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:
Ben Greenfield,
Patrick Arnold,
Jason Fung,
Mark Sisson,
Tom O’Bryan,
Maria Emmerich,
Tommy Wood,
Ken Ford,
Max Lugavere,
Tyler Bramlett,
Bran Walsh,
Dave Asprey,
Tom Seyfried,
Eric Westman,
Tim Noakes,
Phil Maffetone,
Richard Feinman,
Kirk Parsley,
Robb Wolf,
Cate Shanahan,
Ivor Cummins,
Jimmy Moore,
Menno Henselmans,
Mike T Nelson,
Ron Rosedale,
Chris Masterjohn,
Dan Pardi,
Kieren Clarke,
Dominic D’Agostino,
Patricia Daly,
Catherine Crofts,
Grace Liu,
Travis Christofferson, and
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.
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.
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
The second bonus gift is professional cyclist Christopher Kelly navigating the controversial area of ketogenic supplements.
Then Maria Emmerich makes gets practical and shows what it looks like in the kitchen.
You can also watch Tom Seyfried’s interview on how you can use the ketogenic diet as an adjunct treatment for cancer.
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 2 is Mark Sisson, Tom O’Bryan, Maria Emerich and Tommy Wood.
Day 3 is Ken Ford, Max Lugavere, Tyler Bramlett and Bryan Walsh.
Day 4 is with Dave Asprey, Tom Seyfried and Eric Westman.
Day 5 is Tim Noakes, Phil Maffetone, Richard Feinman and Kirk Parsley.
Day 6 is Robb Wolf, Cate Shanahan and Ivor Cummins.
Day 7 is Jimmy Moore, Meno Hesslemans, Mike Nelson and Ron Rosedale.
Day 8 is Chris Masterjohn, Dan Pardi and Kieran Clarke.
Day 9 is Domonic D’Agostino, Patricia Daly and Catherine Crofts.
Day 10 is a Grace Liu, Travis Christofferson and Luis Villasenor.
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.
Warning: This post is a celebration of how data analysis can help us understand how to optimise our nutrition to suit different goals. It may contain novel ideas based on large amounts of data.
If you click on the image below you can see where the different foods sit on the plot of nutrient density versus proportion of insulinogenic calories or click on individual data points to learn more about a particular food and find out why it ranks well or poorly.
I think presenting the data in an interactive format using Tableau makes large amounts of data more accessible compared to a static chart or spreadsheet that can be produced in Excel.
Click on the chart below to see a larger version or, better yet, open the interactive Tableau version here. Click on the different tabs to see how your insulin response relates to different parameters such as carbohydrates, fat, protein, glycemic index, glycemic load and sugar.
I think the food insulin index data is exciting because it helps us better understand what drives blood glucose, insulin, Hyperinsulinemia, metabolic syndrome, and the diseases of western civilisation that are sending us to an early grave and bankrupting our western economy.
I’ve included some brief notes on the interactive charts in order to unpack what I think the data is telling us, but if you want a more detailed discussion of the data I encourage you to check out the articles:
Understanding exactly how fibre and protein affect insulin and glucose demonstrates quantitatively why a low carbohydrate moderate protein approach works so well for people who are insulin resistant.
While lots of people have found the food insulin index data useful, I want to highlight in this article that insulin load is only one factor that should be considered.
If we only consider insulinogenic properties of food there is a risk that we unnecessarily demonise nutrient dense foods that happen to elicit an insulin response. Rather than avoiding insulin, I think it’s better to think in terms of investing a limited insulin budget. And just like different people have different levels of income, different people have a different (but still finite) “insulin budget”. For example…
Someone using therapeutic ketogenic approach to battle epilepsy or cancer will want to minimise the insulin load of their diet by eating very high amounts of fat, fasting, and perhaps supplementing with MCTs or exogenous ketones. Someone pursuing therapeutic ketosis will need to pay particular attention to making sure they obtain adequate nutrition within their very small insulin budget.
If you have Type 1 Diabetes large doses of insulin will send you on a blood glucose roller coaster that might take a day or two to get under control. Eating a Bernstein-esque low carb diet with moderate to high protein levels and lots of non-starchy veggies will make it possible to manage blood glucose levels with physiologic (normal) amounts of insulin without excessive blood glucose and insulin swings.[1][2]
For a type 2 diabetic who struggles to produce enough insulin to maintain their blood glucose in normal ranges, a lower carb moderate insulin load diet will help their pancreas to keep up and achieve normal blood glucose levels while minimising fat storage.
People using a ketogenic approach for weight loss need to keep in mind that reduced insulin levels and ketosis occurs due to a lack of glucose and not higher levels of dietary fat. If your primary goal is weight loss, fat on the plate (or in the coffee cup) should be just enough to stop you from going insane with hunger. Too much dietary fat will mean that there will be no need to mobilise fat from the body.
Athletes and people who are metabolically healthy can be more flexible in their choice of energy source and perhaps focus more on more nutrient dense foods as well as energy dense foods.
insulin is not the bad guy
Humans are great at thinking in absolutes (good/bad; black/white) while ignoring context. We all like to grab hold of our favourite bit of the elephant of metabolic health and hold on tight.
While many people suffer from hyperinsulinemia and its vast array of associated health consequences we need to remember that insulin is critical to life and growth and is required to metabolise protein for muscle growth/repair as well as all the other important functions of amino acids (neurotransmitters etc).[3]
Ideally we should make every bite count if we want to maximise health and longevity. Every calorie should contain the maximum amount of nutrients possible. In a similar way, every unit of insulin that we “invest” should be associated with the maximum amount of nutrition (think of the nutrient density of spinach or liver liver versus than nutrient a soft drink or white bread).
So let’s look at how we can “leverage” our “insulin investment” to maximise our health outcome.
show me the data
In this article I’m going to risk overloading, overwhelming, and confusing you, the reader, with too much data. But at the same time, with all the data available you won’t have to take my word for it. You can make your own conclusions.
If the idea is far out, you need to see the data. All the data. Not the hazard ratio, not just the conclusions from the computer.
My new grand principle of doing science: habeas corpus datorum, let’s see the body of the data. If the conclusion is non-intuitive and goes against previous work or common sense, then the data must be strong and all of it must be clearly presented.
So, how should you read a scientific paper? I usually want to see the pictures first.[4]
Richard David Feinman, The World Turned Upside Down
I am trying to draw conclusions from more than 6000 foods in the USDA foods database. These are hard to present accurately in single charts, so I’ve used a few. If something that you see doesn’t make sense at first you can drill down into the data to check out the detailed description. I have also included as much micronutrient and macronutrient as I can. Just ‘mouse over’ a data point that you’re interested in to see how it compares to another data point.
In the sections below I have given an overview of different ways to look at nutrient density with a more detailed discussion in the appendices at the end of this article. Unfortunately this post is probably not going to work well on your phone.
You’ll need to view it on big screen for best effect.
Sorry.
My 2c on nutrient density
Lots of people talk about nutrient density, however most of the time this is in relation to a few favourite nutrient(s) rather than a broad range spectrum of essential vitamins, minerals, amino acids and fatty acids.
We hear that butter is high in Vitamin K2 and Vitamin D and hence we should eat more of it[5] or that whey protein is high in essential amino acids (e.g. leucine and lysine) and therefore everyone should be buying tubs of it.[6]
A lot of time these claims are used to advertise a product or to argue a particular philosophical position (e.g. zero carb, vegan, plant based, paleo etc). The problem here is that many of these so call ‘nutrient dense superfoods’ do not contain a well rounded range of the nutrients that are required for health, but rather a narrow slice of nutrients.
Paleo, Just Eat Real Foods[7] or ‘plant based’ is a good start, however I think there are some foods that are more useful than others. As detailed in the Building a Better Nutrient Density Index article there are also some nutrients that are harder to obtain in adequate quantities.
Once we identify the nutrients that are harder to obtain we can focus on the foods that contain the highest amounts of these nutrients. At the same time it is also useful to think about nutrient density in the context of specific goals, whether that be therapeutic ketosis, weight loss, diabetes or optimal athletic performance.
The more I try to get my head around what it means to optimise nutrition, the more important nutrient density seems to be. The irony is that many people retreat from insulin to the safe haven of high fat diets that don’t actually have the micronutrients required to optimally power mitochondria, the power plants of our bodies. Like most things, we need to find the right balance.
Most people now seem to understand that hammering high blood glucose with more insulin is dumb because the problem is insulin resistance and poor glucose disposal, not high blood glucose.
But then the next question is what causes insulin resistance?
It seems to me that part of the answer is sluggish mitochondria that aren’t running at optimal efficiency to burn off the energy we throw at them. Part of the reason for this is that we’re not powering them with the right nutrients.
To produce ATP efficiently, the mitochondria need particular things. Glucose or ketone bodies from fat and oxygen are primary.
Your mitochondria can limp along, producing a few ATP on only these three things, but to really do the job right and produce the most ATP, your mitochondria also need thiamine, riboflavin, niacin, pantothenic acid, minerals (especially sulfur, zinc, magnesium, iron and manganese) and antioxidants.
Mitochondria also need plenty of L-carnitine, alpha-lipoic acid, creatine, and ubiquinone (also called coenzyme Q) for peak efficiency.
Dr Terry Wahls
The Wahls Protocol
This video gives an excellent overview of the role that nutrients play to drive the krebs cycle to enable our mitochondria to produce ATP, the energy currency of our cells.
We can then moderate that using insulin load to work within the limits of your current metabolic health (i.e. insulin resistance, muscle mass, activity levels, pancreatic function etc).
You need to eat to maintain the blood glucose levels of a metabolically healthy person.
Robb Wolf
Nutrient density vs proportion of insulinogenic calories
The plot below shows nutrient density versus proportion of insulinogenic calories. The size of the data points are proportional to the energy density of the foods they represent (e.g. the size of the markers for celery with a low energy density are smaller than for butter which has a high energy density).
There is a lot of data here! You can click on the image below to see a larger version of the chart or better yet look at the interactive online Tableau version (which I think is pretty cool!). If you ‘mouse over’ the foods that you’re interested in you can see more details of the foods from the USDA food nutrient database. Click through the various tabs to see how things look for specific food groups.
The x-axis on these charts is nutrient density / calorie. You can find out more about how this is calculated in the Building a better nutrient density index article. Essentially zero is average (or zero standard deviations from the mean) while greater than zero is better than average and less than zero is worse than the average of the 6000 foods analysed.
The nutrient density calculations are based on the USDA database which provides the nutrient content of more than 6000 foods. It does not account for species specific bioavailability or issues such as fat soluble vitamins.
I don’t think we can use this to say that plant foods are better or worse than animal foods, but rather it shows us which foods to avoid due and which foods are the best choices within particular categories.
Personally I think optimal involves getting a balanced range of the most nutrient dense plant and animal based foods.
So what does this data mean and how could it be practically useful?
If you’re metabolically healthy then I think you’d do well eating from the most nutrient dense foods on the right hand side of the chart (i.e. celery, spinach, mushrooms, onions, oranges etc). While many of these nutrient dense foods may have higher proportion of insulinogenic calories I think it’s hard for most people to overeat them.
The foods most people should avoid are the highly insulinogenic low nutrient density foods on the top left of this plot (i.e. soft drinks, fruit juice, sport drinks etc).
If you’re insulin resistant or aiming for therapeutic ketosis (e.g. as an adjunct treatment for cancer or epilepsy or dementia) you will want to move down the chart to the higher fat low insulinogenic foods while keeping to the right as much as possible.
It’s important to note that the high fat foods typically have a lower nutrient density because they do not contain as broad a range of nutrients.
Energy density versus nutrient density
While 60 to 70% of the western population seem to be suffering some level of metabolic syndrome and are insulin resistant[8] some people who are metabolically healthy are still obese.[9] For these people simply reducing the energy density without consideration of carbs or insulin load (i.e. lowering their fat intake with higher amounts of water and fibre) will help them to consume less calories.
Someone who is metabolically healthy (i.e. excellent blood glucose levels etc) yet still obese would do well to focus on the nutrient dense low energy density vegetables, fruits, seafood and meat in the top right of this chart.
This is basically where I’m at after normalising my glucose and HbA1c but I’d still like to drop some more weight. I now need to take my own advice and focus on more nutrient dense proteins and vegetables and indulge less on the yummy high fat foods.
The typical problem with a low fat approach typically comes not from eating too much vegetables or fruit (top right of this chart) but rather when your energy comes from highly insulinogenic, energy dense low nutrient density foods (e.g. processed grains and softdrinks) which end up on the top left of all of these charts.
The only real ‘problem’ with a high nutrient density low energy density approach is that it is physically difficult to get enough food down to achieve an energy surplus. The benefit is that it typically leads to weight loss while still maintaining very high levels of nutrition.
A high nutrient density low energy density approach could still be ketogenic due to the low level of processed carbohydrates and low insulin load.
Lots of people like to count carbohydrates or net carbohydrates (i.e. carbohydrates minus the indigestible fibre). In my view I think it’s better to think in terms of net carbohydrates when eating real foods to make sure you don’t miss out on nutrient dense vegetables.
The chart below shows nutrient density versus net carbohydrates. Focusing on the foods on the top right and avoiding the soft drinks, cereals and breads at the bottom will be a pretty good strategy.
The limitation of net carbs is that it doesn’t account for the impact of protein which is an important consideration for people with type 1 diabetes or advanced type 2 diabetes.
This brings us to my favourite way to look at nutrient density… insulin load.
Thinking in terms of insulin load involves consideration of net carbs plus about half the protein as requiring insulin. Insulin load per 100g of food is neat because it means that we also end up with lower energy density foods as well which is not a bad thing for most people who often wouldn’t mind losing some weight (note: low energy density foods like celery may not be so great if you’re trying to fuel for a marathon).
I think it’s good to also consider the insulin effect of protein because insulin is a finite resource. While people who are metabolically healthy will be able to eat high protein foods without seeing a substantial rise in their blood glucose levels, people who are very insulin resistant or have type 1 diabetes will see their glucose levels rise with protein and may need to inject insulin to cover the protein they eat. This doesn’t mean though that people who are insulin resistant should avoid high protein foods, because they are typically very nutrient dense.
Again, we can see that it’s the soft drinks, breakfast cereals and breads at the bottom of this chart that we really need to be avoiding!
This thinking seems to align with common sense wisdom. Tick.
Hopefully you can see how thinking about nutrient density graphically in combination with other parameters can be useful to refine your food selection for different goals.
The appendices to this article below show more charts for different food groups with a little more discussion of my observations.
Appendix A – Nutrient density vs proportion of insulinogenic calories for therapeutic ketosis
Appendix B – Nutrient density vs energy density for weight loss and / or the metabolically healthy
Appendix C – Nutrient density vs net carbohydrates for people on a low carb diet
Appendix D – Nutrient density vs insulin load for diabetes and therapeutic ketosis
Appendix A – Nutrient density vs proportion of insulinogenic calories for therapeutic ketosis
Foods with a lower proportion of insulinogenic calories can be useful for people trying to achieve therapeutic ketosis, however at the same time we can see at the bottom of this plot that high fat / low insulin load foods are not necessarily the most nutrient dense.
People should ideally choose foods with the highest nutrient density (right hand side) while keeping the proportion of insulinogenic calories in their diet low enough to achieve their goals (e.g. blood glucose, insulin, tumour growth or seizure control).
Vegetables are typically have high levels of vitamins and minerals as well as some protein but not much fat.
Most people, particularly those who are not severely insulin resistant, will do well to focus on the most nutrient dense vegetables on the right hand side of this chart (i.e. celery, spinach, squash, cabbage, broccoli, mushrooms, artichokes, kale) as their energy density, insulin load and net carbs are also low.
Celery is an example of a food with high amounts of vitamins and minerals with a very low energy density, hence it does really well on the nutrients / calorie scale.
The foods in the chart below with the lowest proportion of insulinogenic calories typically have added fat (e.g. french fries, onion rings which are not ideal) or are very high in fibre (e.g. asparagus, spinach and soybeans which is better).
Seafood
Seafood is really the only substantial source of essential omega 3 fatty acids (i.e. DPA, DHA, EPA, ALA) and hence is an important part of a balanced diet.
The highest nutrient density seafoods are cod, anchovy, salmon, caviar and tuna. The lowest insulin load fish are mackerel, herring, salmon and caviar.
Again, we should ideally focus on the most nutrient dense foods on the right hand side of the chart, but move down the chart to the least insulinogenic foods depending on our level of metabolic health.
Animal products
Liver is the most nutrient dense of the animal products (right hand side) while processed meats are less nutrient dense (left hand side). High fat meats are also typically less nutrient dense (bottom of chart).
Non-processed meats are typically well worth the investment of your limited insulin budget.
Nuts seeds
Many nuts and seeds are high fat while also being fairly nutrient dense (i.e. pine nuts, coconut and pecans). Nuts have a low proportion of insulinogenic calories and hence help to normalise blood glucose levels, but possible to overdo if weight loss is your primary goal.
Dairy and egg
Some dairy products are both high fat and nutritious (e.g. parmesan cheese, egg yolk).
Cream and butter are high fat and energy dense so are useful for managing blood glucose levels but are possible to overdo if weight loss is your primary goal.
Low fat dairy products such as skim milk and whey are typically very nutrient poor overall.
Fruit
Some fruits are nutrient dense, but are typically highly insulinogenic (tangerines, cherries, grapes, apricots, oranges and figs). Only olives and avocados have a low proportion of insulinogenic calories, however they are not particularly nutrient dense.
Cereals and grains
Unprocessed grains such as oatmeal, teff, spelt, brown rice and quinoa can be nutrient dense but are highly insulinogenic. Unprocessed grains may be fine if you are metabolically healthy, but choose carefully and don’t go adding sugar, honey or molasses.
However breakfast cereals and most breads are typically highly insulinogenic while also having a poor nutrient density and hence are a poor investment of your limited insulin budget.
This analysis supports the idea that dropping processed grains, packaged breakfast cereals and soft drinks would be a pretty good place to start for most people!
Legumes
Navy beans, lima beans and lentils are nutrient dense but highly insulinogenic.
Peanuts, peanut butter and tofu do OK in terms of both being low insulinogenic as well as nutrient dense.
Processed soy products and meat replacement products are typically highly insulinogenic and have poor nutrient density.
Fats and oils
Fish oil is the most nutritious of the fats. However as a general rule pure fats are not particularly nutrient dense. Margarines and salad dressings are very nutrient poor.
Beverages
Soft drinks, sports drinks and sweetened iced teas are bad news and are an extremely bad investment of your limited insulin budget. Fruit juices are not also not particularly nutrient dense. Better to eat your fruit whole.
Appendix B – Nutrient density vs energy density
Low energy density, high nutrient density foods are a great way to lose weight, particularly for those who are insulin sensitive. As we avoid processed carbs as well as high levels of dietary fat while maintaining high levels of nutrition we can allow the fat to come from our belly rather than our plate.
It’s hard to go wrong with the low energy density high nutrient density foods in the top right of this chart (i.e. celery, mushrooms, spinach, onions, broccoli, seaweed, kale etc).
Seafood
Some seafood is nutrient dense and lower in fat (e.g. oysters, tuna, lobster).
Seafood is important because it provides the essential omega 3 fatty acids that are hard to obtain in significant amounts from vegetables and it provides higher levels of protein.
If you are serious about losing weight you’d do pretty well if you limited yourself to the vegetables in the top right of the chart above and the seafood in the top right of the chart below.
Animal products
There are many nutrient dense low energy density animal foods as shown in the chart below. Liver does pretty well followed by game meat. Processed meats are not so good.
Nuts seeds
Nut are low insulin but not necessarily low energy density or spectacularly great in terms of nutrients per calories. Consider limiting your nuts and seeds if your primary goal is weight loss.
Dairy and egg
Whole egg (top right corner) is probably your best option from the dairy and egg category.
Butter and full fat cheese have a high energy density (bottom).
Low fat dairy is nutrient poor (top left corner)!
Fruit
If your goal is weight loss then low energy density fruits such as tangerines / mandarins, cherries, apricots and pears will be more helpful than energy dense fruits such as bananas, prunes, raisins and dried fruits.
Cereals and grains
Some unprocessed grains are nutritious and have a low energy density (top right), however as a general rule, breakfast cereals and processed grains are a poor investment of your limited insulin budget (bottom of chart).
Legumes
Lima beans, navy beans, tofu, mung beans and hummus are nutrient dense and low energy density (top right). Peanuts have a low insulin load and solid nutrient density but a high energy density (bottom).
Appendix C – Nutrient density vs net carbohydrates for diabetes
Most people keeping track of their carbohydrate intake think in terms of net carbs or total carbohydrates, however this does not consider the insulin demand from protein which is a real consideration if you have diabetes.
Thinking in terms of net carbs will be the best approach for most people; however, if you are highly insulin resistant or have type 1 diabetes you may be better to consider insulin load which considers the effect of protein on insulin.
Choosing foods to the top right of these charts will help you keep nutrition high and net carbohydrates low.
There are plenty of vegetables on the top right of this plot that have minimal net carbs while being very nutrient dense (e.g. celery, spinach, broccoli, asparagus, mushrooms).
Low water foods such as mushrooms, leeks, shallots (at the bottom of the plot) will be hard to eat large quantities of although they have a higher amount of net carbs per 100g.
seafood
Most seafood has minimal levels of net carbs, though it’s interesting to note that some seafoods such as oysters have a glycogen pouch depending on what time in the season they are harvested.
animal products
Similar to seafood, most animal products have negligible amounts of net carbs. The amount that is contained in muscle glycogen is not significant.
Liver and game meats are consistently the most nutrient dense of the animal products.
nuts seeds
Nuts and seeds have some non-fibre carbohydrates. Pine nuts, macadamias and almonds are low in carbs with moderate nutrient density.
dairy and egg
Many dairy and egg products have a high nutrient density as well as being low in net carbs which is why they are popular with low carbers. Fat free cheeses have more carbohydrates.
fruit
There are some lower carb fruits however, it may be wise for people with insulin resistance to avoid many of the higher carbohydrate fruits at the bottom of this chart.
cereals and grains
This chart demonstrates why many breakfast cereals and processed grains (at the bottom of this chart with high levels of carbohydrates and minimal nutrition) are a bad investment of your limited insulin budget. This style of analysis demonstrates why the common wisdom that soft drinks and breakfast cereals are bad news.
legumes
Not all legumes are created equal. Choose wisely. Navy beans, legumes, lima beans and peanuts are probably your safest bet.
beverages
Soft drinks and sports drinks are a very poor investment of your limited insulin budget as they are very low in nutrients.
Appendix D – Nutrient density vs insulin load
Thinking in terms of nutrient density versus insulin load enables us to more intelligently consider how we invest our insulin budget. Again, it’s not that insulin is bad, but rather we should use it wisely for the most nutrient dense foods.
Soft drinks, breakfast cereals and bread at the bottom of this chart are a poor way to invest the limited capacity of your pancreas.
Don’t be afraid of vegetables. Most of them have a very low insulin load. They should take up a large amount of your plate. But choose wisely from the top corner (e.g. celery, spinach, squash cabbage, broccoli).
seafood
There are lots of good investments to be made in the top right of this chart of seafood (oyster, salmon, lobster, mackerel).
animal products
Animal products require insulin but they are rich in amino acids which play an important role in the body. The amount you need will be dependent on your situation and your goals (e.g. someone aiming for therapeutic ketosis will want less while someone looking to build muscle or retain muscle while dieting will want more protein).
nuts seeds
Looking at nuts in terms of insulin load rather than net carbs enables better differentiation based on how much insulin these foods will demand from your system. Pine nuts, macadamia nuts and coconut have the lowest insulin load while being nutrient dense.
dairy and egg
Dairy can be insulinogenic, however the higher fat butter, cream and egg still have a fairly low insulin load.
fruit
Grapefruits, cherries, apples, grapes and oranges have a large amount of nutrition with a low insulin load versus more concentrated or dried fruit options.
cereals and grains
The breakfast cereals at the bottom of this chart with high amounts of insulin demand and lower levels of nutrients are bad news people who are insulin resistant.
legumes
Lima beans, navy beans, and lentils have a fairly low insulin load and high nutrient density. However if you are insulin resistant you will need to eat to your metre and make sure your blood glucose levels don’t rise too much if you eat legumes.
fats and oils
Just because it is low insulin doesn’t mean that it is good for you. Not many very high fat foods have substantial nutrient density. When it comes to nutrient density, fats in whole foods are a better than trying to consume refined oils.
Beverages
Soft drinks are bad news as they will stimulate large amounts of insulin while providing minimal amounts of nutrition and satiety.
There are lots of claims about different dietary approaches.
Fruitarians advocate living on 30 bananas a day say you don’t need much else for health and athletic performance.[1]
Vegans say that in addition to high levels of vitamins and minerals, you can get all the protein and essential fatty acids you need from plant based foods.[2]
Zero Carbers who look like they’re doing great on purely animal foods and no plants and say they don’t need fibre and perhaps vitamins and minerals.[3]
Ketonians believe that you can’t go wrong with fat.[4]
Meanwhile the registered dieticians tell us that we shouldn’t eliminate whole food groups (like grains) or risk missing out on essential nutrients.[5]
As detailed in the Building a Better Nutrient Density Index article, we can quantitatively rank individual foods based on their nutrient density. Eating nutrient dense foods will enable us to maximise satiety and avoid malnutrition and reduce the energy intake while avoiding malnutrition.
The Most Nutrient Dense Superfoods article lists a wide range of whole foods from various food groups. But could you thrive on a single food group? And if you had to live on a single food food group, is there one that would be better than the others?
This article compares the the nutrients provided by the following food groups:
All of the charts below show the vitamins, mineral, amino acids and essential fatty acids on the same scale for comparison. I have also included a selection of the most nutrient foods as an example.
I’ve listed some pros and cons that came to mind for each category. I’m sure you could come up with some of your own.
vegetables
pros
It’s hard to eat too many vegetables as they typically have a low energy density and high nutrient density which will lead to increased satiety (adequate nutrients) and satiation (feeling full).
As well as vitamins and minerals, it appears that you could obtain adequate (but not excessive) protein from nutrient dense vegetables (i.e. you could get more than 100% of the DRI for the amino acids from vegetables only).
Vegans who consume exclusively plant foods tend to have a lower BMI and less diabetes. This makes sense as limiting yourself exclusively to low energy density plant based foods would help to prevent you overeating.
cons
A diet comprising of only vegetables may be lower in Vitamins E, D, choline, and pantothenic acid.
Vitamin V-12 is very low in plant based foods. One of the common concerns when it comes to plant based diets is a lack of vitamin B-12 and vegans often require B-12 injections.[7]
There are negligible quantities for the essential fatty acids EPA and DHA in vegetables. If you were to eat only plant based foods it might be beneficial to supplement with essential fatty acids.[8]
Vegetables are not subsidised the way that grain based foods often are. They do not store and transport as well as more processed foods and hence can be more expensive.
Vegetables can require more preparation and cooking time than processed pre-packaged foods.
food
ND
% insulinogenic
net carbs/100g
calories/100g
celery
1.31
88%
1
17
Chinese cabbage
0.96
73%
1
17
rhubarb
0.83
91%
3
21
lettuce
0.73
83%
2
17
turnip greens
0.69
82%
2
37
asparagus
0.67
77%
2
27
broccoli
0.59
86%
4
42
winter squash
0.59
95%
6
39
fruit
pros
Fruit provides solid levels of vitamins and minerals and has a lower energy density compared to grain based foods.
Fruits are can be more transportable compared to vegetables (e.g. easier to put in school lunches).
cons
Fruit tends to have the same nutritional gaps as vegetables (i.e. vitamin E, D, pantothenic acid, choline and essential fatty acids).
Some fruits have a higher energy density and amount of non-fibre carbohydrates compared to vegetables. This may be an issue if you are watching your blood glucose levels or your weight. Many fruits have a very high proportion of insulinogenic calories so may not be ideal for someone who is insulin resistant as it will raise their blood glucose levels.
food
ND
% insulinogenic
net carbs/100g
calories/100g
cherries
0.30
95%
10
54
orange
0.23
95%
10
55
grapes
0.18
97%
17
77
apples
0.18
97%
11
53
blueberries
0.14
98%
20
91
figs
0.12
96%
16
82
litchis
0.11
94%
15
73
mandarin oranges
0.10
94%
12
59
honeydew melon
0.08
96%
8
40
passion fruit
0.07
91%
13
109
grains and cereals
pros
Grains are cheap compared to fruit and vegetables, largely due to production subsidies.[9]
Grain based foods can be processed (to remove the fibre and water) so they can be easily transported and stored for longer periods.
Grains provide some fibre, but less than vegetables.
Grains provide a provide a wide range of nutrients, but at much lower levels than the other food groups.
cons
The highest nutrient density grain based foods are typically unprocessed and rarely consumed.
The nutrient density of most breads and cereals are very poor, particularly after processing.
Grains have a high energy density, a high proportion of insulinogenic calories and a high amount of non-fibre carbohydrates.
food
ND
% insulinogenic
net carbs/100g
calories/100g
teff
0.31
91%
17
101
spelt
0.24
91%
23
135
quinoa
0.17
79%
19
120
millet
0.14
87%
22
118
brown rice
0.02
90%
22
111
legumes
pros
Legumes provide a range of nutrients at a lower cost compared to vegetables.
The energy density of beans and legumes is moderate so they can provide more fuel if you can’t fit in any more veggies.
Legumes provide a solid level of protein, particularly for those not wanting to consume animal based foods.
cons
The nutrient density of legumes is low compared to other sources such as vegetables.
Legumes have higher levels of non-fibre carbohydrates and a higher proportion of insulinogenic calories which may be problematic if you are watching your blood glucose levels.
Some people can’t tolerate high levels of the lectin proteins in legumes.[10][11]
food
ND
% insulinogenic
net carbs/100g
calories/100g
lima beans
0.22
92%
16
129
navy beans
0.16
86%
16
143
lentils
0.12
89%
12
118
hummus
0.08
46%
8
175
peanuts
0.03
24%
7
605
tofu
0.02
29%
2
112
nuts and seeds
pros
Nuts are higher in what is typically considered to be ‘good fats’ (i.e. MUFA and PUFA).
Being higher in fat they are a good way for people with diabetes to get their calories without raising their blood glucose levels.
cons
Nuts and seeds provide a good range of vitamins and minerals but at lower levels per calorie than some of the other groups due to the higher energy density.
Nuts are calorie dense which may make weight loss more challenging.
Nuts have a relatively low nutrient density due to their high energy density.
food
ND
% insulinogenic
net carbs/100g
calories/100g
sunflower seeds
0.04
27%
20
491
tahini
0.03
22%
17
633
pistachio nuts
0.03
30%
19
602
pine nuts
0.03
14%
2
647
pecans
0.02
10%
5
762
pumpkin seeds
0.00
36%
48
777
macadamia nuts
0.00
9%
5
769
sesame seeds
0.00
26%
12
603
almonds
0.00
18%
7
652
cashew nuts
0.00
27%
30
609
eggs and dairy
pros
Eggs have a solid protein profile, some EPA and DHA and a reasonable amount of vitamins and minerals.
Eggs and cheeses are typically lower in carbohydrates which is useful for people trying to normalise their blood glucose levels.
Dairy foods like cheese and cream are lower in non-fibre carbohydrates and have a low proportion of insulinogenic calories meaning that they won’t significantly raise your blood glucose levels.
cons
The energy density of cheese and some other dairy products is higher which makes it possible to overconsume. Lots of people do better with weight loss when they limit milk and cheese.
While the latest US dietary guidelines committee has stated that saturated fat is no longer a nutrient of concern,[12] many people are still concerned about their levels of saturated fat.
Milk, a commonly consumed dairy product, is not particularly nutrient dense and contains lactose which will raise blood glucose. Though full fat milk is better than low fat.
Many people find that they are allergic to eggs[13] or dairy[14].
food
ND
% insulinogenic
net carbs / 100g
calories / 100g
egg yolk
0.19
19%
3.6
317
egg
0.20
29%
0.7
138
blue cheese
0.16
20%
2.3
354
parmesan cheese
0.16
30%
3.4
411
goat cheese
0.15
22%
2.2
451
edam cheese
0.15
22%
1.4
356
provolone
0.15
24%
2.1
350
gouda cheese
0.15
23%
2.2
356
mozzarella
0.15
51%
24
251
seafood
pros
Seafood contains essential fatty acids EPA and DHA that are hard to obtain in the rest of the food system.
Seafood products have very high levels of protein and substantial levels of many vitamins and minerals.
Seafood has a low to moderate calorie density (i.e. lower than high fat cheese cheese but higher than vegetables).
Because seafood is so rich in essential fatty acids and amino acids we don’t actually need that much to cover our minimum requirements.
cons
Fish can be more expensive than other foods.
Many people are concerned about heavy metal toxicity and sustainability issues surrounding seafood.[15]
food
ND
% insulinogenic
insulin load (g/100g)
calories/100g
oyster
0.12
57%
14
98
anchovy
0.11
42%
21
203
caviar
0.10
32%
22
276
swordfish
0.09
41%
17
165
tuna
0.09
50%
17
137
trout
0.08
43%
17
162
lobster
0.08
69%
14
84
salmon
0.08
50%
15
122
mackerel
0.08
45%
17
149
animal products
pros
Animal products have an excellent amino acid profile as well as significant amounts of other vitamins and minerals.
cons
Animal products are lacking in a number of vitamins and minerals such as manganese, vitamin E, vitamin D, folate and vitamin K as well as essential fatty acids EPA and DHA.
Similar to fish, many people have concerns in the areas of sustainability and environmental impact.
food
ND
% insulinogenic
insulin load (g/100g)
calories / 100g
beef liver
0.39
58%
24
169
chicken liver
0.32
48%
20
165
ham
0.25
55%
20
146
salami
0.22
29%
12
166
bacon
0.17
23%
30
522
turkey heart
0.22
39%
13
130
pork
0.21
54%
21
154
most ketogenic
The ‘most ketogenic foods’ are the 500 foods with the lowest percentage of insulinogenic calories of the 7000 foods in the USDA foods database.
pros
If someone is insulin resistant, replacing processed non-fibre carbohydrates with fat will help to reduce insulin and blood glucose levels.
The ketogenic approach has relatively high levels of essential fatty acids. While the nutritional value of fat is a contentious issue, many fatty acids have substantial positive nutritional value.[16]
People who are insulin resistant will benefit by reducing the insulin load of their diet.
cons
The nutrient density of a therapeutic ketogenic approach is relatively poor. Someone looking to manage insulin resistance and diabetes should maximise nutrient density as much as possible while still maintaining excellent blood glucose levels.
A high fat / low insulin load diet is typically satiating,[17] however it is possible to overdo energy dense foods to the point that you won’t lose weight.
food
ND
% insulinogenic
insulin load (g / 100g)
calories / 100g
sunflower seeds
0.21
20%
24
491
peanuts
0.20
18%
28
605
tahini
0.19
16%
26
633
pine nuts
0.18
11%
18
647
pecans
0.16
5%
9
762
egg yolk
0.19
19%
15
317
macadamia nuts
0.14
5%
9
769
chorizo
0.14
17%
19
448
olives
0.18
15%
3
90
pepperoni
0.14
14%
17
487
sesame seeds
0.13
18%
27
603
camembert cheese
0.14
20%
15
299
most nutrient dense
The chart below shows the comparison of all 7000 foods in the USDA database compared to the top 10% of the foods available prioritised by targeting the harder to obtain nutrients.
macronutrients split of all food groups
Just for interest, the table below shows the comparison of the macronutrients of the various food groups as well as the fibre and energy density.
food group
% insulinogenic
protein (%)
fat (%)
net carbs (%)
fibre (g/200cal)
weight
(g/2000 cal)
vegetables
60
18
11
48
107
2213
fruit
81
4
5
78
52
2142
cereals and grains
82
10
9
75
29
553
eggs and dairy
45
24
41
29
2
920
fish
55
70
26
4
0
155
animal products
46
62
37
1
0
1112
legumes
58
28
24
39
34
1141
nuts and seeds
36
11
58
28
16
382
most ketogenic
10
11
79
3
9
404
moderated nutrient density
54
22
20
39
64
928
comparison of the nutrient density by food groups
The chart below the average nutrient density of all the different food groups in terms of amount of nutrients provided versus the daily recommended intake. If we just look in terms of average nutrient density (blue bars), fish does pretty well, followed by animal products and then vegetables.
However, what we really want is high levels of nutrient density across the board, not just a large amount of a few nutrients. For example, fish and animal products have very high levels of protein but lower levels of vitamins and minerals. By comparison, vegetables have higher levels of vitamins and minerals and do OK when it comes to amino acids. What we want is for the quantity of nutrients to be high and the variability across the nutrients to be low.
The orange bars show the average nutrient density minus 0.8 times the standard deviation in the nutrient density. When we look at it this way the vegetables do the best of the food groups because they provide a good range of vitamins, minerals and proteins.
However, in the end though it’s the most nutrient dense foods that win out because they provide high levels of a broad selection of all the nutrients. So, rather than focusing on a particular food group, if you’re interested in maximising nutrient density, the optimal approach appears to be to focus on the most nutrient dense foods across all of the food groups.
Therapeutic ketosis, which involves reducing the insulin load of our diet to increase fat burning, is an exciting adjunct therapy for a range of chronic conditions such as cancer, epilepsy and dementia. A more aggressive ketogenic approach can also be early stages of a low carb dietary approach to minimise blood sugars and strip excess glucose from the system.
People using a very high fat approach need to be intentional to ensure they obtain adequate nutrition. These meals prioritise a low insulin load while maximising nutrient density as much as possible.
The nutrient density of these meals is not as high as achieved with the other approaches and hence it is recommended that you transition to one of the following approaches as your metabolic health and / or blood glucose levels improve:
Eating plant-based foods can be a great way to improve nutrient density and reduce the amount of highly insulinogenic processed carbohydrates in your diet.
This article looks at how we can make a plant-based diet even more nutrient dense as well as more diabetic friendly by reducing insulin load.
Finally, we will look at whether adding additional food groups such as seafood, dairy or eggs would diminish or improve the nutrient density of a plant based approach.
nutrient density
A nutrient dense diet is key to maximizing health and satiety with a minimum of calories. Maximising nutrient density enables our mitochondria to do more with less. If our world is full of beneficial nutrients our body realises that there is no longer an energy crisis and is more likely to stop searching for more nutrients and lets go of our stored body fat and decrease appetite.
As detailed in the ‘Building a Better Nutrient Density Index’ article, quantifying nutrient density enables us to prioritise foods that contain the highest amount of essential nutrients that are harder to obtain.[1]
The chart below (click to enlarge) shows the percentage of the recommended daily intake of various essential nutrients provided by:
all 7000+ foods in the USDA foods database,
plant based foods, and
the most nutrient dense plant based foods.
Restricting ourselves to ‘plant based’ foods will improve the vitamin and mineral content of the foods we eat. However, focusing on the most nutrient dense plant based foods allows us to improve nutrient density even more.
most nutrient dense plant based foods
Listed below is a summary of the most nutrient dense plant based foods sorted by their nutrient density score.
As you can see from the plot below from Nutrition Data, celery, which has a very high nutrient density score (ND), will provide you with a range of vitamins and minerals equivalent to 81% of your recommended daily intake with 1000 calories and 52% of your protein intake with 1000 calories. Keep in mind though that you would need to eat 100 stalks of celery to get that 1000 calories (and many of these calories will be spent digesting it!).
The fact that celery has a low energy density may be a benefit if you are trying to lose weight, but perhaps would not be so helpful if you are fueling for an Ironman Triathlon.
Also shown in the tables below is the net carbohydrates and calories per 100g for each of the foods listed.
The great thing about most of these foods is that they will provide you with heaps of nutrients while having a low energy density which will make it hard to over consume them to a point that they will spike your blood glucose levels.
In the second half of this article we will look at how we can choose foods that will be more gentle on blood glucose levels for those of us that are more insulin resistant.
vegetables
food
ND
% insulinogenic
insulin load (g/100g)
calories/100g
celery
1.44
48%
2
17
broccoli
0.52
54%
6
42
winter squash
0.39
68%
7
39
seaweed (kelp)
0.39
77%
10
50
okra
0.34
64%
6
37
kale
0.33
74%
10
56
bell peppers
0.33
72%
8
43
turnip greens
0.31
45%
4
37
summer squash
0.30
47%
2
19
radishes
0.27
49%
2
19
mung beans
0.24
77%
5
26
parsnip
0.21
68%
13
76
rhubarb
0.21
57%
3
21
artichokes
0.20
47%
6
54
lettuce
0.20
54%
2
17
white mushrooms
0.16
51%
4
34
sweet corn
0.15
77%
21
111
snap green beans
0.14
61%
6
40
peas
0.14
57%
7
51
jalapeno peppers
0.10
54%
5
35
collards
0.10
50%
5
40
Brussels sprouts
0.08
54%
7
52
asparagus
0.08
48%
3
27
sweet potato
0.06
84%
18
87
pinto beans
0.06
61%
22
142
leek
0.06
77%
7
36
cabbage
0.04
49%
4
30
pumpkin
0.03
73%
4
23
cucumber
0.03
74%
3
18
turnips
0.01
61%
4
24
Chinese cabbage
0.01
49%
2
17
bamboo shoots
0.01
69%
5
28
cassava
0.01
89%
36
160
mustard greens
0.00
50%
4
30
eggplant (cooked)
0.00
67%
7
41
chives
0.00
40%
4
37
potato
-0.03
89%
21
95
seaweed (spirulina)
-0.03
53%
52
395
onions
-0.03
77%
8
41
banana pepper
-0.04
47%
5
39
carrots
-0.04
50%
5
39
lentils (sprouted)
-0.04
90%
29
129
parsley
-0.04
49%
5
44
beets
-0.07
74%
9
48
soybeans (cooked)
-0.08
36%
14
151
arugula
-0.09
47%
4
31
shallots
-0.09
77%
15
78
edamame
-0.10
35%
11
124
portabella mushrooms
-0.15
48%
4
32
shiitake mushrooms (cooked)
-0.15
82%
13
66
carrots (raw)
-0.15
66%
7
44
chicory greens
-0.29
27%
2
28
shiitake mushrooms (raw)
-0.31
55%
6
41
cilantro
-0.41
36%
3
28
alfalfa (sprouted)
-0.41
32%
2
31
spinach
-0.41
41%
3
29
nuts and seeds
food
ND
% insulinogenic
insulin load (g/100g)
calories/100g
coconut water
0.60
66%
3
20
tahini
0.04
19%
30
633
sunflower seeds
0.02
27%
33
491
pistachio nuts
0.02
23%
35
602
pine nuts
0.02
7%
11
647
pecans
0.00
5%
10
762
pumpkin seeds
0.00
33%
64
777
sesame seeds
0.00
16%
25
603
cashew nuts
0.00
25%
38
609
macadamia nuts
0.00
5%
10
769
walnuts
-0.01
15%
25
683
almonds
-0.01
12%
19
652
hazel nuts
-0.01
12%
20
692
chia seeds
-0.01
16%
20
511
brazil nuts
-0.01
9%
15
704
coconut meat
-0.02
4%
8
703
flaxseed
-0.02
11%
16
568
cereals and grains
food
ND
% insulinogenic
insulin load (g/100g)
calories/100g
teff
0.29
80%
20
101
spelt
0.23
79%
27
135
quinoa
0.05
70%
21
120
millet
0.05
83%
24
118
tapioca
0.01
98%
87
356
spaghetti
0.01
94%
87
371
buck wheat
-0.01
79%
74
371
brown rice
-0.01
83%
23
111
oats
-0.02
70%
69
395
wheat flour
-0.03
87%
77
353
rye flour
-0.03
78%
70
359
corn-starch
-0.03
99%
91
367
rice flour
-0.04
84%
76
360
egg noodles
-0.04
80%
28
137
macaroni
-0.05
95%
38
161
fruit
food
ND
% insulinogenic
insulin load (g/100g)
calories/100g
cherries
0.26
79%
11
54
grapes
0.19
92%
18
77
litchis
0.13
82%
15
73
figs
0.10
82%
17
82
apples
0.08
87%
12
53
mandarin oranges
0.04
82%
12
59
dates
0.03
90%
69
308
raisins
0.02
92%
77
336
honeydew melon
0.01
88%
9
40
blueberries
0.01
88%
20
91
passion fruit
-0.01
52%
14
109
oranges
-0.01
79%
11
55
mango
-0.01
84%
14
67
prunes
-0.01
97%
91
378
raisins
-0.03
89%
73
329
raspberries
-0.03
42%
6
58
pear
-0.04
78%
13
64
nectarines
-0.06
67%
8
49
kiwifruit
-0.06
78%
13
67
plantains
-0.06
89%
30
136
plum
-0.06
75%
10
51
pineapple
-0.07
88%
13
57
olives
-0.07
18%
4
90
avocado
-0.07
11%
3
131
legumes
food
ND
% insulinogenic
insulin load (g/100g)
calories/100g
lima beans
0.14
68%
22
129
lentils
0.09
63%
18
118
hummus
0.07
32%
14
175
navy beans
0.07
57%
20
143
peanuts
0.02
19%
28
605
tofu
0.01
29%
8
112
kidney beans
-0.01
87%
58
266
peanut butter
-0.02
19%
31
630
soybeans (cooked)
-0.02
35%
16
187
tempeh
-0.03
37%
20
213
miso
-0.04
53%
28
207
natto
-0.05
33%
19
227
chickpeas
-0.05
73%
26
145
split peas
-0.07
57%
17
119
diabetic friendly nutrient dense vegan foods
While the foods listed above would represent a significant dietary improvement for most people, those who are insulin resistant may struggle to keep their blood glucose levels stable if they eat too much non-fibre carbohydrate that can be found in plant based foods (e.g. bread, sweet potato, quinoa, rice, beans or spaghetti).
It is hard to get too many calories and / or spike your glucose levels if you restrict yourself to vegetables like celery, broccoli and spinach. The problem with this approach comes if you are still hungry after you have eaten your fill of non-starchy veggies and are not wanting to lose more weight. People using a plant based approach may end up filling up on energy dense higher carbohydrate foods which are more likely to raise their blood glucose and insulin levels.
As shown in the chart below, our insulin response to food is only partially explained by the quantity of carbohydrates in our food.
The analysis of the food insulin index data indicates that our insulin response is also influenced by the fibre and the protein in the foods we eat.
We can use the formula below to estimate the amount of insulin that our food will require as shown by the formula below. Foods with a lower insulin load will enable your pancreas to keep up with demand and maintain normal blood glucose levels without the ‘blood glucose roller coaster’.
The higher fat foods actually have a lower nutrient density than the most nutrient dense vegetarian foods listed above. Ideally in time someone with insulin resistance would be able to restore their insulin sensitivity through eating nutrient dense, low insulin load foods along with perhaps intermittent fasting and exercise. However, in the meantime the lower insulin load foods will enable you to maintain normal blood glucose levels.
diabetic friendly plant based foods
The list of foods below is prioritised by both nutrient density and the proportion of insulinogenic calories. These foods will provide high levels of nutrition while also being gentle on your blood glucose levels with lower levels of insulin required.
vegetables
The vegetables in this list have a lower percentage of insulinogenic calories, lower amounts of net carbohydrates and a low energy density and therefore will have a minimal impact on blood glucose levels. While the percentage of insulinogenic calories is often high, the net carbohydrates is low so the effect on blood glucose will be minimal.
food
ND
% insulinogenic
insulin load (g/100g)
calories/100g
celery
1.71
48%
2
17
turnip greens
0.32
45%
4
37
broccoli
0.50
54%
6
42
summer squash
0.28
47%
2
19
artichokes
0.23
47%
6
54
radishes
0.26
49%
2
19
soybeans (cooked)
-0.10
36%
14
151
edamame
-0.12
35%
11
124
chives
-0.04
40%
4
37
chicory greens
-0.34
27%
2
28
collards
0.11
50%
5
40
white mushrooms
0.09
51%
4
34
okra
0.36
64%
6
37
asparagus
0.00
48%
3
27
mustard greens
0.00
50%
4
30
cabbage
-0.04
49%
4
30
banana pepper
-0.09
47%
5
39
arugula
-0.10
47%
4
31
lettuce
0.06
54%
2
17
parsley
-0.04
49%
5
44
endive
-0.56
24%
1
20
rhubarb
0.10
57%
3
21
winter squash
0.34
68%
7
39
peas
0.10
57%
7
51
carrots
-0.06
50%
5
39
bell peppers
0.39
72%
8
43
jalapeno peppers
0.01
54%
5
35
kale
0.41
74%
10
56
Chinese cabbage
-0.12
49%
2
17
alfalfa (sprouted)
-0.49
32%
2
31
Brussels sprouts
-0.03
54%
7
52
portabella mushrooms
-0.15
48%
4
32
seaweed (kelp)
0.42
77%
10
50
snap green beans
0.09
61%
6
40
parsnip
0.19
68%
13
76
cilantro
-0.49
36%
3
28
asparagus
-0.57
34%
2
23
turnips
-0.07
61%
4
24
mung beans
0.26
77%
5
26
spinach
-0.49
41%
3
29
cauliflower
-0.54
41%
3
28
eggplant (cooked)
-0.06
67%
7
41
leek
0.12
77%
7
36
nuts and seeds
Nuts and seeds have a lower proportion of insulinogenic calories as well as being lower in net carbs which makes them diabetic friendly. They do have a considerably higher energy density and hence, unlike the veggies, it is possible to overeat nuts and seeds if you’re keeping an eye on your weight.
food
ND
% insulinogenic
insulin load (g/100g)
calories/100g
coconut meat
-0.02
4%
8
703
macadamia nuts
-0.01
5%
10
769
pecans
0.00
5%
10
762
pine nuts
0.02
7%
11
647
brazil nuts
-0.02
9%
15
704
coconut milk
-0.06
8%
5
246
flaxseed
-0.02
11%
16
568
coconut water
0.76
66%
3
20
fruits
The list of diabetic friendly fruits with a lower proportion of insulinogenic calories ends up being quite short.
food
ND
% insulinogenic
insulin load (g/100g)
calories/100g
avocado
-0.09
11%
3
131
olives
-0.11
18%
4
90
raspberries
-0.04
42%
6
58
passion fruit
-0.03
52%
14
109
blackberries
-0.26
45%
5
48
guava
-0.19
54%
10
76
cherries
0.26
79%
11
54
nectarines
-0.10
67%
8
49
currants
-0.24
66%
10
63
limes
-0.17
71%
8
47
plum
-0.10
75%
10
51
strawberries
-0.27
67%
6
36
kiwifruit
-0.07
78%
13
67
legumes
These legumes have a lower proportion of insulinogenic calories and lower carbohydrates, however there may still be some impact on blood glucose with the moderate levels of carbohydrates, so you may want to keep an eye on your blood glucose levels when you try these foods to see how you react to them.
Barry has been a strict vegetarian since 1970 and was diagnosed with Type 1 Diabetes nine years ago. Barry maintained a nutrient dense plant based diet after his diagnosis, however found that he needed to incorporate dairy, eggs and some oils (e.g. MCT, coconut) into his vegetarian diet in order to achieve acceptable blood glucose control. Barry told me that when he lost 30 lbs when he switched from a vegetarian diet to a LCHF keto lacto ovo vegetarian diet eliminating all grains, bad oils and fruit (except berries).
Barry also came to the conclusion that he would need to incorporate some fish oil into his diet in order to provide adequate levels of essential fatty acids which are not available in significant quantities in plant based products.
Barry asked me to have a look at how a lacto, ovo, pescitarian diet would stack up against the straight vegan approach. So listed below are the most nutrient dense lacto (dairy), ovo (eggs), and pescetarian (seafood) diabetic friendly foods.
For those who are interested in adding eggs or seafood I have listed them based on their nutrient density and proportion of insulinogenic calories.
eggs and dairy
food
ND
% insulinogenic
net carbs/100g
insulin load (g/100g)
calories/100g
butter
0.00
0%
0
1
734
egg yolk
0.04
19%
4
15
317
cream cheese
0.01
10%
4
8
348
sour cream
0.00
9%
3
4
197
goat cheese
0.03
22%
2
25
451
limburger cheese
0.02
18%
0
15
327
blue cheese
0.02
20%
2
18
354
gruyere cheese
0.02
21%
0
22
412
edam cheese
0.02
22%
1
20
356
cream
-0.01
5%
4
5
431
cheddar cheese
0.02
20%
1
20
403
camembert cheese
0.02
20%
0
15
299
muenster cheese
0.02
20%
1
18
368
Monterey
0.02
20%
1
19
373
gouda cheese
0.02
23%
2
20
356
Colby
0.02
20%
3
20
394
feta cheese
0.02
22%
4
14
265
provolone
0.02
24%
2
21
350
brie cheese
0.01
19%
0
16
334
Swiss cheese
0.02
26%
5
25
379
parmesan cheese
0.03
30%
3
31
411
mozzarella
0.01
23%
2
18
318
whole egg
0.03
29%
1
10
138
ricotta cheese
-0.02
25%
3
11
174
Greek Yogurt
-0.05
27%
6
9
130
cottage cheese
-0.06
39%
3
9
93
seafood
food
ND
% insulinogenic
insulin load (g/100g)
calories/100g
caviar
0.09
32%
22
276
anchovy
0.10
42%
21
203
herring
0.07
34%
18
210
sardine
0.05
36%
18
202
trout
0.08
43%
17
162
mackerel
0.07
45%
17
149
oyster
0.11
57%
14
98
tuna
0.08
50%
17
137
salmon
0.07
50%
15
122
sturgeon
0.06
47%
15
129
squid
0.02
50%
21
170
halibut
0.06
63%
16
105
mussel
0.05
61%
25
165
shrimp
0.07
66%
19
113
lobster
0.08
69%
14
84
Pollock
0.06
66%
17
105
whitefish
0.06
67%
17
102
octopus
0.06
69%
27
156
snapper
0.05
64%
15
94
crab
0.07
69%
13
78
whiting
0.03
63%
17
109
haddock
0.04
67%
18
110
crayfish
0.03
64%
12
78
perch
0.01
59%
13
91
haddock
0.02
69%
15
85
clam
0.03
71%
24
135
cod
0.01
67%
17
99
abalone
0.03
76%
19
99
comparison of essential micronutrients
The charts below show the level of vitamins, minerals and amino acids for each of the approaches including for the most nutrient dense foods (without the plant based constraint). All of the reduced insulin load (IL) approaches do well compared to the average of all the foods in the USDA database.
The plot below shows the amino acids and essential fatty acids of the various approaches. This analysis indicates that you can achieve the daily recommended intake of protein from a nutrient dense plant based approach. The area that suffers when it comes to an exclusively plant based approach is the essential fatty acids EPA and DHA which many vegetarians choose to supplement with.
However, with the high levels of omega 3s in seafood it appears that you could probably obtain adequate essential fatty acids from around 200 calories of nutrient dense seafood (or around 10% of your energy intake).
In an effort to simplify things, the chart below shows a comparison of the average of the nutrient density provided by the various lower insulin load diabetic friendly approaches.
When we look at the average (blue bars) the pescetarian approach (i.e. plant based plus seafood, no eggs, no dairy) wins out.
A more useful way to identify the approach that will maximise the nutrient density of all the nutrients is to look at the average minus the standard deviation (orange bars). When we look at it from this perspective the pescetarian approach (i.e. plant based plus seafood without eggs or dairy) wins out again.
So it appears that the optimal approach from a nutrient density perspective is to focus on nutrient dense plant foods with some seafood.
summary
So in summary, there are some great nutrient dense options for people with diabetes who choose to follow a plant based dietary approach. Supplementing a plant based diet with some seafood will provide essential fatty acids and boost protein levels.
more information
If you’re interested in learning more about the nutrient density ranking system check out:
At first it sounds like a bizarre food combination, but when the smartest guy in the room says that he has sardines, oysters, eggs and broccoli as his regular breakfast I wasn’t surprised to find that it scored highly in the nutritional analysis.
Before he started saving the world by progressing Warburg’s mitochondrial theory of cancer and oxygen toxicity seizures for DARPA Dominic D’Agostino studied nutrition and is rumoured to have done some bodybuilding.
Both physical and mental performance are undoubtedly critical to Dom, so it’s not surprising that he is very intentional about what he puts in his mouth to start each day.
As you can see in the plot from Nutrition Data below Dom’s breakfast scores a very high 93 in the vitamins and minerals score and a very solid 139 in the protein score.
You could say this meal was high protein (44%), low carb (10%) and moderate fat (46%), although his fatty coffee and high fat deserts would boost the fat content to make it more “ketogenic”.
I’ve heard Dom say that he aims for a ‘modified Atkins’ approach with higher protein levels rather than a classical therapeutic ketogenic diet which is harder to stick to and might be used for people with epilepsy, cancer, dementia etc. It was intriguing to see that Dom’s standard breakfast ranks the highest in nutrient density rather than therapeutic or nutritional ketosis.
Dom first mentioned his favourite breakfast concoction in his first interview with Tim Ferriss (check out the excellent three hour podcast here). You can hear the shock and slight repulsion in Tim’s voice in the sound check as he responds with
I was aware that broccoli, eggs and sardines are nutritionally amazing, but then the oysters fill out the vitamin and mineral score to take it a little bit higher. Dom obviously understands the importance of Omega 3s which are hard to get in significant quantities from anything other than seafood.
I was surprised to see that oysters can be ‘carby’ (at 23% carbs) which is apparently due to their glucose pouch which varies in size depending when they’re harvested.
If you wanted to skip the oysters due to taste or cost considerations, the combination of sardines, egg and broccoli still does pretty well. This option gives less carbs, a slight decrease in the vitamin and mineral score with an slight increase in the amino acid score.
The combination of nutrient dense seafood with nutrient dense vegetables is hard to beat. The chart below shows my comparison of the nutrients in the various food groups in terms the proportion of the Daily Recommended Intake (DRI) from 2000 calories (click to enlarge).
I couldn’t get any photos of Dom’s breakfast, but I did get a photo of my current go to lunch. Each weekend I get a bunch of good quality celery and chop it up into tubs to take to work each day. I have cans of mackerel and sardines in my drawer at work.
Celery does really well in terms of nutrient density per calorie and sardines and mackerel are high on the nutrient density lists without being outrageously expensive (e.g. caviar, anchovy, swordfish, trout).
When I feel hungry I might start munching on the celery which is pretty filling and hard to binge on. Then if I’m still hungry I’ll have as many cans of mackerel or sardines as it takes to fill me up (which is usually 2 to 4).
At around 2pm this is my first meal of the day (other than espresso shots with cream) at around 2pm. If I start to feel hungry before then I might check my blood glucose to see if I really need to refuel or if I think I’m hungry because I’m bored. I’ll then go home and have an early dinner with the family around 6pm.
I’ve been known to indulge in some peanut butter with, cream, Greek yogurt or even butter if I’m still hungry (e.g. if I’ve ridden to work) but I try to not overdo it as I’m not as shredded as Dom yet.
The simple combination of celery and mackerel also does pretty well in the ranking of 250 meals and aligns well with my current goal of maximising nutrient density and ongoing weight loss now that I’ve been able to stabilise my blood glucose levels.
I’ve spent some time lately analysing these 1100 ketone vs glucose data points looking for the secret to achieving optimal ketone values for weight loss and health.
As you can see from this chart, there is a relationship between ketones and glucose. As your blood glucose levels decrease your blood ketones rise to compensate.
Different glucose : ketone relationships for different people
It seems that each person has a unique relationship between their blood glucose and ketone values that gives us an insight to understand their insulin resistance status and metabolic health.
Characterisation of different metabolic states
Similar to Dr Kraft’s insulin curves, we can characterise different levels of insulin resistance metabolic health using the relationship between glucose and ketones.
If you want to know why hyperinsulinemia is the “unifying theory of chronic disease” it’s worth taking the time to read up on it to provide some more context for the discussion later in this article. [1] [2] [3] [4] [5]
Type 2 Diabetes
If you have type 2 diabetes and your blood glucose levels are consistently high, you are not metabolising carbohydrates well, and will likely benefit from a lower insulin load dietary approach.
When you go a long time between meals, your ketones don’t kick in because of high insulin levels and / or your mitochondria are not functioning optimally. You feel tired and hangry.
Particularly in the early stages when someone is still insulin resistant, a lower insulin load dietary approach will help with satiety and carb cravings while keeping blood glucose levels under control.
Hyperinsulinemia and metabolic disorders
If your blood glucose levels are very low and ketone levels are also very low, you may have an infection or a metabolic disorder that is stopping you from producing enough energy.
The yellow line in the chart above is based on an actual person who is suffering from a range of metabolic related issues including obesity, PCOS, depression, etc. For these people, EXOGENOUS ketones may help to relieve the debilitating symptoms of acute Hyperinsulinemia.
Exciting research is currently underway looking at the use of EXOGENOUS ketones as an adjunct treatment for cancer or to provide energy directly to the mitochondria for people with epilepsy, dementia, Alzheimer’s and the like.[6][7]
Patrick Arnold, who worked with Dr Dominic D’Agostino to develop the first ketone esters and BHB salts, has noted that exogenous ketones may help alleviate the symptoms of the ‘keto flu’ during the transition from a high carb to a low carb dietary approach.
However, as noted by Robb Wolf, once you have successfully transitioned to a lower carb eating style you would need to reduce or eliminate the exogenous ketones to enable your body to fully up-regulate lipolysis (fat burning), maximise ENDOGENOUS ketone production and access your ENDOGENOUS FAT stores.
Insulin resistant
Someone with diabetes who persists with a nutrient dense low insulin load dietary approach may be able to successfully normalise their blood glucose and insulin levels. When this happens your body will be able to more easily release ENDOGENOUS ketones which will help improve satiety between meals, and decrease appetite which will in turn lead to weight loss. Exercising to train your body to do more with less is also helpful.
If you are insulin resistant you are probably not able to metabolise carbohydrates, protein or fats very well. The light blue “mild insulin resistance” line is based on my ketone and glucose values when I started trying to wrap my head around this ketosis thing.
I enthusiastically started adding unrestricted amounts of fat from all the yummy stuff (cheese, butter, cream, peanut butter, BPC etc) in the hope of achieving higher ketone levels and therefore weight loss, but I just got fatter and more inflamed as you can see in the photo on the left. My blood tests suggested I was developing fatty liver in my mid 30s! And I thought I was doing it right with the bacon and BPC?!?!?
The photo on the right is after I worked out how to decrease the insulin load of my diet and learning about intermittent fasting from Jason Fung. I realised that ENDOGENOUS ketosis and weight loss is caused by a lower dietary insulin load, not more EXOGENOUS fat on your plate or in your coffee cup.
I recently purchased a couple of bottles of KetoCaNa from the USA after hearing a number of podcast interviews with Dominic D’Agostino and Patrick Arnold.[8][9]
This metabolic jet fuel is definitely fascinating stuff! My experience is that it gives me the buzz like a BPC, but also has an acute diuretic effect (meaning I need to stay close to a toilet and long drives to work in slow traffic were sometimes humiliating).
I had hoped it would have a weight loss effect like some people seemed to be saying it would.
I did find it had an amazing impact on my appetite. While it was in my system I didn’t care as much about food. However once the ketones were used up my appetite came flooding back. It was like I had ‘bonked’ all of a sudden and needed LOTS OF FOOD NOW!
Unfortunately my hunger and subsequent binge eating seemed to offset the short term appetite suppression. And it was not going to be financially viable for me to maintain a constant level of artificially elevated ketone levels.
I asked around to see if anyone had come across studies demonstrating long term weight loss effects of exogenous ketones.[11]It was a VERY enlightening discussion if you want to check it out here. Wow!
The Pruvit FAQ says that one of the benefits of Keto//OS is weight loss, however no reference to the research studies was provided to Pruve this claim.
Also, the studies that were referenced in the Pruvit FAQ all appear to relate to the benefits of ENDOGENOUS or nutritional ketosis rather than EXOGENOUS ketone supplementation.
According to a Pruvit tele-seminar the EXOGENOUS ketone salts were not designed to be a weight loss product and hence have not been studied for weight loss.
The only studies that we could find that mentioned EXOGENOUS ketone supplementation and weight loss were on rats an they found that there was no long term effect on weight loss.[12]
So in spite of my hopeful $250 outlay it seems that exogenous ketones ARE just a fuel source after all.
Even the experts don’t seem to think exogenous ketones help with fat loss.
The “metabolically healthy” line in the chart above is based on RD Dike man’s ketone and glucose data when he recently did a 21 day fast.
Due to his hard earned metabolic health and improved insulin resistance he has developed the ability to fairly easily release ketones when goes longer periods between meals.
RD has achieved a spectacular HbA1c of 4.4%. Perhaps a two or three day water only fast testing blood glucose and ketones with no exercise would be a useful test of your insulin status? You could use RD’s line as the gold standard.
In spite of his improvement in insulin resistance and blood glucose control, he still says the “siren” of hunger is incredibility difficult to resist and mastering appetite is more challenging than particle physics. As a Chief Scientist at Lockheed Martin, he would know.
RD also told me that when he is not fasting and is eating his regular nutrient dense higher protein meals his ketone levels are not particularly high. While RD fairly easily produces ketones, it seems they are also quickly metabolised so they do not build up in his bloodstream.
Where this gets even more interesting is when we look at the glucose and ketone data in terms of TOTAL ENERGY. That is, from both glucose and ketones.
The average TOTAL ENERGY of the 1100 data points from these 26 fairly healthy people working hard to achieve nutritional ketosis is 6.1mmol/L. It seems the body works to maintain homeostasis around this level.
When the TOTAL ENERGY in our bloodstream increases outside of the normal range it appears the body raises insulin to store the excess energy. That is, unless you have untreated Type 1 Diabetes, in which case you end up in diabetic ketoacidosis with high blood glucose and high ketones.
Regardless of whether your energy takes the form of glucose, ketones or free fatty acids they all contribute to acetyl-coA which is oxidized to produce energy. Forcing excess unused energy to build up in the bloodstream is typically not desirable and can lead to long term issues (gyration, oxidized LDL etc).
I’m not sure if ketones can be converted to glucose or body fat, but it makes sense that excess glucose would be converted to body fat via de novo lip genesis to decrease the TOTAL ENERGY in the blood stream to normal levels.
Ketone bodies have effects on insulin and glucagon secretions that potentially contribute to the control of the rate of their own formation because of antilipolytic and lipolytic hormones, respectively. Ketones also have a direct inhibitory effect on lipolysis in adipose tissue.[15]
This guy seems to agree too. But what would he know? [16][17][18]
Looking at the glucose and ketones together in terms of TOTAL ENERGY was a bit of an ‘ah ha’ moment for me. It helped me to understand why people like Seyfried and D’Agostino always talk about the therapeutic benefits and the insulin lowering effects of a calorie restricted ketogenic diet. [19][20][21][22]
Dealing with high ketones and high glucose typically a concern fro the body because it just doesn’t happen in nature with real whole foods. But now we have refined grains, HFCS, processed fats and exogenous ketones to ‘bio-hack’ our metabolism and send it into overdrive.
While fat doesn’t normally trigger an insulin response, it seems that excess unused energy in the blood stream, regardless of the source, will trigger an increase in insulin to reduce the TOTAL ENERGY in the blood stream.
I am concerned that if people continue to enthusiastically zealously focus on pursuing higher blood ketones “through whatever means you can”[24] in an effort to amplify fat loss they will promote excess energy in the bloodstream which will lead to insulin resistance and hyperinsulinemia.
Using multi-level marketing tactics to distribute therapeutic supplements to the uneducated masses who are desperate to lose weight with a ‘more is better’ approach also troubles me deeply.
My heart sank when I saw this video.
MORE investigation required?
There are anecdotal reports that use of exogenous ketones provide mental clarity, enhanced focus and athletic performance benefits. At the same time there are also people who have been taking these products for a while that don’t appear to be doing so well.
Recently, ketone body supplements (ketone salts and esters) have emerged and may be used to rapidly increase ketone body availability, without the need to first adapt to a ketogenic diet. However, the extent to which ketone bodies regulate skeletal muscle bioenergetics and substrate metabolism during prolonged endurance-type exercise of varying intensity and duration remains unknown. Therefore, at present there are no data available to suggest that ingestion of ketone bodies during exercise improves athletes’ performance under conditions where evidence-based nutritional strategies are applied appropriately.
Ketosis decreased muscle glycolysis and plasma lactate concentrations, while providing an alternative substrate for oxidative phosphorylation. Ketosis increased intramuscular triacylglycerol oxidation during exercise, even in the presence of normal muscle glycogen, co-ingested carbohydrate and elevated insulin. These findings may hold clues to greater human potential and a better understanding of fuel metabolism in health and disease.
I can understand how exogenous ketones could be beneficial for someone who is metabolically healthy and consuming a disciplined hypo-caloric nutrient dense diet. They would likely be able to auto regulate their appetite to easily offset the energy from the EXOGENOUS ketones with less food intake.
While it seems that EXOGENOUS ketones assist in relieving the symptoms of metabolic disorders I’m yet to be convinced that a someone who is obese and / or has Type 2 Diabetes would do as well in the long term, especially if they were hammering MOAR fat and MORE exogenous ketones (along with maybe some sneaky processed carbs on the side) in an effort to get their blood ketones as higher in the hope of losing body fat.
Some questions that I couldn’t find addressed in the Pruvit FAQ that I think would be interesting to study in a long term controlled environment in the in the future are:
What is the a safe dose limit of EXOGENOUS ketones for a young child? How would you adjust their maximum intake based on age and weight?
IF EXOGENOUS ketones do have a long term weight loss effect what is the upper limit of intake of EXOGENOUS ketones to avoid stunting a child’s growth?
Is there a difference in the way EXOGENOUS ketones are processed in someone is metabolically healthy versus someone who is very insulin resistant?
Does the affect on appetite continue beyond the point that the ketones are out of your system?
Do you need to take EXOGENOUS ketones continuously to maintain appetite suppression? Does the effect of ENDOGENOUS wear off as your own ENDOGENOUS ketone production down regulates? Do you need to keep taking more and more EXOGENOUS ketones to maintain healthy appetite control?
How should someone with Type 2 Diabetes adjust their medication and insulin dose based on their dose of EXOGENOUS ketones? Should they be under medical supervision during this period?
Is there a difference in health outcome if you are taking EXOGENOUS ketones in the context of a hypo-caloric ketogenic diet versus a hyper-caloric ketogenic diet? What about a diet high in processed carbs?
Is there a minimum effective dose to achieve optimal long term benefits to your metabolic health or is MORE better?
Are the long term health benefits of EXOGENOUS ketones equivalent to a calorie restricted ketogenic diet?
Unfortunately, I think we will find the answers to these questions sooner rather than later with the large scale experiment that now seems to be well underway.
Alessandro Ferretti recently made the observation that metabolically healthy people tend to have lower TOTAL ENERGY levels at rest (and hence have a lower HbA1c), but are able to quickly mobilise glycogen and fat easily when required (e.g. when fasting or a sprint). They are metabolically flexible[25] and metabolically efficient.[26]
These people would have been able to both conserve energy during a famine and run away from a tiger and live to become our ancestors, while the ones who couldn’t didn’t.
Similar to RD Dikeman, John Halloran is an interesting case. Recently he has been putting a lot of effort into eating nutrient dense foods, intermittent fasting and high intensity exercise.
He is also committed to improving his metabolic fitness to be more competitive in ice hockey. His resting heart rate is now a spectacular 45 bpm!
And he’s been able to lose 10kg (22lb) during July 2016!
At 5.2mmol/L (i.e. glucose of 4.0mmol/L plus ketones of 1.2mmol/L) John’s TOTAL ENERGY is lower than the average of the 26 people shown in the glucose + ketone chart above. Looking good John!
It seems excellent metabolic health is actually characterised by lower TOTAL ENERGY.
MORE is not necessarily BETTER when it comes to health.
Fast well, feed well
To clean up the data a little I removed the ketones vs glucose data points for a couple of people who I thought might be suffering from pancreatic beta cell burnout and one person that was taking exogenous ketones during their fast that had a higher TOTAL ENERGY. I also removed the top 30% of points that I thought were likely high due to measuring after high fat meals.
So now the chart below represents the glucose and ketone values for a group of reasonably metabolically healthy people following a strict ketogenic dietary approach, excluding for the effect of high fat meals, BPC, fat bombs and the like.
The average ketone value for this group of healthy people trying to live a ketogenic lifestyle is 0.7mmol/L. Their average glucose is 4.8mmol/L (or 87mg/dL). The average TOTAL ENERGY is 5.5mmol/L or 99mg/dL.
ketones (mmol/L)
blood glucose (mmol/L)
total energy (mmol/L)
average
0.7
4.8
5.5
30th percentile
0.4
4.6
5.2
70th percentile
0.9
5.1
5.8
The table below shows this in US units (mg/dL).
ketones
(mmol/L)
blood
glucose (mg/dL)
total
energy (mg/dL)
average
0.7
86
99
30th percentile
0.4
83
94
70th percentile
0.9
92
104
It seems we may not necessarily see really high ketone levels in our blood even if we follow a strict ketogenic diet, particularly if we are metabolically healthy and our body is using to ketones efficiently.
The real ketone magic
When we deplete glucose we train our body to produce ketones.
This is where autophagy, increased NAD+ and SIRT1 kicks in to trigger mitochondrial biogenesis and ENDOGENOUS ketone production (i.e. the free ones).[27]The REAL magic of ketosis happens when all these things happen and ketones are release as a byproduct. I do not believe that simply adding EXOGENOUS ketones will have nearly as much benefit to your mitochondria, metabolism and insulin resistance as training your body to produce ENDOGENOUS ketones in a low energy state.
Everything improves when we train our bodies to do more with less (e.g. fasting, high intensity exercise, or even better fasted HIIT). Resistance to insulin will improve as your insulin receptors are no longer drowning in insulin caused by high TOTAL ENERGY building up in your bloodstream.
Driving up ketones artificially through EXOGENOUS inputs (treating the symptom) does NOT lead to increased metabolic health and mitochondrial biogenesis (cure) particularly if you are driving them higher than normal levels and not using them up with activity.
You may be able to artificially mimic the buzz that you would get when the body produces ketones ENDOGENOUSLY, however it seems you may just be driving insulin resistance and hyperinsulinemia if you follow a “MORE is better” approach.
Simply managing symptoms with patented products for profit without addressing the underlying cause often doesn’t end well.
Just like having low blood glucose is not necessarily good if it is primarily caused by high levels of EXOGENOUS insulin couple with a poor diet, or having lower cholesterol due to statins, having high blood ketone values is not necessarily a good thing if it is achieved it by driving up the TOTAL ENERGY in your blood stream with high levels of purified fat and EXOGENOUS ketones.
Nutrient density
When we feed our body with quality nutrients we maximise ATP production which will make us feel energised and satisfied. Nutrient dense foods will nourish our mitochondria and reduce our drive to keep on seeking out nutrients from more food. Greater metabolic efficiency will lead to higher satiety, which leads to less food intake, which leads to a lower TOTAL ENERGY, greater mitochondrial biogenesis, improved insulin sensitivity and lower blood glucose levels.
Prioritising nutrient dense real food is even more important in a ketogenic context.[28]While we can always take supplements, separating nutrients from our energy source is never a great idea, whether it be soda, processed grains, sugar, glucose gels, HFCS, protein powders, processed oils or exogenous ketones.
Based on my analysis of nutrient density I don’t think you should be trying to avoid protein and carbohydrates in the pursuit of higher ketone levels unless you have a legitimate medical reason for perusing therapeutic ketosis (e.g. cancer, Alzheimer’s, epilepsy, dementia etc).
I believe the best approach is to maximise nutrient density as much as possible while working within the limits of your metabolic health and your pancreas’ ability to maintain normal blood glucose levels.
Intermittent fasting
If your goal is metabolic health, weight loss and improving your ability to produce ENDOGENOUS ketones, then developing a practice of FEASTING and FASTING is important.
To start out, experiment by extending your fasting periods until your TOTAL ENERGY is decreasing over time. This will cause your circulating insulin levels to decrease which will force your body to produce ENDOGENOUS ketones from your ENDOGENOUS fat stores.
If you really want to measure something, see how low you can get your glucose levels before your next meal. Then when you do eat, make sure you choose the most nutrient dense foods you possibly can to build your metabolic machinery and give your mitochondria the best chance of supporting a vibrant, active and happy life.
As my wise friend Raymund Edwards keeps reminding me, FAST WELL, FEED WELL.
Epilogue
Like most people dabbling in this low carb thing, I’m still on a journey.
I’d love to be able to share shirtless photos like Ted and Dom but I’m still working to overcome my own genetic propensity for diabetes, obesity, Alzheimer’s and Parkinson’s. I’m still learning and working out how to apply these things in my own life.
Although I do sometimes check blood glucose levels before meals to see how I’m tracking I haven’t been testing ketones much for a year or so after I realised chasing high ketones with more dietary fat wasn’t helping me lose weight.
However after writing this article using other peoples’ data, I was intrigued to see how my ketones were travelling.
This was mid-morning after a kettlebell session.
I was able to get my heart rate up to 190 bpm which is my highest ever! My daughter joined me today so there was some downtime between sets. Usually I do an exercise until my heart rate gets up to at least 170 bpm. I then stop and wait until it drops back down to 140 bpm and then go again.
My aim is to train my mitochondria to pump out more power with less energy (i.e. fasted) to improve insulin sensitivity as well as mitochondrial efficiency and drive mitochondrial bio-genesis.
You can get a lot of work done in an intense 25 to 30-minute session with these weapons of torture that I keep downstairs in my garage (although I don’t think it really matters what you do as long as you push your body to do more with less).
My appetite today was great so I didn’t feel the need to eat until I had dinner with my family.
Previously I would have not been happy with these ketone readings and would have wanted to drive my ketones higher to get into the ‘optimal ketone zone’. I would have wondered “Maybe I should have eaten some MORE butter or had a BPC to drive ketones higher to facilitate fat loss?”
But given I’d still like to lose some more body fat I’m pretty happy with these numbers.
My total energy is low (4.5mmol/L and 5.1mmol/L). Check.
Ketones are present but not too high which means I’m able to mobilise fat but not building it up in my bloodstream. Check.
Blood glucose is low. Check.
All good! Feeling crisp, happy and vibrant thanks to ENDOGENOUS ketones!
(Sorry. I can’t sell you mine. You’ll have to make your own.)
Whatever is going on, it seems helps them run well too![3]
While I’m not sure you can say that these elite cyclists have eschewed all carbohydrate-containing foods, the trend away from processed carbs to whole foods is intriguing.
So if they’re going low carb does it mean they’re now butter, cream, MCT oil after starting the day with BPC?
Dr. James Morton, head of nutrition at Team Sky and an associate professor in the Faculty of Science at Liverpool John Moores University explains:[4][5][6][7][8]
We promote a natural approach to food. Our riders eat food that grows in the ground or on a tree and protein from natural sources.
They need energy, but they also have to stay lean and healthy with a strong immune system. A natural diet is the best way to achieve this.
Fat is important for everything from energy release and muscle health to immunity, but by eating the right food the fat takes care of itself. The riders eat eggs, milk, Greek yogurt, nuts, olive oil, avocados and some red meat for a natural mix of saturated and unsaturated fats.”
To achieve optimal weight Dr Morton asks the riders to “periodise” their carb intake by eating more when they train hard and cutting back when they’re less active.
They routinely train in the morning after eating a protein-rich omelette, instead of carbohydrate-dense bread, to encourage their bodies to burn fat for fuel.[9]
So how does low carb real food thing work?
According to Dr Terry Wahls it seems that nutrient density is a key part of maximising energy output.
To produce ATP efficiently, the mitochondria need particular things. Glucose or ketone bodies from fat and oxygen are primary.
Your mitochondria can limp along, producing a few ATP on only these three things, but to really do the job right and produce the most ATP, your mitochondria also need thiamine (vitamin B1), riboflavin (vitamin B2), niacinamide (vitamin B3), pantothenic acid (vitamin B5), minerals (especially sulfur, zinc, magnesium, iron and manganese) and antioxidants. Mitochondria also need plenty of L-carnitine, alpha-lipoic acid, creatine, and ubiquinone (also called coenzyme Q) for peak efficiency.
If you don’t get all these nutrients or if you are exposed to too many toxins, your ATP production will become less efficient, which leads to two problems:
Your body will produce less energy so they may not be able to do everything they need to do.
Your cells will generate more waste than necessary in the form of free radicals.
Without the right nutrient sources to fuel the ATP production in the mitochondria – which in turn produce energy for the cellular processes required to sustain life – your mitochondria can become starved. The cells then can’t do their job as effectively.[10]
So let’s look at the macro and micronutrient analysis of Chris Froome’s “rest day breakfast” (pictured above). The analysis indicates that it does very well in both the vitamins and minerals score as well as the amino acids score.
If we throw in some spinach Froomey would improve the vitamin and mineral score of his breakfast even further. The addition of spinach increases the nutrient balance score from 57 to 77 while the amino acid score stays high.
Froome’s wife says eating more protein has been one of the keys to losing weight and building muscle leading up to the tour.[11] Getting a quarter of your calories from protein is more than the 16% most people consume, however with 65% of the energy coming from fat you could also call this meal low carb, high fat, or even “ketogenic” depending on which camp you’re in.
This simple but effective meal would be a pretty good option for just about anyone. Froome’s breakfast ranks well regardless of your goals. Based on the ranking system of meals for different goals it comes in at:
#10 (with spinach) and #31 (without spinach) out of 245 meals analysed for the low carb diabetes ranking,
#18 and 52 on the therapeutic ketosis ranking, and
#26 and 64 on the overall nutrient density ranking.
It seems it’s not just the low carbers, “ketonians”[12] and people battling diabetes who are training their bodies to burn fat more efficiently. Maximising your ability to burn fat is critical even if you are extremely metabolically healthy.
The chart below shows comparison of the fat oxidation rate of well trained athletes (WT) versus recreationally (RT) athletes (who are not necessarily following a low carb diet).[13] The well trained athletes are clearly oxidising more fat, which enables them to put out a lot more power (measured in terms of their VO2max). It seems that you ability to efficiently burn fat for fuel it a key component of what sets the elite apart from the amateurs whether you call yourself vegan, ketogenic or a fruitarian.[14]
While carbohydrates help to produce maximal explosive power, it seems that the glucose turbocharger works best when it sits on a big power fat fueled motor. According to Peter Defty (who spent the last couple of years helping 2016 Tour de France second place getter Romain Bardet refine his ability as a fat adapted athlete using his Optimised Fat Metabolism protocol), fat can yield more energy more efficiently with less oxidative stress which requires less recovery time.[15]
Dr Morton also understand the importance of keeping carbohydrates low to maximise mitochondrial biogenesis and to access fat stores. If you want to learn more about his thinking on the use of diet to drive mitochondrial biogenesis you might be interested in checking out his array of published papers on the topic.[16][17][18][19][20][21][22]On the topic of carbohydrate intake Morton says:
Amateur riders are taught the importance of carbohydrates for training and racing, perhaps too much actually.
From our research at Liverpool John Moores University, we now know that deliberately restricting carbs around carefully chosen training sessions can actually enhance training adaptations.
But then of course we must ensure higher carbohydrate intakes for key training sessions and hard stages in racing.
I believe this concept of periodising daily carbohydrate intake is the most exciting part of sports nutrition in the last decade and our challenge now is to address how best we do this practically.
Essentially, exercising your mitochondria in a low insulin and low glucose state forces your body to adapt to using fat for fuel and to use glucose and oxygen efficiently and effectively.[23][24]
Not only is this useful for endurance athletes and people battling diabetes, training your body to use fat and oxygen more effectively is also claimed to be important to minimise anaerobic fermentation which is said to increase your risk of cancer.[25][26][27]
Many of us struggle trying to cope in an environment of excess energy from low nutrient density highly insulinogenic food. If we can’t obtain the necessary nutrients from our food to efficiently produce energy our bodies seek out more and more food in the hope of finding the required nutrients and enough energy to feel OK.
Our bodies do their best to use the energy that we give them, but they are working overtime to pump out insulin to store the excess energy that is not used. Over time our bodies adapt by becoming resistant to insulin in order to stop the excess energy being stored in our liver, pancreas and eyes when our fat stores on our muscles and belly can’t take any more.[28] Then to overcome the insulin resistance the body has to pump out more insulin which makes even less of the energy we eat available for use.
When we call on our mitochondria to produce intensive bursts of energy with minimal fuel (i.e. fasting) or glucose (i.e. low carb) we force our bodies to more efficiently the limited carbohydrate. Suddenly our bodies become insulin sensitive.
Recent studies indicate that people who are fat adapted are able to mobilise higher rates of fat at higher excercise intensities.[29]
With a higher reliance on fat they are able to conserve the precious glucose for explosive efforts.
Then, when they really need the power they have both fuel tanks available to cross the line first… and second!
Even the list of insulinogenic but nutrient dense foods didn’t look that scary for targeted use by someone who is metabolically healthy.
It can be more useful to tell people what they need to focus on rather than what they shouldn’t do. It’s like the proverbial hot plate or ‘wet paint’ sign. You can’t unsee it and you just want to touch it!
If you are busy focusing on the good stuff then you just won’t have any space left for the bad stuff, especially once you start feeling the benefits.
But when it comes down to it, what are the foods that everyone should avoid?
what’s so bad about sugar anyway?
For the past four decades mainstream food recommendations have been dominated by a fear of fat, particularly saturated fat and cholesterol, which if taken to the extreme can lead us to avoid nutrient dense foods and towards insuilnogenic nutrient poor processed low fat foods.
More recently, a growing number of people are advising that we should eat less sugar, from Sarah Wilson’s I Quit Sugar, to Robert Lustig’s Sugar: The Bitter Truth and Damon Gameau’s That Sugar Film. Gary Taubes seems to be softening his stance against carbohydrates in general and is about to release his new book The Case against Sugar.
The World Health Organisation are imploring people to reduce their sugar intake.[1] Investment bank Credit Suisse is predicting a turn away from sugar and and back towards fat, effectively advising people to ‘short sugar’.[2]
But what is it about sugar that makes it uniquely bad? It just the ‘evaporated cane juice’ that we should avoid? What about whole foods than contain some sugar, should we avoid them too?
While added sugars are not good, they’re also an easy target that everyone can get behind. It’s easy to swing from demonising one thing to another, from fat to carbs, to sugar.
I think we need to avoid are foods that quickly boost our insulin and blood glucose levels without providing any substantial nutrition in return.
Foods that should be considered universally bad are foods that are:
highly insulinogenic,
have a low nutrient density,
have a high energy density, and
have negligible fibre.
If you want to maximise the nutritional value of your food, give your pancreas a break so it can keep up, you should AVOID THESE FOODS.
Included in the tables below are:
Nutrient density (ND) is a relative score based on nutrients per calorie (zero is average, less than zero is worse than average).
Net carbs is the amount of non-fibre carbohydrate per 100g of food.
Energy density is the amount of calories per 100g of food.
The ranking of these foods is based on a multi criteria scoring process using all of these factors. I hav taken the ranking criteria for foods to help people manage their diabetes and blood glucose levels and reveresed it.
Without further ado, here is the avoid list.
drinks
Soft drinks provide very little nutritional value, are very insulinogenic and have no fibre so will raise your blood sugar and insulin levels quickly.
food
ND
% insulinogenic
net carbs / 100g
calories / 100g
creaming soda
-0.30
100%
13.3
53
ginger ale
-0.50
100%
8.8
35
cola
-0.40
100%
10.6
42
Gatorade
-0.71
100%
6.4
26
root beer
-0.40
100%
10.6
42
sweetened iced tea
-0.44
100%
9.8
39
energy drink
-0.24
100%
13.0
52
Powerade
-0.54
99%
7.8
32
orange juice
-0.24
99%
13.3
54
sweets
Sweets provide minimal nutrition while being very energy dense and highly insulinogenic. Sugar tops the list of badness, however there are a bunch of other sweets not far behind.
food
ND
% insulinogenic
net carbs / 100g
calories / 100g
sugar
0.05
100%
100
400
candies
0.05
100%
99
394
HFCS
0.04
100%
76
304
marshmallows
0.05
99%
81
334
maple syrup
0.09
99%
91
366
molasses
0.15
100%
75
300
jams and preserves
0.05
97%
67
278
honey
0.16
100%
82
331
fruits and fruit juices
Fruit in its natural state provides fibre, nutrients with a lower energy density. However fruit juice and dried fruit has a much lower nutritional value and is much more insulinogenic.
food
ND
% insulinogenic
net carbs / 100g
calories / 100g
mango nectar
-0.18
98%
13.0
53
apple juice
-0.20
95%
11.1
47
canned peaches
-0.13
93%
17.6
77
grape juice
-0.06
92%
14.0
62
blueberry syrup
-0.05
92%
21.2
94
currants
-0.21
83%
12.2
63
breakfast cereals
Commercial breakfast cereals are not a good way to start the day.
food
ND
% insulinogenic
net carbs / 100g
calories / 100g
rice krispies
0.06
97%
87.9
383
frosted flakes
0.06
96%
85.8
375
corn flakes
0.07
97%
85.9
375
puffed wheat
0.07
94%
78.9
388
honey smacks
0.07
93%
87.5
398
grape nuts
0.07
91%
78.8
387
Wheaties
0.07
92%
80.3
384
puffed millet
0.07
90%
79.6
403
honey nut shredded wheat
0.08
90%
82.0
394
cocoa pebbles
0.07
88%
85.4
400
fruity pebbles
0.05
87%
84.1
398
froot loops
0.09
89%
83.9
397
raisin bran
0.08
89%
72.0
345
grains and pasta
Processed grains are cheap and have a long shelf life, however the processing removes most of the fibre and most of the nutrients which means they are highly insulinogenic and energy dense.
food
ND
% insulinogenic
net carbs / 100g
calories / 100g
corn-starch
0.05
97%
88.7
367
rice flour
0.05
88%
75.3
360
macaroni
0.03
95%
31.7
161
white flour
0.08
95%
77.3
358
corn meal
0.08
92%
73.5
348
wheat flour
0.07
88%
70.7
353
rye flour
0.07
84%
68.9
359
spaghetti
0.05
90%
30.1
155
baked products
Similar to grains and pasta, processed baked products can be low in nutritional value, energy dense and highly insulinogenic.
During his yearlong n=1 ketosis experiment Jimmy Moore in 2012 didn’t give too much away about exactly what he was eating which made me a little frustrated but inquisitive.
What was he doing to keep his blood glucose consistently low and ketones high? Could this help me lose some weight or perhaps my type 1 diabetic wife normalise her blood glucose levels
Jimmy did publish a list of healthy high fat foods (i.e. avocados, butter, whole eggs, coconut oil, bacon, sour cream, 70% ground beef, full fat cheddar cheese and coconut) on the Carb Smart blog but he didn’t give away much more detail.
One meal he did blog as one of his favourites was his “keto eggs” which he included in Keto Clarity and on his blog here. He says it helps him “rock the ketones”. This was often his meal for the day with intermittent fasting. The recipe is shown below:
4-5 pastured eggs
2-3 oz grass-fed butter and/or coconut oil
sea salt
parsley (or your favorite spice)
2 oz full-fat cheese (optional)
2 Tbs Sweet Chili Sauce
3 Tbs sour cream
1 whole avocado
The nutritional analysis for the recipe below shows that it’s certainly ketogenic with 83% fat, 13% protein and 4% carbs. This recipe provides a solid protein score though the vitamins and minerals aren’t as high as some of the other meals. However if your primary aim is therapeutic ketosis then this meal will likely be great for you.
The ranking for the keto eggs recipe, compared to the 241 other meals that have been analysed so far, for each of the approaches is:
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