Understanding the various factors that affect your insulin requirement is critical to the management of diabetes and optimal health.
Living with someone who has Type 1 Diabetes for seventeen have given me an intimate appreciation of how different foods affect your blood glucose levels.
Poor food choices can send you on a blood glucose rollercoaster that can affect your appetite, mood and energy levels for many hours and even days.
Fortunately, the latest insulin index testing data can help us to manage our food choices and stabilise our blood sugars and insulin levels.
In this article, I will share my analysis, experience and insights into how we can use the insights from insulin index testing to optimise your metabolic health.
The blood glucose roller coaster
Since she was ten, my wife Monica has had to manually manage her blood sugars as they swing up with food and then drop again when she injects insulin. The continuous glucose monitor chart below shows a typical daily experience for someone with Type 1 Diabetes.
High blood glucose levels make her feel “yucky”. And then, the plummeting blood glucose levels due to the mega doses of insulin don’t feel good either.
Low blood glucose levels drive you to eat until you feel good again. This wild blood glucose roller coaster ride leaves you exhausted and often depressed. Watching your blood sugars go up and down on a continuous glucose meter can even make you afraid to eat because just about anything you eat will mess up your blood sugar levels.
Monica now has an insulin pump which means she doesn’t have to inject with an insulin syringe six times or more a day. But good blood glucose control still comes down to managing the food you eat. The stabilisation of the swings in blood sugars requires intelligent food choices to manage the insulin load of the food you eat.
The dietary advice that Monica has someone with Type 1 has been sketchy at best. When she was first diagnosed with Type 1, she tells the story of being told to eat so much high carb food that she hid it in the pot plants in her hospital room.
These days the story is pretty much the same. The photo below of Lucy Smith, a young friend of ours, in the hospital just after she was diagnosed with Type 1 Diabetes.
Lots of carbs may stop you experiencing low blood sugar, but then you have to dose with insulin to try to get the blood sugars down. Then, because insulin and carbohydrates work at different rates, there is no way to stabilise blood sugar levels effectively.
When we decided we wanted to have kids, we found a fantastic doctor who helped us to understand how to match insulin with carbs. However, no one really told us how to make better food choices to reduce the amount of insulin required,.
We eventually stumbled across the online low carb community. Since then, Monica has been able to improve her blood glucose control significantly . This has enabled her to have a lot more energy to invest in to being a mother as well as going back to work as a teacher which she loves.
Low carb produces excellent results for people trying to stabilise their blood sugars. But there is still more to the story for people who need to manage the insulin they are injecting.
The latest food insulin index data
In early 2014 I learned about the insulin index research that had been carried out at predominantly the University of Sydney. The goal of this research was to provide more insight into our insulin response to food.
I hoped that by gaining a better understanding of how different foods affect our requirement for insulin that I might be able to help further optimise our food to normalise Monica’s blood glucose swings.
Unfortunately, while the concept of insulin index testing is exciting, the data that is commonly available is hard to make sense of. 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. The insulin score of the various foods tested is shown in the image below.
The food insulin index score of various foods was determined by feeding 1000kJ (or 239 kcal) of a range of foods to non-diabetic participants and measuring their insulin response over three hours. Some example responses to different foods are shown in the chart below
This value is then compared to the insulin response to pure glucose (which is assigned a value of 100%) to arrive at a “food insulin index” value for each food. All foods tested were then ranked relative to pure glucose.
Considering how significant this information could be for people trying to manage their insulin levels I was surprised that there hadn’t been a lot of 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. The chart showing the insulin index of the original 38 foods tested was really more confusing than useful for most people.
[I know this is a bit hard to read. You can click on the image to expand it. I’ve also uploaded these charts to Tableau online here so you can make more sense of the data.]
The chart below shows the relationship between carbohydrates and insulin response for all the foods tested to date.
As you can see, the relationship between the carbohydrates we eat and the insulin we require to metabolise our food is not straightforward.
Some high protein and low-fat foods (e.g. fish and steak) are sitting quite high up on the vertical axis while there are some high fibre foods (e.g. all bran and navy beans) and high fructose foods (e.g. raisins and apples) with a lower insulin response than you might expect.
However, once we account for the effect of protein, fibre we are able to more accurately predict our body’s insulin response to food. The foods in the bottom left corner of this chart will require the least insulin (e.g. butter, olive oil and avocado) while the foods in the top right will need the most insulin (e.g. rice bubbles, cornflakes and jellybeans).
It’s also interesting to note that fructose (a form of sugar found in fruit) requires only about 25% as much insulin as glucose. The glycerol backbone in fat can also be converted to glucose via gluconeogenesis if there is no other glucose available from glucose or protein in the diet. However, neither of these have a massive influence compared to carbohydrates, protein and fibre.
How is this useful?
This improved ability to quantify our insulin response to food enables us to precisely identify foods that require less insulin and reduce the amplitude of our blood sugar swings in response to food.
Many people trying to follow a therapeutic ketogenic diet (for the management of cancer, epilepsy, Alzheimers, dementia etc.) have found it very useful to reduce their insulin requirements and increase their ketone levels.
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. The improvement in the quality of life, energy levels and mood for someone with diabetes when they stabilise their blood sugars is massive.
Limitations of 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 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.
Many people have interpreted the insulin index data as an indication that protein turns into sugar in the bloodstream and should, therefore, be avoided. The reality is more complex than that. If your pancreas is working well then it’s likely that protein will cause your blood sugars to go down. If you see your blood sugars rise after a high protein then it may be because your pancreas cannot produce enough insulin to metabolise the protein and keep blood sugars stable at the same time. While there is no need for someone in this situation to go overboard with protein, it may be better to look at adding extra insulin rather than avoiding protein. Check out Why Do My Blood Sugars Rise after a High Protein Meal for more details.
While stabilising short-term glucose swings is related mainly to the quality of the food we eat, bringing down the overall blood sugar and insulin level down is mostly about weight loss and the quantity of food we eat.
The food insulin index testing was carried out over only three hours so it really only shows how our insulin requirements respond over the short term. Over the longer term, it seems that the insulin demand of our food is proportional to the energy in the food we eat. I encourage you to read The Carbohydrate Insulin Hypothesis vs the Adipose Centric Model of Diabetes and Obesity if you ware interested in managing your blood sugars and optimising your body composition with diet.
Once we stabilise blood sugars with a lower insulin load diet, we then need to focus on reducing the energy density of your food to enable you to lose weight and allow then fat stores to function optimally.
Diabetes occurs when our fat stores become too full, and they can no longer expand and contract to absorb and release the food from our meals, and the excess energy spills into the bloodstream. Increasing the nutrient:energy ratio of our food will allow us to get the nutrients we need with less energy which will, in turn, help us to achieve and maintain an optimal body fat level.
optimal foods for different goals
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.
Building on the ability to quantify insulin load, nutrient density and energy density, more recently I have been developing an exciting new tool. The Nutrient Optimiser reviews your food log diet and helps you to 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 using our ability to calculate the insulin load.
As shown in the chart below, some nutrients are easy to find. However, most of us have a large number of micronutrient gaps and need to prioritise the foods and meals that will provide those harder to find nutrients. Once your glucose levels are normalised, the Nutrient Optimiser will help you to focus more on getting the nutrients you need.
Then, 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.
It’s early days for the Nutrient Optimiser, but the initial results are very promising. I’d love it if you’d head over to NutrientOptimiser.com to get your free report to find your optimal dietary approach and which foods, meals will be ideal for you.
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).
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).
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.
People with diabetes or insulin resistance may do well initially with a low carbohydrate diet to help them normalise blood glucose levels. Managing your appetite is easier once you stabilise your blood glucose levels.
However, once your glucose and insulin levels stabilise, you will likely benefit from reducing the energy density of your diet while also increasing the nutrient density of the foods you eat.
Foods with a lower energy density are more filling and more difficult to overeat which is a useful hack if you want to use the fat on your body for fuel.
The researchers educated all participants to improve their diet quality with nutrient dense whole foods. However, they told half the participants to eat as low fat as they possibly could while the other half ate as little carbohydrates as they practically could.
After six months, the people who were insulin resistant generally did better with a lower carbohydrate approach. However, the people who were insulin sensitive did slightly better on a low-fat, lower energy density approach.
“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.”
The chart below shows the nutrients in the lower energy density high nutrient density foods compared to the average of all the foods in the USDA food database. Eating more of these will ensure you get the nutrients you need with less energy while also avoiding nutrient cravings or deficiencies.
The foods are ranked using a multi-criteria analysis based on their nutrient density (i.e. they provide you with more of the nutrients that are generally harder to find) and their energy density.
A shortlist of some of the foods that have a low nutrient density and a high nutrient density are listed below.
dairy and eggs
whey protein powder
the Nutrient Optimiser
For a longer list of personalised foods and meals to suit your weight loss goals we invite you to get your free report from the Nutrient Optimiser. It’s been really exciting to see how many people have been able to reduce their energy while avoiding cravings.
When we get the nutrients we need, our cravings decrease, and the body can use our stored body fat for fuel.
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. 
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.
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.
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”  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.
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,  a food that isn’t generally considered to be a health food.
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 to pure glucose (which is assigned a value of 100%) to arrive at a “food insulin index” value for each food.
Unfortunately, due to the way the data was presented and the limited amount of foods that had been tested it was hard to make sense of this information in any practical sense.
However, considering how significant this information could be for people trying to manage their insulin levels (e.g. insulin-dependent diabetics and people using therapeutic ketosis for the management of conditions like epilepsy, Alzheimer’s, Parkinson, cancer etc.) 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 because only a small number of foods been tested.
With this additional data perhaps we can make more sense of the various factors that affect insulin, the master regulating hormone of our metabolism?
I plotted the carbohydrates versus the insulin response of foods for more than one hundred foods. Although our insulin response 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.
I ran some analysis on the data and found that we secrete about half as much insulin in response to protein compared to carbohydrate. 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. It is mainly processed directly in the liver, however about a quarter of the fructose is converted to glucose via gluconeogenesis.
Once we correct for protein, fibre and fructose, we get a much better prediction of the insulin response to food compared to carbohydrate alone.
People wanting r ketogenic diet will want to eat foods that lie more towards the bottom left of this chart. Using this understanding, we can also calculate the insulin load of our food. We can also estimate the proportion of the energy in our diet that requires insulin to metabolise or the “the proportion of insulinogenic calories”.
Insulin is not a problem at healthy levels. However, 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. Many of our modern metabolic diseases seem to be closely correlated with our blood glucose control (e.g. diabetes, obesity, heart disease, stroke, cancer).
Understanding how to more accurately calculate our insulin response to food could enable us to manage our diet better 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. The first logical step for someone managing diabetes is to reduce the insulin load of their diet so they can stabilise their
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 healthy blood glucose levels.
The most ketogenic foods
Listed below are the most ketogenic foods. I have included some 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.
Insulin load – foods such as non-starchy vegetables have a higher percentage 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 parameters we can use to optimise our food choices.
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 some 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 food as much as we can while still maintaining excellent blood glucose levels.
The Nutrient Optimiser has been designed to help you manage both the insulin load and the nutrient density of the foods you eat to enable you to stabilise your blood sugars while getting the micronutrients you need and maximise satiety. I invite you to get your free Nutrient Optimiser report to get your personalised list of foods suited to your goals and situation.
The most ketogenic foods
I have sorted the foods below by insulin load which will be useful if you are looking for foods to help you manage the short term insulin load of your diet. 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 are a staple for low carbers, ketogenic dieters and diabetics. Not only are they nutritious they are also low in carbohydrates.
insulin load (g/100g)
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.
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 aren’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.
insulin load (g/100g)
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.
insulin load (g/100g)
full cream milk
Full fat plain Greek yoghurt has the lowest percentage of insulinogenic calories while the sweetened and low-fat options are extremely insulinogenic.
insulin load (g/100g)
plain low-fat yoghurt
skim milk yoghurt
Low-fat fruit yoghurt
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.
insulin load (g/100g)
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 significantly raise your blood glucose levels.
insulin load (g/100g)
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.
insulin load (g/100g)
Seafood is a great source of essential fatty acids which are hard to find in plant-based foods.
It’s no secret that there is no perfect diet for everyone. Optimising your personalised nutritional solution needs consider a number of inputs, such as your:
specific medical conditions; and
I’ve spent a LOT of time over the last couple of years designing prioritised food lists to suit a range of goals and situations. I have grouped the various food lists into the following categories:
foods to optimise your metabolic health (e.g. therapeutic ketosis, diabetes management, weight loss, bodybuilding, and athletic performance, etc.),
foods that boost specific nutrients associated with common health conditions,
ethical, philosophical and religious considerations, and
macronutrient and micronutrient extremes (low carb, keto, high protein, low protein, etc.).
Metabolic health, diabetes management, weight loss and athletic performance
Most people do well if they eat foods that have a higher nutrient density. However, we can tailor our food choices beyond nutrient density to better suit different people with different goals. The ‘nutrients column’ shows the micronutrient profile of each of these approaches. If you click on the ‘foods’ column you’ll be directed through to the Nutrient Optimiser which will give you your personalised list of foods.
If you belong to the 50% of the population that has diabetes or pre-diabetes, your priority should be to normalise your blood glucose levels with a lower insulin load diet. You can use your current blood sugar levels to choose the nutritional approach that will best support your journey towards optimal metabolic health.
The well-formulated ketogenic diet approach is designed for someone who has very high blood sugars or requires therapeutic ketosis. The diabetes and nutritional ketosis approach will be more nutritious and suit people looking to manage their diabetes. Before too long, with the reduction of processed carbohydrates, your blood sugar levels will stabilise to more optimal levels.
Once you have your blood glucose levels under control, you can then focus even more on increasing nutrient density and reducing energy density if you are looking to lose weight. The weight loss (insulin resistant) foods will help you to reduce the energy density of your diet while keeping the insulin load down. Stabilising blood sugar levels, normalising insulin levels and reducing hyper-palatable processed carbs will help many normalise their appetite, reduce food cravings and naturally eat less.
The protein-sparing modified fast (PSMF) approach aims to provide all the essential vitamins, minerals and amino acids with the minimum amount of energy to enable you to achieve aggressive weight loss while minimising your chance of developing nutrient deficiencies, managing cravings and preserving your lean muscle mass.
In the long run, you may even find you have the energy to work out or build muscle for fitness and longevity. This increased level of activity may require higher levels of protein and other nutrients. You may also need higher energy density foods to enable you to ingest enough energy to support your activity levels.
The bodybuilder food list will provide you with plenty of amino acids and minerals to support recovery while the endurance athlete food list increases energy density to fuel increased activity levels while still keeping nutrient density high to fuel activity levels.
How do I implement all this information?
Not that long ago, before the advent of artificial flavours, colourings, refrigerators and packaged food, we were more in touch with our actual nutritional needs and went hunting and gathering in search of the foods that contained the nutrients we needed. We would naturally eat more of what nature provided in preparation for winter. We ate until we got what we needed from the food and stopped.
These food lists would help you to refine your food choices and make up for your appetite that might have been corrupted by the modern food system. When you go shopping each week try to buy more of the foods that are at the top of your list and make sure you find a way to incorporate them into your cooking during the week.
You may find that you like some more than others. Keep working down the list until you find foods that you enjoy.
You may need to do more food preparation rather than on processed and pre-packaged foods. It may take a little bit more effort, but your health is worth it!
Nutrients to address deficiencies associated with common conditions
Most people are somewhere on the spectrum of metabolic health and will do well focusing on the foods that keep their blood sugars stable. There are others that have developed specific conditions exacerbated by long-term nutrient deficiencies. Hence, focusing on the foods that provide more of the nutrients associated with these conditions can help manage or even reverse some of these conditions for some people.
The table below contains details of a range of food lists that are designed to provide more of the nutrients to various health concerns. Eating these foods will not guarantee a reversal of a particular condition. However, prioritising these foods will improve your chances of recovery and minimise reliance on drugs and other medicines.
If you don’t yet have any of these conditions, simply focusing on the most nutrient-dense foods may reduce your chances of developing any of these conditions and help you maintain optimal health for as long as possible.
Some foods make an appearance on many of the lists (e.g. spinach, watercress, broccoli, organ meats). However, each list is unique in their ranking of the various foods. While eating any of the foods on the list will be helpful, focusing on the foods towards the top of the list will maximise the nutrients you need for your condition.
The nutrients prioritised in these lists are generally based on research compiled by Spectracell which identified nutrients that are typically deficient in a range of conditions. You can click on the “wheel” and “references” in the table for more details. Check out the full Spectracell nutrient wheels for a range of conditions here.
Where there is no Spectracell “wheel” available, the nutrients used in the analysis were based on the Nutrient Bible by Henry Oseki which is an excellent detailed resource on the individual nutrients as well as the likely nutrients to support various conditions.
The value of real food
Many modern foods are fortified with synthetic nutrients (e.g. folic acid, B vitamins, vitamin A, vitamin D, iron, iodine, etc.). While it may appear that the food companies are doing this for the benefit of your health or to make up for deficiencies in their processed foods grown quickly using chemical fertilisers, there is good research suggesting that fortification helps to ensure that we don’t lose interest in what would otherwise be bland unpalatable foods.
By adding in a smattering of nutrients that our body actively seeks (e.g. iron, folate, B vitamins, sodium etc) we will maintain an increased appetite for these foods while not getting the range of other nutrients that are also important but do not drive our appetite to the same degree (e.g. potassium, magnesium, choline and vitamin E).
Paul Jaminet in his Perfect Health Diet says “Potassium is the intracellular electrolyte while sodium is the extracellular electrolyte. Cells continually pump sodium outside the cell and potassium inside. Good health depends on the proper dietary balance between potassium and sodium.
“Paleolithic diets were high in potassium, low in sodium; salt was rare and highly valued. So we evolved mechanisms for protecting against the threat of low sodium levels: a food reward system that powerfully rewards salt consumption, and a hormonal network that shuts down urination and sweating whenever sodium is scarce. There are no similar mechanisms to protect us against low potassium levels, even though they are every bit as devastating for our health.”
While supplements can be helpful, obtaining nutrients from whole foods will also maximise your chance of absorption and increase your chance of getting all the necessary complementary micronutrients in adequate quantities without being excessive. Note: excess supplementation of minerals can quickly cause diarrhoea, or the kidneys will excrete excess nutrients from supplements.
I have not included fortified foods that may score highly due to a narrow range of synthetic micronutrients that have been added to highly processed and sugar ladened products.
Nutritious whole foods will provide you with not only the essential nutrients that we can quantify but all the other beneficial non-essential nutrients, phytonutrients, enzymes, and cofactors that are not yet quantified or in the USDA database.
Ethical, philosophical and religious considerations
Many people choose to base their food choices on moral convictions or religious beliefs. I do not have any issue with people making their food choices based on ethical considerations or religious beliefs.
The lists in the table below will help you find the most nutrient dense foods associated with each of these approaches. The food lists have been sorted based on their nutrient score from highest to lowest at the bottom of the table.
We achieve the most nutritious selection of foods when we focus purely on nutrients. If you chose to limit your food choices due to other ethical considerations, then you should pay particular attention to the foods that will provide you with more of the harder-to-find essential nutrients.
In the long run, the goal is to get the nutrients we need from our food to enable us to thrive without over consuming energy. This will give us the best chance of maintaining an ideal body weight, energy levels, performance and avoid the modern diseases of ageing.
Some people like to define their nutritional approach in terms of large or small quantities of a particular macronutrient (e.g. low carb, low fat, high protein, low protein, high or low saturated fat, etc.). The analysis summarised in the table below shows the implication on the nutrients available if you follow any of these approaches.
I think it’s useful to understand the pros and cons of these extremes, particularly in terms of the micronutrients available and the range of foods involved in any of these more extreme approaches.
I hope you find an approach that will suit your current goals and situation and have a glimpse of how you can continue to move your health forward.
I have intentionally included a lot of data in these tables to allow you to fully understand the pros and cons of each approach and compare the nutritional options you might be interested in.
If you want to learn more about how these lists were developed I invite you to read on to learn about nutrient density, insulin load and energy density, and how they can be combined, using the Nutrient Optimiser algorithm to optimise our food choices.
While there are a range of useful parameters that we can use to optimise our nutrition, the most important is arguably nutrient density.
Nutrient density is simply the amount of nutrients per calorie or the amount of the essential nutrients you get in your food each day. Ideally, we want to be meeting the daily recommended intake for all of the nutrients.
Micronutrients seem to have been largely overlooked in our current discussion about nutrition. Perhaps this is because micronutrients are harder to quantify. Without an easy way to quantify micronutrients we tend to focus on simpler metrics such as fat, carbs, saturated fat, protein, vegan, plant based, Paleo, keto, etc.
Unfortunately, neither avoiding a particular nutrient (saturated fat, salt, cholesterol, etc) or aiming for a macronutrient extremes (high fat, low fat, low carb, high carb, high fibre, low protein, etc) or even following our religious or ethical convictions (vegan, vegetarian, plant based etc ) are especially useful when it comes to identifying foods that provide us with the most micronutrients.
But what if we could quantify the micronutrient content of the food we eat?
Enter nutrient density!
The graph below shows the average of the micronutrients in the eight thousand or so foods in the USDA food database as a proportion of the daily recommended daily intake (DRI). Imagine you ate just a little bit of all of these eight thousand foods to make up your 2000 calories for the day.
The nutrients at the bottom of this chart are easy to obtain in our food system (e.g. vitamin C, vitamin B12, vitamin K, and various amino acids). There is little need to worry about these easier to find nutrients.
However, where this analysis is useful is that it highlights the nutrients that we might have to pay extra attention to obtaining in adequate quantities (e.g. vitamin D, choline, vitamin E, potassium, magnesium, calcium, etc.).
After a lot experimenting with different approaches to develop a quantitative analysis method for optimising nutrient density, I found that:
Prioritising foods that are high in only one nutrient (e.g. potassium, omega 3, magnesium, vitamin D, niacin, etc.) means you risk missing out on all the beneficial and complementary nutrients that typically come with real food and isn’t particularly useful. You usually come up with a range of obscure processed foods that have been supplemented with that nutrient.
Focusing on maximising the quantity of all the essential nutrients gives us a VERY high protein list of foods. Protein is relatively easy to obtain in our food system. Prioritising the amino acids provides a list of foods that will be very hard to consume because they are 70% protein. We tend to get more than enough protein when we focus on the harder-to-obtain vitamins and minerals.
Using the Nutrient Optimiser we can focus on the foods that contain more of the nutrients that are harder to find. When we maximise a range of the harder-to-find nutrients, we get a variety of whole foods that contain a broad spectrum of the essential nutrients.
The chart below shows the nutrients provided by the top 10% of the foods in the USDA database when we prioritise for the harder-to-find nutrients. The red bars denote the nutrients that have been prioritised.
If you compare the chart below to the chart above, you will see that by focusing on the foods that contain harder-to-find nutrients we significantly boost all thirty-four essential nutrients!
If you focus on eating foods in this list, you will have a good chance of getting plenty of the essential micronutrients. The most nutrient dense foods in each category are at the top of the list, so you would ideally focus more on the food at the top of the list as much as you could.
I don’t think it matters too much if you want to focus more on more animal or plant based foods. But we tend to achieve the best nutritional outcome when we include a range of vegetables, animal products and seafood. Before the invention of agriculture, food processing and agriculture thee would have been times when plant-based foods were ‘easy pickings’ and others when we had to chase own our fat and protein with less high carbohydrate foods easily available.
Some key observations from all the analysis are that:
Starchy grains do not make the list due to their low nutrient density.
Fruits also do not regularly feature in the lists (other than the exclusively plant based lists) due to the lower nutrients per calorie.
Dairy and nuts make an appearance on the lists that are focused on managing blood sugars, but not where we prioritise keeping energy density low or to lose weight.
Red meat tends to feature more prominently when we need to boost nutrients such as glycine, cysteine and glutamine which are not as prevalent in seafood.
The nutrient score
The “nutrient score” for the most nutrient dense foods is 98.7%. But what does this mean?
The nutrient score allows us to compare the various nutritional approaches quantitatively. We want to meet the daily recommended intake of a particular nutrient. However, there may not be much value getting more than twice the DRI. Once you’ve achieved two times the DRI your efforts would be best spent seeking out other nutrients. If we achieved two times the recommended daily intake for all the nutrients, we would get a score of 100%. That is, we get a perfect score if the entire red rectangle was filled in.
A lot of these food lists score close to a perfect score because they contain a range of the most nutrient dense foods. This is not practical in real life. The nutrient score of a real life diet will be lower than the optimised short list of nutrient dense foods. We tend to choose more energy dense foods that may not be as nutrient dense, or we don’t consume the range of foods that would be necessary to attain a very high nutrient score.
We can see from the chart below that focusing on the least nutrient dense foods will provide an inferior outcome. If all we have to eat is these nutrient poor foods, we will likely develop nutrient deficiencies. Our cravings will drive our appetite to derail even our best calorie restriction intentions.
The great thing about nutrient dense whole foods is that they force out the energy dense processed foods in our diet.
Whether it be low carb, whole food plant based or Paleo, the magic happens when we exchange out nutrient deficient foods for foods that provide you with the nutrients we need with less energy.
The ‘problem’ however with nutrient-dense whole foods is that they make it hard to ingest enough energy. If you are active and are not wanting to lose weight, you may need some higher energy density foods.
Over at KetoGains, they talk about using ‘fat as a lever’. If you are not worried about being low carb or ketogenic or your blood sugar control, you can also think of ‘energy density as a lever’ to manage the amount of energy you can get from your diet.
While a ketogenic diet is typically higher fat, if you want to lose body fat then some of the fat contribution to your diet should come from your body, with less fat required from your plate or coffee mug.
Energy density is a simple concept that can help you fine tune your food choices and is calculated by dividing the calories in a food by its weight. Used in isolation it isn’t particularly useful, but can be helpful whne considered along with nutrient density once you have stabilised your blood sugars by tweaking the insulin load of the food you eat.
If you have stabilised your blood sugars and are trying to lose weight, then minimising the energy density of the foods you eat will help you feel physically full with less energy intake. Practically this might involve filling up on more nonstarchy veggies and perhaps leaner cuts of meat.
Focusing on foods with a lower energy density can help you to get the nutrients you need without overdoing the energy intake. Alternatively, if you are an athlete and need to ingest a lot of fuel, then focusing on higher energy density foods may be helpful.
As shown in my analysis of the food insulin index data below, the amount of carbohydrate correlates with how much our blood sugar rises in response to food. [You can click on the images below to see more detail or click here to drill down into the data more in Tableau online.]
However, carbohydrates alone don’t do a great job of explaining our insulin response to the food we eat. As you can see in the chart below, some high protein, low carb foods still elicit a significant insulin response.
We get a much better prediction of our insulin response to food once we account for the fibre and protein content of our food. Thinking in terms of insulin load (i.e. net carbs + 0.56 x protein) is useful if you are manually injecting insulin to manage your diabetes. If you are insulin resistant, you can reduce the insulin load of your diet to the point that your pancreas can keep up and maintain normal blood sugars.
Reducing the insulin load of your diet will help achieve more stable blood sugar levels and get off the insulin rollercoaster that drives hunger and energy levels. While various studies have not been able to demonstrate a metabolic advantage of one macronutrient versus another, it seems that appetite control is easier for people who are insulin resistant when they manipulate their diet to stabilise their blood sugars.
While too much energy from any source can promote insulin resistance in the long run (note: the pancreas secretes insulin to stop the flow of energy out of the liver when we have plenty of energy coming in via the mouth), increasing the proportion of fat in your diet will lessen the amount of insulin required by your food.
Increasing the percentage of calories from fat in your diet will also reduce your glucose response to food.
Although protein does need some insulin to metabolise, higher protein foods will typically force out the processed carbohydrates and reduce your insulin levels.
If you are part of the 50% of the population that has diabetes or prediabetes, then manipulating the insulin load of your diet will help you stabilise your blood sugar levels. This is a critical priority.
The problem with focusing only on insulin load, however, is that the least insulinogenic foods are primarily refined fats (cream, butter, olive oil, etc.) and do not contain a lot of the essential vitamins, minerals, and amino acids that we need to thrive and be metabolically healthy.
The solution is to find the optimal balance between insulin load and nutrient density. As your blood glucose levels start to improve you can start to focus more on nutrient density and then on reducing energy density if you still need to lose weight.
The various food lists have been developed using a multi-criteria analysis algorithm that uses nutrient density, energy density and insulin load to highlight the ideal foods for a particular person.
Pros and cons of different dietary approaches
The table below outlines the pros and cons of each of the higher level nutritional approaches, who they will be appropriate for and which nutrients are harder to find.
harder to find nutrients
well-formulated ketogenic diet
Someone with an average blood sugar greater than 140 mg/dL or 7.8mmol/L or people who require therapeutic ketosis (i.e. for the management of conditions such as epilepsy, cancer, Alzheimer’s, etc.)
Higher energy density while still being nutrient dense.
Someone looking to repair and build muscle.
Vitamin D, choline, potassium, calcium, magnesium, vitamin E, sodium, vitamin B5, zinc, folate and branched chain amino acids
Support muscle growth.
Not ideal for someone not working out.
Someone who is active
Choline, vitamin D, potassium, calcium vitamin E, magnesium, vitamin B5 and leucine.
Higher energy density foods to support activity.
The table summarises the assumptions used in developing the lists based on religious, ethical or philosophical considerations and provides some brief commentary for each nutritional approach. I encourage you to look in more detail at the data to better understand your preferred approaches.
Assumptions & constraints
the most nutrient dense foods
Prioritises the harder to find nutrients.
Maximises nutrients per calorie.
nutrient dense Paleo
Excludes dairy, grains and processed foods as well as prioritising nutrient density.
Very similar outcome to most nutrient dense approach, though with a reduced range of foods.
low carb Paleo foods
Reduced insulin load to stabilise blood sugars while also maximising nutrient density.
Will stabilise blood sugars more than straight Paleo which can involve more high carb veggies.
Plant based plus fish prioritised for nutrient density.
Some vegans or vegetarians are comfortable eating fish.
Plant based plus molluscs prioritised for nutrient density.
Provides some nutrients that are harder to find on a purely plant based approach (omega 3, vitamin B12). Some vegans are comfortable eating molluscs which are not considered by some to be sentient beings.
low carb pescetarian
Vegetarian plus fish with a focus on nutrient density and a lower insulin load.
Provides a solid nutritional outcome without eating animals or dairy.
whole food plant based
Excludes processed foods and oils. Prioritises nutrient density without focussing on amino acids
It is hard to obtain adequate omega 3 or vitamin B12 on a WFPB approach and hence they may need to supplement.
Weight loss is likely due to the low energy density if you are able to stick to unprocessed foods only.
plant based (diabetes friendly)
Plant based only, with the focus on nutrient density and lower insulin load.
It can be quite hard to achieve a low carb diet, at least in terms of percentages without using a lot of oils or nuts.
Animal only foods prioritised for nutrient density.
A zero carb dietary approach struggles to meet DRI for vitamins K, C and E, folate, potassium and calcium.
Although some argue that nutrient requirements are different in the absence of glucose, though there is limited research to date.
Paleo (without ND)
All Paleo foods without consideration of nutrient density.
Limiting yourself to unprocessed “Paleo food” is no guarantee that you will achieve exceptional nutrient density.
zero carb (no offal)
Animal based foods excluding organ meats.
Organ meats provide a lot of the nutrients in a ZC approach. Not everyone enjoys and eats a lot of organ meats.
plant based (without ND)
All whole food plant based foods without consideration of nutrient density.
A plant based nutritional approach is no guarantee that you will achieve high levels of nutrients.
zero carb (without ND)
Zero carb without nutrient density.
A zero carb approach without consideration of nutrient density can provide a poor nutritional outcome.
My hope is that all this data will be useful for people seeking clear guidance on optimal food choices for them. I hope it will help you cut through the confusion and conflicts of interest that so often plague our food system.
Nutrient density is the centre piece of the algorithm for optimising nutrition to suit people with different goals and to suit different circumstances. When we focus on foods that contain more of the harder-to-find nutrients we tend to boost all nutrients across the board.
A range of optimal food lists have been prepared to suit different states of metabolic health by also considering:
insulin load and energy density,
pre-existing health conditions using targeted nutrients, and
optimal short list of foods that still fit within a person’s ethical or religious system.
Simply focusing on trying to consume more of the foods on these lists will go a long way to helping you achieve optimal nutrition, health and happiness. If you’re still looking for further guidance to help you refine your food choices, then I invite you check out the Nutrient Optimiser which has been designed to identify areas where you could improve your nutrition and help you fine tune your food choices to help you move towards your chosen goal and dreams, whatever they may be.
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.  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). 
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  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.  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  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 ).
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  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 ) for people to have a play with. So I downloaded it to see what I could do with it.  After dropping out the fortified products, we get the following list of foods based ranked on nutrient density per dollar.
Chinese cabbage (Bok Choy)
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.  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. 
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.
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.  Using this approach vegetables shoot to the top of the list with things like spinach, liver, seafood oysters, kale and broccoli rank really well.
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  and before the invention of fire and cooking our ancestors were eating more than 100g of fibre per day. 
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.
All Bran (w/ added extra fibre)
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.
 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.
 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.
 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.
 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.
This article summarises 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 macro nutrient 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.
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).
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 approach 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.
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!
It wasn’t until after we got married and started thinking about having kids that we were able to find a 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.
In the last article we looked at how we could use a combination of the following parameters to compare meals:
nutritional completeness (vitamins and minerals), and
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  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.
Low carb darlings bacon and eggs provide the 10% allowable protein. In an effort to maximise the vitamins and minerals within the available macro nutrient 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 from NutritionData shows that we get a good range of amino acids from the bacon and eggs, adequate fatty acids, no harmful trans fats, 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).
We can get a 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 supplements to cover off on these deficiencies.
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 grammes 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.
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.
Wahls’ Paleo Plus
By following a highly nutrient dense ketogenic diet Dr Terry Wahls claims to have reversed her Multiple Sclerosis  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 WahlsProtocol,  is to achieve nutritional ketosis,  while maximising nutrients as far as possible with nonstarchy 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.
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.
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.
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 .
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. 
While the high-fat breakfast does not provide a broad range of nutrients by itself, the Bulletproof Diet  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. 
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.
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.  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.
Dr Bernstein’s diabetes diet
This approach follows the guidelines set out in his book Dr Bernstein’s Diabetes Solution. 
Eighty-three 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. 
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.
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.  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!
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.
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.
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 macro nutrients 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. 
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.
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 multigrain bread and dinner is spaghetti with mince and cheese, with fruit for morning tea and lunch.
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 “heart 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.
This scenarios models the Mediterranean diet 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, it’s downfall is the high insulinogenic load and it doesn’t provide a better outcome than the lower carbohydrate approaches.
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  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 glycemic 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.
 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.