Category Archives: nutrient density

How optimize your diet for your insulin resistance

Lately I’ve seen a number of common themes come up at low carb conferences and online.  The contentious questions tend to run along the lines of:

  1. I did really well on a low carb diet initially, but my fat loss seems to have stalled. What gives?  What should I do now?
  2. If protein is insulinogenic should I actively avoid protein as well as carbs if my goal is to reduce insulin because low insulin = weight loss?
  3. If eating more fat helped kick start my weight loss journey, then why does eating more fat seem to make me gain weight now?

This article outlines some quantitative parameters around these contentious questions and helps you chose the most appropriate nutritional approach.

The importance of monitoring blood glucose levels

Coming from a diabetes headspace, I’ve seen firsthand the power of a low carb diet in reducing blood glucose and insulin levels.  As a Type 1 Diabetic, my wife Moni has been above to halve her insulin dose with a massive improvement in energy levels, body composition and mood.

If your blood glucose levels are high, then chances are your insulin levels are also high.  Insulin is the hormonal “switch” that causes us to store excess energy as body fat in times of plenty.[1]  Lower levels of insulin in times of food scarcity then enable us to access to the stored energy on our body.[2]

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It makes sense to actively manage the fat storing insulin switch by proactively managing the insulin load of the food we eat.  The chart below shows that our glucose response is fairly well predicted by the carbohydrates we eat.  (note: The “glucose score” is the area under the curve of glucose response to various foods tested over the three hours relative to glucose which gets a score of 100%.) [3] [4]

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Having high blood glucose levels is bad news.[5]  The chart below shows the correlation between HbA1c (a measure of your average glucose levels over three months) and the diseases that will kill most of us, cardiovascular disease, coronary heart disease and stroke.[6]  It makes a lot of sense to do whatever it takes to reduce our blood glucose to the levels of a metabolically healthy person to postpone the major diseases of aging.

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Optimal ketone levels

Ketones in our blood rise when our insulin levels are low.[7]  As shown in the chart below, even better than carbohydrates, insulin levels are better predicted by the net carbohydrates plus about half the protein we eat.[8] [9]

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You may have seen this ‘optimal ketone zone’ chart from Volek and Phinney’s ‘Art and Science of Low Carb Living’.

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The problem however with this chart is that it is difficult for most people to achieve “optimal ketone levels” (i.e. 1.5 to 3.0mmol/L) without fasting for a number of days or making a special effort to eat a lot of additional dietary fat (which may be counterproductive in the long run if you’re trying to lose weight).

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Recently I had the privilege of having Steve Phinney stay at our house when he spoke at a Low Carb Down Under event in Brisbane (btw, he’s also a passionate cook if you let him lose in the kitchen).  I quizzed Steve about the background to his optimal ketosis chart.  He said it was based on two studies, one with cyclists who the adapted to ketosis over a period of six weeks and another ketogenic weight loss study.  In both cases these ‘optimal ketone levels’ (i.e. between 1.5 to 3.0mmol/L) were observed in people who were transitioning into a state of nutritional ketosis.

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Since the publication of this chart in the Art and Science books, Phinney has noted that well trained athletes who are long term fat adapted (e.g. the low carb athletes in the FASTER study[10]) actually show lower levels of ketones than might be expected.  It appears that over time many people, particularly athletes, move beyond simple keto adaption and are able to utilise fat as fuel even more efficiently and their ketone levels reduce further.

Metabolically flexible people are able to access and burn fat efficiently and hence only release free fatty acids or ketones into the bloodstream when they need the energy.  If you’re metabolically healthy and can call on your fat stores as required there’s no need to be walking around with super high levels of glucose or ketones.

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If you’ve been following a ketogenic diet for a while and / or are metabolically healthy then your ketone levels may not be as high as you might expect from looking at Volek and Phinney’s “optimal ketone zone” chart.

And as discussed in my Alkaline Diet vs Acidic Ketones article, higher ketone levels could even be an indication that you have some level of metabolic acidosis.  People with untreated Type 1 Diabetes have very high ketone as well as blood glucose levels at the same time (i.e. ketoacidosis).

Phinney says he does not condone the “adolescent behaviour” of competing to see how high you can get your ketone levels and warns that you can risk loss of lean body mass by chasing high ketone levels with an inappropriately low insulin load approach (i.e. very low carb and very low protein).[11]

People with higher NAD+ levels (an important coenzyme which declines with aging[12]) and lower NADH levels are more likely to produce more breath acetone (which can be measured with the Ketonix) and less BHB ketones in the blood.   Hence, higher consistent levels of breath acetone may be a more useful indication than blood ketones that you are burning fat rather than just eating fat.[13]

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“The ratio of β-OHB to AcAc depends on the NADH/NAD+ ratio inside mitochondria; if NADH concentration is high, the liver releases a higher proportion of β-OHB.”[14]

While I think it’s good to have some ketones in the blood as an indication that your insulin levels aren’t too high, it can be hard to interpret what high or low level of blood ketones mean.

As noted in Peter Attia’s Fat Flux article, the BHB ketones you measure in your blood is a function of:

  • the dietary fat that you’re eating,
  • plus the fat being liberated from your body fat (lipolysis),
  • minus the BHB being used by your muscles, heart and brain.

High blood ketones could mean that your insulin levels are low and your level of lipolysis is high (i.e. lots of fat is being released from your body).  In this case, high ketones are an indicator of metabolic health and may facilitate healthy appetite regulation and enable you to burn your stored body fat.

However, high blood ketone levels could also mean that you are eating a lot of dietary fat (or consuming a lot exogenous ketones) and your body isn’t well adapted to using ketones for fuel and hence unused ketones are building up in your blood stream.  If this is the case, then loading up with more dietary fat in the pursuit of higher ketone levels may cause you to become more insulin resistant and inflamed as your ketone levels rise but the fat is not yet able to be efficiently oxidised for fuel.

The plot below shows a compilation of glucose and ketone values from a range of people following a low carb or “ketogenic” diet.  It seems that the most metabolically healthy people have low blood glucose levels and moderate ketones at rest, however they can easily access plenty of glucose and fat from the body when required.

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It makes sense to me from an evolutionary perspective that someone who is healthy would be able to conserve energy when not active (i.e. hiding in a cave) but then be able to quickly access stored energy when required (i.e. when being chased by a sabre-toothed tiger).  The body doesn’t always need super high blood ketone levels and hence we secrete insulin to remove both glucose and ketones back into storage.

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The exception to this seems to be in periods of extended fasting when the body is on high alert and we are in a super-fuelled state ready to chase down some food at a moment’s notice.

So, unless you’re fasting or exercising intensely, it seems that having a lower total energy (i.e. blood glucose plus blood ketones) might be a better place to be rather than having super high ketone levels.

There is also interesting emerging research suggesting that as we become more fat adapted we can obtain more fuel from fat and hence do not need to rely on ketones which are more of an emergency fuel source during starvation.  It’s as if, just like in time we no longer measure high ketones in the urine as we utilise them better, we also start to show less ketones in the blood.  Quoting my friend Mike Julian:

I think we become less ketogenic with further adaptation simply because as we improve our ability to utilize the fat we create spin off glucose from both glycerol and acetone that goes to restore beta oxidation of fatty acids.

The spin of glucose provides oxaloacetate and restores Krebs function in the liver and reduces ketogenesis in favour of complete oxidation of acetyl-CoA. In short, ketogenesis is a transitional state, not the end goal.

Ketones will be lower if you’re fit.  Even Phinney has said that very adapted individuals are in ketosis starting at 0.3mmol.  Look at how robust the GNG is in the low carb guys in the FASTER study. It is a direct result of the nearly doubled rate of fat oxidation.

All of the glycerol when fat is oxidised has to go somewhere and it is used to make glucose. This glucose is then used to restore the Krebs cycle which means that the can make even better use of fat etc, but reduces GNG via traditional means and in turn reduces ketogenesis.

It’s a system that feeds into itself.  The better fat burner you are, the more glucose you make from fat, the better you are at fat burning and so on.

As we get better at fat utilisation we also get better at deriving glucose from fat metabolism. This source of glucose reduces the need for ketogenesis.[15] [16]

So overall, measuring blood ketones is intriguing, but not always the most reliable measure of where your metabolic health status.  Moreover, eating more dietary fat in an effort to raise your blood ketone levels is no guarantee that you’re going to lose body fat.[17]

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You may be “ketogenic” in that you are able to generate ketones, though they may not necessarily show up in high levels in the blood if you are also athletic and able to use your blood glucose and ketones effectively for energy.

The relationship between ketones and glucose

The chart below shows the generalised relationship between blood glucose and blood ketones for different people with:

  • Type 2 Diabetes,
  • Pre-diabetes,
  • Mild insulin resistance, and
  • someone who is metabolically healthy.

(note: Someone with uncontrolled Type 1 Diabetes would be literally ‘off the chart’ with high blood glucose and high blood ketones.)

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The table below shows the HbA1c incident rates for cardiovascular disease, stroke and coronary heart disease from the chart above to average blood glucose levels and the corresponding ketone levels and glucose : ketone index values.   This gives us a useful understanding of what different HbA1c risk levels look like in terms of average blood glucose levels, ketones and the glucose : ketone index.

metabolic health level HbA1c average blood glucose ketones GKI
 (%)  (mmol/L)  (mg/dL)  (mmol/L)
low normal 4.1 3.9 70 2.1 1.9
optimal 4.5 4.6 83 1.3 3.5
excellent < 5.0 < 5.4 < 97 > 0.5 11
good < 5.4 < 6 < 108 < 0.3 30
danger zone > 6.5 7.8 > 140 < 0.3 39

While it can be interesting to measure ketones, as a general rule, if you have consistently high blood glucose levels you are likely to be insulin resistant and hence will benefit from a higher fat dietary approach.

If you have high insulin and glucose levels, when transitioning to a high fat diet your glucose and insulin levels will likely plummet to be closer to the levels of a metabolically healthy person and suddenly you will be able to access your body fat stores for fuel.  You might quickly find yourself losing weight like it was magic and you’ll think the keto diet is the best thing ever!  Amazingly, lots of people find that they can “eat fat to satiety” and still lose weight (at least during this initial stage).

For the last four decades we’ve been told to avoid fat, particularly saturated fat.  Imagine the excitement, enthusiasm, and maybe even anger, when someone who has been avoiding fat finds that they suddenly start losing weight when the do the opposite to what they’ve been told to do!

But it works until it doesn’t

The problem with adding more dietary fat is that it works until it doesn’t.

Let’s say (based on the levels of metabolic health in the table above) you are able to successfully “level up” from the “danger zone” though “good” blood glucose control to “excellent” blood glucose levels with a high fat dietary approach, but then your weight loss slows and then stops well short of your optimal body fat levels.

What gives?

What do you do now?

Do you listen to the people who say you should eat more fat or the people who say you should eat less fat?

It can be confusing on the interwebs!

I think the answer depends largely on whether you are insulin resistant or insulin sensitive.  You should ‘level up’ to the most nutrient dense nutritional approach that your current level of insulin sensitivity allows.

It’s worth noting that while many people can achieve ‘excellent’ blood glucose levels through dietary manipulation, the people that I’ve seen get to truly optimal blood glucose control tend to be working hard with both their nutrition and training to maximise their lean body mass.

What is insulin resistance anyway?

In order to understand what we need to do when we stop losing weight on keto I think it’s important to understand what causes insulin resistance.

Many people think that people who are fat are simply insulin resistant.  This is partly true.   However, while insulin resistance and obesity are related, it’s not quite that simple.  It’s useful to understand the difference.

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A metabolically flexible insulin sensitive person stores excess energy eaten for later use in the fat stores on the body (i.e. adipose tissue).  When they stop eating, someone who is insulin sensitive will experience a drop in blood glucose and insulin levels and stored body fat will be released.   For the lucky people who are insulin sensitive, calories in calories out (CICO) largely works as advertised.  They find it difficult to depart far from a healthy set point weight without a change in diet quality or insulin load.

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However, as we keep eating more and more low nutrient density foods to obtain the micronutrients we need, we get to a point where the adipose tissue can no longer hold all that excess energy and starts to channel it into the organs because the fat stores are full.

The body knows that this isn’t such a great idea though because our vital organs are, well, vital, so the body becomes insulin resistant as a defence mechanism to avoid damage to vital organs, and hence the levels of sugar in our blood rise to avoid storing the extra energy in the organs.   The body even starts dumping the excess sugar into the urine to avoid having to pump it into the liver, pancreas, eyes and brain.

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The a of the major problems with insulin resistance is appetite dysregulation.  That is, when you are insulin resistant your insulin levels stay higher for longer which then makes it harder for you to access your body fat for fuel between meals.   As shown in this chart, if your blood glucose levels are high the release of fat from your body (ketones) will be low, ghrelin will kick in[18], and it will be hard to go very long without food.  Your appetite will be more likely to win out over your willpower and thus make it hard to lose weight if your insulin levels are high.

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Eating “low carb” or “keto” enables us to lower insulin levels to the point that our appetite works more in line with the way it’s meant to when we were metabolically healthy / insulin sensitive / metabolically flexible.  Our appetite drives us to seek out nutrients and energy when required and stop when we have had enough.   (note: keep in mind though that lower insulin levels are due to eating a lower dietary insulin load, not necessarily due to more dietary fat.)

Once our appetite is restored and we can more easily access our own body fat I think we need to change focus, especially if adding more fat isn’t moving you toward your weight loss goals.

Be a nutrient chaser

Once your blood glucose levels are normalised but you’re stuck on a plateau and not sure where to turn I think it’s a good idea to turn your focus to chasing nutrients rather than ketones or even worrying about blood glucose levels quite so much.

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As your blood glucose and insulin levels decrease, you should be able to release more body fat stores and hence have less need for dietary fat.  When we focus on balancing micronutrients macronutrients largely look after themselves.

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As well as adequate energy, the body works hard to make sure it gets the nutrients it needs to thrive.  The vitamins and minerals that come with whole foods are like the spark that ignites the fuel they contain.[19]  We always get ourselves into trouble when we separate nutrients from energy.  While refined sugars and grains are particularly problematic because they spike insulin, neither refined sugars or purified fats contain the same level of nutrients necessary to power our mitochondria that whole foods do.

The problem comes when we eat nutrient poor foods.  We are left with a residual need for nutrients that are required to convert our food into energy (ATP).  Our appetite will drive us to seek out more food to obtain the required nutrients.

“Added sugars displace nutritionally superior foods from the diet and at the same time increase nutritional requirements. Specifically, vitamins such as thiamine, riboflavin and niacin are necessary for the oxidation of glucose, and phosphates are stripped from ATP in order to metabolise fructose, which leads to cellular ATP depletion. The metabolism of fructose also leads to oxidative stress, inflammation and damage to the mitochondria, causing a state of ATP depletion. Hence, the liberation of calories from added sugars requires nutrients, and increases nutritional demands, but these sugars provide no additional nutrients. Thus, the more added sugars one consumes, the more nutritionally depleted one may become. This may be particularly extreme in individuals whose habitual diet is already lacking in key micronutrients.”[20]

“A nourishing, balanced diet that provides all the required nutrients in the right proportions is the key to minimising appetite and eliminating hunger at minimal caloric intake.”[21]

“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.”[22]

If we don’t get enough amino acids to prevent loss of lean muscle mass the body will also up-regulate appetite (i.e. protein leverage hypothesis).[23] [24]   While we can track our food intake to try to actively manage our energy intake, in the end, appetite, driven by the body’s need for nutrients, tends to win out.

Even if we are successful in limiting our intake, our body senses an energy crisis and slows down to make sure it has enough energy and stored fat to run our inefficient metabolism.  However, when we consume whole foods with a higher nutrient density our appetite tends to be satisfied with less energy because it can run more efficiently with an optimal balance of the nutrients it needs.[25]

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If we want to lose weight we need to find a way to provide the body with the nutrients it needs to function optimally with the minimum amount of energy intake while still maintaining low enough blood glucose and insulin levels to allow energy to flow out of our fat stores. 

Ask the experts

There was an interesting panel discussion in Episode 1161 of Jimmy Moore’s Livin La Vida Low Carb Show “Q&A Medical Panel – 2016 Low Carb Cruise” where someone asked:

LCHF says calories don’t matter.  But I still gain weight even when in ketosis.  What’s up with that?

There was a range of responses from the panel of medical doctors, not all in agreement, but my favourite answer was from Dr Ted Naiman (pictured below on the cruise) who said:

I have tons of patients who absolutely plateau out on this diet.   Everyone who goes on LCHF loses a ton of weight, and then hits a plateau.  This is extremely common.  Almost universal.  

If you eat enough fat, the flow of fat into your adipose sites will equal the flow of fat out of your adipose sites and you’re just going to plateau. 

My number one priority is nutrient density.  Eat less fat bombs and instead eat the highest nutrient density foods you possibly can and then more of the fat that you’re burning comes from your internal body stores. 

I recommend really high fat diets for people who are really glucose dependent to help them get fat adapted.  Then, once you have reached your ideal body weight you have to eat a high fat diet then as well because you’re burning fat.  But there is a period in the middle when you’re plateaued when you do want to eat less fat because you want your fat to come off stored body fat.  

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Are you really insulin resistant?

I think the critical question here is whether you are really insulin resistant.  The most useful measure is simply to test your blood glucose levels.

If you have been diagnosed with diabetes, then you will have a glucose meter and you’ll be able to easily test your blood glucose levels to know where you’re at.  Glucometers are fairly cheap to purchase and often come with a rebate.

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There are many people who are fatter than they want to be but still have reasonable insulin sensitivity and normal blood glucose.  For these people, eating more fat doesn’t always get them where they want to be.[26] [27]

At the same time, many skinny people are actually insulin resistant (TOFI).  It of depends on how much energy your belly is willing to store before it starts pumping the excess fat into your vital organs.

The irony here is that you may look healthier if you are skinny, but it may mean that your adipose tissue is able to store less energy before it transitions to start storing excess energy in your vital organs.

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For those of you that don’t like testing your blood glucose level I have outlined a number of other ways to determine whether you are actually insulin resistant.  This understanding can then be used to understand whether you may need more or less dietary fat.

Oral glucose tolerance test

An Oral Glucose Tolerance Test (OGTT) is the generally accepted medical test for insulin resistance and diabetes.  An OGTT measures someone’s rise in blood glucose in response to a large amount of ingested glucose.   If it goes up too much after a standard amount of glucose then you are deemed to be insulin resistant.

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The problem is most people following a low carb approach will likely fail an OGTT because of physiological insulin resistance.  Someone following a low carb diet won’t have a lot of insulin circulating in their body, so when they ingest a large amount of fast acting glucose their pancreas will respond from a “standing start” and has to pump out a lot of insulin to respond to the glucose.  The glucose levels of someone following a low carb dietary approach may rise quite a lot before the pancreas can catch up.

By comparison, someone eating more carbohydrates would have higher levels of insulin circulating that will act on the glucose as soon as it was ingested with only a little bit of extra insulin needing to be secreted in response to the food and hence the glucose response would be lower.

Kraft test

A Kraft Insulin Assay, which measures insulin response over time to a certain amount of glucose, will give you an accurate idea of whether you’re insulin resistant, however these tests are expensive and fairly hard to obtain.  A Kraft Test might be a useful way to see if your are becoming insulin resistant even if your glucose levels are keeping up, for now.

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Oral protein tolerance test

Whether or not your blood glucose levels rise or decrease in response to a high protein meal with no carbohydrate is also a useful way to understand if you are insulin resistant.

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Someone who is metabolically healthy will release glucagon and insulin in response to protein as it is metabolised to maintain a stable glucose level.[28]  Someone who is insulin resistant may not produce adequate insulin to counteract the glucagon released by the liver and hence they may see their blood glucose levels rise.

If you find your glucose levels do rise significantly response to protein, it may be a sign that you need to slow down a little on the protein (or at least limit processed protein powders and opt for whole food sources of protein which are harder to overeat).

Realistically though, unless you’re severely insulin resistant, have Type 1 Diabetes or are using therapeutic ketosis to manage a chronic health condition such as cancer, epilepsy, alzheimers or dementia, most people don’t need to micromanage their protein intake if they are eating a range of unprocessed whole foods.

Your ability to handle protein may improve with time as your insulin resistance improves or you build a bit more muscle mass.  Actively avoiding protein to minimise insulin may be counterproductive in the long term if it leads to loss of lean body mass.

Optimal dietary approach survey

While testing blood glucose is a pretty good indicator of your insulin resistance status, there are a number of reasons that you may not want to test, including:

  • you don’t yet own a blood glucose meter,
  • you don’t like the sight of your own blood, or
  • test strips can be expensive, especially if not covered by insurance.

Beyond testing your blood glucose and / or ketone levels, there are a wide range of other indicators that you may be insulin resistant and may need a higher fat dietary approach.   I have prepared this multiple choice survey to help people better understand which dietary approach might be ideal for them based on their situation and goals.

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You may be insulin resistant and / or benefit from a higher fat diet if you answer yes to most of these of these questions.[29]   If you answer no to most of these questions then you may do better if you focus on nutrient dense foods rather than more fat.

  1. Do you have a chronic health condition such as cancer, epilepsy, dementia, Alzheimer’s, Parkinson’s, severe insulin resistance or traumatic brain injury?
  2. Have you been diagnosed with diabetes?
  3. Is your HbA1c greater than 6.4%?
  4. Is your fasting glucose greater than 7.0 mmol/L?
  5. Is your post meal glucose level greater than 11.0mmol/L or 200 mg/dL?
  6. Is your triglyceride : HDL ratio greater than 3.0?
  7. Are your triglycerides greater than 1.1mmol/L or 100mg/dL?
  8. Are your blood ketone levels less than 0.3mmol/L?
  9. Is your fasting insulin greater than 20 uIU/mL or 120 pmol/L?
  10. Is your C-reactive protein greater than 1.0 mg/dL?
  11. Does your blood glucose level rise significant after eating a large protein only meal?
  12. Do you have a big hard belly (fat stored around the organs not on the surface)?

Can I take my insulin levels to zero?

You cannot eliminate your need for insulin by eating a 100% fat diet, or even not eating at all.

Back in the 70s Dr Richard Bernstein worked out by self experimentation that people with Type 1 Diabetes require both basal and bolus insulin.  Basal insulin is required, regardless of food intake, to stop the body from breaking down its own lean body mass.  Bolus insulin is required to metabolise the food eaten.[30]

Someone on a typical western diet has about a 50:50 ratio of basal to bolus insulin.  Someone on a low carb diet will require less insulin, however 80% of their insulin dose required as basal insulin and the remaining 20% for their food.  While the body typically doesn’t secrete insulin in response to fat, and appetite is often reduced on a high fat diet, if we force an energy excess with high levels of processed fats there will always be enough basal insulin circulating in the blood to remove the excess energy to our fat stores.

Someone with Type 1 will modify their insulin sensitivity factor in their insulin pump to match their insulin sensitivity to optimise their blood glucose control.  People without Type 1 Diabetes can change their insulin sensitivity (and hence require less insulin) by, amongst other things, being exposed to less insulin[31] and improving our level of lean body mass (muscle) and mitochondrial function.  It is important to ensure your diet has adequate protein to build muscle as well as exercising that muscle to make sure our body is well trained and efficient at using that energy.

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Having well trained lean muscle mass is critical to glucose disposal and insulin action and thus reducing overall insulin levels.[32]  In addition to avoiding foods that quickly raise our blood glucose levels, we need to train our body to dispose of the glucose effectively and efficiently with less reliance on large amounts of insulin through building lean body mass.  This is achieved by (amongst other things like sleep, sunlight, reduced stress etc) eating nutrient dense foods that power up the mitochondria to enable us to burn the energy efficiently.

So just tell me what to eat!

I have prepared the table below to guide people to the most optimal foods based on their blood glucose levels and current level of insulin resistance and whether you need to lose weight (based on your waist to height ratio[33]).

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

There’s no nutrient poor processed grains or added sugars in any of these lists.

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The therapeutic ketosis foods have higher levels of added fat.  The nutrient dense weight loss foods contain more lean proteins and non-starchy veggies and less added fat.

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Someone with poorly controlled Type 2 Diabetes may start out on a high fat ketogenic approach (say 2:1 fat to protein by weight), in time they should be able to progressively ‘level up’ to more nutrient dense foods as their insulin sensitivity improves and they find their blood glucose levels can tolerate it.

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Someone who has long standing diabetes or who has Type 1 Diabetes may settle on a 1:1 for maintenance.  Someone who becomes more insulin sensitive may be able to cut their dietary fat down even more as they are more easily able to release fat from their body fat stores.  Even if someone wanting to lose weight got down to a 1:0.5 protein to fat ratio by weight the majority of their energy is still coming from fat, they’re just given their body a better chance of needing to use dietary fat.

 

I hope this helps you find the optimal approach for you.  I would love to hear how it goes.

references

[1] https://optimisingnutrition.com/2015/06/22/why-we-get-fat-and-what-to-do-about-it-v2/

[2] http://bja.oxfordjournals.org/content/85/1/69.long

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

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

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

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

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

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

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

[10] http://www.sciencedirect.com/science/article/pii/S0026049515003340

[11] https://youtu.be/r8uSv6OgHJE?t=2080

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

[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737348/pdf/OBY-23-2327.pdf

[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4102118/

[15] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140964/

[16] https://www.facebook.com/groups/198981013851366/permalink/261051057644361/?comment_id=261276760955124&comment_tracking=%7B%22tn%22%3A%22R4%22%7D

[17] https://www.youtube.com/watch?v=r8uSv6OgHJE&feature=youtu.be

[18] http://www.nature.com/ejcn/journal/v67/n7/abs/ejcn201390a.html

[19] https://www.amazon.com/Nutritional-Approach-Revised-Model-Medicine-ebook/dp/B00CXECDI8/ref=tmm_kin_swatch_0?_encoding=UTF8&qid=&sr=

[20] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4975866/

[21] http://perfecthealthdiet.com/

[22] http://terrywahls.com/about-the-wahls-protocol/

[23] http://sydney.edu.au/science/outreach/inspiring/news/cpc.shtml

[24] http://www.nature.com/ejcn/journal/vaop/ncurrent/full/ejcn2016256a.html

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

[26] https://optimisingnutrition.com/2016/06/13/low-energy-density-high-nutrient-density-foods-for-weight-loss/

[27] https://www.dropbox.com/s/n8tzuiixb1n1cxi/Weight%20Loss%20on%20Low-Fat%20vs.%20Low-Carbohydrate%20Diets%20by%20Insulin%20Resistance%20Status%20Among%20Overweight%20Adults%20and%20Adults%20With%20Obesity-%20A%20Randomized%20Pilot%20Trial%20(1).pdf?dl=0

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

[29] http://www.thebloodcode.com/

[30] https://www.youtube.com/watch?v=6lrbxITXAVA

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

[32] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2343294/

[33] https://en.wikipedia.org/wiki/Waist-to-height_ratio

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 you goal is to lose weight it will be hard to overeat if you limit your food choices to things like broccoli, 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 catabolise 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 talk 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 is hard to achieve with real food and is 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 grams per kilogram of lean body weight

Some people prefer to talk in terms of terms of percentages or grams 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 is 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 heath 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 a 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 trendline 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 macronutrient targets, but real foods don’t come in neat little packages of protein, fat and carbohydrates.  The chart below shows the macronutrient 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.

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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 gives 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 grams 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 grams) 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 a 180cm person with good glucose control but still wanting to lose weight, your initial target insulin load would be 156g from the superfoods from fat lost 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

curried egg with cows brain

Considering how very nutrient dense offal is, it’s been surprisingly hard to find organ meat recipes that do really well in the nutrition ranking because so many of the recipes are ‘diluted’ with lots of sweet stuff to mask the taste.

That is, until Tristan Haggard sent me their long awaited ‘ketogenic edge cookbook‘.

2016-11-18-1

Tristan and Jessica Haggard from Primal Edge Health moved from California to Ecuador to seek a healthier place to live and raise their family.

Clean water.  More sunshine.  Closer to the equator.

These guys are the real deal.

The recipes in their new cookbook document’s how Jessica lovingly makes sure they ensure they ensure they thrive with their food.  It’s not all offal, but it’s clean, nutrient dense and simple, even when it comes to the deserts.

2016-11-18

This recipe for curried eggs with cows brains does spectacularly  well with the vitamins and minerals as well as the amino acids while still being 68% fat.

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The table below shows the nutritional data per 500 calorie serving.

net carbs Insulin load carb insulin fat protein fibre
4g 16g 27% 68% 21g 14g

Combining the brains  with the egg, spinach and avocado makes for a pretty unbeatable combination when it comes to nutrient density.  In fact it ranks at:

The only thing really missing from the book is a family photo to show how health these nutrient dense whole foods are making them.  So here you go.

I  also recommend you check out their YouTube Channel, blog and podcast for some pragmatic nutrition and lifestyle advice.

 

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

I’m looking forward to Robb Wolf’s new book Wired to Eat in which 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]

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[yes, I may be a Robb Wolf fan boy.]

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 us 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 didnt’ didn’t.

So 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 …

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… and eaten 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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These days we have are surrounded by energy dense hyperpalatable foods that are designed to taste good without providing substantial levels of nutrients.

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When these foods are available our primal programming leaves us defenceless.

Our willpower or our calorie counting apps are no match for engineered foods with an optimised 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 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 research into 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 1000kJ of different foods (see the low energy density high nutrient density foods for weight loss article for more on this complex and intriguing topic).

image21

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

image10

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

image07

Maybe a little too well.

image01

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

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

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

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

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

image18

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

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


what happens when we go low carb?

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

image20

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

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

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

image24

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

image12

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

image08

what happens when we go paleo?

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

image27

Well, maybe.  Maybe not.

image06

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

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

image11

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

image25

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

image03

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

enter nutrient density

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

image15

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

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

image04

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

image22

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

optimal rehabilitation plan?

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

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

the solution

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

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

image30

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

image23

The lists of optimal foods below have been developed to help you manage your primal impulses.  The table below contains links to seperate 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!

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 autoimmune friendly foods

An “autoimmune disease” develops when your immune system, which defends your body against disease, decides your own healthy cells are foreign.  As a result, your immune system attacks healthy body cells.[1]

The list of diseases that are said to be autoimmune related are extensive,[2] [3] and to add insult to injury, people with autoimmune issues often end up with challenging digestive issues.

An autoimmune dietary protocol eliminates foods that can trigger inflammation in people with more sensitive digestion that may be autoimmune related.  The foods typically eliminated include nuts, seeds, beans, grains, artificial sweeteners, dairy, alcohol, chocolate and nightshades.

The remaining foods largely involve vegetables, seafood and animal products.  Given that Type 1 Diabetes is an autoimmune condition I have also created a lower insulin load diabetes friendly autoimmune list of foods that that will be more gentle on blood glucose levels.

Although sticking to the autoimmune friendly list of foods is somewhat restrictive it is a very nutrient dense approach compared to other options as you can see in the comparison of the nutrient density of different nutritional approaches in the chart below where it came in at #2 of the thirteen approaches analsed.

image01

The chart below shows the quantity of nutrients provided by these nutrient dense autoimmune friendly foods compared to the average of all the 8000 foods in the USDA database.

autoimmune-nutrient-dense

This chart shows the amount of nutrients provided by the diabetes friendly autoimmune protocol foods compared to all the foods in the USDA database which are not as high but still better than the average of all the foods available.

autoimmune-dabietes-friendly

An autoimmune protocol is typically a short term ‘reset’ where inflammatory foods are eliminated for a period.  Once things settle down potential other possible trigger foods are slowly reintroduced to see which foods can be tolerated.

For more information see Robb Woolf’s The Paleo Solution, Sarah Ballantyne’s The Paleo Approach or Chris Kresser The Paleo Cure.

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

autoimmune protocol (nutrient dense)

vegetables, spices and fruit 

image19

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
broccoli 23 36% 3 22 2.61
spinach 21 49% 4 23 2.20
zucchini 19 40% 2 17 2.15
watercress 24 65% 2 11 2.15
endive 15 23% 1 17 2.11
chicory greens 14 23% 2 23 2.03
basil 18 47% 3 23 1.91
beet greens 15 35% 2 22 1.86
asparagus 18 50% 3 22 1.85
escarole 11 24% 1 19 1.71
Chinese cabbage 17 54% 2 12 1.70
chard 15 51% 3 19 1.63
parsley 15 48% 5 36 1.63
lettuce 15 50% 2 15 1.60
cauliflower 15 50% 4 25 1.57
alfalfa 9 19% 1 23 1.57
okra 14 50% 3 22 1.49
summer squash 13 45% 2 19 1.47
chives 13 48% 4 30 1.41
portabella mushrooms 14 55% 5 29 1.40
arugula 11 45% 3 25 1.32
turnip greens 11 44% 4 29 1.32
cloves 9 35% 35 274 1.30
sage 7 26% 26 315 1.26
brown mushrooms 16 73% 5 22 1.25
collards 8 37% 4 33 1.18
white mushroom 13 65% 5 22 1.17
celery 10 50% 3 18 1.16
dandelion greens 11 54% 7 45 1.15
sauerkraut 8 39% 2 19 1.15
curry powder 3 13% 14 325 1.15
shiitake mushroom 11 58% 7 39 1.12
yeast extract spread 11 59% 27 185 1.11
cucumber 7 39% 1 12 1.09
seaweed (wakame) 14 79% 11 45 1.01
edamame 6 41% 13 121 0.98
radishes 7 43% 2 16 0.98
spirulina 11 70% 6 26 0.92
avocado -1 8% 3 160 0.92
cabbage 8 55% 4 23 0.85
Brussel sprouts 7 50% 6 42 0.85
thyme 4 34% 31 276 0.84
chayote 5 40% 3 24 0.81
marjoram 3 31% 27 271 0.81

seafood

image21

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
salmon 19 52% 20 156 1.96
fish roe 18 47% 18 143 1.93
trout 16 45% 18 168 1.80
caviar 13 33% 23 264 1.76
anchovy 14 44% 22 210 1.64
oyster 16 59% 14 102 1.57
mackerel 7 14% 10 305 1.53
sturgeon 13 49% 16 135 1.44
cisco 9 29% 13 177 1.43
crab 17 71% 14 83 1.42
halibut 15 66% 17 111 1.29
herring 9 36% 19 217 1.28
flounder 13 57% 12 86 1.28
tuna 11 52% 23 184 1.22
lobster 14 71% 15 89 1.19
shrimp 14 69% 19 119 1.18
rockfish 13 66% 17 109 1.14
pollock 13 69% 18 111 1.09
cod 13 71% 48 290 1.05
crayfish 12 67% 13 82 1.04
perch 10 62% 14 96 0.92
haddock 11 71% 19 116 0.87
whiting 10 66% 18 116 0.85
white fish 10 70% 18 108 0.81

animal products

image09

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
lamb liver 19 48% 20 168 1.99
lamb kidney 19 52% 15 112 1.91
turkey liver 15 47% 21 189 1.70
veal liver 17 55% 26 192 1.69
beef liver 17 59% 25 175 1.61
chicken liver 14 50% 20 172 1.51
beef kidney 14 52% 20 157 1.47
beef brains 7 22% 8 151 1.40
ham 13 59% 17 113 1.22
lamb brains 6 27% 10 154 1.16
lamb heart 9 48% 19 161 1.13
chicken liver pate 7 34% 17 201 1.12
ground turkey 6 30% 19 258 1.12
turkey heart 9 47% 20 174 1.08
rib eye steak 7 41% 21 210 1.07
pork liver 11 59% 23 165 1.05
lean beef 11 61% 23 149 1.05
lamb chop 7 42% 25 234 1.04
roast beef 6 38% 21 219 1.04
roast pork 7 41% 20 199 1.03
beef heart 9 52% 23 179 1.02
salami 2 18% 17 378 1.02
beef rib eye 6 39% 21 215 1.01
chicken 10 60% 22 148 0.98
veal 11 65% 24 151 0.95
turkey meat 8 52% 21 158 0.94
turkey drumstick 8 52% 21 158 0.94
beef tongue 1 16% 11 284 0.93
pork chop 9 57% 23 172 0.93
T-bone steak 3 26% 19 294 0.92
ground pork 8 54% 25 185 0.92
pepperoni 0 13% 16 504 0.92
lamb sweetbread 6 43% 15 144 0.90
pork shoulder 8 56% 22 162 0.88

autoimmune protocol (diabetes friendly)

Vegetables, spices and fruit

image19

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
broccoli 25 36% 3 22 1.78
endive 16 23% 1 17 1.65
chicory greens 14 23% 2 23 1.59
alfalfa 11 19% 1 23 1.54
escarole 11 24% 1 19 1.41
spinach 24 49% 4 23 1.40
zucchini 19 40% 2 17 1.38
beet greens 15 35% 2 22 1.33
curry powder 3 13% 14 325 1.27
asparagus 21 50% 3 22 1.22
basil 19 47% 3 23 1.21
avocado -2 8% 3 160 1.18
watercress 28 65% 2 11 1.17
olives -6 3% 1 145 1.12
turnip greens 14 44% 4 29 1.03
parsley 15 48% 5 36 1.02
sage 5 26% 26 315 1.02
chard 17 51% 3 19 1.01
Chinese cabbage 18 54% 2 12 1.00
lettuce 16 50% 2 15 0.98
portabella mushrooms 18 55% 5 29 0.96
cauliflower 15 50% 4 25 0.95
cloves 8 35% 35 274 0.93
collards 8 37% 4 33 0.93
summer squash 12 45% 2 19 0.92
chives 13 48% 4 30 0.91
okra 14 50% 3 22 0.89
poppy seeds -3 17% 23 525 0.86
sauerkraut 7 39% 2 19 0.85

seafood

image21

food ND % insulinogenic insulin load (g/100g) calories/100g MCA score
mackerel 7 14% 10 305 1.44
fish roe 23 47% 18 143 1.41
caviar 16 33% 23 264 1.40
salmon 24 52% 20 156 1.33
trout 20 45% 18 168 1.29
anchovy 19 44% 22 210 1.27
cisco 11 29% 13 177 1.25
herring 12 36% 19 217 1.14
sardine 12 37% 19 208 1.1
sturgeon 17 49% 16 135 1.04
oyster 20 59% 14 102 0.94
flounder 19 57% 12 86 0.94
tuna 16 52% 23 184 0.93
halibut 21 66% 17 111 0.79
crab 23 71% 14 83 0.77
rockfish 19 66% 17 109 0.72
shrimp 20 69% 19 119 0.69
perch 16 62% 14 96 0.67
lobster 20 71% 15 89 0.66
crayfish 18 67% 13 82 0.66
pollock 19 69% 18 111 0.64
cod 19 71% 48 290 0.57

animal products

image09

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
lamb kidney 25 52% 15 112 1.33
lamb liver 22 48% 20 168 1.32
beef brains 6 22% 8 151 1.24
turkey liver 19 47% 21 189 1.21
lamb brains 7 27% 10 154 1.15
chicken liver 20 50% 20 172 1.15
salami 3 18% 17 378 1.13
pepperoni -0 13% 16 504 1.11
bratwurst 1 16% 13 333 1.08
beef kidney 19 52% 20 157 1.08
ground turkey 8 30% 19 258 1.08
bacon -2 11% 11 417 1.07
veal liver 21 55% 26 192 1.06
pork ribs 1 18% 16 361 1.05
sweetbread -3 12% 9 318 1.04
chicken liver pate 9 34% 17 201 1.04
beef tongue -1 16% 11 284 1.04
kielbasa -1 15% 12 325 1.03
T-bone steak 4 26% 19 294 1.01
beef liver 22 59% 25 175 1.00
pork sausage 1 20% 16 325 1.00
park sausage 3 25% 13 217 1.00
roast beef 10 38% 21 219 0.99
liver sausage -3 13% 10 331 0.99
rib eye steak 11 41% 21 210 0.99
roast pork 11 41% 20 199 0.96
beef rib eye 10 39% 21 215 0.95
beef sausage -1 18% 15 332 0.94
turkey 0 20% 21 414 0.94
turkey bacon -1 19% 11 226 0.92
meatballs -2 19% 14 286 0.91
lamb heart 13 48% 19 161 0.91
knackwurst -4 16% 12 307 0.90
turkey heart 13 47% 20 174 0.89
liver pate -3 16% 13 319 0.89
chorizo -3 17% 19 455 0.87
lamb rib -2 19% 17 361 0.86
lamb chop 10 42% 25 234 0.86
ham 18 59% 17 113 0.85
duck -3 18% 15 337 0.85
blood sausage -5 14% 13 379 0.84

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

references

[1] http://www.healthline.com/health/autoimmune-disorders

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

[3] https://www.aarda.org/disease-list/

comparison of nutrients by food group

There are lots of claims about different dietary approaches.

  • Fruitarians advocate living on 30 bananas a day say you don’t need much else for health and athletic performance.[1]
  • Vegans say that in addition to high levels of vitamins and minerals, you can get all the protein and essential fatty acids you need from plant based foods.[2]
  • Zero Carbers who look like they’re doing great on purely animal foods and no plants and say they don’t need fibre and perhaps vitamins and minerals.[3]
  • Ketonians believe that you can’t go wrong with fat.[4]
  • Meanwhile the registered dieticians tell us that we shouldn’t eliminate whole food groups (like grains) or risk missing out on essential nutrients.[5]

As detailed in the Building a Better Nutrient Density Index article, we can quantitatively rank individual foods based on their nutrient density.  Eating nutrient dense foods will enable us to maximise satiety and avoid malnutrition and reduce the energy intake while avoiding malnutrition.

The Most Nutrient Dense Superfoods  article lists a wide range of whole foods from various food groups.   But could you thrive on a single food group?  And if you had to live on a single food food group, is there one that would be better than the others?

This article compares the the nutrients provided by the following food groups:

  • vegetables
  • fruits
  • cereals and grains
  • legumes
  • nuts and seeds
  • grains and cereals
  • eggs
  • dairy
  • animal products
  • ketogenic[6]
  • must nutrient dense

All of the charts below show the vitamins, mineral, amino acids and essential fatty acids on the same scale for comparison.   I have also included a selection of the most nutrient foods as an example.

I’ve listed some pros and cons that came to mind for each category.  I’m sure you could come up with some of your own.

vegetables

image07

pros

  • It’s hard to eat too many vegetables as they typically have a low energy density and high nutrient density which will lead to increased satiety (adequate nutrients) and satiation (feeling full).
  • As well as vitamins and minerals, it appears that you could obtain adequate (but not excessive) protein from nutrient dense vegetables (i.e. you could get more than 100% of the DRI for the amino acids from vegetables only).
  • Vegans who consume exclusively plant foods tend to have a lower BMI and less diabetes. This makes sense as limiting yourself exclusively to low energy density plant based foods would help to prevent you overeating.

cons

  • A diet comprising of only vegetables may be lower in Vitamins E, D, choline, and pantothenic acid.
  • Vitamin V-12 is very low in plant based foods.  One of the common concerns when it comes to plant based diets is a lack of vitamin B-12 and vegans often require B-12 injections.[7]
  • There are negligible quantities for the essential fatty acids EPA and DHA in vegetables. If you were to eat only plant based foods it might be beneficial to supplement with essential fatty acids.[8]
  • Vegetables are not subsidised the way that grain based foods often are. They do not store and transport as well as more processed foods and hence can be more expensive.
  • Vegetables can require more preparation and cooking time than processed pre-packaged foods.

image19

food ND % insulinogenic net carbs/100g calories/100g
celery 1.31 88% 1 17
Chinese cabbage 0.96 73% 1 17
rhubarb 0.83 91% 3 21
lettuce 0.73 83% 2 17
turnip greens 0.69 82% 2 37
asparagus 0.67 77% 2 27
broccoli 0.59 86% 4 42
winter squash 0.59 95% 6 39

fruit

image06

pros

  • Fruit provides solid levels of vitamins and minerals and has a lower energy density compared to grain based foods.
  • Fruits are can be more transportable compared to vegetables (e.g. easier to put in school lunches).

cons

  • Fruit tends to have the same nutritional gaps as vegetables (i.e. vitamin E, D, pantothenic acid, choline and essential fatty acids).
  • Some fruits have a higher energy density and amount of non-fibre carbohydrates compared to vegetables. This may be an issue if you are watching your blood glucose levels or your weight. Many fruits have a very high proportion of insulinogenic calories so may not be ideal for someone who is insulin resistant as it will raise their blood glucose levels.

image17

food ND % insulinogenic net carbs/100g calories/100g
cherries 0.30 95% 10 54
orange 0.23 95% 10 55
grapes 0.18 97% 17 77
apples 0.18 97% 11 53
blueberries 0.14 98% 20 91
figs 0.12 96% 16 82
litchis 0.11 94% 15 73
mandarin oranges 0.10 94% 12 59
honeydew melon 0.08 96% 8 40
passion fruit 0.07 91% 13 109

grains and cereals

image10

pros

  • Grains are cheap compared to fruit and vegetables, largely due to production subsidies.[9]
  • Grain based foods can be processed (to remove the fibre and water) so they can be easily transported and stored for longer periods.
  • Grains provide some fibre, but less than vegetables.
  • Grains provide a provide a wide range of nutrients, but at much lower levels than the other food groups.

cons

  • The highest nutrient density grain based foods are typically unprocessed and rarely consumed.
  • The nutrient density of most breads and cereals are very poor, particularly after processing.
  • Grains have a high energy density, a high proportion of insulinogenic calories and a high amount of non-fibre carbohydrates. image04
food ND % insulinogenic net carbs/100g calories/100g
teff 0.31 91% 17 101
spelt 0.24 91% 23 135
quinoa 0.17 79% 19 120
millet 0.14 87% 22 118
brown rice 0.02 90% 22 111

legumes

image01

pros

  • Legumes provide a range of nutrients at a lower cost compared to vegetables.
  • The energy density of beans and legumes is moderate so they can provide more fuel if you can’t fit in any more veggies.
  • Legumes provide a solid level of protein, particularly for those not wanting to consume animal based foods.

cons

  • The nutrient density of legumes is low compared to other sources such as vegetables.
  • Legumes have higher levels of non-fibre carbohydrates and a higher proportion of insulinogenic calories which may be problematic if you are watching your blood glucose levels.
  • Some people can’t tolerate high levels of the lectin proteins in legumes.[10] [11]

image11

food ND % insulinogenic net carbs/100g calories/100g
lima beans 0.22 92% 16 129
navy beans 0.16 86% 16 143
lentils 0.12 89% 12 118
hummus 0.08 46% 8 175
peanuts 0.03 24% 7 605
tofu 0.02 29% 2 112

nuts and seeds

image02

pros

  • Nuts are higher in what is typically considered to be ‘good fats’ (i.e. MUFA and PUFA).
  • Being higher in fat they are a good way for people with diabetes to get their calories without raising their blood glucose levels.

cons

  • Nuts and seeds provide a good range of vitamins and minerals but at lower levels per calorie than some of the other groups due to the higher energy density.
  • Nuts are calorie dense which may make weight loss more challenging.
  • Nuts have a relatively low nutrient density due to their high energy density.

image15

food ND % insulinogenic net carbs/100g calories/100g
sunflower seeds 0.04 27% 20 491
tahini 0.03 22% 17 633
pistachio nuts 0.03 30% 19 602
pine nuts 0.03 14% 2 647
pecans 0.02 10% 5 762
pumpkin seeds 0.00 36% 48 777
macadamia nuts 0.00 9% 5 769
sesame seeds 0.00 26% 12 603
almonds 0.00 18% 7 652
cashew nuts 0.00 27% 30 609

eggs and dairy

image08

pros

  • Eggs have a solid protein profile, some EPA and DHA and a reasonable amount of vitamins and minerals.
  • Eggs and cheeses are typically lower in carbohydrates which is useful for people trying to normalise their blood glucose levels.
  • Dairy foods like cheese and cream are lower in non-fibre carbohydrates and have a low proportion of insulinogenic calories meaning that they won’t significantly raise your blood glucose levels.

cons

  • The energy density of cheese and some other dairy products is higher which makes it possible to overconsume. Lots of people do better with weight loss when they limit milk and cheese.
  • While the latest US dietary guidelines committee has stated that saturated fat is no longer a nutrient of concern,[12] many people are still concerned about their levels of saturated fat.
  • Milk, a commonly consumed dairy product, is not particularly nutrient dense and contains lactose which will raise blood glucose. Though full fat milk is better than low fat.
  • Many people find that they are allergic to eggs[13] or dairy[14].

image08

food ND % insulinogenic net carbs / 100g calories / 100g
egg yolk 0.19 19% 3.6 317
egg 0.20 29% 0.7 138
blue cheese 0.16 20% 2.3 354
parmesan cheese 0.16 30% 3.4 411
goat cheese 0.15 22% 2.2 451
edam cheese 0.15 22% 1.4 356
provolone 0.15 24% 2.1 350
gouda cheese 0.15 23% 2.2 356
mozzarella 0.15 51% 24 251

seafood

image14

pros

  • Seafood contains essential fatty acids EPA and DHA that are hard to obtain in the rest of the food system.
  • Seafood products have very high levels of protein and substantial levels of many vitamins and minerals.
  • Seafood has a low to moderate calorie density (i.e. lower than high fat cheese cheese but higher than vegetables).
  • Because seafood is so rich in essential fatty acids and amino acids we don’t actually need that much to cover our minimum requirements.

cons

  • Fish can be more expensive than other foods.
  • Many people are concerned about heavy metal toxicity and sustainability issues surrounding seafood.[15]

image21

food ND % insulinogenic insulin load (g/100g) calories/100g
oyster 0.12 57% 14 98
anchovy 0.11 42% 21 203
caviar 0.10 32% 22 276
swordfish 0.09 41% 17 165
tuna 0.09 50% 17 137
trout 0.08 43% 17 162
lobster 0.08 69% 14 84
salmon 0.08 50% 15 122
mackerel 0.08 45% 17 149

animal products

image11

pros

  • Animal products have an excellent amino acid profile as well as significant amounts of other vitamins and minerals.

cons

  • Animal products are lacking in a number of vitamins and minerals such as manganese, vitamin E, vitamin D, folate and vitamin K as well as essential fatty acids EPA and DHA.
  • Similar to fish, many people have concerns in the areas of sustainability and environmental impact.

image09

food ND % insulinogenic insulin load  (g/100g) calories / 100g
beef liver 0.39 58% 24 169
chicken liver 0.32 48% 20 165
ham 0.25 55% 20 146
salami 0.22 29% 12 166
bacon 0.17 23% 30 522
turkey heart 0.22 39% 13 130
pork 0.21 54% 21 154

most ketogenic

The ‘most ketogenic foods’ are the 500 foods with the lowest percentage of insulinogenic calories of the 7000 foods in the USDA foods database.

image00

pros

  • If someone is insulin resistant, replacing processed non-fibre carbohydrates with fat will help to reduce insulin and blood glucose levels.
  • The ketogenic approach has relatively high levels of essential fatty acids. While the nutritional value of fat is a contentious issue, many fatty acids have substantial positive nutritional value.[16]
  • People who are insulin resistant will benefit by reducing the insulin load of their diet.

cons

  • The nutrient density of a therapeutic ketogenic approach is relatively poor. Someone looking to manage insulin resistance and diabetes should maximise nutrient density as much as possible while still maintaining excellent blood glucose levels.
  • A high fat / low insulin load diet is typically satiating,[17] however it is possible to overdo energy dense foods to the point that you won’t lose weight.
food ND % insulinogenic insulin load  (g / 100g) calories / 100g
sunflower seeds 0.21 20% 24 491
peanuts 0.20 18% 28 605
tahini 0.19 16% 26 633
pine nuts 0.18 11% 18 647
pecans 0.16 5% 9 762
egg yolk 0.19 19% 15 317
macadamia nuts 0.14 5% 9 769
chorizo 0.14 17% 19 448
olives 0.18 15% 3 90
pepperoni 0.14 14% 17 487
sesame seeds 0.13 18% 27 603
camembert cheese 0.14 20% 15 299

most nutrient dense

The chart below shows the comparison of all 7000 foods in the USDA database compared to the top 10% of the foods available prioritised by targeting the harder to obtain nutrients.

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macronutrients split of all food groups

Just for interest, the table below shows the comparison of the macronutrients of the various food groups as well as the fibre and energy density.

food group % insulinogenic protein (%) fat (%) net carbs (%) fibre (g/200cal) weight

 (g/2000 cal)

vegetables 60 18 11 48 107 2213
fruit 81 4 5 78 52 2142
cereals and grains 82 10 9 75 29 553
eggs and dairy 45 24 41 29 2 920
fish 55 70 26 4 0 155
animal products 46 62 37 1 0 1112
legumes 58 28 24 39 34 1141
nuts and seeds 36 11 58 28 16 382
most ketogenic 10 11 79 3 9 404
moderated nutrient density 54 22 20 39 64 928

comparison of the nutrient density by food groups

The chart below the average nutrient density of all the different food groups in terms of amount of nutrients provided versus the daily recommended intake.  If we just look in terms of average nutrient density (blue bars), fish does pretty well, followed by animal products and then vegetables.

However, what we really want is high levels of nutrient density across the board, not just a large amount of a few nutrients.  For example, fish and animal products have very high levels of protein but lower levels of vitamins and minerals.  By comparison, vegetables have higher levels of vitamins and minerals and do OK when it comes to amino acids.  What we want is for the quantity of nutrients to be high and the variability across the nutrients to be low.

The orange bars show the average nutrient density minus 0.8 times the standard deviation in the nutrient density.  When we look at it this way the vegetables do the best of the food groups because they provide a good range of vitamins, minerals and proteins.

image19

However, in the end though it’s the most nutrient dense foods that win out because they provide high levels of a broad selection of all the nutrients.  So, rather than focusing on a particular food group, if you’re interested in maximising nutrient density, the optimal approach appears to be to focus on the most nutrient dense foods across all of the food groups.

 

references

[1] http://www.30bananasaday.com/

[2] https://www.youtube.com/watch?v=n20uGGNoVdo

[3] https://zerocarbzen.com/

[4] http://ketotalk.com/2016/04/17-too-much-fat-higher-vs-lower-ketones-cortisol-testosterone-on-keto/

[5] http://daa.asn.au/for-the-public/smart-eating-for-you/nutrition-a-z/fad-diets/

[6] The most ketogenic foods are the top 500 foods with the lowest proportion of insulinogenic calories.

[7] http://chriskresser.com/why-you-should-think-twice-about-vegetarian-and-vegan-diets/

[8] http://nutritionfacts.org/video/plant-based-omega-3-supplements-2/

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

[10] https://authoritynutrition.com/dietary-lectins/

[11] http://www.marksdailyapple.com/lectins/

[12] https://www.youtube.com/watch?v=a3eu7DQa4bw

[13] http://acaai.org/allergies/types/food-allergies/types-food-allergy/egg-allergy

[14] http://www.mayoclinic.org/diseases-conditions/milk-allergy/basics/symptoms/con-20032147

[15] https://jasonprall.com/blog/mercury-myth-fish-tale-epic-proportion/

[16] https://optimisingnutrition.com/2015/10/11/good-fats-bad-fats/

[17] http://www.ncbi.nlm.nih.gov/pubmed/18175736

Dominic D’Agostino’s breakfast – sardines, oysters, eggs and broccoli

At first it sounds like a bizarre food combination, but when the smartest guy in the room says that he has sardines, oysters, eggs and broccoli as his regular breakfast I wasn’t surprised to find that it scored highly in the nutritional analysis.

Before he started saving the world by progressing Warburg’s mitochondrial theory of cancer and oxygen toxicity seizures for DARPA Dominic D’Agostino studied nutrition and is rumoured to have done some bodybuilding.

Both physical and mental performance are undoubtedly critical to Dom, so it’s not surprising that he is very intentional about what he puts in his mouth to start each day.

As you can see in the plot from Nutrition Data below Dom’s breakfast scores a very high 93 in the vitamins and minerals score and a very solid 139 in the protein score.

You could say this meal was high protein (44%), low carb (10%) and moderate fat (46%), although his fatty coffee and high fat deserts would boost the fat content to make it more “ketogenic”.

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Dom’s breakfast scores well against the 250 meals analysed to date in the meal rankings for different goals coming in at:

  • therapeutic ketosis – 176
  • diabetes and nutritional ketosis – 87
  • nutrient density – 9
  • weight loss – 16

I’ve heard Dom say that he aims for a ‘modified Atkins’ approach with higher protein levels rather than a classical therapeutic ketogenic diet which is harder to stick to and might be used for people with epilepsy, cancer, dementia etc.  It was intriguing to see that Dom’s standard breakfast ranks the highest in nutrient density rather than therapeutic or nutritional ketosis.

Image result for tim ferriss dom d'agostino

Dom first mentioned his favourite breakfast concoction in his first interview with Tim Ferriss (check out the excellent three hour podcast here).   You can hear the shock and slight repulsion in Tim’s voice in the sound check as he responds with

“Do you blend that up in the Vitamix?”

But now Tim, rather than following his own slow carb approach, has made sardines and oysters a regular breakfast staple and mentions it as one of the top 25 great things he learned from podcasts guests in 2015.

The stats for a 500 calorie serve of Dom’s breakfast are shown in the table below.

net carbs

insulin load carb insulin fat protein fibre
6g 38g 18% 46% 44%

6g

oyster20at20ettas

I was aware that broccoli, eggs and sardines are nutritionally amazing, but then the oysters fill out the vitamin and mineral score to take it a little bit higher.  Dom obviously understands the importance of Omega 3s which are hard to get in significant quantities from anything other than seafood.

I was surprised to see that oysters can be ‘carby’ (at 23% carbs) which is apparently due to their glucose pouch which varies in size depending when they’re harvested.

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If you wanted to skip the oysters due to taste or cost considerations, the combination of sardines, egg and broccoli still does pretty well.  This option gives less carbs, a slight decrease in the vitamin and mineral score with an slight increase in the amino acid score.

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The ranking for the sans-oyster option is:

  • therapeutic ketosis –  159
  • diabetes and nutritional ketosis –  67
  • nutrient density –  11
  • weight loss – 20

The stats for a 500 calorie serving are:

net carbs

insulin load carb insulin fat protein fibre
3g 30g 10% 48% 44%

6g

The combination of nutrient dense seafood with nutrient dense vegetables is hard to beat.  The chart below shows my comparison of the nutrients in the various food groups in terms the proportion of the Daily Recommended Intake (DRI) from 2000 calories (click to enlarge).

2016-08-15

I couldn’t get any photos of Dom’s breakfast, but I did get a photo of my current go to lunch.   Each weekend I get a bunch of good quality celery and chop it up into tubs to take to work each day.  I have cans of mackerel and sardines in my drawer at work.

Celery does really well in terms of nutrient density per calorie and sardines and mackerel are high on the nutrient density lists without being outrageously expensive (e.g. caviar, anchovy, swordfish, trout).

mackerel and celery

When I feel hungry I might start munching on the celery which is pretty filling and hard to binge on.  Then if I’m still hungry I’ll have as many cans of mackerel or sardines as it takes to fill me up (which is usually 2 to 4).

At around 2pm this is my first meal of the day (other than espresso shots with cream) at around 2pm.  If I start to feel hungry before then I might check my blood glucose to see if I really need to refuel or if I think I’m hungry because I’m bored.   I’ll then go home and have an early dinner with the family around 6pm.

I’ve been known to indulge in some peanut butter with, cream, Greek yogurt or even butter if I’m still hungry (e.g. if I’ve ridden to work) but I try to not overdo it as I’m not as shredded as Dom yet.

The simple combination of celery and mackerel also does pretty well in the ranking of 250 meals and aligns well with my current goal of maximising nutrient density and ongoing weight loss now that I’ve been able to stabilise my blood glucose levels.

  • therapeutic ketosis – 137
  • diabetes and nutritional ketosis – 36
  • nutrient density – 16
  • weight loss – 8

net carbs

insulin load carb insulin fat protein fibre
8g 33g 25% 51% 35%

6g

 

 

 

 

how to make endogenous ketones at home

I’ve spent some time lately analysing these 1100 ketone vs glucose data points looking for the secret to achieving optimal ketone values for weight loss and health.

image23

As you can see from this chart, there is a relationship between ketones and glucose.  As your blood glucose levels decrease your blood ketones rise to compensate.

Different glucose : ketone relationships for different people

It seems that each person has a unique relationship between their blood glucose and ketone values that gives us an insight to understand their insulin resistance status and metabolic health.

image02

Characterisation of different metabolic states

Similar to Dr Kraft’s insulin curves, we can characterise different levels of insulin resistance metabolic health using the relationship between glucose and ketones.

image27

If you want to know why hyperinsulinemia is the “unifying theory of chronic disease” it’s worth taking the time to read up on it to provide some more context for the discussion later in this article. [1] [2] [3] [4] [5]

Type 2 Diabetes

If you have type 2 diabetes and your blood glucose levels are consistently high, you are not metabolising carbohydrates well, and will likely benefit from a lower insulin load dietary approach.

When you go a long time between meals, your ketones don’t kick in because of high insulin levels and / or your mitochondria are not functioning optimally.  You feel tired and hangry.

Particularly in the early stages when someone is still insulin resistant, a lower insulin load dietary approach will help with satiety and carb cravings while keeping blood glucose levels under control.

Hyperinsulinemia and metabolic disorders

If your blood glucose levels are very low and ketone levels are also very low, you may have an infection or a metabolic disorder that is stopping you from producing enough energy.

The yellow line in the chart above is based on an actual person who is suffering from a range of metabolic related issues including obesity, PCOS, depression, etc.  For these people, EXOGENOUS ketones may help to relieve the debilitating symptoms of acute Hyperinsulinemia.

Exciting research is currently 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]  

2016-08-11.png

Patrick Arnold, who worked with Dr Dominic D’Agostino to develop the first ketone esters and BHB 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, as noted by Robb Wolf, once you have successfully transitioned to a lower carb eating style you would need 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 ENDOGENOUS FAT stores.

2016-08-08.png

Insulin resistant

Someone with diabetes who persists 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 body will be able to more easily release 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.

image20

If you are insulin resistant you are probably not able to metabolise carbohydrates, protein or fats very well.  The light blue “mild insulin resistance” line is based on my ketone and glucose values when I started trying to wrap my head around this ketosis thing.

image27

I enthusiastically started adding unrestricted 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.  My blood tests suggested I was developing fatty liver in my mid 30s!  And I thought I was doing it right with the bacon and BPC?!?!?

The photo on the right is after I worked out how to decrease the insulin load of my diet and learning about intermittent fasting from Jason Fung.  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.

image05

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

This metabolic jet fuel is definitely fascinating stuff!  My experience is that it gives me the buzz like a BPC, but also has an acute diuretic effect (meaning I need to stay close to a toilet and long drives to work in slow traffic were sometimes humiliating).

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.  It was like I had ‘bonked’ all of a sudden and needed LOTS OF FOOD NOW!

image17

Unfortunately my hunger and subsequent binge eating seemed to offset the short term appetite suppression.  And it was not going to be financially viable for me to maintain a constant level of artificially elevated ketone levels.

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.  Wow!

image30

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 Pruve this claim.

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

Princess_Bride_That_Word

According to a Pruvit tele-seminar the EXOGENOUS ketone salts were not designed to be a weight loss product and hence have not been studied for weight loss.

The only studies that we could find that mentioned EXOGENOUS ketone supplementation and weight loss were on rats an 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.

image06

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

image25

 

image28

image16 [13]

Confused yet?  I don’t blame you.

Metabolically healthy

The “metabolically healthy” line in the chart above is based on RD Dike man’s ketone and glucose data when he recently did a 21 day fast.

image32

Due to his hard earned metabolic health and improved insulin resistance he has developed the ability to fairly easily release ketones when goes longer periods between meals.

2016-08-10 (2).png

RD has achieved a spectacular HbA1c of 4.4%.  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 line as the gold standard.

image04

In spite of his improvement in insulin resistance and blood glucose control, he still says the “siren” of hunger is incredibility difficult to resist and mastering appetite is more challenging than particle physics.  As a Chief Scientist at Lockheed Martin, he would know.

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, it seems they are also quickly metabolised so they do not build up in his bloodstream.

I know Luis Villasenor of 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, from both glucose and ketones.

2016-08-12 (11)

The average TOTAL ENERGY of the 1100 data points from these 26 fairly healthy people working hard to achieve nutritional ketosis is 6.1mmol/L. It seems the body works to maintain homeostasis around this level.

When the TOTAL ENERGY in our bloodstream increases outside of the normal range it appears 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.

Regardless of whether your energy takes the form of glucose, ketones or free fatty acids they all contribute to acetyl-coA which is oxidized to produce energy.  Forcing excess unused energy to build up in the bloodstream is typically not desirable and can lead to long term issues (gyration, oxidized 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 lip genesis 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]

This guy seems to agree too.  But what would he know? [16]  [17] [18]

image26

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 Seyfried and 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 typically a concern fro the body because it just doesn’t happen in nature with real 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 in the blood stream, 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 use of 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 were 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.

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 MOAR fat and MORE 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 study in a long term controlled environment in the in the future are:

  1. What is the a 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 affect 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 hypo-caloric ketogenic diet versus a hyper-caloric 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 mobilise glycogen and fat easily when required (e.g. when fasting or a sprint). They are 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.

image29

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

image13

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!

image08

And he’s been able to lose 10kg (22lb) during July 2016!

image12

At 5.2mmol/L (i.e. glucose of 4.0mmol/L plus ketones of 1.2mmol/L) John’s TOTAL ENERGY is lower than the average of the 26 people shown in the glucose + ketone chart above.  Looking good John!

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.

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.

image22

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 ketone magic

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 release 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.

image33

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 drowning in insulin caused by high TOTAL ENERGY building up in your bloodstream.

image01

Driving up ketones artificially through EXOGENOUS inputs (treating the symptom) does NOT lead to increased metabolic health and 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.

Just like having low blood glucose is not necessarily good if it is primarily caused by high levels of EXOGENOUS insulin couple 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 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, greater 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.

Based on my analysis of nutrient density I don’t think you should be trying to avoid protein and carbohydrates in the pursuit of higher ketone levels unless you have a legitimate medical reason for perusing therapeutic ketosis (e.g. cancer, Alzheimer’s, epilepsy, dementia etc).

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I believe the best approach is to maximise nutrient density as much as possible while working within the limits of your metabolic health and your pancreas’ ability to maintain normal blood glucose levels.

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Intermittent fasting

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.

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Check out the how to use your glucose meter as a fuel gauge article or Jason Fung’s Intensive Dietary Management blog for some more ideas on how to get started with fasting.   Rebecca Skvorc Latham has also developed a fasting protocol using weight to guide your eating schedule if your primary goal is weight loss rather than blood glucose control.

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If you really 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.

 

 

Epilogue

Like most people dabbling in this low carb thing, I’m still on a journey.

I’d love to be able to share shirtless photos like Ted and Dom but I’m still working to overcome my own genetic propensity for diabetes, obesity, Alzheimer’s and Parkinson’s.  I’m still learning and working out how to apply these things in my own life.

Although I do sometimes check blood glucose levels before meals to see how I’m tracking I haven’t been testing ketones much for a year or so after I realised chasing high ketones with more dietary fat wasn’t helping me lose weight.

However after writing this article using other peoples’ data, I was intrigued to see how my ketones were travelling.

This was mid-morning after a kettlebell session.

I was able to get my heart rate up to 190 bpm which is my highest ever!  My daughter joined me today so there was some downtime between sets.  Usually I do an exercise until my heart rate gets up to at least 170 bpm.  I then stop and wait until it drops back down to 140 bpm and then go again.

My aim is to train my mitochondria to pump out more power with less energy (i.e. fasted) to improve insulin sensitivity as well as mitochondrial efficiency and drive  mitochondrial bio-genesis.

You can get a lot of work done in an intense 25 to 30-minute session with these weapons of torture that I keep downstairs in my garage (although I don’t think it really matters what you do as long as you push your body to do more with less).

My appetite today was great so I didn’t feel the need to eat until I had dinner with my family.

Previously I would have not been happy with these ketone readings and would have wanted to drive my ketones higher to get into the ‘optimal ketone zone’.  I would have wondered “Maybe I should have eaten some MORE butter or had a BPC to drive ketones higher to facilitate fat loss?”

But given I’d still like to lose some more body fat I’m pretty happy with these numbers.

  • My total energy is low (4.5mmol/L and 5.1mmol/L).  Check.
  • Ketones are present but not too high which means I’m able to mobilise fat but not building it up in my bloodstream.  Check.
  • Blood glucose is low.  Check.

All good!  Feeling crisp, happy and vibrant thanks to ENDOGENOUS ketones!

(Sorry.   I can’t sell you mine.  You’ll have to make your own.)

 

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/

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

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 bad stuff, especially once you start feeling the benefits.

But when it comes down to it, what are the foods that everyone should avoid?

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 to avoid nutrient dense foods and towards insuilnogenic nutrient poor processed 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 in general and is about to release his new book The Case against Sugar.

The World Health Organisation are imploring people to reduce their sugar intake.[1]   Investment bank Credit Suisse is predicting a turn away from sugar and and back towards fat, effectively advising people to ‘short sugar’.[2]

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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?

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:

  • highly insulinogenic,
  • have a low nutrient density, and
  • have a high energy density.

Most diet recommendations succeed largely because they eliminate these foods.

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.

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.

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

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…highly insulinogenic…

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

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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 least nutrient dense avoid foods is vast!

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.

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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.

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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.

image03

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

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

nutrient dense insulinogenic foods for athletes and bulking

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

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

insulin load, a refresher

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

image02

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

image00

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

image01

but why would you want to spike your glucose levels?

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

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

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

the mission…

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

image03

The foods listed below represent the top 10% of the USDA food database prioritised for higher insulin load, higher nutrient density and higher energy density.  In terms of macronutrients they come out at 30% net carbs and 16% fat on average.  While these foods might not be ideal for someone with diabetes they actually look like a pretty healthy list of foods compared to the “food like products” that you’d find in the isles of the supermarket.

The chart below shows that this “nutrient dense bulking” approach does quite well in terms of nutrient density relative to the other approaches analysed coming in at #3 of the thirteen approaches analysed.

image01

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

nutrient-dense-bulking

The foods listed below represent the top 10% of the USDA food database using this ranking system.  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.

vegetables

image19

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
watercress 26 65% 2 11 1.38
broccoli 25 36% 3 22 0.90
spinach 21 49% 4 23 0.89
shiitake mushrooms 5 82% 72 296 0.88
seaweed (wakame) 11 79% 11 45 0.83
brown mushrooms 13 73% 5 22 0.78
Chinese cabbage 18 54% 2 12 0.74
Tomato powder 3 79% 70 302 0.70
white mushroom 13 65% 5 22 0.69
parsley 17 48% 5 36 0.66
mung beans 10 74% 4 19 0.66
spirulina 11 70% 6 26 0.66
asparagus 17 50% 3 22 0.64
chard 16 51% 3 19 0.62
lettuce 16 50% 2 15 0.58
cauliflower 15 50% 4 25 0.58
portabella mushrooms 14 55% 5 29 0.57
seaweed (kelp) 7 77% 10 43 0.57
zucchini 18 40% 2 17 0.55
okra 15 50% 3 22 0.54
chives 14 48% 4 30 0.51
shallots -2 80% 75 348 0.50
radicchio 9 67% 4 23 0.49
yeast extract spread 6 59% 27 185 0.45
peas 9 65% 7 42 0.44

animal products

7450703_orig

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
beef liver 17 59% 25 175 1.04
veal liver 17 55% 26 192 1.01
lamb liver 19 48% 20 168 0.95
lamb kidney 19 52% 15 112 0.93
veal 12 65% 24 151 0.80
lean beef 13 61% 23 149 0.79
chicken (skinless) 12 60% 22 148 0.73
ham 13 59% 17 113 0.73
turkey 11 65% 22 138 0.73
turkey liver 14 47% 21 189 0.71
chicken liver 14 50% 20 172 0.70
beef kidney 14 52% 20 157 0.70
pork liver 11 59% 23 165 0.67
pork chop 11 57% 23 172 0.66
ground beef 10 59% 20 144 0.59
pork shoulder 10 56% 22 162 0.57
ground pork 10 54% 25 185 0.57
leg ham 10 56% 22 165 0.57
sirloin steak 8 57% 24 177 0.48
beef heart 9 52% 23 179 0.48
bison 9 53% 22 171 0.48
chuck steak 9 51% 25 194 0.47

seafood

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
blue crab 19 71% 14 83 1.18
cod 13 71% 48 290 1.16
salmon 21 52% 20 156 1.13
lobster 16 71% 15 89 1.06
halibut 17 66% 17 111 1.06
shrimp 16 69% 19 119 1.03
pollock 14 69% 18 111 0.95
oyster 17 59% 14 102 0.91
rockfish 15 66% 17 109 0.91
haddock 13 71% 19 116 0.88
trout 18 45% 18 168 0.88
octopus 11 71% 28 164 0.88
fish roe 18 47% 18 143 0.87
crayfish 14 67% 13 82 0.86
white fish 11 70% 18 108 0.80
whiting 12 66% 18 116 0.78
flounder 15 57% 12 86 0.75
sturgeon 15 49% 16 135 0.71
tuna 13 52% 23 184 0.71
scallop 8 77% 22 111 0.71
perch 12 62% 14 96 0.68
clam 8 73% 25 142 0.67
anchovy 13 44% 22 210 0.65
caviar 13 33% 23 264 0.55
orange roughy 4 70% 17 105 0.36
herring 9 36% 19 217 0.30

legumes

image11

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
cowpeas 2 79% 68 336 0.72
soy protein isolate 3 72% 69 335 0.65
soy sauce 8 78% 12 57 0.63
navy beans 2 72% 63 337 0.61
black beans 0 73% 63 341 0.55
pinto beans -0 73% 64 347 0.53
kidney beans -0 74% 63 337 0.51
garbanzo beans -2 69% 67 378 0.43
soybeans 3 44% 49 446 0.39
broad beans 1 61% 54 341 0.38

grains

image08

food ND % insulinogenic insulin load (g/100g) calories/100g MCA
baker’s yeast 13 53% 16 105 0.62
wild rice -3 87% 80 357 0.59
brown rice -5 86% 79 367 0.49
oat bran 3 65% 65 246 0.44
white rice -9 95% 84 365 0.41
egg noodles -6 83% 79 384 0.41
cornmeal -7 89% 81 370 0.40
rice flour -8 92% 82 366 0.39
wheat bran 10 38% 34 216 0.37

dairy

image08

food ND % insulinogenic insulin load (g/100g) calories/100g
whey protein powder 5 95% 82 339
cream cheese (low fat) 9 76% 19 105
cottage cheese (low fat) 7 63% 13 81

other dietary approaches

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

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

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

image02