the Nutrient Optimiser Score

It’s natural to want to see how we compare with others to learn how we can keep improving.  We want to be better than yesterday.

This article gives an overview of the Nutrient Optimiser Score and what it takes to get to the top of the Nutrient Optimiser Leaderboard.

Fancy a little “healthy competition”?   Then read on.

My daily nutrient intake

The chart below shows my nutrient profile for three weeks of food logging.

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The vertical axis shows the various essential micronutrient (i.e. vitamins, minerals, amino acids and essential fatty acids).

The horizontal axis is my proportion of the recommended daily intake per day that I achieved for each of these nutrients.

The nutrients are then sorted to show the nutrients that I am getting less of at the top.  The ones that I am getting plenty of are at the bottom.

We don’t really need to worry about getting too much of the nutrients at the bottom of the list as long as they’re coming from whole foods.

By continuing to focus on the nutrients towards the top of the chart we de-emphasise the nutrients we are getting plenty of.

Comparing apples to oranges?

The problem with comparing my profile with someone else’s is that being bigger, I could just eat more food to get more nutrients and this.  This would penalise someone who is smaller or who is trying to restrict their energy intake to lose body fat.  We would be comparing apples and oranges!

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We want to encourage people to consume higher levels of nutrients per calorie.

We hope that the Nutrient Optimiser help people get the nutrients we need without excess energy.  This tends to lead to improved satiety, weight loss and overall metabolic health.

Normalising to RDI / 2000 calories

In order to usefully compare my nutrient density with someone else’s, we need to bring my nutrient intake back to an equivalent amount of nutrients per unit of energy.

To do this we normalise to nutrients per 2000 calories.

During the three weeks that these foods were logged, I was consuming an average of 1567 calories per day.  So to remove the influence of food quantity we normalise intake to RDI / 2000 calories.

The chart below shows my nutrients from the chart above factored up by 2000 / 1567 = 1.28.

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Now we have normalised my nutrients to 2000 calories per day, the Nutrient Score calculated by simply taking the area to the left of the line at 300% line that is filled, which in my case is 90%.

This 300% value is arbitrary.  We initially used 200%, but people were starting to get better at creating nutrient-dense meals.  Setting the line at 300% leaves plenty of room for improvement.

Which nutrients do I need more of?

The table below shows the nutrients that I am getting less of sorted by % DRI.

nutrient % DRI prioritise
Potassium 114% yes
Copper 133% yes
Magnesium 140% yes
Calcium 150% no
Manganese 164% yes
Pantothenic Acid (B5) 178% yes
Vitamin E 181% yes
Folate 196% yes
Omega 3 221% yes
Vitamin C 223% yes

Calcium doesn’t get prioritised due to my lower calcium:magnesium ratio as shown in the bottom left from my Nutrient Optimiser Full Report.

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The Nutrient Optimiser algorithm goes off looking for the foods and meals that will provide me with more of the nine nutrients that I’m not getting as much of.

Rather than worrying about avoiding the nutrients that I’m getting plenty of, the algorithm allows me to focus on getting more of the nutrients that I’m not getting as much of.

Why is this important?

It’s fairly well established that eating too much is not good.  We end up with diabetes, obesity and a whole range of undesirable outcomes.

Maximising nutrient density enables you to get away with fewer calories without missing out on the nutrients you need, which is useful if you are trying to lose body fat.  Focusing on foods with a higher nutrient density tends to lead to increased satiety which enables us to manage our appetite.

If I was a lean endurance athlete I would be looking for more energy dense foods that could provide me with the nutrients I need while still getting plenty of nutrition.

The leaderboard

The image below shows the current Nutrient Optimiser Leaderboard showing the current rankings based on the last four weeks of food logged by these people.

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You can click on the names of the people to view their full report to see what they are eating to make it to the top or the bottom of the leaderboard.

We hope that this public leaderboard will drive some “healthy competition” as well as sharing of information on the different ways we can optimise our nutrition.

How to make it to the top

There is no specific dietary approach that will get you to the top of the leaderboard.  We don’t believe in the magic of any specific approach such as paleo, keto, low carb or vegan.

However, the common thing all the people towards the top of the leaderboard are eating plenty of is minimally processed whole foods.

  • Paul Burgess is a dietician and strength athlete who is using the Nutrient Optimiser to refine his diet in a cutting phase.
  • Carrie Burns Diulus, who comes in at #4 is an orthopedic surgeon who has Type 1 diabetes and follows a plant-based diet.
  • Dr Rhonda Patrick is a nutrition and research guru who runs Found My Fitness.
  • Brianna Theroux is a nutrition and fitness consultant who is very particular about what she puts into her body.

Follow the guidance of the Nutrient Optimiser

The Nutrient Optimiser will give you a list of foods and recipes that will help you boost the nutrients that you are not getting as much of.

The idea is that you just eat more of the meals and foods towards the top of the list.

Over time this will change and adapt as you continue to rebalance your nutrition from the ground up.

If you’re interested, you can get a free Nutrient Optimiser that will give you food and meal suggestions along with recommended macro ranges for your situation.  Once you bit more serious you can start logging your meals in Cronometer and get a more detailed analysis based on your micronutrient profile.

We’re really excited about what this could achieve in the world of nutrition.  We’d love to hear your thoughts, questions and suggestions on how we can make this even better to help more people.

optimising fat and carbs for maximum satiety

In the How much protein do you need to optimise satiety article we looked at the critical role of protein in managing hunger.

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The analysis of half a million days of MyFitnessPal data showed that your body is satisfied with less energy when you give it adequate protein.  Hunger increases if we don’t get enough protein.

So, with protein locked in, this article looks at how fat, carbohydrates and fibre affect our appetite.

Fat

The chart below shows the scatter plot of fat versus % goal calories consumed for about half a million days of food logs from 9,900 MyFitnessPal users.[1]

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On the vertical axis, an intake of less than 100% line means that an individual logged less than their goal for the day.  A typical goal calorie intake is set at about 15% below a person’s Basal Metabolic Rate or the amount of energy needed to maintain weight.

To make sense of all this data, we divided it up into 25 “bins’.  Each of the dots in the middle of the chart below represents the average of 22,000 days of data, while the ones at the extremes where there is less data available represent around 11,000 days of data.

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This analysis suggests that the lowest spontaneous energy intake occurs with a lower fat intake.

Satiety seems to improve a little when we have around 60 to 70% fat, presumably because we can still accommodate a reasonable amount of protein.

Satiety is the worst at the highest levels of fat, likely because refined fat is energy dense and there is no room for protein.

Many people report that they find fat satiating.  However, this is likely because they are able to consume a lot of calories quickly, so they feel full.

However, on a calorie for calorie basis, the data indicates that fat is the least satiating macronutrient.  While you feel full sooner, you had to consume more energy to achieve satiety.

Carbohydrates

The chart below shows the scatter plot for carbohydrate vs % goal intake achieved.

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The simplified chart for carbs is shown below.

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This data suggests that:

  1. We get the lowest satiety when carbohydrates make up about 47% of the energy in our diet.
  2. We see some improvement in satiety with around 25% carbs.
  3. A very low carbohydrate intake provides less satiety, presumably because it corresponds with a higher fat intake.
  4. Satiety improves dramatically when carbohydrates exceed 60%.

Dietary battle lines tend to be drawn around extremes of low or high carbohydrate (e.g. low carb and keto vs plant-based, vegan and fruitarians).  This data suggests that both camps may be correct to some extent.

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We just need to avoid the middle ground of moderate levels of carbohydrate combined with moderate fat levels of fat, particularly with low protein (a.k.a. hyper-palatable junk food).

On the high carb extreme, it’s going to be hard to ingest enough energy to overeat.  But when we add generous amounts of fat, we are able to consume enough energy to exceed our daily requirement.

Then due to oxidative priority, carbohydrates must be burned off first.  So any excess fat that is not burned at the end.

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The moderate carb moderate fat grey zone

So it seems we can do OK with either extreme of high or low carb.  It’s the ‘grey zone’ of moderate fat with moderate carbs that seems to really mess us up.

There are plenty of examples of people who seem to do well on either high or low carb extremes in nature.  However, we very rarely find a combination of both fat and carbs together with low protein.  The closest we come to this in nature is milk, which is ironically a pretty good growth formula!

In order to understand how the ratio of fat to carbs affects our satiety, I plotted the fat versus carb ratio for days where people logged less than 25% protein.

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  • On the left-hand end of the chart, a very high carb low-fat diet can be hard to overeat. It’s just a lot of effort and takes a lot of time to get too much food in your stomach.
  • On the right-hand end of the chart, a very high fat low carb approach is easier to over consume compared to the high carb low fat.
  • But in the middle, we have the ultimate miracle grow formula of fat mixed with carbs.

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In food the food industry, food scientists spend a lot of time trying to optimise for this bliss point of the optimum mix of fat, carbs and salt that will enable us to eat more of their food.

If you want to avoid obesity, diabetes and the most common western diseases your mission is to avoid this grey zone.

Putting it all together

The chart below shows the plots for protein, fat, carbs, sugar and fibre together.

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The key takeaways are that:

  1. Increasing protein improves satiety.
  2. Decreasing fat is likely to help you eat less.
  3. Unprocessed contain more fibre are beneficial.
  4. Varying carbohydrates has a smaller impact on satiety compared to manipulating fat or protein.

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Example foods

So, to understand how to apply this, let’s look at some examples of each of the foods that fit these categories.

High protein to maximise satiety

Once you push protein above 50% there isn’t much room for fat or carbohydrates.   You will struggle to over-consume these foods!

food % protein % fat % carb
cod 92% 8% 0%
haddock 92% 8% 0%
white fish 92% 8% 0%
crab 91% 9% 0%
lobster 91% 9% 0%
egg white 91% 3% 6%
pollock 90% 10% 0%
protein powder 88% 5% 7%
kangaroo 88% 12% 0%
turkey breast 88% 7% 6%
crayfish 86% 14% 0%
whiting 86% 14% 0%
chicken breast 81% 19% 0%
shrimp 81% 14% 5%
ground beef (lean) 76% 24% 0%
molluscs 74% 7% 19%
scallop 74% 7% 19%
sirloin steak (lean) 73% 27% 0%

Worst case macronutrient profile (the grey zone)

These foods have low protein and a mix of carbs and fat.

food % protein % fat % carb
Nutella 4% 50% 46%
choc chip cookie 4% 44% 52%
pie crust 4% 45% 51%
doughnuts 4% 42% 54%
Kit Kat 5% 45% 50%
Danish pastry 6% 44% 50%
M&Ms 6% 48% 46%
Snickers 6% 44% 50%
ice cream 6% 48% 45%
croissant 8% 47% 45%

High satiety, low carb

On the low carb end, we get improved satiety when carbs are below 30%, protein is greater than 20% and we have less than 60% fat.

This is the sort of macronutrient profile that we would have experienced before agriculture away from the equator and/or during winter.

These foods are not as satiating as the ultra-high protein foods, but they will be a vast improvement on low protein junk food diet.

food % protein % fat % carb
caviar 36% 58% 6%
oysters 46% 31% 22%
sardine 49% 51% 0%
herring 47% 53% 0%
turkey 48% 24% 28%
natto 34% 44% 22%
sirloin steak 46% 54% 0%
roast beef 49% 51% 0%
lamb 41% 59% 0%
milk (full fat) 20% 51% 29%
Greek yogurt 37% 46% 16%
chicken 47% 53% 0%
beef ribs 43% 57% 0%
mozzarella 31% 58% 11%
cottage cheese 45% 36% 19%

High satiety, high carb

We also seem to get improved satiety when carbs go above 60% with more than 20% protein.   Most people who lived close to the equator (or in other places during summer) would have had access to higher carb foods that contain less fat.  These foods have a lower energy density and hence are very hard to overeat!

food % protein % fat % carb
mung beans 35% 3% 62%
lentils 30% 3% 67%
chard 30% 8% 62%
lettuce 30% 7% 63%
mushroom 29% 7% 64%
Brussel sprouts 28% 7% 65%
broad beans 27% 3% 70%
peas 26% 3% 71%
turnips 26% 9% 64%
kidney beans 26% 3% 71%
cowpeas 26% 4% 70%
peas 26% 4% 70%
black beans 25% 4% 72%
zucchini 24% 14% 62%
lima beans 24% 7% 70%
artichokes 23% 2% 74%
navy beans 23% 4% 73%
broccoli 23% 9% 68%
kale 23% 11% 67%
seaweed 22% 11% 67%

If you are going to use a high carb low fat approach you may need to go out of your way to ensure you get adequate protein, particularly as proteins from plant-based sources tend to be less bioavailable.

Summary

So, in summary:

  • We seem to get improved satiety with either lower carbohydrates (between 20 and 30%) or high (greater than 60%) carbohydrate.
  • Lowering fat reduces energy density and helps us reduce our overall energy intake.
  • If your goal is to spontaneously reduce calorie intake and lose weight with minimal hunger you should consider:
    • prioritising protein,
    • minimise added or refined fats,
    • avoid foods that are high in both carbs and fat and have minimal protein (aka junk food).

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Alternatively, if you want to ignore macronutrients altogether, you can focus on nutrient density using the Nutrient Optimiser and get pretty much the same outcome.

how much protein do you need to optimise satiety? 

There is a lot of discussion, confusion and misinformation around the interwebs around the topic of protein.

  • Will ‘too much protein’ raise my blood sugars?
  • Will ‘too much protein” ‘kick me out of ketosis’?
  • Won’t ‘too much protein’ hurt my kidneys?
  • Won’t protein raise mTOR and give me cancer?
  • Isn’t protein is a poor energy source?
  • But I don’t want to be a bodybuilder!

While these are all interesting concerns, most people digging into nutrition are interested in losing some body fat and being healthy.  So, fundamentally, I think the most critical question is:

“How much protein do I need to and lose fat without excessive hunger?”

Show me the data!

We recently stumbled across a massive dataset on ResearchGate of more than half a million days or two million meals worth of anonymised MyFitnessPal Food Diary from nearly ten thousand people logging their food for more than two months.

I was intrigued to see what we can we learn about the protein intake of people who succeeded in eating less compared to the people who struggled to meet their goal.

The chart below shows % energy from protein vs how much they ate compared to their goal intake.

  • Greater than 100% means that they failed to meet their target.
  • Less than 100% means that they were able to consume even less than their goal.

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While there is a lot of scatter, we can see that people who consume higher % protein tend to spontaneously eat less, while those who consumed less protein tended to eat more and were less likely to achieve their goal.

We can remove some of the noise in this plot by breaking the data into 20 groups and looking at the average.   This next chart shows the % protein versus the % target intake on average for each of the 20 groups of people.  Each of these dots represents the average of 25,000 days of food logging.

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While there are some extremes, most people tend to get between 12% and 35% of their energy from protein.

What does this look like in terms of lean body mass?

Assuming most people are aiming for a calorie intake about 15% below their Basal Metabolic Rate (BMR), we can estimate their lean body mass using the Katch McArdle formula.  From this, we can then estimate their lean body mass (LBM) and convert the chart into protein in terms of g/kg LBM as shown below.

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A protein intake of around 0.7g/kg LBM (around the Daily Recommended Intake) appears to correspond with minimum satiety while a higher protein intake reduces hunger which will enable you to effortlessly consume less food and lose weight.

Increasing your protein intake from 0.7 to 2.4g/kg LBM appears to correspond to a spontaneous calorie reduction of approximately 15%.  When we consider the fact that protein does not yield as much energy due to the thermic effect of food, we end up with a spontaneous energy deficit of more than 20% simply by prioritising protein!

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Scenarios

Unfortunately, discussions on protein targets often get muddled in a mess of units.  So I thought it would be useful to demonstrate what the minimum and maximum protein amounts look like using different units.

0.7g/kg LBM protein

The table below shows what 0.7g/kg LBM (which provides minimum levels of satiety) looks like in terms of a number of different units for a lean and an obese man (consuming 2000 calories) and woman (consuming 1600 calories).

  • g/kg lean body mass (LBM)
  • g/kg ideal body weight (IBW)
  • g/lb LBM
  • g/lb body weight
  • g/lb ideal body weight.
sex body fat LBM (kg) body weight (kg) IBW (kg) protein (g) g/kg LBM g/kg BW g/kg IBW g/lb LBM g/lb BW g/lb IBW
F 20% 52 65 65 36 0.7 0.6 0.6 0.3 0.3 0.3
M 10% 68.4 76 76 48 0.7 0.6 0.6 0.3 0.3 0.3
F 40% 51.6 86 65 36 0.7 0.4 0.6 0.3 0.2 0.3
M 20% 68.8 86 76 48 0.7 0.6 0.6 0.3 0.3 0.3

2.4 g/kg LBM protein

Meanwhile, the table below shows the protein intake that corresponds to the highest satiety protein intake of 2.4 g/kg LBM.

sex body fat LBM (kg) body weight (kg) IBW (kg) protein (g) g/kg LBM g/kg BW g/kg IBW g/lb LBM g/lb BW g/lb IBW
F 20% 52 65 65 125 2.4 1.9 1.9 1.1 0.9 0.9
M 10% 68.4 76 76 164 2.4 2.2 2.2 1.1 1.0 1.0
F 40% 51.6 86 65 124 2.4 1.4 1.9 1.1 0.7 0.9
M 20% 68.8 86 76 165 2.4 1.9 2.2 1.1 0.9 1.0

My preference is to talk about protein in terms of g/kg LBM because it relates to the amount of metabolically active muscle mass.  However, body weight is simpler because you don’t need to think about how much body fat you have.  Meanwhile, ideal body weight suits some because they have an idea of what weight they would like to be.

If your goal is increased satiety, fat loss and decreased hunger then you will want to move towards the higher levels of protein.  In the first instance, you can just try to make sure you hit a minimum protein intake each day based on your weight and body fat.  This will help kerb the cravings and manage your overall intake.

As you become leaner you may need to dial in your overall energy intake by focusing on leaner protein sources to ensure you get the protein you need without excess energy.

Protein intake levels assumed in the Nutrient Optimiser

If you require therapeutic ketosis to manage epilepsy, Alzheimer’s or Parkinson’s then the Nutrient Optimiser algorithm will calculator your macros using a minimum of 0.8 g/kg LBM.

However, most people who are interested in nutrition are looking for fat loss and/or diabetes management (and not therapeutic ketosis), hence we set the minimum protein intake at 1.8 g/kg LBM.  Dietary approaches with lower protein than this ‘minimum effective dose’ tend to have a poor nutrient density.

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A protein intake of 1.8g/kg LBM corresponds to the level beyond which we don’t appear to get any further gains in muscle growth.[1][2]  However, we do appear to get additional benefit in satiety and nutrient density.

Many people get confused with the numbers and units, which is why we created the Nutrient Optimiser. to calculate your ideal macronutrient range as well as provide you with some suggested foods and meals that will help you reach your goals.

Responses to common concerns

If you are still concerned about ‘too much protein’ I have outlined some brief responses to the common concerns noted at the start of this article.

Too much protein will raise my blood sugars!

People that produce adequate insulin in their pancreas (i.e. not Type 1 diabetic) tend to see a fairly stable blood sugar response to protein.[3]  Some people even experience a drop in blood sugar, so start slowly and titrate up to a more ideal protein intake.[4][5]

While a low carb high-fat diet will mask the symptoms of diabetes by stabilising blood sugar and reducing your HbA1c, it is the reduction of fat stored around your organs that will ultimately reverse your diabetes![6][7]

Too much protein will ‘kick me out of ketosis’!

Ketosis occurs when there is less carbohydrates and proteins to provide oxaloacetate in the Krebs cycle, so we revert to ketosis to burn fat for energy.

If you need to lose weight then more protein will likely drive an energy deficit, which will cause higher ketone levels as you consume your body fat for fuel.  However, keep in mind that BHB ketones are mainly a transport or storage form of energy and do not correspond with effective use of fat for fuel.[8]

While ketones have experienced a surge in popularity thanks in part to people who would like to sell you some, ketones are far from the most important health marker.   

If you are more concerned about elevating your blood ketone levels than the fat that is being stored in your liver, pancreas, heart, eyes and brain and driving you towards the most common diseases of our western civilisation, then may I politely suggest that you should review your priorities?  

This video, while very graphic (you have been warned!), demonstrates why fat loss is not just for bodybuilders, but critical for health and longevity.

Too much protein will hurt my kidneys!

Unless you have late-stage kidney failure and are on dialysis ‘too much protein’ is not a concern.[9][10]  If you are concerned about your protein intake you should talk to your nephrologist (kidney specialist) about the optimal protein level for your situation.  (If you’re not already seeing a nephrologist there’s probably no need to be concerned about ‘too much protein’ hurting your kidneys.)

Will protein raise mTOR and give me cancer?

We need a balance between building up (mTOR and anabolism) and breaking down (fasting and autophagy).  What we do know for sure in all this is that excess energy (regardless of the source) seems to be one of the biggest contributors to diabetes, cancer and other metabolic diseases that accelerate ageing.[11]

image01

Optimising your diet with adequate protein to improve satiety and reduce body fat levels to ensure you are physically robust and independent for as long as possible sound like a much safer bet than crossing your fingers hoping that protein restriction (which only seems to work on worms in a Petri dish) will extend your life.

Protein is a poor source of energy!

Yes, fat is an efficient fuel source compared to protein. But if you have excessive stored body fat then getting more fuel is not your highest priority.  Your body is highly motivated to ensure you consume adequate protein to prevent loss of lean muscle.  Getting adequate fuel is secondary.

Eating lower protein foods means that, in the pursuit of adequate protein, you will need to consume more fuel (i.e. carbs and/or fat) than your body can use.  Conversely, eating higher protein foods reduces appetite.  With adequate protein locked in to build and repair muscle (and enable other vital functions), your body will be happy to get the fuel it needs from your excess stored body fat.

The spontaneous reduction in appetite that we see from the analysis of the half a million days of MyfitnessPal data demonstrates that your body is much more willing to burn your unwanted body fat if it is getting the protein it needs.

Forcing your body to convert some protein to glucose for energy (a.k.a. gluconeogenesis) is not such a bad thing.  If you always give your body some fat or carbs when you need energy it will never need to dip into your body fat stores.

But I don’t want to be a bodybuilder!

The ‘good news’ here is that it takes a lot of intentional effort (and often some extra chemical or hormonal assistance) to build massive muscles. Optimising your protein intake will only enable you to manage your hunger, lose body fat and reverse your diabetes.

Summary

So, in summary. the analysis of half a million days of MyFitnessPal data indicates that:

  • Our bodies seem to be happy with less energy when we provide it with adequate protein.
  • Low protein intakes correspond with the lowest levels of satiety and the highest energy intake.
  • Higher protein intakes tend to increase satiety and spontaneously reduce hunger.
  • Increasing protein from 0.7 g/kg LBM to 2.4 g/kg LBM corresponds to a to spontaneous calorie reduction of approximately 15%, even before we account for the higher thermic effect of protein.

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Thanks so much for reading!  In the next article in this series, we’ll look at what the data can tell us about the relative satiety provided by fat, carbs, sugar and fibre.  You might be surprised by the findings!  So make sure you subscribe to ensure you receive it!

 

References

[1]https://bayesianbodybuilding.com/the-myth-of-1glb-optimal-protein-intake-for-bodybuilders/

[2]https://www.ncbi.nlm.nih.gov/pubmed/1400008

[3]https://optimisingnutrition.com/2015/06/15/the-blood-glucose-glucagon-and-insulin-response-to-protein/

[4]https://optimisingnutrition.com/2015/06/29/trends-outliers-insulin-and-protein/

[5]https://optimisingnutrition.com/2015/06/15/the-blood-glucose-glucagon-and-insulin-response-to-protein/

[6]https://optimisingnutrition.com/2018/05/03/ted-naimans-dam-fat-storage-insulinographic-explained/

[7]https://optimisingnutrition.com/2018/04/12/does-insulin-really-resistance-cause-obesity/

[8]https://optimisingnutrition.com/2018/02/24/is-the-acetoneglucose-ratio-the-holy-grail-of-tracking-optimal-ketosis/

[9]https://twitpl.us/f8Jb

[10]https://www.hindawi.com/journals/jnme/2016/9104792/

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

the carbohydrate-insulin hypothesis vs the adipose centric model of diabetes and obesity

I recently shared Dr Ted Naiman latest “insulinographic” that attempts to explain the adipose centric theory of diabetesity.

It created some great discussion as well as some confusion, so I thought it would be worth an article to unpack the critical insights about how insulin really works in our body and what we can do to reduce body fat and avoid diabetes.

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The first clarification is that this isn’t a meme or a graph.  It’s more an infographic that attempts to explain how insulin is anti-catabolic and works like a dam to hold back the flood of stored energy in our body.

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The dam analogy builds on the line of thought initially detailed in the Does insulin resistance really cause obesity? article.

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Basal vs bolus insulin

I have spent a lot of time analysing the insulin index data which helps us to quantify our short-term insulin response to food.

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This is helpful for people with diabetes (like my wife Monica) to choose foods that keep their blood sugars stable as well as help them more accurately calculate their insulin dose by accounting for carbohydrates, fibre, protein and fructose.

However, with all the focus on carbs, fat and protein, I fear we may have neglected the most important thing that influences our insulin response to the food we eat.

Majoring in the minors

Before we switched to a lower carb dietary approach, my wife Monica was taking about 50 units of insulin per day to manage her Type 1 diabetes.  ABout half of that was for food (bolus) and half was her background insulin (basal).

These days, Monica takes about half the insulin that she used to.  However, now about 80% of her daily insulin dose is basal insulin while only 20% of her insulin is taken to manage her blood sugars levels around meals.

basal insulin

bolus insulin (for food)

total daily insulin

Higher carb diet

25 units

25 units

50 units

Low carb diet

20 units

5 units

25 units

Monica’s basal insulin demand has reduced a little due to some weight loss and improved insulin sensitivity.

The most interesting observation is that the vast majority of the insulin required by someone on a low carb diet is not related to the carbohydrates or even the protein in the food they eat. 

While carbs and protein raise insulin in the short term, the fat on our body and the fat in our diet have the most significant influence on our insulin levels.

The grey area in the chart below shows the insulin released across the day by someone with a functioning pancreas.  The pink line shows how someone with Type 1 diabetes tries to mimic this with an insulin pump.

image12.jpg

A lower carb diet is a no-brainer for someone with diabetes to help them stabilise their blood sugars and appetite.[1]  However, we get to a point of diminishing returns when we only focus on the carbohydrate and protein in our diet while ignoring the fat in our diet and the fat on our body.

image4.jpg

Elevated fasting (or basal) insulin is the elephant in the room for many people on a low carb or keto diet.  Many people on a low carb or ketogenic stabilise their blood sugars and improve HbA1cs, but are still obese with high fasting insulin levels.

The harsh reality is that replacing the carbs and protein in your diet with fat will not reverse your hyperinsulinemia unless it also reduces the amount of fat stored on your body!

But what is going on?

But what can we do?

That’s where Ted Naiman’s “insulinographic” comes in.

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Many people think that elevated insulin is the cause of obesity.  But, I’m coming to realise that most of the time it’s actually the other way around.

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It is actually obesity (or at least being overfat relative to our Personal Fat Threshold) that causes hyperinsulinemia.

Insulin is anti-catabolic

We typically think of insulin as an anabolic hormone that forces amino acids into muscles and glucose into our cells.  But it can actually be more useful to think of insulin’s anti-catabolic properties.[2] [3] [4] [5] [6] [7]

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Rather than just building our muscles and fat stores or forcing glucose into the cells, insulin also works to keep fat and muscle in storage.

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Insulin prevents entropy (or chaos) and ensures that we don’t melt into a puddle like Olaf the Snowman.

Someone with Type 1 diabetes does not have enough insulin to prevent catabolism.  Their protein, fat and glucose stores in their body get released into their bloodstream in an uncontrolled manner and result in high glucose, high free fatty acids and high BHB ketones.

The good news though is that if your pancreas is working, you will produce insulin when you’re not eating to enable you to regulate the amount of fuel being released from storage into your bloodstream.  

Healthy fasting insulin levels in hunter-gatherers range between 3 – 6 mIU/mL.[8]  In western populations, the average fasting insulin level is about 8.6 mIU/mL.[9]  People with insulin resistance or diabetes have much higher levels of fasting insulin.

Insulin is the hormonal signal that raises the dam wall to slow the flow from stored energy via our liver while the energy in our bloodstream is being used up.

The more fat you have to hold back in storage, the higher your insulin levels need to be.

This helps us to understand why many people low carbers who are obese have high fasting insulin levels.  Even though they may be eating minimal amounts of carbs and protein in an effort to keep their insulin levels low, their body is keeping insulin high in an effort to hold their energy in storage until the energy in their bloodstream is used up.

To help elaborate on this I have fleshed out what various scenarios would look like in terms of body fat, insulin levels and energy in the blood (i.e. glucose, ketones and free fatty acids) in the table below.

note: TOFI = thin on the outside, fat on the inside and PFT = personal fat threshold

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I can make you fat

Dr Jason Fung points out that people using exogenous (injected) insulin to manage their diabetes can develop obesity and insulin resistance because of their medications.

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Dr Robert Lustig also explains how someone injected with a little bit of extra insulin at each meal will store more fat and not be able to mobilise their body fat (lipolysis).

To some extent, this is what happens when someone with diabetes injects insulin to cover a crappy nutrient-poor insulinogenic diet.  With large doses of exogenous insulin to cover a high carb processed diet they never quite get the insulin dosing right.  They end up overdosing with insulin and having to eat more to rescue themselves from low blood sugars.  The great thing about a low carb more less processed foods for these people is that it helps stabilise blood sugar and insulin doses which is easier to manage with smaller doses of insulin.

To go back to our “dam” analogy, excessive exogenous insulin for someone who already has hyperinsulinemia is like building our dam wall higher than it needs to be.  The higher dam wall will hold back more energy in storage than it needs to and less of the energy we eat will be released into the bloodstream.

We feel hungrier because the excessive exogenous (injected) insulin is not allowing energy to be released into circulation.

We will end up eating more, and this excess energy will be stored more easily.  We will become more and more resistant to the insulin we are injecting as our fat stores become fuller, and we need more insulin to hold our fat in storage.

The solution here is a low carb diet to help stabilise blood sugars and hunger driven by excessive swings in insulin and blood sugar.

The fatal flaw in the insulin-centric view of obesity

Where this insulin-centric view of diabetes and obesity fails is that it doesn’t translate to someone who is not taking exogenous injected insulin or drugs that stimulate insulin release from their pancreas.  

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Our bodies optimise for efficiency.  Unless you have an insulinoma (a tumour on your pancreas), your pancreas will not secrete more insulin than it needs to.   

Our pancreas will not build the dam wall higher than it needs to be to hold back the energy coming into our system!

Irrespective of insulin levels, you cannot store energy we do not eat.   

At the risk of doing your head in, we can look at the function of insulin as anabolic (building) and anti-catabolic (preventing breakdown) and get to the same conclusion:

  • Anabolic  – Although dietary fat doesn’t raise insulin much in the short term, you will always have enough basal insulin on board to store the fat you eat on your body (note: this is the anabolic.
  • Anti-catabolic – Your pancreas will always produce enough insulin to slow the flow of energy out of the stores on your body while you use up the energy from the food coming in from your mouth.

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Our fasting insulin is proportional to the amount of fat stuffed away in storage which is directly proportional to the amount of food that we have eaten.  

We cannot really blame obesity on insulin resistance.  It is our insulin sensitivity that enables our fat cells to grow.  Once we become insulin resistant, we actually find it harder to store excess energy in our adipose tissue.  

How to keep your basal insulin low

There a number of things that help us lower our dam wall, including:

  • exercise,
  • fasting,
  • a low energy diet, or
  • a high nutrient density diet.

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Exercise

Exercise, particularly resistance excercise or HIIT, is a great way to build insulin sensitivity and helps us to burn off fat and sugar without the need for insulin.[13]  People with Type 1 diabetes find they need to reduce their insulin dose when they are active and increase their basal by about 25% when they don’t exercise.

Fasting

Not eating for a period of time is a great way to reduce your insulin.

Once you use up the glycogen in your liver, your body turns to the fat stores and lowers insulin levels to allow more stored body fat to flow over the dam into the system.

However, for some people, the problem with fasting is that it’s easy to overdo the refeed.

When I was fasting regularly to try to lose some extra fat, I found I would permit myself to eat more than I would otherwise have eaten.  And the foods that I chose to eat were often less nutrient dense and more energy dense dense than usual.

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In spite of the saint-like deprivation for days, I found I didn’t lose much weight over the long-term.  In the end, I seemed to eat back my deficit.  My wife Monica would say ‘I don’t think this fasting thing is working for you!  Why don’t you try eating a little less each day?’

I have talked about using your bathroom scale or blood sugar readings to refine the frequency and quantity of your feeding to make sure you are moving towards your goal.  Unfortunately, just like tracking calories, these approaches to fine tuning your food intake require self-discipline and deprivation which is not fun.

Even better than tracking blood glucose or your weight, another way to manage your fasting/feeding frequency and food intake would be to measure your blood insulin level to ensure it was going down to new lows before you ate, and then ensure that when you refeed that you didn’t drive insulin too high with too much food.

Unfortunately, there is no home test for insulin yet, so our blood glucose metre and the bathroom scale are the best we can do for now.

Many believe that they will keep insulin levels low if they focus on higher fat foods when they refeed.  However, it is possible to drive higher levels of insulin with a high-fat intake in only a short amount of time.

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A relevant example of this is Jimmy Moore’s recent high protein experiment where he reduced his fasting insulin from 14.2 to a very respectable 8.8 mIU/mL in five days on a high protein energy restricted diet.[14] [15] [16]

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Afterwards, he finished the fast on Sunday (8 April as per the date on the Instagram image below) he proceeded to boost his fasting insulin to 18 mIU/mL after a day of high fat refeeding before the laboratory was open to measure his post-experiment labs on Monday.  This post refeed insulin was actually higher than his 14.2 mIU/mL insulin before the experiment began.

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This also aligns with the study results shown below where participants lowered their insulin and triglycerides more higher protein lower carb diet.[17]

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Similarly, this twelve month randomised control low carb study found that people had better outcomes in terms of weight, body fat, insulin, HOMA-IR, HDL, hunger and emotional eating with higher levels protein.

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It will be interesting to see how Jimmy’s upcoming high-fat bio hack goes.  I hypothesise that Jimmy’s short-term insulin level may be lower after meals, but his longer-term fasting insulin will be higher on the high-fat approach.

Once we account for the Thermic Effect of Food (TEF), there is actually more available energy in the high-fat approach as shown in the calculations below.

high protein (3:1) 80% fat
fat (g) 90 168
protein (g) 270 95
fat (cal) 810 1512
protein (cal) 1080 378
energy consumed (cal) 1890 1890
TEF (cal) 405 265
available energy (cal) 1485 1625
short-term insulin higher lower
long-term (fasting) insulin lower higher

With less energy actually available to the body in the high protein scenario, the pancreas will produce less insulin to allow more energy to be released from storage compared to the high-fat scenario.

Low energy diet

As noted in Ted’s insulinographic, a low energy density diet is another way to keep your basal insulin levels down.

You can achieve this by focusing on foods with a lower energy density which will make it harder to overeat.  This will ensure your body fat stores are used.  With less fat to hold back in storage, your insulin levels will decrease.

This is why we see some people who make the switch to a whole foods plant-based diet reduce their insulin requirements and reverse their diabetes.   As long as they stick to whole foods, they will not be able to ingest enough energy to maintain their weight, so their insulin comes down.  However, this does not hold for processed vegan junk food which can still be energy dense, highly processed, hyperpalatable and easy to overconsume.

What about trying to eat less food?

Another option is to try to simply eat less food.  While this can be helpful, it shouldn’t be the only technique used as simply restricting the intake of nutrient-poor junk food is a recipe for nutrient cravings and rebound binge eating.

Nutrient-dense diet

Maximising nutrient density is my favourite hack because it addresses the following factors:

  • Adequate protein. If you eat foods that contain the vitamins, minerals and essential fatty acids you need you will obtain plenty of protein which, on a calorie for calorie basis, is the most satiating macronutrient.   There is a lot of confusion around protein, but the reality is, if you are eating foods that contain adequate levels of vitamins, minerals and essential fatty acids you will be getting plenty of protein.  Conversely, actively avoiding protein may lead to nutrient deficiencies.  Whether you approach this in terms of higher nutrient densitym, targeting the most satiating macronutrients or the foods that will naturally provide you with greater satiety you arrive at pretty much the same point.

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  • Energy density. A nutrient-dense diet typically has plenty of whole foods that have lower levels of refined carbs and processed fats which have a lower energy density and hence are hard to overeat.
  • Minimally processed. Quantifying nutrient density is a foolproof way to ensure that the food contains the micronutrients you need rather than hyperpalatable flavourings and colours from Frankenfoods that are designed to look like they are good for you (but they’re not).  These minimally processed foods are also satiating without being hyperpalatable so are self-limiting.
  • Prevents cravings. Good nutrition, avoiding diabetes, weight control and lower insulin levels seems to boil down to getting the nutrients you need without too much energy.  Focusing on nutrient-dense foods also gives the best chance of avoiding nutrient cravings that will unnecessarily drive your appetite.

Fat raises insulin too, it just takes longer

Most of the time we focus on carbs (and to a lesser extent protein) as being the culprit when it comes to raising insulin levels.   But does this hold true when we look at the big picture?

The insulin index data suggests that higher fat foods have a lower insulin response.  But is this simply because the insulin index testing only measured the insulin response over three hours?

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The chart below on the left shows that insulin rises more slowly for a high-fat meal compared to glucose or a mixed meal.[18]  However, it still rises and looks like it will keep on going for a while after the 120-minute measurement.

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If we were able to test the insulin response over 24 hours, I think we would see that insulin response is actually more closely related to the available energy in our food rather than a specific nutrient.

Is our long-term insulin response simply related to the amount of energy in our food and hence the amount of energy needs to be held back in storage by the liver?

Is it only because carbs and protein have a higher oxidative priority than fat that we see a greater short-term spike in insulin (i.e. the body needs to act more quickly with a sharper insulin response to hold back energy from carbs in storage compared to fat or protein)?

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The adipose centric model of diabesity

The insulin-centric view of obesity, diabetes and insulin resistance focuses on reducing insulin by switching carbs out for fat to control our (short term) insulin response to food.

Meanwhile, the adipose-centric view of diabetes is a little bit more sophisticated and complete as it also considers the long-term insulin response to the food we consume.

Someone who is lean and insulin sensitive will have healthy levels of adipose tissue that can quickly swell to take on more energy and then release it.  If you are insulin sensitive like these guys, you store precious energy very efficiently when it is available.

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But our fat stores can only take in so much energy before they become full.  There is a limit to how high you can build your dam wall.

When your fat cells become stuffed and can’t take on more energy, they are said to be “insulin resistant”.  At this point, any excess energy spills out into the bloodstream as elevated glucose, free fatty acids or ketones.  Excess energy is also pumped into our vital organs, and we develop fatty liver, fatty pancreas, heart disease and the other complications of western civilisation.

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To be clear, it’s not being obese that causes diabetes. Instead, it’s a matter of being overfat relative to your Personal Fat Threshold.  Some people are “blessed” to be able to store a lot more energy in their fat stores before they become insulin resistant and diabetic, while others find that can only store a little bit of energy in their adipose stores before it overflows and ends up being stored in their vital organs and bloodstream.

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Disease progression and reversal

Listed below is the progression from health to disease, with hyperinsulinemia building progressively throughout.

  1. Insulin-sensitive healthy fat levels that are able to easily absorb and release any excess energy for later use.
  2. Expansion and filling of insulin-sensitive adipose tissue with sustained energy excess.
  3. Fat cells become full and exceed your Personal Fat Threshold (largely influenced by genetics).
  4. Fat cells become full and “insulin resistant” relative to other parts of the body.
  5. Excess energy builds up as visceral fat in vital organs and spills over into the bloodstream (aka diabetes).
  6. Excessive swings in blood sugar and insulin cause a dysregulated appetite driving further overeating.
  7. Complications of western disease due to (i.e. obesity, diabetes, heart disease, Parkinsons, Alzheimers, dementia etc).

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To reverse these steps and reduce insulin to normal levels we need to follow to:

  1. Stabilise blood sugars and insulin swings by reducing processed carbohydrates to help improve appetite control and eliminate the need for exogenous insulin.
  2. Focus on more nutrient dense, less energy dense foods to improve satiety and induce an energy deficit.
  3. A sustained energy deficit causes a reduction in visceral fat which improves the function of the heart, liver, pancreas and brain.
  4. Reduced pressure on the adipose fat allows to below the Personal Fat Threshold allows incoming energy to be buffered in fat stores without overflow into the bloodstream (i.e. reversal of diabetes).
  5. Fat loss further reverses insulin levels and blood sugars to achieve optimal levels for longevity and performance.

So what’s the solution?

So, if insulin and carbs aren’t to blame for our obesity and diabetes then what can we do?

Is it back to just eat less, exercise more?

Well sort of, but not exactly.

There are a number of practical steps that we can take to avoid diabesity including:

  • Minimise cheap hyper-palatable processed food that overrides our satiety signals and tricks our taste buds.
  • Invest in quality food and learn to cook at home from fresh whole ingredients.
  • Monitor your nutrient intake by logging your food using Cronometer.
  • Eat your meals mindfully with other people rather than in front of a screen alone.
  • Don’t use food as a source of comfort.
  • Sleep and rest enough so you don’t need to use energy dense food as a pick me up.
  • Be active and build as much lean muscle as you can in order to efficiently burn the carbs and fat you consume.
  • Focus on nutrient-dense foods that are minimally processed that will minimize cravings. If you focus on maximising the good stuff in your diet, you will not have to worry as much about avoiding the processed food that are full of sugars, flavourings and seed oils.
  • Moderate carbs if you need to stabilise blood sugar and insulin swings which can help stabilise appetite. Diabetes and longevity expert, Dr Peter Attia, recommends that we eat foods that will keep our blood sugar low (i.e. less than 90 mg/dL) and with a relatively tight standard deviation of less than 10 mg/dL.[19] [20]
  • Don’t demonise macronutrients, but instead prioritise nutrient-dense whole foods.

If all of the above still don’t get you to where you want to be then you may need to track your intake for a while and titrate down your calorie intake to recalibrate your version satiety.   The good news is that many people find when focusing on maximising the nutrient density of their diet managing the quantity of food isn’t such a big deal.

 

References

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5792004/

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

[3] https://www.ncbi.nlm.nih.gov/pubmed/3298320

[4] https://www.t-nation.com/diet-fat-loss/insulin-advantage

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

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1804253/

[7] https://academic.oup.com/bja/article/85/1/69/263650

[8] http://wholehealthsource.blogspot.com.au/2009/12/whats-ideal-fasting-insulin-level.html

[9] http://wholehealthsource.blogspot.com.au/2009/12/whats-ideal-fasting-insulin-level.html

[10] https://www.ncbi.nlm.nih.gov/pubmed/7972417

[11] http://www.diabetesincontrol.com/insulin-as-a-satiety-signal-in-postprandial-period/

[12] https://weightology.net/insulin-an-undeserved-bad-reputation/

[13] https://www.ncbi.nlm.nih.gov/pubmed/9435517

[14] http://www.ketohackingmd.com/8-7-day-high-protein-hack-experiment-results-part-1/

[15] http://www.ketohackingmd.com/9-7-day-high-protein-hack-experiment-results-part-2/

[16] http://www.ketohackingmd.com/10-7-day-high-protein-hack-experiment-results-part-3/

[17] https://www.ncbi.nlm.nih.gov/pubmed/15817850

[18] https://chrismasterjohnphd.com/2017/07/26/insulin-really-response-carbohydrate-just-gauge-energy-status-mwm-2-23/

[19] https://peterattiamd.com/2016-update/

[20] https://www.youtube.com/watch?v=vDFxdkck354