Category Archives: weight loss

which nutrients is YOUR diet missing?  

I recently took a look at which nutrients might be missing from various popular dietary approaches in preparation for a recent on nutrient density.  At a population level, the chart below shows the proportion of the US population that are deficient in various micronutrients.  Many people are not getting enough vitamin D, vitamin E, magnesium, calcium, etc.

While your body hasn’t read the World Health Organisation’s reports on the Daily Recommended Intake of the various essential nutrients,[1] it’s likely that your appetite will drive you to seek out the nutrients that are lacking.  If we are deficient in something that is required the body kicks in “nutrient hunger” and cravings that will make sure it gets what it needs.[2] [3] [4]

If you work hard to restrict your food intake to a certain dietary approach, but the body doesn’t receive the nutrients it needs, it may slow down and not function at full capacity.   By contrast, adequate nutrition, without too much energy, slows many of the modern diseases of aging such as diabetes, Alzheimer’s and cancer and improves your chance of living healthfully to a ripe old age.[5]

USDA foods database

The chart below shows the nutrients that are both easiest and hardest to obtain from the eight thousand foods in the USDA foods database.  At the bottom of this plot we have iron, various amino acids, and vitamin C, all of which are easy to obtain in adequate quantities.

However, at the top of the chart, we can see that it is much harder to obtain adequate quantities of six essential nutrients (omega 3 fatty acids, vitamin D, choline, vitamin E, and potassium).  We would obtain sufficient quantities of all the other essential nutrients if we ate just a little of each of the foods in the USDA food database.

If we want to maximise nutrient density, it makes sense to prioritise foods that contain more of the harder-to-obtain nutrients.  The chart below shows the nutrients for the top 10% of the 8000 foods in the USDA database (blue bars) when we prioritise for those.  Not only do we get an increase in the more difficult to obtain nutrients, we also get a massive boost in all nutrients.  Rather than being inadequate in six nutrients, we are now lacking only one (alpha-Linolenic acid, an Omega 3 fatty acid).

Limiting our food selection to the most nutrient dense foods makes it easier for us to consume the required nutrients without excessive energy, which is ideal if we are trying to lose fat or reduce calorie intake to slow the diseases of ageing.[6] [7]  Nutrient density becomes even more important if you’re fasting or restricting calories to achieve long term weight loss.

Optimising nutrient density

If you’re reading this, then you’re likely aware that there is a wide variety of dietary approaches that people follow to optimise their health depending on their preferences and beliefs.

I’ve tried to turn many of these beliefs about nutrition into a quantitative algorithm that we can use to evaluate and compare these approaches, and make sure we’re getting the outcome we want (e.g. low insulin, blood glucose control, nutrient density, or low/high energy density).

After testing a number of options, the three quantitative parameters that I have found the three parameters that are most useful are:

  • insulin load,
  • nutrient density, and
  • energy density.

My aim in this post is to show how considering nutrient density can improve various dietary approaches, from therapeutic ketogenic, vegan, paleo, and low fat.   This post highlights which nutrients you will most likely be lacking with each of the different nutritional approaches, which foods you can use to fill these nutritional gaps, and perhaps which supplements you may need if you are still looking for some added nutritional insurance.

There’s been a lot of talk lately by Taubes[8] and Lustig[9] about how bad sugar and fructose are, but I think these nutritive sweeteners are just extreme examples of nutrient poor foods that are highly insulinogenic and energy dense.  At the other end of the spectrum, we have foods like liver, broccoli, and spinach.  Everything else is somewhere in the middle and will support or work against your goals, whatever they may be, to different degrees.

My aim here is to help you see where each of these foods sits on that continuum and use this information to help you refine your food choices to reach your personal goals.

Therapeutic ketogenic diet

Let’s start with the therapeutic ketogenic dietary approach.   I have previously noted that a number of the issues and concerns with the ketogenic diet seem to relate to being able to obtain essential nutrients rather than consuming excessive levels of fat.[10] [11] [12]  On one hand, I’m excited that the concepts of insulin load and percentage of insulinogenic calories have been helpful for people with chronic conditions such as epilepsy, cancer, dementia, Alzheimer’s etc.  However, I think there is a risk their ultra-high fat diet will not contain the nutrients which are critically important for mitochondrial function and energy production.

The chart below shows the vitamins and minerals provided by a therapeutic ketogenic dietary approach if we simply prioritise for low insulin load (red bars)[13] in comparison to the average of all foods in the USDA database (orange bars).  If you don’t pay attention to nutrient density, then a therapeutic ketogenic diet will provide lower levels of nutrition.  As shown in the chart below if we ate a little of all the foods in the USDA database, we would be deficient in six essential nutrients, whereas if we follow a therapeutic ketogenic diet, we will likely be lacking in ten essential nutrients.

The chart below shows the effect of how thinking in terms of nutrient density can improve the therapeutic ketogenic dietary approach (blue bars) compared to prioritising for insulin load only (red bars).  All nutrients are boosted, particularly the harder to obtain ones.

While lots of people find that higher fat whole foods are hard to overeat, there are still some hyper palatable high fat foods that go down easily.  We talk about eating “fat to satiety”, but what happens when nutrient hunger kicks in and your body is craving more potassium, magnesium, calcium, or one of the other nutrients that are harder to obtain in a very high fat dietary approach?  If you keep on consuming large amounts of processed fats that don’t contain the nutrients you require, your appetite may not automatically turn off before you’ve consumed a lot of excess energy!

Low carb

The chart below shows the boost in nutrients when we consider nutrient density combined with a low carbohydrate approach.  It appears that, based on this analysis, that without a focus on nutrient density, a low carbohydrate diet is likely to be deficient in folate, vitamin D, choline, potassium, magnesium, pantothenic acid, calcium, vitamin E and manganese.  With a focus on nutrient dense foods, a low carb diet provides adequate amounts of the majority of nutrients.

Weight loss (insulin sensitive)

The weight loss approach is intended for people who are insulin sensitive but still have excess body fat to lose.  Foods with a lower energy density (e.g. spinach, broccoli cucumber, celery, lettuce etc) typically are harder to overeat because they are bulky.

This approach doesn’t pay any attention to insulin load because it is assumed that people using this approach are not insulin resistant and are able to maintain good blood glucose levels.  Practically, it’s also difficult to achieve a really high insulin load with these foods because they do not contain a large amount of processed carbs and are hard to overeat.

Without consideration of nutrient density, the essential fatty acids tend to be low along with vitamin B-12, choline, and tyrosine.  However, once we factor in nutrient density all these nutrients dramatically improve.

This approach may not be viable for long term maintenance due to the extremely low energy density which would make it hard to get in enough energy.  However, in the short term, it may be appropriate for a period of substantial energy restriction, and will provide maximum nutrition with a minimum amount of energy.

Zero carb

Getting adequate protein on a zero-carb approach is not a problem.  However, unless there is a major focus on organ meats, there are a large number of vitamins and minerals, such as   vitamin K, manganese, vitamin C, vitamin E, vitamin D, potassium, magnesium and calcium that may be worth supplementing.

Vegan

At the other extreme, the chart shows the nutritional analysis of the vegan diet.  The main deficiencies in a vegan approach are omega 3s and vitamin B-12, which are hard to obtain without animal products.  It may be prudent for vegans to consider fish oil supplementation and B-12 injections, or alternatively adding some seafood occasionally.

While it appears possible to obtain the recommended levels of protein, it’s hard to get very high levels of it.    If you are insulin resistant, the fat levels can be increased using added coconut products and nuts.

Higher insulin load foods for bulking

The bulking approach is designed for people who are looking to gain strength and size by combining nutrient density with more calories and insulin load.  Without consideration of nutrient density, a high insulin load means very low nutrient density foods.  However, once we factor in nutrient density, we get a range of highly nutritious foods that may be helpful if you want to gain size and strength, while still maximising health and nutrition.

Paleo

The chart below shows the nutrients provided by the Paleo approach (i.e. no processed foods, dairy or grains) both with and without consideration of nutrient density.  While ‘going Paleo’ eliminates many of the nutrient-poor processed food, it appears to be beneficial to also consider nutrient density as well in addition.

What does this all mean?

So, how do we decide which approach is best?  Unfortunately, it’s not straightforward so I’ll look at this a number of ways.

What we ideally want is to identify the foods that will provide us with high amounts of all of the nutrients.   The blue bars in the chart below represents the average of the % daily recommended intake of all the nutrients in the various approaches evaluated above, without considering nutrient density.  The orange bars represent the average minus 0.5 x the standard deviation which is a measure of reliability.  The higher the reliability the more consistent and high are the nutrients over all.

This chart shows that, in comparison to the other approaches, Paleo foods have a high and consistent level of nutrients; while the vegan and low energy density weight loss foods have high levels of some individual nutrients, but low levels of some others.  Without consideration of nutrient density, the high insulin, low carb and zero carb approaches are a bit lacking in nutrients.

Things become a little more interesting once we factor in nutrient density.  The vegan, therapeutic keto, low carb and zero carb approaches do poorly against the paleo, higher insulin load, most nutrient dense of all foods, and the lower energy density weight loss foods.

Many people will benefit on a high fat therapeutic ketogenic dietary approach, at least until their blood glucose and insulin levels normalise.  However, in time, it may be beneficial to transition to more nutrient dense foods to continue their journey towards optimal health.

As detailed in the ‘how to optimise your diet for insulin resistance’ article, I think you should eat the most nutrient dense foods your pancreas can keep up with while maintaining good blood glucose levels.  In time, someone who is highly insulin resistant may be able to progress to a more nutrient dense and more moderate fat approach if your ultimate goal is to normalise blood glucose levels and lose weight.

Food lists

If you identify with any of these goals, you may be interested in following these food lists.   If blood glucose levels are sky high or you are managing a chronic condition such as epilepsy, cancer, Alzheimer’s or dementia, you may benefit from a higher fat therapeutic keto dietary approach, for a period.  As your glucose levels come under control, you can transition to more nutrient dense foods that will also help you to achieve your weight 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

Getting even more personal

As you can see, nutrients are provided at different levels depending on the approach.  However, most people don’t follow any dietary approach strictly, so the nutrients in your diet will be different depending on your personal habits and preferences.

Rather than trying to pick up someone else’s nutrition plan, or live by a strict list, I think it’s better to refine your current habits, emphasising the good foods, minimising the bad, and progressively trying new foods that may be beneficial.

To this end, I’ve been developing a Nutrient Optimizer algorithm that can help you refine your food choices to suit your goals.  By identifying the foods you are currently eating that align most with your current goals, which ones don’t, and which new foods perhaps you should consider.

Most current nutritional advice is driven by the avoidance of fat, particularly saturated fat, and therefore ends up being next to useless.  Calorie counting apps like MyFitnessPal does nothing but count calories, which is also of limited use.  Cron-o-meter tracks your micronutrients and can recommend foods to boost a single nutrient.  However, there doesn’t seem to be anything available that will tell you which foods will help you actually correct multiple deficiencies and  achieve a diet that is truly balanced in micronutrients.

The Nutrient Optimiser also allows you to tailor the approach to your goals, such as:  therapeutic ketosis, diabetes management, weight loss or just nutrient dense maintenance.  Food preferences like vegan, pescetarian, autoimmune, or paleo can be factored in to the recommended food lists.

At the moment, the process involves manually exporting food intake data from Cron-o-meter, then analysing it in a spreadsheet to manually generate a personalised report.  I am eager to do this as a proof-of-concept for a range of people with various goals (particularly therapeutic ketosis, vegetarian, zero carb, fruitarian) to demonstrate how it works.  So, if you’re happy to have your report shared publicly, and have a couple of weeks of Cron-o-meter data, feel free to send it to me and  have your data analysed.

In time, the plan is to automate the process via an online interface and then ideally an independent mobile app.    To keep up-to-date with progress, watch this space and check out the various analysed examples on the Marty Kendall’s Nutrient Optimiser Facebook page.

Epilogue…  limitations

For completeness, I thought it would be worth mentioning a few limitations relating to calculating nutrient density…

  1. Measuring foods in terms of calories has its own limitations as different macronutrients provide different amounts of energy (ATP) in different people. Some smart friends of mine are working on calculating ATP yield for different foods based on their macronutrient content.  I’ll happily update this analysis in terms of nutrients per ATP as soon as that data is available.  Initial indications are that people who are fat-adapted are able to use fat more efficiently (i.e. less entropy/losses in metabolism) and hence require less calories to yield the same amount of energy in the body (i.e. ATP).  Hence, it appears that it is even more important for someone following a low carb or ketogenic approach to maximise nutrient density in terms of nutrients per calorie.
  2. The official dietary reference values are based on limited research.[14] Typically, they relate to the minimum amount of a nutrient to avoid disease rather than the amount required for optimal function.  They may also vary by person (e.g. someone who is more active may need more protein) and by their diet type (e.g. someone who is on a low carb diet may need less vitamin C to process the limited amount of glucose).  Hence, I think the DRI values should be seen as a minimum.  Ideally, we want to get more than the minimum while not having to ingest too much energy.  I also don’t think nutrients are meant to come as individual vitamins and minerals in a bottle.  The nutrients required to metabolise a certain food typically come packaged in whole foods, and often work synergistically.  Taking supplements or fortifying foods will always be inferior to obtaining nutrients from whole foods.
  3. Species-specific bioavailability and anti-nutrients are contentious topics. Zero carbers will tell you that nutrients in animal based foods are more bioavailable than plant based foods, while the vegans will tell you the opposite.  To date, I haven’t been able to find useful data that would enable me to quantitatively refine the nutrient data in the USDA database regarding bioavailability.  All we currently have is a measure of the nutrients contained in the food– rather than the nutrients that make it into your body after digestion.  Again, if this data ever comes to hand, I’ll eagerly update the analysis.

Overall, I don’t think these limitations make a difference in the outcomes of the analysis.  This is not an exact science and the body doesn’t operation like a rigid machine.  Calculation of nutrient density is just a way to identify the foods that contain the most raw materials with the least amount of calories that your body can work with.

referecnes

[1] http://www.who.int/nutrition/publications/nutrient/en/

[2] https://books.google.com.au/books?id=gtQyAgAAQBAJ&pg=PA185&lpg=PA185&dq=%22nutrient+hunger%22&source=bl&ots=VMRQ8EbvHx&sig=l_xJEksBS538UX3QwQNxVJBXTLw&hl=en&sa=X&ved=0ahUKEwjRj6mSs5DSAhWKyLwKHXBQAjEQ6AEIKDAC#v=onepage&q=%22nutrient%20hunger%22&f=false

[3] https://www.amazon.com/Perfect-Health-Diet-Regain-Weight/dp/1451699158

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

[5] https://optimisingnutrition.com/2016/03/21/wanna-live-forever/

[6] http://ajcn.nutrition.org/content/78/3/361.full

[7] http://www.nature.com/articles/ncomms14063

[8] https://www.amazon.com/Case-Against-Sugar-Gary-Taubes/dp/0307701646

[9] https://www.youtube.com/watch?v=dBnniua6-oM

[10] https://www.thepaleomom.com/adverse-reactions-to-ketogenic-diets-caution-advised/

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

[12] http://www.thelivinlowcarbshow.com/shownotes/10888/868-dr-sarah-ballantyne-challenges-the-wisdom-of-low-carb-diets-for-women-2/

[13] In terms of macronutrients this high fat dietary approach comes out at 80% fat, 15% protein, 2% fibre and 3% net carbs.

[14] http://www.who.int/nutrition/publications/nutrient/en/

analysis of what a nutritionist eats and hospital food

An article in Business Insider, A Nutritionist Shares Pictures of Everything She Eats in a Day, caught my eye recently.  I thought it would be interesting to run the numbers to see how the food diary logged by this nutritionist compared to the four hundred or so meals that I’ve analysed.

Check out the original article if you want to see the daily food log chronicled in photos by the popular and published “Registered Dietician”, who claims to specialise in diabetes and is “passionate about being a good role model.”[1]

The quantities and foods that I analysed in the recipe builder at SELFNutritionData are shown below.  Besides the fact that the only green things she ate during the day were M&M’s, the food log is not particularly divergent from mainstream dietary advice (i.e. no full-strength Coke or McDonald’s).  The nutritional analysis would be much worse if it was a diet full of junk food, which is pretty common for a lot of people these days in this fast-paced convenience-loving world.

image10

This dietician is a national media spokesperson for the Academy of Nutrition and Dietetics.  She has published books and written for several magazines.[2]  Like most nutritionists, she argues for less fat and more whole grains.[3]

image00

So, let’s see how her daily diet stacks up.  The analysis below shows that, when we compare this daily diet against mainstream dietary advice that nutritionists prescribe, it ticks the following boxes:

  1. avoids trans fats,
  2. is low in fat, and
  3. is low in cholesterol.

image05

However, even though the diet is fairly low in fat, it has 29g of saturated fat which is greater than the Heart Association’s recommendation for a maximum of 16g of saturated fat per day.[4]   Unfortunately, the recommended limit of saturated fat is actually quite hard to achieve without relying on low fat highly processed foods.

Ironically, due to the focus on avoiding fat and trying to incorporate more “heart healthy whole grains”, the food recommended by nutritionists ironically tends to be lacking in nutrients.  It makes no sense!

The registered nutritionist’s daily food log also contains more than 400 grams of carbohydrates which will be a massive challenge to someone who is insulin resistant, would likely generate insulin resistance and eventually diabetes in someone who isn’t there yet.

For comparison, check out the analysis shown below of one of my regular meals (stir-fry veggies with some butter and sardines) which has a much higher vitamin and mineral score (94 compared to 55) and better protein score (139 compared to 66).

image03

image18

When it comes to nutrient density and being diabetic friendly, this nutritionist’s daily food log ends up at the bottom of the pile of the four hundred meals that I’ve analysed!

It’s sad that this myopic one-size-fits-all dietary advice is forced on anyone who asks what they should be eating, or anyone whose food is influenced by government nutritional guidelines (e.g. hospitals, schools, jails, nursing homes etc).

Then we are told that dieticians are the only ones that are qualified to give dietary advice, even though the dietary advice that they give revolves around avoidance of saturated fat and more “heart healthy whole grains” and does not actually lead to high levels of micronutrition.

image12

Where it gets even sadder is that this sort of short sighted advice is also given to the people who are the most vulnerable.  The photo below is of Lucy Smith in hospital after being diagnosed with Type 1 Diabetes.  The diet given to her, as a newly diagnosed Type 1 Diabetic, is Weet-Bix, low fat milk, bananas, low fat toast, orange juice, and peaches.

image26

The analysis for Lucy’s hospital-provided breakfast is shown below.

image17

This single meal contains more than 200 grams of carbohydrates (82% of calories).  This breakfast would require a ton of insulin to be injected into her little body, and she would be on a blood glucose / insulin rollercoaster for days to come.

image16

When it comes to nutrient density, this meal has an even lower score than the day in the life of the nutritionist’s own diet discussed above!  Ironically, this hospital prescribed meal ranks at the very bottom of the list of four hundred meals when ranked to identify the best recipes for people with diabetes!

image14

Unfortunately, things don’t seem to have changed much from thirty years ago when my wife Monica was diagnosed with Type 1 Diabetes.  In hospital, after diagnosis, she was given so many carbs that she hid the food in pot plants in her hospital ward room because she just couldn’t eat anymore!  Twenty-five years later, she learned about the low carb dietary approach and she was finally able to reduce the high levels of insulin required to cover her food.

I’ve witnessed firsthand the massive improvements in quality of life (body composition, inflammation, energy levels, dental health etc) when someone comes off the blood glucose/insulin roller coaster!

Monica has been able to halve her daily insulin dose since no longer ascribing to the dietary advice she has been given by the dieticians and diabetes educators.  Her blood glucose levels are now better than ever and when she goes to the dentist, podiatrist and optometrist they tell her she’s doing great and they wouldn’t even know she’s diabetic.  And I get to have my wife around for an extra decade or two!

image04

By the way, Lucy is doing well now too.  Her parents are some of the most knowledgeable people I know when it comes to optimal foods for diabetics and monitoring blood glucose (as shown in this video from her father Paul).

My friend, Troy Stapleton, is another example of someone living with Type 1 Diabetes who has benefited immensely from a low carbohydrate dietary approach that aligns with his metabolic health.  His story and approach has been an inspiration to me.  You can also check out the Standing on the Shoulders of Giants article for a few more encouraging stories of people with Type 1 who got their life back after going against nutritionists orders.

As detailed in the article How to optimise your diet for your insulin resistance, if you have the luxury of being more metabolically healthy (i.e. not diabetic) you can focus on more nutrient dense foods or lower energy density if you’re looking to lose some weight.

image24

It amazes me that dieticians can be so militant and belligerent when they are largely passing on the recommendations of the US Department of AGRICULTURE (i.e. the USDA, also known as “Big Ag”), whose mission it is to promote the economic opportunity and production of AGRICULTURE[5] (i.e. grains and seed oils).  Talk about putting the fox in charge of the hen house!

image09

Speaking of conflicts of interest, it’s worth noting that major nutritionist organisations funding ‘partners’ are big food manufacturers.[6]  Does this influence the recommendations they give?  They claim not.

It’s hard to believe their published research or dietary recommendations could be impartial when so heavily sponsored by the food industry.

image06

Despite these conflicts of interest and a poor track record of success over the past four decades, I don’t think we should be gagging the Accredited Dietitians from publishing poor nutritional advice.  Everyone should be entitled to their freedom of speech and freedom to choose what they eat.

image23

What I do find ironic is that dieticians can bring spurious cases of malpractice against doctors to their governing bodies when they are acting in line with latest research and their personal, professional and clinical observations (e.g. Tim Noakes in South Africa and Gary Fettke in Australia).  At the same time, the Registered Dieticians have no governing body to report to, only their board of directors[7] and their ‘partners’.

image13

image07

While they purport to be protecting the public interest, one could be excused for thinking that the dieticians’ associations are another marketing arm for big food companies and are protecting commercial interest rather than acting on behalf of public health.

16864248_10158266373295383_2174911756581917873_n

Is it just a coincidence that Nestle’s Milo, which is half sugar, is prescribed by hospital dieticians for pregnant and breastfeeding mothers with diabetes?

image30

Unfortunately, the situation isn’t that much different with the diabetes associations.[8]  Why would these institutions ever make recommendations to their members that reduced the amount of medications they needed or reduce the amount of processed food when their financial partners are pharmaceutical companies who manufacture insulin and drugs for diabetes?

image01

What would happen to this financial structure if a significant amount of people started eating whole unprocessed food without a bar code?  The share price of these massive medical and pharmaceutical companies would tank!

image22

After battling cancer himself and studying the role of nutrition in metabolic and mitochondrial disease in depth, Gary Fettke now spends his days as an orthopaedic surgeon amputating limbs mainly due to the complications of diabetes.

No, it’s not pretty, but unfortunately it’s very very real.

image19

Each year Gary volunteers as an orthopaedic surgeon in Vanuatu.[9] [10]  The contrast between the native people living in their natural environment, eating their native foods, and their relatives in town, eating processed foods, is stark.

I took this photo in a traditional village during our holiday in Vanuatu a couple of years ago.  These people eat lots of coconuts (which contains plenty of saturated fat, one of the remaining nutrients that Registered Dieticians still say we should avoid) and fish. These Vanuatu natives are some of the most beautiful, healthiest and happiest people I have ever seen!

image11

Unfortunately, in the capital Port Vila, it’s not so pretty.  The diabetes rates are the third highest in the world.  One in fifty Vanuatu natives have had an amputation!

It is such a big problem. Their diet has changed quite rapidly over the years, so instead of eating their island’s food, they now eat very large quantities of white rice and of course all the liquid sugar, like Coca-Cola and Fanta, and it’s literally killing them.[11]

After seeing the impact of diet, Gary has been outspoken in Australia, bringing attention to the quality of food that people are eating, especially in hospitals.[12]

image27

Gary and his Nutrition for Life Centre also worked with Chef Pete Evans on the “Saving Australia Diet” on national TV with great results achieved.[13]

image20

Then, in return for his efforts, Gary has been reported by the certified dieticians to the Australian Health Practitioner Regulation Agency; and he has been told he can no longer tell his patients to limit sugar even if they have just had their leg amputated due to the complications of diabetes.

Similarly, Tim Noakes has developed a massive following after realising that he needed to go against his own previous publications and advice, when he found he was developing diabetes. The recipe book that he helped write, The Real Meal Revolution, is filled with nutrient dense low carb meals that help people with diabetes achieve normal blood glucose levels, has been massively popular.

image21

Despite his impressive track record of real results, which goes against the general trend of the explosion of diabetes and obesity in western society, Professor Noakes has been reported to the Health Professionals Council of South Africa (HPCSA) and charged with unprofessional conduct, after suggesting that a mother wean her baby on to whole foods rather than processed “baby food”.

image15

This has led to a long and expensive court case which really appears to be more about maintaining the status quo on the supermarket shelves rather than public health.[14]

I think most nutritionists believe that they are doing the right thing by advising their clients to prioritise the avoidance of fat, cholesterol and saturated fat, and eat “heart healthy whole grains”.  However, the foundation of this advice seems to be crumbling from underneath them with the most recent updates to the US Dietary Guidelines that now remove the upper limit on fat and removing cholesterol a nutrient of concern.[15] [16]

However, if we have to rely on Big Food to provide processed food products to achieve the reduced saturated fat aspirations of the dietary guidelines (and in so doing produce very otherwise nutrient poor foods), then perhaps we need to declare them broken and look for new ones?

image02

Makes you wonder how we survived (let alone thrived) with the food that were available to us before the highly-processed foods and the low fat dietary guidelines that came to dominate our food choices in the 1970s.

Unfortunately though, fear of saturated fat still dominates the majority of mainstream dietary recommendations out there and leads to nonsensical food rankings that only suit the grain based food industry.[17] [18]

For example, the simplistic Australian Health Star Rating is based on the energy, saturated fat, sodium, sugar content along with the amount of fruits and vegetables in a product.[19]  This avoidance-based process gives little consideration for the amount of essential nutrients in a product, regardless of where they came from, and hence often returns nonsensical results.

image29

It’s hard to tell whether the attacks on people like Fettke and Noakes are motivated by:

  1. Well-meaning nutritionists who earnestly believe that higher levels of fat and a lack of “heart healthy whole grains” is going to harm people,
  2. Nutritional institutions sensing that they are becoming irrelevant and making a last-ditch attack at their adversaries in an effort to hold onto their jobs,
  3. Processed food manufacturers (i.e. big food) using their “partner organisations” to attack these outspoken thought leaders so they can maintain their strangle hold on nutritional advice that suits them and sells more of their product (i.e. it’s not a conspiracy, it’s just business), or
  4. Some combination of each of these options.

To cut through the confusion and conflicts of interest, wouldn’t it be great if there was an unbiased quantitative way to judge whether a particular food or meal was optimal based its nutrient density?  Perhaps we could even tailor food choices based on blood glucose and metabolic health (i.e. using insulin load), or by manipulating energy density of someone who is insulin sensitive but just needs to lose weight.

If you’ve been following this blog, you may have seen the optimal food lists tailored to specific goals.  To this end, I have devised a system to identify foods for different goals and situations. The table below will help you choose your ideal dietary approach and optimal foods based on your blood glucose levels and waist to height ratio.

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

The first step in improving your nutrition is to minimize processed food that is laced with sugar.  These food lists can help you further optimise your food choices to suit your goals whether they be blood glucose management, weight loss or just maintaining optimal health.

Once you normalise your blood glucose levels, you can then start to focus more on nutrient density.  If you still have weight to lose, then you can focus on foods with a lower energy density to force more energy to come from your body while still maximising nutrition.   You can also find the highest ranking of the four hundred meals that I have analysed listed here.

Several people recently have suggested that I turn the nutrient density ranking system into a mobile app for easy implementation of the ideas and theories outlined on the blog in the real word.

So, my current project is to develop a Nutrient Optimiser that would rank the foods you have eaten based on your current goals (e.g. therapeutic ketosis, diabetes management, weight loss or maximising nutrient density) and recommend new foods to try.  The Nutrient Optimiser would progressively retrain your eating patterns towards ideal by helping you to maximise the more optimal foods, and progressively eliminate the foods that don’t align with your goals.   Whether you are trying to eat less Maccas, or you are practicing Calorie Restriction with Optimal Nutrition (CRON) and trying to live to 120, the Nutrient Optimiser would push you forward to truly optimise your nutrition.

The idea is not to simply create another calorie counting app.  There are plenty of those out there already.  Rather, the Nutrient Optimiser will help you to maximise nutrient density as much as you can, while catering to your other goals.

Rather than being centred on outdated “science” and avoiding boogeymen such as cholesterol, fat and saturated fat, or serving the interest of “financial partners” (e.g. BigFood and BigPharma), the Nutrient Optimiser uses a quantitative algorithm that will help you maximise the nutritional value of the food you eat.

The Nutrient Optimiser, based on the foods logged in the past few weeks, helps you to identify foods that would provide the nutrients that you haven’t been getting as much of.  Rather than just tracking calories, the app will continually adapt to what you eat, ensure that you are getting a broad range of foods that contain the nutrients you need, and ensure you don’t get stuck in a nutritional rut.

For people just starting out, it will help them gently move forward, without the judgement of someone looking over their shoulder.  It will suggest foods they should buy more of, new foods to try, and maybe which foods they should bin and never buy again.

For people who are truly wanting optimal nutrition, it will hopefully be the ultimate tool to continue to refine their food choices to maximise nutrient density while optimising blood glucose, insulin and body fat levels.

As you continue to log your weight, blood glucose levels and whatever other metrics you want to track, the app will progressively prompt you to “level up” to a more optimal nutritional approach.  Then, with your nutritional deficiencies filled, the cravings will dissipate and you will naturally be satisfied with less food.[20] [21]

If something like this is of interest to you and you want to be an early adopter or just check it out the nutritional analysis of other people food logs that have been done so far then then take a look at the Nutrient Optimiser Facebook page and to stay posted as things develop.

 

 

 

references

[1] https://www.amazon.com/Ruth-Frechman/e/B007HDN5IW

[2] http://www.ruthfrechman.com/Meet_Ruth.html

[3] https://www.youtube.com/watch?v=LAugDpr16Jg

[4] http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Know-Your-Fats_UCM_305628_Article.jsp#

[5] https://www.usda.gov/documents/usda-strategic-plan-fy-2014-2018.pdf

[6] http://daa.asn.au/advertising-corporate-partners/program-partners/

[7] http://daa.asn.au/?page_id=136

[8] https://www.diabetesaustralia.com.au/corporate-partners

[9] http://www.hopeforhealthvanuatu.com/volunteers/

[10] https://www.facebook.com/permalink.php?story_fbid=857965770964542&id=393958287365295

[11] http://www.radionz.co.nz/international/programmes/datelinepacific/audio/201818486/hope-given-to-amputees-in-vanuatu

[12] http://www.nofructose.com/2014/12/19/hospital-food-is-crap-and-its-killing-my-patients-and-what-to-do-about-it/

[13] https://au.news.yahoo.com/sunday-night/features/a/31538041/the-saving-australia-diet/#page1

[14] http://foodmed.net/tag/tim-noakes/

[15] http://time.com/3705734/cholesterol-dietary-guidelines/

[16] https://therussells.crossfit.com/2017/01/05/big-food-vs-tim-noakes-the-final-crusade/

[17] http://healthstarrating.gov.au/internet/healthstarrating/publishing.nsf/Content/How-to-use-health-stars

[18] http://www.nuval.com/

[19] http://healthstarrating.gov.au/internet/healthstarrating/publishing.nsf/Content/excel-calculator

[20] http://sydney.edu.au/news/84.html?newsstoryid=12632

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

sardines, spinach, eggs and avocado

My dad has been working hard to craft nutrient dense moderate protein meals.  For a while he was pursuing ketosis with a higher amount of dietary fat and his Bulletproof teas with extra butter after I introduced him to Dave Asprey’s version of “intermittent fasting” .

After an initial period of success  he found he was putting on weight, becoming inflamed and his blood glucose levels were starting to drift back up.

He then started to go for a slightly higher amount of protein in line with the concepts described in Volek and Phinney’s four phases of a ketogenic diet chart.  That is, during weight loss some of the fat being burned each day should come from body fat.  Hence his meals needed to focus on getting adequate protein to support muscle maintenance and obtain other necessary nutrients, while significantly reducing dietary fat.

Once he did this he started losing weight and his ketones actually increased due to the body fat being burned.  With adequate protein in place he then dialed down the dietary fat to the place that still comfortably satisfied hunger.  From there he had some great results in terms of weight loss.

p1090716

This meal of sardines, eggs, spinach, garlic, broccoli sprouts, avocado, goat cheese and a few walnuts is an example of one of those meals.  The details are shown in the analysis below.  As you can see it does well in terms of both the vitamins and minerals and the protein score.  While there is not a lot of added fat in this meal (butter used for cooking) there is still 65% fat from whole foods.

2016-11-19-12

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

net carbs Insulin load carb insulin fat protein fibre
4g 23g 16% 65% 35g 5g

stir fry veggies with sardines

This is a simple  breakfast we’ve been doing at our place lately.

For an speedy pre-work breakfast we buy the veggies pre-chopped from Coles (in a bag) and throw them in the fry pan with some butter.

img_7331-1

For some extra protein and nutrients open a can of sardines when the veggies are done.

2016-11-14-07-05-19

As you can see below, the vitamin and mineral score very well and the protein score is great too!

2016-11-19-7

The veggies contain some carbs, but not a lot of net carbs once you account for the fibre.  This meal has a nice gentle response on Moni’s (my wife who has Type 1 diabetes) blood glucose levels too.

If you were looking for a more ketogenic approach you could add some more butter in the cooking.  If you were looking to lose weight you could add a bit less.

This recipe comes in at:

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

net carbs insulin load carb insulin fat protein fibre
8g 29g 26% 54% 39g 11g

Some other variations on the theme include, veggies with canned salmon and cottage cheese.

img_7431

2016-11-19-9

Or just straight with the almonds, no fish.

 

Moni enjoys this if she’s sick of diary and eggs.

2016-11-19-10

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

net carbs insulin load carb insulin fat protein fibre
12g 22g 55% 65% 18g 14g

how optimize your diet for your insulin resistance

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

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

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

The importance of monitoring blood glucose levels

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

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

image13

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

image19

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

image03

Optimal ketone levels

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

image21

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

image18

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

image26

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

2016-11-15-10-58-17

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

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

image06

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

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

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

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

image27

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

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

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

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

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

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

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

image28

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

image16

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

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

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

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

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

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

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

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

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

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

image24

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

The relationship between ketones and glucose

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

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

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

image02

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

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

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

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

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

But it works until it doesn’t

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

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

What gives?

What do you do now?

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

It can be confusing on the interwebs!

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

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

What is insulin resistance anyway?

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

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

image00

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

image22

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

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

image29

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

image02

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

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

Be a nutrient chaser

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

image30

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

image01

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

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

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

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

“To produce ATP efficiently, the mitochondria need particular things.  Glucose or ketone bodies from fat and oxygen are primary.   Your mitochondria can limp along, producing a few ATP on only these three things, but to really do the job right and produce the most ATP, your mitochondria also need thiamine, riboflavin, niacin, pantothenic acid, minerals (especially sulfur, zinc, magnesium, iron and manganese) and antioxidants.   Mitochondria also need plenty of L-carnitine, alpha-lipoic acid, creatine, and ubiquinone (also called coenzyme Q) for peak efficiency.”[22]

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

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

image04

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

Ask the experts

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

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

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

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

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

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

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

image12

Are you really insulin resistant?

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

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

image25

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

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

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

image23

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

Oral glucose tolerance test

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

image10

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

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

Kraft test

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

image17

Oral protein tolerance test

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

image15

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

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

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

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

Optimal dietary approach survey

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

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

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

image20

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

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

Can I take my insulin levels to zero?

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

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

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

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

image14

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

So just tell me what to eat!

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

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

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

image08

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

image07

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

image11

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

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

references

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[21] http://perfecthealthdiet.com/

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

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

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

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

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

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

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

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

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

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

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

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

how to use your bathroom scale as a fuel gauge

“Complete abstinence is easier than perfect moderation.”

St Augustine

image13

This article is a follow up to the “How to use your glucose metre as a fuel gauge” article, which has been quite popular, with lots of people reporting success in lowering their blood glucose and recalibrating their hunger signals by using the numbers they see on their glucose metre.

image00

To recap, the process revolves around the idea that, perhaps even better than calorie counting or carbohydrate counting, the numbers you see on your blood glucose metre are a good indication of whether you are running low on fuel and need to eat or whether you are just eating out of habit, routine, social boredom or for entertainment.

While eating for pleasure occasionally or as part of a celebration is fine and part of enjoying life, in the long run most of us need to find a way to obtain the nutrients we need with less energy if we want to avoid obesity, diabetes and all the associated negative consequences.

If we eat highly insulinogenic low nutrient density foods regularly our insulin levels stay high and our fat stays locked in storage and hunger drives us to eat more frequently.  However, if we reverse this cycle to lower our glucose and insulin to normal levels we start to eat less frequently and we allow our stored energy to flow out of our fat cells, our appetite decrease and there is a good chance we will lose weight and gain health.

image22

The table below shows the simple process whereby someone could decide if they really need to eat.  Using this process would ensure that their blood glucose levels continue to trend down as their excess energy in their bloodstream and vital organs (pancreas, liver etc) flows out of storage.

blood glucose action
>  7 day average, well slept and low stress delay eating and / or exercise and wait for blood glucose to come down
< 7 day average if hungry, enjoy nutrient dense foods that align with your insulin sensitivity
< 73mg/dL or 4.0 mmol/L if hungry, eat higher insulin load foods and delay exercise

Using numerical outputs to guide our decision making

There is no end of debate as to whether a calorie is a calorie or whether calories matter.   Rather than tracking estimates of inputs like calories eaten or calories burned in exercise, there is nothing like tracking outputs such as your blood glucose levels, waist or weight to understand what your body is doing with the food you are eating and whether you are eating too much or too little.

If your glucose levels, insulin, waist or weight are increasing then chances are you’re eating too much, too often or the wrong type of food.

The plot below is a stark reminder that our chances of living longer improve if we have lower body fat levels or a waist to height ratio close to 0.5.

image12

The problem with tracking glucose levels

The ‘problem’ with tracking blood glucose levels is that, in time, with regular fasting, our glucose levels will normalise to healthy levels but we may still be left with excess weight.  So where do we turn once our blood glucose levels are optimal but our body fat levels are still above optimal?

This brings us to the star of this article, Rebecca Latham, who is a great example of how you can use your body measurements to guide your feast / fast cycle to achieve your long-term goals.

Rebecca has been following a low carb diet since the start of February 2009.  She was featured in the 2010 New Atkins for a New You[1]  as well as on the Atkins site as an example success story.[2]  She was a guest on Episode 404 of Jimmy Moore’s Livin’ La Vida Low Carb podcast.

image01

After a stressful time towards the end of 2015 Rebecca Latham decided she needed to make a focused effort to her lose some extra weight that had crept on.  Rebecca is also particularly motivated by her family history of ALS, Parkinson’s Disease, dementia and cancer and her own ongoing battle with Type 2 Diabetes.

image16

Rebecca’s Protocol

On 1 January 2016 Rebecca set an initial goal to lose 0.2 pounds per day over three months.      Rebecca was also eager to reduce her fasting blood glucose levels from the 100mg/dL back to the 70mg/dL that they had been at before she regained her weight.

Part of Rebecca’s inspiration comes from her uncle, Buell Carlton Cole.

He was general surgeon to the President of the United States, who would control his weight by simply not eating until he returned to his goal weight.  I initially thought this was an unhealthy approach until I read up a more about intermittent fasting.

Rather than simply not eating until she achieved her goal weight, Rebecca’s system involved not eating on days when her weight in the morning was above her target weight.  Her only exception was to be special occasions and celebrations.

Here are Rebecca’s weight loss results during her initial 90-day challenge.  Initial weight loss can be quite quick as the insulin levels drop and the body releases water.  However, it gets a bit harder to continue with straight line weight loss as time goes on as you can see towards the end.

image11

After the reached her initial goal, Rebecca had some issues that she needed to look after and ended up regaining some of the weight as you can see in the plot below of her weight over the past year.  However, once these challenges were behind her she got back on her program.  For the final part leading up to the end of the year she has dropped her goal weight loss back to 0.06lbs per day to hit her goal on 31 December 2016.   See if you can spot the few ‘blips’ around Thanksgiving and Christmas.

15823034_10209877052875396_3419408148461382419_n

This chart shows that she needed to fast for about one day in three through the year to lose nearly a quarter of her body weight over the year!

15823300_10209877058475536_8030290499401844136_n

Reflecting on her journey, Rebecca says:

I reached my highest lifetime weight in February 2009, when I weighed in at 158 pounds, with a body fat percentage of 43.7%. This is my scale weight chart for this past almost eight years, since I started eating low carb high fat (LCHF) and nutritional ketosis.

image03

Each time I lost weight and stopped tracking and weighing myself, I gradually put most of the weight back on again. As you can see by the chart, this happened several times, and the last few times it happened, my weight was going up a little higher each time.

15817831_10209874190763845_1533331424_o

On January 1, 2016, I developed and started using my Protocol. Since starting the Protocol, I took two breaks, once in May 2016 when my husband had a heart attack and I was too concerned with his health to care about my own, but I got back on the Protocol within a couple of weeks and started seeing success again.

The next time I took a break was in July 2016, when I had to eat high carb and not fast for a week in preparation for some metabolic testing. As soon as the testing was over, I was back on the Protocol and started losing again. I have been going strong ever since, with small gains here and there brought on by restaurant meals and Thanksgiving.

I have now I reached my ultimate goal for scale weight, weighing in at 122.4 pounds with a body fat percentage of 25.7%, which means that I have lost approximately 37.5 pounds of body fat. The Protocol is the only thing that has brought me sustained weight loss, and I plan to follow it for the rest of my life!

image10

Many people have a love / hate or even just a hate / hate relationship with their bathroom scale.  It would be nice if low carb or nutrient dense achieved optimal health outcomes without any restriction for everyone.  However, unfortunately, sustaining weight loss in the long term often takes discipline, some form of accountability and some level of restriction for most of us.

While weighing yourself every day isn’t much fun, the national weight control registry data indicates that people who have successfully lost weight and kept it off weigh themselves regularly.[3] [4]  [5] Rebecca’s intended long term maintenance plan will likely be to weigh herself regularly and fast again once her weight goes outside her target range.

image21

Better than calorie counting?

Some people who first try low carb or keto find that they initially lose a lot of weight eating to satiety as their blood glucose and insulin levels drop to healthier levels.  However, in the long term many people find that they need to be more disciplined and mindful of how much and / or how often they are eating to reach their optimal level of body composition.

The great thing about combining fasting with working to a goal like this is that it makes sure you don’t overdo the feasting days.  I’ve found personally that it can be hard to know how much to eat after a fast.  A quantitative system like this helps to manage and calibrate your appetite when you’re feasting.

If you eat to satiety, and not beyond, then you won’t have to fast again as soon as compared to if you binge after your fast.  Eating to satiety on a regular basis means that your body’s metabolism doesn’t slow and adjust in the same way that it would if you maintained a constant caloric restriction.[6]

Life extension benefits

There are a number of benefits to fasting:

  • You can reduce your insulin levels more than if eating small but regular meals which keeps your insulin levels consistently elevated.
  • Fasting gives your body a chance to repair through a process called autophagy which is where the old cells are cleaned up which allow space for the fresh new cells to grow.
  • Fasting trains your body to become ‘metabolically flexible’ so you can use your body fat stores for and your food for fuel.
  • There is less need to focus on the quantity of food eaten at every single meal.
  • It’s not ideal to always be in growth mode with mTOR switched on. Alternating periods of growth and repair appear to be more beneficial in the long term.[7]
  • Fasting makes sense from an ancestral point of view when we wouldn’t have had constant access to plentiful food the way we do now. Periods of intentional restriction mimic what we have become adapted to and follow the seasons of the past.

Fasting also seems to have some special anti-aging effects.  When food is scarce 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 to a time when food is more plentiful and you can reproduce and pass on your genes.  Unfortunately, this emergency repair function doesn’t happen when food is plentiful.

Fasting and blood glucose levels

During the first three months following her Protocol Rebecca added a blood glucose target to also bring her blood sugar down by 0.25 mg/dL per day.  As you can see in the chart below her blood glucose levels have dropped pretty much in parallel with her weight loss during this time.

image06

More recently, she tested her blood glucose levels and found that they were consistently great so she ended up discontinuing the testing because it was becoming monotonous and not helping her make useful decisions.

While it’s useful to track a few things, it can be overwhelming and time consuming to keep track of too many things at once and lead to analysis paralysis.  It’s good to find a handful of things to track that will help you make useful decisions.

Do we lose fat or muscle during fasting?

One hot topic of discussion is the amount of lean mass (i.e. or muscle) that one may lose in long term fasting.

The reality is that any weight loss is going to consist of a combination of water, fat and muscle (or lean muscle mass).  The chart below from Kevin Hall’s model shows that we initially lose a lot of carbohydrate (glycogen) and with it a lot of water.

Protein / muscle loss is the smallest component of loss from the body and this decreases as we adapt more to using fat and ketones rather than relying on glucose.  It takes a few days to adapt to using fat and ketones, but in the long run they are by far the greatest proportion of energy used during fasting.

image23

Rebecca’s experience aligns with this.  She didn’t get a DEXA scan, but she does take regular body measurements which she uses to calculate her body fat percentage (see US Navy Circumference Method).  Based on these measurements she lost 28.6 lbs of fat and 3.0 lbs of lean mass.   So, more than 90% of her weight loss over the past year was fat.

15726291_10209877054995449_1454532664093740434_n

“Problems” with fasting

Jason Fung has recently popularised the concept of fasting in the low carb community via his blog and videos and published The Complete Guide to Fasting.  There is a ton of convincing evidence on the benefits of fasting which is an age old practice for a variety of reasons.

However, Dr Steve Phinney has come out highlighting his concerns with long term fasting with respect to loss of lean tissues as well as vitamins and minerals.    A number of others have expressed concerns that fasting without due care and attention to refeeding will not be beneficial in the long term.

One way to reconcile the differences is to see these concerns as two ends of the spectrum.  Jason’s focus is very sick people who come to him with major kidney issues due to their advanced Type 2 Diabetes, while Steve’s focus is more around maximising athletic performance for those whom maintaining muscle mass is critical to performance.

As you can see in the chart below from Differences in fat, carbohydrate, and protein metabolism between lean and obese subjects undergoing total starvation the proportion of energy from lean body mass increases as our level of available level of body fat decreases.

image20

Also, if you are more fat adapted your body will be able to more easily draw energy from stored body fat rather than requiring glucose which can be drawn from the protein in your body via gluconeogenesis.

Most people don’t fit neatly into either of the extremes, so how do you refine the approach to suit your current situation?   That is where optimising your food choices to suit your current situation comes in.

How much to eat after your fast?

Personally, one challenge I find with fasting is that it’s easy to overdo it when you get to eat again.  I think some people experience this more than others.  Dr Phinney made the analogy that telling someone not to binge at the end of a fast is like telling someone to hold their breath but then not to take too big a breath when they come up for air.

While some people can eat normally the next day after a fast, personally I find that it’s easy to reach for the energy dense lower nutrient dense foods or to give yourself liberty to eat foods that you may not normally eat if you were being disciplined all the time.   By doing this, I’ve found it’s still possible to maintain or gain weight when fasting more days that you eat if you’re not disciplined with what you eat on your feasting days.

image02

If you find yourself reaching for energy dense low nutrient density foods like processed carbs, a block of chocolate or litre of cream after your fast then you could take that as a sign that you need to revert to shorter fasting periods until you’re more fat adapted.

Another challenge with fasting is that it will deplete your system of vital nutrients in the long term meaning that you may be more inclined to binge when you do eat unless you’ve focusing on maximising nutrient density in your feasting periods.[8]

What to eat after you fast

One of the unique things about fasting is that it forces your body into the cleansing process of autophagy and primes the body to rebuild.  Hence, it’s especially important to feed the parts of the body you want to grow (lean muscle mass is critical for long term health[9]) and maximise the nutrient density during the initial refeed.

In some ways, a fast is only as good as the feast afterwards that your body is highly primed to absorb.  For me that means trying to plan some nutrient dense greens and a solid amount of protein for my first meal so I don’t end up reaching for the energy dense cream, butter or peanut butter or indulge in some junk carbage because I feel like I’ve earned it.

If your goal is to lose fat during the fast then it’s important to build back the essential vitamins, minerals and amino acids during the feeding period.   The body will fight to get what it needs in the long run and I think you’ll have a better chance of avoiding cravings and involuntary binging if you maximise the essential nutrients of your food when you do this.  And if you are using fasting to achieve long term weight loss I think it makes sense to try to get the maximum number of nutrients with the least amount of energy (a.k.a.  avoiding empty calories and maximising nutrient density).

People looking to use fasting for long term weight loss may benefit from starting out with a higher fat dietary approach if they are very insulin resistant.  However, as blood glucose levels progressively improve you should be able to transition to a more nutrient dense nutritional approach which will allow you to get your required nutrients with less energy.

I see a lot of arguments online regarding whether high fat keto or high protein is optimal. I think these arguments come down to context.  The table below gives some guidance as to which approach might be right for you initially based on:

  1. your blood glucose levels (if your glucose levels are high you will likely benefit from a higher fat keto approach, at least initially until your glucose levels start to normalise),
  2. ketones (some is better than none, but there’s no need to chase high ketones with heaps of extra dietary fat, especially if you are trying to lose body fat), and
  3. waist to height ratio (this is going to be more useful than BMI to tell you if you still need to lose a bit of weight).
approach average glucose ketones (mmol/L) waist : height
(mg/dL) (mmol/L)
therapeutic ketosis > 140 > 7.8 < 0.3
diabetes and nutritional ketosis 108 to 140 6.0 to 7.8 < 0.3
weight loss (insulin resistant) 97 to 108 5.4 to 6.0 < 0.3 > 0.5
weight loss (insulin sensitive) < 97 < 5.4 > 0.2 > 0.5
nutrient dense maintenance < 97 < 5.4 > 0.2 < 0.5

This graphic from Dr Ted Naiman demonstrates how foods are all somewhere on the sliding scale between maximum energy density and maximum nutrient density.  If we are aiming for long term weight loss, we want to maximise nutrient density as much as we can while keeping blood glucose levels and insulin levels low. Then as we improve blood glucose levels and insulin sensitivity we will be able continue to move towards the right to more nutrient dense approaches which will help to provide satiety and adequate nutrition with less energy.[10]

image05

If / when we reach our ideal weight or level of body fat, we can afford to add back in some more energy dense foods because we are no longer trying to use the glucose in our liver (glycogen) and body fat from our belly.[11] [12]

image14

Rebecca says:

I originally started eating ketogenically a few years ago by eating very high fat, lower protein, and very low (sometimes zero) carbs. That worked for a while, and I lost weight, but as time went on, I found that I was eating so much fat and so little protein that I was getting hungry all the time.

I now get plenty of protein on my eating days. I am 5’3″ and eat 125g on the days that I feast.  I find with this approach I am less hungry and my Protocol requires me to fast less often.[13] [14]

Losing lean muscle mass is bad news whether you’re a bodybuilder, a diabetic or an older person battling sarcopenia.[15]   Not only will losing muscle decrease your metabolic health, glucose disposal and metabolic rate, your body will also increase appetite to regain the muscle, making it harder to keep on losing the fat.[16]

It’s not just about looking buff and building muscles, amino acids are critical to fueling mitochondrial function and creating neurotransmitters that assist in staying happy and sleeping well.  For example, the amino acid tryptophan produces serotonin which makes us happy and melatonin which helps us sleep.[17]

For reference, Rebecca’s 125g of protein per day ends up being 3g/kg LMB.  This equates to 2g/kg LBM per day on average if you factor in the fact that she fasts every third day.   This aligns with Volek and Phinney’s recommendations in the Art and Science of Low Carb Living (i.e. 1.5 – 2g/kg reference body weight) which equates to 1.7 to 2.2g/kg LBM .  In Lyle McDondald’s Rapid Fat Loss Handbook he recommends between 1.8 to 4.4g/kg LBM protein, with higher level of protein if you are lean and more active, and less if you are obese and inactive, to prevent muscle loss during a protein sparing modified fast.

The optimal food lists have been designed to help maximise nutrient density (including ensuring adequate amino acids) ideally without needing to rely on tracking calories.  Rebecca does track what she eats, but mainly to make sure she is getting adequate protein on her feasting days.

The Protocol does not *require* tracking food intake, but I strongly recommend it. I found, for myself, that if I did not track on feast days, I ate too much fat and not enough protein, and I was having to fast a lot more to make my daily goals. Starting in April, I did start using the OKL macros and recommending the same to others.[18]

Rebecca also practices early time restricted feeding (eTRF) which means she eats earlier in the day due to better insulin sensitivity which seems to be producing good results for a lot of people.  I have heard a lot of reports from people that have found that eating earlier rather than later helps with sleep, appetite and blood sugar.

Variations

I encourage you to check out Rebecca’s Facebook group where she has documented her daily progress and learnings and supports others using the Protocol.  You can download a spreadsheet and start tracking and sharing your own progress.  Public accountability and a supportive community are always going to be helpful in achieving such a long-term goal.

image28

Rebecca has ‘stacked’ several different techniques from her learnings to ensure her long term success this time around to fight her genetics and tendency to regain her weight.

Before launching in, there are several considerations to tailor Rebecca’s approach to suit your situation and goals such as:

  • Target rate of weight loss. Rebecca recommends that people aim for a maximum weight loss of 0.2lbs or 0.1kg per day.  Anything more is typically hard to sustain in the long term.  You might be feeling ambitious and this level might be easy to achieve when things are going well but it may be hard to sustain in the longer term, especially if you have a few social gatherings or parties that leave you with some catching up to do.  As you approach your goal weight you may be glad you chose a less aggressive goal as the weight loss becomes a little harder to achieve.

image17

  • Social context. This type of approach can be hard to work around family or social commitments.  I like to enjoy good food with my family on the weekends and save my fasting for work days when it’s easier to skip food.  When I’ve followed this protocol, it leaves me fasting Monday and Tuesday and eating dinner Tuesday night with the family or ideally a hearty breakfast Wednesday morning.  Based on my scale weight I may end up fasting another day or two on Thursday and / or Friday.
  • What’s your maximum fasting tolerance? Fasting gets easier with practice.  You might want to start with just skipping a couple of meals, then going for 36 hours, then a couple of days.  If you find your cravings are leading you to binge or sacrifice food quality, then you may want to stick with shorter fasting periods or aim for a less aggressive target rate of weight loss.
  • What else do you want to measure? The good thing about measuring weight is that it’s easy.  It can however be problematic in that there are a ton of things that influence your weight other than fat gain or loss (e.g. muscle, water, how full is your gut, whne did you go to the toilet etc); it’s an easy way to measure your progress day to day.  In the long term, you want to see a trend in the right direction.  If you have diabetes, then you may also want to track your glucose and even your ketone levels.  It will also be useful to track your waist measurement periodically to see whether you’re getting closer to your optimum waist to height ratio of 0.5, particularly if you are building muscle and hence the BMI categories won’t mean much for you.  For reference, during 2016 Rebecca’s waist to height ratio went from 0.54 to 0.44.

image09

How full is your stress bucket?

A word of warning, again from personal experience, is that this approach is simple, but it’s not necessarily easy.  Wondering what number you will see on the scale each day can be exciting but a bit stressful.  It can be frustrating when you see the number going in the wrong direction or not keeping up with your target rate of weight loss.

image24

Chris Masterjohn recently did an excellent podcast How I Lost 30 Pounds in Four Months and How I Knew It Was Time which I highly recommend if you’re hoping to lose some serious weight.

A regular fasting routine is another thing that you will add to your “stress bucket” and if you don’t already have your sleep, nutrition, relationships, stress, circadian rhythm and regular activity in check then the cortisol and related insulin spikes may make achieving long term success with this approach harder than it would otherwise be.

If you do have these things ticked off and you’re feeling relaxed after a Christmas holidays but may have overdone the celebratory food then you can download a copy of the spreadsheet from My Low Carb Road – Fasting Support and give it a go.

image18

 

references

[1] http://www.why-low-carb-diets-work.com/atkins-forum.html

[2] https://www.carbsmart.com/low-carb-success-story-rebecca-latham.html

[3] https://www.ncbi.nlm.nih.gov/pubmed/24355667

[4] https://www.ncbi.nlm.nih.gov/pubmed/18198319

[5] https://www.ncbi.nlm.nih.gov/pubmed/14668267

[6] https://www.ncbi.nlm.nih.gov/pubmed/20921964

[7] https://optimisingnutrition.com/2016/10/29/the-complete-guide-to-fasting-book-review/

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

[9] https://optimisingnutrition.com/2016/03/21/wanna-live-forever/

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

[11] http://livinlavidalowcarb.com/blog/the-llvlc-show-episode-1161-qa-medical-panel-2016-low-carb-cruise/26797

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

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

[14] http://www.ketoisland.com/blog/is-keto-high-fat-or-low-fat/

[15] https://optimisingnutrition.com/2016/03/21/wanna-live-forever/

[16] http://www.nature.com/ejcn/journal/vaop/ncurrent/full/ejcn2016256a.html?platform=hootsuite

[17]  https://optimisingnutrition.com/2016/12/03/finding-your-optimal-insulin-load/

[18] https://www.facebook.com/groups/MyLowCarbRoadFastingSupport/permalink/147072942381538/

 

eggs florentine with chicken livers and bacon

This recipe for eggs florentine with chicken livers and bacon is from Rebecca Latham who runs the My Low Carb Road – Fasting Support Facebook group.

2016-12-27

By using her regular fasting routine and nutrient dense feasting she has been able to lose 37.5 lb (17kg) of body fat during 2016 (which is significant given she is only 5′ 3″).

15727057_10209821240200114_1785777679376495249_n

This was one of her favourite go to recipes during her weight loss.     Rebecca says:

I originally started eating ketogenically a few years ago by eating very high fat, lower protein, and very low (sometimes zero) carbs.

That worked for a while, and I lost weight, but as time went on, I found that I was eating so much fat and so little protein that I was getting hungry all the time.

I now get plenty of protein on my eating days. I am 5’3″ and eat 125g on the days that I feast

It seems that as you approach your goal weight your body works increases appetite to maintain lean muscle mass.  I think this style of higher protein meal will maximise your chance of managing appetite during weight loss as well as maximising nutrient density to prevent rebound binges due to cravings for nutrients.

15241956_10209573518287221_140411797991623404_n

Rebecca’s recipe is:

114g (4 oz.) raw chicken livers, cut into small pieces
1/4 tsp. chopped, dried rosemary
1/4 tsp. ground, dried thyme
1/4 tsp. garlic powder
1/4 tsp. sea salt
114g (4 oz.) frozen, chopped spinach, cooked, drained, warm
1 Tbs. butter, divided
57g (2 oz.) raw onion, chopped
114g (4 oz.) raw white mushrooms, chopped
2 thick slices bacon, cooked and cut into small pieces
1 Tbs. whiskey
2 raw eggs
Additional sea salt, as desired

In a small bowl, combine chicken livers, spices, and salt, stirring to combine. Set aside.

Preheat a small cast iron skillet on medium-low heat, then add 1/2 Tbs. butter. Add onions, cover and cook for 1 minute. Add mushrooms, cover and cook for an additional 2 minutes, or until veggies start to brown. Add chicken livers to the skillet, and continue to cook, stirring, until liver is cooked medium well. Add bacon and whiskey and stir again.

Cut the remaining 1/2 Tbs. butter into a several pieces and add to the skillet, allowing it to melt down into the bottom of the pan. Do not stir it in.

Carefully break the eggs into the skillet, letting them rest on top of the mixture. Cover the skillet and cook just long enough for the eggs to cook to however you like them. For the whites to be firm and the yolks to be runny, it may take 2-3 minutes.

Arrange the warm spinach on a plate, and with a spatula, carefully lift out the food from the skillet and set on top of the spinach. If there is any butter left in the skillet, pour it over the eggs. Add additional sea salt if desired, and enjoy!

15288609_10209573504406874_9115949053764426960_o

The nutritional analysis for this recipe is shown below.  This recipe comes in at #52 of 400 in the nutrient dense meals ranking and #67 in the diabetes and nutritional ketosis meal ranking.

2016-11-29

However if we sub out some of the onion and add some spinach it comes up to #23 of 400 in the nutrient nutrient dense meals ranking and #27 in the diabetes and nutritional ketosis.  Not bad.

2016-11-30

Look out for the article detailing Rebecca’s fasting / feasting Protocol which will be published on 1 January 2017 just in time for your New Years resolutions.

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

net carbs insulin load carb insulin fat protein fibre
6g 30g 19% 56% 44g 6g

 

curried egg with cows brain

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

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

2016-11-18-1

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

Clean water.  More sunshine.  Closer to the equator.

These guys are the real deal.

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

2016-11-18

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

2016-11-18-3

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

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

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

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

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

 

nutrient dense foods for weight loss and insulin resistance

I’ve talked to a number of people recently who use a combination of the optimal foods for diabetes and nutritional ketosis and the optimal foods for weight loss lists.

So I thought it would be useful to combine the two approaches into a single list of foods for people who want to lose weight but who were still somewhat insulin resistant.

If you’re someone who is moderately insulin resistant and also wants to lose weight then…  read on.

optimal foods for diabetes and nutritional ketosis

My food ranking system revolves around manipulating three parameters to suit different people with different goals:

  • insulin load
  • nutrient density, and
  • energy density.

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

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

img_7321-1

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

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

optimal foods for weight loss

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

2016-10-16-4

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

2016-10-10 (1).png

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

2016-10-16-6

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

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

finding the optimal balance between the extremes

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

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

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

weight-loss-insulin-resistant

vegetables

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

seafood

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

animal products

image09

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

dairy and egg

image08

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

other dietary approaches

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

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

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

image02

a fresh perspective on nutrition

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

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

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

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

image41

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

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

image12

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

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

investing your insulin budget wisely

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

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

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

image39

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

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

insulin is not the bad guy

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

image02

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

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

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

show me the data

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

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

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

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

Richard David Feinman, The World Turned Upside Down

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

image30

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

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

Sorry.

My 2c on nutrient density

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

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

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

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

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

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

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

But then the next question is what causes insulin resistance?

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

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

Your mitochondria can limp along, producing a few ATP on only these three things, but to really do the job right and produce the most ATP, your mitochondria also need thiamine, riboflavin, niacin, pantothenic acid, minerals (especially sulfur, zinc, magnesium, iron and manganese) and antioxidants.

Mitochondria also need plenty of L-carnitine, alpha-lipoic acid, creatine, and ubiquinone (also called coenzyme Q) for peak efficiency.

Dr Terry Wahls

The Wahls Protocol

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

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

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

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

Robb Wolf

robbwolf-468x468[1]

Nutrient density vs proportion of insulinogenic calories

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

image35

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

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

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

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

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

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

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

Energy density versus nutrient density

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

image03

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

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

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

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

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

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

Net carbs versus nutrient density

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

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

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

image28

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

Insulin load versus nutrient density

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

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

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

image33

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

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

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

Summary

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

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

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

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

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

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

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

image35

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

Vegetables

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

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

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

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

image49

Seafood

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

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

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

image23

Animal products

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

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

image32

Nuts seeds

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

image10

Dairy and egg

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

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

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

image38

Fruit

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

image08

Cereals and grains

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

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

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

image11

Legumes

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

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

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

image45

Fats and oils

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

image27

Beverages

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

image40

Appendix B – Nutrient density vs energy density

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

image03

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

Vegetables

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

image34

Seafood

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

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

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

Animal products

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

image24

Nuts seeds

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

image25

Dairy and egg

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

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

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

2016-09-04 (1)

Fruit

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

image09

Cereals and grains

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

image31

Legumes

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

image48

Appendix C – Nutrient density vs net carbohydrates for diabetes

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

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

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

image28

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

vegetables

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

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

2016-09-04 (2)

seafood

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

image44

animal products

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

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

2016-09-04 (4)

nuts seeds

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

image42

dairy and egg

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

2016-09-04 (7)

fruit

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

image22

cereals and grains

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

image04

legumes

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

image50

beverages

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

image29

 

Appendix D – Nutrient density vs insulin load

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

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

image33

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

vegetables

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

image37

seafood

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

image51

animal products

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

image16

nuts seeds

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

image43

dairy and egg

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

image21

fruit

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

2016-09-04 (9)

cereals and grains

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

image00

legumes

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

image45

fats and oils

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

image47

Beverages

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

image15

 

references

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

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

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

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

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

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

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

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

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