diet wars… which one is optimal?

  • This article summarizes 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 macronutrient 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 approaches 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 till after we got married and started thinking about having kids that we were able to find 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.

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Low carb darlings bacon and eggs provide the 10% allowable protein.  In an effort to maximise the vitamins and minerals within the available macronutrient 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 form NutritionData shows that we get a good range of amino acids from the bacon and eggs, adequate fatty acids, no harmful transfats, 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).

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We can get 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 a supplements to cover off on these deficiencies.

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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 grams 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.

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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.

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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 non-starchy 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.

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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]

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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.

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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 one 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.

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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!

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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 macronutrients 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 multi-grain 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 “hearth 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, its 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 glycaemic 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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[If you like what you’ve read here, please check out the full story.]

[Star Wars graphic from Diet Doctor]

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/

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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.

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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.

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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.

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

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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.

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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

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

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