Nutrient deficiency in YOUR diet
I recently took a look at which nutrients might be missing from various popular dietary approaches in preparation for a recent on nutrient density. At a population level, the chart below shows the proportion of the US population has a nutrient deficiency in various micronutrients. Many people are not getting enough vitamin D, vitamin E, magnesium, calcium, etc.
While your body hasn’t read the World Health Organisation’s reports on the Daily Recommended Intake of the various essential nutrients, it’s likely that your appetite will drive you to seek out the nutrients that are lacking. If we are deficient in something that is required the body kicks in “nutrient hunger” and cravings that will make sure it gets what it needs.  
If you work hard to restrict your food intake to a certain dietary approach, but the body doesn’t receive the nutrients it needs, it may slow down and not function at full capacity. By contrast, adequate nutrition, without too much energy, slows many of the modern diseases of aging such as diabetes, Alzheimer’s and cancer and improves your chance of living healthfully to a ripe old age.
USDA foods database
The chart below shows the nutrients that are both easiest and hardest to obtain from the eight thousand foods in the USDA foods database. At the bottom of this plot we have iron, various amino acids, and vitamin C, all of which are easy to obtain in adequate quantities.
However, at the top of the chart, we can see that it is much harder to obtain adequate quantities of six essential nutrients (omega 3 fatty acids, vitamin D, choline, vitamin E, and potassium). We would obtain sufficient quantities of all the other essential nutrients if we ate just a little of each of the foods in the USDA food database.
If we want to maximise nutrient density, it makes sense to prioritise foods that contain more of the harder-to-obtain nutrients. The chart below shows the nutrients for the top 10% of the 8000 foods in the USDA database (blue bars) when we prioritise for those. Not only do we get an increase in the more difficult to obtain nutrients, we also get a massive boost in all nutrients. Rather than being nutrient deficient in six nutrients, we are now lacking only one (alpha-Linolenic acid, an Omega 3 fatty acid).
Limiting our food selection to the most nutrient dense foods makes it easier for us to consume the required nutrients without excessive energy, which is ideal if we are trying to lose fat or reduce calorie intake to slow the diseases of ageing.  Nutrient density becomes even more important if you’re fasting or restricting calories to achieve long term weight loss.
Optimising nutrient density
If you’re reading this, then you’re likely aware that there is a wide variety of dietary approaches that people follow to optimise their health depending on their preferences and beliefs.
I’ve tried to turn many of these beliefs about nutrition into a quantitative algorithm that we can use to evaluate and compare these approaches, and make sure we’re getting the outcome we want (e.g. low insulin, blood glucose control, nutrient density, or low/high energy density).
After testing a number of options, the three quantitative parameters that I have found the three parameters that are most useful are:
- insulin load,
- nutrient density, and
- energy density.
My aim in this post is to show how considering nutrient density can improve various dietary approaches, from therapeutic ketogenic, vegan, paleo, and low fat. This post highlights which nutrients you will most likely be lacking with each of the different nutritional approaches, which foods you can use to fill these nutritional gaps, and perhaps which supplements you may need if you are still looking for some added nutritional insurance.
There’s been a lot of talk lately by Taubes and Lustig about how bad sugar and fructose are, but I think these nutritive sweeteners are just extreme examples of nutrient poor foods that are highly insulinogenic and energy dense. At the other end of the spectrum, we have foods like liver, broccoli, and spinach. Everything else is somewhere in the middle and will support or work against your goals, whatever they may be, to different degrees.
My aim here is to help you see where each of these foods sits on that continuum and use this information to help you refine your food choices to reach your personal goals.
Therapeutic ketogenic diet
Let’s start with the therapeutic ketogenic dietary approach. I have previously noted that a number of the issues and concerns with the ketogenic diet seem to relate to being able to obtain essential nutrients rather than consuming excessive levels of fat.   On one hand, I’m excited that the concepts of insulin load and percentage of insulinogenic calories have been helpful for people with chronic conditions such as epilepsy, cancer, dementia, Alzheimer’s etc. However, I think there is a risk their ultra-high fat diet will not contain the nutrients which are critically important for mitochondrial function and energy production.
The chart below shows the vitamins and minerals provided by a therapeutic ketogenic dietary approach if we simply prioritise for low insulin load (red bars) in comparison to the average of all foods in the USDA database (orange bars). If you don’t pay attention to nutrient density a therapeutic ketogenic diet can provide lower levels of nutrition.
As shown in the chart below if we ate a little of all the foods in the USDA database, we would be nutrient deficient in six essential nutrients, whereas if we follow a therapeutic ketogenic diet, we will likely be lacking in ten essential nutrients.
The chart below shows the effect of how thinking in terms of nutrient density can improve the therapeutic ketogenic dietary approach (blue bars) compared to prioritising for insulin load only (red bars). All nutrients are boosted, particularly the harder to obtain ones.
While lots of people find that higher fat whole foods are hard to overeat, there are still some hyper palatable high fat foods that go down easily. We talk about eating “fat to satiety”, but what happens when nutrient hunger kicks in and your body is craving more potassium, magnesium, calcium, or one of the other nutrients that are harder to obtain in a very high fat dietary approach? If you keep on consuming large amounts of processed fats that don’t contain the nutrients you require, your appetite may not automatically turn off before you’ve consumed a lot of excess energy!
The chart below shows the boost in nutrients when we consider nutrient density combined with a low carbohydrate approach. It appears that, based on this analysis, that without a focus on nutrient density, a low carbohydrate diet is likely to be nutrient deficient in folate, vitamin D, choline, potassium, magnesium, pantothenic acid, calcium, vitamin E and manganese. With a focus on nutrient dense foods, a low carb diet provides adequate amounts of the majority of nutrients.
Weight loss (insulin sensitive)
The weight loss approach is intended for people who are insulin sensitive but still have excess body fat to lose. Foods with a lower energy density (e.g. spinach, broccoli cucumber, celery, lettuce etc) typically are harder to overeat because they are bulky.
This approach doesn’t pay any attention to insulin load because it is assumed that people using this approach are not insulin resistant and are able to maintain good blood glucose levels. Practically, it’s also difficult to achieve a really high insulin load with these foods because they do not contain a large amount of processed carbs and are hard to overeat.
Without consideration of nutrient density, the essential fatty acids tend to be low along with vitamin B-12, choline, and tyrosine. However, once we factor in nutrient density all these nutrients dramatically improve.
This approach may not be viable for long term maintenance due to the extremely low energy density which would make it hard to get in enough energy. However, in the short term, it may be appropriate for a period of substantial energy restriction, and will provide maximum nutrition with a minimum amount of energy.
Getting adequate protein on a zero-carb approach is not a problem. However, unless there is a major focus on organ meats, there are a large number of vitamins and minerals, such as vitamin K, manganese, vitamin C, vitamin E, vitamin D, potassium, magnesium and calcium that may be worth supplementing.
At the other extreme, the chart shows the nutritional analysis of the vegan diet. The main nutrient deficiencies in a vegan approach are omega 3s and vitamin B-12, which are hard to obtain without animal products. It may be prudent for vegans to consider fish oil supplementation and B-12 injections, or alternatively adding some seafood occasionally.
While it appears possible to obtain the recommended levels of protein, it’s hard to get very high levels of it. If you are insulin resistant, the fat levels can be increased using added coconut products and nuts.
Higher insulin load foods for bulking
The bulking approach is designed for people who are looking to gain strength and size by combining nutrient density with more calories and insulin load. Without consideration of nutrient density, a high insulin load means very low nutrient density foods. However, once we factor in nutrient density, we get a range of highly nutritious foods that may be helpful if you want to gain size and strength, while still maximising health and nutrition.
Paleo Nutrient Deficiencies
The chart below shows the nutrients provided by the Paleo approach (i.e. no processed foods, dairy or grains) both with and without consideration of nutrient density. While ‘going Paleo’ eliminates many of the nutrient-poor processed food, it appears to be beneficial to also consider nutrient density as well in addition.
What does this all mean?
So, how do we decide which approach is best? Unfortunately, it’s not straightforward so I’ll look at this a number of ways.
What we ideally want is to identify the foods that will provide us with high amounts of all of the nutrients. The blue bars in the chart below represents the average of the % daily recommended intake of all the nutrients in the various approaches evaluated above, without considering nutrient density. The orange bars represent the average minus 0.5 x the standard deviation which is a measure of reliability. The higher the reliability the more consistent and high are the nutrients overall.
This chart shows that, in comparison to the other approaches, Paleo foods have a high and consistent level of nutrients; while the vegan and low energy density weight loss foods have high levels of some individual nutrients, but low levels of some others. Without consideration of nutrient density, the high insulin, low carb and zero carb approaches are a bit lacking in nutrients.
Things become a little more interesting once we factor in nutrient density. The vegan, therapeutic keto, low carb and zero carb approaches do poorly against the paleo, higher insulin load, most nutrient dense of all foods, and the lower energy density weight loss foods.
Many people will benefit on a high fat therapeutic ketogenic dietary approach, at least until their blood glucose and insulin levels normalise. However, in time, it may be beneficial to transition to more nutrient dense foods to continue their journey towards optimal health.
As detailed in the ‘how to optimise your diet for insulin resistance’ article, I think you should eat the most nutrient dense foods your pancreas can keep up with while maintaining good blood glucose levels. In time, someone who is highly insulin resistant may be able to progress to a more nutrient dense and more moderate fat approach if your ultimate goal is to normalise blood glucose levels and lose weight.
Nutrient Dense Food lists
If you identify with any of these goals, you may be interested in following these food lists. If blood glucose levels are sky high or you are managing a chronic condition such as epilepsy, cancer, Alzheimer’s or dementia, you may benefit from a higher fat therapeutic keto dietary approach, for a period. As your glucose levels come under control, you can transition to more nutrient dense foods that will also help you to achieve your weight goals.
|approach||average glucose||waist : height|
|diabetes and nutritional ketosis||
108 to 140
|6.0 to 7.8|
|weight loss (insulin resistant)||
100 to 108
|5.4 to 6.0||
|weight loss (insulin sensitive)||
|nutrient dense maintenance||
Getting even more personal
As you can see, nutrients are provided at different levels depending on the approach. However, most people don’t follow any dietary approach strictly, so the nutrients in your diet will be different depending on your personal habits and preferences.
Rather than trying to pick up someone else’s nutrition plan, or live by a strict list, I think it’s better to refine your current habits, emphasising the good foods, minimising the bad, and progressively trying new foods that may be beneficial.
To this end, I’ve been developing a Nutrient Optimizer algorithm that can help you refine your food choices to suit your goals. By identifying the foods you are currently eating that align most with your current goals, which ones don’t, and which new foods perhaps you should consider.
Most current nutritional advice is driven by the avoidance of fat, particularly saturated fat, and therefore ends up being next to useless. Calorie counting apps like MyFitnessPal does nothing but count calories, which is also of limited use. Cron-o-meter tracks your micronutrients and can recommend foods to boost a single nutrient. However, there doesn’t seem to be anything available that will tell you which foods will help you actually correct multiple nutrient deficiencies and achieve a diet that is truly balanced in micronutrients.
The Nutrient Optimiser also allows you to tailor the approach to your goals, such as: therapeutic ketosis, diabetes management, weight loss or just nutrient dense maintenance. Food preferences like vegan, pescetarian, autoimmune, or paleo can be factored in to the recommended food lists.
At the moment, the process involves manually exporting food intake data from Cron-o-meter, then analysing it in a spreadsheet to manually generate a personalised report. I am eager to do this as a proof-of-concept for a range of people with various goals (particularly therapeutic ketosis, vegetarian, zero carb, fruitarian) to demonstrate how it works. So, if you’re happy to have your report shared publicly, and have a couple of weeks of Cron-o-meter data, feel free to send it to me and have your data analysed.
In time, the plan is to automate the process via an online interface and then ideally an independent mobile app. To keep up-to-date with progress, watch this space and check out the various analysed examples on the Marty Kendall’s Nutrient Optimiser Facebook page.
For completeness, I thought it would be worth mentioning a few limitations relating to calculating nutrient density…
- Measuring foods in terms of calories has its own limitations as different macronutrients provide different amounts of energy (ATP) in different people. Some smart friends of mine are working on calculating ATP yield for different foods based on their macronutrient content. I’ll happily update this analysis in terms of nutrients per ATP as soon as that data is available. Initial indications are that people who are fat-adapted are able to use fat more efficiently (i.e. less entropy/losses in metabolism) and hence require less calories to yield the same amount of energy in the body (i.e. ATP). Hence, it appears that it is even more important for someone following a low carb or ketogenic approach to maximise nutrient density in terms of nutrients per calorie.
- The official dietary reference values are based on limited research. Typically, they relate to the minimum amount of a nutrient to avoid disease rather than the amount required for optimal function. They may also vary by person (e.g. someone who is more active may need more protein) and by their diet type (e.g. someone who is on a low carb diet may need less vitamin C to process the limited amount of glucose). Hence, I think the DRI values should be seen as a minimum. Ideally, we want to get more than the minimum while not having to ingest too much energy. I also don’t think nutrients are meant to come as individual vitamins and minerals in a bottle. The nutrients required to metabolise a certain food typically come packaged in whole foods, and often work synergistically. Taking supplements or fortifying foods will always be inferior to obtaining nutrients from whole foods.
- Species-specific bioavailability and anti-nutrients are contentious topics. Zero carbers will tell you that nutrients in animal based foods are more bioavailable than plant based foods, while the vegans will tell you the opposite. To date, I haven’t been able to find useful data that would enable me to quantitatively refine the nutrient data in the USDA database regarding bioavailability. All we currently have is a measure of the nutrients contained in the food– rather than the nutrients that make it into your body after digestion. Again, if this data ever comes to hand, I’ll eagerly update the analysis.
Overall, I don’t think these limitations make a difference in the outcomes of the analysis. This is not an exact science and the body doesn’t operate like a rigid machine. Calculation of nutrient density is just a way to identify the foods that contain the rawest materials with the least amount of calories that your body can work with.
 In terms of macronutrients this high fat dietary approach comes out at 80% fat, 15% protein, 2% fibre and 3% net carbs.