fine tuning your diet to suit your goals – Jane

  • Optimising blood glucose, nutrients and gut bacteria can be a delicate balancing act.
  • Some people require a very low carbohydrate approach to achieve normal blood glucose levels, while some may also need to implement a fasting regime as well.
  • Some may also benefit from increased fibre and / or reduced calorie density to improve gut health and achieve further weight loss, however for others this may have unacceptable impacts on their blood glucose.

background

Jane is an experienced ketogenic dieter who has found over years of testing that she is now able to manage her blood sugars to consistently between 70 and 100mg/dL (3.9 to 5.6mmol/L).   Her HbA1c is now 5.1% which is good and her blood lipid numbers are great.

After a long period of fighting and trying to normalise her blood glucose levels using a ketogenic diet, Jane has come to a point where she has stopped monitoring her blood sugars throughout the day and dropped back to occasional checking.

As you can see from the plot below of protein versus net carbs, Jane’s diet is definitely ketogenic (note: the unlabelled points are based on her actual daily food diary, the labelled points are the variations discussed below).

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nutritional analysis of base case diet

The table below shows the comparison of one day from Jane’s food diary with the more than two hundred meals and food diaries that I have analysed to date.  Jane’s base diet ranks at 52 out of 200 when we use the diabetes ranking, so she is doing pretty well overall, with very high scores in the insulin load and protein categories.   As you can see from the scores on the bottom row of the table below, the area where there is still some room for improvement is the fibre as well as vitamins and minerals.

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The nutritional analysis of Jane’s food diary is shown below.  A score of 100 in the nutrient balance and / or the protein quality score would equate to obtaining 100% of the FDA Daily Value (DV) for the various nutrients with 1000 calories.[1]  So  especially given that Jane’s priority is blood glucose control, a score of 40 for the nutrients is good .  A score of 139 for protein quality is excellent , meaning that she is more than meeting her protein requirements.  At 5g per day, her dietary fibre is less than the DV of 25g per day recommended for women.[2]

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with added spinach and mushroom

If Jane wanted to improve her vitamin and mineral score she could add some high fibre nutrient-dense veggies that would not significantly raise blood sugar.  To this end, I have added some extra mushrooms and spinach to the analysis of Jane’s food diary.  The addition of the extra mushroom and spinach produces an improved vitamin and mineral score.  However, this approach would be less ketogenic with 37g of net carbs compared to 15g in the base scenario (see chart and table above).

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with egg

Jane told me that she would be worried these extra carbohydrates from the veggies would raise her blood glucose too much, plus she doesn’t like mushrooms.  She suggested adding egg, which improved the vitamin and mineral score compared to the base but decreased the insulin score as shown below.  The added egg increases the vitamin and mineral score from 40 to 65 (nearly as much as the spinach and mushroom scenario) with only 21g of net carbohydrates per day.

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While the spinach and mushroom option does do better in terms of vitamins and minerals, the egg gives a better total score in the multi criteria analysis.  Hence adding the egg, rather than the spinach and mushrooms would align better with Jane’s goals.

weight loss approach – reduced calorie density and increased fibre

If Jane was looking to reduce body fat and potentially improve her health and vitality through consuming nutrient dense lower calorie density foods she could consider adding more high fibre, low calorie density foods that would make her feel satiated and possibly feed gut bacteria.

Jane says,

I strongly believe in the tie to gut health, enzymes and nutrition as a key.  If LCHF isn’t working then there is some major gut health, hormone or enzyme deficiency going on.

As discussed in the ketogenic fibre article, focusing on a nutrient dense, low calorie density approach that has minimal carbohydrates may help with improvement in both gastrointestinal and overall health.  In the longer term though adding in some more fibrous foods may be beneficial for people to promote good gut bacteria.

The revised food diary shown below has a significant amount of spinach and broccoli and gives a very solid 26g of fibre per day with only 22g of net carbohydrates, which is still “low carb” by most standards.  Some people prefer to use total carbohydrates rather than net carbohydrates.  However, plant based fibre is typically not digestible and thus is unlikely to impact blood sugar significantly.

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While food packaging in the USA shows total carbohydrates with fibre listed separately, in the UK and Australia food labelling already shows net carbohydrates.

This option with egg also has a lower calorie density along with a higher nutrient density compared to the base option meaning that Jane is likely to feel more satiated and find it harder to overeat which may be useful if weight loss is a goal.

Jane may be concerned that this type of approach would adversely affect her blood glucose levels that she’s worked so hard to reduce.  It would be worth going slowly and monitoring post-meal blood sugars while she makes her transition to more nutrient dense high fibre foods.

If she was seeing post meal blood sugars greater than 120 mg/dL (6.7mmol/L), fasting blood sugars drifting above 90 mg/dL (5.0mmol/L) and an average of greater than 100mg/dL (5.4mmol/L) she may want to revert back to her more ketogenic approach.

discussion

Overall, Jane’s ketogenic diet approach is working well for her at the moment, but her situation raises a number of questions.

If Jane was struggling to achieve normal blood sugars with a ketogenic diet, then it is possible that she has a beta cell burnout meaning that her pancreas is no longer able to produce enough insulin (which is not the case given her HbA1c of 5.1%).  If this were the case, then it may be useful to measure her fasting insulin and c-peptide levels to determine whether she is still producing significant amounts of insulin (refer to the article Balancing Diet and Diabetes Medications for more discussion).  However this does not appear to be the case for Jane as she has a good HbA1c although it does require a very highly ketogenic diet approach to achieve this.

Another approach to reducing blood sugars is to focus on stripping the glucagon from the liver through fasting and more intense carbohydrate restriction (as per Westman’s carbohydrate restriction[3] and Fung’s fasting protocols[4]).   However with a very low carbohydrate diet of 1600 calories per day Jane probably does not need to pursue further calorie or glucose restriction, although it would be interesting to see if some periods of fasting help to further improve insulin sensitivity.

Yet another approach would be to focus on healing the gut and other factors that cause someone to become insulin resistant.  Inflammation and infection will often lead to insulin resistance.  If diabetes is an autoimmunity issue that starts in the gut, then the question is what can we do to balance gut bacteria that will enable the body to heal through maximising nutrition together with probiotics and prebiotics (as per Perlmutter[5] and the paleo approach to diabetes[6])?

If Jane desires to go down this road she might need to tolerate slightly higher blood sugars as her body adjusts to plant-based carbohydrates (refer to the Ketogenic Fibre article for a list of foods that will provide fibre without raising blood glucose levels).  Over time, she may find that blood glucose levels settle down as the gastrointestinal microflora balance adapts and she progresses beyond the initial physiological insulin resistance.

As you can see, there is no simple or perfect approach here but rather a number of options that may be useful to consider and test depending on the individual’s circumstances and goals.

 

references

[1] http://nutritiondata.self.com/help/nutrient-balance-indicator

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

[3] https://www.youtube.com/watch?v=dSLf4bzAyOM

[4] https://intensivedietarymanagement.com/tag/intermittent-fasting/

[5] http://www.drperlmutter.com/new-understanding-obesity-epidemic/

[6] http://robbwolf.com/category/real-life-testimonials/diabetes-real-life-testimonials/

8 thoughts on “fine tuning your diet to suit your goals – Jane”

    1. Thanks. I have seen Jason Fung’s posts discussing Roy Taylor’s work. Low carb with fasting seems to have some really exciting potential in the improvement / reversal of type 2.

      1. I know a T2D on insulin injections who did the Roy Taylor protocol of 500 cal per day. In the beginning it went OK, but she went on longer than Taylor’s 8 weeks. After about 4 months, everything stalled and didn’t lose any more weight, what was the purpose of the exercise. Her BS did improve, but she was still injecting insulin, not as much as she used to.

  1. My bet is on getting your gut microbiome up to tip top condition and that means getting more fibre into your diet. From what I have read on the subject, the better your microbiome is (well fed), the better your digestion is. I think it is poor digestion, that results in the increase in glucose in the blood. Jeff Leach recommends eating lots of raw onions, leeks and raw garlic (best fiber sources). Jane could also take dosis of resistant starch like potato starch, plantain starch, Hi-maize starch, inuline, etc. Start with 1/2 teaspoon of each and see how her BG goes. She can increase to to 2 tablespoons (except for inuline) per day.

  2. Hi Marty,

    I am a type 1 diabetic like your wife, and I am also a paediatric diabetes dietitian, low Carb lover and experimenter, health and fitness enthusiast and part time biohacker.

    First of all I have only just come across your work last week, as I was putting the final touches to my site http://www.nakedathlete.co.uk. Honestly you are an inspiration, the time, effort, precision and quality of your work is truley amazing! Well player sir! I know as I have been getting up early and smashing long weekends putting together my site!

    The reason I love your site so much as it uses the FII and takes a scientific based approach to bolusing for insulin! I read the bell PHD thesis over the summer and am part of the TAG group approach to bolusing historically. As a diabetes dietitian I see everyday the frustrations of families struggling with just carb counting! That fact you used stats to come up with the algorithm for insulin load is amazing (beyond my maths skills). I personally use net carbs + 0.5g protein + 0.1g fat but do an extended bolus for the fat portion over 3hrs as studies show delayed effect when fat above 30 to 40g especially when with carbs. But now use 0.56 for protein! Also as you rightly mention the FII only uses 3hr post testing and that’s the limitation but it smokes just counting carbs!

    My site is free for all and is meant to be a resource for people (not just people with diabetes) just wanting to be healthier and want a specific programme to do it with. I am doing the site because i follow the four pillars every day, I want to teach, not preach and I want to make a difference not millions!

    You might be interested in my n=1 on using LCHF and then LCKD

    http://www.nakedathlete.co.uk/naked-me/my-80-day-experiment-12-to-5-1-body-fat/

    Also I have referenced your site on my naked athlete top foods list as it’s very similar to your cheat sheets and was inspired by then as a late addition. I hope that’s ok? If not I will remove it but I think it really helps.

    http://www.nakedathlete.co.uk/nutrition/lchf-10-nutritional-prescriptions-to-become-at-naked-athlete/879-2/

    If you think my site compliments yours and you think I am on the same wave length as you (which I think so but I am more focused on all round health and implantation/psychology, whereas you are pure nutrition science which you are light years ahead!) I was wondering if there may be scope for a little collaboration?

    I was thinking about using your scientific approach to measuring the insulin load, nutrient quality, amino acid quality etc on a 7!day meal plan I am working out to add to my meal ideas and 10 nutritional prescriptions. I am also in the near future going to do a LCKD plan for the people wanting to replicate my second 40 day experience in nutritional ketosis and run the same analysis. I do not want to rip you off and want to reference your amazing work so would you be ok if? 1. I ran the analysis using your formulas and methods and was very careful to reference you? 2. Would you want to help me do that if I provided the meal plan? 3, would you be interested in co authoring or contributing to a page/post/article on how I bloused during days 40 to 80 using a a similar methodology to yours and the excellent control and I would add in my rationale and research for adding in extra for the fat pointing to the recent ish bell and smart paper (2015) systematic review into bolusing strategies (your site should be referenced in the future).

    http://www.nakedathlete.co.uk/nutrition/lchf-10-nutritional-prescriptions-to-become-at-naked-athlete/

    My site is yet to be fully launched but I have published the pages so you can have a look and sign up if you like.

    I am not an egotistical online maniac or someone looking for online fame. I just want to teach, not preach and make difference not millions!

    I used to work for Medtronic as a technical consultant and marketing for a bit and I did a PERSONAL blog on my first 64 days on the MiniMed 640G with SmartGuard here. I did this to tell people what it was really like from a person with type 1 to cut out all the BS I came across in Marketing!

    http://www.mm640g.blogspot.co.uk/?m=1

    Anyway a major ramble there but hopefully you will fell my passion for this and be interested in helping me with your expertise.

    I understand if you do not have the time, lord knows I have Walmart size bags under my eyes with the early morning finishing the site before work!

    Keep doing what your doing and rocking it!

    Sent from my iPhone

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