Tag Archives: carbohydrates

nutrient dense insulinogenic foods for athletes and bulking

As well as identifying nutrient dense diabetic friendly foods, we can use the food insulin index to highlight more insulinogenic nutrient dense higher energy density foods for use by athletes or people wanting gain weight.

This article highlights more insulinogenic nutrient dense foods that could be used by metabolically healthy people to strategically “carb up” before events, to intentionally trigger insulin spikes (e.g. Carb Back-Loading, Alt Shift Diet or the targeted ketogenic diet) or to maximise growth for people who are underweight while still maintaining high levels of nutrition.

insulin load, a refresher

Many people with diabetes will try to reduce the insulin load of their diet to normalise blood glucose levels.  It’s the non-fibre carbohydrates, and to a lesser extent protein, that drive insulin and blood glucose, particularly for someone who is insulin resistant.

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Managing the insulin load of your diet is an effective way to get off the blood glucose roller coaster and stabilise blood glucose levels.  We can calculate the insulin load of our diet based on the carbohydrates, fibre and protein using the formula shown below.

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We can also calculate the percentage of insulinogenic calories to identify the foods that will affect our blood glucose levels the least, or the most.

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but why would you want to spike your glucose levels?

Much of the nutrition and diabetes world is focused on helping people who are struggling with insulin resistance and trying to normalise blood glucose.  However, there are others who are blessed to be metabolically healthy who may want to strategically refill their glycogen tanks or raise their insulin levels.

  • Some follow a targeted ketogenic diet and strategically replenish glucose around workouts by eating higher carbohydrate foods.
  • Some bodybuilders use a cyclical ketogenic diet where they deplete glucose and then replenish glucose periodically.
  • Some fat adapted endurance athletes will look to ‘carb up’ before an event so that they have both glucose and fat based fuel sources (a.k.a. train low, race high).

  • Others find success with dietary approaches such as the AltShift Diet, Carb Back-Loading which alternating periods of extreme high and low carb dietary approaches (not always with the most nutritious high carb foods).

the mission…

Dr Tommy Wood approached me to design a high insulin load and a low insulin load diet regimen that he could try for a month of each to see how his body responded. The constraint was that both the high and low insulin load foods would have to be nutrient dense whole foods so as to be a fair comparison of the effect of insulin load.

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The foods listed below represent the top 10% of the USDA food database prioritised for higher insulin load, higher nutrient density and higher energy density.  In terms of macronutrients they come out at 36% protein, 15% fat and 44% net carbohydrates.

While these foods might not be ideal for someone with diabetes they actually look like a pretty healthy list of foods compared to the “food like products” that you’d find in the isles of the supermarket.

 

This chart shows the nutrients provided by the top 10% of the foods using this ranking compared to the average of all foods in the USDA foods database.

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Also included in the tables below are the nutrient density score, percentage of insulinogenic calories, insulin load, energy density and the multicriteria analysis score score (MCA) that combines all these factors.

vegetables

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food ND insulin load (g/100g) calories/100g MCA
watercress 19 2 11 1.2
seaweed (wakame) 13 11 45 1.0
shiitake mushrooms 5 72 296 0.9
spinach 17 4 23 0.9
brown mushrooms 11 5 22 0.7
asparagus 15 3 22 0.7
chard 14 3 19 0.7
seaweed (kelp) 9 10 43 0.7
yeast extract spread 8 27 185 0.6
white mushroom 11 5 22 0.6
spirulina 10 6 26 0.6
mung beans 9 4 19 0.6
Chinese cabbage 12 2 12 0.5
celery flakes 4 42 319 0.5
portabella mushrooms 11 5 29 0.5
broccoli 11 5 35 0.4
parsley 12 5 36 0.4
lettuce 12 2 15 0.4
radicchio 8 4 23 0.4
shiitake mushroom 9 7 39 0.4
peas 7 7 42 0.4
dandelion greens 9 7 45 0.3
endive 15 1 17 0.3
okra 10 3 22 0.3
pumpkin 6 4 20 0.3
bamboo shoots 8 5 27 0.3
beet greens 12 2 22 0.3
snap beans 8 3 15 0.3
zucchini 11 2 17 0.3

animal products

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food ND insulin load (g/100g) calories/100g MCA
ham (lean only) 11 17 113 0.7
veal liver 9 26 192 0.7
beef liver 9 25 175 0.7
lamb liver 11 20 168 0.7
lamb kidney 11 15 112 0.6
chicken breast 8 22 148 0.5
pork liver 7 23 165 0.5
chicken liver 9 20 172 0.5
pork chop 7 23 172 0.5
veal 6 24 151 0.5
beef kidney 8 20 157 0.5
lean beef 7 23 149 0.5
leg ham 7 22 165 0.5
turkey liver 8 21 189 0.5
pork shoulder 6 22 162 0.4
ground beef 6 20 144 0.4
sirloin steak 6 24 177 0.4
ground pork 6 25 185 0.4

seafood

food ND insulin load (g/100g) calories/100g MCA
cod 14 48 290 1.5
crab 15 14 83 1.1
lobster 14 15 89 1.1
crayfish 12 13 82 0.9
shrimp 11 19 119 0.9
pollock 11 18 111 0.8
octopus 9 28 164 0.8
halibut 11 17 111 0.8
fish roe 13 18 143 0.8
haddock 10 19 116 0.8
white fish 10 18 108 0.8
clam 9 25 142 0.8
scallop 8 22 111 0.7
rockfish 10 17 109 0.7
salmon 11 20 156 0.7
whiting 9 18 116 0.7
perch 10 14 96 0.7
oyster 11 14 102 0.7
flounder 11 12 86 0.6
anchovy 9 22 210 0.6
trout 10 18 168 0.6
caviar 10 23 264 0.6
sturgeon 10 16 135 0.5
tuna 6 23 184 0.3
orange roughy 4 17 105 0.3
sardine 7 19 208 0.3

legumes

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food ND insulin load (g/100g) calories/100g MCA
cowpeas 2 68 336 0.8
black beans 2 63 341 0.6
soybeans 3 49 446 0.6
pinto beans 1 64 347 0.6
kidney beans 1 63 337 0.6
broad beans 2 54 341 0.5
peas 0 57 352 0.4

grains

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food ND insulin load (g/100g) calories/100g MCA
oat bran 6 65 246 0.7
baker’s yeast 10 16 105 0.5
baking powder 2 45 97 0.4
wheat bran 8 34 216 0.4
rye flour 0 58 325 0.4
quinoa 1 22 120 0.1

dairy

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food ND insulin load (g/100g) calories/100g MCA
whey powder 10 82 339 1.6
cream cheese (low fat) 12 19 105 1.0
cottage cheese (low fat) 6 14 72 0.5
parmesan cheese 3 35 420 0.4
cottage cheese (low fat) 7 13 81 0.4
cheddar (non-fat) 6 20 173 0.3
mozzarella 4 26 304 0.3
kefir 6 7 41 0.3
gruyere cheese 3 23 413 0.3
low fat milk 6 8 56 0.2
Greek yogurt (low fat) 5 11 73 0.2
Swiss cheese 3 22 393 0.2
gouda cheese 3 21 356 0.2
cheddar cheese 3 20 410 0.2
egg yolk 6 12 275 0.2
edam cheese 3 21 357 0.1

other dietary approaches

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

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

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

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fine tuning your diet to suit your goals – Wendy

  • There is no single dietary template that works for everyone.
  • Different individuals have particular needs and goals, and nutrition should be adjusted accordingly.
  • It can be useful to compare how your diet stacks up against other dietary approaches to identify where you might further refine and improve your diet.
  • The insulin load of your diet should not exceed the capacity of your pancreas to keep up and achieve normal blood glucose levels.
  • Once excellent blood glucose levels are achieved, reviewing your nutrient density, calorie density and fibre intake can be a useful  refinement to optimise your diet to achieve your goals.

keeping it simple…

Eating should not be complex!

I could understand how some people might find all this discussion about nutrition a bit daunting and / or irrelevant.

If all this talk about food is confusing and leaves you a bit perplexed then I apologise.

The reality is that if most people ate a range of whole foods from natural sources they would be pretty much OK.   Most people will not turn into ripped physique competitors with bulging six packs without meticulously tracking food intake, however most would be able to achieve good health and vitality.

A good diet is something that people will stick to and enjoy without tracking and obsessing over too much.  At the point it becomes enjoyable, effortless and normal it stops being a diet and becomes just a way of eating!

To this end I’ve created a list of optimal foods and optimal meals to suit different goals that people can just run with without too much hassle or conscious thought.

finding your path in all the noise

Unfortunately many of us have spent too long either eating poorly and need some more intense intervention, or have more specific dietary needs (e.g. diabetes, cancer, epilepsy etc) that require more targeted approaches.

My key aim in all of this is to demonstrate how a nutrient dense diet with a managed glucose load can be optimal, and modified to suit a person’s goals.  Rather than giving general platitudes I hope I can add something to the discussion and help people tweak their diet to achieve specific goals.

There is a lot of sometimes-conflicting dietary guidance out there that makes it hard to synthesise it all into a coherent plan that’s right for you.  You may be ketogenic, vegetarian, LCHF, LCHP, Paleo, ‘peagan’, or zero carb, or just do ‘everything in moderation’ (whatever that means).

taking it to the next level

No one eats optimally all the time, however it’s useful to know what can be done to improve things if you want to move further in a particular direction.

If you’re not getting the results from your current approach, you might be motivated enough to refine your current regimen to move further forward in the desired direction.   Unfortunately a lot of people fall into this category and are left looking for a bit more specific guidance on what they can do to reach their goals.

Some people are already putting a lot of thought and effort into what they eat, but sometimes not getting everything they hoped for, whether it be athletic performance, blood sugar control or weight loss.

Quantification of insulin load, nutrient density and fibre are powerful tools to further manipulate your diet in the pursuit of specific goals.  In this article we look at how we can review and refine our current diet to suit specific goals.

I hope that reviewing the application of a number of tools to real life examples can demonstrate how we can manage the glucose load of our diet while at the same time optimising the vitamins, minerals and amino acids.

I think it’s useful to review, refine and tweak someone’s existing diet rather than trying to get them to adopt a whole new way of eating that might be hard to stick to in the long term.  So to this end I’ve reviewed a number of people’s actual food diaries to see what the system would tell us about how they can move forward in a particular direction.

The plan is to profile a dietary analysis every couple of weeks to see how we might apply the tools detailed throughout this blog to optimise their nutrition while keeping in mind their insulin load.

so let’s meet Wendy…

Wendy describes herself as being obese for her entire adult life, except for a few short-lived diet-induced periods (using “eat less, move more” diet templates).  Despite obesity, Wendy had good blood lipids and fasting glucose until early 2014, when fasting glucose crept into the pre-diabetic range.  She had been hypertensive since her mid-20’s, diagnosed as essential or idiopathic hypertension (i.e. no known cause), but was advised it was caused by her obesity.

In early 2014, at age 44, Wendy began exercising regularly and then changed her diet first to lower-carb (inspired by Robert Lustig) and then ultimately low-carb.  She lost over 70 pounds over eighteen months, going from a BMI of 39 to 27.  Wendy says she is comfortable with low-carb eating as a life-long proposition, along with regular exercise (mostly yoga and strength training, with some HIIT).

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Wendy had some insulin resistance before making these changes, but now has blood sugars that are “typically in the 70s, 80s or 90s” and a fasting insulin of 5.1mIU/ml (i.e. upper end of the excellent range).

Wendy’s most recent HbA1C was 5.2% which is pretty good (see Diabetes 102 for more details of target blood sugar and HbA1c levels), so it appears that her insulin resistance has improved with her recent weight loss or at least is in remission with her improved diet and exercise regimen.  Wendy has also been able to drop all hypertension medications and now regularly home-tests blood pressure at slightly-below-normal levels.

Wendy has been very active on the Optimising Nutrition, Managing Insulin blog with a heap of insightful questions and comments.  Lately she’s also been helping me with reviewing and editing of some of the posts on the blog.  She’s certainly an educated, motivated and seasoned nutrition nerd.  You can also read more about Wendy’s journey on her own blog https://fitteratfortyish.wordpress.com/.

If you look at her food diaries you’ll see that the reason she’s lost so much weight already is that she’s eating pretty darn well!  But let’s look at what she could do to further move towards her weight loss goals.

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review of glucose load

First up I’ve analysed Wendy’s macronutrients to determine the insulin load, percentage insulinogenic calories and macronutrient split as shown in the table below.

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With less than 20g net carbohydrates per day, an average of 5% calories from carbohydrates and 23% insulinogenic calories, Wendy’s diet definitely qualifies as low carb!

I’ve plotted the macronutrients from her daily diaries in the chart below (labelled 8, 9 and 10 June).  Two of the three days sit just outside the threshold of Steve Phinney’s well formulated ketogenic diet triangle (i.e. the orange line in the figure below).  This analysis would indicate that Wendy is eating a good diet that would be great for normalisation of blood glucose.

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If Wendy was still having blood sugar issues (say average of greater than 97mg/dL or 5.3mmol/L) she might benefit from reducing her protein to bring her macros back towards the bottom left corner of this chart in order to reduce the total glucose load of the diet and make it more ketogenic.

This is not the case for Wendy though as her blood sugars are now reasonably well controlled, with her insulin resistance improved after her already significant weight loss.  So reducing the insulin load of her diet is not the primary issue.

nutritional analysis – diabetes weighting

I’ve written before about the theory of balancing glucose load while maximising nutrition.  I thought it would be interesting to look at how we could apply this in practice with Wendy’s food diary data.

Using the nutritiondata.self.com recipe analyser I have compared a range of meals and daily food diaries as discussed in the article The Most Nutritious Diabetic Friendly Meals [1] and dietary approaches as discussed in the article Diet Wars…  Which One is Optimal? [2]  In line with this I’ve analysed Wendy’s food diary from 9 June 2015.  The results of the analysis are shown below.

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A score of 100 in either the “nutrient balance” or “protein quality” scores means that you’re covering the recommended daily intake of each of the nutrients with 1000 calories.   What this means in Wendy’s case is that she’s doing pretty well with her protein score at 140.  However there are some possible deficiencies with her vitamins and minerals which are only at 52.

The table below shows a comparison of scores for the 9 June 2015 food diary with the suggested refinements discussed below.  Based on the diabetes weighting (which prioritises low insulin load) Wendy’s diet from 9 June ranks at #77 of 175 which is fairly solid, however there is some room for improvement.

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A score of zero would mean that it is average in comparison to the other meals, greater than zero (blue) means that it is better, while less than zero (red) means that it is worse than average.

The areas that the food from the 9 June 2015 food diary doesn’t do so well is calorie density, vitamins and minerals, and fibre.

so why is fibre and calorie density important?

Every individual is different.  What will work for one person may not work so well for another.  For example, simply applying a body builder or a diabetes dietary approach to Wendy’s situation may not be appropriate given that she wants to continue on her weight loss journey.

The comparison of Wendly’s base diet to the other diets analysed indicates that she could benefit from adding fibre and reducing her calorie density. But why would increasing fibre and reducing calorie density be useful for someone trying to lose weight, particularly when the low carbohydrate approaches advocated by Westman and Eades may likely recommend continuing to focus on a low total carbohydrates (i.e. not net carbohydrates) until goal weight is achieved.

I think the “magic” of the low carbohydrate dietary approach is that it normalises blood glucose levels and reduces insulin so that you can release rather than store fat.  For more detail on the importance of insulin in fat loss check out the article why we get fat and what to do about it v2.

Without a reduction in insulin levels it is difficult to unlock the fat stores for energy. It get frustrated when I hear ‘experts’ in the body building scene just saying that fat people need to achieve a calorie deficit and they’ll be all good, apparently not understanding the effect that a highly insulinogenic diet can have on fat loss and appetite for people who are insulin resistant.

Chris Gardner’s A to Z trial [3] identified that people who are insulin resistant typically only lose weight on a low carbohydrate diet.[4]  The reduced insulin load allows energy to be released from fat stores which in turn leads to increased satiety and decreased calories.  However people who don’t have insulin resistance issues can lose weight with reduced calories regardless of the carbohydrate level as long as they create a calorie deficit.

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However, once you’ve normalised your blood glucose levels and insulin I think all bets are off.  There may be a limit to how far a diet with liberal quantities of added fat will take you when it comes to weight loss.  Somehow you do need to work out a sustainable way to burn more calories than you consume.  However I don’t think this is as simple as just counting calories and maintaining deficit.

While a low carbohydrate / ketogenic diet in maintenance mode involves high levels of dietary fat, you don’t necessarily need to be adding extra dietary fat while you’re trying to lose weight.  If you’re trying to lose weight ideally the energy from fat can come from your body fat stores as shown diagrammatically below in Steve Phinney’s four phases of a ketogenic diet diagram.

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I’ve got a lot of time for Jonathan Bailor who isn’t a big fan of calorie counting.  He prefers rather to manipulate diet so that you naturally feel satiated with fewer calories.  As noted in this video he advocates for nutrient dense foods that have plenty of water, fibre and protein to naturally feel full so you don’t need to manually track calories.  This video gives a good overview of Bailor’s philosophy which I think makes sense for most people.

In my food ranking system I have tried to codify Bailor’s approach using the USDA foods database, and have used a similar approach in the meal ranking system.  The highest ranking meal using the weight loss weighting is Terry Wahls’ lamb skillet meal which is shown below.

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While this meal might have 24g of total carbohydrate there is 16g of fibre, meaning that there is only 8g of net carbs.  So if we abandon the concept of total carbohydrate and focus on net carbohydrates when it comes to real unprocessed whole foods, we can keep our insulin load low and achieve satiety naturally by eating a larger volume of nutrient dense high fibre foods.  This will ideally allow us stop worrying about counting calories while still keeping our insulin load fairly low.

One of the criticisms of Terry Wahls’ diet approach is that there is just so much food and it’s hard to eat it all to get your calories.  If you do not want to lose weight Wahls recommends adding MCT or coconut oil to increase the calorie density.  However you can see how not being able to fit in enough calories (as opposed to just counting calories) would help you to sustain a lower calorie approach without as much conscious effort.

Similarly, Dave Asprey criticises Joel Fuhrman’s ANDI score as a recipe for starvation, which is sort of what we’re after if we are trying to lose weight. [5]  So sure, maybe you’re not going to feel full eating parsley and watercress, but that doesn’t mean you shouldn’t try to eat as many non-starchy veggies as you possibly can as your first priority, and then fill up on the other foods.

While counting calories can be useful and effective as an educational tool, I your appetite will probably win out in the long run unless you find a way of eating that will naturally keep you satiated.  I believe a high fibre, nutrient dense, lower calorie density approach can be helpful to achieve this goal.

See the optimal foods for weight loss article for more details on this topic or this list of foods that are ranked based on these criteria.

improved calorie density and nutrient density

So in Wendy’s case, in order to improve the vitamin and mineral score I’ve reduced the chicken from lunch and added in some spinach and mushroom.  This has raised the “Nutrient Balance” score from 52 to 75.  The chicken is quite calorie dense in comparison to the spinach and mushroom, and you can eat a lot of these veggies without increasing calories very much.

This updated food diary then ranks at #50 of 175 meals analysed (previously #77) based on the diabetes weighting as shown above.  The overall fibre increases from a fairly low 13g to a more reasonable 21g.  This is closer to the recommended daily minimum fibre intake of 25g for women and 30g for men [6]).

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This change does increase the net carbohydrates from 11g to 32g and the insulin load from 60g to 77g, so someone who did have serious insulin resistance or diabetes should monitor their blood sugars to make sure they were not adversely affected by shifting to this approach.

For most people this increase in net carbohydrates would not be a major concern, particularly as the increase in carbohydrates is from low glycemic whole foods which tend to raise blood sugars much less than manufactured products.   You might also find that you end up naturally eating fewer calories because of the high volume of food and the high nutrient density which might leave you satisfied with fewer calories.

reducing calorie density for weight loss

For Wendy, though, blood glucose / insulin resistance is not the primary issue.  Her current priority is to move forward with her weight loss which has now stalled, more than a year into continuous weight loss.

Eliminating processed carbohydrates is critical to the success of the low carbohydrate approach but what do you replace them with?  As per Terry Wahls’ approach I would recommend trying to maximise nutrient dense non-starchy veggies in the first instance and then supplementing with added fats (if required) to make sure you’re satiated.  If we focus on eating as much high fibre, nutrient dense, low calorie density foods as we can we no longer have to worry about limiting how much we eat!

So if we want to tweak Wendy’s meal plan more towards the weight loss goal by decreasing calorie density we can:

  • use a whole avocado rather than half an avocado to increase the fibre,
  • drop the added olive oil (to the extent that is practical for cooking),
  • drop the “half and half” cream to one tablespoon rather than four in the coffee, and
  • drop the calorie dense macadamias.

If we sort the meal revisions based on the weight loss weighting (which emphasises high fibre and low calorie density) we can see that the revised diabetes diet has a ranking of 43.

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With these changes we’ve nearly doubled the weight of the food for the day while keeping the total calories the same.  Fibre has gone up from 13 to 26g which meets the minimum recommended minimum fibre intake.  This approach will be a lot more filling, which is useful if weight loss is the goal.

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Net carbs have gone from 10g in the original scenario to 50g per day.  This is still considered low carbohydrate; however Wendy should keep an eye on her blood sugars as her HbA1c is good but not yet in the excellent range.  If they go outside the normal range (see criteria here), she should revert to the nutrient dense diabetes approach (see criteria and foods here).

Different people will have different carbohydrate tolerances, and these can change as your body heals and releases fat from your belly, liver and pancreas.  Most reasonably healthy people would be able to deal with this level of carbohydrate, particularly given that it is from low calorie density, low GI carbohydrates from vegetables.

As shown in the updated nutritional analysis below, the protein quality score is still pretty high at 135 (down from 140) and the quantity of protein is still quite high at 26% of calories (down from 27%).  The only way to increase the protein quality score without increasing calories further would be to incorporate organ meats, which is not everyone’s cup of tea.   The nutritional completeness score has increased to 88 which is a significant change from the base diet that had 52!

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Reducing excess insulin (as indicated by poor blood sugar control and high body fat levels) is the first priority, however once blood glucose and insulin are stabilised, targeting high fibre nutrient dense foods (while still keeping the insulin load as low as possible) is likely to be the next step when it comes to weight loss.

If there were any nutritional issues that were causing the body to hold onto weight, these may be improved with the highly nutrient dense diet and possibly help to break through the weight stall.

references

[1] https://optimisingnutrition.wordpress.com/2015/03/22/the-most-nutritious-diabetic-friendly-meals/

[2] https://optimisingnutrition.wordpress.com/2015/03/22/best_diet/

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

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

[5] https://www.bulletproofexec.com/cdc-superfoods-andi-score-debunked/

[6] https://www.nrv.gov.au/nutrients/dietary-fibre

the cost of going low carb

  • Analysis of the USDA Cost of Food at Home database shows that fat is the cheapest macronutrient.
  • Protein is the most expensive macronutrient, however a reduced carbohydrate diet does not necessarily require an increase in protein.
  • Reducing the amount of carbohydrate and increasing the amount of fat in your diet is the most effective way to reduce your grocery bill.

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One of the common concerns about eating differently from the norm is that it will be more expensive.

Apparently one of the reasons for the relatively low Recommended Daily Intake for protein of 0.8g/kg is that many people can’t afford to eat more protein. [1]  One of the common criticisms of Paleo or the Banting Diet (LCHF) is that it will be too expensive due to the extra protein. [2]

To see if these concerns were valid I thought it would be interesting to see what the data has can tell us about the relative cost the three macronutrients, protein, carbohydrate and fat.

protein

The chart below shows the cost per calorie versus the percentage of protein in the thousand or so foods in the USDA Cost of Food at Home database. [3]

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Protein is indeed the most expensive of the three macronutrients.  As you move to the right in the chart you can see that your weekly grocery bill will increase.

Average intake of both protein and fat in the United States decreased between 1971 and 2004, with an overall increase in carbohydrate. [4]

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While from a nutritional point of view there area lot of good reasons for people to eat higher levels of protein, a low carbohydrate diet is not necessarily high in protein.

People aiming for therapeutic ketosis may aim for lower amounts of protein to minimise insulin.

Tim Noakes’ Banting diet recommends that people get between 20 and 30% of their calories from protein.  He says that those with diabetes and / or insulin resistance issues should aim for the lower end of this range, while people who are active and healthy can aim for higher amounts.  [5]

Practically it is difficult to eat much more than 30% to 35% protein from real foods.

The table below shows the relative change in cost if we were to increase our protein from current average levels back to 1970s levels, or to moderate levels such as the Mediterranean diet or even the higher protein Atkins approach.

scenario % protein cost ($/kcal) change
2004 average 14.7% 4.67
1970 average 16.9% 4.83 +3%
Mediterranean 20% 5.06 +8%
Atkins 30% 5.79 +24%

As shown in the table below, the most expensive high protein foods tend to be seafood.  For reference, the average cost of food across the more than one thousand foods in the database is $5.37/kcal.

food cost ($/kcal)
crayfish 26
spinach 26
crab 24
spirulina 23
lobster 22
scallops 17
clam 16
haddock 16
cod 15

While protein can be expensive there are some low cost high protein options available.

food cost ($/kcal)
whole egg 1.70
ground turkey 2.13
beef liver 2.81
chicken heart 2.94
cottage cheese 3.58
pork 3.59
chicken liver 3.81
ham 4.10

If you are willing to try organ meats you might get them even cheaper as they are often discarded.   The cheaper organ meats also typically have a much higher nutrient density than the more popular muscle meats or even fruits or vegetables.

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carbohydrates

You often hear the term ‘cheap carbohydrates’, but does this mean that a diet of processed grains and sugars is the most economical way to fill your shopping trolley?

While sugar and corn starch are very cheap food ingredients per calorie, the analysis of the data suggest that a higher carbohydrate diet is actually more expensive overall.

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The cheaper high high carbohydrate foods tend to be processed and calorie dense.   While the most expensive high carbohydrate foods tend to be natural foods that have a much lower calorie density. The table below shows that someone switching from a typical western diet to a reduced carbohydrate diet could make some significant savings.

scenario % carbohydrate cost ($/kcal) change
2004 average 51% 5.57
1970 average 45% 5.37 -4%
low carb 30% 4.77 -14%
ketogenic 5% 3.80 -32%

fat

So if increasing the proportion of protein and carbohydrate both increase the cost of our food bill then what makes it cheaper?  Yes it’s the other macronutrient, fat.

Increasing the proportion of fat in your diet while decreasing the carbohydrates will make your meals tastier, gentler on your blood glucose and cheaper.  Not to mention the fact that people typically spontaneously consume less calories when they consume less carbohydrates.

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You may pay a premium for coconut oil, butter or olive oil relative to corn oil which is the cheapest food ingredient, however these fats are still much cheaper than the other macronutrients.

food cost ($/kcal)
corn oil 0.20
coconut oil 0.31
chicken fat 0.86
butter 1.10
bacon fat 1.12
coconut milk 1.15
cream cheese 1.76
sesame oil 2.00
cream 2.81
olive oil 2.81

It appears that the it’s the very cheapest ingredients that are so prevalent in processed foods – sugar, corn starch, corn oil, high fructose corn syrup.  Regardless of cost you’re always going to have to make a value judgement on the nutritional value of your food.

summary

Increasing the protein content of your diet will increase your grocery bill marginally.

While higher levels of protein may be ideal for people who are healthy and active, LCHF is not necessarily high protein, particularly for those who struggle to regulate their blood glucose levels.

The LCHF approach, with its combination of moderate protein, lower carbohydrates and high fat provides an optimal solution with respect to blood glucose management, nutrition and cost.

references

[1] https://www.facebook.com/physiquescienceradio/posts/378943502302499

[2] http://talkfeed.co.za/lchf-diet-on-a-budget/

[3] http://www.cnpp.usda.gov/USDAFoodPlansCostofFood

[4] http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9146789&fileId=S1368980012005423

[5] http://www.biznews.com/health/2015/01/19/complete-idiots-guide-tim-noakes-diet-banting-lchf/

the Goldilocks glucose zone

  • The body requires somewhere between 160 and 600 calories per day from glucose.
  • This glucose can be sourced both from ingested carbohydrates as well as the glucogenic portion of protein not used for growth and repair.
  • Rather than raising blood glucose immediately, amino acids from protein circulate in the blood until they are required.
  • Excessive glucose from either carbs or protein will lead to increased insulin requirement, insulin resistance, diabetes, obesity and a range of other issues associated with hyperinsulinemia and metabolic syndrome.
  • Someone who is insulin resistant and/or has diminished pancreatic function does not produce adequate insulin to maintain normal blood glucose. Rather than using diabetes medications or exogenous insulin, the alternative option is to decrease one’s dietary insulin load to a point that the body’s natural insulin production can keep up.
  • We can manage our dietary glucose to achieve normal blood sugars by considering the total insulin load from carbohydrate plus the glucogenic portion of protein.

background

Rather than simply focusing on the ideal macronutrient split, this article endeavours to take the discussion one step further to look at how we can optimise the split between dietary glucose and fat given that glucose can be obtained from both carbohydrates, and the glucogenic portion of protein in excess of the body’s requirement for growth and maintenance.

the Goldilocks glucose zone

This article outlines a basis upon which to determine the optimum balance between what are often polar extremes.

On the high glucose end of the argument we are faced with the following issues:

  • high insulin levels,
  • obesity and excess fat accumulation,
  • high blood glucose levels,
  • heart diseases risk, and
  • the plethora of issues that accompany metabolic syndrome and hyperinsulinemia.

At the ketogenic extreme we have concerns about a range of issues including:

  • inadequate fuel for the brain,
  • limited food options,
  • a lack of vitamins and minerals,
  • low fibre,
  • stunted growth,
  • impaired athletic performance, and
  • high cholesterol levels.[1]

Somewhere in the middle there must be an optimal balance of fuel for each individual, a balance between the extremes.

But how do we find this balance point?  Then what do we monitor to ensure we stay there?

Not too hot.  Not too cold.

Not too hard.  Not too soft.

What we are searching for is the “Goldilocks glucose zone”.

the safe starches debate

The ‘safe starches debate’ has been intriguing and has informed my thinking on this controversial issue.

The discussion started at the 2012 Ancestral Health Symposium with a panel hosted by Jimmy Moore. [2]  It continued on the blogs of the two lead representatives of each side of the argument, Paul Jaminet [3] and Ron Rosedale [4].

the case for limiting carbohydrates

On the low carb end of the debate we have Ron Rosedale who argues that:

1. Non-fibre carbohydrates are:

  • detrimental as they lead to increased insulin levels, oxidation and accelerated aging, and
  • unnecessary as we can obtain our glucose needs via gluconeogenesis from protein.

2.  Glucose can be manufactured from glycerol or from lactate and pyruvate recycling.  In some respects this is even better than making glucose from protein. [5]

natural glucose utilisation level

On the not so low carb end of the argument, Paul Jaminet argues that the human body runs on a fuel mix of about 30 to 35% of calories from carbohydrates (say 600 calories per day).  The remaining 70% or so of our fuel comes from fat.

Jaminet recommends that people follow a ‘low carb’ diet, however Jaminet’s version of low carb is a carbohydrate intake somewhere less than the body’s 30% requirement for glucose.  This forces some proportion of the glucose needs to come from gluconeogenesis.

The figure below from The Perfect Health Diet represents this concept graphically. [6]

image001

some perspective

When you look at this in the context of the fact that the typical western diet has 40 to 50% of calories coming from carbohydrates,[8] we are really arguing over whether a low carb diet or a very low carb diet is best for our metabolic health.

Jaminet’s glucose flux has a lot of similarities with Mark Sisson’s Primal Blueprint Carbohydrate Curve. [9]   Jaminet’s 600 calories equates to 150g of carbohydrates which aligns with the top end of Sisson’s ‘effortless weight maintenance zone’.

image003

But what if limiting carbohydrates to less than 150g per day is not working for you (e.g. your blood sugars are not in normal range or you are not achieving weight loss)?

What can we learn from the food insulin index data to help us build on standard carbohydrate counting?

How can we determine the optimum fuel mix for our individual situation, body and goals?

minimum carbohydrate requirement

One of the concerns about a low carbohydrate diet centres on the understanding that the brain needs carbohydrates.

This seems to stem from Institute of Medicine’s advice that the brain needs about 400 calories per day from glucose.  This equates to 100g of carbs which most people wind up to 130g to provide a safety factor.

The IOM however notes that a person who is fat adapted can run on lower amounts of carbohydrates as their brain is fuelled by ketones and there is no minimum requirement for carbohydrates, only glucose which can also be obtained from gluconeogenesis. [10] [11]  In spite of this, nutritionists still recommend a minimum carbohydrate intake.

Jaminet makes a similar differentiation that a typical sedentary person requires about 600 calories for glucose per day, however this may decrease to 300 calories per day for someone on a ketogenic diet.

The understanding of the absolute minimum glucose requirement comes from research by George Cahill who undertook extreme starvation experiments and found that people could survive on as little as 40g of glucose per day (i.e. 160 calories). [12]

In the fed state the body will rely on glucose from ingested carbohydrates.  After a period of fasting it transitions to using glucose form the glycogen stores in the liver and muscles.  Once the glycogen stores are exhausted the body will obtain glucose via gluconeogenesis from cannibalising muscle.

image005

At this point however the brain and the rest of the body have largely transitioned to being fuelled by fat so it only needs to obtain 40g of glucose per day from protein via gluconeogenesis.   This would equate to around 5% of calories from glucose (not necessarily from carbohydrates).

I am not suggesting that starvation ketosis is optimal for most people.  The point is that the body can survive on very little glucose if it needs to for quite a long time.

The longevity crowd will tell you that this is an evolutionary advantage so you can prolong life until a time when there is enough nutrition to reproduce and thrive.  People who could use their fat and muscle for fuel survived to be your ancestors, and those that couldn’t, didn’t.

what is the minimum protein requirement?

According to Nuttall and Gannon [13] the body requires between 32 and 46g of high quality dietary protein to maintain protein balance.

This equates to around 6 to 7% of calories in a 2000 to 2500 calorie diet being taken “off the top” for growth and maintenance, with everything else potentially available as excess.

The same paper notes that the American diet typically consists of between 65 and 100g of protein per day (i.e. 13 to 16% of calories).

three macros or two fuel sources?

Something that has been very interesting to me that I had not understood until recently was that protein is made up of glucogenic and ketogenic amino acids.  Some amino acids can turn into either glucose or fat. [14] [15]

The table below shows the differentiation of amino acids into different categories.

  glycogenic ketogenic both
non-essential Alanine

Arginine

Asparagine

Aspartate

Cysteine

Glutamate

Glutamine

Glycine

Proline

Serine

Tyrosine
essential Histidine

Methionine

Valine

Leucine

Lysine

Isoleucine

Phenylalanine

Tryptophan

Threonine

I will be discussing this concept in more detail in a separate article (The Insulin Index v2), however in essence, what this means is that there are really only two fuel sources for the body, glucose and fat, with “excess” protein being turned into one or the other.

the “well formulated ketogenic diet”

Steve Phinney is probably the most well respected authority on the ketogenic diet.   This figure shows a comparison of what Phinney calls the “well formulated ketogenic diet” (WFKD) as a triangle with a number of possible dietary approaches shown for comparison. [16]

image007

A WKFD can contain 30% protein and 5% carbs or 20% carbs and 10% protein.  A WKFD however cannot however contain 30% protein and 20% carbs because we would get too much glucose which would increase insulin and suppress ketosis.

As shown in the WFKD figure above the protein content of a ketogenic diet can range between 0.8 and 2.4g/kg lean body mass.  However if we are running higher levels of protein we will only achieve ketosis if we also limit carbohydrates.

Listen to Steve Phinney discuss this concept from 2:51 in this video.

Interestingly, the slope of the line along the face of the WKFD triangle corresponds with the assumption that 7% of protein goes off to muscle growth and repair with 75% of the remaining ‘excess’ protein being glucogenic.   This also aligns nicely with the observation from the food insulin index data and the theoretical proportion of glucogenic amino acids in protein.

the Goldilocks glucose zone

Listed below are the various levels of glucose requirement in terms of calories discussed above along with the equivalent carbohydrates and the percent of glucogenic calories in a 2250 calorie diet.

approach glucogenic calories insulin load (g) glucogenic (%)
 glucose utilisation  (Jaminet) 600 150 26.7%
 ketogenic threshold (Phinney) 500 125 22.2%
 ketogenic maintenance (Jaminet) 300 75 13.3%
 starvation (Chaill) 160 40 7.1%
  • The glucose utilisation is Jaminet’s approximation of the glucose calories used by a non-ketogenic person each day. If we run above this level our glycogen stores will become overfull, with excess glucose spilling into the blood, requiring insulin and being stored as fat.  Below this level we need to obtain some of our glucose from protein via gluconeogenesis.
  • The ketogenic threshold represents the theoretical boundary between the WFKD and the rest of the world according to Phinney’s protein vs carbohydrates plot. Below this point our glycogen stores will become depleted to a point that we be forced to rely on our protein and fat stores for energy rather than carbohydrate.  After a period of consuming less carbs than required to keep our glycogen stores topped off we will start to show ketones in our blood and rely on ketones and fat more than glucose.  This level is about 500 calories per day which is about 22% of a 2250 calorie per day diet.
  • The ketogenic maintenance level is based on the 300 calories per day that Jaminet says we need from glucose if we are fat adapted. With a greater proportion of energy coming from fat in the form of ketones we require less glucose for brain function.
  • The starvation level represents what people can survive on as an absolute minimum. In this extreme starvation state the body is cannibalising muscle via gluconeogenesis to convert to glucose to survive.  This is not something I recommend you try at home.  However it is useful to know that the body can survive (but not necessarily thrive) at very low levels of glucose for a significant period of time.

The chart below shows these glucose levels superimposed on a plot of protein versus carbohydrate.  The points on the left hand side of the chart labelled with calorie values represent the point at which all glucogenic calories come from carbohydrates with only the minimum 7% protein for maintenance ingested (i.e. no “excess” protein). Microsoft Word Document 19052015 35145 AM.bmp

As we move to the right we have increasing levels of protein and decreasing levels of carbohydrates to maintain the same total number of glucogenic calories (assuming that 75% of “excess” protein converts to glucose).

The only thing we can be certain of here is that the concepts shown graphically in this figure will not be accurate due to the fact that it is built on a number of layers of theory.  And everyone’s body is different.  However this chart gives us a conceptual framework with which to manipulate our diet to achieve our goals.

The take home message is that, if we are trying to reduce the glucose load of our diet to the point at which our own pancreas can keep up, we need to think, not just in terms of carbohydrates, but in terms of total glucose (or insulin load) from carbohydrates plus excess protein.

I don’t think the body minds that much whether it gets glucose from carbohydrates or protein. [17]  My view is that it is better to maximise vitamins (generally from carbohydrate containing foods) and amino acids (from protein containing foods) as far as possible while at the same time keeping our glucose load within our own pancreas’ ability to keep our blood sugars at normal levels.  What this means is that some people may need to restrict their carbohydrates and their protein more than others to achieve normal blood sugars.

what about the Kitavans?

When faced with the hormonal theory of obesity many people are quick to point to hunter gatherer populations such as the Kitavans that do quite well on high levels of carbohydrates.

Some people seem to tolerate high levels of carbohydrate form whole food sources.  Perhaps they are metabolically flexible such that they can store carbohydrates as fat and quickly use them again, or they are very active and hence using up their glycogen stores regularly, and are very insulin sensitive and adapted to handle significantly more than 600 carbohydrate calories per day from whole food sources.

It may also be that people eating predominantly unprocessed high fibre foods are less likely to be in a caloric excess meaning that they do not have a lot of left over calories to store as fat or to require excess insulin.

Dr Jason Fung points out in this video that in spite of a higher glucose load the Kitavans managed to keep low insulin levels, which seems to be the critical factor.

If you are highly active with great insulin sensitivity and you can consume high levels of carbohydrates while maintaining normal blood glucose and staying lean then good luck to you.  I’m jealous.  Enjoy, at least while it lasts!

It is worth noting that a number of the champions of the low carbohydrate movement such as Tim Noakes, [18] Ben Greenfield [19] and Sami Inkenen [20] found that they had or were becoming diabetic after decades of extreme exercise on a high carbohydrate diet, hence transitioned to a low carbohydrate approach to manage their blood sugars.

comparison of dietary approaches

To help make more sense of this concept I have shown a number of dietary approaches from the article Diet Wars… Which One is Optimal? on the protein vs carbohydrate chart below.

image011

  • Bernstein’s approach is designed to be high protein, low carb, to provide diabetics with their glucose needs from protein which releases glucose more slowly than carbohydrate.
  • This version of the Atkins diet is unlikely to be ketogenic due to the high levels of protein. Reducing carbohydrates and/or protein is likely to be necessary to achieve ketosis, and possibly the weight loss that is typically the aim of the Atkins diet.
  • The Zone and Mediterranean diets, though generally thought to be moderate carbohydrate dietary approaches, are still well above Jaminet’s glucose utilisation threshold.
  • Terry Whals’ Paleo Plus approach achieves a good balance between maximising nutrition through the use of high fibre vegetables and MCT oil without excess protein.
  • The 80% fat diet approach is below the ketogenic maintenance level of 300 glucogenic calories per day but still above starvation ketosis. Personally I think it would be hard for most people to get optimal levels of vitamins, minerals, fibre and possibly protein at these levels without supplementation or focussing on nutrient dense organ meats.  However it may be desirable for someone using ketosis therapeutically for something like cancer or epilepsy.

The typical western diet contains between 40 to 50% carbohydrates, 35 to 40% fat and 15 to 20% protein. [21]  The figure below shows that between 1970 and 2000 carbohydrate intake increased from around 42% to around 49% for men while protein intake has largely stayed constant.  During this period obesity increased from 14.5% to 30.9%. [22]

image014

It’s fair to say that macronutrient composition is only part of the story, but perhaps if we moved the carbohydrate intake back towards the ketogenic corner (along with a shift to more whole unprocessed foods) this trend would turn around again?

what is our light on the horizon?

So how do you decide what dietary approach is optimal for each individual?  What is right for you?  What is the lighthouse on the horizon that you can guide your boat of metabolic health towards?

Back in the Diabetes 102 article we reviewed a number of risk factors that appear to be related to blood sugar control such as the heart disease risks shown in the chart below. [23]

image016

Building on this I developed this table showing the relationship between HbA1c, average blood sugar and ketone values for different heart disease risk categories.

  HbA1c average blood sugar ketones
 (%)  (mmol/L)  (mg/dL)  (mmol/L)
low normal 4.1 3.9 70 4.0
optimal 4.5 4.6 83 2.5
excellent < 5.0 < 5.4 < 97 > 0.3
good < 5.4 < 6 < 108 < 0.3
danger > 6.5 7.8 > 140 < 0.3

Everyone should be striving for optimal blood sugar control in order to manage their overall health and reduce a plethora of risks.

The point where you achieve excellent blood sugar control (i.e. average blood glucose less than 5.4mmol/L) is about where most people will start to show low levels of ketones in their blood.  This is likely to be somewhere around Phinney’s ketogenic threshold (orange line in the protein / carb plot).

People with more severe issues such as extreme insulin resistance, epilepsy, morbid obesity or cancer may choose to push deeper into ketosis beyond the point of simply achieving normal blood sugars and normal HbA1c.  This may require more discipline, intentional supplementation and limitation of food selection than most people are willing to invest.

what gauges do we use to steer the boat?

The most successful diets are the ones that people can stick to.

To this end I have developed a list of optimal foods that prioritises low insulin load, high fibre, nutrient dense foods based on your personal goals (e.g. weight loss, blood sugar control, nutritional ketosis, athletic performance or therapeutic ketosis).  I have also developed this database of optimal meals that will enable you to easily choose simple everyday meals that will provide high levels of nutrition while achieving a low insulin load.

If you have diabetes or insulin resistance then I recommend that you track your blood sugars and ‘eat to your meter’.  You will quickly learn what meals raise your blood sugars and hence what to avoid.

With the understanding that non-fibre carbohydrates plus excess protein raise blood sugar and require insulin you can work to manage your diet until you achieve the excellent blood sugar levels with a reduced or ideally eliminated reliance on medications.

image017

Many people benefit from journaling or tracking food intake on an app such as MyFitnessPal or Cronometre.   Rather than looking at calories or carbohydrates I encourage you to consider insulin load which can be calculated using this formula.

image017

As shown in the table above, you will likely need to get below an insulin load of 150g per day to be under the blue line and under 125g per day to be ketogenic.

While I don’t think it is healthy, natural or normal to consciously monitor everything you eat for extended periods, many people find it useful for a period of time to retrain their habits or to help guide them toward a short term goal.

As a worked example I have calculated the insulin load, % insulinogenic calories as well as the % carbs and % protein for Deshanta from the Optimising Nutrition Facebook group who provided her MyFitnessPal food diary which is summarised in the table below.

carb (g) fat (g) protein (g) fibre (g) insulin load (g) % insulinogenic % carb % pro
143 92 113 42 164 39% 24% 27%
99 99 125 41 128 32% 14% 31%
129 102 134 40 164 36% 20% 30%
50 81 125 17 103 30% 10% 37%
86 88 125 19 137 35% 17% 32%

I’ve also plotted this on the chart below indicating that her diet puts her just outside the realm of a ‘well formulated ketogenic diet’.  If she wanted to improve her blood glucose control further she could consider moving back towards the more ketogenic bottom left of the chart by reducing carbohydrates and / or protein.

image021

If you’re interested in seeing how you can refine your diet to balance your blood sugars with consideration of your blood sugars and glucose load as well as your vitamins and amino acid you could join this closed Facebook group.

what are the levers we can use to steer the boat?

In order to reduce the insulin load of our diet we should do the following:

  1. Increase fibre from non-starchy vegetables (e.g. spinach, mushrooms, peppers, broccoli etc). These will provide vitamins and minerals as well as indigestible fibre that will feed the gut which will also improve insulin resistance. [24]  Increasing fibre in our diet will increase the bulk and the weight of our food without increasing calories or insulin and will tend to decrease our cravings for processed carbohydrates.
  2. Reduce carbohydrates, particularly ones that come in packages with a bar code. Enough said.
  3. If you are not getting the desired results, look to reduce your protein intake until you are achieving excellent blood sugar control and/or your target HbA1c.
  4. If you are still not getting the results you want then look at some form of intermittent fasting to improve your insulin sensitivity and to kick-start ketosis. [25]

Once you are achieving normal blood sugars you may want to occasionally test your blood ketones to confirm you have achieved nutritional ketosis; however tracking your blood sugars will be adequate for most people.

Once you have achieved your desired level of blood sugars, weight and metabolic health you can drop back to monitoring less frequently, just to make sure you are not regressing and then ramp up the efforts again if required.

Then, go outside.  Move.  Have fun.  Find a hobby.  Enjoy life!  And stop thinking so much about food!

[1] http://www.thepaleomom.com/2015/05/adverse-reactions-to-ketogenic-diets-caution-advised.html

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

[3] http://perfecthealthdiet.com/2012/11/the-safe-starches-panel-from-ahs-2012/

[4] http://drrosedale.com/blog/2011/11/22/is-the-term-safe-starches-an-oxymoron/

[5] http://drrosedale.com/blog/2012/08/18/a-conclusion-to-the-safe-starch-debate-by-answering-four-questions/#ixzz3aDeqQiQ9

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

[7] http://perfecthealthdiet.com/2011/02/ketogenic-diets-i-ways-to-make-a-diet-ketogenic/

[8] http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/how-to-eat-healthy/art-20046590

[9] http://www.marksdailyapple.com/press/the-primal-blueprint-diagrams/#axzz3aSDCTDIi

[10] http://lcreview.org/main/130g-carbsday-rda/

[11] See also discussion in Chapter 7 of Richard Feinman’s “The World Turned Upside Down: The Second Low-Carbohydrate Revolution”.

[12] http://www.med.upenn.edu/timm/documents/ReviewArticleTIMM2008-9Lazar-1.pdf

[13] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636610/

[14] http://en.wikipedia.org/wiki/Glucogenic_amino_acid

[15] https://www.dropbox.com/s/4dkl03mz2fci71v/The%20metabolism%20of%20%E2%80%9Csurplus%E2%80%9D%20amino%20acids.pdf?dl=0

[16] https://youtu.be/8NvFyGGXYiI?list=PLrVWtWmYRR2BlAsGG9tr6T-B4xSum8SCc&t=1234

[17] Though it does take more energy to convert protein to glucose, hence a calorie is not a calories when it comes to protein being converted to glucose via gluconeogenesis.

[18] http://thenoakesfoundation.org

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

[20] http://www.samiinkinen.com/post/86875777832/becoming-a-bonk-proof-triathlete-fat-chance

[21] http://www.ncbi.nlm.nih.gov/pubmed/23324441

[22] http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htm

[23] http://www.cardiab.com/content/pdf/1475-2840-12-164.pdf

[24] http://www.amazon.com/Brain-Maker-Power-Microbes-Protect-ebook/dp/B00MEMMS9I

[25] https://intensivedietarymanagement.com/tag/fasting/

the most ketogenic diet foods

  • Ketosis occurs when glucose stores and insulin levels are low which causes the body to switch to the use of fat for fuel.
  • Our insulin response is related not just to carbohydrate, but also the protein and fibre content of our food.
  • This understanding can help us to prioritise foods with a lower insulin load that will help us improve our blood glucose control.

food insulin index

The initial research into the food insulin index was detailed in a 1997 paper An insulin index of foods: the insulin demand generated by 1000-kJ portions of common foods by Susanne Holt, Jennie Brand Miller and Peter Petocz who tested the insulin response to thirty eight different foods.

insulinindex

The food insulin index score of various foods was determined by feeding 1000kJ (or 239 kcal) of different foods to non-diabetic participants and measuring their insulin response over three hours.   This was then compared to the insulin response of pure glucose (which is assigned a value of 100%) to arrive at a “food insulin index” value for each food.

FII versus time chart.jpg

Considering how significant this information could be for people trying to manage their insulin levels (e.g. people with diabetes, “low carbers” or “ketonians”) I was surprised that there hadn’t been much further research or discussion on the topic.  I found a few references and mentions in podcasts, but no one was quite sure what to do with the information, mainly due to the fact that only a small small number of foods been tested.

more food insulin index data

Digging a bit further I came across a recent PhD thesis from the University Of Sydney titled Clinical Application of the Food Insulin Index to Diabetes Mellitus (Kirstine Bell, September 2014) which contained a more extensive list of foods that had been tested since the original study.

With this additional data perhaps we can make more sense of the various factors that affect insulin, the master regulating hormone of our metabolism?

In the chart below I have plotted the carbohydrates versus the insulin response of foods for more than one hundred foods.  Although insulin is loosely correlated with the carbohydrate content of our food, we can see that high protein foods such as steak, tuna and fish still require a significant amount of insulin.

food insulin index - fresh start 9052016 52737 AM.bmp

I ran some analysis on the data and found that we secrete about half as much insulin in response to protein compared to carbohydrate.  And we get the best correlation when we assume that indigestible fibre does not raise insulin.  Interestingly, fructose only requires about a quarter of the insulin as carbohydrate.

Once we account for protein and fibre we get a much better prediction of the insulin response to food compared carbohydrate alone.

food insulin index - fresh start 9052016 52727 AM.bmp

[Check out this cool interactive visualisation of all the FII test data here.]

Using this understanding we can calculate insulin load of our food using the following formula:

insulin load = total carbohydrate – fibre + 0.56 x protein

We can also calculate the proportion of the energy in our food that requires insulin to metabolise (i.e. “the percentage of insulinogenic calories”).

image016

If you have the nutritional properties for a food or a meal you can calculate the percentage  of insulinogenic calories using this calculator created by Dr Ted Naiman.

insulin load, the common denominator

You may have noticed that the internet is full of groups of people passionate about seemingly contradictory dietary approaches that seem to work.

image02

You have the vegans, vegetarians and the longevity crowd who advise that you should minimise animal proteins because they provide excess amino acids which raise IGF-1 and insulin.  People like Joel Fuhrman, T Colin Campbell and Ron Rosedale advise that we should prioritise high fibre unprocessed plant based foods.   This approach, with lower levels of protein, minimal processed carbohydrates and high levels of fibre will have a low insulin load compared to the typical diet.

insulin load = total carbohydrate – fibre + 0.56 x protein

Seemingly on the other end of the spectrum you have the low carbers following an Atkins type diet emphasising higher levels of fat and avoiding carbohydrates.  Similarly, such an approach will also have a relativity low insulin load.

Part of the magic of all of these approaches is that they all manage insulin levels.

possible applications

Insulin is not bad at normal levels, but we are understanding more and more that excess insulin (i.e. hyperinsulinemia) is highly problematic, perhaps as much or more than high blood glucose levels.

Understanding how to calculate our insulin response to food could enable us to better manage our diet to avoid elevated blood glucose and hyperinsulinemia.

The biggest challenge for someone with Type 1 Diabetes (like my wife) occurs when you require a large dose of insulin to address a high blood glucose level that is caused by eating non-fibre carbohydrates and large amounts of protein.  As you can see in continuous glucose monitor plot below, once you’re on the “blood glucose roller-coaster” it’s hard to get off.

It’s much easier to manage your blood glucose levels when the insulin load of your diet is lower (i.e. less non-fibre carbohydrates and moderate protein).

The plot below is from the same person with type 1 diabetes a few weeks later after modifying their diet.  The amplitude of the swings are smaller which makes it easier to manage blood glucose levels with smaller doses of insulin.

A more accurate understanding of insulin load can also help people with diabetes more accurately calculate their insulin dose or people trying to manage conditions like cancer or epilepsy through a therapeutic ketogenic diet.

For the rest of us who are somewhere on the insulin resistance scale, being able to calculate the insulin load of our diet will enable us to design a diet that will enable our pancreas to keep up and maintain normal blood glucose levels.

the most ketogenic foods

Listed below are the foods that will require the least amount of insulin.  I have included a number of other parameters that may be of interest:

  • nutrient density (ND) – high nutrient density foods will help you avoid cravings and achieve satiety with less calories.
  • energy density – foods that contain high levels of fibre and water have a low energy density (i.e. calories per 100g) and will tend to make us full with fewer calories.
  • percentage of insulinogenic calories – this is the proportion of the energy in the food that will require insulin to metabolise.
  • insulin load – foods such as non-starchy vegetables have a higher proportion of insulinogenic calories, but because of their low energy density will have a very low insulin load per 100g of food, meaning that you will need to eat a lot of that particular food for it to affect your blood glucose or insulin significantly.
  • net carbohydrates – these are the digestible carbohydrates that will affect your blood glucose levels and insulin that remain after you account for the indigestible fibre.

The amount you need to prioritise each of these parameters depends on a range of considerations including your blood glucose control and your weight loss goals.   Along with the insulin response to different foods, nutrient density and energy density are other important parameters we can use to optimise our food choices.

2016-07-06 (11)

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

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

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

image02

 

I have sorted the foods below by insulin load which will be useful if you are looking for foods to help you manage the insulin load of your diet.  If you’re interested, the most ketogenic foods article has these foods sorted by their proportion of insulinogenic calories.

Focusing on foods with a low percentage of insulinogenic calories will be useful if you are aiming for a high fat therapeutic ketogenic diet.  Focusing on foods with a low insulin load may be more useful if you want to lose weight and use some of your body fat for fuel.

eggs

Eggs are a staple for low carbers, ketogenic dieters and diabetics.  Not only are they nutritious they are also low in carbohydrates.

 Fried-Egg-Wallpaper-5

food ND % insulinogenic net carbs/100g insulin load  (g/100g) calories/100g
egg white -0.08 74% 1 9 48
whole egg 0.16 29% 1 10 138
egg yolk 0.17 19% 4 15 317

The egg white is higher in protein and hence more insulinogenic.  At the same time the energy density (calories/100g) of the egg white is lower and hence the insulin load per 100g for the egg white is lower.

dairy

Some people believe that red meat and dairy are uniquely insulinogenic, however my reading of the food insulin index data is that there is nothing special about these foods that isn’t explained by their carbohydrate, protein and fibre content.

Dairy foods typically have a high energy density.  This is great if you’re a growing baby, an athlete trying to replenish energy or a bodybuilder trying to spike insulin for hypertrophy. High palatability and high energy density are not a good combination if you’re trying to lose weight.

cheese

food ND % insulinogenic net carbs/100g insulin load  (g/100g) calories/100g
cream cheese 0.09 10% 4 8 348
cottage cheese -0.01 38% 3 9 93
ricotta cheese 0.08 25% 3 11 174
feta cheese 0.15 22% 4 14 265
Limburger cheese 0.16 18% 0 15 327
Camembert cheese 0.16 20% 0 15 299
brie cheese 0.14 19% 0 16 334
Muenster cheese 0.15 20% 1 18 368
blue cheese 0.16 20% 2 18 354
mozzarella 0.15 23% 2 18 318
Monterey 0.15 20% 1 19 373
cheddar cheese 0.15 20% 1 20 403
Colby 0.15 20% 3 20 394
Edam cheese 0.17 22% 1 20 356
Gouda cheese 0.17 23% 2 20 356
provolone 0.17 24% 2 21 350
Gruyère cheese 0.17 21% 0 22 412
goat cheese 0.17 22% 2 25 451
Swiss cheese 0.17 26% 5 25 379
parmesan cheese 0.18 30% 3 31 411

milk and cream

Milk has a higher proportion of insulin calories compared to cheese.  Butter and cream have a lower insulin load and proportion of insulinogenic calories.

36959895мляко

food ND % insulinogenic net carbs/100g insulin load  (g/100g) calories/100g
butter 0.09 0% 0 1 734
cream 0.08 5% 4 5 431
goat milk -0.05 40% 4 7 69
full cream milk -0.10 44% 5 7 65
low fat milk -0.12 58% 5 7 50
human milk -0.14 43% 7 8 71
reduced fat milk -0.13 59% 5 8 51

yoghurt

Full fat plain Greek yoghurt has the lowest percentage of insulinogenic calories while the sweetened and low fat options are extremely insulinogenic.

greek-yogurt

food ND % insulinogenic net carbs/100g insulin load  (g/100g) calories/100g
Greek Yoghurt 0.01 27% 6 9 130
plain low fat yoghurt -0.02 69% 7 11 63
skim milk yoghurt -0.02 86% 8 12 55
low fat fruit yoghurt -0.00 93% 19 22 95

fruit

It’s interesting to note that there are only a handful of fruits with a low percentage of insulinogenic calories (i.e. olives and avocados).  However some fruits like oranges have a lower insulin load because of their low energy density and therefore may not spike your blood sugar as much as dates or raisins which have a high proportion of insulinogenic calories as well as a high insulin load.  If in doubt, get a blood glucose metre and compare how much your favourite foods raise your blood glucose levels.

spanish-olives

food ND % insulinogenic net carbs/100g insulin load  (g/100g) calories/100g
olives 0.02 15% 3 3 90
strawberries -0.15 52% 4 5 36
avocado 0.01 18% 5 6 131
raspberries 0.09 42% 6 6 58
watermelon -0.04 88% 7 7 34
nectarines -0.04 68% 8 8 49
limes 0.05 69% 8 8 47
plum -0.06 74% 9 9 51
peaches -0.23 84% 9 9 44
honeydew melon 0.30 88% 8 9 40
apricots -0.21 74% 9 10 54
apples 0.48 77% 10 10 53
blackberries -0.01 79% 8 10 48
grapefruit -0.30 97% 10 10 42
mango 0.10 66% 10 11 67
pear 0.14 69% 11 11 64
orange 0.49 77% 10 11 55
cherries 0.72 84% 10 11 54
apple juice -0.22 95% 11 11 47
pineapple 0.06 84% 12 12 57
mandarin oranges 1.11 85% 11 12 55
kiwifruit -0.02 76% 12 13 67
currants -0.21 83% 12 13 63
apples -0.15 91% 13 13 58
mango nectar -0.20 98% 13 13 53
grape juice -0.06 92% 14 14 62
passion fruit 0.24 54% 13 15 109
guava -0.13 79% 14 15 76
litchis 0.20 80% 14 15 73
grapes 0.45 80% 15 15 77
boysenberries 0.40 66% 15 16 94
blueberries 0.32 72% 16 16 91
figs 0.37 81% 16 17 82
canned peaches -0.14 93% 18 18 77
bananas -0.02 87% 21 21 99
plantains 0.37 79% 25 25 129
dates 0.17 72% 54 56 308
raisins 0.20 84% 68 70 336
prunes 0.11 97% 89 91 378

vegetables

There aren’t many dietary approaches that don’t advise you to eat more vegetables.  It’s also hard to overeat non-starchy veggies because they have a very low calorie density and are high in fibre.  Again, due to the low energy density the net carbohydrates are low in a lot of the non-starchy veggies and hence won’t significant raise your blood glucose levels.

vegetable-03

food ND % insulinogenic net carbs/100g insulin load  (g/100g) calories/100g
chicory greens -0.25 27% 1 2 28
pickled cucumber -0.99 48% 1 2 13
butter head lettuce -0.98 49% 1 2 16
celery 2.63 49% 1 2 17
radishes 0.70 50% 2 2 19
lettuce 1.34 52% 2 2 17
Chinese cabbage 1.02 60% 1 2 16
chives 0.27 34% 1 3 37
cilantro -0.44 36% 1 3 28
spinach -0.54 41% 1 3 29
mustard greens 0.27 45% 2 3 30
mung beans 0.33 46% 1 3 26
asparagus 1.12 46% 2 3 27
endive -0.60 52% 2 3 20
rhubarb 1.46 57% 3 3 21
summer squash 1.00 65% 2 3 19
artichokes 0.83 33% 3 4 54
turnip greens 1.31 39% 1 4 37
alfalfa (sprouted) -0.54 46% 1 4 31
bamboo shoots 0.90 52% 3 4 28
cabbage 0.81 53% 3 4 30
arugula -0.02 54% 2 4 31
cauliflower -0.60 57% 3 4 28
turnips -0.13 64% 3 4 24
chard (cooked) -0.68 68% 3 4 25
pumpkin -0.04 73% 4 4 23
cucumber -0.03 78% 3 4 18
seaweed (kelp) 0.74 43% 4 5 50
beets 0.34 44% 4 5 48
collards 0.44 46% 2 5 40
snap green beans 0.74 47% 4 5 40
parsley 0.15 49% 3 5 44
jalapeño peppers 0.52 54% 4 5 35
carrots 0.20 55% 5 5 39
okra 0.94 57% 4 5 37
mushrooms 0.65 70% 2 5 30
broccoli 1.21 57% 4 6 42
parsnip 0.73 38% 7 7 76
Brussels sprouts 0.24 54% 5 7 52
peas 0.69 58% 5 7 51
shiitake mushrooms -0.22 60% 5 7 48
bell peppers 0.86 64% 6 7 43
eggplant 0.39 67% 7 7 41
leek 0.13 79% 6 7 36
onions 0.52 77% 7 8 41
winter squash 1.22 80% 7 8 39
kale 0.75 74% 8 10 56

nuts and seeds

Most nuts and seeds have a low percentage of insulinogenic calories though they have a higher energy density are possible to overeat.

food ND % insulinogenic net carbs/100g insulin load  (g/100g) calories/100g
coconut water 1.51 66% 3 3 20
coconut milk 0.03 8% 4 5 246
macadamia nuts 0.12 5% 5 9 769
pecans 0.15 5% 4 9 762
Brazil nuts 0.09 9% 4 15 704
flaxseed 0.08 12% 2 16 568
pine nuts 0.16 11% 9 18 647
coconut meat 0.09 11% 16 20 703
chia seeds 0.10 16% 8 21 511
sunflower seeds 0.18 20% 11 24 491
walnuts 0.10 15% 7 25 683
tahini 0.17 16% 13 26 633
hazel nuts 0.10 16% 15 27 692
almonds 0.11 16% 15 27 652
sesame seeds 0.12 18% 14 27 603
cashew nuts 0.11 22% 24 33 609
pistachio nuts 0.16 23% 19 34 602
pumpkin seeds 0.12 27% 36 53 777

seafood

Seafood is a great source of essential fatty acids which are heard to find in plant based foods.

seafood-salad-5616x3744-shrimp-scallop-greens-738

food ND % insulinogenic insulin load  (g/100g) calories/100g
crayfish 0.21 64% 12 78
perch 0.16 59% 13 91
crab 0.26 69% 13 78
oyster 0.31 57% 14 98
lobster 0.30 69% 14 84
sturgeon 0.26 47% 15 129
salmon 0.28 50% 15 122
snapper 0.25 64% 15 94
haddock 0.21 69% 15 85
halibut 0.27 63% 16 105
swordfish 0.28 41% 17 165
rainbow trout 0.28 43% 17 162
mackerel 0.28 45% 17 149
tuna 0.30 50% 17 137
whiting 0.21 63% 17 109
Pollock 0.27 66% 17 105
white fish 0.27 67% 17 102
orange roughy 0.08 67% 17 99
cod 0.17 67% 17 99
herring 0.26 34% 18 210
sardine 0.24 36% 18 202

animal products

7450703_orig

food ND % insulinogenic insulin load  (g/100g) calories/100g
frankfurter 0.10 14% 11 322
bratwurst 0.05 25% 11 171
beef ribs 0.11 13% 12 349
salami 0.12 29% 12 166
foi gras 0.11 11% 13 459
pate 0.13 16% 13 315
turkey heart 0.16 39% 13 130
duck (with skin) 0.12 17% 14 331
pepperoni 0.13 14% 17 487
polish sausage 0.11 26% 17 259
duck (meat only) 0.17 36% 17 195
lamb 0.14 24% 18 308
chorizo 0.15 17% 19 448
ground turkey 0.19 37% 19 203
veal (sirloin) 0.18 38% 19 195
ostrich 0.19 46% 19 168
chicken liver 0.43 48% 20 165
ham 0.26 55% 20 146
sirloin steak 0.16 28% 21 305
goose 0.17 37% 21 230
pork 0.18 46% 21 182
chicken drumstick 0.17 36% 22 238
turkey breast 0.22 70% 22 127
beef liver 0.46 58% 24 169
chuck steak 0.22 50% 25 197
chicken breast 0.22 56% 25 178
veal (leg) 0.25 56% 25 174
emu 0.24 63% 25 159
bacon 0.18 23% 30 522

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.

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