber, calcium, iron, magnesium, phosphorus, potassium, zinc, copper, manganese, selenium, vitamin A, beta carotene, alpha carotene, lycopene, lutein and zeaxanthin, vitamin E, vitamin C, thiamin, riboflavin, niacin, pantothenic acid, vitamin B6, folate, vitamin B12, choline, vitamin K, phytosterols, glucosinolates, angiogenesis inhibitors, organosulfides, aromatase inhibitors, resistant starch, resveratrol plus ORAC score.[16]

Rather than prioritising all nutrients, I think we only need to worry about boosting the nutrients that we are currently not getting enough of.   To reduce any percieved bias or conflict of interest, my version of the nutrient density index only considers the essential nutrients that have established targets.

While there are many other nutritional parameters that are nice to have (e.g. phytonutrients, lycopene, lutein, zeaxanthin, phytosterols, glucosinolates, organosulfides, resistant starch etc.), they tend to come along for the ride if we focus on getting the essential nutrients from whole foods.

Unfortunately, we currently only have data for the nutrients that are actually in a food.  Hopefully one day we will also be able to account for your digestion, the effect of anti-nutrients and the bioavailability of nutrients from different food sources.

Most of the time these are not a problem as focusing on nutrient-dense foods eliminates most anti-nutrients.  Most people get plenty of amino acids, iron, zinc and vitamin A which are less bioavailability in plant-based sources.  However, if you are consuming a 100% plant-based diet, you may need to pay extra attention to getting adequate of these nutrients.

A well-formulated ketogenic diet

So, going back to the ketogenic foods, once we emphasise the harder-to-find nutrients, we get a massive boost in the micronutrient content of our diet, while still maintaining a ketogenic macronutrient ratio.

The image below shows the ketogenic foods with and without consideration of nutrient density.  When we boost the harder to find nutrients all of the nutrients get a significant boost.

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The nutrient score that you see on each of these charts enables us to compare the nutrient density of each these dietary approaches quantitatively.  While the recommended daily intake levels are not set in stone, and your body doesn’t flip an on/off switch once the minimum levels are achieved, I think we ideally want to meet the recommended intake levels for as many nutrients as we can.  However, there’s probably not much use chasing more than twice the recommended daily intake levels.   So, if we filled the whole red rectangle, we would get a perfect score of 100%.

As you’ll see below, we can create a theoretical list of foods that get us pretty close to a perfect nutrient density score of 100%.  However, in real-life, it’s hard to achieve such a high nutrient density score.  Dr Rhonda Patrick currently holds the top position on the Nutrient Optimiser Leaderboard with a score of 82%.

Low carb is more nutritious than keto

If we tweak the weightings in the multi-criteria analysis and put less emphasis on insulin load and more on nutrient density we get a more nutritious group of low carbohydrate foods and the nutrient score increases from 64% to 97%.

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A summary of these foods is shown below.

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While I could go on about the importance of the various vitamins, minerals and fatty acids, the thing I see most regularly with low carb diets is a lack of alkalising minerals such as potassium, magnesium and calcium.

The chart below shows a typical nutrient profile for someone following a ketogenic diet.  Notice the cluster of lower levels of potassium, magnesium and calcium at the top of the chart.  There has been a lot of talk about sodium lately.  However, it seems that these other minerals are actually harder to get in sufficient quantities.

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Dr James Dinicolantonio references this study in his recent book, The Salt Fix, that shows that low sodium diets tend to lead to insulin resistance.

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The kidneys call on the pancreas to secrete more insulin to help them hold onto sodium when there isn’t much coming in from our diet.[17]

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Volek and Phinney point out that the fundamental problem with low salt diets is that they cause a loss of potassium which is critical for building and maintaining muscle.

“Salt depletion causes a compensatory loss of potassium, which has a negative impact on muscle mass since potassium is a necessary cofactor for building muscle.”

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Managing sodium and potassium is a massive deal for our body, with 40% of the body’s energy and 70% of the brain’s energy used just to manage the sodium-potassium pump that is fundamental to our energy production.

As well as for sodium, the body upregulates our basal insulin to hold on to other electrolytes such as potassium and calcium.[18]

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Ironically, a low carb or ketogenic diet that minimises total carbohydrates in an effort to reduce the bolus insulin required for our food, may actually lead to a reduction in electrolytes that drives insulin resistance through an upregulation of basal insulin to enable our kidneys to hold onto precious electrolytes if we’re not getting sufficient quantities from our diet!

Paul Jaminet points out that Palaeolithic diets were naturally high in potassium and low in sodium.  Salt was rare and highly valued, so we evolved mechanisms for protecting against the threat of low sodium levels.  However, because potassium was plentiful back then, we have not developed similar evolutionary mechanisms to protect us against low potassium levels, even though they are every bit as devastating to our health.[19]

Today, potassium tends to be hard to obtain from our diet or even from supplements (which are limited to 99mg when the RDI is 4800mg or nearly 50 capsules), so we need to pay particular attention to make sure we get enough of it.

While I don’t think it’s ideal to focus on just one nutrient, we get a respectable amount of nutrients if we just chase high potassium foods.

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And while there are a number of fruits (like bananas) in the high potassium foods list, there are still a ton of non-starchy veggies if you need to manage your blood sugar levels.

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Energy density

Once you have normalised your insulin and blood sugar levels to that of a metabolically healthy person, there may not be any use in doubling down on more dietary fat if your goal is to lose body fat.

If your goal is further weight loss, I believe the ideal approach is to maximise the nutritional content of your diet so you can minimise energy intake without risking nutrient cravings.  The image below shows how the weight loss phase of a ketogenic diet includes a substantial amount of fat coming from the body with a more modest dietary intake of fat and lower overall calories.[20]

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Foods with a lower energy density (in terms of calories per weight of food) tend to be more filling and allow you to reduce energy intake naturally which will, in turn, allow your body fat to be used for fuel.

Optimal foods for weight loss if you’re still insulin resistant

These weight loss foods prioritise low energy density while also prioritising nutrient density and a low insulin load to help you lose weight if your blood sugars are still a little elevated.

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And they contain a very respectable amount of nutrients.

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Maximum nutrients with minimum energy

Meanwhile, the foods in this list just prioritise a low energy density and high nutrient density and hence provide a lot of nutrition without too much energy.

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And the nutrient profile is spectacular!

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A Protein Sparing Modified Fast is often used in weight loss clinics to maximise the rate of fat loss while ensuring you get adequate protein to maintain your lean muscle mass.

Adding nutrient density to this protocol will further improve your chances of success by avoiding cravings and nutrient deficiencies while maintaining an aggressive energy deficit.

What I find really interesting here is that, even though we are not prioritising any of the amino acids, we are getting tons of protein!  It seems that when we focus on the harder-to-find nutrients, protein becomes a non-issue.

It’s also interesting to note that the macronutrient split of these the most nutrient dense foods is similar to the macronutrients that generate the lowest ad lib energy intake.[21]

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Conversely, actively avoiding protein tends to have a diabolical impact on the essential vitamin and mineral content of our diet as shown in the chart of the lowest protein foods below.

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As you can see from the food list below, it’s hard to minimise protein without going very high carb or relying on a lot of refined fats.

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Optimal foods for bodybuilders

If you’re a bodybuilder trying to build muscle you can focus on boosting the more anabolic branched chain amino acids (i.e. valine, leucine and isoleucine).

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The foods listed below will help you recover and build muscle if you are working out.

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Optimal foods for endurance athletes

If you are an endurance athlete who doesn’t want to rely on pasta and energy gels to get enough energy you can focus on high energy density foods while still keeping nutrient density high.

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Foods with a higher energy density are not as nutrient dense.  However, these foods are still pretty good.

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Micros > macros?

You may have noticed that the macronutrient splits of the various dietary approaches vary significantly.  However, what is consistently missing from these optimal food lists are sugars and processed grains which contain a pitiful amount of nutrition.  The contrast between the cereals, baked goods, snacks and fast foods…

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… and the most nutrient dense foods is dramatic!

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A low carb diet will ensure that you avoid the majority of these dangerous Franken foods along with the sugars, seed oils, anti-nutrients and chemicals that are often associated with processed grains.

However, what I’ve found, after playing around with all these food lists for a few years, is that everything seems to work out pretty well when we start by prioritising the harder-to-find micronutrients and tweak from there to suit our goals.

Personalised nutrition

A further problem that I identified with these lists is that they do not consider what YOU are currently eating.

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Each person’s interpretation of a low carb, ketogenic or paleo diet will vary depending on preferences, finances, culture, appetite and activity levels.

I think what you really want to know is:

which foods will provide you with more of the nutrients you are not getting from your diet right now?

So this year I’ve developed the Nutrient Optimiser algorithm, a tool that will tell you:

  • what foods you should be eating more of,
  • which foods you should be eating less of, and
  • which new foods you should look for next time you go shopping.

Rather than adopting the Pete Evans diet or the Tom Brady diet for a period and then falling off the wagon once the meal plans run out, the Nutrient Optimiser will help you help you make continual incremental improvements in your journey towards optimal nutrition.

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The algorithm takes your food log, entered in Cronometer, and analyses it to see which nutrients you are currently not getting enough of.

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Nutrient imbalances

We also look at the critical ratios to make sure we’re not prioritising nutrients that are going to exacerbate any current imbalances.  The chart below shows an example of how we can use these ratios to refine the nutrients we want to prioritise.

ratios ratio target recommendation
Omega 6 : Omega 3 0.3 < 4 omega 6 : Omega 3 ratio is good.
Zinc : Copper 7 8 – 12 zinc : copper ratio is outside limits.
Potassium : Sodium 1.5 > 2 potassium : sodium ratio is low.
Calcium : Magnesium 2.3  < 2 calcium : magnesium ratio is high.
Iron : Copper 11 10 – 15 iron : copper ratio is within range.
Calcium : Phosphorus 0.6 > 1.3 calcium : phosphorus ratio is low.

Tailoring nutrition to suit blood sugar and weight loss goals

The Nutrient Optimiser algorithm also helps you choose your ideal dietary approach based on your blood sugars as well as our performance and weight loss goals.

approach average glucose (mg/dL) average glucose (mmol/L)
well formulated ketogenic diet > 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
weight loss (insulin sensitive) < 97 < 5.4
most nutrient dense < 97 < 5.4
nutrient dense maintenance < 97 < 5.4
bodybuilder < 97 < 5.4
endurance athlete < 97 < 5.4

Targeted nutrients to suit your symptoms

We can also factor in additional nutrients that relate to your current symptoms such as diabetes, low testosterone, fertility or a wide range of other conditions associated with nutrient deficiencies.

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Optimal food to suit your goals

The algorithm then generates a suite of personalised food sorted in descending order lists tailored and prioritised to suit your goals.  And coming soon, optimal meals and meal plans that will align with your goals.

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Best and worst days

The algorithm also gives a nutrient score for each day of your food log.  You can learn a lot by reflecting on what you are consuming on your best and worst days.

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Leaderboard

To date, I’ve run the Nutrient Optimiser analysis for about seventy different people.

It’s exciting to see the competitive types try to work their way up the leaderboard.

And if you’re a nutrition nerd like me you may find it interesting to head over to the leaderboard and drill down to see what each of these people is actually eating to achieve these high and low nutrient scores.

Sitting in first place at the top of the leaderboard is Dr Rhonda Patrick who, as you can imagine, does look like she eats pretty healthy.

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But the best competition is against yourself, with incremental improvements by implementing the recommendations of each iteration of the Nutrient Optimiser analysis.  For example, we can see Andy Mant has made leaps and bounds in his diet in preparation for his recent Paris wedding.

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Andy had some great success with plenty of seafood and oysters (check out his report here).  Meanwhile, people like Amy boost their nutrients with organ meats on a zero carb approach.  Others achieve a high level of nutrient density with plenty of green veggies.

The Nutrient Optimiser still doesn’t force you to eat specific foods but allows you the latitude to find the best selection of foods that align with your preferences.

Want to learn more?

If you’re interested, all the food lists (and a whole lot more) are available for free here.

If you want to learn more about the Nutrient Optimiser you can check out the FAQ over at NutrientOptimiser.com.

There are also a number of Facebook groups where you can participate in the discussion about Optimising Nutrition and share the journey.

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My hopes for the future

I presented the guts of this article as a presentation at Low Carb Down Under Gold Coast in October 2017.  A frequent comment was that it was apparent that I had spent a LOT of time developing the food lists and the Nutrient Optimiser.  Yes indeed, this has been a labour of love.  A challenging problem to solve with personal ramifications.

I would love to see the Nutrient Optimiser take off and help a lot of people and perhaps pay for a little of the time that I have invested into it.  Getting some income will enable it to be developed into a quality system that will help a lot more people.

But I really do hope that the system that I have developed will educate people to start an underground revolution by enabling them to confidently make food choices that provide them with the nutrients they need with enough energy while also optimising their hormones.

Decades of epidemiological studies have been fruitless in providing a clear direction as to the optimal human diet.  Nutrition research and education are so fraught with entrenched belief systems, confirmation bias and with conflicts of interest.

It’s impossible for the everyday person to know what they should eat to feel OK and thrive at life.  It seems Big Food is just winning and Big Pharma (also owned by the same companies) is making a killing cleaning up the mess.  The current system is broken and needs to change!

The Nutrient Optimiser algorithm gives us the chance to redesign and rebuild nutrition from the ground up.  My dream is that it will empower educated enthusiasts, then dieticians and personal trainers, then doctors, then insurance companies and then medical systems.  At that point, big food will catch on and realise they need to provide nutritious foods that enable people to thrive and win at life.

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references

[1] http://www.diabetes-book.com/laws-small-numbers/

[2] https://ses.library.usyd.edu.au/handle/2123/11945

[3] https://optimisingnutrition.com/2015/07/06/insulin-index-v2/

[4] https://optimisingnutrition.com/2015/03/30/food_insulin_index/

[5] https://optimisingnutrition.com/2015/03/23/most-ketogenic-diet-foods/

[6] https://optimisingnutrition.com/2017/06/03/why-do-my-blood-sugars-rise-after-a-high-protein-meal/

[7] http://www.medscape.org/viewarticle/438374

[8] https://www.ncbi.nlm.nih.gov/pubmed/16705065

[9] https://www.bodybuilding.com/fun/max_insulin_response.htm

[10] https://www.t-nation.com/diet-fat-loss/anabolic-power-of-insulin

[11] https://www.youtube.com/watch?v=VjQkqFSdDOc

[12] https://chrismasterjohnphd.com/2017/08/19/29-gluconeogenesis-expensive-essential-mwm-2-29/

[13] https://www.ncbi.nlm.nih.gov/pubmed/15836464

[14] https://optimisingnutrition.com/2015/03/30/what-about-fibre-net-carbs-or-total-carbs/

[15] https://optimisingnutrition.com/2016/01/25/fructose-victim-or-villain/

[16] https://www.drfuhrman.com/learn/library/articles/95/andi-food-scores-rating-the-nutrient-density-of-foods

[17] https://www.ncbi.nlm.nih.gov/pubmed/21036373

[18] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC301822/

[19] http://perfecthealthdiet.com/

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

[21] https://www.ncbi.nlm.nih.gov/pubmed/24588967

“high protein” vs “low protein”

In a recent Facebook thread Richard Morris of 2 Keto Dudes fame said:

The lipophobics and the aminophobics are both talking past each other at strawmen.  

The hysteria is not just humorous, it’s confusing and turning away novices.  

This phony controversy causes people to recommend insane amounts of protein at BOTH ends of the spectrum.

Protein tends to be a passionate topic of discussion n the online macronutrient wars.  So I thought it would be useful to set out arguments at both extremes of the ‘protein controversy’ and detail some responses to bring some balance.  My hope is that this article will bring some clarity to the civil war in the low carb/keto community.

The TL:DR summary is:

  • appetite is a reliable driver to make sure you get enough protein to suit your needs,
  • our appetite decreases when we get enough protein,
  • it’s hard to overeat protein because it’s hard to convert to energy, so the body doesn’t want more than it can use,
  • most people get adequate protein without worrying about it too much,
  • people who require a therapeutic ketogenic approach should pay attention to their diet to ensure that they don’t miss out on essential micronutrients while maintaining a low insulin load, and
  • if you prioritise nutritious whole foods, you’re likely getting enough protein but not too much.

If you want more detail, read on! The arguments and responses of the two sides are outlined below.  The article then concludes with some learnings and observations from the Nutrient Optimiser about how we can optimise protein intake to suit our goals and situation.

High protein bros

This section outlines the arguments and responses from the “high protein bro” extreme end of the debate.

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“There is no such thing as too much protein.”

Refined protein supplements do not contain the same quantity of much vitamins, minerals or essential fatty acids as whole foods.

As shown in the plot of percentage protein vs nutrient score, a focus on obtaining adequate vitamins, minerals and essential fatty acids from whole foods typically leads to obtaining plenty of amino acids.  Meanwhile, actively avoiding protein tends to dilute overall nutrient density in terms of vitamins and minerals.

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The body typically down-regulates appetite before it consumes ‘too much protein’.  It is physically difficult to eat ‘too much protein’ from whole foods (although hyperpalatable whey protein shakes may be another matter).

While protein is beneficial, we also need a balanced diet that provides the other vitamins and minerals (e.g. electrolytes that will enable the kidneys to maintain acid/base balance which is critical to insulin sensitivity which is hard to obtain from protein supplements).

In summary, it is possible to focus too much on protein to the point that you are missing out on other important micronutrients.  Conversely though, if you chase micronutrients from whole foods you will get adequate amounts of protein.

“Fasting will cause you to lose muscle due to a lack of protein intake.”

A high-fat diet reduces the need for glucose and therefore the requirements for protein from gluconeogenesis decrease.  Someone who is ‘fat adapted’ with lower insulin and blood glucose levels will also be more readily able to access their stored body fat for fuel.

The body defends lean muscle loss by upregulating appetite.[1]  People with more body fat and/or lower insulin levels will likely find fasting easier than people who are lean and/or have high insulin levels.

Fasting will drive autophagy, which is beneficial, to an extent.  Fasting and feasting is a cyclic process of building and cleaning out.  We need to balance both parts of the cycle.  Humans generally do this well in the absence of hyper-palatable processed foods.

One of the benefits of fasting is that when you re-feed, your body will be more insulin sensitive so you will build back new muscle more efficiently with less protein and insulin required.  People doing regular multi-day fasts should ensure their average protein intake is adequate over a number of days and not just on the days they eat.

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You should target more nutritious foods on your eating days to ensure you are getting adequate nutrients over the long term.  If your goal is to lose body fat, then re-feeding to satiety on very high-fat foods may be counterproductive in terms of fat loss and micronutrient sufficiency.[2]

“Everyone needs to lift heavy weights and be jacked.”

Not everyone wants to look good with their shirt off or is willing to invest the dedication that it takes to have a six-pack.  However, being active and having sufficient lean muscle mass is important to maintaining insulin sensitivity and delaying the diseases of ageing.  Doing something is better than nothing.  Having sufficient lean muscle mass is arguably better than manipulating macronutrients if your goal is glucose disposal and fat burning.

Low protein “ketonians”

This section outlines a number of arguments against ‘too much protein’ along with some responses.

“Too much protein will turn to glucose like chocolate cake in your bloodstream”

Protein can be converted to glucose via gluconeogenesis if there is no other fuel available.  However, gluconeogenesis does not come easily, and the body only resorts to increased levels of gluconeogenesis above baseline levels in emergency situations.  Gluconeogenesis yields only 2 ATP from 6 ATP.[3]

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“Too much protein is dangerous for your kidneys”

High levels of protein are only a concern if you have a pre-existing kidney issue,[4] and even then not everyone is in agreement.

“Protein is expensive and a waste to use for fuel”

The fact that using protein for fuel is metabolically expensive can be beneficial if our goal is fat loss as it increases overall energy expenditure.[5] [6]  By contrast, fat and carbs are more efficient fuel sources.  Higher levels of protein intake will drive satiety as well as being less efficient and cause more losses.

High protein foods are often financially expensive.  Processed high fat and high carb foods are cheaper to produce and hence can have a higher markup applied to them.  Thus, food companies tend to promote cheaper foods with a higher carb and/or fat content.

“Too much protein is dangerous for people with diabetes.”

People with diabetes convert more protein to glucose through uncontrolled gluconeogenesis (i.e. due to insulin resistance in Type 2 and a lack of insulin in Type 1).[7]  They also find it harder to build muscle due to a lack of insulin.  Hence, people with diabetes may benefit from consuming more protein to maintain or gain muscle.

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Conversely, people who are insulin sensitive may require less protein because they can use it more efficiently to build and repair muscle.

Older people tend to require more protein to prevent sarcopenia.[8]  A loss of lean muscle mass is a significant risk factor for older people.[9]

As shown in the chart below, people with diabetes (yellow lines) produce more insulin in response to protein than metabolically healthy people (white lines).[10]  Forcing more protein beyond satiety may make diabetes management more difficult.  However, most people get the results they require from reducing carbohydrates.  The fact that protein turns to glucose can be a useful hack for people with brittle diabetes who want to get their glucose without the aggressive swings that refined carbohydrates can provide.

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“Too much protein will make it hard maintain healthy blood sugar levels because protein stimulates insulin and glucagon.”

Protein requires insulin to metabolise.  Insulin also works to keep glycogen stored in the liver.

As shown in the charts below,[11] an increase in protein in the diet typically forces out processed and refined carbohydrate and so decreases your insulin and glucose response to food.[12] [13] [14] [You can check out the interactive Tableau version of these charts here.]

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People with Type 1 diabetes don’t have enough insulin to metabolise protein and maintain healthy blood sugars at the same time and hence require exogenous insulin.

People with Type 2 diabetes often have plenty of insulin but need to ‘invest’ their insulin wisely on metabolising protein to build muscles and repair their vital organs rather than ‘squandering it’ on refined carbohydrates.

People with hyperinsulinemia will often see their blood sugars decrease after a high protein meal as the insulin released to metabolise the protein also works to reduce their blood sugars.[15]

If you see your blood sugars rise after a high protein meal you may have inadequate insulin.  IF you have an insulin insufficiency, you may need to learn to accurately dose with insulin for protein rather than avoiding protein.[16]

“High protein will shorten life due to excess mTOR stimulation.”

Humans need to balance growth (i.e. increased IGF-1, insulin and mTOR) with repair (i.e. autophagy, fasting and ketosis).  Driving excess growth through unnatural means may not be beneficial for long-term health.

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However, the research into protein restriction and longevity is either theoretical or in worms in a petri dish where they grew more slowly when protein and/or energy was restricted.  Free-living humans typically don’t manage to voluntarily restrict energy intake.  We seem to have an inbuilt drive to protect ourselves from a loss of muscle mass, depression (note: good nutrition, especially amino acids is crucial to brain function) and loss of sex drive, and generally feeling cold and miserable.

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Longevity research in monkeys suggests that energy restriction or at least a reduction in modern processed foods is beneficial.  However, there is no research in mammals that demonstrates that protein restriction extends lifespan or health span.

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The low target protein values proposed by some for longevity (i.e. 0.6g/kg lean body mass or LBM) are practically impossible to achieve from whole foods without the addition of a significant amount of oils and refined fats and/or substantial calorie restriction to the point of rapid weight loss (e.g. check out the Nutrient Optimiser analysis of Dr Rosedale’s diet here).

There is a difference between lifespan and healthspan. Humans in the wild who are frail risk fractures and other complications related to muscle wasting and lethargy.

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As shown in the chart below, there is an optimal balance between growth and wasting.[17]  Too much insulin and you grow to the point that you get complications of metabolic disease.  Too little growth and you become frail, lose your muscle and bone strength then you may fall, break your hip and never get up again.

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“Just eating protein won’t give you gainz!”

Yes indeed!  You need to force an adaptive stress to cause muscle gains, not just eating protein.  If you work out, you will likely crave more protein.  This is natural and healthy and ensures that we can recover, adapt and get stronger.

“Overeating protein will make you fat.”

Excess consumption of any macronutrient will make you fat.  However, eating more protein and fewer carbs and fat tends to increase satiety.[18]

Research in resistance-trained athletes shows that overeating protein does not cause an increase in fat mass.[19] [20]  Research in sedentary adults shows that overeating protein causes a more favourable change in body composition than overeating the same amount of calories from fat and/or carbohydrate.

“Too much protein will lead to rabbit starvation.”

Healthy people can metabolise up to 3.5g/kg protein per day and digest up to 4.3g/kg per day.[21]  This makes sense in an evolutionary context (or even in more recent times before we had refrigerators) when there wouldn’t have been a regular supply of food but we would have needed to be able to use the food when we came across a big hunt after a long famine.

Theoretical research suggests there is no upper limit to protein intake to the point it is dangerous.   However, the practical upper limit seems to be around 50% of energy intake.  If you force extreme levels of protein, you get thirsty and pee out the excess protein.

Growing children and active people tend to crave higher levels of protein to build and repair their muscles (i.e. 10-year-old Bailan Jones, shown on the right here with his brother, who is a growing young man with Type 1 who consumes 4.4g/kg LBM).

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If you’re obese and eat only lean protein, your body will be forced to use body fat for fuel.  If you are very lean and eat nothing but very thin protein satiety will kick in and you will not have enough body fat to burn.  This is dangerous and leads to death.  So if you are already very lean and going to live in the wilderness with only wild rabbits to eat, make sure you take some butter.  However, most people will have adequate body fat to use for fuel for a significant period of time before rabbit starvation would be an issue.

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“If you’re not losing weight, you should cut your protein and your carbs and eat fat to satiety.”

Reducing processed carbs helps to lower insulin and stabilise blood sugars and helps a lot of people reduce their appetite and lose body fat.[22] [23]  However, not everyone reaches their optimal weight with this method.

LCHF / keto works until it doesn’t.

Many people find that they need to reduce dietary fat in addition to carbohydrates to ensure they burn body fat.

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Restricting protein and carbs while eating ‘fat to satiety’ may lead to an inadequate intake of vitamins and minerals which can lead to cravings and a lack of satiety.[24] [25]

While reducing the insulin load of your diet to the point that we achieve healthy blood glucose levels often helps improve satiety, effective weight loss diets typically involve some permutation of reduced fat and/or carbs to achieve a reduction in energy intake.

Medical weight loss clinics typically use a version of a protein sparing modified fast which provides adequate protein to prevent loss of lean muscle mass while restricting carbohydrates and fat.[26] [27] [28]

People on a low carb or keto diet may have an increased requirement for protein due to the body’s increased reliance on protein for glucose compared to someone who is getting their glucose from carbohydrate.[29]  Protein is the most satiating macronutrient and eating more fat when your appetite is actually craving protein, or other nutrients may lead to excess energy intake.[30]

“Too much protein will kick you out of ketosis and halt fat burning.”

Contrary to popular belief (which is often propagated by people marketing ketogenic products), ketosis is only one of a number of pathways that we burn fat.

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Ketones (i.e. AcetoAcetate or AcAc) are produced when there we don’t have enough Oxaloacetate (OAA) to produce citrate in the Krebs cycle.[31]

If you are consuming enough protein and/or carbs to provide OAA you will still burn fat but through the Krebs cycle rather than via ketogenesis.  Thus, you may be “kicked out of ketosis” if you eat more protein but you’re still burning plenty of fat.[32]

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fat burning via Krebs cycle or ketosis (via Amy Berger)

If you have high levels of NADH (which is associated with ageing and diabetes),[33] [34] [35] more of your AcAc will be converted to BHB in the liver.

Most people will see ketones in their blood increase when fasting or restricting energy intake due to the lack of OAA as they burn body fat.  As shown in the chart below, blood glucose levels decrease while BHB increases.

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There are a number of beneficial processes (e.g. autophagy, increased NAD+, increase in sirtuins) that current during fasting/energy restriction that is associated with increased BHB.  It is possible that many of the benefits related to BHB may actually be due to these other beneficial processes that occur in endogenous ketosis (i.e. it’s probably not the ketones).

We can force higher levels of BHB in the blood by eating more dietary fat and less protein and carbohydrates.  In this case, high BHB may be an indication that you are eating more fat than can be burned in the Krebs cycle and it is building up in the blood.   High levels of BHB in the blood do not mean you are achieving the same benefits via exogenous ketosis as we do in endogenous ketosis.

If your AcAc is not converted to BHB due to a low NAD+:NADH ratio you will tend to see more breath acetone (BrAce).  If you do not have metabolic syndrome, you may see higher levels of BrAce (i.e. measured with the Ketonix) and lower levels of BHB in the blood.   You should also be aware that exercise and an adequate intake of B vitamins in the diet will also increase your NAD+ levels and ‘kick you out of ketosis’.

Before you get caught up chasing ketones by whatever means possible, you should keep in mind that someone who is metabolically healthy and easily able to access their body fat stores for fuel (i.e. low insulin levels) will have lower overall levels of energy floating around in their blood (i.e. from blood glucose, ketones or free fatty acids).  Higher levels of energy in the bloodstream is a sign of poor metabolic health and reduced ability to access and burn fat.

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High levels of glucose lead to glycation.  High levels of free fatty acids lead to oxidised LDL.  High levels of glucose and free fatty acids tends to lead to glycated LDL.  High levels of ketones can similarly lead to metabolic acidosis if not balanced with an adequate mineral intake which may also ‘kick you out of ketosis’.[36]

Learnings from the Nutrient Optimiser

What is everyone else doing?

The Nutrient Optimiser Leaderboard demonstrates that low carbers have a wide range of protein intakes.

  • The average fat intake of these people is 60%, with half the people between 54% and 68% calories. The average carb intake is 11% with half the people between 6 and 15%.   So, we can see that this is generally a CLHF population.
  • Half of the people lie between about 1.4 and 2.5g/kg LBM with an average of 2.1g/kg LBM. In terms of percentage, half of the people sit somewhere between 18 and 29% of energy from protein with an average of 24% energy from protein.
  • Dr Rhonda Patrick, who is sitting at the top of the leaderboard, seems to be eating about 2.5g/kg LBM protein even though she says she is not particularly active and eats heaps of veggies.
  • People who are active tend to eat more protein (e.g. Brianna, Andy Mant and Alex Leaf).
  • “High” protein advocates Luis Villasenor of Ketogains and Dr Ted Naiman both seem to be consuming around 2.4g/kg LBM to support recovery from their higher activity exercise levels.
  • People following a zero carb approach tend to be eating more protein (e.g. Shawn Baker at 6.1g/kg LBM and Amy on 3.3g/kg LBM) as more of their energy comes from animal food. Perhaps many of the satiety effects of a Zero Carb dietary approach are actually due to the high satiety effects of protein.
  • The people with less than 1.0g/kg LBM tend to be relying on a significant amount of added fats and do not tend to achieve the highest overall nutrient score (see examples here, here and here).

What are the recommendations?

The very wide range of protein intake levels can be confusing.  Some are outlined below for reference.

  • In long-term fasting, we use about 0.4g/kg LBM protein from our body via gluconeogenesis.
  • The Estimated Average Requirement is 0.68g/kg body weight for men to prevent protein related deficiencies and 0.6g/kg body weight for women.  For a woman with 35% body fat, this equates to 0.92g/kg LBM as a minimum protein intake.[37]  (Note: These standard values are in the context of someone eating a conventional diet where they would typically be getting plenty of glucose from carbohydrates and are not particularly active, and protein requirements may be higher where someone is active and using some protein for glucose via gluconeogenesis.)
  • The Recommended Daily Intake is 0.84g/kg body weight for men to prevent protein related deficiencies and 0.75g/kg body weight for women (Note: For a woman with 35% body fat this equates to 1.15g/kg LBM as a minimum for someone who is sedentary).[38]
  • Steve Phinney recommends 1.5 to 2.0g/kg reference body weight (see slide below from his recent presentation in Brisbane) which equates to around 1.7 to 2.2g/kg LBM for someone wanting to lose 10% of their body weight to achieve their ideal ‘reference weight’. This increased level allows for some glucose to come from protein via gluconeogenesis and allows adequate protein for people who are not eating carbs and active.

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  • Ketogains suggest 0.8 to 1.0g/lb LBM or 1.8 to 2.2g/kg LBM for people who are looking to maintain or build higher levels of muscle mass.
  • Mainstream bodybuilding recommends 1.7 to 2.5g/lb body weight or 3.7 to 5.5g/kg body weight.[39] For someone with 15% body fat, this equates to 4.3 to 6.4g/kg LBM!!!

What happens to micronutrients when we chase protein?

When I first started tinkering with nutrient density, I assumed that we would want to boost all the essential nutrients (i.e. similar to Dr Mat Lalonde’s approach[40]).  The chart below shows the nutrients provided when we prioritise foods that have higher amounts of all the essential micronutrients.  The amino acids are shown in maroon.

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The ‘problem’ with this array of foods is that, because protein is easy to obtain, this group of foods ends up being very high in protein!  Even the “high protein bros” won’t be able to consume seventy percent of their energy from protein.

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As you can see from the figure below, we typically can’t eat more than 50% of our energy from protein.  However, satiety levels tend to be highest, and hence energy intake is the lowest at around 50% protein (dark blue area).[41]

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There is generally no need to prioritise amino acids because it is easy to meet the Recommended Daily Intake for amino acids if we eat whole foods.

Emphasise only harder to find nutrients

Rather than prioritising all the micronutrients, the chart below shows the micronutrient profile that we get if we prioritise the harder to obtain micronutrients (shown in yellow) without prioritising any of the amino acids (shown in maroon).   (Note:  Vitamin E and Pantothenic Acid haven’t been prioritised as the target levels are based on population averages rather than deficiency studies).

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As you can see, we still get heaps of protein. However, we get a much better micronutrient profile in the vitamins and minerals because we are only prioritising the harder to find micronutrients.

Maximising nutrient intake while minimising energy intake appears to be central to reducing natural energy intake and minimising nutrient related cravings and bingeing.  It’s not hard to see how we could reduce our energy intake eating these foods while still getting plenty of the essential micronutrients.

Highest protein foods

For comparison, the chart below shows the nutrient profile of the highest protein foods.   It seems when we prioritise foods based on their protein content we end up missing out on a number of the vitamins and minerals.  Thus, there appears to be a danger that we will miss out on micronutrients when we focus only on protein.

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Do plant-based diets provide enough protein?

The one situation I have seen people not meeting the recommended daily intake levels for protein is people following a purely plant-based diet.  In the nutrient profile shown below, Sidonie is only getting 11% of her calories from protein and you can see that leucine is not meeting the DRI levels while methionine and lysine are just meeting the minimum levels.  This may be a legitimate concern for someone on a plant-based diet as amino acids tend to be less bioavailable from plans in comparison to animals.

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The image below shows the foods that will help to fill in the gaps in her current nutritional profile which is focused on high protein vegetables and legumes.

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This food list shows the foods that would fill in Sidonie’s nutritional gaps if she was open to adding animal foods.  This is an interesting contast to the typical food list for someone on a low carb diet which has a much longer list of vegetables to rebalance the vitamins and minerals.

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Most ketogenic foods

The chart below shows the nutrient profile of the most ketogenic foods (i.e. the ones that require the lowest insulin by limiting carbs and moderating protein).  It seems that, if you actually require therapeutic ketosis (i.e. to manage epilepsy, cancer, dementia or Alzheimer’s), you will need to pay particular attention to getting adequate micronutrients (i.e. notably, choline, folate, potassium, calcium and magnesium).

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Lowest protein foods

And finally, the chart below shows the micronutrient profile if we actively avoid protein.

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It seems that actively avoiding protein has a diabolical impact on the micronutrient profile of our food.  However, when we focus on balancing our diet at a micronutrient level, everything else seems to work out pretty well.

So what should I eat?

With all the conflicting opinions it can be confusing to know what to eat.

In the end, it comes down to eat good food when hungry. 

If we remove hyperpalatable processed foods, I think we’ll have a much better chance of being able to trust our appetite to guide us to the foods that will be good for us.

The food lists below have been prepared to provide the most nutrients while aligning with different goals (e.g. therapeutic ketosis, blood sugar control weight loss, maintenance or athletic performance).  There are a whole lot of other lists in the Optimal Foods for YOU article that are tweaked to suit different goals.

I think if you limit yourself to these shortlists of healthy foods you will be able to listen to your appetite to guide you towards the protein rich foods, the mineral rich foods or the vitamin rich foods depending on your need right now.

approach average glucose (mg/dL) average glucose (mmol/L) PDF foods nutrients
well formulated ketogenic diet > 140 > 7.8 PDF foods nutrients
diabetes and nutritional ketosis 108 to 140 6.0 to 7.8 PDF foods nutrients
weight loss (insulin resistant) 100 to 108 5.4 to 6.0 PDF foods nutrients
weight loss (insulin sensitive) < 97 < 5.4 PDF foods nutrients
most nutrient dense < 97 < 5.4 PDF foods nutrients
nutrient dense maintenance < 97 < 5.4 PDF foods nutrients
bodybuilder < 97 < 5.4 PDF foods nutrients
endurance athlete < 97 < 5.4 PDF foods nutrients

Once you’re eating well and want to further refine your diet you want to check out the Nutrient Optimiser.

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references

[1] http://www.nature.com/ejcn/journal/v71/n3/full/ejcn2016256a.html?foxtrotcallback=true

[2] https://optimisingnutrition.com/2016/10/29/the-complete-guide-to-fasting-book-review/

[3] https://www.youtube.com/watch?v=Og8PTdjVAWE

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031217/

[5] http://www.tandfonline.com/doi/abs/10.1080/07315724.2004.10719381

[6] http://ajcn.nutrition.org/content/87/5/1558S.long

[7] https://www.ncbi.nlm.nih.gov/pubmed/15836464

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555150/

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4066461/

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC524031/

[11] https://public.tableau.com/profile/marty.kendall7139#!/vizhome/foodinsulinindexanalysis/insulinloadvsFII

[12] https://optimisingnutrition.com/2015/06/29/trends-outliers-insulin-and-protein/

[13] https://public.tableau.com/profile/marty.kendall7139#!/vizhome/foodinsulinindexanalysis/fatandFII

[14] https://optimisingnutrition.com/2015/06/29/trends-outliers-insulin-and-protein/

[15] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC524031/

[16] https://optimisingnutrition.com/2015/08/10/insulin-dosing-options-for-type-1-diabetes/

[17] http://press.endocrine.org/doi/full/10.1210/jc.2011-1377

[18] http://ajcn.nutrition.org/content/97/1/86.full

[19] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4617900/

[20] https://jissn.biomedcentral.com/articles/10.1186/1550-2783-11-19

[21] http://www.sciencedirect.com/science/article/pii/S0261561417302030

[22] http://annals.org/aim/article/717451/low-carbohydrate-ketogenic-diet-versus-low-fat-diet-treat-obesity

[23] https://jamanetwork.com/journals/jama/fullarticle/205916?rel=1

[24] https://optimisingnutrition.com/2017/03/19/micronutrients-at-macronutrient-extremes/

[25] https://optimisingnutrition.com/2017/03/11/which-nutrients-is-your-diet-missing/

[26] http://www.mdedge.com/ccjm/article/96116/diabetes/protein-sparing-modified-fast-obese-patients-type-2-diabetes-what-expect

[27] https://www.dropbox.com/s/rjfyvfsovbg9fri/The%20protein-sparing%20modified%20fast%20for%20obese%20patients%20with%20type%202%20diabetes%20What%20to%20expect.pdf?dl=0

[28] https://optimisingnutrition.com/2017/06/17/psmf/

[29] https://www.ncbi.nlm.nih.gov/pubmed/15836464

[30] 2http://ajcn.nutrition.org/content/87/5/1558S.long

[31] http://www.tuitnutrition.com/2017/09/measuring-ketones.html

[32] https://itunes.apple.com/us/podcast/mastering-nutrition/id1107033358?mt=2#Really

[33] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869616/

[34] https://www.hindawi.com/journals/jdr/2015/512618/

[35] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3683958/

[36] https://optimisingnutrition.com/2016/11/19/the-alkaline-diet-vs-acidic-ketones/

[37] https://www.nrv.gov.au/nutrients/protein

[38] https://www.nrv.gov.au/nutrients/protein

[39] https://www.youtube.com/watch?v=3PhVURDZi1c

[40] https://www.youtube.com/watch?v=HwbY12qZcF4

[41] https://www.ncbi.nlm.nih.gov/pubmed/24588967