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] http://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/

34 thoughts on “choosing the right sized low carb band aid”

  1. 3.11am????? How much sleep are you getting, Marty?

    Wonderful information. Thank you.

    My main problem is that people are saying mean things, like asking if we are anorexic. “You are so THIN.” That came from an overweight man who has had 4 melanomas, kidney problems, anemia and balance problems. I don’t say to people, gee you are fat and bloated. We went to a school fete last weekend. We could smell the sugar from the car park.

    Warm wishes to you and your family, always.

    Jill

  2. Hi Marty. You have sadly included just one line regarding the ultimate non insulinogenic dietary regime: intermittent fasting.  I consider it the starting point for all but type 1 diabetics.  Ramp up CHO restriction depending on the degree of metabolic syndrome (insulin resistance). Combine it with, at least, minimal high intensity interval training. And care for your psyche to keep down the cortisol.  Bingo. I’ve lived it for 3 years and taught it for one year. Regards. John Beaney

    1. Thanks for reading John. This article was about the balance between high fat and nutrient density and the difference between eating for diabetes and eating for weight loss which I though was going to be enough of a challenging concept to get across.
      I’ve been working on an interesting article about the glucose : ketone index as a measure of metabolic health that I would value your input on. https://docs.google.com/document/d/11PtdZT3ajqIhCEjzlQj1lzKHCbOj6cDmOC5L_FwNI0M/edit?usp=sharing

  3. Hi Marty,

    You have a really helpful blog. It’s unusually practical and I’m sure is particularly appreciated by those learning to manage their diabetes and weight.

    I do have a bit of a bone to pick about how your present the data from Cornier & Gardner (& Ebbling & Pittas) regarding IS & IR for weight loss. As I’m sure you know, Bill (@caloriesproper) has written about this here http://caloriesproper.com/insulin-resistance-is-a-spectrum/#disqus_thread. Here’s a link to my comment of Bill’s post on the matter where I argue that the studies do not support both of your conclusions http://disq.us/9s8p4y. I’ve also pasted it here below. I hope you find it constructive and would love to have your feedback! Cheers.

    Cornier et al.: randomized for 16 weeks to either a
    – Standard control diet (55% CHO, 30% fat, and 15% protein) for 3 days
    – Hypocaloric diet (400 kcal deficit/d) comprised of either
    – 60% CHO, 20% fat, and 20% protein (HC/LF)
    – 40% CHO, 40% fat, and 20% protein (LC/HF) for the following 16 weeks

    Pittas et al.: randomized for 24 weeks to either a
    – high–glycemic load diet (60% carbohydrate, 20% protein, 20% fat, 15g fiber/1,00kcal) mean estimated daily glycemic index of 82 & glycemic load of 116g /1,000kcal
    – low-glycemic load diet (40% carbohydrate, 30% protein, 30% fat, 15g fiber/1,00kcal) mean estimated daily glycemic index of 53 & glycemic load of 45g /1,000kcal
    – at 30% calorie restriction compared with baseline individual energy needs

    Ebbling et al.: randomized for 6 months to either a
    – Low–Glycemic Load Diet […] target macronutrient composition was 40% of energy from carbohydrate, emphasizing low-glycemic index sources, 35% from fat, and 25% from protein
    – Low-Fat Diet […] target macronutrient composition was 55% of energy from carbohydrate, 20% from fat, and 25% from protein

    Amongst the 3 studies the LowEST-carb diet contains 40% carbohydrate. Who here thinks this is actually low-carb? For a humming bird it’s super low-carb…

    In evolutionary terms, 40% carbohydrate is on the high-carb end of modern-hunter gatherers (see http://dx.doi.org/10.1016/j.nu… Ströhle & Hahn 2011).
    In modern terms, 40% carbohydrate is your average ‘moderate-to-high-carb’ diet.

    In neither case is it a low-carb diet – not by any reasonable definition.

    If the “LC=>IR LF=IS” distribution is true, as you argue Bill (it could very well be), I don’t see how it’s supported by these 3 particular studies (or Gardner’s for that matter).

    1. I think your first priority is to keep blood glucose under control and insulin levels low. For people who are insulin sensitive and still need to lose weight then maximising nutrient density and reducing energy density makes some sense. I have seen a lot of people get themselves into trouble with the ‘if you’re not losing weight you need to add more fat’ advice which doesn’t work for everyone. It seems a lot people have success on a ‘plant based’ Fuhrman style approach if they can stick to it. I agree it’s still early days. The Gardener pilot study is interesting and I’m looking forward to the full trial being released. I’m hoping to be part of the dialogue and give people some options who want to be adventurous and want to exchange their BPC for some celery, broccoli and salmon.

      1. Yeah, I can’t wait for Gardner’s new trial data 🙂

        As you know, there are no calorie receptors in the body. At the lowest of levels, what we have is a bound & unbound NAD/NADH ratio representing our the redox status of our cells that (non-linearly) correlates with the cytosolic lactate/pyruvate ratio. From there, it’s integrated into higher-level signaling, particularly via AMPK and mTOR. With this in mind, it is not obvious to me nor do I see it being supported by (robust) data that “[…] reducing energy density makes some sense [for people who are insulin sensitive and still need to lose weight]”. Surely our appestat is evolved to regulate/handle 100kcals, whether from 11.1g of fat or 33.33g of carbs, no? What pathways or known brain circuit would suggest this? If there is (quality) empirical data to the contrary I’d be interested in finding out about it.

        Leaving aside BPC which you and I obviously know strongly lowers the nutrients-to-calories ratio, I fail to see how broccoli would ‘work’ better for someone than broccoli. Broccoli causes more extension of the stomach, satiating someone more in the short-term. But it is nutrient and calorically poor compared to salmon which in the medium (few hours) to long-term (days) will provide less of the raw materials our cells need to signal satiety. This by no means argues broccoli is bad, just that the act of eating food must accomplish 2 things; 1) calories 2) micronutrients. Broccoli is clearly inferior compared to salmon on both accounts. After all, our broken or functional appestat is composed of cells which need factors 1 & 2.

        I totally agree that the ‘if you’re not losing weight you need to add more fat’ advice is often unhelpful if not down-right hurtful. Yet, I don’t take that to mean that the (apparent) corollary is true; go lower fat & eat plant-based. To me this could very well indicate that you need to fast. Or that protein is way too low or low quality. Or the fats you are eating negatively affect the omega6-to-omega3 ratio. Or that your insulin sensitivity & appestat is not functioning mostly because of bad sleep patterns. Or a 100 other explanations could be true…

        I think the Fuhrman diets aren’t diets but whole life-style practices. It is not possible to know if people achieve those (supposedly good) results because of or despite of the diet. Furthermore, the results are done in a very poorly controlled manner.

        I think we should be cautious about presenting the weight loss options as either low-fat (carbosis) or high-fat (ketosis). Not only is thus unrepresentative of our evolutionary picture but it does not fit observational data of people doing well ‘in between’ those 2 poles.

        Anyways, I want to reiterate how cool your blog is. Keep it up 🙂

      2. Thanks for your support with the blog. It’s great to be part of the conversation.
        The post to come out next Monday goes into the energy density and nutrient density thing a bit more. There are some that say that we tend to eat around the same weight of food. I agree that 100g of celery isn’t going to be as filling as 100g of butter, but at the same time when there is a 43 times difference in energy density I think the energy density has to play some sort of role in satiety. There is a lot of research to support this approach.
        I do have a lot of time for Furhman’s plant based approach but I think it is problematic in that it only counts vitamins and minerals rather than aminos and essential fats.
        My analysis suggest that you can probably meet the DRI values for protein without counting amino acids but however you fall down in the essential fatty acids. On the other extreme I think Lalonde’s version of nutrient density ends up biasing to animal based foods because they have a higher nutrient density per weight (particularly proteins) so you get a very high amino acid.
        I also think per calorie rather than per gram is a more reasonable basis for comparison for the majority of people. I think it’s valuable to focus on the nutrients that are harder to get in large quantities. https://optimisingnutrition.com/2016/05/16/building-a-better-nutrient-density-index/
        I’m not sure I agree that salmon is nutritionally better than broccoli (on a per calorie basis, which you are arguing for). They’re just different, and I think complimentary. I think you’d do pretty well if you limited your diet to just non-starchy veggies and fish.
        http://nutritiondata.self.com/facts/finfish-and-shellfish-products/4231/2
        http://nutritiondata.self.com/facts/vegetables-and-vegetable-products/2356/2
        I think the most interesting question is how we can signal satiety and avoid malnutrition with the minimal calories. Ray Cronise is doing some interesting thinking in this area, though again still in the mindset of avoiding fats and animal based foods which I think are unnecessary constraints to optimising the situation.
        The Ornish approach is also combined with other lifestyle modifications which confound the studies, however I think the ‘problem’ with the Fuhrman approach is that most people can’t limit themselves to just non-starchy veggies (and the lack of essential fatty acids).
        Eliminating processed foods seems to be central to all successful approaches, but we’re unfortunately programmed to enjoy quick fix low effort satiety.
        I think people should normalise blood glucose levels with a low insulin load approach and then add more non-starchy veggies until they lose blood glucose control and back off a bit.

  4. Given the current media coverage and interest, this is certainly a timely article to put some perspective and balance into low carb high fats diet. It is great for glycemic control and I have personally benefited much from it over the past few months. HbA1c 11% to 5.3%, triglycerides down from >200mg to < 100mg. But I do have some reservation about the high fats parts :).

    Especially having come across some of the stronger opinions from Carbsane and company blogs. It basically raises the question, highlighted here…carb reduction does not appear to resolve the underlying insulin resistance issue.

    What is surprising and intriguing then is the recent Salk Institute study on FGF1 protein that appears to resolve insulin sensitivity with a single injection to the brain at 1/10 the dosage compared to other locations. Wow…that seems to be the magical switch for carbs processing.

    Similarly the time restricted feeding study by a separate group from Salk Institute that demonstrates improve carbs/fats processing when feeding to the circadian cycle appears to point out the fact that diet may not matter as much.

    We have found a great tool in low carb…but equally we should not close our minds to other possibilities that may eventually help us to truly regain our health.

    1. I think low carb is useful to reduce the dietary insulin load. As per Jason Fung it seems we get desensitised to constantly high insulin levels, hence insulin resistance. Improved IR along with fasting and other things can help with appetite and weight loss which in turn leads to a reduction in fat levels which can improve the organ function (as per Dr Roy Taylor’s work). I think there is certainly a role for fat, but just adding more won’t necessarily lead to the weight loss and improvement in IR that most people are chasing.

      Thanks for the Salk institute links. I’ll check them out.

  5. Do parsnips truly only have 7 grams of net carbs per 100 g? Everythinkg I’ve read says they have 18g total carbs per 100g, of which 5g is fiber, so the net carb content is 13g (5g sugar + 8g starch).

  6. I feel I have the opposite dilemma from how you closed this post… I’ve reached my goal weight (150 lbs, 5″6′, 42year old, female) but I can not get my fasting blood glucose below 100… Occasionally during the day I’ve tested in the high 80’s but never first thing in the morning. I guess my plateau is with my blood sugar. I’m eating as low carb as possible, (salad, broccoli, cauliflower) with good fat (butter, cream, sour cream, avocado) and meat (ground beef, chicken, bacon). I also eat cheese and a little nuts. Different combinations of these ingredients are my basic menu. I also fast intermittently (16:8) as often as my schedule allows, which is almost every day. I have not established a consistent exercise routine…yet. Do you have any recommendations at all? Should I keep eating this way and work towards routine exercise? Do you think the diet part needs more tweaking? I also believe I am in the early stages of menopause which sometimes seems to frustrate everything I’ve done so far. I appreciate any advice you feel comfortable with sharing. Thank you in advance.

    1. For me, twice daily 20 minute walks = fasting blood glucose below 100 and HDL > 40. (Verified when I stopped walking when pacemaker battery reached end of life.)
      Hi-intensity interval exercise may work even better with less time required.

    2. I am curious when you fast, do you skip breakfast or dinner?

      I have not lost any weight, but fasting glucose stabilized consistently around 100.

      1. Personally I usually skip breakfast and do lunch when I feel hungry and my blood glucose levels have dropped low enough. There are also good arguments for skipping dinner too, however dinner is more the family meal for us.

    3. Sounds like you’re doing pretty well. Exercise will certainly help as will longer periods of fasting if you are concerned. You could try a 24 or 26 hour fast occasionally and see if it helps.

  7. To MyHbA1c…I usually skip breakfast, eat around 10 or 11 then again around 5:30 or 6. My lowest fasting glucose (104) came after a 30 hour fast. The weight loss came before I really implemented the fasting regimen. Do you eat low carb? I started with the suggestions for diabetes control at dietdoctor.com. Discovered fasting (and this website) from there.

    To phIO…I will add regular walking and see what happens, as I do not enjoy high intensity… Thank you for the suggestion.

    1. My wife has type 1 diabetes and I’m working to maintain lower blood glucose levels with a family history of type 2, so yeah, we are generally ‘low carb’.

      Lots of people have success with managing dawn phenomenon with longer fasting periods. Any movement is good too.

    2. Amy,
      I am on low carb with occasional intermittent fasting (once a week) from reading Diet Doctor/Dr Jason Fung etc. Have good glycemic control over the past 8-9 mths and surprisingly this past two weeks starting to have weight gain of 2kg…perhaps I am overdoing my roast pork belly recently…

      Trying to start time restricted feeding after reading the interesting mouse/circadian rhythm study by Salk Institute. Will try to get another baseline HbA1c test soon.

      Based on your eating schedule, you seems to be doing all the right things…

  8. Great work on this blog!
    My first post here….

    I am doing everything right for 2 years now, and lost 40 lbs, Hba1c=4.8%, fasting glucose=85, etc…

    But, I still have:
    HDL ~ 40
    TG ~ 125
    ALT ~ 45
    Waist: A few extra inches…

    I am thinking I need to burn off any excess fat in the liver & pancreas, and empty all fat cells to do a “reset”, otherwise I will remain stuck…

    Any feedback would be greatly appreciated….
    Cheers,
    ~Bruce

      1. Good suggestion on the IF, I am experimenting with it.

        So, does it make sense that the body may have a particular insulin set point at a given level of liver & pancreatic fat, and to breakthrough it you need to force the liver & pancreas to burn off the fat? Maybe the low carb can only take you so far, before you need more aggressive schemes like IF?

        For IF, i am considering 0, 600, or a 1200 calorie longer term restriction. There was a study from Dr. R Taylor at Newcastle that used 600 calorie diets for several weeks. I am thinking 600-1200 would be much more tolerable to me, as my recovery from a 0 calorie 4 day fast recently was rather unpleasant.

        The other option is 24 or 48 hour fasts, but I am afraid it might not be aggressive enough to get a breakthrough.

      2. If I were to venture a wild guess..fasting helps to reset some neural network much more than burning off fats…From the UW FGF1 protein injection to the brain research “We report that a single intracerebroventricular injection of FGF1 at a dose one-tenth of that needed for antidiabetic efficacy following peripheral injection induces sustained diabetes remission in both mouse and rat models of T2D. This antidiabetic effect is not secondary to weight loss, does not increase the risk of hypoglycemia, and involves a novel and incompletely understood mechanism for increasing glucose clearance from the bloodstream. We conclude that the brain has an inherent potential to induce diabetes remission and that brain FGF receptors are potential pharmacological targets for achieving this goal.”
        http://www.ncbi.nlm.nih.gov/pubmed/27213816

  9. Building up metabolic flexibility with IF for 24-48 hour periods sounds like a great plan. I can easily go 16 hours, while 24 is a little more work, and 48 is hard. I can practice that for awhile and see how far it takes me.

    The idea of the glucose meter is a good one. I use a glucose meter to measure fasting glucose every morning, and sometimes after meals. However, I have not tried targeting specific levels. I will try this with IF and see if my levels improve over a few weeks (measuring waking, right before breaking the fast, and postprandial).

    If I can’t get the breakthrough, then I will try longer CF bouts.

    BTW, if you have any references about the mechanisms of liver/pancreatic fat and possible pathways of reversal, it would be much appreciated. I have 2 to share from R. Taylor and R. Lustig respectively. In the youtube video, Lustig goes into greater detail on mechanisms than his other lectures.

    http://www.ncbi.nlm.nih.gov/pubmed/23075228

    https://www.youtube.com/watch?v=UEA6ow1icDc

    (Lustig’s lecture talks about IR mechanisms starting at (16:56). Gets especially interesting at (19:30) for a few minutes, then again at (42:50) to tie it all together.

    Would be curious about your thoughts on these.

    Cheers,
    ~Bruce

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