Category Archives: insulin load

how to optimise the insulin load of your diet for better diabetes management

Insulin is the primary hormone that controls your metabolism.

You need some to survive.

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But too much can be bad news.

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Insulin helps drive amino acids into your muscles to help them grow.

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Insulin helps glucose enter the cells to fuel your mitochondria to produce energy.

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Meanwhile, insulin also works as a brake to keep energy in storage.

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When you eat, your pancreas secretes insulin to slow the release of energy from body fat stores through your liver until the energy coming in from your mouth and in your bloodstream are used up.

How do we become insulin resistant?

I don’t know about you, but I find it hard to resist the yummy food that always seems to be available.

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We no longer have to hunt or gather our food.  It is always available, relatively cheap and flavoured to ensure we can easily eat lots of it.

In our modern food environment, it’s hard to ‘eat to satiety’ without usually eating a little bit too much.  It’s like we’re saving for a winter that never comes.

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Then, to make it even harder, the food industry optimises their products for ‘bliss point’ (with just the right amount of sugar, salt, fat and artificial colours and sweeteners) and creates hyper-palatable foods to drive profit.

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Unfortunately, this all has an impact on more than just our taste buds.

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Eventually, as you continue to consume more energy than you can use, your fat stores become inflamed and can’t take in any more energy.[1] [2]

Your pancreas ramps up its efforts to hold back the pressure of excess energy in our liver and body fat stores.[3] [4]

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If excess energy keeps coming in, the pancreas re-doubles its efforts to clear the glucose from the blood with more and more insulin.

First, the fat stores become full, then the bloodstream and eventually insulin drives the excess energy into other areas in the body that are still insulin sensitive such as your liver, heart, pancreas, eyes and brain.

Over the long term, this combination of high insulin levels and high energy leads to heart disease, fatty liver, Alzheimer’s, Parkinson’s and a whole host of modern diseases.[5] [6] [7]

Type 1 diabetes

People with type 1 diabetes, like my wife Monica, give us an opportunity to understand how insulin works.

The picture below shows “JL” one of the first type 1 diabetics to receive insulin treatment in 1922.  The picture on the left is after diagnosis with diabetes but before treatment with insulin.  The photo on the right is the same child two months.

With insulin injections, he can stop the uncontrolled release of his fat and muscle stores and quickly put weight back on.

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For reasons we don’t fully understand, the pancreas can stop producing insulin.  People with type 1 diabetes need to inject insulin to “cover” the food they eat as well as “basal insulin” to mimic what a healthy pancreas does automatically between meals.

Wise food choices are critical to stabilising blood sugar levels.  Foods that require a significant amount of insulin tend to cause large swings in blood sugar levels.

If your blood levels are high, you will feel tired and will need to take a large dose of insulin to slow the release of glucose from your liver.

If your blood sugars are low, you will feel the need to eat food, preferably something sweet to raise your blood sugars quickly!

It’s hard to control your appetite with these rollercoaster-like swings in blood glucose like the one shown in the chart below.  Our appetite and survival instincts are strong, and we will eat to raise our blood glucose levels to feel good again.

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daily blood sugar data of type 1 diabetic on typical western diet

Foods with a lower insulin load allow people with type 1 diabetes to smooth out their blood sugar swings and stabilise their food cravings.

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daily blood sugar data for the same person with type 1 diabetes on a low carb diet

Type 2 diabetes

While the cause of the disease is different, people with type 1 and type 2 diabetes are in a similar situation.  They both have an overall insulin insufficiency.  People with type 1 don’t produce enough insulin and need to inject insulin.

The insulin resistance in people with type 2 diabetes means that their pancreas cannot produce enough insulin to keep their blood sugar levels stable.   Their fat stores cannot hold all the energy in the system, so it spills out into the bloodstream, and we see elevated blood glucose levels.

For people with type 2 diabetes, reducing the insulin load of the food they eat will enable their pancreas to keep up to maintain more stable blood sugars.  Once the wild swings of glucose and insulin stabilise, it is often easier to go longer between meals or make better food choices.

Insulin sensitivity

While insulin resistance and diabetes are often associated with obesity, you can be fat and still have normal blood sugars and be insulin sensitive.

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People who are insulin sensitive can easily store energy in their adipose tissue and release energy easily later when they are not eating.

Their fat stores of insulin sensitive people are still functioning well.  They take in energy from the food they eat and relatively quickly release it when they are not eating.[8]

If you are insulin sensitive with stable blood sugar levels and want to lose body fat you will probably do well if you focus on eating foods with a higher nutrient density and a lower energy density.  However, if you are insulin resistant, you will likely also benefit from eating foods with a smaller insulin load, at least until your blood sugars stabilise.

Which approach is best for you?

Nutrition is complex, and there is still a lot of disagreement about the role that insulin resistance plays in health and weight loss.  However ultimately, most of us are trying to hack our system to get the nutrients we need without excessive energy.

The Nutrient Optimiser algorithm considers your blood sugars, HbA1c, triglyceride:HDL ratio and waist:height ratio to optimise your blood sugars are while also maximising nutrient density as much as possible.

The food insulin index data

Now we’re going to take a quick look under the hood of the Nutrient Optimiser algorithm to see how the insulin load parameter works.

The chart below shows the relationship between the carbohydrate content of our food and our insulin response.[9] [10] [11] [12]

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carbohydrates vs insulin response (click to enlarge)

The quantity of carbohydrate in your diet explains the majority of your insulin response.  However, if you look carefully in the bottom left corner of the chart above, you will see that there are high protein foods that cause a large insulin response and high fibre foods that cause a smaller insulin response.

Once we account for the effect of fibre and protein, we get a much better prediction of our insulin response to food.  This understanding of the various factors that influence insulin response enables you to prioritise foods that cause a smaller insulin response, as well as more accurately calculate insulin dosing for people with diabetes.

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insulin load (carbohydrates – fibre + 0.56 * protein) vs insulin response

If you are injecting insulin to manage your diabetes then understanding how to quantify the insulin load of your diet can help you more accurately calculate your insulin dose (as detailed in this post).  If you require therapeutic ketosis, you can also identify foods that will minimise your insulin response.

Protein

While protein does require some insulin to build and repair our muscles, the chart below shows us that increasing the proportion of energy from protein will typically force out processed carbohydrates and trigger a lower insulin response.

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Higher levels of protein also tend to generate a smaller glucose response compared to carbohydrates.

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It’s also important to note that protein is the most satiating macronutrient.  If you want to reduce your energy intake without having to meticulously track calories and without excessive hunger it’s important not to avoid protein.  Reducing the amount of energy in your diet will allow the energy in your bloodstream (i.e. glucose, ketones and free fatty acids) to be used up and your insulin levels will come down even further.  

Fat

Obtaining more of your energy from fat will decrease your insulin response…

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…as well as your glucose response.

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However, keep in mind that, as well as the food you eat, your insulin levels are influenced by the food you eat as well as the amount of energy already in your system.

High-fat foods are often energy dense and easy to overeat.  Your pancreas will still need to elevate insulin levels while your body uses up the energy from your diet, so they can still drive insulin resistance if eaten to excess.

The insulin load is a great tool to manage the short-term volatility of your blood sugar levels.  However, if you look at the big picture, lower insulin levels correspond to lower energy in your system (i.e. from your diet and body fat).

Once your blood sugars are stable, it may be prudent to focus on reducing the fat in your diet if you want to use your excess body fat.  This will help to further reduce your blood sugars and insulin levels floating around in your blood towards optimal levels.

Insulin load vs nutrient density

Like many things in life, there is a trade-off as we push things to extremes.  The chart below shows that we tend to optimise nutrient density with about 40% insulinogenic calories.[13]

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If you are insulin resistant, you will probably do better if you maintained less than 40% insulinogenic calories.   If you have diabetes, then you’ll probably need to stay below 25% insulinogenic calories.  If you require a therapeutic ketogenic diet (i.e. for the treatment of cancer, epilepsy, Alzheimer’s, dementia or Parkinson), then you will need to maintain a very low insulin load, which typically means consuming more fat and even reducing your protein intake.

It may not be ideal to maintain such a low insulin load for a long time.  The more you push the insulin load of your diet to either extreme the more you will compromise your micronutrient profile.

What do I do with all this information?

While you may find all this detail a little confusing, you don’t have to worry too much about all the numbers.

We have designed the Nutrient Optimiser algorithm to calculate your target macronutrient ranges to suit your goals and suggest foods and meals that will help you keep your blood sugars stable and normalise your insulin levels while also maximising the nutrient content of your diet.

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Once you attain normal blood sugars, you will ‘level up’ to the next stage of your nutritional journey.

Stay tuned…

In our next instalment, where we will discuss how we can manage the energy density of your food to enable you to get more calories in if you are running a marathon, or help you to feel more satiated with less energy if you are trying to lose weight.

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References

[1] https://www.ncbi.nlm.nih.gov/pubmed/25733684

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

[3] https://www.youtube.com/watch?v=i2WRi7mP1ck

[4] https://www.youtube.com/watch?v=Cdork0TA90U

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

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

[7] https://cardiab.biomedcentral.com/articles/10.1186/1475-2840-12-164

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

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

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

[11] https://www.researchgate.net/profile/Peter_Petocz/publication/13872119_Holt_SHA_Brand_Miller_JC_Petocz_P_An_insulin_index_of_foods_the_insulin_demand_generated_by_1000-kJ_portions_of_common_foods_Am_J_Clin_Nutr_66_1264-1276/links/00b495189da41714fa000000.pdf/download?version=vs

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

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

[14] https://examine.com/nutrition/low-fat-vs-low-carb-for-weight-loss/

[15] https://www.sciencedirect.com/science/article/pii/S1551714416302166

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

[17] https://drruscio.com/high-carb-low-carb-science-actually-says-episode-43/

how much protein do I need on keto?

  • There is a lot of confusion about ‘excess protein’ and whether you can have too much protein on keto.
  • Insulin and protein are used to build and repair your muscles, organs and the other important parts of your body.  This is an important and beneficial use of protein and insulin.
  • Foods that contain the harder to find nutrients (e.g. potassium, magnesium, choline, vitamin D) typically contain plenty of protein.
  • Actively avoiding protein and can lead to a less nutritious diet.
  • Unless you require therapeutic ketosis for the treatment of cancer, epilepsy, Alzheimers, Parkinson or dementia, you should be chasing vitality, health and nutrition along with stable blood sugar levels rather than some arbitrary ketone level.
  • There are a range of different ways to quantify protein intake.  Thinking in terms of percentages can be more confusing than helpful.
  • It’s hard to over-consume protein because it is highly satiating.  However, if you avoid protein your body may drive you to consume more calories until you get the protein it needs.
  • If you follow your appetite and focus on foods that contain the vitamins and minerals you need you will probably get enough protein.

Virta Facebook Live Q&A

I recently had the opportunity to pose some questions about protein intake to the Godfather of Keto, Dr Stephen Phinney in a recent Facebook live Q&A.

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Dr Phinney’s response to my question is shown below, including his recommended protein intake levels of 1.2 to 1.75 g per kg reference body weight of protein.

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While I largely agree with Dr Phinney’s response, I think it’s worth elaborating on some of the issues that are causing so much confusion at the moment.

Will too much protein kick me out of ketosis?

If you’ve read previous posts on Optimising Nutrition you’ve probably seen my analysis of the food insulin index data that shows that our carbohydrate intake alone doesn’t explain our insulin response to food.

The food insulin index data shows that our insulin response to food is more accurately predicted when we consider the fibre and protein content of our food, not just the carbohydrate.

However, I fear that many people have used the insulin load concept as a reason to avoid protein.  I now understand that this is far from optimal within the broader context of good nutrition for health, weight loss and vitality.

If you are interested in learning more the implications of the insulin index data I recommend you check out the following articles:

Effect on blood sugar and insulin

While trading your calories from butter for steak will increase your requirement for insulin, the food insulin index data suggests that as a general rule, getting more of your energy from protein will reduce your insulin requirements as it forces out processed carbohydrates as shown in the chart below.

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Getting more energy from protein tends to decrease our glucose response as it forces out nutrient-poor refined high carb foods.  Your body can convert protein to glucose (i.e. gluconeogenesis) if it really needs to but it’s a lot of work, so it would much rather get energy from carbs or fat.

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Protein is also very satiating.  Once we have enough protein, our body tends to crave more fatty and carby foods for energy.[10] 

While it is both financially and metabolically expensive, protein is the most important component of your diet.  Different people will need different amounts of protein depending on their life stage and activity levels.

While you probably don’t need to be going out of your way to binge on more protein than you can comfortably consume, actively avoiding protein containing foods is a recipe for nutritional disaster.  If you are exercising or lifting heavy then you will naturally crave more protein.

If you actually need higher levels of blood ketones for therapeutic ketosis, it may be a good strategy to consciously restrict protein.  However, I don’t’ think the vast majority of people chasing ketones are looking for therapeutic keto for the management of cancer, Alzheimer’s, epilepsy, dementia or Parkinson’s but rather fat loss or diabetes control.

Protein number crunching

The numbers around protein can be confusing due to the units used.

  • Dr Phinney uses ‘reference body weight’ (RW) (which he says is ‘the weight you were when you were in college’).
  • The mainstream nutrition world talks in terms of total body weight (BW).
  • Meanwhile, the sports nutrition community talk in terms of lean body mass (LBM).

In order to understand what this means in practice, let’s look at an example of a woman who is currently 40% body fat but was 25% in college (i.e. her reference weight).  For argument’s sake let’s say she was 70 kg in college but she is currently 87 kg or 193 lb.  The images below will give you an idea of what these level of body fat levels look like.

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In the table below I have calculated what Dr Phinney’s recommended protein intake looks like for this person in terms of:

  • reference body weight (RW),
  • lean body mass (LBM), and
  • body weight (BW).

Based on Dr Phinney’s guidance, this person should be eating between 84 and 123 g of protein per day.

  body fat weight (kg) weight (lbs) lower limit upper limit
reference weight 25% 70 154 1.2 g/kg RW 1.75 g/kg RW
lean body mass 0% 52.5 116 1.6 g/kg LBM 2.3 g/kg LBM
body weight 40% 87.5 193 1.0 g/kg BW 1.4 g/kg BW
protein (g/day)       84 123

On a practical note, there is nothing low about 2.3 g/kg LBM protein.  While I do track my intake I find it hard to get above 2.2 g/kg LBM even when trying to maximise protein.  At the same time, the lower limit is well above the official Recommended Daily Intake of 0.84 g/kg for men and 0.75 g/kg for women which are set to maintain nitrogen balance and prevent disease (i.e. not achieve optimal health and vitality).

What about percentages?

Talking about protein in terms of percentages of energy intake can be confusing as it depends on your activity levels or whether you are dieting.   Theoretical energy intake requirements are based on your lean body mass and activity levels.

The table below shows what Dr Phinney’s protein recommendation of 1.2 to 1.75 g/kg RW (or 1.6 to 2.3 g/kg LBM) look like for our hypothetical woman above in terms of percentage of energy intake for different energy intakes depending if she was trying to lose weight, maintain weight or was more active.

scenario calories lower upper
30% deficit 1158 29% 42%
sedentary 1654 20% 30%
lightly active 1852 18% 27%
moderately active 2084 16% 24%
vigorously active 2431 14% 20%
protein (g)   84 123

Protein intake in terms of percentage energy intake can vary widely to the point that it’s practically useless.  It’s generally much more useful to talk in terms of protein intake in grams per weight lean body mass rather than percentages.

Protein and nutrient density

Since stumbling across the insulin index, one thing I have found consistently is that nutrient-dense foods are not low in protein.

If you are focusing on the foods that contain the harder to find nutrients (e.g. magnesium, magnesium, choline, vitamin D etc) you will be getting plenty of protein.

Conversely, the only way to really get the ultra-low protein intakes being recommended by many people without an energy deficit is to avoid most solid foods and prioritise macadamia nuts, butter and oils.  It should not be a surprise that it will be hard to get a broad spectrum of essential nutrients with this sort of dietary approach.

As shown in the chart below, nutrient density tends to increase up to about 50% of energy intake.   If you’re eating more than 50% protein you’re likely relying on processed foods and supplements.[11]

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The chart below shows the nutrient profile of the most nutritious foods in the USDA database.  If you could stick to these foods you would easily be getting a lot of the essential nutrients without having to consume too much energy.

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The problem with these foods is that they can be very satiating which makes it hard to get enough energy in if you are active.  However, if you are trying to lose weight these foods may help to ensure that you are getting the nutrients you need with less energy without being hungry.

It’s interesting to see many people who have been experimenting with the Nutrient Optimiser have commented on how little food they can get away with while experiencing minimal levels of hunger.   Nutrient dense foods tend to be hard to overeat and also provide you with the nutrients to prevent cravings and hence reduce appetite.

For comparison, the chart below shows the nutrient profile of the ketogenic diet foods.  That is, the foods that have the lowest percentage insulinogenic calories.   These foods are 80% fat, 15% protein and 3% net carbs).  Ironically, an individual consuming these foods will be meeting the minimum levels of protein but they will be missing out on a large number of other vitamins and minerals.

I find that it’s often the people who are trying to actively avoid protein that find themselves at the bottom of the Nutrient Optimiser Leaderboard with a very poor nutrient profile.

The chart below shows the nutrient profile that we get when we actively avoid protein.  The only nturients that we get enough of in this scenarios is sodium and vitamin C!

Unless you are chasing therapeutic ketosis for the treatment of cancer, epilepsy, Alzheimers or dementia I think your focus should be on building health and maximising nutrition rather than higher ketone values.

If you are getting the micronutrients you need to thrive you will be getting plenty of protein and won’t need to worry too much about getting adequate protein intake.  Conversely, if you are actively avoiding protein you will be unnecessarily sacrificing your other micronutrients (especially if you are replacing your calories from protein and carbs with refined fat).

But will too much protein kick me out of ketosis?

As I write this I have been experimenting with adequate protein with less fat and carbs and maximal nutrients on the Ketogains Bootcamp.  A typical daily Cronometer summary is shown below.

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My protein is sitting at about 2.2g/kg LBM for me given that I’ve been spending a lot of time in the gym lifting heavy during this time.  I’ve also been able to hit many of the nutrients targets while maintaining a significant calorie deficit.

Leading up to this period my blood glucose levels were sitting in the mid 5s (approx 100 mg/dL).  However, once I introduced the energy deficit my glucose levels plummet to the mid 4s (approx 80 mg/dL).

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And although I don’t worry much about ketones, they seem to be sitting at around 0.7 mmol/L, which I’m pretty happy with.

I know if I keep my blood glucose around this level I will continue to lose weight and continue to improve my glucose control and HbA1c.

I also get plenty of breath acetone from endogenous ketones as shown on my Ketonix below.

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Don’t forget the basal insulin!

While there has been a lot of focus on what we can do to not have too much insulin, we need to remember that insulin has a number of important roles including:

  1. to help us get glucose into cells to be used by our mitochondria,
  2. to help build and repair our muscles, and
  3. to control the release of glucose from our liver while the energy in our bloodstream is used up.

People with type 1 diabetes demonstrate happens if we don’t have enough insulin.  Not only would we not be able to store the energy we eat as fat and muscle, the brake comes off the liver and all the stored energy in our body comes flowing out in the form of excess glucose and ketones (i.e. diabetic ketoacidosis).

The image below is the same child, “J.L.”, in the 1920s before and after receiving insulin therapy.  In a healthy person, insulin suppresses the fuel flow from the liver to healthy levels.

In someone on a standard western diet, basal insulin represents about 30% of the today daily dose.  Basal insulin drops to about 50% for someone on a low carb or keto diet.  But you can never drop your insulin requirements to zero.  You always need this basal to stop the uncontrolled flow of fuel from your liver into your bloodstream.

We focus so much on the effect of the food we eat but we forget that it’s also the excess fuel on your body and floating around in our bloodstream that also plays a massive role in the insulin demand on our pancreas.

Whenever there are high levels of energy sitting in our bloodstream (from glucose, ketones or fat) the pancreas has to ramp up basal insulin production until the fuel in our bloodstream is used up.  The more fat there is on our body the harder our pancreas has to work to hold back the pressure of excess fat on our body from being released into our bloodstream.

So, you may believe that your mug of Bulletproof coffee or the fat bomb may not be raising your insulin levels because it does not contain glucose or protein.  However, your pancreas is still working overtime to produce more insulin to hold the fat on your bum and until the energy coming in via your mouth is used up.

You may be able to ramp up your energy expenditure for a while by shivering and fidgeting, more but after a time of overdriving energy you’ll likely end up fat and insulin resistant.

If you really want to reduce your insulin levels you need to work on reducing the excess level of energy floating around in your bloodstream (from any source, including fat, carbs, protein or exogenous ketones) so your pancreas will decrease its production of insulin to allow body fat to be used.

Focusing on obtaining the nutrients you need without too much energy seems like common sense to me.

Therapeutic ketosis

Someone targeting therapeutic ketosis to assist with the management of chronic conditions such as cancer, epilepsy, dementia or Alzheimer’s may benefit from higher levels of ketosis and less reliance on glucose.  But I don’t think the vast majority of people who are Googling “keto” at the moment are looking for a therapeutic treatment.

therapeutic keto

Understanding how to quantify the insulin load of our food enables us to accurately tailor or food choices to suit our goals.  When it comes to insulin load we need to keep it low enough to get the results we need without compromising the nutritional value of the food we eat too much.

The chart below shows that nutrient density peaks at around 40% insulinogenic calories.

  • If you are insulin resistant it would be prudent to have less than 40% insulinogenic calories.
  • Someone on a low carb diet might have less than 25% insulinogenic calories.
  • Someone targeting therapeutic keto will likely need to have less than 15% insulinogenic calories to see therapeutic levels of ketones.

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Unless you really require therapeutic keto then I don’t think there is a need to worry too much about the impact of protein on your blood ketone levels.  Actively avoiding protein tends to lead to compromising nutrient density unnecessarily which may lead to nutrient cravings or deficiencies in the long term.

The glucose : ketone index

People who require therapeutic ketosis should also ensure that they are not driving the total energy in their system too high.  To do this they can track their glucose as well as ketones.  The glucose:ketone ratio (GKI) which was developed by Dr Thomas Seyfried to measure the degree of therapeutic ketosis.[12]

If you’re interested, your GKI can be calculated by dividing your glucose (in mmol/L) by your ketone values.  For example, if your blood glucose is 108 mg/dL and your blood ketones are 0.5mmol/L, GKI = blood glucose / ketone = (108 mg/dL / 18) / 0.5 mmol/L = 6 mmol/L / 0.5mmol/L = 12.

People who are chasing therapeutic ketosis typically do not need to worry about ingesting too much energy.   Driving a hypercaloric state with refined fats is not a major concern for someone trying to keep weight on (e.g. cancer cachexia).  However, ensuring that they are achieving lower glucose levels will ensure that they are not driving insulin resistance.

For reference, the table below shows the relationship between HbA1c, average glucose, ketones and GKI for different scenarios showing how your GKI and ketones correlate with HbA1c and blood glucose.

 metabolic health HbA1c average blood glucose blood ketones GKI
 (%)  (mmol/L)  (mg/dL)  (mmol/L)  
low  4.1 3.9 70 > 0.3 < 4
optimal 4.5 4.6 83 > 0.3 < 15
excellent < 5.0 < 5.4 < 97 > 0.3 < 20
good < 5.4 < 6 < 108 < 0.3 < 40
danger > 6.5 7.8 > 140 < 0.3 > 40

Really low GKI values (i.e. very high ketones and very low glucose) are typically seen in extended fasting when glucose levels to drop and ketones from body fat increase in a low insulin state.

The chart below shows my blood ketone and glucose levels during a seven day fast.  Amazingly, as my blood glucose levels dropped below 4.0 mmol/L my ketones drifted up to 8 mmol/L.  During more recent, however, I haven’t been able to achieve such high ketone levels.

While we can get these high ketone levels during fasting, we typically don’t see them in the fed state.  To give you an idea of what to expect, the chart below shows GKI values over time during fasting for RD Dikeman (from Type 1 Grit), Jimmy Moore, Simon Saunders (Keto Island) and myself.   As a rule of thumb, you might expect to see a GKI value less than 2 after two or three days of water fasting.

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Nutrient density analysis

Being a big fan of Dr Phinney and the Art and Science books, I couldn’t help running his recommended diet through the Nutrient Optimiser.  I entered all the meals in the Art and Science of Low Carb Living into Cronometer and ran it through the Nutrient Optimiser.

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If you’re interested, you can see the full report here and where these meals rank on the leaderboard here.

So what should you do with all this information?

So, to summarise:

  1. If you have great blood sugars and just want to lose weight then you should focus on maximising nutrient density while reducing the energy levels in your bloodstream.  There is no need to worry about “being in ketosis”.  You will produce ketones if you are successfully achieving an energy deficit and burning your own body fat stores.
  2. If you are insulin resistant then you will want to limit your insulin load to a maximum of 2.9 g/kg LBM.  This will restrict carbohydrates in your diet so your blood sugars stabilise.
  3. If you are trying to manage diabetes then you want to keep your insulin load under 1.8 g/kg LBM.  This will restrict carbohydrates and may reduce your protein intake a little.
  4. If you require therapeutic keto then you will want to keep your insulin load less than 1.1 g/kg LBM and may need to consider limiting protein.

The recommended values for protein and insulin load are shown in the table below.

approach

min protein

(g/kg LBM)

max insulin load

(g/kg LBM)

therapeutic ketosis 0.8 1.1
diabetes / nutritional ketosis 1.8 1.8
weight loss (insulin resistant) 1.8 2.9
weight loss (insulin sensitive) 1.8

Can run the numbers for me?

I realise all this data can be confusing if nutrition is not your hobby.

Over the last few months, I’ve been working with a very talented programmer, Alex Zotov, to develop some handy software to help people navigate all this information and put it into practice.

The first instalment of the Nutrient Optmiser is a free calculator that will help you identify the ideal macronutrient ranges to suit your goals as well as a shortlist of optimal foods and meals.  The table below shows how we can determine the optimal approach for you based on your metabolic health, waist to height ratio and goals.

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We’d love you to check it out the Nutrient Optimiser.  We’d love to hear what you think and how we can refine it to suit your goals.

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We hope it will be really helpful for a LOT of people on their journey towards health through optimal nutrition

 

references

[1]https://www.amazon.com.au/Keto-Clarity-Definitive-Benefits-Low-Carb/dp/1628600071

[2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737348/

[3]http://assets.virtahealth.com/docs/Virta_Clinic_10-week_outcomes.pdf

[4]http://www.ncl.ac.uk/press/articles/archive/2017/09/type2diabetesisreversible/

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

[6]https://cardiab.biomedcentral.com/articles/10.1186/1475-2840-12-164

[7]http://circoutcomes.ahajournals.org/content/3/6/661

[8]https://www.perfectketo.com/how-too-much-protein-is-bad-for-ketosis/

[9]https://nutritionfacts.org/video/the-great-protein-fiasco/

[10]https://digitalcommons.wku.edu/ijes/vol10/iss8/16/

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

[12]https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-015-0009-2

optimising protein and insulin load

  • “Low carb”, “ketogenic” or “nutrient dense” mean different things to different people. Defining these terms numerically can help us to choose the right tool for the right application.
  • Decreasing the insulin load of your diet can help normalise blood glucose levels and enable your pancreas to keep up. However, at the same time, a high fat therapeutic ketogenic approach is not necessarily the most nutrient dense option, and may not be optimal in the long term, particularly if your goal is weight loss.
  • Balancing insulin load and nutrient density will enable you to identify the right approach for you at any given point in time.
  • This article suggests ideal macro nutrient, protein and insulin load, and carbohydrate levels for different people with different goals to use as a starting point as they work to optimise their weight and/or blood glucose levels.

context matters

Since I started blogging about the concepts of insulin load and proportion of insulinogenic calories many people have asked:

“What insulin load should I be aiming for?” 

Unfortunately, it’s hard to give a simple answer without some context.

The answer to this question depends on a person’s current metabolic health, age, activity level, weight, height and goals etc.

This post is my attempt to provide an answer with some context.

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disclaimers

Full disclosure…  I don’t like to measure the food I eat.  I have developed the optimal foods lists to highlight what I think are the best foods to suit different goals and levels of metabolic health.

I think food should be nutritious and satiating.  If your goal is to lose weight it will be hard to overeat if you limit your food choices to things like broccoli (which contains sulforaphane), celery, salmon and tuna.

At the same time, some people like to track their food.  Tracking food with apps like MyFitnessPal or Cron-O-Meter can be useful for a time to reflect and use as a tool to help you refine your food choices.  If you’re preparing for a bodybuilding competition you’re probably going to need to track your food to temporarily override your body’s survival to force it to shed additional weight.

Ideal macronutrient balance is a contentious issue and a lot has already been said on the topic.  I’ll try to focus on what I think I have to add to the discussion around the topics of insulin load and nutrient density.

If you want to and skip the detail in the rest of this article, this graphic from Dr Ted Naiman does a good job of summarising optimal foods and ideal macronutrient ranges.   If you’re interested in more detail on the topic, then read on.

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insulin is not the bad guy

The insulin load formula was designed to help us more accurately understand the insulin response to the food we eat, including protein and fibre.

insulin load = total carbohydrates – fibre + 0.56 * protein

The first thing to understand is that insulin per se is not bad.  Insulin is required for energy metabolism and growth.  People who can’t produce enough insulin are called Type 1 Diabetics and typically don’t last long without insulin injections after they catabolize their muscle and body fat.

Insulin only really becomes problematic when we have too much of it (i.e. hyperinsulinemia[1]) due to excess processed carbohydrates (i.e. processed grains, added sugar and soft drinks) and/or a lack of activity which leads to insulin resistance.

The concepts of insulin load and proportion of insulinogenic calories can provide us with a better understanding of how different foods trigger an insulin response and how to quantitatively optimise the insulin load of our diet to suit our unique situation and goals.

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different degrees of the ketogenic diet

Words like “ketogenic”, “low carb” or “nutrient dense” mean different things to different people.   This is where using numbers can be useful to better define what we’re talking about and tailor a dietary approach.  For clarity, I have numerically defined a number of terms that you might hear.

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ketogenic ratio

The therapeutic ketosis community talks about a “ketogenic ratio” such as 3:1 or 4:1 which means that there are three or four parts fat (by weight) for every part protein plus carbohydrate.[2]

For example, a 3:1 ketogenic diet may contain 300g of fat plus 95g of protein with 5g of carbs.  This ends up being 87% fat.  A 4:1 ketogenic ratio is an even more aggressive ketogenic approach that is used in the treatment of epilepsy,[3] cancer or dementia and ends up being 90% fat.

These levels of ketosis are hard to achieve with real food and are hard to sustain in the long term.  Hence, it is typically used as a short term therapeutic treatment.

ratio of fat to protein

People in the ketogenic bodybuilding scene (e.g. Keto Gains) or weight loss might talk about a 1:1 ratio of fat to protein (by weight) for weight loss.    A diet with a 1:1 ratio of fat to protein could be 120g of fat plus 120g of protein.  If we threw in 20g of carbs this would come out at 66% fat (which is still pretty high by mainstream standards).   A 1:2 protein:fat ratio would end up being around 80% fat.

protein grammes per kilogramme of lean body weight

Some people prefer to talk in terms of terms of percentages or grammes of protein per kilo of lean body mass.  For example:

  • The generally accepted minimum level of protein is 0.8g/kg/day of lean body mass to prevent malnutrition.[4] This is based on a minimum requirement of 0.6kg to maintain nitrogen balance and prevent diseases of malnutrition plus a 25% or two standard deviations safety factor.[5]
  • In the Art and Science of Low Carb Performance Volek and Phinney talk recommend consuming between 1.5 and 2.0g/kg of reference body weight (i.e. RW). Reference weight is basically your ideal body weight say at a BMI of 25kg/m2.  So, 1.5 to 2.0kg RW equates to around 1.7 to 2.2g/kg lean body mass (LBM).
  • There is also a practical maximum level where people just can’t eat more lean protein (i.e. rabbit starvation[6]) which kicks in at around 35% of energy from protein.

The table below shows a list of rule of thumb protein quantities for different goals in terms of grams per kilogram of lean body mass and as a percentage of calories assuming weight maintenance.[7]

scenario % calories g/kg LBM
minimum (starvation) 6% 0.4
RDI/sedentary 11% 0.8
typical 16% 1.2
strength athlete 24% 1.8
maximum 35% 2.7

gluconeogenesis

You may have heard that body will convert ‘excess protein’ to glucose via gluconeogenesis, particularly if there are minimal carbohydrates in the diet and/or we can’t yet use fat for fuel.

For some people, this is a concern due to elevated blood glucose levels, but it may also mean that more protein is required because so much is being converted to glucose that you need more to maintain muscles growing your muscles.  As we become more insulin sensitive we may be able to get away with less protein because we are using it better (i.e. we are growing muscles rather than making glucose).

Most people eat more than the minimum level of protein to prevent malnutrition.  People looking to gain muscle mass will require higher levels.  Although keep in mind you do need to be exercising to gain muscle, not just eating protein.

Ensuring adequate protein and exercise is especially important as people age.  Sarcopenia is the process of age related muscle decline which is exacerbated in people with diabetes.

Sadly, many old people fall and break their bones and never get up again.   When it comes to longevity there is a balance between being too big (high IGF-1) and too frail (too little IGF-1).

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carbohydrate counting

Then there is carb counting.

  • People on a ketogenic approach tend to limit themselves to around 20g (net?) carbohydrates.
  • Low carbers might limit themselves to 50g carbs per day.
  • A metabolically healthy low carb athlete might try to stay under 100g of carbs per day.

Limiting non-fibre carbohydrates typically eradicates most processed foods (e.g. sugar, processed grains, sodas etc).   Nutrient density increases as we decrease the amount of non-fibre carbohydrates in our diet.

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protein, insulin load and nutrient density

In the milieu of discussion about protein, I think it’s important to keep in mind that minimum protein levels to prevent the diseases of malnutrition may not necessarily optimal for health and vitality.

Protein is the one macronutrient that correlates well with nutrient density.  Foods with a higher percentage of protein are typically more nutrient dense overall.

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Considering minimum protein levels may be useful if you are looking to drop your energy intake to the bare minimum and while still providing enough protein to prevent loss of lean muscle mass (e.g. a protein sparing modified fast).   However, if you are looking to fill up the rest of your energy intake with fat for weight maintenance then you should be aware that simply eating foods with a higher proportion of fat will not help you maximise nutrient density.

Practically though very high levels of protein will be difficult to achieve because they are very filling, thus it is practically difficult to eat more than around 35% of your energy from protein.  Protein is also an inefficient fuel source meaning that you will lose around 25% of the calories just digesting and converting it to glucose via digestion and gluconeogenesis.

If you are incorporating fasting then I think you will need to make sure you are getting at least the minimum as an average across the week, not just on feasting days to maintain nitrogen balance.  That is,  you might need to try to eat more protein on days you are eating.

what is ketosis?

“Ketogenic” simply means “generates ketones”.

An increase in ketosis occurs when there is a lack of glucogenic substrates (i.e. non-fibre carbohydrates and glucogenic protein).  It’s not primarily about eating an abundance of dietary fat

I think reducing insulin load (i.e. the amount of food that we eat that requires insulin to metabolise), rather than adding dietary fat, is really where it’s at if you’re trying to ‘get into ketosis’.   We can simply wind down the insulin load of our diet to the point that out blood glucose and insulin levels decrease and we can more easily access our stored body fat.

insulin load = total carbohydrates – fibre + 0.56 * protein

Whether a particular approach is ketogenic (i.e. generates ketones) will depend on your metabolic health, activity levels and insulin resistance etc.

Whether you want to be generating ketones from the fat on your excess belly fat rather than your plate (or coffee cup) is also an important consideration if weight loss is one of your goals.

While people aiming for therapeutic ketosis might want to achieve elevated ketone levels by consuming more dietary fat, most people out there are just looking to lose weight for health and aesthetic reasons.  For most people, I think the first step is to reduce dietary insulin load until they achieve normalised blood glucose levels (i.e.  average BG less than 5.6mmol/L or 100mg/dL, blood ketones greater than 0.2 mmol/L).   People with diabetes often call this “eating to your meter”.

Once you’ve achieved normal blood glucose levels and some ketones the next step towards weight loss is to increase nutrient density while still maintaining ketosis.  Deeper levels of ketosis do not necessarily mean more fat loss, particularly if if you have to eat gobs of eating processed fat to get there.

Ray Cronise and David Sinclair recently published an article “Oxidative Priority, Meal Frequency, and the Energy Economy of Food and ACtivity:  Implications for Longevity, Obesity and Cardiometabolic Disease”  which does an interesting job of looking at the ‘oxidative priority’ of various nutrient and demonstrate that the body will burn through nutrients in the following order:

  1. alcohol,
  2. protein (not used for muscle protein synthesis),
  3. non-fibre carbohydrate, and then
  4. fat.

What this suggests to me is that if you want to burn your own body fat you need to minimise the alcohol, protein and carbohydrate which will burn first.  To me, this is another angle on the idea that insulin levels are the signal that stops our body from using our own body fat in times of plenty.   And if we want to access our own body fat we need to reduce the insulin load of our diet to the point we can release our own body fat.

insulin load versus nutrient density

The risk however with the insulin load concept is that people can take things to extremes.  If our only objective is to minimise insulin load we’ll end up just eating bacon, lard, MCT, olive oil… and not much else.

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In his “Perfect Health Diet” book Paul Jaminet talks about “nutrient hunger”, meaning that we are more likely to have an increased appetite if we are missing out on particular nutrients.  He says

“A nourishing, balanced diet that provides all the nutrients in the right proportions is the key to eliminating hunger and minimising appetite.“

In the chart below shows nutrient density versus proportion of insulinogenic calories.  The first thing to note is that there is a lot of scatter!  However, on the right-hand side of the chart, there are high carb soft drinks, breakfast cereals and processed grains that are nutrient poor.  But if we plot a trend line we see that nutrient density peaks somewhere around 40% insulinogenic calories.

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If you are metabolically challenged, you will want to reduce the insulin load of your diet to normalise blood glucose levels.  But if you reduce your insulin load too much you end up living on purified fats that aren’t necessarily nutrient dense.

If we are trying to avoid both carbohydrates and protein we end up limiting our food choices to macadamia nuts, pine nuts and a bunch of isolated fats that aren’t found in nature in that form.  Rather than living on copious amounts of refined oils I think we’re in much safer territory if we maximise nutrient density with whole foods while still maintaining optimal blood glucose levels.

The chart below shows the proportion of insulinogenic calories for the highest-ranking basket of foods (i.e. top 10% of the foods in the USDA foods database) for a range of approaches, from the low insulin therapeutic ketosis, through to the weight loss foods for someone who is insulin sensitive and a lot of fat is coming from their body.  At one end of the scale, a therapeutic ketogenic may only contain 14% insulinogenic calories while a more nutrient dense approach might have more than half of the food requires insulin to metabolise.

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macronutrient splits

It’s one thing to set theoretical macro nutrient targets, but real foods don’t come in neat little packages of protein, fat and carbohydrates.  The chart below shows the macro nutrient split of the most nutrient dense 10% of foods for each of the four nutritional approaches.  The protein level for the weight loss approach might seem high but then once we factor in an energy deficit from our body fat it comes back down.

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In reality, you’re probably not going to be able to achieve weight maintenance if you just stick to the nutrient dense weight loss foods.  You’ll either become full and will end up using your stored body fat to meet the energy deficit or you will reach for some more energy dense foods to make up the calorie deficit.  If you look at the macronutrient split of the most nutrient dense meals for the different approach you find they are lower in protein and higher in fat as shown in the chart below.

2016-12-03-3

nutrient density

The chart below shows the percentage of the daily recommended intake of essential vitamins, minerals, amino acids and fatty acids you can get from 2000 calories for each of the approaches.

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You can meet most of your nutritional requirements with a therapeutic ketogenic diet, however, you’ll have to eat enough calories to maintain your weight to prevent nutritional deficiencies.

As you progress to the more nutrient dense approaches you can meet your nutrient requirements with less energy intake.   The beauty of limiting yourself to nutrient dense whole foods is that you can obtain the required nutrition with less energy and you’ll likely be too full to overeat.

As far as I can see the holy grail of nutrition,  health and longevity is adequate energy without malnutrition.

If we look in more detail we can see that the weight loss (blue) and nutrient dense approaches (green) provide more of the essential micronutrients across the board, not just amino acids.

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While the protein levels in the “weight loss” and “most nutrient dense” approaches are quite high, keep in mind that the food ranking system only prioritises the nutrients that are harder to obtain.

The table below shows the various nutrients that are switched on in the food ranking system for each approach.

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This table shows the number of vitamins, minerals, amino acids and fatty acids counted for each approach.

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In the weight loss and nutrient dense approach, of the twelve essential amino acids, only Tyrosine and Phenylalanine has been counted in the density ranking system.

It just so happens that protein levels are high in whole foods that contain essential vitamins, minerals and fatty acids. 

It appears that if you set out to actively avoid protein it may be harder to get other essential nutrients.  The risk here is that you may be setting yourself up for nutrient hunger, and rebound/stall inducing cravings in the long term as your body becomes depleted of the harder to obtain nutrients.

choosing the right approach for you

I believe one of the key factors in determining which nutritional approach is right for you is your blood glucose levels which give you an insight into your insulin levels and insulin sensitivity.

As shown in the chart below, if your blood glucose levels are high then it’s likely your insulin levels are also high which means you will not be able to easily to access your fat stores.  I have also created this survey which may help you identify whether you are insulin resistant and which foods might be ideal for you right now.

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While you may need to start out with a higher fat approach, as your glucose levels decrease and ketone levels rise a little you will be able to transition to more nutrient dense foods.

The table below shows the relationship between HbA1c, glucose, ketones and GKI.   Once you are getting good blood glucose levels you can start to focus more on nutrient density and weight loss.

 Risk level HbA1c average blood glucose ketones GKI
 (%)  (mmol/L)  (mg/dL)  (mmol/L)
low normal 4.1 4.0 70 5.5 0.7
optimal 4.5 4.6 83 2.5 1.8
excellent < 5.0 < 5.3 < 95 > 0.2 < 30
good < 5.4 < 6.0 < 108 < 0.2
danger > 6.5 7.8 > 140 < 0.2

more numbers

The table below shows what the different nutritional approaches look like in terms of:

  • ketogenic ratio
  • ratio of fat to protein
  • protein (g)/kg LBM
  • insulin load (g/kg LBM)
approach keto ratio fat : protein protein g/LBM insulin load (g/LBM)
therapeutic ketosis 1.8 2.2 1.0 0.9
diabetes 0.9 1.0 1.8 1.5
weight loss (incl. body fat) 0.5 0.6 2.5 2.4
nutrient dense 0.3 0.3 3.0 2.8

The 1.0g/kg LBM for therapeutic ketosis is greater than the RDA minimum of 0.8g/kg LBM so will still provide the minimum amount while still being ketogenic.  It’s hard to find a lot of foods that have less than 1.0g/kg LBM protein in weight maintenance without focussing on processed fats.

At the other extreme most nutrient dense foods are very high in protein but this might also be self-limiting meaning that people won’t be able to eat that much food.  As mentioned earlier, it will be hard to eat enough of the nutrient dense foods to maintain your current weight.  Either you will end up losing weight because you can’t fit as much of these foods in or reaching more energy dense lower nutrient density foods.  Also, if you found you were not achieving great blood glucose levels and some low-level ketones with mean and non-starchy veggies you might want to retreat to a higher fat approach.

The table below lists optimal foods for different goals from most nutrient dense to most ketogenic.    Hopefully, over time you should be able to work towards the more nutrient dense foods as your metabolism heals.

dietary approach printable .pdf
weight loss (insulin sensitive) download
nutrient dense (maintenance) download
weight loss (insulin resistant) download
diabetes and nutritional ketosis download
therapeutic ketosis download

what about mTOR?

Many people are concerned about excess protein causing cancer or inhibiting mTOR (Mammalian Target of Rapamycin).[8]  [9]

From what I can see though, the story with mTOR is similar to insulin.  That is, constantly elevated insulin or constantly stimulated mTOR are problematic and cause excess growth without being interspersed with periods of breakdown and repair.

Our ancestors would have had times when insulin and mTOR were low during winter or between successful hunts.  But during summer (when fruits were plentiful) or after a successful hunt, insulin would be elevated and mTOR suppressed as they gorged on the nutrient dense bounty.

These days we’re more like the futuristic humans from Wall-E than our hunter gather ancestors.   We live in a temperature controlled environment with artificial lighting and tend to put food in our mouths from the moment we wake up to the time we fall asleep.[10]

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Rather than chronic monotony (e.g. eating five or six small meals per day every day), it seems that periods of growth (anabolism) and breakdown and cleaning (catabolism) are optimal to thrive in the long term.  We need periods of both.  One or the other chronically are bad news.

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As my wise friend Raymund Edwards from Optimal Ketogenic Living says

“FAST WELL, FEED WELL.” 

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how much protein?

Optimal protein levels are a contentious topic.  There is research out there that says that excess protein can be problematic from a longevity perspective.  Protein promotes growth, IGF-1, insulin and cell turnover which can theoretically compromise longevity.  At the same time, there are plenty of studies that indicate that we need much more protein than the minimum RDI levels.[11]

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In the end, you need to eat enough protein to prevent loss of lean muscle and maintain strength.  If you’re trying to build lean muscle and working out, then higher levels of protein may be helpful to support muscle growth.  If you are trying to lose weight, then higher levels of protein can be useful to increase satiety and prevent loss of lean muscle mass.  Maintaining muscle mass is critical to keeping your metabolic rate high and avoiding the reduction that can come with chronic restriction.[12] [13]

In addition to building our muscles, protein is critical for building our bones, heart, organs and providing many of the neurotransmitters required for mental health.  So protein from real whole foods is generally nothing to be afraid of.  It’s typically the processed high carb foods that make the detrimental impact on insulin and blood glucose levels.

The table below shows a starting point for protein in grammes depending on your height.  This assumes that someone with a lean body mass (LBM) of 80 kg is burning 2000 calories per day and your lean body mass equates to a BMI of 20 kg/m2.  LBM is current weight minus fat mass minus skeletal mass which again is hard to estimate without a DEXA.

There are a lot of assumptions here so you will need to take as a rule of thumb starting point and track your weight and blood glucose levels and refine accordingly.  It’s unlikely that you will get to the high protein levels of the most nutrient dense approach because either you would feel too full or your glucose levels may rise and ketones disappear, so most people, unless your name is Duane Johnson, will need to moderate back from that level.

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Example:  Let’s say for example you were 180cm and were managing diabetes and elevated blood glucose levels.  You would start with around 117g of protein per day as an initial target and test how that worked with your blood glucose levels.  If your blood glucose levels on average were less than say 5.6mmol/L or 100mg/dL and your ketones were above 0.2mmol/L you could consider increasing transitioning to more nutrient dense foods. 

If you want to see what this looks like in terms of real foods and real meal meals check out the optimal food list and the optimal meals for the different approaches.

insulin load

Using a similar approach, we can calculate the daily insulin load (in grammes) depending on your height and goals.  The values in this table can be used as a rule of thumb for the insulin load of your diet.

If you are not achieving your blood glucose or weight loss goals, then you can consider winding the insulin load back down.  If you are achieving great blood glucose levels, then you might consider choosing more nutrient dense food which might involve more whole protein and more nutrient dense green leafy veggies.

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Example:  Let’s say for example you are an 180cm person with good glucose control but still wanting to lose weight, your initial target insulin load would be 156g from the superfoods for fat loss list.  If you were not losing weight at this level, you could look to wind it back a little until you started losing weight.  If you are consistently achieving blood glucose levels less than 5.6mmol/L or 100mg/dL and ketones greater than 0.2mmol/L you could consider transitioning to more nutrient dense foods. 

summary

In summary, reducing the insulin load of your diet is an important initial step.  However, as your blood glucose and insulin levels normalise there are a number of other steps that you can take towards optimising nutrient density on your journey towards optimal health and body fat.

  1. Reduce the insulin load of your diet (i.e. eliminate processed carbage and maybe consider moderating protein if still necessary) to normalise blood glucose levels and reduce insulin levels to facilitate access to stored body fat.
  2. If your blood glucose levels are less than say 5.6 mmol/L or 100mg/dL and your ketone levels are greater than say 0.2 mmol/L then you could consider transitioning to more nutrient dense foods.
  3. If further weight loss is required, maximise nutrient density and reduce added fats to continue weight loss.
  4. Consider also adding an intermittent fasting routine with periods of nutrient dense feasting. Modify the feasting/fasting cycles to make sure you are getting the results you are after over the long term.
  5. Once optimal/goal weight is achieved, enjoy nutrient dense fattier foods as long as optimal weight and blood glucose levels are maintained.
  6. If blood glucose levels are greater than optimal blood glucose levels, return to step 1.
  7. If current weight is greater goal weight return to step 3.

 

 

references

[1] http://diabesity.ejournals.ca/index.php/diabesity/article/view/19

[2] http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies/ketogenic-diet

[3] http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies/ketogenic-diet

[4] http://www.health.harvard.edu/blog/how-much-protein-do-you-need-every-day-201506188096

[5] https://intensivedietarymanagement.com/how-much-protein-is-excessive/

[6] https://en.wikipedia.org/wiki/Protein_poisoning

[7] https://optimisingnutrition.com/2015/08/31/optimal-protein-intake/

[8] https://www.youtube.com/watch?v=Yv-M-5-s9B0

[9] http://nutritionfacts.org/video/prevent-cancer-from-going-on-tor/

[10] https://www.youtube.com/watch?v=qPpAvvPG0nc

[11] https://www.ncbi.nlm.nih.gov/pubmed/27109436

[12] http://ajcn.nutrition.org/content/87/5/1558S.long

[13] https://en.wikipedia.org/wiki/Protein-sparing_modified_fast

 

post last updated July 2017

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

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

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

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

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

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

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

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

OFT in the wild

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

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… gone to extraordinary lengths to obtain energy dense honey …

image16

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

image02

OFT in captivity

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

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

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

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

 sweet = good = energy to survive winter

But now we have entered a brave new world.

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

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

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

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

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

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

what happens when we go low fat?

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

Sounds logical, right?

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

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

image10

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

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Maybe a little too well.

image01

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

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

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

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

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

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

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


what happens when we go low carb?

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

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

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

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

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

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

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what happens when we go paleo?

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

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Well, maybe.  Maybe not.

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

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

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

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

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

enter nutrient density

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

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

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

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

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

optimal rehabilitation plan?

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

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

the solution

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

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

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

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

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

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

survey

I hope this helps.  Good luck out there!

post last updated OCtober 2017

 

references

[1] http://ketosummit.com/

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

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

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

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

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

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

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

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

nutrient dense foods for weight loss and insulin resistance

I found a number of people that were using a combination of the optimal foods for diabetes and nutritional ketosis and the optimal foods for weight loss lists.  So I thought it would be useful to combine the two approaches into a single list of foods for people who want to lose weight but who were still somewhat insulin resistant.

optimal foods for diabetes and nutritional ketosis

The food ranking system revolves around manipulating these three parameters to suit different goals:

The optimal foods for diabetes and nutritional ketosis list has a low insulin load, is fairly low in non-fibre carbs and moderately high fat while still being as nutrient dense as possible.

This approach suits someone who has Type 1 Diabetes or is lean and looking to achieve nutritional ketosis.  People who are at their goal weight can afford to eat a little more added dietary fat.

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While most people looking to manage their blood glucose levels limit their carbohydrates to some arbitrary number that works for them, maximising nutrient density as well will help you to improve your mitochondrial function and increase your energy levels to ideally overcome your insulin resistance.  Maximising nutrient density also means that your body won’t keep on seeking out more and more food to obtain the nutrients it requires.

People who are very insulin resistant often do well on a higher fat dietary approach initially to let the insulin levels drop, however they often find further success in the long term if they drop their dietary fat to let more fat come from their body.

optimal foods for weight loss

The optimal foods for weight loss list are fairly low in dietary fat to allow for to come from the body during weight loss.  It’s heavy in lean proteins and non-starchy veggies and is VERY nutrient dense.  The chart below shows a comparison of a range of dietary approaches with the insulin sensitive weight loss approach being having the highest nutrient density while diabetes and nutritional ketosis approach comes in at #8 of thirteen.

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This list of foods may look like a low-fat dietary approach, but it’s not really low fat once you factor in your body fat.  The chart from Steve Phinney illustrates how your body fat makes a contribution to the weight loss phase of a well formulated ketogenic diet.

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The weight loss list of foods is also quite bulky (i.e. lots of fibre and water) so they would be very hard to overeat if you stick to just these foods.  The chart below shows a comparison of the various approaches with the weight loss approach having the lowest energy density.

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Eating from the weight loss foods basically equates to a protein sparing modified fast (which is widely held to be the most effect way to lose weight in the long term) meaning that will fill you up so much you won’t be above to overeat while at the same time providing enough protein to preserve lean muscle mass during the weight loss phase.

The “problem” with the aggressive weight loss approach is that it is very low in energy dense comfort foods and it is higher in carbohydrates and protein than most low carbers might be used to, so it might be harder to stick to.  It may also raise your blood glucose levels if you’re still somewhat insulin resistant.

finding the optimal balance between the extremes

I have designed this list of foods for people who are insulin resistant and also looking to lose weight provides a balance between both extremes – high nutrient density, lowish levels of dietary fat and lower energy density.

The foods listed below represent the top 10% of the USDA food database using this ranking system.  I’ve included the nutrient density score, percentage of insulinogenic calories, insulin load (per 100g), energy density (per 100g) and the multicriteria analysis score (MCA) that combines all these factors.

The chart below shows the amount of each nutrient provided by the more balanced approach compared to the average of all the foods in the USDA food database.  As you can see you will still be able to obtain heaps of nutrients while the fat comes from your body.

weight-loss-insulin-resistant

vegetables

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
broccoli 23 36% 3 22 2.07
endive 15 23% 1 17 1.84
coriander 16 30% 2 23 1.79
zucchini 18 40% 2 17 1.75
chicory greens 14 23% 2 23 1.74
spinach 20 49% 4 23 1.66
escarole 11 24% 1 19 1.58
basil 17 47% 3 23 1.55
alfalfa 9 19% 1 23 1.51
watercress 22 65% 2 11 1.51
beet greens 13 35% 2 22 1.49
asparagus 16 50% 3 22 1.44
lettuce 14 50% 2 15 1.33
Chinese cabbage 15 54% 2 12 1.29
summer squash 12 45% 2 19 1.26
okra 13 50% 3 22 1.26
parsley 13 48% 5 36 1.25
cauliflower 13 50% 4 25 1.23
chard 13 51% 3 19 1.22
portabella mushrooms 14 55% 5 29 1.20
mustard greens 9 36% 3 27 1.20
arugula 11 45% 3 25 1.17
turnip greens 10 44% 4 29 1.17
chives 11 48% 4 30 1.14
banana pepper 8 36% 3 27 1.13
paprika 9 27% 26 282 1.11
cucumber 7 39% 1 12 1.08
pickles 7 39% 1 12 1.08
collards 7 37% 4 33 1.07
celery 10 50% 3 18 1.03
brown mushrooms 16 73% 5 22 1.01
avocado -0 8% 3 160 0.99
white mushroom 13 65% 5 22 0.99
shitake mushroom 12 58% 7 39 0.98
red peppers 6 40% 3 31 0.98
dandelion greens 10 54% 7 45 0.97
sauerkraut 5 39% 2 19 0.96
dill 11 59% 8 43 0.96
eggplant 4 35% 3 25 0.95
cloves 9 35% 35 274 0.95
radishes 6 43% 2 16 0.94
sage 7 26% 26 315 0.93
jalapeno peppers 5 37% 3 27 0.93
curry powder 3 13% 14 325 0.92
edamame 7 41% 13 121 0.89
chayote 5 40% 3 24 0.88
olives -5 3% 1 145 0.80
Brussel sprouts 6 50% 6 42 0.78
spirulina 11 70% 6 26 0.76
soybeans (sprouted) 6 49% 12 81 0.76
cabbage 7 55% 4 23 0.75
blackberries -1 27% 3 43 0.71
artichokes 5 49% 7 47 0.71

seafood

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
fish roe 18 47% 18 143 1.45
salmon 19 52% 20 156 1.44
trout 16 45% 18 168 1.36
caviar 13 33% 23 264 1.25
oyster 16 59% 14 102 1.19
cisco 9 29% 13 177 1.17
sturgeon 13 49% 16 135 1.13
mackerel 6 14% 10 305 1.08
anchovy 12 44% 22 210 1.08
crab 17 71% 14 83 1.01
sardines 9 36% 16 185 1.01
flounder 13 57% 12 86 1.01
herring 9 36% 19 217 0.97
sardine 9 37% 19 208 1.0
halibut 15 66% 17 111 0.96
tuna 12 52% 23 184 0.91
rockfish 13 66% 17 109 0.86
lobster 14 71% 15 89 0.85
crayfish 12 67% 13 82 0.82
shrimp 13 69% 19 119 0.81
pollock 13 69% 18 111 0.79
perch 10 62% 14 96 0.73

animal products

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food ND % insulinogenic insulin load (g/100g) calories/100g MCA
lamb liver 19 48% 20 168 1.47
lamb kidney 19 52% 15 112 1.45
turkey liver 16 47% 21 189 1.25
beef brains 8 22% 8 151 1.24
veal liver 17 55% 26 192 1.20
beef liver 17 59% 25 175 1.14
chicken liver 14 50% 20 172 1.13
beef kidney 14 52% 20 157 1.10
lamb brains 6 27% 10 154 1.05
chicken liver pate 7 34% 17 201 0.91
lamb heart 10 48% 19 161 0.90
ham 12 59% 17 113 0.88
ground turkey 6 30% 19 258 0.88
turkey heart 9 47% 20 174 0.85
rib eye steak 8 41% 21 210 0.84
roast pork 7 41% 20 199 0.83
roast beef 7 38% 21 219 0.83
beef tongue 1 16% 11 284 0.81
lamb sweetbread 6 43% 15 144 0.79
lamb chop 8 42% 25 234 0.79
lean beef 11 61% 23 149 0.78
beef heart 9 52% 23 179 0.78
park sausage 2 25% 13 217 0.78
pork liver 11 59% 23 165 0.77
turkey meat 8 52% 21 158 0.74
turkey drumstick 8 52% 21 158 0.74
chicken 10 60% 22 148 0.73

dairy and egg

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food ND % insulinogenic insulin load (g/100g) calories/100g MCA
whole egg 9 30% 10 143 1.20
egg yolk 8 18% 12 275 1.15
sour cream 2 13% 6 198 1.02
cream 2 6% 5 340 0.93
cream cheese 2 11% 10 350 0.84
Swiss cheese 5 22% 22 393 0.80
cheddar cheese 5 20% 20 410 0.78
Greek yogurt 3 37% 9 97 0.74

other dietary approaches

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

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

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

image02

 

Post last updated July 2017

a fresh perspective on nutrition

Warning: This post is a celebration of how data analysis can help us understand how to optimise our nutrition to suit different goals.  It may contain novel ideas based on large amounts of data.   

I was flattered when Chris Green (@heuristics) recently posted a graphical presentation of the food insulin index and my nutrient density data analysis using Tableau.

If you click on the image below you can see where the different foods sit on the plot of nutrient density versus proportion of insulinogenic calories or click on individual data points to learn more about a particular food and find out why it ranks well or poorly.

I think presenting the data in an interactive format using Tableau makes large amounts of data more accessible compared to a static chart or spreadsheet that can be produced in Excel.

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Inspired by Chris’s chart, I uploaded the Food Insulin Index data for 147 foods from Kirstine Bell’s thesis Clinical Application of the Food Insulin Index to Diabetes Mellitus.

Click on the chart below to see a larger version or, better yet, open the interactive Tableau version here.   Click on the different tabs to see how your insulin response relates to different parameters such as carbohydrates, fat, protein, glycemic index, glycemic load and sugar.

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I think the food insulin index data is exciting because it helps us better understand what drives blood glucose, insulin, Hyperinsulinemia, metabolic syndrome, and the diseases of western civilisation that are sending us to an early grave and bankrupting our western economy.

I’ve included some brief notes on the interactive charts in order to unpack what I think the data is telling us, but if you want a more detailed discussion of the data I encourage you to check out the articles:

investing your insulin budget wisely

I think being able to better understand our insulin response to food is exciting for people with Type 1 diabetes (like my wife) to more accurately calculate their insulin dose or people trying to achieve therapeutic ketosis for the treatment of epilepsy or cancer.

Understanding exactly how fibre and protein affect insulin and glucose demonstrates quantitatively why a low carbohydrate moderate protein approach works so well for people who are insulin resistant.

While lots of people have found the food insulin index data useful, I want to highlight in this article that insulin load is only one factor that should be considered.

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If we only consider insulinogenic properties of food there is a risk that we unnecessarily demonise nutrient dense foods that happen to elicit an insulin response.  Rather than avoiding insulin, I think it’s better to think in terms of investing a limited insulin budget.  And just like different people have different levels of income, different people have a different (but still finite) “insulin budget”.  For example…

  • Someone using therapeutic ketogenic approach to battle epilepsy or cancer will want to minimise the insulin load of their diet by eating very high amounts of fat, fasting, and perhaps supplementing with MCTs or exogenous ketones. Someone pursuing therapeutic ketosis will need to pay particular attention to making sure they obtain adequate nutrition within their very small insulin budget.
  • If you have Type 1 Diabetes large doses of insulin will send you on a blood glucose roller coaster that might take a day or two to get under control. Eating a Bernstein-esque low carb diet with moderate to high protein levels and lots of non-starchy veggies will make it possible to manage blood glucose levels with physiologic (normal) amounts of insulin without excessive blood glucose and insulin swings.[1] [2]
  • For a type 2 diabetic who struggles to produce enough insulin to maintain their blood glucose within normal ranges, a lower carb moderate insulin load diet will help their pancreas to keep up and achieve normal blood glucose levels while minimising fat storage.
  • People using a ketogenic approach for weight loss need to keep in mind that reduced insulin levels and ketosis occur due to a lack of glucose and not higher levels of dietary fat. If your primary goal is weight loss, fat on the plate (or in the coffee cup) should be just enough to stop you from going insane with hunger.  Too much dietary fat will mean that there will be no need to mobilise fat from the body.
  • Athletes and people who are metabolically healthy can be more flexible in their choice of energy source and perhaps focus more on more nutrient dense foods as well as energy dense foods.

insulin is not the bad guy

Humans are great at thinking in absolutes (good/bad; black/white) while ignoring context.  We all like to grab hold of our favourite bit of the elephant of metabolic health and hold on tight.

image02

While many people suffer from hyperinsulinemia and its vast array of associated health consequences we need to remember that insulin is critical to life and growth and is required to metabolise protein for muscle growth/repair as well as all the other important functions of amino acids (neurotransmitters etc).[3]

Ideally, we should make every bite count if we want to maximise health and longevity.  Every calorie should contain the maximum amount of nutrients possible.  In a similar way, every unit of insulin that we “invest” should be associated with the maximum amount of nutrition (think of the nutrient density of spinach or liver versus than nutrient a soft drink or white bread).

So let’s look at how we can “leverage” our “insulin investment” to maximise our health outcome.

show me the data

In this article, I’m going to risk overloading, overwhelming, and confusing you, the reader, with too much data.  But at the same time, with all the data available you won’t have to take my word for it.  You can make your own conclusions.

If the idea is far out, you need to see the data. All the data. Not the hazard ratio, not just the conclusions from the computer.

My new grand principle of doing science: habeas corpus datorum, let’s see the body of the data. If the conclusion is non-intuitive and goes against previous work or common sense, then the data must be strong and all of it must be clearly presented.

So, how should you read a scientific paper? I usually want to see the pictures first.[4]

Richard David Feinman, The World Turned Upside Down

I am trying to draw conclusions from more than 6000 foods in the USDA foods database.  These are hard to present accurately in single charts, so I’ve used a few.  If something that you see doesn’t make sense at first you can drill down into the data to check out the detailed description.  I have also included as much micronutrient and macro nutrient as I can.  Just ‘mouse over’ a data point that you’re interested in to see how it compares to another data point.

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In the sections below I have given an overview of different ways to look at nutrient density with a more detailed discussion in the appendices at the end of this article.   Unfortunately, this post is probably not going to work well on your phone.

You’ll need to view it on a big screen for best effect.

Sorry.

My 2c on nutrient density

Lots of people talk about nutrient density, however, most of the time this is in relation to a few favourite nutrient(s) rather than a broad range spectrum of essential vitamins, minerals, amino acids and fatty acids.

We hear that butter is high in Vitamin K2 and Vitamin D and hence we should eat more of it[5] or that whey protein is high in essential amino acids (e.g. leucine and lysine) and therefore everyone should be buying tubs of it.[6]

A lot of time these claims are used to advertise a product or to argue a particular philosophical position (e.g. zero carb, vegan, plant based, paleo etc).  The problem here is that many of these so call ‘nutrient dense superfoods’ do not contain a well-rounded range of the nutrients that are required for health, but rather a narrow slice of nutrients.

Paleo, Just Eat Real Foods[7] or ‘plant based’ is a good start, however I think there are some foods that are more useful than others.  As detailed in the Building a Better Nutrient Density Index article there are also some nutrients that are harder to obtain in adequate quantities.

Once we identify the nutrients that are harder to obtain we can focus on the foods that contain the highest amounts of these nutrients.   At the same time, it is also useful to think about nutrient density in the context of specific goals, whether that be therapeutic ketosis, weight loss, diabetes or optimal athletic performance.

The more I try to get my head around what it means to optimise nutrition, the more important nutrient density seems to be.  The irony is that many people retreat from insulin to the safe haven of high-fat diets that don’t actually have the micro nutrients required to optimally power mitochondria, the power plants of our bodies.  Like most things, we need to find the right balance.

Most people now seem to understand that hammering high blood glucose with more insulin is dumb because the problem is insulin resistance and poor glucose disposal, not high blood glucose.

But then the next question is what causes insulin resistance?

It seems to me that part of the answer is sluggish mitochondrial that aren’t running at optimal efficiency to burn off the energy we throw at them.  Part of the reason for this is that we’re not powering them with the right nutrients.

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, riboflavin, niacin, pantothenic acid, 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.

Dr Terry Wahls

The Wahls Protocol

Terry%20Wahls,%20M.D.%20Photo%20and%20Book%2003272014[1]

This video gives an excellent overview of the role that nutrients play to drive the Krebs cycle to enable our mitochondria to produce ATP, the energy currency of our cells.

We can then moderate that using insulin load to work within the limits of your current metabolic health (i.e. insulin resistance, muscle mass, activity levels, pancreatic function etc).

You need to eat to maintain the blood glucose levels of a metabolically healthy person.

Robb Wolf

robbwolf-468x468[1]

Nutrient density vs proportion of insulinogenic calories

The plot below shows nutrient density versus proportion of insulinogenic calories.   The size of the data points is proportional to the energy density of the foods they represent (e.g. the size of the markers for celery with a low energy density are smaller than for butter which has a high energy density).

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There is a lot of data here!  You can click on the image below to see a larger version of the chart or better yet look at the interactive online Tableau version (which I think is pretty cool!).  If you ‘mouse over’ the foods that you’re interested in you can see more details of the foods from the USDA food nutrient database.  Click through the various tabs to see how things look for specific food groups.

The x-axis on these charts is nutrient density/calorie.  You can find out more about how this is calculated in the Building a better nutrient density index article.  Essentially zero is average (or zero standard deviations from the mean) while greater than zero is better than average and less than zero is worse than the average of the 6000 foods analysed.

The nutrient density calculations are based on the USDA database which provides the nutrient content of more than 6000 foods.  It does not account for species specific bioavailability or issues such as fat soluble vitamins.  

I don’t think we can use this to say that plant foods are better or worse than animal foods, but rather it shows us which foods to avoid due and which foods are the best choices within particular categories.  

Personally, I think optimal involves getting a balanced range of the most nutrient dense plant and animal based foods. 

So what does this data mean and how could it be practically useful?

  • If you’re metabolically healthy then I think you’d do well eating the most nutrient dense foods on the right-hand side of the chart (i.e. celery, spinach, mushrooms, onions, oranges etc). While many of these nutrient dense foods may have a higher proportion of insulinogenic calories I think it’s hard for most people to overeat them.
  • The foods most people should avoid are the highly insulinogenic low nutrient density foods on the top left of this plot (i.e. soft drinks, fruit juice, sport drinks etc).
  • If you’re insulin resistant or aiming for therapeutic ketosis (e.g. as an adjunct treatment for cancer or epilepsy or dementia) you will want to move down the chart to the higher fat low insulinogenic foods while keeping to the right as much as possible.
  • It’s important to note that the high fat foods typically have a lower nutrient density because they do not contain as broad a range of nutrients.

Energy density versus nutrient density

While 60 to 70% of the western population seem to be suffering some level of metabolic syndrome and are insulin resistant[8] some people who are metabolically healthy are still obese.[9]  For these people simply reducing the energy density without consideration of carbs or insulin load (i.e. lowering their fat intake with higher amounts of water and fibre) will help them to consume less calories.

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Someone who is metabolically healthy (i.e. excellent blood glucose levels etc) yet still obese would do well to focus on the nutrient dense low energy density vegetables, fruits, seafood and meat in the top right of this chart.

This is basically where I’m at after normalising my glucose and HbA1c but I’d still like to drop some more weight.  I now need to take my own advice and focus on more nutrient dense proteins and vegetables and indulge less on the yummy high fat foods.

The typical problem with a low fat approach typically comes not from eating too much vegetables or fruit (top right of this chart) but rather when your energy comes from highly insulinogenic, energy dense low nutrient density foods (e.g.  processed grains and softdrinks) which end up on the top left of all of these charts.

The only real ‘problem’ with a high nutrient density low energy density approach is that it is physically difficult to get enough food down to achieve an energy surplus.  The benefit is that it typically leads to weight loss while still maintaining very high levels of nutrition.

A high nutrient density low energy density approach could still be ketogenic due to the low level of processed carbohydrates and low insulin load.

Click here to view the interactive Tableau version of nutrient density versus energy density.

Net carbs versus nutrient density

Lots of people like to count carbohydrates or net carbohydrates (i.e. carbohydrates minus the indigestible fibre).  In my view I think it’s better to think in terms of net carbohydrates when eating real foods to make sure you don’t miss out on nutrient dense vegetables.

The chart below shows nutrient density versus net carbohydrates.  Focusing on the foods on the top right and avoiding the soft drinks, cereals and breads at the bottom will be a pretty good strategy.

The limitation of net carbs is that it doesn’t account for the impact of protein which is an important consideration for people with type 1 diabetes or advanced type 2 diabetes.

image28

Click here to view an interactive Tableau version of nutrient density versus net carbs.

Insulin load versus nutrient density

This brings us to my favourite way to look at nutrient density… insulin load.

Thinking in terms of insulin load involves consideration of net carbs plus about half the protein as requiring insulin.  Insulin load per 100g of food is neat because it means that we also end up with lower energy density foods as well which is not a bad thing for most people who often wouldn’t mind losing some weight (note: low energy density foods like celery may not be so great if you’re trying to fuel for a marathon).

I think it’s good to also consider the insulin effect of protein because insulin is a finite resource.   While people who are metabolically healthy will be able to eat high protein foods without seeing a substantial rise in their blood glucose levels, people who are very insulin resistant or have type 1 diabetes will see their  glucose levels rise with protein and may need to inject insulin to cover the protein they eat.  This doesn’t mean though that people who are insulin resistant should avoid high protein foods, because they are typically very nutrient dense.

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Again, we can see that it’s the soft drinks, breakfast cereals and breads at the bottom of this chart that we really need to be avoiding!

This thinking seems to align with common sense wisdom.  Tick.

Click here to view an interactive version of insulin load versus nutrient density.

Summary

Hopefully you can see how thinking about nutrient density graphically in combination with other parameters can be useful to refine your food selection for different goals.

The appendices to this article below show more charts for different food groups with a little more discussion of my observations.

Or better yet, why not dive into the interactive data in Tableau and see what you can make of it yourself.

  • Appendix A – Nutrient density vs proportion of insulinogenic calories for therapeutic ketosis
  • Appendix B – Nutrient density vs energy density for weight loss and / or the metabolically healthy
  • Appendix C – Nutrient density vs net carbohydrates for people on a low carb diet
  • Appendix D – Nutrient density vs insulin load for diabetes and therapeutic ketosis

Appendix A – Nutrient density vs proportion of insulinogenic calories for therapeutic ketosis

Foods with a lower proportion of insulinogenic calories can be useful for people trying to achieve therapeutic ketosis, however at the same time we can see at the bottom of this plot that high fat / low insulin load foods are not necessarily the most nutrient dense.

People should ideally choose foods with the highest nutrient density (right hand side) while keeping the proportion of insulinogenic calories in their diet low enough to achieve their goals (e.g. blood glucose, insulin, tumour growth or seizure control).

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Click here to view the interactive Tableau version of nutrient density proportion of insulinogenic calories.

Vegetables

Vegetables are typically have high levels of vitamins and minerals as well as some protein but not much fat.

Most people, particularly those who are not severely insulin resistant, will do well to focus on the most nutrient dense vegetables on the right hand side of this chart (i.e. celery, spinach, squash, cabbage, broccoli, mushrooms, artichokes, kale) as their energy density, insulin load and net carbs are also low.

Celery is an example of a food with high amounts of vitamins and minerals with a very low energy density, hence it does really well on the nutrients / calorie scale.

The foods in the chart below with the lowest proportion of insulinogenic calories typically have added fat (e.g. french fries, onion rings which are not ideal) or are very high in fibre (e.g. asparagus, spinach and soybeans which is better).

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Seafood

Seafood is really the only substantial source of essential omega 3 fatty acids (i.e. DPA, DHA, EPA, ALA) and hence is an important part of a balanced diet.

The highest nutrient density seafoods are cod, anchovy, salmon, caviar and tuna.  The lowest insulin load fish are mackerel, herring, salmon and caviar.

Again, we should ideally focus on the most nutrient dense foods on the right hand side of the chart, but move down the chart to the least insulinogenic foods depending on our level of metabolic health.

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Animal products

Liver is the most nutrient dense of the animal products (right hand side) while processed meats are less nutrient dense (left hand side).  High fat meats are also typically less nutrient dense (bottom of chart).

Non-processed meats are typically well worth the investment of your limited insulin budget.

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Nuts seeds

Many nuts and seeds are high fat while also being fairly nutrient dense (i.e. pine nuts, coconut and pecans).  Nuts have a low proportion of insulinogenic calories and hence help to normalise blood glucose levels, but possible to overdo if weight loss is your primary goal.

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Dairy and egg

Some dairy products are both high fat and nutritious (e.g. parmesan cheese, egg yolk).

Cream and butter are high fat and energy dense so are useful for managing blood glucose levels but are possible to overdo if weight loss is your primary goal.

Low fat dairy products such as skim milk and whey are typically very nutrient poor overall.

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Fruit

Some fruits are nutrient dense, but are typically highly insulinogenic (tangerines, cherries, grapes, apricots, oranges and figs).  Only olives and avocados have a low proportion of insulinogenic calories, however they are not particularly nutrient dense.

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Cereals and grains

Unprocessed grains such as oatmeal, teff, spelt, brown rice and quinoa can be nutrient dense but are highly insulinogenic.  Unprocessed grains may be fine if you are metabolically healthy, but choose carefully and don’t go adding sugar, honey or molasses.

However breakfast cereals and most breads are typically highly insulinogenic while also having a poor nutrient density and hence are a poor investment of your limited insulin budget.

This analysis supports the idea that dropping processed grains, packaged breakfast cereals and soft drinks would be a pretty good place to start for most people!

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Legumes

Navy beans, lima beans and lentils are nutrient dense but highly insulinogenic.

Peanuts, peanut butter and tofu do OK in terms of both being low insulinogenic as well as nutrient dense.

Processed soy products and meat replacement products are typically highly insulinogenic and have poor nutrient density.

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Fats and oils

Fish oil is the most nutritious of the fats.  However as a general rule pure fats are not particularly nutrient dense.  Margarines and salad dressings are very nutrient poor.

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Beverages

Soft drinks, sports drinks and sweetened iced teas are bad news and are an extremely bad investment of your limited insulin budget.  Fruit juices are not also not particularly nutrient dense.  Better to eat your fruit whole.

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Appendix B – Nutrient density vs energy density

Low energy density, high nutrient density foods are a great way to lose weight, particularly for those who are insulin sensitive.  As we avoid processed carbs as well as high levels of dietary fat while maintaining high levels of nutrition we can allow the fat to come from our belly rather than our plate.

image03

Click here to view the interactive Tableau version of nutrient density versus energy density.

Vegetables

It’s hard to go wrong with the low energy density high nutrient density foods in the top right of this chart (i.e. celery, mushrooms, spinach, onions, broccoli, seaweed, kale etc).

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Seafood

Some seafood is nutrient dense and lower in fat (e.g. oysters, tuna, lobster).

Seafood is important because it provides the essential omega 3 fatty acids that are hard to obtain in significant amounts from vegetables and it provides higher levels of protein.

If you are serious about losing weight you’d do pretty well if you limited yourself to the vegetables in the top right of the chart above and the seafood in the top right of the chart below.

Animal products

There are many nutrient dense low energy density animal foods as shown in the chart below.  Liver does pretty well followed by game meat.  Processed meats are not so good.

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Nuts seeds

Nut are low insulin but not necessarily low energy density or spectacularly great in terms of nutrients per calories.  Consider limiting your nuts and seeds if your primary goal is weight loss.

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Dairy and egg

Whole egg (top right corner) is probably your best option from the dairy and egg category.

Butter and full fat cheese have a high energy density (bottom).

Low fat dairy is nutrient poor (top left corner)!

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Fruit

If your goal is weight loss then low energy density fruits such as tangerines / mandarins, cherries, apricots and pears will be more helpful than energy dense fruits such as bananas, prunes, raisins and dried fruits.

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Cereals and grains

Some unprocessed grains are nutritious and have a low energy density (top right), however as a general rule, breakfast cereals and processed grains are a poor investment of your limited insulin budget (bottom of chart).

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Legumes

Lima beans, navy beans, tofu, mung beans and hummus are nutrient dense and low energy density (top right).   Peanuts have a  low insulin load and solid nutrient density but a high energy density (bottom).

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Appendix C – Nutrient density vs net carbohydrates for diabetes

Most people keeping track of their carbohydrate intake think in terms of net carbs or total carbohydrates, however this does not consider the insulin demand from protein which is a real consideration if you have diabetes.

Thinking in terms of net carbs will be the best approach for most people; however, if you are highly insulin resistant or have type 1 diabetes you may be better to consider insulin load which considers the effect of protein on insulin.

Choosing foods to the top right of these charts will help you keep nutrition high and net carbohydrates low.

image28

Click here to view an interactive Tableau version of nutrient density versus net carbs.

vegetables

There are plenty of vegetables on the top right of this plot that have minimal net carbs while being very nutrient dense (e.g. celery, spinach, broccoli, asparagus, mushrooms).

Low water foods such as mushrooms, leeks, shallots (at the bottom of the plot) will be hard to eat large quantities of although they have a higher amount of net carbs per 100g.

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seafood

Most seafood has minimal levels of net carbs, though it’s interesting to note that some seafoods such as oysters have a glycogen pouch depending on what time in the season they are harvested.

image44

animal products

Similar to seafood, most animal products have negligible amounts of net carbs.  The amount that is contained in muscle glycogen is not significant.

Liver and game meats are consistently the most nutrient dense of the animal products.

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nuts seeds

Nuts and seeds have some non-fibre carbohydrates.  Pine nuts, macadamias and almonds are low in carbs with moderate nutrient density.

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dairy and egg

Many dairy and egg products have a high nutrient density as well as being low in net carbs which is why they are popular with low carbers.  Fat free cheeses have more carbohydrates.

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fruit

There are some lower carb fruits however, it may be wise for people with insulin resistance to avoid many of the higher carbohydrate fruits at the bottom of this chart.

image22

cereals and grains

This chart demonstrates why many breakfast cereals and processed grains (at the bottom of this chart with high levels of carbohydrates and minimal nutrition) are a bad investment of your limited insulin budget.  This style of analysis demonstrates why the common wisdom that soft drinks and breakfast cereals are bad news.

image04

legumes

Not all legumes are created equal.  Choose wisely.  Navy beans, legumes, lima beans and peanuts are probably your safest bet.

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beverages

Soft drinks and sports drinks are a very poor investment of your limited insulin budget as they are very low in nutrients.

image29

Appendix D – Nutrient density vs insulin load

Thinking in terms of nutrient density versus insulin load enables us to more intelligently consider how we invest our insulin budget.  Again, it’s not that insulin is bad, but rather we should use it wisely for the most nutrient dense foods.

Soft drinks, breakfast cereals and bread at the bottom of this chart are a poor way to invest the limited capacity of your pancreas.

image33

Click here to view an interactive version of insulin load versus nutrient density.

vegetables

Don’t be afraid of vegetables.  Most of them have a very low insulin load.  They should take up a large amount of your plate.  But choose wisely from the top corner (e.g. celery, spinach, squash cabbage, broccoli).

image37

seafood

There are lots of good investments to be made in the top right of this chart of seafood (oyster, salmon, lobster, mackerel).

image51

animal products

Animal products require insulin but they are rich in amino acids which play an important role in the body.   The amount you need will be dependent on your situation and your goals (e.g.  someone aiming for therapeutic ketosis will want less while someone looking to build muscle or retain muscle while dieting will want more protein).

image16

nuts seeds

Looking at nuts in terms of insulin load rather than net carbs enables better differentiation based on how much insulin these foods will demand from your system.   Pine nuts, macadamia nuts and coconut have the lowest insulin load while being nutrient dense.

image43

dairy and egg

Dairy can be insulinogenic, however the higher fat butter, cream and egg still have a fairly low insulin load.

image21

fruit

Grapefruits, cherries, apples, grapes and oranges have a large amount of nutrition with a low insulin load versus more concentrated or dried fruit options.

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cereals and grains

The breakfast cereals at the bottom of this chart with high amounts of insulin demand and lower levels of nutrients are bad news people who are insulin resistant.

image00

legumes

Lima beans, navy beans, and lentils have a fairly low insulin load and high nutrient density.  However if you are insulin resistant you will need to eat to your metre and make sure your blood glucose levels don’t rise too much if you eat legumes.

image45

fats and oils

Just because it is low insulin doesn’t mean that it is good for you.  Not many very high fat foods have substantial nutrient density.  When it comes to nutrient density, fats in whole foods are a better than trying to consume refined oils.

image47

Beverages

Soft drinks are bad news as they will stimulate large amounts of insulin while providing minimal amounts of nutrition and satiety.

image15

references

[1] https://www.youtube.com/channel/UCuJ11OJynsvHMsN48LG18Ag

[2] http://www.diabetes-book.com/

[3] http://www.moodcure.com/

[4] Feinman, Richard David (2014-12-12). The World Turned Upside Down: The Second Low-Carbohydrate Revolution

[5] http://chriskresser.com/vitamin-k2-the-missing-nutrient/

[6] http://www.whfoods.com/genpage.php?tname=foodspice&dbid=38

[7] https://iquitsugar.com/jerf-just-eat-real-food/

[8] https://www.youtube.com/watch?v=horIrfmLvUY

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

are exogenous ketones right for you?

I’ve spent a lot of time lately analysing three thousand ketone vs. glucose data points trying to determine the optimal ketone and blood sugar levels for weight loss, diabetes management, athletic performance and longevity.

In this article, I share my insights and learnings on the benefits, side effects and risks of endogenous and endogenous ketosis.

Exogenous vs. endogenous ketosis

But first, I think it’s important to understand the difference between exogenous and endogenous ketosis:

  • Endogenous ketosis occurs when we go without food for a significant period. Our insulin levels drop, and we transition to burning body fat and ketones in our blood rise.
  • Exogenous ketosis occurs when we drink exogenous ketones or consume a ketogenic diet.

Ketones vs glucose

Ketones are important.  As blood glucose decreases, the ketones in your blood increase to keep our energy levels stable.

The chart below shows three thousand blood glucose vs ketone values measured at the same time from a range of people following a low carbohydrate or ketogenic diet.

BHB ketones vs blood glucose

While there is generally a linear relationship between glucose and ketones, each person has a unique relationship between their blood glucose and ketone values that provide a unique insight into a particular person’s metabolic health.

image02

Some people produce more ketones than others.  Some people have higher blood glucose levels.

What our ketone and glucose values tell us about our metabolic health

Hyperinsulinemia has been called as the “unifying theory of chronic disease” [1] [2] [3] [4] [5].  It’s beneficial to understand where you stand on the spectrum of metabolic health and insulin sensitivity.

The chart below shows the typical relationship between blood glucose and blood ketone for a range of different degrees of insulin resistance/sensitivity.

2017-04-17 (11)

If your blood glucose levels are consistently high it’s likely you are not metabolising carbohydrate well.   When you go without food, endogenous ketones are slow to kick in because your insulin levels are also high.  You feel tired and hungry, and you are likely to eat again sooner and not stop until you feel good.

By contrast, if you are insulin sensitive you may be able to go longer between meals naturally and you will not feel as compelled to eat as much or as often.  If someone is insulin resistant, a lower insulin load dietary approach will help with satiety and carb cravings while keeping blood glucose levels and insulin under control.

hyperinsulinemia and metabolic disorders

Exciting research is coming out underway looking at the use of EXOGENOUS ketones as an adjunct treatment for cancer or to provide energy directly to the mitochondria for people with epilepsy, dementia, Alzheimer’s and the like.[6]  [7]  

EXOGENOUS ketones may help to relieve the debilitating symptoms and side effects of acute hyperinsulinemia, Alzheimer’s, dementia, epilepsy or other conditions where glucose is not used well.

exogenous ketones and the low carb flu

Patrick Arnold, who worked with Dr Dominic D’Agostino to develop the first ketone esters and ketone salts, has noted that exogenous ketones may help alleviate the symptoms of the ‘keto flu’ during the transition from a high carb to a low carb dietary approach.


However, once you have successfully transitioned to a lower carb eating style it may be wise to reduce or eliminate the exogenous ketones to enable your body to fully up-regulate lipolysis (fat burning), maximise ENDOGENOUS ketone production and access your body fat stores.

As discussed in the article Are ketones insulinogenic and does it matter? it exogenous ketones require about half as much insulin as carbohydrate to metabolise (or about the same amount as protein).  Hence the continual use of exogenous ketones will limit how much our insulin levels are able to decrease.

Someone with diabetes who follows with a nutrient dense low insulin load dietary approach may be able to successfully normalise their blood glucose and insulin levels. When this happens, your liver will be able to more easily produce ENDOGENOUS ketones which will help improve satiety between meals and decrease appetite which will, in turn, lead to weight loss.

Exercising to train your body to do more with less is also helpful.

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my experience with exogenous ketones

The light blue “mild insulin resistance” line is based on my ketone and glucose tests when I started trying to wrap my head around low carb/keto.

image

I enthusiastically started adding generous amounts of fat from all the yummy stuff (cheese, butter, cream, peanut butter, BPC etc) in the hope of achieving higher ketone levels and therefore weight loss, but I just got fatter and more inflamed as you can see in the photo on the left.

image05

My blood tests suggested I was developing fatty liver in my mid-30s!  And I thought I was doing it right with lots of bacon and BPC?!?!?

image5

The photo on the right is after I worked out how to decrease the insulin load of my diet and learning about intermittent fasting.  I realised that ENDOGENOUS ketosis and weight loss is caused by a lower dietary insulin load, not more EXOGENOUS fat on your plate or in your coffee cup.

I recently had my HbA1c tested at 4.9%.  It’s getting there.  But knowing what I know now about the importance of glucose control,  I would love to lose a bit more weight and see my HbA1c even lower.

I initially purchased a couple of bottles of KetoCaNa after hearing a number of podcast interviews with Dominic D’Agostino and Patrick Arnold.[8] [9]

Part of the reasons shelling out the money for the exogenous ketones was to see if it would provide a fuel source that didn’t need insulin for my wife Monica who has Type 1 Diabetes.

This metabolic jet fuel is definitely fascinating stuff!  My experience is that it gave me a buzz like a BPC but also has an acute diuretic effect.

I had hoped it would have a weight loss effect like some people seemed to be saying it would.

2016-08-10

I did find it had an amazing impact on my appetite.  While it was in my system I didn’t care as much about food.  However, once the ketones were used up my appetite came flooding back.

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Unfortunately, my hunger and subsequent binge eating seemed to more than offset the short term appetite suppression that had occurred while the exogenous ketones were in my system.  And it was not going to be financially viable for me to maintain a constant level of artificially elevated ketone levels which return to normal levels after a couple of hours.

do exogenous ketones help with weight loss?

I asked around to see if anyone had come across studies demonstrating long term weight loss effects of exogenous ketones.[11]   It was a VERY enlightening discussion if you want to check it out here.

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The Pruvit FAQ says that one of the benefits of Keto//OS is weight loss.  However, no reference to the research studies was provided to prove his claim.

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Also, the studies that were referenced in the Pruvit FAQ all appeared to relate to the benefits of ENDOGENOUS or nutritional ketosis rather than EXOGENOUS ketone supplementation.

Princess_Bride_That_Word

According to Dominic D’Agostino in a Pruvit teleseminar, the EXOGENOUS ketone salts were not designed to be a weight loss product and hence have not been studied for weight loss after all!

The only studies that we could find that mentioned EXOGENOUS ketone supplementation and weight loss were on rats and they found that there was no long term effect on weight loss.[12]   

So in spite of my hopeful $250 outlay, it seems that exogenous ketones ARE just a fuel source after all.

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Even the experts don’t seem to think exogenous ketones help with fat loss.

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image16 [13]

Confused?

I don’t blame you.

Metabolically healthy

The “metabolically healthy” line in the chart above is based on RD Dikeman’s ketone and glucose data when he fasted for 21 days.

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Due to his hard-earned metabolic health and improved insulin resistance RD has developed the ability to fairly easily release ketones when he doesn’t eat for a while.  RD still doesn’t find going without food effortless, but it is easier than when his insulin levels were much higher which prevented his body from accessing his body fat stores.

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Through a disciplined diet and exercise habits RD has achieved a spectacular HbA1c of 4.4%.

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Perhaps a two or three day water only fast testing blood glucose and ketones with no exercise would be a useful test of your insulin status?  You could use RD’s glucose : ketone gradient as the gold standard.

RD also told me that when he is not fasting and is eating his regular nutrient dense higher protein meals his ketone levels are not particularly high. While RD fairly easily produces ketones when fasting, it seems they are also quickly metabolised so they do not build up in his bloodstream.

I know Luis Villasenor from Ketogains finds the same thing.

image10

total energy = ketones + glucose

Where this gets even more interesting is when we look at the glucose and ketone data in terms of TOTAL ENERGY.  That is, the energy coming from both glucose and ketones.

The average TOTAL ENERGY of the three thousand data points from these healthy people working hard to achieve nutritional ketosis is around 6.0mmol/L. It seems the body works to maintain homoeostasis around this level.

optimal fasting ketone and blood sugar levels in ketosis

When the TOTAL ENERGY in our bloodstream increases outside of the normal range it the body raises insulin to store the excess energy.  That is, unless you have untreated type 1 diabetes, in which case you end up in diabetic ketoacidosis with high blood glucose and high ketones due to the lack of insulin available to keep your energy in storage.

Regardless of whether your energy takes the form of glucose, ketones or free fatty acids, they all contribute to acetyl-coA which is oxidised to produce energy.  Forcing excess unused energy to build up in the bloodstream is typically desirable and can lead to long term issues (e.g. glycation, oxidised LDL etc).

I’m not sure if ketones can be converted to glucose or body fat, but it makes sense that excess glucose would be converted to body fat via de novo lipogenesis to decrease the TOTAL ENERGY in the blood stream to normal levels.

A number of studies seem to support this view including Roger Unger’s 1964 paper the Hypoglycemic Action of Ketones.  Evidence for a Stimulatory Feedback of Ketones on the Pancreatic Beta Cells.[14]

Ketone bodies have effects on insulin and glucagon secretions that potentially contribute to the control of the rate of their own formation because of antilipolytic and lipolytic hormones, respectively.  Ketones also have a direct inhibitory effect on lipolysis in adipose tissue.[15]

image26[16] [17] [18]

Looking at the glucose and ketones together in terms of TOTAL ENERGY was a bit of an ‘ah ha’ moment for me.  It helped me to understand why people like Thomas Seyfried and Dominic D’Agostino always talk about the therapeutic benefits and the insulin lowering effects of a calorie restricted ketogenic diet. [19] [20] [21] [22]

Dealing with high ketones and high glucose is typically not a concern because it doesn’t happen in nature or when eating whole foods.  But now we have refined grains, HFCS, processed fats and exogenous ketones to ‘bio hack’ our metabolism and send it into overdrive.

While fat doesn’t normally trigger an insulin response, it seems that excess unused energy, regardless of the source, will trigger an increase in insulin to reduce the TOTAL ENERGY in the blood stream.

I am concerned that if people continue to enthusiastically zealously focus on pursuing higher blood ketones “through whatever means you can[24] in an effort to amplify fat loss they will promote excess energy in the bloodstream which will lead to insulin resistance and hyperinsulinemia.

Using multi-level marketing tactics to distribute therapeutic supplements to the uneducated masses who are desperate to lose weight with a ‘more is better’ approach also troubles me deeply.

My heart sank when I saw this video.

MORE investigation required?

There are anecdotal reports that exogenous ketones provide mental clarity, enhanced focus and athletic performance benefits.  At the same time, there are also people who have been taking these products for a while that don’t appear to be doing so well.

A July 2016 study Ketone Bodies and Exercise Performance: The Next Magic Bullet or Merely Hype? didn’t find that EXOGENOUS ketones to be very exciting.

Recently, ketone body supplements (ketone salts and esters) have emerged and may be used to rapidly increase ketone body availability, without the need to first adapt to a ketogenic diet. However, the extent to which ketone bodies regulate skeletal muscle bioenergetics and substrate metabolism during prolonged endurance-type exercise of varying intensity and duration remains unknown. Therefore, at present there are no data available to suggest that ingestion of ketone bodies during exercise improves athletes’ performance under conditions where evidence-based nutritional strategies are applied appropriately.

However, another study by Veech et al (who is trying to bring his own ketone ester to market) from August 2016 Nutritional Ketosis Alters Fuel Preference and Thereby Endurance Performance in Athletes found in favour of ketones.

Ketosis decreased muscle glycolysis and plasma lactate concentrations, while providing an alternative substrate for oxidative phosphorylation. Ketosis increased intramuscular triacylglycerol oxidation during exercise, even in the presence of normal muscle glycogen, co-ingested carbohydrate and elevated insulin. These findings may hold clues to greater human potential and a better understanding of fuel metabolism in health and disease.

I can understand how exogenous ketones could be beneficial for someone who is metabolically healthy and consuming a disciplined hypo-caloric nutrient dense diet. They would likely be able to auto regulate their appetite to easily offset the energy from the EXOGENOUS ketones with less food intake.

While it seems that EXOGENOUS ketones assist in relieving the symptoms of metabolic disorders I’m yet to be convinced that a someone who is obese and / or has Type 2 Diabetes would do as well in the long term, especially if they were hammering both more fat and exogenous ketones (along with maybe some sneaky processed carbs on the side) in an effort to get their blood ketones as higher in the hope of losing body fat.

Some questions that I couldn’t find addressed in the Pruvit FAQ that I think would be interesting to answer through a controlled study in the future are:

  1. What is the safe dose limit of EXOGENOUS ketones for a young child?  How would you adjust their maximum intake based on age and weight?
  2. IF EXOGENOUS ketones do have a long term weight loss effect what is the upper limit of intake of EXOGENOUS ketones to avoid stunting a child’s growth?
  3. Is there a difference in the way EXOGENOUS ketones are processed in someone is metabolically healthy versus someone who is very insulin resistant?
  4. Does the effect on appetite continue beyond the point that the ketones are out of your system?
  5. Do you need to take EXOGENOUS ketones continuously to maintain appetite suppression?  Does the effect of ENDOGENOUS wear off as your own ENDOGENOUS ketone production down regulates?  Do you need to keep taking more and more EXOGENOUS ketones to maintain healthy appetite control?
  6. How should someone with Type 2 Diabetes adjust their medication and insulin dose based on their dose of EXOGENOUS ketones?  Should they be under medical supervision during this period?
  7. Is there a difference in health outcome if you are taking EXOGENOUS ketones in the context of a hypocaloric ketogenic diet versus a hypercaloric ketogenic diet?  What about a diet high in processed carbs?
  8. Is there a minimum effective dose to achieve optimal long term benefits to your metabolic health or is MORE better?
  9. Are the long term health benefits of EXOGENOUS ketones equivalent to a calorie restricted ketogenic diet?

Unfortunately, I think we will find the answers to these questions sooner rather than later with the large scale experiment that now seems to be well underway.

Perhaps the burden of proof is actually on Pruvit to prove it rather getting their Pruvers to demonstrate that within 59 minutes they are successfully peeing out the product they’ve just paid some serious money for!

The lower the better?

Alessandro Ferretti recently made the observation that metabolically healthy people tend to have lower TOTAL ENERGY levels at rest (and hence have a lower HbA1c), but are able to quickly mobilize glycogen and fat easily when required (e.g. when fasting or a sprint).

Metabolically healthy people are both metabolically flexible[25] and metabolically efficient.[26]   These people would have been able to both conserve energy during a famine and run away from a tiger and live to become our ancestors, while the ones who couldn’t didn’t.

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Similar to RD Dikeman, John Halloran is an interesting case.  He has been putting a lot of effort into eating nutrient dense foods, intermittent fasting and high-intensity exercise.

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He is also committed to improving his metabolic fitness to be more competitive in ice hockey.  His resting heart rate is now a spectacular 45 bpm!

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And he’s been able to lose 10kg (22lb) in one month!

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At 5.2mmol/L (i.e. glucose of 4.0mmol/L plus ketones of 1.2mmol/L) John’s TOTAL ENERGY is well below the average of the 26 people shown in the glucose + ketone chart above.  It seems excellent metabolic health is actually characterised by lower TOTAL ENERGY.

MORE is not necessarily BETTER when it comes to health.

Fast well, feed well

To clean up the data a little I removed the ketones vs glucose data points for a couple of people who I thought might be suffering from pancreatic beta cell burnout and one person that was taking exogenous ketones during their fast that had a higher TOTAL ENERGY.  I also removed the top 30% of points that I thought were likely high due to measuring after high-fat meals or coffee.

So now the chart below represents the glucose and ketone values for a group of reasonably metabolically healthy people following a strict ketogenic dietary approach, excluding for the effect of high-fat meals, BPC, fat bombs and the like.

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The average ketone value for this group of healthy people trying to live a ketogenic lifestyle is 0.7mmol/L. Their average glucose is 4.8mmol/L (or 87mg/dL).  The average TOTAL ENERGY is 5.5mmol/L or 99mg/dL.

ketones (mmol/L)

blood glucose (mmol/L)

total energy (mmol/L)

average

0.7

4.8

5.5

30th percentile

0.4

4.6

5.2

70th percentile

0.9

5.1

5.8

The table below shows this in US units (mg/dL).

ketones
(mmol/L)

blood
glucose (mg/dL)

total
energy (mg/dL)

average

0.7

86

99

30th percentile

0.4

83

94

70th percentile

0.9

92

104

It seems we may not necessarily see really high ketone levels in our blood even if we follow a strict ketogenic diet, particularly if we are metabolically healthy and our body is using to ketones efficiently.

the real magic of ketones

When we deplete glucose we train our body to produce ketones.

This is where autophagy, increased NAD+ and SIRT1 kicks in to trigger mitochondrial biogenesis and ENDOGENOUS ketone production (i.e. the free ones).[27]   The REAL magic of ketosis happens when all these things happen and ketones are released as a byproduct.

I do not believe that simply adding EXOGENOUS ketones will have nearly as much benefit to your mitochondria, metabolism and insulin resistance as training your body to produce ENDOGENOUS ketones in a low energy state.

Everything improves when we train our bodies to do more with less (e.g. fasting, high-intensity exercise, or even better fasted HIIT).  Resistance to insulin will improve as your insulin receptors are no longer flooded with insulin caused by high TOTAL ENERGY building up in your bloodstream (i.e. from glucose, ketones and even free fatty acids).

image01

Driving up ketones artificially through EXOGENOUS inputs (treating the symptom) does NOT lead to increased metabolic health or mitochondrial biogenesis (cure) particularly if you are driving them higher than normal levels and not using them up with activity.

You may be able to artificially mimic the buzz that you would get when the body produces ketones ENDOGENOUSLY, however, it seems you may just be driving insulin resistance and hyperinsulinemia if you follow a “MORE is better” approach.

Simply managing symptoms with patented products for profit without addressing the underlying cause often doesn’t end well.

Perhaps as more exogenous products come to market without the marketing hype that that comes with multi level marketing (e.g. Julian Baker’s Insta Ketone which are a sixth of the price of the Pruvit products) people will get to see if they really do anything useful.

Just like having low blood glucose is not necessarily good if it is primarily caused by high levels of EXOGENOUS insulin coupled with a poor diet or having lower cholesterol due to statins, having high blood ketone values is not necessarily a good thing if it is achieved it by driving up the TOTAL ENERGY in your blood stream with high levels of purified fat and/or EXOGENOUS ketones.

nutrient density

When we feed our body with quality nutrients we maximise ATP production which will make us feel energised and satisfied.  Nutrient dense foods will nourish our mitochondria and reduce our drive to keep on seeking out nutrients from more food.

Greater metabolic efficiency will lead to higher satiety, which leads to less food intake, which leads to a lower TOTAL ENERGY, increased mitochondrial biogenesis, improved insulin sensitivity and lower blood glucose levels.

Prioritising nutrient dense real food is even more important in a ketogenic context.[28]  While we can always take supplements, separating nutrients from our energy source is never a great idea, whether it be soda, processed grains, sugar, glucose gels, HFCS, protein powders, processed oils or exogenous ketones.

the best exogenous ketone supplement

If your goal is metabolic health, weight loss and improving your ability to produce ENDOGENOUS ketones, then developing a practice of FEASTING and FASTING is important.

To start out, experiment by extending your fasting periods until your TOTAL ENERGY is decreasing over time.  This will cause your circulating insulin levels to decrease which will force your body to produce ENDOGENOUS ketones from your ENDOGENOUS fat stores.

best exogenous ketone supplement

Check out the how to use your glucose meter as a fuel gauge article or how to use your bathroom scale as a fuel gauge for some more ideas on how to get started with fasting.

If you want to measure something, see how low you can get your glucose levels before your next meal.  Then when you do eat, make sure you choose the most nutrient dense foods you possibly can to build your metabolic machinery and give your mitochondria the best chance of supporting a vibrant, active and happy life.

As my wise friend Raymund Edwards keeps reminding me, FAST WELL, FEED WELL.

 

 

references

[1] http://www.thefatemperor.com/blog/2015/5/6/the-incredible-dr-joseph-kraft-his-work-on-type-2-diabetes-insulin-reigns-disease

[2] http://www.thefatemperor.com/blog/2015/5/10/lchf-the-genius-of-dr-joseph-r-kraft-exposing-the-true-extent-of-diabetes

[3] https://profgrant.com/2013/08/16/joseph-kraft-why-hyperinsulinemia-matters/

[4] https://www.amazon.com/Diabetes-Epidemic-You-Joseph-Kraft/dp/1425168094

[5] https://www.youtube.com/watch?v=193BP6aORwY

[6] http://fourhourworkweek.com/2016/07/06/dom-dagostino-part-2/

[7] http://www.thelivinlowcarbshow.com/shownotes/10568/848-dr-dominic-dagostino-keto-clarity-expert-interview/

[8] http://superhumanradio.com/579-shr-exclusive-patrick-arnold-back-in-the-supplement-business.html

[9] http://superhumanradio.com/shr-1330-best-practices-for-using-ketone-salts-for-dieting-performance-and-therapeutic-purposes.html

[10] http://docmuscles.shopketo.com/

[11] https://www.facebook.com/groups/optimisingnutrition/permalink/1574631349504574/

[12] https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-016-0069-y

[13] https://www.facebook.com/groups/optimisingnutrition/permalink/1574631349504574/

[14] https://www.dropbox.com/s/287bftreipfpf29/jcinvest00459-0078.pdf?dl=0

[15] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2129159/

[16] https://www.facebook.com/BurnFatNotSugar/

[17] http://www.dietdoctor.com/obesity-caused-much-insulin

[18] http://www.lowcarbcruiseinfo.com/2016/2016-presentations/Hyperinsulinemia.pptx

[19] http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0115147

[20] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1819381/

[21] http://healthimpactnews.com/2013/ketogenic-diet-in-combination-with-calorie-restriction-and-hyperbaric-treatment-offer-new-hope-in-quest-for-non-toxic-cancer-treatment/

[22] https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjK8Jvku7DOAhUJspQKHS5-DkwQFggbMAA&url=http%3A%2F%2Fwww.rsg1foundation.com%2Fdocs%2Fpatient-resources%2FThe%2520Restricted%2520Ketogenic%2520Diet%2520An%2520Alternative.pdf&usg=AFQjCNFuTA7xmWX1pFr6wBTV_hsS7C5j_w&sig2=pcBN_f_kCLSgFKYUy–uug&bvm=bv.129391328,d.dGo

[23] https://www.facebook.com/DocMuscles/videos/10210426555960535/?comment_id=10210431467003308&comment_tracking=%7B%22tn%22%3A%22R9%22%7D&pnref=story&hc_location=ufi

[24] https://www.facebook.com/DocMuscles/videos/10210426555960535/?comment_id=10210431467003308&comment_tracking=%7B%22tn%22%3A%22R4%22%7D&hc_location=ufi

[25] http://guruperformance.com/episode-3-metabolic-flexibility-with-mike-t-nelson-phd/

[26] http://guruperformance.com/tag/metabolic-efficiency/

[27] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852209/

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

 

post last updated: July 2017

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]

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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

foods to avoid… the most processed, insulinogenic, energy dense low nutrient density foods

What are the most insulinogenic, low nutrient density and energy dense processed foods that everyone should avoid for heath and weight loss?

Generally I think it can be more useful to tell people what they should focus on rather than what they shouldn’t do.  It’s like the proverbial hot plate or ‘wet paint’ sign.  You can’t unsee it and you just want to touch it!

If you are busy focusing on the good stuff then you just won’t have any space left for the low nutrient density foods, especially once you start feeling  the benefits.

Rcdg9G6oi[1]

Many people are coming to see sugar as universally bad news.  But why sugar?  Are there other foods that we should avoid for the same reasons?

what’s so bad about sugar anyway?

For the past four decades mainstream food recommendations have been dominated by a fear of fat, particularly saturated fat and cholesterol, which if, taken to the extreme can lead us towards more processed, insulinogenic, nutrient poor, low fat foods.

More recently, a growing number of people are advising that we should eat less sugar… from Sarah Wilson’s I Quit Sugar, to Robert Lustig’s Sugar: The Bitter Truth and Damon Gameau’s That Sugar Film.  Even Gary Taubes seems to be softening his stance against carbohydrates and turning his attention to sugar as the bad guy in his new book The Case against Sugar.

The World Health Organisation are imploring people to reduce their sugar intake to less than 10% of energy, and ideally less than 5%.[1]

Image result for world health organisation

Investment bank Credit Suisse is predicting a turn away from sugar and and back towards fat, effectively advising people to ‘short sugar’.[2]

But what is it about sugar that makes it uniquely bad?  It just the ‘evaporated cane juice’ that we should avoid?

What about whole foods that contain some sugar?  Should we avoid them too?

image00

While added sugars are not good, they’re also an easy target that everyone can get behind.  It’s easy to swing from demonising one thing to another, from fat to carbs, to sugar.

But perhaps this paradigm is overly simplistic?

I think we need to avoid are foods that quickly boost insulin and blood glucose levels without providing any substantial nutrition in return.

Foods that should be considered universally bad are foods that are:

If you want to maximise the nutritional value of your food, give your pancreas a break so it can keep up, you should AVOID THESE FOODS.  Most diet recommendations succeed largely because they eliminate these foods which are typically processed foods.

The chart below (click to enlarge) shows the weightings used in the multi criteria analysis for the various dietary approaches.  The avoid list turns the system on its head to identify foods that have poor nutrient density as well as also being energy dense and insulinogenic.

2016-10-21-3

The charts below shows that, compared to the other approaches, the foods on the avoid list are energy dense…

2016-10-20-1

…highly insulinogenic…

2016-10-20-9

…as well as being nutrient poor, all at the same time!

2016-10-16-4

Considering any of these factors by themselves can be problematic.  But when we combine all these parameters them they  can be much more useful to identify the foods we should avoid, as well as the ones we should prioritise.

As you can see from this chart, the difference between the nutrients provided by the most nutrient dense foods and the avoid list  is vast!  You can see how you would be much more satiated with the more nutrient dense food and your cravings turned off.

2016-10-20-4

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

So without further ado, here is the avoid list.

drinks

Soft drinks provide very little nutritional value, are very insulinogenic and have no fibre so will raise your blood sugar and insulin levels quickly.

image02

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
cream soda -20 100% 13 51 1.02
root beer -20 100% 11 41 1.00
grape soda -19 100% 11 43 1.00
cola -20 99% 10 37 1.00
cranberry-apple juice -19 98% 16 63 0.98
orange and apricot juice -17 97% 13 51 0.86

sweets

Sweets provide minimal nutrition while being very energy dense and highly insulinogenic.  Sugar tops the list of badness, however there are a bunch of other sweets not far behind.

image06

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
candies -20 100% 99 394 1.34
sugar -20 100% 100 389 1.33
jellybeans -20 100% 93 375 1.31
fructose -20 100% 100 368 1.31
brown sugar -19 99% 97 380 1.29
sucralose -20 100% 91 336 1.29
fruit syrup -20 100% 85 341 1.28
skittles -20 90% 91 405 1.28
aspartame -19 99% 91 365 1.24
twizzlers -20 93% 81 348 1.24
marshmallows -19 99% 83 318 1.24
high fructose corn syrup -20 100% 76 281 1.23
maple sugar -18 99% 91 354 1.21
jams and preserves -19 98% 68 278 1.17
orange marmalade -19 99% 66 246 1.17
chocolate frosting. -18 86% 91 389 1.16
chocolate pudding -18 91% 86 378 1.16
Candies, butterscotch -17 92% 90 391 1.15
M&Ms -20 61% 73 475 1.14
tootsie roll -17 91% 89 387 1.13
Milky Way -20 61% 70 463 1.13
chocolate syrup -18 100% 67 269 1.12
butterscotch topping -18 99% 58 216 1.08
Kit Kat -19 49% 65 520 1.08
frosting -18 65% 68 418 1.04
fudge -15 87% 83 383 1.01
honey -19 63% 52 304 0.99
caramels -15 81% 80 382 0.98
tapioca pudding (fat free) -18 94% 22 94 0.91
chocolate frosting -16 61% 63 397 0.90
Twix -16 41% 57 550 0.88

fruits and fruit juices

Fruit in its natural state provides fibre, nutrients with a lower energy density.  However fruit juice and dried fruit has a much lower nutritional value and are much more insulinogenic.

image04

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
candied fruit -20 98% 81 322 1.25
dried apples -17 85% 82 346 1.04
raisins -17 89% 73 296 1.03
dried pears -16 87% 64 262 0.96
dried currants -16 88% 70 283 0.95
apple juice -17 97% 12 47 0.88
litchis -14 89% 69 277 0.87
dried pears -17 83% 32 140 0.86

cereals and baked products

Processed grains are cheap and have a long shelf life, however the processing removes most of the fibre and most of the nutrients which means they are highly insulinogenic and energy dense.

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
corn-starch -20 99% 91 381 1.31
rice puffs -17 93% 90 383 1.13
instant oatmeal -19 70% 68 353 1.06
fudge filled cookies -19 47% 63 533 1.06
girl scout cookies -19 51% 66 520 1.06
Grahams Crackers -17 73% 77 424 1.05
choc chip cookies -18 55% 69 498 1.04
cheesecake -19 49% 63 506 1.04
white flour -15 92% 82 367 1.04
white rice -15 95% 84 365 1.02
water biscuits -17 73% 70 384 1.01
rice flour -15 92% 82 366 1.00
wheat flour -14 91% 81 363 0.96
ice cream cones -13 88% 89 402 0.94
pound cake (fat free) -14 93% 64 283 0.90
Cookies -15 76% 69 348 0.90
cornmeal -13 89% 81 370 0.90
fruitcake -16 71% 60 324 0.88
white flour -12 92% 82 366 0.88
English muffins -16 83% 51 245 0.87

other approaches

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

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

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

image02

post updated May 2017

references

[1] http://www.who.int/mediacentre/news/releases/2015/sugar-guideline/en/

[2] https://www.credit-suisse.com/us/en/articles/articles/news-and-expertise/2013/09/en/is-sugar-turning-the-economy-sour.html

superfoods for diabetes & nutritional ketosis

These foods will help you to maintain excellent blood glucose levels by reducing the insulin load of your diet while at the same time maximising nutrient density to minimise cravings and allow you to get the nutrients you need with less food.

More than carbohydrates or the glycemic index, the food insulin index data suggests that our blood glucose and insulin response to food is better predicted by net carbohydrates plus about half the protein we eat.

There is a relationship between carbohydrate and our insulin response to the food we eat, but it is not that strong, particularly when it comes to high protein foods or high fibre foods.

insulin response to carbohydrate from the food insulin index testing

Accounting for fibre and protein enables us to more accurately predict the amount of insulin that will be required to metabolise a particular food.  This knowledge can be useful for someone with diabetes and/or a person who is insulin resistant to help them calculate their insulin dosage or to choose foods that will require less insulin.  People wanting to follow a ketogenic diet will want to select foods towards the bottom corner of this chart.

insulin response to food = net carbs + 0.56 * protein

If your blood glucose levels are high you are likely insulin resistant (e.g.  type 2 diabetes) or not able to produce enough insulin (e.g. type 1 diabetes) it makes sense to reduce the insulin load of your food so your pancreas can keep up.

This list of foods has been optimised to reduce the insulin load while also maximising nutrient density.  These low insulin load, high nutrient density foods will lead to improved blood sugar control and normalised insulin levels.  Reduced insulin levels will allow body fat to be released and be used for energy to improve body composition and insulin resistance.

As shown in the chart below this selection of foods is also nutrient dense and provides a substantially greater amount of nutrients compared to the average of all foods available.

2017-02-27 (2).png

From a macronutrient perspective, these foods have a similar protein content to the rest of the foods in the USDA database, more fibre but much less digestible non-fibre carbohydrate.  And the carbohydrates that are there come from nutrient dense veggies that are hard to overconsume compared to the processed nutrient poor carbs that are typically causing the issues for people.

2017-02-27 (3).png

Included in the tables are the nutrient density score, percentage of insulinogenic calories, insulin load, energy density and the multicriteria analysis score (MCA) that combines all these factors.  Why not use these lists to inspire your next trip to the grocery store?

vegetables and fruit

image19

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
endive 17 23% 1 17 1.9
chicory greens 15 23% 2 23 1.8
alfalfa 12 19% 1 23 1.7
escarole 14 24% 1 19 1.7
coriander 14 30% 2 23 1.6
spinach 19 49% 4 23 1.3
curry powder 5 13% 14 325 1.3
beet greens 12 35% 2 22 1.3
basil 18 47% 3 23 1.3
zucchini 14 40% 2 17 1.3
asparagus 17 50% 3 22 1.2
paprika 8 27% 26 282 1.2
mustard greens 8 36% 3 27 1.1
parsley 14 48% 5 36 1.1
turnip greens 12 44% 4 29 1.1
banana pepper 7 36% 3 27 1.0
collards 8 37% 4 33 1.0
arugula 12 45% 3 25 1.0
lettuce 14 50% 2 15 1.0
chard 14 51% 3 19 1.0
eggplant 5 35% 3 25 1.0
pickles 8 39% 1 12 1.0
cucumber 8 39% 1 12 1.0
okra 13 50% 3 22 1.0
summer squash 10 45% 2 19 1.0
sage 4 26% 26 315 0.9
poppy seeds 1 17% 23 525 0.9
Chinese cabbage 14 54% 2 12 0.9
watercress 20 65% 2 11 0.9
chives 12 48% 4 30 0.9
broccoli 13 50% 5 35 0.9
edamame 8 41% 13 121 0.9
sauerkraut 6 39% 2 19 0.9
jalapeno peppers 4 37% 3 27 0.9
cloves 6 35% 35 274 0.9
cauliflower 11 50% 4 25 0.9
marjoram 4 31% 27 271 0.9
caraway seed 3 27% 28 333 0.8
thyme 5 34% 31 276 0.8
red peppers 6 40% 3 31 0.8
radishes 7 43% 2 16 0.8
celery 10 50% 3 18 0.8
portabella mushrooms 12 55% 5 29 0.8

eggs and dairy