optimising fat and carbs for maximum satiety

In the How much protein do you need to optimise satiety article we looked at the critical role of protein in managing hunger.

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The analysis of half a million days of MyFitnessPal data showed that your body is satisfied with less energy when you give it adequate protein.  Hunger increases if we don’t get enough protein.

So, with protein locked in, this article looks at how fat, carbohydrates and fibre affect our appetite.

Fat

The chart below shows the scatter plot of fat versus % goal calories consumed for about half a million days of food logs from 9,900 MyFitnessPal users.[1]

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On the vertical axis, an intake of less than 100% line means that an individual logged less than their goal for the day.  A typical goal calorie intake is set at about 15% below a person’s Basal Metabolic Rate or the amount of energy needed to maintain weight.

To make sense of all this data, we divided it up into 25 “bins’.  Each of the dots in the middle of the chart below represents the average of 22,000 days of data, while the ones at the extremes where there is less data available represent around 11,000 days of data.

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This analysis suggests that the lowest spontaneous energy intake occurs with a lower fat intake.

Satiety seems to improve a little when we have around 60 to 70% fat, presumably because we can still accommodate a reasonable amount of protein.

Satiety is the worst at the highest levels of fat, likely because refined fat is energy dense and there is no room for protein.

Many people report that they find fat satiating.  However, this is likely because they are able to consume a lot of calories quickly, so they feel full.

However, on a calorie for calorie basis, the data indicates that fat is the least satiating macronutrient.  While you feel full sooner, you had to consume more energy to achieve satiety.

Carbohydrates

The chart below shows the scatter plot for carbohydrate vs % goal intake achieved.

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The simplified chart for carbs is shown below.

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This data suggests that:

  1. We get the lowest satiety when carbohydrates make up about 47% of the energy in our diet.
  2. We see some improvement in satiety with around 25% carbs.
  3. A very low carbohydrate intake provides less satiety, presumably because it corresponds with a higher fat intake.
  4. Satiety improves dramatically when carbohydrates exceed 60%.

Dietary battle lines tend to be drawn around extremes of low or high carbohydrate (e.g. low carb and keto vs plant-based, vegan and fruitarians).  This data suggests that both camps may be correct to some extent.

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We just need to avoid the middle ground of moderate levels of carbohydrate combined with moderate fat levels of fat, particularly with low protein (a.k.a. hyper-palatable junk food).

On the high carb extreme, it’s going to be hard to ingest enough energy to overeat.  But when we add generous amounts of fat, we are able to consume enough energy to exceed our daily requirement.

Then due to oxidative priority, carbohydrates must be burned off first.  So any excess fat that is not burned at the end.

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The moderate carb moderate fat grey zone

So it seems we can do OK with either extreme of high or low carb.  It’s the ‘grey zone’ of moderate fat with moderate carbs that seems to really mess us up.

There are plenty of examples of people who seem to do well on either high or low carb extremes in nature.  However, we very rarely find a combination of both fat and carbs together with low protein.  The closest we come to this in nature is milk, which is ironically a pretty good growth formula!

In order to understand how the ratio of fat to carbs affects our satiety, I plotted the fat versus carb ratio for days where people logged less than 25% protein.

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  • On the left-hand end of the chart, a very high carb low-fat diet can be hard to overeat. It’s just a lot of effort and takes a lot of time to get too much food in your stomach.
  • On the right-hand end of the chart, a very high fat low carb approach is easier to over consume compared to the high carb low fat.
  • But in the middle, we have the ultimate miracle grow formula of fat mixed with carbs.

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In food the food industry, food scientists spend a lot of time trying to optimise for this bliss point of the optimum mix of fat, carbs and salt that will enable us to eat more of their food.

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If you want to avoid obesity, diabetes and the most common western diseases your mission is to avoid this grey zone.

Putting it all together

The chart below shows the plots for protein, fat, carbs, sugar and fibre together.

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The key takeaways are that:

  1. Increasing protein improves satiety.
  2. Decreasing fat is likely to help you eat less.
  3. Unprocessed contain more fibre are beneficial.
  4. Varying carbohydrates has a smaller impact on satiety compared to manipulating fat or protein.

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Example foods

So, to understand how to apply this, let’s look at some examples of each of the foods that fit these categories.

High protein to maximise satiety

Once you push protein above 50% there isn’t much room for fat or carbohydrates.   You will struggle to over-consume these foods!

food % protein % fat % carb
cod 92% 8% 0%
haddock 92% 8% 0%
white fish 92% 8% 0%
crab 91% 9% 0%
lobster 91% 9% 0%
egg white 91% 3% 6%
pollock 90% 10% 0%
protein powder 88% 5% 7%
kangaroo 88% 12% 0%
turkey breast 88% 7% 6%
crayfish 86% 14% 0%
whiting 86% 14% 0%
chicken breast 81% 19% 0%
shrimp 81% 14% 5%
ground beef (lean) 76% 24% 0%
molluscs 74% 7% 19%
scallop 74% 7% 19%
sirloin steak (lean) 73% 27% 0%

Worst case macronutrient profile (the grey zone)

These foods have low protein and a mix of carbs and fat.

food % protein % fat % carb
Nutella 4% 50% 46%
choc chip cookie 4% 44% 52%
pie crust 4% 45% 51%
doughnuts 4% 42% 54%
Kit Kat 5% 45% 50%
Danish pastry 6% 44% 50%
M&Ms 6% 48% 46%
Snickers 6% 44% 50%
ice cream 6% 48% 45%
croissant 8% 47% 45%

High satiety, low carb

On the low carb end, we get improved satiety when carbs are below 30%, protein is greater than 20% and we have less than 60% fat.

This is the sort of macronutrient profile that we would have experienced before agriculture away from the equator and/or during winter.

These foods are not as satiating as the ultra-high protein foods, but they will be a vast improvement on low protein junk food diet.

food % protein % fat % carb
caviar 36% 58% 6%
oysters 46% 31% 22%
sardine 49% 51% 0%
herring 47% 53% 0%
turkey 48% 24% 28%
natto 34% 44% 22%
sirloin steak 46% 54% 0%
roast beef 49% 51% 0%
lamb 41% 59% 0%
milk (full fat) 20% 51% 29%
Greek yogurt 37% 46% 16%
chicken 47% 53% 0%
beef ribs 43% 57% 0%
mozzarella 31% 58% 11%
cottage cheese 45% 36% 19%

High satiety, high carb

We also seem to get improved satiety when carbs go above 60% with more than 20% protein.   Most people who lived close to the equator (or in other places during summer) would have had access to higher carb foods that contain less fat.  These foods have a lower energy density and hence are very hard to overeat!

food % protein % fat % carb
mung beans 35% 3% 62%
lentils 30% 3% 67%
chard 30% 8% 62%
lettuce 30% 7% 63%
mushroom 29% 7% 64%
Brussel sprouts 28% 7% 65%
broad beans 27% 3% 70%
peas 26% 3% 71%
turnips 26% 9% 64%
kidney beans 26% 3% 71%
cowpeas 26% 4% 70%
peas 26% 4% 70%
black beans 25% 4% 72%
zucchini 24% 14% 62%
lima beans 24% 7% 70%
artichokes 23% 2% 74%
navy beans 23% 4% 73%
broccoli 23% 9% 68%
kale 23% 11% 67%
seaweed 22% 11% 67%

If you are going to use a high carb low fat approach you may need to go out of your way to ensure you get adequate protein, particularly as proteins from plant-based sources tend to be less bioavailable.

Summary

So, in summary:

  • We seem to get improved satiety with either lower carbohydrates (between 20 and 30%) or high (greater than 60%) carbohydrate.
  • Lowering fat reduces energy density and helps us reduce our overall energy intake.
  • If your goal is to spontaneously reduce calorie intake and lose weight with minimal hunger you should consider:
    • prioritising protein,
    • minimise added or refined fats,
    • avoid foods that are high in both carbs and fat and have minimal protein (aka junk food).

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Alternatively, if you want to ignore macronutrients altogether, you can focus on nutrient density using the Nutrient Optimiser and get pretty much the same outcome.

how much protein do you need to optimise satiety? 

There is a lot of discussion, confusion and misinformation around the interwebs around the topic of protein.

  • Will ‘too much protein’ raise my blood sugars?
  • Will ‘too much protein” ‘kick me out of ketosis’?
  • Won’t ‘too much protein’ hurt my kidneys?
  • Won’t protein raise mTOR and give me cancer?
  • Isn’t protein is a poor energy source?
  • But I don’t want to be a bodybuilder!

While these are all interesting concerns, most people digging into nutrition are interested in losing some body fat and being healthy.  So, fundamentally, I think the most critical question is:

“How much protein do I need to and lose fat without excessive hunger?”

Show me the data!

We recently stumbled across a massive dataset on ResearchGate of more than half a million days or two million meals worth of anonymised MyFitnessPal Food Diary from nearly ten thousand people logging their food for more than two months.

I was intrigued to see what we can we learn about the protein intake of people who succeeded in eating less compared to the people who struggled to meet their goal.

The chart below shows % energy from protein vs how much they ate compared to their goal intake.

  • Greater than 100% means that they failed to meet their target.
  • Less than 100% means that they were able to consume even less than their goal.

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While there is a lot of scatter, we can see that people who consume higher % protein tend to spontaneously eat less, while those who consumed less protein tended to eat more and were less likely to achieve their goal.

We can remove some of the noise in this plot by breaking the data into 20 groups and looking at the average.   This next chart shows the % protein versus the % target intake on average for each of the 20 groups of people.  Each of these dots represents the average of 25,000 days of food logging.

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While there are some extremes, most people tend to get between 12% and 35% of their energy from protein.

What does this look like in terms of lean body mass?

Assuming most people are aiming for a calorie intake about 15% below their Basal Metabolic Rate (BMR), we can estimate their lean body mass using the Katch McArdle formula.  From this, we can then estimate their lean body mass (LBM) and convert the chart into protein in terms of g/kg LBM as shown below.

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A protein intake of around 0.7g/kg LBM (around the Daily Recommended Intake) appears to correspond with minimum satiety while a higher protein intake reduces hunger which will enable you to effortlessly consume less food and lose weight.

Increasing your protein intake from 0.7 to 2.4g/kg LBM appears to correspond to a spontaneous calorie reduction of approximately 15%.  When we consider the fact that protein does not yield as much energy due to the thermic effect of food, we end up with a spontaneous energy deficit of more than 20% simply by prioritising protein!

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Scenarios

Unfortunately, discussions on protein targets often get muddled in a mess of units.  So I thought it would be useful to demonstrate what the minimum and maximum protein amounts look like using different units.

0.7g/kg LBM protein

The table below shows what 0.7g/kg LBM (which provides minimum levels of satiety) looks like in terms of a number of different units for a lean and an obese man (consuming 2000 calories) and woman (consuming 1600 calories).

  • g/kg lean body mass (LBM)
  • g/kg ideal body weight (IBW)
  • g/lb LBM
  • g/lb body weight
  • g/lb ideal body weight.
sex body fat LBM (kg) body weight (kg) IBW (kg) protein (g) g/kg LBM g/kg BW g/kg IBW g/lb LBM g/lb BW g/lb IBW
F 20% 52 65 65 36 0.7 0.6 0.6 0.3 0.3 0.3
M 10% 68.4 76 76 48 0.7 0.6 0.6 0.3 0.3 0.3
F 40% 51.6 86 65 36 0.7 0.4 0.6 0.3 0.2 0.3
M 20% 68.8 86 76 48 0.7 0.6 0.6 0.3 0.3 0.3

2.4 g/kg LBM protein

Meanwhile, the table below shows the protein intake that corresponds to the highest satiety protein intake of 2.4 g/kg LBM.

sex body fat LBM (kg) body weight (kg) IBW (kg) protein (g) g/kg LBM g/kg BW g/kg IBW g/lb LBM g/lb BW g/lb IBW
F 20% 52 65 65 125 2.4 1.9 1.9 1.1 0.9 0.9
M 10% 68.4 76 76 164 2.4 2.2 2.2 1.1 1.0 1.0
F 40% 51.6 86 65 124 2.4 1.4 1.9 1.1 0.7 0.9
M 20% 68.8 86 76 165 2.4 1.9 2.2 1.1 0.9 1.0

My preference is to talk about protein in terms of g/kg LBM because it relates to the amount of metabolically active muscle mass.  However, body weight is simpler because you don’t need to think about how much body fat you have.  Meanwhile, ideal body weight suits some because they have an idea of what weight they would like to be.

If your goal is increased satiety, fat loss and decreased hunger then you will want to move towards the higher levels of protein.  In the first instance, you can just try to make sure you hit a minimum protein intake each day based on your weight and body fat.  This will help kerb the cravings and manage your overall intake.

As you become leaner you may need to dial in your overall energy intake by focusing on leaner protein sources to ensure you get the protein you need without excess energy.

Protein intake levels assumed in the Nutrient Optimiser

If you require therapeutic ketosis to manage epilepsy, Alzheimer’s or Parkinson’s then the Nutrient Optimiser algorithm will calculator your macros using a minimum of 0.8 g/kg LBM.

However, most people who are interested in nutrition are looking for fat loss and/or diabetes management (and not therapeutic ketosis), hence we set the minimum protein intake at 1.8 g/kg LBM.  Dietary approaches with lower protein than this ‘minimum effective dose’ tend to have a poor nutrient density.

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A protein intake of 1.8g/kg LBM corresponds to the level beyond which we don’t appear to get any further gains in muscle growth.[1][2]  However, we do appear to get additional benefit in satiety and nutrient density.

Many people get confused with the numbers and units, which is why we created the Nutrient Optimiser. to calculate your ideal macronutrient range as well as provide you with some suggested foods and meals that will help you reach your goals.

Responses to common concerns

If you are still concerned about ‘too much protein’ I have outlined some brief responses to the common concerns noted at the start of this article.

Too much protein will raise my blood sugars!

People that produce adequate insulin in their pancreas (i.e. not Type 1 diabetic) tend to see a fairly stable blood sugar response to protein.[3]  Some people even experience a drop in blood sugar, so start slowly and titrate up to a more ideal protein intake.[4][5]

While a low carb high-fat diet will mask the symptoms of diabetes by stabilising blood sugar and reducing your HbA1c, it is the reduction of fat stored around your organs that will ultimately reverse your diabetes![6][7]

Too much protein will ‘kick me out of ketosis’!

Ketosis occurs when there is less carbohydrates and proteins to provide oxaloacetate in the Krebs cycle, so we revert to ketosis to burn fat for energy.

If you need to lose weight then more protein will likely drive an energy deficit, which will cause higher ketone levels as you consume your body fat for fuel.  However, keep in mind that BHB ketones are mainly a transport or storage form of energy and do not correspond with effective use of fat for fuel.[8]

While ketones have experienced a surge in popularity thanks in part to people who would like to sell you some, ketones are far from the most important health marker.   

If you are more concerned about elevating your blood ketone levels than the fat that is being stored in your liver, pancreas, heart, eyes and brain and driving you towards the most common diseases of our western civilisation, then may I politely suggest that you should review your priorities?  

This video, while very graphic (you have been warned!), demonstrates why fat loss is not just for bodybuilders, but critical for health and longevity.

Too much protein will hurt my kidneys!

Unless you have late-stage kidney failure and are on dialysis ‘too much protein’ is not a concern.[9][10]  If you are concerned about your protein intake you should talk to your nephrologist (kidney specialist) about the optimal protein level for your situation.  (If you’re not already seeing a nephrologist there’s probably no need to be concerned about ‘too much protein’ hurting your kidneys.)

Will protein raise mTOR and give me cancer?

We need a balance between building up (mTOR and anabolism) and breaking down (fasting and autophagy).  What we do know for sure in all this is that excess energy (regardless of the source) seems to be one of the biggest contributors to diabetes, cancer and other metabolic diseases that accelerate ageing.[11]

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Optimising your diet with adequate protein to improve satiety and reduce body fat levels to ensure you are physically robust and independent for as long as possible sound like a much safer bet than crossing your fingers hoping that protein restriction (which only seems to work on worms in a Petri dish) will extend your life.

Protein is a poor source of energy!

Yes, fat is an efficient fuel source compared to protein. But if you have excessive stored body fat then getting more fuel is not your highest priority.  Your body is highly motivated to ensure you consume adequate protein to prevent loss of lean muscle.  Getting adequate fuel is secondary.

Eating lower protein foods means that, in the pursuit of adequate protein, you will need to consume more fuel (i.e. carbs and/or fat) than your body can use.  Conversely, eating higher protein foods reduces appetite.  With adequate protein locked in to build and repair muscle (and enable other vital functions), your body will be happy to get the fuel it needs from your excess stored body fat.

The spontaneous reduction in appetite that we see from the analysis of the half a million days of MyfitnessPal data demonstrates that your body is much more willing to burn your unwanted body fat if it is getting the protein it needs.

Forcing your body to convert some protein to glucose for energy (a.k.a. gluconeogenesis) is not such a bad thing.  If you always give your body some fat or carbs when you need energy it will never need to dip into your body fat stores.

But I don’t want to be a bodybuilder!

The ‘good news’ here is that it takes a lot of intentional effort (and often some extra chemical or hormonal assistance) to build massive muscles. Optimising your protein intake will only enable you to manage your hunger, lose body fat and reverse your diabetes.

Summary

So, in summary. the analysis of half a million days of MyFitnessPal data indicates that:

  • Our bodies seem to be happy with less energy when we provide it with adequate protein.
  • Low protein intakes correspond with the lowest levels of satiety and the highest energy intake.
  • Higher protein intakes tend to increase satiety and spontaneously reduce hunger.
  • Increasing protein from 0.7 g/kg LBM to 2.4 g/kg LBM corresponds to a to spontaneous calorie reduction of approximately 15%, even before we account for the higher thermic effect of protein.

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Thanks so much for reading!  In the next article in this series, we’ll look at what the data can tell us about the relative satiety provided by fat, carbs, sugar and fibre.  You might be surprised by the findings!  So make sure you subscribe to ensure you receive it!

 

References

[1]https://bayesianbodybuilding.com/the-myth-of-1glb-optimal-protein-intake-for-bodybuilders/

[2]https://www.ncbi.nlm.nih.gov/pubmed/1400008

[3]https://optimisingnutrition.com/2015/06/15/the-blood-glucose-glucagon-and-insulin-response-to-protein/

[4]https://optimisingnutrition.com/2015/06/29/trends-outliers-insulin-and-protein/

[5]https://optimisingnutrition.com/2015/06/15/the-blood-glucose-glucagon-and-insulin-response-to-protein/

[6]https://optimisingnutrition.com/2018/05/03/ted-naimans-dam-fat-storage-insulinographic-explained/

[7]https://optimisingnutrition.com/2018/04/12/does-insulin-really-resistance-cause-obesity/

[8]https://optimisingnutrition.com/2018/02/24/is-the-acetoneglucose-ratio-the-holy-grail-of-tracking-optimal-ketosis/

[9]https://twitpl.us/f8Jb

[10]https://www.hindawi.com/journals/jnme/2016/9104792/

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

the carbohydrate-insulin hypothesis vs the adipose centric model of diabetes and obesity

I recently shared Dr Ted Naiman latest “insulinographic” that attempts to explain the adipose centric theory of diabetesity.

It created some great discussion as well as some confusion, so I thought it would be worth an article to unpack the critical insights about how insulin really works in our body and what we can do to reduce body fat and avoid diabetes.

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The first clarification is that this isn’t a meme or a graph.  It’s more an infographic that attempts to explain how insulin is anti-catabolic and works like a dam to hold back the flood of stored energy in our body.

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The dam analogy builds on the line of thought initially detailed in the Does insulin resistance really cause obesity? article.

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Basal vs bolus insulin

I have spent a lot of time analysing the insulin index data which helps us to quantify our short-term insulin response to food.

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This is helpful for people with diabetes (like my wife Monica) to choose foods that keep their blood sugars stable as well as help them more accurately calculate their insulin dose by accounting for carbohydrates, fibre, protein and fructose.

However, with all the focus on carbs, fat and protein, I fear we may have neglected the most important thing that influences our insulin response to the food we eat.

Majoring in the minors

Before we switched to a lower carb dietary approach, my wife Monica was taking about 50 units of insulin per day to manage her Type 1 diabetes.  ABout half of that was for food (bolus) and half was her background insulin (basal).

These days, Monica takes about half the insulin that she used to.  However, now about 80% of her daily insulin dose is basal insulin while only 20% of her insulin is taken to manage her blood sugars levels around meals.

basal insulin

bolus insulin (for food)

total daily insulin

Higher carb diet

25 units

25 units

50 units

Low carb diet

20 units

5 units

25 units

Monica’s basal insulin demand has reduced a little due to some weight loss and improved insulin sensitivity.

The most interesting observation is that the vast majority of the insulin required by someone on a low carb diet is not related to the carbohydrates or even the protein in the food they eat. 

While carbs and protein raise insulin in the short term, the fat on our body and the fat in our diet have the most significant influence on our insulin levels.

The grey area in the chart below shows the insulin released across the day by someone with a functioning pancreas.  The pink line shows how someone with Type 1 diabetes tries to mimic this with an insulin pump.

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A lower carb diet is a no-brainer for someone with diabetes to help them stabilise their blood sugars and appetite.[1]  However, we get to a point of diminishing returns when we only focus on the carbohydrate and protein in our diet while ignoring the fat in our diet and the fat on our body.

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Elevated fasting (or basal) insulin is the elephant in the room for many people on a low carb or keto diet.  Many people on a low carb or ketogenic stabilise their blood sugars and improve HbA1cs, but are still obese with high fasting insulin levels.

The harsh reality is that replacing the carbs and protein in your diet with fat will not reverse your hyperinsulinemia unless it also reduces the amount of fat stored on your body!

But what is going on?

But what can we do?

That’s where Ted Naiman’s “insulinographic” comes in.

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Many people think that elevated insulin is the cause of obesity.  But, I’m coming to realise that most of the time it’s actually the other way around.

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It is actually obesity (or at least being overfat relative to our Personal Fat Threshold) that causes hyperinsulinemia.

Insulin is anti-catabolic

We typically think of insulin as an anabolic hormone that forces amino acids into muscles and glucose into our cells.  But it can actually be more useful to think of insulin’s anti-catabolic properties.[2] [3] [4] [5] [6] [7]

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Rather than just building our muscles and fat stores or forcing glucose into the cells, insulin also works to keep fat and muscle in storage.

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Insulin prevents entropy (or chaos) and ensures that we don’t melt into a puddle like Olaf the Snowman.

Someone with Type 1 diabetes does not have enough insulin to prevent catabolism.  Their protein, fat and glucose stores in their body get released into their bloodstream in an uncontrolled manner and result in high glucose, high free fatty acids and high BHB ketones.

The good news though is that if your pancreas is working, you will produce insulin when you’re not eating to enable you to regulate the amount of fuel being released from storage into your bloodstream.  

Healthy fasting insulin levels in hunter-gatherers range between 3 – 6 mIU/mL.[8]  In western populations, the average fasting insulin level is about 8.6 mIU/mL.[9]  People with insulin resistance or diabetes have much higher levels of fasting insulin.

Insulin is the hormonal signal that raises the dam wall to slow the flow from stored energy via our liver while the energy in our bloodstream is being used up.

The more fat you have to hold back in storage, the higher your insulin levels need to be.

This helps us to understand why many people low carbers who are obese have high fasting insulin levels.  Even though they may be eating minimal amounts of carbs and protein in an effort to keep their insulin levels low, their body is keeping insulin high in an effort to hold their energy in storage until the energy in their bloodstream is used up.

To help elaborate on this I have fleshed out what various scenarios would look like in terms of body fat, insulin levels and energy in the blood (i.e. glucose, ketones and free fatty acids) in the table below.

note: TOFI = thin on the outside, fat on the inside and PFT = personal fat threshold

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I can make you fat

Dr Jason Fung points out that people using exogenous (injected) insulin to manage their diabetes can develop obesity and insulin resistance because of their medications.

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Dr Robert Lustig also explains how someone injected with a little bit of extra insulin at each meal will store more fat and not be able to mobilise their body fat (lipolysis).

To some extent, this is what happens when someone with diabetes injects insulin to cover a crappy nutrient-poor insulinogenic diet.  With large doses of exogenous insulin to cover a high carb processed diet they never quite get the insulin dosing right.  They end up overdosing with insulin and having to eat more to rescue themselves from low blood sugars.  The great thing about a low carb more less processed foods for these people is that it helps stabilise blood sugar and insulin doses which is easier to manage with smaller doses of insulin.

To go back to our “dam” analogy, excessive exogenous insulin for someone who already has hyperinsulinemia is like building our dam wall higher than it needs to be.  The higher dam wall will hold back more energy in storage than it needs to and less of the energy we eat will be released into the bloodstream.

We feel hungrier because the excessive exogenous (injected) insulin is not allowing energy to be released into circulation.

We will end up eating more, and this excess energy will be stored more easily.  We will become more and more resistant to the insulin we are injecting as our fat stores become fuller, and we need more insulin to hold our fat in storage.

The solution here is a low carb diet to help stabilise blood sugars and hunger driven by excessive swings in insulin and blood sugar.

The fatal flaw in the insulin-centric view of obesity

Where this insulin-centric view of diabetes and obesity fails is that it doesn’t translate to someone who is not taking exogenous injected insulin or drugs that stimulate insulin release from their pancreas.  

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Our bodies optimise for efficiency.  Unless you have an insulinoma (a tumour on your pancreas), your pancreas will not secrete more insulin than it needs to.   

Our pancreas will not build the dam wall higher than it needs to be to hold back the energy coming into our system!

Irrespective of insulin levels, you cannot store energy we do not eat.   

At the risk of doing your head in, we can look at the function of insulin as anabolic (building) and anti-catabolic (preventing breakdown) and get to the same conclusion:

  • Anabolic  – Although dietary fat doesn’t raise insulin much in the short term, you will always have enough basal insulin on board to store the fat you eat on your body (note: this is the anabolic.
  • Anti-catabolic – Your pancreas will always produce enough insulin to slow the flow of energy out of the stores on your body while you use up the energy from the food coming in from your mouth.

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Our fasting insulin is proportional to the amount of fat stuffed away in storage which is directly proportional to the amount of food that we have eaten.  

We cannot really blame obesity on insulin resistance.  It is our insulin sensitivity that enables our fat cells to grow.  Once we become insulin resistant, we actually find it harder to store excess energy in our adipose tissue.  

How to keep your basal insulin low

There a number of things that help us lower our dam wall, including:

  • exercise,
  • fasting,
  • a low energy diet, or
  • a high nutrient density diet.

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Exercise

Exercise, particularly resistance excercise or HIIT, is a great way to build insulin sensitivity and helps us to burn off fat and sugar without the need for insulin.[13]  People with Type 1 diabetes find they need to reduce their insulin dose when they are active and increase their basal by about 25% when they don’t exercise.

Fasting

Not eating for a period of time is a great way to reduce your insulin.

Once you use up the glycogen in your liver, your body turns to the fat stores and lowers insulin levels to allow more stored body fat to flow over the dam into the system.

However, for some people, the problem with fasting is that it’s easy to overdo the refeed.

When I was fasting regularly to try to lose some extra fat, I found I would permit myself to eat more than I would otherwise have eaten.  And the foods that I chose to eat were often less nutrient dense and more energy dense dense than usual.

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In spite of the saint-like deprivation for days, I found I didn’t lose much weight over the long-term.  In the end, I seemed to eat back my deficit.  My wife Monica would say ‘I don’t think this fasting thing is working for you!  Why don’t you try eating a little less each day?’

I have talked about using your bathroom scale or blood sugar readings to refine the frequency and quantity of your feeding to make sure you are moving towards your goal.  Unfortunately, just like tracking calories, these approaches to fine tuning your food intake require self-discipline and deprivation which is not fun.

Even better than tracking blood glucose or your weight, another way to manage your fasting/feeding frequency and food intake would be to measure your blood insulin level to ensure it was going down to new lows before you ate, and then ensure that when you refeed that you didn’t drive insulin too high with too much food.

Unfortunately, there is no home test for insulin yet, so our blood glucose metre and bathroom scale are the best we can do for now.

Many believe that they will keep insulin levels low if they focus on higher fat foods when they refeed.  However, it is possible to drive higher levels of insulin with a high-fat intake in only a short amount of time.

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A relevant example of this is Jimmy Moore’s recent high protein experiment where he reduced his fasting insulin from 14.2 to a very respectable 8.8 mIU/mL in five days on a high protein energy restricted diet.[14] [15] [16]

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Afterwards, he finished the fast on Sunday (8 April as per the date on the Instagram image below) he proceeded to boost his fasting insulin to 18 mIU/mL after a day of high fat refeeding before the laboratory was open to measure his post-experiment labs on Monday.  This post refeed insulin was actually higher than his 14.2 mIU/mL insulin before the experiment began.

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This also aligns with the study results shown below where participants lowered their insulin and triglycerides more higher protein lower carb diet.[17]

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Similarly, this twelve month randomised control low carb study found that people had better outcomes in terms of weight, body fat, insulin, HOMA-IR, HDL, hunger and emotional eating with higher levels protein.

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It will be interesting to see how Jimmy’s upcoming high-fat bio hack goes.  I hypothesise that Jimmy’s short-term insulin level may be lower after meals, but his longer-term fasting insulin will be higher on the high-fat approach.

Once we account for the Thermic Effect of Food (TEF), there is actually more available energy in the high-fat approach as shown in the calculations below.

high protein (3:1) 80% fat
fat (g) 90 168
protein (g) 270 95
fat (cal) 810 1512
protein (cal) 1080 378
energy consumed (cal) 1890 1890
TEF (cal) 405 265
available energy (cal) 1485 1625
short-term insulin higher lower
long-term (fasting) insulin lower higher

With less energy actually available to the body in the high protein scenario, the pancreas will produce less insulin to allow more energy to be released from storage compared to the high-fat scenario.

Low energy diet

As noted in Ted’s insulinographic, a low energy density diet is another way to keep your basal insulin levels down.

You can achieve this by focusing on foods with a lower energy density which will make it harder to overeat.  This will ensure your body fat stores are used.  With less fat to hold back in storage, your insulin levels will decrease.

This is why we see some people who make the switch to a whole foods plant-based diet reduce their insulin requirements and reverse their diabetes.   As long as they stick to whole foods, they will not be able to ingest enough energy to maintain their weight, so their insulin comes down.  However, this does not hold for processed vegan junk food which can still be energy dense, highly processed, hyperpalatable and easy to overconsume.

What about trying to eat less food?

Another option is to try to simply eat less food.  While this can be helpful, it shouldn’t be the only technique used as simply restricting the intake of nutrient-poor junk food is a recipe for nutrient cravings and rebound binge eating.

Nutrient-dense diet

Maximising nutrient density is my favourite hack because it addresses the following factors:

  • Adequate protein. If you eat foods that contain the vitamins, minerals and essential fatty acids you need you will obtain plenty of protein which, on a calorie for calorie basis, is the most satiating macronutrient.   There is a lot of confusion around protein, but the reality is, if you are eating foods that contain adequate levels of vitamins, minerals and essential fatty acids you will be getting plenty of protein.  Conversely, actively avoiding protein may lead to nutrient deficiencies.  Whether you approach this in terms of higher nutrient densitym, targeting the most satiating macronutrients or the foods that will naturally provide you with greater satiety you arrive at pretty much the same point.

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  • Energy density. A nutrient-dense diet typically has plenty of whole foods that have lower levels of refined carbs and processed fats which have a lower energy density and hence are hard to overeat.
  • Minimally processed. Quantifying nutrient density is a foolproof way to ensure that the food contains the micronutrients you need rather than hyperpalatable flavourings and colours from Frankenfoods that are designed to look like they are good for you (but they’re not).  These minimally processed foods are also satiating without being hyperpalatable so are self-limiting.
  • Prevents cravings. Good nutrition, avoiding diabetes, weight control and lower insulin levels seems to boil down to getting the nutrients you need without too much energy.  Focusing on nutrient-dense foods also gives the best chance of avoiding nutrient cravings that will unnecessarily drive your appetite.

Fat raises insulin too, it just takes longer

Most of the time we focus on carbs (and to a lesser extent protein) as being the culprit when it comes to raising insulin levels.   But does this hold true when we look at the big picture?

The insulin index data suggests that higher fat foods have a lower insulin response.  But is this simply because the insulin index testing only measured the insulin response over three hours?

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The chart below on the left shows that insulin rises more slowly for a high-fat meal compared to glucose or a mixed meal.[18]  However, it still rises and looks like it will keep on going for a while after the 120-minute measurement.

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If we were able to test the insulin response over 24 hours, I think we would see that insulin response is actually more closely related to the available energy in our food rather than a specific nutrient.

Is our long-term insulin response simply related to the amount of energy in our food and hence the amount of energy needs to be held back in storage by the liver?

Is it only because carbs and protein have a higher oxidative priority than fat that we see a greater short-term spike in insulin (i.e. the body needs to act more quickly with a sharper insulin response to hold back energy from carbs in storage compared to fat or protein)?

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The adipose centric model of diabesity

The insulin-centric view of obesity, diabetes and insulin resistance focuses on reducing insulin by switching carbs out for fat to control our (short term) insulin response to food.

Meanwhile, the adipose-centric view of diabetes is a little bit more sophisticated and complete as it also considers the long-term insulin response to the food we consume.

Someone who is lean and insulin sensitive will have healthy levels of adipose tissue that can quickly swell to take on more energy and then release it.  If you are insulin sensitive like these guys, you store precious energy very efficiently when it is available.

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But our fat stores can only take in so much energy before they become full.  There is a limit to how high you can build your dam wall.

When your fat cells become stuffed and can’t take on more energy, they are said to be “insulin resistant”.  At this point, any excess energy spills out into the bloodstream as elevated glucose, free fatty acids or ketones.  Excess energy is also pumped into our vital organs, and we develop fatty liver, fatty pancreas, heart disease and the other complications of western civilisation.

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To be clear, it’s not being obese that causes diabetes. Instead, it’s a matter of being overfat relative to your Personal Fat Threshold.  Some people are “blessed” to be able to store a lot more energy in their fat stores before they become insulin resistant and diabetic, while others find that can only store a little bit of energy in their adipose stores before it overflows and ends up being stored in their vital organs and bloodstream.

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Disease progression and reversal

Listed below is the progression from health to disease, with hyperinsulinemia building progressively throughout.

  1. Insulin-sensitive healthy fat levels that are able to easily absorb and release any excess energy for later use.
  2. Expansion and filling of insulin-sensitive adipose tissue with sustained energy excess.
  3. Fat cells become full and exceed your Personal Fat Threshold (largely influenced by genetics).
  4. Fat cells become full and “insulin resistant” relative to other parts of the body.
  5. Excess energy builds up as visceral fat in vital organs and spills over into the bloodstream (aka diabetes).
  6. Excessive swings in blood sugar and insulin cause a dysregulated appetite driving further overeating.
  7. Complications of western disease due to (i.e. obesity, diabetes, heart disease, Parkinsons, Alzheimers, dementia etc).

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To reverse these steps and reduce insulin to normal levels we need to follow to:

  1. Stabilise blood sugars and insulin swings by reducing processed carbohydrates to help improve appetite control and eliminate the need for exogenous insulin.
  2. Focus on more nutrient dense, less energy dense foods to improve satiety and induce an energy deficit.
  3. A sustained energy deficit causes a reduction in visceral fat which improves the function of the heart, liver, pancreas and brain.
  4. Reduced pressure on the adipose fat allows to below the Personal Fat Threshold allows incoming energy to be buffered in fat stores without overflow into the bloodstream (i.e. reversal of diabetes).
  5. Fat loss further reverses insulin levels and blood sugars to achieve optimal levels for longevity and performance.

So what’s the solution?

So, if insulin and carbs aren’t to blame for our obesity and diabetes then what can we do?

Is it back to just eat less, exercise more?

Well sort of, but not exactly.

There are a number of practical steps that we can take to avoid diabesity including:

  • Minimise cheap hyper-palatable processed food that overrides our satiety signals and tricks our taste buds.
  • Invest in quality food and learn to cook at home from fresh whole ingredients.
  • Monitor your nutrient intake by logging your food using Cronometer.
  • Eat your meals mindfully with other people rather than in front of a screen alone.
  • Don’t use food as a source of comfort.
  • Sleep and rest enough so you don’t need to use energy dense food as a pick me up.
  • Be active and build as much lean muscle as you can in order to efficiently burn the carbs and fat you consume.
  • Focus on nutrient-dense foods that are minimally processed that will minimize cravings. If you focus on maximising the good stuff in your diet, you will not have to worry as much about avoiding the processed food that are full of sugars, flavourings and seed oils.
  • Moderate carbs if you need to stabilise blood sugar and insulin swings which can help stabilise appetite. Diabetes and longevity expert, Dr Peter Attia, recommends that we eat foods that will keep our blood sugar low (i.e. less than 90 mg/dL) and with a relatively tight standard deviation of less than 10 mg/dL.[19] [20]
  • Don’t demonise macronutrients, but instead prioritise nutrient-dense whole foods.

If all of the above still don’t get you to where you want to be then you may need to track your intake for a while and titrate down your calorie intake to recalibrate your version satiety.   The good news is that many people find when focusing on maximising the nutrient density of their diet managing the quantity of food isn’t such a big deal.

 

References

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5792004/

[2] https://www.ncbi.nlm.nih.gov/pubmed/16705065

[3] https://www.ncbi.nlm.nih.gov/pubmed/3298320

[4] https://www.t-nation.com/diet-fat-loss/insulin-advantage

[5] https://www.ncbi.nlm.nih.gov/pubmed/16705065

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1804253/

[7] https://academic.oup.com/bja/article/85/1/69/263650

[8] http://wholehealthsource.blogspot.com.au/2009/12/whats-ideal-fasting-insulin-level.html

[9] http://wholehealthsource.blogspot.com.au/2009/12/whats-ideal-fasting-insulin-level.html

[10] https://www.ncbi.nlm.nih.gov/pubmed/7972417

[11] http://www.diabetesincontrol.com/insulin-as-a-satiety-signal-in-postprandial-period/

[12] https://weightology.net/insulin-an-undeserved-bad-reputation/

[13] https://www.ncbi.nlm.nih.gov/pubmed/9435517

[14] http://www.ketohackingmd.com/8-7-day-high-protein-hack-experiment-results-part-1/

[15] http://www.ketohackingmd.com/9-7-day-high-protein-hack-experiment-results-part-2/

[16] http://www.ketohackingmd.com/10-7-day-high-protein-hack-experiment-results-part-3/

[17] https://www.ncbi.nlm.nih.gov/pubmed/15817850

[18] https://chrismasterjohnphd.com/2017/07/26/insulin-really-response-carbohydrate-just-gauge-energy-status-mwm-2-23/

[19] https://peterattiamd.com/2016-update/

[20] https://www.youtube.com/watch?v=vDFxdkck354

 

how to optimise your energy and macro-nutrient targets

Most macronutrient and calorie calculators give you a specific target for calories, carbs, fat, protein and fibre.

This is simple, but unfortunately not optimal when it comes to ensuring optimal nutrition.

Nutrient-dense whole foods don’t come in prepackaged satchels of protein, carbs, fat, fibre and calories that you can mix together to meet specific macronutrient and calorie targets.

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In real life, nutritious whole foods have a range of macronutrients and micronutrient profiles.  Some days you might crave more energy or different nutrients based on your needs.

While calories and macros still play a role, chances are that you will do better if you initially focus on nutrient-dense whole foods rather than achieving specific macronutrient and calorie targets.  Once you remove nutrient poor highly processed foods from your diet you will be able to better trust your food cravings and appetite.

Where to focus

The personalised foods and meals in your free Nutrient Optimiser report will help you re-balance your micronutrient profile, stabilise your blood sugars and provide the energy you need from your food (but not too much, particularly if your goal is fat loss).

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To help you make the transition from just thinking in terms of macronutrients and calories, the Nutrient Optimiser provides you with personalised macro and calorie ranges.

The image below shows my macronutrient and energy ranges as someone who is currently 95kg with about 16% body fat and good blood sugars.  My current goal, after building some strength in the gym last year, is to lose some body fat while holding onto as much hard earned muscle mass as I can.

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Working within target ranges enables me to still listen to my appetite which may guide me to eat more on days that I am more active and when I tend to crave more protein and/or carbs.  Conversely, there may be other days when I am less active and less hungry and hence don’t need to eat more than my body is craving.

For me, as someone who has become fairly insulin sensitive with good blood sugars, these macronutrient ranges are fairly wide.  I could consume between 32 and 142 g of fat or up to 151g of non-fibre carbohydrates as long as I’m not overdoing my overall energy intake.

For contrast, I have shown below the macro and energy ranges that the Nutrient Optimiser would give for a woman who was also 95kg but had 50% body fat and type 2 diabetes and looking to lose weight.

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Her overall energy requirement is lower because she has less metabolically active lean mass.  Her target carbohydrate range is much lower to help her control her blood sugars.

At just over 500 calories per day, her lower limit of energy intake is also very low because she has a lot of body fat that can be mobilised.  However, she still needs a minimum level of protein, essential fat intake and other vitamins and minerals.

These macronutrient and calorie ranges can act as a starting point.  As you make progress with your weight loss or get your blood sugars under control, you can update your profile in the Nutrient Optimiser to update these numbers.

We’re also in the process of developing a Nutrient Optimiser Dashboard that will allow you to track your biometric data (e.g. blood sugars, waist, weight, blood ketones, breath ketones, body fat percentage etc.) help you fine-tune your macro and calorie targets to ensure you are moving towards your goal.

Lots of people are wannabe biohackers but end up getting caught up chasing markers that don’t help them reach their goals (e.g. chasing high ketones for weight loss).  Alternatively, they don’t adapt their approach as they progress (e.g. they don’t transition to a more nutrient-dense lower energy density approach once their blood sugars have stabilised on a lower carb diet).

If you have run your free Nutrient Optimiser report we’ll be sure to let you know once the dashboard is ready.

Calories

There is endless debate whether calories, hormones or nutrients matter more.

While most people agree that you need an energy deficit to lose weight and an energy surplus to gain weight, the way your body processes energy is complicated and hence impossible to calculate precisely.

Focusing on calories alone may be short-sighted.  Without attention to food quality and macros, it may be harder to manage your energy intake.

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If you are healthy, your metabolism will increase to burn off any excess energy.  You will fidget more and naturally move around more (i.e. non-exercise activity thermogenesis).

However, most people can’t do this forever, particularly if their food is nutrient poor and causes inflammation.  A chronic energy excess that drives body fat levels higher will most likely cause you to become overweight and insulin resistant once your fat stores cannot take in any more.

Conversely, if you restrict calories, your body will become more efficient.  You will adapt to cope with less energy.  Due to this ‘adaptive thermogenesis’ over time you will need to take in less energy if you want to keep losing weight.

This adaption is often seen as a bad thing.   But for most people, other than not getting to enjoy as much yummy food, training your body to do more with less is highly beneficial.

Metabolic efficiency

If your car is running well, it uses less fuel and gets the job done efficiently.

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But if your car is getting old and blowing heaps of fumes, it’s probably burning more fuel than it really needs.

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We want fuel-efficient cars to minimise cost and the impact on the environment.  But when it comes to choosing the fuel for our body, many of us want to know how much food we can get away with without looking too fat.

Energy is conserved

While our bodies are complex systems and we don’t understand everything that goes on inside them, energy is conserved.

We would love to be able to eat lots and lots of yummy stuff and stay lean, typically doesn’t work out in the long term.

If you are losing weight off your body, you are burning more than you are eating.

If you are gaining weight, you are taking in more energy than you are burning.

However, while energy intake still matters, your primary focus should ideally be on consuming nutrient-dense foods that don’t spike your blood sugars.   Once we have food quality dialled in quantity will fall into place.  Your appetite will start to work the way it is meant to.  Food that contains the micronutrients you need tend to help to prevent nutrient cravings, are more satiating and help you to consume less energy.

Is intermittent fasting better than calorie counting?

The unfortunate reality is that it’s not easy to maintain an energy deficit over a long period of time.

In the low carb or keto world, many people find some version of intermittent fasting helpful.

Others find calorie cycling or a targeted ketogenic diet (i.e. more carbs and/or calories on workout days) to be useful.

Still, others find that refeeds or diet breaks can be helpful to reset your hormones and appetite after a number of days or weeks of conscious and careful restriction.

Personally, I’ve done my share of intermittent fasting but found that I would always manage to compensate for my deprivation and congratulate myself with enough food at the end to maintain my weight over the long term.  And it was hard at the end of the fast to make sure I was eating the most nutrient-dense foods.  Once I started eating I would always find myself reaching for the energy-dense cream and peanut because I had earned it.

After a period of gaining strength in the gym last year and gaining a bit more fat than I would have liked, this year I have been more diligent in tracking my intake and making sure I’m eating nutritiously with adequate protein to support my recovery while maintaining enough of a deficit to ensure ongoing weight loss.

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This has also included a couple of “diet breaks” programmed around intense periods at work when I didn’t want to be thinking about food all the time.  After the period of mental and physical relaxation, once I dialled things back in the water weight dropped off and the weight loss continued.

However, you want to structure it, allowing some room to listen to your body’s signals can be useful.  In the long run, you will need to maintain a deficit if your goal is to lose weight or an overall surplus if your goal is to build muscle.

While not many people find tracking their food intake fun, many people find that they need to track to stay accountable and achieve their goals.  Even a short period of tracking can be helpful to help re-train your eating habits.

Your calorie range for weight loss

Rather than a fixed energy target, if you are trying to lose weight, the Nutrient Optimiser gives you a starting calorie range.

The lower limit calorie intake level is based on the maximum rate of weight loss you can achieve without excessive loss of muscle mass (i.e. 21 calories per pound of body fat)[1] [2] while also getting a minimum amount of protein.  The more fat you have to lose, the more aggressive your deficit can be without risking muscle loss.[3]

If you aim is weight loss, your upper limit calorie intake level is based on your basal metabolic rate (BMR) minus 15%.  This is a reasonably comfortable deficit for moderate fat loss that won’t generate excessive hunger for most people.

If you are feeling ambitious, you can aim for the lower calorie intake level.  But then one day you may feel more hungry or be more active so you can allow yourself to eat up to the upper limit without feeling guilty.

Most people under-report their food intake,[4] so targeting a lower intake will accommodate your optimism bias and crappy reporting.

Example calories and macronutrient ranges

The table below shows my recommended macro ranges from the Nutrient Optimiser in weight loss mode.  My target calorie intake for weight loss is 1,606 to 1,962 calories per day.  For me, this is a 15 to 30% deficit below my theoretical basal metabolic rate of 2,308 calories per day.

 

lower

upper

protein (g)

144

260

fat (g)

32

142

net carbs (g)

0

151

energy (cal)

1,606

1,962

deficit (calories)

702

344

deficit (%)

30%

15%

The image below shows how these lower limits look when entered into Cronometer.

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If you click on the energy bar in the web interface or the app, we get this popup where you enter this calorie range.

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While these values are calculated to four significant figures, they are only estimates of how much energy is in the food you are consuming.  Theoretical calculations should only be used as a starting point and refined based on actual progress.

If you find after a week or two that you are not achieving the weight loss you were hoping for you should reduce the maximum allowable calorie intake to ensure that you are losing weight.  A reasonable rate of weight loss is somewhere between 0.5 and 1.0% of your total body weight per week.  If you’re aggressive and very disciplined, you might be able to achieve a 1.5% loss per week for a short time.

Many people have found that they can sustain a more aggressive rate of weight loss over the long term if they have adequate protein and micronutrients.  You will also find it hard to overeat on the foods and meals recommended by the Nutrient Optimiser.

Similarly, if you find that your blood sugars are not trending down, you can reduce your carb target.  Once your blood sugars are dialled in you can loosen your carb target a little to allow more nutrient-dense foods.

If you’re not looking for weight loss

If you’re a lean athlete not aiming for weight loss, you will be able to ‘eat to satiety’ to ensure you recover.  If you’re looking to gain muscle without too much fat, you will want to target a slight energy excess.

Be careful eating back the calories from exercise if you are trying to lose weight.  Your Fitbit or Strava may tell you that you just burned a lot of calories, but if you enter that into Cronometer and then have the extra ice cream that it says you are allowed, you may find you are not getting the results you hoped for.

Protein

If you want to get more background about the charts and discussion below, the macro targets in the Nutrient Optimiser algorithm are based on the analysis detailed in the How to get the minimum dose of nutrition and Macros > micros? articles.   

Getting enough protein is important when losing weight to prevent loss of lean muscle mass.  The minimum protein intake in the Nutrient Optimiser is based on 1.8 g/kg lean body mass (LBM).

Nutrient density starts to drop off once protein drops too.   Getting adequate protein is as much about maintaining overall nutrient density as it is about getting protein for muscle growth and repair.

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It can be helpful to target higher levels of protein if you are in an aggressive energy deficit.  The upper limit provided by the Nutrient Optimiser is based on the optimum protein intake level or about 45% of your maintenance energy intake.   Beyond this point, any extra protein starts to have a negative impact on nutrient density.

Similar to your calorie ranges, you can click on the protein bar in Cronometer and enter your minimum and maximum protein intake as per the example below.

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If you find that you’re starting to lose too much muscle mass rather than body fat you can increase your minimum protein intake.   It’s hard to track muscle loss vs fat loss accurately, but the chart below is my attempt using my bioimpedance scales.  You can see during the first six weeks (during the Ketogains Bootcamp) I was losing twice as much fat compared to lean mass.  Later in my journey when I’m not working out as much you can see the ratio of lean mass loss vs fat-free mass loss is drifting up.

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Loss of hard-earned lean muscle mass in weight loss is real and you would be wise to do everything you can to avoid it.  Other than taking testosterone, steroids or choosing different parents, resistance training and a higher protein intake are the only things I’m aware of that will help you lose more fat and retain more muscle.

Fat

As shown in the chart below, a very low-fat diet (less than 10% energy from fat) may leave you struggling to achieve a good micronutrient profile.  Hence we recommend getting a minimum fat intake of 0.4 g/kg LBM.  While this is less fat than most people eat you will easily be able to achieve the daily recommended minimum requirements.

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My fat range is shown in the figure below.  If you’re in fat loss mode, you will likely be closer to the lower limit.  If you are trying to gain muscle or are very active, you will likely be eating more fat.

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Carbohydrates

You don’t need a lot of carbs to get a reasonable level of vitamins and minerals.   Non-starchy veggies like spinach and asparagus provide a range of vitamins and minerals that are typically harder to find in animal-based foods.

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The image below shows how this looks when entered into Cronometer.

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If you are managing diabetes?

If you are insulin resistant or have diabetes, the allowable upper limit of carbohydrates provided by the Nutrient Optimiser will be limited to help stabilise your blood sugars.  As you can see from the chart below, there is a balance between nutrient density and a lower dietary insulin load.

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Managing the insulin load of your diet will require a reduction in protein intake if you need a therapeutic ketogenic diet. Most people find that they get the outcome they need by reducing refined carbohydrates.

 

Summary

So, in summary:

  • You should use the Nutrient Optimiser to focus on nutrient-dense whole foods that align with your goals without worrying too much about macronutrients.
  • Logging your food in Cronometer enables the Nutrient Optimiser to fine tune your food and meal choices to rebalance your food choices and improve your micronutrient profile.
  • The calorie and macro ranges provided by the Nutrient Optimiser can be used to double check that you are on the right path.

In the next instalment, we’ll look at how the nutrient score is calculated and what it takes to get yourself to the top of the Nutrient Optimiser leaderboard.

 

References

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

[2] http://www.burnthefatfeedthemuscle.com/how-to-lose-a-pound-of-fat-per-day

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

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064631/

does insulin resistance REALLY cause obesity?  

Many people believe that insulin resistance causes obesity. But as you’ll see in this article, it may very well be the other way around.

Excess body fat appears to drive insulin resistance.  But first, your fat cells need to be insulin sensitive to fill and expand beyond your Personal Fat Threshold.

Once your adipose tissue becomes resistant any excess energy is then shunted into your bloodstream and vital organs, leading to the most prevalent modern diseases such as diabetes, heart disease, Alzheimer’s and Parkinson’s.

What does insulin do?

There is a lot of focus at the moment in some circles on insulin and how to minimise if not eliminate it.  But we need to keep in mind that insulin actually performs a range of critical functions in your body, such as:

  • Facilitating the use of protein to build and repair our muscles and organs,
  • Acting like a brake on our liver to regulate the release of glucose into the bloodstream,
  • Storing excess energy (ideally in our adipose tissue) for later use, and
  • Suppressing the use of our body fat (lipolysis) while the energy from your food is used up.

What happens if we have no insulin?

You may not always like the fat storing function of insulin, but we have to take the good with the bad.  We simply cannot live without it.

Not producing enough endogenous insulin is called type 1 diabetes.  If you develop type 1 diabetes you will:

  • Not be able to use protein to build your muscles and vital organs,
  • Experience elevated blood sugar levels as your liver produces excess glucose,
  • Experience uncontrolled lipolysis, meaning that your fat stores will be quickly mobilised, and
  • Experience elevated blood glucose and BHB ketones (a.k.a. diabetic ketoacidosis).

You may be a little bit jealous of people with type 1 diabetes, thinking that if you could only decrease your insulin a little bit, you’d lose weight.

But having zero insulin is a life-threatening situation.  It’s been less than a century since we’ve been able to treat people with type 1 diabetes (like my wife Monica) with exogenous insulin to keep them alive.

Banting front page

As shown in the photos below, people with uncontrolled type 1 are essentially falling apart.  They are quickly leaching their stored energy into their bloodstream via uncontrolled gluconeogenesis and lipolysis.

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However, as demonstrated in the ‘after’ photos on the right-hand side, once they receive insulin treatment, people with type 1 are able to use the energy from the food they eat, and no longer consume their muscles for fuel.

The most successful approach for people with type 1 diabetes tends to involve fewer carbohydrates without limitations on protein, particularly for growing children.

Adequate insulin dosing is critical to maintaining healthy blood sugar levels as well as enabling the use of protein for growth, repair and maintenance of muscle.

A more modern example is Dave Dikeman, son of RD Dikeman who is one of the admins of Type 1 Grit who follow Dr Bernstein’s recommendations for the treatment of diabetes.

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Dave is shown here in hospital after diagnosis and below recently with his dad.  While some people warn nitrogen poisoning, Dave seems to be thriving on about 250g of protein per day (i.e. about 4.7 g/kg LBM).

rd + dave.jpg

Getting adequate insulin to metabolise the protein required for growth and repair while limiting carbohydrates to maintain normal blood sugar levels appears to be crucial to success for people with diabetes.

What happens if I am insulin sensitive?

Being “insulin sensitive” means that don’t need much insulin to get the job done.

  • Glucose can enter your cells to be used for energy.
  • Your liver responds to insulin and controls the release of glucose and ketones into the bloodstream.
  • You will build muscle relatively easily.
  • Your body can efficiently store excess energy as fat, and your adipose tissue can grow quickly.

Having great insulin sensitivity is a double-edged sword.  While you can control the release of glucose and ketones from your liver into your bloodstream and build muscle, you can also build fat stores quickly.   You need to be insulin sensitive to become morbidly obese.

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I used to believe that if I could become insulin sensitive by reducing carbohydrates and protein.  I thought the key to success was to increase my ketones by eating more fat so I could melt away my body fat, a bit like someone with untreated type 1 diabetes.  (There is a practice called diabulimia where some type 1s intentionally restrict their insulin dosing to lose weight, however, this is a very dangerous practice which drives ketoacidosis, fatigue, muscle wasting, high cholesterol and death).

But ironically it turns out that having insulin-sensitive adipose tissue actually enables your body fat stores to expand to accept more and more energy from the food you eat before they start being channelled into other areas of your body.

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People who are obese are often insulin resistant.  However, this is not always the case.  You can be insulin resistant and still be lean.  You can be obese and still be relatively insulin sensitive.  If you are both insulin resistant and obese, the obesity probably came first.

Related image

How do I become insulin resistant?

Professor Roy Taylor has done some fascinating work showing that different people develop diabetes at different body fat levels.[1]  He coined the term ‘Personal Fat Threshold’ to describe this observation.

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For whatever reason, some people develop diabetes at a low level of body fat while other people need to become obese before they experience elevated blood sugars.[2]  Some people are ‘blessed’ with the ability to expand their fat stores a lot more than others before their fat stores become full.

While most people want to be lean with low levels of body fat, the ability to continue to expand your fat stores can be an advantage.  People who could successfully store lots of energy in their adipose tissue were more likely to survive a famine or a long journey in a canoe to settle a new island or continent.  This phenotype is sometimes called metabolically healthy obese.

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Unfortunately, these populations appear to suffer the most when exposed to hyper-palatable nutrient poor insulinogenic western food.   Highly insulin sensitive and primed for storage of available foods, they very quickly become obese and eventually, after gaining a lot of body fat, diabetic.

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They also seem to be genetically programmed to ensure that they survive the next famine more than others, so when given the opportunity they become more ‘addicted’ to these energy-dense obesogenic foods.  For example, sales of Coca-Cola are the highest on a per person basis in Australia’s Northern Territory in where there is a high proportion of indigenous Aborigines.

Even today, when famines are less common, being able to build large energy stores in your adipose tissue is still an advantage.  These people can store more energy on their body before it gets funnelled into places that fat does not belong (e.g. your liver[3], pancreas, heart[4], eyes and brain[5]).

It’s when your fat stores become insulin resistant and cannot store any more energy things get ugly.[6][7]  When your fat stores get full and can not accept any more energy we say they become resistant to the effects of insulin.[8] Your pancreas ramps up its efforts to store energy.

But in spite of the increasing levels of insulin, less and less energy can be forced into fat stores.  It’s at this point that the excess energy starts to get funnelled into areas of your body that are now more insulin sensitive than your body fat like your liver, pancreas, heart, eyes and brain.

In this video, Ivor Cummins discusses the concept of adipose tissue hypertrophy and how diabetes begins in the fat cells.

I also highly recommend this widely shared podcast with Mike Julian and Alex Leaf, where they share their insights.

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Like many of my posts, most of the insights in this article are gleaned from them based on the latest research that they share in the Optimising Nutrition Facebook Group.

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If you haven’t seen it yet, this video from Ted Naimin is a must watch on the topic of insulin resistance.

People who have lower personal fat threshold are sometimes called TOFI (i.e. thin on the outside, fat on the inside).  These people may look skinny because they have less body fat stored underneath the skin (subcutaneous fat) but they often have lower levels of muscle and much higher amounts of fat stored around their vital organs (visceral fat) and will see elevated blood sugars much earlier.[9]  Being TOFI is arguably more dangerous than to be metabolically healthy obese.

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An extreme example of TOFI is lipodystrophy were people cannot gain body fat and quickly develop diabetes, hyperinsulinemia, fatty liver, hypertriglyceridemia and heart disease because they aren’t able to buffer their energy in their fat stores before it goes to their vital organs.

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So as you can see, if we want to be accurate, it’s not obesity per se that is causing metabolic dysfunction, it is being overfat relative to your Personal Fat Threshold.

Optimal vs insulin resistant blood sugar and ketone levels

As your body fat stores start to fill, you will also see elevated levels of energy in your bloodstream in the form of elevated glucose, ketones and free fatty acids.

The table below shows the official diagnosis criteria for Type 2 diabetes in terms of fasting glucose, blood glucose after eating and HbA1c.

  

fasting

after meal

HbA1c

% pop

mg/dL

mmol/L

mg/dL

mmol/L

 %

“normal”

< 100

< 5.6

< 140

< 7.8

< 6.0%

50%

pre-diabetic 100 – 126

5.6 to 7.0

140 to 200 7.8 to 11.1

6.0-6.4%

40%

type 2 diabetic

> 126

> 7.0

> 200

> 11.1

> 6.4%

10%

However, while the diagnostic criteria define half the population currently as ‘normal’, normal is far from optimal.  If you’re chasing optimal health, the table below shows target blood sugar and HbA1c values that correspond to optimal blood sugar control.

risk level HbA1c average blood sugar
 (%)  (mmol/L)  (mg/dL)
optimal 4.5 4.6 83
excellent < 5.0 < 5.4 < 97
good < 5.4 < 6.0 < 108
danger > 6.5 > 7.8 > 140

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The body tends to find a balance between glucose and ketones depending on available fuel sources.  However, the presence of higher BHB ketones is not necessarily a sign of optimal health.  Higher BHB ketone levels can be a bad sign, especially when they are accompanied by higher blood glucose and free fatty acids.

The chart below shows the sum of about three thousand data points from glucose and BHB ketones measurements for people following a low carbohydrate or ketogenic diet.

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It appears from this data that people who are metabolically healthy tend to have lower blood glucose and lower ketone values, even if they are following a ketogenic diet.  If your goal is to use body fat for fuel, then you will want to be further to the left of this chart with a lower total energy in your bloodstream from glucose and ketones.

Initially, in an energy deficit, you will lose water weight quickly as you empty your glycogen stores, then your blood sugars will reduce.  Then eventually once the faster burning fuel sources are consumed your body will turn to stored body fat.

The table below shows the blood glucose and ketone values if we divide the three thousand data points in the chart above into five quintiles.  It appears that lower blood glucose levels are typically associated with lower ketone levels even on a ketogenic diet.

You may see higher ketone values during a long-term fast or calorie restriction, but generally, ketone levels in the fed state in healthy person on a low carb or ketogenic diet might range between 0.3 and say 1.1 mmol/L with blood glucose less than 5.0mmol/L or 90 mg/dL.

quintile average BG (mmol/L) BG (mg/dL) ketones (mmol/L) total energy (mmol/L)
25th average 75th
1 4.5 80 0.3 0.6 0.7 5.0
2 4.9 88 0.4 0.8 1.1 5.7
3 5.1 92 0.6 1.1 1.5 6.2
4 5.1 92 1.2 1.8 2.3 6.9
5 5.1 92 2.2 3.2 4.0 8.3

To use an engineering analogy, you can think of your liver as dam wall holding back the floodgates of energy in your body while insulin is the signal to raise the floodgates.  If you have a flood of energy coming in your liver will have to release some of the excess energy into the bloodstream.

Related image

If you have lower levels of energy coming in from your diet you will need less insulin to force the liver to hold back the flood of energy stored in your body.

Once you decrease the energy coming in from your diet, your pancreas will be able to slow the production of insulin, which will allow your body fat stores to fill the energy gap.

The ketone data from the recent Virta study[10] below also supports the case for ketones being correlated with body fat levels for people on a ketogenic diet.

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The participants’ ketone levels initially jumped to around 0.6 mmol/L as they switched from a more insulinogenic standard western diet to a ketogenic diet.  But as you can see ketone levels continued to decrease over time to about 0.3 mmol/L as:

  • They lost body fat and then their weight loss stabilised,
  • The amount of energy in their system decreased,
  • Their blood sugars decreased, and
  • Their overall metabolic health improved.

The chart below shows the weight loss over the same period of decreasing ketone values.

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As detailed in this article, BHB ketones can be seen as a storage or transport form of ketones that can be used by the brain and heart but need to be converted back to Acetoacetate to be used by the rest of the body.  While they appear to be useful in some therapeutic situations, higher BHB, for the most part, should be seen as an indication of excess energy status rather than excellent metabolic health.

How do I become insulin sensitive?

Professor Taylor’s research also demonstrated that people become insulin sensitive again once they come back under their own ‘Personal Fat Threshold’ by reducing the pressure in their adipose tissue cells (i.e. lose weight).

With only a small amount of weight loss, their blood sugars come back into line and they start to lose fat from in and around their vital organs.[11][12][13][14]  Or to think of it another way, once you use up the surplus energy in your bloodstream, your body will start feeding on the fat stored in your vital organs as the first priority.

Once our body fat levels decrease to below our Personal Fat Threshold, it seems that they quickly become insulin sensitive and can take in any excess energy.  There is less overflow of energy from the fat cells to spill out into the bloodstream.

The bad news here is that once your adipose tissue becomes insulin sensitive again it can grow quite easily given an environment with surplus energy.  Being more insulin sensitive is part of the reason why it’s so easy to regain weight.

While a low carb diet masks the symptoms of diabetes by stabilising blood glucose levels without a significant reduction in body fat levels, people who lose a significant amount of body fat below their Personal Fat Threshold are no longer diabetic and can pass an oral glucose tolerance test.  Their fat stores can quickly expand to absorb the incoming energy.  Unfortunately, as soon as they put the weight back on (i.e. refill their fat stores), they become diabetic again.

One criticism of Professor Taylor’s work is that it was done with Optifast shakes to ensure rapid weight loss while still getting adequate nutrition (even though it was from meal replacement shakes full of supplements).  The ideal would be that people could learn to create nutrient-dense whole food meals.  Many people find this hard to do in real life, hence the use of meal replacement shakes in order to remove this variable.  The Nutrient Optimiser has been designed to help people form new habits of eating nutrient dense meals that are aligned with their goals. 

How do I know if I’m insulin resistant or insulin sensitive?

There are a range of ways to test to if you are insulin resistant.

Blood sugar

The simplest way is just to test your blood sugar fasting and before a meal.  The tables above show some suggested levels at which you should start to be concerned.  If your blood sugars are elevated then it’s an indication that you are exceeding your Personal Fat Threshold.

Fasting insulin

Fasting insulin levels are also a good guide to determine if you are starting to develop insulin resistance.

  • Healthy hunter-gatherer populations have a fasting insulin of 3 – 6 mIU/mL.[15]The average insulin levels in western populations are 8.6 mIU/L.
  • Meanwhile, the western reference range for fasting insulin is anything less than 25 mIU/L.[16] (This is not optimal.)

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Oral glucose tolerance test

One of the most common tests used in diabetes is the OGTT which is where you drink a sugary drink and see how much your glucose rises over time.[17]  image24

Insulin response patterns (Kraft test)

A more accurate way to understand you are insulin resistant is to test your insulin response to food.

In the chart below the negligible insulin response (blue) is Type 1 diabetes (i.e. insufficient insulin), the green is a healthy insulin response, while the yellow (pattern II), orange (pattern III) and red (pattern IV) are indicative of diabetes and insulin resistance.

image30

While you may have great blood sugar levels, your pancreas may still be working overtime to store the energy from your food in your fat stores, so it doesn’t spill over into your bloodstream.

A Kraft insulin dynamics test, while expensive, is the gold standard in insulin testing.  Dr Kraft’s analysis suggested that 80% of people are using excess insulin to suppress glucose, while a normal glucose screen would suggest that only two-thirds of people are fine.[18][19]

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HOMA-IR

If you have your fasting insulin and glucose data, you can calculate your HOMA-IR which is a measure of the amount of insulin that you need to maintain your blood sugars.  This can be useful for low carbers who sometimes have higher fasting glucose but lower insulin.

The formula is shown below or you can use an online calculator like this one.

  • Less than 1.0 means you are insulin-sensitive which is optimal.
  • Above 1.9 indicates early insulin resistance.
  • Above 2.9 indicates significant insulin resistance.[20]Triglyceride:HDL ratio

You can also use your blood cholesterol test data to understand if you are really insulin resistant. A triglyceride:HDL ratio greater than 3 (in US units) suggests that you may be insulin resistant.  A trig:HDL ratio less than 1.1 is optimal.[21][22]  You can use a calculator like this one to make sure you get the units right.

Abdominal obesity

Waist to height ratio is a simple and effective way to understand if you need to take evasive action to lose weight.

A waist to height ratio of greater than 0.5 for men and 0.46 for women is associated with increased risk mortality.[23]image34

Regardless of whether you are insulin sensitive or insulin resistant, it is highly advisable to do what it takes to reduce your body fat to get your waist to height ratio in check.

Some people will find that they still need to lose further weight to get within their personal fat threshold to get optimal blood glucose and insulin levels.

If you are insulin resistant, your fat tends to get stored in your organs so you may have a big hard ‘beer’ belly.  Someone with abdominal obesity may find their belly is hard because more fat is stored inside around their organs.

If you are insulin sensitive, you may have a big belly but it might hang down more like a floppy garbage bag.  Someone like this is ‘blessed’ to have insulin sensitive adipose tissue that continues to expand more before they develop diabetes and the complications of metabolic syndrome.[24]Screenshot 2018-04-12 08.15.43

Summary

The table below shows values for various parameters that are indicative of insulin resistance.[25]  If you are looking for optimal health, you should target values similar to those in the Quartile 1 column.

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Do medications help?

While replacement of normal healthy levels of insulin is critical for people with type 1 diabetes, supraphysiological doses of insulin only mask symptoms of a poor diet for people whose pancreas is still functioning well.

The chart below shows that complications of diabetes (i.e. cardiovascular disease, stroke, coronary heart disease) increase with higher HbA1c.  Lowering HbA1c however by just using anti-diabetic medications to suppress blood sugar does not help the outcome.

image18

Excess exogenous insulin forces the excess energy into our fat stores, and then subsequently into other more sensitive areas of the body such as our vital organs, brain and eyes.

You can’t just keep eating loads of processed insulinogenic crap and trust that all will be well because your blood sugars are lower.  Exogenous insulin combined with a poor diet actually exacerbates the complications of diabetes.

You need to fix your diet and then add enough insulin to maintain healthy blood glucose levels and effectively use the protein in your diet to build and repair your muscles.

Basal vs bolus insulin

Insulin-dependent diabetics dose with both bolus (or burst) insulin and basal (or background) insulin.  Bolus insulin is mealtime insulin and basal is needed whether you eat or not to enable you to keep your stored energy behind the floodgates of your liver.  

You can reduce the amount of bolus insulin required for food in the short term by reducing the insulin load of your diet.

image7

For someone on a standard mixed diet, about half of their insulin dosing will be bolus with half as basal.  For someone on a low carb diet with a lower insulin load, the majority of their insulin demand will be for basal insulin, with only a small amount required to cover food.

Most low carbers or ketogenic dieters focus on reducing the insulin load of their diet by removing carbohydrates, and sometimes protein, without paying much attention to incoming energy from fat.

This is fine on a whole food Atkins type diet because reducing carbs will typically force a reduction in overall energy intake.  Ignoring energy balance becomes a problem though when you start to ‘hack’ your low carb/keto diet with refined fats, fat bombs and fatty coffee that enable you to get heaps of energy with few carbs and negligible micronutrients.

The irony here is that, in the bigger picture, insulin demand is actually related to your overall stored energy status, as described in this video from Chris Masterjohn.

As shown in the chart below, people with a larger BMI typically have higher levels of insulin  because, as the stored energy in your system continues to increase (regardless of the macronutrient source), our insulin levels have to increase to hold back the flood of stored energy while the excess energy in our system is used up.

image12

The chart below shows that someone who is obese and insulin resistant will have higher insulin levels when they are fasting.  They will also have much higher excursions of insulin after eating due to their insulin resistant adipose tissue not accepting the excess energy.

image1

As our body fat stores continue to build and we keep on taking in energy, our pancreas continues to ramp up insulin production to keep energy in storage until you need it.  In the “good old days” this wasn’t a problem because there were always times when we didn’t have food available.  These days food is relatively cheap, easy to obtain and always associated with celebrations, family, social occasions and self-soothing.  So you are always in storage mode.

As you remain obese, you become resistant to your own insulin and need more and more insulin to do the job.[26][27]  Eventually, your pancreas can burn out through overuse, and you become an insulin-dependent Type 2 diabetic.

image10

Overall, the macro-nutrient composition of our diet only has a relatively small influence on our insulin levels.  Our basal insulin has a much more significant effect on our fasting insulin levels.

We can manipulate our diet by reducing carbohydrates to reduce the bolus insulin demand of our food.  However, we can have a much more dramatic impact on our insulin levels by reducing the total energy levels in our body by finding a way to maintain a long-term energy deficit.

How to reverse insulin resistance?

TL;DR… Reduce body fat while preserving lean muscle mass.

How to preserve lean muscle mass

Lean muscle mass is important because it burns both fat and glucose.  Without muscle, you won’t be able to quickly use the energy from fat and carbs that you eat.

Lean muscle mass is also critical to insulin sensitivity and longevity.  As you get older, it becomes harder to maintain lean muscle mass.[28]  You will need more protein as you get older to slow the inevitable loss of muscle mass.  Once you become weak and frail, your chances of falling and breaking your hip and never getting up again increase!

image14

There is ongoing discussion/argument/controversy about how much protein is ‘too much’.  My analysis of nutrient density suggests that getting a minimum of 1.8 g/kg LBM or about 20% of energy is a good starting point.  More can be better if you are active, lifting heavy or trying to lose fat.

image36

If you focus on getting the nutrients that are harder to find, adequate protein is really a non-issue.  The nutrient profile of the most nutrient-dense foods shown below is generated by prioritising foods that contain the harder to find micro-nutrients (i.e. choline, calcium, magnesium, vitamin E, potassium, pantothenic acid & zinc).

image35

By contrast, if we focus on avoiding protein, we get an abysmal nutrient profile as shown below.  This is why I get so frustrated when people get worked up about ‘too much protein’ or minimising protein in order to achieve elevated ketones as if that was the ultimate goal of health.

image21

We also risk malnutrition if we focus on the most ketogenic foods (i.e. high fat, low carb, low protein).  For most people, their primary goal is health and weight loss and to look great naked, not having high ketones.

So, unless you need a therapeutic ketogenic diet to manage epilepsy, Parkinson’s, Alzheimer’s, dementia or something similar, then there is no need to compromise your nutrition profile by trying to avoid protein or maximise ketones.

image13

Ironically, it’s the people who are insulin resistant that probably needs more protein because they are not able to use the protein available as effectively and they are also losing more amino acids into the blood stream via poorly controlled gluconeogenesis in the liver.

For comparison, the three nutrient profiles are shown below (most nutrient dense, low protein and most ketogenic).  Incorporating more of these nutrient dense foods is a great ‘hack’ to ensure you are getting enough nutrients without excessive energy intake.

image9

How to lose body fat

The short, boring, answer that won’t sell a million gimmicky diet books is to maintain an energy deficit for a long enough period.  This can take the form of:

  • Intermittent fasting (ideally with nutrient dense feeding to prevent malnutrition and binge eating),
  • Calorie counting (perhaps with occasional diet breaks),
  • Maximising nutrient density with whole foods which tends to lead to fewer cravings and less energy dense foods which are harder to overeat, or
  • Some other approach that works for you that enables you to maintain an energy deficit in the long term.

We have designed the Nutrient Optimiser to help you get started on your journey to optimise your nutrition.  Free Report will give you:

  • Recommended macronutrient ranges,
  • Recommended calorie intake to suit your goals,
  • Suggested foods to maximise nutrient density, and
  • Suggested meals to start you off on your journey into nutritious eating.

Some people may find some of the concepts in this post hard complex and difficult to implement.  The Nutrient Optimiser which will continue to adapt as you improve your metabolic health.  We are also working on a dashboard that will track your the biometric data that you have (e.g. weight, blood sugars, waist:height ratio, food logs, ketones etc.) to guide you on the path to help you reach your goal.

Who needs a low carb diet?

So, if insulin resistance is primarily about managing our energy levels, does anyone need a low carb diet?

Insulin-dependent diabetics

Being married to someone with type 1 diabetes and involved in the online diabetes community I have seen firsthand the importance of managing carbohydrate intake.

For someone injecting insulin to cover carbohydrates and protein, a low carb diet enables them to match the smaller dietary insulin load with smaller doses of exogenous insulin.

There will always be errors in calculations in matching insulin to food, so a smaller insulin load enables you to reduce the errors in insulin dosing.  Dr Richard Bernstein calls this The Law of Small Numbers.

Similarly, if you have type 2 diabetes and are injecting insulin, reducing the insulin load of your diet can help you reduce the amount of exogenous insulin you require.  This can in turn help reduce the swings in blood sugar which can help to stabilise appetite and reduce overall food intake which will lead to weight loss.

Conversely, dosing with lots of insulin to cover a poor diet will lead to worsening insulin resistance with larger and larger doses of insulin to cover their poor diet.  This vicious cycle of progressively larger doses ends in tragedy as it becomes more difficult to maintain safe levels of glucose control and typical diabetic symptoms such as peripheral neuropathy, kidney and eyesight disease become unavoidable.

Lots of exogenous insulin will also suppress lipolysis and make you hungrier which will drive appetite further.

So, if you are taking antidiabetic medications, then a lower carb diet is a no-brainer.

What about everyone else?

For people who are insulin resistant but not full-blown diabetic, I’m still a big believer in reducing the insulin load of your diet to the point that you can achieve stable blood glucose levels, but not so much that you compromise nutrient density.  There is a trade-off between insulin load and nutrient density.

image36

Unfortunately, some people get so caught up in being ketogenic that they end up decreasing nutrient density and increasing the energy density of their diet so much that they end up putting on weight due to an excess energy intake.

There is now a growing movement of online groups of people who have been burned by this ‘keto or bust’ mentality, chasing ketone readings by ingesting copious amounts of refined dietary fats or exogenous ketones.

I think a more prudent approach is to titrate carbs down to the point that you achieve great blood sugars and then focus on improving food quality and nutrient density.

For most people, reducing carbohydrates is helpful, not because it may increase ketones, but because it is a means to manage and minimize chronically elevated blood glucose and insulin levels which are the primary drivers of metabolic complications.  Ultimately, we still need to address the cause of the problem (insulin resistance) via creating an energy deficit and losing body fat to below your Personal Fat Threshold.

image15

There are a range of studies that suggest that a lower carbohydrate diet is better for weight loss for people who are insulin resistant.[29][30][31][32] However, the recent DIETFITS Randomised Clinical Trial of 609 obese participants at Standford led by Christopher Gardner indicates that there wasn’t a statistically significant difference between the effects of a healthy lower fat versus a healthy lower carb diet for people who do not have diabetes.

The chart below shows that people who were more insulin resistant lost slightly more weight on a low carb diet (but not enough to be deemed statistically significant)/

image37

On average, both diet groups reduced their energy intake by about 500 calories, not by tracking, but by focusing on improving their diet quality (though again, the healthy low carb diet group reduced their energy intake by about 50 calories more than the healthy low-fat group).

image17

Perhaps one of the main reasons that a low carb diet works so well for so many people is that so many of them are insulin resistant.  A low carb diet quickly helps to stabilise blood glucose and insulin levels which in turn helps to normalise appetite as well as eliminating many processed nutrient poor hyper-palatable foods.

In this video, Chris Gardner explains that study and points out that it was the people who changed their relationship with food and learned to make more nutrient-dense whole food from fresh ingredients at home that did the best overall.

 

In line with these insights, the Nutrient Optimiser algorithm firth helps you to stabilise your blood glucose levels with a lower carbohydrate diet and then guides you to focus on more nutrient-dense whole foods which tend to be more satiating and enable you to spontaneously reduce your energy intake.

image21

Summary

  • If you are insulin sensitive, you will be able to grow both muscle and fat more effectively.
  • While many people think that insulin resistance causes obesity, you actually need to be relatively insulin sensitive to get morbidly obese.
  • You become insulin resistant when your fat cells become too full to hold the excess energy that you are taking in.
  • When you reach your Personal Fat Threshold, your body can no longer force excess energy into storage in your fat cells and it gets stuffed into other places that are more sensitive like your liver, your brain, your heart, your pancreas.
  • When your fat can no longer take up excess energy, it overflows into your bloodstream in the form of elevated glucose, ketones and free fatty acids.
  • Reducing carbohydrates can help manage the symptoms of diabetes and stabilise blood sugars. It can also avoid the excess fat storage that can often come with the use of excess exogenous insulin.  However, for people who do not have diabetes, focusing on nutrient-dense whole foods and maintaining an energy deficit will likely be more important to reverse diabetes and improve insulin resistance.
  • You can reverse insulin resistance by maintaining an energy deficit until you are below your Personal Fat Threshold. Your adipose stores will then have room to take up the extra energy without spilling it into the bloodstream and your vital organs.

 

Thanks

Special thanks for Mike Julian for sharing many of the insights and synthesis of ideas contained in this article as well as RD Dikeman (Type One GRIT), Alex Leaf (Examine.com), Raphi Sirt (BreakNutrition.com). Ben McDonald (Impulsive Keto), Carrie Burns Diulus, Mattias Lindberg (Diet Doctor), Phil Thompson, Robin Reyes and Gillian Ferwerda for their review comments!

 

References

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

[2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4405637/

[3]https://en.wikipedia.org/wiki/Fatty_liver

[4]https://www.nhs.uk/conditions/coronary-heart-disease/causes/

[5]https://www.medicalnewstoday.com/articles/298729.php

[6]https://www.medicalnewstoday.com/articles/265405.php

[7]https://en.wikipedia.org/wiki/Metabolically_healthy_obesity

[8]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4405637/

[9]https://en.wikipedia.org/wiki/File:Coronal_Image_of_a_TOFI_and_a_Normal_Control.jpg

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

[11]https://www.ncbi.nlm.nih.gov/pubmed/26628414

[12]https://www.express.co.uk/life-style/health/623499/losing-one-gram-fat-cure-diabetes

[13]https://idmprogram.com/fatty-pancreas-t2d-9/

[14]https://www.dietdoctor.com/how-losing-one-single-gram-of-fat-might-cure-diabetes

[15]http://wholehealthsource.blogspot.com.au/2009/12/whats-ideal-fasting-insulin-level.html

[16]https://emedicine.medscape.com/article/2089224-overview

[17]https://cf.research.chop.edu/ogtt.php

[18]https://www.facebook.com/BurnFatNotSugar/photos/a.364522923705531.1073741827.364516160372874/532154686942353/?type=3&theater

[19]https://www.amazon.com/Diabetes-Epidemic-You-Joseph-Kraft/dp/142517812X

[20]https://www.thebloodcode.com/homa-ir-calculator/

[21]https://www.thebloodcode.com/know-your-tghdl-ratio-triglyceride-hdl-cholesterol/

[22] The disposal of triglycerides provides insight into what your body is able to do with excess energy. Normal areas of short-term energy storage, like the liver, are at capacity. This proxy informs the actual behaviour of free nutrient. If the trigs are high, especially if the HDL is also diminished, it is implied that nutrient is unable to find easy storage locations with the current level of basal insulin.

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

[24]http://www.mdpi.com/2072-6643/7/11/5475

[25]https://www.ncbi.nlm.nih.gov/pubmed/19789156

[26]https://www.ncbi.nlm.nih.gov/pubmed/8168647

[27]http://sci-hub.tw/10.2337/diab.43.5.696#

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

[29]https://onlinelibrary.wiley.com/doi/full/10.1002/oby.21331

[30]https://www.ncbi.nlm.nih.gov/pubmed/17063925

[31]https://www.ncbi.nlm.nih.gov/pubmed/15897479

[32]https://www.ncbi.nlm.nih.gov/pubmed/16306558

optimising Dr Shawn Baker’s carnivore diet from first principles

recent article looking at Dr Baker’s carnivore diet identified some micronutrient gaps.  This article looks at how we could make some small tweaks to fill these gaps and help him stabilise his blood sugars and naturally boost his testosterone levels.   

Rather than making radical wholesale changes that you probably won’t stick to, the Nutrient Optimiser helps you to make small improvements to your diet. 

This article is a ‘worked example’ of how the Nutrient Optimiser could help refine your diet to achieve your goals while working within whatever constraints you may have.

What are the fundamental principles of nutrition?

I don’t consider myself an advocate of zero carb/carnivore as the ultimate diet for everyone, but I’m intrigued.  I want to understand the fundamental principles of human nutrition. 

image14

There are plenty of anecdotes, zealots and firmly held beliefs when it comes to nutrition.

Everyone has an opinion, everyone has experience, everyone feels strongly about nutrition because everyone eats. 

However, while many people feel a lot of conviction about their way of eating, there seem to be people both thriving and doing poorly on a range of diets that appear to be polar opposites, whether it be carnivore, keto, paleo or whatever. 

While some people believe that diets work because you eliminate all plants (carnivore/zero carb) or animals (i.e. vegan), I’m sceptical about the “magic” of any specific dietary approach.  I want to understand the fundamental principles of nutrition. 

We have tried to make carnivore work in our family to try to help with my wife’s Type 1 and all the autoimmune issues that seem to surround it.  Eating a lot of beef tends to require a lot of insulin for my wife and it can be hard to dose the right amount of insulin to match it. We also found it to be pretty expensive, especially with two growing teenagers.  While I can eat just about anything I choose to, the rest of the family tend to like more variety, so we’ve never been successful going full carnivore. 

I’m currently reading Ray Dalio’s Principles where he describes the process of “backtesting” his theories over centuries of historical financial data to design the trading systems that enabled him to develop Bridgewater Capital into the world’s most successful hedge fund. 

image1

Not only has Dalio used backtesting to eliminate bias from his trading he has developed a company culture of radical honesty around an “idea meritocracy” where anyone in the company is invited to give brutally honest feedback on every member of the company to ensure that they continue to eliminate any biases from their culture.  

As someone who spent a while developing my own trading systems and an engineer who relies on data analysis in my day job, this sort of approach resonates with me.  It is this systems thinking that I have tried to use in the field of nutrition in the development of the Nutrient Optimiser algorithm. 

Nutrition science is quite a young area of research.  We only started to think in terms of nutrients around a century ago.  Humans are complex organisms.  Just like the financial markets, we find ourselves in a range of different environments with different goals and hence require different approaches depending on our situation and goal (e.g. athletes, bodybuilders, diabetes, weight loss, pregnancy, longevity etc.).  

Engineering has a range of safety factors while trading the financial markets requires an understanding of risk and dealing with probability and uncertainty.  Similarly, nutrition is about making the best decisions that we can base on the knowledge that we have.  I’m not claiming that the RDI are perfectly accurate, but as you will see we’re really talking about orders of magnitude differences in nutrients as a proportion of the recommended daily intake.  

I’ve been fortunate to be part of groups like the Optimising Nutrition Facebook Group which tends to be a brutal idea meritocracy when it comes to nutrition where you can learn a lot from smart people based on the latest research.   

Over the years I have identified the following principles of nutrition that can be quantified and used to create a systematised approach in the Nutrient Optimser algorithm.  I’m not saying these are the be all and end all and there will never be anything better, but these are the most useful parameters that I have found that can be quantified.  Before getting into how we can upgrade Shawn’s current diet, let me quickly touch on these.

Principle 1.  Insulin load

While the importance of insulin has been overstated by many people, the reality is that if you have diabetes, lowering the insulin load of your diet will help stabilise your blood sugar levels.  And even if you are not diagnosed with diabetes, keeping stable blood sugars is an important health marker.[1] 

If you are injecting insulin or taking other medications to control your blood sugar levels, then decreasing your dietary insulin load (which is a function of the non-fibre carbohydrates, and to a lesser extent protein) is an important first step. 

However, as shown in the chart below, we can lower insulin load too much to the point that we compromise the nutrient content of our diet.  We need to find the balance point between nutrient density and insulin load. 

image18

Unless you have type 1 diabetes, you can never take your insulin levels to zero.  Insulin is like a brake in your system that stops your stored energy from being used while external energy is coming in. 

While living on butter, bacon and oil might help you stabilise your blood sugars, your blood sugar and insulin levels will not decrease to optimal levels until you stop jamming excess energy into your mouth. 

Principle 2. Nutrient density

Maximising nutrient density means getting the nutrients you need to thrive without consuming too much energy. 

While the daily recommended nutrient targets have their limitations (e.g. bioavailability; anti-nutrients; and context such as activity levels, gender and food combinations), we can identify food and meals that have more of the cluster of micronutrients that you are currently not getting as much of. 

image22

Eating foods that are quantitatively nutrient dense tends to force out the processed junk food.  Foods that are nutrient dense are typically whole foods that don’t need to be coloured, flavoured and engineered to look and taste like they contain the nutrients we need.  They have them naturally in the form and quantities that we have come to thrive on. 

Principle 3.  Energy density

We can also quantitatively manipulate energy density to help us refine our food choices to help us get more or less energy in.  Athletes will want to be able to consume more energy while choosing more low energy dense foods will help you lose body fat.[2]  

Principle 3.  Energy intake (aka calories)

Just like insulin, there is plenty of controversy around calories.  

image20

Some think calories don’t matter. 

Some don’t think they exist. 

But most people acknowledge that energy balance matters. 

However, it’s reasonable to say that just focusing on calories is not the best way to control them or improve your diet.  Without trying to improve the quality of our food, we can end up missing out on the nutrition we need.  But if we dial in insulin load, energy density and nutrient density then satiety and energy intake naturally look after themselves and help you achieve a more normal body fat level. 

However, sometimes it’s still useful to actively manage our calorie intake.  Sometimes this is only required to help retrain our eating habits, or if you want to achieve really low levels of body fat.  Anyone stepping on stage in a bodybuilding competition with single digit body fat percentages is probably tracking their food to ensure they get the results they are after, dialling in calories while making sure they’re getting adequate protein to support their muscle mass. 

image12

Principle 5.  Food sensitivities

Whether it be due to toxins in our environment, excess refined foods, or whatever, food sensitivities are becoming more common.  Many people seem to benefit from eliminating certain foods from their diet, whether it be autoimmune triggering foods, wheat/gluten or whatever. 

This is where the zero carb/carnivore dietary approach seems to shine by removing plant-based foods that could cause an autoimmune or digestive response reaction.  However, I’m not sure everyone needs to eliminate all plant foods. 

Just to keep things interesting, Tommy Wood noted that:

“Neu5gc antibodies seem to be increased in Hashimoto’s (see Jaminet and Gundry), probably propagated by the gut microbiota. So eliminating red meat may help others with certain autoimmune conditions.

“When it comes to “real” food, I think we should be able to tolerate being the omnivores that we are. A true need for any hard eliminations (be that carbs, meat, or anything else) suggests that the underlying problem hasn’t been fixed. Almost all of it is symptom control.

“Though that doesn’t include allergies, obviously. And doesn’t mean you can always figure out how to fix the underlying problem. Good symptom control might be the best we can do in some situations.”

A carnivorous approach may work well for some people to eliminate most inflammatory foods.  You could then start to add back the most nutrient dense foods to see what you can tolerate while still getting all the nutrients you need.   This is basically what we’re going to do with Dr Baker’s diet in the rest of this post. 

Dr Baker’s baseline diet

To recap, the article Dr Shawn Baker’s Carnivore Diet: A Review looked at his typical diet of ribeye steak, mince (ground meat), cheese, eggs, shrimp and salmon. 

image19
Here’s what it looks like in terms of nutrients vs the daily recommended intake levels.  We can see from this that he is getting a lot of amino acids, zinc, iron, B2, B3 and B6 while a number of the other vitamins, minerals and omega 3s are relatively low. 

image15

Note: Shawn didn’t mention sodium in the Tweet above, so I haven’t included it in this analysis. However, I understand that he does salt his food and is now finding benefit from supplementing with sodium to support this massive activity levels.  Most of the time I see people not getting enough potassium and magnesium from their diet rather than sodium, and very few people achieve desirable potassium:sodium ratio.  

With about 4100 calories per day Shawn ends up getting about 6.1g/kg LBM of protein, and he meets the DRI for all but ten essential nutrients. 

However, keep in mind that the DRIs are based on an average male eating 2000 calories per day.  Someone trying to lose weight might only be eating 1200 to 1500 calories per day so they would be getting even fewer nutrients. 

For comparison purposes, the chart below shows Dr Baker’s diet in terms of nutrients per 2000 calories.  With a more normal energy intake, he would be not meeting the DRI for fifteen essential nutrients. 

image11

A lot of the time discussion about these issues degenerates into whether or not the DRIs are accurate.  Hopefully, this chart illustrates that there are multiple orders of magnitude differences in % DRI for some of these nutrients.  The goal of the Nutrient Optimiser is to rebalance this to some extent while still working within your preferences (e.g. zero carb etc).

It’s interesting to hear Shawn talking about supplementing with electrolytes which are often more important for very active people.[3]  Interestingly, it’s the electrolytes like potassium, magnesium and calcium that can be harder to get on a low carb/keto /carnivore diet with a lower intake of green leafy veggies.  I recently heard a 2 Keto Dudes podcast where cohost Carl Franklin was saying that he had developed a tremor in his right hand after a period of eating mainly porchetta that was instantly solved with magnesium supplementation.  Traditional cultures like the Masai would likely have obtained a lot more of these nutrients from eating nose to tail and even drinking fresh blood, rather than eating drained and aged muscle meat.

I’m happy to accept that you probably don’t need to supplement with vitamin C, manganese, vitamin E, calcium, vitamin K1 if you are thriving on a carnivorous diet.  However, it seems that magnesium, potassium and sodium are still very important and the RDIs are still quite relevant.

Scenarios to test

I realise that the DRIs have their shortcomings (e.g. bioavailability, context, antinutrients etc.).  I delved into these issues in the previous post if you want to check that out. 

In this article, I  want to focus on the scenarios below where we could fine tune Dr Baker’s diet to get more nutrients as well as helping him lower his blood sugar levels.   (Note: Robb Wolf has now published Shawn Baker’s full blood test results on his blog here if you’re interested in checking them out).  

There is plenty of discussions out there on the interwebs as to whether a HbA1c is really a concern for Shawn in his context.  Some people say that the excess protein is being converted to glucose.  Some think it’s just the higher energy levels.  Some think that it’s higher lived red blood cells which are causing the higher HbA1c.  Some think he might have an underlying autoimmune condition that is causing his pancreas to not produce enough insulin.  I’m not saying I know.

2018-03-15 11.06.29

Symptomatically he appears to be doing fine with his higher glucose and lower testosterone levels.  I just want to demonstrate how the Nutrient Optimiser would help someone wanting to lower the dietary insulin load to enable their pancreas to keep up.

So, putting the minutia aside, let’s assume we want to find foods that contain more of the nutrients that Shawn’s diet is not providing in large quantities.   I also want to test a couple of scenarios:

  1. with and without plant-based foods, and
  2. maximum nutrient density per calorie vs a more energy dense, higher fat, diabetes-friendly approach.

Shawn is currently eating 6.1 g/kg LBM of protein and has nearly diabetic blood sugar levels and HbA1c.[4]  Most of the time I’m the one banging on that you shouldn’t be afraid of protein.  However, I wonder whether Shawn might do better with a higher fat, lower protein, zero carb approach.  You can convert protein to energy, but it is hard for the body to do, compared to using fat or carbs for energy.

Very low protein diets tend to be low in other nutrients, however more than 1.8g/kg LBM  doesn’t seem to make a difference for most people in terms of building additional muscle mass.  Less protein and more fat might be gentler on his metabolism and help him fuel his activity levels.  Reducing the insulin load of his diet to the point that his pancreas can keep up and maintain normal blood sugar might be beneficial. 

Ted Naiman’s depiction of the protein : energy ratio below illustrates this concept.  A high protein : energy ratio may be useful for people who want to get nutrients and protein without too much energy and drive high levels of satiety that will help them eat less.  However, for someone like Shawn, trying to get more energy into fuel activity, a lower protein energy ratio might be more useful.  A diet with a lower protein : energy level is less nutrient dense but also less insulinogenic which may be helpful for someone like Shawn who has blood sugars and near diabetics HbA1c. 

image8

Ted suggests a protein : energy (i.e. protein / (fat + carbs) all in grams) of around 3:1 for someone trying to lose weight while with something closer to 1:1 for someone trying to maintain their current body fat levels or fuel a lot of activity.  Interestingly, Shawn’s current protein : energy ratio is 2.75 which is closer to the weight loss approach.   

Scenario 1 – Carnivore with max nutrient density

In this scenario, we will look to improve the nutrient content of Shawn’s diet while remaining carnivore, given that it’s working pretty well for him and helping his digestive issues. 

The table below shows the nutrients for which Shawn would fail to meet the DRI if he was eating a standard 2000 calories per day.  

nutrient

% DRI / 2000 calories

Vitamin C

0%

Manganese

2%

Vitamin E

13%

Vitamin A

17%

Vitamin D

19%

Vitamin K1

21%

Folate

27%

Calcium

35%

Pantothenic Acid (B5)

35%

Omega 3

37%

Thiamine (B1)

65%

Sodium

68%

Magnesium

71%

Copper 

77%

Potassium

89%

The chart below shows the nutrients that are associated with testosterone levels according to extensive research by Spectracell.   Shawn is currently getting plenty of zinc, carnitine and vitamin B6, however boosting the vitamin C, vitamin E, vitamin D, vitamin K and folate in his diet may help him naturally boost his testosterone levels which are on the lower end.

testosterone.png

We can use the Nutrient Optimser algorithm to identify the zero carb foods that contain more of the nutrients for which Shawn is not meeting the DRI.  

Listed below are the top 20 foods that would provide nutrients to complement Shawn’s current diet.  (I have crossed out shrimp and salmon because Shawn is already eating these.) 

     liver

     caviar

     cod

     crab

     fish roe

     mussel

     lobster

     anchovy

     trout

     crayfish

     shrimp

     salmon

     lamb kidney

     Halibut

     egg yolk

     Haddock

     Pollock

     Perch

     sardine

     oysters

So let’s say Shawn added 30g of liver (I’ve only added 30g of liver, so we don’t exceed the upper limit for Vitamin A) a tablespoon of caviar, and swapped out some of his steak for cod (Dwayne ‘The Rock’ Johnson also eats a lot of cod) which is high protein and nutrient dense[5]. The table below shows Shawn’s updated daily diet.  

image9

The updated nutrient profile with Shawn’s refined diet shown below.  These additional foods give us a large boost in vitamin A, copper, omega 3 and magnesium, so we are now only missing the DRI for 11 nutrients rather than fifteen. 

image2

This scenario has a protein : energy ratio of 3.7 which is great if Shawn was trying to lose weight, but perhaps not ideal to support a lot of activity. 

Scenario 2 – Nutrient dense carnivore – diabetes friendly

As I mentioned earlier, Shawn may benefit from a higher fat, lower insulin load, carnivorous approach given his elevated blood sugar and HbA1c.   While most people probably need to be eating more protein, Shawn’s pancreas seems to be struggling to keep up with the insulin required to metabolise 560 g of protein per day or an insulin load of 300 g/day. 

Listed below are the higher fat foods that could provide the nutrients that Shawn is missing from his diet with a lower insulin load. 

     egg yolk

     mackerel

     caviar

     liver sausage

     cream

     liverwurst

     whole egg

     sweetbread

     lamb brains

     sour cream

     beef brains

     cream cheese

     bacon

     bratwurst

     butter

     salami

     limburger cheese

     camembert

     fish roe

     liver pate

The table below shows the updated Cronometer food diary with the lean ribeye steak switched for a fattier T-bone and fattier hamburger mince.  I have also added mackerel, bacon and liverwurst. 

image13.png

The chart below shows the nutrient profile of these foods.   Even though we have more fat, we are able to meet the DRI for all but eleven of the essential nutrients.  These foods contain 61% fat and 39% protein which is a more reasonable level for someone wanting to maintain weight and fuel a lot of activity.  With these foods, Shawn would not be missing the DRI for twelve essential nutrients.  These foods have a lower protein : energy ratio of 1.4 which is more appropriate for weight maintenance or to support a lot of activity. 

image4

Scenario 3 – Omnivorous with max nutrient density

So let’s say Shawn wanted to maximise nutrient density from all foods, including some plants, given his main goal is performance rather than just being zero carb.  However, given that Shawn seems to have some digestive issues from his previous high carb processed foods diet we will eliminate any inflammatory foods using the autoimmune protocol filter.  The top twenty foods are shown below:

     spinach

     watercress

     beet greens

     basil

     chard

     parsley

     turnip greens

     endive

     amaranth leaves

     lettuce

     chives

     broccoli

     arugula

     collards

     escarole

     kale

     radicchio

     celery

     cauliflower

     zucchini

     onions

     winter squash

     sauerkraut

     liver

     caviar

     cod

The Cronometer output below shows the updated intake with a little less ribeye and ground beef with some spinach, broccoli, sauerkraut and liver added in.  

image13.png

Shawn would need to test and see how he does with the addition of spinach and broccoli.  While some people don’t tolerate any fibrous foods,[6] I don’t think most people are suffering from excessive amounts of cruciferous vegetables.

From a macronutrient point of view, this ends up being only 2% net carbs which is low by most standards.  From a protein : energy ratio perspective these foods come in at 2.7 which is probably higher than we want for someone trying to fuel a lot of activity. 

The updated nutrient profile is shown below.  We are now meeting the DRI for all but six essential nutrients.   Overall the nutrient profile is more balanced.  We are still getting plenty of amino acids and other nutrients that were high before while we are getting more of the nutrients at the top of the chart.  

image3.png

Scenario 4 – Omnivorous diabetes friendly

In this scenario, we will look to fill the nutrient gaps with a lower insulin load and a lower protein : energy ratio.  The highest ranking foods listed below contain the nutrients Shawn is not getting while having a lower insulin load and more fat. 

     beet greens

     spinach

     turnip greens

     chard

     olives

     lettuce

     arugula

     mackerel

     broccoli

     avocado

     zucchini

     sauerkraut

     caviar

     liver sausage

     blackberries

     cucumber

     celery

     cloves

     liverwurst

     sweetbread

     radishes

     summer squash

     cauliflower

     raspberries

The chart below shows the updated Cronometer food diary with the following changes:

     fattier T-bone steak rather than ribeye,

     fattier hamburger mince

     2 oz liverwurst

     spinach

     olives

     avocado

     mackerel rather than salmon

image9.png

The chart below shows the updated nutrient profile for this approach.  Even though we have 60% fat, we are only missing out on six essential nutrients.  We are still getting heaps of protein, but the lower insulin load (i.e. 22% of calories rather than 34% of calories) could help his pancreas keep up and maintain more stable blood sugars.  This list of food would also give Shawn a protein:energy ratio of 1.3 which might be better to help him fuel his activity. 

image4.png

Comparison

The table below compared the scenarios in terms of:

     calories,

     target DRI levels not achieved,

     nutrient score,

     % protein

     % fat, and

     % insulinogenic.

scenario

calories

nutrient score

protein (%)

fat (%)

insulinogenic (%)

Protein:

energy

baseline

4122

60%

55%

45%

31%

2.75

baseline / 2000 calories

2000

60%

55%

45%

31%

2.75

nutrient dense carnivore

2000

66%

62%

38%

34%

3.7

nutritious diabetes-friendly carnivore

2000

62%

39%

61%

22%

1.44

nutrient dense omnivore

2000

75%

56%

42%

32%

2.71

nutritious diabetes-friendly omnivore

2000

70%

38%

60%

22%

1.33

The chart below shows the % of the Daily Recommended intake for the various nutrients that were not meeting the DRI in the baseline scenario per 2000 calories achieved. 

Screenshot 2018-04-02 13.27.50.png

Hopefully, this helps to illustrate how the nutrient optimiser can be used to refine your food choices while still working within the constraints (e.g. digestion, preferences) and goals (e.g. diabetes management or energy density). 

If you’re interested in fine-tuning your diet, the Nutrient Optimiser Free Report will suggest target macro ranges and foods suit your goals and dietary preferances.  

image21.png

 

 

low and high energy density foods to fine-tune your nutrition

This article looks at energy density and how you can use it to fine-tune your diet to reach your goals.

What is energy density?

Energy density, a measure of the calories in a given weight of food, is the is the third component of Nutrient Optimiser algorithm that you can use once you have nutrient density and insulin load dialled in,

image3

It makes sense intuitively that bulky food full of water and fibre will help you to feel full, even though they don’t provide a lot of energy.

image4

Imagine if all you had to eat were non-starchy, fibrous vegetables like lettuce, broccoli, and celery.  You would struggle to get enough energy.

Your stomach can only hold so much.

image6

However, we gravitate to higher energy density foods to ensure we get the energy we need.

We get a dopamine hit from energy-dense foods helps to ensure our survival a species.  This drove us to hunt down, dig up or fight with bees to get energy-dense foods.

However today, in a world of engineered foods, full of refined carbs and added fats, lower energy density foods may be helpful to reverse engineer your food environment if you are trying to lose weight.

Who should consider lower energy density foods?

Focusing on lower energy density foods only needs to be a priority once you are eating nutrient dense foods and have stabilised your blood sugars. People who are obese and insulin resistant often don’t do well with only celery, broccoli, mushrooms, grapefruit and lettuce to eat.  Hunger and appetite often win in the long run.

While insulin resistant people often have plenty of stored body fat, their insulin levels are still very high.  They may struggle to access their stored body fat and avoid the cravings driven by the blood sugar rollercoaster.  A nutrient dense low carb diet with ‘fat to satiety’ can help these people stabilise their blood sugars without hunger.

image2

Focusing on more nutritious foods that stabilise blood sugars is enough to help many people lose some weight.  However, many find that their weight loss stalls after a while when using a ‘fat to satiety’ approach.  Not fearing fat may have helped them start their journey, but ramping up their fat intake to higher and higher levels often doesn’t achieve the desired results.

At this point, lower energy density foods and meals can be useful to help take the next step to lose more body fat once your blood sugars are stable and you are in the habit of eating nutritious food.  An extreme version of this approach is the Protein Sparing Modified Fast (PSMF) as detailed in Lyle McDonald’s Rapid Fat Loss Handbook and this article.

In short, the PSMF is often used by bodybuilders or weight loss clinics to provide the vitamins, minerals, essential fatty acids and protein necessary with the minimum amount of calories to prevent loss of muscle mass and prevent cravings in dieting.

Low energy density foods

If you’re interested in trying out a lower energy density approach, the nutrient dense low energy density foods listed below will provide plenty of nutrients without too much energy.

Screenshot 2018-03-18 03.49.06

Focusing on these foods will allow you to get all the nutrients you need without too much energy and be able to sustain a long-term energy deficit without excessive cravings.  This chart shows how these foods stack up in terms of nutrients compared to the average of all foods in the USDA database.

Screenshot 2017-12-26 04.20.44.png

Higher energy density foods

Alternatively, we can use energy density parameter to identify foods with a higher energy density to fuel your athletic endeavours or endurance event without having to resort to energy gels which will provide fast digesting energy but not a lot of nutrition.

image1

The list of food will provide you with more energy while still being nutrient dense.  This list contains more nuts, seeds, dairy and fattier cuts of meat.

Screenshot 2018-03-18 03.49.54

As shown in this chart, these high energy density foods are not as nutrient dense as the lower energy density foods, however, they are still an improvement compared to the average of all of the food in the USDA database.

energy dense foods for athletes - with all foods.png

Energy density and satiety

Satiety is complex and involves more than just eating foods that are bulkier.   Ensuring your diet contains enough protein (the most satiating macronutrient) and micronutrients (to avoid cravings), along with stabilising swings in your blood sugar (with a lower insulin load diet) are all pieces of the satiety puzzle.

One of the most interesting pieces of research into satiety is a 1995 paper by Susanne Holt and colleagues, A satiety index of common foods.[3]  This study fed participants 1000 kJ (239 calories) of various foods and looked at how much people ate at a subsequent meal.  The study found that how much our stomach stretches is a significant factor in determining how satiating a particular food is.

The chart below shows SELFNutritionData.com‘s analysis of the data from the 1995 paper which they used to develop their Fullness Factor[4].  This regression analysis shows that satiety per calorie tends to be positively correlated with:

  1. lower energy density (i.e. calories per 100g of food),
  2. higher protein content,
  3. higher fibre, and
  4. lower fat.

image5

The most energy dense foods

The table below shows the energy density (i.e. calories per 100 g) of a range of foods and their weight per 500 calories.

food calories / 100g weight / 500 calories (g)
mushrooms 15 3333
celery 16 3125
broccoli 31 1613
oranges 47 1064
apples 65 769
fish 168 298
steak 250 200
Mars Bar 451 111
cookies 476 105
chips 1242 40
oil 1879 27

You might be able to eat more at dinner if you had a 40 g of chips for lunch compared to three kilograms of mushrooms or celery even though they both contain the same amount of energy.

Show me the data!

For those who like to see the numbers, the table below shows the energy density, nutrient density, macros and % insulinogenic of a range of food lists that we can quantify.  The list is sorted from the lowest energy density to the highest energy density.

  • The energy density of real food can range from 30 to 450 calories per 100 grams.
  • The lowest and highest energy density foods are not necessarily the most nutrient dense, however, nutrient dense food tends to have a lower energy density.
  • The foods that contain very high levels of fat will be energy dense and not necessarily as nutritious on a calorie for calorie basis.
  • The weight loss approaches have a lower energy density.  However, if you are trying to maintain weight or are very active you can still get a fairly nutritious outcome with higher energy approach.
approach nutrient density score density (cals/100g) protein (%) fat (%) net carbs(%) insulinogenic (%)
lowest energy density 61 30 20 10 52 63
weight loss (insulin sensitive) 93 83 42 17 26 50
weight loss (insulin resistant) 92 104 41 25 19 42
highest fibre foods 64 105 20 9 42 53
the most nutritious foods 93 107 43 18 24 49
highest protein foods 57 131 77 21 2 45
maintenance 90 240 40 25 26 48
energy dense foods for athletes 87 351 34 36 21 40
lowest fibre foods 41 404 20 76 3 14
well formulated ketogenic 47 426 16 73 4 13
most ketogenic foods 30 467 15 80 3 11

When do we use energy density?

The table below shows when Nutrient Optimiser uses energy density diet based on your blood glucose levels and waist to height ratio.

approach average blood sugar HbA1c (%) waist : height ratio energy density
(mg/dL) (mmol/L)
weight loss (insulin resistant) 100 – 108 5.4 – 6.0 5.0 – 5.4% > 0.5 lower
weight loss (insulin sensitive) < 97 < 5.4 < 5.0% > 0.5 lower
Bodybuilder (bulking) < 97 < 5.4 < 5.0% < 0.5 higher
endurance athlete < 97 < 5.4 < 5.0% < 0.5 higher

If you haven’t yet, make sure you head over to the Nutrient Optimiser get your free report complete which includes a list of foods and meals tailored to your goals.

 

Refereences

[1] https://betterdoctor.com/health/the-ironman-who-runs-on-fat-not-sugar/

[2] https://www.fxmedicine.com.au/content/counteracting-insulin-resistance-low-carb-high-fat-diet-prof-tim-noakes

[3] https://www.ncbi.nlm.nih.gov/pubmed/7498104

[4] http://nutritiondata.self.com/topics/fullness-factor

Dr Shawn Baker’s Carnivore Diet: a review

Interest in the controversial carnivore diet (a.k.a. zero carb) diet is booming!

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After trying low carb, paleo, and keto, for some people cutting out all carbs and plant foods is the next logical progression in their journey towards optimal health and diabetes control.

But, to some, this sounds counterintuitive!

Could eating only meat be healthy?

What about all those nutrients you get from plants?

Won’t you get too much protein?

What about fibre?

 

This article looks at the pros and cons of the carnivore diet through the lens of the Nutrient Optimiser.

I’m not sure that the carnivore diet is optimal for everyone.  But in light of all the n = 1s, it’s hard to say it doesn’t work really well for some people.

Does the carnivore diet break all the rules of nutrition?

I’m inquisitive.

Thinking out loud.

My aim is to understand the common factors of nutrition that help people thrive so we can apply them in a systematised manner.

Why is the carnivore diet becoming popular?

Other than Shawn Baker, there are a few interesting examples of people who have successfully followed a carnivorous diet for a long time and seem to be thriving.

Joe and Charlene Anderson

Charlene (45) and Joe (60) Anderson have been eating nothing but fatty steak for nineteen years, including through two healthy pregnancies.[1] [2] [3]

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Transitioning to a meat-only diet wasn’t all smooth sailing.  Joe says:

Once I tried a specific, fatty, meat-only diet I felt miserable at first. Massive headaches, depression, fatigue and nausea were common.

By the end of two weeks, however, the veil lifted and I felt great! I discovered that eating this clean meat-only diet was very healing, and I had my own demons and ill health that had to be expelled.

Charlene’s path to healing has taken considerably longer. Although she felt great immediately removing all the fibers, vegetables, and grains that she had been eating for years, she also felt the effects of starving out her Lyme bacteria.

Her body would cycle back and forth from feeling great as the Lyme died off, to feeling horrible because the Lyme was dying off. She gritted her teeth, dug in, and stayed on plan.[4] 

Charlene looks to be doing just fine these days.[5] [6]

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You can read more about Charlene’s journey at Meat Heals or follow Joe on Twitter.

Amber O’Hearn

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Amber is another prominent zero carber who progressed to a carnivorous diet after her success with low carb stalled.  She cut out all plant foods (other than coffee) and found her bipolar benefited significantly and her weight loss improved!

Amber has done a lot of thoughtful research and documented her journey at ketotic.org and empiri.ca.  She doesn’t claim that the carnivorous way of life is right for everyone, but she makes a good case for why we may not necessarily need fruit and “heart healthy grains” to be healthy.

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Dr Georgia Ede

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Psychiatrist Dr Georgia Ede on her Diagnosis Diet blog highlights anti-nutrients in plant-based foods (e.g. phytic acid, goitrogens, oxalates, and tannins) in not just grains and soy, but also cruciferous veggies such as spinach and broccoli, that also contain lots of vitamins and minerals.  Georgia says:

Nutrient bioavailability from plants is in many cases significantly compromised. Just because a plant contains a nutrient does not mean we can access it. One example: due to the oxalate within spinach, virtually none of the iron within spinach is available to the human body. As a second example, the zinc in oysters is virtually impossible to absorb if the oysters are consumed with corn tortillas.

There are too many variables to consider in a mixed diet to be certain how foods will interact in various individuals. Recommended daily intakes for nutrients are based on faulty assumptions and the data used to generate them comes from people eating standard diets. Diets high in refined carbs deplete many nutrients, increasing our apparent requirements.

While some people may benefit from restricting these compounds in their diet, I’m not sure that it’s necessary or optimal for everyone.

Many stressors in life are hormetic and can make you stronger in the long term.  While some people are delicate, we can’t always live in a bubble.

And plant compounds such as oxalates can affect availability you can’t absorb nutrients if they’re not actually available in the foods you are eating.  There is a trade-off between quantity and absorption.  It’s hard to quantify these things but the calculations that I’ve done based on the limited data available indicates that you should probably eat your spinach if you enjoy it.

Dr Gundry

While not strictly a carnivore, Dr Stephen Gundry has recently released The Plant Paradox where he speaks of the dangers of lectins and antinutrients in grains and legumes that many people struggle with, especially if they are prone to an autoimmune response.

While his book title may be a little misleading, Gundry still supports eating nutrient dense green leafy vegetables.

Paleo Medicina

While many people are talking about meat causing cancer Paleo Medicina are using a carnivore diet to treat cancer, autoimmune and other chronic conditions.  This Ketogeek podcast interview with biologist and clinical researcher Dr Zsofia Clemens is an intriguing listen!

Online groups

There are also a number of large online groups of people who swear by just eating meat, including Principia Carnivora and Zeroing in On Health.

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What I find fascinating is that these groups are every bit as passionate about their dietary approach as the plant-based vegans at the other end of the dietary spectrum who also claim that their diet was responsible for healing them of all their ailments.

While online groups are amazing for bringing together like-minded people to support each other on their journey, they are not exactly randomised trials and can suffer from confirmation bias, groupthink and survivorship bias (i.e. only the people that benefit continue to remain in the group and contribute).

I’m not accusing anyone particular of these traits, just nothing that online groups can be subject to these symptoms.  It’s hard to separate the anecdote from the science.

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Dr Baker has established the World Carnivore Tribe group which has a ton of positive anecdotes as well as Meat Heals which has been set up to gather n=1 experiences on a carnivorous way of life.

There’s no denying a LOT of people have found improved their quality of life when they simplified their diet to meat only.

It makes me wonder what the common factors of the optimal human diet are when people are zealous advocates of what appear to be polar opposite approaches.  How do we identify what works and systematise it to help everyone to move towards optimal?

Rather than forcing vegans to be carnivores and carnivores to be vegan, how can we optimise your food choices while still respecting your preferences?

(If you’re interested, we dig into the possible fundamental principles of nutrition in the followup to this article – Optimising Dr Shawn Baker’s Carnivore Diet from First Principles).

Dr Shawn Baker

Dr Shawn Baker (@SBakerMB, shawnbaker1967) is the latest high profile proponent of the carnivore approach to nutrition to burst onto the scene.

Shawn is a strength athlete who needs a lot of food.  In the past, this included plenty of cereals, low-fat yogurt, skim milk, pasta and grains to maintain weight with his high level of activity.[7]

After experiencing digestive issues exacerbated by his poor diet (note the similar story with others who have benefitted from zero carb), he progressively experimented with his diet, moving from the typical high carb to paleo, then low carb, then a targeted ketogenic diet.  However, he found that he would suffer gut distress when he added carbs back in on the cyclic keto approach, and eventually settled on a meat-only carnivorous dietary approach.

He has since gone to set world records in indoor rowing and continues to workout like a beast at 51.

He has been interviewed on a number of podcasts promoting nequalsmany, where he is trying to pool the experiences and test data from a range of people following a carnivorous diet.

Shawn saw a need to gather health and performance data from people following a carnivorous diet to try to understand why they seemed to be thriving in spite of cutting across a lot of mainstream health recommendations.

While I haven’t seen any analysis of the crowdsourced data yet, he recently carried out some testing on himself after a year as a carnivore, which we will look at later in this post.

Nutritional analysis

I’m intrigued at how someone like Shawn could be thriving, so I pinged Dr Baker on Twitter to get his standard diet to analyse in the Nutrient Optimiser.

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The Nutrient Optimiser is a tool designed to help people balance their diet primarily at a micronutrient level.  It then identifies food that provides the nutrients that they need that they are currently not getting in adequate quantities.

As well as maximising micronutrients, the Nutrient Optimiser can manipulate macronutrients and energy density to help you achieve your goals, for example:

  • if you are managing diabetes, we can reduce the insulin load of your diet to help stabilise your blood sugar levels or even further to achieve therapeutic ketosis,
  • if you are fuelling for an endurance event, we can wind up the energy density to help you to get more energy in, and
  • if you are looking to lose weight, we can reduce energy density to ensure you get the nutrient you need with foods that are more filling.

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What I like most about the Nutrient Optimiser is that it removes the various conflicts of interest to demonstrate that the foods that we typically know intuitively are bad for us (e.g. hyper-palatable processed junk foods) provide minimal levels of nutrition and should be avoided.

Balancing your nutrition at a micronutrient level helps to cut through the confusion and commercial bias using widely recognised nutrient targets.   Whether you want to eat only plants for ethical reasons or only animal-based foods because that’s all you can tolerate, the Nutrient Optimiser can help you find the food that will work for you.

My hope is that the Nutrient Optimiser be adopted widely as to help improve your diet regardless of your preferences or goals.

Limitations of a plant-based diet

In systems design, things get interesting when you take them to their limits.

You need to test how something performs at the extremes to iron out the bugs.  In the case of the Nutrient Optimiser, the limits to be tested are macronutrient extremes (carbs, fat, protein) or extremes of plant- vs animal-based food sources.

One of the problems with the Daily Reference Intake (DRI) for essential nutrients is that they were developed in the context of an agriculture-based western diet.   At the extremes, we need to understand which parameters are still relevant and which ones need to be modified.

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In a previous post, we looked at the nutritional sufficiency of the recipes in Dr Greger’s How Not to Die Cookbook.  As shown in the micronutrient nutritional profile below, a plant-based diet contains adequate quantities of most of the essential nutrients other than omega 3, vitamin B12, and choline.

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However, as carnivore diet proponents will be quick to point out, not all nutrients provided by animal- and plant-based foods are the same. Although certain vitamins and minerals exist under the same name, their form and bioavailability differ between plants and animals.

For example, iron in animal foods exists in the form of heme and is more bioavailable than the elemental iron supplied by plants. Animal foods also provide forms of nutrients that the body requires, such as retinol (vitamin A) and EPA / DHA (omega-3s), whereas plant foods supply precursors to these nutrients (beta-carotene and alpha-linolenic acid, respectively).

Unfortunately, we don’t yet have enough data to quantify these variables accurately.  I hope that in the next few years there will be more research that will help us quantify the effect of bioavailability and antinutrients on the amount of nutrients absorbed compared to just what goes into our mouth.

We do need to keep these limitations in mind when analysing a purely plant-based diet, especially if someone is displaying symptoms of deficiency in the nutrients that are borderline.

Carnivore diet

In a similar way, we need to understand the limitations that may apply to a carnivorous diet.  The chart below shows the nutrient profile of a carnivore diet versus all foods in the food system USDA database.  It seems to be harder to meet the Daily Recommended Intake levels of vitamin K1, calcium, vitamin E, vitamin C, and folate. magnesium and potassium just barely make it.

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If you don’t mind some organ meats, you can get a very respectable micronutrient profile in real life.  A great example is Amy, who comes in at #13 on the Nutrient Optimiser Leaderboard with her carnivorous diet with plenty of organ meats, and is meeting the daily intake levels for everything except vitamin C, manganese, vitamin K1, calcium, magnesium, vitamin E, and vitamin D (check out her full report here).

Not everyone likes offal, so the chart below shows the nutrient profile if we remove it.  We would struggle to get adequate vitamin K1, manganese, folate, calcium, vitamin C, vitamin A, vitamin E, and magnesium.  The nutrient score drops from 75% to 67% (although, even without accounting for bioavailability, it is still better than the plant-based diet at 63%).

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Shawn Baker’s diet analysis

Let’s look at what we learn from analysing Dr Baker’s diet.  Shown below is Dr Baker’s average daily intake with lots of steak and hamburger mince with some cheese, eggs, shrimp, and salmon entered into Cronometer.

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The micronutrient fingerprint of Dr Baker’s diet is shown below.  You can check out his full Nutrient Optimiser analysis here.

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At the bottom of the chart , we see that Dr Baker’s diet has a ton of vitamin B12, zinc, iron, and amino acids.  However, at the top of the chart (see the zoomed in segment below), we see that Dr Baker’s diet is lacking in vitamin C, manganese, vitamin A, vitamin D, vitamin K1, folate, calcium, omega 3, and pantothenic acid (at least when you use the RDI as your benchmark).

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However, what do we make of the fact that Dr Baker and a number of his friends appear to be thriving?  Are the recommended nutrient levels just plain wrong?  Which ones are relevant in this context?

In response to my preliminary analysis, Shawn commented:

As you point out, some of the micronutrients may become less of a requirement based upon overall dietary scheme. 

Personally, I don’t necessarily believe the DRIs are relevant to a carnivorous diet in general and would look at clinical endpoints.  For example, calcium deficiency has a clinical manifestation and developing signs of it should lead to deterioration of health rather than its enhancement as I’ve experienced and the same with countless other pure meat eaters. 

It is relevant to note that there are many zero-carb people that have been going many years, to some several decades, on just muscle meats and no offal at all and who also maintain excellent health.

There is no point in telling someone to stop doing something if they are thriving.  However, at the same time I can’t stop thinking of Dr Bruce Ames’ Triage Theory which suggests that, in the absence of adequate nutrients, the body will prioritise nutrients geared towards short-term survival rather than optimal health and longevity.

Dr Baker’s n=1 data

Dr Baker has been spearheading a nequalsmany crowdsourcing of a range of data from people following a carnivorous diet.  While I’m eager to see the full analysis of the data when it’s available, Shawn recently discussed his own test results after fourteen months on a carnivorous diet with Robb Wolf.  I highly recommend you have a listen to the interview on the Paleo Solution Podcast.

Cholesterol

To my eyes, Dr Baker’s cholesterol values are fairly unremarkable other than to note that his TG:HDL ratio is 1.3 (which is good) and his total cholesterol : HDL is 4.6 which is OK.[8] [9]  However, I’m no expert in this contentious area.

Alex Leaf of Examine.com noted that “High LDL-p, low HDL to LDL ratio, low HDL to non-HDL ratio are All strong CVD risk factors”.

Meanwhile, while Dave Feldman of Cholesterol Code offered the following comments:

  • LDL-C and LDL-P are both on the lower end for a low carber who is as lean and fit as Dr Baker is. I suspect this is due to his emphasis on resistance training, which can reduce LDL scores due to a higher rate of use for muscle repair.
  • Small LDL-P is low at 283, and clearly very Pattern A.
  • HDL-C — 40 mg/dL is low for a zero carber.
  • HDL-P was highlighted as being low (out of range) at 28. However, I see this frequently with low carbers across the board.
  • Triglycerides — 54 is certainly very correlative with a very athletic, insulin sensitive metabolism.
  • Lipoprotein (a) — 2 nmol/L is one of the lowest scores I’ve ever seen (maybe THE lowest).
  • The score I most care about is Remnant Cholesterol which is calculated by subtracting both HDL-C and LDL-C from Total Cholesterol. His score of just 11 mg/dL is extremely low risk and suggests he has a very efficient fat metabolism.

HbA1c

What is more interesting and puzzling is Baker’s HbA1c of 6.3% with a fasting blood sugar of 121 mg/dL.

This HbA1c level puts him on the borderline of prediabetes and full-blown type 2 diabetes,[10] which I wouldn’t have expected.   A HbA1c of 6.4% and a fasting glucose of 126 is the cut off for type 2 diabetes. HbA1c of less than 5.0% and fasting glucose of less than 95 mg/dL are typically associated with lower all-cause mortality.[11] [12]

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What is puzzling here is that, while Shawn’s HbA1c is high, he has a fasting insulin level of 2.6 mIU/L which is very low which either suggests he is very insulin sensitive or his pancreas is not producing enough insulin.

Since the release of the Robb Wolf podcast there has been a ton of speculation about his results.  It will be interesting to see if he follows up on any of the gratuitous suggestions for further testing.

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Some people point to HbA1c being an unreliable measure due to the fact that red blood cells live longer in healthier people, however, Dr Baker’s blood sugar values correlate with the HbA1c values.

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Some will say that the 6.1 g/kg/LBM or 560 g of protein per day is driving gluconeogenesis.  (This is a contentious and complicated topic that I have covered at length in the article Why do my blood sugars rise after a high protein meal?)

If you look at things from a total energy perspective you could say that Shawn is just eating a lot to fuel his activity (more than 4000 calories per day) and hence his blood sugars are staying high.

Perhaps it’s a case of extreme physiological insulin resistance where the body chooses to keep glucose levels higher where there is less glucose available and lower insulin levels?

However, I think it’s worth noting that essential minerals such as potassium, calcium, and sodium are essential for maintaining insulin sensitivity.[13] [14] [15]  While the body does a pretty good job of maintaining acid/base balance, the kidneys still need enough substrate (e.g. alkaline minerals such as potassium, magnesium, and sodium) to be able to do this.

Once the kidneys stop being able to tightly regulate pH we can get metabolic acidosis which goes hand in hand with type 2 diabetes.[16] [17] [18] [19]  (This is another complex and contentious topic that I covered in Alkaline Diet vs Acidic Ketones.)

It’s interesting to hear in his discussion with Robb that Dr Baker is finding benefit from adding sodium and electrolytes.  Many people on a low carb dietary approach find that supplementing minerals is important.  The Nutrient Optimiser analysis typically finds that people need more potassium or magnesium rather than sodium.  Sodium is fairly easy to get while potassium and magnesium is much harder for most people.  There are a range of studies suggesting that a higher potassium : sodium ratio is desirable.[20] [21] [22]

At the same time, Dr Baker’s HbA1c could have been a lot higher before he started his carnivore diet due to the high dietary load to fuel so much exercise and bulking and the meat only diet could be improving his HbA1c.  We just don’t know from the available data.

I look forward to the full analysis of the data from the nequalsmany participants.  However, based on the results of Shawn’s n=1 it may be too early to say that zero carb is the cure for type 2 diabetes.

Testosterone

While there are anecdotes of an animal-based carnivorous diet raising testosterone levels, Dr Baker’s endogenous testosterone levels are lower than you might expect given his level of muscularity, leanness, and endurance.

As discussed in the interview with Robb he is experiencing no symptoms of low testosterone and suggests that, similar to TSH and insulin, he may be more sensitive to testosterone and hence the body doesn’t need as much of it.  Others have been more sceptical of Baker’s testosterone results.

Are the nutrient recommendations relevant to someone following a carnivorous approach?

Given that the RDIs are designed to prevent nutrient deficiencies in most of the population, they will be conservative for most people when it comes to deficiencies.  However, what constitutes optimal is a different matter.

The challenge in using the RDIs at extremes is that they have not been adjusted to cater for varying requirements of people following a vegan, keto, or carnivorous approach.

Many people are quick to dismiss the RDIs entirely in view of the numerous anecdotes of people thriving with no plant-based foods.  But I’m eager to understand, as much as we can with the available data, how the parameters might change and what is still relevant and important.

While the DRIs are based on people eating a standard western diet, anecdotally many people seem to find they need to supplement electrolytes when they reduce or remove carbohydrates sources from their diet, so I don’t think we can say that someone on a carnivorous diet would have a lower requirement for electrolytes such as sodium, magnesium or potassium.

Does the carnivore diet break the Nutrient Optimiser?

Dr Baker isn’t going out of his way to chase micronutrients.  I think the fact that he’s eating more than 4000 calories per day will help to make up for the lower availability of some nutrients in animal vs plant-based foods.

A fairer illustration of the potential of the potential of a carnivorous is the nutrient profile for Amy which is shown below, who is following a carnivore diet with heaps of organ meat.

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Although Amy has gone out of her way to maximise her micronutrients as much as anyone practically could with a carnivorous diet she is still not meeting the RDI for vitamin K1, vitamin C, calcium, vitamin E, sodium, and magnesium.

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But is this really an issue?

The Nutrient Optimiser has a zero carb/carnivore diet option for people who chose to eat that way for preference or due to other issues.  This allows people who chose to follow this approach to help manage autoimmune or digestive issues to fine tune their micronutrients as much as possible within those constraints.

The question for me, then, is whether we need to worry about these possible deficiencies?

Vitamin K2 can be converted to K1

Vitamin K1 is primarily found in plants while K2 is synthesised by bacteria in the large intestine of animals and humans.  Vitamin K2 (menaquinones MK1 through MK4) is only a fairly recent discovery.  Hence the USDA food database only contains data on the quantity of K1 (phylloquinone) in foods.

The good news is that most people can convert K2 to K1 and vice versa depending on demand.[23]  Hence, low dietary vitamin K1 intake may not be an issue if you are getting plenty of K2 from sources such as eggs, butter, and liver.

Some nutrients are more bioavailable

As we mentioned before, vitamin A and omega 3 are more bioavailable from animal-based sources.   However, I don’t think this is a real issue either way as it is quite easy to get plenty of these nutrients on a carnivorous diet.

The effect of anti-nutrients on absorption

Iron, calcium, and magnesium may be more bioavailable when there are no oxalates in the diet.[24]  Adequate iron is rarely a problem for someone eating adequate amounts of animal-based protein.  Excess iron is often a problem in males.  Shawn’s ferritin is within range but perhaps above optimal for males.

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Calcium and magnesium do tend to be harder to find, but without plant matter in the diet, it may be more bioavailable.

Grains and legumes can contain lectins, glutens, and phytates that can affect the absorption of minerals like potassium and magnesium.[25]  Unfortunately, we don’t yet have enough data to calculate how much of the various nutrients are getting into your system from the food once you account for bioavailability.

Cooking vegetables also greatly reduces anti-nutrient levels, which adds another layer of complexity to figuring out how much we absorb in a diet of both cooked and raw foods.

For many people, grains just aren’t worth it, especially if they have pre-existing digestive issues.  I’m not sure, however, that the same principle applies to all vegetables.

Personally, my digestion is pretty robust, so I’m not too worried about oxalates in spinach.  I figure the benefit of getting all the vitamins more than offsets the negative impacts, at least for me.  Some plant-based compounds (e.g. sulforaphane) may have a beneficial hormetic effect.[26][27] [28] [29]  However, for some people, their gut is so messed up by modern processed foods that they find they need to cut out all fibre containing foods.

Essential nutrients we require less of when we eat less glucose

There is some evidence to suggest that Vitamin C is not as much of a priority for someone with less glucose to process.   There are examples of plenty of people surviving with minimal vitamin C on a zero carb diet.[30]

Vitamin C is also probably underreported from animal food and often assumed to be zero.  If you want to dig into this more, you can check out Amber O’Hearn’s comprehensive article on vitamin C on a ketogenic diet.

Nutrients that there are is no deficiency testing for

Manganese

There are also a number of nutrients that are based on population average intakes rather than deficiency testing, such as manganese.[31]

Given that manganese is associated with carbohydrate metabolism, there may be a lesser requirement for people following a carnivorous diet.  There may be limited use in chasing targets that are simply based on average intakes of people eating a typical western diet.

Manganese is high in organ meats, which are prized by cultures that do not have access to a lot of plant-based foods, so it is possible to get adequate quantities.    While someone on a zero-carb diet may not need as much, manganese still seems to be a useful nutrient.

Vitamin E

Similarly, the RDI for Vitamin E is based on median population intake levels[32] rather than any deficiency testing, and it is possible that the requirements may be lower for someone not eating as much glucose.

Pantothenic acid (Vitamin B5)

Shawn is not quite meeting the RDI for Vitamin B5 but may not need more unless he has high intakes of alcohol or coffee or has high levels of stress.  The target levels are based on the average intake from population studies, so there’s probably no need to chase the target here for someone on a carnivore diet.

Nutrients that are still important

Vitamin D

Without a lot of seafood, Shawn is not getting a lot of Vitamin D from his food.  However, a lack of dietary vitamin D is not unique to carnivores.  The RDI levels for vitamin D levels are based on the amount required to maintain serum 25(OH)D levels with minimal sunlight.  Interestingly, as shown in the test results, Shawn’s serum vitamin D levels are on the lower end of normal.

Folate

Shawn is getting lower levels of folate compared to the estimated average requirement.  Again, folate can easily be obtained from organ meats which are prized in cultures that do not have access to plant-based foods.

Calcium

Shawn is also not meeting the RDI for calcium.  Calcium can be obtained on a carnivore diet from eggs and sardines or other bony fish.  Target calcium levels are based on balance studies,[33] and your calcium requirements will increase with age.

Omega 3

Shawn is getting a solid amount of omega 3, though not enough to meet the RDI levels or achieve ideal omega 3 : omega 6 balance.   Again, omega 3 is not hard to get from animal-based products if they include some seafood.

Magnesium and potassium

Magnesium and potassium are two minerals that many people do not get enough of when they reduce their carbohydrate intake, particularly green veggies.

The keto flu is a common symptom that people experience early in their ketogenic journey that they can fix with supplementation of alkalising minerals.

I struggle to see that there is a lesser requirement for these minerals on a keto or carnivore diet.  Though itis conceivable that bioavailability is improved when plants are removed from the diet, there is not really enough data to quantify this.

Don’t focus on just one nutrient

All in all, I think nutrients are important.  However, getting wrapped up in chasing the absolute DRI for individual nutrients can be problematic due to the numerous factors outlined above.  Our nutrient requirements will also change based on a range of things such as activity, life stage, the other things you are eating, your gut health and nutrient absorption.

Life is all about making the best choices we can with imperfect data.  We can’t let the lack of perfect stop us from using the data that we have available.  To smooth out the limitations of individual nutrients, the Nutrient Optimiser prioritises foods that contain a cluster of the ten or so nutrients you are getting less of and identifies the foods and meals that contain these nutrients in larger quantities.

So sure, maybe you don’t need as much K1, manganese, vitamin C on a carnivorous diet, the Nutrient Optimiser will help you find the foods that contain the other nutrients that can be harder with your preferred approach to finding the nutrients that are still important.

Historically, humans seem to adapt pretty well to a wide range of food environments over time.  What we don’t seem to do well with is modern hyperpalatable nutrient poor energy-dense foods that are flavoured and coloured to make us think that they are good for us, but actually contain very little actual nutrition.

What about the Maasai?

Many people refer to the Maasai tribe in Africa, who survive on nothing but milk, meat, and blood from their animals, as a precedent for the carnivorous approach.

While they are a thriving, beautiful people, keep in mind that they are drinking blood from their animals and eating fresh meat, nose to tail.

This is not the same as eating only drained muscle meat that has been hung for a long time.  It’s pretty hard to get fresh, undrained meat let alone fresh blood in the west.

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Who should try a carnivorous diet?

One common theme I see for people who seem to thrive on a carnivorous approach is some sort of gut issues (e.g. permeability or bacterial overgrowth) or some sort of autoimmune condition, perhaps due to long-term exposure to processed low nutrient-poor foods.

If your gut is already compromised, then cutting down on fibre and other plant matter, particularly grains, nuts and seeds seems to work wonders for many people.  If you have issues that you find are only healed by staying strictly carnivore then, by all means, stick with it.

You could also use carnivore as an elimination phase and then slowly reintroduce other foods back in to see if you can tolerate them.  You may enjoy a diet that is less restrictive and makes it easier to get the nutrients you need from your diet.  I recommend checking out Chris Kresser’s The Paleo Cure or Natasha Campbell McBride’s GAPS Diet if you want to follow this elimination and reintroduction type approach.

Some people find great success with a carnivore dietary approach.  There are a ton of great testimonials at meatheals.com.  At the same time, I have seen many others that carnivore didn’t work out for.  One friend Samantha found that she became hypersensitive to the smallest whiff of flour and found improvement through a course of probiotics.

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The general motto of the carnivore crowd is to just eat meat when hungry.   This works well for many, but not all.

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Ironically, during the finalisation of this article, I contacted Amy (who has the amazing carnivore nutrient profile shown above) and she advised she was no longer following a zero carb dietary approach and was now pursuing a nutrient dense omnivorous approach.  She had found that she started to gain weight after 2.5 years on a carnivorous diet and her thyroid function diminished.  Amy, who was previously an admin for a major carnivore Facebook group, says:

“All of these, coupled with my EXTREMELY high LDL cholesterol of 500 and my 7-year lack of menstrual cycle, points directly to a failing thyroid.  ZC made it WORSE… MUCH worse.  I went back to a mixed diet in January of this year.  Within 2 weeks of this diet change, I regained all of my natural bowel motility.  And, surprisingly, within 2 months my menstrual cycle returned after 7 years of absence!!  I regained my energy, and I’m now walking daily again, doing daily hour-long sessions of yoga (which I used to love doing years ago), lifting weights 3 days a week, and doing 20 minute HIIT workouts 3 days a week.  I’ve put on some weight, but I look and feel very healthy.  I notice that I’m frequently hot now instead of cold, which I presume is a symptom of my thyroid upregulating to where it should be.  I am scheduled to have a complete thyroid panel, lipid panel, and other hormone tests run at the end of March to see where I am.  But I can clearly tell you that ZC did NOT do MY body any favors.”

Overall, it’s probably fair to say that a carnivore diet can benefit many, particularly if you have major digestive issues.  However, I think it’s probably too soon to say it’s optimal for everyone.

If you do want to pursue a carnivorous diet, then the Nutrient Optimiser can help you identify foods to get as much nutrition as you can within that framework.

If you find that you want something with a little bit more variety and want to include some plants, then there are autoimmune, lactose-free, nut free, or shellfish free options are available to suit your allergies, preferences and intolerances

Summary

  • Some people seem to benefit from a zero carb/carnivore diet, particularly if they have pre-existing gut permeability or bacterial overgrowth.
  • Cutting out nutrient-poor processed inflammatory foods is a common denominator in many successful diets.
  • It is harder to get some nutrients without plants, however, some of these nutrients may not be such a big deal if you are not eating a lot of carbohydrates.
  • While there are plenty of anecdotes, there is not yet a lot of large-scale quantitative research into the long-term impacts of a carnivore diet.
  • It’s still a good idea to maximise the micronutrients in your diet irrespective of your overarching dietary template.

 

 

If, like me, you’re intrigued by the carnivore diet then make sure you also read the followup aricle, Optimising Dr Shawn Baker’s CArnivore Diet from First Principles.

Food lists

I have included some food lists that may be of interest if you want to pursue a carnivorous approach or have major digestive issues.

Carnivore / zero carb

The foods listed below will provide you with the most nutrients per calorie without plants.  The food at the top of each section contains more of the nutrients that are harder to find per calorie.

Screenshot 2018-03-21 04.14.43.png

The nutrient profile of these foods is shown in the chart below.

Screenshot 2017-12-26 06.12.13.png

Carnivore / zero carb (diabetes friendly)

The problem with the nutrient dense carnivore approach is that it contains a lot of protein (63%).  This may drive satiety (meaning it will be hard to get enough calories in) or potentially be problematic for someone dosing with insulin due to the insulinogenic nature of the protein.  The foods below contain more fat which will make it easier to get adequate energy as well as reduce insulin requirements.

Screenshot 2018-03-21 04.23.03.png

The nutrient profile of these foods is shown below (i.e. more fat, less protein and lower micronutrients per calorie).

Screenshot 2017-12-26 07.54.40.png

Autoimmune & SIBO

Many people who benefit from a carnivorous have messed up digestion and/or autoimmune issues.  If you don’t want to go full carnivore, the food list below removes the most inflammatory foods and foods that commonly cause digestive issues while still contain a lot of nutrients.

The nutrient profile of these foods is shown below.

Autoimmune (low carb)

The food list below will provide nutrients with more fat which will enable you to get enough energy.

The nutrient profile of these foods is shown below.

Screenshot 2017-12-28 05.20.33.png

nutrient dense

For comparison, the most nutrient-dense foods are shown below.

The nutrient profile of these foods is shown below.  Keep in mind that these are the nutrients contained in the food and some of these nutrients will be less bioavailable.

 

Thanks

Special thanks to Shawn Baker, Robb Wolf, Alex Leaf, Amber O’Hearn, Dave Feldman, Robin Reyes, Helen Kendall and Raphi Sirt for their input and review into this article.

 

References

[1] http://www.getbig.com/boards/index.php?topic=574036.0

[2] https://www.inquisitr.com/2083582/carnivore-family-has-eaten-a-zero-carb-all-beef-diet-for-the-past-17-years/

[3] https://gistonice.wordpress.com/2015/05/11/when-eating-only-meat-becomes-a-way-of-life-family-lives-on-only-meat-for-the-past-17-years/

[4] http://www.getbig.com/boards/index.php?topic=574036.0

[5] https://zerocarbzen.com/tag/lyme-disease/

[6] https://thenortheasttoday.com/anderson-family-on-meat-diet-for-17-years/

[7] https://www.breaknutrition.com/episode-17-dr-shawn-baker-lifts-like-crane-eats-like-lion/

[8] https://www.ncbi.nlm.nih.gov/pubmed/11176761

[9] https://www.thebloodcode.com/know-your-tghdl-ratio-triglyceride-hdl-cholesterol/

[10] https://optimisingnutrition.com/2015/03/22/diabetes-102/

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

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

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

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

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

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

[17] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4424466/

[18] http://downloads.hindawi.com/journals/jeph/2012/727630.pdf

[19] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195546/

[20] https://www.ncbi.nlm.nih.gov/pubmed/2224920/

[21] https://www.facebook.com/groups/OKL4Vitality/permalink/677232549136149/?hc_location=ufi

[22] https://www.facebook.com/groups/OKL4Vitality/permalink/652513618274709/?hc_location=ufi

[23] https://chrismasterjohnphd.com/2016/12/09/the-ultimate-vitamin-k2-resource/

[24] https://www.ncbi.nlm.nih.gov/pubmed/17440529

[25] jn.nutrition.org/cgi/content/full/129/7/1434S

[26] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2635914/

[27] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4273949/

[28] http://roguehealthandfitness.com/hormesis-health/

[29] http://www.organiclifestylemagazine.com/sulforaphane-why-your-cells-need-cruciferous-vegetables

[30] http://breaknutrition.com/ketogenic-diet-vitamin-c-101/

[31] https://www.nrv.gov.au/nutrients/manganese

[32] https://www.nrv.gov.au/nutrients/vitamin-e

[33] https://www.nrv.gov.au/nutrients/calcium

 

Post updated April 2018.

how to optimise the insulin load of your diet

Insulin is the primary hormone that controls your metabolism.

You need some to survive.

Image result for insulin

But too much can be bad news.

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Insulin helps drive amino acids into your muscles to help them grow.

Image result for muscles

Insulin helps glucose enter the cells to fuel your mitochondria to produce energy.

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Meanwhile, insulin also works as a brake to keep energy in storage.

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When you eat, your pancreas secretes insulin to slow the release of energy from body fat stores through your liver until the energy coming in from your mouth and in your bloodstream are used up.

How do we become insulin resistant?

I don’t know about you, but I find it hard to resist the yummy food that always seems to be available.

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We no longer have to hunt or gather our food.  It is always available, relatively cheap and flavoured to ensure we can easily eat lots of it.

In our modern food environment, it’s hard to ‘eat to satiety’ without usually eating a little bit too much.  It’s like we’re saving for a winter that never comes.

Image result for overfull fuel gauge

Then, to make it even harder, the food industry optimises their products for ‘bliss point’ (with just the right amount of sugar, salt, fat and artificial colours and sweeteners) and creates hyper-palatable foods to drive profit.

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Unfortunately, this all has an impact on more than just our taste buds.

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Eventually, as you continue to consume more energy than you can use, your fat stores become inflamed and can’t take in any more energy.[1] [2]

Your pancreas ramps up its efforts to hold back the pressure of excess energy in our liver and body fat stores.[3] [4]

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If excess energy keeps coming in, the pancreas re-doubles its efforts to clear the glucose from the blood with more and more insulin.

First, the fat stores become full, then the bloodstream and eventually insulin drives the excess energy into other areas in the body that are still insulin sensitive such as your liver, heart, pancreas, eyes and brain.

Over the long term, this combination of high insulin levels and high energy leads to heart disease, fatty liver, Alzheimer’s, Parkinson’s and a whole host of modern diseases.[5] [6] [7]

Type 1 diabetes

People with type 1 diabetes, like my wife Monica, give us an opportunity to understand how insulin works.

The picture below shows “JL” one of the first type 1 diabetics to receive insulin treatment in 1922.  The picture on the left is after diagnosis with diabetes but before treatment with insulin.  The photo on the right is the same child two months.

With insulin injections, he can stop the uncontrolled release of his fat and muscle stores and quickly put weight back on.

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For reasons we don’t fully understand, the pancreas can stop producing insulin.  People with type 1 diabetes need to inject insulin to “cover” the food they eat as well as “basal insulin” to mimic what a healthy pancreas does automatically between meals.

Wise food choices are critical to stabilising blood sugar levels.  Foods that require a significant amount of insulin tend to cause large swings in blood sugar levels.

If your blood levels are high, you will feel tired and will need to take a large dose of insulin to slow the release of glucose from your liver.

If your blood sugars are low, you will feel the need to eat food, preferably something sweet to raise your blood sugars quickly!

It’s hard to control your appetite with these rollercoaster-like swings in blood glucose like the one shown in the chart below.  Our appetite and survival instincts are strong, and we will eat to raise our blood glucose levels to feel good again.

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daily blood sugar data of type 1 diabetic on typical western diet

Foods with a lower insulin load allow people with type 1 diabetes to smooth out their blood sugar swings and stabilise their food cravings.

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daily blood sugar data for the same person with type 1 diabetes on a low carb diet

Type 2 diabetes

While the cause of the disease is different, people with type 1 and type 2 diabetes are in a similar situation.  They both have an overall insulin insufficiency.  People with type 1 don’t produce enough insulin and need to inject insulin.

The insulin resistance in people with type 2 diabetes means that their pancreas cannot produce enough insulin to keep their blood sugar levels stable.   Their fat stores cannot hold all the energy in the system, so it spills out into the bloodstream, and we see elevated blood glucose levels.

For people with type 2 diabetes, reducing the insulin load of the food they eat will enable their pancreas to keep up to maintain more stable blood sugars.  Once the wild swings of glucose and insulin stabilise, it is often easier to go longer between meals or make better food choices.

Insulin sensitivity

While insulin resistance and diabetes are often associated with obesity, you can be fat and still have normal blood sugars and be insulin sensitive.

image6

People who are insulin sensitive can easily store energy in their adipose tissue and release energy easily later when they are not eating.

Their fat stores of insulin sensitive people are still functioning well.  They take in energy from the food they eat and relatively quickly release it when they are not eating.[8]

If you are insulin sensitive with stable blood sugar levels and want to lose body fat you will probably do well if you focus on eating foods with a higher nutrient density and a lower energy density.  However, if you are insulin resistant, you will likely also benefit from eating foods with a smaller insulin load, at least until your blood sugars stabilise.

Which approach is best for you?

Nutrition is complex, and there is still a lot of disagreement about the role that insulin resistance plays in health and weight loss.  However ultimately, most of us are trying to hack our system to get the nutrients we need without excessive energy.

The Nutrient Optimiser algorithm considers your blood sugars, HbA1c, triglyceride:HDL ratio and waist:height ratio to optimise your blood sugars are while also maximising nutrient density as much as possible.

The food insulin index data

Now we’re going to take a quick look under the hood of the Nutrient Optimiser algorithm to see how the insulin load parameter works.

The chart below shows the relationship between the carbohydrate content of our food and our insulin response.[9] [10] [11] [12]

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carbohydrates vs insulin response (click to enlarge)

The quantity of carbohydrate in your diet explains the majority of your insulin response.  However, if you look carefully in the bottom left corner of the chart above, you will see that there are high protein foods that cause a large insulin response and high fibre foods that cause a smaller insulin response.

Once we account for the effect of fibre and protein, we get a much better prediction of our insulin response to food.  This understanding of the various factors that influence insulin response enables you to prioritise foods that cause a smaller insulin response, as well as more accurately calculate insulin dosing for people with diabetes.

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insulin load (carbohydrates – fibre + 0.56 * protein) vs insulin response

If you are injecting insulin to manage your diabetes then understanding how to quantify the insulin load of your diet can help you more accurately calculate your insulin dose (as detailed in this post).  If you require therapeutic ketosis, you can also identify foods that will minimise your insulin response.

Protein

While protein does require some insulin to build and repair our muscles, the chart below shows us that increasing the proportion of energy from protein will typically force out processed carbohydrates and trigger a lower insulin response.

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Higher levels of protein also tend to generate a smaller glucose response compared to carbohydrates.

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It’s also important to note that protein is the most satiating macronutrient.  If you want to reduce your energy intake without having to meticulously track calories and without excessive hunger it’s important not to avoid protein.  Reducing the amount of energy in your diet will allow the energy in your bloodstream (i.e. glucose, ketones and free fatty acids) to be used up and your insulin levels will come down even further.  

Fat

Obtaining more of your energy from fat will decrease your insulin response…

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…as well as your glucose response.

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However, keep in mind that, as well as the food you eat, your insulin levels are influenced by the food you eat as well as the amount of energy already in your system.

High-fat foods are often energy dense and easy to overeat.  Your pancreas will still need to elevate insulin levels while your body uses up the energy from your diet, so they can still drive insulin resistance if eaten to excess.

The insulin load is a great tool to manage the short-term volatility of your blood sugar levels.  However, if you look at the big picture, lower insulin levels correspond to lower energy in your system (i.e. from your diet and body fat).

Once your blood sugars are stable, it may be prudent to focus on reducing the fat in your diet if you want to use your excess body fat.  This will help to further reduce your blood sugars and insulin levels floating around in your blood towards optimal levels.

Insulin load vs nutrient density

Like many things in life, there is a trade-off as we push things to extremes.  The chart below shows that we tend to optimise nutrient density with about 40% insulinogenic calories.[13]

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If you are insulin resistant, you will probably do better if you maintained less than 40% insulinogenic calories.   If you have diabetes, then you’ll probably need to stay below 25% insulinogenic calories.  If you require a therapeutic ketogenic diet (i.e. for the treatment of cancer, epilepsy, Alzheimer’s, dementia or Parkinson), then you will need to maintain a very low insulin load, which typically means consuming more fat and even reducing your protein intake.

It may not be ideal to maintain such a low insulin load for a long time.  The more you push the insulin load of your diet to either extreme the more you will compromise your micronutrient profile.

What do I do with all this information?

While you may find all this detail a little confusing, you don’t have to worry too much about all the numbers.

We have designed the Nutrient Optimiser algorithm to calculate your target macronutrient ranges to suit your goals and suggest foods and meals that will help you keep your blood sugars stable and normalise your insulin levels while also maximising the nutrient content of your diet.

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Once you attain normal blood sugars, you will ‘level up’ to the next stage of your nutritional journey.

Stay tuned…

In our next instalment, where we will discuss how we can manage the energy density of your food to enable you to get more calories in if you are running a marathon, or help you to feel more satiated with less energy if you are trying to lose weight.

image6

 

 

References

[1] https://www.ncbi.nlm.nih.gov/pubmed/25733684

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

[3] https://www.youtube.com/watch?v=i2WRi7mP1ck

[4] https://www.youtube.com/watch?v=Cdork0TA90U

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

[6] https://optimisingnutrition.com/2015/03/22/diabetes-102/

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

[8] https://en.wikipedia.org/wiki/Metabolically_healthy_obesity

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

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

[11] https://www.researchgate.net/profile/Peter_Petocz/publication/13872119_Holt_SHA_Brand_Miller_JC_Petocz_P_An_insulin_index_of_foods_the_insulin_demand_generated_by_1000-kJ_portions_of_common_foods_Am_J_Clin_Nutr_66_1264-1276/links/00b495189da41714fa000000.pdf/download?version=vs

[12] https://ses.library.usyd.edu.au/handle/2123/11945

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

[14] https://examine.com/nutrition/low-fat-vs-low-carb-for-weight-loss/

[15] https://www.sciencedirect.com/science/article/pii/S1551714416302166

[16] http://onlinelibrary.wiley.com/doi/10.1002/oby.21331/full

[17] https://drruscio.com/high-carb-low-carb-science-actually-says-episode-43/

How to maximise nutrient density

We surveyed the Nutrient Optimiser Facebook Group to see what they wanted to learn more about.

Overwhelmingly, the most requested topic was nutrient density.

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Given that nutrient density is the central component of the Nutrient Optimiser algorithm, it’s the perfect place to start this educational series.

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Managing nutrient density ensures you get all the micronutrients you need without too much energy.

This short article will give you an understanding of what “nutrient density” means, why it is important and how you can use the Nutrient Optimiser to improve your diet.

Macronutrients

Most of the time people think in terms of the macronutrients:

  • protein,
  • carbohydrates,
  • fat, and
  • fibre).

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While consideration of macronutrients can be useful, it doesn’t do much to ensure we are obtaining the micronutrients that we need.

Many get enthusiastic about specific macronutrient ratios (e.g. high fat, low carb, low protein, low fat etc.).  Unfortunately, poorly defined macronutrient extremes can be detrimental to your micronutrient profile.  But when you focus on micronutrients,, macronutrients largely look after themselves.

Essential Micronutrients

There is a wide range of compounds in our food that we are adapted to thrive on.  But it’s the essential nutrients that we can’t make from other sources that we need to get from our food.

These essential micronutrients are listed below, divided into their categories of vitamins, minerals, amino acids and essential fatty acids.

vitamins

  • choline
  • thiamine
  • riboflavin
  • niacin
  • pantothenic acid
  • vitamin A
  • vitamin B12
  • vitamin B6
  • vitamin C
  • vitamin D
  • vitamin E
  • vitamin K

minerals

  • calcium
  • copper
  • iron
  • magnesium
  • manganese
  • phosphorus
  • potassium
  • selenium
  • sodium
  • zinc

amino acids

  • cysteine
  • isoleucine
  • leucine
  • lysine
  • phenylalanine
  • threonine
  • tryptophan
  • tyrosine
  • valine
  • methionine
  • histidine

essential fatty acids

  • eicosapentaenoic acid (EPA)
  • docosahexaenoic acid (DHA)

There are conditionally essential nutrients, beneficial nutrients and other compounds that we are aware of but don’t measure.  There’s no need to worry too much about these other substances.

If you are eating minimally processed whole foods with plenty of the essential micronutrients, you’ll likely be getting more than enough of all the other beneficial nutrients.

Recommended daily intake levels

Recommended daily intake levels of the essential nutrients have been established for both sexes at various life stages (i.e. pregnant, young or old).

These recommended intake levels are typically based on the amount that is required to prevent nutrient deficiencies.  It’s usually better to get more than the minimum amount of the essential nutrients where possible.

While supplements can be a useful stop-gap measure, we strongly recommend obtaining more of your nutrients from whole foods which contain all the other beneficial nutrients.

The Nutrient Optimiser will help you determine which nutrients you are currently not getting enough of and which foods and meals will help you fill your micronutrient gaps.

Emphasising the harder-to-find nutrients

Building on the previous work of the likes of Bruce Ames, Joel Fuhrman and Mat Lalonde, the Nutrient Optimiser algorithm focuses on boosting only the nutrients that you are not getting as much of.

If a particular group of nutrients is easy to find or you are already getting heaps of them, there’s no need to focus on trying to get more of them.

The Nutrient Optimiser helps you to rebalance your diet by focusing on the foods that contain the nutrients you are not getting enough of.

The purple bars in the chart below show the nutrients in all the foods in the USDA food database.

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As you can see, some micronutrients are easier to find than others.  Nutrients such as vitamin C, vitamin K and vitamin B12 are generally easy to get enough of while nutrients such as choline, calcium, magnesium and potassium are harder to find.

The light blue bars show the nutrients in the highest ranking 10% of foods in the USDA database when we focus on boosting the nutrients that are harder to find.

We get a massive boost in the nutrients that are harder to find while still getting plenty of the other nutrients.

Nutrient ratios

The Nutrient Optimiser algorithm also looks at the balance between nutrients that operate synergistically.

While the quantity of nutrients is important, the ratio between key nutrients also needs to be considered.  If the nutrient ratios fall outside the target range, they don’t get prioritised.

ratios

target

Zinc : Copper

8 – 12

Potassium : Sodium

> 2

Calcium : Magnesium

 < 2

Iron : Copper

10 – 15

Calcium : Phosphorus

> 1.3

By doing this, the Nutrient Optimiser guides you to eat more of the foods that will help to improve your nutrient balance as well as getting more nutrients per calorie.

Your appetite is the original and ultimate Nutrient Optimiser

The human taste buds have evolved to be the ultimate Nutrient Optimiser, telling you which foods and nutrients you need at a particular point in time.

Wild animals seek out the foods they need at a particular point in time.  Similarly, in the absence of processed hyper-palatable flavoured foods, our cravings guide us to the foods we need.

However, these days, in our modern food environment we have lost the ability to determine what we need.  Our appetite has been tricked into eating foods that look and taste amazing. However, these manufactured foods often contain negligible nutrients.

The Nutrient Optimiser will help you to shortlist foods and meals that contain the nutrients.  Once you’re eating real food that contains nutrients, you can learn to trust your appetite again.

Personalised for you

We have put a lot of effort into developing optimal food lists for different contexts.

  • We can prioritise the nutrients that are harder to find in the USDA foods database.
  • We can prioritise the nutrients that are associated with various health conditions.
  • We can prioritise nutrients that are harder to find in conventional dietary patterns (e.g. ketogenic, low carb, paleo, plant-based, standard western diet, vegan etc.).
  • We can even prioritise the nutrients that most people are missing out on.

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But none of these approaches considers what YOU are eating now and what nutrients you personally need more of.

That’s why we created the Nutrient Optimiser.

The Nutrient Optimiser can use your food log (exported from Cronometer) to identify the nutrients that you are not getting enough of.

The Nutrient Optimiser algorithm then creates your personalised nutritional solution to identify the foods and meals that will fill your current nutritional gaps.

This is truly personalised nutrition, optimised for YOU.

What YOU should eat

Rather than stressing about what NOT to eat, the Nutrient Optimiser helps you focus on what you SHOULD be eating to optimise your diet from first principles.

Once you are getting your fill of the foods that you should be eating, our cravings for the other foods tend to dissipate.  Worrying about what not to eat becomes a non-issue.

One common observation from people who have used the Nutrient Optimiser to refine their food choices is how little food they need to be satisfied.

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Once you solve satiety, optimal weight and body fat levels often look after themselves.

Nutrient density is central

Nutrient density is central to the Nutrient Optimiser algorithm.  However, it is not the only parameter.

The Nutrient Optimiser algorithm also considers:

  • insulin load (to help tweak your diet if you are insulin resistant or have diabetes), and
  • energy density (which can be useful to make your diet even more satiating, so more fat can come from your body).

We’ll cover these other parameters in the following articles.

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nutrient density optimised for diabetes, ketosis, weight loss, longevity and performance

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