the cost of going low carb

  • Analysis of the USDA Cost of Food at Home database shows that fat is the cheapest macronutrient.
  • Protein is the most expensive macronutrient, however a reduced carbohydrate diet does not necessarily require an increase in protein.
  • Reducing the amount of carbohydrate and increasing the amount of fat in your diet is the most effective way to reduce your grocery bill.

background

One of the common concerns about eating differently from the norm is that it will be more expensive.

Apparently one of the reasons for the relatively low Recommended Daily Intake for protein of 0.8g/kg is that many people can’t afford to eat more protein. [1]  One of the common criticisms of Paleo or the Banting Diet (LCHF) is that it will be too expensive due to the extra protein. [2]

To see if these concerns were valid I thought it would be interesting to see what the data has can tell us about the relative cost the three macronutrients, protein, carbohydrate and fat.

protein

The chart below shows the cost per calorie versus the percentage of protein in the thousand or so foods in the USDA Cost of Food at Home database. [3]

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Protein is indeed the most expensive of the three macronutrients.  As you move to the right in the chart you can see that your weekly grocery bill will increase.

Average intake of both protein and fat in the United States decreased between 1971 and 2004, with an overall increase in carbohydrate. [4]

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While from a nutritional point of view there area lot of good reasons for people to eat higher levels of protein, a low carbohydrate diet is not necessarily high in protein.

People aiming for therapeutic ketosis may aim for lower amounts of protein to minimise insulin.

Tim Noakes’ Banting diet recommends that people get between 20 and 30% of their calories from protein.  He says that those with diabetes and / or insulin resistance issues should aim for the lower end of this range, while people who are active and healthy can aim for higher amounts.  [5]

Practically it is difficult to eat much more than 30% to 35% protein from real foods.

The table below shows the relative change in cost if we were to increase our protein from current average levels back to 1970s levels, or to moderate levels such as the Mediterranean diet or even the higher protein Atkins approach.

scenario % protein cost ($/kcal) change
2004 average 14.7% 4.67
1970 average 16.9% 4.83 +3%
Mediterranean 20% 5.06 +8%
Atkins 30% 5.79 +24%

As shown in the table below, the most expensive high protein foods tend to be seafood.  For reference, the average cost of food across the more than one thousand foods in the database is $5.37/kcal.

food cost ($/kcal)
crayfish 26
spinach 26
crab 24
spirulina 23
lobster 22
scallops 17
clam 16
haddock 16
cod 15

While protein can be expensive there are some low cost high protein options available.

food cost ($/kcal)
whole egg 1.70
ground turkey 2.13
beef liver 2.81
chicken heart 2.94
cottage cheese 3.58
pork 3.59
chicken liver 3.81
ham 4.10

If you are willing to try organ meats you might get them even cheaper as they are often discarded.   The cheaper organ meats also typically have a much higher nutrient density than the more popular muscle meats or even fruits or vegetables.

image003

carbohydrates

You often hear the term ‘cheap carbohydrates’, but does this mean that a diet of processed grains and sugars is the most economical way to fill your shopping trolley?

While sugar and corn starch are very cheap food ingredients per calorie, the analysis of the data suggest that a higher carbohydrate diet is actually more expensive overall.

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The cheaper high high carbohydrate foods tend to be processed and calorie dense.   While the most expensive high carbohydrate foods tend to be natural foods that have a much lower calorie density. The table below shows that someone switching from a typical western diet to a reduced carbohydrate diet could make some significant savings.

scenario % carbohydrate cost ($/kcal) change
2004 average 51% 5.57
1970 average 45% 5.37 -4%
low carb 30% 4.77 -14%
ketogenic 5% 3.80 -32%

fat

So if increasing the proportion of protein and carbohydrate both increase the cost of our food bill then what makes it cheaper?  Yes it’s the other macronutrient, fat.

Increasing the proportion of fat in your diet while decreasing the carbohydrates will make your meals tastier, gentler on your blood glucose and cheaper.  Not to mention the fact that people typically spontaneously consume less calories when they consume less carbohydrates.

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You may pay a premium for coconut oil, butter or olive oil relative to corn oil which is the cheapest food ingredient, however these fats are still much cheaper than the other macronutrients.

food cost ($/kcal)
corn oil 0.20
coconut oil 0.31
chicken fat 0.86
butter 1.10
bacon fat 1.12
coconut milk 1.15
cream cheese 1.76
sesame oil 2.00
cream 2.81
olive oil 2.81

It appears that the it’s the very cheapest ingredients that are so prevalent in processed foods – sugar, corn starch, corn oil, high fructose corn syrup.  Regardless of cost you’re always going to have to make a value judgement on the nutritional value of your food.

summary

Increasing the protein content of your diet will increase your grocery bill marginally.

While higher levels of protein may be ideal for people who are healthy and active, LCHF is not necessarily high protein, particularly for those who struggle to regulate their blood glucose levels.

The LCHF approach, with its combination of moderate protein, lower carbohydrates and high fat provides an optimal solution with respect to blood glucose management, nutrition and cost.

references

[1] https://www.facebook.com/physiquescienceradio/posts/378943502302499

[2] http://talkfeed.co.za/lchf-diet-on-a-budget/

[3] http://www.cnpp.usda.gov/USDAFoodPlansCostofFood

[4] http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9146789&fileId=S1368980012005423

[5] http://www.biznews.com/health/2015/01/19/complete-idiots-guide-tim-noakes-diet-banting-lchf/

bacon, eggs, avocado and spinach

This is a pretty incredible combination of superfoods and a taste sensation in your mouth.

As you can see from the NutrientData plot below the nutrients are spectacular with every nutrient and mineral covered and the amino acid score is also very high.

Even though there are 13% carbs most of them (12g out of 17g total carbs) are fibre from the spinach and avocado.

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The table below shows the stats for a 500 calorie serving size.

net carbs

insulin load carb insulin fat protein

fibre

4g 18g 35% 83% 66%

12g

 

 

eggs benedict

This photo is of our favourite breakfast from our holiday in Vanuatu over Christmas – Eggs Benedict, no bread.  So yum!

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The nutritional analysis is of Dave Aspery’s “Bulletproof Benedict” from his Bulletproof Diet Book and involves lots of spinach, butter, eggs and avocado.

It does very well on both the protein score as well as the insulin score having only 3g of net carbs after you account for all indigestible the fibre in the spinach and avocado.

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Overall a very nutritious and delicious low carb meal that ranks number one for diabetes and nutritional ketosis.

The nutritional analysis above is for a larger batch while the table below shows the data for a 500 calorie serving.

net carbs

insulin load carb insulin fat protein fibre
3g 8g 34% 83% 8%

8g

Dave Asprey’s recipe doesn’t include bacon, but if we add some in we get an increase in the protein and a sight decrease in the nutrient score.  The net carbs goes down thought the overall insulin load goes up with the increased protein.  Either way a great option for people trying to manage their blood sugars and optimise their nutrition.

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Details for a 500 calorie serving are below.

net carbs

insulin load carb insulin fat protein fibre
2g 11g 21% 80% 13%

6g

the glucose : ketone index

  • Insulin levels are an even better indicator of metabolic health than blood glucose.
  • You can have “normal” blood glucose levels while still having high insulin levels.
  • Reducing the insulin load of your diet (by reducing net carbs and moderating protein) will reduce blood glucose levels which will lead to reduced insulin and increased blood ketones.
  • Once blood glucose levels are under control and you are registering significant blood ketone levels, the glucose : ketone index (GKI) may be a useful indicator if you want to further fine tune your metabolic health.
  • The GKI provides an approximation of your insulin levels for people who are already fat adapted.
  • A GKI of less than 10 is considered to be a low insulin state. A GKI of less than 1 is the goal for cancer patients using therapeutic ketosis.

background

Since I wrote this article in which I plotted my relationship between blood glucose and ketones I have had some interesting discussions and learned a lot.  Particular thanks go to Raymund Edwards from the Optimal Ketogenic Living Facebook group and Jeff Cyr of the Ketogenic Diabetics Facebook group for sharing their knowledge and experience.

My hypothesis, in the absence of more data, was that for me at least, excellent blood glucose aligned with ketone values of greater than 0.5mmol/L and optimal blood glucose aligned with ketone values of around 1.3mmol/L.

image001

Armed with this information I figured that there was limited benefit in doing the more expensive ketone tests regularly.  Monitoring blood glucose to ensure that the average is less than 5.4mmol/L (100mg/dL) seemed like a pretty good way to track my metabolic control.

The table below shows the relationship I developed between HbA1c, average blood glucose and ketone values based on my n = 1 data.  (Check out the Diabetes 102 article for more details on the basis for the blood sugar level categories and the article Ketosis the cure for diabetes for more details on my learnings measuring ketones and blood glucose).

  HbA1c average blood glucose ketones GKI
 (%)  (mmol/L)  (mg/dL)  (mmol/L)
low normal 4.1 3.9 70 2.1 1.9
optimal 4.5 4.6 83 1.3 3.5
excellent < 5.0 < 5.4 < 97 > 0.5 11
good < 5.4 < 6 < 108 < 0.3 30
danger > 6.5 7.8 > 140 < 0.3 39

the importance of insulin levels

High levels of insulin (hyperinsulinemia) are dangerous and are linked to a wide range of health issues including obesity, heart disease, Alzheimer’s, impotence and cancer. [1]

People with higher insulin levels tend to be more obese as demonstrated by this chart. [2]

image004

As illustrated in the figure below, the insulin levels in an obese person tend to be more constantly raised, rather than the more pulsative characteristics in a normal weight person.  Insulin isn’t bad in and of itself, however constantly elevated insulin is a problem.

image005

The official reference range for fasting insulin pegs “normal” at less than 25 mIU/L [3]; however given that the average insulin levels are 8.6 mIU/L and the western world is going through a crisis of metabolic health, it is probably safe to say that this cut off level is too high. [4]

Stephan Guyenet suggests that, based on healthy populations, optimal fasting insulin levels are likely to be between 2 to 6 mIU/L.  Ron Rosedale says that the lower we have our insulin levels the better. [5]

You are not considered to be ‘pre-diabetic’ until your fasting blood sugars are greater than 5.6mmol/L (100mg/dL) and post meal blood sugars greater than 7.8mmol/L (140mg/dL) however given there is a big gap between optimal blood sugar levels of 4.6mmol/L (83mg/dL) and pre-diabetic there is a good chance you will have higher than desirable insulin levels even if you are not considered ‘pre-diabetic’ (see the Diabetes 102 article for more details on the difference between ‘normal’ and optimal blood glucose levels).

the glucose ketone index calculator

When I joined the Optimal Ketogenic Living I came across Raymund Edwards’ link to this paper by cancer researcher Thomas Seyfried which looked at the relationships between ketones and blood glucose as a possible indicator of metabolic health.

The paper suggests that if someone’s glucose to ketone ratio (GKI) is low then you are metabolically healthy and “fat adapted”.  The GKI value is calculated by dividing the glucose value by the ketone value measured at the same time (both in mmol/L, so those in the US using mg/dL will need to first divide their blood glucose readings by 18 to get to mmol/L).   I have shown the GKI values in the table above based on the average corresponding blood glucose and ketone levels.

According to Seyfried, the goal for cancer patients using a therapeutic ketogenic diet is to have a GKI of less than 1.0.  Patients with chronic disease like cancer typically have glucose to ketone index values of 50 or more.

For most people who are not trying to slow cancer growth or combat epilepsy through a ketogenic diet, anything under 10 is considered to be a “low insulin condition”.  This is indicative that you are not significantly insulin resistant.

my data over time

I have plotted my GKI, along with blood glucose values, in the chart below. In January I managed to improve my blood glucose values by adding some intermittent fasting to what was already a fairly low carb type approach. This caused my blood sugars to come down and ketones to go up. Once my blood glucose reduced and I was showing some ketones, my GKI value was sitting at around 10.

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If your blood glucose levels are above 6.0mmol/L or so it is hardly worth trying to measure ketones as they are going to be negligible and not tell you anything, so I suggest that you save your money on the ketone strips until  you have your blood glucose levels under control.  Once you are able to lower your blood glucose you will start to see blood ketones greater than 0.2mmol/L.

Personally I’m simply after normal blood glucose and some ketones for health, weight management and optimal brain function, so I’m not too concerned with the sort of extremely low GKI values that someone battling cancer or managing epilepsy would be aiming for.  For me achieving really low GKI values would require much greater levels of discipline, extended fasting and greater limitation of foods.  It also might be hard to eat regularly with my family and have the sort of diet that would be required to achieve those levels.

However if you are looking to manage extreme insulin resistance, epilepsy or cancer then pushing for very low GKI values may be worth pursuing.

crowd-sourcing data

Through the Facebook groups I was able to obtain more blood glucose/ketone data to add to mine.  The updated chart with the additional data is shown below, with a lot more points sitting out to the bottom right with higher ketones and lower blood glucose.

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This data consists of:

  • 60 data points from me through my journey from poor blood glucose control to improved blood glucose control and achieving my target weight,
  • 35 data points from my dad who is in a similar position to me, refining his diet and experimenting with intermittent fasting to achieve better blood glucose control, and
  • 60 data points from ten other people much more experienced in the ketogenic diet than me.

What’s interesting to note is that the relationship between blood glucose levels and ketones is not necessarily linear.  As blood glucose levels drop ketones take over as the preferred fuel source.  As ketone levels increase blood glucose levels are held fairly stable.

The people with these exceptional ketone values are not achieving them with high fat diet and lots of MCT oil.  They’re achieving them with multi day fasts.  Ketone will increase as the fast progresses.   Then next time they fast the ketone levels seem to increase more rapidly.

If multi day fasts are not your thing then shorter term intermittent fasting will produce a similar but less dramatic effect to improve insulin sensitivity and help to manage blood glucose levels.

Check out Ted Naiman’s short guide to intermittent fasting here or Jason Fung’s series on fasting here for more info.

I’d love to add some more data to this to better understand the relationship between blood glucose and ketones, so if you do experiment with this style of testing yourself then be sure to send your data through or add it in the comments below.

updated ketone reference values

The table below shows the updated ketone and GKI values that correspond to the various HbA1c risk levels as discussed in this article, with the extra ketone data the ketone levels for “low normal” and “optimal” increase substantially.

  HbA1c average blood glucose ketones GKI
 (%)  (mmol/L)  (mg/dL)  (mmol/L)
low normal 4.1 3.9 70 4.0 1.0
optimal 4.5 4.6 83 2.4 1.8
excellent < 5.0 < 5.4 < 97 > 0.3 18
good < 5.4 < 6 < 108 < 0.3
danger > 6.5 7.8 > 140 < 0.3

This updated analysis seems to align reasonably well with Phinney and Volek’s optimal ketone chart shown below.  From this it appears that:

  • low level nutritional ketosis aligns with your blood glucose being under excellent control,
  • higher levels of ketones occur once you are highly fat adapted, and
  • in someone who is highly fat adapted, the body may hold the blood sugar relatively stable at the lower end of the normal range (using glucagon) while increasing ketones for fuel.

image012

individual glucose : ketone relationships

The chart below shows the glucose values versus ketones plotted for each individual person.  I am not sure what to make of this other than the observation that people who are fat adapted have flatter lines with more points out to the right of the chart.

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The table below shows the GKI for the range of individuals.  You can see that my dad (Merv) and I did not do anywhere as well compared with to the GKI values of the more experienced ketogenic dieters.

Name  GKI
Marty 10.7
Merv 5.2
Yvonne 3.2
Johanne 3.1
Lara 2.8
Nikki 2.7
Suhayb 2.4
Samie 1.7
Jeff 1.7
Raymund 1.3
Ashley 1.5
Sheryl 1.5
Andrew 0.6

Andrew, with the lowest GKI value of 0.6, is using ketosis to fight cancer.  Check out his amazing story here or his blog here.

Jeff Cyr has used the ketogenic dietary approach to recover from extreme type 2 diabetes and now has a fasting insulin level of 2.2 uIU/mL and an HbA1c of 4.4%.  Jeff says that he has also used the ketogenic diet to recover from an autoimmune liver disease called Primary Sclerosing Cholangitis which he was diagnosed with in 2011 and given eight to ten years to live before dying of total liver failure.  His most recent bloodwork indicates that his liver tests are now normal.  No more death sentence!  He has also trimmed down a bit as shown in his before and after photos below.

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summary

Hopefully there will be more research in the future to correlate fasting insulin levels with the GKI values. Or perhaps this dataset can be expanded to enable people to get a better feel for what constitutes optimal ketone values.

If it turns out that fasting insulin is approximately equivalent to GKI then perhaps we should be aiming for a GKI of somewhere less than 6 for general health (based on Guyenet’s definition of optimal), with people battling more serious issues such as cancer or epilepsy targeting 2 or below?

It appears that the GKI is an interesting tool to empower people in the self-quantification and self-management of their health.

references

[1] http://onlinelibrary.wiley.com/doi/10.1111/dom.12412/abstract

[2] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC329588/pdf/jcinvest00481-0161.pdf

[3] http://emedicine.medscape.com/article/2089224-overview

[4] http://wholehealthsource.blogspot.com.au/2009/12/whats-ideal-fasting-insulin-level.html

[5] http://articles.mercola.com/sites/articles/archive/2001/07/14/insulin-part-one.aspx

superfoods for therapeutic ketosis

A therapeutic ketogenic diet has a very low insulin load from non-fibre carbohydrates as well as additional dietary fat to achieve higher ketone to manage chronic conditions such as cancer, epilepsy, alzheimer’s, dementia etc.

The chart below shows our insulin response versus insulin load which considered fibre and protein as well as carbohydrates.

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insulin load = total carbohydrates – fibre + 0.56 x protein

The foods listed below have a very low insulin load while still maximising nutrient density (ND) as much as possible.  Also included in the table are the nutrient density score, percentage of insulinogenic calories, insulin load and energy density.

nuts, seeds and legumes

26765969aae6926f

 

food ND insulin load (g/100g) calories/100g MCA
coconut milk -5 5 230 1.5
flax seed 0 16 534 1.5
coconut cream -6 7 330 1.5
pecans -5 12 691 1.5
macadamia nuts -5 12 718 1.5
brazil nuts -2 16 659 1.5
sesame seeds -2 17 631 1.4
sunflower seeds 3 22 546 1.4
hazelnuts -2 17 629 1.4
coconut meat -6 9 354 1.4
pine nuts -2 21 673 1.4
walnuts -1 22 619 1.3
almonds -1 25 607 1.3
peanut butter 1 27 593 1.3
almond butter -1 26 614 1.3
pumpkin seeds 2 29 559 1.2
peanuts -1 29 599 1.2
butternuts -3 28 612 1.2
sesame butter -1 33 586 1.1
pistachio nuts -2 34 569 1.0

seafood and animal products

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food ND insulin load (g/100g) calories/100g MCA
mackerel 1 10 305 1.5
sweetbread -3 9 318 1.4
bacon -4 11 417 1.4
liver sausage -3 10 331 1.4
bologna -6 9 310 1.4
bratwurst -1 13 333 1.3
pepperoni -4 16 504 1.3
beef brains 3 8 151 1.3
kielbasa -3 12 325 1.3
blood sausage -5 13 379 1.3
knackwurst -4 12 307 1.3
liver pate -4 13 319 1.3
pork ribs -2 16 361 1.3
salami -1 17 378 1.2
frankfurter -4 12 290 1.2
turkey bacon -2 11 226 1.2
beef sausage -3 15 332 1.2
duck -3 15 337 1.2
chorizo -3 19 455 1.2
meatballs -3 14 286 1.2
lamb rib -2 17 361 1.2
pork sausage -2 16 325 1.2
lamb brains 4 10 154 1.2
headcheese -4 8 157 1.2
turkey -2 21 414 1.1
pork sausage 1 13 217 1.1
cisco 4 13 177 1.1
caviar 9 23 264 1.0
bologna -2 11 172 1.0
ground turkey 4 19 258 1.0
T-bone steak -1 19 294 1.0
turkey drumstick (with skin) -1 15 221 1.0
ham -0 11 149 0.9
chicken liver pate 5 17 201 0.9

vegetables, fruit and spices

spanish-olives

 

food ND insulin load (g/100g) calories/100g MCA
alfalfa 15 1 23 1.8
olives -5 1 145 1.8
endive 18 1 17 1.7
avocado -1 3 160 1.7
chicory greens 16 2 23 1.7
curry powder 5 14 325 1.6
escarole 14 1 19 1.6
coriander 15 2 23 1.4
poppy seeds 2 23 525 1.3
paprika 8 26 282 1.3
beet greens 12 2 22 1.2
sage 5 26 315 1.1
blackberries 2 3 43 1.1
caraway seed 3 28 333 1.1
zucchini 14 2 17 1.0
mustard greens 9 3 27 1.0
marjoram 5 27 271 1.0
mustard seed 2 37 508 1.0
banana pepper 8 3 27 1.0
eggplant 6 3 25 1.0
raspberries 0 4 52 1.0
collards 8 4 33 1.0
thyme 7 31 276 0.9
nutmeg -5 32 525 0.9
cloves 7 35 274 0.9

eggs and dairy

dairy20and20eggs

 

food ND insulin load (g/100g) calories/100g MCA
cream -5 5 340 1.6
butter -6 3 718 1.6
egg yolk 5 12 275 1.4
sour cream -4 6 198 1.4
cream cheese -5 10 350 1.4
limburger cheese -1 15 327 1.2
camembert -1 16 300 1.2
cheddar cheese -1 20 410 1.2
brie -3 16 334 1.2
feta cheese -1 15 264 1.2
blue cheese -1 19 353 1.1
Monterey cheese -2 19 373 1.1
muenster cheese -2 19 368 1.1
goat cheese -3 14 264 1.1
Swiss cheese -0 22 393 1.1
whole egg 6 10 143 1.1
gruyere cheese -1 23 413 1.1
Colby -2 20 394 1.1
edam cheese -1 21 357 1.1
gouda cheese -1 21 356 1.1
ricotta -2 12 174 1.0

nutrient density

The chart below shows the nutrition provided by this high fat approach with less than the daily recommended intake of teen different nutrients achieved for ten nutrients.  Hence this style of therapeutic approach is idea for a shorter term intervention with a higher nutrient density approach being adopted when possible.

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other dietary approaches

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

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

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

image02

the therapeutic ketogenic diet

You may have noticed claims that a ketogenic diet can be helpful for a range of chronic conditions.

Domonic D’Agostino is doing interesting research into the possible uses for ketosis, both through diet and supplementation.  His initial funding was from the US Military to research the applications of ketosis for navy seal divers in order to avoid oxygen toxicity seizures.

He has continued this research into how ketosis can starve cancer and be used in conjunction with normal treatments to aid recovery from chemotherapy and slow tumour growth. [1]  His more recent research demonstrates that body builders can maximise their power to weight ratio and recovery using a ketogenic approach.

Dr Mary Newport has received a lot of coverage after treating her husband’s advanced Alzheimer’s with coconut oil. [2]

Terry Whals is undertaking clinical trials of her high nutrient density ketogenic diet that has worked to reverse her own multiple sclerosis.[3]

The ketogenic diet for epilepsy has made a resurgence since director Jim Abrahams [4] found success with the ketogenic diet for his son Charlie and then made a movie of his experience. [5]

The Charlie Foundation (with partner site ketocook.com) supports families working to use a ketogenic dietary approach to manage epileptic seizures. [6]

Jimmy Moore’s Keto Clarity [7] spends three chapters profiling the various conditions that the ketogenic diet has been claimed to be beneficial for.

  • Solid science (chapter 16)
    • Epilepsy
    • Diabetes mellitus
    • Weight loss
    • Polycystic ovary syndrome (PCOS)
    • Irritable bowel syndrome (IBS)
    • GERD and heartburn
    • Non-alcoholic fatty liver disease (NAFLD)
  • Good evidence (chapter 17)
    • Alzheimer’s disease
    • Parkinson’s disease
    • Dementia
    • Schizophrenia, bipolar and other mental illnesses
    • Narcolepsy and other sleep disorders
    • Exercise performance
  • Emerging areas (chapter 18)
    • Cancer
    • Fibromyalgia
    • Chronic pain
    • Migraines
    • Traumatic brain injury
    • Stroke
    • Gum disease and tooth decay
    • Acne
    • Eyesight
    • Amyotrophic lateral sclerosis (ALS)
    • Multiple sclerosis (MS) and Huntington’s disease
    • Aging
    • Kidney disease
    • Restless leg syndrome (RLS)
    • Arthritis
    • Alopecia and hair loss
    • GLUT1 deficiency syndrome

The therapeutic ketogenic diet is similar to the LCHF approach but takes it one step further, with net carbs typically restricted to 25g per day (or sometimes less) and protein restricted to the minimum necessary for muscle repair.

People trying to slow or reverse cancer growth or stop seizures will often also resort to more aggressive measures including supplementing with larger amounts of butter, coconut oil, MCT oils and ketone salts to drive their ketones to higher levels (i.e. 1.5 to 3.0mmol/L).

I figured we could use the food ranking system to prioritise foods with a low insulinogenic load over and above nutrition or the other parameters.

The table below shows the weighting I have used for this ranking.  Still considering nutrient density, cost and calorie density will help to optimise these other elements of nutrition even though we are primarily targeting a low insulin load.

ND / cal fibre / cal ND / $ ND / weight insulinogenic (%) cal / 100g $ / cal
5% 5% 5% 5% 70% 5% 5%

I have also used a filter using Wilders’ formula to show only foods that have a ratio of ketogenic to anti ketogenic calories greater than 1.5.  This is the commonly accepted parameter in therapeutic ketosis circles to determine whether a food or a meal is sufficiently ketogenic.

You could also use this calculator to check the percentage of insulinogenic calories of your food.  If you’re aiming for therapeutic ketosis you’ll probably need to have an overall average of less than 15% and any individual food should ideally have a percentage of insulinogenic calories less than 25%.

The resultant foods are listed below.  This approach will obviously prioritise liberal use of fats and oils along with higher fat dairy products and meats.

Not all of the vegetables have a Wilder’s ketogenic ratio greater than 1.5 but it would still be desirable to include adequate vegetables for nutrition as long as they give they fit your tolerances whether they be net carbs, ketones or something else.

Someone using this approach may choose to supplement vitamins and minerals or use organ meats to achieve their nutrition in order to minimise carbohydrates from the vegetables.

People battling chronic illnesses also often have allergies that will mean that they further need to refine this list.

insulin vitamins & minerals protein fibre calorie density
70% 10% 10% 5% 5%

I hope that these lists will be useful for people who need to maximise ketosis for therapeutic purposes, as well as possibly others with diabetes, insulin resistance or people looking to lose weight who want to use a more aggressive approach for a period.

fats and oils

  • butter
  • coconut oil
  • olive oil
  • fish oil
  • flax seed oil
  • lard
  • bacon grease

nuts, seeds & legumes

  • Brazil nuts
  • pecan nuts
  • peanuts
  • Macadamia nuts
  • sunflower seeds
  • coconut milk
  • pine nuts
  • almonds
  • coconut meat
  • almond butter
  • pumpkin seeds
  • almonds
  • pistachio nuts

fruit

  • avocado
  • olives

dairy and egg

  • egg yolk
  • whole egg
  • cream
  • cream cheese
  • goat cheese
  • cheddar cheese
  • Monterey cheese
  • Camembert
  • Muenster cheese
  • Colby cheese
  • brie
  • blue cheese
  • Edam
  • Gruyere
  • parmesan cheese
  • feta cheese
  • mozzarella cheese
  • gouda
  • Provolone
  • Monterey cheese
  • ricotta cheese
  • cottage cheese

animal products & fish

  • polish sausage
  • link sausage
  • chorizo
  • frankfurter
  • bratwurst
  • beef sausage
  • duck
  • knackwurst
  • bacon
  • bologna
  • herring
  • ground lamb
  • chicken
  • chuck eye steak
  • sardines
  • turkey
  • chicken liver
  • anchovy
  • salmon
  • ham
  • carp
  • trout
  • clam
  • catfish
  • shrimp
  • oyster
  • squid
  • lobster
  • cod
  • haddock

vegetables

  • turnip greens
  • mustard greens
  • coriander
  • spinach
  • artichokes
  • mushrooms
  • chives
  • lettuce
  • alfalfa seeds
  • sauerkraut
  • cauliflower
  • asparagus

[this post is part of the insulin index series]

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

references

[1] https://www.youtube.com/watch?v=3fM9o72ykww

[2] https://www.youtube.com/watch?v=feyydeMFWy4

[3] https://www.youtube.com/watch?v=KLjgBLwH3Wc

[4] http://www.imdb.com/name/nm0000720/

[5] https://www.youtube.com/watch?v=HyeC9IiFKpw

[6] http://www.charliefoundation.org/

[7] http://www.amazon.com/Keto-Clarity-Definitive-Benefits-Low-Carb/dp/1628600071

egg, spinach, cheese and cream

My nine year old son was asking what he could have for breakfast that would be healthy.

This is pretty much the simplest and healthiest recipe that I could design that a nine year old can put together unsupervised.

I’m teaching him to just put some frozen spinach, eggs, cream and cheese into a microwave bowl.

Eggs are a wonderfully complete protein.  Cheese and cream add to the taste as well as adding in other proteins and fat not in the eggs.

IMG_9731

Spinach is such a great superfood with so many micronutrients while being low in net carbs due to the high fibre content.

You can add coconut oil or butter to get extra good fats into your meal to create something wonderfully indulgent, nutritious and that will be gentle on your blood sugars.

IMG_9728

If you’re short on time frozen spinach is quicker than using fresh spinach.  I figure if you’re going to skip the spinach because it takes too long to fry up, then it’s better to go with the frozen option.   I will use frozen kale sometimes too which gives a slightly different taste and texture.

If I’m cooking for the family and have bit more time I’ll do the fresh spinach in the fry pan.   If I’m putting this together for the family before we run out the door in the morning I will use some frozen spinach or kale.

IMG_9736

With only 7g net carbs and heaps of well rounded nutrition (in terms of both vitamins and minerals and amino acids) it’s pretty hard to go wrong with this for any meal.

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The stats for a 500 calorie serving are shown below.  The net carbs are low, the fibre is fairly high with the spinach and most of the insulin requirement is for the slower digesting protein rather than the carbohydrates.

net carbs insulin load carb insulin fat protein fibre
7g 25g 19% 66% 27% 7g

The more spinach the better if you want to maximise the nutrition.   The highest overall score occurs when we we use 700g of spinach.   Though this may be pushing the limits of optimising nutrition, not necessarily palatability or eating pleasure.

If you found 7g of net carbs raised your blood sugar you could certainly reduce some of the spinach, although most people find that counting net carbs in real food (rather than processed / manufactured foods) are OK (see the article fibre… net carbs or total carbs for more info)

Since working through the nutrition analysis comparing different meals, this meal has basically become our preferred go to meal, which you can make as simple or as complex as you want.  If you’re an insulin dependent diabetic you could use this as a regular meal and refine your insulin dosing based what you see on your BG metre after the meals.

I’ve run the analysis below with the kale rather than the spinach.  As much as people rave about kale, it actually does not do as well on the nutrient balance score as spinach!  Spinach scores better in both the nutrient completeness and the amino acids.  Kale also has more total carbohydrates and less fibre which makes less diabetic friendly.

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carbs insulin load carb insulin fat protein fibre
11g 28g 39% 62% 25% 5g

insulin index v2

It’s generally difficult for healthy people to eat too much protein.

However the fact that a portion of protein can convert to glucose which in turn requires insulin can be an important consideration for people with diabetes and / or insulin resistance.

A better understanding of the insulin response to various foods would be useful for diabetics calculating their insulin dose or even to help refine food choices to manage insulin load.

Since launching the optimising nutrition blog I have had many interesting discussions and learned a lot more about protein and how it affects insulin and blood glucose.

The Most Ketogenic Diet Foods article which reviews the food insulin index data and what we can learn about our food choices has received more than 50,000 views (nearly half of the page views on the site).

Given the level of interest I thought it would be useful to review this issue from a number of different angles to cross check the conclusions and the original top down analysis.

the food insulin index… a quick refresher

If you’ve been reading my blog you would have come across discussion of the recent food insulin index testing undertaken at the University of Sydney as detailed in Kirstine Bell’s PhD thesis Clinical Application of the Food Insulin Index to Diabetes Mellitus [1] (Sept 2014).

The primary learning from the recently expanded food insulin index data is that the carbohydrate content of a food only partially explains the insulin response.

The cluster of data points on the left hand side of the figure below shows that:

  1. low carbohydrate, high fat foods trigger a negligible insulin response, while
  2. low carbohydrate high protein foods cause a significant insulin response.

image001

When we assume that fibre is indigestible and protein has about half the insulinogenic effect of carbohydrates we get a much better prediction of insulin response.

image002

The insulin requirement of a particular food is described better by the following formula:

image023

digestion time for protein versus carbohydrates

One of the limitations of the food insulin index data is that the insulin area under the curve was measured over only three hours.  This is not a big deal for foods that are high in carbohydrates as they are generally fully digested within three hours.

However protein can take much longer to digest.  In the article The Blood Glucose, Glucagon and Insulin Response to Protein we saw that the insulin response to protein in diabetics can be even greater and over a longer period than for people who do not have diabetes.

If we were to repeat the food insulin index testing over a longer period it is likely that the measured insulin response would be significantly greater and even more-so in people with diabetes.

That is, the insulin response to protein is likely to be greater than the 56% indicated by the analysis of the food insulin index data if we were to measure the insulin response over a longer period.

Wilder’s ketogenic formula

Dr Russell Wilder of the Mayo Clinic was the first to coin the term ‘ketogenic diet’. [2]  Wilder developed the diet as an alternative to fasting in the treatment of epilepsy in the 1920s.

Wilder also developed the formula shown below to determine whether a diet would be ketogenic.  If the number from this calculation was greater than 1.5 (ideally greater than 2.0) then the diet would be considered to be ketogenic and appropriate for the treatment of epileptics. [3]

image003

This formula is based on the understanding that:

  • 100% of carbohydrate is glucogenic (i.e. converts to glucose),
  • 54% of protein is glucogenic,
  • 46% of protein is ketogenic, and
  • 10% of fat is glucogenic.

I had previously searched for detail on the basis of how Wilder had arrived at the 56% / 46% split for protein and only found references suggesting that the 56% glucogenic potential of protein comes from the analysis of nitrogen in the urine of dogs. [4]  However I recently came across this paper which details Wilder’s thinking in more detail.

Wilder’s conclusion that a diet needs to have more than two times the ketogenic precursors compared to glucogenic precursors is still the basis of the formulation of diets used to treat epilepsy and other conditions today.

According to George Cahill, Krebs also found that 57g of glucose may be derived from 100g of protein. [5]   Again this is similar to the insulin demand for protein observed in the food insulin index tests .

carbohydrate counting

The most straight forward approach is to assume that protein has no impact on insulin or blood sugars.

Dr Richard Berstein and Dr Robert Atkins pioneered the concept of carbohydrate counting for weight loss and diabetes management in the 70s and 80s.  There have been various waves of popularity of low carbohydrate diets with many people finding success.

Carbohydrate counting alone is a reasonable approach that is likely to work for most people, particularly if they are not highly insulin resistant.

However there are some people that reducing carbohydrates alone doesn’t work for.   The fact that protein also generates insulin suggests that managing protein as well as carbohydrates may be necessary to manage insulin levels.

thermic effect of food

You may have heard of the concept of the thermic effect of food.  That is, different foods require different amounts of energy for the digestion process.

For example, a mushroom, which has a very low calorie density and a lot of fibre and protein, may actually require more energy to digest than is obtained from the digestion of the mushroom.

The maximum and minimum thermic effect (also known as the specific dynamic action) for each macronutrient is shown below. [6]

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Compared to carbohydrates and fat, protein only yields between 76% and 84% of the energy per calorie ingested because of losses in digestion.  This is useful to know if you’re trying to minimise calorie intake.

As discussed in the Why We Get Fat V2 article, part of this thermic effect of food is also likely to be due to the fact that there is a significant loss of energy when we convert protein to glucose to be used as energy.

Steve Phinney’s “well formulated ketogenic diet”

One of the key observations from Steve Phinney’s well formulated ketogenic diet (WKFD) chart is that we need to strike a balance between carbohydrates and protein in order to maximise the ketogenic potential of our diet.

image007

You can have 30% protein and 5% carbs or 20% carbs and 10% protein and still be within the bounds of a ketogenic diet.

However if you have 30% protein and 20% carbs you will be outside the realms of a ketogenic diet because you will be producing too much glucose.

According to Nuttall and Gannon [7] the body requires between 32g and 46g of high quality dietary protein to maintain protein balance.  This equates to around 6 to 7% of calories in a 2000 to 2500 calorie diet being taken ‘off the top’ for growth and maintenance, with everything else potentially available as ‘excess’ protein for gluconeogenesis.  [note: This should not be considered optimal, but simply as a minimum reference point for the absolute minimum amount of protein.]

Interestingly, the slope of the line along the face of Phinney’s WFKD triangle corresponds with the assumption that 7% of protein goes to muscle growth and repair (protein synthesis) with 75% of the remaining ‘excess’ protein being glucogenic.

This 75% value is in the “ball park” (although a little higher) of our previous estimate of the glucogenic potential of protein based on the analysis of the food insulin index data.

amino acid potential

More recently I came across more detail on which amino acids are glucogenic, which are ketogenic and which are a bit of both. [8] [9] [10]

The table below shows the various amino acids divided up on the basis of their ketogenic versus glucogenic potential and also which are essential versus non-essential. [11]

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Only two amino acids are exclusively ketogenic.  There is a handful that are both glucogenic and ketogenic.  However most of the amino acids are glycogenic, meaning that they will most likely turn into glucose if not required for protein synthesis.

According to David Bender “In  fasting  and  on  a  low  carbohydrate diet  as  much  of  the  amino  acid  carbon  as  possible  will  be  used  for gluconeogenesis  –  an ATP-expensive, and hence thermogenic process.” 

Hence it appears likely that in a low carbohydrate diet situation excess amino acids that fit under the “both” classification will be turned to glucose rather than ketones because the body needs the extra glucose which it is not getting from ingested carbohydrates.

Conversely if someone is consuming a high carbohydrate diet the excess amino acids that fit into the “both” category will be converted to ketones rather than glucose because the body is getting more than enough glucose from the diet.

So, to some extent, protein is versatile depending on the body’s need. But at the same time it is only a small portion of the amino acids that are able to do this. The fate of the majority of the amino acids is pre-destined.

The figure below shows the process of catabolism of amino acids. [12]

image005

I am not an organic chemist, but from what I understand this means that:

  • The amino acids Leucine and Lysine cannot be converted back to glucose as they are ketogenic;
  • Isoleucine, Tyrosine, Phenylalanine, Tryptophan, Threonine all enter into the amino acid catabolism cycle and can be used for various functions, such as muscle repair and growth, but can also be converted back into glucose if required (glucogenic) or turned into fatty acids (ketogenic); and
  • The remaining amino acids enter the cycle and can be used for a variety of functions in the body, but cannot be converted into fatty acids.  If they are not required they can be turned into glucose and potentially stored as body fat.

The majority of the amino acids obtained from the digestion of protein have the potential to be turned into glucose through gluconeogenesis.

The reason that we don’t see a sharp rise in blood glucose is partly because amino acids from digestion circulate in the blood until they are required.

By contrast, glucose from carbohydrates will be used to refill glycogen stores (liver and muscle) and then find their way quickly into the bloodstream.  In most people the amino acid stores in the blood are not saturated and hence there is plenty of capacity to store amino acids in the bloodstream until they are required, at least if you have good insulin sensitivity and are not diabetic.

The body does need glucose, and it is fine to get it from carbohydrates or protein via gluconeogenesis.  However many people struggle to produce enough insulin and / or are insulin resistant and hence struggle to keep their blood sugars in normal range.

For these people it makes sense to reduce the glucose load of the diet (that requires insulin) to a point that they can maintain normal blood glucose levels.

This glucose tolerance level will vary from person to person depending on their insulin sensitivity and the health of their pancreas.

tallying up the amino acids

I figured I could use this knowledge of the categorisations of the various amino acids to better understand how much of the proteins in the 8000 foods listed in the USDA food database are glucogenic verus ketogenic.

For each food in the USDA database I tallied up the weight of the glucogenic and ketogenic amino acids and the amino acids that fell onto the ‘both’ category and found that:

  • ketogenic amino acids make up only 12% by weight of the total protein across the 8000 foods in the database,
  • glucogenic amino acids comprise 74% of the foods, and
  • amino acids that fit in the “both” comprise 14% of the total weight of amino acids.

This means that somewhere between 78% and 89.5% of protein has the potential to turn into glucose, depending on whether you considered the amino acids in the ‘both’ column to be glucogenic or ketogenic, or somewhere in between.

For someone eating a low carbohydrate diet nearly 90% of ‘excess’ protein could be turned to glucose in the blood stream.

Why is this different to the observation from the food insulin index testing that approximately 56% of protein raises insulin?  Perhaps the following factors come into play:

  1. When we consider the glucogenic potential of the individual amino acids we are considering the maximum potential of protein if it is not first used for protein synthesis.  The amount of protein synthesis will be greater for say an athlete or a body builder, with less protein remaining for gluconeogenesis.
  2. Converting protein to glucose requires energy and hence some of the energy from ingested protein is lost in the process and hence is not converted to glucose.
  3. The insulin index testing is undertaken over only three hours. Protein takes much longer to digest and be metabolised into glucose hence the insulin index testing may underestimate the full glucogenic potential of protein.

which foods have the most ketogenic protein?

So I bet you are wondering which forms of protein have the highest amount of ketogenic protein.  Maybe not?  Well, I was, and I am going to share it with you.

The table below shows the foods from the USDA database that have the most ketogenic protein (assuming the ‘both’ amino acids are split 50/50 glucogenic / ketogenic) in terms of grams of ketogenic amino acids per 100 grams of the food.

Food ketogenic aminos (/100g) % ketogenic protein % insulinogenic
Seal, Bearded Alaskan 19.4g 23% 72%
Whale, Beluga 17.6g 25% 64%
Cod 16.3g 26% 68%
Seaweed, spirulina 14.2g 25% 64%
White fish 13.6g 22% 53%
Parmesan cheese 12.3g 32% 28%
Beef, sirloin 10.0g 33% 50%
Beef, ribeye 9.7g 33% 44%
Bacon 9.3g 25% 22%
Egg yolk 9.2g 27% 18%
Lamb 9.0g 25% 39%
Chicken, breast with skin 7.8g 24% 48%
Salmon 7.0g 28% 45%
Egg, whole 3.3g 26% 29%
Milk 0.9g 29% 43%

It is hard to know what to make of this list other than noting that the seal, whale and cod have the highest amounts of ketogenic protein.

Perhaps there is something about cold water animals that cause them to store more ketogenic amino acids?  This seems to align with what we see in the traditional diets of humans who may eat more fat if they are living further away from the equator but eat more carbohydrates from fruits if they live closer to the equator.

Although seal, whale and cod have high amounts of ketogenic amino acids, overall they are still quite insulinogenic.  In view of the high proportion of insulinogenic properties of some meats it is not surprising that people can thrive on a 100% meat zero carb diet because the body can get as much glucose they need from the meat.[13]  At the same time though, I’m not sure that an all meat diet can provide an optimal array of vitamins and minerals unless you are emphasising organ meats.

In view of the fact that a large amount of protein can be converted to glucose through gluconeogenesis, it seems better to focus on foods that have a lower percentage of insulinogenic calories if you are insulin resistant or do not have a fully functioning pancreas.

While there is no such thing as a glycemic index for protein, it also makes sense to avoid processed foods if you are after stable blood glucose levels and lasting satiety.  Unless you are a bodybuilder who is looking for a quick insulin spike it would be prudent to prioritise whole foods as much as possible.

summary

The table below shows a comparison of a range of glucogenic factors for protein relative to carbohydrate, summarising the discussion above.  Most of the approaches to understanding the insulinogenic portion of protein give an even higher value than suggested by the analysis of the food insulin index data.

Basis % insulinogenic Comment
Carbohydrates only 0% A lower end sensitivity assuming that no protein is converted to glucose (i.e. as per standard carbohydrate counting).
Food insulin index 56% Based on testing of > 100 foods in healthy individuals
Thermic effect of food 77% Average of additional in digestion losses minus 7%.
Wilder’s formula 54% Used in initial ketogenic formula
Krebs  / Janney 57% Based on nitrogen excretion in dogs
Glucogenic potential (min) 78% Based on summing amino acids in USDA foods database, excluding “both” aminos.
Glucogenic potential (max) 89.5% Based on summing amino acids in USDA foods database, including “both” aminos.
Steve Phinney WFKD 75% Assuming that the first 7% of calories goes to growth and repair with 75% of the remaining amino acids being glucogenic.

the most ketogenic foods… updated

I have calculated the insulinogenic potential of the foods shown in this previous article (The Most Ketogenic Diet Foods) using the following approaches:

  • carbohydrates only;
  • food insulin index data (i.e. protein is 56% insulinogenic);
  • thermic effect (i.e. protein is 77% insulinogenic); and
  • maximum glucogenic potential of the amino acids for each food (varies for each food based on data in USDA foods database).

This updated data illustrates the difference in standard carbohydrate counting and the full insulinogenic potential of the food.  While there is a range of values due to the varying amounts and types of protein overall, there is a reasonable alignment between the food insulin index (56%), thermic effect of food (77%) and maximum glucogenic potential values, particularly when we compare it to the carbohydrate only approach for the lowest carbohydrate foods.

least insulinogenic foods

food carb only (0%) FII (56%) thermic (77%) glucogenic (max)
olives 1% 4% 4% 4%
cream 3% 4% 6% 4%
pecans 2% 5% 8% 6%
Macadamia nuts 3% 5% 7% 6%
duck 0% 7% 4% 9%
pork sausage 2% 10% 19% 9%
sesame seeds 7% 7% 10% 11%
sausage 0% 9% 12% 14%
frankfurter 2% 11% 14% 14%
pepperoni 0% 10% 14% 15%
bacon 1% 16% 21% 21%
mackerel 0% 20% 28% 28%

Eggs

egg  carb only (0%) FII 56%) thermic (77%) glucogenic (max)
egg yolk 16% 15% 20% 19%
whole egg 17% 21% 23% 25%
egg white 6% 53% 71% 72%

Dairy products

Cheese

cheese carbs only (0%) FII (56%) thermic (77%) glucogenic (max)
cream cheese 5% 9% 10% 9%
brie 1% 14% 20% 18%
limburger 1% 14% 19% 18%
camembert 1% 15% 21% 19%
Monterey 1% 15% 20% 19%
cheddar 1% 15% 20% 19%
gruyere 0% 17% 23% 20%
Colby 3% 16% 21% 20%
blue 3% 16% 21% 20%
edam 2% 17% 23% 21%
gouda 2% 18% 24% 22%
feta 6% 18% 23% 22%
ricotta, whole milk 7% 21% 27% 24%
mozzarella 3% 20% 26% 26%
cream cheese, low fat 16% 25% 28% 27%
parmesan 3% 21% 27% 28%
mozzarella, skim milk 4% 26% 34% 31%
Swiss 6% 22% 27% 34%
ricotta, part skim milk 15% 33% 40% 37%
cream cheese, fat free 29% 62% 75% 72%
Swiss, low fat 8% 45% 48% 73%
cottage cheese, low fat 17% 55% 69% 86%
mozzarella, non-fat 10% 60% 79% 95%

Milk

milk carb only (0%) FII (56%) thermic (77%) % insulinogenic (max)
Full cream milk, 3.7% fat 29% 41% 41% 43%
Human milk 40% 43% 44% 43%
Skim milk, 1% fat 47% 65% 72% 69%
Chocolate milk, low fat 63% 72% 76% 70%

Yogurt

yogurt carb only (0%) FII (56%) thermic (77%) % insulinogenic (max)
plain, whole milk 30% 42% 48% 46%
Plain, low fat 44% 63% 70% 68%
fruit, low fat 71% 81% 85% 83%
plain, skim milk 55% 78% 87% 85%
fruit, non-fat 70% 90% 97% 96%

Fruits

fruit carb only (0%) FII (56%) thermic (77%) % insulinogenic (max)
olives 1% 3% 4% 4%
avocados 4% 8% 9% 7%
raspberries 42% 42% 51% 45%
blackberries 40% 42% 53% 47%
strawberries 70% 75% 76% 69%
oranges 77% 81% 83% 76%
apples 88% 89% 89% 81%
bananas 91% 91% 95% 86%

Vegetables

vegetable carb only (0%) FII (56%) thermic (77%) % insulinogenic (max)
endive 6% 22% 29% 24%
dock 5% 27% 33% 27%
mustard greens 7% 61% 43% 34%
asparagus 36% 60% 69% 34%
artichoke 22% 35% 39% 38%
sauerkraut 30% 41% 45% 40%
broccoli 3% 35% 47% 42%
lettuce 28% 44% 50% 42%
coriander 15% 36% 44% 43%
chrysanthemum leaves 0% 32% 43% 44%
alfalfa 3% 42% 57% 47%
parsley 34% 52% 59% 48%
cauliflower 32% 50% 56% 48%
spinach 24% 53% 63% 50%
bamboo shoots 19% 50% 62% 51%
mushroom 31% 56% 66% 55%
turnip 17% 30% 34% 62%
onions 78% 85% 88% 82%

Nuts, seeds and legumes

nuts, seeds legumes carbs only (0%) FII (56%) thermic (77%) % insulinogenic (max)
pecans  2% 5%  10% 5%
Macadamia  3% 5%  6% 6%
coconut meat  7% 6%  10% 7%
coconut cream  6% 7% 9% 8%
coconut milk  6% 7% 9% 8%
Brazil nuts  3% 7% 10% 9%
flax seed  1% 8% 12% 11%
walnuts  4% 9%  11% 11%
pine nuts  5% 9%  11% 11%
sesame butter (tahini)  6% 11% 15% 14%
sesame seeds  0% 12% 10% 15%
chia seeds  6% 13% 17% 16%
peanuts  4% 13%  19% 18%
sunflower seeds  9% 14% 19% 18%
pumpkin seeds  6% 14% 22% 19%
pistachio nuts  12% 19%  23% 22%
cashew butter  21% 22% 29% 25%
almonds  7% 13% 18% 17&

Fish

fish carbs only (0%) FII (56%) thermic (77%) % insulinogenic (max)
Tuna 0% 32% 44% 44%
Mackerel 0% 33% 46% 25%
Herring 0% 19% 26% 25%
Salmon 0% 24% 33% 34%
Sardine 0% 26% 36% 36%
Anchovy 0% 31% 42% 42%
Swordfish 0% 31% 42% 42%
Trout 0% 31% 44% 43%
Carp 0% 32% 43% 43%
Yellowtail 0% 36% 49% 49%
Bass 0% 37% 51% 51%
Mullet 0% 37% 51% 51%
Squid 18% 41% 49% 51%
Abalone 23% 47% 55% 57%
Monkfish 0% 44% 59% 60%
Halibut 0% 47% 24% 61%
Mussel 17% 49% 60% 62%
Oyster 21% 46% 56% 63%
Crab 0% 48% 66% 65%
Shrimp 5% 48% 64% 65%
Hadock 0% 51% 68% 66%
Perch 0% 49% 65% 67%
Clam 14% 56% 67% 71%
Scallop 19% 59% 76% 80%

Meat

meat carbs only (0%) FII (56%) thermic (77%) % insulinogenic (max)
Bologna 6% 12% 17% 14%
Frankfurter 2% 11% 14% 14%
Duck 0% 14% 17% 17%
Chorizo 2% 15% 18% 17%
Beef, ribeye 0% 15% 26% 21%
Bacon 1% 15% 21% 21%
Pork, ham 6% 17% 38% 22%
Pork, blade, hocks & shoulder 31% 23% 42% 31%
Turkey 0% 23% 29% 32%
Lamb mince 0% 24% 27% 34%
Chicken 0% 24% 34% 34%

[1] http://ses.library.usyd.edu.au/handle/2123/11945

[2] http://www.thepaleomom.com/2015/05/adverse-reactions-to-ketogenic-diets-caution-advised.html

[3] http://perfecthealthdiet.com/2011/02/ketogenic-diets-i-ways-to-make-a-diet-ketogenic/

[4] https://books.google.com.au/books?id=SqzMBQAAQBAJ&pg=PA245&dq=Krebs+1964+The+metabolic+fate+of+amino+acids.&source=gbs_toc_r&cad=4#v=onepage&q&f=false

[5] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC292907/pdf/jcinvest00272-0077.pdf – Cahill references a 1964 paper by Krebs in this paper but I can’t find the original paper.

[6] http://en.wikipedia.org/wiki/Specific_dynamic_action

[7] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636610/

[8] http://en.wikipedia.org/wiki/Glucogenic_amino_acid

[9] http://en.wikipedia.org/wiki/Ketogenic_amino_acid

[10] https://www.dropbox.com/s/4dkl03mz2fci71v/The%20metabolism%20of%20%E2%80%9Csurplus%E2%80%9D%20amino%20acids.pdf?dl=0

[11] http://www.medschool.lsuhsc.edu/biochemistry/Courses/Biochemistry201/Desai/Amino%20Acid%20Metabolism%20I%2010-14-08.pdf

[12] http://en.wikipedia.org/wiki/Gluconeogenesis

[13] http://zerocarbzen.com/2015/03/09/zero-carb-interview-the-andersen-family/

is this really all so important?

When my wife Monica 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 fixed amount of carbohydrates.  If she went low she had to eat more carbs to bring her blood glucose back up.

Welcome to the everyday blood sugar roller coaster that takes over your life when you have diabetes!

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It wasn’t till after we were married in 2002 and started thinking about having kids that she found a doctor with an interest in diabetes who told her that she could tailor her insulin dose to what she wanted to eat.

Up until this time even the visits to the endocrinologist were to get more scripts for insulin and thyroid medication.  No useful advice was provided about how to manage diabetes.

It’s amazing that the concept of carbohydrate counting was new and shiny in 2003 when Richard Bernstein developed the concepts back in 1970s!

Today, the standard of care for diabetes seems to have incorporated Bernstein’s carbohydrate counting, however the nutritionists and diabetes associations still advises that diabetics should not have to deprive themselves of any food in the pursuit of health.  And like everyone else, they should eat a diet full of “healthy whole grains”.

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 insulin load, high fibre and high nutrient density foods I’m pleased to say that she has 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 dis-regulation.

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It is still not easy and we are still learning, however she is now able to enjoy working as a supply teacher rather than just getting through the morning and needing to sleep during the afternoon before picking up the kids from school.

Her big regret is that she did not discover this earlier, which would have saved her from spending decades living in a fog with limited energy.

The chart below shows the difference diet can make in the management of blood glucose, particularly for a type 1 diabetic (notice that these plots are only two months apart!).  People who find success with this dietary approach find a substantial improvement in quality of life and their state of well being that makes it well worth the effort.

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Below is a recent post on the TYPEONEGRIT Facebook group from a mother of a type 1 diabetic child describing their interaction with her health care team.  It’s still not simple to go against the main stream dietary advice.

We had our team meeting today to discuss LCHF…  they are so terrified of this, even though we have great BG readings, behaviour improvements and learning improvements (noted by us, family, friends and his school) which they didn’t even acknowledge.

The nutritionist is concerned that he won’t be getting the micronutrients that only come from grains and the higher carb vegetables (grains are fortified), then her concern was the B vitamins 1, 3 and 6. 

Then the concern about Iron (what?! have you seen the meat and spinach listed?). Then it was calcium and magnesium (clearly they don’t have a clue about LCHF).

They said they are afraid this diet may cause future developmental harm. We said your diet WILL cause future harm and way more than developmental. Back and forth and on it went. We addressed their concerns with peer reviewed research, and respect to their limited knowledge.

We will be an open book and comply because I want them to learn that T1D care can be so much better than it has been up to now, and pave the way for the next families that wishes to do LCHF.

They will check for vitamins and minerals at his 3 month blood work (again special for our case, which we have to pay for).

The good news here is that after running an intense battery of tests they decided to use this child as Canada’s first case study in LCHF paediatrics for the management of type 1 diabetes.

This post inspired me to run some numbers on a range of diets to see whether there was any issue with the nutritional content of higher fat diets.   It turns out that diets with higher levels of fat can be very nutritious while the grain based diet that everyone is recommended does very poorly, particularly when you take the insulin of these higher carbohydrate diets into account (see the Diet Wars… Which One is  Optimal article for more details).

It breaks my heart to see diabetics living with a highly diminished quality when there is the potential to greatly reduce the impact of diabetes by more informed food choices.

For people with diabetes and their carers diet is important and maybe a matter of life and death, or at least a decision that will greatly affect their quality and length of life.

beef heart chili

This Beef Heart Chili recipe is by Kathleen Guertin from Robb Wolf’s website.  It ranks really well in the weight loss and athletic / metabolically healthy meal rankings due to it’s high nutrient density and low calorie density.

Organ meats top the list when it comes to nutrient density, however I haven’t found a lot of recipes using organ meats that rank really well.  Perhaps it’s because people feel they need to put a lot of not so healthy things with their organ meats to drown out the taste?

This recipe uses heart, ground beef along with a range of spices to build a solid nutritional profile.

If you look closely at the chart below you’ll see that I’ve used pork heart as there is no data for beef heart in the NutritionSELF database.

Robb has had a massive influence on my thinking, along with many others. I like the way he brings everything back to evolutionary principles that need to make sense in the broader context rather than just looking at isolated studies.  I also like the way he promotes quantifying nutritional density as a way to beat the nutritionists at their own game.

Robb believes that Mat Lalonde’s nutritional density work will show the nutritionists that Paleo is better than the recommended western diet using their own system!

I’m hoping that nutritional density combined with the insulin index component will take things one step further to provide a quantitative basis to demonstrate that one meal is better than another.

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The details for a 500 calorie serving (the recipe is for two servings) are shown below.  This recipe does really well on the weight loss ranking because it has a low calorie density and a solid, great nutrient levels and a solid amount of fibre.

net carbs

insulin load carb insulin fat protein fibre
20g 40g 50% 49% 28%

9g

If you are insulin resistant or are sensitive to tomatoes you may want to reduce the tomatoes.  I’ve re-run the numbers with 5 ounces of tomatoes rather than the 26 ounces in the original recipe.  Still not perfectly diabetic friendly, but an improvement and slightly closer to the Bernstein target of 12g carbohydrates per meal.

net carbs

insulin load carb insulin fat protein fibre
15g 36g 42% 53% 30%

6g