diet wars… which one is optimal?
- 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.
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!
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:
- insulinogenic load,
- 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.
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 Wahls Protocol,  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.
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.
 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.
 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.
post updated July 2017