how to get the minimum effective dose of nutrition

The goal of Optimising Nutrition is to help you design the minimum effective dose of nutrition to support your goals (e.g. performance, weight loss, diabetes management, therapeutic ketosis, bodybuilding, etc.).

When we break it down, we require food that:

  • provides adequate micronutrients,
  • with enough energy (but not too much), that
  • enables you to maintain healthy hormone levels.

In nutrition, we talk about parameters such as:

  • macronutrients (protein, carbs, fat, and fibre),
  • carnivore vs plant-based,
  • energy density, and
  • insulin load.

Unfortunately, talking about “high”, “low” or “adequate” often leads to unproductive circular arguments due to a lack of definition.

Optimal typically lies somewhere between the extremes.

A ‘Goldilocks zone’ of not too little.  Not too much.

A ‘minimum effective dose’ if you will.

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If we want to design the minimum effective dose (MED), we need to understand which parameters have the most significant impact on the quality of our nutrition.

With all the discussion about ‘high,’ ‘low’ and ‘not too much’ we need to understand the acceptable range for each of the key parameters to ensure we don’t stray too far from optimum.

What is the ‘minimum effective dose’?

The ‘minimum effective dose’ (MED) is the smallest dose that will produce the desired effect.

In terms of medication, the MED is the minimum amount that will give the desired effect for most people.  Too much of a drug can be expensive and harmful.  Too little won’t have the enough of an effect.

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In fitness, the minimum effective dose is the point beyond which any additional stress would be redundant or even counterproductive to strength and fitness goals.

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In biohacking, the MED is about getting the desired outcome with the minimum investment of time, money or effort.

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What does MED mean regarding nutrition?

There are a handful of interacting factors that help us determine the minimum effective dose of nutrition.  Unfortunately, it’s not possible to optimise all parameters at once.  We need to decide which ones we want to prioritise and which ones we are prepared to sacrifice based on our context and goals.

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Before we get into the details of how we determine the MED of nutrition, let’s set the context with a review of some parameters.

Nutrients

The body needs a range of essential nutrients and benefits from an even more extensive range of non-essential nutrients.

Recommended Dietary Intake (RDIs) or are given as the minimum amount to prevent diseases of malnutrition for most people (i.e. not necessarily optimal health and longevity).

Nutritional requirements vary due to a wide range of factors.  Men need more than women (unless they are pregnant or breastfeeding).[1]

Many nutrients are easy to obtain, but we need to pay particular attention to getting adequate quantities of others.

If we are obtaining the recommended minimum levels for the majority of the essential nutrients, we are likely to significantly exceed the Recommended Daily Intake[2] for a number of these nutrients.

We tend to get a better nutritional outcome when we prioritise the foods that contain the harder-to-find nutrients, and the other nutrients tend to look after themselves.

The upper limit (UL) for most nutrients is difficult, if not impossible, to exceed without supplementations (except for those Arctic explorers that gorged on polar bear liver and felt ill due to hypervitaminosis[3]).

If you are an athlete, you will need more nutrients.  However, you will be able to consume a lot more energy, thus letting you achieve the minimum intake level for most nutrients rather easily.

At the other extreme, if you are restricting energy to lose weight, it may be hard to get enough nutrients from the food you eat.  Focusing on foods with a high nutrient : energy ratio will be critical.

In his Perfect Health Diet,[4] Paul Jaminet notes that:

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

Bruce Ames’s Triage Theory[5] warns that the body will prioritize available nutrients for short-term functions and at the expense of longevity where nutrients are limited.

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Francis Pottenger demonstrated that poor nutrition has generational impacts with his cats that progressively became more deranged to the point that they couldn’t procreate after three generations.[6]

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There is also a growing body of fascinating research suggesting that different nutrient deficiencies are related to specific conditions and boosting these nutrients (ideally with whole foods) will improve these chronic diseases.[7] [8]

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Maximising the nutrient content of our diet with the minimum amount of energy seems to be central to our short-term and our long-term health!

We crave nutrients like salt and protein and go out of our way to make sure we get them.[9] [10] [11]

The Protein Leverage Hypothesis shows that we keep eating until we get enough protein.[12]

A pregnant woman will crave weird foods and obscure flavours to ensure she’s getting the nutrients to grow a healthy baby.

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As you will see below, nutrition and protein are tightly interrelated.  Rather than the ‘Protein Leverage Hypothesis’, I think it’s reasonable to think that there is a ‘Nutrient Leverage’ effect such that we seek out more food until we get the nutrients we need.

It’s not unreasonable to think that getting adequate nutrients from the food we eat is a critical component of our satiety mechanism and managing our appetite.  If we don’t obtain sufficient nutrients from our food, we will be more likely to seek out more food in search of nutrients, and thus end up over-consuming energy and become obese and/or diabetic.

With our modern trend towards processed foods that are optimised for bliss point[13] and profit margin rather than nutrient content, it’s not surprising that we have an epidemic of malnourished obese people.[14] [15]

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Adequate energy

While we have developed our appetite to seek out foods that contain the nutrients we need, our drive for energy is even stronger.

Adapted biologically to scarcity, we tend to consume a little more energy than we need in preparation for leaner times.  However, today in our modern processed food environment with fossil fuels, chemical fertilisers, and artificial flavourings, winter never comes.[16]

Before the advent of processed foods, energy always came packaged with adequate nutrients.  However, this is no longer always the case.

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To thrive in our modern world with primal instincts, we need to find a way to reverse-engineer our food environment to ensure that we prioritise foods with the nutrients we require without too much energy.

Perhaps we need a shortlist of optimal foods and meals that will provide the minimum effective dose of nutrients that we require without having to consume excess energy.

Insulin load

Insulin is arguably the most important metabolic hormone that helps us build muscle, use glucose and keep stored energy locked away for a later day.

Adequate levels of insulin are critical to survival.  People with Type 1 diabetes die without insulin.  However, today’s processed foods tend to drive our insulin levels too high for too long, thus leading to insulin resistance and the majority of modern disease.[17]

Low carb and ketogenic diets help us bring insulin and blood sugar levels under control.  At the same time foods with an extremely low insulin load are tend to be mostly fat and do not contain the vitamins and minerals that we need.

We need to balance the reduction in insulin load that will help us stabilise blood sugars and insulin levels in our body without excessively and unnecessarily compromising nutrient density.

The official “Acceptable Macronutrient Distribution Range”

The table below shows the Acceptable Macronutrient Distribution Range for macronutrients to reduce chronic disease risk whilst still ensuring adequate micronutrient status along with the currently typical macronutrient” according to the Institutes of Medicine (IOM) [18][19].

macronutrient lower upper
protein 15% 35%
fat 20% 35%
carbohydrates 45% 65%

The Australian Ministry of Health notes that only 10% of energy is required from protein to cover physiological needs.  However, this level is insufficient to provide adequate micronutrients levels.  Active communities have much higher protein intake levels with no apparent adverse health effects.[20]

The chart below shows that our carbohydrate intake is trending up while fat has trended down as we have followed the official guidance to avoid fat to avoid heart disease over the past four decades.[21]

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The table below shows the typical macronutrient intake for the US, UK and eighteen non-Asian countries from the PURE study.

parameter protein fat carbs
United States (NHANES, 2000)[22] 15% 33% 52%
United Kingdom 16% 35% 50
non-Asia (PURE) 17% 28% 55%
Asia (PURE) 15% 21% 65%

A number of people such as Gary Taubes[23] and Nina Teicholz[24] have argued that the unnecessary fear of fat and retreat to processed carbohydrates has contributed to the obesity epidemic.

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One of the main goals of this article is to consider whether the ‘Acceptable Macronutrient Ranges’ set by the Institute of Medicine actually allows us to optimise nutrient density.

The data analysis

I’ve previously discussed the relationship between macronutrients and the nutrient density of individual foods (see Micronutrients at Macronutrient Extremes and Which Nutrients is YOUR Diet Missing?).  However, I thought it would be interesting to look at things in terms of the nutrient score for each nutritional approach.

To understand the relationship between nutrition and various food parameters I updated the analysis for a wide range of nutritional approaches as shown in the table below (sorted in descending order for nutrient density).  The table below shows the nutrients provided by 43 different nutritional approaches along with the shortlist of foods associated with each goal.  (This took me a LOT of time to re-run, so I’d love you to check it out).

approach score foods pdf nutrients
most nutrient dense 96% foods pdf nutrients
adrenal fatigue 96% foods pdf nutrients
weight loss (insulin resistant) 96% foods pdf nutrients
pregnancy 96% foods pdf nutrients
alkaline 96% foods pdf nutrients
asthma 96% foods pdf nutrients
testosterone 96% foods pdf nutrients
nutrient dense paleo 96% foods pdf nutrients
weight loss (insulin sensitive) 96% foods pdf nutrients
hypertension 96% foods pdf nutrients
excess estrogen 96% foods pdf nutrients
autism 96% foods pdf nutrients
hypothyroidism 95% foods pdf nutrients
pescetarian 95% foods pdf nutrients
breastfeeding 95% foods pdf nutrients
female fertility 95% foods pdf nutrients
sleep and insomnia 95% foods pdf nutrients
nutrient dense maintenance 94% foods pdf nutrients
depression 94% foods pdf nutrients
mitochondrial health 94% foods pdf nutrients
autoimmune friendly 94% foods pdf nutrients
bodybuilder 92% foods pdf nutrients
nutrient dense athlete 91% foods pdf nutrients
nutrient dense low carb 91% foods pdf nutrients
nutrient dense paleo (low carb) 90% foods pdf nutrients
mitochondrial health (low carb) 89% foods pdf nutrients
gestational diabetes 89% foods pdf nutrients
bivalve vegan 87% foods pdf nutrients
autoimmune (low carb) 84% foods pdf nutrients
nutrient dense plant based 81% foods pdf nutrients
nutrient dense carnivore 80% foods pdf nutrients
lowest energy density 77% nutrients
plant based (low carb) 76% foods pdf nutrients
highest protein 70% nutrients
well formulated ketogenic 63% foods pdf nutrients
lowest carb 56% nutrients
most ketogenic 44% nutrients
highest fat 43% nutrients
lowest fat 35% nutrients
highest carb 26% nutrients
highest energy density 22% nutrients
lowest protein 16% nutrients
most insulinogenic 3% nutrients

This table shows the macronutrient split of each of these approaches.  To make sense of all this data, I have plotted each these parameters against nutrient density and included some discussion on what I think this means in the following sections.

approach score protein fat net carbs fibre density
most nutrient dense 96% 40% 16% 29% 16% 104
adrenal fatigue 96% 47% 18% 23% 13% 107
weight loss (insulin resistant) 96% 42% 24% 18% 15% 101
pregnancy 96% 41% 18% 27% 15% 113
alkaline 96% 33% 20% 28% 18% 112
asthma 96% 41% 16% 27% 16% 102
testosterone 96% 40% 17% 28% 15% 115
nutrient dense paleo 96% 47% 17% 22% 14% 92
weight loss (insulin sensitive) 96% 51% 18% 19% 12% 85
hypertension 96% 42% 16% 27% 15% 105
excess estrogen 96% 50% 19% 19% 12% 109
autism 96% 48% 17% 22% 13% 103
hypothyroidism 95% 52% 18% 9% 9% 122
pescetarian 95% 37% 16% 31% 16% 108
breastfeeding 95% 42% 17% 26% 15% 101
female fertility 95% 55% 20% 16% 9% 110
sleep and insomnia 95% 44% 16% 28% 12% 134
nutrient dense maintenance 94% 42% 23% 26% 9% 240
depression 94% 59% 21% 12% 8% 114
mitochondrial health 94% 34% 14% 35% 17% 126
autoimmune friendly 94% 53% 21% 17% 10% 102
bodybuilder 92% 64% 23% 8% 5% 120
nutrient dense athlete 91% 39% 40% 15% 5% 366
nutrient dense low carb 91% 28% 50% 10% 12% 222
nutrient dense paleo (low carb) 90% 26% 53% 10% 11% 260
mitochondrial health (low carb) 89% 25% 47% 13% 14% 211
gestational diabetes 89% 27% 56% 8% 9% 257
bivalve vegan 87% 21% 14% 45% 20% 129
autoimmune (low carb) 84% 26% 58% 8% 8% 285
nutrient dense plant based 81% 20% 16% 45% 20% 151
nutrient dense carnivore 80% 65% 30% 5% 0% 143
lowest energy density 77% 20% 10% 52% 18% 30
plant based (low carb) 76% 17% 29% 35% 19% 241
highest protein 70% 77% 22% 1% 0% 132
well formulated ketogenic 63% 16% 73% 4% 6% 423
lowest carb 56% 30% 70% 0% 0% 361
most ketogenic 44% 15% 80% 3% 2% 466
highest fat 43% 14% 81% 3% 1% 470
lowest fat 35% 8% 1% 84% 7% 143
highest carb 26% 3% 1% 90% 6% 141
highest energy density 22% 6% 64% 28% 2% 599
lowest protein 16% 1% 27% 68% 3% 308
most insulinogenic 3% 6% 2% 90% 2% 190

The table below shows the correlation coefficient between nutrient density and each of the parameters along with the P value indicating that there is a reasonable degree of statistical significance.

parameter R2 P
protein 0.89 < 0.0001
% insulinogenic 0.66 < 0.001
carbs 0.62 < 0.0001
net carbs 0.60 < 0.0001
fibre 0.47 < 0.0001
fat 0.41 < 0.0001
density 0.32 0.004

Protein vs nutrient density

Given that protein has the highest correlation with nutrient density score (R2 = 0.89) let’s start by looking at the relationship between protein and nutrient density.

The chart below shows the relationship between the nutrient density score and the percentage of energy from protein.   It seems that nutrient density peaks in around 45% of calories from protein.

If we were to use a nutrient density score of 70% as our cut off for our minimum effective dose of nutrition we would have a lower limit of 19% protein and an upper limit of 78% energy from protein.

This optimal level is significantly above the typical protein intake of around 16% of energy and even greater than the upper end of the official Acceptable Macronutrient Distribution Range of 15 to 35%.

The chart below shows the micronutrients provided by the most nutrient-dense foods.  That is, the highest ranking 10% of foods in the eight thousand foods in the USDA food database when we boost the harder to find nutrients (shown in yellow).[25]    These foods provide the best balance of micronutrients to meet the Recommended Daily Intake Levels.

What’s worth noting here is that this shortlist of nutrient-dense foods are NOT identified by prioritising any of the amino acids.  We just happen to get plenty of protein from foods that contain more of the harder-to-find nutrients (i.e. omega 3, choline, vitamin D, calcium magnesium potassium, zinc and thiamine).

The nutrient score in this analysis is calculated based on the proportion of the area between 0 and 300% of the RDI for the various nutrients.  If we could find a group of foods that provided 300% of the recommended daily intake (RDI) of all nutrients we would get a perfect score.

If your goal was just to maintain weight or fuel your endurance activities you could argue that such high a high level of nutrient density is excessive.  You may end up fueling up with some more energy dense fat or refined carbs.  However, maximising the nutrient : energy ratio of your diet would be very useful if you were trying to reduce your energy intake to lose weight.

According to Bruce Ames’ Triage Theory,[26] maximising nutrient density enables us to maximise both our short-term and long-term health and vitality.

Perhaps with a higher nutrient : energy ratio, the body would be happier with a lower energy intake for longer without overwhelming cravings that may derail our weight loss efforts?

On the far right of the plot of protein vs nutrient density above we have the highest protein foods.  Prioritising amino acids alone gives us a massive 77% of energy from protein!  However, as you can see from the chart below, we will miss out on a number of essential vitamins and minerals (e.g. vitamin A, vitamin K, folate, manganese, vitamin D, calcium etc.).

Just prioritising high protein foods doesn’t achieve optimal outcomes.  We need to prioritise nutrients!

At the other extreme, the nutrient profile of the lowest protein foods is shown below.  If we actively avoid protein, we end up with an inferior nutritional outcome.

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If there is such as thing as ‘too much protein’ we could say that it occur when we are getting more than half our energy intake from protein (which is hard to do!).

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Lately, a lot of people are concerned about reducing protein to minimise insulin and mTOR.[27] [28]  While chronically high overall energy intake is indeed a problem, I am concerned that an intentionally low protein dietary approach will have a very poor nutrient outcome.  We then risk being driven to overeat in an effort to find nutrients that we are not getting from our low protein diet.

As suggested by Ames’ Triage Theory, if we miss out on nutrients by prioritising low protein foods, our body diverts our nutrients to short-term survival rather than longevity.  Pottenger’s cats suggest that our descendants will develop degenerative diseases, become lazy and eventually not be able to procreate due to our poor nutritional status.  The most logical solution seems to be to increase our nutrient intake without overdoing energy intake.

The ‘problem’ however with really high nutrient foods is that they, ironically, provide you with too much nutrition.  It’s hard to overeat highly nutrient-dense foods.  Your appetite switches off and you will lose body fat.  As shown in the chart below, it seems we have the lowest ad libitum energy intake when 40 to 50% of our energy comes from protein.[29]  This seems to align with the highest nutrient density foods shown above.

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Excessively high levels of protein is not a good idea from an evolutionary perspective because protein is very satiating.  We need the more energy-dense fat and carbs to fuel us to chase our food down and help us get in enough energy to store body fat to make it through the winter.

However, forcing ‘rabbit starvation’ may be a useful hack if you have body fat to lose.  For someone wanting to lose weight, a higher percentage of protein with a lower overall energy intake might be optimal.

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So is 40 to 50% protein optimal for everyone?

Not necessarily!  It depends on who you are and your goals.

For most people, consuming a nutrient-dense diet will increase the proportion of energy from protein beyond the typical 16% intake.  At the other extreme, it seems that increasing protein beyond 50% of energy intake would dilute nutrient density as well as be too satiating!

When it comes to protein, the minimum effective dose is whatever comes with more nutrient-dense foods, but not so much that satiety kicks in so hard that you can’t maintain your body weight.

The minimum effective dose appears to be around 19% of energy from protein with higher levels providing more overall nutrition.

If you are active and need to consume a lot of energy, then the optimal 45% protein will be impractical.  However, if you are aggressively cutting calories and eating a very nutrient-dense energy-restricted diet with a high nutrient : energy ratio then closer to 45% may be optimal.

Insulin load

After protein, the parameter that is most correlated with nutrient density is insulin load.  Insulin load is a proxy for the amount of insulin that our pancreas will need to produce and is proportional to the carbohydrates, minus fibre plus about half the protein.

If you have diabetes, you need to invest your available insulin wisely.  Consuming highly insulinogenic foods will make insulin dosing hard to calculate if you have Type 1 diabetes.  People with Type 2 won’t have enough insulin to keep up to overcome their insulin resistance and maintain excellent blood sugars.

Someone who already has diabetes will benefit by reducing the insulin load of their diet to help normalise their blood sugars, particularly if they have been overloading their pancreas with processed carbs and sugars.

A typical western diet has about 60% or more insulinogenic calories.  The chart below shows that we get the minimum effective dose (i.e. a nutrient density score of 70%) with an insulin load of 19%, optimal at around 41% of energy and an upper limit of 65%.  Overall nutrient density starts to suffer outside these limits and we would have to pay more particular attention to our nutrition.

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The current typical macro intake suggests that we are 65% insulinogenic calories on average in non-Asian countries and 73% in Asian countries.  And if this is typical it is likely that many people are consuming much more than this.

Perhaps highly insulinogenic low nutrient density processed foods could be playing a role in the epidemic of diabesity?

Carbohydrates vs nutrient density

This chart shows the relationship between nutrient density and total carbohydrates…

… and nutrient density vs net carbohydrates.

It seems the minimum effective dose of net carbs is 0% and 8% in terms of total carbs with an optimal nutritional outcome at around 30% net carbs or 35% total carbs.  The upper limit is 60% net carbs or 65% total carbs.

This upper limit aligns with the official “Acceptable Macronutrient Distribution Range” for carbohydrates of 65%.  What is worth noting here is that the typical intake is 55% which is greater than the optimal nutrient intake.  The lower limit of the official AMDR is 45% which appears to be unnecessarily high, especially for someone who is not active or is already developing metabolic syndrome.

Many people in low carb circles are fond of point out that ‘there is no such thing as an essential carbohydrate’.  However, foods that contain essential vitamins and minerals also often come packaged with carbohydrates.  At the same time, you can also get plenty of vitamins and minerals from organ meats and shellfish if green leafy veggies aren’t your thing.

If you already have diabetes you should lower your carbohydrate intake to the level that lets you achieve excellent blood sugar control.  In order to control your blood sugars, you will need to reduce your carbohydrates to a level less than the typical level of 55% and most likely less than the optimal level of 30%.

You can continue to refine your approach and ‘eat to your meter’ until you get the blood sugars you are chasing.  However, unless you require therapeutic ketosis (i.e. to manage chronic conditions such as cancer, epilepsy, dementia or Alzheimers), there is probably no need to drive carbohydrate intake much lower than 8% as you may struggle to obtain the broad range of essential nutrients.

Fat vs nutrient density

While there is a lot of talk about “high fat” or “low fat”, fat is actually a relatively poor predictor of nutrient density (R2 = 0.41).  The minimum effective dose seems to set at around 10% of energy intake with an upper limit of 65% fat.   Outside this window, it tends to be harder to get excellent nutrition.

The average intake of fat in western diets is around 28%.   Most people would benefit from consuming more than, particularly if they are not trying to lose weight.  However, there might not be any benefit in going over 65% of energy from fat, particularly if your primary goal is to lose body fat.  If your goal is to control your blood sugar and insulin levels then increasing fat is probably a better option than increasing energy from carbs if you can’t fit any more protein in.

Overall, I don’t think we need to target a specific fat or carb intake.  In the days before we had refrigerators, we would naturally cycle our intakes seasonally between more carbs in summer and more fat in the winter.  However, these days our macronutrient intake seems to be driven more by profit margins and shelf lives (i.e. less protein and more refined fats and sugars) which keeps us in a higher carb summer-like phase.

Fibre

Foods with more fibre tend to be more nutritious and less process.  I don’t think this is necessarily due to the fibre (i.e. you may not benefit by loading up on fibre supplements), but rather because plant-based foods often have nutrients that are harder to find in animal-based foods.

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Some people seem to thrive on a zero carb diet, especially when switching from a processed high carb diet which can cause gut dysbiosis.  However, it can be challenging to get as much of the essential vitamins and minerals from a diet with no fibre (although if you are eating nose to tail including minerals from blood this may be another matter).

Energy density

Energy density has the lowest correlation with nutrient density (R2 = 0.32).  However, as a general rule, less energy-dense foods tend to more nutritious.

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Energy density can be a useful tool to help us identify foods that are more filling with less energy if we are looking to lose weight.  Alternatively, we can look for higher energy-dense food that is still nutritious if we are looking to fuel high levels of activity.

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Carnivore vs plant based

Another nutritional battle that seems to be raging is the plant-based versus carnivorous diets (i.e. no plants).  The good thing about either extreme here is that they both generally eliminate highly processed foods.

A whole food plant based dietary approach will remove processed junk foods and leave low energy density high fibre foods that will make it hard to lose weight.  As you can see it is hard to get omega 3 or vitamin B12 on a plant-based diet there are a number of amino acids that are harder to get due to the amount in the plant-based foods and the bioavailability of plant-based proteins.  If you are consuming a diet that is predominantly plant-based you should look out for symptoms of deficiencies associated with omega 3, vitamin B12 and even protein and consider supplementing accordingly.

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The chart below shows the micronutrient profile of a nutrient-dense carnivore diet.  As you can see, there are a number of nutrients that are harder to obtain with this approach.  However, there is some evidence to suggest that you may not need as much of some nutrients if you are not consuming as much glucose.  Again, understanding which nutrients you are not getting in large quantities may be useful to help you identify supplements or look out for symptoms.

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Suggested updates to the Acceptable Macronutrient Range

The table below shows suggested minimum effective dose, optimal and upper limit macronutrient splits along with the current intake levels for comparison.

parameter protein fat total carbs insulin load
minimum effective dose 19% 10% 8% 19%
optimal* 45% 36% 35% 41%
upper limit 78% 65% 65% 65%
current (NHANES, 2000) 15% 33% 52% 60%
United Kingdom 16% 35% 50% 59%
non-Asia (PURE) 17% 28% 55% 65%
Asia (PURE) 15% 21% 65% 73%

It seems that to improve their nutrition, most people would benefit from:

  • more protein,
  • more fat,
  • less carbs, and
  • a lower insulin load.

However, food doesn’t come in neat packages of carbs, fats and protein.  Trying to increase protein by adding protein powder or fat by increasing butter or cream may not lead to an optimal nutritional outcome.  But if you focus on meeting your micronutrient requirements with real food the macronutrients will typically look after themselves.

* If you are astute you might notice that the optimal macros actually sum up to 116%.  This is to be expected given that it is not a closed system.  In reality, most people will struggle to consume “optimal” protein levels.  As a general rule of thumb starting with a three-way split of protein, fat and carbs is a reasonable starting point if you insist in thinking in terms of macros.  You can then make refinements from there to suit your goals (e.g. diabetes control, therapeutic keto, weight loss, athlete etc) and preferences (e.g. low carb, high carb, paleo, vegan etc).

Suggested minimum effective dose levels

In the end, nutrition is about getting enough nutrients without too much energy.  Percentages also don’t mean that much for a real person wanting to know what to eat.

The table below shows you the minimum amount of each macronutrient you might need to also provide a solid level of nutrition in terms of your current lean body mass (i.e. total weight minus your fat) and grammes per kilo and grams per pound of LBM.

LBM (kg) LBM (lbs) minimum effective dose (g)
protein fat  net carbs total carbs insulin load
40 88 72 17 0 30 72
45 99 79 18 0 33 79
50 110 85 20 0 36 85
55 121 91 21 0 38 91
60 132 97 23 0 41 97
65 143 104 24 0 44 104
70 154 110 26 0 46 110
75 165 116 27 0 49 116
80 176 123 29 0 52 123
85 187 129 30 0 54 129
90 198 135 32 0 57 135
95 209 142 33 0 60 142
100 220 148 35 0 62 148
g/kg LBM 1.8 0.4 0 0.75 1.8
g/lb LBM 0.8 0.2 0 0.3 0.8

These minimum levels will leave you with a shortfall of energy that you will have to make up from your body fat or other dietary inputs.  There is endless debate about which diet is optimal and leads to longevity.  However, the one thing that nearly everyone seems to agree on is that taking in too much energy is a problem.  So erring on the side of less rather than more is going to be a good thing.

Optimal intake levels

This table shows you the levels that you would need to hit the optimal nutritional outcome for each of these parameters.  In practice, most people will find such high levels of protein difficult to consume and may end up making up any energy shortfall from body fat, dietary fat or dietary carbs.  Nutrient density is important, however, it’s not the only thing.  Most people will end up diluting their nutrient density somewhat in order to get in energy from higher fat or higher carb foods.

LBM (kg) LBM (lbs) optimal intake (g)
protein fat  net carbs total carbs insulin load
40 88 171 61 114 133 156
45 99 186 66 124 145 169
50 110 201 71 134 156 183
55 121 216 77 144 168 197
60 132 231 82 154 180 210
65 143 246 87 164 191 224
70 154 261 93 174 203 238
75 165 276 98 184 215 251
80 176 291 103 194 226 265
85 187 306 109 204 238 279
90 198 321 114 214 249 292
95 209 336 119 224 261 306
100 220 351 125 234 273 319
g/kg LBM 4.3 1.5 2.9 3.3 3.9
g/lb LBM 1.9 0.7 1.3 1.5 1.8

I could show the upper limit of each nutrient too, however, don’t think there’s much practical use precisely quantifying these amounts.  If you are active then your appetite will increase to encourage you to get more food.  If you are gaining unwanted weight then you probably need to back off the intake.

Food lists

I encourage you to make use of the food lists in the table below.  Click on the ‘foods’ hyperlink to open the food list as an image or the ‘pdf’ to download to print.  You can also check out the nutrient profile to see what nutrients these food lists contain and which nutrients have been profiled.  Once you reduce the nutrient-poor foods, you will be able to trust your appetite to guide you to the foods that contain the nutrients you need.

approach score foods pdf nutrients
most nutrient dense 96% foods pdf nutrients
adrenal fatigue 96% foods pdf nutrients
weight loss (insulin resistant) 96% foods pdf nutrients
pregnancy 96% foods pdf nutrients
alkaline 96% foods pdf nutrients
asthma 96% foods pdf nutrients
testosterone 96% foods pdf nutrients
nutrient dense paleo 96% foods pdf nutrients
weight loss (insulin sensitive) 96% foods pdf nutrients
hypertension 96% foods pdf nutrients
excess estrogen 96% foods pdf nutrients
autism 96% foods pdf nutrients
hypothyroidism 95% foods pdf nutrients
pescetarian 95% foods pdf nutrients
breastfeeding 95% foods pdf nutrients
female fertility 95% foods pdf nutrients
sleep and insomnia 95% foods pdf nutrients
nutrient dense maintenance 94% foods pdf nutrients
depression 94% foods pdf nutrients
mitochondrial health 94% foods pdf nutrients
autoimmune friendly 94% foods pdf nutrients
bodybuilder 92% foods pdf nutrients
nutrient dense athlete 91% foods pdf nutrients
nutrient dense low carb 91% foods pdf nutrients
nutrient dense paleo (low carb) 90% foods pdf nutrients
mitochondrial health (low carb) 89% foods pdf nutrients
gestational diabetes 89% foods pdf nutrients
bivalve vegan 87% foods pdf nutrients
autoimmune (low carb) 84% foods pdf nutrients
nutrient dense plant based 81% foods pdf nutrients
nutrient dense carnivore 80% foods pdf nutrients
plant based (low carb) 76% foods pdf nutrients
well formulated ketogenic 63% foods pdf nutrients

Once you feel you have got the hang of eating mostly nutrient dense foods, you may wish to use the Nutrient Optimiser to identify the nutrient gaps as the foods and meals that will help you optimise your nutrition.

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references

[1] https://optimisingnutrition.com/2017/05/23/personalised-nutrition/

[2] https://www.nhmrc.gov.au/guidelines-publications/n35-n36-n37

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

[4] https://www.amazon.com.au/Perfect-Health-Diet-Regain-Weight-ebook/dp/B007USA6MM

[5] https://www.bruceames.org/Triage.pdf

[6] https://en.wikipedia.org/wiki/Francis_M._Pottenger_Jr.

[7] https://www.dropbox.com/s/to3f84z77sckvjx/Interactive-Library-Nutrient_Correlation_Wheels-2.pdf?dl=0

[8] https://www.amazon.com/Nutrient-Bible-Henry-Osiecki/dp/1875239545/ref=tmm_pap_title_0?_encoding=UTF8&qid=&sr=

[9] https://www.ncbi.nlm.nih.gov/pubmed/28121382

[10] https://www.dropbox.com/s/zej4razn4dn993y/protein%20leverage%20hypothesis%20-%20simpson2005.pdf?dl=0

[11] https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=5&cad=rja&uact=8&ved=0ahUKEwigtuWKl_7WAhUIQLwKHeDdC74QFghFMAQ&url=http%3A%2F%2Fwww.sciencedirect.com%2Fscience%2Farticle%2Fpii%2FS2212877817305379&usg=AOvVaw3NNHJwsTp33sDHvoOVdpAA

[12] https://www.ncbi.nlm.nih.gov/pubmed/15836464

[13] https://en.wikipedia.org/wiki/Bliss_point_(food)

[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3313629/

[15] https://www.ncbi.nlm.nih.gov/pubmed/16332298

[16] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4209489/

[17] https://optimisingnutrition.com/2015/03/22/diabetes-102/

[18] https://www.ncbi.nlm.nih.gov/pubmed/16004827

[19] https://www.nrv.gov.au/chronic-disease/summary

[20] https://www.nrv.gov.au/chronic-disease/summary

[21] https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htm

[22] http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32252-3/abstract

[23] http://garytaubes.com/

[24] https://thebigfatsurprise.com/

[25] Note: we have not prioritised using Vitamin E and Pantothenic Acid due to the fact that the DRI targets are based on population averages rather than deficiency studies.

[26] https://www.bruceames.org/Triage.pdf

[27] http://www.meandmydiabetes.com/2010/05/07/ron-rosedale-protein-the-good-the-bad-and-the-ugly/

[28] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4209489/

[29] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3192127/

redesigning nutrition from first principles

In a sea of nutritional gurus, theories and conflicting opinions, have you ever wondered,

“What should I eat to optimise my blood sugars, weight and health to feel great and thrive?”

If your answer is “yes,” you’re in luck!

This article sets out a bold proposal and methodology to redesign nutrition from the ground up using first principles.

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It also gives you a peek under the hood of the Nutrient Optimiser, an exciting new tool to help you identify optimal foods to incorporate into your diet to achieve your goals.

Overview

But before you dive in, let me give you an overview of where we’re going.

  • Humans require food that contains:
    • adequate nutrients,
    • energy (but not too much), and
    • the ability to maintain healthy hormone levels.
  • The Nutrient Optimiser algorithm considers insulin load, nutrient density and energy density to identify optimal foods to suit different people with different goals.
  • People with diabetes or some degree of metabolic syndrome are on a blood sugar/insulin rollercoaster which drives appetite and fat storage.
  • Stabilising blood sugars and insulin levels using a lower insulin load dietary approach can help to normalise appetite and improve energy levels and often leads to a degree of spontaneous weight loss.
  • Being able to accurately quantify the insulin load of our food enables us to ensure we invest it wisely on protein and other nutrient-dense foods while still maintaining excellent blood sugar levels.
  • The foods that require the least insulin are typically high-fat foods which may not contain adequate amounts of vitamins and minerals.  We need to find the balance between a lower insulin load and adequate nutrient density.
  • Some nutrients are easier to obtain than others. The nutrient density index embedded in the Nutrient Optimiser algorithm prioritises foods that contain more of the harder to find nutrients.
  • People on a low carb or ketogenic diet often miss out on a number of nutrients, particularly electrolytes (e.g. potassium, magnesium, calcium and sodium) and our pancreas will increase insulin levels to enable our kidneys to hold on to these nutrients if we are not getting enough of them from our diet, and thus drive insulin resistance.
  • We can use energy density to manage how filling our food is to suit our goals.  For example, someone wanting to lose weight by eating less by decreasing their energy density or someone wanting to eat more by increasing energy density.
  • The Nutrient Optimiser considers what you are currently eating and identifies nutrient-dense whole foods that will provide the nutrients that you are not getting enough of while also managing your blood sugars and weight goals.
  • The Nutrient Optimiser can help retrain people to make progressively better food choices and reduce nutrient-poor processed foods using a quantitative algorithm that eliminates the emotion, belief and conflicts of interest that often derail our best nutritional ntentions.

My why

My name is Marty Kendall, and my journey into nutrition started fifteen years ago when this happened…

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…and we started thinking about having these.

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My wife Monica has Type 1 Diabetes.  Not too long after we got married we started researching how we could optimise her blood glucose control to minimise the risks associated with a diabetic pregnancy.

And personally, I have a family history and my own struggles with prediabetes and obesity (as you can see from the “before and after” below).

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By day I’m an engineer.  I like to use data to optimise things quantitatively.

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I even spent a period of time developing trading systems.  In this environment, it is critical to eliminate emotion, belief and confirmation bias.

As they say, necessity is the mother of invention.  I got frustrated with the lack of useful information for people with diabetes and decided to take matters into my own hands to create the optimal nutritional solution for my family.

The key components of optimal nutrition

You may have noticed that there is a lot of argument and conjecture about what is the best diet.  Unfortunately, decades of expensive epidemiological studies don’t seem to have provided any clarity.

Paleo, vegan, low carb, fruitarian, pescetarian, Mediterranean, vegetarian, plant-based, ketogenic, the list of nutritional camps goes on and on.

But when you peel away the dogmatic belief and conflicts of interest I think what we really need from our food is:

  • adequate nutrients,
  • enough energy (but not too much), and
  • the ability to maintain healthy hormone levels (e.g. insulin, ghrelin, leptin, mTOR etc.).

After experimenting with a range of parameters to optimise nutrition, the three that I have found to be most useful are:

While not as useful by themselves, we can combine these parameters using a multi-criteria analysis and apply different weightings to each parameter to optimise food choices to suit different people with different goals.

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Given that the diabetes epidemic is exploding, let me start by discussing how we can quantify the insulin load of the food we eat to optimise our blood sugar control.

The blood sugar rollercoaster

Someone with diabetes is on a constant rollercoaster of treating blood sugars with insulin.

You eat, and your blood sugars go up.  You dose with insulin, and eventually, your blood sugars start to come down.  Then you find your blood sugars have dropped too low so you feel compelled to eat again.  Maybe something sweet or a glucose tablet that you wouldn’t have otherwise eaten.  This cycle continues night and day.

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The blood sugar – insulin roller coaster leaves you feeling fatigued and hangry, often gaining weight due to fat storage effects of excess insulin.

When the inputs of food and insulin are both large, it’s impossible to match the right amount of insulin to the food you eat.  There is always a massive error!  And the blood sugar swings are like a bad theme park ride.

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So logically, the goal for someone wanting to manage their blood sugars is to reduce the dietary inputs that need insulin.[1]   But then, the next question is:

“What exactly is it in our food that raises blood glucose and requires insulin, and then how can we accurately quantify it so we can more effectively manage it?” 

The food insulin index data

A couple of years back, I stumbled across a motherload of Food Insulin Index data in a University of Sydney thesis[2] that I thought might hold some clues about how we could more accurately manage insulin.

So I exported the data into a spreadsheet and started tinkering with it to better understand the relationship between the food we eat, our glucose response and the insulin we need.

Our blood sugar response to glucose

It’s not a great surprise for most people to see that our blood glucose response is correlated with the carbohydrate we eat.

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However, things get more interesting when we look at the insulin response to the food we eat.

Measuring our insulin response to food relative to glucose

The Food Insulin Index quantifies the area ‘under the curve’ insulin response to a range of foods.  Pure glucose is assigned a score of 100%, and everything else is measured relative to that.

The food insulin index is a little bit like the Glycemic Index.  However, rather than just measuring the maximum rise in blood glucose, the food insulin index measures the insulin response to the food we eat over time.

Understanding our insulin response to the food we eat is much more useful for someone who cannot keep their blood sugars at normal levels due to insulin resistance (type 2 diabetes) or not being able to produce enough insulin (type 1 diabetes).

Carbohydrates versus insulin response

When we plot carbohydrates against the Food Insulin Index, we find that, while high-fat foods such as bacon and avocado have a small insulin response, high protein foods (e.g. steak and fish) have a significant insulin response even though they don’t contain any carbs.

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People with Type 1 diabetes find that they need insulin to cover the protein they eat.  However, the details of why and how much are often not well understood which leads to poor blood sugar control.

Fats versus insulin response

Higher fat foods have a smaller insulin response, while low-fat foods (which are typically processed grain products) have a high insulin response.

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[Note: There are a couple of situations where fat will require insulin.  The glycerol backbone that holds fat molecules together can be converted to glucose via gluconeogenesis which will need insulin to metabolise.  Also, when we consume more energy than we require over the long term, regardless of macronutrient source, the pancreas secretes insulin to keep energy stored in the liver while the energy coming in from our diet is used up.   However, the changes in insulin levels due to dietary fat are negligible in the short term compared to the carbohydrates and protein.]

The insulin response to dietary protein

Although protein needs some insulin to help us build and repair our muscles and organs, higher protein foods tend to have a lower insulin response because they force out refined carbohydrates from our diet.

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Does protein turn into chocolate cake?

When I first started looking into this issue, I thought the reason that protein requires insulin was because the glucogenic amino acids in protein were being converted to glucose which needs insulin.[3]

But I have since come to understand that it’s not quite that simple.  Protein does not turn to chocolate cake in our bloodstream.

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I feel partially responsible for propagating that misunderstanding with my early posts on the food insulin index.[4] [5]  Many people are avoiding protein to minimise insulin, and I’ve been trying to set the record straight.[6]

Insulin has many critical roles in our body.

  • Most people are aware that insulin helps the body take glucose into the cells to be used for energy.[7]
  • Bodybuilders are well aware that insulin is an anabolic hormone that helps us use the protein we eat to build and repair muscle and organs.[8] [9] [10]
  • The third, lesser-known function of insulin, is that it works to hold glucose in the liver (i.e. glycogen) for later use when we’re not eating.[11]

Type 2 diabetes occurs when we become resistant to the effects of insulin, and stored glucose leaches out into our bloodstream.  Similarly, Type 1 diabetes occurs when the pancreas can’t produce enough insulin to keep glycogen stored in the liver, and we see our blood sugars rise.  Effective and efficient use of insulin in our body is critical to our metabolic health.

Most of the amino acids that make up protein can be converted to glucose via gluconeogenesis, but converting protein to ATP it’s really difficult compared to just using fat and/or carbs. for energy[12]  It takes a lot of energy to convert protein to glucose (we use 6 ATP to yield only 2 ATP of energy!).  So the body tends to look for other energy sources once you’ve consumed enough protein.

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That’s why you can quickly become full-on lean protein, but we always have a “dessert stomach” with enough room for carbs and fat which are much easier for the body to use for energy.

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Let me clarify this with a real-life example that is close to home.

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Pictured above is my wife Monica’s blood glucose response measured with a continuous glucose meter) to this meal of steak and veggies shown below.

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Over the first few hours after finishing the meal the carbohydrates in the veggies digest and raise her blood sugars.  Then the insulin that she injected with the meal kicks in and brings the blood sugars down.

But then over a period of about ten hours, we can see that she is slowly metabolising the steak which requires insulin for the anabolic process of muscle repair.  While the insulin is going to work on the protein, Monica doesn’t have enough insulin to stop the glucose being released into the bloodstream.

You could be forgiven for thinking that protein is being converted to sugar.  But it’s actually the glycogen in the liver leaching into the blood due to a lack of insulin.  Monica actually needs more insulin here to enable her to build and repair her muscles as well as keep glucose in storage in the liver at the same time!

Most people see their blood sugar decrease after a high protein meal due to the effect of insulin (the insulin released to metabolise the protein also brings the blood sugars down and keeps the glycogen shut in the liver).  If you find that your blood sugars rise significantly after a high protein meal, it might be a sign that you actually need more insulin to ensure you are effectively using the protein you are eating.

According to the Protein Leverage Hypothesis, (Simpson, 2005) rather than minimising protein, someone with diabetes eating less carbohydrate may actually require more protein.

“One source of protein loss is hepatic gluconeogenesis, whereby amino acids are used to produce glucose. This is inhibited by insulin, as is the breakdown of muscle proteins to release amino acids, and therefore occurs mainly during periods of fasting.

“However, inhibition of gluconeogenesis and protein catabolism is impaired when insulin release is abnormal, insulin resistance occurs, or when circulating levels of free fatty acids in the blood are high.

“These are interdependent conditions that are associated with overweight and obesity and are especially pronounced in type 2 diabetes. It might be predicted that the result of higher rates of hepatic gluconeogenesis will be an increased requirement for protein in the diet.”  [13] 

Type 1 Diabetes guru Richard Bernstein says he found it hard to build and maintain muscle before he understood the importance of matching insulin with protein.

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However, after matching adequate protein with the right amount of insulin this is no longer a problem, even after more than seven decades of living with Type 1 Diabetes.

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At the same time though, there’s no point choking down more protein beyond what you have an appetite for.   Regardless of the macronutrient source, there’s no use consuming more energy than you need, particularly as the errors in matching food with insulin can exacerbate the glucose/insulin rollercoaster.

Anyone who is somewhere on the spectrum of metabolic disease needs to invest their limited supply of insulin wisely (e.g. to metabolise protein to build and maintain muscle and metabolise limited glucose from nutrient dense green leafy veggies) rather than squander it (on refined grains and sugars).

I hope this interlude into protein metabolism gives you an insight into why a good understanding of our insulin response to protein is important.   While there are a wide range of other hormones that drive our metabolism (e.g. mTOR, leptin, ghrelin and PPK) most of these fall in line if we optimise insulin and blood glucose levels.

Fibre

As a general rule, indigestible fibre does not require insulin and does not raise blood sugar levels.  High fibre foods such as All Bran and navy beans tend to have a lower insulin response due to their high indigestible fibre content.  Hence, it appears that a ‘net carbs’ approach makes sense, at least for whole foods.[14]

[Note:  Many people with Type 1 find that they do require insulin or have a blood sugar response to sugar alcohols and other fibres used in manufactured foods so it may be prudent to adopt a total carbs approach when dealing with foods that come in a packet and claims to have low ‘net carbs’.]

Fructose

Fructose (a.k.a. fruit sugar) is processed in the liver without requiring insulin.  However, some of it is converted to glucose via gluconeogenesis.[15]   Analysis of the food insulin index data suggests that 25% of the fructose we eat requires insulin.   However, this is typically such a small component and difficult to calculate, so it’s generally not worth worrying about.

The solution

After playing around with the Food Insulin Index data for a while, I found we can more accurately predict our insulin response to the food we eat when, in addition to carbohydrate, we also consider the effect of indigestible fibre and protein.

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[If you want to dig into this data a little more you can check out these charts in an interactive Tableau format here.]

With this improved understanding, we can then develop these formulas to calculate the insulin load and the percentage of insulinogenic calories.

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Understanding the insulin load of our food helps us to more accurately calculate the insulin people with diabetes would need to inject, including for protein.   Or conversely, it can help them make better food choices so their pancreas can keep up and maintain healthy blood sugar levels.

Being able to calculate the proportion of insulinogenic calories allows us to identify the most ketogenic foods that will elicit the smallest insulin response in our pancreas.  Understanding the percentage of insulinogenic calories can be beneficial for people who require therapeutic ketosis to help with the management of cancer, epilepsy, Alzheimer’s or dementia.

With better food choices that require smaller inputs of insulin, we are able to smooth out the blood sugar-insulin roller coaster.

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This is a big deal for someone with Type 1 diabetes.  However, the same principles apply to anyone on the spectrum of metabolic disease (which is a growing portion of the population).

I believe our first priority should be to normalise blood sugar and insulin swings.  Often satiety and weight loss will naturally follow as we are able to access our own body fat more efficiently and are not driven to eat by fluctuations in blood glucose and insulin.

Lack of nutrients in fattiest foods

However, after looking at the foods that elicit the smallest insulin response, I realised we may have another problem.  The least insulinogenic foods tend to be mainly fat!

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While an unnecessary fear of fat has driven the unfortunate low-fat processed food saga that has been in place for most of my lifetime, I think we also need to acknowledge that the highest fat foods typically do not contain a lot of the essential vitamins and minerals.

This chart shows the nutrients contained in the fattiest foods as a percentage of the recommended daily intake for each of the essential nutrients.  The nutrients are then sorted to identify which nutrients these foods fail to provide in adequate quantities.

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So if you ate a little bit of the eight hundred fattiest foods of the eight thousand foods in the USDA database you would not be getting the DRI for the following micronutrients:

  1. Vitamin D
  2. Folate
  3. Potassium
  4. Choline
  5. Manganese
  6. Vitamin C
  7. Magnesium
  8. Calcium
  9. Pantothenic acid
  10. Vitamin K
  11. Riboflavin
  12. Vitamin B6
  13. Vitamin A
  14. Vitamin E

Nutrients lacking in the most ketogenic foods

Rather than sorting by percentage fat, this chart shows the nutrients contained in the most ketogenic foods using the percentage insulinogenic calories formula shown above.

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While these foods (refer summary below) are an improvement on the nutritional profile of the fattiest foods, they still do not provide the recommended daily intake for about a third of the essential nutrients.

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So the next question is, what can we do to maintain low insulin levels and while still getting the micronutrients we need?

Enter nutrient density.

Nutrient density

Building on the work of the likes of Dr Mat Lalonde and Dr Joel Fuhrman I developed a nutrient density index to identify foods that contain more of the nutrients that are harder to find.

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Dr Lalonde’s nutrient density system considered all the essential nutrients in terms of nutrients per weight of foods and ended up with a very protein heavy (e.g. 60 to 70% of energy) array of foods.

Dr Fuhrman’s Aggregate Nutrient Density Index considered vitamins and minerals (but not amino acids or essential fatty acids) along with a range of other factors as noted below.

The following nutrients were included in the evaluation: fiber, calcium, iron, magnesium, phosphorus, potassium, zinc, copper, manganese, selenium, vitamin A, beta carotene, alpha carotene, lycopene, lutein and zeaxanthin, vitamin E, vitamin C, thiamin, riboflavin, niacin, pantothenic acid, vitamin B6, folate, vitamin B12, choline, vitamin K, phytosterols, glucosinolates, angiogenesis inhibitors, organosulfides, aromatase inhibitors, resistant starch, resveratrol plus ORAC score.[16]

Rather than prioritising all nutrients, I think we only need to worry about boosting the nutrients that we are currently not getting enough of.   To reduce any percieved bias or conflict of interest, my version of the nutrient density index only considers the essential nutrients that have established targets.

While there are many other nutritional parameters that are nice to have (e.g. phytonutrients, lycopene, lutein, zeaxanthin, phytosterols, glucosinolates, organosulfides, resistant starch etc.), they tend to come along for the ride if we focus on getting the essential nutrients from whole foods.

Unfortunately, we currently only have data for the nutrients that are actually in a food.  Hopefully one day we will also be able to account for your digestion, the effect of anti-nutrients and the bioavailability of nutrients from different food sources.

Most of the time these are not a problem as focusing on nutrient-dense foods eliminates most anti-nutrients.  Most people get plenty of amino acids, iron, zinc and vitamin A which are less bioavailability in plant-based sources.  However, if you are consuming a 100% plant-based diet, you may need to pay extra attention to getting adequate of these nutrients.

A well-formulated ketogenic diet

So, going back to the ketogenic foods, once we emphasise the harder-to-find nutrients, we get a massive boost in the micronutrient content of our diet, while still maintaining a ketogenic macronutrient ratio.

The image below shows the ketogenic foods with and without consideration of nutrient density.  When we boost the harder to find nutrients all of the nutrients get a significant boost.

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The nutrient score that you see on each of these charts enables us to compare the nutrient density of each these dietary approaches quantitatively.  While the recommended daily intake levels are not set in stone, and your body doesn’t flip an on/off switch once the minimum levels are achieved, I think we ideally want to meet the recommended intake levels for as many nutrients as we can.  However, there’s probably not much use chasing more than twice the recommended daily intake levels.   So, if we filled the whole red rectangle, we would get a perfect score of 100%.

As you’ll see below, we can create a theoretical list of foods that get us pretty close to a perfect nutrient density score of 100%.  However, in real-life, it’s hard to achieve such a high nutrient density score.  Dr Rhonda Patrick currently holds the top position on the Nutrient Optimiser Leaderboard with a score of 82%.

Low carb is more nutritious than keto

If we tweak the weightings in the multi-criteria analysis and put less emphasis on insulin load and more on nutrient density we get a more nutritious group of low carbohydrate foods and the nutrient score increases from 64% to 97%.

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A summary of these foods is shown below.

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While I could go on about the importance of the various vitamins, minerals and fatty acids, the thing I see most regularly with low carb diets is a lack of alkalising minerals such as potassium, magnesium and calcium.

The chart below shows a typical nutrient profile for someone following a ketogenic diet.  Notice the cluster of lower levels of potassium, magnesium and calcium at the top of the chart.  There has been a lot of talk about sodium lately.  However, it seems that these other minerals are actually harder to get in sufficient quantities.

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Dr James Dinicolantonio references this study in his recent book, The Salt Fix, that shows that low sodium diets tend to lead to insulin resistance.

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The kidneys call on the pancreas to secrete more insulin to help them hold onto sodium when there isn’t much coming in from our diet.[17]

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Volek and Phinney point out that the fundamental problem with low salt diets is that they cause a loss of potassium which is critical for building and maintaining muscle.

“Salt depletion causes a compensatory loss of potassium, which has a negative impact on muscle mass since potassium is a necessary cofactor for building muscle.”

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Managing sodium and potassium is a massive deal for our body, with 40% of the body’s energy and 70% of the brain’s energy used just to manage the sodium-potassium pump that is fundamental to our energy production.

As well as for sodium, the body upregulates our basal insulin to hold on to other electrolytes such as potassium and calcium.[18]

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Ironically, a low carb or ketogenic diet that minimises total carbohydrates in an effort to reduce the bolus insulin required for our food, may actually lead to a reduction in electrolytes that drives insulin resistance through an upregulation of basal insulin to enable our kidneys to hold onto precious electrolytes if we’re not getting sufficient quantities from our diet!

Paul Jaminet points out that Palaeolithic diets were naturally high in potassium and low in sodium.  Salt was rare and highly valued, so we evolved mechanisms for protecting against the threat of low sodium levels.  However, because potassium was plentiful back then, we have not developed similar evolutionary mechanisms to protect us against low potassium levels, even though they are every bit as devastating to our health.[19]

Today, potassium tends to be hard to obtain from our diet or even from supplements (which are limited to 99mg when the RDI is 4800mg or nearly 50 capsules), so we need to pay particular attention to make sure we get enough of it.

While I don’t think it’s ideal to focus on just one nutrient, we get a respectable amount of nutrients if we just chase high potassium foods.

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And while there are a number of fruits (like bananas) in the high potassium foods list, there are still a ton of non-starchy veggies if you need to manage your blood sugar levels.

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Energy density

Once you have normalised your insulin and blood sugar levels to that of a metabolically healthy person, there may not be any use in doubling down on more dietary fat if your goal is to lose body fat.

If your goal is further weight loss, I believe the ideal approach is to maximise the nutritional content of your diet so you can minimise energy intake without risking nutrient cravings.  The image below shows how the weight loss phase of a ketogenic diet includes a substantial amount of fat coming from the body with a more modest dietary intake of fat and lower overall calories.[20]

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Foods with a lower energy density (in terms of calories per weight of food) tend to be more filling and allow you to reduce energy intake naturally which will, in turn, allow your body fat to be used for fuel.

Optimal foods for weight loss if you’re still insulin resistant

These weight loss foods prioritise low energy density while also prioritising nutrient density and a low insulin load to help you lose weight if your blood sugars are still a little elevated.

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And they contain a very respectable amount of nutrients.

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Maximum nutrients with minimum energy

Meanwhile, the foods in this list just prioritise a low energy density and high nutrient density and hence provide a lot of nutrition without too much energy.

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And the nutrient profile is spectacular!

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A Protein Sparing Modified Fast is often used in weight loss clinics to maximise the rate of fat loss while ensuring you get adequate protein to maintain your lean muscle mass.

Adding nutrient density to this protocol will further improve your chances of success by avoiding cravings and nutrient deficiencies while maintaining an aggressive energy deficit.

What I find really interesting here is that, even though we are not prioritising any of the amino acids, we are getting tons of protein!  It seems that when we focus on the harder-to-find nutrients, protein becomes a non-issue.

It’s also interesting to note that the macronutrient split of these the most nutrient dense foods is similar to the macronutrients that generate the lowest ad lib energy intake.[21]

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Conversely, actively avoiding protein tends to have a diabolical impact on the essential vitamin and mineral content of our diet as shown in the chart of the lowest protein foods below.

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As you can see from the food list below, it’s hard to minimise protein without going very high carb or relying on a lot of refined fats.

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Optimal foods for bodybuilders

If you’re a bodybuilder trying to build muscle you can focus on boosting the more anabolic branched chain amino acids (i.e. valine, leucine and isoleucine).

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The foods listed below will help you recover and build muscle if you are working out.

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Optimal foods for endurance athletes

If you are an endurance athlete who doesn’t want to rely on pasta and energy gels to get enough energy you can focus on high energy density foods while still keeping nutrient density high.

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Foods with a higher energy density are not as nutrient dense.  However, these foods are still pretty good.

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Micros > macros?

You may have noticed that the macronutrient splits of the various dietary approaches vary significantly.  However, what is consistently missing from these optimal food lists are sugars and processed grains which contain a pitiful amount of nutrition.  The contrast between the cereals, baked goods, snacks and fast foods…

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… and the most nutrient dense foods is dramatic!

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A low carb diet will ensure that you avoid the majority of these dangerous Franken foods along with the sugars, seed oils, anti-nutrients and chemicals that are often associated with processed grains.

However, what I’ve found, after playing around with all these food lists for a few years, is that everything seems to work out pretty well when we start by prioritising the harder-to-find micronutrients and tweak from there to suit our goals.

Personalised nutrition

A further problem that I identified with these lists is that they do not consider what YOU are currently eating.

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Each person’s interpretation of a low carb, ketogenic or paleo diet will vary depending on preferences, finances, culture, appetite and activity levels.

I think what you really want to know is:

which foods will provide you with more of the nutrients you are not getting from your diet right now?

So this year I’ve developed the Nutrient Optimiser algorithm, a tool that will tell you:

  • what foods you should be eating more of,
  • which foods you should be eating less of, and
  • which new foods you should look for next time you go shopping.

Rather than adopting the Pete Evans diet or the Tom Brady diet for a period and then falling off the wagon once the meal plans run out, the Nutrient Optimiser will help you help you make continual incremental improvements in your journey towards optimal nutrition.

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The algorithm takes your food log, entered in Cronometer, and analyses it to see which nutrients you are currently not getting enough of.

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Nutrient imbalances

We also look at the critical ratios to make sure we’re not prioritising nutrients that are going to exacerbate any current imbalances.  The chart below shows an example of how we can use these ratios to refine the nutrients we want to prioritise.

ratios ratio target recommendation
Omega 6 : Omega 3 0.3 < 4 omega 6 : Omega 3 ratio is good.
Zinc : Copper 7 8 – 12 zinc : copper ratio is outside limits.
Potassium : Sodium 1.5 > 2 potassium : sodium ratio is low.
Calcium : Magnesium 2.3  < 2 calcium : magnesium ratio is high.
Iron : Copper 11 10 – 15 iron : copper ratio is within range.
Calcium : Phosphorus 0.6 > 1.3 calcium : phosphorus ratio is low.

Tailoring nutrition to suit blood sugar and weight loss goals

The Nutrient Optimiser algorithm also helps you choose your ideal dietary approach based on your blood sugars as well as our performance and weight loss goals.

approach average glucose (mg/dL) average glucose (mmol/L)
well formulated ketogenic diet > 140 > 7.8
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) < 97 < 5.4
most nutrient dense < 97 < 5.4
nutrient dense maintenance < 97 < 5.4
bodybuilder < 97 < 5.4
endurance athlete < 97 < 5.4

Targeted nutrients to suit your symptoms

We can also factor in additional nutrients that relate to your current symptoms such as diabetes, low testosterone, fertility or a wide range of other conditions associated with nutrient deficiencies.

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Optimal food to suit your goals

The algorithm then generates a suite of personalised food sorted in descending order lists tailored and prioritised to suit your goals.  And coming soon, optimal meals and meal plans that will align with your goals.

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Best and worst days

The algorithm also gives a nutrient score for each day of your food log.  You can learn a lot by reflecting on what you are consuming on your best and worst days.

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Leaderboard

To date, I’ve run the Nutrient Optimiser analysis for about seventy different people.

It’s exciting to see the competitive types try to work their way up the leaderboard.

And if you’re a nutrition nerd like me you may find it interesting to head over to the leaderboard and drill down to see what each of these people is actually eating to achieve these high and low nutrient scores.

Sitting in first place at the top of the leaderboard is Dr Rhonda Patrick who, as you can imagine, does look like she eats pretty healthy.

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But the best competition is against yourself, with incremental improvements by implementing the recommendations of each iteration of the Nutrient Optimiser analysis.  For example, we can see Andy Mant has made leaps and bounds in his diet in preparation for his recent Paris wedding.

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Andy had some great success with plenty of seafood and oysters (check out his report here).  Meanwhile, people like Amy boost their nutrients with organ meats on a zero carb approach.  Others achieve a high level of nutrient density with plenty of green veggies.

The Nutrient Optimiser still doesn’t force you to eat specific foods but allows you the latitude to find the best selection of foods that align with your preferences.

Want to learn more?

If you’re interested, all the food lists (and a whole lot more) are available for free here.

If you want to learn more about the Nutrient Optimiser you can check out the FAQ over at NutrientOptimiser.com.

There are also a number of Facebook groups where you can participate in the discussion about Optimising Nutrition and share the journey.

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My hopes for the future

I presented the guts of this article as a presentation at Low Carb Down Under Gold Coast in October 2017.  A frequent comment was that it was apparent that I had spent a LOT of time developing the food lists and the Nutrient Optimiser.  Yes indeed, this has been a labour of love.  A challenging problem to solve with personal ramifications.

I would love to see the Nutrient Optimiser take off and help a lot of people and perhaps pay for a little of the time that I have invested into it.  Getting some income will enable it to be developed into a quality system that will help a lot more people.

But I really do hope that the system that I have developed will educate people to start an underground revolution by enabling them to confidently make food choices that provide them with the nutrients they need with enough energy while also optimising their hormones.

Decades of epidemiological studies have been fruitless in providing a clear direction as to the optimal human diet.  Nutrition research and education are so fraught with entrenched belief systems, confirmation bias and with conflicts of interest.

It’s impossible for the everyday person to know what they should eat to feel OK and thrive at life.  It seems Big Food is just winning and Big Pharma (also owned by the same companies) is making a killing cleaning up the mess.  The current system is broken and needs to change!

The Nutrient Optimiser algorithm gives us the chance to redesign and rebuild nutrition from the ground up.  My dream is that it will empower educated enthusiasts, then dieticians and personal trainers, then doctors, then insurance companies and then medical systems.  At that point, big food will catch on and realise they need to provide nutritious foods that enable people to thrive and win at life.

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references

[1] http://www.diabetes-book.com/laws-small-numbers/

[2] https://ses.library.usyd.edu.au/handle/2123/11945

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

[4] https://optimisingnutrition.com/2015/03/30/food_insulin_index/

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

[6] https://optimisingnutrition.com/2017/06/03/why-do-my-blood-sugars-rise-after-a-high-protein-meal/

[7] http://www.medscape.org/viewarticle/438374

[8] https://www.ncbi.nlm.nih.gov/pubmed/16705065

[9] https://www.bodybuilding.com/fun/max_insulin_response.htm

[10] https://www.t-nation.com/diet-fat-loss/anabolic-power-of-insulin

[11] https://www.youtube.com/watch?v=VjQkqFSdDOc

[12] https://chrismasterjohnphd.com/2017/08/19/29-gluconeogenesis-expensive-essential-mwm-2-29/

[13] https://www.ncbi.nlm.nih.gov/pubmed/15836464

[14] https://optimisingnutrition.com/2015/03/30/what-about-fibre-net-carbs-or-total-carbs/

[15] https://optimisingnutrition.com/2016/01/25/fructose-victim-or-villain/

[16] https://www.drfuhrman.com/learn/library/articles/95/andi-food-scores-rating-the-nutrient-density-of-foods

[17] https://www.ncbi.nlm.nih.gov/pubmed/21036373

[18] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC301822/

[19] http://perfecthealthdiet.com/

[20] https://www.youtube.com/watch?v=2KYYnEAYCGk

[21] https://www.ncbi.nlm.nih.gov/pubmed/24588967

“high protein” vs “low protein”

In a recent Facebook thread Richard Morris of 2 Keto Dudes fame said:

The lipophobics and the aminophobics are both talking past each other at strawmen.  

The hysteria is not just humorous, it’s confusing and turning away novices.  

This phony controversy causes people to recommend insane amounts of protein at BOTH ends of the spectrum.

Protein tends to be a passionate topic of discussion n the online macronutrient wars.  So I thought it would be useful to set out arguments at both extremes of the ‘protein controversy’ and detail some responses to bring some balance.  My hope is that this article will bring some clarity to the civil war in the low carb/keto community.

The TL:DR summary is:

  • appetite is a reliable driver to make sure you get enough protein to suit your needs,
  • our appetite decreases when we get enough protein,
  • it’s hard to overeat protein because it’s hard to convert to energy, so the body doesn’t want more than it can use,
  • most people get adequate protein without worrying about it too much,
  • people who require a therapeutic ketogenic approach should pay attention to their diet to ensure that they don’t miss out on essential micronutrients while maintaining a low insulin load, and
  • if you prioritise nutritious whole foods, you’re likely getting enough protein but not too much.

If you want more detail, read on! The arguments and responses of the two sides are outlined below.  The article then concludes with some learnings and observations from the Nutrient Optimiser about how we can optimise protein intake to suit our goals and situation.

High protein bros

This section outlines the arguments and responses from the “high protein bro” extreme end of the debate.

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“There is no such thing as too much protein.”

Refined protein supplements do not contain the same quantity of much vitamins, minerals or essential fatty acids as whole foods.

As shown in the plot of percentage protein vs nutrient score, a focus on obtaining adequate vitamins, minerals and essential fatty acids from whole foods typically leads to obtaining plenty of amino acids.  Meanwhile, actively avoiding protein tends to dilute overall nutrient density in terms of vitamins and minerals.

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The body typically down-regulates appetite before it consumes ‘too much protein’.  It is physically difficult to eat ‘too much protein’ from whole foods (although hyperpalatable whey protein shakes may be another matter).

While protein is beneficial, we also need a balanced diet that provides the other vitamins and minerals (e.g. electrolytes that will enable the kidneys to maintain acid/base balance which is critical to insulin sensitivity which is hard to obtain from protein supplements).

In summary, it is possible to focus too much on protein to the point that you are missing out on other important micronutrients.  Conversely though, if you chase micronutrients from whole foods you will get adequate amounts of protein.

“Fasting will cause you to lose muscle due to a lack of protein intake.”

A high-fat diet reduces the need for glucose and therefore the requirements for protein from gluconeogenesis decrease.  Someone who is ‘fat adapted’ with lower insulin and blood glucose levels will also be more readily able to access their stored body fat for fuel.

The body defends lean muscle loss by upregulating appetite.[1]  People with more body fat and/or lower insulin levels will likely find fasting easier than people who are lean and/or have high insulin levels.

Fasting will drive autophagy, which is beneficial, to an extent.  Fasting and feasting is a cyclic process of building and cleaning out.  We need to balance both parts of the cycle.  Humans generally do this well in the absence of hyper-palatable processed foods.

One of the benefits of fasting is that when you re-feed, your body will be more insulin sensitive so you will build back new muscle more efficiently with less protein and insulin required.  People doing regular multi-day fasts should ensure their average protein intake is adequate over a number of days and not just on the days they eat.

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You should target more nutritious foods on your eating days to ensure you are getting adequate nutrients over the long term.  If your goal is to lose body fat, then re-feeding to satiety on very high-fat foods may be counterproductive in terms of fat loss and micronutrient sufficiency.[2]

“Everyone needs to lift heavy weights and be jacked.”

Not everyone wants to look good with their shirt off or is willing to invest the dedication that it takes to have a six-pack.  However, being active and having sufficient lean muscle mass is important to maintaining insulin sensitivity and delaying the diseases of ageing.  Doing something is better than nothing.  Having sufficient lean muscle mass is arguably better than manipulating macronutrients if your goal is glucose disposal and fat burning.

Low protein “ketonians”

This section outlines a number of arguments against ‘too much protein’ along with some responses.

“Too much protein will turn to glucose like chocolate cake in your bloodstream”

Protein can be converted to glucose via gluconeogenesis if there is no other fuel available.  However, gluconeogenesis does not come easily, and the body only resorts to increased levels of gluconeogenesis above baseline levels in emergency situations.  Gluconeogenesis yields only 2 ATP from 6 ATP.[3]

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“Too much protein is dangerous for your kidneys”

High levels of protein are only a concern if you have a pre-existing kidney issue,[4] and even then not everyone is in agreement.

“Protein is expensive and a waste to use for fuel”

The fact that using protein for fuel is metabolically expensive can be beneficial if our goal is fat loss as it increases overall energy expenditure.[5] [6]  By contrast, fat and carbs are more efficient fuel sources.  Higher levels of protein intake will drive satiety as well as being less efficient and cause more losses.

High protein foods are often financially expensive.  Processed high fat and high carb foods are cheaper to produce and hence can have a higher markup applied to them.  Thus, food companies tend to promote cheaper foods with a higher carb and/or fat content.

“Too much protein is dangerous for people with diabetes.”

People with diabetes convert more protein to glucose through uncontrolled gluconeogenesis (i.e. due to insulin resistance in Type 2 and a lack of insulin in Type 1).[7]  They also find it harder to build muscle due to a lack of insulin.  Hence, people with diabetes may benefit from consuming more protein to maintain or gain muscle.

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Conversely, people who are insulin sensitive may require less protein because they can use it more efficiently to build and repair muscle.

Older people tend to require more protein to prevent sarcopenia.[8]  A loss of lean muscle mass is a significant risk factor for older people.[9]

As shown in the chart below, people with diabetes (yellow lines) produce more insulin in response to protein than metabolically healthy people (white lines).[10]  Forcing more protein beyond satiety may make diabetes management more difficult.  However, most people get the results they require from reducing carbohydrates.  The fact that protein turns to glucose can be a useful hack for people with brittle diabetes who want to get their glucose without the aggressive swings that refined carbohydrates can provide.

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“Too much protein will make it hard maintain healthy blood sugar levels because protein stimulates insulin and glucagon.”

Protein requires insulin to metabolise.  Insulin also works to keep glycogen stored in the liver.

As shown in the charts below,[11] an increase in protein in the diet typically forces out processed and refined carbohydrate and so decreases your insulin and glucose response to food.[12] [13] [14] [You can check out the interactive Tableau version of these charts here.]

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People with Type 1 diabetes don’t have enough insulin to metabolise protein and maintain healthy blood sugars at the same time and hence require exogenous insulin.

People with Type 2 diabetes often have plenty of insulin but need to ‘invest’ their insulin wisely on metabolising protein to build muscles and repair their vital organs rather than ‘squandering it’ on refined carbohydrates.

People with hyperinsulinemia will often see their blood sugars decrease after a high protein meal as the insulin released to metabolise the protein also works to reduce their blood sugars.[15]

If you see your blood sugars rise after a high protein meal you may have inadequate insulin.  IF you have an insulin insufficiency, you may need to learn to accurately dose with insulin for protein rather than avoiding protein.[16]

“High protein will shorten life due to excess mTOR stimulation.”

Humans need to balance growth (i.e. increased IGF-1, insulin and mTOR) with repair (i.e. autophagy, fasting and ketosis).  Driving excess growth through unnatural means may not be beneficial for long-term health.

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However, the research into protein restriction and longevity is either theoretical or in worms in a petri dish where they grew more slowly when protein and/or energy was restricted.  Free-living humans typically don’t manage to voluntarily restrict energy intake.  We seem to have an inbuilt drive to protect ourselves from a loss of muscle mass, depression (note: good nutrition, especially amino acids is crucial to brain function) and loss of sex drive, and generally feeling cold and miserable.

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Longevity research in monkeys suggests that energy restriction or at least a reduction in modern processed foods is beneficial.  However, there is no research in mammals that demonstrates that protein restriction extends lifespan or health span.

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The low target protein values proposed by some for longevity (i.e. 0.6g/kg lean body mass or LBM) are practically impossible to achieve from whole foods without the addition of a significant amount of oils and refined fats and/or substantial calorie restriction to the point of rapid weight loss (e.g. check out the Nutrient Optimiser analysis of Dr Rosedale’s diet here).

There is a difference between lifespan and healthspan. Humans in the wild who are frail risk fractures and other complications related to muscle wasting and lethargy.

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As shown in the chart below, there is an optimal balance between growth and wasting.[17]  Too much insulin and you grow to the point that you get complications of metabolic disease.  Too little growth and you become frail, lose your muscle and bone strength then you may fall, break your hip and never get up again.

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“Just eating protein won’t give you gainz!”

Yes indeed!  You need to force an adaptive stress to cause muscle gains, not just eating protein.  If you work out, you will likely crave more protein.  This is natural and healthy and ensures that we can recover, adapt and get stronger.

“Overeating protein will make you fat.”

Excess consumption of any macronutrient will make you fat.  However, eating more protein and fewer carbs and fat tends to increase satiety.[18]

Research in resistance-trained athletes shows that overeating protein does not cause an increase in fat mass.[19] [20]  Research in sedentary adults shows that overeating protein causes a more favourable change in body composition than overeating the same amount of calories from fat and/or carbohydrate.

“Too much protein will lead to rabbit starvation.”

Healthy people can metabolise up to 3.5g/kg protein per day and digest up to 4.3g/kg per day.[21]  This makes sense in an evolutionary context (or even in more recent times before we had refrigerators) when there wouldn’t have been a regular supply of food but we would have needed to be able to use the food when we came across a big hunt after a long famine.

Theoretical research suggests there is no upper limit to protein intake to the point it is dangerous.   However, the practical upper limit seems to be around 50% of energy intake.  If you force extreme levels of protein, you get thirsty and pee out the excess protein.

Growing children and active people tend to crave higher levels of protein to build and repair their muscles (i.e. 10-year-old Bailan Jones, shown on the right here with his brother, who is a growing young man with Type 1 who consumes 4.4g/kg LBM).

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If you’re obese and eat only lean protein, your body will be forced to use body fat for fuel.  If you are very lean and eat nothing but very thin protein satiety will kick in and you will not have enough body fat to burn.  This is dangerous and leads to death.  So if you are already very lean and going to live in the wilderness with only wild rabbits to eat, make sure you take some butter.  However, most people will have adequate body fat to use for fuel for a significant period of time before rabbit starvation would be an issue.

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“If you’re not losing weight, you should cut your protein and your carbs and eat fat to satiety.”

Reducing processed carbs helps to lower insulin and stabilise blood sugars and helps a lot of people reduce their appetite and lose body fat.[22] [23]  However, not everyone reaches their optimal weight with this method.

LCHF / keto works until it doesn’t.

Many people find that they need to reduce dietary fat in addition to carbohydrates to ensure they burn body fat.

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Restricting protein and carbs while eating ‘fat to satiety’ may lead to an inadequate intake of vitamins and minerals which can lead to cravings and a lack of satiety.[24] [25]

While reducing the insulin load of your diet to the point that we achieve healthy blood glucose levels often helps improve satiety, effective weight loss diets typically involve some permutation of reduced fat and/or carbs to achieve a reduction in energy intake.

Medical weight loss clinics typically use a version of a protein sparing modified fast which provides adequate protein to prevent loss of lean muscle mass while restricting carbohydrates and fat.[26] [27] [28]

People on a low carb or keto diet may have an increased requirement for protein due to the body’s increased reliance on protein for glucose compared to someone who is getting their glucose from carbohydrate.[29]  Protein is the most satiating macronutrient and eating more fat when your appetite is actually craving protein, or other nutrients may lead to excess energy intake.[30]

“Too much protein will kick you out of ketosis and halt fat burning.”

Contrary to popular belief (which is often propagated by people marketing ketogenic products), ketosis is only one of a number of pathways that we burn fat.

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Ketones (i.e. AcetoAcetate or AcAc) are produced when there we don’t have enough Oxaloacetate (OAA) to produce citrate in the Krebs cycle.[31]

If you are consuming enough protein and/or carbs to provide OAA you will still burn fat but through the Krebs cycle rather than via ketogenesis.  Thus, you may be “kicked out of ketosis” if you eat more protein but you’re still burning plenty of fat.[32]

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fat burning via Krebs cycle or ketosis (via Amy Berger)

If you have high levels of NADH (which is associated with ageing and diabetes),[33] [34] [35] more of your AcAc will be converted to BHB in the liver.

Most people will see ketones in their blood increase when fasting or restricting energy intake due to the lack of OAA as they burn body fat.  As shown in the chart below, blood glucose levels decrease while BHB increases.

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There are a number of beneficial processes (e.g. autophagy, increased NAD+, increase in sirtuins) that current during fasting/energy restriction that is associated with increased BHB.  It is possible that many of the benefits related to BHB may actually be due to these other beneficial processes that occur in endogenous ketosis (i.e. it’s probably not the ketones).

We can force higher levels of BHB in the blood by eating more dietary fat and less protein and carbohydrates.  In this case, high BHB may be an indication that you are eating more fat than can be burned in the Krebs cycle and it is building up in the blood.   High levels of BHB in the blood do not mean you are achieving the same benefits via exogenous ketosis as we do in endogenous ketosis.

If your AcAc is not converted to BHB due to a low NAD+:NADH ratio you will tend to see more breath acetone (BrAce).  If you do not have metabolic syndrome, you may see higher levels of BrAce (i.e. measured with the Ketonix) and lower levels of BHB in the blood.   You should also be aware that exercise and an adequate intake of B vitamins in the diet will also increase your NAD+ levels and ‘kick you out of ketosis’.

Before you get caught up chasing ketones by whatever means possible, you should keep in mind that someone who is metabolically healthy and easily able to access their body fat stores for fuel (i.e. low insulin levels) will have lower overall levels of energy floating around in their blood (i.e. from blood glucose, ketones or free fatty acids).  Higher levels of energy in the bloodstream is a sign of poor metabolic health and reduced ability to access and burn fat.

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High levels of glucose lead to glycation.  High levels of free fatty acids lead to oxidised LDL.  High levels of glucose and free fatty acids tends to lead to glycated LDL.  High levels of ketones can similarly lead to metabolic acidosis if not balanced with an adequate mineral intake which may also ‘kick you out of ketosis’.[36]

Learnings from the Nutrient Optimiser

What is everyone else doing?

The Nutrient Optimiser Leaderboard demonstrates that low carbers have a wide range of protein intakes.

  • The average fat intake of these people is 60%, with half the people between 54% and 68% calories. The average carb intake is 11% with half the people between 6 and 15%.   So, we can see that this is generally a CLHF population.
  • Half of the people lie between about 1.4 and 2.5g/kg LBM with an average of 2.1g/kg LBM. In terms of percentage, half of the people sit somewhere between 18 and 29% of energy from protein with an average of 24% energy from protein.
  • Dr Rhonda Patrick, who is sitting at the top of the leaderboard, seems to be eating about 2.5g/kg LBM protein even though she says she is not particularly active and eats heaps of veggies.
  • People who are active tend to eat more protein (e.g. Brianna, Andy Mant and Alex Leaf).
  • “High” protein advocates Luis Villasenor of Ketogains and Dr Ted Naiman both seem to be consuming around 2.4g/kg LBM to support recovery from their higher activity exercise levels.
  • People following a zero carb approach tend to be eating more protein (e.g. Shawn Baker at 6.1g/kg LBM and Amy on 3.3g/kg LBM) as more of their energy comes from animal food. Perhaps many of the satiety effects of a Zero Carb dietary approach are actually due to the high satiety effects of protein.
  • The people with less than 1.0g/kg LBM tend to be relying on a significant amount of added fats and do not tend to achieve the highest overall nutrient score (see examples here, here and here).

What are the recommendations?

The very wide range of protein intake levels can be confusing.  Some are outlined below for reference.

  • In long-term fasting, we use about 0.4g/kg LBM protein from our body via gluconeogenesis.
  • The Estimated Average Requirement is 0.68g/kg body weight for men to prevent protein related deficiencies and 0.6g/kg body weight for women.  For a woman with 35% body fat, this equates to 0.92g/kg LBM as a minimum protein intake.[37]  (Note: These standard values are in the context of someone eating a conventional diet where they would typically be getting plenty of glucose from carbohydrates and are not particularly active, and protein requirements may be higher where someone is active and using some protein for glucose via gluconeogenesis.)
  • The Recommended Daily Intake is 0.84g/kg body weight for men to prevent protein related deficiencies and 0.75g/kg body weight for women (Note: For a woman with 35% body fat this equates to 1.15g/kg LBM as a minimum for someone who is sedentary).[38]
  • Steve Phinney recommends 1.5 to 2.0g/kg reference body weight (see slide below from his recent presentation in Brisbane) which equates to around 1.7 to 2.2g/kg LBM for someone wanting to lose 10% of their body weight to achieve their ideal ‘reference weight’. This increased level allows for some glucose to come from protein via gluconeogenesis and allows adequate protein for people who are not eating carbs and active.

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  • Ketogains suggest 0.8 to 1.0g/lb LBM or 1.8 to 2.2g/kg LBM for people who are looking to maintain or build higher levels of muscle mass.
  • Mainstream bodybuilding recommends 1.7 to 2.5g/lb body weight or 3.7 to 5.5g/kg body weight.[39] For someone with 15% body fat, this equates to 4.3 to 6.4g/kg LBM!!!

What happens to micronutrients when we chase protein?

When I first started tinkering with nutrient density, I assumed that we would want to boost all the essential nutrients (i.e. similar to Dr Mat Lalonde’s approach[40]).  The chart below shows the nutrients provided when we prioritise foods that have higher amounts of all the essential micronutrients.  The amino acids are shown in maroon.

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The ‘problem’ with this array of foods is that, because protein is easy to obtain, this group of foods ends up being very high in protein!  Even the “high protein bros” won’t be able to consume seventy percent of their energy from protein.

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As you can see from the figure below, we typically can’t eat more than 50% of our energy from protein.  However, satiety levels tend to be highest, and hence energy intake is the lowest at around 50% protein (dark blue area).[41]

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There is generally no need to prioritise amino acids because it is easy to meet the Recommended Daily Intake for amino acids if we eat whole foods.

Emphasise only harder to find nutrients

Rather than prioritising all the micronutrients, the chart below shows the micronutrient profile that we get if we prioritise the harder to obtain micronutrients (shown in yellow) without prioritising any of the amino acids (shown in maroon).   (Note:  Vitamin E and Pantothenic Acid haven’t been prioritised as the target levels are based on population averages rather than deficiency studies).

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As you can see, we still get heaps of protein. However, we get a much better micronutrient profile in the vitamins and minerals because we are only prioritising the harder to find micronutrients.

Maximising nutrient intake while minimising energy intake appears to be central to reducing natural energy intake and minimising nutrient related cravings and bingeing.  It’s not hard to see how we could reduce our energy intake eating these foods while still getting plenty of the essential micronutrients.

Highest protein foods

For comparison, the chart below shows the nutrient profile of the highest protein foods.   It seems when we prioritise foods based on their protein content we end up missing out on a number of the vitamins and minerals.  Thus, there appears to be a danger that we will miss out on micronutrients when we focus only on protein.

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Do plant-based diets provide enough protein?

The one situation I have seen people not meeting the recommended daily intake levels for protein is people following a purely plant-based diet.  In the nutrient profile shown below, Sidonie is only getting 11% of her calories from protein and you can see that leucine is not meeting the DRI levels while methionine and lysine are just meeting the minimum levels.  This may be a legitimate concern for someone on a plant-based diet as amino acids tend to be less bioavailable from plans in comparison to animals.

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The image below shows the foods that will help to fill in the gaps in her current nutritional profile which is focused on high protein vegetables and legumes.

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This food list shows the foods that would fill in Sidonie’s nutritional gaps if she was open to adding animal foods.  This is an interesting contast to the typical food list for someone on a low carb diet which has a much longer list of vegetables to rebalance the vitamins and minerals.

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Most ketogenic foods

The chart below shows the nutrient profile of the most ketogenic foods (i.e. the ones that require the lowest insulin by limiting carbs and moderating protein).  It seems that, if you actually require therapeutic ketosis (i.e. to manage epilepsy, cancer, dementia or Alzheimer’s), you will need to pay particular attention to getting adequate micronutrients (i.e. notably, choline, folate, potassium, calcium and magnesium).

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Lowest protein foods

And finally, the chart below shows the micronutrient profile if we actively avoid protein.

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It seems that actively avoiding protein has a diabolical impact on the micronutrient profile of our food.  However, when we focus on balancing our diet at a micronutrient level, everything else seems to work out pretty well.

So what should I eat?

With all the conflicting opinions it can be confusing to know what to eat.

In the end, it comes down to eat good food when hungry. 

If we remove hyperpalatable processed foods, I think we’ll have a much better chance of being able to trust our appetite to guide us to the foods that will be good for us.

The food lists below have been prepared to provide the most nutrients while aligning with different goals (e.g. therapeutic ketosis, blood sugar control weight loss, maintenance or athletic performance).  There are a whole lot of other lists in the Optimal Foods for YOU article that are tweaked to suit different goals.

I think if you limit yourself to these shortlists of healthy foods you will be able to listen to your appetite to guide you towards the protein rich foods, the mineral rich foods or the vitamin rich foods depending on your need right now.

approach average glucose (mg/dL) average glucose (mmol/L) PDF foods nutrients
well formulated ketogenic diet > 140 > 7.8 PDF foods nutrients
diabetes and nutritional ketosis 108 to 140 6.0 to 7.8 PDF foods nutrients
weight loss (insulin resistant) 100 to 108 5.4 to 6.0 PDF foods nutrients
weight loss (insulin sensitive) < 97 < 5.4 PDF foods nutrients
most nutrient dense < 97 < 5.4 PDF foods nutrients
nutrient dense maintenance < 97 < 5.4 PDF foods nutrients
bodybuilder < 97 < 5.4 PDF foods nutrients
endurance athlete < 97 < 5.4 PDF foods nutrients

Once you’re eating well and want to further refine your diet you want to check out the Nutrient Optimiser.

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references

[1] http://www.nature.com/ejcn/journal/v71/n3/full/ejcn2016256a.html?foxtrotcallback=true

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