Tag Archives: diabetes

articles, blood sugar, diabetes, insulin resisatnce, nutrient density, weight loss

analysis of what a nutritionist eats and hospital food

February 25, 2017 Marty Kendall 7 Comments

An article in Business Insider, “A N utritionist S hares P ictures of E verything S he E ats in a D ay”, caught my eye recently. I thought it would be interesting to run the numbers to see how the food diary logged by this nutritionist compared to the four hundred or so meals that I’ve analysed.

Check out the original article if you want to see the daily food log chronicled in photos by the popular and published “Registered Dietician”, who claims to specialise in diabetes and is “passionate about being a good role model.”^[1]

The quantities and foods that I analysed in the recipe builder at SELFNutritionData are shown below. Besides the fact that the only green things she ate during the day were M&M’s, the food log is not particularly divergent from mainstream dietary advice (i.e. no full-strength Coke or McDonald’s). The nutritional analysis would be much worse if it was a diet full of junk food, which is pretty common for a lot of people these days in this fast-paced convenience-loving world.

This dietician is a national media spokesperson for the Academy of Nutrition and Dietetics. She has published books and written for several magazines.^[2] Like most nutritionists, she argues for less fat and more whole grains.^[3]

So, let’s see how her daily diet stacks up. The analysis below shows that, when we compare this daily diet against mainstream dietary advice that nutritionists prescribe, it ticks the following boxes:

avoids trans fats,
is low in fat, and
is low in cholesterol.

However, even though the diet is fairly low in fat, it has 29g of saturated fat which is greater than the Heart Association’s recommendation for a maximum of 16g of saturated fat per day.^[4] Unfortunately, the recommended limit of saturated fat is actually quite hard to achieve without relying on low fat highly processed foods.

Ironically, due to the focus on avoiding fat and trying to incorporate more “heart healthy whole grains”, the food recommended by nutritionists ironically tends to be lacking in nutrients. It makes no sense!

The registered nutritionist’s daily food log also contains more than 400 grams of carbohydrates which will be a massive challenge to someone who is insulin resistant, would likely generate insulin resistance and eventually diabetes in someone who isn’t there yet.

For comparison, check out the analysis shown below of one of my regular meals (stir-fry veggies with some butter and sardines) which has a much higher vitamin and mineral score (94 compared to 55) and better protein score (139 compared to 66).

When it comes to nutrient density and being diabetic friendly, this nutritionist’s daily food log ends up at the bottom of the pile of the four hundred meals that I’ve analysed!

It’s sad that this myopic one-size-fits-all dietary advice is forced on anyone who asks what they should be eating, or anyone whose food is influenced by government nutritional guidelines (e.g. hospitals, schools, jails, nursing homes etc).

Then we are told that dieticians are the only ones that are qualified to give dietary advice, even though the dietary advice that they give revolves around avoidance of saturated fat and more “heart healthy whole grains” and does not actually lead to high levels of micronutrition.

Where it gets even sadder is that this sort of short sighted advice is also given to the people who are the most vulnerable. The photo below is of Lucy Smith in hospital after being diagnosed with Type 1 Diabetes. The diet given to her, as a newly diagnosed Type 1 Diabetic, is Weet-Bix, low fat milk, bananas, low fat toast, orange juice, and peaches.

The analysis for Lucy’s hospital-provided breakfast is shown below.

This single meal contains more than 200 grams of carbohydrates (82% of calories). This breakfast would require a ton of insulin to be injected into her little body, and she would be on a blood glucose / insulin rollercoaster for days to come.

When it comes to nutrient density, this meal has an even lower score than the day in the life of the nutritionist’s own diet discussed above! Ironically, this hospital prescribed meal ranks at the very bottom of the list of four hundred meals when ranked to identify the best recipes for people with diabetes!

Unfortunately, things don’t seem to have changed much from thirty years ago when my wife Monica was diagnosed with Type 1 Diabetes. In hospital, after diagnosis, she was given so many carbs that she hid the food in pot plants in her hospital ward room because she just couldn’t eat anymore! Twenty-five years later, she learned about the low carb dietary approach and she was finally able to reduce the high levels of insulin required to cover her food.

I’ve witnessed firsthand the massive improvements in quality of life (body composition, inflammation, energy levels, dental health etc) when someone comes off the blood glucose/insulin roller coaster!

Monica has been able to halve her daily insulin dose since no longer ascribing to the dietary advice she has been given by the dieticians and diabetes educators. Her blood glucose levels are now better than ever and when she goes to the dentist, podiatrist and optometrist they tell her she’s doing great and they wouldn’t even know she’s diabetic. And I get to have my wife around for an extra decade or two!

By the way, Lucy is doing well now too. Her parents are some of the most knowledgeable people I know when it comes to optimal foods for diabetics and monitoring blood glucose (as shown in this video from her father Paul).

My friend, Troy Stapleton, is another example of someone living with Type 1 Diabetes who has benefited immensely from a low carbohydrate dietary approach that aligns with his metabolic health. His story and approach has been an inspiration to me. You can also check out the Standing on the Shoulders of Giants article for a few more encouraging stories of people with Type 1 who got their life back after going against nutritionists orders.

As detailed in the article How to optimise your diet for your insulin resistance, if you have the luxury of being more metabolically healthy (i.e. not diabetic) you can focus on more nutrient dense foods or lower energy density if you’re looking to lose some weight.

It amazes me that dieticians can be so militant and belligerent when they are largely passing on the recommendations of the US Department of AGRICULTURE (i.e. the USDA, also known as “Big Ag”), whose mission it is to promote the economic opportunity and production of AGRICULTURE^[5] (i.e. grains and seed oils). Talk about putting the fox in charge of the hen house!

Speaking of conflicts of interest, it’s worth noting that major nutritionist organisations funding ‘partners’ are big food manufacturers.^[6] Does this influence the recommendations they give? They claim not.

It’s hard to believe their published research or dietary recommendations could be impartial when so heavily sponsored by the food industry.

Despite these conflicts of interest and a poor track record of success over the past four decades, I don’t think we should be gagging the Accredited Dietitians from publishing poor nutritional advice. Everyone should be entitled to their freedom of speech and freedom to choose what they eat.

What I do find ironic is that dieticians can bring spurious cases of malpractice against doctors to their governing bodies when they are acting in line with latest research and their personal, professional and clinical observations (e.g. Tim Noakes in South Africa and Gary Fettke in Australia). At the same time, the Registered Dieticians have no governing body to report to, only their board of directors^[7] and their ‘partners’.

While they purport to be protecting the public interest, one could be excused for thinking that the dieticians’ associations are another marketing arm for big food companies and are protecting commercial interest rather than acting on behalf of public health.

Is it just a coincidence that Nestle’s Milo, which is half sugar, is prescribed by hospital dieticians for pregnant and breastfeeding mothers with diabetes?

Unfortunately, the situation isn’t that much different with the diabetes associations.^[8] Why would these institutions ever make recommendations to their members that reduced the amount of medications they needed or reduce the amount of processed food when their financial partners are pharmaceutical companies who manufacture insulin and drugs for diabetes?

What would happen to this financial structure if a significant amount of people started eating whole unprocessed food without a bar code? The share price of these massive medical and pharmaceutical companies would tank!

After battling cancer himself and studying the role of nutrition in metabolic and mitochondrial disease in depth, Gary Fettke now spends his days as an orthopaedic surgeon amputating limbs mainly due to the complications of diabetes.

No, it’s not pretty, but unfortunately it’s very very real.

Each year Gary volunteers as an orthopaedic surgeon in Vanuatu.^[9] ^[10] The contrast between the native people living in their natural environment, eating their native foods, and their relatives in town, eating processed foods, is stark.

I took this photo in a traditional village during our holiday in Vanuatu a couple of years ago. These people eat lots of coconuts (which contains plenty of saturated fat, one of the remaining nutrients that Registered Dieticians still say we should avoid) and fish. These Vanuatu natives are some of the most beautiful, healthiest and happiest people I have ever seen!

Unfortunately, in the capital Port Vila, it’s not so pretty. The diabetes rates are the third highest in the world. One in fifty Vanuatu natives have had an amputation!

It is such a big problem. Their diet has changed quite rapidly over the years, so instead of eating their island’s food, they now eat very large quantities of white rice and of course all the liquid sugar, like Coca-Cola and Fanta, and it’s literally killing them.^[11]

After seeing the impact of diet, Gary has been outspoken in Australia, bringing attention to the quality of food that people are eating, especially in hospitals.^[12]

Gary and his Nutrition for Life Centre also worked with Chef Pete Evans on the “Saving Australia Diet” on national TV with great results achieved.^[13]

Then, in return for his efforts, Gary has been reported by the certified dieticians to the Australian Health Practitioner Regulation Agency; and he has been told he can no longer tell his patients to limit sugar even if they have just had their leg amputated due to the complications of diabetes.

Similarly, Tim Noakes has developed a massive following after realising that he needed to go against his own previous publications and advice, when he found he was developing diabetes. The recipe book that he helped write, The Real Meal Revolution, is filled with nutrient dense low carb meals that help people with diabetes achieve normal blood glucose levels, has been massively popular.

Despite his impressive track record of real results, which goes against the general trend of the explosion of diabetes and obesity in western society, Professor Noakes has been reported to the Health Professionals Council of South Africa (HPCSA) and charged with unprofessional conduct, after suggesting that a mother wean her baby on to whole foods rather than processed “baby food”.

This has led to a long and expensive court case which really appears to be more about maintaining the status quo on the supermarket shelves rather than public health.^[14]

I think most nutritionists believe that they are doing the right thing by advising their clients to prioritise the avoidance of fat, cholesterol and saturated fat, and eat “heart healthy whole grains”. However, the foundation of this advice seems to be crumbling from underneath them with the most recent updates to the US Dietary Guidelines that now remove the upper limit on fat and removing cholesterol a nutrient of concern.^[15] ^[16]

However, if we have to rely on Big Food to provide processed food products to achieve the reduced saturated fat aspirations of the dietary guidelines (and in so doing produce very otherwise nutrient poor foods), then perhaps we need to declare them broken and look for new ones?

Makes you wonder how we survived (let alone thrived) with the food that were available to us before the highly-processed foods and the low fat dietary guidelines that came to dominate our food choices in the 1970s.

Unfortunately though, fear of saturated fat still dominates the majority of mainstream dietary recommendations out there and leads to nonsensical food rankings that only suit the grain based food industry.^[17] ^[18]

For example, the simplistic Australian Health Star Rating is based on the energy, saturated fat, sodium, sugar content along with the amount of fruits and vegetables in a product.^[19] This avoidance-based process gives little consideration for the amount of essential nutrients in a product, regardless of where they came from, and hence often returns nonsensical results.

It’s hard to tell whether the attacks on people like Fettke and Noakes are motivated by:

Well-meaning nutritionists who earnestly believe that higher levels of fat and a lack of “heart healthy whole grains” is going to harm people,
Nutritional institutions sensing that they are becoming irrelevant and making a last-ditch attack at their adversaries in an effort to hold onto their jobs,
Processed food manufacturers (i.e. big food) using their “partner organisations” to attack these outspoken thought leaders so they can maintain their strangle hold on nutritional advice that suits them and sells more of their product (i.e. it’s not a conspiracy, it’s just business), or
Some combination of each of these options.

To cut through the confusion and conflicts of interest, wouldn’t it be great if there was an unbiased quantitative way to judge whether a particular food or meal was optimal based its nutrient density? Perhaps we could even tailor food choices based on blood glucose and metabolic health (i.e. using insulin load), or by manipulating energy density of someone who is insulin sensitive but just needs to lose weight.

If you’ve been following this blog, you may have seen the optimal food lists tailored to specific goals. To this end, I have devised a system to identify foods for different goals and situations. The table below will help you choose your ideal dietary approach and optimal foods based on your blood glucose levels and waist to height ratio.

approach	average glucose		waist : height
approach	(mg/dL)	(mmol/L)	waist : height
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
nutrient dense maintenance	< 97	< 5.4	< 0.5

The first step in improving your nutrition is to minimize processed food that is laced with sugar. These food lists can help you further optimise your food choices to suit your goals whether they be blood glucose management, weight loss or just maintaining optimal health.

Once you normalise your blood glucose levels, you can then start to focus more on nutrient density. If you still have weight to lose, then you can focus on foods with a lower energy density to force more energy to come from your body while still maximising nutrition. You can also find the highest ranking of the four hundred meals that I have analysed listed here.

Several people recently have suggested that I turn the nutrient density ranking system into a mobile app for easy implementation of the ideas and theories outlined on the blog in the real word.

So, my current project is to develop a Nutrient Optimiser that would rank the foods you have eaten based on your current goals (e.g. therapeutic ketosis, diabetes management, weight loss or maximising nutrient density) and recommend new foods to try. The Nutrient Optimiser would progressively retrain your eating patterns towards ideal by helping you to maximise the more optimal foods, and progressively eliminate the foods that don’t align with your goals. Whether you are trying to eat less Maccas, or you are practicing Calorie Restriction with Optimal Nutrition (CRON) and trying to live to 120, the Nutrient Optimiser would push you forward to truly optimise your nutrition.

The idea is not to simply create another calorie counting app. There are plenty of those out there already. Rather, the Nutrient Optimiser will help you to maximise nutrient density as much as you can, while catering to your other goals.

Rather than being centred on outdated “science” and avoiding boogeymen such as cholesterol, fat and saturated fat, or serving the interest of “financial partners” (e.g. BigFood and BigPharma), the Nutrient Optimiser uses a quantitative algorithm that will help you maximise the nutritional value of the food you eat.

The Nutrient Optimiser, based on the foods logged in the past few weeks, helps you to identify foods that would provide the nutrients that you haven’t been getting as much of. Rather than just tracking calories, the app will continually adapt to what you eat, ensure that you are getting a broad range of foods that contain the nutrients you need, and ensure you don’t get stuck in a nutritional rut.

For people just starting out, it will help them gently move forward, without the judgement of someone looking over their shoulder. It will suggest foods they should buy more of, new foods to try, and maybe which foods they should bin and never buy again.

For people who are truly wanting optimal nutrition, it will hopefully be the ultimate tool to continue to refine their food choices to maximise nutrient density while optimising blood glucose, insulin and body fat levels.

As you continue to log your weight, blood glucose levels and whatever other metrics you want to track, the app will progressively prompt you to “level up” to a more optimal nutritional approach. Then, with your nutritional deficiencies filled, the cravings will dissipate and you will naturally be satisfied with less food.^[20] ^[21]

If something like this is of interest to you and you want to be an early adopter or just check it out the nutritional analysis of other people food logs that have been done so far then then take a look at the Nutrient Optimiser Facebook page and to stay posted as things develop.

references

^[1] https://www.amazon.com/Ruth-Frechman/e/B007HDN5IW

^[2] http://www.ruthfrechman.com/Meet_Ruth.html

^[3] https://www.youtube.com/watch?v=LAugDpr16Jg

^[4] http://www.heart.org/HEARTORG/Conditions/Cholesterol/PreventionTreatmentofHighCholesterol/Know-Your-Fats_UCM_305628_Article.jsp#

^[5] https://www.usda.gov/documents/usda-strategic-plan-fy-2014-2018.pdf

^[6] http://daa.asn.au/advertising-corporate-partners/program-partners/

^[7] http://daa.asn.au/?page_id=136

^[8] https://www.diabetesaustralia.com.au/corporate-partners

^[9] http://www.hopeforhealthvanuatu.com/volunteers/

^[10] https://www.facebook.com/permalink.php?story_fbid=857965770964542&id=393958287365295

^[11] http://www.radionz.co.nz/international/programmes/datelinepacific/audio/201818486/hope-given-to-amputees-in-vanuatu

^[12] http://www.nofructose.com/2014/12/19/hospital-food-is-crap-and-its-killing-my-patients-and-what-to-do-about-it/

^[13] https://au.news.yahoo.com/sunday-night/features/a/31538041/the-saving-australia-diet/#page1

^[14] http://foodmed.net/tag/tim-noakes/

^[15] http://time.com/3705734/cholesterol-dietary-guidelines/

^[16] https://therussells.crossfit.com/2017/01/05/big-food-vs-tim-noakes-the-final-crusade/

^[17] http://healthstarrating.gov.au/internet/healthstarrating/publishing.nsf/Content/How-to-use-health-stars

^[18] http://www.nuval.com/

^[19] http://healthstarrating.gov.au/internet/healthstarrating/publishing.nsf/Content/excel-calculator

^[20] http://sydney.edu.au/news/84.html?newsstoryid=12632

^[21] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988700/

how to get more of the harder to find micronutrients per calorie

February 13, 2017 Marty Kendall 13 Comments

There’s a lot of talk about “nutrient density” and “superfoods”, but what do these terms really mean? Which foods actually give the most nutritional bang for your calorie buck? That is, which foods provide the most nutrients for the least number of calories?

Some approaches to quantifying nutrient density (e.g. Joel Fuhrman’s Aggregate Nutrient Density Index) have looked at vitamins and minerals (along with other parameters that are only available for fruits and vegetables) per calorie, but do not consider essential fatty acids and amino acids.

Meanwhile, Registered Dietitians’ recommendations and mainstream food ranking approaches revolve around avoiding nutrients such as saturated fat, cholesterol and salt. Unfortunately, this avoidance based approach to ranking foods does nothing to increase beneficial nutrients.

Avoidance of these demonised food elements typically ends up ignoring the whole unprocessed foods that contain the most nutrients. Instead, current ranking systems encourage prioritisation of processed foods that have been manufactured to be low in fat, saturated fat, salt or cholesterol.

The resultant fat-free manufactured products are so nutrient poor that they must be fortified with a smattering of synthetic vitamins to prevent the malnutrition that would otherwise occur. Food manufacturers also add sugar and synthetic flavours to make them palatable. After a few decades, food scientists have now learned to optimise sweetness to target “bliss point”^[1] which continues to drive upwards in sweetness.[2]

With synthetic flavourings, we can make hyperpalatable food stuffs that taste so much more intense than real foods that are found in nature. After a generation or two of fake food we have forgotten what real food, in its natural form, tastes or even looks like. Unfortunately, at the same time our food production is becoming more reliant on fertilisers to grow crops bigger and faster but the end result is food that doesn’t naturally taste as good as they used to because they don’t contain the same number of nutrients. Our senses of taste and smell don’t have a chance of being able to find real nutrients amongst the plethora of super sweet and unnaturally flavoured foods. This industrialized chemical storm also taxes your liver, kidneys, and digestive system and encourages disease instead of leading to health.

So, if we can’t trust our senses anymore to find the nutrients we need what can we do?

As much as food technology has got us into this mess, the good news is that by quantifying nutrient density we can identify the foods that contain the most nutrients. Then after a period without the distraction of sweeteners and artificial flavours and we can re-learn trust our tongue, nose, appetite and cravings to find the real nutrients that our body need.

The chart below shows the nutrients contained in the eight thousand foods in the USDA database per 2000 calories. While it’s easy to get the minimum levels of iron, vitamin C and several the amino acids (at the bottom of the chart), it’s harder to obtain adequate quantities of omega 3 fatty acids, vitamin D, choline, vitamin E and potassium (shown at the top of the list).

Rather than trying to get more of all the essential micronutrients, we can prioritise the following nutrients that are harder to find:

alpha-Linolenic acid (Omega 3 fatty acids)
Vitamin D
Choline
Vitamin E
EPA + DHA (Omega 3 fatty acids)
Potassium
Calcium
Magnesium
Pantothenic acid
Tyrosine
Thiamin
Zinc

The chart below lists the nutrients provided by the average of all food in the USDA database (orange bars) compared to the nutrients provided by the most nutrient dense foods (blue bars). But focusing on the most nutrient dense foods, not only do we get more of the harder-to-find nutrients, we also improve the quantity of all the essential nutrients!

Macronutrient split

The chart below shows a comparison of the macronutrients in the most nutrient dense foods compared to the average of all foods in the USDA database. Although we have prioritised for only one amino acid (Tyrosine), it appears that the food that contain the most essential fatty acids, vitamins and minerals are also higher in protein.

The quantity of fibre also increases substantially. Nutrient dense vegetables come with large amounts of fibre which makes these foods more filling and harder to overeat.

The most nutrient dense foods also have a much lower energy density. This makes these nutrient dense foods harder to overeat. As well as feeling physically full, your body is likely to feel satiated once it has obtained the nutrients it needs.^[3] ^[4]

Notice the proportion of fat and non-fibre carbohydrates are lower in the most nutrient dense foods. In a way, I think we need to consider foods as nutrients and fuel separately. The initial goal is to eat the foods that contain the nutrients to live an awesome life and support your bodily functions. The secondary goal is to get enough fuel from higher energy density foods to support your activity and maintain ideal body fat. Too often we sacrifice essential nutrients and nutrient density and instead choose irresistibly tasty and high calorie food products for a “quick rush”.

The most nutrient dense foods

The most nutrient dense foods (i.e. the top 10% of the eight thousand foods in the USDA database) are listed below along with their nutrient density scores (ND) which is based on the harder to find nutrients.

If you’re interested in all the gory details of the nutrient density score is calculated you can check out the Building a Better Nutrient Density Index article. But in short the system compared the nutrients per calorie across all the foods in the USDA database. A score is given based on the standard deviation from the mean. If a certain food contains a lot of a certain nutrient it gets a large score. If it contains an average amount of a certain nutrient it gets a zero score. If it contains a little bit or none it gets a negative score. We then sum all these individual nutrients scores for the nutrients that are harder to find that we want to emphasise.

If you want to check whether a particular food is nutrient dense I recommend Googling “nutrient data self [insert your favourite food here]” to see how it ranks. For example, the image below shows that spinach does exceptionally well in both the nutrient balance (vitamins and minerals) and protein quality score.

Vegetables

Fibrous green vegetables are the highest-ranking nutrient dense foods. Few people argue with the idea that veggies are good for you. The nutrient density analysis confirms this.

food	ND
watercress	16
endive	16
spinach	16
broccoli (sulforaphane)	13
escarole	13
asparagus	13
chicory greens	13
coriander	13
parsley	13
okra	12
lettuce	12
arugula	12
zucchini	12
brown mushrooms	12
Chinese cabbage	12
beet greens	11
seaweed	11
chard	11
chives	10
dandelion greens	10
cauliflower	10
turnip greens	10
celery	10
summer squash	10
yeast extract spread	10
alfalfa	9
radicchio	9
spirulina	9
white mushroom	9
pickles	8
cucumber	8
cabbage	8
mung beans	8
portabella mushrooms	8
mustard greens	8
collards	8
edamame	8
shiitake mushroom	8
snap beans	8
peas	8
artichokes	7
banana pepper	7
onions	7
soybeans (sprouted)	7
radishes	7
sauerkraut	7
pumpkin	7
kale	6
red peppers	6
butternut squash	6
Brussel sprouts	6
shiitake mushrooms	6
chayote	6
eggplant	6
jalapeno peppers	6
bamboo shoots	6
winter squash	5
turnips	5
rhubarb	5

Herbs and spices

Spices add flavour and nutrients and plenty of vitamins and minerals.

food	ND
basil	14
dill	9
paprika	7
cloves	6
thyme	6
sage	6
curry powder	5
marjoram	5
tarragon	4
pepper	3

Seafood

Seafood provides amino acids as well as Omega 3 fatty acids which are harder to get from other foods.

food	ND
crab	12
lobster	11
fish roe	10
oyster	9
crayfish	9
caviar	8
salmon	8
cod	8
trout	8
halibut	8
pollock	8
rockfish	7
sturgeon	7
shrimp	7
white fish	7
flounder	7
octopus	7
haddock	6
perch	6
whiting	6
anchovy	6
clam	6
sardine	5
scallop	5
tuna	5

Dairy and eggs

Only low fat cream cheese makes the list in terms of nutrients per calorie as other dairy products typically have more fat and not as many essential nutrients per calorie.

It’s true that eggs are a nutritional powerhouse of vitamins, minerals and protein. However, when it comes to the harder to find nutrients per calorie non-starchy veggies still win out.

It’s a similar story for nuts which don’t make the list. Full fat dairy and nuts can be a great source of energy and nutrition, particularly if you are insulin resistant or have diabetes, but if you’re just looking to maximise the harder to find nutrients per calorie the list of dairy and nuts isn’t that long.

food	ND
cream cheese (fat free)	8
whole egg	6
egg yolk	5
cottage cheese (low fat)	4
egg white	2

Animal products

Organ meats do well as well.

food	ND
turkey liver	9
veal liver	9
chicken liver	8
lamb liver	8
lamb kidney	7
ham (lean only)	6
pork liver	6
chicken breast	5
pork chop	5
turkey drumstick	4
turkey meat	4
lamb heart	4
leg ham	4
chicken liver pate	4
pork shoulder	4
veal	4

Pros and cons of nutrient density

The most obvious benefits of eating the most nutrient dense foods are that they:

provide the most essential nutrients with the fewest calories,
assist to normalize body weight (both lean tissue and body fat),
minimise cravings and the binge eating relating to nutrient hunger^[5],
provide the nutrients your body needs to thrive and optimise mitochondrial health, and
help achieve and maintain overall good health.

Maintaining a healthy weight with adequate protein and while avoiding excess energy intake will help you to avoid a lot of the diseases of aging. These foods will also be quite filling and hard to overeat due to the low energy density and high fibre content.

At the same time, it will be hard to get enough energy if you just ate from the foods in this list. If you are very active you will also find it hard to in down enough energy for a lot of intense activity. If you are insulin resistant you may want to start out with higher fat foods that will still provide plenty of energy without raising causing blood sugar swings.

Nutrient density plus…

Eating exclusively from the list of the most nutrient dense foods may not be appropriate for everyone, particularly if you are just starting out on your health food journey. The table below lists several nutritional approaches that are suitable for different people depending on their blood glucose levels / insulin resistance and weight goals.

approach	average glucose		waist : height
approach	(mg/dL)	(mmol/L)	waist : height
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

Getting even more personal

If you’re interested in optimising your diet for nutrient density as well as tailoring it to your blood glucose and weight loss goals I would love you to check out an a new tool I’ve been developing, the Nutrient Optimiser. It will review your food log and, rather than just tracking calories it will identify your biggest nutrient deficiencies and the most nutrient dense foods to fix them. You can also tailor the insulin load of the food recommendations to help normalize blood sugars and then energy density if you still have weight to lose. It’s still early days, but the future looks very exciting!

references

^[1] https://www.amazon.com/Dorito-Effect-Surprising-Truth-Flavor/dp/1476724237

[2] http://www.nytimes.com/2013/02/24/magazine/the-extraordinary-science-of-junk-food.html

^[3] http://sydney.edu.au/science/outreach/inspiring/news/cpc.shtml

^[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988700/

^[5] https://books.google.com.au/books?id=gtQyAgAAQBAJ&pg=PA185&lpg=PA185&dq=%22nutrient+hunger%22&source=bl&ots=VMRPgGgALA&sig=bCs4K5AKbQdQadtSfIniBizMsQA&hl=en&sa=X&ved=0ahUKEwjL7d2eqYvSAhWRq5QKHaAjA9AQ6AEIJjAC#v=onepage&q=%22nutrient%20hunger%22&f=false

articles, insulin index, insulin load, nutrient density

optimising protein and insulin load

December 3, 2016 Marty Kendall 8 Comments

“Low carb”, “ketogenic” or “nutrient dense” mean different things to different people. Defining these terms numerically can help us to choose the right tool for the right application.
Decreasing the insulin load of your diet can help normalise blood glucose levels and enable your pancreas to keep up. However, at the same time a high fat therapeutic ketogenic approach is not necessarily the most nutrient dense option, and may not be optimal in the long term, particularly if your goal is weight loss.
Balancing insulin load and nutrient density will enable you to identify the right approach for you at any given point in time.
This article suggests ideal macro nutrient, protein and insulin load, and carbohydrate levels for different people with different goals to use as a starting point as they work to optimise their weight and / or blood glucose levels.

context matters

Since I started blogging about the concepts of insulin load and proportion of insulinogenic calories many people have asked:

“What insulin load should I be aiming for?”

Unfortunately, it’s hard to give a simple answer without some context.

The answer to this question depends on a person’s current metabolic health, age, activity level, weight, height and goals etc.

This post is my attempt to provide an answer with some context.

disclaimers

Full disclosure… I don’t like to measure the food I eat. I have developed the optimal foods lists to highlight what I think are the best foods to suit different goals and levels of metabolic health.

I think food should be nutritious and satiating. If you goal is to lose weight it will be hard to overeat if you limit your food choices to things like broccoli (which contains sulforaphane), celery, salmon and tuna.

At the same time, some people like to track their food. Tracking food with apps like MyFitnessPal or Cron-O-Meter can be useful for a time to reflect and use as a tool to help you refine your food choices. If you’re preparing for a bodybuilding competition you’re probably going to need to track your food to temporarily override your body’s survival to force it to shed additional weight.

Ideal macronutrient balance is a contentious issue and a lot has already been said on the topic. I’ll try to focus on what I think I have to add to the discussion around the topics of insulin load and nutrient density.

If you want to and skip the detail in the rest of this article, this graphic from Dr Ted Naiman does a good job of summarising optimal foods and ideal macronutrient ranges. If you’re interested in more detail on the topic, then read on.

insulin is not the bad guy

The insulin load formula was designed to help us more accurately understand the insulin response to the food we eat, including protein and fibre.

insulin load = total carbohydrates – fibre + 0.56 * protein

The first thing to understand is that insulin per se is not bad. Insulin is required for energy metabolism and growth. People who can’t produce enough insulin are called Type 1 Diabetics and typically don’t last long without insulin injections after they catabolise their muscle and body fat.

Insulin only really becomes problematic when we have too much of it (i.e. hyperinsulinemia^[1]) due to excess processed carbohydrates (i.e. processed grains, added sugar and soft drinks) and/or a lack of activity which leads to insulin resistance.

The concepts of insulin load and proportion of insulinogenic calories can provide us with a better understanding of how different foods trigger an insulin response and how to quantitatively optimise the insulin load of our diet to suit our unique situation and goals.

different degrees of the ketogenic diet

Words like “ketogenic”, “low carb” or “nutrient dense” mean different things to different people. This is where using numbers can be useful to better define what we’re talking about and tailor a dietary approach. For clarity, I have numerically defined a number of terms that you might hear.

ketogenic ratio

The therapeutic ketosis community talk about a “ketogenic ratio” such as 3:1 or 4:1 which means that there are three or four parts fat (by weight) for every part protein plus carbohydrate.^[2]

For example, a 3:1 ketogenic diet may contain 300g of fat plus 95g of protein with 5g of carbs. This ends up being 87% fat. A 4:1 ketogenic ratio is an even more aggressive ketogenic approach that is used in the treatment of epilepsy,^[3] cancer or dementia and ends up being 90% fat.

These levels of ketosis is hard to achieve with real food and is hard to sustain in the long term. Hence, it is typically used as a short term therapeutic treatment.

ratio of fat to protein

People in the ketogenic bodybuilding scene (e.g. Keto Gains) or weight loss might talk about a 1:1 ratio of fat to protein (by weight) for weight loss. A diet with a 1:1 ratio of fat to protein could be 120g of fat plus 120g of protein. If we threw in 20g of carbs this would come out at 66% fat (which is still pretty high by mainstream standards). A 1:2 protein:fat ratio would end up being around 80% fat.

protein grams per kilogram of lean body weight

Some people prefer to talk in terms of terms of percentages or grams of protein per kilo of lean body mass. For example:

The generally accepted minimum level of protein is 0.8g/kg/day of lean body mass to prevent malnutrition.^[4] This is based on a minimum requirement of 0.6kg to maintain nitrogen balance and prevent diseases of malnutrition plus a 25% or two standard deviations safety factor.^[5]
In the Art and Science of Low Carb Performance Volek and Phinney talk recommend consuming between 1.5 and 2.0g/kg of reference body weight (i.e. RW). Reference weight is basically your ideal body weight say at a BMI of 25kg/m². So, 1.5 to 2.0kg RW equates to around 1.7 to 2.2g/kg lean body mass (LBM).
There is also a practical maximum level where people just can’t eat more lean protein (i.e. rabbit starvation^[6]) which kicks in at around 35% of energy from protein.

The table below shows a list of rule of thumb protein quantities for different goals in terms of grams per kilogram of lean body mass and as a percentage of calories assuming weight maintenance.^[7]

scenario	% calories	g/kg LBM
minimum (starvation)	6%	0.4
RDI/sedentary	11%	0.8
typical	16%	1.2
strength athlete	24%	1.8
maximum	35%	2.7

gluconeogenesis

You may have heard that body will convert ‘excess protein’ to glucose via gluconeogenesis, particularly if there is minimal carbohydrates in the diet and/or we can’t yet use fat for fuel.

For some people this is a concern due to elevated blood glucose levels, but it may also mean that more protein is required because so much is being converted to glucose that you need more to maintain muscles growing your muscles. As we become more insulin sensitive we may be able to get away with less protein because we are using it better (i.e. we are growing muscles rather than making glucose).

Most people eat more than the minimum level of protein to prevent malnutrition. People looking to gain muscle mass will require higher levels. Although keep in mind you do need to be exercising to gain muscle, not just eating protein.

Ensuring adequate protein and exercise is especially important as people age. Sarcopenia is the process of age related muscle decline which is exacerbated in people with diabetes.

Sadly, many old people fall and break their bones and never get up again. When it comes to longevity there is a balance between being too big (high IGF-1) and too frail (too little IGF-1).

carbohydrate counting

Then there is carb counting.

People on a ketogenic approach tend to limit themselves to around 20g (net?) carbohydrates.
Low carbers might limit themselves to 50g carbs per day.
A metabolically healthy low carb athlete might try to stay under 100g of carbs per day.

Limiting non-fibre carbohydrates typically eradicates most processed foods (e.g. sugar, processed grains, sodas etc). Nutrient density increases as we decrease the amount of non-fibre carbohydrates in our diet.

protein, insulin load and nutrient density

In the milieu of discussion about protein I think it’s important to keep in mind that minimum protein levels to prevent the diseases of malnutrition may not necessarily optimal for health and vitality.

Protein is the one macronutrient that correlates well with nutrient density. Foods with a higher percentage of protein are typically more nutrient dense overall.

Considering minimum protein levels may be useful if you are looking to drop your energy intake to the bare minimum and while still providing enough protein to prevent loss of lean muscle mass (e.g. a protein sparing modified fast). However, if you are looking to fill up the rest of your energy intake with fat for weight maintenance then you should be aware that simply eating foods with a higher proportion of fat will not help you maximise nutrient density.

Practically though very high levels of protein will be difficult to achieve because they are very filling, thus it is practically difficult to eat more than around 35% of your energy from protein. Protein is also an inefficient fuel source meaning that you will lose around 25% of the calories just digesting and converting it to glucose via digestion and gluconeogenesis.

If you are incorporating fasting then I think you will need to make sure you are getting at least the minimum as an average across the week, not just on feasting days to maintain nitrogen balance. That is, you might need to try to eat more protein on days you are eating.

what is ketosis?

“Ketogenic” simply means “generates ketones”.

An increase in ketosis occurs when there is a lack of glucogenic substrates (i.e. non-fibre carbohydrates and glucogenic protein). It’s not primarily about eating an abundance of dietary fat.

I think reducing insulin load (i.e. the amount of food that we eat that requires insulin to metabolise), rather than adding dietary fat, is really where it’s at if you’re trying to ‘get into ketosis’. We can simply wind down the insulin load of our diet to the point that out blood glucose and insulin levels decrease and we can more easily access our stored body fat.

insulin load = total carbohydrates – fibre + 0.56 * protein

Whether a particular approach is ketogenic (i.e. generates ketones) will depend on your metabolic health, activity levels and insulin resistance etc.

Whether you want to be generating ketones from the fat on your excess belly fat rather than your plate (or coffee cup) is also an important consideration if weight loss is one of your goals.

While people aiming for therapeutic ketosis might want to achieve elevated ketone levels by consuming more dietary fat, most people out there are just looking to lose weight for heath and aesthetic reasons. For most people, I think the first step is to reduce dietary insulin load until they achieve normalised blood glucose levels (i.e. average BG less than 5.6mmol/L or 100mg/dL, blood ketones greater than 0.2 mmol/L). People with diabetes often call this “eating to your meter”.

Once you’ve achieved normal blood glucose levels and some ketones the next step towards weight loss is to increase nutrient density while still maintaining ketosis. Deeper levels of ketosis do not necessarily mean more fat loss, particularly if if you have to eat gobs of eating processed fat to get there.

Ray Cronise and David Sinclair recently published an article “Oxidative Priority, Meal Frequency, and the Energy Economy of Food and ACtivity: Implications for Longevity, Obesity and Cardiometabolic Disease” which does an interesting job of looking at the ‘oxidative priority’ of various nutrient and demonstrate that the body will burn through nutrients in the following order:

alcohol,
protein (not used for muscle protein synthesis),
non fibre carbohydrate, and then
fat.

What this suggests to me is that if you want to burn your own body fat you need to minimise the alcohol, protein and carbohydrate which will burn first. To me this is another angle on the idea that insulin levels are the signal that stops our body from using our own body fat in times of plenty. And if we want to access our own body fat we need to reduce the insulin load of our diet to the point we can release our own body fat.

insulin load versus nutrient density

The risk however with the insulin load concept is that people can take things to extremes. If our only objective is to minimise insulin load we’ll end up just eating bacon, lard, MCT, olive oil… and not much else.

In his “Perfect Health Diet” book Paul Jaminet talks about “nutrient hunger”, meaning that we are more likely to have an increased appetite if we are missing out on a particular nutrients. He says

“A nourishing, balanced diet that provides all the nutrients in the right proportions is the key to eliminating hunger and minimising appetite.“

In the chart below shows nutrient density versus proportion of insulinogenic calories. The first thing to note is that there is a lot of scatter! However, on the right-hand side of the chart there are high carb soft drinks, breakfast cereals and processed grains that are nutrient poor. But if we plot a trendline we see that nutrient density peaks somewhere around 40% insulinogenic calories.

If you are metabolically challenged, you will want to reduce the insulin load of your diet to normalise blood glucose levels. But if you reduce your insulin load too much you end up living on purified fats that aren’t necessarily nutrient dense.

If we are trying to avoid both carbohydrates and protein we end up limiting our food choices to macadamia nuts, pine nuts and a bunch of isolated fats that aren’t found in nature in that form. Rather than living on copious amounts of refined oils I think we’re in much safer territory if we maximise nutrient density with whole foods while still maintaining optimal blood glucose levels.

The chart below shows the proportion of insulinogenic calories for the highest-ranking basket of foods (i.e. top 10% of the foods in the USDA foods database) for a range of approaches, from the low insulin therapeutic ketosis, through to the weight loss foods for someone who is insulin sensitive and a lot of fat is coming from their body. At one end of the scale a therapeutic ketogenic may only contain 14% insulinogenic calories while a more nutrient dense approach might have more than half of the food requires insulin to metabolise.

macronutrient splits

It’s one thing to set theoretical macronutrient targets, but real foods don’t come in neat little packages of protein, fat and carbohydrates. The chart below shows the macronutrient split of the most nutrient dense 10% of foods for each of the four nutritional approaches. The protein level for the weight loss approach might seem high but then once we factor in an energy deficit from our body fat it comes back down.

In reality you’re probably not going to be able to achieve weight maintenance if you just stick to the nutrient dense weight loss foods. You’ll either become full and will end up using your stored body fat to meet the energy deficit or you will reach for some more energy dense foods to make up the calorie deficit. If you look at the macronutrient split of the most nutrient dense meals for the different approach you find they are lower in protein and higher in fat as shown in the chart below.

nutrient density

The chart below shows the percentage of the daily recommended intake of essential vitamins, minerals, amino acids and fatty acids you can get from 2000 calories for each of the approaches.

You can meet most of your nutritional requirements with a therapeutic ketogenic diet, however you’ll have to eat enough calories to maintain your weight to prevent nutritional deficiencies.

As you progress to the more nutrient dense approaches you can meet your nutrient requirements with less energy intake. The beauty of limiting yourself to nutrient dense whole foods is that you can obtain the required nutrition with less energy and you’ll likely be too full to overeat.

As far as I can see the holy grail of nutrition, health and longevity is adequate energy without malnutrition.

If we look in more detail we can see that the weight loss (blue) and nutrient dense approaches (green) provide more of the essential micronutrients across the board, not just amino acids.

While the protein levels in the “weight loss” and “most nutrient dense” approaches are quite high, keep in mind that the food ranking system only prioritises the nutrients that are harder to obtain.

The table below shows the various nutrients that are switched on in the food ranking system for each approach.

This table shows the number of vitamins, minerals, amino acids and fatty acids counted for each approach.

In the weight loss and nutrient dense approach, of the twelve essential amino acids, only Tyrosine and Phenylalanine has been counted in the density ranking system.

It just so happens that protein levels are high in whole foods that contain essential vitamins, minerals and fatty acids.

It appears that if you set out to actively avoid protein it may be harder to get other essential nutrients. The risk here is that you may be setting yourself up for nutrient hunger, and rebound/stall inducing cravings in the long term as your body becomes depleted of the harder to obtain nutrients.

choosing the right approach for you

I believe one of the key factors in determining which nutritional approach is right for you is your blood glucose levels which gives you an insight into your insulin levels and insulin sensitivity.

As shown in the chart below, if your blood glucose levels are high then it’s likely your insulin levels are also high which means you will not be able to easily to access your fat stores. I have also created this survey which may help you identify whether you are insulin resistant and which foods might be ideal for you right now.

While you may need to start out with a higher fat approach, as your glucose levels decrease and ketone levels rise a little you will be able to transition to more nutrient dense foods.

The table below shows the relationship between HbA1c, glucose, ketones and GKI. Once you are getting good blood glucose levels you can start to focus more on nutrient density and weight loss.

Risk level	HbA1c	average blood glucose		ketones	GKI
Risk level	(%)	(mmol/L)	(mg/dL)	(mmol/L)	GKI
low normal	4.1	4.0	70	5.5	0.7
optimal	4.5	4.6	83	2.5	1.8
excellent	< 5.0	< 5.3	< 95	> 0.2	< 30
good	< 5.4	< 6.0	< 108	< 0.2
danger	> 6.5	7.8	> 140	< 0.2

more numbers

The table below shows what the different nutritional approaches look like in terms of:

ketogenic ratio
ratio of fat to protein
protein (g)/kg LBM
insulin load (g/kg LBM)

approach	keto ratio	fat : protein	protein g/LBM	insulin load (g/LBM)
therapeutic ketosis	1.8	2.2	1.0	0.9
diabetes	0.9	1.0	1.8	1.5
weight loss (incl. body fat)	0.5	0.6	2.5	2.4
nutrient dense	0.3	0.3	3.0	2.8

The 1.0g/kg LBM for therapeutic ketosis is greater than the RDA minimum of 0.8g/kg LBM so will still provide the minimum amount while still being ketogenic. It’s hard to find a lot of foods that have less than 1.0g/kg LBM protein in weight maintenance without focussing on processed fats.

At the other extreme most nutrient dense foods are very high in protein but this might also be self-limiting meaning that people won’t be able to eat that much food. As mentioned earlier, it will be hard to eat enough of the nutrient dense foods to maintain your current weight. Either you will end up losing weight because you can’t fit as much of these foods in or reaching more energy dense lower nutrient density foods. Also, if you found you were not achieving great blood glucose levels and some low-level ketones with mean and non-starchy veggies you might want to retreat to a higher fat approach.

The table below lists optimal foods for different goals from most nutrient dense to most ketogenic. Hopefully over time you should be able to work towards the more nutrient dense foods as your metabolism heals.

dietary approach	printable .pdf
weight loss (insulin sensitive)	download
nutrient dense (maintenance)	download
weight loss (insulin resistant)	download
diabetes and nutritional ketosis	download
therapeutic ketosis	download

what about mTOR?

Many people are concerned about excess protein causing cancer or inhibiting mTOR (Mammalian Target of Rapamycin).^[8] ^[9]

From what I can see though, the story with mTOR is similar to insulin. That is, constantly elevated insulin or constantly stimulated mTOR are problematic and cause excess growth without being interspersed with periods of breakdown and repair.

Our ancestors would have had times when insulin and mTOR were low during winter or between successful hunts. But during summer (when fruits were plentiful) or after a successful hunt, insulin would be elevated and mTOR suppressed as they gorged on the nutrient dense bounty.

These days we’re more like the futuristic humans from Wall-E than our hunter gather ancestors. We live in a temperature controlled environment with artificial lighting and tend to put food in our mouths from the moment we wake up to the time we fall asleep.^[10]

Rather than chronic monotony (e.g. eating five or six small meals per day every day), it seems that periods of growth (anabolism) and breakdown and cleaning (catabolism) are optimal to thrive in the long term. We need periods of both. One or the other chronically are bad news.

As my wise friend Raymund Edwards from Optimal Ketogenic Living says

“FAST WELL, FEED WELL.”

how much protein?

Optimal protein levels are a contentious topic. There is research out there that says that excess protein can be problematic from a longevity perspective. Protein promotes growth, IGF-1, insulin and cell turnover which can theoretically compromise longevity. At the same time, there are plenty of studies that indicate that we need much more protein than the minimum RDI levels.^[11]

In the end, you need to eat enough protein to prevent loss of lean muscle and maintain strength. If you’re trying to build lean muscle and working out, then higher levels of protein may be helpful to support muscle growth. If you are trying to lose weight, then higher levels of protein can be useful to increase satiety and prevent loss of lean muscle mass. Maintaining muscle mass is critical to keeping your metabolic rate high and avoiding the reduction that can come with chronic restriction.^[12] ^[13]

In addition to building our muscles, protein is critical for building our bones, heart, organs and providing many of the neurotransmitters required for mental health. So protein from real whole foods is generally nothing to be afraid of. It’s typically the processed high carb foods that make the detrimental impact on insulin and blood glucose levels.

The table below shows a starting point for protein in grams depending on your height. This assumes that someone with a lean body mass (LBM) of 80 kg is burning 2000 calories per day and your lean body mass equates to a BMI of 20 kg/m². LBM is current weight minus fat mass minus skeletal mass which again is hard to estimate without a DEXA.

There are a lot of assumptions here so you will need to take as a rule of thumb starting point and track your weight and blood glucose levels and refine accordingly. It’s unlikely that you will get to the high protein levels of the most nutrient dense approach because either you would feel too full or your glucose levels may rise and ketones disappear, so most people, unless your name is Duane Johnson, will need to moderate back from that level.

Example: Let’s say for example you were 180cm and were managing diabetes and elevated blood glucose levels. You would start with around 117g of protein per day as an initial target and test how that worked with your blood glucose levels. If your blood glucose levels on average were less than say 5.6mmol/L or 100mg/dL and your ketones were above 0.2mmol/L you could consider increasing transitioning to more nutrient dense foods.

If you want to see what this looks like in terms of real foods and real meal meals check out the optimal food list and the optimal meals for the different approaches.

insulin load

Using a similar approach, we can calculate the daily insulin load (in grams) depending on your height and goals. The values in this table can be used as a rule of thumb for the insulin load of your diet.

If you are not achieving your blood glucose or weight loss goals, then you can consider winding the insulin load back down. If you are achieving great blood glucose levels, then you might consider choosing more nutrient dense food which might involve more whole protein and more nutrient dense green leafy veggies.

Example: Let’s say for example you are a 180cm person with good glucose control but still wanting to lose weight, your initial target insulin load would be 156g from the superfoods from fat lost list. If you were not losing weight at this level, you could look to wind it back a little until you started losing weight. If you are consistently achieving blood glucose levels less than 5.6mmol/L or 100mg/dL and ketones greater than 0.2mmol/L you could consider transitioning to more nutrient dense foods.

summary

In summary, reducing the insulin load of your diet is an important initial step. However, as your blood glucose and insulin levels normalise there are a number of other steps that you can take towards optimising nutrient density on your journey towards optimal health and body fat.

Reduce the insulin load of your diet (i.e. eliminate processed carbage and maybe consider moderating protein if still necessary) to normalise blood glucose levels and reduce insulin levels to facilitate access to stored body fat.
If your blood glucose levels are less than say 5.6 mmol/L or 100mg/dL and your ketone levels are greater than say 0.2 mmol/L then you could consider transitioning to more nutrient dense foods.
If further weight loss is required, maximise nutrient density and reduce added fats to continue weight loss.
Consider also adding an intermittent fasting routine with periods of nutrient dense feasting. Modify the feasting/fasting cycles to make sure you are getting the results you are after over the long term.
Once optimal/goal weight is achieved, enjoy nutrient dense fattier foods as long as optimal weight and blood glucose levels are maintained.
If blood glucose levels are greater than optimal blood glucose levels, return to step 1.
If current weight is greater goal weight return to step 3.

references

^[1] http://diabesity.ejournals.ca/index.php/diabesity/article/view/19

^[2] http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies/ketogenic-diet

^[3] http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies/ketogenic-diet

^[4] http://www.health.harvard.edu/blog/how-much-protein-do-you-need-every-day-201506188096

^[5] https://intensivedietarymanagement.com/how-much-protein-is-excessive/

^[6] https://en.wikipedia.org/wiki/Protein_poisoning

^[7] https://optimisingnutrition.com/2015/08/31/optimal-protein-intake/

^[8] https://www.youtube.com/watch?v=Yv-M-5-s9B0

^[9] http://nutritionfacts.org/video/prevent-cancer-from-going-on-tor/

^[10] https://www.youtube.com/watch?v=qPpAvvPG0nc

^[11] https://www.ncbi.nlm.nih.gov/pubmed/27109436

^[12] http://ajcn.nutrition.org/content/87/5/1558S.long

^[13] https://en.wikipedia.org/wiki/Protein-sparing_modified_fast

blood sugar, diabetes, fasting, fat, healthy foods, insulin index, insulin resistance, ketones

the complete guide to fasting (review)

October 29, 2016 Marty Kendall 14 Comments

Considering the massive amount of research and interest in the idea of fasting, not a lot has been written for the general population on the topic.

Brad Pilon’s 2009 e-book Eat Stop Eat was a great, though fairly concise, resource on the mechanisms and benefits of fasting.

Martin Berkhan’s LeanGains blog had a cult following for a while in the bodybuilding community.

Michael Mosley’s 2012 documentary Eat, Fast and Live Longer documentary piqued the public interest and was followed by the popular 5:2 Diet book.

Then in 2013, Jason Fung emerged onto the low carb scene with his epic six part Aetiology of Obesity YouTube Series in which he detailed a wide range of theories relating to obesity and diabetes.

Essentially, Jason’s key points are that:

simply treating Type 2 diabetes with more insulin to suppress blood glucose levels while continuing to eat the diet that caused the diabetes is futile,
people with Type 2 diabetes are already secreting plenty of insulin, and
insulin resistance is the real problem that needs to be addressed.

Jason’s Intensive Dietary Management blog has explored a lot of concepts that made their way into his March 2016 book, The Obesity Code. However surprisingly, given that Jason is the fasting guy, the book didn’t talk much about fasting.

my experience with fasting

I have benefited personally from implementing an intermittent fasting routine after getting my head around Jason’s work. I like the way I look and perform, both mentally and physically, after a few days of not eating. I also like the way my belt feels looser and my clothes fit better.

Complete abstinence is easier than perfect moderation.

St Augustine

I recently did a seven day fast and since then I’ve done a series of four day fasts, testing my glucose and blood and breath ketones with a range of different supplements (e.g. alkaline mineral mix, exogenous ketones, bulletproof coffee / fat fast and Nicotinamide Riboside) to see if they made any difference to how I feel and perform, both mentally and physically.

Fasting does become easier with practice as your body gets used to accessing fat for fuel.

I love the mental clarity! My workout performance and capacity even seems to be better when I’ve fasted for a few days.

My key fasting takeaways are:

Fasting is not that hard. Give it a try.
You can build up slowly.
If you don’t feel good. Eat!

The more I learn about health and nutrition, the more I realise how critical it is to be able to burn fat and conserve glucose for occasional use. We get into all sorts of trouble when we get stuck burning glucose.

Our body is like a hybrid car with a slow burning fat motor (with a big fuel tank) and high octane glucose motor (with a small fuel tank). If you’re always filling the small high octane fuel tank to overflowing, you’ll always be stuck burning glucose and your fat burning engine will start to seize up (i.e. insulin resistance and diabetes).

Reducing the processed carbs in our diet enables us to lower our insulin levels and retrain our body to burn fat again. But nothing lowers insulin as aggressively and effectively as not eating.

Even though lots of Jason’s thoughts on fasting seem self-evident, his blog elucidating them has been very popular, perhaps because the concept of fasting is novel in the context of our current nutritional education.

We’ve been trained, or at least given permission, to eat as often as we want by the people that are selling food or sponsored by them.^[1]

context

Jason’s angle on obesity and diabetes comes from his background as a nephrologist (kidney specialist) who deals with chronically ill people who are a long way down the wrong track before they come to his office. Jason also talks about how he had tried to educate his patients about reducing their carbs, however after eating the same thing for 70 years this is just too hard for many people to change.

Desperate times call for desperate measures!

Many of these patients come to him jamming in hundreds of units a day of insulin to suppress blood glucose levels, even though their own pancreas is still likely secreting more than enough insulin.

Rather than continuing to hammer more insulin to suppress the symptom (high blood glucose), the solution, according to Jason, is to attack the ultimate cause (insulin resistance) directly.

Jimmy Moore is well known to most people that have an interest in low carb or ketogenic diets. Whether you agree with his approach, it’s safe to say that low carb and keto would not be as popular today without his role.

Meanwhile Jason talks about trying to educate people about reducing the processed carbs from their diet not working, not because of the science but more due to people not being able to change their eating habits after 70 years.

the Complete Guide to Fasting

You’ve probably heard by now that Jason has teamed up with Jimmy to write The Complete Guide to Fasting which captures Jason’s extensive thoughts on fasting from the blog along with Jimmy’s n=1 experiences and wraps them up in a cohesive comprehensive manual with a colourful bow.

Jason and Jimmy both sent me a copy of their new 304 page book, The Complete Guide to Fasting, to review (thanks guys). So here goes…

Similar to The Obesity Code, TCGTF is a compilation of ideas that Jason has developed on his Intensive Dietary Management blog. Blogging is a great way to get the ideas together and thrash them out in a public forum. Some people love to read the latest blog posts and debate the minutiae, however most people would rather spend the $9 and sit down with a comprehensive book and get the full story.

Unlike The Obesity Code, TCGTF is a bright, full colour production with great graphics that will make it worth buying the hard copy to have and to hold.

TCGTF did originally have the working title Fasting Clarity as a follow on from Jimmy’s previous Cholesterol Clarity and Keto Clarity. However, other than Jimmy’s discussion of his n=1 fasting experiences, TCGTF is predominantly written in Jason’s voice building from his blog, so it wouldn’t be appropriate for it to have become the third in Jimmy’s Clarity series.

What is similar to Jimmy’s clarity series is that it’s easy to read and accessible for people who are looking for an entry level resource. This book will be great for people who are interested in the idea of fasting. It is indeed the complete guide to fasting and is full of references to studies, however it doesn’t go into so much depth as to lose the average reader with scientific detail and jargon.

The book covers:

Jimmy’s n=1 experience with fasting,
Dr George Cahill’s seminal work on the effects of fasting on metabolism, glucose, ghrelin, insulin, and electrolytes,
the history of fasting over the centuries,
myth busting about fasting,
fasting in weight loss,
fasting and diabetes, physical health, and mental clarity,
managing hunger during a fast,
when not to fast, and
when fasting can go wrong.

The book is complete with a section on fasting fluids (water, coffee, tea, broth) and a range of different protocols that you can use depending on what suits you. What did seem out of place are the recipes for proper meals. Apparently, the publisher insisted they include these to widen the appeal (If you don’t like the fasting bit you’ve still got some new recipes?)

Overall, the book will be an obvious addition to the library (or Kindle) of people who are already fans of Jason and / or Jimmy and want a polished, consolidated presentation of all their previous work with a bunch of new material added.

TCGTF will also be a great read for someone who is interested learning more about fasting and wants to start at the beginning. TCGTF is the most comprehensive book on the topic of fasting that I’m aware of.

my additional 2c…

Jason doesn’t mind weighing into a controversial argument, using some hyperbole or dropping the occasional F-bomb for effect and Jimmy’s no stranger to controversy either, so I thought I’d take this opportunity to give you my 2c on some of the topical issues at the fringe that aren’t specifically unpacked in the book. We learn more as we thrash out the controversial issues at the fringes. Many arguments come down to context.

target glucose levels

Jason has come under attack for using the word ‘cured’ in relation to HbAc1 values that most diabetes associations would consider non-diabetic,^[2] though are not yet optimal.^[3]

In the book Jason does discuss relaxing target blood glucose levels during fasting. This makes sense for someone taking a slew of diabetic medications. They’re probably not going to continue the journey if they end up in a hypoglycaemic coma on day one.

The chart below shows the real life blood glucose variability for someone with Type 1 Diabetes on a standard diet. With such massive fluctuations in glucose levels, it’s impossible to target ideal blood glucose levels (e.g. Dr Bernstein’s magic target blood glucose number of 4.6 mmol/L or 83 mg/dL).

If your glucose levels are swinging wildly due to a poor diet coupled with lots of medication, your glucose levels are simply going to tank when you stop eating. Hence, a safe approach is to back off the medication, at least initially, until your glucose levels have normalized.

Being married to someone with Type 1 Diabetes, I have learned the practical realities of getting blood glucose levels as low as possible while still avoiding dangerous lows.^[4] My wife Monica doesn’t feel well when her blood glucose levels are too low, but neither does she feel good with high blood glucose levels. Balancing insulin and food to get blood glucose levels as low as possible without experiencing lows requires constant monitoring.

The chart below shows how scattered blood glucose levels can be even if you’re fairly well controlled. Ideally you want the average blood glucose level to be as low as possible while minimising the number of hypoglycaemic episodes (i.e. below the red line). If you can’t reduce the variability you just can’t bring the average blood glucose level down. The last thing you want is to be eating to raise your blood glucose levels because you had too much blood glucose lowering medication.

Pretty much everyone agrees that it’s dumb to be eating crap food and dosing with industrial levels of insulin to manage blood glucose levels. High levels of exogenous insulin just drive the sugar that is not being used to be stored as fat in your belly, then your organs, and then in the more fragile places like your eyes and the brain.

Jason’s perspective is that people who are chronically insulin resistant and morbidly obese are likely producing more than enough insulin. The last thing they need is exogenous insulin which will keep the fat locked up in their belly and vital organs. Dropping insulin levels as low as possible using a low insulin load diet and fasting coupled with reducing medications will let the fat flow out.

fasting to optimise blood glucose levels

In the long run, neither high insulin nor high glucose levels are optimal.

Once you’ve broken the back of your insulin resistance with fasting, you can continue to drive your blood glucose levels down towards optimal levels.

One of the most popular articles on the Optimising Nutrition blog is how to use your glucose meter as a fuel gauge which details how you can time your fasting based on your blood glucose levels to ensure they continue to reduce.

Your blood glucose levels can help calibrate your hunger and help you to understand if you really need to eat. I think this is a great approach for people whose main issue is high blood glucose levels and who aren’t ready to launch into longer multi day fasts.

In a similar way, a disciplined fasting routine can help optimise blood glucose levels in the long term. The chart below shows a plot of Rebecca Latham’s blood glucose levels over three months where she used her fasting blood glucose numbers AND body weight to decide if she would eat on any given day.

While there is some scatter in the blood glucose levels, you can see that regular fasting does help to reduce blood glucose levels over the long term.

Once you’ve lost your weight , broken the back of your insulin resistance and stopped eating crap food, you may find that you still need some exogenous insulin or other diabetic medication to optimise blood glucose levels if you have burned out your pancreas.

fasting frequency

The TGTF book covers off on several fasting regimens such as intermittent fasting, 24 hours, 36 hours, 42 hours and 7 to 14 days. One concept that I’m intrigued by, similar to the idea of using your glucose meter as a fuel gauge, is using your bathroom scale as a fuel gauge.

The reality, at least in my experience, is that we can overcompensate for our fasting during our feasting and end up not moving forward toward our goal.

If your goal is to lose weight I like the idea of tracking your weight and not eating on days that your weight is above your goal weight for that day.

Again, Rebecca Latham has done a great job building an online community around the concept of using weight as a signal to fast through her Facebook group My Low Carb Road – Fasting Support.

The chart below shows Rebecca’s weight loss journey through 2016 where she initially targeted a weight loss of 0.2 pounds AND a reduction of 0.25 mg/dL in blood glucose per day. After three months, she stabilized for a period (during a period when she had a number of major family issues to look after). She is now using a less aggressive weight loss goal as she heads for her long-term target weight at the end of the year.

The chart below shows the fasting frequency required to achieve her goals during 2016. Tracking her weight against her target rate of weight loss has required her to fast a little more than one day in three to stay on track.

Eating quality food is part of the battle, but managing how often you eat is also an important consideration. After you’ve fasted for a few days, you can easily excuse yourself for eating more when you feast again. And maybe it’s OK to enjoy your food when you do eat rather than tracking every calorie and trying to consciously limit them.

The obvious caveat is that there are a lot of other things that influence your scale weight such as muscle gain, water, GI tract contents etc, but this is another way to keep yourself accountable over the long term.

FAST WELL, FEED WELL

Fasting is a key component of the metabolic healing process, but it’s only one part of the story.

Fasting is like ripping out your kitchen to put in a new one. You have to demolish and remove the old stovetop to put the new shiny one back in. You don’t sticky tape the new marble bench top over the crappy old Laminex. You have to clean out the old junk before you implement the new, latest, and greatest model.

In fasting, the demolition process is called autophagy, where the body ‘self eats’ the old proteins and aging body parts. The great thing about minimising all food intake is that you get a deeper cleanse than other options such as fat fast, 500 calories per day or a protein sparing modified fast (PSMF).

But keep in mind that it’s the feast after the fast that builds up the shiny, new body parts that will help you live a longer, healthier, and happier life.

“Fasting without proper refeeding is called anorexia.”

Mike Julian

Even fasting guru Valter Longo is now talking about the importance of feast / fast cycles rather than chronic restriction. In the end you need to find the right balance of feasting / fasting, insulin / glucagon, mTOR / AMPK that is right for you.

In TCGTF, Jason and Jimmy talk about prioritising nutrient dense, natural, unprocessed, low carb, moderate protein foods after the fast. I’d like to reiterate that principle and emphasise that nutrient density becomes even more important if you are fasting regularly or for longer periods.

In the long term, I think your body will drive you to seek out more food if you’re not giving it the nutrients it needs to thrive. Conversely, I think if you are providing your body with the nutrients it needs with the minimum of calories I think you will have a better chance of accessing your own body fat and reaching your fat loss goals.

optimising insulin levels AND nutrient density

It’s been great to see the concept of the food insulin index and insulin load being used by so many people! In theory, when people reduce the insulin load of their diet they more easily access their own body fat and thus normalizes appetite.

Some people who are very insulin resistant do well, at least initially, on a very high fat diet. However, as glycogen levels are depleted and blood glucose levels start to normalise, I think it is prudent to transition to the most nutrient dense foods possible while still maintaining good (though maybe not yet optimal) blood glucose levels.

The problem with doubling down on reducing insulin by fasting combined with eating only ultra-low insulinogenic foods is that you end up “refeeding” with refined fat after your fast.

While lowering carbs and improving food quality is the first step, I think that, as soon as possible you should start focusing on building up your metabolic machinery (i.e. muscles and mitochondria). A low carb nutrient dense diet is part of the story, but I don’t see many people with amazing insulin sensitivity that don’t also have a good amount of lean muscle mass which is critical to ‘glucose disposal’, good blood sugar levels and metabolic health.

This recent IHMC video from Doug McGuff provides a stark reminder of why we should all be focusing on maximising strength and lean muscle mass to slow aging.

The chart below shows a comparison of the nutrient density of the various dietary approaches. Unfortunately, a super high fat diet is not necessarily going to be as nutrient dense and thus support muscle growth, weight loss, or optimal mitochondrial function as well as other options.

The chart below (click to enlarge) shows a comparison of the various essential nutrients provided by a high fat therapeutic ketogenic dietary approach versus a nutrient dense approach that would suit someone who is insulin sensitive.

I developed a range of lists of optimal foods that will help people in different situations with different goals to maximise the nutrient density that should be delivered in the feast after the fast. The table below contains links to separate blog posts and printable .pdfs. The table is sorted from highest to lowest nutrient density. In time, you may be able to progress to a more nutrient dense set of foods as your insulin resistance improves.

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

protein

Jason had a “robust discussion” with Steve Phinney over the topic of ideal protein levels recently during the Q&A session at the recent Low Carb Vail Conference.

To give some context again, Phinney is used to dealing with athletes who require optimal performance and are looking to optimise strength. Meanwhile Jason’s patient population is typically morbidly obese people who are on kidney dialysis and probably have some excess protein, as well as a lot of fat that they could donate to the cause of losing weight.

I also know that Jimmy is a fan of Ron Rosedale’s approach of minimising protein to minimise stimulation of mTOR. Jimmy and Ron are currently working on another book (mTOR Clarity?). Protein also stimulates mTOR which regulates growth which is great when you’re young but perhaps is not so great when you’ve grown more than enough.

The typical concern that people have with protein in a ketogenic context is that it raises blood insulin in people who are insulin resistant. ‘Excess protein’ can be converted to blood glucose via gluconeogenesis in people who are insulin resistant and can’t metabolise fat very well.

Managing insulin dosing for someone with Type 1 Diabetes like my wife Monica is a real issue, though she doesn’t actively avoid protein. She just needs to dose with adequate insulin for the protein being eaten to manage the glucose rise.

The chart below shows the difference in glucose and insulin response to protein in people who have Type 2 Diabetes (yellow lines) versus insulin sensitive (white lines) showing that someone who is insulin resistant will need more insulin to deal with the protein.

As well as insulin resistance, these people are also “anabolic resistant” meaning that some of the protein that they eat is turned into glucose rather than muscle leaving them with muscles that are wasting away.

People who are insulin resistant are leaching protein into their bloodstream as glucose because they can’t mobilise their fat stores for fuel. They are dependent on glucose and they’ll even catabolise their own muscle to get the glucose they need if they stop eating glucose.

While it’s nice to minimise insulin levels, I wonder whether people who are in this situation may actually need more protein to make up for the protein that is being lost by the conversion to glucose to enable them to maintain lean muscle mass. Perhaps it’s actually the people who are insulin sensitive that can get away with lower levels of protein?

As well as improving diet quality which will reduce insulin and thus improve insulin resistance, in the long term it’s also very important to maintain and build muscle to be able to dispose of glucose efficiently and also improve insulin resistance.

In TCGTF Jason talks about the fact that the rate of the use of protein for fuel is reduced during a fast and someone becomes more insulin sensitive. He goes to great lengths to point out that concern over muscle loss shouldn’t stop you trying out fasting (which is a valid point).

A big part of the magic of fasting is that you clean out some of your oldest and dodgiest proteins in your body and set the stage for rebuilding back new high quality parts. But the reality is that you will lose some protein from your body during a fast (though this is not altogether a bad thing).^[5] ^[6]

Bodybuilders often talk about the “anabolic window” after a workout where they can maximise muscle growth after a workout. Similarly, one of the awesome things about fasting is that you reduce your insulin resistance and anabolic resistance meaning that when at the end of your fast your body is primed to allocate the high quality nutrients you eat in the right place (i.e. your muscles not your belly or blood stream).

In the end, I think optimal protein intake has to be guided to some extent by appetite. You’ll want more if you need it, and less if you don’t.

I think if we focus on eating from a shortlist of nutrient dense unprocessed foods we won’t have to worry too much about whether we should be eating 0.8 or 2.2 g/kg of lean body mass.

However, avoiding nutrient dense, protein-containing foods and instead “feasting” on processed fat when you break your fast will be counter-productive if your goal is weight loss and waste a golden opportunity to build new muscle.

are you really insulin resistant?

Insulin resistance and obesity is a continuum.

Not everyone who is obese is necessarily insulin resistant.

If you are really insulin resistant, then fasting, reducing carbs, and maybe increasing the fat content of your diet will enable you to improve your insulin resistance. This will then help with appetite regulation because your ketones will kick in when your blood glucose levels drop.

However, if you continue to overdo your energy intake (e.g. by chasing high ketones with a super high fat, low protein diet), then chances are, just like your body is primed to store protein as muscle, you will be very effective at storing that dietary fat as body fat.

I fear there are a lot of people who are obese but actually insulin sensitive who are pursuing a therapeutic ketogenic dietary approach in the belief that it will lead to weight loss. If you’re not sure which approach is right for you and whether you are insulin resistant, this survey may help you identify your optimal dietary approach.

optimal ketone levels

Measuring ketones is really fascinating but confusing as well.

“Don’t be a purple peetone chaser.”

Carrie Brown, The Ketovangelist Podcast Ep 78

Urine ketones strips have limited use and will disappear as you start to actually use the ketones for energy.

In a similar way blood ketones can be fleeting. Some is better than none, but more is not necessarily better. As shown in the chart of my seven day fast below I have had amazing ketones and felt really buzzed at that point but since then I haven’t been able to repeat this. I think sometimes as your body adapts to burning fat for fuel the ketones may be really high but then as it becomes efficient it will stabilise and run at lower ketone levels even when fasting.

If your ketone levels are high when fasting then that’s great. Keep it up. They might stay high. They might decrease. But don’t chase super high ketones in the fed state unless you are about to race the Tour de France or if you want your body to pump out some extra insulin to bring them back down and store them as fat.

The chart below shows the sum of 1200 data points of ketones and blood glucose levels from about 30 people living a ketogenic lifestyle. Some of the time they have really high blood ketone levels but I think the real magic of fasting happens when the energy in our bloodstream decreases and we force our body to rely on our own body fat stores.

the root cause of insulin resistance is…

So we’ve worked out that large amounts of processed carbs drive high blood glucose and insulin levels which is bad.

We’ve also worked out that insulin resistance drives insulin levels higher, which is bad.

But what is the root cause of insulin resistance?

I think Jason has touched on a key component in that, as with many things, resistance is caused by excess. If we can normalise insulin levels, then our sensitivity to insulin will return, similar to our exposure to caffeine or alcohol.

However, at the same time, I think insulin resistance is potentially more fundamentally caused by our sluggish mitochondria that don’t have enough capacity (number or strength) to process the energy we are throwing at them, regardless of whether they come from protein, carbs, or fat.

A low carb diet lowers the bar to enable us to normalise our blood glucose levels. However, the other end of the spectrum is focusing on training our body and our mitochondria to be able to jump higher. In the long term this is achieved through, among other things, maximising nutrient dense foods and building lean body mass through resistance exercise.

summary

The Complete Guide to Fasting is, as per the title, the complete guide to fasting. It’s the most comprehensive guide to the nuances of fasting out there and there’s a good balance between the technical detail, while still being accessible for the general public.
Fasting can help optimise blood glucose and weight in the long term, with a disciplined regimen.
Fasting makes the body more insulin sensitive and primes it for growth. When you feast after you fast, it is ideal to make sure you maximise nutrient density of the food you eat as much as possible while maintaining reasonable blood glucose levels.
Understanding your current degree of insulin resistance can help you decide which nutritional approach is right for you. As you implement a fasting routine and transition from insulin resistance to insulin sensitivity you will likely benefit from transitioning from a low insulin load approach to a more nutrient dense approach.

references

^[1] https://intensivedietarymanagement.com/of-traitors-and-truths/

^[2] https://www.diabetes.org.uk/About_us/What-we-say/Diagnosis-ongoing-management-monitoring/New_diagnostic_criteria_for_diabetes/

^[3] https://optimisingnutrition.com/2015/03/22/diabetes-102/

^[4] https://optimisingnutrition.com/2015/08/17/balancing-diet-and-diabetes-medications/

^[5] https://www.dropbox.com/s/h3pi53njcfu4czl/Physiological%20adaptation%20to%20prolonged%20starvation%20-%20Deranged%20Physiology.pdf?dl=0

^[6] https://www.facebook.com/groups/optimisingnutrition/permalink/1602953576672351/?comment_id=1603210273313348&comment_tracking=%7B%22tn%22%3A%22R9%22%7D

athletes, calorie density, carbohydrates, cheat sheets, diabetes, insulin index, insulin load, insulin resistance, nutrient density, therapeutic ketosis

energy density, food hyper-palatability and reverse engineering optimal foraging theory

October 23, 2016 Marty Kendall 4 Comments

In Robb Wolf’s new book Wired to Eat he talks about the dilemma of optimal foraging theory (OFT) and how it’s a miracle in our modern environment that even more of us aren’t fat, sick and nearly dead.^[1]

But what is optimal foraging theory^[2]? In essence it is the concept that we’re programmed to hunt and gather and ingest as much energy us we can with the least amount of energy expenditure or order to maximise survival of the species.

In engineering or economics this is akin to a cost : benefit analysis. Essentially we want maximum benefit for minimum investment.

In a hunter gatherer / paleo / evolutionary context this would mean that we would make an investment (i.e. effort / time / hassle that we could have otherwise spent having fun, procreating or looking after our family) to travel to new places where food was plentiful and easier to obtain.

In these new areas we could spend as little time as possible hunting and gathering and more time relaxing. Once the food became scarce again we would move on to find another ‘land of plenty’.

The people who were good at obtaining the maximum amount of food with the minimum amount of effort survived and thrived and populated the world, and thus became our ancestors. Those that didnt’ didn’t.

You can see how the OFT paradigm would be well imprinted on our psyche.

OFT in the wild

In the wild, OFT means that native hunter gatherers would have gone bananas for bananas when they were available…

… gone to extraordinary lengths to obtain energy dense honey …

… and eaten the fattiest cuts of meat and offal, giving the muscle meat to the dogs.

OFT in captivity

But what happens when we translate OFT into a modern context?

Until recently we have never had the situation where nutrition and energy could be separated.

In nature, if something tastes good it is generally good for you.

Our ancestors, at least the ones that survived, grew to understand that as a general rule:

sweet = good = energy to survive winter

But now we have entered a brave new world.

We are now surrounded by energy dense hyperpalatable foods that are designed to taste good without providing substantial levels of nutrients.

Our primal programming is defenceless to these foods. Our willpower or our calorie counting apps are no match for engineered foods optimised for bliss point.

These days diabetes is becoming a bigger problem than starvation in the developing world due to a lack of nutritional value in the the foods they are eating.^[3]

The recent industrialisation of the world food system has resulted in a nutritional transition in which developing nations are simultaneously experiencing undernutrition and obesity.

In addition, an abundance of inexpensive, high-density foods laden with sugar and fats is available to a population that expends little energy to obtain such large numbers of calories.

Furthermore, the abundant variety of ultra processed foods overrides the sensory-specific satiety mechanism, thus leading to overconsumption.”^[4]

what happens when we go low fat?

So if the problem is simply that we eat too many calories, one solution is to reduce the energy density of our food by avoiding fat, which is the most energy dense of the macronutrients.

Sounds logical, right?

The satiety index demonstrates that there is some basis to the concept that we feel more full with lower energy density, high fibre, high protein foods.^[5] ^[6] The chart below shows how hungry people report being in the two hours after being fed 1000 kJ of different foods (see the low energy density high nutrient density foods for weight loss article for more on this complex and intriguing topic).

However the problem comes when we focus on reducing fat (along with perhaps reduced cost, increased shelf life and palatability combined with an attempt to reach that optimal bliss point ^[7]), we end up with cheap manufactured food like products that have little nutritional value.

Grain subsidies were brought in to establish and promote cheap ways to feed people to prevent starvation with cheap calories.^[8] It seems now they’ve achieved that goal.^[9]

Maybe a little too well.

The foods lowest in fat however are not necessarily the most nutrient dense. Nutritional excellence and macronutrients are are not necessarily related.

In his blog post Overeating and Brain Evolution: The Omnivore’s REAL Dilemma Robb Wolf says:

I am pretty burned out on the protein, carbs, fat shindig. I’m starting to think that framework creates more confusion than answers.

Thinking about optimum foraging theory, palate novelty and a few related topics will (hopefully) provide a much better framework for folks to affect positive change.

The chart below shows a comparison of the micronutrients provided by the least nutrient dense 10% of foods versus the most nutrient dense foods compared to the average of all foods available in the USDA foods database.

The quantity of essential nutrients you can get with the same amount of energy is massive! If eating is about obtaining adequate nutrients then the quality of our food, not just macronutrients or calories matters greatly!

Another problem with simply avoiding fat is that the foods lowest in fat are also the most insulinogenic, so we’re left with foods that don’t satiate us with nutrients and also raise our insulin levels. The chart below shows that the least nutrient dense food are also the most insulinogenic.

what happens when we go low carb?

So the obvious thing to do is eliminate all carbohydrates because low fat was such a failure. Right?

So we swing to the other extreme and avoid all carbohydrates and enjoy fat ad libitum to make up for lost time.

The problem again is that at the other extreme of the macronutrient pendulum we may find that we have limited nutrients.

The chart below shows a comparison of the nutrient density of different dietary approaches showing that a super high fat therapeutic ketogenic approach may not be ideal for everyone, at least in terms of nutrient density. High fat foods are not always the most nutrient dense and can also, just like low fat foods, be engineered to be hyperpalatable to help us to eat more of them.

The chart below shows the relationship (or lack thereof) between the percentage of fat in our food and the nutrient density. Simply avoiding or binging on fat does not ensure we are optimising our nutrition.

While many people find that their appetite is normalised whey they reduce the insulin load of their diet high fat foods are more energy dense so it can be easy to overdo the high fat dairy and nuts if you’re one of the unlucky people whose appetite doesn’t disappear.

what happens when we go paleo?

So if the ‘paleo diet’ worked so well for paleo peeps then maybe we should retreat back there? Back to the plantains, the honey and the fattiest cuts of meat?

Well, maybe. Maybe not.

For some people ‘going paleo’ works really well. Particularly if you’re really active.

Nutrient dense, energy dense whole foods work really well if you’re also going to the CrossFit Box to hang out with your best buds five times a week.

But for the rest of us that aren’t insanely active, then maybe simply ‘going paleo’ is not the best option…

… particularly if we start tucking into the energy dense ‘paleo comfort foods’.

If we’re not so active, then intentionally limiting our exposure to highly energy dense hyperpalatable foods can be a useful way to manage our OFT programming.

enter nutrient density

A lot of people find that nutrient dense non-starchy veggies, or even simply going “plant based”, works really well, particularly if you have some excess body fat (and maybe even stored protein) that you want to contribute to your daily energy expenditure.

Limiting ourselves to the most nutrient dense foods (in terms of nutrients per calorie) enables us to sidestep the trap of modern foods which have separated nutrients and energy. Nutrient dense foods also boost our mitochondrial function, and fuel the fat burning Krebs cycle so we can be less dependent on a regular sugar hit to make us feel good (Cori cycle).

Limiting yourself to nutrient dense foods (i.e. nutrients per calorie) is a great way to reverse engineer optimal foraging theory.

If your problem is that energy dense low nutrient density hyperpalatable foods are just too easy to overeat, then actively constraining your foods to those that have the highest nutrients per calorie could help manage the negative effects of OFT that are engrained in our system by imposing an external constraint.

But if you’re a lean Ironman triathlete these foods are probably not going to get you through. You will need more energy than you can easily obtain from nutrient dense spinach and broccoli.

optimal rehabilitation plan?

So while there is no one size fits all solution, it seems that we have some useful principles that we can use to shortlist our food selection.

We are hardwired to get the maximum amount of energy with the least amount of effort (i.e. optimal foraging theory).
Commercialised manufactured foods have separated nutrients from food and made it very easy to obtain a lot of energy with a small investment.
Eliminating fat can leave us with cheap hyperpalatable grain-based fat free highly insulinogenic foods that will leave us with spiralling insulin and blood glucose levels.
Eating nutrient dense whole foods is a great discipline, but we still need to tailor our energy density to our situation (i.e. weight loss vs athlete).

the solution

So I think we have three useful quantitative parameters with which to optimise our food choices to suit our current situation:

insulin load (which helps as to normalise our blood glucose levels),
nutrient density (which helps us make sure we are getting the most nutrients per calorie possible), and
energy density (helps us to manage the impulses of OFT in the modern world).

I have used a multi criteria analysis to rank the foods for each goal. The chart below shows the weightings used for each approach.

The lists of optimal foods below have been developed to help you manage your primal impulses. The table below contains links to seperate blog posts and printable .pdfs for a range of dietary approaches that may be of interest depending on your goals and situation.

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

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

I hope this helps. Good luck out there!

post last updated May 2017

references

^[1] http://ketosummit.com/

^[2] https://en.wikipedia.org/wiki/Optimal_foraging_theory

^[3] http://www.hoajonline.com/obesity/2052-5966/2/2

^[4] https://www.ncbi.nlm.nih.gov/pubmed/24564590

^[5] http://nutritiondata.self.com/topics/fullness-factor

^[6] https://www.ncbi.nlm.nih.gov/pubmed/7498104

^[7] https://www.nextnature.net/2013/02/how-food-scientists-engineer-the-bliss-point-in-junk-food/

^[8] https://en.wikipedia.org/wiki/Agricultural_subsidy

^[9] http://blog.diabeticcare.com/diabetes-obesity-growth-trend-u-s/

healthy foods, nutrient density

the most nutrient dense autoimmune friendly foods

October 17, 2016 Marty Kendall 19 Comments

An “autoimmune disease” develops when your immune system, which defends your body against disease, decides your own healthy cells are foreign. As a result, your immune system attacks healthy body cells.^[1]

The list of diseases that are said to be autoimmune related are extensive,^[2] ^[3] and to add insult to injury, people with autoimmune issues often end up with challenging digestive issues.

An autoimmune dietary protocol eliminates foods that can trigger inflammation in people with more sensitive digestion that may be autoimmune related. The foods typically eliminated include nuts, seeds, beans, grains, artificial sweeteners, dairy, alcohol, chocolate and nightshades.

The remaining foods largely involve vegetables, seafood and animal products. Given that Type 1 Diabetes is an autoimmune condition I have also created a lower insulin load diabetes friendly autoimmune list of foods that that will be more gentle on blood glucose levels.

Although sticking to the autoimmune friendly list of foods is somewhat restrictive it is a very nutrient dense approach compared to other options as you can see in the comparison of the nutrient density of different nutritional approaches in the chart below where it came in at #2 of the thirteen approaches analysed. The nutrients provided by these foods in comparison to the USDA foods database is shown below.

The nutrient density of the diabetes friendly list is shown below.

An autoimmune protocol is often a short term ‘reset’ where inflammatory foods are eliminated for a period. Once things settle down potential other possible trigger foods are slowly reintroduced to see which foods can be tolerated.

For more information see Robb Woolf’s The Paleo Solution, Sarah Ballantyne’s The Paleo Approach or Chris Kresser The Paleo Cure.

The foods listed below represent the top 10% of the USDA food database using this ranking system. Also included in the table are the nutrient density score, percentage of insulinogenic calories, insulin load, energy density and the multicriteria analysis score (MCA) that combines all these factors.

autoimmune protocol (nutrient dense)

vegetables, spices and fruit

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g	MCA
endive	11	23%	1	17	3.0
chicory greens	11	23%	2	23	2.9
spinach	12	49%	4	23	2.8
watercress	13	65%	2	11	2.8
dandelion greens	11	54%	7	45	2.5
beet greens	9	35%	2	22	2.4
basil	10	47%	3	23	2.4
escarole	8	24%	1	19	2.4
chard	10	51%	3	19	2.4
asparagus	10	50%	3	22	2.4
zucchini	9	40%	2	17	2.4
arugula	9	45%	3	25	2.3
lettuce	10	50%	2	15	2.3
Chinese cabbage	10	54%	2	12	2.2
sage	7	26%	26	315	2.2
alfalfa	7	19%	1	23	2.2
parsley	9	48%	5	36	2.1
curry powder	6	13%	14	325	2.1
summer squash	8	45%	2	19	2.0
okra	8	50%	3	22	2.0
paprika	6	27%	26	282	2.0
cloves	7	35%	35	274	1.9
broccoli	8	50%	5	35	1.9
collards	7	37%	4	33	1.9
turnip greens	7	44%	4	29	1.8
thyme	6	34%	31	276	1.8
brown mushrooms	9	73%	5	22	1.8
cucumber	6	39%	1	12	1.7
chives	7	48%	4	30	1.7
celery	7	50%	3	18	1.6
artichokes	6	49%	7	47	1.6
cabbage	7	55%	4	23	1.6
marjoram	5	31%	27	271	1.6
cauliflower	6	50%	4	25	1.6
sauerkraut	5	39%	2	19	1.5
portabella mushrooms	6	55%	5	29	1.5
edamame	5	41%	13	121	1.5
poppy seeds	3	17%	23	525	1.4
shiitake mushroom	6	58%	7	39	1.4
white mushroom	7	65%	5	22	1.4
celery flakes	6	53%	42	319	1.4
seaweed (wakame)	8	79%	11	45	1.3
radicchio	6	67%	4	23	1.3
rhubarb	5	55%	3	21	1.2
kale	6	60%	5	28	1.2
bamboo shoots	6	60%	5	27	1.2
radishes	4	43%	2	16	1.2
yeast extract spread	5	59%	27	185	1.2
seaweed (kelp)	7	77%	10	43	1.2
turnips	5	51%	3	21	1.2
Brussel sprouts	4	50%	6	42	1.1
Rutabagas, raw	5	57%	6	37	1.1
chayote	3	40%	3	24	1.1
onions	5	65%	6	32	1.0
blackberries	2	27%	3	43	1.0
tarragon	4	62%	56	295	0.9
pumpkin	6	76%	4	20	0.9
carrots	4	61%	4	23	0.9
peas	4	65%	7	42	0.9
spirulina	5	70%	6	26	0.8
avocado	-0	8%	3	160	0.8
red cabbage	3	55%	5	29	0.8

seafood

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g	MCA
fish roe	9	47%	18	143	2.2
caviar	6	33%	23	264	1.8
mackerel	4	14%	10	305	1.6
trout	6	45%	18	168	1.6
salmon	7	52%	20	156	1.6
flounder	7	57%	12	86	1.6
oyster	7	59%	14	102	1.5
cod	8	71%	48	290	1.5
sardine	5	37%	19	208	1.5
sturgeon	6	49%	16	135	1.5
halibut	7	66%	17	111	1.5
crayfish	7	67%	13	82	1.5
crab	8	71%	14	83	1.4
cisco	4	29%	13	177	1.4
pollock	7	69%	18	111	1.4
perch	6	62%	14	96	1.3
rockfish	7	66%	17	109	1.3
anchovy	4	44%	22	210	1.3
lobster	7	71%	15	89	1.2
herring	3	36%	19	217	1.2
shrimp	6	69%	19	119	1.1
whiting	6	66%	18	116	1.1
haddock	6	71%	19	116	1.1
white fish	6	70%	18	108	1.1
clam	5	73%	25	142	0.9

animal products

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g	MCA
beef brains	4	22%	8	151	1.6
lamb liver	5	48%	20	168	1.3
ham (lean only)	5	59%	17	113	1.1
lamb kidney	4	52%	15	112	1.1
turkey ham	3	45%	14	124	1.0
lamb sweetbread	3	43%	15	144	1.0
turkey liver	3	47%	21	189	1.0
lamb brains	2	27%	10	154	0.9
ground turkey	1	30%	19	258	0.8
turkey (skinless)	2	40%	16	170	0.8
turkey heart	3	47%	20	174	0.8
roast ham	2	41%	18	178	0.8

autoimmune protocol (diabetes friendly)

Vegetables, spices and fruit

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g	MCA
endive	14	23%	1	17	2.5
chicory greens	13	23%	2	23	2.3
escarole	11	24%	1	19	2.1
alfalfa	10	19%	1	23	2.1
curry powder	6	13%	14	325	1.8
beet greens	11	35%	2	22	1.8
spinach	13	49%	4	23	1.7
zucchini	11	40%	2	17	1.7
paprika	7	27%	26	282	1.6
arugula	12	45%	3	25	1.6
basil	12	47%	3	23	1.6
sage	7	26%	26	315	1.6
asparagus	12	50%	3	22	1.5
chard	12	51%	3	19	1.4
watercress	15	65%	2	11	1.4
parsley	11	48%	5	36	1.4
avocado	0	8%	3	160	1.4
cucumber	8	39%	1	12	1.4
lettuce	11	50%	2	15	1.4
poppy seeds	3	17%	23	525	1.4
collards	7	37%	4	33	1.4
summer squash	9	45%	2	19	1.3
cloves	7	35%	35	274	1.3
broccoli	10	50%	5	35	1.3
thyme	6	34%	31	276	1.3
olives	-2	3%	1	145	1.3
dandelion greens	11	54%	7	45	1.3
okra	10	50%	3	22	1.3
Chinese cabbage	10	54%	2	12	1.2
marjoram	4	31%	27	271	1.2
chives	8	48%	4	30	1.2
turnip greens	7	44%	4	29	1.2
sauerkraut	6	39%	2	19	1.1
celery	8	50%	3	18	1.1
blackberries	3	27%	3	43	1.1
cauliflower	8	50%	4	25	1.1
chayote	5	40%	3	24	1.1
portabella mushrooms	9	55%	5	29	1.0
edamame	5	41%	13	121	1.0
radishes	5	43%	2	16	1.0
artichokes	7	49%	7	47	1.0
brown mushrooms	13	73%	5	22	1.0
shiitake mushroom	9	58%	7	39	0.9
raspberries	1	30%	4	52	0.9
cabbage	7	55%	4	23	0.9

seafood

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g	MCA
mackerel	3	14%	10	305	1.5
caviar	8	33%	23	264	1.5
fish roe	9	47%	18	143	1.3
cisco	3	29%	13	177	1.1
trout	7	45%	18	168	1.1
sardine	5	37%	19	208	1.1
oyster	9	59%	14	102	1.0
herring	3	36%	19	217	0.9
salmon	7	52%	20	156	0.9
sturgeon	6	49%	16	135	0.9
anchovy	5	44%	22	210	0.9

animal products

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g	MCA
beef brains	5	22%	8	151	1.5
lamb brains	3	27%	10	154	1.2
lamb liver	8	48%	20	168	1.1
sweetbread	-2	12%	9	318	1.1
liver sausage	-2	13%	10	331	1.0
turkey bacon	-1	19%	11	226	1.0
bacon	-3	11%	11	417	1.0
meatballs	-1	19%	14	286	1.0
kielbasa	-2	15%	12	325	0.9
bratwurst	-2	16%	13	333	0.9
ground turkey	2	30%	19	258	0.9
salami	-1	18%	17	378	0.9
turkey	-1	20%	21	414	0.9
turkey liver	6	47%	21	189	0.9
ham	1	29%	11	149	0.9
pepperoni	-3	13%	16	504	0.9
headcheese	-2	20%	8	157	0.9
lamb kidney	7	52%	15	112	0.9
bologna	-4	11%	9	310	0.9
pork ribs	-2	18%	16	361	0.9
bologna	-0	26%	11	172	0.9
pork sausage	-0	25%	13	217	0.9
pork sausage	-2	20%	16	325	0.8
knackwurst	-3	16%	12	307	0.8
turkey drumstick (with skin)	0	28%	15	221	0.8
chorizo	-2	17%	19	455	0.8
chicken liver pate	1	34%	17	201	0.8

other dietary approaches

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

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

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

references

^[1] http://www.healthline.com/health/autoimmune-disorders

^[2] https://en.wikipedia.org/wiki/Autoimmune_disease

^[3] https://www.aarda.org/disease-list/

articles, foods, insulin load, insulin resisatnce, insulin resistance, weight loss

nutrient dense foods for weight loss and insulin resistance

October 10, 2016 Marty Kendall 70 Comments

I found a number of people that were using the a combination of the optimal foods for diabetes and nutritional ketosis and the optimal foods for weight loss lists. So I thought it would be useful to combine the two approaches into a single list of foods for people who want to lose weight but who were still somewhat insulin resistant.

optimal foods for diabetes and nutritional ketosis

The food ranking system revolves around manipulating these three parameters to suit different goals:

The optimal foods for diabetes and nutritional ketosis list has a low insulin load, is fairly low in non-fibre carbs and moderately high fat while still being as nutrient dense as possible.

This approach suits someone who has Type 1 Diabetes or is lean and looking to achieve nutritional ketosis. People who are at their goal weight can afford to eat a little more added dietary fat.

While most people looking to manage their blood glucose levels limit their carbohydrates to some arbitrary number that works for them, maximising nutrient density as well will help you to improve your mitochondrial function and increase your energy levels to ideally overcome your insulin resistance. Maximising nutrient density also means that your body won’t keep on seeking out more and more food to obtain the nutrients it requires.

People who are very insulin resistant often do well on a higher fat dietary approach initially to let the insulin levels drop, however they often find further success in the long term if they drop their dietary fat to let more fat come from their body.

optimal foods for weight loss

The optimal foods for weight loss list is fairly low in dietary fat to allow for to come form the body during weight loss. It’s heavy in lean proteins and non-starchy veggies and is VERY nutrient dense. The chart below shows a comparison of a range of dietary approaches with the insulin sensitive weight loss approach being having the highest nutrient density while the diabetes and nutritional ketosis approach comes in at #8 of thirteen.

This list of foods may look like a low fat dietary approach, but it’s not really low fat once you factor in your body fat. The chart from Steve Phinney illustrates how your body fat makes a contribution to the weight loss phase of a well formulated ketogenic diet.

The weight loss list of foods is also quite bulky (i.e. lots of fibre and water) so they would be very hard to overeat if you stick to just these foods. The chart below show a comparison of the various approaches with the weight loss approach having the lowest energy density.

Eating from the weight loss foods basically equates to a protein sparing modified fast (which is widely held to be the most effect way to lose weight in the long term) meaning that will fill you up so much you won’t be above to overeat while at the same time providing enough protein to preserve lean muscle mass during the weight loss phase.

The “problem” with the aggressive weight loss approach is that it is very low in energy dense comfort foods and it is higher in carbohydrates and protein than most low carbers might be used to, so it might be harder to stick to. It may also raise your blood glucose levels if you’re still somewhat insulin resistant.

finding the optimal balance between the extremes

I have designed this list of foods for people who are insulin resistant and also looking to lose weight provides a balance between both extremes – high nutrient density, lowish levels of dietary fat and lower energy density.

The foods listed below represent the top 10% of the USDA food database using this ranking system. I’ve included the nutrient density score, percentage of insulinogenic calories, insulin load (per 100g), energy density (per 100g) and the multicriteria analysis score score (MCA) that combines all these factors.

The chart below shows the amount of each nutrient provided by the more balanced approach compared to average of all the foods in the USDA food database. As you can see you will still be able to obtain heaps of nutrients while the fat comes from your body.

vegetables

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g	MCA
broccoli	23	36%	3	22	2.07
endive	15	23%	1	17	1.84
coriander	16	30%	2	23	1.79
zucchini	18	40%	2	17	1.75
chicory greens	14	23%	2	23	1.74
spinach	20	49%	4	23	1.66
escarole	11	24%	1	19	1.58
basil	17	47%	3	23	1.55
alfalfa	9	19%	1	23	1.51
watercress	22	65%	2	11	1.51
beet greens	13	35%	2	22	1.49
asparagus	16	50%	3	22	1.44
lettuce	14	50%	2	15	1.33
Chinese cabbage	15	54%	2	12	1.29
summer squash	12	45%	2	19	1.26
okra	13	50%	3	22	1.26
parsley	13	48%	5	36	1.25
cauliflower	13	50%	4	25	1.23
chard	13	51%	3	19	1.22
portabella mushrooms	14	55%	5	29	1.20
mustard greens	9	36%	3	27	1.20
arugula	11	45%	3	25	1.17
turnip greens	10	44%	4	29	1.17
chives	11	48%	4	30	1.14
banana pepper	8	36%	3	27	1.13
paprika	9	27%	26	282	1.11
cucumber	7	39%	1	12	1.08
pickles	7	39%	1	12	1.08
collards	7	37%	4	33	1.07
celery	10	50%	3	18	1.03
brown mushrooms	16	73%	5	22	1.01
avocado	-0	8%	3	160	0.99
white mushroom	13	65%	5	22	0.99
shitake mushroom	12	58%	7	39	0.98
red peppers	6	40%	3	31	0.98
dandelion greens	10	54%	7	45	0.97
sauerkraut	5	39%	2	19	0.96
dill	11	59%	8	43	0.96
eggplant	4	35%	3	25	0.95
cloves	9	35%	35	274	0.95
radishes	6	43%	2	16	0.94
sage	7	26%	26	315	0.93
jalapeno peppers	5	37%	3	27	0.93
curry powder	3	13%	14	325	0.92
edamame	7	41%	13	121	0.89
chayote	5	40%	3	24	0.88
olives	-5	3%	1	145	0.80
Brussel sprouts	6	50%	6	42	0.78
spirulina	11	70%	6	26	0.76
soybeans (sprouted)	6	49%	12	81	0.76
cabbage	7	55%	4	23	0.75
blackberries	-1	27%	3	43	0.71
artichokes	5	49%	7	47	0.71

seafood

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g	MCA
fish roe	18	47%	18	143	1.45
salmon	19	52%	20	156	1.44
trout	16	45%	18	168	1.36
caviar	13	33%	23	264	1.25
oyster	16	59%	14	102	1.19
cisco	9	29%	13	177	1.17
sturgeon	13	49%	16	135	1.13
mackerel	6	14%	10	305	1.08
anchovy	12	44%	22	210	1.08
crab	17	71%	14	83	1.01
sardines	9	36%	16	185	1.01
flounder	13	57%	12	86	1.01
herring	9	36%	19	217	0.97
sardine	9	37%	19	208	1.0
halibut	15	66%	17	111	0.96
tuna	12	52%	23	184	0.91
rockfish	13	66%	17	109	0.86
lobster	14	71%	15	89	0.85
crayfish	12	67%	13	82	0.82
shrimp	13	69%	19	119	0.81
pollock	13	69%	18	111	0.79
perch	10	62%	14	96	0.73

animal products

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g	MCA
lamb liver	19	48%	20	168	1.47
lamb kidney	19	52%	15	112	1.45
turkey liver	16	47%	21	189	1.25
beef brains	8	22%	8	151	1.24
veal liver	17	55%	26	192	1.20
beef liver	17	59%	25	175	1.14
chicken liver	14	50%	20	172	1.13
beef kidney	14	52%	20	157	1.10
lamb brains	6	27%	10	154	1.05
chicken liver pate	7	34%	17	201	0.91
lamb heart	10	48%	19	161	0.90
ham	12	59%	17	113	0.88
ground turkey	6	30%	19	258	0.88
turkey heart	9	47%	20	174	0.85
rib eye steak	8	41%	21	210	0.84
roast pork	7	41%	20	199	0.83
roast beef	7	38%	21	219	0.83
beef tongue	1	16%	11	284	0.81
lamb sweetbread	6	43%	15	144	0.79
lamb chop	8	42%	25	234	0.79
lean beef	11	61%	23	149	0.78
beef heart	9	52%	23	179	0.78
park sausage	2	25%	13	217	0.78
pork liver	11	59%	23	165	0.77
turkey meat	8	52%	21	158	0.74
turkey drumstick	8	52%	21	158	0.74
chicken	10	60%	22	148	0.73

dairy and egg

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g	MCA
whole egg	9	30%	10	143	1.20
egg yolk	8	18%	12	275	1.15
sour cream	2	13%	6	198	1.02
cream	2	6%	5	340	0.93
cream cheese	2	11%	10	350	0.84
Swiss cheese	5	22%	22	393	0.80
cheddar cheese	5	20%	20	410	0.78
Greek yogurt	3	37%	9	97	0.74

other dietary approaches

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

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

athletes, nutrient density, recipes

Dom D’Agostino’s breakfast – sardines, oysters, eggs and broccoli

August 15, 2016 Marty Kendall 19 Comments

At first it sounds like a bizarre combination, but when the smartest guy in keto says that he has sardines, oysters, eggs and broccoli (which is high in sulforaphane, which Rhonda Patrick is also a big fan of) as his regular breakfast I wasn’t surprised to find this diet scored highly in the nutritional analysis.

Before he started saving the world by developing Warburg’s mitochondrial theory of cancer and oxygen toxicity seizures for DARPA Dominic D’Agostino studied nutrition and is rumoured to be able to do a 500 pound deadlift for 10 reps after a week of fasting.

Both physical and mental performance are undoubtedly critical to Dom, so it’s not surprising that he is very intentional about his diet and and what he puts in his mouth to start each day.

As you can see in the plot from Nutrition Data below Dom’s breakfast scores a very high 93 in the vitamins and minerals score and a very solid 139 in the protein score.

You could say this meal was high protein (44%), low carb (10%) and moderate fat (46%), although his fatty coffee and high fat deserts would boost the fat content to make it more “ketogenic”.

Dom’s breakfast scores well against the 250 meals analysed to date in the meal rankings for different goals coming in at:

therapeutic ketosis – 176
diabetes and nutritional ketosis – 87
nutrient density – 9
weight loss – 16

I’ve heard Dom say that he aims for a ‘modified Atkins’ approach with higher protein levels rather than a classical therapeutic ketogenic diet which is harder to stick to and might be used for people with epilepsy, cancer, dementia etc. It was intriguing to see that Dom’s standard breakfast ranks the highest in nutrient density rather than therapeutic or nutritional ketosis.

Dom first mentioned his favourite breakfast concoction in his first interview with Tim Ferriss (check out the excellent three hour podcast here). You can hear the shock and slight repulsion in Tim’s voice in the sound check as he responds with

“Do you blend that up in the Vitamix?”

But now Tim, rather than following his own slow carb approach, has made sardines and oysters a regular breakfast staple and mentions it as one of the top 25 great things he learned from podcasts guests in 2015.

The stats for a 500 calorie serve of Dom’s breakfast are shown in the table below.

net carbs	insulin load	carb insulin	fat	protein	fibre
6g	38g	18%	46%	44%	6g

I was aware that broccoli, eggs and sardines are nutritionally amazing, but then the oysters fill out the vitamin and mineral score to take it a little bit higher. Dom obviously understands the importance of Omega 3s which are hard to get in significant quantities from anything other than seafood.

I was surprised to see that oysters can be ‘carby’ (at 23% carbs) which is apparently due to their glucose pouch which varies in size depending when they’re harvested.

If you wanted to skip the oysters due to taste or cost considerations, the combination of sardines, egg and broccoli still does pretty well. This option gives less carbs, a slight decrease in the vitamin and mineral score with an slight increase in the amino acid score.

The ranking for the sans-oyster option is:

therapeutic ketosis – 159
diabetes and nutritional ketosis – 67
nutrient density – 11
weight loss – 20

The stats for a 500 calorie serving are:

net carbs	insulin load	carb insulin	fat	protein	fibre
3g	30g	10%	48%	44%	6g

The combination of nutrient dense seafood with nutrient dense vegetables is hard to beat. The chart below shows my comparison of the nutrients in the various food groups in terms the proportion of the Daily Recommended Intake (DRI) from 2000 calories (click to enlarge).

I couldn’t get any photos of Dom’s breakfast, but I did get a photo of my current go to lunch. Each weekend I get a bunch of good quality celery and chop it up into tubs to take to work each day. I have cans of mackerel and sardines in my drawer at work.

Celery does really well in terms of nutrient density per calorie and sardines and mackerel are high on the nutrient density lists without being outrageously expensive (e.g. caviar, anchovy, swordfish, trout).

When I feel hungry I might start munching on the celery which is pretty filling and hard to binge on. Then if I’m still hungry I’ll have as many cans of mackerel or sardines as it takes to fill me up (which is usually 2 to 4).

At around 2pm this is my first meal of the day (other than espresso shots with cream) at around 2pm. If I start to feel hungry before then I might check my blood glucose to see if I really need to refuel or if I think I’m hungry because I’m bored. I’ll then go home and have an early dinner with the family around 6pm.

I’ve been known to indulge in some peanut butter with, cream, Greek yogurt or even butter if I’m still hungry (e.g. if I’ve ridden to work) but I try to not overdo it as I’m not as shredded as Dom yet.

The simple combination of celery and mackerel also does pretty well in the ranking of 250 meals and aligns well with my current goal of maximising nutrient density and ongoing weight loss now that I’ve been able to stabilise my blood glucose levels.

therapeutic ketosis – 137
diabetes and nutritional ketosis – 36
nutrient density – 16
weight loss – 8

net carbs	insulin load	carb insulin	fat	protein	fibre
8g	33g	25%	51%	35%	6g

articles, diabetes, nutrient density, weight loss

choosing the right sized low carb band aid

May 30, 2016 Marty Kendall 34 Comments

This article identifies nutrient dense low insulin load foods that can help to stabilise your blood glucose levels and allow your own pancreas to keep up.
Once you normalise your blood glucose and lose some weight the progressive addition of nutrient dense low energy density foods may help continue your weight loss and improve your metabolic health.

how important is insulin sensitivity?

Managing your blood glucose levels through diet seems to be a major issue, if not THE most significant issue when it comes to health, longevity and reducing your risk of the leading causes of death (i.e. heart attack, stroke, cancer, Alzheimer’s and Parkinson’s Disease).^{^[1]}

As indicated by the charts below the lowest risk of the diseases associated with metabolic disease occurs when your HbA1c is less than 5% (i.e. an average blood glucose levels less than 100 mg/dL or 5.4 mmol/L).^{^[2]}

Insulin is an anabolic hormone that helps store nutrients and prevent their breakdown. High levels of insulin (hyperinsulinemia) can lead to excess fat storage. Excess insulin can also prevents us from accessing stored body fat.

is low carb the best approach for everyone?

There are people who will argue that you can eat as much fat as you want.

At the same time there are people who will argue that you can eat as much protein as you want.

And you guessed it, there are also people who argue that you can eat as much carbohydrate as you want.

So who is right?

It seems that Christopher Gardner’s recent study Weight loss on low-fat vs. low-carbohydrate diets by insulin resistance status among overweight adults and adults with obesity: A randomized pilot trial^{^[3]} might bring some clarity to the macro nutrient wars.^{^[4]}

As always, context matters.

It seems that there is no one single approach that is optimal for everyone all the time.

As well as encouraging participants to eat nutrient dense whole foods, Gardener’s study divided the participants up based on their insulin sensitivity and asked them to restrict carbohydrates or restrict fat as much as they could over a period of six months living in the real world without tracking calories.

As you can see from the chart below:

everyone did well when they increased their intake of nutrient dense whole foods;
participants who were insulin sensitive did better on the low energy density low fat foods; while
those where were insulin resistant did better on the low carbohydrate low insulin load foods.

This observation from Gardener’s study also aligns with the findings of the results of a 2005 study Insulin Sensitivity Determines the Effectiveness of Dietary Macronutrient Composition on Weight Loss in Obese Women (Cornier et al, 2005)^{^[5]} which also found that people who were insulin resistant did better with LCHF while those who were insulin sensitive did better on the HCLF approach.

Similarly, people who are insulin resistant improve their fatty liver on a low GI diet.^{^[6]}

Again, the results from Pitas (2005) show that people who are insulin sensitive lose more weight on a high glycemic diet while the people who were insulin resistant lose more on the low glycemic load diet.

In this video David Ludwig explains why someone who is insulin resistant might do better with a reduced carbohydrate approach.

am I insulin resistant?

So the obvious question then is whether or not you are insulin resistant and how do you tell?

Insulin resistance, and the compensatory hyperinsulinemia that follows, appear to be caused primarily by excess body fat, particularly around the abdomen and organs, which leads to inflammation, insulin resistance and elevated blood glucose levels.^{^[7]}

So if you have big belly there’s a pretty good chance you are also insulin resistant and have elevated blood glucose and / or high insulin levels. So having a waist circumference greater than half your height is a good indication you are insulin resistant.^{^[8]} ^{^[9]} ^{^[10]}

Unfortunately your size is not a perfect indicator of your metabolic health. Some people manage to store more fat before inflammation and insulin resistance sets in.^{^[11]} These people are called metabolically healthy obese.^{^[12]} Conversely some people can look thin on the outside but still have fat around their organs which causes insulin resistance. These people are called TOFIs (thin outside, fat inside).^{^[13]}

A more accurate way to ascertain if you are insulin resistant is to test your blood glucose levels. If your blood glucose levels are consistently above 5.0mmol/L or 90 mg/dL before meals then you might have a problem. If you wanted to get more serious you could get a fasting insulin test, a HOMA-IR test, test your glucose : ketone ratio or get an oral glucose tolerance test.

If you have elevated blood glucose and insulin levels you probably need to eat less processed carbohydrates. If you are obese but have great blood glucose levels then it’s probably time to incorporate some more lower energy density higher nutrient density foods to help you reduce your calorie intake.

nutrient dense low carb foods for blood glucose control

For most people, the nutrient dense foods shown in the ‘building a better nutrient density’ article would be a major improvement.

People who are insulin sensitive but still want to lose weight would do well with low calorie density high nutrient density foods.

However, for someone who is insulin resistant, the most nutrient dense foods, which have about 50% insulinogenic calories, may lead to unacceptable blood glucose swings. People who are unable to produce enough insulin or are insulin resistant need to manage their insulin budget and make sure that the insulinogenic foods that they do eat maximise nutrient density in order to provide adequate amino acids for muscle growth and repair and sufficient vitamins and minerals.

Where this gets more interesting is when we combine nutrient density with the proportion of insulinogenic calories to optimise both glucose levels and nutrient density. Listed below is a summary of the top 1000 foods of the 7000+ foods in the USDA database when we prioritise by both nutrient density and insulin load.

Included in the tables below are a number of parameters that may be useful:

The nutrient density score is based on the number of standard deviations above the average that a particular food is from the average.
The percentage of insulinogenic calories is the proportion of the energy in the food that can turn to glucose and require insulin.
The net carbs per 100g is the amount of digestible non-fibre carbohydrates in the food that can raise your blood glucose levels.
The insulin load is the weight of food per 100g that will require insulin to metabolise.
The energy density is the number of calories per 100g of the food. If you’re watching your weight as well as your blood glucose numbers than keeping the energy density down will also be of interest.

Vegetables

Listed below are the highest ranking vegetables.

While many of these vegetables have a high proportion of insulinogenic calories (i.e. digestible non-fibre carbohydrates that can raise blood glucose levels) they are also highly nutritious and have very low levels of non-carbohydrates and energy per 100g. Most people would have to eat a lot of these to have a significant impact on blood glucose levels.

Most of us would do well to focus on filling up on any of these vegetables to help keep overall calories down to assist with weight loss which is critical for improving insulin resistance. If you typically avoid vegetables due to blood glucose concerns then you could start out slowly and progressively increase your intake of these vegetables while keeping an eye on your blood glucose levels.

food	ND	% insulinogenic	net carbs/100g	insulin load (g/100g)	calories/100g
celery	2.63	49%	1	2	17
turnip greens	1.31	39%	1	4	37
rhubarb	1.46	57%	3	3	21
lettuce	1.34	52%	2	2	17
broccoli	1.21	57%	4	6	42
asparagus	1.12	46%	2	3	27
winter squash	1.22	80%	7	8	39
artichokes	0.83	33%	3	4	54
Chinese cabbage	1.02	60%	1	2	16
okra	0.94	57%	4	5	37
summer squash	1.00	65%	2	3	19
bamboo shoots	0.90	52%	3	4	28
seaweed (kelp)	0.74	43%	4	5	50
bell peppers	0.86	64%	6	7	43
cabbage	0.81	53%	3	4	30
snap green beans	0.74	47%	4	5	40
radishes	0.70	50%	2	2	19
peas	0.69	58%	5	7	51
kale	0.75	74%	8	10	56
dill	0.42	30%	2	4	52
thyme	0.27	21%	14	19	359
mushrooms	0.65	70%	2	5	30
jalapeno peppers	0.52	54%	4	5	35
collards	0.44	46%	2	5	40
paprika	0.19	17%	8	16	389
black pepper	0.24	36%	24	29	327
beets	0.34	44%	4	5	48
chives	0.27	34%	1	3	37
bay leaf	0.21	37%	34	38	406
mung beans	0.33	46%	1	3	26
onions	0.52	77%	7	8	41
mustard greens	0.27	45%	2	3	30

fruit

This list of diabetic friendly fruits is quite short compared to the veggies.

food	ND	% insulinogenic	net carbs/100g	insulin load (g/100g)	calories/100g
olives	0.02	15%	3	3	90
avocado	0.01	18%	5	6	131
raspberries	0.09	42%	6	6	58

nuts, seeds and legumes

The great thing about nuts and seeds is that they have a low percentage of insulinogenic calories and are often low in non-fibre carbohydrates. The drawback is that they have a much higher energy density due to their higher fat content and are not as high in nutrients as the non-starchy green veggies. Keep in mind that you can overdo the nuts if you are keeping an eye on your weight as well as your blood glucose levels.

food	ND	% insulinogenic	net carbs/100g	insulin load (g/100g)	calories/100g
pecans	0.15	5%	4	9	762
pine nuts	0.16	11%	9	18	647
tahini	0.17	16%	13	26	633
peanuts	0.17	18%	7	28	605
sunflower seeds	0.18	20%	11	24	491
macadamia nuts	0.12	5%	5	9	769
hummus	0.26	32%	8	14	175
pistachio nuts	0.16	23%	19	34	602
sesame seeds	0.12	18%	14	27	603
almonds	0.11	16%	15	27	652
brazil nuts	0.09	9%	4	15	704
chia seeds	0.10	16%	8	21	511
tofu	0.17	28%	2	8	112
walnuts	0.10	15%	7	25	683
coconut meat	0.09	11%	16	20	703
hazelnuts	0.10	16%	15	27	692
cashew nuts	0.11	22%	24	33	609
flaxseed	0.08	12%	2	16	568

dairy and eggs

Eggs and cheese are great in terms of proportion of insulinogenic calories. The nutrient density of these foods is above average but not as high as the non-starchy vegetables. As with the nuts, keep in mind that the energy density of these foods is high so it is possible to overdo them if you are keeping an eye on your weight as well as your blood glucose levels.

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g
butter	0.11	0%	1	734
cream cheese	0.15	10%	8	348
goat cheese	0.18	22%	25	451
egg yolk	0.18	19%	15	317
Gruyère cheese	0.18	21%	22	412
sour cream	0.12	9%	4	197
Limburger cheese	0.17	18%	15	327
cream	0.10	5%	5	431
Edam cheese	0.18	22%	20	356
blue cheese	0.17	20%	18	354
Gouda cheese	0.18	23%	20	356
cheddar cheese	0.16	20%	20	403
Muenster cheese	0.16	20%	18	368
Camembert cheese	0.17	20%	15	299
Monterey	0.16	20%	19	373
Colby	0.16	20%	20	394
feta cheese	0.17	22%	14	265
brie cheese	0.15	19%	16	334
provolone	0.17	24%	21	350
Swiss cheese	0.18	26%	25	379
parmesan cheese	0.19	30%	31	411
mozzarella	0.15	23%	18	318
whole egg	0.17	29%	10	138

seafood

Getting an adequate intake of omega 3 essential oils is important and it’s hard to do without eating fish. Higher protein lower fat fish such as cod will require more insulin to process though this is typically not an issue unless you have type 1 diabetes and need to calculate and time your insulin doses or have advanced type 2 where your insulin response is not well matched to your glucagon response from the protein.

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g
caviar	0.30	32%	22	276
anchovy	0.34	42%	21	203
herring	0.26	34%	18	210
sardine	0.24	36%	18	202
swordfish	0.28	41%	17	165
rainbow trout	0.28	43%	17	162
mackerel	0.28	45%	17	149
tuna	0.30	50%	17	137
sturgeon	0.26	47%	15	129
salmon	0.28	50%	15	122

animal products

Higher fat animal products will have a lower insulin response but but they also have a higher energy density. All these foods have more nutrients than average but not as many as the non-starchy vegetables.

food	ND	% insulinogenic	insulin load (g/100g)	calories/100g
chicken liver	0.43	48%	20	165
beef liver	0.46	58%	24	169
bacon	0.18	23%	30	522
pepperoni	0.13	14%	17	487
chorizo	0.15	17%	19	448
foie gras	0.11	11%	13	459
pate	0.13	16%	13	315
beef ribs	0.11	13%	12	349
duck (with skin)	0.12	17%	14	331
salami	0.12	18%	12	258
lamb	0.14	24%	18	308
beef steak	0.16	28%	21	305
frankfurter	0.10	14%	11	322
ground turkey	0.19	37%	19	203
chicken drumstick	0.17	36%	22	238

is low carb a band aid or cure?

Some people say that a reduced carbohydrate approach only addresses the symptom (high blood glucose) rather than the cause (insulin resistance). However, the studies highlighted above suggest that the low carb “band aid” also helps with the healing process (e.g. fat loss).

If you are insulin resistant, then reducing the insulin load of your diet using the foods listed above to the point you achieve excellent blood glucose levels will most likely be helpful.

insulin load (g)=total carbohydrates (g)-fiber (g) + 0.56*protein (g)

As shown in the plots below, it’s the non-fibre carbohydrates, and to a lesser extent the protein, that drives our insulin and blood glucose response to food.

I’ve hit a plateau in my low carb diet, what now?

Let’s say you’re someone who has done well with a low carb diet. You’ve heard the message not to fear fat, reduced your carbs and seen a near miraculous improvement in your blood glucose and insulin levels. But, you haven’t quite reached your goal weight yet.

Listed below is a range of pieces of advice that you might hear given to people in this situation:

Just eat more fat.
Reduce total carbs.
Focus more on nutrient dense low calorie density more satiating foods.
Reduce net carbs.
Reduce the insulin load of your diet.
Eat more fibre.
Exercise more.
Lift heavy things to build lean muscle.
Develop a fasting routine.
Eat more plant based foods.
Get more sunshine.
Get less blue light at night.
Eat only during daylight hours.
Sleep more.
Do some high intensity exercise.
Cut out nuts and dairy.
Track your calories and reduce them until you start losing weight.
Stop stressing about your blood glucose levels so much, you’re just raising your cortisol!
Get another hobby and stop navel gazing so much!

In the list above I’ve crossed out (a) and (b) which I think could be counter productive.

As suggested by the studies noted above, there may be a point as you achieve normal blood glucose levels that someone would benefit from focussing on higher nutrient density and lower energy density rather than just low carbs.

The million-dollar question is, what is the cut over point where you can move on from the LCHF blood glucose rehabilitation approach and start focusing on weight loss in order to further improve your metabolic health?

I think the point at which you deem yourself to have become metabolically flexible is when your average blood glucose levels are less than 100mg/dL or 5.4mmol/L. At this point you will also be starting to show low level blood ketones.^{^[14]} It is at this point you can start adding some of the nutrient dense low energy density foods to see what effect they have on your blood glucose levels.

When to start focussing on high nutrient density low energy density foods

The chart below (click to enlarge) shows a comparison of the nutrient density for the following dietary approaches:

all foods,
high nutrient density foods,
nutrient dense low carbohydrate foods, and
nutrient dense low calorie density foods.

The low carbohydrate foods listed above will be more nutritious compared to the average of all of the foods available. However, if you have normal blood glucose levels it might be a good idea to try to incorporate more nutrient dense low energy density foods that may be more filling and nutritious to help you to continue to progress on your weight loss journey.

If your appetite is influenced by obtaining adequate nutrients from your diet and / or energy density then it may be wise to reduce the carbs in your diet only as much as you need to normalise your blood glucose levels, otherwise you may risk compromising the nutrient density of your diet.

The extent of the carbohydrate restriction (or the size of the band aid required) depends on the extent of the metabolic damage that you have sustained. It may not be sensible to sign up for a full body cast (e.g. very high fat therapeutic ketogenic diet) if you only have a broken toe (e.g. mild insulin resistance).

As you start to heal your insulin resistance you may be able to progress from the higher fat diabetic friendly list of foods above to incorporate more more nutrient dense, lower energy density foods.

Then maybe in the long run, once you optimise your weight loss, you might be able to focus on the most nutrient dense foods for optimal health.

references

^{^[1]} https://optimisingnutrition.com/2016/03/21/wanna-live-forever/

^{^[2]} http://www.diabetes.co.uk/hba1c-to-blood-sugar-level-converter.html

^{^[3]} http://onlinelibrary.wiley.com/doi/10.1002/oby.21331/full

^{^[4]} The results of Gardner’s full study should be available in late 2016.

^{^[5]} http://onlinelibrary.wiley.com/doi/10.1038/oby.2005.79/epdf

^{^[6]} http://ajcn.nutrition.org/content/84/1/136.full.pdf+html

^{^[7]} http://www.ncbi.nlm.nih.gov/pubmed/25515001

^{^[8]} https://en.wikipedia.org/wiki/Waist-to-height_ratio

^{^[9]} https://www.google.com.au/search?q=obesity+code&spell=1&sa=X&ved=0ahUKEwjpg8b94P7LAhUCE5QKHS63AP4QvwUIGSgA&biw=1218&bih=939

^{^[10]} http://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-13-91

^{^[12]} https://en.wikipedia.org/wiki/Metabolically_healthy_obesity

^{^[13]} https://en.wikipedia.org/wiki/TOFI

^{^[14]} https://optimisingnutrition.com/2015/07/20/the-glucose-ketone-relationship/

articles, insulin index, weight loss

insulin load… the greatest thing since carb counting?

May 2, 2016 Marty Kendall 58 Comments

In previous articles I have outlined the idea of the insulin load ^[1] ^[2]which is similar to carbohydrate counting, but also accounts for the effect of protein, fibre ad fructose.

insulin load = total carbohydrates – fibre + 0.56 x protein

show me the data!

Most people understand that dietary carbohydrate is the primary nutrient that influences blood glucose and insulin as shown in the charts below. However, indigestible fibre^{^[3]} and glucogenic amino acids (protein)^{^[4]} ^{^[5]} also affect our blood glucose and our insulin response to food.

We can better predict the insulin and glucose response to our food if we also account for the effect of protein and indigestible carbohydrates (i.e. fibre). People aiming to follow ketogenic diet will want to eat foods towards the bottom left of these charts.

I was pleased to see Jason Fung even mention the food insulin index and the Optimising Nutrition blog at the recent low carb conference in Vail Colorado and it has been great to see a handful of people like Patricia and Mike put this theory into practice with great results as detailed in this article.

Patricia Berry Moore

This comment from Patricia Berry Moore made my day.

Marty! Are you the Low Carb Down Under Marty??!

You and Sarah Hallberg are why I started LCHF. And went from a very unhealthy type 2 diabetic at 156 lbs to a very healthy 113 lbs.

THANK YOU!

Patricia had seen my presentation on the food insulin index, applied the theory, and it worked!

Patricia said:

I use the insulin load concept.

I find it helps me refine my macros. A little less protein a bit more carbs and you can find that sweet spot. For me 50g per day is perfect.

My doctor threatened me with insulin and so I started went digging and found your lectures.

Over 10 months I lost 43 lbs (I’m 5’2″). I was pre-diabetic for ten years and then type 2 diabetic for ten years.

I am now off all my meds. I was on eight different ones for high blood pressure, high cholesterol, arthritis, re-flux, diabetes.

I’m never going back, so thank you!

This is Patricia’s “before photo.” You can see a ‘puffiness’ in her face characteristic of insulin resistance and hyperinsulinemia, which causes fluid retention. I showed this photo to my 12 year old daughter who said “that’s how you used to look.” Thanks dear… I think.

If you’ve hit a plateau it might be worth tracking the insulin load of your food for a while to fine tune your diet. Patricia says:

I use the app Lose it! which helps me track macros. So it’s pretty easy to keep a running total of my insulin load too.

I started at around 80g per day. As I decreased it, my blood sugars improved.

At this point my fasting blood glucose run at 65 – 75 mg/dL with an insulin load around 50g per day or so.

LCHF has really saved my life Marty.

This is Patricia now. Congratulations Patricia!

a little closer to home

As mentioned by my daughter, this is me before and after trying out my low insulin load, high nutrient density foods. I don’t think my hair moved in the 18 months between when these work profile photos were taken, but some inflammation and weight certainly did. My family assures me that at my worst I was bigger and unhealthier looking than the photo on the left!

The photo below on the left is my daughter’s “before photo” after spending 9 months in a high insulin environment. Children born to mothers who are type 1 diabetic and dosing with lots of insulin tend to be delivered early via C-section due to their excessive size caused by the high levels of insulin from the mother. The photo on the right is her twelve years later, all grown up!

The photos below are the same child, “JL,” who was one of the first type 1 diabetic children to receive insulin treatment in 1922. Without insulin he’s wasting away, literally eating his own fat and muscle, unable to metabolise carbohydrate. Two months later the photo on the right shows that he’s been able to make a full recovery with insulin injections.

The photo below is of another Type 1 sufferer before and after receiving exogenous insulin.

Hopefully from these photos you can see how there’s a “Goldilocks zone” for insulin. Not too little. Not too much. Just right. You can use the quantification of insulin load to find your sweet spot.

Mike Alward

I received similar feedback recently from Mike Alward who has also successfully applied the insulin load theory. Mike says:

I just wanted to say thanks for your work on insulin load, food insulin index and glucose : ketone index. It really helped me to understand what was holding me back from reaching and being able to maintain a state of optimal ketosis.

I manage my insulin load to ~75g per day. My BG has come down and my ketones are now in the optimal range. My GKI is now below 3.

I used to be pre-diabetic with blood glucose up around 6.5 mmol/L. Now, I am in the 4.5 – 4.7mmol/L range.

Being in optimal ketosis has helped to control my appetite and cravings (especially sugar), which has made intermittent fasting so much easier.

Keep up this important work!

With this reduced insulin approach Mike is able to accommodate a solid amount of protein into his diet while maintaining excellent blood glucose and ketone levels. Like anything, you can have too much of a good thing, including protein.

Many people find that as their insulin resistance improves they are able to handle a higher insulin load diet which may enable a higher nutrient density and less fat. If you are highly insulin resistant you may need to focus on a very low insulin load, high fat approach. As your blood glucose levels stabilise you will be able to transition to more nutrient dense foods that may have a higher insulin load.

Mike says:

My insulin load target is ~90g – 100g of protein / day. I am 6’0″.

Mike likes to track a range of different health makers.

I track my weight calories, macros, calculated insulin load, blood glucose, blood ketones and GKI.

Not everybody “geeks out” on this stuff. I am totally into “nerd safaris” to research non-conventional wisdom health.

I just got several folks to calculate their insulin load, and their heads almost exploded when I introduced them to GKI.

You can see in the chart below how Mike’s ketones have increased as he has reduced the insulin load of his diet.

The chart below shows how Mike’s glucose : ketone index (an approximation of insulin levels) has decreased as he lowered the insulin load of his diet.

Tracking the insulin load of your diet is a little more complex than just counting carbs, but not that much more work if you’re already tracking your food intake. Personally, I’m not a big fan of tracking everything you eat forever, but it can be useful to keep a food diary for a time to reflect and refine.

If you just want to know what you should eat these lists of optimal foods for different goals may be useful for you.

how to calculate your insulin load

So how do you calculate the insulin load of your diet?

If you’re already tracking your food intake it’s a pretty simple thing to do. Below is an example output from MyFitnessPal^{^[6]} showing the food intake for the day comprising of:

carbohydrates (70g),
fibre (63g), and
protein (104g)

So we start with the insulin load formula:

insulin load = carbohydrates (g) – fibre (g) + 0.56 x protein (g)

Insert our values:

insulin load = 70g carbohydrates – 63g fibre + 0.56 x 104g protein

and calculate insulin load:

insulin load = 65g

It’s not that much different to tracking net carbs, but instead you also account for protein which also requires insulin.

I initially developed this calculation for people with Type 1 Diabetes (like my wife) who need to calculate their insulin dosage but it can work in a similar way for someone wanting to reduce the demand on their pancreas to the point that it can keep up and maintain normal blood glucose levels.

Reducing your insulin levels to normal healthy levels will allow your stored fat to be used for energy and manage your appetite. As you track your insulin load you can keep eliminating the foods that are driving it up until the point that you see the weight loss and blood glucose levels that you’re chasing. More recently I have incorporated this as a metric you can track in the Nutrient Optimiser to achieve your target glucose and ketone levels.

The appropriate insulin load will vary from person to person. A small woman aiming for weight loss using a lower protein ketogenic approach might have an insulin load as low as 40g per day while a larger man looking who is active and looking build muscle might have an insulin load as high as 300g per day.

A higher insulin load diet would allow more plant based foods, less fat and potentially a higher nutrient density (e.g. 40 to 50% of insulinogenic calories). The first priority will be to reduce the insulin load of your diet to the point where you can normalise your blood glucose levels and reduced insulin (e.g. 20 to 30% of insulinogenic calories).

The best idea is to start tracking where you’re currently at and look to reduce your daily insulin load until you achieve excellent blood glucose levels (i.e. average less than 5.6 mmol/L or 100 mg/dL). Once you normalise your blood glucose levels you could keep winding it down further until you achieve your desired level of ketones. As your body heals and you start to reduce the amount of fat around your organs you may be able to tolerate a higher insulin load diet and more nutrient dense diet in time.

a little more on the insulin load theory

So is it all about the insulin load? What about calories and conservation of energy?

In a metabolic ward context we typically find conservation of energy / CICO holds true. If anything someone on a high fat diet may be able to maintain their weight with less calories because fat is easier to digest and products less wasted energy (enthalpy). But in a free living environment how much we eat is influenced by our appetite which is influenced by the nutrient density of our food choices as well as our levels of insulin resistance.

This video gives a good overview of how insulin (either injected or from our own pancreas) affects whether we store fat on our body or release it to be used for fuel and how excess insulin can be problematic.

Most people think of macro nutrients in terms of carbohydrates, protein and fat as per the the picture below. They think that if we eat too much fat it will be stored as body fat. But the reality is a little bit more complex than that.

In the chart below the grey slices of the pie chart (i.e. the non-fibre carbohydrate and the glucogenic protein) are the components of your food that are glucogenic and will require insulin to metabolise.

The blue components are ketogenic (i.e. the dietary fat and the ketogenic protein) and do not require insulin to metabolise. If you’re lucky enough to be insulin sensitive you will burn the food you eat and your appetite will be well regulated with minimal change in body weight.

Indigestible fibre (black slice) doesn’t significantly affect our insulin response or even contribute to calories for us but rather is used to feed the bacteria in our gut. Fibre is a true ‘free food’.

If the insulin load of our diet is too high we are more likely to store a portion of the food. If we are insulin resistant our body will have to generate more insulin to deal with the non-fibre carbohydrate and glucogenic protein while increasing our chances that some of the food we eat will be stored on our body. We feel hungry and need to keep eating to obtain adequate energy. Calories still matter, but outside a controlled metabolic ward, body fat accumulation is more about managing fat storage and appetite than about counting calories.

Calories still matter, but outside a controlled metabolic laboratory, body fat accumulation is more about managing fat storage and appetite than consciously counting calories. Many people refer to insulin as the thermostat that controls our metabolism and our fat storage.

The good news here is that we can use our understanding of the storage properties of insulin to our advantage. If we are able to decrease the insulin load of our diet we are less likely to store fat and more likely to be able to use some of our stored body fat for energy. This will mean that we feel less compelled to eat because we are able to use up our own body fat rather than constantly eating. This reduced dietary insulin load scenario will lead to lower insulin levels, less storage, more use of body fat for fuel, a decreased appetite and a reduction in energy intake.

So, to reduce the insulin load of diet include you can:

eat more fibre,
eat less digestible carbohydrates, and
make sure your protein intake is not excessive.

can you eat too much fat?

Can you still eat too fat much while keeping the insulin load of your diet low?

The short answer is yes, especially if you’re chasing a certain macro nutrient value or high ketone values. Some people are able to stay very lean on a high fat ketogenic diet, but others need to also manage their dietary fat inputs to achieve their goal of body fat output.

The good news is that a low insulin load nutrient dense diet diet will typically lead to increased satiety and reduced energy intake.

The bad news is that excess energy, whatever the source, will lead to fat gain, inflammation and insulin resistance.

Many people recommend that you should eat ‘fat to satiety’. Unfortunately, high fat foods can be easy to overeat, at least for some individuals. There is no need to force yourself to eat extra fat if you are trying to lose weight. There’s no need to go out of your way to add extra fat and oils to your food. If your goal is weight loss, you can obtain more than enough fat from whole-food sources.

basal insulin and insulin resistance

The other unfortunate fact is that the insulin produced in response to food is less than half of the amount of insulin that your body produces. You pancreas is constantly producing basal insulin to manage the flow of energy out of your liver and to remove excess energy from your blood stream.

In addition to reducing the insulin load of your diet you may also need to increase the periods between your meals (intermittent fasting) and focus on building lean muscle mass to improve your insulin sensitivity. This will allow your insulin levels to decrease even more so that body fat can be accessed for fuel.

Implementing an intermittent fasting regimen can be useful for people who find that reducing the dietary insulin load doesn’t lead to enough reduction in appetite.

As detailed in the how to use your glucose metre as a fuel gauge article, waiting until your blood glucose levels drop can be a useful way to increase the timing between meals and to understand whether your hunger is real. Once your blood glucose levels normalise you can even use your your bathroom scale to help time your fasting / feasting cycle to achieve your weight loss goals.

You can get a substantial decrease in insulin levels with a regular 18 to 24 hour fast. After this drop in insulin you may find your hunger levels actually decrease after a longer period of not eating.

summary

To regain control of your appetite you need to insulin load of your diet to the point that your pancreas can keep up and maintain normal blood glucose levels consistent with your personal metabolic health and level of insulin sensitivity.
If your blood glucose and insulin level are high then you should work to decrease the insulin load of your diet.
As the insulin load of your diet decreases you should see your blood glucose levels come down, your appetite reduce and your ketone levels come up.
If you’re still not seeing the results you want then the next step is to try intermittent fasting to further reduce your insulin and blood glucose as well as mitigate your overall food take.
As your blood glucose levels start to normalise you can start to focus on more nutrient dense foods with a lower energy density that may be helpful if weight loss is your goal.

The foods lists in the table below have been optimised to suit different levels of insulin resistance and tailored to your weight loss goals.

approach	average glucose		waist : height
approach	(mg/dL)	(mmol/L)	waist : height
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 last updated: April 2017

references

^{^[1]} https://optimisingnutrition.com/2015/03/23/most-ketogenic-diet-foods/

^{^[2]} https://optimisingnutrition.com/2015/03/22/ketosis-the-cure-for-diabetes/

^{^[3]} https://en.wikipedia.org/wiki/Dietary_fiber

^{^[4]} https://optimisingnutrition.com/2015/07/06/insulin-index-v2/

^{^[5]} https://en.wikipedia.org/wiki/Glucogenic_amino_acid

^{^[6]} https://www.myfitnesspal.com/

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