All posts by Marty Kendall

Don’t Eat for Winter!

Modern processed food uses the same formula that Mother Nature uses to provide hyper-palatable food in autumn to help us eat more, store fat, and prepare for winter.

In our modern food environment “comfort foods” are designed to be delicious and allow us to consume more of them.

We are instinctively drawn to foods that fit this special autumnal gorge formula because they provide energy quickly with minimal effort.

The modern food industry has responded to our prehistoric urges with an abundance of cheap and tasty foods that will quickly prepare you for winter 365 days a year.

This article lists nutrient-dense foods that use the autumn formula to help you achieve your goals.  If you are a hard-charging athlete, they will allow you to eat more to fuel your activity.  If you have some extra body fat you’d like to lose, we also will look at how we can use this understanding to manage our appetite.

The squirrel formula

After reading my recent articles looking at the relationship between macronutrients and satiety, Cian Foley contacted me to share his Autumnal Squirrel Gorge Formula.

Cian made the insightful observation that, rather than carbs alone or fat alone, it’s the combination of lower protein with moderate fat and moderate carbohydrate that makes foods easy to overeat and store fat.  While this was a survival advantage, it has a diabolical impact on our health today.

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Foods with this unique macronutrient profile can help you recover from long bouts of exercise quickly.  But they will also help you store body fat efficiently if you’re not thin or active.

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In nature, we have milk that helps babies grow.

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Acorns help squirrels prepare for winter.

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And now hyper-palatable junk food has been designed around the same formula that enables us to buy, eat and store more as body fat.

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Fast food

I liked the way Cian presented the macros as a “star chart” on his Don’t Eat for Winter blog (as shown in the chart above).

I thought it would be interesting to build on this approach to look at the macronutrient profile of different food groups.

The chart below shows the macros for the average of all the foods in the USDA database (blue) compared to fast food (orange).  I have shown indigestible fibre and net carbs as well as protein and fat.

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On average, fast food has more fat, less fibre and less protein compared to the average of all foods in the database.

protein fat net carbs fibre ND
average 26% 32% 37% 5% 24%
fast food 20% 42% 35% 3% 23%

Most nutrient dense

in contrast to fast food, the table below shows how the most nutrient-dense foods compare in terms of macronutrients and nutrient density.

[Note: Nutrient-dense foods are those that have higher levels of potassium, magnesium, zinc, selenium, vitamin E, vitamin B5, vitamin D, thiamine, choline and omega 3 which are harder to find in our commercialised and industrialised food system.]

  protein fat net carbs fibre ND
average 26% 32% 37% 5% 24%
nutrient dense 49% 20% 20% 11% 61%

Nutrient dense foods tend to have more protein and fibre, with less fat and digestible carbohydrate.

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This table lists some of the most nutrient-dense foods along with their macronutrient split and nutrient density score.

names % protein % fat % net carbs % fibre ND
asparagus 34% 7% 30% 29% 96%
mushrooms 36% 3% 53% 9% 89%
oyster 43% 34% 24% 0% 88%
crab 91% 9% 0% 0% 86%
lobster 91% 9% 0% 0% 85%
spinach 41% 8% 18% 33% 85%

You don’t need a lot of these foods to get adequate vitamins and minerals.  These foods are harder to overeat, and you’ll be more likely to burn some of your body fat at the end of the day, rather than storing more.

High protein

As shown at the top of this chart below, the analysis of half a million days of MyFitnessPal data demonstrates that higher protein foods are typically more satiating and help people to eat less.

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The table below shows the macro profile of the highest protein foods in the USDA database (i.e. the top 10% highest ranking foods).

protein fat net carbs fibre ND
average 26% 32% 37% 5% 24%
highest protein 77% 22% 1% 0% 43%

High protein foods are often animal-based and hence do not contain a lot of carbohydrates.  They also have a very respectable nutrient density score.

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As discussed in this article, prioritising protein tends to lead to satiety and a spontaneously reduced energy intake.

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If you’re interested in increasing your protein intake, the table below lists some higher protein foods.

names % protein % fat % net carbs % fibre ND
cod 97% 3% 0% 0% 28%
tuna 96% 4% 0% 0% 63%
shrimp 95% 5% 0% 0% 28%
haddock 94% 6% 0% 0% 64%
crab 93% 7% 0% 0% 48%
egg white 91% 9% 0% 0% 28%

Low fat / high carb

Interestingly, it seems that people consuming a low-fat diet or high-carb diet are also able to maintain a lower calorie intake.  Thin whole food plant-based vegans are an example of this.

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The table below shows the macros for the lowest fat foods in the USDA database (which also happen to be high in carbohydrates).

protein fat net carbs fibre ND
average 26% 32% 37% 5% 24%
low fat / high carb 8% 1% 84% 7% 14%

The advantage of high-carb whole food plant-based foods is that it is hard to consume enough energy to overeat because of the low-fat content, low energy density and high fibre content.

The downside is that the nutrient density tends to be lower.  While green leafy veggies are an excellent source of micronutrients, processed grains and sugars are low in the nutrients we need more of.  The protein content of these foods is also lower and may not be adequate if you are trying to improve your body composition.

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The table below shows some nutrient-dense foods that are low in fat and higher in carbs.

names % protein % fat % net carbs % fibre ND
pumpkin 13% 3% 78% 6% 62%
shiitake mushrooms 9% 3% 75% 13% 61%
butternut squash 8% 2% 75% 15% 55%
acorn squash 7% 2% 78% 13% 48%
parsnips 7% 4% 71% 19% 43%
winter squash 10% 3% 72% 15% 39%
Jerusalem-artichokes 10% 0% 81% 8% 37%
sweet potato 9% 1% 76% 14% 34%

Before the invention of refrigerators or the ability to store grains, humans would have consumed higher protein, higher fat foods in winter when energy from plant foods was less available, and vice versa.  Rarely did we have a situation where both carbs and fat were abundant at the same time.

Low protein / high fat

One of the more interesting observations from the MFP data analysis is that low-protein high-fat foods seem to have an inferior outcome in terms of satiety (as shown at the bottom of this chart).

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If you are trying to lose body fat, avoiding protein and eating “fat to satiety” doesn’t appear to be a great strategy.  In fact, it is the only approach that led people to consistently consume more than their calorie goal.

The table and chart below show the nutrient density and macronutrient profile of the foods in the USDA database that have less protein and more fat.

protein fat net carbs fibre ND
average 26% 32% 37% 5% 24%
low protein high fat 5% 89% 4% 1% 10%

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Nuts provide minerals, but as a general rule, the nutrient density of these foods is reduced.

names % protein % fat % net carbs % fibre ND
sunflower seeds 13% 76% 4% 6% 43%
brazil nuts 8% 85% 2% 4% 35%
almonds 13% 76% 4% 6% 29%
avocado 5% 76% 4% 15% 26%
sour cream 5% 86% 9.1% 0% 18%
peanut butter 14% 72% 11% 3% 18%
olives 4% 70% 14% 11% 16%
cream 3% 94% 3.2% 0% 15%
walnuts 14% 80% 2% 4% 11%

If you need to consume a therapeutic ketogenic diet to help with the management of epilepsy, Alzheimer’s or dementia, then you would be wise to pay extra attention to micronutrients and consider supplements and/or targeted foods that will provide additional nutrients.

Lower protein, moderate fat, moderate carbs

Coming back to the autumnal squirrel gorge formula, the My Fitness Pal demonstrated that we tend to eat more when we consume foods with less protein, but more carbs and fat at the same time.

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In line with these observations, a recent study in Cell, Supra-Additive Effects of Combining Fat and Carbohydrate on Food Reward found that people are willing to pay more for foods that contain a combination of fat and carbohydrate.  We naturally crave these foods if they are available.  The processed food industry is only too happy to fulfil the demand.

The table below shows the macronutrient profile and nutrient density of the lower-protein (< 20%) foods that have moderate fat (>30%) and moderate carbs (>30%).

protein fat net carbs fibre ND
average 26% 32% 37% 5% 24%
low protein mod fat mod carbs 8% 42% 47% 3% 8%

Compared to average, these foods have less protein, more fat, less fibre and more digestible carbohydrates.  This is the macronutrient profile that is diabolical!

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A selection of the foods that fit this macronutrient profile is listed below.  The most nutrient dense are mashed potato with butter, chocolate milk and potato chips, and it just gets worse from there.

names % protein % fat % net carbs % fibre ND score
mashed potatoes (with butter) 7% 42% 43% 7% 33%
chocolate milk 15% 36% 45% 4% 21%
potato chips 5% 56% 37% 2% 18%
custard 10% 50% 37% 3% 17%
french toast 14% 43% 44% 0% 16%
waffles 11% 44% 45% 0% 16%
blueberry muffins 5% 39% 55% 1% 14%
hash brown 5% 43% 48% 5% 13%
garlic bread 10% 43% 45% 3% 13%
human breast milk 6% 55% 39% 0% 13%
ice cream 7% 48% 44% 1% 12%
pancakes 11% 39% 50% 0% 12%
blueberry pancakes 11% 37% 52% 0% 11%
ice cream 7% 53% 39% 1% 10%
dark chocolate 4% 53% 38% 5% 10%
Snickers 6% 44% 48% 2% 10%
popcorn 7% 49% 37% 8% 10%
cheese bread 10% 46% 42% 2% 9%
Toblerone 4% 49% 45% 2% 8%
pecan pie 5% 47% 49% 0% 8%
acorns 6% 53% 41% 0% 8%
biscuits 8% 42% 49% 2% 8%
ice cream cone 6% 55% 38% 1% 7%
Twix 5% 54% 38% 2% 7%
Kit Kat 5% 45% 49% 1% 6%
white chocolate 4% 53% 43% 0% 5%
choc chip cookies 4% 42% 52% 2% 4%
Girl Scout Cookies 3% 46% 48% 4% 3%
pie crust 3% 51% 45% 1% 2%
Kit Kat 5% 47% 47% 1% 1%
toffee 1% 53% 46% 0% 1%
M&Ms 4% 36% 59% 2% 0%
Milky Way 4% 37% 58% 1% 0%
Milk Chocolate 4% 52% 42% 2% 0%

Looking down this list, you know intuitively that these foods are not good for you in significant quantities!  The only natural foods on this list are acorns (remember the squirrel formula?) and breast milk (which helps little things grow quickly into big things).  The rest are “comfort foods” that have been engineered to enable us to eat more of them while providing very little in the way of protein or nutrients.

These foods may be great if you have run a marathon but not so good if you’re a couch potato with some extra fat to lose.

Our ancestors would have loved these foods because they provide a lot of energy quickly with minimal effort and would enable them to survive through winter.

Our instincts help us avoid starvation.  In the olden days, we had to prioritise foods with higher energy density energy and didn’t have to worry much about nutrients.  Mother Nature knew exactly what we needed to prepare for winter, and just like mum’s cooking, we find it very hard to resist these foods when they are placed in front of us.

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In his Don’t Eat for Winter book Cian included this chart that I think is brilliant!  He went through the USDA database and tabulated the average Glycemic Index of the foods that naturally grow in various months.  As you can see from the little humans below, the high GI foods do a great job of preparing us for winter when would rely on using the stored body fat as fuel.  Not only have we manipulated our food environment to be, we have manipulated our light environment so we are exposed to stimulating blue light from our screens and mobile devices any time we are not trying to sleep.

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Today, the food industry has responded to our prehistoric urges with an abundance of autumnal foods with carbs and fats that will fatten is up for winter ALL YEAR ROUND!!!

I don’t think you can blame just fat or carbs.  Both the grains and added fats that have increased in our diet.

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Grains, vegetable oils and refined dairy fats are cheap, transportable and have a long shelf life, but are not a necessarily a good investment if you are interested in managing your waistline, diabetes risk or your long-term health.

Putting ourselves in Grok’s shoes can be useful.  But rather than trying to follow in his footsteps, we need to reverse engineer our instincts to stay healthy and avoid the diseases of modern civilisation.

Summary

If you want to avoid obesity and overeating, then an excellent place to start is to stay away from low nutrient density foods that are low in protein and have a mixture of fat and carbs.   Ted Naiman’s infographic below sums this up nicely.

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The combination of carbs and fat together is rare, but in today’s food environment it typically signifies “junk food” or “comfort food”.  We are almost powerless against these man-made food “products” when given the opportunity.

If you’re looking for a bit of extra help, you may want to check out your free and personalised Nutrient Optimiser report to find foods and meals that are ideal for your situation and goals and stop preparing for a winter!

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is breakfast the most important meal of the day?

According to some, the idea that “breakfast is the most important meal of the day” was generated by Kellogg’s to sell cereal designed to decrease libido and control masturbation.

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Today, many people like to skip breakfast because they are busy in the morning or to help manage their food intake across the day.

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But what can half a million days of MyFitnessPal data tell us about whether eating breakfast is optimal to manage our appetite in order to stay healthy and lean?

To understand the effect of breakfast on our appetite we plotted the proportion of calories consumed at breakfast versus the degree to which people were able to achieve their calorie goal when logging in MyFitnessPal.  A score of greater than 100% means that a person was not able to achieve their target calorie intake.  A score of less than 100% indicates that a person’s reported consumption was under their goal.

is breakfast the most important meal of the day - scatter

Granted, there are limitations with self-reported data versus a metabolic ward study, but many of the concerns are common across the board and cancel themselves out.  While there is plenty of scatter, there is a definite trend towards eating less across the day in the people that consumed more of their daily calories at breakfast.

To help make sense of all the scatter, the chart below shows the average for the different “bins” of data based on the proportion of a person’s daily calories consumed at breakfast.

is breakfast the most important meal of the day - optimising nutrition.png

Most people instinctively prefer to eat a larger dinner with a minimal breakfast.  But keep in mind that our instincts have developed to help us avoid starvation and store fat in preparation for winter, not to avoid diabetes or look good naked.

It’s often more convenient to eat at night when we are with our family and friends and have unlimited access to our fridge and cupboard.  It’s easy to sit down in front of Netflix with a bag of chips and chocolate and eat mindlessly.  Afterwards, you go to sleep which maximises your body’s opportunity to store the food you just ate.

This data seems to align with emerging research indicating that early time restricted-feeding (eTRF) approach with a hearty meal eaten earlier in the day helps to improve satiety and reduce appetite.

The study from Satchin Panda’s lab found that, on average, people eat for 14.75 hours per day.  On average, people consume their maintenance calories by 6:36 pm, but many continue to eat as long as they are still conscious.

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In the second phase of the study participants were encouraged people to follow a more compressed eating window with their the bulk of their food consumed earlier in the day.   Although it took some time to adjust, they unanimously loved the change!

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Stay tuned for future articles where we’ll look at:

  • What should you eat at each meal if you want to maximise satiety and lose weight with less effort (spoiler alert: it’s not starchy cereal)?
  • How many meals a day is optimal?
  • Which meals are most important?

In the meantime, if you’re looking for some nutrient dense breakfast ideas tailored to your goals, head over and get your free Nutrient Optimiser report.  We hope you love it!

 

Notes

  • Analysis was limited to people who logged more than one meal a day to eliminate people who did not log meals.
  • Analysis was limited to people with goal energy intake between 1000 and 2500 calories to focus on people aiming for weight loss.
  • Analysis limited to people who achieved between 50% and 300% of their goal calorie intake to eliminate incomplete days and extraordinary eating days.
  • n = 310,479 days of data

 

how to upload your Cronometer data to the Nutrient Optimiser

We’ve worked hard to make the Nutrient Optimiser easy to use while also allowing people to use available data to personalise the recommendations to suit your goals.

We don’t want everyone to have to track every morsel they eat to benefit from the Nutrient Optimiser algorithm.  To avoid this chore, we have characterised the typical nutrient deficiencies of a range of different diets that you might identify with (e.g. low carb, paleo, keto, vegan, plant-based etc).  We also allow you to select conditions that can benefit from emphasising various nutrients.

However, if you want to step up the accuracy of the guidance you receive from the Nutrient Optimiser, we also allow you to upload your food log from Cronometer to enable the Nutrient Optimiser algorithm to further fine-tune your nutritional prescription.

Why Cronometer?

One of the most common questions is whether we can use your data from MyFitnessPal or another food tracking app.

The answer here is both yes and no.

We are in the process of setting up an API link between the Nutrient Optimiser and MyFitnessPal to read your calories and macronutrient data.  This will enable us, based on your macronutrient profile, to get a feel for what micronutrients you might be missing in your diet.   This will be great for people who have been using MFP for a while and don’t need ultimate precision.

Unfortunately, only Cronometer uses the high-quality databases necessary to provide the accurate macronutrient data that the Nutrient Optimiser algorithm relies on.

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Other apps may have a lot more foods in their database, but they are typically entered by users and often inaccurate.  They also do not provide the full spectrum of micronutrient data.

The team at Cronometer have done a great job refining their app and web interface to make it user-friendly as well as purchasing the professional food databases.

Cronometer has a free online interface and a $4.99 app that you can use on your phone.  There are additional features in the Gold Edition.  But you don’t need to be paid up to download the data to copy across into the Nutrient Optimiser.

While it is not possible to connect the Nutrient Optimiser directly into your Cronometer account, we can download your data and upload to the Nutrient Optimiser.

How to download your Cronometer data

The main thing you need from Cronometer is the servings.csv file which contains the details of your food log, calories and micronutrients.

To get this, log into your Cronometer account and head over to https://cronometer.com/#profile on a computer (i.e. not on your phone or tablet).

Click on the ‘spiky wheel’ in the account information section and click on ‘Export Data’ (as shown in the screen grab below).

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You can change the date range if you want and hit the ‘export servings’ button.  This will save you servings.csv file on your computer.

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You can then go ahead and upload your servings.csv file into your free Nutrient Optimiser report.

Uploading into the Nutrient Optimiser Free Report

To get to the free report just tell us what you’re interested in with the drop-down box at nutrientoptimiser.com, fill in your email address and then hit ‘join now’.

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Once you’ve filled in the basic details, the “Want even more precision?  Upload your Cronometer data” option will pop up.

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Click on that hyperlink, and you’ll get this screen and be able to drag and drop your Cronometer file.

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Full report

Once you have completed your free report you will have the option to upgrade to get a more detailed ‘full report’ if you click on https://nutrientoptimiser.com/apply/.

You can upload your Cronometer data whenever you want.  We suggest checking in every week or so to get some new suggestions on how you can keep refining your food choices.

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We hope this makes things as clear as possible and helps you to optimise your nutrition from first principles so you can live life to the fullest!

optimising macros for fat loss with less hunger

Many people like to define their diet based on macro ranges, such as:

  • low-carb,
  • ketogenic,
  • high-fat,
  • low-fat,
  • high-protein, or
  • high-carb.

However, if you want to control your appetite, reduce body fat, and improve your health, you probably want to know if your chosen dietary preference works.

Everyone agrees that consciously restricting calories can be difficult.  We want to understand how we can manipulate macronutrients and micronutrients to improve satiety and reduce hunger which will lead to a spontaneous reduction in appetite and sustained fat loss.

My Nutrient Optimiser partner Alex Zotov and I have been busy lately mining the database of half a million days of MyFitnessPal data for insights that can help us refine our algorithm to help people achieve their goal with more precision.  It’s fascinating to be able to quantitatively answer common questions and dispel many myths about nutrition with this massive data set!

Data cleaning

In order to focus on people trying to lose weight, we filtered for people with a calorie goal of between 1000 and 2500 calories and eliminated days where people consumed more than 300% or less than 50% of their target calorie intake.  This trimmed reduced out data set down from the original 587,187 days of data to 438,014 days of completed food diaries.

Definitions of diets by macronutrient range

The table below shows how we sliced up the data based on macronutrient ranges that align with different popular dietary approaches.

  • The “n” is the number of days in each ‘bucket’ of data.
  • The “%” column shows the percentage of days that meet that criteria.
  • The average row represents the average macronutrient breakdown of all 438,014 days of data. Each of the dietary approaches are subsets of this data.
Diet Protein Fat Carbs n %
Low-protein, high-fat < 15% > 70% 1,887 0.43%
High-fat > 70% 7,229 2%
Junk food < 20% > 30% > 35% 84,781 19%
Low-protein < 15% 87,985 20%
Standard Western 10 – 20% 30 – 40% 35-50% 43,504 10%
Low-carb, higher-fat > 60% < 30% 18,581 4%
Very low carb < 15% 21,644 5%
Low-fat < 25% 75,859 18%
Low-carb < 30% 64,960 15%
Low-carb, high-protein > 20% < 35% 34,870 8%
High-carb > 70% 4,966 1%
High-protein > 30% 72,473 17%
Very high protein > 40% 15,205 3%
Average  22% 36% 43% 438,014 100%

Average macros (%)

The chart below shows what each of the diet approaches looks like in terms of macronutrients for the days that met the criteria for each ‘bucket’.

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Average diet macros (grams)

Many people like to manage their diet by limiting or targeting a certain quantity of a particular macronutrient, so the table shows the average intake of each of the approaches in grams.  If you currently track your diet you might like to see how you compare to these averages.

Diet Protein (g) Fat (g) Carbs (g)
Very high protein 165 45 97
High protein 137 53 122
Low carb, high protein 116 86 54
Low carbohydrate 107 88 72
Low fat 93 33 201
Very low carb 101 107 31
Low carb, high fat 81 120 40
High fat 69 134 29
Standard Western 70 67 193
Junk food 62 76 185
Low protein 49 67 205
High carbohydrate 38 20 248
Low protein, high fat 47 158 47
average 86 62 168

Satiety of different macronutrient diet approaches

This table shows the average goal and actual calorie intake for each of the groups.  The right-hand column shows the average of the actual intake divided by their calorie goal and multiplied by 100%.

A calorie goal in MyFitnessPal is set by a person’s Basal Metabolic Rate minus an allowance to ensure that they achieve an energy deficit if they are trying to achieve weight loss.

  • A score of less than 100% means that someone was able to eat less than calorie goal for the day.
  • A score of greater than 100% indicates that someone was able to eat less than they planned.
Diet Goal (cals) Actual (cals) % Goal
Low protein, high fat 1,698 1,796 106%
High fat 1,698 1,597 94%
Junk food 1,779 1,673 94%
Low protein 1,730 1,615 93%
Standard Western 1,806 1,655 92%
Low carb, high fat 1,721 1,569 91%
average 1,795 1,575 88%
Very low carb 1,714 1,490 87%
Low fat 1,787 1,478 83%
Low carbohydrate 1,753 1,506 86%
Low carb, high protein 1,735 1,461 84%
High carbohydrate 1,592 1,325 83%
High protein 1,834 1,511 82%
Very high protein 1,804 1,453 81%

This chart shows the goal vs actual calorie intake for each approach graphically.

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The chart below shows the % goal achieved for each approach graphically.

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Discussion

Looking at the goal vs actual calories in the chart below we can see that:

  • The people following a low-protein, high-fat approach were the only ones to exceed their calorie target consistently.
  • The people using the high-protein diet had the highest target calorie intakes, suggesting that they were active and likely had more metabolically active muscle mass, and hence a higher BMR.
  • The high-carb approaches seemed to have a lower goal intake, indicating that these people may have already been typically smaller or had less muscle mass.

Both the high-fat and low-protein approaches have a negative impact on satiety.  Combining these two approaches (i.e. high-fat with low-protein) appears to lead to people to eat much more than planned.

Avoiding protein (i.e. in pursuit of ketones or due fear of gluconeogenesis) and consuming “fat to satiety” appears to significantly increase your chances of overeating.

Lowering carbohydrates provides slightly better than average satiety.  Focusing on reducing carbohydrates while also prioritising protein seems to provide a better outcome.

When we look at the correlation between macronutrient consumption and the ability to achieve your target calorie goal, we see that higher protein has the strongest alignment with followed by lower fat.  Restricting carbohydrate seems to have a much smaller impact on spontaneous calorie intake.

This observation from the data also aligns with this recent study that tested high protein low carb vs normal protein high fat and found that “Body-weight loss and weight-maintenance depends on the high-protein, but not on the ‘low-carb’ component of the diet, while it is unrelated to the concomitant fat-content of the diet.”

A higher protein approach with less fat may be more advantageous in terms of satiety if your goal is fat loss.

A high carb approach such as a Whole Food Plant Based approach may lead to weight loss.  However, it may not provide adequate protein to prevent loss of lean muscle which is a real concern during weight loss.

Also, keep in mind that plant-based amino acids and some micronutrients such as vitamin A and omega 3s are less bioavailable from plant-based sources compared to animal-based sources.

Someone following a high carb plant-based approach should monitor their body fat levels during weight loss and look to add additional protein if they are losing excessive amounts of lean muscle mass or their % body fat is increasing even though they are losing weight.

Personally, I used to follow more of a low carb high-fat approach in an effort to manage my insulin levels and blood sugars.  However, recently I have found much better results in terms of satiety and body composition by prioritising protein.

When you buy into the Carbohydrate-Insulin Hypothesis of Obesity, a lot of things get blamed on insulin resistance.  I was a victim, and my obesity was beyond my control (or so I thought).

I now realise that following a diet that enables you to eat less and control hunger is what will reverse insulin resistance (see this article for more discussion) and lead to increased satiety and fat loss.

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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.

image5.png

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.

Screenshot 2018-05-20 07.14.49.png

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]

image10.png

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.

image5.png

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.

image8.png

The simplified chart for carbs is shown below.

image9.png

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.

image6.jpg

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.

image6

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.

image12.png

  • 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.

donut-522440_960_720[1].jpg

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.

image7.png

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).

image7.png

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.

image4.png

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.

Screenshot 2018-05-18 02.42.23.png

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.

image11

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.

image2

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.

Screenshot 2018-05-18 02.41.25.png

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.

image20.png

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.

image21.png

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

image8.png

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.

image7.png

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.

image8.png

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.

image16.png

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]

image14.png

image22.png

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.

image2.jpg

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

image1.png

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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

 

how to optimise your energy and macro-nutrient targets

Most macronutrient and calorie calculators give you a specific target for calories, carbs, fat, protein and fibre.

This is simple, but unfortunately not optimal when it comes to ensuring optimal nutrition.

Nutrient-dense whole foods don’t come in prepackaged satchels of protein, carbs, fat, fibre and calories that you can mix together to meet specific macronutrient and calorie targets.

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In real life, nutritious whole foods have a range of macronutrients and micronutrient profiles.  Some days you might crave more energy or different nutrients based on your needs.

While calories and macros still play a role, chances are that you will do better if you initially focus on nutrient-dense whole foods rather than achieving specific macronutrient and calorie targets.  Once you remove nutrient poor highly processed foods from your diet you will be able to better trust your food cravings and appetite.

Where to focus

The personalised foods and meals in your free Nutrient Optimiser report will help you re-balance your micronutrient profile, stabilise your blood sugars and provide the energy you need from your food (but not too much, particularly if your goal is fat loss).

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To help you make the transition from just thinking in terms of macronutrients and calories, the Nutrient Optimiser provides you with personalised macro and calorie ranges.

The image below shows my macronutrient and energy ranges as someone who is currently 95kg with about 16% body fat and good blood sugars.  My current goal, after building some strength in the gym last year, is to lose some body fat while holding onto as much hard earned muscle mass as I can.

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Working within target ranges enables me to still listen to my appetite which may guide me to eat more on days that I am more active and when I tend to crave more protein and/or carbs.  Conversely, there may be other days when I am less active and less hungry and hence don’t need to eat more than my body is craving.

For me, as someone who has become fairly insulin sensitive with good blood sugars, these macronutrient ranges are fairly wide.  I could consume between 32 and 142 g of fat or up to 151g of non-fibre carbohydrates as long as I’m not overdoing my overall energy intake.

For contrast, I have shown below the macro and energy ranges that the Nutrient Optimiser would give for a woman who was also 95kg but had 50% body fat and type 2 diabetes and looking to lose weight.

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Her overall energy requirement is lower because she has less metabolically active lean mass.  Her target carbohydrate range is much lower to help her control her blood sugars.

At just over 500 calories per day, her lower limit of energy intake is also very low because she has a lot of body fat that can be mobilised.  However, she still needs a minimum level of protein, essential fat intake and other vitamins and minerals.

These macronutrient and calorie ranges can act as a starting point.  As you make progress with your weight loss or get your blood sugars under control, you can update your profile in the Nutrient Optimiser to update these numbers.

We’re also in the process of developing a Nutrient Optimiser Dashboard that will allow you to track your biometric data (e.g. blood sugars, waist, weight, blood ketones, breath ketones, body fat percentage etc.) help you fine-tune your macro and calorie targets to ensure you are moving towards your goal.

Lots of people are wannabe biohackers but end up getting caught up chasing markers that don’t help them reach their goals (e.g. chasing high ketones for weight loss).  Alternatively, they don’t adapt their approach as they progress (e.g. they don’t transition to a more nutrient-dense lower energy density approach once their blood sugars have stabilised on a lower carb diet).

If you have run your free Nutrient Optimiser report we’ll be sure to let you know once the dashboard is ready.

Calories

There is endless debate whether calories, hormones or nutrients matter more.

While most people agree that you need an energy deficit to lose weight and an energy surplus to gain weight, the way your body processes energy is complicated and hence impossible to calculate precisely.

Focusing on calories alone may be short-sighted.  Without attention to food quality and macros, it may be harder to manage your energy intake.

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If you are healthy, your metabolism will increase to burn off any excess energy.  You will fidget more and naturally move around more (i.e. non-exercise activity thermogenesis).

However, most people can’t do this forever, particularly if their food is nutrient poor and causes inflammation.  A chronic energy excess that drives body fat levels higher will most likely cause you to become overweight and insulin resistant once your fat stores cannot take in any more.

Conversely, if you restrict calories, your body will become more efficient.  You will adapt to cope with less energy.  Due to this ‘adaptive thermogenesis’ over time you will need to take in less energy if you want to keep losing weight.

This adaption is often seen as a bad thing.   But for most people, other than not getting to enjoy as much yummy food, training your body to do more with less is highly beneficial.

Metabolic efficiency

If your car is running well, it uses less fuel and gets the job done efficiently.

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But if your car is getting old and blowing heaps of fumes, it’s probably burning more fuel than it really needs.

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We want fuel-efficient cars to minimise cost and the impact on the environment.  But when it comes to choosing the fuel for our body, many of us want to know how much food we can get away with without looking too fat.

Energy is conserved

While our bodies are complex systems and we don’t understand everything that goes on inside them, energy is conserved.

We would love to be able to eat lots and lots of yummy stuff and stay lean, typically doesn’t work out in the long term.

If you are losing weight off your body, you are burning more than you are eating.

If you are gaining weight, you are taking in more energy than you are burning.

However, while energy intake still matters, your primary focus should ideally be on consuming nutrient-dense foods that don’t spike your blood sugars.   Once we have food quality dialled in quantity will fall into place.  Your appetite will start to work the way it is meant to.  Food that contains the micronutrients you need tend to help to prevent nutrient cravings, are more satiating and help you to consume less energy.

Is intermittent fasting better than calorie counting?

The unfortunate reality is that it’s not easy to maintain an energy deficit over a long period of time.

In the low carb or keto world, many people find some version of intermittent fasting helpful.

Others find calorie cycling or a targeted ketogenic diet (i.e. more carbs and/or calories on workout days) to be useful.

Still, others find that refeeds or diet breaks can be helpful to reset your hormones and appetite after a number of days or weeks of conscious and careful restriction.

Personally, I’ve done my share of intermittent fasting but found that I would always manage to compensate for my deprivation and congratulate myself with enough food at the end to maintain my weight over the long term.  And it was hard at the end of the fast to make sure I was eating the most nutrient-dense foods.  Once I started eating I would always find myself reaching for the energy-dense cream and peanut because I had earned it.

After a period of gaining strength in the gym last year and gaining a bit more fat than I would have liked, this year I have been more diligent in tracking my intake and making sure I’m eating nutritiously with adequate protein to support my recovery while maintaining enough of a deficit to ensure ongoing weight loss.

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This has also included a couple of “diet breaks” programmed around intense periods at work when I didn’t want to be thinking about food all the time.  After the period of mental and physical relaxation, once I dialled things back in the water weight dropped off and the weight loss continued.

However, you want to structure it, allowing some room to listen to your body’s signals can be useful.  In the long run, you will need to maintain a deficit if your goal is to lose weight or an overall surplus if your goal is to build muscle.

While not many people find tracking their food intake fun, many people find that they need to track to stay accountable and achieve their goals.  Even a short period of tracking can be helpful to help re-train your eating habits.

Your calorie range for weight loss

Rather than a fixed energy target, if you are trying to lose weight, the Nutrient Optimiser gives you a starting calorie range.

The lower limit calorie intake level is based on the maximum rate of weight loss you can achieve without excessive loss of muscle mass (i.e. 21 calories per pound of body fat)[1] [2] while also getting a minimum amount of protein.  The more fat you have to lose, the more aggressive your deficit can be without risking muscle loss.[3]

If you aim is weight loss, your upper limit calorie intake level is based on your basal metabolic rate (BMR) minus 15%.  This is a reasonably comfortable deficit for moderate fat loss that won’t generate excessive hunger for most people.

If you are feeling ambitious, you can aim for the lower calorie intake level.  But then one day you may feel more hungry or be more active so you can allow yourself to eat up to the upper limit without feeling guilty.

Most people under-report their food intake,[4] so targeting a lower intake will accommodate your optimism bias and crappy reporting.

Example calories and macronutrient ranges

The table below shows my recommended macro ranges from the Nutrient Optimiser in weight loss mode.  My target calorie intake for weight loss is 1,606 to 1,962 calories per day.  For me, this is a 15 to 30% deficit below my theoretical basal metabolic rate of 2,308 calories per day.

 

lower

upper

protein (g)

144

260

fat (g)

32

142

net carbs (g)

0

151

energy (cal)

1,606

1,962

deficit (calories)

702

344

deficit (%)

30%

15%

The image below shows how these lower limits look when entered into Cronometer.

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If you click on the energy bar in the web interface or the app, we get this popup where you enter this calorie range.

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While these values are calculated to four significant figures, they are only estimates of how much energy is in the food you are consuming.  Theoretical calculations should only be used as a starting point and refined based on actual progress.

If you find after a week or two that you are not achieving the weight loss you were hoping for you should reduce the maximum allowable calorie intake to ensure that you are losing weight.  A reasonable rate of weight loss is somewhere between 0.5 and 1.0% of your total body weight per week.  If you’re aggressive and very disciplined, you might be able to achieve a 1.5% loss per week for a short time.

Many people have found that they can sustain a more aggressive rate of weight loss over the long term if they have adequate protein and micronutrients.  You will also find it hard to overeat on the foods and meals recommended by the Nutrient Optimiser.

Similarly, if you find that your blood sugars are not trending down, you can reduce your carb target.  Once your blood sugars are dialled in you can loosen your carb target a little to allow more nutrient-dense foods.

If you’re not looking for weight loss

If you’re a lean athlete not aiming for weight loss, you will be able to ‘eat to satiety’ to ensure you recover.  If you’re looking to gain muscle without too much fat, you will want to target a slight energy excess.

Be careful eating back the calories from exercise if you are trying to lose weight.  Your Fitbit or Strava may tell you that you just burned a lot of calories, but if you enter that into Cronometer and then have the extra ice cream that it says you are allowed, you may find you are not getting the results you hoped for.

Protein

If you want to get more background about the charts and discussion below, the macro targets in the Nutrient Optimiser algorithm are based on the analysis detailed in the How to get the minimum dose of nutrition and Macros > micros? articles.   

Getting enough protein is important when losing weight to prevent loss of lean muscle mass.  The minimum protein intake in the Nutrient Optimiser is based on 1.8 g/kg lean body mass (LBM).

Nutrient density starts to drop off once protein drops too.   Getting adequate protein is as much about maintaining overall nutrient density as it is about getting protein for muscle growth and repair.

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It can be helpful to target higher levels of protein if you are in an aggressive energy deficit.  The upper limit provided by the Nutrient Optimiser is based on the optimum protein intake level or about 45% of your maintenance energy intake.   Beyond this point, any extra protein starts to have a negative impact on nutrient density.

Similar to your calorie ranges, you can click on the protein bar in Cronometer and enter your minimum and maximum protein intake as per the example below.

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If you find that you’re starting to lose too much muscle mass rather than body fat you can increase your minimum protein intake.   It’s hard to track muscle loss vs fat loss accurately, but the chart below is my attempt using my bioimpedance scales.  You can see during the first six weeks (during the Ketogains Bootcamp) I was losing twice as much fat compared to lean mass.  Later in my journey when I’m not working out as much you can see the ratio of lean mass loss vs fat-free mass loss is drifting up.

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Loss of hard-earned lean muscle mass in weight loss is real and you would be wise to do everything you can to avoid it.  Other than taking testosterone, steroids or choosing different parents, resistance training and a higher protein intake are the only things I’m aware of that will help you lose more fat and retain more muscle.

Fat

As shown in the chart below, a very low-fat diet (less than 10% energy from fat) may leave you struggling to achieve a good micronutrient profile.  Hence we recommend getting a minimum fat intake of 0.4 g/kg LBM.  While this is less fat than most people eat you will easily be able to achieve the daily recommended minimum requirements.

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My fat range is shown in the figure below.  If you’re in fat loss mode, you will likely be closer to the lower limit.  If you are trying to gain muscle or are very active, you will likely be eating more fat.

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Carbohydrates

You don’t need a lot of carbs to get a reasonable level of vitamins and minerals.   Non-starchy veggies like spinach and asparagus provide a range of vitamins and minerals that are typically harder to find in animal-based foods.

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The image below shows how this looks when entered into Cronometer.

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If you are managing diabetes?

If you are insulin resistant or have diabetes, the allowable upper limit of carbohydrates provided by the Nutrient Optimiser will be limited to help stabilise your blood sugars.  As you can see from the chart below, there is a balance between nutrient density and a lower dietary insulin load.

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Managing the insulin load of your diet will require a reduction in protein intake if you need a therapeutic ketogenic diet. Most people find that they get the outcome they need by reducing refined carbohydrates.

 

Summary

So, in summary:

  • You should use the Nutrient Optimiser to focus on nutrient-dense whole foods that align with your goals without worrying too much about macronutrients.
  • Logging your food in Cronometer enables the Nutrient Optimiser to fine tune your food and meal choices to rebalance your food choices and improve your micronutrient profile.
  • The calorie and macro ranges provided by the Nutrient Optimiser can be used to double check that you are on the right path.

In the next instalment, we’ll look at how the nutrient score is calculated and what it takes to get yourself to the top of the Nutrient Optimiser leaderboard.

 

References

[1] https://www.ncbi.nlm.nih.gov/pubmed/15615615

[2] http://www.burnthefatfeedthemuscle.com/how-to-lose-a-pound-of-fat-per-day

[3] https://optimisingnutrition.com/2017/10/30/nutrition-how-to-get-the-minimum-effective-dose/

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4064631/

does insulin resistance REALLY cause obesity?  

Many people believe that insulin resistance causes obesity. But as you’ll see in this article, it may very well be the other way around.

Excess body fat appears to drive insulin resistance.  But first, your fat cells need to be insulin sensitive to fill and expand beyond your Personal Fat Threshold.

Once your adipose tissue becomes resistant any excess energy is then shunted into your bloodstream and vital organs, leading to the most prevalent modern diseases such as diabetes, heart disease, Alzheimer’s and Parkinson’s.

What does insulin do?

There is a lot of focus at the moment in some circles on insulin and how to minimise if not eliminate it.  But we need to keep in mind that insulin actually performs a range of critical functions in your body, such as:

  • Facilitating the use of protein to build and repair our muscles and organs,
  • Acting like a brake on our liver to regulate the release of glucose into the bloodstream,
  • Storing excess energy (ideally in our adipose tissue) for later use, and
  • Suppressing the use of our body fat (lipolysis) while the energy from your food is used up.

What happens if we have no insulin?

You may not always like the fat storing function of insulin, but we have to take the good with the bad.  We simply cannot live without it.

Not producing enough endogenous insulin is called type 1 diabetes.  If you develop type 1 diabetes you will:

  • Not be able to use protein to build your muscles and vital organs,
  • Experience elevated blood sugar levels as your liver produces excess glucose,
  • Experience uncontrolled lipolysis, meaning that your fat stores will be quickly mobilised, and
  • Experience elevated blood glucose and BHB ketones (a.k.a. diabetic ketoacidosis).

You may be a little bit jealous of people with type 1 diabetes, thinking that if you could only decrease your insulin a little bit, you’d lose weight.

But having zero insulin is a life-threatening situation.  It’s been less than a century since we’ve been able to treat people with type 1 diabetes (like my wife Monica) with exogenous insulin to keep them alive.

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As shown in the photos below, people with uncontrolled type 1 are essentially falling apart.  They are quickly leaching their stored energy into their bloodstream via uncontrolled gluconeogenesis and lipolysis.

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However, as demonstrated in the ‘after’ photos on the right-hand side, once they receive insulin treatment, people with type 1 are able to use the energy from the food they eat, and no longer consume their muscles for fuel.

The most successful approach for people with type 1 diabetes tends to involve fewer carbohydrates without limitations on protein, particularly for growing children.

Adequate insulin dosing is critical to maintaining healthy blood sugar levels as well as enabling the use of protein for growth, repair and maintenance of muscle.

A more modern example is Dave Dikeman, son of RD Dikeman who is one of the admins of Type 1 Grit who follow Dr Bernstein’s recommendations for the treatment of diabetes.

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Dave is shown here in hospital after diagnosis and below recently with his dad.  While some people warn nitrogen poisoning, Dave seems to be thriving on about 250g of protein per day (i.e. about 4.7 g/kg LBM).

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Getting adequate insulin to metabolise the protein required for growth and repair while limiting carbohydrates to maintain normal blood sugar levels appears to be crucial to success for people with diabetes.

What happens if I am insulin sensitive?

Being “insulin sensitive” means that don’t need much insulin to get the job done.

  • Glucose can enter your cells to be used for energy.
  • Your liver responds to insulin and controls the release of glucose and ketones into the bloodstream.
  • You will build muscle relatively easily.
  • Your body can efficiently store excess energy as fat, and your adipose tissue can grow quickly.

Having great insulin sensitivity is a double-edged sword.  While you can control the release of glucose and ketones from your liver into your bloodstream and build muscle, you can also build fat stores quickly.   You need to be insulin sensitive to become morbidly obese.

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I used to believe that if I could become insulin sensitive by reducing carbohydrates and protein.  I thought the key to success was to increase my ketones by eating more fat so I could melt away my body fat, a bit like someone with untreated type 1 diabetes.  (There is a practice called diabulimia where some type 1s intentionally restrict their insulin dosing to lose weight, however, this is a very dangerous practice which drives ketoacidosis, fatigue, muscle wasting, high cholesterol and death).

But ironically it turns out that having insulin-sensitive adipose tissue actually enables your body fat stores to expand to accept more and more energy from the food you eat before they start being channelled into other areas of your body.

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People who are obese are often insulin resistant.  However, this is not always the case.  You can be insulin resistant and still be lean.  You can be obese and still be relatively insulin sensitive.  If you are both insulin resistant and obese, the obesity probably came first.

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How do I become insulin resistant?

Professor Roy Taylor has done some fascinating work showing that different people develop diabetes at different body fat levels.[1]  He coined the term ‘Personal Fat Threshold’ to describe this observation.

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For whatever reason, some people develop diabetes at a low level of body fat while other people need to become obese before they experience elevated blood sugars.[2]  Some people are ‘blessed’ with the ability to expand their fat stores a lot more than others before their fat stores become full.

While most people want to be lean with low levels of body fat, the ability to continue to expand your fat stores can be an advantage.  People who could successfully store lots of energy in their adipose tissue were more likely to survive a famine or a long journey in a canoe to settle a new island or continent.  This phenotype is sometimes called metabolically healthy obese.

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Unfortunately, these populations appear to suffer the most when exposed to hyper-palatable nutrient poor insulinogenic western food.   Highly insulin sensitive and primed for storage of available foods, they very quickly become obese and eventually, after gaining a lot of body fat, diabetic.

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They also seem to be genetically programmed to ensure that they survive the next famine more than others, so when given the opportunity they become more ‘addicted’ to these energy-dense obesogenic foods.  For example, sales of Coca-Cola are the highest on a per person basis in Australia’s Northern Territory in where there is a high proportion of indigenous Aborigines.

Even today, when famines are less common, being able to build large energy stores in your adipose tissue is still an advantage.  These people can store more energy on their body before it gets funnelled into places that fat does not belong (e.g. your liver[3], pancreas, heart[4], eyes and brain[5]).

It’s when your fat stores become insulin resistant and cannot store any more energy things get ugly.[6][7]  When your fat stores get full and can not accept any more energy we say they become resistant to the effects of insulin.[8] Your pancreas ramps up its efforts to store energy.

But in spite of the increasing levels of insulin, less and less energy can be forced into fat stores.  It’s at this point that the excess energy starts to get funnelled into areas of your body that are now more insulin sensitive than your body fat like your liver, pancreas, heart, eyes and brain.

In this video, Ivor Cummins discusses the concept of adipose tissue hypertrophy and how diabetes begins in the fat cells.

I also highly recommend this widely shared podcast with Mike Julian and Alex Leaf, where they share their insights.

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Like many of my posts, most of the insights in this article are gleaned from them based on the latest research that they share in the Optimising Nutrition Facebook Group.

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If you haven’t seen it yet, this video from Ted Naimin is a must watch on the topic of insulin resistance.

People who have lower personal fat threshold are sometimes called TOFI (i.e. thin on the outside, fat on the inside).  These people may look skinny because they have less body fat stored underneath the skin (subcutaneous fat) but they often have lower levels of muscle and much higher amounts of fat stored around their vital organs (visceral fat) and will see elevated blood sugars much earlier.[9]  Being TOFI is arguably more dangerous than to be metabolically healthy obese.

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An extreme example of TOFI is lipodystrophy were people cannot gain body fat and quickly develop diabetes, hyperinsulinemia, fatty liver, hypertriglyceridemia and heart disease because they aren’t able to buffer their energy in their fat stores before it goes to their vital organs.

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So as you can see, if we want to be accurate, it’s not obesity per se that is causing metabolic dysfunction, it is being overfat relative to your Personal Fat Threshold.

Optimal vs insulin resistant blood sugar and ketone levels

As your body fat stores start to fill, you will also see elevated levels of energy in your bloodstream in the form of elevated glucose, ketones and free fatty acids.

The table below shows the official diagnosis criteria for Type 2 diabetes in terms of fasting glucose, blood glucose after eating and HbA1c.

  

fasting

after meal

HbA1c

% pop

mg/dL

mmol/L

mg/dL

mmol/L

 %

“normal”

< 100

< 5.6

< 140

< 7.8

< 6.0%

50%

pre-diabetic 100 – 126

5.6 to 7.0

140 to 200 7.8 to 11.1

6.0-6.4%

40%

type 2 diabetic

> 126

> 7.0

> 200

> 11.1

> 6.4%

10%

However, while the diagnostic criteria define half the population currently as ‘normal’, normal is far from optimal.  If you’re chasing optimal health, the table below shows target blood sugar and HbA1c values that correspond to optimal blood sugar control.

risk level HbA1c average blood sugar
 (%)  (mmol/L)  (mg/dL)
optimal 4.5 4.6 83
excellent < 5.0 < 5.4 < 97
good < 5.4 < 6.0 < 108
danger > 6.5 > 7.8 > 140

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The body tends to find a balance between glucose and ketones depending on available fuel sources.  However, the presence of higher BHB ketones is not necessarily a sign of optimal health.  Higher BHB ketone levels can be a bad sign, especially when they are accompanied by higher blood glucose and free fatty acids.

The chart below shows the sum of about three thousand data points from glucose and BHB ketones measurements for people following a low carbohydrate or ketogenic diet.

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It appears from this data that people who are metabolically healthy tend to have lower blood glucose and lower ketone values, even if they are following a ketogenic diet.  If your goal is to use body fat for fuel, then you will want to be further to the left of this chart with a lower total energy in your bloodstream from glucose and ketones.

Initially, in an energy deficit, you will lose water weight quickly as you empty your glycogen stores, then your blood sugars will reduce.  Then eventually once the faster burning fuel sources are consumed your body will turn to stored body fat.

The table below shows the blood glucose and ketone values if we divide the three thousand data points in the chart above into five quintiles.  It appears that lower blood glucose levels are typically associated with lower ketone levels even on a ketogenic diet.

You may see higher ketone values during a long-term fast or calorie restriction, but generally, ketone levels in the fed state in healthy person on a low carb or ketogenic diet might range between 0.3 and say 1.1 mmol/L with blood glucose less than 5.0mmol/L or 90 mg/dL.

quintile average BG (mmol/L) BG (mg/dL) ketones (mmol/L) total energy (mmol/L)
25th average 75th
1 4.5 80 0.3 0.6 0.7 5.0
2 4.9 88 0.4 0.8 1.1 5.7
3 5.1 92 0.6 1.1 1.5 6.2
4 5.1 92 1.2 1.8 2.3 6.9
5 5.1 92 2.2 3.2 4.0 8.3

To use an engineering analogy, you can think of your liver as dam wall holding back the floodgates of energy in your body while insulin is the signal to raise the floodgates.  If you have a flood of energy coming in your liver will have to release some of the excess energy into the bloodstream.

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If you have lower levels of energy coming in from your diet you will need less insulin to force the liver to hold back the flood of energy stored in your body.

Once you decrease the energy coming in from your diet, your pancreas will be able to slow the production of insulin, which will allow your body fat stores to fill the energy gap.

The ketone data from the recent Virta study[10] below also supports the case for ketones being correlated with body fat levels for people on a ketogenic diet.

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The participants’ ketone levels initially jumped to around 0.6 mmol/L as they switched from a more insulinogenic standard western diet to a ketogenic diet.  But as you can see ketone levels continued to decrease over time to about 0.3 mmol/L as:

  • They lost body fat and then their weight loss stabilised,
  • The amount of energy in their system decreased,
  • Their blood sugars decreased, and
  • Their overall metabolic health improved.

The chart below shows the weight loss over the same period of decreasing ketone values.

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As detailed in this article, BHB ketones can be seen as a storage or transport form of ketones that can be used by the brain and heart but need to be converted back to Acetoacetate to be used by the rest of the body.  While they appear to be useful in some therapeutic situations, higher BHB, for the most part, should be seen as an indication of excess energy status rather than excellent metabolic health.

How do I become insulin sensitive?

Professor Taylor’s research also demonstrated that people become insulin sensitive again once they come back under their own ‘Personal Fat Threshold’ by reducing the pressure in their adipose tissue cells (i.e. lose weight).

With only a small amount of weight loss, their blood sugars come back into line and they start to lose fat from in and around their vital organs.[11][12][13][14]  Or to think of it another way, once you use up the surplus energy in your bloodstream, your body will start feeding on the fat stored in your vital organs as the first priority.

Once our body fat levels decrease to below our Personal Fat Threshold, it seems that they quickly become insulin sensitive and can take in any excess energy.  There is less overflow of energy from the fat cells to spill out into the bloodstream.

The bad news here is that once your adipose tissue becomes insulin sensitive again it can grow quite easily given an environment with surplus energy.  Being more insulin sensitive is part of the reason why it’s so easy to regain weight.

While a low carb diet masks the symptoms of diabetes by stabilising blood glucose levels without a significant reduction in body fat levels, people who lose a significant amount of body fat below their Personal Fat Threshold are no longer diabetic and can pass an oral glucose tolerance test.  Their fat stores can quickly expand to absorb the incoming energy.  Unfortunately, as soon as they put the weight back on (i.e. refill their fat stores), they become diabetic again.

One criticism of Professor Taylor’s work is that it was done with Optifast shakes to ensure rapid weight loss while still getting adequate nutrition (even though it was from meal replacement shakes full of supplements).  The ideal would be that people could learn to create nutrient-dense whole food meals.  Many people find this hard to do in real life, hence the use of meal replacement shakes in order to remove this variable.  The Nutrient Optimiser has been designed to help people form new habits of eating nutrient dense meals that are aligned with their goals. 

How do I know if I’m insulin resistant or insulin sensitive?

There are a range of ways to test to if you are insulin resistant.

Blood sugar

The simplest way is just to test your blood sugar fasting and before a meal.  The tables above show some suggested levels at which you should start to be concerned.  If your blood sugars are elevated then it’s an indication that you are exceeding your Personal Fat Threshold.

Fasting insulin

Fasting insulin levels are also a good guide to determine if you are starting to develop insulin resistance.

  • Healthy hunter-gatherer populations have a fasting insulin of 3 – 6 mIU/mL.[15]The average insulin levels in western populations are 8.6 mIU/L.
  • Meanwhile, the western reference range for fasting insulin is anything less than 25 mIU/L.[16] (This is not optimal.)

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Oral glucose tolerance test

One of the most common tests used in diabetes is the OGTT which is where you drink a sugary drink and see how much your glucose rises over time.[17]  image24

Insulin response patterns (Kraft test)

A more accurate way to understand you are insulin resistant is to test your insulin response to food.

In the chart below the negligible insulin response (blue) is Type 1 diabetes (i.e. insufficient insulin), the green is a healthy insulin response, while the yellow (pattern II), orange (pattern III) and red (pattern IV) are indicative of diabetes and insulin resistance.

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While you may have great blood sugar levels, your pancreas may still be working overtime to store the energy from your food in your fat stores, so it doesn’t spill over into your bloodstream.

A Kraft insulin dynamics test, while expensive, is the gold standard in insulin testing.  Dr Kraft’s analysis suggested that 80% of people are using excess insulin to suppress glucose, while a normal glucose screen would suggest that only two-thirds of people are fine.[18][19]

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HOMA-IR

If you have your fasting insulin and glucose data, you can calculate your HOMA-IR which is a measure of the amount of insulin that you need to maintain your blood sugars.  This can be useful for low carbers who sometimes have higher fasting glucose but lower insulin.

The formula is shown below or you can use an online calculator like this one.

  • Less than 1.0 means you are insulin-sensitive which is optimal.
  • Above 1.9 indicates early insulin resistance.
  • Above 2.9 indicates significant insulin resistance.[20]Triglyceride:HDL ratio

You can also use your blood cholesterol test data to understand if you are really insulin resistant. A triglyceride:HDL ratio greater than 3 (in US units) suggests that you may be insulin resistant.  A trig:HDL ratio less than 1.1 is optimal.[21][22]  You can use a calculator like this one to make sure you get the units right.

Abdominal obesity

Waist to height ratio is a simple and effective way to understand if you need to take evasive action to lose weight.

A waist to height ratio of greater than 0.5 for men and 0.46 for women is associated with increased risk mortality.[23]image34

Regardless of whether you are insulin sensitive or insulin resistant, it is highly advisable to do what it takes to reduce your body fat to get your waist to height ratio in check.

Some people will find that they still need to lose further weight to get within their personal fat threshold to get optimal blood glucose and insulin levels.

If you are insulin resistant, your fat tends to get stored in your organs so you may have a big hard ‘beer’ belly.  Someone with abdominal obesity may find their belly is hard because more fat is stored inside around their organs.

If you are insulin sensitive, you may have a big belly but it might hang down more like a floppy garbage bag.  Someone like this is ‘blessed’ to have insulin sensitive adipose tissue that continues to expand more before they develop diabetes and the complications of metabolic syndrome.[24]Screenshot 2018-04-12 08.15.43

Summary

The table below shows values for various parameters that are indicative of insulin resistance.[25]  If you are looking for optimal health, you should target values similar to those in the Quartile 1 column.

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Do medications help?

While replacement of normal healthy levels of insulin is critical for people with type 1 diabetes, supraphysiological doses of insulin only mask symptoms of a poor diet for people whose pancreas is still functioning well.

The chart below shows that complications of diabetes (i.e. cardiovascular disease, stroke, coronary heart disease) increase with higher HbA1c.  Lowering HbA1c however by just using anti-diabetic medications to suppress blood sugar does not help the outcome.

image18

Excess exogenous insulin forces the excess energy into our fat stores, and then subsequently into other more sensitive areas of the body such as our vital organs, brain and eyes.

You can’t just keep eating loads of processed insulinogenic crap and trust that all will be well because your blood sugars are lower.  Exogenous insulin combined with a poor diet actually exacerbates the complications of diabetes.

You need to fix your diet and then add enough insulin to maintain healthy blood glucose levels and effectively use the protein in your diet to build and repair your muscles.

Basal vs bolus insulin

Insulin-dependent diabetics dose with both bolus (or burst) insulin and basal (or background) insulin.  Bolus insulin is mealtime insulin and basal is needed whether you eat or not to enable you to keep your stored energy behind the floodgates of your liver.  

You can reduce the amount of bolus insulin required for food in the short term by reducing the insulin load of your diet.

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For someone on a standard mixed diet, about half of their insulin dosing will be bolus with half as basal.  For someone on a low carb diet with a lower insulin load, the majority of their insulin demand will be for basal insulin, with only a small amount required to cover food.

Most low carbers or ketogenic dieters focus on reducing the insulin load of their diet by removing carbohydrates, and sometimes protein, without paying much attention to incoming energy from fat.

This is fine on a whole food Atkins type diet because reducing carbs will typically force a reduction in overall energy intake.  Ignoring energy balance becomes a problem though when you start to ‘hack’ your low carb/keto diet with refined fats, fat bombs and fatty coffee that enable you to get heaps of energy with few carbs and negligible micronutrients.

The irony here is that, in the bigger picture, insulin demand is actually related to your overall stored energy status, as described in this video from Chris Masterjohn.

As shown in the chart below, people with a larger BMI typically have higher levels of insulin  because, as the stored energy in your system continues to increase (regardless of the macronutrient source), our insulin levels have to increase to hold back the flood of stored energy while the excess energy in our system is used up.

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The chart below shows that someone who is obese and insulin resistant will have higher insulin levels when they are fasting.  They will also have much higher excursions of insulin after eating due to their insulin resistant adipose tissue not accepting the excess energy.

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As our body fat stores continue to build and we keep on taking in energy, our pancreas continues to ramp up insulin production to keep energy in storage until you need it.  In the “good old days” this wasn’t a problem because there were always times when we didn’t have food available.  These days food is relatively cheap, easy to obtain and always associated with celebrations, family, social occasions and self-soothing.  So you are always in storage mode.

As you remain obese, you become resistant to your own insulin and need more and more insulin to do the job.[26][27]  Eventually, your pancreas can burn out through overuse, and you become an insulin-dependent Type 2 diabetic.

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Overall, the macro-nutrient composition of our diet only has a relatively small influence on our insulin levels.  Our basal insulin has a much more significant effect on our fasting insulin levels.

We can manipulate our diet by reducing carbohydrates to reduce the bolus insulin demand of our food.  However, we can have a much more dramatic impact on our insulin levels by reducing the total energy levels in our body by finding a way to maintain a long-term energy deficit.

How to reverse insulin resistance?

TL;DR… Reduce body fat while preserving lean muscle mass.

How to preserve lean muscle mass

Lean muscle mass is important because it burns both fat and glucose.  Without muscle, you won’t be able to quickly use the energy from fat and carbs that you eat.

Lean muscle mass is also critical to insulin sensitivity and longevity.  As you get older, it becomes harder to maintain lean muscle mass.[28]  You will need more protein as you get older to slow the inevitable loss of muscle mass.  Once you become weak and frail, your chances of falling and breaking your hip and never getting up again increase!

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There is ongoing discussion/argument/controversy about how much protein is ‘too much’.  My analysis of nutrient density suggests that getting a minimum of 1.8 g/kg LBM or about 20% of energy is a good starting point.  More can be better if you are active, lifting heavy or trying to lose fat.

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If you focus on getting the nutrients that are harder to find, adequate protein is really a non-issue.  The nutrient profile of the most nutrient-dense foods shown below is generated by prioritising foods that contain the harder to find micro-nutrients (i.e. choline, calcium, magnesium, vitamin E, potassium, pantothenic acid & zinc).

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By contrast, if we focus on avoiding protein, we get an abysmal nutrient profile as shown below.  This is why I get so frustrated when people get worked up about ‘too much protein’ or minimising protein in order to achieve elevated ketones as if that was the ultimate goal of health.

image21

We also risk malnutrition if we focus on the most ketogenic foods (i.e. high fat, low carb, low protein).  For most people, their primary goal is health and weight loss and to look great naked, not having high ketones.

So, unless you need a therapeutic ketogenic diet to manage epilepsy, Parkinson’s, Alzheimer’s, dementia or something similar, then there is no need to compromise your nutrition profile by trying to avoid protein or maximise ketones.

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Ironically, it’s the people who are insulin resistant that probably needs more protein because they are not able to use the protein available as effectively and they are also losing more amino acids into the blood stream via poorly controlled gluconeogenesis in the liver.

For comparison, the three nutrient profiles are shown below (most nutrient dense, low protein and most ketogenic).  Incorporating more of these nutrient dense foods is a great ‘hack’ to ensure you are getting enough nutrients without excessive energy intake.

image9

How to lose body fat

The short, boring, answer that won’t sell a million gimmicky diet books is to maintain an energy deficit for a long enough period.  This can take the form of:

  • Intermittent fasting (ideally with nutrient dense feeding to prevent malnutrition and binge eating),
  • Calorie counting (perhaps with occasional diet breaks),
  • Maximising nutrient density with whole foods which tends to lead to fewer cravings and less energy dense foods which are harder to overeat, or
  • Some other approach that works for you that enables you to maintain an energy deficit in the long term.

We have designed the Nutrient Optimiser to help you get started on your journey to optimise your nutrition.  Free Report will give you:

  • Recommended macronutrient ranges,
  • Recommended calorie intake to suit your goals,
  • Suggested foods to maximise nutrient density, and
  • Suggested meals to start you off on your journey into nutritious eating.

Some people may find some of the concepts in this post hard complex and difficult to implement.  The Nutrient Optimiser which will continue to adapt as you improve your metabolic health.  We are also working on a dashboard that will track your the biometric data that you have (e.g. weight, blood sugars, waist:height ratio, food logs, ketones etc.) to guide you on the path to help you reach your goal.

Who needs a low carb diet?

So, if insulin resistance is primarily about managing our energy levels, does anyone need a low carb diet?

Insulin-dependent diabetics

Being married to someone with type 1 diabetes and involved in the online diabetes community I have seen firsthand the importance of managing carbohydrate intake.

For someone injecting insulin to cover carbohydrates and protein, a low carb diet enables them to match the smaller dietary insulin load with smaller doses of exogenous insulin.

There will always be errors in calculations in matching insulin to food, so a smaller insulin load enables you to reduce the errors in insulin dosing.  Dr Richard Bernstein calls this The Law of Small Numbers.

Similarly, if you have type 2 diabetes and are injecting insulin, reducing the insulin load of your diet can help you reduce the amount of exogenous insulin you require.  This can in turn help reduce the swings in blood sugar which can help to stabilise appetite and reduce overall food intake which will lead to weight loss.

Conversely, dosing with lots of insulin to cover a poor diet will lead to worsening insulin resistance with larger and larger doses of insulin to cover their poor diet.  This vicious cycle of progressively larger doses ends in tragedy as it becomes more difficult to maintain safe levels of glucose control and typical diabetic symptoms such as peripheral neuropathy, kidney and eyesight disease become unavoidable.

Lots of exogenous insulin will also suppress lipolysis and make you hungrier which will drive appetite further.

So, if you are taking antidiabetic medications, then a lower carb diet is a no-brainer.

What about everyone else?

For people who are insulin resistant but not full-blown diabetic, I’m still a big believer in reducing the insulin load of your diet to the point that you can achieve stable blood glucose levels, but not so much that you compromise nutrient density.  There is a trade-off between insulin load and nutrient density.

image36

Unfortunately, some people get so caught up in being ketogenic that they end up decreasing nutrient density and increasing the energy density of their diet so much that they end up putting on weight due to an excess energy intake.

There is now a growing movement of online groups of people who have been burned by this ‘keto or bust’ mentality, chasing ketone readings by ingesting copious amounts of refined dietary fats or exogenous ketones.

I think a more prudent approach is to titrate carbs down to the point that you achieve great blood sugars and then focus on improving food quality and nutrient density.

For most people, reducing carbohydrates is helpful, not because it may increase ketones, but because it is a means to manage and minimize chronically elevated blood glucose and insulin levels which are the primary drivers of metabolic complications.  Ultimately, we still need to address the cause of the problem (insulin resistance) via creating an energy deficit and losing body fat to below your Personal Fat Threshold.

image15

There are a range of studies that suggest that a lower carbohydrate diet is better for weight loss for people who are insulin resistant.[29][30][31][32] However, the recent DIETFITS Randomised Clinical Trial of 609 obese participants at Standford led by Christopher Gardner indicates that there wasn’t a statistically significant difference between the effects of a healthy lower fat versus a healthy lower carb diet for people who do not have diabetes.

The chart below shows that people who were more insulin resistant lost slightly more weight on a low carb diet (but not enough to be deemed statistically significant)/

image37

On average, both diet groups reduced their energy intake by about 500 calories, not by tracking, but by focusing on improving their diet quality (though again, the healthy low carb diet group reduced their energy intake by about 50 calories more than the healthy low-fat group).

image17

Perhaps one of the main reasons that a low carb diet works so well for so many people is that so many of them are insulin resistant.  A low carb diet quickly helps to stabilise blood glucose and insulin levels which in turn helps to normalise appetite as well as eliminating many processed nutrient poor hyper-palatable foods.

In this video, Chris Gardner explains that study and points out that it was the people who changed their relationship with food and learned to make more nutrient-dense whole food from fresh ingredients at home that did the best overall.

 

In line with these insights, the Nutrient Optimiser algorithm firth helps you to stabilise your blood glucose levels with a lower carbohydrate diet and then guides you to focus on more nutrient-dense whole foods which tend to be more satiating and enable you to spontaneously reduce your energy intake.

image21

Summary

  • If you are insulin sensitive, you will be able to grow both muscle and fat more effectively.
  • While many people think that insulin resistance causes obesity, you actually need to be relatively insulin sensitive to get morbidly obese.
  • You become insulin resistant when your fat cells become too full to hold the excess energy that you are taking in.
  • When you reach your Personal Fat Threshold, your body can no longer force excess energy into storage in your fat cells and it gets stuffed into other places that are more sensitive like your liver, your brain, your heart, your pancreas.
  • When your fat can no longer take up excess energy, it overflows into your bloodstream in the form of elevated glucose, ketones and free fatty acids.
  • Reducing carbohydrates can help manage the symptoms of diabetes and stabilise blood sugars. It can also avoid the excess fat storage that can often come with the use of excess exogenous insulin.  However, for people who do not have diabetes, focusing on nutrient-dense whole foods and maintaining an energy deficit will likely be more important to reverse diabetes and improve insulin resistance.
  • You can reverse insulin resistance by maintaining an energy deficit until you are below your Personal Fat Threshold. Your adipose stores will then have room to take up the extra energy without spilling it into the bloodstream and your vital organs.

 

Thanks

Special thanks for Mike Julian for sharing many of the insights and synthesis of ideas contained in this article as well as RD Dikeman (Type One GRIT), Alex Leaf (Examine.com), Raphi Sirt (BreakNutrition.com). Ben McDonald (Impulsive Keto), Carrie Burns Diulus, Mattias Lindberg (Diet Doctor), Phil Thompson, Robin Reyes and Gillian Ferwerda for their review comments!

 

References

[1]https://www.ncbi.nlm.nih.gov/pubmed/25515001

[2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4405637/

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

[4]https://www.nhs.uk/conditions/coronary-heart-disease/causes/

[5]https://www.medicalnewstoday.com/articles/298729.php

[6]https://www.medicalnewstoday.com/articles/265405.php

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

[8]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4405637/

[9]https://en.wikipedia.org/wiki/File:Coronal_Image_of_a_TOFI_and_a_Normal_Control.jpg

[10]https://link.springer.com/article/10.1007%2Fs13300-018-0373-9

[11]https://www.ncbi.nlm.nih.gov/pubmed/26628414

[12]https://www.express.co.uk/life-style/health/623499/losing-one-gram-fat-cure-diabetes

[13]https://idmprogram.com/fatty-pancreas-t2d-9/

[14]https://www.dietdoctor.com/how-losing-one-single-gram-of-fat-might-cure-diabetes

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

[16]https://emedicine.medscape.com/article/2089224-overview

[17]https://cf.research.chop.edu/ogtt.php

[18]https://www.facebook.com/BurnFatNotSugar/photos/a.364522923705531.1073741827.364516160372874/532154686942353/?type=3&theater

[19]https://www.amazon.com/Diabetes-Epidemic-You-Joseph-Kraft/dp/142517812X

[20]https://www.thebloodcode.com/homa-ir-calculator/

[21]https://www.thebloodcode.com/know-your-tghdl-ratio-triglyceride-hdl-cholesterol/

[22] The disposal of triglycerides provides insight into what your body is able to do with excess energy. Normal areas of short-term energy storage, like the liver, are at capacity. This proxy informs the actual behaviour of free nutrient. If the trigs are high, especially if the HDL is also diminished, it is implied that nutrient is unable to find easy storage locations with the current level of basal insulin.

[23]http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0103483

[24]http://www.mdpi.com/2072-6643/7/11/5475

[25]https://www.ncbi.nlm.nih.gov/pubmed/19789156

[26]https://www.ncbi.nlm.nih.gov/pubmed/8168647

[27]http://sci-hub.tw/10.2337/diab.43.5.696#

[28]https://www.nrv.gov.au/nutrients/protein

[29]https://onlinelibrary.wiley.com/doi/full/10.1002/oby.21331

[30]https://www.ncbi.nlm.nih.gov/pubmed/17063925

[31]https://www.ncbi.nlm.nih.gov/pubmed/15897479

[32]https://www.ncbi.nlm.nih.gov/pubmed/16306558