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optimal foods for YOU

It’s no secret that there is no perfect diet for everyone.  Your nutritional requirements depend on many factors, including your age, health status, activity levels, and goals.

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I’ve spent a lot of time over the last couple of years designing prioritised food lists to suit a range of goals and situations.  This article summarises this labour of love into what I hope will be a useful resource that will help a lot of people.

I have grouped the various food lists into the following categories:

  • foods to optimise your metabolic health (e.g. therapeutic ketosis, diabetes management, weight loss, bodybuilding, and athletic performance, etc.),
  • foods that boost specific nutrients associated with common health conditions,
  • ethical, philosophical and religious considerations, and
  • macronutrient and micronutrient extremes (low carb, keto, high protein, low protein, etc.).

For those of you who just want to know which foods you should eat more of, I have included the food lists up front.

If you want to understand how I have developed the various food lists, continue reading to the end of the article.

Metabolic health, diabetes management, weight loss and athletic performance

Most people do well if they eat more nutrient dense foods.  However, we can tailor our food choices beyond nutrient density to better suit different people with different goals.

The table below contains optimal food for various metabolic situations.  In the table below you can:

  • click on the ‘PDF’ to open a printable list of ‘foods’,
  • download the list as graphic to save to your phone by clicking on the ‘foods’, or
  • click on the ‘nutrients’ to see the amount of each nutrient that those groups of foods contain.
approach average glucose (mg/dL) average glucose (mmol/L) PDF foods nutrients
well formulated ketogenic diet > 140 > 7.8 PDF foods nutrients
diabetes and nutritional ketosis 108 to 140 6.0 to 7.8 PDF foods nutrients
weight loss (insulin resistant) 100 to 108 5.4 to 6.0 PDF foods nutrients
protein sparing modified fast (PSMF) < 97 < 5.4 PDF foods nutrients
most nutrient dense < 97 < 5.4 PDF foods nutrients
nutrient dense maintenance < 97 < 5.4 PDF foods nutrients
bodybuilder < 97 < 5.4 PDF foods nutrients
endurance athlete < 97 < 5.4 PDF foods nutrients

I hope that these lists will help all those people who just don’t know what to eat.  Lots of people, my family included, have found these useful to print out and stick to their fridge or take it shopping for some inspiration.

If you belong to the 50% of the population that has diabetes or pre-diabetes,[1] your priority should be to normalise your blood glucose levels with a lower insulin load diet.  You can use your current blood sugar levels to choose the nutritional approach that will best support your journey towards optimal metabolic health.

The well- formulated ketogenic diet approach is designed for someone who has very high blood sugars or requires therapeutic ketosis.  The diabetes and nutritional ketosis approach will be more nutritious and suit people looking to manage their diabetes.  Before too long, with the reduction of processed carbohydrates, your blood sugar levels will stabilise to more optimal levels.

Once you have your blood glucose levels under control, you can then focus even more on increasing nutrient density and reducing energy density if you are looking to lose weight.   The weight loss (insulin resistant) foods will help you to reduce the energy density of your diet while keeping the insulin load down.  Stabilising blood sugar levels, normalising insulin levels and reducing hyper palatable processed carbs will help many normalise their appetite, reduce food cravings and naturally eat less.

The protein-sparing modified fast (PSMF) approach aims to provide all the essential vitamins, minerals and amino acids with the minimum amount of energy to enable you to achieve aggressive weight loss while minimising your chance of developing nutrient deficiencies, keeping cravings at bay and losing your lean muscle mass.

In the long run, you may even find you have the energy to work out or build muscle for fitness and longevity.  This increased level of activity may require higher levels of protein and other nutrients.   You may also need higher energy density foods to enable you to ingest enough energy to support your activity levels.

The bodybuilder food list will provide you with plenty of amino acids and minerals to support recovery while the endurance athlete food list increases energy density to fuel increased activity levels while still keeping nutrient density high to fuel activity levels.

How do I implement all this information?

Not that long ago, before the advent of artificial flavours, colourings, refrigerators and packaged food, we were more in touch with our actual nutritional needs and went hunting and gathering in search of the foods that contained the nutrients we needed.  We ate until we got what we needed from the food and stopped.

The idea is that these food lists would help you to refine your food choices and make up for your appetite that might have been corrupted by the modern food system.  When you go shopping each week try to buy more of the foods that are at the top of your list and make sure you find a way to incorporate them into your cooking during the week.  You will not be able to eat all of the foods on the list.  You may find that you like some more than others.  Keep working down the list until you find foods that you enjoy and can easily eat lots of.

You will likely need to prepare your food more than relying as much on processed and pre-packed foods.  It may take a little bit more effort, but your health is worth it!

Nutrients to address deficiencies associated with common conditions

Most people are somewhere on the spectrum of metabolic health and will do well focusing on the foods that keep their blood sugars stable.  However, there are others that have developed specific conditions exacerbated by long term nutrient deficiencies.  Hence, focusing on the foods that provide more of the nutrients associated with these conditions can help manage or even reverse some of these conditions for some people.

The table below contains a range of food lists that are designed to provide more of the nutrients related to a diverse range of common health issues.  Eating these foods will not guarantee a reversal of a particular condition.  However, prioritising these foods will improve your chances of recovery and minimise reliance on drugs and other medicines.

If you don’t yet have any of these conditions, simply focusing on the most nutrient dense foods[2][3] may reduce your chances of developing poor health.

Some foods make an appearance on many of the lists (e.g. spinach, watercress, broccoli, organ meats).  However, as you look through each of the lists, you will see that they are unique in their ranking of the various foods required to provide the prioritised nutrients.  While eating any of the foods on the list will be helpful, focusing on the foods towards the top of the list will maximise the nutrients you need for your condition.

approach score PDF foods nutrients wheel references
most nutrient dense foods 99.0% PDF foods nutrients
aggressive weight loss (PSMF) 98.4% PDF foods nutrients wheel references
adrenal fatigue 99.1% PDF foods nutrients
asthma 98.5% PDF foods nutrients wheel references
autism 95.5% PDF foods nutrients wheel references
depression 98.3% PDF foods nutrients wheel references
dyslipidemia 99.1% PDF foods nutrients wheel references
estrogen 98.4% PDF foods nutrients wheel references
fatigue 98.1% PDF foods nutrients wheel references
female fertility 98.3% PDF foods nutrients wheel references
hypertension 98.2% PDF foods nutrients wheel references
hypothyroidism 98.8% PDF foods nutrients wheel references
inflammation 98.3% PDF foods nutrients wheel references
methylation 97.6% PDF foods nutrients wheel references
sleep and insomnia 98.8% PDF foods nutrients wheel references
telomeres 96.9% PDF foods nutrients wheel references
low carb autoimmune friendly 97.3% PDF foods nutrients
alkaline (diabetes friendly) 96.9% PDF foods nutrients
testosterone 97.7% PDF foods nutrients wheel references
alkaline 96.4% PDF foods nutrients
autoimmune & SIBO 95.7% PDF foods nutrients
weight loss (insulin resistant) 99.3% PDF foods nutrients wheel references
diabetes friendly, autoimmune, & SIBO 76.0% PDF foods nutrients

The nutrients prioritised in these lists are generally based on research compiled by Spectracell which identified nutrients that are typically deficient in a range of conditions.  You can click on the “wheel” and “references” in the table for more details.   Check out the full Spectracell nutrient wheels for a range of conditions here.

Where there is no Spectracell “wheel” available, the nutrients used in the analysis were based on the Nutrient Bible by Henry Oseki which is an excellent detailed resource on the individual nutrients as well as the likely nutrients to support various conditions.

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The value of real food

Many modern foods are fortified with synthetic nutrients (e.g. folic acid, B vitamins, vitamin A, vitamin D, iron, iodine, etc.).[4]  While it may appear that the food companies are doing this for the benefit of your health or to make up for deficiencies in their processed foods grown quickly using chemical fertilisers, there is good research suggesting that fortification helps to ensure that we don’t lose interest in what would otherwise be bland unpalatable foods.[5] [6] [7]

By adding in a smattering of nutrients that our body actively seeks (e.g. iron, folate, B vitamins, sodium etc) we will maintain an increased appetite for these foods while not getting the range of other nutrients that are also important but do not drive our appetite to the same degree (e.g. potassium, magnesium, choline and vitamin E).

Paul Jaminet in his Perfect Health Diet[8] says “Potassium is the intracellular electrolyte while sodium is the extracellular electrolyte.  Cells continually pump sodium outside the cell and potassium inside.  Good health depends on the proper dietary balance between potassium and sodium.  Paleolithic diets were high in potassium, low in sodium; salt was rare and highly valued.  So we evolved mechanisms for protecting against the threat of low sodium levels: a food reward system that powerfully rewards salt consumption, and a hormonal network that shuts down urination and sweating whenever sodium is scarce.  There are no similar mechanisms to protect us against low potassium levels, even though they are every bit as devastating for our health.”

While supplements can be helpful, obtaining nutrients from whole foods will also maximise your chance of absorption and increase your chance of getting all the necessary complementary micronutrients in adequate quantities without being excessive. Note: excess supplementation of minerals can quickly cause diarrhoea, or the kidneys will excrete excess nutrients from supplements.’

I have not included fortified foods that may score highly due to a narrow range of synthetic micronutrients that have been added to highly processed and sugar ladened products.

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Nutritious whole foods will provide you with not only the essential nutrients that we can quantify but all the other beneficial non-essential nutrients, phytonutrients, enzymes, and cofactors[9] [10] that are not yet quantified or in the USDA database.

Ethical, philosophical and religious considerations

Many people choose to base their food choices on moral convictions or religious beliefs.  I do not have any issue with people making their food choices based on ethical considerations or religious beliefs.  I do, however, object to people claiming that their approach is nutritionally superior and forcing it onto others on that premise which is not supported by science.

The lists in the table below will help you find the most nutrient dense foods associated with each of these approaches.  The food lists have been sorted based on their nutrient score from highest to lowest at the bottom of the table.

approach score PDF foods nutrient profile
the most nutrient dense foods 99% PDF foods nutrients
nutrient dense Paleo 99% PDF click nutrients
low carb Paleo foods 97% PDF foods nutrients
pescetarian 95% PDF foods nutrients
bivalve vegan 92% PDF foods nutrients
low carb pescetarian 95% PDF foods nutrients
whole food plant based 80% PDF foods nutrients
plant based (diabetes friendly) 76% PDF foods nutrients
zero carb 76% PDF foods nutrients
Paleo (without ND) 64% nutrients
zero carb (no offal) 58% PDF foods nutrients
plant based (without ND) 57% nutrients
zero carb (without ND) 42% foods nutrients

As you might expect, we achieve the most nutritious selection of foods when we focus purely on nutrients.   If you chose to limit your food choices due to other ethical considerations, then you should pay particular attention to the foods that will provide you with more of the harder-to-find essential nutrients.

In the long run, the goal is to get the nutrients we need from our food to enable us to thrive without over consuming energy.  This will give us the best chance of maintaining an ideal body weight, energy levels, performance and avoid the modern diseases of ageing.[11]

See the discussion below detailing the pros and cons of each approach and the nutrients that may need to be supplemented based on the various approaches.

Macronutrient extremes

Some people like to define their nutritional approach in terms of large or small quantities of a particular macronutrient (e.g. low carb, low fat, high protein, low protein, high or low saturated fat, etc.).  The analysis in the table below shows the implication on the nutrients available if you follow any of these approaches.

I think it’s useful to understand the pros and cons of these extremes, particularly in terms of the micronutrients available and the range of foods involved in any of these more extreme approaches.

While high protein, low carb or ketogenic appear to have some positive impact on nutrient density, focusing on the most nutrient dense foods provides a vastly superior micronutrient outcome.

approach score PDF foods nutrients
the most nutrient dense foods 99% PDF foods nutrients
average of all foods in USDA database 75% nutrients
high protein foods 58% PDF foods nutrients
lowest carb 54% nutrients
most ketogenic 42% PDF foods nutrients
highest fat 33% PDF foods nutrients
lowest saturated fat 32% nutrients
lowest fat 31% PDF foods nutrients
highest saturated fat 29% nutrients
lowest fat 31% PDF foods nutrients
the most insulinogenic foods 27% PDF foods nutrients
highest carb 15% nutrients
lowest protein 5% PDF foods nutrients
the avoid list 3% foods nutrients

So that brings us to the end of the food lists section.  I hope you find an approach that will suit your current goals and situation and have a glimpse of how you can continue to move your health forward.

I have intentionally included a lot of data in these tables to allow you to fully understand the pros and cons of each approach and compare the nutritional options you might be interested in.  I hope you will dig into the data in the table for the short list of approaches that you may be interested in.

If you want to learn more about how these lists were developed I invite you to read on to learn about nutrient density, insulin load and energy density, and how they can be combined, using the Nutrient Optimiser algorithm to optimise our food choices.

 

Nutrient density

While there are a range of useful parameters that we can use to optimise our nutrition, the most important is arguably nutrient density.

Nutrient density is simply the amount of nutrients per calorie or the amount of the essential nutrients you get in your food each day.  Ideally, we want to be meeting the daily recommended intake for all of the nutrients.

Micronutrients seem to have been largely overlooked in our current discussion about nutrition. Perhaps this is because micronutrients are harder to quantify.  Without an easy way to quantify micronutrients we tend to focus on simpler metrics such as fat, carbs, saturated fat, protein, vegan, plant based, Paleo, keto, etc.

Unfortunately, neither avoiding a particular nutrient (saturated fat, salt, cholesterol, etc) or aiming for a macronutrient extremes (high fat, low fat, low carb, high carb, high fibre, low protein, etc) or even following our religious or ethical convictions (vegan, vegetarian, plant based etc ) are especially useful when it comes to identifying foods that provide us with the most micronutrients.

But what if we could quantify the micronutrient content of the food we eat?

Enter nutrient density!

The graph below shows the average of the micronutrients in the eight thousand or so foods in the USDA food database as a proportion of the daily recommended daily intake (DRI).  Imagine you ate just a little bit of all of these eight thousand foods to make up your 2000 calories for the day.

The nutrients at the bottom of this chart are easy to obtain in our food system (e.g. vitamin C, vitamin B12, vitamin K, and various amino acids).  There is little need to worry about these easier to find nutrients.  However, where this analysis is useful is that it highlights the nutrients that we might have to pay extra attention to obtaining in adequate quantities (e.g. vitamin D, choline, vitamin E, potassium, magnesium, calcium, etc.).

After a lot experimenting with different approaches to develop a quantitative analysis method for optimising nutrient density, I found that:

  1. Prioritising foods that are high in only one nutrient (e.g. potassium, omega 3, magnesium, vitamin D, niacin, etc.) means you risk missing out on all the beneficial and complementary nutrients that typically come with real food and isn’t particularly useful.  You usually come up with a range of obscure processed foods that have been supplemented with that nutrient.
  2. Focusing on maximising the quantity of all the essential nutrients gives us a VERY high protein list of foods.  Protein is relatively easy to obtain in our food system.  Prioritising the amino acids provides a list of foods that will be very hard to consume because they are 70% protein.  We tend to get more than enough protein when we focus on the harder-to-obtain vitamins and minerals.
  3. Using the Nutrient Optimiser we can focus on the foods that contain more of the nutrients that are harder to find.  When we maximise a range of the harder-to-find nutrients, we get a variety of whole foods that contain a broad spectrum of the essential nutrients.

The chart below shows the nutrients provided by the top 10% of the foods in the USDA database when we prioritise for the harder-to-find nutrients (i.e. vitamin D, choline, vitamin E, calcium, potassium, magnesium, zinc, pantothenic acid, selenium, and niacin).  The red bars denote the nutrients that have been prioritised.   That is, foods that contain more of these micronutrients per calorie rank higher in the analysis.

If you compare the chart below to the chart above, you will see that by focusing on the foods that contain harder-to-find nutrients we significantly boost all thirty-four essential nutrients!

If you focus on eating foods in this list, you will have a good chance of getting plenty of the essential micronutrients.  The most nutrient dense foods in each category are at the top of the list, so you would ideally focus more on the food at the top of the list as much as you could.

I don’t think it matters too much if you want to focus more on animal or plant based foods.  We tend to achieve the best nutritional outcome when we include a range of vegetables, animal products and seafood.

  • What is notably missing from all of these lists is sugar and refined grains which have a very low nutrient density.
  • Fruits also do not feature in the lists (other than the exclusively plant based lists) due to the lower nutrients per calorie compared to nonstarchy vegetables and animal foods.
  • Dairy and nuts make an appearance on the lists only where it is not a priority to keep energy density low or to lose weight.
  • Red meat tends to feature more prominently when we need to boost nutrients such as glycine, cysteine and glutamine which are not as prevalent in seafood.

The nutrient score

You will notice the “nutrient score” for the most nutrient dense foods is 98.7%.  But what does this mean?

The nutrient score is designed to compare the various nutritional approaches quantitatively.  We want to meet the daily recommended intake of a particular nutrient.  However, there may not be much value getting more than twice the DRI.  Once you’ve achieved two times the DRI your efforts would be best spent seeking out other nutrients.  If we achieved two times the recommended daily intake for all the nutrients, we would get a score of 100%.  That is, we get a perfect score if the entire red rectangle was filled in.

A lot of these food lists score close to a perfect score because they contain a range of the most nutrient dense foods.  This is not practical in real life.  The nutrient score of a real life diet will be lower than the optimised short list of nutrient dense foods.  We tend to choose more energy dense foods that may not be as nutrient dense, or we don’t consume the range of foods that would be necessary to attain a very high nutrient score.  Dr Rhonda Patrick currently holds the record for the highest scoring food log with 82%.  You can check out her Nutrient Optimiser analysis here.

At the other end of the spectrum, we can see from the chart below that focusing on the least nutrient dense foods will provide an inferior outcome.   If all we have to eat is these nutrient poor foods, we will likely develop nutrient deficiencies.  Our cravings will drive our appetite to derail even our best calorie restriction intentions.

Energy density

The great thing about nutrient dense whole foods is that they typically force out the energy dense processed foods in our diet.

Whether it be low carb, whole food plant based or Paleo, the magic happens when we switch out nutrient deficient foods for foods that provide you with the nutrients we need with less energy.

The ‘problem’ however with nutrient dense whole foods is that they make it hard to ingest enough energy.  If you are active and are not wanting to lose weight, you may need some higher energy density foods.

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Over at KetoGains, they talk about using ‘fat as a lever’.[12]  If you are not worried about being low carb or ketogenic or your blood sugar control, you can also think of ‘energy density as a lever’ to manage the amount of energy you can get from your diet.  While a ketogenic diet is typically higher fat, if you want to lose body fat then some of the fat contribution to your diet should come from your body, with less fat required from your plate or coffee mug.

Energy density is a simple concept that can help you fine tune your food choices and is calculated by dividing the calories in a food by its weight.  Used in isolation it isn’t particularly useful, but can be helpful whne considered along with nutrient density once you have stabilised your blood sugars by tweaking the insulin load of the food you eat.

If you have stabilised your blood sugars and are trying to lose weight, then minimising the energy density of the foods you eat will help you feel physically full with less energy intake.  Practically this might involve filling up on more nonstarchy veggies and perhaps leaner cuts of meat.

Focusing on foods with a lower energy density can help you to get the nutrients you need without overdoing the energy intake.

Alternatively, if you are an athlete and need to ingest a lot of fuel, then focusing on higher energy density foods may be helpful.

Insulin load

As shown in my analysis of the food insulin index data below, the amount of carbohydrate correlates with how much our blood sugar rises in response to food.  [You can click on the images below to see more detail or click here to drill down into the data more in Tableau online.]

However, carbohydrates alone don’t do a great job of explaining our insulin response to the food we eat.  As you can see in the chart below, some high protein, low carb foods still elicit a significant insulin response.

We get a much better prediction of our insulin response to food once we account for the fibre and protein content of our food.  Thinking in terms of insulin load (i.e. net carbs + 0.56 x protein) is useful if you are manually injecting insulin to manage your diabetes.  If you are insulin resistant, you can reduce the insulin load of your diet to the point that your pancreas can keep up and maintain normal blood sugars.

Reducing the insulin load of your diet will help achieve more stable blood sugar levels and get off the insulin rollercoaster that drives hunger and energy levels.  While various studies have not been able to demonstrate a metabolic advantage of one macronutrient versus another, it seems that appetite control is easier for people who are insulin resistant when they manipulate their diet to stabilise their blood sugars.

While too much energy from any source can promote insulin resistance in the long run (note: the pancreas secretes insulin to stop the flow of energy out of the liver when we have plenty of energy coming in via the mouth), increasing the proportion of fat in your diet will lessen the amount of insulin required by your food.

Increasing the percentage of calories from fat in your diet will also reduce your glucose response to food.

Although protein does need some insulin to metabolise, higher protein foods will typically force out the processed carbohydrates and reduce your insulin levels.

So what does all this mean?

If you are part of the 50% of the population that has diabetes or prediabetes, then manipulating the insulin load of your diet will help you stabilise your blood sugar levels.  This is a critical priority.

The problem with focusing only on insulin load, however, is that the least insulinogenic foods are primarily refined fats (cream, butter, olive oil, etc.) and do not contain a lot of the essential vitamins, minerals, and amino acids that we need to thrive and be metabolically healthy.

The solution is to find the optimal balance between insulin load and nutrient density.  As your blood glucose levels start to improve you can start to focus more on nutrient density and then on reducing energy density if you still need to lose weight.

The various food lists have been developed using a multi-criteria analysis algorithm that uses nutrient density, energy density and insulin load to highlight the ideal foods for a particular person.

Pros and cons of different dietary approaches

The table below outlines the pros and cons of each of the higher level nutritional approaches, who they will be appropriate for and which nutrients are harder to find.

approach who harder to find nutrients Pros Cons
well-formulated ketogenic diet Someone with an average blood sugar greater than 140 mg/dL or 7.8mmol/L or people who require therapeutic ketosis (i.e. for the management of conditions such as epilepsy, cancer, Alzheimer’s, etc.) Vitamin D, choline, potassium, vitamin B5, zinc, niacin, magnesium, calcium selenium and folate. Aggressively lowers insulin load to stabilise blood sugars and drive ketogenesis.  Higher fat levels can help to increase satiety while in early adoption phase. High energy density and low nutrient density mean that it may not yield optimal weight loss or health in the long term for everyone.
diabetes and nutritional ketosis People with an average blood sugar of greater than 108 mg/dL or 6.0mmol/L. Choline, vitamin D, vitamin E, potassium, magnesium, vitamin B5, niacin, calcium and zinc. Helps optimise blood sugar control and eliminate the swings that can drive appetite. Higher energy density means that not everyone will achieve optimal weight without also focussing on energy density.
weight loss (insulin resistant) People who are slightly insulin resistant but want to lose weight. Vitamin D, choline, potassium, calcium, magnesium, vitamin E, zinc, niacin. Lower energy density will help ensure a reduction in energy intake.  Higher nutrient density will reduce cravings. Lower satiety due to lower energy intake.
protein-sparing modified fast (PSMF) Someone targeting aggressive short term weight loss while maintaining muscle mass. Vitamin D, choline, vitamin E, calcium, potassium, magnesium, zinc. Very nutrient dense and very low energy density will drive weight loss.  Very hard to overeat these foods. Significant discipline, racking and planning required.
nutrient dense maintenance Someone looking to maintain their current weight. Choline, vitamin D, potassium, calcium, magnesium, zinc. Higher energy density while still being nutrient dense.
bodybuilder Someone looking to repair and build muscle. Vitamin D, choline, potassium, calcium, magnesium, vitamin E, sodium, vitamin B5, zinc, folate and branched chain amino acids Support muscle growth. Not ideal for someone not working out.
endurance athlete Someone who is active Choline, vitamin D, potassium, calcium vitamin E, magnesium, vitamin B5 and leucine. Higher energy density foods to support activity.

This table summarises the assumptions used in developing the lists based on religious, ethical or philosophical considerations and provides some brief commentary for each nutritional approach.  I encourage you to look in more detail at the data to better understand your preferred approaches.

approach score Assumptions & constraints Comment 
the most nutrient dense foods 100% Prioritises the harder to find nutrients. Maximises nutrients per calorie.
nutrient dense Paleo 99% Excludes dairy, grains and processed foods as well as prioritising nutrient density. Very similar outcome to most nutrient dense approach, though with a reduced range of foods.
low carb Paleo foods 97% Reduced insulin load to stabilise blood sugars while also maximising nutrient density. Will stabilise blood sugars more than straight Paleo which can involve more high carb veggies.
pescetarian 95% Plant based plus fish prioritised for nutrient density. Some vegans or vegetarians are comfortable eating fish.
bivalve vegan 92% Plant based plus molluscs prioritised for nutrient density. Provides some nutrients that are harder to find on a purely plant based approach (omega 3, vitamin B12).  Some vegans are comfortable eating molluscs which are not considered by some to be sentient beings.
low carb pescetarian 95% Vegetarian plus fish with a focus on nutrient density and a lower insulin load. Provides a solid nutritional outcome without eating animals or dairy.
whole food plant based 80% Excludes processed foods and oils.  Prioritises nutrient density without focussing on amino acids It is hard to obtain adequate omega 3 or vitamin B12 on a WFPB approach and hence they may need to supplement.

Weight loss is likely due to the low energy density if you are able to stick to unprocessed foods only.

plant based (diabetes friendly) 76% Plant based only, with the focus on nutrient density and lower insulin load. It can be quite hard to achieve a low carb diet, at least in terms of percentages without using a lot of oils or nuts.
zero carb 76% Animal only foods prioritised for nutrient density. A zero carb dietary approach struggles to meet DRI for vitamins K, C and E, folate, potassium and calcium.

Although some argue that nutrient requirements are different in the absence of glucose, though there is limited research to date.

Paleo (without ND) 64% All Paleo foods without consideration of nutrient density. Limiting yourself to unprocessed “Paleo food” is no guarantee that you will achieve exceptional nutrient density.
zero carb (no offal) 58% Animal based foods excluding organ meats. Organ meats provide a lot of the nutrients in a ZC approach.  Not everyone enjoys and eats a lot of organ meats.
plant based (without ND) 57% All whole food plant based foods without consideration of nutrient density. A plant based nutritional approach is no guarantee that you will achieve high levels of nutrients.
zero carb (without ND) 42% Zero carb without nutrient density. A zero carb approach without consideration of nutrient density can provide a poor nutritional outcome.

Summary

Congratulations, you’ve nearly reached the end of this data-heavy article!!

My hope is that all this data will be useful for people seeking clear guidance on optimal food choices for them.  I hope it will help you cut through the confusion and conflicts of interest that so often plague our food system.

Nutrient density is the centre piece of the algorithm for optimising nutrition to suit people with different goals and to suit different circumstances.  When we focus on foods that contain more of the harder-to-find nutrients we tend to boost all nutrients across the board.

A range of optimal food lists have been prepared to suit different states of metabolic health by also considering:

  • insulin load and energy density,
  • pre-existing health conditions using targeted nutrients, and
  • optimal short list of foods that still fit within a person’s ethical or religious system.

Simply focusing on trying to consume more of the foods on these lists will go a long way to helping you achieve optimal nutrition, health and happiness.  If you’re still looking for further guidance to help you refine your food choices, then I invite you check out the Nutrient Optimiser which has been designed to identify areas where you could improve your nutrition and help you fine tune your food choices to help you move towards your chosen goal and dreams, whatever they may be.

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references

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

[2] https://optimisingnutrition.com/2016/05/16/building-a-better-nutrient-density-index/

[3] https://optimisingnutrition.com/2015/03/22/towards-a-personalised-food-ranking-system/

[4] https://en.wikipedia.org/wiki/Food_fortification

[5] https://freetheanimal.com/2015/06/enrichment-theory-everything.html

[6] https://freetheanimal.com/2016/05/enrichment-promotes-everything.html

[7] https://freetheanimal.com/2015/10/fortification-obesity-refinements.html

[8] http://perfecthealthdiet.com/

[9] https://suppversity.blogspot.com.au/2017/08/vitamin-b6-b12-c-e-folate-iron.html

[10] http://suppversity.blogspot.com.au/2015/04/studies-confirm-natural-and-synthetic.html

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

[12] https://ketogains.com/2017/06/energy-balance-macros-nutrient-density/

your personalised food ranking system

  • A number of attempts have been made to develop food rankings.
  • We can combine the concept of insulin load with nutrient density to help us make optimal food choices based on our goals, situation and budget.
  • This article looks at other ways to prioritise our our food choices quantitatively to design a food ranking to suit your situation, goals and budget.

Mat Lalonde’s nutrient density

Dr Mat Lalonde developed a ranking of foods based on nutrient density in terms of nutrients per gram using the USDA food database. [1]  This analysis identified organ meats as one of the more nutritious foods, with vegetables coming in second.  Fruits and grains landed much further down the list.

Lalonde noted that people wanting to lose weight may wish to prioritise in terms nutrient density per calorie, however he had chosen to analyse nutrient density in terms of weight as that might be more relevant for athletes (Lalonde is a CrossFit athlete as well as a biochemist). [2]

I was left excited, yet a little unsatisfied, wondering what the ranking might look like in terms of calories, or maybe some other measure.

Aggregate Nutrient Density Index (ANDI)

Joel Fuhrman’s Aggregate Nutrient Density Index (ANDI) ranks foods based on micronutrients per calorie [3] but excludes a number of essential vitamins and minerals while placing extra emphasis on the oxygen radical absorbance capacity.

This approach heavily biases plant foods and seems to ignore the nutritional benefits of animal foods. [4]  Kale ranks at the top of the list, largely due to its massive amount of vitamin K.

Unfortunately a massive dose of vitamin K isn’t much use to us in the context of a low fat given that vitamin K (along with vitamin D and E) is a fat soluble vitamin.  It’s also not much use having a food that ranks off the chart in one nutrient but it’s that good in a number of other areas.   Vitamin K is important but you can only absorb so much in one day.

Another criticism that has been levelled at ANDI is that simply using nutrition per calorie prioritises very low calorie density foods that may not be viable for anyone doing a significant amount of activity.

Dave Asprey’s Bulletproof Diet

Dave Asprey developed the Bulletproof Diet Infographic [5] which is a simple ranking of foods to avoid and preference based on both nutritional density and toxins.

The downside of this is that it shows only a select range of foods and doesn’t explain why each of the foods has the ranking that is has been given (though there is a good discussion of the toxins and various issues in his book [6]).

Most people would be happy with this visual list of foods to preference and avoid, and I recommend you check it out, however I wanted to see the numbers to understand why one food ranked above another.

nutrient density per dollar

I also came across a food ranking system in terms of nutrient density per dollar.  Dale Cumore of the blog Solving Nutrition [7] had created a ranking based on nutrient density per dollar cost of that food to arrive at the cheapest way to get nutrition for around 1000 foods that he could find cost data for.

Dale included a link to his  spreadsheet on his blog (in which he has mimicked Lalonde’s analysis [8]) for people to have a play with.  So I downloaded it to see what I could do with it. [9]     After dropping out the fortified products, we get the following list of foods based ranked on nutrient density per dollar.

  • bagels
  • French rolls
  • croissants
  • muffins
  • lentils
  • tortillas
  • rice
  • parsley
  • beef liver
  • spaghetti
  • Chinese cabbage (Bok Choy)
  • sunflower seeds
  • White bread
  • chicken liver
  • peanut butter
  • skim milk
  • peanuts
  • chives
  • whole eggs
  • brown rice
  • sweet potato
  • cabbage
  • orange juice

Grains are actually a cost effective way to get nutrients, however not necessarily the most healthy.    People believe that most if not all grains should be avoided. [10]  My ten year old daughter knows that if she eats bread she will end up tired, with a stomach ache and dark circles around her eyes.  However if  cost is your number one priority you might find this list useful.

cost per calorie

Cost will always be a consideration to some degree.  Some people may not have the finances to buy grass fed organic while others will have the means to invest in food as preventative medicine.  Listed below are the cheapest foods in terms of cost per calorie.  Again, grains (including white rice), candy and sugar rank up there with some of the cheapest ways to get calories. [11]

While it’s true that grass fed beef, salmon and organic vegetables can be more expensive than boxed cereals and sugar, it’s also worth noting that obtaining significant proportion of your calories from fats such as coconut oil and butter can actually be very cost effective on a per calorie basis.

  • pumpernickel rolls
  • croissants
  • bagels
  • canola oil
  • French rolls
  • margarine
  • what muffins
  • coconut oil
  • granulated sugar
  • rice
  • brown sugar
  • mayonnaise
  • doughnuts
  • tortillas
  • cake mix
  • peanut butter
  • cranberry juice
  • spaghetti
  • sausage
  • corn starch

nutrient density per calorie

Nutrient density per calorie is a useful measurement for someone wanting to lose weight while maximising nutrition.   One line of health and weight loss thinking says that once the body obtains adequate nutrients it will stop searching for food and overeating will be minimised. [12]  Using this approach vegetables shoot to the top of the list with things like spinach, liver, seafood oysters, kale and broccoli rank really well.

  • spinach
  • chicken liver
  • beef liver
  • beet greens
  • veal liver
  • pork liver
  • duck liver
  • goose liver
  • turnip greens
  • mustard greens
  • parsley
  • chard
  • oyster
  • coriander
  • dandelion greens
  • basil
  • caviar
  • kale
  • broccoli
  • All bran
  • collards

fibre per calorie

One of the more exciting concepts in the diet space recently is the concept that what you eat could possibly change your gut bacteria for better or worse.

While this area is still in its infancy the thinking is that lean people have a higher bacteriodes : fermicutes ratio and that this can be influenced by eating more fibre and taking prebiotics.

Typical daily fibre intake is around 17g for those of us in western civilisation. It is said that African hunter gatherer children obtain more than 150g of fibre per day from eating unprocessed foods in their natural state [13] and before the invention of fire and cooking our ancestors were eating more than 100g of fibre per day. [14]

Fibre in carbohydrate-containing foods neutralises the insulinogenic effect of the carbohydrate.  Fibre is not digestible by the human gut and hence it does not provide energy or cause a rise in blood sugar or insulin.

The typical western recommendation is to get at least 30g of fibre per day to improve your blood sugar and cholesterol levels.  Most people don’t achieve these levels even when eating “healthy whole grains”, largely due to the high level of processing in most popular foods.

It’s also worth noting that it’s better to lightly steam your veggies rather than cooking them until they’re soft so that the fibre remains intact.

Ironically the number one recommended source for fibre is from “healthy whole grains”.  While whole grains will be marginally better than processed grains such as white bread, they also have a high glycemic load and will be much more insulinogenic than other options such as non-starchy vegetables.  The end result of eating the whole grains is increased blood sugars and cholesterol, which is exactly what “healthy whole grains” was meant to help us avoid!

If we rank for fibre per calorie we end up with a few spices such a cinnamon, curry powder, or cocoa at the top of the list along with vegies such as turnip, artichoke, sauerkraut, cauliflower.  All Bran features in the list but only because it has been fortified with extra fibre.

  • cinnamon
  • turnip greens
  • artichoke
  • curry powder
  • sauerkraut
  • cauliflower
  • raspberries
  • lettuce
  • blackberries
  • lemon peel
  • All Bran (w/ added extra fibre)
  • oregano
  • wheat bran
  • eggplant
  • basil

practical application

These lists of foods ranked based on one measurement or another are interesting, however they are not particularly useful by themselves.  If we went by Lalonde’s system we’d be eating bacon and organ meats all the time.  If we went by the ANDI system we’d be living off kale.  And if we just looked at the proportion of insulinogenic calories we would be living off butter, cream and oils.

But it gets interesting though when you can combine the various measurements to highlight foods to suit your individual goals.

In my previous articles on diets for weight loss, blood sugar management and athletes I provide a list of optimal foods for using different weightings for the following:

  • nutrient density per calorie,
  • fibre per calorie,
  • nutrient density per dollar,
  • nutrient density per 100g,
  • proportion of insulinogenic calories,
  • calories per 100g, and
  • cost per calorie.

Listed below are the weightings that I’ve devised for each situation.

I’ve also developed a suite of ‘cheat sheets’ to highlight optimal food choices to suit your goals, whether they be weight loss,  normalising weight loss or or athletic performance.

Why not print one out and stick it to your fridge as a helpful reminder or use them for some inspiration for your next shopping expedition?

In the next article we’ll look at how we can use this style of analysis to identify diabetic friendly, ketogenic, nutrient dense meals.

weighting for blood sugar control and ketosis

ND / calorie fibre / calorie ND / 100g ND / weight insulinogenic (%) calorie / 100g $ / calorie
15% 5% 5% 10% 50% 10% 5%
weighting for weight loss
ND / calorie fibre / calorie ND / 100g ND / weight insulinogenic (%) calorie / 100g $ / calorie
15% 10% 10% 5% 20% 30% 10%
weighting for athletes and metabolically healthy
ND / calorie fibre / calorie ND / 100g ND / weight insulinogenic (%) calorie / 100g $ / calorie
15% 10% 10% 30% 20% 5% 10%
weighting for theraputic ketosis
ND / calorie fibre / calorie ND / 100g ND / weight insulinogenic (%) calorie / 100g $ / calorie
5% 5% 5% 5% 70% 5% 5%

references

[1] http://ketopia.com/nutrient-density-sticking-to-the-essentials-mathieu-lalonde-ahs12/

[2] https://www.youtube.com/watch?v=HwbY12qZcF4

[3] http://www.wholefoodsmarket.com/healthy-eating/andi-guide

[4] http://www.westonaprice.org/book-reviews/eat-to-live-by-joel-fuhrman/

[5] http://www.bulletproofexec.com/wp-content/uploads/2014/01/Bulletproof-Diet-Infographic-Vector.pdf

[6] http://www.amazon.com/The-Bulletproof-Diet-Reclaim-Upgrade/dp/162336518X

[7] http://blog.paleohacks.com/ultimate-guide-paleo-diet-budget/

[8] The analysis considers the relative amount of calcium, iron, magnesium phosphorus, potassium, zinc, copper, manganese, selenium, vitamin C, thiamine, riboflavin, niacin, panto acid, vitamin B6, choline, vitamin B12, Vitamin A, vitamin D, Vitamin E and Vitamin K across more than 1000 foods.  No weighting of these vitamins based on a view of their relative importance, though this refinement could be made to the analysis for a specific need.  This unweighted approach however highlights foods that have a broad spectrum of nutrients at significant levels.

[9] The statistical analysis in the spreadsheet downloaded compares the value of a nutrient in each food to the average of the full database of foods and gives it a score based on the number of standard deviations from the mean.  I also modified the spreadsheet such that a score for one nutrient could not be greater than three (i.e. three standard deviations from the mean).   Just because Kale has an inordinate amount of Vitamin K doesn’t mean that it ranks at the top of the list on the basis of just one nutrient.

[10] https://www.youtube.com/watch?v=VvfTV57iPUY

[11] If you wanted to view this cynically you could say that the fact that grains and sugars have the lowest cost per calorie enables food manufacturers to place the largest mark up on these foods when reselling them in cardboard boxes in the supermarket.  It’s harder to put a bar code on generic vegetables and meat products that are already relatively expensive.

[12] See discussion in chapter 17 Nutrient Hunger in Paul Jaminet’s Perfect Health Diet where he notes that a nourishing, balanced diet that provides all nutrients in the right proportions is the key to eliminating hunger an minimising appetite and eliminating hunger at minimal caloric intake is a key to weight loss.  

[13] http://www.abc.net.au/catalyst/stories/4067184.htm

[14] http://www.gregdavis.ca/share/paleo-articles/academic/The%20Ancestral%20Human%20Diet%20by%20S.%20Boyd%20Eaton.pdf

optimal meals

To date I’ve analysed more than 200 meals and ranked them based on different criteria for different goals.  For more details on the basis of the meal rankings see the most nutritious diabetic friendly meals.

Each week I’m posting one of these meals.  To see the recipes posted to date click here.

A more complete ranking for each category will be published once a few more recipes have been posted.

diet wars… which one is optimal?

  • This article summarises the  analysis of a range of dietary approaches to:
    • understand whether a high-fat diet can provide optimal nutrition, and
    • to identify common factors across a range of healthy dietary approaches.
  • The table below shows the macro nutrient split of the approaches evaluated.  They are sorted by the total score for each of the dietary approaches based on insulin load, vitamins and minerals and protein of each.

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  • The chart below shows the total score for the approaches graphically, sorted from highest to lowest ranking, left to right and the contribution of each of the components that make up the total score (insulin load, vitamins and minerals, and protein).

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  • The highest ranking approaches involve organ meats.  If you’re not into liver then non-starchy vegetables are your next best option to maximise nutrients while keeping the insulin load low.
  • The extreme high-fat approach (3% carbs from spinach and 10% protein) does not provide optimal levels of vitamins and minerals. This style of approach may be useful for more extreme therapeutic treatments for epilepsy, Parkinsons, or cancer, however, supplementation may be required if this were used over the long term.
  • A diet with 80% calories from fat and 7% of calories from carbohydrates can meet most of the recommended daily intake values for vitamins and minerals.
  • A diet with 75% fat and 10% carbohydrates from non-starchy vegetables can achieve an optimal balance between vitamins and minerals and insulin load.
  • The fruitarian and budget grains approach both scored poorly across the board.
  • Dietary approaches without animal products struggle to provide adequate amino acids, vitamins and minerals.
  • Optimal nutrition can be provided using a range of macronutrient profiles. When we consider the insulin load, nutrients and protein quality, the highest scoring dietary approaches use between 50 to 80% fat, 13 to 34% protein and 7 to 16% carbohydrates.  Within this window, we can then refine the diet based on the goals of the individual whether they be weight loss, blood sugar control/ketosis or athletic performance.

[download printable .pdf version]

standard advice for diabetics

When my wife was diagnosed with type 1 diabetes at ten she was advised to eat at least 130g of carbohydrates with every meal.  The insulin dose was kept fixed to cover this amount of carbohydrates.  Then if she went low she had to eat more carbs to raise her blood sugars.

Welcome to the everyday blood sugar roller coaster that takes over your life as a diabetic!

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It wasn’t until after we got married and started thinking about having kids that we were able to find a doctor with an interest in diabetes who told her that she could tailor her insulin dose to what she wanted to eat (i.e. carb counting).  Though the advice was that diabetics shouldn’t have to deprive themselves of anything they wanted and that they should eat like everyone else, a diet full of “healthy whole grains”.

During her pregnancies, we’d go to see the endocrinologists at the hospital who would look at her blood sugars and tell her that they should be lower.  We’d ask how to achieve this but they would have no useful response.  It wasn’t until we discovered Paleo and then low carb through family members and social media that she found that she could improve blood sugar control through diet.

More recently by refining our diet to prioritise low insulinogenic, high fibre and high nutrient density foods I’m pleased to say that she’s been able to find another level of improved blood sugar control, increased energy and reduced depression and anxiety that so often comes with blood sugar dysregulation.

She’s now able to enjoy working as a teacher rather than just getting through the morning and needing to sleep the afternoon before picking up the kids.  Her only regret is that she didn’t discover this earlier so she didn’t have to spend decades living in a fog with limited energy.

For the general population nutrition isn’t such a big deal, but for diabetics and their carers, it is a matter of life and death or at least a decision that will greatly affect their health and length of life.

In order to understand whether there is any basis to the claim that a low carbohydrate diet cannot provide adequate nutrition, I have undertaken a nutritional analysis of a range of possible diets.   A handful of these are profiled below.

ranking system

In the last article we looked at how we could use a combination of the following parameters to compare meals:

  1. insulinogenic load,
  2. nutritional completeness (vitamins and minerals), and
  3. amino acid sufficiency (protein).

This same approach has been used to compare a range of dietary approaches.  Each daily meal plan was normalised to a 2000 calorie per day diet.

Where not following a present meal plan, I designed the daily meals using the highest ranking food using the food ranking system and adjusted the quantities to suit the target macronutrients.

high fat, low carb, extreme ketogenic

Steve Phinney talks about a “well formulated ketogenic diet” (WFKD) window [1] in his comparison with other dietary approaches.   In this scenario, I designed an extreme ketogenic diet to minimise insulin demand and maximise ketosis with 3% carbs and 10% protein.

image016

Low carb darlings bacon and eggs provide the 10% allowable protein.  In an effort to maximise the vitamins and minerals within the available macro nutrient constraints I have used 200g of nutrient dense high fibre spinach to fill out the 3% carbs.  Then 60ml of coconut cream in 2 coffees and the rest split across 60g of equal parts cream, coconut cream and olive oil.

The analysis below from NutritionData shows that we get a good range of amino acids from the bacon and eggs, adequate fatty acids, no harmful trans fats, and very low glycemic load.  This diet provides good amounts of selenium, choline and niacin, however, the nutritional completeness score is low at only 38 with less than optimum levels of a wide range of other vitamins and minerals.  If we were to substitute the bacon and eggs with chicken liver we are able to achieve an improved nutritional completeness (from a score of 38 to 53).

image017

We can get a good level of amino acids from an extreme end ketogenic diet, particularly if we are selective with our choices of meats.  However, the vitamins and minerals obtained from food are less than optimal compared to other approaches that allow more vegetables.  The detailed nutritional analysis of this dietary approach shows that with only 3% carbs coming from 200g of spinach we are not meeting a handful of the RDI daily targets for vitamins and minerals.  Someone on this style of diet should consider taking supplements to cover off on these deficiencies.

image018

not so extreme ketogenic

So if a diet made up of 3% carbs from spinach and 87% fat from bacon, butter and cream won’t provide meet our daily dietary requirements for vitamins then how what level of carbohydrates is required to meet the recommended daily intake levels and what level is required to achieve optimal nutrition?

The nutrition analysis shows the results if we drop the fats slightly and the carbs to 7% using a head of broccoli and 500 grammes of spinach.

The nutritional analysis below shows that we could achieve the RDI daily values for most of the vitamins and minerals with an 80% fat diet and only 2000 calories per day.

image019

The analysis below takes this a little further so we are getting 75% of calories from fat.  At this point, we are getting excellent nutrient and protein scores and well exceeding the RDI for vitamins and minerals.

image020

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Wahls’ Paleo Plus

By following a highly nutrient dense ketogenic diet Dr Terry Wahls claims to have reversed her Multiple Sclerosis [2] and is undertaking experiments to verify that this high nutrient density approach works for others with Multiple Sclerosis.

The aim of the Wahls Paleo Plus, as detailed in The Wahls Protocol[3] is to achieve nutritional ketosis, [4] while maximising nutrients as far as possible with nonstarchy vegetables as well as coconut oil, coconut cream and MCT oil which help facilitate nutritional ketosis which a higher level of carbohydrates.

Whals’ approach aims to not just meet but exceed the nutrient recommended nutrient intake levels as shown in the comparison of both the Wahls Diet and the typical US diet against the recommended daily intake for a range of key vitamins below.

image022

While supplements can still be useful, it is ideal to obtain all your nutrients from real food as they are usually better absorbed in their natural form and with fats (fat soluble vitamins A, D, E and K) than in tablets and isolation.  Eating real food also ensures you get a wide range of nutrients that can be found in plants in nature rather than just the limited number of vitamins and minerals on the recommended daily allowance checklist.

The daily diet shown below is taken from one of the daily diet plans in the Wahls Paleo Plus meal plan approach in The Wahls Protocol[5]

image023

As shown below this diet scenario achieves an excellent nutritional completeness score.  Although the carbohydrate count is moderately high at 18% of calories the fibre is also high at 37g which mitigates the insulinogenic effects of many of the carbohydrates.  Whals also uses generous helpings of MCT oil and coconut oil to make sure the diet is ketogenic while still supplying high amounts of fibre and nutrition.

This dietary approach is excellent if you are willing to put in the effort.  Dr Wahls’ dietary approach brings together the best of low carbohydrate / low insulin thinking with the learnings from the Paleo template which emphasises eating food that could be found in nature before the advent of agriculture.

image024

Bulletproof diet

Dave Asprey’s approach to “Bulletproof Intermittent Fasting” has become popular as it provides many of the benefits of intermittent fasting without the same intensity of hunger [6].

Asprey notes that this is ideal for someone with a normal life and a day job (e.g. someone who is not a professional bodybuilder) who doesn’t want to be distracted by hunger pangs through the morning. [7]

While the high-fat breakfast does not provide a broad range of nutrients by itself, the Bulletproof Diet [8] aims to maximise nutrients through the use of real food at lunch and dinner.

Bulletproof Coffee provides your body with a holiday from insulin for a large portion of the day which is a good thing if you follow it up with highly nutritious meals when you do eat.

This diet scenario aims to be ketogenic while achieving a good nutrient profile using real food during the rest of the day.  For the meals other than breakfast I have picked nutrient dense high-fat foods in line with Asprey’s Bulletproof Diet, including chicken liver at dinner. [9]

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The analysis demonstrates that you can get adequate nutrition while fasting in the morning or using fatty coffee or tea, particularly if you use nutrient dense foods through the rest of the day.

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Atkins Diet

The modern low carbohydrate diet movement basically instigated by Dr Robert Atkins who recommended reducing carbohydrates to achieve weight loss.

The Atkins approach involves using a low carb induction phase (i.e. max 30g of carbs) and then slowly increasing the carbohydrates once weight loss is achieved and insulin sensitivity restored.  No restrictions are put on protein, and vegetables are not emphasised as much as with the more recent Paleo and LCHF movement.

The meal plan below is from the Everything Atkins website. [10]   It has high protein levels at 32% and low-end fibre at only 9g per day.  While the aim of this approach is to keep insulin levels low the high protein and low fibre values of this approach end up generating quite high levels of insulin and not be ideal if your goal is weight loss.

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Dr Bernstein’s diabetes diet

This approach follows the guidelines set out in his book Dr Bernstein’s Diabetes Solution[11]

Eighty-three year old Dr Richard Bernstein is himself a type 1 diabetic and diabetics who are disciplined enough to follow his diet swear by it and achieve excellent results.

Bernstein was an engineer and was one of the first people to obtain a blood glucose metre to test his own blood sugars.  He soon realised that carbohydrate containing foods raised his blood sugar and went on to experiment and work out how much a certain amount of carbohydrate containing foods raised his blood sugar and how much insulin it took to lower his blood sugars.  He wrote up his methodology but was unable to get it published, being told that there was no value for diabetics obtaining normal blood sugars. [12]

Bernstein went on to study medicine in order to get people to recognise his ideas.  “Dr B” as he is affectionately known by his disciples, is the father of carbohydrate counting for type 1 diabetics.

image029

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Bernstein’s general advice is to eat a diet that contains no more than 30g carbs per day (i.e. 6g at breakfast, 12 at lunch and 12g at dinner).   Protein levels are based on the patient’s need to gain or lose weight. [13]   This gives a good nutrient score, an excellent amino acid score and a relatively low insulin load.

By following this approach type 1 diabetics are able to achieve better blood sugar control by having smaller inputs and thus smaller errors in the important parameters of diabetes management such as carbohydrate intake and insulin dose.

high fibre vegetarian

Vegetarian luminary Michael Pollan famously condensed his recommendations for diet into the meme “eat food, mostly plants, and not too much.”  I’ve try to maximise nutrition and minimise insulin demand by selecting nutrient dense high fibre vegetables based on the ranking system discussed above.

I’ve used mung beans, spinach, lentils and Brussel sprouts to achieve adequate protein while still being vegetarian.  Without the lentils, it was hard to get enough energy into the diet to meet the 2000 kcal/day requirement.  This approach requires you to eat more than 4kg of food to get adequate calories and in the process, you get 143g of fibre!

image031

The nutritional analysis below shows that we get an extremely high level of nutrients overall with the highest vitamin and mineral score of all of the scenarios of 94, however, there is no vitamin D, B, saturated far or Choline which is typically obtained from animal products.

On the amino acid score, we have a range of the basic amino acids from the plant proteins although not as much as with dietary approaches that contain animal products.   The glycemic load is also high however the percentage of insulinogenic calories is still reasonably low at 27% due to the massive amounts of fibre.

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This dietary approach is an extreme example of what can be achieved using high fibre vegetables without animal products.  While some people may choose to eat this way for ethical reasons it would be preferable to also add enough animal protein to cover off on the missing nutrients and amino acids.

Many people feel fantastic on a vegan style diet for a while but then stop feeling great and regress after a period of months.  It may sound macabre, but in the early stages of weight loss a person is probably getting the nutrients that are lacking in their diet from burning their own body fat and muscle protein.  As weight stabilises they will start to notice the effects of the missing vitamins, minerals and amino acids that are important for brain health.

Zone diet

The Zone Diet was published in the mid-90s by Barry Sears and aims to provide a “balanced” approach to nutrition than the recommending a macronutrient split of 40% carbohydrates, 30% fat and 30% protein.  While 40% carbohydrates is high in comparison to low carb and ketogenic approaches discussed above it is significantly less than the typical diet at the time it the book was published.

About five years ago I read the Zone Diet and started recording what we were eating and found that we were consuming more like 60% carbohydrates.  We found exciting results in weight loss, blood sugar control and a range of other health markers as a family by reducing our macro nutrients closer to the 40:30:30 macronutrient split.

The Zone Diet approach has been used widely by the CrossFit community who are active and need to fuel their significant amounts of exercise and recovery.  I have analysed a diet plan that I found in the CrossFit Journal. [14]

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The nutritional analysis shows that this diet approach has a moderate nutrient density but still has a high glycemic load.  We don’t seem to be getting any increased benefit from increasing carbohydrates or eating more fruit.  This approach might be acceptable for people who already have excellent blood sugar control and exercise a lot.

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grains on a budget

This approach prioritises nutrient density per dollar and allows grains, peanuts and low-fat products.   It generally aligns with the standard American / Australian Diet with its high level of “healthy whole grains”.  Breakfast is corn flakes with reduced fat milk and a coffee with sugar, lunch is a Vegemite sandwich on multigrain bread and dinner is spaghetti with mince and cheese, with fruit for morning tea and lunch.

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The nutritional analysis shows that the diet overall is lacklustre.  It has 60% carbohydrates and with only 25g of fibre while it generates the highest insulin requirement of any of the dietary approaches.

Although the diet contains a range of “heart healthy whole grains” and fruits it is still quite low in nutrients and minerals compared to the other lower carbohydrate dietary approaches discussed above.

While this approach may be cheaper than buying fresh fruit and veggies we don’t seem to get anything special in terms of nutrition by using “heart healthy whole grains” in spite of the higher glycemic load.

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Mediterranean Diet

This scenarios models the Mediterranean diet[15]   which is often recommended for people to follow by dieticians.  It uses olive oil which is a monounsaturated fat and minimises butter and steak and other foods that contain saturated fats.  While this approach is nutritious, it’s downfall is the high insulinogenic load and it doesn’t provide a better outcome than the lower carbohydrate approaches.

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Durianrider’s fruitarian diet

In this scenario, I have modelled a fruitarian diet to understand the other extreme.

Durianrider (aka Harley Johnstone) is a passionate advocate for the high carbohydrate, low fat, low protein diet.  He runs the blog 30 Bananas a Day [16] and seems to make his living from advertising revenue from YouTube videos where he aggressively critiques other people’s lifestyles and nutritional approaches.

Durianrider is also very active and does an extraordinary amount of cycling and running to burn off his nearly 7000 calories per day of fruit per day which includes:

  • 1 watermelon 20lb
  • 1/2 head of celery
  • 3000 calories of bananas – a box full
  • sultanas – approx. 1/2 cup
  • citrus – oranges, 15 lbs

This approach is very high carbohydrate with an extremely high glycemic load.  This approach has the highest insulin demand with 71% of the calories being insulinogenic.   The amino acid profile is low compared to the other approaches, with a number of nutrients completely missing without any animal products.  In spite of the massive amount of fruit we don’t get a great result in terms of vitamins and minerals and the overall amino acids from proteins is low.

This approach is extreme, and without massive amounts of exercise to burn all the sugars from the fruits this dietary approach would quickly lead to an overloaded pancreas and type 2 diabetes.

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references

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

[2] Dr Wahls’ “Mind Your Mitochondria” TED talk has more than two million views.  See https://www.youtube.com/watch?v=KLjgBLwH3Wc

[3] http://www.amazon.com/The-Wahls-Protocol-Progressive-Principles/dp/1583335218

[4] It’s a little bit more painful and a little more expensive to get a blood ketone metre, but it’s an excellent way to confirm whether you’re burning fat for fuel.  See http://www.dietdoctor.com/lose-weight-by-achieving-optimal-ketosis for a concise overview of testing for your own ketones at home.

[5] http://www.amazon.com/The-Wahls-Protocol-Progressive-Principles/dp/1583335218

[6] Brad Pilon’s Eat Stop Eat does a good job of covering the science and the benefits of intermittent fasting – http://www.eatstopeat.com/

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

[8] http://www.amazon.com/The-Bulletproof-Diet-Reclaim-Upgrade/dp/162336518X

[9] See http://cdn.shopify.com/s/files/1/0243/9705/files/Bulletproof-Diet-Infographic.pdf?8043

[10] http://www.everythingatkins.net/samplemenus.html

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

[12] https://www.youtube.com/watch?v=WFNGdKSXx64

[13] Bernstein’s design for a diabetic diet for type 1 diabetics is not primarily to achieve ketosis.  Ensuring that a diet has adequate protein and other nutrients is important.  Bernstein’s approach aims for a maximum of 7% of calories from carbs and adequate protein to manage growth or weight.

[14] http://library.crossfit.com/free/pdf/cfjissue21_May04.pdf

[15] http://www.eatingwell.com/nutrition_health/weight_loss_diet_plans/diet_meal_plans/5_day_1500_calorie_diet_meal_plan?page=3

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

 

post updated July 2017

the most nutritious diabetic friendly meals

  • This article outlines a system to identify nutritious diabetic-friendly meals that minimise insulin load while maximising nutrition.
  • Choosing highly ranked meals will reduce the need to count carbs or calories.
  • Type 1  diabetics can use this system to calculate the total insulin required to cover carbs and protein and the split between the carb and protein bolus.
  • This approach can also be used to prioritise for weight loss and high nutrient density rather than blood sugar control.

[skip to the list of the most nutritious diabetic friendly meals]

it all started when…

Angelo Copola at Humans are not Broken ran a nutritional comparison of Bulletproof Coffee and his super nutritious breakfast tortilla using the free recipe builder function at SELFNutrition.com.  His blog post Bulletproof Coffee vs Breakfast is worth a read.

It was never going to be a fair fight if you compare these two extremes on the basis of vitamins, minerals and fibre alone.  The breakfast tortilla was always going to win out over the fatty coffee.

Personally, I’m partial to the occasional Bulletproof Coffee which has taken the world by storm and helped a lot of people.

I’m also aware that Dave Asprey’s Bulletproof Diet Book emphasis nutrient dense low toxin foods.

So using BPC to give your body a holiday from insulin and then eating highly nutrient dense foods at night makes sense.

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I also know that, as nutritious as it is, the tortilla recipe would not work for a type 1 diabetic like my wife.  A meal like that would send her on a blood sugar roller coaster.

So it got me thinking.  Is there a way to consider the nutritional value of a meal while also considering the insulin load?  Could we use our understanding of the proportion of insulinogenic calories to better prioritise nutritious meals that were also diabetic friendly?

the rules

Many people will judge whether meal is right for them based on calories alone.

Some will look deeper at the macronutrients.

image024

People wanting to lose weight will often target low calorie density or high fibre foods that are more filling.

Some will dig a little bit further and look at the micronutrients (i.e. vitamins and minerals).

Some body builders and people looking to optimise cognitive performance, will also look at the protein quality (i.e. the amino acids) in a food.

I suggest that an optimal diet that takes all these factors into account should be rank well across the following parameters;

  1. insulinogenic load,
  2. nutritional completeness (vitamins and minerals),
  3. amino acid sufficiency (protein),
  4. fibre content, and
  5. calorie density.

different strokes for different folks

The beauty of the food ranking system (as discussed in the previous article) is that we can tailor the weightings of different parameters to suit an individual’s unique goals.  We can also use a similar approach when comparing complete meals rather than individual food ingredients.

blood sugar control and / or nutritional ketosis

The highest priority for a diabetic is to normalise their blood sugars by reducing their insulin load in line with these weightings.   These weightings will will provide good nutrition while helping to normalise blood sugars.

insulin vitamins & minerals protein fibre calorie density
50% 15% 15% 10% 10%

weight loss

All going well, a diabetic may use a low insulin load diet with some fasting to regain insulin sensitivity and improve their blood sugar control.  If they still have weight to lose they may wish to further reduce their calorie intake to help to shed any remaining unwanted weight.

To do this they could use a a high fibre, low calorie density approach with less emphasis on insulin load that still provides excellent nutrition.

insulin vitamins & minerals protein fibre calorie density
20% 20% 20% 20% 20%

therapeutic ketosis

Many people feel that high levels of ketosis are beneficial for a range of chronic illnesses.  Someone looking to minimise insulin and drive their blood ketones up as much as possible will want to set the meal weightings to minimise insulin load as much as possible.

insulin vitamins & minerals protein fibre calorie density
70% 10% 10% 5% 5%

athletes and the metabolically healthy

If someone has lost excess weight and healed their metabolism, the person finds that they have energy to exercise they may benefit from nutritious meals with a little more carbohydrate to replenish glycogen around intense exercise.

insulin vitamins & minerals protein fibre calorie density
20% 30% 30% 10% 10%

With all of these scenarios the proviso is that they are maintaining excellent blood sugar control and that they revert back to the low insulin load dietary scenario if their blood sugars fall outside the “excellent” range shown in the table below.

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
danger > 6.5 7.8 > 140 0

meal ranking

I have set up a spreadsheet to compare meals using these parameters to identify healthy nutritious diabetic friendly meals for my family.

To date I have analysed nearly 200 meals.  Some of these we eat on a regular basis.  Others I found in recipe books, websites and Facebook forums that I thought looked good and I would like to try.

As we try out these meals at home I plan to take a photo and tell you a story about it, with a link to the recipe.

low carb breakfast stax

One of the highest ranking recipes using the meal ranking system is the Low Carb Breakfast Stax from the ketogenic recipe site Ruled.Me.  It’s hard to believe that something that looks so indulgent could also be so healthy.

breakfastpizza (1)

I dropped the recipe into the free recipe builder at SELFNutrionData, hit analyse and it pops out the snazzy nutritional analysis shown below.

There is a heap of interesting info here if you want to reflect on the nutritional value of your favourite foods.

Microsoft Word Document 23032015 33120 AM.bmp

Using the macro-nutrient profile and fibre values we can calculate the percentage of insulinogenic calories using this formula:

image011

The “nutrient balance” plot on the bottom left shows the distribution of vitamins and minerals in the meal.  This chart shows us that with the egg, spinach and bacon we have covered off on most vitamins and minerals with good levels of sufficiency.

You can look at the detail to find out where you might be able to further improve a meal by filling in any deficiencies, however I’ve just taken the completeness score (82 in this case) compare with other meals.

The chart on the bottom right shows the distribution of the various amino acids in the protein which is interesting to make sure you’re getting everything you need for muscle growth and brain health.  I’ve taken the amino acid score (147 in this case) to compare with other meals.

SELFNutrionData also calculates the serving size in grams for a meal.  Using this we can calculate the calorie density of a meal (i.e. in terms of calories per gram).  This helps us prioritise meals that are bulky and contain a lot of water, however in order to avoid prioritising meals are just beverages I have also incorporated the fibre per calorie as a separate metric.

Each individual score or the meal gets a ranked score based on the highest and lowest extremes (ranking score = (score – mean) / standard deviation) and these five values are summed together to get the total score for that meal.

If you want to delve into the inner workings of the spreadsheet you can download if from the files section on  at the group facebook.com/groups/optimisingnutrition.

the end of calorie and carb counting?

This may all sound a bit complex, but the end result is a list of nutritious, diabetic friendly meals that will keep you full and minimise blood sugar swings.

If you chose foods from the top of this list and the meals from near the top of this list chances are you won’t have to worry about counting calories or even carbohydrates to keep your blood sugars stable, stay in ketosis, stay satiated or keep the weight off.

share your recipes

If you’ve got a recipe that you would like to see analysed to find out how it stacks up with the others then please post the recipie and a photos over at facebook.com/groups/optimisingnutrition.  I’d love to run the analysis and add it to the list.

In the next article we’ll compare a range of dietary approaches to see how a high fat diet stacks up.

Nutrition for athletes and the metabolically healthy

  • Most people, once fat adapted, will do fine on a high fat ketogenic diet  and not need additional carbs to be able to exercise.
  • Learning to be metabolically flexible (i.e. using both fat and carbohydrates for fuel) can be a major advantage for an athlete.
  • Athletes and may benefit from increasing carbohydrates around competitions to speed recovery and replenish glycogen stores.
  • This article highlights some nutrient dense food options that contain slightly more carbohydrates to support intense exercise.

more about me

I became interested in the concept of low carbohydrate fuelling strategies when I started commuting to work on my bike.

The first problem is that I live 30km (18 miles) from work, but still chose to ride, both ways, in an effort to get fit and lose weight.

The second problem was that when I got home after riding 60km I just wanted to eat until I stopped feeling hungry.

The third problem was that when I weighed myself, in spite of the massive amounts of exercise that I was doing, the scale wasn’t moving in the direction that I wanted it to!

I had heard that athletes such as Ben Greenfield [1], Tim Olsen [2], Zach Bitter [3] and Sami Inkinen [4] were blowing away records using a restricted carbohydrate approach.  I wanted to be just like them.  Even a little bit.

low carb versus high carb for endurance

Typical preparation for endurance events involves “carbing up” with large doses of pasta before an event and precise timing of added simple carbs such as gels during the event to keep the glycogen fuel tank full.

One of the challenges for endurance athletes is staying fuelled without gut issues from constant ingestions of sugar gels and sports drinks.

The often used analogy is that being an athlete on a high carbohydrate diets is like being a fuel tanker constantly having to stop at the gas station to fill up. [5]

The advantage to using a ketogenic fuelling approach is that we train our bodies to be “metabolically flexible” and able access our body fat in addition to the stored glycogen in our liver and muscles for fuel.

The results below show how someone who is metabolically flexible will obtain a larger proportion of their fuel from their body fat meaning and become less dependent on refuelling with carbohydrates.

image008

advantages of keeping carbs low for athletes

Aside from endurance performance, there are a number of reasons that you may want to control your control your carbohydrate intake if you’re an athlete:

  1. To help you get / stay lean. Keeping your power to weight ratio high is important so you don’t have to drag excess weight around the course.
  2. To reduce diabetes risk and all the associated issues. Keeping your blood sugars close to optimal for long term health should be seen as a greater goal than short term performance.
  3. To improve overall health and longevity due by decreasing inflammation, oxidation free radical damage.
  4. To improved energy stability and reduce gastrointestinal distress.

when is a ketogenic diet not a good idea?

Robb Wolf says that while he is a big fan of the ketogenic approach combined with intermittent fasting, the people that seem to do it are not the overweight sedentary office workers who might benefit the most from it, but rather the people doing intense workouts combined with intermittent fasting and burning themselves into the ground. [7]

There can also be some advantages in having your glycogen fuel tank full for explosive power in intense exercise.  Some people choose to “train low, race high”, meaning that during a race you can keep your glycogen stores reserved for intense burst efforts such as sprinting to the finish line. [8]

Minimising carbs most of the time and adding a few more for ‘game day’ can be a good strategy to maximise performance.

how much carbohydrate do you need?

Insulin is required to grow muscle (and store fat). [9]

Body builders use a protein shake or simple carbs to spike insulin and support muscle grown (anabolism) before or after a workout. [10] [11]  Some will even inject insulin before a workout to maximise muscle growth.

Programs such as the TKD or John Kiefer’s Carb Backloading [12] or Carb Nite [13] is designed for physique competitors wanting the benefits of ketogenic diet without burning themselves into the ground or stalling in the long term.  It should be noted though that this approach is not necessarily ketogenic or optimal for long term health.

Ben Greenfield recommends endurance athletes aim for a lower level of carbs most of the time (say 10%) but then increase carbohydrates to around 30% from real whole foods before and / or after demanding exercise.

Cerial Killers 2: Run on Fat [14] tells the story of Sami Inkinen working with Steve Phinney to refine his diet to 70% far, 20% protein, 10% carbs to undertaken the caloric equivalent of two marathons a day for fourth days to row between San Francisco and Hawaii, proving that you don’t need many carbs at all to undertake intense exercise. [15]

Keep in mind too that if weight loss is your goal then shorter bursts of intense exercise will raise your metabolism without leaving you wanting to eat everything in sight.  Extended cardio may leave you hungry to a point that you may just eat all the calories that you just burned, then some, particularly if you’re not yet fat adapted.

can you handle it?

This all needs to be taken in the context of keeping your blood sugars close as close to optimal as you can get them.  Even if you are lean and fit it is worth periodically checking your blood sugars.

If your blood sugars are drifting up then it might be time to take evasive action and prioritise your long term health over short term sports performance.

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

Professor Tim Noakes has stated that he believes that no athlete needs more than 200g of carbohydrates per day. [16]  Noakes himself, the author of the Bible of carbohydrate fuelling for endurance athletes, [17] switched to a low carb diet after realising that he had become a type 2 diabetic after years of following his own high carb fuelling strategies.

Similarly, Sami Ikenin [18] became a low carb advocate after realising that his high carb diet that he was following had led him to become diabetic.  After he switched to a restricted carb approach, he improved his triathlon performance and recently rowed from California to Hawaii on a 70% fat diet to raise awareness of the dangers of sugar. [19]

what should I eat?

Previously I showed how we can use the food ranking system [20] to prioritise foods for weight loss and diabetes.  We can also use the food ranking system to prioritise nutrient dense foods with a little more carbohydrates if blood sugar control is not such a concern.

This weighting system emphasises nutrient density per gram (40% weighting), and nutrient density per calorie (15%) with a lesser weighting towards the insulinogenic properties of the food (25%).

Cost is also a consideration given that an athlete might be consuming larger amounts of food than someone trying to lose weight.  The resultant food rankings are shown below.

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

Rich Froning’s favourite peanut butter [21] rates well along with a wide range of nutrient dense nuts and seeds.

Vegetables, as always do well, with spinach and mushrooms at the top of the list.  Sweet potato scrapes in at the end of the vegetables as good nutrient dense high carb option.

A number of grain based foods such as rice and oats make the cut due to their nutrient density and low cost.  There’s been plenty of debate around the topic of ‘safe starches’ [22] however I think it depends on your context.  If you’re active and keeping your blood sugars under control then things like rice, and potatoes may be useful to speed recovery around intense exercise if you feel the need.

A number of breads make it into the list due to the fact that they are a low cost source of nutrition.  However many people will avoid these due to concerns over gluten leading to a leaky gut etc.

Organ meats, as always, ranks highly.  It’s interesting to note that bacon ranks as the first non-seafood meat.

There are also more fruit choices on this approach if you’re not worried about blood sugar.

nuts, seeds and legumes

  • peanut butter
  • sunflower seeds
  • peanuts
  • brazil nuts
  • pumpkin seeds
  • pistachio nuts
  • pecans
  • cashews
  • almonds
  • pine nuts
  • macadamia nuts
  • lentils
  • kidney beans
  • mung beans
  • chick peas
  • coconut meat

vegetables and spices

  • spinach
  • mushrooms
  • chives
  • coriander
  • chard
  • turnip greens
  • rosemary
  • spirulina
  • cinnamon
  • ginger
  • broccoli
  • lentils
  • Brussel sprouts
  • Kale
  • asparagus
  • Sweet potato

dairy and egg

  • egg yolk
  • whole egg
  • cheese
  • milk

animal products

  • organ meats (liver, heart, giblets)
  • sardine
  • oyster
  • anchovy
  • cod
  • herring
  • bacon
  • oyster
  • chorizo
  • mussel
  • trout
  • salmon
  • tuna
  • beef jerky
  • turkey
  • ground beef
  • lamb

fats and oils

  • olive oil
  • coconut oil
  • butter

fruit

  • avocado
  • olives
  • raspberries
  • blackberries
  • oranges
  • banana
  • dates
  • strawberries

grains

  • tortilla
  • oats
  • white bread
  • multi grain bread
  • croissants
  • oat bran muffins
  • rice

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?

daily meal plan

An example daily meal plan using the highest ranking foods is shown below.  For breakfast we have bacon with spinach and eggs, a salad with tuna for lunch, salmon and veggies for dinner with nuts for snacks.

image029

This would give us a macronutrient break down of 25% carbs, 27% protein and 48% fat.   The other advantage of eating more carbohydrates is that we can increase our fibre even higher, with this scenario giving 45g fibre per day to contribute to good gut health.

In the next article we’ll look at how we can use the food insulin index data to calculate the most ketogenic diet foods.

references

[1] http://www.bengreenfieldfitness.com/2013/05/low-carb-triathlon-training/

[2] http://www.timothyallenolson.com/2013/04/10/nutrition/

[3] http://zachbitter.com/blog/2012/10/high-carb-vs-high-fat.html

[4] http://www.samiinkinen.com/

[5] http://www.thecavewomandiva.com/?p=121

[6] http://www.ultrarunning.com/features/health-and-nutrition/the-emerging-science-on-fat-adaptation/

[7] http://blog.dansplan.com/why-dietary-fat-is-fattening-and-when-its-not/

[8] http://thatpaleoguy.com/2010/09/15/high-fat-diets-for-cyclists-part-one-of-six/

[9] https://www.t-nation.com/diet-fat-loss/insulin-advantage

[10] http://livinlavidalowcarb.com/blog/tag/ben-greenfield

[11] http://beyondtrainingbook.com/

[12] http://carbbackloading.com

[13] http://carbnite.com/

[14] http://www.cerealkillersmovie.com/

[15] http://www.fatchancerow.org/expedition/

[16] https://twitter.com/proftimnoakes/status/450136949459001344

[17] http://www.amazon.com/Lore-Running-Edition-Timothy-Noakes/dp/0873229592

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

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

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

[21] http://www.mensfitnessmagazine.com.au/2012/02/the-fittest-man-on-earth/

[22] https://www.youtube.com/watch?v=XyvlWUQAkxM

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

what are normal blood glucose and ketone levels?

  • 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 closer to optimum levels is possibly the most important thing you can do to manage your health, reduce body fat and slow ageing.
  • Blood ketones tend to rise as blood glucose levels decrease, though they can vary depending on a number of factors.
  • People who are physically fit and / or who have been following a ketogenic lifestyle for a long period do not tend to show very high blood ketone levels.

what is diabetes?

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

Diabetes is expensive.  In 2012 it cost the US a quarter of a trillion dollars in hospital costs and lost productivity and the cost of “diabesity” is forecast to triple by 2050 grow and become a major burden our economy.  Diabesity has even been classed as a matter of economic and national  security (Pompkin, 2013).

One in twelve people are considered to have Type 2 diabetes, however forty percent of the US population are considered to be “pre diabetic” and this number is forecast to grow by more than half over the next two decades to 592 million people by 2035.  If you have prediabetes you have a one in two chance of progressing to Type 2 Diabetes within five years.

Related image

The generally accepted diagnosis levels for prediabetes and Type 2 Diabetes are shown in the table below.

 

 

fasting

after meal

hbA1c

% pop

mg/dL

mmol/L

mg/dL

mmol/L

 %

“normal”

< 100

< 5.6

< 140

< 7.8

< 6.0%

50%

pre-diabetic 100 – 126

5.6 to 7.0

140 to 200 7.8 to 11.1

6.0-6.4%

40%

type 2 diabetic

> 126

> 7.0

> 200

> 11.1

> 6.4%

10%

However, while the diagnostic criteria defines half the population currently as ‘normal’, normal is far from optimal.

what are the risks of high blood sugars?

The Hba1c [7] is a test that gives an indication of your average blood sugar over the past three months.  While half the western population has a Hba1c of greater than 6.0% and hence is considered to have prediabetes or full blown Type 2 Diabetes, the risks of stroke, heart disease and and death from any cause start at much lower levels.

Figure

Your rate of brain shrinkage increases with HbA1c.Chrome Legacy Window 22032015 14339 PM.bmp

Increasing HbA1c is associated with an increased risk of cancer.

image13

Your risk of cardiovascular disease, coronary heart disease and stroke all increase with HbA1c.  And anti-diabetic medications, even though they reduce your blood glucose levels, don’t help reduce your risk.

image003

You have a much better chance of delaying the most common diseases of aging if you have a Hba1c of less than 5.0%.  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 and slow aging, regardless of whether you have been formally diagnosed with diabetes.

what are optimal blood sugars?

You can use your average blood sugar values from a home blood glucose metre to see how you’re tracking compared to optimal.

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

The conversion between HbA1c and average blood sugar are shown in the table below. The “risk levels” are based on the cardiovascular disease and stroke data above.

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

By the time you become “pre-diabetic” with a HbA1c greater 6.0% you’re well into the danger zone and it’s likely that your pancreas has been pumping out high amounts of insulin trying to keep up for some time and you are well and losing the battle of metabolic health.  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]

what are optimal ketone levels?

Once you get your head around blood glucose you may come across the ketogenic diet and managing blood ketone levels.  High blood ketone levels are dangerous in someone with Type 1 Diabetes when they have no insulin and very high blood glucose and ketones at the same time (i.e. ketoacidosis).  However lower blood ketones with healthy blood sugars are a sign that you have a good balance between your fat burning and glucose burning metabolisms.

The chart below shows how glucose and ketone values are related for different people with different levels of metabolic health.  In someone with full blown Type 2 Diabetes their blood sugars and insulin levels are high and they struggle to release ketones and body fat stores when they don’t eat so they are driven to eat again.  By contrast, someone who is metabolically healthy has low glucose and insulin levels and will more easily be able to go longer periods without food as their body fat stores can be released easily.

2017-04-17 (11).png

To look at this another way, the chart below shows two thousand glucose and ketone values from numerous people following a low carb lifestyle.  Most people maintain the sum of their blood glucose and ketone levels (i.e. total energy) at around 6.0mmol/L.  If you’re on the left hand side of this chart with a lower total energy level you will be pulling stored energy from your body (i.e. endogenous ketosis).  However if your total energy is high (e.g. due to large amounts of refined fats or exogenous ketones) your body will likely be secreting extra insulin to bring the excess energy out of your blood stream back into your body fat stores.

2017-04-28.png

Someone who is metabolically healthy will tend to run at a lower total energy because they can more easily mobilise their stored energy when required.  Think of one of our ancestors hiding in a cave.  There is no point in having high levels of energy floating around in his bloodstream all the time (unused glucose in the blood becomes glycated and unused cholesterol becomes oxidised).  But when required they can quickly mobilise the energy to run away from whatever wanted to eat them.

Image result for caveman running from dinosaur

The table below shows the the ketones corresponding to the different levels of metabolic health, HbA1c, blood ketones and the glucose : ketone index.

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

If you’re an athlete or have been following a low carb diet for a while your blood ketone levels may be lower.   Unless you’re chasing therapeutic ketosis there is no need to add extra dietary fat to achieve higher ketone levels, particularly if your goal is fat loss from your body.

how to optimise your blood sugars?

There are a number of things you can do to reduce your HbA1c, improve your insulin sensitivity and reduce your total energy including:

Large doses of highly insulinogenic foods require high doses of insulin to  normalise blood glucose.   The continuous glucose monitor plot below shows the blood sugar roller coaster experienced by a Type 1 Diabetic on a normal western diet.  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.

image004 - Copy (2)

Through the use of a low insulin load dietary approach even someone with Type 1 Diabetes can achieve normal healthy blood glucose levels without resorting to mega doses of insulin.  Even if you are do not have diabetes you can use a low insulin load diet to optimise your blood glucose levels.

food lists optimised to suit your goal

The table below has been designed to help you choose the dietary approach that is most appropriate for you based on your weight loss goals and glucose levels.  As your blood glucose levels under control with a lower insulin load diet you can then start to focus on more nutrient dense foods which will help eliminate processed junk foods and help you to be satiated with less food.

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

post updated: April 2017

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

post updated: April 2017

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

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