the latest food insulin index data

Living with someone who has Type 1 Diabetes for fifteen years I’ve gained an intimate understanding of how food and insulin can take your blood glucose levels on a wild ride. Since she was ten, my wife Monica’s had to manually manage her blood sugars as they swing up with food and then drop again when she injects insulin.

how to get off the the blood glucose rollercoaster

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High blood glucose levels make her feel “yucky”.  Plummeting blood glucose levels due to the mega doses of insulin don’t feel good either.  Then low blood glucose levels drive you to eat until you feel good again.  This wild blood glucose rollercoaster ride leaves you exhausted.

Young female injecting insulin in her abdomen

The dietary advice she received over the past three decades living with Type 1 has been sketchy at best.  When she was first diagnosed Monica tells the story of being made to eat so much high carb food that she hid it in the pot plants in her hospital room.

When we decided we wanted to have kids we found a great doctor who helped us to understand how to match insulin with carbs, but moderating the input of carbohydrate that necessitates insulin was never mentioned by doctors, endocrinologists or diabetes educators.

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We eventually stumbled across low carb and she was above to significantly improve her blood glucose control.

the latest food insulin index data

Then in early 2014 I came across Jason Fung’s Aetiology of Obesity series on YouTube where he discussed the food insulin index research that had been carried out at the University of Sydney which seemed to provide more insight into our insulin response to food.

I hoped that by gaining a better understanding how different foods affects our requirement for insulin I might be able to further refine our food choices to further reduce the amplitude of Monica’s blood glucose swings.

The initial research into the food insulin index was detailed in a 1997 paper An insulin index of foods: the insulin demand generated by 1000-kJ portions of common foods by Susanne Holt, Jennie Brand Miller and Peter Petocz who tested the insulin response to thirty eight different foods.

insulinindex

The food insulin index score of various foods was determined by feeding 1000kJ (or 239 kcal) of different foods to non-diabetic participants and measuring their insulin response over three hours.   This was then compared to the insulin response of pure glucose, which is assigned a value of 100%, to arrive at a “food insulin index” value for each food.

FII versus time chart.jpg

Considering how significant this information could be for people trying to manage their insulin levels (e.g. people with diabetes, “low carbers” or “ketonians”) I was surprised that there hadn’t been much further research or discussion on the topic.  I found a few references and mentions in podcasts, but no one was quite sure what to do with the information, mainly due to the fact that only a small number of foods been tested.

After some searching I came across a PhD thesis Clinical Application of the Food Insulin Index to Diabetes Mellitus (Kirstine Bell, September 2014).   Appendix 3 of the thesis contained an extensive food insulin index database of foods that had now been tested.  I plotted the relationship between carbohydrates and the food insulin index data.

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As you can see, the relationship between carbohydrates and insulin is not straightforward.  There are a number of high protein and low fat foods sitting quite high up on the vertical axis while there are a number of high fibre foods with a lower insulin response that you might expect.  However, once we account for the effect of protein, fibre and fructose we get are able to more accurately predict our body’s response insulin response to food.

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If you want to dig into this data a bit more you can check out the interactive Tableau version here.

As detailed in the most ketogenic diet foods article, this improved ability to quantify our insulin response to food enables us to identify foods that require less insulin and reduce the amplitude of our blood sugar swings in response to food.  This understanding could also prove invaluable for who require a therapeutic ketogenic dietary approach as an adjunct to cancer treatment, epilepsy or dementia.

Calculating the proportion of insulinogenic calories is useful for people who require a very low insulin therapeutic ketogenic diet while the insulin load is useful for people managing hyperinsulinemia, insulin resistance or diabetes.

Monica’s daily insulin dose has dropped from more than fifty units a day to closer to 20 units of insulin per day and the amplitude of her blood glucose swings is much smaller.

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While living with Type 1 will never be fun, the journey towards normal blood glucose levels has been more than worth it, with Moni’s energy levels improving to the point she can go back to work and look forward to a long, healthy and happy life.

the problem with the food insulin index

The problem with looking at things purely from a food insulin index perspective is that the resultant high fat foods do not provide a broad range of micronutrients.

A diet with a very low proportion of insulinogenic calories also tends to be very energy dense which can make portion control more challenging for people wanting to lose weight.

This refined understanding of how to calculate our insulin response to food is a useful parameter, along with nutrient density and energy density, which enables us to prioritise our food choices to suit different goals.

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optimals foods for different goals

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

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

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

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the Nutrient Optimiser

Building on the ability to quantify insulin load, nutrient density and energy density, more recently I have been developing a novel tool.  The Nutrient Optimiser reviews your food log diet and helps you to initially normalise your blood glucose and insulin levels by gradually retraining your eating habits by eliminating foods that boost your insulin level and blood glucose levels.

Once your glucose levels are normalised the Nutrient Optimiser focusses on your micronutrient fingerprint to identify foods that will fill in your micronutrient deficiencies with real food.

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If you still have weight to lose, the Nutrient Optimiser will focus on the energy density of your diet until you have achieved your desired level of weight loss.  Alternatively, the Nutrient Optimiser can help you if you were looking to increase your insulin levels for bulking or identify higher energy density foods for athletes.

It’s early days for the Nutrient Optimiser, but the initial results are very promising.

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Last updated: April 2017

fibre… net carbs or total carbs?

Looking at the foods sitting above the trend line the chart below it appears that the foods with the greatest insulin response compared to what would be predicted by carbohydrate and protein tend to be the ones that are more processed such as ice-cream, baked beans, pancakes and Jelly Beans.

On the lower side of the trend line we have less processed foods (e.g. full cream milk, navy beans, porridge and All Bran with added fibre).

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Processed foods tend to contain less fibre, while carbohydrates in their original state typically contain more fibre.  Fibre is indigestible carbohydrate and hence does not raise blood sugars or require insulin.

Fibre is also important for the health of our gut and feeds the good bacteria in our digestive tract.

Could it be possible to also use fibre as a proxy for the level of processing to help refine the prediction of insulin demand by different foods?

In order to test whether fibre is useful to predict insulin demand I tested the relationship between carbohydrates plus different amounts of the fibre in the various foods.

The best correlation was achieved by removing all of the fibre.  Using net carbs gives an increased correlation compared to the carbohydrates alone (i.e. R2 = 0.435 compared to R2 = 0.482).

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Considering the carbohydrates, protein and fibre in a food enables us to more accurately predict insulin demand.

This concept is known in the low carb community as “net carbs”.  If you’re trying count carbohydrates to manage insulin people are often advised to consider the total carbohydrates minus the fibre as fibre cannot be digested but is rather digested by our intestinal bacteria.

This aligns with the understanding that carbohydrates consumed with the packaging that they came with (i.e. fibre) do not have as big an effect on insulin.

This relationship might be part of the reason why many populations have maintained good health on a higher level of carbohydrate consumed in their raw natural state compared to when they come from the supermarket in boxes with barcodes.

There is some disagreement on how to deal with fibre on a restricted carbohydrate diet:

  • Some people say you should ignore fibre because “net carbs” is just a marketing ploy.
  • Some people choose to count half the fibre as carbs as a middle ground.
  • Experienced type 1 diabetics who monitor their blood sugars using continuous glucose meters will tell you that the fibre in their veggies will not raise their blood sugars however they ignore the fibre in packaged foods because it does raise their blood sugar.

My interpretation of the food insulin index data indicates that real fibre in foods is indigestible and hence does not raise blood sugar and require insulin.  However excess cooking and processing will soften this fibre and make it digestible.

It appears that the fibre in a food is a useful proxy for the level of processing and helps us to better predict the insulin demand of a food.

If you want to reduce your insulin load you can increase the amount of non-starchy veggies such as spinach, broccoli, mushrooms, Brussel sprouts and kale in your diet.

If you’re using packaged diet products then I suggest you ignore the fibre content, or maybe don’t buy them in the first place.

The major problem I see with encouraging people to consider total carbohydrates rather than net carbohydrates is that it will encourage people to avoid vegetables which not be optimal for health in the long term.  The reality is, when you take fibre into account, you can eat a lot of non-starchy vegetables without significantly impacting your net carbohydrates.

[next article…  how do you like your veggies… cooked or raw?]

[this post is part of the insulin index series]

[Like what you’re reading?  Skip to the full story here.]

how do you like your veggies… cooked or raw?

superfoods for weight loss (high nutrient density, low energy density)

People who are insulin resistant typically benefit from eating foods with a lower insulin load which helps normalise insulin and blood glucose.  Managing appetite is easier if you’re not on the blood glucose roller coaster.

However people who are obese but are also insulin sensitive seem to benefit even more by reducing energy density and maximising nutrient density as much as possible.  The foods listed below have a very low 82 calories per 100g compared to the average of the USDA foods database of 231 calories per 100g which will make them very hard to overeat.

In terms of macronutrients these foods have:

  • more protein (which will prevent loss of lean muscle mass),
  • more fibre (which will make you full and slow digestion),
  • less fat (thus allowing a contribution from body fat),
  • less digestible carbohydrates (which will maintain stable blood glucose levels).

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Once your blood glucose levels have been brought under control by reducing the insulin load of your diet, foods with a low energy density and high nutrient density will likely help you continue your journey towards optimum health and weight.

As shown in the chart below, these foods are very nutrient dense, with all nutrients other than the Omega 3 fatty acids meeting the recommended daily intake levels.  These foods will provide a substantial improvement in nutrient density compared to the average of all the foods in the USDA food database.

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The chart below is from a recent pilot trial by Christopher Gardner of Stanford (Weight loss on low-fat vs. low-carbohydrate diets by insulin resistance status among overweight adults and adults with obesity: A randomized pilot trial) which showed that the people who were insulin resistant generally did better on a higher fat low carbohydrate diet while people who were more insulin sensitive did better on a lower fat, lower energy density approach.

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Everyone in the study did better by eating more more nutrient dense unprocessed foods regardless of the macronutrient composition!

These foods will enable you to minimise your energy intake (calories) without and minimise your chance of experiencing any nutritional deficiencies.  For example, if you were fasting or dieting, focusing on these foods would maximise your chance of long term successes and minimising cravings.

The foods listed below represent the top 10% of the USDA food database prioritised for high nutrient density and low energy density.  The highest ranking foods involve lean proteins, non starchy veggies and seafood.  High fat dairy, processed grains and energy dense nuts and seeds don’t make the list.

The nutrient dense, high fibre, low energy density foods listed below will help you feel full with fewer calories, increase satiety and make it easier to control appetite.  This approach is similar to a protein sparing modified fast which which reduces your dietary fat on the basis that it will be coming from your body. Adequate protein is also critical to building lean muscle mass which is critical to your metabolic health.

“A nourishing, balanced diet that provides all the required nutrients in the right proportions is the key to minimising appetite and eliminating hunger at minimal caloric intake.”

Paul Jaminet

Also included in the table are the nutrient density score, load, energy density and the multicriteria analysis score score (MCA) that combines all these factors.

vegetables

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food ND calories/100g MCA
spinach 17 23 3.7
watercress 17 11 3.5
endive 16 17 3.4
asparagus 15 22 3.3
chicory greens 14 23 3.1
basil 14 23 3.0
coriander 14 23 3.0
seaweed (wakame) 14 45 3.0
chard 13 19 2.9
brown mushrooms 13 22 2.9
arugula 13 25 2.8
escarole 13 19 2.8
lettuce 13 15 2.8
broccoli 13 35 2.8
zucchini 12 17 2.8
parsley 12 36 2.7
Chinese cabbage 12 12 2.7
beet greens 12 22 2.7
okra 11 22 2.5
seaweed (kelp) 11 43 2.5
alfalfa 11 23 2.4
pickles 10 12 2.4
celery 10 18 2.4
dandelion greens 10 45 2.3
cauliflower 10 25 2.3
chives 10 30 2.3
white mushroom 10 22 2.3
mung beans 10 19 2.3
yeast extract spread 11 185 2.3
summer squash 10 19 2.3
radicchio 10 23 2.2
snap beans 9 15 2.2
turnip greens 9 29 2.2
portabella mushrooms 9 29 2.2
mustard greens 9 27 2.1
sauerkraut 9 19 2.0
cucumber 8 12 2.0
spirulina 8 26 2.0
shiitake mushroom 8 39 2.0
cabbage 8 23 2.0
collards 8 33 1.9
artichokes 8 47 1.9
dill 8 43 1.9
radishes 7 16 1.8
jalapeno peppers 7 27 1.7
banana pepper 7 27 1.7
bamboo shoots 7 27 1.7
turnips 6 21 1.6
onions 6 32 1.6
edamame 7 121 1.6
pumpkin 6 20 1.6
peas 6 42 1.6
Brussel sprouts 6 42 1.6
soybeans (sprouted) 6 81 1.5
red peppers 5 31 1.4
chayote 5 24 1.4
kale 5 28 1.4
winter squash 5 40 1.4
eggplant 5 25 1.4
butternut squash 5 45 1.3
paprika 7 282 1.3
red cabbage 5 29 1.3
sage 7 315 1.3
carrots 4 23 1.2

seafood

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food ND calories/100g MCA
crab 13 83 2.8
lobster 12 89 2.6
crayfish 11 82 2.4
fish roe 11 143 2.3
cod 12 290 2.3
oyster 10 102 2.1
halibut 9 111 2.0
shrimp 9 119 1.9
flounder 9 86 1.9
pollock 9 111 1.9
salmon 9 156 1.9
perch 8 96 1.8
trout 9 168 1.8
rockfish 8 109 1.8
white fish 8 108 1.7
sturgeon 8 135 1.7
haddock 8 116 1.7
scallop 7 111 1.7
caviar 9 264 1.7
anchovy 8 210 1.6
whiting 7 116 1.6
octopus 7 164 1.5
clam 6 142 1.5
sardine 6 208 1.3

animal products

7450703_orig

food ND calories/100g MCA
ham (lean only) 9 113 1.9
lamb liver 9 168 1.9
veal liver 9 192 1.9
turkey liver 9 189 1.9
lamb kidney 8 112 1.9
beef liver 8 175 1.8
chicken liver 8 172 1.8
beef kidney 7 157 1.5
pork liver 6 165 1.3
chicken breast 5 148 1.2
lamb sweetbread 5 144 1.2
pork chop 5 172 1.1
turkey drumstick 5 158 1.1
turkey meat 5 158 1.1
lamb heart 5 161 1.1
leg ham 4 165 1.0
lean beef 4 149 1.0
veal 4 151 1.0

dairy and eggs

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food ND calories/100g MCA
cream cheese (low fat) 10 105 2.2
kefir 7 41 1.8
whole egg 6 143 1.3
low fat milk 5 56 1.3
egg yolk 6 275 1.3
milk 5 61 1.2

other approaches

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

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

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

image02

food insulin index

The initial research into the food insulin index is detailed in a 1997 paper by Susanne Holt et al who tested the insulin demand of thirty eight different foods. [1]

The food insulin index of various foods was determined by feeding 1000kJ (or 239 kcal) of a particular food to non-diabetics and measuring the insulin secretion over three hours.   The insulin secreted for that food over three hours was compared to that of white bread (which was assigned a value of 100%) to arrive at a “food insulin index” value for each food.

fii-versus-time-chart

Considering how potentially significant this data could be for people trying to minimise the insulin effect of food (e.g. “low carbers” or keto dieters) I was surprised that there hadn’t been much further discussion or research over the past five years.

I found a few references and occasional discussions in podcast, but no one was quite sure what to do with the information, partly due to the small number of foods that had been tested.

foods that require the least insulin

Looking at the food insulin index data from the initial testing we can see that the foods lowest on the insulin index are largely fat.

food protein
(g/MJ)
fat
(g/MJ)
carb
(g/MJ)
fibre
(g/MJ)
insulin index
(%)
butter 0 27 0 0 2
olive oil 0 27 0 0 3
bacon 16 19 1 0 9
peanut butter 9 20 7 5 11
Bologna 24 9 13 3 11
peanuts 10 20 5 2 15
tuna 24 15 2 0 16

If we abandon the authority of the food pyramid and our fear of saturated fat, the logical extension of this is that the ideal diet for diabetics or people wanting to lose weight by reducing their insulin load might be to prioritise foods such as butter, oils and bacon that require the least insulin.

Bob Briggs has a YouTube video “Butter Makes Your Pants Fall Off” [2] with more than 100,000 views where he explains the mechanisms of low carbohydrate nutrition, how insulin promotes fat storage, and how reducing carbohydrates and eating healthier fats leads to a reduction in appetite and can help people lose weight.  The food insulin index helps to explain why this is the case.

The ranking of olive oil in the food insulin index (along with the intermittent fasting practised by the Greek Orthodox Church on Crete and consumption of significant amounts of fatty fish) may go some way to explaining the success of the Mediterranean diet which is widely advocated for heart health and longevity.

It may be a stretch, but the food insulin index may also go someway to explaining why Rich Froning keeps winning the CrossFit Games and looking so ripped in spite of consuming an inordinate amount of peanut butter, [3] a food that isn’t generally considered to be a health food.

men-running-rich-froning1

 last updated May 2017

References

[1] http://ajcn.nutrition.org/content/66/5/1264.short

[2] https://www.youtube.com/watch?v=h6aMN6NLOTQ

[3] http://www.examiner.com/article/crossfit-champ-rich-froning-reveals-diet-and-workout-secrets

the most ketogenic diet foods

  • Ketosis occurs when glucose stores and insulin levels are low which causes the body to switch to the use of fat for fuel.
  • Our insulin response is related not just to carbohydrate, but also the protein and fibre content of our food.
  • This understanding can help us to prioritise foods with a lower insulin load that will help us improve our blood glucose control.

food insulin index

The initial research into the food insulin index was detailed in a 1997 paper An insulin index of foods: the insulin demand generated by 1000-kJ portions of common foods by Susanne Holt, Jennie Brand Miller and Peter Petocz who tested the insulin response to thirty eight different foods.

insulinindex

The food insulin index score of various foods was determined by feeding 1000kJ (or 239 kcal) of different foods to non-diabetic participants and measuring their insulin response over three hours.   This was then compared to the insulin response of pure glucose (which is assigned a value of 100%) to arrive at a “food insulin index” value for each food.

FII versus time chart.jpg

Considering how significant this information could be for people trying to manage their insulin levels (e.g. people with diabetes, “low carbers” or “ketonians”) I was surprised that there hadn’t been much further research or discussion on the topic.  I found a few references and mentions in podcasts, but no one was quite sure what to do with the information, mainly due to the fact that only a small small number of foods been tested.

more food insulin index data

Digging a bit further I came across a recent PhD thesis from the University Of Sydney titled Clinical Application of the Food Insulin Index to Diabetes Mellitus (Kirstine Bell, September 2014) which contained a more extensive list of foods that had been tested since the original study.

With this additional data perhaps we can make more sense of the various factors that affect insulin, the master regulating hormone of our metabolism?

In the chart below I have plotted the carbohydrates versus the insulin response of foods for more than one hundred foods.  Although insulin is loosely correlated with the carbohydrate content of our food, we can see that high protein foods such as steak, tuna and fish still require a significant amount of insulin.

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I ran some analysis on the data and found that we secrete about half as much insulin in response to protein compared to carbohydrate.  And we get the best correlation when we assume that indigestible fibre does not raise insulin.  Interestingly, fructose only requires about a quarter of the insulin as carbohydrate.

Once we account for protein and fibre we get a much better prediction of the insulin response to food compared carbohydrate alone.  People wanting to follow a low carb or ketogenic diet will want to eat foods that lie towards the bottom left of this chart.

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[Check out this cool interactive visualisation of all the FII test data here.]

Using this understanding we can calculate insulin load of our food using the following formula:

insulin load = total carbohydrate – fibre + 0.56 x protein – 0.725 x fructose

We can also calculate the proportion of the energy in our food that requires insulin to metabolise (i.e. “the percentage of insulinogenic calories”).

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If you have the macronutrient details of food or a meal you can calculate the percentage  of insulinogenic calories using this calculator created by Dr Ted Naiman.

possible applications

Insulin is not bad at normal levels, but we are understanding more and more that excess insulin (e.g. hyperinsulinemia, insulin resistance, Type 2 diabetes) is highly problematic, perhaps as much or more than high blood glucose levels.

Understanding how to calculate our insulin response to food could enable us to better manage our diet to avoid elevated blood glucose and hyperinsulinemia.

The biggest challenge for someone with Type 1 Diabetes (like my wife) occurs when you require a large dose of insulin to address a high blood glucose level that is caused by eating non-fibre carbohydrates and large amounts of protein.  It’s much easier to manage your blood glucose levels when the insulin load of your diet is lower (i.e. less non-fibre carbohydrates and moderate protein).

A more accurate understanding of insulin load can also help people with diabetes more accurately calculate their insulin dose or people trying to manage conditions like cancer or epilepsy through a therapeutic ketogenic diet.

For the rest of us who are somewhere on the insulin resistance scale, being able to calculate the insulin load of our diet will enable us to enable our pancreas to keep with our diet and maintain normal blood glucose levels.

the most ketogenic foods

Listed below are the most ketogenic foods.  I have included a number of other parameters that may be of interest:

  • energy density – foods that contain high levels of fibre and water have a low energy density (i.e. calories per 100g) and will tend to make us full with fewer calories.
  • percentage of insulinogenic calories – this is the proportion of the energy in the food that will require insulin to metabolise.
  • insulin load – foods such as non-starchy vegetables have a higher proportion of insulinogenic calories, but because of their low energy density will have a very low insulin load per 100g of food, meaning that you will need to eat a lot of that particular food for it to affect your blood glucose or insulin significantly.
  • net carbohydrates – these are the digestible carbohydrates that will affect your blood glucose levels and insulin that remain after you account for the indigestible fibre.

The amount you need to prioritise each of these parameters depends on a range of considerations including your blood glucose control and your weight loss goals.   Along with the insulin response to different foods, nutrient density and energy density are other important parameters we can use to optimise our food choices.

2016-07-06 (11)

The chart below shows the nutrients provided by the most ketogenic foods in comparison to the USDA foods database.  We can see that there are quite a number of nutrients that are less available in the most ketogenic foods compared to the average of the foods that commonly available.   While it is valuable to manage the insulin load of our diet it is also important to maximise the nutrient density of our diet as much as we can while still maintaining excellent blood glucose levels.

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different foods for different goals

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

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

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

image02

I have sorted the foods below by insulin load which will be useful if you are looking for foods to help you manage the insulin load of your diet.  If you’re interested, the most ketogenic foods article has these foods sorted by their proportion of insulinogenic calories.

Focusing on foods with a low percentage of insulinogenic calories will be useful if you are aiming for a high fat therapeutic ketogenic diet.  Focusing on foods with a low insulin load may be more useful if you want to lose weight and use some of your body fat for fuel.

the most ketogenic diet foods

eggs

Eggs are a staple for low carbers, ketogenic dieters and diabetics.  Not only are they nutritious they are also low in carbohydrates.

 Fried-Egg-Wallpaper-5

food % insulinogenic insulin load (g/100g) calories/100g
egg yolk 18% 12 275
whole egg 30% 10 143
egg white 74% 9 52

The egg white is higher in protein and hence more insulinogenic.  At the same time the energy density (calories/100g) of the egg white is lower and hence the insulin load per 100g for the egg white is lower.

dairy

Some people believe that red meat and dairy are uniquely insulinogenic, however my reading of the food insulin index data is that there is nothing special about these foods that isn’t explained by their carbohydrate, protein and fibre content.

Dairy foods typically have a high energy density.  This is great if you’re a growing baby, an athlete trying to replenish energy or a bodybuilder trying to spike insulin for hypertrophy.  High palatability and high energy density are not a good combination if you’re trying to lose weight.

cheese

food % insulinogenic net carbs/100g insulin load  (g/100g) calories/100g
cream cheese 10% 4 8 348
cottage cheese 38% 3 9 93
ricotta cheese 25% 3 11 174
feta cheese 22% 4 14 265
Limburger cheese 18% 0 15 327
Camembert cheese 20% 0 15 299
brie cheese 19% 0 16 334
Muenster cheese 20% 1 18 368
blue cheese 20% 2 18 354
mozzarella 23% 2 18 318
Monterey 20% 1 19 373
cheddar cheese 20% 1 20 403
Colby 20% 3 20 394
Edam cheese 22% 1 20 356
Gouda cheese 23% 2 20 356
provolone 24% 2 21 350
Gruyère cheese 21% 0 22 412
goat cheese 22% 2 25 451
Swiss cheese 26% 5 25 379
parmesan cheese 30% 3 31 411

milk and cream

Milk has a higher proportion of insulin calories compared to cheese.  Butter and cream have a lower insulin load and proportion of insulinogenic calories.

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food % insulinogenic net carbs/100g insulin load  (g/100g) calories/100g
butter 0% 0 1 734
cream 5% 4 5 431
goat milk 40% 4 7 69
full cream milk 44% 5 7 65
low fat milk 58% 5 7 50
human milk 43% 7 8 71
reduced fat milk 59% 5 8 51

yoghurt

Full fat plain Greek yoghurt has the lowest percentage of insulinogenic calories while the sweetened and low fat options are extremely insulinogenic.

greek-yogurt

food % insulinogenic net carbs/100g insulin load  (g/100g) calories/100g
Greek Yoghurt 27% 6 9 130
plain low fat yoghurt 69% 7 11 63
skim milk yoghurt 86% 8 12 55
low fat fruit yoghurt 93% 19 22 95

fruit

It’s interesting to note that there are only a handful of fruits with a low percentage of insulinogenic calories (i.e. olives and avocados).  However some fruits like oranges have a lower insulin load because of their low energy density and therefore may not spike your blood sugar as much as dates or raisins which have a high proportion of insulinogenic calories as well as a high insulin load.  If in doubt, get a blood glucose metre and compare how much your favourite foods raise your blood glucose levels.

spanish-olives

food % insulinogenic insulin load (g/100g) calories/100g
olives 3% 1 145
avocado 8% 3 160
blackberries 27% 3 43
raspberries 30% 4 52
strawberries 49% 4 32
apples 50% 7 52
gooseberries 52% 6 44
passionfruit 52% 14 97
apples 54% 7 48
pears 54% 7 50
boysenberries 54% 8 50
kiwifruit 55% 9 61
carambola 56% 5 31
blueberries 56% 9 57
blueberries 58% 14 88
watermelon 60% 5 30
jackfruit 61% 16 95
cherries 61% 9 50
mango 63% 11 60
pears 64% 7 42
cranberries 65% 8 46

vegetables

There aren’t many dietary approaches that don’t advise you to eat more vegetables.  It’s also hard to overeat non-starchy veggies because they have a very low calorie density and are high in fibre.  Again, due to the low energy density the net carbohydrates are low in a lot of the non-starchy veggies and hence won’t significant raise your blood glucose levels.

vegetable-03

food % insulinogenic insulin load (g/100g) calories/100g
alfalfa 19% 1 23
chicory greens 23% 2 23
endive 23% 1 17
escarole 24% 1 19
coriander 30% 2 23
beet greens 35% 2 22
banana pepper 36% 3 27
mustard greens 36% 3 27
collards 37% 4 33
jalapeno peppers 37% 3 27
sauerkraut 39% 2 19
pickles 39% 1 12
cucumber 39% 1 12
zucchini 40% 2 17
red peppers 40% 3 31
chayote 40% 3 24
edamame 41% 13 121
radishes 43% 2 16
turnip greens 44% 4 29
summer squash 45% 2 19
arugula 45% 3 25
carrots 47% 5 37
parsley 48% 5 36
chives 48% 4 30
spinach 49% 4 23
artichokes 49% 7 47
soybeans (sprouted) 49% 12 81
Brussel sprouts 50% 6 42
lettuce 50% 2 15
asparagus 50% 3 22
celery 50% 3 18
bamboo shoots 50% 2 11
okra 50% 3 22
cauliflower 50% 4 25
broccoli 50% 5 35
turnips 51% 3 21
chard 51% 3 19
celery flakes 53% 42 319
dandelion greens 54% 7 45
Chinese cabbage 54% 2 12
red cabbage 55% 5 29
portabella mushrooms 55% 5 29
rhubarb 55% 3 21
cabbage 55% 4 23
shiitake mushroom 58% 7 39
snap beans 58% 3 15
yeast extract spread 59% 27 185
kale 60% 5 28
bamboo shoots 60% 5 27
turnips 61% 4 22
carrots 61% 4 23
potatoes 64% 26 158

nuts and seeds

Most nuts and seeds have a low percentage of insulinogenic calories though they have a higher energy density are possible to overeat.

food % insulinogenic insulin load (g/100g) calories/100g
macadamia nuts 6% 12 718
pecans 6% 12 691
coconut cream 8% 7 330
coconut milk 8% 5 230
brazil nuts 9% 16 659
coconut meat 10% 9 354
sesame seeds 10% 17 631
hazelnuts 10% 17 629
pine nuts 11% 21 673
flax seed 11% 16 534
walnuts 13% 22 619
sunflower seeds 15% 22 546
almonds 15% 25 607
almond butter 16% 26 614
butternuts 17% 28 612
pumpkin seeds 19% 29 559
sesame butter 21% 33 586
pistachio nuts 22% 34 569
cashews 26% 40 580
coconut 34% 39 443
gingko nuts 52% 15 111
coconut water 66% 3 19

seafood

Seafood is a great source of essential fatty acids which are heard to find in plant based foods.

seafood-salad-5616x3744-shrimp-scallop-greens-738

food % insulinogenic insulin load (g/100g) calories/100g
mackerel 14% 10 305
cisco 29% 13 177
caviar 33% 23 264
herring 36% 19 217
sardine 37% 19 208
anchovy 44% 22 210
trout 45% 18 168
fish roe 47% 18 143
sturgeon 49% 16 135
salmon 52% 20 156
tuna 52% 23 184
flounder 57% 12 86
oyster 59% 14 102
perch 62% 14 96
rockfish 66% 17 109
whiting 66% 18 116
halibut 66% 17 111
crayfish 67% 13 82
shrimp 69% 19 119
pollock 69% 18 111
white fish 70% 18 108
orange roughy 70% 17 105
haddock 71% 19 116
cod 71% 48 290
octopus 71% 28 164
lobster 71% 15 89
crab 71% 14 83
clam 73% 25 142
scallop 77% 22 111

animal products

7450703_orig

food % insulinogenic insulin load (g/100g) calories/100g
bacon 11% 11 417
bologna 11% 9 310
sweetbread 12% 9 318
liver sausage 13% 10 331
pepperoni 13% 16 504
blood sausage 14% 13 379
kielbasa 15% 12 325
knackwurst 16% 12 307
liver pate 16% 13 319
bratwurst 16% 13 333
frankfurter 17% 12 290
chorizo 17% 19 455
pork ribs 18% 16 361
beef sausage 18% 15 332
duck 18% 15 337
salami 18% 17 378
meatballs 19% 14 286
lamb rib 19% 17 361
turkey bacon 19% 11 226
pork sausage 20% 16 325
headcheese 20% 8 157
turkey 20% 21 414
beef brains 22% 8 151
pork sausage 25% 13 217
bologna 26% 11 172
T-bone steak 26% 19 294
lamb brains 27% 10 154

the Nutrient Optimiser

Building on the ability to quantify insulin load, nutrient density and energy density, more recently I have been developing a novel tool.  The Nutrient Optimiser reviews your food log diet and helps you to initially normalise your blood glucose and insulin levels by gradually retraining your eating habits by eliminating foods that boost your insulin level and blood glucose levels.

Once your glucose levels are normalised the Nutrient Optimiser focusses on your micronutrient fingerprint to identify foods that will fill in your micronutrient deficiencies with real food.

2017-03-08-2

If you still have weight to lose, the Nutrient Optimiser will focus on the energy density of your diet until you have achieved your desired level of weight loss.  Alternatively, the Nutrient Optimiser can help you if you were looking to increase your insulin levels for bulking or identify higher energy density foods for athletes.

It’s early days for the Nutrient Optimiser, but the initial results are very promising.

2017-03-082

Post last updated: April 2017

articles

optimal foods for different goals

We can prioritise the foods we eat by balancing nutrient density, insulin load and energy density to suit out individual goals and current metabolic health.

2016-07-06 (11)

Click on the links below to see the optimal foods for each goal, or read on for an overview of the system.

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

insulin load

Insulin is an important hormone that regulates growth and energy storage as well as fat loss and cellular repair.  Too much insulin, due excess processed foods or insulin resistance can be a problem.

While reducing carbohydrates will reduce insulin levels, as you can see from the plot of carbohydrates versus insulin index below, carbohydrates only tells us part of the story.

image11

Considering the carbohydrates minus fibre plus about half of the protein we eat provides a better estimation of the insulin load of our food.

image02

We can use this understanding to prioritise foods for:

  • growth and bulking with higher amounts of insulin, or
  • fat loss and autophagy with lower amount of insulin.

nutrient density

Unfortunately, the foods with the lowest insulin load are refined oils and fats which often don’t contain a large amount of essential nutrients (i.e. vitamins, minerals and amino acids).

Maximising the nutrient density of the foods we eat is important for a wide range of reasons.  Ideally, to minimise cravings and maximise satiety, we want to maximise the nutrients per calorie of the foods we eat (i.e. nutrient density).

Nutrient dense foods are typically whole foods that have been subjected to minimal processing.  These nutrient dense foods come with a range of micro and macro nutrients.

We  quantify nutrient density by comparing the essential nutrients in a food to the rest of the foods available and adding up all these scores for the essential vitamins, minerals, amino acids and fatty acids that are harder to find.

Focusing on the more nutrient dense foods can make a massive difference to the quality of our diet and manage our cravings and appetite.

2016-07-14 (2)

energy density

Lastly, low energy density foods (i.e. foods that contain more fibre and water and less fat) help us to feel full with less energy and help us to use our own body fat for fuel.  Low energy density foods are also typically more nutrient dense.  Focusing on foods with a lower energy density can be particularly helpful if we already have great blood glucose levels but still have more fat to lose.

which approach is right for me?

The focus of the system is to help you find the foods that will help you maintain great blood glucose levels while maximising nutrient density as much as possible.

The right approach for you will depend on your current metabolic health and weight loss goals.  In the end we want to ingest adequate energy while avoiding malnutrition and maintain normal insulin and blood glucose levels.  energy-density-vs-nutrient-density

Focusing on insulin load is great if you have a chronic health condition such as cancer, epilepsy or dementia that will benefit from a therapeutic ketogenic approach.

Someone with very high blood glucose and insulin levels may also benefit initially from a therapeutic ketogenic approach as they adapt.

However, as blood glucose levels improve, you will ideally be able to transition to more nutrient dense dietary approach.

The table below gives some guidance on which nutritional approach would be ideal based on your average blood glucose levels and your waist to height ratio.

approach

average glucose

waist : height

(mg/dL)

(mmol/L)

therapeutic ketosis

> 140

> 7.8

diabetes and nutritional ketosis

108 to 140

6.0 to 7.8

weight loss (insulin resistant)

100 to 108

5.4 to 6.0

> 0.5

weight loss (insulin sensitive)

< 97

< 5.4

> 0.5

bulking

< 97

< 5.4

< 0.5

nutrient dense maintenance

< 97

< 5.4

< 0.5

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

post last updated: April 2017

your personalised food ranking system

  • A number of attempts have been made to develop food rankings.
  • We can combine the concept of insulin load with nutrient density to help us make optimal food choices based on our goals, situation and budget.
  • This article looks at other ways to prioritise our our food choices quantitatively to design a food ranking to suit your situation, goals and budget.

Mat Lalonde’s nutrient density

Dr Mat Lalonde developed a ranking of foods based on nutrient density in terms of nutrients per gram using the USDA food database. [1]  This analysis identified organ meats as one of the more nutritious foods, with vegetables coming in second.  Fruits and grains landed much further down the list.

Lalonde noted that people wanting to lose weight may wish to prioritise in terms nutrient density per calorie, however he had chosen to analyse nutrient density in terms of weight as that might be more relevant for athletes (Lalonde is a CrossFit athlete as well as a biochemist). [2]

I was left excited, yet a little unsatisfied, wondering what the ranking might look like in terms of calories, or maybe some other measure.

Aggregate Nutrient Density Index (ANDI)

Joel Fuhrman’s Aggregate Nutrient Density Index (ANDI) ranks foods based on micronutrients per calorie [3] but excludes a number of essential vitamins and minerals while placing extra emphasis on the oxygen radical absorbance capacity.

This approach heavily biases plant foods and seems to ignore the nutritional benefits of animal foods. [4]  Kale ranks at the top of the list, largely due to its massive amount of vitamin K.

Unfortunately a massive dose of vitamin K isn’t much use to us in the context of a low fat given that vitamin K (along with vitamin D and E) is a fat soluble vitamin.  It’s also not much use having a food that ranks off the chart in one nutrient but it’s that good in a number of other areas.   Vitamin K is important but you can only absorb so much in one day.

Another criticism that has been levelled at ANDI is that simply using nutrition per calorie prioritises very low calorie density foods that may not be viable for anyone doing a significant amount of activity.

Dave Asprey’s Bulletproof Diet

Dave Asprey developed the Bulletproof Diet Infographic [5] which is a simple ranking of foods to avoid and preference based on both nutritional density and toxins.

The downside of this is that it shows only a select range of foods and doesn’t explain why each of the foods has the ranking that is has been given (though there is a good discussion of the toxins and various issues in his book [6]).

Most people would be happy with this visual list of foods to preference and avoid, and I recommend you check it out, however I wanted to see the numbers to understand why one food ranked above another.

nutrient density per dollar

I also came across a food ranking system in terms of nutrient density per dollar.  Dale Cumore of the blog Solving Nutrition [7] had created a ranking based on nutrient density per dollar cost of that food to arrive at the cheapest way to get nutrition for around 1000 foods that he could find cost data for.

Dale included a link to his  spreadsheet on his blog (in which he has mimicked Lalonde’s analysis [8]) for people to have a play with.  So I downloaded it to see what I could do with it. [9]     After dropping out the fortified products, we get the following list of foods based ranked on nutrient density per dollar.

  • bagels
  • French rolls
  • croissants
  • muffins
  • lentils
  • tortillas
  • rice
  • parsley
  • beef liver
  • spaghetti
  • Chinese cabbage (Bok Choy)
  • sunflower seeds
  • White bread
  • chicken liver
  • peanut butter
  • skim milk
  • peanuts
  • chives
  • whole eggs
  • brown rice
  • sweet potato
  • cabbage
  • orange juice

Grains are actually a cost effective way to get nutrients, however not necessarily the most healthy.    People believe that most if not all grains should be avoided. [10]  My ten year old daughter knows that if she eats bread she will end up tired, with a stomach ache and dark circles around her eyes.  However if  cost is your number one priority you might find this list useful.

cost per calorie

Cost will always be a consideration to some degree.  Some people may not have the finances to buy grass fed organic while others will have the means to invest in food as preventative medicine.  Listed below are the cheapest foods in terms of cost per calorie.  Again, grains (including white rice), candy and sugar rank up there with some of the cheapest ways to get calories. [11]

While it’s true that grass fed beef, salmon and organic vegetables can be more expensive than boxed cereals and sugar, it’s also worth noting that obtaining significant proportion of your calories from fats such as coconut oil and butter can actually be very cost effective on a per calorie basis.

  • pumpernickel rolls
  • croissants
  • bagels
  • canola oil
  • French rolls
  • margarine
  • what muffins
  • coconut oil
  • granulated sugar
  • rice
  • brown sugar
  • mayonnaise
  • doughnuts
  • tortillas
  • cake mix
  • peanut butter
  • cranberry juice
  • spaghetti
  • sausage
  • corn starch

nutrient density per calorie

Nutrient density per calorie is a useful measurement for someone wanting to lose weight while maximising nutrition.   One line of health and weight loss thinking says that once the body obtains adequate nutrients it will stop searching for food and overeating will be minimised. [12]  Using this approach vegetables shoot to the top of the list with things like spinach, liver, seafood oysters, kale and broccoli rank really well.

  • spinach
  • chicken liver
  • beef liver
  • beet greens
  • veal liver
  • pork liver
  • duck liver
  • goose liver
  • turnip greens
  • mustard greens
  • parsley
  • chard
  • oyster
  • coriander
  • dandelion greens
  • basil
  • caviar
  • kale
  • broccoli
  • All bran
  • collards

fibre per calorie

One of the more exciting concepts in the diet space recently is the concept that what you eat could possibly change your gut bacteria for better or worse.

While this area is still in its infancy the thinking is that lean people have a higher bacteriodes : fermicutes ratio and that this can be influenced by eating more fibre and taking prebiotics.

Typical daily fibre intake is around 17g for those of us in western civilisation. It is said that African hunter gatherer children obtain more than 150g of fibre per day from eating unprocessed foods in their natural state [13] and before the invention of fire and cooking our ancestors were eating more than 100g of fibre per day. [14]

Fibre in carbohydrate-containing foods neutralises the insulinogenic effect of the carbohydrate.  Fibre is not digestible by the human gut and hence it does not provide energy or cause a rise in blood sugar or insulin.

The typical western recommendation is to get at least 30g of fibre per day to improve your blood sugar and cholesterol levels.  Most people don’t achieve these levels even when eating “healthy whole grains”, largely due to the high level of processing in most popular foods.

It’s also worth noting that it’s better to lightly steam your veggies rather than cooking them until they’re soft so that the fibre remains intact.

Ironically the number one recommended source for fibre is from “healthy whole grains”.  While whole grains will be marginally better than processed grains such as white bread, they also have a high glycemic load and will be much more insulinogenic than other options such as non-starchy vegetables.  The end result of eating the whole grains is increased blood sugars and cholesterol, which is exactly what “healthy whole grains” was meant to help us avoid!

If we rank for fibre per calorie we end up with a few spices such a cinnamon, curry powder, or cocoa at the top of the list along with vegies such as turnip, artichoke, sauerkraut, cauliflower.  All Bran features in the list but only because it has been fortified with extra fibre.

  • cinnamon
  • turnip greens
  • artichoke
  • curry powder
  • sauerkraut
  • cauliflower
  • raspberries
  • lettuce
  • blackberries
  • lemon peel
  • All Bran (w/ added extra fibre)
  • oregano
  • wheat bran
  • eggplant
  • basil

practical application

These lists of foods ranked based on one measurement or another are interesting, however they are not particularly useful by themselves.  If we went by Lalonde’s system we’d be eating bacon and organ meats all the time.  If we went by the ANDI system we’d be living off kale.  And if we just looked at the proportion of insulinogenic calories we would be living off butter, cream and oils.

But it gets interesting though when you can combine the various measurements to highlight foods to suit your individual goals.

In my previous articles on diets for weight loss, blood sugar management and athletes I provide a list of optimal foods for using different weightings for the following:

  • nutrient density per calorie,
  • fibre per calorie,
  • nutrient density per dollar,
  • nutrient density per 100g,
  • proportion of insulinogenic calories,
  • calories per 100g, and
  • cost per calorie.

Listed below are the weightings that I’ve devised for each situation.

I’ve also developed a suite of ‘cheat sheets’ to highlight optimal food choices to suit your goals, whether they be weight loss,  normalising weight loss or or athletic performance.

Why not print one out and stick it to your fridge as a helpful reminder or use them for some inspiration for your next shopping expedition?

In the next article we’ll look at how we can use this style of analysis to identify diabetic friendly, ketogenic, nutrient dense meals.

weighting for blood sugar control and ketosis

ND / calorie fibre / calorie ND / 100g ND / weight insulinogenic (%) calorie / 100g $ / calorie
15% 5% 5% 10% 50% 10% 5%
weighting for weight loss
ND / calorie fibre / calorie ND / 100g ND / weight insulinogenic (%) calorie / 100g $ / calorie
15% 10% 10% 5% 20% 30% 10%
weighting for athletes and metabolically healthy
ND / calorie fibre / calorie ND / 100g ND / weight insulinogenic (%) calorie / 100g $ / calorie
15% 10% 10% 30% 20% 5% 10%
weighting for theraputic ketosis
ND / calorie fibre / calorie ND / 100g ND / weight insulinogenic (%) calorie / 100g $ / calorie
5% 5% 5% 5% 70% 5% 5%

references

[1] http://ketopia.com/nutrient-density-sticking-to-the-essentials-mathieu-lalonde-ahs12/

[2] https://www.youtube.com/watch?v=HwbY12qZcF4

[3] http://www.wholefoodsmarket.com/healthy-eating/andi-guide

[4] http://www.westonaprice.org/book-reviews/eat-to-live-by-joel-fuhrman/

[5] http://www.bulletproofexec.com/wp-content/uploads/2014/01/Bulletproof-Diet-Infographic-Vector.pdf

[6] http://www.amazon.com/The-Bulletproof-Diet-Reclaim-Upgrade/dp/162336518X

[7] http://blog.paleohacks.com/ultimate-guide-paleo-diet-budget/

[8] The analysis considers the relative amount of calcium, iron, magnesium phosphorus, potassium, zinc, copper, manganese, selenium, vitamin C, thiamine, riboflavin, niacin, panto acid, vitamin B6, choline, vitamin B12, Vitamin A, vitamin D, Vitamin E and Vitamin K across more than 1000 foods.  No weighting of these vitamins based on a view of their relative importance, though this refinement could be made to the analysis for a specific need.  This unweighted approach however highlights foods that have a broad spectrum of nutrients at significant levels.

[9] The statistical analysis in the spreadsheet downloaded compares the value of a nutrient in each food to the average of the full database of foods and gives it a score based on the number of standard deviations from the mean.  I also modified the spreadsheet such that a score for one nutrient could not be greater than three (i.e. three standard deviations from the mean).   Just because Kale has an inordinate amount of Vitamin K doesn’t mean that it ranks at the top of the list on the basis of just one nutrient.

[10] https://www.youtube.com/watch?v=VvfTV57iPUY

[11] If you wanted to view this cynically you could say that the fact that grains and sugars have the lowest cost per calorie enables food manufacturers to place the largest mark up on these foods when reselling them in cardboard boxes in the supermarket.  It’s harder to put a bar code on generic vegetables and meat products that are already relatively expensive.

[12] See discussion in chapter 17 Nutrient Hunger in Paul Jaminet’s Perfect Health Diet where he notes that a nourishing, balanced diet that provides all nutrients in the right proportions is the key to eliminating hunger an minimising appetite and eliminating hunger at minimal caloric intake is a key to weight loss.  

[13] http://www.abc.net.au/catalyst/stories/4067184.htm

[14] http://www.gregdavis.ca/share/paleo-articles/academic/The%20Ancestral%20Human%20Diet%20by%20S.%20Boyd%20Eaton.pdf

optimal meals

To date I’ve analysed more than 200 meals and ranked them based on different criteria for different goals.  For more details on the basis of the meal rankings see the most nutritious diabetic friendly meals.

Each week I’m posting one of these meals.  To see the recipes posted to date click here.

A more complete ranking for each category will be published once a few more recipes have been posted.

diet wars… which one is optimal?

  • This article summarizes the  analysis of a range of dietary approaches to:
    • understand whether a high fat diet can provide optimal nutrition, and
    • to identify common factors across a range of healthy dietary approaches.
  • The table below shows the macronutrient split of the approaches evaluated.  They are sorted by the total score for each of the dietary approaches based on insulin load, vitamins and minerals and protein of each.

Microsoft Word Document 24032015 30957 AM.bmp

  • The chart below shows the total score for the approaches graphically, sorted from highest to lowest ranking, left to right and the contribution of each of the components that make up the total score (insulin load, vitamins and minerals, and protein).

image015

  • The highest ranking approaches involve organ meats.  If you’re not into liver then non-starchy vegetables are your next best option to maximise nutrients while keeping the insulin load low.
  • The extreme high fat approach (3% carbs from spinach and 10% protein) does not provide optimal levels of vitamins and minerals. This style of approach may be useful for more extreme therapeutic treatments for epilepsy, Parkinsons, or cancer, however supplementation may be required if this were used over the long term.
  • A diet with 80% calories from fat and 7% of calories from carbohydrates can meet most of the recommended daily intake values for vitamins and minerals.
  • A diet with 75% fat and 10% carbohydrates from non-starchy vegetables can achieve an optimal balance between vitamins and minerals and insulin load.
  • The fruitarian and budget grains approaches both scored poorly across the board.
  • Dietary approaches without animal products struggle to provide adequate amino acids, vitamins and minerals.
  • Optimal nutrition can be provided using a range of macronutrient profiles. When we consider the insulin load, nutrients and protein quality, the highest scoring dietary approaches use between 50 to 80% fat, 13 to 34% protein and 7 to 16% carbohydrates.  Within this window we can then refine the diet based on the goals of the individual whether they be weight loss, blood sugar control / ketosis or athletic performance.

[download printable .pdf version]

standard advice for diabetics

When my wife was diagnosed with type 1 diabetes at ten she was advised to eat at least 130g of carbohydrates with every meal.  The insulin dose was kept fixed to cover this amount of carbohydrates.  Then if she went low she had to eat more carbs to raise her blood sugars.

Welcome to the everyday blood sugar roller coaster that takes over your life as a diabetic!

1-150131150046303

It wasn’t till after we got married and started thinking about having kids that we were able to find doctor with an interest in diabetes who told her that she could tailor her insulin dose to what she wanted to eat (i.e. carb counting).  Though the advice was that diabetics shouldn’t have to deprive themselves of anything they wanted, and that they should eat like everyone else, a diet full of “healthy whole grains”.

During her pregnancies we’d go to see the endocrinologists at the hospital who would look at her blood sugars and tell her that they should be lower.  We’d ask how to achieve this but they would have no useful response.  It wasn’t until we discovered Paleo and then low carb through family members and social media that she found that she could improve blood sugar control through diet.

More recently by refining our diet to prioritise low insulinogenic, high fibre and high nutrient density foods I’m pleased to say that she’s been able to find another level of improved blood sugar control, increased energy and reduced depression and anxiety that so often comes with blood sugar dysregulation.

She’s now able to enjoy working as a teacher rather than just getting through the morning and needing to sleep the afternoon before picking up the kids.  Her only regret is that she didn’t discover this earlier so she didn’t have to spend decades living in a fog with limited energy.

For the general population nutrition isn’t such a big deal, but for diabetics and their carers it is a matter of life and death, or at least a decision that will greatly affect their health and length of life.

In order to understand whether there is any basis to the claim that a low carbohydrate diet cannot provide adequate nutrition I have undertaken a nutritional analysis of a range of possible diets.   A handful of these are profiled below.

ranking system

In the last article we looked at how we could use a combination of the following parameters to compare meals:

  1. insulinogenic load,
  2. nutritional completeness (vitamins and minerals), and
  3. amino acid sufficiency (protein).

This same approach has been used to compare a range of dietary approaches.  Each daily meal plan was normalised to a 2000 calorie per day diet.

Where not following a present meal plan I designed the daily meals using the highest ranking food using the food ranking system and adjusted the quantities to suit the target macronutrients.

high fat, low carb, extreme ketogenic

Steve Phinney talks about a “well formulated ketogenic diet” (WFKD) window [1] in his comparison with other dietary approaches.   In this scenario I designed an extreme ketogenic diet to minimise insulin demand and maximise ketosis with 3% carbs and 10% protein.

image016

Low carb darlings bacon and eggs provide the 10% allowable protein.  In an effort to maximise the vitamins and minerals within the available macronutrient constraints I have used 200g of nutrient dense high fibre spinach to fill out the 3% carbs.  Then 60ml of coconut cream in 2 coffees and the rest split across 60g of equal parts cream, coconut cream and olive oil.

The analysis below form NutritionData shows that we get a good range of amino acids from the bacon and eggs, adequate fatty acids, no harmful transfats, and very low glycemic load.  This diet provides good amounts of selenium, choline and niacin, however the nutritional completeness score is low at only 38 with less than optimum levels of a wide range of other vitamins and minerals.  If we were to substitute the bacon and eggs with chicken liver we are able to achieve an improved nutritional completeness (from a score of 38 to 53).

image017

We can get good level of amino acids from an extreme end ketogenic diet, particularly if we are selective with our choices of meats.  However the vitamins and minerals obtained from food are less than optimal compared to other approaches that allow more vegetables.  The detailed nutritional analysis of this dietary approach shows that with only 3% carbs coming from 200g of spinach we are not meeting a handful of the RDI daily targets for vitamins and minerals.  Someone on this style of diet should consider taking a supplements to cover off on these deficiencies.

image018

not so extreme ketogenic

So if a diet made up of 3% carbs from spinach and 87% fat from bacon, butter and cream won’t provide meet our daily dietary requirements for vitamins then how what level of carbohydrates is required to meet the recommended daily intake levels and what level is required to achieve optimal nutrition?

The nutrition analysis shows the results if we drop the fats slightly and the carbs to 7% using a head of broccoli and 500 grams of spinach.

The nutritional analysis below shows that we could achieve the RDI daily values for most of the vitamins and minerals with an 80% fat diet and only 2000 calories per day.

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The analysis below takes this a little further so we are getting 75% of calories from fat.  At this point we are getting excellent nutrient and protein scores and well exceeding the RDI for vitamins and minerals.

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Wahls’ Paleo Plus

By following a highly nutrient dense ketogenic diet Dr Terry Wahls claims to have reversed her Multiple Sclerosis [2] and is undertaking experiments to verify that this high nutrient density approach works for others with Multiple Sclerosis.

The aim of the Wahls Paleo Plus, as detailed in The Wahls Protocol[3] is to achieve nutritional ketosis, [4] while maximising nutrients as far as possible with non-starchy vegetables as well as coconut oil, coconut cream and MCT oil which help facilitate nutritional ketosis which a higher level of carbohydrates.

Whals’ approach aims to not just meet but exceed the nutrient recommended nutrient intake levels as shown in the comparison of both the Wahls Diet and the typical US diet against the recommended daily intake for a range of key vitamins below.

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While supplements can still be useful, it is ideal to obtain all your nutrients from real food as they are usually better absorbed in their natural form and with fats (fat soluble vitamins A, D, E and K) than in tablets and isolation.  Eating real food also ensures you get a wide range of nutrients that can be found in plants in nature rather than just the limited number of vitamins and minerals on the recommended daily allowance checklist.

The daily diet shown below is taken from one of the daily diet plans in the Wahls Paleo Plus meal plan approach in The Wahls Protocol[5]

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As shown below this diet scenario achieves an excellent nutritional completeness score.  Although the carbohydrate count is moderately high at 18% of calories the fibre is also high at 37g which mitigates the insulinogenic effects of many of the carbohydrates.  Whals also uses generous helpings of MCT oil and coconut oil to make sure the diet is ketogenic while still supplying high amounts of fibre and nutrition.

This dietary approach is excellent if you are willing to put in the effort.  Dr Wahls’ dietary approach brings together the best of low carbohydrate / low insulin thinking with the learnings from the Paleo template which emphasises eating food that could be found in nature before the advent of agriculture.

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Bulletproof diet

Dave Asprey’s approach to “Bulletproof Intermittent Fasting” has become  popular as it provides many of the benefits of intermittent fasting without the same intensity of hunger [6].

Asprey notes that this is ideal for someone with a normal life and a day job (e.g. someone who is not a professional bodybuilder) who doesn’t want to be distracted by hunger pangs through the morning. [7]

While the high fat breakfast does not provide a broad range of nutrients by itself, the Bulletproof Diet [8] aims to maximise nutrients through the use of real food at lunch and dinner.

Bulletproof Coffee provides your body with a holiday from insulin for a large portion of the day which is a good thing if you follow it up with highly nutritious meals when you do eat.

This diet scenario aims to be ketogenic while achieving a good nutrient profile using real food during the rest of the day.  For the meals other than breakfast I have picked nutrient dense high fat foods in line with Asprey’s Bulletproof Diet, including chicken liver at dinner. [9]

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The analysis demonstrates that you can get adequate nutrition while fasting in the morning or using fatty coffee or tea, particularly if you use nutrient dense foods through the rest of the day.

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Atkins Diet

The modern low carbohydrate diet movement basically instigated by Dr Robert Atkins who recommended reducing carbohydrates to achieve weight loss.

The Atkins approach involves using a low carb induction phase (i.e. max 30g of carbs) and then slowly increasing the carbohydrates once weight loss is achieved and insulin sensitivity restored.  No restrictions are put on protein, and vegetables are not emphasised as much as with the more recent Paleo and LCHF movement.

The meal plan below is from the Everything Atkins website. [10]   It has high protein levels at 32% and low end fibre at only 9g per day.  While the aim of this approach is to keep insulin levels low the high protein and low fibre values of this approach end up generating quite high levels of insulin and not be ideal if your goal is weight loss.

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Dr Bernstein’s diabetes diet

This approach follows the guidelines set out in his book Dr Bernstein’s Diabetes Solution[11]

Eighty one year old Dr Richard Bernstein is himself a type 1 diabetic and diabetics who are disciplined enough to follow his diet swear by it and achieve excellent results.

Bernstein was an engineer and was one of the first people to obtain a blood glucose metre to test his own blood sugars.  He soon realised that carbohydrate containing foods raised his blood sugar and went on to experiment and work out how much a certain amount of carbohydrate containing foods raised his blood sugar and how much insulin it took to lower his blood sugars.  He wrote up his methodology but was unable to get it published, being told that there was no value for diabetics obtaining normal blood sugars. [12]

Bernstein went on to study medicine in order to get people to recognise his ideas.  “Dr B” as he is affectionately known by his disciples, is the father of carbohydrate counting for type 1 diabetics.

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Bernstein’s general advice is to eat a diet that contains no more than 30g carbs per day (i.e. 6g at breakfast, 12 at lunch and 12g at dinner).   Protein levels are based on the patient’s need to gain or lose weight. [13]   This gives a good nutrient score, an excellent amino acid score and a relatively low insulin load.

By following this approach type 1 diabetics are able to achieve better blood sugar control by having smaller inputs and thus smaller errors in the important parameters of diabetes management such as carbohydrate intake and insulin dose.

high fibre vegetarian

Vegetarian luminary Michael Pollan famously condensed his recommendations for diet into the meme “eat food, mostly plants, and not too much.”  I’ve try to maximise nutrition and minimise insulin demand by selecting nutrient dense high fibre vegetables based on the ranking system discussed above.

I’ve used mung beans, spinach, lentils and Brussel sprouts to achieve adequate protein while still being vegetarian.  Without the lentils it was hard to get enough energy into the diet to meet the 2000 kcal / day requirement.  This approach requires you to eat more than 4kg of food to get adequate calories and in the process you get 143g of fibre!

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The nutritional analysis below shows that we get an extremely high level of nutrients overall with the highest vitamin and mineral score of all of the scenarios of 94, however there is no vitamin D, B, saturated far or Choline which is typically obtained from animal products.

On the amino acid score we have a range of the basic amino acids from the plant proteins although not as much as with dietary approaches that contain animal products.   The glycemic load is also high however the percentage of insulinogenic calories is still reasonably low at 27% due to the massive amounts of fibre.

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This dietary approach is an extreme example of what can be achieved using high fibre vegetables without animal products.  While some people may choose to eat this way for ethical reasons it would be preferable to also add enough animal protein to cover off on the missing nutrients and amino acids.

Many people feel fantastic on a vegan style diet for a while but then stop feeling great and regress after a period of months.  It may sound macabre, but in the early stages of weight loss a person is probably getting the nutrients that are lacking in their diet from burning their own body fat and muscle protein.  As weight stabilises they will start to notice the effects of the missing vitamins, minerals and amino acids that are important for brain health.

Zone diet

The Zone Diet was published in the mid-90s by Barry Sears and aims to provide a “balanced” approach to nutrition than the recommending a macronutrient split of 40% carbohydrates, 30% fat and 30% protein.  While 40% carbohydrates is high in comparison to low carb and ketogenic approaches discussed above it is significantly less than the typical diet at the time it the book was published.

About five years ago I read the Zone Diet and started recording what we were eating and found that we were consuming more like 60% carbohydrates.  We found exciting results in weight loss, blood sugar control and a range of other health markers as a family by reducing our macronutrients closer to the 40:30:30 macronutrient split.

The Zone Diet approach has been used widely by the CrossFit community who are active and need to fuel their significant amounts of exercise and recovery.  I have analysed a diet plan that I found in the CrossFit Journal. [14]

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The nutritional analysis shows that this diet approach has a moderate nutrient density but still has a high glycemic load.  We don’t seem to be getting any increased benefit from increasing carbohydrates or eating more fruit.  This approach might be acceptable for people who already have excellent blood sugar control and exercise a lot.

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grains on a budget

This approach prioritises nutrient density per dollar and allows grains, peanuts and low fat products.   It generally aligns with the standard American / Australian Diet with its high level of “healthy whole grains”.  Breakfast is corn flakes with reduced fat milk and a coffee with sugar, lunch is a Vegemite sandwich on multi-grain bread and dinner is spaghetti with mince and cheese, with fruit for morning tea and lunch.

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The nutritional analysis shows that the diet overall is lacklustre.  It has 60% carbohydrates and with only 25g of fibre while it generates the highest insulin requirement of any of the dietary approaches.

Although the diet contains a range of “hearth healthy whole grains” and fruits it is still quite low in nutrients and minerals compared to the other lower carbohydrate dietary approaches discussed above.

While this approach may be cheaper than buying fresh fruit and veggies we don’t seem to get anything special in terms of nutrition by using “heart healthy whole grains” in spite of the higher glycemic load.

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Mediterranean Diet

This scenarios models the Mediterranean diet[15]   which is often recommended for people to follow by dieticians.  It uses olive oil which is a monounsaturated fat and minimises butter and steak and other foods that contain saturated fats.  While this approach is nutritious, its downfall is the high insulinogenic load and it doesn’t provide a better outcome than the lower carbohydrate approaches.

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Durianrider’s fruitarian diet

In this scenario I have modelled a fruitarian diet to understand the other extreme.

Durianrider (aka Harley Johnstone) is a passionate advocate for the high carbohydrate, low fat, low protein diet.  He runs the blog 30 Bananas a Day [16] and seems to make his living from advertising revenue from YouTube videos where he aggressively critiques other people’s lifestyles and nutritional approaches.

Durianrider is also very active and does an extraordinary amount of cycling and running to burn off his nearly 7000 calories per day of fruit per day which includes:

  • 1 watermelon 20lb
  • 1/2 head of celery
  • 3000 calories of bananas – a box full
  • sultanas – approx. 1/2 cup
  • citrus – oranges, 15 lbs

This approach is very high carbohydrate with an extremely high glycaemic load.  This approach has the highest insulin demand with 71% of the calories being insulinogenic.   The amino acid profile is low compared to the other approaches, with a number of nutrients completely missing without any animal products.  In spite of the massive amount of fruit we don’t get a great result in terms of vitamins and minerals and the overall amino acids from proteins is low.

This approach is extreme, and without massive amounts of exercise to burn all the sugars from the fruits this dietary approach would quickly lead to an overloaded pancreas and type 2 diabetes.

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[If you like what you’ve read here, please check out the full story.]

[Star Wars graphic from Diet Doctor]

references

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

[2] Dr Wahls’ “Mind Your Mitochondria” TED talk has more than two million views.  See https://www.youtube.com/watch?v=KLjgBLwH3Wc

[3] http://www.amazon.com/The-Wahls-Protocol-Progressive-Principles/dp/1583335218

[4] It’s a little bit more painful and a little more expensive to get a blood ketone metre, but it’s an excellent way to confirm whether you’re burning fat for fuel.  See http://www.dietdoctor.com/lose-weight-by-achieving-optimal-ketosis for a concise overview of testing for your own ketones at home.

[5] http://www.amazon.com/The-Wahls-Protocol-Progressive-Principles/dp/1583335218

[6] Brad Pilon’s Eat Stop Eat does a good job of covering the science and the benefits of intermittent fasting – http://www.eatstopeat.com/

[7] https://www.bulletproofexec.com/bulletproof-fasting/

[8] http://www.amazon.com/The-Bulletproof-Diet-Reclaim-Upgrade/dp/162336518X

[9] See http://cdn.shopify.com/s/files/1/0243/9705/files/Bulletproof-Diet-Infographic.pdf?8043

[10] http://www.everythingatkins.net/samplemenus.html

[11] http://www.diabetes-book.com/

[12] https://www.youtube.com/watch?v=WFNGdKSXx64

[13] Bernstein’s design for a diabetic diet for type 1 diabetics is not primarily to achieve ketosis.  Ensuring that a diet has adequate protein and other nutrients is important.  Bernstein’s approach aims for a maximum of 7% of calories from carbs and adequate protein to manage growth or weight.

[14] http://library.crossfit.com/free/pdf/cfjissue21_May04.pdf

[15] http://www.eatingwell.com/nutrition_health/weight_loss_diet_plans/diet_meal_plans/5_day_1500_calorie_diet_meal_plan?page=3

[16] http://www.30bananasaday.com/