fibre on a ketogenic diet

fibre on a ketogenic diet

  • 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.  Chris Kelly 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.

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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…

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… and more like this.

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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/

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45 thoughts on “fibre on a ketogenic diet”

  1. THANK YOU! Thank you for sharing the results of your work. I am, and I assume countless others are, so much better as a result of all you do. I look forward to your emails and am finding my way with your generous contributions to my personal knowledge base. I so appreciate that you are after fact/truth and not strictly stuck in any diet camp. I went from an A1c of 12.7 to 5.7 in 5 months following a vlchf diet with intermittent fasting. (Based on testing I predict my next A1c will be low 5.) I found that fasting began to cause my glucose to rise so I began to eat more frequently and my glucose returned to optimal. Vinegar/wine/RS did not improve glucose for me. I become sensitive to foods if I consume them too frequently so it is always a matter of continually mixing it up. I don’t know that there is a single approach to optimum glucose and that is why I so appreciate your work! It provides great and varied information that allows me to continually explore safe options.
    Kathy

    Like

  2. “… this area is interesting but not clear cut and subject to prejudice…”

    That is the most salient phrase in your post.

    Dr Ron Rosedale was quite clear on the topic. What
    did he say that you disagree with?

    Like

    1. I’m not aware of the Rosedale quote you are referring to, although I know he talks a lot about avoiding ‘non-fibre carbohydrates’ which I concur with.

      I just think some of the research sets up the high fat approach for failure due to the fact that they used a low nutrient density low fibre approach versus a highly nutrient dense high fibre approach. I can’t see any good research where they have tested diets that were both high fibre and nutrient dense but with different levels of fat.

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      1. I’ll have to go back and have another look at the video. I like Rosedale’s “non-fibre carbohydrates” approach. I think gut health and the effect of diet on our gut bacteria is still an evolving field of science. My comment here was more than some of the studies looked like they set out to be anti low carb and designed a low nutrient density low fibre diet to make sure it failed.

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  3. The Four Corners Diet (formerly GO Diet) developed by doctors Goldberg and O’Mara is a low-carb diet that also emphasizes fiber and mono fats.

    http://www.amazon.com/Four-Corners-Diet-Low-Carb-Lifetime/dp/1569244278/ref=sr_1_1

    You can get a used copy on the Internet for a penny plus shipping.

    http://www.amazon.com/Four-Corners-Diet-Low-Carb-Lifetime/dp/1569244278/ref=sr_1_1

    You can get a used copy on the Internet for a penny plus shipping.

    Liked by 1 person

  4. Thanks Gretchen. I really like the idea of a high fibre, high fat, nutrient dense diet that is high in omega 3s and monounsaturated fats.

    Seems a fair bit of it is on Google Books too. Checking it out now.

    https://books.google.com.au/books?id=Ufn7aWsVRfAC&pg=PP4&lpg=PP4&dq=The+Four+Corners+Diet:+The+Healthy+Low-Carb+Way+of+Eating+for+a+Lifetime&source=bl&ots=jvXuMcNnbD&sig=Z9-NP8cSZn8P-xg0y2z1BFVDYGY&hl=en&sa=X&ved=0CDAQ6AEwA2oVChMIrPi8nPKryAIVRRumCh3GBAJE#v=onepage&q&f=false

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  5. Did he really say this?

    “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.”

    If he said this, it’s not true, at least as for trials involving fecal transplants. As far as I see, there are very few studies of fecal transplants on humans, and none that have shown reversal of type 2 diabetes. This describes an improvement in insulin sensitivity:

    http://www.medpagetoday.com/MeetingCoverage/EASD/22352

    But that’s far from reversing type 2 diabetes.

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      1. Being smart has nothing to do with it.

        My problem with this area is that there are very few studies of any duration involving humans for anything more than a small length of time. The vast majority of the studies are for animals, which may or may not (likely “not”) transfer to humans.

        Heck, if you take samples of your poop from two different locations, you can get two vastly different results. For instance, see the following:

        https://www.sciencenews.org/blog/gory-details/here%E2%80%99s-poop-getting-your-gut-microbiome-analyzed

        http://blogs.scientificamerican.com/oscillator/which-bacteria-are-in-my-poop-it-depends-where-you-look/

        If you can’t accurately determine what’s in your poop, then you can’t determine what you should be doing or eating.

        Another problem I have is why can’t you just eat vegetables and kimchi (or other fermented product)? Why do you have to go out and get Bob’s Potato starch or raw potatoes or green bananas? What’s wrong with real, local food? Did our ancestors have horrible microbiomes because they couldn’t access these materials? Does that make logical sense to anyone?

        The real kicker is that there are no long term, randomized controlled trials involving these. So, what we have are people telling us how and what to eat based on very few studies with a paltry number of people involved. This reminds me of something similar — the food pyramid. The very reason I eat the way I do now (low carb, high fat with intermittent fasting) is that the food pyramid and my low fat diet almost killed me. I’m honestly afraid to follow anything now that does not have long term, randomized controlled trials.

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      2. Our microbiome is certainly an evolving area of research and understanding Bob.

        I agree on your comment about potato starch… There are now studies showing that raw potato starch lowers diversity of the microbiome and feeds pathogens (bad). Hence the varied list of real foods that contain fibre.

        LCHF with IF seems to be the Holy Grail if there is one.

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  6. I was sent a link to your blog the other day, and WOW what a fantastic blog post you have just put up. I was blown away. I have read it TWICE to make sure I got everything right. I have also added it to the top of favourites and will be spending some time to go through all your posts.

    In the meantime the following link was of interest to me, and possibly to you.

    http://www.ncbi.nlm.nih.gov/pubmed/?term=High-level+adherence+to+a+Mediterranean+diet+beneficially+impacts+the+gut+microbiota+and+associated+metabolome

    Habitual diet plays a major role in shaping the composition of the gut microbiota. How true in my case. I have pretty much stuck to the same eating plan for the last 40 years, so have definitely upset my flat mates to put it mildly. Your observation that we should be eating much more high fibre whole foods instead of resorting to “powders” is so true.

    Thank you for doing all the hard slog for us readers.

    Liked by 1 person

  7. I’ve noticed that the majority of low-insulinogenic foods on your list are high in Omega-6. I guess we’d have to balance that out with sources of Omega-3 (which in itself can raise blood sugar).

    Like

      1. The overabundance of nuts and nut products, for one. Chard/mustard greens for another. Avocados for a third…refer to the Nutrient Data Base, and go all the way to the bottom left of the nutrient analysis for the Omega-3/Omega-6 ratios.

        http://nutritiondata.self.com/

        As you may know, more than a handful of nuts a day throws your Omega balance out of whack–so exactly how much fiber are you going to get in that mere handful? Not much! You’re better off playing up the broccoli, cauliflower, radishes. and greens because of the Omega-3 content. The Atkins Induction food list is great for a starting list (but there are a few O-6 offenders). So have a SALAD wit your nuts…or a salad with the handful of nuts in it.

        I believe spinach may be an 0-3 food, and may have fiber in it, but since Hubby’s allergic to it, we don’t use it, and I haven’t looked it up in the NDB lately. Who knows? It may turn out to be an answer to the dilemma.

        Also, I noticed that you left off coconut flour–yeah, it’s an O-6 offender, but it work great as fiber as long as you balance it with the appropriate amount of 0-3 foods (such as in baked goods, casseroles/stuffings, quiche crusts, wraps/tortillas, etc.) Coconut flour is purported to be 55% fiber, but i see different numbers for it in different places. All I know is a tortilla made from it + greens and meat (a taco) helped Hubby lower his BG by 10 points. Too much of, though, causes diarrhea in him.

        May I suggest a salad made with high 0-3 veggies every night with dinner to get fiber + 0-3?

        For bell pepper lovers, here’s a tip for you: yellow and red ones contain the LEAST amount of 0-6, while the green ones contain the HIGHEST. Olives (both green and black) are on the 0-6 offender list, so no cauliflower crust pizza decor with these babies.

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  8. Please “study” the work of Dr. Natasha Campbell-McBride-brilliant work/knowledge regarding probiotics and microbiota! and fiber!
    I resolved my gut problems-mainly constipation, but also GI spasms, reflux and insomnia- following her recommendations taking out fibre!! I lived on high fiber foods-eating up to 30-40+ grams per day for years. Big mistake.
    Good and bad micros populate the colon and to get rid of the bad microbiome you unfortunately initially also need to starve the good bacteria, but, by introducing fermented foods and broths you introduce new/diverse bacteria into the colon-follow the diet until all symptoms are resolved. For adults it can mean up to 2-3 years after which you can eat “normal” foods again. (But who would want to go back to the tasteless recommended diets from dietary guidelines-stocking your kitchen/pantry with copious amounts of silly lifeless packaged food that results in a big messy GI-tract).
    I recently had to backtrack on my GAPS program (Dr. McBride’s program) because of recurring severe constipation problems eating too much fiber (I only re-introduced raw salad ingredients). As soon as I eat well cooked vegetables with fats, no raw salad, no raw vegetables, no fibrous parts, no grains, no fruit, I feel wonderful with no constipation whatsoever. Green juices and low carb vegetables will suffice.
    Never ever thought I could resolve this 30+ year constipation problem, never thought it was reversible!!! Most symptoms normally disappear within a very short period-days/weeks-but it does take time to heal and seal your gut and rid yourself of the leaky gut from eating sugar, too much insoluble fiber, overeating, processed foods and too little fermented foods.
    I would rather not mention my cholesterol levels from eating more animal fats, but as she (Dr. McBride) says, it should not even be measured because it rarely, if ever, is a health marker for CVD. Both my parents died because of heart disease with all the cholesterol levels beautifully within the recommended ranges, without using statins-therefore I do not believe the cholesterol hype of maintaining low cholesterol levels!
    Try to get more than 10-15g of soluble/fermentable fiber eating a high fiber diet-it is about impossible. We have established the fact that we are not cockroaches or ruminants, so why would we want to eat indigestible fiber to push “the numbers” up to 25-38g. It is the fermentable fiber that is the most important for microbiome and the absolutely precious animal fats to enhance bile flow to promote peristalsis in order to get rid of all the toxins and debris in the body to prevent disease/cvd.
    Once again, just unbelievable, I bought the Oct 2015 Reader’s Digest with the ‘latest about a heart healthy diet’ and the blood cholesterol ranges for heart health .
    It must have been written by Coca-Cola.

    Like

    1. “Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms. Patients who stopped or reduced dietary fiber had significant improvement in their symptoms while those who continued on a high fiber diet had no change….Idiopathic constipation and its associated symptoms can be effectively reduced by stopping or even lowering the intake of dietary fiber.” World Journal of Gastroenterology. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3435786/

      I had long ago bought the idea that fiber was essential, as were grains, starches, fruits, vegetables etc.. Essential for the bottom line of the food industry but I am certainly healthier without them.

      Like

      1. I have found that raising my fat intake acted the same way increasing fiber does–a HFLC diet in no way constipated me.

        Like

    2. I have not read the GAPS book myself, but my wife has and I have read Kresser’s Paleo Code which builds on Campbell-McBride’s work.

      It seems that for people with major gut issues they have to go back to basics, kill off the bad bacteria (and maybe most bacteria) and build it back up very slowly.

      I wonder if many people benefit on a fibre free low carb diet initially but then don’t get to the building back phase which these processes talk about.

      So glad it’s working for you.

      Like

  9. I believe this is from Dr. Eric Westman:
    “Bringing more fiber to solve constipation is just
    like bringing more cars to solve a traffic jamb.”

    Like

  10. Marty, in ferreting out the highest fiber/highest O-3/lowest carb veggies, you’ll find that they tend to run anywhere from 1-4 gr. fiber per 100 gr. (about 1/2 c. American measure), either raw or cooked. Watercress is high in O-3, but zilch when it comes to fiber. Caulifower gains a gram in fiber if it’s cooked.

    Chia seeds are 11 gr. fiber per 1 oz. (1 T.), and ground flax is about 2 gr. fiber per oz. (1 T.). Coconut flour has 5 gr. of fiber per oz. (1 T.) as per Livestrong site (the NDB doesn’t have an entry for it). So I guess the answer is to mix your fibers (through a combination of baked goods and veggies) within a LCHF diet.

    Now what I DON’T know: does the mixing have to occur with each meal, or can it be done over a 24-hour period? Vegans can do incomplete protein combinations over a 24-hour period to get the needed complete proteins, as the amino acids meet each other in the gut, and form complete proteins. I have no idea if fiber works the same way or not–vegan or omnivore.

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  11. Marty:

    I’m curious re: your reaction to Kathy’s
    October 7th comment above.

    I’m not sold on the benefits of fiber and
    your post seems to make a leap based
    on vague or no evidence.

    Like

    1. This is my understanding based on the work of Chris Kresser and a number of people who work in this area. For people who have major GI issues it seems beneficial to strip things back to basics and slowly build back up foods as they are tolerated.

      We have also worked with Elizma on my wife Monica’s gut heath to overcome SIBO using this type of procedure. She used a low sugar approach with high doses of vitamin C initially to kill off a lot of the bacteria and then build back a more balanced microbiome.

      It’s not my area of expertise but I have a lot of respect for the people who do get it and can help people who really need it.

      Like

  12. Hi Marty
    I was surprised to hear that fibre might not be great for everyone but I’ve not read much about GI issues as my area of interest is type 2. I first read on Jason Fung’s blog that fibre can be an antidote for insulin and it really shows up in my fasting BGLs. I don’t eat a lot of carbs these days but it even seems to help with protein overloads. If I eat an omelette with a salad and a bit of green crap (spinach) in it my readings can be as much as 3 points lower than if I just eat a plain omelette. I’m really interested to find out more about getting healthy bacteria into my gut too. It might help keep those BGLs falling. Otherwise I might have to resort to something difficult and nasty like (please no!) exercise or intermittent fasting!
    Thanks for the massive dose of info.
    Carmel

    Like

  13. Have any other analyses that weigh ‘prebiotic’ fibers separate from ‘fiber’ in general. Seems if we are learning anything it’s that not all fibers are the same – certainly insoluble versus soluble – and even the specific solubles. I love your weighing insulinogenicity and fiber content together to identify veggies for a gut-healthy keto diet and the inulin-specific analysis is particularly interesting. But I wondered if there is like a prebiotic score you could generate and use in the index for the larger list instead of just fiber generally, which I’m assuming includes insoluble fiber, which is of significantly less value.

    Liked by 1 person

  14. Great blog! Do you have any tips for aspiring writers?

    I’m hoping to start my own site soon but I’m a little lost on everything.

    Would you recommend starting with a free platform like WordPress or go for a paid option? There are so
    many choices out there that I’m completely overwhelmed ..
    Any suggestions? Cheers!

    Like

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