choosing the right sized low carb band aid

  • This article identifies nutrient dense low insulin load foods that can help to stabilise your blood glucose levels and allow your own pancreas to keep up.
  • Once you normalise your blood glucose and lose some weight the progressive addition of nutrient dense low energy density foods may help continue your weight loss and improve your metabolic health.

how important is insulin sensitivity?

Managing your blood glucose levels through diet seems to be a major issue, if not THE most significant issue when it comes to health, longevity and reducing your risk of the leading causes of death (i.e. heart attack, stroke, cancer, Alzheimer’s and Parkinson’s Disease).[1]

As indicated by the charts below the lowest risk of the diseases associated with metabolic disease occurs when your HbA1c is less than 5% (i.e. an average blood glucose levels less than 100 mg/dL or 5.4 mmol/L).[2]

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Insulin is an anabolic hormone that helps store nutrients and prevent their breakdown.   High levels of insulin (hyperinsulinemia) can lead to excess fat storage.  Excess insulin can also prevents us from accessing stored body fat.

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is low carb the best approach for everyone?

There are people who will argue that you can eat as much fat as you want.

At the same time there are people who will argue that you can eat as much protein as you want.

And you guessed it, there are also people who argue that you can eat as much carbohydrate as you want.

So who is right?

It seems that Christopher Gardner’s recent study Weight loss on low-fat vs. low-carbohydrate diets by insulin resistance status among overweight adults and adults with obesity: A randomized pilot trial[3] might bring some clarity to the macro nutrient wars.[4]

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As always, context matters.

It seems that there is no one single approach that is optimal for everyone all the time.

As well as encouraging participants to eat nutrient dense whole foods, Gardener’s study divided the participants up based on their insulin sensitivity and asked them to restrict carbohydrates or restrict fat as much as they could over a period of six months living in the real world without tracking calories.

As you can see from the chart below:

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This observation from Gardener’s study also aligns with the findings of the results of a 2005 study Insulin Sensitivity Determines the Effectiveness of Dietary Macronutrient Composition on Weight Loss in Obese Women (Cornier et al, 2005)[5] which also found that people who were insulin resistant did better with LCHF while those who were insulin sensitive did better on the HCLF approach.

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Similarly, people who are insulin resistant improve their fatty liver on a low GI diet.[6]

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Again, the results from Pitas (2005) show that people who are insulin sensitive lose more weight on a high glycemic diet while the people who were insulin resistant lose more on the low glycemic load diet.

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In this video David Ludwig explains why someone who is insulin resistant might do better with a reduced carbohydrate approach.

am I insulin resistant?

So the obvious question then is whether or not you are insulin resistant and how do you tell?

Insulin resistance, and the compensatory hyperinsulinemia that follows, appear to be caused primarily by excess body fat, particularly around the abdomen and organs, which leads to inflammation, insulin resistance and elevated blood glucose levels.[7]

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So if you have big belly there’s a pretty good chance you are also insulin resistant and have elevated blood glucose and / or high insulin levels.  So having a waist circumference greater than half your height is a good indication you are insulin resistant.[8]  [9] [10]

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Unfortunately your size is not a perfect indicator of your metabolic health.  Some people manage to store more fat before inflammation and insulin resistance sets in.[11]  These people are called metabolically healthy obese.[12]    Conversely some people can look thin on the outside but still have fat around their organs which causes insulin resistance.  These people are called TOFIs (thin outside, fat inside).[13]

A more accurate way to ascertain if you are insulin resistant is to test your blood glucose levels. If your blood glucose levels are consistently above 5.0mmol/L or 90 mg/dL before meals then you might have a problem.  If you wanted to get more serious you could get a fasting insulin test, a HOMA-IR test, test your glucose : ketone ratio or get an oral glucose tolerance test.

If you have elevated blood glucose and insulin levels you probably need to eat less processed carbohydrates.  If you are obese but have great blood glucose levels then it’s probably time to incorporate some more lower energy density higher nutrient density foods to help you reduce your calorie intake.

nutrient dense low carb foods for blood glucose control

For most people, the nutrient dense foods shown in the ‘building a better nutrient density’ article would be a major improvement.

People who are insulin sensitive but still want to lose weight would do well with low calorie density high nutrient density foods.

However, for someone who is insulin resistant, the most nutrient dense foods, which have about 50% insulinogenic calories, may lead to unacceptable blood glucose swings.   People who are unable to produce enough insulin or are insulin resistant need to manage their insulin budget and make sure that the insulinogenic foods that they do eat maximise nutrient density in order to provide adequate amino acids for muscle growth and repair and sufficient vitamins and minerals.

Where this gets more interesting is when we combine nutrient density with the proportion of insulinogenic calories to optimise both glucose levels and nutrient density.   Listed below is a summary of the top 1000 foods of the 7000+ foods in the USDA database when we prioritise by both nutrient density and insulin load.

Included in the tables below are a number of parameters that may be useful:

  1. The nutrient density score is based on the number of standard deviations above the average that a particular food is from the average.
  2. The percentage of insulinogenic calories is the proportion of the energy in the food that can turn to glucose and require insulin.
  3. The net carbs per 100g is the amount of digestible non-fibre carbohydrates in the food that can raise your blood glucose levels.
  4. The insulin load is the weight of food per 100g that will require insulin to metabolise.
  5. The energy density is the number of calories per 100g of the food. If you’re watching your weight as well as your blood glucose numbers than keeping the energy density down will also be of interest.

Vegetables

Listed below are the highest ranking vegetables.

While many of these vegetables have a high proportion of insulinogenic calories (i.e. digestible non-fibre carbohydrates that can raise blood glucose levels) they are also highly nutritious and have very low levels of non-carbohydrates and energy per 100g.  Most people would have to eat a lot of these to have a significant impact on blood glucose levels.

Most of us would do well to focus on filling up on any of these vegetables to help keep overall calories down to assist with weight loss which is critical for improving insulin resistance.  If you typically avoid vegetables due to blood glucose concerns then you could start out slowly  and progressively increase your intake of these vegetables while keeping an eye on your blood glucose levels.

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food ND % insulinogenic net carbs/100g insulin load (g/100g) calories/100g
celery 2.63 49% 1 2 17
turnip greens 1.31 39% 1 4 37
rhubarb 1.46 57% 3 3 21
lettuce 1.34 52% 2 2 17
broccoli 1.21 57% 4 6 42
asparagus 1.12 46% 2 3 27
winter squash 1.22 80% 7 8 39
artichokes 0.83 33% 3 4 54
Chinese cabbage 1.02 60% 1 2 16
okra 0.94 57% 4 5 37
summer squash 1.00 65% 2 3 19
bamboo shoots 0.90 52% 3 4 28
seaweed (kelp) 0.74 43% 4 5 50
bell peppers 0.86 64% 6 7 43
cabbage 0.81 53% 3 4 30
snap green beans 0.74 47% 4 5 40
radishes 0.70 50% 2 2 19
peas 0.69 58% 5 7 51
kale 0.75 74% 8 10 56
dill 0.42 30% 2 4 52
thyme 0.27 21% 14 19 359
mushrooms 0.65 70% 2 5 30
jalapeno peppers 0.52 54% 4 5 35
collards 0.44 46% 2 5 40
paprika 0.19 17% 8 16 389
black pepper 0.24 36% 24 29 327
beets 0.34 44% 4 5 48
chives 0.27 34% 1 3 37
bay leaf 0.21 37% 34 38 406
mung beans 0.33 46% 1 3 26
onions 0.52 77% 7 8 41
mustard greens 0.27 45% 2 3 30

fruit

This list of diabetic friendly fruits is quite short compared to the veggies.

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food ND % insulinogenic net carbs/100g insulin load (g/100g) calories/100g
olives 0.02 15% 3 3 90
avocado 0.01 18% 5 6 131
raspberries 0.09 42% 6 6 58

nuts, seeds and legumes

The great thing about nuts and seeds is that they have a low percentage of insulinogenic calories and are often low in non-fibre carbohydrates.   The drawback is that they have a much higher energy density due to their higher fat content and are not as high in nutrients as the non-starchy green veggies.  Keep in mind that you can overdo the nuts if you are keeping an eye on your weight as well as your blood glucose levels.

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food ND % insulinogenic net carbs/100g insulin load (g/100g) calories/100g
pecans 0.15 5% 4 9 762
pine nuts 0.16 11% 9 18 647
tahini 0.17 16% 13 26 633
peanuts 0.17 18% 7 28 605
sunflower seeds 0.18 20% 11 24 491
macadamia nuts 0.12 5% 5 9 769
hummus 0.26 32% 8 14 175
pistachio nuts 0.16 23% 19 34 602
sesame seeds 0.12 18% 14 27 603
almonds 0.11 16% 15 27 652
brazil nuts 0.09 9% 4 15 704
chia seeds 0.10 16% 8 21 511
tofu 0.17 28% 2 8 112
walnuts 0.10 15% 7 25 683
coconut meat 0.09 11% 16 20 703
hazelnuts 0.10 16% 15 27 692
cashew nuts 0.11 22% 24 33 609
flaxseed 0.08 12% 2 16 568

dairy and eggs

Eggs and cheese are great in terms of proportion of insulinogenic calories.   The nutrient density of these foods is above average but not as high as the non-starchy vegetables.  As with the nuts, keep in mind that the energy density of these foods is high so it is possible to overdo them if you are keeping an eye on your weight as well as your blood glucose levels.

dairy20and20eggs

food ND % insulinogenic insulin load  (g/100g) calories/100g
butter 0.11 0% 1 734
cream cheese 0.15 10% 8 348
goat cheese 0.18 22% 25 451
egg yolk 0.18 19% 15 317
Gruyère cheese 0.18 21% 22 412
sour cream 0.12 9% 4 197
Limburger cheese 0.17 18% 15 327
cream 0.10 5% 5 431
Edam cheese 0.18 22% 20 356
blue cheese 0.17 20% 18 354
Gouda cheese 0.18 23% 20 356
cheddar cheese 0.16 20% 20 403
Muenster cheese 0.16 20% 18 368
Camembert cheese 0.17 20% 15 299
Monterey 0.16 20% 19 373
Colby 0.16 20% 20 394
feta cheese 0.17 22% 14 265
brie cheese 0.15 19% 16 334
provolone 0.17 24% 21 350
Swiss cheese 0.18 26% 25 379
parmesan cheese 0.19 30% 31 411
mozzarella 0.15 23% 18 318
whole egg 0.17 29% 10 138

seafood

Getting an adequate intake of omega 3 essential oils is important and it’s hard to do without eating fish. Higher protein lower fat fish such as cod will require more insulin to process though this is typically not an issue unless you have type 1 diabetes and need to calculate and time your insulin doses or have advanced type 2 where your insulin response is not well matched to your glucagon response from the protein.

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food ND % insulinogenic insulin load (g/100g) calories/100g
caviar 0.30 32% 22 276
anchovy 0.34 42% 21 203
herring 0.26 34% 18 210
sardine 0.24 36% 18 202
swordfish 0.28 41% 17 165
rainbow trout 0.28 43% 17 162
mackerel 0.28 45% 17 149
tuna 0.30 50% 17 137
sturgeon 0.26 47% 15 129
salmon 0.28 50% 15 122

animal products

Higher fat animal products will have a lower insulin response but but they also have a higher energy density.  All these foods have more nutrients than average but not as many as the non-starchy vegetables.

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food ND % insulinogenic insulin load (g/100g) calories/100g
chicken liver 0.43 48% 20 165
beef liver 0.46 58% 24 169
bacon 0.18 23% 30 522
pepperoni 0.13 14% 17 487
chorizo 0.15 17% 19 448
foie gras 0.11 11% 13 459
pate 0.13 16% 13 315
beef ribs 0.11 13% 12 349
duck (with skin) 0.12 17% 14 331
salami 0.12 18% 12 258
lamb 0.14 24% 18 308
beef steak 0.16 28% 21 305
frankfurter 0.10 14% 11 322
ground turkey 0.19 37% 19 203
chicken drumstick 0.17 36% 22 238

is low carb a band aid or cure?

Some people say that a reduced carbohydrate approach only addresses the symptom (high blood glucose) rather than the cause (insulin resistance).  However, the studies highlighted above suggest that the low carb “band aid” also helps with the healing process (e.g. fat loss).

If you are insulin resistant, then reducing the insulin load of your diet using the foods listed above to the point you achieve excellent blood glucose levels will most likely be helpful.

insulin load (g)=total carbohydrates (g)-fiber (g) + 0.56*protein (g)

As shown in the plots below, it’s the non-fibre carbohydrates, and to a lesser extent the protein, that drives our insulin and blood glucose response to food.

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I’ve hit a plateau in my low carb diet, what now?

Let’s say you’re someone who has done well with a low carb diet.  You’ve heard the message not to fear fat, reduced your carbs and seen a near miraculous improvement in your blood glucose and insulin levels.  But, you haven’t quite reached your goal weight yet.

Listed below is a range of pieces of advice that you might hear given to people in this situation:

  1. Just eat more fat.
  2. Reduce total carbs.
  3. Focus more on nutrient dense low calorie density more satiating foods.
  4. Reduce net carbs.
  5. Reduce the insulin load of your diet.
  6. Eat more fibre.
  7. Exercise more.
  8. Lift heavy things to build lean muscle.
  9. Develop a fasting routine.
  10. Eat more plant based foods.
  11. Get more sunshine.
  12. Get less blue light at night.
  13. Eat only during daylight hours.
  14. Sleep more.
  15. Do some high intensity exercise.
  16. Cut out nuts and dairy.
  17. Track your calories and reduce them until you start losing weight.
  18. Stop stressing about your blood glucose levels so much, you’re just raising your cortisol!
  19. Get another hobby and stop navel gazing so much!

In the list above I’ve crossed out (a) and (b) which I think could be counter productive.

As suggested by the studies noted above, there may be a point as you achieve normal blood glucose levels that someone would benefit from focussing on higher nutrient density and lower energy density rather than just low carbs.

The million-dollar question is, what is the cut over point where you can move on from the LCHF blood glucose rehabilitation approach and start focusing on weight loss in order to further improve your metabolic health?

I think the point at which you deem yourself to have become metabolically flexible is when your average blood glucose levels are less than 100mg/dL or 5.4mmol/L.  At this point you will also be starting to show low level blood ketones.[14]  It is at this point you can start adding some of the nutrient dense low energy density foods to see what effect they have on your blood glucose levels.

When to start focussing on high nutrient density low energy density foods

The chart below (click to enlarge) shows a comparison of the nutrient density for the following dietary approaches:

  1. all foods,
  2. high nutrient density foods,
  3. nutrient dense low carbohydrate foods, and
  4. nutrient dense low calorie density foods.

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The low carbohydrate foods listed above will be more nutritious compared to the average of all of the foods available.  However, if you have normal blood glucose levels it might be a good idea to try to incorporate more nutrient dense low energy density foods that may be more filling and nutritious to help you to continue to progress on your weight loss journey.

If your appetite is influenced by obtaining adequate nutrients from your diet and / or energy density then it may be wise to reduce the carbs in your diet only as much as you need to normalise your blood glucose levels, otherwise you may risk compromising the nutrient density of your diet.

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The extent of the carbohydrate restriction (or the size of the band aid required) depends on the extent of the metabolic damage that you have sustained.  It may not be sensible to sign up for a full body cast (e.g. very high fat therapeutic ketogenic diet) if you only have a broken toe (e.g.  mild insulin resistance).

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As you start to heal your insulin resistance you may be able to progress from the higher fat diabetic friendly list of foods above to incorporate more more nutrient dense, lower energy density foods.

Then maybe in the long run, once you optimise your weight loss, you might be able to focus on the most nutrient dense foods for optimal health.

references

[1] https://optimisingnutrition.com/2016/03/21/wanna-live-forever/

[2] http://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html

[3] http://onlinelibrary.wiley.com/doi/10.1002/oby.21331/full

[4] The results of Gardner’s full study should be available in late 2016.

[5] http://onlinelibrary.wiley.com/doi/10.1038/oby.2005.79/epdf

[6] http://ajcn.nutrition.org/content/84/1/136.full.pdf+html

[7] http://www.ncbi.nlm.nih.gov/pubmed/25515001

[8] https://en.wikipedia.org/wiki/Waist-to-height_ratio

[9] https://www.google.com.au/search?q=obesity+code&spell=1&sa=X&ved=0ahUKEwjpg8b94P7LAhUCE5QKHS63AP4QvwUIGSgA&biw=1218&bih=939

[10] http://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-13-91

[12] https://en.wikipedia.org/wiki/Metabolically_healthy_obesity

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

[14] https://optimisingnutrition.com/2015/07/20/the-glucose-ketone-relationship/

Jimmy Moore’s slow cooked pork with veggies

Jimmy posted this meal on his Facebook feed a while ago.

Slow cooked pastured pork Boston butt cooked in @BareBonesBroth, local organic kale, broccoli, cauliflower, snow peas, home garden zucchini, local organic squash, home garden herbs (cilantro, dill, basil), local Garden blend sauerkraut, avocado, grass-fed butter, sea salt, and pepper. #lowcarb#highfat #ketogenic #realfood #howireallyeat

The meal does really well in both the nutrient balance score and the protein quality score while still being fairly high in fat.

The total carbs are up a bit but you’re only looking at about 15g net carbs per 500 calories which is pretty good for most people unless you are really insulin resistant.

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It would be interesting to see how Jimmy does with his ketones and blood sugars after eating something like this.  Over the short term he might see a rise in his blood sugars, however, over the long term the reduced calorie density, higher nutrient density and higher fibre might work really well for him.

As always, if you’re struggling with blood glucose control you should ‘eat to your meter’ and make sure the foods you eat don’t drive up your blood glucose levels too much.

net carbs insulin load carb insulin fat protein fibre
15g 39g 39% 64% 18%

14g

building a better nutrient density index

  • Nutrient dense foods can increase satiety by providing adequate nutrition and reduced cravings with less energy.
  • Some approaches to nutrient density focus on vitamins and minerals while others use a broader range of nutrients that include essential amino acids and essential fatty acids.
  • This article outlines a new system for prioritisation of foods that focuses on essential nutrients that are more difficult to obtain.

why nutrient density matters

Dr Joel Fuhrman has done some great work developing and testing his dietary approach based on high nutrient density foods.[1]

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Fuhrman’s research suggests that a high nutrient density approach (HND) to food selection leads to a range of benefits including improved:

  • blood sugar control,
  • weight loss,
  • blood pressure, and
  • blood markers.[2]

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People following a high nutrient density approach tend to feel more satiated with fewer calories and are able to skip meals more easily.[3]

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Harvard researcher Dr Christopher Gardner has also shown the benefits of a high fibre, nutrient dense dietary approach with his recent paper Weight loss on low-fat vs. low-carbohydrate diets by insulin resistance status among overweight adults and adults with obesity: A randomized pilot trial.[4]

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In this study all participants were encouraged to eat nutrient dense, higher fibre, unprocessed foods.  While the participants who were insulin resistant benefited more from a low carbohydrate approach and insulin sensitive people benefited more from a low energy density / low fat approach, everyone lost weight and improved their blood markers without having to consciously count calories!

calories or nutrients?

It’s generally accepted that people will lose weight if they consume less calories, however the real challenge is managing appetite in the long term.

“Appetite is a dragon.  Losing weight is brutally tough.  Harder than particle physics.”

says RD Dikeman (pictured) who has made some great progress via tight blood glucose control (using the process outlined in the article how to use your blood glucose meter as a fuel gauge), avoidance of processed carbs and intermittent fasting.[5]

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Most people find that appetite and metabolism win out over willpower or conscious calorie counting in the long run.  Either we end up binging on the foods we were craving or our metabolism slows down to cope with the reduced energy intake.[6]

But what if satiety is influenced by the quantity of nutrients rather than the calories in our food?  Paul Jaminet in his Perfect Health Diet books says:

“A nourishing, balanced diet that provides all the required nutrients in the right proportions is the key to minimising appetite and eliminating hunger at minimal caloric intake.”

But how do we know if we are getting the required nutrients in the right proportions?   Which foods will help us maximise our chance of achieving nutrient density while minimising energy?

The chart below (click for a larger image) shows the percentage of the recommended daily reference intake (DRI)[7] of the various nutrients that you would obtain if you ate a little bit of ALL of the 7000+ foods in the USDA foods database.

  • Without following any particular dietary approach it seems from this that it’s fairly easy to obtain the recommended amounts of most of the amino acids, iron, phosphorus, selenium, niacin and Vitamin B-12.
  • However, without paying attention to the nutrient density of your diet or supplementation you will have to consume well beyond 2000 calories to obtain the recommended daily intake of calcium, magnesium, potassium, copper, vitamin E, vitamin D, pantothenic acid, choline and the essential fatty acids EPA and DHA.

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Satiety is a complex and controversial topic.  There are many factors including, palatability, mouth feel, smell, protein, fibre, mood, insulin resistance etc etc etc.   Obtaining adequate nutrients may not be the only thing that influences appetite, but it just might be a significant piece of the complex puzzle.  As you will see below, nutrient dense foods are typically also unprocessed whole foods that you would be less likely to binge on than a packet of Pringles, pizza and a bottle of coke (i.e. ‘foods with no brakes‘).

The slide below from a presentation by Bruce Ames demonstrates that there might be some room for improvement in the nutrient density of most people’s diets.[8]

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This slide shows how many people are lacking in a range of key micro-nutrients.  Very few people are getting adequate omega-3 essential fatty acids.

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limitations of daily reference intake values

The daily recommended intake (DRI)[9] values are typically conservative.  You may do fine with much lower levels than the recommended intake levels.  The only way to really know if you are lacking in a particular nutrient would be to get blood tests to see if you are deficient in any nutrients.[10]

In lieu of regular blood testing of all the essential nutrients you can use the DRI values as a guide to understand if you are getting a ‘balanced diet’ with adequate amounts of the essential nutrients.  Some people use apps like cronometre to see if they are meeting their minimum levels of various nutrients, but how do you know which foods will give you the best chance of maximising your nutrition?

There are meal replacement shakes (e.g. Soylent, Optifast, Ambronite etc) that enable you to theoretically meet the DRI values with a minimum amount of calories.  However the safest approach is probably going to be to focus on nutrient dense unprocessed foods that contain all the essential nutrients that we know about as well as the other nutrients that we don’t yet know about.

Your metabolism may not have read the World Health Organisation’s research on the daily reference intake of the various nutrients however, if appetite is at least partially driven by obtaining adequate nutrition you can see why we are less likely to binge on nutrient dense whole foods.

The slide below from Bruce Ames shows the commonly accepted essential vitamins, minerals, amino acids and fatty acids that we require.

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how to calculate nutrient density

Calculation of nutrient density is far from a precise science.  Different people have taken different approaches and arrived at different food rankings.

Joel Fuhrman’s take on nutrient density uses vitamins and minerals with no consideration of amino acids or fatty acids.   Fuhrman’s ANDI index also includes phytosterols, glucosinolates, angiogenesis inhibitors, organosulfides, aromatase inhibitors, resistant starch, resveratrol and Oxygen Radical Absorbance Capacity (ORAC) in the scoring.  These additional parameters are not available in the USDA food database and are not part of the generally accepted list of essential nutrients, so it’s hard to include them in a comprehensive analysis.[11]   The highest scoring foods with or without these additional parameters are similar (i.e. green leafy veggies) so I don’t think omitting these parameters will materially change the overall outcome.

Based on his analysis Fuhrman recommends a diet high in vegetables and fruit with a minimum of animal products and processed carbohydrates.  Fuhrman recommends eating animal products only occasionally, ideally fish to provide omega 3 fatty acids.  It’s not hard to see how restricting yourself to non-starchy veggies would help you to reduce your energy intake.

More recently Dr Mat Lalonde developed an alternative approach to analysing nutrient density which also includes essential amino acids and essential fatty acids.  With the inclusion of animal products this approach tends to prioritise high protein animal based foods.  Lalonde’s approach is based on nutrients per weight of food which may be useful for an athlete wanting to quickly refuel, however Fuhrman’s nutrietns per calorie may be more useful for someone wanting to lose weight.

The low carb community’s criticism of Fuhrman’s approach is that it is too high in carbohydrates and that it is unnecessarily biased towards plant based foods.   Meanwhile the vegan community’s criticism of Lalonde’s approach is that the higher protein and fat levels are unnecessary and even dangerous.[12]  They claim you can get adequate amounts without going out of your way to make it a priority.

As detailed in the optimal foods for different goals I previously had a go at developing a nutrient density ranking system that includes forty three (43) beneficial nutrients including vitamins and minerals as well as beneficial amino acids and fatty acids.   While this ‘belt and braces’ approach to nutrient density will ensure that you maximise the nutrient density of your food there is also a risk that it will prioritise nutrients that are easy to obtain at the expense of nutrients that are less common in our food system.

So which approach is optimal?  Vitamins and minerals only, all beneficial nutrients, or perhaps something else?  Which approach will enable you to obtain a nourishing, balanced diet that provides all the required nutrients in the right proportions to minimise appetite and eliminate hunger with a minimal caloric intake.

comparison of approaches to nutrient density

The chart below (click for a larger image) compares the nutrients we obtain for the following approaches:

  • all foods,
  • top 500 foods prioritised using vitamins and minerals, and
  • top 500 foods prioritised using all 43 beneficial micro-nutrients.

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We can see from this analysis that:

  • Following either approach to maximising nutrient density provides an immense improvement compared to the average of all of the foods in the USDA database.
  • The vitamins and minerals only approach does better in terms of most of the vitamins and minerals.
  • The most nutrient dense approach using forty three micro-nutrients does better when it comes to amino acids (protein), essential fatty acids (DHA and EPA), vitamin B-12, zinc, selenium and niacin.
  • There is a lot of variability in the amounts of nutrients in terms of percentage of the DRI.

So if our goal is to avoid malnutrition with the minimum amount of calories, which approach is optimal?

Perhaps what we need, rather than amplifying all nutrients, is to prioritise the foods with the nutrients that are harder to obtain?

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removing the overachievers

The chart below shows the proportion of the population that consume less than the recommended amount of various essential nutrients.  From this it seems we should, as a minimum, prioritise vitamin D, vitamin E, magnesium, calcium, vitamin A and vitamin C.

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Starting with the full list of forty-three beneficial nutrients I have progressively removed the ‘overachievers’ so we only prioritise the harder to obtain nutrients.  The nutrients that you could obtain more than 500% of the daily recommended intake (DRI) with 2000 calories have been removed from the system.

I have also removed the fatty acids that could be considered contentious in a minimalist food ranking system.  So rather than 43 nutrients we end up prioritising only the 27 hardest to obtain essential nutrients.

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

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

The chart below (click for larger image) shows the outcome of the moderated approach compared to the other approaches (i.e. all foods, vitamins and minerals only and all 43 nutrients).  A number of the nutrients that were lower using the “all nutrients” approach have improved (i.e. calcium, magnesium, vitamin A, vitamin C, selenium, vitamin E and vitamin D).

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which one is best?

The moderated approach does pretty well across the board.  The problem  is that it’s hard to make sense of all this data to confirm which approach is optimal.  How do we simplify the decision process?

In engineering we often think in terms of reliability statistics.[13]

Let’s say Acme brand widget is really strong on average but highly variable.  If you buy a box of Acme widgets most of them will be strong, but you might get some low strength duds.  Acme of widget not reliable so we have to be conservative when it comes to the design assumptions.   In the design we might assume that a widget is only as strong as the average minus one or two standard deviations of the strength to make sure our design is conservative.

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However if we can decrease the variability by improving the manufacturing process and produce a box of widgets that are not quite as strong on average but less variable we can assume a lower factor of safety and assume more capacity in a design using that bolt.

Perhaps we can use a similar analysis approach when it comes to nutrient density.  What we ideally want is a diet that has high levels of all of the essential nutrients without any nutrient deficiencies that would require supplementation.

The chart below plots the average of all the nutrients as a proportion of the DRI (blue bars).  We can see that all three approaches to ranking nutrient density do better than the average of all foods in the USDA database, with the “43 micro-nutrients” approach scoring the best.  However we know from the chart above that this high score is largely due to very high amino acid scores for the “all 43 micro-nutrients” approach.

The vitamins and minerals only approach also does well, however we also know that this is due to the higher score in the vitamins and minerals with lower scores in some of the other nutrients such as the proteins and essential fatty acids.

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The orange bars in the plot represent the average minus 0.8 times the standard deviation of the nutrients as a percentage of the DRI requirement.  Using this approach to comparison it appears that the moderated nutrient density approach is better because we have less variability across the nutrients, with some lower highs and lots of higher lows compared to the other approaches.

What this means in practice is that the moderated approach will more reliably provide you with the essential vitamins, minerals, amino acids and fatty acids that you require without needing to supplement or overeat to provide the missing nutrients.   The moderated nutrient density approach seems to give us a better outcome in terms of nutrient density.

most nutrient dense foods

Listed below is a summary of the top 1000 foods prioritised by the moderated nutrient density system detailed above.

In addition to nutrient density score (note: 0 is average and a score of 2 means that a food is two standard deviations above the mean) I have also included a number of other parameters that may be of interest.

  • The percentage of insulinogenic calories and net carbs per 100g of food will be of interest for someone who aiming for a high fat therapeutic ketogenic diet.
  • The insulin load may be of interest for someone who is insulin resistant and wanting to consume a diet that their pancreas can keep up with.
  • Net carbs will be useful for someone doing standard carbohydrate counting.
  • The energy density (calories per 100g) will be of interest for someone looking to decrease the energy density of their diet for weight loss.

I have also shown the vitamin, mineral and protein plots for some of the highest ranking foods in each category to get a feel for the nutrition provided by each of these foods.

Choosing nutrient dense whole foods typically ensures that the other relevant parameters are favourable, though these other factors may be of interest depending on your situation.

Future articles will look at how we can fine tune our food selection to suit people who are insulin resistant and wanting to normalise their blood glucose levels or who are insulin sensitive and still looking to lose weight.  In the meantime you can check out these summary food lists that are based around these ideas:

vegetables

If you look down the nutrient density (ND) scores of all the foods you will see that the vegetables do really well compared to the other food groups.  If you were aiming to maximise nutrient density you could simply focus on eating as many vegetables as you could with perhaps some supplemental seafood for essential fatty acids. image09

Celery tops the list of nutrient dense dense foods because it has a lot of vitamins and minerals with very few calories.  The chart below from Nutrition Data shows that we would obtain 81% of our required vitamins and minerals from 1000 calories and 52% of the protein.   The is that we would need to eat 100 celery stalks to obtain that 1000 calories!  However you can see how in terms of nutrients per calorie celery is amazing and you wouldn’t go wrong trying to fill up on these high nutrient density low calorie density foods.

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food ND % insulinogenic net carbs/100g insulin load  (g/100g) calories/100g
celery 2.63 49% 1 2 17
rhubarb 1.46 57% 3 3 21
turnip greens 1.31 39% 1 4 37
lettuce 1.34 52% 2 2 17
winter squash 1.22 80% 7 8 39
broccoli 1.21 57% 4 6 42
asparagus 1.12 46% 2 3 27
Chinese cabbage 1.02 60% 1 2 16
summer squash 1.00 65% 2 3 19
okra 0.94 57% 4 5 37
bamboo shoots 0.90 52% 3 4 28
bell peppers 0.86 64% 6 7 43
artichokes 0.83 33% 3 4 54
cabbage 0.81 53% 3 4 30
kale 0.75 74% 8 10 56
parsnip 0.73 38% 7 7 76
seaweed (kelp) 0.74 43% 4 5 50
snap green beans 0.74 47% 4 5 40
peas 0.69 58% 5 7 51
radishes 0.70 50% 2 2 19
mushrooms 0.65 70% 2 5 30
sweet potato 0.51 82% 17 18 87
onions 0.52 77% 7 8 41
jalapeno peppers 0.52 54% 4 5 35
pinto beans 0.44 60% 16 21 142
sweet corn 0.43 47% 10 13 111
collards 0.44 46% 2 5 40
dill 0.42 30% 2 4 52
eggplant 0.39 67% 7 7 41
beets 0.34 44% 4 5 48
shallots 0.27 60% 46 56 377
mung beans 0.33 46% 1 3 26
thyme 0.27 21% 14 19 359
black pepper 0.24 36% 24 29 327
bay leaf 0.21 37% 34 38 406
chives 0.27 34% 1 3 37
mustard greens 0.27 45% 2 3 30
Brussels sprouts 0.24 54% 5 7 52
shiitake mushrooms 0.20 68% 51 59 349
paprika 0.19 17% 8 16 389

fruit

The list of nutrient dense fruits is shorter than the vegetables due to the higher amount of calories and sugar in proportion to the amount of nutrients.

The plot below shows that we get 57% of the vitamins and minerals and 44% of our protein from 1000 calories of mandarin orange.

Nutrition Facts and Analysis for Oranges, raw, all commercial varieties - Google Chrome 16052016 54708 AM.bmp

food ND % insulinogenic net carbs/100g insulin load (g/100g) calories/100g
cherries 0.72 84% 10 11 54
orange 0.49 77% 10 11 55
apples 0.48 77% 10 10 53
grapes 0.45 80% 15 15 77
figs 0.37 81% 16 17 82
blueberries 0.32 72% 16 16 91
mandarin oranges 0.31 63% 9 9 59
honeydew melon 0.30 88% 8 9 40
passion fruit 0.24 54% 13 15 109
raisins 0.20 84% 68 70 336
litchis 0.20 80% 14 15 73
dates 0.17 72% 54 56 308

legumes

Legumes tend to have a higher energy density than the vegetables and thus may be useful if you need some more calories to support your activity and can’t fit in any more celery, lettuce and broccoli.

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The Nutrition Data plot below for lentils shows that 1000 calories will provide 58% of your vitamins and minerals and 86% of your protein.

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food ND % insulinogenic net carbs/100g insulin load  (g/100g) calories/100g
lima beans 0.56 71% 16 23 129
navy beans 0.47 55% 15 20 143
lentils 0.35 62% 12 18 118
hummus 0.26 32% 8 14 175
peanuts 0.17 18% 7 28 605

grains

The nutrient dense grains tend to be the least processed.  Unfortunately most grains are consumed in a highly processed form.

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The plot below shows that oats will give us minerals and a substantial amount of protein, but are not as high in the vitamins compared with a number of the other foods. image11

food ND % insulinogenic net carbs/100g insulin load  (g/100g) calories/100g
oatmeal 0.77 58% 8 10 67
teff 0.70 54% 11 14 101
spelt 0.58 54% 14 18 135
rice noodles 0.54 87% 22 23 105
quinoa 0.45 55% 14 16 120
oat bran 0.35 57% 29 38 264
millet 0.34 76% 20 22 118
rye bread 0.30 64% 37 45 282
rice bran bread 0.25 54% 31 37 273
wheat bran bread 0.24 68% 37 44 257
oat bran muffins 0.23 48% 29 35 288

dairy and eggs

The nutrient density score for eggs and dairy is not as high as the vegetables, however the proportion of insulinogenic calories and net carbohydrates is lower which will mean that these foods have a minimal impact on blood glucose levels.

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The plot below shows that we would get half of our required vitamins and minerals and 136% of our protein requirements from 1000 calories of eggs (i.e. 14 eggs).

image12

food ND % insulinogenic net carbs/100g insulin load  (g/100g) calories/100g
parmesan cheese 0.18 30% 3 31 411
goat cheese 0.17 22% 2 25 451
edam cheese 0.17 22% 1 20 356
gruyere cheese 0.17 21% 0 22 412
Swiss cheese 0.17 26% 5 25 379
egg yolk 0.17 19% 4 15 317
gouda cheese 0.17 23% 2 20 356
provolone 0.17 24% 2 21 350
blue cheese 0.16 20% 2 18 354
cheddar cheese 0.15 20% 1 20 403
limburger cheese 0.16 18% 0 15 327
camembert cheese 0.16 20% 0 15 299
Monterey 0.15 20% 1 19 373
muenster cheese 0.15 20% 1 18 368
Colby 0.15 20% 3 20 394
whole egg 0.16 29% 1 10 138

nuts and seeds

Nuts and seeds are more energy dense but lower in carbohydrates due to their higher fat content.  While nuts and seeds will help someone achieve more stable blood glucose levels it is common knowledge in low carb circles that you need to watch your intake of nuts, seeds and dairy if you’re trying to lose weight.

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food ND % insulinogenic net carbs/100g insulin load  (g/100g) calories/100g
coconut water 1.51 66% 3 3 20
sunflower seeds 0.18 20% 11 24 491
tahini 0.17 16% 13 26 633
pine nuts 0.16 11% 9 18 647
pecans 0.15 5% 4 9 762
pistachio nuts 0.16 23% 19 34 602

seafood

Omega 3 fatty acids are important but hard to get in the diet, so it’s worth going out of your way to ensure you are getting enough.

seafood-salad-5616x3744-shrimp-scallop-greens-738

The plot below shows that we can get more than half of our vitamins and minerals and 148% of our protein requirements from 1000 calories of sardines.

image08

food ND % insulinogenic insulin load  (g/100g) calories/100g
anchovy 0.34 42% 21 203
caviar 0.30 32% 22 276
tuna 0.30 50% 17 137
oyster 0.31 57% 14 98
rainbow trout 0.28 43% 17 162
mackerel 0.28 45% 17 149
swordfish 0.28 41% 17 165
lobster 0.30 69% 14 84
herring 0.26 34% 18 210
salmon 0.28 50% 15 122
whitefish 0.27 67% 17 102
octopus 0.26 69% 27 156
halibut 0.27 63% 16 105
Pollock 0.27 66% 17 105
sturgeon 0.26 47% 15 129
sardine 0.24 36% 18 202
shrimp 0.26 66% 19 113
crab 0.26 69% 13 78
snapper 0.25 64% 15 94
haddock 0.24 67% 18 110
mussel 0.22 61% 25 165
whiting 0.21 63% 17 109
crayfish 0.21 64% 12 78
abalone 0.21 76% 19 99
haddock 0.21 69% 15 85
clam 0.20 71% 24 135

animal products

When it comes to animal products the lower fat cuts tend to rank higher when it comes to nutrient density.

7450703_orig

Liver ranks the highest overall and the vitamin and minerals score as well as the protein score is substantial.

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food ND % insulinogenic insulin load  (g/100g) calories/100g
beef liver 0.46 58% 24 169
chicken liver 0.43 48% 20 165
ham 0.26 55% 20 146
pork 0.25 54% 21 154
veal (leg) 0.25 56% 25 174
emu 0.24 63% 25 159
beef 0.22 50% 25 197
chicken breast 0.22 56% 25 178
turkey breast 0.22 70% 22 127
bacon 0.18 23% 30 522
ground turkey 0.19 37% 19 203
ostrich 0.19 46% 19 168
veal (sirloin) 0.18 38% 19 195
pork 0.18 46% 21 182
chicken drumstick 0.17 36% 22 238
goose 0.17 37% 21 230
duck (meat only) 0.17 36% 17 195
beef steak 0.16 28% 21 305

should everybody eat just these nutrient dense foods?

As a general rule most people would do well eating from this list of nutrient dense whole foods.  Unprocessed nutrient dense foods would be a major improvement for most people.  There is however opportunity to further refine this for specific goals such as weight loss or diabetes.

In future articles we will look at how we can use the concepts of energy density and insulin load to further refine this list for people who are looking to lose weight and for people who have diabetes and need to control their blood glucose levels.  In the mean time you may be interested in these summary food lists:

 

references

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

[2] https://www.drfuhrman.com/members/m_library/OJPM20120300014_73341742.pdf

[3] https://www.drfuhrman.com/library/changing_perceptions_of_hunger.pdf

[4] http://onlinelibrary.wiley.com/doi/10.1002/oby.21331/full

[5] RD also happens to be a physicist and a chief scientist with defence contractor Lockheed Martin.  He is also an admin on the TYPE ONE GRIT facebook group for people with type 1 diabetes (his son has type 1 diabetes) and produces Dr Bernstein’s Diabetes University.

[6] http://www.amazon.com/Obesity-Code-Unlocking-Secrets-Weight/dp/1771641258

[7] https://ods.od.nih.gov/Health_Information/Dietary_Reference_Intakes.aspx

[8] https://www.youtube.com/watch?v=ZVQmPVBjubw

[9] http://www.mydailyintake.net/nutrients/

[10] http://www.lifeextension.com/vitamins-supplements/blood-tests/nutrient-testing

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

[12] http://www.vegsource.com/articles/protein.danger.htm

[13] https://en.wikipedia.org/wiki/Reliability_(statistics)

humans are not broken breakfast

One of the things that inspired me to try this line of nutritional analysis was a post by Angelo Coppola on his blog Humans are Not Broken where he showed that his breakfast tortilla is better nutritionally than Bulletrpoof Coffee.

As an occasional drinker of Bulletproof Coffee, Angelo’s approach to nutritional analysis and comparing two very different meals got me thinking.

Surely it can’t be that simple. I know that something that high in carbs wouldn’t be great for a diabetic like my wife, but at the same time it was clear than his whole food tortilla was going to have a much wider array of nutrients.

I figured the food insulin index might be a useful tool to also consider how particular foods might work for someone who doesn’t ideal blood sugar control.

So anyway, I ran the numbers, and this tortilla wrap has one of the highest nutritional completeness score (based on vitamins and minerals) of any of the meals I’ve analysed.

The downside is that it also has a very high 65% insulinogenic calories and 61g net carbs which is not so good for someone with diabetes.  A type 1 diabetic would need to dose about 4 units of insulin for this meal and would then be on the blood sugar roller coaster for the rest of the day.

What I like about this approach to ranking foods is that it doesn’t have to fall into a particular camp such as LCHF, Atkins, Paleo, vegetarian, vegan etc. It just optimises for nutritious food, and for people who don’t have perfect blood sugar control (which is most of us) manages insulin.

We can say that this meal would be great for someone with great blood glucose control and looking for a nutrient dense option.  With all the fibre and low calorie density this meal would be great for someone looking for fat loss.

10922880_10152571871125544_2331020752807010244_n

net carbs

insulin load carb insulin fat protein fibre
61g 72g 85% 12% 17%

19g

insulin load… the greatest thing since carb counting?

In a few previous articles I have outlined the idea of the insulin load.[1] [2]  The concept is similar to carbohydrate counting, but also accounts for the effect of protein.

insulin load = total carbohydrates – fibre + 0.56 x protein

show me the data!

Most people understand that dietary carbohydrate is the primary nutrient that influences blood glucose and insulin.

image13

image11

However, while carbohydrate is the dominant nutrient that influences insulin and blood glucose response, indigestible fiber[3] and glucogenic amino acids (protein)[4] [5] also affect our blood glucose and our insulin response to food.  We can better predict the insulin and glucose response to our food if we also account for the effect of protein and indigestible carbohydrates (i.e. fibre).

image24

image22

I was pleased to see Jason Fung even mention the food insulin index and the Optimising Nutrition blog at the recent low carb conference in Vail Colorado.  And it has been great to see a handful of people like Patricia and Mike put this theory into practice with great results as detailed in this article.

Patricia Berry Moore

This comment from Patricia Berry Moore made my day.

Marty! Are you the low carb down under Marty??!

You and Sarah Hallberg are why I started LCHF.  And went from a very unhealthy type 2 diabetic at 156 lbs to a very healthy 113 lbs.

THANK YOU!

Patricia had seen my presentation on the food insulin index, applied the theory, and it worked!

Patricia says:

I use the insulin load concept. 

I find it helps me mess with my macros.  A little less protein a bit more carbs. 

And you can find that sweet spot.  For me 50g per day is perfect.

My doctor threatened me with insulin and so I started went digging and found your lectures. 

Over 10 months I lost 43 lbs (I’m 5’2″).  I was pre-diabetic for ten years and then type 2 diabetic for ten years. 

I am now off all my meds.  I was on eight different ones for high blood pressure, high cholesterol, arthritis, reflux, diabetes.

I’m never going back, so thank you!

This is Patricia’s “before photo.”  You can see a ‘puffiness’ in her face characteristic of insulin resistance and hyperinsulinemia, which causes fluid retention.  I showed this photo to my 12 year old daughter who said “that’s how you used to look.”  Thanks dear…  I think.

image17

If you’ve hit a plateau it might be worth tracking the insulin load of your food for a while to fine tune your diet.   Patricia says:

I use the app Lose it! which helps me track macros. So it’s pretty easy to keep a running total of my insulin load too. 

I started at around 80g per day.  As I decreased it, my blood sugars improved. 

At this point my fasting blood glucose run at 65 – 75 mg/dL with an insulin load around 50g per day or so. 

LCHF has really saved my life Marty.

This is Patricia now.  Congratulations Patricia!  You look like a different person!

image16

A little closer to home

As mentioned by my daughter, this is me before and after trying out my low insulin load, high nutrient density foods.  I don’t think my hair moved in the 18 months between when these work profile photos were taken, but some inflammation and weight certainly did.  My family assures me I was bigger and unhealthier looking than the photo on the left!

image07

The photo below on the left is my daughter’s “before photo” after spending 9 months in a high insulin environment.  Children born to mothers who are type 1 diabetic and dosing with lots of insulin tend to be delivered early via C-section due to their excessive size caused by the high levels of insulin from the mother.  The photo on the right is her twelve years later, all grown up and beautiful!

image15

The photos below are the same child, “JL,” who was one of the first type 1 diabetic children to receive insulin treatment in 1922.  Without insulin he’s wasting away, literally eating his own fat and muscle, unable to metabolize carbohydrate.  Two months later the photo on the right shows that he’s been able to make a full recovery with the exogenous insulin injection.

image06

Here’s other similar photos before and after receiving exogenous insulin.  

image03

Hopefully from these photos you can see how there’s a “Goldilocks zone” for insulin.  Not too little.  Not too much.  Just right.

Mike Alward

I received similar feedback recently from Mike Alward who has also successfully applied the insulin load theory.  Mike says:

I just wanted to say thanks for your work on insulin load, food insulin index and glucose : ketone index.  It really helped me to understand what was holding me back from reaching and being able to maintain a state of optimal ketosis. 

I manage my insulin load to ~75g per day.  My BG has come down and my ketones are now in the optimal range.  My GKI is now below 3. 

I used to be pre-diabetic with blood glucose up around 6.5 mmol/L.  Now, I am in the 4.5 – 4.7mmol/L range. 

Being in optimal ketosis has helped to control my appetite and cravings (especially sugar), which has made intermittent fasting so much easier.

Keep up this important work!  

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With this reduced insulin approach Mike is able to accommodate a solid amount of protein into his diet while maintaining excellent blood glucose and ketone levels.  Like anything, you can have too much of a good thing, including protein.  Many people find that as their insulin resistance improves they are able to handle a higher insulin load diet which may enable a higher nutrient density and less fat.    Mike says:

My target is ~90g – 100g of protein / day.  I am 6’0″.

Mike likes to track a range of different health makers.

I track my weight calories, macros, calculated insulin load, blood glucose, blood ketones and GKI.

Not everybody “geeks out” on this stuff.  I am totally into “nerd safaris” to research non-conventional wisdom health. 

I just got several folks to calculate their insulin load, and their heads almost exploded when I introduced them to GKI.  

You can see in the chart below how Mike’s ketones have increased as he has reduced the insulin load of his diet.

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The chart below shows how Mike’s glucose : ketone index (an approximation of insulin levels) has decreased as he lowered the insulin load of his diet.

image19

Tracking the insulin load of your diet is a little more complex than just counting carbs, but not that much more work if you’re already tracking your food intake.  Personally I’m not a big fan of tracking everything you eat but it can be useful to keep a food diary for a time to reflect and refine.   If you just want to know what you should eat these lists of optimal foods for different goals may be useful for you.

how to calculate your insulin load

So how do you calculate the insulin load of your diet?

If you’re already tracking your food intake it’s a pretty simple thing to do.  Below is an example output from MyFitnessPal[6] showing the food intake for the day comprising of:

  • carbohydrates (70g),
  • fiber (63g), and
  • protein (104g)

image09

So we start with the insulin load formula:

insulin load = carbohydrates (g– fibre (g) + 0.56 x protein (g)

Insert our values:

insulin load = 70g carbohydrates-63g fibre + 0.56 x 104g protein

and calculate:

insulin load = 65g

It’s not that much different to tracking net carbs, but instead you also account for protein which also requires insulin.  I initially developed this calculation for people with type 1 diabetes (like my wife) who need to calculate their insulin dosage but it can work in a similar way for someone wanting to reduce the demand on their pancreas to the point that it can keep up and maintain normal blood glucose levels.

Reducing your insulin levels to normal healthy levels will allow your stored fat to be used for energy and manage your appetite.   As you track your insulin load you can keep eliminating the foods that are driving it up until the point that you see the weight loss and blood glucose levels that you’re chasing.

image21

The appropriate insulin load will vary from person to person.  A small woman aiming for weight loss using a lower protein ketogenic approach might have an insulin load as low as 40g per day while a larger man looking who is active and looking build  muscle might have an insulin load as high as 300g per day.  A higher insulin load diet would allow more plant based foods, less fat and potentially a higher nutrient density (e.g. 40 to 50% of insulinogenic calories) however I think the first priority will be to reduce the insulin load of your diet to the point where you can normalise your blood glucose levels and reduced insulin (e.g. 20 to 30% of insulinogenic calories).

The best idea is to start tracking where you’re currently at and look to reduce your daily insulin load until you achieve excellent blood glucose levels (i.e. average less than 5.6 mmol/L or 100 mg/dL).  Once you normalise your blood glucose levels you could keep winding it down further until you achieve your desired level of ketones.  As your body heals and you start to reduce the amount of fat around your organs you may be able to tolerate a higher insulin load diet in time.

a little more on the insulin load theory

So is it all about the insulin load?  What about calories and conservation of energy?

This video gives a good overview of how insulin (either injected or from our own pancreas) affects  whether we store fat on our body or release it to be used for fuel.

Most people think of macro nutrients in terms of carbohydrates, protein and fat as per the the picture below.   They think that if we eat too much fat it will be stored as body fat.  But the reality is a little bit more complex than that.

image04

In the chart below the grey slices of the pie chart (i.e. the non-fibre carbohydrate and the glucogenic protein) are the components of your food that are glucogenic and will require insulin to metabolise.

The blue components are ketogenic (i.e. the dietary fat and the ketogenic protein) and do not require insulin to metabolise.  If you’re lucky enough to be insulin sensitive you will burn the food you eat and your appetite will be well regulated with minimal change in body weight.

image05

Indigestible fibre (black slice) doesn’t really have any effect on insulin or even contribute to calories for us but rather is used to feed the bacteria in our gut.  Fibre is a true ‘free food’.

If the insulin load of our diet is high then we are more likely to store a portion of the food.  If we are insulin resistant our body will have to generate more insulin to deal with the non fibre carbohydrate and glucogenic protein while  increasing our chances that some of the food we eat will be stored on our body.  We will then feel hungry and need to keep eating to obtain adequate energy.  Calories still matter, but outside a controlled metabolic laboratory, body fat accumulation is more about managing fat storage and appetite than about counting calories.  

image08

Calories still matter, but outside a controlled metabolic laboratory, body fat accumulation is more about managing fat storage and appetite than consciously counting calories.  Many people refer to insulin as the thermostat that controls our metabolism and how much fat we store.

The good news here is that we can use our understanding of the storage properties of insulin to our advantage.  If we are able to decrease the insulin load of our diet we are less likely to store fat and more likely to be able to use some of our stored body fat for energy.  This will mean that we feel less compelled to eat because we are able to use up our own body fat rather than constantly eating.   This reduced dietary insulin load scenario will lead to lower insulin levels, less storage, more use of body fat for fuel, a decreased appetite and a reduction in energy intake.  

image10

What can you do to reduce the insulin load of diet include?

  1. eat more fibre,
  2. eat less digestible carbohydrates, and
  3. make sure your protein intake is not excessive.

can you eat too much fat?

Can you still eat too fat much while keeping the insulin load of your diet low?  The short answer is yes, especially if you’re chasing a certain macro nutrient value or high ketone values.

The good news is that a higher fat low insulin diet will typically lead to increased satiety and reduced energy intake.

The bad news is that excess energy, whatever the source, will lead to fat gain, inflammation and insulin resistance.

Many people recommend that you should eat ‘fat to satiety’.  Unfortunately, high fat foods can be easy to overeat, at least for some individuals. There is no need to force yourself to eat extra fat if you are trying to lose weight.  If you’re trying to lose weight there’s no need to go out of your way to add extra fat and oils to your food but rather obtain your fat from whole-food sources.

The other unfortunate fact is that the insulin produced in response to food is less than half of the amount of insulin that your body produces.  In addition to reducing the insulin load of your diet you may also need to increase the periods between your meals.  This will allow your insulin levels to decrease even more so that body fat can be accessed for fuel.

Implementing an intermittent fasting regimen can be useful for people who find that reducing the dietary insulin load doesn’t lead to enough reduction in appetite.

As detailed in the how to use your glucose metre as a fuel gauge article, waiting until your blood glucose levels drop can be a useful way to increase the timing between meals and to understand whether your hunger is real.

You can get a substantial decrease in insulin levels with a regular 18 to 24 hour fast.image23.png

summary

  • The end game is to reduce the insulin load of your diet to the point that your pancreas can keep up and maintain normal blood glucose levels consistent with your personal metabolic health and level of insulin sensitivity.
  • If your blood glucose and insulin level are high then you should work to decrease the insulin load of your diet.
  • As the insulin load of your diet decreases you should see your blood glucose levels come down as well, your appetite reduce and your ketone levels come up.
  • If you’re still not seeing the results you want then the next step is to try intermittent fasting to further reduce your insulin and blood glucose as well as mitigate your overall food take.

references

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

[2] https://optimisingnutrition.com/2015/03/22/ketosis-the-cure-for-diabetes/

[3] https://en.wikipedia.org/wiki/Dietary_fiber

[4] https://optimisingnutrition.com/2015/07/06/insulin-index-v2/

[5] https://en.wikipedia.org/wiki/Glucogenic_amino_acid

[6] https://www.myfitnesspal.com/