optimal foods for different goals

A number of attempts have been made to rank foods based on their nutrient density or some other measure.

Useful parameters that can be used to optimal foods for different goals include:

  • nutrient density / calorie,
  • nutrient density / cost,
  • nutrient density / weight,
  • fibre / calorie,
  • fibre / weight,
  • calorie / weight,
  • cost / calorie, and
  • percentage insulinogenic calories.

This article details a new system that combines these parameters to identify optimal foods for different goals such as:

  • weight loss,
  • diabetes and nutritional ketosis,
  • therapeutic ketosis, and
  • athletes and the metabolically healthy.

My hope is that all this number crunching will help take the some of the guess work and ambiguity out of nutrition.

If we agree that we should focus on nutrient dense foods that don’t overload our pancreas’s ability produce adequate insulin, then we can move closer to agreeing which foods are optimal for an individual’s individual needs.

If you want to skip the detail, the end result of is a number of simple lists of optimal foods for different goals that you can access via the links below. If you want more detail then read on.

goal blog cheat sheet detailed list
therapeutic ketosis visit download download
diabetes and nutritional ketosis visit download download
fat loss visit download download
athletes and metabolically healthy visit download download

Firstly let’s take a look at a number of approaches that have previously been used to rank and prioritise foods.

low carbohydrate diets

As popularized by Dr Robert Atkins, limiting carbohydrates is a simple way to prioritise foods to reduce insulin demand.

By restricting carbohydrates intake, a range of foods are excluded, particularly those that are highly processed and contain added sugars.

While a low carb approach will reduce the insulin load of our food, no specific consideration is given to nutrient density or food quality.

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Aggregate Nutrient Density Index (ANDI)

In contrast to Akins’ approach, Joel Fuhrman’s Aggregate Nutrient Density Index (ANDI)[1] ranks foods based on micronutrients per calorie.[2]

I think there is an element of genius to Fuhrman’s nutrient density ranking system.  However when you look in the detail you find it is based on a select range of vitamins and minerals without any consideration of beneficial amino acids or fatty acids.

Fuhrman’s nutritarian approach has come under criticism for excluding a number of essential nutrients and placing extra emphasis on more fringe measures such as “oxygen radical absorbance capacity”.

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To determine the ANDI scores, an equal-calorie serving of each food was evaluated. The following nutrients were included in the evaluation: fiber, calcium, iron, magnesium, phosphorus, potassium, zinc, copper, manganese, selenium, vitamin A, beta carotene, alpha carotene, lycopene, lutein and zeaxanthin, vitamin E, vitamin C, thiamin, riboflavin, niacin, pantothenic acid, vitamin B6, folate, vitamin B12, choline, vitamin K, phytosterols, glucosinolates, angiogenesis inhibitors, organosulfides, aromatase inhibitors, resistant starch, resveratrol plus ORAC score.

While claiming to be “evidence driven”, without the inclusion of amino acids or fatty acids Fuhrman’s “nutritarian” approach ends up being heavily biased towards plant based foods.[3]   

Another issue with Furhman’s ANDI is that it can be skewed by a single nutrient present in very high quantities. For example, kale ranks at the top of Furhman’s list primarily due to its massive amount of Vitamin K.  Unfortunately, a mega dose of Vitamin K, which is a fat soluble vitamin, may have limited use by itself.  Rather than finding foods that are high in one nutrient it would be ideal to identify foods that were high in a broad range of nutrients.

Ranking foods in terms of nutrient density per calorie also tends to prioritise leafy veggies, which is great if you are trying to lose weight but not ideal if you’re an athlete trying to fuel up for an intense workout on kale and watercress.

While I think most people would benefit from consuming more green leafy vegetables, in the long term I think they will also benefit from foods with adequate protein protein and beneficial fatty acids.

In the short term someone who is obese has plenty of excess fatty acids and amino acids to spare so they will likely feel great as they are losing weight, however as their weight loss slows and they stop feasting off their own protein and fat the benefits of the a very low fat, very low protein approach may diminish.

NuVal

Professor Dr David Katz and an auspicious group of friends have developed the NuVal[4] food ranking system which uses the following sixteen positive ‘numerator nutrients’ to compare and rank common foods:

  • Fibre
  • Folate
  • Vitamin A
  • Vitamin C
  • Vitamin D
  • Vitamin E
  • Vitamin B12
  • Vitamin B6
  • Potassium
  • Calcium
  • Zinc
  • omega-3 fatty acids
  • total bioflavonoids
  • total carotenoids
  • Magnesium
  • Iron

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The sum of the ‘numerator nutrients’ is divided by the sum of the ‘denominator nutrients’ listed below to calculate a score of between one and one hundred:

  • saturated fat
  • trans fat
  • sodium
  • sugar
  • cholesterol

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The NuVal system also considers the following ‘additional entries’:

  • protein quality
  • fat quality
  • glycemic load
  • energy density

It’s interesting to note the foods to which it gives a score of 100 including:

  • non-fat skim milk,
  • sweet potato,
  • tomatoes,
  • beans,
  • bananas,
  • blueberries,
  • mango, and
  • wheat bran.

While the stated goal of the NuVal system is to combat diabetes, the food insulin index[5] shows that many of these foods will be problematic for a diabetic trying to maintain normal blood glucose levels.

Some of the more puzzling scores thrown up by the system include:

  • shrimp – 40
  • lobster – 60
  • coconut – 24
  • chicken – 57
  • beef – 46

Other concerns with the NuVal system include:

  • Because it biases heavily against saturated fat, some diabetic friendly foods like beef and coconut are further down the list.
  • The number of foods analysed is fairly limited.
  • Only sixteen vitamins and minerals are included in the analysis.
  • Dietary cholesterol is penalised by the NuVal system although dietary cholesterol does not necessarily lead to cholesterol in the blood or heart disease.
  • The NuVal algorithm has been calibrated to fit the views of the panel of experts, hence it is likely that it will simply reinforce previously held views.
  • Considering added sugar and the glycemic index are a good start, however I think using the food insulin index would be more useful as it is a better measure of the actual amount of glucose being metabolised.

Dave Asprey’s Bulletproof Diet Roadmap

Dave Asprey has developed the Bulletproof Diet Infographic[6] which is a simple ranking of foods to avoid, and preference based on both nutritional density and toxins.

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While I think Asprey’s ranking system is excellent, the downside is that it features only a select range of foods and does not explain why each of the foods has been given a particular ranking, although there is a good discussion of the toxins and various other considerations in his Bulletproof Diet Book.[7]

Asprey’s list also doesn’t differentiate between what would be most appropriate for someone with diabetes versus an athlete, or someone aiming for therapeutic ketosis or wanting to lose weight.

Soylent

Another noteworthy foray into the realm of optimising nutrition is Rob Reinhardt’s Soylent.[8]

Reinhardt set out to produce a manufactured food that ticked off all of the micronutrient Recommended Daily Intake (RDI) values, while reducing the cost and the hassle of food preparation.

While Reinhardt notes that his creation would be healthier than the ramen noodles that he was living on before creating Soylent[9], there are a number of downsides to this food replacement which is basically a protein shake on steroids.

Using manufactured foods leaves you exposed to not getting all of the non-essential micronutrients or even the beneficial nutrients that haven’t made it to the current list.  Eating real whole foods seems to be a safer option to ensure you are getting all the nutrients you need.

Mat Lalonde’s nutrient density

After reviewing the various options available and finding them lacking, Dr Mathieu Lalonde developed an excellent ranking of foods based on nutrient density per weight of food using the USDA food database.[11]

Lalonde also included a broader range of nutrients than Fuhrman or Katz by also considering beneficial amino acids and fatty acids.

This analysis identified organ meats as one of the more nutritious foods, followed by herbs and spices, nuts and seeds.

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In this video of his AHS2012 presentation Lalonde noted that people wanting to lose weight may wish to prioritise in terms of nutrient density per calorie, however he chose 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). [12]

After watching this video and hearing about his quantitative approach to nutrient density I was left excited, yet a little unsatisfied, wondering what the ranking might look like in terms of nutrient density / calories.

fibre per calorie

One of the more interesting concepts in the area of nutrition recently is that what you eat could affect your gut bacteria.

Typical daily fibre intake is around 17g for those of us in western civilisation compared to the Recommended Daily Intake (RDI) of 25 to 30g per day.[17]

It is said that African hunter gatherer children obtain more than 150g of fibre per day from eating unprocessed foods in their natural state[18], and before the invention of fire and cooking our ancestors were eating more than 100g of fibre per day.[19]

Fibre is not digestible by the human gut and hence it does not provide energy or cause a rise in blood sugar or insulin.  Fibre in our food neutralises the insulinogenic effect of carbohydrate.[20]

If we rank for fibre per calorie we end up with a few spices such as cinnamon, curry powder, or cocoa at the top of the list along with veggies such as turnip, artichoke, sauerkraut, and cauliflower.

  1. cinnamon
  2. turnip greens
  3. artichoke
  4. curry powder
  5. sauerkraut
  6. cauliflower
  7. raspberries
  8. lettuce
  9. blackberries
  10. lemon peel

Again, this list is interesting, but not something you can live by.  Somehow we need to combine all these approaches to arrive at a more useful list that balances all of these considerations.

what are the “essential nutrients”?

So after reviewing these ranking systems I thought it would be interesting to design my own that would build on these previous approaches as well as considering the insulin response to food to make it more useful for people with diabetes.

The obvious starting point is to agree on the nutrients that should be included.  Listed below are the commonly accepted list of essential amino acids, vitamins and minerals.[21]

vitamins

  1. Choline
  2. Thiamine
  3. Riboflavin
  4. Niacin
  5. Pantothenic acid
  6. Vitamin A
  7. Vitamin B12
  8. Vitamin B6
  9. Vitamin C
  10. Vitamin D
  11. Vitamin E
  12. Vitamin K

minerals

  1. Calcium
  2. Copper
  3. Iron
  4. Magnesium
  5. Manganese
  6. Phosphorus
  7. Potassium
  8. Selenium
  9. Sodium
  10. Zinc

amino acids

  1. Cysteine
  2. Isoleucine
  3. Leucine
  4. Lysine
  5. Phenylalanine
  6. Threonine
  7. Tryptophan
  8. Tyrosine
  9. Valine
  10. Methionine
  11. Histidine

fatty acids

The list of essential and conditionally essential fatty acids is shorter than the other lists and is largely made up of omega 3 fats that the human body cannot manufacture in sufficient quantities. We need to go out of our way to incorporate these into our diet.

  1. Docosahexaenoic acid (DHA) (22:6 n-3)
  2. Eicosapentaenoic acid (EPA) (20:5 n-3)
  3. Docosapentaenoic acid (DPA) (22:5 n-3)
  4. Alpha-linolenic acid (18:3 n-3)

Given that a large part of my focus is to create a system that prioritises diabetic-friendly foods, I thought it would be good to give some more detailed consideration to other ‘good fats’, given that fat typically comprises more than half of the calories for someone following a reduced carbohydrate approach.  Listed below are the additional fatty acids that research shows to be beneficial.

  1. Arachidonic acid (20:4)
  2. Oleic acid (18:1)
  3. Lauric acid (12:0)
  4. Capric acid (10:0)
  5. Pentadecanoic acid (15:0)
  6. Margaric acid (17:0)

You can read more on the reason for inclusion of these additional good fats the Good Fats, Bad Fats article.

nutrient density score

Building on Joel Fuhrman and Matt Lalonde’s nutrient density approach, the nutrient score score is a relative score calculated by comparing the amount of a particular nutrient in each food against all of the foods.

For example, if a particular food has an average amount of Vitamin C compared to the 8,000 other foods in the database it will get a score of zero because it is zero standard deviations from the mean.  If it has a large amount of a certain nutrient then it will receive a high score.

If the amount that a particular nutrient is two standard deviations from the mean then it will get a score of two for that nutrient.  If however it is five standard deviations from the mean it gets a maximum score of three in order to avoid prioritising foods that have massive amounts of one single nutrient versus foods that have solid amounts of a range of essential nutrients.

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One example of where this limitation comes into play is kale, which has a massive amount of Vitamin K versus spinach which has a high amount of Vitamin K but also has a range of other nutrients.  Because of the upper limit on the score for a single nutrient the system gives a higher priority to spinach, which has a more well-rounded nutrient profile rather than simply being an overachiever in one or two nutrients.

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The nutrient score for a food is the sum of the individual nutrient scores across the forty three nutrients.  The higher the score the more nutritious that food is in comparison to the other foods in the database.

Weighting one nutrient as more important than another could be useful for an individual with a particular goal or health condition (e.g. DHA for someone battling brain cancer).  However I have chosen to keep ‘clean’ to avoid arguments about bias with equal weighting given to each nutrient.[22]  This system will simply highlight foods that have a wide range and a high quantities of nutrients.

weighted multi criteria analyses

Ranking foods by an individual parameter is interesting, however it doesn’t produce a balanced list of foods that you can live by.  Where things start to get interesting is when we combine the different parameters using a multi criteria analysis to suit different goals.

As an engineer I often use a multi criteria analysis (MCA) to analyse a lot of data.  A numerical MCA is a useful way to make sense of a large amount of data and shortlist from a wide range of options.

 

The available parameters from the USDA foods spreadsheet are:

  • nutrient density / calorie,
  • nutrient density / weight,
  • fibre / calorie,
  • fibre / weight,
  • calorie / weight, and
  • percentage insulinogenic calories.

The table below shows the weightings given to each criteria refined to create a shortlist of foods to suit different goals.

goal

ND / cal

ND / weight fibre / cal fibre / weight calories / weight

insulinogenic (%)

fat loss

40%

5% 5% 5% 25%

20%

athlete

5%

30% 10% 5% 5%

45%

diabetes & nutritional ketosis

5%

20% 10% 5% 10%

50%

therapeutic ketosis

5%

20% 5% 5% 0%

65%

  • Someone aiming for therapeutic ketosis will want to minimise their insulin load while maximising nutrition in the context of a very high fat diet.
  • Someone with diabetes or trying to achieve nutritional ketosis will also want to minimise their insulin load, however they should also look to maximise nutrient density and obtain adequate fibre.
  • Someone who has control of their blood glucose levels but is still trying to achieve fat loss will likely benefit from a diet with a reduced calorie density while still maximising fibre and nutrition.
  • An athlete’s primary priority will be to maximise nutrients without as much concern for calorie density or insulin load.

reality check

I have refined these weightings used in the MCA by reviewing the top 500 foods (of the 8000 foods in the USDA foods database) for each scenario.

goal

fibre (g) 

weight (g)  % protein % net carbs % insulinogenic

% fat

fat loss

45

1614 29% 13% 33%

31%

athlete

25

436 26% 12% 31%

56%

diabetes & nutritional ketosis

25

413 30% 4% 21%

58%

therapeutic ketosis

13

357 14% 3% 14%

80%

average all foods

26

899 26% 38% 52%

31%

It’s interesting to see that the net carbohydrates ends up being relatively low for all scenarios when we maximise nutrient density.  It appears that starchy carbs (e.g. grains and sugars) have a relatively low nutrient density compared to other available foods.

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The big differentiator across the approaches is calorie density.  If someone has stabilised their blood glucose and insulin levels then the next step in the journey may be to decrease calorie density to naturally manage food intake.  The fat loss approach is slightly more insulinogenic however practically it will be difficult to fit in all the food.

the results

While this process is somewhat convoluted the end result is a fairly simple list of foods that are ideal for different goals.  I have included a shortlist of the highest ranking foods on the blog here along with ‘cheat sheets’ that you can print and stick to your fridge or compile your food lists from.

It’s been great to see many people benefit from focusing these shortlists.  If you’re inquisitive and like to ‘peek under the hood’ I have also included links to a more detailed list that shows the basis of the rankings for each food.

goal blog cheat sheet detailed list
therapeutic ketosis visit download download
diabetes and nutritional ketosis visit download download
fat loss visit download download
athletes and metabolically healthy visit download download

references

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

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

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

[4] https://www.nuval.com/

[5] https://optimisingnutrition.wordpress.com/the-insulin-index/

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

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

[8] https://www.soylent.com/

[9] http://www.newyorker.com/magazine/2014/05/12/the-end-of-food

[10] http://robrhinehart.com/?p=424

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

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

[13] http://solvingnutrition.com/engineering-the-cheapest-and-healthiest-diet-on-a-budget/

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

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

[16] http://perfecthealthdiet.com/

[17] https://www.nrv.gov.au/nutrients/dietary-fibre

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

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

[20] https://optimisingnutrition.wordpress.com/2015/03/30/what-about-fibre-net-carbs-or-total-carbs/

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

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

good fats, bad fats

Even more than cholesterol or other blood markers it appears clear that insulin resistance, elevated blood glucose and hyperinsulinemia increase your risk of heart disease, obesity, stroke, cancer andom dementia.[1]

An understanding of the food insulin index data tends to lead people to increase the fat content of their diet in in an effort to normalise blood glucose and reduce insulin levels.[2]

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If a significant proportion of your calories are coming from fat it makes sense to look at the composition of our high fat food choices.

So let’s take a look what we could consider to be “good fats” and “bad fats” and the implications for prioritising our food choices.

a quick primer on fats

You’re likely aware that there are different classifications of fat based on their chemical structure:

  • saturated,
  • monounsaturated, and
  • polyunsaturated.

What this means is that:

  • saturated fatty acids have no double bonds between individual carbon atoms (note: saturated fats are denoted by X:0 where the X is the length of the carbon chain and 0 is the number of double bonds),
  • monounsaturated fats have one double bond (e.g. X:1), and
  • polyunsaturated fats have more than one double bond (e.g. X:2).

If you want to learn more about this topic I suggest you check out this page on nutritiondata.self.com.  It’s interesting to follow the links to see which foods are the highest in the different types of fats.

mainstream dietary advice

The standard mainstream dietary advice is to to:

  1. avoid trans fats,
  2. limit saturated fats to less than 7% of energy intake,
  3. emphasise omega 3 fats, polyunsaturated fats and monounsaturated fats, and
  4. keep dietary fat to between 20 to 35% of energy intake.[3]

The Mediterranean Diet is typically promoted as being the ideal dietary model,[4] [5] [6] although interestingly in practice people from the Mediterranean region actually consume more than the recommended amount of fat, typically from olive oils and fatty fish.[7] [8] [9] [10]

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dietary fats versus adipose tissue

Jeff Volek and Steve Phinney in the Art and Science of Low Carbohydrate Performance[11] [12] note that the majority of human body fat consists of monounsaturated fatty acids, with smaller amounts of saturated fats and polyunsaturated fats.  They argue that if the body stores a greater proportion of monounsaturated fatty acids for energy in times of famine then it makes sense to align our dietary fat intake with these ratios.

The table below compares the composition of human adipose tissue[13] versus the proportion of fats across the 8000 foods in the USDA database.  Based on this logic it appears that we should go out of our way to emphasis monounsaturated fat given than saturated and polyunsaturated fats are plentiful in our food system.

% adipose

dietary

adipose / dietary

saturated

30%

36%

81%

monounsaturated

54%

42%

129%

polyunsaturated

16%

22%

75%

The chart below shows the relative proportions of each of the fatty acids in human adipose tissue.  Oleic acid (18:1) (a monounsaturated fat) is the most plentiful, followed by Palmitic acid (16:0) (a saturated fat) and Linoleic acid (18:2) (a polyunsaturated fat).image004

Taking Volek and Phinney’s logic a step further, the table below shows a comparison of the proportion of each fatty acid in our adipose tissue compared to their availability in the modern diet (based on the average across the 8000 foods in the USDA database).  It appears that we have more than enough Stearic acid (18:0), Linoleic acid (18:2) and Linolenic acid (18:3) available in the food system while a number of the other fatty acids are deficient.

isomer

adipose (mol %) % adipose dietary adipose / dietary class

14:0

2.8

3.0% 2.7% 110%

SFA

16:0

21.5

23.0% 17.4% 132%

SFA

16:1 n-7

7.2 7.7% 2.08% 369%

MUFA

18:0

3.4 3.6% 9.2% 39%

SFA

18:1 n-9

43.5 46.5% 36.6% 127%

MUFA

18:2 n-6

13.9 14.9% 17.5% 85%

PUFA

18:3 n-3

0.8 0.9% 1.8% 48%

PUFA

20:3 n-6

0.2 0.2% 0.012% 1744%

PUFA

22:4 n-6

0.1 0.1% 0.004% 2426%

PUFA

22:5 n-3

0.1 0.1% 0.1% 140%

PUFA

22:6 n-3 0.1 0.1% 0.3% 37%

PUFA

oleic acid versus linoleic acid

The two most prevalent fats in our diet and on our body are Oleic acid (18:1) and Linoleic acid (18:2).

While Linoleic acid (18:2) is considered to be an essential fatty acid [14] (meaning that the body cannot manufacture it from other dietary components) the data in the table above indicates that there is a relative abundance of it in the dietary system.

Many people believe that excess Linoleic acid (18:2) from vegetable oils (which causes an imbalance in our omega 3 : omega 6 ratio) is a major contributor to the obesity epidemic. [15]

The common wisdom is that olive oil, which is high in the monounsaturated fat Oleic acid (18:1), is a healthy ‘good fat’. [16]  When we look at the research it appears well established that emphasising the monounsaturated Oleic acid (18:1) and reducing the polyunsaturated Linoleic acid (18:2) will improved insulin resistance.[17] [18] [19] [20]

omega 3 fatty acids

Improving the omega-3 : omega-6 ratio is widely regarded as important to reduce inflammation and optimise brain function and mental health.[21] [22]    Omega 3 fatty acids are typically obtained from seafood and are generally considered to be ‘good fats’ that we should be maximising for health.

While there appears to be plenty of DHA (22:6 n-3) available in the diet when we simply consider the composition of adipose tissue, it’s worth noting that DHA makes up 30% of the brain and 50% of our retina, so it is probably going to fall into the category of ‘good fats’ that we should be going out of our way to pursue in our diet.

A recent mouse study showed that fish oil (high in omega 3 fatty acids) is better than lard (high in saturated fatty acids, particularly palmitic acid (16:0) and stearic acid (18:0)) when it comes to weight gain, gut bacteria, obesity and insulin resistance.[23]  While people are clearly different from mice, it’s not unreasonable to think that fish oil might be better than eating lard.

Omega 3 fats are relatively rare in our food system which means we need to go out of our way to incorporate them into our diet.   The table below shows the omega 3 fatty acids that I think we should count as good fat along with the foods they are commonly found in.

isomer common name common foods
22:6 n-3 (DHA) Docosahexaenoic acid (DHA) fish oil, caviar, seal oil, cod liver oil, sardine oil
20:5 n-3 (EPA) Eicosapentaenoic acid (EPA) fish oil, caviar, fish
18:3 n-3 c,c,c (ALA) Alpha-linolenic acid peanut butter, flax seed, butter
22:5 n-3 (DPA) Docosapentaenoic acid (DPA) seal oil, fish oil – menhaden, fish oil – salmon.

MCT oils

You might have heard a lot of talk about MCT (medium chain triglycerides) oils recently.  These shorter chain fats appear to bypass the lymphatic system and are transported directly to the liver via the portal vein.

Many people find benefit from using MCT oil as an aid to extend periods between meals or and cognitive enhancement.[24]  MCT oils are more readily turned into ketones which provide an alternative fuel source to the brain.   In turn, ketones can increase satiety[25] and decrease appetite, both of which may facilitate weight loss.[26]

image005

MCTs make up about 1.1% of the fats in our food supply in coconut oil, butter, cheese and cream, however to get higher levels you will to supplement.

isomer common name common foods
12:0 Lauric acid palm kernel oil, coconut oil
10:0 Capric acid cheese, coconut oil, palm kernel oil
8:0 Caprylic acid coconut oil, coconut cream, palm kernel oil
6:0 Caproic acid butter, cheese, cream

trans fats

Artificial trans fats (a.k.a. partially hydrogenated oils) are one of the few components of the diet that are widely accepted as unhealthy.[27]   If you look at the foods in which artificial trans fats are the most prevalent, it’s hard to disagree.

isomer common foods
18:1 t (g) soy shortening, margarine, canola oil
18:2 t (g) KFC, margarine
18:2 t,t (g) McDonald’s, fast foods
16:1 t (g) thickshake, cheeseburger, hamburger, fast foods

The issue with counting all trans fats as a bad fat is that they can also occur naturally in small amounts in meats and dairy such as grass fed beef.[28] [29]

image006

Given that the USDA database does not differentiate between partially hydrogenated oils and naturally occurring trans fats, I have not assigned trans fats a negative mark.  Emphasising other ‘good fats’ will demote foods that contain artificial trans fats.

the effect of replacing carbohydrates with fat

The common view is that dietary fat, particularly saturated and trans fats, should be avoided in order to optimise blood cholesterol markers.  But what happens when we substitute fat for carbohydrates?

The chart below from a paper by cardiologist Dariush Mozaffarian[30] indicates that trans fats (TFA) have a negative impact on all blood markers (i.e. TC/HDL, LDL and HDL).  So there’s no disagreement there.

However increasing dietary saturated fat:

  • increases LDL (note: this is generally considered to be bad although it’s not clear if this is large buoyant of small dense LDL),
  • has minimal effect on the total cholesterol to HDL ratio, and
  • increases HDL (good).

Replacing carbohydrates (CHO) with either monounsaturated (MUFA) or polyunsaturated (PUFA) have what are generally regarded to be positive outcomes.

image007

Whether or not saturated fat is beneficial starts to become a little clearer when we look at the effect of individual fatty acids.  The data below shows that while Lauric acid (12:0) increases LDL it also has very a positive effect on increasing HDL and decreasing the TC : HDL ratio.

image008

saturated fats and insulin resistance

Mozaffarian says

“SFA has been considered a risk factor for insulin resistance and diabetes mellitus, but review of the current evidence indicates surprisingly equivocal findings. SFA consumption inconsistently affects insulin resistance in controlled trials and has not been associated with incident diabetes in prospective cohort studies.”[31]

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Things start to get more interesting when you look at the relationship between individual fatty acids, insulin resistance and type 2 diabetes.

The investigators found that saturated fatty acids with an odd number of carbon atoms in their chain (15:0 and 17:0) were associated with a lower risk of type 2 diabetes, whereas even-chain saturated fatty acids—14:0, 16:0, and 18:0—were associated with a higher risk.  Longer-chain saturated fatty acids (20:0, 22:0 and 24:0) also were found to be inversely associated with incident type 2 diabetes. [32] [33] [34]   

This also aligns with the mouse study that mentioned above where fish oil was found to have a better outcome on obesity and gut health compared to lard (which is high in 16:0 and 18:0).

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The table below shows the foods that these ‘good fats’ are contained in.  Meat and nuts are embraced in the paleo and low carb scenes.  The benefits of dairy are debated, but this is typically related to the casein and lactose content which some people don’t tolerate well.

isomer common name common foods
17:0 Heptadecanoic acid tofu, lamb, beef
20:0 Arachidic acid macadamia nuts, peanut butter
22:0 Behenic acid peanut oil, peanut butter, sunflower oil, macadamia nuts
15:0 Pentadecanoic acid cream cheese, sour cream, lamb, beef
24:0 Lignoceric acid peanut butter, rosemary, macadamia nuts, cashew nuts, sunflower seeds

summary

Listed below (in order of prevalence in the dietary system) are the ten fatty acids that I think should be included in the list of ‘good fats’ along with the common foods that they are contained in and the basis for their inclusion.

fatty acid common foods comment
Oleic acid (18:1) olive oil, sunflower oil, hazelnut oil, safflower oil, soybean oil, almond oil, avocado oil commonly associated with positive health outcomes and key component of Mediterranean diet

improves insulin resistance.

most abundant fatty acid in human adipose tissue

underrepresented in food system.

reduces TC:HDL ratio

Lauric acid (12:0) palm kernel oil, coconut oil increases HDL

decreases TC:HDL ratio.

Alpha-linolenic acid (18:3 n-3) peanut butter, flaxseed, nuts, cloves, cheese omega-3.

inflammation lowering

improves insulin resistance

Capric acid (10:0) cheese, coconut oil MCT oil.

Improves HDL:LDL ratio.

Docosahexaenoic acid (DHA) (22:6 n-3) fish oil – salmon, caviar, seal oil, cod liver oil, sardine oil essential fatty acid

omega 3.

abundant in human brain.

Arachidonic acid (20:4) salmon, chicken heart, liver, brain conditionally essential.

rare in food system.

Eicosapentaenoic acid (EPA) (20:5 n-3) fish oil, caviar, fish omega-3.

inflammation lowering.

improves brain function.

Margaric acid (17:0) tofu, lamb, frankfurter, beef sausage reduced risk of type 2 diabetes.
Docosapentaenoic acid (DPA) (22:5 n-3) seal oil, fish oil – menhaden, fish oil – salmon omega-3 though small quantities.
Pentadecanoic acid (15:0) cream cheese, sour cream, lamb. lower risk of type 2 diabetes

And for completeness listed below (in order of their prevalence in the dietary system) are the fatty acids in the USDA food database that didn’t make the ‘good fats’ list.

fatty acid common foods comment
Linoleic acid (18:2) safflower oil, grapeseed oil, sunflower oil, walnut oil n-6 component is essential however overly abundant in food system

substituting linoleic acid for oleic acid has been shown to improve insulin resistance

Palmitic acid (16:0) palm oil, fish oil – menhaden, butter, lard higher risk of type 2 diabetes

poor gut bacteria outcomes in mice study

Stearic acid (18:0) cocoa butter, shortening, margarine, lard increased risk of type 2 diabetes.

poor gut bacteria outcomes in mice study.

overly abundant in food system

18:1 c canola oil, margarine subset of 18:1 – no need to double count
18:2 n-6 c,c soy oil, sunflower oil, soybean oil, mayonnaise subset of 18:2.
Myristic acid (14:0) nutmeg, coconut oil Increased risk of type 2 diabetes
Palmitoleic acid (16:1) macadamia nuts, fish oil, seal, whale Increased risk of type 2 diabetes
Linolenic acid (18:3) flax seed, chia seed, walnuts, basil adequate in food system.

only count n-3 ALA component.

18:1 t Soy shortening, margarine, canola oil. trans fat
Gadoleic acid (20:0) seal, eel, fish oil – herring, fish -–halibut, fish oil – cod liver, salmon small quantities and limited research.
Caprylic acid (8:0) coconut oil, coconut cream. MCT but rare in food system other than manufactured foods
Erucic acid (22:1) herring, halibut, sardine, cod liver no clear health benefits / research
Butyric acid (4:0) butter, cheese MCT but rare in food system other than manufactured foods
16:1 c KFC, Popeye’s, fast food predominantly in fast foods.
Caproic acid (6:0) butter, cheese, cream. MCT but rare in food system other than manufactured foods
Arachidic acid (20:0) macadamia nuts, peanut butter. reduced risk of type 2 diabetes but rare in food system.
Behenic acid (22:0) peanut oil, peanut butter, sunflower oil, macadamia  nuts, reduced risk of type 2 diabetes but rare in food system.
Myristoleic acid (14:0) frankfurter, beef sausage, bologna, cream cheese minimal research.

small quantities in food system

18:2 i soy oil, canola oil, margarine, French fries minimal research.

small quantities in food system

Heptadecenoic acid (17:0) tofu, broccoli, beef minimal research.

small quantities in food system

18:2 t KFC, margarine trans fat
18:4 fish oil – sardine, fish oil – salmon, fish oil – menhaden, oysters very small quantities in food system
Eicosadienoic acid (20:2 n-6 c,c) English muffin, margarine, fast foods, pine nuts, ham
Lignoceric acid (24:0) peanut butter, rosemary, macadamia nuts, cashew nuts, sunflower seeds reduced risk of type 2 diabetes
18:2 t,t MacDonald’s, fast foods trans fat
Eicosatrienoic acid (20:3) pine nuts, mustard, whitefish, seal, salmon appears beneficial but minimal quantities in food system
Pentadecenoic acid (15:0) tofu, miso, beef sausage appears beneficial but minimal quantities in food system
Gamma-linolenic acid (18:3 n-6) margarine omega 6

minimal quantities.

16:1 t thick shake, cheeseburger, hamburger, fast foods. trans fat
20:3 n-6 KFC, Popeye’s, fast food. Omega 6 and primarily in fast food
Nervonic acid (24:1 c) mustard, salmon, seal, flax seed likely beneficial, but minimal quantities
22:1 c margarine. minimal quantities in food system

optimal fatty foods

Shown below is the list of fatty foods sorted by their relative quantity of the good fats with their percentage of insulinogenic calories also shown.  The order itself is not that important (otherwise the seals and whales would be even more endangered due to this article), however the big winners are:

  • fish oil (seal, whale, menhaden, sardine, herring, salmon, cod liver),
  • fish (smelt, salmon, herring, caviar, mackerel, caviar, trout, swordfish),
  • lamb, pork and beef, and
  • cheese, butter and cream.
food % insulinogenic nutrient density
oil – bearded seal 0% 20.6
oil – beluga whale 0% 17.9
oil – spotted seal 0% 17.4
smelt – dried 33% 14.4
salmon 39% 14.1
fish oil – cod liver 0% 14.0
fish oil – salmon 0% 13.4
fish oil – sardine 0% 13.1
fish oil – menhaden 0% 13.0
fish oil – herring 0% 12.7
lamb fat 2% 12.7
mackerel 14% 11.5
pork fat 3% 11.0
whitefish 38% 10.9
cream cheese 8% 10.4
caviar 26% 10.3
bacon fat 0% 9.8
butter 0% 9.0
roe 37% 8.9
sablefish 16% 8.7
seal 22% 8.5
beef steak 21% 8.3
parmesan cheese 24% 8.2
herring 19% 8.2
whitefish 33% 8.2
pepperoni 10% 8.1
beef sausage 9% 7.5
turkey fat 0% 7.1
lamb 16% 7.1
macadamia nuts 5% 7.0

It’s important to keep in mind that consuming enough “good fats” is only part of the nutrition story.  In the next article we’ll look at how we can use this understanding of good fats along with our understanding of vitamins, mineral and amino acids to identify the most nutrient dense foods for different goals.

references

[1] https://optimisingnutrition.wordpress.com/2015/03/22/diabetes-102/

[2] https://optimisingnutrition.wordpress.com/2015/03/23/most-ketogenic-diet-foods/

[3] http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/fat/art-20045550?pg=2

[4] http://health.usnews.com/best-diet/mediterranean-diet

[5] http://diabeticmediterraneandiet.com/ketogenic-mediterranean-diet/

[6] http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801

[7]  http://www.nature.com/ejcn/journal/v56/n10/full/1601413a.html

[8] http://www.internationaloliveoil.org/estaticos/view/87-mediterranean-diet-pyramid

[9] http://www.ncbi.nlm.nih.gov/pubmed/10700478

[10] http://ajcn.nutrition.org/content/61/6/1402S.full.pdf+html

[11] http://www.artandscienceoflowcarb.com/

[12] http://www.amazon.com/The-Art-Science-Carbohydrate-Performance/dp/0983490716

[13] http://www.researchgate.net/publication/5416860_Hodson_L_Skeaff_CM_Fielding_BA._Fatty_acid_composition_of_adipose_tissue_and_blood_in_humans_and_its_use_as_a_biomarker_of_dietary_intake._Prog_Lipid_Res_47_348-380

[14] https://en.wikipedia.org/wiki/Linoleic_acid

[15] http://www.forbes.com/sites/realspin/2015/09/29/could-so-called-healthy-vegetable-and-seed-oils-be-making-us-fat-and-sick/

[16] http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801

[17] http://www.ncbi.nlm.nih.gov/pubmed/10700478

[18] http://www.ncbi.nlm.nih.gov/pubmed/14713277

[19] http://qjmed.oxfordjournals.org/content/93/2/85

[20] http://www.ncbi.nlm.nih.gov/pubmed/10700478

[21] http://www.ncbi.nlm.nih.gov/pubmed/12442909

[22] http://chriskresser.com/how-too-much-omega-6-and-not-enough-omega-3-is-making-us-sick/

[23] http://www.the-scientist.com/?articles.view/articleNo/43854/title/how-fats-influence-the-microbiome/

[24] http://www.bulletproofexec.com/how-to-make-your-coffee-bulletproof-and-your-morning-too/

[25] http://www.nature.com/ijo/journal/v25/n9/full/0801682a.html

[26] http://www.nature.com/ijo/journal/v25/n9/full/0801682a.html

[27] http://www.marksdailyapple.com/why-are-trans-fats-bad/#axzz3mSg8Rg6D

[28] http://chriskresser.com/can-some-trans-fats-be-healthy/

[29] http://www.ncbi.nlm.nih.gov/pubmed/21427742

[30] http://www.ncbi.nlm.nih.gov/pubmed/20354806

[31] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950931/

[32] http://www.thelancet.com/journals/landia/article/PIIS2213-8587(14)70166-4/fulltext?rss=yes

[33] http://www.medscape.com/viewarticle/829920

[34] http://www.thelancet.com/action/showFullTextImages?pii=S2213-8587%2814%2970146-9

ketogenic fibre

  • High fibre foods are often high in carbohydrates which can be problematic for people with diabetes or those trying to achieve ketosis.
  • People aiming for a low carbohydrate diet often avoid all carbohydrates, including fibre, however this may not be optimal for gut health or overall nutrition in the long term.
  • This article highlights nutrient dense, low carbohydrate sources of fibre that will have a minimal effect on blood glucose levels while helping to support gut health.

Dr Michael Ruscio

The human gut and the bacteria that inhabit it are still largely a mystery.  However the latest research indicates that it is important.

I recently heard an intriguing information-packed interview with Michael Ruscio on Episode 985 of Jimmy Moore’s Livin’ La Vida Low Carb Show where he said that:

  • Some people don’t do well with a very low carb approach in the long term;
  • Some studies indicate that a very high fat diet can lead to increased intestinal permeability (aka leaky gut) which can lead to insulin resistance;
  • In spite of the possible risk to optimal gut health, Dr Ruscio advises his patients to use a LCHF approach to manage blood glucose and weight, particularly for those who are insulin resistant;
  • His preferred approach is to start patients on a low carbohydrate autoimmune protocol and slowly increase carbohydrates to find their tolerance level for carbohydrates where they stop benefiting in terms of body weight or body fat; and
  • People on a low carb diet may benefit from a diet high in fibre / prebiotics / FODMAPs to promote microbial diversity and improve insulin sensitivity.

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While some people believe that it is beneficial to try to manipulate the firmicutes : bacteroides ratio[1]  [2] or some other feature of gut microbiome,[3] Dr Ruscio says that this is far from settled science.  What we do know is that a more diverse population of gut bacteria will reduce the probability that one strain of bacteria will take over our gut and become dominant (i.e. overgrowth).

Early exposure to a range of bacteria in a less sanitised environment helps to improve the ‘tone’ of our gut bacteria and reduces our chance of developing autoimmune issues.

While Dr Ruscio is cautious to highlight that we can’t just run a test and treat based on the results, he does a great job of teasing out what we can really know from the latest research on gut health in his AHS2014 talk.

total or net carbohydrates?

Prebiotics are, quite simply, indigestible food ingredients that stimulate the growth and maintenance of beneficial gut microbiota.[4]

While prebiotic fibre[5] appears to be beneficial for the gut microbiome, some people in the low carbohydrate scene will avoid fibre containing foods to eliminate the risk of these foods impacting on their blood glucose levels.[6] [7] [8]

In practice, however, this approach leaves people with a fibre intake well below the recommended minimum of 25g for women and 30g per day for men.[9]

In his article Sorry Low Carbers Your Microbiome is Just Not that Into You[10] Jeff Leach of the Human Food Project notes that (although he eats a high fat high fibre diet) people consuming a low carbohydrate diet aren’t necessarily slimmer.  He suggests that this may be due to the lack of fermentable fibre.

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The confusion around whether to count ‘total carbs’ or ‘net carbs’ is exacerbated by the fact that many people find that, despite claims of low net carbohydrates and high fibre, some manufactured ‘low carb’ products will often raise blood glucose levels.

At the same time, the food insulin index data suggests that there is no insulin response to fibre in foods.  As detailed in this article, the correlation between insulin response and net carbs is much better than with total carbohydrates.   This makes sense when we consider that fibre is not digested and absorbed by our intestinal tract but is instead metabolized by our gut bacteria.

The formula below for the calculation of insulin load is based on the observation that there is no insulin response to fibre and thus fibre should be negated from the calculation.  To minimise the insulin load of our diet we need to prioritise foods that are high in fibre, low in digestible carbohydrates, and moderate in protein.

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For most people this is largely a theoretical issue, but for people with type 1 diabetes who need to accurately calculate their insulin dose it becomes more important.  The most prudent approach used by experienced type 1’s is to take a ‘net carbs’ approach to real whole foods, while assuming half or maybe all of the fibre in manufactured food products will be digestible (or ideally avoiding manufactured foods completely).

If you are particularly concerned about your blood glucose levels the ideal approach is to do your own n=1 experiment to test and track your own blood glucose levels to see if they rise after a particular food.

David Perlmutter

Dr David Perlmutter is a fascinating character on the cutting edge of the latest in health and wellness.

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Perlmutter talks a lot about the benefits of prebiotics and probiotics for gut and brain health.  Prebiotics are fibres that are not digestible by our stomach but rather feed the bacteria in our gut.  Probiotics involve actually ingesting bacteria such as those found in yogurt, sauerkraut, Kombucha, Kefir, or other fermented foods.

Perlmutter notes that Americans typically get about five grams of fibre per day compared to the estimated one hundred and thirty grams of fibre that our Palaeolithic ancestors appear to have consumed.[11]

Dr Perlmutter spoke recently on Mark Sisson’s Primal Blueprint podcast[12] about how he believed that type 2 diabetes relates to changes in the gut bacteria and noted that this condition has been reversed through faecal transplants, which transfers healthy gut bacteria from one person into another.

Perlmutter promotes foods high in inulin[13] to feed the gut bacteria.  Unfortunately, the issue for people with carbohydrate intolerance is that many of these foods are high in digestible carbohydrates that may also drive their blood glucose levels up.

I thought it would be useful to combine Perlmutter’s list of high inulin foods[14] with an evaluation of their proportion of insulinogenic calories and nutrient density.

As shown in the table below, the highest weighting used in the multi-criteria ranking is given to the insulinogenic properties of the foods (i.e. in order to prioritise foods that will not raise blood glucose levels), with some weighting given to fibre per calorie and fibre per weight, then to nutrient density per calorie and nutrient density per weight, and then calories per weight.

I find that it is important to consider the nutrient and fibre density in terms of both weight and calories.  Considering calories alone will bias towards leafy veggies and herbs while considering weight will bias towards nuts and seeds.  The best approach seems to be to consider both to get a balance.

ND / cal ND / weight fibre / cal fibre / weight calories / 100g insulinogenic (%) total
7.5% 7.5% 15% 15% 10% 45% 100%

Shown below are Perlmutter’s recommended probiotic foods from his Brain Maker book[15] sorted based on their insulinogenic properties, fibre content per calorie and nutrient density.    The foods with the lowest percentage of insulinogenic calories will have the lowest effect on blood glucose levels.   You can see more detail of the analysis here.

name % insulinogenic fibre (g) / kcal fibre (g) / 100g
asparagus 47% 0.08 2.1
dandelion greens 47% 0.07 2.9
onion 56% 0.06 2.4
leek 81% 0.03 1.8
garlic 85% 0.01 2.1
Jerusalem-artichoke 87% 0.02 1.6
chicory root 87% 0.02 1.5

It’s worth noting that Perlmutter generally recommends eating these foods raw.  As detailed in this article, cooking will change the fibre content of the foods, but perhaps not as much as you might think.

FODMAP foods

Limiting FODMAP foods (i.e. Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) is a way of improving digestion in those with irritable bowel syndrome (IBS).[16]   However, eliminating FODMAP foods may not be ideal in the long term.  Once you have digestive issues under control it may be beneficial to slowly reintroduce FODMAP foods to promote a more diverse bacteria as well as increasing your nutrients.

After a period of avoiding FODMAP foods, the overgrowth of undesirable gut bacteria should diminish and you may be able to tolerate small amounts introduced slowly.[17]

In order to understand which FODMAP foods contain the most fibre and would be gentlest on blood glucose levels, I have run the FODMAP foods through the multi-criteria analysis with the weightings shown above.   A shortlist of the highest ranking FODMAP foods is shown below.  You can download the full detailed list here.

name % insulinogenic fibre(g) / kcal fibre (g) / 100g
celery seed 34% 0.03 12
peanuts 14% 0.02 10
peanut butter 17% 0.01 6
pistachio nuts 19% 0.02 10
cashew nuts 23% 0.01 3
beans 57% 0.07 25
broad beans 55% 0.07 25
lentils 50% 0.09 31

our experience

Personally, I can eat pretty much anything and not have it bother me.  However, I know that eating nutrient dense foods with a lower insulin load has helped me to feel brighter, less inflamed, and less fat.

On the other end of the spectrum, my wife Monica has type 1 diabetes and a host of digestive issues that seem to be part of the autoimmunity package deal.  For her, feeling good, getting enough rest, having good gut health, and staying on top of her health is a constant battle.

I’ve been banging on about low carb diets for a while, but Monica’s ability to increase the amount of fat in her diet has been limited.  Whenever she’d have a high fat meal she would end up with stomach distress with the same situation occurring with anything that was meant to be ‘helpful’ for the gut like resistant starch, MCT oil or glucomannan.

Late last year we found an excellent naturopath, Elizma Lambert from Realize Health, who was able to identify from her symptoms and testing that she had small intestinal bacterial overgrowth (SIBO) which was stopping her from being able to digest the fats that were critical to succeeding on a low carbohydrate diet.

Elizma was able to guide Moni through a process of cleansing the small intestine and then repopulating it with a diverse range of good bacteria.  After testing her faecal microbiota through the Bioscreen lab in Melbourne[18] Elizma was able to identify areas where there was an overgrowth that needed to be treated followed by re-population with a diverse range of new good bacteria.

Individuals suffering from diabetes often struggle to metabolise fats and she also helped her, through supplementation of L-carnitine, to get her fat metabolism moving which has also enabled her to better clear the LDL cholesterol in her blood.[19]  Once the digestion and blood glucose levels improved, her depression also lifted and she was able to decrease medications.

More recently however Moni had to have antibiotics for an infection.  Unfortunately, the antibiotics also blew away the newly established good gut bacteria for a while, and a lot of the gut distress and depression issues regressed and she has had to work again to rebuild the good gut bacteria.

We’re blessed to have Elizma just around the corner from us in Brisbane Australia, however if you’re dealing with autoimmune or digestive issues then I encourage you to find someone who can guide you through the process, or even contact Elizma directly as she is now able to do consults via Skype.  Similarly, Chris Kelly of Nourish Balance Thrive in California, United States, will be able to guide you through the minefield back to metabolic health.

Jimmy Moore’s n=1

I’ve got a lot of time for prolific podcaster Jimmy Moore.  I have learned a great deal from his eager pursuit of information from all the experts that he interviews on his show.  After a life of morbid obesity, his brother dying at 41, and both grandfathers dying in their early 50s, Jimmy is on a quest to improve his own health and share his journey and learnings with the world in the process.

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Jimmy did a very public n=1 ketosis experiment where he lost 78 pounds (35kg) over a year of eating to optimise his blood glucose and maintain nutritional ketosis.  Launching from this he wrote the books Cholesterol Clarity and Keto Clarity which has done a lot to increase the profile of the ketogenic diet in the public consciousness.

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More recently however Jimmy has struggled to keep the weight off and blood glucose levels down in spite of continuing with a high fat ketogenic diet and keeping his calories reasonably low.  Jimmy has been quite up-front about this, even sharing all his test data and two podcast interviews with Chris Kelly of Nourish Balance Thrive.[20]

In the first interview[21] Chris recommended that Jimmy get into a regular exercise routine, eat more veggies, and stop donating blood due to his low iron levels.

After his interview with Chris, Jimmy’s Facebook and Instagram accounts started showing a lot of great looking plates of food piled with heaps of colourful veggies under the hashtag #howIreallyeat.

It seemed that Jimmy has moved on from his position of minimising total carbohydrates to maintain ketosis in favour of maximising veggies and nutrient density.

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In their second interview[22] Chris discussed Jimmy’s gut bacteria and possible overuse of dairy, and noted that Jimmy had a particularly limited population of gut bacteria.

Chris: And it’s very unusual for me to see what I saw on your test result, Jimmy, which is really low levels of all of the markers that come from bacteria. I wouldn’t like to say for sure that this means that there’s no bacteria there or undergrowth or anything like that. Again, I think it’s definitely — Once you seen this, it’s worth doing the experiment especially since I’ve seen on the CHRON-O-Meter results that your fibre was only a third of what the RDA is.

Jimmy: It’s higher now.

It seems that after finding that he was not keeping the weight off with the very high fat ketogenic approach that had helped him initially, he was eager to listen to Chris and try more nutrient dense veggies and fibre.  It’s also worth noting that Chris himself eats a very high fat ketogenic diet, but at the same time manages to get very high levels of fibre and nutrient density as detailed in this article.

It’s hard to know if Jimmy’s limited diversity of gut bacteria is the reason for his lifelong struggle with obesity or if it has more recently been exacerbated by his restricted palette of high fat foods low in prebiotic fibre.   Jimmy is not the first person I have seen struggle to balance their blood glucose levels in spite of following a disciplined high fat ketogenic diet.

Is Jimmy’s apparent limited microbial diversity due to years of poor nutrition before he found low carb, something weird in the water in North Carolina, or his prolonged extreme high fat diet?  Whatever the case, I think Jimmy would do well to take Chris’ advice and continue with his diet heavy in non-starchy veggies that look very tasty, nutrient dense and full of fibre.

Diabetes is a complex disease; however, it seems that gut health and fibre are part of the puzzle.

what does the research say?

I went looking for studies that support the idea that, as suggested by Dr Ruscio, a high fat diet can cause leaky gut and insulin resistance and found a handful of moderately useful references.

  • An article by Jamie Scott referenced a study where they found that people on a diet high in omega-6 rich seed oils developed leaky gut, however people on saturated fats fared much better.[23]
  • A rodent study from Thomas Seyfried suggested that a diet with excess calories and ketogenic macros can lead to weight gain and poor blood glucose outcomes.[24] However it’s worth noting that the food being tested in the experiment was a high fat powdered formula medical food.  It’s hard to know if you would get the same results whole foods.
  • In Episode 65 of Tim Ferris’s podcast Peter Attia talks about how he sees some people not thriving on a ketogenic diet, particularly if there is not an energy deficit.[25]
  • The study A High-Fat Diet Is Associated With Endotoxemia That Originates From the Gut[26] compares a ‘prudent diet’ (20% fat, 60% carbs, 31g fibre) with the ‘western diet’ (40% fat, 40% carbs and 12.5g fibre) for a month and finds that plasma endotoxin activity increases on the ‘western diet’ compared to the ‘prudent diet’. There are no further details of the diets, however given the difference in fiber it is likely that the ‘prudent diet’ was loaded with veggies while the ‘western diet’ was processed carbs.  I think it’s hard to draw any meaningful conclusions from this other than more fiber is better than less fiber, particularly given that 40% fat is not really a high fat low carbohydrate diet.
  • The study Comparative effects of very low-carbohydrate, high-fat and high carbohydrate, low-fat weight-loss diets on bowel habit and faecal short-chain fatty acids and bacterial populations[27] compares a low carbohydrate high fat diet (5% carbs, 13g fibre) with a high carbohydrate high fibre diet (including high fibre bran cereal and lentils) (46.4% carbs, 31.5g fibre) and found that the low carb diet group had less butyrate and bifidobacteria than the higher carbohydrate group.
  • A range of papers suggest high fat foods lead to metabolic disorders via the mechanism described graphically below. [28] I’m far from an expert in this emerging field of research, however it appears to me that the mechanism is more likely to relate to the lack of fibre and nutrients rather than necessarily the presence of fat in the diet.

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Overall, I would say that research in this area is interesting but not clear cut and subject to prejudice (i.e. people just ‘know’ that high fat diets are bad for you) and bias (e.g. an experiment where the ‘prudent diet’ is full of nutrient dense veggies and fibre while the high fat approach is nutritionally limp by comparison).

Paleo ambassadors such as Chris Kresser,[29] and Robb Wolf[30] have been getting excited lately about a paper by Ian Spreadbury Comparison with ancestral diets suggests dense acellular carbohydrates promote an inflammatory microbiota, and may be the primary dietary cause of leptin resistance and obesity.[31]  ‘Acellular carbohydrates’ refers to carbohydrates that are not contained within cellular storage vacules. This includes cereal grains and flours, whereas roots and tubers contain starch within cells (cellular).  The title of the paper pretty much says it all.

The paper makes a lot of sense, however what is missing is the ability to quantify ‘acellular carbohydrate’.  If we were to try to tie this back to something quantifiable I would say fibre is good, while processed non-fibrous carbohydrates are bad.

My takeaway learnings from the research is that:

  1. For whatever reason, some people don’t do well long term on an extreme high fat approach.
  2. Omega-3 fats are better when it comes to gut and metabolic health compared to omega-6 polyunsaturated fats.[32]
  3. A hypocaloric ketogenic diet is better than a hypercaloric ketogenic diet.
  4. More fibre is better than less fibre unless you are recovering from digestive issues such as SIBO or IBS. Reducing fermentable fibre is a temporary solution until the yeasts or bacteria are cleared from the small intestine, and in no way a long-term approach to a healthy diet and biochemistry.

From an evolutionary point of view I cannot see a mechanism that demonstrates how naturally occurring fats that we have been eating for many generations (e.g. olive oil, butter, coconut oil, cream, etc.) have suddenly become the cause of the gut distress and autoimmunity that we have seen flourish in recent decades when the use of sugar and highly processed grains have also exploded.

butyrate

According to Wikipedia:

Butyrates are important as food for cells lining the mammalian colon (colonocytes). Without butyrates for energy, colon cells undergo autophagy (self-digestion) and die.

Short-chain fatty acids, which include butyrate, are produced by beneficial colonic bacteria (probiotics) that feed on, or ferment prebiotics, which are plant products that contain adequate amounts of dietary fibre.

These short-chain fatty acids benefit the colonocytes by increasing energy production and cell proliferation and may protect against colon cancer.[33]

There have been two recent health fads which attempt to increase butyrate:

  • resistant starch, and
  • Bulletproof coffee.

Increasing the amount of resistant starch in the diet, as promoted by Richard Nikoley[34] and Tim ‘Tater Tot’ Steele,[35] aims to actively feed the good gut bacteria and increase butyrate in the gut from the bacterial fermentation of the resistant starch.  Robb Wolf’s sensitive digestion seems to have benefited from adding resistant starch.  Mark Sisson also came out with a definitive guide to resistant starch that was overall in favour of it.[36]

Personally I’ve tried resistant starch.  It definitely does something in your gut.  I can’t say that my life was changed markedly for the better, but it may be a useful supplement.  Though as with all supplements, it’s probably not ideal to be taking them for the rest of your life but rather find the required nutrients in real whole food if possible.

One of the claimed benefits of Bulletproof coffee is that high butyrate content of the grass-fed butter is beneficial for the gut.[37]  What is not clear though is whether the ingested butyrate actually gets to the lower intestine, as it is a small molecule which would likely be absorbed before it reaches the large intestine.  Using butyrate as a suppository or part of an enema is an option, but it seems a better idea to have the colonic bacteria present to produce butyrate and other short chain fatty acids for gut health.

safe starches

Paul Jaminet is a proponent of safe starches to improve gut health.  In his Perfect Health Diet he recommends eating some carbohydrate foods such as white rice, white potato, and sweet potato.[38]

These minimally processed whole foods are better than processed carbohydrate and I can understand how these safe starches could be beneficial to feed gut bacteria, which may lead to an overall improvement in health.  However, for a diabetic these high GI and high carbohydrate foods likely do not provide an acceptable solution when it comes to blood glucose levels.

sugar, processed carbohydrates and gut health

It seems most people agree that that cutting out sugar and processed foods is a good thing.

Dropping sugar and processed carbohydrates will reduce your chance of feeding an overgrowth of ‘bad bacteria’ (especially Streptococcus, Enterococcus and yeasts such as Candida albicans).

Enter the low carb paleo approach with plenty of nutrient dense fibre.[39] [40]

fibre and satiety

Fibre makes us feel full.  While high fat foods are calorie dense (at nine calories per gram), high fibre foods increase the bulk of our food without necessarily increasing calories.

Glucomannan is a water soluble dietary fibre with some clear research findings behind it, showing that it absorbs water and swells in your stomach to promote a feeling of fullness, as well as working as a prebiotic to increase the diversity of bacteria in the gut.[41]

The other good thing about high fibre foods is that they often come packaged with plenty of nutrients.

Real whole foods will be more likely to contain the essential nutrients, as well as other beneficial nutrients that we have not yet identified.  Isn’t the ideal food something that will give us plenty of fibre to feed our gut, keep us full, give us nutrients and keep us regular?

While there are lots of fibre supplements out there (e.g. glucomannnan, potato starch, and psyllium husk) I think the ideal way is to maximise the nutrient dense high fibre foods.

In line with the idea that we want to promote a good range of healthy gut bacteria, we also want to eat a wide range of fibre in our food (soluble, insoluble and mucilaginous) to promote a wide range of gut bacteria.

so how do we get fibre without raising blood sugars?

Again, we seem to have a balancing act between maximising fibre and nutrition on one hand and managing blood glucose levels on the other.

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So what foods can we eat that will give us all the good stuff without negatively impacting our blood glucose levels?

Rather than just looking at high inulin foods or FODMAP foods as discussed above, I have analysed all of the USDA foods database to find the foods that have the highest amount of fibre that will provide us with plenty of nutrients and be gentle on our blood glucose levels.

The highest ranking foods are shown below while a more extensive list can be downloaded here (note: this list is sorted based using a multi criteria analysis that considers fibre, nutrient density and insulinogenic properties).  Foods with a lower percentage of insulinogenic calories will be gentler on your blood glucose levels while the foods with more fibre will be great for your gut.

As you look down this list you will see that most of these foods are nutrient dense seeds, herbs or leafy vegetables.  Rice and wheat feature in the mix, but only in their natural unprocessed form.

food % insulinogenic fibre (g) / kcal fibre (g) / 100g
flaxseed 8% 0.05 27
sesame seeds 12% 0.03 17
caraway seed 22% 0.09 38
chili powder 24% 0.09 35
rosemary 23% 0.10 43
basil 29% 0.12 38
sage 26% 0.10 40
sunflower seeds 11% 0.02 12
sesame seeds 14% 0.02 12
hazelnuts 8% 0.02 11
paprika 28% 0.09 35
savory 30% 0.13 46
marjoram 31% 0.11 40
parsley 32% 0.10 33
curry powder 31% 0.08 33
almonds 14% 0.02 12
mustard seed 22% 0.02 12
pine nuts 9% 0.08 43
almond butter 12% 0.02 10
Kellogg’s all-bran w/ ex fibre 35% 0.13 50
oregano 36% 0.12 43
thyme 36% 0.10 37
cloves 35% 0.08 34
spearmint 39% 0.09 30
sesame butter (tahini) 18% 0.02 9
peanuts 14% 0.02 10
pepper, red or cayenne 34% 0.06 27
pistachio nuts 19% 0.02 10
cumin seed 39% 0.02 11
turmeric 51% 0.06 21
celery flakes 53% 0.09 28
avocados 7% 0.04 7
pepper, black 54% 0.08 25
chives 54% 0.07 26
peanut flour 39% 0.03 13
radishes 60% 0.08 24
peppers 45% 0.07 22
coconut meat 6% 0.02 16
chia seeds 13% 0.07 34

As shown in the formula below the percentage of insulinogenic calories is lower the more fibre we have.

image01

If you are concerned about your blood sugar then try to choose foods with a lower percentage of insulinogenic calories, keeping in mind that a whole egg is about 25%.

summary

In summary, I think a ‘well formulated ketogenic diet’ that will be beneficial for both blood glucose and overall health looks less like this…

image14

… and more like this.

image13

A high fibre nutrient dense diet will give you a better chance of achieving health without messing up your blood glucose levels.

acknowledgements

  • Thanks to Alex Leaf and Elizma Lambert of Realize Health for reviewing this article and providing some of the more technical detail. If you feel like you’ve tried everything and still need some help I highly recommend contacting Elizma who can arrange some additional testing and get to the bottom of the issue.
  • Thanks to Jimmy Moore for chasing Dr Ruscio for some more references on the subject and Michael Ruscio for providing references.

references

[1] https://microbewiki.kenyon.edu/index.php/Link_Between_Microbes_and_Obesity

[2] http://drruscio.com/probiotics-weight-loss-test-810/

[3] http://humanfoodproject.com/please-pass-microbes/

[4] http://www.marksdailyapple.com/prebiotics/#axzz3j5eI13iu

[5] http://www.marksdailyapple.com/prebiotics/#axzz3j5XIihW8

[6] https://proteinpower.com/drmike/2006/08/30/a-cautionary-tale-of-mucus-fore-and-aft/

[7] http://talkfeed.co.za/web-hold-lchf-diet-answers/

[8] http://authoritynutrition.com/10-myths-within-the-low-carb-community/

[9] http://www.webmd.com/diet/guide/fiber-how-much-do-you-need

[10] http://humanfoodproject.com/sorry-low-carbers-your-microbiome-is-just-not-that-into-you/

[11] http://www.humansarenotbroken.com/plant-paleo-part-2-grains-legumes-fiber-and-antinutrients/

[12] http://blog.primalblueprint.com/episode-70-dr-david-perlmutter/

[13] https://en.wikipedia.org/wiki/Inulin

[14] http://www.amazon.com/Brain-Maker-Power-Microbes-Protect/dp/0316380105

[15] http://www.drperlmutter.com/about/brain-maker-by-david-perlmutter-md/

[16] http://shepherdworks.com.au/disease-information/low-fodmap-diet

[17] http://www.thepaleomom.com/2012/09/reintroducing-foods-after-following-the-autoimmune-protocol.html

[18] http://www.bioscreenmedical.com/

[19] http://www.suppversity.com/2015/04/acute-l-carnitine-tartrate.html#vo2

[20] http://www.nourishbalancethrive.com/

[21] http://www.thelivinlowcarbshow.com/shownotes/12392/961-christopher-kelly-analyzes-latest-functional-health-tests-for-jimmy-moore/

[22] http://www.nourishbalancethrive.com/podcasts/nourish-balance-thrive/diet-consultation-jimmy-moore/

[23] http://thatpaleoguy.com/2012/01/05/dietary-fat-can-modulate-intestinal-tight-junction-integrity/

[24] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1819381/

[25] http://fourhourworkweek.com/2015/03/18/mark-hart-raoul-pal-peter-attia/

[26] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3978718/

[27] http://journals.cambridge.org/download.php?file=%2FBJN%2FBJN101_10%2FS0007114508094658a.pdf&code=b061b827201900699a5cdd4ecca8b84c

[28] http://www.slideshare.net/aeislas/the-role-of-the-gut-microbiota-in-nutrition-and-health

[29] https://chriskresser.com/are-vegetarian-diets-better-for-the-microbiome/

[30] http://robbwolf.com/wp-content/uploads/2015/07/Paleo-Solution-279.pdf

[31] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402009/

[32] http://www.ncbi.nlm.nih.gov/pubmed/23249760

[33] https://en.wikipedia.org/wiki/Butyrate

[34] http://freetheanimal.com/

[35] http://vegetablepharm.blogspot.com.au/

[36] http://www.marksdailyapple.com/the-definitive-guide-to-resistant-starch/#axzz3iL8QNff1

[37] https://www.bulletproofexec.com/real-superfoods-that-destroy-inflammation-in-your-brain-the-body-response-that-may-change-your-mental-health-forever/

[38] http://perfecthealthdiet.com/

[39] https://iquitsugar.com/it-all-starts-in-your-gut/

[40] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1379072/

[41] http://authoritynutrition.com/glucomannan/

Bulletproof coffee

I, along with a growing number of people it seems, enjoy starting the day sometimes with a “Bulletproof Coffee” which for me involves two shots of espresso coffee, a chunk of butter and a dash of MCT oil (or coconut oil) and blended into a fatty frothy brew.

1512359_10152570446810544_755357712744850191_n

The theory is that this high fat coffee satiates and helps you get through the morning while keeping your insulin levels down until a later lunch or even through until dinner.

See https://www.bulletproofexec.com/bulletproof-fasting/ for more details.

Looking at the analysis below, you can see that the nutritional completeness score is low, but you have to remember that this should be part of a nutrient dense diet through the rest of the day.

10532496_10152569867360544_2998626556923275989_n

If you look at my comparison of diet scenarios you’ll see that even if you use a fatty coffee for breakfast you can still get excellent nutrition while keeping the overall insulin load low overall and rank very highly.

net carbs

insulin load carb insulin fat protein

fibre

0g 0g 0% 99% 1%

0g

Some people like to throw a raw egg in and this brings up the nutrient score and enable you to kickstart the day with some protein in your system, although this will cause some insulin release so you won’t get all the benefits of low keeping your insulin levels low.

10407744_10152569874360544_6048303705133977438_n

net carbs insulin load carb insulin fat protein fibre
0g 4g 0% 92% 8%

0g

If you don’t like coffee or are dealing with adrenal fatigue green tea with coconut oil or butter will work too.