Tag Archives: coronary heart disease

Antonio C. Martinez II’s type 2 diabetes reversal

Can fasting improve blood glucose levels and reduce the need for diabetes medications?  Antonio Martinez was eager to find out, so he set out on his own n = 1 experiment.  

Antonio is an Attorney at Law (Martindale Hubbard Distinguished Rating and in The Legal Network Top Lawyers in New York) and businessman who worked for the late Dr Robert C. Atkins MD in government relations and appeared on his radio show in the 90s.  

Antonio was one of the principal lobbyists and strategists involved in the passage of the Dietary Supplement Health and Education Act of 1994 (DSHEA) and has been involved in health care issues in law and policy throughout his career.

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Back in the 90s Antonio adopted a low carb approach to lose weight for a time but says he then resumed a more moderate diet.  It wasn’t until Antonio started to have his own health issues, including type 2 diabetes and a heart attack, that he realised he needed to intensify his efforts.

type 2 diabetes diagnosis

Antonio has a family history of Type 2 Diabetes, with both his mother and father suffering from the condition.  Diagnosed with Type 2 Diabetes in 2002, Antonio was initially put on Metformin and eventually Janumet in 2008.

With the help of anti diabetic medications Antonio maintained a HbA1c in the 6s and was commended for his great blood glucose control.  However even though he kept his blood glucose under the American Diabetes Association recommended maximum HbA1c of 7% Antonio was  still at risk for cardiovascular disease.  

As shown in the chart below, people with a HbA1c of less than 5.0% have the lowest risk of cardiovascular disease and stroke, however it doesn’t seem to count if you are using anti-diabetes medications to reduce blood glucose levels as they simply drive the excess energy back into storage as fat.  

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While anti-diabetic medications help to lower blood glucose levels (the symptom) these medications do not necessarily reduce your disease risk or allow the fat in your organs (the cause) to be released to restore insulin sensitivity (the solution).

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Insulin is an anabolic hormone which means that it enables the body to build energy stores.  If your problem is hyperinsulinemia, Type 2 Diabetes or fatty liver then your goal should be to lower your blood glucose and insulin levels to enable your stored body fat to be used for energy.  Medicating high blood glucose without dietary changes will drive the energy back into storage as fat (including in your heart, liver and pancreas).

The diagram below from Dr Ted Naiman helps to explain how both high insulin levels (hyperinsulinemia) and high blood glucose levels (hyperglycemia) are interrelated and both bad news.

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heart attack!  

Sadly, on March 28, 2014, Antonio suffered a heart attack and had a stent placed in one artery.  

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Upon admission to the hospital he weighed 158 lbs and had a HbA1c of 7%.   After the heart attack Antonio was prescribed aspirin, blood pressure medication, a statin, an anti-coagulant, and a beta blocker.  Within a short time he began to experience side effects from the multiple medications.  

Frustrated, he re-read a number of health and medical materials and told his doctors he would not be taking medications for the rest of his life.  He also watched the documentary “Cereal Killers” which was a light bulb moment for him.  

reduced carbohydrate approach

In July 2014, Antonio told his doctor and cardiologist that he was going on a high fat low carbohydrate diet.  While his doctors did not advise against it, they were skeptical and warned him that he would have to have labs done frequently to monitor the impact of the diet.  

Then in September 2014 Antonio received a call from his doctor who said

Congratulations.  Whatever you are doing, keep doing it. You have a normal HbA1c!  I’m taking you off Janumet. Take Metformin at the lowest dose as a control.

As shown below, Antonio’s HbA1c had come down from 6.6% to 4.9% with the low carbohydrate dietary approach.  He had also dropped thirteen pounds to 145 lbs, his blood pressure had normalized, his HDL increased by 20 points and his triglycerides dropped below 100 mg/dL.  

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tackling dawn phenomenon  

Despite eating only two low carb meals per day Antonio became concerned towards the end of 2015 that his morning blood sugar levels were starting to drift up.  

Dawn Phenomenon is the process where the body secretes a range of hormones and glucose in preparation for the day, however if you are insulin resistant then the insulin response may not be adequate to maintain normal blood glucose levels.  Having already experienced a heart attack he took this seriously and was eager to do whatever he could to reverse the situation.   

So to kick off the new year Antonio adopted a regular fasting regime which involved going to bed without dinner on Sunday night and then not eating until Tuesday evening.  This gives him a 44 to 48 hour fasting window each week.   

The chart below shows Antonio’s blood glucose numbers through December before the fasting protocol and then through January and February with the fasting protocol in place.   

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Real life blood glucose numbers are always going to bounce around, however you can see that Antonio’s average blood glucose values have really improved.   

I am getting the best numbers that I’ve ever had and no Dawn Phenomenon.  

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While the longer fasts are working well for Antonio he could also use shorter more regular fasting periods to keep his blood glucose down.    Check out the Using your glucose meter as a fuel gauge article for some ideas on how you can make sure your average blood glucose is trending in the right direction.

One way of viewing high blood glucose levels and Dawn Phenomenon is the body’s way of releasing excess stored energy into the bloodstream to be used.  If you are insulin resistant the body will use a process called gluconeogenesis to convert excess protein, and even fat to an extent, into glucose.  

Once the excess fat decreases people will often become more insulin sensitive and the body will stop pumping out this extra glucose.  

HbA1c

Starting out with an HbA1c of 5.1% Antonio was already doing pretty well due to his disciplined low carb approach.  However the addition of the fasting protocol helped him break through the plateau and bring his blood glucose levels down even further towards optimal levels.  Based on his blood glucose values he now has an HbA1c of around 4.6% which is pretty much optimal.   

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ketones

Antonio’s ketones are solid but actually trending down after introducing the fasting regime.  The fact that Antonio has lower ketones values is not really a concern given that he’s likely using his ketones more effectively for energy rather than letting them build up in the blood as might be the case with a high fat diet without fasting.   

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I think many people get themselves into trouble chasing high ketone values by adding more dietary fat without improving their metabolism and insulin sensitivity to the point that they can actually use the ketones.   Fasting forces your body to learn to use ketones for fuel.  

glucose : ketone index

The ratio between glucose and ketones (GKI) can be a more useful measure when your blood glucose levels are reducing.  A reducing GKI is an indication that your insulin levels are decreasing and your metabolic health is improving.   

Antonio’s glucose : ketone ratio (GKI) improves each time he fasts and that it is trending down over time.  These low GKI values indicate that he is achieving excellent metabolic health.  

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Thomas Seyfried’s GKI is a useful tool to track your metabolic health once your blood glucose values are approaching optimal levels.  Seyfried aims for his cancer patients to have a GKI of 1.0, though a GKI below 10 is considered to be a fairly low insulin state and less than three is excellent metabolic health for someone not chasing therapeutic ketosis.  

no turning back?

Antonio continues to enjoy the weekly fasts during which he focuses on drinking lots of different teas, coffee, and some bone broth.  His weight has now dropped to 141 pounds and he is wearing the same size clothes as he wore in college.  

When his friends ask him how he reversed his type 2 diabetes and got skinny.  He replies,

By eating a high fat low carbohydrate diet based upon eating real food.

I work to keep my food macros in the range of 70 percent fat, 20 percent protein, 10 percent carbs as my ideal targets.  I do watch my protein intake because excess will convert via gluconeogenesis.

I will likely maintain this approach for the rest of my life.  I am loving my results!

Antonio says:

Another way to look at insulin resistance is your body telling you that you’re eating too much, eating too much of the wrong things or just eating too often.  Our ancestors were hunter foragers whose eating habits were more like feast and famine, not three meals with snacks.  Know and respect your insulin because it will command you to do so or otherwise wreak metabolic havoc on your health.

You can also think of your blood glucose meter as a fuel gauge.  If your blood glucose levels are high then it might be time to stop filling the fuel tank for a while.  

Intermittent fasting is like going to a metabolic gym and working out.  Your body gets the opportunity to repair, recover, regenerate. Used intelligently, it will make the difference for your health and insulin sensitizing.

I am disappointed in the medical establishment because they should know better and they do not.  Why isn’t clinical and therapeutic nutrition education mandatory in medical school and taught with the same emphasis as pharmacology?  

And before go thinking Antonio is a saint that loves deprivation, he likes to feast too!  Here he is with Ivor Cummins at Antonio’s favorite New York restaurant with some red wine..

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… Brussell sprouts salad…

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..some pate…

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…and Le Côte de Beouf.

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Lots of people would call this a ‘heart attack on a plate’, but for Antonio it seems to be working the other way.  Here’s the blood glucose and ketone results the next morning.

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And here’s Antonio recently on the job full of life and vitality.

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Antonio with Former U.S. Senate Majority Leader Tom Daschle in Washington DC, February 2016

cured?

Is Antonio cured of his type 2 diabetes?   The answer depends on your definition of “cured”.   

Will Antonio be able to eat processed junk food five times a day?  Probably not.   

However if Antonio keeps up this fasting protocol along with his low carbohydrate approach then he just might be able to maintain optimal blood glucose levels without fear of another heart attack.  

If that’s your definition of “cured” then the answer might be yes.   

Congratulations Antonio and keep up the great work!

[This article has now been translated to Spanish.  Check it out here.]

references

[1] http://www.thelivinlowcarbshow.com/shownotes/12960/997-attorney-Antonio-martinez-pushing-lchf-through-public-policy-and-the-law/

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

[3] http://www.fitnessunderoath.com/the-44-hour-diet/

[4] https://optimisingnutrition.com/2015/07/20/the-glucose-ketone-relationship/

contact

If you’re going through a similar experience Antonio would love to hear from you via his website at www.acmartinez2.com

good fats, bad fats

Even more than cholesterol or other blood markers it appears clear that insulin resistance, elevated blood glucose and hyperinsulinemia increase your risk of heart disease, obesity, stroke, cancer andom dementia.[1]

An understanding of the food insulin index data tends to lead people to increase the fat content of their diet in in an effort to normalise blood glucose and reduce insulin levels.[2]

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If a significant proportion of your calories are coming from fat it makes sense to look at the composition of our high fat food choices.

So let’s take a look what we could consider to be “good fats” and “bad fats” and the implications for prioritising our food choices.

a quick primer on fats

You’re likely aware that there are different classifications of fat based on their chemical structure:

  • saturated,
  • monounsaturated, and
  • polyunsaturated.

What this means is that:

  • saturated fatty acids have no double bonds between individual carbon atoms (note: saturated fats are denoted by X:0 where the X is the length of the carbon chain and 0 is the number of double bonds),
  • monounsaturated fats have one double bond (e.g. X:1), and
  • polyunsaturated fats have more than one double bond (e.g. X:2).

If you want to learn more about this topic I suggest you check out this page on nutritiondata.self.com.  It’s interesting to follow the links to see which foods are the highest in the different types of fats.

mainstream dietary advice

The standard mainstream dietary advice is to to:

  1. avoid trans fats,
  2. limit saturated fats to less than 7% of energy intake,
  3. emphasise omega 3 fats, polyunsaturated fats and monounsaturated fats, and
  4. keep dietary fat to between 20 to 35% of energy intake.[3]

The Mediterranean Diet is typically promoted as being the ideal dietary model,[4] [5] [6] although interestingly in practice people from the Mediterranean region actually consume more than the recommended amount of fat, typically from olive oils and fatty fish.[7] [8] [9] [10]

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dietary fats versus adipose tissue

Jeff Volek and Steve Phinney in the Art and Science of Low Carbohydrate Performance[11] [12] note that the majority of human body fat consists of monounsaturated fatty acids, with smaller amounts of saturated fats and polyunsaturated fats.  They argue that if the body stores a greater proportion of monounsaturated fatty acids for energy in times of famine then it makes sense to align our dietary fat intake with these ratios.

The table below compares the composition of human adipose tissue[13] versus the proportion of fats across the 8000 foods in the USDA database.  Based on this logic it appears that we should go out of our way to emphasis monounsaturated fat given than saturated and polyunsaturated fats are plentiful in our food system.

% adipose

dietary

adipose / dietary

saturated

30%

36%

81%

monounsaturated

54%

42%

129%

polyunsaturated

16%

22%

75%

The chart below shows the relative proportions of each of the fatty acids in human adipose tissue.  Oleic acid (18:1) (a monounsaturated fat) is the most plentiful, followed by Palmitic acid (16:0) (a saturated fat) and Linoleic acid (18:2) (a polyunsaturated fat).image004

Taking Volek and Phinney’s logic a step further, the table below shows a comparison of the proportion of each fatty acid in our adipose tissue compared to their availability in the modern diet (based on the average across the 8000 foods in the USDA database).  It appears that we have more than enough Stearic acid (18:0), Linoleic acid (18:2) and Linolenic acid (18:3) available in the food system while a number of the other fatty acids are deficient.

isomer

adipose (mol %) % adipose dietary adipose / dietary class

14:0

2.8

3.0% 2.7% 110%

SFA

16:0

21.5

23.0% 17.4% 132%

SFA

16:1 n-7

7.2 7.7% 2.08% 369%

MUFA

18:0

3.4 3.6% 9.2% 39%

SFA

18:1 n-9

43.5 46.5% 36.6% 127%

MUFA

18:2 n-6

13.9 14.9% 17.5% 85%

PUFA

18:3 n-3

0.8 0.9% 1.8% 48%

PUFA

20:3 n-6

0.2 0.2% 0.012% 1744%

PUFA

22:4 n-6

0.1 0.1% 0.004% 2426%

PUFA

22:5 n-3

0.1 0.1% 0.1% 140%

PUFA

22:6 n-3 0.1 0.1% 0.3% 37%

PUFA

oleic acid versus linoleic acid

The two most prevalent fats in our diet and on our body are Oleic acid (18:1) and Linoleic acid (18:2).

While Linoleic acid (18:2) is considered to be an essential fatty acid [14] (meaning that the body cannot manufacture it from other dietary components) the data in the table above indicates that there is a relative abundance of it in the dietary system.

Many people believe that excess Linoleic acid (18:2) from vegetable oils (which causes an imbalance in our omega 3 : omega 6 ratio) is a major contributor to the obesity epidemic. [15]

The common wisdom is that olive oil, which is high in the monounsaturated fat Oleic acid (18:1), is a healthy ‘good fat’. [16]  When we look at the research it appears well established that emphasising the monounsaturated Oleic acid (18:1) and reducing the polyunsaturated Linoleic acid (18:2) will improved insulin resistance.[17] [18] [19] [20]

omega 3 fatty acids

Improving the omega-3 : omega-6 ratio is widely regarded as important to reduce inflammation and optimise brain function and mental health.[21] [22]    Omega 3 fatty acids are typically obtained from seafood and are generally considered to be ‘good fats’ that we should be maximising for health.

While there appears to be plenty of DHA (22:6 n-3) available in the diet when we simply consider the composition of adipose tissue, it’s worth noting that DHA makes up 30% of the brain and 50% of our retina, so it is probably going to fall into the category of ‘good fats’ that we should be going out of our way to pursue in our diet.

A recent mouse study showed that fish oil (high in omega 3 fatty acids) is better than lard (high in saturated fatty acids, particularly palmitic acid (16:0) and stearic acid (18:0)) when it comes to weight gain, gut bacteria, obesity and insulin resistance.[23]  While people are clearly different from mice, it’s not unreasonable to think that fish oil might be better than eating lard.

Omega 3 fats are relatively rare in our food system which means we need to go out of our way to incorporate them into our diet.   The table below shows the omega 3 fatty acids that I think we should count as good fat along with the foods they are commonly found in.

isomer common name common foods
22:6 n-3 (DHA) Docosahexaenoic acid (DHA) fish oil, caviar, seal oil, cod liver oil, sardine oil
20:5 n-3 (EPA) Eicosapentaenoic acid (EPA) fish oil, caviar, fish
18:3 n-3 c,c,c (ALA) Alpha-linolenic acid peanut butter, flax seed, butter
22:5 n-3 (DPA) Docosapentaenoic acid (DPA) seal oil, fish oil – menhaden, fish oil – salmon.

MCT oils

You might have heard a lot of talk about MCT (medium chain triglycerides) oils recently.  These shorter chain fats appear to bypass the lymphatic system and are transported directly to the liver via the portal vein.

Many people find benefit from using MCT oil as an aid to extend periods between meals or and cognitive enhancement.[24]  MCT oils are more readily turned into ketones which provide an alternative fuel source to the brain.   In turn, ketones can increase satiety[25] and decrease appetite, both of which may facilitate weight loss.[26]

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MCTs make up about 1.1% of the fats in our food supply in coconut oil, butter, cheese and cream, however to get higher levels you will to supplement.

isomer common name common foods
12:0 Lauric acid palm kernel oil, coconut oil
10:0 Capric acid cheese, coconut oil, palm kernel oil
8:0 Caprylic acid coconut oil, coconut cream, palm kernel oil
6:0 Caproic acid butter, cheese, cream

trans fats

Artificial trans fats (a.k.a. partially hydrogenated oils) are one of the few components of the diet that are widely accepted as unhealthy.[27]   If you look at the foods in which artificial trans fats are the most prevalent, it’s hard to disagree.

isomer common foods
18:1 t (g) soy shortening, margarine, canola oil
18:2 t (g) KFC, margarine
18:2 t,t (g) McDonald’s, fast foods
16:1 t (g) thickshake, cheeseburger, hamburger, fast foods

The issue with counting all trans fats as a bad fat is that they can also occur naturally in small amounts in meats and dairy such as grass fed beef.[28] [29]

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Given that the USDA database does not differentiate between partially hydrogenated oils and naturally occurring trans fats, I have not assigned trans fats a negative mark.  Emphasising other ‘good fats’ will demote foods that contain artificial trans fats.

the effect of replacing carbohydrates with fat

The common view is that dietary fat, particularly saturated and trans fats, should be avoided in order to optimise blood cholesterol markers.  But what happens when we substitute fat for carbohydrates?

The chart below from a paper by cardiologist Dariush Mozaffarian[30] indicates that trans fats (TFA) have a negative impact on all blood markers (i.e. TC/HDL, LDL and HDL).  So there’s no disagreement there.

However increasing dietary saturated fat:

  • increases LDL (note: this is generally considered to be bad although it’s not clear if this is large buoyant of small dense LDL),
  • has minimal effect on the total cholesterol to HDL ratio, and
  • increases HDL (good).

Replacing carbohydrates (CHO) with either monounsaturated (MUFA) or polyunsaturated (PUFA) have what are generally regarded to be positive outcomes.

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Whether or not saturated fat is beneficial starts to become a little clearer when we look at the effect of individual fatty acids.  The data below shows that while Lauric acid (12:0) increases LDL it also has very a positive effect on increasing HDL and decreasing the TC : HDL ratio.

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saturated fats and insulin resistance

Mozaffarian says

“SFA has been considered a risk factor for insulin resistance and diabetes mellitus, but review of the current evidence indicates surprisingly equivocal findings. SFA consumption inconsistently affects insulin resistance in controlled trials and has not been associated with incident diabetes in prospective cohort studies.”[31]

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Things start to get more interesting when you look at the relationship between individual fatty acids, insulin resistance and type 2 diabetes.

The investigators found that saturated fatty acids with an odd number of carbon atoms in their chain (15:0 and 17:0) were associated with a lower risk of type 2 diabetes, whereas even-chain saturated fatty acids—14:0, 16:0, and 18:0—were associated with a higher risk.  Longer-chain saturated fatty acids (20:0, 22:0 and 24:0) also were found to be inversely associated with incident type 2 diabetes. [32] [33] [34]   

This also aligns with the mouse study that mentioned above where fish oil was found to have a better outcome on obesity and gut health compared to lard (which is high in 16:0 and 18:0).

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The table below shows the foods that these ‘good fats’ are contained in.  Meat and nuts are embraced in the paleo and low carb scenes.  The benefits of dairy are debated, but this is typically related to the casein and lactose content which some people don’t tolerate well.

isomer common name common foods
17:0 Heptadecanoic acid tofu, lamb, beef
20:0 Arachidic acid macadamia nuts, peanut butter
22:0 Behenic acid peanut oil, peanut butter, sunflower oil, macadamia nuts
15:0 Pentadecanoic acid cream cheese, sour cream, lamb, beef
24:0 Lignoceric acid peanut butter, rosemary, macadamia nuts, cashew nuts, sunflower seeds

summary

Listed below (in order of prevalence in the dietary system) are the ten fatty acids that I think should be included in the list of ‘good fats’ along with the common foods that they are contained in and the basis for their inclusion.

fatty acid common foods comment
Oleic acid (18:1) olive oil, sunflower oil, hazelnut oil, safflower oil, soybean oil, almond oil, avocado oil commonly associated with positive health outcomes and key component of Mediterranean diet

improves insulin resistance.

most abundant fatty acid in human adipose tissue

underrepresented in food system.

reduces TC:HDL ratio

Lauric acid (12:0) palm kernel oil, coconut oil increases HDL

decreases TC:HDL ratio.

Alpha-linolenic acid (18:3 n-3) peanut butter, flaxseed, nuts, cloves, cheese omega-3.

inflammation lowering

improves insulin resistance

Capric acid (10:0) cheese, coconut oil MCT oil.

Improves HDL:LDL ratio.

Docosahexaenoic acid (DHA) (22:6 n-3) fish oil – salmon, caviar, seal oil, cod liver oil, sardine oil essential fatty acid

omega 3.

abundant in human brain.

Arachidonic acid (20:4) salmon, chicken heart, liver, brain conditionally essential.

rare in food system.

Eicosapentaenoic acid (EPA) (20:5 n-3) fish oil, caviar, fish omega-3.

inflammation lowering.

improves brain function.

Margaric acid (17:0) tofu, lamb, frankfurter, beef sausage reduced risk of type 2 diabetes.
Docosapentaenoic acid (DPA) (22:5 n-3) seal oil, fish oil – menhaden, fish oil – salmon omega-3 though small quantities.
Pentadecanoic acid (15:0) cream cheese, sour cream, lamb. lower risk of type 2 diabetes

And for completeness listed below (in order of their prevalence in the dietary system) are the fatty acids in the USDA food database that didn’t make the ‘good fats’ list.

fatty acid common foods comment
Linoleic acid (18:2) safflower oil, grapeseed oil, sunflower oil, walnut oil n-6 component is essential however overly abundant in food system

substituting linoleic acid for oleic acid has been shown to improve insulin resistance

Palmitic acid (16:0) palm oil, fish oil – menhaden, butter, lard higher risk of type 2 diabetes

poor gut bacteria outcomes in mice study

Stearic acid (18:0) cocoa butter, shortening, margarine, lard increased risk of type 2 diabetes.

poor gut bacteria outcomes in mice study.

overly abundant in food system

18:1 c canola oil, margarine subset of 18:1 – no need to double count
18:2 n-6 c,c soy oil, sunflower oil, soybean oil, mayonnaise subset of 18:2.
Myristic acid (14:0) nutmeg, coconut oil Increased risk of type 2 diabetes
Palmitoleic acid (16:1) macadamia nuts, fish oil, seal, whale Increased risk of type 2 diabetes
Linolenic acid (18:3) flax seed, chia seed, walnuts, basil adequate in food system.

only count n-3 ALA component.

18:1 t Soy shortening, margarine, canola oil. trans fat
Gadoleic acid (20:0) seal, eel, fish oil – herring, fish -–halibut, fish oil – cod liver, salmon small quantities and limited research.
Caprylic acid (8:0) coconut oil, coconut cream. MCT but rare in food system other than manufactured foods
Erucic acid (22:1) herring, halibut, sardine, cod liver no clear health benefits / research
Butyric acid (4:0) butter, cheese MCT but rare in food system other than manufactured foods
16:1 c KFC, Popeye’s, fast food predominantly in fast foods.
Caproic acid (6:0) butter, cheese, cream. MCT but rare in food system other than manufactured foods
Arachidic acid (20:0) macadamia nuts, peanut butter. reduced risk of type 2 diabetes but rare in food system.
Behenic acid (22:0) peanut oil, peanut butter, sunflower oil, macadamia  nuts, reduced risk of type 2 diabetes but rare in food system.
Myristoleic acid (14:0) frankfurter, beef sausage, bologna, cream cheese minimal research.

small quantities in food system

18:2 i soy oil, canola oil, margarine, French fries minimal research.

small quantities in food system

Heptadecenoic acid (17:0) tofu, broccoli, beef minimal research.

small quantities in food system

18:2 t KFC, margarine trans fat
18:4 fish oil – sardine, fish oil – salmon, fish oil – menhaden, oysters very small quantities in food system
Eicosadienoic acid (20:2 n-6 c,c) English muffin, margarine, fast foods, pine nuts, ham
Lignoceric acid (24:0) peanut butter, rosemary, macadamia nuts, cashew nuts, sunflower seeds reduced risk of type 2 diabetes
18:2 t,t MacDonald’s, fast foods trans fat
Eicosatrienoic acid (20:3) pine nuts, mustard, whitefish, seal, salmon appears beneficial but minimal quantities in food system
Pentadecenoic acid (15:0) tofu, miso, beef sausage appears beneficial but minimal quantities in food system
Gamma-linolenic acid (18:3 n-6) margarine omega 6

minimal quantities.

16:1 t thick shake, cheeseburger, hamburger, fast foods. trans fat
20:3 n-6 KFC, Popeye’s, fast food. Omega 6 and primarily in fast food
Nervonic acid (24:1 c) mustard, salmon, seal, flax seed likely beneficial, but minimal quantities
22:1 c margarine. minimal quantities in food system

optimal fatty foods

Shown below is the list of fatty foods sorted by their relative quantity of the good fats with their percentage of insulinogenic calories also shown.  The order itself is not that important (otherwise the seals and whales would be even more endangered due to this article), however the big winners are:

  • fish oil (seal, whale, menhaden, sardine, herring, salmon, cod liver),
  • fish (smelt, salmon, herring, caviar, mackerel, caviar, trout, swordfish),
  • lamb, pork and beef, and
  • cheese, butter and cream.
food % insulinogenic nutrient density
oil – bearded seal 0% 20.6
oil – beluga whale 0% 17.9
oil – spotted seal 0% 17.4
smelt – dried 33% 14.4
salmon 39% 14.1
fish oil – cod liver 0% 14.0
fish oil – salmon 0% 13.4
fish oil – sardine 0% 13.1
fish oil – menhaden 0% 13.0
fish oil – herring 0% 12.7
lamb fat 2% 12.7
mackerel 14% 11.5
pork fat 3% 11.0
whitefish 38% 10.9
cream cheese 8% 10.4
caviar 26% 10.3
bacon fat 0% 9.8
butter 0% 9.0
roe 37% 8.9
sablefish 16% 8.7
seal 22% 8.5
beef steak 21% 8.3
parmesan cheese 24% 8.2
herring 19% 8.2
whitefish 33% 8.2
pepperoni 10% 8.1
beef sausage 9% 7.5
turkey fat 0% 7.1
lamb 16% 7.1
macadamia nuts 5% 7.0

It’s important to keep in mind that consuming enough “good fats” is only part of the nutrition story.  In the next article we’ll look at how we can use this understanding of good fats along with our understanding of vitamins, mineral and amino acids to identify the most nutrient dense foods for different goals.

references

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

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

[3] http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/fat/art-20045550?pg=2

[4] http://health.usnews.com/best-diet/mediterranean-diet

[5] http://diabeticmediterraneandiet.com/ketogenic-mediterranean-diet/

[6] http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801

[7]  http://www.nature.com/ejcn/journal/v56/n10/full/1601413a.html

[8] http://www.internationaloliveoil.org/estaticos/view/87-mediterranean-diet-pyramid

[9] http://www.ncbi.nlm.nih.gov/pubmed/10700478

[10] http://ajcn.nutrition.org/content/61/6/1402S.full.pdf+html

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

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

[13] http://www.researchgate.net/publication/5416860_Hodson_L_Skeaff_CM_Fielding_BA._Fatty_acid_composition_of_adipose_tissue_and_blood_in_humans_and_its_use_as_a_biomarker_of_dietary_intake._Prog_Lipid_Res_47_348-380

[14] https://en.wikipedia.org/wiki/Linoleic_acid

[15] http://www.forbes.com/sites/realspin/2015/09/29/could-so-called-healthy-vegetable-and-seed-oils-be-making-us-fat-and-sick/

[16] http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801

[17] http://www.ncbi.nlm.nih.gov/pubmed/10700478

[18] http://www.ncbi.nlm.nih.gov/pubmed/14713277

[19] http://qjmed.oxfordjournals.org/content/93/2/85

[20] http://www.ncbi.nlm.nih.gov/pubmed/10700478

[21] http://www.ncbi.nlm.nih.gov/pubmed/12442909

[22] http://chriskresser.com/how-too-much-omega-6-and-not-enough-omega-3-is-making-us-sick/

[23] http://www.the-scientist.com/?articles.view/articleNo/43854/title/how-fats-influence-the-microbiome/

[24] http://www.bulletproofexec.com/how-to-make-your-coffee-bulletproof-and-your-morning-too/

[25] http://www.nature.com/ijo/journal/v25/n9/full/0801682a.html

[26] http://www.nature.com/ijo/journal/v25/n9/full/0801682a.html

[27] http://www.marksdailyapple.com/why-are-trans-fats-bad/#axzz3mSg8Rg6D

[28] http://chriskresser.com/can-some-trans-fats-be-healthy/

[29] http://www.ncbi.nlm.nih.gov/pubmed/21427742

[30] http://www.ncbi.nlm.nih.gov/pubmed/20354806

[31] http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950931/

[32] http://www.thelancet.com/journals/landia/article/PIIS2213-8587(14)70166-4/fulltext?rss=yes

[33] http://www.medscape.com/viewarticle/829920

[34] http://www.thelancet.com/action/showFullTextImages?pii=S2213-8587%2814%2970146-9

beef heart chili

This Beef Heart Chili recipe is by Kathleen Guertin from Robb Wolf’s website.  It ranks really well in the weight loss and athletic / metabolically healthy meal rankings due to it’s high nutrient density and low calorie density.

Organ meats top the list when it comes to nutrient density, however I haven’t found a lot of recipes using organ meats that rank really well.  Perhaps it’s because people feel they need to put a lot of not so healthy things with their organ meats to drown out the taste?

This recipe uses heart, ground beef along with a range of spices to build a solid nutritional profile.

If you look closely at the chart below you’ll see that I’ve used pork heart as there is no data for beef heart in the NutritionSELF database.

Robb has had a massive influence on my thinking, along with many others. I like the way he brings everything back to evolutionary principles that need to make sense in the broader context rather than just looking at isolated studies.  I also like the way he promotes quantifying nutritional density as a way to beat the nutritionists at their own game.

Robb believes that Mat Lalonde’s nutritional density work will show the nutritionists that Paleo is better than the recommended western diet using their own system!

I’m hoping that nutritional density combined with the insulin index component will take things one step further to provide a quantitative basis to demonstrate that one meal is better than another.

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The details for a 500 calorie serving (the recipe is for two servings) are shown below.  This recipe does really well on the weight loss ranking because it has a low calorie density and a solid, great nutrient levels and a solid amount of fibre.

net carbs

insulin load carb insulin fat protein fibre
20g 40g 50% 49% 28%

9g

If you are insulin resistant or are sensitive to tomatoes you may want to reduce the tomatoes.  I’ve re-run the numbers with 5 ounces of tomatoes rather than the 26 ounces in the original recipe.  Still not perfectly diabetic friendly, but an improvement and slightly closer to the Bernstein target of 12g carbohydrates per meal.

net carbs

insulin load carb insulin fat protein fibre
15g 36g 42% 53% 30%

6g

what are normal blood glucose and ketone levels?

  • Elevated insulin and blood glucose levels are associated with a wide range of health issues including obesity, mental health, cancer, cardiovascular disease, and stroke.
  • “Normal” blood sugars are not necessarily optimal for long term health.
  • Most people are somewhere on the spectrum between optimal blood sugars and full blown Type 2 Diabetes.
  • Maintaining blood sugars closer to optimum levels is possibly the most important thing you can do to manage your health, reduce body fat and slow ageing.
  • Blood ketones tend to rise as blood glucose levels decrease, though they can vary depending on a number of factors.
  • People who are physically fit and / or who have been following a ketogenic lifestyle for a long period do not tend to show very high blood ketone levels.

what is diabetes?

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

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

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

Related image

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

 

 

fasting

after meal

hbA1c

% pop

mg/dL

mmol/L

mg/dL

mmol/L

 %

“normal”

< 100

< 5.6

< 140

< 7.8

< 6.0%

50%

pre-diabetic 100 – 126

5.6 to 7.0

140 to 200 7.8 to 11.1

6.0-6.4%

40%

type 2 diabetic

> 126

> 7.0

> 200

> 11.1

> 6.4%

10%

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

what are the risks of high blood sugars?

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

Figure

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Increasing HbA1c is associated with an increased risk of cancer.

image13

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

image003

You have a much better chance of delaying the most common diseases of aging if you have a Hba1c of less than 5.0%.  Keeping your blood sugar under control is possibly the most important thing you can do to manage your health, manage body fat, gut health, reduce your risk of cancer and slow aging, regardless of whether you have been formally diagnosed with diabetes.

what are optimal blood sugars?

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

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

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

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

By the time you become “pre-diabetic” with a HbA1c greater 6.0% you’re well into the danger zone and it’s likely that your pancreas has been pumping out high amounts of insulin trying to keep up for some time and you are well and losing the battle of metabolic health.  If you’re exposed to modern processed foods then it’s likely that you are somewhere on the spectrum between optimal and full blown diabetes. [16]

what are optimal ketone levels?

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

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

2017-04-17 (11).png

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

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

Image result for caveman running from dinosaur

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

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

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

how to optimise your blood sugars?

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

Large doses of highly insulinogenic foods require high doses of insulin to  normalise blood glucose.   The continuous glucose monitor plot below shows the blood sugar roller coaster experienced by a Type 1 Diabetic on a normal western diet.  This style of blood sugar fluctuation occurs to some extents in all of us to some degree, depending on our diet and our insulin sensitivity.

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

food lists optimised to suit your goal

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

approach

average glucose

waist : height

(mg/dL)

(mmol/L)
therapeutic ketosis

> 140

> 7.8

diabetes and nutritional ketosis

108 to 140

6.0 to 7.8

weight loss (insulin resistant)

100 to 108

5.4 to 6.0

> 0.5

weight loss (insulin sensitive)

< 97

< 5.4

> 0.5
bulking

< 97

< 5.4

< 0.5

nutrient dense maintenance

< 97

< 5.4

< 0.5

post updated: April 2017

references

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

post updated: April 2017