optimal foods for weight loss

  • Prioritising foods that provide adequate nutrition with minimal calories increases your chances of achieving health, satiety and weight loss.
  • Weight loss can be achieved by eating high fibre, nutrient dense, low calorie density, low carbohydrate foods.
  • Eating more on days when you are active and less on low activity days will be more effective in the long term than monotonous calorie restriction.
  • Eating more fat than required for satiety you may not be giving your body a chance to burn body fat.

how to lose weight

Looking for a sure fire diet to lose weight, guaranteed?  Try eating this every day:

Breakfast

  • mushroom – 200g
  • spinach – 4 cups
  • artichoke – 120g
  • raspberries – 200g
  • pepper – 6g
  • parsley – 1 cup

Lunch  

  • collard greens – 2 cups
  • Swiss chard – 1 cup
  • turnip – 200g
  • steamed broccoli – 5 cups
  • Brussel sprouts – 16 oz
  • mung beans – 0.5 cups

Dinner

  • lentils – 3 cups
  • asparagus – 200g
  • mushroom – 200g

Will this meal plan lead to fat loss?  Yes.

Could most people do this in long term?  Probably not.

On first glance it doesn’t look like a ketogenic diet, however given that you probably couldn’t actually eat all that food in a day and you’d end up using so much of your own body fat it would probably be ketogenic.

This high fibre, high nutrient density low calorie density would require you to eat a massive four kilograms (nine pounds) of food a day to get 2000 calories.

The positives of this approach are:

  • extremely low calorie density,
  • extremely high fibre (150g per day compared to the average western intake of 17g per day),
  • extremely high nutrient density,
  • extremely filling, and
  • although 70% carbohydrates, the massive amount of fibre means the insulin load is only moderate, making it better for a diabetic than the typical western diet.

The negatives of this approach are:

  • without any fat in the diet you may not be able to actually absorb all the nutrition from the fat soluble vitamins A, E and K,
  • vitamin B, vitamin D, cholesterol and saturated fat are non-existent,
  • protein quality is only moderate without any animal protein, and
  • it may be hard to cook many of these foods without any added fats.

If you’re interested in a ketogenic diet you’re probably not going want to follow this sort of extreme vegetarian-style diet.  However there are a few things that we can learn from this approach that we could incorporate into a ketogenic approach.

high fibre, low calorie density

Eating high fibre, low calorie density foods will help to keep you full.  Non-starchy vegetables are bulky, contain a lot of water, fibre as well as lot of nutrients.

protein hunger

While counting calories will work over the short term, your body will win out over your mind and your iPhone app in the long term if you’re not giving it the nutrients it needs.

Recent research [1] suggests that we will keep eating until we get enough protein and eating foods low in protein leads people to eat more calories than they need.

Ensuring that you’re getting adequate protein (say 15 to 30% of calories) will cause you to be satiated with less calories.

nutrient hunger

In a similar way, if you’re not giving your body the vitamins and minerals it needs it will keep on seeking out more food.

In his Perfect Health Diet [2] Paul Jaminet notes that a nourishing, balanced diet that provides all the required nutrients in the right proportions is the key to eliminating hunger and minimising appetite and eliminating hunger at minimal caloric intake.  

intermittent fasting

If you keep your calorie intake consistently low for an extended period of time your body will sense an impending famine and slow down your metabolism, leaving you tired, cold, depressed and miserable.

Don’t be afraid to mix it up a bit with restricted calories a few days a week by missing a few meals on low activity days and then eating to satiate your hunger on higher activity days.

In our current food environment we don’t give our body any time when it’s not awash with calories and insulin than enable your bodies to use our stored body fat for energy.

Eat when you’re hungry.  But conversely, don’t be afraid to not eat when you’re not hungry.

“Break-fast” is an important meal, even if it occurs at 3pm in the afternoon!

eat fat to lose fat?

The reason that eating a high fat diet leads to increased satiety is that your body can access your stored body fat.

In most people eating a ketogenic diet leads to greater satiety because you’re using body fat for fuel, which leads to a reduction in food intake.

Conversely if you are eating a diet full of simple carbohydrates your insulin levels will stay high and your body fat will be locked away.

When you lose fat, your body burns the saturated fat on your body.  If at first you don’t succeed by reducing your insulinogenic load and intermittent fasting consider cutting back your dietary fat intake to create a caloric deficit which will be filled by your body fat. [3]

Some people can eat massive amounts of fat while keeping carbs low and lose weight, [4] however others can lose their way on a LCHF or ketogenic diet by eating too much dietary fat and end up not getting the results they hoped for.

Jimmy Moore emphasis that you need to eat fat to satiety[5]  If you mainline dietary fat and are not hearing your natural satiety signals you’re not going to give your body the best chance to burn body fat.

insulin sensitivity

One of the most famous diet studies looking at low carb diets is Dr Chris Gardner’s A to Z Study. [6]  Gardner, a practicing vegan, was surprised to find that it was the Atkins dieters who lost the most weight in his study.

More interestingly though were the results of a follow-up analysis where he assessed peoples’ insulin resistance.  He found was that people who were insulin resistant lost the most weight on the low carb diet while the insulin resistant lost nothing on the higher carbohydrate diets. [7]

How do you know if you’re insulin resistant?  Your weight and waist line are pretty good indicators, but your average blood sugar is even better.  If you want to know what diet is right for you, pick up a blood sugar metre from your local chemist and do some testing.

If your average blood sugars are in the excellent range according to the values below then focussing on carbohydrates as your primary goal may not be ideal.

risk level HbA1c average blood sugar
 (%)  (mmol/L)  (mg/dL)
optimal 4.5 4.6 83
excellent < 5.0 < 5.4 < 97
good < 5.4 < 6.0 < 108
danger > 6.5 > 7.8 > 140

food choices for weight loss

We can use the food prioritisation system [9] to identify foods that align with these goals by prioritising nutrient density (20% weighting), fibre (10% weighting), and low calorie density (30% weighting).

ND / calorie fibre / calorie ND / $ ND / weight insulinogenic (%) calorie / 100g $ / calorie
15% 10% 10% 5% 20% 30% 10%

The resultant foods are listed below, in order of priority, using these weightings.

A few items that you would not generally expect to see on a ketogenic diet come to the top of the list such as lentils and mung beans due to their low calorie density, high fibre content and low cost.

This weighting system does not give a high priority to fats and oils as they are coming from the body fat stores.  The list of nuts and seeds is also quite short in view of their high calorie density.

I’ve also developed this ‘cheat sheet’ using this approach to highlight optimal food choices depending, wither they be reducing insulin, weight loss or athletic performance.   Why not print it out and stick it to your fridge as a helpful reminder or when you’re looking for some inspiration for your next shopping expedition?

vegetables & spices

  • spinach
  • chives
  • turnip greens
  • coriander
  • mushrooms
  • broccoli
  • Brussel sprouts
  • kale
  • artichokes
  • Bok choy
  • peas
  • kidney beans
  • lettuce
  • sweet potato
  • carrots
  • lima beans
  • seaweed
  • asparagus
  • celery

animal products

  • organ meats
  • oyster
  • herring
  • sardine
  • pork sausage
  • ham
  • chicken
  • pork
  • turkey
  • salmon
  • mackerel
  • anchovy
  • crab
  • lobster
  • trout
  • beef

fruits

  • avocado
  • olives
  • guavas
  • raspberries
  • kiwifruit

dairy

  • whole egg
  • egg yolk
  • ricotta cheese
  • parmesan cheese
  • feta cheese
  • milk

nuts, seeds & legumes

  • lentils
  • chick peas
  • mung beans
  • kidney beans
  • lima beans
  • coconut milk
  • peanut butter
  • peanuts
  • brazil nuts
  • coconut meat

fats and oils

  • butter
  • coconut oil
  • olive oil
  • fish oil
  • flaxseed oil

example daily diet

Below is an example daily meal plan for someone wanting to lose weight by reducing calorie density and maximise nutrition using the prioritised list of foods above.  There’s nothing radical or objectionable here other than the high amounts of nutrient dense green veggies you need to eat in a day.  Some added fat is used for cooking.  There are no snacks and no calorie dense nuts and seeds.

image007

Using this approach we achieve great nutrition and protein scores along with an impressive 36g of fibre per day.

This approach involves eating nearly two kilograms of food which would leave you feeling quite full.

Although this diet is full of veggies it still has 60% of the dietary calories coming from fat.  If we ran a 1/3 calorie deficit in the early stages of a weight loss program we would have 73% of the calories coming from fat when your body fat is included.  This would very likely be ketogenic.

With the high amount of fibre, the net carbs are quite low at 44g per day which would still qualify as low carb diet.

If you find your blood sugars are unacceptably high you should consider backing off on the carbohydrate containing foods.   On the other hand if your blood sugars were excellent you could even consider increasing the non-starchy veggies to increase satiety and reduce the calorie density.

In our next article we’ll look at nutrient dense foods options that might work for you if your blood sugars are excellent and you’re doing intense exercise.

references

[1] https://www.youtube.com/watch?v=4ATDvhZQo4A&t=1677

[2] http://perfecthealthdiet.com/the-diet/

[3] http://livinlavidalowcarb.com/blog/tag/ron-rosedale

[4] http://live.smashthefat.com/why-i-didnt-get-fat/

[5] http://www.amazon.com/Keto-Clarity-Definitive-Benefits-Low-Carb/dp/1628600071

[6] http://jama.jamanetwork.com/article.aspx?articleid=205916

[7] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3504183/

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

[9] https://www.dropbox.com/s/ninuwyreda0epix/Optimising%20nutrition%2C%20managing%20insulin.docx?dl=0

ketosis… the cure for diabetes?

  • A reduced insulin load diet will lead to normalised blood sugars and improved insulin sensitivity.
  • A reduced insulin load diet can be achieved by reducing carbohydrates, moderating protein and choosing higher fibre foods.
  • Intermittent fasting also reduces insulin load.
  • Measuring your blood sugars is a simple and cost effective way to check that your metabolic health is on track.
  • A diet of nutrient dense, high fibre, high fat foods is the best way to optimise nutrition and minimise the risks associated with diabetes.

how to become diabetic…

In the “good old days” there were periods of feast and famine.  Food was typically eaten with the fibrous packing that it came with. In today’s modern food environment we are encouraged by the food industry (and those sponsored by it) to eat breakfast, lunch, dinner, snacks, pre-workout meals, post workout stacks, sports gels during exercise, and maybe some Gatorade to speed recovery.

Today’s food is plentiful, typically highly processed and low in fibre.  Carbohydrate and sugar based foods have a long shelf life, can be transported long distances and therefore cheap. Win, win?  Maybe not.

As we keep loading our bodies with simple sugars and carbohydrates our pancreas has to work overtime to produce insulin to shuttle excess sugar from the blood to your fat stores.

AVPageView 23042015 33836 AM.bmp

Over time we become insulin resistant and the pancreas can’t keep up. Once your blood sugars get high enough you will be diagnosed with “type 2 diabetes” and put on medication to improve your insulin sensitivity, for a time. If nothing changes in your food intake your insulin sensitivity will continue to deteriorate until you reach a point when you’ll need to inject insulin to keep your blood sugars down.

Injecting excessive amounts of insulin will cause you gain even more body fat. Recently we have learned that it’s not just the high blood sugars that are diabolical for your health, high levels of insulin are also toxic. [1]

Doesn’t sound like much of a solution does it?

…and how to reverse it

While there are many aspects to managing diabetes including stress, sleep, food quality and environmental toxins, the simplest and most effective thing you can do to achieve optimal blood sugars is to do the opposite of what caused the problem in the first place.

Listed below are the main things that cause diabetes and what we can do to reverse it.

leads to diabetes reverses diabetes
Excessive sugar and simple carbohydrates in the diet generate high insulin load Reduce foods in your diet that require insulin [2]
Constant food with no significant periods between meals when insulin levels are reduced Create periods when your body does not have significant amounts of circulating insulin (i.e. intermittent fasting).

Sounds simple.  But it’s not easy or quick to reverse years of metabolic damage.   Your body is hard-wired to retain fat so it can survive the next famine.

Worth the effort?  People who have done it say yes.  That’s why they’re so annoyingly passionate about it!

Remember the type 1 diabetic roller coaster blood sugars in the last post?  The CGM plot shows the blood sugars of the same person a few months later on a low insulin load diet. [3] [4] [5]

image004 - Copy

foods that require insulin

You’re likely already aware that foods containing carbohydrates require your pancreas to produce insulin.

Recently I stumbled across some recent food insulin index test data [6] that indicates:

  • protein requires about half as much insulin as carbohydrates per gram on average, [7] and
  • carbohydrates in the form of indigestible fibre do not require insulin. [8]

So if you’re trying to reduce the insulin load of your diet you should:

  • limit simple processed carbohydrates that do not contain fibre,
  • choose high fibre foods (such as non-starchy vegetables) to obtain vitamins and minerals while keeping net carbohydrates low, and
  • back off on the protein if you’re not achieving the normalised blood sugars, weight loss or nutritional ketosis results you’re after.

insulin load

Rather than simply counting carbs, you could get a bit fancy and calculate your total insulin load using this formula:

Microsoft Word Document 25032015 45826 AM.bmp

Most people will achieve nutritional ketosis with an insulin load of around 100 to 150 grams. Athletes and weight lifters will be able to tolerate more without messing up their blood sugars.  Inactive people aiming for weight loss may need to reduce their insulin load further. I don’t think that it’s ideal for most people to weigh and measure their food for extended periods.

If you’re not getting the results you want then tracking your food in MyFitnessPal or something similar can be a useful in the short term to retrain your dietary habits.

measuring for ketones versus measuring blood sugar

Once you get over seeing a little drop of your own blood, measuring your own blood sugar is pretty simple and painless, and is much cheaper than measuring blood ketones. In Australia and Canada blood sugar strips are about $0.16 compared to blood ketone strips which are about $0.80. [9]  In the US ketone strips are much more expensive, and basically unaffordable. Ketostix (which measure ketones in your urine) will typically only work for a little while until your body learns to use fat for fuel.

relationship between blood sugars and ketones

Blood sugar can be a useful way to see if you’re in ketosis. The chart below shows my blood sugars versus ketones over the last nine months or so that I’ve been trying to achieve nutritional ketosis.

tracking BGs [Last saved by user] 16042015 82501 AM.bmp IMG_7191

Based on my n=1 experience I’ve added the ketone levels which correlates HbA1c, average blood sugar and ketones.  This suggests that excellent blood sugar control for me is achieved when I’ve got ketone levels between 0.5 and 1.3mmol/L.

HbA1c average blood sugar ketones
 (%)  (mmol/L)  (mg/dL)  (mmol/L)
low normal 4.1 3.9 70 2.1
optimal 4.5 4.6 83 1.3
excellent < 5.0 < 5.4 < 97 > 0.5
good < 5.4 < 6 < 108 < 0.3
danger > 6.5 7.8 > 140 < 0.3

is more ketosis better?

The point way out to the right with a high ketone level of 2.1mmol/L and a blood sugar of 4.0mmol/L occurred after I cycled to work two days in a row on Bulletproof Coffee with a good amount of MCT oil.

In The Art and Science of Low Carbohydrate Performance [10] Volek and Phinney say that “light nutritional ketosis” occurs when blood ketones are between 0.5mmol/L and 1.0mmol/L and “optimal ketosis” is between 1.0mmol/L and 3.0mmol/L.

Based on the fact that an optimal blood sugar corresponds to a ketone reading of 1.3mmol/L and the low end of healthy normal blood sugars corresponds to a ketone reading of 2.1mmol/L I wonder if there is really any value in aiming for higher ketone values?

It’s interesting to note that Sami Inkenen, when rowing from the US to Hawaii on an 80% fat diet, [11] [12] was only getting ketones of around 0.6mmol/L [13]. If you’re striving for mental focus then loading up with butter, coconut oil and MCT oil to jack up your ketones might be for you.

If your aim is exercise performance or fat loss then ketones between 0.5mmol/L and 1.3mmol/L might be all you need to aim for. I also think loading up on dietary fat at the expense of getting adequate protein, vitamins and minerals may be counterproductive in the long term.

On the other end of the argument though, if you have good control of your blood sugars you should be showing some level of ketones in your blood.  If you consistently measure at a ketone value of less than 0.2mmol/L then it’s likely your blood sugar is not yet optimal.

what to do?

If you find this interesting and want to experiment I recommend that you buy a blood glucose metre and track your blood sugars for a while. I enter my results into a spreadsheet and look at the average of the past twenty results.

You can adjust your insulin load (i.e. less carbs, more fibre, moderate protein) until you achieve your target blood glucose level. As you test you’ll also notice that some foods cause your blood sugars to rise more than others.  Make sure you scratch those off your “do again” list.

You might also notice as you get your blood sugars under control you will get a metallic taste in your mouth, stronger smelling urine or a different body odour.  These are all signs that you’re transitioning into ketosis.  These symptoms typically don’t last for too long. If at first you don’t succeed, throw in some intermittent fasting.  I use bulletproof Coffee [16] to help me skip breakfast and sometimes lunch a couple of times a week.

Intermittent fasting is more effective than constant calorie restriction which can cause your metabolism to slow down due to conserve energy for the famine it thinks is coming. [17] [18] Having extended periods when insulin levels are low allows your body to learn to use body fat for fuel.

Once you begin to reset your insulin sensitivity you might start to notice a lack of inflammation and puffiness.  You may also find that you’re finally losing that stubborn weight and breaking through that dreaded plateau.  You may notice you feel great and your head is clearer than it’s been for a long time.  Or that that may just be my experience.

physiological insulin resistance

Some people find that as they reduce their carbohydrates that their fasting blood sugars will drift up.  This has been termed ‘physiological insulin resistance’ and is where the body develops a level of insulin resistance in the muscles to prioritise glucose for the brain. For some people this can be a transitionary phase on the way to stable ketosis.  It’s not thought to be something to be concerned about as it doesn’t cause elevated levels of insulin which is what can be really detrimental.

However some type 1 diabetics find it to be an issue long term and choose to increase the carbohydrates and protein in their food so they are just outside nutritional ketosis to reduce this effect.

My experience is that during this phase my post meal blood sugars were great even though the fasting blood sugars were higher than optimal.  As I continued to persist with more fat and added some intermittent fasting this went away and I was able to achieve lower fasting blood sugars.

Particularly during this time it is important to keep an eye on your average blood sugar (i.e. both fasting and after meals) and make sure it’s under 5.4mmol/L (100mg/dL).

can you eat too much fat?

It’s good to see medical researchers [19] and the media [20] coming out and admitting that the fear of fats over the past 30 years has led to diabolical health outcomes.

The fear of fat has forced people to eat more simple carbohydrates which has led to the diabetes epidemic. I analysed a number of dietary scenarios to see if there is any truth to the fear that low carbohydrate diets do not provide adequate nutrition and that you need your “heart healthy whole grains” to achieve optimal health, provide enough sugar for the brain, support growth in children etc. While a grain-based diet can be cheaper, my analysis suggest that a high fat diet that focuses on high fibre, high nutrient density, non-starchy vegetables is better in terms of the nutrition it provides and managing insulin demand.

The optimal diet to balance vitamins and minerals, amino acids and insulin load appears to contain between sixty and eighty percent calories from fat. It is possible to meet the recommended daily intake for most vitamins and minerals with 80% of calories coming from fat.

At the other end of the scale, higher levels of carbs may leave you storing more fat than you want to due to high insulin levels.

which foods are optimal?

What foods are optimal?  It all depends on your unique situation, goals and even finances.

I have developed a system to prioritise food choices based on the insulin properties of various foods as well as a range of other factors including:

  • nutrient density per calorie,
  • fibre per calorie,
  • nutrient density per dollar,
  • calorie density per weight, and
  • calories per dollar.

The list of foods below is a summary of the highest ranking foods using the weighting shown below in order to identify low insulin, high nutrient density food choices will lead to improved blood sugar control, mood, mental clarity, weight loss and overall health.

ND / calorie fibre / calorie ND / $ ND / weight insulinogenic (%) calorie / 100g $ / calorie
15% 5% 5% 10% 50% 10% 5%

Next time you’re wanting a nutritious meal that will push you into ketosis or lower your blood sugars you could consider some of these foods.

I’ve also developed this ‘cheat sheet using this approach to highlight optimal food choices depending, whether they be reducing insulin, weight loss or athletic performance.   Why not print it out and stick it to your fridge as a reminder of your optimal foods or to inspire your next shopping expedition?

vegetables

  • turnip greens
  • coriander (cilantro)
  • rosemary
  • spinach
  • parsley
  • peppers / capsicum
  • chives
  • mustard greens
  • collards
  • mushrooms
  • Swiss chard
  • artichokes
  • broccoli
  • Brussel sprouts
  • kale

fats and oils

  • butter
  • coconut oil
  • olive oil
  • fish oil
  • flaxseed oil

fruits

  • avocados
  • olives

eggs & dairy

  • whole egg
  • goat cheese
  • goat cheese
  • parmesan cheese
  • cheddar
  • cream
  • camembert
  • feta
  • cream cheese
  • blue cheese
  • Colby cheese
  • Swiss cheese
  • edam cheese
  • brie
  • gouda
  • mozzarella
  • ricotta
  • cottage cheese

nuts & seeds

  • brazil nuts
  • sunflower seeds
  • pecans
  • pumpkin seeds
  • almonds
  • macadamia nuts
  • pine nuts
  • coconut milk
  • coconut meat
  • pistachio nuts
  • cashews

animal products

  • organ means (liver, kidney, heart etc)
  • chorizo
  • bratwurst
  • herring
  • chicken
  • frankfurter
  • mackerel
  • duck
  • beef sausage
  • bacon
  • turkey
  • anchovy
  • ground beef
  • lamb
  • bologna
  • turkey
  • beef steak

In the next article we’ll look at which foods are optimal for weight loss by prioritising low calorie density, high fibre high nutrient density foods that will also help stabilise your blood sugars.

references

[1] https://www.youtube.com/watch?v=4oZ4UqtbB_g

[2] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2716748/

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

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

[5] https://www.facebook.com/Type1Grit

[6] http://ses.library.usyd.edu.au/handle/2123/11945

[7] Some anecdotal evidence and studies such as http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342171/pdf/IJE2015-216918.pdf indicate that it’s the protein in excess of the body’s needs for muscle growth and repair that gets turned to glucose and requires insulin.

[8] http://healthyeating.sfgate.com/indigestible-carbohydrates-1023.html

[9] http://www.ebay.com.au/itm/BEST-PRICE-10-X-ABBOTT-FREESTYLE-OPTIUM-KETONE-TEST-STRIPS-10-TOTAL-100-STRIPS/181527585627?_trksid=p2054897.c100204.m3164&_trkparms=aid%3D222007%26algo%3DSIC.MBE%26ao%3D1%26asc%3D20140407115239%26meid%3Db2cedda776824d9f8ed5d131a3232ea7%26pid%3D100204%26rk%3D3%26rkt%3D24%26sd%3D281508543955

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

[11] https://gumroad.com/l/CK219

[12] http://www.fatchancerow.org/

[13] https://twitter.com/samiinkinen/status/451089012166385664

[14] https://www.facebook.com/ketogains

[15] https://www.facebook.com/ketogains

[16] https://www.bulletproofexec.com/bulletproof-fasting/

[17] https://www.youtube.com/watch?v=4oZ4UqtbB_g

[18] http://www.bodybuilding.com/fun/drsquat6.htm

[19] http://www.touchendocrinology.com/articles/nutrition-revolution-end-high-carbohydrates-era-diabetes-prevention-and-management [20] http://time.com/2863227/ending-the-war-on-fat/

[21] https://www.dropbox.com/s/h0zd5pjgw0gfqgq/Appendix%20D%20-%20Nutritional%20analysis%20of%20typical%20diets.docx?dl=0

[22] https://www.dropbox.com/s/ninuwyreda0epix/Optimising%20nutrition%2C%20managing%20insulin.docx?dl=0

diabetes 102

  • Elevated insulin and blood glucose levels are associated with a wide range of health issues including obesity, mental health, cancer, cardiovascular disease, and stroke.
  • “Normal” blood sugars are not necessarily optimal for long term health.
  • Most people are somewhere on the spectrum between optimal blood sugars and full blown type 2 diabetes.
  • Maintaining blood sugars close to optimum is possibly the most important thing you can do to manage your health, reduce body fat, and slow ageing.
  • A diet with a low insulin load will lower blood glucose and allow you to access your body fat for energy.

what is diabetes?

“Diabetes” refers to a group of metabolic diseases where a person has high blood sugars over an extended period of time.

Type 2 diabetes occurs when people become insulin resistant and their blood sugars drift higher.  The generally accepted diagnosis levels for type 2 diabetes are:

  fasting after meal
  (mg/dL) (mmol/L) (mg/dL) (mmol/L)
“normal” < 100 < 5.6 < 140 < 7.8
pre-diabetic 100 – 126 5.6 to 7.0 140 to 200 7.8 to 11.1
type 2 diabetic > 126 > 7.0 > 200 > 11.1

Currently one in twelve adults worldwide are classified as diabetic based on this diagnostic riteria.  This number is forecast to grow by more than half over the next two decades to 592 million people by 2035. [1]

Approximately ten percent of people classified as diabetic have type 1 diabetes which is a condition where a person’s immune system attacks the cells in their pancreas and from that time on they have to inject insulin to survive. [2]   While less common, we can learn a lot from type 1s who successfully manage their blood sugars.

what are the risks?

Low carb health advocates such as Dr David Perlmutter, [3] Nora Gedgaudas [4], Dr Ron Rosedale [5] and Dr William Davis [6] tell us that we should restrict carbohydrate for metabolic and brain health as well as to prevent a range of diseases.

Hba1c [7] is a test that gives an indication of your average blood sugar over the past three months.  The chart below shows one of the more confronting charts from Dr Perlmutter’s Grain Brain [8] demonstrating that the rate of brain shrinkage with age increases with increasing blood sugar.Chrome Legacy Window 22032015 14339 PM.bmp

This chart shows that an increase in HbA1c is also associated with an increased risk of cancer.

image002

This chart shows that here is a very close relationship between insulin secretion and body mass index (BMI).

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These charts show that the risk for cardiovascular disease, coronary heart disease and stroke all increase with higher blood sugar levels.

image003

Antidiabetic medication, even if it reduces your blood sugar, doesn’t help reduce your risk of cardiovascular disease, which is the number one cause of death globally.

The link between your blood glucose control and your chance of requiring a cardiac bypass is hard to argue with. [22]

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Keeping your blood sugar under control is possibly the most important thing you can do to manage your health, manage body fat, gut health, reduce your risk of cancer [11] and slow aging, regardless of whether you have been formally diagnosed with diabetes. [12] [13]

Diabetes is expensive.  In 2012 it cost the US a quarter of a trillion dollars in hospital costs and lost productivity [14] and the cost of “diabesity” is forecast to triple by 2050 grow and become a major burden our economy.

what are optimal blood sugars?

If you’re not a diabetic getting your HbA1c checked by your doctor regularly you can use your average blood sugar values from a home blood glucose metre to see how you’re tracking compared to optimal.  Blood glucose metres are available readily online or at your local chemist.  You can pick them up for less than $10.  The higher end ones will also measure your blood ketone levels. [15]

The conversion between HbA1c and average blood sugar are shown in the table below.  I have also shown various risk levels based on the cardiovascular disease data above.  If you want to calculate your average blood sugar simply take the average of all your blood sugar tests – fasting, before meals and after meals.

risk level HbA1c average blood sugar
 (%)  (mmol/L)  (mg/dL)
optimal 4.5 4.6 83
excellent < 5.0 < 5.4 < 97
good < 5.4 < 6.0 < 108
danger > 6.5 > 7.8 > 140

Comparing the diabetes diagnosis criteria in the first table with these optimal levels it’s clear that blood sugars that are considered “normal” are far from optimal.

By the time you’re “pre-diabetic” you’re well into the danger zone.  By the time your blood sugars become elevated it’s likely that your pancreas has been trying to pump out extra insulin for some time and you are well and truly losing the battle of metabolic health.  Dr Ron Rosedale says that if you’re exposed to modern processed foods then it’s likely that you are somewhere on the spectrum between optimal and full blown diabetes. [16]

Doctor Richard Bernstein recommends an ideal blood sugar of 83mg/dL (or 4.6mmol/L) for type 1 diabetics. [17]  Paul Jaminet notes that the optimal range for blood sugar is between 70 and 100mg/dL (3.9mg/dL and 5.6mmol/L). [18]

A type 1 diabetic will carefully balance their carbohydrates and insulin doses throughout the day to try to keep their blood sugar within this narrow range.  However this is impossible on the diet recommended to them in line with the Food Pyramid / MyPlate with lots of “healthy whole grains”.

The continuous glucose monitor plot below shows the typical blood sugar roller coaster experienced by a type 1 diabetic.  This style of blood sugar fluctuation occurs to some extents in all of us to some degree, depending on our diet and our insulin sensitivity.

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what does insulin do?

The hormone insulin allows us to clear excess sugar from the blood and store it for later as body fat.  This adaptation was a great advantage for our ancestors who would consume sweet fruits in summer and store some body fat for winter.   It’s said that our ability to store fat via insulin enabled your ancestors to survive through the ice age. [19]  The people who couldn’t do this so well aren’t your ancestors, if you know what I mean.

Achieving nutritional ketosis is all the rage these days, but what it means in simple terms is that you have low enough levels of insulin to enable stored body fat to be used for energy. [20]  If your insulin levels are too high you’ll end up storing more of your food as fat.  You’ll then need to eat extra to make it through the day. [21]

In the next article we’ll look at what you can do to normalise your blood glucose levels by choosing foods with a low insulin load.

references

[1] http://www.dailymail.co.uk/health/article-2997882/Diabetes-epidemic-400-million-sufferers-worldwide-Number-condition-set-soar-55-20-years-unless-humans-change-way-eat-exercise.html

[2] http://en.wikipedia.org/wiki/Diabetes_mellitus_type_1

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

[4] http://www.primalbody-primalmind.com/about-nora-gedgaudas/

[5] http://drrosedale.com/#axzz3TzvVehTb

[6] http://www.wheatbellyblog.com/

[7] http://www.diabetes.co.uk/what-is-hba1c.html

[8] http://www.amazon.com/Grain-Brain-Surprising-Sugar-Your-Killers/dp/031623480X

[9] http://www.drperlmutter.com/important-blood-test/

[10] http://www.cardiab.com/content/12/1/164

[11] http://freetheanimal.com/2009/02/sugar-feeds-cancer.html

[12] http://chriskresser.com/how-to-prevent-diabetes-and-heart-disease-for-16

[13] http://www.drperlmutter.com/important-blood-test/

[14] http://care.diabetesjournals.org/content/36/4/1033.full

[15] http://www.ebay.com.au/itm/like/251841014229?limghlpsr=true&hlpv=2&ops=true&viphx=1&hlpht=true&lpid=107&chn=ps

[16] https://vimeo.com/52872503

[17] https://www.youtube.com/watch?v=zJGAbZIvRh8

[18] http://perfecthealthdiet.com/2011/11/safe-starches-symposium-dr-ron-rosedale/

[19] http://www.primalbody-primalmind.com/

[20] http://www.dietdoctor.com/lose-weight-by-achieving-optimal-ketosis

[21] https://www.youtube.com/watch?v=Yo3TRbkIrow

[22]  http://www.cardiothoracicsurgery.org/content/3/1/63

nutrient density optimised for diabetes, ketosis, weight loss, longevity and performance

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