Category Archives: carbohydrates

vegan vs keto for diabetes… which is one optimal?

I recently watched the Mastering Diabetes teleseminar on ketogenic diets with high hopes of picking up some gems of wisdom from the rising stars of the plant-based diabetes community.

Unfortunately, I was underwhelmed with what I heard.

I shared my frustration on Facebook.

Robb Wolf suggested I put together a response to some of the misinformation in the teleseminar.  Hence this post.  [Robb did an excellent breakdown on the claims in the What the Health Netflix doco, What the Health: A Wolf’s Eye View, which I highly recommend checking out if you haven’t already.]

What’s actually wrong with the keto diet for diabetes?

Cyrus Khambatta (aka Mangoman) and Robby Barbaro (The Mindful Diabetic) should be uniquely qualified, both academically and experientially having themselves lived with type 1 diabetes for decades.

If I were was going to attack keto for diabetes management, then there would have been a couple of ‘free kicks’ I think they could have taken.  So, in fairness to both sides, I’ll touch on a few of what I see as legitimate issues with ‘popular keto’ before I dissect the Mastering Diabetes presentation.

Giving fat a free pass

Humans like things to be straightforward and binary.

Yes or No.

Black or white.

High fat or low fat.

Low carb or high fat.

High protein or low protein.

Plants only or animals only.

For the last four decades, we have been told that fat, particularly saturated fat, is bad because it causes heart diseases and should be avoided.

The tide is now turning.  However, there will always be people who take things to the extreme.

Now fat is healthy.  But is more is better?

Ketones are good.  So more is better?

For many people, a higher fat diet will be more satiating, particularly compared to processed grains and sugars.  However, not everyone can ‘eat fat to satiety’ without some level of restraint and self-discipline.  We can’t all trust our appetite to kick in to effortlessly provide the lean and chiselled body that they dream of.

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My personal experience is that you can overdo the fat and drive insulin resistance by pushing fat too hard.  If you exceed your ‘personal fat threshold’[1], your adipose tissues will become insulin resistant, and the body will start pushing excess energy to the vital organs.

While there is no need to fear fat, there is no reason to go hog wild to compensate for the butter and bacon deficiencies that we all developed over the past four decades.

When it comes to nutrition, you need to get your big rocks in place first (i.e. the nutrient dense foods).  You can then fill up with fuel such as fattier foods if you do not want to burn any body fat.  You could even add some starchy carbs if your blood sugars allow.

Having some level ketones is an indication that your insulin levels aren’t too high and your metabolism is working.  However, if you are not yet metabolically healthy, chasing ‘fauxtosis’ by loading up on butter, coconut oil, cream and exogenous ketones to achieve high blood ketone levels can be a recipe for hypercaloric metabolic disaster that will drive insulin resistance.

People with type 1 diabetes (such as the Mastering Diabetes guys and my wife Monica) have a unique insight into the various factors that affect their insulin sensitivity.  They can monitor their daily insulin dose.

I know some people with type 1 diabetes who have made an effort to chase higher ketones with more refined fat and less protein but found that they ended up needing more insulin.  Retreating to a moderate to high protein approach with less added fat (as per Dr Bernstein’s recommended approach for Type 1 diabetes) enabled them to improve their insulin sensitivity (e.g. check out Allison’s Nutrient Optimiser analysis here).

This phenomenon is not unique to people with type 1 diabetes.  There seem to be more and more people start out believing calories don’t count, only hormones.  They then put their faith in the ‘magic ketone fairy’ and end up driving insulin resistance and obesity chasing ‘optimal ketone levels’ with more and more added fat.[2]

I have a dream

Before we get into the nutritional analysis, permit me this indulgence to share my vision (with a hat tip to Martin Luther King) from Martin Laurence Kendall.

I have a dream that one-day nutrition will be defined by the nutrients that a food contains and the health benefits that it confers rather than religious and ethical beliefs or commercial interests.

I have a dream that all people, mothers and children, fathers and brothers, would be able to clearly understand the foods that are truly optimal for them.

I have a dream that one day all people afflicted with diabetes will be able to choose foods that will enable them to achieve normal blood sugars and restore the health and vitality that they deserve. 

Further, that they will be able to choose optimal foods, with engineering precision, without being affiliated with the needless ridicule that they will needlessly die of a heart attack due to unnecessary fears about ‘artery-clogging saturated fat’ or ‘harmful animal proteins’. 

I have a dream that one day people will have, freely in their grasp, quality nutritional information that enables them to make informed choices that will, in turn, bring about a new day in the commercial food environment. 

I dream that one day all people, obese, diabetic, children and athletes alike,  will be free from the corruption of Big Food and Big Pharma working through diabetes educators, diabetes associations, heart associations, medical institutions and animal welfare advocates.   

Free at least.  Free at last. 

I hope that one day we will be free at last. 

Indulgence over.  On with the data.

On with the data.

Nutrient deficiencies in a high-fat diet

Another fact that I thought Cyrus and Robby would mention was that very high-fat foods tend to have a weak nutrient profile, especially compared to non-starchy vegetables.

The chart below shows the nutrients provided by the 800 highest fat foods out of the 8000 foods in the USDA database.   If we prioritise fat, we will likely be lacking in around half of the essential nutrients.

A summary of some of the highest fat foods is shown below.

[For some real-life examples of the poor nutrient profiles achieved by people chasing high ketone levels in the misguided pursuit of weight loss check out the Nutrient Optimiser reports here, here, here here and here.]

Vitamins and minerals,  in particularly electrolytes such as potassium, magnesium and calcium are critical to support our mitochondria, enabling them to produce energy and maximise insulin sensitivity.

People in the keto community are conscious that electrolytes are essential and go out of their way to supplement with magnesium, calcium, sodium and potassium as well as taking bone broth.

The kidneys let go of water and electrolytes when insulin levels drop.  A ketogenic diet without attention to green leafy veggies is at risk of being very low in electrolytes.  This will cause the pancreas to secrete more insulin to hold onto the scarce electrolytes.  This increase in insulin levels may[3] ironically drive insulin resistance.

Whether you call them electrolytes or alkaline foods[5], our bodies need enough substrate to allow our kidneys to maintain a good acid/base balance without having to work too hard.  Focusing on minerals can helps us maximise insulin sensitivity and ensure oxygen is efficiently be carried around our bloodstream.

There are plenty of foods available to provide the micronutrients that you need if you actually require therapeutic ketosis as an adjunct to cancer, epilepsy or dementia.  We can achieve the Daily Recommended Intake (DRI) for most of the nutrients while still maintaining a low dietary insulin load.

The short list of foods that comprise a ‘well formulated ketogenic diet’ are shown below.

However, if you just need to manage diabetes with a low-carb diet (rather than therapeutic ketosis), you can achieve even higher levels of nutrition while maintaining stable blood sugars.

Given my family history of Type 2 and my wife Monica’s Type 1 diabetes, we generally focus on the foods listed below.  Lots of people have found these lists useful.  You can pin them to the fridge as a reminder of what you should focus on or print it out to take shopping next time when you need some inspiration.   (There is a complete list of nutrient dense foods to suit different goals at the end of this article.)

Now my blood glucose levels are more stable, I’ve been trying to back off on the higher fat foods and focus on more nutrient-dense foods to build muscle and lose fat.

The ‘problem’ with the most nutrient-dense foods (as shown below) is that they typically have a very low energy density so it will be nearly impossible to get enough energy to prevent rapid weight loss.

Prioritising nutrient-dense foods is the secret to obtaining the nutrients you need with the lowest energy intake.  If you don’t want to keep losing weight or want to run a marathon then adding some higher energy density foods will be useful.

High carbohydrate foods are not  nutritious

After watching the Mastering Diabetes teleseminar, you will get the feeling that the Mastering Diabetes guys believe carbohydrate can do no wrong and we should only fear fat.

The reality, however, is that the foods with the least fat are generally even more nutritionally corrupt than the highest fat foods.

Not all of the low-fat foods are going to be beneficial.

Defining your nutritional approach as ‘high carbohydrate’ is not wise, especially if you are trying to manage diabetes.  The foods with the most carbohydrates in our food system are typically very nutritionally deficient as well as highly insulinogenic.

If a ‘low carb diet’ leads you to avoid processed foods you may be better off.  However, I don’t think defining nutrition in terms of macronutrient extremes is particularly useful. [6]

Plant-based versus animal-based foods

One area where vegans potentially have it over carnivores is vitamins and minerals.  As shown in the chart below, a zero carb diet does not provide really high levels of many nutrients.

2017-06-26-5[1]

At the same time, there are plenty of people who appear to be thriving on a zero carb dietary approach.  Many people with severe autoimmune related digestive issues succeed when they switch to a zero carb approach.   Zero carb advocates will also tell you that they don’t need the recommended daily intake levels of the various micronutrients that are based on limited data or deficiency studies in people eating a standard high carb western diet.

2017-06-26-4[1]

A plant-based diet can provide a reasonably nutrient dense outcome.  However, it will be hard to get adequate levels of omega 3, vitamin D and vitamin B-12.  People following a strictly plant-based approach may need to supplement with these nutrients.

Achieving the minimum protein intake levels is possible.  However, many people have concerns about the reduced bioavailability of plant based proteins and whether or not the minimum protein intake levels are actually optimal, particularly if you are active or older.

It’s also worth noting that other nutrients such as iron, vitamin A and omega 3 will be more bioavailable from animal-based sources.  So it’s not as simple as comparing the nutrients in the food, what gets into your body is what really matters.

If you are going to follow a plant-based diet then prioritising the food listed below will give you the best chance of success.  Most people are going to do best somewhere on the spectrum between exclusively plant-based and solely animal-based foods.

The real problem comes when we start to heavily process our food.  Rather than prioritising the most nutrient dense and minimally processed vegetables, fruits and legumes, many vegans end up living on processed grains, cereal, sugar and soy products that have been treated with a host of fertilisers and pesticides.  Meanwhile, many zero carbers or keto peeps end up living on nothing but bacon or processed meats from animals that were fed nutrient poor corn and grains with added antibiotics to make them grow quicker.

The vegan echo chamber

I have spent a good chunk of time hanging out in many vegan or plant-based groups trying to understand their position and gain insights about nutrient density.  I have learned a lot from people like Professor Christopher Gardner, Ray Cronise and Dr Joel Fuhrman.  Much of the analysis in this is based on the integration of my learnings their work with Dr Richard Bernstein and Dr Matt Lalonde.

Unfortunately, it seems that the vast majority of vegan/plant-based education comes from Dr Michael Greger through his sanitised, highly processed and hyper-palatable “Nutrition Facts” videos.

While Greger covers a lot of relevant research and raises some valid points, a lot of the time he seems to twist the science to ensure that the moral of the story is always ‘eat plants, not animals’.  Plant-based is better.  Eating animals will be bad for your health.

Without evolutionary context, we are asked again and again to believe that fat (particularly saturated fat) and ‘animal protein’ (whatever the hell that is!) is the primary cause of heart disease, the complications of diabetes and practically every other modern health ill.

There is no demonstrated biochemical mechanism provided as to how we suddenly became allergic to animal products.  Meanwhile, vegans advocates generally give a free pass to sugar and processed grains.

With more than six million views and an estimated earnings of more than $100k per year from YouTube[7] (not to mention donations[8]), there appear to be a LOT of people eager to lap up the nutritional and medical justification of their ethical position.

Greger’s unique ‘interpretation’ of the scientific data all starts to make sense once you understand that he is the Director for Public Health and Human Agriculture for the Humane Society International.[9]

The mission of the Humane Society is to celebrate animals, confront cruelty and shape public opinion.

I wonder if Greger does his researching, writing, filming and editing the Nutrition Facts videos as a hobby after he gets home after working 50 hours a week and commuting?   Or perhaps he creates these videos as an employee of the Humane Society as part of their stated goal to shape public opinion on animal cruelty?

It seems Mangoman and Robby are pretty tight with Greger.[10]  Makes me wonder if Mastering Diabetes is a coordinated and strategic assault by the Humane Society on the low carb/keto/diabetes community who have become immune to Dr Greger.

I am by no means advocating animal cruelty.  However, as a human,  if you are looking for the best advice on human nutrition, is it wise to put your blind faith and unswerving trust in someone whose explicitly stated primary goal is animal welfare?

Do you really want to save the planet?

Worrying about whether we eat plants or animals exclusively is a modern luxury, an intellectual indulgence of sorts.

For the majority of human history, we have been opportunistic omnivores.  When plants were the only thing that was available, we would eat them.  When we could, we would chase down an animal to get the protein we need to thrive.  We never had to worry about nutrient density because the foods we ate grew in fertile soil without pesticides.  The animals we ate were eating their natural foods which were also nutritious for them.

Humans thrived and were able to populate the world because we learned to hunt, store, cook and process food.  We became very good at getting the nutrients we needed with the minimum amount of effort.[11][12] [13]

Unfortunately, we have now become too good at processing food.

Many of us are now fantasising nostalgically about Paleo times.

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It’s one thing to worry about saving animals, but ultimately we need to save the planet and our human race from accelerated extinction.

Our newfound ability to harvest fossil fuels enables us to move around in cars and grow a massive amount of food with chemical fertilisers.  These foods grow quickly and give us plenty of energy, but few nutrients that we then process and feed to animals or humans.[14]

Take a moment to think about how your life would be different if we had never discovered fossil fuels (e.g. coal or oil).  For as long as it lasts we are gorging ourselves on stored energy that is making us lazy and obese and driving not just us, but life as we know it to an early grave. If you want to care about something it should be the sustainability of the global environment (including animals and humans).

If you want to care about something it should be the sustainability of the global environment (including animals and humans).

While humans are probably the biggest threat to the long-term sustainability of earth as we know it, most of us aren’t willing to volunteer ourselves or our family as the first ones to check out to save the planet.

[If you want some challenging thoughts on this topic you should check out Daniel Vitalis’ Why I Hunt podcast.]

The plural of anecdote is not data

So, finally, onto the Mastering Diabetes video.

Cyrus and Robbie look like genuinely nice guys.

They are both living with type 1 diabetes.

They look like they’re happy and thriving on a plant-based diet full of fruits and vegetables.

To be honest, they look a lot healthier than many recovering diabetics in the low-carb scene.

But at the same time, the zero carbers will hold up anecdotes of people who have not eaten a plant for decades and look as great as the Johnson Family.

Or Dr Shawn Baker who is setting world records as a masters athlete since cutting plants out of his diet.

Then the keto folks will point to Dr Dominic D’Agostino who thrives on high fat and exogenous ketones and is exceptionally smart and can lift very heavy stuff at the same time.

 [15]

While it’s useful to look at populations of people following a particular diet to look for trends, anecdote does not equal data.

It is more useful to look at underlying metrics (such as nutrient density and insulin load) that we can use to identify the optimal diet for humans.

I thought they would know better

Cyrus Khambatta is a smart guy.  He was studying mechanical engineering at Stanford before he got type 1 and changed course to study nutritional biochemistry.

However, for all his ability in nutrition, engineering and mathematics (I took those classes, and I know how hard they are!), I thought he would have more to offer than what was presented!

People with diabetes get screwed around by the mainstream medical system and ‘diabetes education’ system.  The system doesn’t really understand how it works, so they give them bad advice (e.g. “just eat like we tell everyone else to and cover it with insulin”)!

I remember clearly the anxiety and confusion we experienced after going to an appointment with the hospital endocrinologist when my wife Monica was pregnant with our daughter.

At her visits, she would routinely be told that she needed to reduce her blood sugars to avoid the many serious risks and complications and risks for her and the baby.  Monica asked what else she could do to get the blood sugars down, but they had no advice.  They just wanted to see them lower.

We now have two healthy and wonderful kids, but I if I can I would love to see other people spared the anxiety as well as minimise the genuine health risks related to diabetes.  Hence my quest to understand how we can make intelligent food choices to optimise blood sugar and insulin levels.

What is the actual relationship between insulin and the food we eat?

The food insulin index data is a highly valuable resource that helps us to understand what causes us to secrete insulin and our blood sugars to rise.   The chart below shows the results of the food insulin index testing on more than 100 different foods (click to enlarge).

The food insulin index testing demonstrates clearly that we have the lowest insulin response to fats and oils while we have the highest insulin response to high carbohydrate foods like jelly beans and rice bubbles.   However, when we plot this data, we see that carbohydrate does not fully explain our insulin response.

We get a much better prediction of our insulin response when we account for protein (which requires insulin to metabolise) and non-digestible fibre.

Eating more fat will decrease the amount of insulin required to keep our blood sugars stable.

Eating more protein will reduce the amount of insulin your pancreas has to produce because it will push the more insulinogenic processed carbohydrates and sugar out of your diet.

How to improve your insulin sensitivity

If you reduce your intake of processed carbs and sugars, your insulin requirements will come down.  Once your organs and muscles are no longer swimming in insulin, you will become more insulin sensitive (just like you become more sensitive to coffee or alcohol if you cut back your intake).

If you are injecting insulin, reducing the insulin load of your diet will enable you to significantly reduce your insulin dosage which will, in turn, allow you to more easily access your own body fat stores for fuel.[16]

This data is an inconvenient truth for both high carb vegans or the nutritional recommendations such Food Pyramid / My Plate generated by the US Dept of Agriculture.  But I think it could be beneficial for people who want to effectively manage their diabetes.

Granted, if you switch your processed grains and sugar for fruits and vegetables, you will do better.  But is it really optimal?

If you can’t win, move the goalposts!!!!

So what do you do if you can’t win with science?

You change the rules!  You move the goalposts.

It was Cyrus and Robby’s unique definition of insulin resistance that really frustrated me.

So you can understand my frustration, I need to explain the difference between basal and bolus insulin which is a daily reality for someone with type 1 diabetes.

  • Bolus insulin is taken with food and is proportional to the insulin load of the food they eat (i.e. carbs – fibre + half protein)[17].
  • Basal insulin is the insulin that your pancreas would produce through the day and night whether or not you eat anything.  It’s the basal insulin that keeps your fat in storage and your muscles from being used for fuel.

You need both, but their function is different.

For someone eating a standard western diet about one-third to a half of their insulin will be basal insulin with the majority being bolus insulin for the food you eat.

When you switch to a low carb or keto diet this ratio flips and the majority of your insulin is basal insulin.  You only need a little bit of bolus insulin to cover the small amount of carbohydrates and protein that you eat.   With less glucose to deal with, you don’t need as much insulin, and your blood sugars stabilise.[18]

A significant portion of the Mastering Diabetes video was devoted to explaining their new creative definition of insulin sensitivity.  The fundamental problem with this central piece of the Mastering Diabetes argument is that it conflates basal and bolus insulin.  Your basal insulin is irrelevant if you are trying to do this sort of insulin sensitivity calculation!

It’s just the bolus insulin (i.e. for food) that matters when it comes to insulin sensitivity.  The calculations in the table below demonstrate my point.   If you take the denominator to your insulin sensitivity calculations to be the basal + bolus insulin, then the high carb approach has a better insulin sensitivity.  If you only consider the bolus insulin (the only sensible approach in my view), then you declare the low-carb approach to be the winner.

  low carb high carb conclusion
ISF (g carb/unit insulin) 6 5
carbs (g) 50 500
bolus insulin (units) 8.3 100
basal insulin (units) 20 20
total daily insulin (per day) 28 120
24 carb / 24-hour insulin (basal + bolus) 1.8 4.2 High carb is better
24 carb / 24-hour insulin (bolus only) 6.0 5.0 Low carb is better

The chart below shows the difference in the daily blood sugar fluctuations of someone on a standard western diet and then after switching to a lower carb diet.  The difference in the blood sugar levels is night and day!  The difference in the quality of life between these two situations when it comes to energy levels, anxiety, depression, mood etc. is also immensely different.

I pinged Mastering Diabetes on their Facebook page to clarify if the cornerstone of their whole argument includes basal and bolus insulin.  Unfortunately, my fears were confirmed (though they have since deleted their response and kicked me out of their Facebook Group).

Tight blood sugar control isn’t that important after all?

The next argument they try to run is that tight blood sugars really aren’t that necessary.

Cyrus (who is very active and practices intermittent fasting) has a Hba1c in the high 5s.

Robbie has a Hb1c in the low 6s.

Granted, this is good compared to the majority of the Type 1 population. They’ll have a better chance of thriving with good blood sugars if they are eating lots of vegetables and fruit compared to more processed grains and sugars that make up the typical diet.  But it’s still a far cry from the blood sugar control of people following the type of low-carb approach advocated by Dr Richard Bernstein.

The problem I see with defining your diet as vegan or plant-based is that most people don’t have the self-discipline to stick with eating only vegetables and fruit and end up filling up on more processed (but still technically vegan) processed junk food.

Cyrus and Robbie argue that normal blood glucose fluctuations are between 70mg/dL to 145 mg/dL or 3.8 to 8.0mmol/L.

The problem with this argument is that what currently passes for ‘normal’ is far from optimal.[19]  Complications from diabetes start to kick in well below what is widely considered “normal”.


Just because it’s normal for most people to do Facebook on their phone while they drive doesn’t mean it’s ideal or optimal.  Just because it’s normal to have poor blood sugar and most people are dying of metabolic diseases doesn’t sound like a persuasive argument for plant-based diet being optimal to me!

If you’re happy to settle for less than optimal blood sugar control because you have a strong ethical position, then that’s fine, but don’t construe it as optimal for everyone when it’s not.

The reality is that many people over at Type 1 Grit following Dr Bernstein’s approach are doing fabulously!  Not everyone will achieve optimal, but it’s useful to know what to aim for and how to get there.

If you had a child or loved one with Type 1 diabetes would you want the opportunity to choose the approach that would yield the best results or would you prefer your advice to be tainted with ethical or commercial bias?

Check out the video the Type 1 Grit group put together for Dr B’s 83rd birthday to thank him for changing their lives.

Insulin resistance and metabolic syndrome are a big deal, so let’s not ruin more lives than we need to with bad advice that is based on bad math or putting ethical convictions or religious beliefs ahead of human health.

Understanding physiological insulin resistance

Cyrus and Robbie argue that someone on a low carb diet won’t deal with carbohydrate well when they are exposed to them.  This phenomenon is real, but is typically due to what is termed ‘physiological insulin resistance’.

Someone who eats a lot of carbohydrates will have high levels of insulin floating around in their bloodstream.  Then when they eat a carb bolus, their pancreas is primed to shoot out some more insulin to mop up the glucose and stop more glucose being released into the bloodstream via the liver.  By contrast, someone who doesn’t eat a lot of carbohydrates will have low levels of insulin in their bloodstream and need to wind up their pancreas to produce insulin to bring down the glucose.

This phenomenon is also referred to the first phase versus second insulin response.  Someone who is not eating a lot of carbs will have a slower first phase insulin response.

It’s like comparing someone’s time over 100m when they are starting from a standstill versus someone using a rolling start.  It’s not a relevant comparison.  This phenomenon will go away after a few days on a high carb diet.

At the same time though, micronutrients such as potassium, magnesium and calcium are critical to maintaining healthy insulin sensitivity and glucose uptake.   Metabolic acidosis (caused by a lack of dietary electrolytes) appears to cause an upregulation in insulin by the pancreas to hold onto precious electrolytes.  Over the long term, this could be another driver of insulin resistance, metabolic syndrome and diabetes. [20]

Getting adequate dietary electrolytes from green leafy vegetables will make it easier for our body to maintain acid/base balance.  However, I don’t think we need to feed all diabetics a high carbohydrate exclusively plant-based diet to achieve this.

Eating fat makes you fat?

The vegan community seems to confuse eating fat and storing fat.  The Ancel Keys / vegan story is that we store fat in our body because we overeat dietary fat.  However, the reality is that we get fat because we eat more than we burn.

As shown in the graphic below from Ray Cronise’s Oxidative Priority paper, we will only burn fat (from our body or diet) once we’ve burned through the alcohol, ketones, protein and carbohydrate and fat that we eat (in that order).[21]

When we eat our body prioritises the refilling of our glucose and glycogen stores in our blood stream and liver (which can hold about 1200 to 2000 calories) before we start to store the excess energy in our adipose tissue.  Our body fat stores can hold a lot more energy, but not an unlimited amount.  Once our fat stores are full and can hold no more, they become insulin resistant.  We then start to store the excess energy in our vital organs such as our liver, kidney, brain, eyes, heart, etc.

The trick to weight loss is to keep your blood sugar levels low enough so that your liver glycogen is being replenished from your body fat rather than always having overfull glycogen stores, so we need to offload excess energy to our fat stores.[22]

One of the many roles of insulin is to shut off the flow of stored energy from the liver into the bloodstream.  If energy is coming in the pancreas will upregulate insulin to stop the flow of glucose from the liver back into the bloodstream (regardless of whether you’re eating carbs, fat or protein from animal or plant-based sources).  The best way to reduce insulin is to stop eating and let your stored energy flow back into your bloodstream.

In a way, you can think of your liver as your fuel tank and you your blood glucose meter as the fuel gauge.  If your blood sugars are high, you should think twice about whether you really need more fuel now.

If you are insulin sensitive, the bad news is that you can easily store excess energy as body fat very efficiently.  Insulin is an anabolic hormone that will help you to grow.  However, when you are insulin sensitive, you can lose fat relatively quickly when you reduce energy intake.  If you are insulin sensitive your circulating insulin levels will be low, and fuel will more easily flow from storage.  Hence you won’t be such a mindless slave to your uncontrollable appetite.

If you are insulin resistant and have high levels of circulating insulin, you may struggle to release your stored body fat.  Your appetite will drive you to seek out food because you can’t efficiently access it from your body stores.   You won’t be able to go very long between meals.

A low-carb diet can be helpful for someone who is insulin resistant because it can help lower insulin which in turn help them to normalise their appetite.  Teaching that we get fat because we eat fat is just outdated science.

Even Dr Joel Fuhman will tell you that actively avoiding fat is stupid.  He will also tell you that there is some value in eating fish on a regular basis to ensure you get adequate amounts of omega 3s and vitamin B-12.

Complications on a ketogenic diet

There are plenty of studies that show the shortcomings of a ketogenic diet.  Sarah Ballantyne did a great job of summarising these on her Paleo Mom Blog here.

When you look in detail however you find that the adverse reactions the ketogenic diet are typically due to ‘keto in a can’ formula products.

While these food substitutes will help achieve therapeutic ketosis to help manage epilepsy or other chronic conditions, many of these keto formula products end up being very low in micronutrients.[23]

Obtaining a significant amount of your energy intake from processed food-like products that have been separated from nutrients is not a good idea (e.g. whether it be sugar, processed grains, refined oils or exogenous ketones).

Is a low-carb diet actually good for diabetes?

Unfortunately, Cyrus and Robby didn’t mention the benefits of a low-carb diet for people with diabetes which are fairly well documented.  The seminal paper that summarises much of the latest work in this area is documented in Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base.

Anyone who is on the fence about using a low-carb diet to manage diabetes should check out this paper which shows that a low-carb diet is better for weight, HbA1c, glucose, HDL and triglycerides compared to low GI or a grain-based diet.

Another well-known study is Christopher Gardener’s A to Z trial[24]  where they found that the Atkins diet did much better than the low-fat, particularly if you were already insulin resistant.[25]

Image result for atkins at to z

What should you eat if you are a vegan with diabetes?

So, after all this, what should we eat to maintain optimal blood sugar levels?  Cyrus and Robby’s view is shown below.    Unfortunately, it appears that their recommendations are driven more by their philosophical and ethical views rather than the nutrient content of the food or their ability to stabilise blood sugars.

  • In the green column, most people with diabetes aren’t going to do too well with a lot of fruits, starchy veggies, and beans. Intact whole grains do contain substantial nutrients but are very hard to find in our modern food system.  Who actually eats wheat bran as a significant part of their diet?  The vast majority of grains are processed with the nutrients discarded, so they are tasty and shelf stable.
  • In the red column, dairy eggs, meat, fish and poultry can be nutrient dense and keep your blood sugars stable (as long as you’re not afraid of fat in whole foods or ‘animal protein’).
  • In the orange column, higher fat foods like nuts, seeds, avocados, coconut and olives can be useful to help stabilise your blood sugars, but it is possible to overconsume them if your goal is to lose weight.

We want to maximise nutrient density as much as possible while keeping the insulin load of our diet down to the point that we keep blood sugars stable.

This does not end up being super high fat or super low fat.  Fat just comes along with nutritious whole foods.

If you have diabetes, then a little more dietary fat initially may help to stabilise blood sugars.  Once your blood glucose levels have stabilised, you can start to decrease the dietary fat and increase nutrient density as much as you can while still maintaining excellent blood sugar levels.

A low insulin load diabetes-friendly plant-based nutritional approach will be lacking omega 3 and vitamin B-12.

The shortlist of nutrient dense low insulin load plant-based foods is shown below.  The foods at the top of each section should be reasonably safe for most people with diabetes.  You should test your blood sugars to see how you respond to some of the foods further down the list.

Many people who are conscious of animal welfare will eat fish (i.e. pescetarian).  Adding some fish will provide a much better nutritional profile than eating plants alone, with plenty of vitamin B12 and omega 3 available from the seafood.

I hope this is helpful for people who want to choose a plant-based approach to maximise nutrient density and maintain excellent blood sugar control.

If you’re still confused, I have designed the Nutrient Optimiser to identify what foods you should add or remove from your diet to ensure you are getting the nutrients you need while maintaining excellent blood sugar levels.

So which approach is optimal?

It depends.

The optimal approach for you will depend on your situation and goals.

Going plant based may be an improvement if your diet is currently full of sugar and processed grains, but it is not the singular solution to every ill.  (For an excellent example of a very nutrient dense plant-based dietary approach check out David’s Nutrient Optimiser analysis here.)

To help you make more informed food choices, I have devised two different ways of measuring food quality:

  • Proportion of insulinogenic calories, and
  • Nutrient density.

The proportion of insulinogenic calories is the percentage of the food you eat that will require insulin to metabolise.  The table below lists a range of nutritional approaches ranked by the percentage of insulinogenic calories (right-hand column).

If you’re interested in any of these approaches, you can download the list and save it to your phone or print it out to take shopping for some inspiration.

approach pdf foods nutrient profile % insulinogenic
well formulated ketogenic diet pdf foods profile 21
low carb pdf foods profile 34
plant based (diabetes friendly) pdf foods profile 56
weight loss and insulin resistance pdf foods profile 59
low carb pescitarian pdf foods profile 61
the most nutrient dense foods pdf foods profile 67
plant-based pdf foods profile 68
plant based (without ND) profile 73

Simply switching to a plant-based nutritional approach will leave you with 73% of your diet requiring insulin to metabolise.  The diabetes-friendly plant-based approach will be an improvement, but a low-carb or ketogenic diet may be better if your goal is stable blood glucose levels.

Another way to look at things is nutrient density.  You may have noticed the nutrient profiles shown above have a red dotted box.  If a particular nutritional approach provides two times the Daily Recommended Intake for all essential nutrients, then you would get a perfect score of 100%.  You can see below that the most nutritious foods below are pretty close to 100%.

By contrast, if we only focus on ‘plant-based foods’ nutritional outcome is not so flash.  Thinking only in terms of plant-based is not automatically nutrient dense.

I have sorted the various food lists in the table below based on their nutrient score.  My suggestion is to start at the top with the most nutrient dense foods and work your way down until you find an approach that suits your ethical framework or religious beliefs that will also enable you to stabilise your blood glucose levels (i.e. lower % insulinogenic calories).

approach score pdf foods nutrient profile % insulinogenic
the most nutrient dense foods 99.7% pdf foods profile 67
weight loss and insulin resistance 99.3% pdf foods profile 59
low carb pescitarian 94.5% pdf foods profile 61
low carbohydrate 81.0% pdf foods profile 34
plant based 78.0% pdf foods profile 68
plant based (diabetes friendly) 76.0% pdf foods profile 56
well formulated ketogenic diet 74.0% pdf foods profile 21
plant based (without ND) 57.0% profile 73

Summary

  • While many people chose exclusively plant-based foods, they are not necessarily a better dietary choice compared to a more varied diet.
  • Someone following an exclusively plant-based approach will require supplementation with vitamin B-12, vitamin D and omega 3s.
  • Fat is not necessarily good or bad. Swinging to macronutrient extremes will not lead to an optimal outcome.
  • Reducing the insulin load of your diet will help to normalise your blood sugar and insulin levels.
  • Ideally, you should aim to achieve the blood sugars of a metabolically healthy person while maximising nutrient density at the same time.

 

references

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

[2]https://optimisingnutrition.com/2015/07/20/the-glucose-ketone-relationship/

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

[4]https://www.quackwatch.org/01QuackeryRelatedTopics/DSH/coral2.html

[5]https://authoritynutrition.com/the-alkaline-diet-myth/

[6]https://optimisingnutrition.com/2017/03/19/micronutrients-at-macronutrient-extremes/

[7]https://socialblade.com/youtube/user/nutritionfactsorg

[8]https://nutritionfacts.org/donate/

[9]http://www.hsi.org/about/who_we_are/leadership/subject_experts/michael_greger.html

[10]https://www.facebook.com/mangomannutrition/videos/656469947843978/

[11]https://optimisingnutrition.com/2016/10/23/energy-density-food-hyper-palatability-and-reverse-engineering-optimal-foraging-theory/

[12]https://en.wikipedia.org/wiki/Optimal_foraging_theory

[13]http://www.hoajonline.com/obesity/2052-5966/2/2

[14]https://www.amazon.com/Dorito-Effect-Surprising-Truth-Flavor/dp/1476724237

[15]https://fineartamerica.com/featured/8-muscleart-marius-poser-classic-jake-hartz.html

[16]https://www.ncbi.nlm.nih.gov/pubmed/21241239

[17]https://optimisingnutrition.com/2015/08/10/insulin-dosing-options-for-type-1-diabetes/

[18]https://www.facebook.com/Type1Grit/

[19]https://optimisingnutrition.com/2015/07/20/the-glucose-ketone-relationship/

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

[21]http://online.liebertpub.com/doi/full/10.1089/met.2016.0108

[22]https://optimisingnutrition.com/2016/02/15/how-to-use-your-glucose-meter-as-a-fuel-gauge/

[23]http://ketotalk.com/2016/06/23-responding-to-the-paleo-mom-dr-sarah-ballantynes-claims-against-the-ketogenic-diet/

[24]http://jamanetwork.com/journals/jama/fullarticle/205916

[25]http://onlinelibrary.wiley.com/doi/10.1002/oby.21331/full

 

post udpated September 2017

 

 

micronutrients at macronutrient extremes

In the previous article, Which Nutrients is YOUR Diet Missing?, we looked at the micronutrients that you might be lacking when following popular dietary strategies such as vegan, Paleo, keto, or zero carb.

As a follow-up, I thought it would be interesting to look at the effect on essential micronutrients if we define our dietary approach in terms of macronutrient extremes such as low carb, high fat, high protein, high carb, or low protein.

Humans tend to think in extreme terms.  It’s easy to follow a binary approach to nutrition, but which, if any, of these are the most useful in terms of maximising the nutrition provided by our diet?

For most of my life, best practice nutrition has been defined by a fear of fat which spawned the low-fat processed food era.

And because protein is necessary for muscle growth, more must be better?

But protein is also insulinogenic, so less protein must be good.  Right?

And then of course there is low carb, which has been popular since the appearance of the Atkins diet appeared in the early 1970s.

atkins.jpg

But then there are a good number of people who still define their diet as being high carb.

Banana-girl-.jpg

All of them seem to be similarly zealous about their all-or-nothing approach.

But are any of these macronutrient extreme approaches beneficial?  And if so, which one leads us to the optimal selection of nutritious foods that will lead to health, happiness, optimal weight, and longevity?

why bother with nutrient density?

The premise of nutrient density is that we want to maximise the quantity of essential micronutrients that we need to support our bodily functions while not overdoing energy intake.

Micronutrient dense foods allow us to obtain adequate nutrition with fewer calories.  Then, with our nutrients accounted for, higher micronutrient density might just lead to higher satiety levels, reduced appetite, reduced food intake and optimal body fat levels.

At the other extreme, if we consume fewer foods with a lower nutrient density, we will likely end up needing to consume more food to obtain the nutrients we need to survive and thrive.  If our appetite drives us to keep on eating until we obtain the nutrients we need, we may end up having to consume too much energy and and end up storing unwanted energy as fat.

macronutrient comparison

In this post, we’ll look at the micronutrients provided by the highest-ranking foods when we sort the eight thousand foods in the USDA database by the most and least fat, protein, and carbs.

Approach % protein % fat % net carbs % fibre
high fat 14% 82% 3% 1%
low net carbs 33% 67% 0% 0%
most nutrient dense 49% 19% 20% 12%
high protein 77% 22% 1% 0%
least nutrient dense 7% 32% 59% 2%
low protein 1% 27% 68% 3%
low fat 8% 1% 84% 7%
high net carbs 3% 2% 92% 2%

This chart shows the macronutrient split for these extreme approaches.

fat

While low carb is still in the lead in terms of internet searches (as shown in the Google Trends data below), the ketogenic diet is becoming pretty popular these days.

The chart below shows the nutrients provided by 2000 calories of the fattiest foods.  Nutrients are expressed in terms of the percentage of the daily recommended intake (DRI), for each nutrient, per 2000 calories (i.e. a typical daily intake).

While we achieve adequate amounts of about half of the essential micronutrients with a therapeutic ketogenic diet, we may need to consider supplementing some of the harder to obtain nutrients such as vitamin C[1], vitamin D, potassium, choline, vitamin K, and magnesium.

Looking at things from the other extreme, a low-fat diet will give you a ton of vitamin C, sodium, manganese, and iron.  However, it will be harder to obtain adequate quantities of the twenty-one essential nutrients, particularly essential fatty acids.

saturated fat

These days, the US Dietary Guidelines have lifted their limit on fat and cholesterol but retained their limitation on saturated fat.  Saturated fat and trans fats remain the two nutrients that we are advised to avoid.

The chart below shows the outcome when we avoid saturated fat.  The top 10% of foods with the lowest saturated fat are lacking (i.e. < 100% DRI) in nineteen essential nutrients.

At the other extreme, foods with the most saturated fat are slightly better with seventeen essential micronutrients lacking.

As discussed in the ‘What about Saturated Fat?’ article, I think saturated fat is neither a concern nor a priority.  Saturated fat a great clean-burning fuel, but there’s no need for us to make up for the last four decades of avoidance by suddenly binging on it.

The chart below shows a comparison of the nutrient density of the quartiles of saturated fat in terms of percentage of energy.  It seems that the foods with moderate levels of saturated fat that are the most nutrient dense.

protein

Once you move past the fear of fat, the next hot topic is optimal protein levels.

The ‘high protein bros’ recommend more protein for muscle growth and satiety, while many in the low carb/keto community target lower protein levels for longevity and ketosis through minimising insulin and mTOR signalling.[2]

As shown in the chart below, when rank foods to minimise protein, we end up with only four essential nutrients meeting the recommended daily guidelines to prevent malnutrition.

At the other extreme, if we prioritise protein we end up with ten nutrients that we fall short of.  The other twenty-six essential nutrients meet the minimum recommended levels.

Not only does protein contain essential amino acids, this analysis indicates that higher protein foods generally come bundled with high amounts of vitamins and minerals, such as vitamin B-12, selenium, vitamin B-6, riboflavin and copper.

It’s one thing to talk about targeting the minimum daily protein that you can get away with if you are looking to preserve muscle in fasting or extreme calorie deprivation during long term weight loss.  It’s a whole different discussion if you’re looking to minimise protein while making up the rest of your daily energy intake with fats or carbs!

carbohydrates

The chart below shows the nutrients we obtain if we maximise energy from non-fibre digestible carbohydrates (i.e. net carbs).  This high carb approach provides adequate amounts of twelve of the essential nutrients, while still being inadequate in twenty-four essential nutrients.

The chart below shows that low carb performs better than high carb, only falling short in sixteen essential micronutrients.

One of the benefits of a low carb approach, is that it often forces the elimination of many processed foods that fill the supermarket shelves to satisfy the demand for low fat foods driven by the admonition by the for the last four decades by the ruling dietary establishment to minimise fat.

A nutrient dense diet contains less non-fibre carb than the typical diet, but some people will do better, at least for a while, on a carb restricted diet.  Another major benefit of low carb is for insulin resistant people when they can lower their blood glucose and insulin levels on a carb restricted diet.  Many people find it easier to lose excess body fat once they have restored their insulin sensitivity.

nutrient density

You’re probably wondering where all these analyses are headed.

With all of these extreme approaches being so deficient in many micronutrients, you must be thinking “I hope there is a happy ending to this story, and soon.”

The good news is that we can manipulate our food selection to maximise micronutrients.  But first, here’s something to scare you even more.

The chart below shows the outcome when we minimise the harder-to-find nutrients.  This low nutrient density approach ends up being adequate in only three essential nutrients: sodium, vitamin C and iron.

The good news is shown in the chart below, which quantifies the nutrients provided by the most nutrient dense foods when we prioritise for the harder to find nutrients.  Alpha linolenic acid (found mainly in nuts and seeds) is hard to come by in adequate quantities, however we can obtain the daily recommended intake of all the other nutrients when we prioritise the harder to find micronutrients.

comparison of nutrients adequate

It’s a little hard to present and digest this analysis clearly.  There is no agreed protocol to compare the nutrient density foods.  So I’ve tried to summarise it in a number of different ways to allow you to draw your own conclusions.

Firstly, the chart below shows the number of nutrients that each macronutrient extreme is adequate in, from the most nutrient dense at the top to the least nutrient dense at the bottom.

The chart below shows a stacked bar chart of the various nutrients in terms of % DRI.  It’s like we have added up all the above charts for each nutrient and stacked them on top of each other.  This chart demonstrates that there is a is a massive difference between the most nutrient dense and least nutrient dense approaches.  If you’re foods that have a lower nutrient density you might just be hungrier compared to if you are eating the same number of calorie of the most nutrient dense foods which will much more effectively provide you with your essential micronutrients.

But  we needn’t be too concerned about the micronutrients that are easy to obtain.  What we really care about is the nutrients that are harder to obtain.  The chart below shows the sum of the eighteen nutrients that are harder to obtain for each extreme approach.

application

It seems that thinking in terms of macronutrient extremes has some usefulness.  However, focusing on micronutrient density seems to provide an order of magnitude improvement in the level of actual nutrients provided by our food.

Maybe it’s time for a new trend?

The ‘problem’ with nutrient dense foods is that that they are so lean and contain so much fibre that it can be hard to consume enough calories to maintain weight.  You’ll just be too full!

If you are insulin sensitive and not looking to lose weight, then you could consider adding some more ‘Paleo friendly’ carbs such as beets, squash, yams, and sweet potatoes, and/or some fattier cuts of meat to fuel your activity.  If you are insulin resistant, you may need to add some fattier (but still relatively nutrient dense) foods to maintain your weight while also keeping your blood glucose and insulin levels in check.

Perhaps micronutrient density is the most important parameter to pursue in our diet.  Then with that cornerstone in place we can personalise our nutritional approach to suit our goals (e.g. weight loss, ketosis, athletic performance or healthy maintenance).

The various food lists in the table below are designed with micronutrient density as the main priority, but also consider insulin load and energy density to suit different goals.

approach average glucose waist : height
(mg/dL) (mmol/L)
therapeutic ketosis > 140 > 7.8
diabetes and nutritional ketosis 108 to 140 6.0 to 7.8
weight loss (insulin resistant) 100 to 108 5.4 to 6.0 > 0.5
weight loss (insulin sensitive) < 97 < 5.4 > 0.5
bulking < 97 < 5.4 < 0.5
nutrient dense maintenance < 97 < 5.4 < 0.5

personalisation

In the end, no one sticks to an optimal list of foods that perfectly balances their diet 100% of the time.

I’ve been working on a system that will give you feedback on YOUR current diet, identify which nutrients you are currently lacking, and which supplements or real whole foods you may need to add or subtract to optimise your nutrition.  Most people don’t eat perfectly all the time, but we could all use some help moving forward towards optimal.

Check out the Nutrient Optimiser page for more details.

 

notes

[1] There is a strong case for the idea that the DRI for vitamin C could be relaxed for a diet with lower glucose.  See http://breaknutrition.com/ketogenic-diet-vitamin-c-101/ and http://orthomolecular.org/library/jom/2005/pdf/2005-v20n03-p179.pdf

[2] Check out this video by Ron Rosedale for an overview of the topic of protein, mTOR signalling and longevity.  https://www.youtube.com/watch?v=xtZ0LqUBySQ

energy density, food hyper-palatability and reverse engineering optimal foraging theory

In Robb Wolf’s new book Wired to Eat he talks about the dilemma of optimal foraging theory (OFT) and how it’s a miracle in our modern environment that even more of us aren’t fat, sick and nearly dead.[1]

But what is optimal foraging theory[2]?   In essence, it is the concept that we’re programmed to hunt and gather and ingest as much energy as we can with the least amount of energy expenditure or order to maximise survival of the species.

In engineering or economics, this is akin to a cost : benefit analysis.  Essentially we want maximum benefit for minimum investment.

image13

In a hunter-gatherer / paleo / evolutionary context this would mean that we would make an investment (i.e. effort / time / hassle that we could have otherwise spent having fun, procreating or looking after our family) to travel to new places where food was plentiful and easier to obtain.

In these new areas, we could spend as little time as possible hunting and gathering and more time relaxing.  Once the food became scarce again we would move on to find another ‘land of plenty’.

The people who were good at obtaining the maximum amount of food with the minimum amount of effort survived and thrived and populated the world, and thus became our ancestors.  Those that didn’t, didn’t.

You can see how the OFT paradigm would be well imprinted on our psyche.

OFT in the wild

In the wild, OFT means that native hunter-gatherers would have gone bananas for bananas when they were available…

image28

… gone to extraordinary lengths to obtain energy dense honey …

image16

… and eat the fattiest cuts of meat and offal, giving the muscle meat to the dogs.

image02

OFT in captivity

But what happens when we translate OFT into a modern context?

image09

Until recently we have never had the situation where nutrition and energy could be separated.

In nature, if something tastes good it is generally good for you.

Our ancestors, at least the ones that survived, grew to understand that as a general rule:

 sweet = good = energy to survive winter

But now we have entered a brave new world.

image19

We are now surrounded by energy dense hyper-palatable foods that are designed to taste good without providing substantial levels of nutrients.

image05

Our primal programming is defenceless to these foods.  Our willpower or our calorie counting apps are no match for engineered foods optimised for bliss point.

image14

These days diabetes is becoming a bigger problem than starvation in the developing world due to a lack of nutritional value in the foods they are eating.[3]

The recent industrialisation of the world food system has resulted in a nutritional transition in which developing nations are simultaneously experiencing undernutrition and obesity.

In addition, an abundance of inexpensive, high-density foods laden with sugar and fats is available to a population that expends little energy to obtain such large numbers of calories.

Furthermore, the abundant variety of ultra processed foods overrides the sensory-specific satiety mechanism, thus leading to overconsumption.”[4]

what happens when we go low fat?

So if the problem is simply that we eat too many calories, one solution is to reduce the energy density of our food by avoiding fat, which is the most energy dense of the macronutrients.

Sounds logical, right?

The satiety index demonstrates that there is some basis to the concept that we feel more full with lower energy density, high fibre, high protein foods.[5] [6]   The chart below shows how hungry people report being in the two hours after being fed 1000 kJ of different foods (see the low energy density high nutrient density foods for weight loss article for more on this complex and intriguing topic).

image21

However the problem comes when we focus on reducing fat (along with perhaps reduced cost, increased shelf life and palatability combined with an attempt to reach that optimal bliss point[7]), we end up with cheap manufactured food-like products that have little nutritional value.

image10

Grain subsidies were brought in to establish and promote cheap ways to feed people to prevent starvation with cheap calories.[8]  It seems now they’ve achieved that goal.[9]

image07

Maybe a little too well.

image01

The foods lowest in fat, however, are not necessarily the most nutrient dense.     Nutritional excellence and macronutrients are not necessarily related.

In his blog post Overeating and Brain Evolution: The Omnivore’s REAL Dilemma Robb Wolf says:

I am pretty burned out on the protein, carbs, fat shindig. I’m starting to think that framework creates more confusion than answers.

Thinking about optimum foraging theory, palate novelty and a few related topics will (hopefully) provide a much better framework for folks to affect positive change. 

The chart below shows a comparison of the micronutrients provided by the least nutrient-dense 10% of foods versus the most nutrient dense foods compared to the average of all foods available in the USDA foods database.

image18

The quantity of essential nutrients you can get with the same amount of energy is massive!  If eating is about obtaining adequate nutrients then the quality of our food, not just macronutrients or calories matters greatly!

Another problem with simply avoiding fat is that the foods lowest in fat are also the most insulinogenic, so we’re left with foods that don’t satiate us with nutrients and also raise our insulin levels.  The chart below shows that the least nutrient dense food are also the most insulinogenic.


what happens when we go low carb?

So the obvious thing to do is eliminate all carbohydrates because low fat was such a failure.  Right?

image20

So we swing to the other extreme and avoid all carbohydrates and enjoy fat ad libitum to make up for lost time.

The problem again is that at the other extreme of the macronutrient pendulum we may find that we have limited nutrients.

The chart below shows a comparison of the nutrient density of different dietary approaches showing that a super high fat therapeutic ketogenic approach may not be ideal for everyone, at least in terms of nutrient density.  High-fat foods are not always the most nutrient dense and can also, just like low-fat foods, be engineered to be hyperpalatable to help us to eat more of them.

image24

The chart below shows the relationship (or lack thereof) between the percentage of fat in our food and the nutrient density.   Simply avoiding or binging on fat does not ensure we are optimising our nutrition.

image12

While many people find that their appetite is normalised whey they reduce the insulin load of their diet high-fat foods are more energy dense so it can be easy to overdo the high-fat dairy and nuts if you’re one of the unlucky people whose appetite doesn’t disappear.

image08

what happens when we go paleo?

So if the ‘paleo diet’ worked so well for paleo peeps then maybe we should retreat back there?  Back to the plantains, the honey and the fattiest cuts of meat?

image27

Well, maybe.  Maybe not.

image06

For some people ‘going paleo’ works really well.  Particularly if you’re really active.

Nutrient dense, energy dense whole foods work really well if you’re also going to the CrossFit Box to hang out with your best buds five times a week.

image11

But for the rest of us that aren’t insanely active, then maybe simply ‘going paleo’ is not the best option…

image25

… particularly if we start tucking into the energy dense ‘paleo comfort foods’.

image03

If we’re not so active, then intentionally limiting our exposure to highly energy dense hyper palatable foods can be a useful way to manage our OFT programming.

enter nutrient density

A lot of people find that nutrient dense non-starchy veggies, or even simply going “plant-based”, works really well, particularly if you have some excess body fat (and maybe even stored protein) that you want to contribute to your daily energy expenditure.

image15

Limiting ourselves to the most nutrient-dense foods (in terms of nutrients per calorie) enables us to sidestep the trap of modern foods which have separated nutrients and energy.  Nutrient-dense foods also boost our mitochondrial function, and fuel the fat burning Krebs cycle so we can be less dependent on a regular sugar hit to make us feel good (Cori cycle).

Limiting yourself to nutrient dense foods (i.e. nutrients per calorie) is a great way to reverse engineer optimal foraging theory.

image04

If your problem is that energy dense low nutrient density hyperpalatable foods are just too easy to overeat, then actively constraining your foods to those that have the highest nutrients per calorie could help manage the negative effects of OFT that are engrained in our system by imposing an external constraint.

image22

But if you’re a lean Ironman triathlete these foods are probably not going to get you through.  You will need more energy than you can easily obtain from nutrient-dense spinach and broccoli.

optimal rehabilitation plan?

So while there is no one size fits all solution, it seems that we have some useful principles that we can use to shortlist our food selection.

  1. We are hardwired to get the maximum amount of energy with the least amount of effort (i.e. optimal foraging theory).
  2. Commercialised manufactured foods have separated nutrients from food and made it very easy to obtain a lot of energy with a small investment.
  3. Eliminating fat can leave us with cheap hyperpalatable grain-based fat-free highly insulinogenic foods that will leave us with spiralling insulin and blood glucose levels.
  4. Eating nutrient dense whole foods is a great discipline, but we still need to tailor our energy density to our situation (i.e. weight loss vs athlete).

the solution

So I think we have three useful quantitative parameters with which to optimise our food choices to suit our current situation:

  1. insulin load (which helps as to normalise our blood glucose levels),
  2. nutrient density (which helps us make sure we are getting the most nutrients per calorie possible), and
  3. energy density (helps us to manage the impulses of OFT in the modern world).

image30

I have used a multi-criteria analysis to rank the foods for each goal.  The chart below shows the weightings used for each approach.

image23

The lists of optimal foods below have been developed to help you manage your primal impulses.  The table below contains links to separate blog posts and printable .pdfs for a range of dietary approaches that may be of interest depending on your goals and situation.

dietary approach printable .pdf
weight loss (insulin sensitive) download
autoimmune (nutrient dense) download
alkaline foods download
nutrient dense bulking download
nutrient dense (maintenance) download
weight loss (insulin resistant) download
autoimmune (diabetes friendly) download
zero carb download
diabetes and nutritional ketosis download
vegan (nutrient dense) download
vegan (diabetic friendly) download
therapeutic ketosis download
avoid download

If you’re not sure which approach is right for you and whether you are insulin resistant this survey may help you identify your optimal dietary approach.

survey

I hope this helps.  Good luck out there!

post last updated OCtober 2017

 

references

[1] http://ketosummit.com/

[2] https://en.wikipedia.org/wiki/Optimal_foraging_theory

[3] http://www.hoajonline.com/obesity/2052-5966/2/2

[4] https://www.ncbi.nlm.nih.gov/pubmed/24564590

[5] http://nutritiondata.self.com/topics/fullness-factor

[6] https://www.ncbi.nlm.nih.gov/pubmed/7498104

[7] https://www.nextnature.net/2013/02/how-food-scientists-engineer-the-bliss-point-in-junk-food/

[8] https://en.wikipedia.org/wiki/Agricultural_subsidy

[9] http://blog.diabeticcare.com/diabetes-obesity-growth-trend-u-s/

the breakfast of champions (Chris Froome and Romain Bardet diet analysis)

My Facebook feed has been flooded lately with stories about Tour de France cyclists going low carb.[1]

image05[1]

Or is it high protein?[2]

image10[1]

Whatever is going on, it seems to help them run well too![3]

image09[1]

While I’m not sure you can say that these elite cyclists have eschewed all carbohydrate-containing foods,  the trend away from processed carbs to whole foods is intriguing.

So if they’re going low carb does it mean they’re now butter, cream, MCT oil after starting the day with BPC?

Dr James Morton, head of nutrition at Team Sky and an associate professor in the Faculty of Science at Liverpool John Moores University explains:[4] [5] [6] [7] [8]

We promote a natural approach to food.  Our riders eat food that grows in the ground or on a tree and protein from natural sources.

They need energy, but they also have to stay lean and healthy with a strong immune system. A natural diet is the best way to achieve this.

Fat is important for everything from energy release and muscle health to immunity, but by eating the right food the fat takes care of itself.  The riders eat eggs, milk, Greek yogurt, nuts, olive oil, avocados and some red meat for a natural mix of saturated and unsaturated fats.”

To achieve optimal weight, Dr Morton asks the riders to “periodize” their carb intake by eating more when they train hard and cutting back when they’re less active.

They routinely train in the morning after eating a protein-rich omelette, instead of carbohydrate-dense bread, to encourage their bodies to burn fat for fuel.[9]

image03[1]

So how does low carb real food thing work?

According to Dr Terry Wahls, it seems that nutrient density is a vital part of maximising energy output.

To produce ATP efficiently, the mitochondria need particular things.  Glucose or ketone bodies from fat and oxygen are primary.  

Your mitochondria can limp along, producing a few ATP on only these three things, but to really do the job right and produce the most ATP, your mitochondria also need thiamine (vitamin B1), riboflavin (vitamin B2), niacinamide (vitamin B3), pantothenic acid (vitamin B5), minerals (especially sulfur, zinc, magnesium, iron and manganese) and antioxidants.  Mitochondria also need plenty of L-carnitine, alpha-lipoic acid, creatine, and ubiquinone (also called coenzyme Q) for peak efficiency.  

If you don’t get all these nutrients or if you are exposed to too many toxins, your ATP production will become less efficient, which leads to two problems:

Your body will produce less energy so they may not be able to do everything they need to do.

Your cells will generate more waste than necessary in the form of free radicals.

Without the right nutrient sources to fuel the ATP production in the mitochondria – which in turn produce energy for the cellular processes required to sustain life – your mitochondria can become starved.  The cells then can’t do their job as effectively.[10] 

So let’s look at the macro and micro nutrient analysis of Chris Froome’s “rest day breakfast” (pictured above).   The analysis indicates that it does very well in both the vitamins and minerals score as well as the amino acids score.

image12[1]

If we throw in some spinach Froomey would improve the vitamin and mineral score of his breakfast even further.  The addition of spinach increases the nutrient balance score from 57 to 77 while the amino acid score stays high.

image14[1]

Froome’s wife says eating more protein has been one of the keys to losing weight and building muscle leading up to the tour.[11]  Getting a quarter of your calories from protein is more than the 16% most people consume, however with 65% of the energy coming from fat you could also call this meal low carb, high fat, or even “ketogenic” depending on which camp you’re in.

image01[1]

This simple but effective meal would be a pretty good option for just about anyone.  Froome’s breakfast ranks well regardless of your goals.  Based on the ranking system of meals for different purposes it comes in at:

  • #10 (with spinach) and #31 (without spinach) out of 245 meals analysed for the low carb diabetes ranking,
  • #18 and 52 on the therapeutic ketosis ranking, and
  • #26 and 64 on the overall nutrient density ranking.

image00[1]

It seems it’s not just the low carbers, “ketonians”[12] and people battling diabetes who are training their bodies to burn fat more efficiently.  Maximising your ability to burn fat is critical even if you are extremely metabolically healthy.

The chart below shows a comparison of the fat oxidation rate of well-trained athletes (WT) versus recreationally (RT) athletes (who are not necessarily following a low carb diet).[13]  The well-trained athletes are clearly oxidising more fat, which enables them to put out a lot more power (measured in terms of their VO2max).   It seems that your ability to efficiently burn fat for fuel it a key component of what sets the elite apart from the amateurs whether you call yourself vegan, ketogenic or a fruitarian.[14]

image07[1]

While carbohydrates help to produce maximal explosive power, it seems that the glucose turbocharger works best when it sits on a big power fat fueled motor.  According to Peter Defty (who spent the last couple of years helping 2016 Tour de France second place getter Romain Bardet refine his ability as a fat adapted athlete using his Optimised Fat Metabolism protocol), fat can yield more energy more efficiently with less oxidative stress which requires less recovery time.[15]

Dr Morton also understands the importance of keeping carbohydrates low to maximise mitochondrial biogenesis and to access fat stores.  If you want to learn more about his thinking on the use of diet to drive mitochondrial biogenesis you might be interested in checking out his array of published papers on the topic.[16] [17] [18] [19] [20] [21] [22]   On the topic of carbohydrate intake Morton says:

Amateur riders are taught the importance of carbohydrates for training and racing, perhaps too much actually.

From our research at Liverpool John Moores University, we now know that deliberately restricting carbs around carefully chosen training sessions can actually enhance training adaptations.

But then of course we must ensure higher carbohydrate intakes for key training sessions and hard stages in racing.

I believe this concept of periodising daily carbohydrate intake is the most exciting part of sports nutrition in the last decade and our challenge now is to address how best we do this practically.

Essentially, exercising your mitochondria in a low insulin and low glucose state forces your body to adapt to using fat for fuel and to use glucose and oxygen efficiently and effectively.[23] [24]

image06[1]

Not only is this useful for endurance athletes and people battling diabetes, training your body to use fat and oxygen more efficiently is also claimed to be important to minimise anaerobic fermentation which is said to increase your risk of cancer.[25] [26] [27]

Many of us struggle to cope in an environment of excess energy from low nutrient density highly insulinogenic food.  If we can’t obtain the necessary nutrients from our food to efficiently produce energy our bodies seek out more and more food in the hope of finding the required nutrients and enough energy to feel OK.

image13[1]

Our bodies do their best to use the energy that we give them, but they are working overtime to pump out insulin to store the excess energy that is not used.  Over time our bodies adapt by becoming resistant to insulin to stop the excess energy being stored in our liver, pancreas and eyes when our fat stores in our muscles and belly can’t take any more.[28]  Then to overcome the insulin resistance the body has to pump out more insulin which makes even less of the energy we eat available for use.

image04[1]

When we call on our mitochondria to produce intense bursts of energy with minimal fuel (i.e. fasting) or glucose (i.e. low carb), we force our bodies to more efficiently the limited carbohydrate.  Suddenly our bodies become insulin sensitive.

Recent studies indicate that people who are fat adapted are able to mobilise higher rates of fat at higher exercise intensities.[29]

image08[2]

With a higher reliance on fat, they are able to conserve the precious glucose for explosive efforts.

image02[1]

Then, when they really need the power, they have both fuel tanks available to cross the line first… and second!

image11[1]

 

 

references

[1] http://realmealrevolution.com/real-thinking/great-news-for-lchf-first-and-second-place-riders-of-the-tour-de-france-are

[2] http://www.businessinsider.com.au/chris-froome-weight-loss-tour-de-france-2016-7?r=US&IR=T

[3] https://www.youtube.com/watch?v=UPqxUA70ulo

[4] http://www.telegraph.co.uk/men/recreational-cycling/how-to-eat-like-a-tour-de-france-cyclist/

[5] http://www.teamsky.com/teamsky/home/article/68342#CpWWiwr2TyE0EA2P.97

[6] https://www.ljmu.ac.uk/about-us/staff-profiles/faculty-of-science/sport-and-exercise-sciences/james-morton

[7] http://www.ncbi.nlm.nih.gov/pubmed/23364526

[8] http://www.ncbi.nlm.nih.gov/pubmed/23263742

[9] http://realmealrevolution.com/real-thinking/great-news-for-lchf-first-and-second-place-riders-of-the-tour-de-france-are

[10] https://www.amazon.com/Wahls-Protocol-Autoimmune-Conditions-Principles/dp/1583335544

[11]

[12] http://ketotalk.com/2016/04/19-inflammatory-keto-foods-build-muscle-on-moderate-protein-baby-boomer-ketonians/

[13] http://m.bmjopensem.bmj.com/content/1/1/e000047.full

[14] http://www.30bananasaday.com/profile/durianrider

[15] http://www.vespapower.com/mighty-mitochondria/

[16] https://www.ljmu.ac.uk/about-us/staff-profiles/faculty-of-science/sport-and-exercise-sciences/james-morton

[17] http://ajpregu.physiology.org/content/304/6/R450

[18] http://www.ncbi.nlm.nih.gov/pubmed/23263742

[19] http://www.ncbi.nlm.nih.gov/pubmed/19265068

[20] http://journals.lww.com/acsm-msse/pages/articleviewer.aspx?year=9000&issue=00000&article=97464&type=abstract

[21] http://www.sciencedirect.com/science/article/pii/S0891584916000307

[22] http://www.tandfonline.com/doi/abs/10.1080/17461391.2014.920926

[23] https://www.fightaging.org/archives/2011/04/calorie-restriction-increases-mitochondrial-biogenesis/

[24] http://www.marksdailyapple.com/managing-your-mitochondria/#axzz4G2D39DgB

[25] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4493566/

[26] https://www.amazon.com/Tripping-Over-Truth-Metabolic-Illuminates/dp/1500600318

[27] https://www.youtube.com/watch?v=PuG5XZSR4vs

[28] http://www.ncbi.nlm.nih.gov/pubmed/25515001

[29] http://www.vespapower.com/the-emerging-science-on-fat-adaptation/

post updated July 2017

nutrient dense insulinogenic foods for bodybuilding

As well as identifying nutrient dense diabetic friendly foods, we can use the food insulin index to highlight more insulinogenic nutrient dense higher energy density foods for use by athletes or people wanting gain weight.

This article highlights more insulinogenic nutrient dense foods that could be used by metabolically healthy people to strategically “carb up” before events, to intentionally trigger insulin spikes (e.g. Carb Back-Loading, Alt Shift Diet or the targeted ketogenic diet) or to maximise growth for people who are underweight while still maintaining high levels of nutrition.

insulin load, a refresher

Many people with diabetes will try to reduce the insulin load of their diet to normalise blood glucose levels.  It’s the non-fibre carbohydrates, and to a lesser extent protein, that drive insulin and blood glucose, particularly for someone who is insulin resistant.

image02

Managing the insulin load of your diet is an effective way to get off the blood glucose roller coaster and stabilise blood glucose levels.  We can calculate the insulin load of our diet based on the carbohydrates, fibre and protein using the formula shown below.

image00

We can also calculate the percentage of insulinogenic calories to identify the foods that will affect our blood glucose levels the least, or the most.

image01

but why would you want to spike your glucose levels?

Much of the nutrition and diabetes world is focused on helping people who are struggling with insulin resistance and trying to normalise blood glucose.  However, there are others who are blessed to be metabolically healthy who may want to strategically refill their glycogen tanks or raise their insulin levels.

  • Some follow a targeted ketogenic diet and strategically replenish glucose around workouts by eating higher carbohydrate foods.
  • Some bodybuilders use a cyclical ketogenic diet where they deplete glucose and then replenish glucose periodically.
  • Some fat adapted endurance athletes will look to ‘carb up’ before an event so that they have both glucose and fat based fuel sources (a.k.a. train low, race high).

  • Others find success with dietary approaches such as the AltShift Diet, Carb Back-Loading which alternating periods of extreme high and low carb dietary approaches (not always with the most nutritious high carb foods).

the mission…

Dr Tommy Wood approached me to design a high insulin load and a low insulin load diet regimen that he could try for a month of each to see how his body responded. The constraint was that both the high and low insulin load foods would have to be nutrient dense whole foods so as to be a fair comparison of the effect of insulin load.

image03

The foods listed below represent the top 10% of the USDA food database prioritised for higher insulin load, higher nutrient density and higher energy density.  In terms of macronutrients they come out at 36% protein, 15% fat and 44% net carbohydrates.

While these foods might not be ideal for someone with diabetes they actually look like a pretty healthy list of foods compared to the “food like products” that you’d find in the isles of the supermarket.

This chart shows the nutrients provided by the top 10% of the foods using this ranking compared to the average of all foods in the USDA foods database.

2017-02-19 (7).png

Also included in the tables below are the nutrient density score, percentage of insulinogenic calories, insulin load, energy density and the multicriteria analysis score score (MCA) that combines all these factors.

vegetables

image19

food ND insulin load (g/100g) calories/100g MCA
watercress 19 2 11 1.2
seaweed (wakame) 13 11 45 1.0
shiitake mushrooms 5 72 296 0.9
spinach 17 4 23 0.9
brown mushrooms 11 5 22 0.7
asparagus 15 3 22 0.7
chard 14 3 19 0.7
seaweed (kelp) 9 10 43 0.7
yeast extract spread 8 27 185 0.6
white mushroom 11 5 22 0.6
spirulina 10 6 26 0.6
mung beans 9 4 19 0.6
Chinese cabbage 12 2 12 0.5
celery flakes 4 42 319 0.5
portabella mushrooms 11 5 29 0.5
broccoli 11 5 35 0.4
parsley 12 5 36 0.4
lettuce 12 2 15 0.4
radicchio 8 4 23 0.4
shiitake mushroom 9 7 39 0.4
peas 7 7 42 0.4
dandelion greens 9 7 45 0.3
endive 15 1 17 0.3
okra 10 3 22 0.3
pumpkin 6 4 20 0.3
bamboo shoots 8 5 27 0.3
beet greens 12 2 22 0.3
snap beans 8 3 15 0.3
zucchini 11 2 17 0.3

animal products

7450703_orig

food ND insulin load (g/100g) calories/100g MCA
ham (lean only) 11 17 113 0.7
veal liver 9 26 192 0.7
beef liver 9 25 175 0.7
lamb liver 11 20 168 0.7
lamb kidney 11 15 112 0.6
chicken breast 8 22 148 0.5
pork liver 7 23 165 0.5
chicken liver 9 20 172 0.5
pork chop 7 23 172 0.5
veal 6 24 151 0.5
beef kidney 8 20 157 0.5
lean beef 7 23 149 0.5
leg ham 7 22 165 0.5
turkey liver 8 21 189 0.5
pork shoulder 6 22 162 0.4
ground beef 6 20 144 0.4
sirloin steak 6 24 177 0.4
ground pork 6 25 185 0.4

seafood

food ND insulin load (g/100g) calories/100g MCA
cod 14 48 290 1.5
crab 15 14 83 1.1
lobster 14 15 89 1.1
crayfish 12 13 82 0.9
shrimp 11 19 119 0.9
pollock 11 18 111 0.8
octopus 9 28 164 0.8
halibut 11 17 111 0.8
fish roe 13 18 143 0.8
haddock 10 19 116 0.8
white fish 10 18 108 0.8
clam 9 25 142 0.8
scallop 8 22 111 0.7
rockfish 10 17 109 0.7
salmon 11 20 156 0.7
whiting 9 18 116 0.7
perch 10 14 96 0.7
oyster 11 14 102 0.7
flounder 11 12 86 0.6
anchovy 9 22 210 0.6
trout 10 18 168 0.6
caviar 10 23 264 0.6
sturgeon 10 16 135 0.5
tuna 6 23 184 0.3
orange roughy 4 17 105 0.3
sardine 7 19 208 0.3

legumes

image11

food ND insulin load (g/100g) calories/100g MCA
cowpeas 2 68 336 0.8
black beans 2 63 341 0.6
soybeans 3 49 446 0.6
pinto beans 1 64 347 0.6
kidney beans 1 63 337 0.6
broad beans 2 54 341 0.5
peas 0 57 352 0.4

grains

image08

food ND insulin load (g/100g) calories/100g MCA
oat bran 6 65 246 0.7
baker’s yeast 10 16 105 0.5
baking powder 2 45 97 0.4
wheat bran 8 34 216 0.4
rye flour 0 58 325 0.4
quinoa 1 22 120 0.1

dairy

image08

food ND insulin load (g/100g) calories/100g MCA
whey powder 10 82 339 1.6
cream cheese (low fat) 12 19 105 1.0
cottage cheese (low fat) 6 14 72 0.5
parmesan cheese 3 35 420 0.4
cottage cheese (low fat) 7 13 81 0.4
cheddar (non-fat) 6 20 173 0.3
mozzarella 4 26 304 0.3
kefir 6 7 41 0.3
gruyere cheese 3 23 413 0.3
low fat milk 6 8 56 0.2
Greek yogurt (low fat) 5 11 73 0.2
Swiss cheese 3 22 393 0.2
gouda cheese 3 21 356 0.2
cheddar cheese 3 20 410 0.2
egg yolk 6 12 275 0.2
edam cheese 3 21 357 0.1

other dietary approaches

The table below contains links to separate blog posts and printable .pdfs detailing optimal foods for a range of dietary approaches (sorted from most to least nutrient dense) that may be of interest depending on your situation and goals.   You can print them out to stick to your fridge or take on your next shopping expedition for some inspiration.

dietary approach printable .pdf
weight loss (insulin sensitive) download
autoimmune (nutrient dense) download
alkaline foods download
nutrient dense bulking download
nutrient dense (maintenance) download
weight loss (insulin resistant) download
autoimmune (diabetes friendly) download
zero carb download
diabetes and nutritional ketosis download
vegan (nutrient dense) download
vegan (diabetic friendly) download
therapeutic ketosis download
avoid download

If you’re not sure which approach is right for you and whether you are insulin resistant, this survey may help identify the optimal dietary approach for you.

image02

the most nutrient dense foods for different goals

While a lot of attention is often given to macronutrient balance, quantifying the vitamin and mineral sufficiency of our diet is typically done by guesswork.  This article lists the foods that are highest in amino acids, vitamins, minerals or omega 3 refined to suit people with different goals (e.g. diabetes management, weight loss, therapeutic ketosis or a metabolically healthy athlete).

I’ve spent some time lately analysing people’s food diaries, noting nutritional deficiencies, and suggesting specific foods to fill nutritional gaps while still being mindful of the capacity of the individual to process glucose based on their individual insulin sensitivity and pancreatic function.  The output from nutritiondata.self.com below shows an example of the nutrient balance and protein quality analysis.

image001

In this instance the meal has plenty of protein but is lacking in vitamins and minerals, which is not uncommon for people who are trying to reduce their carbohydrates to minimise their blood glucose levels.

The pink spokes of the nutrient balance plot on the left shows the vitamins while the white shows the minerals.  On the right hand side the individual spokes of the protein quality score represent individual amino acids.

A score of 100 means that you will meet the recommended daily intake (RDI) for all the nutrients with 1000 calories, so a score of 40 in the nutrient balance as shown is less than desirable if we are trying to maximise nutrition. [1]

I thought it would be useful to develop a ‘shortlist’ of foods to enable people to find foods with high levels of particular nutrients to fill in possible deficiencies while being mindful of their ability to deal with glucose.

essential nutrients

The list of essential nutrients below is the basis of the nutrient density scoring system used in the Your Personal Food Ranking System article, with equal weighting given to each of these essential nutrients. [2]

The only essential nutrients not included in this list are the omega-6 fatty acids which we typically get more than enough of in our western diet.  [3]

essential fatty acids

  1. alpha-Linolenic acid (omega-3) (18:3)
  2. docosahexaenoic acid (omega-3) (22:6)

amino acids

  1. cysteine
  2. isoleucine
  3. leucine
  4. lysine
  5. phenylalanine
  6. threonine
  7. tryptophan
  8. tyrosine
  9. valine
  10. methionine
  11. histidine

vitamins

  1. choline
  2. thiamine
  3. riboflavin
  4. niacin
  5. pantothenic acid
  6. vitamin A
  7. vitamin B12
  8. vitamin B6
  9. vitamin C
  10. vitamin D
  11. vitamin E
  12. vitamin K

minerals

  1. calcium
  2. copper
  3. iron
  4. magnesium
  5. manganese
  6. phosphorus
  7. potassium
  8. selenium
  9. sodium
  10. zinc

the lists

Previously I’ve developed short lists of nutrient dense foods also based on their insulin load or other parameters (see optimal foods lists).

But what if we want to get more specific and find the optimal foods for a diabetic who is getting adequate protein but needs more vitamins or minerals?  What about someone whose goal is nutritional ketosis who is trying to maximise their omega-3 fats to nurture their brain?

To this end the next step is to develop more specific lists of nutrient dense foods in specific categories (i.e. omega-3, vitamins, minerals and amino acids) which can be tailored to individual carbohydrate tolerance levels.

I’ve exported the top foods using each of the ranking criteria from the 8000 foods in the database.  You can click on the ‘download’ link to open the .pdf to see the full list.  Each .pdf file shows the relative weighting of the various components of the multi criteria ranking system.  The top five are highlighted in the following discussion below.

It’s worth noting that the ranking system is based on both nutrient density / calorie, and calorie density / weight.  Considering nutrient density / calorie will preference low calorie density foods such as leafy veggies and herbs.  Considering calorie density / weight tends to prioritise animal foods.  Evenly balancing both parameters seems to be a logical approach.

You’re probably not going to get your daily energy requirements from basil and parsley so you’ll realistically need to move down the list to the more calorie dense foods once you’ve eaten as much of the green leafy veggies as you can.  The same also applies if some foods listed are not available in your area.

weighting all nutrients omega-3 vitamins minerals aminos
no insulin index contribution download download download download download
athlete download download download download download
weight loss download download download download download
diabetes and nutritional ketosis download download download download download
therapeutic ketosis download download download download download

all nutrients

This section looks at the most nutrient dense foods across all of the essential nutrients shown above.  Consider including the weighting tables.

no insulin index contribution

If we do not consider insulin load then we get the following highly nutrient dense foods:

  1. liver,
  2. cod,
  3. parsley,
  4. white fish, and
  5. spirulina / seaweed

Liver tops the list.  This aligns with Matt Lalonde’s analysis of nutrient density as detailed in his AHS 2012 presentation.

It’s likely the nutrient density of cod, which is second on the list of the most nutrient dense foods, is the reason that Dwayne Johnson (a.k.a. The Rock) eats an inordinate amount of it. [4]

image003

It certainly seems to be working for him.

Duane Johnson 2 - Copy

athlete and metabolically healthy

If you have no issue with obesity or insulin resistance then you’ll likely want to simply select foods at the top of the nutrient dense foods list.  However most people will also benefit from considering their insulin load along with fibre and calorie density.   Most of us mere mortals aren’t as active or metabolically healthy as Dwayne.

When we consider insulin load we get the following foods at the top of the list:

  1. basil,
  2. parsley,
  3. spearmint,
  4. paprika, and
  5. liver

We grow basil in a little herb garden and use it to make a pesto with pine nuts, parmesan and olive oil.  It’s so delicious!   (And when I say ‘we’ I mean my amazing wife Monica.)

Aaron Tait Photography

You’ll note that spices and herbs typically rank highly in a lot of these lists.  The good news is that they typically have a very low calorie density, high nutrient density and are high in fibre.

The challenge again is that it’s hard to get all your energy needs from herbs alone, so after you’ve included as many herbs and green leafy veggies as you can fit in, go further down the list to select other more calorie dense foods to meet your required intake.

weight loss

If we reduce calorie density, increase fibre and pay some attention to insulin load for the weight loss scenario we get the following foods:

  1. wax gourd (winter melon),
  2. basil,
  3. endive,
  4. chicory, and
  5. dock

If you’re wondering what a winter melon looks like (like I was), here it is.

image008

The winter melon does well in this ranking because it is very fibrous, has a very low calorie density and a very low 8% insulinogenic calories which means that it has very few digestible carbohydrates.

Again, basil does pretty well along with a range of nutrient dense herbs.  Basil is more nutrient dense than the winter melon while still having a very low calorie density.

diabetes and nutritional ketosis

If we factor carbohydrate tolerance into the mix and want to keep the insulin load of our diet low we get the following foods:

  1. wax gourd (winter melon),
  2. chia seeds,
  3. flax seeds,
  4. avocado, and
  5. olives

Wax gourd does well again due to its high fibre and low calorie density; however if you’re looking for excellent nutrient density as well, then chia seeds and flax seeds may be better choices.  When it comes to flax seeds are best eaten ‘fresh ground’ (in a bullet grinder) for digestibility and also freshness and that over consumption may be problematic when it comes to increasing estrogens.

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therapeutic ketosis

Then if we’re looking for the most nutrient dense foods that will support therapeutic ketosis we get the following list:

  1. flax seeds,
  2. fish oils,
  3. wax gourd,
  4. avocado, and
  5. brazil nuts.

Good nutrition is about more than simply eating more fat.  When you look at the top foods using this ranking you’ll see that you will need to use a little more discretion (e.g. avoiding vegetable oils, margarine and fortified products) due to the fact that nutrients and fibre have such a low ranking.

ganze und halbe reife avocado isoliert auf weissem hintergrund

fatty acids

Omega-3 fats are important and most of us generally don’t get enough, but rather get too many omega-6 fats from grain based processed foods.

Along with high levels of processed carbohydrates, excess levels of processed omega-6 fats are now being blamed for the current obesity epidemic. [5]

The foods highlighted in the following section will help you get more omega-3 to correct the balance.

no insulin index contribution

If we’re looking for the foods that are the highest in omega 3 fatty acids without consideration of insulin load we get:

  1. salmon,
  2. whitefish,
  3. shad,
  4. fish oil, and
  5. herring

I like salmon, but it’s not cheap.  I find sardines are still pretty amazing but much more cost effective. [6]  If you’re going to pay for salmon to get omega 3 fatty acids then you should make sure it’s wild caught to avoid the omega 6 oils and antibiotics in the grain fed farmed salmon.

Sardines have a very high nutrient density but still not as much omega 3 fatty (i.e. 1480mg per 100g for sardines versus 2586mg per 100g for salmon).

image014

athlete and metabolically healthy

If we factor in some consideration of insulin load, fibre and calorie density we get:

  1. salmon,
  2. marjoram,
  3. chia seeds,
  4. shad, and
  5. white fish

It’s interesting to see that there are also  excellent vegetarian sources of omega-3 fatty acids such as marjoram (pictured below) and chia seeds (though some may argue that the bio-availability of the omega 3 in the salmon is better than the plant products).

image016

weight loss

Some of the top ranking foods with omega-3 fatty acids for weight loss are:

  1. brain,
  2. chia seeds,
  3. sablefish,
  4. mackerel, and
  5. herring

While seafood is expensive, brain is cheap, though a little higher on the gross factor.

image018

Cancer survivor Andrew Scarborough tries to maximise omega 3 fatty acids to keep his brain tumour and epilepsy at bay and makes sure he eats as much brain as he can.

diabetes, nutritional ketosis and therapeutic ketosis

And if you wanted to know the oils with the highest omega-3 content, here they are:

  1. Fish oil – menhaden,
  2. Fish oil – sardine,
  3. Fish oil – salmon,
  4. Fish oil – cod liver, and
  5. Oil – seal

image019

amino acids

This section will be of interest to people trying to build muscle by highlighting the foods highest in amino acids.

no insulin index contribution

So what are the best sources of protein, regardless of insulin load?

  1. cod,
  2. egg white,
  3. soy protein isolate,
  4. whitefish, and
  5. whole egg

Again, Dwayne Johnson’s cod does well, but so does the humble egg, either the whites or the whole thing.

We have been told to limit egg consumption over the last few decades, but now, in case you didn’t get the memo, saturated fat is no longer a nutrient of concern so they’re OK again.

And while egg whites do well if you’re only looking for amino acids, however if you are also chasing vitamins, minerals and good fats I’d prefer to eat the whole egg.

image021

athlete and metabolically healthy

If you have some regard for the insulin load of your diet you end up with this list of higher fat foods:

  1. parmesan cheese,
  2. beef,
  3. tofu,
  4. whole egg, and
  5. cod.

image023

weight loss

If we aim for lower calorie density foods for weight loss we get this list:

  1. bratwurst,
  2. basil,
  3. beef,
  4. chia seeds, and
  5. parmesan cheese

The bratwurst sausage does really well in the nutrition analysis because it is nutrient dense both in amino acids and high fat which keeps the insulin load down.

image025

diabetes and nutritional ketosis

If you’re concerned about your blood glucose levels then this list of foods may be useful:

  1. chia seeds,
  2. flax seed,
  3. pork sausage,
  4. bratwurst, and
  5. sesame seeds

image028

Therapeutic ketosis

And those who are aiming for therapeutic ketosis who want to keep their insulin load from low protein may find these foods useful:

  1. flax seed,
  2. pork sausage,
  3. sesame seeds,
  4. chia seeds, and
  5. pork

image030

vitamins

People focusing on reducing their carbohydrate load will sometimes neglect vitamins and minerals, especially if they are counting total carbs rather than net carbs which can lead to neglecting veggies.

I think most people should be trying to increase the levels of indigestible fibre as it decreases the insulin load of their diet, [7] feeds good gut bacteria, leaves you feeling fuller for longer and generally comes packaged with heaps of good vitamins and minerals.

At the same time it is true that some high fibre foods also come with digestible carbohydrates which may not be desirable for someone who is trying to manage the insulin load of their diet.

The foods listed in this section will enable you to increase your vitamins while managing the insulin load of your diet to suit your goals.

no insulin index contribution

These foods will give you the biggest bang for your buck in the vitamin and mineral department if insulin resistance is not an issue for you:

  1. red peppers,
  2. liver,
  3. chilli powder,
  4. coriander, and
  5. egg yolk

Peppers (or capsicums as they’re called in Australia) are great in omelettes. image031

Liver is also very high in vitamins if you just can’t tolerate veggies.

athlete and metabolically healthy

If we bring the insulin load of your diet into consideration then these foods come to the top of the list:

  1. paprika,
  2. chilli powder,
  3. liver,
  4. red peppers, and
  5. sage

It’s interesting to see so many spices ranking so highly in these lists.  Not only are they nutrient dense but they also make the foods taste better and are more satisfying.

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Good food doesn’t have to taste bland!

weight loss

If weight loss is of interest to you then this list of lower calorie density foods might be useful:

  1. chilli powder,
  2. chicory greens,
  3. paprika,
  4. liver, and
  5. spinach

It will be very challenging to eat too many calories with these foods.  We find spinach to be pretty versatile whether it is in a salad or an omelette.

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diabetes and nutritional ketosis

These foods will give you lots of vitamins if you are trying to manage your blood glucose levels:

  1. chilli powder,
  2. endive,
  3. paprika
  4. turnip greens, and
  5. liver

Most green leafy veggies will be great for people with diabetes as well as providing excellent nutrient density and heaps of fibre.

image037

therapeutic ketosis

If you really need to keep your blood sugars down then getting your vitamins from these foods may be helpful:

  1. chilli powder,
  2. liver,
  3. liver sausage,
  4. egg yolk, and
  5. avocado

image039

minerals

no insulin index contribution

Ever wondered which real whole foods would give you the most minerals per calorie without resorting to supplements?

Here’s your answer:

  1. coriander,
  2. celery seed,
  3. basil,
  4. parsley, and
  5. spearmint

Even if you found a vitamin and mineral supplement that ticked off on all the essential nutrients there’s no guarantee that they will be absorbed by your body, or that you’re not missing a nutrient that is not currently deemed ‘essential’.  Real foods will always trump supplements!

As you look down these lists you may notice that herbs and spices top the list of foods that have a lot of minerals.  Once you have eaten as much coriander, basil, parsley and spearmint as you can and still feel hungry keep doing down the list and you will find more calorie dense foods such as spinach, eggs, sunflower seeds, and sesame seeds etc which are more common and easier to fill up on.

image041

athlete and metabolically healthy

If we factor in some consideration of insulin load then we get this list:

  1. basil,
  2. spearmint,
  3. wheat bran (crude),
  4. parsley, and
  5. marjoram

Wheat bran (crude) features in this list but it’s very rarely eaten in this natural state.  Most of the value is lost when you remove the husk from the wheat.

As much as we’re told that we shouldn’t eliminate whole food groups, grain based products just don’t rate well when you prioritise foods in terms of nutrient density.

image043

weight loss

If you’re looking for some lower calorie density options the list changes slightly:

  1. basil,
  2. caraway seed,
  3. marjoram,
  4. wheat bran (crude), and
  5. chilli powder

image044

diabetes and nutritional ketosis

If you’re trying to manage your blood sugars then this is your list of foods that are packed with minerals:

  1. basil,
  2. caraway seed,
  3. flax seed,
  4. chilli powder, and
  5. rosemary.

image045

therapeutic ketosis

If you’re aiming for therapeutic ketosis then the higher fat nuts come into the picture to get your minerals:

  1. flaxseed,
  2. sesame seed,
  3. pine / pinon nuts,
  4. sunflower seeds, and
  5. hazel nuts.

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application

So what does all this mean and how can we apply it?

I don’t think it’s necessary or ideal to track your food all the time, however it’s well worth taking a typical day of food and entering it into the recipe builder at nutritiondata.self.com to see where you might be lacking.

Are your vitamins or minerals low?  Protein?  What about fibre.

If you find these are lacking you can use these food lists to fill nutritional gaps while keeping in mind your ability to process carbohydrates and attaining your personal goals.

references

[1] http://nutritiondata.self.com/help/analysis-help

[2] http://ketopia.com/nutrient-density-sticking-to-the-essentials-mathieu-lalonde-ahs12/

[3] The omega 6 fatty acids are also classed as essential however it is generally recognised that we have more omega omega 6 than omega 3.

[4] http://www.muscleandfitness.com/nutrition/meal-plans/smell-what-rock-cooking

[5] http://ebm.sagepub.com/content/233/6/674.short

[6] http://nutritiondata.self.com/facts/finfish-and-shellfish-products/4114/2

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

the cost of going low carb

  • Analysis of the USDA Cost of Food at Home database shows that fat is the cheapest macronutrient.
  • Protein is the most expensive macronutrient, however a reduced carbohydrate diet does not necessarily require an increase in protein.
  • Reducing the amount of carbohydrate and increasing the amount of fat in your diet is the most effective way to reduce your grocery bill.

background

One of the common concerns about eating differently from the norm is that it will be more expensive.

Apparently one of the reasons for the relatively low Recommended Daily Intake for protein of 0.8g/kg is that many people can’t afford to eat more protein. [1]  One of the common criticisms of Paleo or the Banting Diet (LCHF) is that it will be too expensive due to the extra protein. [2]

To see if these concerns were valid I thought it would be interesting to see what the data has can tell us about the relative cost the three macronutrients, protein, carbohydrate and fat.

protein

The chart below shows the cost per calorie versus the percentage of protein in the thousand or so foods in the USDA Cost of Food at Home database. [3]

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Protein is indeed the most expensive of the three macronutrients.  As you move to the right in the chart you can see that your weekly grocery bill will increase.

Average intake of both protein and fat in the United States decreased between 1971 and 2004, with an overall increase in carbohydrate. [4]

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While from a nutritional point of view there area lot of good reasons for people to eat higher levels of protein, a low carbohydrate diet is not necessarily high in protein.

People aiming for therapeutic ketosis may aim for lower amounts of protein to minimise insulin.

Tim Noakes’ Banting diet recommends that people get between 20 and 30% of their calories from protein.  He says that those with diabetes and / or insulin resistance issues should aim for the lower end of this range, while people who are active and healthy can aim for higher amounts.  [5]

Practically it is difficult to eat much more than 30% to 35% protein from real foods.

The table below shows the relative change in cost if we were to increase our protein from current average levels back to 1970s levels, or to moderate levels such as the Mediterranean diet or even the higher protein Atkins approach.

scenario % protein cost ($/kcal) change
2004 average 14.7% 4.67
1970 average 16.9% 4.83 +3%
Mediterranean 20% 5.06 +8%
Atkins 30% 5.79 +24%

As shown in the table below, the most expensive high protein foods tend to be seafood.  For reference, the average cost of food across the more than one thousand foods in the database is $5.37/kcal.

food cost ($/kcal)
crayfish 26
spinach 26
crab 24
spirulina 23
lobster 22
scallops 17
clam 16
haddock 16
cod 15

While protein can be expensive there are some low cost high protein options available.

food cost ($/kcal)
whole egg 1.70
ground turkey 2.13
beef liver 2.81
chicken heart 2.94
cottage cheese 3.58
pork 3.59
chicken liver 3.81
ham 4.10

If you are willing to try organ meats you might get them even cheaper as they are often discarded.   The cheaper organ meats also typically have a much higher nutrient density than the more popular muscle meats or even fruits or vegetables.

image003

carbohydrates

You often hear the term ‘cheap carbohydrates’, but does this mean that a diet of processed grains and sugars is the most economical way to fill your shopping trolley?

While sugar and corn starch are very cheap food ingredients per calorie, the analysis of the data suggest that a higher carbohydrate diet is actually more expensive overall.

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The cheaper high high carbohydrate foods tend to be processed and calorie dense.   While the most expensive high carbohydrate foods tend to be natural foods that have a much lower calorie density. The table below shows that someone switching from a typical western diet to a reduced carbohydrate diet could make some significant savings.

scenario % carbohydrate cost ($/kcal) change
2004 average 51% 5.57
1970 average 45% 5.37 -4%
low carb 30% 4.77 -14%
ketogenic 5% 3.80 -32%

fat

So if increasing the proportion of protein and carbohydrate both increase the cost of our food bill then what makes it cheaper?  Yes it’s the other macronutrient, fat.

Increasing the proportion of fat in your diet while decreasing the carbohydrates will make your meals tastier, gentler on your blood glucose and cheaper.  Not to mention the fact that people typically spontaneously consume less calories when they consume less carbohydrates.

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You may pay a premium for coconut oil, butter or olive oil relative to corn oil which is the cheapest food ingredient, however these fats are still much cheaper than the other macronutrients.

food cost ($/kcal)
corn oil 0.20
coconut oil 0.31
chicken fat 0.86
butter 1.10
bacon fat 1.12
coconut milk 1.15
cream cheese 1.76
sesame oil 2.00
cream 2.81
olive oil 2.81

It appears that the it’s the very cheapest ingredients that are so prevalent in processed foods – sugar, corn starch, corn oil, high fructose corn syrup.  Regardless of cost you’re always going to have to make a value judgement on the nutritional value of your food.

summary

Increasing the protein content of your diet will increase your grocery bill marginally.

While higher levels of protein may be ideal for people who are healthy and active, LCHF is not necessarily high protein, particularly for those who struggle to regulate their blood glucose levels.

The LCHF approach, with its combination of moderate protein, lower carbohydrates and high fat provides an optimal solution with respect to blood glucose management, nutrition and cost.

references

[1] https://www.facebook.com/physiquescienceradio/posts/378943502302499

[2] http://talkfeed.co.za/lchf-diet-on-a-budget/

[3] http://www.cnpp.usda.gov/USDAFoodPlansCostofFood

[4] http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9146789&fileId=S1368980012005423

[5] http://www.biznews.com/health/2015/01/19/complete-idiots-guide-tim-noakes-diet-banting-lchf/

the food insulin index v2

It’s generally difficult for healthy people to eat too much protein.  However the fact that protein requires some insulin to metabolise is an important consideration for people who need to inject extra to keep their blood glucose levels stable.

A better understanding of the insulin response to various foods would be useful for diabetics calculating their insulin dose or even to help refine food choices to manage insulin load.

Since launching the optimising nutrition blog I have had many interesting discussions and learned a lot about protein and how it affects insulin and blood glucose.

The Most Ketogenic Diet Foods article which reviews the food insulin index data and what we can learn about our food choices has received almost 200,000 view.  Given the level of interest, I thought it would be useful to review this topic in more detail.

the food insulin index… a quick refresher

If you’ve been reading Optimising Nutrition blog you would have come across discussion of the recent food insulin index testing undertaken at the University of Sydney as detailed in Kirstine Bell’s PhD thesis Clinical Application of the Food Insulin Index to Diabetes Mellitus [1] (Sept 2014).

The primary learning from the recently expanded food insulin index data is that the carbohydrate content of a food only partially explains the insulin response.  The protein, fibre and fructose also affect our insulin response to our food.

The cluster of data points on the left-hand side of the figure below shows that:

  1. low carbohydrate, high fat foods trigger a negligible insulin response, while
  2. low carbohydrate high protein foods cause a significant insulin response.

image001

When we assume that fibre is indigestible and protein has about half the insulinogenic effect of carbohydrates we get a much better prediction of insulin response.

image002

The insulin requirement of a particular food is described better by the following formula:

insulin load = total carbohydrates – fibre + 0.56 * protein

digestion time for protein versus carbohydrates

One of the limitations of the food insulin index data is that the insulin area under the curve was measured over only three hours.  This is not a big deal for foods that are high in carbohydrates as they are generally fully digested within three hours.

However protein can take much longer to digest.  In the article The Blood Glucose, Glucagon and Insulin Response to Protein we saw that the insulin response to protein in diabetics can be even greater and over a longer period than for people who do not have diabetes.

If we were to repeat the food insulin index testing over a longer period it is likely that the measured insulin response would be significantly greater and even more-so in people with diabetes.  That is, the insulin response to protein may be greater than the 56% of the insulin response to carbohydrate indicated by the analysis of the food insulin index data if we were to measure the insulin response over a longer period.

Wilder’s ketogenic formula

Dr Russell Wilder of the Mayo Clinic was the first to coin the term ‘ketogenic diet’. [2]  Wilder developed the diet as an alternative to fasting in the treatment of epilepsy in the 1920s.

Image result for dr russell wilder

Wilder also developed the formula shown below to determine whether a diet would be ketogenic.  If the number from this calculation was greater than 1.5 (ideally greater than 2.0) then the diet would be considered to be ketogenic and appropriate for the treatment of epileptics. [3]

image003

This formula is based on the understanding that:

  • 100% of carbohydrate is glucogenic (i.e. converts to glucose),
  • 54% of protein is glucogenic,
  • 46% of protein is ketogenic, and
  • 10% of fat is glucogenic.

I had previously searched for detail of how Wilder had arrived at the 56% / 46% split for protein and only found references suggesting that the 56% glucogenic potential of protein comes from the analysis of nitrogen in the urine of dogs. [4]  However I recently came across this paper which details Wilder’s thinking in more detail.

Wilder’s conclusion that a diet needs to have more than two times the ketogenic precursors compared to glucogenic precursors is still the basis of the formulation of diets used to treat epilepsy.

According to George Cahill, Krebs also found that 57g of glucose may be derived from 100g of protein. [5]   Again, this is similar to the insulin demand for protein observed in the food insulin index tests.

carbohydrate counting

The most straight forward approach is to assume that protein has no impact on insulin or blood sugars.

Dr Richard Berstein and Dr Robert Atkins pioneered the concept of carbohydrate counting for weight loss and diabetes management in the 70s and 80s.  There have been various waves of popularity of low carbohydrate diets with many people finding success.

Carbohydrate counting alone is a reasonable approach that is likely to work for most people, particularly if they are not highly insulin resistant.

However, there are some people that reducing carbohydrates alone doesn’t work for.   The fact that protein also generates insulin suggests that managing protein as well as carbohydrates may be necessary to manage insulin levels.

thermic effect of food

You may have heard of the concept of the thermic effect of food where different foods require different amounts of energy for the digestion process.  For example, a mushroom, which has a very low calorie density and a lot of fibre and protein, may require more energy to digest than is obtained from the digestion of the mushroom.

The maximum and minimum thermic effect (also known as the specific dynamic action) for each macronutrient is shown below. [6]

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Compared to carbohydrates and fat, protein only yields between 76% and 84% of the energy per calorie ingested because of losses in digestion.  This is useful to know if you’re trying to minimise calorie intake.

As discussed in the Why We Get Fat V2 article, part of this thermic effect of food is also likely to be due to the fact that there is a significant loss of energy when we convert protein to glucose to be used as energy.  The body doesn’t like to do this other than in an emergency.

Steve Phinney’s “well formulated ketogenic diet”

One of the key observations from Steve Phinney’s well formulated ketogenic diet (WKFD) chart is that we need to strike a balance between carbohydrates and protein in order to maximise the ketogenic potential of our diet.

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You can have 30% protein and 5% carbs or 20% carbs and 10% protein and still be within the bounds of a ketogenic diet.  However if you have 30% protein and 20% carbs you will be outside the realms of a ketogenic diet because you will be producing too much glucose.

According to Nuttall and Gannon [7] the body requires between 32 and 46g per day of high quality dietary protein to maintain protein balance.  This equates to around 6 to 7% of calories in a 2000 to 2500 calorie diet being taken ‘off the top’ for growth and maintenance, with everything else potentially available as ‘excess’ protein for gluconeogenesis.  This should not be considered optimal, but simply a minimum reference point for the absolute minimum amount of protein.

Interestingly, the slope of the line along the face of Phinney’s WFKD triangle corresponds with the assumption that 7% of protein goes to muscle growth and repair (protein synthesis) with 75% of the remaining ‘excess’ protein being glucogenic.  This 75% value is in the “ball park” (although a little higher) of our previous estimate of the glucogenic potential of protein based on the analysis of the food insulin index data.

amino acid potential

We also have an understanding of which amino acids are glucogenic, which are ketogenic and which are a bit of both. [8] [9] [10]  The table below shows the various amino acids divided up on the basis of their ketogenic versus glucogenic potential and also which are essential versus non-essential. [11]

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Only two amino acids are exclusively ketogenic.  There is a handful that are both glucogenic and ketogenic.  However most of the amino acids are glycogenic, meaning that they will most likely turn into glucose if not required for protein synthesis.

According to David Bender “In  fasting  and  on  a  low  carbohydrate diet  as  much  of  the  amino  acid  carbon  as  possible  will  be  used  for gluconeogenesis, an ATP-expensive, and hence thermogenic process.” 

Hence it appears likely that in a low carbohydrate diet situation excess amino acids that fit under the “both” classification will be turned to glucose rather than ketones because the body needs the extra glucose which it is not getting from ingested carbohydrates.

Conversely, if someone is consuming a high carbohydrate diet the excess amino acids that fit into the “both” category will be converted to ketones rather than glucose because the body is getting more than enough glucose from the diet.

So, to some extent, protein is versatile depending on the body’s need. But at the same time, it is only a small portion of the amino acids that are able to do this. The fate of the majority of the amino acids is pre-destined.

the krebs cycle

The figure below shows the process of catabolism of amino acids. [12]

image005

I am not an organic chemist, but from what I understand this means that:

  • The amino acids Leucine and Lysine cannot be converted back to glucose as they are ketogenic;
  • Isoleucine, Tyrosine, Phenylalanine, Tryptophan, Threonine all enter into the amino acid catabolism cycle and can be used for various functions, such as muscle repair and growth, but can also be converted back into glucose if required (glucogenic) or turned into fatty acids (ketogenic); and
  • The remaining amino acids enter the cycle and can be used for a variety of functions in the body, but cannot be converted into fatty acids.  If they are not required they can be turned into glucose and potentially stored as body fat.

The majority of the amino acids obtained from the digestion of protein have the potential to be turned into glucose through gluconeogenesis.

The reason that we don’t see a sharp rise in blood glucose is partly because amino acids from digestion circulate in the blood until they are required.  Gluconeogenesis is a demand driven process.  Glucose is pulled from amino acids when there is no other source rather than pushed into the bloodstream due to ingestion of excess protein.

By contrast, glucose from carbohydrates will be used to refill glycogen stores (liver and muscle) and then find their way quickly into the bloodstream.  In most people, the amino acid stores in the blood are not saturated and hence there is plenty of capacity to store amino acids until they are required, at least if you have good insulin sensitivity and are not diabetic.

The body does need glucose, and it is fine to get it from carbohydrates or protein via gluconeogenesis.  However many people struggle to produce enough insulin and / or are insulin resistant and hence struggle to keep their blood sugars in normal range.  For these people it makes sense to reduce the insulin load their diet (the portion that requires insulin) to a point that they can maintain normal blood glucose levels.

tallying up the amino acids

I figured I could use this knowledge of the categorisations of the various amino acids to better understand how much of the proteins in the 8000 foods listed in the USDA food database are glucogenic versus ketogenic.

For each food in the USDA database I tallied up the weight of the glucogenic and ketogenic amino acids and the amino acids that fell onto the ‘both’ category and found that:

  • ketogenic amino acids make up only 12% by weight of the total protein across the 8000 foods in the database,
  • glucogenic amino acids comprise 74% of the foods, and
  • amino acids that fit in the “both” comprise 14% of the total weight of amino acids.

This means that somewhere between 78% and 89.5% of protein has the potential to turn into glucose, depending on whether you considered the amino acids in the ‘both’ column to be glucogenic or ketogenic, or somewhere in between.

For someone eating a low carbohydrate diet nearly 90% of ‘excess’ protein could be turned to glucose in the blood stream.

Why is this different to the observation from the food insulin index testing that approximately 56% of protein raises insulin?  Perhaps the following factors come into play:

  1. When we consider the glucogenic potential of the individual amino acids we are considering the maximum potential of protein if it is not first used for protein synthesis.  The amount of protein synthesis will be greater for say an athlete or a body builder, with less protein remaining for gluconeogenesis.
  2. Converting protein to glucose requires energy and hence some of the energy from ingested protein is lost in the process and hence is not converted to glucose.
  3. The insulin index testing is undertaken over only three hours. Protein takes much longer to digest and be metabolised into glucose hence the insulin index testing may underestimate the full glucogenic potential of protein.

which foods have the most ketogenic protein?

So I bet you are wondering which forms of protein have the highest amount of ketogenic protein.  Maybe not?  Well, I was, and I am going to share it with you.

The table below shows the foods from the USDA database that have the most ketogenic protein (assuming the ‘both’ amino acids are split 50/50 glucogenic / ketogenic) in terms of grams of ketogenic amino acids per 100 grams of the food.

Food ketogenic aminos ( per 100g) % ketogenic protein % insulinogenic
Seal, Bearded Alaskan 19.4g 23% 72%
Whale, Beluga 17.6g 25% 64%
Cod 16.3g 26% 68%
Seaweed, spirulina 14.2g 25% 64%
White fish 13.6g 22% 53%
Parmesan cheese 12.3g 32% 28%
Beef, sirloin 10.0g 33% 50%
Beef, ribeye 9.7g 33% 44%
Bacon 9.3g 25% 22%
Egg yolk 9.2g 27% 18%
Lamb 9.0g 25% 39%
Chicken, breast with skin 7.8g 24% 48%
Salmon 7.0g 28% 45%
Egg, whole 3.3g 26% 29%
Milk 0.9g 29% 43%

It is hard to know what to make of this list other than noting that the seal, whale and cod have the highest amounts of ketogenic protein.  Perhaps there is something about cold water animals that cause them to store more ketogenic amino acids?  This seems to align with what we see in the traditional diets of humans who may eat more fat if they are living further away from the equator but eat more carbohydrates from fruits if they live closer to the equator.

Although seal, whale and cod have high amounts of ketogenic amino acids, overall they are still quite insulinogenic.  In view of the high proportion of insulinogenic properties of some meats it is not surprising that people can thrive on a 100% meat zero carb diet because the body can get as much glucose they need from the meat.[13]  At the same time though, I’m not sure that an all meat diet can provide an optimal array of vitamins and minerals unless you are emphasising organ meats.

In view of the fact that a large amount of protein can be converted to glucose through gluconeogenesis, it seems better to focus on foods that have a lower percentage of insulinogenic calories if you are insulin resistant or do not have a fully functioning pancreas.

Rather than worrying about whether you’re eating too much protein, most people will do fine if they limit their processed grains and sugars and eating as much protein as their appetite directs them to.  If you are aiming for a therapeutic ketogenic diet to manage chronic conditions such as cancer, epilepsy or dementia, then you may want to consider moderating your protein intake to drive ketosis.

While there is no such thing as a glycemic index for protein, it also makes sense to avoid processed foods if you are after stable blood glucose levels and lasting satiety.  Unless you are a bodybuilder who is looking for a quick insulin spike it would be prudent to prioritise protein from whole foods.

summary

The table below shows a comparison of a range of glucogenic factors for protein relative to carbohydrate, summarising the discussion above.  Most of the approaches to understanding the insulinogenic portion of protein give an even higher value than suggested by the analysis of the food insulin index data.

Basis % insulinogenic Comment
Carbohydrates only 0% A lower end sensitivity assuming that no protein is converted to glucose (i.e. as per standard carbohydrate counting).
Food insulin index 56% Based on testing of > 100 foods in healthy individuals
Thermic effect of food 77% Average of additional in digestion losses minus 7%.
Wilder’s formula 54% Used in initial ketogenic formula
Krebs  / Janney 57% Based on nitrogen excretion in dogs
Glucogenic potential (min) 78% Based on summing amino acids in USDA foods database, excluding “both” aminos.
Glucogenic potential (max) 89.5% Based on summing amino acids in USDA foods database, including “both” aminos.
Steve Phinney WFKD 75% Assuming that the first 7% of calories goes to growth and repair with 75% of the remaining amino acids being glucogenic.

the most ketogenic foods… updated

I have calculated the insulinogenic potential of the foods shown in this previous article (The Most Ketogenic Diet Foods) using the following approaches:

  • carbohydrates only;
  • food insulin index data (i.e. protein is 56% insulinogenic);
  • thermic effect (i.e. protein is 77% insulinogenic); and
  • maximum glucogenic potential of the amino acids for each food (varies for each food based on data in USDA foods database).

This updated data illustrates the difference in standard carbohydrate counting and the full insulinogenic potential of the food.  While there is a range of values due to the varying amounts and types of protein overall, there is a reasonable alignment between the food insulin index (56%), thermic effect of food (77%) and maximum glucogenic potential values, particularly when we compare it to the carbohydrate only approach for the lowest carbohydrate foods.

least insulinogenic foods

food carb only (0%) FII (56%) thermic (77%) glucogenic (max)
olives 1% 4% 4% 4%
cream 3% 4% 6% 4%
pecans 2% 5% 8% 6%
Macadamia nuts 3% 5% 7% 6%
duck 0% 7% 4% 9%
pork sausage 2% 10% 19% 9%
sesame seeds 7% 7% 10% 11%
sausage 0% 9% 12% 14%
frankfurter 2% 11% 14% 14%
pepperoni 0% 10% 14% 15%
bacon 1% 16% 21% 21%
mackerel 0% 20% 28% 28%

Eggs

egg  carb only (0%) FII 56%) thermic (77%) glucogenic (max)
egg yolk 16% 15% 20% 19%
whole egg 17% 21% 23% 25%
egg white 6% 53% 71% 72%

Dairy products

Cheese

cheese carbs only (0%) FII (56%) thermic (77%) glucogenic (max)
cream cheese 5% 9% 10% 9%
brie 1% 14% 20% 18%
limburger 1% 14% 19% 18%
camembert 1% 15% 21% 19%
Monterey 1% 15% 20% 19%
cheddar 1% 15% 20% 19%
gruyere 0% 17% 23% 20%
Colby 3% 16% 21% 20%
blue 3% 16% 21% 20%
edam 2% 17% 23% 21%
gouda 2% 18% 24% 22%
feta 6% 18% 23% 22%
ricotta, whole milk 7% 21% 27% 24%
mozzarella 3% 20% 26% 26%
cream cheese, low fat 16% 25% 28% 27%
parmesan 3% 21% 27% 28%
mozzarella, skim milk 4% 26% 34% 31%
Swiss 6% 22% 27% 34%
ricotta, part skim milk 15% 33% 40% 37%
cream cheese, fat free 29% 62% 75% 72%
Swiss, low fat 8% 45% 48% 73%
cottage cheese, low fat 17% 55% 69% 86%
mozzarella, non-fat 10% 60% 79% 95%

Milk

milk carb only (0%) FII (56%) thermic (77%) % insulinogenic (max)
Full cream milk, 3.7% fat 29% 41% 41% 43%
Human milk 40% 43% 44% 43%
Skim milk, 1% fat 47% 65% 72% 69%
Chocolate milk, low fat 63% 72% 76% 70%

Yogurt

yogurt carb only (0%) FII (56%) thermic (77%) % insulinogenic (max)
plain, whole milk 30% 42% 48% 46%
Plain, low fat 44% 63% 70% 68%
fruit, low fat 71% 81% 85% 83%
plain, skim milk 55% 78% 87% 85%
fruit, non-fat 70% 90% 97% 96%

Fruits

fruit carb only (0%) FII (56%) thermic (77%) % insulinogenic (max)
olives 1% 3% 4% 4%
avocados 4% 8% 9% 7%
raspberries 42% 42% 51% 45%
blackberries 40% 42% 53% 47%
strawberries 70% 75% 76% 69%
oranges 77% 81% 83% 76%
apples 88% 89% 89% 81%
bananas 91% 91% 95% 86%

Vegetables

vegetable carb only (0%) FII (56%) thermic (77%) % insulinogenic (max)
endive 6% 22% 29% 24%
dock 5% 27% 33% 27%
mustard greens 7% 61% 43% 34%
asparagus 36% 60% 69% 34%
artichoke 22% 35% 39% 38%
sauerkraut 30% 41% 45% 40%
broccoli 3% 35% 47% 42%
lettuce 28% 44% 50% 42%
coriander 15% 36% 44% 43%
chrysanthemum leaves 0% 32% 43% 44%
alfalfa 3% 42% 57% 47%
parsley 34% 52% 59% 48%
cauliflower 32% 50% 56% 48%
spinach 24% 53% 63% 50%
bamboo shoots 19% 50% 62% 51%
mushroom 31% 56% 66% 55%
turnip 17% 30% 34% 62%
onions 78% 85% 88% 82%

Nuts, seeds and legumes

nuts, seeds legumes carbs only (0%) FII (56%) thermic (77%) % insulinogenic (max)
pecans  2% 5%  10% 5%
Macadamia  3% 5%  6% 6%
coconut meat  7% 6%  10% 7%
coconut cream  6% 7% 9% 8%
coconut milk  6% 7% 9% 8%
Brazil nuts  3% 7% 10% 9%
flax seed  1% 8% 12% 11%
walnuts  4% 9%  11% 11%
pine nuts  5% 9%  11% 11%
sesame butter (tahini)  6% 11% 15% 14%
sesame seeds  0% 12% 10% 15%
chia seeds  6% 13% 17% 16%
peanuts  4% 13%  19% 18%
sunflower seeds  9% 14% 19% 18%
pumpkin seeds  6% 14% 22% 19%
pistachio nuts  12% 19%  23% 22%
cashew butter  21% 22% 29% 25%
almonds  7% 13% 18% 17&

Fish

fish carbs only (0%) FII (56%) thermic (77%) % insulinogenic (max)
Tuna 0% 32% 44% 44%
Mackerel 0% 33% 46% 25%
Herring 0% 19% 26% 25%
Salmon 0% 24% 33% 34%
Sardine 0% 26% 36% 36%
Anchovy 0% 31% 42% 42%
Swordfish 0% 31% 42% 42%
Trout 0% 31% 44% 43%
Carp 0% 32% 43% 43%
Yellowtail 0% 36% 49% 49%
Bass 0% 37% 51% 51%
Mullet 0% 37% 51% 51%
Squid 18% 41% 49% 51%
Abalone 23% 47% 55% 57%
Monkfish 0% 44% 59% 60%
Halibut 0% 47% 24% 61%
Mussel 17% 49% 60% 62%
Oyster 21% 46% 56% 63%
Crab 0% 48% 66% 65%
Shrimp 5% 48% 64% 65%
Hadock 0% 51% 68% 66%
Perch 0% 49% 65% 67%
Clam 14% 56% 67% 71%
Scallop 19% 59% 76% 80%

Meat

meat carbs only (0%) FII (56%) thermic (77%) % insulinogenic (max)
Bologna 6% 12% 17% 14%
Frankfurter 2% 11% 14% 14%
Duck 0% 14% 17% 17%
Chorizo 2% 15% 18% 17%
Beef, ribeye 0% 15% 26% 21%
Bacon 1% 15% 21% 21%
Pork, ham 6% 17% 38% 22%
Pork, blade, hocks & shoulder 31% 23% 42% 31%
Turkey 0% 23% 29% 32%
Lamb mince 0% 24% 27% 34%
Chicken 0% 24% 34% 34%

post last updated May 2017

references

[1] http://ses.library.usyd.edu.au/handle/2123/11945

[2] http://www.thepaleomom.com/2015/05/adverse-reactions-to-ketogenic-diets-caution-advised.html

[3] http://perfecthealthdiet.com/2011/02/ketogenic-diets-i-ways-to-make-a-diet-ketogenic/

[4] https://books.google.com.au/books?id=SqzMBQAAQBAJ&pg=PA245&dq=Krebs+1964+The+metabolic+fate+of+amino+acids.&source=gbs_toc_r&cad=4#v=onepage&q&f=false

[5] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC292907/pdf/jcinvest00272-0077.pdf – Cahill references a 1964 paper by Krebs in this paper but I can’t find the original paper.

[6] http://en.wikipedia.org/wiki/Specific_dynamic_action

[7] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636610/

[8] http://en.wikipedia.org/wiki/Glucogenic_amino_acid

[9] http://en.wikipedia.org/wiki/Ketogenic_amino_acid

[10] https://www.dropbox.com/s/4dkl03mz2fci71v/The%20metabolism%20of%20%E2%80%9Csurplus%E2%80%9D%20amino%20acids.pdf?dl=0

[11] http://www.medschool.lsuhsc.edu/biochemistry/Courses/Biochemistry201/Desai/Amino%20Acid%20Metabolism%20I%2010-14-08.pdf

[12] http://en.wikipedia.org/wiki/Gluconeogenesis

[13] http://zerocarbzen.com/2015/03/09/zero-carb-interview-the-andersen-family/

trends, outliers, insulin and protein

  • The carbohydrate content of a food alone does not accurately predict insulin response.  Protein and fibre content of food also influence in insulin response.
  • The food insulin index data indicates that dietary fat is the one macronutrient that does not does not require a significant amount of insulin.
  • Net carbohydrates plus approximately half protein correlates well with observed insulin response.
  • This knowledge can be used to help select low insulin foods and more accurately calculate insulin doses for diabetics.

background

Back before the GFC I used to dabble in share trading.  I don’t know much about financial systems, but I spent a good deal of time designing and testing “trend following” trading systems.

One of the pitfalls for newbies is to design a system with excessive “curve fitting”.  That is, to design a complex system that would work fantastically on a specific set of historical data.  If you ran an overly curve fitted system on another set of data or tried to trade it in real time it would fail because it was too finely tuned to the discrete set of historical data.

“Everything should be as simple as possible, but no simpler.”

Albert Einstein

Another lesson from trading is that you should be able to describe simply why a good system works.  My trading system scanned the market for stocks that were moving up quickly over a number of time periods with minimal volatility so that I could place a close ‘stop loss’ that would take me out of the trade quickly if the trend turned.

When the GFC hit things got too volatile and I got out of the market.  It was no longer fun.  However the skills I learned as an amatuer a quantitative trader (along with my day job running multi criteria analyses to identify motorway alignments, road investments and the like) have given me an interesting angle on nutrition that I hope people find useful.

On the Optimising Nutrition blog I have tried to describe a system to manage nutrition that makes sense to me.  I want to document the things that I wish someone had shown us when we started out trying to understand diabetes and nutrition.

If we want to understand and predict the behaviour of insulin, the master regulator hormone of the human body, we need to first determine what we know that is accurate, significant and useful that we can use.

Kirstine Bell’s PhD thesis Clinical Application of the Food Insulin Index to Diabetes Mellitus[1] (Sept 2014) details the results of the latest food insulin test data for more than one hundred foods.  It also evaluates the relationship between insulin demand and protein, fat, carbohydrates, glycaemic index, glycaemic load, indigestible fibre, individual amino acids and blood glucose.

Previously I have discussed in a moderate amount of detail how to calculate how much insulin may be required based on the carbohydrate, protein and fibre ingested.  Given the importance of this issue, this article looks in more detail at what can be learned from the test data included in this thesis about the relationship between these parameters, with a view to better manage blood glucose and insulin demand.  You will see that I have tried to look at the issue from a number of different directions and have also included a more rigorous statistical analysis.

carbohydrate

Most people know that carbohydrates require insulin.  As shown in the chart below, carbohydrates goes some way to explaining insulin response.  However it is far from a perfect relationship (R2 = 0.44, r = 0.67, p < 0.05).

image001

indigestible fibre

Taking indigestible fibre into account (i.e. net carbohydrates) improves the relationship (R2 = 0.48, r = 0.69, p < 0.05).  The best correlation is achieved when we subtract all the indigestible fibre from the total carbohydrate value.  However we can see from the cluster of data points on the vertical axis there is something going on that is not explained by carbohydrates alone.

image002

The importance of dietary fibre should not be discounted, especially when trying to reduce insulin demand.  Some recommend that diabetics limit total carbohydrates, rather than considering net carbohydrates, or non-fibre carbohydrates.  The danger with a total carbohydrates approach is that people will avoid fibrous non-starchy vegetables that provide vitamins and minerals that cannot be obtained from other foods (unless you’re consuming a significant amount of organ meats), as well as feeding the gut bacteria which is also important to help improve insulin sensitivity and the body’s ability to digest fats. [2]

fat

The food insulin index data indicates that foods that are largely comprised of fat have a negligible insulin response (R2 = 0.38, r = 0.631, p < 0.001).

image003

To put this another way, the chart below shows the sum of carbohydrate plus protein (i.e. the non-fat content of foods) versus the insulin index (R2 = 0.38, r = 0.62, p < 0.001) indicating that:

  • the greater the proportion of fat in a particular food the less insulin is required; and
  • the more carbohydrates and / or protein ingested the more insulin is required.

image004

Hence, it appears that to reduce insulin demand we need to reduce carbs and / or protein!

The figure below shows a similar chart for the glucose score (i.e. the area under the curve of the blood glucose rise over three hours after ingestion of the food).  Again, this indicates that the blood glucose response is lowest for foods that contain a higher proportion of calories from fat (R2 = 0.45, r = 0.68, p < 0.001).

image005

While it appears that insulin demand is triggered by carbohydrates and protein, what is not clear is the relative degree to which carbohydrates and protein contribute to insulin demand.  Are they equivalent or does protein cause a smaller insulin  response?

protein

Another observation from trading is that you can learn a lot by considering outliers.  You have to decide whether the data points that don’t quite fit the trend are garbage or ‘black swans’ need to be accounted for in the system.

In the carbohydrate vs insulin relationship the outliers are the high protein foods that trigger a higher insulin response than can be explained by considering carbohydrates alone.

As shown in this plot, high protein foods are typically lower in carbohydrates which produce the greatest amount of glucose.  Choosing higher protein foods will generally reduce insulin (R2 = 0.10, r = 0.47, p < 0.001).

image006

Increasing protein will also typically lead to a spontaneous reduction in intake due to the thermic and satiety effects of protein. [3] [4]   Protein is critically important for many bodily functions.  It is vital to eat adequate protein.

However protein in excess of the body’s needs for growth and repair can be converted to glucose.  The fact that protein can turn to glucose represents a potential ‘hack’ for diabetics trying to manage their blood glucose as they can get the glucose required for brain function without spiking blood glucose as much as carbohydrates.

Choosing higher protein foods will generally lead to better blood glucose control.  Although high protein foods still raise the blood glucose somewhat, particularly if you are not insulin sensitive, however the blood glucose response is gentler and hence the pancreas can secrete enough insulin to balance blood glucose.

image007

For most people, transitioning to a reduced carbohydrate whole foods diet will give them most of the results they are after.  However for people with Type 1 Diabetes or people trying to design a therapeutic ketogenic diet, consideration of protein may be important to further refine the process to achieve the desired outcomes.

For a healthy bodybuilder the glucogenic and insulinogenic effect of protein might be an anabolic advantage, with the post workout protein shake providing an insulin spike to help build muscle.

However for someone struggling to lose weight on a low carb diet, considering the insulinogenic effect of protein might just be what they need to reduce insulin and normalise blood sugars and thus enable them to reach their goals.

glycaemic index

The glycaemic index is a reasonable predictor of insulin demand in terms of correlation (R2 = 0.54, r = 73, p < 0.01), however the ‘elephant in the room’ again is the high protein low carbohydrate foods (e.g. white fish, low fat cheese, lean beef etc).

image009

The other issue is that the glycaemic index is an empirical measurement that has to be measured in humans “in vivo” and can’t easily be calculated based on commonly available food properties.  And again, the glycaemic index does not deal with the insulin response from high protein foods.

glycaemic load

The same issues apply to glycaemic load.  There is a reasonable correlation between glycaemic load and insulin demand.  However it still does not explain the insulin effect of high protein foods (R2 = 0.57, r = 0.75, p < 0.01).  And you have to run these tests in real people “in vivo”.

image010

glucose score

Like the food insulin index, the glucose score is measured “in vivo” based on the area under the curve of a healthy person’s glucose rise due to a particular food.

Glucose score is interesting in that it actually achieves an excellent correlation with insulin demand (R2 = 0.75, r = 0.87, p < 0.001), however there is still a disconnect when it comes to high protein foods.

image010

It seems that some foods that do not raise blood glucose significantly over three hours still elicit an insulin response.  High protein foods digest slowly although they do still require insulin to metabolise.  In a normal healthy person the body’s insulin response to protein is balanced by release of glycogen from the liver, with blood glucose being kept in balance by insulin and glycogen. [5]

In a normal person the insulin keeps up with this slow blood glucose rise and hence we do not see a pronounced blood glucose spike due to high protein foods.

The interesting outliers here are processed low fat milk products that seem to require more insulin than would be anticipated by the blood glucose response.  On the other side of the trend line we have brown rice, pasta and other less processed whole foods which raises the blood glucose but does not require as much insulin as might be expected.

Accounting for fibre (i.e. net carbs rather than total carbs) goes some way to help anticipate the effect of processing.  However the effect of processed foods is an interesting area for future study that is beyond the capacity of this dataset to address.

I ran a number of correlation analysis and could not find an explanation of why a certain food sat above or below the trend line, whether it be carbohydrates, sugar, fibre or protein.

sugar

The sugar content of a food is not a particularly useful predictor of insulin demand (R2 = 0.10, r = 0.32, p = 0.001) compared with net carbohydrates (R2 = 0.48, r = 0.69, p < 0.05).  Quitting sugar is only part of the solution.  Most people struggling with diabetes or obesity should ideally consider their total carbohydrate intake.

image011

curve fitting

Kirstine Bells’ Clinical Application of the Food Insulin Index to Diabetes Mellitus[6] documents the development of a number of formula to explain the relationship between food properties and the food insulin index response.  The aim of this her thesis was essentially to build an improved glycemic index to predict insulin response rather than only considering changes in blood glucose.

The chart below shows the best relationship developed using a stepwise multiple linear regression analysis of the various parameters to forecast insulin demand documented in Clinical Application of the Food Insulin Index to Diabetes Mellitus. [7]

The correlation is excellent (R2 = 0.78, r = 0.89, p < 0.001).  However this relationship relies heavily on the glucose score (GS) which has to be tested “in vivo”.

image012

If we strip out the glucose score then the best relationship achieved in the thesis is the one shown below using carbohydrates and protein with a correction factor (R2 = 0.46, r = 0.68, p < 0.001).

The problem with this approach is that it assumes that high fat foods have some insulinogenic effect.  However we have seen above that high fat foods have a negligible insulin response.  This formula also does not account for indigestible fibre which should be subtracted from the total carbohydrate count.  And according to this formula a food with zero carbohydrate and zero protein would still have a significant insulin index response of 10.4, which does not make sense.

image013

simple is true

If we take out indigestible fibre (net carbs), assume that fat has a negligible insulin response and refine the protein factor to maximise the correlation with the test data, we end up with this chart which has an improved correlation compared to the model above (R2 = 0.49, r = 0.70, p < 0.001).

image014

This approach also does a good job of predicting blood glucose (R2 = 0.59, r = 0.77, p < 0.001) as shown in the chart below.

image015

practical application

Individual foods can be ranked and prioritised based on their proportion of insulinogenic calories using the following formula:

image016

Foods with the lowest proportion of insulinogenic calories will have the gentlest impact on blood glucose and have the lowest insulin demand, a consideration which will be very useful for people who are insulin resistant (i.e. Type 2 Diabetes or Pre-Diabetes) or not able to produce adequate insulin themselves (i.e. Type 1 Diabetes).

You can find a detailed list of foods ranked by their proportion of insulinogenic calories here and with consideration of nutrients and other factors based on different goals here.

Diabetics and people wanting to reduce the insulin demand of their diet can track the total insulin load (as opposed to carbohydrate counting) using the following formula:

image017

The total insulin load can be reduced by decreasing carbohydrates, increasing fibre, moderating protein to the body’s optimum requirement and increasing fat until target blood glucose are achieved.

can we design a “perfect” system?

There is still quite a degree of in this real life data.  This could be due to measurement error in the macronutrients, food quantity, individual characteristics of the people that the food was tested on, or something else.

This approach considering the insulinogenic effect of protein and carbohydrates does however help to better predict insulin demand than carbohydrate alone.

The fact that there is still a high degree of variability in the data and hence limited ability to accurately predict the insulin response to food can be mitigated by keeping the overall insulin load of the diet reasonably low.

Dr Richard Bernstein talks about the ‘law of small numbers’ whereby the compounding errors in the calculation of insulin requirement and the mismatch of insulin response with the rate of digestion misalign means that it is impossible to accurately calculate insulin dose.

The only way to manage the high level of variability is to reduce insulin demand to manageable levels.  This is especially beneficial for people who are injecting insulin, but also relevant for the rest of us.

summary

Building on the analysis of the food insulin index data, the key assumptions that underpin this system are:

  1. carbohydrates require insulin,
  2. indigestible fibre does not require insulin, and
  3. the glucogenic portion of protein that is not used for growth and repair and not lost in digestion also requires insulin.

In order to reduce our insulin load we should do the following, in order of priority:

  1. Reduce insulin load until you normalise blood glucose levels (i.e. reduce digestible carbohydrates and moderate protein if necessary),
  2. Increase nutrient density as much as you can while still maintaining good blood glucose levels (note: this will likely also include fibre from non-starchy veggies which will also increase fibre which reduces insulin and slows digestion),
  3. Reduce dietary fat if you still need to reduce body fat levels, and
  4. Implement an intermittent fasting routine to improve your insulin sensitivity and to kick-start ketosis.

references

[1] http://ses.library.usyd.edu.au/handle/2123/11945

[2] http://www.amazon.com/Brain-Maker-Power-Microbes-Protect/dp/0316380105

[3] http://wholehealthsource.blogspot.com.au/2013/04/glucagon-dietary-protein-and-low.html

[4] http://www.ncbi.nlm.nih.gov/pubmed/16002798

[5] http://wholehealthsource.blogspot.com.au/2013/04/glucagon-dietary-protein-and-low.html

[6] http://ses.library.usyd.edu.au/handle/2123/11945

[7] http://ses.library.usyd.edu.au/handle/2123/11945

[8] http://www.amazon.com/Brain-Maker-Power-Microbes-Protect-ebook/dp/B00MEMMS9I

what is a ‘well formulated ketogenic diet’?

While everyone uses fat for fuel to some degree, a ketogenic diet aims to reduce insulin levels to a point where ketone levels are high enough to be measured in the blood, breath or urine. [1]

In starvation, insulin levels plummet with glucose levels coming down and ketone levels increase progressively.

Chrome Legacy Window 27062015 23415 AM.bmp

According to Dr Steve Phinney’s chart below, a “well formulated ketogenic diet” contains between 3 and 20% carbohydrates and between 10 and 30% protein.

image016

Other dietary templates such as the Mediterranean or Paleo diets typically contain more carbohydrates and less fat.

The concern typically expressed about restricted carbohydrate diets is that they will not provide adequate nutrition (i.e. vitamins, minerals and amino acids).

Diabetics, along with the general population, are advised to eat in line with the USDA Food Pyramid / My Plate guidelines which emphasise “healthy whole grains” while discouraging saturated fat and cholesterol.

Diabetics are told that they should not deprive themselves of any foods or not to risk getting inadequate nutrition, but rather to “cover” any carbohydrates they eat with insulin (or treat with medications such as Metformin for type 2 diabetics).

Even in health circles ketosis is sometimes considered to be extreme and not worth the effort for most people, but is it really that hard to achieve?

When we look at the relationship between ketones, blood sugar and HbA1c we see that someone with excellent blood glucose levels will have a moderate amount of blood ketones.

The chart and table below are based on my tracking of blood sugars and ketone values.  Optimal blood (i.e. 4.6mmol/L) glucose corresponds to a ketone value of about 1.3mmol/L.

tracking BGs [Last saved by user] 16042015 82501 AM.bmp

HbA1c average blood sugar ketones
 (%)  (mmol/L)  (mg/dL)  (mmol/L)
low normal 4.1 3.9 70 2.1
optimal 4.5 4.6 83 1.3
excellent < 5.0 < 5.4 < 97 > 0.4
good < 5.4 < 6.0 < 108 < 0.3
danger > 6.5 > 7.8 > 140 < 0.3

In view of this it’s hard to see why ketosis is extreme.  It’s just what happens when someone has reduced their dietary insulin load to a point where they are achieving excellent blood sugars!

Ketosis is a sliding scale.  Some people will want to push their ketone levels to therapeutic levels though fasting and a higher fat diet, but this may not be necessary for general health.

Most people would benefit from reducing their dietary insulin load to a point where their blood sugars are close to excellent.

See Diabetes 102 for more info on what your blood sugars should be and the Goldilocks Glucose Zone for more thoughts on how to manipulate your diet to get excellent blood glucose levels.

I am a big fan of Steve Phinney (I attended a masterclass with him when he was in Brisbane last year), but I think he potentially alienates people when he starts off talking about the Inuit and Steffanson living off all meat diets.

I also understand why the people generally might baulk at the idea of mainlining butter and MCT oil to drive up ketones.  “How can eating all that extra fat really be healthy?” they ask.

I propose an alternative sales pitch for ketosis:

  1. ketosis occurs when your blood sugars are close to optimal,
  2. blood sugars can be optimised by reducing the insulin load of your diet, and
  3. once you optimise your blood sugars you will reduce your hunger, access your body fat for fuel and a whole host of other health markers will improve.

What’s not to like?

What do you think?

[this post is part of the insulin index series]

[Like what you’re reading?  Skip to the full story here.]

[1] http://www.dietdoctor.com/lose-weight-by-achieving-optimal-ketosis

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