Tag Archives: diabetes insulin

spinach and egg

I’m a pretty simple cook, but sometimes the simple things in life are the best.   You don’t have to achieve great feats of molecular gastronomy to get a hearty nutrient dense start to the day.

This recipe is a simply egg and spinach fried up with some dill, some cream with the egg and coconut oil with the spinach for cooking.

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The ‘secret’ here is to go heavy on the spinach.  Spinach always gives an amazing nutritional profile.

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Even with four eggs and 300g of spinach the end result is still very much ketogenic as well as being nutrient dense!

For some extra taste and you could throw in some mozzarella with the egg.

For all it’s simplicity, this recipe ends up ranking at #9 in the diabetes and nutritional ketosis ranking and #17 in the therapeutic ketogenic meals ranking.

The table below shows the nutritional data per 500 calorie serving.

net carbs insulin load carb insulin fat protein fibre
5g 18g 28% 72% 24g 6g

 

 

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the most nutrient dense foods for different goals

While a lot of attention is often given to macronutrient balance, quantifying the vitamin and mineral sufficiency of our diet is typically done by guesswork.  This article lists the foods that are highest in amino acids, vitamins, minerals or omega 3 refined to suit people with different goals (e.g. diabetes management, weight loss, therapeutic ketosis or a metabolically healthy athlete).

I’ve spent some time lately analysing people’s food diaries, noting nutritional deficiencies, and suggesting specific foods to fill nutritional gaps while still being mindful of the capacity of the individual to process glucose based on their individual insulin sensitivity and pancreatic function.  The output from nutritiondata.self.com below shows an example of the nutrient balance and protein quality analysis.

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In this instance the meal has plenty of protein but is lacking in vitamins and minerals, which is not uncommon for people who are trying to reduce their carbohydrates to minimise their blood glucose levels.

The pink spokes of the nutrient balance plot on the left shows the vitamins while the white shows the minerals.  On the right hand side the individual spokes of the protein quality score represent individual amino acids.

A score of 100 means that you will meet the recommended daily intake (RDI) for all the nutrients with 1000 calories, so a score of 40 in the nutrient balance as shown is less than desirable if we are trying to maximise nutrition. [1]

I thought it would be useful to develop a ‘shortlist’ of foods to enable people to find foods with high levels of particular nutrients to fill in possible deficiencies while being mindful of their ability to deal with glucose.

essential nutrients

The list of essential nutrients below is the basis of the nutrient density scoring system used in the Your Personal Food Ranking System article, with equal weighting given to each of these essential nutrients. [2]

The only essential nutrients not included in this list are the omega-6 fatty acids which we typically get more than enough of in our western diet.  [3]

essential fatty acids

  1. alpha-Linolenic acid (omega-3) (18:3)
  2. docosahexaenoic acid (omega-3) (22:6)

amino acids

  1. cysteine
  2. isoleucine
  3. leucine
  4. lysine
  5. phenylalanine
  6. threonine
  7. tryptophan
  8. tyrosine
  9. valine
  10. methionine
  11. histidine

vitamins

  1. choline
  2. thiamine
  3. riboflavin
  4. niacin
  5. pantothenic acid
  6. vitamin A
  7. vitamin B12
  8. vitamin B6
  9. vitamin C
  10. vitamin D
  11. vitamin E
  12. vitamin K

minerals

  1. calcium
  2. copper
  3. iron
  4. magnesium
  5. manganese
  6. phosphorus
  7. potassium
  8. selenium
  9. sodium
  10. zinc

the lists

Previously I’ve developed short lists of nutrient dense foods also based on their insulin load or other parameters (see optimal foods lists).

But what if we want to get more specific and find the optimal foods for a diabetic who is getting adequate protein but needs more vitamins or minerals?  What about someone whose goal is nutritional ketosis who is trying to maximise their omega-3 fats to nurture their brain?

To this end the next step is to develop more specific lists of nutrient dense foods in specific categories (i.e. omega-3, vitamins, minerals and amino acids) which can be tailored to individual carbohydrate tolerance levels.

I’ve exported the top foods using each of the ranking criteria from the 8000 foods in the database.  You can click on the ‘download’ link to open the .pdf to see the full list.  Each .pdf file shows the relative weighting of the various components of the multi criteria ranking system.  The top five are highlighted in the following discussion below.

It’s worth noting that the ranking system is based on both nutrient density / calorie, and calorie density / weight.  Considering nutrient density / calorie will preference low calorie density foods such as leafy veggies and herbs.  Considering calorie density / weight tends to prioritise animal foods.  Evenly balancing both parameters seems to be a logical approach.

You’re probably not going to get your daily energy requirements from basil and parsley so you’ll realistically need to move down the list to the more calorie dense foods once you’ve eaten as much of the green leafy veggies as you can.  The same also applies if some foods listed are not available in your area.

weighting all nutrients omega-3 vitamins minerals aminos
no insulin index contribution download download download download download
athlete download download download download download
weight loss download download download download download
diabetes and nutritional ketosis download download download download download
therapeutic ketosis download download download download download

all nutrients

This section looks at the most nutrient dense foods across all of the essential nutrients shown above.  Consider including the weighting tables.

no insulin index contribution

If we do not consider insulin load then we get the following highly nutrient dense foods:

  1. liver,
  2. cod,
  3. parsley,
  4. white fish, and
  5. spirulina / seaweed

Liver tops the list.  This aligns with Matt Lalonde’s analysis of nutrient density as detailed in his AHS 2012 presentation.

It’s likely the nutrient density of cod, which is second on the list of the most nutrient dense foods, is the reason that Dwayne Johnson (a.k.a. The Rock) eats an inordinate amount of it. [4]

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It certainly seems to be working for him.

Duane Johnson 2 - Copy

athlete and metabolically healthy

If you have no issue with obesity or insulin resistance then you’ll likely want to simply select foods at the top of the nutrient dense foods list.  However most people will also benefit from considering their insulin load along with fibre and calorie density.   Most of us mere mortals aren’t as active or metabolically healthy as Dwayne.

When we consider insulin load we get the following foods at the top of the list:

  1. basil,
  2. parsley,
  3. spearmint,
  4. paprika, and
  5. liver

We grow basil in a little herb garden and use it to make a pesto with pine nuts, parmesan and olive oil.  It’s so delicious!   (And when I say ‘we’ I mean my amazing wife Monica.)

Aaron Tait Photography

You’ll note that spices and herbs typically rank highly in a lot of these lists.  The good news is that they typically have a very low calorie density, high nutrient density and are high in fibre.

The challenge again is that it’s hard to get all your energy needs from herbs alone, so after you’ve included as many herbs and green leafy veggies as you can fit in, go further down the list to select other more calorie dense foods to meet your required intake.

weight loss

If we reduce calorie density, increase fibre and pay some attention to insulin load for the weight loss scenario we get the following foods:

  1. wax gourd (winter melon),
  2. basil,
  3. endive,
  4. chicory, and
  5. dock

If you’re wondering what a winter melon looks like (like I was), here it is.

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The winter melon does well in this ranking because it is very fibrous, has a very low calorie density and a very low 8% insulinogenic calories which means that it has very few digestible carbohydrates.

Again, basil does pretty well along with a range of nutrient dense herbs.  Basil is more nutrient dense than the winter melon while still having a very low calorie density.

diabetes and nutritional ketosis

If we factor carbohydrate tolerance into the mix and want to keep the insulin load of our diet low we get the following foods:

  1. wax gourd (winter melon),
  2. chia seeds,
  3. flax seeds,
  4. avocado, and
  5. olives

Wax gourd does well again due to its high fibre and low calorie density; however if you’re looking for excellent nutrient density as well, then chia seeds and flax seeds may be better choices.  When it comes to flax seeds are best eaten ‘fresh ground’ (in a bullet grinder) for digestibility and also freshness and that over consumption may be problematic when it comes to increasing estrogens.

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therapeutic ketosis

Then if we’re looking for the most nutrient dense foods that will support therapeutic ketosis we get the following list:

  1. flax seeds,
  2. fish oils,
  3. wax gourd,
  4. avocado, and
  5. brazil nuts.

Good nutrition is about more than simply eating more fat.  When you look at the top foods using this ranking you’ll see that you will need to use a little more discretion (e.g. avoiding vegetable oils, margarine and fortified products) due to the fact that nutrients and fibre have such a low ranking.

ganze und halbe reife avocado isoliert auf weissem hintergrund

fatty acids

Omega-3 fats are important and most of us generally don’t get enough, but rather get too many omega-6 fats from grain based processed foods.

Along with high levels of processed carbohydrates, excess levels of processed omega-6 fats are now being blamed for the current obesity epidemic. [5]

The foods highlighted in the following section will help you get more omega-3 to correct the balance.

no insulin index contribution

If we’re looking for the foods that are the highest in omega 3 fatty acids without consideration of insulin load we get:

  1. salmon,
  2. whitefish,
  3. shad,
  4. fish oil, and
  5. herring

I like salmon, but it’s not cheap.  I find sardines are still pretty amazing but much more cost effective. [6]  If you’re going to pay for salmon to get omega 3 fatty acids then you should make sure it’s wild caught to avoid the omega 6 oils and antibiotics in the grain fed farmed salmon.

Sardines have a very high nutrient density but still not as much omega 3 fatty (i.e. 1480mg per 100g for sardines versus 2586mg per 100g for salmon).

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athlete and metabolically healthy

If we factor in some consideration of insulin load, fibre and calorie density we get:

  1. salmon,
  2. marjoram,
  3. chia seeds,
  4. shad, and
  5. white fish

It’s interesting to see that there are also  excellent vegetarian sources of omega-3 fatty acids such as marjoram (pictured below) and chia seeds (though some may argue that the bio-availability of the omega 3 in the salmon is better than the plant products).

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weight loss

Some of the top ranking foods with omega-3 fatty acids for weight loss are:

  1. brain,
  2. chia seeds,
  3. sablefish,
  4. mackerel, and
  5. herring

While seafood is expensive, brain is cheap, though a little higher on the gross factor.

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Cancer survivor Andrew Scarborough tries to maximise omega 3 fatty acids to keep his brain tumour and epilepsy at bay and makes sure he eats as much brain as he can.

diabetes, nutritional ketosis and therapeutic ketosis

And if you wanted to know the oils with the highest omega-3 content, here they are:

  1. Fish oil – menhaden,
  2. Fish oil – sardine,
  3. Fish oil – salmon,
  4. Fish oil – cod liver, and
  5. Oil – seal

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amino acids

This section will be of interest to people trying to build muscle by highlighting the foods highest in amino acids.

no insulin index contribution

So what are the best sources of protein, regardless of insulin load?

  1. cod,
  2. egg white,
  3. soy protein isolate,
  4. whitefish, and
  5. whole egg

Again, Dwayne Johnson’s cod does well, but so does the humble egg, either the whites or the whole thing.

We have been told to limit egg consumption over the last few decades, but now, in case you didn’t get the memo, saturated fat is no longer a nutrient of concern so they’re OK again.

And while egg whites do well if you’re only looking for amino acids, however if you are also chasing vitamins, minerals and good fats I’d prefer to eat the whole egg.

image021

athlete and metabolically healthy

If you have some regard for the insulin load of your diet you end up with this list of higher fat foods:

  1. parmesan cheese,
  2. beef,
  3. tofu,
  4. whole egg, and
  5. cod.

image023

weight loss

If we aim for lower calorie density foods for weight loss we get this list:

  1. bratwurst,
  2. basil,
  3. beef,
  4. chia seeds, and
  5. parmesan cheese

The bratwurst sausage does really well in the nutrition analysis because it is nutrient dense both in amino acids and high fat which keeps the insulin load down.

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diabetes and nutritional ketosis

If you’re concerned about your blood glucose levels then this list of foods may be useful:

  1. chia seeds,
  2. flax seed,
  3. pork sausage,
  4. bratwurst, and
  5. sesame seeds

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Therapeutic ketosis

And those who are aiming for therapeutic ketosis who want to keep their insulin load from low protein may find these foods useful:

  1. flax seed,
  2. pork sausage,
  3. sesame seeds,
  4. chia seeds, and
  5. pork

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vitamins

People focusing on reducing their carbohydrate load will sometimes neglect vitamins and minerals, especially if they are counting total carbs rather than net carbs which can lead to neglecting veggies.

I think most people should be trying to increase the levels of indigestible fibre as it decreases the insulin load of their diet, [7] feeds good gut bacteria, leaves you feeling fuller for longer and generally comes packaged with heaps of good vitamins and minerals.

At the same time it is true that some high fibre foods also come with digestible carbohydrates which may not be desirable for someone who is trying to manage the insulin load of their diet.

The foods listed in this section will enable you to increase your vitamins while managing the insulin load of your diet to suit your goals.

no insulin index contribution

These foods will give you the biggest bang for your buck in the vitamin and mineral department if insulin resistance is not an issue for you:

  1. red peppers,
  2. liver,
  3. chilli powder,
  4. coriander, and
  5. egg yolk

Peppers (or capsicums as they’re called in Australia) are great in omelettes. image031

Liver is also very high in vitamins if you just can’t tolerate veggies.

athlete and metabolically healthy

If we bring the insulin load of your diet into consideration then these foods come to the top of the list:

  1. paprika,
  2. chilli powder,
  3. liver,
  4. red peppers, and
  5. sage

It’s interesting to see so many spices ranking so highly in these lists.  Not only are they nutrient dense but they also make the foods taste better and are more satisfying.

image034

Good food doesn’t have to taste bland!

weight loss

If weight loss is of interest to you then this list of lower calorie density foods might be useful:

  1. chilli powder,
  2. chicory greens,
  3. paprika,
  4. liver, and
  5. spinach

It will be very challenging to eat too many calories with these foods.  We find spinach to be pretty versatile whether it is in a salad or an omelette.

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diabetes and nutritional ketosis

These foods will give you lots of vitamins if you are trying to manage your blood glucose levels:

  1. chilli powder,
  2. endive,
  3. paprika
  4. turnip greens, and
  5. liver

Most green leafy veggies will be great for people with diabetes as well as providing excellent nutrient density and heaps of fibre.

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therapeutic ketosis

If you really need to keep your blood sugars down then getting your vitamins from these foods may be helpful:

  1. chilli powder,
  2. liver,
  3. liver sausage,
  4. egg yolk, and
  5. avocado

image039

minerals

no insulin index contribution

Ever wondered which real whole foods would give you the most minerals per calorie without resorting to supplements?

Here’s your answer:

  1. coriander,
  2. celery seed,
  3. basil,
  4. parsley, and
  5. spearmint

Even if you found a vitamin and mineral supplement that ticked off on all the essential nutrients there’s no guarantee that they will be absorbed by your body, or that you’re not missing a nutrient that is not currently deemed ‘essential’.  Real foods will always trump supplements!

As you look down these lists you may notice that herbs and spices top the list of foods that have a lot of minerals.  Once you have eaten as much coriander, basil, parsley and spearmint as you can and still feel hungry keep doing down the list and you will find more calorie dense foods such as spinach, eggs, sunflower seeds, and sesame seeds etc which are more common and easier to fill up on.

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athlete and metabolically healthy

If we factor in some consideration of insulin load then we get this list:

  1. basil,
  2. spearmint,
  3. wheat bran (crude),
  4. parsley, and
  5. marjoram

Wheat bran (crude) features in this list but it’s very rarely eaten in this natural state.  Most of the value is lost when you remove the husk from the wheat.

As much as we’re told that we shouldn’t eliminate whole food groups, grain based products just don’t rate well when you prioritise foods in terms of nutrient density.

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weight loss

If you’re looking for some lower calorie density options the list changes slightly:

  1. basil,
  2. caraway seed,
  3. marjoram,
  4. wheat bran (crude), and
  5. chilli powder

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diabetes and nutritional ketosis

If you’re trying to manage your blood sugars then this is your list of foods that are packed with minerals:

  1. basil,
  2. caraway seed,
  3. flax seed,
  4. chilli powder, and
  5. rosemary.

image045

therapeutic ketosis

If you’re aiming for therapeutic ketosis then the higher fat nuts come into the picture to get your minerals:

  1. flaxseed,
  2. sesame seed,
  3. pine / pinon nuts,
  4. sunflower seeds, and
  5. hazel nuts.

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application

So what does all this mean and how can we apply it?

I don’t think it’s necessary or ideal to track your food all the time, however it’s well worth taking a typical day of food and entering it into the recipe builder at nutritiondata.self.com to see where you might be lacking.

Are your vitamins or minerals low?  Protein?  What about fibre.

If you find these are lacking you can use these food lists to fill nutritional gaps while keeping in mind your ability to process carbohydrates and attaining your personal goals.

references

[1] http://nutritiondata.self.com/help/analysis-help

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

[3] The omega 6 fatty acids are also classed as essential however it is generally recognised that we have more omega omega 6 than omega 3.

[4] http://www.muscleandfitness.com/nutrition/meal-plans/smell-what-rock-cooking

[5] http://ebm.sagepub.com/content/233/6/674.short

[6] http://nutritiondata.self.com/facts/finfish-and-shellfish-products/4114/2

[7] https://optimisingnutrition.wordpress.com/2015/03/30/what-about-fibre-net-carbs-or-total-carbs/

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]

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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’.

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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/

are dairy and red meat uniquely insulinogenic?

The original 1997 paper by Susan Holt et al [1] looking at the food insulin index suggested that dairy and meat proteins may be more insulinogenic than vegetable proteins.  The problem with this study was that 38 data points weren’t really enough to draw a meaningful conclusion.

You may have also heard it said that “diary is insulinogenic”, suggesting that perhaps dairy products have some special hormonal property that requires more insulin than other foods. [2]

In order to test whether particular groups of foods might have unique insulinogenic properties I have plotted the insulin response for various types of proteins separately (note: without taking fibre into account).

Fish (based on only four data points) and dairy (based on thirteen data points) seem to have the greatest insulin reaction while vegetables and animal protein have the lowest insulin response.

Microsoft Word Document 21032015 31938 AM.bmp

However if we account for the indigestible fibre (i.e. net carbs) then legumes (based on only five data points) appear to require more insulin while fruit and vegetables require less insulin.

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Based on the available data it does not appear that that insulin response is influenced significantly by anything other than carbohydrates, fibre and protein in a food.

So in summary, there is very little difference in the insulin response of the various foods once fibre is taken into account.

  • non-fibre carbohydrates require insulin;
  • protein requires about half as much insulin as carbohydrate; and
  • fibre does not require insulin or raise blood sugar.

.

[next article…  can you eat too much fat on a low carb diet?]

[this post is part of the insulin index series]

[Like what you’re reading?  Skip to the full story here.]

[1] http://ajcn.nutrition.org/content/66/5/1264.abstract

[2] http://www.marksdailyapple.com/dairy-insulin/

food insulin index

The initial research into the food insulin index is detailed in a 1997 paper by Susanne Holt et al who tested the insulin demand of thirty eight different foods. [1]

The food insulin index of various foods was determined by feeding 1000kJ (or 239 kcal) of a particular food to non-diabetics and measuring the insulin secretion over three hours.   The insulin secreted for that food over three hours was compared to that of white bread (which was assigned a value of 100%) to arrive at a “food insulin index” value for each food.

fii-versus-time-chart

Considering how potentially significant this data could be for people trying to minimise the insulin effect of food (e.g. “low carbers” or keto dieters) I was surprised that there hadn’t been much further discussion or research over the past five years.

I found a few references and occasional discussions in podcast, but no one was quite sure what to do with the information, partly due to the small number of foods that had been tested.

foods that require the least insulin

Looking at the food insulin index data from the initial testing we can see that the foods lowest on the insulin index are largely fat.

food protein
(g/MJ)
fat
(g/MJ)
carb
(g/MJ)
fibre
(g/MJ)
insulin index
(%)
butter 0 27 0 0 2
olive oil 0 27 0 0 3
bacon 16 19 1 0 9
peanut butter 9 20 7 5 11
Bologna 24 9 13 3 11
peanuts 10 20 5 2 15
tuna 24 15 2 0 16

If we abandon the authority of the food pyramid and our fear of saturated fat, the logical extension of this is that the ideal diet for diabetics or people wanting to lose weight by reducing their insulin load might be to prioritise foods such as butter, oils and bacon that require the least insulin.

Bob Briggs has a YouTube video “Butter Makes Your Pants Fall Off” [2] with more than 100,000 views where he explains the mechanisms of low carbohydrate nutrition, how insulin promotes fat storage, and how reducing carbohydrates and eating healthier fats leads to a reduction in appetite and can help people lose weight.  The food insulin index helps to explain why this is the case.

The ranking of olive oil in the food insulin index (along with the intermittent fasting practised by the Greek Orthodox Church on Crete and consumption of significant amounts of fatty fish) may go some way to explaining the success of the Mediterranean diet which is widely advocated for heart health and longevity.

It may be a stretch, but the food insulin index may also go someway to explaining why Rich Froning keeps winning the CrossFit Games and looking so ripped in spite of consuming an inordinate amount of peanut butter, [3] a food that isn’t generally considered to be a health food.

men-running-rich-froning1

 last updated May 2017

References

[1] http://ajcn.nutrition.org/content/66/5/1264.short

[2] https://www.youtube.com/watch?v=h6aMN6NLOTQ

[3] http://www.examiner.com/article/crossfit-champ-rich-froning-reveals-diet-and-workout-secrets