Category Archives: protein

protein sparing modified fast (PSMF) diet foods

The Protein Sparing Modified Fast (PSMF) is regarded by many to be the most effective way to lose body fat while preventing loss of lean muscle and rebound binge eating due to nutrient deficiencies.

First developed in the 1970s, the PSMF has seen various permutations in weight loss clinics and the bodybuilding community.

While the details vary depending on context, a PSMF generally defined as an energy restricted diet with adequate protein while simultaneously limiting carbohydrates and fat.

Technically, the PSMF will be ketogenic because a significant amount of body fat will be burned due to a restricted energy intake.

Adequate protein is provided to prevent loss of lean muscle mass.  Supplements are often used to prevent nutrient deficiencies.

This article outlines the key principles of the PSMF that can be applied to weight loss or maintenance over the long-term.

Optimal nutrient dense foods are identified for someone looking for an aggressive weight cut (e.g. a bodybuilder leading up to a competition) as well as a hybrid low carb – PSMF approach for someone who is insulin resistant wanting to lose a significant amount of weight over a longer period.

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Medical applications of the PSMF

In the medical application of the PSMF patients obtain the majority of their energy from protein while keeping energy from carbohydrates and fat low.[1]

  • Protein levels are set at 1.2 to 1.5 g/kg of ideal body weight per day.  (For someone with 30% body fat wanting to get to 10% body fat this would be equivalent to 1.5 to 1.9g protein per kilogram of lean body mass or LBM.)
  • Carbohydrate intake is typically restricted to less than 20 to 50 g/day.
  • Additional dietary fat beyond what comes with lean protein sources is minimised.
  • Patients in the weight loss clinic setting are restricted to less than 800 kcal/day.

The Cleveland Clinic has done extensive research into the use of adequate protein low-calorie diets for aggressive weight loss with the following encouraging findings:[2] [3] [4]

  • patients are encouraged by the initial period of rapid weight loss which leads to a lower dropout rate;[5]
  • meal replacements in the form of commercial shakes or bars can be used, however learning to make meals from whole foods critical to developing habits that lay the foundation for long-term success;
  • the PSMF is effective for people with normal glycemic control as well as pre-diabetes or type 2 diabetes;[6]
  • people on a whole food-based PSMF are significantly less hungry and preoccupied with eating compared to those on a liquid-formula based version of the PSMF; and
  • most of the weight lost during a PSMF is from fat tissue rather than muscle.[7]

Adherence to a very-low-calorie, ketogenic PSMF program results in major short-term health benefits for obese patients with type 2 diabetes. These benefits include significant weight loss, often more than 18kg, within 6 months. 

In addition, significant improvements in fasting glucose and haemoglobin A1c levels are linked to the caloric and carbohydrate restriction of the PSMF.

Insulin resistance was also attenuated, with possible partial restoration of pancreatic beta-cell capacity.[8] [9]

Body building applications

Lyle McDonald reinvented the PSMF in body building community with his 2005 Rapid Fat Loss Handbook.

McDonald details how someone can individualise the PSMF based on their goals and context.

  • Someone who is already very lean and undertaking heavy weight training will need higher levels of protein.
  • Someone who isn’t yet lean may do better with a less aggressive approach over a longer period.
  • McDonald’s recommended protein intake ranges from 2.2g/kg LBM to 4.4g/kg LBM!
  • Unlimited green leafy fibrous veggies are strongly encouraged as they are filling and provide the vitamins and minerals with minimal calories.
  • McDonald also recommends supplementing with a good multivitamin, sodium potassium, magnesium, taurine, calcium and fish oil.
  • A PSMF is typically not a long-term proposition due to nutrient deficiencies.

KetoGains’ Luis Villasenor added:

McDonald’s recommendations seem “massive” to most people due to the book being geared toward strength athletes who DO require more protein as they are effectively breaking it down when strength training. 

Bodybuilders who diet down to 4 – 5% bodyfat need an increased protein intake when preparing for a contest as their aim is to maintain as much as lean mass as possible; and for that, one needs protein and resistance exercise. 

With my clients, to avoid nutrient deficiencies, we use a “Ketogains PSMF” which adds 3-4 whole eggs a day, at least 150g spinach, plus other green veggies, and some avocado. The rest is lean sources of protein and more veggies, plus electrolytes.  This effectively puts the person in between 35 to 50g fats and 20g net carbs.  The rest of their energy comes from lean protein.

Protein drives satiety

The body actively defends loss of muscle mass by increasing appetite after periods of fasting or low protein consumption to ensure that muscle mass is retained.[10]

Conversely, the Protein Leverage Hypothesis (Simpson, 2005) suggests that we continue to eat food until we get enough protein for critical bodily functions.[11] [12]

“Protein generally increases satiety to a greater extent than carbohydrate or fat and may facilitate a reduction in energy consumption under ad libitum dietary conditions.”[13] [14]

If we eat lower protein foods, we may end up consuming more energy to obtain our adequate protein.   Conversely, we can ‘hack’ our appetite by prioritising adequate protein while minimising energy from carbohydrate and fat.

  • Minimum carbohydrate requirement: While there is a need for the vitamins and minerals that are often packaged with carbohydrate containing foods (i.e. vegetables), there is indeed no such thing as an essential nutrient.
  • Minimum fat requirement: Most people have plenty of body fat stores that they can draw on and hence do not have an immediate need for dietary fat other than the essential Omega 3 fatty acids.

So, theoretically, if we get adequate protein as well as vitamins, minerals, the essential fatty acids can go a long way to providing everything that we need for long-term survival with less energy which is really the holy grail of weight loss and long-term maintenance.

Thermic effect of food

The other advantage of consuming a higher protein diet is increased thermogenesis (i.e. the energy lost in the process of converting food into energy).  The thermic effect (or specific dynamic action) is 5 to 15% for carbohydrates and fat and 20 to 35% for protein.[15]

The thermic effect of food is illustrated nicely by these images from Physioqonomics.[16]  We lose a lot more calories metabolising protein compared to fat or carbohydrates.

While we can convert protein to glucose (i.e. gluconeogenesis), it is really hard, and our body doesn’t like to do unless it has to.[17]

Satiety typically kicks in quickly once we have had adequate protein and we go in search of fat or carbs which are easier to convert to energy.  Just think, you can only eat so much steak, but you always have a ‘dessert stomach’, even after a big meal.

While there is much debate over the “metabolic advantage” of fat vs. carbohydrates with claims that we can eat more calories of fat than carbs, there is actually an advantage’ when it comes to how many calories of protein we eat versus how much we can convert to energy.

Should you just eat the highest protein foods?

So, the obvious question is:

What should I eat on a PSMF?

The table below lists the foods with the highest protein content as a percentage of energy.  These foods may be useful if you are looking to boost your protein intake.

food % protein
cod 92%
haddock 92%
white fish 92%
orange roughy (fish) 92%
crab 91%
lobster 91%
egg white 91%
mozzarella cheese (non-fat) 90%
pollock 90%
protein powder (whey) 89%
turkey breast (fat-free) 88%
halibut 86%
crayfish 86%
whiting 86%
rockfish 86%
molluscs 86%
veal 84%
perch 81%
shrimp 81%
trout 81%
chicken breast 79%
lean beef 79%
whey protein concentrate (WPC) 78%
octopus 77%
ground beef 76%
pork chop 75%
flounder 74%
beef tripe 74%
pork shoulder 74%
scallop 74%
leg ham 74%
sirloin steak 73%
ham (lean only) 73%
beef heart 73%
turkey (skinless) 72%
clam 72%
turkey gizzard 72%
top round steak (fat trimmed) 72%
lamb kidney 71%
beef heart 70%
beef kidney 70%

I have summarised these in this image for easy reference.

The problem with a very high protein diet

But wait!

While you may be getting plenty of essential amino acids if you focus purely on high protein foods, there is a good chance that you may not be getting all the vitamins and minerals you need.

As shown in the chart below, there is a strong relationship between protein and nutrient density.  However, if we just focus on high protein foods, we may still end up missing out on the harder to find vitamins and minerals.[18]

The chart below shows the micronutrients provided by the top 10% of the foods in the USDA database when sorted for maximum protein content.

Now imagine, that rather than getting 2000 calories, we are getting only 800 or 400 calories during long-term fasting or extreme dieting.  We have a higher chance of becoming deficient in many key nutrients which may in turn increase appetite and drive us to eat more than we would like to.

Ensuring you are getting adequate micronutrients is a key component to long-term success in weight loss and maintenance.  

In the Rapid Fat Loss Handbook McDonald mentions ‘The Last Chance Diet’ which was popular in the 1970s and 80s.  It was essentially a PSMF centred around liquid nutrition which led to the death of a number of devotees due to some fatal flaws.[19] [20]

First, they picked the cheapest protein source available, collagen; a protein that provides essentially zero nutrition to the body.  Second, they provided zero supplemental vitamins and minerals (some of which would have been obtained if the dieters had been eating whole foods in the first place). This caused a couple of problems including cardiac heart loss (from the total lack of protein) and arrhythmias from the lack of minerals.

Basically, the problem wasn’t with the approach so much as with the food choices.

PSMF’s based around whole foods (which provide high quality proteins as well as vitamins and minerals) and with adequate mineral supplementation have shown no such problems.[21]

Bruce Ames’ Triage Theory

Nutrient density becomes even more important when we consciously try to limit our energy intake.

Attaining adequate micronutrients can help to mitigate metabolic/mitochondrial slowdown and adaption to the severe calorie deficit.  If we are getting the range of micronutrients we need, the body is more likely to keep on feasting on our own excess fat stores without reacting like there is a famine and holding onto our excess fat stores.

Similar to the protein leverage hypothesis, it seems if we provide the body with low nutrient density food it is driven to consume more energy to ensure that it gets the nutrients it needs.

I get some comments in response to the Nutrient Optimiser analysis suggesting that the Daily Recommended Intakes (DRI) for various micronutrients are excessive because an individual person has done fine on a diet per for a period of time with a less than optimal nutrient profile.

While we can argue that the some of the DRIs for various nutrients are overly conservative, you also don’t have to look too far to find people that argue that we need multiple times the DRI for another particular nutrient to optimise our health and longevity.

I don’t think we need to worry about precisely meeting the daily recommended intake for every single micronutrient every single day.  There is no diet that meets the daily recommended intake for every nutrient without overdoing others.  I think a healthy well-balanced diet will achieve the DRI for the majority of the essential micronutrients most of the time.

More research is required to understand whether our requirements for different nutrients change depending on our diet (e.g. how much less vitamin C do we need if we are not consuming as much glucose) and how much more bioavailable nutrients are from plants versus animals.

However, if you are an order of magnitude under the DRI for a handful of nutrients, perhaps you should consider focussing on foods that contain that contain higher levels of that cluster of nutrients.  If you are an order of magnitude over the DRI for a particular group of nutrients you don’t need to prioritise foods that contain those nutrients.

Bruce Ames’ sobering Triage Theory suggests that if we are low in critical nutrients, the body will prioritise those nutrients for functions essential to short term survival rather than longevity and preventing the diseases of ageing (e.g. cancer, heart disease, Parkinson’s, Alzheimer’s, etc.).

“The triage theory posits that some functions of micronutrients (the approximately 40 essential vitamins, minerals, fatty acids, and amino acids) are restricted during shortage and that functions required for short-term survival take precedence over those that are less essential.  Insidious changes accumulate as a consequence of restriction, which increases the risk of diseases of ageing.”[22] [23]

So, while we might do OK with poor nutrition for a period of time, we will probably do better if we obtain a solid amount of all the essential nutrients.  Ideally, we would get these nutrients from whole foods which are more likely to contain all the non-essential but also beneficial vitamins and minerals that we don’t track.

Low energy density

Another way to maximise nutrient density and prioritise protein at the same time is to reduce the energy density of the food we eat.

As shown in the chart below there is a relationship between the harder to find nutrients and energy density.[24]  While fat is a great fuel source and should not be feared or avoided, refined high-fat foods do not typically contain high levels of the harder to find vitamins and minerals that we need to thrive.  Foods with more fibre and water are also more filling and are more difficult to overeat and will lead to increased short term satiety.

If we prioritise adequate protein while minimising fat and carbohydrates we make up the deficit from our own body fat stores. Hence there is no need to prioritise dietary fat.

The nutrient dense adequate protein diet

So, to recap:

  1. getting adequate protein is important, especially if we are fasting or restricting energy intake, and
  2. not getting adequate nutrients is potentially dangerous and possibly the fatal flaw of the PSMF.

We can use the Nutrient Optimiser to prioritise foods with the nutrients we want to obtain more of.   Listed below are the 20 nutrients that have been prioritised in the following list of prioritised foods.

  1. Alpha-linolenic acid
  2. EPA + DHA
  3. Vitamin E
  4. Vitamin D
  5. Choline
  6. Calcium
  7. Magnesium
  8. Potassium
  9. Thiamine
  10. Phosphorus
  11. Pantothenic acid
  12. Manganese
  13. Folate
  14. Zinc
  15. Niacin
  16. Riboflavin
  17. Valine
  18. Selenium
  19. Leucine
  20. Tyrosine

Prioritising amino acids is usually unnecessary because maximising vitamins and minerals generally leads to more than adequate protein.   However, in a PSMF where we are severely limiting energy we want to increase protein as well (hence valine, leucine and tyrosine have been included).  As well as nutrient density, we have also prioritised low energy density foods in the multicriteria analysis.

The chart below shows the resultant micro nutrient profile achieved if we ate 2000 calories per day of these foods.  In the chart above we saw that if we just focus on protein, we will not be meeting the DRI for eleven nutrients.  However, when we focus on nutrient density, we get adequate quantities of all nutrients other than the Omega 3 fatty acid alpha-linolenic acid.

The chart below shows the same foods if we only ate 600 calories per day rather than 2000.  Even with these highly nutrient dense foods, we miss the DRI for eight of the essential nutrients.  Hence, we may still benefit from supplementing with Omega 3, vitamin D, calcium, magnesium and potassium.   The nutrients provided by an energy restricted diet without also prioritising nutrient density would be much worse.

It’s not hard to imagine that our ability to maintain a low energy intake and achieve sustained weight loss is likely related to getting adequate levels of the various essential micronutrients without having to over consume energy.  Conversely, a nutrient poor diet will likely drive us to consume excess energy which will lead to obesity.

Best foods for a PSMF

The tables below summarise highest ranking 10% of foods in the USDA database when we prioritise for high nutrient density and low energy density.

Also included in the tables are:

  • the nutrient density score (based on the 20 nutrients listed above),
  • energy density, and
  • the MCA which is the overall ranking from the multi criteria analysis.

Compared to the highest protein food listed above which are 80% protein, these foods work out to be 59% protein, 20% fat, 13% net carbs and 8% fibre.  While this may seem high, as we will see in the ‘calorie math’ section below, it becomes more reasonable once we account for the energy from body fat.

Vegetables

It would be hard to imagine getting fat by overeating the vegetables listed below.

Maximising your intake of these vegetables will ensure you are getting adequate vitamins and minerals and hence maximise your chance of long-term success.

While these vegetables have a very high nutrient density score (ND) in terms of nutrients per calorie, they also have a low energy density which means you need to eat a lot of them to get the nutrients you need.

The downside of vegetables is that they can be expensive and take time to prepare fresh.

food % protein ND calories/100g MCA
watercress 60%  25  11  3.1
spinach 41%  23  23  2.9
seaweed (laver) 50%  22  35  2.7
asparagus 34%  21  22  2.7
basil 44%  20  23  2.5
endive 25%  19  17  2.5
white mushroom 43%  19  22  2.4
brown mushrooms 36%  18  22  2.4
portabella mushrooms 36%  18  29  2.4
Chinese cabbage 42%  17  12  2.3
lettuce 30%  16  15  2.2
coriander 31%  16  23  2.1
chicory greens 24%  16  23  2.1
alfalfa 52%  16  23  2.1
spirulina 64%  16  26  2.1
chard 30%  15  19  2.1
zucchini 24%  15  17  2.1
seaweed (wakame) 22%  15  45  2.0
parsley 27%  15  36  2.0
escarole 25%  15  19  2.0
okra 27%  15  22  2.0
beet greens 32%  14  22  2.0
shiitake mushroom 29%  15  39  2.0
turnip greens 36%  14  29  1.9
chives 35%  14  30  1.9
broccoli 23%  14  35  1.8
mung beans 35%  13  19  1.8
arugula 33%  12  25  1.7
dill 27%  12  43  1.7
cauliflower 26%  12  25  1.7
celery 16%  11  18  1.6
summer squash 18%  10  19  1.5
seaweed (kelp) 13%  11  43  1.5
yeast extract spread 52%  12  185  1.5
radicchio 22%  9  23  1.4
pickles 14%  9  12  1.4
cucumber 14%  9  12  1.4
mustard greens 34%  9  27  1.4
peas 26%  9  42  1.4
snap beans 18%  9  15  1.4
collards 27%  9  33  1.3
cabbage 18%  8  23  1.3
soybeans (sprouted) 34%  8  81  1.2
onions 19%  7  32  1.2
pumpkin 12%  7  20  1.2
kale 23%  7  28  1.2
radishes 16%  7  16  1.2
banana pepper 21%  7  27  1.2
bamboo shoots 43%  7  11  1.2
Brussel sprouts 28%  7  42  1.1
edamame 37%  8  121  1.1
artichokes 23%  6  47  1.1
sauerkraut 17%  5  19  1.0
red peppers 13%  6  31  1.0
eggplant 13%  5  25  1.0
chayote 9%  5  24  1.0

Animal products

These animal products are both nutrient dense and have a low energy density compared to fattier cuts of meat.  While the nutrient density scores are not as high as for the vegetables, the energy density is higher so you will be able to get more nutrients in using these foods.

food % protein ND calories/100g MCA
lamb kidney 71%  19  112  2.2
chicken liver 62%  19  172  2.2
beef liver 63%  18  175  2.1
veal liver 61%  18  192  2.0
lamb liver 61%  17  168  2.0
turkey liver 59%  17  189  2.0
ham (lean only) 73%  16  113  1.9
pork liver 66%  16  165  1.9
beef kidney 70%  15  157  1.7
chicken breast 79%  13  148  1.6
pork chop 75%  13  172  1.5
veal 84%  12  151  1.5
pork shoulder 74%  12  162  1.4
lean beef 79%  11  149  1.4
leg ham 74%  11  165  1.4
ground pork 69%  11  185  1.4
turkey heart 60%  11  174  1.3
lamb heart 65%  11  161  1.3
beef tripe 74%  9  103  1.3
ground beef 76%  10  144  1.2
sirloin steak 73%  10  177  1.2
beef heart 70%  10  179  1.2
turkey meat 66%  10  158  1.2
turkey drumstick 66%  10  158  1.2
bison 69%  9  171  1.1
chicken liver pate 27%  9  201  1.1
turkey gizzard 72%  8  155  1.1
lamb sweetbread 59%  8  144  1.0
chicken drumstick 62%  8  149  1.0
veal loin 63%  8  175  1.0
roast pork 53%  8  199  1.0

Seafood

Omega 3 fats (EPA, DHA and ALA) are essential and harder to get so you should prioritise fish in your nutrient dense PSMF.

food % protein ND calories/100g MCA
crab 91%  20  83  2.4
fish roe 58%  19  143  2.2
crayfish 86%  18  82  2.2
lobster 91%  18  89  2.2
halibut 86%  17  111  2.1
pollock 90%  16  111  1.9
salmon 68%  16  156  1.9
rockfish 86%  15  109  1.9
flounder 74%  14  86  1.8
oyster 46%  14  102  1.8
shrimp 81%  14  119  1.8
haddock 92%  14  116  1.8
perch 81%  14  96  1.7
cod 92%  16  290  1.7
sturgeon 64%  14  135  1.7
whiting 86%  13  116  1.6
trout 59%  13  168  1.6
octopus 77%  13  164  1.5
white fish 92%  12  108  1.5
anchovy 57%  13  210  1.5
clam 72%  12  142  1.5
tuna 68%  11  184  1.3
scallop 74%  9  111  1.3
caviar 36%  11  264  1.2
orange roughy 92%  8  105  1.2
sardine 49%  10  208  1.2
molluscs 86%  8  130  1.1

Egg and dairy

Eggs are nutritious.  Only a couple of low fat dairy products make the list.  Higher fat foods such as butter and cream need to be minimised on a PSMF to allow your body to use the fat from your butt and your belly.

food % protein ND calories/100g MCA
cream cheese (low fat) 61%  11  105  1.5
whole egg 36%  9  143  1.2
egg white 91%  7  52  1.1
cottage cheese (low fat) 51%  7  81  1.1

These nutrient dense PSMF foods are summarised in this image for easy reference.

Calorie math

To make this a little more practical let’s look at some calorie math using a hypothetical scenario.

Let’s say Super Ted is looking to get shredded for the Ketogains conference in two weeks where he wants to pose for shirtless but also wants to stay strong and to win the arm wrestle and beat the reigning champion, Mighty Mouse.

Super Ted currently weighs 160 lbs or 73kg and has 10% body fat.  His maintenance energy intake is 2336 cal/per day.

While getting the majority of your energy intake from protein might seem excessive…

… it’s not so dramatic when you also take into account the body fat being burned.

Between the 8% dietary fat (8%) his body fat stores (60%) Super Ted will be getting a ketogenic level of 68% of his energy from fat while also adequate protein to maintain his muscles and enough carb containing vegetables to get the vitamins and minerals that are also critical to his long-term success.

The details of the calorie math are shown below.  Once you take the energy deficit into account Super Ted is consuming 2.2g/kg LBM.

body weight (kg) 73
body weight (lbs) 160
body fat (%) 10%
lean body mass (kg) 62
maintenance (cal) 2336
deficit 60%
diet (calories) 934
protein (% diet) 59%
fat (% diet) 20%
net carbs (% diet) 13%
diet protein (g) 138
dietary fat (g) 21
body fat (g) 156
body fat (kg/week) 1.1
net carbs (g) 30
fibre (g) 19
protein (% energy burned) 24%
dietary fat (% energy burned) 8%
carbohydrate (% energy burned) 5%
protein (g/kg LBM) 2.2

These calculations assume that Super Ted’s insulin levels are going to be low enough to allow him to yield a significant amount of energy from his body fat stores.   Similar to fasting, it may take a few days before glycogen stores to be depleted enough for his insulin levels to drop which will allow his fat stores to more easily flow out of storage.  

These calculations also do not account for the metabolic slowdown that you will get during long term energy restriction.  This is the same with any way of eating that consciously restricts energy intake.  However, I think if we can minimise nutrient deficiencies we will have a better chance of avoiding an increase in which could drive our body to seek out the missing nutrients that it is not getting enough of.  

When you look at his Nutrient Optimiser analysis, you see that Ted Naiman (aka Super Ted) is actually consuming 2.4g/kg LBM.

Meanwhile, Luis Villasenor (aka Mighty Mouse) is also consuming protein at 2.4g/kg LBM during his PSMF.  Luis says his regular protein intake is around 140g increases this up to 180g during a strict PSMF.

Insulin resistant long-term fat loss scenario

For most of us, such an aggressive fat loss approach might be hard to maintain long-term.  So, let’s consider another scenario with another hypothetical character.

Introducing…  Big Ted.

As you can see, Big Ted doesn’t post shirtless for photos on the internet.

At 110kg and 30% body fat Big Ted is far from shredded.

Big Ted is also pre diabetic.

His doctor has warned him that if he doesn’t lose a significant amount of weight he will need to take Metformin and then insulin before too long.

Big Ted is motivated to drop a large amount of weight with perhaps a calorie deficit of 30% which will take him about 30 weeks to get to his goal weight of 90kg.

We can refine Big Ted’s PSMF approach given that his circumstances and goals are different from Super Ted’s.

Nutrients to prioritise

Given Big Ted is not looking to be as dramatically calorie restricted we only need to prioritise the following nutrients.

  1. Alpha-linolenic acid
  2. EPA + DHA
  3. Choline
  4. Vitamin D
  5. Vitamin E
  6. Calcium
  7. Magnesium
  8. Potassium
  9. Phosphorus
  10. Zinc

Although amino acids are not prioritised the resultant list of foods is still 36% protein, 30% fat and 20% net carbs.

Rather than just prioritising nutrient density and energy density, this scenario also prioritises a lower insulin load given Big Ted’s looming pre diabetes situation.

This is basically a hybrid between a PSMF and a low carb diet.

The chart below shows the nutrient profile of these foods once we take a 30% energy deficit into account.  Big Ted will be meeting the DRI for all his nutrient other than Omega 3s which he may need to supplement.

Calorie math

The charts below show the energy consumed and energy burned.

There is a significant amount of fibre which will not be metabolised for energy but rather feed his gut bacteria.  There is still a solid amount of net carbs from veggies. However, there is no sugars or processed grains to be seen, so they’re not about to boost his insulin or send him on a blood sugar roller coaster.

Once his body fat loss is accounted for, half of Big Ted’s energy expenditure is still coming from fat.

Although we didn’t prioritise amino acids we still get a solid 2.2g protein per kilogram LBM.

body weight (kg) 110
body weight (lbs) 242
body fat (%) 30%
lean body mass (kg) 77
maintenance (cal) 3000
deficit 30%
diet (cals) 1875
protein (% diet) 36%
fat (% diet) 30%
net carbs (% diet) 20%
fibre (%) 14%
diet protein (g) 169
dietary fat (g) 63
body fat (g) 100
body fat (kg/week) 0.7
net carbs (g) 94
fibre (g) 66
protein 23%
dietary fat 19%
carbohydrate 13%
protein (g/kg LBM) 2.2

Optimal foods for Big Ted are listed below.

Vegetables

food % protein ND calories/100g MCA
endive 25% 11 17 2.5
chicory greens 24% 11 23 2.4
coriander 31% 10 23 2.2
escarole 25% 9 19 2.1
spinach 41% 12 23 2.1
basil 44% 11 23 2.0
alfalfa 52% 7 23 2.0
zucchini 24% 9 17 1.9
chard 30% 11 19 1.9
arugula 33% 10 25 1.9
beet greens 32% 8 22 1.9
mustard greens 34% 8 27 1.8
watercress 60% 12 11 1.7
asparagus 34% 9 22 1.7
parsley 27% 9 36 1.7
Chinese cabbage 42% 9 12 1.6
curry powder 14% 6 325 1.6
collards 27% 7 33 1.6
summer squash 18% 8 19 1.6
lettuce 30% 8 15 1.6
paprika 15% 7 282 1.6
turnip greens 36% 7 29 1.5
broccoli 23% 8 35 1.5
cloves 6% 7 274 1.4
sauerkraut 17% 6 19 1.4
banana pepper 21% 5 27 1.4
okra 27% 7 22 1.4
pickles 14% 5 12 1.4
cucumber 14% 5 12 1.4
chives 35% 7 30 1.3
celery 16% 7 18 1.3
brown mushrooms 36% 10 22 1.3
sage 11% 5 315 1.3
artichokes 23% 6 47 1.3
marjoram 14% 5 271 1.3
thyme 10% 6 276 1.3
cauliflower 26% 6 25 1.3
edamame 37% 5 121 1.2
portabella mushrooms 36% 7 29 1.2
radishes 16% 5 16 1.2
eggplant 13% 4 25 1.2
cabbage 18% 6 23 1.2
blackberries 11% 3 43 1.2
shiitake mushroom 29% 6 39 1.1
radicchio 22% 8 23 1.1
jalapeno peppers 12% 3 27 1.1
caraway seed 19% 4 333 1.1
chayote 9% 4 24 1.1
rhubarb 15% 5 21 1.0
avocado 5% -0 160 1.0
snap beans 18% 6 15 1.0
red peppers 13% 3 31 1.0
olives 3% -1 145 1.0
turnips 26% 5 21 1.0
white mushroom 43% 7 22 1.0
dill 27% 6 43 1.0
poppy seeds 13% 3 525 1.0
kale 23% 5 28 0.9
seaweed (kelp) 13% 8 43 0.9
raspberries 8% 1 52 0.9
seaweed (laver) 50% 8 35 0.9
soybeans (sprouted) 34% 4 81 0.9
seaweed (wakame) 22% 8 45 0.9
Brussel sprouts 28% 4 42 0.9
celery flakes 14% 6 319 0.9
cumin 16% 4 375 0.8
bamboo shoots 43% 3 11 0.8
carrots 6% 3 37 0.8
onions 19% 5 32 0.8
carrots 9% 5 23 0.8
dill seed 15% 3 305 0.7
mustard seed 19% 2 508 0.7

Animal products

food % protein ND calories/100g MCA
beef brains 32% 5 151 1.5
turkey ham 63% 4 124 1.0
lamb brains 36% 2 154 1.0
lamb sweetbread 59% 4 144 0.9
turkey (skinless) 72% 3 170 0.8
turkey liver 59% 4 189 0.8
ground turkey 39% 2 258 0.8
lamb liver 61% 4 168 0.8
turkey drumstick (with skin) 50% 1 221 0.8
turkey bacon 29% 0 226 0.8
headcheese 36% –       0 157 0.8
lamb kidney 71% 4 112 0.8
turkey heart 60% 3 174 0.8
sweetbread 16% –       1 318 0.7

Seafood

food % protein ND calories/100g MCA
fish roe 58% 9 143 1.6
oyster 46% 10 102 1.5
mackerel 25% 4 305 1.4
caviar 36% 6 264 1.4
molluscs 86% 8 130 1.4
crab 91% 10 83 1.3
sardine 49% 6 208 1.2
flounder 74% 7 86 1.2
trout 59% 6 168 1.2
cisco 38% 4 177 1.2
sturgeon 64% 6 135 1.2
crayfish 86% 8 82 1.2
salmon 68% 7 156 1.2
lobster 91% 9 89 1.1
halibut 86% 8 111 1.1
anchovy 57% 5 210 1.0
perch 81% 7 96 1.0
herring 47% 4 217 1.0
rockfish 86% 7 109 1.0
pollock 90% 7 111 1.0
cod 92% 8 290 0.9
shrimp 81% 7 119 0.9
whiting 86% 6 116 0.8
white fish 92% 6 108 0.8
haddock 92% 6 116 0.7

Egg

food % protein ND calories/100g MCA
egg yolk 21% 4 275 1.4
whole egg 36% 4 143 1.3

Nut sand seeds

food % protein ND calories/100g MCA
tofu 43% 3 83 1.0
sunflower seeds 13% 2 546 0.9
pumpkin seeds 20% 3 559 0.8
flax seed 13% 1 534 0.8
almonds 13% 2 607 0.7

This image below summarises these foods for easy reference.

The nutrient profile of these foods is also excellent.  These foods will help Big Ted to minimise his chance of developing nutrient deficiencies which may lead to rebound binge eating and derail his long term weight loss efforts.

How often should I eat on a PSMF?

Big Ted is fond of intermittent fasting.  He finds it easier to not eat for a day or two and then eat to satiety rather than trying to count calories or restrict energy.

Meanwhile, Super Ted likes to eat two meals per day which save him time and helps him not overeat.

Personally, I don’t think it matters exactly when you eat as long as you stick to the foods that align best with your goals.  Recent research suggests that in the fasted state we can use up to 3.5 g/kg/day and digest up to 4.3 g/kg/day.[25]  This makes sense in an evolutionary context when there wouldn’t have been a regular supply of food but we would have needed to be able to use the food when we came across a big hunt after a long famine.

Either Super Ted or Big Ted could still utilise their required protein intake if they followed an alternate day fasting or 5:2 plan or indeed any other permutation of fasting.  What is important though is that they ensure that they stick to their nutrient dense diet when they break their fast rather than reaching for the more energy dense foods when they eat again.

How low can you go?

Hopefully, this article has given you some actionable principles:

  • During weight loss, you should ensure that you get adequate protein while fat and carbs can be limited to achieve the energy deficit required to suit your target rate of loss.
  • As well as protein intake, we should aim to maximise all micro nutrients (vitamins, minerals, essential fatty acids and amino acids) ideally using whole foods.
  • You will find it hard to obtain adequate vitamins, minerals and essential fatty acids at one extreme or the other of protein intake.

As discussed in the ‘How Much Protein is Too Much’ article I noted that the minimum intake of protein and minimum essential fats tally up to around 314 calories as shown in the table below.

If we could stick to this approach, we would have a massive and highly ketogenic 85% of our energy coming from our body fat.  However, you would be at an increased risk of inadequate vitamins, mineral and fatty acids with such a low energy intake.

macro DRI (g) DRI (calories) % energy
minimum protein 56 224 71%
essential fats 10 90 29%
total 66 314 100%

If you’re starving to death and only have lean protein available you might call it “rabbit starvation”.  However, if you still have plenty of body fat to burn it’s a PSMF.

#context matters


PSMFs for aggressive weight loss in a medical context generally aim for around 800 calories per day.

Lyle McDonald suggests that people following a PSMF for aggressive weight loss over a short period (e.g. cutting in the lead up to a bodybuilding show) might be eating between 400 and 800 calories per day.

Each person needs to find the ideal approach that they can live with in the long-term.

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How to do a nutrient dense PSMF

  • Eat mostly foods from the lists below.  
    • The nutrient dense PSMF diet foods are ideal for aggressive short term weight loss (i.e. leading up to a bodybuilding comp).
    • The nutrient dense weight loss foods for insulin resistance may be more appropriate if you have more weight to lose over a longer period.
    • Minimum protein intake in a weight loss clinic setting is 1.2g/kg total body weight.
    • Appetite will likely drive you to eat more protein if you are working out.   2.4g/kg lean body mass is typical for someone lifting heavy.
    • The highest protein foodcan be used to increase protein intake if required.
    • Focusing on these foods will ensure you still get adequate protein as well as vitamins and minerals while minimising energy consumption.
    • Limit carbs to what comes with non-starch veggies (i.e. no processed grains or sugars).
    • Limit fat to what comes with the lean protein foods.
  • Don’t eat too much
    • It will be hard to overeat these high nutrient density low energy density foods.
    • You may not have to consciously limit your food intake if you can focus only eat these foods.
    • It may be beneficial to track or plan your energy intake to achieve your goals.
    • Ratchet down your energy intake until you achieve your desired rate of weight loss.
  • Lift heavy / exercise (optional)
    • Working out will help you to use the protein to build lean muscle and keep your metabolic rate up.
  • Repeat 

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Summary

  • The protein sparing modified fast (PSMF) provides adequate levels of protein to support lean muscle mass while restricting energy from carbohydrates and fat.
  • Protein intakes vary widely depending on the goals and the level of energy restriction between.
  • Providing adequate nutrients, ideally from whole foods, is critical to long term weight loss and maintenance.
  • Just maximising protein may not provide optimal levels of vitamins and minerals. Therefore, it’s important to prioritise nutrient dense foods to improve your chances of long-term success.
  • While the PSMF is commonly used in weight loss clinics and in the bodybuilding community, the principle can also be applied in other situations.

 

References

[1] http://www.mdedge.com/ccjm/article/96116/diabetes/protein-sparing-modified-fast-obese-patients-type-2-diabetes-what-expect

[2] https://www.ncbi.nlm.nih.gov/pubmed/9149474

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4784653/ama

[4] https://www.ncbi.nlm.nih.gov/pubmed/4037162

[5] http://www.mdedge.com/ccjm/article/96116/diabetes/protein-sparing-modified-fast-obese-patients-type-2-diabetes-what-expect

[6] https://www.ncbi.nlm.nih.gov/pubmed/24513578

[7] http://www.mdedge.com/ccjm/article/96116/diabetes/protein-sparing-modified-fast-obese-patients-type-2-diabetes-what-expect

[8] https://www.dropbox.com/s/rjfyvfsovbg9fri/The%20protein-sparing%20modified%20fast%20for%20obese%20patients%20with%20type%202%20diabetes%20What%20to%20expect.pdf?dl=0

[9] http://www.mdedge.com/ccjm/article/96116/diabetes/protein-sparing-modified-fast-obese-patients-type-2-diabetes-what-expect

[10] http://www.nature.com/ejcn/journal/v71/n3/full/ejcn2016256a.html

[11] http://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2005.00178.x/abstract

[12] https://www.dropbox.com/s/zej4razn4dn993y/protein%20leverage%20hypothesis%20-%20simpson2005.pdf?dl=0

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

[14] https://www.ncbi.nlm.nih.gov/pubmed/15466943

[15] https://en.wikipedia.org/wiki/Specific_dynamic_action

[16] http://physiqonomics.com/calories-child-friendly-version/

[17] http://www.biologydiscussion.com/biochemistry/energy-production/specific-dynamic-action-factors-and-example-energy-production/43998

[18] https://optimisingnutrition.com/2017/05/27/is-there-a-relationship-between-macronutrients-and-diet-quality/

[19] http://www.dietsinreview.com/diets/last-chance-diet/

[20] https://www.amazon.com/Last-Chance-Diet-When-Everything-Failed/dp/0818402393

[21] http://www.bodyrecomposition.com/the-rapid-fat-loss-handbook/

[22] https://www.ncbi.nlm.nih.gov/pubmed/19692494

[23] http://ajcn.nutrition.org/content/90/4/889.full.pdf+html

[24] https://optimisingnutrition.com/2017/05/27/is-there-a-relationship-between-macronutrients-and-diet-quality/

[25] http://www.sciencedirect.com/science/article/pii/S0261561417302030

 

post updated July 2017

how much protein is too much?

Now that fat is out of the spotlight, the focus for many in low carb and vegan circles has turned to protein as the macronutrient that needs to be avoided for health, good blood sugar control and longevity.

At the same time there are still are plenty of ‘meat heads’ who say that their ‘brotein’ can do no wrong and you can’t get enough of it.

In the sea of conflicting opinions and advice, how do we determine the optimal amount of protein that will suit our situation, goals and needs?

How much protein do we need?

How much is too little protein?

How much protein is too much?

This is an intriguing, controversial and multifaceted discussion.

So hold on as I try to unpack the various perspectives!

Typical guidance

First, let’s look at the general recommendations for protein intake.

Lean body mass

Protein recommendations are often given in terms of grams per kilogram of lean body (LBM) where “LBM” is your current weight minus your fat mass.

Protein is required to support your muscles, not your fat.

You can use a DEXA scan, bioimpedance scale or pictures (like the ones below) to estimate your level of body fat (% BF) and then calculate your LBM using the following formula:

lean body mass (LBM) = body weight weight x (100% – %BF) / 100%. 

None of these methods are particularly accurate.  However, calculating your body fat levels or protein intake to a high degree of accuracy is not necessary for most people.

Absolute minimum protein requirement

According to Cahill’s starvation studies[1] we burn around 0.4g/kg LBM per day of protein via gluconeogenesis during long term starvation.

After we burn through the food in our stomach and then the glycogen stored in our liver and muscle, the body will turn to its own internal protein stores (i.e. muscles, organs etc) and, to a lesser extent, fat (glycerol backbone) to obtain glucose via gluconeogenesis.

The figure below shows that we use less protein the longer we go without food.  After a couple of days of no food, fat and ketones kick in to supply the energy deficit.

People with better insulin sensitivity may burn through less protein as they are able to access their body fat stores for energy more easily when they go without food.  However, people who are lean and insulin sensitive may have less body fat to burn before the body will turn to protein during fasting.  Hence, extended fasting is not typically recommended if you are super lean.

Gluconeogenesis peaks at around two days and decreases thereafter as insulin levels decrease  and ketones rise further.  While chronic muscle loss is bad news (sarcopenia), particularly in old age, short term gluconeogenesis and autophagy is not necessarily a bad thing as the body will ‘self eat’ and clean out the old and sick and superfluous parts of the body for fuel.

After a fast the body is primed and highly insulin sensitive and ready to build new muscle.   Fasting can actually be beneficial for gaining muscle provided that the refeed has adequate amounts of amino acids to support muscle growth.

Daily recommended protein intake

The Daily Recommended Intake (DRI) for protein is 0.84g/kg of body weight (BW) while the Estimated Average Requirement (EAR) is 0.68 g/kg BW.[2]

This minimum protein level is based on nitrogen balance studies that indicate that if healthy test subjects eat less than around 0.6 g/kg BW you will be losing muscle and be at risk of the various diseases of malnutrition and then factored up to 0.8 g/kg BW as a factor of safety.[3] [4] [5] [6] [7]

Keep in mind though that the DRI is a recommended minimum per day to prevent diseases related to protein deficiency.  This is not necessarily optimal.

More recent studies have indicated that higher quantities of protein may be necessary, particularly for older people.[8] [9] [10] [11] [12] [13]

Older people appear to require 1.0 to 1.3 g per kilogram of total body mass per day protein to optimize physical function, particularly whilst undertaking resistance exercise recommendations.[14]

As discussed in the article Is there any relationship between macronutrients and diet quality (micronutrients) it’s actually quite hard to achieve adequate levels of vitamins and minerals while also hitting these minimum DRI levels.

According to Simpson and Raubenheimer in Obesity: the protein leverage hypothesis (2005) people with diabetes may actually need to eat more protein to ensure that they have adequate levels to build lean muscle mass given that gluconeogenesis can be higher due to insulin resistance.

Keep in mind too that minimum protein recommendations are given in terms of total bodyweight, not lean body mass.  For someone with 30% body fat 0.8g/kg BW will convert to 1.1 g/kg LBM.

If you fast for a day or two you should consider compensating with more protein on your feasting days.  If you are fasting for fat loss there is no need to replace additional fat when you feast.

DRI for individual amino acids

If we dig a little deeper we see that there are also requirements for individual amino acids as shown in the table below.[15] [16]  Depending on what you’re eating you can be deficient in some amino acids while getting enough other amino acids.

 

Amino acid(s) mg per kg body weight mg per 70 kg mg per 100 kg
Histidine 10 700 1000
Isoleucine 20 1400 2000
Leucine 39 2730 3900
Lysine 30 2100 3000
Methionine Cysteine 10.4 + 4.1 (15 total) 1050 1500
Phenylalanine + Tyrosine 25 (total) 1750 2500
Threonine 15 1050 1500
Tryptophan 4 280 400
Valine 26 1820 2600

The Nutrient Optimiser reviews the individual amino acids to make sure they are all adequate.     People who are running close to the minimum DRI for protein overall are typically deficient in a handful of individual aminos.

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Typical protein intake

The average protein intake for the general western population is about 1.2 g/kg LBM or around 16% of calories.[17]  This is greater than the minimum required to maintain nitrogen balance in the figure above and the DRI values.

It seems that most people get enough protein without trying too hard.   However, what constitutes as “enough” protein will vary depending on whether you are going through puberty, weight lifting,a middle aged sedentary office worker or an elderly person in a nursing home.

Appetite is a strong drive that ensures that you don’t stop eating until you get enough protein.  Average protein intake seems to be consistent across cultures and time.[18]

Practical maximum protein intake

Recent research indicates that, when fasted, we can use up to 3.5g/kg/day and breakdown and metabolise up to 4.3g/kg/day.[19]  This makes sense in an evolutionary context where would be primed to use a lot of protein after going without and then making up for lost time after a successful hunt.

Rabbit starvation’ is said to occur when people only have lean protein available and just can’t get enough calories in because they are eating only lean protein.  However, I have seen people eat higher levels of protein in an energy excess situation when they are trying to gain weight (e.g. Andy Mant who is trying to gain size eating and muscle 4.4g/kg LBM or Bailan Jones who is a growing young man with type 1 diabetes at 5.0g/kg LBM).

From a pure calorie standpoint we could theoretically eat up to around 7g/kg LBM using very protein foods.   However, most people will struggle to eat more than 3.5g/kg LBM because protein is very satiating and it is hard to find protein containing foods that don’t come with substantial amounts of fat.

The chart below shows the nutrient score for the highest protein 10% of the foods in the USDA database.  What we can see is that high protein foods provide a ton of amino acids while lacking key vitamins and minerals.  This is not an optimally balanced diet at a micronutrient level.  Rather than worrying specifically about ‘too much protein’ I think it’s more useful to think in terms of getting the range of micronutrients you need without having to consume excess energy.

I think the real problem eating ‘too much protein’ is that once our protein goes too high we end up reducing the amount of vitamins, minerals and essential fatty acids that our food contains.  While it is important to get adequate amino acids, it is also important to get adequate vitamins, minerals and essential fatty acids.

It’s also worth keeping in mind that protein has a net acidic load that the body needs to balance to maintain acid/base homeostasis.  If we eat a lot of protein without adequate amount of alkalising minerals (e.g. potassium, magnesium, phosphorus and calcium) our kidney may struggle to maintain an optimal pH balance which can lead to low level metabolic acidosis in the long term.[20] [21]

How will you spend your “discretionary calories”?

I think it’s important to keep in mind that the DRIs for protein are a minimum to prevent disease and should not be treated as optimal targets or maximum values.  Finding the right balance of all the essential nutrients is quite a balancing act.

In this video Dr Donald Layman points out that if we targeted the minimum DRI for protein, carbs and fat we would end up with only eight hundred calories per day whereas, on average, we eat around 2300 calories per day.  Hence, there is a window of “discretionary calories” that we can chose how we fill to make up our daily energy requirements.

People in low carb circles are fond of saying ‘there is no such thing as an essential carbohydrate’.  So, once we cut the carbs out we are left with only 314 calories to meet our essential macronutrient requirements as shown in the table below.

macro DRI (g) DRI (calories) % energy
minimum protein 56 224 71%
Essential fats 10 90 29%
total 66 314 100%

Now this might be reasonable if we were minimising calories for weight loss (e.g. we could try to live on protein powder and Omega 3 capsules).  However, this this would be impossible to achieve with whole food.

Discretionary calories from body fat

The chart below shows the break up of energy sources if we were living on the minimum DRI for protein and essential fatty acids.  85% of our energy would be coming from our body fat stores.  This would be the ultimate protein sparing modified fast (PSMF) however there is a pretty good chance we would struggle to obtain adequate levels of vitamins and minerals from 300 calories.

Then once we reached our goal weight we would need to work out what we are going to fill the rest of our intake with to prevent drastic weight loss (and literally starving to death)?

From carbs

Another option is to fill the window of ‘discretionary calories’ with carbohydrates which would look like this.

macro DRI (g) DRI (cals) % energy
protein 56 224 10%
carbs 497 1986 86%
fats 10 90 4%
total 563 2300 100%

From protein

Filling your energy deficit with protein would be impossible in terms of available foods (even with protein powders which are only 80% protein) as well as the strong satiety that would kick in well before then.

macro DRI (g) DRI (cals) % energy
protein 545 2181 91%
carbs 7 29 5%
fats 10 90 4%
total 250 2300 100%

From fat

The other option is to fill the remaining energy deficit with dietary fat.  This looks like a therapeutic ketogenic macro ratios.  This will be difficult without consuming the majority of your energy intake from butter, cream and MCT oil.

macro DRI (g) DRI (cals) % energy
protein 56 224 10%
carbs 7 29 5%
fats 227 2047 85%
total 291 2300 100%

Optimising for micronutrients and insulin load

My suggestion is to look to fill your remaining energy requirements with foods that provide the micronutrients you need while keeping an eye on the insulin load of your diet.

Keeping your blood sugar and insulin levels down will help normalise appetite and access your own fat stores for fuel.

However, ensuring that you are getting the micronutrients you need will help you prevent nutrient cravings with less energy which will be ideal for optimising longevity, insulin resistance and blood sugar levels.

How much protein are real people actually eating?

Protein in real life varies significantly, as evidenced by the fifty or so people on whom I have run the Nutrient Optimiser analysis.   As you can see in the table below, protein intake in real life is highly variable.  The average protein intake amongst these people who are generally following a low carb diet is 2.1g/kg LBM.

Name score protein (g/kg LBM) protein (%) fat (%) fibre (%) net carbs (%)
Rhonda Patrick 82% 2.5 17% 57% 10% 15%
Briana Theroux-Hulsey 79% 3.5 29% 21% 15% 35%
David Houghton 77% 0.6 17% 2% 21% 60%
Andy Mant v3 77% 4.4 27% 53% 5% 15%
Alber Van Zyl 75% 1 15% 77% 2% 6%
Alma Fuente 75% 5.3 27% 60% 7% 6%
Mike Berta 74% 2.1 31% 58% 4% 7%
Alex Leaf 74% 3.3 33% 26% 10% 32%
Alex Ferrari 74% 2 17% 54% 6% 24%
Deb Pinsky Lambert v2 72% 1.2 31% 61% 3% 6%
Luis Villasenor 72% 2.4 43% 48% 3% 5%
Gayle Louise 71% 2.4 40% 49% 4% 7%
Ted Naiman 70% 2.4 24% 64% 5% 7%
Andy Mant v2 70% 3 26% 54% 6% 15%
Robin Reyes v3 69% 1.6 18% 67% 6% 8%
Ruth Jamieson v2 66% 1.6 18% 67% 6% 8%
Amy 65% 3.3 41% 57% 0 1%
Paul Burgess 64% 1.9 28% 46% 6% 19%
Chris Hobson 63% 2.3 27% 63% 3% 8%
Ingunn Lovik 62% 1.5 21% 70% 1% 8%
Sophia Thom 62% 1.1 24% 65% 4% 7%
James DiNicolantonio 62% 3.3 26% 53% 5% 16%
Franziska Spritzler 61% 2.3 27% 55% 10% 8%
Sarah Koenck 58% 2.2 14% 77% 4% 6%
Ruth Jamieson v1 57% 1.4 19% 65% 7% 9%
Maria Fornarciari 52% 1.6 30% 61% 3% 6%
Matija Mlakar 50% 2.1 23% 49% 11% 17%
Nicole Jacobi 48% 2.8 32% 60% 3% 6%
Graeme Monteith 48% 2.6 18% 67% 5% 10%
Dave Knowles 46% 2.4 31% 63% 2% 3%
John Robertson 46% 1.4 16% 59% 4% 21%
Leah Williamson 44% 1.8 19% 75% 2% 3%
Nicole Ricine 43% 2.1 18% 79% 1% 2%
Balin Jones 43% 5 26% 66% 3% 5%
Kevin Tunis 37% 1.2 17% 76%% 1%% 7%%
Andy Mant v1 34% 3.7 35% 54% 2% 9%
George 34% 0.8 9% 69% 9% 12%
Robin Reyes v2 32% 1.6 21% 59% 4% 15%
Lorraine Ayre 30% 1.3 19% 64% 5% 12%
Terry Palmer 29% 1.5 25% 62% 5% 8%
Paul Stansel 28% 1.5 18% 77% 2% 3%
Gigi Giodani 26% 1.6 15% 81% 1% 2%
John Kerr 25% 0.7 11% 84% 2% 3%
Robin Reyes v1 23% 1.1 13% 50% 2% 35%
Bacon Man 22% 2.6 30% 69% 0% 1%
Patrick Butts v1 21% 0.8 18% 73% 4% 5%
Patrick Butts v2 20% 1.4 26% 66% 3% 6%
Harry Nguyen 20% 2.3 20% 72% 4% 4%
average 53% 2.1 24% 60% 5% 11%
25th percentile 34% 1.4 18% 54% 3% 6%
75th percentile 70% 2.5 28% 68% 6% 15%

I have also included the 25th and 75th percentiles, which indicate that half of these people were eating between:

  • 1.4 and 2.5g/kg LBM protein per day,
  • 18 and 29% energy from protein,
  • 54 and 67% energy from fat, and
  • 6 and 15% energy from net carbs.

Very few of these people are consuming anywhere near the minimum DRI levels for protein.  And the people who are the closest have some of the poorest nutrient scores.

Protein scales with activity levels

Unfortunately, simply eating protein doesn’t build muscles.  You also need to exercise to use the protein to build lean body mass (i.e. muscles).  If you’re active, you’ll need more protein for growth and repair of muscles.  If you’re sedentary you’ll need less.

There appears to be an upper limit to how much protein can be used for muscle protein synthesis (i.e. to grow and repair your muscles).  If you’re active, then it’s likely that your appetite for protein will increase to make sure you get these higher levels of protein to prevent muscle loss.

As shown in the figure below from Effects of Exercise on Dietary Protein Requirements (Lemon, 1999):[22] [23]

  • a strength athlete won’t stimulate more muscle protein synthesis by eating more than about 1.8 g/kg LBM;
  • an endurance athlete won’t trigger more muscle protein synthesis with more than around 1.4 g/kg LBM; and
  • someone who is sedentary won’t trigger more muscle protein synthesis with more than around 0.9 g/kg LBM.

So, if you are wanting to minimise energy intake while still building muscle you could use these values as a minimum protein intake.

is protein really a good source of energy?

We typically think in terms of the macronutrients, carbs, fat and protein as if they are all sources of energy.  However, there are some that argue that protein should not be considered be an energy source equivalent to carbs and fat.

Protein is critical for growth and repair of our muscles and organs and our neurotransmitters.[24]  While it is true that protein can be converted to glucose and ketones if required, the reality is that it is not easy for the body to do this![25]

The amount of energy lost in processing each macronutrient (i.e. the thermic effect of food or specific dynamic action) is shown in the table below.[26]  Compared to carbohydrate and fat, it takes a lot of energy to convert protein to glucose.  The body just doesn’t want to do it unless there is absolutely is no glucose available from any other sources.

macronutrient min max
carbohydrate 5% 15%
Protein 20% 35%
fat 5% 15%

Personally, I find that if I eat a lot of protein and not much else my appetite for carbs or fat will increase.  It seems that my body wants to use anything other than protein to replenish liver glycogen.  To quote Jason Fung:[27]

Why would your body store excess energy as fat, if it meant to burn protein as soon as the chips were down? Protein is functional tissue and has many purposes other than energy storage, whereas fat is specialised for energy storage.

Would it not make sense that you would use fat for energy instead of protein?  Why would we think Mother Nature is some kind of crazy? 

That is kind of like storing firewood for heat. But as soon as you need heat, you chop up your sofa and throw it into the fire. That is completely idiotic and that is not the way our bodies are designed to work.

oxidative priority

There is only a small capacity for protein storage in our blood stream and we waste around 25% of the energy from the protein as heat in processing it.  Hence, the body typically doesn’t drive us to overeat protein, but it can be used for fuel if there is nothing else to burn.   It makes sense that protein sends a strong satiety signal back to our brain once we have eaten as much as we can use.

It’s also useful to look at protein in terms of oxidative priority.  Craig Emmerich from mariamindbodyhealth.com has prepared the below refinement of Ray Cronise’s oxidative priority chart[28] (see Oxidative Priority, Meal Frequency, and the Energy Economy of Food and Activity: Implications for Longevity, Obesity, and Cardiometabolic Disease) by adding in ketones.

What this means is:

  1. The body will prioritise clearance of alcohol because there is no storage system for it.
  2. Similarly, the body will look to clear ketones from the system because there is minimal storage capacity for them in the blood.
  3. The body will look to clear protein that hasn’t been used for muscle repair and neurotransmitters for brain function.
  4. We will turn to glucose, for which we have a greater storage capacity in our liver, muscles and bloodstream.
  5. Lastly, once we have burned through all these other substrates, will we look to burn our fat, either dietary or the fat stored on our body.

So, if you want to burn body fat you need to limit alcohol, exogenous ketones, protein, carbohydrate and dietary fat.

Oxidative priority versus insulin load

I think Cronise’s oxidative priority concept is another way to look at the insulin load of our diet.

insulin load = carbohydrates – fibre + 0.56 * protein

Our body uses insulin to keep glycogen stored in our liver and fat in our adipose cells until the other fuels are used up.  There is no point in going out of our way to consume excessive protein because it takes more effort to burn through before we can get to the fat on our plate or our belly.   However, it is logical that our appetite switches off once we get enough protein because there is no room to store excess protein and it’s hard work to burn it.

but what about mTOR?

mTOR (mammalian target of rapamycin) controls our fuel flow and our appetite.  Similar to insulin and insulin-like growth factor (IGF-1), mTOR promotes growth.  Growth is good if we are a baby or a teenager.  But some people grow too much.

There is a limited number of times we can turn over our cells in our lifetime.  Constant periods of plenty without periods of restriction leads to continued growth of unwanted things like cancer.

Dr Ron Rosedale is a proponent of limiting protein in an effort to extend lifespan.

There have been a number of other proponents of limitation of animal protein in the vegan circle for some time. Dr Greger’s Plant Based NutritionFacts.org recommends limitation of methionine, leucine and isoleucine.

Dr Steven Gundry recommends a grain free high fat version of the protein restricted approach.

One option in response to this theory is to consistently restrict protein to achieve long term health.  Some people try to keep their protein low to ensure that they are always in a state of autophagy or muscle breakdown and self eating.

However, I don’t think chronic intentional protein restriction is necessarily optimal.  What we are aiming for is adequate, but not excessive, energy intake (including protein) without malnutrition (i.e. vitamins, minerals, aminos and essential fatty acids).

On top of this, balanced periods of feasting and fasting will allow autophagy and growth.

Before we had refrigerators

In the days before agriculture, fertilisers from fossil fuels, and even refrigerators in our homes (less than 100 years ago) our environment would enforce periods of growth and period of famine.

These days, we can source cheap food to keep on growing 24/7, 365 days a year.   We have no externally enforced periods of autophagy when we can clear the old and dying proteins in our body.

If we have growth interspersed with fasting, then we give the body a chance to build muscle and use protein for repair while also giving the body a chance to clean house and purge the dying white blood cells and burgeoning cancer cells before it gets ugly.

Your body will naturally crave more protein in periods of activity and repair and less in periods of inactivity.  If your appetite isn’t working as well as you’d like it to (i.e. you have more body fat than you would like), you can force a feast / fast cycle based on managing your weight or your blood glucose levels.

Like many things in life, optimal protein intake is a balance between extremes.  More is not necessarily better.  But less is not better either.  We want our body to thrive on enough, but not too much energy while still getting the micronutrients it needs.

Too much mTOR and IGF-1 can stimulate excessive growth and cancer while too little can lead to muscle loss, which does not support health in old age.[29]   The EAR and DRI for protein actually increase for people over 70 to prevent sarcopenia.  If you are lacking lean muscle mass then there is a greater chance you will not have great insulin sensitivity in old age.

If you are suffering from sarcopenia you may fall and break your hip and never get up again.  As shown in the figure below, too much or too little IGF-1 is not good.  As with most things, it’s a balance.

protein leverage hypothesis

Protein is critical to life so our appetite typically makes sure we get enough.  “Obesity: The protein leverage hypothesis[30] suggests that we keep eating until we get enough protein.  If we are getting plenty of protein then we will stop eating when we get enough energy and protein.

In the wild, animals have an innate sense of the nutrients they need and which foods will provide those requirements, whether they be protein, energy or other micronutrients.

While it’s easy to track macronutrients and calories, I think it’s often the body’s micronutrient needs that derail our calorie restriction efforts and aspirations.

Most of the food that is available to us these days is much more deficient in micronutrients than it once was, but at the same time it is flavoured and coloured to make it appear that it has heaps more nutrition than it actually does; so we keep on eating the food that is manufactured to look and taste good, all the while not getting the micronutrients we really need from the food, so we just keep eating.

We need a range of nutrients from our food to fuel our mitochondria so that it can efficiently burn through the food we eat, and not have it sit around in the blood.[31] [32]

For instance, the figure below from Spectracell shows the nutrients that are often missing in people with diabetes.[33]  We need all these nutrients from our food to support our mitochondria to effectively produce energy from our food and stop excess glucose and fatty, fatty acids and ketones building up in our blood stream.

action steps

It’s important to meet your minimum protein intake which may be higher if you are growing, older or active.

Once you’ve met the minimum intake of protein and essential fatty acids (about 314 calories per day) you need to decide what you are going to fill the rest of your “discretionary calories” with to prevent starvation.

If you are looking for therapeutic ketosis (i.e. for cancer, epilepsy, dementia, Alzheimer’s etc) then you may want to get the majority of your energy from fat while maintaining minimum protein levels and also staying in an energy deficit (see optimal foods for therapeutic ketosis).[34] [35]

If you’re managing diabetes and not looking to lose weight you will likely want to keep your carbohydrates low and get more of your energy from fat (see optimal foods for diabetes and nutritional ketosis).

If you’re wanting to lose body fat then perhaps you can count the energy from your body as part of your daily intake and try to maximise the nutrient density of the remaining intake.  That is, maximise nutrients with the minimum amount of energy intake (see optimal foods for fat loss).

summary

  • You can get too much protein but at the same time you can get too little protein.
  • Periods of feasting and fasting are beneficial rather than targeting chronic high or low protein.
  • It’s very hard to get a good balance of micronutrients with low protein. Protein tends to come packaged with other nutrients.
  • If you focus on micronutrients (vitamins, minerals, amino acids, fatty acids) then the macronutrients (carbs, fat and protein) largely look after themselves. We will get enough, but not excessive, amounts of protein.

 

references

[1] http://www.nejm.org/doi/full/10.1056/NEJM197003192821209

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

[3] http://ajcn.nutrition.org/content/77/1/109.full

[4] https://www.ketogenicforums.com/t/hobbit-vs-2-keto-dudes/10641/12

[5] http://www.ketogenic-diet-resource.com/daily-protein-requirement.html

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

[7] http://perfecthealthdiet.com/category/nutrients/protein/

[8] https://www.ncbi.nlm.nih.gov/pubmed/11382798

[9] https://www.ncbi.nlm.nih.gov/pubmed/23867520

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4623318/

[11] https://www.ncbi.nlm.nih.gov/pubmed/12626690

[12] http://ajcn.nutrition.org/content/99/4/891.long

[13] http://ajcn.nutrition.org/content/86/4/995.long

[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555150/

[15] http://apps.who.int/iris/bitstream/10665/43411/1/WHO_TRS_935_eng.pdf

[16] https://en.wikipedia.org/wiki/Essential_amino_acid

[17] http://ajcn.nutrition.org/content/87/5/1554S.full

[18] https://www.ncbi.nlm.nih.gov/pubmed/15836464

[19] http://www.sciencedirect.com/science/article/pii/S0261561417302030

[20] https://optimisingnutrition.com/2016/11/19/the-alkaline-diet-vs-acidic-ketones/

[21] https://www.youtube.com/watch?v=E44yCNpP8bs

[22] https://www.researchgate.net/publication/13445647_Effects_of_Exercise_on_Dietary_Protein_Requirements

[23] http://bayesianbodybuilding.com/the-myth-of-1glb-optimal-protein-intake-for-bodybuilders/

[24] https://www.ncbi.nlm.nih.gov/pubmed/7903674

[25] https://www.ncbi.nlm.nih.gov/m/pubmed/22215165/

[26] https://en.wikipedia.org/wiki/Specific_dynamic_action

[27] https://intensivedietarymanagement.com/fasting-and-muscle-mass-fasting-part-14/

[28] http://online.liebertpub.com/doi/pdf/10.1089/met.2016.0108

[29] https://academic.oup.com/jcem/article-lookup/doi/10.1210/jc.2011-1377

[30] http://onlinelibrary.wiley.com/doi/10.1111/j.1467-789X.2005.00178.x/full

[31] http://www.simonandschuster.com.au/books/The-Dorito-Effect/Mark-Schatzker/9781476724232

[32] https://www.researchgate.net/profile/Fred_Provenza

[33] https://naturallynourishedrd.com/wp-content/uploads/2013/09/Interactive-Library-Nutrient_Correlation_Wheels-2.pdf

[34] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263749/

[35] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215472/

why do my blood sugars rise after a high protein meal?

Complex issues often require more detail than you can pack into a Facebook post.

One such area of confusion and controversy is gluconeogenesis and the impact of protein on blood sugar and ketosis.

2017-06-03 02.27.38.png

Some common questions that I see floating around the interwebs include:

  • If you are managing diabetes, should you avoid protein because it can convert to glucose and “kick you out of ketosis”?

Imageresultforketonesglucose

  • If you’ve dropped the carbs and protein to manage your blood sugars, should you eat “fat to satiety” or continue to add more fats until you achieve “optimal ketosis” (i.e. blood ketone levels between 1.5 and 3.0mmol/L)?

  • Then, if adding fat doesn’t get you into the “optimal ketosis zone”, do you need exogenous ketones to get your ketones up so you can start to lose weight?

  • And what exactly is a “well formulated ketogenic diet” anyway?

This article explores:

  • the reason that some people may see an increase in their blood sugars and a decrease in their ketones after a high protein meal,
  • what it means for their health, and
  • what they can do to optimise the metabolic health.

Protein is insulinogenic and can convert to glucose

You’re probably aware that protein can be converted to glucose via a process in the body called gluconeogenesis.

Gluconeogenesis is the process of converting another substrate (e.g. protein or fat[1]) to glucose.

  1. Gluco = glucose
  2. Neo = new
  3. Genesis = creation
  4. Gluconeogenesis = new glucose creation

As shown in the table below, all but two of the amino acids (i.e. the building blocks of protein) can be converted to glucose.  Five others can be converted to either glucose or ketones depending on the body’s requirements at the time.

Once your body has used up the protein, it needs to build and repair muscle and make neurotransmitters, etc. any “excess protein” can be used to refill the small protein stores in the blood stream and replenish glycogen stores in the liver via gluconeogenesis.

The fact that protein can be converted to glucose is of interest to people with diabetes who go to great lengths to keep their blood sugar under control (e.g. taking medications, changing their diet, exercising, trying to lose weight, etc.).[2]

Someone on a very low carbohydrate diet may end up relying more on protein for glucose via gluconeogenesis.[3]  The benefit of getting more glucose from protein via gluconeogenesis rather than carbs is that it is a slow process and easier to control with measured doses of insulin compared to simple carbs which will cause more abrupt blood sugar rollercoaster.

How much insulin does protein require?

The food insulin index data[4] [5] [6] is an untapped treasure trove of data that can help us understand the impact of foods on our metabolism.   I have discussed how we can use the insulin index at length in the articles here, but have summarised some relevant observations below.

Our glucose response to carbohydrate

The food insulin index testing measured the glucose and insulin response to various foods in healthy people (i.e. non-diabetic young university students).

To calculate the glucose score or the insulin index pure glucose gets a score of 100% while everything else gets a score between zero and 100% based on the comparative glucose or insulin area under the curve response.  So we are comparing the glucose and insulin response to various foods to eating pure glucose.

As shown in the chart below, the blood glucose response of healthy people is proportional to their carbohydrate intake.  High protein meat and fish and high-fat foods (butter, cream, oil) tend to have a negligible impact on glucose.

Our insulin response to carbohydrates

The story is not so simple when it comes to our insulin response to food.

As shown in the chart below, the carbohydrate content of our food only partially predicts our insulin response to food.  Low fat, low carb, high protein foods elicit a significant insulin response.

As you can see in the chart below, once we account for protein we get a better prediction of our insulin response to food.  It seems we require about half as much insulin for protein as we do for carbohydrate on a gram for gram basis to metabolise protein and use it to repair our muscles and organs.

image10

But does this mean we should avoid or minimise protein for optimal diabetes management or weight loss?

Does protein actually turn to chocolate cake?

Read on to find the answer.

What happens to insulin and blood sugar when we increase protein?

While protein does generate an insulin response, increasing the protein content of our food typically decreases our insulin response to food.

Increasing protein generally forces out processed carbs from our diet and improves the amount of vitamins and minerals contained in our food.[7]

Similarly, increasing the protein content of your food will also decrease your glucose response to food.

But what about a huge protein meal?

It’s worth noting that the food insulin index testing was done using 1000 kJ or 240 calories of each food (i.e. a substantial snack, not really a full meal).  But what about if we ate a LOT of protein?  Wouldn’t we get a blood sugar response then?

The figure below shows the glucose response to 80g of glucose vs. 180g of protein (i.e. a MASSIVE amount of protein).  While we get a roller coaster-like blood sugar rise in response to the ingestion of glucose, blood sugar remains relatively stable in response to the large protein meal.[8] [9] [10]

So, if protein can turn to glucose, why don’t we see massive glucose spike?

What is going on?

The role of insulin and glucagon in glucose control

To properly understand how we process protein, it’s critical to understand the role of the hormones insulin and glucagon in controlling the release of glycogen release from our liver.

These terms can be confusing.  So let me spell it out.

  • The liver stores glucose in the form of glycogen in the liver.
  • Glucagon is the hormone that pushes glycogen out into the bloodstream as blood glucose.
  • Insulin is the opposing hormone that keeps glycogen stored in our liver.

When it comes to getting glucose out of the liver, glucagon is like the accelerator pedal while insulin is the brake.

When our blood glucose is elevated, or we have external sources of glucose, the pancreas secretes insulin to shut off the release of glycogen from the liver until we have used up or stored the excess energy.

Insulin helps to turn off the flow of glucose from our liver and store some of the excess glucose in the blood as glycogen and, to a much lesser extent, fat (via de novo lipogenesis).  It also tells the body to start using glucose as its primary energy source to decrease it to normal levels.

We can push the glucagon pedal to extract the glycogen stores in our liver by eating less carbohydrate (i.e. low carb or keto diets), even better yet, not eating at all (aka fasting)!

High insulin levels effectively mean that we have enough fuel in our blood stream and we need to put down the fork.

While fat typically doesn’t require significant amounts of insulin to metabolise, an excess of energy from any source will cause the body to ramp up insulin to shut off the release of stored energy from the liver and the fat stores.

Glucose, insulin and glucagon response to a high carbohydrate meal

At the risk of getting a little technical, let’s look at how our hormones respond to different types of meals.

As shown in the chart above, when we eat a high carbohydrate meal insulin rises to stop the release of glycogen.  Meanwhile, glucagon drops to stop stimulating the release of glycogen from the liver.  When we have enough incoming glucose via our mouth, we don’t need any more glucose from the liver.[11]

Glucose, insulin and glucagon response to a high protein meal

When we eat a high protein meal, both glucagon and insulin rise to maintain steady blood glucose levels while promoting the storage and use of protein to repair our muscles and organs and make neurotransmitters, etc. (i.e. important stuff!).

In someone with a healthy metabolism, we get a balance between the brake (insulin) and the accelerator (glucagon).  Hence, we don’t get any glycogen released from the liver into the bloodstream to raise our blood sugar because the insulin from the protein is turning off the glucose from the liver.

This is why metabolically healthy people see a flat line blood sugar response to protein.

(You may need to read that a few times to understand it.  It’s taken a couple of years for it to sink in for me.) 

Insulin response to protein for people with diabetes

Things are different if you have diabetes.

Insulin resistance means that between our fatty liver and insulin resistant adipose tissue, things don’t work as smoothly.

While your blood sugar may rise or fall in response to protein your insulin will need to rise a lot more to metabolise the protein to build muscle and repair your organs.

Unfortunately, people who are insulin resistant may struggle to build muscle because of the insulin resistance.  Then the higher levels of insulin may drive them to store more fat in the process.[12]  Becoming insulin sensitive is important!

The chart below shows the difference in the blood glucose and insulin response to protein in a group of people who are metabolically healthy (white lines) versus people who have type 2 diabetes (yellow lines).[13]

People with diabetes may see their glucose levels drop from a high level after a large protein meal and will have a much greater insulin response due to their insulin resistance.  People with more advanced diabetes (i.e. beta cell burn out or Type 1 diabetes) may even see their blood sugar rise.  This is because their ability to produce insulin to metabolise the protein and keep glycogen in storage cannot keep up with the demand.

Drawing on the brake/accelerator analogy, it’s not necessarily protein turning into glucose in the blood stream via gluconeogenesis, but rather the glucagon kicking in and a sluggish insulin response that isn’t able to balance out the glucagon response to keep the glycogen locked away in the liver.

Healthy people will be able to balance the opposing hormonal forces of the insulin (brake) and the glucagon (accelerator), but if we are insulin resistant and/or don’t have a properly functioning pancreas (brake), we won’t be able to produce as much insulin to balance the glucagon response.

Someone who is insulin resistant has normally functioning accelerator pedal (glucagon stimulating glucose release in the blood) but a faulty brake (insulin).

Real life example

To unpack this further, let’s look at an example close to home.

The picture below is of a family meal (i.e. steak, sauerkraut, beans and broccoli) that we had when my wife Monica (who has Type 1 Diabetes) was wearing a continuous glucose meter.

The photo of the continuous glucose monitor below shows Monica’s blood sugar response after the meal which we had at about 5:30 pm.  Her blood sugar rises in response to the veggies and then comes back down as the insulin kicks in.

image31.jpg

The process to bring her blood sugars back under control from a few carbs in the veggies takes about two hours.

But over the next twelve hours, Monica’s blood sugar level drifts up as the insulin dose goes to work as she metabolises the protein.  For all intents and purposes though it looks like the protein is turning to glucose in her blood!

image24.jpg

This is not a one off.  We’ve seen this blood glucose response regularly.

Many people with type 1 diabetes know they need to dose with adequate insulin for protein.  Once you work out how to reduce simple carbs, working out how to dose for protein is the next frontier of proper insulin management. It’s complicated and sometimes confusing.

More insulin or less protein?

So, what is the problem here?  Why are Monica’s blood sugars rising?

Is it too much protein?

Or not enough insulin (i.e. because she has type 1 diabetes)?

I think the best way to explain the rise in blood sugars is that there is not enough insulin to keep the glycogen locked away in her liver and metabolise the protein to build muscle and repair her organs at the same time.

Meanwhile, the glycogen pedal is pushed down as it normally would be in response to a protein which is driving the glucose up in her bloodstream.

There is just not enough insulin in the gas tank (pancreas) to do everything that needs to be done.

So, if Monica had a choice, should she:

  • A. Keep her blood sugars stable and stop metabolising protein to repair her muscles and organs,
  • B.  Metabolise protein to build her muscles and repair her organs while letting her blood sugars drift up, or
  • C. Both of the above.

Personally, I think the correct answer is C.

While it’s probably not wise to go hog-wild with protein supplements and powders if you have diabetes, as detailed in this article, swinging to the other extreme to target minimal protein levels is a sure way to end up with a poor nutritional outcome.

According to Simpson and Raubenheimer in Obesity: the protein leverage hypothesis (2005), people with diabetes may actually need to eat more protein to ensure that they have adequate amounts to build lean muscle mass given that higher levels of gluconeogenesis may cause more protein loss to glucose due to their insulin resistance.

One source of protein loss is hepatic gluconeogenesis, whereby amino acids are used to produce glucose. This is inhibited by insulin, as is the breakdown of muscle proteins to release amino acids, and therefore occurs mainly during periods of fasting (or low carb).

However, inhibition of gluconeogenesis and protein catabolism is impaired when insulin release is abnormal, insulin resistance occurs, or when circulating levels of free fatty acids in the blood are high. These are interdependent conditions that are associated with overweight and obesity, and are especially pronounced in type 2 diabetes (12,34).

It might be predicted that the result of higher rates of hepatic gluconeogenesis will be an INCREASED requirement for protein in the diet.

A lot of my early motivation in developing the Optimising Nutrition blog was to understand which foods provoked the least insulin response and how to more accurately calculate insulin dosing for people with diabetes to help Monica get off the blood glucose roller coaster.

Like Ted Naiman, I thought if we reduced the insulin load from our food (including minimising protein) we would have a pretty good chance of losing a lot of weight (just like someone with uncontrolled type 1 diabetes).

I no longer think we need to restrict protein to optimise insulin resistance.  However, there’s no need to go to the other extreme and binge on protein.   Worrying about getting too little or too much protein is largely irrelevant.  We will get enough protein when we eat a nutritious diet.  Left to its own devices, our appetite typically does a good job of seeking out adequate protein to suit our current needs.

Meanwhile actively aiming to minimise protein will make it harder to maintain lean muscle mass which is critical to glucose disposal and insulin sensitivity.

If you see your blood sugar levels rise due to protein, it is likely due to inability to produce enough insulin rather than too much protein.

Basal and bolus insulin

One option to minimise the adverse effects of excess insulin is to focus on reducing the insulin load of our diet and eat only high-fat foods that have a low proportion of insulinogenic calories (i.e. ones towards the bottom left of this chart).

If you are highly insulin resistant and obese, this will work like magic, at least for a little while.

People who suddenly stop eating processed junk carbs and eat more fat often find that their appetite plummets as the insulin demand of their food drops and they are more easily able to access their own body fat.[14] [15]

But this is only part of the story.  Again, we can learn a lot about insulin from people with Type 1 diabetes who have to manually manage their insulin dose.

In diabetes management there are two kinds of insulin doses:

  1. basal insulin, and
  2. bolus insulin.

The bolus insulin is the insulin for the food we eat.

The basal insulin is a steady flow of insulin that is required throughout the day and night.

Without the basal insulin, we would disintegrate into uncontrolled gluconeogenesis and ketoacidosis (e.g. uncontrolled type 1 diabetes).

In a person eating a typical western diet around half the insulin given in a day is for the food and half is basal insulin. The chart below shows the daily insulin dose of a person with type 1 diabetes eating a standard diet.  The white component is the basal, and the black is the bolus for their food.

In someone following a low carb diet only around 30% of the insulin is for the food and 70% is basal insulin as shown below in my wife Monica’s daily insulin dose shown below.

daily insulin.jpg

We can only reduce our insulin requirements marginally by changing our diet.   We always need basal insulin.  If we’re insulin resistant, we’ll need more.

Like caffeine or alcohol, we become more sensitive to insulin when we are exposed to less of it.  As we reduce the insulin load of our diet, our insulin sensitivity will improve.

But not everyone who follows a low carb diet instantly turns into a super athlete.  There has to be more to the story.

How to improve your basal insulin sensitivity

In addition to modifying our diet, we can also improve our blood glucose control by maximizing our body’s ability to dispose of glucose without relying on insulin (i.e. non-insulin mediated glucose uptake).  We enhance our insulin sensitivity and our ability to use glucose by building more lean muscle mass.

I used to think that if we just dropped the insulin load of our diet down far enough, we would be able to lose weight, a bit like someone with uncontrolled type 1 diabetes.  But now I understand that there will always be enough basal insulin in our system to store excess energy (regardless of the source) and stop our liver from releasing stored energy.

While a diabetic can reduce their insulin requirements for food by eating food with lots of fat, they can actually end up insulin resistant and need more basal insulin if they drive over abundance of energy, regardless of whether it’s from protein, fat or carbs.[16]

While ketones can rise to quite high levels when fasting (which is great), I fear that some people are chasing high ketone levels with lots of dietary fat and the excess energy may lead to insulin resistance in the long term.

Dr Bernstein’s approach

The method recommended by Dr Bernstein (who has type 1 diabetes himself) is typically lower in carbs, adequate protein (depending on whether you are a growing child) and moderate in fat.

Even at 83, Dr B feels it is important to maintain lean muscle mass through regular exercise to maximise his insulin sensitivity.

Will too much protein “kick me out of ketosis”?

While the ketogenic diet is becoming popular, I think most people who are interested in it do not necessarily require therapeutic ketosis, but rather are chasing weight loss or blood sugar control/diabetes management.

2017-06-03 (6).png

If you are managing a condition that benefits from high levels of ketosis (e.g. epilepsy, dementia, cancer, traumatic brain injury, Alzheimer’s) then limiting protein may be necessary to ensure continuously elevated ketone levels and reduce insulin to avoid driving growth in tumour cells and cancer.  

Giving the burgeoning interest in the ketogenic dietary approach, I think it’s important to understand the difference between exogenous ketosis and endogenous ketosis.

  • Endogenous ketosis occurs when a person eats less than the body needs to maintain energy homeostasis and we are forced to up the glycogen in our liver and then our body fat to make up the difference.
  • Exogenous ketosis (or nutritional ketosis) occurs when we eat lots of dietary fat (or take exogenous ketones), and we see blood ketones (beta hydroxybutyrate) build up in the blood. We are burning dietary fat for fuel.

Higher levels of ketones in the blood are an indication that you are eating more fat than you are burning.  Having some level of blood ketones is an indication that your insulin is low, but whether your blood ketones are high or low should not be a major cause for concern as long as your blood glucose levels are also low.  Unless we are doing a long term fast, we will all be somewhere on the spectrum between exogenous and endogenous ketosis.

Keep in mind though that most of the beneficial things we attribute to “ketosis” and the “ketogenic diet” occurs when we are in endogenous ketosis (i.e.  when fat is coming from our body, not our plate or coffee cup).

As detailed in the popular article What are Optimal Ketone and Blood Sugar Levels in Ketosis? it seems that lower levels of total energy (i.e. towards the left of this the chart below) is a better place to be, particularly if we are chasing weight loss or diabetes management.

Our blood ketones may not be as high when we are in endogenous ketosis, but that’s OK because most of the good stuff happens in a low energy state.  

Endogenous ketosis Exogenous ketosis
Low total energy (i.e. blood glucose + blood ketones + free fatty acids) High total energy (i.e. blood glucose + blood ketones + free fatty acids)
Stored energy taken from body fat for fuel Ingested energy used preferentially as fuel
Stable ketone production all day Sharp rise of ketones for a short duration.  Need to keep adding fat or exogenous ketones to maintain elevated ketones.
Insulin levels are low which allows release of glycogen from our liver and fat stores Insulin levels increase to hold glycogen in liver and fat in adipose tissue
Mitochondrial biogenesis, autophagy, increase in NAD+, increase in SIRT1 Mitochondrial energy overload, autophagy turned off, decrease in NAD+
Body fat and liver glycogen used for fuel Liver glycogen refilled and excess energy in the bloodstream stored as fat.

Summary

  • Gluconeogenesis is the creation of new glucose (generally from protein).
  • Protein requires about half as much insulin as carbohydrate to metabolise.
  • Increasing protein intake will generally improve our blood glucose and insulin levels.  Protein forces out processed carbohydrates, increasing the nutritional quality of our diet and helps us to build muscle which in turn burns glucose more efficiently.
  • In a metabolically healthy person glucagon balances the insulin response to protein, so we see a flat line blood sugar response to even a large protein meal.
  • If you cannot produce enough insulin, you may see glucose rise as your body tries to metabolise the protein and keep the energy stored in the liver at the same time.
  • The insulin for the food we eat (bolus) represents less than half of our daily insulin demand. We can improve our basal insulin sensitivity by building lean muscle mass and improving mitochondrial function via a nutrient dense diet.
  • If we are aiming for weight loss and health, then low blood sugars and low ketones will be more desirable rather than chasing high ketone levels via exogenous ketosis.

references

[1] http://journals.plos.org/ploscompbiol/article?id=10.1371/journal.pcbi.1002116

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636610/

[3] https://optimisingnutrition.com/2015/06/04/the-goldilocks-glucose-zone/

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

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

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

[7] https://optimisingnutrition.com/2017/05/27/is-there-a-relationship-between-macronutrients-and-diet-quality/

[8] https://www.ncbi.nlm.nih.gov/pubmed/16694439

[9] http://caloriesproper.com/dietary-protein-does-not-negatively-impact-blood-glucose-control/beef-vs-glucose/

[10] http://www.ketotic.org/2013/01/protein-gluconeogenesis-and-blood-sugar.html#¹

[11] https://books.google.com.au/books?id=3FNYdShrCwIC&printsec=frontcover&dq=marks+basic+medical+biochemistry&hl=en&sa=X&ei=-ctaVcivOJfq8AXL84CAAw&redir_esc=y#v=onepage&q=glucagon&f=false

[12] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997013/

[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC524031/

[14] https://docmuscles.com/

[15] https://optimisingnutrition.com/2017/01/15/how-optimize-your-diet-for-your-insulin-resistance/

[16] https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-11-23

 

post last updated August 2017

is there a relationship between macronutrients and diet quality?

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

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

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

Image result for confusing

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

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

2017-05-23

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

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

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

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

Nutrient density

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

All foods

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

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

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

The most nutrient dense foods

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

Why should we pursue a nutrient dense diet?

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

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

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

Which nutrients do we need to worry about?

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

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

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

Which nutrients are easier to find?

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

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

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

Can you get too much of a good thing?

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

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

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

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

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

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

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

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

Is there any relationship between macronutrients and nutrient density?

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

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

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

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

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

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

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

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

Protein versus nutrients density

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

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

2017-05-28 (9).png

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

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

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

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

It’s hard to separate good nutrition and protein.

Fat versus nutrient density

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

2017-05-28

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

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

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

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

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

Sugar versus nutrient density

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

2017-05-28 (1)

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

Energy density versus nutrient density

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

2017-05-28 (2).png

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

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

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

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

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

Net carbs versus nutrient density

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

2017-05-28 (4).png

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

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

Fibre

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

2017-05-28 (5).png

Insulinogenic calories

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

2017-05-28 (7).png

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

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

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

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

Summary

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

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

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

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

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

2017-05-28 03.41.23.png

chasing nutrients vs chasing macros

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

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

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

Maximise all nutrients

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

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

Maximise protein

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

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

Minimising protein and maximising fat

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

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

Prioritising the harder to find nutrients

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

Learnings from the Nutrient Optimiser analysis

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

The nutrient density score

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

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

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

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

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

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

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

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

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

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

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

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

Protein

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

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

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

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

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

% insulinogenic

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

Fat

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

Net carbs

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

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

Fibre

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

Summary

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

references

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

micronutrients at macronutrient extremes

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

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

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

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

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

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

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

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

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

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

why bother with nutrient density?

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

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

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

macronutrient comparison

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

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

This chart shows the macronutrient split for these extreme approaches.

fat

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

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

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

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

saturated fat

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

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

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

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

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

protein

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

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

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

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

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

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

carbohydrates

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

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

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

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

nutrient density

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

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

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

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

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

comparison of nutrients adequate

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

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

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

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

application

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

Maybe it’s time for a new trend?

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

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

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

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

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

personalisation

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

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

Check out the Nutrient Optimiser page for more details.

 

notes

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

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

are exogenous ketones right for you?

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

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

Exogenous vs. endogenous ketosis

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

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

Ketones vs glucose

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

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

BHB ketones vs blood glucose

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

image02

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

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

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

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

2017-04-17 (11)

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

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

hyperinsulinemia and metabolic disorders

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

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

exogenous ketones and the low carb flu

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


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

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

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

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

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my experience with exogenous ketones

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

image

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

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

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

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

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

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

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

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

2016-08-10

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

image17

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

do exogenous ketones help with weight loss?

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

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

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

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

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

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

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

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image16 [13]

Confused?

I don’t blame you.

Metabolically healthy

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

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

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

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

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

I know Luis Villasenor from Ketogains finds the same thing.

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total energy = ketones + glucose

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

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

optimal fasting ketone and blood sugar levels in ketosis

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

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

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

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

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

image26[16] [17] [18]

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

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

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

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

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

My heart sank when I saw this video.

MORE investigation required?

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

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

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

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

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

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

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

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

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

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

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

The lower the better?

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

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

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

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

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

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

MORE is not necessarily BETTER when it comes to health.

Fast well, feed well

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

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

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

ketones (mmol/L)

blood glucose (mmol/L)

total energy (mmol/L)

average

0.7

4.8

5.5

30th percentile

0.4

4.6

5.2

70th percentile

0.9

5.1

5.8

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

ketones
(mmol/L)

blood
glucose (mg/dL)

total
energy (mg/dL)

average

0.7

86

99

30th percentile

0.4

83

94

70th percentile

0.9

92

104

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

the real magic of ketones

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

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

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

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

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

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

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

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

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

nutrient density

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

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

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

the best exogenous ketone supplement

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

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

best exogenous ketone supplement

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

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

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

 

 

references

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

post last updated: July 2017

want to live forever?

Living a long, vibrant, healthy life is a common goal.  But what can we do to extend our health span?

Should we eat more fruit and veggies?  Less processed foods?  More protein?  Less protein?  Exercise more?  Lose weight?  Sleep more?  Get more sun?  Less blue light?

Confused yet?

The numerous facets of health and longevity are complex and above my pay grade.  However, I am willing to add my two cents to the discussion in the areas of insulin, blood glucose, fasting and nutrition along with some input from people I respect.

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Dr Ted’s top tips

My wise mate Dr Ted Naiman recently commented on the topic of longevity.

I see centenarians at work, and as far as I can tell it is important to be:

– insulin sensitive,

– active, and

– relatively strong

Extreme careful protein restriction? Not so much.  I for one will focus on the first three.

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Not only is Ted enviably buff, he also has a neat way of condensing wisdom into short bites that are worth unpacking a little further.

insulin sensitive

The leading causes of death in adults in the western world (i.e. heart disease, stroke, cancer, Alzheimer’s and Parkinson’s)[1] all have something in common.  They are diseases of modern society, related to metabolic health and exacerbated by excessive insulin and / or high blood glucose levels.

People who live longer still die from these same diseases, they just succumb to them later.

This chart (from Barbieri, 2001) shows that insulin resistance generally deteriorates with age.  However if you’re one of the few to make it past 90 then chances are your insulin resistance is pretty spectacular!

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Ted’s infographic below explains how insulin resistance and metabolic syndrome leads to hyperinsulinemia (elevated insulin) and hyperglycaemia (elevated blood glucose) and then to heart disease and many of the other diseases of modern society.

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The chart below indicates that you have a much better chance of delaying the top two causes of death in western society (i.e. heart attack and stroke) if you have a lower HbA1c.[2] [3]

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And your chance of maintaining a big brain that is free of Alzheimer’s and Parkinson’s (causes of number four and five)[4] seems to be greatly improved if you keep your blood glucose levels low.

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We’ll come back to cancer, cause of death number three, a little later.

relatively strong

While you might be able to make an argument for longevity around restricting protein or even calories based on laboratory experiments, people live in the real world and need adequate strength to move around, stay active and be relatively strong.  People who are lean and strong intuitively look healthy and attractive to us.

Longevity research is typically done in yeast, worms, mice or other animals who live protected in captivity.  Unfortunately, real people don’t live in protected laboratory environments in a petri dish.  We live in the real world where real people break.

Loss of muscle as we age (i.e. sarcopenia) is a major issue.  Many older people become brittle and weak.  They take a fall, break their hip and never get up.  Maintaining strength and lean muscle mass is important.

You don’t see many fat animals in the wild, but at the same time you don’t see skinny animals, unless they are sick.  Animals that survive in their natural environment are lean, strong and fast.  They have to be to survive, to catch food and avoid being eaten.

Humans in the wild also tend to be strong and lean.

Similar to Ted Naiman, Ian Rambo (pictured below), 62, is a fan of intermittent fasting and a moderate protein diet.  Rambo doesn’t look like he’s about to trip and break his hip any time soon.

12719385_10153555753198542_6383765872037081186_o[1]

active

A lot can be said about exercise, longevity and metabolic health.

Peter Attia, who recently left NUSi to go back to practice medicine with a focus on longevity, says:

Glucose disposal is everything. The best way to get there is by increasing the muscle’s capacity to take up glucose and make glycogen, and that’s best accomplished through lifting heavy weights. Doing so also increases health span (i.e. reducing injuries, lowering pain, and increasing mobility through life).[5]

Exercise depletes the glucose in our blood, liver and muscles and causes us to tap into our fat stores.  But it’s more than just about using up energy.

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As metabolic health and mitochondrial density improves through exercise, our fat oxidation rate increases.  We become metabolically flexible which means that we can easily use glucose or fat for fuel.  Once we improve our fitness and insulin sensitivity we get to the point that we can even obtain some of the glucose we need from fat.

My friend Mike Julian commented:

Every triglyceride that is broken down gives up one glycerol molecule.  Two glycerol molecules will make one glucose.   So the more fat we are capable of burning, the more glucose we can make from fat oxidation, thus the better we get at restoring muscle glycogen without eating carbohydrates.

Also the glycogen that we do burn produces lactate, which is then recycled to make more glucose in the cori cycle, which also contributes to muscle glycogen stores during recovery.

The goal is to increase mitochondrial density so that we are very good at oxidizing fats. When we have poor mitochondrial density we are far more prone to switching over to anaerobic metabolism at low activity levels and anaerobic activities require glucose.

So if we can’t burn fat at high rates due to low numbers of mitochondria, we can’t make much glucose from glycerol via fat oxidation, so in turn our bodies go to plan B which is to make it out of amino acids in order to make up for the rest of what it needs.

So if you increase your mitochondrial density through exercise, you’ll oxidize a higher volume of fat, which will give a higher yield of glucose from glycerol and thus reduce your body’s need to break down aminos from dietary protein and lean mass.

Post exercise increased fat oxidation due to mitochondrial density produces more ketones during the recovery period which get used preferentially so the increased glucose production during that time can go towards refilling of glycogen stores rather than be oxidized for energy. This is why many top keto athletes will fast for a few hours post training. If they eat straight away they miss out on this phenomenon and actually will recover slower.

caloric restriction

Building on the prior trials in yeast and worms, the current dietary restriction longevity experiments in rhesus monkeys are looking positive.  You can see the monkey on the right who has been living on 30% less calories looks younger and healthier than the monkey on the left who is the same age.

The monkeys who eat less have less age related disease and live longer.[6]

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While avoiding excess energy intake is beneficial, there are differing opinions on how this translates to humans in the real world in terms of increased life span.

Peter Attia says:

Most people in this space, the super-in-the-weeds people on this topic that I’ve spoken with at length, do not believe caloric restriction actually enhances survival in the wild. 

Nobody disputes that for most species it enhances survival in the laboratory, but once you get into the wild, you’re basically trading one type of mortality for another.[7]

So many things in life are a balance and involve compromise.  While you need adequate nutrition to be strong and active, our bodies also age more slowly if we don’t subject ourselves to excess energy.

Another problem with calorie restriction is that unfortunately most of us don’t have the self-discipline to limit our food intake all the time.  When we do eat we find it hard to stop until we are satisfied.  Our survival instincts don’t know about the studies in the monkeys, the worms and the yeast.

Most people find it hard to maintain constant caloric restriction when they have free will and unlimited access to food.  And then the cruel trick for people who do have the discipline to consistently reduce their energy intake is that the body will scale back its energy expenditure to stay within the reduced energy intake.

intermittent fasting

 “Complete abstinence is easier than perfect moderation.”

Saint Augustine[8]

So if caloric restriction doesn’t necessarily work, then what’s the solution?  Jason Fung makes a compelling case for the benefits of intermittent fasting rather than chronic calorie restriction.

When there is a lack of food a process called autophagy (from the Greek auto, “self” and phagein, “to eat”) kicks in and we turn to our own old cells for nutrients.  Autophagy is nature’s way of getting the energy we need when we don’t eat in addition to cleaning out the old junk in our bodies and brains.  When we get to eat again we build up new, fresh healthier cells.

But this process of cell clean up and regeneration cannot occur without giving the body the chance to clean out the old cells first.[9]  We regenerate and slow aging when we don’t always have a constant supply of energy.  One of the advantages of intermittent fasting over simply reducing calories is that you get a deeper cleanse of the old cells with total restriction of energy inputs.

In the video below David Sinclair explains how our body makes a special effort to repair itself when there is a lack of food.  In a famine your body senses an emergency and sends out Sirtuin proteins to maximise the health of our mitochondria to increase the chance that you will survive the famine and have the best chance of living until a time when food is more plentiful and you can reproduce and pass on your genes.  Unfortunately, this emergency repair function just doesn’t happen when food is plentiful.  They’re working on drugs that will mimic this effect, but in the meantime, intermittent fasting is free.

As detailed in the how to use your glucose meter as a fuel gauge article, it can be useful to track blood glucose or weight to help guide the frequency and duration of intermittent fasting to make sure you’re moving towards your goals.

protein restriction?

Many people hypothesise that restricting protein is an important component to slow aging.

Dr Ron Rosedale talks a lot about the dangers of glycation and the kinase mTOR.  His hypothesis, as articulated in the Safe Starches Debate and AHS 2012, is that we should avoid carbohydrates to avoid the dis-benefits of glycation, particularly as we can get the glucose we need from protein and to a lesser extent from fat.  When you see that all the major diseases of aging are correlated with high blood sugars and high insulin levels you might think that he is onto something.

In his AHS 2012 talk Rosedale discusses the dangers of mTOR (mammalian target of rapamycin).  mTOR is activated when we eat protein and raise insulin and leads to suppression of autophagy.  In view of this Rosedale recommends relatively low levels of protein for people with diabetes (e.g. 0.6g/kg) and even lower for people who are battling cancer (e.g. 0.45g/kg).

Vegan luminary Dr Michael Gregor points to the various drawbacks of excess dietary protein and makes a compelling case for restricting animal protein by focusing on plant foods rather than caloric restriction or intermittent fasting.

There’s a fascinating August 2015 paper by Valter Longo et al that gives an overview of the current thinking in longevity.[10]   While it mentions protein restriction as a possible area for future investigation, discussion of protein restriction generally seems to be in the context of intermittent restriction with subsequent re-feeding.

To date, very few studies have been performed in humans on the potential beneficial effects of protein and/or amino acid restriction on aging processes or age-associated chronic diseases. [11]

There are obvious benefits in having periods where the body can clean out old proteins, however you also need high quality nutrition to build back the new shiny parts.

While I have gone to great lengths to bring attention to the fact that protein contributes to the insulin load of the diet, I struggle with the concept of chronic protein avoidance when so many of the things I read talk about the mental health benefits of protein,[12] [13] the benefits of lean muscle mass for metabolic health, the satiety benefits of protein and the importance of lean muscle as we get older to ensure we can be active and strong rather than brittle.[14]

Like everything though it’s a balancing act.  Binging on protein supplements and egg whites to get big and jacked is not going to lead to optimal health and longevity.  Some of these guys are even injecting extra insulin for its anabolic hypertrophy effects on top of the anabolic hormones.  This is not healthy and not natural.

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So how much protein do you need when you do eat?   I think you need enough to be strong and active but at the same time without raising insulin and blood sugars and decreasing ketones.

Lean muscle = good

Insulin sensitivity = good

Excess body fat = bad

High insulin = bad

cancer

There’s also a growing momentum around the metabolic theory of cancer (the number three leading cause of death) which hypotheses that excess glucose feeds cancer growth and restricting glucose through a therapeutic ketogenic diet with intermittent fasting will reduce your risk of cancer.

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There is some great work by Thomas Seyfried, Travis Christoferson and Domonic D’Agostino that is well worth your time if you haven’t already seen it.

image17

When you hear Seyfriend talk he seems very proud of and excited about the glucose : ketone index (GKI) which he developed as a proxy for a person’s insulin levels.  As you can see in the chart below, as our blood glucose levels decrease ketone levels rise.

image19

More than blood glucose or ketones alone, the relationship between your blood glucose and ketones seems to be a good proxy for your insulin sensitivity.

It seems that someone with a GKI of less than 10 has fairly low insulin levels, someone with a GKI of less than 3 has excellent metabolic health, while someone battling cancer might want to target a GKI of 1.0.

Reducing the insulin load of your diet can reduce your glucose levels, increase your ketones and reduce your risk of metabolic syndrome and the most prominent causes of death (i.e. heart disease, stroke, cancer, Alzheimer’s and Parkinson’s).

image00

Just to be clear, you people who achieve these excellent insulin resistance levels don’t get get there by simple adding more fat to their morning coffee but through disciplined intermittent fasting which tends to lead to reduction in body fat which improves insulin resistance.

finding the optimal balance

On one extreme too much food will make us fat and insulin resistant and stop the body from repairing itself.

On the other extreme calorie restriction will make us frail and vulnerable to disease and accidents.

So how do we find the middle ground?

On the topic of carbohydrates Peter Attia says:

You want to consume basically as much glucose as you can tolerate before you start to get out of glucose homeostasis. For me there’s a different number than for the next person, and you have to find what the level is.

I’ve been wearing a continuous glucose monitor for several months now. Every day I just have it spit out my 24-hour average of glucose plus a standard deviation, and I now know my sweet spot. I like to have a 24-hour average of between 91 and 93 mg/dL with a standard deviation less than 10.

We can’t measure insulin in real time. To me, the Holy Grail would be to have an area under the curve of insulin, but this becomes a pretty good proxy.

It’s fascinating to see that Attia, who is a super fit semi pro athlete is going to the effort of wearing a continuous glucose meter full time.  CGMs are generally worn by people with type 1 diabetes like my wife.

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The process he is describes of reducing dietary glucose intake to a point where blood glucose levels are normalised is essentially the process used by the people we see who are managing type 1 diabetes as well as possible.

The food insulin index testing measured the area under the curve response to various foods (i.e. what Attia describes as the Holy Grail) and has been really useful for us to understand which dietary inputs cause the greatest blood glucose swings and require largest amounts of insulin.

I think the reason that Attia is recommending ‘as much glucose as you can tolerate’ is to fuel your energy needs for activity, maximise nutrition and dietary flexibility.  This level of blood glucose control will give him an HbA1c of 4.8% which will put him in the lowest risk category for the most common diseases of aging.  But to maintain such a tight standard deviation he’s going to be managing the net carbs and protein in his diet so his blood sugar doesn’t go over 100mg/dL or 5.6mmol/L too often.

Dr Roy Taylor recently released an interesting paper where he proposes that each person has a personal fat threshold[15].  Rather than the BMI chart or body fat, there is a certain level at which the body fat becomes inflamed and insulin resistant which leads to diabetes and all the issues related to metabolic syndrome.  What this means in practice is if your blood glucose levels are rising above optimal you need to eat less to lose body fat.

When it comes to protein Attia says:

What I’m telling my patients is really you only need as much protein as is necessary to preserve muscle mass.

You have a sliding scale, which is carbohydrate goes up until you hit your glucose and insulin ceiling, protein comes down until you’re about to erode into muscle mass and slip into positive nitrogen balance, and then fat becomes the delta.

So in somebody like me, that’s probably about 20% carb, 20% protein 60% fat.

I’ve done everything from vegan to full ketogenic.  I’ve experimented with the entire spectrum of religions, but nevertheless, that’s the framework.[16]

It’s worth noting here that this quote from Peter is in the context him talking at length about mTOR, ROS, glucose control and protein restriction.  Attia is one of the smartest guys in nutrition, medicine and anti-aging science, but he’s not avoiding protein.  He’s making sure he gets enough to maintain lean muscle mass but not so much that it messes with his glucose levels or requires a significant glucose response.

Attia also talks about maximising glucose and minimising protein to normalise blood glucose and insulin.  Given that the focus is on managing insulin levels, I think you could also take the opposite approach to minimise carbs and maximise protein as much as you can without disrupting glucose or losing ketones.   People with type 1 diabetes will tend to consume medium to higher protein levels (which provide glucose but without the same degree of glucose swing) with lower levels of carbohydrates.

Or alternatively find your own balance of net carbs and protein that gives excellent blood glucose levels and some ketones.

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When it comes to finding the optimal level of protein and energy Dr Tommy Wood said:

The anti-IGF-1 (insulin like growth factor) crowd confuse me. Lots = bad (cancer). Very little = also bad (sarcopenia and broken hips).[17]

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caloric restriction

One of the pioneers in the field of longevity is Roy Walford,[18] who developed the concept of Calorie Restriction with Optimal Nutrition (CRON).  Many of the ideas in this article and the blog overall are built around Walford’s ideas regarding optimising nutrition for health and longevity.

While Walford lived his theories in practice, he unfortunately died at 79 of ALS so we didn’t really get to find out whether calorie restriction delayed the major diseases of aging for him.  The pictures below are taken of Dr Walford before and after two years living in Biosphere 2.[19]

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Walford was the crew’s physician and meticulously recorded the health markers of the Biosphere 2 ‘crew members’[20].  It’s interesting to see how markers like the BMI chart, glucose, insulin and HbA1c all improved markedly with the semi-starvation conditions during the experiment, however they reverted to more normal levels after resuming normal eating.

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optimal nutrition

If we are going to fast and / or restrict calories to optimise our metabolic health it’s even more important that we make sure that the food we do eat, when we eat it, provides all the nutrients that we need to thrive and build back new shiny parts of our body.  Unfortunately it seems that the optimal nutrition component of Walford’s CRON concept is not discussed much these days.

In the article optimal foods for different goals I have detailed a system that can be tailored to identify nutrient dense foods for different goals to balance nutrient density and insulin load.  I hope this will help to spark further discussion around the topic of nutrient density and which foods would be most helpful for different people.

summary…

So what does all this mean?  What do we know about maximising our metabolic health and avoiding the primary diseases of aging?

Is too much energy bad… yes.

Is eating all the time bad…. yes.

Is excess protein bad… maybe, maybe not, however the vegans would say that we should avoid animal protein and stick to only plant based foods.

Are excess carbohydrates bad… maybe, maybe not, however the low carb / keto crowd would say that you need to avoid carbohydrates because they raise your insulin.

Is excess protein and excess non-fibre carbohydrates bad… most likely, yes.

Both carbohydrates and protein will raise insulin, blood glucose, IGF-1 and upregulate mTOR which all accelerate aging.

In the end though we have to eat.  We are programmed for survival.   While not eating too much and intermittent fasting are important considerations, when we do eat though we should maximise the nutrient density and prioritise foods that do not not raise our insulin and blood glucose levels.  I think if you get that right a lot of the other things will follow.

There is no perfect dietary solution for all.  What is best for you will come down to your situation, goals and preferences.

Some people will prefer zero carb with lots of meat.

Some people feel strongly about avoiding animal products and do well on a plant based diet with minimal processed foods.

Some will aim for a therapeutic ketosis approach to tackle major metabolic issues.

All of these extremes are viable but a balance somewhere in the middle might be easier to maintain in the long term while also maximising the nutrient density of the calories we consume.

What is almost certainly dangerous for most people is the low fat, high insulin load approach that has been recommended for the past few decades and seems to have led to increased consumption of low nutrient density highly processed food products by many.

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references

[1] http://chriskresser.com/the-keys-to-longevity-with-peter-attia/

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

[3] http://cardiothoracicsurgery.biomedcentral.com/articles/10.1186/1749-8090-3-63

[4] http://chriskresser.com/the-keys-to-longevity-with-peter-attia/

[5] http://chriskresser.com/the-keys-to-longevity-with-peter-attia/

[6] http://www.nature.com/ncomms/2014/140401/ncomms4557/fig_tab/ncomms4557_F1.html

[7] http://chriskresser.com/the-keys-to-longevity-with-peter-attia/

[8] http://www.goodreads.com/quotes/6741-complete-abstinence-is-easier-than-perfect-moderation

[9] https://intensivedietarymanagement.com/fasting-and-autophagy-fasting-25/

[10] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531065/

[11] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531065/

[12] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738337/

[13] https://www.moodcure.com/safe_alternatives_to_antidepressants.html

[14] http://www.webmd.com/healthy-aging/sarcopenia-with-aging

[15] http://www.clinsci.org/content/128/7/405

[16] http://chriskresser.com/the-keys-to-longevity-with-peter-attia/

[17] http://press.endocrine.org/doi/full/10.1210/jc.2011-1377

[18] https://en.wikipedia.org/wiki/Roy_Walford

[19] https://en.wikipedia.org/wiki/Biosphere_2

[20] https://m.biomedgerontology.oxfordjournals.org/content/57/6/B211.full

[21] http://www.walford.com/cronmeals1.htm

[22] https://www.drfuhrman.com/library/andi-food-scores.aspx

[23] https://www.youtube.com/watch?v=ZVQmPVBjubw

Fine tuning your diet to suit your goals – Darth Luiggi

It looks like Luis Villasenor is doing something right.

Luis (aka Darth Luiggi who runs the Ketogains Facebook Group) has been on a ketogenic diet for more than 14 years!

Here are a couple of video interviews where Luis explains his approach.

He is also very active in coaching the more than 7000 Ketogains members on his Facebook group and Reddit.

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Recently I was able to get a look at a few days of Luis’s food diary on My Fitness Pal so I thought it would be interesting to run some numbers on his diet.

My focus of the blog has been on optimising diet for diabetes management, however I wanted to also demonstrate that a nutritious low insulin load diet is also great for health and fitness.

The analysis below shows the combination of three meals.  Along with plenty of protein (beef, chicken, egg, pork) he also has a solid amount of vegetables (broccoli, lettuce and spinach) as well as a good amount of added fats (butter, olive oil and coconut oil) to maintain ketosis.

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The nutritional analysis of these three meals is shown below.  As you would expect from the dude who runs Ketogains, the carbs are low at 5% with the protein being fairly substantial at 29% of daily calories.

The protein score is excellent with 145% of the RDI being met with 1000 calories and 58% of the RDI for vitamins and minerals being met with 1000 calories.

A score of 100 means that you will meet the recommended daily intake (RDI) for all the nutrients with 1000 calories, as discussed in the previous ‘the most nutrient dense food for different goals’ article.

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The table below shows how Luis’s diet stacks up based on the nutritional ketosis weighting.

At 26g of fibre per day his fibre score is solid but not high compared to the other meals analysed.  His calorie density is high but that isn’t a big issue given that he is already fairly lean.

The insulin score is not extremely high as there is a solid amount of protein and he’s not worried about diabetes or achieving therapeutic ketosis.

The vitamin and mineral score is the one area that could be improved, though it is better than average.

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As you will hear on the videos, Luis is already a big advocate for leafy greens as an integral part of a ketogenic diet.

If we did want to improve the vitamin and mineral score we could simply add extra spinach and broccoli (or any of the nutrient dense veggies from this list).

I’ve dropped the lettuce (which is not as nutrient dense) and increased the broccoli and spinach so we have 400g of each across the three meals.

The resultant nutritional analysis for the revised food diary is shown below.  The nutrient balance score has increased from 58 to 70 and we’d only have 8g of net carbohydrates per meal in spite of the significant increase in vitamins and minerals.

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With the increase in non-starchy veggies we increase the fibre intake from 26g to 40g across the three meals which would mean that he would now meet the recommended daily fibre intake of 30g per day for men.

The other advantage of this approach is that it would be more filling which may lead to a decreased overall calorie intake.  While Luis knows the power of a ketogenic diet for weight loss he also knows that to get such a low percentage body fat you also need to run in a calorie deficit and this approach may assist in naturally controlling appetite and satiety.

He is currently in a ‘cutting phase’ which is why he is tracking his food intake in My Fitness Pal, so reducing his calorie density and increasing fibre might help him to spontaneously achieve a reduction in overall energy intake.

If you’re interested in using the ketogenic diet as part of a bodybuilding routine I would definitely recommend checking out Ketogains.  Even though he looks tough with all those muscles he’s really polite, gracious and only too willing to help other people on the journey.  And regardless of your goals, Luis’s Ketogains calculator is an excellent tool if you want to calculate your macros or target grams of protein, fat and carbs.

the most nutrient dense foods for different goals

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

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

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

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

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

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

essential nutrients

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

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

essential fatty acids

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

amino acids

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

vitamins

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

minerals

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

the lists

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

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

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

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

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

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

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

all nutrients

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

no insulin index contribution

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

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

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

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

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It certainly seems to be working for him.

Duane Johnson 2 - Copy

athlete and metabolically healthy

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

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

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

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

Aaron Tait Photography

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

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

weight loss

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

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

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

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

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

diabetes and nutritional ketosis

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

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

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

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therapeutic ketosis

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

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

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

ganze und halbe reife avocado isoliert auf weissem hintergrund

fatty acids

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

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

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

no insulin index contribution

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

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

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

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

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athlete and metabolically healthy

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

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

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

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weight loss

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

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

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

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

diabetes, nutritional ketosis and therapeutic ketosis

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

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

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amino acids

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

no insulin index contribution

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

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

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

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

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

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athlete and metabolically healthy

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

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

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weight loss

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

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

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

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diabetes and nutritional ketosis

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

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

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Therapeutic ketosis

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

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

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vitamins

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

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

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

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

no insulin index contribution

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

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

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

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

athlete and metabolically healthy

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

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

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

image034

Good food doesn’t have to taste bland!

weight loss

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

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

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

image036

diabetes and nutritional ketosis

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

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

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

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therapeutic ketosis

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

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

image039

minerals

no insulin index contribution

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

Here’s your answer:

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

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

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

image041

athlete and metabolically healthy

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

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

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

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

image043

weight loss

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

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

image044

diabetes and nutritional ketosis

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

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

image045

therapeutic ketosis

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

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

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application

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

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

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

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

references

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

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

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

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

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

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

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

optimising micronutrients and macronutrients for different goals

  • This article looks at the macro and micronutrient split for the most nutrient dense foods using a multi criteria analysis tailored for different goals (i.e. diabetes, therapeutic ketosis, weight loss and athletic performance).
  • High protein foods are typically much more nutrient dense than high carbohydrate foods.
  • The optimal protein intake for athletes, people who are metabolically healthy and people who are trying to lose weight is virtually unrestricted, particularly as the blood glucose impact from gluconeogenesis is not a concern and the amount of protein someone can eat is self-limiting.
  • People with diabetes and metabolic syndrome may benefit from a more moderate protein intake in order to reduce their insulin load to the point that that their pancreas can keep up and maintain normal blood glucose levels.

the setup

In a number of previous articles I have discussed minimum glucose and protein requirements based on starvation experiments.  Thinking that these are recommendations for protein a number of people responded noting that 0.8g/kg lean body mass (LBM) or 8% of calories is too low. [1]

My typical response to these comments has been along the lines of:

  • We need to get adequate amino acids from protein, just like we need adequate vitamins and minerals.
  • It’s all about finding the balance between adequate nutrition while keeping your dietary glucose load low enough so your pancreas can function efficiently.
  • The optimal approach is going to be different for each individual, depending on your needs, activity levels, personal situation and goals.

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But what does this look like in practice?  What is the optimal macronutrient ratio that balances the competing goals of maximising nutrition while not overloading our body’s capacity to process those nutrients?  How do we get adequate protein for growth, repair and mental function while avoiding high blood glucose and excess body fat?

How do you find a way through all the contradictory health advice from different health camps saying ‘you can’t eat too much protein’, ‘maximise your veggies’, ‘eat fat to lose fat’, or others saying ‘intermittent fasting is the rediscovered cure for everything’?

different strokes for different folks

Context matters when it comes to designing the optimal diet.

In the article Your Personal Food Ranking System I outlined a multi criteria system to help prioritise food choices for different situations.  The system uses different weightings for a range of parameters available from the USDA food database.  I then used these parameters and weightings to develop lists of optimal foods for different situations (i.e. weight loss, diabetes / nutritional ketosis, therapeutic ketosis, and athlete / metabolically healthy) highlighting foods from the top 25% of the foods ranked using those weightings.

In developing these lists of optimal foods I also included cost considerations as a factor.  However in the discussion of optimal nutrition I don’t think cost is as important.  I also wanted to use the full USDA database of nearly 8000 foods rather than the smaller database of around 1000 foods that I have cost data for.

So we are left with the following parameters from which to develop a food ranking system:

  • nutrient density / calorie,
  • nutrient density / weight,
  • fibre / calorie,
  • fibre / weight,
  • percentage of insulinogenic calories, and
  • calories / weight.

fibre

Fibre can be useful to help feed and increase the diversity of our gut bacteria which appears to be good for a range of benefits including insulin sensitivity and autoimmunity.

The amount of fibre per calorie also seems to be a good proxy for the degree of processing involved in carbohydrate containing foods.

  • Highly processed foods = bad.
  • Minimally processed foods = good.

calorie density

Regardless of calories, it seems we eat about the same weight of food per day. [2]

Calorie density is related to fibre content.  Decreasing calorie density is a useful way to spontaneously manage energy intake.

A low calorie density typically means that your food contains a lot of water, so by itself it isn’t particularly useful;  a fortified energy drink or a slice of watermelon will end up scoring highly when we only consider nutrient density per calorie.

Considering both calorie density and fibre together ends up being a much more useful approach.

proportion of insulinogenic calories

If you are insulin resistant or obese then managing the insulin load of your diet will be an important consideration.  The percentage of insulinogenic calories concept builds on the food insulin index testing which demonstrates that both carbohydrates and protein require insulin. [3]

Keeping your percentage of insulinogenic calories low (as defined by the formula below) means reducing net carbohydrates, increasing fibre and possibly moderating protein.

image002

This formula biases against non-fibre carbohydrates.  As noted earlier, one of the major concerns people have with this approach to identifying optimal foods is that we still need our protein.  So the question is, “to what extent would protein be penalised if we also try to maximise our nutrients?”

nutrient density

The nutrient density concept builds on the excellent work of Mat Lalonde which he discusses in this video from AHS 2012.

Lalonde shortlisted the following essential nutrients [4] which have been used in the nutritional analysis as part of the multi criteria analysis:

Essential fatty acids [5]

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

Amino acids

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

Vitamins

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

Minerals

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

It is worth noting that the list of essential amino acids, vitamins and minerals has about equal number of elements (i.e. eleven amino acids, twelve vitamins and ten minerals).  Hence it is unlikely that we would end up biasing towards high protein foods just because we have more amino acids being counted than say vitamins or minerals.

The nutrient density for a certain food is based on a relative score calculated by comparing the amount of a particular nutrient in each food with the all of the foods in the database.

For example, if a food has an average amount of vitamin C compared to the 8000 other foods in the database it will get a score of zero because it is zero standard deviations from the mean.  If it has a large amount of a certain nutrient then it will receive a high score.  If it is two standard deviations from the mean then it gets a score of two for that nutrient.  If however it is five standard deviations from the mean it gets a maximum score of three in order to avoid prioritising foods that have massive amounts of one nutrient versus foods that have high amounts of a number of nutrients.

Kale

One example of where this limitation comes into play is kale, which has a massive amount of vitamin K, [6] versus spinach which has a high amount of vitamin K but also has a range of other nutrients and ends up with a higher overall nutrient density score.  Because of the upper limit on the score for a single nutrient, this system would give a higher ranking to spinach which has a more well-rounded nutrient profile rather than simply being an over achiever in one or two nutrients.

image004

No weighting of individual nutrients has been applied.  Weighting one nutrient as more important than another could be useful for a particular person with a particular goal or health condition.  However at the same time it’s nice to keep the analysis ‘clean’ to avoid arguments about bias. [7]  This unweighted approach highlights foods that have a broad spectrum of nutrients at significant levels.

minimum protein

So what is the minimum amount of protein that we require?

  • According to Nuttall and Gannon [8] the body requires between 32 and 46g of high quality dietary protein per day to maintain protein balance in a starvation situation. This equates to around 6 to 7% of calories in a 2000 to 2500 calorie diet but in starvation this is how much your body will cannibalize off your muscle per day if it gets no food, with the rest coming from body fat stores.
  • The recommended daily intake (RDI) of 0.8g/kg LBM is based on an estimated average requirement (EAR) of 0.66g/kg LBM which is the amount estimated to ensure that 50% of the population are not deficient.
  • Ron Rosedale, an advocate of ketogenic diets and minimising insulin as far as possible, recommends 1.0g/kg LBM for most people, 1.25g/kg LBM if you exercise and 0.8g/kg LBM for people with diabetes. [9] [10] [11] [12]

typical protein intake

As a reference point, the American diet typically consists of between 65 and 100g of protein per day.  According to NHANES fat and protein intake has decreased over the last few decades as carbohydrate content has increased. [13]

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maximum protein

Most people will find it difficult to eat more than 30% of their calories from protein from whole foods, though you can push to higher levels by using protein powders.

Protein is very satiating so our intake is typically self-limiting.  The upper limit of protein intake for our liver is said to be 200 to 300g per day, or 35 to 40% of calories from protein. [14]

The term ‘rabbit starvation’ refers to a situation where people who only have lean rabbits to eat starve because they just can’t process any more protein. [15]

This video from Dr Donald Layman gives an overview of the benefits of protein.  He says that the range of safe protein intake varies between 0.8g/kg LBM and 2.5g/kg LBM.

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Steve Phinney’s WFKD triangle suggests that people will find it hard to achieve nutritional ketosis with protein levels greater than 30% of calories or 2.4g/kg LBM, even if they have very low carbohydrate levels.

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In The Myth of 1 g/lb: Optimal Protein Intake for Bodybuilders[16] Menno Henselmans argues that there is a limit to how much protein we can metabolise to grow muscle.  More protein does not necessarily mean more “gainz”.  As shown in the figure below:

  • people who are sedentary will be unlikely to gain more muscle with more than 0.8kg/kg lean body mass;
  • an endurance athlete may not gain more muscle with more than 1.3g/kg lean body mass; and
  • a strength athlete will not activate more protein synthesis by eating more than around 1.8g/kg lean body mass.

image008

Interestingly Luis Villasenor (aka Darth Luiggi, pictured below), who runs Ketogains and is studying under Henselmans, recently changed the upper limit on his Ketogains macro calculator to include an upper limit of 1.8g/kg total body mass for protein to reflect Menno’s findings.

image009

Luis said his rationale behind the protein levels in the Ketogains macro calculator:

  • lower limit of 0.8 to 1.0g per pound of lean pound of body weight, and  .
  • upper limit that will not affect ketosis = 1.8g per total kilogram.

Luis says that protein grams over 1.8g/kg total body mass should be counted as 50% toward daily carb intake and that higher levels of protein can hinder ketone production.  Higher levels of protein are not necessarily going to be a problem if your carbs are low and / or you are insulin sensitive and have your blood glucose levels under control.  This approach certainly seems to be working for Luis!

While there is a limit to the amount of amino acids we can use for muscle growth and repair, it’s important to note that amino acids are also important for mental health.  Julia Ross’s Mood Cure details how nutrients can be targeted to address depression and a range of other mental health issues. [17]  So protein in excess of what is required for our muscles is not necessarily wasted.

To summarise, the table below shows a comparison of these minimum and maximum levels in terms of percentage of daily calories, grams per kilogram of lean body mass and grams per day for a 2250 calorie per day diet for a man with 74kg lean body mass (LBM).

scenario PRO (g/day) PRO (%) g/kg LBM
minimum (starvation) 32 6% 0.4
RDI / sedentary 59 11% 0.8
typical 90 16% 1.2
strength athlete 133 24% 1.8
WFKD max 169 30% 2.3
maximum 197 35% 2.7

the Goldilocks glucose zone

I believe that consideration of optimal protein intake needs to have some regard for the carbohydrate level, given that we can get the glucose we need from both protein and carbohydrate.  If we increase the glucose load (from carbohydrates and / or protein) above what our body can tolerate then we drive up blood glucose and insulin levels, thus ending up with obesity and diabetes.

In the Goldilocks Glucose Zone article I looked at how we can obtain glucose from both carbohydrate and protein (through gluconeogenesis).  If we are more towards the bottom left of the plot of protein versus carbohydrate chart, our diet is more likely to be more ketogenic.  However, the more we minimise protein and carbohydrates the more we risk not obtaining the fibre and nutrients that might be harder to find on a higher fat diet diet of butter, coconut oil and avocado.

What this means in practice is that the more ketogenic our diet is, the more intentional we have to be about achieving adequate nutrition and maximising the nutrient density of the foods that we eat.

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therapeutic ketosis

Let’s first look at the most extreme end of the spectrum, therapeutic ketosis.  This approach is based on the theory that a low insulin load diet will help control conditions such as cancer and epilepsy.

The table below shows the weighting criteria for therapeutic ketosis, with a low percentage of insulinogenic calories being the primary goal.  Minimal weighting is given to fibre and calorie density with moderate weighting given to nutrient density.

ND / cal fibre / cal ND / weight calories / 100g insulinogenic (%)
10% 5% 10% 5% 70%

People who are aiming for therapeutic ketosis in an effort to conquer cancer or epilepsy are typically motivated to reduce the insulin load of their diet, sometimes at the expense of nutrition.

Check out Andrew Scarborough’s story for a fascinating example of someone who has worked very hard to maximise nutrition while still having a very low insulin load.   Andrew focuses on maximising omega-3 fats and has to avoid ketogenic favourites such as avocado and coconut oil due to his intolerances.

I’ve sorted the foods in the USDA food database using these weightings and plotted the highest ranking 5% of these foods against the protein versus net carbs chart with the various levels of ketosis.  On average these foods have a very low 1.4% net carbohydrates and a fairly low 11% protein (i.e. approximately the RDI minimum level for sedentary people).

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In the bottom left hand corner of the chart butter, cream and oils make the list due to their very low percentage of insulinogenic calories.  However what I find most interesting is to look at the foods that make the list due to their higher nutritional value such as spices, olives, bacon and cheese.

You can download the list of the top 500 foods ranked using this system here to review the outputs of the system in more detail.  Because nutrient density and fibre don’t play a big part in this ranking there are lot of high fat foods here that don’t have a lot of amazing nutritional properties, so you’ll need to use your discretion to find foods from this list that suit your goals other than just being high fat.

diabetes and nutritional ketosis

The table below shows the weighting to identify optimal foods for diabetes and nutritional ketosis.  This approach is less extreme than the therapeutic ketosis approach with only half the weighting in the multi criteria analysis being given to the insulinogenic properties with some of the weighting spread to nutritional density and calorie density.

ND / cal fibre / cal ND / weight calories / 100g insulinogenic (%)
10% 10% 10% 10% 60%

The plot below shows the top 5% of foods in the USDA database ranked using this weighting in terms of protein versus net carbohydrates.  On average these foods have 2% net carbohydrates and 20% protein which aligns reasonably well with what we see practiced in the low carbohydrate and diabetic community.

Protein levels are moderate in order to ensure adequate levels of amino acids while managing the insulin load of the diet.  With such low levels of carbohydrates this approach is certainly still ketogenic!

To give some context it’s worth noting that the typical western diet is about 15% of calories from protein, [18] so most people would need to eat more protein to achieve these levels.

Again, it’s interesting to look at the outliers that make the cut due to their nutritional density such as black pepper, parsley, rosemary, spinach and liver.  Although these foods have a higher percentage of insulinogenic calories it would be hard to overeat them.

You can download the top 500 foods using this system here.

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weight loss

This approach to the weighting of the multi criteria ranking is designed for someone who already has their blood glucose levels under control, but still wants to lose more weight.

Some people find that they can achieve their target weight on a ketogenic diet.  However others don’t have the same degree of success and perhaps may need more help to reduce their calories lower through food choices to help them lose weight.

While many people find that a higher fat diet will naturally lead to increased satiety with the reduced insulin load enabling stored body fat to be released for fuel, it is still possible to overdo your calories on a high fat diet.  Too many calories, even with ketogenic macronutrient ratios, can still mess with your insulin sensitivity and cause weight gain. [19]

Chris Gardner’s A to Z trial [20] highlighted that people with insulin resistance lost the most weight if they reduced their insulin load, while people who were not insulin resistant could lose weight on any diet as long it was low enough in calories. [21] [22]

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The table below shows the weighting for the suggested optimal foods for weight loss which prioritises high fibre, high nutrient density and low calorie density foods rather than focusing as much on insulin load.

ND / cal fibre / cal ND / weight calories / 100g insulinogenic (%)
15% 10% 15% 20% 40%

This approach might be appropriate for a person that still has weight to lose but has gained control of their blood glucose levels and meets the following criteria:

  • HbA1c < 5.4mmol/L
  • fasting blood sugar < 5.0mmol/L (90mg/dL)
  • average blood sugar < 5.4mmol/L (100mg/dL)
  • post meal blood sugar < 6.7mmol/L (120mg/dL)

Being overweight and / or having a larger than desirable waist line is usually a good sign you are insulin resistant, so most people wanting to lose weight should typically start with the diabetes / nutritional ketosis approach (possibly with some intermittent fasting) until they get their blood glucose levels and insulin resistance under control.

As indicated by the chart above from the analysis of Gardner’s study, the low carb approach worked the best regardless of insulin resistance status.  Designing a diet that is high in fibre, has high nutrient density,  while still being fairly low in carbohydrates and calories, may help automatically limit food intake and manage calorie intake. This way we are focusing on food quality rather than having to count calories!

The plot below shows the top 500 foods using the weight loss ranking.  You will note that there are a lot of foods that sit well outside the ketogenic triangle.  On average we have 4% net carbohydrates and 36% protein.

Once we reduce the emphasis on glucose load the system will strongly prioritise protein rather than carbohydrate-based foods to source nutrition!

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With the priority on high fibre and low calorie density, this approach would simply make it physically difficult for someone to overeat.  The insulin load will naturally be reduced because you just won’t be able to binge on calorie dense foods!

If you can manage to eat 2250 calories per day (i.e. typical intake[23]) of the top 10% of foods prioritised using these weightings you would be eating 150g of net carbs but also 130g of fibre!  Most people would struggle to eat this much fibre and volume of food.  If they were able to consume only 1500 calories per day they would be getting 120g of protein, 100g net carbs and 85g of fibre.

While 100g of net carbohydrates is high by low carb standards it is much less than the 300g per day consumed by most people and is unlikely to drive insulin resistance in most people because the carbohydrates being consumed would have an extremely low glycemic index!

If you find your blood glucose levels are drifting up using this approach (i.e. post meal blood sugars of greater than 6.7mmol/L or 120mg/dL) you could revert back to the diabetic / nutritional ketosis approach to make certain you are keeping your insulin levels low enough to be able to successfully lose weight.

You can download the top 500 highest ranking foods using this approach here.

athletes and metabolically healthy

As shown in the weightings in the table below, this approach maximises nutrient density without trying to minimise calorie density.  If you’re a lean athlete trying to refuel quickly you won’t want to be eating a pile of low calorie density lettuce and spinach to fill your calorie needs.  You will be interested in maximising nutrient density to maximise health and athletic performance.

ND / cal fibre / cal ND / weight calories / 100g insulinogenic (%)
30% 10% 30% 10% 20%

The top 500 foods using this ranking are plotted below.  On average these foods are 4% net carbohydrate and 36% protein.  Most people will find it difficult to eat greater than 30% protein from whole food sources, so as with the weight loss approach, this scenario would enable you to basically eat as much protein as you wanted from real food sources.

If you’re lean and insulin sensitive then it’s hard to eat too much protein.  Again, if you found that your blood glucose levels were driving up with this approach you should revert to foods with a lower insulin load.

You can download the top 500 highest ranking foods using this approach here.

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without consideration of insulin load

To see if the insulin load was adversely biasing the analysis against carbohydrate and towards protein, I thought that it would be worth running the analysis without the percentage of insulinogenic calories as a consideration.

The table below shows the weightings used for this scenario which heavily bias towards nutrient density and with a smaller weighting towards fibre and calorie density.

ND / cal fibre / cal ND / weight calories / 100g insulinogenic (%)
35% 15% 35% 15% 0%

The chart below shows the most nutrient dense 500 foods plotted on the protein versus net carbohydrates chart with an average of 54% protein and 12% carbohydrates.  While the carbohydrates comes up a little compared to the other scenarios the protein is very high.

If the insulin load is not considered the macronutrient split of the highest ranking foods is 54% protein and 12% carbohydrates.  However this isn’t realistic as we can’t physically eat that much protein, so we will end up eating either more fat or carbohydrate rather than all that protein.  If you have some level of insulin resistance, fat is the logical choice rather than carbohydrates in order to maintain normal blood glucose levels.

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You can download the highest ranking 500 foods using this criteria here.

summary

The table below lists the average protein and net carbs for the highest ranking foods for the four dietary approaches.  The figure below shows this graphically.

approach protein (%) net carbs (%) insulinogenic (%) protein (g) net carb (g)
therapeutic ketosis 11% 1% 8% 62 6
diabetes / nutritional ketosis 20% 2% 13% 113 11
weight loss (2250 cal) 36% 4% 24% 203 22
weight loss (1500 cal) 29% 3% 19% 109 11
athlete / metabolically healthy 36% 12% 38% 203 67
typical western diet 16% 50% 59% 90 281

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When it comes to weight loss it’s also useful to consider the fat that is coming from your body.  I have shown the macronutrient split for the weight loss scenario both in terms of a 2250 calorie per day diet and as a 1500 calorie per day diet assuming that the calorie deficit is coming from fat stores.

For athletes and the metabolically healthy, protein is largely unrestricted when it comes to maximising nutrient density.  The maximum amount of protein for people who are insulin sensitive will come down to how much they can physically eat.

Even if blood glucose levels are not a concern the most nutrient dense foods are still quite low in net carbohydrates.

If you have some degree of insulin resistance or elevated blood sugar it may be useful to moderate protein levels to some extent as well as cutting carbs.  If you are watching your blood glucose levels and / or ketones you can wind the amount of protein back until you achieve your target levels.

In all scenarios nutrient density was maximised, with much less carbohydrate relative to the western diet.

references

[1] See comments section in https://optimisingnutrition.wordpress.com/2015/06/15/the-blood-glucose-glucagon-and-insulin-response-to-protein/ and https://optimisingnutrition.wordpress.com/2015/06/22/why-Regardwe-get-fat-and-what-to-do-about-it-v2/

[2] http://www.precisionnutrition.com/what-are-your-4-lbs

[3] It’s worth noting that Metformin works by limiting gluconeogenesis (i.e. the conversion of protein into glucose) in order to help the body better manage blood glucose levels (see http://www.ncbi.nlm.nih.gov/pubmed/24847880).

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

[5] The omega 6 fatty acids are also classed as essentially however it is generally recognised that we have more e

[6] Possibly more than the body could ever use especially in a low fat environment given that it is a fat soluble nutrient.

[7] For example see Chris Masterjohn’s review of Joel Furhman’s ANDI index at http://www.westonaprice.org/book-reviews/eat-to-live-by-joel-fuhrman/

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

[9] http://www.ketogenic-diet-resource.com/daily-protein-requirement.html

[10] http://drrosedale.com/blog/2011/11/21/ron-rosedale-protein-the-good-the-bad-and-the-ugly/#axzz3gVOJ69np

[11] http://www.meandmydiabetes.com/2010/05/07/ron-rosedale-protein-the-good-the-bad-and-the-ugly/

[12] While Rosedale has his reasons for reducing protein such as longevity and avoiding the mTOR metabolic pathway, this minimal protein approach may not be ideal if your goal is to maximise nutrition.  Check out this interesting discussion between Robb Wolf and Jamie Scott from the 52 minute mark in this podcast about the balance between health and longevity when it comes to optimal protein intake levels.  – http://robbwolf.com/2015/07/21/episode-279-jamie-scott-the-state-of-paleo-and-ahsnz/.  I tend to agree with the approach to maximise health and vitality now rather than eating for theoretical longevity with reduced health and vitality now.

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

[14] http://www.paleoplan.com/2011/04-22/meat-is-not-the-devil-high-protein/

[15] https://en.wikipedia.org/wiki/Rabbit_starvation

[16] http://bayesianbodybuilding.com/the-myth-of-1glb-optimal-protein-intake-for-bodybuilders/

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

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

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

[20] http://jama.jamanetwork.com/article.aspx?articleid=205916

[21] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3504183/

[22] http://profgrant.com/2015/07/21/5-reasons-sugar-not-fat-is-the-problem/

[23] http://www.nhs.uk/chq/pages/1126.aspx?categoryid=51