optimising protein and insulin load

  • “Low carb”, “ketogenic” or “nutrient dense” mean different things to different people. Defining these terms numerically can help us to choose the right tool for the right application.
  • Decreasing the insulin load of your diet can help normalise blood glucose levels and enable your pancreas to keep up. However, at the same time a high fat therapeutic ketogenic approach is not necessarily the most nutrient dense option, and may not be optimal in the long term, particularly if your goal is weight loss.
  • Balancing insulin load and nutrient density will enable you to identify the right approach for you at any given point in time.
  • This article suggests ideal macro nutrient, protein and insulin load, and carbohydrate levels for different people with different goals to use as a starting point as they work to optimise their weight and / or blood glucose levels.

context matters

Since I started blogging about the concepts of insulin load and proportion of insulinogenic calories many people have asked:

“What insulin load should I be aiming for?” 

Unfortunately, it’s hard to give a simple answer without some context.

The answer to this question depends on a person’s current metabolic health, age, activity level, weight, height and goals etc.

This post is my attempt to provide an answer with some context.

image16

disclaimers

Full disclosure…  I don’t like to measure the food I eat.  I have developed the optimal foods lists to highlight what I think are the best foods to suit different goals and levels of metabolic health.

I think food should be nutritious and satiating.  If you goal is to lose weight it will be hard to overeat if you limit your food choices to things like broccoli, celery, salmon and tuna.

At the same time, some people like to track their food.  Tracking food with apps like MyFitnessPal or Cron-O-Meter can be useful for a time to reflect and use as a tool to help you refine your food choices.  If you’re preparing for a bodybuilding competition you’re probably going to need to track your food to temporarily override your body’s survival to force it to shed additional weight.

Ideal macronutrient balance is a contentious issue and a lot has already been said on the topic.  I’ll try to focus on what I think I have to add to the discussion around the topics of insulin load and nutrient density.

If you want to and skip the detail in the rest of this article, this graphic from Dr Ted Naiman does a good job of summarising optimal foods and ideal macronutrient ranges.   If you’re interested in more detail on the topic, then read on.

image17

insulin is not the bad guy

The insulin load formula was designed to help us more accurately understand the insulin response to the food we eat, including protein and fibre.

insulin load = total carbohydrates – fibre + 0.56 * protein

The first thing to understand is that insulin per se is not bad.  Insulin is required for energy metabolism and growth.  People who can’t produce enough insulin are called Type 1 Diabetics and typically don’t last long without insulin injections after they catabolise their muscle and body fat.

Insulin only really becomes problematic when we have too much of it (i.e. hyperinsulinemia[1]) due to excess processed carbohydrates (i.e. processed grains, added sugar and soft drinks) and/or a lack of activity which leads to insulin resistance.

The concepts of insulin load and proportion of insulinogenic calories can provide us with a better understanding of how different foods trigger an insulin response and how to quantitatively optimise the insulin load of our diet to suit our unique situation and goals.

image20

different degrees of the ketogenic diet

Words like “ketogenic”, “low carb” or “nutrient dense” mean different things to different people.   This is where using numbers can be useful to better define what we’re talking about and tailor a dietary approach.  For clarity, I have numerically defined a number of terms that you might hear.

image18

ketogenic ratio

The therapeutic ketosis community talk about a “ketogenic ratio” such as 3:1 or 4:1 which means that there are three or four parts fat (by weight) for every part protein plus carbohydrate.[2]

For example, a 3:1 ketogenic diet may contain 300g of fat plus 95g of protein with 5g of carbs.  This ends up being 87% fat.  A 4:1 ketogenic ratio is an even more aggressive ketogenic approach that is used in the treatment of epilepsy,[3] cancer or dementia and ends up being 90% fat.

These levels of ketosis is hard to achieve with real food and is hard to sustain in the long term.  Hence, it is typically used as a short term therapeutic treatment.

ratio of fat to protein

People in the ketogenic bodybuilding scene (e.g. Keto Gains) or weight loss might talk about a 1:1 ratio of fat to protein (by weight) for weight loss.    A diet with a 1:1 ratio of fat to protein could be 120g of fat plus 120g of protein.  If we threw in 20g of carbs this would come out at 66% fat (which is still pretty high by mainstream standards).   A 1:2 protein:fat ratio would end up being around 80% fat.

protein grams per kilogram of lean body weight

Some people prefer to talk in terms of terms of percentages or grams of protein per kilo of lean body mass.  For example:

  • The generally accepted minimum level of protein is 0.8g/kg/day of lean body mass to prevent malnutrition.[4] This is based on a minimum requirement of 0.6kg to maintain nitrogen balance and prevent diseases of malnutrition plus a 25% or two standard deviations safety factor.[5]
  • In the Art and Science of Low Carb Performance Volek and Phinney talk recommend consuming between 1.5 and 2.0g/kg of reference body weight (i.e. RW). Reference weight is basically your ideal body weight say at a BMI of 25kg/m2.  So, 1.5 to 2.0kg RW equates to around 1.7 to 2.2g/kg lean body mass (LBM).
  • There is also a practical maximum level where people just can’t eat more lean protein (i.e. rabbit starvation[6]) which kicks in at around 35% of energy from protein.

The table below shows a list of rule of thumb protein quantities for different goals in terms of grams per kilogram of lean body mass and as a percentage of calories assuming weight maintenance.[7]

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

gluconeogenesis

You may have heard that body will convert ‘excess protein’ to glucose via gluconeogenesis, particularly if there is minimal carbohydrates in the diet and/or we can’t yet use fat for fuel.

For some people this is a concern due to elevated blood glucose levels, but it may also mean that more protein is required because so much is being converted to glucose that you need more to maintain muscles growing your muscles.  As we become more insulin sensitive we may be able to get away with less protein because we are using it better (i.e. we are growing muscles rather than making glucose).

Most people eat more than the minimum level of protein to prevent malnutrition.  People looking to gain muscle mass will require higher levels.  Although keep in mind you do need to be exercising to gain muscle, not just eating protein.

Ensuring adequate protein and exercise is especially important as people age.  Sarcopenia is the process of age related muscle decline which is exacerbated in people with diabetes.

Sadly, many old people fall and break their bones and never get up again.   When it comes to longevity there is a balance between being too big (high IGF-1) and too frail (too little IGF-1).

image03

carbohydrate counting

Then there is carb counting.

  • People on a ketogenic approach tend to limit themselves to around 20g (net?) carbohydrates.
  • Low carbers might limit themselves to 50g carbs per day.
  • A metabolically healthy low carb athlete might try to stay under 100g of carbs per day.

Limiting non-fibre carbohydrates typically eradicates most processed foods (e.g. sugar, processed grains, sodas etc).   Nutrient density increases as we decrease the amount of non-fibre carbohydrates in our diet.

image01

protein, insulin load and nutrient density

In the milieu of discussion about protein I think it’s important to keep in mind that minimum protein levels to prevent the diseases of malnutrition may not necessarily optimal for health and vitality.

Protein is the one macronutrient that correlates well with nutrient density.  Foods with a higher percentage of protein are typically more nutrient dense overall.

image22

Considering minimum protein levels may be useful if you are looking to drop your energy intake to the bare minimum and while still providing enough protein to prevent loss of lean muscle mass (e.g. a protein sparing modified fast).   However, if you are looking to fill up the rest of your energy intake with fat for weight maintenance then you should be aware that simply eating foods with a higher proportion of fat will not help you maximise nutrient density.

Practically though very high levels of protein will be difficult to achieve because they are very filling, thus it is practically difficult to eat more than around 35% of your energy from protein.  Protein is also an inefficient fuel source meaning that you will lose around 25% of the calories just digesting and converting it to glucose via digestion and gluconeogenesis.

If you are incorporating fasting then I think you will need to make sure you are getting at least the minimum as an average across the week, not just on feasting days to maintain nitrogen balance.  That is,  you might need to try to eat more protein on days you are eating.

what is ketosis?

“Ketogenic” simply means “generates ketones”.

An increase in ketosis occurs when there is a lack of glucogenic substrates (i.e. non-fibre carbohydrates and glucogenic protein).  It’s not primarily about eating an abundance of dietary fat

I think reducing insulin load (i.e. the amount of food that we eat that requires insulin to metabolise), rather than adding dietary fat, is really where it’s at if you’re trying to ‘get into ketosis’.   We can simply wind down the insulin load of our diet to the point that out blood glucose and insulin levels decrease and we can more easily access our stored body fat.

insulin load = total carbohydrates – fibre + 0.56 * protein

Whether a particular approach is ketogenic (i.e. generates ketones) will depend on your metabolic health, activity levels and insulin resistance etc.

Whether you want to be generating ketones from the fat on your excess belly fat rather than your plate (or coffee cup) is also an important consideration if weight loss is one of your goals.

While people aiming for therapeutic ketosis might want to achieve elevated ketone levels by consuming more dietary fat, most people out there are just looking to lose weight for heath and aesthetic reasons.  For most people, I think the first step is to reduce dietary insulin load until they achieve normalised blood glucose levels (i.e.  average BG less than 5.6mmol/L or 100mg/dL, blood ketones greater than 0.2 mmol/L).   People with diabetes often call this “eating to your meter”.

Once you’ve achieved normal blood glucose levels and some ketones the next step towards weight loss is to increase nutrient density while still maintaining ketosis.  Deeper levels of ketosis do not necessarily mean more fat loss, particularly if if you have to eat gobs of eating processed fat to get there.

Ray Cronise and David Sinclair recently published an article “Oxidative Priority, Meal Frequency, and the Energy Economy of Food and ACtivity:  Implications for Longevity, Obesity and Cardiometabolic Disease”  which does an interesting job of looking at the ‘oxidative priority’ of various nutrient and demonstrate that the body will burn through nutrients in the following order:

  1. alcohol,
  2. protein (not used for muscle protein synthesis),
  3. non fibre carbohydrate, and then
  4. fat.

What this suggests to me is that if you want to burn your own body fat you need to minimise the alcohol, protein and carbohydrate which will burn first.  To me this is another angle on the idea that insulin levels are the signal that stops our body from using our own body fat in times of plenty.   And if we want to access our own body fat we need to reduce the insulin load of our diet to the point we can release our own body fat.

insulin load versus nutrient density

The risk however with the insulin load concept is that people can take things to extremes.  If our only objective is to minimise insulin load we’ll end up just eating bacon, lard, MCT, olive oil… and not much else.

image05

In his “Perfect Health Diet” book Paul Jaminet talks about “nutrient hunger”, meaning that we are more likely to have an increased appetite if we are missing out on a particular nutrients.  He says

“A nourishing, balanced diet that provides all the nutrients in the right proportions is the key to eliminating hunger and minimising appetite.“

In the chart below shows nutrient density versus proportion of insulinogenic calories.  The first thing to note is that there is a lot of scatter!  However, on the right-hand side of the chart there are high carb soft drinks, breakfast cereals and processed grains that are nutrient poor.  But if we plot a trendline we see that nutrient density peaks somewhere around 40% insulinogenic calories.

image14

If you are metabolically challenged, you will want to reduce the insulin load of your diet to normalise blood glucose levels.  But if you reduce your insulin load too much you end up living on purified fats that aren’t necessarily nutrient dense.

If we are trying to avoid both carbohydrates and protein we end up limiting our food choices to macadamia nuts, pine nuts and a bunch of isolated fats that aren’t found in nature in that form.  Rather than living on copious amounts of refined oils I think we’re in much safer territory if we maximise nutrient density with whole foods while still maintaining optimal blood glucose levels.

The chart below shows the proportion of insulinogenic calories for the highest-ranking basket of foods (i.e. top 10% of the foods in the USDA foods database) for a range of approaches, from the low insulin therapeutic ketosis, through to the weight loss foods for someone who is insulin sensitive and a lot of fat is coming from their body.  At one end of the scale a therapeutic ketogenic may only contain 14% insulinogenic calories while a more nutrient dense approach might have more than half of the food requires insulin to metabolise.

image11

macronutrient splits

It’s one thing to set theoretical macronutrient targets, but real foods don’t come in neat little packages of protein, fat and carbohydrates.  The chart below shows the macronutrient split of the most nutrient dense 10% of foods for each of the four nutritional approaches.  The protein level for the weight loss approach might seem high but then once we factor in an energy deficit from our body fat it comes back down.

image06

In reality you’re probably not going to be able to achieve weight maintenance if you just stick to the nutrient dense weight loss foods.  You’ll either become full and will end up using your stored body fat to meet the energy deficit or you will reach for some more energy dense foods to make up the calorie deficit.  If you look at the macronutrient split of the most nutrient dense meals for the different approach you find they are lower in protein and higher in fat as shown in the chart below.

2016-12-03-3

nutrient density

The chart below shows the percentage of the daily recommended intake of essential vitamins, minerals, amino acids and fatty acids you can get from 2000 calories for each of the approaches.

image04

You can meet most of your nutritional requirements with a therapeutic ketogenic diet, however you’ll have to eat enough calories to maintain your weight to prevent nutritional deficiencies.

As you progress to the more nutrient dense approaches you can meet your nutrient requirements with less energy intake.   The beauty of limiting yourself to nutrient dense whole foods is that you can obtain the required nutrition with less energy and you’ll likely be too full to overeat.

As far as I can see the holy grail of nutrition,  health and longevity is adequate energy without malnutrition.

If we look in more detail we can see that the weight loss (blue) and nutrient dense approaches (green) provide more of the essential micronutrients across the board, not just amino acids.

image02

While the protein levels in the “weight loss” and “most nutrient dense” approaches are quite high, keep in mind that the food ranking system only prioritises the nutrients that are harder to obtain.

The table below shows the various nutrients that are switched on in the food ranking system for each approach.

image07

This table shows the number of vitamins, minerals, amino acids and fatty acids counted for each approach.

image00

In the weight loss and nutrient dense approach, of the twelve essential amino acids, only Tyrosine and Phenylalanine has been counted in the density ranking system.

It just so happens that protein levels are high in whole foods that contain essential vitamins, minerals and fatty acids. 

It appears that if you set out to actively avoid protein it may be harder to get other essential nutrients.  The risk here is that you may be setting yourself up for nutrient hunger, and rebound/stall inducing cravings in the long term as your body becomes depleted of the harder to obtain nutrients.

choosing the right approach for you

I believe one of the key factors in determining which nutritional approach is right for you is your blood glucose levels which gives you an insight into your insulin levels and insulin sensitivity.

As shown in the chart below, if your blood glucose levels are high then it’s likely your insulin levels are also high which means you will not be able to easily to access your fat stores.  I have also created this survey which may help you identify whether you are insulin resistant and which foods might be ideal for you right now.

image19

While you may need to start out with a higher fat approach, as your glucose levels decrease and ketone levels rise a little you will be able to transition to more nutrient dense foods.

The table below shows the relationship between HbA1c, glucose, ketones and GKI.   Once you are getting good blood glucose levels you can start to focus more on nutrient density and weight loss.

 Risk level HbA1c average blood glucose ketones GKI
 (%)  (mmol/L)  (mg/dL)  (mmol/L)
low normal 4.1 4.0 70 5.5 0.7
optimal 4.5 4.6 83 2.5 1.8
excellent < 5.0 < 5.3 < 95 > 0.2 < 30
good < 5.4 < 6.0 < 108 < 0.2
danger > 6.5 7.8 > 140 < 0.2

more numbers

The table below shows what the different nutritional approaches look like in terms of:

  • ketogenic ratio
  • ratio of fat to protein
  • protein (g)/kg LBM
  • insulin load (g/kg LBM)
approach keto ratio fat : protein protein g/LBM insulin load (g/LBM)
therapeutic ketosis 1.8 2.2 1.0 0.9
diabetes 0.9 1.0 1.8 1.5
weight loss (incl. body fat) 0.5 0.6 2.5 2.4
nutrient dense 0.3 0.3 3.0 2.8

The 1.0g/kg LBM for therapeutic ketosis is greater than the RDA minimum of 0.8g/kg LBM so will still provide the minimum amount while still being ketogenic.  It’s hard to find a lot of foods that have less than 1.0g/kg LBM protein in weight maintenance without focussing on processed fats.

At the other extreme most nutrient dense foods are very high in protein but this might also be self-limiting meaning that people won’t be able to eat that much food.  As mentioned earlier, it will be hard to eat enough of the nutrient dense foods to maintain your current weight.  Either you will end up losing weight because you can’t fit as much of these foods in or reaching more energy dense lower nutrient density foods.  Also, if you found you were not achieving great blood glucose levels and some low-level ketones with mean and non-starchy veggies you might want to retreat to a higher fat approach.

The table below lists optimal foods for different goals from most nutrient dense to most ketogenic.    Hopefully over time you should be able to work towards the more nutrient dense foods as your metabolism heals.

dietary approach printable .pdf
weight loss (insulin sensitive) download
nutrient dense (maintenance) download
weight loss (insulin resistant) download
diabetes and nutritional ketosis download
therapeutic ketosis download

what about mTOR?

Many people are concerned about excess protein causing cancer or inhibiting mTOR (Mammalian Target of Rapamycin).[8]  [9]

From what I can see though, the story with mTOR is similar to insulin.  That is, constantly elevated insulin or constantly stimulated mTOR are problematic and cause excess growth without being interspersed with periods of breakdown and repair.

Our ancestors would have had times when insulin and mTOR were low during winter or between successful hunts.  But during summer (when fruits were plentiful) or after a successful hunt, insulin would be elevated and mTOR suppressed as they gorged on the nutrient dense bounty.

These days we’re more like the futuristic humans from Wall-E than our hunter gather ancestors.   We live in a temperature controlled environment with artificial lighting and tend to put food in our mouths from the moment we wake up to the time we fall asleep.[10]

image15

Rather than chronic monotony (e.g. eating five or six small meals per day every day), it seems that periods of growth (anabolism) and breakdown and cleaning (catabolism) are optimal to thrive in the long term.  We need periods of both.  One or the other chronically are bad news.

image00

As my wise friend Raymund Edwards from Optimal Ketogenic Living says

“FAST WELL, FEED WELL.” 

image21

how much protein?

Optimal protein levels are a contentious topic.  There is research out there that says that excess protein can be problematic from a longevity perspective.  Protein promotes growth, IGF-1, insulin and cell turnover which can theoretically compromise longevity.  At the same time, there are plenty of studies that indicate that we need much more protein than the minimum RDI levels.[11]

image09

In the end, you need to eat enough protein to prevent loss of lean muscle and maintain strength.  If you’re trying to build lean muscle and working out, then higher levels of protein may be helpful to support muscle growth.  If you are trying to lose weight, then higher levels of protein can be useful to increase satiety and prevent loss of lean muscle mass.  Maintaining muscle mass is critical to keeping your metabolic rate high and avoiding the reduction that can come with chronic restriction.[12] [13]

In addition to building our muscles, protein is critical for building our bones, heart, organs and providing many of the neurotransmitters required for mental health.  So protein from real whole foods is generally nothing to be afraid of.  It’s typically the processed high carb foods that make the detrimental impact on  insulin and blood glucose levels.

The table below shows a starting point for protein in grams depending on your height.  This assumes that someone with a lean body mass (LBM) of 80 kg is burning 2000 calories per day and your lean body mass equates to a BMI of 20 kg/m2.  LBM is current weight minus fat mass minus skeletal mass which again is hard to estimate without a DEXA.

There are a lot of assumptions here so you will need to take as a rule of thumb starting point and track your weight and blood glucose levels and refine accordingly.  It’s unlikely that you will get to the high protein levels of the most nutrient dense approach because either you would feel too full or your glucose levels may rise and ketones disappear, so most people, unless your name is Duane Johnson, will need to moderate back from that level.

image10

Example:  Let’s say for example you were 180cm and were managing diabetes and elevated blood glucose levels.  You would start with around 117g of protein per day as an initial target and test how that worked with your blood glucose levels.  If your blood glucose levels on average were less than say 5.6mmol/L or 100mg/dL and your ketones were above 0.2mmol/L you could consider increasing transitioning to more nutrient dense foods. 

If you want to see what this looks like in terms of real foods and real meal meals check out the optimal food list and the optimal meals for the different approaches.

insulin load

Using a similar approach, we can calculate the daily insulin load (in grams) depending on your height and goals.  The values in this table can be used as a rule of thumb for the insulin load of your diet.

If you are not achieving your blood glucose or weight loss goals, then you can consider winding the insulin load back down.  If you are achieving great blood glucose levels, then you might consider choosing more nutrient dense food which might involve more whole protein and more nutrient dense green leafy veggies.

image08

Example:  Let’s say for example you are a 180cm person with good glucose control but still wanting to lose weight, your initial target insulin load would be 156g from the superfoods from fat lost list.  If you were not losing weight at this level, you could look to wind it back a little until you started losing weight.  If you are consistently achieving blood glucose levels less than 5.6mmol/L or 100mg/dL and ketones greater than 0.2mmol/L you could consider transitioning to more nutrient dense foods. 

summary

In summary, reducing the insulin load of your diet is an important initial step.  However, as your blood glucose and insulin levels normalise there are a number of other steps that you can take towards optimising nutrient density on your journey towards optimal health and body fat.

  1. Reduce the insulin load of your diet (i.e. eliminate processed carbage and maybe consider moderating protein if still necessary) to normalise blood glucose levels and reduce insulin levels to facilitate access to stored body fat.
  2. If your blood glucose levels are less than say 5.6 mmol/L or 100mg/dL and your ketone levels are greater than say 0.2 mmol/L then you could consider transitioning to more nutrient dense foods.
  3. If further weight loss is required, maximise nutrient density and reduce added fats to continue weight loss.
  4. Consider also adding an intermittent fasting routine with periods of nutrient dense feasting. Modify the feasting/fasting cycles to make sure you are getting the results you are after over the long term.
  5. Once optimal/goal weight is achieved, enjoy nutrient dense fattier foods as long as optimal weight and blood glucose levels are maintained.
  6. If blood glucose levels are greater than optimal blood glucose levels, return to step 1.
  7. If current weight is greater goal weight return to step 3.

references

[1] http://diabesity.ejournals.ca/index.php/diabesity/article/view/19

[2] http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies/ketogenic-diet

[3] http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies/ketogenic-diet

[4] http://www.health.harvard.edu/blog/how-much-protein-do-you-need-every-day-201506188096

[5] https://intensivedietarymanagement.com/how-much-protein-is-excessive/

[6] https://en.wikipedia.org/wiki/Protein_poisoning

[7] https://optimisingnutrition.com/2015/08/31/optimal-protein-intake/

[8] https://www.youtube.com/watch?v=Yv-M-5-s9B0

[9] http://nutritionfacts.org/video/prevent-cancer-from-going-on-tor/

[10] https://www.youtube.com/watch?v=qPpAvvPG0nc

[11] https://www.ncbi.nlm.nih.gov/pubmed/27109436

[12] http://ajcn.nutrition.org/content/87/5/1558S.long

[13] https://en.wikipedia.org/wiki/Protein-sparing_modified_fast

spinach and egg

I’m a pretty simple cook, but sometimes the simple things in life are the best.   You don’t have to achieve great feats of molecular gastronomy to get a hearty nutrient dense start to the day.

This recipe is a simply egg and spinach fried up with some dill, some cream with the egg and coconut oil with the spinach for cooking.

img_6295-copy

The ‘secret’ here is to go heavy on the spinach.  Spinach always gives an amazing nutritional profile.

2016-11-19-5

Even with four eggs and 300g of spinach the end result is still very much ketogenic as well as being nutrient dense!

For some extra taste and you could throw in some mozzarella with the egg.

For all it’s simplicity, this recipe ends up ranking at #9 in the diabetes and nutritional ketosis ranking and #17 in the therapeutic ketogenic meals ranking.

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

net carbs insulin load carb insulin fat protein fibre
5g 18g 28% 72% 24g 6g

 

 

the alkaline diet vs acidic ketones

  • Whether you think eating alkaline foods is useful or woo woo junk it appears that metabolic acidosis is a thing.
  • Metabolic acidosis seems to be interrelated with insulin resistance, Type 2 Diabetes and retention of muscle mass.
  • To prevent metabolic acidosis it appears prudent to ensure that your body has adequate minerals to enable your kidneys to balance pH over the long term. This can be achieved by eating plenty of veggies and / or supplementing with alkaline minerals (e.g. magnesium, sodium, potassium, zinc etc).
  • If you eat plenty of veggies you’re probably getting enough alkalising minerals, however you can easily test your urine to see if your dietary acid load is high.
  • If you are targeting a high fat therapeutic ketogenic diet, following a zero-carb dietary approach and / or taking exogenous ketones it seems then it may be even more important to be mindful of your acid load and consider mineral supplementation.

some unique ketone and blood glucose results

Recently I had a very interesting, surprising and exciting experience during a fast.  The chart below shows my ketones, glucose and ‘total energy’ (i.e. glucose plus ketones) over the seven days.

image03

My ketones increased to above 8.0 mmol/L.  They even couldn’t be read on my ketone metre!

image14

I really did feel sky high on ketones!

It was the full keto brochure experience.  It was like my body fat was effortlessly feeding my brain with delicious, succulent ketones!  I felt great.

This chart shows my glucose : ketone index (GKI) dropping to below 0.5 after a few days.

image07

The orange dots in this chart shows the relationship between glucose and ketones about 18 months ago when I first started trying this keto thing (after I read ‘Jimmy’s Moore’s Keto Clarity’).  The blue dots show the relationship between my glucose and ketones during the recent fast.  As you can see from the much flatter line, my blood glucose levels were lower and I could more easily access my body fat for fuel to manage my appetite.

image21

The frustrating thing is that, thinking I was now a bonafide keto super hero, I’ve tried to repeat this feat of super ketones and perfect blood glucose levels without any luck!   My ketones just didn’t go as high again!

So, what’s the go?  What changed?  What gives?  What was it that let me trip with the magic ketone fairies in Keto Land for such a short period!

image53

context

So let’s rewind the story a little and give some context…

In July 2016, I got some blood tests.  I’d been good with my diet, eating nutrient dense foods, with some fasting and intense exercise.

My HbA1c was great at 4.9% and the cholesterol markers were all good.

I went to see Elizma Lambert (pictured below), my family doctor / naturopath / friend / mentor / hero, with the simple request that I wanted to feel superhuman.  I felt like I had been doing all the right things (e.g. good food, exercise etc) but not quite getting results that I was after (e.g. weight loss, energy levels, higher ketone levels).

image00

Elizma said everything looked good but my blood tests indicated that I was acidic.  But what does this mean?

  • You can see in the test results shown below that my uric acid levels are at the top of the normal range. High uric acid levels can be affected by fasting and exercise (i.e. lactic acid)[1] which may have influenced my test results.
  • I had also been using exogenous ketones occasionally around workouts leading up to these tests. I wondered whether they might contribute to the acidity.
  • My bicarbonate levels were on the low end which I’ve now learned suggests that I was running low on alkalising minerals (i.e. magnesium, calcium and potassium) for my kidneys to balance the acid load I was serving up with my exercise, diet and fasting.
  • My calcium and potassium were also on the lower end of the normal range.

image01

So Elizma sent me away with a mineral mix of magnesium, potassium, N-acetyl Cysteine and Calcium-D-Glucarate to help with the acidity issue that she had observed in my tests and to help improve my fat metabolism.

image25

I wasn’t sure what to expect, if anything.  But after a couple of weeks of taking this stuff my brain felt really clear and sharp and I felt full of energy.  I actually felt the superhuman energy and crispness that I’d been hoping for!

image38

My blood glucose and ketone levels were spot on.  And my hunger seemed to be massively reduced.

image51

So, just for interest, I decided to see how long I could go without eating.

Seven days later I had some spectacular ketone readings.

image03

As well as the alkalizing mineral mix, I was also taking some Celtic sea salt, Carnitine, Creatine and some alkalising green powder to keep my micronutrients up during the seven days.  I was aware of keto experts like Steve Phinney advocating adequate electrolytes during keto or fasting and I wanted to give myself the best chance of surviving and keeping up with my day job as well as riding to work.  I also started taking Nicotinamide Riboside which arrived on day four of the fast.

image36

So unfortunately, it wasn’t a really well controlled experiment to understand which supplement during my ‘fasting’ had the biggest effect.

Towards the end, I ran out of the alkalising mineral mix and I spent the day in the sun at a birthday party with my daughter (pictured below on the last day…  she knows how to pose for better for photos than me).

image42

I started to feel a bit shabby, so I decided to eat.

I figured seven days was a good ‘achievement’.

Since then I’ve tried a number of four-day fasts with various supplements (i.e. the alkalising minerals, Nicotinamide Riboside, exogenous ketones, a ‘fat fast’ and Robert Miller’s MitoFuel) to understand what the magic ingredient was, but I haven’t been able to repeat the phenomenal ketone excursions.

15204045_10154380499344807_1281857376_o.jpg

I quizzed Elizma about what she thought might have happened.  Could it simply be the alkalising mineral mix that causes the magic ketone fairies to visit me?  She said:

Whether you call it resistance or stuck, the alkalizing minerals can open up a lot of enzyme pathways that work at more neutral pH levels, which means it’s like opening the door with a massive crowd outside.

Once the door is open everyone just rushes through (giving you those big readings), but the crowd eventually thins out and becomes a regular stream of customers walking through the door again.

Very interesting though.  Every single person on ketogenic diet that I have tested have high acidity levels, which is natural considering that ketones are highly acidic, but it does mean it’s something to really look out for when ketogenic.

Hmmm…  intriguing.

Then I came across a Ben Greenfield podcast with Yuri Elkaim where he talked about alkaline diets.  It got interesting when Yuri started talking about the Potential Renal Acid Load which is based around the balance between the foods that leave an acidic residue (i.e. sulphur from protein and phosphorus) versus the foods that leave an alkaline residue once metabolised (i.e. magnesium, calcium and potassium).

image35

Previously when I’d heard talk of alkaline foods I’d written it off as woo woo.  But maybe this might explain the symptoms what I’d experienced (e.g. loss of appetite, high ketones, perfect blood glucose etc)?   Given the fact that taking the magnesium, potassium and calcium supplements had worked wonders for me I was interested and thought I’d dig into the topic a little further.

Here’s a video from Yuri on the pros of the alkaline dietary approach.  I’m not saying I’m advocating 100% of this, but it’ll give you an overview of some of the theory on alkaline diets from one of the less fringe advocates of the concept of alkalising.

let’s start with the basics

As I am prone to do, I went down a bit of a ‘rabbit hole’ looking at the research on this topic looking for answers trying to understand and explain my experience.   In this article I have tried to explain my journey and learnings along the way.

So let’s start with the less controversial stuff.  Basic biochem.

pH (or “potential hydrogen”) is a measure of the number of negatively charged hydrogen ions (H+).[2]

More formally, “pH is the negative of the logarithm to base 10 of the molar concentration, measured in units of moles per liter, of hydrogen ions.”

But why should we care about pH?

Well, when it comes down to it, your entire metabolism exists to pass around hydrogen ions.

You call it energy.  It’s important.

image30

maintaining pH homeostasis

The body goes to great lengths via a range of different systems to keep different parts of your body at a specific pH to enable the chemical reactions that fuel metabolism to continue function.

A pH of 7.0 is “neutral”, however the blood is slightly alkaline at somewhere between a pH of 7.35 and 7.45.  It’s virtually impossible to change the pH of your blood outside this range.

If your pH drops to 6.9, you’re in a coma.  At 6.8 you’re dead.[3]

image46

At this point many people simply say “see, we can’t change the pH of our blood so worrying about alkalinity is bogus garbage” (or something to that effect) and walk away.  Conversation over.

image24

However, I think it’s interesting to think about how the body actually maintains this tight homeostasis and whether a pH of 7.35 is different (more acidic) to a pH of 7.45 (more alkaline).

The body has so many different buffers and so many different systems and ways of mitigating pH.   Intracellularly, it has phosphate; extracellularly, hydrogen types of proteins. The lungs get involved, the kidneys get involved.   Which just tells you is the more processes or mechanisms in the body, or systems, devoted to a certain subject or topic of process, the more important that process is.

Bryan Walsh, Keto Summit Interview[4]

Part of the body’s pH balance involves our kidneys which use the various minerals that it obtains from our food to keep a tight rein on the acid / base balance of our blood.

The minerals that can donate acid forming negative charge are:

  • Bromine (Br-)
  • Chlorine (Cl-)
  • Copper (Cu-)
  • Fluorine (Fl-)
  • Iodine (I-)
  • Phosphorus (P-)
  • Silicon (Si-)
  • Sulphur (Su-)

The minerals that can donate alkaline positive charge are:

  • Boron (B+)
  • Calcium (Ca+)
  • Iron (Fe+)
  • Magnesium (Mg+)
  • Manganese (Mn+)
  • Nickel (Ni+)
  • Potassium (P+)
  • Sodium (Na+)
  • Zinc (Zn+)

alkalinity, carbon dioxide and oxygen

In Australia, one of our premier tourist attractions, Great Barrier Reef, is dying as the ocean absorbs CO2 from the atmosphere and becomes more acidic.[5]  It’s not hard to see how an increasing environmental acid load could similarly be affecting our internal microbiome.[6]

image33

Every farmer knows the importance of getting the pH of the soil right before planting a crop.  A higher pH is achieved by adding extra potassium and lime which is taken up by the plant.   The pH of the soil in which plants are grown can have considerable influence on the mineral content of the food we eat.

When it comes to the pH and net acid load in the human diet, there has been considerable change from the hunter gather civilization to the present.[7]

As we continue to grow mono crops in the same field year after year with farmers relying on chemical fertiliser to provide nutrients for the plant, it’s understandable that our veggies are also decreasing in nutrient content, particularly the alkalising minerals.

With the agricultural revolution (last 10,000 years) and even more recently with industrialization (last 200 years), there has been a decrease in potassium (K) compared to sodium (Na) and an increase in chloride compared to bicarbonate found in the diet.

It is generally accepted that agricultural humans today have a diet poor in magnesium and potassium as well as fibre and rich in saturated fat, simple sugars, sodium, and chloride as compared to the pre-agricultural period. [8]

This results in a diet that may induce metabolic acidosis which is mismatched to the genetically determined nutritional requirements. With aging, there is a gradual loss of renal acid-base regulatory function and a resultant increase in diet-induced metabolic acidosis while on the modern diet.[9]

Even if you don’t like veggies, it’s not hard to see how the meat from animals fed with grains (which contain less alkalising minerals than grass) grown with chemical fertilisers could be leading to a higher acid load compared to animals that are able to eat grass and other natural stuff.

image47

When the pH of something is higher (more alkaline) it can hold more dissolved oxygen.  If it is more acidic (lower pH) it can hold less oxygen.  Blood with a pH of 7.3 (more acidic) and can carry 65% less oxygen than blood at a pH of 7.45 (more alkaline).[10]

Good things happen when there is more oxygen available.  For example, when there is more oxygen the body is able to utilise the fat burning Krebs Cycle based / aerobic metabolism (with oxygen) and less on the sugar based Cori cycle / anaerobic metabolism (without oxygen).

Conversely, more acidic = not so good.

image05[11] [12]

While still controversial, in the 1930s Otto Warburg (pictured below, with poodle) suggested that “cancer cells live in hypoxic, very low oxygen, and acidic conditions and derive energy from sugars by fermenting them the way yeast does.” [13] From this, he theorized that these low-oxygen and more acidic conditions caused cancer.

image18

So low oxygen = bad.  Lots of oxygen = good.

Wim Hof, Iceman Extraordinaire, achieves superhuman feats essentially by hyperventilating to increase the oxygen in his blood.

image41

the effect of food and alkalinity

There is some indication that this ability to absorb more oxygen is also affected by the food we eat.

The chart below shows how athletes on a lower acid load dietary approach appear to be burning more fat (as indicated by a lower respiratory exchange ratio or RER[14]) and have a longer lead time to exhaustion.[15]

image45

The study Effects of Dietary Acid Load on Exercise Metabolism and Anaerobic Exercise Performance (Caciano et al, 2015) noted that:

An alkaline promoting (low-PRAL) diet increases anaerobic exercise performance, as evidenced by greater time-to-exhaustion during high-intensity treadmill running.

Preliminary evidence suggests that an alkaline promoting (low-PRAL) diet increases lipid oxidation and may have a carbohydrate-sparing effect during submaximal endurance exercise, although further studies are needed.[16]

More fat burning = winning!

image26

This aligns with my personal experience.  During a good workout it feels like my cells can “breath better”.  My stamina and performance in my cycling or kettlebell workouts is not so much limited by my strength but more by my ability to recover my breath quickly.  When everything is working just right I seem to be able to maintain a high heart rate easily for a longer time without running out of breath.

image02

The chart below shows my heart rate during a good kettlebell session.

image10

It seems that a lower insulin load (i.e. low carb / ketogenic) diet with lower levels of insulin enables us to tap into our fat stores more easily.  However, in addition, it seems that a more alkaline pH also helps us burn more fat by enabling us to access more oxygen as well.

potential renal acid load

So how does all this this relate to nutrition and optimising our food choices?

Well, back in the late 1870s a scientist named Marcellin Berthelot used the Bomb Calorimeter to study the amount of heat produced or absorbed during chemical reactions.[17]  This machine consisted of a cylinder-shaped chamber, pressurized oxygen, and a small amount of water.

image04

Berthelot would take various food substances and incinerate them within this device which turned the item into an ash-type substance. When this ash was mixed with water, Berthelot could check the pH of each item to determine whether a food was acidic or alkaline after it had been burned.

The Potential Renal Acid Load (PRAL) revolves around the idea that there is a residual ash remaining after a food is metabolised in our body that is either acidic or basic.  This residual ash, which has a net acidic or alkaline property, then needs to be cleared from the body to maintain optimal pH.[18] [19] [20]

A simplified PRAL value can be calculated based on the most dominant nutrients affecting pH.  That is, protein (which forms sulphur) and phosphorus (acidic) minus the magnesium, calcium and potassium (alkaline).

Potential renal acid load (PRAL) = [0.49 x grams of protein + 0.037 x mg of phosphorus]  – [0.026 x mg magnesium + 0.013 x mg calcium + 0.021 x mg potassium] 

If the PRAL value is negative, then you are left with an alkaline residue.

If the PRAL number is positive, then you are left with a net acidic residue that needs to be cleared by the kidneys.

urine ph

While significantly changing the pH of the blood is controversial, the food we eat does seem to have an impact on the pH of our urine as the kidneys clear the excess acid load that is not used up in balancing our pH.[21] [22]  The theory is that pH of our urine changes based on whether the residual ash from our food after it is metabolised is either acidic or alkaline.

The chart below shows the urine pH of the test subjects in the Effects of Dietary Acid Load on Exercise Metabolism and Anaerobic Exercise Performance study mentioned above.  In the cross over trial participants performed the best when they had a more alkaline urine pH greater than 7.0 (alkaline) in comparison to when they had a pH less than 6.0 (acidic).

image19

balancing electrolytes

If you’re a die hard low carber / ketonian congratulations in getting this far into the article before switching off and writing me off as a vegan tree hugging hippie.

You’ll also likely be aware that in The Art and Science of Low Carbohydrate Performance Volek and Phinney talk a lot about how important it is to manage minerals and electrolytes when following a low carb / ketogenic dietary approach.  Chapter 9 of The Art and Science of Low Carbohydrate Performance is all about how important it is to make sure you keep up your electrolytes in the form of sodium, potassium, magnesium and zinc.

[Steve was recently in Brisbane and we had the privilege of having him stay at our place.  Not only did he make us his famous blue cheese dressing (see action shot below) I also got to pick his brains for a day!]

2016-11-15-10-58-17

You get bonus points if you realised that these critical electrolytes that Volek and Phinney talk about are the same as the alkalising minerals in the PRAL formula (i.e. magnesium, calcium and potassium)!  Maybe erring on the side of being alkaline and ensuring good mineral / electrolyte management in a keto diet are two sides of the same coin?

image34

We can get this critical electrolytes from supplements or more ideally from real food.

As you dig further you quickly find that the discussions around PRAL can go sideways really quickly and turn into a keto / carnivore vs vegan / plant based argument.

I have tried to wade through the science versus woo woo, which I’ll try to summarise later in this article.  But for now let’s jump into what the analysis of PRAL could mean for our choices around what we should eat.

the most alkaline foods

The table below shows the most alkaline foods with their nutrient density (ND), and PRAL value per 100g and PRAL / 2000 calories.[23]

Most lists I’ve seen use PRAL per 100 calories.  However, I think it’s more useful to think of it in terms of the amount as a proportion of your daily energy intake (i.e. per 2000 calories).

To make the lists more concise I’ve filtered for the most nutrient dense foods for each category.

vegetables and spices

image15

The PRAL values of the most nutrient dense vegetables are listed below.  Overall vegetables are quite alkaline (i.e. negative PRAL values).  Only alfalfa has a positive PRAL value due to high levels of phosphorus.

The other observation here is that nutrient density and alkalinity don’t necessarily go hand in hand.  It’s not as simple as saying ‘eat your veggies’ because there is a wide range of nutrient density and PRAL values within the vegetables.

If you are striving for optimal in terms of ND and PRAL then some veggies are better than others.

food ND PRAL / 2000 cal PRAL / 100g
beet greens 19 -1,523 -17
Chinese cabbage 20 -1,241 -7
watercress 24 -1,034 -6
spinach 25 -895 -10
chard 19 -857 -8
coriander 23 -841 -10
chicory greens 18 -724 -8
dill 16 -721 -15
endive 19 -707 -6
arugula 16 -629 -8
parsley 19 -618 -11
celery 12 -610 -5
basil 22 -569 -7
mustard greens 16 -507 -7
escarole 15 -495 -5
zucchini 20 -489 -4
pickles 11 -424 -3
lettuce 19 -419 -3
summer squash 13 -397 -4
brown mushrooms 16 -383 -4
yeast extract spread 12 -369 -34
dandelion greens 16 -353 -8
cauliflower 15 -351 -4
sauerkraut 11 -328 -3
chives 16 -317 -5
turnip greens 13 -307 -4
banana pepper 10 -296 -4
sage 13 -295 -46
cabbage 10 -286 -3
paprika 11 -262 -37
okra 15 -243 -3
seaweed (kelp) 12 -224 -5
cloves 13 -216 -30
snap beans 11 -215 -2
white mushroom 13 -205 -2
portabella mushrooms 13 -204 -3
asparagus 20 -199 -2
broccoli 27 -167 -2
collards 11 -141 -2
shiitake mushroom 11 -80 -2
mung beans 13 -64 -1
seaweed (wakame) 17 -59 -1
spirulina 11 -1 -0
alfalfa 12 154 2

dairy

image08

Dairy is widely regarded to be some of the most acidic of foods.   As you can see below there are a wide range of PRAL values, from slightly alkaline high fat cream and butter to the low fat cheeses which are quite acidic.

Even though dairy can be nutrient dense, many people seem to do better with their weight or allergies when they limit dairy.

Personally, I know I lost some weight when I reduced dairy for a period.  I thought it might be related to the energy density.  Maybe the minerals and pH balance plays a role too and living on a low carb diet primarily comprised of cheese could be a problem for some people in the long term.

food ND PRAL/2000 cal PRAL/100g
sour cream 4 -2 0
low fat milk 4 -1 0
milk (full fat) 2 0 0
butter 3 0 0
cream 4 3 1
milk 5 5 0
kefir 10 14 0
cream cheese 4 15 3
brie 1 66 11
blue cheese 2 68 12
Colby 0 83 16
cheddar cheese 7 85 17
feta cheese 5 85 11
muenster cheese 1 87 16
camembert 2 87 13
Monterey cheese 1 88 16
limburger cheese 2 90 15
edam cheese 2 100 18
Greek yogurt 6 100 5
parmesan cheese 6 102 21
gruyere cheese 2 103 21
Swiss cheese 7 104 21
gouda cheese 3 113 20
goat cheese 2 119 16
mozzarella 8 123 19
egg yolk 8 133 18
whole egg 7 133 10
Greek yogurt (low fat) 6 143 5
cottage cheese (low fat) 6 157 6
cheddar (non-fat) 2 262 23
cream cheese (low fat) 8 306

16

baked products, cereals and grains

image04

Baked products, cereals and grains, in addition to generally having quite poor nutrient density values are also typically highly insulinogenic.

Baking soda or bicarbonate is a powerful alkaline supplement that can be used to aggressively shift pH.

Other than wheat bran and baker’s yeast (think vegemite, marmite or brewer’s yeast), processed grains have a poor nutritional value while also being quite alkaline AND insulinogenic.

According to Bill Davis the phytates in grains also make it harder to absorb alkalising minerals.[24]

No wonder processed grains are problematic for so many people.

food ND PRAL/2000 cal PRAL/100g
baking soda 0 -309 -15
oat bran muffins -4 13 2
crackers -3 18 4
croissant -2 22 5
blueberry muffins -4 23 4
bagels -4 23 3
wheat bran bread -4 27 3
rice bran bread -3 28 3
egg bread -4 31 4
wheat bran 12 32 3
bread roll -4 32 4
quinoa -2 38 2
rye flour -3 40 7
English muffins -3 50 5
baker’s yeast 15 50 3
wild rice -4 53 9
pancakes -4 128 22
oat bran 3 137 17

seafood

image21

Seafood is typically acidic due to the protein though also nutrient dense.  However, as we’ll see later, it’s not as simple as avoiding protein, as protein seems to help with calcium absorption.[25]

food ND PRAL/2000 cal PRAL/100g
mackerel 7 34 5
anchovy 13 69 7
cisco 7 75 7
caviar 14 76 10
octopus 9 107 9
herring 7 114 12
white fish 8 123 7
trout 14 131 11
sardines 8 136 13
oyster 18 146 7
sardine 8 153 16
sturgeon 11 165 11
pollock 11 168 9
rockfish 11 168 9
halibut 12 175 10
salmon 17 180 14
haddock 9 188 11
whiting 8 197 11
tuna 9 197 18
lobster 12 201 9
cod 11 205 30
crab 15 238 10
crayfish 11 253 10
shrimp 12 282 17
fish roe 16 285 20
perch 8 297 14
flounder 11 322 14

animal foods

image09

Animal products have a high PRAL values due to their protein content.     Grain fed animals are likely to be even worse than animals able to eat their natural diet.

food ND PRAL/2000 cal PRAL/100g
chicken liver pate 7 105 11
rib eye steak 5 130 14
lamb chop 5 139 16
bison 5 166 14
beef brains 8 166 13
ground pork 6 168 16
ground beef 6 171 12
leg ham 6 175 14
pork shoulder 6 178 14
turkey heart 8 182 16
turkey meat 6 188 15
turkey drumstick 6 188 15
chicken 7 189 14
pork chop 6 195 17
beef tripe 6 208 11
lamb heart 8 212 17
lean beef 9 216 16
turkey liver 14 218 21
pork liver 10 218 18
beef heart 5 220 18
beef heart 8 229 21
turkey 6 230 16
chicken liver 15 233 14
ham 11 239 13
veal 8 239 18
veal liver 16 244 23
chicken liver 14 250 22
beef liver 16 262 23
lamb kidney 19 267 15
lamb liver 18 274 23
beef kidney 13 283 22

fruits

fruits-and-vegetables

Fruits are typically quite alkaline, however the nutrient density value is typically less than ideal.  Fruits are also typically quite insulinogenic.  So I don’t think it’s a matter of simply  saying that we should eat a ton of “fruits and vegetables” if nutrient density or insulin load are also an issue.

food ND PRAL/2000 cal PRAL/100g
rhubarb 3 -621 -7
cantaloupe -2 -298 -5
honeydew melon -4 -247 -4
jackfruit -3 -186 -9
kiwifruit -2 -184 -6
apricots -4 -180 -4
grapefruit -4 -174 -3
peaches -4 -160 -3
strawberries -1 -159 -3
oranges -4 -156 -4
carambola -2 -138 -2
blueberries -0 -137 -3
blackberries -1 -130 -3
limes -3 -115 -2
avocado -1 -102 -8
raspberries -2 -93 -2
boysenberries -2 -86 -2
blackberries -4 -69 -2

legumes

image11

Legumes have a range of PRAL values, though again the nutrient density values are not that great compared to the veggies, seafood or animal products.

food ND PRAL/2000 cal PRAL/100g
navy beans 0 -32 -5
soybeans 2 -21 -5
cowpeas 1 -14 -2
peanut butter 2 -5 -1
broad beans -1 -2 -0
lentils 0 37 2
tofu 4 41 2
soy protein isolate 0 400 67

nuts and seeds

nuts_seeds

There are a range of PRAL values when it comes to nuts and seeds depending on the mineral content.

Anything based on coconut seems to do well in terms of nutrient density and alkalinity.  There’s nothing quite like fresh coconut water.  The photo below shows how we finished our recent holiday in Fiji!

image44

food ND PRAL/2000 cal PRAL/100g
coconut water 4 -539 -5
gingko nuts -6 -20 -1
coconut milk 0 -16 -2
coconut meat -1 -15 -3
coconut -1 -13 -3
coconut cream -1 -9 -1
hazelnuts -3 -6 -2
macadamia nuts -2 -4 -1
sesame butter -1 -3 -1
almond butter -2 5 2
pecans -6 6 2
almonds -2 7 2
flax seed -2 8 2
pistachio nuts -3 8 2
cashews -2 24 7
brazil nuts -3 25 8
pine nuts -4 26 9
butternuts -6 43 13
walnuts -3 44 14
sesame seeds -3 54 17
pumpkin seeds 1 98 27
sunflower seeds 2 110 30

balancing alkalinity and nutrient density

So my big takeaway from the analysis above is that alkalinity and nutrient density are not necessarily related.  You can’t just say ‘eat your fruits and vegetables and avoid protein’ to manage your alkalinity and maximise nutrients at the same time.  Particularly given that protein is the one macronutrient that seems to be correlated with nutrient density.

Recent clinical studies and a meta-analysis have indicated either no effect or a modest benefit associated with higher protein intakes. These contradictory considerations may be explained by the existence of a two-faced relationship between protein and bone, with simultaneous positive and negative pathways. In opposition to the negative effects of dietary acid load, protein may exert positive effects related to improving calcium absorption, increasing insulin-like growth factor 1, or improving lean body mass, which, in turn, improves bone strength.[26]

The chart below shows  a comparison of the nutrient density of the top 10% of the USDA food database for a range of dietary approaches.  If we prioritise our food choices based on low PRAL values alone we end up with a lower nutrient density.

image52

Most things in nutrition are not binary.  We can’t just take one parameter and use it to guide ALL our decisions about nutrition.  That includes protein, carbs, fat, energy density, nutrient density or alkalinity.

Where it gets gets is when we mix and match a number of factors to prioritise our food choices to suit our goals.

image20

Nutrient dense low alkaline foods typically have quite a low energy density so we don’t have to worry too much about that.  To develop the list of more alkaline nutrient dense in the following section I have factored in:

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

The chart below shows a comparison of the nutrients provided by the top 10% of foods for the following approaches:

  • low PRAL,
  • nutrient dense alkaline, and
  • nutrient dense maintenance.

image31

If we just prioritise low PRAL (grey bars) then the amino acids drop.  However, if we prioritise low PRAL and nutrient density we get a better balance of alkalinity and nutrient density across the board.

  • The chart below shows a comparison of macronutrients.
  • The nutrient dense approach is quite high in protein while the more alkaline approach has less protein and more carbs from more veggies.
  • If we only look at minimising PRAL we get a lot of fibre and less protein.
  • The nutrient dense alkaline approach provides a reasonable balance in terms of macronutrients.

image50

From an insulin load perspective, the low PRAL approach is relatively insulinogenic.  Considering insulin load in the multi criteria analysis gives us a little bit of additional dietary fat which is useful for blood glucose regulation or satiety, particularly if we’re not trying to lose weight.  Moderate amounts of dietary fat help with the absorption of the fat-soluble vitamins A, D, E and K).

image11

The chart below shows a comparison of some of the key minerals provided by a number of dietary approaches (note: phosphorus is acidic while the magnesium, calcium, potassium and sodium are alkaline).

  • The therapeutic ketosis and the average of all foods do not have a lot of alkalising magnesium, calcium, potassium and sodium to balance the acid forming phosphorus.
  • By comparison, the nutrient dense alkaline and low PRAL foods have a lot more alkalising minerals to balance the acidic phosphorus.

image16

Rather than worrying about actively balancing our pH I think we focus on maximising nutrient density our body will have what it needs to do what is necessary to balance pH.  Maximising nutrient density will also minimise nutrient hunger so our bodies will be satisfied with less and our kidneys won’t have to process as much.

The chart below shows that after Vitamin D and Vitamin E, many people are getting less than the recommended intake of magnesium, calcium and zinc (i.e. alkalising minerals).

image13

PRAL value of different nutritional approaches

The chart shows the PRAL value for thirteen different nutritional approaches outlined on this blog.

  • The nutrient dense vegan approach the is the most alkaline while the zero-carb approach is the most acidic.
  • The nutrient dense alkaline foods (listed below) end up being nearly as alkaline as the vegan.
  • On average, the 8000 foods in the USDA database have a net acid load.
  • The zero carb, high insulin load and therapeutic ketogenic approaches have net acid load.
  • Most of the other approaches that focus on nutrient density have adequate vegetables to ensure that they are alkaline overall.

image12

If the alkalinity of our diet does actually have a bearing on insulin resistance, oxygen availability / hypoxia, insulin sensitivity I wonder if people pursuing a therapeutic ketogenic approach should actually be considering prioritising their veggies and / or or mineral supplements that will balance their alkalinity to balance out their diet.

Results of recent observational studies confirm an association between insulin resistance and metabolic acidosis markers, including low serum bicarbonate, high serum anion gap, hypocitraturia, and low urine pH.[27]

image28

nutrient dense alkaline foods

The list of foods is prioritised for nutrient density, alkalinity and a lower insulin load.

vegetables, spices and fruit

image19

The list of vegetables and fruit below are both nutrient dense and highly alkaline.  Whether you buy into this alkaline food theory it will be hard to go wrong if you eat more of these foods which are nutrient dense and have a low insulin load.

If you are concerned that your body is lacking alkalising minerals, focusing on the green leafies at the top of this list will be a good first step.   Real food is always going to be a better option than supplements.

food ND insulin load (g/100g) calories/100g PRAL/2000 cal PRAL/100g
spinach 28 4 23 -895 -10
endive 20 1 17 -707 -6
broccoli 29 3 22 -167 -2
watercress 28 2 11 -1,034 -6
basil 24 3 23 -569 -7
coriander 19 2 23 -841 -10
chicory greens 17 2 23 -724 -8
beet greens 19 2 22 -1,523 -17
zucchini 19 2 17 -489 -4
chard 21 3 19 -857 -8
Chinese cabbage 21 2 12 -1,241 -7
escarole 15 1 19 -495 -5
parsley 20 5 36 -618 -11
lettuce 19 2 15 -419 -3
turnip greens 18 4 29 -307 -4
asparagus 21 3 22 -199 -2
mustard greens 12 3 27 -507 -7
chives 17 4 30 -317 -5
arugula 13 3 25 -629 -8
dill 15 8 43 -721 -15
sage 11 26 315 -295 -46
cauliflower 15 4 25 -351 -4
summer squash 12 2 19 -397 -4
paprika 11 26 282 -262 -37
celery 11 3 18 -610 -5
pickles 9 1 12 -424 -3
okra 15 3 22 -243 -3
dandelion greens 13 7 45 -353 -8
cloves 12 35 274 -216 -30
sauerkraut 9 2 19 -328 -3
cucumber 7 1 12 -424 -3
radishes 6 2 16 -551 -4
thyme 8 31 276 -257 -35
collards 11 4 33 -141 -2
portabella mushrooms 14 5 29 -204 -3
banana pepper 8 3 27 -296 -4
jalapeno peppers 8 3 27 -269 -4
marjoram 4 27 271 -364 -49
alfalfa 12 1 23 154 2
curry powder 6 14 325 -107 -17
yeast extract spread 10 27 185 -369 -34
white mushroom 14 5 22 -205 -2
brown mushrooms 12 5 22 -383 -4
kale 10 5 28 -302 -4
bamboo shoots 7 5 27 -591 -8
cabbage 9 4 23 -286 -3
snap beans 11 3 15 -215 -2
red peppers 7 3 31 -219 -3
radicchio 9 4 23 -413 -5
spirulina 17 6 26 -1 -0
eggplant 3 3 25 -314 -4
seaweed (wakame) 17 11 45 -59 -1
tarragon 6 56 295 -437 -65
Brussel sprouts 9 6 42 -145 -3
onions 8 6 32 -312 -5
radishes 4 3 18 -488 -4
turnips 5 3 21 -275 -3
mung beans 14 4 19 -64 -1
shiitake mushroom 10 7 39 -80 -2
chayote 4 3 24 -228 -3
red cabbage 5 5 29 -312 -5
celery flakes 1 42 319 -530 -84
seaweed (kelp) 10 10 43 -224 -5
pepper 1 36 318 -198 -31
peas 10 7 42 -98 -2
avocado -3 3 160 -102 -8
rhubarb 0 3 21 -621 -7
edamame 7 13 121 7 0
caraway seed 2 28 333 -80 -13
dill seed 2 43 305 -218 -33
soybeans (sprouted) 8 12 81 -16 -1
Pimento, canned 6 4 23 -207 -2
artichokes 3 7 47 -211 -5
turmeric 5 52 312 -227 -35
cumin 1 44 375 -171 -32
pumpkin 4 4 20 -380 -4
carrots 4 4 23 -254 -3

nuts and seeds

image15

Coconuts do pretty well.  Some of the other nuts are not so nutrient dense or alkaline, so this list isn’t too long.  Keep in mind that drinking a lot of coconut water might not be ideal for someone with diabetes due to the carbohydrate content.

food ND insulin load (g/100g) Calories / 100g PRAL / 2000 cal PRAL / 100g MCA
coconut water 4 3 19 -539 -5 0.8
coconut milk -2 5 230 -16 -2 0.6
coconut meat -2 9 354 -15 -3 0.6
coconut cream -2 7 330 -9 -1 0.6
macadamia nuts -4 12 718 -4 -1 0.6
sunflower seeds 0 22 546 110 30 0.5
flax seed -3 16 534 8 2 0.5
almond butter -2 26 614 5 2 0.5
pumpkin seeds 0 29 559 98 27 0.5

seafood

image21

If you are eating plenty of veggies I think you can so afford to also eat plenty of nutrient dense seafood as the acid / alkaline will balance each other out in the long run.   While there have been some concerns that a high protein diet will cause acidity that will, in turn, cause osteoporosis due to calcium being used to buffer the acid, more recent research indicates that protein has a net positive effect on bone health.[28] [29]

food ND insulin load (g/100g) calories/100g PRAL/2000 cal PRAL/100g MCA
salmon 22 20 156 180 14 1.3
caviar 16 23 264 76 10 1.3
anchovy 17 22 210 69 7 1.2
trout 18 18 168 131 11 1.2
fish roe 20 18 143 285 20 1.1
oyster 19 14 102 146 7 1.1
cisco 9 13 177 75 7 1.0
sturgeon 15 16 135 165 11 0.9
mackerel 5 10 305 34 5 0.9
herring 10 19 217 114 12 0.8
crab 19 14 83 238 10 0.8
halibut 17 17 111 175 10 0.8
sardine 10 19 208 153 16 0.8
sardines 9 16 185 136 13 0.8
tuna 14 23 184 197 18 0.8
rockfish 15 17 109 168 9 0.7
lobster 17 15 89 201 9 0.7
pollock 16 18 111 168 9 0.7
octopus 14 28 164 107 9 0.6
cod 15 48 290 205 30 0.6
shrimp 16 19 119 282 17 0.6
flounder 15 12 86 322 14 0.6
white fish 13 18 108 123 7 0.6
crayfish 15 13 82 253 10 0.6

dairy and egg

image08

A number of cheeses make it onto the list due to their nutrient density along with egg, butter and cream.  Cheese are typically acidic however, in moderation, they can potentially form part of a well-rounded diet.

The problem, I think, is a that a lot of people looking for a low carb / keto dietary approach (me included) end up eating large quantities of dairy (e.g. cream, cheese and butter) and end up struggling to keep the weight off or find that they are “allergic to dairy”.   Perhaps excess acid load without adequate minerals to balance it from green leafy veggies may be playing a role here?

food ND insulin load (g/100g) calories/100g PRAL/2000 cal PRAL/100g MCA
Swiss cheese 9 22 393 104 21 1.0
cheddar cheese 8 20 410 85 17 1.0
egg yolk 8 12 275 133 18 1.0
cream 2 5 340 3 1 0.9
butter 1 3 718 0 -0 0.9
whole egg 10 10 143 133 10 0.9
cream cheese 3 10 350 15 3 0.9
sour cream 3 6 198 -2 -0 0.9
mozzarella 9 26 304 123 19 0.8
feta cheese 6 15 264 85 11 0.8
parmesan cheese 8 35 420 102 21 0.8
limburger cheese 4 15 327 90 15 0.7
camembert 4 16 300 87 13 0.7
gruyere cheese 4 23 413 103 21 0.7
blue cheese 3 19 353 68 12 0.7
gouda cheese 4 21 356 113 20 0.7
brie 2 16 334 66 11 0.7
goat cheese 4 14 264 119 16 0.7
edam cheese 4 21 357 100 18 0.6

animal products

image09

Several animal products make the list even though they carry an acid load.  I don’t think “animal protein” is really a concern if you are also eating your alkalising veggies.  Seafood and animal products are also nutrient dense and have beneficial properties, including lean body mass[30] and bone health.    If you can, it’s going to be ideal to consume seafood and animals that aren’t fed more acidic grains.

food ND insulin load (g/100g) calories / 100g PRAL / 2000 cal PRAL / 100g MCA
lamb kidney 23 15 112 267 15 1.27
lamb liver 22 20 168 274 23 1.20
chicken liver 20 13 119 233 14 1.15
veal liver 20 26 192 244 23 1.06
chicken liver 18 20 172 250 22 1.02
beef liver 20 25 175 262 23 1.00
turkey liver 16 21 189 218 21 0.98
smelt 14 44 386 182 35 0.9
beef kidney 17 20 157 283 22 0.87
rib eye steak 10 21 210 130 14 0.8
chicken liver pate 8 17 201 105 11 0.79
pork liver 16 23 165 218 18 0.79
roast beef 9 21 219 115 13 0.8
lamb heart 13 19 161 212 17 0.75
ground turkey 6 19 258 115 15 0.7
ham 15 17 113 239 13 0.7
turkey heart 11 20 174 182 16 0.69
roast pork 9 20 199 130 13 0.7
salami 2 17 378 47 9 0.7
lamb chop 9 25 234 139 16 0.7
beef heart 13 23 179 229 21 0.66
beef brains 5 8 151 166 13 0.65
lean beef 14 23 149 216 16 0.6
ground pork 11 25 185 168 16 0.6
T-bone steak 3 19 294 91 13 0.6
chicken 13 22 148 189 14 0.6
pepperoni -1 16 504 35 9 0.6

other dietary approaches

I’ve added this list to the various dietary in the table below.  If you’re already getting plenty of veggies then acidity probably won’t be a problem with your acid balance.  But if you already have metabolic acidosis, gout or kidney concerns they you may want to focus on getting more of the alkaline foods.

dietary approach printable .pdf
weight loss (insulin sensitive) download
autoimmune (nutrient dense) download
alkaline foods download
nutrient dense bulking download
nutrient dense (maintenance) download
weight loss (insulin resistant) download
autoimmune (diabetes friendly) download
zero carb download
diabetes and nutritional ketosis download
vegan (nutrient dense) download
vegan (diabetic friendly) download
therapeutic ketosis download
avoid download

If you’re not sure which approach is right for you and whether you are insulin resistant, this survey may help you identify your optimal dietary approach.

image43

am I getting enough veggies?

If you have blood tests handy you can see if they show any of the following signs that may suggest that your diet is more acidic and / or you are struggling to balance your acid load:

  • high uric acid levels,
  • low bicarbonate levels / CO2 levels,
  • a high anion gap,[31]
  • high potassium, or
  • low sodium / potassium ratio,

These values will give you an indication whether your kidneys are keeping up and you might need to review your diet.

If you don’t have the blood tests available, you can test your urine pH which gives you an indication of how much acid versus alkaline ash your kidneys are clearing after digestion.  This will not necessarily tell you how alkaline your blood is, but rather whether your body is having to excrete alkaline or acidic waste products after digestion which appears to still be a relevant guide.

The chart below shows the urine pH of people in the Caciano et al study noted above when they changed their diet to a low PRAL (alkaline) or high PRAL (acidic) dietary approach.   Most participants could achieve the high PRAL acidic target of greater than a pH of 6.0 within four days.  However, it took some participants up to nine days of changing their diet to achieve an alkaline pH of greater than 7.0.

image19

If you’re interested, you can grab some pH test tape and see where you are currently at.  If you find your urine is more acidic (i.e.  pH lower than 6.0) you could consider manipulating your diet and / or use mineral supplements until you are achieving a pH of greater than 6.8 or so.

image15

supplementation

Obviously eating real food such as the ones listed above is preferable.  However, if simply adding more non-starchy veggies listed above doesn’t work for you there are a number of other more aggressive options that you can turn to.

One popular approach is to use a greens powder.  On the positive side, a few spoonful’s of this will quickly give you lots of micronutrients and alkalising minerals.  However, real veggies are always going to be better and it will give you about one gram of carbohydrates per serving.

image40

Another option is to use baking soda which is highly alkaline and has been shown to improve athletic performance in a range of studies (check out the plethora of study reviews on Adel’s SuppVersity site if you are interested in seeing how the alkalinity provided by Bicarbonate can affect exercise performance).[32] [33] [34]

image39

In situations that result in acute acidosis, supplementing younger patients with sodium bicarbonate prior to exhaustive exercise resulted in significantly less acidosis in the blood than those that were not supplemented with sodium bicarbonate.[35]

The pros of baking soda is that it is cheap and effective and will turn your urine pee sticks blue very quickly (see picture below).  It may also cause gut distress if you have a sensitive gut (as many people with diabetes do).  And you’ll also be missing out on all the other benefits of eating whole veggies.

image08

Elizma says:

I prefer citrate minerals since taking bicarb soda can dilute stomach acid when taken with meals whereas citrate minerals can be taken at any time.  Using citrate minerals has a ‘bicarbonate sparing’ effect without necessarily taking bicarbonate.

By reducing the workload on the pancreas more ATP is available to produce insulin.   The lungs can only deal with volatile acids that can be excreted via CO2, but the kidneys have to do the rest via ammonia.

I think people try and simplify it for themselves by talking about acid / alkaline diets when it’s more to do with minerals imbalances and other factors that shift metabolic acid production.

But does it really matter what we call it if people eat better?

In our house what we’re trying to do is maximise the green leafy veggies, not overdo the dairy, perhaps increase the coconut intake as well as taking the a little and then take the potassium, calcium and magnesium citrate mineral supplement mix until the urine pH consistently is above 6.8.

are ketones acidic ketones?

If you are taking exogenous ketone supplements, then making sure you get your green leafies or taking a mineral supplement may be even more important.

Your body will likely secrete some insulin to bring down the total energy in your bloodstream if you have really high ketones, particularly in a fed state.  A recent study indicated that the pancreas does not secrete insulin in response to ketones alone, but rather when glucose is greater than 5.0 mmol/L or 90 mg/dL and you add in additional ketones.

So, I wondered if adding exogenous ketones to a diet that is not already ketogenic (i.e. high blood glucose levels) is a recipe for accelerated hyperinsulinemia and acidity?

image22

I had some exogenous ketones lying around the house so I thought it would be interesting to test at what point they become acidic.

Seems the answer is yes for the ketone salts…

image06

2016-11-19 11.03.08.jpg

… and so is the ketone ester.

image37

So maybe some of the acidity that I saw on my blood tests could also have been contributed to by me dabbling with exogenous ketones?

image49 [36]

So are exogenous ketones also acidic inside the body?  In the name of science I downed two packets of Keto//OS.  My ketone value went from 0.6 to 0.8mmol/L and the increased insulin released to clear the exogenous ketones also brought the blood glucose levels down over a period of about five hours.

2016-11-19 10.49.07.jpg

But the pH of my urine also went from alkaline to acidic as my kidneys worked to clear the acid load from the exogenous ketones.  I sure hope all those people with the recurring order of Keto//OS are also taking mineral supplements and ideally eating lots of green leafy veggies.

2016-11-19 12.57.53.jpg

I also wonder what the long term effects of high levels of exogenous ketones will be on people who are taking them for cancer and other conditions which appear to be exacerbated by insulin and acidity.  I suppose time will tell.

Interestingly there are some people who feel that increased ketones are more a downstream symptom of increased NAD+.  It’s actually the increased NAD+ that occurs in fasting and carb restriction and the upregulated Sitruins that is causing the positive outcomes and not actually the ketones themselves.

2016-11-20 03.04.20.png

endogenous ketones

Endogenous ketones are acidic too,[37] [38] though this is not really a problem in someone who has a functioning pancreas and is producing adequate insulin to keep ketone levels under control.  When the pancreas fails to produce adequate insulin in (i.e. Type 1 Diabetes) it is called ketoacidosis and it can be very dangerous.

In a metabolically healthy person, alkalising minerals play a role in balancing out the acid load of the ketones and actually neutralising them.  Perhaps this is part of the reason that many metabolically fit athletes do not tend to see really high blood ketones even if they have been following a ketogenic diet for a long time?  If their kidneys and pancreas are functioning well they have adequate minerals to balance their acidity they will be able to happily operate most of the time with very low glucose and ketone values (i.e. low total energy).

Perhaps the reverse could be an interesting “hack” if you really wanted to achieve higher blood ketone values without fasting?

In his Keto Summit interview Bryan Walsh (pictured below) raised some interesting questions about pH balance on a long term ketogenic diet.

Can we deplete our buffering capacity by being in this chronically acidic state all the time, a self-induced acidic state, meaning a ketogenic diet?  Long term can we deplete our body’s ability to mitigate this pH shift? 

The body will still maintain an incredibly tight pH.  But at what expense? What are we using up that we may have used for something else to try to maintain this golden egg of pH in the body?

I don’t think over time you’d see somebody’s pH shift.  But what I do think is that other things would suffer as a consequence.

image32

metabolic acidosis and insulin resistance

When you dig into the literature there seem to be a lot of parallels between Type 2 Diabetes and metabolic acidosis.[39] [40] [41]  Type 2 Diabetes and kidney disease often occur together.

“[The] dietary acid load is directly associated with an increased risk of type 2 diabetes. From a public health perspective, dietary recommendations should not only incriminate specific food groups but also include recommendations on the overall quality of the diet, notably the need to maintain an adequate acid/base balance.”[42]

image09

The pancreas’ job is to maintain normal blood glucose levels within a tight range.  The adipose tissue continues to store the excess energy from processed carbs through de novo lipogenesis until it can’t take anymore and we become insulin resistant in order to slow the storage of fat in the adipose tissue.  Then, in the long run the pancreas burns out and we require exogenous insulin.

Similar to the pancreas’ role with glucose, it seems the kidneys maintain our pH within a tight range.  But then over time if it is subjected to excessive acid load, just like excessive glucose in our pancreas, our tight grip on pH may slip, even a little.  Then the kidneys start to burn out.  They no longer maintain optimal acid levels, but rather slightly more acidic levels and then lose their grip on optimal oxygenation of the blood which leads to a plethora of metabolic issues.

Similar to maintaining tight blood glucose control, part of the solution to slow the decline in our kidney function may be to eat some more leafy greens while minimizing the acidic load from nutrient poor foods such as sugar and processed grains.

muscle loss

Another parallel between Type 2 Diabetes and metabolic acidosis is muscle loss.  Our ability to optimise lean muscle mass is critical to maintaining good glucose disposal and insulin sensitivity.

Recent insights indicate that several consequences of metabolic acidosis including the development of insulin resistance can stimulate muscle protein degradation.[43]

So if we don’t eat our veggies maybe we risk losing our gainz?!?!?

In Type 2 Diabetes we often see excess gluconeogenesis when the body can’t burn fat due to high insulin / insulin resistance and instead to protein in our diet and body for energy.

Evidence increasingly suggests that acidosis promotes muscle protein wasting by both increasing protein degradation and inhibiting protein synthesis.

Correction of acidosis may therefore help to preserve muscle mass and improve the health of patients with pathological conditions associated with acidosis.[44]

The chart below shows that people with the highest amount of potassium excretion in the urine (i.e. most alkaline) had a greater percentage of lean body mass.  Perhaps the quickest way to get buff is to get adequate protein AND eat your veggies to enhance fat burning and reduce your reliance on glucose and protein for energy.

image27

It has been demonstrated that even the slightest degree of metabolic acidosis produces insulin resistance in healthy humans. Many recent epidemiological studies link metabolic acidosis indicators with insulin resistance and systemic hypertension.

The strongly acidogenic diet consumed in developed countries produces a lifetime acidotic state, exacerbated by excess body weight and aging, which may result in insulin resistance, metabolic syndrome, and Type 2 diabetes, contributing to cardiovascular risk, along with genetic causes, lack of physical exercise, and other factors… 

Even very slight levels of chronic kidney insufficiency are associated with increased cardiovascular risk, which may be explained at least in part by deficient acid excretory capacity of the kidney and consequent metabolic acidosis-induced insulin resistance.[45]

image23 [46]

As we age, there is a loss of muscle mass, which may predispose us to falls and fractures. A three-year study looking at a diet rich in potassium, such as fruits and vegetables, as well
as a reduced acid load, resulted in preservation of muscle mass in older men and women. Conditions such as chronic renal failure that result in chronic metabolic acidosis result in accelerated breakdown in skeletal muscle. 

Correction of acidosis may preserve muscle mass in conditions where muscle wasting is common such as diabetic ketosis, trauma, sepsis, chronic obstructive lung disease, and renal failure.[47]

summary

  • Whether you think eating alkaline foods is useful or woo woo junk it appears that metabolic acidosis is a thing.
  • Metabolic acidosis seems to be interrelated with insulin resistance, Type 2 Diabetes and retention of muscle mass.
  • To prevent metabolic acidosis it appears prudent to ensure that your body has adequate minerals to enable your kidneys to balance pH over the long term. This can be achieved by eating plenty of veggies and / or supplementing with alkaline minerals (e.g. magnesium, sodium, potassium, zinc etc).
  • If you eat plenty of veggies you’re probably getting enough alkalising minerals, however you can easily test your urine to see if your dietary acid load is high.
  • If you are targeting a high fat therapeutic ketogenic diet, following a zero carb dietary approach and / or taking exogenous ketones it seems then it may be even more important to be mindful of your acid load and consider mineral supplementation.

epilogue

So, you may be wondering how my ketones are going these days with the alkalising minerals on board.  They seem to be a little lower now with the mineral supplementation.   When I fast for a few days they kick in and might get to around 2.0mmol/L and hunger is not a big deal.  I think the ketones are doing what they’re meant to do.

I’m still not exactly sure why my ketone spiked off the chart that brief period.  I think Elizma’s explanation makes sense.  That is, my insulin sensitivity improved and the flood gate of free fatty acids was released for a time and then settled down.  In time though I think the alkalising minerals balance out the ketones and keep them from getting too high.

I have also been taking the Niacel on an ongoing basis to increase NAD+ which in appears to increase the breath acetone (fat burning) and decreases the ketones in the blood (BHB).  But more on that in future posts.  This one is already too long.

The ratio of β-OHB to AcAc depends on the NADH/NAD+ ratio inside mitochondria; if NADH concentration is high, the liver releases a higher proportion of β-OHB.[48]

I think being able to run with a lower total energy (i.e. glucose plus ketones) in the blood most of the time might be a good thing.  When high levels of glucose or ketone are required (e.g. fasting or explosive exercise) they can be easily accessed if we have good insulin sensitivity.

P.P.S.

Elizma and I have been talking about kicking off an occasional Q&A podcast.  So, if you have any questions in the area of functional medicine, MTHFR, nutrigenomics / 23andme (Elizma) or diabetes and nutrition (me) then feel free to leave some questions below to kick off our first one.  It could be a fun adventure.

references

[1] https://www.ncbi.nlm.nih.gov/pubmed/8396707

[2] https://en.wikipedia.org/wiki/PH

[3] http://www.forbes.com/sites/quora/2016/03/11/how-our-bodies-go-to-extraordinary-lengths-to-maintain-safe-ph-levels/#4dd8545c208a http://www.forbes.com/sites/quora/2016/03/11/how-our-bodies-go-to-extraordinary-lengths-to-maintain-safe-ph-levels/#667262df208a

[4] http://ketosummit.com/

[5] http://www.gbrmpa.gov.au/managing-the-reef/threats-to-the-reef/climate-change/how-climate-change-can-affect-the-reef/ocean-acidification

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

[7] http://thepaleodiet.com/acidbase-balance/

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

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

[10] http://christinecronau.com/wp-content/uploads/2014/01/pH.pdf

[11] https://www.facebook.com/drjackkruse/posts/1537554709642211

[12] http://www.nature.com/articles/srep35907

[13] https://en.wikipedia.org/wiki/Warburg_hypothesis

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

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

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

[17] http://www.madehow.com/inventorbios/32/Pierre-Eug-ne-Marcellin-Berthelot.html

[18] https://www.ncbi.nlm.nih.gov/pubmed/7797810

[19] http://www.precisionnutrition.com/acid-base

[20] http://thepaleodiet.com/acidbase-balance/

[21] https://www.ncbi.nlm.nih.gov/pubmed/7797810

[22] https://www.ncbi.nlm.nih.gov/m/pubmed/23439373/

[23] https://www.ncbi.nlm.nih.gov/pubmed/7797810

[24] http://www.wheatbellyblog.com/2015/02/mind-minerals/

[25] https://www.ncbi.nlm.nih.gov/pubmed/21248199

[26] https://www.ncbi.nlm.nih.gov/m/pubmed/21457266/

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

[28] http://nutritionfacts.org/video/alkaline-diets-animal-protein-and-calcium-loss/

[29] https://www.ncbi.nlm.nih.gov/pubmed/15546911

[30] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2597402/

[31] https://en.wikipedia.org/wiki/High_anion_gap_metabolic_acidosis

[32] http://firstendurance.com/the-ph-of-foods-and-their-effect-on-performance/

[33] https://www.facebook.com/groups/optimisingnutrition/permalink/1607541596213549/?comment_id=1608380926129616&comment_tracking=%7B%22tn%22%3A%22R%22%7D

[34] https://www.facebook.com/groups/optimisingnutrition/permalink/1607541596213549/?comment_id=1608380926129616&comment_tracking=%7B%22tn%22%3A%22R%22%7D

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

[36] https://www.facebook.com/livinlowcarbman/photos/a.145604576319.138059.91566951319/10154770616481320/?type=3&comment_id=10154788120686320&comment_tracking=%7B%22tn%22%3A%22R%22%7D

[37] http://chemistry.stackexchange.com/questions/54459/why-are-ketones-acidic

[38] http://answers.wikia.com/wiki/Is_a_ketone_an_acid_or_a_base

[39] http://l.facebook.com/l.php?u=http%3A%2F%2Fsuppversity.blogspot.com.au%2F2013%2F04%2Fscience-round-up-seconds-macro-mineral.html&h=sAQHCVlPJ

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

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

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

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

[44] https://www.ncbi.nlm.nih.gov/pubmed/15586003

[45] https://www.ncbi.nlm.nih.gov/pubmed/21352078

[46] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3155690/

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

[48] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709699/

curried egg with cows brain

Considering how very nutrient dense offal is, it’s been surprisingly hard to find organ meat recipes that do really well in the nutrition ranking because so many of the recipes are ‘diluted’ with lots of sweet stuff to mask the taste.

That is, until Tristan Haggard sent me their long awaited ‘ketogenic edge cookbook‘.

2016-11-18-1

Tristan and Jessica Haggard from Primal Edge Health moved from California to Ecuador to seek a healthier place to live and raise their family.

Clean water.  More sunshine.  Closer to the equator.

These guys are the real deal.

The recipes in their new cookbook document’s how Jessica lovingly makes sure they ensure they ensure they thrive with their food.  It’s not all offal, but it’s clean, nutrient dense and simple, even when it comes to the deserts.

2016-11-18

This recipe for curried eggs with cows brains does spectacularly  well with the vitamins and minerals as well as the amino acids while still being 68% fat.

2016-11-18-3

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

net carbs Insulin load carb insulin fat protein fibre
4g 16g 27% 68% 21g 14g

Combining the brains  with the egg, spinach and avocado makes for a pretty unbeatable combination when it comes to nutrient density.  In fact it ranks at:

The only thing really missing from the book is a family photo to show how health these nutrient dense whole foods are making them.  So here you go.

I  also recommend you check out their YouTube Channel, blog and podcast for some pragmatic nutrition and lifestyle advice.

 

zero carb

For most people the optimal dietary approach seems to include a balance of plant and animal based foods.  Some people prefer more (or all) plants due to ethical or religious reasons, while others prefer to avoid vegetables and grains.

Some people just don’t like veggies, while others struggle to digest plant fibres and find relief from debilitating digestive, mental health[1] or other symptoms when they avoid plant based foods and even dairy.[2] [3] [4]

Others feel that the nutrients in plant based foods are less bioavailable and that the nutrients in animal based foods will be more easily absorbed.[5]

image04

The chart below shows a comparison of the nutrients provided by:

  • the most nutrient dense zero carb foods,
  • the most nutrient dense plant based foods, and
  • the most nutrient dense foods available.

As you might expect, the zero carb foods (red bars) do well in the proteins and fatty acids while the plant based foods (blue bars) generally contain more vitamins and minerals.

image07

The chart below is a comparison of the average amount of nutrients (as a percentage of the daily recommended intake) for a range of dietary approaches.  A zero carb approach can provide you with a solid amount of nutrients, and likely more than a plant only based approach, though not as much as dietary approaches that incorporates both plant and animal based foods.[6]

161104-updated-nutrient-analysis-7112016-54706-am-bmp

Going zero carb will reduce the insulin load compared to most dietary approaches, although the higher levels of protein may mean that you won’t necessarily be ‘ketogenic’ or showing high levels of blood ketones.

2016-11-07-1

While the recommended daily intake values for various nutrients is debatable, it appears that it is more difficult to obtain the recommended quantity of Calcium, Magnesium, Potassium, Vitamin E and Vitamin C on a zero carb approach compared to others that contain plant based foods and hence it may be useful to supplement these nutrients.

You’ll notice the most nutrient dense zero carb foods listed below contain a solid amount of organ meats which are very nutrient dense.  The chart below shows the nutrient density of the highest ranking zero carb foods with and without organ meats (cutting out all carbohydrate containing foods narrows the list of available foods from 8000 to 2887 and removing offal narrows the list to 2784 available foods).

You can see from this comparison that organ meats makes a significant difference to the levels of copper, manganese, selenium, vitamin A and vitamin B-12.  So if you are going to go with a zero carb approach it makes sense to maximise your organ meats.

image03

The zero carb foods below are sorted using both nutrient density and insulin load (to make sure you’re not just eating lean protein).

Also included in the table are the nutrient density scores, percentage of insulinogenic calories, insulin load, energy density and the multicriteria analysis score (MCA) that combines all these factors (see the building a better nutrient density index article for more details on the MCA process).

offal

food ND insulin load (g/100g) calories/100g MCA
lamb liver 18 20 168 1.9
lamb kidney 19 15 112 1.9
chicken liver 15 13 119 1.7
veal liver 16 26 192 1.5
turkey liver 14 21 189 1.5
beef brains 8 8 151 1.5
chicken liver 14 20 172 1.5
beef liver 16 25 175 1.5
beef kidney 13 20 157 1.4
chicken liver pate 7 17 201 1.2
lamb brains 5 10 154 1.1
turkey heart 8 20 174 1.0
lamb heart 8 19 161 1.0
pork liver 10 23 165 1.0
liver sausage 0 10 331 0.9
beef heart 8 23 179 0.9
beef heart 5 16 165 0.9
lamb sweetbread 4 15 144 0.8
sweetbread -3 9 318 0.7
beef tripe 6 14 103 0.7
liver pate -4 13 319 0.5

animal products

food ND insulin load (g/100g) calories/100g MCA
ground turkey 4 19 258 1.0
ham 11 17 113 1.0
salami 1 17 378 1.0
pepperoni -1 16 504 0.9
lamb chop 5 25 234 0.9
rib eye steak 5 21 210 0.9
roast pork 5 20 199 0.9
roast beef 4 21 219 0.9
meatballs 0 14 286 0.9
T-bone steak 2 19 294 0.8
turkey bacon 0 11 226 0.8
lean beef 9 23 149 0.8
park sausage 1 13 217 0.8
turkey 0 21 414 0.8
kielbasa -1 12 325 0.8
pork sausage -0 16 325 0.8
pork ribs -1 16 361 0.8
bacon -2 11 417 0.8
turkey meat 6 21 158 0.8
turkey drumstick 6 21 158 0.8
roast ham 4 18 178 0.8
chicken 7 22 148 0.7
veal 8 24 151 0.7
pork chop 6 23 172 0.7
ground pork 6 25 185 0.7
bratwurst -2 13 333 0.7

seafood

food ND insulin load (g/100g) calories/100g MCA
caviar 14 23 264 1.8
fish roe 16 18 143 1.7
salmon 17 20 156 1.7
oyster 18 14 102 1.6
trout 14 18 168 1.6
mackerel 7 10 305 1.6
anchovy 13 22 210 1.5
cisco 7 13 177 1.3
sturgeon 11 16 135 1.2
sardines 8 16 185 1.2
crab 15 14 83 1.2
sardine 8 19 208 1.2
herring 7 19 217 1.2
flounder 11 12 86 1.1
halibut 12 17 111 1.0
tuna 9 23 184 1.0
shrimp 12 19 119 0.9
lobster 12 15 89 0.9
rockfish 11 17 109 0.9
crayfish 11 13 82 0.9
pollock 11 18 111 0.9
cod 11 48 290 0.8
perch 8 14 96 0.7
octopus 9 28 164 0.7
haddock 9 19 116 0.6
whiting 8 18 116 0.6
white fish 8 18 108 0.5

dairy and egg

food ND insulin load (g/100g) calories/100g MCA
egg yolk 8 12 275 1.6
cream 4 5 340 1.4
butter 3 3 718 1.4
cheddar cheese 7 20 410 1.4
Swiss cheese 7 22 393 1.4
cream cheese 4 10 350 1.3
sour cream 4 6 198 1.3
whole egg 7 10 143 1.3
feta cheese 5 15 264 1.2
mozzarella 8 26 304 1.2
parmesan cheese 6 35 420 1.1
limburger cheese 2 15 327 1.1
camembert 2 16 300 1.0
Greek yogurt 6 9 97 1.0
goat cheese 2 14 264 1.0
gouda cheese 3 21 356 1.0
gruyere cheese 2 23 413 1.0
blue cheese 2 19 353 1.0
edam cheese 2 21 357 0.9
brie 1 16 334 0.9
Monterey cheese 1 19 373 0.9
muenster cheese 1 19 368 0.8
kefir 10 7 41 0.8
Colby 0 20 394 0.8
ricotta -0 12 174 0.7
sour cream (light) -1 9 136 0.6
cottage cheese (low fat) 6 13 81 0.6
Greek yogurt (low fat) 6 11 73 0.6

other dietary approaches

The table below contains links to separate blog posts and printable .pdfs for a range of dietary approaches (sorted from most to least nutrient dense) that may be of interest depending on your situation and goals.   You can print them out to stick to your fridge or take on your next shopping expedition for some inspiration.

dietary approach printable .pdf
weight loss (insulin sensitive) download
autoimmune (nutrient dense) download
alkaline foods download
nutrient dense bulking download
nutrient dense (maintenance) download
weight loss (insulin resistant) download
autoimmune (diabetes friendly) download
zero carb download
diabetes and nutritional ketosis download
vegan (nutrient dense) download
vegan (diabetic friendly) download
therapeutic ketosis download
avoid download

If you’re not sure which approach is right for you and whether you are insulin resistant, this survey may help identify the optimal dietary approach for you.

image02

 

notes

[1] https://zerocarbzen.com/2016/10/04/zero-carb-interview-amber-ohearn/

[2] https://www.gutsense.org/fiber-menace/about-fiber-menace-book.html

[3] https://optimisingnutrition.com/2015/10/05/ketogenic-fibre/

[4] https://zerocarbzen.com/

[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3153292/

[6] However, keep in mind that this analysis is based on the USDA database that includes all the nutrients in the food rather than what will be absorbed.  Species specific nutrient bioavailability is still an emerging area.  While we can measure the nutrient in a food, it is hard to quantify how much of those nutrients are digested and absorbed into the body.

the complete guide to fasting (review)

Considering the massive amount of research and interest in the idea of fasting, not a lot has been written for the general population on the topic.

Brad Pilon’s 2009 e-book Eat Stop Eat was a great, though fairly concise, resource on the mechanisms and benefits of fasting.

image08

Martin Berkhan’s LeanGains blog had a cult following for a while in the bodybuilding community.

image17Michael Mosley’s 2012 documentary Eat, Fast and Live Longer documentary piqued the public interest and was followed by the popular 5:2 Diet book.

Then in 2013, Jason Fung emerged onto the low carb scene with his epic six part Aetiology of Obesity YouTube Series in which he detailed a wide range of theories relating to obesity and diabetes.

Essentially, Jason’s key points are that:

  • simply treating Type 2 diabetes with more insulin to suppress blood glucose levels while continuing to eat the diet that caused the diabetes is futile,
  • people with Type 2 diabetes are already secreting plenty of insulin, and
  • insulin resistance is the real problem that needs to be addressed.

Jason’s Intensive Dietary Management blog has explored a lot of concepts that made their way into his March 2016 book, The Obesity Code.  However surprisingly, given that Jason is the fasting guy, the book didn’t talk much about fasting.

my experience with fasting

I have benefited personally from implementing an intermittent fasting routine after getting my head around Jason’s work.  I like the way I look and perform, both mentally and physically, after a few days of not eating.  I also like the way my belt feels looser and my clothes fit better.

Complete abstinence is easier than perfect moderation.

St Augustine

I recently did a seven day fast and since then I’ve done a series of four day fasts, testing my glucose and blood and breath ketones with a range of different supplements (e.g. alkaline mineral mix, exogenous ketones, bulletproof coffee / fat fast and Nicotinamide Riboside) to see if they made any difference to how I feel and perform, both mentally and physically.

Fasting does become easier with practice as your body gets used to accessing fat for fuel.

I love the mental clarity!   My workout performance and capacity even seems to be better when I’ve fasted for a few days.

My key fasting takeaways are:

  1. Fasting is not that hard. Give it a try.
  2. You can build up slowly.
  3. If you don’t feel good. Eat!

The more I learn about health and nutrition, the more I realise how critical it is to be able to burn fat and conserve glucose for occasional use.  We get into all sorts of trouble when we get stuck burning glucose.

Our body is like a hybrid car with a slow burning fat motor (with a big fuel tank) and high octane glucose motor (with a small fuel tank).  If you’re always filling the small high octane fuel tank to overflowing, you’ll always be stuck burning glucose and your fat burning engine will start to seize up (i.e. insulin resistance and diabetes).

image25

Reducing the processed carbs in our diet enables us to lower our insulin levels and retrain our body to burn fat again.  But nothing lowers insulin as aggressively and effectively as not eating.

Even though lots of Jason’s thoughts on fasting seem self-evident, his blog elucidating them has been very popular, perhaps because the concept of fasting is novel in the context of our current nutritional education.

We’ve been trained, or at least given permission, to eat as often as we want by the people that are selling food or sponsored by them.[1]

context

Jason’s angle on obesity and diabetes comes from his background as a nephrologist (kidney specialist) who deals with chronically ill people who are a long way down the wrong track before they come to his office.  Jason also talks about how he had tried to educate his patients about reducing their carbs, however after eating the same thing for 70 years this is just too hard for many people to change.

2016-10-29-6

Desperate times call for desperate measures!

image11

Many of these patients come to him jamming in hundreds of units a day of insulin to suppress blood glucose levels, even though their own pancreas is still likely secreting more than enough insulin.

image07

Rather than continuing to hammer more insulin to suppress the symptom (high blood glucose), the solution, according to Jason, is to attack the ultimate cause (insulin resistance) directly.

Jimmy Moore is well known to most people that have an interest in low carb or ketogenic diets.  Whether you agree with his approach, it’s safe to say that low carb and keto would not be as popular today without his role.

image06

Meanwhile Jason talks about trying to educate people about reducing the processed carbs from their diet not working, not because of the science but more due to people not being able to change their eating habits after 70 years.

the Complete Guide to Fasting

You’ve probably heard by now that Jason has teamed up with Jimmy to write The Complete  Guide to Fasting which captures Jason’s extensive thoughts on fasting from the blog along with Jimmy’s n=1 experiences and wraps them up in a cohesive comprehensive manual with a colourful bow.

image01

Jason and Jimmy both sent me a copy of their new 304 page book, The Complete Guide to Fasting, to review (thanks guys).   So here goes…

Similar to The Obesity Code, TCGTF is a compilation of ideas that Jason has developed on his Intensive Dietary Management blog.  Blogging is a great way to get the ideas together and thrash them out in a public forum.   Some people love to read the latest blog posts and debate the minutiae, however most people would rather spend the $9 and sit down with a comprehensive book and get the full story.

Unlike The Obesity Code, TCGTF is a bright, full colour production with great graphics that will make it worth buying the hard copy to have and to hold.

TCGTF did originally have the working title Fasting Clarity as a follow on from Jimmy’s previous Cholesterol Clarity and Keto Clarity.   However, other than Jimmy’s discussion of his n=1 fasting experiences, TCGTF is predominantly written in Jason’s voice building from his blog, so it wouldn’t be appropriate for it to have become the third in Jimmy’s Clarity series.

What is similar to Jimmy’s clarity series is that it’s easy to read and accessible for people who are looking for an entry level resource.  This book will be great for people who are interested in the idea of fasting.  It is indeed the complete guide to fasting and is full of references to studies, however it doesn’t go into so much depth as to lose the average reader with scientific detail and jargon.

The book covers:

  • Jimmy’s n=1 experience with fasting,
  • Dr George Cahill’s seminal work on the effects of fasting on metabolism, glucose, ghrelin, insulin, and electrolytes,
  • the history of fasting over the centuries,
  • myth busting about fasting,
  • fasting in weight loss,
  • fasting and diabetes, physical health, and mental clarity,
  • managing hunger during a fast,
  • when not to fast, and
  • when fasting can go wrong.

The book is complete with a section on fasting fluids (water, coffee, tea, broth) and a range of different protocols that you can use depending on what suits you.  What did seem out of place are the recipes for proper meals.  Apparently, the publisher insisted they include these to widen the appeal (If you don’t like the fasting bit you’ve still got some new recipes?)

Overall, the book will be an obvious addition to the library (or Kindle) of people who are already fans of Jason and / or Jimmy and want a polished, consolidated presentation of all their previous work with a bunch of new material added.

TCGTF will also be a great read for someone who is interested learning more about fasting and wants to start at the beginning.   TCGTF is the most comprehensive book on the topic of fasting that I’m aware of.

my additional 2c…

Jason doesn’t mind weighing into a controversial argument, using some hyperbole or dropping the occasional F-bomb for effect and Jimmy’s no stranger to controversy either, so I thought I’d take this opportunity to give you my 2c on some of the topical issues at the fringe that aren’t specifically unpacked in the book.  We learn more as we thrash out the controversial issues at the fringes.   Many arguments come down to context.

target glucose levels

Jason has come under attack for using the word ‘cured’ in relation to HbAc1 values that most diabetes associations would consider non-diabetic,[2] though are not yet optimal.[3]

In the book Jason does discuss relaxing target blood glucose levels during fasting.  This makes sense for someone taking a slew of diabetic medications.   They’re probably not going to continue the journey if they end up in a hypoglycaemic coma on day one.

image12

The chart below shows the real life blood glucose variability for someone with Type 1 Diabetes on a standard diet.  With such massive fluctuations in glucose levels, it’s impossible to target ideal blood glucose levels (e.g. Dr Bernstein’s magic target blood glucose number of 4.6 mmol/L or 83 mg/dL).

image31

If your glucose levels are swinging wildly due to a poor diet coupled with lots of medication, your glucose levels are simply going to tank when you stop eating.  Hence, a safe approach is to back off the medication, at least initially, until your glucose levels have normalized.

Being married to someone with Type 1 Diabetes, I have learned the practical realities of getting blood glucose levels as low as possible while still avoiding dangerous lows.[4]  My wife Monica doesn’t feel well when her blood glucose levels are too low, but neither does she feel good with high blood glucose levels.  Balancing insulin and food to get blood glucose levels as low as possible without experiencing lows requires constant monitoring.

The chart below shows how scattered blood glucose levels can be even if you’re fairly well controlled.   Ideally you want the average blood glucose level to be as low as possible while minimising the number of hypoglycaemic episodes (i.e. below the red line).  If you can’t reduce the variability you just can’t bring the average blood glucose level down.  The last thing you want is to be eating to raise your blood glucose levels because you had too much blood glucose lowering medication.

image24

Pretty much everyone agrees that it’s dumb to be eating crap food and dosing with industrial levels of insulin to manage blood glucose levels.   High levels of exogenous insulin just drive the sugar that is not being used to be stored as fat in your belly, then your organs, and then in the more fragile places like your eyes and the brain.

Jason’s perspective is that people who are chronically insulin resistant and morbidly obese are likely producing more than enough insulin.  The last thing they need is exogenous insulin which will keep the fat locked up in their belly and vital organs.  Dropping insulin levels as low as possible using a low insulin load diet and fasting coupled with reducing medications will let the fat flow out.

image00

fasting to optimise blood glucose levels

In the long run, neither high insulin nor high glucose levels are optimal.

image10

Once you’ve broken the back of your insulin resistance with fasting, you can continue to drive your blood glucose levels down towards optimal levels.

One of the most popular articles on the Optimising Nutrition blog is how to use your glucose meter as a fuel gauge which details how you can time your fasting based on your blood glucose levels to ensure they continue to reduce.

image04

Your blood glucose levels can help calibrate your hunger and help you to understand if you really need to eat.  I think this is a great approach for people whose main issue is high blood glucose levels and who aren’t ready to launch into longer multi day fasts.

image26

In a similar way, a disciplined fasting routine can help optimise blood glucose levels in the long term.  The chart below shows a plot of Rebecca Latham’s blood glucose levels over three months where she used her fasting blood glucose numbers AND body weight to decide if she would eat on any given day.

image09

While there is some scatter in the blood glucose levels, you can see that regular fasting does help to reduce blood glucose levels over the long term.

Once you’ve lost your weight , broken the back of your insulin resistance and stopped eating crap food, you may find that you still need some exogenous insulin or other diabetic medication to optimise blood glucose levels if you have burned out your pancreas.

fasting frequency

The TGTF book covers off on several fasting regimens such as intermittent fasting, 24 hours, 36 hours, 42 hours and 7 to 14 days.  One concept that I’m intrigued by, similar to the idea of using your glucose meter as a fuel gauge, is using your bathroom scale as a fuel gauge.

image02

The reality, at least in my experience, is that we can overcompensate for our fasting during our feasting and end up not moving forward toward our goal.

If your goal is to lose weight I like the idea of tracking your weight and not eating on days that your weight is above your goal weight for that day.

14633142_10209291396354349_7869008000126784615_o

Again, Rebecca Latham has done a great job building an online community around the concept of using weight as a signal to fast through her Facebook group  My Low Carb Road – Fasting Support.

image28

The chart below shows Rebecca’s weight loss journey through 2016 where she initially targeted a weight loss of 0.2 pounds AND a reduction of 0.25 mg/dL in blood glucose per day.   After three months, she stabilized for a period (during a period when she had a number of major family issues to look after).  She is now using a less aggressive weight loss goal as she heads for her long-term target weight at the end of the year.

image15

The chart below shows the fasting frequency required to achieve her goals during 2016.  Tracking her weight against her target rate of weight loss has required her to fast a little more than one day in three to stay on track.

image16

Eating quality food is part of the battle, but managing how often you eat is also an important consideration.  After you’ve fasted for a few days, you can easily excuse yourself for eating more when you feast again.  And maybe it’s OK to enjoy your food when you do eat rather than tracking every calorie and trying to consciously limit them.

The obvious caveat is that there are a lot of other things that influence your scale weight such as muscle gain, water, GI tract contents etc, but this is another way to keep yourself accountable over the long term.

FAST WELL, FEED WELL

Fasting is a key component of the metabolic healing process, but it’s only one part of the story.

image29

Fasting is like ripping out your kitchen to put in a new one.   You have to demolish and remove the old stovetop to put the new shiny one back in.  You don’t sticky tape the new marble bench top over the crappy old Laminex.  You have to clean out the old junk before you implement the new, latest, and greatest model.

image32

In fasting, the demolition process is called autophagy, where the body ‘self eats’ the old proteins and aging body parts.   The great thing about minimising all food intake is that you get a deeper cleanse than other options such as fat fast, 500 calories per day or a protein sparing modified fast (PSMF).

But keep in mind that it’s the feast after the fast that builds up the shiny, new body parts that will help you live a longer, healthier, and happier life.

“Fasting without proper refeeding is called anorexia.” 

Mike Julian

Even fasting guru Valter Longo is now talking about the importance of feast / fast cycles rather than chronic restriction.  In the end you need to find the right balance of feasting / fasting, insulin / glucagon, mTOR / AMPK that is right for you.

In TCGTF, Jason and Jimmy talk about prioritising nutrient dense, natural, unprocessed,  low carb, moderate protein foods after the fast.  I’d like to reiterate that principle and emphasise that nutrient density becomes even more important if you are fasting regularly or for longer periods.

In the long term, I think your body will drive you to seek out more food if you’re not giving it the nutrients it needs to thrive.  Conversely, I think if you are providing your body with the nutrients it needs with the minimum of calories I think you will have a better chance of accessing your own body fat and reaching your fat loss goals.

optimising insulin levels AND nutrient density

It’s been great to see the concept of the food insulin index and insulin load being used by so many people!  In theory, when people reduce the insulin load of their diet they more easily access their own body fat and thus normalizes appetite.

image30

Some people who are very insulin resistant do well, at least initially, on a very high fat diet.  However, as glycogen levels are depleted and blood glucose levels start to normalise, I think it is prudent to transition to the most nutrient dense foods possible while still maintaining good (though maybe not yet optimal) blood glucose levels.

The problem with doubling down on reducing insulin by fasting combined with eating only ultra-low insulinogenic foods is that you end up “refeeding” with refined fat after your fast.

image22

While lowering carbs and improving food quality is the first step, I think that, as soon as possible you should start focusing on building up your metabolic machinery (i.e.  muscles and mitochondria).   A low carb nutrient dense diet is part of the story, but I don’t see many people with amazing insulin sensitivity that don’t also have a good amount of lean muscle mass which is critical to ‘glucose disposal’, good blood sugar levels and metabolic health.

This recent IHMC video from Doug McGuff provides a stark reminder of why we should all be focusing on maximising strength and lean muscle mass to slow aging.

The chart below shows a comparison of the nutrient density of the various dietary approaches.  Unfortunately, a super high fat diet is not necessarily going to be as nutrient dense and thus support muscle growth, weight loss, or optimal mitochondrial function as well as other options.

image03

The chart below (click to enlarge) shows a comparison of the various essential nutrients provided by a high fat therapeutic ketogenic dietary approach versus a nutrient dense approach that would suit someone who is insulin sensitive.

image33

I developed a range of lists of optimal foods that will help people in different situations with different goals to maximise the nutrient density that should be delivered in the feast after the fast.   The table below contains links to separate blog posts and printable .pdfs.  The table is sorted from highest to lowest nutrient density.   In time, you may be able to progress to a more nutrient dense set of foods as your insulin resistance improves.

dietary approach printable .pdf
weight loss (insulin sensitive) download
autoimmune (nutrient dense) download
alkaline foods download
nutrient dense bulking download
nutrient dense (maintenance) download
weight loss (insulin resistant) download
autoimmune (diabetes friendly) download
zero carb download
diabetes and nutritional ketosis download
vegan (nutrient dense) download
vegan (diabetic friendly) download
therapeutic ketosis download
avoid download

protein

Jason had  a “robust discussion” with Steve Phinney over the topic of ideal protein levels recently during the Q&A session at the recent Low Carb Vail Conference.

To give some context again, Phinney is used to dealing with athletes who require optimal performance and are looking to optimise strength.  Meanwhile Jason’s patient population is typically morbidly obese people who are on kidney dialysis and probably have some excess protein, as well as a lot of fat that they could donate to the cause of losing weight.

I also know that Jimmy is a fan of Ron Rosedale’s approach of minimising protein to minimise stimulation of mTOR.  Jimmy and Ron are currently working on another book (mTOR Clarity?).  Protein also stimulates mTOR which regulates growth which is great when you’re young but perhaps is not so great when you’ve grown more than enough.

The typical concern that people have with protein in a ketogenic context is that it raises blood insulin in people who are insulin resistant.  ‘Excess protein’ can be converted to blood glucose via gluconeogenesis in people who are insulin resistant and can’t metabolise fat very well.

Managing insulin dosing for someone with Type 1 Diabetes like my wife Monica is a real issue, though she doesn’t actively avoid protein.  She just needs to dose with adequate insulin for the protein being eaten to manage the glucose rise.

The chart below shows the difference in glucose and insulin response to protein in people who have Type 2 Diabetes (yellow lines) versus insulin sensitive (white lines) showing that someone who is insulin resistant will need more insulin to deal with the protein.

image14

As well as insulin resistance, these people are also “anabolic resistant” meaning that some of the protein that they eat is turned into glucose rather than muscle leaving them with muscles that are wasting away.

People who are insulin resistant are leaching protein into their bloodstream as glucose because they can’t mobilise their fat stores for fuel.  They are dependent on glucose and they’ll even catabolise their own muscle to get the glucose they need if they stop eating glucose.

While it’s nice to minimise insulin levels, I wonder whether people who are in this situation may actually need more protein to make up for the protein that is being lost by the conversion to glucose to enable them to maintain lean muscle mass.  Perhaps it’s actually the people who are insulin sensitive that can get away with lower levels of protein?

As well as improving diet quality which will reduce insulin and thus improve insulin resistance, in the long term it’s also very important to maintain and build muscle to be able to dispose of glucose efficiently and also improve insulin resistance.

In TCGTF Jason talks about the fact that the rate of the use of protein for fuel is reduced during a fast and someone becomes more insulin sensitive.  He goes to great lengths to point out that concern over muscle loss shouldn’t stop you trying out fasting (which is a valid point).

image18

A big part of the magic of fasting is that you clean out some of your oldest and dodgiest proteins in your body and set the stage for rebuilding back new high quality parts.   But the reality is that you will lose some protein from your body during a fast (though this is not altogether a bad thing).[5] [6]

Bodybuilders often talk about the “anabolic window” after a workout where they can maximise muscle growth after a workout.  Similarly, one of the awesome things about fasting is that you reduce your insulin resistance and anabolic resistance meaning that when at the end of your fast your body is primed to allocate the high quality nutrients you eat in the right place (i.e. your muscles not your belly or blood stream).

In the end, I think optimal protein intake has to be guided to some extent by appetite.  You’ll want more if you need it, and less if you don’t.

I think if we focus on eating from a shortlist of nutrient dense unprocessed foods we won’t have to worry too much about whether we should be eating 0.8 or 2.2 g/kg of lean body mass.

However, avoiding nutrient dense, protein-containing foods and instead “feasting” on processed fat when you break your fast will be counter-productive if your goal is weight loss and waste a golden opportunity to build new muscle.

are you really insulin resistant?

Insulin resistance and obesity is a continuum.

Not everyone who is obese is necessarily insulin resistant.

If you are really insulin resistant, then fasting, reducing carbs, and maybe increasing the fat content of your diet will enable you to improve your insulin resistance.  This will then help with appetite regulation because your ketones will kick in when your blood glucose levels drop.

However, if you continue to overdo your energy intake (e.g. by chasing high ketones with a super high fat, low protein diet), then chances are, just like your body is primed to store protein as muscle, you will be very effective at storing that dietary fat as body fat.

image05

I fear there are a lot of people who are obese but actually insulin sensitive who are pursuing a therapeutic ketogenic dietary approach in the belief that it will lead to weight loss.  If you’re not sure which approach is right for you and whether you are insulin resistant, this survey may help you identify your optimal dietary approach.

image19

optimal ketone levels

Measuring ketones is really fascinating but confusing as well.

“Don’t be a purple peetone chaser.”

Carrie Brown, The Ketovangelist Podcast Ep 78

Urine ketones strips have limited use and will disappear as you start to actually use the ketones for energy.

In a similar way blood ketones can be fleeting.  Some is better than none, but more is not necessarily better.  As shown in the chart of my seven day fast below I have had amazing ketones and felt really buzzed at that point but since then I haven’t been able to repeat this.  I think sometimes as your body adapts to burning fat for fuel the ketones may be really high but then as it becomes efficient it will stabilise and run at lower ketone levels even when fasting.

image27

If your ketone levels are high when fasting then that’s great.  Keep it up.  They might stay high.  They might decrease.  But don’t chase super high ketones in the fed state unless you are about to race the Tour de France or if you want your body to pump out some extra insulin to bring them back down and store them as fat.

image20

The chart below shows the sum of 1200 data points of ketones and blood glucose levels from about 30 people living a ketogenic lifestyle.  Some of the time they have really high blood ketone levels but I think the real magic of fasting happens when the energy in our bloodstream decreases and we force our body to rely on our own body fat stores.

the root cause of insulin resistance is…

So we’ve worked out that large amounts of processed carbs drive high blood glucose and insulin levels which is bad.

We’ve also worked out that insulin resistance drives insulin levels higher, which is bad.

But what is the root cause of insulin resistance?

I think Jason has touched on a key component in that, as with many things, resistance is caused by excess.  If we can normalise insulin levels, then our sensitivity to insulin will return, similar to our exposure to caffeine or alcohol.

However, at the same time, I think insulin resistance is potentially more fundamentally caused by our sluggish mitochondria that don’t have enough capacity (number or strength) to process the energy we are throwing at them, regardless of whether they come from protein, carbs, or fat.

image13

A low carb diet lowers the bar to enable us to normalise our blood glucose levels.  However, the other end of the spectrum is focusing on training our body and our mitochondria to be able to jump higher.  In the long term this is achieved through, among other things, maximising nutrient dense foods and building lean body mass through resistance exercise.

image23

summary

  1. The Complete Guide to Fasting is, as per the title, the complete guide to fasting. It’s the most comprehensive guide to the nuances of fasting out there and there’s a good balance between the technical detail, while still being accessible for the general public.
  2. Fasting can help optimise blood glucose and weight in the long term, with a disciplined regimen.
  3. Fasting makes the body more insulin sensitive and primes it for growth. When you feast after you fast, it is ideal to make sure you maximise nutrient density of the food you eat as much as possible while maintaining reasonable blood glucose levels.
  4. Understanding your current degree of insulin resistance can help you decide which nutritional approach is right for you. As you implement a fasting routine and transition from insulin resistance to insulin sensitivity you will likely benefit from transitioning from a low insulin load approach to a more nutrient dense approach.

 

references

[1] https://intensivedietarymanagement.com/of-traitors-and-truths/

[2] https://www.diabetes.org.uk/About_us/What-we-say/Diagnosis-ongoing-management-monitoring/New_diagnostic_criteria_for_diabetes/

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

[4] https://optimisingnutrition.com/2015/08/17/balancing-diet-and-diabetes-medications/

[5] https://www.dropbox.com/s/h3pi53njcfu4czl/Physiological%20adaptation%20to%20prolonged%20starvation%20-%20Deranged%20Physiology.pdf?dl=0

[6] https://www.facebook.com/groups/optimisingnutrition/permalink/1602953576672351/?comment_id=1603210273313348&comment_tracking=%7B%22tn%22%3A%22R9%22%7D

energy density, food hyper-palatability and reverse engineering optimal foraging theory

I’m looking forward to Robb Wolf’s new book Wired to Eat in which he talks about the dilemma of optimal foraging theory (OFT) and how it’s a miracle in our modern environment that even more of us aren’t fat, sick and nearly dead.[1]

image26

[yes, I may be a Robb Wolf fan boy.]

But what is  optimal foraging theory[2]?   In essence it is the concept that we’re programmed to hunt and gather and ingest as much energy us we can with the least amount of energy expenditure or order to maximise survival of the species.

In engineering or economics this is akin to a cost : benefit analysis.  Essentially we want maximum benefit for minimum investment.

image13

In a hunter gatherer / paleo / evolutionary context this would mean that we would make an investment (i.e. effort / time / hassle that we could have otherwise spent having fun, procreating or looking after our family) to travel to new places where food was plentiful and easier to obtain.

In these new areas we could spend as little time as possible hunting and gathering and more time relaxing.  Once the food became scarce again we would move on to find another land of plenty.

The people who were good at obtaining the maximum amount of food with the minimum amount of effort survived and thrived and populated the world, and thus became our ancestors.  Those that didnt’ didn’t.

So you can see how the OFT paradigm would be well imprinted on our psyche.

OFT in the wild

In the wild, OFT means that native hunter gatherers would have gone bananas for bananas when they were available…

image28

… gone to extraordinary lengths to obtain energy dense honey …

image16

… and eaten the fattiest cuts of meat and offal, giving the muscle meat to the dogs.

image02

OFT in captivity

But what happens when we translate OFT into a modern context?

image09

Until recently we have never had the situation where nutrition and energy could be separated.

In nature, if something tastes good it is generally good for you.

Our ancestors, at least the ones that survived, grew to understand that as a general rule:

 sweet = good = energy to survive winter

But now we have entered a brave new world.

image19

These days we have are surrounded by energy dense hyperpalatable foods that are designed to taste good without providing substantial levels of nutrients.

image05

When these foods are available our primal programming leaves us defenceless.

Our willpower or our calorie counting apps are no match for engineered foods with an optimised bliss point.

image14

These days diabetes is becoming a bigger problem than starvation in the developing world due to a lack of nutritional value in the the foods they are eating.[3]

The recent industrialisation of the world food system has resulted in a nutritional transition in which developing nations are simultaneously experiencing undernutrition and obesity.

In addition, an abundance of inexpensive, high-density foods laden with sugar and fats is available to a population that expends little energy to obtain such large numbers of calories.

Furthermore, the abundant variety of ultra processed foods overrides the sensory-specific satiety mechanism, thus leading to overconsumption.”[4]

what happens when we go low fat?

So if the problem is simply that we eat too many calories, one solution is to reduce the energy density of our food by avoiding fat, which is the most energy dense of the macronutrients.

Sounds logical, right?

The research into the satiety index demonstrates that there is some basis to the concept that we feel more full with lower energy density, high fibre, high protein foods.[5] [6]   The chart below shows how hungry people report being in the two hours after being fed 1000kJ of different foods (see the low energy density high nutrient density foods for weight loss article for more on this complex and intriguing topic).

image21

However the problem comes when we focus on reducing fat (along with perhaps reduced cost, increased shelf life and palatability combined with an attempt to reach that optimal bliss point[7]), we end up with cheap manufactured food like products that have little nutritional value.

image10

Grain subsidies were brought in to establish and promote cheap ways to feed people to prevent starvation.[8]  It seems now they’ve achieved that goal.[9]

image07

Maybe a little too well.

image01

The foods lowest in fat however are not necessarily the most nutrient dense.     Nutritional excellence and macronutrients are are not necessarily related.

In his blog post Overeating and Brain Evolution: The Omnivore’s REAL Dilemma Robb Wolf says:

I am pretty burned out on the protein, carbs, fat shindig. I’m starting to think that framework creates more confusion than answers.

Thinking about optimum foraging theory, palate novelty and a few related topics will (hopefully) provide a much better framework for folks to affect positive change. 

The chart below shows a comparison of the micronutrients provided by the least nutrient dense 10% of foods versus the most nutrient dense foods compared to the average of all foods available in the USDA foods database.

image18

The quantity of essential nutrients you can get with the same amount of energy is massive!  If eating is about obtaining adequate nutrients then the quality of our food, not just macronutrients or calories matters greatly!

Another problem with simply avoiding fat is that the foods lowest in fat are also the most insulinogenic so we’re left with foods that don’t satiate us with nutrients and also raise our insulin levels.  The chart below shows that the least nutrient dense food are also the most insulinogenic.


what happens when we go low carb?

So the obvious thing to do is to rebel and eliminate all carbohydrates because low fat was such a failure.  Right?

image20

So we swing to the other extreme and avoid all carbohydrates and enjoy fat ad libitum to make up for lost time.

The problem again is that at the other extreme of the macronutrient pendulum we may find that we have limited nutrients.

The chart below shows a comparison of the nutrient density of different dietary approaches showing that a super high fat therapeutic ketogenic approach may not be ideal for everyone, at least in terms of nutrient density.  High fat foods are not always the most nutrient dense and can also, just like low fat foods, be engineered to be hyperpalatable to help us to eat more of them.

image24

The chart below shows the relationship (or lack thereof) between the percentage of fat in our food and the nutrient density.   Simply avoiding or binging on fat does not ensure we are optimising our nutrition.

image12

While many people find that their appetite is normalised whey they reduce the insulin load of their diet high fat foods are more energy dense so it can be easy to overdo the high fat dairy and nuts if you’re one of the unlucky people whose appetite doesn’t disappear.

image08

what happens when we go paleo?

So if ‘paleo foods’ worked so well for paleo peeps then maybe we should retreat back there?  Back to the plantains, the honey and the fattiest cuts of meat?

image27

Well, maybe.  Maybe not.

image06

For some people ‘going paleo’ works really well.  Particularly if you’re really active.

Nutrient dense, energy dense whole foods work really well if you’re also going to the CrossFit Box to hang out with your best buds five times a week.

image11

But for the rest of us that aren’t insanely active, then maybe simply ‘going paleo’ is not the best option…

image25

… particularly if we start tucking into the energy dense ‘paleo comfort foods’.

image03

If we’re not so active, then intentionally limiting our exposure to highly energy dense hyperpalatable foods can be a useful way to manage our OFT programming.

enter nutrient density

A lot of people find that nutrient dense non-starchy veggies, or even simply going “plant based”, works really well, particularly if you have some excess body fat (and maybe even stored protein) that you want to contribute to your daily energy expenditure.

image15

Limiting ourselves to the most nutrient dense foods (in terms of nutrients per calorie) enables us to sidestep the trap of modern foods which have separated nutrients and energy.  Nutrient dense foods also boost our mitochondrial function, and fuel the fat burning Krebs cycle so we can be less dependent on a sugar hit for energy (Cori cycle).

Limiting yourself to nutrient dense foods (i.e. nutrients per calorie) is a great way to reverse engineer optimal foraging theory.

image04

If your problem is that energy dense low nutrient density hyperpalatable foods are just too easy to overeat, then actively constraining your foods to those that have the highest nutrients per calorie could help manage the negative effects of OFT that are engrained in our system by imposing an external constraint.

image22

But if you’re a lean Ironman triathlete these foods are probably not going to get you through.  You will need more energy than you can get from nutrient dense spinach and broccoli.

optimal rehabilitation plan?

So while there is no one size fits all solution, it seems that we have some useful principles that we can use to shortlist our food selection.

  1. We are hardwired to get the maximum amount of energy with the least amount of effort (i.e. optimal foraging theory).
  2. Commercialised manufactured foods have separated nutrients from food and made it very easy to obtain a lot of energy with a small investment.
  3. Eliminating fat can leave us with cheap hyperpalatable grain-based fat free highly insulinogenic foods that will leave us with spiralling insulin and blood glucose levels.
  4. Eating nutrient dense whole foods is a great discipline, but we still need to tailor our energy density to our situation (i.e. weight loss vs athlete).

the solution

So I think we have three useful quantitative parameters with which to optimise our food choices to suit our current situation:

  1. insulin load (which helps as to normalise our blood glucose levels),
  2. nutrient density (which helps us make sure we are getting the most nutrients per calorie possible), and
  3. energy density (helps us to manage the impulses of OFT in the modern world).

image30

I have used a multi criteria analysis to rank the foods for each goal.  The chart below shows the weightings used for each approach.

image23

The lists of optimal foods below have been developed to help you manage your primal impulses.  The table below contains links to seperate blog posts and printable .pdfs for a range of dietary approaches that may be of interest depending on your goals and situation.

dietary approach printable .pdf
weight loss (insulin sensitive) download
autoimmune (nutrient dense) download
alkaline foods download
nutrient dense bulking download
nutrient dense (maintenance) download
weight loss (insulin resistant) download
autoimmune (diabetes friendly) download
zero carb download
diabetes and nutritional ketosis download
vegan (nutrient dense) download
vegan (diabetic friendly) download
therapeutic ketosis download
avoid download

If you’re not sure which approach is right for you and whether you are insulin resistant this survey may help you identify your optimal dietary approach.

survey

I hope this helps.

Good luck out there!

references

[1] http://ketosummit.com/

[2] https://en.wikipedia.org/wiki/Optimal_foraging_theory

[3] http://www.hoajonline.com/obesity/2052-5966/2/2

[4] https://www.ncbi.nlm.nih.gov/pubmed/24564590

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

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

[7] https://www.nextnature.net/2013/02/how-food-scientists-engineer-the-bliss-point-in-junk-food/

[8] https://en.wikipedia.org/wiki/Agricultural_subsidy

[9] http://blog.diabeticcare.com/diabetes-obesity-growth-trend-u-s/

nutrient dense autoimmune friendly foods

An “autoimmune disease” develops when your immune system, which defends your body against disease, decides your own healthy cells are foreign.  As a result, your immune system attacks healthy body cells.[1]

The list of diseases that are said to be autoimmune related are extensive,[2] [3] and to add insult to injury, people with autoimmune issues often end up with challenging digestive issues.

An autoimmune dietary protocol eliminates foods that can trigger inflammation in people with more sensitive digestion that may be autoimmune related.  The foods typically eliminated include nuts, seeds, beans, grains, artificial sweeteners, dairy, alcohol, chocolate and nightshades.

The remaining foods largely involve vegetables, seafood and animal products.  Given that Type 1 Diabetes is an autoimmune condition I have also created a lower insulin load diabetes friendly autoimmune list of foods that that will be more gentle on blood glucose levels.

Although sticking to the autoimmune friendly list of foods is somewhat restrictive it is a very nutrient dense approach compared to other options as you can see in the comparison of the nutrient density of different nutritional approaches in the chart below where it came in at #2 of the thirteen approaches analsed.

image01

The chart below shows the quantity of nutrients provided by these nutrient dense autoimmune friendly foods compared to the average of all the 8000 foods in the USDA database.

autoimmune-nutrient-dense

This chart shows the amount of nutrients provided by the diabetes friendly autoimmune protocol foods compared to all the foods in the USDA database which are not as high but still better than the average of all the foods available.

autoimmune-dabietes-friendly

An autoimmune protocol is typically a short term ‘reset’ where inflammatory foods are eliminated for a period.  Once things settle down potential other possible trigger foods are slowly reintroduced to see which foods can be tolerated.

For more information see Robb Woolf’s The Paleo Solution, Sarah Ballantyne’s The Paleo Approach or Chris Kresser The Paleo Cure.

The foods listed below represent the top 10% of the USDA food database using this ranking system.  Also included in the table are the nutrient density score, percentage of insulinogenic calories, insulin load, energy density and the multicriteria analysis score (MCA) that combines all these factors.

autoimmune protocol (nutrient dense)

vegetables, spices and fruit 

image19

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
broccoli 23 36% 3 22 2.61
spinach 21 49% 4 23 2.20
zucchini 19 40% 2 17 2.15
watercress 24 65% 2 11 2.15
endive 15 23% 1 17 2.11
chicory greens 14 23% 2 23 2.03
basil 18 47% 3 23 1.91
beet greens 15 35% 2 22 1.86
asparagus 18 50% 3 22 1.85
escarole 11 24% 1 19 1.71
Chinese cabbage 17 54% 2 12 1.70
chard 15 51% 3 19 1.63
parsley 15 48% 5 36 1.63
lettuce 15 50% 2 15 1.60
cauliflower 15 50% 4 25 1.57
alfalfa 9 19% 1 23 1.57
okra 14 50% 3 22 1.49
summer squash 13 45% 2 19 1.47
chives 13 48% 4 30 1.41
portabella mushrooms 14 55% 5 29 1.40
arugula 11 45% 3 25 1.32
turnip greens 11 44% 4 29 1.32
cloves 9 35% 35 274 1.30
sage 7 26% 26 315 1.26
brown mushrooms 16 73% 5 22 1.25
collards 8 37% 4 33 1.18
white mushroom 13 65% 5 22 1.17
celery 10 50% 3 18 1.16
dandelion greens 11 54% 7 45 1.15
sauerkraut 8 39% 2 19 1.15
curry powder 3 13% 14 325 1.15
shiitake mushroom 11 58% 7 39 1.12
yeast extract spread 11 59% 27 185 1.11
cucumber 7 39% 1 12 1.09
seaweed (wakame) 14 79% 11 45 1.01
edamame 6 41% 13 121 0.98
radishes 7 43% 2 16 0.98
spirulina 11 70% 6 26 0.92
avocado -1 8% 3 160 0.92
cabbage 8 55% 4 23 0.85
Brussel sprouts 7 50% 6 42 0.85
thyme 4 34% 31 276 0.84
chayote 5 40% 3 24 0.81
marjoram 3 31% 27 271 0.81

seafood

image21

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
salmon 19 52% 20 156 1.96
fish roe 18 47% 18 143 1.93
trout 16 45% 18 168 1.80
caviar 13 33% 23 264 1.76
anchovy 14 44% 22 210 1.64
oyster 16 59% 14 102 1.57
mackerel 7 14% 10 305 1.53
sturgeon 13 49% 16 135 1.44
cisco 9 29% 13 177 1.43
crab 17 71% 14 83 1.42
halibut 15 66% 17 111 1.29
herring 9 36% 19 217 1.28
flounder 13 57% 12 86 1.28
tuna 11 52% 23 184 1.22
lobster 14 71% 15 89 1.19
shrimp 14 69% 19 119 1.18
rockfish 13 66% 17 109 1.14
pollock 13 69% 18 111 1.09
cod 13 71% 48 290 1.05
crayfish 12 67% 13 82 1.04
perch 10 62% 14 96 0.92
haddock 11 71% 19 116 0.87
whiting 10 66% 18 116 0.85
white fish 10 70% 18 108 0.81

animal products

image09

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
lamb liver 19 48% 20 168 1.99
lamb kidney 19 52% 15 112 1.91
turkey liver 15 47% 21 189 1.70
veal liver 17 55% 26 192 1.69
beef liver 17 59% 25 175 1.61
chicken liver 14 50% 20 172 1.51
beef kidney 14 52% 20 157 1.47
beef brains 7 22% 8 151 1.40
ham 13 59% 17 113 1.22
lamb brains 6 27% 10 154 1.16
lamb heart 9 48% 19 161 1.13
chicken liver pate 7 34% 17 201 1.12
ground turkey 6 30% 19 258 1.12
turkey heart 9 47% 20 174 1.08
rib eye steak 7 41% 21 210 1.07
pork liver 11 59% 23 165 1.05
lean beef 11 61% 23 149 1.05
lamb chop 7 42% 25 234 1.04
roast beef 6 38% 21 219 1.04
roast pork 7 41% 20 199 1.03
beef heart 9 52% 23 179 1.02
salami 2 18% 17 378 1.02
beef rib eye 6 39% 21 215 1.01
chicken 10 60% 22 148 0.98
veal 11 65% 24 151 0.95
turkey meat 8 52% 21 158 0.94
turkey drumstick 8 52% 21 158 0.94
beef tongue 1 16% 11 284 0.93
pork chop 9 57% 23 172 0.93
T-bone steak 3 26% 19 294 0.92
ground pork 8 54% 25 185 0.92
pepperoni 0 13% 16 504 0.92
lamb sweetbread 6 43% 15 144 0.90
pork shoulder 8 56% 22 162 0.88

autoimmune protocol (diabetes friendly)

Vegetables, spices and fruit

image19

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
broccoli 25 36% 3 22 1.78
endive 16 23% 1 17 1.65
chicory greens 14 23% 2 23 1.59
alfalfa 11 19% 1 23 1.54
escarole 11 24% 1 19 1.41
spinach 24 49% 4 23 1.40
zucchini 19 40% 2 17 1.38
beet greens 15 35% 2 22 1.33
curry powder 3 13% 14 325 1.27
asparagus 21 50% 3 22 1.22
basil 19 47% 3 23 1.21
avocado -2 8% 3 160 1.18
watercress 28 65% 2 11 1.17
olives -6 3% 1 145 1.12
turnip greens 14 44% 4 29 1.03
parsley 15 48% 5 36 1.02
sage 5 26% 26 315 1.02
chard 17 51% 3 19 1.01
Chinese cabbage 18 54% 2 12 1.00
lettuce 16 50% 2 15 0.98
portabella mushrooms 18 55% 5 29 0.96
cauliflower 15 50% 4 25 0.95
cloves 8 35% 35 274 0.93
collards 8 37% 4 33 0.93
summer squash 12 45% 2 19 0.92
chives 13 48% 4 30 0.91
okra 14 50% 3 22 0.89
poppy seeds -3 17% 23 525 0.86
sauerkraut 7 39% 2 19 0.85

seafood

image21

food ND % insulinogenic insulin load (g/100g) calories/100g MCA score
mackerel 7 14% 10 305 1.44
fish roe 23 47% 18 143 1.41
caviar 16 33% 23 264 1.40
salmon 24 52% 20 156 1.33
trout 20 45% 18 168 1.29
anchovy 19 44% 22 210 1.27
cisco 11 29% 13 177 1.25
herring 12 36% 19 217 1.14
sardine 12 37% 19 208 1.1
sturgeon 17 49% 16 135 1.04
oyster 20 59% 14 102 0.94
flounder 19 57% 12 86 0.94
tuna 16 52% 23 184 0.93
halibut 21 66% 17 111 0.79
crab 23 71% 14 83 0.77
rockfish 19 66% 17 109 0.72
shrimp 20 69% 19 119 0.69
perch 16 62% 14 96 0.67
lobster 20 71% 15 89 0.66
crayfish 18 67% 13 82 0.66
pollock 19 69% 18 111 0.64
cod 19 71% 48 290 0.57

animal products

image09

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
lamb kidney 25 52% 15 112 1.33
lamb liver 22 48% 20 168 1.32
beef brains 6 22% 8 151 1.24
turkey liver 19 47% 21 189 1.21
lamb brains 7 27% 10 154 1.15
chicken liver 20 50% 20 172 1.15
salami 3 18% 17 378 1.13
pepperoni -0 13% 16 504 1.11
bratwurst 1 16% 13 333 1.08
beef kidney 19 52% 20 157 1.08
ground turkey 8 30% 19 258 1.08
bacon -2 11% 11 417 1.07
veal liver 21 55% 26 192 1.06
pork ribs 1 18% 16 361 1.05
sweetbread -3 12% 9 318 1.04
chicken liver pate 9 34% 17 201 1.04
beef tongue -1 16% 11 284 1.04
kielbasa -1 15% 12 325 1.03
T-bone steak 4 26% 19 294 1.01
beef liver 22 59% 25 175 1.00
pork sausage 1 20% 16 325 1.00
park sausage 3 25% 13 217 1.00
roast beef 10 38% 21 219 0.99
liver sausage -3 13% 10 331 0.99
rib eye steak 11 41% 21 210 0.99
roast pork 11 41% 20 199 0.96
beef rib eye 10 39% 21 215 0.95
beef sausage -1 18% 15 332 0.94
turkey 0 20% 21 414 0.94
turkey bacon -1 19% 11 226 0.92
meatballs -2 19% 14 286 0.91
lamb heart 13 48% 19 161 0.91
knackwurst -4 16% 12 307 0.90
turkey heart 13 47% 20 174 0.89
liver pate -3 16% 13 319 0.89
chorizo -3 17% 19 455 0.87
lamb rib -2 19% 17 361 0.86
lamb chop 10 42% 25 234 0.86
ham 18 59% 17 113 0.85
duck -3 18% 15 337 0.85
blood sausage -5 14% 13 379 0.84

other dietary approaches

The table below contains links to separate blog posts and printable .pdfs for a range of dietary approaches (sorted from most to least nutrient dense) that may be of interest depending on your situation and goals.   You can print them out to stick to your fridge or take on your next shopping expedition for some inspiration.

dietary approach printable .pdf
weight loss (insulin sensitive) download
autoimmune (nutrient dense) download
alkaline foods download
nutrient dense bulking download
nutrient dense (maintenance) download
weight loss (insulin resistant) download
autoimmune (diabetes friendly) download
zero carb download
diabetes and nutritional ketosis download
vegan (nutrient dense) download
vegan (diabetic friendly) download
therapeutic ketosis download
avoid download

If you’re not sure which approach is right for you and whether you are insulin resistant, this survey may help identify the optimal dietary approach for you.

image02

references

[1] http://www.healthline.com/health/autoimmune-disorders

[2] https://en.wikipedia.org/wiki/Autoimmune_disease

[3] https://www.aarda.org/disease-list/

nutrient dense foods for weight loss and insulin resistance

I’ve talked to a number of people recently who use a combination of the optimal foods for diabetes and nutritional ketosis and the optimal foods for weight loss lists.

So I thought it would be useful to combine the two approaches into a single list of foods for people who want to lose weight but who were still somewhat insulin resistant.

If you’re someone who is moderately insulin resistant and also wants to lose weight then…  read on.

optimal foods for diabetes and nutritional ketosis

My food ranking system revolves around manipulating three parameters to suit different people with different goals:

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

The optimal foods for diabetes and nutritional ketosis list has a low insulin load, is fairly low in non-fibre carbs and moderately high fat while still being as nutrient dense as possible.

This approach suits someone who has Type 1 Diabetes or is lean and looking to achieve nutritional ketosis.  People who are at their goal weight can afford to eat a little more added dietary fat.

img_7321-1

While  most people looking to manage their blood glucose levels limit their carbohydrates to some arbitrary number that works for them, maximising nutrient density as well will help you to improve your mitochondrial function and increase your energy levels to ideally overcome your insulin resistance.  Maximising nutrient density also means that your body won’t keep on seeking out more and more food to obtain the nutrients it requires.

People who are very insulin resistant often do well on a higher fat dietary approach initially to let the insulin levels drop, however they often find further success in the long term if they drop their dietary fat to let more fat come from their body.

optimal foods for weight loss

The optimal foods for weight loss list is fairly low in dietary fat to allow for to come form the body during weight loss.  It’s heavy in lean proteins and non-starchy veggies and is VERY nutrient dense.  The chart below shows a comparison of a range of dietary approaches with the insulin sensitive weight loss approach being having the highest nutrient density while the diabetes and nutritional ketosis approach comes in at #8 of thirteen.

2016-10-16-4

This list of foods may look like a low fat dietary approach, but it’s not really low fat once you factor in your body fat.  The chart from Steve Phinney illustrates how your body fat makes a contribution to the weight loss phase of a well formulated ketogenic diet.

2016-10-10 (1).png

The weight loss list of foods is also quite bulky (i.e. lots of fibre and water) so they would be very hard to overeat if you stick to just these foods.  The chart below show a comparison of the various approaches with the weight loss approach having the lowest energy density.

2016-10-16-6

Eating from the weight loss foods basically equates to a protein sparing modified fast (which is widely held to be the most effect way to lose weight in the long term) meaning that will fill you up so much you won’t be above to overeat while at the same time providing enough protein to preserve lean muscle mass during the weight loss phase.

The “problem” with the aggressive weight loss approach is that it is very low in energy dense comfort foods and it is higher in carbohydrates and protein than most low carbers might be used to, so it might be harder to stick to.  It may also raise your blood glucose levels if you’re still somewhat insulin resistant.

finding the optimal balance between the extremes

I have designed this list of foods for people who are insulin resistant and also looking to lose weight provides a balance between both extremes – high nutrient density, lowish levels of dietary fat and lower energy density.

The foods listed below represent the top 10% of the USDA food database using this ranking system.  I’ve included the nutrient density score, percentage of insulinogenic calories, insulin load (per 100g), energy density (per 100g) and the multicriteria analysis score score (MCA) that combines all these factors.

The chart below shows the amount of each nutrient provided by the more balanced approach compared to average of all the foods in the USDA food database.  As you can see you will still be able to obtain heaps of nutrients while the fat comes from your body.

weight-loss-insulin-resistant

vegetables

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
broccoli 23 36% 3 22 2.07
endive 15 23% 1 17 1.84
coriander 16 30% 2 23 1.79
zucchini 18 40% 2 17 1.75
chicory greens 14 23% 2 23 1.74
spinach 20 49% 4 23 1.66
escarole 11 24% 1 19 1.58
basil 17 47% 3 23 1.55
alfalfa 9 19% 1 23 1.51
watercress 22 65% 2 11 1.51
beet greens 13 35% 2 22 1.49
asparagus 16 50% 3 22 1.44
lettuce 14 50% 2 15 1.33
Chinese cabbage 15 54% 2 12 1.29
summer squash 12 45% 2 19 1.26
okra 13 50% 3 22 1.26
parsley 13 48% 5 36 1.25
cauliflower 13 50% 4 25 1.23
chard 13 51% 3 19 1.22
portabella mushrooms 14 55% 5 29 1.20
mustard greens 9 36% 3 27 1.20
arugula 11 45% 3 25 1.17
turnip greens 10 44% 4 29 1.17
chives 11 48% 4 30 1.14
banana pepper 8 36% 3 27 1.13
paprika 9 27% 26 282 1.11
cucumber 7 39% 1 12 1.08
pickles 7 39% 1 12 1.08
collards 7 37% 4 33 1.07
celery 10 50% 3 18 1.03
brown mushrooms 16 73% 5 22 1.01
avocado -0 8% 3 160 0.99
white mushroom 13 65% 5 22 0.99
shitake mushroom 12 58% 7 39 0.98
red peppers 6 40% 3 31 0.98
dandelion greens 10 54% 7 45 0.97
sauerkraut 5 39% 2 19 0.96
dill 11 59% 8 43 0.96
eggplant 4 35% 3 25 0.95
cloves 9 35% 35 274 0.95
radishes 6 43% 2 16 0.94
sage 7 26% 26 315 0.93
jalapeno peppers 5 37% 3 27 0.93
curry powder 3 13% 14 325 0.92
edamame 7 41% 13 121 0.89
chayote 5 40% 3 24 0.88
olives -5 3% 1 145 0.80
Brussel sprouts 6 50% 6 42 0.78
spirulina 11 70% 6 26 0.76
soybeans (sprouted) 6 49% 12 81 0.76
cabbage 7 55% 4 23 0.75
blackberries -1 27% 3 43 0.71
artichokes 5 49% 7 47 0.71

seafood

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
fish roe 18 47% 18 143 1.45
salmon 19 52% 20 156 1.44
trout 16 45% 18 168 1.36
caviar 13 33% 23 264 1.25
oyster 16 59% 14 102 1.19
cisco 9 29% 13 177 1.17
sturgeon 13 49% 16 135 1.13
mackerel 6 14% 10 305 1.08
anchovy 12 44% 22 210 1.08
crab 17 71% 14 83 1.01
sardines 9 36% 16 185 1.01
flounder 13 57% 12 86 1.01
herring 9 36% 19 217 0.97
sardine 9 37% 19 208 1.0
halibut 15 66% 17 111 0.96
tuna 12 52% 23 184 0.91
rockfish 13 66% 17 109 0.86
lobster 14 71% 15 89 0.85
crayfish 12 67% 13 82 0.82
shrimp 13 69% 19 119 0.81
pollock 13 69% 18 111 0.79
perch 10 62% 14 96 0.73

animal products

image09

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
lamb liver 19 48% 20 168 1.47
lamb kidney 19 52% 15 112 1.45
turkey liver 16 47% 21 189 1.25
beef brains 8 22% 8 151 1.24
veal liver 17 55% 26 192 1.20
beef liver 17 59% 25 175 1.14
chicken liver 14 50% 20 172 1.13
beef kidney 14 52% 20 157 1.10
lamb brains 6 27% 10 154 1.05
chicken liver pate 7 34% 17 201 0.91
lamb heart 10 48% 19 161 0.90
ham 12 59% 17 113 0.88
ground turkey 6 30% 19 258 0.88
turkey heart 9 47% 20 174 0.85
rib eye steak 8 41% 21 210 0.84
roast pork 7 41% 20 199 0.83
roast beef 7 38% 21 219 0.83
beef tongue 1 16% 11 284 0.81
lamb sweetbread 6 43% 15 144 0.79
lamb chop 8 42% 25 234 0.79
lean beef 11 61% 23 149 0.78
beef heart 9 52% 23 179 0.78
park sausage 2 25% 13 217 0.78
pork liver 11 59% 23 165 0.77
turkey meat 8 52% 21 158 0.74
turkey drumstick 8 52% 21 158 0.74
chicken 10 60% 22 148 0.73

dairy and egg

image08

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
whole egg 9 30% 10 143 1.20
egg yolk 8 18% 12 275 1.15
sour cream 2 13% 6 198 1.02
cream 2 6% 5 340 0.93
cream cheese 2 11% 10 350 0.84
Swiss cheese 5 22% 22 393 0.80
cheddar cheese 5 20% 20 410 0.78
Greek yogurt 3 37% 9 97 0.74

other dietary approaches

The table below contains links to separate blog posts and printable .pdfs for a range of dietary approaches (sorted from most to least nutrient dense) that may be of interest depending on your situation and goals.   You can print them out to stick to your fridge or take on your next shopping expedition for some inspiration.

dietary approach printable .pdf
weight loss (insulin sensitive) download
autoimmune (nutrient dense) download
alkaline foods download
nutrient dense bulking download
nutrient dense (maintenance) download
weight loss (insulin resistant) download
autoimmune (diabetes friendly) download
zero carb download
diabetes and nutritional ketosis download
vegan (nutrient dense) download
vegan (diabetic friendly) download
therapeutic ketosis download
avoid download

If you’re not sure which approach is right for you and whether you are insulin resistant, this survey may help identify the optimal dietary approach for you.

image02

The Keto Summit

I’m really excited to be a part of the Keto Summit being hosted by Chris Kelly and Tommy Wood of Nourish Balance Thrive.

I have learned so much from Chris and Tommy with their generous sharing of knowledge.  It’s now exciting to see them gather a wide range of experts, potentially with divergent opinions, all captured in one place.

Chris Kelly has spent the last few months interviewing the big names in the area of low carb and ketogenic nutrition for diabetes management, therapeutic ketosis and athletic performance, including:

  1. Ben Greenfield,
  2. Patrick Arnold,
  3. Jason Fung,
  4. Mark Sisson,
  5. Tom O’Bryan,
  6. Maria Emmerich,
  7. Tommy Wood,
  8. Ken Ford,
  9. Max Lugavere,
  10. Tyler Bramlett,
  11. Bran Walsh,
  12. Dave Asprey,
  13. Tom Seyfried,
  14. Eric Westman,
  15. Tim Noakes,
  16. Phil Maffetone,
  17. Richard Feinman,
  18. Kirk Parsley,
  19. Robb Wolf,
  20. Cate Shanahan,
  21. Ivor Cummins,
  22. Jimmy Moore,
  23. Menno Henselmans,
  24. Mike T Nelson,
  25. Ron Rosedale,
  26. Chris Masterjohn,
  27. Dan Pardi,
  28. Kieren Clarke,
  29. Dominic D’Agostino,
  30. Patricia Daly,
  31. Catherine Crofts,
  32. Grace Liu,
  33. Travis Christofferson, and
  34. Luis Villasenor.

It’s a REALLY exciting honour to be a part of this list of experts with my heroes and so many people I have learned so much from! 

You can sign up to watch the videos free between 25 September and 6 October 2016 or you can buy them for a small fee to watch at any time.  

free

The prelaunch period runs until 24 September 2016.   Up until this time you will be able to receive unlimited access to the summit at a discount rate.

prelaunch

When you register for the summit sign up you will be able to get three masterclasses.  Firstly with Tommy Wood on:

  • keto 101
  • weight loss, and
  • performance

gift1

The second bonus gift is professional cyclist Christopher Kelly navigating the controversial area of ketogenic supplements.

gift2

Then Maria Emmerich makes gets practical and shows what it looks like in the kitchen.

gift3

You can also watch Tom Seyfried’s interview on how you can use the ketogenic diet as an adjunct treatment for cancer.

pre-launch-seyfried-2

Over the 10 days of the summit, once you sign up,  you will be able to watch a selection of videos for free for 24 hours.

Day 1 is Ben Greenfield, Patrick Arnold (who developed KetoCaNa and exogenous ketone product with Domonic D’Agostino), Jason Fung and myself.

day-1

Day 2 is Mark Sisson, Tom O’Bryan, Maria Emerich and Tommy Wood.

day-2

Day 3 is Ken Ford, Max Lugavere, Tyler Bramlett and Bryan Walsh.

day-3

Day 4 is with Dave Asprey, Tom Seyfried and Eric Westman.

14333693_2088664861358616_4888973425821995313_n

Day 5 is Tim Noakes, Phil Maffetone, Richard Feinman and Kirk Parsley.

14425363_2088665108025258_3701546959216737858_o

Day 6 is Robb Wolf, Cate Shanahan and Ivor Cummins.

14432943_2088665291358573_8704444337297181151_n

Day 7 is Jimmy Moore, Meno Hesslemans, Mike Nelson and Ron Rosedale.

14368928_2088665621358540_7476868503643273163_n

Day 8 is Chris Masterjohn, Dan Pardi and Kieran Clarke.

14344836_2088666201358482_8920762954162571480_n

Day 9 is Domonic D’Agostino, Patricia Daly and Catherine Crofts.

14359069_2088667021358400_4111396429733131114_n

Day 10 is a Grace Liu, Travis Christofferson and Luis Villasenor.

14222300_2088667238025045_6129472523973471536_n

October 5th and 6th will be the encore replay days where you will be able to watch the most popular presentations again.

Happily, if you do end up paying to have unlimited access to all the presentations (rather than only being able to watch them on a specific day) using my affiliate link I will receive a commission fee for promoting the event.

This is the first time I’ve been involved in something like this.  It’s great to be able to support Chris and Tommy who have put so much effort into their amazing podcast.  It’s also nice to see a little bit of money to justify the time I’m invested in developing the blog and not with my family or working paid overtime at my day job.

I’m excited!  I hope you enjoy the Keto Summit presentations and look forward to seeing the discussion it generates.

fbad1-registration

%d bloggers like this: