Category Archives: fat

is there a relationship between macronutrients and diet quality?

Q:  To achieve optimal health, diabetes control and longevity you should:

  • Eat more fat to burn your body fat.
  • Follow a Protein Sparing Modified Fast (PSMF).
  • Eat more protein and lift heavy.
  • Drink Bulletproof Coffee.
  • Fast more.
  • Decrease protein and eat more fat bombs.
  • Take exogenous ketones, butter and MCT oil to boost your blood ketones.
  • Eat only plants.
  • Eat no plants.
  • All of the above.
  • None of the above.
  • I give up! All you ‘diet gurus’ can’t agree.  I’m going back to Maccas where things are simple!

Although many of these answers are contradictory, all are ‘correct’ depending on which low carb / keto group(s) you belong to.  It can be confusing out there on the interwebs!

Image result for confusing

For the last two years I’ve been working to refine our ability to quantitatively define and optimise our food quality (a.k.a. nutrient density).

At the start of 2017, I developed the Nutrient Optimiser and have since run detailed macronutrient and micronutrients analyses for more than forty people, all with different starting points and with different goals.

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With all the conflicting advice out there and my personal quest to manage diabetes while maximising nutrient density, I wondered what my nutrient analysis tools might be able to tell us about the relationship between macronutrients and micronutrients to provide some clarity to the circular debates that I see so often online.

I’m never sure where these articles will end up when I start the analysis.  And this one is certainly interesting!

The analysis suggests that a nutrient dense diet is typically not low in protein.  However just focusing on increasing protein won’t necessarily lead to a nutrient dense outcome.

We get a much better outcome when we focus on the harder-to-find micronutrients (i.e. vitamins, minerals and essential fatty acids).  From there we can tweak the nutrient dense template to suit our goals (e.g. weight loss, diabetes control, muscle gain, athletic performance or therapeutic ketosis).

Nutrient density

Let’s quickly look at what we mean by ‘nutrient density’ and how we can quantify it.

All foods

The chart below shows the nutrients provided by the 8,000 foods in the USDA database in terms of the percentage of the Daily Recommended Intake (DRI) if you ate just a little bit of all of them.

It’s easy to meet the recommended minimum intake of the micronutrients shown at the bottom of the chart (e.g. vitamin B12 and most of the amino acids) (at least if you are eating animal products).

However, you really have to go out of your way to get adequate amounts of the nutrients at the top of the chart (e.g. omega 3, vitamin D, choline, vitamin E, calcium, manganese and magnesium).

The most nutrient dense foods

The chart below shows the micronutrients provided by the most nutrient dense foods.  When we focus on foods that contain more of the harder-to-find nutrients we can get a massive boost in all the micronutrients.

Why should we pursue a nutrient dense diet?

With adequate amounts of nutrients being provided by the food we eat there is a good chance we will be able to satisfy our cravings with less energy.

Obtaining adequate levels of all the micronutrients will ensure that we have what we need to drive our mitochondria at full power rather than limping along.  We will feel energised and may find that our appetite turns off sooner and we will be less likely to overeat and get fat.[1] [2]  [3] [4] [5] [6] [7] [8] [9] [10] [11]

The chart below shows a comparison of the most nutrient dense 10% of the foods available compared to all the foods in the USDA database.  We get a significant improvement in our food quality by prioritising more nutrient dense foods.

Which nutrients do we need to worry about?

After a ton of trial and error and systems refinement (and some robust debates with Ray Cronise) I finally figured out that maximising nutrient density works best when we only focus on boosting the nutrients that are harder to obtain.

The nutrients listed below tend to be generally harder to get in adequate quantities:

  • Alpha-linolenic acid
  • EPA + DHA
  • Choline
  • Vitamin D
  • Vitamin E
  • Calcium
  • Magnesium
  • Potassium
  • Phosphorus
  • Zinc
  • Thiamine
  • Pantothenic acid
  • Niacin
  • Manganese
  • Folate
  • Selenium

Which nutrients are easier to find?

Listed below are the micronutrients that we don’t need to prioritise because they are fairly easy to get enough of:

  • Leucine
  • Valine
  • Sodium
  • Methionine
  • Isoleucine
  • Tyrosine
  • Riboflavin
  • Lysine
  • Vitamin B-6
  • Histidine
  • Threonine
  • Phenylalanine
  • Tryptophan
  • Iron
  • Vitamin C
  • Copper
  • Vitamin A
  • Vitamin B-12
  • Vitamin K

I have intentionally left out all the amino acids (i.e. protein) from the prioritisation because, as you will see below, it’s easy to get enough protein when we focus on the vitamins, minerals and essential fatty acids.

Can you get too much of a good thing?

As a general rule it’s hard to get excess micronutrients from real food, but it is possible.

  • While we can get more than thirty times the DRI for vitamin K from a nutrient dense diet there is no upper toxicity level of toxicity for vitamin K[12] [13] from natural sources.  However you can get too much menadione which is used as a vitamin K supplement.[14] [15]
  • We can get eighteen times the DRI for vitamin B12 from a nutrient dense diet, however again, there is no upper limit established for B12.[16] [17]
  • We can get seventeen times the DRI for Vitamin A from a nutrient dense diet. It is possible to get vitamin A toxicity, though again this typically occurs from supplementation.[18] [19]  There are some reports of Hypervitaminosis A from explorers gorging on polar bear liver, but this is not likely to be a common occurance.[20] [21]
  • We can get around twelve times the DRI for copper from a nutrient dense diet which is around the upper limit.  Though these high levels are unlikely to occur without high liver consumption which is not common.
  • A nutrient dense diet can provide around fifteen times the DRI for vitamin C however the upper limit is more than 20 times the DRI.[22] [23] Excessive vitamin C supplementation usually causes diarrhea, so it’s largely a self limiting situation.
  • A nutrient dense diet will provide around ten times the DRI for iron while the upper limit is set at around six times the DRI. Many women are iron deficient while many men have hemochromatosis which is excess iron storage.  Liver, mushroom, seaweed and spices are the highest sources of iron.  It’s useful to understand your current iron status to know whether you need more or less iron or should even be considering donating blood.
  • It is quite easy to get more than the DRI for amino acids. While high protein diets do not cause kidney disease in healthy people there is no need to chase excess super high levels of protein.[24]   And just like liver, most people will struggle to eat excessive amounts.

So yes, it is possible to get excessive levels of some micronutrients, though generally not a concern unless you are eating a LOT of liver or supplementing with synthetic nutrients.

The chart below shows the nutrient profile of Amy who is following a zero carb diet with a lot of organ meats.  While she is generally getting high levels of most nutrients, she is still not meeting the DRI for a number of vitamins and minerals that are typically found in plant foods (e.g. vitamin K1, calcium, manganese, vitamin E, magnesium and potassium).

At the other extreme we have David who is eating a plant based diet that has plenty of vitamins and minerals but less amino acids.  He knows he needs to supplement with vitamin B12 and vitamin D which are hard to get from a purely plant based diet.

When it comes to nutrient density I often see arguments around whether or not the daily recommended intake levels are correct and whether they might vary for different people with different dietary approaches and whether or not nutrients from plant or animal based food are more bioavailable.

While I think these are definitely under researched areas I think these discussions are not so relevant when we’re orders of magnitude above or below the DRI values.  We need to identify the full range of foods, from whatever source, that will provide the nutrients that we’re not getting enough.  We can then choose from within those to suit our tastes and preferences.  Our appetite can be a pretty good guide once we eliminate the processed hyper palatable nutrient poor foods that our willpower is no match for.

There is plenty of discussion about excess protein or excess calories.  While it’s true that excess is typically not good, I think it’s more valuable to focus on eating foods that contain more of the nutrients that we are currently not getting enough of.   When we’re eating nutrient dense whole foods we’re less likely to need to consciously worry about calories, protein, fat, carbs, sugar, fibre or whatever.

Is there any relationship between macronutrients and nutrient density?

While I don’t see a lot of discussion about nutrient density or food quality, there is seemingly endless debate in social media in low carb and keto circles around macronutrients.  People are often very passionate about eating more or less protein, carbs, fat and fibre.

Perhaps this is because macronutrients are reasonably easy to track and understand.  Or maybe it is because the previous approach hasn’t worked, so they swing to the other extreme.

We’ve been told for so long that fat is bad and now people are realising that it’s not as bad as they were told, so they swing to the other extreme.  Now fat can do no wrong.

Meanwhile, there are plenty of people who stick to fat being bad and wanting to avoid it.

Different people have different perspectives on the multifaceted topic of nutrition.

But is there really any value gained by focusing on primarily on macronutrients?  Will it improve our food quality or the adequacy of the various essential micronutrients?

To understand whether there is any useful relationship between the various macros and micronutrient adequacy I have plotted the various macronutrients versus the nutrient density score for the 8,000 foods in the USDA foods database.

Note: In this analysis a high nutrient density score means that a particular food has a relatively large amount of the harder-to-find nutrients listed above.  

Protein versus nutrients density

There is a lot of debate about protein and whether we should be getting more or less of it.

The chart below shows the nutrient density score for the harder-to-find vitamins, minerals and essential fatty acids vs protein (%).

2017-05-28 (9).png

Although amino acids have not included in the nutrient density score it appears that the more nutrient dense foods have more protein.  Conversely, foods with less protein have less of the nutrients that are harder to find.

It seems that if we avoid protein we will end up with less nutrients overall.  While if we focus on getting the nutrients that are harder to find we will get enough protein.

However, as they say, correlation does not equal causation.  There is a lot of scatter in this chart.  In this case the correlation (R2) of this relationship is 0.31.

This analysis makes me wonder if the studies that the benefits from increased protein are not at least in part from, not just getting adequate amino acids, but the increased levels of the other micronutrients that often come along with protein.

It’s hard to separate good nutrition and protein.

Fat versus nutrient density

The chart below shows the nutrient density score versus the percentage of calories from fat.

2017-05-28

The first thing to point out here is that there is a massive amount of scatter and a low degree of correlation between fat and micronutrients (R2 = 0.06).

However, it does seem that very high fat foods contain less of the harder-to-find nutrients.

Meanwhile at the other extreme very low fat foods can either be nutrient poor (e.g. sugar and processed grains which would be at the bottom left of this chart) or very nutrient dense (e.g. non-starchy vegetables which would be at the top right of this chart).

If we run a trend line through all these foods we see that the highest nutrient density occurs at around 30% calories from fat.

The reality is that not many people live primarily on high nutrient density low fat foods at the top left corner of this chart. People avoiding fat will often slip into the bottom left of this chart and resort to the low fat processed grains and sugars to get enough energy to get through the day.

Sugar versus nutrient density

There is currently a lot of focus on sugar as the primary culprit for our poor health.  Gary Taubes and Damon Gameau are down on sugar while Robert Lustig is leading the charge against fructose or fruit sugar.

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This analysis suggests that foods with more sugar have a poorer nutrient density, though it’s hard to make sense of this unless we differentiate between added refined sugar and naturally occurring sugar in plant based foods that come with a ton of other nutrients.  However, low sugar content does not necessarily guarantee excellent nutrient density.

Energy density versus nutrient density

Energy density is the amount of energy we get per gram of food.

2017-05-28 (2).png

Minimally processed foods contain more water and fibre and thus have a lower energy density but also tend to have a higher nutrient density.

Meanwhile, processed foods that are shelf stable and easy to transport typically have less water and fibre and more preservatives.

While lower energy density foods have a higher nutrient density, most people won’t survive long on a diet of only lettuce, broccoli and celery.  They will need some more energy dense foods to survive.

However, if you are looking to lose weight in a hurry while still getting the nutrients you need, focusing on lower energy density foods might not be a bad place to start.

Most people agree that eating more veggies will be better for their health, but the unfortunate reality is that it takes some time and money to prepare the food yourself rather than reaching for a quick and cheap energy hit with minimal effort.

Net carbs versus nutrient density

Foods with more digestible carbohydrates typically have a lower nutrient density.

2017-05-28 (4).png

However, simply going low carb doesn’t guarantee that we maximise nutrient density  There is a range of high and low nutrient density foods at the low carb end.

Whether or not you carbs are nutrient dense will likely depend more on whether they are highly processed or in their natural form, and will likely make a bigger contribution to their nutrient density than the quantity of carbs.

Fibre

Higher fibre foods contain more nutrients.  However, we can’t just add fibre supplements to maximise nutrient density.  Plant based whole foods that also happen to have heaps of fibre that provide us with more higher levels of nutrition.

2017-05-28 (5).png

Insulinogenic calories

The proportion of insulinogenic calories is the proportion of the food we eat that requires insulin to metabolise.

2017-05-28 (7).png

On the right hand side of the chart, highly processed foods with minimal protein and fat typically don’t provide a lot of the harder-to-find nutrients.

Meanwhile on the left hand side of the chart, foods with minimal fibre, carbs and protein are also less nutritious.

If we plot a trendline it appears that the maximum nutrient density occurs at around 50% insulinogenic calories.

If you are already insulin resistant you may want to steer your dietary ship to the left with a lower insulin load diet to the point that your pancreas can keep up and maintain normal blood sugars.  Meanwhile if you’re fit and insulin sensitive you will be able to have more leeway when it comes to macros and insulin load.

Summary

So what to make of all this?  Which of these parameters has the best correlation with food quality or nutrient density?  The table below shows the various parameters sorted by their correlation (R2) with their nutrient density score.

parameter correlation comment
protein 0.32 Nutrient dense foods tend to have more protein.
energy density 0.15 Lower energy density foods are typically more nutrient dense.
net carbs 0.12 Foods with more net carbs are typically less nutritious.
insulinogenic 0.11 Nutrient density peaks at around 50% insulinogenic calories.  Extremes are not optimal.
fibre 0.08 High fibre foods are often more nutritious.
fat 0.07 Nutrient density peaks at around 30% fat.
sugar 0.04 High sugar content correlates with low nutrient density

It seems that if we want to optimise the quality of our diet we should:

  1. Focus on the foods that contain the harder-to-find nutrients.
  2. Not actively avoid protein.
  3. Chose lower energy density foods when we can.
  4. Avoid foods that are largely digestible carbs with minimal fibre (e.g. processed grains and sugars).
  5. Chose moderately insulinogenic foods without swinging to either extreme (though we should err on the less insulinogenic side if we already have diabetes).

Meanwhile, sugar, fat and fibre, aren’t spectacular predictors of nutrition.

2017-05-28 03.41.23.png

chasing nutrients vs chasing macros

So, if protein is good, more is better, right?   Bring me the bulk tub of protein powder!

Not so fast.  It is important to understand the difference between emphasising:

  • all nutrients,
  • protein,
  • less insulinogenic foods, and
  • harder-to-find nutrients.

Maximise all nutrients

The chart below shows what happens to the micronutrient profile when we simply maximise all nutrients.

The amino acids are through the roof (69% protein) because aminos are easy to find in our food system, but we’re still lacking in many of the harder to get nutrients.

Maximise protein

If nutrient density correlates with protein then it makes some sense to prioritise protein.    Doesn’t it?

The chart below shows what happens to the nutrient profile if we sort the USDA foods database by % protein.  It seems that if we simply focus on protein we get a poor vitamin and mineral profile.

Minimising protein and maximising fat

Minimising protein and carbs while maximising fat is all the rage in the keto scene.  Unfortunately, a very low insulin load diet is not a high nutrient density approach as we can see from the chart below.  While we get adequate protein (15%), the vitamin and mineral profile is poor.   With 80% of our energy coming from fat we are deficient in about half the micronutrients.

Perhaps a very high fat therapeutic ketogenic approach should be reserved for special circumstances and extra attention given to the nutrients you won’t be able to get from your food?

Prioritising the harder to find nutrients

The chart below shows the outcome when we focus the harder to find nutrients (excluding amino acids).  We get adequate quantities of all the micronutrients and still plenty of protein.

Learnings from the Nutrient Optimiser analysis

It’s one thing to look theoretically in a database of individual foods.  But it’s another to look at what people are eating in real life.  Next, I’m going to share what I’ve learned from analysing a lot of different people’s food logs in the Nutrient Optimiser.

The nutrient density score

But first, I need to introduce you to the Nutrient Density Score.

The chart below shows Rhonda Patrick’s nutrient analysis.  Rhonda’s diet is not particularly extreme in anything other than nutrients.

Rhonda would score 100% if she could achieve 200% of the DRI for the hardest to hardest to find lower half of the nutrients.  However, because she doesn’t achieve 200% with all of the lesser scoring half of the nutrients she only gets a Nutrient Density Score of 81.3%.

For reference, if we add a little bit of all the foods in in the USDA database we would get a nutrient density score of 63% .  The most nutrient dense 10% of the foods in the USDA database will give us a nutrient density score of 93%.  Even Rhonda has some room for improvement.

By contrast, the chart below shows Patrick’s nutrient density score which comes in at only 21%. Patrick is following a very high fat keto approach even though his blood sugars are great and he doesn’t appear to be insulin resistant, just obese.

With so many of his micronutrients being nowhere near the DRI vales Patrick will need to eat a lot more of his current diet to meet the daily recommended intake for most of the nutrients.

There is a good chance that that Patrick will be craving more food to obtain the nutrients that he needs to get through the day.  Even though he is trying to lose weight, he might end up overeating more calories using his current diet than if he spent a week eating with Rhonda.

The table below shows the nutrient density score for more than forty Nutrient Optimiser analyses that I’ve run to date along with:

  • protein (g/kg LBM),
  • protein (%)
  • fat (%)
  • fibre (%)
  • net carbs (%).

I encourage you to click on each of the names below to review their nutrient analysis to see what they are and aren’t eating to get these scores.

Name score protein (g/kg LBM) protein fat fibre (%) net carbs (%)
Rhonda Patrick 82% 2.5 17% 57% 10% 15%
Briana Theroux-Hulsey 79% 3.5 29% 21% 15% 35%
David Houghton 77% 0.6 17% 2% 21% 60%
Andy Mant v3 77% 4.4 27% 53% 5% 15%
Alber Van Zyl 75% 1.0 15% 77% 2% 6%
Alma Fuente 75% 5.3 27% 60% 7% 6%
Mike Berta 74% 2.1 31% 58% 4% 7%
Alex Leaf 74% 3.3 33% 26% 10% 32%
Alex Ferrari 74% 2.0 17% 54% 6% 24%
Deb Pinsky Lambert v2 72% 1.2 31% 61% 3% 6%
Luis Villasenor 72% 2.4 43% 48% 3% 5%
Gayle Louise 71% 2.4 40% 49% 4% 7%
Andy Mant v2 70% 3.0 26% 54% 6% 15%
Robin Reyes v3 69% 1.6 18% 67% 6% 8%
Ruth Jamieson v2 66% 1.6 18% 67% 6% 8%
Amy 65% 3.3 41% 57% 0 1%
Ingunn Lovik 62% 1.5 21% 70% 1% 8%
Sophia Thom 62% 1.1 24% 65% 4% 7%
Franziska Spritzler 61% 2.3 27% 55% 10% 8%
Sarah Koenck 58% 2.2 14% 77% 4% 6%
Ruth Jamieson v1 57% 1.4 19% 65% 7% 9%
Maria Fornaciari 52% 1.6 30% 61% 3% 6%
Matija Mlakar 50% 2.1 23% 49% 11% 17%
Nicole Jacobi 48% 2.8 32% 60% 3% 6%
Graeme Monteith 48% 2.6 18% 67% 5% 10%
Dave Knowles 46% 2.4 31% 63% 2% 3%
John Robertson 46% 1.4 16% 59% 4% 21%
Leah Williamson 44% 1.8 19% 75% 2% 3%
Balin Jones 43% 5.0 26% 66% 3% 5%
Andy Mant v1 34% 3.7 35% 54% 2% 9%
George 34% 0.8 9% 69% 9% 12%
Robin Reyes v2 32% 1.6 21% 59% 4% 15%
Lorraine Ayre 30% 1.3 19% 64% 5% 12%
Terry Palmer 29% 1.5 25% 62% 5% 8%
Paul Stansel 28% 1.5 18% 77% 2% 3%
Gigi Giodani 26% 1.6 15% 81% 1% 2%
John Kerr 25% 0.7 11% 84% 2% 3%
Robin Reyes v1 23% 1.1 13% 50% 2% 35%
Patrick Butts v1 21% 0.8 18% 73% 4% 5%
Patrick Butts v2 20% 1.4 26% 66% 3% 6%
Harry Nguyen 20% 2.3 20% 72% 4% 4%

In the charts below we’ll quickly look at the relationship between the macros and their nutrient score.

Protein

This chart shows the relationship between protein intake and each person’s nutrient density score.  The average protein intake for this range of people following a low carb or keto diet is 2.1g/kg LBM or 23% of energy.

On the top left corner of the chart we have David who is following a plant based diet and intentionally getting lower levels of protein but also maximising vitamins and minerals from plant based foods.

On the bottom left we have a number of people following a therapeutic ketogenic diet targeting low protein and high fat.

As long as you are not trying to target low protein and high fat to generate higher blood ketones then it doesn’t seem to matter what your protein intake is.  Most people get enough protein to support their activity levels.

The chart below shows the nutrient density score versus protein (%).  Again, it seems that it’s hard to get high levels of nutrients if you are targeting minimal protein levels.

% insulinogenic

The story is similar with insulin load.  Reducing the insulin load of your diet to the point that your blood sugars normalise is a great idea, but less is not necessarily better.  We want to avoid really high insulin levels but not drive it so low that we don’t have enough nutrients to repair our muscles and organs.

Fat

High levels of fat do not guarantee high levels of nutrition.

Net carbs

It’s good to reduce the carbohydrate load of your diet to normalise your blood glucose levels, but again minimising is not necessarily the best idea and may be unnecessary if you are not managing diabetes.

Higher levels of isn’t necessarily bad either when it comes to nutrient density.  On the top right of the chart we have David who is striving for a nutrient dense plant based diet with about 35% net carbs while for contrast we have Robin’s baseline junk food diet which also has about 35% net carbs which has about the same nutrient density score as the very high fat therapeutic keto dietary approaches on the bottom left of the chart.

Fibre

Higher levels of fibre typically correlate with more nutrition (although you can get heaps of nutrients from shellfish and organ meats with minimal fibre intake).

Summary

  • A nutrient dense diet is not low in protein; however focusing on protein won’t necessarily guarantee great nutrition.
  • Foods with a lower energy density are often more nutrient dense. To maintain our body weight and growth we will need to add more energy dense foods (i.e. more non-fibre carb and / or fat).  Meanwhile, dialling back the energy density and forcing your body to use your stored body fat can be a good strategy for weight loss.
  • Reducing your carb intake or the insulin load of your diet can be useful if you are managing diabetes. However less is not necessarily better.
  • For the most part ensuring you are getting the harder-to-find micronutrients will maximising your diet quality without going to macronutrient extremes.

references

[1] https://www.youtube.com/watch?v=rYXF0l18ciI

[2] https://www.youtube.com/watch?v=ncVJfZZ7bTM

[3] https://www.youtube.com/watch?v=ZjUgX91VZpk

[4] http://perfecthealthdiet.com/2011/02/perfect-health-diet-weight-loss-version/

[5] https://www.ncbi.nlm.nih.gov/pubmed/18469287

[6] https://www.ncbi.nlm.nih.gov/pubmed/19785688

[7] http://www.tandfonline.com/doi/abs/10.1080/13590840220143062?journalCode=ijne20&

[8] https://www.ncbi.nlm.nih.gov/pubmed/19263591

[9] http://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2007.00465.x/abstract

[10] https://www.ncbi.nlm.nih.gov/pubmed/20142823

[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988700/

[12] http://www.consumerlab.com/RDAs/#VitaminK

[13] http://www.consumerlab.com/RDAs/#VitaminK

[14] https://en.wikipedia.org/wiki/Menadione

[15] https://www.amazon.com/Nutrient-Bible-Henry-Osiecki/dp/1875239545

[16] http://www.consumerlab.com/RDAs/#B12

[17] https://www.amazon.com/Nutrient-Bible-Henry-Osiecki/dp/1875239545

[18] http://www.mayoclinic.org/drugs-supplements/vitamin-a/safety/hrb-20060201

[19] http://www.consumerlab.com/RDAs/

[20] https://www.121dietitian.com/never-eat-a-polar-bears-liver/

[21] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1257872/

[22] http://www.consumerlab.com/RDAs/#VitaminC

[23] https://www.amazon.com/Nutrient-Bible-Henry-Osiecki/dp/1875239545

[24] https://chriskresser.com/do-high-protein-diets-cause-kidney-disease-and-cancer/

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

the complete guide to fasting (review)

Considering the massive amount of research and interest in the idea of fasting, not a lot has been written for the general population on the topic.

Brad Pilon’s 2009 e-book Eat Stop Eat was a great, though fairly concise, resource on the mechanisms and benefits of fasting.

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Martin Berkhan’s LeanGains blog had a cult following for a while in the bodybuilding community.

image17Michael Mosley’s 2012 documentary Eat, Fast and Live Longer documentary piqued the public interest and was followed by the popular 5:2 Diet book.

Then in 2013, Jason Fung emerged onto the low carb scene with his epic six part Aetiology of Obesity YouTube Series in which he detailed a wide range of theories relating to obesity and diabetes.

Essentially, Jason’s key points are that:

  • simply treating Type 2 diabetes with more insulin to suppress blood glucose levels while continuing to eat the diet that caused the diabetes is futile,
  • people with Type 2 diabetes are already secreting plenty of insulin, and
  • insulin resistance is the real problem that needs to be addressed.

Jason’s Intensive Dietary Management blog has explored a lot of concepts that made their way into his March 2016 book, The Obesity Code.  However surprisingly, given that Jason is the fasting guy, the book didn’t talk much about fasting.

my experience with fasting

I have benefited personally from implementing an intermittent fasting routine after getting my head around Jason’s work.  I like the way I look and perform, both mentally and physically, after a few days of not eating.  I also like the way my belt feels looser and my clothes fit better.

Complete abstinence is easier than perfect moderation.

St Augustine

I recently did a seven day fast and since then I’ve done a series of four day fasts, testing my glucose and blood and breath ketones with a range of different supplements (e.g. alkaline mineral mix, exogenous ketones, bulletproof coffee/fat fast and Nicotinamide Riboside) to see if they made any difference to how I feel and perform, both mentally and physically.

Fasting does become easier with practice as your body gets used to accessing fat for fuel.

I love the mental clarity!   My workout performance and capacity even seem to be better when I’ve fasted for a few days.

My key fasting takeaways are:

  1. Fasting is not that hard. Give it a try.
  2. You can build up slowly.
  3. If you don’t feel good. Eat!

The more I learn about health and nutrition, the more I realise how critical it is to be able to burn fat and conserve glucose for occasional use.  We get into all sorts of trouble when we get stuck burning glucose.

Our body is like a hybrid car with a slow burning fat motor (with a big fuel tank) and high octane glucose motor (with a small fuel tank).  If you’re always filling the small high octane fuel tank to overflowing, you’ll always be stuck burning glucose and your fat burning engine will start to seize up (i.e. insulin resistance and diabetes).

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Reducing the processed carbs in our diet enables us to lower our insulin levels and retrain our body to burn fat again.  But nothing lowers insulin as aggressively and effectively as not eating.

Even though lots of Jason’s thoughts on fasting seem self-evident, his blog elucidating them has been very popular, perhaps because the concept of fasting is novel in the context of our current nutritional education.

We’ve been trained, or at least given permission, to eat as often as we want by the people that are selling food or sponsored by them.[1]

context

Jason’s angle on obesity and diabetes comes from his background as a nephrologist (kidney specialist) who deals with chronically ill people who are a long way down the wrong track before they come to his office.  Jason also talks about how he had tried to educate his patients about reducing their carbs, however, after eating the same thing for 70 years, this is just too hard for many people to change.

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Desperate times call for desperate measures!

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Many of these patients come to him jamming in hundreds of units a day of insulin to suppress blood glucose levels, even though their own pancreas is still likely secreting more than enough insulin.

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Rather than continuing to hammer more insulin to suppress the symptom (high blood glucose), the solution, according to Jason, is to attack the ultimate cause (insulin resistance) directly.

Jimmy Moore is well known to most people that have an interest in low carb or ketogenic diets.  Whether you agree with his approach, it’s safe to say that low carb and keto would not be as popular today without his role.

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Meanwhile, Jason talks about trying to educate people about reducing the processed carbs from their diet not working, not because of the science but more due to people not being able to change their eating habits after 70 years.

the Complete Guide to Fasting

You’ve probably heard by now that Jason has teamed up with Jimmy to write The Complete  Guide to Fasting which captures Jason’s extensive thoughts on fasting from the blog along with Jimmy’s n=1 experiences and wraps them up in a cohesive comprehensive manual with a colourful bow.

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Jason and Jimmy both sent me a copy of their new 304-page book, The Complete Guide to Fasting, to review (thanks guys).   So here goes…

Similar to The Obesity Code, TCGTF is a compilation of ideas that Jason has developed on his Intensive Dietary Management blog.  Blogging is a great way to get the ideas together and thrash them out in a public forum.   Some people love to read the latest blog posts and debate the minutiae, however, most people would rather spend the $9 and sit down with a comprehensive book and get the full story.

Unlike The Obesity Code, TCGTF is a bright, ffull-colourproduction with great graphics that will make it worth buying the hard copy to have and to hold.

TCGTF did originally have the working title Fasting Clarity as a follow on from Jimmy’s previous Cholesterol Clarity and Keto Clarity.   However, other than Jimmy’s discussion of his n=1 fasting experiences, TCGTF is predominantly written in Jason’s voice building from his blog, so it wouldn’t be appropriate for it to have become the third in Jimmy’s Clarity series.

What is similar to Jimmy’s clarity series is that it’s easy to read and accessible for people who are looking for an entry level resource.  This book will be great for people who are interested in the idea of fasting.  It is indeed the complete guide to fasting and is full of references to studies, however, it doesn’t go into so much depth as to lose the average reader with scientific detail and jargon.

The book covers:

  • Jimmy’s n=1 experience with fasting,
  • Dr George Cahill’s seminal work on the effects of fasting on metabolism, glucose, ghrelin, insulin, and electrolytes,
  • the history of fasting over the centuries,
  • myth busting about fasting,
  • fasting in weight loss,
  • fasting and diabetes, physical health, and mental clarity,
  • managing hunger during a fast,
  • when not to fast, and
  • when fasting can go wrong.

The book is complete with a section on fasting fluids (water, coffee, tea, broth) and a range of different protocols that you can use depending on what suits you.  What did seem out of place are the recipes for proper meals.  Apparently, the publisher insisted they include these to widen the appeal (If you don’t like the fasting bit you’ve still got some new recipes?)

Overall, the book will be an obvious addition to the library (or Kindle) of people who are already fans of Jason and / or Jimmy and want a polished, consolidated presentation of all their previous work with a bunch of new material added.

TCGTF will also be a great read for someone who is interested learning more about fasting and wants to start at the beginning.   TCGTF is the most comprehensive book on the topic of fasting that I’m aware of.

my additional 2c…

Jason doesn’t mind weighing into a controversial argument, using some hyperbole or dropping the occasional F-bomb for effect and Jimmy’s no stranger to controversy either, so I thought I’d take this opportunity to give you my 2c on some of the topical issues at the fringe that aren’t specifically unpacked in the book.  We learn more as we thrash out the controversial issues at the fringes.   Many arguments come down to context.

target glucose levels

Jason has come under attack for using the word ‘cured’ in relation to HbAc1 values that most diabetes associations would consider non-diabetic,[2] though are not yet optimal.[3]

In the book Jason does discuss relaxing target blood glucose levels during fasting.  This makes sense for someone taking a slew of diabetic medications.   They’re probably not going to continue the journey if they end up in a hypoglycaemic coma on day one.

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The chart below shows the real life blood glucose variability for someone with Type 1 Diabetes on a standard diet.  With such massive fluctuations in glucose levels, it’s impossible to target ideal blood glucose levels (e.g. Dr Bernstein’s magic target blood glucose number of 4.6 mmol/L or 83 mg/dL).

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If your glucose levels are swinging wildly due to a poor diet coupled with lots of medication, your glucose levels are simply going to tank when you stop eating.  Hence, a safe approach is to back off the medication, at least initially, until your glucose levels have normalized.

Being married to someone with Type 1 Diabetes, I have learned the practical realities of getting blood glucose levels as low as possible while still avoiding dangerous lows.[4]  My wife Monica doesn’t feel well when her blood glucose levels are too low, but neither does she feel good with high blood glucose levels.  Balancing insulin and food to get blood glucose levels as low as possible without experiencing lows requires constant monitoring.

The chart below shows how scattered blood glucose levels can be even if you’re fairly well controlled.   Ideally you want the average blood glucose level to be as low as possible while minimising the number of hypoglycaemic episodes (i.e. below the red line).  If you can’t reduce the variability you just can’t bring the average blood glucose level down.  The last thing you want is to be eating to raise your blood glucose levels because you had too much blood glucose lowering medication.

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Pretty much everyone agrees that it’s dumb to be eating crap food and dosing with industrial levels of insulin to manage blood glucose levels.   High levels of exogenous insulin just drive the sugar that is not being used to be stored as fat in your belly, then your organs, and then in the more fragile places like your eyes and the brain.

Jason’s perspective is that people who are chronically insulin resistant and morbidly obese are likely producing more than enough insulin.  The last thing they need is exogenous insulin which will keep the fat locked up in their belly and vital organs.  Dropping insulin levels as low as possible using a low insulin load diet and fasting coupled with reducing medications will let the fat flow out.

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fasting to optimise blood glucose levels

In the long run, neither high insulin nor high glucose levels are optimal.

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Once you’ve broken the back of your insulin resistance with fasting, you can continue to drive your blood glucose levels down towards optimal levels.

One of the most popular articles on the Optimising Nutrition blog is how to use your glucose meter as a fuel gauge which details how you can time your fasting based on your blood glucose levels to ensure they continue to reduce.

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Your blood glucose levels can help calibrate your hunger and help you to understand if you really need to eat.  I think this is a great approach for people whose main issue is high blood glucose levels and who aren’t ready to launch into longer multi day fasts.

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In a similar way, a disciplined fasting routine can help optimise blood glucose levels in the long term.  The chart below shows a plot of Rebecca Latham’s blood glucose levels over three months where she used her fasting blood glucose numbers AND body weight to decide if she would eat on any given day.

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While there is some scatter in the blood glucose levels, you can see that regular fasting does help to reduce blood glucose levels over the long term.

Once you’ve lost your weight , broken the back of your insulin resistance and stopped eating crap food, you may find that you still need some exogenous insulin or other diabetic medication to optimise blood glucose levels if you have burned out your pancreas.

fasting frequency

The TGTF book covers off on several fasting regimens such as intermittent fasting, 24 hours, 36 hours, 42 hours and 7 to 14 days.  One concept that I’m intrigued by, similar to the idea of using your glucose meter as a fuel gauge, is using your bathroom scale as a fuel gauge.

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The reality, at least in my experience, is that we can overcompensate for our fasting during our feasting and end up not moving forward toward our goal.

If your goal is to lose weight I like the idea of tracking your weight and not eating on days that your weight is above your goal weight for that day.

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Again, Rebecca Latham has done a great job building an online community around the concept of using weight as a signal to fast through her Facebook group  My Low Carb Road – Fasting Support.

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The chart below shows Rebecca’s weight loss journey through 2016 where she initially targeted a weight loss of 0.2 pounds AND a reduction of 0.25 mg/dL in blood glucose per day.   After three months, she stabilized for a period (during a period when she had a number of major family issues to look after).  She is now using a less aggressive weight loss goal as she heads for her long-term target weight at the end of the year.

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The chart below shows the fasting frequency required to achieve her goals during 2016.  Tracking her weight against her target rate of weight loss has required her to fast a little more than one day in three to stay on track.

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Eating quality food is part of the battle, but managing how often you eat is also an important consideration.  After you’ve fasted for a few days, you can easily excuse yourself for eating more when you feast again.  And maybe it’s OK to enjoy your food when you do eat rather than tracking every calorie and trying to consciously limit them.

The obvious caveat is that there are a lot of other things that influence your scale weight such as muscle gain, water, GI tract contents etc, but this is another way to keep yourself accountable over the long term.

FAST WELL, FEED WELL

Fasting is a key component of the metabolic healing process, but it’s only one part of the story.

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Fasting is like ripping out your kitchen to put in a new one.   You have to demolish and remove the old stovetop to put the new shiny one back in.  You don’t sticky tape the new marble bench top over the crappy old Laminex.  You have to clean out the old junk before you implement the new, latest, and greatest model.

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In fasting, the demolition process is called autophagy, where the body ‘self eats’ the old proteins and aging body parts.   The great thing about minimising all food intake is that you get a deeper cleanse than other options such as fat fast, 500 calories per day or a protein sparing modified fast (PSMF).

But keep in mind that it’s the feast after the fast that builds up the shiny, new body parts that will help you live a longer, healthier, and happier life.

“Fasting without proper refeeding is called anorexia.” 

Mike Julian

Even fasting guru Valter Longo is now talking about the importance of feast / fast cycles rather than chronic restriction.  In the end you need to find the right balance of feasting / fasting, insulin / glucagon, mTOR / AMPK that is right for you.

In TCGTF, Jason and Jimmy talk about prioritising nutrient dense, natural, unprocessed,  low carb, moderate protein foods after the fast.  I’d like to reiterate that principle and emphasise that nutrient density becomes even more important if you are fasting regularly or for longer periods.

In the long term, I think your body will drive you to seek out more food if you’re not giving it the nutrients it needs to thrive.  Conversely, I think if you are providing your body with the nutrients it needs with the minimum of calories I think you will have a better chance of accessing your own body fat and reaching your fat loss goals.

optimising insulin levels AND nutrient density

It’s been great to see the concept of the food insulin index and insulin load being used by so many people!  In theory, when people reduce the insulin load of their diet they more easily access their own body fat and thus normalizes appetite.

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Some people who are very insulin resistant do well, at least initially, on a very high fat diet.  However, as glycogen levels are depleted and blood glucose levels start to normalise, I think it is prudent to transition to the most nutrient dense foods possible while still maintaining good (though maybe not yet optimal) blood glucose levels.

The problem with doubling down on reducing insulin by fasting combined with eating only ultra-low insulinogenic foods is that you end up “refeeding” with refined fat after your fast.

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While lowering carbs and improving food quality is the first step, I think that, as soon as possible you should start focusing on building up your metabolic machinery (i.e.  muscles and mitochondria).   A low carb nutrient dense diet is part of the story, but I don’t see many people with amazing insulin sensitivity that don’t also have a good amount of lean muscle mass which is critical to ‘glucose disposal’, good blood sugar levels and metabolic health.

This recent IHMC video from Doug McGuff provides a stark reminder of why we should all be focusing on maximising strength and lean muscle mass to slow aging.

The chart below shows a comparison of the nutrient density of the various dietary approaches.  Unfortunately, a super high fat diet is not necessarily going to be as nutrient dense and thus support muscle growth, weight loss, or optimal mitochondrial function as well as other options.

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The chart below (click to enlarge) shows a comparison of the various essential nutrients provided by a high fat therapeutic ketogenic dietary approach versus a nutrient dense approach that would suit someone who is insulin sensitive.

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I developed a range of lists of optimal foods that will help people in different situations with different goals to maximise the nutrient density that should be delivered in the feast after the fast.   The table below contains links to separate blog posts and printable .pdfs.  The table is sorted from highest to lowest nutrient density.   In time, you may be able to progress to a more nutrient dense set of foods as your insulin resistance improves.

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

protein

Jason had  a “robust discussion” with Steve Phinney over the topic of ideal protein levels recently during the Q&A session at the recent Low Carb Vail Conference.

To give some context again, Phinney is used to dealing with athletes who require optimal performance and are looking to optimise strength.  Meanwhile Jason’s patient population is typically morbidly obese people who are on kidney dialysis and probably have some excess protein, as well as a lot of fat that they could donate to the cause of losing weight.

I also know that Jimmy is a fan of Ron Rosedale’s approach of minimising protein to minimise stimulation of mTOR.  Jimmy and Ron are currently working on another book (mTOR Clarity?).  Protein also stimulates mTOR which regulates growth which is great when you’re young but perhaps is not so great when you’ve grown more than enough.

The typical concern that people have with protein in a ketogenic context is that it raises blood insulin in people who are insulin resistant.  ‘Excess protein’ can be converted to blood glucose via gluconeogenesis in people who are insulin resistant and can’t metabolise fat very well.

Managing insulin dosing for someone with Type 1 Diabetes like my wife Monica is a real issue, though she doesn’t actively avoid protein.  She just needs to dose with adequate insulin for the protein being eaten to manage the glucose rise.

The chart below shows the difference in glucose and insulin response to protein in people who have Type 2 Diabetes (yellow lines) versus insulin sensitive (white lines) showing that someone who is insulin resistant will need more insulin to deal with the protein.

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As well as insulin resistance, these people are also “anabolic resistant” meaning that some of the protein that they eat is turned into glucose rather than muscle leaving them with muscles that are wasting away.

People who are insulin resistant are leaching protein into their bloodstream as glucose because they can’t mobilise their fat stores for fuel.  They are dependent on glucose and they’ll even catabolise their own muscle to get the glucose they need if they stop eating glucose.

While it’s nice to minimise insulin levels, I wonder whether people who are in this situation may actually need more protein to make up for the protein that is being lost by the conversion to glucose to enable them to maintain lean muscle mass.  Perhaps it’s actually the people who are insulin sensitive that can get away with lower levels of protein?

As well as improving diet quality which will reduce insulin and thus improve insulin resistance, in the long term it’s also very important to maintain and build muscle to be able to dispose of glucose efficiently and also improve insulin resistance.

In TCGTF Jason talks about the fact that the rate of the use of protein for fuel is reduced during a fast and someone becomes more insulin sensitive.  He goes to great lengths to point out that concern over muscle loss shouldn’t stop you trying out fasting (which is a valid point).

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A big part of the magic of fasting is that you clean out some of your oldest and dodgiest proteins in your body and set the stage for rebuilding back new high quality parts.   But the reality is that you will lose some protein from your body during a fast (though this is not altogether a bad thing).[5] [6]

Bodybuilders often talk about the “anabolic window” after a workout where they can maximise muscle growth after a workout.  Similarly, one of the awesome things about fasting is that you reduce your insulin resistance and anabolic resistance meaning that when at the end of your fast your body is primed to allocate the high quality nutrients you eat in the right place (i.e. your muscles not your belly or blood stream).

In the end, I think optimal protein intake has to be guided to some extent by appetite.  You’ll want more if you need it, and less if you don’t.

I think if we focus on eating from a shortlist of nutrient dense unprocessed foods we won’t have to worry too much about whether we should be eating 0.8 or 2.2 g/kg of lean body mass.

However, avoiding nutrient dense, protein-containing foods and instead “feasting” on processed fat when you break your fast will be counter-productive if your goal is weight loss and waste a golden opportunity to build new muscle.

are you really insulin resistant?

Insulin resistance and obesity is a continuum.

Not everyone who is obese is necessarily insulin resistant.

If you are really insulin resistant, then fasting, reducing carbs, and maybe increasing the fat content of your diet will enable you to improve your insulin resistance.  This will then help with appetite regulation because your ketones will kick in when your blood glucose levels drop.

However, if you continue to overdo your energy intake (e.g. by chasing high ketones with a super high fat, low protein diet), then chances are, just like your body is primed to store protein as muscle, you will be very effective at storing that dietary fat as body fat.

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I fear there are a lot of people who are obese but actually insulin sensitive who are pursuing a therapeutic ketogenic dietary approach in the belief that it will lead to weight loss.  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.

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optimal ketone levels

Measuring ketones is really fascinating but confusing as well.

“Don’t be a purple peetone chaser.”

Carrie Brown, The Ketovangelist Podcast Ep 78

Urine ketones strips have limited use and will disappear as you start to actually use the ketones for energy.

In a similar way blood ketones can be fleeting.  Some is better than none, but more is not necessarily better.  As shown in the chart of my seven day fast below I have had amazing ketones and felt really buzzed at that point but since then I haven’t been able to repeat this.  I think sometimes as your body adapts to burning fat for fuel the ketones may be really high but then as it becomes efficient it will stabilise and run at lower ketone levels even when fasting.

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If your ketone levels are high when fasting then that’s great.  Keep it up.  They might stay high.  They might decrease.  But don’t chase super high ketones in the fed state unless you are about to race the Tour de France or if you want your body to pump out some extra insulin to bring them back down and store them as fat.

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The chart below shows the sum of 1200 data points of ketones and blood glucose levels from about 30 people living a ketogenic lifestyle.  Some of the time they have really high blood ketone levels but I think the real magic of fasting happens when the energy in our bloodstream decreases and we force our body to rely on our own body fat stores.

the root cause of insulin resistance is…

So we’ve worked out that large amounts of processed carbs drive high blood glucose and insulin levels which is bad.

We’ve also worked out that insulin resistance drives insulin levels higher, which is bad.

But what is the root cause of insulin resistance?

I think Jason has touched on a key component in that, as with many things, resistance is caused by excess.  If we can normalise insulin levels, then our sensitivity to insulin will return, similar to our exposure to caffeine or alcohol.

However, at the same time, I think insulin resistance is potentially more fundamentally caused by our sluggish mitochondria that don’t have enough capacity (number or strength) to process the energy we are throwing at them, regardless of whether they come from protein, carbs, or fat.

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A low carb diet lowers the bar to enable us to normalise our blood glucose levels.  However, the other end of the spectrum is focusing on training our body and our mitochondria to be able to jump higher.  In the long term this is achieved through, among other things, maximising nutrient dense foods and building lean body mass through resistance exercise.

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summary

  1. The Complete Guide to Fasting is, as per the title, the complete guide to fasting. It’s the most comprehensive guide to the nuances of fasting out there and there’s a good balance between the technical detail, while still being accessible for the general public.
  2. Fasting can help optimise blood glucose and weight in the long term, with a disciplined regimen.
  3. Fasting makes the body more insulin sensitive and primes it for growth. When you feast after you fast, it is ideal to make sure you maximise nutrient density of the food you eat as much as possible while maintaining reasonable blood glucose levels.
  4. Understanding your current degree of insulin resistance can help you decide which nutritional approach is right for you. As you implement a fasting routine and transition from insulin resistance to insulin sensitivity you will likely benefit from transitioning from a low insulin load approach to a more nutrient dense approach.

references

[1] https://intensivedietarymanagement.com/of-traitors-and-truths/

[2] https://www.diabetes.org.uk/About_us/What-we-say/Diagnosis-ongoing-management-monitoring/New_diagnostic_criteria_for_diabetes/

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

[4] https://optimisingnutrition.com/2015/08/17/balancing-diet-and-diabetes-medications/

[5] https://www.dropbox.com/s/h3pi53njcfu4czl/Physiological%20adaptation%20to%20prolonged%20starvation%20-%20Deranged%20Physiology.pdf?dl=0

[6] https://www.facebook.com/groups/optimisingnutrition/permalink/1602953576672351/?comment_id=1603210273313348&comment_tracking=%7B%22tn%22%3A%22R9%22%7D

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

what about saturated fat?

  • The topic of saturated fat continues to be contentious.
  • While most people agree these days that minimising sugar and processed carbohydrates is a good, thing many still struggle with the idea of eating fat, particularly saturated fat.  At the other extreme there are some people who have heard the message to ‘not fear the fat’ loud and clear and seem to be making up for lost time by eating copious amounts of processed fat.
  • This article looks at what happens to nutrient density when we swing to the extremes of either very low or very high levels of saturated fat intake in our diet.  As per usual, optimal lies somewhere between the extremes.
  • If we focus on nutrient dense whole foods issues like dietary saturated fat and cholesterol tend to look after themselves.

saturated fat in various food approaches

There are plenty of different views on fat and saturated fat and very little agreement between the extremes.

If you spend much time trying to research the issue you will likely come away confused after trying to understand the implications of the epidemiological and rodent studies.

People are also very passionate on both sides of this argument.  It can be hard to know which guru to believe.

Is saturated fat the greatest dietary villain or saviour leading us from the wilderness of the low fat dark ages?

image04

You may be aware that the USDA Dietary Advisory Committee recently changed position on dietary cholesterol and removed their upper limit on fat.[1]  They did however retain their recommended upper limit on saturated fat (10% in the USA and 11% in the UK).

As noted by Dr Frank Hu in the video below, the upper limit is not based on any specific research that higher levels of saturated fat are dangerous, but rather the fact that what they consider to be healthy diets (e.g. Mediterranean, Ornish etc) were within these upper limits.

Over the last four decades massive industries have developed around the concept of lowering cholesterol in your blood through diet or drugs in order to reduce your risk of heart disease, so there is going to be a high degree of inertia that will make any change in thinking happen slowly at best.

With all the concern and confusion about saturated fat I thought it would be interesting to check the saturated fat content of the highest ranking foods identified by the food ranking system to see how they compare with the upper limits.

The table below shows that none of the food lists exceed the recommended upper limit for saturated fatty acids.  Even the diabetic friendly low insulin load approach with half the energy coming from fat has a saturated fat level less than 11%.

approach SFA fat protein insulinogenic
most nutrient dense 5.6% 22% 30% 52%
low energy density 6.9% 17% 37% 55%
low insulin load 9.7% 49% 20% 30%

So it seems that focus on nutrient dense whole foods we end with moderate, but not excessive, levels of saturated fat.[2]  

what happens if we get rid of all saturated fat?

It’s always useful to test a theory by looking at what happens at the extremes.

I starting wondering about the relationship between saturated fat and nutrient density.

“What would happen to nutrient density if you removed ALL saturated fat?”

“Does avoiding saturated fat affect nutrient density for the better or worse?”

The chart below (click to enlarge) shows the essential nutrients for foods that have no saturated fatty acids (SFA) compared to vegetables, seafood and the most nutrient dense foods.

This analysis indicates that if you eliminate saturated fatty acids the nutrient density plummets!  As you can see from the little red bars on the graph, you might be able to obtain solid levels of Vitamin C and Vitamin A from a diet with no saturated fat but everything else is abysmal!

image01

how does SFA influence nutrient density?

So eliminating saturated fat completely doesn’t appear to be such a great idea.   But what does the other extreme look like?

I sorted the 7000+ foods in the USDA database by their saturated fat content and divided them into four equal “quartiles”.  The table below shows the SFA as a percentage of calories for the different quartiles.  Interestingly, only the highest quartile exceeds the arbitrary limit for saturated fat (i.e. 13% compared to the 10% arbitrary upper limit in USA or 11% in the UK).

quartile SFA fat protein insulinogenic
first 0.05% 18% 15% 72%
second 1.1% 20% 28% 63%
third 4.5% 32% 38% 52%
fourth 13% 50% 22% 38%

I think the most interesting observation here is in the right hand column.  The more you try to avoid saturated fat the more insulinogenic your diet ends up being.  That is, in the avoidance of saturated fat you may end up exacerbating any genetic propensity that you may have towards insulin resistance and diabetes by eating foods that require your pancreas to produce high levels of insulin to keep up!

One of the challenges with the low fat approach is that the avoidance of fat can often lead to increased consumption of highly processed, highly insulinogenic foods which tend to be a problem for people who are insulin resistant.

In the 70s when they started to encourage people to eat less saturated fat (which was associated with fried junk food) people didn’t eat more vegetables as they’d hoped.  Instead people ate more processed foods that now had to be sweetened with sugar to make sure it didn’t taste like cardboard.  Some would argue that this increase in low nutrient density carbohydrates has been a major contributor to the current obesity epidemic.

image08

“Replacement of saturated fat by carbohydrates, particularly refined carbohydrates and added sugars, increases levels of triglyceride and small LDL particles and reduces high-density lipoprotein, cholesterol, effects that are of particular concern in the context of the increased prevalence of obesity and insulin resistance.”[3]

The chart below (click to enlarge) shows the nutrient density for the various nutrients for each of the saturated fat quartiles.  While it’s hard to digest all the detail on this chart it appears that, the third quartile (i.e. more saturated fat than average) tends to have the highest nutrient density on average however the second quartile is more consistently high (i.e. less highs and low).

image03

The chart below shows the average of the nutrient density across the quartiles of saturated fat.  The lowest quartile has the lowest amount of nutrients both in terms of average and being consistently high.  The foods that are the highest in saturated fat have more nutrition than the foods low in saturated fat.  However the second and third quartiles have the most.

image02

what’s the latest on saturated fat?

In this video from Dr Frank Hu points out that when you’re talking about whether saturated fat is good or bad it’s important to consider what you are exchanging it with.  For example, saturated fat is good if it’s replacing processed carbohydrates, but not so good if you are replacing your vegetables with processed saturated fat.

The most interesting paper I have found on the topic is Saturated fat and cardiometabolic risk factors, coronary heart disease, stroke, and diabetes: a fresh look at the evidence by Dariush Mozaffarin[4] which indicates that, while total cholesterol in the blood may increase with increased dietary saturated fat, the changes in HDL and total cholesterol : HDL ratio are positive.

image06

When we look in more detail it seems that saturated fats such as 14:0 and 16:0 (typically found in dairy) have positive effects on HDL and insulin sensitivity.

image05

So in the end it seems the case for or against saturated fat is confusing at best (see the Good Fats, Bad Fats article for more detail).

More recently there has been a more thorough analysis of the data from the Minnesota Coronary Experiment (1968 to 1973) on which the diet-heart hypothesis was based and which has driven the avoidance of fat in the western diet.[5] [6] [7]   The understanding based on this original research headed up by Ancel Keys, was that increased fat raises ‘bad cholesterol’ which leads to heart attacks.

Does the more rigorous analysis of the full data still support this hypothesis?    To quote from Professor Grant Schofield:[8]

The diet-heart hypothesis says that saturated fat raises cholesterol and thus causes heart disease.  Widespread acceptance of this idea has shaped the way we look and how we eat more than anything else in the history of health and medicine.

It’s still the cornerstone of conventional wisdom and dietary guidelines in virtually every country. It’s still the reason the conventional experts can’t take the biologically obvious leap to embracing low carb healthy fat diets for important treatments like weight loss and diabetes.

So, 40+ years on. Here it is in all its glory, published in the BMJ no less. What did they find?

“Available evidence from randomized controlled trials shows that replacement of saturated fat in the diet with linoleic acid effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease or all causes.

“Findings from the Minnesota Coronary Experiment add to growing evidence that incomplete publication has contributed to overestimation of the benefits of replacing saturated fat with vegetable oils rich in linoleic acid.”

That’s right, there was no support for their hypothesis in a randomised trial of more than 9500. Replacing saturated fat with Omega 6 fat did reduce cholesterol, but as we’d predict had no effect on heart disease.

The one effect they did see was that older subjects who lowered their cholesterol had higher overall mortality.  Yes, cholesterol lowering in older adults caused more death. This is an effect already seen in some population studies.

So it seems that the diet–heart hypothesis that tells us to avoid fat, particularly saturated fat, is on shaky ground these days.

so what now?

So, should we avoid fat at all costs?

image09

Or, after all these years of being told to avoid saturated fat should we rebel and make up for lost time?

image07

As with most things, optimal lies somewhere between the extremes.

Perhaps if we focus on nutrient dense whole foods then issues like dietary fat and cholesterol will look after themselves?

 

references

[1] http://www.hsph.harvard.edu/news/features/assessing-the-new-u-s-dietary-guidelines/

[2] http://daa.asn.au/for-the-public/smart-eating-for-you/nutrition-a-z/nutrient-reference-values-nrvs/

[3] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2943062/

[4] http://www.ncbi.nlm.nih.gov/pubmed/20354806

[5] http://www.pubfacts.com/detail/27071971/Re-evaluation-of-the-traditional-diet-heart-hypothesis-analysis-of-recovered-data-from-Minnesota-Cor

[6] http://whatthefatbook.com/prof-grant-on-minnesota-coronary-experiment/

[7] http://www.cbc.ca/news/health/the-case-of-the-missing-data-1.1412420

[8] http://whatthefatbook.com/prof-grant-on-minnesota-coronary-experiment/

good fats, bad fats

Even more than cholesterol or other blood markers it appears clear that insulin resistance, elevated blood glucose and hyperinsulinemia increase your risk of heart disease, obesity, stroke, cancer andom dementia.[1]

An understanding of the food insulin index data tends to lead people to increase the fat content of their diet in in an effort to normalise blood glucose and reduce insulin levels.[2]

image001

If a significant proportion of your calories are coming from fat it makes sense to look at the composition of our high fat food choices.

So let’s take a look what we could consider to be “good fats” and “bad fats” and the implications for prioritising our food choices.

a quick primer on fats

You’re likely aware that there are different classifications of fat based on their chemical structure:

  • saturated,
  • monounsaturated, and
  • polyunsaturated.

What this means is that:

  • saturated fatty acids have no double bonds between individual carbon atoms (note: saturated fats are denoted by X:0 where the X is the length of the carbon chain and 0 is the number of double bonds),
  • monounsaturated fats have one double bond (e.g. X:1), and
  • polyunsaturated fats have more than one double bond (e.g. X:2).

If you want to learn more about this topic I suggest you check out this page on nutritiondata.self.com.  It’s interesting to follow the links to see which foods are the highest in the different types of fats.

mainstream dietary advice

The standard mainstream dietary advice is to to:

  1. avoid trans fats,
  2. limit saturated fats to less than 7% of energy intake,
  3. emphasise omega 3 fats, polyunsaturated fats and monounsaturated fats, and
  4. keep dietary fat to between 20 to 35% of energy intake.[3]

The Mediterranean Diet is typically promoted as being the ideal dietary model,[4] [5] [6] although interestingly in practice people from the Mediterranean region actually consume more than the recommended amount of fat, typically from olive oils and fatty fish.[7] [8] [9] [10]

image003

dietary fats versus adipose tissue

Jeff Volek and Steve Phinney in the Art and Science of Low Carbohydrate Performance[11] [12] note that the majority of human body fat consists of monounsaturated fatty acids, with smaller amounts of saturated fats and polyunsaturated fats.  They argue that if the body stores a greater proportion of monounsaturated fatty acids for energy in times of famine then it makes sense to align our dietary fat intake with these ratios.

The table below compares the composition of human adipose tissue[13] versus the proportion of fats across the 8000 foods in the USDA database.  Based on this logic it appears that we should go out of our way to emphasis monounsaturated fat given than saturated and polyunsaturated fats are plentiful in our food system.

% adipose

dietary

adipose / dietary

saturated

30%

36%

81%

monounsaturated

54%

42%

129%

polyunsaturated

16%

22%

75%

The chart below shows the relative proportions of each of the fatty acids in human adipose tissue.  Oleic acid (18:1) (a monounsaturated fat) is the most plentiful, followed by Palmitic acid (16:0) (a saturated fat) and Linoleic acid (18:2) (a polyunsaturated fat).image004

Taking Volek and Phinney’s logic a step further, the table below shows a comparison of the proportion of each fatty acid in our adipose tissue compared to their availability in the modern diet (based on the average across the 8000 foods in the USDA database).  It appears that we have more than enough Stearic acid (18:0), Linoleic acid (18:2) and Linolenic acid (18:3) available in the food system while a number of the other fatty acids are deficient.

isomer

adipose (mol %) % adipose dietary adipose / dietary class

14:0

2.8

3.0% 2.7% 110%

SFA

16:0

21.5

23.0% 17.4% 132%

SFA

16:1 n-7

7.2 7.7% 2.08% 369%

MUFA

18:0

3.4 3.6% 9.2% 39%

SFA

18:1 n-9

43.5 46.5% 36.6% 127%

MUFA

18:2 n-6

13.9 14.9% 17.5% 85%

PUFA

18:3 n-3

0.8 0.9% 1.8% 48%

PUFA

20:3 n-6

0.2 0.2% 0.012% 1744%

PUFA

22:4 n-6

0.1 0.1% 0.004% 2426%

PUFA

22:5 n-3

0.1 0.1% 0.1% 140%

PUFA

22:6 n-3 0.1 0.1% 0.3% 37%

PUFA

oleic acid versus linoleic acid

The two most prevalent fats in our diet and on our body are Oleic acid (18:1) and Linoleic acid (18:2).

While Linoleic acid (18:2) is considered to be an essential fatty acid [14] (meaning that the body cannot manufacture it from other dietary components) the data in the table above indicates that there is a relative abundance of it in the dietary system.

Many people believe that excess Linoleic acid (18:2) from vegetable oils (which causes an imbalance in our omega 3 : omega 6 ratio) is a major contributor to the obesity epidemic. [15]

The common wisdom is that olive oil, which is high in the monounsaturated fat Oleic acid (18:1), is a healthy ‘good fat’. [16]  When we look at the research it appears well established that emphasising the monounsaturated Oleic acid (18:1) and reducing the polyunsaturated Linoleic acid (18:2) will improved insulin resistance.[17] [18] [19] [20]

omega 3 fatty acids

Improving the omega-3 : omega-6 ratio is widely regarded as important to reduce inflammation and optimise brain function and mental health.[21] [22]    Omega 3 fatty acids are typically obtained from seafood and are generally considered to be ‘good fats’ that we should be maximising for health.

While there appears to be plenty of DHA (22:6 n-3) available in the diet when we simply consider the composition of adipose tissue, it’s worth noting that DHA makes up 30% of the brain and 50% of our retina, so it is probably going to fall into the category of ‘good fats’ that we should be going out of our way to pursue in our diet.

A recent mouse study showed that fish oil (high in omega 3 fatty acids) is better than lard (high in saturated fatty acids, particularly palmitic acid (16:0) and stearic acid (18:0)) when it comes to weight gain, gut bacteria, obesity and insulin resistance.[23]  While people are clearly different from mice, it’s not unreasonable to think that fish oil might be better than eating lard.

Omega 3 fats are relatively rare in our food system which means we need to go out of our way to incorporate them into our diet.   The table below shows the omega 3 fatty acids that I think we should count as good fat along with the foods they are commonly found in.

isomer common name common foods
22:6 n-3 (DHA) Docosahexaenoic acid (DHA) fish oil, caviar, seal oil, cod liver oil, sardine oil
20:5 n-3 (EPA) Eicosapentaenoic acid (EPA) fish oil, caviar, fish
18:3 n-3 c,c,c (ALA) Alpha-linolenic acid peanut butter, flax seed, butter
22:5 n-3 (DPA) Docosapentaenoic acid (DPA) seal oil, fish oil – menhaden, fish oil – salmon.

MCT oils

You might have heard a lot of talk about MCT (medium chain triglycerides) oils recently.  These shorter chain fats appear to bypass the lymphatic system and are transported directly to the liver via the portal vein.

Many people find benefit from using MCT oil as an aid to extend periods between meals or and cognitive enhancement.[24]  MCT oils are more readily turned into ketones which provide an alternative fuel source to the brain.   In turn, ketones can increase satiety[25] and decrease appetite, both of which may facilitate weight loss.[26]

image005

MCTs make up about 1.1% of the fats in our food supply in coconut oil, butter, cheese and cream, however to get higher levels you will to supplement.

isomer common name common foods
12:0 Lauric acid palm kernel oil, coconut oil
10:0 Capric acid cheese, coconut oil, palm kernel oil
8:0 Caprylic acid coconut oil, coconut cream, palm kernel oil
6:0 Caproic acid butter, cheese, cream

trans fats

Artificial trans fats (a.k.a. partially hydrogenated oils) are one of the few components of the diet that are widely accepted as unhealthy.[27]   If you look at the foods in which artificial trans fats are the most prevalent, it’s hard to disagree.

isomer common foods
18:1 t (g) soy shortening, margarine, canola oil
18:2 t (g) KFC, margarine
18:2 t,t (g) McDonald’s, fast foods
16:1 t (g) thickshake, cheeseburger, hamburger, fast foods

The issue with counting all trans fats as a bad fat is that they can also occur naturally in small amounts in meats and dairy such as grass fed beef.[28] [29]

image006

Given that the USDA database does not differentiate between partially hydrogenated oils and naturally occurring trans fats, I have not assigned trans fats a negative mark.  Emphasising other ‘good fats’ will demote foods that contain artificial trans fats.

the effect of replacing carbohydrates with fat

The common view is that dietary fat, particularly saturated and trans fats, should be avoided in order to optimise blood cholesterol markers.  But what happens when we substitute fat for carbohydrates?

The chart below from a paper by cardiologist Dariush Mozaffarian[30] indicates that trans fats (TFA) have a negative impact on all blood markers (i.e. TC/HDL, LDL and HDL).  So there’s no disagreement there.

However increasing dietary saturated fat:

  • increases LDL (note: this is generally considered to be bad although it’s not clear if this is large buoyant of small dense LDL),
  • has minimal effect on the total cholesterol to HDL ratio, and
  • increases HDL (good).

Replacing carbohydrates (CHO) with either monounsaturated (MUFA) or polyunsaturated (PUFA) have what are generally regarded to be positive outcomes.

image007

Whether or not saturated fat is beneficial starts to become a little clearer when we look at the effect of individual fatty acids.  The data below shows that while Lauric acid (12:0) increases LDL it also has very a positive effect on increasing HDL and decreasing the TC : HDL ratio.

image008

saturated fats and insulin resistance

Mozaffarian says

“SFA has been considered a risk factor for insulin resistance and diabetes mellitus, but review of the current evidence indicates surprisingly equivocal findings. SFA consumption inconsistently affects insulin resistance in controlled trials and has not been associated with incident diabetes in prospective cohort studies.”[31]

image009

Things start to get more interesting when you look at the relationship between individual fatty acids, insulin resistance and type 2 diabetes.

The investigators found that saturated fatty acids with an odd number of carbon atoms in their chain (15:0 and 17:0) were associated with a lower risk of type 2 diabetes, whereas even-chain saturated fatty acids—14:0, 16:0, and 18:0—were associated with a higher risk.  Longer-chain saturated fatty acids (20:0, 22:0 and 24:0) also were found to be inversely associated with incident type 2 diabetes. [32] [33] [34]   

This also aligns with the mouse study that mentioned above where fish oil was found to have a better outcome on obesity and gut health compared to lard (which is high in 16:0 and 18:0).

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The table below shows the foods that these ‘good fats’ are contained in.  Meat and nuts are embraced in the paleo and low carb scenes.  The benefits of dairy are debated, but this is typically related to the casein and lactose content which some people don’t tolerate well.

isomer common name common foods
17:0 Heptadecanoic acid tofu, lamb, beef
20:0 Arachidic acid macadamia nuts, peanut butter
22:0 Behenic acid peanut oil, peanut butter, sunflower oil, macadamia nuts
15:0 Pentadecanoic acid cream cheese, sour cream, lamb, beef
24:0 Lignoceric acid peanut butter, rosemary, macadamia nuts, cashew nuts, sunflower seeds

summary

Listed below (in order of prevalence in the dietary system) are the ten fatty acids that I think should be included in the list of ‘good fats’ along with the common foods that they are contained in and the basis for their inclusion.

fatty acid common foods comment
Oleic acid (18:1) olive oil, sunflower oil, hazelnut oil, safflower oil, soybean oil, almond oil, avocado oil commonly associated with positive health outcomes and key component of Mediterranean diet

improves insulin resistance.

most abundant fatty acid in human adipose tissue

underrepresented in food system.

reduces TC:HDL ratio

Lauric acid (12:0) palm kernel oil, coconut oil increases HDL

decreases TC:HDL ratio.

Alpha-linolenic acid (18:3 n-3) peanut butter, flaxseed, nuts, cloves, cheese omega-3.

inflammation lowering

improves insulin resistance

Capric acid (10:0) cheese, coconut oil MCT oil.

Improves HDL:LDL ratio.

Docosahexaenoic acid (DHA) (22:6 n-3) fish oil – salmon, caviar, seal oil, cod liver oil, sardine oil essential fatty acid

omega 3.

abundant in human brain.

Arachidonic acid (20:4) salmon, chicken heart, liver, brain conditionally essential.

rare in food system.

Eicosapentaenoic acid (EPA) (20:5 n-3) fish oil, caviar, fish omega-3.

inflammation lowering.

improves brain function.

Margaric acid (17:0) tofu, lamb, frankfurter, beef sausage reduced risk of type 2 diabetes.
Docosapentaenoic acid (DPA) (22:5 n-3) seal oil, fish oil – menhaden, fish oil – salmon omega-3 though small quantities.
Pentadecanoic acid (15:0) cream cheese, sour cream, lamb. lower risk of type 2 diabetes

And for completeness listed below (in order of their prevalence in the dietary system) are the fatty acids in the USDA food database that didn’t make the ‘good fats’ list.

fatty acid common foods comment
Linoleic acid (18:2) safflower oil, grapeseed oil, sunflower oil, walnut oil n-6 component is essential however overly abundant in food system

substituting linoleic acid for oleic acid has been shown to improve insulin resistance

Palmitic acid (16:0) palm oil, fish oil – menhaden, butter, lard higher risk of type 2 diabetes

poor gut bacteria outcomes in mice study

Stearic acid (18:0) cocoa butter, shortening, margarine, lard increased risk of type 2 diabetes.

poor gut bacteria outcomes in mice study.

overly abundant in food system

18:1 c canola oil, margarine subset of 18:1 – no need to double count
18:2 n-6 c,c soy oil, sunflower oil, soybean oil, mayonnaise subset of 18:2.
Myristic acid (14:0) nutmeg, coconut oil Increased risk of type 2 diabetes
Palmitoleic acid (16:1) macadamia nuts, fish oil, seal, whale Increased risk of type 2 diabetes
Linolenic acid (18:3) flax seed, chia seed, walnuts, basil adequate in food system.

only count n-3 ALA component.

18:1 t Soy shortening, margarine, canola oil. trans fat
Gadoleic acid (20:0) seal, eel, fish oil – herring, fish -–halibut, fish oil – cod liver, salmon small quantities and limited research.
Caprylic acid (8:0) coconut oil, coconut cream. MCT but rare in food system other than manufactured foods
Erucic acid (22:1) herring, halibut, sardine, cod liver no clear health benefits / research
Butyric acid (4:0) butter, cheese MCT but rare in food system other than manufactured foods
16:1 c KFC, Popeye’s, fast food predominantly in fast foods.
Caproic acid (6:0) butter, cheese, cream. MCT but rare in food system other than manufactured foods
Arachidic acid (20:0) macadamia nuts, peanut butter. reduced risk of type 2 diabetes but rare in food system.
Behenic acid (22:0) peanut oil, peanut butter, sunflower oil, macadamia  nuts, reduced risk of type 2 diabetes but rare in food system.
Myristoleic acid (14:0) frankfurter, beef sausage, bologna, cream cheese minimal research.

small quantities in food system

18:2 i soy oil, canola oil, margarine, French fries minimal research.

small quantities in food system

Heptadecenoic acid (17:0) tofu, broccoli, beef minimal research.

small quantities in food system

18:2 t KFC, margarine trans fat
18:4 fish oil – sardine, fish oil – salmon, fish oil – menhaden, oysters very small quantities in food system
Eicosadienoic acid (20:2 n-6 c,c) English muffin, margarine, fast foods, pine nuts, ham
Lignoceric acid (24:0) peanut butter, rosemary, macadamia nuts, cashew nuts, sunflower seeds reduced risk of type 2 diabetes
18:2 t,t MacDonald’s, fast foods trans fat
Eicosatrienoic acid (20:3) pine nuts, mustard, whitefish, seal, salmon appears beneficial but minimal quantities in food system
Pentadecenoic acid (15:0) tofu, miso, beef sausage appears beneficial but minimal quantities in food system
Gamma-linolenic acid (18:3 n-6) margarine omega 6

minimal quantities.

16:1 t thick shake, cheeseburger, hamburger, fast foods. trans fat
20:3 n-6 KFC, Popeye’s, fast food. Omega 6 and primarily in fast food
Nervonic acid (24:1 c) mustard, salmon, seal, flax seed likely beneficial, but minimal quantities
22:1 c margarine. minimal quantities in food system

optimal fatty foods

Shown below is the list of fatty foods sorted by their relative quantity of the good fats with their percentage of insulinogenic calories also shown.  The order itself is not that important (otherwise the seals and whales would be even more endangered due to this article), however the big winners are:

  • fish oil (seal, whale, menhaden, sardine, herring, salmon, cod liver),
  • fish (smelt, salmon, herring, caviar, mackerel, caviar, trout, swordfish),
  • lamb, pork and beef, and
  • cheese, butter and cream.
food % insulinogenic nutrient density
oil – bearded seal 0% 20.6
oil – beluga whale 0% 17.9
oil – spotted seal 0% 17.4
smelt – dried 33% 14.4
salmon 39% 14.1
fish oil – cod liver 0% 14.0
fish oil – salmon 0% 13.4
fish oil – sardine 0% 13.1
fish oil – menhaden 0% 13.0
fish oil – herring 0% 12.7
lamb fat 2% 12.7
mackerel 14% 11.5
pork fat 3% 11.0
whitefish 38% 10.9
cream cheese 8% 10.4
caviar 26% 10.3
bacon fat 0% 9.8
butter 0% 9.0
roe 37% 8.9
sablefish 16% 8.7
seal 22% 8.5
beef steak 21% 8.3
parmesan cheese 24% 8.2
herring 19% 8.2
whitefish 33% 8.2
pepperoni 10% 8.1
beef sausage 9% 7.5
turkey fat 0% 7.1
lamb 16% 7.1
macadamia nuts 5% 7.0

It’s important to keep in mind that consuming enough “good fats” is only part of the nutrition story.  In the next article we’ll look at how we can use this understanding of good fats along with our understanding of vitamins, mineral and amino acids to identify the most nutrient dense foods for different goals.

references

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

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

[3] http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/fat/art-20045550?pg=2

[4] http://health.usnews.com/best-diet/mediterranean-diet

[5] http://diabeticmediterraneandiet.com/ketogenic-mediterranean-diet/

[6] http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801

[7]  http://www.nature.com/ejcn/journal/v56/n10/full/1601413a.html

[8] http://www.internationaloliveoil.org/estaticos/view/87-mediterranean-diet-pyramid

[9] http://www.ncbi.nlm.nih.gov/pubmed/10700478

[10] http://ajcn.nutrition.org/content/61/6/1402S.full.pdf+html

[11] http://www.artandscienceoflowcarb.com/

[12] http://www.amazon.com/The-Art-Science-Carbohydrate-Performance/dp/0983490716

[13] http://www.researchgate.net/publication/5416860_Hodson_L_Skeaff_CM_Fielding_BA._Fatty_acid_composition_of_adipose_tissue_and_blood_in_humans_and_its_use_as_a_biomarker_of_dietary_intake._Prog_Lipid_Res_47_348-380

[14] https://en.wikipedia.org/wiki/Linoleic_acid

[15] http://www.forbes.com/sites/realspin/2015/09/29/could-so-called-healthy-vegetable-and-seed-oils-be-making-us-fat-and-sick/

[16] http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801

[17] http://www.ncbi.nlm.nih.gov/pubmed/10700478

[18] http://www.ncbi.nlm.nih.gov/pubmed/14713277

[19] http://qjmed.oxfordjournals.org/content/93/2/85

[20] http://www.ncbi.nlm.nih.gov/pubmed/10700478

[21] http://www.ncbi.nlm.nih.gov/pubmed/12442909

[22] http://chriskresser.com/how-too-much-omega-6-and-not-enough-omega-3-is-making-us-sick/

[23] http://www.the-scientist.com/?articles.view/articleNo/43854/title/how-fats-influence-the-microbiome/

[24] http://www.bulletproofexec.com/how-to-make-your-coffee-bulletproof-and-your-morning-too/

[25] http://www.nature.com/ijo/journal/v25/n9/full/0801682a.html

[26] http://www.nature.com/ijo/journal/v25/n9/full/0801682a.html

[27] http://www.marksdailyapple.com/why-are-trans-fats-bad/#axzz3mSg8Rg6D

[28] http://chriskresser.com/can-some-trans-fats-be-healthy/

[29] http://www.ncbi.nlm.nih.gov/pubmed/21427742

[30] http://www.ncbi.nlm.nih.gov/pubmed/20354806

[31] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950931/

[32] http://www.thelancet.com/journals/landia/article/PIIS2213-8587(14)70166-4/fulltext?rss=yes

[33] http://www.medscape.com/viewarticle/829920

[34] http://www.thelancet.com/action/showFullTextImages?pii=S2213-8587%2814%2970146-9